HOSPITAL CORPS 
HANDBOOK 
UNITED STATES NAVY 
1023 HOSPITAL CORPS HANDBOOK 
UNITED STATES NAVY 
1923 
u.s. Published by 
l t« 
THE. BUREAU OF MEDICINE AND SURGERY 
UNDER THE AUTHORITY OF 
THE SECRETARY OF THE NAVY 
WASHINGTON 
GOVERNMENT PRINTING OFFICE 
1923 Bureau of Medicine and Surgery, 
Navy Department, 
Washington, D. C., May 1, 1923. 
The Hospital Corps Handbook, United States Navy, 1923, is compiled from 
articles prepared by members of the Medical, Hospital, and Nurse Corps, and 
reviewed and revised by Lieuts. W. J. C. Agnew and W. W. Behlow, Medical 
Corps, and Chief Pharmacist N. L. Saunders, United States Navy. It is pub- 
lished for the instruction and guidance of members of the Medical Department 
of the United States Navy and for use at the Hospital Corps Training Schools. 
E. R. Stitt, 
Surgeon General, 'U. S. Navy. 
II TABLE OF CONTENTS. 
Page. 
Foreword v 
Chapter. 
1. History of the Hospital Corps 1 
2. Anatomy and physiology 5 
3. First aid and minor surgery 57 
(a) Bandaging : 98 
(b) Dental first aid 110 
4. Nursing 115 
(a) Operating room and surgical technique 163 
(b) Anesthesia 1 178 
(c) Physiotherapy 193 
(d) Foods and dietetics 222 
5. Preventive medicine, hygiene and sanitation 237 
(a) Field sanitation 311 
(b) Venereal diseases 324 
(c) Embalming 347 
6. Chemistry 353 
7. Pharmacy 383 
8. Materia medica 407 
(a) Drug addiction 483 
9. Toxicology __ 489 
10. Bacteriology, blood work, and immunity 501 
(a) Animal parasites of man 510 
(ft) Urinalysis and blood chemistry « 521 
11. Special activities and information 525 
(a) Duty independent of medical officers 525 
(b) Duty with ship’s landing force and on shore patrol 533 
(c) Duty with Marine Corps expeditionary forces : 539 
(d) Roentgenology 544 
(e) Chemical Warfare 554 
(/) Deaths and medico-legal matters 563 
(g) Recruiting 575 
12. Administration 579 
(a) General plan, arrangement and management of naval 
hospitals 579 
(b) Organization, clerical duties and procedures 582 
(c) Commissary work 650 
Index 683 
III FOREWORD. 
The Hospital Corps Handbook, United States Navy, 1923, replaces the 
familiar “ Handy Book ” and under its new title is a revised edition of that 
book 
Its object is to present in epitomized form certain important subjects and 
facts which will be of assistance to members of the Hospital Corps in the 
performance of their duties, and to serve as a reference book containing in- 
structions relative to the duties of the Hospital Corps of the Navy. 
Readers of the handbook should realize the importance of not depending 
entirely upon it for the information desired, and are urged to consult reference 
books obtainable, as a rule, from the library of any medical officer. Frequent 
reference should be made to the United States Navy Regulations, the Manual 
of the Medical Department, and the Bureau of Navigation Manual. The 
Naval Medical Bulletin and the Hospital Corps Quarterly contain valuable 
information and should be read carefully, paying particular attention to the 
copies of circular letters issued by the Bureau of Medicine and Surgery, and 
other bureaus, found in the last few pages of these publications. 
Members of the Hospital Corps are cautioned against assuming too great 
responsibilities but they should feel at liberty and are urged to report any 
severe, unusual, or questionable case to a medical officer. Men on independent 
duty must, of course, assume responsibilities not ordinarily required in routine 
performance of duty, but should not neglect to report serious and doubtful 
cases to the first medical officer available. 
Guarding the health of members of the naval service is just as important 
as the treatment and care of the sick, and for this reason hospital corpsmen 
on independent duty are advised not to forget to make such suggestions to 
their commanding officers as will tend to prevent outbreaks of epidemics or 
disease. 
One of the most important things for members of the Hospital Corps to 
realize and to put into practice, is that all entries in health records, rough 
logs, smooth logs, etc., regarding the nature of sickness or injuries must be 
considered as confidential, and care should be taken not to permit the data 
contained in the health records from being disseminated or discussed among 
personnel other than members of the Medical and Hospital Corps. This should 
not be considered as prohibiting the consultation of hospital corpsmen on 
independent duty with their commanding officers on matters affecting the 
health of the personnel under their care. 
Appreciation and thanks are herewith expressed for the courtesy of the 
following publishers in permitting the reproduction and use of certain illustra- 
tions in this book, William Wood & Co. for figures 5, 6, 9, 12, 14, 15, 19, 20, 26, 
30, 32, 37, 52, 59, 140, 155, W. B. Saunders Co. for figures 54, 55, 66, 72, 97, 98, 
99, 100, 101, 102, 104, 105, 106, 107, 141, Lea & Febiger for figures 7, 8, 13, 23, 24, 
36, 38, 40, 44, 45, 46, 47, 48, 49, 50, 51, 65, 73, 75, 76, 77, 78, 80, 85, 86, 89, 94, 95, 
96, 142, 146, 148, P. Blakiston’s Son & Co. for figures 10, 11, 18, 53, 147, 149, 160, 
162, 164, 179, 180, 181, 182, 183, 184, 185, 186, 187, 188, 189, 190, 191, 192, 193, 
Paul B. Hoeber for figures 196, 197, 200, 201, and D. Appleton & Co. for figure 
143, and for the assistance rendered by Francis Doty, chief pharmacist’s mate, 
United States Navy, in preparing the index, L. L. Sargent, pharmacist’s mate, 
first class, United States Navy, in typewriting the manuscript, and V. N. De- 
Santis, pharmacist’s mate, third class, United States Navy, in preparing several 
of the sketches and illustrations. 
V CHAPTER I. 
HISTORY OF THE HOSPITAL CORPS OF THE UNITED 
STATES NAVY.1 
Prior to 1898 the duties attendant upon the care of the sick and injured of the 
Naval Establishment were performed by certain individuals whose appoint- 
ment or enlistment was provided for from time to time, under various designa- 
tions and titles, by order of the Navy Department. 
In the earliest days of the Navy, afloat, the care of the sick and injured 
devolved upon the surgeon and the surgeon’s mate, with the assistance of such 
members of the crew as were detailed to help in emergencies. 
An act of Congress, approved March 2, 1799, provided: “A convenient place 
shall be set apart for the sick and hurt men, to which they are to be re- 
moved * * * and some of the crew shall be appointed to attend them, and 
keep the place clean.” The place assigned on board ships for the care of the 
sick, in acordance with the above act, was usually referred to as the “ cockpit ” 
and in later years it was designated as the “ sickbay.” 
The “loblolly boy ” was the title designating the man or boy first specifically 
detailed to assist in the care of the sick and injured. The name probably 
originated in the British Navy, as it appears in some of the early writings on 
that service. The first official use of the title in the United States Navy ap- 
pears in the Naval Regulations published in 1814 where it is stated: “ The 
loblolly boy is to serve the surgeon and surgeon’s mate.” 
The following is quoted from United States Naval Regulations, 1818: “The 
surgeon shall be allowed a faithful attendant to issue, under his direction, all 
supplies and provisions and hospital stores, and to attend the preparation of 
nourishment for the sick. 
“ The surgeon’s mates shall be particularly careful in directing the loblolly 
boy to keep the cockpit clean, and every article therein belonging to the Medi- 
cal Department. 
“ The surgeon shall prescribe for casual cases on the gun deck every morning 
at 9 o’clock, due notice having been previously given by his' loblolly boy by 
the ringing of a bell.” 
The loblolly boy was succeeded by a male “ nurse ” in accordance with a gen- 
eral order of the Navy Department of June 16, 1861, which stated: “ There shall 
be allowed to each vessel commissioned for sea service, with a complement of 
less than two hundred, one nurse, and with two hundred and over two nurses 
* * * to be appointed by the surgeon and approved by the commander of 
the ship, and to be borne upon the ship’s books for special service upon the 
sick.” 
About the year 1873 the title of “ bayman ” came into use, and this title 
was recognized officially in the United States Naval Regulations published in 
1876, and it remained in effect until the organization of the Hospital Corps 
of the Navy in 1898. 
Baymen were enlisted as landsmen for general service, and rated bayman by 
the commanding officer on the recommendation of the surgeon, or senior medical 
officer. The number was regulated by the complement of the vessel. 
1 Prepared by Chief Pharmacist J. Holden, United States Navy. 
1 2 
HOSPITAL CORPS HANDBOOK. 
The record of the advent of surgeon’s stewards in the Navy is more or 
obscure, but this seems to have been shortly after the Bureau of Medicine and 
Surgery was established in 1842. The following is an extract from a letter 
found in the old files of the bureau under date of May 5, 1843. 
“ A circular is now under consideration to allow a surgeon’s steward to all 
hospitals and vessels, without necessity to sign articles, but to be appointed.” 
The Medical Journal of the U. S. S. Rapidan, 1844, bears a notation that an 
applicant for surgeon’s steward wTas found disqualified for appointment on ac- 
count of physical disability. 
Orginally surgeon’s stewards were enlisted as landsmen or seamen, and were 
appointed by the commanding officer on the recommendation of the surgeon of 
the vessel. They were classed as petty officers and could be disrated for in- 
competency or misbehavior. 
By general order of the Navy Department, November 11, 1861, their status 
was changed to “ appointed petty officer ”; appointments were made for the 
“ duration of the cruise ” and they were subject to discharge for misbehavior, 
“ the fact of misbehavior to be established by a summary court.” 
The title of surgeon’s steward was changed to apothecary by circular order 
of the Navy Department, dated December 8, 1866. This order reads: “ The 
designation of persons serving as surgeon’s steward is changed to that of 
apothecary, and they will be appointed for duty in the Medical Department of 
the Navy, ashore and afloat, in the same manner as surgeon’s stewards have 
heretofore been appointed. Apothecaries of the first class will rank with boat- 
swains, * * * , Apothecaries of the second class will rank with boat- 
swain’s mates in charge, * * * , Apothecaries of the third class will rank 
with boatswain’s mates.” 
United States Naval Regulations, 1893, article 1683, prescribed that: “Apoth- 
ecaries for shore stations shall, with the approval of the Secretary of the 
Navy, be appointed by the Chief of the Bureau of Medicine and Surgery.” 
United States Naval Regulations, 1896, article 797, prescribed that: “A 
candidate for examination and first enlistment as apothecary must be a gradu- 
ate of some recognized college of pharmacy.” 
The title of “ apothecary ” was changed to “ hospital steward ” by act of 
Congress of June 17, 1898. 
The Hospital Corps of the United States Navy came into existence as an 
organized unit of the Medical Department under the provisions of an act of 
Congress, approved June 17, 1898. 
This act established the grade of pharmacist, and the ratings of hospital 
steward, hospital apprentice, first class, and hospital apprentice; provided for 
appointments to the grade of pharmacist, and the enlisted ratings; fixed the 
pay and allowances; and specified the duties to be performed. 
An act of Congress, approved August 22, 1912, provided that pharmacists 
after six years from date of warrant and after satisfactorily passing the pre- 
scribed examination should be commissioned chief pharmacists, and when so 
commissioned, have the rank, pay, and allowances of a chief boatswain. 
The present organization of the Hospital Corps is in accordance with an act 
of Congress, approved August 29, 1916, and it is considered of sufficient im- 
portance, as a matter of general information to all hospital corpsmen, to quote 
the text of this act relating to the Hospital Corps in full. 
“ Hereafter the authorized strength of the Hospital Corps of the Navy 
shall equal three and one-half per centum of the authorized strength of the 
Navy and Marine Corps, and shall be in addition thereto, and as soon as the HISTORY OF THE HOSPITAL CORPS. 
3 
necessary transfers or appointments may be effected the Hospital Corps of 
the United States Navy shall consist of the following grades and ratings: 
Chief pharmacists, pharmacists, and enlisted men classified as chief pharma- 
cist’s mates; pharmacist’s mates, first class; pharmacist’s mates, second class; 
pharmacist’s mates, third class; hospital apprentices, first class; and hospital 
apprentices, second class; such classifications in enlisted ratings to correspond 
respectively to the enlisted ratings, seaman branch, of chief petty officers; 
petty officers, first class; petty officers, second class; petty officers, third 
class; seaman, first class; and seaman, second class; Provided, That enlisted 
men of other ratings in the Navy and in the Marine Corps shall be eligible 
for transfer to the Hospital Corps, and men of that corps to other ratings 
in the Navy and the Marine Corps. 
“ The President may hereafter, from time to time, appoint as many pharma- 
cists as may'be deemed necessary, from the rating of chief pharmacist’s mate, 
subject to such moral, physical, and professional examinations and require- 
ments as to length of service as the Secretary of the Navy may prescribe: 
Provided, That the pharmacists now in the Hospital Corps of the United States 
Navy or hereafter appointed therein in accordance with the provisions of 
the act shall have the same rank, pay, and allowances as are now or may 
hereafter he allowed other warrant officers. 
“ Pharmacists shall, after six years from the date of warrant, he commis- 
sioned chief pharmacists after passing satisfactorily such examinations as 
the Secretary of the Navy may prescribe, and shall, when so commissioned, 
have the same rank, pay, and allowances as now or may hereafter he allowed 
other commissioned warrant officers; Provided, That the pharmacists at 
present in the service who have served or may hereafter serve six or more 
years in that grade shall be eligible for promotion to the grade of chief 
pharmacist upon satisfactorily passing the examinations provided for in this 
act. 
“ The secretary of the Navy is hereby empowered to limit and fix the num- 
bers in the various ratings. 
“ Section three of an act entitled ‘An act to organize a Hospital Corps of the 
Navy of the United States; to define its duties and regulate its pay,’ approved 
June seventeenth, eighteen hundred and ninety-eight, he, and the same is hereby, 
repealed, and the pay, allowances, and emoluments of the enlisted men of the 
Hospital Corps shall he the same as are now, or may hereafter be, allowed 
for respective corresponding ratings, except the rating of turret captain of 
the first class in the seaman branch of the Navy; Provided, That the pay of 
the rating of the chief pharmacist’s mate shall he the same as that now allowed 
for the existing rating of hospital steward. 
“ Hospital and ambulance service with such commands and at such places 
as may he prescribed by the Secretary of the Navy, shall be performed by 
members of said corps, and the corps shall he a constituent part of the Medical 
Department of the Navy; and the enlisted men thereof shall be a part of the 
enlisted force provided by law for the Navy. 
“ Officers and enlisted men of the Medical Department of the Navy, serving 
with a body of marines detached for service with the Army in accordance 
with the provisions of section sixteen hundred and twenty-one of the Revised 
Statutes, shall, while so serving, he subject to the rules and articles of war 
prescribed for the government of the Army in the same manner as the officers 
and men of the Marine Corps while so serving.” CHAPTER II. 
ANATOMY AND PHYSIOLOGY.1 
The human body is composed of a combination of several systems of organs, 
which fulfill special functions. These systems are further divided into their 
component tissues, which are collections of the fundamental unit, the cell. 
Anatomy is the study of the structure of the body and the relation of the 
different tissues and organs of the body to one another, in fact, it is a rather 
comprehensive term which includes several closely related branches of study. 
The structure of the individual is not the same at all periods of life, differing 
to a marked degree in the foetus, the new-born child and the adult. 
Embryology is a study of the development of the offspring from the begin- 
ning of the germ cell, or fertilization, to birth. 
Histology, or microscopical anatomy, is a study of the minute structure of 
the normal tissues of the body. 
Comparative anatomy, or morphology, is the study and comparison of the 
structural aspects of different animals to each other. 
Fig. 1.—Various forms of cells: a, Squamous epithelium from the tongue ; 
t>, columnar cell from the small intestine ; c, a polyhedral or spheroidal 
cell from the liver ; d, a smooth-muscle cell from the muscular coat of 
the stomach. X 550. (Ferguson.) 
Physiology is the science which treats of the function of living bodies, and 
teaches the use and activity of the various organs in life. 
Pathology is the science which treats of the modifications of function and 
changes in structure of living bodies caused by disease. 
The cell is the fundamental unit of structure and function of all the tissues 
of the body. It is made of a mass of protoplasm, which is divided into two 
parts, the cell body, or cytoplasm, a granular or gelatinous fluid held in a 
spongy network and limited in most cases by a cell wall; and an essential 
organ known as the nucleus, which contains granules called chromatin. These 
cells vary in shape, size, structure of protoplasm, and staining qualities, as 
well as in shape, size, and location of nucleus within the cell. Every cell is 
formed by the division of a preexisting cell. Every cell has a definite life 
cycle. It grows, performs its proper function, and ceases to exist, either by 
dividing into two daughter cells, or by dying and breaking up into fragments. 
(Fig. 1.) 
1 Prepared by Lieut. W. E. Golden, Medical Corps, United States Navy ; reviewed by 
Lieut. F. C. Hill, Medical Corps, United States Navy. 
5 6 
HOSPITAL CORPS HANDBOOK, 
The tissue are collections of cells of constant structure and function, and 
although the tissues may be modified by situation, they can always be identified 
when studied microscopically. 
There are five fundamental tissues, epithelial, connective, muscular, nervous, 
and fluid, and each of these are characterized by certain peculiarities of struc- 
ture and function. The epithelial tissues are formed of different types of 
epithelial cells with a small amount of intercellular substance, and make up 
the covering of mucous membranes, glandular substance, and the free surface 
of the skin. There are several types of epithelial cells, depending on the func- 
tion they perform. Perhaps the simplest classification of epithelial cells is with 
regard to shape. The flat cells of the skin, mouth, and urethra are called 
squamous cells, and the irregularly shaped cells found in glands, the intestines, 
trachea, and bronchi are called columnar cells. 
Some of the cells are specialized in order that they can perform certain 
functions. The columnar cells of the trachea have upon their free margin 
minute liair-like projections called cilia, which, by a 
wavelike motion toward the mouth, aid in discharging 
secretions from the lungs. (Fig. 2.) Other epithelial 
cells partake of the nature of nervous tissue and by their 
specialization enable us to see, hear, taste, and smell, 
and afford the sense of touch. They are neuroepithelial 
cells. 
Connective tissue is the supporting tissue of the body. 
In this tissue the cells are scanty, and the inter- 
cellular substance considerable. A new element is found 
here, the connective tissue fiber. This tissue may be modified by the depo- 
sition of mineral salts, fat, gelatin, or elastin. The various forms of con- 
nective tissue are areolar tissue, a loose network found under the skin and 
between muscle fibers; dense fibrous tissue found in tendons, ligaments, and 
surrounding various organs; adipose tissue or fat; lymphoid tissue, as the 
tonsils, adenoids, and spleen; cartilaginous; osseous tissue or bone; and 
Fig. 2.—Ciliary epi- 
thelium. (K 511 i - 
ker.) 
THE BONES AND JOINTS. 
Osteology is the study of the skeletal system which is composed of the bones 
and certain cartilaginous and membranous parts associated with them. It in- 
cludes the study of the structure of individual bones. 
Artlirology or syndesmology is the study of the joints or articulations, taking 
into consideration the parts forming the joints, and the mechanism of each 
joint. 
The skeleton is the bony framework of the body. Its function is to support 
the body, preserve shape, protect certain vital organs, and to afford attach- 
ments for muscles in order that complicated movements may be effected. 
(Fig. 3.) 
Bone or osseous tissue, may be regarded as white fibrous connective tissue 
which has undergone calcification by deposition of certain lime salts. These 
salts increase in quantity as a person ages, making the hones harder hut more 
brittle. The bones are made up of an outer shell of hard compact tissue, and 
an inner part of spongy or cancellous tissue, which is filled with large marrow 
cavities. (Fig. 4.) The bone marrow is of two types, yellow marrow, com- 
posed chiefly of fat, found in the medullary cavities of long bones; and red 
marrow, containing very little fat and abundantly supplied with blood, found 
chiefly in the spongy tissue. The true marrow cell, which resembles in some ANATOMY AND PHYSIOLOGY. 
7 
respects colorless red blood corpuscles, is found here. In addition to these 
there are reddish colored nucleated cells, the erythroblasts, from which the red- 
blood corpuscles are formed. 
The ends and facets of bone are covered by cartilage, which forms the 
articulating surfaces, and enters into the formation of joints. All those por- 
tions of the bone not covered by an articular cartilage are covered by a thin, 
vascular membrane of 
fibrous tissue called peri- 
osteum. This membrane 
has the power of gener- 
ating new bone, and 
serves this purpose in 
the normal growth of 
bone and when the origi- 
nal bone has been de- 
stroyed. 
Bone is nourished from 
small arteries, one or 
more for each bone, 
which enter the bone by 
small openings called 
nutrient canals or fora- 
mina. It also receives 
nourishment from capil- 
laries of the periosteum 
which dip down into 
small irregularities or 
pits in the bone surface. 
Bone is developed by 
the ossification of carti- 
lage or certain mem- 
branes. Tins ossification 
begins in the embryo and 
is not completed until 
adult life. In a long 
bone, the primary center 
of ossification is in the 
shaft and is called the 
diaphysis; at a later 
stage one or more sec- 
ondary centers of ossifi- 
cation called epiphyses 
appear in the cartilagi- 
nous knobs at the ends of 
the shaft. Complete fusion by osseous' union of epiphysis and diaphysis occurs 
at variable periods of life and prior to this union the two are bound together by 
a cartilaginous union called the epiphyseal line. Because of this carti- 
laginous union the extremities in youth are better able to withstand shocks 
and jars. The periosteum produces growth in the circumference of long 
bones, but another factor is concerned in an increase in the length of these 
bones. The two parts of the bone, the diaphysis and epiphysis, are separated 
by a zone of cartilage which is extremely active in the growth of bone 
1. Cranium. 
2. Vertebral 
column. 
3. Clavicle. 
4. Ribs. 
5. Sternum. 
6. Scapula. 
7. Humerus. 
8. Radius. 
9. Ulna. 
10. Carpus. 
11. Metacarpus. 
12. Phalanges. 
13. Pelvis. 
14. Femur. 
15. Patella. 
16. Tibia. 
17. Fibula. 
18. Tarsus. 
Metatarsus. 
Phalanges. 
Fig. 3.—The skeleton. (Manual of Instruction, Royal 
Naval Sick Berth Staff.) 8 
HOSPITAL, CORPS HANDBOOK. 
due to invasion of vessels and cells from the vascular zone which sur- 
rounds the epiphysis. This provides for the growth of the shaft toward 
the epiphysis and the epiphysis toward the shaft, and continues as long as 
the intervening layer of cartilage persists. 
Two hundred and six bones make up the bony framework or skeleton; 
this includes the bones of the ear, and the patellae. 
Bones are classified as to type as follows: 
Long, short, flat, and irregular. A long bone 
consists of a shaft and two extremities. The 
shaft is formed of compact tissue, which is 
thickest in the middle, where the bone is 
most slender and the strain greatest and is 
hollowed out in the interior to form the 
medullary canal. The extremities are made 
up of cancellous tissue with a thin coating of 
compact substance, and are more or less ex- 
panded for greater convenience of articulation 
and to afford a broad surface for muscular at- 
tachments, as seen in the femur and the humerus. Short bones are small and 
irregularly shaped. Their texture is spongy throughout, except for a thin 
crust of compact tissue covering the surface, as in the bones of the wrists 
and ankles. Flat bones are found where the principal requirement is either 
extensive protection or the pro- 
vision of broad surfaces for mus- 
cular attachment. The bony tissue 
is formed into broad or elongated 
flat plates which are composed of 
compact tissue enclosing a variable 
amount of cancellous tissue, • as 
in the bones of the cranium, the 
sternum and the hip bones. Irreg- 
ular bones are those which, on ac- 
count of their peculiar shape, can 
not be grouped under any of the 
preceding heads; for example, the 
vertebrae, the mandible and the 
hyoid bones. 
In studying the topography or 
surface markings of bones it is 
necessary to understand the fol- 
lowing terms: 
Process — any marked bony 
prominence; tuberosity—a large 
process; tubercle—a small process; spine—a sharp, slender process; condyle— 
a rounded knuckle-like process; crest—a narrow ridge of bone; head—a portion 
of a bone supported on a constricted part or neck. 
The divisions of the skeleton are tabulated below: 
Head or skull: The bones of the cranium, the face, and the ear ossicles. 
Hyoid bone: A U-shaped bone located in the base of the tongue, between the 
mandible and larynx, connected by ligaments to the styloid processes of the 
Fig. 4.—Transverse section of com- 
pact tissue of bone. Magnified 
about 150 diameters. (Sharpey.) 
Fig. 5.—Skull: a, Nasal bones; b, superior 
maxilla; c, mandible; d, occipital bone; 
e, temporal bone; f, parietal bone; y, 
frontal bone. (Mason.) ANATOMY AND PHYSIOLOGY, 
9 
temporal bones, and serving as attachment for some of the muscles of the neck 
connected with deglutition and respiration. 
Trunk: The vertebrae, the sternum, and the ribs. 
Upper extremities. 
Lower extremities. 
The head. 
The head or skull is divisible into the cranium or brain case and the anterior 
region or face. (Fig. 5.) 
The cranium is elliptical in shape. The bones are united along irregular 
lines called sutures, and form immovable joints. The bones of the upper, or 
dome-shaped part are very hard and afford protection 
to the delicate brain tissue contained within the cranial 
cavity. The bones of the lower part or base are somewhat 
thinner and softer and are pierced hy various openings 
called foramina, through which pass nerves and blood 
vessels. The largest of these openings is the foramen 
magnum, through which pass the spinal cord, its coverings, 
certain cranial nerves, and the vertebral arteries. 
The dome of the cranium is made up of the following 
bones, the tivo parietals, the frontal, the upper part of 
the occipital, and the tivo temporals. The base is made up 
of the sphenoid, the ethmoid, the lower part of the occipital, 
and the two temporals. In all, eight bones make up the 
cranium. Some of the bones of the cranium contain small 
cavities or sinuses, which are connected by small openings 
to either the nasal cavity or the middle ear. The frontal 
bone has two of these cavities, one over each eye, called the 
frontal sinuses, which connect with the nasal cavity, as 
also do the cavities found in the ethmoid, the sphenoid, and 
maxillae. The temporal bones contain numerous small 
cavities in a prominence called the mastoid process. These 
cavities open into the middle ear. 
Fourteen bones make up the face. There are two nasals 
forming the bridge of the nose, two maxillaries forming 
the upper jaw and part of the frame work of the face; 
two lachrymals, small fragile bones forming part of the 
inner wall of the orbit; two turbinate bones, small pro- 
tuberances on the outer wall of each nostril; two palate 
bones, forming the back part of the hard palate and part 
of the floor and outer wall of the nasal fossa; two malar 
or zygomatic bones, the cheek bones; the vomer which 
forms a part of the central septum of the nose; and the 
mandible or lower jaw. 
The bones of the face form the oral or mouth cavity, and in conjunction with 
the cranial bones form the orbital cavities or eye sockets, and the nasal cavi- 
ties. The external auditory canal, the middle ear, and the internal ear are 
contained in the temporal bone. 
In the middle ear there is a jointed chain of three small movable bones named 
the malleus (hammer), the incus (anvil), and the stapes (stirrup). These 
bones communicate the vibrations of the eardrum to the internal ear. 
Fig. 6.—Spinal col 
umn : A, Cervical; 
B, dorsal; G, lum- 
bar ; D, sacrum; 
E, coccyx. (Ma- 
son.) 10 
HOSPITAL CORPS HANDBOOK. 
The trunk. 
The spinal or vertebral column is formed by a series of bones called ver- 
tebra;, and, in a man of average height, is about 28 inches long. In youth 
these bones number 33, and according to the positions they occupy are named: 
The cervical (7), in the neck; the thoracic (12), 
in the thorax; the lumbar (5), in the loins; the 
sacral (5), in the pelvis; and the coccygeal (4), in 
the pelvis. The vertebra of the three upper portions 
of the spine are separated and movable throughout 
life and are known as true vertebra. In the adult 
those of the lower two portions are firmly united 
into two bones, five to form the sacrum, and four to 
form the coccyx and are known as false vertebra. 
(Fig. 6.) 
Each vertebra consists of two essential parts, an 
anterior solid portion or body, and a posterior por- 
tion or arch. Each arch has seven processes, four 
articular, two lateral, and one spinous which pro- 
jects backward. The structure of the vertebra varies somewhat in each region, 
dependent upon mobility and necessity for strength for apport. (Fig. 7.) 
Viewed from the side, the spinal colm a- curves, which are al- 
ternately convex and concave. The two < .ueavc or backward curves, in the 
thoracic and pelvic or sacral regions, are 
designed for the accommodation of viscera, 
and the two convex or forward curves, in 
the neck and lumbar regions are compensa- 
tory curves, the result of an upright po- 
sition. 
The thorax is a conical elongated bony 
cage formed by the sternum and 
cartilages in front, the 12 ribs on ea side, 
and the bodies of the 12 thoracic vertebra 
behind. It contains and protects the princi- 
pal organs of circulation and respiration. 
(Fig. 8.) 
The sternum or breast bone is a flat, nar- 
row bone, situated in the median line in 
front of the chest and consists of three 
parts. The upper part, called the manubri- 
um, is triangular in shape, the apex of the 
triangle joining the middle part of the 
sternum, which is called the gladiolus. The 
third part, the ensiform or xiphoid process, 
is a small thin piece of bone, cartilaginous 
in youth, which extends from the lower end of the gladiolus. On either side of 
the sternum are notches for the attachment of the costal cartilages. At the 
upper part of the manubrium are notches, one on either side, for attachment of 
the clavicles. 
The ribs, 24 in number, are situated 12 on each side of the thoracic cavity. 
They all are connected with the thoracic vertebra at the back. The first seven 
pairs are connected by costal cartilages with the sternum in front and are 
called the true ribs. The cartilages of the eighth, ninth, and tenth ribs are 
fused together, and these ribs therefore are called false ribs. The eleventh 
Fig. 7. — Seventh cervical 
vertebra. (Gray.) 
Fig. 8.—The thorax. Ventral view. 
(Gray.) ANATOMY AND PHYSIOLOGY. 
11 
and twelfth ribs have no cartilages attaching them to the sternum and are called 
the floating ribs. 
The upper extremity. 
The bones of the upper extremity are: The collar bone or clavicle; the shoul- 
der blade or scapula; the bone of the arm or the humerus; the bones of the 
forearm or the radius and the ulna; the 8 bones of the wrist or the carpal bones; 
the 5 bones forming the palm of the 
hand, or the metacarpal bones; and the 
14 bones of the fingers or phalanges. 
The carpal bones consist of the na- 
vicular (scaphoid) ; the os lunatum 
(semilunar) ; the os triquetrum (cunei- 
form) ; the os pisiforme (pisiform) ; the 
greater multangular (trapezium) ; the lesser multangular (trapezoid) ; the 
os capitatum (os magnum) and the os harnatum (unciform).2 
The clavicle is a long bone attached at the inner end to the upper border 
of the sternum. (Fig. 9.) It extends outward, in a horizontal plane, over 
the first rib, and is attached at its outer end to the acromion process of the 
scapula. The muscui * attachment" ‘»re some of the auxiliary muscles Qf res- 
piration, the pectoral ft :kfno-mastoid, the sterno-hyoid, and the 
shoulder muscles, the deltoid arid the trapezius. The function of the clavicle is 
to hold the shoulders backward, thus maintain- 
ing an erect posture. Fracture of this bone 
allows the shoulder to move downward, inward, 
and forward. 
The scapula is a flat, triangular bone, situated 
in the upper lateral, and posterior aspect of the 
trunk, from the second to the seventh rib, its 
posterioi >rder being about 1 inch from the 
vertebral column. (Fig. 10.) On the posterior 
surface it has a triangular process called the 
spine, which ends laterally in the acromion proc- 
ess, articulating with the clavicle. On the supe- 
rior margin of the scapula is a hook-like pro- 
jection called the coracoid process. Just in- 
ferior to the coracoid and the acromion proc- 
esses, on the lateral margin is a smooth concave 
surface, the glenoid fossa, for articulation with 
the head of the humerus. The anterior surface of the scapula is practically 
smooth and serves as the attachment for the subscapularis muscle. There are 17 
muscles attached to the scapula. These muscles serve as auxiliary muscles 
of respiration and assist in moving the arm and the head. 
The humerus is a long bone having a shaft and two extremities and reaches 
from the shoulder to the elbow. (Fig. 11.) The upper end, or head, is smooth 
and rounded, and articulates with the scapula forming the shoulder joint. 
Just below the head the circumference of the shaft is constricted to form 
Fig. 9.—The clavicle. (Mason.) 
Fig. 10.—Posterior aspect of 
right scapula. (Potter.) 
3 The Basle anatomical terminology is used throughout this chapter. Readers who are 
familiar with the old teminology are referred to Cunningham's Text Book of Anatomy, 
which gives the old term in parenthesis immediately following those of the Basle termi- 
nology, as shown in the above paragraph. 
47829°—23 2 12 
HOSPITAL CORPS HANDBOOK. 
the anatomical neck. Below the anatomical neck are two knobs known as 
the greater and the lesser tuberosites, to which are attached the muscles which 
hold the bone in place and assist in movements of the shoulder joint. The 
upper part of the shaft just below the tuberosities is called the surgical neck 
because of the frequency of fracture at this point. The shaft is cylindrical in 
shape in its upper half, becomes somewhat flattened in 
the lower one-third, and terminates in the surface, articu- 
lating with the bones of the forearm. On the anterior 
side of the humerus, just above the articular surface, 
are two small depressions, the coronoid fossa, which re- 
ceives the coronoid process of the ulna, and the radial 
fossa, which receives the head of the radius when the 
forearm is flexed. On the posterior part of this same 
surface is a deep depression, the olecranon fossa, which 
receives the olecranon process of the ulna when the 
forearm is extended. On either side of these articular 
surfaces are projections of the bone called the lateral 
and the medial epicondyles, which serve as the origin of 
certain groups of muscles which function in the move- 
ments of the forearm. 
In the forearm there are two long bones, the radius and 
the ulna, which extend from elbow to wrist. (Fig. 12.) 
The ulna is on the little finger side and the radius on 
the thumb side of the forearm. The ulna is largest at the elbow and small at 
the wrist, while the reverse is true of the radius. On the upper extremity 
of the ulna there are two prominent eminences, the olecranon and coronoid 
processes, and two cavities, the incisura semilunaris and incisura radialis. 
The olecranon process is situated on the upper and back part and forms 
the projection commonly called the elbow; the coronoid is 
on the front and upper part. Between these two processes 
is a semilunar depression called the incisura semilunaris, 
which forms the articular surface of the ulna with the 
humerus. The incisura radialis is a small depression ex- 
ternal to the coronoid process and articulates with the 
radius. Both bones articulate with the humerus to form 
the elbow joint. On the upper third of both the radius and 
the ulna are tuberosities for the attachment of muscles. 
At the lower end of the ulna, projecting medially, is a 
process of bone called the styloid process. There is a 
corresponding but larger process on the external surface 
of the radius, at its lower extremity, likewise called the 
styloid process. The lower extremities of the two bones 
articulate with each other, but the radius alone enters 
into the formation of the wrist joint and articulates with 
the os navicularis, and the os lunatum. 
The ossa carpi, or bones of the wrist are arranged in two rows of four each 
and due to their peculiar shapes and the multiplicity of articulating surfaces 
are capable of being moved in almost any direction. 
The bones of the hand are small long bones called metacarpals, five in all. 
They are numbered in order, the first being that of the thumb and the fifth 
that of the little finger. 
The bones of the fingers are also small long bones, called phalanges. There 
are 14, 3 for each finger and 2 for each thumb. The first or terminal phalanx 
Fig. 11. — Humerus. 
(Potter.) 
Fig. 12.—Radius and 
ulna. (Mason.) ANATOMY AND PHYSIOLOGY. 
13 
of each finger articulates with the corresponding metacarpal bone. The other 
two phalanges are known, respectively, as the middle and distal phalanges. 
The bones of the thumbs are called the terminal and the distal phalanges. 
The lower extremity. 
The bones of the lower extremity are the os coxae (os innominatum or hip 
bone) ; the femur (or thigh bone) ; the patella (or knee cap) ; the tibia 
(or shin bone) ; the fibula (or calf bone) ; 
seven tarsal bones, the talus (astragulus), 
calcaneus, navicular, first, second and 
third cuneiform and the cuboid; five 
metatarsal bones; and fourteen phalanges. 
The pelvis is made up of the hip bones 
articulating with the sacrum dorsally and 
with each other ventrally at the joint 
called the symphysis pubis. (Fig. 13.) 
The hip bone (os coxae) is a large irregu- 
lar bone, composed of three segments called 
the ilium, the pubis, and the ischium. The 
former is the large flat part of the bone, the crest of which forms the hip. It 
articulates posteriorly with the sacrum, and anteriorly is contiguous with the 
pubic bone. The angular portion of this bone, the pubis, articulates with its 
fellow on the opposite side at the symphysis pubis and forms the pubic arch. 
The third portion, the ischium, is also angular and forms the lower part of the 
os coxfe. The three portions unite and form, on the external aspect, a smooth 
hollow cavity called the acetabulum which receives the head of the femur and 
forms the articulation of that bone with the os coxae. 
An opening, the obturator foramen, situated between the 
three portions of the os coxae in front of, below, and 
medial to the acetabulum affords passage for muscles, 
nerves, and blood vessels. There are several important 
bony landmarks on the os coxae; the crest of the ilium 
which terminates anteriorly in a bony process called the 
anterior superior iliac spine; the pubic spine on the upper 
surface of the pubic bone near the symphysis; the greater 
sciatic notch which is just above the acetabulum; and 
the lesser sciatic notch which is just below the greater 
sciatic notch and separated from it by the ischial 
spine. 
The muscles attached to the hip bones are those of 
the abdomen and back and those utilized in moving 
the legs. 
The femur is the longest and the strongest hone in 
the body. It extends from the hip to the knee of 
each lower extremity. (Fig. 14.) The upper portion of the femur consists 
of a rounded head, which is joined to the shaft by a constricted neck. Two 
eminences are found on the upper part of the shaft of the femur—the 
greater trochanter, which caps the upper and lateral part of the shaft and 
overhangs the neck of the femur from above and behind; and the lesser 
trochanter, which is situated on the upper dorsal aspect of the shaft where 
the latter becomes continuous with the neck of the femur. The head articu- 
lates witii the acetabular cavity in the hip bone. The lower portion of the 
femur is larger than the upper, and is flattened on its posterior and an- 
Fig. 13.—Pelvis (adult). (Gray.) 
Fig. 14. — Femur. 
(Mason.) 14 
terior surfaces to form two large bony eminences, one on each side, called 
tlie lateral (outer) and medial (inner) condyles. These condyles are sepa- 
rated in front by a smooth depression which articulates with the patella. 
On the upper part of the medial condyle is a bony process, the adductor tubercle, 
to which are attached the adductor muscles of the thigh. The anterior and 
inferior surfaces of the condyles articulate with the patella and tibia. On the 
outer surface of the lateral condyle and the inner surface of the medial 
condyle are projections of bone, called the lateral and the medial epicondyles, 
to which are attached some of the ligaments of the knee. 
The patella, or knee cap, is a sesamoid bone, somewhat triangular in shape, 
situated in the tendon of the quadriceps muscle. It forms part of the knee 
joint. 
The two bones of the leg, the tibia and the fibula, are long bones. (Fig. 1.1.) 
The tibia extends from the knee joint to the ankle joint. Its upper surface 
is large and expanded into two lateral eminences with concave surfaces which 
receive the condyles of the femur. The lower extremity of the tibia is 
smaller than the upper portion and extends downward on the inner side to 
form the medial malleolus. The lower end of the tibia 
articulates with the fibula and the talus (astragulus) to 
form the ankle joint. 
The fibula is external to and articulates with the tibia 
just below its lateral condyle. At its lower end the 
fibula articulates with the talus and the tibia, and the 
outer side is prolonged to form the lateral malleolus at 
the lower external portion. 
The seven tarsals or ankle bones are of irregular form 
and vary in size. The talus articulates with the tibia 
and the fibula above and the calcaneus and the na- 
vicular bones below. The calcaneus or heel bone is 
the largest tarsal bone. It forms the heel and articu- 
lates with the talus and the cuboid which in turn ar- 
ticulates with the fourth and fifth metatarsals. The 
navicular bone, placed between the talus and the first, 
second, and third cuneiform bones, is the key stone of 
the pedal arch and any luxation on its part tends to produce flat feet. The 
three cuneiform bones articulate respectively with the first, second, and third 
metatarsal bones. 
The remaining bones of the foot correspond to those of the hand except 
that the bones which correspond to the metacarpals are termed the metatarsal 
bones. 
Joints. 
The various bones composing the skeleton are connected to one another at 
different parts of their surfaces. These unions are called joints. 
The three types of joints are the immovable joints, such as those of the 
cranium and the face (excepting the lower jaw) ; the partly movable joints. 
such as the symphysis pubis and the lower tibio-fibular articulation; and the 
true or freely movable joints, such as the hip and the shoulder joints. 
The movable joints may be divided into gliding joints, such as those between 
the articular processes of the vertebrae, the hinge joints, with movements to 
and fro in one plane, as the elbow (fig. 16), the knee, the finger and the toe 
joints; the ball and socket joints, consisting of a rounded head of one bone 
which is received into a cup-like cavity of another, as the hip and shoulder 
joints; the rotary joint in which one bone rotates on another which is station- 
HOSPITAL CORPS HANDBOOK. 
Fig. 15.—Tibia and 
fibula. (Mason.) ANATOMY AND PHYSIOLOGY. 
15 
ary, as the first anil second vertabrse; the condyloid joints in which an oval 
head is received into an elliptical cavity, as the metacarpo-phalangeal joints; 
and the saddle joints in which each articulating surface is concave in one di- 
rection and convex in another, the bones fitting together in the manner of a 
man in a saddle, as the joint formed by the greater multangular and first 
metacarpal bones. 
The structures which enter into the formation of joints vary with the type 
of articulation. In every instance there are two or more skeletal elements 
(bone or cartilage) and in addition a uniting medium, the amount and type 
of which depends on the type of the joint. In immovable joints this medium 
consists of a very thin layer of the common matrix, either fibrous membrane 
or cartilage. In slightly movable joints this connecting membrane or cartilage 
may be more fully developed. In the freely mov- 
able joints there is a joint cavity which is sur- 
rounded by an articular capsule of fibrous tissue. 
The capsule and intra-articular surfaces of the 
bones are lined with a synovial membrane which 
secretes synovial or joint fluid into the cavity. 
Each articular surface of bone is covered with a 
layer of cartilage, and in some joints there are 
discs of cartilage called intraarticular discs which 
are inserted into the joint cavities. In many 
joints where extra strength is needed accessory 
joint ligaments are present as in the case of the 
knee and the elbow joints. 
Joints permit movements of the skeletal parts 
with each other. The kinds of movements are as 
follows: 
Flexion—bending, as in raising the forearm on 
the arm; extension—straightening of a limb or 
part; abduction—drawing a member away from 
the medial line of the body; adduction—bringing a 
member toward the medial line of the body; rota- 
tion—turning on its own axis; circumduction—a 
combination of flexion, extension, adduction, and 
abduction in such a manner that the joint forms the apex of a cone and the 
free end of the part travels through a circle which forms the base of the cone. 
MYOLOGY OR THE MUSCULAR SYSTEM. 
The muscular tissue constitutes a large part of the fleshy portions of the 
body, enters into the structure of many of the internal organs and forms from 
forty to fifty per cent of the body weight. It is by the action of this tissue 
that movements of the body are produced. 
Muscle tissue is composed of a number of muscle cells winch are held to- 
gether by delicate connective tissue. The muscle tissue is held together in 
bundles by a reticular tissue, and forms the various muscles. There are three 
distinct types of muscle tissue: 
The striated or voluntary muscle which makes up the skeletal muscles, is 
subject to voluntary nerve control. (Fig. 17.) The individual muscle cell is 
elongated, multinuclear and contains striations peculiar to it. 
Fig. 16.—Right elhow-joint 
cut through at right angles 
to the axis of the trochlea 
humeri, •> from the ulnar 
side. (Spalteholz.) 16 
HOSPITAL CORPS HANDBOOK. 
The nonstriated or involuntary muscle which makes up most of the muscles 
of the viscera, except the heart, and which is under the control of the sympa- 
thetic nervous system is not subject to stimulation at the volition of the indi- 
vidual. The individual cell of this variety of muscle is plain and without 
striations. 
Cardiac muscle which is involuntary is found only in the heart substance. 
The muscle cell is made up of short mononucleated cells with striations. 
Muscle tissue is a highly specialized tissue and exhibits the following 
properties: 
Irritability—response to stimuli, usually received from nerves; contractility— 
the power which enables muscles to become shorter and thicker on receiving the 
proper stimuli; tonicity—a mild, sustained contraction giving the skeletal 
muscles firmness and maintaining a slight steady pull on their attachments; 
extensibility—the power of muscles to be stretched. 
When a muscle contracts it uses a certain amount of energy to do a 
certain amount of work. To supply this energy carbohydrates are taken from 
the blood stream and oxidized to form carbon dioxide and water. There is 
also some loss on the protein constituent of muscles at each contraction. 
However, in ordinary activities the blood supply to muscles is increased, 
thereby bringing an increase of food materials, 
carrying away the waste products of metabolism, 
and thus enabling the muscle to build up and in- 
crease its efficiency. In cases of overexertion the 
toxic products of metabolism will accumulate to such 
an extent that the phenomena of fatigue is pro- 
duced and in some cases results in contracture or 
muscular cramp. . 
When the muscle substance dies it passes from a 
viscous to a solid state, becomes rigid and loses its 
power to react to stimuli. The stiffening and hard- 
ening of the muscles after death is due to this 
phenomena, which is called rigor mortis. 
The muscles of the body are divided into the following groups: those of the 
head and face; of the neck; of the trunk, which is subdivided into those of 
chest, thorax, abdomen, back and perineum; those of the upper extremity; 
and those of the lower extremity. (Fig. 18.) 
The muscles of the head and face consist of numerous groups of small 
muscles which act in the movements of the eyes, the face, the scalp and 
assist in mastication, deglutition, talking and expression. 
The muscles of the neck move the head from side to side, backward and 
forward, and rotate it. Some of these muscles act as auxiliary muscles of 
respiration, assist in deglutition, in speaking, and in other complicated move- 
ments of the head and neck. 
The muscles of the back are divided into five layers, the superficial layer 
and four deep layers. They act on the spinal column to keep the trunk in 
an erect posture, and permit movements from side to side, forward and back- 
ward, and a moderate amount of circumduction. Those of the chest and 
thorax, including the diaphragm, the great muscle which separates the thoracic 
from the abdominal cavities, are chiefly respiratory muscles. These muscles, 
with the exception of the diaphragm, assist in movements of the trunk, the 
neck and the upper extremities. The muscles of the abdomen are the external 
oblique, the internal oblique, the rectus abdominis, and the transversus abdo- 
minis. The rectus muscle is a paired muscle situated on each side of the 
Fig. 17.—Striped muscle 
fiber. (Sharpey.) ANATOMY AND PHYSIOLOGY. 
17 
Fig. 18.—Superficial muscles of the body. (After Brubaker.) 18 
HOSPITAL CORPS HANDBOOK. 
median line of the abdomen within the fibrous aponeurosis of the oblique 
muscles. It extends from the symphysis pubis to the thoracic wall. These 
muscles form the sides and front of the abdominal wall. They assist in 
micturition and defsecation by compressing the abdominal viscera. They 
also assist in respiration and emesis, flex the thorax on the pelvis and aid 
in lateral flexion and rotation of the spine. 
The inguinal ligament (Poupart’s) is a thickened band of fibers of the 
aponeurosis of the external oblique muscle, extending from the anterior 
superior spine of the ilium to the spine of the pubis. Just above this ligament 
and parallel to it is the inguinal canal through which pass the spermatic cord 
in the male, and the round ligament of the uterus in the female. The inner 
opening in the transversalis muscle is called the internal inguinal ring; the 
outer opening in the tendon of the external oblique muscle is called the ex- 
ternal inguinal ring. These openings form weak places in the abdominal wall, 
and are the frequent sites of a protrusion of parts of the viscera. Such 
protrusion is called a hernia or rupture. Other weak places are the umbilicus, 
and the femoral ring which serves as a passage for the vessels to the lower 
extremity. 
The muscles of the perineum are those surrounding the base of the repro- 
ductive organs and the rectum and form the floor of the pelvis. Their action 
is to assist in micturition and defsecation. 
The muscles of the upper extremity are divided into those of the shoulder, 
which act to move that joint; those of the arm ; those of the forearm ; and those 
of the hand. 
The muscles on the front of the arm flex the forearm; those on the back ex- 
tend it. The same principle applies generally to the muscles which arise from 
the bones of the forearm and are attached to the bones of the hand or fingers. 
Some of these muscles however act to pronate the hand (turn palmar surface 
down) and others to supinate the hand (turn the palmar surface up). The 
muscles of the palm and the back of the hand, flex, extend, adduct, abduct and 
circumduct the fingers and the thumbs. 
The muscles of the lotver extremity are divided into those of the hip; the 
thigh, the leg and the foot. The muscles on the anterior side of the hip flex 
the thigh on the abdomen, those on the posterior extend, those on the medial 
side adduct and those on the lateral side abduct. Combinations of these ac- 
tions produce circumduction of the lower extremity. 
The muscles of the posterior portion of the thigh flex the leg on the thigh. 
Those of the anterior portion extend the leg. The muscles having origin on the 
anterior surface and on the posterior surface of the bones of the leg, flex, ex- 
tend, and circumduct the foot. The muscles of the dorsal and the ventral sur- 
faces of the foot extend and flex the toes respectively. 
SPECIAL MEMBRANES AND GLANDS IN GENERAL. 
A membrane is an enveloping or lining tissue of the body. The chief mem- 
branes are classified as: Serous, synovial, mucous and cutaneous. 
Serous membranes are thin, transparent, fairly strong and elastic. Their 
surfaces are moistened by a fluid resembling serum. They are found lining 
closed cavities and passages which do not communicate with the exterior. These 
membranes consist of two layers; the endothelium, a modified epithelium, and 
the corium, a thin layer of fibrous tissue and blood and lymph vessels. They 
are divided into the following three classes: 
Serous membranes proper, which consist of a closed sac, one part of which is 
attached to the walls of the cavity which it lines, and the other reflected over ANATOMY AND PHYSIOLOGY. 
19 
the surface of the organs contained in that cavity. This class includes the 
pleurae, which cover the lungs and line the thoracic cavity; the pericardium 
Which covers the heart; the peritoneum which lines the abdominal wall, and 
clothes its contained viscera; the lining membrane of the vascular system; the 
internal coat of the heart, blood vessels and lymphatics; the capsule of Tenon, 
hack of the eyeball; and the arachnoid coat of the meninges. The serous mem- 
branes serve as a protective covering by forming a smooth slippery lining and 
secreting a serum which acts as a lubricating fluid. 
Synovial membranes are associated with joints and muscles and secrete a 
viscid glairy fluid called synovial or joint fluid. These membranes are articu- 
lar, which surround and lubricate the joints; vaginal, which forms the sheaths 
of tendons about some joints; and bursal, which form simple sacs interposed 
between soft tissue and bone. The latter may be deep seated between muscle 
or tendon and bone, or superficial between skin and bone, for example, the 
patellar bursm. 
The mucous membranes line the cavities which communicate with the exterior. 
Their surfaces are coated over and protected by mucus. The mucous membranes 
of the body may be divided into the gastro-pulmonary, and the genito-urinary. 
The gastro-pulmonary mucous membrane covers the inside of the alimentary 
tract and the air passages and all cavities communicating with them. This 
includes the accessory sinuses of the nose; the lachrymal ducts; the conjunctiva ;' 
the auditory canals, including the middle ear and the mastoid cells; the common 
bile duct; the gall bladder; the biliary ducts; the pancreatic duct; and the sali- 
vary ducts. The genito-urinary mucous membrane furnishes the inside lining 
of the urethra; the bladder; the ureters; the pelvis and tubules of the kidney; 
and all of the genital ducts including the prostatic, the seminal and the vas 
deferens. 
The cutaneous membrane is the external covering of the body, or skin. Its 
structure and functions will be discussed later. 
A gland is an organ which secretes something essential to the system or 
excretes waste materials, the retention of which would be deleterious to the 
body. 
Glands are of three types; simple, compound, and ductless. 
Simple glands are generally tubular or sacular in structure and open to the 
surface by a single duct. 
Compound glands are glands the structure of which is subdivided into smaller 
tubular or sacular structures which open by smaller ducts into a main duct. 
Ductless glands are glandular structures which have no ducts. They dis- 
charge their secretion directly into the blood or lymph streams. 
THE VASCULAR SYSTEM AND CIRCULATING FLUIDS. 
The blood is the fluid whfch circulates through the heart, arteries, veins and 
capillaries and supplies nutritive material to ail parts of the body. Blood is 
slightly heavier than water (specific gravity of 1.055) and is composed of plasma 
and corpuscular elements. 
The quantity of blood in the adult is estimated at about one twentieth of the 
body weight, which is about four quarts in an average man weighing one hun- 
dred and sixty pounds. 
The functions of the blood are as follows: (1) It serves as a medium for 
the interchange of gases, that is, it carries oxygen to the cells and removes 
carbon dioxide from the cells. (2) It serves as a medium for the interchange 
of nutritive and waste materials, that is, it carries nutrient materials to the 
cells and waste material from them. (3) A medium for the transmission of 20 
HOSPITAL OOBPS HANDBOOK. 
internal secretions. (4) It aids in equalizing and maintaining body tempera- 
ture. (5) It aids in protecting the body from toxic substances, that is, assists 
in maintaining body resistance. 
The cellular contents or elements of the blood are the red cells, the white cells, 
and the blood platelets. 
The red blood cells are circular, biconcave discs about -j-zVff of an inch in 
diameter. (Fig. 19.) They have no nucleus. Their number, which varies 
greatly under different conditions of health, is, in the adult male, about five 
million to five and one half mill ons per cubic millimeter. Their red color is 
due to the presence of hemoglobin, a substance composed of iron salt and a 
protein, which has the power of combining easily with oxygen to form oxy- 
hseinoglobin, which is a loose chemical combination in which oxygen is carried 
from the lungs to the tissues. Haemoglobin also possesses the power of removing 
carbon dioxide from the tissues in the same manner. The affinity of oxygen 
and carbon dioxide for haemoglobin depends upon the concentration of these 
gases at the point of exchange. The oxygen being at a greater concentration 
in the lungs is combined with the haemoglobin of the blood and forms oxy- 
haemoglobin, the carbon dioxide being given off. The carbon dioxide being at 
a greater concentration in the tissues is combined with the haemoglobin and 
forms carbon-dioxide-hsemoglobin, the oxygen being given 
off. In the adult the organ for the reproduction of the 
red cells is the red marrow of bone. The cells thus 
produced are nucleated, but lose their nuclei before en- 
tering the blood stream. A large number of red cor- 
puscles are destroyed daily, in what manner it is not 
definitely known. This destruction may take place in the 
liver, the spleen, or in the lymph nodes. It is known, 
however, that a certain amount of haematin is excreted 
daily in the bile, a fact which substantiates the destruc- 
tion of red blood cells in the liver. 
The white blood corpuscles are nucleated blood cells 
which vary in size and shape. They are somewhat larger 
than red cells. The average number of white blood cells in a cubic millimeter 
of blood is from six to eight thousand under normal conditions. An increase 
in white cells, called leucocytosis may occur under varying conditions. The 
most marked increases of white blood cells occur in certain pathological con- 
ditions and infections, and a knowledge of the variations under these conditions 
is an important aid to diagnosis. Leucopenia is a condition in which the white 
blood cells in the blood are below the normal standard in number. The white 
blood cells may be divided into two main groups, leucocytes and lymphocytes. 
Leucocytes have the striking property of amoeboid movement. They may 
pass through the walls of the blood vessels into the surrounding tissue. This 
process is known as migration. The function of the leucocytes is to serve as 
protective agents to the body. They do this by contributing to the formation 
of certain antibodies, also by the ingestion and destruction of bacteria, a proc- 
ess called phagocytosis. They also aid in the absorption of digested fat and 
proteins and in the clotting of blood. 
The lymphocytes may be divided into large and small lymphocytes. The 
small lymphocytes are about the size of the red blood corpuscles. They con- 
tain a large round nucleus centrally placed, which stains deeply, and is sur- 
rounded by a narrow zone of cytoplasm, which takes a stain less deeply. These 
cells compose about 20 to 25 per cent of the white blood corpuscles. The large 
lymphocytes have similar staining qualities, but are much larger and contain 
Fig. 19.—a, b, c, d, 
Red cells, side, 
edge, in rouleaux, 
crenated; e, f, 
■white cells. (Ma- 
son.) ANATOMY AND PHYSIOLOGY. 
21 
more cytoplasm than the small lymphocytes. This large type constitutes 5 to 
10 per cent of the white blood corpuscles. The lymphocytes have their origin 
in the lymph glands, the spleen, and the bone marrow. 
Leucocytes may be granular or nongranular. The nongranular leucocytes 
are the large mononuclear cells and the transitional cells. The large mono- 
nuclear cells have the same general shape as the large lymphocytes, but the 
nucleus and the cytoplasm stain less deeply. Normally these cells form from 
1 to 2 per cent of the total leucocytes. The transitional cells are of the general 
shape and appearance of the preceding, except that the nuclei are characteristi- 
cally indented on one side and when stained present a more washed-out appear- 
ance. These cells constitute about 2 to 4 per cent of white blood cells in normal 
blood. 
The granular leucocytes are distinguished on the basis of granules in their 
cytoplasm. The nuclei of these cells may be of many shapes, and are called 
polymorphonuclear leucocytes. There are three varieties of these cells: 
1. Neutrophiles, in which the granules take a light lilac stain when stained 
by one of the Romanowsky methods. These cells make up about two-thirds of 
the white blood cells. 
2. Eosinophiles, the granules of which when stained with the above stain take 
a pink or red tint due to their affinity for the acid element of the stain. 
These cells compose from 1 to 2 per cent of white blood cells. 
3. Basophiles, the granules of which take on a violet color, due to affinitj 
for the element of the basic stain. In normal blood they usually amount to less 
than 1 per cent of the white cells. 
The blood platelets are small disk-shaped bodies found in the blood. They 
are smaller than the red blood corpuscles, vary in shape, and are normally 
present in the blood in the number of about 300,000 per cubic millimeter. 
They consist only of protoplasm and contain nuclear material. Knowledge oi 
the origin of these platelets is uncertain but it is believed that they are frag- 
ments of the blood cells. Their important function is to aid in the clotting 
of the blood. 
The blood plasma is a clear, slightly yellowish fluid, containing a variety of 
substances, and serving as a source of nutrition. It is a means of removing the 
waste products resulting from the functional activity of the body cells, and 
also serves as a means of transportation for the blood corpuscles. Plasma 
consists of water, in which these substances are held in solution or in suspen- 
sion. 
Three proteins are present in the blood plasma—sero-albumin, paraglobulin, 
and fibrinogen. The significance of the two former proteins is obscure, but the 
latter, fibrinogen, is essential in forming the insoluble fibrin necessary in the 
process of clotting the blood. Fibrinogen is considered to be produced in the 
liver. A class of substances known as extractives, consisting of food products 
and waste products as urea, and uric acid, are also present in the blood plasma. 
Mineral salts, sucli as the chlorides, sulphates, carbonates, and phosphates of 
sodium, calcium, and magnesium are very important constituents in the blood 
plasma and are concerned in the nourishment and the building up of the 
tissues. The integrity of the red blood corpuscles depends upon the percentage 
of salt present. The amount of mineral salt is normally equivalent to about 
nine-tenths of 1 per cent of sodium chloride solution which fluid is 
isotonic with the tissue fluids. A solution containing less mineral salt, hypo- 
tonic, will cause the red blood corpuscles to absorb water. This condition 
results in the red blood corpuscles swelling and bursting, thus discharging their 
haemoglobin. 22 
HOSPITAL COUPS HANDBOOK. 
This process is called haemolysis, and may be caused by certain bacterial 
products called hcemolysin. In case of a solution containing more than the 
above percentage of salt, water is extracted from the corpuscles and they 
shrivel or become crenated. The above facts must be remembered in intra- 
venous medication. 
Other substances found in plasma consist of certain gases, oxygen, nitrogen, 
and carbon dioxide; internal secretions of glands; certain enzymes; and special 
substances such as antigens and antibodies. 
The most important change effected during coagulation of the blood is the 
formation of fibrin, which results from several preliminary reactions. Fi- 
brinogen, the substance from which fibrin arises, is contained in the plasma of 
the normal blood. It is, however, an inert body and must be activated by a 
ferment called thrombin, in order that fibrin may be produced. Thrombin is 
not present in normal blood but is formed from the tlirombogen or prothrombin 
which is contained in the blood. The presence of some form of soluble cal- 
cium salts together with an organic thromboplastic agent (thrombokinase) is 
essential in order that the tlirombogen may act. When blood is brought into 
contact with a foreign substance, as air, destruction of thrombocytes results, 
thrombokinase is liberated and acts with the soluble calcium salts in the blood 
to change the tlirombogen into thrombin. The thrombin then acts upon the 
fibrinogen to form fibrin. Coagulation or clotting is accomplished by these 
delicate shreds of fibrin which traverse the blood in various directions and 
encircle large colonies of corpuscles. The meshes of this fibrin network grad- 
ually are drawn closer together and the corpuscular elements become more 
tightly packed together. 
This process is expressed diagrammatically as follows: 
Cellular elements=thromboplastic substance. 
Thromboplastic substance+soluble calcium salts+thrombogen=thrombin. 
Tli rombin+fibrinogen=fibr in. 
The formation of a clot closes the opening of wounded vessels and prevents 
complete exsanguination. This clotting power differs in different individuals. 
Normally three to five minutes is a sufficient time for a clot to form but in rare 
cases even trivial wounds may cause severe and dangerous haemorrhages. This 
condition in which clotting of the blood is delayed is known as haemophilia, 
and a person having this condition is called a haemophiliac. 
Clotting of the blood may be hastened by the application of heat, as hot 
towels (wet or dry) or hot douches; by contact of the bleeding surface with 
foreign substances, as gauze, cotton, etc.; by pressure over the bleeding area, 
and sometimes by rubbing the part involved to produce an extraction of the 
cellular elements from the tissues. 
A large portion of the entire quantity of the blood may be lost without fatal 
result to the individual. The plasma of the blood is quickly regenerated by 
extraction of fluid from the tissues. This process may he artificially per- 
formed by the intravenous injection of an isotonic saline solution. A longer 
time is required to regenerate the cellular contents of the blood, days or weeks 
being necessary at times. 
The lymph is a colorless fluid found in the lymph vessels and in all of the 
tissue or intercellular spaces of the body. It consists of blood plasma and 
leucocytes and serves as a medium of interchange between the blood and 
the tissues. It carries nourishment to the tissues and waste materials from 
them to the blood. This action is carried on by osmosis or dialysis. ANATOMY AND PHYSIOLOGY. 
23 
The vascular system. 
The organs of the blood vascular system are the heart, the arteries, the 
capillaries, and the veins. 
The heart is a hollow, muscular organ, about the size of a closed fist and 
is pyramidal in shape. (Fig. 20.) It is located between the lungs in the 
front and center of the thoracic cavity, and extends from the second costal 
cartilage above to the interval between the fifth and sixth ribs on the left side, 
and from about one half inch to the right of the right side of the sternum 
to about 2\ inches to the left of the left border of the sternum. Its base is 
held suspended by the great vessels and is directed upward, backward, and to 
the right. The pointed end or the apex points downward, forward, and to 
the left. 
The heart is enclosed in an inverted sac of serous membrane called the 
pericardium. The inner layer of the pericardium is closely adherent to the 
musculature of the heart; its outer sur- 
face is reflected over the inner layer 
forming a potential cavity which contains 
a small quantity of fluid, the pericardial 
fluid. This fluid lubricates the surfaces 
of the pericardium and prevents fric- 
tion during the movements of the heart. 
The inside of the heart is lined with 
a delicate serous membrane called the 
endocardium. 
The main portion of the heart is com- 
posed of muscular tissue, called the myo- 
cardium. This muscular tissue is of a 
special type found only in the heart and 
is involuntary. The fibers of this tissue 
are striated and the cells have but one 
nucleus. (See muscle tissue above.) The 
arrangement of the muscles of the heart 
is very intricate. Some muscles run 
transversely, others longitudinally, others 
obliquely, and the muscles in the apex 
make a spiral turn or twist, thus en- 
abling an even obliteration of the cavity 
of the heart during contraction. A cer- 
tain amount of reticular tissue, vessels, 
nerves, and some ganglia are situated 
between the heart muscles. 
The heart cavity is divided by a longitudinal muscular septum into the right 
and left halves; the right half transmitting venous, and the left half arterial 
blood. Each half of the heart is divided into two cavities, the upper ones called 
the atria or the auricles, and the lower ones called ventriculi, or the ventricles. 
(Fig. 21.) During foetal life a communication, the foramen ovale, exists between 
the auricles of the heart. This, however, closes immediately after birth. Each 
atrium or auricle communicates with its corresponding ventriculum or ventricle 
by means of an oval aperture, called the atrio-ventricular or the auriculo-ven- 
tricular openings—right and left. The muscular walls of the auricles are much 
thinner than those of the ventricles and the wall of the left ventricle is much 
thicker than that of the right ventricle. This difference in development is ac- 
counted for by the greater amount of work performed by the ventricles than by 
Fig. 20.—The heart. (Mason.) 24 
HOSPITAL CORPS HANDBOOK. 
the auricles, and the corresponding greater amount of work performed by the 
left ventricle than by the right ventricle. 
Each of the cavities of the heart is lined with the endocardium, which by 
folding upon itself forms the valves of the heart. These valves guard the 
various cardiac orifices. The number and shape of the cusps or segments 
which make up these valves vary depending upon the location of the valves. At 
the right auriculo-ventricular orifice the valve known as the tricuspid valve 
consists of three cusps which are triangular in shape. The left auriculo-ven- 
tricular valve called the biscuspid or mitral valve consists of two cusps. At the 
orifices of the pulmonary artery in the right ventricle and the aorta in the left 
ventricle are three half-moon-sliaped valves called the semilunar valves. 
The right and left coronary arteries furnish the blood supply to the heart 
itself. The nerve supply is from the pneumogastrac, stimulation of which tends 
to slow the heart beat, and from the sympathetic nervous system, stimulation 
of which tends to accelerate the heart beat. 
The heart is an automatic organ which during life undergoes rhythmical con- 
traction continuously. The central nervous system may regulate and control 
these contractions, but it has nothing to do with the cause of these rhythmical 
contractions, the origin of which is not definitely 
known. (See references at end of chapter.) 
The heart beat consists of an active phase or 
period of contraction called the systole, and a period 
of dilation and rest called the diastole. Normally 
the heart rate at rest is about 72 beats- per minute, 
but this varies according to age, sex, exercise, tem- 
peratui'e, and in certain pathological conditions. 
If the ear is applied to the chest, over the area 
of the heart, certain sounds which recur more or 
less regularly may be heard. The first sound, a 
long booming one, is caused by the closure of the 
auriculo-ventricular valves and by the contraction 
of the ventricles; the second, a short, sharp sound, 
is attributed to the closure of the semilunar valves. 
In certain diseases of the heart these sounds may 
become altered or obscure and conditions called 
murmurs are frequently produced. These murmurs 
may he caused by the failure of the valves to close 
properly, permitting a regurgitation of blood into the cavity from which it is 
being forced, or by the failure of the valves to open properly, thus partially 
occluding the passage of blood. This condition is called stenosis of the par- 
ticular valves involved. 
The arteries are hollow, elastic tubes possessing a certain amount of rigidity. 
They carry blood away from the heart. These vessels are composed of three 
coats, an inner endothelial lining, a middle muscular coat composed of in- 
voluntary muscle tissue and elastic fibrous tissue, and an outer fibrous coat. 
The muscular tissue of the arteries is supplied with nerves from the sympathetic 
system called vasomotor nerves. These serve to cause dilation or constriction 
of the lumen. The smaller divisions of the arteries are called the arterioles. 
The capillaries are exceedingly minute vessels which are composed of simple 
endothelial lining only. These vessels communicate with each other and form 
an interlacing network throughout the body. It is in the capillaries that 
the chief work of the blood is performed, Here the exchange of food and 
Fig. 21.—Heart, with right 
auricle and ventricle 
opened. (Allen Thom- 
son.) ANATOMY AND PHYSIOLOGY. 
25 
waste materials between the blood and the body tissues take place. From 
the capillaries the blood is collected into the veins. 
The veins are collapsible vessels which carry blood to the heart. They are 
similar in structure to the arteries, except that the walls of the veins are 
thinner; the middle coat contains less muscle tissue and elastic fibers, and in 
many of the veins are paired semilunar valves which act to prevent the back- 
ward flow of blood in the veins. (Fig. 22.) 
The general circulatory system is divided into the pulmonary circulation 
which embraces that extending from the right ventricle to the lungs, at which 
place the blood is aerated, and its return to the left auricle; and the systemic 
circulation which embraces that extending from the left ventricle through 
all parts of the body and its return to the right auricle. 
To trace the circulation we will begin with the venous blood entering the 
right auricle by the inferior and the superior venw cavce. This venous blood 
passes from the right auricle, through the right auriculo-ventricular open- 
ing past the tricuspid valves, into the right ventricle. 
When the right ventricle contracts the tricuspid valve 
closes and the blood is forced past the pulmonary semi- 
lunar valves into the pulmemary artery. This artery 
bifurcates or divides into two branches, one branch going 
to each lung where it is subdivided into smaller arteries, 
arterioles, and capillaries which surround the alveoli or air 
sacs, of the lungs. During its circulation in the lungs the 
blood becomes aerated and is returned via the smaller 
vessels to the four pulmonary veins, two from each lung, 
which empty into the left auricle. From the left auricle 
the blood passes through the left auriculo-ventricular 
opening past the bicuspid or mitral valve into the left 
ventricle, where, upon contraction of this part, it is dis- 
charged past the aortic semilunar valves into the aorta. 
From the aorta the blood flows through its branches, the 
arteries, and the arterioles, to the capillaries in every 
part of the body. The blood is returned by the capil- 
laries to the veins, and finally reaches the right auricle 
through the venae cavse. 
The contraction of the left ventricle forcing the 
blood into the arteries, causes a wavelike expansion 
of the arteries which is synchronous with a heart 
beat. This is called the pulse, and may be felt at certain points where the 
arteries approach the body surface. The most common location is where 
the radial artery passes over the distal end of the radius, in each of the upper 
extremities. 
Blood pressure is the force of the blood exerted against the walls of the 
vessels in which it is contained. Although the term includes the pressure in 
the arteries, veins, and capillaries, the usual application of the term is to 
arterial pressure alone. The highest pressure—that is, that produced by the 
forceful propulsion of the blood through the arteries at each contraction of 
the ventricle—is known as the systolic blood pressure. Under normal condi- 
tions in the young adult this pressure is equivalent to about 120 millimeters 
of mercury, but varies as to age, sex, and condition of arteries and heart. 
Roughly, systolic blood pressure equals 100 plus the age of the individual. A 
certain amount of blood pressure is maintained in the arteries during the 
Fig. 22.—Valves of 
a vein. In the 
lower part of the 
figure are seen the 
parietal valves; 
the upper part 
shows the mouth 
of a vein guarded 
by a valve. (Poir- 
ier and Charpy.) 26 
HOSPITAL CORPS HANDBOOK. 
period of cardiac relaxation. This is caused by the elasticity and tonicity of 
the arteries and by the peripheral resistance. This pressure is known as the 
diastolic blood pressure. In normal young adults it is equivalent to from 70 
to 90 millimeters of mercury. The difference between these pressures is called 
the pulse pressure. 
The blood vessels. 
The aorta is the main trunk of the arterial system. (Fig. 23.) Springing 
from the left ventricle of the heart, the aorta arches over the root of the left 
lung, descends along the vertebral column, and after passing through the 
diaphragm into the abdominal cavity, terminates at the level of the fourth 
lumbar vertebra where it divides into the right and the left common iliac 
arteries. During its course the aorta is a continuous single trunk, which 
gradually diminishes in size and gives oft branches at various points. The 
aorta may be divided into the thoracic (com- 
monly known as the ascending, the arch, and 
the descending) and the abdominal portions. 
The ascending aorta, a short part contained 
in the pericardium, gives off two branches, 
the right and the left coronary arteries, which 
supply the musculature of the heart. 
The arch of the aorta extends from the 
ascending aorta, around the root of the left 
lung, to the border of the fourth thoracic 
vertebra. During its course it gives off three 
branches; the innominate, the left common 
carotid, and the left subclavian arteries. 
The innominate artery is a short arterial 
trunk about 2 inches in length. It arises 
from the right upper surface of the arch of 
the aorta, and ascends obliquely toward the 
right sterno-clavicular articulation where it divides into the right subclavian 
and the right common carotid arteries. 
The left common carotid artery arises at the middle of the upper surface of 
the aortic arch. The right and left common carotid arteries ascend obliquely 
on each side of the neck to the level of the laryngeal prominence where they 
divide into the external and the internal carotids. The external carotid artery 
supplies the throat, tongue, face, ears, and the walls of the cranium; the in- 
ternal carotid artery supplies the brain and the eyes. 
The subclavian arteries, the right passing from the innominate artery and 
the left from the aortic arch itself, form the first part of the arterial trunks 
which supply the upper extremities. These arteries give off branches to the 
back, the chest, the neck, and the brain. The subclavian artery as it passes 
over the first rib into the axilla is called the axillary artery. This vessel gives 
off branches to the chest, the shoulder, and the arm. The axillary artery on 
passing the armpit becomes the brachial artery, which gives off branches to 
the bone and muscles of the arm, and terminates just below the level of the 
elbow by dividing into the ulnar and the radial arteries. The ulnar artery, 
the larger of the two branches extends along the medial side of the forearm 
to the palm of the hand where it forms the superficial volar arch. The 
radial artery extends along the outer side of the forearm to the palm of the 
hand where it forms the deep volar arch. This deep volar arch anasto- 
moses with the superficial volar arch and supplies the hand with blood. 
(Fig. 24.) 
Fig. 23.-—Plan of the branches of 
the arch of the aorta. (Gray.) ANATOMY AND PHYSIOLOGY. 
27 
The descending aorta extends from the arch of the aorta to the diaphragm and 
gives off the following brandies: 
1. The intercostal arteries which are paired, 9 or 10 on each side, and supply 
the intercostal muscles and the adjacent structures. 
2. The superior phrenic arteries, which are small branches supplying the 
upper surface of the diaphragm. 
3. The bronchial arteries, two left and one right, which are the nutrient ves- 
sels of the lungs and the bronchi. 
4. The mediastinal arteries which are numerous small brandies supplying the 
lymph nodes and the areolar tissue of the mediastinum. 
5. The oesophageal arteries, four or 
five in number, which anastomose 
around the oesophagus. 
6. The pericardial arteries, three or 
four small vessels distributed to the 
pericardium. 
The abdominal aorta begins at the 
aortic opening in the diaphragm at the 
lower level of the last thoracic verte- 
bra, and terminates at the level of the 
fourtli lumbar vertebra by dividing into 
the common iliac arteries. The branches 
of the abdominal aorta are divided into 
two groups, those which supply the 
viscera, the visceral arteries, and 
those which are distributed to the 
walls of the abdomen, the parietal 
arteries. 
The visceral group consist of: 
1. The coeliac axis, a short wide ves- 
sel, one-half inch in length, which 
arises from the front of the aorta 
just below the diaphragm and divides 
into three branches; the gastric, sup- 
plying the stomach; the hepatic, sup- 
plying the liver, the gall bladder, and 
the duodenum; and the splenic, supplying the spleen and a part of the stomach 
and the pancreas. 
2. The suprarenal arteries, right and left, which are distributed to the 
suprarenal glands. 
3. The superior mesenteric artery which arises from the front of the aorta 
just below the suprarenal arteries and supplies the small intestine, except the 
duodenum and half of the large intestine. 
4. The spermatic arteries (ovarian in female), right and left, which are 
distributed to the testes (ovaries in the female). 
5. The inferior mesenteric artery which arises from the front of the aorta 
about an inch above the bifurcation and is distributed over the lower half of 
the large intestine and the rectum. 
The parietal group includes: 
1. The inferior phrenic arteries, right and left, which supply the lower sur- 
face of the diaphragm. 
47829°—23 3 
Fig. 24.—Volar arches, left hand: 
&, Superficial volar arch; D, deep 
volar arch ; U, ulnar artery; R, radial 
artery. (Gray, modified.) 28 
HOSPITAL CORPS HANDBOOK. 
2. The lumbar arteries, usually four pairs, which supply the posterior and 
lateral abdominal wall and muscles. 
3. The middle sacral artery, a small vessel which is a direct continuation of 
the abdominal aorta and supplies the sacrum and coccyx. 
The common iliac arteries (left and right) begin at the bifurcation of the 
aorta, extend downward and outward for 2 inches, when they divide 
into the hypogastric and the external iliac arteries. The hypogastric arteries 
supply branches to the pelvic walls, the pelvic viscera, the external genitals, 
and the buttocks. The external iliac artery forms the first part of a continuous 
arterial trunk which supplies the lower extremity and extends to the lower 
border of the inguinal ligament, where it passes from the abdomen through 
the femoral opening and becomes the femoral artery. The external iliac artery 
partially supplies the anterior abdominal wall and the external genitals. The 
femoral artery runs an oblique course around the femur inward and back- 
ward in the upper three fourths of the thigh to the posterior surface of the 
knee joint, where it becomes the popliteal artery. The femoral artery supplies 
branches to the muscles, the bone, and the skin of the thigh. The popliteal 
artery, after giving off branches anastomosing around the knee joint, divides 
into the anterior and the posterior tibial arteries. The anterior tibial artery, 
the smaller of the two branches, passes forward between the tibia and fibula 
and then down the front of the leg to the ankle, where it become the dorsalis 
pedis artery which supplies the dorsal surface of the foot. The posterior 
tibial artery passes down the back of the leg to the ankle, where it divides 
into two branches which supply the sole of the foot. It gives off various 
branches, the largest of which, the peroneal artery, also passes to the plantar 
surface of the foot and supplies some of the muscles and skin of the foot and 
the ankle joint. 
The veins begin as small branches called venules which unite to form larger 
vessels. Veins differ from arteries in that they have a larger capacity, thinner 
walls, and contain valves which assist in supporting the column of blood. 
This is necessary because most of the cardiac impulse is lost during the 
course of blood through the- capillaries. 
The veins are divided into the pulmonary, the systemic, and the portal 
systems. 
It has been shown that the pulmonary arteries end in capillaries about the 
alveoli of the lungs. After oxygenation blood is collected from these capillaries 
by the venules which unite to form a vein from each of the five pulmonary 
lobes. The right lung, however, sends but two veins to the heart as does the 
left lung, the veins of the superior and the inferior lobes of the right lung 
uniting. There are, then, four pulmonary veins carrying blood from the root 
of the lungs to the left atrium or auricle of the heart. These are the only 
veins in the body which carry bright red, arterial, or oxygenated blood. 
The systemic veins are arranged in two sets, the deep and the superficial. 
The deep veins as a rule accompany their corresponding arteries and usually 
are called by a corresponding name. The large arteries have only one 
accompanying vein, but the medium sized or smaller arteries have, as a rule, 
two veins which anastomose freely with each other. 
The superficial veins lie just under the skin, where in many localities they 
may be easily seen. The superficial veins of the lower extremity are the 
internal or long saphenous vein, which starts on top of the inner side of the 
foot and runs up the inner side of the leg and thigh to terminate just below 
the groin in the femoral vein, and the small saphenous vein, which starts in ANATOMY AND PHYSIOLOGY. 
29 
a similar manner on the outer side of the foot and terminates just behind the 
knee in the popliteal vein. 
The superficial veins of the forearm and the arm begin from the dorsal 
venous arch and the volar venous plexus of the hand. The cephalic vein 
passes up the outer side and the basilic vein up the inner side of the forearm 
and arm and empty into the axillary vein, which becomes the subclavian. The 
median vein passes up the middle of the forearm and at the level of the el- 
bow terminates by sending a branch to both the cephalic and basilic veins. 
The largest veins of the neck are the two internal jugular veins. The princi- 
pal function of these vessels is to return the blood from the brain. They are 
in close proximity to the common carotid arteries and therefore are deeply 
seated. They unite with the subclavian vein of either side to form the innom- 
inate veins. 
The great superficial veins of the neck are the external jugular veins, right 
and left, which receive the blood from the face and the exterior of the 
cranium and empty into the right and left subclavian veins. 
All of the venous blood from the upper half of the body is carried to the right 
auricle by the superior vena cava, while that from the lower half of the 
body is carried to the same place by the 
inferior vena cava. The two venae cavae are 
joined together by the vena azygos, which 
also collects blood from most of the inter- 
costal spaces. 
The portal system is composed of four large 
veins: The gastric, the splenic, the inferior, 
and the superior mesenteric veins. These 
vessels collect blood from the intestinal tract, 
the spleen, and the pancreas. They unite to 
form the portal vein, which enters the liver 
and divides into capillaries and blood spaces, 
from which another set of veins, the hepatic, 
arises. The hepatic veins terminate in the in- 
ferior vena cava. The purpose of the portal 
circulation is to subject the blood containing 
the product of digestion to the special action 
of the liver before it enters the general 
circulation. 
The lymph vascular system is an open system of vessels which form a net- 
work throughout the body and connect with serous and tissue spaces. (Fig. 25.) 
This system also forms certain lymph trunks, the most important of which, the 
thoracic duct, terminates in the left innominate vein. The continuity of lymph 
vessels is interrupted by interposed lymph glands. The lymph glands probably 
serve in part as filters and as sources of origin of the lymphocytes. The flow of 
lymph is maintained by means of the difference in pressure in the various tissue 
spaces and in the large veins of the neck. This is brought about by the muscular 
movements of the body, and by the differences in intrathoracic pressure during 
the phases of respiration. The backward flow of the lymph is prevented by the 
presence of valves which are similar to those found in the veins. 
The thoracic duct is from 15 to 18 inches long and extends from the 
level of the second lumbar vertebra to the root of the neck. This vessel is 
situated just in front of the vertebrae and empties into the left innominate vein 
at its origin. All lymphatic vessels of the body empty into the thoracic duct, 
Fig. 25.—Nodes of the inguinal 
region with the afferent and 
some of the efferent lymphatics. 
(Poirier and Charpy.) 30 
HOSPITAL CORPS HANDBOOK. 
except those from the right side of the head, the right upper extremity, and the 
right chest and its contents, all of which empty into the right lymphatic duct. 
This is a short duct one-half inch in length lying at the root of the neck and 
emptying into the right innominate vein. This vessel receives the lymph from 
the abhve-mentioned regions. 
THE RESPIRATORY SYSTEM. 
The respiratory apparatus consists of the nasal chambers, the pharynx, the 
larynx, the trachea, the bronchi, the lungs, and the pleurae. The air entering 
the nasal chambers, or the mouth, passes through the pharynx, through an open- 
ing called the glottis into the larynx and from there into the trachea, the 
bronchi, and the alveoli or air 
sacs of the lungs. (Fig. 26.) 
The nasal chambers are ir- 
regular wedge-shaped cavities, 
lined with fine hairs which act 
as filters and remove dust 
particles from the inspired air. 
The pharynx, by virtue of its 
position between the nasal 
chambers, the mouth, and the 
larynx, merely forms a pas- 
sageway for the air. 
The larynx, or the organ of 
voice, is situated in the upper 
end front part of the neck be- 
tween the trachea and the base 
of the tongue. It is a triangu- 
lar box composed of nine pieces 
of cartilage which are con- 
nected by ligaments. The 
largest of these cartilages, the 
thyroid cartilage, forms a ver- 
tical projection in the midline 
of the neck. The upper part 
of this cartilage constitutes 
the so-called “Adam’s apple.” 
In the interior of the larynx 
are located the vocal folds or cords, which aid in the production of voice. 
The slit between the folds of this organ is called the glottis. It is protected 
by a leaf-shaped lid, the epiglottis, which closes over it during the act of 
swallowing. 
The trachea is a fibrous muscular tube about inches long, situated 
between the larynx and its termination in the right and left bronchi 
opposite the fifth thoracic vertebra. It lies in front of the oesophagus and is 
strengthened by about sixteen to twenty C-shaped bars of cartilage. These 
cartilaginous structures are complete in front and incomplete behind. This 
serves the purpose of keeping the trachea open. The trachea is lined with 
ciliated columnar epithelium, the movement of which is upward toward the 
exterior, thus aiding in removing foreign material and secretions from the 
lungs. 
The bronchi, right and left, are structures similar to the trachea, with 
cartilaginous plaques instead of bars, each entering into a corresponding 
Fig.- 26.—The larynx, trachea, right and left 
bronchi, and the lungs. The latter have been 
cut open to show the method of division and sub- 
division of the bronchi. (Mason.) ANATOMY AND PHYSIOLOGY. 
31 
lung. The right bronchus is larger, shorter, and more vertical than the left, 
so that foreign bodies in the trachea are likely to be directed toward this 
bronchus. The bronchi divide into small branches similar to a tree, and 
finally the smallest branches, the bronchioles, end in the little sacs, called 
air vesicles or alveoli. These air sacs are very numerous and make up the 
greater part of the lung substance. 
There are two lungs. The right lung has three lobes, which are larger, 
heavier, broader, and shorter than those of the left lung, which has only two 
lobes. The lungs occupy practically all of the thoracic cavity. They are 
spongy organs consisting of the alveoli, the bronchial tubes, blood vessels, 
lymphatics and nerves held together by connective tissue. There are two 
types of circulation in the lungs, the pulmonary, which brings the blood from 
the right heart to the lungs for aeration and returns it to the heart, and that 
from the bronchial branches of the aorta which supply the lung tissue itself. 
The nerve supply of the lungs is from the pneumogastric nerve and from the 
sympathetic nervous system. 
The pleura is a closed serous sac enveloping the lung and lining the thoracic 
wall. The portion of the pleura which covers the lung is known as the 
visceral pleura and dips into the fissures between the lobes. The pleura is re- 
flected back to line the thoracic wall and is then called the parietal or costal 
pleura. Each lung is enveloped in its own pleural sac. These sacs do not 
communicate with each other, and the potential cavity between the two layers 
of pleura contains a very small amount of serous fluid which acts as a 
lubricant during respiratory movements of the lungs. The region between 
the two pleural sacs in which the remaining thoracic viscera are located is 
called the mediastinum. 
The cycle of respiration is divided into three phases: 
1. Inspiration, or the flow of air into the lungs. 
2. Expiration, or the flow of air out of the lungs. 
3. A period of rest. 
The cycle is completed about eighteen times per minute in the normal adult 
while at rest. In the act of inspiration the diaphragm contracts and the 
ribs are elevated by the accessory muscles of respiration, thus enlarging the 
thoracic cavity, and creating a negative pressure in the cavity. This permits 
the lungs to expand and causes the outside air to rush in and equalize the 
pressure. In expiration the diaphragm relaxes, and the elasticity of the 
lungs, together with the weight and the elasticity of the chest walls, causes 
the chest to return to its original size, expelling a certain amount of air from 
the lungs. 
The lungs, when filled to their utmost capacity, hold about 4,500 cubic centi- 
meters of air. Practically 500 cubic centimeters of air is breathed out at a 
normal quiet expiration. This air which is changed at each respiration is 
called the tidal air. The amount of air breathed out or in may be increased by 
forceful expiration and inspiration. The amount of air left in the lungs after 
the most forceful expiration is about 1,000 cubic centimeters and known as the 
residual air. Under normal conditions the reserve supply of air in the lungs is 
about 2,600 cubic centimeters. 
The consensus of opinion is that the automaticity of the respiratory apparatus 
is under control of the respiratory center which is located in the medulla. 
This center is in turn dependent on the carbon dioxide content of the blood, 
an increase of carbon dioxide stimulating the center. The rate of respirations 
may be controlled, to a certain extent, voluntarily. 32 
HOSPITAL CORPS HANDBOOK. 
Certain sounds are produced by the entry and exit of air from the alveoli 
of the lungs and the bronchi. These sounds may he variously modified in 
lung diseases. 
Certain abnormal types of breathing may be noted. Dyspnoea is labored or 
difficult breathing. Apnoea is a condition in which there is a temporary ces- 
sation of breathing. Asphyxia is the condition produced by oxygen starvation 
and is caused by prolonged interference with the aeration of the blood. Many 
of our emotions, such as sighing, laughing, crying, speaking, or singing produce 
to some extent modified respiratory movements. 
The process of aeration of the blood takes place in the lungs, the inspired 
air losing a certain amount of oxygen and taking up a certain amount of 
carbon dioxide. Gases have the property of diffusibility through a semi- 
permeable membrane; that is, they pass from a medium of a greater density 
to one of less density. The actual pressure of oxygen in venous blood is less 
than that of the aveolar air from which it is separated by diffusing through the 
thin cell layer which lines the capillaries and the alveoli. The reverse holds 
true of carbon dioxide. (See above, haemoglobin.) 
In order to understand tlie processes concerned with digestion, it is necessary 
to know the meaning of the various terms used in describing this process. 
Digestion is the process or act by which various food products are converted 
into simpler substances which can be absorbed and assimilated. 
Mastication is the division of food into small particles. 
This is accomplished by means of the teeth. 
Insalivation is the mixing of food with the saliva. 
This takes place within the mouth. 
Deglutition or swallowing is the act of transferring 
food from the mouth to the stomach. 
Enzymes are complex organic chemical compounds 
capable of producing, by catalytic action, the transforma- 
tion of some other compound or compounds. 
Absorption, as applied to digestion, means the taking 
up of digested food products, either in solution or sus- 
pension, by the blood and the lymph from the alimentary 
tract. 
Peristalsis is a worm like contraction which passes 
along the intestinal tract. This movement moves or pro- 
pels the contents of the intestine. 
Defalcation is the term applied to the act of expelling 
fseces from the rectum. 
The digestive system consists of the alimentary canal 
and the accessory organs. (Fig. 27.) The alimentary 
canal is a continuous tube extending from the mouth to the anus. It is com- 
posed of the mouth, the pharynx, the oesophagus, the stomach, and the small 
and large intestines. The accessory organs of digestion are the teeth, the 
tongue, the salivary glands, the liver, the gall bladder, and the pancreas. 
The mouth or buccal cavity is nearly oval in shape, and is formed in front 
by the lips; above, by the hard palate in front, and the soft palate behind; at 
the sides, by the cheeks; and below or at the floor, by the tongue. This cavity 
opens posteriorly into the pharynx from which it is partially separated by 
the anterior pillars of the fauces and the uvula which is a small flap of mucous 
THE DIGESTIVE SYSTEM. 
Fig. 27.—Diagram of 
the alimentary tube 
and its appendages. 
(Testut.) ANATOMY AND PHYSIOLOGY. 
33 
membrane hanging from the soft palate. In the small depression between the 
anterior and posterior pillars of the fauces, on either side, is a small mass of 
lymphoid tissue called the tonsil. The semicircular borders of the upper and 
lower jaw bones (the alveolar processes), contain sockets for the reception 
of the teeth. In the adult there are 32 teeth, 16 in each jaw, 4 incisors, 2 cus- 
pids (canines), 4 bicuspids, and 6 molars. The structure of the teeth is de- 
scribed in the section on dental first-aid (p. 110). 
The tongue is a muscular organ forming the floor of the mouth. It contains 
the special organs of taste, and assists in speech and in mixing and swallowing 
the food. 
The salivary glands, consisting of three pairs, which discharge their secretion, 
saliva, into the mouth are as follows. The parotid glands situated in front of 
and below the ear, discharge their secretion by way of Stenson's duct which 
enters the mouth opposite the second molar tooth of the upper jaw. The sub- 
maxilliary glands lying under the lower jaw, and the sublingual glands under 
the tongue, discharge their secretions via ducts into the floor of the mouth. 
The pharynx is a funnel-shaped cavity between the mouth and the oesoph- 
agus, and communicates with, the mouth, nose, larynx, oesophagus, and the ears, 
the latter by means of the auditory or Eusta- 
chian tubes. 
The (esophagus is a muscular tube, about 10 
inches in length, extending from the pharynx 
to the stomach, situated practically in the 
median line but inclining slightly to the left. 
It rests on the vertebral column and pierces 
the diaphragm about a half inch above its 
termination at the cardiac orifice of the 
stomach. It is composed of three layers, an 
inner mucous layer of squamous epithelium, a 
middle layer of submucous connective tissue, 
and an outer or muscular layer which is composed of involuntary muscle tissue, 
containing internal circular fibers and external longitudinal fibers. 
The stomach is a hollow muscular organ, the shape and size of which depends 
somewhat upon its contents. (Fig. 28.) The capacity of this organ is about 
five pints in the adult. The stomach has two openings, one at the oesophageal 
end called the cardiac orifice, the other at the intestinal end called the pylorus. 
The upper surface of the stomach is concave and is known as the lesser 
curvature; the lower surface is convex and is called the greater curvature. 
The bay-like cavity formed by the greater curvature is known as the fundus, 
the upper part of which is called the cardiac end and the lower part the 
pyloric end. The stomach is composed of three coats—the outer or serous coat; 
the middle or muscular coat, in which the muscular fibers are arranged cir- 
cularly, obliquely, and longitudinally ; and the inner or mucous coat of columnar 
epithelial cells. The inner coat is arranged in many folds and contains 
numerous glands which secrete the gastric juice. 
The intestine is a musculo-membranous tube about 28 feet long. It begins at 
the pyloric orifice of the stomach and ends at the anus. It is divided into the 
small and the large intestine. The small intestine is about 23 feet in length, 
lies coiled in the abdomen, and is divided into three parts, the first, the duo- 
denum, which is about 12 inches long; the second, the jejunum, about 9 feet 
in length; and the third, the ileum, about 13 feet in length. The small intes- 
tine is made up of three coats—the outer or serous coat, made up of visceral 
Fig. 28.—The stomach. (Cun- 
ningham.) 34 
peritoneum; the middle or muscular coat, consisting of two layers of involun- 
tary muscle, an outer longitudinal and an inner circular layer; and the inner or 
mucous coat. The mucous coat is arranged in little folds or elevations called 
villi. (Fig. 29.) On the inner side of these villi are small capillaries and lym- 
phatics which collect the digested food products. There are numerous glands in 
this inner coat of the intestines. This is especially so in tlie duodenum, where 
intestinal fluids or juices which aid in the 
digestion of certain foods are secreted. 
Two ducts from the accessory organs of 
digestion open into the intestine, the pan- 
creatic duct from the pancreas, and the 
common bile duct from the liver and the 
gall bladder. The wormlike movements 
of the intestine, called peristalsis, produced 
by the contraction of the muscular coats, 
mix the food contained in the intestine 
with the digestive juices and move the 
intestinal contents onward. The coats of 
the large intestine are arranged in the same 
manner as those of the small intestine, 
and are of the same structure, except that 
the longitudinal muscle fibers of the large intestine are arranged in three 
bands, which extend the entire length of the colon and are somewhat shorter 
than the rest of the tube, thus causing the walls to pucker. The mucous coat 
of the large intestine is smooth and contains no villi, but secretes a mucus 
which lubricates the tube. 
The large intestine has a greater lumen than the small intestine and is 
divided into the following parts: The ccecum; the ascending colon, which curves 
at the lower border of the liver, forming the hepatic flexure; the transverse 
colon, which traverses the abdomen to the splenic region, at which place it 
curves downward, forming the splenic flexure; the descending colon, which 
descends to the brim of the pelvis over 
which it curves to form the sigmoid 
flexure; and the rectum, in which the 
faeces are retained until they are ex- 
pelled at intervals by the voluntary 
act of defaecation. At the union of the 
ileum with the caecum two folds of 
mucous membrane form the ileoccecal 
valve. This valve prevents regurgita- 
tion of the contents of the large into 
the small intestine. At the blind end of the caecum is a small wormlike projec- 
tion called the vermiform appendix. 
The pancreas is a prismatic shaped gland about 10 inches long, presenting 
three surfaces of nearly equal width (1| inches). (Fig. 30.) It is situated 
behind the stomach at about the level of the second lumbar vertebra. It has 
a head, a body, and a tail. Its head is surrounded by the duodenum, into which 
the pancreatic duct discharges. The pancreas is a compound gland containing 
a certain amount of interglandular or connective tissue. In this connective 
tissue are small areas of modified glandular tissue having no ducts. These are 
called the islands of Langerhans. They discharge their secretion directly into 
the blood stream and are considered to have some influence in the metabolism 
of sugar, and also upon the activities of the other glands of internal secretion. 
HOSPITAL CORPS HANDBOOK. 
Fig. 29.-—Villi of small intestine. 
(Cadiat.) 
Fig. 30.—Pancreas. (Mason.) ANATOMY AND PHYSIOLOGY. 
35 
Absence of these islands or disease of the pancreas involving them causes a 
disease known as diabetes mellitus. 
The liver is the largest gland in the body and weighs from 50 to 60 ounces 
in the normal adult. (Fig. 31.) This organ measures 8 to 9 inches from side 
to side, 4 to 5 inches perpendicularly, and 6 to 7 inches from front to back. 
It is placed directly under the diaphragm in the right side of the abdominal 
cavity, and is held in position by ligaments which are formed by the peritoneum. 
The liver is divided into five lobes by five fissures, the largest of which is the 
transverse fissure, through which the vessels, ducts, and nerves enter and leave 
the organ. The liver has a double blood supply. One blood supply is from the 
hepatic artery of the systemic circulation, and the other is from the portal 
vein carrying absorbed food material from the intestine. The drainage foi 
both sets of capillaries is the hepatic vein which empties into the inferior vena 
cava. The liver is made up of many minute lobules of liver cells arranged 
concentrically about a central vein, which is a small venule of the hepatic vein. 
The lobules are held together by connective tissue which contains the capil- 
laries of the hepatic artery and the portal vein, as well as the bile ducts. It 
is to be seen that the blood from these vessels must come in close association 
with the liver cells in order to reach the 
central venule. In the gall-bladder fissure on 
the lower surface of the liver is the gall blad- 
der, a small muscular pear-shaped sac about 3 
to 4 inches long which serves as a reservoir 
for the bile. 
The bile is partly an excretion which carries 
off certain waste products, and partly a diges- 
tive secretion. Bile is manufactured in the 
liver cells and is collected by the biliary ducts 
which unite to form the hepatic duct. The 
hepatic duct is joined by the duct from the gall 
bladder and forms the common bile duct which 
opens into the duodenum. The bile is formed 
more or less continually but enters the intestines only during periods of diges- 
tion. It is prevented from entering the intestines at other times because of the 
fact that the orifice of the common bile duct is closed except during digestion. 
The bile at these times is stored up in the gall bladder. Bile is a golden yel- 
low or dark olive colored fluid, mildly alkaline, and is secreted normally in 
amounts of from 500 to 800 cubic centimeters per day. As an excretion the 
bile removes certain waste products of metabolism such as disintegrated liver 
cells and the bile pigments; as a digestive secretion it aids in the digestion in 
the preparation of fats for absorption. Bile is considered to limit to a certain 
extent putrefactive action in the intestines. 
The functions of the liver are important and numerous and are as follows: 
1. Bile secreting.—It manufactures and secretes bile. 
2. Glycogenic.—It manufactures glycogen from monosaccharides brought to 
the liver from the digestive tract by the portal vein. Glycogen is stored in the 
liver and is reconverted into dextrose by the action of a special enzyme at such 
times as body activities require it. 
3. Storing of fat.—A certain amount of fat may be stored within the liver 
cells. 
4. XJrea producing.—Takes up nitrogenous waste products from the blood and 
converts them into urea, which is discharged back into the blood stream for 
elimination by the kidneys. 
Fig. 31.—The liver. (Cunning- 
ham.) 36 
HOSPITAL CORPS HANDBOOK. 
5. Removes by means of the bile certain other waste products, such as broken- 
down red corpuscles and bile pigments. 
6. The liver is considered by some authorities as the source of fibrinogen and 
prothrombin. This organ is the site of origin of blood cells in the embryo. 
The peritoneum is a serous membrane lining the abdominal cavity and is re- 
flected onto the various organs contained therein. It completely covers some 
of these organs and only partially covers certain others. It is lubricated by a 
small amount of serous liquid, the peritoneal fluid, thus making a smooth sur- 
face for the free movement of the intestines. Parts of the duodenum, the colon, 
the bladder, and the kidneys are not covered by peritoneum; the remaining 
principal abdominal organs are completely surrounded by this membrane. 
Numerous folds of the peritoneum extend between the various organs and serve 
to connect them with the posterior wall of the abdomen and with one another, 
such as the various ligaments of the liver and the mesentery which holds the 
intestines in place and contains the vessels which supply them. The omentum, 
an apron-like structure composed of four layers of peritoneum with enclosed 
fat, is pendant from the transverse colon, and is freely movable. It is of 
service in walling off inflammations or infections within the abdominal cavity. 
In the process of digestion, food is taken into the mouth, finely divided by 
mastication and mixed with the saliva. The saliva is a colorless or opalescent, 
viscid liquid of slightly alkaline reaction which contains two digestive enzymes. 
These enzymes, active in alkaline media, are the ptyalin which converts starches 
to maltose and dextrin; and the maltase which breaks up maltose into dextrose. 
Prom the mouth the food, by the act of swallowing or deglutition, passes into 
the oesophagus, through which it is carried into the stomach, where it is thor- 
oughly mixed, by the movements of the stomach wall, with the gastric juice to 
form chyme. Chyme is the thick liquid mass into which the food is converted 
by gastric digestion. 
The gastric juice is a thin colorless or nearly colorless liquid having a strongly 
acid reaction. It is secreted by the glands within the mucous coating of the 
stomach, contains hydrochloric acid, and three enzymes, pepsin, rennin, and 
lipase. The food on mixing with the gastric juice becomes acid in reaction. 
The hydrochloric acid destroys the ptyalin, aids in coagulating the proteins, 
and also activates the proteolytic enzyme, pepsin, which is secreted in an in- 
active form, pepsinogen. Pepsin acts on the proteins of the food breaking them 
into simpler compounds known as peptones and proteoses. This action is 
preparatory to more complete digestion in the intestines. Rennin acts upon the 
soluble protein of milk, caseinogen, to form a curd or casein. Lipase is a fat- 
splitting enzyme, present in only a small quantity, and has very little activity. 
The period required for gastric digestion is dependent upon the type of food 
taken, the average time being about five hours. The ejection of chyme through 
the pylorus occurs at regular intervals and depends on the activity, the con- 
sistency, and the acidity of the chyme. Hydrochloric acid in the stomach seems 
to favor relaxation of the pyloric sphincter, which remains closed after each 
ejection until the acidity in the duodenum is neutralized. Absorption in the 
stomach is limited to small amounts of liquids, soluble substances such as salts, 
and simple sugars such as may have resulted from salivary digestion. 
In the duodenum the chyme becomes mixed with the intestinal juices 
secreted by glands in the mucous membrane of the duodenum, the pancreatic 
juice, and the bile. The intestinal juice is alkaline in reaction and contains 
four enzymes, which take up and complete the unfinished work of the 
gastric and the pancreatic juices. Three of these are sugar-splitting enzymes ANATOMY AND PHYSIOLOGY. 
37 
and the fourth a proteolytic enzyme. Their activities are illustrated by the 
following table: 
Enzyme. 
Acting on— 
End products. 
Cane sugar 
Dextrose and levulose. 
Dextrose and dextrin. 
Galactose and levulose. 
Amino acids. 
The pancreatic juice is a thin, limpid liquid, slightly alkaline in reaction. 
Its secretion is started as soon as the chyme passes the pylorus. The pan- 
creatic juice contains three enzymes: trypsin, a proteolytic ferment; amylopsin, 
a starch-splitting ferment; and steapsin, a fat-splitting enzyme. Trypsin, like 
pepsin, is secreted in an inactive form, trypsinogen, and must be activated by a 
hormone called enterokinase which is present in the intestinal juices. Tabu- 
larly the activities of pancreatic enzymes are represented as follows: 
Enzyme. 
Acting cn— 
End products. 
Amino acids. 
Dextrin and maltose. 
Fatty acid and glycerin. 
Fats 
The action of steapsin in breaking down and saponifying fats is aided and 
facilitated by the presence of bile. 
While all digestive juices are added to food by the time it leaves the 
duodenum, digestion and absorption continue throughout practically the 
whole of the intestinal tract, although the greatest part takes place in the 
small intestine. Absorption takes place by two paths, (1) by the capillaries 
of the villi to the blood stream, and (2) by the lymphatics to the thoracic 
duct and the superior vena cava. The fats in their emulsified and saponified 
form are absorbed chiefly by the lymphatic vessels or the lacteals. The products 
of protein digestion, chiefly amino acids, and of carbohydrate digestion, 
chiefly monosaccharides, are absorbed by the blood stream, and are carried 
to the liver by the portal vein. In the liver the excess sugar is withdrawn 
and stored as glycogen, the amount of sugar in the blood remaining constant. 
A small amount of fat is absorbed by the capillaries, part of which is ap- 
propriated by the liver for its own use and for storage. 
There is a small amount of food absorption and a marked absorption of 
water from the large intestine. This rapid loss of water gives the faeces their 
consistency at the time the intestinal contents reach the rectum. 
SPLEEN AND DUCTLESS GLANDS. 
The spleen is situated directly below the diaphragm behind and to the left 
of the stomach. It is bean shaped, convex on the outer surface, and weighs 
usually from 5 to 8 ounces. It is dark purplish in color, and is composed 
of a fibrous capsule filled with a pulpy mass of lymphoid cells. This organ 
is well supplied with blood, and has the peculiarity that when the minute 
arteriole stage is reached the blood escapes into the spleen pulp and is collected 
by the small venules, the capillary system being absent. Its functions are 
not definitely known, but it is supposed to be concerned with the production 
of lymphocytes both in the embryo and in the new born. The spleen may be 38 
HOSPITAL CORPS HANDBOOK. 
involved in certain other metabolic processes, as the production of haemoglobin, 
the manufacture of uric acid from certain protein waste products, and as an 
aid to digestion in the production of an activating substance for certain 
enzymes. 
The ductless glands are secretory epithelial structures having no ducts, and 
produce an internal secretion which is filtered directly into the blood or the 
lymph stream. The principal ductless glands are the thyroid, the parathyroids, 
the thymus, the suprarenals, and the pituitary and the pineal bodies. Some of 
the typical glands, as the pancreas, and the testicles (ovaries in the female) 
have ducts, and yet contain certain interstitial structure which discharge 
an internal secretion into the blood stream. 
The thyroid gland is a highly vascular body situated on the sides of the 
trachea at its junction with the larynx and extends upward on each side of 
the larynx. It consists of two lateral lobes connected across the middle line by 
a narrow transverse band called the isthmus. The internal structure consists 
of vesicles of different sizes, lined with a single layer of epithelial cells and 
containing a colloid material. The thyroid forms a substance containing a large 
percentage of iodine and having certain influences on metabolic and nervous 
activities. Complete thyroidectomy or removal of the thyroid, leaving the para- 
thyroids uninjured, is usually followed by a state of chronic malnutrition or 
cachexia. Cretinism is the result of a congenital defect or atrophy of the 
thyroid gland, which causes the arrest of skeletal and mental development. On 
atrophy of this gland in the adult, a similar phenomenon called myxcedema re- 
sults, the body becomes puffed and pasty, and the mentality blunted. In hyper- 
thyroidism there is an extreme nervousness, increased metabolism, quickened 
heart action, and in some cases protrusion of the eyeballs (exopthalmos). 
The parathyroids are four small bodies of epithelioid tissue situated on or 
near the posterior surface of the lateral lobes of the thyroid, two on each side. 
They furnish an internal secretion which aids in neutralizing certain toxic sub- 
stances. It is known that on complete removal of the parathyroids, death re- 
sults from acute tetany. 
The thymus gland consists of two lobes, situated on each side of the midline 
in the upper thorax extending, at the time of maximum development, from the 
fourth costal cartilage to the lower border of the thyroid gland. This gland is 
considered to reach its maximum size in childhood, and while it undergoes 
atrophy after puberty it does not entirely disappear. Its function is obscure, 
but it is believed to have a definite effect on the growth of the body and the de- 
velopment of the reproductive organs. Removal or atrophy of the gland causes 
precocious sexual characteristics. 
The suprarenal or adrenal glands are two flattened, irregular masses situ- 
ated extraperitoneally in the back part of the abdomen, just above and in front 
of the kidneys. The average size of the glands is about 2 inches by 2 inches, 
and one-fourth of an inch thick. These glands consist of a highly vascular cen- 
tral mass of chromaphil tissue, the medulla, enclosed within a capsule of cortical 
substance, which is in turn enclosed by a fibrous capsule. The medulla secretes 
adrenalin (epinephrin) which exerts a marked influence on the tone of the 
blood vessels and the heart. It increases blood pressure by causing contraction 
of the blood vessels and slowing and increasing the force of the heart beat. 
It also seems to increase the hydrolysis of glycogen, producing an increase of 
sugar in the blood stream, and has some effect on the skeletal muscles by les- 
sening their tendency to fatigue. The function of the cortex of this gland is 
not definitely known, but it is supposed to neutralize certain toxins and to 
manufacture a lipoid element necessary in all cellular structures. In Addison’s 39 
ANATOMY AND PHYSIOLOGY. 
disease the gland is involved causing a deficiency of secretion, and producing 
symptoms of great prostration with loss of tone of the musculature and of the 
organs of circulation. 
The pituitary body or hypophysis is a small gland attached to the base of 
the brain by a pedicle and situated in a depression in the sphenoid bone. It is 
composed of an anterior lobe and a posterior lobe to which a glandular portion, 
the pars intermedia, is closely adherent. The anterior portion is glandular, 
while the posterior portion is composed of neuroglia cells and fibers. The 
internal secretion of the anterior lobe seems to have an effect on the body 
growth, conditions of the gland such as tumors or hyperplasia producing the 
symptoms of gigantism, acromegaly, and precocious sexual development. A 
decrease in the secretion of this gland over a continued length of time produces 
the opposite effect, and complete suppression of the secretion results in death. 
The secretion of the posterior lobe, inclusive of the pars intermedia, acts as a 
stimulant to the involuntary muscles, increases blood pressure, slows the heart 
beat, stimulates certain glands to greater activity as the kidney and mammary 
glands, and acts on sugar metabolism in a way similar to the adrenal secretion. 
The pineal body or the epiphysis, is a small gland projecting from the roof 
of the third ventricle of the brain. It reaches its greatest growth about the 
seventh year, after which time the glandular structure degenerates, and is re- 
placed by connective tissue. Its secretion seems to have the effect of inhibiting 
growth and restraining the development of the sexual organs. 
THE EXCRETIONS. 
Excretions are waste products resulting from the activities of the body, and 
are discharged to the exterior by means of several organs. The excretory 
organs are as follows : 
The urinary system, which eliminates water, and certain organic and in- 
organic waste products; the skin, which eliminates water, organic and inor- 
ganic waste materials by means of perspiration; the lungs, which eliminate 
certain gaseous waste products, i. e., carbon dioxide, water vapor, and small 
amounts of ammonia; and the alimentary tract, which eliminates the residue 
remaining after digestion, and the products discharged into it, such as bile. 
The urine in man is usually yellowish in color and acid in reaction. 
The reaction, however, depends upon the character of the individual’s food. 
It has an average specific gravity of about 1.020. The average daily output 
of urine is about 40 to 50 ounces, depending upon many factors, such as 
the temperature of the atmosphere and the ingestion of liquids. Urine is 
composed of about 95 per cent of water and 5 per cent of soluble organic and 
inorganic salts. The greater part of the organic substances are nitrogenous 
waste end products of protein metabolism. Urea forms about 2 per cent 
of the total solids, and other nitrogen compounds are present in minor quanti- 
ties. The remaining solids are made up of inorganic salts of sodium, calciums 
ammonium, potassium, and magnesium. Certain abnormal constituents as 
albumin, sugar, indican, acetone, casts, and blood may be found under patho- 
logical conditions. 
The sweat, or perspiration, excreted by the sweat glands of the skin, is a 
watery, turbid liquid, with a salty taste and a distinctive rancid odor. It has 
an alkaline reaction. Normally about 1 quart of this fluid is excreted daily, 
but the amount varies widely with the temperature of the atmosphere, the 
humidity, and the amount of exercise taken. The sweat consists chiefly of 
water with small quantities of salts, fatty acids, urea, and carbon dioxide. 40 
HOSPITAL CORPS HANDBOOK 
The skin. 
The skin is a tough elastic membrane forming the outer covering of the 
body, and contains certain appendages as the hair and nails. Certain glands, 
as the sweat and the sebaceous glands, discharge their secretions upon the 
surface of the skin. (Fig. 32.) 
The skin is made up of two layers, the epidermis, or cuticle, and the derma, 
or true skin. The epidermis consists of stratified squamous epithelium, the 
superficial layer being horny and hard, and the inner layer known as the 
gcrminative layer consisting of soft protoplasmic 
cells. 
The derma is a highly sensitive and vascular 
layer of connective tissue, in which is found 
blood vessels, hair follicles, sweat and sebaceous 
glands, and nerve endings. 
The sweat glands are coiled tubular glands, 
the coil of which lies embedded in the derma and 
surrounds a small tuft of capillaries. These 
glands are located in the subcutaneous tissue and 
open by a duct upon the surface of the skin. The 
sweat glands serve as excretory organs, excreting 
the sweat or perspiration. The sebaceous glands 
are compound sacular glands, the ducts of which 
open about the hair shaft. These glands secrete 
an oily substance, sebum, which keeps the skin 
soft and pliable. The true skin is well supplied 
with specialized nerve endings which carry im- 
pressions of touch, heat, cold, and pain. The 
true skin also contains motor nerves to blood 
vessels, and secretory nerve fibers to the glands. 
The skin serves as a protective covering to aid 
in the preservation of body temperature, and as 
an excretory organ. It contains the special nerve 
fibers mentioned in the above photograph. 
The urinary system. 
The urinary system consists of the kidneys, 
the ureters, the bladder, and the urethra. 
(Fig. 33.) 
The kidneys, two in number, are located at the back of the abdominal cavity, 
behind the peritoneum, one on each side of the spinal column, and extend from 
the level of the twelfth thoracic to that of the third lumbar vertebrae. The 
right kidney is slightly lower than the left. These organs are bean shaped, 
and each kidney is about 4 inches long, 2 inches wide, and 1J inches thick. 
Each is surrounded by a thin fibrous capsule and lies embedded in a mass of 
extraperitoneal fat. The kidney substance consists of an outer third, the 
cortex, and an inner two-thirds, the medulla which surrounds a funnel shaped 
cavity, and the pelvis. Fig. 34.) The cortex of the kidney is made up of 
cuboidal epithelial cells lining either convoluted or straight tubules, and thou- 
sands of small structures known as the Malpighian bodies or renal corpuscles. 
These bodies are made up of small tufts of capillaries called the glomeruli, 
which are invested by a small membraneous sac inverted over them except at 
the point where a small blood vessel enters and leaves the capillary tuft. This 
Fig. 32.—Perpendicular sec- 
tion of the skin, showing: 
a, The epidermis, cuticle, or 
scarf skin; b, layer of dark- 
colored cells; c, the papillse 
on the surface of d, the 
corium, derma, cutis vera 
or true skin, and e, the fat 
cells underlying it; f, a 
perspiratory pore or aper- 
ture ; g, the duct, and h, 
the coiled substance of a 
sudoriparous gland; i, the 
shaft of a hair; lc, its root, 
and l, sebaceous glands com- 
municating with the interior 
of the hair follicle. (Ma- 
son.) ANATOMY AND PHYSIOLOGY. 
41 
capsule forms a beginning of the uriniferous tubule which is lined with secre- 
tory cells and is continued as the primary convoluted tubule. The latter are 
straight tubules, which enter and pass through the medulla of the kidney and 
discharge the urine into the kidney pelvis. The blood supply of the kidneys 
is maintained through the renal artery and the venous return is via the renal 
vein. These vessels enter and leave the depression on the inner border of the 
kidney known as the hilus. The generally accepted theory of secretion of urine 
pe. The pelvis of the kidney, 
cor. The cortex, the part between the 
cortex and the pelvis being the medul- 
lary portion, 
pyr. Pyramid, 
ca. The calices. 
m. r. The medullary rays. 
U. The ureters. 
B. The bladder, 
o. u. The ureteral openings, 
i. u. m. The internal urinary meatus, 
o. e. d. The openings of the ejaculatory 
ducts in the prostatic urethra, 
g. u. s. The genito-urinary sinus, 
v. m. The veru montanum. 
b. u. The bulbous urethra. 
d. c. Openings of the ducts of Cowper’s 
glands. 
c. c. Corpus cavernosum. 
c. s. Corpus spongiosum, 
u. Urethra. 
f. n. Fossa navicularis. 
e. u. m. External urinary meatus. 
Fig. 33.—Anterior view of the opened genito-urinary tract in the male. (Guiteras.) 
is that it is a combination of the processes of filtration and secretion, the water 
and soluble mineral salts filtering through the capsule of the glomeruli, and 
the organic constituents, such as urea and uric acid, being secreted by the cells 
lining the tubules. 
The ureters are two musculo-membranous tubes about the size of a goose 
quill in diameter and about 15 inches long. They connect the pelvis of the 
kidney and the bladder, leaving the kidney at the liilus and entering the 
bladder at the lower and back portion of the organ, where they deliver to 
the bladder the excretion of the kidneys. The course of the ureters is obliquely 
through the muscular walls of the bladder, so that when the bladder is 42 
HOSPITAL CORPS HANDBOOK. 
distended the coats of the ureters are approximated in such a manner that 
regurgitation or urine from the bladder is prevented. 
The urinary bladder is a musculo-membranous sac situated in the pelvis 
just behind the pubis, and does not, under normal conditions, extend above 
the upper border of the symphysis. It acts as a reservoir for urine until such 
time as micturition is convenient. When moderately distended the bladder 
holds about 1 pint. Upon the inner surface of the bladder in the upper 
part or fundus the mucous membrane is thrown into folds or rugw. The lower 
portion presents a comparatively smooth triangular surface, known as the 
vesical trigone, outlined by the openings of the two ureters and the urethra. 
Micturition or the act of voiding urine is an involuntary mechanism con- 
trolled partly by volition. 
The urethra is a membranous tube passing from the bladder along the 
under surface of the penis to the distal end of that organ where it terminates 
in the meatus. It serves to convey the urine and, in 
the male, the secretions of the genital glands to the ex- 
terior. It is about 8 inches long, and is divided into 
three parts, the prostatic, the membranous, and the 
penile portions. The prostatic urethra, about 1 inch in 
length, is surrounded by the prostate gland and contains 
the orifices of the prostatic and the ejaculatory ducts. 
In this portion the lumen of the urethra is the largest. 
The membranous urethra is about one-half inch in length 
and consists of that portion which pierces the urogenital 
diaphragm. The penile urethra is the longest portion 
and lies along the base of the penis, extending to its 
external opening, the urinary meatus. {See section on 
Venereal Diseases.) 
THE MALE GENITAL ORGANS. 
The male genital organs consist of the testes, the 
epididymis, the scrotum, ductus deferens, seminal vesi- 
cles, prostate gland, bulbo-urethral glands, urethra, and 
the penis. 
The testes are two glandular organs suspended from 
the inguinal region by the spermatic cord and surrounded 
and supported by a musculo-membranous sac, the scrotum. The testicle 
proper is ovoid in shape and is composed of tubular glands held together by 
connective tissue. These gland cells form the male generative cell, the sperma- 
tozoa. The interstitial cells of the testis have an internal secretion which 
promotes the development of masculine characteristics. The tubules of the 
testicle unite to form a long tortuous tube which lies along its posterior sur- 
face and connects with the ductus deferens. This tube or body is called the 
epididymis. 
The ductus deferens {vas deferens) is the excretory duct of the testicle and 
runs in the spermatic cord through the inguinal canal into the abdomen, thence 
extra-peritoneally on a convergent course to the seminal vesicles. The sper- 
matic cord forms the pedicle of each testicle and extends from the internal 
abdominal ring to the back of the testis, and is made up of the ductus deferens, 
spermatic arteries and veins, lymphatics, nerves, cremasteric muscle and fascia. 
The seminal vesicles are two glandular pouches between the bladder and 
rectum, and unite with the ductus deferens to form the ejaculatory duct. 
Fig. 34.—The kidney 
on section. (Gui- 
teras.) 1. Capsule. 
2. Pyramids of 
• Malpighi. 3. Col- 
umns of Bertini. 
4. Renal artery. 
5. Same, its pos- 
terior branch. 
6. Same, its an- 
terior branch. 7. 
Peripyramidal ar- 
teries. 8. Renal 
pelvis. 9. Ureter. 43 
These vesicles serve as a reservoir for the semen and add a secretion of their 
own. The ejaculatory ducts pass from the seminal vesicles between the lobes 
of the prostate gland and open into the floor of the prostatic urethra. 
The prostate (jland surrounds the first portion of the urethra, and resembles 
a horse-chestnut in form. The glandular and muscle tissue of this gland is 
surrounded by a dense fibrous capsule. The gland secretes a fluid which is an 
essential element of the semen. The bulbo-urethral glands are two small 
bodies about the size of a pea situated one on each side of the membranous 
urethra and opening into it. These glands secrete a fluid which forms part of 
the seminal fluid. 
The penis consists of three more or less cylindrical bodies of erectile tissue. 
The two corpora cavernosa lie above the corpus spongiosum which contains 
the urethra. The glans penis, forming the distal end of the penis, is continu- 
ous with the corpus spongiosum and contains the external opening of the 
urethra, the meatus. The covering of the shaft of the penis is loose skin, but 
that portion reflected over the glans penis is a 
thin layer of skin lined with mucous membrane, 
and is called the prepuce. 
THE NERVOUS SYSTEM. 
The nervous system frequently is termed “ the 
ruler of the body.” “ Its first great work is to 
cause all parts of the body to work harmoniously 
together. Its second is to act as the organ of the 
mind.” 
The nervous system is divided into the cerebro- 
spinal system and the sympathetic or ganglionic 
system. The cerebrospinal system consists of the 
brain and the cranial nerves, and the spinal cord 
and its nerves. The sympathetic or ganglionic sys- 
tem consists of double chains of ganglia or collec- 
tions of nerve matter situated on either side of the vertebrae and extending from 
the skull to the pelvis. In addition there are several groups or collections of 
disconnected ganglia, situated in the abdomen, which supply the internal organs 
and the walls of blood vessels with their nerve influence. A collection of these 
nerve ganglia is called a plexus; for example, the cardiac plexus supplying the 
heart, the solar plexus supplying the stomach, the pulmonary the lungs, and the 
hypogastric the organs in that region of the body. 
Nerve tissue is either cellular or fibrous tissue. The cellular tissue is gray 
in color and is found in the brain, spinal cord, and all nerve centers. The 
fibrous tissue is either gray or white in color. The gray fibers are found in the 
sympathetic or ganglionic system and the white chiefly in the brain and spinal 
cord. 
A nerve is a whitish colored cord-like substance which conveys impulses 
from one part of the body to another. The nervous system is made up of 
numerous small nerve cells. 
Nerve cells or neurones vary in size and shape and possess one or more 
processes, one of which is called the axone or axis cylinder process because it 
becomes the axis cylinder of a nerve fiber; the others are called dendrites or 
protoplasmic processes. (Fig. 35.) Nerve cells are grouped as unipolar, bi- 
polar, and multipolar, according to the number of processes they possess. 
47829°—23 4 
ANATOMY AND PHYSIOLOGY. 
Fig. 35.—Motor nerve cell. 
(Howell.) 44 
HOSPITAL CORPS HANDBOOK. 
A nerve center is any group of cells of gray nerve substance having a com- 
mon function. It has the power to generate, receive, and transmit impulses. A 
nerve can only conduct the impulse generated in a nerve center. 
A motor nerve is one whose function is to produce motion. A sensory nerve 
is one by means of which pain, hunger, sensations, etc., are felt. A vaso-motor 
nerve is one which conveys impressions of either contraction or dilatation to 
the vascular system. A mixed nerve is one which contains both motor and sen- 
sory fibers. An afferent nerve is one which conducts impressions to a nerve 
center only. 
White nerve substance or nerve-fiber contains two kinds of fibers, the medul- 
lated or white and the nonmedullated or gray. 
The medullated fibers contain a central core or axis cylinder which is sur- 
rounded by a medullary sheath or white substance of Schwamm, composed of 
fatty matter in a iluid state which protects the axis cylinder. This medullary 
sheath is enclosed in a sheath called the neurilemma. These medullated fibers 
compose the white matter 
of the nervous system and 
are found in the brain, 
spinal cord, ganglia, and in 
nerve trunks distributed 
to all parts of the body. 
Nerves are supplied by a 
very minute system of capil- 
lary blood vessels. 
The nonmedullated fibers, 
called the gray or gelati- 
nous nerve-fibers, consist of 
an axis cylinder which is 
enclosed in a nucleated 
sheath. These fibers consti- 
tute most of the sympathetic 
nervous system and include 
some of the cerebrospinal 
system, forming the gray 
matter of the brain and the 
spinal cord. 
The brain, the largest and the most complex mass of nervous tissue in the 
body is contained in the cavity formed by the bones of the cranium. It is 
covered by three membranes, or meninges, the dura mater, the pia mater and 
the arachnoid. 
The dura mater, a dense membrane of fibrous connective tissue, contains many 
blood vessels and is arranged in two layers, except in a few places. The outer 
layer of the dura mater is adherent to the inside surfaces of the bones of the 
skull where it forms their periosteum. The inner layer covers the brain and 
sends numerous prolongations inward for the support and protection of the 
lobes of the brain. These projections form the sinuses of the brain through 
which the blood is returned from the brain to the large veins of the neck. They 
also form the sheath for the nerves leaving the cranial cavity. 
The pia mater, a delicate membrane of connective tissue containing a net- 
work of blood and lymph vessels, lies under the dura mater and extends to all 
crevices and depressions of the brain. It contains the blood vessels of the 
brain and supplies blood to all parts of the brain. It frequently is called the 
nutritive membrane. 
Fig. 36.—Scheme showing the connection of the sev- 
eral parts of the brain. (Gray.) ANATOMY AND PHYSIOLOGY. 
45 
The arachnoid, a delicate serous membrane, lies between the dura mater and 
the pia mater. Except in the longitudinal fissure of the brain this membrane 
does not dip down into the crevices and depressions of the brain. Between the 
arachnoid and the pia mater is a space called the subarachnoid space, in which 
is found a certain amount of cerebro-spinal fluid. 
The brain itself is divided into three main parts: The forebram, containing 
the cerebral hemispheres and other bodies; the midbrain, a short, constricted 
portion connecting the pons and cerebellum with the forebrain; and the hind- 
brain, consisting of the medulla oblongata, pons, and cerebellum. (Fig. 36.) 
The pons Varolii consists of two rope-like bundles running from the cerebellum 
to form a broad mass in the midline of the cranial cavity, and its fibers join the 
two hemispheres of the cerebellum and connect the medulla with the cerebrum. 
The cerebrum, the largest part of the brain, fills the whole of the upper part 
of the cavity of the skull. It is composed of gray matter externally which is 
the active part of the brain and white matter internally in which are embedded 
masses of gray matter. The outer portion of the cerebrum is made up of alter- 
nate elevations called convolutions and depressions called fissures. Some of 
these fissures occur at an early age in foetal development and divide the hemi- 
spheres into lobes which bear names corresponding to the cranial bones near 
which they lie. 
The great longitudinal fissure extends from the front to the back of the cere- 
brum and completely divides it into two hemispheres, which are connected by a 
broad transverse band of white fibers called the corpus collosum. The trans- 
verse fissure separates the cerebrum from the cerebellum. The fissures of the 
brain divide each hemisphere into sections called lobes. These lobes are (1) 
frontal lobe, (2) parietal lobe, (3) temporal lobe, (4) occipital lobe, and (5) 
the central lobe or the Island of Reil. Among the important fissures are the 
fissure of Rolando, called the central sulcus running from the top and near the 
middle of each hemisphere downward and forward for two-thirds of its vertical 
measurement and separating the frontal lobe from the parietal lobe; the lateral 
cerebral fissure (Fissure of Sylvius), dividing the frontal and parietal lobes 
from the temporal lobe; and the parieto-occipital fissure separating the pareital 
from the occipital lobe. 
The function of the cerebrum is to govern all of the mental activities and 
coordinate body movements. This section of the brain contains the centers or 
seats of reason, intelligence, will, memory, and all of the higher emotions 
and feelings. Certain areas of the brain have a preponderance of control 
over certain functions, although all areas are more or less closely connected 
by association fibers. For instance, the frontal lobe is primarily the seat of 
reasoning or higher psychical thought, that portion just anterior to the central 
fissure is the motor area, the temporal lobe is the seat of hearing, and the 
occipital lobe is the seat of vision. 
The white matter consists of fibers which run in three directions (1) from 
above downward, (2) from the front backward, and (3) from side to side. 
They form a connection between the different parts of the brain and connect 
the brain with the spinal cord. 
The interior part of the brain contains cavities called ventricles which com- 
municate with the cavity of the spinal cord and contain small amounts of 
ceebospinal fluid. 
The cerebellum lies in the posterior and inferior part of the skull cavity 
between the occipital lobes of the cerebrum above and the medulla oblongata 
below. This part of the brain is divided into a middle segment called the 
vermis and two lateral lobes or hemispheres which are subdivided by fissures 46 
HOSPITAL, CORPS HANDBOOK. 
into smaller convolutions. The surface of the cerebellum consists of gray mat- 
ter, the interior of white matter. The principle function of the cerebellum 
is to coordinate ordinary movements and to maintain equilibrium. 
The medulla oblongata is continuous with the spinal cord which, as it enters 
the cranium through the foramen magnum, becomes a widened oblong-shaped 
mass. It rests on a groove in the occipital bone, and forms the floor of a cavity 
between the two hemispheres of the cerebellum. It is hollow, and contains the 
expanded continuation of the spinal canal, which is called the fourth ventricle 
of the brain. The surface of the medulla contains several fissures which form 
convolutions. The functions of the medulla 
are similar to those of the spinal cord, 
namely, conduction, reflex action and 
automatic action. Its function of con- 
duction is important as it conducts all 
impressions passing between the brain and 
the spinal cord. The important reflex 
centers contained in the medulla are: (1) 
The respiratory center for regulating the 
function of respiration, (2) the accelerator 
centers for the heart, (3) the vasomoter 
center. 
The spinal cord is that part of the cen- 
tral nerve system which lies in the spinal 
canal, extending from the medulla oblongata 
to the first lumbar vertebra. (Fig. 37.) 
At the first lumbar vertebra the spinal cord 
gives off a number of fibers, which continue 
in the spinal canal to form a tail-like ex- 
pansion called the cauda equina. The three 
coats or membranes which cover the brain 
extend down and cover the spinal cord. The 
subarhcliinoid space between the aracliinoid 
and the pia mater is likewise continued and 
contains a fluid called the cerebrospinal 
fluid, which serves as a protection to the 
brain and the spinal cord. Between the 
dura mater and the vertebral column is a 
protective covering of fatty tissue which 
also serves as a protection to the spinal cord. 
The spinal cord does not fit tightly in the 
spinal canal, thus permitting movement of 
the vertebra1. It tapers from above down- 
ward. It can be said roughly to be from 16 to 20 inches long and three-fourths 
of an inch in thickness. 
Two fissures, the ventro-median fissure anteriorly and the dorso-median fissure 
posteriorly, almost completely divide the spinal cord, leaving only a narrow 
bridge of substance connecting the two halves. The bridge is called the isth- 
mus of the spinal cord and contains a minute central cavity or canal which 
traverses the entire cord and communicates with the cavity of the brain. 
The spinal cord is made up of white matter surrounding an H-shaped section 
of gray matter. The anterior parts or horns of this H-shaped substance are 
short and bulky while the posterior ones are long and slender. (Fig. 38.) The 
white matter of the cord is composed of medullated nerves, the gray of cell 
Fig. 37.—Spinal cord and nerves. 
(Mason.) ANATOMY AND PHYSIOLOGY. 
47 
bodies, dendrites, axones, and collateral branches held together by neuroglia. 
In the spinal cord the nerve fibers lie in bundles, which are called tracts or 
columns. The function of these tracts is to transmit sensory impressions to 
and motor impressions from the 
brain. 
The cerebral or cranial nerves. 
The cerebral or cranial nerves, 
consisting of 12 pairs, originate in 
the brain and supply certain definite 
areas of the body. They are of three 
varieties, (1) sensory nerves, (2) 
motor nerves, and (3) mixed nerves 
which contain botli sensory and motor 
nerve fibers. These cranial nerves 
after leaving the cranium through 
the definite anatomical exits split up 
into branches and are widely distributed. They are numbered from before 
backward in the order in which they arise from the brain, and are named in 
accordance with their nature, function, or distribution. 
The number, name, type, distribution, and function of these cranial nerves 
is given below. 
Fig. 38.—Transsection of the spinal cord 
at the midthoracic region. (Gray.) 
Nerve 
No. 
Nerve name. 
Type. 
Distribution. 
Function. 
1 
Olfactory 
Sensory. 
Upper third of the nasal cavity.. 
Sense of smell. 
2 
Optic 
Sight. 
Movements of eye. 
3 
Oculomotor 
Motor... 
All eye muscles except superior 
oblique and external rectus. 
4 
Trochlear 
Superior oblique muscle of eye.. 
Do. 
5 
Trigeminal 
Mixed... 
Skin of face, eyeball, lachrymal 
glands, mucous lining of 
mouth and pharynx, teeth, 
and tongue, muscles of masti- 
cation. 
Taste, mastication, secretion, 
and touch. 
6 
Abducens 
Motor... 
External rectus muscle of eye... 
Movements of eye. 
7 
Facial 
All muscles of expression of face; 
also supplies ear and part of 
neck. 
Facial expression. 
8 
Auditory 
Sensory. 
Mixed... 
Hearing and equilibrium. 
Taste, movement of pharyngeal 
muscles and sensation to 
mucous membrane of phar- 
9 
Glossopharyngeal. 
Tongue and pharynx 
10 
Pneumogastric 
.. -do 
Larynx, trachea, lungs, heart, 
pharynx, oesophagus, and 
stomach. 
Both motor and sensory to 
lungs and larynx. Cardio- 
inhibitory. Motor to oeso- 
phagus and stomach. 
11 
Spinal accessory... 
Hypoglossal... 
Motor... 
Certain neck muscles 
Movements of head. 
12 
Tongue 
Movements of tongue. 
The spinal nerves. 
These nerves, 31 pairs in number, having their origin in the spinal cord by 
two roots, pass from the vertebral canal through the intervertebral foramina 
and are distributed to the various parts of the body. There are 8 spinal 
nerves in the cervical, 12 in the thoracic, 5 in the lumbar and 6 in the pelvic 
region. The anterior roots of the spinal nerves are the motor roots, tiie 
posterior, the sensory roots. Thus all of these nerves are mixed nerves; that 
is, they carry both sensory and motor impressions. After leaving the in- 
traspinous cavity these nerves split up into two divisions, the posterior divi- 48 
HOSPITAL COUPS HANDBOOK. 
sion supplying the muscles and the integument of the back as individual 
nerves, the anterior divisions uniting to form plexuses from which the nerve 
supply to the extremities and other parts of the body is derived. 
The sympathetic nervous system. 
The function of the sympathetic nervous system is to maintain control over 
the visceral activities of the body. Most of the functions of this system are 
performed unconsciously. The viscera are under the control of this system and 
ot the central nervous system. The impulses to the viscera from the central 
nervous system are distributed through the sympathetic nervous system. 
Nerve action. 
The basis of all functional activity of the nervous system is the so-called 
reflex action. Nerve fibers which carry impulses away from the nerve centers 
are called efferent 
or motor neurones 
(from the Latin ef- 
fere, to hear away). 
Those which carry 
impulses to the nerve 
centers are called 
afferent or sensory 
neurones (from the 
Latin afferre, to hear 
toward). A receptor 
is any mechanism 
through which exter- 
nal forces can give 
rise to nerve impulses. 
Thus the end of a 
sensory nerve is called 
a receptor ending. 
“A reflex act is one 
which is executed in 
response to an exter- 
nal stimulus.” It is 
an unconscious act, 
and does not require 
attention, as closing 
the eyelids to prevent 
foreign objects from 
entering the eye. 
The following are 
essential in refiex ac- 
tions : (1) There must 
be a receptor on which the stimulus is brought to bear. (2) There must be a 
path to the central nervous system, the afferent or sensory neurones by which the 
sensory impulse is carried (B) There must be a path from the central nervous 
system, the efferent or motor neurones by which the motor impulse is carried. 
A reflex action takes place by an impulse, generated at the receptor ending of 
a nerve, traveling up the sensory (afferent) neurones to the central nervous 
system, through the cell body, traveling down the motor (efferent) neurones 
to the muscles or gland cells, where the action is produced. 
Pig. 39.—Diagram of reflex action: a, Tack pricking hand; 
b, b’, afferent nerves ; c, &, c", nerve cells ; d, d’, efferent 
nerves ; c, muscle moving hand ; f, white matter ; g, gray 
matter; h, spinal cord; i, medulla oblongata; k, brain. ANATOMY AND PHYSIOLOGY. 
49 
The impulses or reflex actions may be sent to and received from the brain. 
However, it is believed that in most cases the sensory impluses are received 
in the spinal cord and the motor impulses originated therein. (Fig. 39.) 
Thus, in response to impulses received over the afferent or sensory neurones, 
the nerve cells in the spinal cord send out orders without waiting for the im- 
pulse to be sent to the brain or central nervous system and the orders to be 
sent out from there. As an example, the hand is pricked by a tack. The 
receptor nerve ending receives the sensation and the afferent or. sensory 
neurones carry it to the spinal cord and brain. Before the sensation has reached 
the brain, however, an order to lift the hand has been originated by the nerve 
cells in the cord and sent out by the efferent or motor neurones. The hand 
is moved and the brain made conscious of the prick at about the same time. 
Reflexes are classed as simple reflexes, in which a single muscle or gland 
is involved as in the corneal reflex; complex reflexes in which several muscles 
or glands are involved, the action remaining perfectly coordinated, as in 
the patellar reflexes; spreading reflexes in which a large number of muscles 
are involved; tonic reflexes or continuous reflexes in which a reaction is 
repeated a number of times, as in swallowing, coughing, hiccoughing, etc.; and 
association or perception reflexes in which a mental picture produces reaction, 
as in the flow of saliva or gastric juice when well-cooked food is seen or smelled, 
or when one person yawning causes others to do likewise. 
Special senses. 
The special senses may be classified broadly as sight, hearing, smell, taste, 
and touch. 
The visual apparatus consists of the eyeballs, the optic nervesand the 
visual centers in the brain, together with certain associated organs, as the 
eyelids, eyebrows, muscles of the eyeball, and the lachrymal apparatus. 
The eyelids are two thin movable folds projecting from above and below, 
placed in front of the eye. They are covered externally by skin, and internally 
by a mucous membrane, the conjunctiva. This internal lining, the conjunc- 
tiva, is reflected over the front of the eyeball. The interior of the eyelid 
is composed chiefly of connective tissue, part of which is dense fibrous 
tissue which forms the tarsal cartilage. Several small glands, the Meibomian 
glands, are situated in this connective tissue. The upper eyelid contains a 
small muscle which acts to elevate or lower it. On the margin of each 
lid are double or triple rows of short hairs or cilia called the eyelashes. The 
function of the eyelids is to afford protection to the eyes. They are movable 
shades which may exclude light, dust, and other injurious substances. 
The lachrymal apparatus consists of the lachrymal glands, the canaliculi, 
the lachrymal sac, and the nasal duct. The lachrymal gland is situated at 
the upper and outer angle of the orbit and secretes tears which flow to the 
surface of the conjunctiva via several small ducts. This secretion passes 
over the eyeball and is collected by the canaliculi at the inner angle of the 
conjunctiva. These canaliculi communicate with the lachrymal sac from 
which the tears are discharged into the nose through the nasal ducts. 
The orbits are bony cavities in which the eyeball and its muscles are con- 
tained. They are shaped like a four-sided pyramid and are made up of seven 
bones, the zygomatic, maxilla, palate, ethmoid, frontal, sphenoid, and lachrymal. 
The orbit contains two openings posteriorly, the optic foramen for the passage 
of the optic nerve and the ophthalmic artery; and the sphenoidal fissure for 
passage of the ophthalmic vein and nerves to the muscles of the eye. 50 
HOSPITAL CORPS HANDBOOK. 
There are six extrinsic muscles of the eye the function of which is to 
move the eyeball. These are the four recti muscles, the internal, the exter- 
nal, the superior, and the inferior, and the two oblique muscles, the inferior 
and the superior. (Fig. 40.) The innervation of these muscles has been shown 
under the cranial nerves. 
The eyeball is made up of three distinct coats or layers. (Fig. 41.) The 
outer layer consists of the sclera and the cornea. The sclera or “ the white of 
the eye” is a dense, tough, fibrous membrane covering the posterior five-sixths 
of the eyeball and pierced posteriorly by 
the optic nerve. In front where the light 
enters the eye the sclera changes to a trans- 
parent membrane having no blood vessels, 
which covers the remaining one-sixth of the 
eyeball and is known as the cornea. 
The middle layer is composed of the 
choroid and the iris. The choroid is a thin, 
vascular, chocolate-colored membrane lin- 
ing the sclera and containing a network of 
blood vessels and pierced in the back by 
the optic nerve. It is folded inward and 
arranged in radiating folds about the lens of the eye. These folds form the 
ciliary processes and are well supplied with nerves and blood vessels and the 
ciliary muscle is contained therein. The iris is a thin, circular, contractile disk 
directly back of the cornea and suspended in front of the lens but not in con- 
tact with it, and perforated near its center by a circular opening called the 
pupil. It divides the space between the cornea and the lens into an anterior 
and posterior chamber which contain 
a watery substance called the aque- 
ous humor. The iris is composed of 
connective tissue, pigment cells, 
blood vessels, and contains two sets 
of muscles. One set of muscle fibers 
contracts the pupil, the other dilates 
it. The function of the iris is to 
regulate the amount of light enter- 
ing the eye—by contracting it de- 
cx-eases the amount of light entering, 
by dilating it increases it. 
The inner layer of the eye is the 
retina, which is essentially the ex- 
panded fibers of the optic nerve. It 
is the screen on which the images 
fall, is most essential to vision, and 
is a transparent, purplish-colored 
membrane situated between the inner surface of the choroid and the outer sur- 
face of the vitreous body, a transparent jellylike substance nearly filling the 
cavity of the eyeball and separated from the retina by the hyaloid membrane. 
The i-etina consists of eight layers of cells, the most important of which is the 
first or external layer called “ layer of rods and cones,” which acts as end 
organs to the optic nerve. 
The crystalline lens is a solid transparent body enclosed in a transparent 
capsule or membrane and held in place by a ligament. It is situated between the 
iris in front and the vitreous body behind. The lens is an elastic body which 
Fig. 40.-—Muscles of the right orbit. 
(Gray.) 
Fig. 41,—The right eye in horizontal section. 
(Toldt.) ANATOMY AND PHYSIOLOGY. 
51 
hardens and loses its elasticity with age. It is kept normally tense by the pull 
of the suspensory ligament on the capsule. When the eye is adjusted for near 
vision, the ciliary muscle contracts, drawing the choroid forward, relaxing the 
suspensory ligament and allowing the lens to change its shape. This is called 
accommodation. 
Common defects of accommodation are: 
1. Hypermetropic, or farsightedness, a condition in which the focal point for 
near objects is behind the retina. 
2. Myopia, or nearsightedness, a condition in 
which the rays are brought to a focal point before 
the retina is reached. 
3. Presbyopia, a condition similar to hypermt-- 
tropia, found in old age and due to loss of elas- 
ticity of the lens. 
4. Astigmatism, a condition in which the curva- 
ture of the cornea or lens is defective, causing a 
dispersion of rays and a blurring of the image. 
The ear or the organ of hearing is composed 
of three parts: The external, the middle, and the 
internal ear. (Fig. 42.) The external ear con- 
sists of the auricle and the external auditory canal, which extends from the 
outside to the eardrum, or tympanic membrane. This membrane separates the 
external from the middle ear. 
The middle ear is a small, irregular cavity located in the temporal bone. 
It communicates with the pharynx by the Eustachian or auditory tube and 
also with the mastoid portion of the temporal bone. The middle ear is sepa- 
rated from the internal ear by a thin bony plate containing two small open- 
ings which are covered with a thin membrane. Within the middle ear are the 
car ossicles or ear bones. (Fig. 43.) These form a chain and extend from 
the eardrum to the fenestrum ovale of the internal ear. The fenestrum ovale 
is the connection between the middle and the internal ear. The internal car 
contains the perceptive organ of hearing. It consists of a bony labyrinth 
hollowed out of the temporal bone. This labyrinth is lined with a membrane 
which contains a fluid called, cndolymph and is divided into the vestibule, the 
semicircular canals, and the cochlea. The semicircular canals and vestibule re- 
ceive nerve endings from the vestibular branch of the 
auditory nerve and have to do with the sensation of 
equilibrium. 
The end organs of hearing are located in the cochlea. 
Hearing is accomplished by sound waves which strike 
against the eardrum and are transmitted by the ear 
ossicles to the nedolymph of the internal ear, the move- 
ment of which stimulates the end organs of hearing. 
The center of hearing is in the temporal lobes of the 
brain. 
The sense of smell is accomplished by emanations of 
certain substances coming in contact with special nerve 
endings of the olfactory nerve which are distributed to the mucous membrane 
of the upper part of the nasal chamber. 
Taste is accomplished by certain end organs known as taste buds, which are 
groups of modified epithelium cells of the tongue around which terminate nerve 
fibers. The perceptive portions of the tongue are the tip, the borders and the 
posterior portion of the dorsum. The nerves concerned with the sense of taste 
are the chorda tympani of the facial, the Ungual branch of the trigeminal, 
Fig. 42.—-Section through 
right, external, middle, and 
internal ear. (Howell.) 
Fig. 43.—The bones 
of the middle ear : 
M, Malleus; I, in- 
cus ; 8, stapes. 
(Howell.) 52 
hospital corps handbook. 
and the glossopharyngeal. The center of taste is considered to be in the hippo- 
campal lobe of the brain. There are four fundmental tastes; salt, sweet, acid, 
and bitter. The pleasing variations which commonly are called taste are 
usually combinations of taste and smell. It is necessary for a substance to be 
in solution to stimulate taste buds. 
Certain special functions and activities. 
Speech, or the expression of coherent thought is brought about by a com- 
bination of several acts under control of a certain brain center. The center 
of speech is considered to be located deep in the left temporal lobe of the brain. 
The larynx contains two vocal folds controlled by muscles which separate or 
bring these folds together according to the pitch of tone desired. When air 
is forced from the lungs past these folds certain sounds are produced, and in 
conjunction with the movements of the pharynx, tongue, lips, and cheeks artic- 
ulate speech results. 
Sleep is a period of more or less unconsciousness, during which most of the 
higher psychical powers are quiescent, but during which the physiological 
activities continue. It usually is considered a period of rest, in which the 
constructive processes exceed the disassimilitory or catabolic changes. Certain 
changes take place during sleep; respiration is slowed, the pulse slowed, and 
less blood is sent to the brain and greater amounts to the extremities. The 
cause and necessity for definite periods of sleep is not thoroughly understood. 
Heat regulation, or maintenance of constant body temperature is a two- 
sided process, and consists of controlling the loss of heat as well as the pro- 
duction of heat. Heat is lost through the excreta, through expired air, by 
evaporation of sweat, and by radiation and conduction from the skin. Heat is 
produced by physiological oxidations within the body. This is effected by 
muscular exercises and partly by the variety and quantity of food. 
The preservation or elimination of heat is controlled chiefly by the sympa- 
thetic nervous system, by nerves to sweat glands and vasomotor nerves. An 
increase of blood to the skin, increases the loss of heat by radiation. The 
opposite effect may be produced by vasoconstriction or decrease of blood to 
the skin. 
Fever is an abnormal condition of increased temperature, the exact cause 
of which is unknown. Generally it is considered to be a metabolic disturbance 
caused by certain toxic substances which act upon a possible heat center in 
the brain and influence the sympathetic nervous system. 
References. 
Anatomy.—Gray. 
Text Book of Anatomy.—Cunningham. 
Human Anatomy.—Piersol. ANATOMY AND PHYSIOLOGY. 
53 
Fig. 44.—Surface markings of front of thorax and abdomen. (Gray, modified.) LSL, 
Lateral sternal line ; PSL, parasternal line; ML, mammary line; TPP, transpyloric 
plane ; TTP, transtubercular plane ; LLL, left lateral line ; ITC, hypochondriac region ; 
E, epigastric region ; L, lumbar region ; U, umbilical region ; I, inguinal region ; HG, 
hypogastric region 
Fig. 4o.—Surface markings of heart (6) ; pleura (7) ; left lung, upper lobe (4), lower 
lobe (5); right lung, upper lobe (1), middle lobe (2), lower lobe (3). (Gray, 
modified.) 54 
HOSPITAL CORPS HANDBOOK 
Fig. 46.—Surface markings of front of abdomen. (Gray, modified.) L>, Liver; S, 
stomach; C, caecum; AC, ascending colon; TC, transverse colon; DC, descending 
colon; PC, pelvic colon ; 5L, fifth lumbar vertebra; TPP, transpyloric plane; TTP, 
transtubercular plane. 
Fig. 47.—Surface markings of front of abdomen. (Gray, modified.) D, Duodenum; 
P, pancreas; K, kidneys; 11T, 12T, eleventh and twelfth thoracic vertebne; 4L, 5L, 
fourth and fifth lumbar vertebrae. ANATOMY AND PHYSIOLOGY. 
55 
Fig. 48.—Surface markings of back of lumbar region. (Gray, modified.) L, Portion 
of right lung; P, portion of right pleura ; RK, right kidney ; RU, right ureter; LtJ, 
left ureter; LK, left kidney; S, spleen. 
Fig. 49.—Relations of the middle meningeal artery to the surface of the skull. (Gray, 
modified.) A, Anterior branch; B, posterior branch; C, lateral sinus; D, sigmoid 
sinus; E, suprameatal triangle. 56 
HOSPITAL CORPS HANDBOOK. 
Fig. 50.—Front of right upper extremity, showing surface markings of brachial artery, 
x x. (Gray, modified.) 
Fig. 51.—Front of right thigh, showing surface markings of inguinal (Poupart's) liga- 
ment (A A) ; hypogastric (internal iliac) artery (B B) ; and femoral artery (x x). 
(Gray, modified.) CHAPTER III. 
FIRST AID AND MINOR SURGERY.1 
First aid is that which is done for the injured and ill in cases of emergency; 
it should neither supersede nor take the place of proper medical or surgical 
attention and should consist of furnishing temporary assistance to a sufferer 
pending the arrival of medical aid. The most important fact to remember in 
first-aid treatment is to summon a medical officer or some one capable of 
rendering the proper treatment. A hospital corpsman giving first aid should 
do so with evident display of self-assurance and authority born of knowledge, 
with decision, calmness, alacrity, and alertness of mind, thus obtaining the 
confidence of the patient and of interested bystanders. 
INFLAMMATION. 
Inflammation may be described as the changes which occur in living tissue 
when it is injured, providing that the injury is not of such a degree as tends 
to destroy the structure and vitality of the patient. When tissue is injured, 
the following changes take place: Engorgement of the blood capillaries in the 
injured tissue and a seepage through the dilated capillary walls of blood 
fluids and blood cells, particularly white blood cells (phagocytes). Nature 
brings about these changes with the object in view of bringing aid of a repara- 
tive and a nutritive nature to the cells which make up the tissue injured. 
Inflammation manifests itself by certain local signs and symptoms which are 
produced by changes in the injured tissue. These symptoms are heat, pain, 
discoloration, swelling, and disordered function of the part involved. Heat 
and discoloration are due to the enlargement of the blood capillaries, the 
swelling to the throwing out of blood fluids and cells into the injured tissues, 
and the pain to the pressure of pent-up fluids on the nerve ends in the 
area affected. The constitutional symptoms, increase of temperature and in- 
crease of white blood cells (leucocytosis), depend in a large measure upon 
the cause of the inflammation and the absorption into the general circulation 
of the broken-down products of this inflammation. 
The causes of inflammation are: Traumatic, such as blows and mechanical 
irritation; chemical, such as stings of insects, mustard, venom of serpents, 
ivy poisoning, etc.; thermal, heat and cold; microorganisms, such as staphy- 
lococcus, streptococcus, etc.; and agencies, such as electricity, X-rays, actinic 
rays of the sun, etc. 
The main general principles involved in the treatment of inflammations are: 
(1) To remove the exciting cause; (2) to keep the inflamed part at rest; 
and (3) to reduce the local blood pressure by elevation of the part. 
Other agencies employed in the treatment of inflammation are heat and cold, 
wet dressings, and ointments. Heat acts by softening the tissues and hasten- 
ing the carrying away of the products of inflammation, thus decreasing the 
pressure on the nerve ends in the inflamed area. Cold acts by contracting 
1 Prepared by Lieut. Commander R. H. Laning, Medical Corps, United States Navy. 
57 58 
HOSPITAL COIiPS HANDBOOK. 
the dilated blood capillaries and thus decreasing tension. Wet dressings and 
ointments act by softening the tissues and frequently contain some agent 
to rid the inflamed area of the specific cause of the inflammation—some micro- 
organism, for instance. 
The conditions in which inflammation plays a very important part are: 
Fractures, dislocations, sprains, strains, wounds, burns, frostbite, and many 
kinds of infection. 
Inflammation due to microorganisms or bacteria differs from inflammation 
due to other causes in that the cause of septic inflammation, or inflammation 
due to bacteria, is a living organism which multiplies and throws off poisons 
in increasing quantities until such time as the white blood cells and blood 
fluids thrown out from the dilated capillaries can overpower it. In the case 
of aseptic inflammation the cause is other than bacterial. 
The principal danger in a septic inflammation is that the white blood cells 
and blood fluids will not be able to overcome the microorganisms which may 
gain access to the circulation and set up areas of inflammation elsewhere in 
the body. The term applied in this condition is sepsis. 
Bacteria which cause infection or sepsis are present in myriads on the surface 
of our bodies and on every article we touch, unless it has been sterilized. 
Our skin and mucous membranes protect us from infection and sepsis, and 
it is only when there is a break in these tissues that the bacteria of sepsis gain 
entrance and start septic inflammation. All bacteria of infection and sepsis 
do not cause the same degree of inflammation, some causing mild and others 
very severe inflammation. In the case of some it is easy for blood fluids and 
white blood cells to limit the inflammation locally, while with others it is 
difficult for them to do so. 
An abscess is a localized area of infective inflammation containing live 
and dead microorganisms, live and dead phagocytes (white blood cells which 
have been combating the microorganisms), fluids forced out from the blood 
capillaries, and the broken-down products of dead tissue cells. The content 
of an abscess is called pus. 
The treatment of an abscess is in accordance with the rules for treating 
other inflammations, but with the added rule that the pus when formed must 
be evacuated. Abscesses should be incised and drainage instituted, in order 
to reduce pressure on the tissues, rid the tissue of the irritating products of 
infective inflammation, and lessen the chances of the infecting organism 
gaining access to the general circulation and causing further troubles. Strict 
care must be taken not to introduce further infective organisms when the 
incision is made; that is, an aseptic technique must be employed. The in- 
cision must be large enough- to allow good drainage. Never squeeze the 
abscess, as this tends to break down nature’s barrier and to spread the 
infection. Depending on the severity of the inflammation, more or less of this 
tissue may die, and this dead tissue is spoken of as slough. When the slough 
includes the skin or mucuous membrane, an tilcer results. 
A boil or furuncle is an abscess in the true skin in which the infecting micro- 
organism generally gains access by way of a sebaceous or sweat gland, and in 
which there is a small slough in or beneath the true skin. 
A carbu'ncle is a boil or furuncle in which there are multiple sloughs often 
coalescing in one beneath the true skin. When the pus from these sloughs finds 
its way to the surface an opening occurs, hence the numerous foci of pointing 
(coming to a head). While one incision is sufficient for an ordinary boil or 
furuncle, numerous incisions are required in a carbuncle on account of the 
extensive area of the infective inflammation and resulting slough. Carbuncles FIRST AID AND MINOR SURGERY. 
59 
are very dangerous, particularly about the face on account of the danger of 
spread of the infection to other parts of the body, and a patient suffering 
from one should be brought immediately under the care of a medical officer. 
It a furuncle breaks, one opening results; if a carbuncle breaks, numerous 
openings result. Diabetes, Bright’s disease, and conditions of lowered resist- 
ance brought about by living in impure air, on improper foods, etc., render an 
individual particularly susceptible to boils. Boils and furuncles may be treated 
by nicking the surface of the skin in the shape of a cross ( + ) (crucial inci- 
sion) over the area in which the pointing will take place and then applying a 
Bier’s cup. This method relieves the pain and soreness almost immediately. 
SHOCK. 
Shock is a sudden interference with the vital activities of the body con- 
trolled by the nervous system, which may lie likened to a system of electric 
wiring. If too heavy a current is made to traverse these wires, they are likely 
to be burned out, or the fuses blown. In the same way, if too violent im- 
pulses traverse the nerve paths in our bodies, there may be death from com- 
plete nonfunctioning of the nervous system, or there may result a much milder 
condition in which there is only partial functioning of the same. As the 
nervous system controls all the vital activities, so in shock all the vital func- 
tions are more or less affected. Practically any impulse traversing the nerve 
paths, if severe enough, may cause shock. There is emotional shock, where 
the impulses originate in the brain; traumatic shock from a severe blow in the 
solar plexus or testicle, or from crushing or cutting of a large nerve trunk; 
or electrical shock from a heavy electric current traversing the nerve paths. 
One of the main effects of too violent impulses on the nerve track is the loss 
of nerve control over the blood vessels, resulting in the circulating blood col- 
lecting in the veins, especially the large veins of the abdomen and depriving 
the brain and other parts of the body of their supply. More or less shock 
occurs from all injuries. Depending upon the stability of the nervous systems 
of individuals, what might cause a mild case of shock in one could cause a 
severe case in another. 
Symptoms. 
A person suffering from severe shock lies in a drowsy condition, with the 
limbs limp, but generally is not totally unconscious. The skin is pale and 
cold; the temperature is subnormal; the pulse is feeble, fluttering, and rapid, 
and may be irregular and barely perceptible; the respirations are shallow and 
sighing; the pupils are generally dilated. Great thirst is frequently an ac- 
companiment of shock. 
The sensibility of these patients often is lowered and they do not feel pain 
as acutely as in a normal condition. Shock may result in immediate death 
from heart failure, or a condition known as reaction may be established. 
This state frequently is ushered in by vomiting and is characterized by a 
gradual return of color to the skin and a rise of body temperature accompanied 
by an improvement in the heart’s action and fuller and deeper respirations. 
After reaction is established, it is not unusual for the patient to fall into a 
sound sleep. In a case of mild shock, there may be nothing more than mo- 
mentary paleness, weakness, and perhaps some temporary confusion of the 
thought. Other names applied to condition of shock are faintness and collapse. 
Concealed haemorrhage resembles shock very closely, and always must be, 
kept in mind in all cases of severe shock. 
47829°—28 f> 60 
HOSPITAL CORPS HANDBOOK. 
Treatment. 
The principle underlying the treatment of shock is to bring the blood which 
has accumulated in the large abdominal veins back into the general circu- 
lation, to bring the proper blood supply back to the brain where the vital 
centers are situated and to the surface of the body, and to administer proper 
stimulation. If the shock is at all severe, a medical officer should be sum- 
moned immediately, but treatment must be started at once without waiting 
for his arrival. This may be accomplished by placing the patient in the proper 
position, applying warmth and administering stimulants. The position in 
which the shocked person is to be placed is on the back with the head low in 
order that the blood will tend to run into the brain. A good way to do 
this is to raise the foot of the bed or bench on which lying. Never raise 
the head of a shocked person by placing it on a pillow. The application of 
warmth acts as a stimulant, and also tends to bring the blood to the surface 
of the body. Warmth should be applied both externally and internally. Ex- 
ternally, warmth is applied by friction and rubbing of legs and arms briskly 
toward the trunk, by putting the patient on a bed in a warm room, cover- 
ing with blankets and surrounding with hot water bags, hot bricks or 
stones. Care must be taken that the latter are properly covered and not so 
hot as to burn the patient. Loss of body heat always increases shock; there- 
fore, never remove more clothing than necessary from a shocked person, and 
when possible spread blankets or coats over him. Be careful, while rubbing, 
that the patient is not uncovered. Warmth is applied internally by hot drinks 
such as coffee or hot beef tea in' small amounts, given frequently, and hot 
enemas, such as two pints of hot saline solution. Care must be taken not to 
burn the patient. Stimulants used by mouth are one-half teaspoonful of 
aromatic spirit of ammonia in one-half glass of hot water, hot coffee, hot 
tea, hot beef tea, or plain hot water; hyperdermically, one-thirtieth grain of 
strychnine, or caffeine and sodium benzoate, 2 to 5 grains; and by inhalation, 
smelling salts or ordinary water of ammonia. Unconscious persons or those 
unable to swallow should never be given anything by mouth. The inhalation 
method is particularly useful in such cases. 
It must be borne in mind in the treatment of all severe injuries that they 
are accompanied by more or less shock, and that the treatment of this shock 
is perhaps just as important as the treatment of the injury itself. 
HEMORRHAGE. 
Haemorrhage or Weeding is the escape of blood from the heart or blood 
vessels due to a break in their walls. Haemorrhage is spoken of as arterial, 
venous, and capillary, depending upon whether the escape of blood is from 
arteries, veins, or capillaries. In arterial haemorrhage the blood is bright red 
in color, and escapes in jets; in venous haemorrhage there is a rapid flow of 
dark blood, a welling up, as it were, without any spurting; and in capillary 
haemorrhage there is a steady oozing of red blood from the entire wounded 
surface. 
Nature’s method of arresting haemorrhage is by the clotting of blood thus 
forming a plug at the point of bleeding. In the average healthy person, it 
takes from three to five minutes for blood to clot. There are, however, some 
abnormal people whose blood clotting time is very much lengthened and the 
arrest of haemorrhage in them is very difficult. These people are spoken of as 
haemophiliacs or Weeders. The clot of blood which arrests the haemorrhage 
eventually organizes and permanently plugs the break in the vessel wall if it FIRST AID AND MINOR SURGERY. 
61 
remains undisturbed. Certain factors favor and hasten the formation of a 
clot at the point of bleeding, such as the stopping or slowing of the blood 
stream at that point, and the obliteration or decrease in size of the opening in 
the blood vessel where the haemorrhage is occurring. When an artery is cut 
or torn, the muscular wall contracts thus decreasing the size of the opening. 
With the increase in loss of blood, the pressure within the circulatory system 
becomes lower and lower. When the haemorrhage occurs in a confined space, 
the pressure of exuding blood in the surrounding tissue and on the blood vessel 
wall tends to slow the current of blood and close the opening in the blood 
vessel wall. 
Treatment. 
It is possible to assist nature in arresting haemorrhage hy elevation of the 
bleeding part, thus decreasing the pressure of blood at the point of haemor- 
rhage with the help of gravity; by keeping the patient at complete rest so 
that the blood clot at the point of bleeding will not be disturbed and so that 
the blood pressure at that point will be as low as possible, due to the slow 
beating of the heart; by the application of heat or cold, which tends to cause 
the blood vessel wall to contract; by the use, at the point of haemorrhage, of 
styptics, medicinal substances which act to hasten blood clotting or cause con- 
traction of blood vessel walls; by the use of pressure to close the bleeding 
vessel; and by the use of ligation or torsion, also to close the bleeding vessel. 
Do not give stimulants in treatment of haemorrhage, as they increase the blood 
pressure and tend to cause the dislodgement of the clot at the bleeding point. 
Capillary hcemorrhage is treated by elevating the part and applying very 
hot or very cold water, followed by the application of uniform pressure by means 
of a gauze compress and bandage. In some cases it may be necessary to apply 
a styptic, such as adrenalin. Epistaxis, or nose bleed, and bleeding from a 
tooth socket after extraction of the tooth are examples of capillary haemorrhage. 
In epistaxis, or nose bleed, keep the patient quiet and in a sitting position; 
remove collar or any constriction about the neck; apply cold or ice to the 
back of the neck, and instruct the patient to breathe through his mouth and 
not to blow his nose. The cold application to the back of the neck causes a 
reflex contraction of the blood vessels of the nose. Styptics, such as a solution 
of alum or of adrenalin, may be snuffed up the nose. Put a roll of paper 
under the upper lip, between it and the gum. If bleeding still continues, the 
nostril must be packed by taking some soft material—cotton, linen, or lint— 
and gently forcing it well back into the nose. If bleeding continues, the person 
is probably a haemophiliac and a medical officer should be summoned. In 
severe bleeding from a tooth socket, pack the cavity tightly with cotton or 
linen saturated with some styptic, such as adrenalin or alum; then have the 
jaws closed tightly and apply a Barton or a four-tailed bandage. 
Venous hcemorrhage.—Elevate the part (so little velocity is there in the 
venous current that often this procedure alone will stop the bleeding). If 
bleeding continues, make pressure directly over the wound with a sterile com- 
press. If venous haemorrhage is from an extremity, the limb should be 
bandaged from toes or fingers up to the bleeding point in addition to pressure 
over the point. A common location for severe venous haemorrhage is from 
varicose veins of the legs. 
Arterial hcemorrhage.—In the treatment of arterial haemorrhage prompt and 
decisive measures are required, particularly in the case of haemorrhage from 
the large arteries. Haemorrhage from the femoral artery may result fatally 
in a few minutes. The main reliance must be on the more strenuous methods, 62 
HOSPITAL CORPS HANDBOOK. 
viz., pressure, ligation, and torsion. Ligation is the tying oft of an artery with 
sutures, and torsion consists in twisting the end of the vessel with forceps 
or an artery clamp for five or six rotations; the two methods should be left 
to a medical officer and should not be undertaken by the first-aid man. This 
leaves the pressure methods available as the main reliance of the first-aid man. 
Pressure to control arterial haemorrhage always must be applied at some 
point between the bleeding point and the heart, preferably at a point where 
the bleeding artery can be compressed against bone. (Fig. 52.) Pressure may 
be applied by means of the fingers, spoken of as digital pressure, or by means 
of compresses or by the application of a tourniquet. Digital pressure can serve 
only for a short time, as the fingers soon become tired. This pressure should 
be made with the thumbs and should be firm enough to arrest the bleeding; it 
should be made over the clothes, as too much time may be lost in removing them. 
You will know that you are pressing on the right place by feeling the artery 
beating beneath the thumbs and by the arrest of the bleeding; if you can not 
find the artery, make pressure directly over the bleeding point. As pressure 
with the thumb soon becomes tiresome, have an assistant slip his thumb over 
yours and take your place while you prepare to apply other pressure methods, 
either tourniquet or compress. A tourniquet is a constricting band and there 
are various kinds. The principle of all tourniquets is a pad over the artery 
to bring the pressure on the artery and take it off the veins, a band around 
the limb and over the pad, and some means of tightening the band. There are 
a number of special tourniquets, but as they are not usually at hand, a suitable 
one must be improvised. An excellent one may be improvised with a rubber 
bandage, a number of turns being made about the limb and the rolled portion 
of the bandage then placed under the last turn in such a position as to press 
directly on the artery. The most common improvised tourniquet is the so-called 
Spanish windlass, in which arrangement any rounded, smooth, hard object, 
such as a stone, a cork, or a roller bandage, is used as a compress; for the band, 
a handkerchief, a suspender, a waistbelt, a bandage, or anything of the sort 
may be used. To tighten the band, a stick or bayonet, scabbard, or something 
of the kind is passed under the band and twisted until the bleeding ceases, 
when the ends of the stick are tied to the limb to prevent the band from be- 
coming untwisted. Pressure by means of compresses may be effected as fol- 
lows : A number of small pieces of gauze or linen, or a tampon, previously 
rendered sterile or antiseptic, are placed in the wound, one on top of the other, 
until there are a sufficient number to compress the bleeding vessel; a bandage 
then is applied firmly to hold them in place and exert the necessary pressure. 
Sometimes more effective pressure can be obtained by employing a compress 
of gradually increasing size (cone-shaped with apex nearest the vessel). Com- 
presses may be applied in the same manner along the course of the vessel. 
The dangers in the use of tourniquets and constricting bands for the control 
of haemorrhage are that if applied tight enough to stop artery haemorrhage they 
cause pain and swelling of the limb, and if left long enough may cause gangrene 
or death of the part below the constriction. Therefore they should be watched 
and loosened from time to time, at about half-hour intervals. If on loosening 
the tourniquet the bleeding starts again, tighten it up; if there is no appear- 
ance of bleeding leave the loose tourniquet in place, with an attendant in- 
structed to tighten it should the bleeding recur. The tourniquet method is the 
most effective in the majority of cases, but due to the attendant after dangers, in 
all but the most severe haemorrhages of the larger arteries arrest of the bleed- 
ing by elevation of the part and the compress method should be tried first. 
All possible care should be taken not to infect the tissue with dirty applica- FIRST AID AND MINOR SURGERY. 
63 
tions, but sometimes in tremendous haemorrhages all these precautions have 
to be laid aside to save the person’s life. In all cases of severe haemorrhage 
the above-mentioned measures are only preliminary to arrival of a surgeon. 
With great loss of blood, the patient suffers severe collapse and must be 
given treatment for shock, except that stimulants must not be given unless the 
blood vessel has been safely secured 
against recurrence of the haemorrhage. 
After severe haemorrhage tremendous 
thirst generally is complained of and 
should be relieved with frequent, small 
drinks. This may be termed the consti- 
tutional treatment of haemorrhage. 
The specific treatment for haemorrhage 
from certain parts of the body is de- 
scribed immediately following. 
Bleeding from the scalp.—Apply pres- 
sure over wound with compress and 
bandage. 
Arterial bleeding from the lips.—Grasp 
lips between thumb and fingers on each 
side of wound, as the arteries to the lips 
come from both sides. 
Arterial haemorrhage in other parts of 
the face.—Apply digital pressure on the 
facial artery against the lower jaw mid- 
way between the ear and chin where its 
pulsation can be left. (Fig. 52.) 
Arterial haemorrhage from neck.—Ap- 
ply digital pressure with the thumb on 
the carotid artery against the vertebrae. 
(A tourniquet can not be used in this 
location.) (Fig. 52.) 
Arterial haemorrhage from the arm- 
pit.—Place a compress in the armpit and 
bind the arm tightly to the side. If this 
fails, compress the subclavian artery be- 
hind the clavicle (collar bone) between 
the thumb and first rib, or compress it 
with a key, the handle of which has 
been padded. (Fig. 52.) 
Arterial haemorrhage of arm, forearm, 
or hand.—Apply digital pressure on the 
brachial artery on the inner side of the 
biceps, and then apply a tourniquet a 
little higher up. In case of arterial 
haemorrhage of the forearm, a pad may be placed in the bend of the elbow and 
the forearm forcibly flexed on the arm. In case the haemorrhage is from the 
palm, either of the above two methods may be used, or a large firm compress 
may be placed in the hand with the fingers very tightly closed over it and 
bandaged in place. (Fig. 52.) 
Arterial haemorrhage from the thigh, leg, or foot.—Compress the femoral 
artery against the head of the femur just below the middle of the groin with 
Fig. 52.—Skeleton with black and dotted 
lines showing the course of the ar- 
teries and x indicating the pressure 
points. (Mason.) 64 
HOSPITAL CORPS HANDBOOK. 
both thumbs, then apply a tourniquet to replace the thumbs. In case the 
haemorrhage is in the leg or foot, another method is to put a pad behind the 
knee, to flex the leg forcibly, and tie it in that position. With arterial haemor- 
rhage in the foot, in place of the above two methods, compression can be made, 
when the bleeding point is on the dorsal surface on the anterior tibial artery 
at the instep; and, when the bleeding is on the plantar surface, on the posterior 
tibial artery behind the internal malleolus. (Fig. 52.) 
Haemoptysis is haemorrhage from the lungs. It may result from wounds of 
the lung but more often is due to disease of these organs. The patient usually 
is seized by a fit of coughing and spits up bright red, frothy blood. Unfor- 
tunately, nothing can be done to arrest the haemorrhage quickly. The treatment 
consists of immediately summoning a medical officer, and in the meantime keep- 
ing the patient absolutely quiet, at rest, and giving ice by mouth. Listen over 
the chest, and where rattling is heard, apply an ice bag. Avoid all stimulants. 
Haemorrhage from the stomach.—The vomited blood is usually dark in color 
and may be mixed with food. It always should be remembered that vomited 
blood does not necessarily indicate haemorrhage from the stomach; blood coming 
from the back of the nose and throat may have been swallowed, and inquiry 
should be made to find out if there has been any nosebleed. The blood from pul- 
monary haemorrhage contains air and is frothy while blood from the stomach is 
not. The treatment is the same as for haemorrhage from the lungs, except that 
the ice bag is applied over the upper abdomen. 
Internal haemorrhage, also called concealed haemorrhage, may occur in any 
of the cavities and from any of the organs of the body as the result of injuries 
or disease. It is a condition which may be very difficult to diagnose, as the 
bleeding can not be seen. Frequently the only symptoms are those of shock. 
In such cases, summon a medical officer immediately; in the meantime, place 
the patient flat on his back and keep him absolutely quiet. Opiates are indicated 
in haemorrhage of this nature, their purpose being to produce quietness. 
Primary haemorrhage occurs immediately on receipt of a wound or injury. 
After the arrest of primary haemorrhage, a recurrence may occur caused by dis- 
lodgement of the clot, the slipping of a ligature, or front the opening of a blood 
vessel by separation of a slough. Recurrence of haemorrhage within 24 hours 
is spoken of as consecutive or intermediate, and recurrence after that time is 
spoken of as secondary haemorrhage. 
WOUNDS. 
A wound is defined as the forcible solution of continuity of any of the tissues 
of the body. The principal kinds of wounds are: Clean or aseptic wounds; 
infected or septic wounds; and poisoned wounds. A clean or aseptic wound is 
one to which no germs have gained access; the best example of it being a wound 
made by the surgeon’s knife. An infected or septic wound is one in which there 
have been introduced pus-producing organisms {see inflammation), or such 
organisms' as produce tetanus or lockjaw, gas gangrene, or hydrophobia. A 
poisoned wound is one in which some nonliving poison, as distinguished from 
bacteria or microorganisms, has been introduced by the agent causing the 
wound; e. g., bites of insects, scorpions, snakes, etc. 
An incised wound is one made by a sharp cutting instrument, the class of 
wounds commonly known as cuts. A lacerated wound is the result of the tear- 
ing of the skin and underlying tissues by blunt instruments or machinery and 
presents ragged edges, which do not retract much, and which, as a rule, con- 
sist of masses of torn tissues, frequently with dirt ground into them. A con- 
tused wound is one in which the division of tissue is accompanied by more or FIRST AID AND MINOR SURGERY. 
65 
less severe crushing. A punctured wound is deep and narrow; e. g., stabs are 
punctured wounds. Crushing wounds are more serious than they first appear, 
due to the fact that the dead tissues are an excellent culture medium for the 
growth of microorganisms of infective inflammation, resulting sometimes not 
only in loss of the part but also in general infection of the body; that is, 
septicaemia or blood poisoning. The term gunshot wound is applied to any 
wound inflicted by a weapon of warfare, such as by rifles, pistols, cannon, etc. 
When the skin and underlying tissues are divided, blood vessels, generally 
capillaries, also are divided, and there is more or less bleeding from the cut 
surfaces of the tissue, forming a clot between the cut surfaces. Young con- 
nective-tissue cells and capillary buds grow into this clot from the edges of 
the wound, replacing the blood elements. These young connective-tissue cells 
and the young capillaries form what is known as granulation tissue or “ proud 
flesh.” Later the young connective-tissue cells and capillary buds develop into 
the mature connective tissue, and the epithelium of the skin grows over it from 
the edges of the wound. When the cut surfaces are so close together that there 
is very little granulation tissue required to heal the wound, healing is said to 
be by first intention; when the wound is gaping and considerable granulation 
tissue is required, healing is said to be by second intention. Pus infection 
causes gaping of wounds, therefore in wounds infected with pus bacteria, 
healing is by second intention. Connective tissue filling in a gaping wound 
forms the so-called “ scar.” 
Unless cut ends of tendons are brought together, the two ends will be so re- 
tracted, and there will be so much connective tissue formed between them in 
the healing of the wound, that the function of the tendon will be lost. Unless 
the cut ends of a nerve trunk are brought together, the function of that nerve 
will be lost forever. Nerve fibrils making up a nerve trunk regenerate centrif- 
ugally, and if the pathway for this regeneration is blocked by a wall of con- 
nective tissue, these fibrils can never reach the part they are supposed to ener- 
vate. 
The local factors preventing and delaying the healing of wounds are: Infec- 
lion with pus bacteria ; the presence in the wound of foreign bodies, such as dirt, 
bits of clothing, etc.; and a lowered vitality of the edges of the wound due to 
crushing and tearing of the tissues, etc. General and constitutional factors 
also prevent and delay healing; among these factors being poor circulation of 
blood, diabetes, Bright’s disease, and syphilis. 
General principles underlying the treatment of wounds. 
Stop haemorrhage and treat shock; so handle the wound as not to introduce 
fresh bacteria of infection; remove foreign bodies such as dirt, bits of clothing, 
etc., from the wound; if infective bacteria already have been introduced into 
the wound, take measures to eliminate them or to prevent their development. 
If the wound is an aseptic one, bring the edges together so that it can heal 
by first intention; if the wound is an infected one, keep the wound open and 
furnishing drainage (see inflammation) ; if the wound is a poisoned one, 
neutralize the poison in it and prevent its entrance into the general circulation; 
treat any constitutional condition which may delay or prevent healing. 
There are two main types of infective bacteria as applied to wounds: Aerobic 
and anai'robic. Aerobic bacteria are those that live and multiply in the 
presence of air; anaerobic bacteria are those which live and multiply in the 
absence of air. The bacteria which cause infective inflammation or blood 
poisoning are principally staphylococci, streptococci, and bacillus pyocyaneus, 
these being aerobic. There are several anaerobic bacteria, viz., those of 66 
HOSPITAL CORPS HANDBOOK. 
tetanus or lockjaw, of hydrophobia, and of gas gangrene, which was such a 
common infection in the trenches during the World War. 
Inasmuch as the bacteria of pus infection are present everywhere, any wound 
is likely to be infected with them. However, contused and lacerated wounds 
are most likely to suffer from infective inflammation, owing to the lowered 
vitality of the tissues. The bacteria of tetanus or lockjaw and of gas gangrene 
are found in exceptional numbers in the intestinal contents of herbivorous 
animals, such as horses and cattle, and, for that reason, wounds inflicted by 
objects which have been contaminated by manure or by heavily fertilized soil 
are most liable to have introduced into them the bacteria of these diseases. In 
badly lacerated wounds and in punctured wounds there is great likelihood of 
absence of air due to the flapping back of the torn tissues after infliction of 
the wound, and for this reason these types of wounds afford a very favorable 
environment for the development of tetanus or gas gangrene. The bacteria of 
hydrophobia are found in the saliva of a rabid animal, and are introduced 
by their bites. These bites are generally either lacerated or punctured wounds, 
with their associated anaerobic conditions. Tetanus or lockjaw frequently 
occurs after stepping on a nail near a barn or stable, the nail previously having 
become infected with tetanus bacilli from the excretions of the horses or cattle. 
A wound dressing consists of everything used to cover or dress a wound. 
The pad which is put directly over the wound is called a compress. In ordinary 
emergency treatment a wound dressing consists of a compress with bandage to 
hold it on. A dressing may be either dry or wet, aseptic or antiseptic. An 
aseptic dressing is one which is sterile; that is, one with no bacteria on it. An 
antiseptic dressing is one which, in addition to being sterile, contains some sub- 
stance for killing bacteria. A xoet dressing generally is an antiseptic dressing. 
A wet antiseptic dressing generally is used in wounds where infective inflamma- 
tion is going on, whereas a dry sterile dressing is used to cover a recent wound 
which is considered to be free from infection. The purpose of a wound dress- 
ing is to stop licemorrhage, to prevent introduction of bacteria, and to prevent 
further injury to the wound. 
The Navy supplies a first-aid packet which is an hermetically sealed tin 
can containing a dry sterile' dressing. This is excellent for a small wound. The 
directions for its use are contained in the packet. For large wounds, sick 
bays aboard ship are furnished with large and small shell-wound dressings. 
All these dressings consist of a sterile gauze compress with bandage attached. 
Any piece of cloth such as gauze, cotton, linen, muslin, or a handkerchief is 
suitable for a compress in case of emergency, provided it is rendered sterile, 
and anything that can be used for bandaging is suitable as a bandage. The 
most vital point about material used as the compress of a wound dressing is 
that, before it is applied to a wound, it should be rendered sterile. 
The part of the dressing which is to come in contact with the wound must be 
kept absolutely sterile; i. e., it must not be touched with any part of the body 
or anything else except sterile instruments allowed to touch it before its ap- 
plication to the wound. In an emergency, material to be used in a wound 
dressing may be sterilized by boiling it for 10 minutes. 
When a patient can be brought under the care of a medical officer in the very 
near future, the procedure necessary in the first-aid treatment in the case 
of ordinary wounds is: Stop the haemorrhage, treat the shock, and apply a 
sterile dressing to the wound. If a surgeon is not available, the wound must be 
further treated as described hereafter. 
In treating a freshly made wound suspected of being contaminated (all 
wounds should be suspected of contamination by infective organisms unless MUST AID AND MINOR SURGERY. 
67 
made under strictly aseptic precautions) the following procedure is recom- 
mended : Cleanse one’s own hands as thoroughly as possible by a thorough 
scrubbing with soap and hot water, followed, if possible, by immersion of the 
hands in hot 1:1,000 bichloride of mercury solution or in 70 per cent alcohol. 
Sterilize all instruments to be used in removing foreign bodies such as dirt, 
glass, splinters, etc., or for shaving the skin about the wound. If there is 
much bleeding, arrest the haemorrhage. If there is much hair about the part, 
remove it by cutting or shaving for a distance of several inches from the cut 
edges. If there is much grease in and about the wound, remove it with tur- 
pentine or gasoline. Remove all foreign particles with sterile forceps. Clean 
the skin about the wound with a sterile damp cloth, and, while doing this, pro- 
tect the wound with a piece of sterile gauze. Dry the wound and skin about 
it with sterile dry cloth or cotton. Apply tincture of iodine to all parts of the 
wound and to the skin about the wound for a distance of about one-half 
inch beyond the wound edges. After the skin has been well dried, the wound 
edges are brought together and dry wound dressing applied. 
There is no substance which should be used by the first-aid man to wash a 
wound. In the first place, he only washes in more dirt than he washes 
out, and, secondly, ordinary water is dangerous, as it contains many 
bacteria; this applies equally to soap and water. Strong antiseptics such 
as bichloride of mercury or carbolic acid will destroy the cells of the body 
which dispose of the pus bacteria, before they kill the latter, and should never 
be used except in certain wounds described below. Peroxide of hydrogen is 
not strong enough to kill all bacteria, and in a large or deep wound it washes 
some of these bacteria to uninfected parts which then become infected. There- 
fore, use none of these preparations in a wound, which should be covered with 
a sterile cloth, while cleaning the skin around the wound as described above. 
If, however, there is much greasy dirt rubbed into the wound, the latter should 
be gently swabbed out with sterile gauze or a cotton applicator, saturated with 
benzine or gasoline, and foreign bodies picked out with sterile forceps. Tinc- 
ture of iodine is the only substance to be used in an ordinary fresh wound by 
the first-aid man, aside from benzine and gasoline to cut grease, if present. 
The tincture of iodine should be used within two hours after the wound is 
inflicted, as after that time it is probably valueless. Tincture of iodine 
is best applied with a camel’s-hair brush, but a bit of cotton on a stick 
answers the purpose very well; the brush or cotton need not be sterilized, as 
the iodine accomplishes this. The tincture of iodine may be poured into a 
wound. Iodine can be used in wounds practically anywhere in the body except 
in or near the eyes, where it must never be used. 
Attempts to bring the wound edges together should not be made when the 
patient can be brought under the care of a surgeon in the very near future, 
but if a question of days is to elapse before the service of a medical officer can 
be obtained, coaptation should be done in cases requiring it. The edges of a 
wound should not be brought together before foreign bodies and dirt have been 
removed and wound edges cleaned. Wounds in which infective inflammation 
is going on should be left open and allowed to drain. The two methods by which 
coaptation may be accomplished are by means of sutures and by means of 
adhesive strips. The former is preferable, as by the latter method bacteria 
of infective inflammation most probably will be introduced. As a rule, the edges 
of large deep wounds should not be too tightly apposed. Some chance of 
escape should be left for the serum and blood which are sure to be present; 
that is, means of drainage should be applied. This may be done by the use of 
small pieces of sterile rubber tubing, strands of catgut or silkworm gut, or a 68 
HOSPITAL CORPS HANDBOOK. 
narrow strip of gauze which has been sterilized by boiling. These drains 
should be placed in the lower angle of the wound. Wounds which are dirty 
and look badly should be left wide open. (Figs. 100, 101.) 
The materials ordinarily used for sutures a<re plain catgut, chromicized 
catgut, kangaroo tendon, silkworm gut, silk, or linen; sometimes horsehair 
also is used. Suture material, also called ligatures, is divided into absorbable 
and nonabsorbable ligatures. Absorbable ligatures are those which can be 
left in a wound, inasmuch as the tissues absorb them, and included in this class 
are catgut and kangaroo tendon. Silkworm gut, silk, linen, and horsehair 
are nonabsorbable ligatures and must be removed after six or seven days. 
Chromicized catgut is catgut which has been so treated that it is not as 
quickly absorbed as plain catgut. Catgut is the ligature to be preferred in 
the suturing of wounds. Needles used in the suturing of wounds are: Curved, 
straight, and round, or cutting. Where the skin must be pierced, the curved 
cutting needle is preferable. The main point about all suture material to be 
used in a wound is that it must be sterile. In case of emergency, an ordinary 
seamstress’ needle with cotton or silk thread, well sterilized by boiling, may be 
used. This suture is nonabsorbable and must be removed after six or seven 
days. With the operator’s hands, and also the wound, well cleansed, the needle, 
threaded with the suture, is passed through the skin about one-eighth of an 
inch from the cut edge and on out through the opposite side at a corresponding 
point. The suture then is tied, and the ends cut, leaving about one-quarter of 
an inch remaining; care should be taken in tying the suture to use but little 
tension, sufficient only to bring the cut edges in accurate approximation. The 
remaining stitches are inserted in the same manner at a distance of from 
one-quarter to one-half of an inch apart until the wound is closed. When a 
tendon or large nerve has been cut, the ends must be brought together and 
sutured with catgut before the wound is closed. Suturing of tendons and 
nerves should be done by medical officers. 
The manner in which a wound showing evidence of infective inflammation is 
treated, is: Elevate the part; put it at rest; remove foreign bodies, if present; 
remove enough sutures, if present, to obtain good drainage; insert drain; apply 
a wet antiseptic dressing; and treat the constitutional symptoma 
Wet antiseptic dressings generally are made up of a layer of sterile gauze, 
saturated with an antiseptic solution, to be applied directly on the wound. A 
layer of sterile cotton is then applied, some impervious material such as oiled 
silk or waxed paper put over the dressing in order to retain the moisture, and a 
bandage over all. The dressing should be kept wet with the antiseptic solution, 
either by frequent changing or by having perforated rubber tubes between the 
gauze and cotton through which the dressing can be periodically moistened 
with the antiseptic solution. The antiseptic solutions usually employed in wet 
dressings are: Bichloride of mercury solution 1-5,000; saturated solution of 
boric acid; and Dakin’s solution. Bichloride of mercury solution should not 
be applied on a wound freshly painted with tincture of iodine, as a very corro- 
sive iodide of mercury is formed. 
If the symptoms of an infected wound are severe, put the patient to bed, 
clear out the bowels with a brisk purgative, and apply an ice cap to the head 
to reduce the fever. 
The measures taken in fresh wounds suspected of being infected with 
tetanus or gas gangrene are: The wound is cleaned and treated as above, and 
kept freely open for a time in order that anaerobic conditions may not exist 
for the growth of these bacteria. As a further precautionary measure, tetanus FIRST AID AND MINOR SURGERY. 
69 
antitoxin is given. A punctured wound suspected of being infected is fre- 
quently cauterized with pure carbolic acid, afterwards applying alcohol and 
a dry wound dressing. 
Symptoms and treatment of special types of wounds. 
Wounds inflicted by an animal suspected of being rabid or of having rabies 
are to be treated in the following manner: Thoroughly cauterize the wound 
with fuming nitric acid and neutralize with sodium hydrate solution, 1 per 
cent, or sodium bicarbonate solution, 10 per cent. The Pasteur treatment may 
Fig. 53.—1, SiDgle row of scales posterior to vent (poisonous snake—water moc- 
casin) ; 2, double row of scales of harmless snake (yatrix) ; 3, side view head of 
pit viper; 4, side view head of harmless snake; 5, dorsal view pit viper; 6, 
dorsal view of harmless snake; 7 and 9, bite puncture and skull of Flaps; 
8 and 10, same of harmless snake; 11, poison apparatus of rattlesnake. (Stitt.) 
be given later. In the absence of fuming nitric acid, a red-hot needle may 
be used to cauterize the wound. Do not use silver nitrate or carbolic acid 
for cauterizing these wounds. Apply a dry wound dressing. 
Poisonous wounds due to causes other than to bites of poisonous snakes include 
ordinary insect bites, such as those produced by mosquitoes, fleas, ants, and 
bees. These bites require but little treatment. Sometimes the sting of a bee 
is broken off and remains in the skin. In treating these cases always search 
for the sting and remove it if it be present. As the poison of insects is com- 
posed chiefly of an acid, the local application of some alkali should be em- 70 
HOSPITAL CORPS HANDBOOK. 
ployed, either water of ammonia or a solution of washing soda affords great 
relief. Bites of the more poisonous spiders, centipedes, tarantulas, and scor- 
pions require prompt treatment. Tie a ligature or tourniquet about the in- 
jured part between the wound and the heart to prevent absorption into the 
general circulation; enlarge the bite by making an incision at its site, suck 
out the wound to produce bleeding, and apply crystals of potassium perman- 
ganate or tincture of iodine. If there he abrasions or open lesions in the 
mouth, it is not advisable to suck the wound. Release the tourniquet after 
a time to permit temporary restoration of circulation, replace it and repeat 
this process every half hour as long as may be necessary. Apply a wound 
dressing to the wound and treat shock which sometimes occurs in these cases. 
Poisonous snakes are classified into viperine snakes and colubrine snakes. 
To the viperine family belong the rattlesnake, the copperhead, the water moc- 
casin, the viper; to the colubrines belong the cobra and the coral snake. In 
poisonous snakes the teeth are arranged in two rows, with a fang on each 
side, outside the teeth near the point of the jaw. Nonpoisonous snakes have 
four rows of teeth without fangs. (Fig. 53.) The imprint of the wound 
often will tell whether a person has been bitten by a poisonous or a non- 
poisonous snake. The venom of different poisonous snakes differs in its action. 
The poisonous constituents are neurotoxin, a nerve poison, and haemorrliagin, 
which injures the lining of the blood vessels so that an escape of blood occurs 
into the surrounding tissues; a third constituent is hcemolysin, which destroys 
red blood cells. The venom of colubrine snakes is made up principally of 
neurotoxin and that of viperine of luemorrhagin. In colubrine poisoning, the 
local symptoms are not marked, though there are at times severe pain and 
some tenderness, swelling, and discoloration at the site of the bite; then in 
to 2i hours the patient begins to feel tired and drowsy, there often being some 
nausea and vomiting; paralysis sets in, generally affecting the extremities 
first and then becoming more generalized, finally affecting respiration, so that 
the patient’s breathing becomes slow and shallow and finally ceases; convul- 
sions also may be present. In viperine poisoning there is pain at the seat 
of the bite, which soon becomes excruciating, with rapid swelling and dis- 
coloration ; there is at the same time a feeling of nausea and faintness, while 
a sense of depression takes hold of the individual; the pulse becomes rapid 
and feeble, and the breathing is labored; in fatal cases, death may occur in 
24 to 48 hours. The severity of the symptoms and final outcome depend upon 
the amount of venom injected and absorbed into the general circulation, which 
in a large measure depends on the size of the snake. 
The treatment of wounds inflicted by a poisonous snake follows: If the 
wound is in an extremity, tie a bandage or handkerchief tightly about the limb 
between the wound and the heart; incise the wound freely and suck out as much 
of the poison as possible. If there be abrasions or open lesions in the mouth 
it is not advisable to suck the wound. With a hypodermic syringe, inject a 
2-per cent solution of potassium permanganate into and about the bite to de- 
stroy any poison which is left. If a hypodermic syringe and potassium per- 
manganate is not available, the bite should be cauterized with a lighted match, 
a hot coal, or a little gunpowder rubbed in and ignited. Meanwhile, give stimu- 
lants in the shape of coffee and strychnine, one-thirtieth grain. The ligature 
should be loosened about every half hour to allow restoration of the circula- 
tion, but should be tightened up immediately if symptoms of general poisoning 
occur. There are two serums on the market for the treatment of poisoning 
by snake bite; one which neutralizes neurotoxin and another which neutralizes 
luemorrhagin. They are injected hypodermically or intravenously and are very FIRST AID AND MINOR SURGERY. 
71 
effective if properly used; that is, serum to combat the venom of a colubrine 
snake must be used against that type of snake bite, and the specific serum for 
the viperine snake venom used to combat the toxin of that type of snake, in 
order to get results. 
Gunshot wounds inflicted by bullets.—Always look for the wounds of entrance 
and of exit and apply a sterile dressing to each. Concealed hemorrhage and 
injury to internal organs are the most dangerous results of these wounds and 
depend on the course taken by the bullet. The wounds of entrance and exit 
caused by high velocity bullets may be so small as to be hardly visible, while 
the wound of entrance may be very small and the wound of exit large, due to 
the explosive effect of the high velocity bullet on the tissues. Never probe a bul- 
let wound, as a bullet is very likely to be sterile, and by probing you are almost 
sure to introduce germs of infective inflammation. 
Symptoms and treatment of penetrating wounds of the chest.—The symptoms 
are the presence of air bubbles in the wound, difficult breathing, coughing, and 
spitting of blood. The first-aid treatment consists in laying the patient on 
the injured side, firmly bandaging the chest, summoning medical aid, and the 
general treatment for wounds. 
Symptoms and treatment of wounds of the abdomen with injury to the 
intestines and stomach.—The signs of injury to the intestines are the escape 
of gas or feces through the wound and the passage of blood in the stools. In- 
jury of the stomach may result in the escape of its contents through the 
wound and the presence of bloody vomitus. Keep the patient absolutely quiet 
and place under the care of a surgeon as soon as possible, as every moment’s 
delay in surgical treatment lowers his chance of recovery. With a large 
abdominal wound from which more or less of the abdominal contents escape, 
place a sterile cloth over the wound and the extruded intestines; bandage in 
place and keep the dressing wet with sterile normal salt solution until the 
patient can be placed under the care of a surgeon. 
Treatment for tvounds of the eye.—Remove the foreign body, if present, as 
described under removal of foreign bodies (p. 87). Never use tincture of 
iodine or other strong antiseptics in the eye. Boric acid solution or an 
organic silver preparation (silvol or argyrol) are the only antiseptics to be 
used in the eye. All eye wounds should be brought under the care of a 
medical officer as soon as possible. In the meantime cover both eyes with 
absorbent cotton or soft cloths so as to keep the eyelids still, and hold the 
dressing in place with bandages around the head. Be careful not to put 
on these bandages so tightly that they will cause pressure on the eyeball. In 
case some time must elapse before the services of a medical officer can he 
obtained, the dressing should he kept wet with cool saturated solution of boric 
acid, and if secretions are present, the eye should be irrigated at frequent in- 
tervals with warm saturated solution of boric acid. In lifting the eyelid do not 
press on the lid, but lift the upper lid by traction on the region above it; this 
prevents scratching of the cornea by pressure. 
CONTUSIONS, STRAINS, AND SPRAINS. 
A contusion, or as it is commonly termed, a bruise, is a crushing and tearing 
of the tissues, usually without a break in the skin. It is characterized by 
swelling, tenderness, and discoloration, due to the rupture of blood vessels 
in the neighborhood of the injury. At first the discoloration is red, then 
blue or black, and finally turns yellow or green, commonly called black and 
blue spots. The change in color is due to the chemical change in the color- 
ing matter of the blood ligemoglobin. The rapidity in the formation of the 72 
HOSPITAL CORPS HANDBOOK. 
swelling and its size depends on the number and size of the blood vessels 
ruptured. Contusions vary in extent from an ordinary black and blue spot 
to the almost complete pulpification of a limb with laceration of blood vessels 
and nerves such as sometimes occurs in railway or other accidents. A “ black 
eye ” is an example of a contusion. 
Slight contusions as a rule require no treatment. With severe contusions 
there is more or less shock which must be treated. For the contusion itself, 
the treatment is to stop the subcutaneous haemorrhage; this can he done by 
rest and elevation of the part; by very hot or cold applications; and if the 
injury is in a limb, firm, even pressure of a bandage may be effective. Later, 
when the bleeding has ceased, the absorption of the extravasated blood may 
he hastened by hot fomentations and massage. In the case of severve con- 
tusions and in contusions in elderly people, hot water is much better than 
cold, as the latter tends to lower the vitality of injured tissue. 
A strain is the overstretching of a muscle or tendon with an attendant 
rupture of the muscle or tendon fibers. In severe strains, small blood vessels 
often are ruptured, resulting in the escape of blood into 
the muscles in the same way that, in the case of a bruise, 
blood escapes beneath the skin. It is generally the result 
of violent exertion or sudden unexpected movement The 
symptoms are pain in the affected muscle, stiffness, lame- 
ness, and more or less swelling. If complete rupture oc- 
curs, there will he loss of power of the affected muscle 
and on examination there will be found a distinct gap 
with considerable swelling above it, due to retraction of 
the muscle fibers. 
For slight strain, the treatment consists of strapping 
with adhesive plaster or bandages, which, with rest, gives 
the most comfort. After two or three days, graduated 
massage may be given. If rupture occurs, in the absence 
of surgical assistance immobilize the part by splints or 
bandages and place the part in such a position that the 
muscles are relaxed, thus allowing the torn fibers to come 
together. 
A sprain is an injury to a joint due to wrenching or twisting its ligaments 
and adjacent soft parts. There also may be injury to cartilages, and even 
portions of bone to which the ligaments are attached may be torn away. 
Accompanying these injuries there is more or less escape of blood into the 
joint itself and surrounding tissues, resulting in severe pain and marked 
swelling of the injured part. Later, discoloration develops at the site of 
injury. Sprains of the ankle and wrist are the most common. Frequently it 
is difficult to determine whether or not a sprain is not complicated with 
fracture. An X-ray examination is always advisable to determine the presence 
of a fracture in these cases. 
In the treatment of sprains all severe cases should be brought under the 
care of a medical officer, particularly as the condition may he complicated with 
fracture. Elevate the joint and apply very hot or very cold water for one-half 
an hour to an hour to stop the subcutaneous haemorrhage; then apply a tight 
bandage and keep the joint at rest in order to give the torn ligaments and 
tissues a chance to heal and the effused blood to be absorbed. Treatment of 
a sprain of the ankle by immediate strapping of the joint and allowing the 
patient to walk about may he practiced in the less severe uncomplicated cases, 
Fig. 54. -— Strapping 
of ankle. First 
step. (Owen.) FIRST AID AND MINOR SURGERY. 
73 
For this purpose strips of adhesive plaster 1 to 14 inches wide and about 18 
inches long should be obtained. A strip is started well behind at the junction 
of the lower and middle third of the leg on the uninjured side, and is carried 
down under the heel with considerable tension, across the sole, and up the 
other side of the joint. (Fig. 54.) The middle of another strip is applied to the 
point of the heel and the two ends are carried forward over the foot, but not far 
enough to meet. Leg strips and foot strips alternate, interlacing with each 
other and overlapping about one-third of the previous strip each time until 
the ankle joint is covered. Strapping in this manner 
furnishes pressure and at the same time fixes the 
joint and gives support to the torn ligaments. (Fig. 
55.) If an individual is unable to walk immediately 
after injury to the ankle, the injury should be con- 
sidered as a fracture until proved otherwise. 
DISLOCATIONS. 
A dislocation is a slipping away from each other 
of the bones which form a joint, resulting usually 
in a locking of the bones in the new position. Neces- 
sarily the dislocation is attended with tearing of 
the ligaments, and often with rupture of the mus- 
cular attachments as well, except in a joint which, 
on account of frequent prior dislocations, has had its 
ligaments so stretched that not only is dislocation 
easy but no tearing of the ligaments results. As a 
result of the tearing of structure about the joint, 
there is also rupturing of the blood vessels, with consequent swelling and 
discoloration. 
Dislocations must be differentiated from fractures and sprains. In all three 
conditions there may be swelling and pain in the neighborhood of a joint. In 
fracture there is an unnatural movement of the bone between the joints instead 
of immobility at the joint as in dislocations, and the movement is attended with 
a grating sound and sensation; the deformity is in the bone between the joints in 
fractures, whereas the deformity is at the joint in 
dislocations. In dislocations there is immobility 
at the joint and between the joints, and the 
head of the dislocated bone may be felt in an 
abnormal position. In sprains there is absence 
of any of the symptoms of dislocation except 
swelling and pain. As a rule sprains are momen- 
tary dislocations in which the head of the bone 
has slipped back into place. 
The treatment consists in restoring the bones to their normal positions, 
spoken of as “ reducing the dislocation,” and then so confining the parts that a 
recurrence of the trouble will be improbable. The joint should he immo- 
bilized until the rents in the ligaments have healed. While some dislocations 
slip easily back into place, to properly reduce the majority requires considerable 
knowledge and skill. Without careful manipulation blood vessels and nerves 
not only may be injured but a simple dislocation may become complicated with 
fracture. In view of the above, if surgical aid can he obtained within a day or 
two, do not attempt to reduce a dislocation, except perhaps in case of the jaw 
Fig. 55. — Strapping of 
ankle. Completed. 
(Owen.) 
Fig. 56. — Clove liitch. (Da 
Costa.) 74 
HOSPITAL CORPS HANDBOOK. 
and finger; loosen the clothing about the injured part and support it as com- 
fortably as possible in the new position, or if the patient must be moved, 
support the limb in a sling or by splints and bandages, and summon surgical 
assistance. If, however, surgical assistance can not be had for some time, 
three or four days, careful attempts 
should be made to reduce the dislocation, 
as the head of the bones concerned 
most probably will become bound by con- 
nective tissue formation and then re- 
duction will become next to impossible 
without an operation. Shock is often 
present with major dislocations and 
should be treated. 
Treatment of certain dislocations. 
Dislocation of the jaw.—In this con- 
dition the patient can not speak or close 
his jaws. The dislocation is due gen- 
erally to a blow upon the mouth when 
open or by yawning or laughing. This 
dislocation usually is reduced without 
much difficulty, but there is great danger of the thumbs of the operator being 
bitten. Wrap the thumbs well with a handkerchief or bandage, stand in 
front of the patient, and while pressing with 
the thumbs in the mouth just back of the last 
lower molars, at the same time lift up the chin 
with the fingers. The jaw usually will snap at 
once into place, and the thumbs must be quickly 
withdrawn to prevent them from being bitten. 
After reduction, bind the lower jaw to the upper 
with a Barton or a four tailed bandage. (Fig. 84.) 
Dislocation of finger joints.—With a dislocated finger joint, pull on the dis- 
located end, at the same time bending it backward if the dislocation is forward, 
or forward if the dislocation is backward, and push- 
ing the joint into place; strap or splint the finger. 
(Fig. 58.) 
Dislocation of the shoulder.—In this dislocation, the 
arm is held rigid, the elbow stands off a distance of 
3 or 4 inches from the body, and the shoulder appears 
flat with a marked depression beneath the point of 
the shoulder. In addition there is a pain and swelling 
at the site of injury, and the head of the humerus can 
be felt in an abnormal position as compared with the 
other side. Do not try to reduce this dislocation if 
surgical assistance can be had in a few days; if not, try 
one of the three methods below. (Fig. 59.) 
(a) Stimson’s method.—Place the patient on a canvas 
cot or stretcher, lying on the injured side, arm hanging 
through a hole made in the cot or stretcher in the median line at a distance 
of about 18 inches from the head end. The cot or stretcher first should be 
elevated from the floor by means of chairs or blocks so that the hand does not 
touch the floor. Fasten a 10-pound weight on the dependent arm, and, in 
from 5 to 10 minutes, the muscles usually have become sufficiently relaxed to 
Fig. 57.—Dislocation of jaw. 
Fig. 58.—Backward disloca- 
tion of finger. Reduction 
by extension. (Hamilton.) 
Fig. 59.—Subglenoid 
dislocation of the 
shoulder. (Mason.) FIRST AID AND MINOR SURGERY. 
75 
allow tlie head of the bone to slip into its proper place of its own accord. If 
it should not do so, the weights should be removed and the arm carefully 
brought to the patient’s side against the operator’s fist, held in the armpit. 
This should force the head of the bone back in place. Apply a Velpeau or 
Desault bandage without the pad in the armpit and keep the arm bandaged for 
a week. 
(b) Kocher’s method.—The patient should be in either the sitting or stand- 
ing posture, preferably the former. Grasping the affected arm at the elbow 
a 6 c 
Fig. 60.-—Kocher’s method of reduction, by manipulation : a, First 
movement, outward rotation; 6, second movement, elevation of 
the elbow ; c, third movement, inward rotation and lowering of 
the elbow. (Ceppi.) 
and wrist, flex the elbow to a right angle and press the arm against the chest. 
(Fig. 60.) Turn the forearm as far as possible from the chest by external 
(outward) rotation of the humerus. Maintaining this external rotation, 
carry the elbow slowly inward across the front of the chest to the center line 
of the body. With the arm in this position quickly rotate the forearm inward 
until the hand touches the sound shoulder. Lower the elbow. Immobilize the 
entire arm by the application of a special 
bandage of the chest or a Velpeau bandage 
without the axillary pad. 
(c) Reduction by traction or extension.— 
Place the patient upon his back on the deck 
or table. The operator takes off one shoe, 
inserts his heel under the armpit of the 
dislocated side and makes traction upon the 
arm dowmward and slightly toward the 
patient’s body. In doing this, care must 
be taken not to employ too great leverage 
action upon the arms, as a fracture might 
be produced. After reduction, immobilize 
the joint with a Velpeau or Desault bandage without the pad in the armpit, 
and keep the arm bandaged for a week. If dislocation fails to be reduced by 
above methods, do not persist in your efforts, as it is then a case for operative 
surgery. (Fig. 61.) 
Dislocation of the elbow, hip, and knee.—These dislocations are not as com- 
mon as shoulder dislocations. The bones may be displaced in various direc- 
tions and their reduction is difficult and often dangerous. First-aid treatment 
consists in obtaining surgical assistance, making the patient comfortable 
with pillows, etc., and treating for shock, if present. 
Compound dislocations are those in which the head of the bone has been 
forced through the skin and underlying tissues. Here not only the dislocation 
47829°—23 6 
Fig. 61.—Reduction of dislocation 
humerus by lieel in axilla. (Erich- 
sen.) 76 
HOSPITAL, CORPS HANDBOOK. 
but also the wound must be treated. A complicated dislocation is one in which 
a large blood vessel or nerve has been injured. 
FRACTURES. 
A fracture is a break in one or more bones of the body. Fractures are 
classified as simple or closed, and open or compound. A simple or closed frac- 
a b c d 
Fig. 62.—Complete fractures : a, Transverse ; b, spiral; c, dentated; 
d, oblique or multiple. (DaCosta.) 
ture is one in which there is no opening to the outside air. An open or com- 
pound fracture is one in which, by a break in the overlying skin and other 
tissue, there is direct communication between the outside air and the broken 
bone. A compound fracture is always very serious, owing to the likelihood of 
infection. In an infected compound fracture, not only is it difficult to obtain 
union of the bones, but there is danger to life from the 
infection itself. This element of infection is absent in 
simple fractures. 
Careless handling of fractures may convert a simple 
into a compound fracture, and there is grave danger of 
injuring blood vessels, nerves, and other tissues in the 
neighborhood of the fracture (complicated fracture). 
A complete fracture is one in which the bone is sev- 
ered through its entire thickness. (Fig. 62.) An incom- 
plete or green-stick fracture is one in which the bone is 
broken or bent, but not broken entirely through. (It re- 
sembles the condition obtained from an effort to break a 
green stick.) (Fig. 63.) A multiple fracture is one in 
which the bone is broken into more than two fragments, 
the lines of fracture, not, however, communicating with 
each other. A comminuted fracture is one in which the 
bone is broken into several pieces, the lines of fracture 
communicating with one another. (Fig. 64.) A compli- 
cated fracture is one accompanied by an injury to some surrounding part, as 
an injury to a joint, muscle, nerve, or blood vessel. An impacted fracture is 
one in which one fragment of the bone is driven into the other, the two remain- 
ing tightly wedged. (Fig. 65.) 
When a bone breaks, there is always an injury to the periosteum, or bone 
covering, and to the surrounding tissues. There is also haemorrhage about the 
ends of the fragments, and the space between the two fragments rapidly be- 
Fig. 63.—Green-stick 
fracture. FIRST AID AND MINOR SURGERY. 
77 
comes filled with a blood clot. This blood clot becomes organized as de- 
scribed in the healing of wounds, forming a callus which surrounds the ends 
of the fragments, and, as it were, glues them together. At first the callus con- 
sists only of fibrous tissue, but later there is growth of bone cells, and a de- 
posit of lime salts which changes the callus into dense bone. 
The following factors may prevent the union of fractures: Infection prevent- 
ing the formation of a callus; the interposition between the fragments of muscle 
of other tissue; improper reduction of the fracture; 
general constitutional conditions such as syphilis, tu- 
berculosis, diabetes, Bright’s disease, and an inability 
on the part of the patient’s body to deposit bone in the 
callus. This latter condition in which fibrous tissue, but 
not bone, is deposited in the callus is spoken of as 
“ fibrous union.” 
In the diagnosis of fracture the following conditions 
usually will be found: (1) There is a loss of power 
in the part, for example, if the leg is broken, the man 
has fallen and can not arise; (2) the part is in an unnatu- 
ral position, and comparison of a fractured limb with the 
uninjured one will show that there is a deformity be- 
tween the joints and that the injured limb is probably 
shorter; (3) movement can be obtained where normally there is no motion, 
with grating of the broken ends of the bone; in a fractured limb, if an attempt 
to move the limb is made it will be found that there is movement in the bone 
between the joints where there should be none, and the broken ends of the 
bone grating together (crepitus) can be felt and heard; (4) there is the 
history of violence and the patient will say that he heard the bone crack and 
give way; and (5) the patient complains of great pain 
and tenderness at the seat of fracture and there is 
swelling present, due to bleeding from the broken 
ends. Whenever a fracture is suspected or doubt- 
ful, an X-ray picture of the part should be ob- 
tained, as this is the surest means of determining 
fracture. 
General principles for the treatment of simple frac- 
tures. 
Take measures to bring the patient under the care 
of a medical officer. The object of treatment before 
a medical officer can take charge of the case, if his 
services can not be had promptly, is to prevent further 
injury, especially injury to blood vessels and nerves, 
and puncture of the skin by the sharp, knife-like 
edges of the broken bone, and to treat shock if it is 
present. The patient should be placed in a com- 
fortable position while waiting for the surgeon, and if it is necessary to move 
the fractured part in doing this or in treating shock, one hand should support 
the broken bone on each side of the break. The bone must not bend at the 
break while the patient changes his position to a more comfortable one. Sup- 
port the broken bone in a natural position on a pillow or folded coat, great care 
being taken that it is not bent or does not drag on the point of fracture. If 
there is doubt as to whether or not a fracture is present, do not manipulate the 
part, but treat it as a fracture until the arrival of a surgeon. Do not move the 
Fig. 64.—Comminuted 
fracture. 
Fig. 65. — Impacted 
fracture of femur. 
(Wharton.) 78 
HOSPITAL COUPS HANDBOOK. 
patient more than is necessary before the fracture has been set and secured. 
If the injured person is wearing thin summer clothing, it will not always be 
necessary to remove it; if thick clothing is worn, however, it is difficult to de- 
termine whether or not a fracture has occurred or the character of the injury. 
In the latter case, never try to take off the clothing, but cut it in the seams with 
a sharp knife or scissors. If the patient can not be brought under the care of a 
surgeon for a day or more, the fracture must be set and immobilized as 
described below. If a fracture is not set, it will unite in bad position and the 
bone will have to be refractured to secure proper alignment. 
In the treatment of compound fractures the services of a medical officer 
should be obtained as soon as possible. In the meantime, treat the shock and 
the wound as described in the section on wounds. After treatment of the 
wound, treat the fracture as above. In case no surgeon is available for a day 
or more, the fracture may be set as described below, always keeping in mind 
the proper treatment of the wound while so doing, thus preventing, as far as 
possible, infection which is a serious complication in fractures. 
The setting of a fracture consists of bringing the two fragments in apposition 
and in holding them in that position. The force which keeps the fragments out 
of apposition and which must be overcome in order to bring them into appo- 
sition is muscular contraction. This muscular contraction is overcome by exten- 
sion and counterextension. Extension is pulling the far or distal end of the 
limb, and counterextension is merely holding the near or proximal end 
next the trunk. Extension and counterextension must be applied until 
the deformity and shortening disappear and the two limbs look alike. 
Where the muscular contraction is great, as in fractures of the thigh, the 
fragments frequently can not be brought into apposition without relaxation 
of the muscles by a general amesthetic or by gradual tiring out of the muscles 
by a steady pull with weights and pulley. In these cases extension and 
counterextension frequently have to be applied for some time after the fracture 
has been set in order to maintain the fragments in apposition. The fragments 
of a fractured bone are held in apposition by means of splints, plaster of 
Paris bandages, ordinary bandages, etc. 
Splints are agents for immobilizing a fractured part. There are two general 
classifications of splints, traction splints and coaptation splints. Tractwn 
splints are those which, in addition to immobilizing a fracture, are constructed 
in such a manner that by • their use extension and counterextension can be 
applied without the use of other apparatus for this purpose. Coaptation splints 
are those which are used solely to immobilize the fracture. Traction splints 
are indicated in fractures where there is much muscle pull tending to dis- 
place the fragments. The most common traction splints are: The Thomas leg 
splint and modifications of the same, the Jones humerus traction splint, the 
Hodgen anterior thigh and leg splint, the wire ladder splint, and the Cabot 
posterior wire splint. To obtain extension by use of these splints, adhesive 
strips or tapes are fastened to the skin and attached to the distal end of the 
splint, while counterextension is obtained by the push of the other end of the 
splint against the body. 
In an emergency any material which has sufficient firmness to give support 
to a limb will answer for coaptation splints. Examples are umbrellas, canes, 
swords, scabbards, guns, cigar boxes, wire, leather, laths, tent pins, pillows, 
or folded coat. In fractures of the thigh and leg, the sound limb may be used 
as a splint. Plaster of Paris bandage may be used. Adhesive plaster gener- 
ally is used to splint a fractured rib. The materials used for splints must be 
light but sufficiently rigid to prevent bending; long enough to fix into the 
joints above and below the fracture; broad enough to prevent pinching of the FIRST AID AND MINOR SURGERY. 
79 
limb in bandaging; and sufficiently padded to protect tbe part from undue 
pressure. 
Coaptation splints may be applied temporarily over tbe clothing and should 
always be wrell padded, as a hard board against an injured limb soon becomes 
very painful. Oakum, cotton, grass, moss, portions of clothing, or any soft 
material will answer for the padding. If possible, two splints should be ap- 
plied to a limb, while in fractures of the leg three generally are used, one 
on each side and one behind. In applying splints, have an assistant hold them 
in position and then firmly fasten them to the limb by several turns of a 
roller bandage, adhesive strips, handkerchiefs, pieces of rope, or portions of 
clothing. Whereas splints should be applied snugly, care should be taken 
not to apply them too tightly for fear of cutting off the blood circulation; 
leave the tips of the fingers and toes exposed and watch the circulation. If 
the tips of the fingers are blue and cold, or if, upon pressing upon the nails, 
the normal pink color does not quickly return, the dressing is too tight. 
Remember that whereas a splint may be applied with the proper degree of 
snugness, later swelling of the fractured limb may cause it to be too tight. The 
use of plaster of Paris as splinting material should be left to the surgeon. 
Fractures of the skull are classified as fractures of the vault and fractures 
of the base of the skull. Fractures of the skull are dangerous on account 
of the probability of injury to the brain. In fractures of the vault, the danger 
lies in tearing of the brain tissue itself by the fragments of bone, and in 
tearing of the blood-vessel walls, resulting in haemorrhage, with the resulting 
compression of the brain. Compression of the brain also may result from the 
displaced fragments of broken bone. In fractures of the base of the skull, the 
principle dangers are rupture of the meningeal arteries, resulting in intra- 
cranial haemorrhage and compression of the brain. Both types of fracture may 
be compound, while there is the added danger of infection which, in fractures 
of the vault, occurs through injury to the overlying tissue at the site of 
fracture and, in fractures of the base, to infection from the nose and ears 
due to a tearing of the mucous membrane of the nose and middle ear. 
In fractures of the skull, unless compound or depressed, all the usual symp- 
toms of fracture are absent, or entirely overshadowed by the injury to the 
brain. The most prominent brain symptoms are loss of consciousness and 
paralysis; if the loss of consciousness is sudden, it is probably due to con- 
cussion or to the pressure of a piece of bone; if it comes on slowly, it is apt 
to be the result of haemorrhage from a torn blood vessel. In fracture of the 
base of the skull, there may be bleeding from the nose or ears, or into the 
orbits, or under tbe conjunctiva; the escape of cerebrospinal fluid—a clear, 
watery serum—from the ears is considered a sure sign of fracture of the 
base. 
In the treatment of a fracture of the skull obtain the services of a medical 
officer as soon as possible. In the meantime, keep the patient quiet, in a re- 
cumbent position, and apply an ice bag to the head; if the fracture is com- 
pound, treat the wound. Avoid stimulants. 
In fractures of the spine the spinal cord is generally injured or cut across, 
with resulting paralysis to all parts below the fracture. On passing the 
fingers down the spine, irregularity of the spinous processes with deformity 
will usually be noted, as wTell as local pain over site of fracture. Keep the 
patient perfectly quiet, and lying flat on his back until surgical aid can be 
obtained. If it is necessary to move him, it should be done with extreme care 
to prevent any additional injury to the spinal cord. 80 
HOSPITAL CORPS HANDBOOK. 
Symptoms and treatment for a fractured nose.—There is usually consid- 
erable deformity, the bridge of the nose being depressed and pushed to one 
side, crepitus generally can be felt, and there is considerable nosebleed. Re- 
turn the bones to their normal position, if possible, by gentle manipulation. 
To bold the bones in position, apply two very small rolls of narrow bandage 
on either side of the nose and hold the rolls in place with short strips of 
adhesive plaster. Check the bleeding by syringing the nostril with hot or 
cold water, or, if necessary, pack the nostrils with cotton. Warn the patient 
not to blow his nose. 
Symptoms and treatment of fracture of the lower jaw.—In fracture of the 
lower jaw, the line of teeth is irregular and there may be bleeding from the 
mouth ; the patient can not open his mouth, and by passing the fingers along 
the line of the lower jaw, localized pain and deformity can he noted. Push 
the bones into place and apply a four-tailed or Barton bandage. The patient 
must be fed through a tube, and the mouth kept clean, as these fractures are 
generally compound. Place the patient under the care of a surgeon as soon 
as possible. (Fig. 66.) 
Symptoms and treatment of fracture of the rib.—The symptoms are pain or 
“ stitch ” in the side, and some difficulty in breathing. Pain may he especially 
severe if the patient coughs or sneezes, 
or breathes deeply. The danger in 
rib fracture is injury to the lung, and 
with this complication, there may be 
spitting up of blood and escape of air 
beneath the tissues of the chest wall, a 
condition called emphysema. On ex- 
amination, by passing the fingers along 
each rib in succession, one will be able 
to find a local point of tenderness, 
and often a false point of motion or 
grating in one or more of them. By 
placing the ear against the injured 
side and asking the patient to take a 
deep breath, grating may be heard dis- 
tinctly. As it is impossible to splint only one or two ribs, in order to immo- 
bilize the fracture it is necessary to immobilize the whole side on which the 
fracture has occurred. This splinting can be temporarily accomplished with 
a broad binder of muslin, a triangular bandage, or an ordinary roller 
bandage applied firmly around the chest, but the best method is to strap 
the chest with adhesive plaster. Procure a strip of plaster wide enough to 
cover the injured side, about 8 or 9 inches wide, and long enough to extend 
from the spine behind to just beyond the median line in front, and apply 
as follows: With the patient standing with arms above the head, tell him 
to let all his breath out, and as he does this quickly apply the plaster to 
the injured side, starting just a little to the other side of the spine in the 
back and bring the strap to just beyond the middle line in front. The 
plaster is applied at the end of a forced expiration because at this time the 
broken fragments are more nearly in apposition. In place of a single strip 
of plaster, several strips, each about two and a half inches wide, may be 
applied, beginning well below the fracture and gradually working up. Apply 
each strip with firmness, at the end of a forced expiration, allowing it to 
overlap one-third of the one below. When there is injury to the lungs accom- 
panied by spitting up of blood, keep the patient quiet in bed and give cracked 
ice by mouth. 
Fig. 66.—Fracture of lower jaw, show- 
ing loss of alignment oif teeth. (Scud- 
der, modified.) FIRST AID AND MINOR SURGERY. 
81 
Symptoms and treatment of fracture of the clavicle or collar hone.—In 
fracture of the clavicle, the attitude of the patient is characteristic; the 
shoulder drops downward, inward, and forward, and he attempts to support 
it by holding the elbow of the injured side in the hand of the sound side. The 
collar bone lying immediately under the skin, the fracture is easily made 
out from the deformity and localized pain and tenderness. As an emer- 
gency dressing until the patient comes under the care of a surgeon, all that 
is required is a large arm sling with a pad in the armpit and the arm bound to 
the side. Later treatment, in the absence of a sur- 
geon, consists in the application of any dressing 
which will keep the shoulder up, back, and outward, 
thus holding the fragments in their normal position. 
Many forms of dressing are used for this purpose, 
especially the Velpeau or Desault bandages or the 
Sayre dressing. {See section on Bandaging.) 
Symptoms and treatment of fracture of the 
humerus or arm hone.—Fracture of the humerus 
has all the general signs and symptoms of fracture. 
A fracture of the neck or upper third of the bone 
may be put up temporarily by placing a pad or 
folded towel in the armpit and securing the arm to 
the side with a bandage; then place a sling about 
the wrist. With this dressing, the weight of the arm 
and forearm acts as an extension. Fracture in the middle of the shaft of the 
bone may be treated by the use of two broad splints, or better, four narrow 
ones, placed about the seat of injury and secured by a bandage or strips of 
adhesive plaster, the wrist being supported by a sling. Care must be taken that 
the splint does not extend too high in the armpit, as thus it might compress 
the blood vessels or at least be exceedingly painful. A fracture near the elbow 
joint may be dressed temporarily by simply applying a 
large arm sling and securing the arm to the body. Frac- 
tures in this locality are serious from the liability of 
the joint to become stiff, and the patient should be 
brought under the care of a surgeon as soon as possible. 
Symptoms and treatment of fracture of the bones of 
the forearm.—When both bones of the forearm are frac- 
tured all the usual signs of fracture are present. When 
only one bone is broken, the other acts as a splint and 
but little deformity will be apparent, but there is in- 
ability to use the forearm, and on examination, 
tenderness and a false point of motion can be dis- 
covered at the seat of injury. With a fracture of 
the radius alone, low down and just above the wrist, 
there is a well-marked deformity, termed silver-fork 
deformity. (Fig. 67.) A transverse fracture of the radius just above the 
wrist is spoken of as Cone’s fracture, and, as the bones are usually impacted, 
no grating or crepitus is present. (Fig. 68.) The tip (styloid process) of 
the lower end of the ulna frequently is broken off and there may be rupture 
of the internal lateral ligament of the wrist. In treating fractures of the 
forearm, the limb should be put up with the elbow bent at a right angle, the 
forearm across the chest, with the palm of the hand turned in and thumb 
pointing upward. First reduce the deformity by gentle traction upon the 
hand, and then apply two well-phdded splints to the seat of fracture, having 
Fig. 67.—-Deformity at the 
wrist consequent upon 
displacement back- 
ward of the lower frag- 
ment of the radius after 
fracture at its lower ex- 
tremity. (Levis.) 
Fig. 68.—Effect upon 
the lower end of 
the radius of the 
cross-breaking 
strain produced by 
extreme backward 
flexion of the hand. 
(Pilcher.) 82 
HOSPITAL CORPS HANDBOOK. 
them long enough to extend from the elbow to below the wrist; bandage 
the splints, and support the forearm by means of a sling. It is very im- 
portant that all cases of Colle’s fracture should be brought under the care 
of a surgeon as soon as possible, as, unless the fracture is properly reduced 
and treated, the deformity is apt to be permanent. 
Symptoms and treatment of fracture of the metacarpals, or wrist bones.■— 
Deformity and pain are the most prominent symptoms. Apply splints on the 
hack and front of the hand, reaching from the finger tips halfway up the 
forearm. 
Treatment of fractured fingers.—If only one finger is fractured, a narrow 
splint, such as a wooden tongue depressor, should be applied to the palmar 
surface of the finger and secured by strips of adhesive plaster. If several fingers 
are broken, it is better to place a pad in the palm of the hand and apply two 
well-padded splints, extending from below the tips of the fingers well up on the 
forearm. 
Symptoms and treatment of fractures of the pelvis.—The patient is unable 
to sit up or stand and complains of great pain and a sense of coming apart. 
Crepitus may be felt on strong pressure. These fractures generally are accom- 
panied with injury to internal organs and more or less shock. With injury 
to the bladder blood is passed in the urine. When fracture of the pelvis is sus- 
pected have the patient lie quietly on his back, apply a tight binder or bandage 
to the hips, and also fasten the knees together. He should be moved witli 
great care and transported on a stretcher which will not sag. The patient’s 
bed should be fixed so that it will not sag under his pelvis and the thighs 
should be supported with pillows. In case of bleeding from the bladder, which 
indicates a rupture of that organ, a catheter should be introduced and left 
in, so that the urine will not accumulate and escape into the peritoneal cavity. 
A urinary antiseptic (hexamethylenamine (urotropin)) should be administered 
by mouth. 
Symptoms and treatment of fractures of the femur or thigh.—The patient 
usually lies with the toes of the injured limb pointing outward; any attempt 
to move the limbs results in a spasm of the muscles and causes the patient 
excrutiating pain; there is loss of power in the limb, the patient being unable 
to lift it. On examination, if the fracture is on the shaft of the bone, a false 
point of motion is discovered. By measurements the fractured limb is found 
to be shorter than the other one, due to the pull of the powerful thigh muscles. 
Measurement should he made on each limb and compared by stretching a string 
from the anterior superior spine of the ilium to the internal malleolus with the 
patient on his back. Emergency treatment consists in applying two splints, 
one on the outside reaching from the armpit to beyond the foot and one on the in- 
side from the crotch to the foot. The splints should be tied in five places— 
around the ankle, over the knee, just below the hip, around the pelvis, and just 
below the axilla. It is well also to tie the two limbs together. The patient 
must be brought under the care of a surgeon as soon as possible, as an 
anaesthetic is frequently necessary to effect reduction, and a traction splint or 
other means of extension is generally required. 
Symptoms and treatment of fracture of the patella or knee cap.—In the frac- 
ture of the patella, the patient can not stand or walk, the upper fragment is 
drawn up to the thigh by the powerful muscle attached to it, and the gap can 
be felt readily; the joint swells up at once. Put the limb up straight with a 
well padded splint behind the thigh and leg. The two fragments can be brought 
together by strips of adhesive plaster, one strip passing above the upper frag- 
ment, and the other below the lower one, or in place of the adhesive plaster a 
figure-of-eight bandage may be applied. The patient should be put to bed with FIRST AID AND MINOR SURGERY. 
83 
the injured leg elevated on a pillow, and ice should be applied to the joint 
with the object of limiting and decreasing the swelling. Place the patient 
under the care of a surgeon as soon as possible. 
Symptoms and treatment of fracture of the leg.—When both bones of the leg 
are broken, the usual signs and symptoms of fracture are present. These frac- 
tures often are compound. If only one bone, is broken, the other acts as a splint 
and deformity will not be so marked, but there will be present a local point of 
tenderness, swelling, and probably discoloration of the skin. Fracture of the 
lower end of the fibula is spoken of as Pott’s fracture. (Fig. 69.) Pott’s fracture 
generally is accompanied by tearing of the internal lateral ligaments of the ankle 
joint or by a fracture of the internal malleolus, in which case there is great 
deformity and turning out of the foot. In case it is purely a fracture of the 
lower end of the fibula, there may be few of 
the usual signs of fracture and the injury may 
be mistaken for a sprain. For treatment of frac- 
tures of the leg, reduce any deformity by traction 
in the long axis of the limb, and then apply three 
well-padded splints, two side splints, and a pos- 
terior one (in case of Pott’s fracture, do not apply 
a posterior splint). The latter is to give support 
and prevent a backward sagging at the seat of 
fracture. A pillow and two side splints also 
make an excellent temporary dressing; a pillow 
covered by a pillow case is placed upon the deck, 
and the injured leg is laid carefully upon it; the 
edges of the pillow then are brought up around 
the foot and limb and are pinned in place; finally 
the two side splints are applied outside the 
I>illow and are secured in place by straps of 
adhesive plaster or strips of bandage. 
Treatment for fracture of the foot.—Apply a 
light splint to the sole of the foot, and keep it 
immobilized by two side splints extending up each 
side of the leg from below the foot. Place the 
patient under a surgeon’s care, so that a plaster 
of Paris bandage may be applied. 
INJURIES DUE TO HEAT AND COLD. 
Injuries due to heat are classified into the general or constitutional, includ- 
ing heat stroke or sunstroke and heat exhaustion; and local, including burns 
and scalds. 
Heat stroke, sunstroke, or insolation is due to prolonged exposure to excessive 
heat, usually to the heat of the sun. It may, however, occur in hot rooms, 
particularly in firerooms aboard ship. Exhaustion and improper clothing pre- 
venting the proper elimination of heat from the body surface are powerful 
contributing factors; hence this condition is especially apt to occur to men on 
the march, particularly when marching in close formation. The warning symp- 
toms are headache, dizziness, irritability, frequent desire to urinate, and seeing 
things red or purplish. With or without these symptoms, the patient suddenly 
falls unconscious; the skin is dry and intensely hot; pupils contracted; pulse 
full and strong; respirations snoring; there may be convulsions; if the tem- 
perature of the body can be taken it usually will be found to be very high, 
105° to 109° F., or higher. The condition is very serious, and unless imme- 
Fig. 09.—Pott’s fracture, 84 
HOSPITAL CORPS HANDBOOK. 
diately relieved terminates in death. The treatment has for its object the 
rapid reduction in temperature. The patient should be brought to the coolest 
accessible spot, in the shade, if out of doors; on deck if in the fireroom of a 
ship; the clothing removed; an ice bag applied to the head and cold water 
poured over the patient continually. At the same time, the body may be 
rubbed with ice, and if a tub is available, immersed in cold water. The treat- 
ment should continue until the temperature is reduced. If the patient is able 
to swallow, cold, not iced, water should be given to drink, and this should 
be repeated as often as possible. Serious results are liable to follow a sun- 
stroke, even when death does not occur; the most common of these after effects 
are permanent headache, paralysis, mental confusion, or even insanity. More- 
over, one who has had a sunstroke is ever after very susceptible to the action 
of the sun. 
Heat exhaustion is due to the same causes as heat stroke. Under the same 
conditions, one man may get heat stroke, while another gets heat exhaustion. 
The warning symptoms are dizziness, often with nausea and vomiting associated 
in some instances, particularly in firerooms aboard ship, with cramps in the 
muscles. The patient suddenly falls; is not unconscious and may be easily 
aroused ; temperature is subnormal; the face is pale, skin cool and moist; pupils 
dilated or normal; pulse very weak; respirations shallow, perhaps sighing; 
and perhaps one or several sets of muscles in painful contraction. In this 
condition of heat exhaustion certain muscles or groups of muscles frequently 
are thrown into violent contractions which cause excruciating pain. This 
condition is relieved by hot applications, immersion of the part or the person’s 
body in a hot bath, or by the administration of an opiate (hypodermic injection 
of morphine). The treatment for heat exhaustion consists in moving the pa- 
tient into the shade or on deck, loosening the clothing, keeping the head low, 
and giving water and some stimulant, such as hot coffee or aromatic spirits 
of ammonia. After removal to sick bay or hospital, he should be kept perfectly 
quiet in bed with liot-water bottles and blankets around him if necessary. 
Burns and Scalds. 
Burns are produced by a flame, hot solids, hot fluids, caustics such as strong 
acids and strong alkalies, wires charged with a heavy electric current, sun’s 
rays, and X-rays; scalds are produced by hot liquids. Burns and scalds differ 
only in that with the former the hairs are removed, whereas in the latter they 
are not; the treatment is the same for both. Burns usually are said to be of 
the first, second, and third degree; those which cause merely redness are of the 
first degree; if blisters are raised, they are of the second degree; if there is 
charring and destruction of tissue, the burn is of the third degree. The symp- 
toms of burns are shock, which may be profound; chilly sensations, and pain; 
the pain may be agonizing or slight. The result of the burn depends more upon 
the extent of surface affected than upon its depth, a burn of the first degree 
being almost fatal if two thirds of the body surface be affected, and one of the 
second degree if one third of the body is burned. The chances of recovery are 
much less in children and elderly people. With extensive burns of the body 
surface, the danger in the first 24 hours is from shock; after that from internal 
congestion and inflammation, suppression of urine from nonfunctioning of the 
kidneys, ulcerations of the duodenum, intestinal haemorrhage, and finally ex- 
haustion or infection. If the entire thickness of the skin is destroyed, terrible 
deformities are apt to follow the contraction of the skin which follows healing. 
As the result of inhalation of live steam from bursted steam pipes, the respira- FIRST AID AND MIXOR SURGERY. 
85 
tory tract may suffer from burns, causing death in many instances from suffoca- 
tion or shock. X-ray burns are particularly slow in healing. 
The treatment of burns is both constitutional and local. The constitutional 
treatment consists in the treatment of shock and pain, on the one hand, and, 
on the other hand, in measures to prevent suppression of urine, in combating 
the toxaemia and the effects of infection, etc. In addition to local measures 
for the treatment of pain, the administration of morphine, one-fourth grain, 
hypodermically, is frequently necessary. The bowels must be kept open, 
and plenty of water given by mouth, and also at times by rectum, so that the 
kidneys will continue to act. The smaller the area of body surface burned 
the less necessity is there for constitutional treatment. The object of the 
local treatment is to remove the cause, to allay pain, prevent infection, and 
promote healing. The deeper the burn, the more important do the methods 
for the prevention of infection become, and vice versa. The greatest factor in 
the causation of pain in burns is the movement of air over the inflamed 
area, and therefore local treatment in first-degree burns consists in the cover- 
ing of the burned surface with a film of oil. If the burn has been caused by a 
caustic such as an acid or an alkali, before the film of oil is applied the acid 
must be neutralized with bicarbonate of soda or ordinary baking soda, and the 
alkali by a weak solution of acetic acid or ordinary vinegar. To cover the 
burned surface with a film of oil, any fresh, bland oil, such as cream, vaseline, 
liquid petrolatum, or olive oil will answer the purpose. In burns of the second 
and third degree the quickest temporary means of excluding air is to immerse 
the part or the entire body in warm water; then, having everything in readiness, 
carefully cut away the clothing, leaving such as may be sticking to the burned 
skin; blisters should be left undisturbed unless they are very tense and painful, 
when they may be punctured by a sterilized needle, and the content allowed 
to escape. The wound next should be cleansed carefully and dressed with 
sterile gauze dipped in warm Dakin’s solution, or a solution of boric acid, or 
picric acid (10 parts in 80 parts of alcohol and 1,000 parts of sterile water) ; 
and over the gauze place a thick layer of sterile absorbent cotton. When the 
burns are extensive, small portions only should be exposed and dressed at a 
time. When the first dressing is finished it should he kept moist with the 
antiseptic solution, and left on as long as possible. The ambrine treatment for 
burns may be used in first and second degree burns, if on hand. Ambrine and 
its substitutes consist of paraffin and resin of such consistency that they remain 
liquid while hot, and solidify on cooling. The burn first is covered with a film 
of liquid petrolatum (preferably sterile), the ambrine is melted and cooled to 
about 100° F., and applied with a brush or preferably a sprayer. Place the 
patient under the care of a medical officer as soon as possible. 
In rendering first aid at a fire the points to be kept in mind are: (1) Prevent 
drafts from fanning the fire. Shut and keep shut all doors and windows. If one's 
own clothing catches afire, do not run, as this fans the flames; lie down on the 
deck or a bed and roll up as 'tightly as possible in a rug, shawl, overcoat, blanket, 
or other woolen cloth, leaving only the head out; if nothing can be obtained in 
which to wrap up in, lie down and roll over slowly, at the same time beating out 
the fire with the hands. If another person’s clothing catches afire, throw 
to the ground and smother the fire with a coat, blanket, rug, or the like; in 
doing this care should be taken to stand at the head, and, holding down with 
one foot one edge of the blanket or whatever is used, to throw it toward the 
teet of the individual; the flames thus are swept away from the rescuer and 
from the face of the burning person. (2) Remember that the air within 6 86 
HOSPITAL CORPS HANDBOOK. 
inches of the deck is free from smoke, so when unable to breathe a rescuer 
should crawl along the floor with the head low, dragging anyone who has been 
rescued behind him. The rescuer should tie a wet handkerchief or cloth over 
the mouth and nose to minimize the danger of suffocation. 
Cold or chilling. 
Injuries due to cold are classified as (jencral, or constitutional, not local. 
Prolonged exposure to extreme cold results in a general depression or lowering 
of the vitality, a gradual chilling of the body, and a congestion of the internal 
organs. The body and limbs first feel numb and heavy, and then become stiff; 
drowsiness and an irresistible desire to sleep take hold of the individual. If 
left alone, unconsciousness rapidly follows. When found in such a condi- 
tion, life not yet being extinct, one should be taken into a cold room, all 
clothing removed, and the body rubbed briskly with sheets or towels wet with 
cold water. As soon as the stiffness is removed artificial respiration should be 
performed; and when the patient is able to swallow warm drinks should be 
given. When there are signs of returning consciousness and circulation the 
body may be enveloped in a blanket and the temperature of the room gradually 
raised. The reason why a frozen person must not be removed to a warm room 
is that the sudden restoration of the circulation gives rise to violent congestions 
and often to sudden death from the formation of clots in the blood vessels. 
In intense cold, frostbite not infrequently occurs without one’s knowing it, 
but usually the ears, fingers, etc., become painfully cold, and then one suddenly 
realizes that no longer is there any feeling in the parts. The color of the 
frozen part is white or grayish white. The object of treatment is to bring the 
frozen part gradually to its normal temperature. The danger of sudden thaw- 
ing is congestion and bursting of the capillary walls which have been weak- 
ened by freezing, and resulting in gangrene or death of the part; therefore the 
patient should not go into a warm room or near a fire. Rub the part vigor- 
ously with wet snow or ice- water; never with dry snow, as the temperature 
of the dry snow may be much below freezing and rubbing with it would aggra- 
vate the condition. When the pain and redness return use warm water gradu- 
ally. Chilblain is a condition of acute or chronic congestion occurring espe- 
cially in the feet and due to bringing cold feet near the fire too suddenly or 
merely following exposure to cold in persons with poor circulation. On the 
part affected are red spots, more or less swollen, which burn and itch intensely. 
The treatment consists in stimulating applications, such as liniments and 
tincture of iodine. Susceptible persons should wear woolen socks. 
REMOVAL OF FOREIGN BODIES. 
Either inanimate objects such as splinters, cinders, marbles, peas, beans, etc., 
or animate objects such as insects, maggots, ticks, etc., may gain access to the 
tissues and cavities of the body. With regard to the removal of inanimate 
foreign bodies, if their removal is difficult or liable to be attended with much 
damage to the tissues, the patient should be brought under the care of a sur- 
geon as soon as possible for the removal of the foreign body. If the services 
of a medical officer are not to be had for some time, then the first-aid man 
must be guided by the probable relative benefit to the patient of having him 
wait the required time for expert treatment or of doing the operation himself. 
The main principle to be kept in mind in the removal of an inanimate foreign 
body is to avoid infecting the tissues, by using sterile appliances, and to do as 
little damage to the tissues as possible. The main principle underlying the 
treatment of conditions where insects, etc., have gained access to tissues and FIRST AID AND MINOR SURGERY. 
87 
cavities of the body is to kill the object first and then remove it. Creatures 
such as insects and ticks are best killed by putting some bland oil, such as 
olive oil or liquid petrolatum, into the cavity to which they have gained access, 
the oil covering over their breathing pores and thus suffocating them, after 
which they may usually be easily washed out.' 
Foreign bodies in the eye. 
Foreign bodies, such as particles of dust, cinders, etc., may lodge under the 
lids, upon the conjunctiva, or upon the cornea. In the latter situation they 
are seen and removed with the greatest difficulty, and the removal ordinarily 
should not be attempted by other than a medical officer. To remove a foreign 
body from the eye, the best improvised article and the one that nearly always 
is at hand is a match. Light a match and after it has burned a moment, blow 
it out; then with a clean handkerchief and a circular movement of the fingers, 
wipe off the charred end, leaving a soft, clean, splinterless point with which to 
remove the foreign body. To examine the lower lid, draw it down with the 
fingers, at the same time letting the patient look up; if the foreign body is 
not found there, evert the upper lid by standing behind the patient with the 
head upon your chest, and telling the patient to look down; at the same 
time press a match or the end of the finger firmly against the outside of the 
lid about a quarter of an inch behind its margin. Draw the lid down by the 
lashes, and turn it upward and outward over the match or finger tip. If the 
particle still is not visible, search the ball of the eye carefully for it, and 
when it is found, lift it off gently by a quick movement with the point of the 
match. If the eye is very irritable, it may be necessary to put in a few drops 
of 2 per cent cocaine solution. It is important to remember that even after a 
foreign body is removed from the eye there is often for some time a sensation 
as if it were still there. Instill a few drops of 5-10 per cent silvol and irrigate 
the eye with boric solution. 
Foreign bodies in the ear. 
The foreign body may be an insect, a pea, a grain of wheat, a pebble, a plug 
of hardened wax, etc. An insect in the ear by its movements and buzzing often 
causes the most intense annoyance. Hold the head over on one side with the 
ear containing the insect uppermost; drop in 5 or 10 drops of bland oil, such 
as olive oil or liquid petrolatum, and then syringe the ear. If the foreign body 
is vegetable, such as a pea, water should not be used, as it may cause the pea 
to swell and thereby render its extraction more difficult. If the pea is visible, 
bend the loop of a fine hairpin and try to get beyond it so as to hook it out. 
As there is always danger of injuring the drum when instruments are pressed 
into the ear, it should be a guiding rule that no instrument should be passed 
beyond the point where its tip can be seen. Hardened wax may be softened 
with a few drops of hydrogen dioxide, then removed by syringing with a warm 
5 per cent solution of soda. 
Foreign bodies in the nose. 
Children and insane persons often push peas and other foreign bodies into 
the nose, and occasionally flies deposit their eggs there, with the result that 
maggots develop in the nasal cavity. Foreign bodies are best removed by 
closing the free nostril with the finger and forcibly blowing through the 
obstructed side; snuffing a little powdered tobacco or pepper will cause 
sneezing and aid in the expulsion; if this does not succeed and the body can 
be seen, it may be hooked out with a bent hairpin in the same manner as 
described for the ear; or, finally, a small smooth stick or a slender pencil may 88 
HOSPITAL CORPS HANDBOOK. 
be wrapped with a little cotton and used to push the foreign body gently back 
through the posterior nares into the mouth ; press straight backward, never 
upward. The presence of maggots in the nose is a very serious condition, 
which may result in death. Let the patient inhale through the nose a half- 
teaspoonful of chloroform, and while the maggots are stupefied, syringe them 
out with warm normal salt solution. 
Foreign bodies in the throat. 
F'oreign bodies in the throat are usually bones or masses of food. If the bone 
can be seen and reached it may be removed by fingers or forceps; if not, it may 
be carried down by eating dry bread. If the obstruction is a mass of food it 
may he dislodged by forcible blows on the back between the shoulders or the 
fingers may be passed into the throat to hook it out or to cause its ejection by 
vomiting. Foreign bodies in the air passages cause violent cough and difficult 
breathing; the case is urgent, and in the case of a child, he may be held up by his 
heels and shaken; if an adult, inversion also may be attempted, and the case 
treated as described for foreign body in the throat. 
Foreign bodies in the stomach. 
Foreign bodies sometimes are swallowed and reach the stomach and intes- 
tines. Such cases are not usually serious. If the body is angular or pointed, 
such as a tack or pin, feed the patient on substances which leave considerable 
residue to cover and protect the sharp points—potatoes, bananas, bread, etc. 
Do not give laxatives, as they will render the movements liquid, and thus leave 
sharp points exposed and because the increased peristalsis favors injury to the 
intestinal walls. The patient should, however, be brought under the care of a 
surgeon. 
Foreign bodies in the skin. 
Here we find splinters, thorns, needles, pins, fishhooks, pieces of glass, 
gunpowder, etc. For splinters and thorns pass the point of the blade 
of a pocketknife under them; with the thumb-nail press the splinter 
against the blade and draw it out; or use a pointed dissecting or dress- 
ing forceps. If the splinter is buried, open up the skin a little with the point 
of a knife or a needle until it can be reached; if under a nail, cut a notch in the 
nail so as to expose it. If a needle or a pin is broken off in the skin and can 
not be grasped with forceps, cut a small hole in the end of a cork and press it 
down over the point of entrance of the needle; this may cause the needle to 
emerge so far that it can be grasped. The needle may be so situated that it is 
best to push it through and extract it on the other side. If the needle or pin is 
in the foot or the hand and can not be extracted, the patient should be directed 
not to use the part, as muscular action will cause it to work in deeper. A fish- 
hook or an arrow can not be drawn out on account of the barbs; they must be 
pushed through. Gunpowder is removed best by a thorough scrubbing with soft 
soap and a stiff brush, the remaining grains being picked out with a needle. 
SUFFOCATION OR ASPHYXIA. 
Asphyxia or suffocation is a condition where breathing or respiration has 
ceased due to the lack of the proper supply of oxygen in the lungs, or due to a 
condition in the blood" rendering it unable to absorb oxygen from the lungs. 
Suffocation may be caused by stoppage of the air passages mechanically, as by 
water in drowning; by a foreign body; by a diphtheritic membrane, extending 
into the larynx; by a tumor; by a constricting band around the neck; and by FIRST AID AND MINOR SURGERY. 
89 
a swelling of the mucous membranes, such as sometimes follows the inhalation 
of live steam or irritating gas such as chlorine. It may be due to the air we 
breathe having its oxygen content replaced by some other gas or by the air we 
breathe containing a gas which by its action on the blood renders it incapable of 
taking on oxygen during its circulation in the lungs (carbon monoxide). 
Treatment for suffocation or asphyxia. 
First, remove the cause of the suffocation, then establish natural breathing 
by means of artificial respiration, and later treat the shock. 
Artificial respiration.—There are several accepted methods of applying arti- 
ficial respiration. Do not rely upon any special apparatus, as it is fre- 
quently out of order and not available when most needed. The so-called 
Schaeffer’s method of artificial respiration is probably the best all around 
method and is applied as follows: The patient is placed face downward 
with a roll of clothing under the chest, and the face, properly protected, 
turned to one side. The operator kneels astride of the patient’s thighs, facing 
toward the head, and places his hands on the lower part of the thorax with his 
fingers spread over the lowest ribs. Then with the arms held straight, press 
upward and inward, bringing the whole weight of the operator against the 
chest. (Fig. 70.) This compresses the lower part of the chest and abdomen, 
Fig. 70.—Expiration; pressure on 
(Keen.) 
Fig. 71.—Inspiration ; pressure off. 
(Keen.) 
forcing out the air and producing expiration. After two or three seconds the 
pressure is released by swinging backward, but the operator’s hands are not 
removed from the patient. This permits the chest wall to expand and produces 
inspiration. This alternate compression and release of the chest should be ap- 
plied about fifteen times a minute. (Fig. 71.) 
Artificial respiration may be required in those persons apparently drowned;; 
asphyxiated by gases, fumes, or noxious vapors, and anaesthetics; electric 
shock; shock or collapse; freezing or exposure to extremes of heat or cold;; 
cases of poisoning, etc.; in other words, in all cases in which breathing is tem- 
porarily suspended. The symptoms by which we may recognize the necessity for 
artificial respiration are: cyanosis (blueness of the skin and membranes) ; sus- 
pension of respiration; or shallow breathing in some cases of poisoning. 
Artificial respiration should be continued for at least two hours before giving 
up hope for the revival of the patient. 
Treatment for a person apparently drowned.—Every minute and second 
counts, so waste no time. Have bystanders move away to give the victim all the 
air possible. Loosen clothing about neck, chest, and abdomen. With handker- 
chief or towel in hand, gently swab out the mouth and throat to remove mud or 
mucus. Turn the patient over, face downward, place the hands under the 
abdomen, one on either side, and lift the patient, in an endeavor to drain the 
lungs and stomach, then with a large roll of clothing under the abdomen, and 
by making firm pressure upon the loins, continue the effort to expel the water 90 
HOSPITAL CORPS HANDBOOK. 
from the lungs and stomach. If the individual then does not breathe, proceed 
immediately with artificial respiration. It is well at the same time to try to 
stimulate respiration by having an assistant hold ammonia or smelling salts to 
the nostrils, liecovery from drowning has occurred where persons have been 
submerged for some minutes; the statements of observers as to length of time of 
immersion can never be accepted, as in emergencies of this sort minutes seem 
like hours. When breathing has become established, remove wet clothing and 
treat the shock. 
Treatment for a person suffocated by hanging or by strangulation.—Promptly 
remove any constriction from the neck and also clothing from around the chest. 
Attempt to excite breathing by dashing cold water on the face and body; if this 
fails, pi*oceed with artificial respiration. 
Treatment for a person suffocated by choking.—The choking may be due to a 
foreign body or to such a thing as a diphtheritic membrane. Make an attempt 
to remove the offending material as described in a previous paragraph. In 
many of these cases it will be necessary to do a tracheotomy; that is, cut 
a hole in the windpipe, or in diphtheritic cases, either an intubation or tracheot- 
omy. This, however, must be done by a surgeon and no time whatsoever must 
be lost in bringing the patient under his care. After removal of the obstruct- 
ing material, perform artificial respiration in the manner described above. 
Treatment for the most common type of suffocation from poisonous gases.— 
Poisoning from illuminating gas and from breathing the exhaust gases from 
gasoline engines are the most common types of gas poisoning. It is the carbon 
monoxide in these gases which is responsible for the damage. When carbon 
monoxide is in sufficient concentration in the air we breathe it forms a 
stable compound with the haemoglobin of our blood; this prevents the haemoglo- 
bin from taking up oxygen and carrying it to the tissues. The patient must be 
removed as soon as possible into the fresh air, and artificial respiration insti- 
tuted. In the meantime send for a physician, as it often becomes necessary 
to let out some of the patient’s blood and substitute therefor good blood from 
some one else (transfusion). A person poisoned with carbon monoxide pre- 
sents a cherry red appearance on cheeks and lips. 
UNCONSCIOUSNESS. 
Insensibility and unconsciousness are one and the same thing. There are vary- 
ing degrees of unconsciousness, and the same agent causing partial unconscious- 
ness, if further applied, may cause total unconsciousness. There are numerous 
causes for unconsciousness, and in order to properly treat it the cause must be 
discovered. To treat a case of unconsciousness is one of the most difficult 
tilings that may fall to the lot of the first-aid man. In all cases of uncon- 
sciousness strenuous efforts should be made to bring the patient under the 
care of a medical officer as soon as possible. To ascertain the cause of un- 
consciousness, the first-aid man should be very observant of the surroundings 
as well as of any evidence on the person of the patient which might give a clue 
to the cause. If there are any observers on the ground or any who are ac- 
quainted with the patient’s habits and past history, all information possible 
should be obtained from them. The patient’s body should be examined for evi- 
dences of injury, bleeding, or paralysis. It should be noted whether the skin 
is moist and cold or hot and dry. The character of the respirations should be 
noted, whether deep, strong, and fast, or whether weak, shallow, and slow. It 
should be noted whether the pulse is weak and shallow, or whether it is bound- 
ing and strong. The condition of the pupils should be noted; whether they FIRST AID AND MINOR SURGERY. 
91 
are even or uneven, dilated or contracted. The breath should be smelled for 
evidence of alcohol, and a note made whether there is frothing at the mouth or 
injury to the tongue. The common causes for unconsciousness are suffocation, 
bleeding, shock, electric shock, heat exhaustion, freezing, sunstroke, epilepsy 
or fits, apoplexy and injury to the brain (concussion and compression), alco- 
holism and certain other poisons, hysteria, and uraemia. For the symptoms 
and treatment of suffocation, bleeding, shock, heat exhaustion, sunstroke, and 
freezing, see previous paragraphs, and for symptoms of poisoning see chapter 
on Toxicology. 
Electric shock is caused by coming in contact with a “live wire”; spasmodic 
contraction of the muscles occurs so that the person can not let go. Depend- 
ing on the strength of the current in the wires in contact with the patient, 
sudden death or insensibility, with or without severe burns, may be caused. 
The first thing to be done is to rescue the patient by setting him free from 
the wire, and this must be done with great care, as to touch him with bare 
hands will cause the rescuer to get the same shock. With a simple quick 
motion, free the victim from the current. Use any dry nonconductor (cloth- 
ing, rope, board) to move either the victim or the wire. Beware of using 
metal or any moist material. While freeing the victim from the live wire 
have every effort also made to shut off the current quickly. Immediately start 
artificial respiration, and when voluntary breathing returns, treat for shock. 
The burns must be treated as other burns. Lightning stroke causes similar 
symptoms to the above and the treatment is the same. 
Epilepsy or fits.—In epilepsy there may be fits with insensibility, or a mere 
momentary unconsciousness with slight muscular twitching, but in which the 
patient does not fall. In the severe form, with or without warning signs, the 
person suddenly cries out in a peculiar manner and falls in a fit; at first the 
entire body is rigid, then there are general convulsions with jerking of the 
limbs, contortion of the face, and foaming at the mouth. After a few minutes 
the convulsions are followed by profound stupor, and this generally passes off 
into a deep sleep. During the attack the eyeballs may be touched without the 
patient flinching, the pupils are dilated, the patient often bites his tongue, and 
there may be involuntary evacuations of the bowels and bladder. Epileptic 
unconsciousness may be distinguished from other forms by the history of the 
fit, and of other previous fits, by the foam at the mouth and the bitten tongue 
and by the absence of any paralysis. As far as treatment goes, nothing can 
be done to stop the fit or to control it; all that can be done is to prevent the 
patient from hurting himself and to make him as comfortable as possible; do 
not attempt to hold him, but twist a handkerchief, passing it between his jaws, 
and tie it at the back of the neck until after the fit is over to keep him from 
biting his tongue. After the fit is over let the patient sleep as long as he will. 
One must be on the lookout in the service for men feigning epileptic fits in 
order to obtain a discharge. The feigned attacks usually occur at night when 
no one can see them; the man does not fall so as to hurt himself, does not bite 
his tongue, flinches when the eyeball is touched, the pupils are not dilated, and 
the patient can be aroused. When there is foaming at the mouth a piece of 
soap often will be found inside the mouth. A pail of cold water suddenly 
thrown upon the man’s head and shoulders usually makes the diagnosis; it 
promptly revives the malingerer, but has little or no effect on the epileptic. 
Concussion of the brain.—Concussion of the brain is the condition present 
when a man has been “ knocked senseless ” or “ stunned.” It is a jarring and 
shaking of the brain due to blows or falls upon the head or falls upon the 
47829°—23 7 92 
HOSPITAL CORPS HANDBOOK. 
feetthe brain almost stops working for a time. The symptoms are uncon- 
sciousness, pallor of the face, breathing so quiet and shallow that it hardly 
can be detected, pulse fluttering, pupils equal and usually contracted. The 
degree of insensibility varies. Sometimes the patient can be aroused, but is 
irritable, and lapses again into unconsciousness which may last minutes or 
hours. Vomiting and turning on the side are favorable symptoms. The treat- 
ment consists in perfect rest in a dark, quiet room; warmth applied externally 
if the surface is cold; and aromatic spirits of ammonia by inhalation if there 
is much depression. 
Compression of the brain and apoplexy.—Compression of the brain is, as its 
name implies, a pressure on the brain. This pressure is due usually to either 
a piece of bone or to haemorrhage from a torn vessel within the cranium, 
and as the blood can not leave the cranial cavity it compresses the brain. This 
compression prevents certain parts of the brain from working. When the 
bleeding is the result of injury the condition is called compression of the brain; 
when it is the result of the bursting of a diseased blood vessel without any 
violence it is called apoplexy; the result and the symptoms are practically the 
same. The symptoms of compression are profound unconsciousness; loud, 
snoring breathing; slow pulse; pupils usually unequal and not reacting to 
light; and usually paralysis on one side of the body. If the compression is 
due to a piece of broken bone, the symptoms come immediately after the injury, 
while if it is due to bleeding they may come on later and gradually. The treat- 
ment of apoplexy consists of keeping the patient absolutely quiet, at rest in a 
comfortable position, and applying cold applications to the head during the 
acute stage. Do not administer stimulants. When convalescent, regulate diet, 
recommend a very moderate amount of exercise, and instruct the patient to 
avoid worry and excitement. 
Hysterical unconsciousness.—Hysteria is a disease of the nervous system 
accompanied by loss of control over the emotions. It usually is seen in women, 
but also may be present in nervous men. The disease is manifested in a great 
variety of ways, but the only form we shall consider is that accompanied by 
convulsions. In this form hysteria may closely resemble epilepsy. The patient 
usually has an attack of laughing and crying and gradually “ works himself 
up ” to such an extent that he falls in a convulsion. The attacks sometimes 
are prolonged for several hours, and, upon recovery, it is not uncommon to find 
the patient laughing or sobbing for some time after. He appears to be uncon- 
scious, but in falling he always picks out some soft spot or chair to fall upon, 
and is careful not to injure himself. The tongue rarely is bitten in hysteria. 
Hysteria may be mistaken for epilepsy, but in the latter condition the fall is 
sudden, and the sufferer frequently receives painful scalp wounds or injuries 
to the tongue. While hysteria is a disease, the patient nevertheless should be 
treated with firmness. The subjects usually crave sympathy. To sympathize 
with such a patient is the worst possible thing and simply prolongs the 
attack or hastens another. The best thing to do is to leave the patient alone— 
of course seeing that no harm can come to him. When he recovers and finds 
himself alone and without sympathy it is not likely that he will repeat the 
attacks. In prolonged convulsions, throwing water in the face usually will 
terminate the seizure. 
Uraemia or the insensibility of Bright’s disease.—The insensibility of Bright’s 
disease is really an acute poisoning from the retention of the waste products 
which the diseased kidneys are not able to eliminate. The unconsciousness 
often is attended with delirium and convulsions. The pupils are contracted, FIRST’ AID AND MINOR SURGERY. 
93 
the pulse is slow, there is a peculiar odor of the breath, and tlie breathing is 
loud and snoring. The distinguishing characteristics are the history of Bright's 
disease, the waxy color of the skin, sometimes dropsy, abnormal urine (albu- 
min, casts, etc.), the equally contracted pupils, and the absence of paralysis. 
Emergency treatment consists in applying cold cloths to the head and a hot 
mustard poultice to the back of the kidneys. If the services of a medical 
officer are not available within a brief period of time, catheterize, and give an 
enema and a hot pack. 
Unconsciousness caused by acute alcoholism.—The use of alcohol, if carried to 
excess, produces a condition of unconsciousness which is very likely to be con- 
founded with other allied conditions. Too great care can not be taken in exam- 
ining these cases thoroughly, as mistakes are of frequent occurrence, and cases 
of fractured skull or apoplexy often are pronounced mere alcoholism. Do not 
be led astray by the fact that a person has an odor of liquor about him. He 
may have been drinking and had a stroke of apoplexy, or may in falling have 
fractured his skull. If there is the least doubt, it is better to give the patient 
the benefit than to run any risks. A person suffering from alcoholic coma lies 
in a supor, but usually can be partially aroused and made to answer ques- 
tions. The face is flushed, the pulse is full and rapid, and the respirations are 
deep. The pupils usually are dilated and the breath has the heavy odor of 
alcohol. Ordinary intoxication rarely requires any treatment besides rest and 
sleep. If the patient is in an exhausted state, it is well to wash out the 
stomach, then cover him warmly and apply heat to the extremities. If coma is 
present, try to arouse the patient by cold douching or striking with wet towels. 
If the pulse is weak, stimulants should be given; inhalations of ammonia and 
the internal use of strychnine or caffeine may be employed if the patient is 
conscious. The use of strong coffee by the rectum is of great service. 
(Treatment of methyl (wood) alcohol poisoning is described in the chapter on 
Toxicology.) 
When unable to diagnose exactly the cause of unconsciousness determine, if 
possible, that it is due neither to a poison, to bleeding, nor to sunstroke, for 
each of these demands immediate special treatment, nor to suffocation, for 
which it would be necessary, of course, to give artificial respiration. Then, 
unless it is necessary to give the special treatment, if the patient is pale and 
weak, have him lie down with his head low and warm and stimulate him in 
every way possible; on the contrary, if the face is red and pulse is very strong, 
while the position for the patient should also be lying down, the head should 
be raised. No stimulants should be given in the latter condition, and cold water 
should be sprinkled on the face and chest. 
ACUTE ABDOMINAL CONDITIONS. 
The most common serious acute abdominal conditions are acute appendi- 
citis, perforating ulcers of the stomach or duodenum, intestinal obstruction, 
gall-stone colic, kidney-stone colic, and poisoning by infected food or by other 
poisons. Pain and tenderness in the abdomen, general or localized or both, 
nausea and vomiting, and more or less shock are symptoms common to these 
conditions. Beginning pneumonia, lead poisoning (painter’s colic), and in- 
flammation of the testicle are conditions outside of the abdomen which may 
produce similar symptoms. Acute indigestion and constipation are compara- 
tively mild conditions which may be confused with these conditions. 
Many cases of acute appendicitis, obstruction of the bowels, and acute pan- 
creatitis have been diagnosed as acute indigestion or constipation, resulting in 
the death of the patient. All cases presenting symptoms of abdominal pain or 94 
HOSPITAL CORPS HANDBOOK. 
nausea and vomiting, particularly when associated with more or less shock, 
should be brought under the care of a medical officer as soon as possible, as 
time is a very important element in averting a fatal end in many of these con- 
ditions. One always should suspect something more than ordinary indigestion 
or constipation if there is much prostration, shock, or elevated temperature, or 
if the symptoms persist for any length of time. Many a person suffering from 
acute appendicitis or obstruction of the bowels will ascribe the condition to 
something that has been eaten, but do not be deceived by such a statement. Get 
all the information possible as to how the attack started, history of previous at- 
tacks, and symptoms prior to the present attack, whether the patient has 
vomited blood or not, and when the bowels last moved; take the temperature 
and pulse rate; lay the patient flat with the abdomen bared and determine by 
gentle and careful palpation where the pain and tenderness are most marked. 
Make a white blood count if possible. 
Acute appendicitis.—Appendicitis is an inflammation of the appendix. 
A patient frequently complains for several days before the attack of indiges- 
tion, loss of appetitte, constipation, or diarrhoea and uneasiness in the abdo- 
men, or the attack may come on suddenly. The pain may start in the 
pit of the stomach, then become generalized over the abdomen, and, finally 
after several hours, become localized in the right lower quadrant of the ab- 
domen with marked tenderness on pressure and rigidity of muscles over that 
point. Vomiting generally comes on three or four hours after the beginning 
of the attack. The temperature may he subnormal from mild shock or be 
elevated to 100° or 101° F. There is generally an increase in white blood cells 
to above 10,000 per cubic millimeter. In acute appendicitis the appendix be- 
comes full of pus and the danger lies in its rupture with resulting peritonitis. 
Many cases never rupture, whereas others often rupture in three or four hours 
after the attack starts. The object is to remove the appendix before its 
rupture, as otherwise death may ensue from peritonitis, or the abdomen may 
have to be drained for months with or without final recovery and perhaps re- 
sulting in the formation of adhesions, making the patient more or less of 
a permanent invalid. The treatment consists in placing the patient under 
the care of a surgeon as soon as possible. In the meantime put to bed, 
giving nothing by mouth, not even hot water; give a soap and water enema 
very low and under very little pressure, and put a hot-water bag over the ap- 
pendix. Do not use an ice bag. In case no medical officer is available for some 
time, liquids in small amounts may be given after 48 hours. Never give a 
cathartic to a person suspected of having acute appendicitis. 
Acute intestinal obstruction.—In this condition, a loop of bowel becomes con- 
stricted, resulting in the inability of the intestinal contents to move beyond the 
point of constriction and cutting off the blood supply to this loop of the bowel 
with resulting gangrene or death to the bowel. This condition is followed by 
absorption of poisons from the intestines, peritonitis, and death if the condition 
is not relieved. Two very common ways for the bowel to become constricted are 
by means of adhesions within the abdomen and by a loop of bowel becoming 
strangulated in a hernia, or rupture, as it is commonly called. The symptoms 
are inability to pass gas or foeces by the rectum, pain in the abdomen, vomiting 
becoming more and more frequent, and violent shock. The abdomen may be 
distended above the point of constriction and be flat below that point. There is 
generally a leucocytosis as in appendicitis. The loop of bowel must be relieved 
of its constriction or death will ensue. Place the patient under the care of a 
surgeon at the earliest possible moment. In the meantime, take the following 
measures: (1) If the obstruction is due to a strangulated hernia, and the case FIRST AID AND MINOR SURGERY. 
95 
has not gone too far, put the patient in a hot tub with the buttocks elevated in 
order to relax the inguinal ring, and exert gentle pressure over the tumor. 
(2) Put the patient to bed, give a soap and water enema, and nothing by 
mouth. Never give a person suspected of suffering from obstruction of the 
bowels a purgative. 
Perforated gastric or duodenal ulcer.—Generally, though not always, a person 
suffering from perforated ulcer of the stomach or duodenum gives a long history 
of stomach trouble. Acute pain “ in the pit of the stomach,” associated 
with more or less shock, is suddenly felt. The pain is sudden and intensely 
violent, which is greatly increased by swallowing fluids, by vomiting, by turning 
the body, by cough, by respiration, and by pressure. This pain may radiate 
throughout the abdomen, but the chief tenderness is in the region of the 
stomach. Vomiting occurs in about one-half the cases at the time of perfora- 
tion. Shock may be severe following the perforation, but, as a rule, does not 
last long. A boardlike rigidity of the muscles of the abdomen is present, and 
the temperature is usually normal or subnormal. The danger from perforated 
ulcer of the stomach or duodenum is peritonitis, due to the escape of stomach 
or duodenal contents into the peritoneal cavity. The treatment consists in 
bringing the patient under the care of a surgeon as soon as possible before 
peritonitis sets in; in the meantime, put the patient to bed, give absolutely 
nothing by mouth and put an ice bag over the stomach; and treat shock and 
hemorrhage if present. 
Gall-stone colic.—Gall-stone colic is due to the passage, or the attempt at 
passage, of a gall stone from the gall bladder to the intestines. Depending on 
the location of the stones, a person with gall stones may or may not be jaundiced. 
The patient frequently gives a history of stomach trouble with or without 
jaundice and may give a history of previous gall-stone colic. The colic con- 
sists of spasmodic, excruciating pain over the stomach and liver, radiating 
upward over the right half of the thorax, frequently up under the right shoulder 
blade. The patient is very nauseated, and usually vomits, and often the vomit- 
ing is violent. The abdomen is distended and a condition of collapse soon 
comes on. The respirations are shallow, the patient groans, cries out, or 
flings about the bed, often assuming strange contorted positions, trying to 
obtain relief, frequently holding one hand over the liver region. The pain 
is one of the most excruciating a human being can experience. The usual 
duration of an attack is from 4 to 20 hours, although it might last much longer. 
The temperature is usually normal or subnormal. The patient should be 
brought under the care of a medical officer as soon as possible. If one is not 
at hand, give one-fourth grain of morphine hypodermically, followed in an hour 
by another one-fourtli grain, and place a hot-water bag over the liver at the 
lower border of the ribs. 
Kidney-stone colic.—This condition is due to a small stone from the kidney 
entering into the ureter, which it blocks, tears, or distends. The pain is 
gradual or sudden in onset, is fearful in intensity, and runs from the lumbar 
region down the corresponding thigh and testicle and into the abdomen and 
back. There are nausea, vomiting, collapse, and sometimes unconsciousness or 
convulsions. Frequent attempts at urination result in pain but little urine. 
The urine is often smoky or red from injury to the ureter. After a time the 
pain vanishes, due to the stone falling back into the pelvis of the kidney or 
to its passing on into the bladder. Treatment consists of bringing the patient 
under the care of a medical officer, and, in the meantime, putting to bed, 
giving plenty of water by mouth to increase the flow of urine, putting a 
hot-water bag on the affected side of the abdomen, and, if necessary, giving 
morphine, one-fourth grain hypodermically. 96 
HOSPITAL CORPS HANDBOOK. 
Poisoning causing acute abdominal symptoms.—If the poisoning is due to 
infected foods or foods containing poisonous ptomaines which have been eaten, 
it is probable that more than one person will apply for treatment. The symp- 
toms are vomiting, diarrhoea (at times bloody), fever, abdominal cramps, and 
sometimes considerable prostration. In the absence of a medical officer, clear 
out the intestines with a good dose of castor oil. If a severe case occurs, put 
the patient to bed, give a purge, and allow nothing by mouth except plenty of 
■water, until symptoms abate, then increase diet gradually. (For other types 
of poisoning, see chapter on Toxicology.) 
In case the acute abdominal symptoms are due to inflammation of the 
testicles, there usually will be a history of urethral infection, or mumps, or 
injury to the testicle, and on examination the part will be seen to be tender and 
swollen. Lead poisoning may resemble in its symptoms any acute abdominal 
condition mentioned, particularly acute intestinal obstruction and appendicitis; 
in this case, however, there is a history of working with lead, paint, or in 
compartments laden with lead paint chippings; the so-called “ blue line ” at 
the margin of the gums most likely will be present, and a blood smear stained 
with Wright’s stain will show stippled red cells and probably amemia. In 
case the symptoms are due to a beginning pneumonia, there usually will be a 
history of chills a short time before, the respiration will be increased with a 
rising fever, and perhaps a beginning cough with sputum. There is generally 
a high leucocytosis, even up to 30,000. 
The main principles a first-aid man should remember when treating a case 
with acute abdominal symptoms are: (1) No purgative should be given when 
appendicitis or intestinal obstruction is suspected; (2) the time elapsing 
before surgical aid can be obtained is of the greatest importance for the 
future welfare of the patient; (3) no morphine or opium should be given for 
pain except in frank cases of gall-stone and kidney-stone colic, as this will 
mask the symptoms for the surgeon when he arrives. 
SOME COMMON EMERGENCY SYMPTOMS. 
Fever is a name given to a group of symptoms consisting of a rise of temper- 
ature above normal (98.6° Fv), with attendant increase in the pulse rate and 
a rise in the number of respirations per minute; associated with which are 
generally headache and flushing of the face, a feeling of weakness, irritability, 
and loss of appetite. Fever is simply a group of symptoms and is not a 
disease in itself. Fever is one of the main symptoms of all infectious diseases 
and infections and for some time may be the only evidence of an infection 
or an infectious disease. It may, however, simply be due to the results of 
constipation, with absorption of poisonous products from the intestine, but 
as a rule the temperature in these cases does not go above 101° F. 
Handling a fever ease.—If possible bring the patient under the care of a 
medical oflicer. The problem in a case of fever is to And the cause if possible. 
Get the history of the case, how long there has been fever, what other symp- 
toms have been or are present; if there has been exposure to an acute infec- 
tious disease, or constipation; and examine the throat and skin for evidences 
of the cause. If no other symptoms are present but an acute fever, which is 
not very high, and if the patient is not particularly sick, a good purgative 
probably will give relief. Do not load the patient up with drugs. Constipa- 
tion with fever is spoken of as autointoxication. If the patient has a high 
fever and is sick, give a brisk purgative, put to bed on a liquid diet, and 
put an ice bag on the head. In the meantime try to obtain the services of FIRST AID AFD MIFOR SURGERY. 
97 
a medical officer and watch the patient carefully for symptoms which will point 
the way to ascertaining the cause of his fever. In case the beginning of an 
infectious disease is suspected the patient, of course, should he isolated. 
A cold.—The term “ cold ” is applied to a group of symptoms consisting of a 
running at the nose, lachrymation (overflow of tears), fever, generally with 
headache and malaise (opposite of well-being). These symptoms may be due 
to a so-called common cold or they may be forerunners of such infectious dis- 
eases as influenza, measles, infantile paralysis, or cerebrospinal fever. If the 
patient is quite sick, fever high, and depression is marked, particularly if there 
has been exposure to the above-mentioned infectious diseases, suspect that 
it is something more than a common cold, and, if possible, place under the 
care of a medical officer. Find out whether the patient has been recently ex- 
posed to the above diseases, and by questions and examination ascertain whether 
further symptoms are present which may lead to a diagnosis. Give the pa- 
tient a brisk purgative; isolate, and keep on the lookout for further symp- 
toms. If the case is one of common cold, a brisk purgative should be given 
early, the patient advised to drink plenty of water, and hot drinks given at 
night, possibly with 10 grains of aspirin, or Dover’s powder, to stimulate per- 
spiration. 
Headache.—Headache may be due to a great variety of causes. It is a very 
constant accompaniment of fever, of acute infectious diseases, of autointoxica- 
tion (see above), and of head injuries. It very frequently is due to eye strain. 
In all cases of headache it is well always to take the temperature and to inquire 
into the condition of the patient’s bowels. There must be a cause, and the 
problem is to find it. Do not try to cure headaches with drugs without trying 
to find out the cause, except perhaps in emergency 10 grains of aspirin may be 
given after a good purgative. Patients with frequent headaches should always 
consult a medical officer when available. 
Diarrhoea.—Diarrhoea is a term applied to a condition characterized by the 
passage of frequent, watery stools. It may be due to diseases such as dysen- 
tery, meat or other poisoning, typhoid or other fever, or simply to the presence 
in the intestine of some irritating material from fermentation and putrefaction. 
Always take the temperature of a person suffering from diarrhoea; question 
and examine for any other symptoms present or for information able to be 
given. All cases of severe or continued diarrhoea should be brought under the 
care of a medical officer. In case the diarrhoea is due to overeating, with con- 
sequent absorption of the products of intestinal putrefaction, administer a 
brisk cathartic to get rid of the offending material. 
Hiccough.—Hiccough usually is due to overeating and indigestion. It is 
caused by spasmodic construction of the diaphragm, the great muscle wThich 
separates the chest from the abdomen. This is the reason that holding the 
breath as long as possible usually will cure this condition, as the air in the 
chest forces the diaphragm down so that it does not contract. Drinking a 
large glass of water in small sips without taking a breath has exactly the same 
effect. A sudden fright occasionally stops a hiccough, because it causes the 
patient to take a long breath. If none of these methods are successful, removal 
of the irritating material from the stomach by vomiting almost always will cure 
the hiccough. It may, however, be due to some constitutional disease, such as 
Bright’s disease, and persistent cases should be brought under the care of a 
medical officer. 
Convulsions.—Convulsions are most commonly due to epilepsy, hysteria, and 
various kinds of poisoning. See paragraphs on unconsciousness and chapter 
on Toxicology. The ti'eatment consists in summoning a medical officer, keeping 98 
HOSPITAL CORPS HANDBOOK. 
the patient from biting the tongue or inflicting other injury, and finding out 
all you can to ascertain the cause. 
Earache.—Earache may be due to a diseased molar tooth, to beginning 
mumps, to a stoppage of the Eustachian tube from an inflammation of the 
throat, and from inflammation or abscess of the external auditory canal of 
the ear drum or of the middle ear. In treating, examine the teeth and if there 
is a molar tooth diseased on the affected side, treat it as described in the 
section on Dental First Aid. Examine the throat, and if it is inflamed treat it 
as described below. Examine for beginning mumps by feeling back of the angle 
of the jaw for tenderness and swelling and put some dilute acetic acid on the 
back of the tongue to see whether it causes pain and aching in that locality. 
Pull the ear upward and backward and see if there is swelling and redness in 
the external auditory canal; if so, the earache is due to inflammation here or in 
the middle ear. Inflammation of the middle ear is dangerous, owing to the 
possibility of extension of the process into the mastoid cells, and from there 
to the brain unless prompt surgical attention is given. If the earache is due 
to inflammation of the middle ear, get the patient under the care of a surgeon 
as soon possible, as the ear drum probably will have to be incised. In 
the meantime, for inflammation of the external auditory canal or middle ear, 
put the patient to bed with hot applications or a hot-water bottle on the 
affected ear. 
Chills.—Chills may be simply the result of overexposure to cold and wet, 
or may be the forerunner of pneumonia, or part of an attack of malarial fever 
or other disease. Always watch the patient with a chill for other symptoms 
during and after the chills. The immediate treatment consists of putting 
the patient in bed between hot blankets, using hot water bags, and giving 
hot drinks. 
Sore throat.—Sore throat may be one of the symptoms in quite a large 
number of diseases, particularly ordinary tonsillitis, diphtheria, scarlet fever, 
Vincent’s angina, and syphilis. Always have these diseases in mind in a 
case of sore throat, and never fail to examine thoroughly the throat in all 
cases. If a membrane is present in the throat, the case may be one of ordinary 
tonsillitis, of diphtheria, or of scarlet fever. If ulcers are present on the 
throat, syphilis may be the cause. A good treatment for an ordinary sore 
throat is to give a brisk cathartic, have the patient gargle his throat every 
hour with Dobell’s solution or diluted vinegar, and, after gargling, to paint the 
throat with Lugol’s solution of iodine. When possible, always make a smear 
and stain from the throat of a case of tonsillitis and examine for diphtheria 
organisms. When in doubt about a case, isolate it and bring it under the 
care of a medical officer as soon as possible. 
References. 
Modern. Surgery.—Da Costa. 
Traumatic Surgery.—Moorhead. 
Operative Surgery.—Binnie. 
The Treatment of Injuries.—Owen. 
Bandages and Bandaging.1 
Bandages are employed to hold dressings applied to the surface of the 
body, to secure splints in the treatment of fractures and dislocations, to create 
pressure, to immobilize joints, and to correct deformity. 
1 Prepared by Lieut. W. W. Behlow, Medical Corps, United States Navy. BANDAGES AND BANDAGING. 
99 
Various materials are employed in making bandages, such as gauze, flannel, 
crinoline, muslin, linen, rubber, and elastic webbing. Gauze frequently is used 
because it is light, soft, thin, porous, readily adjusted and easily applied. 
Flannel, being soft and elastic, may be applied smoothly and evenly, and as 
it absorbs moisture and maintains bodily heat, is very useful for certain 
conditions. Crinoline, rather than gauze, is used in making plaster of Paris 
bandages, as the mesh of the crinoline holds the plaster more satisfactorily 
than gauze. Muslin is employed in making bandages because it is inexpen- 
sive and readily obtainable. It should be soaked in water to cause shrinkage, 
dried, and finally ironed to remove wrinkles. A large piece of this material 
easily may be torn into strips of the desired width. 
Rubber and elastic webbing are used to afford firm support to a part. 
The webbing is preferable to the pure rubber bandage, as it permits the 
evaporation of moisture. 
It is of the greatest importance that a hospital corpsman should become 
familiar with the general rules of bandaging and proficient in the application 
of the various types of bandages. The comfort of a patient, the security of 
the dressing, and the professional reputation of the hospital corpsman depend 
upon the proper application of a bandage. A neatly and properly applied 
bandage is an indication that the dressing covered by the bandage has been 
properly performed. An untidy, uncomfortable, insecure, improperly applied 
bandage reasonably may lead one to suspect that the underlying dressing 
is of the same character and can result only in adverse criticism. 
Various types of bandages, commonly used, are the roller bandage, the 
triangular bandage, and the many-tailed bandage. 
The roller bandage is made from one of the above-mentioned materials, the 
width and length depending upon the part to be bandaged. For convenience 
and ease of application, the strip of material is rolled into the form of a 
cylinder. Each bandage of this type should consist of only one piece, free 
from wrinkles, seams, selvage, and any imperfections that may cause dis- 
comfort to the patient. Although there are various types of mechanical 
appliances used in winding bandages it is essential that hospital corpsmen 
should be able to roll a bandage by hand. 
The strips of bandage material should be folded at one extremity several 
times to form a small, firm cylinder. This cylinder is held by its extremities 
with the index finger and thumb of the left hand. The free end of the bandage 
is held between the index finger and thumb of the right hand, close to the 
cylinder. With this hand the bandage then is revolved around the cylinder, 
which is held in the left hand, the free fingers of which aid in turning the 
cylindrical roll. The amount of tension exerted upon the free end will de- 
termine the firmness of the completed roller. A roller bandage consists of 
the free end or initial extremity, the body, and the terminal extremity in the 
center of the cylinder. 
The length and width of bandages vary according to the purposes for 
which they are employed. The sizes most frequently used are: 1 inch 
wide, 3 yards long, for the hand, fingers, and toes; 2 inches wide, 6 yards long, 
for head bandages; 2\ inches wide, 7 yards long, for extremities; 3 inches 
wide, 9 yards long, for thigh, groin and trunk. 
GENERAL RULES FOR BANDAGING. 
In applying a bandage, the initial extremity is held in the left hand with the 
external surface of the bandage applied to the part. The roll is held firmly 
in the right hand, which controls the tension and actual application of the 100 
HOSPITAL CORPS HANDBOOK. 
bandage. It may be necessary, at times, to transfer the roll from the right 
to the left hand. 
Bandages should be applied evenly, firmly, and not too tightly. Excessive 
pressure may cause interference with the circulation and may lead to disastrous 
consequences. In bandaging an extremity it is therefore advisable to leave 
the fingers or toes exposed in order that the circulation of these parts may 
be readily observed. It is likewise safer to apply a large number of turns 
of a bandage rather than to depend upon a few too firmly applied turns to 
secure a splint or dressing. 
In applying a wet bandage, or one that may become wet in holding a wet 
dressing in place, it is necessary to allow for shrinkage. The turns of a 
bandage should completely cover the skin, as any uncovered areas of skin 
may become pinched between the turns, with resulting discomfort. 
Bandages should be applied in such a manner that skin surfaces are not 
brought into contact, as perspiration will cause excoriation and maceration 
of the skin. 
In bandaging an extremity it is advisable to include the whole member 
(arm and hand, leg and foot), excepting the fingers and toes, in order that 
uniform pressure may he maintained throughout. It is also desirable in 
bandaging a limb that the part be placed in the position it will occupy when 
the dressing is finally completed, as variations in flexion or extension of the 
part will cause changes in the pressure of certain parts of the bandage. 
The initial turns of a bandage of an extremity (including spica bandages 
of the hip and shoulder) always should be applied securely, and, when possible, 
around the part of the limb that has the smallest circumference. Thus in 
bandaging the arm or hand the initial turns usually are applied around the 
wrist, and in bandaging the leg or foot the initial turns are applied im- 
mediately above the ankle. 
In order to prevent slipping of the initial turns, it is advisable to fold about 
one-half inch of one edge of the bandage under each turn as it is applied. This 
improvised hem not only will aid in anchoring the initial extremity of the 
bandage but also provides a finished, even, neat, cuff-like border. When the 
size of the part and of the bandage permit, the exposed edge of each turn 
also should be folded under, as described above, as the finished bandage then 
presents a neat appearance, and the exposed edge will not become frayed or 
unraveled. In ascending bandages, the exposed edge will be the lower edge 
of the bandage, whereas in descending bandages the exposed edge will be the 
upper edge of the bandage. The final turns of a completed bandage usually 
are secured in the same manner as are the initial turns, by the employment 
of two or more circular turns. As both edges of the final circular turn are 
necessarily exposed, they should be folded under to present a neat, cuff-like 
appearance. The terminal extremity of the completed bandage is turned 
under and secured to the final turns by either a safety pin or adhesive tape. 
When these are not available, the end of the bandage may be split lengthwise 
for several inches, and the two resulting tails secured around the part by 
tying. 
When the turns of a bandage cross each ocher, as in the figure-of-eight, 
the spiral reverse, and the spica, the line of crossings should be straight, and 
if practicable, should be in the center line of the part bandaged, but the line 
of crossings should not be over a bony prominence. Likewise the exposed 
portion of each turn should be of approximately the same width. 
In removing a bandage, it may be cut, preferably with bandage scissors. 
In doing so the operator should be careful to avoid interference with the un- 
derlying dressing and the affected area. BANDAGES AND BANDAGING. 
101 
If tlie bandage is removed without cutting, its folds should be gathered 
up in first one and then the other hand as the bandage is unwound. This 
procedure will facilitate removal and the rewinding of the 
bandage, if that he desirable. 
APPLICATION OF BANDAGES AND THEIR USES. 
Circular bandage.—After anchoring the initial turns 
of the bandage, as described in a previous paragraph, a 
series of circular turns is made around the part. Bach 
turn should overlie accurately the turn beneath it, neither 
ascending nor descending. Uses: Itetention of dressing 
to a limited portion of an extremity, the neck, or the head; 
compression to control venous haemorrhage and to promote 
venous stasis. 
Spiral bandage.—After anchoring the initial turns, each 
turn is applied in a spiral direction in such a manner as to 
overlie one-third of the preceding turn. (Fig. 72.) As 
usually applied to an extremity the upper edge of each 
turn of an ascending spiral is tighter than the lower edge 
with resulting inequality of pressure. For this reason 
many surgeons object to its use on an extremity. How- 
ever, this apparent fault may be overcome to a great 
extent by applying the bandage in the manner described 
in a preceding paragraph. Uses: Retention of dressings of the arm, chest, 
and abdomen. 
Oblique bandage.—A series of oblique turns are applied around a part in 
such a manner as to have an uncovered area between turns. The width of the 
uncovered area should be uniform throughout. 
Uses: Retention of thick dressings or of tem- 
porary dressings which require frequent removal. 
Recurrent bandage.—In applying this band- 
age, the roller, after securing the primary turns, 
is carried completely over a part to a point 
opposite its origin, and then reflected and 
brought back to the starting point, where it is 
secured by one or more circular turns. 
In the recurrent bandage of the hand, the 
bandage is secured at the wrist, carried over 
the back of the hand, around the tips of the 
fingers, across the palm to the wrist. Held at 
this point by the disengaged hand of the oper- 
ator, the bandage is carried across the palm 
around the tips of the fingers, across the back 
of the hand to the wrist, where it is held by 
the thumb of the operator’s disengaged hand. 
Each turn overlies one-third of the preceding 
turn. The original turn over the fingers may 
cover the middle and ring fingers, with each 
succeeding turn applied alternately over the other fingers first to one side and then 
to the other of the middle finger; or the original turn over the fingers may be ap- 
plied over the first finger or over the little finger, each subsequent turn covering 
a portion of the remaining exposed fingers. The reflected portion of the bandage 
at the wrist is then secured by a number of circular turns. It is customary to 
complete such a bandage with a figure-of-eight bandage enclosing the entire hand. 
Fig. 72.—Spiral band- 
age. (Owen.) 
Fig. 73.—Figure-of-eight 
bandage. (Wharton, modi- 
fied.) 102 
HOSPITAL CORPS HANDBOOK. 
Figure-of-eight bandage.—This is undoubtedly the most useful bandage and, 
with its various modifications, probably is employed more frequently than any 
other bandage. The hospital corpsman should perfect himself in the applica- 
tion of this bandage, as, with a few exceptions, the majority of bandages are ap- 
plied on the principle of the figure of eight. Its name is derived from the fact 
that the turns are applied so as to form a figure 8. Although it is employed 
commonly in bandages of the joints (elbow, knee, and ankle), it frequently is 
applied in bandaging the neck and axilla, the head and neck, and the head and 
jaw (Barton). If properly applied, it may be used very successfully in bandag- 
ing the extremities. 
Figure-of-eight of hand and wrist.—After anchoring the bandage with two 
circular turns about the wrist the bandage is carried across the back of the 
hand to the base of the fingers, then into the palm, across the palm to the back 
of the hand, and across the back of the hand to the starting point at the wrist, 
where one circular turn is made. This general course is followed with several 
similar turns, each one overlying about one third of the preceding turn on the 
back of the hand. After a sufficient number of turns has been made, the 
bandage is terminated with a circular 
turn around the wrist. Uses: Retention 
of dressings on the back of the hand or 
in the palm. (Fig. 73.) 
Figure-of-eight of forearm.—This band- 
age may be the continuation of the figure- 
of-eight of the wrist and hand, or may 
be started with primary circular turns 
of the wrist. The bandage is carried 
obliquely upward across the back of the 
forearm and around the arm in its natu- 
ral course, where it forms the upper 
loop of the figure-of-eight. The bandage 
then is carried in an oblique direction 
downward, across the back of the arm, 
where it crosses the upward turn of the 
bondage. Then it is carried around the lower end of the forearm to complete 
the lower loop of the figure-of-eight. The same process is repeated several 
times until the elbow is reached, each turn overlapping the upper one-half or 
three-quarters of the preceding turn. The bandage is terminated finally with 
two or more circular turns at the elbow. The final circular turn, with both 
upper and lower edges of the bandage folded under, should be applied firmly 
and should present a neat cuft'-like appearance at the upper end of the com- 
pleted bandage. 
During the application of this bandage there is always considerable slack in 
one edge of the bandage where it is carried around the arm. As the bandaging 
proceeds, however, these loose edges are covered by the ascending turns of the 
bandage. Uses: Retention of dressings and covering of splints. (Fig. 73.) 
The spiral reverse bandage of the arm.—This bandage is in reality a modifi- 
cation of the figure-of-eight, in that only the lower loop or one-half of the figure 
of eight is completed. After anchoring the primary turns, the bandage is car- 
ried obliquely upward on the back of the arm. When this turn reaches the 
center line of the arm, the thumb of the disengaged (usually the left) hand is 
placed upon the body of the bandage to hold it securely in place upon the arm. 
The operator then unrolls about 5 or 6 inches of bandage which is held slack 
and is folded upon itself by changing the position of the hand holding the 
Fig. 74.—Spiral reverse. (Eliason.) BANDAGES AND BANDAGING. 
103 
roller from supination to pronation. The bandage then is carried obliquely 
downward across the arm to a point opposite that from which the ascending 
turn started. It then is tightened slightly to conform to the part accu- 
rately, then is carried around the limb and the procedure is repeated. It 
is necessary to retain the thumb upon the point of reverse until the succeed- 
ing turn reaches that point. As in the figure-of-eight, each turn should overlie 
at least one-third of the preceding turn, and the reverses should be in a straight 
line. (Fig. 74.) 
Complete bandage of the hand.—After securing the initial turns around the 
wrist, a recurrent bandage of the hand is applied. The bandage then is carried 
obliquely across the back of the hand to the tip of the index finger. A circular 
turn is made around the ends of the fingers. The fingers and hand then are 
covered by a figure-of-eight or spiral reverse bandage, which finally is completed 
by two or more circular turns around the wrist. This bandage may or may not 
be applied to include the thumb. Uses: Retention of dressings of the hand. 
(Fig. 75.) 
Demigauntlet bandage.—Using a 1-inch bandage, secure the initial turns at 
the wrist and carry the bandage across the back of the hand to the base of 
Fig. 75.—Complete 
bandage of hand. 
(Wharton.) 
Fig. 76.—Demigaunt- 
let of hand. (Whar- 
ton.) 
FiG. 77.—Gauntlet 
bandage of hand. 
(Wharton.) 
the thumb, around the thumb, across the back of the hand to the wrist, where 
a circular turn is made. The same procedure is repeated successively for 
each finger and the bandage finally terminated with a circular turn around the 
wrist. (Uses: Retention of dressings on back of hand. (Fig. 76.) 
The gauntlet.—The demigauntlet bandage may be extended to include the 
entire thumb and fingers with either simple spiral turns or spiral reverse turns 
of each digit. (Fig. 77.) 
Figure-of-eiglit bandage of the elbow.—With the elbow in the desired posi- 
tion, the initial extremity is secured by circular turns around the forearm just 
below the elbow. The bandage then is carried upward over the flexure of the 
elbow in an oblique direction and passed around the arm just above the elbow, 
where a circular turn is made, and then is carried obliquely down- 
ward across the flexure and passed around the forearm. This procedure is 
repeated, with each turn overlying the preceding turn, the turns of the forearm 
ascending and those of the arm descending until the entire joint is covered. 
The final one is a circular turn around the elbow joint itself. This bandage 
may be started with a circular turn around the joint followed by figure-of- 
eight turns covering the upper part of the forearm and the lower part of the 
arm. Uses: Retention of dressings around the elbow joint. 104 
Spica bandage of right shoulder (ascending).—After securing the initial ex- 
tremity by two circular turns around the arm opposite the axillary fold, the 
bandage is carried diagonally across the arm and front of the chest to the 
axilla of the opposite side, then around the back of the chest, across the arm 
and the upward turn to the point of origin. After carry- 
ing the bandage around the arm, this procedure is re- 
peated, each turn overlying about two-thirds of the pre- 
ceding turn until the entire shoulder is covered. The 
turns should cross in a straight line extending up the 
center line of the arm over the point of the shoulder. 
Likewise the turns across the chest and back should over- 
lap each other uniformly, and the turns in the opposite 
axilla should overlap each other exactly. The bandage 
may be secured by either a pin or by adhesive tape. Uses: Retention of 
dressings of shoulder and axilla, and of shoulder cap. (Fig. 78.) 
Bandages of the lower extremity.—The bandages described in the preceding 
paragraphs may be applied to the corre- 
sponding parts of the lower extremity. 
However, a description of a few of the 
special bandages of the lower extremity 
is considered advisable. 
Spica bandage of the groin (ascend- 
ing).— After securing the initial turns 
around the upper part of the thigh just 
below the groin, the bandage is carried 
obliquely upward across the lower ab- 
domen to the iliac crest of the opposite 
side, transversely across the back and 
then downward obliquely across the front of the thigh, across the upward turn 
of the bandage and around the thigh to the point or origin, thus completing a 
figure-of-eight. This is repeated several times until the entire groin is covered, 
each turn overlying about two-thirds of the preceding 
turn. The same care in regard to the line of crossings of 
the turns and to the uniform overlapping of the bandage 
on the abdomen should be observed, as is noted in the de- 
scription of the spica bandage of the shoulder. Uses: Re- 
tention of dressings in region of the groin. (Fig. 81.) 
Spica bandage of the foot.—The initial extremity is 
secured by two circular turns around the legt just above 
the ankle. The bandage then is carried across the dorsum 
of the foot to the base of the toes where a circular turn is 
made around the foot. After two or three spiral reverse 
turns are made the bandage is carried across the dorsum 
of the foot, backward alongside of the heel, around the 
heel, forward along the other side of the heel across the 
preceding upward turn on the dorsum of the foot and 
around the foot to the starting point of the turn. This 
pi’ocess is x-epeated, the turns gradually ascending on both 
the foot and the heel, the crossings of bandage being in 
the midline of the dorsum of the foot. The bandage finally is carried upward 
around the ankle and secured by two or more circular turns at its original 
stai’ting point. It is possible to apply this bandage without the use of the spiral 
reverse turns, by employing the figui’e-of-eight throughout. Uses: Retention of 
dressings on the foot, and support for sprained ankle. (Fig. 82.) 
HOSPITAL COEPS HANDBOOK. 
Fig. 78.—Spica of 
thumb. (Whar- 
ton.) 
Fig. 79.—Spica of the shoulder. Spica 
loops of the shoulder. (Eliason.) 
Fig. 80.—Bandage 
of stump. (Whar- 
ton.) BANDAGES AND BANDAGING. 
105 
Bandage of foot, not covering the heel {French).—After securing the initial 
extremity by two circular turns around the leg just above the ankle the bandage 
is carried obliquely across the dorsum of the foot to the base of the toes where 
a circular turn is made around the foot. The bandage is carried up the foot 
by a few spiral reverse turns crossing in the center line, and then applied as 
a figure-of-eight around the ankle and instep. The bandage may be terminated 
just above the ankle or be extended up the leg as far as may be necessary. It 
Fig. 81.—Ascending spica. Descend- 
ing spica. (Eliason.) 
Fig. 82.-—Spica of the foot (first step). 
Spica of the foot (completed). (Ella- 
sou.) 
is frequently practicable to apply this bandage without employing the spiral 
reverse turns, the figure-of-eight being applied following the circular turns at 
the base of the toes. Uses: Retention of dressings of foot. This bandage 
usually is employed in application of bandages covering the entire leg. 
Special bandages. 
Velpeau bandage.—The fingers of the affected side are placed upon the oppo- 
site shoulder, a pad placed in the axilla, and the skin surfaces separated by 
sheet wadding. Place the initial extremity of the band- 
age on the shoulder blade of the sound side, carry 
the bandage across the outer portion of the affected 
shoulder, downward over the outer and posterior sur- 
face of the flexed arm, behind the point of the elbow, 
obliquely across the back of the forearm and chest to the 
opposite axilla, and around to the point of origin. After 
repeating this turn once, the bandage is carried from 
the point of origin across the back and side of chest, 
in front of the flexed elbow and transversely across 
the front of the chest. Then it is carried around the 
other side of the chest, diagonally across the back to the 
affected shoulder. The first turn then is repeated, fol- 
lowed by a second circular turn around the chest and 
flexed arm. Each vertical turn over the shoulder overlaps two-thirds of the pre- 
ceding turn, ascending from the outer part of the shoulder to the neck and from 
the upper posterior surface of the arm inward toward the point of the elbow. 
Each transverse turn also overlies one-third of the preceding turn. These 
transverse turns are continued until’the last turn covers the wrist. The band- 
age is finally secured with pins, both where it ends and at various points 
where the turns of the bandage cross each other. (The initial turns of this 
bandage may be secured by circular turns around the chest under the arm of 
the affected side.) Uses: Fixation of arm in treatment of fractured clavicle 
Pig. 83.—Velpeau 
(start). (Elia- 
son.) 106 
HOSPITAL CORPS HANDBOOK. 
and fixation of humerus after reduction of dislocated shoulder joint. (Figs. 
83, 84, 85.) 
Barton bandage.—With the initial extremity of the bandage applied to the 
head just behind the right mastoid process the bandage is carried under the 
bony prominence at the back of the head, upward and forward back of the left 
ear, obliquely across the top of the head, downward in front of the right ear, 
under the chin, upward in front of left ear, obliquely 
across the top of the head, crossing the first turn 
in the midline of the head, thence backward and down- 
ward to the point of origin behind the right mastoid. 
Then it is carried around the back of the head under 
the left ear, around the front of the chin, under the 
right ear to the point of origin. This procedure is 
repeated several times, each turn exactly overlying the 
preceding turn. The bandage is secured with a pin or 
strip of adhesive tape, and either a pin or adhesive 
may be applied at the crossing on top of the head. 
Uses: Fracture of lower jaw; retention of dressings of 
chin. (Fig. 86.) 
Recurrent bandage of head (Mellon bandage).—The initial turns are applied 
around the head, passing around the nape of the neck, above each ear and 
around the forehead. When the bandage has reached the center of the fore- 
head on the third turn, its free margin is held by a finger of the left hand and 
the bandage is reversed and carried over the top of the head in the center line 
to the nape of the neck. With an assistant holding the bandage at the latter 
point, it is reflected forward over the top of the head covering the right half of 
Fig. 84.—Velpeau 
(posterior view). 
(Eliason.) 
Fig. 85. — Velpeau bandage. 
(Wharton.) 
Fig. 86.—Barton bandage. 
(Wliarton.) 
the preceding turn. When it reaches the forehead in the midline it again is 
reflected over the top of the head, overlying the left half of the first turn. At 
the nape of the neck in the center line it is again reflected and carried forward 
overlying the outer half of the second turn. This process is repeated until the 
entire head is covered, the turns alternating to the right and left of the center 
line. The bandage finally is completed by several circular turns overlying the 
original turns and fixing the ends of antero-posterior turns at the nape of the 
neck and on the forehead, where pins should be applied to provide additional 
security. Uses: Retention of dressings of wounds of the scalp, of fractures 
and operative wounds of the skull. (This bandage may be applied with the BANDAGES AND BANDAGING. 
107 
turns over the head in a transverse direction extending from ear to ear.) 
(Fig. 87.) 
Crossed bandage of one eye.—The initial extremity is secured by a circular 
turn around the head below the bony prominence at the back, above both ears 
and across the forehead. The bandage then is carried from the back of the 
head, below the ear, obliquely across the outer part of the cheek to the base 
of the nose at its junction with the forehead, over the opposite side of the 
head and downward behind the mastoid process. A circular turn then is car- 
ried around the head, overlying exactly the original turns. A second turn 
under the ear and across the face and head then is 
applied, overlapping the upper two-thirds of the preced- 
ing turn. These alternating turns are repeated until the 
eye (and if more comfortable, the ear on the same side) 
is completely covered. The bandage is completed with a 
final circular turn around the head. Uses: Retention of 
dressing of the eye. (Fig. 87.) 
Crossed bandage of both eyes.—The initial turns are 
applied as above, and the bandage carried forward below 
the right ear, diagonally upward across the cheek to the 
base of the nose and over the opposite side of the head 
above the left ear, and downward behind the left 
mastoid process. Then a circular turn is applied. When 
the roller reaches the back of the head below the 
bony prominence it is carried obliquely forward and slightly upward over the 
right ear across the forehead and downward over the left eye, the lower margin 
of the bandage crossing the previous turn at the junction of the nose with the 
forehead. The bandage then is carried across the left cheek below the left ear 
and backward to the nape of the neck. Then a circular turn is made, followed 
by a repetition of the previous turns across the eyes, each circular turn accu- 
rately covering its predecessor and each oblique turn overlying the upper 
one-half of the preceding turn, until 
both eyes are completely covered. The 
ears may or may not be included in the 
bandage, which is completed by two 
circular turns around the head. Pins 
are placed at the intersections of the 
bandage. (Fig. 88.) 
Sayre dressing.—This consists of two 
strips of adhesive plaster 3 inches 
wide and 2 yards long. Two circular 
turns of a flannel bandage, 4 inches 
wide, are applied to the arm of the 
affected side just below the axillary 
fold. The end of one adhesive strip is looped around the arm (overly- 
ing the flannel bandage) and pinned, with the loop sufficiently large not to 
constrict the arm. With the arm drawn upward and backward, the strip 
of plaster is carried across the back and around the opposite side of the 
chest. It may end here or be carried completely around the chest. The 
hand of the injured side now is placed as near as possible to the shoulder 
of the sound side, the skin surfaces being separated by sheet wadding. The 
end of the second strip is applied over the scapula of the affected side (some 
surgeons start this strip at the top of the posterior surface of the arm of 
47829°—23 8 
Fig. 87. — Recurrent 
turns. (Eliason.) 
Fig. 88.—Crossed bandage (figure-of- 
eight) of the eye. Crossed bandage 
of both eyes. (Eliason.) 108 
HOSPITAL CORPS HANDBOOK. 
the affected side; others apply the initial extremity of this strip on the 
shoulder of the sound side) and is carried downward on the posterior surface 
of the arm of the affected side, under the point of the elbow, diagonally 
across the chest on the posterior surface of the forearm and hand, over the 
sound shoulder down the back where it joins the first strip of plaster. A 
small hole is cut in this strip to receive the point of the elbow, which must 
be protected by a layer of cotton or sheet wadding. Then the entire dressing 
is covered with a Velpeau bandage. Uses: Treatment of fractures of the 
clavicle. (Fig. 89.) 
“T ” bandage.—This bandage consists of a horizontal bandage to which 
is attached, about its middle, a vertical bandage of approximately one-half 
the length of the horizontal bandage. The horizontal portion is employed to 
secure the bandage to the body, the vertical portion being used to retain 
dressings. This bandage is very useful in retaining dressings about the 
perineum and anal region. When used for this purpose, the horizontal band 
is applied around the abdomen above the iliac crests, in such a manner that 
the vertical portion is placed exactly in the midline of the back directly over 
the spine. The vertical portion then is brought forward between the thighs 
and secured to the horizontal portion in 
front of the abdomen. The vertical portion 
may be split longitudinally to form two strips 
of equal width. 
Double “ T ” bandage.—This differs from 
the above in having two vertical strips in- 
stead of only one. The horizontal portion 
may be of any desired width. It frequently 
is used for the retention of dressings of the 
chest, breast, and abdomen. When so em- 
ployed the two vertical strips are carried 
over the shoulders from the back to the front 
and secured by pins to the horizontal portion. 
Many-tailed bandage. — The four-tailed 
bandage readily is made by splitting a strip 
of muslin or other material of the desired width, lengthwise, within a few 
inches of the center of the strip. This provides a bandage with a body and 
four tails. 
The many-tailed bandage is prepared in a similar manner, by splitting the 
muslin or other material into several strips, having a sufficiently large area 
in the center for the retention of dressings, etc. The number of tails on 
each side should be the same. 
Plaster of Paris bandage.—These bandages are prepared by impregnating 
the meshes of crinoline with plaster of Paris of the extra calcined, dental 
variety. A strip of crinoline about 3 or 4 inches wide, and usually 4 or 
5 yards long, is placed on a table. Plaster of Paris then is dusted upon 
the strip, and evenly rubbed into the meshes of the fabric. A very satisfactory 
method of preparing this bandage is by constructing a wooden box, 12 inches 
long, 6 inches wide and 3 inches deep, and at each end, just above the bottom 
of the box, cutting a slit 5 inches long and one-eighth to one-quarter inch 
wide. The end of the bandage is drawn into the box through one slit, across 
the bottom of the box, and out of the box through the other slit. A sufficient 
quantity of the plaster of Paris to cover the bandage with a layer of pow- 
der 1 inch deep is placed in the box. As the bandage is drawn through, 
plaster of Taris is rubbed into the meshes with the hand or preferably with 
Fig. 89.—Sayre’s dressing for frac- 
ture of the clavicle, showing 
application of first and second 
strips. (Wharton.) BANDAGES AND BANDAGING. 
109 
a smooth piece of wood approximately 4 inches in length. The bandage may 
be loosely rolled into a cylinder as it emerges from the box. If the bandages 
are not to be used within a few hours, they should be wrapped in paper to 
prevent absorption of moisture. 
Application of the plaster-of-Paris bandage.—The part to be encased in 
plaster of Paris should be covered with a suitable bandage of soft material, 
preferably flannel. The bony prominences should be well protected with cot- 
ton. Care should be taken to remove all creases in the dressing and bandage. 
Two rolls of the plaster-of-Paris bandage are placed in warm water. When 
bubbles cease to arise from the bandage one roll is removed from the water, 
the excess water being expressed by grasping the roll at its two ends and 
exerting pressure with the hands. This method prevents the loss of a con- 
siderable amount of plaster through the ends of the roll. (Note.—As soon as 
a bandage is removed from the water replace it with another bandage.) 
The bandage should be applied rapidly and evenly to the limb. No special 
form of bandage is necessary, as it is sufficient that the part be properly cov- 
ered. The second bandage is applied as soon as the first has been completed. 
During the application of the bandage it should be rubbed with the hands in 
order to provide a smooth even surface. It also is desirable to rub some loose 
plaster into the dressing. When the final roller has been applied the surface 
of the completed dressing should be rubbed evenly with liquid plaster prepared 
by addition of water to dry plaster until it has the consistency of thick cream. 
In many cases, such as compound fractures, it is frequently necessary to 
provide access to certain areas of the encased limb. After the bandage has 
partially set a “ window ” or trap may be cut in the bandage over the desired 
area. 
Removal of a plaster-of-Paris bandage may be accomplished with the aid of 
a plaster saw. If none is available the plaster may be softened with a small 
amount of peroxide of hydrogen, hydrochloric acid, or vinegar, and then may 
be cut with a knife. 
Uses: Fixation of fractures; ambulant treatment of fractures; fixation and 
treatment of injuries and diseases of joints. 
Starched bandage.—This bandage may be obtained already prepared or it 
may be prepared in the following manner: Starch is mixed with cold water 
until a thin, creamy mixture results. This is heated to form a clear mucilagi- 
nous liquid. The part should he covered with a flannel bandage over which 
a gauze bandage is applied. The starch then is rubbed evenly into the 
meshes of the material. A second gauze bandage is applied and again treated 
with the starch mixture. This may be repeated until the desired thickness of 
the bandage is obtained. 
Bandages impregnated with starch may be moistened and applied wet to a 
part. This type of bandage is occasionally useful in the treatment of sprains 
of the thumb or fingers. 
Triangular bandage.—This bandage is useful in emergencies when the mate- 
rials for other types of bandages are not available. Although almost any 
material may be used, unbleached muslin is preferable when it can be obtained. 
Whatever the material, it should be cut to form a square approximately 3 
feet by 3 feet. This square is folded diagonally and cut along the folded 
border to form two triangular bandages. This bandage may be used either in 
its triangular form or folded to make a cravat bandage. The former may be 
employed as a protective covering or as a bandage to retain dressings applied 
to a part. The cravat bandage is made by placing the apex of the triangle 110 
HOSPITAL CORPS HANDBOOK, 
on the base line and folding the bandage lengthwise to the width desired. In 
this form this bandage may be used for many purposes. 
References. 
The Treatment of Emergencies.—Owen. 
Minor and Operative Surgery, Including Bandaging.—Wharton. 
Dental First Aid.1 
Dental first aid consists of the alleviation of pain associated with the teeth 
and their processes. Pain affecting the teeth is a sign that a diseased condition 
exists, and while pain temporarily may be relieved, permanent relief can be 
expected only when the services of a dental officer are obtained. 
To understand the principles of dental first aid it is necessary that one should 
have a knowledge of the structure of the teeth. 
STRUCTURE OF THE TEETH. 
A tooth is a hard, bony specialized structure of the jaws, the primary func- 
tion of which is the seizure and mastication of food. 
The fundamental parts of the tooth are the crown, neck, root, and pulp 
cavity. (Fig. 90.) The crown is that portion of the tooth above the gums; 
the neck, that constricted portion just be- 
low the crown; and the root, that part 
svhich is embedded in the alveolar process 
if the jawbone. A longitudinal section of 
the tooth will show the presence of a cen- 
tral chamber, having the general shape of 
the tooth, which is called the pulp cavity. 
The teeth are composed of the following 
tissues: 
Enamel, a calcified tissue covering the 
irown of the tooth, a hard substance which 
forms the protective covering for the softer dentine underneath, and offers 
resistance to wear and to the chemical action of saliva. Enamel is com- 
posed almost entirely of lime salts, its histological structure taking the 
form of hexagonal prisms or rods which lie at right angles to the plane of the 
dentine upon which it is supported. These prisms or rods are held together 
by a very minute layer of cement substance which is not visible to the naked 
eye. When the teeth are not properly cared for this cement substance is dis- 
solved out and the enamel rods break down, exposing the dentine to the action 
of the fluids of the mouth. 
The dentine makes up the bulk of the tooth and gives it its typical form. 
Among the chief characteristics of the dentine are its density and vitality. Its 
substance is composed largely of minute canals termed dentinal tubules, run- 
ning at right angles to the pulp chamber, and encasing prolongations of the 
dentine building cells, or odontoblasts, which in turn serve to communicate 
sensation to the dental pulp. 
Cementum covers the outer surface of the roots of the teeth, and closely re- 
sembles bone. It receives its name from its action, that of cementing the 
tooth in the socket, and serves as an attachment for the fibers of the peridental 
membrane, which lines the socket of the tooth. 
Fig. 90.—Vertical section of molar 
tooth. (Gray.) 
1 Prepared by Lieut. Commanders H. B. Harvey and W, L. Parnall, Medical Corps 
Dental Surgeons, United States Navy. DENTAL FIRST AID. 
111 
The dental pulp is composed of blood vessels, nerves, and lymphatics. It is 
extremely sensitive and highly vascular. After developing the dentine, the pulp 
remains to furnish nutrition and to convey sensations which are necessary for 
the protection of the tissues. 
The teeth appear in two sets, the first, 20 in number, known as the temporary 
or milk teeth, and the second, the permanent or succedaneous set, which begins 
to replace the temporary at the end of the sixth year. The permanent teeth 
are 32 in number, 16 in each jaw, namely, two central incisors, two lateral 
incisors, two cuspids (canines), four bicuspids, and six molars, the last ones 
of which commonly are called the wisdom teeth. (Fig. 91.) 
Changes in the structure of the teeth may result from the action of putre- 
factive agents in particles of food lodged in the spaces between and around 
the teeth and also from the presence of various bacteria. In addition to causing 
decay of the teeth, these agents may cause irrita- 
tion of the gums. The prevention of these changes 
is considered a part of dental first aid. 
Decay of the teeth and irritation of the gums to 
a large degree can be prevented by attention to 
and the execution of a few simple principles. “A 
clean tooth never decays ” is a well-known slogan, 
which, while not true in its entirety, has so much 
in its favor that it is well worth keeping in mind. 
Decay occurs most frequently in places which 
are not kept clean. The surfaces of the teeth 
which are seen when the mouth is opened are kept 
clean and polished, to a great extent, by the cheeks 
on one side and the food and tongue on the other. 
The spaces between the teeth, however, are not 
kept free from debris by the above means or 
by rough food, which well might serve that pur- 
pose. Our attention is, therefore, to be directed 
toward these spaces. In the usual procedure of 
brushing the teeth the surfaces which are kept 
clean by the tongue, food, and cheeks are the only 
ones which also are scrubbed with the toothbrush. 
The spaces which are vital in the prevention of 
decay of the teeth as a rule are not cleansed. 
To clean these spaces it is necessary to get in 
between the teeth and remove from these spaces food debris, bacteria, and the 
products of decomposition. Several methods for the attainment of this result 
have been advocated, among which the use of dental floss has been the most 
satisfactory. By its use the individual may remove much of the offending 
material. A much simpler and more efficient method is that in which a small 
brush with the bristle tufts not set too closely together is laid against the 
neck of the teeth, bristle ends toward the tooth, and the bristles gently worked 
into the spaces between the teeth with a sort of oscillating motion. This is 
to be repeated several times in each vicinity. To help keep tone in the gums 
the brush should be passed briskly over all surfaces of mucous membrane in 
the mouth, including the tongue. Salt on the brush or salt water is a good 
routine practice, though no objection exists to the use of the most popular 
dentifrices. Brushing the teeth and gums four times a day, upon arising and 
after each meal, is given as the ideal, but most of us must be content with a 
night and morning brush. 
Fig. 91.—Right half of upper 
jaw (from below), with 
the corresponding teeth. 
The letters and numbers 
point to the classes of 
teeth and the numbers in 
classes. (Gray.) 112 
HOSPITAL CORPS HANDBOOK. 
FIRST AID IN DENTISTRY. 
Severe pain of dental origin is usually from one of two causes, the first and 
most frequent being that commonly known as toothache and resulting from an 
infection and inflammation of the pulp or nerve of the tooth. Decay destroys 
the enamel of the tooth and exposes the dentine. The dentine is, in turn, dis- 
integrated by decay, which permits bacteria and decayed food products to gain 
access to the delicate nerve tissue composing the pulp of the tooth. This causes 
infection, inflammation, congestion, an increase in the amount of blood in the 
part, and pain, which results when the sensitive nerve tissue is unduly com- 
pressed against the hard, unyielding surfaces of the tooth which surround the 
pulp chamber. In order to relieve this pain either the nerve must be deadened 
or the excess of blood permitted to escape. The former often is effected by 
inserting a sedative into the cavity. This soothes the pain by its inhibitory 
action upon the bacteria and by its anesthetizing effect upon the substance 
of the nerve tissue. For this purpose oil of cloves, phenol, eugenol, or, better 
still, a preparation which consists essentially of oil of cloves in which chlore- 
tone has been dissolved, may be used. Before efficient action or penetration 
from any medicament is to be expected all decayed food material and softened 
matter must be gently removed from the cavity. This may be accomplished 
with any suitable instrument, after which the cavity should be flushed with 
warm water. The cavity then should be dried with small pledgets of cotton 
and kept intact from the saliva by means of large pieces of cotton placed in 
the mouth between the teeth and cheeks. A small piece of cotton moistened 
with the desired medicament, care being taken to prevent an excess of the 
solution from coming in contact with the gum and causing discomfort, is placed 
in the cavity and covered by another piece of cotton which has been dipped 
in compound tincture of benzoin or Sandarac varnish. The purpose of this 
procedure is to form a gummy outer covering which comes in contact with 
the saliva. In many cases it will be found that simple toothache can be relieved 
in this manner, but in those cases in which relief is not experienced an attempt 
should be made to puncture the pulp and permit some of the blood to escape. 
The pain caused by puncturing the pulp is severe and it is advisable to tell the 
patient that you are about to do this in an endeavor to relieve the pain. If 
bleeding is effected, relief is obtained within a few minutes after the sedative 
is reapplied. A sharp instrument is employed for this purpose and is forced 
quickly through the decayed material in the direction of and into the pulp. 
The second common cause of severe dental pain is an abscess. This is the 
result of the putrefaction of a dental pulp which has died in the tooth, as a 
result of which gases are formed and pressure is exerted toward the apex of 
the root. This also forces the decayed material and bacteria into the tissue 
at the end of the root and sets up an inflammation in the vicinity. This in- 
flammation is outside of the tooth, in the jawbone, and any medicament ap- 
plied to the tooth or in the cavity will not be likely to have the desired effect. 
To relieve pain from this cause it is necessary to make some form of an 
opening so that the gas and other foreign material present may escape. This 
may be done in two ways. While placing a finger against the tooth to steady 
it, a sharp instrument is worked into the pulp canal, which, when opened, often 
permits the gases to escape and brings relief. If, however, the inflammation 
has progressed to a certain point, it will continue unless drainage is estab- 
lished through the bone. An opening for this purpose easily can be made by 
the dentist with proper instruments. It is always possible to extract the 
tooth involved, but this should be done only as a last resort. 
Teeth which are acutely abscessed are very tender to the touch and feel to 
the patient longer than they should be. The duration of the formation of an DENTAL FIRST AID. 
113 
abscess varies, but pus formation or suppuration usually occurs within 72 
hours and is accompanied by swelling. The swelling indicates that an open- 
ing through the bone has been made by the pus working its way toward the 
surface and the pain usually ceases at this stage. This cessation of pain is 
due to the fact that the pus no longer is confined between unyielding plates of 
bone, but is escaping into the soft tissues, at which time the tissues are ready to 
be opened (incised). The tissues are examined with the finger to determine a 
point of fluctuation, at which place an incision is made directly toward the 
bone and in the general direction of the end of the root of the offending tooth. 
This will permit the pus to evacuate and will relieve the condition for the 
time being. 
Occasionally a patient points to a perfectly sound tooth and complains of it 
aching. It is, of course, possible that nerve trouble does exist in that tooth, 
but it is always advisable to look at the other teeth on the same side of the 
jaw, both above and below, for a cavity, and if one is found, to cleanse it and 
apply a sedative. This often relieves pain in such cases. Reflected pain is 
the term given this condition, and so far as the patient is able to judge the 
pain is present in the tooth to which he points. 
The lower third molar teeth often are the cause of pain and swelling during 
their eruption. Upon looking into the mouth toward the angle of the jaw and 
just back of the last tooth, occasionally a part of a tooth coming through the 
gum may be seen, with swelling and redness in the vicinity. In an endeavor 
to relieve this condition, wrap a small instrument or blunt probe tightly with 
a wisp of cotton, dip this in tincture of iodine, and insert the probe gently 
between the tooth and the gum, carefully working it around the crown of the 
tooth. In some instances this simple treatment will result in the evacuation 
of some pus and afford temporary relief. The patient should be instructed to 
take hot salt water, as hot as can be borne, into his mouth and to hold this in 
the vicinity of the tooth. This procedure should be repeated frequently. 
Where a crown or large filling is present in a tooth which is giving trouble, 
it is usually necessary to make an opening through the filling or crown to 
obtain access to the dental pulp to which a sedative is applied or the pressure 
removed. 
Gumboils, so called, are small pimples on the gums and are frequently 
present. This condition is painless, but by no means should they be neglected 
as it indicates in most cases the presence of a dead nerve in a nearby tooth. 
This condition should receive professional attention at the first opportunity in 
order that the health of the individual may not be menaced. 
In general, cold will cause an aching tooth to become more painful, while 
it often will ease the pain in a tooth which is about to suppurate and form an 
abscess. This test can be applied by retaining ice water in the mouth for a 
few seconds. 
In case it becomes necessary to extract a tooth or the roots of a tooth, an 
endeavor should be made to work the beaks of the forceps up along the roots 
until they are well up on them and a firm grip obtained. Then rock the forceps 
gently from side to side until the roots loosen, when traction should be applied 
and extraction made. Do not attempt to remove a tooth until it has been 
loosened in the socket, thus lessening the possibility of breaking off the roots 
which remain in the jaw and are exceedingly difficult to remove without the 
use of other instruments. 
A condition of sloughing of the gums is seen occasionally wherein the gums 
assume a very red and inflamed appearance and have a film of dead whitened 
tissue over their surfaces and between the teeth. The gums bleed when touched 
and sometimes cause severe pain. In this condition the patient usually com- 
plains of discomfort when eating or when brushing the teeth. This condition 114 
HOSPITAL CORPS HANDBOOK. 
is ulcerative stomatitis, which may be called Vincent's angina (so-called Trench 
mouth). All cases of ulcerative stomatitis should be considered as contagious 
and patients having this condition should he warned to separate their mess gear, 
dishes, drinking cups, pipes, etc., and to boil their eating utensils after use. 
The treatment of this condition consists of using a mouth wash of peroxide 
of hydrogen (full or half strength), which should he retained in the mouth 
for some time and should be followed by rinsing the mouth with warm water. 
A one-tenth of 1 per cent solution of chlorazene, full strength Fowler’s solution, 
7 per cent solution of chromic acid, or a 5 per cent solution of arsphenamine in 
glycerin then should be applied to all of the inflamed surfaces. Wads of cotton 
should he inserted between the cheeks and the teeth and between the tongue and 
the teeth to absorb the excess of this solution, which should be freely applied 
and permitted to remain on the surfaces of the gums for 10 minutes by the 
clock. The arsphenamine solution is preferable, but is not available always on 
smaller vessels. The patient should be cautioned not to swallow any of the 
solutions used in this treatment. The application of these medicines should be 
followed by rinsing the mouth and the whole procedure repeated three times 
daily. The patient should be referred to a dental or medical officer when the 
services of one become available. 
TEMPORARY FILLING MATERIAL. 
Attempts to fill teeth by one who has not had training in this procedure 
usually result in failure. If the filling material does not become dislodged and 
work out, decay may continue to progress under the filling. 
We have at our command however, a temporary filling material, which 
is valuable where indicated and can be prepared easily and inserted by any one. 
It consists of a paste of zinc oxide and eugenol, prepared by mixing on a slab 
with a spatula, adding sufficient powder to make a paste of a consistency less 
than putty. It can be used in two ways. For a filling which will last a week 
or so and can be removed without difficulty with small instruments, place over 
the paste, while on the slab, a piece of clean blotting paper and apply sufficient 
pressure to absorb all excess liquid. This will leave a mass with puttylike 
consistency, which should be transferred to the cavity in small pieces, and 
forced into the cavity with gentle pressure until it is filled completely. 
For a filling which will last perhaps several months and stand the stress of 
mastication the blotter should not be used at first. Instead, a piece of cotton 
about the size of the cavity should be selected and laid on the mass. The 
paste should be thoroughly incorporated in the cotton fibers by continued 
spatulation on the slab. When this is accomplished the blotting paper should 
be applied to remove excess fluid. The resultant mass can be transferred to 
the cavity and the edges gently tucked in to make a smooth surface. This fill- 
ing can be removed only with difficulty. If merely to keep food and debris from 
a cavity which is sensitive to sweets, heat, or cold but which has not definitely 
ached, incorporation of cotton is advocated. It can be removed with a sharp 
instrument by picking away a little of the surface at a time. 
Zinc oxide and eugenol paste will not harden in a day outside of the mouth 
but assumes a dense compact form in a short time after being placed in a 
cavity. The action of the saliva and body temperature cause it to set. Such a 
filling has several advantages. No special skill is required in its preparation. 
No special instruments are needed. It has marked sedative and anodyne 
effects. It has definite antiseptic properties. If made without cotton it may 
be readily removed. If made with cotton it will withstand mastication for 
several months. 
References. 
Operative Dentistry (2 vois.).—Black. CHAPTER IY. 
NURSING.1 
The qualifications necessary for a good hospital corpsman may be classified 
under three headings, physical, mental, and moral. Physical qualifications re- 
quire health, strength, and endurance, and these can be maintained only by the 
faithful practice of habits of personal cleanliness, strict obedience to the laws 
of hygiene, avoidance of causes of indigestion, the securing of a sufficient 
amount of fresh air, sleep, exercise and recreation, and prompt attention to all 
minor ailments. To be mentally qualified requires education, judgment, the 
faculty of observation, a sense of order, and a good memory. 
Higher education, although desirable, is not absolutely essential for the 
success of a hospital corpsman, but he must have a high order of intel- 
ligence and a real desire to learn. With these assets it soon will be 
realized how important it is to know the underlying principles that govern 
the work in which he is engaged. Observation is the faculty of taking 
notice of things and requires constant practice for its development. A hospital 
corpsman must be quick to observe minute details and equally quick to act 
intelligently in accordance with his observations. Loss of valuable time and 
many reproofs may be avoided by quick observation. A hospital corpsman 
possessing this quality when assisting at a treatment or an operation, will 
notice what is required and anticipate the doctor’s needs. 
Judgment is the faculty of being able to reach a correct decision; that is, 
knowing what is best to do or say under known conditions. A hospital corps- 
man’s observation and judgment should be such that when two conditions are 
placed before him he will weigh them quickly in his mind and decide as to the 
relative value of each. 
The sense of order must be cultivated both in mind and habits, and literally 
means, “ a place for everything and everything in its place.” A hospital corps- 
man should not tolerate disorder in the things about him nor should he allow 
confusion in his work. He must strive to make his work better than another’s 
work. Particular care in folding gauze for dressings, folding linen, and 
arranging supplies helps to cultivate the habit of exactness. 
Memory is very important in nursing. It requires constant practice of con- 
centrating one’s attention on the thing at hand, and of forming mental asso- 
ciations which will assist in recalling the things to be remembered. 
Moral qualifications required by hospital corpsmen include truthfulness, 
obedience, dignity, tact, courtesy, sympathy, and economy. 
Truthfulness in the care of the sick takes on a broader meaning and embraces 
honesty of purpose, frank acknowledgment of an error, prompt confession of 
anything left undone, absolute accuracy of statements, and the conscientious 
performance of minute details. 
1 Prepared by S. V. Kiel, A. Chew, and V. M. Visel, members of the Nurse Corps, 
United States Navy. 116 
HOSPITAL CORPS HANDBOOK. 
Obedience does not mean merely obeying rules and regulations, but in- 
cludes prompt, unquestioning, and intelligent obedience to authority, regardless 
of whether the person in authority is an officer or a fellow hospital corpsman. 
Dignity, if genuine, admits of no rudeness or familiarity from others, and at 
the same time is free of any display of personal importance or superiority. 
Tact is the ability to deal with others without giving offense; in other 
words, it is doing or saying the right thing at the right time. 
Courtesy is defined as a well-bred consideration for others founded upon kind- 
ness, and is a very necessary qualification when the sick are irritable, fault- 
finding, or unjust in criticism. It must be remembered always that a sick 
person is like a child and often is not responsible for his speech and actions. 
Sympathy is the feeling corresponding to that which the other person feels, 
and may be expressed by a smile or an encouraging word, but must not inter- 
fere with the carrying out of orders, treatments, or dressings. Patients are 
benefited by receiving proper care and treatment, although the reason for such 
may not be evident at the time to either the hospital corpsman or to the 
patient. 
Economy in all things is very essential. Extravagant habits are easily 
acquired where there are large quantities of supplies, and must be especially 
guarded against. 
Professional ethics may be defined as the moral obligation which a hospital 
corpsman owes to the service, its officers, the hospital, the ship, the station, or 
the training school, and to his fellow hospital corpsmen. He should always 
so conduct himself that he will do his part to be a credit to and add to the 
good reputation of the service, of the Medical Department, and of the unit to 
which he is attached. 
MANAGEMENT AND GENERAL SUPERVISION OF WARDS. 
Hospital wards are under the general supervision of the executive officer, 
and each ward is under the direct supervision of a ward officer. The chief 
nurse has general charge of medical and surgical wards, and in each ward a 
nurse has direct charge of that ward. Hospital corpsmen are detailed for ward 
duty and are under the direction of the nurse, who is responsible for the care 
and nursing of the patients and for the management of the ward. In the 
absence of a nurse the senior hospital corpsman assumes charge of the ward. 
. The venereal wards are in charge of senior members of the Hospital Corps, 
with others detailed to assist. Under the direction of the medical officer, they 
administer medicines and give treatments, including venereal prophylaxis, do 
the dressings, and are responsible for the care and nursing of the patients and 
the order and cleanliness of the wards. 
On board all fighting ships the hospital corpsmen perform all the duties of 
their own and of the Nurse Corps. 
Admission of a patient.—When a new patient is admitted into a ward it is 
necessary to obtain a record of his name, rate, the ship or station from which he 
was received, the name and address of his nearest relative or friend, the date 
and place of his birth, and any other information required for the admission 
card. This card is made out in duplicate, one copy for the ward files and the 
other for the ward officer’s office, whence it finally goes to the record office. A 
bedside card or tag is made out showing the patient’s name, rate, age, diagnosis, 
and religion. This is placed in the card, rack attached to the bed, or, in the 
absence of a card rack, is tied to the foot of the bed. NTJKSING. 
117 
The patient’s temperature, pulse, and respiration are taken and recorded. He 
then is given a bath—either a shower, tub, or sponge bath in bed, as the case 
may permit—is dressed in a clean suit of pajamas, and retained in bed until 
seen by the ward officer. During the batli the patient should be inspected care- 
fully for skin eruptions, ulcers, tumors, swellings, gonorrhoea, vermin, and 
other evidences of venereal or contagious diseases, and for the presence of any 
other abnormalities. The results of this inspection should be reported to the 
person in charge of the ward. The patient’s money and valuables should be 
listed, put into an envelope marked with his name, rate, and the date, and 
turned over to the executive officer for safe-keeping. Receipts for such deposits 
are given by the executive officer. In the temporary absence of the executive 
officer the officer of the day is his representative. The patient’s toilet articles, 
papers, books, and any personal effects which may be required in the ward are 
placed in his bedside locker. All other effects, properly tagged, are sent to the 
bag room. 
Daily routine duties in a ward.—Bed patients should have their hands and 
faces washed and teeth cleaned by the hospital corpsman on night duty in the 
ward. All patients should have their hair combed and all temperatures should 
be taken before the day staff comes on duty. The day staff serves all break- 
fasts and clears away the dishes. The ward hospital corpsman is responsible 
for the patients under his charge, and should see that they are given their 
proper diets. If the food on any tray remains untouched, he should determine 
the reason; it may be that the patient needed assistance in order to eat, or that 
he had lost his appetite, or for some other reason did not desire food. Whatever 
the cause, a report should be made to the medical officer. 
Beds should be made up and the ward aired, swept, and dusted, and then put 
in readiness for sick call at 9 o’clock. All ward work should be discontinued 
during sick call. There should be absolute silence during sick call and all 
convalescent patients who are able should stand at attention at their bedsides. 
When making sick call with the ward medical officer, towels, tongue depres- 
sors, flash light, and stethoscope should be carried for the use of the doctor. All 
orders should be written in the order book and signed by the ward officer before 
leaving. The drug book, diet sheet, requisition slips, and liberty lists should be 
in readiness for the ward officer’s signature. 
After sick call, the order “ carry on ” may be given, uncompleted work in 
the ward finished, treatments and medicines administered, dressings done, 
slips taken to their respective offices and the ward made ready for the execu- 
tive officer’s inspection. All supplies for the day should be obtained between 
the hours of 10 and 12 and drug baskets taken from the dispensary before 
noon. Attention should be given to medicines, temperatures, and diets between 
11 o’clock and noon. After dinner the patients should be allowed to rest and 
the hospital corpsmen should police the wards. The necessary work of the 
ward must, however, be carried on. A hospital corpsman under no circum- 
stances should leave his ward without permission or proper relief. On visiting 
days he should see that visitors do not sit or recline on the beds, provide 
chairs for visitors, and when visiting hour is over, see that they leave the 
ward. If visitors have not heard the word passed that visiting hours have 
ended, the hospital corpsman should tactfully inform them that it is time 
for them to go. The evening meals then are served, and not sooner than one 
hour afterwards, baths should be given (all patients should have baths at 
least every other day). Evening sick call is held sometime after 7 o’clock, 
and should be followed by the evening treatments, medicines, and dressings. 
All patients are mustered, any absentees reported to the officer of the day. 118 
HOSPITAL CORPS HANDBOOK, 
and all ward lights, except night lights, put out at taps. The wards, heads, 
bath rooms, diet kitchen and offices should be left in a clean condition by the 
day hospital corpsmen. There should be sufficient ice in the refrigerator for 
the night as well as enough supplies, such as milk, fruit, eggs, and broth, for the 
fluid diets, and eggs for the morning breakfasts. 
Care and cleaning of a ward.—The essential conditions which should be 
maintained in a ward or sick bay are: Proper ventilation, freedom from 
unpleasant odors, uniform temperature (the degree required depending upon 
the diseases in the ward), cleanliness, definite places for furniture and utensils, 
and furniture and furnishings kept free from stains and defacement. 
In order to have proper ventilation in a ward the incoming air must be 
pure, the air in the ward kept in circulation without causing a draft. Exposure 
of patients should be avoided by having them sufficiently covered when the 
windows are opened to air the ward. 
The necessary precautions to prevent odors in wards are : Bed-pans should 
be covered when carrying them through the ward, and should be clean when 
not in use; bed covers may be kept free from faecal odor when giving an 
enema by using a blanket which can be aired; patients and bedding should 
be absolutely clean; dressing and garbage pails should be kept covered, emptied 
frequently and kept clean; hoppers and toilets should be properly flushed and 
a deodorant used frequently; and waste pipes, sinks, and hoppers should be 
free from obstruction. 
A low temperature, providing the patient’s body is kept warm, often will act 
as a respiratory and circulatory stimulant. Patients who are restless and 
excited frequently become quiet and go to sleep out of doors or in a cold 
room, while, on the contrary, patients become restless and do not sleep well 
in a hot ward. Patients with chronic diseases, associated with poor circulation 
and anaemia, usually require warmer surroundings than fever patients, while 
those in shock and under the influence of an anaesthetic temporarily require 
a still warmer environment. The average ward temperature should be 68° F., 
during the day and 65° F., at night. 
The cleanliness of a ward is of great importance, as dust and dirt favor 
the development of bacteria. The wards, including beds, lockers, chairs, desks, 
windows, radiators, electric light fixtures, doors, woodwork and paintwork, 
should be dusted daily. 
The materials usually used in cleaning are: Brooms, mops, dustpans, cloth 
dusters, warm water, soap powder where fresh water is used, salt-water soap 
where salt water is used, sand soap, and metal polish. Hot water should be 
used to remove dirt and cold water to remove blood stains. The addition of a 
small amount of sodium carbonate (washing soda) or ammonia will soften the 
water. If lye is used great care must be taken to dissolve it first in water, 
and to open the can over a hopper or on a cement or stone deck, to prevent the 
powder from destroying and staining woodwork, paint, varnish, etc. 
Ink stains may be removed from linen by the application of lemon juice and 
salt, afterwards putting the material in the sunlight to dry and then washing 
with warm water and soap. If the stain has not disappeared the process should 
be repeated. To remove iodine stains, wash the spot with alcohol or boiling 
water. Permanganate of potash stain may be removed by washing it in a solu- 
tion of oxalic acid, followed by ammonia water, and then rinsing in clear 
water. Silver nitrate stain may be removed by covering the spot with tincture 
of iodine and after a few minutes washing with alcohol, ammonia water, and 
clear hot water. Vaseline stains may be removed with kerosene and hot water 
and soap. Rust stains on iron and steel may be removed with kerosene, but NURSING. 
119 
care must be taken not to apply kerosene to a stove at such time that it will 
not have evaporated before the stove is used. This precaution is necessary 
because of the inflammable nature of kerosene. If alcohol is spilled on a white 
enamel surface, oil should be applied to the spot before attempting to remove 
the alcohol. This is necessary because the enamel is soluble and may be 
removed by the alcohol. Rust and other stains may be removed from granite 
and enamel ware by washing with kerosene, hot water, and soap. All utensils 
should be dried thoroughly before they are put away, in order that rusting 
may be prevented. Rust stains on fabrics may be removed by washing in warm 
oxalic acid or citric acid solution (if the colors will bear it) and rinsing in 
water. Do not apply hydrogen peroxide to any fabric for the removal of stains, 
as it tends to destroy the fibers of the fabric. 
The walls of a ward should be swept down once a week with a long-handled 
broom and, if possible, washed once a month. 
The cleaning of floors depends upon the material of which they are made. 
They should be swept as often as necessary, at least three times a day, and 
care taken that no dust is raised in the ward during the sweeping. Stone and 
unpolished wooden floors should be scrubbed occasionally with a scrubbing 
brush, hot water, and soap powder. The water should be changed frequently. 
Dirty water will not clean anything. After washing, floors should be thor- 
oughly dried and hardwood floors should be waxed and polished once each 
week. 
Everything in a ward should be dusted daily. In dusting, a damp (not wet) 
duster should be used, a basin of clean water should be at hand in which to 
rinse the duster frequently. It is impossible to clean anything with dirty water 
or a dirty duster. The habit of removing dust with a firm stroke should be 
formed, as it is a waste of time and energy to move the duster back and forth 
on a surface. Dust should be removed from cracks and crevices (those too small 
for the duster to enter may be cleaned with the point of a wooden toothpick), 
and when dusting beds, the bars which are not exposed should not be forgotten. 
When cleaning the medicine cabinet, remove only a few bottles at a time (if 
called away they will not have to be left out of place). If dusting is done 
daily and systematically, everything will be ready for the commanding officer’s 
inspection without any extra effort. Dusters always should be washed after 
use and not put away unclean. Polished furniture should be dusted with a 
dry duster or one that has been slightly oiled. 
Copper, brass, and nickel should be cleaned frequently with the regulation 
metal polish. Alcohol and ammonia should be used sparingly, as they de- 
teriorate the polish. Sand soap should not be used for glass or metal, as it 
may scratch the surface. Porcelain tubs and sinks are cleaned best with hot 
water and the special cleansing materials provided for that purpose. Acid 
destroys the polish on marble, therefore an alkali should be used to neutralize 
and remove the acid. If orange or lemon juice is spilled, ammonia and soda 
applied immediately will prevent a stain. 
Refrigerators should be washed out daily with hot water and soap and the 
drains should be cleaned and pans emptied at least three times a day. 
Utensils such as bedpans, urinals, and irrigating cans should be scrubbed 
daily with hot water, brush, and soap, and kept clean at all times. Rubber 
sheets and rubber utensils are cleaned best with warm (not hot) water and 
soap, then rinsed in a disinfectant solution and hung up to dry. Under no 
conditions should they be folded and put away until thoroughly dried. Heat, 
acids, and fats destroy rubber. 120 
HOSPITAL CORPS HANDBOOK. 
Beds should be dusted daily with a damp duster, and on the discharge or 
death of a patient the springs should be whisked with a disinfectant solution 
and the bedstead washed with hot water and soap. 
Temperature, pulse, and respiration.—The chief source of heat production in 
the body is the oxidation of material derived from the food which takes place 
in tissues, especially in the muscles and the secretory glands. Heat also is 
derived from friction within the body caused by movements of the muscles, by 
the circulation of the blood and other internal activities, by the ingestion of 
hot foods and drinks, and by radiation from the sun, fires, and appliances which 
generate external heat. Although heat is being generated constantly within 
the body, the body temperature of a healthy person remains at approximately 
98.6° F. This is brought about by the fact that there is an equally constant 
loss of heat effected in the following ways: By radiation and conduction from 
external surfaces of the body, by constant evaporation of water from the 
skin, by taking into the lungs colder air which requires heating before being 
exhaled, and by the ingestion of cold food or drink. 
Heat production and heat elimination are adjusted by the vasomotor nerves. 
When the outer air becomes er the superficial blood vessels, by action of 
GENERAL NURSING PROCEDURES. 
the vasomotor nerves, contract, and consequently there is less blood at the 
surface to become chilled and more in the interior of the body to further oxi- 
dation. Individuals adopt certain voluntary means of regulating body heat; 
for example, when cold, they put on more clothing, eat and drink more hot food 
and liquids, and take more vigorous exercise, and when they are too warm they 
do the reverse. 
The degree of heat of the body is measured with a clinical thermometer. 
In a healthy adult the normal temperature should be 98.6° F., but this is 
subject to daily fluctuations of a fraction of a degree. Normally the tempera- 
ture rises gradually from 7 a. m. until the corresponding time in the evening, 
when it as gradually falls; usually reaching its maximum between 5 and 8 
p. m., and its minimum between 2 and 6 a. m. In children the average tem- 
perature is higher and in old people lower. 
Excessive exercise, excitement, constipation, or indigestion may cause a 
slight rise in temperature in a healthy person. Marked rises in temperature 
are due to bacterial activity in the body and to failure of the mechanism which 
controls the elimination of excess heat, and marked falls in temperature to 
vomiting, diarrhoea, lowered vitality, haemorrhage, shock, and any depression 
of the nervous system. 
The following table indicates the deviations in temperature and the 
significance: 
°F. 
103-106 
101-103 
99-101 
°c. 
39-41 
38-39 
37-38 
°F. 
98-99 
97-96 
96-95 
°C. 
36. 5-37 
36-35. 5 
35. 5-35 
The temperature of the body is taken with a clinical thermometer, by 
mouth, axilla, rectum, or groin. (Fig. 92.) In taking temperature by mouth, NURSING. 
121 
the hospital corpsman should make certain that the patient recently has not 
had any hot or cold substances in his mouth. After carefully removing any of 
the disinfecting solution on the thermometer the mercury bulb should be placed 
under the tongue, and the patient instructed to keep his lips closed during 
the time the temperature is being taken. The temperature should not be 
taken by mouth when the patient is coughing, has dyspnoea, is unconscious, 
delirious, insane, or too young to understand what to do. Do not leave the 
thermometer in the mouth longer than the time required for it to register 
(one to three minutes usually). 
When taking temperature by axilla, wipe the surface thoroughly dry, place 
the bulb in the hollow of the armpit with the stem pointing toward the 
chest and see that the patient holds his arm pressed closely to his side for 
at least five minutes. Temperature taken by axilla or groin is 0.5° lower than 
by mouth. 
In taking the temperature by rectum, the bulb should be well lubricated 
with vaseline before inserting and the rectum should be free from fecal 
matter. The thermometer is inserted gently for about 1 inch, pointing it 
slowly backward. It is allowed to remain for at least five minutes. Never 
allow a patient to insert the thermometer. Rectal thermometers and their 
containers should be properly marked, “ for rectal temperatures.” The rectal 
temperature is 1° higher than that recorded by the mouth. 
Clinical thermometers and their care.—A clinical thermometer is a self-regis- 
tering instrument which is used to ascertain the body heat. It contains a glass 
bulb filled with mercury and a stem on which there is a graduated scale. 
Mercury is expanded by heat, and when the bulb is placed in contact with a 
warm body the mercury expands and forces the column up the graduated 
scale; the height which the column reaches depends upon the degree of tem- 
perature. Clinical thermometers are self-registering—that is, the mercury 
remains at the height to which it has ascended until shaken down. Therefore, 
it is always necessary to see that the thermometer is shaken down to about 
95° before using. The mercury is shaken down by firmly holding the upper 
half of the thermometer between the first and second fingers and thumb, flex- 
ing the hand and giving a quick sharp jerk, repeating until the mercury 
registers 95°. It is not advisable to force the mercury below 95°, because 
there is a slight constriction in the stem, which, if the mercury goes below 
this point, may prevent proper expansion of the mercury column. If this 
happens, it can be brought up again by carefully placing the thermometer 
in warm water at not over 100° F. A thermometer should he shaken down 
over a bed to lessen the possibility of breaking if it slips from the hand. 
Thermometers should be cleaned before and after use. When in constant 
use they should be kept in a disinfecting solution with a soft pad of cotton at 
the bottom of the container. The container should be kept filled with the 
solution and changed daily. Thermometers used for rectal temperatures 
should be kept in separate containers and marked plainly. When thermometers 
are not marked to indicate how long they require to register, they should 
be considered to be three-minute instruments. The average thermometer 
requires three minutes to register properly. Should a thermometer apparently 
fail to register accurately a patient’s temperature, the latter should be taken 
a second time with another thermometer. 
Pulse. 
The momentary distention of the arteries caused by the blood being forced 
into them at each contraction of the left ventricle of the heart is called the 
pulse, and wherever a large artery approaches the surface of the body this 122 
HOSPITAL CORPS HANDBOOK. 
pulsation may be felt and counted. The common locations for taking and 
recording pulse are the radial arteries at the wrists on the thumb side; the 
facial arteries where they pass over the lower jaw bone, just forward of the 
angle of the jaw; the temporal arteries, slightly above and in front of the 
ears; the femoral arteries at the inner surface of the upper part of the thighs; 
and the dorsalis pedis arteries on the dorsal surfaces of the feet. 
The principal points to notice when counting a pulse are its frequency, 
volume, tension, regularity, and any peculiarities in the pulse or the condition 
of the artery. 
Frequency of pulse rate is the number of pulsations occurring per minute, 
and it is this number which is recorded. A good way to estimate the pulse 
rate is to count the number of pulsations for 30 seconds, the number for a 
second 30 seconds, and if the numbers are the same, multiply by 2. If not, 
count for one or more additional 30-second periods. In counting or taking a 
pulse, the middle and index fingers are placed over the artery and the artery 
lightly compressed against the bone. Never use the thumb, because there is a 
superficial artery in the thumb which might register your own instead of the 
patient’s pulse. Do not make too strong pressure, for if the pulsations are 
feeble, the pressure may obliterate them. This is a very common fault with 
beginners. When taking the pulse at the wrist, the patient’s arm should rest 
upon something, and before and after counting, the fingers should be held 
over the artery long enough to note characteristics other than the frequency of 
the pulse. 
A normal pulse in an adult should feel firm and elastic, and should be regular 
both in rate (72-78 pulsations per minute) and in rhythm. There are various 
types of irregularity both in rate and in rhythm which, if recognized, should 
be recorded when the pulse is taken. 
The volume of the pulse refers to its size and depends upon the force of the 
systolic contraction of the heart and upon the general physical condition of 
the body. Some of the conditions affecting the volume of the pulse are dis- 
ease, exercise, excitement and emotion, the action of drugs, fatigue, and sleep. 
When the volume of blood flowing through the arteries is great the pulse is said 
to be full, and if at the same time the frequency of the beat is increased it 
is said to be full and bounding. Other descriptive terms used in connection 
with the volume of the pulse are thready, when the pulse feels like a little 
thread; hard, when the pulse is very small in volume but feels hard; and 
small, when the volume is lower than usual. 
Tension is the resistance of the walls of the arteries to the pressure of the 
blood stream and the force of the blood pressure is estimated by the degree of 
tension. If an artery remains distended between beats, its tension is said to 
be high; but if it does not remain distended between beats, is easily compressed 
and feels empty, the tension is spoken of as low. Drugs and disease as well as 
other conditions, such as haemorrhage and changes in the elasticity of the 
arteries, may alter the tension of the pulse. To determine the tension of the 
pulse, the pressure required to obliterate the pulse beat is noted. Accurate 
measurements can be obtained only by use of the sphygmomanometer (blood- 
pressure apparatus), but an approximate idea of the tension may be obtained 
by increasing the pressure of the finger nearest the heart until the other finger 
fails to feel the pulse beat. 
The regularity in rate and rhythm of the pulse varies as a result of the 
action of drugs, disease, and in accordance with the physical and mental con- 
dition of the patient. Usually the pulse rate rises at the rate of about 10 
beats for every 1 degree of increase in temperature, though in some diseases NURSING. 
123 
the pulse beat may be high or low in proportion to the degree of temperature. 
A pulse is said to be regular when each successive heat is equal in volume, 
tension, and frequency. 
There are several variations occurring in the rhythm of the pulse and the 
most common of these irregularities is known as intermittent pulse. Although 
the heart may not miss a beat, because of failure of the arteries to distend 
properly the pulse skips a beat. This intermission may occur at regular or 
irregular intervals, and while it may be due to a weakened heart or some condi- 
tion of the arteries it frequently occurs in apparently healthy persons who are 
addicted to the overuse of alcohol, coffee, tea, or tobacco. However, when a 
pulse is irregular in rate, in rhythm, or in both, this irregularity generally is 
a symptom of serious disease, commonly of the heart. Beats may follow each 
other with great rapidity and then change to slow with perhaps an intermission, 
and at the same time a variation in force and volume may be present. 
A dicrotic pulse (from a Greek word meaning double beat) is one which 
frequently occurs in typhoid fever and other diseases causing a depleted con- 
dition of the system. It is due to lack of tone of the arterial walls. The pulse 
is said to be dicrotic when the beats seem divided, the second part of the 
beat being weaker than the first part. In this condition the two beats must 
be counted as one, in recording the pulse rate. 
When taking the pulse the condition of the artery should be noted by gentle 
and careful digital examination while apparently taking the pulse. A normal 
artery feels round and elastic, and usually is firm. But if it feels twisted, or 
hard and unyielding, and gives one an impression that it is brittle, this infor- 
mation should be reported to the medical officer and recorded, as such conditions 
often are important symptoms of disease. 
It is sometimes necessary to take the pulse in each wrist because of difficulty 
in obtaining an accurate count in one; and in certain conditions not often 
found, the pulse in one wrist is not the same as that in the other. 
Respiration. 
Respiration is the alternate expansion and contraction of the chest walls 
causing the lungs to expand and contract. The expansion movement, by means 
of which air is drawn into the lungs, is known as inspiration and the contrac- 
tion movement, which forces the air out of the lungs, is known as expiration. 
Respiration consists of one inspiration and its accompanying expiration and a 
period of rest between them. The normal number of respirations of a healthy 
adult is 18 to 24 per minute. The respiratory movements are more or less 
under the patient’s control and therefore should be counted without his knowl- 
edge. To do this, keep the fingers upon the pulse as though still counting it, 
at the same time watching the rise and fall of the patient’s chest, thus counting 
the respiration for a full minute. In recording the respiratory movements, 
notation should be made as to whether or not they are shallow or deep, regular 
or irregular, and whether or not the chest walls expand normally. Any diffi- 
culty in breathing, or labored breathing which usually is accompanied by rapid 
respirations should be noted. This condition may be caused by heart disease 
or by conditions of the lungs. Cheyne-Stokes respiration begins quietly, each 
succeeding respiration being louder and deeper until a climax is reached, which 
is followed by a complete pause before inspiration is again resumed. 
Clinical charts and clinical notes. 
A clinical chart should be prepared and kept up to date for each person ad- 
mitted to the ward. (Fig. 93.) The clinical chart (N. M. S. Form “Q”) 
47829°—23 9 124 
HOSPITAL CORPS HANDBOOK. 
shows the name of the patient, the rate, rank (in the case of oilicers), the 
diagnosis, age, and race. The year, month, day of the month, and the day of the 
disease usually are recorded by figures; the time of taking the temperature, 
pulse, and respiration is recorded in either the “ a. m.” or “ p. m.” spaces, 
and the frequency and amounts of urine and stools indicated in the spaces so 
N. M. S. Q. 
CLINICAL 
CHART 
Page 
No. . 
/ 
Name 
' JZC. 
Diagnosis 
Race, 
Age 
Year and 
Month 
72#3 
Da;4 of 
Month 
TT 
30 
3/ 
/ * 
z 
3 
V 
jT 
£ 
7 
7 
/o 
Day of 
Disease 
6~ 
7 
P 
? 
/O 
// 
/3 
/3 
/y 
/S’ 
V S-/2< i 
tf 9 ,/2i • • 
4-BMj '■ ■ 
; ; 
tM2s 
“Tp 
TIT 
s,w 
«P'/21 
Z'V'd'iz 
xlf i 8 JSL 
]-)38'/2 
FT frs/z 
FT V 
j 
1 /J 
! 
106 
i ! ! 
j i i 
i i j ; ; 
MM! 
1 i i 
1 1 1 
! i 
i i 
i i 
1 
i i j 
1 
ill 
i i i M 
it!' 
ill 
i • i i j 
iii 
• i ! • 1 
i • ' 
! ' ' 
]T 
1 
! ! ; 
111 
\!! i i 
Mil! 
; i 
III! 
•iii! 
! • ! ! ! 
• 
i | 
1 
1 
1 
i ; 
i j ' UL, 
j j i j j 
' i * 
1 1 
1 ! i 
1 i 
i i 
1 i 
1 
xf-.i 
i44- 
. i i/i r 
••fMfrf 
S 
1m 
j j i j j 
■ 1 i 
i i 
1 t 
i ' 
i ' 
! I 
1 ! 
< 
_*_.d 
! | j 
hii! 
| i i j | 
li! 
i j i 1 i 
! ! ! 
i t 
I 
TT 
s 
! 1 ! 
MM' 
i i\i i 
1 ! i i i 
• i ; 1 i 
i i 1 
i! 
TT 
1 ' ! 
I i | i | 
Mil 
1 1 1 | 1 
i 1 1 
1 ! 1 
i | 
; ! 
NORMAL 
! J ! ! ! 
: 1 | ;\> 
1 
F/i 
i i 1 
i j iTr 
: I i ! i 
j ; i ! i 
11 i 
i i 
1 J 
1 
v! j 
i 
i 
•i ! 
: | ! 
I j | : ; 
j : j | i 
; ; i | i 
j i j j i 
i i 
! i 
1 
1 
! i 
i 
i 
j i 
I i ! ! ! 
i ' 1 i ' 
M 
! ; 
i 
iiij: 
| j i ! ! 
i ! ! ; : 
j J j J j 
l- 
i i 
l 
! j j i j 
jli:: 
: i : j : 
! j j ! 1 
| i ! i 1 
1 i ' i 1 
i i 
i t 
1 i 
i 
; ! | 
: ; : : j 
; : ! i i 
'iiij 
11 i 
TT 
1 
1 i 
i 
i | 
x-! -i 
! i i i ; 
i i : i i 
: : i i j 
t i i i j 
i i : 
i 
1 
1 
i 1 
PULSE 
! 
-.1 >r*T r 
—v 
'V\! ! 
• i i i j 
' ' i i , 
i ! ‘ 
1 i 
1 
! 1 
i 
: ' ! 
! ! i : : 
; : 
• ' i i ' 
■ i i • t 
j 1 ! 
1 
IT 
i i 
1 i i i ; 
I!!-;; 
; J ! ! j 
1 : i 
i i 
1 
i i 
! ! ! 
! ! ! ! ! 
i j ! ; : 
; i : ; \ 
! i i 
i i 
i i 
! 1 
! • 
NORMAL 
i • < 
• ! 1 ! ! 
: ! 1 1 1 
• ; i • ■ 
i 
. ! 
1 
70 
~i ; , 
j ; j j ; 
Till! 
i i : M 
T| j ! i 
j j 
1 1 
1 
i i 
k-' ! 
r- * ’■ 
! i ; i i 
III!! 
! ! ! ! ! 
' ' i i i 
1 ; ; 
j J j i • 
j ! j j j 
1 i i i j 
1 1 
1 1 
1 
i i 
i 
| } * 
! ! j i ! 
i i i i ; 
1 ; > i i 
; 1 1 i | 
i ' ' ' 
! i | 
1 1 
j | 
i 
i} 
TTT 
! | i j 1 
i 1 ■] ! ! 
I | ! | i 
• i i i i 
i i i i i 
! i ! 
1 I 
1 
1 
55 4 
i j | 
1 1 j ! I 
! ! i ; } 
j | j ! ! 
I 1 i j 
i i i i i 
i ' * i i 
i i 1 
| 1 
i 
H 
j ! i i ; 
! i ! l-i< 
111!'! 
: i 1 i 
1 
i 
i 
'T+1' 
"T4-xn 
; i 
X'TVL.-*4*' 
..XT\ ; ; 
; i i i i 
! • • • i 
! ! ! 
i 
1 i 
i i 
a J6 
! : 1 
iiij! 
! iTTT 
! 1 i ! 1 
i i i i 
'iii 
! 1- 
1 ! ! 
i 
i • 
J ' 
- - - 
jj 
l-U 
NORMAL 
! i ! 
. 
“7“j | 
! i ! 
! : ! ! ! 
! ! 1 i j 
i 1 ! 
1 1 
1 l 
' 1 
i 
1 1 
i ; i 
! | i | | 
‘ i j ! i 
| j ! i' | 
! ! i i'l 
1 ; i 
! i 
! i 
i 1 
Urine 
w 
/ZOO 
c 
//oo 
aso 
1700 
Motes, 
Stools 
0 
1 J_ 
/ o 
/ 
/ / 
/// 
// 
/ 
// 
/ 
// 
// 
Day after Operation may be entered in red in the space for Day of Disease. 
Draw heavy lines to separate calendar days. 
t-M0l 
Fig. 93.— 
Typical clinical chart. 
designated for that purpose. The word “ mouth,” “ rectal,” “ axilla,” or 
“ groin ” placed in red ink in the space marked “ temperature ” indicates to 
the medical officer the manner in which the temperature is taken. The dots 
indicating the temperature should be made in such a manner that they may be 
seen distinctly. These dots should not be too large, and should be in the 
center between the dotted vertical lines, the distance between the horizontal 
straight lines depending upon the fraction of the degree of temperature. The NURSING. 
125 
lines joining the dots should he straight, not curved, and at the end of the 
day a red line should be drawn vertically from the top to the bottom of the 
chart to indicate the day of the disease. The hospital day begins at midnight 
and ends the following midnight. 
An additional sheet, called clinical notes (N. M. S. H. Form 17) should 
accompany the clinical chart and indicate all treatments and medications with 
statements regarding the results. For example, after the administration of a 
narcotic, a note should be made stating the effect obtained; in like manner 
a notation of the effects of stimulants should be recorded in the remarks 
column of the chart. The diet should be noted and also any abnormality 
which may arise, and if it is impossible to administer any treatment or food 
which has been ordered, this especially should be recorded. 
Charts and records are used to enable the doctor to know the condition 
of the patient during his absence, to provide a means of comparing the patient’s 
condition from day to day, to indicate the effect of medicines and treatments 
ordered, and to provide a record that may be preserved indefinitely for use 
in compiling statistics and for similar purposes or investigations. All records 
should be neat, free from erasures, the printing or writing should be legible, 
the lettering small but readable, and the statements accurate, brief, clear, 
and to the point. All medication and treatments should be recorded, together 
with the time administered, and the results obtained. Any unusual occurrence, 
such as haemorrhage, vomiting, etc., should be recorded in detail. When it is 
necessary to keep a record of the amount of urine voided, it generally is re- 
quired that a record of the amount of fluids taken for the day be also kept. 
Administration of medicines. 
Before a hospital corpsman should be allowed to administer medicines he 
should know the physiological action of the medicines in common use (this 
enables him to observe the effects of the medicines), the minimum and maxi- 
mum doses of drugs, especially poisonous ones (such knowledge will prevent 
mistakes), and the treatment of poisoning by the various classes of poisons. 
He should be familiar with the signs of overdosing, and should watch for any 
unusual symptoms after administration (some people have an idiosyncrasy for 
certain drugs and some drugs are not excreted readily, thus accumulating 
in the system and producing a poisoning effect). A hospital corpsman should 
appreciate and understand that it is easy for certain people to contract the 
drug habit, and any unusual facts regarding the patient’s apparent desire 
for drugs should be reported to the medical officer. 
A hospital corpsman should be familiar with all the abbreviations and 
symbols used in writing prescriptions in order that he may understand the 
orders. (See chapter on Pharmacy.) 
The methods of administering medicines are taken up in the chapter on 
Materia Medica. A medicine list should be kept in the ward and should 
contain the patient’s name, the medicine prescribed, the dosage, and the manner 
in which it is to be given. This enables a relief-hospital corpsman. to dispense 
the medications without referring to the order book. 
The following important points should be remembered in the care of, the 
measuring of, and the administration of medicines. The poison locker should 
be locked at all times when access to its contents is not required and the key 
retained by either the ward nurse or an experienced hospital corpsman, pref- 
erably one of the higher ratings. On inspection morning the poison locker 
should not be opened until the commanding officer indicates his wish to 
inspect it, and then should be locked immediately in his presence. All medi- 
cine bottles and labels should be clean and arranged in an orderly manner. 126 
HOSPITAL CORPS HAND BOOK. 
All medicines should be kept in a cool place and unlabeled medicinal prepara- 
tions should not be allowed in the ward (in case of doubt throw the medicine 
away—never guess). Medicines should be administered in the proper manner, 
at the proper time, to the proper person, and in the correct amount; those to be 
given before or after eating one-half hour before or after the meal. Graduates 
and pipettes should be used in measuring drugs; minims should be measured 
as minims and drops as drops when so ordered. There is a marked difference 
in the amounts of certain drugs when measured as minims and as drops. 
Accuracy in measurements is of paramount importance. In pouring medicines 
the glass or container should be held on a level with the eye; if the mark is 
above, too little may be dispensed, and if below, too much. The label on the bottle 
should be read at least three times—at the time of taking the bottle off the 
shelf, before removing the desired amount, and after the medicine has been 
removed. This procedure is a triple check to insure the use of the correct 
medicine. All bottles containing a sediment or preparations which are not 
clear should be thoroughly shaken before use. To avoid staining the label 
when pouring a medicine the bottle should be held in such a manner that the 
label will be on the upper side, and before replacing it the rim of the bottle 
or container should be wiped with a piece of gauze. It is a good plan to recork 
bottles immediately after removing any of the contents, as many medicines 
contain or are dissolved in volatile substances and will become stronger or 
weaker if allowed to remain uncorked. Medicines which change color or form 
a precipitate when combined (indicating the probability that a chemical change 
has taken place) should not be administered until after the medical officer’s 
attention has been invited to this fact. 
It is advisable to withhold certain foods prior to and during the administra- 
tion of certain medicines, as milk and eggs when calomel is given (the protein 
combines with the mercury to form an albuminate which will not produce the 
desired result and may be injurious to the patient). Syrupy cough medicines 
should not be diluted, as dilution will lessen the soothing effect. Drugs which 
irritate the mucous membrane of the alimentary tract to an injurious degree 
should be well diluted. Saline cathartics given to lessen oedema should be 
diluted sparingly, while those given for cathartic purposes should be well 
diluted. Doses of medicines should be made as palatable as possible; drinking 
water should be either very hot or very cold, never lukewarm. Ice water in a 
clean glass given immediately after taking medicine is appreciated by the 
patient. Castor oil may be given by rinsing the glass with lemon or orange 
juice, leaving about an ounce in the glass, pouring in the oil, and covering 
with more lemon or orange juice sweetened to taste. Another glass containing 
fruit juice should follow the oil. Acids and liquid preparations containing 
iron should be given through a tube or straw, because they corrode or dis- 
color the teeth. A patient never should be permitted to administer medicine 
to another patient. Powders and cachets should be placed far back on the 
tongue and hard pills or triturates should be pulverized. Absolute cleanliness 
in regard to measuring glasses, pipettes, tubes, and medicine glasses should be 
strictly observed. 
Procedure for giving medicines by mouth.—Every ward should have a medi- 
cine tray holding glasses, a small pitcher for ice water, a glass rod to stir the 
medicines, a piece of gauze to wipe the rims of the bottles, and a small glass 
jar or box to hold the medicine cards. These cards are disks or squares of 
cardboard, which fit over the medicine glasses, and indicate the patient’s name, 
medicine, dose, and how often it is to be given. The use of these cards will pre- 
vent mistakes when there are several medicines on the tray. When ready to Nursing. 
12*7 
prepare medicines the tickets for the same hour of administration should be 
selected, and all those calling for the same medicine be grouped together. The 
following procedure should be strictly observed: Take the medicine glass in 
the left hand, read the label of the medicine bottle, take the bottle in the right 
hand and shake it; take the cork between the third and fourtli fingers of the 
left hand and remove it; raise the glass until the mark representing the 
amount to be given is on a level with the eyes and pour the required amount 
into the medicine glass. If more than one patient is to receive the same medi- 
cine, the required number of doses should be poured out before wiping the 
bottle, recorking it, and replacing it. The label should be read again to make 
sure the correct medicine has been used. Small portions of ice water should 
then be added to cover the medicines, and the proper tickets placed on the 
glasses. Some empty glasses should be placed on the tray in order that the 
patients may be given some clear water to drink after taking the medicines. 
Before giving the medicine to the patient the name on the medicine card should 
be read again to avoid mistakes. Medicine glasses should be washed immedi- 
ately and the tray left clean and ready for use when the next medications are 
due. 
Steam inhalations may be given with an apparatus so arranged that the exit 
for the steam is in close proximity to the patient’s nose and mouth, or a large 
kettle may be used and placed at a slight distance from the patient and a 
canopy or tent arranged above the bed, over the patient’s head and shoulders, 
thus directing the steam toward the patient in a manner which will allow it to 
be inhaled. 
Oxygen inhalations.—Oxygen is supplied in steel containers in which the gas 
is confined under considerable pressure. In administering oxygen it fre- 
quently is passed through water, with two objects in view: First, to gauge the 
amount being administered; and, secondly, to allow the gas to absorb moisture 
in order that it may have a less drying effect upon the mucous membranes. 
This is accomplished by leading the flow of gas through a glass flask or other 
closed glass container partially filled with water. By means of a tube the gas 
is liberated under the surface of the water. Collecting above the water in the 
upper part of the flask, it is led away by a tube to the patient, to whom 
it is administered through either a piece of tubing, a funnel, or a special mask. 
The key of the oxygen container should be turned sufficiently to permit the 
oxygen to flow into the water of the flask at the desired rate, and the funnel 
held away from the patient’s face until the flow of oxygen has been adjusted. 
If too much oxygen is allowed to enter the bottle, water may be blown through 
the tubing. When the flow has been regulated hold the funnel near the patient’s 
nose and mouth, but not sufficiently close to cause the exhaled air to strike 
against the funnel and be reinhaled. 
Subcutaneous injections.—Hypodermic injections are injections of drugs or 
their preparations into the subcutaneous tissues of the body and are given 
when prompt action is required when medicines can not be taken by mouth or 
when secretions of the stomach or intestines interfere with the action of the 
drug. Drugs used for subcutaneous injection as a rule are especially pre- 
pared. They are put up in concentrated form, and great care should be taken 
to have them pure and sterile. Some drugs intended for this use are put in 
the form of compressed tablets, which should be dissolved in warm sterile 
water before administering. The dangers attending the use of hypodermics 
are: The formation of abscesses, the breaking of the hypodermic needle, and 
the possibility of injecting the drugs directly into the blood vessels. Abscesses 
are avoided by using only drugs known to be pure and sterile, by sterilizing 128 
HOSPITAL CORPS HANDBOOK. 
the hypodermic needle and syringe carefully, by cleansing the patient’s skin 
thoroughly at the site selected for injection, and by avoiding all irritation of 
the subcutaneous tissue. Blunt needles and irritating medicines should be 
avoided. The risk of breaking a needle in the flesh may be avoided by not 
using a bent or defective needle and by preventing sudden movement of the 
part which might cause the needle to break. If the patient has never been 
given a hypodermic injection, it is advisable to explain what is going to be 
done, that it may cause slight pain, and that sudden movements during the 
process should be avoided. A hypodermic injection should not be given to a 
delirious patient without some one to assist. It should not be given over a 
bony prominence or near large blood vessels or on the inner side of the arms or 
legs where the large blood vessels are situated. 
At least one hypodermic outfit should be clean and ready for immediate use 
at all times iu cases of emergency. (Fig. 94.) The needles should be straight, 
sterile, and sharp. The inside of the needle will become rusted if it is not 
thoroughly dried and the wire inserted when not in use. To dry the bore of a 
needle the wire should be removed and dried with a piece of gauze, reinserted, 
and the process repeated until the wire is perfectly dry when removed. A dry 
wire is inserted before putting the needle away. When a glass syringe is 
used the piston should be removed before boiling to prevent destruction of the 
syringe by expansion of the plunger when heated. The syringe must not be 
dropped into boiling water. Metal 
syringes containing rubber or leather 
washers should not be boiled, but may 
be sterilized by alternately filling and 
emptying with a 5 per cent solution of 
carbolic acid, followed by alcohol, and 
then rinsing with sterile water. This 
should be done both before and after 
using. 
In preparing tablets for hypodermic use the following procedure should be 
observed: If a glass syringe is used attach the needle, drop the tablet into the 
syringe, and add 20 minims of sterile water, insert the piston, shake the 
syringe to dissolve the tablet thoroughly, expel the air, and proceed to admin- 
ister the contents of the syringe to the patient. If the piston can not be 
removed from the syringe or if it is of metal, dissolve the tablet in not more 
than 30 minims of warm (not over body temperature) sterile water in a 
sterile minim glass or sterile spoon and draw the solution into the syringe in 
the usual manner. Do not boil the tablet in the water, as a high degree of 
heat causes chemical changes in many drugs. 
In giving a hypodermic injection boil the syringe and needle for one minute, 
attach the needle to the syringe, load the barrel of the syringe with one or two 
drops of sterile solution more than the desired amount, point the needle upward, 
press the piston until all the air bubbles disappear and only the required 
amount of medicine remains in the syringe. The outer surface of the arm or 
leg into which the medicine is to be injected, after being washed thoroughly 
with alcohol, is taken up and held firmly between the thumb and first finger to 
form a cushion of muscle and to stretch the skin. The needle is inserted 
quickly, preferably at an angle and preferbaly toward the trunk, and gentle but 
gradual pressure applied to the piston. (Fig. 95.) When the syringe has been 
emptied, remove the needle, press a sterile sponge quickly over the hole to pre- 
vent escape of the fluid, examine the needle to make sure it is intact, knead 
the spot geutly for a few seconds, and clean the syringe and needle, carefully 
Fig. 94.—Hypodermic syringe and nee- 
dles. (Wharton.) NURSING. 
129 
drying and replacing the wire. Great care must be taken not to allow air to 
be injected into the tissues, as it may enter the circulation and cause grave 
complications or death. 
Care and comfort of a patient. 
In the care of patients, especially fever patients, the following general rules, 
subject to modification by the medical officer, should be observed: Provide 
plenty of fresh air without causing draughts; guard against glaring light in 
the patient’s eyes; observe extreme cleanliness, both with regard to the patient 
and to yourself; apply cold to the patient’s head and heat to his feet, if 
necessary; keep the mouth, tongue, and teeth clean at all times of the day or 
night; and give necessary cooling drinks frequently. A delirious patient never 
should be left unattended. The prescribed diet should be carefully followed. 
A notation should be made of evacuation of the bowels and bladder, and any 
abnormalities present should be brought to the attention of the medical officer. 
Carrying out orders and administering treatments and medicines are not all 
that is necessary in the care of patients. Prompt recognition of changes in the 
condition of a patient and good nursing, when it is a question of life or death, 
may be the deciding factor in saving a life. 
Rest means that the vital organs, especially the heart, are to be spared all 
unnecessary effort. In order to accomplish this the patient not only must be 
kept quiet in bed, but all ex- 
citement, anxiety, and an- 
noyance must be prevented. 
When a person has fever, it 
takes very little to arouse ex- 
citement or cause anxiety, 
therefore, he never should be 
told about anything going on 
in any other part of the hos- 
pital, nor should he know the 
facts contained on his clinical chart. Under no circumstances should a nurse 
or hospital corpsman discuss the patient’s condition in his presence. Seem- 
ingly unconscious patients often hear every word. Never whisper near a patient, 
as it is very annoying to an ill person. Trivial things which a patient would not 
notice when well may be a source of great irritation when sick. Actions which 
hardly would seem an effort or require much energy, such as holding a glass, 
drinking very rapidly, or trying to drink out of glass instead of using a drink- 
ing tube, often exhaust the patient. A weak patient never should be permitted 
to turn or move unaided. Patients have been known to fall back dead after 
slight exertions similar to those mentioned above. 
To secure the comfort of a patient and prevent the development of bed- 
sores, fatigue, or exhaustion the position should be changed occasion- 
ally ; change the position of pillows as soon as they become disordered and 
uncomfortable; when the patient is very thin, relieve pressure on bony promi- 
nences with air rings or pads made of cotton or gauze; flex the knees to relieve 
abdominal strain or pain ; support the bed clothing with a cradle when its weight 
causes discomfort to any part of the body; and when a weak person sits up 
or lies on the side furnish support with pillows, which should be so arranged 
that the patient will not be required to use any effort to maintain the position. 
To (jive and remove a bedpan.—The bedpan must be warm and dry. Flex the 
patient’s knees if possible, pass one hand under the sacrum, gently raise him, 
and insert the pan. When removing the bedpan it is necessary to raise the 
Fig. 95.—Method of giving a hypodermic injection. 
(Wharton.) 130 
HOSPITAL CORPS HANDBOOK. 
patient in the same manner, for if an attempt to remove the bedpan without 
doing so is made the fluid contents may be spilled on the bed, or the rubbing 
of the bedpan on the skin may cause an abrasion which readily will develop 
into a bedsore. After using the bedpan the patient should be cleaned with 
warm water and soap and carefully dried. 
Care of the mouth.—Convalescent patients and those who are not very ill 
require the same daily cleansing and washing of the mouth and teeth as does 
a healthy person. A fever patient, however, requires special attention and 
faithful care, since with a high temperature there is likely to be an insuffi- 
ciency of the secretions of the mouth which in health tend to keep the mouth 
moist and clean. This may be the result of inactivity of the glands of the 
mouth or the rapid evaporation of the moisture on account of the high fever. 
Whatever its cause may be, if this condition persists for any length of time, 
the membranes will become very dry and crack, and only the greatest care 
will prevent the appearance of either sordes or herpes, which in turn may 
develop into very serious complications. A fever patient’s mouth should be 
washed after every feeding, whether the food is fluid or solid. This applies 
to the patient both at night and during the day. Carelessness of the night 
watch may undo all the faithful work of the previous day. One thorough 
cleansing should be given in the morning as well as in the evening. By this 
is meant that the tongue should be well scrubbed with a piece of gauze on a 
tongue depressor, the teeth cleansed with gauze, and dental floss used to remove 
any retained food material between them. If the mouth is too sore to use 
a toothbrush, a piece of gauze may be wrapped around the finger and the 
teeth cleansed with it, after which the patient should rinse the mouth with an 
antiseptic mouth wash (Dobell’s solution or a solution of boric acid and lemon 
juice with a few drops of tincture of myrrh added). The tongue never should 
be scrubbed after feeding, as the patient might be inclined to vomit, especially 
if the back of the throat is touched. The best time to do this is about 10 
minutes before a feeding is due. Fever patients should be given a glass of 
water after each feeding and frequently between feedings. This not only helps 
to keep the mouth moist and clean, but also flushes the kidneys and assists in 
reducing the fever. 
Rubs.—In order to give an acceptable rub or to handle a patient with com- 
fort to him, the hospital corpsman must take care of his hands. Rough, hard, 
cold hands can not but annoy, while a soft, smooth, warm, gentle hand brings 
infinite comfort. 
In rubbing with alcohol, wet the hand just enough so that it does not drip. 
On the arms and legs use both hands for rubbing, on the chest and back 
usually but one. The stroke should be rather long, not too quick, firm enough 
to stir the circulation, yet light enough to glide over the skin without pulling. 
Try all the time to think of the muscles and blood vessels under your hand, and 
endeavor to reach and stir them. Forget the skin as far as possible, except that 
you are not to let your fingers pull or pinch it. Use the whole hand, palm, and 
fingers, almost grasping the flesh with it. Do not use the ends of the fingers 
too much. 
Counter irritants are substances which when applied to any area of the body 
surface will produce irritation of the sensory nerve endings lying beneath the 
surface. This process relieves congestion and inflammation in either an ad- 
joining part or some distant part. The principal uses of counterirritants are 
to relieve congestion and inflammation as in tonsillitis, pneumonia, and head- 
ache; to promote absorption of serous effusions, as in pleurisy, and exudates 
around joints; to stimulate nerve centers in collapse; and to increase peri- NURSING. 
131 
stalsis and thus overcome tympanites. Substances used as counterirritants 
produce different stages of irritation according to their strength and the length 
of time applied and are known as rubefacients or reddeners, which cause the 
superficial vessels to dilate and redden the skin; vesicants which produce a 
blister; and caustics or escharotics, which cause a burn or sloughing. (See 
chapter on Materia Medica.) 
Rubefacients, in general use, are heat (both dry and moist), mustard pastes, 
flaxseed poultices, stupes, cupping, and certain liniments. Unless special care 
is exercised in the use of rubefacients, blisters may be caused which, unlike 
those resulting from vesicants, may be very slow in healing, and may become 
infected. 
Vesicants are applied especially for the purpose of causing absorption or re- 
moval of inflammatory deposits after true inflammation has ceased. (The one 
most frequently used is cantharidal collodion.) Caustics or escharotics in com- 
mon use are silver nitrate and actual cautery. 
Stupes, or hot fomentations, are prepared by placing two layers of flannel 
in boiling water, wringing as dry as possible by means of a canvas or towel 
and applying directly to the skin, which has been greased with petrolatum to 
prevent blistering. The flannels are covered with a light rubber sheeting 
or heavier flannel and kept in place with a bandage or binder, and are changed 
frequently. They usually are allowed to remain over a period of from 20 
minutes to 1 hour, or as directed. If the stupes are ordered over a broken 
surface, sterile gauze should be used and wrung dry by means of a sterile 
towel, observing tbe strictest asepsis in regard to water, hands, material, etc. 
The most desirable manner of using turpentine stupes is to mix tbe turpen- 
tine with oil, in the proportion of one part of turpentine to two of oil for an 
adult, one part of turpentine to six of oil for children. This is applied to the 
area of the skin desired and the hot flannel then applied. The oil and turpen- 
tine must be well stirred before each application. 
Mustard sinapisms (plasters) are used in the form of a mustard paste or mus- 
tard leaf. The paste is made from flour and warm water, into which mustard is 
stirred in the proportion desired, usually varying from one-eiglitli to one-half, the 
latter proportion for applications to the chest. If the skin is sensitive the white 
of an egg should be mixed with the mustard. Spread the paste on thick muslin, 
turn in the edges, and cover the surface next to the skin with gauze. This ap- 
plication generally is allowed to remain not longer than 15 minutes, and 
should be watched carefully. Certain individuals blister more readily than 
others. After removing, if the skin is very red, a bland ointment should be 
applied. If the official mustard leaf is used, it should be dipped in tepid water, 
allowed to drip, applied directly to tbe skin or on a layer of thin muslin, al- 
lowed to remain for 5 or 10 minutes, and watched carefully to avoid blist- 
ering. After removal tbe surface should be dried and kept covered until all 
redness has disappeared. 
Poultices are applications of substances which when parboiled retain heat 
and moisture. Flaxseed meal is used most commonly for poultices. In prepar- 
ing a flaxseed poultice the water must be boiling and all appliances must be 
at hand to prevent the poultice from cooling during preparation. The muslin 
to hold the poultice should be 2 inches larger than the required poultice. The 
flaxseed meal should be stirred into the boiling water, and when the mixture 
is cohesive and does not adhere to the sides of the saucepan it is spread upon 
muslin and smoothed with a spatula to a thickness of three-quarters of an 
inch, dipping the spatula in boiling water frequently. The margins of the 
muslin should be turned in and the poultice rolled into a warm towel or car- 132 
PXOSPITAL CORPS HANDBOOK. 
ried to the patient on a hot-water bag. Before applying, the poultice should 
he tested against the cheek and then applied directly to the skin, provided the 
poultice does not contain an Irritating ingredient. It should be covered with 
thin rubber sheeting and with a layer of cotton kept in place by means of a 
binder or bandage and removed in an hour or as soon as it becomes cold. 
tJpon removal the surface should be dried, the skin carefully observed and 
covered with a layer of warm cotton, which should remain until the next 
application or until removal is directed. 
Cupping is the application to the surface of the skin of glass cups in which 
a vacuum has been created by the use of heat or with a pump or a rubber 
bulb. (Fig. 96.) As a result of the vacuum the tissue under the cups is 
forced into them. This results in the hypersemia of this tissue both as a 
local effect and for the relief of congestion in underlying structures. Cups 
provided with pumps and bulbs are known as Bier’s cups, named after the 
inventor, and vary in shape and size (usually one cup is used to cover the 
entire area). Another method is to create a vacuum by means of heat, ana 
when so done a number of cups are used at the same time. The cups must 
be dry, especially the rim. 
The inside of the cup is moistened with cotton soaked in alcohol, care being 
taken to avoid having any alcohol on the rim of the cup. Then ignite the 
alcohol which is retained on the inner surface of the cup, and before the flame 
is extinguished invert the cup and hold for a second to make certain no alcohol 
has collected. Apply immediately 
to the affected area. In removing 
cups never pull them off, but insert 
under the rim a small portion of the 
handle of a spoon or other suitable 
object which has been thoroughly 
cleaned, elevate slightly to permit 
the admission of air and destroy the vacuum. Before applying cups by this 
method a blanket should be obtained and placed where it will be available in 
the event of an accident (tire). 
In applying a Bier’s cup with a bulb select one large enough to extend about 
1 inch beyond the inflamed area, oil the edges with vaseline, place the cup in 
position, and gently squeeze the bulb. As the bulb resumes its shape a vacuum 
will be created in the cup. This will cause the tissue to rise within the cup. 
If the pump method is used, the air should not be exhausted too quickly or too 
extensively; to do so may cause pain and discomfort to the patient. The color 
of the skin should be watched carefully, and pumping should cease when the 
skin assumes a mottled appearance or if the patient complains of pain. 
In using a Spanish-fly or cantliaridal collodion blister the skin should be 
surgically prepared and the collodion then applied to the selected surface by 
means of a camel’s-hair brush, having first outlined the area with vaseline. 
The application shoud be allowed to dry for a few minutes and then be covered 
with gauze and oiled-silk or waxed paper, and examined from time to time. It 
usually takes from four to eight hours for a blister to form. If a blister does 
not form within this time, the application should be removed and a poultice 
applied over the site. After the blister has been raised, it should be asepti- 
cally opened, the fluid gently pressed out with sterile cotton, and a dry sterile 
dressing applied. Strict aseptic precautions are necessary. 
Cold applications frequently are used in the treatment of inflammation, be- 
cause of the depressing action of the cold on the activity of the circulation. 
Cold inhibits the multiplication of bacteria and also the forming of toxins. 
Fits. 96.—Cupping glass and air pump. (Whar- 
ton.) NURSING. 
133 
It relieves pain by causing contraction of the blood vessels, thus relieving 
congestion, and by reducing the irritability of the sensory nerve endings. 
Cold usually is applied in tlie form of ice, iced water, and iced solutions 
by the use of ice caps, ice coils, compresses, local baths or irrigations. 
In using ice caps the ice should be broken into pieces about the size of a 
walnut, using a canvas bag and mallet. After half filling the bag the air 
should be expelled and the cap securely screwed down. The bag should not 
bt more than three-quarters full and always should be covered with gauze. 
After use the surface of the bag should be washed with a disinfectant and 
hung up to dry before putting away. 
Cold compresses consist of several layers of gauze or absorbent cotton im- 
mersed in cold water or iced water, wrung out to remove the excess water, 
and applied to the desired part. These compresses must be changed very fre- 
quently in order to keep the part cold. Eye and throat compresses are the 
most commonly used cold compresses. Absorbent cotton should be used for 
the eye compresses, the pad consisting of several layers of cotton a little 
larger than the eye in size but not large enough to extend over the bridge of 
the nose. If both eyes are to be treated, separate pads and separate basins 
of iced water should be used for each eye. When there is discharge from the 
eye the same compress must never be used more than once. A receptacle 
should be provided, in which to throw the soiled compresses. A compress 
should not be allowed to remain on a part until it becomes warm. 
Hot applications are applied for the stimulating effect (heat expands the 
tissues and thus increases hypersemia to a greater degree than any of the 
other counterirritants). Moist heat induces softening of the tissues and at 
the temperature attained by the use of poultices, if applied directly over an 
inflamed area, will favor suppuration. For this reason the use of poultices 
sometimes may produce harmful results. Moist heat is more penetrating 
than dry heat. Counterirritation by heat usually is produced by the use 
of hot-water bags, hot-air baths, compresses, poultices, stupes, and by elec- 
tric pads. 
Hot-water bags.—The water must not be hot enough to scald; the bag should 
be half full; superfluous air should be forced out of the bag before the cap 
is screwed on; an uncovered hot-water bag should never be given to patient, 
and care should be taken that a blanket intervenes between tlie covered bag 
and the body of an unconscious patient. Post-operative patients require special 
care when hot-water bags are applied and should not be left alone while the 
hot-water bags are in his bed. A hospital corpsman never should take a 
patient’s word concerning the temperature of a bag, but should judge for 
himself and carefully watch the skin for reaction. 
Tlie use of electric pads requires important precautions. When these ap- 
pliances are used the hospital corpsman should make sure that the insulating 
material around the wires is intact; otherwise the bedclothes may be set on 
fire. It should be remembered that if the pad is used continuously for any 
length of time its temperature will increase and it may burn the patient, 
the heat causing the perspiration to scald him. 
Hot ivet dressings should be applied in the form of fluffed gauze or rolled 
gauze compresses wrung out of a hot antiseptic or sterile solution. They should 
be applied and covered with thin oiled silk or rubber sheeting to protect the 
bedclothes and mattress, and a hot-water bag should be placed outside of the 
rubber sheeting to maintain the heat. Precautions should be taken against 
permitting a wet dressing to become cold, especially at night; carelessness may 
result in the development of serious complications. 134 
HOSPITAL CORPS HANDBOOK. 
A pneumonia jacket or chest protector may be made of soft flannel, double 
thickness, or of cotton placed between two layers of gauze cut to fit the body. 
It should have arm holes and shoulder pieces and should cover the thorax. 
One side should be left open and fastened with tapes under the arm and over 
the shoulder. The cotton should be held in place by stitches. 
Bed making. 
Making beds correctly is one of the first things a hospital corpsman should 
learn. Neatly and correctly made beds add greatly to the appearance of a 
ward and to the comfort of the patients. Loose and sagging beds should not 
he used and special care should be taken to prevent bed coverings from becom- 
ing too tight for the patient’s comfort. Whenever a patient is temporarily out 
of the bed occupied the bed should be straightened and smoothed before the 
return of the patient. 
The method of making beds varies in the different hospitals. At some the 
spread is tucked in and at others it is not; at some a blanket is rolled and 
placed at the foot of the spread while at others it is not. The fundamental 
principles, however, are the same at all hospitals, namely, protection of the 
mattress, cleanliness, tightness of the under and draw sheets, and warmth 
for the comfort of the patient. 
A mattress always should be protected with a mattress cover, a linen cover 
being washed and sterilized more easily than the mattress. The moisture in 
sterilizing often ruins the mattress. The bed linen should be changed as 
often as necessary, but economy should be practiced where laundry conditions 
are unfavorable and where there is a scarcity of linen. Care should be taken 
to avoid placing badly stained linen on beds. The under and draw sheets 
should he drawn tight to prevent the formation of wrinkles under the patient, 
which makes possible the development of bedsores. There should be sufficient 
covering to keep the patient warm and, while it is necessary to have the bed- 
clothes look neat and tight, care should he taken to avoid the causing of pres- 
sure sores on the toes. Beds and bedding should be kept free from vermin. 
If signs of bedbugs appear the bed should be cleaned with a disinfectant solu- 
tion and the bedding and mattress sterilized by steam. It is imperative that 
no clothing, papers, books, food, pipes, tobacco, or other articles be kept under 
the pillows or mattresses. 
The proper manner of making a bed is to obtain all the necessary bedding, 
put it in a place convenient to the bed, remove all clothing which may be on 
the bed and turn the mattress either from top to bottom or from side to side. 
(1) The mattress cover should be placed over the mattress from the head to 
foot, corners neatly fitted and the tapes tied at the foot of the mattress. 
(2) The bottom sheet should be placed on the mattress right side uppermost 
with the wide hem at the head of the bed, and so arranged that it hangs equally 
over the sides of the mattress. The wide hem should he folded over the head of 
the mattress and an 18-inch tuck made with envelope corners at each side. The 
sheet then is pulled down to the foot of the bed, made taut and the sides tightly 
tucked in. (3) The top sheet is placed on the bed wrong side uppermost with 
the wide hem toward the head of the bed and even with the upper edge of the 
mattress. It should be placed so that it hangs equally over the sides. The end 
is folded smoothly under the foot of the mattress, envelope corners made and 
the sheet freed from wrinkles. (4) Next the blanket is placed on the bed in 
such a manner that it hangs equally at the sides and is 6 inches from the head 
of the bed. The blanket then is folded over the foot of the mattress, tucked 
in, envelope corners made, and the entire blanket freed from wrinkles. (5) The NURSING. 
135 
spread next is placed in such a manner that it will be right side uppermost 
(anchor pointing to the lower left corner of the bed), hanging equally at the 
sides and should just cover the blanket at the head end. The foot end then is 
folded smoothly under the mattress, tucked in, envelope corners made, and freed 
from wrinkles. (6) The upper part of the sheet extending beyond the blanket 
and spread should be folded back over them and the spread, blanket, and sheet 
tucked in tightly at the sides or allowed to hang in accordance with the local 
rules. (7) Pillow cases are applied to the pillows, arranged in such a manner 
that the corners will be well filled and then placed at the head of the bed with 
the seam to the back and the closed end toward the entrance of the ward. 
Fracture bed.—This type of bed differs from the ordinary bed in that a full 
sized perforated board, a frame of slats, or a number of slats are placed 
between the springs and mattress to prevent any motion at the point of frac- 
ture by sagging of the mattress. 
Ether bed.—This sometimes is called an anaesthetic bed, and it is prepared es- 
pecially for patients who are or have recently been anaesthetized. It resembles 
an ordinary bed, except for the fact that the upper sheet, blanket, and spread 
are tucked in at the bottom but not at the sides and are neatly folded, fanlike, 
at the foot of the bed. A rubber sheet is placed across the center of the bed, 
about the distance of a pillow from the head of the bed, tucked ia smoothly 
on both sides, and covered with a drawsheet, which is an ordinary sheet 
folded crosswise to cover the rubber and extending 2 inches beyond the 
rubber at the top and bottom. This sheet is tucked in smoothly and 
tightly on both sides and a rubber pillow cover or small rubber sheet cov- 
ered with a towel secured at the head of the bed in place of the regular 
pillow and the towel secured to the mattress with safety pins. The pillow 
should be placed on edge against the head bars of the bed and fastened to them 
with two strips of gauze bandage. At least two hot-water bags should be 
placed on the bed and the whole bed covered with an extra blanket turned up 
at the sides, in order that the entire blanket and the bed may become warm 
before the patient returns from the operating room and is placed in it. The 
hot-water bags should be removed from the bed immediately prior to arrival 
of the patient. A suit of clean pajamas should be wrapped around the hot- 
water hags to warm and when required placed on the patient. The following 
articles should be placed on the bedside locker: Towels, gauze, two pus basins, 
mouth gag, tongue forceps, clock or watch, pencil and paper, and on the floor 
at the foot of the bed a set of shock blocks upon which to raise the foot of the 
bed in case of severe shock. 
Changing the mattress with the patient in bed may be accomplished as fol- 
lows. The spread should be folded neatly and placed on a chair. The sides 
of the upper sheet and blanket should be folded over the patient, and the 
bottom part of it folded under the legs. The pillows should be removed, the 
lower sheets loosened and the sides of the sheets including the rubber sheet 
rolled close to the patient. One side of the rolled sheet then 'should be 
pulled, drawing the patient toward your side of the mattress, an assistant 
should stand on the opposite side of the bed and draw the mattress toward 
his side until half of the springs are exposed. This exposed part is covered 
with a fresh mattress, the patient drawn upon it, the old mattress discarded 
and the fresh mattress pulled into position. The patient should be drawn 
toward the center of the bed, and the making up of the bed continued. If 
the under sheets are to be changed, the vacant half of the mattress should be 
changed with fresh linen, and before the patient is drawn to the center of 
the bed, the patient lifted (with some assistance) on to the clean side, the 136 
HOSPITAL CORPS HANDBOOK. 
soiled linen removed, the clean sheets drawn over the remainder of the 
mattress, and the making of the bed completed. 
Turning the mattress with the patient in bed.—This may he accomplished 
in a manner similar to changing the mattress, except that after drawing the 
mattress to one side of the bed, the springs should he covered with three 
pillows and the patient lifted on to them. The mattress then is turned top 
to bottom, the patient lifted back on the mattress, and the bed made up as 
before. 
Changing lower sheet of bed patient.—In making this change it is necessary 
to loosen all of the clothing from the head, foot, and sides of the mattress, 
and to remove the pillows and all upper clothing except the sheet. The patient 
then is turned on one side. The lower sheet is folded or rolled lengthwise 
close to the patient’s back and a clean sheet folded or rolled lengthwise to 
its middle and placed close up to the soiled sheet. The patient is turned on 
his opposite side, the soiled clothes removed, the clean sheet freed from 
wrinkles and tucked in at the head and sides to make it taut. If a drawsheet 
is present it should be removed with the soiled sheet and a clean drawsheet 
folded or rolled and placed in its correct position at the same time and in the 
same manner as the lower sheet. If it is impossible to turn the patient 
upon his side, assistance should be obtained. With an assistant on the op- 
posite side of the bed, it is possible to loosen the clothing all around, and to 
remove the pillow. The head, shoulders, body, and hips are supported in 
that order while the soiled sheet is folded or rolled and gradually removed 
from head to foot, following it up with a clean sheet which has been rolled 
or folded and which is unrolled or unfolded as the soiled one is withdrawn. 
Changing clothing of a helpless or unconscious patient.—If the sleeves 
do not slip off readily, one hand should he slipped through the armhole, the 
patient’s arm grasped above the elbow, bent slightly, and gently drawn back- 
ward, while with the other hand the sleeve is removed by pulling the armhole 
or the wrist. If the arm is injured, the sleeve of the injured arm is removed 
last, but in putting on the pajama coat, the injured arm is put in first. The 
pajama coat should be pulled well down in the hack in order to avoid wrinkles. 
In the case of helpless and unconscious patients it is better to have the 
pajama coat buttoned in the back. The most efficient way to remove a coat 
from a helpless patient, is to draw it well up to the shoulders, then bring it 
over the head, taking out first one arm and then the other. The trousers 
are pulled down to the ankles, both legs are lifted with one arm, and the 
trousers removed with the free hand. If the leg or foot is injured or swollen 
the trouser leg should be cut at the seam to facilitate repair. 
Moving and lifting patients.—Before being lifted a patient should be drawn 
to the edge of the bed, thus minimizing the degree of stooping required. When 
stooping is unavoidable, the lifter should bend his knees and hips, throw back 
his shoulders and retain them in that position. Before lifting, the patient 
should be instructed to make himself rigid, and to remain so while being lifted. 
When two or more persons are lifting a patient, it should be done in unison, 
one directing and giving the word to start when ready, but when carrying a 
patient one carrier should step off with the right foot and the other with the 
left, to prevent swinging. 
In moving a helpless patient to the side of the bed, his head and shoulders 
should be supported with one arm and the other arm gently placed under the 
small of his back. The assistant standing on the same side of the bed should 
pass one arm under the upper part of the patient’s thighs, and the other under 
his knees. The patient thus can be lifted easily to one side of the bed. A NURSING. 
137 
heavy patient may be turned or moved more easily by loosening the drawsheet 
and pulling it to one side of the bed, or by grasping the loosened end of the 
sheet on a line with the shoulders and thighs and then gently pulling it upward 
and turning the patient on his side. 
A weak or helpless patient should be turned on his side by placing one arm 
under his far shoulder, obliquely across the back in such a manner that the 
hand comes under the patient’s near side; the other arm should be placed under 
his hips from the far side, the patient raised slightly and drawn somewhat 
backward, and turned toward the attendant. It may be necessary to make 
some change in the position of the patient’s shoulders or hips. In moving the 
shoulders of a helpless patient the hospital corpsman’s arms should be placed 
on either side of the patient’s body, bringing the hands under the lower 
arm, then the patient should be raised slightly and moved as required. The 
hips should be moved in the same manner. 
Restraining apparatus.—The appliances commonly provided in hospitals for 
the restraint of violent patients are the straight jacket, made of soft canvas, 
with sleeves sewed to the sides, and buckles arranged so that the patient can 
be strapped into it without suffering any discomfort; and leather cuffs of 
sizes to fit the wrists and ankles, commonly known as anklets or wristlets. 
Sheets and strips of canvas often are substituted for these in restraining the 
arms and thighs. No attempt should be made to restrain a patient without 
assistance, and when a patient is delirious or insane he should not be restrained 
and left without a guard; under these conditions he may devise means of 
escape. In restraining the arms and legs, interference with circulation should 
be avoided. If appliances are not well padded, chafing and ulceration may 
result, and if the patient struggles, constant watch should be kept to prevent 
the restraint from becoming tightened. This applies especially when the jacket 
is used, and care must be taken to see that the patient’s respiratory move- 
ments are unhampered. The pulse and general condition of a delirious patient 
struggling against restraint should be watched earefully; sudden death not 
infrequently occurs during this state. The extra work thrown upon the 
patient’s heart by the violent movements often produces conditions which can 
not be compensated. 
The care of the dead and the disposition of patient’s effects are discussed in 
the section on Deaths and Medico-legal Matters. 
As soon as a patient is pronounced dead by a medical officer this entry 
should be made on the chart: “ Patient pronounced dead,” followed by the 
hour, minute, and the name of the doctor who pronounced the death. 
Massage is discussed in the chapter on Physiotherapy. 
RECOGNITION AND PREVENTION OF DISEASE; GENERAL PRIN- 
CIPLES GOVERNING THE CARE OF PATIENTS. 
Communicable diseases are those which may be transmitted from one person 
to another and gain entrance into the body by way of the mouth and nose 
(respiratory and alimentary tracts), from contaminated food and drink, drop- 
lets from breath, infected dishes, linen, contaminated articles, by bites of in- 
fected insects (mosquitoes, body lice, fleas, flies), and by entrance of infective 
agents through abrasions of the skin and mucous membranes. 
Communicable diseases are described in the chapter on Preventive Medicine, 
Hygiene, and Sanitation. A few of the common diseases are mentioned here- 
after with a short description of the nursing care necessary in the treatment. 
Some of the common eruptive diseases are: German measles, measles, scarlet 
fever, smallpox, chicken pox. Water-borne diseases are: Typhoid fever, dysen- 138 
HOSPITAL CORPS HANDBOOK 
tery, and cholera. Those caused by the bite of an insect: Malaria, yellow fever, 
dengue, typhus. Those caused by entrance of infective agents through abrasions 
of the skin: Tetanus, septicaemia, erysipelas, and gas bacillus infection. Dis- 
eases of the respiratory tract are: Bronchitis, influenza, pneumonia, and 
tuberculosis. Those caused by special organisms: Tonsillitis, Vincent’s angina, 
diphtheria, and meningitis. Some of the special diseases which are not com- 
municable but often occur as complications or sequellae of communicable dis- 
eases are: Acute endocarditis, pleurisy, rheumatic fever, nephritis. 
Active and passive immunity are described in the chapter on Bacteriology, 
Blood Work, and Immunity. 
Symptoms of a disease may be defined as “Any evidence of disease or of a 
disordered condition; a change in the body or its functions indicative of some 
abnormal bodily or mental state.” Physical signs are described as “ conditions 
that can be seen, heard, or felt by the diagnostician” (inspection, auscultation, 
palpation, and percussion). Symptoms may be divided into two classes: Ob- 
jective, those observed by the onlooker; and subjective, those complained of by 
the patient but not seen by the observer, such as pain, discomfort, and nausea. 
Some of the important symptoms are: Changes in the temperature, pulse, 
respiration, color of skin, facial expression, appearance of eyes, mental con- 
dition, odor of breath, etc. 
In observing the condition of the body, the following should be looked for: 
Emaciation, sores, and eruptions, including the type and location; swellings, 
especially of the face or feet; the presence and location of abnormal promi- 
nences ; involuntary twitchings of muscular contractions, local or general; 
and any other abnormalities. 
The position a patient’s body assumes should be noted and the location and 
character of any pain observed. The position of the body during sleep is also 
important. 
Perspiration, if warm, is natural during crisis or following high fevers and 
is considered as a favorable symptom; if the perspiration is cold and the body 
has a clammy feeling the symptoms are not favorable. Profuse periodic 
attacks of perspiration occur in rheumatic fever and in tuberculosis, especially 
at night. A chill should be observed for its duration and severity. The condi- 
tion of the nose, throat, mouth, teeth, and tongue should be carefully noted. 
Sensitiveness, especially in the abdomen, is important. The amount of 
urine voided during 24 hours should be noted and the appearance described. 
Stools should be observed for color, form, consistency, and odor. 
Personal prophylactic measures (voluntary) consist of: Sufficient and 
proper nourishment; an adequate amount of fresh air and sunshine; avoidance 
of excessive fatigue and overworking of any one part of the body; keeping 
the system properly flushed (regular movements of the bowels and passage 
of normal amounts of urine) ; and training the body to react to sudden alterna- 
tion of heat and cold. Involuntary measures consist of: The normal secretions 
of the body (hydrochloric acid in the stomach; the alkaline digestive juices) 
and the presence and action of antibodies (immunity producing agents) in 
the body. 
General prophylactic measures consist of: Isolation; sunshine; and the 
proper disposition of discharges, droplets, and excreta containing bacteria. 
Gauze handkerchiefs and paper sputum cups should be burned ; thermometers, 
dishes, utensils, and linen sterilized or disirfected; and the hands thoroughly 
scrubbed under running water and soap for at least three minutes, followed by 
the application of a disinfectant hand lotion. Excreta should be covered until 
such time as it may be disposed of readily by disinfection or burning. All NURSING. 
139 
doors and windows should be screened properly, especially in malaria and 
yellow fever cases. When screens are not available cotton netting should be 
used over the patients. All insects should he killed. 
The general nursing care of all diseases consists of: Absolute cleanliness; 
plenty of fresh air; proper ventilation; daily bath as ordered; cleansing of 
mouth before and after feeding; forcing of fluids, unless otherwise directed; 
and giving the prescribed diet regularly. Care should be taken to observe and 
chart stools and urine; to wash the buttocks after each stool; to take and 
chart temperature, pulse, and respiration conscientiously, at regular intervals, 
noting the character of pulse and respirations; to give medicines accurately 
and at the proper time; and to change the patient’s position fre- 
quently. When fever is present the patient’s mouth should be sprayed fre- 
quently ; the lips moistened with liquid petrolatum; and the hack and pressure 
surfaces rubbed at least twice daily, or more frequently, if necessary. 
The hospital corpsman caring for patients with communicable diseases 
should observe the following rules: Wear a cap and gown in the ward or 
room; wash the face and hantfs with tincture of green soap before meals and 
before leaving the ward; wash the hands with some antiseptic solution after 
handling the patient or contaminated articles; when irrigating a diptheria 
patient’s throat wear glasses and a gauze mask over mouth and nose, and take 
a daily walk in fresh air or light exercises daily. 
A medical officer visiting cases of communicable disease should wear a gown 
which when not in use should he folded in such a manner that the inside is 
kept clean. If it is hung in the patient’s room, the contaminated side should he 
out; if hung in an outside room, the contaminated side should be folded in. 
A basin of hot water, tincture of green soap, and clean towels should be in 
readiness for the doctor’s use upon completion of his visit. 
The following points are important in the after care of patients who have had 
communicable diseases. A thorough cleansing bath, including the hair, should 
be given prior to the discharge or transfer from the ward; the clothing worn in 
the ward should be sterilized before removing, as should also the hammock, 
etc., before storing in the hag room'. After removal of the patient all 
windows should be opened and all curtains removed to admit plenty of fresh air 
and sunshine, and the walls and all furniture should be washed thoroughly 
with soap and water. All mattresses, pillows, and blankets should be sterilized 
immediately; the linen, gowns, etc., sterilized or disinfected before sending to 
the laundry; the dishes and utensils if isolated should he sterilized or disin- 
fected before returning them to their proper places; and the thermometers 
entirely covered with a disinfectant solution and soaked for 20 to 30 minutes. 
The following is a brief description of a few of the communicable diseases 
which a hospital corpsman frequently is called upon to nurse. (See chapter 
on Preventive Medicine, Hygiene, and Sanitation for a more complete de- 
scription. ) 
Eruptive diseases. 
Measles.—Cause is an unknown filterable virus; incubation period is from 7 to 
18 days; symptoms are coryza, sneezing, cough, nausea, vomiting, chilliness. 
Fever, first day, 102° to 104° F., which on the third day gradually drops and then 
rises with the appearance of the eruption, the temperature dropping by lysis as 
the rash fades. The eruption is seen first on the mucous membranes of the 
cheeks, prior to its appearance on the skin. On the third or fourth day it appears 
on the chin or forehead, sides of the neck, face, and the body. It consists 
of red, elevated spots which run together, forming crescent-shaped blotches. 
47829°—23 10 140 
HOSPITAL CORPS HANDBOOK. 
Common complications of measles are: Broncho-pneumonia, laryngitis, otitis 
media. The nursing care consists of darkening the room or shading the eyes, 
forbidding the patient to read and washing the eyes frequently with boric- 
acid solution. The nose, mouth, and throat should be kept clean and the room 
warm and free from draughts. Itching of the skin may be troublesome and 
may he relieved by cocoa butter rubs. 
German measles.—Cause is unknown; incubation period is from 10 to 21 
days. Symptoms are headache, nausea, vomiting, conjunctivitis, pharyngitis, 
swelling of the glands of the neck, especially those behind and just below the 
ears, and slight febrile rise. The temperature for a short time may be quite 
high. In some cases the symptoms are so slight that the patient hardly seems 
to be sick. It frequently happens that the first knowledge a patient has of the 
disease is the appearance of the eruption. The rash and the swollen glands 
are the two principal diagnostic symptoms. The eruption appears within 24 
to 48 hours, first on the face, spreading over the entire body, usually beginning 
to fade on the second day. It consists of large, isolated, pinkish macules, 
resembling the rash of measles, or small, bright red macules, close together, 
resembling the rash of scarlet fever but without the characteristic stippling 
of the latter disease. The eruption, which usually is altogether out of pro- 
portion to the constitutional symptoms, sometimes presents a papular appear- 
ance and occasionally consists of small vesicles, which may appear in crops. 
Pneumonia, nephritis, intestinal disorders, and suppuration of the enlarged 
glands are complications which may occur. The nursing care consists of 
quietness and rest in bed for at least one week, hot or cold applications to the 
neck, washing the eyes frequently with boric-acid solution, relieving itching of 
the skin (if present) with cocoa-butter rubs and keeping the nose, mouth, and 
throat clean. 
Scarlet fever.—Cause is unknown; incubation period is from 2 to 7 days, 
usually 3 or 4. Symptoms are chill, sore throat, headache, strawberry 
tongue, and eruption. The temperature is 104° to 105° F. for the first 
four or five days, dropping by lysis. The eruption appears within 18 to 30 
hours, first on the chest and neck, then on the back, face, arms, legs, hands, 
and feet. It is pin point in appearance, usually scarlet red, very diffuse, and 
disappears upon pressure. Desquamation takes place in long strips at the 
expiration of a week or 10 days, and continues from one to seven weeks. Some 
possible complications are: Otitis media, acute endocarditis, nephritis, and 
arthritis. Chronic endocarditis and myocarditis, chronic nephritis, blindness, 
deafness, and paralysis may be the sequelae to this disease. The nursing 
care consists of keeping the room warm and free from drafts, and carefully 
observing the urine, which should he measured, and the appearance and amount 
charted. 
Smallpox.—Cause is unknown; incubation period generally is from 10 to 14 
days; and the symptoms are characterized by a sudden onset, chill, vomiting, 
and severe headache and intense backache. The temperature is from 103° to 
105° F., until the rash appears, at which time it falls. Pustules are formed, 
usually at the end of the ninth day, associated with a rise of temperature 
which after several days drops by lysis. The eruption appears on the third 
day on the palms, soles, and the hair line of the forehead, the first stage 
being characterized by a hard lump under the skin, the second stage by vesicles 
above the skin, and the third stage by the appearance of pus in the vesicles. 
Only one stage is present at a time. Some possible complications are septi- 
caemia, pyaemia, myocarditis, nephritis, pharyngitis, abscesses, and cellulitis. 
The nursing care consists of washing the pus from the lesions with a disin- NUKSING. 
141 
feetant, applying oil or vaseline to relieve itching-, encasing the hands in cot- 
ton gloves, and irrigating the eyes every two hours. Hospital corpsmen caring 
for a smallpox case should have been vaccinated recently. 
Chicken pox.—Cause is unknown; the incubation period is from 2 to 3 
weeks; and the symptoms are chilliness, mild headache, and a temperature of 
100° to 102° F., for the first two or three days, at the end of which time 
it returns to normal. The eruption appears within 24 hours in crops on the 
trunk, back, and chest, all stages being present at the same time, new crops 
coming out before the old ones have disappeared. The skin lesions are very 
itchy. The nursing care consists of sponging and oiling the skin daily, and 
using cotton gloves, if necessary. 
Mumps.—Cause is unknown; the incubation period is from 12 to 26 days; 
and the symptoms are headache, nausea, pains and swelling of parotid 
glands (just below and in front of the ear). The temperature in mild cases 
varies from 100° to 102° F., in severe cases it may reach 105° F. Some com- 
mon complications are earache, otitis media, and orchitis. The nursing care 
consists of retaining the patient in bed and keeping him warm until the swell- 
ing disappears. 
Water-borne diseases. 
Typhoid fever.—Caused by the Bacillus typhosus; the incubation period is 
from 7 to 21 days; and the symptoms are, at the onset, headache, nausea, 
pain in back, legs, and abdomen, loss of appetite, coated tongue, epistaxis, diar- 
rhoea, and frequently bronchitis. Later the spleen becomes enlarged, the Widal 
reaction becomes positive, stools become liquid yellow (pea-soup appearance), or 
the patient may be constipated. The temperature during the first week rises a 
degree or a degree and a half higher each evening and drops slightly each morn- 
ing. During the second week it remains continuously high (103° to <104° F.), 
with a very slight morning remission, and during the third week the remissions 
are more marked ; in favorable cases the decline is gradual and in mild cases the 
temperature reaches normal at the end of the third week. The majority of nor- 
mal cases end in the fourth week of the disease. The pulse varies from 80 to 
100, is dicrotic and slow in proportion to fever. Haemorrhage and perforation 
of the intestines are indicated by a sudden, rapid, and weak pulse, associated 
with marked rapid fall of temperature. The tongue is coated white at first, and 
later becomes very dry and brown or black in the center. The approach of con- 
valescence is indicated when the tongue begins to moisten and become clear 
around the edges. The mental condition is usually dull and stupid and fre- 
quently is accompanied by delirium. A continued low, muttering delirium, with 
picking at the bedclothes, is an unfavorable symptom. A typhoid-fever patient 
never should be left unattended. The eruption or rash appears as small, rose- 
colored spots on the abdomen, the lower part of the chest, and the back, which 
disappear temporarily upon pressure. It develops after 7 to 10 days, lasts 
2 to 3 days, and then fades, leaving a brownish stain for a time. Successive 
crops of this rash form until the middle of the third week. Some common 
complications are tympanites, haemorrhage from the intestines, perforation of 
the intestines, and dilation of the heart. Endocarditis, empyaema, periostitis, 
meningitis, pneumonia, deafness, phlebitis, and thrombosis may be the sequelae. 
The nursing care consists of carefully watching the patient’s position, which 
should be recumbent and changed frequently, and support being afforded with 
pillows. All exertion on the part of the patient must be avoided, and he should 
have absolute rest. The mouth should be kept clean, guarding against reinfec- 
tion; the prescribed diet should be strictly adhered to and plenty of water 142 
HOSPITAL CORPS HANDBOOK. 
should be given. Daily enemata usually are prescribed if necessary. No 
cathartics should be given, and the buttocks should be washed after each stool. 
Special care should be observed to prevent bedsores. 
Bacillary dysentery.—Caused by Bacillus dysenteries; is highly infectious 
and is characterized by a sudden onset, frequent small stools, containing 
blood, mucus, pus, and very little feces, and accompanied by tenesmus, 
with pain and tenderness over the colon. In severe cases the temperature is 
high, there is great prostration, and excessive toxaemia. Death frequently 
results within a few days. Some of the common complications are emaciation 
and anaemia. The nursing care consists of maintaining plenty of fresh air, 
quiet, and cleanliness. Stools should be carefully observed and charted. 
Rectal irrigations frequently are prescribed, and in administering them great 
care and caution are necessary. 
Cholera.—Caused by the Spirillum choleras asiaticce; incubation period is 
from 1 to 5 days. The disease is characterized by the following symp- 
toms: Headache, malaise, diarrhoea, and colic. During the later stages or 
stage of collapse, excessive vomiting, purging, high temperature, cold and 
clammy shrunken and livid skin, rapid emaciation, intense thirst, severe mus- 
cular cramps, diminished secretion of urine, and rice-water stools (water and 
salts from the blood, and epithelium from the intestinal walls) are present. An 
increased temperature with a warm feeling of the body indicates the turning 
point, and recovery usually results. Failure of the heart action is the most 
common complication. The nursing care consists of isolation, absolute quiet, 
the application of external heat, and the administration of normal saline solu- 
tion by hypodermoclysis. 
Diseases transmitted by insects. 
Malaria.—Caused by malarial parasites (protozoa) ; the tertian life cycle is 
48 hours, ending on the third day; the quartan life cycle is 72 hours, ending on 
the fourth day; and the sestivo-autumnal life cycle varies from 36 to 72 hours. 
Malaria is transmitted by the anopheles mosquito (female) by biting, usually 
at dusk and at night. The incubation period is not definite, and the disease is 
characterized by a chill every 48 to 72 hours, sometimes occurring more often. 
The chill is coincident with the rupture of the red corpuscle containing the 
parasite, which has previously subdivided into numerous smaller forms 
(sporozoa). 
During and after the chill the patient usually has a headache, is nauseated, 
the pulse is frequent and full, the temperature is very high (occasionally 
107° F.), and is accompanied by profuse sweating. Severe cases of malaria 
may show typhoidal symptoms, while mild cases usually feel comparatively well 
between chills, the temperature, pulse, and respiration being normal. Some of 
the common complications are anaemia, congestion of the liver and kidneys, and 
bloody urine. The nursing care consists of noting and recording all chills, 
their duration, time of starting and ending, and their severity, varying from a 
slight chilly sensation to shaking of the entire bed. Temperature, pulse, and 
respiration should be taken every hour after a chill until they return to the 
previous temperature, pulse, and respiration. During a chill external heat 
should be applied and the patient surrounded with hot-water bottles and kept 
in bed. Plenty of easily digested, nutritious food should be given and the 
bowels and kidneys kept active. The prevention of malaria is taken up in the 
chapter on Preventive Medicine, Hygiene, and Sanitation. 
Yellow fever.—Caused by the Leptospira icteroides, transmitted by a mos- 
quito, the Aedes segypti; incubation period is a few hours to five days, and the NURSING. 
143 
disease is characterized by a chill, muscular pain, especially in the legs and 
back, jaundice of the skin and conjunctive, and vomiting (sometimes black 
vomitus or digested blood). The eyes become watery, glazed, and sunken; 
the temperature reaches 102° to 103° F. for two, three, or four days, when it 
drops to normal. At the end of 24 hours it rises to 102° F., then falls by 
crisis or lysis. The pulse rate is first 90 to 115 and later comparatively slow. 
Some of the common complications are suppression of urine and haemorrhage 
from any part of the body. The nursing care consists of keeping the patient 
absolutely quiet. Hot applications, counterirritants, and light massage should 
be applied for muscular pain. All urine should be measured, its appearance 
noted and charted. The patient’s bed should be covered with cotton netting. 
Typhus.—Cause not definitely determined; is transmitted by the body louse; 
incubation period is 12 days; and the disease is characterized by a chill, head- 
ache, and delirium. The temperature is high during the first week, with a 
marked remission in the morning during the second week, and at the end of 13 
to 14 days returns by crisis to normal. The eruption appears on the fourth 
day; at first as elevated rose spots or patches which later assume a dusky hue 
and lose elevation, appearing as ecchymotic areas under the epidermis. The 
nursing care consists of maintaining an abundant supply of pure, fresh air and 
the usual general fever nursing. 
Diseases which may result from an abrasion of the skin or mucous membrane. 
Tetanus.—Caused by the Bacillus tetani; the incubation period is one day to 
three weeks; and the disease is characterized by rigidity of muscles, beginning 
with the jaws and neck, and progressing until all except the arms are involved. 
Convulsions are caused by the slightest stimuli and vary in severity, some- 
times reaching the extent that the body becomes arched so that the head and 
heels only touch the bed. The temperature varies from 103° to 105° F., and 
the pulse rate is about 110. The nursing care consists of maintaining absolute 
quiet, keeping the room dark, and general nursing care and prophylactic 
measures. It is frequently necessary to resort to nasal or rectal feedings. 
Septiccemia.—Caused by a pus-forming organism; the incubation period is 
from two hours to two or three days; and the disease is characterized by 
chills, temperature of 102° to 105° F., nausea, headache, anorexia, and all the 
febrile symptoms. Cases of this disease often become typhoidal in type with 
or without delirium, the skin becoming cold, the body freely perspiring, marked 
cyanosis being present, and the face being pinched and drawn. Pyajmia is a 
common complication. The nursing care consists of maintaining plenty of 
fresh air, an abundance of nutritious food, and careful general nursing. 
Erysipelas.—Caused by the Streptococcus erysipelatis; incubation period is 
from 24 to 72 hours; and the disease is characterized by a sudden onset with 
chill, nausea and vomiting, high temperature, and appearance of localized in- 
flammation of the skin. The area of skin involved is red, swollen, and sharply 
limited, and sometimes is accompanied by severe pain. The nursing care con- 
sists of isolation, the administration of plenty of fluids, and rigid precautions 
against transmitting the infection to the surgical cases. It is imperative to use 
all prophylactic measures. 
Diseases of the respiratory tract. 
Acute bronchitis.-—Caused by irritation and infection of the respiratory tract 
following exposure to wet and cold, and is characterized by the following 
symptoms: Sore throat, general malaise, constant cough with pain in the 
sternal region, and temperature of 101° to 103° F. during the first week. 144 
HOSPITAL CORPS HANDBOOK. 
Chronic bronchitis is the most common complication. The nursing care con- 
sists of maintaining plenty of fresh, moist, but warm air, and keeping the 
room free from drafts, steam inhalations, if ordered, and general nursing 
care. 
Influenza.—Caused by the Bacillus influenza; incubation period is from two 
to four days. The disease is characterized by a sudden onset with slight chill; 
intense aching of muscles (legs and back) ; coryza; frequently sore throat; and 
increase in temperature in mild cases to 100° to 102° F., in severe cases to 103° 
to 104° F., dropping by lysis to normal. Otitis media, sinusitis, bronchitis, 
pneumonia, and myocarditis are common complications. The nursing care 
consists of keeping the room warm and free from drafts and general nursing. 
Pneumonia.—Caused by infection of the lungs by one of several organisms; 
incubation period is from 24 hours to 7 days; and the disease is characterized 
by the following symptoms: A chill, severe pain in the chest, temperature 
rises to 104° or 105° F., remaining high for from three to nine days, at which 
time it falls to normal or below in a few hours (crisis) or more slowly (lysis) ; 
the respirations are shallow, rapid (up to 60), and labored; and the pulse is 
full and bounding (96 to 120 to 140). During the first stage of the disease 
the sputum is a frothy, serous fluid mixed with mucus, and streaked with 
blood; during the second stage it becomes prune juice or brownish red in color, 
due to the presence of blood; and during the third stage it is abundant, shows 
evidence of less blood, which gradually disappears, the sputum gradually be- 
coming less in quantity, until it returns to normal. Cyanosis, oedema of lungs, 
tympanites, circulatory failure, and pleurisy are the common complications. 
Empysema, abscess of the lung, and gangrene of the lung may be the sequelae. 
The nursing care consists of limiting all movements of the patient which require 
exertion, etc. Tenacious or sticky sputum should be carefully wiped from the 
lips with small pieces of gauze and placed in a paper bag to be burned later. 
The patient must be encouraged not to talk too much. Visitors should not be 
permitted except by the doctor’s permission. Unfavorable symptoms, espe- 
cially delirium, should be watched for. Maintain plenty of fresh air, keep the 
patient warm, and avoid drafts. A rectal tube having its free end in a pus 
basin may be inserted and hot fomentations applied to the abdomen to relieve 
discomfort in tympanites. The patient should not be permitted to sit up 
during convalescence until orders to that effect are issued by the medical officer 
in charge of the case. 
Tuberculosis.—Caused by infection with the Bacillus tuberculosis, and charac- 
terized by the following symptoms: Loss of appetite, loss of weight, a short 
hacking cough with the production of more or less sputum, a moderate increase 
of temperature in the afternoon, a hectic flush, especially in the afternoon, and 
a soft and rapid pulse. Later in the disease there are usually emaciation, 
progressive weakness, and night sweats. The sputum contains the bacillus 
tuberculosis. The nursing care consists of keeping the patient out of doors and 
dressed warmly, giving an abundance of nutritious foods, and general nursing 
care. 
Special diseases. 
Diphtheria.—Caused by the Bacillus diphtheria, which produces a very viru- 
lent toxin. Incubation period is from 1 to 10 days. The disease is charac- 
terized by the following symptoms: General malaise, swelling of the glands of 
the neck, and soreness of the throat. At first the throat is red and slightly 
swollen; by the end of the first day a pale gray membrane appears on the ton- 
sils, and may extend to the pillars, uvula, pharynx and soft palate. This mem- NURSING. 
145 
brane is removed with difficulty and leaves a bleeding surface. The temperature 
is comparatively low, seldom rising above 103° F., lasts from 7 to 10 days, and 
falls by lysis. The pulse is rapid and in severe cases, weak, and irregular. 
Cardiac weakness is indicated when the pulse rate falls below 60, or increases 
above 120. The common complications are heart failure, acute nephritis, 
broncho-pneumonia, paralysis, especially of the muscles of the eyes, the pharynx, 
and the vagus nerve. The nursing care consists of spraying and irrigating the 
throat, giving plenty of nourishment and water, watching for regurgitation of 
food and water, and preventing all exertion and excitement. The patient should 
not be allowed to sit up too soon during convalescence, because of the danger- 
of overtaxing the heart. Preventive measures are taken up in the chapter on 
Preventive Medicine, Hygiene, and Sanitation. 
Follicular tonsillitis.—Caused by infection with the Streptococcus or Staphy- 
lococcus pyogenes; the incubation period is from 24 to 72 hours, and the disease 
is characterized by the following symptoms: Sore throat, the tonsils are red and 
swollen and covered, or partly covered, with yellowish white patches which are 
removed easily and leave no bleeding surface. The disease causes severe pain 
in the throat, and a temperature of about 103° F., which falls by lysis. Marked 
prostration is a prominent symptom and the disease is frequently complicated 
by suppurative tonsillitis, rheumatism, and acute endocarditis. 
Suppurative tonsillitis is characterized by intense pain in the region of the 
throat, and the presence of exudate which covers the surface of the tonsils. 
Abscesses may form and discharge thick, foetid pus. The nursing care consists 
of using gargles or sprays of astringent and antiseptic solutions; and applying 
ice caps or hot water bags to the throat. The diet consists of very hot or ice 
cold liquids. 
Vincent's angina.—Caused by Vincent’s spirochete (Spirochccta vincenti), as- 
sociated with the fusiform bacillus. Incubation period is from 24 to 72 hours. 
Symptoms: Somewhat similar to tonsillitis. A gray foetid exudate covers the 
ulcerated areas. The nursing care consists of isolation and general prophylactic 
measures. 
Meningitis.—Caused by the meningococcus (diplococcus intracellular is menin- 
gitidis). Incubation period is uncertain. The disease is characterized by the 
following symptoms: A sudden onset, chill, or convulsion, intense headache, 
projectile vomiting, photophobia, and strabismus. The temperature runs an 
irregular course; the muscles of the neck become rigid, the head is retracted, 
attempts to extend the thigh and leg meet with resistance, and the skin and 
muscles become very sensitive. Pneumonia, pleurisy, endocarditis, pericarditis, 
and otitis media are the common complications. Deafness, blindness, local or 
general paralysis, and mental derangement may he the sequelae. The nursing 
care consists of maintaining absolute quiet; keeping the room cool and dark 
and at a temperature of 65° F., the practice of general prophylactic measures, 
and nasal feedings, if necessary. 
Diseases which are not communicable but often are sequelae of communicable 
diseases. 
Acute endocarditis.—Caused by infection from various organisms; and char- 
acterized by the following symptoms: In mild cases there is usually dyspnoea 
on exertion, but the patient may have no subjective symptoms; in severe cases 
the pulse is rapid and the patient has marked palpitation of and a varying de- 
gree of pain in the heart, accompanying dyspnoea. The nursing care consists 
of maintaining absolute quiet, avoiding all excitement or worry, insisting upon 146 
HOSPITAL CORPS HANDBOOK. 
rest in bed, unless advised otherwise, providing plenty of fresh, warm air, and 
easily digested foods. An ice cap over the heart is often beneficial. 
Rheumatic fever.—Caused by an organism, probably the streptococcus rheu- 
maticus, and characterized by the following symptoms: Slight malaise, fever, 
sore throat, pain and tenderness in the affected joints, which become red and 
swollen (as swelling subsides in one joint, another joint usually becomes in- 
volved). The disease continues for several weeks, and relapses are frequent. 
The patient usually perspires profusely, and the temperature rises to 102° to 
104° F., with marked remissions. The pulse is rapid and weak, and the urine 
scanty, highly colored, and acid in reaction. Common complications are 
endocarditis, myocarditis, pericarditis, tonsillitis, and anaemia. The nursing 
care consists of maintaining absolute quiet, sparing the patient from all ex- 
ertion and excitement, observing great care in handling or moving, usina' 
bed cradles to relieve weight of bed clothes, and applying flannel bandages with 
or without oil of gaultheria dressings to the affected joints. During excessive 
perspiration the patient should be kept between light woolen blankets, and the 
room should be kept warm and free from draughts, but well ventilated. The 
throat and mouth should be kept clean, and alkaline water and proper diet ad- 
ministered. 
Acute nephritis.—Caused by exposure to cold or by bacterial infection. It is 
characterized by the following symptoms which may vary somewhat: Eyelids 
puffy and cedematous, pallor, headache, and pain in back, nausea, vomiting, 
dizziness, chills, and usually some elevation in temperature. The urine is 
scanty and contains albumin. The nursing care consists of keeping up elimina- 
tion through the bowels and skin by active catharsis, and the administration 
of hot baths and packs; the diet should contain no proteins, and in severe cases 
should be salt free. All urine should be measured and charted, and the room 
kept warm and free from draughts to avoid chilling the patient. 
SUEGICAL NUESING. 
Preparation of patient for operation.—The details of the preparation of 
patients for operation differ somewhat in the various hospitals, but the general 
principles are the same. Five essential points which should be remembered are: 
The patient’s skin should be clean, especially so at the site of operation; the 
stomach should be empty (the diet regulated prior to operation) ; the bowels 
should be empty (accomplished by giving a catharsis the night before followed 
by enemata the morning of operation) ; the bladder should be empty (the 
patient should void urine or be catheterized before going to the operating 
room) ; the patient’s mouth should he examined for artificial teeth, and if any 
are found they should be removed. 
To avoid tiring the patient on the day of operation, a bath should be given 
the day before, and the finger and toe nails carefully cleaned. If the patient is 
able to take his own bath it should be permitted, but an examination should be 
made afterwards to see that the bath has been satisfactory. Patients with an 
elevated temperature should he given a cleansing sponge bath. 
Every patient should void urine before being taken to the operating room. If 
unable to do so, a report to this effect should be made to the operating-room 
staff, in order that the surgeon will know before operating and, if necessary, 
order the patient to be catheterized. Catheterization lessens the danger of 
an incision being made into the bladder during an abdominal operation. 
Specimens of urine should be sent to the laboratory the morning before and 
another the morning following an operation. NURSING. 
147 
Except in cases of an emergency operation, the patient is given a cathartic 
the evening before the operation (one-half ounce of castor oil acts quickly 
and does not remove too much of the body fluids by purgation). The 
morning of the operation a soapsuds enema, which may be repeated if neces- 
sary, should be given. Not more than three enemas should be given, as more 
than that number tend to cause too much intestinal distention, with resulting 
lack of peristalsis after the operation. 
Diet on the day before operation should be nutritious but light, and no solid 
food should be given within 12 hours before an operation. If the patient 
is weak and requires food, strained soup or broths may be given up to six 
hours before the operation, after which time nothing should be taken by 
mouth. The patient should be encouraged to drink water freely until eight 
hours before the operation. The less food a patient receives before an opera- 
tion the better, as a rule, will be the recuperation after the anaesthesia. 
Preparation for a mouth operation.—This preparation is the same as for any 
other operation, except that an antiseptic mouth wasli should be used every 
3 hours during the 24 hours preceding the operation. Each mouth wash 
should be followed by a nasal douche. 
Rectal preparation.—Rectal preparation is the same as that for other opera- 
tions, except that on the morning of operation, instead of a soapsuds enema, 
the patient is given a colonic flushing, which is continued until the return 
flow is clear. 
By having the skin clean one source of infection is- removed and the pores 
are open to throw off the toxins in the body resulting from the anaesthesia. In 
emptying the intestines and bladder the danger of accidental incision with the 
evacuation of contents into the abdominal cavity is .removed. Having the 
stomach empty prevents the entrance into the trachea of solid substances, 
which might cause choking, and also helps to prevent post-operative nausea. 
The principal object to bear in mind is that the patient must not be tired by 
the severity of the preparation. 
In preparing an acute abdominal case do not subject the patient to the 
slightest strain in lifting or moving, and if an enema is ordered, introduce the 
tube carefully, regulating the flow of water in such a manner that any sudden 
inflation of the bowel and rupture of a possible pus sack may be avoided. 
The hospital corpsman Should see that the patient goes to the operating room 
in good spirits and not in a mentally depressed state; the anaesthetic will be 
taken more easily and recovery will be quicker. 
Final preparations.—Shortly before the patient leaves the ward a clean cotton 
nightgown, open down the back, and flannel operating-room stockings should be 
put on; loose artificial teeth should be removed, if present, and the clinical 
chart should be written up indicating, especially, the time and the amount of 
urine voided. 
Post-operative care during the first 24 hours.—After operation under general 
anaesthesia a patient usually remains in an unconscious condition for some 
time and the circulation is poor, due to the nervous depression from the anaes- 
thetic. The patient really is in a state of shock and must receive especial care 
until reaction takes place and perfect consciousness of surroundings is recov- 
ered. The room or ward to which the patient is returned should be warm, 
with plenty of fresh air, but no draughts or glaring lights; the ether bed must 
be prepared with warm blankets; he must be carefully lifted from the stretcher 
to the bed, and the danger of injuring the arms avoided; he should not 
be left alone until he is fully conscious, and hot-water bags should not be left 
in the bed of an unconscious patient unless so ordered by the doctor. The 148 
HOSPITAL, CORPS HANDBOOK. 
patient’s pulse and respiration should be taken and recorded every 15 min- 
utes, the tongue watched to avoid its falling back and choking the patient; and 
the hospital corpsman should press his fingers just below the angle of the jaw 
to force the lower jaw slightly forward. If the patient vomits, the head should 
be turned to one side. If a post-abdominal-operative patient retches severely, 
slight pressure toward the wound should be made with the hands to prevent 
tearing of the sutures. 
Hospital corpsmen assigned to post-operative cases should avoid exposure 
of the patient (sudden change of temperature may cause pneumonia). Water 
should not be placed within the patient’s reach until he is allowed to have it. 
Intense thirst may be relieved by wetting the lips with wet gauze or allowing 
the patient to rinse his mouth. When water is allowed it should be given in 
small quantities, either hot or cold—never lukewarm. If it is impossible for 
the patient to void urine within 10 hours after the operation the medical 
officer in charge should be notified, and, if he so directs, the patient should 
be catheterized. Frequent bathing of the hands and face is very comforting 
to the patient. 
Nausea may be controlled by applying heat in the form' of a hot-water bag 
or hot compress to the region of the stomach. Cracked ice, finely crushed and 
fed with a spoon, frequently relieves nausea. If persistent, a mustard plaster 
or hot stupes may be used or a gastric lavage given. These remedies are 
applied only when so directed by the medical officer. 
Replenishing the system with fluid after operation.—Fluid may be introduced 
into the body by proctoclysis, enteroclysis, or by hypordermoclysis. The fluid 
usually administered is normal salt solution, and the reasons for this choice 
are: It stimulates the heart action, flushes the kidneys, provides the tissue 
cells with the fluid they require, and lessens the patient’s thirst. 
Urine.—A specimen of urine should be sent to the laboratory before and 
after an operation, and daily for several days afterwards, if there is any ab- 
normality in the amount voided or in the character of the urine. Voiding or 
being catheterized within 10 hours after an operation lessens the danger 
of retention of urine and brings to notice suppression of the urine if it is 
present. 
Subsequent post-operative care.—Usually the underlying factors in the post- 
operative condition are the depression of the nervous system by the ansesthetic, 
poor circulation, loss of muscle tone, and diminished oxidation. These factors 
constitute the main conditions of what is known as post-operative shock and 
subject the patient to numerous post-operative complications. 
Distension of the intestines is due to lessened peristalsis, caused by lack 
of muscle tone, and causes an accumulation of gas to collect in the intestines, 
a condition which in abdominal cases may become very dangerous. Unless 
relieved, the intestines become very distended and paralyzed, thus preventing 
peristalsis. The distended intestines may push the diaphragm up against 
the heart and lungs and interfere with the functioning of these organs. 
An operation causes diminished oxidation, which lessens the heat production 
in the body and results in a subnormal temperature which usually rises as 
a result of the reaction which follows. The condition of the respiratory tract 
predisposes the patient to pneumonia and that of the alimentary tract to 
nausea. The kidneys are irritated, partly by the action of the drug they are 
trying to eliminate and partly by the action of the substances they are trying 
to excrete. The acids which arise from the latter may poison the individual 
and induce a condition known as acidosis or autointoxication. Another ab- 
normal condition is the lack of fluids in the body, due to purging before the NURSING. 
149 
operation, the loss of blood during the operation, the inability to take fluids 
by mouth, and also to the effects of the anaesthetic. 
The aim of aftertreatment is to counteract the effects of the operation 
upon the system and to prevent the occurrence of complications which may 
arise, either as the result of the effect of the operation or because of the 
conditions for which the operation was performed 
In after-treatment the following symptoms should be noted: Evidence of 
severe pain in the region of operation (see if bandage is too tight and report 
at once) ; abdominal strain, which may be relieved by placing a pillow under- 
time flexed knees; and pain in the small of the back, which may be due to 
position and length of time on the operating table, and which may be relieved 
by placing small pads or pillows under the affected parts. Flatulence or gas 
in the intestines can be relieved by introducing a well-lubricated rectal tube 
into the rectum for a distance of about 8 inches, or by a carminative enema, 
or by the application of turpentine stupes to the abdomen. These treatments 
must be ordered by the medical officer. Change in color or increasing pallor 
Is a sign of haemorrhage; pallor with a pinched expression is a sign of shock 
or collapse; cyanosed or bluish hue is a sign of cardiac or respiratory compli- 
cation ; and rapid or difficult breathing may be a sign of congestion of the 
lungs. All of these symptoms should be reported at once and the patient should 
not be left alone. 
Diet in post-operative care is of the utmost importance. Never give a diet 
other than that ordered by the medical officer. Usually for the first 6 to 12 
hours after operation, water only should be given unless specially ordered; 
the second day, liquids without milk; and the third day, liquids with milk. 
The third night, if the operation was not a rectal one, the patient usually is 
given a mild cathartic, after which he may receive a soft diet, and finally 
graduate to a full diet. After a hsemorrhoid operation the patient usually is 
kept on a liquid diet for a number of days to avoid a residue accumulating in 
the intestines which would cause a bowel movement, expel the packing, and 
possibly result in a haemorrhage. If, as is sometimes the case, a patient has 
persistent nausea for days after the operation, great care should he observed 
regarding the diet. It should be liquid in form, hut as concentrated as possible 
and administered frequently in very small amounts. It may be necessary to 
give partially digested foods, such as peptonized milk, etc. Articles of food 
which the patient especially likes, provided they are digestible, are often more 
likely to be retained. 
The treatment of abdominal operations when infection has been present is 
important. The patient should be kept quiet so that localized septic matter 
will not be scattered throughout the abdominal cavity; the system must be 
flushed with fluid (enteroclysis), and if the patient is able to drink, water 
should be forced and all the nourishment possible should be given. For 
abdominal drainage the patient should be placed in Fowler’s position, in which 
the patient is placed in a semisitting posture at an angle of 45°, supported 
by pillows or a back rest, the buttocks resting hgainst the pillows, which may 
be secured to the bed by bandages to prevent slipping. In this position pillows 
should be placed under the knees and elbows. In most hospitals Gateh' frames 
which can be adjusted so that the patient will be held in this position without 
additional pillows are used on the beds. 
In surgical nursing baths are as important as in medical nursing, in that 
they keep the pores of the skin open and help rid the system of its contained 
toxins. The back should be kept clean and dry. No wrinkles in the clothing 150 
HOSPITAL CORPS HANDBOOK. 
(personal or bed) of the patient should be permitted, as a septic condition 
predisposes to bedsores. 
Enemata are fluid injections into the lower bowel by way of the rectum. 
They are given to wash out the intestines, to provide stimulation, or to supply 
food to the patient. In administering enemata the patient should lie either 
on the left side or flat upon the back with the knees flexed, and all necessary 
articles should be at hand before administration. An enema may be given 
“ low ” by passing the tube into the rectum for a distance of 3 or 4 inches only, 
or “ high ” by passing the tube a distance of from 8 to 10 inches into the rectum. 
The following instructions should be observed when giving an enema: Have 
the nozzle well lubricated and avoid injecting air or chilled fluid. To do this 
the tube should be filled with fluid, which should be allowed to escape until 
that in the tube is at the required temperature. Then clamp the tube to retain 
the fluid while the rectal tip is being inserted gently upward, backward, and 
toward the left. The part of the tube in the rectum should not be moved about, 
and the enema should be administered slowly, pausing frequently to avoid caus- 
ing peristalsis. When the enema has been completed the tube should be with- 
drawn gently and the tube pinched to avoid spilling any of the remaining fluid. 
If a funnel is used in place of an enema can, care should be taken to replenish 
the fluid before the funnel is empty, thus preventing air from being admitted 
to the intestines. 
There are several kinds of enemata. For example, an anthelmintic enema 
is given to destroy worms; an antiseptic enema to destroy bacteria; an astrin- 
gent enema to contract the tissues and superficial capillaries and is used both in 
cases of hemorrhage and in certain forms of diarrhoea ; a carminative enema to 
relieve flatulence usually is given with or before a soapsuds enema and the pa- 
tient encouraged to retain it for half an hour; and an emollient enema to soothe 
irritation of the mucous membrane of the intestines, thereby checking diarrhoea 
(starch of a creamy consistency usually being used, at a temperature of 103° F., 
and administered through a catheter). Nutrient enemata are given for the 
purpose of supplying nourishment to patients when they either can not or will 
not take food by mouth. The food administered in this manner must be par- 
tially digested, as the digestive juices are not present in the large intestines. 
Some of the ingredients used are peptonized beef extract or peptonized milk 
with egg, the amount never being more than 6 ounces, at a temperature not 
exceeding 100° F.; otherwise the digestive process will not be continued after 
the material enters the intestines. A soapsuds enema always should be given 
one-half hour before a nutrient enema, except when nutrient enemata are 
ordered continuously, in which case the soapsuds enema is given once a day 
before the first nutrient one. Purgative or cleansing enemata are given when 
immediate action is required, when nausea or other ill effects are feared from 
catharsis by mouth, when a thorough cleansing of the intestines is required, or 
when the action of catharsis is to be furthered by emptying the boweL From 
1 to 4 pints of soapsuds solution is used (castile or any bland soap always 
should be used, never an irritating soap which might injure the mucous lining of 
the intestines), at a temperature of 105° F., and the patient should be encouraged 
to retain it from 5 to 15 minutes to effect a good result. Sedative enemata, 
usually containing chloral or bromide, are given as a local or general sedative. 
Stimulating enemata are given for general stimulation and may contain 
whisky, brandy, coffee, or normal saline solution, and usually are preceded 
by a soapsuds enema. They are given slowly, high, at a temperature of 110° F., 
and must be retained. A saline enema may be given to supply the tissues with 
fluid and to relieve thirst. The temperature should be 110° F., and it should CURSING. 
151 
be given high and slowly in amounts of from 8 to 10 ounces, which must be 
retained to allow absorption. 
When a high oil enema is ordered, olive oil and glycerin in amounts of 0 to 8 
ounces at a temperature of 00° F. usually are used. This enenia must be given 
high and slowly and followed in from two to four hours by a soapsuds enema. 
A rectal suppository should be lubricated with oil and passed as far into the 
passage as the finger will permit; the patient should lie on his left side; and 
the finger should be protected with a rubber cot, also lubricated. 
Enteroclysis, sometimes called intestinal irrigation or colonic flushing, differs 
from an enema in two ways. In the first place, more fluid is used, usually 2 
to 6 gallons of normal saline or sodium bicarbonate solution, and, second, means 
are provided for the immediate removal of the fluid by inserting two colon 
tubes, one for the inflow inserted about 8 or 10 inches and the other for the 
outflow or siphoning off, which is inserted for a distance of about 3 inches. 
The purpose of enteroclysis is to flush out the intestines, to stimulate the kid- 
neys, and often to rid the body of toxins. 
In giving enteroclysis the patient should be brought to the very edge of the 
bed, in the same position as for an enema, covered with a blanket, the bed- 
clothes drawn down and an operating pad placed under the patient in such a 
manner that it will drain into a bucket at the side of the bed. The irrigating 
can should be filled from one of the pitchers containing the solution at a tem- 
perature of 110° F., air being let out of the tube by allowing water to run 
through until the proper temperature is obtained. The end of the tube is lubri- 
cated and inserted gently from 8 to 10 inches into the rectum. The second 
tube for outflow should be lubricated at the rectal end and inserted for a 
distance of 3 inches. The return flow should begin almost immediately after 
the inflow has been started and should drain into the bucket at the side of the 
bed. The inflow should be continuous until all of the fluid has been used or 
until the return is absolutely clear. Air should not be allowed to enter the tube 
when refilling the can and may be prevented by adding more of the solution 
before the can is entirely empty. It is best to precede this treatment with a 
cleansing enema to avoid difficulty from possible impaction of fasces in the 
return tube. "The returned fluid should be examined and carefully noted as to 
whether it is clear, discolored, or contains mucus either in the form of specks, 
flakes, or stringy particles. If the patient becomes exhausted during the treat- 
ment, it should be discontinued immediately. The irrigating can should not be 
more than 2 or 3 feet above the pelvis of the patient, thus preventing the flow 
from becoming too great to obtain perfect siphonage. 
Protoclysis, sometimes called the Murphy drip, is a slow infusion, usually 
of normal salt or glucose solution, into the intestines by way of the rectum. 
(Fig. 97.) It is intended that the solution be entirely absorbed. For this, 
reason the apparatus used is so arranged that the fluid enters the rectum 
drop by drop at the rate of 40 drops to the minute. The purpose of proctoclysis 
is to supply the system with fluid after haemorrhage, shock, or diarrhoea, or 
when water can not be taken by mouth. 
When giving proctoclysis the patient should lie on the left side or back, 
with knees flexed; air should be expelled from the tube by allowing the solu- 
tion to run until it is of the required temperature, at which time the flow 
should be regulated by adjustment of the drop attachment. The rectal end 
of the tube (which should be a medium-sized catheter, not a colon tube} 
should be lubricated and inserted 8 to 10 inches into the rectum, and fastened 
to the bed by means of a safety pin or adhesive plaster. A thermometer 152 
HOSPITAL CORPS HANDBOOK. 
should be used to indicate the beat of the solution in the irrigating can. about 
which hot-water bottles should be applied and blankets wrapped, in order to 
maintain the required temperature of the solution. If a standard proctoclysis 
outfit is used the heat of the solution is regulated when passing through the 
saline heater or a thermos hot-water bottle, which is a part of the equipment. 
When ordered to give proctoclysis for “ two hours on, and off for half an 
hour,” it is not necessary to remove the tube for the half hour unless it 
annoys the patient. When the system has been supplied with a sufficient 
Fig. 97.—Apparatus for continuous proctoclysis (Murphy drip). (Warnshuis.) 
amount of fluid tMs fact will be indicated by tbe patient’s inability to retain 
the solution. 
Hypodermoclysis is an infusion into the subcutaneous tissues, administered 
by the doctor only, and is used chiefly as a substitute for proctoclysis when 
for any reason it is inadvisable to inject fluid into the rectum or when imme- 
diate absorption is required. 
In the preparation for hypodermoclysis it is imperative to keep all mate- 
rials, apparatus, and solutions used absolutely sterile during the procedure. 
The site of the injection should be sterilized by painting with iodine and 
draped with sterile field cloths. It is advisable at times to inject a solution NURSING. 
153 
of cocaine at the site where needles are to be inserted. The solution should 
be given very slowly, and the assisting hospital corpsman, with sterile hands, 
should gently massage the surrounding tissues to further absorption. Five 
hundred to 1,000 cubic centimeters of solution may be given in this manner, 
but care must be taken to avoid admitting air into the tissues and against 
allowing the fluid to accumulate and cause pressure on the nerve endings. 
Catheterization is the emptying of the bladder of its contents by means of a 
tubular surgical instrument. (Fig. 98.) A soft rubber catheter, previously 
rendered sterile, should be used when practicable. Strict aseptic precautions 
must be observed to avoid infecting the bladder. The catheter, lubricated with 
sterilized oil, should be gently inserted into the urethra and passed in carefully 
until the urine begins to flow. When the bladder is empty the catheter 
should be removed carefully and a compress applied to the urethral exit to 
prevent the escape of the remaining urine. Improper care, by introducing 
bacteria into the bladder or injuring the mucous membrane lining, may give 
rise to an inflammatory condition which is usually very difficult to cure; there- 
fore it is important that the strictest asepsis be maintained in preparing for, 
and during the procedure of, catheterization. The person who is to insert 
the catheter must have surgically clean hands, should observe that the end 
of the catheter to be inserted does not come in contact with anything un- 
Fig. 98.—Tray for catheterization. (Warnshuis.) 
sterile, and should see that the glans has been cleansed with an antiseptic. 
Force should not be used when inserting the catheter. If the bladder is 
greatly distended, not more than 600 cubic centimeters of urine should be 
withdrawn at a time in order to prevent a sudden collapse of that organ. 
The urine should be measured, and the amount obtained recorded on the 
patient’s chart, together with the time of catheterization. 
Expedients that should be tried to cause voluntary micturition before cathe- 
terization is resorted to are: Placing the patient on a bedpan and pouring warm 
water over the pubis; applying hot compresses or a hot-water bag to the pubis; 
if the patient is near a bathroom, allow water to run from a faucet, in order 
that he mayffiear the sound of running water; give plenty of liquids to drink, 
if allowed, especially vichy, mineral waters, and lemonade; and with the 
doctor’s permission only, allow the patient to sit up, with support. This latter 
procedure must not be permitted without the doctor’s consent. 
Bladder irrigation is the process of washing out the bladder with 1 to 2 pints 
of a sterile solution having a temperature of 100° to 110° F. The procedure is 154 
HOSPITAL, COUPS HANDBOOK. 
the same as that employed for catheterization, except that instead of removing 
the catheter when the fluid has been withdrawn the irrigator tubing, from 
which the air has been expelled, is attached to the catheter, the clamp opened, 
and from one-half a pint to three-quarters of a pint of the irrigation solution 
allowed to run slowly into the bladder. The flow should be checked when the 
bladder becomes full, the tubing disconnected, and the bladder allowed to 
drain; when the bladder is empty the tubing should be reconnected and the 
process repeated until the returning solution is clear or the desired amount 
has been given. If a funnel is used, about 8 ounces of the solution should be 
injected and half of the quantity siphoned off, repeating the injection with 4 or 
5 ounces of the solution until the bladder is sufficiently irrigated. Introduction 
Fig. 99.—Gastric lavage. (Warnshuis.) 
of air should be carefully guarded against. With the use of a double or return 
flow catheter about one-half pint may be injected at a time. 
Lavage is the process of irrigating the stomach, and frequently is used to 
remove poisons or irritating material (fig. 99) which may be causing nausea 
and for cleansing purposes. 
For administering a gastric lavage the following articles should be at hand: 
A stomach tube in a basin of ice; a funnel to insert into the open end of the 
tube; a pitcher containing the solution to be used (usually bicarbonate 
5 per cent or boric acid 2 per cent at a temperature of 105° F.) ; a rubber 
apron or sheet, to protect the patient and bedding; a pus basin (in case the 
patient vomits) ; a small roll of bandage or a cork to place between the teeth in 
case of resistance; a bucket to receive the contents of the stomach; and a rubber 
sheet to protect the floor. NURSING. 
155 
Before starting the treatment the patient should be reassured and instructed 
to breathe naturally and to make motions of swallowing while the tube is 
forced gently down the oesophagus. The patient should be in bed or seated 
in a low chair, the tube moistened in ice water and placed far back on the 
tongue, care being taken to direct the tube over the epiglottis into the oesophagus 
(the patient assisting by swallowing as the tube is inserted for a distance of 
18 to 20 inches). The funnel is held a foot higher than the patient’s mouth 
and from one-half to 1 pint of water allowed to flow into the stomach, then the 
funnel is lowered and the contents are siphoned off. This procedure is repeated 
until the water returns clear. If blood appears, the treatment should be dis- 
continued at once and the medical officer notified. The tube should he pinched 
when removing, and removed quickly, to prevent draining the contents of the 
tube into the stomach and to prevent nausea. The character of the return, a 
statement showing the amount of liquid used before it returned clear, and a 
description of the contents, whether mucous or containing other foreign sub- 
stances, should be recorded on the patient’s clinical notes. 
Gavage is the introduction of food into the stomach by means of a stomach 
tube. It is used when a patient will not or can not take food in the usual 
way. The following articles are necessary in giving a gastric gavage: Food, 
stomach tube in basin of ice, and a funnel to insert in the open end of the 
tube. The procedure for gavage is the same as that used for lavage, except 
that a few seconds are allowed to elapse after passage of the tube in order 
that the patient’s musuclar contractions may be quieted. The liquid, usually 
milk, broth, or eggnog, should be poured slowly and the tube removed quickly. 
Nasal gavage or nasal feeding is resorted to when a patient is unmanage- 
able or following operations upon the mouth or throat. The articles neces- 
sary for this treatment are the same as for gavage, except that a catheter 
is used instead of the stomach tube, and the catheter is lubricated with 
glycerin instead of being moistened with ice water. Special precautions neces- 
sary in nasal feeding are: To make sure the tube has not entered the trachea 
and to use no force during insertion. If there is any obstruction in the 
nostril, remove the tube and insert it in the other side, as there may be a 
curve in the septum of the nose on the obstructed side. 
SURGICAL DRESSINGS. 
Before taking up the methods of dressing wounds it is necessary to know 
important facts relating to the nature and healing of wounds and the condi- 
tions which may interfere with healing. (Refer to the chapter on First Aid 
and Minor Surgery for classification of wounds and the manner in which 
wounds are healed.) 
Points to remember when preparing for and when dressing wounds.—Always 
dress aseptic wounds before dressing suppurating wounds. Absolute asepsis 
must be maintained. Moisten adhesive plaster and adherent gauze before 
attempting to remove. Pull adhesive strips toward the wound on both sides 
and pull quickly to avoid causing pain. Use sterile forceps to remove dress- 
ings from a wound and to hold the sponges which are used for wiping dis- 
charges from the skin; never use the same pair of forceps for handling 
sterile supplies. When washing the skin around the wound always wipe 
away from the wound. Do not touch with the fingers anything that can he 
handled with a pair of forceps, even when wearing gloves. Do not squeeze 
a suppurating wound nor any localized collection of pus; doing so may force 
47829°—23 11 156 
HOSPITAL CORPS HANDBOOK. 
the infection through the adjacent tissue; Bier’s cups should be used, or Carrel- 
Dakin treatment instituted. If told to irrigate a wound with hydrogen perox- 
ide, irrigate thoroughly afterward with saline or boric acid solution to remove 
all decomposed material. Remove discharge and sloughs with forceps or 
by means of irrigation, not by rubbing with a sponge. When a caustic, such 
as silver nitrate, is used after irrigation, first dry. the area with gauze to 
prevent the spread of the caustic. When using a caustic, touch only the granu- 
lations that need the treatment. When packing a wound with gauze do not 
rub it or pack the gauze down tightly; it should be loose and fluffy, otherwise 
it will not absorb the secretions and will interfere with drainage. When 
discharge irritates the skin the skin should be covered with vaseline gauze. 
Always note and report any abnormal conditions in a wound. Always reinforce 
a dressing as soon as discharge appears at the surface; soiled dressings look 
unsightly and are a breeding place for bacteria. If more than one dressing 
is to be done, rinse the hands with alcohol or a disinfectant solution before 
and after each dressing. Use sterile forceps to remove sterile material from 
a sterile jar; in removing the cover, invert it in order to prevent anything 
touching the inside. When pouring a sterile solution from a bottle always 
wipe the rim of the bottle first with sterile gauze. 
Kinds of dressings.—Wet dressings, to be effectual, should be kept wet by 
moistening every three hours. They should be covered with oiled silk' or 
waxed paper in order that they may retain moisture and remain sterile and 
that the bedclothes may be protected. A dry dressing is usually a dry sterile 
pad fastened with adhesive or a bandage. 
Procedure in applying a dressing.—The hands must be scrubbed with tincture 
of, green soap and water for 10 minutes before any dressings are started. 
Remove the soiled dressing with a pair of forceps; sponge the wound with dry 
sterile sponges or wipes, or ones dipped in alcohol or an antiseptic solution; 
be careful not to go over the same area more than once, using only one motion 
with firm but gentle pressure. The used sponge being discarded, another is 
taken to wipe around the outside of the wound (wiping away from the wound) ; 
apply the sterile dressing with forceps and strap with adhesive. Rinse the 
hands with alcohol or a disinfectant solution before starting another dressing. 
Dressing tray.—When only one dressing is to be done, the dressing tray 
usually contains instruments sterile (tissue forceps, hsemostat, probe, scissors, 
and a scalpel if needed) ; sterile sponges and dressings; bandages and cotton if 
necessary; and two cups or containers with alcohol in one and the solution 
preferred by the surgeon in the other. When two or more dressings are to be 
done, it is necessary to place more instruments and supplies on the tray. The 
tray should be covered with a sterile field cloth, on which sterile things are laid, 
and covered with another sterile cloth whenever the tray is not in actual use. 
To remove skin sutures.—Take the suture on one side of the knot with the 
forceps, cut it on the other side as close to the skin as possible, and then draw 
it gently backward and outward. Some surgeons have the suture holes 
painted with a weak solution of iodine and others cover them with collodion, 
while some prefer a compress wet with alcohol placed over the wound for a 
few minutes before applying a dry sterile dressing. A dry dressing is usually 
a folded compress (large or small) secured in place by adhesive plaster, 
bandage, or binder. Clean wounds are not dressed as frequently as infected 
wounds; the latter are dressed at least once a day and sometimes more often, 
according to the amount of drainage. NURSING. 
157 
All dressing performed by hospital corpsmen must be in accordance with 
instructions received from medical officers having charge of the cases. 
BATHS. 
A bath is any yielding medium such as water, vapor, mud, or sand in which 
the body is wholly or partly immersed for conservation or restoration of the 
health. 
Baths are classified in regard to temperature or extent. A general bath is 
either a tub or a sponge bath; a local bath may be a sitz, pelvic, or foot bath. 
The baths most frequently used in routine nursing are for cleansing pur- 
poses, to reduce temperature, and to induce perspiration. 
Baths are given for the following purposes: (1) Cleansing; (2) for general 
stimulation; (3) to induce perspiration; (4) for reduction of temperature or 
inflammation; (5) as a nerve tonic or sedative; (6) as a counterirritant; and 
(7) medicated baths, in specific cases, either for the local effect on the skin or 
for their general action upon the system. 
Depending upon their temperature, baths are known as tepid, 85° to 92° F. 
(sedative) ; hot, 100° to 110° F. (depressant) ; cold, 60° to 70° F. (stimulant). 
A cleansing bath is important because the skin serves the body not only as a 
covering but also as an excretory organ, being in this respect very important. 
The skin performs this function through the agency of the sweat glands, 
and if these glands become clogged the work of the skin is hindered. This 
condition must be prevented, particularly during an illness when the waste 
products of the body are especially injurious, and during which time their 
presence in the system increases the danger of bedsores, boils, small abscesses, 
and a general toxic state. The sweat glands can be clogged quite as readily 
by the secretions which they are trying to eliminate as by anything from 
without. It is a mistake to assume that a patient in bed who does not appear 
dirty does not require a bath. Baths should be given at least three times a 
week. The ideal times for a bath are in the morning, before retiring, or one 
hour after meals. 
The bath upon admission of a patient may be given in bed or in the tub, 
according to the temperature of the patient, his condition, and the character 
of his disease or injury. 
Bed bath.—In preparing for a bed bath (1) close the windows, have the 
room warm and devoid of draughts; and (2) bring everything required to 
the bedside. Two large bath blankets, two towels (face and bath), hot-water 
bag, soap, and nailbrush, a foot tub half filled with water at 110° F., and a 
pitcher of hot water with which to keep the bath at the required temperature 
are required. 
When giving the bath draw the patient to one side of the bed, place a 
folded blanket over the chest; turn down the bedclothes, at the same time un- 
folding the blanket over the patient. Place a second blanket under patient and 
take off the pajama suit. Then proceed with the bath, washing, in order, 
the face, ears, neck, chest, arms, and abdomen (warm water is essential for 
this part) ; then gently turn the patient and wash the back, legs, and feet. 
In washing exert a firm but gentle pressure, and dry each part immediately 
after the washing of it has been completed. When washing the feet it is 
advisable to put them in the tub. Give the patient an alcohol rub at the end 
of the bath. The alcohol evaporates rapidly and will further the drying 
process, as well as harden the outer layer of the skin and lessen the danger 158 
HOSPITAL, OOEPS HANDBOOK. 
of the development of bedsores. Never expose the patient; the whole bath 
can be given under the blanket. The bath must not be considered complete 
until the finger and toe nails have been examined, cleansed, and pared. 
When and how to give a tub bath.—As a general rule a patient may be 
given a tub bath if his pulse is fairly strong and regular, temperature nor- 
mal, and general condition good. Fill the bath tub full of water at 100° F., 
and see that towels, wash cloths, and soap are at hand. Even when patients 
are well' and able to take their own baths, they must not be allowed to lock 
the bathroom door, nor be left alone for any appreciable length of time. 
In case of collapse, the bath must be discontinued at once; apply heat 
(blankets and liot-water bags) ; give hot drinks; keep the patient at rest and 
administer the stimulants ordered by the doctor. 
Application of cold.—The principal purposes of application of cold are: 
(1) Stimulation of the vital processes, circulation, respiration, etc.; (2) relief 
of congestion; (3) stimulation and quieting of the nervous system; (4) reduc- 
tion of temperature. (See section on Physiotherapy, subsection Hydrotherapy.) 
The primary effect of cold is the contraction of the superficial blood vessels, 
thus driving the blood from the surface to the interior of the body. 
The following rules should be observed in the administration of cold baths; 
A cold compress or ice cap should be applied to the head to prevent an increased 
flow of blood to that part of the body; a hot-water bag should be placed at 
the feet, as this tends to prevent chill or rigor, conditions which are evidence 
of muscular contraction and a too decided difference between the temperature 
of the central and the peripheral portions of the body. Continuous light fric- 
tion is given for the same reason. Stimulants should be administered 15 or 
20 minutes before the bath to prevent chilling and to help counteract any 
undesirable effect from immersion; hot drinks should be given after the bath, 
and blankets should be left on until reaction takes place. 
Baths for high temperature usually are given every three or four hours 
while the temperature is 103° F. or over. The temperatures of baths vary 
from 65° to 95° F., and the duration also varies (10 to 20 minutes being the 
average). The temperature, pulse, and respiration always should be taken 
one hour after the bath and charted with dotted line to indicate the drop 
or rise. 
Method of giving cold pack.—Protect the bed with a rubber sheet; wrap a 
wet sheet around the patient in such manner that no two surfaces of skin 
come together; apply a binder to the loins; keep the sheet wet by squeezing 
water of the required temperature over it; rub the surface of the sheet briskly; 
apply an ice cap to the patient’s head and a hot-water bag to his feet. The 
duration of the pack should be 15 minutes. 
In giving a cold pack when the patient is not to be turned, the following 
apparatus and materials are essential: A large basin or foot tub containing 
water at the temperature prescribed (usually 68° to 75° F.) ; three bath towels; 
several cotton or linen towels, the number depending upon their size (usually 
seven or eight) ; a bath thermometer; a basin containing a few small pieces of 
ice; an ice cap or compress ; a liot-water bag; and a binder for the loins. 
Remove all top covers except the sheet; pass the binder around the pelvis; 
protect the bed by placing a bath towel on either side of the patient and one 
over the legs; wring the towels fairly dry and place them around the arms and 
legs and over the chest and abdomen; remove the top sheet; have an extra 
towel in the water with which to start changing those on the body, and change 
them in turn at the rate of one every minute, rubbing the towels covering the 
body between changes. Dry the body by rubbing with a dry towel; cover with NURSING. 
159 
a blanket; apply a hot-water bag to the feet; draw up the bedclothes and 
administer a hot drink of either broth or beef tea. 
The principal purposes for hot baths and packs are (1) to induce perspiration 
and (2) to relieve muscular tension. 
The articles necessary for giving hot packs are: An ice cap, four blankets, 
one towel, a foot tub lined with a rubber sheet in which to carry blankets wrung 
out of very hot water, five hot-water bags, pitchers of hot and cool water, a 
glass and drinking tube, and a large rubber sheet. 
Soak two blankets in water at 150° F., leaving one corner of the upper and 
lower edge of each blanket out of the water (these corners should be diagonally 
opposite each other, as the blanket will then, when stretched, be somewhat on 
the bias) ; wring each blanket separately (two hospital corpsmen are required, 
each taking a dry corner and twisting in opposite directions until the blanket 
has been wrung dry. It then should be placed in the foot tub lined with a 
rubber sheet covering hot-water bags, and the process repeated with the second 
blanket) ; carry the blankets to the bedside while the rubber sheet is still folded 
over them; pass two dry blankets with rubber sheet between under the patient; 
remove the pajama suit; wrap the patient in the dry blanket upon which he is 
lying; and turn the upper bedclothes over the foot of the bed. Place one hot 
blanket under the patient and one over him; fold the rubber sheet over the 
wet blankets; pull up the bedclothes, placing a towel around the patient’s neck; 
apply an ice cap to the head and hot-water bags to the hips, arms, and feet. 
Watch the patient’s pulse and encourage him to drink freely, unless directed to 
the contrary. The usual duration of this pack is 20 minutes. 
During and after removing a hot pack take the pulse at the temporal artery 
frequently; give plenty of fluids while the patient is in the pack; watch for 
collapse, in which case discontinue the pack and apply external heat; remove 
the wet blankets under cover of a dry one, thus avoiding exposure; wrap the 
patient in a dry blanket and leave an ice cap applied to tlie head and a hot- 
water bag to feet. Draw up the bedclothes and let the patient remain between 
blankets for one hour, at the expiration of which time dry the patient and give 
him an alcohol rub. 
Foot baths are used for the relief of congestion either in the feet or in some 
other part of the body, as the throat, abdomen, or chest. Sometimes mustard is 
added in the proportion of two tablespoonfuls to the gallon of water. 
To give a foot bath in bed the articles required are a foot tub half full of 
water at 108° to 112° F., a large blanket, a small towel, and a pitcher con- 
taining water at 180° F. 
Loosen the upper bedcovers at the foot of the bed and double them back to 
expose the feet and legs to the knees; gently lift the legs and arrange a rubber 
sheet, covered with a bath towel, on the bed under the feet; place the foot 
tub on the bed alongside of the feet and place a folded hand towel over the 
edge of the foot tub upon which the legs will rest when in the tub. Next put 
the arm nearest the foot of the bed across the tub and place the other arm, the 
hand of which supports the heels, under the patient’s legs; raise the feet 
from the bed and at the same time draw the tub into position; place the 
patient’s feet gradually into the tub, lowering and lifting them into and out 
of the water several times until he becomes accustomed to the temperature, 
keeping the free arm across the tub during this procedure. A folded blanket 
then may be wrapped around the tub and the bedclothes drawn down. The 
feet usually are left in the water for 20 or 30 minutes, and the water main- 
tained at the required temperature by adding water from the pitcher. During 
this process place the hand between the stream of water and the patient’s feet 160 
HOSPITAL CORPS HANDBOOK. 
to guard against injury. In removing the feet put one arm and hand under the 
patient’s legs and heels; lift the feet from the tub; hold them above it for a 
few seconds in order that the excess water may drain off; place them on a 
bath towel; remove the tub from the bed; and dry the feet and legs thoroughly. 
Gently remove the rubber sheet and towel and replace the bedcovers. 
Sitz bath.—In this type of bath the thighs and trunk up to the waist line 
only are immersed; the temperature of the water is 110° to 112° F.; and the 
duration is from 5 to 10 minutes. 
Salt glow.—Prepare two large pads of gauze by dipping them in a saturated 
solution of common salt and allowing them to dry thoroughly before using. 
Hub the patient with the pads, using gentle vigor until the whole body shows a 
pink warm glow, and follow with a warm bath. 
In a busy ward it is often necessary to give baths at other times than nave 
been mentioned as the ideal times. However, a bath never should he given 
within a period of less than one hour after a meal. This delay is necessary 
because a bath stimulates the blood vessels of the skin, and filling them, takes 
blood from the stomach and intestines at a time when it is needed for the 
process of digestion. 
Care to be exercised in treatment baths.—No two skin surfaces should be 
permitted to come together during either a hot or cold pack; watch for collapse 
during the process; protect the bed; avoid pressure upon the abdomen; avoid 
too much turning of a very ill patient; heat should be applied after a bath; 
screen the bed; prevent draughts; have the room warm before giving the bath. 
Medicated baths.—Bran, starch, bicarbonate of soda, and sulphur baths are 
used in the treatment of skin diseases. Mustard, Nauheim, and salt baths 
are used to produce counterirritation, improve the cutaneous circulation, and 
thereby relieve congestion of the viscera and for other abnormal conditions. 
For medicated baths the trunk and extremities should be covered with 
water. This requires the tub to be between half and three-quarters full; an 
ordinary sized tub when half full contains 25 gallons or 100 quarts. 
Bran bath.—Boil pounds of bran in a bag for 20 minutes, drain off the 
fluid and add it to the bath water, which should be at a temperature of about 
95° F. 
Bicarbonate of soda bath.—This bath is used to allay itching of the skin. 
It is prepared by dissolving in the bath 8 ounces of bicarbonate of soda to each 
gallon of water used. 
Starch bath.—Mix one-half pound of starch with sufficient cold water to 
cover it and add slowly sufficient hot water to make a paste of about the 
consistency of a thick cream; pour this into the bath water and mix thoroughly 
with the hands. 
Sulphur bath.—Dissolve sulphurated potash in a small quantity of hot water 
and add this to the bath water. From 1 to 2 ounces of sulphur usually are 
used for this bath, and the temperature should be between 85° and 95° F. 
In medicated baths the patient lies quietly in the bath for 10 to 20 minutes 
and then is removed and enveloped in a warm sheet and dried gently by 
patting over the sheet. These baths are given largely for their soothing effect 
upon the irritated skin; rubbing will counteract the benefit of the hath 
and should not be practiced. 
The application of light and heat for therapeutic purposes is fully taken up 
in the section on Physiotherapy. 
Bed or pressure sores. 
The predisposing causes of these conditions are lowered vitality, extreme 
emaciation, and general oedema; the immediate causes are moisture, crumbs, NUD8IKG. 
161 
wrinkles in tlie bedclothing, pressure or position, and sometimes improperly 
applied appliances. 
The preventive measures consist of bathing the pressure points with soap 
and water, frequent light massage, rubbing the parts with alcohol, powdering, 
and relieving pressure. Soap and water prevent clogging of the ducts in the 
skin, massage improves the local circulation, alcohol hardens the skin, powder 
absorbs moisture, and pressure is relieved by the use of an air ring, air cushion, 
pad, frequent change of position, and readjustment of dressings or appliances. 
Douches and irrigations. 
A douche is a local bath of running water used for the purpose of cleansing 
a cavity, to apply heat or cold to inflamed surfaces, to arrest local luemor- 
rhage, and to apply medical treatment. 
Nasal irrigation.—In administering nasal irrigations the stream should be 
of small caliber and under slight pressure. The patient should lean forward 
with his chin depressed and mouth open, and should breathe through the 
mouth. The great danger attending a nasal irrigation is infection of the 
middle ear, caused by forcing some of the discharge into the Eustachian tube. 
The following is a list of the articles required for this treatment: (1) A small 
irrigator with 12 inches or more of rubber tubing attached; (2) nasal tips 
attached to the distal end of the rubber tube; (3) a basin in which the used 
solution may be collected; (4) a towel; (5) a piece of gauze to be used as a 
handkerchief; and (6) the desired solution (usually normal salt solution, 
1 to 500, at a temperature of 108° F.). Place the solution in the irrigator, 
properly connected with the tube and nasal attachment; hang the irrigator in 
such a position that it will be 2 or 3 inches higher than the patient’s nose; 
allow the solution to flow through the tube until the air contained therein has 
been expelled, at which time the flow is checked by pressure of the thumb and 
index finger. Insert the nasal tip in one nostril and permit the solution to 
flow into that nostril and escape through the one on the opposite side, thus 
washing out the nasal cavity. If either one or the other side of the nasal 
cavity is obstructed, the solution should be allowed to flow into that side until 
the obstruction has been removed, care being taken not to cause too great a 
pressure. Irrigation should be discontinued immediately if the patient begins 
to cough or choke. 
Pharyngeal douche.—The chief purposes of this douche are to prepare for an 
operation on the interior of the throat and as a cleansing agent in suppurative 
conditions of the throat. The following appliances are necessary: (1) An 
irrigator; (2) a piece of rubber tubing 2 to 4 feet long with a clamp attached; 
(3) a tip (a curved drinking tube often is used) ; (4) a tongue depressor; 
(5) a rubber dressing sheet; (d) a dressing towel; (7) a basin; and (8) 1 quart 
of normal salt solution, temperature 100° F., or a specially ordered solution. 
In administering this treatment it is advisable to cover the rubber sheet with 
a dressing towel and place it about the patient’s neck for the protection of the 
bed and patient’s clothing. The irrigator should be filled with the required 
solution and placed in such a position that it is 3 feet above the patient’s head, 
which should be bent forward to prevent the discharge, if present, from being 
washed down the patient’s throat. The basin should be so placed that it col- 
lects the used solution which flows from the mouth. The patient’s tongue 
should be depressed with a tongue depressor and the tip moved gently from 
side to side in such a manner that the irrigating fluid will reach all parts of the 
pharynx. Should it be inadvisable to have the patient in a sitting posture, the 162 
HOSPITAL CORPS HANDBOOK. 
irrigation may be performed with the patient lying in bed with his head turned 
to one side. 
Aural or ear douche.—The following appliances are required in this treat- 
ment: (1) An irrigator; (2) rubber tubing 12 inches long; (3) pus basin; 
(4) a small rubber dressing sheet; (5) a dressing towel; (6) sterile absorbent 
cotton; and (7) solution of boric acid, 2 per cent or a specially ordered solu- 
tion, at a temperature of 100° to 105° F. The patient should sit with his head 
inclined to the side or lie in sucli a position that the affected ear is uppermost. 
The rubber sheet, covered with a dressing towel, should be applied to protect 
the clothing; the irrigator filled witli the desired solution and placed about 
12 inches above the ear. Any discharge about the outer ear should be removed 
by gently wiping with cotton. Gentle but firm tension in a backward and 
upward direction should be applied to the upper part of the ear, and the nozzle 
should not be placed beyond the opening of the auditory canal. The solution 
should be permitted to flow gently into the ear and out into the basin. If pain or 
dizziness is caused, the irrigation should be discontinued and the medical officer 
notified. When irrigation is completed the ear should be dried with small 
pledgets of absorbent cotton. This is done by holding the auricle in proper 
position, inserting a pledget of cotton and leaving it for a few seconds to 
absorb the moisture, and then removing it. This procedure is repeated with a 
dry pledget each time until the cotton, when removed, is perfectly dry. A 
pointed instrument should not be inserted into the ear in this procedure. 
Eye douche.—The following appliances are necessary: (1) A basin containing 
about one pint of solution (boric acid 2 per cent, temperature 100° F., or 
specially ordered solution) ; (2) some sterile absorbent cotton sponges; (3) 
a basin to collect the solution as it flows from the eyes (pus basin preferred) ; 
(4) a small rubber dressing sheet; (5) a sterile dressing towel; (6) a basin 
for used pledgets; and (7) a probe or applicator. When cleansing the eye 
after operation, everything except the basin last named and the rubber sheet 
should be sterile. The operators’ hands, and, at all times, everything used, 
must be scrupulously clean. 
The patient sits or lies, as circumstances require, in such a manner that 
the head is tilted and the eye to be treated is lower than the other one. 
The rubber sheet, covered with the towel, should be adjusted and a basin 
placed in position to catch the solution as it runs from the eye. Any free 
discharge on the eyelids should be wiped away very gently with a cotton 
sponge wet in the solution (wipe from the inner toward, but not to, the outer 
angle, downward and outward from the outer angle). The same sponge 
should not be used more than once. One lid should be everted and a current 
of solution is then squeezed from a sponge over the eye, directing the current 
from the inner to the outer angle of the eye, otherwise the discharge may be 
washed into the lachrymal sac and a serious inflammation may result. The 
douche of the eye should continue in this manner until all of the discharge 
has been washed away. The other lid then should be everted and the process 
repeated. If both eyes are douched, separate utensils must be used; and the 
operator’s hands thoroughly disinfected before douching the other eye. The 
uninfected eye should be shielded carefully. When the eye is not inflamed, it is 
not always necessary to evert the lids, they may be drawn apart with the 
thumb and forefinger, and the patient directed to look up. Drops not intended 
for cleansing purposes should be put into the outer angle of the eye. 
An eye cup is a glass container small and oval in shape and should be filled 
two-thirds full of solution (boric acid, 2 per cent, at a temperature of 100° OPERATING ROOM AND SURGICAL TECHNIQUE. 
163 
F.). The patient’s head should be bent forward and the cup pressed firmly 
over the closed eye; then holding the cup in position, the patient should throw 
his head backward and open and close the eye alternately for two, three, or 
five minutes. The head then should be bent forward and the cup removed. 
References. 
Practical nursing.—Maxwell and Pope. 
Modern methods in nursing.—Sanders. 
Operating Room and Surgical Technique.1 
When we speak of an operating room we speak broadly, meaning not only the 
room where we actually operate but all the other rooms directly associated. 
This section of a hospital or of the sick bay aboard ship is a most important 
place, and upon its equipment and care depend to a considerable extent the 
success or failure of an operation. Of course surgeons often are required by 
necessity to perform operations under conditions far from satisfactory; for 
instance, under war conditinos or in isolated farmhouses. However, whenever 
possible, operations of a major character should be performed in hospitals where 
the patient can be safeguarded by all possible aseptic conditions. 
The operating room. 
The actual size of the operating room should be determined by the number 
and character of the operations to be performed and the space available. How- 
ever, it should be sufficiently large to preclude the necessity of crowding, yet 
not so spacious that it is difficult either to clean, ventilate, or heat. 
Lighting.—Good lighting is of paramount importance by day and night. Da 
Costa writes, “ In northern latitudes northern light is the best,” because with 
this exposure the trying glare of the sun is avoided. Large windows are 
desirable, preferably of plate glass, and with as few sashes as possible. Storm 
windows should be installed, either of the temporary or permanent variety, for 
during the cold months the heat loss through a single layer of glass, without 
an insulating air space, is great. A skylight, likewise of the storm-window 
type, is much to be desired. Adjustable curtains for the skylight and windows 
are necessary in order that there may be appropriate gradation of light, taking 
it for granted that the operating room is inaccessible to the gaze of unauthor- 
ized individuals. 
As a general rule, routine operations are performed during the hours of 
daylight, preferably in the morning, because by so doing the patient is saved 
much anxiety and the surgeon is at his best mentally and physically. Emer- 
gencies arise when it is necessary to operate by artificial light. The direct 
system of lighting in which electric lights with parabolic reflectors are sus- 
pended at the proper focal distance from the operating table is almost universal 
and quite satisfactory. The indirect system of reflected light is expensive, 
complicated, and as a rule unsatisfactory, unless a very complex system of 
accurately angulated mirrors has been installed so that no shadows are thrown 
on the operative field. 
In addition to the lights over the operating table, there must be provided 
several appropriately located side lights and wall sockets for the convenient 
attachment of electrical instruments. 
The electric current for some reason may fail, and to provide for this con- 
tingency several flashlights should be kept ready for immediate use and storage 
batteries installed capable of supplying current to two 25-watt portable lights 
for two hours. 
1 Prepared by Commander C. M. Oman, Medical Corps, United States Navy. 164 
HOSPITAL CORPS HANDBOOK. 
Gas as a substitute for electricity is undesirable, because ether in the presence 
of a flame is a menace and so much heat may be generated by the burning gas 
that the operating room becomes insufferable. 
Ventilation.—The ventilation of an operating room must be as nearly perfect 
as possible. However, the structural details of this problem essentially concern 
the engineer and architect. Suffice it to say that fresh, clean, warm, moist air 
should be constantly provided and drafts avoided. It is well also to em- 
phasize the importance of having a vestibule entrance to the operating room, 
for frequently an operation otherwise successful lias ended disastrously because 
the patient was chilled by a draft from a cold corridor into which the door 
directly opened. 
Heating.—The heating equipment should he either steam or hot water, de- 
signed to maintain a temperature of 80° F. under all weather conditions. A 
hot-air system should not be used because of the dust and dirt which it stirs 
and scatters broadcast. The ideal temperature for operating is 78° F., hut a 
variation of 1 or 2 degrees is difficult to prevent, and of no practical importance. 
An overheated operating room saps the vitality of the surgeon and his assistants. 
The patient’s body must he kept warm, and to accomplish this purpose, yet 
avoid excessive heat in the operating room, there are manufactured operating 
tables, warmed by electricity or by hot-water coils, but, as a matter of fact, 
such a table is not necessary provided hot-water bottles are placed judiciously 
and the patient covered with warm blankets before and during the operation. 
On the other hand, an underheated, chilly operating room is dangerous to the 
patient as a predisposing cause of surgical shock and pneumonia. 
Equipment.—It might well be noted that the history of medicine is replete 
with accounts of the most excellent work done without instruments and equip- 
ment now usually considered indispensable, and the man capable of adapting 
himself to circumstances, accomplishing his purpose despite incomplete equip- 
ment, is sought for and singled out among many. Originality and initiative are 
essential qualities of the surgeon or surgical assistant. 
An operating table with all accessories, adjustable as to height and the vari- 
ous standard positions, is desirable, but this type of table is expensive, and quite 
as good work may be performed on one of a simple design, provided proper 
forethought is given the type of operation and the required position of the 
patient. On the table there should be a soft pad about 1J inches thick 
covered with rubber sheeting and over all a linen sheet. In addition to 
the operating table but few pieces of apparatus are necessary. There should 
be two or three tables with glass or polished metal tops—preferably metal—for 
surgical dressings and instruments to be used during the operation, one single 
and one double hand basin stand, an irrigating stand, two enamel buckets with 
covers, and a set of glass shelves for solutions, ligatures, drains, pins, etc. All 
the operating-room accessories should be of simple, sturdy, easily cleaned 
design, and should be painted with a durable white enamel. 
Cleanliness.—The walls and floor of the operating room should be built of 
waterproof material with a smooth surface and so constructed that sharp, dirt- 
collecting angles are avoided. Glazed porcelain tile for the walls and un- 
glazed porcelain tile for the floor are admirably suited for the purpose in 
hospitals on shore, but on battleships, while it may be possible to have a tiled 
floor, the walls are usually steel, painted white, because the great vibration 
caused by gunfire might loosen or crack a tile wall. The floor should be 
washed daily with soap and warm water and the standing equipment wiped 
with a moist cloth. Once a week a hose should be played over the walls and 
the floor washed with any of the standard soap powders. During an operation OPERATING ROOM AND SURGICAL TECHNIQUE. 
165 
the blood and other stains on the floor should be removed as quickly as pos- 
sible, and, if a second operation is to be performed immediately, the floor, if 
necessary, should be cleaned by hand and not with a mop. 
Adjoining rooms. 
Adjoining an operating room in hospitals on shore and on hospital ships 
certain additional rooms, as noted below, are desirable: 
1. Anaesthetizing room. 
2. Wash room. 
3. Cleaning-gear room. 
4. Sterilizing room. 
5. Surgical-dressings room. 
6. Storeroom. 
7. Instrument room. 
Anaesthetizing room.—The anaesthetizing room should be equipped with a 
revolving stool and a stand on which should be— 
1. Etherizing mask. 
2. Gauze strips. 
3. Ether (in original cans). 
4. Hypodermic outfit (complete). 
5. Adrenalin hydrochloride. 
6. Mouth gag. 
7. Tongue forceps. 
8. Boric acid solution, with eye dropper. 
9. Boric acid ointment. 
10. Sphygmomanometer. 
11. Anaesthetist’s chart. 
12. Clock, with second hand. 
13. Pus basin. 
14. Pharyngeal tubes. 
In addition to the equipment as described above there should be an up-to-date 
machine for using nitrous oxide and oxygen in conjunction with ether. 
Wash room.—In the wash room there should be at least two lavatories, 
with foot or knee control for the hot and cold water, a shower bath and toilet, 
and clothes lockers for the use of the surgeon and his assistants when they 
change into the operating suits. It is well also to have in this room a basin 
stand for the solutions used to disinfect the hands after the preliminary 
scrubbing, in order that when the surgeon enters the operating room he is 
ready to receive his operating gown and proceed without delay. 
Cleaning-gear room.—Leading into the wash room should be a room for 
the cleaning gear used in the operating room. In this room should be a large 
deep sink with running hot and cold water, in which the linen used during 
operations may be soaked and the greater part of blood stains removed before 
sending to the laundry. The cleaning-gear room, it should be remembered, is 
an integral part of the operating-room equipment, and as such must be scrupu- 
lously cared for. 
Sterilizing room.—The standard Navy sterilizing equipment consists of— 
1. Utensil sterilizer. 
2. Instrument sterilizer. 
3. Hot sterile water tank. 
4. Cold sterile water tank. 
5. Autoclave. 
6. Glass-lined tank for sterile normal salt solution. 166 
HOSPITAL CORPS HANDBOOK. 
This is complete in itself and should be in the sterilizing room'. Despite the 
fact that this equipment is sturdily constructed, constant care must be taken 
that it is always in working condition and the printed directions furnished by 
the manufacturers exactly observed. 
The autoclave is the machine used to sterilize or make safe for surgical 
use, by steam under pressure, the various dressings and solutions used in the 
operating room. It should never be entrusted to an inexperienced or careless 
person, for in inexperienced or careless hands it is dangerous, as it may fail to 
kill infectious organisms, thereby endangering the lives of patients. 
Surgical-dressings room.—The surgical-dressings room should he constructed 
similarly to the operating room, with tiled walls and floor. In this room are 
made, prepared, and stored, after sterilization, the various surgical dressings 
and packages of linen, such as gowns, sheets, towels, etc., used in operations. 
Here cleanliness is of paramount importance. Ample locker and shelf space 
should be provided, and also a large smooth-top worktable. 
Storeroom.—There should be a storeroom solely for the storage of operating- 
room supplies. Much valuable time may he lost unless such a room is 
provided and kept fully stocked in anticipation of emergencies. 
Instrument room.—An instrument room, while not a necessity, is advan- 
tageous. However, as a rule, unless the clinic is unusually large and of great 
variety, suitably designed glass cabinets placed in the surgical-dressings room 
will suffice. 
SURGICAL TECHNIQUE. 
Years ago patients and surgeons dreaded operations because of the great 
number of deaths resulting from infection through the operative wound. It 
was believed that wounds were infected by bacteria in the air, and during an 
operation the operating room was sprayed with an antiseptic solution, but 
now we know that infection is due to bacteria introduced directly into the 
wound from the skin of the patient or by the hands, unclean instruments, or 
other equipment used during an operation, and that the bacteria in the air 
play a very minor part in the infection of wounds—in fact, so small a part 
that this mode of infection may be disregarded. 
Asepsis.—The ideal of modern surgery is to prevent infection by having 
everything which comes in contact with the patient at the time of operation, 
and at subsequent dressings, surgically clean—free from bacteria—ASEPTIC. 
Asepsis is difficult to maintain and constant vigilance must be exercised be- 
fore, during, and after an operation to attain this end, and no failure of 
technique, however trivial, should pass uncorrected. 
Infection.—Infection is said to exist when pathogenic bacteria (or germs 
capable of causing disease) gain access to the tissues of the body in such 
numbers that their presence is made manifest by characteristic symptoms. 
Inflammation.—Inflammation well may be described as the first objective 
(outward) symptom of infection and is characterized by local pain, heat, red- 
ness, swelling and disordered function. The general or subjective symptoms of 
inflammation vary greatly, depending upon the amount and anatomical location 
of tissue involved, the physical condition of the patient, and the virulence 
(poison production strength) of the infecting organism. Fever is the most 
constant subjective symptom of inflammation, but it may be so slight that it 
escapes notice and on the other hand it may be so severe that recovery of the 
patient seems doubtful. Aseptic treatment and careful observation of wounds, 
traumatic or operative, is imperative, in order that in the first place infection 
with its subsequent possibilities may be prevented and, secondly, if infection 
does occur it may be recognized promptly and appropriately treated. OPERATING ROOM AND SURGICAL TECHNIQUE. 
167 
Suppuration.—Suppuration is the result of inflammation and is due to the 
liquefying action of pyogenic (pus producing) organisms on the exudates of 
tissues damaged by inflammation and also upon the tissues themselves, form- 
ing pus. 
Sepsis.—When a wound has become so infected that the inflammation does 
no,t subside and pus forms, it is termed a “ septic ” wound. Frequently, as a re- 
sult of the passage of bacteria from a septic wound into the blood stream or of 
the absorption of the toxins (poisons) elaborated by the bacteria, grave 
general symptoms are caused and sepsis (blood poisoning) is said to be 
present. 
Putrefaction.—By putrefaction we mean that inflammation has so far 
progressed that the tissues have been devitalized and a foul or putrid odor 
arises from the wound. The putrid odor is due to the action of putrefactive 
bacteria—e. g., colon bacillus of malignant oedema, etc. 
Pyogenic bacteria.—The various strains (varieties) of the staphylococcus and 
streptococcus are the causative agents in the majority of surgical infections. 
Other organisms such as the Bacillus tuberculosis, Bacillus anthracis (bacillus 
of anthrax), Bacillus mallei (bacillus of glanders), the pneumococcus, Bacillus 
coll communis, Bacillus tetani (bacillus of lockjaw), Bacillus aerogenes cap- 
sulatus (gas bacillus) are, however, frequently demonstrable. The staphylo- 
coccus is the most common cause of infection. It rarely causes alarming 
constitutional symptoms, and as a rule such an infectious process remains quite 
localized. The streptococcus is more virulent and tends to invade the whole 
system. Infection of wounds by one type of organism is quite rare; two or 
more varieties usually are present and the coincident symptoms are dependent 
upon tlie predominating bacterium, either because of its virulence or numbers. 
It is well to note that the encapsulated spores or buds of the bacillus anthracis 
are the most difficult of all germs to kill, and any process which will render 
them harmless (and they must be dead to be harmless) may be relied upon to 
accomplish the same result as regards the other bacteria. 
Antiseptic, disinfectant, and deodorizer.—An antiseptic agent is one which 
inhibits (stops) the growth of or kills the bacteria but not the spores, and a 
disinfectant or germicide is an agent which will kill not only bacteria but also 
spores. The terms antiseptic and disinfectant, while literally they may be 
differentiated, are now, from a practical standpoint, considered synonymous 
and may be correctly used interchangeably. 
A deodorizer is neither a germicide nor an antiseptic, but merely an agent 
which destroys or renders less offensive disagreeable odors. Charcoal is per- 
haps the best example of a deodorizer. Antisepsis and sterilization are general 
terms indicative of measures taken to prevent or inhibit infection. 
The disinfectants in common surgical use are: 
1. Alcohol 70-95 per cent. 
2. Phenol (carbolic acid) 95 per cent. 
3. Corrosive sublimate (bichloride of mercury) 1-200, 1-10C 
The antiseptics customarily used for surgical purposes are: 
1. Alcohol 70 per cent. 
2. Phenol \ to 5 per cent. 
3. Corrosive sublimate solution 1 to 5,000, 1 to 10,000. 
4. Boric acid, saturated solution. 
5. Tincture of iodine 2 to 7 per cent. 
6. Permanganate of potash solution 1 to 1,000, 1 to 5,000. 
7. Harrington’s solution. 
8. Dakin’s solution. 168 
HOSPITAL COEPS HANDBOOK. 
Normal salt solution is a 0.85 per cent solution of salt (sodium chloride) in 
water, which should he freshly distilled (8.5 grams of salt in 1,000 c. c. of water). 
Sterilization. 
Sterilization is a process by which infectious organisms and their spores 
are killed. There are three methods of sterilization: (1) Mechanical, (2) 
thermal, and (3) chemical. 
Mechanical sterilization.—Mechanical methods of sterilization are unde- 
pendable and are usually but preliminary steps to sterilization by heat or 
chemicals. There are two general methods now in use: 
(a) Scrubbing. 
(b) Irrigation. 
(a) A thorough preliminary scrubbing, with soap and water, of a part of 
the body, or any article for surgical use, is frequently of great importance. 
The best example of the necessity of this procedure is the preparation of the 
hands of the surgeon and assistants for an operation. All instruments, enamel 
ware, and glassware should be thoroughly washed with soap and hot water 
immediately after use, as this process removes most of the germs and makes 
subsequent sterilizations more easily effective. 
(b) The irrigation of wounds with sterile water or other aqueous solutions 
has a distinct place in modern surgery. Running water is a splendid me- 
chanical cleanser, and, in many cases, will remove infectious organisms when 
other methods fail. 
Thermal sterilization.—Heat is the most efficient agent of sterilization and, 
when properly used, is absolutely certain in its germicidal action. 
The use of moist heat as a sterilizing agent is best discussed under two 
headings: 
(a) Boiling water. 
(b) Live steam (normal pressure or increased pressure). 
(a) Boiling water is the simplest method of sterilization, killing anthrax 
spores in three minutes. This method is used chiefly for sterilizing instru- 
ments (except those with lenses), glass and metal ware. In emergencies sur- 
gical dressings may be boiled, but it is far more satisfactory to have them dry 
at the time of operation. 
(b) Live steam is air-free steam and for sterilization purposes is used under 
normal or increased pressure. Steam under increased pressure is termed super- 
heated steam and is the best method of sterilization. Steam at normal pressure 
is but little used at the present time. 
An autoclave is a sterilizer in which steam under pressure (superheated 
steam) is used. A vacuum first is created to insure penetration of the steam, 
and when the proper reading of negative pressure (vacuum) is registered in the 
gauge superheated steam is admitted to the chamber and the articles therein 
subjected to a steam pressure of 15 pounds for one-half to three-quarters of an 
hour. At the end of this time all organisms will have been killed and the 
dressings or other articles rendered safe to use. but they are wet. A second 
vacuum then is induced and maintained until they are dry. One such steriliza- 
tion ordinarily is sufficient to preclude the possibility of infection, but that 
there may not exist the slightest doubt as to the asepsis of the sterilized material 
the process is repeated two or three times, despite the fact that anthrax spores 
are killed by live steam in 12 minutes. This method of repeated sterilization, 
either by steam or boiling, is termed fractional sterilization. OPERATING ROOM AND SURGICAL TECHNIQUE. 
169 
The method of sterilization in which dry heat is used includes the use of the 
actual cautery, a flame, or hot air. Hot air is fairly satisfactory and it will 
kill anthrax spores in about three hours at 140° C. The cautery is a positive 
germicide, hut causes extensive destruction of the tissues. Sterilization by a 
flame is rarely, if ever, used in surgery. 
Chemical sterilization.—Many chemicals will kill bacteria and spores, but in 
order to do so promptly such a strong solution or concentration must be used 
that the tissues likewise are destroyed. This result is usually undesirable. 
Therefore the use of chemicals as sterilizing agents is confined chiefly to the 
sterilization of instruments which boiling or steam would ruin, or in weak solu- 
tion as an adjunct to the mechanical method of sterilization. However, chem- 
icals in solution of appropriate strength have a distinct field of usefulness in 
the treatment of infected wounds. 
Below are briefly described some of the more common chemical disinfectants 
(germicides). 
Alcohol in strength varying from 50 to 95 per cent is used for the disinfecting 
of cutting instruments, disinfection of hands of surgeons, and cleansing the 
skin of sebaceous material preparatory to the application of iodine. 
Iodine (7 per cent tincture) is a reliable germicide, and its chief use is as a 
skin-disinfectant, but it is used also in the treatment of infected wounds. Its 
action, however, is much impaired by a wet or greasy surface. 
Bichloride of mercury has very little power of penetration in strong solu- 
tions, but in weak solutions is a powerful germicide for superficial germs. 
Bichloride of mercury as a germicide in deep wounds is of comparatively little 
value, as contact with the tissues forms an albuminate of mercury and hinders 
the subsequent action of the drug. Instruments never should be sterilized in 
a solution of this drug because of its corrosive action. 
Carbolic acid (phenol) is less powerful than bichloride of mercury and its 
chief use in surgery (£ to 5 per cent solution) is as a substitute for boiling or 
steam sterilization, and in 95 per cent solution as a local cauterizing agent. 
Carbolic-acid dressings should not be used because of the possibility of subse- 
quent gangrene. 
Potassium permanganate is an excellent deodorizer and, in addition, is a 
good disinfectant for the hands in saturated solution. 
Boric acid is a very mild antiseptic and generally is used in saturated solu- 
tion (4 per cent) for the irrigation of infected wounds or the sterilization of 
instruments which heat in any form would destroy. 
The active principal of Dakin's solution is chlorine, and when properly used 
is a most valuable and efficient disinfectant. 
Formaldehyde is an excellent germicide and is used either as a gas or in 
solution. It is very irritating to the tissues and seldom is applied in a dress- 
ing; in weak solutions (1 to 2 per cent) it wil] prove a satisfactory sterilizing 
solution for instruments. Formaldehyde gas is perhaps the most satisfactory 
method of sterilizing instruments which heat or moisture would injure, such as 
webbing catheters, cystoscopes, etc. 
Iodoform in contact with moisture frees iodine and is a good antiseptic, but 
its odor is so pronounced and disagreeable that its use, to a great extent, has 
been curtailed. 
Surgical dressings. 
Surgical dressings commonly are made from gauze, cotton, flannel, rubber, 
linen, etc. The gauze and cotton should be of good quality and capable of 
rapidly absorbing fluids. 170 
HOSPITAL CORPS HANDBOOK. 
It sometimes happens that the gauze, as received from the manufacturers, is 
sized—that is, coated with a starch preparation which makes it unfit for surgi- 
cal use—and such gauze must be boiled in a 1 per cent solution of sodium 
carbonate in order to remove this sizing. 
Each hospital is more or less individual as regards the design of its surgical 
dressings. As a general rule, gauze is used in four forms: (a) Sponges, 
(6) packs, (c) strips, and (d) in covering cotton pads. 
(a) Sponges.—Formerly natural or sea sponges were used during operations, 
but, on account of the fact that they are practically impossible to sterilize, their 
use has been discontinued, and small squares of folded gauze, four or five 
layers in thickness, have been substituted. 
(h) Packs.—Gauze packs usually are made of folded gauze 8 or 10 inches 
square and of 7 or 8 thicknesses, the gauze stitched around the sides. 
Attached to one corner is a tape. These gauze packs are used commonly for 
the purpose of “ wailing off ” an operative area, and as they enter the ab- 
dominal cavity it is important that they be not lost. An instrument or metal 
ring is, as a rule, secured to the end of the tape in order that such a mishap is 
rendered less likely, or, if such an accident does happen and the pad is sewn 
up in the wound, its presence may be determined easily by the X-ray, which 
will show the metal ring or instrument. 
(c) Strips.—Gauze strips deservedly are becoming more and more popular 
inasmuch as they are less likely to be misplaced. They may be of any con- 
venient length, width, or thickness. 
(d) Cotton pads.—Cotton is a most valuable adjunct in surgical dressings, 
but should not be placed on or in a wound without a protective covering of 
gauze, because the cotton fibers may be left in the wound and, as foreign bodies, 
cause or prolong an inflammatory process. 
Gauze dressings should be made neatly and carefully, witli no frayed edges, 
and should be made up in small packages covered with unbleached muslin or 
some other appropriate wrapping material. Common pins may he used to 
secure these coverings, the points of which should not show when the package 
is completed, in order that no infection may be carried into the dressings, caps, 
masks, etc., by the withdrawal of the pin. 
Sponge count.—The number of gauze sponges or packs, etc., in a package 
should be standardized and the used sponges or packs, etc., counted and checked 
against the number contained in the original packages, so that if any are miss- 
ing the loss may be discovered and search instituted before the abdominal 
wound is closed. 
Operating-room linen.—Under the heading of surgical dressings may well be 
mentioned the operating-room linen and rubber gloves. 
Sheets.—All sheets should be neatly and appropriately folded and made up 
in packages containing two or four each. It is necessary also to have on hand 
a supply of towels in packages of four each. Special operating sheets, with an 
oval opening in the center about 8 inches by 2 inches, known as laparotomy 
sheets, are used now universally, and may be packed either separately or 
included in the package of plain sheets. 
Caps and masks.—In order to prevent infection of the operative wound by 
dandruff and droplets from the nose and mouth, the surgeon and assistants 
should wear caps and masks, which are made of cotton cloth and gauze. Some- 
times the mask and cap are made of one piece of cotton cloth, but as a rule 
they are separate articles, and are put on before scrubbing the hands. Steriliza- 
tion of these articles is not absolutely necessary but desirable. OPERATING ROOM AND SURGICAL TECHNIQUE. 
171 
Operating gowns.—Operating gowns are large, loose-fitting cotton garments 
extending from neck to ankle, opened down the back, and usually have long 
sleeves. The surgeon and assistants put on these gowns over a clean white 
operating suit, which is worn in preference to ordinary clothes, immediately 
after the sterilization of their hands. 
The proper sterilization of sheets, gowns, masks, etc., is of great importance. 
They should be sterilized in an Autoclave, under 15 pounds pressure for at least 
30 minutes, and this process should be repeated at least three times in order 
that even the most remote possibility of infection may be removed. 
Rubber gloves.—It is practically impossible to perfectly sterilize the hands, 
and therefore rubber gloves, which can be made absolutely aseptic, should be 
used at all operations. They serve the double purpose of protecting the patient 
and surgeon from infection. Rubber gloves may be sterilized either in an auto- 
clave (dry sterilized) or by boiling. If an autoclave is used, two steriliza- 
tions, at 12 to 15 pounds pressure for 15 minutes, are sufficient. Longer sterili- 
zation and greater pressure rapidly rot the rubber. If the gloves are boiled, 
plain water should be used and the gloves boiled for 20 minutes. It is, as a rule, 
more convenient to put on dry rubber gloves. 
Bandages.—Bandages are made of unbleached muslin, gauze, mull, and 
crinoline, in appropriate widths and as a rule about 10 yards long. Gauze 
bandages are in almost universal use and require no special description. The 
same may be said of muslin bandages, except that they are less elastic than the 
gauze bandages and are usually used when partial or complete fixation is indi- 
cated. Mull is an expensive cloth, but makes a durable bandage. Crinoline is 
a cotton gauze heavily impregnated with starch. Crinoline bandages (so-called 
starch bandages) are valuable when a light, fixed (hard) dressing is neces- 
sary and they are applied wet. Plaster of Paris bandages are made of a 
strong, coarse cotton gauze, loosely wound, into which plaster of Paris has 
been thoroughly rubbed. A plaster of Paris bandage accomplishes the same 
purpose as the starch bandage, but is much heavier, stronger, and more durable. 
It should not be applied directly to the skin, but over some sort of protective 
dressing such as cotton wadding. 
Adhesive plaster.—The adhesive plaster in satisfactory general use to-day 
is made of firm cloth wdth, on one side, a sticky, rubber preparation impreg- 
nated with zinc oxide. Its adaptability for surgical purposes is almost un- 
limited and no surgical dressing equipment is complete without it. 
Surgical drainage material. 
The drains continuously used for surgical purposes are: 
1. Tubes—(a) rubber, (b) glass. 
2. Gauze drains. 
3. Rubber dam drains. 
4. Cigarette drains. 
5. Horsehair or silk drains. (Figs. 100, 101.) 
Tube drains.— (a) Rubber tubing makes an excellent drain for ordinary 
purposes and may be purchased in sterile glass containers ready for use or 
may, at the time of operation, be sterilized by boiling for seven minutes in 
plain water. To prevent the disappearance of a rubber tube into a body 
cavity, it should be secured to the skin either by a nonabsorbable suture or 
transfixed with a safety pin. (b) Glass tubing may be used for drainage pur- 
poses but it is dangerous, because of fragility and difficulty in securing. 
47829°—23 12 172 
HOSPITAL CORPS HANDBOOK. 
Gauze drains.—Gauze drains should be carefully prepared with no selvage 
edge and sterilized by either steam or boiling. Their use usually is limited 
to small superficial cavities such as result from the incision of a furuncle. 
They should be changed frequently, for they rapidly cease to function and 
mechanically plug the sinus, thereby defeating its purpose. 
Fig. 100.—Rubber drains: Perforated rubber tube; split rubber tubing with several 
lengths of gauze; cigarette drain of rubber tissue with gauze inserted. (Warnshuis.) 
Rubber dam drains.—Rubber dam is excellent drainage material and is 
sterilized by boiling in plain water for seven minutes. As a rule it is not 
irritating to the tissues and may be removed easily and painlessly. 
Cigarette drains.—A cigarette drain is made by rolling a piece of sterile 
gauze in rubber dam so that the ends of the gauze project three-quarters of an 
Fig. 101.—Silkworm-gut drain. (Warnshuis.) 
incli beyond the rubber. This type of drain is used chiefly in abdominal 
surgery. 
Horsehair or silk drains.—Horsehair or silk drains should be sterilized by 
boiling in plain water for 10 minutes. They make most excellent drains for 
small sinuses or cavities. 
Sutures and ligatures. 
Sutures and ligatures are made of absorbable and nonabsorbable material. 
Catgut is made from submucous coat of sheep intestines and usually is used sub- OPERATING ROOM AND SURGICAL TECHNIQUE. 
173 
cuticularly when an absorbable material is indicated, as for instance in tying 
a bleeding blood vessel or sewing a cut muscle. It now is prepared ready for 
use by various manufacturers put up in glass tubes which may be sterilized. 
Two kinds of catgut commonly are used—plain catgut in sizes 00, 0, 1, 2, 3, 4. 
(Plain catgut will last in the tissues about 8 or 10 days.) Chromicized 
catgut in the same sizes is prepared to last 10 to 20 days. Kangaroo tendon 
is made from the ligaments of the kangaroo’s tail. It is very strong and is 
used particularly in the repair of hernia, lasting 20 to 30 days. Catgut and 
kangaroo tendon are the only dependable forms of absorbable suture or liga- 
ture material. Nonabsorbable sutures and ligatures are made from silk, 
horsehair, silkworm gut, and celluloid linen thread (Pagenstecher), silver 
wire and bronze wire. Such suture material is used chiefly for sewing skin 
wounds. However, celluloid linen thread is frequently used in intestinal 
surgery, but in many cases an absorbable suture material is used entirely. 
Instruments. 
It is of paramount importance that surgical instruments be kept in good 
condition. They should be washed thoroughly, preferably in cold water, imme- 
diately after an operation in order that the bloodstains, etc., may be removed 
more easily. After washing they should be dried thoroughly, particular at- 
tention being given the joints. Having been dried, they should be wiped 
with mineral oil or vaseline to prevent subsequent rusting. Surgical instru- 
ments, as a rule, are sterilized by boiling in a 1 per cent solution of sodium 
carbonate for at least 10 minutes. The sodium carbonate in the water pre- 
vents rusting. Cutting instruments, such as scalpels, scissors, chisels, etc., 
may be boiled, but it is better to immerse them in an antiseptic solution, such 
as a 70 per cent solution of alcohol or 5 per cent solution of phenol for 20 
minutes. If they are boiled the cutting edge is dulled. Instruments should 
be kept in air-tight cabinets, but if such equipment is not available any clean 
locker may be used, provided, as suggested above, the instruments are kept 
thoroughly oiled. 
Fig. 102.—Instrument stand with instruments arranged. Note 2 scalpels, 3 Mayo 
scissors, 3 tissue forceps, 4 Kelly curved hsemostats, 3 Mayo curved hsemostats, 
2 straight Mayo hsemostats, 4 straight Kelly hsemostats, 2 sponge sticks with 
sponges, 2 clamps, 2 pairs retractors, a blunt dissector, and an appendical tucker. 
(Warnsliuis.) 174 
HOSPITAL CORPS HANDBOOK. 
It is impracticable to attempt a description of the instruments necessary 
for all operations. Certain ones always are used (listed below) and should 
be neatly arranged on an operating stand which extends over but does not 
touch the patient during an operation and is covered with a sterile cover. 
The others should be conveniently at hand on an instrument table. (Fig. 102.) 
If special instruments are necessary the surgeon or his assistant should select 
them prior to operating. 
Instruments for use in all operations: 
1. Scalpels (2). 
2. Scissors (2), 1 straight, 1 curved. 
3. Thumb forceps (2). 
4. Kelly hsemostats (6). 
5. Oclisner hsemostats (6), straight. 
6. Ochsner hsemostats (6), curved. 
7. Probe. 
8. Retractors (2 pair, large and small). 
9. Needle holder (2). 
10. Sponge holder (2). 
11. Towel clips (4). 
Preparation of the hands. 
There are many methods described for the preparation of the hands prior 
to operating. However, only one method, and, incidentally, the simplest and 
most satisfactory, used on the surgical service of the Naval Hospital, Wash- 
ington, D. C., will be described: 
“ Scrub the hands and forearms to the elbow with a bristle brush and green 
soap in warm running water for 10 minutes. Wash the soapsuds off and 
immerse the arms to the elbow in a 70 per cent solution of alcohol for five 
minutes. Allow the alcohol to dry by evaporation.” 
Care of patient on operating table. 
Before coming to the anaesthetizing room all foreign bodies in the mouth 
should have been removed, but it is well to inspect the patient’s mouth as a 
matter of precaution. 
Generally the patient is anaesthetized on the operating table, which is 
wheeled into the operating room. This feature of technique is quite desirable, 
because it obviates the necessity of lifting an unconscious, relaxed body, with 
the possibility of breaking bones, due to pendulant arms and legs. The oper- 
ating table should be padded well so that the patient may rest comfortably. 
Prior to the administration of the anaesthetic the patient should be clothed 
in a cotton nightgown extending to the knees and open down the back so 
that at the time of operation there may be no difficulty in exposing the desired 
part. Loose, flannel, operating-room stockings coming well above the knee 
should be put on and the patient covered with a sheet and blanket. When 
anaesthesia is complete the sheet and blanket should be removed and the 
patient covered with two blankets, drawn lengthwise across the body, slightly 
overlapping at about the level of the umbilicus, so that the field of operation 
may be exposed without entirely uncovering the patient. 
Preparation of patient for operation. 
The desired part is exposed by folding back the blankets and wfiped with 
gauze dampened with benzene. The purpose of the benzene is to remove the 
natural oils and greasy excretions of the skin, insuring prompt, efficient action 
of the tincture of iodine (U. S. P.), which then is applied liberally over a wide OPERATING ROOM AND SURGICAL TECHNIQUE. 
175 
surface. This method of skin preparation is well adapted for even emergency 
operations. 
When the iodine has dried the patient is draped for operation with sheets 
and towels, so that only the surface immediately surrounding the incision is 
exposed. The more skin area uncovered the greater is 
the chance of infection, because it is practically impos- 
sible to render skin aseptic. 
Operating room personnel. 
The operating room personnel required and their 
duties are described immediately following (figs. 103, 
104) : 
1. Surgeon. 
2. First assistant surgeon. 
3. Second assistant surgeon. 
4. Operating-room nurse. 
5. Surgical nurse. 
6. Hospital corpsmen. 
a. Hospital corpsman assistant. 
b. Hospital corpsman, general detail. 
Surgeon.—The surgeon performs the operation and all others in the operating 
room are responsible to him. It should be remembered that often a patient’s 
Fig. 103.—Diagram of 
arrangement of ta- 
bles and assistants 
for abdominal opera- 
tion. (Bryant.) 
Fig. 104.—The operative group. (Warnshuis.) 
life is in his hands and that proper, willing, and intelligent assistance is of 
prime importance. (Fig. 105.) 
First assistant surgeon.—The first assistant surgeon’s duty is to immediately 
assist the operating surgeon, and as a rule stands opposite to him at the 
operating table. 176 
HOSPITAL CORPS HANDBOOK. 
Second assistant surgeon.—The second assistant surgeon also assists the 
operating surgeon, but stands beside him. 
Operating-room nurse.—The duties of the operating-room nurse are mainly 
of a supervisory nature. It is taken for granted that her training is such 
that she is competent to and does instruct the others in the operating room 
technique. She assumes the responsibility for the efficiency of all routine 
measures and it is for her to see that all semblance of confusion is avoided. 
At the time of operation her main duty is to anticipate the needs of all the 
operating room personnel. 
Surgical nurse.—The surgical nurse is first assistant to the operating room 
nurse and assumes her duties when necessary. During an operation she 
scrubs up and is responsible for the instrument and surgical dressings tables. 
She should be the first to scrub and drape the 
tables with sterile sheets preparatory to assorting 
the dressings and instruments. 
Hospital corpsmen.—There should be two hos- 
pital corpsmen detailed from the operating room 
force, and they should alternate in assisting the 
surgical nurse at operations. During an opera- 
tion the hospital corpsman assistant should be in 
charge of the instrument stand which is extended 
over the patient and on which are the instruments 
constantly needed during the operation. He 
should keep these instruments clean and in place. 
In addition to caring for the instruments, he 
should see that sutures and ligatures are always 
ready and be prompt to hand either or both to the 
surgeon without delay. 
The hospital corpsman on general detail is the 
general “ handy man ” in the operating room. He 
should be constantly on the alert to render service. 
Preparation for an operation.—It is assumed 
that as described above the surgical dressings, i. e., 
sponges, strips, gowns, sheets, gloves, etc., have 
been sterilized and are on hand ready for use, and 
that ample warning has been given the operating 
room personnel to enable them to devote their 
whole time and attention to the coming operation. 
(1) The operating-room nurse is informed that an operation for will 
be performed at a. m. 
(2) The operating-room nurse directs the operating personnel to report at 
least 30 minutes before the time set for the operation. 
(3) When the operation is such that special or unusual instruments are 
necessary, the hospital corpsman assistant selects the instruments to be used 
and puts them, wrapped in a cotton cloth, to boil in the sterilizer. With the 
instruments should be boiled three or four medicine glasses in which may be 
poured various disinfectants, such as iodine, carbolic acid, etc. In some hos- 
pitals the technique calls for the boiling of the glass tubes containing sutures 
and ligatures, but usually they are kept immersed in an antiseptic solution 
and are removed with sterile forceps when necessary. 
(4) The hospital corpsman assistant and hospital corpsman on general 
detail place the hand basins, enamel pitchers, etc., in the utensil sterilizer. 
(5) Fifteen minutes before the scheduled time of operation the cutting 
instruments are placed in the sterilizing solution. 
Fig. 105.—Surgeon properly 
gloved and gowned. (Warn- 
sliuis.) OPERATING ROOM AND SURGICAL TECHNIQUE. 
177 
(6) All hands assist in placing the operating room equipment in convenient 
locations. 
(7) The operating-room nurse and surgical nurse select the packages of 
sterile goods which they anticipate will he used and place them on the table 
in the surgical dressings room. (When a pack of sterile dressings in opened, 
care should be taken not to break asepsis.) 
(8) The surgical nurse and hospital corpsman assistant put on caps and 
masks and “ scrub up.” 
(9) The operating-room nurse hands the surgical nurse a sterile gown from 
a sterile package and assists her to put it on. The hospital corpsman on 
general detail does likewise for the hospital corpsman assistant. 
(10) Both the surgical nurse and the hospital corpsman assistant put on 
sterile rubber gloves which are handed them from sterile packages. 
(11) The surgical nurse drapes, with sterile sheets, the table for sterile 
gowns and gloves, the instrument table, the surgical dressings table, and 
basin stands. 
(12) The hospital corpsman assistant drapes the instrument stand with a 
specially designed cover. 
(13) The hospital corpsman on general detail carries the sterilized instru- 
ments and utensils in their trays to the hospital corpsman assistant, who 
places the instruments on the instrument table and the hand basins on the 
draped stands. 
(14) The operating-room nurse opens the sterile packs and hands the surgi- 
cal nurse the surgical dressings, sterile sheets, towels, etc., which she places 
on the surgical dressings table. 
(15) The hospital corpsman assistant is handed the sterile gowns and gloves 
intended for the surgeon and his assistants, which he places on the table pre- 
pared for that purpose. 
(16) The surgical nurse and hospital corpsman assistant sort and arrange 
the instruments on the instrument table and prepare the ligatures and sutures. 
(17) The hospital corpsman assistant selects the instruments, sutures, and 
ligatures, as described in a previous paragraph, and places them on the instru- 
ment stand. 
(18) Having accomplished the above, all instruments and supplies are cov- 
ered with sterile sheets and the surgeon notified that the operating room is 
ready. 
(19) The surgeon directs that the patient be taken to the anaesthetizing room 
and the anaesthetic administered. 
(20) The surgeon and the first and second assistants “ scrub up ” and put on 
sterile gowns and gloves. 
(21) The patient, completely anaesthetized, is brought into the operating 
room. 
(22) The hospital corpsman on general detail wipes the skin of the patient 
at the site of operation with gauze moistened with benzine. 
(23) The surgical nurse hands the first and second assistants sponges, held 
in haemostats, with 7 per cent tincture of iodine, with which they “ paint ” the 
area cleansed with benzine. 
(24) The hospital corpsman assistant and the second assistant drape the 
patient with sterile sheets and towels so placed that only a small area of 
skin remains exposed for the incision. 
(25) The surgeon comes to the operating table; all assume proper places. 
(26) The hospital corpsman assistant hands the surgeon the scalpel and 
the incision is made. 178 
HOSPITAL CORPS HANDBOOK. 
It should be remembered that most patients are unfamiliar with hospital 
routine, and that they come to a hospital for the relief of pain, either mental 
or physical, and are naturally quite anxious. The most casual remark may be 
exaggerated, and all conversation within the hearing of the patient should 
be reassuring. 
When a patient is going under an anaesthetic loud talking or rattling 
instruments is frequently terrifying and should not occur. Great care should 
be taken in this respect during an operation under local anaesthesia. Keen 
assistance and operating “ teamwork ” will obviate conversation to a great 
extent, and there is no excuse for dropping or rattling instruments. 
During an operation all evidence of haste, hurry, or confusion should be 
avoided. Peace, quiet, and tranquillity should prevail. Emergencies should be 
met with confident anticipation and with no outward manifestation of the 
unusual. The patient’s welfare is the ultimate aim of surgery, and to this 
end all effort must be conscientiously directed. 
References. 
Principles of Surgical Nursing.—Wamshuis. 
Modern Surgery.—Da Costa. 
Anaesthesia.1 
INTRODUCTORY REMARKS. 
Anaesthesia is the state in which total or partial loss or absence of feeling 
or sensation exists and may he the result of disease or injury or the applica- 
tion or inhalation of anaesthesia-producing drugs. It is known as “ general ” 
or “local” (regional) according to the extent of insensibility. 
General anaesthesia produces a state of unconsciousness, associated with 
general loss of sensation, including, of course, the loss of sensibility to pain, and 
usually is induced by inhalation, but may be caused by the introduction of 
various agencies into the system by other channels than the respiratory 
tract 
Local anaesthesia (more properly called analgesia) produces loss of sensi- 
bility to pain without the loss of the other sensations, such as heat, touch, 
etc. The area involved depends upon the site of injection of the analgesic 
agent and may include extensive areas or regions of the body. When so 
employed it is also termed regional anaesthesia or analgesia. The administra- 
tion of local analgesic agents is performed usually by the operating surgeon 
with or without the aid of an assistant. 
The principles governing the administration of general anaesthetic agents 
have advanced remarkably during recent years. Formerly, and to a large 
extent at the present time, the various factors influencing the proper induction 
of an anaesthesia have been and are neglected. In large hospitals where a 
number of operations are performed daily the tendency is to hurry the patient 
for the waiting surgeon, thereby forcing the patient under the influence of the 
anaesthetic as rapidly as possible and employing excessive quantities of the 
agent in a short period of time. This practice very frequently produces a 
greater degree of narcosis than is either necessary or desirable, increases the 
danger to the patient unnecessarily and prolongs the stage of recovery from 
the anaesthetic, and by increasing the surgical shock frequently prolongs the 
convalescence of the patient. 
1 Prepared by Lieut. W. W. Behlow, Medical Corps, United States Navy. ANAESTHESIA. 
179 
The development of specialists in anaesthesia during recent years has 
increased the knowledge of this very important branch of surgical procedure. 
As a result of this specialization many important facts concerning anaesthesia 
have been learned. The trained anaesthetist is not satisfied with merely keep- 
ing his patient under the influence of the anaesthetic, as was formerly the 
practice, but endeavors to induce and maintain a light, even, surgical stage of 
of anaesthesia during the entire operation. The various factors which influ- 
ence the proper administration of the anaesthetic are discussed in detail in 
another section. 
The successful administration of a general anaesthetic by inhalation depends 
upon the maintenance of efficient respiration, the regulation of the dosage 
of the chosen drug, and the preservation of adequate temperature, circulation, 
blood pressure, and vitality of the patient. 
The anaesthetist is required in many instances to assume great responsibili- 
ties and should be thoroughly equipped mentally and physically for his duties. 
He should possess perfect senses of sight and hearing, keen scent, and gentleness 
of touch. He also should acquire a thorough knowledge of the methods of 
handling patients and dealing with them with tact and courtesy. In this 
connection it should be emphasized that patients awaiting operation frequently 
and needlessly are alarmed by the carelessly and thoughtlessly spoken word 
of the attending hospital corpsman. This is especially true in the operating 
room during the early stages of anaesthesia when the patient appears to be 
unconscious. At such times his hearing is often very acute and he is likely 
to hear conversation concerning his condition which might cause him needless 
anxiety and add to the risks of the operation. In hospitals patients are 
usually under the influence of the anaesthetic before they are transported to 
the operating room. On board ship and at smaller shore stations this is often 
not practicable and the administration of the anaesthetic is begun in the operat- 
ing room. Under the latter conditions it is not very pleasant to the patient 
to hear needless discussion of either his own or other cases nor to listen to 
the noisy handling of instruments and other surgical equipment. 
While a patient is under the influence of an anaesthetic, particularly during 
the period of recovery, he is frequently very talkative, even garrulous. During 
this period he is likely to make statements which during his conscious, saner 
moments he would hesitate to make. He may at times be very offensive in his 
speech. It is the bounden duty of attending hospital corpsmen to consider all 
such statements as strictly confidential and privileged communications. In- 
formation obtained from a patient under these circumstances never should be 
disseminated. After recovery from anaesthesia, a patient frequently is worried 
by the thought that he disclosed information that might prove very embar- 
rassing, and he questions his attendants concerning his conduct during the 
priod of anaesthesia. At such times a diplomatic and tactful reply always is 
indicated. 
As patients frequently become violent during the early stages of anaesthesia 
there always should be at least one other person in addition to the anaesthetist 
present during this period in order that the patient may neither do injury to 
himself nor to the anaesthetist. 
Female patients are frequently the victims of delusions while under the in- 
fluence of a general anaesthetic. As a matter of precaution it is advisable 
under such circumstances to insist upon the presence of a third person. 
The responsibility of the anaesthetist does not terminate with the completion 
of the operation. He is directly responsible for the patient during the trans- 
portation of the latter to the recovery room or to his bed and until properly 
relieved by a competent attendant. 180 
HOSPITAE CORPS HANDBOOK. 
GENERAL ANAESTHESIA. 
Preparation of patient for operation.—The success of anaesthesia in regard 
to the ultimate recovery of the patient depends largely upon the preliminary 
preparation, the treatment during the course of the anaesthesia, and the care 
of the patient after the anaesthetic has been discontinued. 
The condition of the patient will, of course, be the deciding factor in what- 
ever preparatory treatment is given. In hospital practice it is usually prac- 
ticable in ordinary cases to devote sufficient time to the preparation of the 
patient. On board ship and at smaller stations, when operative procedure 
is considered necessary and a hospital is not available, such operations fre- 
quently assume an emergency status, and proper preparation is not always 
possible. In both groups of cases the hospital eorpsman will be guided by the 
instructions of the medical officer. 
The following suggestions concerning the management of surgical cases from 
the anaesthetist’s viewpoint are considered to be of value in the ordinary sur- 
gical case. All are subject to modification by the operating surgeon and should 
not be carried into effect without his specific instructions. 
A warm bath, if the condition of the patient permits, with thorough cleansing 
of skin, should be given the night before operation. At this time all hair over 
and adjoining the area of operation should be removed with scissors and 
razor. 
In order to avoid all possible sources of infection of the respiratory tract 
and to decrease the incidence of inhalation pneumonia, the hygiene of the 
mouth and nasal passages should not be neglected. A suitable mouth wash 
and spray should be used frequently up to the time of operation. A careful 
notation of loose, pivot, or artificial teeth should be made, and any removable 
teeth, plate, or other object removed prior to the administration of the 
anaesthetic. 
The bladder should be emptied either voluntarily or, if absolutely necessary, 
by catheterization before the operation. If practicable and time and the con- 
dition of the patient permit, the intestinal tract should be emptied, using for 
this purpose a purgative, 24 hours prior to operation, followed in 8 hours by an 
enema. Such a procedure is not applicable to abdominal cases, which always 
require special preparation. 
The diet prior to operation is subject to so many changing factors that it is 
safe to withhold all food unless instructions to the contrary are received. The 
same rule applies to the giving of water and other liquids. 
During this course of preparation the hospital eorpsman always should re- 
member that the mental or psychic state of the patient must be carefully con- 
sidered in order to insure a smooth, safe, and satisfactory anaesthesia. There- 
fore anything that will cause or increase fear or anxiety will militate against 
what otherwise might be a successful anaesthesia. As far as the patient is 
concerned, he is, in his own opinion, the only individual of consequence under 
medical care at that particular time and he expects the utmost consideration. 
Every effort should be made to make the patient’s thoughts run in pleasant 
channels. 
Medical treatment prior to operation includes measures to insure rest and 
quietude and proper functioning of the essential organs, such as the heart and 
circulatory system, and to counteract the effects of disordered function brought 
about by disease. It is the practice of many surgeons to administer an opiate 
hypodermically shortly before tbe operation. This opiate usually is morphine 
and frequently is combined with atropine, which drug counteracts the depress- 
ing effect of the morphine on the respiratory center and also inhibits the secre- ANAESTHESIA. 
181 
tory activities of the respiratory tract. The hospital eorpsman never should 
administer any drug without specific instructions from the medical officer. 
The preliminary preparation of the patient in the more difficult cases and 
in emergencies depends entirely upon the patient’s condition, the amount of 
time available, and the surrounding conditions. In such cases it is essential 
that the hospital eorpsman await instructions from the medical officer. As it 
is believed that sterilization with iodine preparations is less effective in the 
presence of moisture, preparation of the held of operation, including shaving 
of the hair within 12 hours of operation, should be performed without the use 
of water or other liquid preparations. In such cases the maintenance of abso- 
lute rest and abstinence from food and liquids is of the utmost importance. 
It is frequently advisable and necessary to wash out the stomach prior to 
operation in order to prevent vomiting during anaesthesia, with its attendant 
danger of inhalation of foreign substances and of obstruction to proper respira- 
tion. As will be noted in another section, a similar procedure often is followed 
upon completion of the operation. 
In all cases the care of the patient on the operating table is extremely impor- 
tant. As the body temperature usually falls during anaesthesia, it is essential 
that the patient be covered with at least two blankets during the operation. 
The patient’s arms must not be allowed to hang down over the side of the 
operating table, nor should they be allowed to assume unnatural positions, 
causing unusual pressure which may result in paralysis of nerves, especially 
the musculospiral (radial) nerve. 
The general type of operation usually is known to the anaesthetist, and he 
therefore should provide the necessary attachments for the table to maintain 
the patient in any of the positions required by the surgeon. 
The maintenance of respiration is all important, and it is essential that 
unnecessary pressure upon the thorax, such as may be caused by the surgeon’s 
arms or by instruments, be eliminated. The patient’s clothing should be quite 
loose, though warm. In the case of nitrous oxide, frequently administered in 
day clothing, especial care must be taken to loosen all clothing about the neck, 
chest, and upper abdomen, thus eliminating the possibility of pressure, which 
may cause cessation of respiration. 
Anaesthetist’s table. 
The average anaesthesia in the ordinary surgical case is completed without 
incident or difficulty. Although most of the difficulties encountered are respira- 
tory and easily can be overcome without the aid of instruments, it is occasion- 
ally necessary to adopt unusual measures to maintain a clear air passage. 
The anaesthetist always should have the following equipment at hand and 
immediately available for use in an emergency (fig. 106) : 
(a) Wooden mouth gag. 
(&) Tongue forceps. 
(c) A curved needle threaded with silk, sterilized, and in a sterile pack- 
age. 
(d) Sterile hypodermic syringe with the following drugs in sterile solu- 
tion in appropriate containers: 
Caffeine sodium-benzoate. 
Atropine sulphate. 
Alcohol (or brandy). 
(e) Tracheotomy set. 
(f) Gauze strips. 182 
HOSPITAL CORPS HANDBOOK. 
(g) Forceps (to hold gauze sponge). 
(h) Watch or small clock. 
(i) Pus basin. 
This equipment is placed on a small table near the anaesthetist and within 
easy reach. It never should be necessary to ask for any of these important 
articles during anaesthesia, as delay in meeting an emergency may result in 
disaster. 
In addition to the above list it is desirable to have an anaesthetist’s chart 
for the recording of data, an extra supply of the anaesthetic agent, and, when 
necessary, a blood-pressure apparatus, should the surgeon request data on blood 
pressure during the operation. 
Some cases require gastric lavage (washing out of stomach) during or upon 
completion of operation. It is essential, therefore, that a stomach tube be 
available in the operating room. 
Fig. 106.—Ansesthestist’s table of supplies. Cans of ether, chloroform, vaseline, castor 
oil, medicine dropper, hypodermic syringes, hypodermic tablets, glass Oif sterile 
water, vomitus basin, anaesthetic masks, towels, gauze, mouth gag, tongue forceps. 
(Warnshuis.) 
Anaesthetic agents. 
The agents or combinations of agents which fulfill the requirements of a 
general anaesthetic are nitrous oxide, ether, chloroform, ethyl chloride, and 
combinations' and sequences of these with each other and with oxygen. 
The choice of the anaesthetic to be used is left entirely to the medical officer 
in charge of the case, and is governed by the condition of the patient, the 
type of operation, the climatic conditions, and the type of agent available. 
The hospital corpsman is particularly interested in the last two conditions. 
In very hot climates, as in the Tropics, it is frequently next to impossible 
to induct general anaesthesia with ether, as it is so volatile that evaporation 
occurs almost immediately upon release from its container. Under such con- 
ditions it may be necessary to use chloroform. As nitrous oxide and ethyl 
chloride usually are not available in sufficient quantities outside of the hospi- 
tals, dependence must be placed upon ether and chloroform. It is therefore 
essential that the hospital corpsman become thoroughly familiar with the 
administration of these two anaesthetic agents, especially the former. ANAESTHESIA. 
183 
Administration of the anaesthetic in general anaesthesia. 
Cardinal principles.—Insufficient oxygenation of the blood is the cause of 
most of the difficulties in securing a quiet, peaceful, satisfactory anaesthesia, 
and of a large percentage of fatalities in connection with the use of anaes- 
thetics. 
The first important object, therefore, is to maintain a clear air passage 
in the patient. The anaesthetist should familiarize himself with the signs of 
obstructed breathing and should be able to recognize and overcome these 
obstructions as they occur. The most common causes of obstruction of the air 
passages are partial obstruction of the nasal passages, frequently found in 
otherwise normal individuals; the presence of mucus in the mouth, pharynx, 
and naso-pharynx; firm closure of the jaws in the early stage of anaesthesia 
(patients with no teeth are prone to press their upper and lower gums 
together so firmly that very little or no air can enter) ; dropping of the lower 
jaw and “ swallowing ” of the tongue; position of patient with reference to 
mechanical pressure; spasm of the laryngeal muscles. 
The only sure practice to follow in observing the patient’s breathing is to 
hear or feel every respiration. As the patient’s respiratory efforts continue, 
even after obstruction of the air passages, it is not enough that the anaesthetist 
should only see the chest and abdominal movements. 
Mucus should be removed with a gauze sponge held in forceps. Dropping 
of the jaw and “ swallowing ” of the tongue should be overcome by light, even 
pressure under the jaw. In this connection it may be stated that long continued 
pressure over a small area of the jawbone may cause considerable soreness 
and tenderness for several days. It is occasionally necessary to hold the 
tongue forward by means of tongue forceps, although this procedure should 
be avoided if possible. Turning the patient’s head to one side allows the 
drainage of mucus and other secretions and frequently prevents the backward 
drop of the tongue and jaw. 
Laryngeal spasm usually is due to reflex action; a most frequent cause is too 
strong anaesthetic vapor. Withholding of the anaesthetic frequently will over- 
come the spasm. Impending vomiting with its resulting laryngeal spasm may be 
prevented by deepening the anaesthesia. 
The question which naturally arises in each and every case is “ How far is 
the patient under the influence of the anaesthetic?” It is essential that the 
anaesthetist know the exact degree of narcosis present at any and every given 
moment of anaesthesia. The requirements of the operation decide the depth of 
anaesthesia desired in each case. Constant practice in administering anaes- 
thetics is necessary to obtain a knowledge of the finer details concerning general 
anaesthesia. The more important details will be discussed in that section de- 
voted to the administration of ether. 
Ether. 
Properties.—A light, volatile, colorless, highly inflammable liquid with a 
peculiar penetrating odor and burning taste. Its vapors are heavier than air. 
Caution.—Explosions and burning with fatal results have resulted from care- 
lessness in the use of ether. Great care should be taken to avoid using this 
agent near an open flame, such as is found in a lighted gas jet, lamp, burning 
candle or stove, or in the vicinity of a hot cautery or electric spark. 
Ether is administered by (1) the open or drop method, (2) the semiclosed 
(cone) method, or (3) the closed inhaler method. 
In cold climates when the temperature does not cause too rapid volatiliza- 
tion of the ether, the open or drop method is the best, as the amount of mucus 184 
HOSPITAL CORPS HANDBOOK. 
secreted is generally much less, the tendency to coughing and labored breath- 
ing is decreased, the patient’s color is better, and the pulse rate and blood pres- 
sure are well maintained. Most of the effects of deficient oxygenation of the 
blood do not occur, as this method permits the admixture of an adequate supply 
of oxygen from the air. 
Patients addicted to the use of alcoholic liquors usually will prove unsuit- 
able for this method, as they frequently require a rather forced administration 
during the second or excitable stage. For such individuals and in hot climates 
either the cone method or chloroform, preferably the former if possible, should 
be used. As the closed inhaler rarely is used outside of hospitals, no further 
mention will be made of its use. With the cone method, there is a tendency to 
administer the anaesthetic unevenly, with the result that the concentration of 
the ether vapor varies considerably, particularly during the first and second 
stages of the anaesthesia. This variation in concentration leads to reflex re- 
actions such as spasms of the larynx, coughing, retching, etc. There is also 
a tendency with this method to force the patient under the influence of the 
anaesthetic. 
Anaesthesia.—When ether is administered slowly by inhalation its action on 
the patient may be divided into four stages as follows: (1) The stage of 
light anaesthesia, in which occurs the primary decrease of consciousness ac- 
companied by a feeling of asphyxia and ringing in the ears. Respiration is 
accelerated; the blood pressure is increased slightly; the pulse becomes full 
and bounding; and the color of the skin becomes heightened. Concentrated 
vapor in this stage will cause coughing, holding of the breath, swallowing, 
spasm of the glottis, muscular rigidity, turning of head from side to side and 
slight dilatation of the pupils. (2) The stage of excitement. In this stage the 
controlling centers in the cerebrum are depressed and there is incoordination 
of movements and speech, which may amount to violent struggling and shout- 
ing. Memory, volition, and intelligence are interfered with; consciousness is 
partially or wholly lost; marked rigidity of muscles supervenes; the pupils are 
dilated and mobile; secretions of the respiratory tract are increased markedly; 
the face is very flushed ; perspiration is evident and the breathing may be irregu- 
lar. As the patient passes from this stage to the third stage, vomiting is not infre- 
quent. (3) The stage of surgical anaesthesia, when the cerebrum and spinal cord 
are paralyzed, sensation to pain is lost, and there is complete unconsciousness and 
relaxation. The respirations are deep, regular, and generally audible. A soft 
stertor may be considered normal. A strong stertor indicates obstruction of the 
air passage which requires immediate attention. The color of the face, ears, and 
lips is normal; the pupil is usually normal or contracted, but reacts to light; 
and the eyeball is eccentric or oscillatory. If the eyeball is stationary 
on center with pupil dilated, the patient is receiving too much ether, the 
the administration of which should be discontinued at once. The lid reflex 
is weakly active; coughing and plionation are absent; and the heart action is 
accelerated. As anaesthesia progresses the face may become more flushed than 
normal. From the third stage the patient may change in the direction of 
consciousness or deepening narcosis, the fourth stage. Returning conscious- 
ness is indicated by the following signs: Respiration regular, not full, but quiet; 
pallor of face; moderate dilatation of the pupils with light reflex; increased 
activity of lid reflex; swallowing movements; return of phonation. (4) The 
fourth or dangerous stage is the stage of overdose of the anaesthetic. The 
medulla oblongata becomes paralyzed and asphyxia and weakened circulation 
follow. Death occurs in this stage from paralysis of the respiratory center 
in the medulla. The signs of the fourth stage are weak, shallow respiration, ANAESTHESIA. 
185 
cyanosis, soft feeble irregular pulse, dilatation of pupils with no reaction to 
light, absence of lid reflex, central fixation of eyeballs, separation of eyelids, 
and fall of blood pressure. 
Method of eliciting the corneal lid reflex.—The reflex closure of the upper 
eyelid gradually diminishes in activity as ansestliesia becomes more profound. 
This reflex activity of the upper eyelid in response to stimulation of the cornea 
is considered one of the most important signs in determining the degree of 
narcosis. This sign may be elicited in the following way, according to Gard- 
ner : “ Standing above or behind the patient, the pulp or palmar surface of the 
middle finger only of one hand should be gently inserted between the closed 
eyelids and made to draw the upper lid open as far as to disclose two-thirds 
of the cornea. Whilst doing this that finger pulp very gently but definitely 
brushes against the surface of the cornea, passing first over its exact center 
and then against the palpebral edge of the upper eyelid in one movement, 
which ends with the sudden letting go of the lid from the finger. The degree 
of activity with which the upper eyelid then closes constitutes the most inva- 
riable evidence of the extent to which the muscular and nervous systems are at 
the moment paralyzed by the anaesthesia.” 
Induction of ether anaesthesia. 
Open or drop method.—When the patient is in as comfortable a position as 
possible the face should be anointed with a bland ointment and the eyes cov- 
ered with a layer of gauze. The mouth and nose then are covered either with 
one of several types of gauze mask or with three or four strips of gauze. It is 
best to allow the patient to breathe several times with the gauze in position in 
order that the patient may become accustomed to its presence and also to 
determine whether or not the thickness of the gauze is too great to permit free 
and easy respiration. 
Before beginning the administration of the anaesthetic, which to some patients 
may be very disagreeable, it is frequently desirable to drop a few drops of oil 
of bitter orange peel on the gauze. This is then followed by the ether, which 
should be administered drop by drop, very slowly at first, then gradually in- 
creasing the amount until the patient can take the strongest vapor. The ether 
should be dropped over an area involving the mouth and nares. The patient 
should never be hurried and should never be advised to breathe deeply, as a 
feeling of suffocation will ensue and the patient is also likely to struggle. 
During the administration of the anaesthetic the anaesthetist should talk con- 
stantly to his patient in order to maintain the latter’s confidence. In other 
words, the anaesthetist should talk his patient to sleep. By this method under 
ordinary conditions the patient can be brought under the influence of ether in 
from four to six minutes. 
Cone method.—This method differs little from that just described. It per- 
mits, however, rebreathing of the anaesthetic and in very hot climates is pref- 
erable to the open method, as there is less evaporation of the agent. In 
order to prevent too great a loss through evaporation, the cone may be sur- 
rounded with wet cold towels. In using the cone method it is always best to 
begin with the drop method, changing to the cone as the patient reaches the 
stage of surgical anaesthesia. With either method less ether is required to 
maintain the surgical stage of anaesthesia than is needed in either the first or 
second stage. 
Chloroform. 
Chloroform is a heavy, colorless, transparent, noninflammable liquid with a 
pleasant odor and burning, sweet taste. In general, it resembles ether in its 186 
HOSPITAL CORPS HANDBOOK. 
action, but is about three or four times more powerful and produces general 
anaesthesia much more rapidly. Its great danger is the marked depressant 
effect it exerts on the heart and circulation. Prolonged anaesthesia with chloro- 
form may cause degeneration (alteration of the tissues) of the kidney and 
liver. As it has a marked local irritant action, great care must be used in the 
proper protection of the skin and eyes. It is less volatile than ether and there- 
fore frequently is used in hot climates. It will not burn and therefore may 
be used in the presence of a naked flame or cautery. It causes much less 
activity of the secretory organs of the respiratory tract and rarely produces 
postnarcotic vomiting. It decomposes fairly readily with the formation of 
toxic substances; therefore only absolutely fresh chloroform from a sealed 
container should be employed. 
The physiological action of chloroform causes a primary rise in blood pres- 
sure, followed by a fall considerably below normal; the pulse rate usually 
falls; and the color of the skin is heightened at first, but with the fall of the 
blood pressure the color becomes paler. The various changes in the pupils 
and the activity of the corneal lid reflexes are the same with chloroform as 
with ether anaesthesia. A more careful observance of the pupillary and lid 
reflexes is essential in chloroform anaesthesia. The effects of an overdose with 
chloroform appear with alarming suddenness, and for this reason it is necessary 
that every effort be made to administer the drug evenly, smoothly, and as 
lightly as possible. The best method to obtain these desirable results is the 
open or drop method. 
Open or drop method.—Owing to the local irritant action of the drug it is 
essential that a mask be employed for the administration of chloroform. It is 
also desirable to anoint the face and necessary to cover the eyes as in ether 
anaesthesia. The administration of the anaesthetic is the same as in the 
case of ether, but even greater care is required in order that an overdose 
may be prevented. If the patient struggles with resulting sudden increase of 
respiratory efforts, or if the adult patient holds his breath, or if a child cries 
during the administration of the drug, remove the mask in order that the 
deep inspiration which follows these respiratory efforts will not cause inhala- 
tion of an excessive amount of the anaesthetic. During the second stage of 
anaesthesia special effort must be made to maintain a free air passage. At this 
period many patients have a spasm of the masseter (maxillary) muscles with 
resulting closure of the jaws. During this stage of excitement, a slight twist 
of the head also may cause interference with breathing. Never “ push ” chloro- 
form anaesthesia. If the patient will not relax under this drug, change to 
ether until the stage of relaxation supervenes and then return to chloroform 
if it is deemed desirable to do so. If the drug has been administered properly, 
the stage of excitement should not occur, although it is frequently difficult 
with alcoholic or athletic patients to induce anaesthesia without a conspicuous 
stage of excitement. An open air passage and absolute silence in the room 
during the induction period will enable the anaesthetist to carry his patient 
successfully to the third or surgical stage of anaesthesia. The pulse is most 
important in chloroform anaesthesia; a pulse below 50 and extreme pallor are 
danger signals for the circulation. In full surgical anaesthesia, the pulse 
should be full and regular; any change in fullness or rhythm should be a warn- 
ing to the anaethetist. An increase in volume and rhythm indicates returning 
consciousness; a running pulse indicates shock; and an irregular pulse means 
danger. Respiration should be full and regular. Shallow respiration indicates 
failing circulation, shock, or may occur just before vomiting. Stimulation of 
the respiration may be brought about by adding a few drops of ether to the ANESTHESIA. 
187 
mask, an occasional drop of aromatic spirit of ammonia, or by rubbing the lips 
with a piece of gauze or a towel. 
Closed method.—As hospital corpsmen rarely will be called upon to admin- 
ister chloroform by this method, no description of its use will be given here. 
Ethyl chloride. 
Ethyl chloride is a colorless, mobile, highly volatile, exceedingly inflammable 
liquid at low temperatures, possessing a sweet taste and a pungent fragrant 
odor. 
Although ethyl chloride is employed occasionally as a general anaesthetic 
agent, its use for such a purpose in the Navy is not general. The duration of 
the anaesthesia is exceedingly brief and a continuous safe narcosis is not 
easily maintained. Its usefulness as a general anaesthetic is more or less 
limited to minor operations which do not require prolonged anaesthesia. As 
the administration of this agent requires the services of an expert anaesthetist, 
further details regarding its use in general anaesthesia will be omitted. 
Nitrous oxide. 
Nitrous oxide is a colorless transparent gas slightly heavier than air. 
with a sweetish taste and practically odorless. 
When used alone without oxygen, it produces a state of anoxaemia (asphyxia), 
with loss of consciousness and sensibility to pain. Its usefulness under 
such conditions is limited to operations requiring little time for their com- 
pletion. 
Combined with orygen in certain proportions, nitrous oxide now is rec- 
ognized as one of the important and most useful anaesthetic agents for 
prolonged major operations as well as for dental operations and those 
of a minor character. The rapidity with which unconsciousness supervenes 
and consciousness returns, and the absence of unpleasant concurrent' effects 
such as occur with ether and chloroform, make this drug an ideal anaesthetic 
agent. Its use, however, requires special apparatus, which therefore limits the 
employment of this drug for major operations to hospital practice where the 
services of a specialist in anaesthesia are available. No further details 
regarding its administration will be given here. 
Combinations and sequences of various anaesthetic agents. 
Various factors and conditions frequently require either combinations or 
sequences of the anaesthetic agents described in the foregoing pages. Numer- 
ous attempts have been made to create an ideal agent for general anaesthesia 
by the admixture of various agents. The most important and most useful 
of these mixtures are the combinations of chloroform and ether, either alone 
or with alcohol in varying proportions. The ACE mixture, composed of one 
part absolute alcohol, two parts chlorform, and three parts ether by volume, 
has been extensively used and has proven to be nearly twice as safe as 
chloroform alone. A freshly prepared mixture of two parts of chloroform 
and three parts ether is very easy to prepare and may be used by the drop 
method. It follows the general course of anaesthesia, described above in the 
sections on ether and chloroform, and may be considered a very satisfactory 
anaesthetic for most cases. 
In hospitals where the nitrous oxide apparatus is available it is not unusual 
to employ that drug to induce unconsciousness. When this stage has been 
47829°—23 13 188 
HOSPITAL CORPS HANDBOOK. 
reached, either ether or chloroform, usually the former, is admitted very 
slowly to the gas chamber of the apparatus until the patient is fully under 
the effects of the second drug, at which time the nitrous oxide may be dis- 
continued. 
In prolonged operations it is frequently desirable to limit the total amount 
of ether or chloroform employed. In such cases, recourse is had to the 
substitutions of the ether or chlorform by nitrous oxide. By instituting nitrous 
oxide anaesthesia in this manner a comparatively nonpoisonous anaesthetic re- 
places a poisonous one at a time when a stronger anaesthetic is capable of 
doing the most damage. 
It is occasionally necessary or advisable for various reasons to change from 
ether to chloroform or vice versa during an operation. Should this be neces- 
sary little difficulty will be experienced provided the anaesthetist has a com- 
plete knowledge of his patient’s condition at all times during the course of the 
anaesthesia. 
Treatment of emergencies. 
While every effort should be made to prevent the occurrence of emergencies, 
it is nevertheless true that, even in the hand of the most expert anaesthetists, 
various crises may occur which require immediate treatment. These emer- 
gencies or crises may be grouped under two headings, those due to respiratory 
failure and those due to circulatory failure. Reference already has been made 
to certain causes of respiratory obstruction and the indicated remedial measures 
have been discussed. The main effort in cases of respiratory failure should be 
directed toward clearance of the air passage and maintenance of the act of res- 
piration. If the latter be not voluntary, artificial respiration is indicated. Reg- 
ular pressure on the chest, drawing the tongue forward and lowering the head 
usually will restore normal breathing. If this procedure fails, it may be 
necessary to perform artificial respiration in accordance with the Sylvester 
method. Large amounts of fluid in the abdominal and pleural cavities may 
be the cause of respiratory embarrassment, and measures directed toward at 
least partial removal of these causes should be instituted. 
The loss of the pupillary and corneal lid reflexes, associated with feeble 
respiration and increasing cyanosis, indicates paralysis of the respiratory 
center in the medulla. A hypodermic injection of atropine sulphate should 
be given immediately and artificial respiration instituted and continued until 
normal breathing is resumed. Anaemia of the brain, due to extensive haem- 
orrhage or to chloroform, is counteracted by lowering the head and raising 
the lower limbs if necessary. 
Circulatory failure recognized by a running, feeble, or irregular pulse, in- 
creasing pallor, and feeble respirations must be overcome by stimulation of 
respiration as indicated above and by the administration hypodermically of 
cardiac stimulants (caffeine, brandy, etc.). 
Any change in the general condition of the patient should be communicated 
immediately to the operating surgeon. The latter depends upon the anaes- 
thetist to inform him concerning the progress of the anaesthesia, and the 
anaesthetist should not hesitate to institute whatever measures are indicated 
to promote a successful anaesthesia. 
Care of the patient after operation. 
Transportation to bed.—In transpoi’ting the patient from the operating room 
to his bed, care should be taken that he is well covered with blankets. Unless ANAESTHESIA. 
189 
other instructions have been issued it is also desirable to have the head slightly 
lower than the rest of the body in order that proper circulation of the brain 
may be maintained and also that secretions from the mouth or, in case of vomit- 
ing, foreign material may not enter the trachea and lungs. 
The bed, as described in another chapter, should be prepared for the patient 
in advance, care being taken to remove all hot-water bottles or electric heating 
apparatus, which should not be replaced until the patient has regained con- 
sciousness. A liberal supply of blankets will be all that is necessary to main- 
tain the proper temperature. Until the patient is conscious, it is the principal 
duty of the attendant to maintain a free air passage. Removal of excess mucus 
from the mouth and throat may be aided by turning the patient’s head to one 
side, thus permitting proper drainage. (Pig. 107.) The same maneuver is 
necessary when the patient vomits, as inhalation of particles of vomitus is prob- 
ably one of the most frequent causes of post-operative pneumonia. As the pa- 
tient approaches consciousness he is likely to become restless and will fre- 
quently attempt to interfere with the surgical dressings. He is also likely 
Fig. 107.—Recovering from anaesthetic. Supporting jaw of unconscious patient. Head 
turned to side ; no pillow ; towel to protect bedding; additional light blanket thrown 
over the bed for added warmth. On the table are shown hypodermic, glass of sterile 
water, sponges, towels, and vomitus basin. (Warnshuis.) 
to expose himself to chilling by removing what appears to him to be excessive 
bed covering. After certain types of operations, special arrangements of the 
bed are indicated. Among the most important of these is the so-called Fowlefs 
position. A description of this position will be found elsewhere. It is men- 
tioned here because it is sometimes difficult to maintain a patient properly in 
this position. In fact, unless care be taken, the patient will be found to have 
slid down from his proper place to the foot of the bed. 
Opinions differ regarding the administration of fluids by mouth following 
general anaesthesia, and particularly following abdominal operations. It is 
therefore a safe rule never to give any fluids unless definite instructions have 
been received from the medical officer, whose advice always should be sought 
regarding all treatment. 190 
HOSPITAL COUPS HANDBOOK. 
LOCAL AND REGIONAL ANAESTHESIA. 
In the past few years notable advances have been made in the employment 
of local anaesthesia. It is not unusual at the present time to perform' ex- 
tensive major operations under local or regional anaesthesia. In many cases 
it is purely a matter of choice, while in others it is one of necessity. 
As the duties of a hospital corpsman do not contemplate the employment of 
narcotic agents in the absence of a medical officer, and as the actual adminis- 
tration of local anaesthesia is performed practically always by the operating 
surgeon, the various methods of administration will not be discussed here. 
Local anaesthesia may be produced by physical means as well as by drugs. 
The physical agents are pressure, rarely used by itself in this enlightened 
age, and cold. Freezing causes loss of sensibility to pain. The most common 
method of attaining local anaesthesia through freezing is the employment of 
the ethyl chloride spray, which is such a common occurrence that no further 
mention of its use need be made here. One insanitary, totally uncalled for, 
nonsurgical practice in connection with the use of ethyl chloride spray is the 
all too frequent habit of blowing tbe breath upon the operative area to hasten 
freezing. This is a practice which deserves the most severe condemnation for 
obvious reasons. 
Local anaesthesia through the physiological action of certain drugs has been 
employed for many years. Various drugs have been used for this purpose, 
but few are efficient and many have been discarded after brief and unsatis- 
factory trials. 
The most common drugs now used are cocaine, novocaine (procaine), and 
quinine and urea hydrochloride. Mention also should be made of eucaine, and 
various other substitutes for cocaine, which have become popular because of 
their lesser toxicity. 
In the preparation of solutions of cocaine and novocaine it is the usual prac- 
tice to introduce a certain percentage of adrenalin and to employ physio- 
logical salt solution as the solvent of the drug. The use of adrenalin is based 
upon its action upon the blood vessels (vaso-constriction), which, by constric- 
tion of the vessel walls, causes local ischaemia (deficiency of blood supply), 
an effect similar to that produced by cold and pressure, and also by hinder- 
ing absorption, acts as a safeguard against poisoning. By lessening the tend- 
ency to haemorrhage it also aids the surgeon in maintaining a dry field of 
operation. 
Physiological salt solution (0.85 per cent) is employed as a solvent because 
it is a so-called isotonic solution, in that it has the same specific gravity and 
the same freezing point as the tissue fluids. Fluids of greater or less osmotic 
tension cause pain by drawing water from the tissues or by causing them to 
swell. Physiological salt solution does not injure the tissues and therefore 
does not retard recovery. 
In the preparation and sterilization of cocaine solutions for hypodermic use it 
is essential to remember that they are chemically unstable and do not stand 
repeated or prolonged boiling. 
There are several methods used in the sterilization of cocaine solutions. 
Solutions of cocaine, minus the adrenalin, may be boiled just before use and the 
adrenalin added drop by drop. Cocaine solutions also stand sterilization in 
the autoclave fairly well (20 minutes at 115° to 120° C.) and if corked imme- 
diately afterwards will be efficient for a long time. Cocaine and adrenalin also 
may be obtained in tablet form and may be sterilized in that form by dry heat 
at 80° C. for one hour on three successive days. The solution is prepared ANESTHESIA. 
191 
by dissolving the tablet in Sterile physiological salt solution. Cocaine com- 
monly is employed in 0.1 per cent and 1 per cent solutions. 
Novocaine is recognized now as the safest of the local anesthetics. It will 
stand boiling and its solutions will keep for a long time. Adrenalin increases 
and prolongs the action of novocaine. These two drugs in combination are also 
prepared in the form of a tablet, ready for solution in physiological salt solu- 
tion. Novocaine is much slower in its action than cocaine. It is commonly em- 
ployed in 0.5 to 1 per cent solutions. 
Quinine and urea hydrochloride causes rapid anaesthesia of prolonged dura- 
tion and is said to be practically nontoxic. For application to mucous mem- 
branes a 10 to 20 per cent solution is used; for injection purposes the strength 
of the solution is usually 0.5 to 1 per cent. 
Preparation, of the patient. 
For extensive operations under local or regional anaesthesia, the preparation 
of the patient will, in general, follow the same rules previously described under 
general anaesthesia. 
For minor operations, it is usually unnecessary to prescribe any special 
preparation, although it is advisable for the patient to refrain from partaking 
of a heavy meal and to observe special care regarding normal movements of 
the bowels. 
The local preparation of the operative area will depend upon the personal 
wishes and technique of the operating surgeon, whose advice should be sought 
before any local preparation is begun. 
Overdosage and poisoning from cocaine. 
The safe average dose of cocaine is about three-fourths grain, but this varies 
within wide limits. Less than this amount frequently will produce toxic 
symptoms if thrown into the circulation too rapidly in susceptible individuals. 
On the contrary, many times this amount may be given when well diluted and 
when absorption is retarded. 
The age and condition of the patient is an important factor in cocaine poi- 
soning. Young people, due to their highly sensitive nervous system, are usually 
more susceptible than adults. 
The symptoms usually are grouped into two stages, excitation and paralysis. 
The symptoms of mild intoxication are loquacity, laughing, singing, and later 
nausea, vertigo, faintness, and thoracic oppression. 
The more severe symptoms are rapid and weak pulse, oppressed or rapid 
respiration, mental excitement and anxiety, restlessness with twitching oi 
the muscles. At times there may ensue violent delirium, convulsions, and 
unconsciousness ending in death. During the early stage the pupils usually 
are dilated, but may be contracted at times. Occasionally the stage of excite- 
ment is entirely absent. 
Treatment.—Place the patient in a horizontal position with the head 
lowered; fresh air; for the weakened circulation give ammonia by inhalation 
and cardiac stimulants hypodermically; for the convulsions, either ether or 
chloroform (preferably the former) may be employed. Should respiration 
cease it is necessary to resort to artificial respiration. 
SPINAL ANESTHESIA. 
Although this method of producing surgical anesthesia is not within the prov- 
ince of the hospital corpsman, it is desirable that he understand the general 
principles underlying the procedure. 192 
HOSPITAL CORPS HANDBOOK. 
The introduction of anaesthetic agents into the spinal canal causes an ex- 
tensive blocking of the nerves at the site of injection and anaesthesia of all 
the parts to which these nerves are distributed. 
The agents most frequently employed are solutions of tropococaine, stovaine, 
and novocaine. The last is considered by many surgeons to be the safest of 
all anaesthetics for use in spinal anaesthesia. In the preparation of the pa- 
tient the hospital corpsman will be guided by instructions received from the 
medical officer. In general, it is customary to prepare the patient in the 
same manner as described in the section devoted to general anaesthesia. Locally, 
it is necessary to prepare the site of injection as well as the area of operation. 
Occasionally patients show alarming symptoms of respiratory or circulatory 
failure. It is therefore essential that an emergency tray be at hand con- 
taining sterile hypodermic syringes, needles, and solutions of atropine sulphate, 
caffeine sodium-benzoate, strychnine, and if possible either brandy or its 
present-day substitute, ethyl alcohol. 
During the entire course of the operation the anaesthetist should engage 
the patient in conversation, not only to divert the attention but to increase 
activity of the brain. Questions by the anaesthetist requiring extensive 
answers from the patient aid the latter’s respiration. If there is a tendency 
to nausea, the application of cold wet sponges on the lips, forehead, and neck 
is grateful to the patient and aids in the checking of nausea and vomiting. 
After treatment.—As the patient is conscious the ordinary routine directions 
regarding the air passages are not required in these cases. Nausea frequently 
occurs, however, and while not troublesome in itself, may cause complications 
following abdominal operations. Application of cold as described above fre- 
quently relieves this distressing condition. 
Respiratory failure is not frequent, but when it occurs it requires active 
stimulation and, if necessary, artificial respiration. 
Headache is a very frequent and annoying sequel of operations under this 
type of anaesthesia. It usually can be controlled by ice bag and aspirin, the 
patient being kept flat in bed. Vomiting may be controlled as described under 
treatment of nausea. If such methods do not produce favorable results, gastric 
lavage is usually successful. 
Retention of urine may occur and is relieved by catheterization. Fortunately 
this unpleasant complication is neither frequent nor of long duration. 
Diet.—The conditions requiring the operation and the type of operation itself 
naturally determine the type, quantity, and quality of diet. It is always safe 
to withhold all food and fluids until special instructions concerning them are 
received from the medical officer. 
References. 
Barber.—Nitrous Oxide. 
Barton.—Administration of Ethyl Chloride. 
Blum field.—Anaesthetics. 
Boyle.—Anaesthetics. 
Braun.—Local Anaesthesia. 
Crandon and Ehrenfried.—Surgical After-Treatment. 
Da Costa.—Surgery. 
Gardner.—Anaesthesia. 
Gwathmey.—Anaesthesia. 
Ilewitt.—Anaesthetics. 
Labat.—Regional Anaesthesia. 
Luke.—Guide to Anaesthetists. 
Magaw, Alice.—“A Review of Over Fourteen Thousand Surgical Anaesthesias,” Surg. 
Gyn. and Obst., Dec., 1000. 
Mortimer.-—Anaesthesia and Analgesia. 
Patton.—Anaesthetics. 
Turnbull.—Anaesthesia. 
Williams.—Anaesthesia. HOSPITAL CORPS HANDBOOK. 
193 
Physiotherapy.1 
Physiotherapy is the application of physical remedies in the treatment of 
diseases and injuries. In most hospitals and clinics it includes massage, medi- 
cal gymnastics, hydrotherapy, radiant heat, and light therapy and electro- 
therapy. 
MASSAGE. 
Massage is the therapeutic manipulation of soft tissues in the form of 
stroking (effleurage), rubbing (friction), kneading (petrissage), hacking, 
clapping, beating, and vibration (tapotement). The fingers and hands 
generally are used to perform these manipulations, and the fingers and hands 
of the operator should be clean and warm. To prevent causing unnecessary 
discomfort or pain to the patient the use of a lubricant such as cocoa butter, 
a bland oil, or an appropriate liniment is necessary. 
The manipulations of massage. 
Effleurage (fig. 108) is given to assist the circulation of blood and lymph. 
The strokings are therefore always toward the heart and most commonly 
Fig. 108.—Eflleurage of arm. 
over veins and lymph vessels that easily can be affected, as in front of the 
neck by strokes from the chin to the clavicles, and in the extremities, by 
long strokes from the wrist to the shoulder, and from the foot to the fold 
of the groin. It also is used frequently to relieve local congestion, as for 
example, in a recent sprain, when light effleurage will bring on a visible 
reduction of the swelling with marked relief. The strokings are performed 
with the flat hand, a portion of the hand, or with the thumb and forefinger, 
depending upon the size of the part to be treated. 
1 Prepared by Lieut. E. G. Hakansson, Medical Corps, United States Navy. 194 
HOSPITAL CORPS HANDBOOK. 
Friction (fig. 109) is a rubbing with pressure and is used chiefly to break up 
old inflammatory products, such as the fibrosis in a stiff joint or an adherent 
scar. To accomplish this, the rubb!ng must be done with considerable pressure, 
often to the point of causing some pain. It is performed with the thumb 
or three middle fingers or with the whole palm of the hand. Friction should 
be followed by effleurage to relieve the congestion produced and to promote 
an active circulation. 
Petrissage (fig. 110) consists of a kneading of the muscles and other deep tis- 
sues to promote normal metabolism, or to favor absorption of inflammatory 
products. It is performed either with the whole of the palmar surface of the 
hand or with fingers and thumb, depending on the size of the muscle or mass 
treated. 
Tapotement (fig. Ill) consists of a series of gentle blows, one following 
another in rapid succession. The effect is essentially a mechanical stimulation 
Fig. 109.—Friction of knee-joint. 
of muscles and nerves. It is performed in various ways; hacking across the 
muscles with the ulnar borders of the hands; clapping with a slightly cupped 
hand, used for large surfaces such as the back and chest; tapping with the 
finger tips for small areas; beating with the ulnar border of the closed hand 
for large thick muscle groups such as the gluteal muscles; and vibration, best 
performed by mechanical vibrators. 
General massage is used mostly as a substitute for physical exercise when 
it can not be taken, as, for instance, when a chronic illness confines a patient 
to bed. The greater part of the body is treated; first the hand, forearm, arm 
and shoulder on each side; then the foot, leg, and thigh on each side; then 
the abdomen, and finally the back and gluteal regions. Each part, except the 
abdomen, which is treated according to the method described below, is given 
effleurage, petrissage, tapotement, and then effleurage again as a finishing ma- 
nipulation. All manipulations should be performed with only moderate PHYSIOTHERAPY. 
195 
strength and without causing discomfort to the patient. The treatment should 
take about 45 minutes, 15 minutes of which should be set aside for the ab- 
dominal massage. 
Abdominal massage (tig. 112) is given most frequently for chronic constipa- 
tion due to laxity of the musculature of the intestines. It is also useful as a 
means of aiding the absorption of foodstuffs from the alimentary canal. Better 
digestion and improved appetite frequently result from this treatment. It is 
performed mainly as small circular manipulations with steady pressure aiming 
at a kneading of the alimentary canal between the anterior and posterior 
Fig. 110.—Petrissage of forearm. 
abdominal walls. This manipulation is best performed by the palmar surfaces 
of the three middle fingers on hyperextension. Attempts are made to manip- 
ulate all parts of the alimentary canal; first the stomach in the epigastric 
region, next the small intestines in the umbilical region, and lastly the colon, 
beginning over the caecum, and the sigmoid flexure down to the symphysis pubis. 
This procedure will result in rubbing every half inch of the colon that 
can be reached. The treatment should be concluded by strokings over the 
transverse and descending colon and the sigmoid flexure to empty the contents 
into the rectum. It should be remembered in this connection that the impor- 
tant effect of the abdominal massage is not the forcing onward of the con- 
tents, but the mechanical stimulation by the kneading of the muscles in the 
walls of the alimentary canal. The treatment should occupy at least 15 
minutes and should be given daily, or in obstinate cases of constipation, twice 
daily. Good results usually are obtained after two weeks treatment, but in 
many cases several months of treatment are required. 196 
HOSPITAL CORPS HANDBOOK. 
Fig. 111.—Tapotement of back. 
Fig. 112.—Abdominal massage. PHYSIOTHERAPY. 
197 
Contraindications to massage.—Massage is contraindicated in many skin 
lesions, particularly those of an infectious nature; some diseases and changes 
in the blood vessels, such as aneurism, variocosities, and phlebitis; when there 
is danger of haemorrhage as in haemophilia, leukaemia, purpura, and scurvy; 
and in the vicinity of foreign bodies. Because of the danger of spreading 
disease, massage can not be given near purulent processes, tuberculous lesions, 
and malignant tumors. Abdominal massage must not be given in the presence 
of acute inflammatory conditions in or adjacent to the peritoneal cavity, such 
as appendicitis, ulcers of the stomach, and ulcers of the intestines. 
Some general rules for massage.—The patient should be in a comfortable posi- 
tion and in as complete muscular relaxation as possible. To obtain relaxation, 
support of the part to be treated is nec- 
essary. 
The operator should choose a position 
which will allow him to efficiently perform 
his work and, at the same time, one which 
will call for no unnecessary exertion. It is 
imperative that the hands be thoroughly 
washed before and after administering 
treatments. 
MEDICAL GYMNASTICS. 
Medical gymnastics, also called therapeu- 
tic exercises, corrective gymnastics, Swed- 
ish movements, muscle training, and other 
similar names, is a systematic exercise of 
the motor apparatus of the body applied in 
the treatment of disease and deformities. 
The main parts of the motor apparatus 
are: The skeletal muscles, the bones, the 
joints, the motor nerves, and the sensory 
nerves which convey deep impressions from 
muscles and joints. These, then, are the 
tools in medical gymnastics and the work 
performed with these tools consists of 
changes in positions and movements. 
Starting positions.—In order that the movements may be performed in a 
uniform manner and have a definite effect, it is essential that they be given 
from certain positions, called starting positions. These starting positions are 
classed as fundamental and derived positions. The five fundamental positions 
are: 
1. Standing (fig. 113).—Heels together, feet at about an angle of 70° to 
each other, knees fully extended, trunk erect, abdomen drawn in tightly, 
shoulders lowered and flattened out at the back, head erect with chin slightly 
drawn in, arms close to the sides, and all joints extended. 
2. KneehStanding (fig. 114).—Most commonly used on a table with the feet 
beyond the edge. The body on the knees, which should he together; the 
position otherwise is the same as the standing position. 
3. Sitting (fig. 115).—Taken on a chair or a stool. The body rests chiefly on 
the tuberosities of the ischium, but the thighs should be supported and the feet 
rest on the floor. The hip, knee, and ankle joints should form right angles. 
The positions of the head, trunk, and arms are the same as in the standing 
position. 
Fig. 113.—Standing fundamental posi- 
tion. 198 
HOSPITAL CORPS HANDBOOK. 
4. Lying (fig. 116).—The body is stretched out on a horizontal surface, arms 
at the sides, muscles relaxed. 
5. Hanging.—Taken on a horizontal bar or similar apparatus. The hands 
over-grasp or under-grasp the bar at shoulders breadth. The arms, trunk, 
Fig. 114.—Knee-standing fundamental 
position. 
Fig. 115.—Sitting fundamental posi- 
tion. 
and legs are held straight, and the head is carried slightly back. The body 
must not hang too slack; the muscles must work to such an extent as to avoid 
too strong stretching of ligaments and capsules. 
Fig. 116.—-Lying fundamental position. 
Derived positions are obtained from each of the above fundamental positions 
by changing the position of (1) the legs, (2) the arms, (3) the trunk, and 
(4) by various combinations of these positions. In this way an almost endless 
number of positions may be obtained. PHYSIOTHEEAPY. 
199 
Following is a short description of some of the more commonly used derived 
positions, showing their muscular mechanism and the effects and uses. 
Positions which are derived from the fundamental standing position are: 
(a) By changing the position of the legs, consisting of fall-out-standing (Fig. 
117) : In this position one foot is moved about three foot lengths straight for- 
ward or backward, at the same time the body falls forward and the front 
knee is bent to a point in a vertical line with the toes; the trunk and the fully 
extended posterior leg must be in a straight line (to take up and maintain this 
position a larger number of muscles are brought into action, especially the back 
muscles, and more particularly those of the lumbar region on the side opposite 
to the posterior leg. This posi- 
tion therefore is used to correct 
a lateral curve of the spine with 
the convexity on the opposite 
side to the posterior leg) ; toe- 
standing: Heels raised as high 
as possible from the ground 
and kept in contact with each 
other; knee - bend - standing: 
Knees flexed to right angle and 
separated; walk-standing: One 
foot moved forward about two 
foot lengths; and stride-stand- 
ing: One foot moved two foot 
lengths to one side. 
(&) By changing the position 
of the arms, consisting of: Yard- 
standvng (fig. 118), in which 
the arms are abducted to the 
horizontal plane and carried 
back in line with the shoulders, 
the shoulders kept lowered and 
drawn back, hand and finger 
joints extended, palms turned 
down, and the fingers closed 
(the working muscles are the 
deltoid, trapezius, and serratus 
magnus, and the principal effect 
is an expansion of the thorax 
and a strengthening of the pos- 
terior shoulder muscles, which 
must be held in complete con- 
traction to fix the shoulder blades during the movement. The position there- 
fore is used in the treatment of flat chest and “ winged ” shoulders) ; hips- 
firm-standing: Hands placed on the hips with fingers forward and thumb 
backward; neck-firm-standing: Hands carried up to the back of the neck, 
finger tips touching, elbows well back, head high; reach-standing: Arms brought 
forward to a level with the shoulders, width of shoulders apart, palms facing 
each other; bend-standing: Flexion in elbow joints as far as possible, elbows 
close to the sides, shoulders lowered and drawn back; and stretch-standing: 
Arms in complete extension overhead, carried well back, palms facing each 
other. 
Fig. 117.—Fall-out-standing. 200 
HOSPITAL CORPS HANDBOOK. 
(c) By changing the position of the trunk, consisting of: Turn-standing (Fig. 
119) : Trunk rotated to one side as far as possible, the pelvis taking part in the 
rotation, head and shoulders 
not rotating (the chief effects 
are exercise of the rotator mus- 
cles of the trunk and pelvis, 
and increased mobility of the 
ribs and joints of the spine) ; 
stoop-standing: Forward bend- 
ing, chiefly at the hip joint, to 
a right angle between trunk 
and thigh, spine and legs kept 
straight; lax - stoop - standing: 
Forward and downward bend- 
ing of the body at hip joints 
and in lumbar spine, knees fully 
extended; arcli-standing: Trunk 
bent backward with as much 
movement as possible in the 
dorsal region; and side-bend- 
standing: Trunk bent directly 
to the side. 
(d) By combination, consist- 
ing of various combinations of 
above positions which are valu- 
able and frequently used, for example: Hip-firm-stoop-standing; stretch-stride- 
arch-standing ; and stretch-fall-out-standing. 
2. A number of positions may be derived 
from the fundamental knee-standing position 
in the same manner as from the standing. 
In medical gymnastics the following are used : 
Hips - firm -stride- knee - standing; neck-firm- 
stride - knee - standing; stretch - stride - knee - 
standing ; hips - firm - arch - stride - knee-stand- 
ing ; neck-firm-arch-stride-knee-standing ; and 
stretch-arch-stride-knee-standing. 
3. The following positions may be derived 
from the fundamental sitting position: (a) 
By changing the position of the arms, hips- 
firm-sitting ; neck-firm-sitting ; reach-sitting ; 
and stretch-sitting. These positions arise in 
the same way as the corresponding positions 
derived from the standing positions. 
(b) By changing the position of the legs: 
Stride-sitting (feet placed two foot lengths 
apart) ; and ride-sitting (patient sits astride 
a bench or a chair). 
(c) By changing the position of the trunk : 
Arch-sitting; stoop-sitting; and turn-sitting 
(these are similar to the corresponding 
positions derived from the fundamental 
standing positions) ; fall-standing (backward falling of the trunk, knees or 
feet supported), a position much used for the exercise of abdominal muscles; 
and spring-sitting, a position similar to the fall-out-standing except that the 
Fig. 118.—Yard standing. 
Fig. 119.—Turn standing. PHYSIOTHERAPY. 
201 
anterior thigh rests on a stool (used in various combinations for spinal 
curvatures). 
(d) By combination: Hips-firm-ride-sittmg ; and stretch-stoop-stride sitting 
are two of the most commonly used in this group. 
4. The following positions may be derived from the fundamental lying posi- 
tion : 
(a) By changing the position of the arms: Hips-firm-lying; neck-firm-lying; 
and stretch-lying. 
Fig. 120.—Leg-forward-lying. 
(6) By changing the position of the legs: Stride-lying; and sit-lying; (legs 
hang freely down beyond the edge of a bench). 
(c) By changing the position of the trunk: naif-lying (a position halfway 
between the sitting and lying positions as when seated in a Morris chair) is 
Fig. 121.—Arch-leg-side-lying. 
restful, requires the use of no muscles, and is recommended for weak patients; 
forward-lying (patient lies face down on a bench or bed) ; leg-fonvard-lying 
(Fig. 120), (patient lies face down on a bench, with only the legs resting on it 
while the trunk lies beyond the edge of the bench, the feet and legs being fixed 
by a strap or held by an assistant) ; arch-leg-forward-lying (same as the pre- 
ceding position with a bending backward of the spine) ; leg-side-lying; and 
arch-legsule-lying (fig. 121), corresponding to the last two positions wTith the 202 
HOSPITAL, CORPS HANDBOOK. 
patient lying on one side. These four leg-lying positions are much used in 
the gymnastic treatment of spinal curvatures. 
5. The most important position derived from the fundamental hanging position 
is arch-hanging. In this position the bar should be at the height of the patient’s 
head or chest, legs moved back and supported by tips of toes on the floor, body 
lowered until it hangs in an arch, elbows and knee joints fully extended (used 
in treating kyphosis). 
Movements.—For the purpose of medical gymnastics movements may be 
classed as: Active movements which are performed by the patient himself; 
and passive movements which are performed in the patient’s joint by some 
outside force (a person or an apparatus) and without any muscular effort 
on the part of the patient. 
Active movements are further divided into: Free movements, performed by 
the patient himself without any assistance; and resistance movements, per- 
formed with the cooperation of an operator. Resistance movements are either 
concentric or eccentric. In the concentric movement the working muscles are 
shortened; for example, in flexion of the elbow against resistance the flexors 
work concentrically. In the eccentric movement the working muscles are 
lengthened; for example, the flexors work eccentrically in the extension of the 
flexed elbow by the operator while the patient resists the movement. 
Movements of the various joints and appropriate starting positions.—The 
various starting positions and the different kinds of movements above described 
furnish a system for prescribing exercises of well-defined effects for any part 
of the motor apparatus and for any degree of disability for which medical 
gymnastics can be used. In order to prescribe tbe most effective movements 
and avoid harmful results it is necessary to have a knowledge not only of the 
mechanics and effects of the various movements, but also of the anatomy and 
physiology of the human body and the nature of the disability to be treated. 
It therefore must be left to the medical officers or persons who have made a 
special study of this subject to prescribe the proper remedial exercises. 
The duty of hospital corpsmen in this regard is to administer the move- 
ments prescribed. Practical training is necessary in order that this work 
may be carried out in an efficient manner. A fair understanding of the subject 
can be obtained by giving or taking the different types of movements (passive, 
free active, resistance, concentric, and eccentric) in the various joints from 
several starting positions. As a guide, some of the most commonly used 
movements will be enumerated. 
1. Movements in the ankle joint, consisting of: Half-lying foot-bending and 
stretching; free-standing foot-bending and stretching (alternate toe and heel 
raising) ; half-lying and sitting, with foot-rolling; and sitting with foot-inver- 
sion and eversion. 
2. Movements in the knee joint, consisting of: Half-lying, sitting, and for- 
ward-lying with knee-bending and stretching. 
3. Movements in the hip joint, consisting of: 
(a) For flexor muscles of the hip joint, hip-firm alternate knee raising; lying, 
knee-updrawing and down-pressing; lying, and stretch-lying with leg-lifting 
and down-pressing. 
(&) Combined flexion in hip and knee joints, consisting of stretch-grasp- 
lying, leg-updrawing and down-pressing. 
(c) For extensor muscles of hip joint, consisting of back-lean-standing, leg- 
forward-drawing, and backward-carrying. 
(d) Combined extension in the hip and knee joints, consisting of half- 
lying, leg-out-stretching. PHYSIOTHERAPY. 
203 
(e) Combined extension in the hip, knee, and ankle joints, consisting of 
hips-firm-standing, heel-raising knee-bending. 
(f) Movements for the adductor muscles of the hip joint, consisting of crook- 
half-lying, knee-parting and in-pressing. 
(g) Movements for the adductor muscles of the hip joint, consisting of crook- 
half-lying, knee-closing and out-drawing. 
(h) Movements for the rotator muscles of the hip joint, consisting of half- 
lying, leg-rotation. 
4. Movements in the wrist joint, consisting of sitting, wrist-bending and 
stretching; and sitting, wrist-rolling. 
5. Movements in the elbow joint, consisting of sitting, fore-arm-rotation; 
and sitting, forearm-bending and stretching. 
6. Movements in the shoulder joint, consisting of standing, arm-lifting-side- 
ways ; standing, arm-lifting-forward; yard-standing, arm-rolling; stretch-lying, 
arm-bending and stretching; and stretch-stoop-stride-sitting, arm-bending and 
stretching. 
7. Head and neck movements, consisting of arch-hanging neck-raising; stand- 
ing, head-side-bending and raising; lying, head-rotation; and hips-firm-standing, 
head-rolling. 
8. Trunk movements, consisting of; hips-firm-ride-sitting, trunk-backward- 
drawing and raising; stretch-knee-stride-standing, backward-drawing and 
raising; neck-firm side-bending and raising; yard-standing, alternate trunk- 
turning ; and hips-firm-stride-standing, trunk-rolling. 
General rules for giving movements. 
1. Movements as a rule should be taken to the full extent. 
2. At the limit a little overstretching is given to increase the range of 
movement. 
3. In resistance movements the resistance must be given from the very 
beginning to the end of the movement. 
4. Resistance must be regulated carefully according to the strength of the 
patient. Shaking or unevenness of the movement shows that the resistance 
is too strong. 
5. Respiratory exercises and most trunk exercises must be given in time 
with the breathing. Movements of the extremities may be given : :ore quickly. 
6. The patient must breathe freely throughout the movement. 
7. The operator should take a suitable position so that he can give the ex- 
ercise firmly and continuously. 
8. All grasps must be with a flexible hand, firm, but not pinching. 
General effects of movements. 
1. The blood supply of the working muscles is increased. 
2. Because of this increased supply of blood to the working muscles, the 
amount of blood in the other parts of the body is diminished. By strong 
leg movements it is possible to remove congestion in the head. 
3. By continued exercise the muscles become larger and stronger. 
4. The mobility of the joints is increased, especially if the movements are 
taken to the extreme limit. 
5. The heart action becomes stronger to meet the demand for more blood in 
the working muscles. 
6. The circulation in the veins is assisted in several ways: (a) The con- 
tracting muscles as they thicken press upon the veins in the vicinity and force 
the contents onward toward the heart; and (b) with the alternate lengthen- 
47829°—23 14 204 
HOSPITAL CORPS HANDBOOK. 
ing and shortening of the veins that pass over the moving joints, there is an 
alternate increase and diminution of capacity resulting in a pumping of 
the blood toward the heart. 
7. Respiratory activity is increased to meet the increased need of oxygen. 
This leads to better expansion of the chest and improved circulation and ven- 
tilation of the lung. 
The above effects occur particularly during active movements. Passive 
movements have similar effects, but to a very much less degree. 
HYDROTHERAPY. 
Hydrotherapy is the treatment of diseases and disabilities by baths, packs, 
compresses, and other forms of water applications to the skin. 
In the physiology of the skin are several points of importance in hydro- 
therapy. The outer layer of the skin, the epidermis, is practically a water- 
proof covering. Under this lies the true skin with networks of blood vessels 
and nerves. Deeper in are the sebaceous glands and the sweat glands. With 
these various structures the skin performs important functions in the mainte- 
nance of life. The regulation of the body temperature is done mainly through 
the skin, and this function is of particular interest to hydrotherapy. When 
the body is exposed to heat the sweat glands pour out their secretion, the 
evaporation of which cools the body surface. At the same time the skin 
capillaries dilate, allowing a large amount of blood to circulate at the surface 
and be cooled off. When the body is exposed to cold the perspiration is checked 
almost completely and the capillaries are contracted, thus permitting only a 
small amount of blood to come to the cold surface. Only a healthy skin, 
a skin with blood vessels and sweat glands that respond promptly and 
effectively to temperature variations, can perform this function satisfactorily. 
In hydrotherapy, as later will be explained, we have the means of keeping a 
skin active and ready to respond to temperature changes. 
Another physiological condition of importance in hydrotherapy is the reflex 
connections between the nerves of the skin and the nerves that control various 
vital functions, such as respiration, heart action, muscular tension, and tissue 
metabolism, An evidence of these connections is the familiar effect on the 
Fig. 122.—Ablution. PHYSIOTHERAPY. 
205 
respiration of a sudden application of cold water to the chest, abdomen, or 
back, as when a towel wrung out in cold water is slapped on one of these 
parts or when one steps under a cold shower. First, there is a momentary 
suspension of respiration, then a deep gasp followed by regular and full respira- 
tion. Through these reflexes it becomes possible to stimulate or depress 
many important functions in the body by hydrotherapeutic applications. These 
effects will be referred to further in the discussion of the various baths and 
packs. 
The hydrotherapeutic reaction.—In hydrotherapy the reaction is a very im 
portant feature. In brief, the reaction is the response of the patient to a cold 
application. The reaction is just the opposite to the first effect of cold. 
First effect of cold. 
1. Contraction of blood vessels of 
the skin; quickened pulse. 
2. The skin becomes pallid and 
“ gooseflesh ” appears; perspiration is 
checked. 
3. Respiration is momentarily 
checked, then becomes quick, deep, 
and gasping. 
4. Shivering, chattering of teeth, 
sensation of chilliness and distress. 
Reaction. 
1. Dilatation of the blood vessels of 
the skin ; slowed pulse. 
2. The skin “ pinks up,” a rapid cur- 
rent of aerated blood is flowing in 
the capillaries. The activity of sweat 
glands and sebaceous glands is in- 
creased and the skin becomes smooth 
and supple. 
3. Respiration slower. 
4. Sensation of warmth and a com- 
fortable glow in the skin, a general 
feeling of well being; the muscles pos- 
sess greater tone, and mental foggi- 
ness gives way to alertness. 
The reaction usually sets in as soon as the cold is withdrawn, or in case 
the cold application is prolonged, within one or two minutes. People in good 
health react more quickly than those in impaired health. If the patient does 
not react, the application has been too much for the vital activities and it 
has done harm rather than good. Failure to react is shown by .blueness of 
the lips and a pallid or blue, gooseflesh skin instead of a pink and smooth 
one. The patient has a chill and all the discomfort accompanying it. 
If this occurs, or if the patient is slow in reacting, measures to favor the 
reaction must he applied, as follows: 
1. Before the cold application the body and skin temperature may be raised 
by exercise (in the robust), electric-light baths, hot-air baths, and by hot 
drinks; 
2. During the cold application by friction by attendant or by the patient 
himself; 
3. After the application by friction with the hand or a warm towel, hot 
drinks, a warm room and warm coverings. 
Technique of hydrotherapy. 
An elaborate technique and a high degree of skill are not necessary for suc- 
cessful hydrotherapeutic applications, but careful attention to details and 
precision in the application are essential. The technique, effect, and uses 
of a few of the most valuable and most commonly used hydrotherapeutic 
applications are described. 206 
HOSPITAL CORPS HANDBOOK. 
Ablution (fig. 122).—A rubber sheet, a blanket and a sheet are spread on 
one side of the bed, one third hanging over the side and the third along the 
opposite edge rolled. Place a pail or tub filled with water near the bed. 
The patient is undressed but covered except on the parts to be treated. Freely 
apply water successively to arms (not forearms), chest, abdomen, and thighs, 
using the bare hand or a linen washcloth and accompany by friction and light 
clapping; then dry and replace the part under cover. In vigorous individuals 
with high fever, drying may be delayed until the ablution is completed. Give 
the first ablution at 85° F. and reduce the temperature 5° F. each time until 
70° F. is reached. Repeat every two hours if the patient is awake and if the 
character of the fever so requires. 
The ablution is a mild antifebrile application. In addition to the cooling 
effect, the friction and the impact of the water produce a refreshing reaction 
with a warm glow in the skin and a feeling of stimulation throughout the body. 
It is far superior to the commonly used sponging, which is merely an unpleas- 
Fig. 123.—Sheet bath. 
ant moistening of the skin, and apt to produce chilling, since no reaction is 
brought on. 
Towel bath.—Place a linen towel wrung out of water at 80° F. to 70° F. 
successively over the chest, abdomen, back, arm's, and thighs. Squeeze 
water at 70° to 60° F. from a sponge or the towel. Apply friction and patting 
with the flat hand over the wet towel. 
This is another antifebrile application. It is more effective than the ablu- 
tion. The cooling action can be regulated by (1) the temperature of the water, 
(2) the duration of the procedure, and (3) by the number of applications on 
each part. 
Sheet bath (fig. 123).—Place a rubber sheet on the bed and on this a linen 
sheet wrung out of water at 80° to 90° F. Bathe the patient’s head and face 
with ice water, wrap a cold towel-turban about his head, place him on the wet 
sheet and quickly wrap him, as follows: while he holds both arms up, the right 
third of the sheet is wrapped snugly around the body and the right leg and 
foot with the upper edge close under the arms. The arms now are brought 
down and the other part of the sheet is brought over the body, arms, and legs, PHYSIOTHERAPY. 
207 
with the upper border around the shoulder and neck and the lower border 
tucked beneath the heels. The entire left edge is tucked under the neck and 
beneath the right side of the body. Now, with flat hands, give gentle friction 
and patting over the wet sheet. As soon as the sheet is heated up alternate 
the friction with the squeezing of cold water, 60° to 70° F., from a sponge 
over successive parts of the body. If the patient begins to shiver discontinue 
the cold water and give friction until he warms up again. The cooling effect 
may be increased by allowing the patient to remain in the sheet for half an 
hour, or longer if asleep, having first withdrawn the rubber sheet and wrapped 
him in a blanket. 
The sheet bath is an efficient antifebrile application. It is more severe 
than the ablution and the towel bath, but milder than the cold friction bath (see 
below), for which it may form a substitute where the necessary facilities for 
such a bath can not be procured. In its effect on the body temperature, on 
the circulation, and other functions it is very similar to the cold friction bath. 
Cold friction bath.—Fill a bathtub to three-fourths of its depth with water 
from 70° to 80° F. If the patient is acutely ill, as in typhoid fever, the tub 
should be near the patient’s bed. The patient is given a small cup of hot coffee 
just before he is undressed. His face having been bathed with ice water, he is 
lifted into the bath and gently lowered. The head should be supported by a 
water cushion suspended from the head of the tub or it should be held by an 
attendant. Immediately after the submersion and during the whole bath 
gentle friction should be given to prevent chilling, cyanosis, and collapse. 
Every part of the body except the lower part of the abdomen should receive 
this friction. Several times during the bath, water at 60° F. is gently poured, 
from a basin, over the patient’s head, the face being protected by a folded 
towel around the forehead. The duration of the bath is usually 15 minutes. 
Complaint of chilliness is no reason for discontinuing the bath unless there is, 
at the same time, a chattering of the teeth. Blueness of the face indicates an 
enfeebled heart action and is also a sign for immediate removal from the bath. 
During the bath a double blanket and a sheet are spread on the bed, the 
pillow is covered with towels and several hot-water bags are placed at the feet. 
When the bath is finished the patient is lifted out gently and placed in 
the prepared bed, quickly but carefully wrapped in the sheet and blanket and 
allowed to remain in them for 5 to 10 minutes. If, however, the patient’s 
temperature was lower than 103° F. per rectum before the bath, or if there 
is decided chilliness after removal, the patient should be dried immediately 
before being wrapped in the sheet and blanket. 
The cold friction bath is the well-known Brand bath for the treatment 
of typhoid fever. The beneficial effect of this procedure is due not only 
to the reduction of the temperature but also, and to a much greater extent, 
to that improvement in the circulation, respiration, mental condition, and 
muscle tone which is a part of the hydrotherapeutic reaction. With the aid 
of friction the skin capillaries dilate and a free flow of blood is permitted. 
At the same time the stimulation of the sensory nerves of the skin by the cold 
and the friction excites the heart to better contractions. This improves the 
circulation in all parts of the body, and the congestion of the internal 
organs is decreased. The hurried shallow respiration of the typhoid patient 
becomes deeper and slower. The flaccid muscles improve in tension in re- 
sponse to the cold and the improved circulation. The depression of the nervous 
system, drowsiness, and delirium give way to a calm and clear mind. A 
refreshing sleep often follows this bath. 208 
HOSPITAL CORPS HANDBOOK. 
Wet pack (fig. 124).—A bed sheet, a rubber sheet, and two large woolen 
blankets are spread upon a mattress in the order mentioned. Upon this 
is spread smoothly a sheet wrung out of water at 60° to 70° F. The 
patient is placed on this sheet and his arms are raised alongside his head. 
One-third rof the sheet is drawn from left to right across the chest. The 
arms are lowered, the sheet intervening between them and the sides of the 
trunk, and the other two-thirds of the sheet are brought across the body, 
covering both arms. The lower part of the sheet is pressed between the 
thighs and legs and the lower border tucked under the heels avoiding 
tension on the toes. Each blanket now is wrapped separately and as tightly 
as is possible around the trunk and legs. The upper borders are reversed 
Fig. 124.—Wet pack. 
so as to get a close fit around the neck. Both sides are tucked under the 
body and drawn tight. The lower edge of the blanket next is gathered to- 
gether and tucked beneath the heels. Lastly, the sheet is wrapped similarly 
and tucked in at the neck to prevent annoying irritation from the blankets. 
If the patient does not warm up, he may he covered with one or two additional 
blankets. A cold wet-towel turban is placed on his head, and this is changed 
several times in order to keep the head cool. The important points in the 
application of a wet pack are: 
(1) All parts of the skin surface must be in contact with the wet sheet. 
(2) There must be complete exclusion of air. 
(3) The blankets must he applied tight. 
The duration of the pack should be from one-half to one hour and unless 
given for insomnia a needle douche or a fan douche should be given immediately 
upon removal. If given for insomnia, the pack should be applied in the PHYSIOTHERAPY. 
209 
bed and the patient allowed to remain in the pack, if asleep. In case the 
patient complains of being too warm one of the blankets may be removed. 
There is first the usual effect of cold. Within one to five minutes the reac- 
tion appears. The skin vessels dilate and the body surface begins to heat up. 
Loss of heat is inhibited by the enveloping blankets and the patient soon lies 
in a warm, moist, and soothing envelope. He becomes drowsy and sleepy and 
wants to be left alone. If prolonged for one hour, the wet sheet is heated 
above the normal body temperature, perspiration appears on the forehead, and 
the elimination from the skin "is increased. The wet pack is used mostly for 
insomnia and restlessness in psychiatric patients. It is equally valuable for 
the excitement and delirium in acute febrile diseases. (Fig. 125.) 
Hammock hath or continuous bath.—A bathtub designed especially for ham- 
mock baths is desirable. It should be provided with a thermostatic control 
Fig. 125.—Wet pack, completed. 
to insure an even temperature, an overflow drain in addition to the bottom 
drain, and a hammock that can be secured to the sides of the tub. The patient 
lies in the hammock completely submerged except the head. The tub should be 
covered with a blanket supported by light bars lying across the edges. The 
temperature of a hammock bath should be agreeable to the patient and some- 
where between 90° and 100° F. The bath should be of short duration at first 
and gradually prolonged. It may be given continuously night and day for 
weeks and even months. If the patient can not sleep in the bath he should be 
removed to a bed at night. He also should be removed for urination and de- 
flation, except when the patient’s condition makes these interruptions un- 
desirable, when these needs may be satisfied in the tub. To prevent puckering 
and peeling of the skin, the patient should be annointed with lanolin until the 
skin becomes used to the water. The constant presence of an attendant is 
required. 210 
HOSPITAL, CORPS HANDBOOK. 
Tlie hammock bath is very similar to the wet pack in its effect. The patient 
is in a neutral medium, which has a quieting effect. It is used mainly for the 
same purpose, to quiet restless and maniacal patients. It differs from the 
wet pack in that it furnishes very little restraint. A very much disturbed 
patient, therefore, can be treated with more success in a pack than in the ham- 
mock bath. 
Fomentations.—A fomentation is a hot application. The most satisfactory 
material to use for the compresses is heavy flannel which is cut in sizes to fit 
the region to be treated. Four to six layers are usually needed. It is steeped 
in boiling water and then thoroughly wrung out so that every drop of hot 
FiG. 126.—Whirlpool bath for arms. 
water is expelled. A clothes wringer is most convenient ft>r this purpose but a 
satisfactory wringer can be made of a crash towel and two strong sticks about 
24 inches long, one secured to each end of the towel by stitching. The fomen- 
tation compress is placed in the towel, lowered into the boiling water, and then 
wrung out by twisting the towel by means of tile sticks. It then is 
quickly carried to the patient and there taken out and placed on the part to be 
treated. If a clothes wringer is used, the fomentation compress is rolled as it 
comes out of the wringer and carried to the patient in a piece of dry flannel or 
a towel. If the patient complains of burning, pass the hand once or twice be- 
tween the skin and the fomentation. This will remove any drops of hot water 
that may have formed and at the same time cool the flannel. If the fomenta- 
tion compress has been wrung out completely there is but little danger of a 
burn. It is well, however, not to apply the fomentation too hot at the begin- PHYSIOTHERAPY. 
211 
ning. The compress should be repeated every 8 or 10 minutes. After the 
last application the part is washed off quickly with water at 75° F. and dried. 
The fomentation is a means of applying heat with moisture and produces an 
active hyperaemia and muscular relaxation. It is of value in relieving the pain 
and congestion of inflammation of superficial structures. 
Whirlpool bath.—The whirlpool bath is a continuous bath in a rapid 
current of hot water, applied to the whole or a part of an extremity. 
The limb is placed in a vessel of suitable size and shape in which a strong 
current is maintained by a continuous flow of water. To increase the pressure 
and reduce the amount of water needed, an aerator is attached to the nozzle. 
(Figs. 126, 127.) The temperature may vary from 105° to 120° F. In cases of 
Fig. 127.—Whirlpool bath for legs. 
nerve injuries it is well to increase the temperature very gradually and guard 
against scalds of anaesthetic areas. The duration may vary from 15 minutes 
to 1 hour. 
The whirlpool bath furnishes a means of giving heat and at the same time 
a very gentle massage by the current and the bubbling. An arterial hyperaemia 
is produced, and muscular spasm and pain are relieved. 
Douche.—In the douche the patient is showered or sprayed by water. The 
most commonly used forms are the shower, the circular douche, and the jet 
and fan douche. With the shower and the circular douche (fig. 128) practically 
all parts of the patient’s skin are exposed to fine streams of water under mild 
pressure. With the jet douche (fig. 129) a heavy stream of water under 20 to 
35 pounds pressure is played on the patient from a distance of about 10 feet. 
By placing the tip of the index finger on the nozzle outlet the jet is broken up 
into a fan douche. (Fig. 130.) When giving a jet douche the patient stands 
within the stall of the circular douche. The attendant stands behind the con- 
trol table and having made the adjustments for temperature and pressure 
directs the stream on the back, sides, and front of the trunk and extremities. 212 
HOSPITAL, CORPS HANDBOOK. 
moving it up and down. The coarseness of the stream is changed to suit the 
patient’s endurance. After a few treatments tlxe jet usually can be borne on 
the back. It never is applied to the chest and abdomen. 
The douche acts as a stimulant to the nerves of the skin. The impact of the 
water gives a mechanical excitation which brings on a rapid reaction. It is 
used as a finishing procedure in various forms of hydrotlierapeutic measures 
and for stimulation in cases of physical and mental depression. 
Scottish or alternate douche.—This is an application of alternating hot and 
cold jet and fan douches with temperatures of 100° to 125° F. for the hot and 
55° to 70° F. for the cold. The hot jet 
is applied about five times as long as 
the cold, the latter being given only a 
few seconds each time. The duration of 
the whole treatment varies from one to 
three minutes. 
RADIANT HEAT AND. LIGHT. 
Radiant heat and light are obtained 
from radiant energy, a force transmitted 
by the ether in the form of waves. 
The longer waves of this force are the 
Hertzian waves which are produced by 
spark discharges from condensers, and 
utilized in wireless communications. 
The length of these waves varies from a 
few meters to many thousand meters. 
Next to the Hertzian waves in order of 
decreasing wave length are the heat 
waves, also called infra-red rays, which 
extend to a wave length of less than 
one-thousandth of a millimeter. At this 
point radiant energy becomes visible as 
the various colors, red, orange, yellow, 
green, blue, indigo, and violet. White 
light is a combination of all the wave 
lengths of the visible spectrum, from 
the red to the violet. Beyond the violet 
is a region of invisible energy called 
ultra-violet light. Further up the scale 
of decreasing wave lengths we find the 
Roentgen rays which are about one 
ten millionth of a millimeter in length, 
and at the upper known limit the gamma rays of radium. The whole series 
of waves is called the spectrum of radiant energy. The* parts referred to 
are shown diagrammatically in Figure 131. With the exception of the long 
Hertzian waves all these parts of the spectrum are utilized in the treatment 
of disease. The use of heat rays (radiant heat) and the ultra-violet rays 
fall within the scope of physiotherapy. 
Radiant heat.—The most commonly used means of applying radiant heat for 
treatment purposes are: (1) The electric light bath cabinet in which the whole 
body, with the exception of the head, is exposed to the light and heat of a 
large number of electric bulbs; (2) heat applicators for the trunk, legs, and 
Fig. 128.—Circular douche. PHYSIOTHERAPY. 
213 
Fig. 129.—Jet douche. 
Pig. 130.—Fan douche. 214 
HOSPITAL CORPS HANDBOOK. 
arms, in which groups of from 4 to 12 carbon filament lamps, usually 130 
watts, are set under a metallic reflector curved to fit these parts (fig. 132) ; 
(3) so-called deep therapy lamps in which a high wattage bulb, usually about 
1,500 watts, is set in a dome-shaped reflector (fig. 133) ; this also is used for 
local treatments of various parts of the body. 
Fig. 131.—Graphic representation of the spectrum of radiant energy. 
The electric light bath cabinet is used mostly in connection with hydrotherapy 
and mainly for two purposes: (1) To heat the skin preliminary to cold douches 
in order to make the cold feel less disagreeable and to favor the reaction; for 
this purpose the duration of the heat bath is limited to the point where visible 
Fig. 132.—Heat applicator for arm. 
perspiration begins to appear, usually less than five minutes; and (2) to in- 
crease the elimination from the skin, for which purpose an exposure of from 
10 to 20 minutes, after the visible perspiration begins to appear, is required. 
The technique of giving a cabinet bath is very simple. The patient having un- 
dressed is seated in the cabinet in which the lights have been turned on for a 
sufficient time to have the cabinet comfortably warm. The doors are closed, PHYSIOTHERAPY. 
215 
a towel is wrapped snugly around the patient’s neck and a cold wet-towel turban 
placed on his head. If the treatment is prolonged over more than 15 minutes 
the patient should, be watched carefully and if he complains of faintness or if 
the pulse becomes rapid and weak he should be taken out immediately. Faint- 
ness may be due to a current of hot air escaping in front of the patient’s face 
through a carelessly applied neck towel. The head turban must be kept cold, 
either by rubbing a piece of ice over it or by renewing it about every five 
minutes. If it is allowed to heat up, a sensation of fullness in the head or head- 
ache may develop. During prolonged treatments the patient should drink 
several glasses of water. Treatments in the electric light bath cabinet must 
be followed always by a cold application of some kind; such as a shower bath, 
a circular douche, or a jet and fan douche; or if these facilities are not avail- 
able an ablution or a cold plunge will be satisfactory. 
Fig. 133.—Deep therapy lamp. 
The heat applicators and the deep therapy lamps are used to produce an 
arterial hypergemia in and around inflammatory lesions of joints, muscles, 
lymph glands and subcutaneous tissues. It also is used in the treatment of 
otitis media, sinusitis, and tonsillitis. Usually these apparatus are adjusted 
as close to the skin as the patient will allow, the patient’s sensation of heat 
being the best guide, except when there are areas of anaesthesia, in which case 
the greatest care must he used to prevent burns, and when it is advisable to 
use a slightly greater distance than that which patients with normal sensa- 
tions will allow. Radiant heat burns are very serious. They are usually 
deep, extending through the subcutaneous tissues and followed by extensive 
sloughing. The duration of a treatment should not be less than one-half hour, 
as a rule, the longer the exposure the better the result; but no treatment 
should be continuous for more than two hours. Two or three exposures daily 
may be given. In order to increase the hypersemia of the part treated, it may 
be rubbed off at intervals with ice-cold water. 
Ultra-violet rays.—As the name indicates and as previously mentioned, the 
ultra-violet radiations are beyond the violet of the spectrum of radiant energy. 216 
HOSPITAL CORPS HANDBOOK. 
These radiations are not converted into heat when absorbed, as is the case with 
the infra-red, but are chemically active. For this reason they frequently are 
referred to as chemical rays. A familiar chemical effect of these rays is their 
action on the photographic film, the silver salts in the film being so changed 
that metallic silver is precipitated when the developer is applied. Chemically 
active radiations are not confined to the ultra-violet region of the spectrum 
but are also present in the visible spectrum, especially in the violet end. In 
the region of the red rays there is very little chemical effect. This explains 
the use of red light in the developing rooms. 
Sources of ultra-violet rays.—The natural source of this energy is the sun- 
light, in which it is found in amounts varying with atmospheric conditions and 
the altitude. In cloudy or foggy weather a good part of these rays, particu- 
larly the shorter waves, are absorbed by the moisture. Smoky and dusty air 
similarly stops these radiations. The greatest intensity of ultra-violet rays 
from the sun is found in high altitudes with clear atmosphere. Artificially, 
ultra-violet rays are produced for therapeutic purposes in specially constructed 
arc lamps. The type most commonly used in this country at the present time 
is the mercury vapor arc lamp. Carbon arc and tungsten arc lamps are used 
in a few clinics. In the mercury vapor arc lamp the electric arc is sprung 
between two pools of mercury or one pool of mercury and a tungsten filament, 
all contained in a tube of quartz. To obtain a circuit the tube is tilted so that 
a small stream of mercury connects the two poles. The current heats up the 
mercury and converts some of it into a vapor which forms the arc and emits 
an abundance of ultra-violet radiation. The tube is made of quartz because 
this substance transmits all except the very shortest waves of the ultra-violet 
rays. Glass transmits only the longest waves just beyond the violet end of the 
visible spectrum. 
There are two types of lamps, the air-cooled and the water-cooled. In the 
air-cooled lamp the burner is placed in a cylindrical or a spherical housing with 
adjusting devices for varying the angle of reflection of the rays and the size of 
the beam of light. The only means of cooling is by the air current which 
rises through the heated lamps. 
As considerable heat is generated, 8 inches is the shortest distance at 
which an exposure of the skin can be made. Closer approximation will result 
in a heat burn. 
In the water-cooled lamp the burner is enclosed in a small water-tight casing 
and surrounded by a metal water jacket with openings for inflow and outflow of 
water and with a quartz window for the transmission of the light.- When this 
lamp is burning a continuous circulation of cold water must be maintained. This 
absorbs the heat radiations so effectively that the quartz window is kept cool 
and the lamp can be placed in contact with the skin without giving even a 
sensation of heat. 
Effect on the skin.—The most apparent effect of ultra-violet rays on the 
human body is the sunburn. This is an inflammatory reaction of the skin 
varying from a slight redness lasting only a few hours to a severe superficial 
inflammation with blister formations, and followed by a brownish pigmenta- 
tion. The blister is the most severe lesion that the ultra-violet rays can pro- 
duce. Deep burns, such as may result from the excessive application of heat, 
never result from the application of ultra-violet rays. This is due to the slight 
penetration of these rays, the longest of which reach the depth of only 0.1 
millimeter. 
Ultra-violet radiations are used in the treatment of some skin diseases. Those 
most commonly treated by this remedy are tuberculosis of the skin, acne, PHYSIOTHERAPY. 
217 
psoriasis, and eczema. Cures or improvement are due to the destruction and 
peeling of the diseased skin, in the same manner as the superficial layers of 
the healthy skin are destroyed in a sunburn, and to a stimulation of the growth 
of healthy skin. 
Ultra-violet rays have a beneficial action not only on tuberculosis of the 
skin but also on tuberculosis of joints, bones, and lymph glands. For this 
purpose the sunlight has been found to be superior to the radiations from the 
mercury vapor arc. 
Their effect on wounds is similar to the effect on skin diseases. The diseased 
tissue is destroyed and the growth of healthy granulations stimulated. 
Ultra-violet radiations are believed to aid in the prevention and cure of 
rickets. This effect can be obtained only by radiations with wave lengths 
shorter than those transmitted by ordinary window glass. If sunlight is used, 
outdoor exposures are therefore necessary. 
How to operate the mercury vapor arc and quartz lamps.—(1) The air- 
cooled lamp. Turn on the current and tilt the burner so as to make a stream 
of mercury run along the tube and close the circuit. Do not hold the burner 
in this position for more than a moment, otherwise the short circuit estab- 
lished by the metallic mercury will blow the fuse. Sometimes the tilting has 
to be repeated a few times before the arc is sprung. Allow the lamp to burn 
at least five minutes before using it. During this time the mercury forming 
the arc becomes completely volatilized and the intensity of the radiations reach 
the maximum and a constant level. Give the exposure as ordered. The order 
for an ultra-violet ray exposure usually specifies the distance and the time. 
Measure the distance from the burner to the highest point of the area to be 
treated. The safest way of timing the exposure is by the use of an interval 
timer, a clocklike device which may be set to give an alarm after any desired 
period from 15 seconds to two hours. In all exposures about or near the face, 
the eyes of the patient must be shielded by goggles. Failure to protect the eyes 
may cause a severe conjunctivitis often resulting seriously. 
(2) The water-cooled lamp. The first step in the operation of the water- 
cooled lamp is to start the water circulating in the cooling device. The inflow 
tube is attached to a cold-water hydrant and the end of the outflow tube 
placed in the sink. The water is turned on to moderate pressure and when it 
is found to flow freely, the electric current is turned on and the lamp 
started in the same manner as the air-cooled lamp. Treatments by the water- 
cooled lamp are given commonly with the quartz window of the lamp in con- 
tact with the skin. Sometimes quartz applicators in the shape of disks or rods 
are attached immediately in front of the quartz wfindow, and, by means of 
these, the radiations can be localized to small areas or applied in cavities such 
as the mouth or nose. When deep penetration of the rays is desired the blood, 
which is a powerful absorbent of ultra-violet radiations, is pressed out of the 
tissues immediately under the applicators, by slight pressure. 
In order to get the maximum amount of radiations from the lamps it is 
necessary that the quartz burner, quartz window, and applicators are clean, 
and that the water in the water-cooled lamp is clear and free from particles in 
suspension. A thin film of dust or grease on the burner or on an applicator 
or cloudy water will absorb a large part of the rays. Avoid handling of the 
burner. Should this be necessary, it must be cleaned before being used, other- 
wise the marks of the fingers may be etched into the quartz and obstruct or 
refract the rays. 
Standardizing the lamps.—Even if all orders for treatment by ultra-violet 
rays specify the time of exposure, the distance and other details, in order to 218 
HOSPITAL CORPS HANDBOOK. 
be reliable the operator must know certain standards in the effect of his lamps 
on the skin. For this purpose the reaction of the skin may be divided into 
four degrees. 
First degree, redness but no peeling. 
Second degree, redness followed by slight peeling. 
Third degree, intense redness followed by peeling in strips and sheets. 
Fourth degree, blistering. 
To standardize a lamp it is necessary to expose the skin experimentally to 
determine the length of the exposure, at various distances, which will pro- 
duce these four degrees of reaction. Since lamps of the same type and 
make vary in strength of radiations it is necessary to standardize each lamp, 
and further, due to the fact that a fair skin reacts to shorter exposure than 
a more pigmented skin, it is necessary to have two standards, one for blond 
people and one for brunettes. By making the experimental exposures through 
a small square window in a piece of material, as adhesive plaster, that does 
not transmit the ultra-violet rays, a large number of exposures can be made 
on a small area. The inner surface of the forearm is convenient for this pur- 
pose. An accurate record of the time and distance of the exposure of each 
square is kept and when the reaction appears and runs its course, the result 
in each square is checked up. In this manner the desired standard of dosage 
readily can be obtained. 
ELECTROTHERAPY. 
The constant galvanic current. 
Source and apparatus.—The galvanic current used in therapeutics is a low- 
tension current with a voltage from 1 to 80 volts. The amperage varies from 1 
to 100 milliamperes. It is obtained either from cells in series, dry or wet, or 
from an electric current main. The latter source is the more convenient and 
the most commonly used. If the current in the main is an alternating current, 
a motor generator or a rectifier is needed to convert the alternating to a direct 
current. A direct current being available, the only apparatus needed is a 
so-called galvanic plate, the essential parts of which are a rheostat, a milli- 
amperemeter, and two binding posts. By means of the rheostat the strength 
of the current can be controlled. The amperage going through is shown by 
the milliamperemeter. A pair of connecting cords and a pair of electric pads 
complete the equipment. A graphic representation of this current is shown 
in Figure 134. 
Technique of administration.—Soak the pads in salt solution, about 1 per 
cent, until thoroughly wet and squeeze them out just enough to stop the drip- 
ping. Spread a thin layer of cotton on the pad, moisten this and then apply 
the pads to the part to be treated. Ascertain that the current to the galvanic 
plate is turned off and that the rheostat control is so set that no current can go 
through; now join the binding posts to the pads by means of the connecting 
cords, turn on the current and gradually increase it by adjustment of the 
rheostat until the desired amount of current goes through. When the treat- 
ment is completed proceed in the reverse order, first turn the rheostat control 
to the neutral point, then turn off the current, and lastly remove the pads. 
The cotton film, having been used for sanitary reasons only, is discarded. 
The constant galvanic current flows in one direction only and has a distinct 
polarity. At the positive pole where the reaction is acid, the vessels are con- 
stricted and the tissues hardened. At the negative pole the reaction is alkaline 
and the blood vessels are dilated and the tissues softened. These polar effects 
take place only at the pads. Between the pads, in the so-called interpolar path, PHYSIOTHEBAPY. 
219 
the principal effect is a mild heat which induces an increased blood supply 
and better nutrition of the tissues. 
The effect of the negative pole is used to soften hard and adherent scars. 
A small pad connected to the negative pole is placed on the scar and a larger 
pad for the positive pole is placed on some indifferent part of the skin; for 
example, under the shoulders, on the abdomen, buttocks, or thighs. The inter- 
polar action is used in conditions such as atrophy, chronic arthritis, and neu- 
ritis where a mild heat with better blood supply helps to restore normal con- 
ditions. 
How to identify the poles.—Place the metal tips of two cords connected to 
the binding posts in a bowl containing salt solution and turn on the current. 
The tip at which the bubbles form connects to the negative pole. 
Interrupted galvanic current. 
A galvanic current, applied with a gradual increase from zero and maintained 
without any sudden variations, excites no muscular contraction, but if the cur- 
rent is applied suddenly or interrupted, 
a muscular contraction results. The 
principal use of this interrupted gal- 
vanic current (fig. 134) is to exercise 
paralyzed muscles that do not respond 
to any other current. The current is 
obtained in the same manner as the con- 
stant galvanic current. The simplest 
and best method of interrupting it is 
by means of an interrupter electrode. 
This device is provided with a “ make ” 
and “ break ” key. By pressing down 
the handle of this key the circuit is 
opened (break) and when the pressure 
is released a spring pulls the key back 
which closes the circuit (make). 
The sinusoidal current. 
This current has a gradual and rhyth- 
mical rise and fall of voltage with a 
change of polarity at each rise. It dif- 
fers from the simple alternating cur- 
rent, used for lighting and power only 
in that its rise from zero to maximum 
and its fall from maximum to zero are gradual, not sudden. A graphic repre- 
sentation of this current is shown in Figure 134. 
The main use of this current is the exercise of paralyzed or weak muscles. 
In addition to the stimulation of musclar contractions, the frequent changes in 
polarity have a decided stimulating effect on the nutrition of the tissues. 
The sinusoidal current is less painful than the interrupted galvanic. 
The faradic current. 
This current is obtained from an induction coil. It is an interrupted and 
alternating current. In the ordinary faradic coil the voltage is high and in- 
terruptions rapid; in the so-called Bristow coil, which now is used extensively, 
the voltage is lower, the interruptions slower, and the current less painful. 
Fig. 134.—Graphic illustration of the con- 
stant galvanic, the interrupted galvanic, 
and the sinusoidal currents. 1. Con- 
stant galvanic. 2. Interrupted galvanic : 
AB represents the sudden rise at make, 
BC the period of flow, CD the sudden 
fall at break, and DE the period of no 
current. 3. Sinusoidal current, one com- 
plete cycle : ABC represents the rise and 
fall of the current flowing in one direc- 
tion and CDE the rise and fall of the 
current flowing in the opposite direction. 220 
HOSPITAL CORPS HANDBOOK. 
The faradic current is a powerful stimulant to muscles, causing contractions 
that are sustained as long as the current is applied. It is used principally 
in the reeducation of paralyzed and weakened muscles. It is applied in a 
similar manner as the interrupted galvanic. 
The high frequency current. 
This current is an alternating current with such high frequency that it goes 
through the living tissue without producing any muscular contractions. Most 
of the high frequency machines give a current of not less than 50,000 alterna- 
tions per second. 
How the high frequency current is produced (fig. 135).—The main parts of a 
high frequency apparatus are a transformer to raise the voltage, and an 
oscillating circuit to produce the rapid alternations. 
The apparatus operates on an alternating current. If a direct current only 
is available, a converter is necessary. The alternating current first is led 
through a rheostat through which the amount of current supplied to the appa- 
ratus can be regulated; from the rheostat the current goes into a step-up trans- 
former, where the necessary raise in voltage is obtained. The high-tension 
current from the secondary windings of the transformer then is led into the 
oscillating circuit, which consists of a condenser, a solenoid, and a spark gap. 
The condensers may be considered instantaneous storage batteries capable of 
storing and discharging a current many thousand times a second. The spark 
gap is a resistance, the air betweeen the points being the resisting substance. 
The solenoid is a coil of wire with low 
resistance placed in conduction with 
the condensers. 
The current from the transformer 
meeting the resistance of the spark gap 
takes the path of least resistance and 
goes into the condensers, placing a posi- 
tive charge on one side and an induced negative charge on the opposite side, 
or just the reverse, according to the phase of the alternating-current cycle. 
When the potential of these two charges is sufficient to overcome the resist- 
ance of the spark gap, the current sparks across, goes through the solenoid, 
and neutralizes the charges in the condenser. At the moment of neutralization 
the current in the solenoid ceases, the lines of force collapse, and a current 
going in the opposite direction to the first is induced in the solenoid charging 
the opposite side of the condenser until the spark gap breaks again. Each 
time the current breaks the resistance of the gap, voltage is lost and in that 
manner decreased until the current no longer can jump the gap. Before this 
standstill occurs the current has flowed back and forth hundreds of times. All 
these oscillations take place during one phase of the alternating current, which, 
in a 60-cycle current, is one qne-hundred-and-twentieth of a second. As a mat- 
ter of fact, the oscillations stop before the next alternation comes and there 
is a period of no oscillations for each alternation of the main current. Graphi- 
cally, the high-frequency current may therefore be represented as in figure 
136. By tapping the solenoid, the so-called D’Arsonval current is obtained. 
Most high-frequency apparatus also give the Tesla or Oudin current, in which 
the voltage is raised a second time with a corresponding decrease of amperage. 
The difference, then, between a Tesla or Oudin current and a D’Arsonval cur- 
rent is one of voltage and amperage, the D’Arsonval current being a high- 
frequency current of relatively low voltage and high amperage and the Oudin 
current a high-frequency current of high voltage and low amperage. 
Fig. 135.—Graphic representation of a 
highifrequency current. PHYSIOTHERAPY. 
221 
Methods of application.—(1) Diathermy is the application of a high fre- 
quency current to a part of the body by means of two electrodes connected to the 
D’Arsonval circuit. The effect of this current is a heating of the tissues trav- 
ersed by the current. By varying the density of the current all degrees of 
heating may be produced even up to a point where the tissues are cooked and 
charred. When this destructive effect is desired, for example, in the removal 
of malignant growths, the procedure is called electrocoagulation. 
Technique of giving diathermy.—Metal electrodes of block tin, 22 gauge, are 
most satisfactory. They are cut in size and shape to fit the part to be 
treated. In order to get the best contact possible the skin and the electrode 
surfaces are soaped freely. The electrodes are secured by a few turns of an 
elastic bandage, with just enough tension to hold the metal in contact with 
the skin, and then connected to a D’Arsonval circuit. 
With the spark gap closed, the current is turned on. By 
adjusting the rheostat and the spark gap, the current is 
increased very slowly until the milliamperemeter shows 
the desired amount of current. The patient should feel 
a sensation of heat but no burning or sticking. It is not 
necessary or safe to give as much as the patient can stand ; 
mild heat frequently being more beneficial than intense 
heat. The treatment usually is continued for about one- 
half hour. When completed, the current is reduced gradu- 
ally by closing the spark gap and the rheostat, and finally 
the main switch is turned off. 
(2) Auto-condensation.—This may be considered as 
diathermy applied to the whole body. The patient is 
placed in an auto-condensation chair (fig. 137) which con- 
tains a metal plate fixed under an insulating material. 
The metal plate is connected to one terminal of the D’Ar- 
sonval circuit while a metal handle or a metal tube held 
by the patient is connected to the other. The patient and 
the metal plate are charged and discharged alternately 
with each oscillation of the solenoid current, the whole 
body being brought under the influence of the current. 
(3) Vacuum and nonvacuum electrode treatments.—The 
vacuum electrodes are closed glass tubes partially ex- 
hausted to make them as good conductors as possible. A 
platinum wire is fused into one end, and connected to the 
Oudin terminal. When the current is turned on the air within the glass glows 
with a violet light. When the electrode is placed on the skin, showers of sparks 
pass from the surface of the glass, a pricking sensation is felt, and the skin 
becomes hot and red. 
The nonvacuum electrodes are lined with a film of mercury which forms 
the conducting medium instead of the rarified air in the vacuum electrodes. 
Static electricity. 
This type of electricity is obtained from the static machine. It is a high 
voltage current with very low amperage. It is applied as (1) static wave 
current; (2) static sparks; (3) static induced current; and (4) static brush 
discharge. The three first mentioned forms produce very strong and deep 
contractions and are used to dispel congestion. The brush discharge is more 
superficial in its effect and is used as a counterirritant in cases of neuritis 
and pain from other causes. 
Fig. 136.—Diagram- 
matic representa- 
tion of the circuits 
in a high-frequency 
apparatus. 222 
HOSPITAL CORPS HANDBOOK. 
Summary of effect and uses of electricity. 
The electric current is used in the treatment of diseases and injuries, pri- 
marily for two purposes: 
(1) To stimulate contractions of muscles. The interrupted galvanic, the 
sinusoidal, the faradic, the static wave, the static sparks, and the static in- 
duced current are used for this purpose. 
(2) To heat the tissues and thereby induce better circulation and nutrition. 
The constant galvanic and the high frequency currents in the form of dia- 
Fig. 137.—Auto-condensation chair. 
thermy, auto-condensation, and vacuum and nonvacuum electrode currents 
are used for this purpose. 
References. 
Massage and Therapeutic Exercises.—McMillan. 
Epitome of Hydrotherapy.—Baruch. 
The Principles of Electrotherapy and Their Practical Application.—Turrell. 
Food and Dietetics.1 
Food may be defined as material taken into the body to supply nourishment 
or replace tissue waste. Every physical act on the part of an individual uses 
up a part of the force that has been derived from food. The maintenance of 
1 Prepared by Lieut. Commander W. A. Bloedorn, Medical Corps, United States Navy. FOOD AND DIETETICS. 
223 
body heat also consumes a part of this material, and in young and growing 
individuals a certain amount is consumed in building up the new tissue. 
Food as it is taken into the body differs greatly in composition from the 
material that can be utilized in cell growth and in replacing the tissue waste. 
The function of digestion is to alter the food in such a manner that it may 
be absorbed by the blood, assimilated, and utilized by the various body tissues. 
CLASSIFICATION OF FOODS. 
Foods may be divided into the inorganic, which include water and the 
various mineral salts, and the organic, which include carbohydrates, fats, pro- 
teins, and vitamines. 
Inorganic foods. 
Water.—Water enters into the composition of every tissue of the body and 
forms more than 60 per cent of the entire body weight. It acts as a solvent 
and aids in the elimination of waste. 
Salts.—The principal salts of the body are calcium phosphate and various 
compounds of potassium, sodium, magnesium, and iron. The mineral salts 
are very necessary to life and health. The chlorides, phosphates, sulphates, 
and carbonates occur in combination with sodium and potassium. The phos- 
phates and carbonates combine with calcium and magnesium. The functions 
of the salts are to maintain alkaline or neutral reaction of body fluids; to fur- 
nish material for acidity or alkalinity of digestive fluids; to maintain osmotic 
pressure; to supply the bones, teeth, and cartilage; to assist in the clotting 
of blood; to influence elasticity and irritability of nerves and muscles. 
Organic foods. 
Proteins.—These are substances which contain nitrogen, are essential to 
life, and are considered as combinations of the various amino-acids. They 
contain, in addition to carbon, hydrogen, oxygen, and nitrogen, usually some 
other element such as sulphur, phosphorus, iron, copper, iodine, manganese, or 
zinc. They differ from carbohydrates and fats in containing nitrogen. Various 
combinations of the above-named elements result in many different kinds 
of proteins. Proteins are essential to life and the body constantly is metaboliz- 
ing protein whether any is being taken in as food or not. In ordinary life, the 
body is in protein equilibrium and such protein as is ingested is metabolized. 
In starvation, more protein is used up than is taken in, and in some wasting 
diseases, such as tuberculosis, in fevers, and in hyperthyroidism, this same 
condition of affairs may obtain. 
In certain pathological conditions, such as nephritis, there may be retention 
of nitrogenous substances in the body due to failure of the kidneys to excrete 
them. 
Protein is metabolized by oxidation processes chiefly into urea, ammonia, 
carbon dioxide, and water. The proteins are absorbed as amino-acids. 
The source of protein foods may be either animal or vegetable. The chief 
animal sources are meat, fish, eggs, and milk. The chief vegetable sources are 
peas, beans, lentils, and peanuts. The animal foods as a rule are richer in 
protein than the vegetable foods. 
The function of proteins is to repair tissue waste, supply material for growth, 
and yield energy. 
Carbohydrates.—Carbohydrate is a term applied to compounds of carbon, 
hydrogen, and oxygen, and the name is used because most of these substances 
contain hydrogen and oxygen in the same proportion as it is found in water- The 224 
HOSPITAL CORPS HANDBOOK. 
carbohydrates may be divided into the monosaccharides, Cs Hi2 Oo, disac- 
charides, C12H22O11, and the polysaccharides (CoHioOs)*. 
Monosaccharides include laevulose, dextrose, galactose, and the glucosides. 
They are found in nature in fruits and as constituents of various di and poly- 
saccharides. Dextrose or grape sugar is the result of the action of dilute acids 
on starch and forms the principal part of commercial glucose. 
The disaccharides yield two molecules of monosaccharides on hydrolysis. 
They include cane sugar or sucrose, maltose, and lactose. 
The polysaccharides are either insoluble or form colloids in aqueous solutions 
and are represented by starch, glycogen, dextrins, cellulose, various gums, muci- 
lage, and inulin. The function of the carbohydrates is to furnish energy for 
muscular and nutritive processes, to help to maintain body temperature, and to 
form a reserve fund in the form of glycogen in time of need. The excess of 
carbohydrate is converted into adipose tissue. 
Fats.—Fats consist of carbon, hydrogen, and oxygen, but the hydrogen con- 
tent is relatively high. Fat enters into the composition of protoplasm and 
enables it to take up water without dissolving. The fats of the body are esters 
of glycerin. Glycerin is a triatomic alcohol, and all of the hydroxyl groups 
are replaced by acid radicals, palmitic, stearic, and oleic acids as a rule. 
The source of fats is the cream and butter from milk; vegetable oils, such 
as olive, cottonseed, corn, coconut; meat fats, such as lard, bacon, salt pork, 
beef suet and drippings; fish fats or oils such as cod liver oil, and nuts such as 
peanuts, almonds, Brazil nuts. Fat is utilized in the body to build up the fatty 
tissues and enters very largely into the composition of red bone marrow. The 
fats are oxidized until they are reduced to carbon dioxide and water. Part of 
the fats of the body are derived from the transformation of carbohydrates and 
part also from protein. The fats form the chief fuel supply, yielding heat and 
energy. They are stored up as adipose tissue to form a reserve supply in time 
of need. They act as a protein sparer, protect the body from mechanical injury, 
act as a packing and support to visceral organs, especially the kidneys, and 
prevent too rapid loss of heat when exposed to cold. 
The vitamines are discussed in the chapter on Preventive Medicine, Hygiene, 
and Sanitation. 
The following table of Atwater illustrates the uses of the various food ele- 
ments : 
NUTRITIVE INGREDIENTS OF FOOD. 
Food as pur- 
chased con- 
tains— 
Sdible portion—e. g., flesh of meat, yolk and white of egg 
wheat flour, etc. 
fWater. 
Protein. 
Fats. 
Carbohydrates. 
Mineral matter. 
[Nutrients. 
tefuse—e. g., bones, entrails, shells, bran, etc. 
USES OF NUTRIENTS IN THE BODY. 
Protein forms tissues—e. g., white (albumin) of eggs, curd (casein) of milk, lean meat, 
gluten of wheat, etc. 
Fats are stored as fat—e. g., fat of meat, butter, olive oil, oils of corn, wheat, etc. 
Carbohydrates are transformed into fat—e. g., sugars, starches, etc. 
Mineral matters (ash) share in forming bone, assist in digestion—e. g., phosphates of 
lime, etc., potash, soda, etc. 
All serve as fuel to 
yield energy in 
the forms of heat 
and muscular 
power. 
The energy value of food. 
The food that is used in the body furnishes the same amount of energy 
that it would furnish if burned in a furnace or calorimeter, providing the 
end products in each case are the same. The heat values of foods may, 
therefore, be taken as a standard of their food value. FOOD AND DIETETICS. 
225 
The heat value of various foods may be determined experimentally by the 
use of an instrument known as the bomb calorimeter, the result being ex- 
pressed in calories. 
A calorie is the amount of heat that is necessary to raise the temperature 
of 1 kilogram of tvater 1° C. 
The fuel value of the various classes of food as ordinarily supplied is as 
follows: 
1 gram of protein furnishes 4 calories. 
1 gram of fat furnishes 9 calories. 
1 gram of carbohydrate furnishes 4 calories. 
The food requirements of an individual vary with the activity, age, size, 
and sex. It may be said roughly that about 40 calories are required for 
each kilogram of body weight for an active individual. 
The amount of tension under which work is done also will influence the 
food requirement. Even if no muscular work is done a certain amount of 
food is required to maintain the body. Perhaps the greatest demand is to 
maintain muscle tone, which probably uses up from one-third to one-half of 
the energy required at rest. 
The following figures are those of Rubner for an adult weighing 65 kilos, 
or about 145 pounds: 
During rest in bed 1,800 calories, or 28 calories per kilo. 
In repose 2,100 calories, or 32 calories per kilo. 
In light work 2,300 calories, or 33 calories per kilo. 
In moderate work 2,600 calories, or 40 calories per kilo. 
In hard work 3,100 calories, or 48 calories per kilo. 
The occupation or the character of the work performed has a great influence 
on the amount and character of the food needed, and it is not well to lay down 
a general rule regarding caloric intake which should apply to all individuals. 
In cold climates fat and protein food are used to a greater extent than in 
hot climates, where more carbohydrates are preferred. 
As a rule women require less food than men. This is due largely to their 
more sedentary life and relatively small weight. 
It has been shown that the amount of food needed is directly proportional to 
the superficial area of the body and that the metabolism varies in direct pro- 
portion to the amount of skin surface. 
After determining the total amount of food required the next question to 
determine is how much protein, fat, and carbohydrate should be used to supply 
the desired number of calories. There is some difference of opinion on this 
subject, although we know, to a fair degree of accuracy, the amount of each 
which can be utilized to the best advantage. The total amount of food required 
depends largely upon the amount of exercise taken. The protein metabolism, 
however, does not depend so much upon the amount of exercise as it does upon 
the amount of food taken. We know that carbohydrate and fat protect the 
body protein, and if a diet is used which is low in protein, nitrogen equilibrium 
may be obtained by adding fats and carbohydrates to the diet, providing, of 
course, the protein intake does not fall below the minimum requirement. Ordi- 
narily the protein intake, to supply the average body requirements, need not 
exceed 120 grams nor be under 60 grams daily, and it is probably safe to say 
that the optimum lies between these two figures, varying with the individual 
conditions. 
As regards the amount of fat and carbohydrate in the average diet, there is 
also some difference of opinion, although the figures do not vary as much as 226 
HOSPITAL CORPS HANDBOOK. 
for the protein. The following distribution might be considered a fair aver- 
age percentage of the various foodstuffs: 
Carbohydrates 275 gramsX4=l, 100 calories. 
Fat 100 grams X 9= 900 calories. 
Protein 75 grams X 4= 300 calories. 
Total 2, 300 calories. 
Undernutrition lessens the natural power of resistance to diseases, while 
overeating puts unnecessary strain on the organs of digestion and elimination, 
favors obesity, and increases the amount of waste products. 
Flavors and condiments.—These substances have no nutritive value, but are 
used to increase the appetite by rendering food more palatable and adding 
savor to the diet. Spices are represented by such substances as ginger, cinna- 
mon, nutmeg, and cloves; flavoring extracts by vanilla, lemon, strawberry, and 
condiments by mustard, horseradish, pepper, salt, vinegar. 
Beverages.—Tea and coffee may be regarded as stimulants due to the effect 
of caffein, while cocoa contains carbohydrates, fats, and proteins. The various 
meat extracts contain little in the way of food value, but have a stimulating 
effect on the digestive secretions. 
PLANNING OF DIET. 
Probably the best way to work out a diet in an individual case is first to 
determine the number of calories required. Of this amount, from 10 to 15 per 
cent should be furnished by protein. The nature of the protein should be con- 
sidered, and those containing the necessary amounts of amino-acids should be 
included. The proteins found in milk and meat are, as a rule, more valuable 
than those in vegetables. The remainder of the calories is to be made up from 
fats and carbohydrates. These are interchangeable within certain limits. 
Ordinarily the amount of fat taken does not exceed 60 to 100 grams per 
day and the balance is made up in carbohydrates. 
The diet also should contain the various salts needed in metabolism and on 
a general mixed diet this will be present practically always, but on restricted 
diets the salts may be too low. Iron-containing foods of value are spinach, 
lettuce, asparagus, the legumes, yolk of egg, and meat. 
Calcium is contained in such foods as milk, cheese, cauliflower, string beans, 
carrots, lettuce, rhubarb, oranges, and lemons. 
Phosphorus is found in such foods as milk, cheese, legumes, meat, yolk of egg, 
oatmeal, cauliflower, spinach, lettuce, asparagus, and tomatoes. With ordi- 
nary diets these requirements easily are met and this emphasizes the im- 
portance of milk products, salads, and other green vegetables. 
Foods ordinarily should furnish more bases than acids, and meats, cereals, 
and other acid-forming foods should be offset by those containing alkalies, as 
potatoes, bananas, vegetables, and fruits. 
Vitamines are important and seem to bear a relation to the phosphorus 
content of the food. (See chapter on “ Preventive Medicine, Hygiene, and Sani- 
tation.”) 
There always should be an antiscorbutic in the diet such as some fresh fruit 
or vegetable. The food also should contain sufficient bulk. 
As a knowledge of the composition, use, and digestibility of foods is essential 
in the planning of diets, the following principal food substances are discussed 
briefly: FOOD AND DIETETICS. 
227 
Animal foods. 
Meat.—Meat is one of the most important articles of food and is man’s chief 
source of protein. Meat contains muscle tissue, connective tissue, blood ves- 
sels, nerves, and lymphatics, together with a varying amount of fat. 
Cooking has the effect of rendering connective tissue soluble and allowing 
the digestive secretion to mingle more freely with the muscle fibers. It also 
increases the flavor and appearance of the meat and destroys bacteria which 
may be present in the meat. 
Beef.—An ox from 3 to 5 years old supplies the best beef. The meat of a 
very lean animal will contain about 75 per cent of water and 2 per cent of fat. 
The muscles least exercised are the most tender and make the best roasts and 
steaks. Beef juice is nutritious when properly prepared and contains from 
5 to 10 per cent of protein. 
Veal.—Veal is more difficult to digest than beef and is obtained from calves 
6 to 10 weeks old. In some persons it tends to produce digestive disturbances 
and is to be avoided in cases of digestive disability. 
Mutton.—Mutton is obtained from the 3 to 5 year old sheep and is considered 
by some writers more digestible than beef. 
Lamb.—Is obtained from sheep less than a year old and is as digestible as 
beef or mutton but contains relatively too much fat. 
Pork.—Pork is the most indigestible of all meats on account of the large 
percentage of fat it contains. 
Ham and bacon.—Ham and bacon are both more digestible than pork. When 
cooked crisp, thin slices of bacon are digested easily. 
Animal viscera.—Animal viscera are not quite so nutritious as most meats. 
Tripe, liver, kidney, and brains are used extensively. The heart is tough and 
indigestible. Sweetbreads, either the pancreas or the thymus gland of the calf, 
are digested easily. 
Poultry.—Chicken is one of the most digestible and agreeable varieties of 
meat. Squab is also a desirable and easily digested food. Game birds are 
digested easily and are richer in extractives. 
Fish.—Fish is used very widely as a food and is always best used in season. 
Fish are in best condition just before spawning. After this process they be- 
come thin and unfit for food. Fish undergo decomposition rapidly and as a 
rule should be eaten in as fresh condition as possible. Shell fish (oysters, 
clams, and mussels) may be eaten raw or cooked. Oysters, when eaten raw and 
fresh, are very digestible but when cooked are less easily digested. 
Eggs.—Hens’ eggs are consumed in large quantities but those of the duck, 
turkey, guinea hen, and wild fowl also are eaten. Eggs contain mainly protein 
and fat in addition to water and mineral matter. Eggs are highly nutritious 
and when served with milk or broth form an important article of diet for con- 
valescent patients. 
Milk.—Milk is probably the most important of animal roods, containing all 
the elements necessary for the maintenance of life. It forms the exclusive 
diet for young growing mammals but is unsuited as an exclusive diet for adults. 
It contains about 4 per cent of fat, 3.3 per cent of protein, 5 per cent of carbo- 
hydrate, 0.7 per cent of mineral matter, and 87 per cent of water. Heat is em- 
ployed in keeping milk, usually by two methods—either sterilization or Pas- 
teurization. Sterilisation is accomplished by boiling for 10 minutes or longer. 
There are certain objections to sterilized milk as it kills the ferments and places 
milk in the class of so-called “ dead foods.” It may be used to advantage, how- 
ever, in very hot weather when ice is not available. Pasteurisation means 
heating the milk to about 167° F. and maintaining this degree of temperature 228 
HOSPITAL CORPS HANDBOOK. 
from 20 to 45 minutes, and then cooling the milk rapidly to about 40° F. This 
treatment kills most of the bacteria, particularly the pathogenic bacteria, but 
does not render the milk sterile; however, it does not materially change the 
composition of the milk. Pasteurized milk must be kept cool to prevent deteri- 
oration. 
Vegetable foods. 
Vegetable foods differ from animal foods in that they contain more starch 
and sugar and a relatively small amount of protein. 
Cereals.—These are the most important of the vegetable foods and to this 
class belong wheat, corn, rye, oats, barley, rice, and buckwheat. The cereals 
are supplied chiefly in the form of flour or meal. 
Legumes.—Peas and beans are the most important legumes and contain a 
liberal proportion of protein. Lentils are used comparatively little in the United 
States, but are used extensively in other countries. Peanuts belong to this 
class and differ from other legumes in that they contain a large amount of 
fat. The principal legumes, peas and beans, should be well cooked so that the 
cellulose enclosing the vegetable cells is broken down. 
Roots and tubers.—This includes potatoes, sweet potatoes, yams, artichokes, 
beets, carrots, parsnips, turnips, and radishes. They contain both starch and 
sugar but are relatively lower in nutritive value than either legumes or cereals. 
Green vegetables.—Green vegetables are valuable not only on account of 
their nutriment but for variety and relish and for their content of salts and 
vitamines. They also give bulk to the food which is important on account of 
its mechanical action in maintaining a healthy alimentary tract. The princi- 
pal articles of food in this class are cabbage, cauliflower, spinach, lettuce, 
sorrel, tomatoes, eggplant, cucumbers, asparagas, rhubarb, pumpkin, squash, 
onions, and garlic. 
Fruits and nuts.—Fruits are used extensively as flavoring agents. Their 
chief nutrient constituent is sugar, the principal sugar being levulose and some- 
times cane sugar. The mineral elements of fruit contain potash with tartaric, 
stearic, and malic acids. The antiscorbutic properties of fruits are due to 
their salts and vitamines. Fruits also act as diuretics and laxatives. The 
most easily digested fruits are oranges, lemons, grapes, and peaches. Apples, 
pears, and bananas are slightly less digestible. 
Nuts contain a large quantity of fat and somewhat more protein than 
fruits. They are taken mainly as a dessert and as a rule do not constitute a 
large source of nutriment. They are not digested easily as a rule, owing to the 
large amount of cellulose and high proportion of fat. 
SPECIAL METHODS OF FEEDING. 
Special methods of feeding include rectal feeding, duodenal alimentation, 
nutrient inunctions, intravascular injection, saline irrigations and saline in- 
fusions. 
Nutrient enemata.—This consists in the administration of food by rectum. 
With careful technique, a patient may be fed by rectum for a period of 
several weeks, although it is doubtful if more than one-sixth to one-fourth of 
the total caloric requirements can be supplied in this manner. The rectum 
first should be cleansed thoroughly by high injection of normal saline solution 
an hour before the enema is to be given. This cleansing enema should be 
given at least once a day. 
Nutrient enemata may be indicated in extremely weakened conditions when 
the quantity of food taken through the mouth is insufficient to maintain life; 
in obstruction of the pharynx or oesophagus, and in paralytic conditions of FOOD AND DIETETICS. 
229 
the pharynx when the patient is unable to swallow food; in diseases of the 
stomach, as in cancer with stricture and in delirious, comatose, or insane per- 
sons who can not be fed by mouth. 
The usual nutrient enema consists of milk, which has been pancreatized for 
24 hours and boiled, about 8 ounces, to which may be added either 2 to 3 drams 
of dextrose, 2 to 3 drams of alcohol, one or two yolks of egg, or a combination 
of all three. 
The nutrient enema usually is given by the drop method and it is sometimes 
advisable to add 10 or 15 drops of tincture of opium as a sedative. 
Duodenal alimentation.—This consists of feeding through a duodenal tube 
which has been introduced through the stomach and is a desirable way of 
feeding a patient in conditions in which the stomach needs a rest. 
Nutrient inunctions.—Particularly if oils such as olive oil, cod liver oil, 
coconut oil, or cocoa butter are used, nutrient inunctions are sometimes of 
value, especially in infants suffering from marasmus or malnutrition. 
Intravascular injection.—This consists in introducing fluid into a vein, usually 
in the form of salt, alkaline, and glucose solutions. It usually is practiced as 
an emergency measure and not as a routine procedure. 
Subcutaneous feeding.—This method of administration is somewhat unsatis- 
factory, but solutions of glucose in normal salt solution and also olive oil have 
been given in this manner. 
Saline irrigation and infusion.—Saline irrigations by rectum are especially 
useful in such conditions as haemorrhage and in various acute fevers when it 
is inadvisable to give fluids by mouth. They serve to allay thirst and are 
a very useful means of increasing the amount of fluid in the system. Saline 
infusion given subcutaneously is useful in cases where the patient can not 
retain a rectal solution and usually is given in the chest wall, lumbar region, 
abdominal wall, or buttock. 
DIET IN DISEASES. 
In feeding the sick, it is advisable to carry out the patient’s wishes whenever 
practicable, and to a certain extent make allowance for likes and dislikes and 
certain idiosyncrasies A tactful, observing, and sympathetic nurse who ac- 
quaints himself or herself with these facts will be of the greatest help to the 
physician in carrying on his dietary regime. The nurse should have a knowl- 
edge of practical dietetics and of the amount of food required by different 
types of patients. 
Food should be given at regular intervals. This is particularly important 
in semiconscious or comatose patients, and in the conscious patient regularity 
in meals is also of distinct advantage. 
The appetite of the convalescent patient requires catering to, as patients 
in this condition are apt to be more fastidious than when they are well. 
The sick room should be neat, and no dishes, utensils, or food allowed to 
stand about the room either before or after using. Food and drink should 
be served from scrupulously clean utensils. These utensils should be as at- 
tractive as possible, and the food must be dainty and appetizing in appearance. 
If the patient approaches his food with the flow of his digestive secretions 
stimulated by the psychic reaction to the odors and appearance of the food, he 
is in a position to get the greatest amount of good from his meal. 
An attractive dish, garnished with sprigs of green, accompanied by clean 
linen and bright silverware, will go a long way toward accomplishing this result. 
Food that is stale or has acquired an unpleasant odor or taste from standing 
in a refrigerator should never be given. A strong egg in an eggnog or an 230 
HOSPITAL CORPS HANDBOOK. 
odorous piece of meat may be the means of turning the patient away from 
much needed nourishment. 
The patient should be made to feel that the utmost cleanliness and care 
have been observed, and the face and hands of the patient should be cleansed 
before food is given, and the lips and teeth cleansed after the meal is completed. 
If the mouth is dry, it should be moistened from time to time with, a mixture 
of water, glycerin, and lemon juice. 
Ancemia.—The diet in anaemia should consist of easily digested food rela- 
tively rich in iron and other salts, such as milk, eggs, raw beef, beef juice, oat- 
meal, whole-meat preparations, green vegetables, and fruits. 
Cardiac diseases.—In acute heart failure with oedema, the patient usually 
is placed on a restricted diet consisting of 800 to 900 c. c. of milk in 24 hours 
until the oedema tends to disappear. The transition from milk to a more solid 
diet is begun slowly by adding gradually soft cooked eggs, dry toast, baked 
potato, fish, or the white meat of chicken. Later, as the cardiac condition 
improves, more solid food is given, but never a large amount of food at any 
one meal, in order to avoid embarrassing the heart by a well-filled stomach. 
Constipation.—In the ordinary type of constipation, due to sluggish action 
of the bowel, and not due to mechanical obstruction, it is advisable to give 
food which tends somewhat to irritate and stimulate peristalsis, such as oat- 
meal, whole wheat, vegetables, fruit, and a liberal amount of water. 
Diarrhoea.—In the ordinary type of diarrhoea, due to an acute gastroin- 
testinal disorder, give bland nonirritating liquids for a diet, well-cooked and 
strained gruels, such as arrowroot, farina, and rice, and boiled milk. Later, 
as the condition improves, lean meat and fish, potatoes, simple extracts, and 
milk puddings may be added. 
Diabetes.—The ordinary preliminary treatment consists in a starvation diet 
until the urine is free from sugar. During this period only boullion or clear 
soup is given. After the urine has been free from sugar for 24 hours, pro- 
teins and carbohydrates are slowly added until tolerance is reached, together 
with easily digested food, such as bacon, butter, or cream. The amount of fat 
always should bear some relation to the amount of carbohydrate ingested, as 
a certain amount of carbohydrate is necessary to properly metabolize the fat 
ingested. Saccharine may be substituted for sugar for sweetening purposes. 
The diet of a diabetic as a rule easily can be made up to the required bulk 
by using a liberal quantity of green vegetables which contain a low amount of 
carbohydrate. Later, as the limit of tolerance is reached, the patient should 
be kept under close observation for any evidence of acidosis or glycosuria. 
Gastric ulcer.—Lenhartz or Sippy diet or some similar diet is probably the 
most generally used. This consists of hourly feedings during the first 10 days 
of small amounts of milk and cream, between which feedings alkalies are given 
by mouth. Later the feedings are given at two-hour intervals, and at the end 
of four or five weeks five or six feedings a day are given, with gradual addi- 
tion of semisolids and later solid foods. 
Gout.—Prohibit food of glandular organs, such as sweetbreads, liver, kid- 
neys, and all food rich in extractives, as well as acid and highly seasoned 
foods. The diet should consist principally of milk, cream, eggs, butter, farina, 
tapioca, cornstarch, extracts, ice cream, water ices, potatoes, and possibly a 
little boiled meat. 
Nephritis.—In an acute attack with oedema, avoid condiments and salt in the 
diet and give bland, easily digested food with not more protein than is necessary 
to maintain the basal requirements, the balance of the diet being made up 
from carbohydrates and fats in sufficient amounts to maintain the caloric FOOD AND DIETETICS. 
231 
requirements of the individual. In some cases the Karell diet is recommended, 
consisting of 800 c. c. of milk a day, although it is not considered advisable 
to maintain the patient on this diet for any length of time. 
In the chronic forms of nephritis the above principle still holds, it being 
advisable to throw the minimum amount of work on the kidneys and to elimi- 
nate all irritating and highly seasoned dishes from the menu. The restriction 
of protein intake below that required for the actual body needs is inadvisable, 
as if insufficient protein is derived from the food the patient will make up the 
deficiency from his own tissues. 
As regards the amount of water a patient with nephritis should take, it is 
not advisable to lay down any specific rule, as the amount which should be 
taken in each case depends upon the ability to excrete water, and this can be 
ascertained readily if the amount ingested and the amount excreted is meas- 
ured daily. 
Obesity.—In obesity, determine the number of calories you wish the patient 
to have each day, giving less, of course, than the amount required to maintain 
the weight of the patient. Ordinarily, if a patient is up and about and can 
combine a restricted diet with a certain amount of exercise, the efforts at 
reduction of weight will be much more effective. A diet containing 1,200 to 
1,500 calories per day, together with exercise, such as walking 3 to 5 miles a 
day, usually will accomplish the desired result. If the patient is placed on 
foods of low caloric value such as the green vegetables, and items such as 
butter, cream, bread, and potatoes eliminated from the diet, he usually can get 
along without suffering inconvenience or severe hunger. 
Fevers.—In fever the metabolic processes are increased and the power of 
assimilation is lowered. In order to maintain a fever patient properly the food 
should be easy to take, easy to digest, and readily assimilated. Milk is the 
almost universally used food in this condition, but must be supplemented by ad- 
ditional items. Cream is of great value owing to its high caloric content, and 
eggs also constitute a valuable addition to the diet. Meats ordinarily are not 
used in fevers, although the meat juices may be used occasionally. The balance 
of the diet may be made up from sugars and starches, and sufficient fluid should 
be supplied to keep the patient comfortable. 
Tuberculosis.—It is advisable to take meat, milk, and eggs in as large quan- 
tities as can be digested and to give some form of raw meat daily. The patient 
should be impressed with the fact that diet is of primary importance in the 
treatment of this disease and should be given specific directions covering articles 
eaten as well as those to be avoided. A small diet well digested and assimilated 
is much better than overfeeding. The nutrition of the patient is a reliable 
guide as to the progress of the disease. There can be no doubt that food pre- 
pared in an appetizing manner and which is digested and assimilated easily is 
one of the most important factors in treating tuberculosis. A good chef is prob- 
ably as valuable an adjunct to a tuberculosis sanitarium as the medical man 
himself. 
CLASSIFICATION OF DIETS. 
The ordinary diets used in the Navy may be generally divided into the fol- 
lowing classes: Liquid, soft, regular, and special diets. Liquid diet may be 
prescribed with or without milk and consists of sweet milk, buttermilk, whey, 
cocoa, cream soups, eggnogs, ice cream, broths, strained gruels, beef tea, beef 
juice, barley or ice water, albuminous drinks, tea or coffee. Soft diet includes, 
in addition to the above articles, eggs (soft boiled, scrambled, or poached), 
dry and milk toast, extracts, gelatin, oranges, grapefruit, prunes, baked apples, 232 
HOSPITAL CORPS HANDBOOK. 
blancmanges, and cereals. Regular diet is the same diet given to the regular 
mess, with the exception of having fruit and cereal added to the breakfast and 
stewed or fresh fruits added to the evening meal. 
Under the heading of special diets, we may put in the Lenhartz, Sippy, Kar- 
ell, and the other special dietaries which are indicated in some particular 
diseases and which the medical officer may prescribe for some particular case. 
RECIPES.1 
Peptonized milk (warm process).—Put one-half cup (gill) of cold water 
and the powder contained in one peptonizing tube into a clean quart bottle and 
shake thoroughly; add a pint of cold fresh milk and shake again; then place 
the bottle in a pail or kettle of warm water at about 115° F., or not too hot 
to immerse the whole hand in it without discomfort. Keep the bottle in the 
water bath for 5 or 10 minutes, or longer if it is desired to peptonize the milk 
quite completely, then put it immediately on ice in order to check the process 
of digestion and keep the milk from spoiling. The container should be placed 
directly in contact with the ice. 
The degree of peptonization is regulated very simply in this process by the 
length of time during which the milk is kept in the water bath. It is Seldom 
necessary to peptonize milk until it becomes bitter. 
In the following formulas for preparation of food for the sick, those marked 
with an asterisk are quoted from “ Dietetics for Nurses,” by F. T. Proudfit. 
Juice of 1 orange. 
1 tablespoonful sugar. 
* Orangeade. 
Juice of \ lemon. 
Enough water to fill the glass. 
* Albuminized Orangeade. 
Make orangeade as directed in above recipe without the addition of water. 
Break the whites of two eggs into a saucer and with scissors cut the albumin 
until free from membrane and strain, stir this into the orange juice and add 
several pieces of cracked ice. This is both nourishing and palatable, and the 
taste of the egg can not be detected. 
1 egg. 
f tablespoonful sugar. 
Speck of salt. 
Egg Nog. 
| cup milk. 
Flavor with nutmeg. 
Beat the egg, add the sugar and salt; blend thoroughly, add the milk and 
nutmeg. Serve immediately. 
* Cocoa. 
i cup boiling water. 
§ cup milk. 
2 teaspoonsful cocoa, 
i teaspoonful sugar. 
Mix cocoa and sugar together and add boiling water slowly. Boil 3 to 5 
minutes; heat milk in double boiler and add cocoa mixture. Beat with 
egg beater to distribute cocoa and prevent scum forming. Serve with or 
without whipped cream. Cocoa may be reinforced as directed in “ broths ” 
with albumin or the whole or yolk of one egg well beaten. If the white alone 
1 Prepared by members of the faculty of the United States Naval Hospital Corps 
Training School, San Francisco, Calif. FOOD AND DIETETICS. 
233 
is used, care must be observed that the liquid is not enough to coagulate the 
albumin. Proprietary foods and casein preparations are used in like manner. 
* Malted Milk Chocolate ob Cocoa. 
1 tablespoonful malted milk. 
1 tablespoonful cocoa or grated choco- 
late. 
6 ounces milk. 
2 ounces water. 
i teaspoonful sugar. 
4-5 drops vanilla extract. 
Mix cocoa or chocolate with water and boil 2-3 minutes. Pour milk into a 
double boiler and heat, mix malted milk with a little water and stir into the 
hot milk, add the cocoa paste, sugar, and vanila, beat the mixture briskly to 
mix ingredients thoroughly, and serve with or without cream. 
Chocolate Sybtjp. 
1 ounce (3 tablespoonsful) chocolate. 
1 cup boiling water. 
11 cups sugar. 
1 tablespoonful of vanilla. 
Put chocolate in a saucepan and add the water gradually, stirring all the 
time. Add sugar and stir until it begins to boil; boil three minutes, strain, 
cool, and add one tablespoonful vanilla. Bottle and keep in a cold place. 
Chocolate Shake. (Individual rule.) 
2 tablespoonsful chopped ice. 
2 tablespoonsful chocolate syrup. 
3 tablespoonsful whipped cream. 
cup milk. 
I cup soda water or carbonated water. 
Shake or stir well before drinking. A tablespoonful of vanilla ice cream is 
a desirable addition. It is a delicious drink, even if the soda or carbonated 
water are omitted. 
A plainer drink is made by combining the syrup, three-fourths cup milk, and 
the ice, and shaking well. 
* Coffee. 
2 tablespoonfuls ground coffee. 
2 teasponfuls white of egg. 
1 cup boiling water. 
i cup cold (boiled) water. 
Mix coffee with 1 tablespoonful of cold water and egg white in small pot 
(after scalding pot), add boiling water; allow to boil 3 minutes; stir down and 
add cold water; set pot where coffee will stay hot, but not boil, for 10 to 15 
minutes, serve with cream and sugar or to flavor use hot milk. 
1 egg. 
* Coddled Egg. 
| 1 pint water. 
Allow water to boil; wash egg; drop into boiling water and place saucepan 
where water will keep hot, but not boil; allow to stand 7 or 8 minutes. Serve 
with salt. 
* Soft Cooked Egg. 
Proceed as for coddled eggs, but allow egg to remain from 10 to 15 minutes 
or even longer, if very soft eggs are not desired. 
* Poached Egg. 
Have small, shallow saucepan half filled with boiling water or milk, if an egg 
poacher is at hand, use that; otherwise, lower a flat perforated spoon into 
water and place where the water cannot boil. Break the egg carefully into 234 
HOSPITAL COUPS HANDBOOK. 
the spoon, taking care not to break the yolk; allow to stand in hot water until 
the white is of the consistency of jelly; lift out, slide egg on to hot toast, 
taking care not to break. (A broken poached egg is very unappetizing, as well 
as untidy in appearance). 
1 egg. 
i cup milk. 
1 teaspoonful butter. 
Scrambled Egg. 
\ teaspoonful salt. 
Small pinch pepper. 
Beat egg in top of double boiler until light, add milk and rest of ingredients 
and stir over boiling water until it thickens; allow it to stand a few minutes 
without stirring, to set. Serve on toast or hot rice. 
* Baked Custard. 
1 egg. 
1 tablespoonful sugar. 
I £ cup milk. 
A few drops of vanilla. 
Beat eggs and sugar together, stir into milk, grease custard cup with butter, 
pour in the mixture. Set cup on several layers of paper in a deep pan, surround 
with hot water (to about half its depth). Set pan in moderate oven and allow 
to cook slowly until custard is firm in the center. It may be served hot or 
chilled and turned out, with a tablespoonful of whipped cream on top. 
Care must be taken not to allow the oven to get hot, or the egg will coagulate, 
making a watery, unpalatable, and indigestible mixture. 
* Soft Custard. 
1 egg (or 2 yolks). 
1 tablespoonful sugar. 
1 cup milk. 
A few drops of vanilla. 
Heat milk in double boiler. Beat egg and sugar together. When milk has 
reached the scalding point (small bubbles form around the edge of the sauce- 
pan), stir in the egg. Care must be taken not to allow the water under the 
saucepan to become too hot, as the custard will curdle if the egg is cooked at 
too high a degree of temperature. The custard must be stirred constantly in 
the beginning until it begins to thicken, then several times a minute until it 
is of the desired consistency and the raw taste is cooked out of the egg. This 
mixture is done when it will form a coating upon the spoon. Serve with whipped 
cream on top. 
Beef Tea with Hydrochloric Acid. 
Select one-half pound of good beef; remove everything that is not clear 
meat. Chop it fine. Put in pint fruit jar and add one cup cold water and 
five drops dilute hydrochloric acid. Stir and set in refrigerator or any cold 
place for two hours to digest. Then strain, season with salt, and serve in 
dainty china cup on account of color. If one should object to color, heat the 
tea in a double boiler just till color changes. Do not strain. Beef tea made 
in this way is recommended by physicians for feeble children and patients much 
weakened by sickness. 
Beef Juice. 
Select a piece of meat from the rump or top of the round. Remove all fat 
and broil or warm slightly one or two minutes, to set free the juices; lay on 
plate and cut meat in various directions that more juice may be extracted; 
then squeeze out the juice by means of a press, lemon squeezer, or potato ricer FOOD AND DIETETICS. 
235 
into a slightly warmed cup. Salt if necessary, and serve at once. Prepare only 
enough to serve, as it does not keep well. Serve in dainty china cup to 
disguise color. One pound of meat yields four ounces of juice. 
Orange Jelly. (Individual rule.) 
1 teaspoonful granulated gelatin. 
1 tablespoonful cold water. 
3 tablespoonfuls boiling water. 
2 tablespoonfuls sugar. 
3 tablespoonfuls orange juice. 
2 teaspoonfuls lemon juice. 
Soak the gelatin in the cold water one-half hour; add the boiling water 
and dissolve. Add sugar and fruit juice, strain through a cloth and strainer 
into cold, wet mold. 
Cocoa Junket. (Individual rule.) 
1 tablespoonful cocoa. 
2 teaspoonfuls sugar. 
2 tablespoonfuls boiling water. 
1 cup milk. 
i Junket tablet. 
1 teaspoonful cold water. 
3 drops vanilla. 
Mix the cocoa, sugar, boiling water, and cook over heat and rub to a 
smooth paste; add gradually the fresh cool milk. Heat until lukewarm (not 
more), add vanilla and then tablet dissolved in the cold water. Pour mixture 
immediately into sherbet cups, partly full. Stand in warm room undisturbed 
until firm, like jelly, then put on ice to cool. 
References. 
Practical Dietetics (Diet in Health and Disease).—A. F. Pattee. 
Dietetics for Nurses.—Proudfit. 
Diet in Health and Disease.—Friedenwald and Ruhrah. 
47829°—23 16 CHAPTER V. 
PREVENTIVE MEDICINE, HYGIENE, AND SANITATION.1 
PRACTICAL PREVENTIVE MEDICINE. 
Preventive medicine may be defined as that branch of science that deals with 
prevention and control of disease. Hygiene and sanitation, which are included 
within its scope, often are confused with it. Hygiene is the science of health, 
or the proper care of the body to permit the proper functioning of the various 
organs and tissues, whereas sanitation is the proper care of man’s surround- 
ings or environment. 
Preventive medicine must not be restricted to the prevention and control of 
diseases, communicable from man to man or from animal to man by means of 
microorganisms, but should be considered as the prevention and control of all 
diseases with which man is afflicted. For instance, the prevention of diseases 
due to lack of proper food, to the lack of exercise, to faulty methods of living, 
to improper working conditions, and atmospheric conditions, are as much a 
field of preventive medicine as the prevention of communicable diseases. How- 
ever, the greatest success thus tar has been obtained in the prevention of infec- 
tious diseases, and particularly the so-called environmental diseases. In the 
practice of preventive medicine it is necessary or desirable to know the cause, the 
nature, and in what manner man contracts a disease before such diseases may 
be controlled. This study of epidemic diseases is known as epidemiology. Once 
the epidemiology of a disease is known the control becomes much easier. How- 
ever, this is not always the case, for some diseases were controlled about as well 
before the discovery of the cause of the disease as they have been since. As an 
example, smallpox, for which neither the cause nor the exact means of trans- 
mission are known, is one disease which may be controlled practically com- 
pletely. 
The control of communicable diseases is a problem with which the medical 
officer and the hospital corpsman have to deal constantly. Therefore, the com- 
municable diseases which are most liable to attack the Navy will be dealt with 
in detail. Before considering each communicable disease separately it will be 
well for the reader to have an understanding of some terms which will be used. 
Source of infection.—Man is the great reservoir of infection for organisms 
pathogenic to man. However, some animals also harbor organisms pathogenic 
to man. Not only the individual ill with a disease may harbbr the organisms 
but those who are well may act as carriers. 
Modes of transmission (Fig. 138).—These may be classified in the following 
general groups: 
(a) Contact. 
(ft) Foods, including water and ice, milk and dairy products, meat and 
shellfish, and vegetables. 
(c) Insects. Mechanical transmission. Biological transmission. 
(d) Soil. 
(e) Fomites. 
1 Prepared by Lieut. Commander R. F. Jones, Medical Corps, United States Navy. 
237 238 
HOSPITAL CORPS HANDBOOK. 
Carrier.—A person who, without symptoms of a communicable disease, har- 
bors and disseminates the specific microorganisms. 
Cleaning.—This term signifies the removal, by scrubbing and washing, of 
organic matter on which and in which bacteria may find favorable conditions 
for prolonging life and virulence; also the removal by the same means of 
bacteria adherent to surfaces. 
Contact.—A “ contact ” is any person or animal known to have been suf- 
ficiently near to an infected person or animal to have been exposed to the 
transfer of infectious material directly or by articles freshly soiled with such 
material. 
Means of contact transmission of disease.—These may be grouped as follows: 
(a) Mouth spray or droplet infection. In talking, coughing, or sneezing per- 
sons emit from the mouth a fine spray of saliva which will contain micro- 
organisms harbored in the mouth, nasopharynx, and respiratory passages of 
FINGERS 
Excreta 
FROM 
Patients 
or 
Germ 
Carriers 
Foods 
(milk) 
Vecetables 
Oysters 
&c. 
MOUTHS 
OF 
Persons 
FLIES 
WATER 
Fig. 138.—Illustrating the participation of several routes of dissemination in the propa- 
gation of the typhoid bacillus. (U. S. Public Health Reports.) 
the infected individual. Droplets will remain suspended in the air for varying 
lengths of time and air currents may distribute them short distances. Ulti- 
mately they will dry and desiccation of the microorganism will occur. The 
radius of droplet infection without air current is about 6 or 8 feet. 
(&) Hands and fingers contaminated with secretions are unquestionably the 
most important agencies in contact infection. Hands and fingers may infect 
directly or indirectly. 
(c) Direct approximation of body surfaces of two different individuals, such 
as that occurring during kissing or sexual intercourse. 
Delousing.—By delousing is meant the process by which a person and his 
personal apparel are treated, so that neither the adults nor the eggs of Pediculus 
vestimenti, Pediculus capitis or Phthirius pubis survive. 
Disinfection.—By this is meant the destroying of the vitality of pathogenic 
microorganisms by chemical or physical means. When the word concurrent 
is used as qualifying disinfection, it indicates the application of disinfection 
immediately after the discharge from the body of an infected person of infec- PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
239 
tious material or the soiling of articles with such infectious discharges. When 
the word terminal is used as qualifying disinfection, it indicates the process 
of rendering the personal clothing and immediate physical environment of the 
patient free from the possibility of conveying the infection to others at the 
time when the patient is no longer a source of infection. For methods of 
disinfection see page 265. 
Education in personal cleanliness.—By this phrase it is intended to include 
all the various means available to impress upon all members of the community, 
young and old, and especially when communicable disease is prevalent or 
during epidemics, by spoken and printed word, and by illustration and sug- 
gestion, the necessity of— 
(1) Washing the body daily with soap and water. 
(2) Washing the hands in soap and water after voiding bowels or bladder 
and always before eating. 
(3) Keeping the hands and unclean articles, or articles which have been used 
for toilet purposes by others, away from mouth, nose, eyes, ears, and genital 
organs. 
(4) Avoiding the use of common or unclean eating, drinking, or toilet articles 
of any kind, such as towels, handkerchiefs, hairbrushes, drinking cups, pipes, etc. 
(5) Avoiding direct exposure to the spray from the noses and mouths of 
people who cough and sneeze, or laugh and talk loudly, with wide-open mouth, 
or in explosive manner. 
Fumigation.—By fumigation is meant a process by which the destruction of 
insects, as mosquitoes and body lice, and animals, as rats, is accomplished by 
the employment of gaseous agents. 
Isolation.—By isolation is meant the separating of persons suffering from 
a communicable disease, or carriers of the infecting organism, from other 
persons, in such places and under such conditions as will prevent the direct 
or indirect conveyance of the infectious agent to susceptible persons. 
Quarantine.2—By quarantine is meant the limitation of freedom of movement 
of persons or animals who have been exposed to communicable disease for a 
period of time equal to the incubation period of the disease to which they have 
been exposed. 
Renovation.—By renovation is meant, in addition to cleansing, such treatment 
of the walls, floors, and ceilings of rooms or houses as may be necessary to 
place the premises in a satisfactory sanitary condition. 
Report of a disease.—By “ report of a disease ” is meant the notification sent 
to the health authorities, and, in the case of communicable diseases in animals, 
also to the respective departments of agriculture, who have immediate juris- 
diction, that a case of communicable disease exists in a specified person or 
animal at a given address. 
Susceptibles.—A susceptible is a person or animal who is not known to have 
become immune to the particular communicable disease in question by natural 
or artificial processes. 
2 In view of the various ambiguous and inaccurate uses to which the words “ isolation ” 
and “ quarantine ” not infrequently are put,, it has seemed best to adopt arbitrar ily the 
word “ isolation ” as describing the limitation put upon the movements of the known sick 
or “ carrier ” individual or animal, and the “ quarantine ” the limitations put upon 
exposed or “ contact ” individuals or persons. 240 
HOSPITAL CORPS HANDBOOK. 
GROUP I. DISEASES TRANSMITTED BY DISCHARGES FROM THE 
MOUTH AND NOSE, 
* Diphtheria. 
* Scarlet fever. 
* Measles. 
* German measles. 
* Whooping cough. 
* Mumps. 
* Pneumonia. 
* Cerebrospinal fever. 
* Influenza. 
* Tuberculosis. 
* Septic sore throat. 
Tonsillitis, acute follicular. 
Leprosy. 
Poliomyelitis, acute. 
Vincent’s angina. 
Note.—Those diseases marked with asterisk are discussed. 
Cerebrospinal fever. 
1. Infective agent: Diplococcus intracellularis meningitidis (the meningococ- 
cus). 
2. Source of infection: Discharges from the nose and mouth of infected per- 
sons. Clinically recovered cases, and healthy persons who have never had the 
disease but have been in contact with cases of the disease or other carriers, act 
as carriers and are found frequently, especially during epidemics. Such healthy 
carriers not uncommonly are found independent of epidemic prevalence of the 
disease. 
3. Mode of transmission: By direct contact with infected persons and carriers, 
and indirectly by contact with articles freshly soiled with the nasal and mouth 
discharges of such persons. 
4. Incubation period: Two or ten days, commonly seven. Occasionally for 
longer periods when a person is a carrier for a time before developing the 
disease. 
5. Period of communicability: During the clinical course of the disease and 
until the specific organism no longer is present in the nasal and mouth dis- 
charges of the patient. The same applies to healthy carriers so far as it affects 
persistence of infectious discharges. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms, confirmed by the 
microscopic and bacteriological examination of the spinal fluid, 
and by bacteriological examination of nasal and pharyngeal 
secretions. 
2. Isolation of infected persons and carriers until the nasopharynx 
is free from the infecting organisms, or, at the earliest, until 
one week after the fever has subsided—while it is not necessary 
to culture the entire personnel of a station, it should be the 
practice of the service to culture all contacts and to isolate the 
positives found among them. 
3. Immunization may prove of value. Immunization by the use of 
vaccine is still in the experimental stage. 
4. Quarantine—None. 
5. Concurrent disinfection of discharges from the nose and mouth 
and of articles soiled therewith. 
G. Terminal disinfection—Cleaning. 
(B) General measures— 
1. Search for carriers among families and associates of recognized 
cases by bacteriological examination of posterior nares of all 
contacts. Carriers should be observed daily. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
241 
6. Methods of control—Continued. 
(B) General measures—Continued. 
2. Education as to personal cleanliness and necessity of avoiding 
contact and droplet infection. 
3. Prevention of overcrowding, such as is common in living quar- 
ters, transportation conveyances, working places, and places of 
public assembly in the civilian population, and in inadequately 
ventilated closed quarters in barracks, camps, and ships among 
military units. 
Diphtheria. 
1. Infectious agent: Bacillus diphtheria (the Klebs-Loeffler bacillus). 
2. Source of infection: Discharge from diphtheritic lesions of nose, throat, 
conjunctiva, vagina, and wound surfaces. Secretions from the nose and 
throat of carriers of the bacillus. 
3. Mode of transmission: Directly by personal contact, indirectly by articles 
freshly soiled with discharges usually from nose and throat or through infected 
milk or milk products. 
4. Incubation period: Usually two to five days, occasionally longer if a 
healthy carrier stage precedes the development of clinical symptoms. 
5. Period of communicability: Until virulent bacilli have disappeared from 
the secretions and the lesions. The persistence of the bacilli after the lesions 
have healed is variable. In fully three-quarters of the cases they disappear 
within two weeks. In 65 per cent of cases the bacilli disappear in four weeks. 
In exceptional cases virulent bacilli remain in the throat and discharges for 
from two to six months. 
6. Methods of conti'ol: 
(A) The infected individual and his environment— 
1. Recognition of the disease—By clinical symptoms with confir- 
mation by bacteriological examination of discharges. 
2. Isolation—Until two cultures from the throat and two from 
the nose, taken not less than 24 hours apart, fail to show the 
presence of diphtheria bacilli. Isolation may be terminated 
if persistent diphtheria bacilli prove avirulent. Where ter- 
mination by culture is impracticable cases may be terminated 
with fair safety as a rule 16 days after onset of the disease. 
3. Immunization—Exposed susceptibles to be promptly immunized 
by antitoxin. (By susceptibles is meant such individuals as are 
found to be nonimmune by the Schick test, i. e., those who give 
a positive reaction.) This procedure is costly and its effective- 
ness difficult to determine. 
4. Quarantine—All exposed persons until shown by bacteriological 
examination not to be carriers. 
5. Concurrent disinfection of all articles which have been in con- 
tact with the patient and all articles soiled by discharges 
from the patient. 
6. Terminal disinfection—At the end of the illness, thorough air- 
ing and sunning of the sick room, with cleaning or renovation. 
(B) General measures— 
1. Pasteurization of milk supply. 
2. Application of the Schick test to all contacts, and immunization 
of all susceptibles. The application of the Schick test to all 
men in the Navy who have been exposed is not always prac- 
ticable and this process is left to the discretion of the in- 
dividual medical officer. 242 
HOSPITAL CORPS HANDBOOK, 
6. Methods of control—Continued. 
(B) General measures—Continued. 
3. Application of the Scliick test to all children. 
4. Immunization by toxin-antitoxin inoculation of all susceptibles. 
5. Determination of presence or absence of carriers among contacts 
and, so far as practicable, in the community at large. 
German measles. 
1. Infectious agent: Unknown. 
2. Source of infection: Secretions of the mouth and possibly of the nose. 
3. Mode of transmission: By direct contact with the patient or with articles 
freshly soiled with the discharges from the nose or throat of the patient. 
4. Incubation period: From 10 to 21 days. 
5. Period of communicability: Eight days from onset of the disease. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms. 
2. Isolation—Separation of the patient from nonimmune children 
and exclusion of the patient from school and public places for 
the period of presumed infectivity. In the Navy all cases of 
German measles should be isolated. 
3. Immunization—None. 
4. Quarantine—None except exclusion of nonimmune children from 
school and public gatherings from the eleventh to the twenty- 
second day from date of exposure to a recognized case. 
5. Concurrent disinfection—Discharges from the nose and throat 
. of the patient and articles soiled by discharges. 
6. Terminal disinfection—Airing and cleaning. 
(B) General measures—None. 
Note.—The reason for attempting to control this disease is that it may be 
confused with scarlet fever during its early stages; each person having symp- 
toms of the disease therefore should be placed under the care of a physician 
and the case should be reported to the local department of health. 
Influenza. 
1. Infectious agent: Unknown and disputed. Evidence for and against the 
Bacterium influenzae is conflicting. 
2. Source of infection: Typical or atypical human cases. 
3. Mode of transmission: By direct or indirect contact with the patient or 
with articles freshly soiled with the discharges from the nose or throat of the 
patient. 
4. Incubation period: From one to three days. 
5. Period of communicability: Indefinite and uncertain. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms. 
2. Isolation—Separation of patients from susceptibles for the period 
of their illness. 
3. Artificial immunization—In the absence of definite knowledge of 
the causative organism, there is no scientific basis for the em- 
ployment of vaccines as a prophylactic measure, a fact which is 
substantiated by the universal failure of the various bacterins 
employed for this purpose in 1919. No methods of artificial ac- 
tive or passive immunization are known at present. 
4. Quarantine—None. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
243 
6. Methods of control—Continued. 
(A) The infected individual and his environment—Continued. 
5. Concurrent disinfection—Of the secretions of the mouth and nose, 
and of articles contaminated therewith. 
6. Terminal disinfection—Cleaning. 
(B) General measures—Education of the public in habits of peisonal 
cleanliness and in the danger of association or contact with those 
showing catarrhal symptoms or with cough. 
Measles. 
1. Infectious agent: A filterable virus. 
2. Source of infection: Buccal and nasal secretions of an infected individual. 
3. Mode of transmission: Directly from person to person; indirectly through 
articles freshly soiled with the buccal and nasal discharges of an infected 
individual. The most easily transmitted of all communicable diseases. 
4. Incubation period: Seven to 18 days; usually 14 days. 
5. Period of communicability: During the period of catarrhal symptoms an! 
until the cessation of abnormal mucous membrane secretions—minimum period 
of seven days; from two days before to five days after the appearance of the 
rash. 
6. Methods of control: Measles is more highly communicable than any of the 
communicable diseases of the respiratory type with the possible exception of 
influenza. It is a difficult disease to control because it is communicable in the 
prodromal or preemptive stage before the disease is recognizable. 
(A) The infected individual and his environment— 
1. Recognition of the disease—As soon as possible by the clinical 
symptoms, special attention being given to slight rise in tem- 
perature, catarrhal inflammation of the throat, nose, and eyes, 
and Koplik’s spots—small bluish-white spots, the size of a pin- 
head, surrounded by a reddish areola on the mucous membrane 
of the cheeks and lips. 
Early detection of every new case with prompt isolation is 
the most important of practicable measures for the suppression 
of an outbreak of measles. Careful daily inspection of the 
entire personnel, or at least all who possibly could have been 
exposed, is a very important preventive measure in this con- 
nection. All members of the crew should be instructed to re- 
port at the sick bay immediately in case any symptom develops 
which may be a prodrome of measles. Hospital corpsmen, chief 
petty officers, and petty officers should be on the alert to see 
that these instructions are carried out. As pointed out by 
Gatewood, in his Naval Hygiene, new cases tend to appear 
during an outbreak in successive crops at intervals of 11 to 
14 days. Special vigilance is indicated toward the end of each 
interval but inspections should be performed with care at all 
times.- 
2. Isolation—During period of communicability and for at least 
seven days after the appearance of the rash. All persons who 
show presumptive signs of developing the disease also should 
be isolated promptly. Every person who has a temperature of 
99.5° F., cough, coryza, or congestion of the conjunctivse should 
be regarded as a suspect. 
3. Management of the case—Measles patients should be isolated in 
quarters that can be ventilated adequately and kept uniformly 
warm. There should be at least 8 feet of separation between 244 
HOSPITAL CORPS HANDBOOK. 
Methods of control—Continued. 
(A) The infected individual and his environment—Continued. 
3. Management of the case—Continued. 
centers of beds, and screens should be placed or strung between 
beds to facilitate cubicle isolation. In the isolation hospital, 
patients whose throats show the presence of haemolytic strep- 
tococci should be removed from the general measles ward and 
isolated in a special group or groups. In any event, patients 
developing pneumonia should be removed from other cases of 
measles and treated separately or in a measles-pneumonia 
ward. Careful bedside disinfection and a rigid cubicle system 
technique of asepsis should be practiced in all cases, including 
the invariable use of caps and gowns and immediate disinfection 
of the hands of the medical officer, hospital corpsman, or other 
person each time after coming in contact with the case. Flies 
must be excluded. Separate gowns should be used for attend- 
ance upon different patients or different groups of patients, 
and gowns should be kept clean by frequent sterilization. It 
is only by minute attention to details that cross infection in 
hospital can be prevented. In view of susceptibility to pneu- 
monia, measles patients should be kept in bed for five days after 
the temperature has returned to normal, and they should be 
retained in hospital, in a convalescent ward, perhaps, for at 
least 10 days after convalescence is established. As a general 
policy, measles patients should be transferred promptly to hos- 
pital. However, in cold and stormy weather a long ambulance 
ride or transfer by boat involves considerable risk. Should it 
be impracticable to avoid such risk the patient should be 
clad warmly; every effort should be made to protect him from 
exposure and to prevent chilling. 
4. Immunization—None. 
5. Quarantine—In civil practice when the exposure has occurred in 
the same household, children who have not had measles should 
be excluded from school until 18 days have elapsed since ap- 
pearance of the rash in the last case. It is permissible in ac- 
cordance with modern ideas to allow a susceptible child to 
continue at school for seven days after the date of appearance 
of earliest symptoms in the first case to which exposed; or, 
in the event of a single known exposure, for seven days from 
that time. The same practice should be followed in the case 
of a susceptible teacher who has been exposed to the disease. 
It is good practice to restrict the movements of other sus- 
ceptible adults, known to have been exposed to measles, during 
the last few days of the incubation period. While often imprac- 
ticable in civil public health work, this measure usually can 
be applied in the Navy and among its civilian employees. Ex- 
posed susceptible persons also should be excluded from all 
public gatherings during the 14-day incubation period. Quaran- 
tine of naval vessels or naval stations in which measles has 
occurred is unnecessary. Definitely determined susceptible 
contacts may be quarantined within the organization. At naval 
training stations, companies of recruits under training, in 
which a case of measles appears, should be segregated from 
other companies, and actual contacts should be separated from 
the rest of the unit. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
245 
6. Methods of control—Continued. 
(A) Tlie infected individual and his environment—Continued. 
6. Concurrent disinfection—All articles soiled with secretions of 
the nose and throat. 
7. Terminal disinfection—Thorough cleansing, airing, and sunning 
of the room occupied by a patient with this disease is all 
that is necessary. Terminal fumigation is of little or no value, 
as the virus of measles does not withstand drying or live long on 
fomites. After 14 days have elapsed there is little danger in 
occupying rooms previously occupied by measles patients. 
(B) General measures— 
1. Daily examination of exposed persons and of persons possibly 
exposed. A nonimmune person exhibiting a rise of temperature 
of 1° or more should be isolated at once pending diagnosis. 
2. Where daily observation of school children by a physician or nurse 
is practicable, schools should not be closed or classes discon- 
tinued. Similar rules should apply in handling enlisted men; 
it should not be necessary to interfere with drills and routine 
training. 
3. Education of the public as to the danger of exposing young chil- 
dren to those exhibiting acute catarrhal symptoms of any kind. 
4. In naval organizations when measles occurs, or is liable to be 
introduced, the personnel should be acquainted with the nature 
of the disease, the character of its prodromal symptoms, and the 
measures necessary to prevent its spread. All necessary instruc- 
tions should be given to the crew verbally and posted on the 
bulletin board. Attention should be paid to the sterilization of 
mess gear and avoidance of the use of drinking utensils and 
other articles in common. 
Mumps. 
1. Infective organism: Unknown. 
2. Source of infection: Secretions of the mouth and possibly of the nose. 
3. Mode of transmission: By direct contact with an infected person or with 
articles freshly soiled with the discharges from the nose or throat of such 
infected persons. 
4. Incubation 'period: From 12 to 26 days. The most common period, 18 days, 
accepted as usual. A period of 21 days is not uncommon. f 
5. Period of communicability: Unknown, but assumed to persist until the 
parotid gland has returned to its normal size. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Inflammation of Steno’s duct may 
be of assistance in recognizing the early stage of the disease. 
The diagnosis usually is made on swelling of the parotid gland. 
2. Isolation—Separation of the patient from nonimmune children 
and exclusion of the patient from school and public places for 
the period of presumed infectivity. 
3. Immunization—None. 
4. Quarantine—Limited to exclusion of nonimmune children from 
school and public gatherings for 21 days after last exposure 
to a recognized case. 
5. Concurrent disinfection—All articles soiled with the discharges 
from the nose and throat of the patient. 
6. Terminal disinfection—None. 
(B) General measures—None. 246 
HOSPITAL CORPS HANDBOOK. 
Pneumonia. 
1. Infectious agent: Various pathogenic bacteria commonly found in the nose, 
throat, and mouth, such as the pneumococcus, the bacillus of Freidlander, the 
influenza bacillus, etc. 
2. Source of infection: Discharges from the mouth and nose of apparently 
healthy carriers, as well as of recognized infected individuals, and articles 
freshly soiled with such discharges. 
3. Mode of transmission: By direct contact with an infected person, or with 
articles freshly soiled with the discharges from the nose or throat of, and pos- 
sibly from infected dust or rooms occupied by, infected person. 
4. Incubation period: Short, usually two to three days. 
5. Period of communicability: Unknown; presumably until the mouth and 
nasal discharges no longer carry the infectious agent in an abundant amount or 
in a virulent form. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms. Specific infecting 
organisms may be determined by serological and bacteriological 
tests early in the course of the disease. 
2. Isolation—Patient during clinical course of the disease. 
3. Immunization—None; vaccines are worthy of further careful trial. 
4. Quarantine—None. 
5. Concurrent disinfection—Discharges from the nose and throat of 
the patient. 
6. Terminal disinfection—Thorough cleaning, airing, and sunning. 
(B) General measures—In institutions and camps, when practicable, 
people in large numbers should not be congregated closely within 
doors. The general resistance should be conserved by getting good 
feeding, fresh air, temperance in the use of alcoholic beverages, 
and other hygienic measures. 
Note.—The early reporting of pneumonia is highly desirable in view of its 
communicability and the possibility of effective treatment of certain types with 
curative serums. 
Scarlet fever. 
1. Infectious agent: Unknown. 
2. Source of infection: The belief at present is that the virus is contained 
in the secretions from the nose and throat, in the blood, and in the lymph 
nodes, and that it is given off in the discharges from the mouth, the nose, 
the ears, and from broken-down glands of infected persons. 
3. Mode of transmission: Directly by personal contact with an infected 
person; indirectly by articles freshly soiled. with discharges of an infected 
person, or through contaminated milk. 
4. Incubation period: Two to seven days, usually three or four days. 
5. Period of communicability: Four weeks from the onset of the disease, 
without regard to desquamation, and until all abnormal discharges have stopped 
and all open sores have healed. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—By clinical symptoms. 
2. Isolation—In home or hospital, maintained in each case until 
the end of the period of infectivity. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
247 
6. Methods of control—Continued. 
(A) The infected individual and his environment—Continued. 
3. Quarantine—Exclusion of exposed susceptible children and teach- 
ers from school, and food handlers from their work, until seven 
days have elapsed since last exposure to a recognized case. 
In the Navy it is not considered necessary to quarantine groups 
of men who have been exposed to an infected individual. 
4. Concurrent disinfection—Of all articles which have been in contact 
with a patient and all articles soiled with discharges of the patient. 
5. Terminal disinfection—Thorough cleaning. 
(B) General measures: 
1. Daily examination of exposed children and of other possibly 
exposed persons for a week after last exposure. 
2. Schools should not be closed where daily observation of the chil- 
dren by a physician or nurse can be provided for. 
3. Education as to special danger of exposing young children to 
those exhibiting acute catarrhal symptoms of any kind. 
4. Pasteurization of milk supply. 
Septic sore throat. 
1. Infectious agent: Streptococcus (haemolytic type). 
2. Source of infection: The human nasopharynx, usually the tonsils, any 
case of acute streptococcus inflammation of these structures being a potential 
source of infection, including the period of convalescence of such cases. The 
udder of a cow infected by the milker is an occasional source of infection. In 
such udders the physical signs of mastitis are usually absent. 
3. Mode of transmission: Direct or indirect human contact; consumption 
of raw milk from an infected udder. 
4. Incubation period: One to three days. 
5. Period of communicability: In man, presumably during the continuance of 
clinical symptoms; in the cow, during the continuance of discharge of the 
streptococci in the milk, the condition in the udder tending to a spontaneous sub- 
sidence. The carrier stage may follow convalescence and persist for some time. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms. Bacteriological 
examination of the lesions or discharges from the tonsils and 
nasopharynx may be useful. 
2. Isolation—During the clinical course of the disease and convales- 
cence, and particularly exclusion of the patient from partici- 
pation in the production or handling of milk or milk products. 
3. Immunization—None. 
4. Quarantine—None. 
5. Concurrent disinfection—Articles soiled with discharges from 
the nose and throat of the patient. 
6. Terminal disinfection—Cleaning. 
(B) General measures— 
1. Exclusion of suspected milk supply from public sale or use until 
pasteurized. The exclusion of the milk of an infected cow or 
cows in small herds is possible when based on bacteriological 
examination of the milk of each cow, and preferably the milk 
from each quarter of the udder at frequent intervals. 
2. Pasteurization of all milk. 
3. Education in the principles of personal hygiene and avoidance 
of the use of common towels, drinking and eating utensils. 248 
HOSPITAL CORPS HANDBOOK 
Tuberculosis (pulmonary). 
1. Infectious agent: Bacillus tuberculosis (human). (In rare instances the 
bovine tubercle bacillus has been proved to be the cause of a pulmonary tuber- 
culosis.) 
2. Source of infection: The specific organism present in the discharges, or 
articles freshly soiled with the discharges from any open tuberculous lesions, 
the most important discharge being sputum. Of less importance are discharges 
from the intestinal and genito-urinary tracts, or from lesions of the lymphatic 
glands, bone, and skin. 
3. Mode of transmission: Direct or indirect contact with an infected person 
by coughing, sneezing, or other droplet infection, kissing, common use of un- 
sterilized food utensils, pipes, toys, drinking cups, etc., and possibly by con- 
taminated flies and dust. 
4. Incubation period: Variable and dependent upon the type of the disease. 
5. Period of communicability: Exists as long as the specific organism is 
eliminated by the host. Commences when a lesion becomes an open one—i. e., 
discharging tubercle bacilli—and continues until it heals or death occurs. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—By clinical symptoms and by thorough 
physical examination, confirmed by bacteriological examination 
and by serological tests. 
2. Isolation of such “ open ” cases as do not observe the precau- 
tion necessary to prevent the spread of the disease. 
3. Immunization—None. 
4. Quarantine—None. 
5 Concurrent disinfection of sputum and articles soiled with 
it. Particular attention should be paid to prompt disposal or 
disinfection of sputum itself, of handkerchiefs, cloths, or paper 
soiled therewith, and of eating utensils used by the patient. 
6. Terminal disinfection—Cleaning and renovation. 
(B) General measures— 
1. Education of the public in regard to the dangers of tuberculosis 
and the methods of control, with especial stress upon the danger 
of exposure and infection in early childhood. 
2. Provision of dispensaries and visiting-nurse service for discovery 
of early cases and supervision of home cases. 
3. Provision of hospitals for isolation of advanced cases and sana- 
toria for the treatment of early cases. 
4. Provision of open-air schools and preventoria for pretuberculous 
children. ; ' 
5. Improvement of housing conditions and the nutrition of the poor. 
6. Ventilation and elimination_of dusts in industrial establishments 
and places of public assembly. 
7. Improvement of habits of personal hygiene and betterment of 
general living conditions. 
8. Separation of babies from tuberculous mothers at birth. 
Tuberculosis (other than pulmonary). 
1. Infectious agent: Bacillus tuberculosis (human and bovine). 
2. Source of infection: Discharges from mouth, nose, bowels, and genito- 
urinary tract of infected humans; articles freshly soiled with such discharges; 
milk from tuberculous cattle; rarely the discharging lesion of bones, joints, 
and lymph nodes. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
249 
3. Mode of transmission: By direct contact with infected persons, by con- 
taminated food, and possibly by contact with articles freshly soiled with the 
discharges of infected persons. 
4. Incubation period: Unknown. 
5. Period of communicability: Until lesions are healed. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms confirmed by bac- 
teriological and serological examinations. 
2. Isolation—None. 
3. Immunization—None. 
4. Quarantine—None. 
5. Concurrent disinfection—Discharges and articles freshly soiled 
with them. 
6. Terminal disinfection—Cleaning. 
(B) General measures— 
1. Pasteurization of milk and inspection of meats. 
2. Eradication of tuberculous cows from milch herds used in sup- 
plying raw milk. 
3. Patients with open lesions should be prohibited from handling 
foods which are consumed raw. 
Whooping cough. 
1. Infectious agent: Bacillus pertussis (Bordet-Gengou). 
2. Source of infection: Discharges from the laryngeal and bronchial mucous 
membranes of infected persons (sometimes also of infected dogs and cats, 
which are known to be susceptible). 
3. Mode of transmission: Contact with an infected person or animal or with 
articles freshly soiled with the discharges of such person or animal. 
4. Incubation period: Within 14 days. 
5. Period of communicability: Particularly communicated in the early ca- 
tarrhal stages before the characteristic whoop makes the clinical diagnosis 
possible. Communicability probably persists not longer than two weeks after 
the development of the characteristic whoop or approximately four weeks after 
the onset of catarrhal symptoms. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms, supported by a 
differential leucocyte count, and confirmed where possible by 
bacteriological examination of bronchial secretions. 
2. Isolation—Separation of the patient from susceptible children, 
and exclusion of the patient from school and public places for 
the period of presumed infectivity. 
3. Immunization—Use of prophylactic vaccination recommended by 
some observers. Not effective in all cases. 
4. Quarantine—Limited to the exclusion of nonimmune children from 
school and public gatherings for 14 days after their last ex- 
posure to a recognized case. 
5. Concurrent disinfection—Discharges from the nose and throat of 
the patient and articles soiled with such discharges. 
6. Terminal disinfection—Cleaning of the premises used by the 
patient. 250 
HOSPITAL CORPS HANDBOOK. 
6. Methods of control—Continued. 
(B) General measures—Education in habits of personal cleanliness and 
in the dangers of association or contact with those showing ca- 
tarrhal symptoms with cough. 
GROUP II. DISEASES TRANSMITTED BY DISCHARGES FROM THE 
INTESTINAL TRACT. 
* Typhoid fever. | * Dysentery, bacillary. 
* Paratyphoid fever. * Dysentery, amoebic. 
* Hookworm disease. I * Cholera, Asiatic. 
Note.-—Those diseases marked with asterisk are discussed. 
Cholera. 
1. Infectious agent: Spirillum, choleras asiaticce. 
2. Source of infection: Bowel discharges and vomitus of infected persons, and 
faeces of convalescent or healthy carriers. Ten per cent of contacts may he 
found to be carriers. 
3. Mode of transmission: By food and water polluted by the infective agent; 
by contact with infected persons, carriers, or articles freshly soiled by their dis- 
charges ; by flies. 
4. Incubation period: One to five, usually three, days, occasionally longer if 
the healthy-carrier stage, before development of symptoms, is included. 
5. Period of communicability: Usually 7 to 14 days or longer and until the in- 
fective organism is absent from the bowel discharges. 
6. Methods of control: 
(A) Tbe infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms, confirmed by bac- 
teriological examination. 
2. Isolation of patient in hospital or screened room. 
3. Immunization by vaccination may be of value. 
4. Quarantine—Contacts for five days from last exposure, or longer 
if stools are found to contain the cholera vibrio. 
5. Concurrent disinfection—Prompt and thorough disinfection of the 
stools and vomited matter. Articles used by and in connection 
with the patient must be disinfected before removal from the 
room. Food left by the patient should be burned. 
6. Terminal disinfection—Bodies of those dying from cholera should 
be cremated, if practicable, or otherwise wrapped in a sheet 
wet with disinfectant solution and placed in water-tight caskets. 
The room in which a sick patient was isolated should be thor- 
oughly cleaned and disinfected. 
(B) General measures— 
1. Rigid personal prophylaxis of attendants by scrupulous cleanli- 
ness, disinfection of hands each time after handling patient or 
touching articles contaminated by dejecta, the avoidance of eat- 
ing or drinking anything in the room of the patient, and the 
prohibition of those attendant on the sick from entering the 
kitchen. 
2. The bacteriological examination of the stools of all contacts to 
determine carriers. Isolation of carriers. 
3. Water should be boiled, if used for drinking or toilet purposes, or 
if used in washing dishes or food containers, unless the water 
supply is adequately protected against contamination or is so 
treated, as by chlorination, that the cholera vibrio can not sur- 
vive in it. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
251 
6. Methods of control—Continued. 
(B) General measures—Continued. 
4. Careful supervision of food and drink. Where cholera is preva- 
lent, only cooked foods should be used. Food and drink after 
cooking or boiling should be protected against contamination, 
as by flies and human handling. 
(C) Epidemic measures—Inspection service for early detection and iso- 
lation of cases; examination of persons exposed in infected centers 
for detection of carriers, with isolation or control of carriers; 
disinfection of rooms occupied by the sick; and the detention, 
in suitable camps for five days, of those desirous of leaving for 
another locality. Those so detained should be examined for de- 
tection of carriers. 
Dysentery (amoebic). 
1. Infectious agent: Amoeba histolytica. 
2. Source of infection: The bowel discharges of infected persons. 
3. Mode of transmission: By drinking contaminated water, and by eating 
infected foods, and by hand-to-mouth transfer of infected material; from 
objects soiled with discharges of an infected individual, or of a carrier, by 
flies. 
4. Incubation period: Unknown. 
5. Period of communicability: During course of disease and until repeated 
microscopic examination of stools shows absence of Amoeba histolytica. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms confirmed by mi- 
croscopic examination of stools. 
2. Isolation—None. 
3. Immunization—None. 
4. Quarantine—None. 
5. Concurrent disinfection of the bowel discharges. 
6. Terminal disinfection—Cleaning. 
(B) General measures— 
1. Boil drinking water, unless the supply is known to be free from 
contamination. 
2. Water supply should be protected against contamination and 
supervision should be exercised over all foods eaten raw. 
Dysentery (bacillary). 
1. Infectious agent: Bacillus dysenteriw. 
2. Source of infection: The bowel discharges of infected persons. 
3. Mode of transmission: By drinking contaminated water, and by eating 
infected foods, and by hand-to-mouth transfer of infected material; from ob- 
jects soiled with discharges of an infected individual, or of a carrier, by flies. 
4. Incubation period: Two to seven days. 
5. Period of communicability: During the febrile period of the disease and 
until the organism is absent from the bowel discharges. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms confirmed by 
serological and bacteriological tests. 
2. Isolation—Infected individuals during the communicable period 
of the disease. 
47829°—23 17 252 
HOSPITAL CORPS HANDBOOK. 
6. Methods of control—^Continued. 
(A) The infected individual and his environment—Continued. 
3. Immunization—Vaccines give considerable immunity. Owing to 
severe reactions their use is not universal, nor should it be made 
compulsory except under extreme emergency. 
4. Quarantine—None. 
5. Concurrent disinfection—Bowel discharges. 
6. Terminal disinfection—Cleaning. 
(B) General measures— 
1. Rigid personal prophylaxis of attendants upon infected persons. 
2. No milk or food for human consumption should be sold from a 
place occupied by a patient unless the persons engaged therein 
occupy quarters separate from the house where the patient is 
sick, and all utensils used are cleaned and kept in a separate 
building, and under a permit from the health officer. 
3. All attendants upon persons affected with this disease should be 
prohibited from having anything to do with the handling of 
food. 
4. Necessary precautions against flies. 
Hookworm disease. 
1. Infectious agent: Anchylostoma (Necator americanus). (See p. 515.) 
2. Sources of infection: Faeces of infected persons. Infection generally takes 
place through the skin, occasionally by the mouth. 
3. Mode of transmission: The larval forms pierce the skin, usually of the foot, 
and passing through the lymphatics to the vena cava and the right heart, thence 
in the blood stream to the lungs, they pierce the capillary walls and pass into 
the alveoli. Then they pass up the bronchi and trachea to the throat, whence 
they are swallowed and finally lodge in the small intestine. Also by drinking 
water containing larvae, by eating soiled food, by hand to mouth transmission 
of the eggs or larvae from objects soiled with infected discharges. 
4. Incubation period: Seven to ten weeks. 
5. Period of communicability: As long as the parasite or its ova are found in 
the bowel discharges of an infected individual. Contaminated soil remains in- 
fective for five months in the absence of freezing. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Microscopic examination of bowel dis- 
charges. 
2. Isolation—None. 
3. Immunization—None. 
4. Quarantine—None. 
5. Concurrent disinfection—Sanitary disposal of bowel discharges. 
6. Terminal disinfection—None. 
7. Treatment—Appropriate treatment of infected individual to rid 
the intestinal canal of the parasite and its ova. 
8. Examination of all men recruited from the Southern States and 
the Philippines. 
(B) General measures— 
1. Education as to dangers of soil pollution. 
2. Prevention of soil pollution by installation of sanitary disposal 
systems for human discharges. 
3. Personal prophylaxis by cleanliness and the wearing of shoes. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
253 
Paratyphoid fever. 
1. Infectious agent: Bacillus paratyphosus A or B. 
2. Source of infection: Bowel discharges and urine of infected persons, and 
foods contaminated with such discharges of infected persons or of healthy 
carriers. Healthy carriers may be numerous in an outbreak. 
3. Mode of transmission: Directly by personal contact; indirectly by contact 
with articles freshly soiled with the discharges of infected persons or through 
milk, water, or food contaminated by such discharges. 
4. Incubation period: Four to ten days; average, seven days. 
5. Period of communicability: From the appearance of prodromal symptoms, 
throughout the illness and relapses, during convalescence, and until repeated 
bacteriological examinations of discharges show absence of the infecting or- 
ganism. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms, confirmed by 
specific agglutination test, and by bacteriological examination 
of blood, bowel discharges, or urine. 
2. Isolation—In fly-proof room, preferably under hospital conditions, 
of such cases as can not command adequate sanitary environ- 
ment and nursing care in their homes. 
3. Immunization of exposed susceptibles—Navy regulations require 
that all men shall be immunized against paratyphoid fever. 
4. Quarantine—None. 
5. Concurrent disinfection—Disinfection of all bowel and urinary dis- 
charges and articles soiled with them. 
6. Terminal disinfection—Cleaning. 
(B) General measures— 
1. Purification of public water supplies. 
2. Pasteurization of public milk supplies. 
3. Supervision of other food supplies and of food handlers. 
4. Prevention of fly breeding. 
5. Sanitary disposal of human excreta. 
6. Extension of immunization by vaccination as far as practicable. 
7. Supervision of paratyphoid carriers and their exclusion from the 
handling of foods. 
8. Systematic examination of fecal specimens from those who have 
been in contact with recognized cases to detect carriers. 
9. Exclusion of suspected milk supplies pending discovery of the 
person or other cause of contamination of the milk. 
10. Exclusion of water supply, if contaminated, until adequately 
treated with hypochlorite or other efficient disinfectant, or un- 
less all water used for toilet, cooking, and drinking purposes 
is boiled before use. (See p. 291.) 
Typhoid fever. 
1. Infectious agent: Bacillus typhosus. 
2. Source of infection: Fsecal discharges and urine of infected individuals. 
Healthy carriers are common. 
3. Mode of transmission: Conveyance of the specific organism by direct or 
indirect contact with a source of infection. Among indirect means of trans- 
mission are contaminated water, milk, and shellfish. Contaminated flies have 
been common means of transmission in epidemics. 
4. Incubation period: From 7 to 21 days, averaging 10 to 14 days. 254 
HOSPITAL CORPS HANDBOOK. 
5. Period of communicability: From the appearance of prodromal symp- 
toms throughout the illness and relapses during convalescence and until re- 
peated bacteriological examinations of the discharges show persistent absence 
of the infecting organism. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms, confirmed by 
specific agglutination test and bacteriological examination of 
blood, bowel discharges, or urine. 
2. Isolation—In fly-proof room, preferably under hospital condi- 
tions, of such cases as can not command adequate sanitary 
environment and nursing care in their homes. 
3. Immunization—Of susceptibles who are known to have been ex- 
posed or are suspected of having been exposed. Navy regula- 
tions require that all men shall be immunized against typhoid 
fever. 
4. Quarantine—None. 
5. Concurrent disinfection—Disinfection of all bowel and urinary 
discharges and articles soiled with them. 
6. Terminal disinfection—Cleaning. 
(B) General measures— 
1. Purification of public water supplies. 
2.. Pasteurization of public milk supplies. 
3. Supervision of other food supplies and of food handlers. 
4. Prevention of fly breeding. 
5. Sanitary disposal of human excreta. 
6. Extension of immunization by vaccination as far as practicable. 
7. Supervision of typhoid carriers and their exclusion from the 
handling of foods. 
8. Systematic examination of faecal specimens from those who have 
been in contact with recognized cases to detect carriers. 
9. Exclusion of suspected milk supplies pending discovery of the per- 
son or other cause of contamination of the milk. 
10. Exclusion of water supply, if contaminated, until adequately 
treated with hypochlorite or other efficient disinfectant, or 
unless all water used for toilet, cooking, and drinking purposes 
is boiled before use. 
GROUP III. DISEASES TRANSMITTED BY INSECTS AND OTHER 
ARTHROPODS. 
* Dengue. Relapsing fever 
* Malaria. Pappataci fever. 
* Plague. Oriental sore. 
* Typhus fever. Tsutugamucbi fever. 
* Yellow fever. Kala-azar. 
Filariasis. Histoplasmosis. 
Trench fever. Rocky Mountain spotted fever. 
Note.—Those diseases marked with asterisk are discussed. 
Dengue. 
1. Infectious agent: Unknown. 
2. Source of infection: The blood of infected persons. 
3. Mode of transmission: By the bite of infected mosquitoes, probably Aedes 
ccgypti (perhaps also Culex quinquefasciatus). 
4. Incubation period: Four to five days. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
255 
5. Period of communicability: During the febrile stage of the disease. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms. 
2. Isolation—The patient must be kept in a screened room and 
under mosquito nets. 
3. Immunization—None. 
4. Quarantine—None. 
5. Concurrent disinfection—None. 
6. Terminal disinfection—None. Upon termination of the case 
fumigation of the room and house to destroy mosquitoes. 
(B) General measures— 
Measures directed toward the elimination of mosquitoes. Screen- 
ing of rooms. (See “Malaria.”) 
Malaria. 
1. Infectious agent: The several species of malarial organisms. (See section 
on Animal Parasites of Man.) 
2. Source of infection: The blood of an infected individual. 
3. Mode of transmission: By bite of the infected anopheles mosquito. The 
mosquito is infected by biting an individual suffering from acute or chronic 
malaria. The parasite develops in the body of the mosquito for 10 to 14 
days, after which time the sporozoites appear in its salivary glands. 
4. Incubation period: Varies with the type of species of infecting organism 
and the amount of infection; usually 14 days in the tertian variety. 
5. Period of communicability: As long as the malaria organism exists in the 
blood. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms, always to be con- 
firmed by microscopical examination of the blood. 
2. Isolation—Use of mosquito nets by patient until blood is free of 
malarial parasites. 
3. Immunization—None. 
4. Quarantine—None. 
5. Concurrent disinfection—None. Destroy by capture or swatting 
all mosquitoes in the sick room. 
(B) General measures— 
1. Search for carriers by examination of blood smears. 
2. Screen sleeping and living quarters. 
3. Kill mosquitoes in living quarters. (See pp. 268, 270, 273.) 
4. Destruction of mosquito breeding places by— 
(a) Drainage. 
(ft) Training of watercourses. 
(c) Filling. 
5. Destruction of mosquito larvae. 
(a) Application of thin films of oil to surface of water (by 
drip can or spraying crude oil is best). 
(b) Stocking swamps and pools with species of fish that 
will eat the mosquito larvae. 
(e) Application of Paris green to the surface of the water. 256 
HOSPITAL CORPS HANDBOOK. 
Plague (bubonic, septicaemic, pneumonic). 
1. Infectious agent: Bacillus pestis. 
2. Source of infection: Blood of infected persons and animals and sputum of 
human cases of plague pneumonia. 
3. Mode of transmission: Direct in the pneumonic form. In other forms the 
disease generally is transmitted by the bites of fleas (Xenopsylla cheopis and 
Ceratophyllus fasciatus), by which the disease is carried from rats to man; also 
by fleas from other rodents. Accidental, by inoculation, or by the bites of in- 
fected animals. Bedbugs may transmit the infection; flies possibly may con- 
vey the infection. 
4. Incubation period: Commonly from 3 to 7 days, although occasionally pro- 
longed to 8 or even 14 days. 
5. Period of communicability: Until convalescence is well established, period 
undetermined. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms, confirmed by bac- 
teriological examination of blood, pus from glandular lesion, or 
sputum. 
2. Isolation—Patient in hospital if practicable; if not, in a screened 
room which is free from vermin. 
3. Immunization—Passive immunization of known exposed contacts; 
active immunization of those who may be exposed. 
4. Quarantine—Contacts for seven days. 
5. Concurrent disinfection—All discharges and articles freshly soiled 
therewith. 
♦ 
6. Terminal disinfection—Thorough cleaning followed by thorough 
disinfection. 
(B) General measures— 
1. Extermination of rats and vermin by use of known methods for 
their destruction; destruction of rats on ships arriving from 
infected ports; examination of rats, ground squirrels, etc., in 
areas where the infection persists, for evidence of endemic prev- 
alence of the disease among them. 
2. Supervision of autopsies of all deaths during epidemics. 
3. Supervision of the disposal of the dead during epidemics, whether 
by burial, transfer, or holding in vault, whatever the cause of 
death. 
4. Cremation or burial in quicklime of those dying of this disease. 
Typhus fever. 
1. Infectious agent: Not yet definitely determined. 
2. Source of infection: The blood of infected individuals. 
3. Mode of transmission: Infectious agent transmitted by lice. 
4. Incubation period: Five to twenty days; usually twelve days. 
5. Period of communicability: Until 36 hours have elapsed after the tempera- 
ture reaches normal. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms. (Confirmation by 
bacteriological examination of blood is claimed by Plotz.) 
Finding of Rickettsia bodies. 
2. Isolation—In a vermin-free room. All attendants should wear 
vermin-proof clothing. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
257 
6. Methods of control—Continued. 
(A) The infected individual and his environment—Continued. 
3. Immunization—Claimed to be practicable by use of vaccine (Plotz, 
Olitzky, and Baehr). Not yet generally accepted. 
4. Quarantine—Exposed susceptibles for 12 days after last exposure. 
5. Concurrent disinfection—None. 
6. Terminal disinfection—Destroy all vermin and vermin eggs on 
body of patient, if not already accomplished. Destroy all vermin 
and eggs on clothing. Rooms to be rendered free from vermin. 
(B) General measures—Delousing of persons, clothing, and premises 
during epidemics, or when they have come or have been brought 
into an uninfected place from an infected community. 
Yellow fever. 
1. Infectious agent: Leptospira icteroides. 
2. Source of infection: The blood of infected persons. 
3. Mode of transmission: By the bite of infected aedes cegypti mosquitoes. 
4. Incubation period: Three to five days; occasionally six days. 
5. Period of communicability: First three days of the fever. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms. 
2. Isolation—Isolate from mosquitoes in a special hospital ward or 
thoroughly screened rooms. If necessary, the room or ward 
should be freed from mosquitoes by fumigation. Isolation neces- 
sary only for the first three days of the fever. 
3. Immunization—None. Noguchi claims that he has produced a 
serum which has value as an immunizing agent. 
4. Quarantine—Contacts for six days. 
5. Concurrent disinfection—None. 
6. Terminal disinfection—None. Upon termination of case the prem- 
ises should be rendered free from mosquitoes by fumigation. 
(B) General measures— 
1. See general measures for malaria. 
2. Since the habits of aedes segypti differ from those of anophelines, 
some difference in the water accumulations attacked must be 
noted. The aedes segypti is a species that lives closely in as- 
sociation with man, breeding largely in artificial accumula- 
tions of water close to dwellings, such as cisterns, barrels, and 
cans. It is diurnal (daytime) in its first feeding and later 
nocturnal. It is never found in marshes or swamps, so that at- 
tention need not be given to these, unless a simultaneous at- 
tack on malaria is also desired. 
GROUP IV. DISEASES TRANSMITTED BY DIRECT CONTACT. 
* Venereal diseases. 
Yaws. 
I Impetigo contagiosa. 
I Ring worm. 
Note.—Those diseases marked with asterisk are discussed. 
Chancroid. 
1. Infectious agent: Bacterium ulceris chancrosi. 
2. Source of infection: Pus and secretion from the chancroid itself. 
3. Mode of transmission: By direct contact with infected persons. Almost 
invariably through sexual intercourse. Possibly in other ways. Indirectly as 
mentioned in syphilis. 
4. Incubation period: Usually within 5 days; always within 10 days. 258 
HOSPITAL CORPS HANDBOOK. 
5. Period of communicability: During continuance of specific organism and 
lesion. 
6. Method of control: 
(A) The infected individual and his environment—Same as for syphilis. 
(B) General measures—Same as for syphilis. 
Gonorrhoea. 
1. Infectious agent: Gonococcus. 
2. Source of infection: Discharges from lesions or inflamed mucous mem- 
branes and glands of infected persons, viz., urethral, vaginal, cervical, con- 
junctival mucous membranes, and Bartholin’s or Skene’s glands in the female, 
and Cowper’s and the prostate glands in the male. 
3. Mode of transmission: By direct personal contact with infected persons, 
almost invariably through sexual intercourse, and indirectly by contact with 
articles freshly soiled with the discharges of such persons. 
4. Incubation period: One to eight days, usually three to five days. 
5. Period of communicability: As long as the gonococcus persists in any of 
the discharges, whether the infection be an old or a recent one. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms, confirmed by bac- 
teriological examination or serum reaction. 
2. Isolation—When the lesions are in the genito-urinary tract, ex- 
clusion from sexual contact, and when the lesions are con- 
junctival, exclusion from school or contact with children, as 
long as the discharges contain the infecting organism. In the 
Navy restriction of liberty until gonococcus disappears from dis- 
charges. 
3. Immunization—None. 
4. Quarantine—None. 
5. Concurrent disinfection—Discharges from lesions and articles 
soiled therewith. 
6. Terminal disinfection—-None. 
(B) General measures— 
1. Education in matters- of sex hygiene, particularly as to the fact 
that continence in both sexes at all ages is compatible with 
health and development. 
2. Provision for accurate and early diagnosis, and treatment in 
hospitals and dispensaries of infected persons with considera- 
tion for privacy of record and provision for following cases 
until cured. 
3. Repression of prostitution by use of police power and control 
of use of living premises. 
4. Restriction of sale of alcoholic beverages. 
5. Restrictions of advertising' of services or medicines for the 
treatment of sex diseases, etc. 
6. Elimination of common towels and toilet articles from public 
places. 
7. Use of prophylactic silver solution in the eyes of the new born. 
8. Exclusion of persons in the communicable stage of the disease 
from participation in the preparing and serving of food. PEEYENTIYE MEDICINE, HYGIENE, AND SANITATION. 
259 
6. Methods of control—Continued. 
(B) General measures—Continued. 
9. Personal prophylaxis should be advised to those who expose 
themselves to opportunity for infection. In the Navy personal 
prophylaxis is given in the following manner: 
(a) Prophylactic tubes containing calomel 33, camphor 
2, phenol 3, anhydrous lanolin 39, benzoinated lard 
20, and beeswax 3, to be used immediately after 
exposure, are furnished upon application. 
(5) Ship’s prophylaxis given in the following manner: 
1. Thoroughly wash the parts with soap and water, 
and then with a 1:5,000 solution of bichloride 
of mercury. 
2. Instruct the man to pass urine before taking 
prophylactic treatment. 
3. Inject 2 per cent protargol solution (or 10 per cent 
argyrol or 10 per cent silvol) into anterior 
urethra with syringe and hold meatus closed 
for five minutes. (About one-half fluidounce of 
solution used.) 
4. Thoroughly apply a liberal amount of calomel 
ointment (33 per cent calomel powder by weight 
in adeps lame liydrosus) to penis and scrotum. 
5. Instruct the man not to wash or wipe the oint- 
ment off; for several hours. 
Syphilis. 
1. Infectious agent: Treponema pallidum. 
2. Source of infection: Discharges from the lesions of the skin and mucous 
membranes, and the blood of infected persons, and articles freshly soiled with 
such discharges or blood in which the Treponema pallidum is present. 
3. Mode of transmission: By direct personal contact with infected persons, 
usually through sexual intercourse, and indirectly by contact with discharges 
from lesions or with the blood of such persons. 
4. Incubation period: About three weeks. (In rare instances reported to have 
been as long as 70 days.) 
5. Period of communicability: As long as the lesions are open upon the skin or 
mucous membranes and until the body is freed from the infecting organisms, 
as shown by microscopic examination of material from ulcers and by serum 
reaction. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms, confirmed by 
microscopical examination of discharges and by serum reactions. 
2. Isolation—Exclusion from sexual contact and from preparation or 
serving of food during the early and active period of the dis- 
ease ; otherwise none, unless the patient is unwilling to heed 
or is incapable of observing the precautions required by the 
medical adviser. In the Navy restriction of men’s liberty must 
be enforced as long as there are open lesions. 
3. Immunization—None. 
4. Quarantine—None. 
5. Concurrent disinfection—Of discharges and of articles soiled 
therewith, including mess gear. 
6. Terminal disinfection—None. 260 
HOSPITAL CORPS HANDBOOK. 
6. Methods of control—Continued. 
(B) General measures— 
1. Education in matters of sexual hygiene, particularly as to the 
fact that continence in both sexes at all ages is compatible with 
health and development. 
2. Provision for accurate and early diagnosis and treatment, in 
hospitals and dispensaries, of infected persons, with considera- 
tion for privacy of record, and provision for following cases 
until cured. 
3. Repression of prostitution by use of the police power and control 
of use of living premises. 
4. Restriction of sale of alcoholic beverages. 
5. Restriction of advertising of services or medicine for treatment 
of sex diseases, etc. 
6. Abandonment of the use of common towels, cups, and toilet 
articles and eating utensils, unless sterilized after use. 
7. Exclusion of persons in the communicable stage of the disease 
from participation in the preparing and serving of food. 
8. Personal prophylaxis should be advised to those who expose them- 
selves to opportunity to infection. Personal prophylaxis in the 
Navy is given in the following manner: 
(a) See “gonorrhoea,” page 259. 
(b) See “gonorrhoea,” page 259. 
GROUP V. DISEASES OF LOWER ANIMALS WHICH MAY BE TRANS- 
MITTED TO MAN. 
* Rabies. 
Glanders. 
Anthrax. 
Malta fever. 
Foot-and-mouth-disease. 
Actinomycosis. 
Milk sickness. 
* Trichinosis. 
Note.—Those diseases marked with asterisk are discussed. 
Rabies. 
1. Infectious agent: Unknown. 
2. Source of infection: Saliva of infected animals, chiefly dogs. 
3. Mode of transmission: Inoculation with saliva of infected animals through 
abrasion of skin or mucous membrane, almost always by bites or scratches. 
4. Incubation period: Usually two or six weeks. May be prolonged to six 
months or even longer. 
5. Period of communicability: For 15 days in the dog (not known in man) 
before the onset of clinical symptoms and throughout the clinical course of 
the disease. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms, confirmed by the 
presence of Negri bodies in the brain of an infected animal, 
or by animal inoculations with material from the brain of 
such infected animal. 
2. Isolation—None if patient is under adequate medical supervision 
and the immediate attendants are warned of possibility of 
inoculation by human virus. 
3. Immunization—Preventive vaccination (Pasteur treatment) after 
exposure to infection by inoculation. 
4. Quarantine—None. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
261 
6. Methods of control—Continued. 
(A) The infected individual and his environment—Continued. 
5. Concurrent disinfection of saliva of patient and articles soiled 
therewith. 
6. Terminal disinfection—Thorough cleaning. 
(B) General measures— 
1. Muzzling of dogs when on public streets or in places to which the 
public has access. 
2. Detention and examination of dogs suspected of having rabies. 
3. Immediate antirabic treatment of people bitten by dogs or by 
other animals suspected or known to have rabies, unless the 
animal is proved not to be rabid by subsequent observation or 
by microscopic examination of the brain and cord. 
Trichinosis. 
1. Infectious agent: Trichinella spiralis. 
2. Source of infection: Uncooked or insufficiently cooked meat of infected hogs. 
3. Mode of transmission: Consumption of undercooked infected pork products. 
4. Incubation period: Variable; usually about one week. 
5. Period of communicability: Disease is not transmitted by human host. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms, confirmed by 
microscopical examination of muscle tissue containing trichinae. 
2. Isolation—None. 
3. Immunization—None. 
4. Quarantine—None. 
5. Concurrent disinfection—Sanitary disposal of the faeces of the 
patient. 
6. Terminal disinfection—None. 
(B) General measures— 
1. Inspection of pork products for the detection of trichinosis. 
2. Thorough cooking of all pork products at a temperature of 100° 
F. or over. 
GROUP VI. MISCELLANEOUS DISEASES. 
* Chicken pox. 
* Smallpox. 
I * Tetanus. 
| * Trachoma. 
Note.—Those diseases marked with asterisk are discussed. 
Chicken pox. 
1. Infectious agent: Unknown. 
2. Source of infection: The infectious agent is presumably present in the 
lesions of the skin and of the mucous membranes; the latter appearing early 
and rupturing as soon as they appear, render the disease communicable early, 
that is, before the exanthem is in evidence. 
3. Mode of transmission: Directly from person to person; indirectly through 
articles freshly soiled by discharges from an infected individual. 
4. Incubation period: Two to three weeks. 
5. Period of communicability: Until the primary scabs have disappeared from 
the mucous membranes and the skin. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms. The differential 
diagnosis of this disease from smallpox is important, especially 
in people over 15 years of age. 262 
HOSPITAL CORPS HANDBOOK. 
6. Methods of control—Continued. 
(A) The infected individual and his environment—Continued. 
2. Isolation—Exclusion of patient from school, and prevention of 
contact with nonimmune persons. 
3. Immunization—None. 
4. Quarantine—None. 
5. Concurrent disinfection of articles soiled by discharges from 
lesions. 
6. Terminal disinfection—Thorough cleaning. 
(B) General measures—None. 
Smallpox. 
1. Infectious agent: Unknown. 
2. Source of infection: Lesions of the skin and mucous membranes of in- 
fected persons. 
3. Mode of transmission: By direct personal contact; by articles soiled with 
discharges from lesions. The virus may be present in all body discharges, 
including faeces and urine. It may be carried by flies. 
4. Incubation period: Ten to fourteen days. (Cases with incubation period 
of 21 days are reported.) 
5. Period of communicability: From first symptoms to disappearance of all 
scabs and crusts. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms. Tests for im- 
munity may prove useful. 
2. Isolation—Hospital isolation in screened wards, free from vermin, 
until the period of infectivity is over. 
3. Immunization—Vaccination is made compulsory by the Navy 
Regulations. 
4. Quarantine—Segregation of all exposed persons for 21 days from 
date of last exposure, or until protected by vaccination. 
5. Concurrent disinfection of all discharges and articles soiled there- 
with. 
6. Terminal disinfection—Thorough cleaning and disinfection of 
premises. 
(B) General measures—General vaccination in infancy, revaccination of 
children on entering school, and of entire population when the 
disease is prevalent. Medical officers must carry out the pro- 
cedure of vaccination with greatest care. 
Methods of Vaccination. 
Vaccination should be performed on the outer surface of the upper arm 
opposite the insertion of the deltoid muscle. The skin at the site of the opera- 
tion should be cleansed with warm water and alcohol and should be allowed 
to dry before the vaccine is applied. A drop of vaccine then should be placed 
on the skin and introduced through the epidermis, but not through the cutis, 
in one of the following ways, all of which are acceptable. The vaccine should 
be allowed to dry before the clothing is replaced. A dressing is not necessary. 
Incision.—With a point of a needle or scalpel two or three small incisions 
not more than one-eighth of an inch in length and at least an inch apart are 
made through the drop of vaccine. The incision or scratch should not be deep 
enough to draw blood. Cross incisions or multiple incisions must not be em- 
ployed under any circumstances. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
263 
Puncture.—A sterile needle is held nearly parallel with the skin and the 
point pressed through a drop of virus so as to make about six oblique pricks 
or shallow punctures through the epidermis to the cutis, but not deep enough 
to draw blood. The punctures should be confined to an area not more than 
one-eighth of an inch in diameter. 
Chisel method.—The sharp end of a chisel, not more than one-eighth of an 
inch broad, is held against the tightly stretched skin, and, by a single quick, 
rotary motion, a small, circular portion of epidermis is removed, exposing the 
derma and drawing serum, but not blood. The vaccine virus then is placed 
upon the scarified spot and rubbed in by means of a sterile toothpick. This is 
the preferable method. 
Interpretation of Results of Vaccination. 
A proper interpretation of the reaction following vaccination is necessary. 
Vaccination, properly performed, using fresh, potent virus, will result in one 
of the following reactions: 
Vaccinia or primary reaction.—In a person who has never been vaccinated 
before, or in those in whom immunity has been lost completely, the take should 
give the typical picture known as the primary reaction (vaccinia). Within 
from 24 to 36 hours the vaccination wound heals. For the first two days, which 
is the period of incubation, the site of the little operation remains apparently 
normal. On the third or fourth day a small papule appears on the skin where 
the vaccine virus was introduced. In another day a small vesicle appears on 
the summit of papule. This vesicle gradually increases in size, umbilication 
developing as it enlarges. The umbilication is due to the multilocular nature 
of the vesicle; if pricked with a needle, only that portion of the lymph con- 
tained in the compartment opened will exude. The vesicle develops into a 
pustule by the eighth or tenth day, turning yellowish in color, the skin around 
it becoming more inflamed. In two or three days the pustules dry and a scab 
is formed, which drops off in 10 days or two weeks, leaving a permanent pitted 
scar. 
Vaccinoid or accelerated reaction.—In persons previously vaccinated, or those 
having had smallpox, but who partially have lost their immunity, the accel- 
erated reaction is obtained. The accelerated reaction runs a somewhat more 
rapid course, in which the period of incubation is shortened and in which the 
height of the pustular stage is reached about the sixth or eighth day. All 
signs and symptoms are less severe than in the primary reaction. The result- 
ing scar is much smaller and not so deep. 
Both of the above reactions should be considered as a positive take. 
Immediate reaction (reaction of immunity).—Where the immunity of the 
individual is still present, the immediate reaction will be obtained, which re- 
sembles a cutaneous tuberculin reaction. Within 24 to 48 hours after the in- 
oculation a small reddened papule appears, which fades out by the fourth day 
without producing a vesicle. This reaction is often pronounced and recorded 
as negative, whereas it is in reality an excellent indication that immunity is 
still present. It always should be looked for front 36 to 48 hours after inocula- 
tion. If the papule is delayed until the fifth day, it is indicative of an abortive 
reaction and the operation should be repeated with fresh virus. 
When none of the above reactions are obtained—primary, 5-9 days; acceler- 
ated, 3-5 days; immediate, 24-48 hours—the medical officer should investigate 
the potency of the virus by vaccinating persons who have never been vaccinated 
before. The technique of the operation also should be investigated thoroughly. 264 
HOSPITAL CORPS HANDBOOK. 
Vaccine virus is very liable to lose its potency if it is not kept in a cool place, 
preferably on ice. It should be used immediately after removal from the ice 
box. 
Tetanus. 
1. Infectious agent: Bacillus tetani. 
2. Source of infection: Animal manure, and soil fertilized with animal 
manure, and, rarely, the discharges from infected wounds. 
3. Mode of transmission: Inoculation, or wound infection. 
4. Incubation period: Six to fourteen days, usually nine. 
5. Period of communicability: Patient not infectious except in rare instances 
where wound discharges are infectious. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms; may be confirmed 
bacteriologically. 
2. Isolation—None. 
3. Immunization—By antitoxin, single or repeated injection. 
4. Quarantine—None. 
5. Concurrent disinfection—None. 
6. Terminal disinfection—None. 
(B) General measures— 
1. Supervision of the practice of obstetrics. 
2. Educational propaganda such as “ safety-first ” campaign, and 
safe and sane Fourth of July ” campaign. 
3. Prophylactic use of tetanus antitoxin where wounds have been 
acquired in regions where the soil is known to be heavily con- 
taminated, and in all cases where wounds are ragged or pene- 
trating. 
4. Removal of all foreign matter as early as possible from all wounds. 
5. Supervision of biological products, especially vaccines and sera. 
Trachoma. 
1. Infectious agent: The chief, although not yet known to be the only, infec- 
tious agents are the luemoglobinophilic bacilli, including the so-called. Kocli- 
Weeks bacillus. 
2. Source of infection: Secretions and purulent discharges from the conjunc- 
tive and adnexed mucous membranes of the infected persons. 
3. Mode of transmission: By direct contact with infected persons and in- 
directly by contact with articles freshly soiled with the infective discharges of 
such persons. 
4. Incubation period: Undetermined. 
5. Period of communicability: During the persistence of lesions of the con- 
junctivae and of the adnexed mucous membranes or of discharges from such 
lesions. 
6. Methods of control: 
(A) The infected individual and his environment— 
1. Recognition of the disease—Clinical symptoms. Bacteriological 
examination of the conjunctival secretions and lesions may be 
useful. 
2. Isolation—Exclusion of the patient from general school classes. 
3. Immunization—None. 
4. Quarantine—None. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
265 
6. Methods of control—Continued. 
(A) The infected individual and his environment—Continued. 
5. Concurrent disinfection of discharges and articles soiled there- 
with. 
6. Terminal disinfection—None. 
(B) General measures— 
1. Search for cases by examination of school children, of immigrants, 
and among the families and associates of recognized cases; in 
addition, search for acute secreting disease of conjunctivae and 
adnexed mucous membranes, both among school children and in 
theii; families, and treatment of such cases until cured. 
2. Elimination of common towels and toilet articles from public 
places. 
3. Education in the principles of personal cleanliness and the neces- 
sity of avoiding direct or indirect transference of body dis- 
charges. 
4. Control of public dispensaries where communicable eye diseases 
are treated. 
Summary of Methods Used in the Prevention and Control of Communicable 
Disease. 
1. Public health education. 
2. Early detection of cases and prompt isolation. 
3. Quarantine. 
4. Detection of carriers. 
5. Disinfection and extermination of insects. 
6. Closure of places of public assembly. 
7. Regulation of travel from ship to ship or from shore station to ship. 
8. Sanitary regulation of housing conditions; i. e., number of men living in 
barracks, use of cubicles, proper ventilation, lighting, and heating. 
9. Use of masks, goggles, and gowns. 
10. Application of disinfectants to mucous membranes of the nose and throat, 
genital tract, and eye. 
11. Internal administration of drugs for prophylactic purposes. 
12. Use of vaccine and immune serums. 
13. Destruction or control of animals which are actual or potential carriers 
of disease. 
14. Protection against insect carriers of disease. 
15. Sanitary control of food supplies. 
16. Sanitary disposal of human excreta and refuse. 
17. Sanitary maintenance of purity of water supply. 
DISINFECTION AND DISINFECTANTS. 
Substances used in disinfection are of three classes which are next discussed. 
Physical disinfectants. 
Sunlight.—Direct sunlight will kill pathogenic bacteria after varying times 
of exposure. For instance, plague bacilli are killed in less than an hour, while 
typhoid organisms require six hours’ exposure. The violet and ultra-violet 
rays are the most active, the red and yellow rays being practically inert. 
Burning.—Of unquestioned efficiency but seldom practiced on account of 
expense. 
Boiling.—Very efficient and of wide range of applicability. The articles must 
be wholly immersed for not less than 10 minutes in water actually boiling 266 
HOSPITAL CORPS HAND BOOK. 
(100° C.). The addition of 1 per cent of carbonate of soda renders the process 
applicable to polished steel, cutting instruments, or tools. 
Steam.— (a) Flowing steam (not under pressure) when applied under suit- 
able conditions is an efficient disinfecting agent. The exposure must be con- 
tinued 30 minutes after the temperature has reached 100° C. (Fig. 139.) 
Steam under pressure without vacuum will sterilize, provided the process 
is continued 20 minutes after the pressure reached 15 pounds per square inch. 
The air must be expelled from the apparatus at the beginning of the process. 
If impracticable to obtain the designated pressure, a longer exposure will ac- 
complish the same result. 
The best method of applying steam under pressure is in a special apparatus 
with vacuum attachment, the object of the vacuum apparatus being to expel the 
Fig. 139.—Type of sack steam disinfector operated on a steam line. Note white cloud 
of steam emerging. For full description see Notes on Preventive Medicine for Medical 
Officers, United States Navy, United States Naval Medical Bulletin, September, 1922. 
air and to promote the penetration of the steam. The process is to be con- 
tinued for 20 minutes after the pressure reaches 10 pounds to the square inch. 
A vacuum should be drawn before articles are removed from the sterilizer. 
Clothing, fabrics, textiles, curtains, hangings, etc., may be treated by either 
of the above methods as circumstances may demand. 
Articles injured by steam, such as leather, furs, skins, rubber, trunks, 
valises, hats, and caps, bound books, silks, and fine woolens, should not be dis- 
infected by steam. Such articles should be disinfected by formaldehyde gas 
or any of the agents mentioned below which may be applicable thereto. Those 
which will be injured by wetting should be disinfected by a gaseous agent. 
Clothing, textiles, and baggage which are clean and in good condition but 
suspected of infection, can be disinfected efficiently and least injuriously by 
formaldehyde gas generated by one of the methods described later. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
267 
Textiles which are soiled with discharges of the sick or wThich presumably 
are deeply infected must be disinfected by one of the following methods: 
1. Boiling. 
2. Steam. 
3. Immersion in one of the germicidal solutions. 
Cooking and eating utensils always are to be disinfected by immersion in 
boiling water or by steam. 
Chemical solutions. 
Bichloride of mercury.—As a chemical disinfectant corrosive sublimate or 
bichloride of mercury in solution has been used quite extensively. It lias some 
marked disadvantages, however, which tend to limit its usefulness. It has 
a destructive action on metals and must be placed in wooden, glass, or 
earthenware vessels. It can not be used to disinfect any material containing 
albumin, since it forms inert albuminates. It acts as a mordant and fixes 
stains in soiled fabrics. It is very poisonous and its solutions should not be 
used to disinfect dishes to be used later for serving food. Solutions of bichloride 
of mercury in distilled water after a time become reduced in strength through 
the formation of oxychloride of mercury, and all are incompatible with alkalies 
and their carbonates, limewater, soaps, and most metallic salts. As a disin- 
fectant bichloride of mercury commonly is used in a strength of 1-1,000, adding 
to the water used for solution 2 parts per 1,000 of sodium or ammonium 
chloride. The material to be disinfected should be immersed in the solution 
(contained in an earthenware or wooden vessel) for at least an hour. Walls 
and floors may be scrubbed down with the solution, which should be allowed to 
dry on them. 
Potassium mercuric iodide possesses material advantages as a disinfectant 
over the bichloride. It is a more powerful germicide, does not coagulate al- 
bumin nor cause precipitation with pus or blood unless they are in excess, 
is more penetrating, less irritating to the skin and to wounds, less toxic, and 
does not cause immediate corrosion of metals. Potassium mercuric iodide 
may be prepared by placing 2.9 grams of corrosive mercuric chloride and 8.1 
grams of potassium iodide in a mortar and mixing intimately by trituration 
until the mixture is reduced to a very fine brick-dust powder. This powder 
should be kept dry in a well-stoppered blue bottle and labeled “ Poison.” One 
and one-tenth grams of this mixture equal 1 gram of potassium mercuric 
iodide. To prepare a 1-2,000 solution of potassium mercuric iodide dissolve 
1.1 grams of the potassium mercuric iodide mixture in about 500 c. c. of hot 
water and dilute to 2,000 c. c. 
Carbolic acid (phenol).—The standard solution of carbolic acid is a 5 
per cent solution. To make this solution, pure carbolic acid crystals should be 
melted over a water bath and hot water gradually added. It is an efficient dis- 
infectant and is the standard used for standardizing other disinfectants. Owing 
to its expense other members of the same group have been introduced for gen- 
eral disinfectant purposes. Among the more efficient and convenient of these is 
cresol, as Liquor Cresolis Compound, U. S. P. This may be made by mixing 1 
part of cresol and 1 part of soft soap and letting stand over night. The resulting 
compound makes a perfect solution with water, and a 1 in 20 solution is consid- 
ered equal to a 5 per cent phenol solution. Liquor Cresolis Compound has a dis- 
infectant value of 3 (phenol being 1), lysol 2.12, creolin 3.25, and trikresol 2.62. 
Faeces, urine, sputum, etc., to be disinfected, should remain in contact with an 
equal quantity of the cresol compound in 5 per cent solution for an hour. A 
47829°—23 18 268 
HOSPITAL CORPS HANDBOOK. 
5 per cent solution of the cresol compound is suitable for disinfecting spit kids, 
contaminated clothing, and the walls and decks of compartments. Lysol, 
creolin, cyllin, izal, and trikresol are other members of this group, but are too 
expensive for general use. 
Formalin.—Formalin containing 40 per cent of formaldehyde may be used 
in a 5 per cent solution (commercial formalin 50 c. c., water 950 c. c.) as a 
substitute for bichloride of mercury or carbolic acid, and is useful for the dis- 
infection of surfaces, fabrics, and a great variety of objects, because of its non- 
injurious character. It is also an excellent deodorant. Formalin to act 
efficiently must be in at least a 5 per cent solution. For instance, if a pint of 
ffeces is to be disinfected, 1 pint of a 10 per cent formalin solution should be 
used, the mixture to stand for one hour. 
Lime.—It must be remembered that air-slaked lime is inert as a disinfectant. 
For disinfecting faeces, freshly prepared milk of lime is excellent. It is made 
by mixing unslaked lime with four times its volume of water. An equal 
quantity should be added to the faeces to be disinfected. 
Chlorinated lime.—When chlorinated lime does not contain less than 30 per 
cent of available chlorine, it is an excellent disinfectant. When the package 
containing it is opened there should be a strong odor of chlorine. Its efficacy 
depends on the chlorine it contains in the form of hypochlorite of lime. For 
a working disinfectant solution, add 1 pound to 4 gallons of water. This is 
satisfactory for mopping floors and for disinfecting faeces, sputum, and urine; 
equal parts of the excreta and disinfecting solution being mixed and allowed to 
stand for one hour. 
For chlorination of drinking water see page 290. 
Gaseous disinfectants. 
Sulphur dioxide.—This is a weak germicide, but a potent insecticide; to be 
efficient it requires the presence of moisture. It is only a surface disinfectant 
and is lacking in penetrating properties. An atmosphere containing 4.5 per cent 
can be obtained by burning 5 pounds of sulphur per 1,000 cubic feet of space. 
This amount requires the evaporation or volatilization of about 1 pint of water. 
Under these conditions the time of exposure should be not less than 24 hours 
for bacterial infections. 
The following standards as to strength and exposure for the destruction of 
rats and vermin are quoted from the Quarantine Laws and Regulations of the 
United States. 
1. For mosquito destruction: Two pounds of sulphur per thousand cubic feet 
of space, exposure for one hour. 
2. For destruction of lice: Four pounds of sulphur per thousand cubic feet of 
space, exposure for six hours. 
3. For destruction of rats (fleas) : Three pounds of sulphur per thousand 
cubic feet of space, exposure for six hours. 
The above standards are for superstructure, partially filled storerooms, and 
empty holds. For cargo-laden holds and well-filled storerooms, or in compart- 
ments that are packed with materials, the time of exposure should be doubled. 
The sulphur may be burned in shallow iron pots (Dutch ovens), containing 
not more than 30 pounds of sulphur to each pot; the pots should stand in vessels 
of water. Quicker and better results can be obtained from burning the same 
total amount of sulphur in a number of shallow ovens (Dutch ovens) 5 to 10 
pounds in each, than in a few large ovens. The sulphur pots should be elevated 
from the bottom of the compartment to be disinfected in order to obtain the 
maximum possible percentage of combustion of sulphur. The sulphur should PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
269 
be in a state of fine division. Ignition is accomplished best with alcohol 
(special care being taken with this method to prevent damage to cargo or vessel 
by fire), or the sulphur may be burned in a special furnace, the sulphur dioxide 
being distributed by a power fan. This method is peculiarly applicable to cargo 
vessels. Liquefied sulphur dioxide may be used for disinfection in place of sul- 
phur dioxide generated as above, it being borne in mind that this process will 
require 2 pounds of the liquefied gas for each pound of sulphur, as indicated in 
the above paragraph. (Fig. 140.) 
Sulphur dioxide is especially applicable to the holds of vessels or to compart- 
ments that may be tightly closed and that do not contain objects that would be 
injured by the gas. Sulphur dioxide bleaches fabrics or materials dyed with 
vegetable or aniline dyes. It destroys linen or cotton goods by rotting the fiber 
through the agency of the acids formed. It injures most metals. It is promptly 
destructive to all forms of animal life. This property renders it a valuable 
agent for the extermination of rats, insects, and other vermin. Sulphur dioxide 
is a germicide only in the presence of moisture, and even then will not kill 
spore-bearing organisms. If clothing is washed immediately after sulphur dis- 
infection, the rotting effect will be greatly lessened. If used in spaces contain- 
ing machinery, all metal parts should be coated with vaseline. 
Formaldehyde.—Formaldehyde is effective as a surface disinfectant if 
applied by one of the methods given below. Formaldehyde gas has the advan- 
tage as a disinfectant that it 
does not injure fabrics or most 
colors. It is valueless as an in- 
secticide and fails to kill vermin, 
such as rats, mice, roaches, bed- 
bugs, etc. It is not applicable 
in the disinfection of holds of 
large vessels. Formaldehyde is 
used in the disinfection of rooms, 
clothing, and fabrics, but should not be depended upon for bedding, upholstered 
furniture, mattresses, and the like, wThere deep penetration is required. The 
temperature should be above 50° F., and there should be at least 60 per cent of 
humidity for efficient formaldehyde disinfection. Many formalin solutions do 
not contain 40 per cent formaldehyde, owing to evaporation or deterioration, and 
it is advisable to use a quantity in excess of the amount prescribed in these 
regulations. It is not efficient in cold dry rooms. 
The method of producing formaldehyde gas by pouring formalin on potas- 
sium permanganate is one of the most convenient and efficient of the various 
methods and has replaced largely the more expensive autoclaves and lamps. 
To prepare a room for disinfection, measure the net cubic space and calculate 
the amounts of ingredients required. Allow 500 c. c. of formalin and 250 grams 
of potassium permanganate or 250 grams of barium dioxide for each 1,000 
cubic feet of space. Paste up with paper strips all cracks and openings. Then 
take a pan partly filled with water and place in this a second receptacle of 
glass or metal containing the permanganate or barium dioxide. Then pour 
the formalin from a pitcher or bucket on the permanganate crystals or barium 
dioxide powder. The gas is generated in great amount in a few seconds. The 
receptacle containing the formalin and permanganate or barium dioxide 
should be large enough to contain ten times the volume of formalin, as there 
is a tendency for the mixture to foam over the sides of the container. The 
room or compartment should be closed tightly for 6 to 12 hours and then 
flooded with air, and sunshine if possible. 
Fig. 140.—Burning sulphur. (Mason.) 270 
HOSPITAL CORPS HANDBOOK. 
Another practical method is that of spraying formalin on sheets. The forma- 
lin (40 per cent) should be sprayed on sheets suspended in the room in such a 
manner that the solution remains in small drops on the sheet. Spray not less 
than 10 ounces of formalin (40 per cent) for each 1,000 cubic feet. Used in this 
way a sheet will hold about 5 ounces without dripping or the drops running 
together. The room must be very tightly sealed in disinfecting with this 
process and kept closed not less than 12 hours. The method is limited to rooms 
or compartments not exceeding 2,000 cubic feet. The formalin also may be 
sprayed upon the walls, floors, and objects in the room. 
For single rooms the use of a paraform lamp is quite convenient. Special 
lamps can be obtained to burn the paraform tablets or a pint tin cup will 
suffice for the heating of 1 ounce of paraform. The lamp or alcohol flame 
under the receptacle must not be high enough to ignite the paraform, which 
burns readily and in so doing does not give off formaldehyde gas. One ounce 
of paraform is sufficient for a space of 500 cubic feet. One can dissolve 2 
ounces of paraform in 8 ounces of boiling water and then pour this over 4 
ounces of potassium permanganate in a 2-gallon pail. 
Hydrocyanic acid gas.—Hydrocyanic-acid gas is the most penetrating and 
the most toxic of all fumigants. As an insecticide it is superior to all other 
gases, but it is not efficient as a germicide. It is generated easily and quickly, 
requires very little apparatus, is not destructive to inanimate objects, and in 
the hands of experienced operators and safeguarded by certain precautionary 
measures its use is not attended by unusual dangers. It will penetrate into 
the interior of porous bodies such as mattresses, hammocks, and bags in a short 
time, and in a longer time into closed drawers, trunks, and other containers 
having pervious joints and cracks. Those engaged in the work must be properly 
equipped and supervised with reasonable skill and care or fatalities are liable 
to result. 
Hydrocyanic-acid gas is generated by the mixture of water, sulphuric acid, 
and a cyanide salt (either potassium or sodium) in the following proportions: 
1. To each ounce of potassium cyanide, 1 fluid ounce of commercial sulphuric 
acid 66 B (degrees Baume) and 2J fluid ounces of water shall be used. (Com- 
mercial cyanide of potash not infrequently has a fused chloride blended with 
it. Such preparations should not be used, as the chloride affects the generation 
of the gas.) 
2. To each ounce of sodium cyanide, li ounces of commercial sulphuric acid 
66 B and 2 fluid ounces of water shall be used. All ingredients should be 
weighed and mixed immediately prior to fumigation. 
The strength of cyanide gas and the duration of exposure varies with the 
object sought. The standards in this respect are as follows: 
1. For destruction of mosquitoes: One-half ounce of sodium cyanide per 
thousand cubic feet of space, exposure one-lialf hour. 
2. For destruction of fleas: Two and one-half ounces of sodium cyanide per 
thousand cubic feet of space, exposure one-half hour. This is of academic 
interest only, as in practice ships are not fumigated for flea destruction only, 
but always with the idea of rat destruction as well as flea destruction. 
3. For destruction of rodents (rats and mice) : Five ounces of sodium cyanide 
per thousand cubic feeet of space, exposure for two hours. 
4. For destruction of lice: Ten ounces of sodium cyanide per thousand cubic 
feet of space, exposure for two hours. 
5. For destruction of bedbugs: Five ounces of sodium cyanide per thousand 
cubic feet of space, exposure for one hour. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
271 
The above standards apply to empty holds and superstructures, except store- 
rooms that contain a large quantity of stores. In cargo-laden holds or in well- 
packed storerooms the length of exposure should be doubled. 
The process of fumigation is essentially very simple. The proper quantity 
of sodium or postassium cyanide (preferably contained in a paper bag) is 
dropped into a wooden barrel (preferably of oak), an earthenware crock, or an 
iron bucket (without soldered seams), containing a mixture of sulphuric acid 
and water in the proper proportions. The operator should leave the compart- 
ment as rapidly as possible, tightly closing the entrance to the compartment as 
he leaves. The gas should be allowed to act for from 1 to 48 hours according 
to the circumstances. When the compartment is opened it should be thoroughly 
ventilated before a human being is permitted to enter. A captive animal, such 
as a guinea pig, rat, or cat, should be lowered or put into the compartment for 
a few minutes to determine whether it is safe for a person to enter. 
On account of the great danger to human life from hydrocyanic acid gas the 
entire crew should be removed from the ship during the fumigation process and 
none should be permitted on board until the medical officer having charge of the 
fumigation operations states that it is safe. 
General instructions for fumigation of vessels. 
For computing the air space of a vessel a registered ton should be estimated 
as containing 100 cubic feet. A vessel of 1,000 net tonnage would, therefore, 
contain 100,000 cubic feet of air space in the holds alone, since net tonnage in- 
dicates the cargo carrying capacity in contradistinction to the gross tonnage 
which indicates the ship’s total cubic capacity. The cubic capacity of crews’ 
quarters, cabins, engine room, poop deck, or other above-deck compartments 
have to be computed for each individual compartment. 
The various details in connection with the fumigation of vessels are of an 
importance almost equal to the nature of the fumigant used, and the observa- 
tion of these details to a large extent determine the effectiveness or the in- 
efficiency of the fumigation. All possible care should be observed to see that 
dead space in the vessel is opened up and all practical measures should be 
taken to aid in the diffusion of the fumigating gas; this is especially important 
when sulphur dioxide is used. All dunnage and loose material from the holds 
of a vessel that is not cargo-laden should be arranged in compact order and 
placed on elevated platforms to avoid rat harborage. If sulphur dioxide is 
generated in a furnace and led into the vessel, it should be introduced at the 
lowest point and the hatches left open for a short while so as to permit of the 
escape of air and hasten diffusion of the sulphur fumes. Pipe casing should 
be opened up and from one end of the vessel to the other there should be a 
certain number of limber boards removed so as to permit of penetration of the 
gas into the bilges. Any planked-over spaces between the outer and the inner 
sheathing of a vessel also should be opened freely, and whenever there is dead 
space, it should be opened up so that there will be free circulation of the gas. 
Careful attention should be given to lifeboats, which often are infested by rats 
which resort to these places for water. Preferably, lifeboats should be cleaned 
and flooded by water prior to fumigation of the vessel. Very close attention 
should be given to the poop deck, which is a space frequently containing a 
heterogeneous collection of litter and is generally badly rat infested. In gen- 
eral, the engine room and firerooms do not harbor rats, but in the treatment 
of a plague-infested vessel they should be fumigated. 
The cost of the disinfectants for naval vessels as well as their fumigation is 
a charge against appropriations of the Bureau of Construction and Repair and 
not against those of the Bureau of Medicine and Surgery. 272 
HOSPITAL CORPS HANDBOOK. 
Preparation, of spaces to be disinfected. 
The disinfection of a room requires careful attention to detail on the part 
of those doing the work. The room should be sealed as nearly hermetically as 
possible. The cracks around the doors, transoms, windows, fireplaces, entrances 
of radiator pipes, and heating and ventilating openings should be made air-tight 
by pasting paper over them. (Fig. 141.) For the closure of cracks in the doors, 
windows, and the like, the following has been found to be a useful method: 
Cut strips of newspaper sufficiently wide, say 3 inches, smear green soap over 
them and then paste over the cracks. This will be found to be air-tight and 
has the advantage of dissolving readily with water when it is desired to remove 
the paper after disinfection. Starch paste, flour paste, and the like may be used, 
but green soap is preferable when 
available. The keyhole, voice tubes, 
and the cracks at the meeting rail 
of upper and lower window sashes 
should not be forgotten. Material 
and utensils should be in readi- 
ness to seal the door of exit after 
the operator has started the gener- 
ation of the disinfectant, and hur- 
riedly left the room. 
On board ship the fumigation of 
certain compartments is compara- 
tively easy, and in other cases ex- 
tremely difficult. The presence of 
water-tight doors and air-ports, 
each of which has its rubber gas- 
ket, enables the closure of these 
openings without pasting paper 
over them. The ventilating louvers 
must be tightly closed by sealing 
them up, and care must be taken to 
see that the small triangular open- 
ings which result from the over- 
lapping of steel plates at their 
point of contact with a bulkhead 
are also closed. In staterooms 
the grating at the top for purposes 
of ventilation should be closed. 
Any metal in the room, especially 
brass, should be coated with vase- 
line if sulphur dioxide is to be used. Drawers should be opened and their 
contents shaken out or strung on lines in the room. Bedding should be treated 
similarly to enable the gas to come in contact with all surfaces to be disinfected, 
since the gaseous disinfectants possess little or no penetrating power. 
In large compartments on the gun deck there may be great difficulty in closing 
sufficiently to perform a fumigation. In such case thorough aeration and the 
use of disinfecting solutions will accomplish the desired effect. If the fumi- 
gation of a ship is intended to be general, preparation should be made to com- 
mence the generation of the fumigant almost simultaneously in the various parts 
of the ship. It is desirable to commence at one end of the ship, disinfecting 
one compartment after another and driving rodents and vermin ahead of the 
disinfecting process toward the other end of the ship. Employment of this 
Fig. 141.—For the purpose of .fumigation, all 
cracks around doors and windows except the 
door of exit should be sealed with adhesive 
paper. (Boyd.) PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
273 
method is more apt to result in exterminating vermin than if isolated com- 
partments are fumigated from time to time, the vermin being driven from a 
compartment, seeking refuge in an adjacent one, and returning to infest the 
fumigated one after the process is repeated. 
Destruction of vermin. 
The following agents are useful for the destruction of vermin: 
(a) Hydrocyanic acid gas. (See p. 270.) 
(b) Sulphur dioxide. (See p. 268.) 
(c) Steam. (See p. 266.) 
(d) Oxide of carbon.—The oxides of carbon are efficient to destroy rats, 
but do not kill fleas or other insects. They are obtained by burning carbon, 
coke, or charcoal in special apparatus. The gas as produced consists of about 
5 per cent carbon monoxide, 18 per cent carbon dioxide, and 77 per cent 
nitrogen. Twenty kilos of carbon, coke, or charcoal are used for every 1,000 
cubic meters of space. The gas is allowed to remain in the ship for two 
hours, and from seven to eight hours are allowed for it to leave. This is 
about equivalent to li pounds of carbon (coke) to 1,000 cubic feet of air 
space. As this gas is very fatal to man and gives no warning of its presence, 
being odorless, a small amount of sulphur dioxide should be added to give 
warning of its presence. As it does not kill fleas, it can not be depended on 
for complete work, where there is evidence of plague among rats on the 
vessel, as the infected fleas would infest the rats coming aboard after the 
deratization. 
(e) Pyrethrum.—The fumes of burning pyrethrum may he used to destroy 
mosquitoes when other fumigants are not available or when they can not be 
used. Four pounds per 1,000 cubic feet of space with two hours’ exposure will 
destroy practically all mosquitoes, but precautions should be taken to sweep 
up and destroy any that may have escaped. Pyrethrum stains walls and 
paper, and is the least reliable of the culecides. 
Rats.—Where it is impracticable to exterminate rats by the use of 
hydrocyanic acid gas, funnel gases (carbon monoxide and carbon dioxide 
principally) or sulphur dioxide, an endeavor should be made to elimi- 
nate them' by: (1) Trapping, using a suitable bait, such as cheese, skin 
of a ham, grain, or other food which is not easily obtained by rats. Traps 
should be placed in rat runways or near rat holes and always should be 
placed out of sight. Snap traps are more efficient than cage traps. (2) 
Poisoning—Arsenic in the strength of 25 to 50 per cent by weight, combined 
with corn-meal mush or cooked rice, to which a little sugar or syrup may be 
added, has proven to be very effective. (Poison should not be used when 
other animals or humans are liable to mistake it for food.) A mixture com- 
posed of plaster of Paris 6 parts, pulverized sugar 1 part, and flour 2 parts 
has been used to advantage in the destruction of rats. This should be ex- 
posed in a dry place in open dishes. To attract rats the edge of the dish 
may be smeared with oil in which sardines have been packed. (3) Starva- 
tion. Food should be kept in rat-proof containers and garbage in rat-proof 
metal garbage cans. (4) Rat proofing of houses. (5) Placing rat guards on 
all ship’s lines. 
Fleas.—Fleas may be destroyed by: (1) Hydrocyanic acid gas; (2) sulphur 
dioxide; (3) crude petroleum (fuel oil), kerosene oil, or gasoline; (4) an 
emulsion of kerosene oil made as follows: Kerosene 20 parts, soft soap 1 
part, water 5 parts (the soap is dissolved in the water by aid of heat and the 
kerosene oil gradually stirred in the hot mixture). 
Lice.—Lice may be destroyed by: (1) Dry heat at 60° C., exposure 30 
minutes. (2) Hot water 60° C., exposure 30 minutes. (3) Steam under pres- 274 
HOSPITAL CORPS HANDBOOK. 
sure, exposure 15 minutes. Vacuum should be obtained both before and after 
placing clothes in sterilizer in order that they may be dry when removed. (Ar- 
ticles such as leather, furs, skin, rubber, books, etc., should not be placed in the 
sterilizer.) (4) Steeping for 20 minutes in a 2 per cent solution of equal parts 
of crude carbolic acid and soft soap in water at a temperature not below 50° P. 
(5) Immersion of verminous garments in gasoline, benzine, kerosene, turpen- 
tine, dichlorethylene (Dutch liquid, Dutch oil), or tetrachlorethane (carbon 
bichloride). (The latter two are not inflammable.) 
In addition to the treatment of the clothing of infested persons it is well 
to wash the body with liquid soap, made by boiling soap chips, 1 part, in 4 
parts water, and adding kerosene 2 parts. After this mixture jellies, use by 
mixing 1 part with 4 parts of warm water. 
In the case of a male person infested with pediculus capitis, the hair 
should be clipped short. In the case of a female, the hair should be treated by 
a thorough application of a mixture of equal parts of kerosene oil and vinegar. 
The head then should be covered with a towel and, after a lapse of a half hour, 
washed with warm water and soap. The kerosene kills the lice and the vinegar 
lossens the nits. 
Pediculi pubis should be destroyed by clipping the pubic hairs and by 
application of mercurial ointment (50 per cent) or kerosene oil. 
Cockroaches may be eliminated by: (1) Hydrocyanic acid gas. (2) Sulphur 
dioxide. (3) Steam (4) Sodium fluoride powder, which must be liberally 
sprinkled or blown by means of a powder blower into corners, drawers, closets, 
and other places of concealment. It must be distributed in such a way that 
it will not be swept up or removed. It should be allowed to remain and act 
for weeks at a time. (5) Trapping: A simple form of trap consists of a dish, 
basin, or jar with a stick leading up to the top as a runway from which they 
slip into the trap which has been baited with mucilage or sweetened meal. 
(6) Mixture of kerosene 98 per cent and cresol 2 per cent, which should be 
sprayed into infested places. 
Bedbugs may be eliminated by: (1) Hydrocyanic acid gas. (2) Sulphur 
dioxide. (3) Steam under pressure in a special apparatus with vacuum at- 
tachment is the simplest way of ridding mattresses and bedding of bedbugs. 
(4) Heated air. It has been found that a temperature of 140° F. is sufficient 
to kill bedbugs and their eggs. (5) Kerosene and cresol solution (2% per cent 
in water), equal parts, when properly applied. (6) Turpentine and phenol (95 
per cent solution in water), equal parts, when applied with paint or varnish 
brush. (7) Flaming: Useful for metal beds and springs. (8) Oil of mirbane 
three-fourths ounce, crystallized carbolic acid 1J ounces, kerosene or benzine 
32 ounces. Add the oil of mirbane to the kerosene; stirring slowly. The 
carbolic-acid crystals, after having been liquefied, should be added to the mixed 
oil, stirring rapidly. (9) Sodium chloride (common salt) one-half ounce, 
bichloride of mercury (corrosive sublimate) one-half ounce, water 2 ounces, 
alcohol 2 ounces, spirits of turpentine 6 ounces. 
The above mixtures may be applied with feathers, small brushes, or spray 
syringes. 
MARITIME QUARANTINE. 
Medical officers of ships acting as health officers of the population under 
their charge are required to comply with the quarantine laws of this and 
other countries, and also naval medical officers from time to time are required 
to act as health officers of the port in certain of our colonial possessions. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
275 
Ships arriving in the United States with any of the following diseases on 
hoard are quarantinable, viz., leprosy, cholera, plague, smallpox, yellow fever, 
and typhus fever. 
Alien lepers are not permitted to land. Lepers, if citizens of the United 
States, must he handled in accordance with the local laws in force at the port 
of landing. 
Persons exposed to any of the following diseases should he quarantined for 
the full period of incubation, viz., cholera, 5 days; yellow fever, 6 days; small- 
pox, 18 days; typhus fever, 12 days; plague, 7 days. 
The certificate of a naval medical officer concerning the sanitary conditions 
prevalent on his ship usually is accepted by the health authorities of the port. 
AIR, VENTILATION, HEAT, AND HOUSING. 
Air constitutes a gaseous ocean in which we live; it is made of a mixture of 
gases and is not a chemical compound. The percentage of ingredients of this 
mixture by volume are approximately as follows: Oxygen, 21; nitrogen, 78; 
carbon dioxide, 0.03; argon, 0.94; and traces of such gases as helium, krypton, 
neon, xenon, hydrogen, hydrogen peroxide, ammonia, and ozone. In addition to 
the above there is present in the air varying amounts of water vapor, and there 
are suspended in the air such particles as dust, bacteria, yeasts, etc. 
Air and its relation to health.—Air in relation to health serves two im- 
portant functions, the interchange of gases in respiration and the regulation 
of body temperature. For the part which air plays in our body economy 
through respiration, see aeration of the blood in the chapter on Anatomy and 
Physiology. As described in the chapter on Food and Dietetics, this jxrocess 
of metabolism, which is coexistent with life, results in the creation of tre- 
mendous amounts of heat by our bodies. If there were no means by which this 
heat could be eliminated death soon would result. The means by which the 
heat manufactured by our bodies is eliminated is mainly through the air by 
radiation, conduction, convection, and evaporation (perspiration), which will 
be described in detail later. 
The name “ crowd poisoning ” is applied to the symptoms arising in individ- 
uals when confined in poorly ventilated crowded halls, compartments, and 
rooms, or those symptoms arising in men marching in the center of military 
formation on warm, humid days. Crowd poisoning may be acute or chronic. 
Acute crowd poisoning is closely related to heat stroke and heat exhaustion. 
(See chapter on First Aid and Minor Surgery.) The acute effects of vitiated 
air usually are lassitude, headache, dizziness, nausea, vomiting, and even col- 
lapse ; in extreme cases, death may ensue. The chronic effects, so far as known, 
include anaemia, weakness, and disturbances of digestion. Prolonged exposure 
to vitiated atmosphere influences all our life functions and lowers our resist- 
ance to certain infections, e. g., the pus cocci, the tubercle bacillus, the pneu- 
mococcus, and the microdrgamsnis causing common colds (see lowered resist- 
ance in section on Immunity). When a group of individuals occupy a relatively 
small, poorly ventilated space, there is only a comparatively small decrease of 
oxygen and increase of carbon dioxide before symptoms of crowd poisoning 
appear. It will be shown later that an atmosphere with an oxygen content of 
only 15 per cent, and a carbon dioxide content of 2 to 4 per cent may not be 
harmful. It has been shown that rebreathing of air causes the air to become 
more and more humid, and, of course, the evaporation from our body surfaces 
causes the same thing. Moreover, the humidity of inhabited rooms becomes 
higher and higher. In other words, there is marked change in the physical 276 
HOSPITAL COUPS HANDBOOK. 
conditions of the air. It can be shown that in a room where individuals are 
suffering from “ crowd poisoning,” by lowering the temperature, decreasing 
the humidity, or setting up air currents, the symptoms of crowd poisoning can 
be made to disappear, showing that it is a change in the physical condition of 
the air which is the most important factor jn crowd poisoning, and not, as 
formerly thought, a change in the chemical constituents. 
Chemical constituents of the air and their relation to health.—Oxygen affects 
the combustion of the food eaten and stimulates digestion and metabolism. 
(See chapter on Anatomy and Physiology.) Nitrogen simply acts as a diluent 
for the oxygen and plays no active part in our body economy. Small variations 
in the oxygen content of the air make no special difference in our body func- 
tions ; it may drop to 17 per cent or may rise to 25 per cent or higher, without 
any apparent alteration in our body functions. An atmosphere, however, con- 
taining only 11 to 12 per cent of oxygen becomes dangerous, and 7.2 per cent 
results in death. Localities where the air is liable not to contain a sufficient 
percentage of oxygen to support life are the bottoms of deep wells, in subma- 
rines, and in the double bottoms of ships, especially when these latter have 
been sealed for a long time, and such substances as red lead and linseed oil 
have consumed a considerable portion of the oxygen of the air. Before entering 
a deep well, or double bottom, the air should be tested to determine whether it 
is low in oxygen. 
The normal variations of the carbon dioxide of the air are too small to be 
of sanitary importance, and it is only when stagnant or enclosed air has its 
carbon dioxide content very much increased that it may have a bearing on 
health. Carbon dioxide is not a poison. A certain amount of carbon dioxide 
is necessary for the body, as by its presence in the blood, the action of the 
heart is regulated and the respiratory center stimulated. With any great in- 
crease in carbon dioxide content, for instance up to 5 to 15 per cent, there is 
generally a corresponding decrease in the oxygen content. The carbon dioxide 
content of air, however, is an indication of the amount of use of certain air 
by human beings, and its estimation may be used as the index of vitiation, but 
this is not as reliable as was once thought. 
The other chemical constituents of the air, with the exception of nitrogen, 
which is discussed under the heading “Effects of Increased and' Decreased 
Atmospheric Pressure,” have so little bearing on health, it is not considered 
necessary to discuss them. 
Physical properties of the atmosphere and their relations ler health.—By the 
physical properties of the air is meant the temperature, the humidity, and 
the movement of air. Their relation to our body health depends on how 
much or how little they affect the dissipation of heat from our body surfaces 
by radiation, conduction, convection, and evaporation. 
By radiation is meant the emanation of heat rays in direct lines from an 
object generating heat, e. g., the heat of a fire felt when standing in front 
of it. By conduction is meant transmission of heat to a contiguous sub- 
stance, e. g., when a red-hot poker is put into water, the poker is cooled and 
the water heated. By convection is meant the transmission of heat to a 
constantly changing medium such as an air current. Heat is lost by evapora- 
tion in accordance with a law of physics, i. e., when a liquid is changed to a 
gas, heat is abstracted from the evaporating surface to be stored in the 
gas as latent heat. If the air has the same or a higher temperature than 
our bodies, there can be no giving off of heat from our bodies by radiation 
or conduction; if there is no movement of air about our bodies, there can be no 
loss of heat by convection; and if the air surrounding our bodies is saturated PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
277 
with aqueous vapor, there can be no loss of heat by evaporation of perspira- 
tion. The above factors explain the discomfort of a hot, still, moist day, and 
the relative comfort of a hotter day, that is breezy and dry. Where the elimi- 
nation of heat by our bodies is required, the body, through its heat-regulating 
center in the medulla, diverts the greater portion of the blood to the skin, thus 
bringing it in contact with the air and permitting the elimination of heat by 
radiation, conduction, and convection, and also causes perspiration to be in- 
creased, thus permitting elimination of heat by evaporation. When con- 
servation of heat is required by the body, through the same heat-regulating 
center, the amount of perspiration is diminished, and the blood diverted to 
the interior of the body. 
If these physical properties of the air are such that not enough of our body 
heat can be thrown off, symptoms such as heat stroke, heat exhaustion (see 
chapter on First Aid and Minor Surgery) and “crowd poisoning” result. 
On the other hand, if the physical properties of the air surrounding the 
bodies are such that too much heat is eliminated, general or local freezing 
may result (see chapter on First Aid and Minor Surgery) or there may be a 
lowering of resistance to such diseases as pneumonia, colds, etc. Humidity in- 
fluences the output of heat from the body in two ways: (1) It increases the 
conductivity of atmosphere for heat—a cooling influence—hence cold moist 
air is chilling; (2) it interferes with evaporation of perspiration—a heating 
influence—hence warm moist air is enervating. There is a neutral zone, 
around 68° F., at which humidity has comparatively little effect. Hence, if 
the temperature of a room is kept just right and the occupants are sitting still, 
it makes little difference whether the air is humid or dry. However, a differ- 
ence of a few degrees above or below this temperature will have a marked 
influence. If air is too dry, as a general rule it results in parched and irri- 
tated mucous membranes of the mouth and nose and smarting of the eyes 
from too rapid evaporation. The so-called comfort zone has a maximum tem- 
perature 70° F., a minimum humidity, 30 per cent; a minimum temperature, 
55° to 60° F., and a maximum humidity, 55 per cent. The body has, however, 
great powers of adaptibility by a gradual change, and this is one of the factors 
in acclimatization. 
The effects of increased atmospheric pressure upon health.—Whether 
we live at sea level or on mountain tops, the pressure of gases in our 
tissues is in equilibrium with the pressure of gases surrounding us. With 
sudden changes of atmospheric pressure, certain changes and symptoms are 
produced in our bodies by the effort on the part of the gases, principally 
nitrogen, within our bodies, to come into equilibrium with the atmospheric 
pressure outside, and also by the fact that the atmospheric content of oxygen 
per cubic foot decreases with the pressure, and vice versa. 
Men in the Navy are subjected to increased pressure principally in deep-sea 
diving. With every 10 meters’ depth in diving the pressure increases 1 atmos- 
phere—e. g., at a depth of 30 meters (about 100 feet) a diver is exposed 
to a pressure of 4 atmospheres, or about 60 pounds to the square inch. The 
symptoms produced as pressure is being increased are not particularly marked; 
there is a slowing of respiration, and pain in the ears due to pressure on the 
ear drums, which may be relieved by swallowing. It is when the diver is 
brought to the surface from under pressure that dangerous symptoms may 
occur; these symptoms are spoken of as caisson disease. Daring compression, 
the body continues to absorb the gases of the air according to physical laws, 
and as the pressure is released these gases are released in accordance with the 
same laws. If the decompression is too rapid, the molecules of gases within 278 
HOSPITAL CORPS HANDBOOK. 
the body tissues and fluids tend to coalesce and form bubbles, and the escaping 
of these bubbles through the tissues, and particularly through the capillary 
Walls, causes the symptoms of caisson disease. The symptoms of caisson dis- 
ease are excruciating pain in the muscles and joints, called “ bends ”; haemor- 
rhages from nose and ears; paralysis, unconsciousness, and even death 
from plugging of blood capillaries by air bubbles (air emboli) and haemorrhages 
into the brain and spinal cord. The prevention of caisson disease consists in 
decompressing individuals subjected to high px-essures gradually; this may be 
accomplished by putting them through graduated decompression chambers, or 
in the case of divers by raising them to the surface slowly. If a man begins 
to show symptoms of caisson disease, he must be placed immediately under 
pressure and decompressed slowly. 
The effects of decreased atmospheric pressure upon health.—The symptoms of 
decreased pressure are due to the rarefied air, as well as to the decreased 
pressux-e, and come on when ascending high mountains or ascending in aircraft. 
The limit at which life may be sustained is about 26,000 feet, at which height 
consciousness is lost. The symptoms commonly are spoken of as “ mountain 
sickness.” The effects of decreased pressures are increased by cold, active 
muscular exertion, or improper clothing. The noticeable symptoms are increase 
in the respiration ; noises in the head and dizziness; impairment of the senses of 
sight, hearing, and touch; dullness of the intellectual faculties, and a strong 
desire to sleep. With more sudden changes to a rarefied atmosphere, fainting, 
weakness, difficult breathing, dizziness, nausea, and vomiting may occur. The 
prevention of mountain sickness consists in keeping warm, avoidance of muscu- 
lar exertion, inhalations from an oxygen tank, and gradual ascent into rarefied 
atmosphere. 
Poisonous gases ivhich mag contaminate the air of naval ships.—The com- 
monest poisonous gas found at times in the air is carbon monoxide, which has 
been considered in the section on suffocation in the chapter on “ First Aid and 
Minor -Surgery.” Such gases as chlorine, resulting from sea water getting 
around storage batteries, methane from coal bunkers, etc., may contaminate 
the air of naval ships and produce characteristic poisoning. Sewer gas and 
other noxious odors do harm by affecting our mental state, but other than 
that ai’e not particularly harmful. 
Microorganisms in the atmosphere.—In the open air, on account of nature’s 
disinfecting agencies, there is very little danger from pathogenic microorgan- 
isms, except in the immediate neighborhood of persons with diseases spread by 
mouth, nose, and throat secretions, but in crowded, ill-ventilated halls and 
compartments there is considerable danger of this because of the constant 
spraying of the air by coughing, sneezing, etc., on the part of the inmates, 
because of the sweeping of the decks or floors, where the inmates may have 
expectorated, and because nature’s disinfecting agencies are not as powerful 
under these conditions. 
Ventilation. 
Ventilation is the process by which air, the physical and chemical composi- 
tions of which have been vitiated by human use, is removed and replaced with 
fresh air, having the proper physical and chemical conditions for the use of 
our bodies. 
Before discussing ventilation, it will be well to see what is meant by good 
air, bad air, and the changes which take place in normal atmosphere when 
human beings occupy a confined space. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
279 
By good air is meant air which is free from dust, smoke, and odors, of 
moderate coolness and humidity, and free from accumulations of respiratory 
products and body excretions. 
By bad air is meant air which produces discomfort which is caused by 
heat and humidity and the odors of the air in closed spaces. Whereas the 
odors are of no definite harm to the body, except for being disagreeable, it is one 
of the best indicators of poor ventilation, since well-ventilated rooms are usu- 
ally free of odors. 
The following changes take place in normal atmosphere when human beings 
occupy confined spaces: 
(1) The oxygen is reduced by respiration. 
(2) The carbon dioxide is increased by the same process. 
(3) There is given off in the air a greater or lesser amount of organic 
matter, which is perceived by us as odors. Most of this organic matter comes 
from the mouth, from the teeth, skin, and clothing, and, to a lesser extent, 
from the lungs. 
(4) The temperature of the air is raised by the heat given off by the body 
in the process of metabolism. 
(5) The humidity of the air is increased by the moisture given off from 
the breath and from the skin of the body. 
(6) Bacteria are supplied by the body. 
(7) Dust is stirred up as a result of the movements of the body. 
Ventilation is designated as natural and artificial. Inasmuch as the Navy 
has to deal with ventilation afloat and ashore, each will be taken up 
separately. 
Ventilation of houses.—Natural ventilation ashore is produced by having 
openings in the walls, floors, and ceilings of a room, which permit of free natu- 
ral circulation of the outside air. This can be obtained best by having open- 
ings on opposite sides of the room. Natural ventilation may be assisted ashore 
by window ventilators, ridge ventilators, screens over windows, etc. 
Artificial ventilation on shore is much the same as that used aboard ship. 
It is produced by fans, blowers, or other mechanical appliances, all of which 
will be described under “Artificial ventilation of ships.” 
Ventilation of ships.—On ships natural ventilation occurs (1) through per- 
manent openings in the decks or hull, such as hatches or openings in the deck 
for accession to spaces below; (2) ventilating cowls; (3) air ports in the 
ship’s sides; (4) smoke pipes and smoke-pipe casings; (5) elevator shafts; 
(6) chutes; (7) voice tubes; (8) cargo ports; (9) ammunition hoists; and 
(10) gun ports. Natural ventilation may be assisted by the use of scoops in 
air ports, wind sails, and screens. 
In the artificial ventilation of ships there are three systems which may be 
used: (1) The plenum, or supply system; (2) the exhaust system; (3) a com- 
bination of the plenum and exhaust system. 
The plenum or supply system is that in which fresh air is drawn from with- 
out and supplied by means of centrifugal or propeller fans to the spaces to 
be ventilated. For systems of duct ventilation, such as is used aboard ship, the 
centrifugal type of blower fan is used. The fresh air is drawn in by a central 
opening at the side and forced out by the revolutions of the blades through a 
duct at the left which is connected to a series of ventilating ducts which dis- 
tribute the air to the compartment. It is important, in planning for plenum ven- 
tilation, either ashore or afloat, that the air should be taken in at such a point 
as to be protected from sources of odors and dust. Plenum ventilation often is 
combined with air washing or artificial humidification as well as with heat. 280 
HOSPITAL CORPS HANDBOOK. 
When the centrifugal type of fan is used for an exhaust system, the ducts 
leading from the compartment must be connected with the central opening and 
the other opening of the fan with the outside air. 
The terminals of the various distributing ventilating ducts vary in location. 
The terminals in the plenum system of ventilation should be located as nearly 
as possible in the breathing zone, yet they should be placed so that they do not 
produce drafts uncomfortable to the occupants. In our latest type of ships the 
terminals of the air ducts are placed at a level of about 3 feet above the deck, 
and the air current is directed horizontally to avoid raising dust from the deck. 
The exhaust system is the reverse of the plenum system. Instead of supply- 
ing fresh air and allowing it to escape through natural openings, the exhaust 
system draws the vitiated air from the compartment, discharges it to the outer 
air, and makes no provision for the admission of the fresh air, except as it 
may come in through natural openings, such as hatches, etc., to take the 
place of the withdrawn foul air. This system possesses disadvantages, and 
should be employed alone only in places where great heat, humidity, injurious 
gas, and dust, or disagreeable odors should be removed. It generally is used 
in “ heads ” and magazines. 
The combined system of ventilation provides for a plenum system and an 
exhaust system. Usually this system of ventilation is used in sick bays. 
In any system of ventilation an endeavor should be made to supply each 
occupant with 3,000 cubic feet of fresh air per hour. A properly designed sys- 
tem will allow six complete changes of the air during this time. 
The efficiency of ventilation may be tested in the following manner: 
(1) By making an analysis of the various portions of the air of the compart- 
ment when occupied. This analysis may be divided into four parts: 
(а) Estimation of carbon dioxide content. 
(б) The physical examination, which consists in noting any odors or ex- 
cessive dust which may be present; and the determination of the 
temperature by a wet and dry bulb thermometer (psychrometer) 
(Fig. 142), in this way determining the temperature and humidity. 
(c) The determination of the movement of the air. 
(d) The determination of the cooling power of the air. 
(2) Clinical effects—that is, the effect on the occupants living in the com- 
partment. 
Heating. 
There are three methods in common use for heating compartments or rooms— 
(1) direct heating, effected by radiators, open fires, stoves, open gas heaters, 
etc.; (2) indirect heating, effected by supplying to the room air previously 
heated elsewhere, as by furnaces or by a thermoventilation system; (3) di- 
rect-indirect heating, effected by a combination of the two methods described 
above, in which part of the heat is supplied by warm air entering the room 
and part by local radiators or stoves. 
Most of our barrack buildings on shore, and the older ships of the Navy, as 
well as the modern smaller ships, are heated by the direct method, but all of 
our modern capital ships are heated by the indirect system, or by the direct- 
indirect system combined. In the indirect systems, such as used aboard ships 
of the Tennessee class, the air also is humidified. This system of heating is 
difficult to control. 
Regardless of what heating system is used, living rooms ashore and compart- 
ments aboard ship should be kept at a temperature of about 65° to 70° F. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
281 
Housing of naval personnel. 
Overcrowding.—Buildings used as barracks, and compartments aboard ship 
for sleeping purposes, show great variety in size and type. 
The housing of a number of men together in a single room or compartment 
is always conducive to the spread of disease, especially communicable dis- 
eases of the respiratory type and those carried by vermin. Other things 
being equal, the greater the number of men quartered in a barrack room 
the greater the danger. 
Fig. 142.—Types of sling psychrometers for determining temperature 
and relative humidity. (Park.) 
Under the close associations of barrack life, or life aboard ship, the types of 
bacteria found in the nose and throat tend to become uniform throughout the 
personnel. Thus the percentage of those who will become carriers of such 
pathogenic microorganisms as pneumococci, streptococci, meningococci, and 
diphtheria bacilli, if the causative agent is introduced, will be much 
greater than among the same number of persons housed under ordinary 
conditions. The general principle, therefore, is that small barracks, preferably 
small individual buildings, or units, are safer than large barracks. Large 
barracks at least should be divided into compartments to house its occupants 
more or less separately in groups as small as consistent with military and ad- 
ministrative requirements. 282 
HOSPITAL CORPS HANDBOOK. 
The congestion of population (density) which results from housing a large 
number of men in barracks, either in a large barracks building or in a number 
of smaller barracks, is of great epidemiological importance apart from the 
question of overcrowding. However, other things being equal, the smaller the 
buildings and the fewer men quartered in each compartment the better. 
No barrack room should be planned to accommodate more than 50 men, 
and under no circumstances should more men be put into a barrack room 
than the number for which it was planned. 
Housing standards for barracks.—Minimum standards with regard to space 
provide 500 cubic feet of air space and 50 square feet of floor area per occupant. 
In addition there is a third requirement to fix the other two, namely, that there 
shall be not less than 5 feet of separation between the center lines of cots, 
bunks, or hammocks. Without the latter, in wide rooms there could be 50 
feet of floor space per person with the cots touching each other. In lofty rooms 
or compartments there could be 500 cubic feet of air space per capita with 
much less than 50 square feet of floor area, but this would meet neither simple 
hygienic nor special epidemiological needs. Even where the required per 
capita floor space is provided, good administration is necessary with constant 
watchfulness to see that those in charge of the barracks or the men them- 
selves do not move bunks or cots closer together to make room for other pur- 
poses. If space for recreation or other purposes is contemplated for the dormi- 
tory compartment, it should be provided wholly in addition to the space pro- 
vided by the above minimum standards. 
Living conditions on board ship.—At first glance it would seem that with a 
large number of men living together in such a small space as the various decks 
of a ship together afford, the dangers of overcrowding and density of popula- 
tion would produce their maximum effect. As a matter of fact, it has been 
our experience that neither density of complement nor overcrowding on board 
ship is nearly as serious in its results as in barracks ashore. This may be 
accounted for in several ways. 
In the first place, the crew naturally divides into several groups—deck force, 
subdivided into divisions; engineer force, fireroom force, commissary force, 
electricians and other artisan groups, mess attendants, etc.—and there is not 
as much contact between the different groups as one might think; at least, 
not under conditions which are essentially indoor conditions. 
In the second place, the crew of a naval vessel is well disciplined; every 
man has his station and duties definitely assigned and knows his environment 
thoroughly. 
In the next place, disease is almost bound to be detected early. Every man 
is under constant watch, and if a man who feels sick or appears ill does not 
report promptly at the sick bay some one else usually sends him there. 
Another important matter is that exposure to foci of infection in civilian 
communities is inconstant or irregular. 
Finally, air passes through a modern ship rapidly, especially in spaces where 
members of the crew congregate in numbers. 
Light and illumination. 
Light and its relation to health.—Light may be natural light from the sun’s 
rays, or it may be artificial. The latter is for purposes of illumination and 
the former serves two purposes, viz., illumination and the production of cer- 
tain effects on life processes. 
Natural light is made up of energy given off from the sun and is conceived 
of as being made up of waves in the ether of various lengths, the longer color 
waves when striking our retinas giving us the sensation of red, and the PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
283 
shortest color waves giving us the sensation of violet, with the intermediate 
waves giving us the other colors of the spectrum, and the sum total of these 
waves giving us white light. In addition to the sun’s energy, which shows 
itself in ether waves producing effects in our retinas as colored or white light, 
there are mingled with these ether waves those which produce heat, the actinic 
or ultra-violet rays, which are the bactericidal waves of sunlight, and, no 
doubt, numerous others which are not yet known to human science. Sunlight 
is absolutely necessary for the growth of most forms of vegetable life, and its 
effect on the human body is seen in various ways, e. g., children deprived of 
sunlight are particularly prone to rickets; the stimulating effect of sunlight on 
going to the Tropics from a temperate climate, followed soon by a depressant 
one; the production of sunburn and freckles on the human skin. The study 
of the effects of sunlight on the human body is still in its infancy. 
The sanitary factors involved in illumination consist of, first, the effects of 
different types of illumination on our mental state, and, second, the tendency 
of various features in illumination to produce eyestrain. Brilliant illumina- 
tion tends to cheerfulness and activity, and vice versa. Red illumination is 
stimulating, violet and blue illumination is depressing, and green restful. 
Eyestrain.—Eyestrain results from such features of illumination as cause 
the muscles of accommodation of the eye (see chapter on Anatomy and Physi- 
ology) to work too continuously or too often in order to properly regulate 
the amount of light striking the retina and to accommodate for near and for 
distant objects. The principal features in illuminations producing eyestrain 
are insufficient light, especially when reading or writing, excessive light, flicker- 
ing light, brilliant points of light, irregular reflection of light, and streaks or 
shadows on a reading or writing page. Continued use of strained eyes may 
result in permanent damage to the eye as well as reflex troubles such as head- 
ache, indigestion, etc. 
Location of lights in a room and at desks.—Lights should be placed in rooms 
out of the field of vision, as on the ceiling. Desk l'glits should be so placed that 
the source of light is out of the field of vision of the individual using the desk, 
i. e., back of him, and also over his left shoulder in a right-handed man, so 
that an uneven illumination will not be produced on the writing page by the 
shadow of his hand. 
Direct and indirect illumination.—Direct illumination is that which comes 
from a visible source; indirect illumination is that which results from placing 
the lamps behind a screen, the light thus being thrown on the ceiling and 
reflected downward. The latter is much better, as bright points in the line 
of vision are prevented. 
Lighting of wards, sick rooms, and living spaces.—Wards, sick rooms, and 
living spaces should have plenty of sunlight. Patients should not have to face 
the windows or lights, as the constant glare of the light is trying and disagree- 
able to the eyes. The light should come from their backs or sides, and the 
windows should have shades, in order properly to regulate the light. 
FOOD AND ITS RELATION TO HEALTH AND DISEASE. 
Food may affect health as a result of— 
(1) Natural poisons contained therein. 
(2) Animal parasites contained within the food. 
(3) Plant parasites (bacteria) contained in the food. 
(4) Toxins developing in the food as a result of bacteria. 
47829°—23 19 284 
HOSPITAL CORPS HANDBOOK 
(5) Special poisons contained in the food. 
(6) Poisons accidentally or purposely added. 
(7) Amount—too little or too much food. 
(8) Composition—unbalanced diet. 
(9) Disturbance of digestion and metabolism. 
(10) Food idiosyncrasy. 
Natural poisons.—Foods may be natural poisons, as in the case of certain 
mushrooms, some fish, or the alkaloids in various species of plants. 
Animal parasites.—Foods may convey an'mal parasites such as trichinae, and 
the hog, beef, and fish tapeworms. These parasites, as a rule, occur as ante- 
mortem infections in the flesh of food animals. The larval stages of such 
parasites, which usually are destroyed by cooking, infect man as a result of 
eating insufficiently cooked foods. For a description of the life history of 
these parasites, see section on Animal Parasites of Man. 
Plant foods also may carry the parasites and the eggs or larvae of various 
animal parasites—the amoeba, causing dysentery; the hookworm, causing hook- 
worm disease; the ascaris, causing ascariasis. 
Plant parasites.—Foods usually contain a number of bacteria. Both animal 
and vegetable foods nfay convey bacteria pathogenic in man. The principal 
diseases spread in this way are typhoid and paratyphoid fevers, bacillary 
dysentery, amoebic dysentery, cholera, tuberculosis, diphtheria, scarlet fever, 
and septic sore throat. The foods that ordinarily are eaten uncooked are most 
liable to spread disease. Milk and its products, above all others, is the food 
which most commonly transmits disease. 
The so-called “ food poisoning ” usually is due to an infection with the 
Gaertner group of bacilli, or one of the other closely allied members of 
the colon-typhoid group. It was considered formerly that foods might be 
injurious as a result of ptomaine developing in the putrefaction of foods. 
This no longer is considered to be true, and all such food poisoning now 
is believed to be due to some type of infection. 
Toxins.—Poisonous substances develop in the food as the result of bacterial 
activity. The only example of this group is botulism. Preserved foods, es- 
pecially sausage, ripe olives, asparagus, and home-canned vegetables, may 
be contaminated with the Bacillus botulinus. The factory-canned products, 
which are subjected to very high temperatures, and closely inspected, rarely 
contain pathogenic bacteria. 
Special poisons.—Foods may contain, at times, special poisons, as for ex- 
ample, solanin in sprouted potatoes, or ergot in rye. Poisoning has been re- 
ported from eating an excessive amount of rhubarb leaves. 
Poisons accidentally or purposely added.—A great variety of poisons may 
find their way into food, either through accident or intent. Some of these, 
when added as preservatives in accordance with the Pure Food and Drugs Act, 
in very small quantities, are not considered as poisonous, but when added 
in large amounts, they are injurious to health. Such substances as arsenic, 
lead, caustic alkalies, acids, and many forms of adulterants are found in 
food substances from time to time. Poisonous substances also may form in 
the food as the result of the food acting upon the container in which it is 
preserved, i. e., if the container is not properly made. However, poisonous 
substances rarely develop in tin cans as made today of thin iron coated with 
tin. 
Amount.—The health may be injured by eating too much or too little food. 
Thus, an excess of food predisposes to obesity, and perhaps to arteriosclerosis, 
as well as degenerative changes in the liver and kidney; an insufficient amount PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
285 
of food undermines the health, and may bring about such changes as war 
oedema, etc. 
Composition.—An unbalanced diet affects growth, vigor, and health in many 
ways. A diet may be deficient in vitamines, organic acid compounds, or min- 
erals, such as phosphate and calcium. A diet also may be deficient in one of the 
necessary constituents, fats, carbohydrates, or proteins, which will lead to 
disorders of metabolism or undernourishment. An insufficient amount of 
cellulose, or roughage, is a common cause of constipation. Highly spiced and 
stimulating diets are irritating, both to the digestive tubes and organs of ex- 
cretion. An excess of carbohydrates favors fermentation; an excess of fat 
leads to acidosis: an excess of protein favors putrefactive changes. 
Deficiency diseases. 
Since the vitamines play such an important part in the known deficiency 
diseases, it may be well to discuss these in connection with certain deficiency 
diseases, which may be prevented by the inclusion of such substances in 
the diet. 
Vitamines are accessory factors in the diet necessary for growth and metab- 
olism. Their physical and chemical properties are not known; however, 
the effects of the lack of them in the food have been studied very thoroughly 
biologically. At present it may be stated that there are three distinguishable 
vitamines: Vitamine A, vitamine B, vitamine C. 
Vitamine A is found abundantly in nature, in milk, butter, eggs, the fat of 
glandular organs, such as cod-liver oil, and also in the leaves of plants. The 
seeds of plants contain a lesser amount of this substance. Inasmuch as the 
seed contains this vitamine in the outer layers and germ cells, highly milled 
flour and polished rice contain practically none of it. Milk and green leaves 
of plants therefore are regarded as protective foods; one of these always 
should be in the diet. A lack of this vitamine in the diet prevents growth 
of the young, and will cause an inflammation and ulceration of the eye—• 
xerophthalmia. 
Vitamine B is widely distributed in many forms of natural foods. It is 
found in animal tissues, leaves, and tubers. It is never associated with fats 
or oils of either animal or plant origin. The ordinary food of our diet con- 
tains several times the amount of water soluble vitamine B, which is necessary 
to the maintenance of growth and health in animals. As with vitamine A, it 
is found in seeds in the outer layers and germ cells. A deficiency of this 
vitamine in the diet brings about a disease known as beriberi. 
Vitamine O is abundant in the juices of fresh sweet limes, lemons, sauer 
kraut, milk, and fresh potatoes. A lack of this vitamine brings about a condi- 
tion known as scurvy. 
Other than scurvy, beriberi and xerophthalmia, rickets, and pellagra are 
believed to be due to a deficiency in diet. Rickets is due to a lack of a vita- 
mine recently described and certain other substances in the diet as salts, as 
well as to poor hygienic conditions. 
Pellagra is believed to be due to a diet which contains improper types of 
protein. There are 18 to 20 different amino acids in protein foods. Seven or 
eight of these are essential. If some of these seven or eight are lacking, the 
condition spoken of as pellagra is brought about. 
All of these dietary deficiency diseases may be prevented by supplying the 
substances lacking in the diet. For instance, beriberi may be prevented by 
supplying the body with legumes and other vegetables; scurvy, by supplying 286 
HOSPITAL CORPS HANDBOOK. 
the body with lemon and orange juice, fresh potatoes, milk, etc.; pellagra, by 
supplying the body with fresh animal food, milk, and legumes. 
Disturbance of digestion and metabolism.—Foods, otherwise wholesome, 
may be injurious on account of faulty digestion or disturbances of metabolism. 
The common causes of such troubles are eating too fast, imperfect mastication, 
eating when fatigued or overheated, injudicious combinations, especially un- 
ripe fruits or vegetables containing raw or partly cooked starch, etc. 
Food idiosyncrasy.—Food poisoning of this nature is anaphylactic in char- 
acter. It is usually impossible to determine how or when the idiosyncrasy was 
acquired, and sometimes it is difficult to determine the particular article of 
diet responsible. Some people develop a rash or other symptoms when eating 
sea food, others when eating strawberries, eggs, tomatoes, and many other types 
of foods. 
For a description of the classes of foods, use of foods, values of food, and 
pasteurization of milk, see chapter on Food and Dietetics. 
For methods of preservation and inspection of food, and the manner in which 
it is adulterated, see chapter on Commissary Work. 
WATER AND ITS RELATION TO HEALTH AND DISEASE. 
Although water is not classed technically as a food, it is an essential arti- 
cle of diet, for the body requires for its daily physiological use from 1,800 
to 2,100 c. c. of water, 
ingested as such, with 
approximately 600 c. c. 
additional, ingested 
with solid food. More- 
over, it bears an im- 
portant relationship to 
personal hygiene, in- 
asmuch as it is essen- 
tial for the mainte- 
nance of proper clean- 
liness of the person, 
the clothing, and other 
objects with which man 
comes in contact. Fur- 
thermore, water bears 
an important relation- 
ship to certain dis- 
eases, particularly the 
communicable diseases, 
as it offers an impor- 
tant route in the trans- 
mission of several spe- 
cies of infective agents. 
Sources of water supply. 
The sources of water supply are, as a rule, rain water, surface water, and 
ground water. In addition, the Navy obtains much of its water supply by 
means of distillation. 
Rain water, when collected under sanitary conditions, is the purest of all nat- 
ural waters. However, this source of water supply, on account of the careless 
manner in which the water is stored or collected, may be dangerous, because of 
the fact that the surfaces upon which the water is collected are usually dirty, 
Fig. 143.—Shallow well penetrating limestone. (Rosenau.) PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
287 
and the cisterns or rain barrels in which the water is stored offer breeding 
places for mosquitoes and easily may become polluted. 
Surface water.—Included in this class are waters from rivers, lakes, ponds, 
of impounding reservoirs. Since rivers and creeks often are used as natural 
sewers, water obtained from this source should not he used unless treated by 
one of the means described below. 
Ground water is obtained from springs, shallow wells, and deep artesian 
wells. Springs are formed when ground water—water above the first impervi- 
ous stratum of the earth’s surface—is caused to overflow upon the surface as 
a result of geological formation. They often are found to he polluted in the 
same manner as are rivers and 
creeks. Provided the drainage 
area around the spring is pro- 
tected properly, this offers a 
good source of water supply, 
i. e., if the springs are not in 
limestone regions. (Fig. 143.) 
Shallow wells, unless properly 
constructed, are dangerous. 
However, when properly con- 
structed and located in sandy 
soil—not limestone country— 
they offer an excellent source of 
water supply. (Fig. 144.) It 
should be remembered that sur- 
face water is purified as it perco- 
lates through fine sandy soil. 
This is nature’s process of filtra- 
tion ; the organic matter is oxi- 
dized and the bacteria are 
strained out largely by biological 
action. The soil can take care of 
a large amount of pollution, and, 
if not overburdened or if the geo- 
logical formation is such that it 
has no cracks or crevices, the 
ground water may be entirely 
free from objectionable sub- 
stances and bacteria. (Fig. 145.) 
Artesian wells, in contradis- 
tinction to shallow wells, are 
wells which penetrate an imper- 
vious stratum of the earth’s surface. Water obtained from this source fur- 
nishes the safest and most satisfactory water supply. Such water is usually 
clear and of high sanitary quality. (Fig. 146.) 
Distilled water.—The process of distillation of water aboard ship is as 
follows: Water from over the side is pumped into the evaporators which con- 
tain steam pipes. This water is heated and the steam thus generated is con- 
densed by cold wrater from over the side circulating around the steam pipes 
in the distillers. The pure distilled water then, is led into tanks where it is 
aerated. If boiling is too energetic in the evaporators, droplets of salt water 
pass over into the distillers and cause the distilled water to contain chlorides, 
Fig. 144.—A model well, cased with brick laid 
in cement mortar and properly graded, curbed, 
and protected. (Virginia Health Bulletin.) 288 
HOSPITAL CORPS HANDBOOK. 
and hence have a salty taste. This commonly is spoken of as priming. From 
a hygenic standpoint, it is not dangerous, as all pathogenic bacteria are killed 
by the boiling of the water. However, if there is a leak in the distiller tubes, 
the cool, untreated circulating water coming from over the side may infect the 
distilled water as well as add chlorides to it. (Fig. 147.) 
Sanitary analysis of water. 
Since water bears such an important relationship to disease in connection 
with the transfer of infective agents, it is essential that information concerning 
its past history should be secured. A proper sanitary analysis of water 
includes: 
(1) A physical examination to determine odor, color, turbidity, and taste. 
(2) A microscopic examina- 
tion to determine the number 
and character of the particles 
in suspension, especially algae. 
(3) Chemical examination to 
determine the amount and na- 
ture of chemical impurities. 
(4) A bacteriological exam- 
ination to estimate the number 
and kind of bacteria, the B. coli 
being the most important. 
(5) A sanitary survey of the 
watershed, including methods 
of collecting, handling, storing, 
and disturbing the water. 
The last is the most impor- 
tant of all the procedures out- 
lined above. 
Purification of water. 
The following are the methods 
used in the purification of water: 
(1) Clarification by sedimen- 
tation. 
(a) Aluminium sulphate. 
(b) Iron and lime. 
(2) Filtration. 
(a) Slow sand filters. 
(b) Rapid mechanical 
gravity filters. 
(c) Pressure filters. 
(3) Sterilization. 
(a) Chlorine. 
(b) Ultra-violet rays. 
(c) Ozone. 
(d) Copper sulphate. 
Sedimentation may be brought about by allowing the water to stand in 
large surface ponds, or by lowering the velocity of a stream. This method 
is used largely to remove turbidity, and is of little value in the removal of 
bacteria. 
Sedimentation is hastened by the use of coagulents, aluminium sulphate, 
or iron and lime. Coagulents must be supplied to water before the water 
is passed through rapid mechanical filters. 
Fig. 145.—A type of dangerous well frequently 
found in use. The openings in the top and 
around the mouth of the well allow the en- 
trance of polluting matter such as may be 
brought from the stable or privy on the feet 
of persons or poultry; the rough masonry of 
the walls makes contamination through the 
soil easy; the handling of the buckets and 
chains may cause gross contamination and im- 
mediate introduction into the water of the 
germs of typhoid fever or of other diseases. 
(Virginia Health Bulletin.) PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
289 
Fig. 146.—Geological formation favorable to the obtaining of water by means of arte- 
sian wells. (Harrington.) 
Fig. 147.—A diagram showing the general plan of the apparatus used for distilling salt 
water on board ship. The salt water is evaporated by means of steam coils which 
pass through it. The vapor is then distilled, being cooled by passing around pipes in 
which salt water is circulating. (Gatewood.) 290 
HOSPITAL CORPS HANDBOOK. 
Slow sand filtration.—This is accomplished by large filters, either open or 
covered, about an acre in extent, consisting of tiles overlaid with gravel and 
coarse and fine sand in a sealed concrete basin. The bacteria are not re- 
moved by a straining process of the sand grains, but as a result of the action 
of age and protozoa which collect in the interspaces in the surface layers 
of the sand, and have direct action on the bacteria. No preliminary treat- 
ment with coagulents is necessary with slow sand filtration. (Fig. 148.) 
Rapid sand filtration.—Pressure and rapid gravity filters are used for this 
purpose. The operation of each type of sand filter is based on the same 
principles. Filtration is brought about by the formation of films of the 
coagulent around the grains of sand and on the surface through which the 
water passes, either by gravity or pressure. The coagulent usually used is 
aluminium sulphate, or iron and lime combined, the coagulent being added in 
the sedimentation basin. 
This is the type of filter usually employed in the Navy. Inasmuch as these 
filters clog very rapidly, they have to be washed frequently, usually every 24 
hours or oftener. They are cleaned in 
two ways: (1) By reversing the flow 
of water and mechanically raking the 
sand, and (2) by reversing the flow of 
water and passing an air current 
through the filter, which agitates the 
sand. 
The gravity filters, or open filters, are 
reservoirs of wood or concrete. The 
pressure filters are cylindrical tanks. 
Sterilization of water. 
In the Navy and in the United States 
generally chlorine is used largely for 
this purpose. It may be applied either as liquid chlorine or as a soldtion of 
bleaching powder. The chlorine usually is added after the water has been 
filtered, in the proportion of one-tenth to five-tenths part per million. 
Chlorinated lime, or bleach (30% available chlorine), frequently is used in 
the Navy for the sterilization of small quantities of water in Lyster bags, 
or in tanks aboard ship. It should be added in the proportion of 1 gram 
per 40 gallons. 
The ultra-violet ray is used largely in the Navy for the sterilization of water 
for swimming pools. Such water must be filtered before being exposed to the 
ultra-violet rays. 
Ozone is not used in the Navy for the sterilization of water, but is used 
extensively in Europe and, to some extent, in the United States. The water 
also must be filtered before it is exposed to ozone. 
Copper sulphate is used to clear the water of algse. 
Water supply on the march and in camp. 
Water supply.—No water other than distilled, boiled, or chlorinated water 
should be used for drinking or cooking purposes. Previous sedimentation and 
filtration is desirable, and for this purpose barrels or boxes containing pebbles, 
sand, and charcoal may be used. The pebbles and sand should be disinfected by 
prolonged heating before the filter is constructed. 
The camp water supply, even in temporary camps, should be placed under 
sentry supervision. 
Fig. 148.—Schematic drawing of slow 
sand filter. (Harrington.) PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
291 
For chlorination of drinking water in camp use one ampule, each containing 
1 gram of calcium hypochlorite, for every 40 gallons of water, and allow to act 
for at least one hour before drinking. This should be done in Lyster bags 
when practicable. 
For use on the march, make a stock solution by dissolving the contents of 
one ampule in a canteen full of water. Use teasponfuls of stock solution 
(more exactly, 6.5 c. c.) to chlorinate one canteen full of water. To chlorinate 
one bucket full (3.5 gals.) of water, use 88 c. c., or approximately one-half 
glass, of stock solution. 
The chlorination of water may be tested after 30 minutes by adding 10 drops 
of starch-iodide solution (potassium iodide, 10 per cent, soluble starch 1 per 
cent, and zinc sulphate, 0.5 per cent) to a cup full of water. The appearance 
of a blue color indicates that sufficient chlorine has been used. If no color 
appears it shows that the hypo- 
chlorite is of inferior quality or 
the water is probably lightly pol- 
luted. 
In order to avoid under-chlori- 
nation and also the taste result- 
ing from over-chlorination, the 
following method is recommended: 
The contents of a tube of calcium 
hypochlorite (1 gram) are added 
to a Lyster bag of raw water, 
stirring the powder in well and 
allowing the water to stand from 
10 minutes to half an hour, de- 
pending upon the physical condi- 
tion of the water. (Fig. 149.) A 
test should be made immediately 
after adding the hypochlorite to 
make sure that an excess is pres- 
ent, and it is desirable that a 
second test be made at the end 
of the sterilization period. These tests may be made by adding half an 
ampule of a solution of ortliotoluidine (0.1 per cent orthotoluidine in 10 per 
cent solution of hydrochloric acid in 1 c. c. ampule) to a small quantity of the 
treated water contained in an ordnance cup. In the presence of free chlorine 
a coloration is produced which ranges in shade from a light canary-yellow 
to a dark red, depending upon the amount of free chlorine present. At the end 
of the sterilization period the rank taste and odor of the sterile water may 
be removed by adding 1 gram of sodium thiosulphate, and the water is ready 
for drinking. The small quantity of thiosulphate added is scarcely sufficient 
to alter the taste of the water; indeed, it is difficult to differentiate by taste 
between raw water and water that has been thus treated. The amount 
of sodium thiosulphate remaining after treatment is negligible, since only 1 
gram is added originally to the 38 gallons of water, and the greater part of 
this is used up in the reaction with the free chlorine. In this method the tube 
of calcium hypochlorite should be emptied directly into the bag full of water 
and rapidly stirred in by means of a stick. This stick should be left in the 
water throughout the whole process of treatment, for, if removed and then 
later used to stir in sodium thiosulphate, it may serve to reinfect the water 
Fig. 149.—Lyster bags supported by stacked lit- 
ters. (Ford.) 292 
HOSPITAL CORPS HANDBOOK. 
If the test fails to reveal a definite yellow color after the addition of one tube 
of calcium hypochlorite, another tube should be added and the water again 
tested. 
The main feature of the above procedure is that polluted water may be con- 
siderably overdosed with calcium hypochlorite so as to insure effective sterili- 
zation, and then made palatable by dechlorination. 
DISPOSAL OP SEWAGE AND REFUSE. 
The term “ sewage ” includes not only human excreta, solid and liquid, but 
also the waste water and impurities coming from human habitations. By 
“ refuse ” is meant the waste of a city, camp, navy yard, station, etc., other 
than sewage, and includes garbage, ashes, rubbish, street cleanings, and manure. 
Sewage. 
The basic principle that underlies all methods of sewage disposal is to get 
rid of the sewage as speedily as possible with the least nuisance to the 
smallest number of people, with the least danger to health and property, and 
at the smallest cost. 
All methods of sewage disposal fall under two general heads—the “ water 
carriage system ” and the “ dry system.” The “ water carriage system ” is 
based upon the principle of removing a burden from the community to an- 
other place, and may be used wherever there is an available water supply for 
flushing purposes. Such systems are used at all of our naval shore stations 
in the United States, and aboard all of our ships. There are several general 
means of disposal of sewage by the “ water carriage system.” 
Dilution.—This is the oldest, simplest, cheapest, and where practicable, 
the best method, taking advantage, as it does, of the ability of bodies of water 
to purify themselves. The process of purification depends upon certain chemi- 
cal and biological changes for which a sufficient supply of free or “ dissolved ” 
oxygen in the water is essential. Under suitable conditions, the complex or- 
ganic matter is broken up and oxidized by bacteria into simpler forms, such 
as nitrates, carbon dioxide, and water. Bacteria are food for protozoa, the dis- 
solved matter for algm; protozoa and algte are food for rotifers and Crustacea, 
and these in turn for aquatic animals and fishes. These animals require oxygen 
and produce carbon dioxide, while plants consume the latter and produce 
oxygen. If the chemical balance is disturbed, the biological cycle described 
above is broken and a nuisance follows. 
The determining factors as to suitability of this method are: 
(a) Amount and character of water in the receiving body with reference 
to dilution and available dissolved oxygen. 
(b) Current, with reference to diffusion and transfer and as to constancy 
of flow, whether constant in direction and force or tidal. 
(c) Proximity of outfalls to intakes for water supply, and to bathing beaches 
or shellfish areas. 
The sewage of all ships is disposed of by the dilution method. As a rule, 
most of our ships are in salt water, and this is a perfectly safe method of 
disposal of sewage. However, a few of our ships are in bodies of fresh water, 
such as the ships in reserve in the Great Lakes. These ships tend to pollute 
fresh water, but are really not a nuisance inasmuch as a far greater amount 
of sewage is emptied into these bodies of fresh water by the cities or towns 
adjacent thereto. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
293 
Sewage treatment.—At some of our naval stations ashore the sewage is 
treated before it is emptied into adjacent bodies of water. In the treatment 
of sewage, the following results are sought: 
1. The separation of suspended matter from the liquid sewage. 
2. Destruction of organic matter in the liquid sewage. 
3. The destruction or removal of bacteria from the effluent of treatment 
plants. 
Several methods are employed to secure these results. In any method used, 
great care and judgment must be employed in the operation of the plants. 
The treatment of sewage may be divided into two general systems—the prepara- 
tory process and the purification process. 
Sewage may be prepared for purification by the following means: 
1. Screens: To remove coarse material. 
2. Sedimentation: To remove relatively heavy suspended matter. 
3. Settling tanks: Large basins which retain the sewage from 1 to 12 hours, 
permitting sedimentation of fine particles, organic and inorganic. 
4. Septic tanks: These 
are sedimentation tanks 
designed to retain the 
sewage from 8 to 24 
hours. This process, 
aside from the physical 
sedimentation of solids, 
depends upon anaerobic 
bacterial action. Baffles 
are arranged to retard 
the flow. Sludge re- 
mains for long periods, 
affording opportunity for 
intensified bacterial ac- 
tion under anaerobic 
conditions. Some of the 
solid organic matter is 
digested or reduced; a 
heavy scum is formed on 
the surface and there is a continual rising and falling of sludge as a result of 
the gases formed. The quality of the effluent water leaving a septic tank is not 
materially improved over raw sewage. It may be foul smelling and septic action 
can not be depended upon to render sewage safe in so far as the spread of infec- 
tion is concerned. The septic process does result in breaking down solids, and 
therefore these tanks may be very useful in connection with sprinkling filters or 
other oxidation methods. (Fig. 150.) 
5. Digestion tanks: Various attempts have been made to remove the objec- 
tionable features of the original Cameron septic tank just described. The best 
known and most successful substitute is the Imlioff digestion tank. This is a 
deep tank, divided into an upper and lower compartment by sloping partitions, 
between which is left an open slot. (Fig. 151.) 
Under this slot there is an inverted V-shaped trough, the base of which is 
wider than the slot. Sewage is admitted into and flows through the upper 
chamber. There should be multiple inlets and baffles to distribute the sewage. 
As it travels along, matter heavier than water settles and escapes through the 
slot into the lower compartment, where digestion takes place. Gases formed in 
the sludge rise vertically and can not escape into the upper tank because of the 
Fig. 150.—Septic tank for small numbers of persons. 
Brick construction, heavily plastered inside; size suit- 
able for 180 to 280 gallons of sewage daily (nominally 
4 to 7 persons). (U. S. Public Health Reports.) 294 
HOSPITAL CORPS HANDBOOK. 
inverted trough. The gases are allowed to escape through openings directly 
from the lower chamber into the outside air. One of the principal objections 
to the old septic tank is thus obviated; the continual disturbance of the sewage 
by gases rising forcibly from the sludge seriously interfered with sedimenta- 
tion in the one-story tank. Whereas in septic tanks sewage must be allowed 
to remain from 8 to 24 hours, even then yielding a foul effluent as an end result, 
tanks constructed on the new two-story Imhoff design are capable of removing a 
higher percentage of settleable matter from the sewage in retention periods of 
from two to three hours, with a fresh inodorous sludge of low-water content 
and small bulk. The disposal of sludge is usually a big problem, so the small 
bulk and low-water content of Imhoff tank sludge is in itself a great asset. 
About 65 to 75 per cent of suspended matter and from 25 to 75 per cent of 
the contained bacteria are removed from medium-strength sewage by this 
treatment. 
Imhoff tanks, or septic tanks, can be of wood or concrete construction, and 
the size should be calculated to allow for not less than two hours’ delay, or 
one-twelfth of the daily flow plus about 50 per cent to allow for peak loads. 
For example, a station having a complement of 1,200 men with a daily per 
capita water consumption of 100 gallons would have under a “ separate ” 
system roughly 120,000 gallons of sewage to be 
disposed of each day, or an average of 5,000 
gallons per hour. A tank designed to provide 
for a two-hour delay obviously must have a 
capacity of 10,000 gallons. With the additional 
allowance for peak loads the tank therefore 
should have a capacity of 15,000 gallons. If a 
combined system is used a further allowance 
naturally must be made for storm water. Capac- 
ity should be reckoned on the upper-chamber 
contents. 
It should be remarked that a new Imhoff 
tank, or septic tank, if put into use without 
giving it a start with the proper bacteria and 
other flora, may not work efficiently for some months; it should, therefore, be 
“ seeded ” with a few buckets of sludge or manure. When sludge is removed 
some of the fresher sludge should be left in the tank for the same purpose. 
Purification.—The purification processes are designed to free the fluid coming 
from the various types of sedimentation basins of as many bacteria as possible 
and of disagreeable organic matter. 
The following methods, all of which depend upon aerobic bacterial action, 
are used: 
1. Subsurface irrigation. The water coming from the tanks is discharged 
intermittently through one or more systems of open hollow-tile pipes, placed 
from 12 to 18 inches below the surface of the soil. The liquid thus is dis- 
charged into the subsoil, where bacterial activities are greatest. 
2. Surface .irrigation. The sewage from tanks is discharged into trenches on 
cultivated land and allowed to permeate the soil. 
3. Intermittent sand filtration. Filters similar to slow sand filters described 
on page 290. 
4. Contact beds. 
5. Trickling filters. 
Finally, at some naval training stations, and in many cities of the United 
States, the water emanating from the sewage after being treated is further 
treated with chlorine. 
Fig. 151.—Imhoff sedimentation 
tank, sectional view. (Modern 
Hospital.) PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
295 
In the dry system faecal matter is received in pails, water-tight receptacles, 
pits, or latrines. This system is suitable for isolated houses or small groups of 
houses, for temporary camps, where the natural drainage is into a public 
water supply which must be protected, or where no water for a water carriage 
system is available. The safety of the system depends upon proper care by 
user and collector; cleanliness in handling, prompt and frequent collection, 
disinfection of receptacles, protection of faecal material against flies, and in- 
cineration or burial in a suitable locality. 
Refuse. 
Aboard ship.—The disposal of refuse aboard ship is not a great problem. 
Dry refuse, such as paper, boxes, etc., is disposed of by burning in the fire 
boxes of the boilers on coal-burning ships or on modern ships in incinerators. 
Tin cans are disposed of by puncturing and then throwing over the side. Wet 
garbage, such as waste from meals and galleys, is disposed of by placing it in 
slop chutes. 
Some port regulations are to the effect that no garbage or other refuse may 
be thrown into the harbor. Under such conditions, tin cans, etc., have to be 
placed on specially provided lighters, which are brought alongside at regular 
intervals. On coal-burning ships, ashes have to be disposed of in a similar 
way in harbor. At navy yards refuse from ships is disposed of on the dock 
in specially provided garbage containers, which are cared for by the yard 
forces. The ships are required to keep such places clean and free from odor 
as long as they are being used by individual ships. 
In time of war ships are not permitted to throw garbage or tin cans over 
the side. During daylight there are specially constructed bins which collect 
and hold all garbage until nighttime, when the entire bin is dumped. The 
reason for this is that a fleet or a ship may be traced by the floating refuse 
which is thrown over the side. Under such conditions the medical officer 
of a ship should pay particular attention to large garbage bins. Although 
no diseases may be disseminated in this way, the bins are a nuisance unless 
kept clean. 
Disposal of refuse ashore.—Refuse should be collected from the galleys, 
barracks, houses, etc., in specially provided water-tight containers, which are 
covered to prevent the access of flies. The refuse should be separated, ashes 
being put into one can; tin cans into another; paper and wood, etc., into 
another can; and wet garbage in a separate can. 
Tin cans may be of value; if there are a sufficient number, they may be 
sold. Otherwise, they will have to be disposed of by dumping at a convenient 
place, in order that the odors emanating therefrom will not be a nuisance. 
Dry rubbish, such as wood, paper, etc., should be burned in an incinerator, 
which is provided at all such stations. 
Kitchen refuse may be disposed of in one of three ways: 
(1) By feeding to hogs. Some stations have maintained a hog farm, and 
this has been profitable. 
(2) By selling garbage to contractors. Contractors use this garbage either 
by feeding to hogs, or by extracting the fat and other material from it. 
(3) By incineration. This is the most costly method, and perfectly good 
food material is being wasted. But where it is impossible to maintain a hog 
farm in the near vicinity of the station, such as the station in the city of 
New York, it is more economical to incinerate the garbage than to haul it 
long distances. Ashes on shore should be used to fill in low lands, but unless 
the ashes are kept separate from the rest of the refuse it is likely to be a 
nuisance. 296 
HOSPITAL CORPS HANDBOOK. 
Manure.—Inasmuch as manure offers such an ideal breeding place for flies, 
it should not be allowed to accumulate around corrals or stables. The manure 
may be disposed of by being taken away every morning and spread out thinly 
so that it will dry. Or it may be placed in fly-proof bins and held there until it is 
hauled away. Manure may be sprayed with a solution of hellebore or borax, to 
kill maggots and at the same time preserve it as a fertilizer. It also may 
be burned, but since manure is valuable as a fertilizer, this rarely is done. 
PERSONAL HYGIENE. 
By personal hygiene is meant any measures taken by the individual by which 
he can avoid disease and promote his health and strength. These measures 
include the eating of the proper amount and kind of food, drinking the proper 
kind and amount of water, the wearing of proper clothing to suit the tempera- 
ture, the breathing of wholesome air, all of which tend, to heighten re- 
sistance; the avoidance of habits and practices which are liable to contract 
or transmit infectious diseases such as those borne by the mouth, nose, throat, 
intestinal, venereal secretions, etc.; the proper use of the eyes; all of which have 
been touched on in preceding sections. Cleanliness of the person and clothing 
is one of the first requisites for good health. A daily bath should be taken when 
practicable. The hair should be kept short, finger nails kept trimmed and 
cleaned, teeth brushed twice daily, and the exposed parts of the body, face, 
and neck bathed frequently, and the armpits and genitals at least once a day. 
Dirty bodies and dirty and infected clothing are very often the cause of skin 
and other diseases. 
Effect of proper exercise on health.—With proper exercise, the elimination 
of waste products from our bodies is increased through deeper breathing, more 
perspiration; the muscles and heart become better nourished by more rapid 
metabolism, and a better circulation improves all the other functions of the 
body; the digestion is improved; and resistace to certain diseases is increased. 
Care of the botcels.—The bowels should move daily, otherwise poisonous 
substances are absorbed into the system. If proper food is eaten and proper 
exercise taken, the bowels generally wTill look after themselves. 
Effect of the mental state on health.—A cheerful state of mind promotes and 
benefits all the functions of the body and vice versa. 
Dental hygiene.— (See section on Dental First Aid.) By dental hygiene 
is meant the care of the teeth and mouth. The teeth should be brushed 
at least twice a day, and preferably after each meal, the object being to pre- 
vent decomposing matter from resting on the teeth: a clean tooth does not de- 
cay. The structure of the toothbrush and manner of brushing the teeth should 
be such as to insure the removal of all food particles and foreign matter from 
around and between the teeth; this always is done more readily by the use 
of a good toothpaste. One should have the teeth scraped and cleaned period- 
ically by a dentist in order to have removed the hard calcareous matter that 
may accumulate at the margins of the gums and which tends to cause recession 
of the gums and pyorrhcea. Pyorrhoea is an infectious inflammation of the 
gums and a most difficult condition to cure and this, together with recession 
of the gums, frequently results in the loss and decay of teeth. Whenever a 
decayed condition is noted in a tooth, one always should go to a dentist for 
prompt treatment while the tooth yet may be saved. Improper care of the 
mouth and teeth results in infection at the roots of the teeth, and from here, 
the infectious microorganism may gain access to the blood and set up con- 
ditions such as articular rheumatism with perhaps heart disease, Bright’s 
disease of the kidney, severe neuralgias, besides such local conditions as alveo- 
lar abscess with toothache. 297 
PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
CLOTHING. 
The chief purposes of clothing are: 
1. To maintain the temperature of the body, and, by preventing the loss of 
animal heat, to diminish to some extent the demand for food. 
2. To hinder as little as possible the chief heat-regulating mechanism, viz., 
evaporation from the skin. 
3. To afford the greatest possible freedom to all muscular acts and to avoid 
the compression of the body. 
4. To protect the body from heat, cold, wind, and rain. 
5. To protect against mechanical injury, frost, or the direct rays of the sun. 
The value of any material for clothing purposes depends upon: 
1. The slowness with which it permits the passage of heat to or from the 
body. 
2. The slowness with which it permits the evaporation of water. 
3. The amount of air its meshes contain. 
4. Its impermeability to the wind. 
5. Its adaptability to some special purposes. 
The materials from which clothing is made are derived from: 
1. The animal kingdom: (a) Silk, (b) wool, (c) leather, (d) fur. 
2. The vegetable kingdom: (a) Cotton, (ft) linen, (c) papers and other fibers. 
Silk.—This is an excellent nonconductor of heat, is almost as hygroscopic 
as wool, and affords a warm clothing. It takes coloring matter easily, and is 
therefore of value from an aesthetic standpoint. It is an excellent material for 
undergarments. Its great disadvantage is its high cost. 
Wool.—This is obtained from the hair of many animals, viz., sheep, goats, 
camels, alpacas, etc. In a general sense it is probably the most valuable of 
clothing materials, because: 
1. It usually is worn in such a way as to entangle large quantities of air 
in its meshes, and thus prevents either sudden lowering or raising of the 
body temperature, because dry air is a good nonconductor. 
2. It is very hygroscopic; readily taking up water and perspiration, and 
giving them off slowly, thus reducing “ the cooling by evaporation ” to a 
minimum, and regulating the heat dissipation of the body. 
3. When saturated, it still permits the passage of air through its substance. 
Its disadvantages are that: 
1. It can not be worn next to the skin. 
2. It absorbs odors. 
3. It shrinks quickly if washed carelessly. 
4. It readily wears out. 
5. It is moderately expensive. 
Leather.—This is used chiefly as foot coverings on account of its durability, 
pliability, and imperviousness to moisture. It is used in cold countries 
because it resists the force of the wind and efficiently surrounds the body with 
a layer of warm air. 
Fur.—This protects against the wind and the cold on account of the 
impermeability of the skin, and of the large quantity of air entangled in the 
fur itself. It is heavy and expensive. 
Cotton.—This is used more generally for clothing than any other material. 
It is hard and durable, but not as hygroscopic as wool. If smoothly woven 
and of light color it makes cool garments for warm seasons. For cold seasons, 298 
HOSPITAL CORPS HANDBOOK. 
it should be made to resemble wool by having large air spaces in the fabric 
and by being made of some dark color. It should not be worn while exercis- 
ing, unless removed immediately thereafter, because it permits too rapid 
evaporation and cooling. It does not shrink, is very nonabsorbent of water, 
and conducts heat less rapidly than linen, but more rapidly than wool. It is 
very absorbent of odors. Its chief advantage is its cheapness. 
Linen.—This is valued for its durability and for its purity of color when 
bleached. Its hygroscopic and heat-conducting properties are about the same 
as those of cotton, but it is more expensive than cotton. It is excellent for 
clothing in the Tropics, but soils easily. It is cooler, smoother, and less irritat- 
ing to the skin than cotton. 
Paper.—This is used extensively in countries where poverty prevents the use 
of the more favorable materials. Its use is quite common among the Chinese 
and Japanese, and it was used extensively by the Germans during the recent 
World War. Paper is warm because of its impermeability. 
The most important use of clothing in cold climates is to protect against 
cold. This is accomplished by diminishing the radiation of heat from the body. 
The radiation of the heat from the body diminishes with the number of layers 
of clothing worn, because with each new layer of clothing we add another 
layer of air. Warm clothing depends upon the following factors: 
1. The capacity for retaining the natural body heat. 
2. The color. Color absorbs heat in the order named herewith. Black, dark 
blue, light blue, dark green, red, light green, light yellow, pale straw, white. 
3. The degree of porosity. Flannel is the most porous, silk the least porous. 
Starching and ironing tend to close the pores in clothing and render it more 
impervious. The wearing of unstarched clothing in hot weather is, therefore, 
more comfortable. In winter, starching and ironing serve to conserve the heat 
of the body. 
4. The surface finish. Rough surfaces are generally warmer than those 
which are smooth, because the rough surfaces stimulate the skin and favor 
capillary circulation. 
5. The hygroscopic properties. The hygroscopicity of the various materials 
is as follows: Wool, fur, eiderdown, linen, cotton. 
6. The number of layers. With each new layer of clothing, in addition to 
getting the benefit of an additional thickness, we get also an additional layer 
of air, thus adding another good nonconductor and diminishing the radiation of 
heat from the body. 
7. The texture. Loosely woven clothing has more air in its meshes, and is, 
therefore, a better nonconductor of heat. A loosely woven cotton cloth, such as 
bath toweling, may be warmer than a finely woven woolen cloth, because it 
will absorb a slightly greater quantity of water. 
Infected clothing. 
Clothing, linen, and other garments are capable of holding a relatively large 
number of microorganisms and vermin. The number of bacteria found is in 
direct ratio to the number of days the garment has been worn (clothing in 
contact with the body). Wool has a greater capacity for germs than cotton or 
silk. Under all conditions pathogenic bacteria contained in clothing gradually 
die out There is also a progressive decline in the power of development of 
bacteria, as they undergo a gradual diminution in virulence. This virulence 
they can retain in clothing for a considerable, but not indefinite, time. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
299 
VITAL STATISTICS—METHODS USED IN THE UNITED STATES 
NAVY. 
The importance of vital statistics to the practice of preventive medicine 
can not be overstated. Without the statistical method comparatively little 
progress would have been made in epidemiology and less toward the pre- 
vention and control of disease. 
The statistical method is the method of presenting facts in numerical form 
in order that they may he studied in comparison with other facts, numeri- 
cally stated or otherwise. 
Vital statistics are the numerical presentation of facts relating to sickness, 
deaths, births, and marriages for the population (or complement) as a whole, 
or for specified groups or classes. Vital statistics commonly are prepared 
INFLUENZA EPIDEMIC. U.S.NAVY. 
JANUARY Z-APRIL 1.1922. 
RATIOS PER I.OOO. 
Fig. 152.—Type of arithmetical chart. 
specifically for the following population groups or classes: Sex, age group, 
race and color, occupational group. 
Statistics may be prepared for subgroups of these; for instance, whites of 
the male sex, belonging to the age group, 20 to 29. Furthermore, it may be 
that only males of a particular occupational class are under consideration. 
Graphic methods for presenting statistics. 
Although statistics present facts for study in the form of numerals, their 
significance can not be grasped always until the statistical facts have been 
further presented in graphic form—curves, lines, bar charts, spot-pin maps, 
pin charts, etc. (Figs. 152, 153, 154.) 
Graphic records are constantly necessary in statistical work for the fol- 
lowing reasons: 
(1) They make it possible to perceive instantly facts which otherwise might 
be concealed or discovered only after careful study. 
47829°—23 20 300 
HOSPITAL CORPS HANDBOOK. 
(2) They make it possible to place before the eye at one time, in under- 
standable form, information which otherwise could not be presented without 
long tables of figures accompanied by long and involved explanation. 
(3) They facilitate comparison of facts with other facts, closely correlated, 
remotely related, or, perhaps, as determined by study, bearing no relation 
whatever. 
(4) By their means it is possible at times to make a person untrained in the 
statistical method perceive certain facts and appreciate their significance when 
by other means he could not be made to understand. 
(5) Either the relation or the possible relation of one set of facts to another 
set of facts, and still other facts may be recorded pictorially on a single chart 
or map. 
ANNUAL ADMISSION RATES PER 1000. 
MALARIA.MEASLES.MUMPS AND PNEUMONIA. 
1921 
Fig. 153.—Type of logarithmic chart. 
(6) In conjunction with the records for previous corresponding periods of 
time, graphic records show the trend of current events and sometimes enable 
one to look into the future for a short distance. 
In administrative work the routine use of graphic records insures that im- 
portant information which otherwise might be buried in the files and forgotten 
will be kept in view. Frequently such records can be used to advantage in 
attempting to convince other persons of the necessity for certain preventive 
measures. 
Subject matter of the vital statistics of the Navy. 
In the Navy vital statistics are limited almost exclusively to morbidity 
statistics and mortality statistics. In a few instances—Virgin Islands, Guam, 
Samoa—birth and marriage statistics are collected for the civilian population. 
The subject matter of vital statistics of the Navy is composed of— 
1. Basic data.— (a) Individual morbidity reports, i. e., the Form F card, 
which shows the diagnosis and certain attending circumstances for each admis- PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
301 
sion to the sick list. (6) Individual mortality reports; the death certificate, 
Form N. 
2. Summarized written or telegraphic reports of new cases and deaths. 
3. Compilations, i. e., tables or tabulations showing cases, deaths, or rates. 
4. Graphic charts, spot maps, or charts posted by means of colored spot pins. 
Correct vital statistics depend upon the accuracy and completeness of the 
basic data. Morbidity returns are incomplete when mild cases of a disease 
are not reported, and incorrect when erroneous diagnoses are recorded. A 
morbidity report is incomplete when any of the data required on the form is 
omitted. Mortality reports are incomplete when any of the required data are 
omitted, and incorrect when sufficient collateral evidence to insure correct 
classification of the death witli regard to cause is missing. The death certifi- 
cate also must contain the necessary information to enable the bureau to charge 
the death to the station or ship where the disease or injury resulting in death 
was acquired, and not to the place where death occurred—in a naval hospital, 
perhaps. 
OCCUPATIONAL GROUPS OF THE U.S.NAVT-ALL CAUSES 
1921. 
RATIOS PER 1.000. 
ADMISSIONS. 
Fig. 154.—Type of bar chart. 
Purpose of vital statistics. 
The immediate and most important purpose, from the standpoint of pre- 
ventive medicine, is to furnish information as to when, where, and under what 
circumstances, disease is occurring. It follows, therefore, that morbidity and 
mortality reports invariably should be made as promptly as possible. Reports 
should be forwarded promptly as a matter of routine even when, from the local 
viewpoint, no apparent reason for haste exists. 
The historical value of vital statistics is also very great. Complete statistics 
must be prepared for each calendar year. 
Use of vital statistics. 
Alone, vital statistics do not necessarily prove anything. The facts thus pre- 
sented in arithmetical form may or may not comprise all the facts pertaining 
to the question under consideration—almost invariably they do not. All epi- 
demiological factors which possibly may have a bearing on the question must 
be taken into consideration. 
It is because of positive but unwarranted assertions based on statistics, by 
persons who fail to observe proper limitations, owing to lack of thorough train- 302 
HOSPITAL CORPS HANDBOOK. 
ing in the statistical method, that uninformed or misinformed persons not in- 
frequently question the value of the statistical method in general, and of any 
statistics in particular that may be invoked in perfectly logical support of a 
given contention. 
The answer to the old saying, “ There are two kinds of lies, ordinary lies 
and statistics,” is, “ Figures do not lie, but unfortunately liars do make use of 
figures.” 
The idea of comparison always is involved in statistics. The user may 
not be conscious of this, but everything in the universe is relative to some- 
thing else, and if any given statistical statement appears to be absolute it is 
merely because it unconsciously is interpreted and weighed in association with 
similar information previously acquired. More frequently in practice the at- 
tempt frankly is made to compare the statistical information under considera- 
tion with other statistical data, and often with information of a different char- 
acter as well. 
Standards of comparison. 
In order that any fact or set of statistical facts may be compared honestly 
with other facts in the realm of vital statistics they all must be expressed in 
the same ratio to population or group in the population. 
The ratio itself does not matter; that is, the rate may be per 100, per 1,000, 
per 100,000, or per 1,000,000 of population as best suits the purpose. To change 
a rate per 100 to the equivalent rate per 1,000 is a simple matter of sliding 
the decimal point over one place to the right. Rates per 1,000 are used for 
most purposes. 
To make satisfactory comparisons we should have available standard rates, 
“ norms,” so called. The rate for a whole previous year, or preferably the 
mean rate for a series of previous years, is used for this pupose. Ordinarily 
figures should not be used for more than the five-year period immediately pre- 
ceding. Conditions tend to change, and circumstances may not permit true 
comparison with figures relating to a more remote period. There are certain 
exceptions to this rule. For example, it may be desired to show a death rate, 
by years, for a long period of time. 
In studying the rate from a given condition for a season of the year, a cer- 
tain month for instance, the similar rates for the corresponding month of 
previous years should be available, although very likely we will compare 
it also with the average whole-year rate. 
As a rule, morbidity and mortality rates are computed for current study 
by weeks, by months, and by years; occasionally by 5-year or 10-year periods. 
Exceptionally, as for an epidemic of influenza, morbidity and mortality rates 
are computed by days in order that a more complete statistical analysis of 
the outbreak may be made. 
Rates for weeks or for months or other short periods of time fluctuate 
widely. The weekly rate is almost sure to vary a great deal from week to 
week. Because of this the fairest available whole-year rate always should be 
borne in mind. 
Naturally it follows that the rate for the week or other short-time period 
must be expressed in terms of an annual rate in order to facilitate comparison. 
This is done as follows: The number of cases (or deaths) for the week is 
multiplied by 52 and the rate then computed. This rate is called the annual 
rate for the week. We merely assume that if conditions were exactly the 
same for the other 51 weeks the whole-year rate would be that figure. 
It is our practice to express all rates as annual rates, whether for a week, 
month, whole year, or longer period. In this way any rate may be compared PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
303 
directly with standard rates or with rates for any other period of time, 
shorter or longer, or with regard to season of the year, corresponding or dif- 
ferent period. 
Population statistics. 
It is clear that we must have accurate or nearly accurate population (com- 
plement) figures in order to compute approximately correct rates. In civil 
practice the estimated mid-year population as of July 1 is taken. 
In the Navy the daily average complement for the period under considera- 
tion is used. This is determined by taking the total number of daily rations 
issued and commuted during the period (figures obtainable from the supply de- 
partment). This figure is divided by the number of days in the period and then 
the number of officers and others not entitled to rations is added. 
The larger the complement the smaller the error caused in a rate by incor- 
rect complement figures. In any event the omission or addition of one case (or 
death) will have more effect on the rate than a considerable variation in the 
complement. 
Annual rates. 
An annual rate per thousand is. obtained for a definite period of time—a 
week, month, quarter, or entire year—by multiplying the number of deaths or 
admissions for the given period by 365 and dividing by the number of days in 
the period; this figure then is multiplied by 1,000 and divided by the average 
daily complement. The cases (or deaths) for a week may be multiplied by 52; 
for a month by 12. 
The rate for the entire year, of course, is an annual rate. It is computed 
simply by multiplying the number of cases (or deaths) which have occurred 
during the year by 1,000 and dividing by the daily average complement for 
the whole year. 
Provisional rates and final rates. 
Morbidity and mortality rates computed from week to week or from month 
to month must, of necessity, be provisional rates based upon reports for the 
period in question as received. Final rates ordinarily are not prepared until 
after the end of the year when final returns have been received. Then the 
figures may be reviewed and corrections made in weekly or monthly rates by ex- 
cluding cases (or deaths) which actually did not occur in a given period, and 
by charging them to the week or month in which they did occur. (In civil 
practice, in revising death rates, corrections sometimes are made for deaths 
occurring in the community but chargeable elsewhere.) 
Current morbidity and mortality rates are prepared as a matter of routine 
in order that the incidence, distribution, and severity of disease may be de- 
termined for comparison with similar figures for past periods and other com- 
munities. 
It must be borne in mind that rates for short periods of time—weekly and 
monthly rates—fluctuate widely because of epidemic conditions, seasonal and 
other periodic or cyclic influences, and fortuitous circumstances. Such rates 
always should be compared with similar rates for corresponding periods of past 
years, although rates for past whole years furnish a guide as to what may be 
regarded as a normal average, seasonal and other influences, of course, being 
taken into consideration. 
Comparison between one naval station and another, or between ships, and 
especially between ships and stations, should not be made without taking into 
consideration a number of conditions which may vary widely—number of per- 304 
HOSPITAL CORPS HANDBOOK. 
sonnel, density of population, overcrowding, housing conditions, permanency 
and character of the personnel, nature of activities carried on, environment, 
geographical location, climate, and season. 
In the Bureau of Medicine and Surgery provisional annual morbidity rates 
are computed and plotted on charts each week for the Navy as a whole and for 
shore stations separately and combined. Separate rates are plotted for the 
classifications—all causes, diseases only, communicable diseases as a class, 
venereal diseases as a class, and each of the important communicable diseases. 
A monthly chart of the venereal-disease rate is kept for every ship in commis- 
sion and for each shore station. 
The general death rate of the Navy for “ All causes ” and the rate for 
“ Diseases only ” are computed every Monday from certificates of death (Form 
N) received during the preceding week. 
Rates other than those expressed in terms of annual rates. 
Epidemic rate.—Epidemic morbidity rate. Epidemic mortality rate. Com- 
puted simply as the rate per thousand of complement attacked or died as a re- 
sult of the epidemic, regardless of its length. 
Attack rate.—Sometimes used to indicate the incidence of a disease among 
those presumed or known to have been exposed. Generally expressed as the 
percentage of cases occurring among contacts. With regard to influenza, it 
is permissible to conclude that practically everybody in the community has been 
exposed if the disease is epidemic. 
Case fatality rate.—Percentage of fatal cases among persons attacked by a 
given disease. Computed by multiplying the number of deaths by 100 and 
dividing by the total number of cases, fatal cases included. 
To express this, medical officers frequently use other terms, such as “ mor- 
tality,” “ mortality rate,” or “ death rate.” The objection to use of the ex- 
pression “ mortality ” is that it is not always clear that the case-fatality rate 
is meant. The other terms have an entirely different meaning, viz., the ratio 
of deaths to the population or some group in the population. 
Percentage of sick.—This rate expresses the daily average percentage of men 
on the sick list, for the given cause or causes, during the stated period. It 
sometimes is called the noneffective rate, because when all causes are included it 
indicates the percentage of complement constantly noneffective during the 
stated period. 
To compute the percentage of sick for a given disease it is necessary to know 
the number of sick days. This figure divided by the number of days in the 
period gives the daily average number of patients on the sick list with the 
given disease. This number is multiplied by 100 and divided by the daily aver- 
age complement. 
This rate is of little value from the standpoint of prevention, but it is of 
interest from an economic point of view, and thus becomes of interest from the 
broad standpoint of preventive medicine, as well as general medicine. For the 
service as a whole the percentage of sick, as calculated at the close of the year 
upon receipt of final returns, gives definite information as to the percentage of 
men constantly off duty as a result of disability from any one or all causes. 
For example, the percentage of sick, entire Navy, for the calendar year 1917 
was 2.18. Suppose a working strength of not less than 500,000 men were re- 
quired ; on the basis of 2.18 per cent constantly noneffective, the total strength 
must be not less than 510,900. 
The percentage of sick for an individual ship or station may be very mis- 
leading. It does not give definite information as to the incidence and preva- PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
305 
lence of disease—for this purpose ice must have the numbers of new cases and 
deaths. A few patients treated on board may lead to a high percentage of 
sick; on the other hand, the percentage of sick may remain low in spite of a 
large number of admissions to the sick list if patients are transferred im- 
mediately. For example, consider two ships, each having a complement of 
1,000 men; each admits to the sick list during the month 10 cases of gonorrhoea 
(annual admission rate for the month, 120 per thousand), but in one ship all 
cases are treated on board with the result that 52 sick days chargeable to 
gonorrhoea occur in that month, resulting in 0.173 per cent of sick due to that 
disease. In the other ship, let us assume, all cases that are not admitted for 
record only, with no sick days, are transferred on the day of admission, 
resulting in no sick days, and consequently zero percentage of sick for the 
month chargeable to gonorrhoea. 
It is obvious that a comparatively high percentage of sick does not, neces- 
sarily, constitute a discreditable showing, and that a low percentage does not 
necessarily indicate a low incidence of disease. 
Minimum rate.—The lowest rate in a series of rates. 
Maximum rate.—The highest rate in a series of rates. 
Median rate.—The rate which stands in a series halfway between the 
minimum and maximum rates. 
The mode (modal rate).—The rate which occurs in the series with the 
greatest frequency. In some series the mode is not apparent. 
The items of a series arranged in order from the minimum to the maximum 
figure are said to have been placed in array. 
Mean rate.—The average rate independently computed from the combined 
basic data included in the series—not the average of the rates. 
Example: Communicable diseases, exclusive of influenza and venereal 
diseases, at the Naval Training Station, Newport, It. I., first quarter of 1920: 
Month. 
Average 
daily com- 
plement. 
Cases. 
Annual 
rate per 
1,000. 
January 
2,540 
6 
30.70 
February 
2,794 
23 
107.01 
March .• 
3,267 
41 
130.52 
The mean annual rate for the quarter is 97.65 (obtained as follows: 70 cases 
multiplied by 4, then by 1,000, and divided by the average daily complement 
for the quarter, 2,867). 
Average of the rates.—In the above example the average of the rates is 
89.41. The discrepancy is obvious. In rough calculations it is often sufficient 
to take the average of a series of rates, but the figure thus obtained must not 
be regarded as the mean rate. (See Weighted and unweighted measures.) 
Combined rate.—The average rate for two or more communities combined— 
not the average of the rates. 
Example: Death rate from disease, entire Navy, April, 1920: 
Navy. 
Marine 
Corps. 
Entire 
Navy. 
Average daily complement for the month 
114,543 
43 
16,478 
131,021 
Deaths from disease 
12 
55 
Annual death rate per 1,000 for the month 
4.88 
9.46 
5.45 306 
HOSPITAL CORPS HANDBOOK. 
The combined rate is, therefore, 5.45. Clearly, it would not be proper to 
take the average of the rates, 7.17, as the death rate of the entire Navy. If 
that were done, undue weight would be given to the comparatively small com- 
plement of the Marine Corps and not enough to the relatively large comple- 
ment of the rest of the Navy. If the complements were equal the combined 
rate and the average of the rates would agree. This also would liold for a 
series embracing more than two items if the complements were all equal. 
Other terms used in statistical work. 
Series of data.—The items of a series may be either rates or basic statistical 
data (cases or deaths). 
Geographical series.—The items in the series represent ships, stations, or 
other places. 
Historical series.—The items in the. series refer to time periods, each series 
representing a single place. 
Weighted and unweighted averages.—If the arithmetical averages of two 
or more series are added together and divided by the number of series the 
average thus obtained is an unweighted average. It is an average of averages 
and does not give due weight to differences in complement. Example, an 
average of the rates instead of a properly computed mean or combined rate as 
described above. 
Likewise, in dealing with cases or deaths directly, care must be exercised 
not to take an average of averages or the result will not be a properly weighted 
average; especially should comparison be avoided betw*een unweighted aver- 
ages for a series of places, or time periods, and a weighted average for another 
series. 
Moving average.—This is calculated as a series of averages moving along, 
so to speak, through a series of rates. The moving average is most useful 
where the rates are to be plotted as a curve representing a great many time 
periods in unbroken sequence, especially when there is reason to believe that 
the fluctuations observed in the individual rates are largely due to periodic 
or cyclic influences. Suppose we have the death rate by years for a given 
place plotted on a chart as a curve extending over a long period. There will 
be fluctuations from year to year, of course. If a curve for successive five- 
year averages instead of by single years is plotted, the fluctuations will 
be smoothed out to a considerable extent, but the effect of unusually high 
or low rates will be merged in each separate five-year average and the tend- 
ency will be to conceal any periodic effect on the rate that is due to cyclic 
phenomena which periodically recur, such as epidemics of influenza, measles, 
unusually bad winters, • etc. 
A curve can be plotted from moving averages that will smooth out fluctuating 
rates and yet preserve in the comparatively smooth curve the influence of regu- 
larly recurring fluctuations. This is best explained by an example. Suppose 
we had the following series of rates: 3.5, 4.2, 4.0. 6.1, 5.2, 4.2, 4.0, 3.2, 4.6, 
4.2, and perhaps a longer series. To plot a moving average curve on a! 
3-year pivot (3-year moving average) we would proceed as follows: The 
average for the first three rates, 3.5, 4.2, 4.0, is taken and plotted under the 4.0 
rate as the first moving average plot point. The next moving average point 
is obtained from the rates, 4.2, 4.0, 6.1; the next from 4.0, 6.1, 5.2, and so on, 
dropping a rate and taking up the next in the series for each new moving 
average point. The following diagram illustrates this. The figures in pa- PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
307 
rentlieses refer to the position on the chart of the first, second, third moving 
average plot point, etc.: 
3. 5 4. 2 4. 0 <5. 1 5. 2 4. 2 4. 0 3. 2 4. 6 
The moving average period may be taken as 5 years, 7 years, 10 years, or 
other pivot number. The closer the period chosen approximates the periodicity 
of recurring phenomena the better their influence will be brought out. It 
sometimes is desirable to try two or three moving average periods to see which 
works out best. 
The question sometimes arises as to whether the first moving average 
plot point should be set back. For instance, in a long series of montldy rates 
the moving average is to be calculated on moving average periods of 12 months; 
strictly speaking, the first moving average plot point falls on the date of the 
twelfth month, but it is usually permissible to antedate it to the sixth month, 
in which case half of the data from which it is calculated lies before and 
half behind it. 
Progressive average.—This is a simple matter of plotting under each new 
rate in the series the average of all preceding rates from the beginning of 
the series. 
Suppose we are charting the death rate of the Navy by weeks from the 
first of the year. The rates fluctuate from week to week. The progressive 
average curve shows, each week, the average annual rate from the first of 
the year to date. Inasmuch as all rates are expressed as annual rates, the 
progressive average for the last week of the year actually is the annual rate 
for the year, subject of course to revision upon receipt of final returns. 
Of course, the correct procedure is to compute the mean rate for each new 
progressive average point, but for ordinary purposes the average of the pre- 
ceding rates is sufficiently accurate to show the trend of the curve, which is 
frequently so obscured by fluctuations that it can not be perceived without a 
progressive average curve, plotted along with the fluctuating curve. The follow- 
ing diagram shows the scheme. The figures in parentheses indicate the posi- 
tions on the chart of the progressive average plot points. 
3.5 4.2 4.0 6.1 5.2 4.2 4.0 3.2 4.6 
Compilation of statistical data. 
On board ship, or at a naval station, compilation is ordinarily a simple 
matter of counting up the total number of admissions to the sick list, or the 
number of admissions on account of certain diseases, deaths, and number of sick 
days. The daily average complement must be determined in order that rates 
may be computed. 308 
HOSPITAL CORPS HANDBOOK. 
Where thousands of i*eports must be handled, as in the bureau, card-punching 
machines, sorting machines, adding machines, and machines for calculating 
rates are used. 
Where a great many reports must be handled without machines, recourse to 
hand tally sheets must be had. The cross 5 method usually is employed; 
i. e., ie cross method sometimes is used: 
Sheets of paper are ruled in accordance with the different combination of 
data to be tallied from five individual reports. 
From the figures thus obtained rates may be computed, and these may be 
presented for study on graphic charts in the form of curves plotted to scale, or 
as bars plotted or drawn to scale. 
Before statistical data can he compiled they must be definitely classified, both 
with regard to the complement and type of disease. The complement is classi- 
fied in accordance with the established ranks and ratings of the Navy, and com- 
posite groups such as recruits, fireroom force, deck force, officers, enlisted men, 
age groups, force ashore, force afloat, etc. 
To make accurate classification of diseases possible, medical officers are re- 
quired strictly to follow the Navy Nomenclature and Classification of Diseases, 
Injuries, and Poisons. This is divided into two parts: (a) The nomenclature, 
which is merely an alphabetical list of the acceptable names of diseases, and 
(b) classification. This is a composite classification based in part upon ana- 
tomical considerations, but in so far as the important communicable diseases 
are concerned, upon modes of transmission which have a more or less direct 
bearing on measures for their prevention and control. Therefore, when the 
medical officer is in doubt as to which of two diagnostic terms he should select, 
reference should be made to the classification table in order that the title se- 
lected will place the case in its proper class. Care must he used to select the 
title which actually fits the case. For example, the title, “ cerebrospinal fever ” 
is to be used when, in the judgment of the medical officer, the disease is prob- 
ably meningococcus meningitis, even though meningococci have not been recov- 
ered by lumbar puncture or by nasopharyngeal swab. The term meningitis 
cerebrospinal means some other form of acute cerebrospinal meningitis-pneu- 
mococcus, streptococcus, etc., other than tuberculous meningitis. 
Deaths are classified in the bureau in accordance with the International List 
of the Causes of Death. 
For routine statistical study disabilities and deaths are classed broadly as 
follows: 
1. All causes. 
2. Diseases only. 
3. Accidents and injuries, including poisons. 
4. Accidents and injuries. 
5. Drowning. 
6. Communicable diseases exclusive of venereal diseases, influenza, tonsillitis, 
and minor infections of the respiratory tract. 
7. Each of the more important communicable diseases separately: Cerebro- 
spinal fever, chicken pox, diphtheria, influenza, malaria, measles, mumps, pneu- 
monia-primary broncho, pneumonia lobar, scarlet fever, smallpox, tuberculosis 
(all forms). 
8. Venereal diseases as a class. 
9. Gonococcus infection, syphilis, and chancroidal infection, separately. PREVENTIVE MEDICINE, HYGIENE, AND SANITATION. 
309 
The figures for any special grouping of diseases can be obtained quickly in 
the bureau by means of sorting machines. The groups mentioned above are 
used as a matter of routine, and rates also are computed weekly for each of 
the 26 classes of the Navy nomenclature classification. 
Summary of rates used in presenting morbidity and mortality statistics: 
Morbidity rates : 
General morbidity rates (rates expressed in terms of 
the whole complement without regard to sex, age, 
race, or occupational group). 
Specific morbidity rates (rates for specified groups or 
classes in the complement, as age group, race, or 
occupational group). 
[For all causes, 
j For a given disease. 
[For a class of diseases. 
[For all causes. 
{For a given disease. 
I For a class of diseases. 
Mortality rates : 
General death rates (ratesi expressed in terms of the 
■whole complement without regard to sex, age, race, 
or occupational group). 
Specific death rates (rates for specified groups or 
classes in the complement, as age group, race or 
occupational group). 
[For all causes (this is the 
I crude death rate). 
I For a given disease. 
I For a class of diseases. 
[ For all causes. 
For a given disease. 
I For a class of diseases. 
Interpretation of vital statistics. 
It is the main purpose of vital statistics to establish relationship between 
different facts relating to sickness and death. Such relationship is termed 
correlation. The underlying purpose, of course, is to determine cause and effect. 
This brings us at once into the domain of logic. 
Cause of an event.—The circumstances which must have preceded in order 
that the event should happen (Jevons; Lessons in Logic). An event seldom 
has a single cause. Statistics do not in themselves establish cause. However, 
the first step is to prove the existence of correlation, and this may be ac- 
complished by the statistical method. 
Correlation.—Correlation may be simple or complex. 
Primary or simple correlation (direct comparison).—Two series of data 
only are compared. Example: Death rates from pneumonia set forth by 
months, to determine correlation between pneumonia mortality and season of 
the year. 
From the statistical standpoint epidemiological data are known as variables. 
In any given problem one of the variables always is used to interpret or 
measure the other data. This one is termed the independent variable. In 
the above example the death rates are measured by months; months, there- 
fore, constitute the independent variable. 
Almost without exception, when time periods constitute one of the variables, 
it is the independent variable. The same is true of classifications such as 
sex, age groups, races, occupational groups, etc. 
The data to he measured are termed dependent variables. Numbers of cases, 
deaths, morbidity and mortality rates, percentage of all sorts of things, 
bacterial counts, gallons, cubic feet of water, and similar data expressed in 
varying or fluctuating numbers naturally constitute dependent variables. 
On a chart the horizontal scale always should be used to show the inde- 
pendent variable and the fluctuating dependent variable should be plotted 
to the vertical scale (the numerical scale). 
When correlation is established definitely between two series of data a casual 
relationship is demonstrated thereby provided connection between the vari- 
ables also can be established. Connection is not shown by statistics alone. 
Causal relationship does not necessarily mean the only cause. 
Secondary or indirect correlation.—Three or more series of data are com- 
pared ; data not obtainable in comparable form for direct comparison. The 
processes of logic are more complicated in such instances, and the liability 
to arrive at an erroneous conclusion is greater. 310 
HOSPITAL CORPS HANDBOOK. 
We must bear in mind the mathematical proposition that two things which 
equal a third are equal to each other, but it also must be remembered in statis- 
tical work that two series of data ivhich vary closely with a third may not 
bear a causal relation, or, indeed, any relation whatever to each other. 
Example involving secondary correlation.—An epidemic of cerebrospinal fever 
at the Naval Training Station, Great Lakes, 111., epidemiological factors: 
Number, frequency, and distribution of the cases. 
Number and distribution of carriers. 
Length of service of those attacked. 
Housing conditions. 
Month of the year and weather conditions. 
Personal hygiene of those attacked. 
Fatigue, worry, and exposure to other predisposing influences. 
Prevalence of other diseases. 
It is only by establishing direct and indirect correlation between the inci- 
dence of the disease and these factors (and any other factors which seem to 
have a bearing) that the whole truth about the outbreak can be determined. 
Experience during the war showed that there was low correlation between 
cases and carriers but that a high degree of correlation existed between the 
incidence of the disease and certain combinations of the other factors which 
in turn were closely correlated with each other. 
Methods of demonstrating correlation.— (a) By graphic charts, comparison 
of curves or bars, (b) By mathematical formulae involving the use of co- 
efficients. 
Demonstration of cause or causal relationship.—1. The synthetic method of 
proof, by which known particular facts are pieced together in order to reach 
a more general conclusion. This is the inductive method of reasoning. 
There must be agreement between the facts which are to be accumulated. 
It is, therefore, sometimes called the method of agreement. The following rules 
are applicable to the synthetic method of proof: 
(a) Rule of agreement: If certain instances of the phenomenon in question 
have only one circumstance in common, that circumstance is the cause of the 
phenomenon (or the effect, depending upon the proposition). 
(&) Rule of difference: When the phenomenon in question occurs in one in- 
stance and is absent in another, and one circumstance only is missing in the 
latter instance, all other circumstances being in agreement, then that one cir- 
cumstance is the cause or an inseparable part of the cause of the phenomenon 
(or effect, depending upon the nature of the proposition). 
(c) Rule of combined agreement and difference: When the phenomenon in 
question occurs in two or more instances and is absent in other instances, if 
there is one circumstance common to all instances in which the phenomenon 
does occur, and all instances in which the phenomenon is absent have nothing 
in common but the absence of that circumstance, then that circumstance is the 
cause or an inseparable part of the cause of the phenomenon (or effect, de- 
pending upon the nature of the proposition). 
In the synthetic method a few instances are not sufficient to establish proof, 
fl'he larger the series the stronger the proof. 
2. The analytic method of proof.—Deductive reasoning by which a proposi- 
tion is asserted to be true after which the proof is sought in correct premises, 
and so on from one proposition to another until a known truth is reached and 
the main proposition proved. In other words, the mind looks ahead to the con- 
clusion and then seeks to justify that conclusion by establishing correct prem- 
ises for its logical proof. This method must be resorted to when it is not clear 
how to start the ordinary inductive method. FIELD SANITATION. 
311 
3. Idle indirect method of proof.—Logical process of reductio ad absurdum. 
Fallacies and pitfalls.—There is always danger of unfair comparison of mor- 
bidity and mortality statistics for different places when consideration is not 
given to— 
1. Comparative reliability of the basic data. 
2. The accuracy with which the data for each place were compiled and the 
methods of computing rates. 
3. Epidemiological influences—-comparative effect of potent factors. 
4. The danger of concealed classification. 
There is always danger that statistical data which purport to convey certain 
definite information may be concealing classes such as sex, age, race, color, or 
particular occupation, which, if revealed, might cause a very different inter- 
pretation to be placed on the figures. For example, if we compare the inci- 
dence rates of pulmonary tuberculosis among employees in two different in- 
dustries a conclusion that one may be more conducive to the development of 
the disease than the other may be fallacious, because the figures may conceal 
the fact that the majority of employees in one are very young, while in the 
other they are mostly persons beyond middle age. In the same way nationality 
or race may be concealed. Negroes in the United States have a high death 
rate from tuberculosis irrespective of occupation. 
The following example illustrates the necessity for constant guard against 
the introduction of concealed facts. A very extensive experiment to determine 
the possible prophylactic value of pneumococcus vaccine was conducted in a 
series of large institutions, by vaccinating every other newcomer, leaving each 
alternate one as a control. Now, some of these upon arrival were in good 
physical condition; others not. In cases of choice it practically worked out 
that an undue proportion of those who were not well to start with fell into the 
group of controls. For the first few months the death rate from pneumonia 
was much lower among those vaccinated. The figures concealed the fact that 
a higher proportion of those unvaccinated probably would have contracted and 
succumbed to pneumonia under any circumstances. 
References. 
Preventive Medicine and Hygiene.-—Roseneau. 
Preventive Medicine and Hygiene.—Park. 
Practical Preventive Medicine.—Boyd. 
Principles of Hygiene.—Bergey. 
Naval Hygiene.—Gatewood. 
Naval Hygiene.—Pryor. 
Field Sanitation.1 
The activities of a medicomilitary organization tend to concentrate toward 
one primary objective, “ The conservation of physical efficiency for combat 
The hospital corpsmen of the Navy serve ashore, as well as afloat, and in 
addition to their duties pertaining to naval warfare must be prepared to serve 
as members of the medical department of a naval landing party or a Marine 
Corps expeditionary force; and, as such, require a knowledge of field conditions. 
One of the prime requisites for victory is health. In order to fight, an army 
literally and figuratively has to “ take the field." Consequently field hygiene 
and sanitation is one of the most important subjects for military sanitarians, 
as at this time the laws of preventive medicine are made applicable to war, and 
1 Prepared by Lieut. Commander W. L. Mann, Medical Corps, United States Navy. 312 
HOSPITAL CORPS HANDBOOK. 
this adaptability to war-time conditions is the supreme test of all military 
efficiency. 
The functions of a medicomilitary organization may be divided roughly into 
(a) prevention of disease, and (b) treatment of disease. Prevention is of such 
vast importance to the military personnel that this function only will be con- 
sidered in this discussion. The measures undertaken for the prevention of 
disease probably have saved many more lives than curative medicine, thus 
emphasizing the old adage “An ounce of prevention is worth a pound of cure.” 
Concisely expressed, the major portion of field sanitation may be outlined 
under the following topics: 
1. Food and water. 
2. Conservancy (proper waste disposal). 
3. Insect control. 
4. The hygiene of the march. 
FOOD AND WATER. 
Food. 
In the field a large percentage of the rations is issued in tin containers, the 
contents of which, due to improper preparation, exposure to excessive heat, 
and lack of care in handling, frequently undergo decomposition and become 
especially dangerous to health if their use is permitted. Therefore a careful 
inspection of all canned goods should be required. The terms “ springers ” 
and “ swells ” are applied to bulged, blown, or swollen cans, which, when pres- 
sure is made on the ends, give a crackling sound. “ Springers ” are caused by 
overloading the cans, and, while not desirable, the contents are suitable for 
use. “ Swells ” are caused by the formation of gas due to decomposition and 
may be differentiated from “ springers ” by a splashing sound when the can is 
shaken and a hollow note when gently tapped. These should be condemned 
as unfit for use. 
Occasionally the inside of a can may present a blackened appearance (so- 
called can burn). This condition is not due to putrefaction, but is caused 
by the precipitation of stannous sulphide in an acid medium. Formerly, a 
can with two solder holes was indicative of a “ swell ” which had been punc- 
tured to let out the gas and then resoldered, but now many manufacturing 
firms use two solder holes in sealing their cans. It is well to reject cans with 
three solder holes. 
Water. 
Water constitutes 60 per cent of the body weight, or the equivalent of 10 
gallons in the average man’s body. The loss of 1 gallon of this body water has 
serious consequences, and if l\ gallons are lost the result is fatal. It is esti- 
mated that 1 quart of water is sufficient for about miles of marching under 
ordinary climatic conditions. 
Daily allowance.—The average water allowance in camp is as follows: Two 
gallons per man and 10 gallons per horse. The minimum per man is one-half 
gallon for drinking and one-half gallon for cooking purposes. Six gallons is 
the minimum for a horse. 
Source.—The sources of water are (a ) rain water; (b) surface water, such 
as lakes, ponds, etc.; and (c) underground, which includes wells, springs, etc. 
All these vary in degree as to purity and potability. Rain water is usually 
the most satisfactory of any of the natural waters. Large bodies of water— 
for example, large lakes—are, because of the greater dilution of contaminating 
material, more likely to contain satisfactory water than smaller ones. One FIELD SANITATION. 
313 
should be suspicious of all surface water. The appearance of water is no index 
of its purity, and all water must be considered as contaminated until tests 
prove it otherwise. Wells are of two varieties, deep or shallow. Water taken 
from shallow wells is always questionable, while that from deep wells or deep 
springs is usually suitable for human consumption. If water is used from a 
running stream, it should be taken at a point where there is considerable 
depth and a strong current, and always “upstream,” or, in other words, above 
the camp site. Provisions for watering horses should be made below the site 
chosen from which to obtain drinking water, and for washing clothes, still 
farther downstream. 
Storage, collection, and distribution.—Water receptacles should be kept well 
covered, and as the ground in close proximity to them is likely to become 
muddy, it is advisable to build a sand or gravel pit 2 feet square and 1 foot 
deep to absorb the waste. The receptacles should be cleaned daily with boiling 
water, or, still better, rinsed with a solution of one-third of a teaspoonful of 
potassium permanganate to 1 gallon of water, or with a 1-1,000 solution of 
chlorinated lime. These are harmless and more certain in their action than 
boiling wrater when used alone. 
Canteens when not in use should be emptied and dried and should be fre- 
quently washed with the above solution. Weak tea, highly recommended for 
use in the canteens, should be boiling hot when poured in, thus insuring ster ility 
of the canteen as well as the contents. Drinking cups should not be used in 
common by several individuals. Should conditions arise which make it abso- 
lutely necessary to use common drinking cups, a certain degree of safety may 
be insured by keeping the cups when not in use immersed in a 1 per cent 
solution of formalin. 
Purification.—Boiling the water for 10 minutes is the simplest method of 
purification. Should the water be turbid, it may be clarified by the addition 
of 6 grains of alum to the gallon, stirring well and allowing the sediment to 
settle. 
Chlorination of water is extensively practiced to-day. Calcium hypochlorite 
(bleaching powder), the agent used, is on the supply table under the caption 
Calx chlorinata, U. S. P. A simple formula for its use is as follows: Dissolve 
one-half teaspoonful of chlorinated lime, taken from a freshly opened con- 
tainer, in 1 pint of water, and label this “ stock solution.” This solution 
deteriorates rapidly and a fresh solution should be prepared every four days. 
One-half teaspoonful of this stock solution added to each gallon of water, 
stirred well and allowed to settle for 20 minutes, will insure the destruction 
of all bacteria. These measures approximate the quantities given in the 
chapter on Preventive Medicine, Hygiene, and Sanitation. 
See paragraph 2666, Manual of the Medical Department, U. S. Navy, 1922, 
for instructions regarding the use of the Lyster bag. 
CONSERVANCY OR THE DISPOSAL OF WASTE. 
Waste may be divided as follows: 
1. Refuse—(a) Garbage; (b) Rubbish (boxes, paper, etc.). 
2. Excreta—(a) Night soil (urine and faeces) ; (b) Manure. 
Collection of waste.—Metal garbage cans, if available (wooden or cardboard 
boxes may be substituted), should he placed at intervals in the company streets 
for the deposit of and collection of waste paper, burnt matches, fruit peelings, 
cigarette stumps, etc. This accomplishes primary cleanliness of the camp 
and inculcates the habit of tidiness in the men. 314 
HOSPITAL CORPS HANDBOOK. 
Garbage cans should be well covered and placed on raised platforms at least 
2 feet above the ground. The soil beneath these platforms easily is contami- 
nated by the overflow or drippings and requires careful supervision to prevent 
pollution and fly breeding. The surface should be scraped or raked daily and 
shoveled into the garbage can, fresh dry earth being then spread over the 
scraped area. The promiscuous use of lime to cover over filth is not recom- 
mended. 
The ultimate disposal of waste.—The final disposal of waste ultimately is 
confined to two procedures, viz., burning or burial. In camps of a few days’ 
Fig. 155.—Garbage incinerator or crematory. (Mason.) 
occupation, an ordinary pit will suffice as a means of disposal of liquid and 
solid waste. The pits for the kitchen refuse should be located near the place 
where the men wash their mess kits. After scraping the refuse food into this 
pit, each man immerses his mess kit and other utensils into a can of soapy 
water, which is boiling over a fire. Then after this washing, the mess kits and 
other utensils should be rinsed in a similar can of boiling clear water. It 
Fig. 156.—The Army “ Leavenworth ” type pit incinerator, built one-half scale. 
will be found that no wiping of the mess kits is required, as they will dry 
almost immediately. 
Field sanitary devices.—The following points should he kept in mind: (a) 
Field sanitary devices, such as latrines, urinals, incinerators (Figs. 155, 156), 
etc., are simple in character, and are comparatively easy to construct; constant 
attention and supervision is necessary to maintain field sanitary devices in 
such condition that there will he no weak link in the chain of sanitation. 
Latrine frontage.—In determining the total length of latrine pits necessary 
for an organization, multiply the number of men by one-tenth and the result 
will be the expression in yards of the total length of latrines required, except FIELD SAFTITATIOJL 
315 
in commands of less than 400 men, when a multiple of one-seventh should be 
used. For example, a regiment of 940 men will require 94 yards of latrine 
frontage, while a battalion of 280 men will need 40 yards (280X7—40). 
Location and care of latrines.—The latrines should be located at a distance 
of at least 50 yards from the camps and as widely separated from the kitchens 
Fig. 157.—A row of latrines and urinals. 
as possible. In open latrines each man is required to cover his excreta with 
fresh earth. Each morning the pits may be burned out with straw and crude 
oil. When latrines are boxed over, as in the “ Harvard knockdown box,” the 
inside of the pit and box should be thoroughly blackened, using 1 pound of 
Fig. 158.—The “ Lucas ” and “ Back to Back ” modification of straddle trenches. 
bone black to 3 gallons of crude oil. This method acts as a deterrent to flies, as 
they tend to avoid blackened surfaces. 
Types of latrines.—The type most easily constructed is the straddle trench, 
known as the 1-2-3 latrine, the dimensions of which are easily remembered, 
viz., 1 foot wide, 2 feet deep, and 3 feet long. (Fig. 157.) These are highly 
recommended because of the slight possibility of the sides being soiled with 
47829°—23 21 316 
HOSPITAL CORPS HANDBOOK. 
urine or faeces. They may be boxed over with seats arranged back to back 
or constructed according to the Lucas modification. (Fig. 158.) 
An important point to remember is that the bacteria which disintegrate the 
urine and faeces are found in the upper few inches of the soil, and for this 
reason these superficial latrines permit a more rapid sterilization of the dejecta 
than the deep trenches. 
During the halt shallow ditches may be dug with a stick, trench shovel, or 
the bayonet. In a camp of a few days’ duration, the straddle trenches will 
suffice. For camps of longer occupation, deep latrines, boxed over with the 
Harvard latrine box, are recommended. 
All trench latrines, when they become filled to within half a foot of the sur- 
face, should be well covered over with earth and labeled with an “ L.” This 
serves to inform future occupants 
regarding the location of abandoned 
latrines. In camps, not of a perma- 
nent nature or when troops are 
constantly on the move, burial is the 
most convenient and the only rapid 
means of waste disposal and is prac- 
ticed universally in our modern ar- 
mies. Incineration has the advan- 
tage of a complete destruction of 
all waste and is the better method 
from a sanitary viewpoint. 
Specifications of incinerators.— 
The Caldwell type is the name ap- 
plied to two trenches dug at right 
angles to each other, intersecting 
in the center. (Fig. 159.) The di- 
mensions are: Length, 6 feet; width, 
1 foot; depth at the center, 1 foot. 
There is a gradual slope upward 
from the center to the surface at 
either end. A chimney is impro- 
vised at the center by using a bar- 
rel and covering its sides with clay; 
scrap iron can be utilized for build- 
ing a grate, and stones for lining 
the sides of the trenches. A strong 
fire is started at the bottom of the 
chimney, and the draft is regulated 
by closing the trench openings 
which are out of line with the wind. 
Solid garbage is burned by throwing it down the chimney, while the liquid 
refuse is evaporated by pouring it on the hot stones. 
Disposal of liquid waste.—Dishwater, bath water, and other waste water 
should be drained into “ soakage pits.” Grease and soap soon clog tlie pit, 
unless some provision is made for them. This clogging is combated by the use 
of traps. (Fig. 160.) 
A urinal soakage pit is constructed as follows: Dig a pit 4 feet square and 
4 feet deep, fill up to within 6 inches of the surface with large stones or empty 
perforated tin cans, and insert four pieces of iron piping 4| feet long, one at 
each corner. Tin funnels are fitted and inserted into the ends of the iron pipes. 
This style is used extensively abroad. (Fig. 162.) 
Fig. 159.—Caldwell incinerator. FIELD SANITATION. 
317 
Horse litter may be used as fertilizer or may be burned. It is used as fer- 
tilizer by (a) distribution, which method is applicable only in warm, sunny 
weather, the manure being spread on hard, level ground, care being taken to 
have it spread in a thin layer, and to have it raked over a few hours later and 
till small lumps broken up, thus permitting rapid drying and preventing fly 
■CROSS-SECTION- 
•JOAKAGE - PIT- F0E-WA5TE-WATEE- 
-W1TH-GREA5E-AND-SOAP -TRAP 
(AFTER. 'ULE ah) 
Fig. 160.— (From “ Sanitation in War,” by Lelean.) 
breeding; (b) close packing (biotliermic method), by which method the manure 
is moistened with water and closely packed by gradually adding new manure 
and beating the pile with shovels, the center of the pile undergoing fermenta- 
tion, and a temperature of more than 150° F. generated, which is sufficient 
to destroy the eggs and larv?e of flies under the surface of the pile; (c) larval 
flytrap, in which the manure is stored on an elevated platform composed of 
parallel slats, underneath which is placed a receptacle containing water or 318 
HOSPITAL CORPS HANDBOOK. 
some insecticide solution. The pile being exposed encourages flies to lay their 
eggs, which are hatched into maggots that burrow through the pile in search 
of earth, with the result that they fall between the slats into the solution be- 
low, where they are destroyed; (d) chemicals, three-fourths pound of borax 
to each 10 cubic feet of manure sifted on fresh manure and then sprinkled 
with water will prevent the fly eggs from hatching. 
A wire hammock slung between two trees may be improvised as a manure 
incinerator. The requisites are an amount of heavy wire, a pair of wire clip- 
pers, and a little ingenuity. The manure is thrown on the hammock and 
burned. The hammock can be 
swung with a pendulum-like mo- 
tion in order to increase the draft, 
which will facilitate the destruc- 
tion of the litter. This method 
proved very successful at the Ma- 
rine Barracks, Quantico, Va. An- 
other method is to place the manure 
in piles 2 by 2 feet, known as 
windrows, sprinkle them with oil, 
and burn. 
INSECT CONTROL. 
Flies.—Flies breed in manure, 
human excreta, and decaying or- 
ganic matter. (See methods of dis- 
posal of manure.) The picket line 
should be burned over weekly, using 
crude oil and straw for this purpose. 
All galleys should be securely 
screened and all food should be 
kept in screened receptacles. Mos- 
quito netting may be utilized to 
make fly-proof cages in which to 
place the food after it has been 
prepared. The presence of a large 
number of flies almost always in- 
dicates that food or filth, or both, is 
present somewhere in the vicinity. 
Traps and swatters should be 
used freely. In daytime flies tend 
to settle on broad surfaces, but at night they prefer hanging cords, wires, etc. 
Flies are attracted by the sunlight except on a very warm day, when they seek 
the shade. Liquids containing poison may be used to kill flies, for example: One 
per cent sodium salicylate or one-half of 1 per cent formaldehyde solution 
(2$ per cent solution of formalin) in milk, also a solution of sodium arsenite. 
The fumes of gasoline are fatal to flies. Put the gasoline in a saucer or a 
can, and pass the same under the flies resting on the ceiling, horizontal wires, 
and other places. 
Sticky fly-paper may be made by heating castor oil, five parts by weight, 
and powdered resin, eight parts, until the resin is dissolved. Do not boil. The 
solution is applied while hot to glazed paper. 
Pig. 161.—Improvised field shower bath, soak- 
age pit, and soap trap for waste water. FIELD SANITATION. 
319 
Mosquitoes.—In draining an area containing mosquito-breeding places make 
the drains as few as possible, clean cut, with sloping edges, narrow bottoms, 
and straight courses. If necessary, laterals may be run into the central ditch, 
i. e., “ fishbone ” drainage. Laterals should join the main ditch at an acute 
angle in order to lessen the deposit of silt and debris. Frequent inspection 
and constant repair are necessary for the proper maintenance of the ditches. 
•CHOSS-SECTION- 
•URINE • 50AKAGE • PIT • 
MOPI FIE.D FODM'LtLtAH' 
Fig. 162.— (Fi*om “ Sanitation in War,” by Lelean.) 
When it is impossible to drain certain mosquito-breeding areas they may 
be controlled by oiling, using crude petroleum, about one-half ounce for every 
15 square feet. The oil forms a thin layer on the surface of the water, and 
when the mosquito larva, commonly called a wiggletail, comes to the surface 
the oil clogs up the breathing apparatus and kills the larva by asphyxiation. 
A larvicide which usually contains carbolic acid has been successfully used 
in Panama. 320 
HOSPITAL CORPS HANDBOOK. 
Kerosene is used extensively in some tropical countries as a repellant to 
mosquitoes. Spirits of camphor and oil of pennyroyal will keep away mos- 
quitoes, but their action is not lasting, and a single application will not suffice 
through the night. One part of oil of citronella and four parts of vaseline 
is highly recommended. 
A satisfactory culicide consists of equal parts (by weight) of carbolic acid 
crystals and gum camphor. The acid is slowly melted and then gradually 
poured over the camphor, forming a clear volatile liquid. Volatilize 3 ounces of 
the mixture for every 1.000 cubic feet of space. Sulphur, 2 pounds per 1,000 
Pig. 103.—-Modified urinal soakage pit with replaceable screened tin funnels. 
cubic feet, is also used. Remedies for mosquito bites include soap, alcohol, 
ammonia, and glycerin. 
Division of common insects. 
Common 
name. 
Species 
or genera. 
Common dis- 
eases trans- 
mitted. 
Breeding places. 
Life history. 
Range of 
flight. 
Flies 
JMusca 
[Typhoid; chol- 
era; dysen- 
tery; diar- 
Manure; garbage; 
decaying mat- 
ter. 
Eggs hatch out in 12 to 
24 hours into larvae. 
Larvae grow rapidly 
Several miles. 
\domestica. 
Anopheles. 
rhcca:small- 
pox; erysip- 
. elas. 
Malarial fever. 
Rural; stagnant 
and in four to six d ays 
become pupae (resting 
stage). Intwotofour 
days mature to adults. 
Ova deposited in mass 
One-halfmile, 
Mosquitoes.. 
Stegomyia. 
Yellow fever.. 
pools; among 
grass and rushes; 
swamps and 
marshes. 
Domestic; develop 
of 250 eggs; in two to 
four days, hatched into 
larvae and in a week 
reach pupa or wingless 
resting stage. In two 
or three days develop 
wings and become 
adult mosquitoes. 
Female lays 70 eggs. 
usually 
against the 
wind. 
Maximum of 
Lice 
Pediculus.. 
Typhus fever; 
in water in any 
container near a 
house or in gut- 
ters, cisterns, 
spouts, etc. 
Breed and spend 
Larvae hatch out in 
two days and develop 
into pupae in one week. 
Then in two or three 
days become mature 
adults. 
Eggs cling to hair or 
75 feet; usu- 
ally hide in 
nooks away 
from wind. 
Do not travel 
relapsing 
fever. 
their entire life 
on warm-blooded 
animals, includ- 
ing man. 
clothing of host (man). 
They hatch out in 
three to four days and 
maturcin lOto 15days. 
much; keep 
close to one 
host. FIELD SANITATION. 
321 
Lice.—Body lice are concerned in the transmission of typhus fever. Vari- 
ous methods are employed in attempts at the eradication of this parasite. 
The clothes may be immersed in gasoline or kerosene. N. C. I. powder con- 
sists of 96 per cent naphthalene and 2 per cent each of creosote and iodoform. 
This powder is dusted in the interior of the clothes. 
Steam heat kills both the adult lice and the eggs. The Serbian barrel 
makes a simple and efficient means of sterilizing the clothes. It will be profit- 
■C R.OSS-SECTION- 
-SL^mn-umL- 
Pig. 164.— (From “ Sanitation in War,” by Lelean.) 
able to study this device in the accompanying sketch, as it is made easily and 
is a very useful means of sterilization. (Fig. 164.) 
THE MARCH. 
Marching is usually a military necessity executed to bring troops into advan- 
tageous or strategic positions at or near the battle line. It is therefore neces- 
sary to take well-known precautions in order that the men may arrive at their 322 
HOSPITAL CORPS HANDBOOK. 
destination in the best physical condition and not completely fatigued. The 
starting hour, of course, is determined by the existing necessites. However, 
whenever possible it should be in the early morning when the men are fresh 
and active and the air is cool and stimulating. The greater portion of the 
march therefore is accomplished before the heat of the day becomes intense. 
Night marching should be practiced only when military necessity demands, 
because the depressing physical effects usually outweigh the advantage of 
strategic positions. Unless unavoidable, strenuous marching during the heat 
of the day should not be attempted. 
Previous to the start a meal of bread, cereals, milk, tea, or coffee should be 
allowed. Marching with empty stomachs is weakening and therefore detri- 
mental. 
The length of the march for a division or a brigade under normal conditions 
should not exceed 12 or 15 miles daily. The length of a day’s march, how- 
ever, is not measured by miles, but according to the condition of the roads, the 
weather, the pace, the loads carried, etc. 
The rate of the march should not average more than 2£ miles per hour, 
inclusive of stops; more than this will lead to fatigue and exhaustion. To 
average this, one hundred and twenty 30-inch steps a minute are required. 
The march should be at route step, in open ranks, half on each side of the 
road. This decreases the heavy, devitalizing cloud of dust, foul odors, water 
vapor from perspiration, etc., which tends to hang over close-order ranks. 
The march should end with the same equal pace with which it started; the 
frequent “ final spurt ” should not be invoked, as at this stage it is doubly 
depressing. The men should alternate between marching in step and at 
ease; singing and whistling popular tunes is to be encouraged. This distracts 
their minds from their fatigued condition, and is probably the surest way of 
preventing early exhaustion. Straggling, either from poor disicpline or fa- 
tigue, is always to be avoided, as it is depressing to the “ morale ” of the 
entire body of troops. 
In hot weather coats should be unbuttoned or removed on the march, but 
replaced at halts. The body should be inclined slightly forward, similar to 
the position assumed in mounting a flight of stairs. This is especially to be 
advised if the soldier is carrying his full equipment. Marching rigidly erect 
necessitates the expenditure of a great muscular effort and therefore produces 
early fatigue. 
Smoking on the march has a depressing effect on the physical condition of 
the men, particularly upon the heart and lungs. It also has a tendency to 
cause the mouth to become dry, creating excessive thirst. This practice should 
be strictly prohibited. 
Before the start, only the average amount of water to a meal should be 
ingested and the water bottles filled with water, unsweetened tea, or coffee. 
Following this, the canteens should not be resorted to until 7£ miles have 
been covered. The contents then should take the men to the end of the 15-mile 
march. The average normal requirements are 1 quart of water at the end of 
every 71 miles. 
The wise old soldier will march nearly all day with only an occasional re- 
course to his water bottle and then very sparingly. The young and unwise sol- 
dier will drink excessively every few miles, and as a consequence becomes 
“ waterlogged,” perspires freely, tires easily, and refills his bottle from every 
strange, perhaps heavily contaminated, stream along the wayside. Water 
bottles should not be filled from the strange sources until the quality of the 
water is approved by the medical officer. FIELD SANITATION. 
323 
A fairly satisfactory method of allaying the thirst while on the march is to 
suck on a small pebble placed in the mouth, to excite the flow of saliva, at the 
same time breathing through the nose. 
At the end of the first 10 minutes, a short halt of a few minutes is advised 
to enable the compensatory activities of the heart and respiratory organs to 
adjust themselves to the march, or, in other words, to gain “ the second wind.” 
Subsequent halts of 5 or 10 minutes are ordered at the end of each hour and 
halts of 30 minutes at the one-half or three-quarters point of the march. 
During the rest periods the men may lie upon their backs, but should replace 
or rebutton their coats and avoid undue exposure to drafts or winds. 
It is necessary to assume a strict regimental sanitary discipline along the 
line of march. A small detail including a medical officer can be sent ahead to 
select the suitable camp site or resting haven, to investigate the water supply, 
and to prepare urine pits and shallow latrines. 
Great care and many precautions must be exercised at these cursory halts to 
prevent the casual fouling and contamination of the surrounding vicinity. A 
sanitary detail should stand watch over this allotted area to insure proper 
use and care. When the march is resumed these men should fill the trenches 
and leave the area as clean and wholesome as practical. 
Light food may be ingested when two-thirds the distance is covered. The 
main meal is not served until one-half hour after the days’ march is completed. 
Selection of a camp site. 
The following characteristics recommend a site: 
1. Accessibility to a supply of good water, fuel, and forage. 
2. Sandy loam or gravel soil. 
3. Elevated site, well drained, such as a sloping plateau or high river bank. 
4. Shade trees as protection from the sun’s rays in warm weather. 
5. Hills and forests acting as windbreaks in cold weather. 
6. Grass. 
The following features are unfavorable. 
1. Recent use as a camp site. 
2. Dry bed of river, ravine, or base of hills. 
3. Clay or alluvial soil. 
4. Proximity to marshes, swamps, or other areas of mosquito breeding. 
Care of the feet. 
It is difficult to overemphasize the value of the proper care of the feet. It 
is said that during the first days of a campaign 10 to 25 per cent of the men are 
physically disabled from foot troubles. Of course the prevention of the foot 
injury while marching depends upon properly fitting shoes and socks. The 
common mistake of the recruit is to call for the same size shoe worn in civil 
life. With the noticeable difference in the last of the military shoe, especially 
its width, the man will receive a shoe perhaps three or four sizes too short, and 
in a few weeks will develop some form of sore feet. To obviate these common 
mistakes the feet must be measured by an officer, the man must wear his full 
equipment to cause full expansion of the feet, and the inner surface of the 
shoe must be a quarter of an inch longer and wider than the foot. It is also 
essential to keep the feet clean, to prevent abrasions and infections. The feet 
must be washed daily at the end of the march, clean socks should replace the 
dirty ones, which should be washed and dried overnight. If water is not 
abundant the feet can be cleaned by wiping them, particularly the toes, with a 
wet cloth. 324 
HOSPITAL CORPS HANDBOOK. 
It is equally imperative to wear properly fitting socks; small ones will pinch 
the feet and readily become torn, forming creases; too large socks very soon 
fold and crease beneath the feet, bruising and blistering the skin. Torn Socks 
must not be worn while on the march. Repaired socks are also harmful 
to the feet. It is well to stretch the socks at the end of a days’ march. If 
washing is impossible, change and put them on the opposite feet to the ones 
on which they were worn the day before. 
For tender, sore feet a powder of salicylic acid 3 parts, starch 10 parts, 
and talcum 87 parts placed within the sock relieves the condition. Rubbing 
soap or vaseline over the tender area is also useful. Blisters should be 
pricked with a sterile pin or needle, and the area protected by a small pad. 
Chafing between the toes is cured easily by cleanliness, a small wedge of 
cotton separating the toes, and the application of the above foot powder. 
Corns are treated by salicylic acid collodion or ointment applied nightly after 
a hot foot bath; usually after four or six applications the corn easily can 
be removed with a clean instrument. Careful attention to the feet of march- 
ing men is as important as the attention bestowed on the rifle, and many 
foot troubles can be eliminated by the rules described above. 
The Venereal Diseases.1 
The venereal diseases are those contracted through sexual intercourse and 
include syphilis, gonorrhoea, and chancroid. These disease are very preva- 
lent in every community and do a great deal of damage not only to the in- 
dividuals affected hut to the community by reason of invalidism and pre- 
mature death. In a military service the venereal diseases cause much loss 
of efficiency. In the year 1917 the British Army lost the services of 98,000 
men as a result of venereal disease. During the same year, the total number 
of admissions for venereal disease in the United States Army was 71,955, re- 
sulting in 875,553 sick days. In the United States Navy during the nine years 
1909 to 1917, inclusive, an average of 158 men out of every 1,000 were admitted 
to the sick list for venereal disease. 
It is highly probable that every person who indulges in promiscuous sexual 
intercourse sooner or later acquires one or several of the venereal diseases. 
It lias been estimated that GO per cent of the adult male population of the 
United States have had gonorrhoea. Now that routine Wassermann tests are 
made in many large civil hospitals, it is found that from 20 to 30 per cent 
of all admissions give a positive reaction indicating syphilis. 
In 1917, in a large Pacific coast city, 97 per cent of the prostitutes were 
found to be infected with venereal disease. In a city on the Atlantic coast, 
96 per cent of the prostitutes had venereal disease. These statistics may 
serve as an index of the prevalence of venereal disease among persons who 
practice promiscuous sexual indulgence. 
The effects of venereal disease are far-reaching. In the case of syphilis 
the effects are in the beginning slight and local, but as the organism which 
causes the disease spreads throughout the body they become grave. One 
great danger is that early in the progress of the disease the symptoms are 
often so trivial that no anxiety is aroused in the patient’s mind. The symp- 
toms may be so slight as not to be observed. The patient may not seek treat- 
ment and he may succeed in unknowingly infecting other people. 
When the infection becomes generalized every organ and every system in the 
body may be attacked. Syphilis is specially liable to attack the walls of the 
1 Prepared by Lieut. Commander W. M. Kerr, Medical Corps, United States Navy. VENEREAL DISEASES. 
325 
arteries. When this occurs the muscular portion of the artery often is replaced 
by nonelastic fibrous tissue. The artery becomes thickened and hardened. 
Hardening of arteries is a natural process which accompanies advancing age, but 
the hardening process resulting from syphilis is much more rapid and dangerous 
as far as life is concerned. If the arteries of the brain become thickened and 
hardened the blood supply is diminished and the portion of the brain supplied 
with blood by the artery affected ceases to exercise its function. What the 
symptoms will be depends upon what part of the brain is involved, but the 
condition may cause mental debility, insanity, loss of speech or memory, or 
paralysis. Syphilis frequently attacks the aorta, the great artery leading from 
the heart. A part of tlie wall of the aorta becomes thickened and loses its 
elasticity by the formation of fibrous tissue which is weaker than the muscle 
in the wall of the vessel. The force of the blood stream causes a bulging of 
this weakened part and in time the wall becomes thinner and the bulging 
greater until eventually a distinct pouch is formed. The bulging of an artery 
in this manner is known as an aneurysm. The thinning of the wall makes the 
aneurysm very liable to burst. This often happens and the patient dies sud- 
denly. Syphilis frequently causes disease of the heart or other important 
internal organs. 
Perhaps the most important part of the body attacked by syphilis is the 
nervous system. Either the brain or the spinal cord, or both, may be affected. 
Once the organism of syphilis has lodged in the nervous system it is extremely 
difficult to evict it. A man with syphilis, if he marries, may infect his wfife, 
and a child horn after the infection is apt to show7 grave manifestations 
of the disease. Syphilis is a most frequent cause of miscarriage in pregnant 
women. 
The local inflammation of the urethra, which is all that most patients see 
in gonorrhoea, is actually the least of its dangers. Apart from the danger of 
infection of the eyes and the general infection of the body resulting in heart 
disease and gonorrhoeal rheumatism, the complications due to direct extension 
of the disease are different in the two sexes. In man all of the organs con- 
nected with the genito-urinary tract may become infected. In women grave 
complications are common. Invasion of the uterus, the tubes, and the peri- 
toneum by the organism is frequent. This invasion takes place either shortly 
after infection or after the birth of the first child. The gonorrhoea may subside 
and become quiet in the glands of the mucous membrane of the vagina until 
pregnancy excites a congestion that increases the virulence of the bacteria caus- 
ing the disease. By these virulent organisms the child’s eyes are endangered at 
birth; its mother’s uterus and tubes immediately thereafter. It is estimated 
that in 10 per cent of blind children the blindness is due to gonorrhoeal in- 
fection of the eyes during birth. Over 60 per cent of the inmates of asylums 
for the blind are made blind by gonorrhoea. Gonorrhoea of the uterus and 
tubes usually makes a woman sterile—that is, unable to conceive children. Be- 
sides depriving a woman of her children, gonorrhoea may render her a 
permanent invalid—may even cost her her life. It is a curious fact that gonor- 
rhoea in women is either much milder or much more severe than the disease in 
man. Some women while heavily infected have few or no symptoms of the 
disease and are not inconvenienced by it. Others are overwhelmed by gonor- 
rhoeal abscesses in the tubes, in the pelvis, or by peritonitis. They must 
undergo severe surgical operations or die; should they recover they often are 
invalids the rest of their lives. 326 
HOSPITAL COKPS HANDBOOK. 
GONORRHOEA. 
Gonorrhoea (clap) is a disease caused by a specific organism called the 
gonococcus. It affects both men and women but does not occur in any of the 
lower animals. In men it is due to the deposition of the gonococcus oil 
the mucous membrane of the urethra during sexual intercourse with a woman 
having the disease. Its usual manifestation is a local inflammation of the 
infected surface. This inflammation is characterized primarily by redness, 
swelling, and exudation of pus which appears at the outlet of the urethra as 
a creamy drop. 
The specific organism causing gonorrhoea belongs to that class of bacteria 
known as the cocci. When stained and viewed through the microscope they 
usually are seen in pairs, the 
adjacent margins being flat- 
tened so that each pair looks 
like two coffee beans placed 
side by side. Generally they 
are found in large numbers in 
the pus of acute gonorrhoea 
and for the most part are con- 
tained within the pus cells. 
In the earliest stage of the dis- 
ease, when the secretion is 
glairy, a considerable number 
may be seen lying free or ad- 
hering to the surface of cells 
thrown off from the inflamed 
mucous membrane, but when 
the condition becomes purulent 
the large proportion within the 
pus cells is very striking. 
The gonococcus stains read- 
ily with methylene blue and is 
“ gram negative ”—an impor- 
tant point in differentiating 
them from other organisms of 
similar shape occurring some- 
times in the urethra. 
The incubation period—that 
is, the time which elapses be- 
tween the exposure to infec- 
tion and the onset of the 
symptoms—is on an average from five to seven days. 
In order to properly appreciate the description of gonorrhoea as it occurs 
in the male, some little knowledge of the male sexual organs is necessary. 
The accompanying illustration is made extremely diagrammatic for the sake 
of clearness and in order to avoid anatomical details which are unnecessary 
for our present purpose. 
The numeral (1) represents the kidney, and passing down from that to the 
bladder (3) is a tube called the ureter (2). Urine is produced by the kidney 
and passes down through the ureter to the bladder where it is stored before 
being passed out of the body. The urinary passage from the bladder to the 
outside of the body is known as the urethra. It is divided into several parts, 
Pig. 165.—Diagram of the male genito urinary sys- 
tem, side view. 1, Kidney ; 2, ureter; 3, blad- 
der ; 4, prostate gland; 4(a), posterior urethra; 
5, membranous urethra; 6, anterior urethra ; 
7, pendulous portion of anterior urethra; 8, 
testicle; 9, epididymis; 10, vas deferens. VENEREAL DISEASES. 
327 
the most inward part, labeled (4a), is called the posterior urethra. Next 
comes a short part (5) called the membranous urethra. This is surrounded 
by a muscle which has the function, when it is contracted, of retaining the 
urine in the bladder; and when it is relaxed, of allowing the urine to be passed. 
This muscle is the compressor muscle of the urethra. The remainder of the 
urethra is termed the anterior urethra. It runs in the body of the penis to its 
outlet, which is called the meatus. The anterior urethra is subdivided 
further into the pendulous (7) portion. There are two channels entering 
the posterior urethra. One comes from a gland called the prostate. The 
other comes from the testicle. The latter channel is a very long tube and that 
portion near the testicle is fine and convoluted and is known as the epididymis. 
That portion of the tube between the epididymis and the urethra .is the vas 
deferens. 
During intercourse the gonococci enter the anterior part of the urethra and 
proceed to grow into the delicate lining membrane where they set up an in- 
flammation. The disease at first is an acute inflammation of the anterior part 
of the urethra and hence at this stage often is called acute anterior urethritis. 
About five to seven days after exposure to infection the patient notices a slight 
sensation of burning, itching, or pain about the meatus. The pain or burning 
is most marked during urination owing to the irritation caused by the urine 
passing over the inflamed area within the urethra. After a day or two a 
small quantity of glairy mucus can be squeezed out from the meatus, the lips of 
which now are found to be inflamed and have a tendency to stick together. 
This mucous stage lasts for about 24 hours and at the end of that time the 
discharge assumes a decidedly purulent character. The pain is sharper and 
during urination there is a marked burning sensation in the urethra. The 
discharge becomes profuse, yellowisli-green in color, creamy in consistence, and 
sometimes tinged with blood, the lips of the meatus and often the entire head 
of the penis are bright red in color, hot, and swollen. In severe cases the 
lymphatics on the dorsum of the penis become swollen and painful, and as they 
communicate with the inguinal glands these latter may become enlarged and 
tender. 
The infection spreads and the entire anterior urethra becomes inflamed. 
Every act of urination is now painful as the urine is forced through the 
urethra, whose caliber has been greatly lessened by the swelling of its mucous 
membrane. The pain may be so severe as to inhibit the passage of urine. 
Painful erections occur, especially at night, which rob the patient of his 
rest, and in this way cause debility, general malaise, and nervousness. 
The symptoms increase in severity up to about the third week of the dis- 
ease, and then in favorable cases gradually decline until at the end of about 
six weeks the patient is practically normal. The discharge almost disappears 
and the only reminder of the disease may be a little moistness at the meatus in 
the morning. The patient perhaps considers himself cured, but may find that 
any dietetic indiscretion, such as the drinking of alcoholic beverages or sexual 
intercourse, causes a reappearance of the symptoms. 
The foregoing description refers to an uncomplicated and untreated case. 
Although the patient is free of symptoms, he is not cured. The disease 
merely has become chronic. The urethra has become tolerant to the gonococ- 
cus which is still present, as generally can be shown by microscopic exami- 
nation. 
Chronic gonorrhoea, or gleet as it is sometimes called, is a serious matter. 
It is the man with chronic gonorrhoea who mainly is responsible for the spread 
of the disease, The patient is quite unaware that he is in an infective state and 328 
HOSPITAL CORPS HANDBOOK. 
lie may marry without any misgiving. The gonococcus to which his urethra is 
practically immune is then implanted in the vaginal mucous membrane of 
his wife, and in this fresh soil takes on renewed activity. It not infrequently 
happens that such a man after a few weeks of married life finds symptoms of 
acute gonorrhoea developing in himself. He usually suspects his wife and 
serious domestic trouble may result. In reality all that has happened is that 
he has been reinfected by his own organisms which have become rejuvenated 
by their residence in the genital passages of his wife. 
The gonorrhoeal process rarely is limited to the anterior urethra. In about 
90 per cent of all cases of acute gonorrhoea the infection passes quite quickly 
up the urethra to and beyond tbe region of the compressor muscle of the urethra. 
When this locality is passed inflammation is set up in the posterior urethra. 
This invasion of the deeper parts of the urethra may take place gradually 
and with such mild symptoms as to escape detection; but in the majority of 
cases it is indicated by a sudden and very marked decrease in the amount of 
discharge at the meatus, accompanied by frequency of the desire to urinate, 
with inability to hold the urine when the desire come on. 
In the mild cases involvement of the posterior urethra may be detected by 
means of the two-glass test, which is performed in the following manner: 
The patient passes the greater part of his urine into one glass and the re- 
mainder into another. If the disease is confined to the anterior urethra, the 
urine in the first glass wTill be cloudy from the pus washed out of the anterior 
urethra, while in the second glass it will be clear, as it consists of normal 
urine from the bladder passed through a urethra which has been washed clean 
of pus. Should the posterior urethra be involved, however, the pus from it, es- 
caping backward into the bladder, renders all the urine in it cloudy; the urine 
in both glasses therefore will be cloudy, the first a trifle more so than the 
second, as it consists of turbid urine from the bladder in addition to the an- 
terior urethral discharge which it washes out. 
Gonococci not infrequently enters the duct of the prostate gland, giving rise 
to an inflammation known as prostatitis, indicated by severe pain in the rec- 
tum which is generally intensified by defsecation. This inflammation may go 
on to the formation of an abscess which may burrow in various directions and 
burst into important near-by structures with serious results. The prostatic 
inflammation when chronic may give rise to an increase in the size of the gland. 
As the prostate surrounds the urethra just where it leaves the bladder, this 
increase in the size of the gland may interfere with the complete emptying of 
the bladder. The urine thus retained may decompose, become infected, and 
cause inflammation of the bladder. This inflammation may extend up the 
ureter and involve the kidney with serious x'esults. 
When gonorrhoeal infection of the posterior urethra spreads along the vas 
deferens to the epididymis inflammation of that organ is set up. Such inflam- 
mation is known as epididymitis. About 5 per cent of all cases of gonorrhoea 
under treatment develop this condition. The patient first notices a slight ten- 
derness along the course of the epididymis. Later on the pain becomes very 
severe, and the scrotum or bag in which the testicles hang, becomes swollen and 
puffy. Constitutional symptoms may be severe and the patient’s temperature 
may rise to 104° F. With proper treatment after about a week of acute symp- 
toms the condition begins to subside. Although the patient may not complain 
of either pain or discomfort, the epididymis has not returned to its normal 
healthy condition, and the affair tends to become active again on the slightest 
indiscretion, such as getting out of bed too soon. VENEREAL DISEASES. 
329 
The important effect of an epididymitis is that the inflammation often causes 
the caliber of the epididymis to become narrowed or obliterated, with the result 
that spermatozoa no longer are able to pass from, the testicle to the urethra* 
In other words, the patient has become sterile on that side. If there has been 
epididymitis on both sides the patient becomes completely sterile. He still re- 
tains his potency but the ejaculated fluid, mainly prostatic secretion, is scanty 
in quantity and is devoid of spermatozoa. Impregnation of the female is thus 
impossible, hence the unfortunate patient no longer can reproduce his species. 
An important sequel of gonorrhoea is stricture of the urethra. By this is 
meant a norrowing of the urethra by scar tissue at the site of an ulceration 
set up by the gonococcus. The narrowing of the urethra interferes with the 
free flow of urine and in time may cause complete retention or inability on the 
part of the patient to pass his urine. 
Treatment of gonorrhoea. 
The following outline of treatment is recommended for the use of hospital 
corpsmen who are on independent duty. All patients with gonorrhoea should 
be referred to a medical officer as soon as possible. 
In the acute stage the patient must be kept quiet. For the first week or 10 
days, or even longer if the symptoms of inflammation are very marked, the 
diet should be light and easily digested. The following articles should be 
excluded: Ham, bacon, red meats, green vegetables, fresh fruits of all kinds, 
condiments and spices, coffee, chocolate, cocoa, all alcoholic drinks, ginger ale, 
and similar effervescent waters. 
The testicles must be supported by a well-fitting suspensory bandage, which 
does not press upward on the urethra at the junction of the penis with the 
scrotum and thus interfere with the free drainage of the urethra. The head 
of the penis and the cavity of the foreskin must be kept clean by the frequent 
washing of these parts with hot water. 
The penis should be so dressed as to allow free drainage of the pus from the 
urethra, which at the same time must be kept from the cavity of the foreskin, 
the patient’s fingers and clothing. These requirements are filled by a piece 
of gauze cut about 4 inches square, with a slit in the center through which 
the head of the penis is passed until the gauze rests in the groove behind the 
head. The foreskin then is drawn down over the gauze which protrudes from 
the orifice of the foreskin and catches the pus as it is discharged from the 
urethra. This dressing should be changed several times daily according to the 
amount of the discharge. If the foreskin is too short to hold the above dress- 
ing in place, the end of the penis can be covered by a Bull Durham tobacco 
bag into which some gauze is placed. Never plug up the cavity of the foreskin 
with cotton or use cotton in a tobacco bag, as this interferes with the free 
discharge of pus and will favor the spread of the infection to the posterior 
urethra. To allay local pain and inflammation the penis should be immersed 
several times a day in hot water. 
A hot sitz-bath relieves to a great extent the feeling of soreness in the 
perineum. This bath is indicated if the patient has difficulty in passing urine. 
The heat has a tendency to relax the inflamed parts and the urine may be 
passed directly into the bath water. 
In all manipulations of the penis it is important to remember that the gono- 
coccus when transferred to the eyes will set up a severe inflammation which 
may result in permanent impairment of vision. 
As soon as a case of gonorrhoea comes under treatment the patient should 
he warned of the danger of infecting the eyes, the necessity of thoroughly wash- 330 
HOSPITAL CORPS HANDBOOK. 
ing the hands after handling the penis, and the danger of contaminating 
towels, etc., and in this way causing the infection of others. 
The bowels should be kept freely open, preferably by vegetable cathartics, 
as saline purgatives are apt to produce more or less urethral irritation. 
To render the urine bland and nonirritating the patient should drink water 
freely, a glassful every hour during the day and whenever he wakes at night. 
For the prevention of painful erections the patient should be instructed to 
empty his bladder just before retiring, to sleep on bis side on a hard mattress, 
with as little covering as possible. 
If awakened by an erection, he usually can obtain relief by emptying the 
bladder and by cold applications to the penis. 
When, in a few days, as a result of the above constitutional treatment, the 
very acute inflammatory symptoms begin to subside, as is indicated by a dimi- 
nution and thinning of the urethral discharge, less pain on urination, and a de- 
crease in the redness and swelling of the meatus, a bland and nonirritating hand 
injection, administered by the patient himself, may be employed. For this pur- 
pose a solution containing a quarter to a half of 1 per cent of protargol may be 
used. If the injection causes irritation, as it sometimes does, it must be 
discontinued for a time, until the irritation has abated, and then resumed 
cautiously, using a weaker solution than that employed when signs of irrita- 
tion developed. 
Hand injections are given as follows: The patient urinates, wipes the 
meatus with a bit of gauze, gently inserts the nozzle of the syringe completely 
filled with the solution used into the meatus, the lips of which are lightly 
pressed together from side to side against the syringe; the solution then is 
forced in very slowly until there is a feeling of distention in the urethra, 
when it may be allowed to escape, or if not too uncomfortable, kept in for a 
minute or two. While the fluid is being injected the patient should contract 
the compresser muscle of the urethra, much as if he were trying to hold back 
the contents of the bladder, in order to prevent the passage backward of any 
of the medication into the posterior urethra. 
If the foregoing treatment has been successful, in about three weeks the 
patient will have only a trifling urethral discharge, sometimes seen only in 
the morning, with flakes or shreds in the urine. At this stage the injection 
should be changed to a solution of zinc sulphate one-half of 1 per cent in 
strength, administered daily. 
The patient should be warned against “ stripping ” or “ milking ” the penis 
in an endeavor to find a “ morning drop.” This manipulation irritates the 
inflamed mucous membrane of the urethra and retards healing. 
The patient’s urine should be watched daily by the two-glass method de- 
scribed above and as soon as evidence of acute posterior urethritis develops 
all injections must be suspended. 
The patient should be kept very quiet and, if possible, put to bed for a 
few days, on a light, nutritious diet with the testicles properly supported. The 
bowels must be kept freely open as any accumulation of faeces in the rectum is 
liable to irritate the inflamed deep urethra and the prostate gland. 
Water should be taken freely. Hot water bags over the bladder or against 
the perineum relieve the pain in the deep urethra, as does the hot sitz-bath. 
If retention of urine occurs, it should be relieved promptly by the hot sitz- 
bath, or if that measure fails, by catheterization with a soft-rubber catheter. 
When the frequency in urination, bladder irritation, and other acute inflam- 
matory symptoms begin to subside, the local urethral treatment may be care- 
fully resumed and the patient allowed to be up and about. VENEREAL DISEASES. 
331 
There are several complications of acute gonorrhoea which require special 
treatment. 
Balanitis.—This is an inflammatory process attacking the mucous membrane 
of the head of the penis, and if accompanied by inflammation of the mucous 
membrane lining the foreskin, as it generally is, it is called balanoposthitis. 
It is caused by uncleanliness or by allowing smegma or gonorrhoeal pus to 
collect beneath the foreskin, where more or less inflammation is set up. The 
condition usually occurs in persons with a long tight foreskin, a condition 
which prevents retraction and proper cleansing of the parts. In treating this 
condition the parts must be kept clean by washing with hot water and 
separated by means of gauze wet in boric acid solution. When the acute 
process has subsided the parts may be treated by careful cleansing, drying, 
and the application night and morning of a dusting powder, such as thymol 
iodide. If the foreskin can not be retracted, the space about the head of the 
penis may be washed out with hot water or salt solution injected by means 
of a syringe. If there is considerable swelling of the parts the patient should 
be kept in bed with the penis enveloped by a wet dressing of salt or boric 
acid solution. Soaking the entire penis in hot solution is useful. 
Phimosis.—This is a deformity of the foreskin which renders its retraction 
behind the head of the penis impossible because of the small opening in the 
foreskin. The remedy is circumcision. Often the condition induces an attack of 
balanitis or balanoposthitis. 
Paraphimosis.—This is a condition in which a tight foreskin has been re- 
tracted behind the head of the penis and can not be brought forward readily. 
The small opening in the foreskin forms a band of constriction on the dorsal 
surface of the penis, which, interfering with the circulation of the blood, causes 
more or less deformity of the organ from oedema. The condition causes great 
discomfort and if neglected may go on even to ulceration and gangrene of the 
foreskin and head of the penis. 
The first requirement of treatment is the immediate reduction of the dis- 
placed foreskin. This often can be accomplished in the following manner: 
With the two thumbs pressing on the head of the penis at either side of the 
meatus, and the index and middle fingers behind the constriction, the blood is 
pressed out of the head, which being thus reduced in size and softened, is pushed 
back through the constricting ring and the foreskin drawn forward. 
Should this procedure fail, owing to the tightness of the constriction, a small 
longitudinal incision must be made, under local anaesthesia, completely through 
the constricting band, on the dorsal surface, after which the foreskin easily can 
be brought forward, the wound being dressed with sterile gauze. 
Epididymitis.—This is one of the most frequent complications of acute pos- 
terior urethritis. The patient should be put to bed and given a brisk cathartic. 
The enlarged scrotum with its painful contents should be supported by a band 
of zinc oxide adhesive plaster 3 or 4 inches wide, which passes beneath the 
scrotum to each thigh, care being taken to have the thighs, legs, and inner borders 
of the feet close together before applying the plaster. If there is much hair on 
the thighs it should be shaved off to prevent pain when the plaster is removed. 
The scrotum, supported as above described, is surrounded with gauze which 
is kept wet day and night with boric-acid solution or a saturated solution of 
magnesium sulphate. When the acute inflammatory symptoms have subsided, 
as a result of the above treatment, 20 per cent ointment of ichthyol is spread 
over the scrotum, which then is surrounded by a layer of lint or nonabsorbent 
cotton, over which is placed a piece of oiled silk or impermeable paper, the 
47820°—23 22 332 
HOSPITAL CORPS HAND BOOK. 
whole dressing being kept in position by a snug suspensory bandage. The 
patient is allowed to get up four or five days after all pain, tenderness, and 
temperature have disappeared. If he is allowed out of bed too soon a recur- 
rence of the symptoms is likely. 
Prostatitis.—Acute inflammation of the prostate gland is a very com- 
mon complication of acute posterior urethritis. When infected the gland be- 
comes engorged with blood and swollen. This gives rise to a sense of fullness 
in the perineum and rectum, accompanied by irritation of the bladder. There 
is more or less pain in the prostate, as the fecal masses press upon it as they 
pass through the rectum during defecation. The finger, covered with a rubber 
finger cot, if introduced into the rectum finds the gland to be enlarged, hot, 
and painful. 
A patient suffering from acute prostatitis should be put to bed immediately. 
All injections should be stopped and the urine rendered bland by copious 
drafts of water. The bowels should be moved freely every day, using vege- 
table cathartics for the purpose. Hot-water bottles over the bladder and against 
the perineum are useful. Much relief is obtained from the use of hot rectal 
irrigations of normal salt solution given twice a day in the following manner: 
The patient lies on his side with the buttocks near the edge of the bed or 
table. An irrigating can filled with saline solution at a temperature not over 
115° F. is so suspended that its lower end is about 1 foot above the patient’s 
hips. Two rectal tubes thoroughly lubricated with petrolatum are inserted 
very gently for a distance of about 3 inches in such a way that the outlet of 
one tube is near the gland. The fluid in the can is allowed to flow slowly into 
the rectum through this tube and out through the other which may have to 
be adjusted by withdrawing it a little to obtain a ready return flow. The 
posterior surface of the prostate thus is bathed with hot saline solution. Each 
treatment should last from 20 to 30 minutes. 
Gonorrhceal ophthalmia.—Gonorrhoeal infection of the eye in the adult is 
caused by the accidental transference of gonorrhoeal pus from the genitals to 
the eyes by means of the fingers, dressings, or towels. It is one of the most 
serious complications of gonorrhoea as it may result in either partial or com- 
plete blindness. 
The symptoms usually appear within a few hours after infection and consist 
of redness and swelling of the conjunctiva, increased lachrymation, accom- 
panied by intense itching and a feeling as if a foreign body were under the lids. 
The conjunctivitis is associated with a profuse purulent secretion in which 
gonococci may be found on microscopical examination. 
The eyelids rapidly become red and swollen and the patient is soon unable 
to open the eye. 
The treatment may be divided into prophylactic and curative. 
Prophylaxis consists in thoroughly cleansing the hands after administering 
treatment or after handling the penis, the sterilization of all instruments and 
the immediate burning of all dressings which have been soiled by gonorrhceal 
discharge. 
When a gonorrhceal infection of an eye is suspected, the patient should be 
put to bed at once. If only one eye is affected, the sound one is covered 
with a glass shield to prevent its infection; this shield consists of a watch 
glass placed against a hole slightly smaller than the glass, in the center of a 
piece of adhesive plaster inches square; the adhesive plaster is fas- 
tened to the skin about the eye and nose. It is advisable to leave a small 
area of the plaster nonadherent at the outer edge of the eye to permit the VENEREAL, DISEASES. 
333 
evaporation of moisture from the skin, which otherwise would collect within 
the shield. 
The infected eye must be washed out day and night with cold boric acid 
solution as often as any secretion accumulates. This flushing of the eye 
should be followed by the instillation of a drop of 10 per cent silvol solution 
into the eye. In the intervals between the washings the eye should be kept 
covered with cold compresses—squares of gauze taken from a block of ice 
if possible, and changed every two or three minutes. These gauze squares 
should be used only once and then burned. Rubber gloves should be worn 
when giving these treatments. The eye is flushed out by means of an irrigator 
held high enough to allow the cold boric acid solution to flow out in a gentle 
stream. 
The patient should be gotten to a medical officer as quickly as possible. 
By the foregoing methods of treatment the hospital corpsman can not expect 
to cure a gonorrhoeal infection, but by adhering to the treatment advocated 
lie can relieve his patient of many distressing symptoms and shorten the time 
required by the medical officer to effect a cure. 
SYPHILIS. 
Syphilis is a chronic, infectious disease caused by a protozoon, one of the 
lowest forms of animal life, called the Treponema pallidum. There are two 
forms of syphilis: The acquired form and the hereditary form. Acquired 
syphilis is communicated by a syphilitic person to one free from the disease, 
the point of inoculation always being marked by a sore which is called the 
initial lesion or chancre. Hereditary syphilis is transmitted before the patient 
is born from either one or both parents. In this form there is no chancre, the 
onset of the disease being marked by general manifestations which may be 
noticed at the time or shortly after the syphilitic child is born. In this dis- 
cussion we will confine our remarks to the acquired form of the disease. 
The course of the disease may be described best by considering it to occur 
in three different periods or stages: The primary, the secondary, and the ter- 
tiary. These stages are not always clearly defined, as signs or lesions of the 
tertiary stage may occur in the secondary stage, or vice versa. To avoid this 
confusion some writers speak of early lesions and late lesions; that is, those 
occurring early in the course of the disease and those occurring late. 
Primary stage.—The primary stage of syphilis consists of two periods of 
incubation, the first of which exists from' the time the Treponema pallidum 
enters some abrasion to the appearance of the initial lesion or chancre and, 
as a rule, lasts from 14 to 21 days; but it may be as short as 10 or as long as 
70 days. This is followed immediately by the second period of incubation, 
which dates from the formation of the initial lesion to the development of cer- 
tain constitutional manifestations, and usually occupies 40 to 45 days, but 
may be prolonged to 60, 70, or even 90 days. In other words, the primary stage 
represents a progression of the Treponema pallidum throughout the body. It 
first gains access through some minute abrasion, multiplies at tbe site of that 
abrasion, forming the chancre, then the treponemata pass through the lym- 
phatics into the general blood stream and are distributed all over the body. 
The entire duration of the primary stage averages from 50 to 80 days. The 
site of the primary lesion is generally marked by a scar. 
Secondary stage.—The secondary stage of syphilis, or the stage of constitu- 
tional manifestations, is characterized by superficial lesions of the skin and 
mucous membranes and enlargement of the lymphatic glands throughout the 
entire body. The superficial lymphatic glands easily may be felt under the skin. 334 
HOSPITAL CORPS HANDBOOK. 
In many patients there also may be various constitutional disturbances such as 
fever, headaches, pains in the bones, muscles, and joints, and a general feeling of 
debilitation. The duration of this stage is variable, usually lasting from one 
to two years, depending greatly upon the constitution of the patient. 
Tertiary stage.—This stage usually begins at about the end of the second 
year, but is not observed so frequently now as formerly, owing to modern 
methods of treatment. It manifests itself by destructive lesions in various 
portions of the body, also by affections of the nervous and vascular systems, 
the various organs of the body, and the bones. 
The secretion of the chancre is highly contagious, as it teems with trepone- 
mata. The secretions of the secondary lesions and the blood and lymph in 
the secondary stage are also contagious. Tertiary lesions are also often infec- 
tious, hut they do not contain as many treponemata as the primary and second- 
ary lesions. 
Syphilitic infection may result from direct contact with a syphilitic person 
either through sexual intercourse, kissing, or the handling of open lesions, or 
it may be contracted from syphilitic secretions deposited upon any article used 
by a syphilitic person and then transferred from it to a healthy person. 
Among such articles may be mentioned cigars, cigarettes, pipes, toothbrushes, 
pencils, chewing gum, handkerchiefs, drinking and eating utensils, musical 
instruments, razors, surgical and dental instruments, unless properly steril- 
ized, etc. 
Symptoms. 
The initial lesion or chancre.—It is produced by inoculation of syphilitic 
blood or the secretions of primary, secondary, or tertiary lesions, appears gen- 
erally from 14 to 21 days after inoculation, and is situated always at the point 
where the Treponema pallidum entered the body. Usually there is but one 
initial lesion, although several may be present at the same time, infection hav- 
ing occurred simultaneously at several points. 
Chancres found upon the genital organs are called genital chancres, while 
those situated elsewhere upon the body are designated as extragenital chancres. 
Most frequently the initial lesion occurs upon the genitals, but it may be lo- 
cated anywhere on the body, as the lips, tongue, fingers, etc. 
There is nothing absolutely characteristic in the appearance of the initial 
lesion in its very early stage. Generally it begins as a small erosion from 
which exudes a variable amount of serous secretion in which the Treponema 
pallidum may be found by appropriate methods on microscopical examination. 
It may appear as a small dry papule, as a small silvery spot, or a purple 
nodule. Whatever the form first assumed the chancre develops into a super- 
ficial ulceration which often is surrounded by a hard ring of induration. This 
ring of induration is rather characteristic of the chancre. 
Since the discovery of the Treponema pallidum and methods of demonstrating 
this organism under the microscope, many innocent-looking ulcerations which 
formerly would have been considered as trivial infections have been found to 
be syphilitic. For this reason all ulcerations encountered by hospital corpsmen 
on independent duty should he referred to a medical officer as soon as possible 
for microscopic examination of the secretions. Syphilis to-day is treated by 
the intravenous administration of certain preparations of arsenic such as sal- 
varsan or neosalvarsan which kill the treponemata in the tissues. If a diag- 
nosis can be made during the stage of the initial lesion before the treponemata 
have been able to cause many changes in the patient’s tissues, he is cured 
more easily. Hence no antiseptic dressing should be applied tq any suspicious VENEREAL DISEASES. 
335 
ulceration before its secretion has been examined microscopically. Antiseptics 
tend to kill off the treponemata in the lesion, making it difficult or impossible 
to make a positive diagnosis at this stage. If the medical officer has to wait 
for the appearance of secondary lesions to confirm his diagnosis much valuable 
time is lost. 
By the time the chancre is formed the t-reponemata have multiplied and 
passed along the lymphatics to the adjacent lymphatic glands or even into the 
general blood stream. Therefore it will do no good to excise or to cauterize 
the lesion with the hope of preventing the spread of the disease. The chancre 
should be kept clean and protected by a dressing from all sources of irritation 
and infection. 
A dressing wet with salt solution should be used until the secretion has been 
found to contain Treponema pallidum. After this the lesion should be washed 
with bichloride of mercury solution (1:5.000) night and morning and kept 
covered with a dressing wet with this solution. In the later stages when 
there is little secretion a dusting powder of equal parts of calomel and boric 
acid may be used. 
When the chancre is well developed the lymphatic glands in its immediate 
vicinity become indurated. Unless the chancre has become infected with 
pus-forming organisms, these glands are painless, freely movable, and separate 
from each other. 
Secondary stage.—A few weeks after the appearance of the chancre a rash 
known as the primary rash makes its appearance. This early skin lesion gen- 
erally consists of small spots or macules which are at first pinkish, then 
fading to a brownish red, although it may assume a variety of forms. This 
lash is symmetrically distributed over the trunk, neck, and limbs. Sometimes 
the face is involved. The rash does not itch, and frequently is not noticed 
by the patient. By the time the rash is well developed the patient frequently 
experiences sore throat, some hoarseness, headache, and generally there is an 
elevation of the temperature. The hair on the back of the head may become 
thin in patches. The primary rash is followed in untreated cases by an in- 
finite variety of skin manifestations in the shape of macules, papules, pustules, 
or combinations of these lesions. Many of these lesions are altered in ap- 
pearance by the heat of the body, moisture, and pressure. An example of a 
skin lesion altered in this way is found in the moist patches, or condylomata, 
as they are called, which form about the anus. They are lesions which vary 
from one-third to three-quarters of an inch in diameter and are either round 
or oval. The edges are sharply defined and rise at right angles to the skin. 
The top is flat and covered with glistening secretion which swarms with 
treponemata. 
At the time of the primary rash and long after it has faded certain lesions 
called mucous patches may be seen in the mouth. They are small erosions of 
the mucous membrane most commonly seen on the inner surface of the lips, 
especially at the angles of the mouth, but they are found also on the pillars 
of the fauces, the tonsils, and tongue, the mucous membrane linig, the cheek, 
on the gums, and even upon the pharynx. These lesions are sharply circum- 
scribed and there is usually no inflammatory area surrounding them. The 
secretion from them is highly infectious. 
Early in the secondary stage the Wassermann test for syphilis based upon the 
phenomenon of blood complement fixation is generally positive. 
The tertiary stage.—The tertiary or late stage of syphilis is characterized 
by the formation of tumorlike processes called gummata and the deposition 
of fibrous tissue in various organs. Either deep or superficial structures may 336 
HOSPITAL CORPS HANDBOOK. 
be attacked, but the Treponema pallidum has a marked predilection for nervous 
tissues, the arteries, bone, skin, liver, testicles, and the eye. This stage gen- 
erally begins not less than 18 months after the appearance of the initial lesion, 
and it may be delayed for even 20 or more years. Locomotor ataxia and paresis, 
which are syphilitic affections, quite frequently appear years after the primary 
infection. 
Treatment of syphilis. 
The treatment of this disease should be begun just as soon as the diagnosis 
is made. This applies especially to the chancre stage, where, as has been men- 
tioned, the outlook is much better if efficient medication is administered before 
the treponemata have had an opportunity to produce tissue changes through- 
out the body. The physician no longer waits for the appearance of secondary 
lesions, for now by means of the dark-field illuminator he often can diagnose 
syphilis positively just as soon as the initial lesion becomes manifest. 
In the Navy syphilis is treated principally by the administration in- 
travenously of arsphenamine or neoarsplienamine. 
A board of medical officers composed of representatives of the Army, Navy, 
and Public Health Service, appointed to investigate safe methods of administer- 
ing arsphenamine and neoarsphenamine has recently recommended the fol- 
lowing standard instructions for the preparation and intravenous administration 
of these preparations for use by the Medical Department of the Army, of the 
Navy, and by the Veterans’ Bureau and the Public Health Service. 
The administration of these preparations is never to be attempted by a 
hospital corpsman. These instructions are placed here in order that hospital 
corpsmen may have information regarding an accepted method of preparation 
of arsphenamine and neoarsphenamine for administration by a medical officer. 
I. Method of injection. 
Only the gravity method should be employed in administering arsphenamine. 
II. Materials required. 
A. Erlenmeyer flasks, 500 to 1,000 e. c. capacity. 
B. Funnels, glass, 4-inch. 
C. Cylinders, graduated, 500 to 1,000 c. c. capacity. 
D. Gravity apparatus, consisting of— 
1. Gravity graduated glass cylinders, 300 c. c. capacity; long graduations at 
the 100 c. c. marks; medium long graduations every 25 c. c.; short gradua- 
tions for each 5 c. c.; the zero point to be at the top and the 300 mark to be at 
the bottom of the cylinder. 
2. Rubber tubing, pure gum, heavy wall, inside diameter, five thirty-seconds 
inch (about 4 mm.) of lengths to limit height of the cylinder to 3 feet above the 
patient’s arm. 
Caution.—Before being used the first time the tubing should be filled with 
normal sodium hydroxide solution for not less than six hours. It then should 
be rinsed thoroughly in water, sterilized by boiling, and then be rinsed care- 
fully with sterile water again just before using. 
3. Needles with slip joint, 19 standard gauge, medium bevel, length of 
cannula li inches. While not necessary, the Fordyce type of needle is a great 
convenience. The correct gauge is highly important, as it influences the rate 
of flow. Proper care of the needles is important. They should be cleaned 
immediately after use and precautions taken to prevent rust. Just before 
ARSPHENAMINE. VENEREAL DISEASES. 
337 
Sterilization the point should be freshened on a stone, if necessary. A dull 
needle tends to make a dissatisfied patient. 
4. Glass tubing, 6 mm. in diameter, for windows, which should be inserted in 
the rubber tubing so as to be a few inches from the lower end. 
5. Adapters for attaching needles to end of tubing. These may be of metal 
or glass. If of glass, they will serve as extra windows as well as adapters. 
6. Pinch cocks (Mohr’s) for cutting off the flow to be applied a short dis- 
tance above the needle. 
E. Sterile gauze, cut in small squares for filtering the solution. 
F. Sterile freshly distilled water. This water should be distilled in glass 
or block tin. and should be sterilized immediately by autoclaving or boiling in 
Erlenmeyer flasks. These flasks should be stoppered with a gauze-wrapped 
cotton plug and capped with paper or tin foil. Preparation of the water should 
preferable be carried out on the day before use so that it will be fresh and 
cool at the time needed. 
G. Sterile salt solution. This should be made with water prepared as above 
and chemically pure sodium chloride. Sterilization should be carried out as 
given above. The strength of the salt solution should be the usual 0.85 per 
cent. The use of salt solution in the place of distilled water for the dilution 
is considered a refinement which is not necessary in routine work, but it may 
have some advantages, since a solution of arsphenamine in distilled water is 
not isotonic. 
H. Normal sodium hydroxide volumetric solution (U. S. P. IX, p. 573). 
Enough of this can be prepared at one time to last for a month or longer, 
provided it is kept in a rubber-stoppered wax or paraffin lined bottle. There is 
danger of deterioration on account of absorption of C02 from the air and of 
reactions with the glass container. A wax-lined bottle can be prepared by 
placing wax or paraffin in a bottle, melting it with dry heat, and spreading 
the melted wax by rotation over the inside of the bottle as it is cooling. If 
precipitate is found in the alkali, it is probably an evidence of deterioration of 
the solution, which should be discarded. 
I. Burette or pipette. A graduated burette or pipette for accurately measur- 
ing the alkali. 
All the glassware mentioned above should be of chemical standard. All 
apparatus should be surgically clean, freshly sterilized, and cool at time of 
using. The apparatus should be sterilized by dry heat or autoclave with the 
exception of the tubing and the needles, which should be boiled. 
If the medical officer lias any doubt about being able to obtain pure normal 
sodium hydroxide solution the same will be supplied on request to the Naval 
Medical School, Washington, D. C. 
III. Inspection of drug. 
A. Note and record manufacturer, lot number, and particularly the dosage 
slated on the label. 
B. Examine ampules critically and do not use any which are cracked or in 
which the powder is not freely mobile and is not of a pale yellow to a lemon 
yellow in color. Forward any suspected ampules, with explanatory letter, 
directly to the Hygienic Laboratory, Washington, D. C., for examination. 
C. The ampules, having satisfactorily passed preliminary inspection, should 
be immersed in 95 per cent alcohol primarily to detect any minute cracks in 
the glass not visible on preliminary inspection, and also to cleanse the ampule. 
Lay ampules on sterile towel to dry, or wipe off alcohol with sterile gauze. 338 
HOSPITAL CORPS HANDBOOK. 
IV. Preparation of solution. 
A. The amount to be prepared at one time will depend on the number of 
patients, but unit quantities of more than 10 average doses should not be 
prepared. 
B. Place in Erlenmeyer flasks about 10 c. c. of freshly distilled sterile water 
for each decigram of arsplienamine to be used, e. g., 100 c. c. for 1 gram. 
Open ampule and sprinkle—do not dump—contents on surface of water. The 
temperature of the water is of great importance. For all brands of arsphena- 
mine, except for arsenobenzol manufactured by the Dermatological Research 
Institute, the water should be at room temperature and, as a rule, the drug 
should go into solution with little or no agitation within a few minutes. A 
slight amount of shaking is permissible with any product, but always should 
be kept at a minimum. 
Exception.—The arsplienamine manufactured by the Dermatological Research 
Institute requires either hot water alone, or it can be dissolved in cold water, 
if the powder flrst is moistened thoroughly with ethyl alcohol (about 1 c. c. 
to 0.6 gram). This amount of alcohol is harmless. 
When the arsplienamine has completely dissolved, forming a perfectly clear 
solution with an absence of any gelatinous particles when viewed by trans- 
mitted light, it is ready for alkalinization. If for any reason the arsplienamine 
fails to form a perfect solution it must be discarded. 
C. Correct alkalinization is extremely important; failure to alkalinize prop- 
erly causes more reactions than any other error connected with the use of 
arsplienamine. 
1. The exact method consists in the addition, all at once, of 0.85 c. c. normal 
sodium hydroxide solution for each 0.1 gram of arsplienamine used, e. g., 8.5 
c. c. for 1 gram of drug. This is the correct amount necessary to form the 
disodium salt of arsplienamine, the form which is best tolerated by the patient. 
2. Approximate method of alkalinization. An exception to the rate that only 
standardized normal alkali should be used may be made in case this is not 
obtainable. Under such circumstances, the exact concentration of alkali being 
unknown, the operator should keep in mind the following facts: Arsplienamine 
as it appears on the market is the diliydrocliloride of the arsplienamine base 
which is soluble in water, but the solution is strongly acid and highly toxic. 
Upon the gradual addition of sodium hydroxide, a precipitate at once begins 
to form and then redissolves. This property of the drug, not understood by 
some physicians, has caused them to mistake the end point. This mistake is 
especially apt to occur when the operator thinks he is using a 15 per cent so- 
lution, when in reality the solution is only 4 or 5 per cent. The drug when 
injected in this still strongly acid state, the monohydrochloride, produces se- 
rious reactions and sometimes death. 
When a little over one-fourtli of the amount of alkali indicated under (1) 
has been added, the precipitate no longer redissolves. From this point on until 
there has been added almost three-fourths of the amount of alkali necessary 
to form the disodium salt, the precipitate remains and does not redissolve on 
shaking. But when three-fourths of the total amount necessary has been added 
the precipitate redissolves. 
It is at this point, when just enough alkali has been added to dissolve the 
precipitate, that the solution very frequently has been injected. This solution 
of the monosodium salt is the most frequent cause of reactions. At this point 
75 per cent of the correct amount of sodium hydroxide solution has been added 
and hence an additional one-third of the total amount of alkali used up to this VENEREAL DISEASES. 
339 
point should now be added. This last addition is the remaining 25 per cent of the 
correct amount corresponding to a total of 0.85 c. c. per 0.1 gram of standard- 
ized N/l NaOH solution as mentioned under (1) above; e. g., if 3.3 c. c. of an 
unknown solution were required for completely clearing a solution containing 
2 grams of arsplienamine, 1.1 c. c. more should be added. With a thorough 
understanding of the above the operator may roughly standardize his alkali 
against the arsphenamine. No two brands of arsphenamine vary greatly in 
the amount of alkali required, while various alkali solutions vary in strength 
by several hundred per cent. 
The pa of a proper solution is about 10, and it is impossible to buffer it to 
neutrality by common buffers without precipitation. Moreover, the alkaline 
solution is well tolerated if given slowly and well diluted. 
3. “ Haphazard method ” of alkalinization, or drop method. This is men- 
tioned only to condemn it. It is inconceivable that the operator will be unable 
to secure some sort of a graduated measuring device in order to measure the 
alkali instead of guessing at the amount. Numerous reactions from under- 
alkalinization have occurred with this method, particularly where several doses 
of the drug are prepared at one time. The alkali has beeen added with a 
dropper until clearing occurred, and then a few additional drops have been 
added regardless of whether the solution contained 1 or 10 doses. Less fre- 
quently overalkalinization also has occurred. The injection of an overalkalin- 
ized solution causes pain along the vein and thrombosis. 
D. Filtration and dilution to proper strength of the alkalinized solution.— 
With sterile forceps place four layers of sterile gauze in the funnel. Wash 
with sterile water. Pour alkaline solution through into a graduated cylinder 
and then rinse the filter with enough sterile distilled water to bring the 
total for each decigram of drug up to 25 c. c.; e. g., for 1 gram of arsphenamine 
250 c. c. of solution should be made. This washing the drug through the 
filter with the water insures full dosage. If a saline solution is desired, it is 
used at this point in place of the distilled water, at usual strength, 0.85 per 
cent. 
E. Time the solution should be allowed to stand.—The properly alkalinized, 
filtered, and diluted solution now should stand for at least 30 minutes before 
being injected, to allow complete stabilization of the reactions. The toxicity 
is considerably reduced by this delay. The solution may stand as long as 
three hours without undergoing any increase in toxicity, provided it is pro- 
tected from the air, not shaken, and provided the temperature does not exceed 
30° C. The solution is now ready for administration. 
F. Temperature.—30° C. is the correct temperature at which the drug should 
be introduced; in no case should it be warmed above this point. 
G. Dosage.—As a rule the initial dose should be small. The average dose 
used is about 0.4 gram for 150 pounds body weight, but no hard and fast rule 
can be laid down; each case should be considered individually by the clinician. 
When a radical cure is being sought and the patient tolerates the injection 
well, full doses should be given. 
V. Administration. 
A. Emphasis should be laid on the complete physical examination preliminary 
to administering arsenical treatment for evidence of renal, cardiovascular, or 
visceral changes, in the presence of which it should be used cautiously. 
Weekly urinalyses should be made during treatment. The patient should be 
questioned concerning any reactions following the last treatment, with special 
reference to any toxic skin eruptions as danger signals against further treat- 
ment. Any evidence of an exfoliative dermatitis is an absolute contraindication 340 
HOSPITAL CORPS HANDBOOK. 
against any further treatment with any arsenical. Evidence of jaundice also 
should be looked for and if present is an indication for caution. In late cases 
the possibility of a Herxlieimer reaction following a large injection shoiild be 
remembered. This may be fatal should vital structures be involved. Each 
patient should receive individual consideration and not simply be run through 
the mill. 
B. Preparation of patient.—A mild cathartic should be given the night 
before and no food should be eaten within two or three hours before the injec- 
tion. Only a light meal should be taken a few hours following the injection. 
Ambulatory patients should rest for a short time after the injection. If large 
doses are being given, the patient preferably should be kept in bed until the 
following morning. 
C. The patient should be placed in a recumbent position. 
D. The gravity apparatus should be arranged to provide a column of solu- 
tion not over 3 feet in height. The tubing should be rinsed with sterile water, 
then the cylinder and tubing should be filled with the solution and the air 
expelled by elevating the end of the tube above the level of the fluid in the 
cylinder. Apply pinchcock. 
E. Select a suitable vein in either arm and sterilize the overlying skin by 
applying tincture of iodine, which preferably should be removed after a minute 
or two with 95 per cent alcohol. 
F. Apply rubber tourniquet. 
G. Insert needle, bevel up, in two stages, and allow a few drops of blood to 
escape to indicate entrance to the vein. The needle should be slid well into 
the vein, in order to avoid escape of the point from the vein on further slight 
manipulations. Now connect adapter attached to gravity apparatus. Open 
pinchcock and snap it over window. 
H. Pate of injection.—If the specifications as to the gauge of needle, etc., 
have been followed, the correct rate of injection practically is insured, i. e., by 
the size of the needle and the length of the tube; however, this should not be 
taken for granted, but the exact time should be observed and in no case should 
the rate exceed 25 c. c. in one minute or 0.4 gram dose in four minutes; five 
minutes is preferable. A graduated sand glass which runs for five minutes 
is a convenient timer. The rate of flow should be even as well as slow. Should 
patient show any signs of reaction, stop. It is highly desirable, in sensitive 
patients, to wait a minute or two after injection of first 0.1 gram before pro- 
ceeding with rest of injection. When the necessary amount has been injected, 
cut off flow with pinchcock, disconnect tubing, allow a few drops of blood to 
escape, and then withdraw needle and place sterile gauze over the puncture, 
instructing the patient to hold it there for a few minutes. If another injection 
is to be given immediately, run a little fluid out of the tube; if any blood shows, 
empty cylinder and start over with a new sterile tube. 
NEO ARSPHEN AMINE. 
I. Method of injection. 
The use of the gravity method is strongly recommended, especially in clinics 
where a considerable number of doses are to be given. It was demonstrated 
in one clinic that the average time required to give 100 injections was reduced, 
without changing the personnel, when the gravity method was substituted 
for the syringe method and a high percentage of reactions due directly or indi- 
rectly to the syringe method also ceased to occur. With the gravity apparatus 
arranged to deliver a dose in about four minutes, one operator was able to 
run two tables much more easily than one table with the syringe method. 341 
VENEBEAL DISEASES. 
It is recognized, however, that there are circumstances in which the syringe 
method is indicated, as in the field where apparatus must be reduced to a mini- 
mum. Under these circumstances the use of neoarsphenamine by the syringe 
method is a valuable therapeutic measure. It fills a need, but technically is 
inferior to the gravity method, and therapeutically either method is inferior to 
ai'sphenamine given by the gravity method. 
II. Apparatus required. 
A. When the gravity method is to be used: 
1. Gravity apparatus (see Arsphenamine). 
2. Erlenmeyer flasks, 50-300 c. c. 
3. Funnels, glass, 2-inch. 
4. Sterile gauze. 
5. Graduated glass cylinders, 100 to 500 c. c. 
6. Sterile distilled Water (see Arsphenamine). 
7. Saline 0.85 per cent prepared as (see Arsphenamine). 
B. When syringe method is to' be used: 
As above, except in place of gravity apparatus— 
1. 20 to 50 c. c. all-glass syringes. 
2. Rubber tubing, short, with adapters connecting syringe and needle. 
3. Needles, 25 standard gauge, medium bevel. 
III. Inspection of drug. 
An even more critical examination should be made than in case of arsphena- 
mine, as neoarsphenamine occasionally decomposes in the ampule, even when 
no cracks are present. The powder should be freely mobile and canary yellow 
to orange red in color. When it approaches a red color, is distinctly lumpy or 
solidified, do not use, but forward samples to the Hygienic Laboratory for 
examination. 
Immerse in alcohol the ampules which have passed inspection to further 
eliminate the presence of cracks and to clean the ampule. 
IV. Preparation of solution. 
A. Amount to be prepared at one time.—In marked contrast to the practice 
with arsphenamine, do not prepare any more solution at one time than can be 
administered within 20 minutes. 
B. Concentration.—Preferably 1 decigram should be dissolved in 12.5 c. c. 
of water. This solution is then twice as concentrated as an arsphenamine solu- 
tion. Concentrations as high as 1 decigram in 0.5 c. c. of water can be used in 
the field or under other special circumstances. The highly concentrated solu- 
tions, however, should be given very slowly. 
C. Solution. 
1. Put in Erlenmeyer flask 12.5 c. c. sterile distilled water for each decigram 
of neoarsphenamine. In the field the concentrated solution can be made in the 
ampule itself by using water supplied in another ampule. 
Caution.—The distilled water used must be at room temperature and not to 
exceed 30° C. 
2. Open ampule and sprinkle—do not dump—powder into the water and 
by preference allow to go into solution with no agitation whatever. Slight 
rotation of the flask is permissible. Shaking the solution increases its toxicity 
and should be avoided. 
In case the solution does not form a perfectly clear and transparent solution 
it should under no circumstances be used. Whether it requires 1 minute or 10 
minutes for the drug to form a perfect solution is unimportant, but it should not 
require more than 10 minutes. The important point is not the rate of solubility 
but the complete solubility of the drug. 342 
HOSPITAL CORPS HANDBOOK. 
3. As soon as the neoarsphenamine is in solution filter through washed gauze 
into tall, narrow cylinders and keep stoppered. It is preferable to use a size 
of cylinder which the solution will nearly fill. The smaller the air column 
over the solution the less the danger of increased toxicity. The solution is 
now ready to inject and, in marked contrast to the arsphenamine solution, 
which should stand at least 30 minutes before its injection, the neoarsphenamine 
solution should he injected immediately, and in no case shall it be allowed to 
stand longer than 20 minutes. 
4. Dosage.—The initial dose as a rule should be small. The average dose is 
about 0.6 gram for 150 pounds body weight, but no attempts to lay down a 
hard and fast rule in this regard are made. The patient must be individualized. 
V. Administration. 
The directions made under arsphenamine apply to the administration of 
neoarsphenamine with the exception of the dosage, rate, and method of admin- 
istration. 
Rate.—If instructions have been followed, the proper rate practically is 
insured by the character of the apparatus, but it must be checked by using a 
timepiece, and in no case, whether the gravity or whether the syringe method 
is used, should more than 0.1 gram of neoarsphenamine he injected in 30 sec- 
onds or 0.6 gram in 3 minutes. This time is one-half that required for arsphen- 
amine. In giving concentrated solutions especial care is necessary in order to 
carry out this rule. 
In conjunction with the administration of salvarsan and neosalvarsan, mer- 
cury often is given, usually by inunction—that is, by being rubbed into the 
skin—or by intramuscular injection. 
The method of inunction is as follows: Five grams of mercurial ointment are 
rubbed daily or every other day into a portion of the body which is free from 
hair. The part to be used should be washed first with hot water and soap, 
and the ointment should be rubbed in well. This may be done either by the 
patient himself or by some one else, and in the latter case the back may be 
used. The rubbing should be continued until the ointment has disappeared, 
which usually takes about one-half hour. A different part of the body should 
be selected for each of seven days. The first day rub the ointment into the 
inside of the right arm, the second day into the left arm, the third day into 
the inside of the right leg, the fourth day into the left leg, the fifth day into 
the right flank, the sixth day into the left flank, and the seventh day into 
the abdomen. After a few days’ rest the treatment is begun again, using the 
right arm. 
In the administration of mercury by intramuscular injections either soluble 
or insoluble preparations are used. Of the former may be cited as an example 
bichloride of mercury in sterile, watery solution, 1 cubic centimeter containing 
0.02 gram, which is given in doses varying from 0.01 to 0.02 gram every three 
to five days. Salicylate of mercury is an insoluble form often used in a 10 
per cent suspension in sterile liquid petrolatum. One cubic centimeter of this 
suspension contains 0.06 gram. The dose is from 0.03 to 0.06 gram every five 
to eight days. The mixture must be thoroughly shaken just before use. 
The injections are given with an all-glass syringe, preferably a 2 c. c. Luer 
type, and a platino-iridium needle about an inch and a quarter long. The 
injections are given in the buttocks. The patient should lie on his side or 
abdomen or bend over a table. The sight of the injection is painted with 
tincture of iodine. The needle is inserted at right angles deeply into the 
muscles. There is very little pain if the needle is sharp. The piston of the 
syringe should be drawn up slightly to make sure that the needle is not in a VENEREAL DISEASES. 
343 
bloocl vessel—a very important point, as death may result if the oily suspen- 
sion is thrown into a blood vessel. The injection is made slowly, and the 
needle is withdrawn rapidly, and firm pressure, with a rotary motion, using a 
small piece of sterile gauze, is made over the site of the injection. If this is 
done carefully, it is very rare for any of the suspension to leak out. The 
puncture point should be covered with a small collodion dressing. 
CHANCROID. 
The chancroid is an acute inflammatory destructive ulceration whose action 
is local in character and limited to the parts upon which it is situated and 
to the lymphatic vessels and glands which are in anatomical relation to those 
parts. It is commonly venereal in origin. The secretion of a chancroid is 
highly infectious, and the condition may be transferred by inoculation in an 
abrasion of the skin of another person or upon the individual already the 
victim of it. It is not a generalized disease like syphilis, but is in reality a 
form of infected wound. A specific bacteria, the bacillus of Ducrey, has been 
reported as the cause of chancroid, but the condition is peculiarly liable to 
mixed infection. A smear taken from the surface of the ulcer usually shows 
numerous pyogenic bacteria, and few if any of the specific bacilli. Hence 
such a smear can not be depended upon for diagnosis. Frequently syphilitic 
infection and chancroid virus exist in the same ulceration, the patient having 
been inoculated with both diseases at the same time. 
Chancroids upon the male genitals are most common in the groove behind 
the head of the penis, especially in the little pocket on each side of the 
frsenum, but they may affect the head of the penis, the inner surface and free 
border of the foreskin, and the skin covering the penis. 
The condition commonly begins as a single ulcer, but often secondary ulcera- 
tions are formed quickly by inoculation with the secretions, so that by the 
time the patient reports for treatment several sores are present. 
The chancroid has no fixed period of incubation, usually appearing two to 
five days after infection. 
The rapidity of its development depends on the resistance of the tissues upon 
which it is situated. Chancroids develop imich more rapidly on mucous 
membrane than they do upon skin, which appears to offer more obstruction 
to the invasion of the causative organisms. 
The chancroid usually begins as a small pustule, about which is a highly 
inflammatory area. The pustule soon breaks down, leaving a round or irreg- 
ular ulcer, with sharply defined edges and undermined walls. The floor of 
the ulcer is rough and generally is bathed by a purulent secretion. The ulcer 
sometimes bleeds easily and it may be very painful. There is a varying 
amount of inflamatory thickening of the tissues around and beneath the sore, 
which shades off gradually into the surrounding parts, thus differing from 
the ring-like induration of the syphilitic chancre, which is hard and sharply 
outlined. The ulcer has a tendency to spread. 
The chancroid is prone to certain complications of which the most common 
are mixed infection with syphilis, mixed infection with pyogenic organisms, 
destruction of the frsenum, phimosis, balanoposthitis, lymphangitis, and in- 
guinal adenitis (bubo). 
When a patient has what appears to be a chancroid one can never be sure 
that he has not a chancre (syphilis). This rule is without exception. For this 
reason whenever possible the serum exuding from every ulceration on the 
genitals which appears after intercourse should be examined microscopically 344 
HOSPITAL CORPS HANDBOOK. 
for Treponema pallidum, and no antiseptic dressing should be applied until 
after this examination has been made. 
Unless neglected or irritated by underclothing or dressings chancroids some- 
times heal quickly. A chancroid at the opening of the foreskin, however, is 
usually a long time in healing. The friction of underclothes or even the 
softest dressing so irritates the sore that though it may lose all its chancroidal 
characteristics and become a simple sluggish ulceration it lingers after weeks 
of the most painstaking treatment. 
A chancroid beneath a long foreskin, however loose, usually produces an 
acute inflammation in the foreskin, the swelling of which produces a phimosis. 
This retains the secretions of the chancroid, which, bathed in this irritating 
pus and protected from effective treatment, promptly invades both the head 
of the penis and the foreskin, and instead of healing tends to eat its way 
through these parts. If the foreskin is retracted in an effort to get at the 
lesion, a paraphimosis which can not be reduced complicates matters. 
A common complication of chancroid is destruction of the framum in the 
following manner. A chancroid appears at once on both sides of the frsenum; 
as it enlarges it eats a hole in the frsenum', leaving a narrow bridge of tissue 
which in time is eaten away. This ulceration as long as the bridge of tissue is 
present is very resistant to treatment. 
In chancroid of the penis the infection may enter the lymphatic vessels 
causing an inflammation of these channels (lymphangitis). The infection 
travels along these vessels to the inguinal glands. The glands in either one or 
both groins become enlarged, matted together and very painful (adenitis). In 
a short while the skin over them assumes a red, brawny appearance. Sup- 
puration of the glandular mass soon begins; an abscess forms which if not 
incised ruptures spontaneously, leaving a deep, sloughing pocket with under- 
mined and broken-down edges. The infected mass in the groin often is called 
a bubo. 
This complication is very frequent, occurring about once in every three 
cases. 
Treatment of chancroid. 
Whenever it is possible to have the serum of the chancroid examined mi- 
croscopically for Treponema pallidum use a simple wet dressing of salt 
solution until after the examination. The treatment of the lesion depends 
somewhat upon its situation, the important points being to keep it absolutely 
clean, free from all irritation, separated by dressings from healthy tissues, 
and never to cauterize it. 
The ulcer and surrounding parts should be thoroughly washed in hot bichlo- 
ride of mercury solution (1-5000) three times a day or more frequently if indi- 
cated. Dry the ulcer and dust it with powdered silvol crystals, then apply a 
moist salt solution dressing. 
All dressings used upon or about the sore must be destroyed and the hands 
should be washed carefully immediately after the dressing is completed in 
order not to transfer the infection. Warn the patient to avoid all violent ex- 
ercise and to walk about as little as possible in the hope of preventing sup- 
purating inguinal glands. Watch the groins carefully and at the first sign 
of painful matting together of the glands put the patient to bed with a hot- 
water bottle over the swelling. 
Do not, under any circumstances, paint the swelling with iodine. It does 
no good and causes irritation of the skin, so that if the bubo does eventually 
suppurate and is opened the surrounding skin is ready for infection. VENEREAL DISEASES. 
345 
More or les*s extensive inflammation of the penis calls for soaks of hot bichlo- 
ride of mercury solution (1-5000), wet dressings, rest in bed, elevation of the 
penis, and incision if pus forms in the cellular tissues. 
When chancroids are situated beneath a long, tight foreskin, which can not 
be retracted, a good plan is to make two lateral incisions under local anaesthesia 
through the foreskin which expose the head of the penis for inspection and 
local treatment, thus preventing sloughing with more or less destruction of 
the head of the penis and surrounding parts. This operation is performed in 
the following manner: 
The patient having been anaesthetized, the parts are shaved and rendered 
surgically clean; with heavy scissors or a scalpel and grooved director a 
lateral incision is made through each side of the foreskin from its free edge 
down to the groove behind the head, thus forming an upper and a lower flap, 
which, when retracted, expose the entire head of the penis and the inner sur- 
face of the foreskin. The chancroids then are treated as already described, 
and the raw edges of the wounds protected from infection by frequent dress- 
ings and irrigations with very hot bichloride solution. The bleeding, which 
usually is quite pronounced, is controlled readily by the pressure of the dress- 
ing. When the infection has subsided and the wounds have healed, the flaps 
may be trimmed off by a medical officer, leaving a scar as in ordinary cir- 
cumcision. 
Never attempt to pull back a tight foreskin. The paraphimosis which will 
probably result is not easy to reduce, and is the most common cause of gangrene 
of the penis. 
When a chancroid has eaten through the frrnnum leaving a bridge of tissue, 
the bridge should be cut between two ligatures and the chancroid treated in the 
way recommended. The incision of the bridge of tissue hastens healing consid- 
erably. 
An abscess of the inguinal glands should be drained by a very small incision 
followed by injection of a 10 per cent iodoform-in-petrolatum ointment, using 
an ordinary conical glass penis syringe previously filled with the ointment. A 
cold, wet bichloride dressing is applied with a fairly firm spica bandage, the 
cold congealing the ointment in the abscess cavity and thus preventing its escape 
into the dressing. The patient should be kept quiet in bed for two days. The 
dressing is removed at the end of the second day, all pus wiped away, the skin 
cleaned, and the abscess cavity filled with the ointment; the wet dressing and 
the spica bandage again applied. This treatment removes the pus and relieves 
the pain, but does not always cure the condition. Later on the infected glands 
may have to be removed by a medical officer. 
VENEREAL WARTS. 
These usually appear as small wart-like growths springing from the mucous 
membrane of the head of the penis or the innner surface of the foreskin, the 
region of the frsenum or the margin of the meatus. They are not necessarily 
venereal. Their cause usually can be traced to irritation incident to prolonged 
contact with inflammatory discharges. Thus, in the uncleanly with long fore- 
skins, in those suffering from gonorrhoea or chancroid, these growths are not 
uncommon. The redundant or phimotic foreskin which prevents proper cleans- 
ing is an important predisposing cause. 
The treatment consists of complete removal of the growth with possibly cir- 
cumcision, and this is the only reliable treatment. 346 
HOSPITAL CORPS HANDBOOK. 
HERPES. 
Herpes is a condition which is not venereal but which is mentioned in this 
connection because of its frequency and the liability of its confusion with 
venereal sores. This affection is characterized by the rather sudden appear- 
ance of small blisters upon a reddened base. Commonly they appear in or 
about the groove behind the head of the penis, involving both the head and 
the foreskin. The blisters quickly break leaving rounded or irregular erosions 
or ulcers which may run together forming a ring of ulceration around the penis. 
Sometimes these blisters are accompanied by intense pain, and the pain may 
precede the development of the blister. 
Herpes having once appeared is prone to develop again; at times the re- 
currence quickly follows the first attack, new crops of blisters forming as 
fast as the earlier lesions are healed. More frequently there is a distinct 
interval between the attacks. 
The lesions should be kept clean and dusted witli thymol iodide. If the con- 
dition is very acute a wet boric-acid dressing is useful. 
THE PREVENTION OF VENEREAL DISEASES. 
The venereal diseases are important in any community because of their 
prevalence, ready transmissibility, and grave results. A venereal disease that 
has attacked more than half of the men of the country during youth, a dis- 
ease that brings misery to thousands of children and suffering to hundreds of 
t housands of women is a disease to be shunned. A disease that enters the family 
almost exclusively through promiscuous sexual intercourse, that may be trans- 
mitted long after the patient thinks himself or herself cured; that may be 
transmitted to the wife from the prostitute by the offending husband; that 
may be passed front the wife thus innocently infected to her child certainly is 
one to be avoided. 
The man who practices promiscuous cohabitation sooner or later contracts 
one of the venereal diseases in spite of every precaution. In one way, and one 
only, can a man prevent infection with venereal disease, and that is by abso- 
Intely and completely avoiding sexual intercourse until he marries the woman 
who is to be his partner through life. Clean living, the indulgence in athletic 
sports which promote health and occupy the mind, and the avoidance of alcohol 
during hours of relaxation are important factors in the prevention of venereal 
disease. 
In order to assist those who have not the moral stamina to resist sexual 
temptation several so-called preventive or prophylactic treatments have been 
advocated. In reality these are early treatments for venereal disease, as they 
presuppose the deposition of the infecting organisms on the genital organs or 
in the urethra. Prominent among the safety measures recommended is the 
rubber condom, but it may break and so admit infection. 
Some measure of safety is afforded by urination and thorough washing with 
soap and water immediately after cohabitation. To this end the following 
therapeutic measure adds a far greater assurance of safety if applied soon 
after intercourse: 
Wash the parts well with soap and water, then with a 1-5,000 solution of 
bichloride of mercury. 
Fill the anterior urethra with a 2 per cent solution of protargol by means of 
a glass penis syringe and retain the solution in the urethra by pressing the 
lips of the meatus together for five minutes. EMBALMING. 
347 
Apply a 33 per cent calomel ointment to the penis, rubbing it well into the 
skin and mucous membrane, paying particular attention to the region about 
the fnenum. It is also advisable to thoroughly anoint the pubic region and 
entire scrotum, as extragenital infections frequently occur on these parts. 
This medication is only reasonably effective if applied within the first hour 
after coitus. The materials required are not easily carried, so in the Navy 
this treatment can be administered conveniently to a man only upon his return- 
ing to his ship or station. Statistics of venereal infection in the Navy have 
shown that this treatment is of little value after three hours following exposure 
to infection. 
It has been found that 55.4 per cent of venereal infections are acquired while 
men are distant from the ship or station—that is, while they are on leave or 
extended liberty. For this reason medical officers of the Navy are authorized 
to issue, on request, compound calomel ointment, a preparation that is reason- 
ably effective against gonorrhoea and syphilis, in a form adapted to personal 
application. 
The complete item is made up as follows: 
(a) Outer waxed-paper envelope. 
(b) “Directions for use,” printed on thin waxed paper. 
(c) A collapsible container holding 7.5 grams of compound calomel 
ointment. 
The directions for use printed on the waxed-paper are as follows: 
DIRECTIONS. 
Use IMMEDIATELY After Exposure. 
1. (a) Urinate. 
(b) Wash parts with soap and water, if possible. 
(c) In any case, dry parts carefully. 
2. (a) Inject into the canal one-half the contents of the tube at once, grasping the lips 
to prevent escape of the ointment. 
(b) Massage canal for not less than three minutes, so as to spread the ointment 
over its walls. 
(c) Let the ointment remain until it is necessary to urinate. 
3. (a) With remainder of the ointment, anoint the whole length of the penis. Rub in 
thoroughly, paying special attention to the head and near-by p:irts. 
(b) Wrap penis in this paper to avoid soiling the clothes. 
(c) Let the ointment remain at least twelve (12) hours. 
4. Note.—A small amount of ointment rubbed over the penis before exposure helps 
prevent infection. 
While statistics show that the results obtained from this tube are better 
than with treatment taken after return to the ship or station, the method is by 
no means infallible and the man who persists in promiscous sexual indulgence 
relying on any of these methods of early treatment to prevent infection is 
sooner or later doomed to disappointment. 
References. 
Syphilis.—Hazen. 
The Practice of Urology.—Chetwood. 
U rology.—Keyes. 
I Urology (2 vols.).—Guiteras. 
Modern Urology.—Cabot. 
Military Urology.—American Red Cross. 
Embalming.1 
All members of the Hospital Corps should be familiar with the procedures 
necessary in embalming the bodies of the dead and preparing the remains 
for interment or shipment. 
1 Prepared from section 3, chapter 19, Manual of the Medical Department. 
47829°—23 23 348 
HOSPITAL COKPS HANDBOOK. 
Whenever deaths occur reference should be made to articles 908, 1513, and 
1841, Navy Regulations, and chapter 19, Manual of the Medical Department. 
All bodies prepared for interment or shipment under the supervision of 
naval medical officers are thoroughly and completely embalmed in the manner 
described hereafter, using the embalming fluid as prescribed. If the embalming 
is done in the United States by a licensed embalmer he may be permitted to 
use the standard embalming fluid with which he is familiar. 
It is incumbent on all Navy embalmers to exercise great care in the preserva- 
tion of bodies and their preparation for the casket, so that they may reach 
relatives showing evidence of respectful and careful handling, without signs 
of decomposition and with the so-called natural appearance preserved. 
Shaving and modeling of the features should be completed before beginning 
the injection. A liberal application of vaseline prevents subsequent drying 
and is an important matter in respect to the face and hands. 
Although recommended as tending to produce a more pleasing appearance 
of the body and lessening the liability to development of discolored spots and 
localized collections of gas, it is not necessary to drain the veins of contained 
blood. 
Embalming to be satisfactory requires both arterial and cavity injection. 
Arterial injection. 
(a) The arterial system shall be injected with an amount of the prescribed 
embalming fluid equal to 15 per cent of the body weight, estimating 450 c. c. 
of fluid as 1 pound. (Fig. 166.) 
Inject each femoral artery toward toes with 2 per cent body weight. 
Inject each brachial artery toward fingers with 1 per cent body weight. 
Inject one common carotid artery toward head with 2 per cent body weight. 
Inject same common carotid artery toward heart with 7 per cent body 
weight. 
Total amount of fluid, including both femorals and both brachials, 15 per 
cent body weight. 
(b) The technique of injection is important, because prolonged preservation 
depends upon saturation of every tissue of the body with embalming fluid. 
To insure uniform distribution it is usually necessary to make all six injec- 
tions. The return of fluid through the veins while the extremities are being 
injected will indicate saturation of the extremities, and the return of fluid 
during the carotid injection upward will indicate sufficient fluid has been 
injected into the head and upper extremities. 
Penetration is promoted by repeated flexion and extension of limbs and by 
massage of soft parts. An advancing line of firmness of the tissues may be 
taken as an indication of the progress of the fluid. 
It is an easy matter to overinject so that the face and hands are puffy and 
unnatural. To avoid this two signs may be accepted as indicating that suffi- 
cient fluid has been used regardless of the actual amount injected, namely: 
First, if the eyes, lips, or one side of the face become overdistended, or in the 
case of an extremity when it is apparent that the fluid has circulated from 
the smaller arteries through capillaries into veins; and, second, when the 
tissues of a region are uniformly firm, with no “ soft ” areas remaining. 
Overinjection, however, is not objectionable if a long time is to elapse before 
the remains are to be viewed, since a slow shrinkage of the body usually takes 
place. 
(c) When the carotids are being injected, massage of the face and adjacent 
parts is important, it being especially necessary to make sure that the fluid 
reaches less vascular parts, such as the tip of the nose and margins of the EMBALMING. 
349 
THE NAVY STANDARD 
EMBALMING OUTFIT 
TROCAR 
SCALPEL 
SCISSORS 
ANEURISM NEEDLE 
TISSUE FORCEPS 
NASAL TUBE 
ARTERIAL TUBE 
LONG FLEXIBLE ARTERY 
DRAINAGE TUBE 
MAKE INCISION IN 
NECESSARY ARTERIES 
ARTERIAL TUBE INSERTEO 
INJECTION APPARATUS 
INJECT FEMORAL ARTERIES 
TOWARD TOES 
INJECT ONE CAROTIO 
ARTERY TOWARD HEAD 
& TOWARD HEART 
INJECT BRACHIAL 
ARTERIES TOWARD 
FINGERS 
DRAINAGE OF ABDOMEN 
INJECTION OF ABDOMEN 
DRAINAGE OF THORAX 
INJECTION OF THORAX 
|"-\ LIQUID FORMALDEHYDE 13.5 C.C. 
BORAX (SODIUM BORATE) 5.0 QMS. 
I \/ GLYCERIN (OPTIONAL) 5.0 C.C. 
I A WATER. SUFFICIENT TO MAKE 100.0 C.C. 
(3) PREPARE EMBALMING FLUID. 
@ ASSEMBLE OUTFIT FOR USE 
© INJECT FEMORAL ARTERIES TOWARO TOES. 
(g) INJECT BRACHIAL ARTERIES TOWARO FINGERS. 
© INJECT ONE CAROTID ARTERY TOWARD HEAD 
AND TOWARD HEART. 
(§) DRAIN ANO INJECT THORAX. 
©DRAIN AND INJECT A8D0MEN. 
© TIE UP ARTERIES AND SEW UP INCISIONS IN 
SKIN. 
AMOUNT OF FLUID TO USE 15 V. OF BODY WEIGHT. 
2 V. IN EACH FEMORAL ARTERY. 
I 7. IN EACH BRACHIAL ARTERY. 
27. IN ONE CAROTIO ARTERY TOWARO HEAD. 
77. IN SAME CAROTID ARTERY TOWARD HEART. 
INJECT THORAX UNTIL SLIGHT EPIGASTRIC FULLNESS 
IS APPARENT. 
INJECT ABDOMEN UNTIL SLIGHT 01STENT I ON IS 
■ ■ - - APPARENT. -* — 
Fig. 166. 350 
HOSPITAL COUPS HANDBOOK. 
ears. Here, as elsewhere, palpable firmness of the tissues is the indication 
of successful injection. If any of these parts remain soft after completion of 
the arterial injection and show signs of “ skin slipping,” fluid should he intro- 
duced by means of a hypodermic syringe, the point of the needle being inserted 
through the ear, hair line, nostril, or mouth, so that the puncture may be 
invisible. 
When, as sometimes happens, it is impossible to attain uniform firmness at 
the first injection, a second injection undertaken the next day often reaches 
the soft areas. 
Cavity injection. 
Besides injection of the arterial system, cavity injection should be per- 
formed, as much additional fluid being used for this purpose as may be 
required. When circumstances permit delay, it is well to postpone cavity injec- 
tion until several hours have elapsed after the arterial injection has been com- 
pleted. By that time, if a second arterial injection is to be required, the 
necessity for it will be apparent, and then it can be undertaken prior to intro- 
ducing the breaks in the arterial system entailed by cavity injection. 
(a) Thorax.—By means of aspiration at several points remove all body 
fluids and inject each pleural cavity with embalming fluid under moderate 
pressure until a slight epigastric fullness becomes apparent. 
(b) Abdomen.—By means of aspiration, the point of the needle being ex- 
tensively moved about, remove as far as possible all gas, liquid intestinal 
contents, and pathological fluids. Then inject embalming fluid, again moving 
the needle point about extensively, until slight distention is apparent. Kneading 
of the abdomen favors diffusion of the fluid. 
General instructions. 
(a) After autopsy bodies are to be embalmed in the same way; but in such 
cases the cavities of the abdomen, chest, and skull, after complete removal of 
all viscera, shall be packed with absorbent cotton saturated with embalming 
fluid. 
(b) If fluid can not be forced into an artery because of clots or other reasons, 
such as mutilation or advanced decomposition, multiple injections may be made 
into the tissues, which then should be wrapped in cotton saturated in embalm- 
ing fluid. In such case, further, the anus, mouth, and nostrils should be plugged 
with cotton soaked in embalming fluid, and the entire body, including the face, 
ears, and hair, washed with the fluid. 
(c) the case of a body dead of smallpox, plague, Asiatic cholera, typhus 
fever, diphtheria, or scarlet fever, the remains, after being washed and after 
completion of the embalming, shall be bandaged completely, excepting the head, 
with muslin soaked in embalming fluid. The hands and face shall be enveloped 
in a suitable cloth saturated with embalming fluid. 
Embalming fluid. 
(a)The formula for the embalming fluid to be used is given herewith. 
Liquid formaldehyde (U. S. P. solution of formaldehyde) c. c 13.5 
Sodium borate (borax) grams__ 5.0 
Glycerin (optional) c. c__ 5.0 
Water, sufficient to make 1 c. c 100. 0 
Should the solution of formaldehyde contain less than 37 per cent of formal- 
dehyde gas, the amount used should be increased proportionately. EMBALMING. 
351 
(6) As this solution is irritating to many skins, some form of protection is 
advisable. Gloves may be worn in special cases, but in general it will be found 
more convenient and equally safe to annoint the hands prior to beginning work 
with a heavy protective ointment. 
(c) The exact composition of an embalming fluid is of less importance than 
the method of injecting it; but service embalmers, who may be acquainted with 
civilian practice and inclined to follow it, should remember that methods which 
have proved equal to preserving remains for a few days in temperate regions 
may be entirely inadequate to preserve bodies for months in the Tropics. The 
fluid represented by the formula quoted (Francis) will retain its stability for 
more than 2% years; it has proved effective in preserving human subjects ex- 
posed for two months to a temperature of 98° F.; and the property of formal- 
dehyde in acid solution of bleaching muscular tissue to an ashy gray is over- 
come by the addition of borax, which furnishes the desired alkalinity without 
causing deterioration of the solution. This formula is to be used, therefore, in 
all cases. 
(d) The fluid hardens tissues so rapidly that thorough penetration to more 
remote parts often is hindered. For this reason the whole procedure should be 
carried out expeditiously, and it is recommended that at each site specified the 
injection be started with half-strength solution; when the return flow is estab- 
lished the full-strength solution then should be used as directed in this chapter. 
(e) The pressure essential to successful injection may be obtained either by 
elevating the container to a height of 6 feet or by means of a bicycle foot pump. 
The details requiring attention in employing either method will suggest them- 
selves. CHAPTER VI. 
CHEMISTRY.1 
GENERAL INTRODUCTION. 
The study of objects surrounding us constitutes the natural sciences, the 
larger divisions of which are astronomy, geology, botany, zoology, chemistry, 
and physics. One would have little difficulty in arriving at the conclusion 
that the study of a planet came within the realm of astronomy or that when 
studying plants one was pursuing the science of botany. However, it is not 
so easy to differentiate clearly between the sciences of chemistry and physics 
since both treat of the phenomena of matter. 
Suppose a stick of sulphur held in the hand is rapidly twirled or thrown 
through the air. It may be shattered or broken but it still is sulphur; any 
change occurring is superficial and has to do only with shape or position. Sup- 
pose the sulphur is placed in a mortar and finely ground, then fine iron filings 
added, and the two intimately mixed until a gray colored powder is obtained. 
If the powder is fine enough, it is possible that the naked eye may not detect 
the different particles and that the mass will present a uniform and homo- 
geneous appearance, but the mixture is not homogeneous. Should a portion 
of this mixture be placed beneath the lens of a microscope the particles of 
sulphur and iron readily can be distinguished from each other. The mixture 
is therefore heterogeneous; that is, composed of unlike or dissimilar particles 
and is simply a physical mixture or, as is said in chemistry, a physical change. 
The proportion of either ingredient may be changed at will, either by adding 
more of one of the ingredients or by the removal of one of those present. By 
adding carbon disulphide the sulphur can be dissolved from the mixture and 
poured off, leaving the iron, or by applying a magnet the iron may. be with- 
drawn. Suppose that a part of this mixture of powdered iron and sulphur is 
placed within a test tube and heated over a Bunsen burner; the mass will fuse, 
will reach a red heat, and finally will glow brilliantly, and when cooled will 
present the appearance of a black, hard, fused mass. If a fragment be broken 
off, powdered, and placed beneath the microscope it will be seen that it pre- 
sents a homogeneous appearance, all particles being similar. An attempt to 
remove a portion of the particles with a magnet will fail, and any solvent used 
will act on all particles alike. Clearly the mass is different from the original 
powder because the heating of the sulphur and iron together has produced a 
chemical change in which a new substance or compound has been formed. This 
new compound is called ferrous sulphide and is composed of approximately 
35 per cent of sulphur and 65 per cent of iron by weight. These weights are 
constant and never vary, as is the case in physical mixtures. From this fact 
the following law has been adduced: “A chemical compound is always com- 
posed of the same ingredients in the same proportion by weightThis is 
1 Prepared by Chief Pharmacist G. F. Lyon, U. S. Navy. 
353 354 
HOSPITAR CORPS HANDBOOK. 
called the law of constant proportions or Dalton’s law. Dalton also discovered 
the law of multiple proportions which will be discussed later. A law, as the 
word is used in science, is a statement summing up facts which actually have 
been found to be true after a large number of experiments have been performed 
carefully, accurately observed, and verified. 
It has been shown by the above that a chemical change differs from a phys- 
ical one in that, while physical changes are superficial, the changes occurring 
during a chemical reaction are internal. The whole nature of the reacting sub- 
stances undergoes a profound change, resulting in the formation of new sub- 
stances markedly differing in characteristics and properties from those of the 
original substance or substances. From these facts it must be concluded that 
chemistry is that science which treats of the composition of matter, and includes 
the study of the natural phenomena by which changes due to the influence of 
chemical energy occur, and the principles involved therein. 
To discover what elements are in any substance and to learn what are the 
laws governing the actions of elements upon each other is the principal object 
of chemistry. The process by which the composition of substances is determined 
is known as analysis, and that by which substances are produced by combining 
elements, is’ known as synthesis. 
Physics. 
Matter is anything which has weight and occupies space. The different ob- 
jects about us which may be seen and which come within the above definition 
apparently are in numbers without end. Yet it has been demonstrated by 
chemists that there are only about 80 substances known which can not be 
produced from other substances, or which can not themselves be resolved or 
divided into two or more substances. These substances are spoken of as ele- 
ments, because they are elemental in nature; that is, they represent the simplest 
forms of matter. Substances containing more than one element obviously can 
be resolved into simpler products and therefore are compound matter. Such 
substances are known as compounds. 
Matter exists in three states—solid, liquid, and gaseous—and therefore it is 
not surprising to learn that an element in its natural state may be either a 
solid, a liquid, or a gas. Some authorities mention a fourth state—radiant—and 
give radium emanations as an example. Solid matter is bounded on all sides, 
but does not require confinement, liquid matter requires confinement on sides 
and bottom, while it is necessary to confine gaseous matter on all sides. Many 
characteristics are possessed by matter, a few of which are indestructibility, 
divisibility, porosity, and gravitation. 
Regardless of what physical or chemical change may take place, matter can 
not be destroyed nor can it be created anew. If a substance is changed physi- 
cally or chemically it still exists in another form, as has been shown in the 
mixing of sulphur and iron and the heating of sulphur and iron. The divisi- 
bility of matter is that property which permits of its division into small par- 
ticles, each of which is still the same substance, as in the breaking of the stick 
of sulphur mentioned above. Porosity is a property of matter in which the 
particles composing it are surrounded by spaces. That these spaces exist may 
be shown by mixing equal quantities of water and alcohol, when, instead of 
having twice the quantity of either the water or alcohol, there is only approxi- 
mately 97 per cent of the total original quantity of both. This example, while 
demonstrating certain laws concerning changes in volume of liquids, shows con- 
clusively that the particles of one being smaller than those of the other have 
fitted themselves into the intermolecular spaces between the larger particles. 
If they had not, the total quantity after mixing would have been twice the CHEMISTRY. 
355 
original quantity of either instead of but 97%. The degree of porosity 
varies with the density of the substance. Charcoal is very porous, readily 
permitting the passage of water, and sometimes the spaces or pores may 
be seen with the naked eye. That even very dense substances are porous 
is proven by the fact that gases may be forced to pass through thick 
plates of metal or stone if sufficient pressure is exerted upon them'. Grav- 
itation is a common property of matter by which its particles attract 
other particles, and all masses attract each other. The resistance offered by 
a substance on being lifted or carried is an example of gravitation, another is 
the falling to earth of a body thrown into the air. It might be considered that 
it was the earth alone which exerted attraction in these cases, but most exact 
experiments have proved that the bodies also exert an attraction for the earth, 
and the amount of the force of this attraction is directly proportional to the 
mass of the bodies. The law of gravitation is known as Newton's Law and is, 
that “All bodies attract each other ivith a force directly proportional to their 
masses and inversely proportional to the squares of their distance apart.” 
Mass is any quantity of matter which may be apprehended by the senses and 
may be either elemental or compound in character. All masses are composed 
of multitudes of small groups known as molecules, which in turn are composed 
of most minute particles of matter designated as atoms. A molecule is the 
smallest particle of matter capable of existing by itself and retaining its physi- 
cal characteristics, and is composed of two or more atoms. The atoms of a 
molecule may be similar as in a molecule of iron or of sulphur, or dissimilar as 
in a molecule of ferrous sulphide, which contains one atom each of iron and 
sulphur. Atoms are the smallest indivisible units in which matter can exist, 
are the smallest particles of matter that take part in chemical reactions, and, 
as they can not exist in the free state, generally are found in combination with 
other atoms. 
In addition to those properties given above, solid matter, particularly the 
metals, possesses others which will be briefly described. Most solids resist at- 
tempts to force a passage through their particles, due to their hardness. When 
external force is applied, solids easily are broken or fractured, and this is 
known as brittleness. The resistance of solids to attempts to pull their par- 
ticles apart is called tenacity. Malleability is a property possessed by solids 
which permits their being rolled or hammered into sheets. Solids, especially 
metals, may be drawn into fine strands, and the property allowing this to be 
done is ductility. Another property of matter is cohesion. 
In studying chemistry the word “ force ” often is used in connection with the 
natural phenomena affecting the many chemical and physical changes taking 
place and described. For this reason the definition of the word “ force,” and its 
attendant word, energy, is given here. 
Force is the action of one body upon another, or is that which produces, 
changes, or stops motion. It is a manifestation of energy winch may be caused 
in different ways, as by electricity, heat, and light. 
Energy is capacity for doing work and is measured by the work that can 
be done. The amount of force that can be expended depends upon the energy 
contained in an atom of the substance doing the work. Energy exists in 
many different forms as in the motion of masses, in heat, light, electricity, 
etc., all of which constantly are causing vibration. Energy is of two kinds, 
potential and kinetic. The energy which is stored in all bodies and capable 
of being manifested, as that in a drawn bow, is potential energy, and when 
it is manifested as by the sending of an arrow through space, it is kinetic, 
that is, actual or moving, energy is exhibied. 356 
HOSPITAL CORPS HANDBOOK. 
That particular property of matter which holds particles of like composition 
together in a mass so firmly that considerable external force is required to 
part them is the force of cohesion. (The force of adhesion differs from 
cohesion in that it holds together bodies of unlike composition, an 
example being the adherence of a liquid to a solid.) Atoms possess this 
force of attraction to a degree which holds them together Avithin a molecule. 
It is possessed by molecules in varying degrees; for instance the molecules of 
a solid are held firmly together while in liquids the cohesion of the molecules 
is just about balanced by a repellant force, the result being that the molecules 
(which are farther apart than in solids) apparently can slide around each 
other. This fact allows the liquid to assume the same shape as the walls 
of the vessel which holds it. Molecular attraction is almost wholly 
absent in either elemental or compound gases, owing to the weak attractive 
force and the presence of a strong repellant force which causes the molecules 
to separate as widely as possible. In the study of chemistry this force gen- 
erally is spoken of as chemical affinity, which is defined as the power of at- 
traction that an atom of one element may have for an atom of some other 
element, binding them together to form a molecule. Atoms of some elements 
may possess marked affinity for each other, and have little or no affinity for 
atoms of other elements, while a few elements are known which seem to 
have no chemical affinity and form no compounds. Thus pure hydrogen and 
chlorine, in the presence of even weak sunlight, will unite with almost explo- 
sive violence, while under no conditions has a union of oxygen with fluorine 
been accomplished. Generally speaking, it may be said that an element of 
positive quality will have a much greater affinity for an element of negative 
quality than it will have for an element of positive character. It follows 
that the converse is likewise true. Oxygen is a noted exception, since it will 
unite readily with all known elements except fluorine and the elements of 
the argon group. The members of the argon group seem to possess no affinity 
for any known element and all efforts to combine any one of them with other 
elements have failed. Chemical reactions between elements depend primarily 
upon affinity, and if there is none, chemical change can not take place. Other 
factors which increase or limit the degree of completion to which a reaction 
can go and the speed with which it may be consumated are heat, light, elec- 
tricity, catalytic agents, and pressure. 
Atomic weight. 
Atoms of the same element always possess the same weight in relation to any 
definite standard selected with which to compare them, but the weight of an 
atom of one element is never the same as that of an atom of any other element. 
Atomic weight of course is purely relative, as it is impossible to weigh single 
atoms, and is of service only when compared to the weight of a definite 
standard. For a great many years hydrogen, since it is the lightest of all 
known elements, was used as the standard for atomic weights and its 
atomic weight arbitrarily was placed as 1, but hydrogen is very difficult 
to obtain in a pure state and mistakes as to its actual weight frequently 
occurred. Each time an apparatus or process was developed which came a little 
nearer to obtaining pure hydrogen, and consequently nearer the determination 
of its true weight, a revision, entailing recalculations of the atomic weights 
of all other elements, became necessary. This caused much work and finally 
the use of hydrogen as a standard was discontinued and oxygen substituted. 
Under the old system the atomic weight of oxygen was 15.88 but in the new 
system was fixed at 1G. Thus when it is stated that the atomic weight of CHEMISTRY. 
357 
sulphur is 32, it ie meant that the weight of an atom of sulphur bears the 
same relationship to the weight of an atom of oxygen as 32 bears to 16, and 
similarly, since the atomic weight of iron is approximately 56, the relationship 
between the atomic weights of iron and of oxygen is as 56 is to 16. 
Molecular weight. 
The weight of a molecule is the sum of the weights of all atoms which com- 
pose it. A molecule of hydrochloric acid is composed of an atom of hydrogen 
and an atom of chlorine. The atomic weight of hydrogen being 1.008 and 
the atomic weight of chlorine 35.46, the molecular weight of hydrochloric 
acid is the sum of 1.008 and 35.46, or 36.468, and the relationship of the molec- 
ular weight of hydrochloric acid is to the atomic weight of oxygen as 36.468 
is to 16. 
NOTATION. 
Chemical symbols. 
For convenience in working out chemical equations, and in representing the 
results of chemical action, abbreviations of the names of the elements, called 
symbols, are used. These symbols have become fixed by long usage and 
usually consist of the first letter of the name of the element they denote, as 
O for oxygen, H for hydrogen, N for nitrogen. As some elements have names 
beginning with the same letter some other letter of the name is added, as Fe 
for iron, Cu for copper, Hg for mercury, Mg for magnesium. When used in 
connection with the expression of a chemical formula the symbol represents 
more than just the name of the element; it represents a definite quantity of 
that element, an atom, and since atoms have weight, it also represents a 
definite weight of the element. As atoms are the smallest particles of matter 
there can be no subdivision of them and they must occur as one or in multiples 
of one. When necessary to express more than one atom the symbol is written, 
and a little below and to the right the proper numeral is placed; thus, four 
atoms of iron would be written, Fe4. Similarly Cla and Hg2 represents six 
atoms of chlorine and two of mercury, respectively. 
Of the known elements there are only about 20 of sufficient importance to 
a hospital corpsman that any particular study should be made of them at this 
time. All arrangements of elements by classes for purposes of study, or other- 
wise, are arbitrary. However, it is believed that the arrangement given in 
Table II will be of assistance in remembering the valence and separating the 
positive elements from the negative. The characteristics of the positive and 
negative groups are quite different. The members of the positive group are 
base formers, while the members of the negative group are acid producers. 
It is quite necessary, in order to understand why a certain chemical formula 
represents a specific compound, and to be able to write the correct formula 
for a compound when named, that the symbols and valencies of all the ele- 
ments given in Table II be thoroughly learned. Also, in order to facilitate 
the calculations of reacting weights, a thorough knowledge of the approximate 
atomic weight of these same elements, as given in Table I, likewise should 
be acquired. For this reason it is recommended that the whole of Table II be 
memorized before proceeding further with the study of this chapter. 
Chemical formulas. 
A chemical formula is a group of symbols showing the kinds and amounts 
of elements contained in a compound. A formula standing alone represents 
one molecule of the substance. A symbol of an element contained in a 
molecule represents one atom of that element. If more than one atom is 358 
HOSPITAL CORPS HANDBOOK. 
present in a molecule, the proper small numeral is written in, as explained 
above. If it is desired to express more than one molecule, a large numeral is 
written before the formula. This large numeral multiplies everything within 
the formula, much the same as a multiple of an algebraic quantity is expressed, 
for example: II20 is the formula for water, and as written represents one 
molecule of that compound, while 2H20 represents two molecules. To be cor- 
rect a chemical formula must balance. It has been learned that oxygen has a 
valence of II while the valence of hydrogen is I. Manifestly one atom of 
hydrogen is not the equivalent of one atom of oxygen in combining power, 
and if the two are combined it will require two atoms of hydrogen to balance 
or equalize one atom of oxygen, as in any given compound all valencies of each 
atom must he employed; that is to say, no element may have a free valence 
in any saturated compound. The valence of barium is II, and therefore one 
atom of barium can unite with one atom of oxygen to form a molecule of 
barium oxide. If the valence of one element of a compound is a multiple of 
the valence of the other element in the compound, take the symbol of the 
element with the lower valence as many times as it is contained in the valence 
of the other element and write the quotient as the exponent of the element 
with the lower valence as directed before. To write the formula of silicon 
oxide and have it balance, silicon having a valence of IV and oxygen II, the 
symbol of oxygen must be multiplied by 2. The formula of silicon oxide, there- 
fore, is Si02. If the valencies of the two elements concerned are not equiva- 
lent and are not multiples of each other, write the symbols side by side and 
take each symbol as many times as the other has valencies. The valence of 
aluminium is III, and one atom of that element is not balanced by one atom 
of oxygen with a valence of II, so to write the correct formula of aluminium 
oxide it is necessary to take the symbol of aluminium twice and the symbol of 
oxygen thrice, which gives the formula A1203. This is the simplest arrangement 
in which the two can be combined to form a compound. 
Chemical formulas are of four kinds, which are named and described as 
follows: Empirical formulas show the quality but not the quantity (other than 
relative) of compounds, as in (CsHioOc)*, the formula of starch,' but when some 
special arrangement of the atoms of the substance is made to show not only the 
quality and quantity of the elements in a compound hut the relationship between 
the different elements or groups of elements they are known as rational for- 
mulas, an example of such an arrangement being (0H)2S02 the formula of 
sulphuric acid. Graphic or structural formulas are those in which the relative 
position of the atoms is shown as a picture, the exact linking of the atoms 
being given with the symbols of the elements entering into the compound. 
Graphic formulas are shown on page 360. Stereochemic formulas are used in 
the study of such advanced chemistry that they will not be discussed. 
In order to understand the use of chemical formulas, especially graphic for- 
mulas, a knowledge of the combining power of elements, which is based on that 
of the atoms of the element, is necessary. 
VALENCE. 
The combining power of an atom of an element is known as valence. It some- 
times is spoken of as the saturating or replacing power of an element. Hydro- 
gen is taken as the standard in fixing the valuation of valencies, and its valence 
arbitrarily is designated as one. In some elements valence is comparative, be- 
cause they will not combine with hydrogen, as mercury, for instance. The 
valence of such elements is determined by comparison of the combining element CHEMISTRY. 
359 
with one which will combine with hydrogen. Therefore, as one atom of mer- 
cury will combine with one of oxygen, and it is known that one oxygen will 
combine with two hydrogen, the valence of mercury is said to be two. If an 
element has such strength, or valence, that it can unite with two atoms of 
hydrogen, it is said to have a valence of two. If it can unite with four atoms 
of hydrogen its valence is four, etc. Elements often are designated as being 
univalent, divalent, trivalent, or tetravalent, respectively, when their atoms are 
possessed of one, two, three, or four valencies. Similarly, they may be desig- 
nated as monads, diads, triads, tetrads, etc. The valence of an element may be 
indicated also by Roman numerals placed to the upper right hand of the symbol. 
A hexad atom can unite with and completely neutralize six atoms of a monad, 
three atoms of a diad, two atoms of a triad, or one atom of a hexad. An atom 
of a tetrad could unite with four atoms of a monad, two atoms of a diad, or 
one atom of another tetrad. Furthermore, any triad, tetrad, etc., atom may 
neutralize several different kinds of atoms of lower valence at one and the 
same time. For example, a hexad may unite with one triad, one diad, and one 
monad, or with any other combination of atoms the sum of whose valencies 
does not exceed six. 
Valence may be likened to men having as many hands as elements have 
valencies and each hand ready to grasp the hand of another person and form 
a bond. Sometimes, as shown above, one hand may be so strong that it takes 
more than one of the other’s hands to hold the grip which forms the bond. 
Polyvalence. 
Certain elements may possess more than one valence. An atom of mercury, 
for instance, under some circumstances, will combine with one atom of chlorine, 
forming mercurous chloride, commonly known as calomel, and under other 
conditions it will combine with two atoms of that element to form mercuric 
chloride, popularly but erroneously called bichloride of mercury. Just why an 
element may possess this quality of polyvalence is not known. It only is known 
that they do possess it. 
When an element changes its valence, either higher or lower, the change 
usually is in degrees of two, changing from monad to triad, diad to tetrad, 
etc., or the reverse. Exceptions to this rule are known, however, as iron, 
which changes its valence 1 degree at a time, as from a valence of 1 to a valence 
of 2, and from 2 to 3. 
That these varying valencies may be indicated, the terminations ous and ic 
are used, denoting the lower and higher valence, respectively, as cuprous oxide, 
Cu20, in which copper has the valence of 1, and cupric oxide, CuO, in which 
copper has the valence of 2. 
When all the valencies of an element are satisfied or hooked up with others 
a compound is said to be saturated. In some compounds it is believed that 
valencies for which there is no satisfying valence may hook up with each 
other, although this is not known positively. For instance, in ammonium chlo- 
ride, NH4C1, it is known that nitrogen acts as a pentad and has all valencies 
satisfied, while in ammonia gas, NH3, it is known that nitrogen acts as a triad 
having 3 valencies satisfied. The fact that by adding hydrochloric acid to 
ammonia gas, ammonium chloride is produced, with the consequent increase in 
valence from 3 to 5, and the knowledge of similar occurrences in other com- 
pounds, has led to the belief that possibly the unsatisfied valencies unite with 
each other in compounds which otherwise would not be saturated. 
Valence also is indicated by using the symbol of the element with bonds, or 
arms, as they might be called, equal to the degrees of valence extending from 360 
HOSPITAL CORPS HANDBOOK. 
it. It is not necessary that these bonds be attached to the symbol in any 
definite position, but only the proper number of bonds corresponding to the 
degree of valence may be used. To illustrate the above the following examples 
are given showing the placing of the required number of bonds about the symbol 
of the element and the name of the degree of valence: 
Monad Diad Triad Tetrad Pentad 
H— —O— —it— — C— =A= 
I 
—Jf= =N= —=N= — 
Different positions of bonds. 
Practical use of graphic formulas to show the composition of compounds is 
obtained by linking the bonds of the symbol of one element with those of others, 
so that all bonds are joined, always remembering that only one bond of an 
element ever can be linked with one bond of another atom. Some examples 
of common compounds written graphically are: 
Water Nitric Acid Ammonia 
//O /H 
H-O—H H—O—N/ N\ H 
XH 
To show how the formula of a compound may be written, acetic acid can be 
represented in any of the following ways: 
H O 
HC2H302; C2H402; H— (t—l—O—H 
H 
NOMENCLATURE. 
To be a compound a substance must be composed of atoms of two or more 
elements. The naming of chemical compounds depends on a system in which cer- 
tain accepted terminations are added to the name of one of the elements in the 
compound. These terminations are considered as meaning that nothing but 
the elements specifically named is present in the compound. For compounds 
containing only two elements or one element and a radicle the termination ide 
is used; compounds formed in the union of oxygen, sulphur, chlorine, etc., with 
another element or radicle are known as oxides, sulphides, chlorides, etc., 
respectively. 
In addition to this termination there are other ways of distinguishing com- 
pounds, each of which indicates a compound formed by the combination of ele- 
ments in different proportions. Copper oxide is the proper designation of both 
the cuprous and cupric salts of copper, for they contain only two elements, but 
they are different bodies. Therefore the cuprous salt is designated as copper 
suboxide and the cupric salt as copper monoxide. Sub is used to indicate a 
difference in the normal combination of the elements in a salt and in this case 
there is less oxygen in combination with copper than there is in copper mon- CHEMISTRY. 
361 
oxide. Mon is but one of the several syllables used to designate the relative 
quantities of elements which combine in more than one proportion, the others, 
with examples, being: Carbon dioxide, C02; sulphur trioxide, S03; carbon tetra- 
chloride, CCh; and phosphorous peniachloride, PC15, etc. Occasionally a com- 
pound has one-half more of an element than another compound containing the 
same elements, or the proportion is as 1 to But as fractions are not al- 
lowed in formulas the whole expression is multiplied by two and the proportion 
becomes as 2 to 3, and such compounds are known as sesqui-compounds, the 
word sesqui meaning one and a half. The formula of iron-sesquioxide, there- 
fore, instead of being FeOi-| is Fe2Os. 
Other syllables and terminations used in the naming of compounds will be ex- 
plained during consideration of acids, bases, and salts (these being the prin- 
cipal representatives of ternary compounds), those which have been given above 
being used almost entirely in binary compounds. 
Binary compounds are those in which the molecules are made up of only two 
different elements, as water, H20, potassium iodide, KI, or calcium oxide, CaO. 
A molecule of a ternary compound contains atoms of three or more different ele- 
ments, as potassium chlorate, KCIO3, magnesium sulphate MgSCh, or sulphuric 
acid, H2SO4. Ternary compounds are considered as being first derived from 
binary compounds. 
ELECTRICAL PROPERTIES OF THE ELEMENTS. 
Before proceeding further, it is necessary to discuss electricity and its rela- 
tion to the elements, as many conditions existing and changes occurring are 
directly concerned with this natural phenomenon. 
Electricity usually is spoken of as static and dynamic. Static electricity is 
the form which remains stationary until activated by friction, while dynamic 
electricity is the electricity of action, producing power, heat, and light. 
Two conditions are exhibited by electrical excitement and are known as posi- 
tive and negative. The points in any apparatus developing electricity at which 
these conditions are manifested are called poles or electrodes, and they further 
are designated as positive and negative from the character of the electricity 
discharged from them. These points may be distinguished also by the sign + 
for the -positive or anode pole and the sign — for the negative or cathode pole. 
It is a well-known law that similar or like electricities repel each other and 
dissimilar or unlike electricities attract each other and that bodies charged with 
positive or negative electricity act in the same manner. From knowledge of 
this law has developed a practical application of its principles in determining 
many important relations between elements. This is known as electrolytic dis- 
sociation or ionization. 
The experiments conducted to determine the relations of electricity to 
chemistry have shown that elements contain electrical charges, some being 
positively charged and others negatively. Generally these experiments have 
been carried out on solutions of substances made up of known elements in 
water, contained in vessels known as “ decomposing cells.” In these cells 
are placed the electric terminals (electrodes or poles) of the apparatus pro- 
ducing the electricity. Thus if a current of electricity is passed through a 
solution of hydrochloric acid in water, chlorine is given off at the positive or 
anode pole and hydrogen at the negative or cathode. Water, when pure, 
does not conduct electricity appreciably, but solutions of acids, bases, and salts, 
which are compounds of elements, conduct electricity readily. In doing so, 
however, it involves the breaking up of the substances dissolved which is 
known as electrolysis, and substances whose aqueous solutions conduct elec- 
tricity are known as electrolytes. There are substances which do not conduct 362 
HOSPITAL CORPS HANDBOOK. 
electricity, such as organic bodies like sugar, starch, and albumin, and these 
are known as nonelectrolytes. 
In connection with ionization is a natural phenomenon known as osmotic 
pressure in which solutions of the same substance but of different strengths 
when brought in contact with each other gradually are entirely mingled as the 
result of one solution pushing its way into the other. If a bladder, which is a 
semipermeable animal membrane is filled with a mixture of alcohol and water, 
tied tightly, and immersed in water, it will slowly swell until it bursts. This 
is due to the fact that water can pass through the pores in the membrane hut 
the alcohol can not, and consequently the bladder finally becomes so full 
that it ruptures. Experiments conducted have shown that electrolytes possess 
osmotic pressure in a higher degree than nonelectrolytes. Chemists finally 
decided that, because of certain facts determined in the course of their in- 
vestigations, a modification of the molecules in solutions of electrolytes took 
place by the mere act of solution, in which two groups were developed from 
each molecule, one positively charged and the other negatively. These groups 
were termed ions and the conditions bringing about their formation ionization 
or electrolytic dissociation. 
It has been shown how molecules of electrolytes, when dissolved in water, 
break up into independent particles called “ ions ” charged with positive or 
negative electricity. The properties of such a solution are fixed by the nature 
and numbers of these particles that are present hut their formation does 
not require the presence of electric current. Those which are charged with 
positive electricity are attracted to the negative pole and those charged 
with negative electricity are attracted to the positive pole. These ions 
move about in the solution just like independent molecules. From this fact 
comes the name “ ion,” a Greek word meaning to go, to wander. Positive ions 
are indicated by the sign + placed above the symbol of the element, or above 
and to the right, and negative ions by the sign —. 
The ion differs from an atom or molecule in that it carries a charge of 
electricity. This electrical charge modifies greatly the usual chemical action 
of the element, and secondary reactions sometimes occur between the liberated 
ions and the liquid around the pole or even with the substance of the pole 
itself. If an electric current be passed through an aqueous solution of Na2S04 
(sodium sulphate), it would be expected that in dissociation sodium would 
be liberated at one pole and the group SCh at the other. However, what ac- 
tually occurs is: The sodium attacks the water and caustic soda (NaOH) is 
formed, while hydrogen is liberated. Then the group S04 reacts with the 
water (HaO) and we have H2S04 (sulphuric acid) with oxygen liberated. 
Sodium as an ion differs from ordinary sodium in its properties. It has been 
explained that in the dissociation of any molecule two kinds of ions are 
formed, one positive and the other negative, and the sum of the positive charges 
is always equal to the sum of the negative charges. Thus, in the dissociation 
of NaCl we have: 
NaCl=Na+ Cl~ 
Therefore the solution is electrically neutral, the positive Na ion just equaling 
the negative Cl ion. 
If we have divalent radicles, on dissociation they will become ions carrying 
a double charge. So also trivalent ions will carry a triple charge. Ex- 
amples are: 
CuCl2=Cu++ 2C1- 
FeCl=Fe+++ 3C1~ CHEMISTRY. 
363 
In the above the coefficients two and three multiply the charges as well as the 
radicles themselves, so that the number of positive and negative charges are 
equal. 
In the electrolysis of sodium sulphate a solution of NaaSCh gives the ions 
2Na+ SOr The sodium atoms when discharged decompose the water about 
the cathode pole thus: 
Na+11,0=NaOH+H, 
The SOi ions when discharged at the anode pole decompose the water thus: 
S04+H20=H2S04+0, 
and new substances have been formed at the cathode and anode poles. 
Many modern chemists hold the ionic theory to be untenable, giving as rea- 
sons certain phenomena that are too involved to explain here, but the theory 
of ionization generally is accepted. 
In closing this subject concerning the electrical nature of the elements it 
may be said, approximately, that the metals are all positive and the non- 
metals negative. This is only partially true, and, moreover, while an element 
may be classed usually as positive or negative it might under certain conditions 
exhibit certain functions of the opposite group. Thus zinc and aluminium 
are both classed as metals and are generally quite positive in character, yet 
under certain specific conditions they will act when brought into contact with 
a stronger and more basic metal much as a negative or nonmetal would under 
the same circumstances. 
REACTIONS AND EQUATIONS. 
In chemistry these terms are synonymous in so far as their use is concerned. 
It has been shown how chemical symbols are used to indicate the composition 
of a substance, and chemical symbols are used further to show exactly the 
nature of the chemical changes which occur when different substances come in 
contact with each other. The grouping of the symbols in this manner is called 
a reaction, but, strictly speaking, the statement is an “ equation of the re- 
action,” as it is written in the form of an equation and both sides of the equa- 
tion must balance. It is customary to speak of these expressions either as 
reactions or equations. The signs of addition, +, and equality, = or —>, are 
used in expressing the reaction, but as the reaction may be reversible the use 
of the words “ results in ” or “ produces ” is preferred to “ equals.” 
By the use of chemical symbols a chemical equation may be described as a 
shorthand method of recording what has happened in a chemical reaction 
and obviously must be a statement of facts that actually occurred. In other 
words, the equation is written to fit the reaction, and consequently equations 
can not be written until it is known through testing and experimenting ex- 
actly what has happened in any given instance. The general laws of chemistry 
and physics and observations of large numbers of reactions have been studied 
until it is known just what will happen in the majority of cases where 
specific reagents (compounds used for producing reactions) are brought in 
contact. 
In writing reactions or equations, three difficulties usually are encountered. 
These difficulties are to know if a given change will occur, to know the amount 
of the substance to be used, and to know the character of the substance formed 
in the reaction. The first difficulty is experienced because the varying electri- 
cal natures of the elements affect their affinities, and the disturbing of ordinary 
affinities by the formation of insoluble bodies when liquid substances capable 
47829°—23 24 364 
HOSPITAL CORPS HANDBOOK. 
of producing them are brought together, the facility with which bodies that 
can be volatilized or converted into a gas diminish in their chemical power 
when this occurs, and the proportion or concentration of the substances 
brought in contact with each other. The second difficulty met with is caused 
by the necessity of knowing the ratio in which the substances can react upon 
each other, and is determined by their valencies. The third difficulty en- 
countered is due to the electrical relations of the ions of the substances coming 
in contact with each other, in which it is necessary to remember that electro- 
positive ions can unite only with electro-negative ions. Reactions may be the 
result of four factors, which are: 
(1) Direct combination, as, iron and sulphur when heated unite to form 
ferrous sulphide. Fe+S —»FeS. 
(2) Simple decomposition, when a compound is decomposed or broken up 
into simpler substances, as, calcium carbonate when heated, breaks up into 
calcium oxide and carbon dioxide. CaCOs+Heat —»CaO+C02. 
(3) Substitution, or displacement, when an element replaces one of those 
present in a compound, as, when zinc replaces the hydrogen in sulphuric acid 
forming zinc sulphate and hydrogen. Zu+IRSCh—^ZnSOi-f211. 
(4) By double decomposition when all the reacting compounds are decom- 
posed and entirely new compounds formed, as, calcium hydroxide and hydro- 
chloric acid react to form calcium chloride and water. Ca(OH)2+2HCl 
—>CaCl2+2H20. 
When dealing with reactions generally between acids and metals, or metallic 
oxides or hydroxides, it is safe to assume that a salt of known content will be 
formed; for example, when zinc is placed in a solution of hydrochloric acid it 
is known that zinc chloride will be among the products formed and that hydro- 
gen will be another product. 
It is very much simpler to write the equation Zn+2HC1—■> ZnCl2+H2 than 
it is to write a statement that an atom of zinc plus two molecules of hydro- 
chloric acid will produce a molecule of zinc chloride and a molecule of hydrogen 
(or two atoms of hydrogen), as the equation expresses the same facts and 
more. 
It was learned that the atoms of all the elements possess weight and that 
this weight is comparable to the weight of an atom of hydrogen. It therefore 
follows that if an atom of zinc and two molecules of hydrochloric acid will 
produce a molecule of zinc chloride and a molecule of hydrogen, a definite 
weight of each of the former must produce a definite weight of each of the 
latter, since, through the law of the conservation of mass, it is learned that no 
matter, or weight, is lost or gained in any chemical reaction. The actual weight 
of any atom is not known, but the relative weights are; therefore, let the atomic 
and molecular weights of the elements and compounds involved in the above 
equation be placed in the proper position just above the equation and observe 
the result. Zinc has an atomic weight of approximately 65.4, and as only one 
atom of that element is involved in this equation that figure is placed above the 
symbol of zinc. The atomic weight of hydrogen is, roughly, 1, and of chlorine 
35.5. The molecular weight of hydrochloric acid therefore is 36.5, but as that 
figure represents the weight of only one molecule and in this equation two 
molecules are involved, the number is doubled and the number 73 placed above 
the formula of hydrochloric acid. The molecular weight of zinc chloride must 
be the atomic weight of zinc (65.4 plus twice the atomic weight of chlorine 
(35.5X2=71) or 136.4), which is written above the formula of that compound. CHEMISTRY. 
365 
and 2, of course, is the molecular weight of hydrogen. The equation then 
appears as follows: 
65.4 73 136.4 2 
ZnT2HCl=ZnCl2+H2. 
As no weight may be lost or gained in a chemical reaction, the combined 
weights of zinc and hydrochloric acid should just equal the combined weights 
of zinc chloride and two atoms of hydrogen, and it is found that they do, the 
sum of the weights of the elements and compounds on either side of the 
equality sign being 138.4. Now, irrespective of what the actual weight of the 
atoms or molecules may be, this equation shows that 65.4 parts by weight of 
zinc and 73 parts by weight of hydrochloric acid will produce 136.4 parts by 
weight of zinc chloride and 2 parts by weight of hydrogen. One may substi- 
tute any unit of weight desired—grains, ounces, tons, kilograms, or grams—for 
the word “ part ” and the actual weights involved read off as such. If a chemi- 
cal equation is written correctly, the combined weights of the reacting sub- 
stances will exactly equal the combined weights of all the products. It natu- 
rally follows that if a compound is formed which contains more atoms of an 
element, or requires two or more radicles to balance it, and those amounts are 
not contained in one molecule of the substance from which it is to be supplied, 
more molecules of that substance must be used. In other words, enough of the 
substance must be used to supply the amounts needed. Suppose metallic cal- 
cium is dropped into some hydrochloric acid. It is known that calcium chloride 
(CaCb) will be formed, the equation being: 
40 73 111 2 
Ca+2HCl=CaCl2+H;! 
Since a molecule of calcium chloride contains two atoms of chlorine and one 
molecule of hydrochloric acid contains only one atom of chlorine, it is necessary 
to use two molecules of that acid. Determining the weights involved in the 
above equation, we find that 111 parts of calcium chloride and 2 parts of 
hydrogen are formed by the action of 73 parts of hydrochloric acid on 40 parts of 
calcium, all parts being by weight. 
By applying the above principles the weights of any substances required to 
produce a definite weight of a specific compound may be calculated. First the 
equation must be stated and balanced, next the reacting weights must be 
written in their respective places above the equation, and then, by making a 
simple statement in proportion, the required weights easily are ascertained. 
Suppose the problem is to ascertain the quantity of hydrochloric acid neces- 
sary to produce 75 grams of calcium chloride. By reference to the preceding 
equation it is noted that 73 grams of hydrochloric acid will produce 111 grams 
of calcium chloride. It follows, then, that: 
73: 111:: x: 75 
wherein it is found that x equals 49.32+ grams of hydrochloric acid. Simi- 
larly, had the problem been to determine how much calcium chloride could be 
made from 1,850 grams of hydrochloric acid the statement would have been: 
73 : 111:: 1850 : x, 
and x would equal 2,813+ grams of calcium chloride. 
The weights expressed in the foregoing equations are for 100 per cent, or 
absolute compounds, which are compounds with absolutely no diluents or im- 
purities present. Unfortunately such compounds rarely are met with in prac- 
tice, so that when dealing with actual cases it generally is necessary, after 366 
HOSPITAL CORPS HANDBOOK. 
determining the required weights of the absolute substance, to calculate how 
much of the impure or diluted product at hand will be necessary to furnish 
the required amount of absolute substance. In dealing with liquids the specific 
gravity, in addition, must be taken into consideration. Suppose the problem 
is to determine how many c. c. of a solution of sulphuric acid, specific gravity 
1.90, 90 per cent by weight, will be required to liberate 1,125 grams of hydro- 
chloric acid from the appropriate quantity of sodium chloride. The equation 
is written and the reacting weights calculated. Using approximate atomic 
weights, this would be as follows: 
117 98 142 73 
2NaCl+H2S04=Na2S04+2HCl 
which shows that 98 grams of absolute sulphuric acid will produce 73 grams 
of absolute hydrochloric acid. Then, 
98: 73:: x: 1125 
and x is found to equal 1,510+ grams. 
Now, the specific gravity of the solution of sulphuric acid to be used is 1.90, 
therefore 1 c. c. will weigh 1.9 grams .(volume X sp. gr. — weight), of which 
90 per cent, or 1.71 grams, is absolute sulphuric acid. Then, if 1 c. c. contains 
1.71 grams of absolute acid and 1.510 grams of the absolute acid are needed, by 
dividing 1,510 by 1.71 the required number of c. c. is ascertained, which is, 
in this case, 883+. 
It also will be observed that many compounds are crystalline in character, 
and in these crystals the compounds are combined loosely with one or more 
molecules of water (water of crystallization), and the weight of this water, 
though it may be driven oft by heating the crystal, must be taken into consid- 
eration when the crystals themselves are used. The molecular weight of 
sodium carbonate, for instance, is, in round numbers, 110, but crystals of this 
compound can not be indicated always as Na2C03. In one official salt the 
compound exists as Na2CO3.10H2O ; therefore to obtain 110 grams of the absolute 
salt in this case it will be necessary to weigh out 286 grams of the crystals of 
that compound. 
Reversible reactions.—It has been previously stated that the degree of com- 
pletion to which a reaction may proceed and the speed of the reaction are con- 
tingent upon certain factors which were named. Therefore, to a certain extent, 
a reaction may be controlled partially and in some cases they may be made to 
proceed in either direction; that is,'the products under suitable conditions will 
produce the original substances. Such reactions are said to he reversible. The 
reaction between calcium oxide and carbon dioxide is of this nature, for, if a 
stream of carbon dioxide is allowed to pass over calcium oxide, calcium car- 
bonate is produced; while if calcium carbonate is heated, that compound is 
decomposed into calcium oxide and carbon dioxide. Such a reaction is written 
as follows: CaCO,+Heat^CaO+CO, 
This equation simply means that the reaction may proceed from left to right, 
or vice versa, according to the conditions obtaining at the time. (See Law of 
Chemical Equilibrium.) 
In connection with the writing of equations showing reactions, the following 
rules, with examples, are given to assist the student. 
(1) Any metal plus any acid gives a salt of the metal plus hydrogen. Ex- 
ample : 
Ag + HCl=AgCl + H 
Metal Acid Salt Hydrogen CHEMISTRY. 
367 
(2) Any hydroxide plus any acid gives a salt of the acid used plus water. 
Example: 
NaOH + H2S02=NaHS04 -f H,0 
Hydroxide Acid Salt Water 
(3) Any carbonate plus any acid gives a salt of the acid used plus carbon 
dioxide plus water. Example: 
NaC03 + HN03=NaN03 + C02 + H.,0 
Carbonate 
Acid 
Salt 
Carbon 
Dioxide 
Water 
(4) Any metal plus water which produces a reaction gives a hydroxide of the 
metal plus hydrogen. Example: 
Na -f H,0 = NaOH + H 
Metal Water Hydroxide Hydrogen 
RADICLES. 
Combinations of elements which act as elements are radicles. Another way 
of defining radicles is by saying that they are groups of atoms having unsatis- 
fied valency. These combinations remain together and act as a single element, 
but can not exist in the free state. They always are found in combination with 
other atoms, although they may act in every way as single atoms in chemical 
reactions. The valency of radicles is determined by the number of valencies 
unsatisfied, and is known as saturated, (CH4), monad, (CH3), diad, (CO), etc. 
With but few exceptions the names of radicles terminate in yl, as "hydroxyl, 
carbonyl, methyl, etc., and they are identified in chemical formulas by enclosing 
them in brackets or parentheses, as Fe(OH)3, instead of Fe03H3. In addition 
to being known as a radicle such a group of atoms may be known as a residue; 
that is, what remains after the removal of an atom from a saturated molecule. 
The formulas, valencies, and names of some of the more important radicles 
are given in the table below. 
Formula. 
Name. 
Valency. 
Formula. 
Name. 
Valency. 
NH( 
CHu 
NH, 
CN 
OH... 
CO 
Although generally referred to as the sulphuric and sulphurous radicles, 
the groups S03 and S02 are really anhydrides, which are compounds derived 
from acids by the abstraction of a molecule of water. Literally, anhydride 
means “ without water.” 
Radicles play a most important part in the various reactions of analytic 
and synthetic chemistry, readily interchanging with atoms in chemical re- 
actions. Radicles are so closely interwoven in the theories and laws concern- 
ing the formation of acids, bases, and salts that consideration of them will be 
continued in the discussion of: 
ACIDS, BASES, AND SALTS. 
Any one of these three different kinds of compounds in turn may be either 
a binary or ternary compound. 
Adds are compounds of an electro-negative element, or group of elements, 
with hydrogen. They may, or may not, contain oxygen. Acids neutralize 368 
HOSPITAL CORPS HANDBOOK. 
(nullify) alkalies, destroy or change the color of litmus or other indicators, 
are sour to the taste and have a corrosive action on animal and vegetable 
tissues. Through their action on metals hydrogen is liberated from the acid, 
the metal taking its place and forming a salt. 
There are two important classes of acids which are known as binary, hydro- 
gen, hydro, or halogen acids, and ternary, oxy, or oxygen acids. Examples 
of each are shown below. 
Hydrogen acids. 
Oxygen acids. 
HC1 Hydrochloric acid. 
HBr Hydrobromic acid. 
HI Hydriodic acid. 
IIF Hydrofluoric acid. 
H2SO4 Sulphuric acid. 
HNO3 Nitric acid. 
H3PO4 Phosphoric acid. 
II2CO3 Carbonic acid. 
HCIO3 Chloric acid. 
The strength of an acid is said to depend upon the degree to which it can 
dissociate or ionize. When an oxide of a negative element is dissolved in 
water an acid is produced. Theoretically, then, in order to manufacture an 
acid the first step is to produce an oxide of the element. Such an oxide is 
known as an acid anhydride, which may be described as an acid from which 
all hydrogen with sufficient oxygen to form water has been removed. For 
purposes of nomenclature all ternary acids are considered to he derived from 
acid anhydrides. 
A molecule of an acid may be said to be composed of two parts—its replace- 
able hydrogen and the remainder of the molecule. This remainder is known 
as an acid radicle or residue. If an acid contains one atom of hydrogen to 
a molecule, as does hydrochloric acid, one atom of any univalent element may 
replace that hydrogen to form a normal salt, hut as an atom of a divalent ele- 
ment is the equivalent in strength, or valence, to two hydrogen atoms one 
divalent atom can replace the hydrogen contained in two molecules of such 
an acid. Conversely, if the acid contains two atoms of replaceable hydrogen 
to a molecule, as sulphuric acid, it is evident that it must require two atoms 
of a univalent element, or one atom of a divalent element to replace it. For 
that reason radicles are regarded as groups not broken up easily, which act 
as a unit in most reactions, and which possess valence (or basicity) the same 
as do elements, this basicity being controlled by the number of replaceable 
hydrogen atoms in a molecule of the acid of which they are the residue; for 
example: 
Acid. 
Radicle. 
Basicity. 
HN03 
-NO3 
1 
HCIO3 
-CIO3 
1 
H2CO3 
-CO3 
2 
— SO4 
2 
H3PO4... 
=P04 
3 
H3BO3. 
=B<>3 
3 
The formula for a radicle may be written correctly and no attention paid to 
the valence of any particular element in it, since these elements are acting as 
a group, or whole, and, as stated above, the valence or basicity of the radicle 
or group is governed solely by the number of replaceable hydrogen atoms origi- 
nally combined with them in the acid of which they are the residue. Observ- 
ing the matter in this light, it is clear that by knowing the valence of the base CHEMISTRY. 
369 
to be used and the formula of the acid from which the radicle is derived, the 
two then may be combined exactly in the same manner as would be two ele- 
ments to form any binary compound. For example, it is desired to write the 
formula for zinc carbonate. Zinc has a valence of two. Its symbol, Zn, is 
written down. A carbonate must come from carbonic acid, since carbon is the 
characteristic element in that radicle and “ ate ” salts come from “ ic ” acids. 
The formula for carbonic acid is H2CO3. The carbonate radicle therefore must 
be OOs and is written down alongside and next after the symbol for zinc. Car- 
bonic acid, containing two atoms of replaceable hydrogen to a molecule, shows 
that the carbonate radicle must be dibasic and accordingly will exactly match 
in valence strength with one atom of zinc. The formula for zinc carbonate 
therefore is ZnC03. In other words, zinc being divalent, is equal in combining 
power to two hydrogen atoms and can replace them in any acid. Sodium is 
univalent, and it would require two atoms of that element to replace all the 
hydrogen in a molecule of carbonic acid, so that the formula for sodium car- 
bonate would be Na2C03. Whenever a whole radicle must be used in a formula 
more than one time (unless it is a binary radicle) it is necessary to enclose it 
within parentheses and multiply it by using a small numeral suffixed somewhat 
below the parentheses, as is done in the case of multiplying a single atom. 
For example— 
Calcium chlorate Ca(C103)2 
Ferric sulphate Fe2(S04)3 
Ferrous phosphate Fe3(P04)2 
Carbonate radicles generally are broken up when brought in contact with an 
acid or when heated, and therefore when a carbonate reacts with an acid 
another carbonate is not formed, but carbon dioxide and water are among the 
products. This is shown by the equation marked (a) below. When heated all 
carbonates except those of the alkalies will produce carbon dioxide and an 
oxide of the element with which it is combined as a carbonate, as shown by the 
equation marked (6). 
(a) CaC03+H2S04=CaS04+C02+H20 
(6) CaC03+Heat=Ca0+C02 
In order to become familiar with writing formulas it is suggested that they 
be written whenever possible until one is able to set down without error the 
formula for any salt that might be formed from the union of any positive 
element given in Table II with any acid listed in Table III. Many such pos- 
sible combinations do not actually exist, but the mere setting down of the 
formulas for such hypothetical compounds can do no harm, and the practice 
so obtained should prove most beneficial. Here let it be said that very 
few salts actually are formed by treating a metal or its base with an acid, 
though practically all of them can be so produced. Many of the acids do not 
exist as such, and others, though formation is possible, are of such a weak 
or unstable nature that their use outside of a laboratory would be most imprac- 
ticable, and in most instances formation of salts by such a method would prove 
too costly. In practice, therefore, compounds are produced usually by other 
methods, an outline of which will be given later. 
Most of the acid-forming elements are polyvalent, and therefore they can 
unite with oxygen to produce more than one oxide. In the cases of those 
elements which form only two oxides, as nitrogen or arsenic, the nomenclature 
is easy and is carried out exactly as described for all binary compounds; that 
is, there would be nitrous and nitric oxides and arsenic and arsenous oxides. 370 
HOSPITAL CORPS HANDBOOK. 
In examining chlorine it will be seen that this element possesses four distinct 
sets of valencies, and therefore can unite with oxygen in four ways. It 
develops that chlorine, as well as others of these polyvalent elements, has two 
sets of valencies with which it unites with oxygen much more often than it 
does with its other two sets. Also that these more common compounds with 
oxygen are much more stable. To the compounds formed by these two sets of 
valencies the endings ic and ous are given. Thus we get chloric oxide (C1205) 
and chlorous oxide (CI2O3), in which the valence of chlorine is V and III, 
respectively. For the oxides next above the ic form the prefix per is used, and 
for the oxide next below the ous form the prefix hypo. Accordingly the oxides 
of chlorine are named as follows: Perchloric oxide, chloric oxide, chlorous 
oxide, and hypochlorous oxide. Such oxides, as previously described, also may 
be named by the use of Greek numerals. Therefore, for example, chloric oxide 
correctly may be called chloric oxide, chlorine pentoxide, or chloric anhydride. 
As has been said, an acid is produced by dissolving a negative oxide (acid 
anhydride) in water, and the acid so produced inherits the name of the oxide, 
the word “ acid ” simply being substituted for the word “ oxide ”; therefore 
sulphuric oxide produces sulphuric acid, nitric oxide produces nitric acid, and 
hypophospliorous oxide produces hypophosphorous acid, and chloric, iodic, and 
bromic acids are derived, respectively, from chloric, iodic, and bromic an- 
hydrides. The negative element which unites with oxygen to form an acid 
anhydride is known as the “ characteristic ” element of that oxide and of the 
acid produced from it. It is the element that gives the acid its name. Thus 
sulphur is the characteristic element in sulphuric acid, etc. The reaction 
that actually occurs when an anhydride is dissolved in water is that the two 
molecules unite in such a manner that one or more hydroxyl groups are formed, 
so that, if lines are used to designate valence or bonds, the transformation 
that takes place is as shown in the following graphic formula of sulphuric 
acid: 
Sulphuric anhydride ] , m , ... „ . , . .. 
„ . , . , . ., 1 + Water yields Sulphuric acid 
Sulphuric trioxide J 
S=“ ♦(£- Sip 
so3 + h2o —♦ h2so4 
It should be noted that it is only the hydrogen contained in the hydroxyl 
group of a ternary acid that can be replaced by a metal or a base. Usually in 
all inorganic acids all of the hydrogen is so combined but not always. The 
formula given for phosphorous acid in Table III is H3PO3, but only two of the 
hydrogen atoms can be replaced for the reason that only two are contained in 
hydroxyl groups, as is shown below by the graphic formula of that acid, and 
experiments have proven that hydrogen not so contained is not replaceable by a 
positive element. 
Phosphorous Acid 
P-O-H 
Ef 
H3PO3 CHEMISTRY. 
371 
Phosphorous acid is the only one listed in Table III containing hydrogen that 
is not part of a hydroxyl group, and is therefore the only one so listed in 
which all the hydrogen can not be replaced. 
Bases as a general rule are compounds of electropositive elements with 
oxygen or with oxygen and hydrogen. They frequently are spoken of as 
hydroxides and alkalies, and often are considered as electropositive elements 
or radicles which are united with hydroxyl (OH). Bases have several 
characteristic properties, such as: 
(a) Reaction with acids to form salts. 
(b) Alkaline reaction, if soluble, turning litmus from red to blue. 
(c) Soapy, alkaline taste, if soluble. 
(d) Power to interact with acids and neutralize them, taking away their 
characteristic properties. 
In theory, for purposes of nomenclature, bases are regarded as being formed 
either by the direct union of some basic element and oxygen, as calcium 
oxide, CaO, or by the action of a positive element or its oxide on water, 
whereby a hydroxide is formed, as potassium hydroxide, KOH. A hydroxide 
is a compound in which an atom of an element is combined with one or more 
groups of hydroxyl (—OH). Being a radicle, hydroxyl can not exist by itself. 
When combined as a hydroxide it may be regarded as water in which one of 
the hydrogen atoms has been replaced by another element. Hydroxides are 
regarded as binary compounds, since the group (—OH) acts much the same 
as a univalent element. Hydrqxides must not be confused with hydrates. 
The latter are additive compounds of one or more whole molecules of water 
with a molecule of some other compound, such as, for instance, terpin hydrate 
(Ci0H2o02.H20). 
When acids are mixed with bases mutual arrangements of the compositions 
of these substances take place, and the products of this interaction between 
acids and bases are known as salts. This term should not be confused with 
the common name of sodium chloride, “salt.” 
Salts are compounds formed when all or a part of the replaceable hydrogen 
in an acid has been replaced by a positive element. There are four kinds of 
salts, classified according to the amounts of the acids and bases entering into 
the reaction, and are known as normal or neutral, acid or mixed, double, and 
basic or oxy or sub. 
'Normal salts are those in which all the replaceable hydrogen of an acid 
has been replaced by a metal or base, as in calcium sulphate (CaS04). 
Acid salts are those in which the amount of the base is not sufficient to 
allow complete reaction and only a part of the replaceable hydrogen of the 
acid can be replaced by a metal or base, as sodium acid sulphate (NaHSO*). 
Because of the presence of this unreplaceable hydrogen, acid salts are named 
as above, and tbeir formulas always contain an H. They also are designated 
as hydrogen salts or, instead of using the word acid or hydrogen in their names, 
the prefix “ bi ” may be used, and when so used always denotes an acid salt. 
Its use in any other kind of compound is incorrect, and therefore should 
never be used in place of the Greek numeral “ di ” to indicate a double 
quantity. Bichloride of mercury is an example of the incorrect use of this 
word. Sodium acid sulphate, then, correctly may be called by that name 
or sodium hydrogen sulphate or sodium bisulphate. 
Double salts are those in which the hydrogen of an acid has been re- 
placed by two or more elements, as in sodium and potassium sulphate, NaKSCh, 
or by an element and a radicle, as in sodium ammonium sulphate, NaNH4S04. 
Basic salts are those which contain more base than is required to form a 
normal salt. Their structure is generally somewhat complicated. They are 372 
HOSPITAL CORPS HANDBOOK. 
regarded generally as being ’ formed when there is not enough acid present 
to neutralize the base. An example of a basic salt is bismuth subnitrate or, 
as it is sometimes called, bismuth oxynitrate. This basic salt is prepared by the 
decomposition of bismuth nitrate in a large quantity of water according to 
the following reaction: 
Bi(N03)3 + 2II20 —> Bi0(N03).H20 + 2HN03 
Bismuth nitrate Water gives Bismuth subnitrate Nitric acid 
In the reaction shown above it might seem that there was sufficient nitric 
acid present to neutralize the base (a metal in this case) but immediately 
water is added to the normal salt (bismuth nitrate), two of the acid anhy- 
drides (N03) in it combine with two of the hydrogen atoms in the water 
to form nitric acid, so it can be seen that there is not enough acid (NO.i) 
present in bismuth subnitrate to neutralize the base, the base bismuth having 
a valency of 3 while the valency of the acid anhydride is but 1. 
Just as the acids are named from the anhydrides from which they are 
derived, so, too, are salts named from the acid which produces them, by nam- 
ing the first or basic part of the salt just as described for the basic part of 
binary salts and dropping the ending of the names of the acid and substitut- 
ing other endings. Since the salt of a binary acid is itself a binary compound 
its name must end in “ ide ” so that from a reaction of zinc and hydrochloric 
acid would be obtained zinc chloride. The names of all ternary acids, as 
has been learned, end either in “ ous ” or “ ic ” and the names of the salts 
from these acids end in “ ite ” or “ ate ” respectively. In all salts, except 
binaries, any prefix the acid may have had is carried over and incorporated 
in the name of the salt. Thus it may be said that “ ous ” acids produce 
“ ite ” salts, “ ic ” acids produce “ ate ” salts, “ per-ic ” acids produce “ per- 
ate ” salts, “ hypo-ous ” acids produce “ hypo-ite ” salts, and “ meta-ic ” acids 
produce “ meta-ate ” salts. Similarly, any other prefix the name of a specific 
acid may have is inherited by any salt it may produce, as, for instance, 
pyrophosphoric acid produces pyrophosphates. 
All rules are tested by the exceptions thereto, and it must not be inferred 
from anything that has been said, or from anything which follows, that in 
all instances the facts will adhere rigidly to the theory laid down. The 
scheme of nomenclature for acids and salts herein described is conceived as 
the one most nearly fitting all cases. It is purely theoretical and conceives 
that all acids are formed from their respective anhydrides, as described above, 
and further, that all salts are derived directly through the action of an acid 
on a positive element, or upon an oxide or hydroxide of a positive element 
(bases). 
For the reason that ternary acids are produced from binary compounds and 
all other ternary compounds in turn are derived from the acids, and in order 
to determine the formula of any salt, it is necessary that the formula of 
every acid listed in Table III be committed to memory. Just as it is impor- 
tant to know the valencies of the different elements before it is possible to 
accurately write the correct formula for any acids, so it is important to know 
these formulas before it will be possible to write the formula of any com- 
pound (salt) derived from them. 
GENERAL CONSIDERATION OE THE ELEMENTS. 
Having considered many of the general principles of chemistry and something 
of the relation between the sciences of physics and chemistry, it is but fitting 
that elements themselves should be discussed. CHEMISTRY. 
373 
The definition and number of elements and many of their qualities have been 
given and will not be repeated now. As has been explained before, there are 
but comparatively few of the total number of known elements that are of any 
great importance. The greater part of the solid portion of the earth, of animal 
and vegetable matter, and water and the air are composed of these few ele- 
ments—about 20 in number. To show how important are these few elements 
the following examples are given: 
(a) It has been estimated that approximately 8 elements make up the crust 
of the earth, and of these oxygen forms nearly 48 per cent. 
(b) About eight-ninths of the water (by weight) is oxygen. 
(c) By volume air consists of almost one-fifth oxygen and four-fifths nitrogen. 
(d) The principal element entering into the structure of living things is 
carbon. 
(e) Hydrogen, oxygen, and nitrogen are essential constituents of animal and 
vegetable life. 
To simplify the study of the elements, it has been found desirable and 
convenient to group them into classes or families according to the similarity of 
their general chemical properties. In this way knowledge of one element affords 
an indication of the characteristics of the others in the same class, as often the 
members of the same family show striking resemblances to one another. Some 
of these families, with the family name and members, are as follows: 
Family. 
Chlorine. 
Sulphur. 
Calcium. 
Calcium. 
Strontium. 
Barium. 
1 Bromine 
Selenium 
In addition to this arrangement in family groups another natural classifica- 
tion of the elements divides them into metals and nonmetals, or metalloids, as 
the latter are sometimes called. 
Such elements as possess what is known as metallic luster, are good conduc- 
tors of electricity and heat, form bases when combined with oxygen, and are 
capable of replacing all or part of the hydrogen in acids, are classed as metals. 
Elements which do not have the above properties and whose physical and 
chemical properties are entirely different from those of the metals are classed 
as nonmetals, although the oxides of these elements when in combination with 
water may have acid properties, and in this one respect somewhat resemble the 
metals. 
In the discussion of physical properties of matter it was explained that it 
exists in three forms—solid, liquid, and gaseous. Elements, being elementary 
matter, also have physical properties, and in the consideration of these physical 
properties it is found that there are solid, liquid, and gaseous elements. At 
ordinary temperature the majority of elements are solid substances, two are 
liquid (bromine and mercury), and many are gases. Five of the elements 
found in the latter form, and among the most important, are hydrogen, oxygen, 
nitrogen, chlorine, and fluorine. 
Most, if not all, of the solid elements are found in various forms having 
names descriptive of these peculiarly characteristic arrangements. Thus there 
are solids in the crystalline form, the shape of the crystals showing perfect 374 
HOSPITAL CORPS HANDBOOK. 
geometrical figures and differing in each substance which is crystallizable; 
solids known as isomorphous having the same general formation, as all the 
alums; solids termed amorphous having no definite or distinctive formation, 
such as red iodide of mercury; and solids called dimorphous or polymorphous 
which appear respectively in two or more different forms, as carbon, sulphur, 
etc. Tiie assumption of such different forms by elements is called allotropy 
and the different forms are spoken of as allotropic modifications. 
A few of the gaseous elements also are capable of existing in more than one 
form, as oxygen, an allotropic modification of which is ozone. 
A few of the elements have a distinctive odor or taste, as chlorine, iodine, 
and bromine, but most do not. 
In studying the nonmetals the facts concerning them generally considered 
are: 
(a) Symbols, atomic weights, and derivation of names. 
(ft) State of aggregation, as solid, liquid, or gaseous, and valencies. 
(c) Occurrence in nature, as in a free or combined state or in combination 
only. 
(d) Time of discovery and history; sources. 
(e) Preparation and properties. 
For the metals the facts generally considered are: 
(a) Symbols, atomic weights, and derivation of names. 
(ft) Melting points, specific gravities, and valencies. 
(c) Occurrence in nature, as in a free or combined state or in combination 
only. 
(d) Time of discovery and history; sources. 
(e) Classification, as light metals (earth metals, alkaline earth metals, and 
alkali metals) and heavy metals (arsenic group, lead group, and iron group). 
(f) Properties, manufacture and alloys. 
Most of the elements known as metals have a white, grayish, bluish white, 
or dark gray color, but a few other colors are known, as red (copper) or yellow 
(gold). 
All metals are fusible, and some are so volatile that they can be distilled. 
Some metals (as iron) will lose their metallic luster when exposed to the air 
and even burn if heated to a high enough degree, while others retain it. 
Metals whose oxides are decomposed into oxygen and the respective metal 
by the application of heat alone are termed noble metals (gold, silver, mercury, 
and platinum are examples), the others base metals. 
Among the classification of metals given above appear alkalies and alkaline 
earths. An alkali is described chemically as any substance having marked basic 
properties, and characterized by the taste peculiar to them and their power to 
form salts with acids and turn red litmus paper to blue. They all are of soft 
wax-like consistence, oxidize in the air, and energetically decompose water. 
The stronger alkalies are caustic and react with fats and oils to form soaps 
and of all the metals are the only ones whose hydroxides and carbonates are 
not decomposed by heat. An earth, in chemistry, is a metallic oxide difficult 
to reduce, and these substances once were classed as elements. Alkaline earths 
are substances named as such because their properties are intermediate be- 
tween alkalies and earths, while resembling both, and usually are the oxides 
of barium, calcium, and strontium. They have a distinct luster and are white 
or yellow in color; and though they decompose water, it is done much more CHEMISTRY. 
375 
slowly than by the alkalies. A characteristic of the alkaline earths to be 
remembered is the insolubility of their carbonates, sulphates, and phosphates. 
The addition of oxygen to an element to form a different substance is 
oxidation, and the removal of oxygen from a compound is reduction. Sub- 
stances which introduce oxygen into an element are known as oxidizing agents, 
and examples are nitric acid and potassium permanganate, these substances 
as well as others freely giving up their oxygen to combine with other elements. 
An example of a reducing agent, a substance capable of abstracting oxygen 
from a compound, is hydrogen, which, as is well known, easily combines with 
oxygen to form water. 
LAWS AND THEORIES. 
In studying the various elements which unite with each other to form 
more than one compound it has been found that “ if two elements, A and B, 
are capable of uniting in several proportions, the quantities of B which com- 
bine with a fixed quantity of A bear a simple ratio to each other” This is 
known as the law of multiple proportions, or Dalton’s law, and, stated more 
simply, means that if two elements, “A” and “ B,” can unite with each other 
to form two or more compounds, as “ AB ” and “ AB2,” the weights of “ B ” in 
“AB ” and in “AB2 ” bear a simple relationship to each other. 
The general principles of both the atomic and the molecular theories have 
been explained, hut it is well to state here that a theory differs from a law. 
While a law is a general summing up of facts actually proven, a theory is 
only a presumption that certain things are true, based probably upon strong 
circumstantial evidence, hut upon no actual, concrete, proven facts. It has 
never been possible to divide a portion of a compound so minutely as to be 
able to isolate or see a single molecule nor, obviously, to reduce a single 
molecule to its component atoms. Yet chemists believe that some such par- 
ticles do exist, and that they behave as has been explained before. A Portugese 
chemist, Avogadro, is considered as the father of the molecular theory, for, 
while engaged in studying atomic and combining weights, he advanced the 
theory of double atoms, or molecules, as an explanation for the action of 
certain gases that could not be accounted for solely by the atomic theory. 
In this connection Avogadro enunciated the hypothesis, or law as it usually 
is known, which bears his name: “ Equal volumes of gases under the same 
conditions always contain the same number of molecules,” and he explained 
that a molecule was a combination of two or more atoms. If this hypothesis 
be correct, and it is so regarded, then at any given temperature and pressure 
a liter of any pure gas will contain exactly’ the same number of molecules 
as a liter of any other pure gas contains under the same conditions; no more, 
no less. It has been determined by careful experiments that 2.016 grams of 
hydrogen (its molecular weight expressed as grams) will have a volume of 
22.38 liters if measured under standard conditions; that is, at a temperature 
of 0° C. and a barometric pressure of 760 mm. If equal volumes of gases 
contain equal numbers of molecules under the same conditions, and if there 
is a definite relationship between the weights of all atoms and molecules, it 
follows then that there must be a definite relationship between the molecular 
volumes of all gases. Briefly stated, and for the reasons set forth above, it 
is known that the molecular weight of any pure gas, when expressed in grams, 376 
HOSPITAL CORPS HANDBOOK. 
will, under standard conditions, have a volume of 22.38 liters. An illustration 
may help—thus: 
Gas. 
Formula. 
Molecular 
weight. 
Molecular 
volume. 
Cl2 
71 
L. 
22.38 
HC1 
36.5 
22.38 
C02 
44 
22. 38 
N2O5 
94 
22.38 
This factor of molecular volume is useful in calculating the volume of any 
gas that may he formed in a given reaction. Thus, referring to a problem 
previously stated wherein the weight of sulphuric acid was sought, consider 
that the volume of HCl also was required. The molecular weight of HC1 is 
36.5 and the volume sought is that of 1,125 grams of that acid. Therefore: 
36.5 : 1125 :: 22.38: x 
in which x will equal 689.7+liters. It rarely occurs, however, that standard 
conditions obtain either when the reaction takes place or when the gas is 
measured, so that the volume of the gas must be adjusted to the conditions 
that actually exist at the time. Boyle's law states that the volume of a gas 
varies inversely as the pressure and directly as the temperature. If a cork is 
pressed it shrinks in size, and the same thing is true of gases, whether the 
pressure be mechanical or due to atmospheric conditions, and furthermore its 
shrinkage is in direct ratio to the increase of pressure; thus 100 c. c. of a gas 
at a pressure of one atmosphere (760 mm.) would shrink to 50 c. c. when 
subjected to a pressure of two atmospheres (1.520 mm.), thus: 
760:1520:: 50: 100. 
It is apparent that the volume decreases as the pressure increases. 
For corrections due to changes in temperature Charles' law states that a gas 
not only increases or decreases in volume, according as the temperature is 
increased or decreased, but it does so in a regular progression, which is the 
same in all cases. This expansion or shrinkage amounts to 1/273 of the volume 
of gas at 0° C. (1/493 for each degree F.). If 1 c. c. of gas, measured at 0° C., 
was cooled through all the successive degrees below 0° C. it would, according 
to this law, completely disappear, at —273° C. The latter is, therefore, desig- 
nated as absolute zero. Absolute zero has never been reached, but in experi- 
ments with helium it has been closely approached. Volumes of gases may be 
adjusted for temperature also through the use of a statement in proportion. 
Thus, assume that the 100 c. c. of gas, alluded to above, were measured at 0° C. 
and again at 15° C.; then: 
273 .-273+15:: 100 :x 
in which x will equal 109.15, the volume of gas at 15° O. 
Of interest, but not of great importance at this point, are the law of Gay 
Lussac and the law of Henry. Gay Lussac’s laiv states that when two or more CHEMISTRY. 
377 
gaseous constituents combine chemically and the product so produced is also 
a gas, the combined volumes of the original gases bear a simple relation to the 
volume of the product. Henry’s law has to do with solution of gases and states 
that the quantity of a gas dissolved by a given quantity of a liquid is propor- 
tional to the pressure of the gas. 
Another law, relative to the effects of light, heat, etc., as well as other fac- 
tors, in reactions, is known as the law of chemical and physical equilibrium. 
When chemical or physical equilibrium exists, and one of the factors upon 
which it depends is altered, a change is produced which opposes the first equi- 
librium. Thus, hydrogen and chlorine may be mixed at a low temperature in 
the dark and no change or reaction will take place, but if the temperature is 
raised or sunlight admitted the two will unite with explosive violence. 
ACIDIMETRY AND ALKALIMETRY. 
For the benefit more especially of those having some knowledge of chemistry 
and whose work may require the use of test solutions and indicators and a 
knowledge of the methods used in calculating the results obtained the following 
brief discussion of these advanced chemical procedures is given. 
An alkali is an oxide or hydroxide of an alkali metal. The alkali metals 
are lithium, sodium, potassium, rubidium, and caesium. These alkalies and 
certain other oxides and hydroxides of the alkaline earths, particularly those 
of calcium, and also ammonium hydroxide, are used in acidimetry and alka- 
limetry. It has been learned that the compounds named above neutralize 
acid to form salts and definite weights of each are involved. Therefore by 
the use of a solution of known strength of either an acid or an alkali, and 
being provided with the means of determining just when absolute neutraliza- 
tion is effected it follows that the strength of either may be readily ascertained. 
The means of determining the point of neutralization generally is by the use of 
a solution known as an indicator. Indicators lose or change color in the 
presence of certain acids or alkalies, and by noting such loss or change the 
exact point of neutralization easily is determined. 
Ordinarily the testing solution is placed in a long, cylindrical, graduated 
glass container known as a burette, which is provided with a stopcock and 
small orifice so that the liquid may be let out by drops. A sample of the 
liquid to be tested is placed in a glass beaker directly beneath the burette and 
a few drops of the proper indicator added thereto. The testing solution 
then is allowed to drop into the latter liquid drop by drop until the color of 
the indicator is lost or changed, depending upon the nature of the specific 
solution used. This operation is known as titration. When neutralization 
has been effected, a reading is made from the burette and the amount of 
testing solution used is noted. The reacting weights of the compounds in- 
volved are calculated, and then by proportion, as explained before, the amount 
of active substance in the volume of the solution actually tested is ascertained, 
from which it is simple to 'calculate either the percentage strength or the 
actual amount of substance contained in any volume of the solution. 
The testing solutions generally used for the purposes described above are 
known as volumetric solutions, and they are prepared in such a manner as to 378 
HOSPITAL CORPS HANDBOOK. 
contain in 1 liter a definite weight of replaceable hydrogen or its equivalent. A 
N 
normal volumetric solution contains 1 gram of replaceable hydrogen or 
its equivalent to a liter. A tenth-normal volumetric solution ( is 1/10 the 
strength of a normal volumetric solution—that is, it contains 1/10 of a gram 
of replaceable hydrogen or its equivalent to a liter. A hundredth-normal 
N 
volumetric solution (jqqVS) is 1/100 the strength of a normal volumetric solu- 
2N 
tion, and a double-normal volumetric solution (— YS) is twice the strength of 
a normal volumetric solution, etc. 
To prepare a normal volumetric solution of an acid, as 1 gram of replaceable 
hydrogen is required for each liter of finished solution, it follows that in the 
case of unibasic acids, such as hydrochloric acid, by taking tbe molecular weight 
of the acid expressed in grams and dissolving in enough water to make a liter 
(1,000 c. c.), the required amount of hydrogen will be secured. Sulphuric acid 
is a dibasic acid and its molecular weight is 98. As it contains two hydrogen 
atoms to a molecule, there are 2 grams of replaceable hydrogen in every 98 
grams of acid; therefore one-half of its molecular weight, expressed in grams, 
would be used, as is also true of all other dibasic acids. For tribasic acids 
one-tliird of the molecular weight, expressed in grams, would be used. To make 
a volumetric solution other than a normal one the amount required for a normal 
solution first is ascertained and then adjusted for the strength desired. It is 
obvious that specific gravity, purity, etc., are factors that must be taken into 
consideration in preparing the solution. 
Calculation following titration.—A solution of 1,000 c. c. of KOH is to be 
tested to determine the amount of KOH contained in it by titration with 
N 
of HC1. One thousand c. c. of such a VS would contain 3.65 grams of HC1, 
and 10 c. c., the amount that would be used, would contain 0.0365 gram. To this 
10 c. c., contained in a beaker, a few drops of a 1 per cent alcoholic solution of 
phenolphthalein is added and the solution placed below the burette containing 
tbe KOH solution, which then is allowed to drop into the solution of HC1. 
When, for example, 2 c. c. of the KOH solution has run into the acid, the color 
of the latter suddenly develops a faint pinkish tint that does not disappear 
when the beaker is shaken, indicating that the acid is neutralized. The titra- 
tion then is stopped. HC1 and KOH react as follows: 
56 36.5 74.5 18 
K0H+HC1=KC1+H,0 
Since 36.5 grams of HC1 will neutralize 56 grams of KOH, then: 
36.5 : 56:: .0365 : x 
x=.056 
Since 2 c. c. of the KOH solution tested contained 0.056 gram of KOH, 1,000 c. c. 
would contain 28 grams of KOH. This problem might be reversed and the 
amount of absolute HC1 in a given volume determined by titrating against a 
VS of KOH. 
References. 
Manual of Chemistry.—Simon. 
Pharmaceutical and Medical Chemistry.—Sadtler and Coblentz. 
Compend of Medical Chemistry.—Leffmann. 
Introduction to the Study of Chemistry.—Remsen. 
Outlines of Chemistry.—Kahlenberg. CHEMISTRY, 
379 
TABLE I. 
Table of Elements and Their Atomic Weights. 
FAdopted by the International Committee on Atomic Weights in 1915. (0=16.) Latin names in paren- 
theses.] 
Name. 
Symbol. 
Atomic 
weight. 
Name. 
Symbol. 
Atomic 
weight. 
A1 
27.1 
Molybdenum 
Mo 
96.0 
Sb 
120.2 
Nd 
144.3 
A. 
39.88 
Neon". 
Ne 
20.2 
74.96 
Nickel 
Ni 
58.68 
Ba 
137.37 
Niton (Radium emanation).. 
Nt 
222.4 
Bi. 
208.0 
Nitrogen 
N 
14.01 
B 
11.0 
Osmium 
Os 
190.9 
Br.. . 
79.92 
Oxygen 
O 
16.0 
Cd 
112.4 
Palladium 
Pd 
106.7 
Cs 
132.81 
Phosphorus 
P 
31.04 
Ca 
40.07 
Platinum 
Pt 
195.2 
C 
12.0 
Potassium (Kalium) 
K 
39.1 
Ce 
140.25 
Pr 
140.6 
Cl 
35.46 
Radium 
Ra 
226.4 
Cr... 
52.0 
Rhodium 
Rh 
102.9 
58.97 
Rubidium 
Rb 
85.45 
Cb. 
93.5 
Ruthenium 
Ru 
101.7 
Cu 
63.57 
Samarium 
Sa 
150.4 
Dy.. 
162.5 
Scandium 
Sc 
44.1 
Er 
167.7 
Selenium 
Se 
79.2 
Eu ... 
152.0 
Silicon 
Si 
28.3 
F 
19.0 
Silver (Argentum) 
Ag 
107.88 
Gd 
157.3 
Sodium (Natrium) 
Na 
23.0 
Ga 
69.9 
Strontium 
Sr 
87.63 
Ge . . 
72.5 
Sulphur 
S 
32.07 
Gl.. 
9.1 
Tantalum 
Ta 
181.5 
197.2 
Tellurium 
To 
127.5 
He.. 
3.99 
Terbium 
Tb 
159.2 
Ho 
163.5 
Thallium 
T1 
204.0 
H .. 
1.008 
Thorium 
Th 
232.4 
In 
114.8 
Thulium 
Tm 
168. 5 
I 
126.92 
Tin (Stannum) 
Sn 
119.0 
Ir 
193.1 
Titanium 
Ti 
48.1 
Fe 
55.84 
Tungsten ( Wolfram) 
W 
184.0 
82.92 
Uranium 
U 
238.5 
La. 
139.0 
V 
51.0 
Pb 
207.1 
Xe 
130.2 
Li 
6.94 
Y tterbium (Neoytterbium)... 
Yb 
172.0 
174.0 
Yt 
89.0 
24.32 
Zinc 
Zn 
65.37 
Manganese 
Mercury (Hydrargyrum) 
Mn 
Hg 
54.93 
200.6 
Zirconium 
Zr 
90.6 
* Also called Niobium, Nb. t Also called Beryllium, Be, t Also called Didymium, Di. 
TABLE II. 
Positive Elements. 
Base formers. 
Valence I. 
Valence II. 
Valence III. 
Valence I and 
II. 
Valence II and 
III. 
Valence III and 
IV. 
Ag 
Ba 
Alt 
Cu 
Fe 
Pt 
K 
Ca 
Bi 
Hg 
Sn 
Li 
Mg 
Na 
Ni 
Pb 
Znf 
t Aluminium and zinc, in a few cases, act as negatives, occurring in compounds as 
the “ characteristic ” element in the radicle, forming aluminates and zincates, 380 
HOSPITAL CORPS HANDBOOK. 
Negative Elements. 
Acid formers. 
Valence I. 
Valence II. 
Valence III and 
V. 
Valence IV. 
Valence I, III, 
V, and VII. 
Valence II IV, 
and VI. 
F 
0 
AsJ 
C 
Br 
Mnf 
II* 
N 
Si 
Cl 
s§ 
P 
I 
SbJ 
Groups or Radicles. 
Positive; Valence I. 
Negative; Valence I. 
Ammonium, NH(— 
Hydroxyl, 
Cyanogen, 
—OH Forms hydroxides. 
—CN Forms cyanides. 
* Hydrogen is a positive element but is classed here with the negative group for 
the reason that it is the one element that is present in all acids and because it is not 
a base-forming element. 
I Manganese, arsenic, and antimony act as weak bases under some conditions. 
§ In some compounds sulphur seems to have a valence of VIII. 
Ammonium.—The positive radicle ammonium, —NH4, can not exist by itself. 
When ammonia gas, NH3, is dissolved in water a molecule of each unite to form 
ammonium hydroxide, NH4OH. Chemically, ammonia is nitrogen trihydride, 
and as such the nitrogen must have a valence of III. When brought in contact 
with water the nitrogen is considered to be oxidized to its maximum valence, V, 
with which it can hold the four hydrogen atoms and one hydroxyl group. This 
hydroxyl group can be exchanged for other radicles similarly, as though it were 
attached to a single positive element. The formation of ammonium hydroxide 
is shown graphically: 
NO-NT 
NH3 H20 NH4(OH) 
Ammonia gas Water Ammonium hydroxide 
Hydroxyl.—The univalent radicle OH, consisting of one atom of hydrogen 
and oxygen. It can not exist by itself, and is a characteristic part of bases, 
alcohols, oxyacids, etc. 
Cyanogen.—Cyanogen is an organic compound whose formula is C2N2. It 
can combine with a molecule of hydrogen to form HCN, thus H2+C2N2=H2CaNs 
or 2HCN. The group—CN resembles a monovalent element in its actions, and 
salts containing the group therefore are classed as binaries. CHEMISTRY. 
381 
TABLE III. 
Inorganic Acids. 
Binary or hydraeids. 
Name. 
Formula. 
Name. 
Formula. 
1 
Name. 
Formula. 
Hydrobromic 
Hydrochloric 
HBr 
HC1 
Hydrocyanic 
Hydrofluoric 
HCN 
HF 
Hydriodic 
Hydrosulphuric 
HI 
H2S 
These acids form salts whose names terminate in the ending ide and the prefix 
hydro is not used in naming the salt. Thus hydrochloric acid produces chlorides 
and hydrosulphuric acid produces sulphides. 
Ternary or oxyaeids. 
Name. 
Formula. 
Name. 
Formula. 
Name. 
Formula. 
HBrOs 
Perchloric 
HCIO4 
Pyrosulphuric 
H-SjOr 
HBr02 
HClOs 
Sulphuric 
H2SO4 
TTP.rO 
HCIO2 
H^AsO-t 
HC10 
H-SOs 
H?As03 
HIO, 
Hyposulphurous...... 
H2SO2 
H^BiO? 
HNO3 
H4P2O7 
HN02 
h3p‘o4 
HBO2 
HiSi04 
HPOs 
HjMnsOg 
H»Si03 
H3P63 
H2M11O4 
Chromic 
H^CrOi 
H3PO2 
H-)C02 
H2S208 
HCNO 
Salts formed by these acids are named as follows: Acids whose names end 
in ic produce salts whose names end in ate; acids whose names end in ous pro- 
duce salts whose names end in ite and any prefix occurring in the name of the 
acid before the part referring to the “ characteristic ” element also is used in 
the name of the salt. Thus sulphuric acid produces sulphates, sulphurous acid 
produces sulphites, and persulphurie acid produces persulpliates. 
Some of these acids may not actually exist and some are so unstable that 
their actual use, outside a laboratory, would he impracticable, but salts of all 
of them are existent. 
The formulas shown above are molecular formulas in that they express the 
content, qualitatively and quantitatively, of a molecule. CHAPTER VII. 
PHARMACY.1 
Pharmacy is the science which treats of medicinal substances and includes, 
in addition to the art of preparing and dispensing them, their identification, 
selection, preservation, combination, and analysis. It is also the name of a 
place where medicines are sold, a drug store. Pharmacy is divided into two 
great classes—theoretical and practical. 
Theoretical pharmacy embraces those sciences which treat of the substances 
used as medicines that are obtained from the vegetable, mineral, and animal 
kingdoms, as well as the laws governing them. In the study of pharmacy a 
knowledge of several other sciences is necessary and these are: 
Botany, the science or study of plants. 
Mineralogy, the science of inorganic substances found in and on the earth. 
Zoology, the science which treats of animals. 
Physics, the science which describes and explains the changes produced in 
bodies by which their original identity is not destroyed. 
Chemistry, the science which treats of those changes which alter the original 
identity of bodies. 
Materia medica, the science which treats of the medicinal substances that 
are used in the treatment of diseases. 
Posology, the science of dosage. 
Pharmacognosy, the science which treats of crude drugs. 
Toxicology, the science which treats of poisons. 
Bacteriology, the science which treats of microorganisms. 
Practical pharmacy is that branch of pharmacy which treats of the opera- 
tions, processes, and methods used in applying the principles of theoretical 
pharmacy. 
PHARMACOPOEIAS, DISPENSATORIES, AND THE NATIONAL 
FORMULARY. 
A pharmacopoeia is an authoritative list of medicinal substances, with defini- 
tions and descriptions or formulas for their preparation. All civilized nations 
recognize the necessity for authoritative standards defining the character, 
establishing the purity, and regulating the strength of medicines. Some coun- 
tries have no pharmacopoeia of their own and usually adopt those of other 
countries or supply standard pharmaceutical works for the same purpose. The 
General Government and those of the several States accept the United States 
Pharmacopoeia, which is issued under the authority of the Government, as 
authoritative. It is revised every 10 years by a committee appointed from the 
professions of medicine and pharmacy. 
The titles of the medicinal substances are indicated in the United States 
Pharmacopoeia by— 
(1) The official Latin title. Example: Ceratum resince. 
(2) The official English title. Example: Rosin cerate. 
(3) The synonym. Example: Basilicon ointment. 
1 Prepared by Chief Pharmacist L. W. Rider, United States Navy. 
383 384 
HOSPITAL CORPS HANDBOOK. 
(4) The botanical name (in the case of plants). Example: Acacia Senegal. 
(5) The symbolic formula (in the case of chemicals). Example: KC103. 
The official Latin title is used in designating the drug when precision is 
required. Because it is a dead language and not liable to change, the Latin 
language was chosen. The official English title is employed in ordinary conver- 
sation and commercial transactions. Synonyms are usually from old and unsci- 
entific sources, but long usage prevents their being entirely ignored. The 
botanical name is that which is recognized by botanists for plants and serves 
as the base of the official name. An example is Capsicum fastigiatum, the 
botanical name for cayenne pepper, capsicum indicating the genus and fas- 
tigiatum the species to which the plant belongs. To establish the identity of 
vegetable drugs, it is absolutely necessary to use the botanical name. 
A symbolic formula is a combination of chemical symbols representing briefly 
and exactly the structure of the article to which they refer. Examples: 
HC1; H«SO«; HN03. 
A rule known as the purity rubric was introduced into the United States 
Pharmacopoeia to limit the quantity of harmless impurities in chemicals and 
of foreign matter in vegetable drugs. It might seem that chemicals should 
he always 100 per cent pure, but practical experience has shown that absolute 
purity can not be had without greatly increasing the cost of the article, and 
the presence of very small quantities of harmless impurities does not affect 
their medicinal value. Foreign matter in vegetable drugs usually refers to 
foreign substances whose presence or admixture is excluded, but in some cases 
refers to the roots, stems, or seeds of the same plant from which the drug is 
obtained. 
The doses used in the United States Pharmacopoeia give the average approxi- 
mate dose for adults in the metric system and the equivalent in ordinary 
weights and measures. It should be remembered that it is only the average 
dose wffiich is given. 
Dispensatories furnish comments on the drugs and chemical substances 
described in the United States Pharmacopoeia and give their physical, medical, 
and pharmaceutical histories as well as their doses and uses. In them is pre- 
sented information concerning important nonofficial drugs and official drugs in 
other pharmacopoeias. Two of the principal dispensatories are the United 
States Dispensatory and the National Dispensatory. 
The National Formulary is prepared by a committee appointed by the Amer- 
ican Pharmaceutical Association, and is a legal standard, as the Pure Food 
and Drugs Act directs that the standard for drugs and preparations therein 
shall be employed in enforcing the several statutes. It contains reliable rec- 
ipes for well-known pharmaceuticals, and also provides a standard for all 
drugs used in making preparations when such ingredients are not recognized 
by the United States Pharmacopoeia. 
METROLOGY. 
Metrology is the study of measures of extension, volume, weight, and the 
relation of these to each other. The word is derived from Greek words mean- 
ing measure and discourse. 
Weight is defined as the difference between the attraction of the earth and 
that of surrounding bodies for bodies on the surface of the earth. The weight 
of a body depends upon its bulk and density, density being the amount of 
matter in a given bulk of the body. PHARMACY. 
385 
Weighing is the balancing of a body of known gravitating force with one 
whose gravity is not known to estimate the gravitating force of the latter, 
which is called its weight. 
Weights are bodies of known gravitating force used for weighing. The ap- 
paratus used for weighing are scales and weights. Weights are based upon 
standards known as the grain and the meter. 
The grain weight was established by an act of Henry III of England in 1266, 
who decreed that “An English silver penny, called the sterling, round and with- 
out clipping, shall weigh 32 grains of wheat, well dried and gathered out of 
the middle of the ear.” 
The metric system, often called the French or decimal system, originated 
with Prince de Talleyrand, Bishop of Autun, France, in 1790, and is now used 
legally by most of the civilized nations of the world. Even in countries where 
its use is not compulsory, as the United States, it finds especial favor with 
scientists in their technical work. 
The basis of this system is the unit of length, the meter, which is about one 
forty-millionth part of the circumference of the earth around its poles and 
is equivalent to 39.37 inches. From the meter the units of capacity and 
weight are derived, the former being the liter which is the cube of one-tenth 
part of a meter, and the latter the gram which is the weight of that quantity of 
distilled water at 4° C.2 which will fill the cube of one one-liundredth part of a 
meter. The denominations of this system are multiplied by the Greek words: 
Deka, meaning ten; hecto, meaning hundred; and kilo, meaning thousand, and 
are divided by the Latin words: Deci, meaning one-tenth; centi, meaning one- 
hundredth ; and milli, meaning one-thousandth. 
The weights and measures in general use in this country are avoirdupois, 
used in commercial buying and selling; troy, used by jewelers; apothecaries, 
used by pharmacists in compounding; and the metric system. 
English System. Metric Equivalent. 
Avoirdupois weight: 
1 gram gram.. 0.065 
4.37.5 grains make 1 ounce (oz.) grams.. 28.35 
16 ounces make 1 pound (lb.) do 453.60 
100 pounds make 1 hundredweight (cwt.). 
20 hundredweight make 1 ton. 
Apothecaries’ weight: 
1 grain gram.. 0.065 
20 grains make 1 scruple O) grams.. 1.30 
3 scruples make 1 dram 13) do 3.90 
8 drams make 1 ounce (5) : do 31.103 
12 ounces make 1 pound do..:. 373.236 
Troy weight: 
1 grain gram.. 0.065 
24 grains make 1 pennyweight (dwt.) grams.. 1.555 
20 pennyweights make 1 ounce do 31.103 
12 ounces make 1 pound do 373.236 
Apothecaries measure: 
1 minim (0.95grain) (TT|) c. c.. 0.06 
60 minims make 1 fluid dram (f 3) do 3. 70 
8 fluid drams make 1 fluid ounce (f 3) do 29. 57 
16 fluid ounces make 1 pint (O) do 475.18 
8 pints make 1 gallon 3 (Cong.) do 3,785.40 
Linear measure: 
linch millimeters.. 25.4 
12 inches make 1 foot centimeters.. 30.48 
3 feet make 1 yard meter.. 0.914 
5.5 yards make 1 rod (or perch). 
40 rods make 1 furlong. 
8 furlongs make 1 mile do 1,609.35 
TABLES OE WEIGHTS AND MEASURES. 
2 This degree is specified as the temperature at which 1 c. c. of distilled water shall 
weigh 1 gram because at that temperature water has its maximum density; a given 
volume of water being lighter either above or below that temperature. 
31 gallon contains 231 cubic inches, and 1 fluid ounce of distilled water weighs 454.6 
grains at 25° C. 386 
HOSPITAL CORPS HANDBOOK. 
Metric System. English Equivalent. 
Length: 
Kilometer, 1,000 meters mile.. f 
Hectometer, 100 meters. 
Decameter, 10 meters. 
Meter (unit) inches.. 39.37 
Decimeter, one-tenth meter do 3.937 
Centimeter, one-hundredth meter do f 
Millimeter, one-thousandth meter do & 
Capacity: 
Kiloliter, 1,000 liters. 
Hectoliter, 100 liters. 
Decaliter, lOliters. 
Liter (unit), cube of one-tenth meter fluid ounces.. 33.814 
Deciliter, one-tenth liter do 3.3811 
Centiliter, one-hundredth liter fluid ounces.. 4 
Milliliter, one-thousandth liter (c. c.) minims.. 16.23 
Weight: 
Kilogram, l.MOgram, &8&S&&: gg 
Hectogram, 100 grams. 
Decagram, 10 grams. 
Gram (unit) grains.. 15.432 
Decigram, one-tenth gram do 1.5 
Centigram, one-hundredth gram do I 
Milligram, one-thousandth gram do 
Approximate measures: 
Apothecaries. Metric. 
A tumblerful f 5 viii -.. 240 c. c. 
A teacupful fgiv 120 c.c. 
A wineglassful f3ii 60 c. e. 
A tablespoonful... f3iv 16 c.c 
A dessertspoonful f 3 ii 8 c.c. 
Ateaspoonful f§i 4 c. c. 
To convert metric weights or measures into those in ordinary use multiply 
the metric quantities by the corresponding equivalent. Therefore, to convert: 
Meters into inches, multiply by 39.370. 
Liters into fluid ounces, multiply by 33.815. 
Grams into grains, multiply by 15.432. 
To convert the weights or measures in ordinary use into metric weights or 
measures multiply the quantities by the corresponding equivalent. Therefore, 
to convert: 
Inches into meters, multiply by 0.0254. 
Fluid ounces into milliliters, multiply by 29.572. 
Grains into grams, multiply by 0.0648. 
Balances and measures. 
Balances are instruments for determining the relative weight of substances. 
There are five kinds: 
(1) Single beam, equal arm. 
(2) Single beam, unequal arm. 
(3) Double beam, unequal arm. 
(4) Compound lever balance. 
(5) Torsion balance. 
In the construction of the single beam, equal arm, a beam is suspended on 
a knife-edge, which divides it into equal arms, and knife-edges are placed at 
each end of the beam on the same plane and at exactly equal distances from 
the point of suspension to support the pans which carry the substances to he 
weighed. The construction of the single beam, unequal arm, can he seen by 
inspecting the well-known Fairbanks scales. This type of balance depends on 
the principle in physics: “The power is to the weight or resistance in the 
inverse ratio of the arms of the lever.” The longer arm of the beam is grad- PHARMACY. 
387 
uated for a movable weight, the use of which dispenses with small weights and 
is a decided advantage. 
In the double beam, unequal arm, the construction is the same as above, 
but with two parallel beams, and is employed for weighing liquids, etc., the 
outside beam being used to tare the bottle or jar. 
A compound lever balance is well shown in Fairbanks platform scales. It 
is used on druggists’ counters and sometimes for prescription scales. 
A torsion balance is one in which a compound beam is balanced and sup- 
ported upon an immovable frame. The beam is prevented from slipping out 
of place, and the torsion is secured by a flattened gold wire stretched with 
powerful tension upon the center frame and firmly fastened to the underside 
of the beam. Upon the ends of the beam are fastened the movable frames 
which support the pans. Motion of the beam may be arrested easily by moving 
the lever, and the delicacy of the balance is increased by placing a weight upon 
the index, whereby the center of gravity is elevated. In this type of balance 
knife-edges are done away with entirely. 
Liquids are measured by the use of graduated vessels of tinned copper or 
iron, agateware, and glass. For use in the practice of pharmacy glass meas- 
ures are preferable, vessels of the other materials usually being used in meas- 
uring quantities larger than 1 pint. To measure small quantities of liquids, 
such as minims, glass vessels known as pipettes often are used because of the 
assurance of accuracy. 
Pipettes are glass tubes with a constricted point and graduated on the side. 
They are used by applying suction to the upper end and holding the liquid in 
the tube by placing the finger on the upper end while reading off the contents. 
Owing to capillary attraction, the top of the liquid in a graduated pipette 
presents a cup shape. This is called a meniscus. A line drawn through the 
bottom of the meniscus usually is selected as the reading point. 
A drop, through error, is supposed to be a minim; but though this may be 
approximately true when applied to water, it is not true in regard to other 
liquids. Thick viscous liquids produce large drops; heavy mobile liquids small 
ones. A drop of syrup of acacia is five times as large as a drop of chloroform. 
The size of a drop depends also upon the shape of the vessel from which 
dropped, upon the form of the lip, upon adhesion, cohesion, rapidity of flow, 
and viscosity. A drop of liquid from a curved eye-dropper is larger than one 
from a straight dropper having the same sized opening, because the straight 
one generally is held at an angle so that the drop falls from one side of the 
orifice, but with a curved dropper the drop falls from the whole circle of the 
orifice. 
Specific gravity. 
Specific gravity is the relative weight of equal bulks or volumes of different 
bodies. Water at a given temperature and atmospheric pressure is taken as 
the standard. The rules for taking specific gravity can be found in any refer- 
ence or text book on pharmacy. Methods by which specific gravity may be 
taken are: 
(1) By the specific-gravity bottle. 
(2) By the use of Lovi’s beads. 
(3) By the use of the hydrometer (water). 
(4) By the use of the lactometer (milk). 
(5) By the use of the alcoholometer (alcohol), 
(6) By the use of the urinometer (urine). 388 
HOSPITAL CORPS HANDBOOK. 
Specific volume. 
Specific volume is the volume of one body compared with the volume of an 
equal weight of another body selected as a standard, both bodies having the 
same temperature. It is directly opposite to specific gravity. The temperature 
chosen is usually 25° C. (77° F.). To obtain the specific volume of bodies (or 
the space materials take up) divide the specific gravity of water (1.000) by the 
specific gravity of the liquid. 
Pharmaceutical arithmetic. 
Alligation, or the “ rule of mixtures,” is a process in arithmetic whereby may 
be ascertained the value or price of a compound by determining the relative 
proportions and prices of the ingredients. In pharmacy, the principles of alli- 
gation are used to determine the quantities of substances of different strengths 
necessary to be mixed so that a mixture of a given strength may be produced. 
As applied to pharmacy alligation sometimes is termed mathematical pharmacy. 
Unless one is familiar with mathematics alligation is not readily understood 
and soon is forgotten. Every problem of alligation can be solved if a line be 
drawn and the percentage wanted placed above, and the percentages necessary 
to use placed below, thus: 
Nine is subtracted from 12, leaving 3, which figure is placed under the 14, and 
12 is subtracted from 14, leaving 2, which figure is placed under the 9; there- 
fore it takes 2 parts of a 9 per cent mixture and 3 parts of a 14 per cent mix- 
ture to make 5 parts of a 12 per cent mixture. 
If necessary to use substances of three or four different percentages, the 
arrangements of a problem to prepare a 1,000 c. c. mixture of a 12 per cent 
mixture from a 9, 11, 14, and 16 per cent mixture would be: 
By subtracting as before it is found that it would take 4 parts of 9 per cent, 
2 parts of 11 per cent, 1 part of 14 per cent, and 3 parts of 16 per cent mixtures 
to pi'oduce a 12 per cent mixture. As 1,000 c. c. of the 12 per cent mixture are 
required, and it requires a total of 10 parts of the different mixtures, four-tenths 
of 1,000 c, c., or 400 c. c. of the 9 per cent; two-tenths of 1,000 c. c., or 200 c. e. 
of the 11 per cent; one-tenth of 1,000 c. c., or 100 c. c. of the 14 per cent; and PHARMACY. 
389 
three-tenths of 1,000 e. c., or 300 c. c. of the 16 per cent mixtures are necessary; 
adding the number of c. c. of each percentage required gives 1,000 c. c. 
To prove the above example proceed as follows: Multiply the number of 
parts used by the percentages, add the columns of parts and answers, and divide 
the larger by the smaller. The result of this division should be the percentage 
desired if the operations are correct. 
4 X 9 = 36 
2 X 11 = 22 
1X14= 14 
_3 X 16 = _48 
10 )120(12 
10 
20 
20 
A simple modification of alligation is that of percentage as outlined in the 
last pharmacopoeia under alcohol, where the rule of dilution is given. To make 
20 per cent alcohol from 95 per cent alcohol take 20 c. c. of 95 per cent alcohol 
and add enough water to make 95 c. c., when approximately 20 per cent 
alcohol is the result. 
PHARMACEUTICAL PROCESSES. 
Heat. 
Heat is a form of radiant energy, due to molecular vibration, which produces 
the sensation called warmth. This molecular motion may be produced by 
friction, electricity, light, and chemical reaction. Heat is produced when 
alcohol and water are mixed, due to a chemical reaction in which a con- 
traction of volume takes place, forming hydrates of alcohol; when sparks 
are obtained from a piece of flint and a steel, due to friction; when a burning 
glass ignites a substance by concentration of the rays of the sun, due to 
light; and when an electric current passes through wires having high re- 
sistance, as in an electric toaster, due to electricity. Heat may be produced 
by igniting coal, alcohol, kerosene, gasoline, wood, and illuminating gas. The 
latter frequently is used in a special apparatus known as a Bunsen burner, 
which permits the regulation of the flame by the admixture of air. The blue 
flame of a Bunsen burner is hotter than the luminous flame because heat 
is caused by oxidation and in the blue flame all the carbon is not oxidized, 
but is heated to the incandescent condition which produces light. The expres- 
sion, “ melting point ” is used in pharmacy as a means of identifying a body 
or proving its purity. It is the temperature at which a substance melts or fuses. 
Heat is measured and spoken of in degrees of temperature. By temperature 
is meant the sensibility of an object to the effects of heat. Temperature 
can not be measured in itself, so it is estimated by its effect on solids, liquids, 
and gases. Instruments used to measure temperature are known as ther- 
mometers or heat measurers. 
A thermometer consists of a glass tube with capillary bore, sealed at one 
end, the other end terminating in a bulb. The bulb is filled with mercury 
or other fluid, which being expanded by heat, rises in the tube and indicates 
the degree of heat, either on an index scratched on the tube itself, or marked 
on a piece of paper against which the tube is placed. 390 
HOSPITAL CORPS HANDBOOK. 
Three scales are used in marking the degrees of a thermometer; they are 
centigrade, Fahrenheit, and Reaumur. The freezing point of water in the 
centigrade scale is zero; the boiling point is 100°. In the Fahrenheit scale 
water freezes at 32° ; the boiling point being 212°. In the R6aumer scale the 
freezing point is zero and the boiling point 80°. (Fig. 167.) 
To convert centigrade degrees into Fahrenheit above 32, multiply by 1.8 and 
add 32. To convert Fahrenheit degrees above 32 into those of centigrade, 
subtract 32 and divide by 1.8. 
In pharmacy there are several processes requiring the application of high 
heat, which are thus explained: 
Ignition is the process of strongly heating solid or semisolid substances, the 
residue being the object sought. 
Fusion is the process of liquefying solid bodies by the application of heat 
without the use of a solvent. 
Calcination is the process of separating volatile substances from the fixed 
inorganic matter by the application of heat without fusion. 
Deflagration is the process of heating one inorganic sub- 
stance with another capable of yielding oxygen (usually a 
nitrate or chlorate). Used also in chemical test work. 
Carbonization is the process of heating organic sub- 
stances without the presence of air until the volatile prod- 
ucts are driven off and the product resembles charcoal. 
Torref action (roasting) is the process of modifying 
organic substances by the application of heat, but not 
enough to carbonize them. 
Incineration is the process of strongly heating organic 
substances in the presence of air until all the carbon is 
consumed and an ash is the result. Used chemically in 
test work for the estimation of the total organic matter, 
the ash being the part sought. 
Sublimation is the process of separating volatile solids 
from those nonvolatile or less volatile by vaporization and 
condensation. 
Other operations in pharmacy require the use of heat until matter assumes 
the form required. These are described under the various terms, such as 
evaporation, distillation, desiccation, exsiccation, granulation, and sublimation, 
which are explained as follows: 
Vaporization or evaporation is the process of separating volatile bodies from 
less volatile bodies by the aid of heat at varying temperatures, the fixed part 
being the object sought. 
Distillation is the process of converting a liquid into a gas by vaporization 
and condensing the gas back into a liquid; in other words, distillation is the 
evaporation of a liquid and condensation of its vapor. Separation of a liquid 
from a solid by vaporization and condensation also is known as distillation. 
The apparatus required for distillation consists of a boiler in which vaporiza- 
tion takes place, and the condenser, in which the vapors are chilled until they 
become liquid in form. This combination is called a still. In making distilled 
water the first 10 volumes and the last 15 volumes should be thrown away, as 
they hold in solution practically all the gases that were in solution before dis- 
tillation. Ordinary water contains ammonia, carbon dioxide, inorganic matter, 
and bacteria; therefore distilled water should be used in filling prescriptions. 
Fractional distillation is the process of gradually separating, by distillation, 
the liquids forming a mixture and collecting the condensed vapors coming over 
Fig. 167.—Thermom- 
eters ; from left to 
right, Fahrenheit, 
Centigrade, Reau- 
mur. (Remington.) PHARMACY. 
391 
in portions or fractions as the temperature increases. Example: Separation of 
alcohol from water. 
Destructive distillation is the process of decomposing solid organic substances, 
such as wood or coal, by heating in a closed vessel and collecting the volatilized 
products resulting. Air must be kept out of the vessel 
or combustion will occur. Example: Methyl alcohol, 
acetic acid, creosote, etc., from wood; illuminating 
gas, coal tar, etc., from coal. 
Desiccation (drying out) is the process of depriving 
solids of moisture and at as low a temperature as 
possible. The objects of desiccation are: 
(1) To aid in preservation; 
(2) To reduce the bulk; and 
(3) To aid in grating, grinding, or powdering. 
Exsiccation is the process of depriving a solid crys- 
talline substance of its water of crystallization or 
moisture by the use of strong heat. 
Granulation is the process of heating the solution of 
a chemical substance, with constant stirring, until the moisture has evapo- 
rated and a coarse-grained powder is produced. 
The following pharmaceutical operations do not require the use of heat: 
Comminution is the process of tearing drugs to pieces or reducing them to 
powder. This is done by cutting, rasping, 
grinding, powdering, grating, chopping, bruis- 
ing, rolling, stamping, triturating, levigating, 
elutriating, and granulating. 
Several of the instruments used in the proc- 
ess mentioned above are the pruning knife and 
shears, the herb cutter, the half-round rasp for 
grating: the iron pestle and mortar for bruising; the drug mill for grinding. 
Trituration is the process of rubbing substances to fine particles, usually 
with a mortar and pestle. (Fig. 170.) 
The fineness of powders is spoken of and pow- 
ders are known as very fine, fine, moderately fine, 
moderately coarse, and coarse; and powders also 
are known by numbers indicating the fineness of 
division, 80, 60, 50, 40, and 20, respectively. When 
powder is spoken of as a No. 80 powder, it is un- 
derstood that this powder must pass through a 
sieve which has 80 meshes to the linear inch, and 
is classed as a very fine powder; the same is re- 
quired and understood for the other numbers, as 
specified in the United States Pharmacopoeia. 
Levigation is the process of reducing a powder 
to finer particles than can be attained through 
trituration, and is accomplished by placing a sub- 
stance on a slab, moistening with a few drops of 
a liquid, and rubbing over the slab with an instru- 
ment known as a muller. The muller is rotated in a circular motion as if drawing 
the figure 8. If the muller is made of porphyry, the process is called porpliyrization. 
Elutriation is the process of obtaining a substance in a fine powder by 
suspending it in water and allowing the heavier particles to subside and 
decanting the supernatant liquid and collecting the residue. 
Fig. 168.—Distilling 
flask. (Remington.) 
Fig. 169.—-Spatulas. (Reming- 
ton.) 
Fig. 170.—Pestle, hard rubber 
handle. Wedgewood mortar 
and pestle. (Remington.) 392 
HOSPITAL CORPS HANDBOOK. 
It sometimes happens that to reduce a substance to a powder another sub- 
stance must be used, afterwards removing the foreign substance in a suitable 
way. An instance of this process, called pulverization by intervention, is the 
powdering of camphor, which is done by the addition of a few drops of alcohol, 
afterwards removing the alcohol by evaporation. 
Solution. 
A solution is a permanent and complete incorporation of a solid or gaseous 
substance with a liquid. The substance dissolved is called a solute, the product 
a solution, and the liquid used a solvent. If the solvent 
will dissolve no more of the substance, the product is called 
a saturated solution. Solutions are of two kinds, simple 
and chemical. 
In a simple solution no change occurs in the chemical 
structure of the dissolved substance, as in the case of sugar 
dissolved in water. 
In a chemical solution a change does take place in the 
chemical structure of the dissolved substance, as in the case 
of the preparation of solution of nitrate of mercury, when 
red mercuric oxide is dissolved in a mixture of nitric acid 
and distilled water, with the result that the mercuric oxide 
is changed to mercuric nitrate. 
The making of solutions may be hastened by pulverizing 
the substance, by agitation, and also by heat. 
Saturated solutions, although saturated with one sub- 
stance, still may act as solvents for other substances. 
As a rule, simple solutions lower temperature and chemical solutions raise 
temperature. 
Stock solutions of mercuric chloride should contain a little ammonium chlo- 
ride, as it prevents the reduction that slowly takes place in a solution of pure 
mercuric chloride. The ammonia makes it more 
soluble because a double compound is formed. 
Potassium iodide should not be kept long in 
stock solutions, as iodine is liberated. 
Eye washes and hypodermic solutions should 
be filtered to be sure that no solid matter is 
left that would cause irritation. 
Of the solvents used in pharmacy, water is 
the first and most important. Other solvents 
used are alcohol, glycerin, ether, benzin, chloro- 
form, carbon bisulphide, acids, and oils. 
Separation of fluids from solids. 
Some of the processes in pharmacy used to 
separate fluids from solids are lotion, decanta- 
tion, eolation, filtration, clarification, expression, percolation, etc. They are 
explained as follows: 
Lotion is the separating of soluble matter from a solid by pouring a liquid 
upon it, which dissolves and washes out the soluble portion. 
Decantation is the separating of a liquid from a solid by pouring off the 
liquid. Sometimes this is effected by the use of a siphon. 
Colation (straining) is the separating of a solid from a liquid by pouring 
the mixture upon a cloth or other porous substance, which permits the fluid 
to pass through but retains the solid. 
Fig. 171.—Spritz bot- 
tle. Used in the 
washing of a pre- 
cipitate. (Reming- 
ton.) 
Fig. 172.—Siphonage. (Reming- 
ton.) PHARMACY. 
393 
Filtration is the separating of a liquid from a solid with the view of obtain- 
ing a transparent liquid. 
One of the most important substances used as a Alter is paper, which is used 
to a great extent in pharmacy, but other substances are employed as Alters 
as required in certain conditions. These are sand, asbestos, charcoal, talc, 
etc. Filter papers are known as plain and plaited, the plain ones being used 
for retaining and washing the precipitate, and the plaited 
ones for ordinary operations. 
In making most oAicial waters puriAed talc is used, be- 
cause it enables the volatile substances to be broken into 
minute particles, thereby increasing the surface exposed 
to the solvent action of the water, and removes the excess 
of the volatile substance, making a clear solution. Talc 
is not soluble appreciably in water or other liquids. Mag- 
nesium carbonate is objectionable as a substitute for talc, 
because the commercial article contains some hydroxide, 
which is somewhat soluble in water, thus making a solu- 
tion that is suAiciently alkaline to cause the formation 
of a precipitate when metallic or alkaloidal salts are 
added to the water. Again, magnesium carbonate combines with the acids 
that normally are present in some of the oils, forming soluble compounds which 
may give colored preparations. 
Clarification is the process by which, without the use of a strainer or Alter, 
solid substances which interfere with their transparency are separated from 
liquids. It may be effected in the following 
ways: By the application of heat; by the addition 
of water; the use of albumin, gelatin, and milk; 
by fermentation; the use of paper pulp; and by 
long standing, when the solid substance settles 
to the bottom of the container and is known as 
a sediment. This method of clariAcation some- 
times is called sedimentation. 
A sediment is the solid matter separated by the 
action of gravity alone from a liquid in which it 
has been suspended. 
Precipitation is a process of separating solid 
particles from a solution by the action of heat, 
light, or chemical substances and is also a method 
used in testing chemicals. The precipitate is the 
separated solid. The added liquid causing the 
precipitate is the precipitant. The liquid remaining is called the supernatant 
liquid. The objects of precipitation are: 
(1) To obtain solid substances in a Ane powder; 
(2) To purify solids; 
(3) To obtain through chemical reaction substances which are insoluble 
in the supernatant liquid. 
Percolation is a process whereby a powder contained in a suitable vessel 
is deprived of its soluble constituents by the descent of a solution through it. 
It also is called the process of displacement because it was Arst observed that 
ether poured on powdered bitter almonds displaced the Axed oil which it con- 
tained without materially mixing with it. Percolation is used in pharmacy 
for extracting the virtues of drugs in the preparation of tinctures, Auid ex- 
Fig. 173. — Folded 
filter. (Reming- 
ton.) 
Fig. 174.—Official percolator 
on left and process of per- 
colation. (Remington.) 394 
HOSPITAL CORPS HANDBOOK. 
tracts, etc. The container used is called a percolator, which is a cylindrical 
vessel with a porous diaphragm below, into which the drug in the form of 
powder is introduced, and its soluble portions extracted by the descent of a 
solvent through it. This solvent is termed the menstruum. The liquid com- 
ing from the percolator, impregnated with the soluble principles of the drug, 
is called the percolate. Each succeeding portion of the percolate is less highly 
colored and contains less of the active principles of the drug than the preced- 
ing percolate because the first portion of menstruum, in its descent through the 
powder, has the greatest opportunity to come in contact with the largest por- 
tions of the soluble principles. These soluble principles are found in the 
finer dust scattered through the powder and in the thoroughly disintegrated 
particles which offer but slight resistence to the passage of the menstruum. 
Crystallization. 
By crystallization is meant the formation of crystals. Most substances as 
they pass from a liquid or gaseous condition to a solid state assume regular 
geometric forms, which are bounded by plane faces and definite angles, and are 
the outcome of the disposition of molecules of the same substance always to 
assume the same regular shape. These forms are called crystals, and the study 
of crystals is crystallography. Some bodies do 
not crystallize, and these are spoken of as 
amorphous, which means shapeless or without 
definite form, examples of such substances 
being chalk, acacia, etc. Crystals may be ob- 
tained in several ways and usually have a tend- 
ency to split or cleave in one direction more 
than another. Six systems of crystals, each 
different from the others and each having sev- 
eral subdivisions, are recognized. These sys- 
tems are based upon the different general char- 
acteristics assumed by crystals. 
In crystallization many substances contain 
water in combination with the crystal, and this 
water is spoken of as water of crystallization. 
Bodies containing water of crystallization generally are spoken of to-day as 
hydrated, and use of the term “ water of crystallization ” is being dropped. 
When crystals lose this water of crystallization and form a powder on the 
outside they effloresce; those that absorb water are said to be hygroscopic, but 
when they absorb sufficient water to liquefy they are said to deliquesce. After 
the crystals have been formed the liquid remaining is known as the mother 
liquor. 
Some substances in crystallizing form masses of crystals and in the process 
mechanically imprison water in the interstices between the crystals. Such 
imprisoned water is known as interstitial water and may be freed by crushing 
the mass or gently heating it. 
It is sometimes necessary to separate crystallizable from noncrystallizable 
substances, and the means or process taken to separate them is known as 
dialysis. The vessel used for this operation, called a dialyzer (Fig. 175), has a 
drumlike head or diaphragm made of porouslike membrane at one end ; into this 
the substances to be separated are placed in the form of a solution and the whole 
floated on water where the crystallizable substance passes through the drum 
head into the water below, leaving the noncrystallizable substances behind. 
This operation is spoken of in pharmacy as “ by osmosis ” or passing through. 
Fig. 175.—Dialyzer. (Reming- 
ton.) PHARMACY. 
395 
The substances which are crystallizable are called crystalloids, and those 
which are not crystallizable are called colloids. Thus it is seen that the object 
of this process is to obtain either the crystallizable or noncrystallizable sub- 
stance free from the other. 
Extraction is the art of separating the soluble principles from drugs by 
treating them with a liquid in which the principles are soluble. The solvent 
is called a menstruum. There are several methods of extraction which com- 
monly are known as maceration, expression, percolation, digestion, infusion, 
and decoction. Maceration is the soaking of a drug in a solvent until the 
soluble portions dissolve. Expression is the process of forcibly separating 
liquids from solids. To accomplish this presses are employed. Presses are 
known as spiral twist, screw, roller, wedge, lever, and hydraulic, according to 
the mechanical principles involved in their action. Digestion is maceration 
with gentle heat. Infusion is the making of liquid preparations by pouring hot 
or cold water over the drug and allowing the drug to macerate the specified 
time. Decoction is the making of liquid preparations by boiling the drug for 
15 minutes or longer with water. 
FORMS OF PHARMACEUTICAL PREPARATIONS DIRECTED BY THE 
UNITED STATES PHARMACOPOEIA. 
In applying those processes in pharmacy which have been described to the 
manufacture of pharmaceutical preparations, pharmaceuticals are divided into 
two classes known as galenic preparations and chemical preparations. Galenic 
preparations are those in the manufacture of which no chemical action is 
involved, and chemical preparations are those in which chemical change occurs 
during their manufacture. Chemical change occurs in the making of some 
galenic preparations, and some chemical preparations can be made by galenic 
means, but for convenience in studying pharmaceutical preparations the divi- 
sion into these two classes is customary. 
Official pharmaceutical preparations are grouped further in two general 
classes showing the nature of the preparation. These are liquids and solids. 
Liquid preparations are those in which the medicinal substance is contained 
in various liquid bases, and solid preparations are those in which the medici- 
nal substance is incorporated in a solid or semisolid base. 
Liquid preparations also are grouped in classes according to the nature of 
the principal bases used in their manufacture, i. e.: 
Acetone preparations. 
Acetous preparations. 
Alcoholic preparations. 
Aqueous preparations. 
Ethereal preparations. 
Glycerine preparations. 
Oleaginous preparations. 
Solid preparations are grouped in classes according to the nature of the 
preparation, i. e.: 
Cerates. 
Extracts. 
Masses. 
Ointments. 
Plasters. 
Pills. 
Powders. 
Resins. 
Suppositories. 
Triturations. 
Troches. 
In addition to the above there are natural preparations, some of which are 
alkaloids, glucosides, and other neutral principles, acids, alkalies, etc. 
47829°—23 26 396 
HOSPITAL CORPS HANDBOOK. 
Both liquid and solid preparations may be made with maceration and perco- 
lation or without maceration and percolation. 
Liquid preparations. 
Aceta (vinegars) are liquid preparations obtained by extracting the active 
principles of drugs by maceration or percolation with vinegar or dilute acetic 
acid. Acetic acid is used because it is a good solvent, is a preservative, and 
possesses antiseptic properties. Though the use of vinegars dates back to the 
time of Hippocrates, they have been supplanted by the use of the tincture and 
fluid extract, and there now is left but one official vinegar, i. e., vinegar of 
squill. 
Aqucp (waters) are aqueous solutions of volatile substances. There are 
20 official waters. 
There are various methods of preparation, viz.: Simple solution in cold water 
by agitation (example, aqua chloroformi) ; by passing gases through water 
(example, aqua ammonise) ; solution in hot water; filtration through an absorb- 
ent powder (example, aqua cinnamomi) ; filtration through pulp or shredded 
paper; percolation through cotton impregnated with the substance; distillation 
(example, aqua hamamelidis). 
A jug is better than a bottle in making flavoring waters by mixing oil with 
hot water, as the rough surface of the jug helps to break up the oil. Cinnamon 
water may become acid because the oil contains cinnamic aldehyde, which 
slowly oxidizes to cinnamic acid. 
Ammonia water is used in making aromatic spirits of ammonia for its thera- 
peutic effect, and also to convert the ammonium bicarbonate into the normal 
carbonate, so that it will be soluble in alcohol. The United States Pharma- 
copoeia directs the use of ammonium carbonate in “ translucent pieces ” so as to 
get the requisite amount of salt. Opaque pieces have lost ammonia and carbon 
dioxide and consist of ammonium bicarbonate. Aromatic spirit of ammonia 
is set aside for 12 hours in order to allow time for the ammonium hydroxide 
to act on the ammonium bicarbonate and change it to the carbonate. Aromatic 
spirit of ammonia turns dark on keeping for some time, because the alcohol 
frequently contains some aldehyde and other impurities which are darkened 
by ammonia; then the gradual increase in color is due to the action of ammonia 
on the oils. 
In mixing sulphuric acid and water the acid should he poured into the water, 
not the water into the acid, as there is less heat, less steam generated, and less 
danger of accident. Sulphuric acid and water when mixed produce heat, due 
to chemical reaction, and contraction of the total volume occurs. Sulphuric 
acid when dropped on organic matter (as wood) blackens it, because the acid 
abstracts the elements of water and leaves carbon. 
Lime, when mixed with water, produces heat, because a chemical reaction 
takes place, forming calcium hydroxide. 
Collodia (collodions) are liquid preparations intended for external use having 
a solution of pyroxylin or guncotton for a base in a mixture of ether and alcohol. 
There are three official collodions. 
Elixiria (elixirs) are aromatic, sweetened, alcoholic preparations contain- 
ing small amounts of active medicinal substances. Elixirs are made with a 
menstruum of alcohol and water and there are two official. 
Emulsa (emulsions) are soft liquid preparations resembling milk, and 
consisting of an insoluble substance of an oily or resinous nature suspended 
in water by means of gum, yolk of egg, or other viscid matter. There are four 
official emulsions. PHARMACY. 
397 
There are two types of emulsions used in pharmacy, the oil-in-water 
type and the water-in-oil type. Almost all emulsions which are intended for 
internal use, such as cod-liver oil, etc., belong to the first type, where the 
oil droplets coated with a film of hydrated acacia are suspended in water. 
The film around the droplets prevents their running together. Preparations 
like hydrous wool fat, carron oil, etc., intended for external use are emulsions 
of the water-in-oil type, in which water, in the form of droplets, is suspended 
in oil. Emulsions are unstable and should be freshly prepared when desired. 
Milk, various plant juices, and the emulsions resulting when asafoetida, myrrh, 
etc., are triturated with water, are termed natural emulsions. 
Fluidextracta (fluid extracts) are concentrated alcoholic preparations of 
vegetable drugs made by percolation, representing in each cubic centimeter 
the activity of one gram of the drug. In other words, they are 100 per cent 
tinctures. There are five general processes for the manufacture of fluid extracts: 
(1) Percolation with partial evaporation. 
(2) Fractional or divided percolation. 
(3) Repercolation. 
(4) Percolation with complete exhaustion. 
(5) Maceration with hydraulic pressure. 
The United States Pharmacopoeia gives general pharmacopoeial formulas 
called “ type processes.” Types “ A ” and “ B ” are methods of percolation 
with partial evaporation, the only difference being whether or not the men- 
struum contains glycerin. Type “ C ” is percolation without evaporation and 
type “ D ” directs the preparation of an infusion or decoction of the drug and 
addition to it of sufficient alcohol to preserve it. Examples of each process 
are: 
Type “ A ” process, fluid extract of belladona root. 
Type “ B ” process, fluid extract of ipecac. 
Type “ C ” process, fluid extract of aconite. 
Type “ D ” process, fluid extract of cascara sagrada. 
As a rule fluid extracts keep well; the precipitate, often occurring, almost 
invariably is inert. It must be borne in mind that in some cases the precipitate 
in fluid extracts contains a valuable constituent, and in such cases the precipi- 
tate should be retained. As there is no table showing which should be retained 
or rejected, it is customary to dispense fluid extracts in clear form. 
The United States Pharmacopoeia, eighth revision, gave 85 official fluid 
extracts; in the ninth revision there are monographs for 49. Those deleted 
are recognized by the National Formulary. 
Glycerita (glycerites or glyceroles) are mixtures or solutions of medicinal 
substances with glycerin. Glycerite of starch is not a solution but a semisolid 
mass. There are five official glycerites. 
Infusa (infusions) are aqueous preparations of vegetable drugs and, unless 
otherwise dirested, represent 5 per cent of the drug. Boiling water is used 
in making infusions. There are two infusions official, varying in strength 
from 1$ to 6 per cent. 
Linimenta (liniments) are thin, oleaginous preparations for external use, 
applied by friction. Not all liniments contain insoluble matter, some are 
clear alcoholic solutions, such as soap liniment; some are clear oleaginous solu- 
tions, such as camphor liniment; turpentine liniment is more or less a trans- 
parent semi-solid mass; ammonia and lime liniments are opaque. There are 
eight official liniments. 
Heat is used in making camphor liniment to aid the solution of camphor and 
the camphor dissolves more quickly if coarsely powdered. Powdered or granu- 398 
HOSPITAL CORPS HANDBOOK. 
lar soap is preferable to bar soap in making soap liniment, as it is more con- 
stant in the amount of water it contains. Soap liniment should be allowed to 
stand 24 hours before filtering, so that the sodium palmitate contained in the 
soap (which goes into solution at first, but afterwards precipitates) may be 
filtered out. 
Chloroform liniment sometimes separates into two layers because an ex- 
cess of water or a deficient amount of alcohol was used in making the soap 
liniment. With the present formulas, however, this is hardly liable to take 
place. Ammonia liniment sometimes becomes solid because the ammonia acts 
on the oil and forms a soap. Lime liniment gets thick because a soap slowly 
forms. 
Liquores (solutions) are aqueous solutions of nonvolatile substances. Liquors 
are divided into two classes according to the method of preparation: By simple 
solution and chemical aqueous solution. Twenty-five are official. 
Liquor calcis is a simple solution; liquor ammonii acetatis is a chemical 
solution. 
Magmce (magmas) are liquid preparations containing suspended insoluble, 
inorganic chemical substances in a finely subdivided state. There are two 
magmas official. 
Mellita {honeys) are thick liquid solutions of a syrupy consistency contain- 
ing medicinal principles prepared by dissolving the medicinal ingredient in 
honey. The official name for honey is mel. There are three official honeys. 
Misturce (mixtures) are liquids containing undissolved matter and insoluble 
nonfatty substances. Since they contain insoluble matter they must be dis- 
pensed with a “ Shake well ” label. There are two official mixtures. 
Muscilagines (mucilages) are thick, viscid, adhesive liquids made by dis- 
solving gum in water, or by extracting the mucilaginous principles in plants by 
means of water. They are made either with or without heat. Two mucilages 
are official. 
Oleata (oleates) are solutions of metallic oxides or alkaloids in oleic acid. 
They are intended for external use and there is one official oleate. 
Oleoresince (oleoresins) are liquid preparations of natural oils and resins 
extracted from vegetable substances by percolation with ether or alcohol. 
There are two classes of oleoresins, natural and pharmaceutical. Natural 
oleoresins are mixtures of volatile oils and resin exuding from plants, such as 
copaiba, whereas pharmaceutical oleoresins are manufactured by placing the 
drug without moistening in a suitable apparatus and percolating with the ap- 
propriate solvent. This solvent then is distilled from the percolate, leaving a 
small quantity of oily liquids behind; this is the official oleroesin. Example: 
Oleoresin of aspidii (male form). There are six official oleoresins. 
Spiritus (spirits) are alcoholic solutions of volatile substances. They are 
classified according to the method by which they are made, as, simple solution, 
solution with maceration, gaseous solution, chemical reaction and distillation. 
Fifteen spirits are official. 
Syrupi (syrups) are preparations containing medicated or flavoring substances 
in a concentrated aqueous solution of sugar. A concentrated aqueous solution 
of sugar is called syrup, or simple syrup; if a pleasant fruit or aromatic flavor 
is added, it is termed a flavored syrup; while if the addition is of a medicinal 
character, the product is a medicated syrup. Simple syrup is made by the aid 
of heat and by the cold process. 
An excess of iron over iodine is used in making syrup of iodide of iron, 
because if an excess of iodine were used it could not be removed by filtration 
as can iron. An excess of iron promotes the reaction and prevents oxidation, PHARMACY. 
399 
The reaction in making syrup of iodide of iron is more rapid after some ferrous 
iodide has been formed, as the chemical reaction generates heat, and heat 
aids the reaction. Ferrous iodide dissolves iodine, changing it into a form 
that will react more readily with iron. Sometimes it is necessary to check 
this reaction, as the heat generated may crack the vessel or volatilize the iodine. 
In making the syrup of iodide of iron the mixture of iodine, iron, and water is 
heated to boiling before filtering so as to complete the' chemical reaction. 
Sugar is added to solution of ferrous iodide before filtering, as it is a reducing 
agent and helps to prevent the oxidation of ferrous iodide. Hypophosphorous 
acid added to syrup .of iodide of iron prevents oxidation and liberation of iodine. 
Syrup of iodide of iron becomes red as iodine is liberated gradually and dis- 
solved, and caramelization of the sugar sometimes may take place. Direct 
siinliglit prevents or retards the liberation of iodine in syrup of ferrous iodide 
and reduces it after it has been liberated. As air oxidizes syrup of iodide of 
iron, bottles containing it should be kept full. 
Glycerine is used in syrup of ipecac to prevent souring. Potassium carbonate 
is used in syrup of rhubarb and aromatic syrup of rhubarb to prevent the pre- 
cipitation of resinous matter by forming a soluble compound with it. There are 
22 official syrups. 
Glucose is prepared by the action of sulphuric acid on starch, and also may 
be obtained from candied sugar, grapes, and other sources. The term glucose 
is applied to the syrupy form; a solid form of glucose is obtainable and known 
under the terms of dextrose and grape sugar. 
Tincturoe (tinctures) are alcoholic solutions of nonvolatile substances ob- 
tained by extraction of the drugs, with the exception of tincture of iodine, but 
the presence of potassium iodide, which is nonvolatile, in this tincture, brings 
it practically within the definition given. 
There are 44 official tinctures, varying in strength from 0.4 per cent to 50 per 
cent, the majority being 10 per cent and 20 per cent. Those not included in the 
10 or 20 per cent tinctures are: 
Per cent. 
Tr. opii campliorata 0. 4- 1 
Tr. gambir composita 5 
Tr. moschi 5 
Tr. lavendulfB composita 5. 5 
Tr. iodi 6. 5- 7. 5 
Tr. ferri chloridi 13 
Tr. cardamomi 15 
Tr. benzoini composita 24 
Tr. aurantii dulcis 50 
Tr. lactucarii 50 
Tr. limonis corticis 50 
They are made by several processes, which are as follows: Solution or dilu- 
tion, maceration, digestion and maceration, percolation, and digestion and per- 
colation. 
Potassium iodide is used in tincture of iodine to aid solution of the iodine 
and prevent its precipitation when water is added to the tincture. Water is 
now used in tincture of iodine to dissolve potassium iodide, as it dissolves very 
slowly in alcohol. The use of decolorized tincture of iodine should be dis- 
couraged, as the title tincture is misleading, it being really a tincture of the 
iodides of sodium and ammonium, and not having the physiological effect of 
iodine. 400 
HOSPITAL CORPS HANDBOOK. 
Solid preparations. 
Cerata (cerates) are unctuous substances and easily spread at ordinary 
temperature upon muslin or similar material with a spatula, but not so soft 
that they will liquefy and run when applied to the skin. They are called 
cerates on account of the presence of wax (cera). Substances used for bases 
are oil, lard, petroleum, wax, and sometimes paraffin or spermaceti in tbe 
presence of wax are used to raise the melting point of the bases. There are 
three official cerates. 
Emplastra (plasters) are substances intended for external application. They 
are of tenacious but pliable consistence, adhere to the skin, and require the aid 
of heat in spreading them. .They usually are spread on muslin, leather, or 
paper, and have lead plaster, a gum resin, or Burgundy pitch as a base. There 
are seven official plasters. 
Extracts (extracts) are solid, semisolid, or powdered preparations obtained 
by evaporating solutions of vegetable substances. There are 24 official extracts. 
Extracts are made in two ways, by extraction of the dried and powdered drug 
with a solvent and by expression of the fresh moist drug, and then evaporating 
to a pilular consistence or to dryness. The United States Pharmacopoeia recog- 
nizes two kinds of extracts, the pilular (solid or semisolid) and the pow- 
dered. In some extracts a lit- 
tle glycerin is added to pre- 
vent hardening of the mass. 
Masses (masses) are com- 
binations of medicines worked 
up with enough liquid to make 
solids of sufficient plasticity 
to roll into pills. There are 
two official masses. 
Pilules (pills) are small, solid bodies usually of a spherical shape, which are 
intended to be swallowed whole, and thereby produce medical action. Pills are 
composed of the active ingredients and the excipients. The mass must be ad- 
hesive, firm, and plastic. The excipients may be liquid or solid. The liquids 
used as excipients are water, syrup, acacia, mucilage of acacia, glycerin, glu- 
cose, honey, glycerite of starch, and glycerite of tragacanth; the solids used 
as excipients are confection of rose, bread crumbs, althea, soap, rosin cerate, 
cocoa butter, and petrolatum. There are seven official pills. To successfully 
make pills requires considerable experience and before proceeding reference to 
any standard practice of pharmacy should be had. 
Pulveres (powders) are a class of preparations composed of finely powdered 
dry substances that when administered by the mouth are not repulsive to the 
sense of taste and not caustic or corrosive in their local action. There are 
seven official powders. A mortar and pestle usually are used in making 
powders. Powders frequently are dispensed in gelatin capsules. 
Resines (resins).—The official resins are solid preparations consisting prin- 
cipally of resinous principles found in plants and usually precipitated from 
their alcoholic solutions by the use of water. There are four official resins. 
Suppositoria (suppositories) are solid bodies containing medicinal substances 
of different weights and shapes, adapted for introduction into orifices of the 
human body, and melt easily at blood temperature. The vehicles usually used 
for suppositories are oil of theobroma, glycerinated gelatin, or sodium stearate. 
Suppositories should be of sufficient consistency to retain their shape when 
inserted and at the same time melt at the temperature of the body. They 
may be made by hand or by molds, of which there are three kinds—individual 
molds, divided molds, and liquid molds. 
Fig. 176.—Empty capsules. (Remington.) PHARMACY. 
401 
Cocoa butter makes the best suppository base, because it is solid at ordinary 
temperature, liquid at body temperature, and is a bland, soothing substance. 
Trouble is experienced in making suppositories of phenol, chloral hydrate, 
naphthalene, and similar compounds, because the oil is softened by these, and 
it may be necessary to add a hardening agent. Gelatin should not be used 
as a base for ichthyol suppositories, as it is not soluble with gelatin. Sodium 
carbonate and stearic acid are used in making glycerin suppositories as they 
react, making sodium stearate which will solidify a large amount of glycerin. 
Glycerin suppositories should be preserved in tight vessels because, being some- 
what hygroscopic, they tend to become liquid on exposure to air. 
Suppositories containing tannic acid are best made in the cold (not melting 
the base), because heat causes the acid to form tough, hard masses. The 
suppository of glycerin is the only one official. 
Trochisci or troches (lozenges) are solid, small, flattened, or cylindrical 
masses, consisting chiefly of medicinal powders incorporated with sugar, 
mucilage, etc. Their preparation consists of 
making the ingredients into a mass, which is 
rolled into a thin sheet and then cut into 
proper shape with a lozenge cutter. There are 
five official troches. 
Unguent a (ointments) are fatty mixtures 
of medicinal substances (softer consistency 
than cerates), with a base of lard, fixed oils, 
or petrolatum, and intended to be applied 
to the skin by inunction. They have a low 
melting point (due to less wax being used 
than in a cerate). 
Ointments usually are made in two ways, 
by fusion and by incorporation. In fusion 
the fatty substances are liquefied by the aid of 
heat and the medicinal substance incorporated 
while the fats are liquid or after solidification , 
by incorporation the medicinal substance is rubbed up with the solid fatty 
matter, either in a mortar or on a slab. 
An ointment base should not be rancid, not only because of the odor but the 
free acid is frequently irritating and may cause chemical reaction. Petroleum is 
a good ointment base in certain cases, because it is cheap, is not readily absorbed, 
consequently acting as a protective, and does not become rancid. Hydrous wool 
fat is a good ointment base, because it is readily absorbed, carrying with it the 
medicinal agent, and can be mixed with a large percentage of water or other 
liquid without losing its ointment properties, especially in making an ointment 
when liquids are called for which are not miscible with the prescribed base. 
The United States Pharmacopoeia allows as much as 30 per cent of water in 
hydrous wool fat, as anhydrous wool fat is very tough and sticky and the pres- 
ence of that amount of water gives it the proper consistency for an ointment 
base. As the anhydrous wool fat is good for making ointments containing a 
large amount of water or other liquids, it is recognized in addition to the 
hydrous wool fat. 
Lard, because it is cheap, quite readily absorbed, and will mix with some 
water, is a good ointment base. Melted lard should be stirred and cooled 
quickly when used, as it is less likely to become granular. When lard is 
benzoinated the antiseptics dissolved out of the benzoin retard rancidity. 
Yellow wax is better for an ointment base than white wax, because in 
bleaching wax a change takes place which makes it more liable to become 
Fig. 177.—Suppository molds. 
(Remington.) 402 
HOSPITAL CORPS HANDBOOK. 
rancid. Paraffin is an objectionable substitute for wax in ointments, as it 
has a tendency to make the ointment granular. 
ingredients having high melting points should be melted before those having 
a lower melting point, as the high heat necessary to melt the former may be 
injurious to the latter. Ointments should be stirred when cooling, because 
the ingredients having high melting points usually will solidify first, resulting 
in a granular ointment. 
Glycerite of starch makes a good ointment base in certain cases because it 
is not greasy and can be washed off without difficulty. In making ointment of 
boric acid it is stirred until congealed, as boric acid is not soluble in petrolatum 
and is held mechanically. 
Glycerin is used in tannic-acid ointment to dissolve the acid and make it 
more effective. Metal spatulas should not be used in making tannic-acid oint- 
ment, as it attacks the iron, forming tannate of iron, resulting in a darkened 
ointment. If the spatula first is smeared with the fatty substance, there is 
little danger. 
In making cold cream (ointment of rose water) rose water is used instead of 
oil of roses to perfume it, as the water makes it softer and more creamy. 
Ointment of rose water is stirred for some time because the longer it is stirred 
the whiter it becomes. Borax is used in cold cream to give a whiter and 
more creamy preparation. Water is warmed in making cold cream, because 
if not warmed it may chill the melted base and make it lumpy or granular. 
Many cold creams are made with paraffin and liquid petrolatum', as it is a 
cheaper base and one that does not become rancid. 
In making belladonna ointment the extract is rubbed with dilute alcohol to 
thoroughly soften the extract so as to make a homogeneous mixture. Wood fat 
then is used to take up the liquid. 
Oleate of mercury is used in making mercurial ointment because it will hold 
mercury in a microscopic state of subdivision. Mercurial ointment should be 
kept in a cool place, as the mercury separates out when warmed. A metal 
spatula should not be used in handling citrine ointment, as the ointment is acid 
and attacks iron. Citrine ointment sometimes becomes dark colored when 
mixed with an alkali because the mercury has been partly reduced to the 
mercurous condition and the alkali causes the black oxide to be formed. 
Lanolin is better for making oxide of mercury ointment than the simple 
ointment, as the mercury oxide is not reduced readily. 
Potassium iodide is used in iodine ointment, as iodine can not be reduced to 
an impalpable powder, but is very soluble in a glycerin solution of potassium 
iodide, and this solution can be mixed intimately with the base. Glycerin is 
used in iodine ointment to dissolve the potassium iodide. Water is objection- 
able because it evaporates and the iodide is left in gritty crystals. 
Natural preparations. 
Acids, from a medical standpoint, are medicines which in concentrated form 
act, usually as caustics, to destroy tissues. From the vegetable kingdom the 
principal acids derived are acetic, citric, and benzoic, and from the mineral 
kingdom nitric, phosphorous, sulphuric, and hydrochloric. 
Alkalies (antacids) are agents which neutralize acids, acts as escharotics on 
tissue, and, when in contact with the mouth of the duct of the glands producing 
them, are supposed to check alkaline and stimulate acid secretions. The chief 
members of this group are sodium, potassium, ammonium, calcium, magnesium, 
and lithium. 
Alkaloids are active, nitrogenous principles existing in plants and extracted 
from them by chemical art. They are organic bases and form salts with acids. PHARMACY. 
403 
There are 23 official alkaloids, under either tlieir own names or those of their 
salts, including pelletierine and veratrine, which are mixtures of alkaloids. 
Tlieir official Latin titles end in “ ina,” the English in “ ine.” 
Glucosides are organic' compounds belonging to the group of neutral principles 
which exist in plants and which, by the action of reagents or natural ferments, 
split up into glucose or a related carbohydrate and some other body. Their 
official Latin titles end in “ inum,” the English in “ in.” There are two official 
glucosides, but a number of drugs containing glucosides (glucosidal drugs) are 
official. Besides glucosides there are several other natural principles whose 
names terminate in “ inum ” and “ in ” but have no relationship to the group of 
glucosides. 
Essential or volatile oils are those substances found in the blossoms, flowers, 
and fruits of plants which usually contain odorous principles. They may exist 
in the plant or be produced by the reaction of certain constituents when brought, 
in contact with water. They sometimes are formed through destructive dis- 
tillation and may be obtained from the animal kingdom. While rapidly being 
displaced by a more correct classification, essential oils customarily are grouped 
in four classes, known as the terpenes, oxygenated oils, nitrogenated oils, and 
sulphurated oils. A point of differentiation between volatile oils and fixed oils is 
that the former leave no stain behind after gently evaporating a drop of the 
oil placed on filter paper. Essential oils are used principally in the manufacture 
of perfumes and cosmetics. 
Fixed oils and fats are obtained from both the vegetable and animal king- 
doms. When touched they leave a greasy feeling on the fingers, they are 
insoluble in water, and leave a permanent oily stain on paper. Nearly all 
fixed oils and fats are natural combinations of glycerin with stearic, oleic, and 
palmitic acids, and they are extensively used in the manufacture of soaps. 
Soaps are products made by boiling oils and fats with a solution of some 
caustic alkali until a thick mass is formed, glycerin being set free. 
Unsaponifiable fats are official fats which can not be classed with either the 
fixed or volatile oils, yet which in some respects partake of the properties of 
both. Petrolatum in its several forms, paraffin, petroleum, benzin, and the 
products of petroleum belong to this group. 
PRESCRIPTIONS. 
A prescription is a formula which a physician writes, specifying the substance 
he intends to have administered to a patient. It is written in Latin because 
it is the official language of science, is understood throughout the world, and, 
being a dead language, is not subject to change. 
The parts of a prescription are: 
(1) Name of patient and date. 
(2) Superscription, indicated by the symbol “ I$,” standing for the Latin 
word recipe (take thou). 
(3) Inscription, expressing the name and quantities of the ingredients, 
viz., the base, the adjuvant, the corrective, and the vehicle. 
(4) Subscription, directions to the pharmacist. 
(5) Signature or transcription, directions to the patient, ending with the 
prescriber’s name. 
Model Prescription. 
R For John Jonets 3/15/23 
Sodii bromidi 16 gm. (5ivl 
Antipyrinse 8 gm. ( 5ii) 
Liquor acidi arsenosi 4 c. c. (foi) 
Aquse menthse piperitae-q. s. ad. 120 c. c. (£§iv) 
Miser et signa : One teaspoonful in water three times daily after 
meals. 
John Doe, M. D. 404 
HOSPITAL CORPS HANDBOOK. 
In filling prescriptions note carefully the dose of all medicines prescribed, 
because the physician is human and is liable to make an error. In law the 
pharmacist, as well as the physician, is held responsible in case of an overdose, 
and suit for damages is more likely to be brought against the pharmacist than 
the physician. 
The words “ Use as directed ” should be avoided by the prescriber, as the 
patient is generally in a more or less nervous condition and likely to forget the 
details; then, too, by having the directions of the prescription it makes another 
safeguard in that pharmacists can detect an error more readily if one is 
present. Upon the dose depends the safety. 
In filling prescriptions requiring the mixture of an insoluble substance with 
a liquid, it is preferable to rub it in a mortar with a small amount of liquid, 
because if the solid is put simply into a bottle and shaken the substance may 
“ lump ” and require time and agitation in order to get it mixed. This is 
particularly true with calomel, magnesia, sulphur, or a vegetable drug. 
Table of Principal Latin Words Used in Pharmacy, with Contraction 
and Meaning. 
Term or phrase. 
Contraction. 
Meaning. 
Ad 
Ad 
To, up to. 
Add 
Add, let it be added. 
At pleasure. 
White. 
Adlib 
Albus 
Alb 
Every other hour. 
Before eating. 
Boiling water. 
Aqua bulliens 
Aq. bul! 
Well. 
Bis in die 
Twice a day. 
Let him (or her) take. 
Paper. 
Food. 
Cibus 
Cochlear or cochleare, Cochleatim 
Coch., Cochleat... 
A spoonful, by spoonfuls. 
A tablespoonful. 
A large spoonful (about half an ounce). 
A dessertspoonful (about 2 fluid drams). 
A teaspoonful (about 1 fluid dram). 
Col 
Collunarium 
Collvrium 
An eye wash. 
A gallon. 
Against. 
Contra 
Cortex 
Cort 
Cum 
C 
With. 
Let it be divided into equal parts. 
Ejusdem 
Et 
Fac., fiat 
F., ft... . 
Make, let it be made. 
Make 12 papers. 
Make 12 pills. 
Make 12 powders. 
Let it be made according to the rules of art. 
Fiant chartulse xii 
Fiant pilulse xii 
Ft.pil.xii_. 
Fiant secundum artis regulas 
F.S.A.R 
Fiat solutio 
Filtra 
Filter (thou). 
Flavus 
Gargarisma 
A gargle. 
A drop. 
By drops. 
Gutta 
Gtt. 
Guttatim 
Idem 
Misce 
M 
Mix. 
Non 
Not. 
Do not repeat. 
A pint. 
Equal parts. 
After eating. 
Occasionally, as needed. 
A powder. 
Octarius 
0 
Post cibum 
P. c 
Pulvis 
Pulv 
Quantum sufficiat, Quantum satis 
Recipe 
Q. S 
R 
Take (thou). PHARMACY. 
405 
Table of Principal Latin Words Used in Pharmacy, etc.—Continued. 
Term or phrase. 
Contraction. 
Meaning. 
Secundum artem, Secundum naturam. 
S. a., S. n 
Ss 
According to art, according to nature. 
A half. 
Mark thou. 
Dissolve. 
Above. 
Three times a day. 
The last ordered. 
An ounce. 
As directed. 
Sig 
Ter in die 
Ultimo (or ultima) pnescriptus 
T.i.d 
Ult. prsesc 
Ut Diet 
INCOMPATIBILITY. 
Incompatibility is a condition in which drugs used in pharmaceutical mix- 
tures will not combine, produce new compounds, or are therapeutically opposed. 
These conditions are known as pharmaceutical, chemical, and therapeutic in- 
compatibility. 
Chemical incompatibility is chemical action resulting in the decomposition of 
one or more of the ingredients entering into the prescription. It may result 
in precipitation, production of a gas, change in color, or explosive poisonous 
compounds, and is sometimes intentional. Examples: Alkaloids will be precipi- 
tated from their solution by tannic acid, alkalies, carbonates, iodine or iodides, 
phosphates, boric acid, and borates. Explosive compounds will result from 
mixing powerful oxidizing agents with others which are readily oxidizable, 
such as nitric, free hydrochloric, and nitrohydrochloric acids, potassium 
chlorate, or potassium permanganate with glycerin, sugar, alcohol, oils, ethers, 
tannin, sulphur, sulphides, phosphorous, and liypophosphites. Glucosides are 
decomposed with substances containing emulsin. Iron salts with tannic acid 
or drugs containing tannin produce inky mixtures. 
Pharmaceutical incompatibility is the condition arising from mixture of 
pharmaceutical preparations which result in the physical dissociation of one 
or more constituents, but without chemical action. Examples: Tincture of 
chloride of iron added to syrup of acacia will gelatinize; fluid extracts diluted 
with liquids differing from those used in the fluid extracts cause the gum, 
albumin, resin, or mucilage to separate. Water is the solvent for albuminous, 
gelatinous, gummy, and saccharine bodies and for a large number of inorganic 
salts, while alcohol is the solvent for volatile oils and resins, gumresins, resin- 
oids, balsams, and all drugs containing these substances as their active prin- 
ciples. The solvent power of either alcohol or water for the particular sub- 
stance decreases in proportion to the amount of one added to the other. 
Therapeutic incompatibility occurs when two agents antagonistic to each 
other in their action on the human system are given together. Examples: 
Belladonna in any form with physostigmine; a solution of bromide of potash 
with strychnine; opium with caffeine; solutions containing pepsin with alkalies 
or pancreatin with acids. 
In many cases physiological antagonists intentionally are given together so 
that one will act as a guard against the excessive action of the other, as the 
use of morphine with atropine. 
THE HARRISON NARCOTIC LAW. 
The Harrison narcotic law, enacted by the United States Congress December 
17, 1914, provides that on or after March 1, 1915, every person who produces, 406 
HOSPITAL CORPS HANDBOOK. 
BSRCSNTAGE SO LOT I ON TABLE, showing the quantity of drug and water to us® far preparing aqueous 
solutions of different strengths. In the calculations 456 grains have4Seen taken as the of 
1 fluidounce of distilled water. To prepare solutions of strength designated helow, TAKE: 
Water Grains of drug to mate a solution containing 
Fluid- 
ounces 
-mo 
TOT 
1 
1 
2oo6 
TOT 
1 
OT) 
4* 
1# 
2$ 
3$ 
4£ 
5% 
IC# 
20$ 
25$ 
50$ 
~300U 
■' i 
2 
0.046 
0.057 
0.076 
0.114 
0.228 
0.457 
1.14 
2.3 
4.6 
7. 
9.5 
12. 
25.3 
57. 
76. 
228. 
1 
0.091 
0.114 
0.152 
0.228 
0.456 
0.913 
2.29 
4.6 
9.3 
14.1 
19. 
24. 
50.6 
114. 
152. 
456. 
2 
0.182 
0.228 
0.304 
0.456 
0.912 
1.83 
4.58 
9.2 
18.6 
28.2 
38. 
48. 
101.3 
228. 
304. 
912. 
3 
0.273 
0.342 
0.456 
0.684 
1.37 
2.74 
6.87 
13.8 
27.9 
42.3 
57. 
72. 
151.9 
342. 
456. 
1363. 
4 
0.365 
0.456 
0.608 
0.912 
1.82 
3.65 
9.16 
18.4 
37.2 
56.4 
76. 
96. 
202.6 
456. 
608. 
1824© 
6 
0.547 
0.684 
0.912 
1.37 
2.74 
5.48 
13.75 
27.6 
55.8 
84.6 
114. 
144. 
303.9 
684. 
912. 
2736© 
8 
0.729 
0.912 
1.22 
1.82 
3.65 
7.31 
18.32 
36.8 
74.4 
112.8 
152. 
192. 
405.2 
912. 
1216. 
3648. 
12 
1.094 
1.37 
1.82 
2.74 
5.47 
10.96 
27.5 
55.2 
111.6 
169.2 
228. 
288. 
607.9 
1368. 
1824. 
5472. 
16 
1.46 
1.82 
2.43 
3.65 
7.3 
14.6 
36.64 
73.6 
148.8 
225.6 
304. 
384. 
810.4 
1824. 
2430. 
7296. 
imports, manufactures, com- 
pounds, deals in, dispenses, sells, 
distributes, or gives away opium 
or coca leaves or any compound, 
manufacture, salt, derivative, or 
preparation thereof, shall regis- 
ter with the collector of internal 
revenue of his district his 
name or style, place of business, 
and place or places where such 
business is carried on. The 
provisions of this act are not 
construed to apply to tire sale, 
distribution, giving away, dis- 
pensing, or possession of prepa- 
rations and remedies which do 
not contain more than 2 grains 
of opium or more than one- 
eighth grain of heroin, or more 
than 1 grain of codeine, or 
any salt or derivative of them 
in 1 fluid ounce, or, if a solid 
or semisolid preparation, in 1 
avoirdupois ounce, or to lini- 
ments, ointments, or other prep- 
arations which are prepared for 
external use, except liniments, 
ointments, and other prepara- 
tions which contain cocaine, 
* * * etc.; provided such 
preparations are sold, distrib- 
uted, given away, dispensed, or 
possessed as medicines and not 
for the purpose of evading the 
intentions .or provisions of this 
act. 
Hospital corpsmen are re- 
ferred to the following para- 
graphs in the Manual of the 
Medical Department for infor- 
mation regarding the custody 
and use of narcotics in the 
United States Navy: 737-739, 
756, 1157, 1699, 1723, 1794. 
References. 
Principles of Pharmacy.—Arny. 
Practice of Pharmacy.—Remington. 
Compend of Pharmacy.—Stewart. 
Whys in Pharmacy.—Ruddiman. 
Incompatibilities in Prescriptions.— 
Ruddiman. 
Pharmaceutical and Medical Chemis- 
try.—Sadtler and Coblentz. 
Fig. 178.—Percentage solution table. (Squibb’s Message, June, 1922.) CHAPTER VIII. 
MATERIA MEDICA.1 
GENERAL CONSIDERATIONS. 
Used in the treatment of disease are many substances obtained from the 
animal, vegetable, and mineral kingdoms. These substances generally are 
spoken of as medicines and in studying them, it is necessary to consider their 
source, composition, physical characteristics, chemical properties, preparation 
and administration, and physiological and toxicological action. The science 
which treats of the substances used as medicines is materia medica. 
That particular science which relates to the properties of medicinal sub- 
stances and the application of remedial agents in the treatment of disease is 
known as therapeutics. In addition to the use of drugs as remedial agents, 
electricity, water, serums and vaccines, light rays, heat, physical, mechanical, 
and operative measures, and hygienic agents are employed for curative pur- 
poses. Therapeutics is divided into three classes known as rational, which 
is based upon known laws of the remedies and the diseases, empirical, based 
entirely on the results of clinical observation and experience, and general, 
when remedial agents other than drugs or medicines are used. 
Medicines may he divided into two general groups—stimulants, which in- 
crease the functional activity of the body or of any organ or tissue, and 
sedatives, which lessen or reduce the functional activity and, according to 
their composition, are inorganic or organic. 
Ttie various preparations of drugs or the different forms in which they may 
be used and the names given to substances of vegetable origin have been 
discussed in the chapter on Pharmacy. 
Medicinal substances usually are described according to their actions and 
effects on the body or its organs and tissues, and following is a list of the 
terms used, with definitions of the therapeutic action of each. 
Alteratives: Medicines used to modify nutrition so as to overcome morbid 
processes. 
Analgesics or Anodynes: Medicines used to allay pain. 
Anaesthetics: Drugs used to produce local or general insensibility. 
Anaphrodisiacs: Medicines which depress the sexual appetite and function. 
Anhydrotics: Medicines which are used to diminish perspiration. 
Antacids: Medicines used to neutralize acid in the stomach and intestines. 
Anthelmintics: Medicines used to destroy or expel intestinal worms. 
Antidotes: Medicines or agents which act upon poisons in such a manner 
as to alter their composition, rendering them less poisonous, and so preventing 
their toxic action from being exerted upon the organism. 
Antiemetics: Medicines used to arrest vomiting. 
Antiperiodics: Medicines used for the relief of periodically recurring dis- 
eases, such as malaria. 
Antiphlogistic^: Medicines or agents which reduce or dissipate inflammation. 
Antipyretics: Medicines used in the reduction of body temperature in fevers. 
1 Prepared by Chief Pharmacist E, G, Swann, United States Navy, 
407 408 
HOSPITAL CORPS HANDBOOK. 
Antiseptics: Substances which have the power of preventing the growth and 
development of bacteria. 
Antisialics: Medicines or agents which reduce the secretion of the saliva. 
Antispasmodics: Medicines used for the relief of nervous irritability and 
minor spasms. 
Antisyphilitics: Medicines used in the treatment of syphilis. 
Aperient: A mild cathartic. 
Aphrodisiacs: Medicines which stimulate sexual appetite and function. 
Aromatics: Medicines characterized by a fragrant or spicy taste and odor 
and which stimulate the gastrointestinal mucous membrane. 
Aromatic hitters: Medicines which unite the properties of the aromatics and 
the simple bitters. 
Astringents: Medicines which produce shrinkage of mucous membranes or 
raw tissues, decreasing the amount of exudation from them. 
Bitters, simple: Medicines which have a bitter taste and have the effect of 
stimulating the gastrointestinal mucous membrane without affecting the gen- 
eral system. 
Cardiac depressants: Medicines used to lessen the force and frequency of the 
heart’s action. 
Cardiac stimulants: Medicines used to increase the force and frequency of 
the heart’s action. 
Carminatives: Medicines which aid in the expulsion of gas from the stomach 
and intestines by increasing peristalsis, stimulating circulation, etc. 
Cathartics: Medicines which increase or hasten the evacuation of the intes- 
tines. They are classified according to their power, as follows: Laxatives or 
aperients, simple purgatives, drastic purgatives, saline purgatives, hydrogogues, 
cholagogues. 
Cerebral depressants: Medicines which lower or suspend the functions of the 
higher brain after a preliminary stage of excitement. 
Cerebral excitants: Medicines which, if given in proper doses, increase the 
functional activity of the cerebrum without causing any subsequent depression 
or suspension of the brain function. 
Correctives: Medicines which are used to correct or render more pleasant 
the action of other remedies, especially purgatives. 
Deliriants: Medicines which excite the functional activity of the higher brain 
to such a degree as to disorder the mental faculties and produce intellectual 
confusion, loss of will power, delirium, and even convulsions. 
Demulcents: Substances usually of oleaginous or mucilaginous natures, 
which soothe and protect the parts to which they are applied. 
Deodorants: Substances which destroy or hide foul odors. 
Diaphoretics: Medicines which produce increased excretion of sweat. 
Digestants: Ferments and acids which have the power of aiding in the solu- 
tion of food. 
Disinfectants: Substances which have the power of destroying disease germs. 
Diuretics: Medicines which increase the secretion of the urine. 
Emetics: Medicines which produce vomiting. 
Escharotics or caustics: Substances which destroy the tissue to which they 
are applied and produce a slough. 
Expectorants: Medicines which increase bronchial secretion. 
Febrifuges: Medicines which lessen fever. 
Haemostatics: Medicines which arrest haemorrhages (usually applied to in- 
ternal bleeding). MATERIA MEDICA. 
409 
Hepatic stimulants: Medicines which increase the functional activity of the 
liver cells and the amount of bile secreted. 
Hypnotics: Medicines which, in the proper doses, produce sleep without nar- 
cotic or deliriant effects. 
Irritants: Substances which, when applied to the skin, produce more or less 
vascular excitement. When employed to excite a reflex influence on a part 
remote from the place of application they are termed counterirritants. Rube- 
facients, 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. 
Motor depressants: Medicines which lower the functional activity of the 
spinal cord and the motor apparatus, and in large doses paralyze them directly. 
Motor excitants: Medicines which increase the functional activity'of the 
spinal cord and motor apparatus, producing heightened reflex excitability, dis- 
turbances of motility, and when given in large doses, tetanic convulsions; their 
ultimate effect being motor paralysis from overstimulation. 
Mydriatics: Medicines which cause dilation of the pupil. 
Myotics: Medicines which cause contraction of the pupil. 
Narcotics: Drugs which “lessen the relationship of the individual to the ex- 
ternal world.” At first excitant to the higher brain they soon cause profound 
sleep, characterized by increasing stupor, and if the dose is sufficient, coma, in- 
sensibility, and death by paralysis of the nerve centers which control organic 
life. 
Neurotics: Medicines which act upon the nervous system. 
Nutriants: Medicines which modify the nutritive processes. 
Nutrients: Substances which give nourishment to the system. 
Parasiticides: Medicines which destroy the various animal and vegetable 
parasites. 
Prophylactics: Medicines which prevent the taking or the development of 
disease. 
Pulmonary sedatives: Medicines which relieve cough and dyspnoea by lessen- 
ing the irritability of either the respiratory center or the nerves of respiration. 
Purgatives: Medicines which produce free evacuation of the bowels. 
Refrigerants: Medicines which impart a sensation of coldness and thereby 
allay thirst and restlessness. 
Renal depressants: Medicines or agents which lessen the secretion of the urine. 
Respiratory depressants: Medicines which lower the action of the respiratory 
center. 
Respiratory stimulants: Medicines which exalt the function of the respiratory 
center in the medulla, quickening and deepening the breathing. 
Sialogogues: Medicines which increase the secretion of the salivary glands 
(the secretion of the mouth). 
Soporifics: Hypnotics. 
Specifics: Medicines whicv have a direct curative influence on certain indi- 
vidual diseases. 
Stomachics or gastric tonics: Medicines which increase the appetite and pro- 
mote gastric digestion. 
Styptics: Medicines or applications to control external hsemorhages. 
Tcmiacides: Medicines which kill the tapeworm. 
Tonics: Medicines which augment gradually and permanently the strength 
and vital activity of the body or its organs, increasing the vigor of the entire 
system. 
Vermicides: Medicines which kill intestinal worms. 
Vermifuges: Medicines which cause the expulsion of intestinal worms. 410 
HOSPITAL CORPS HANDBOOK. 
Vesical sedatives: Medicines which lessen the irritability of the bladder, 
deci’easing the desire to urinate, and relieving vesical pain and tenesmus. 
Vesical tonics: Medicines which increase the tone of the muscular fibers in 
the wall of the bladder, consequently the power for contracting and expelling 
the urine is increased. 
Administration of medicines. 
The normal or adult dose of medicine is based upon the condition that the 
individual must be 24 years of age and weigh about 150 pounds. Persons un- 
der 24 and over GO years of age require smaller doses in proportion. 
In computing the dose for persons under 24 years of age, the following rules 
are applicable. Young’s rule directs that the age of the person be taken as 
the numerator of the fraction and the age plus 12 as the denominator. Thus 
for a child 3 years old 3 would he the numerator and 3 plus 12, or 15, the 
q 
denominator, —- —1/5 of adult dose. Cowling’s rule directs that the age 
O ~j~ 11 
at next birthday be taken as the numerator of the fraction, and 24 (the age 
of the adult) as the denominator of the fraction. 
In using either of the above rules it should be remembered that children usu- 
ally require larger doses of purgatives, diaphoretics, and diuretics, and smaller 
doses of narcotics than is called for. 
When the dose of a drug is spoken of, the amount necessary to produce a 
medicinal effect in an adult, or the therapeutic dose, ordinarily is meant. The 
doses given in the Pharmacopoeia are the average therapeutic doses. In ad- 
dition, there are the minimum dose, the smallest quantity which can produce 
a medicinal effect, the maximum dose, the largest quantity which can be given 
without probable poisoning or harmful effects, the toxic dose, which is the 
amount producing poisoning, and the lethal dose, which is the smallest dose 
that will produce death. The average dose is the one usually learned. In 
the administration of medicines there are many factors which affect the dose, 
the method of administration, and the frequency of the doses. These condi- 
tions, briefly described, are: 
1. Age.—Children (see above rules) and aged adults as a rule require less 
than the normal adult dose. 
2. Sex.—Females require smaller doses than males. 
3. Race.—Negroes usually require larger and Asiatics smaller doses than 
white people. 
4. Physical condition.—Strong, burly patients require larger doses than 
weak patients. 
5. Temperament.—Sanguine (ardent, cheerful, full-blooded) temperaments 
require smaller doses of stimulants than phlegmatic (heavy, dull, stolid, 
apathetic) temperaments. 
6. Idiosyncrasy.—'This is the peculiarity of individuals to tolerate certain 
drugs. 
7. Climate.—People in warm climates, as a rule, require smaller doses of 
purgatives. 
8. Occupation.—Men working out of doors at hard labor will require larger 
doses than those who sit at a desk all day. 
9. Habitual use.—This modifies the dose by lessening the medicinal power 
of the drug, and the dose must be increased greatly to obtain a medicinal 
effect (opium, morphine, and cocaine users). 
10. Disease.—Disease conditions modify the dose, as in tetanus and peri- 
tonitis, when larger doses of narcotics are tolerated. MATERIA MEDICA. 
411 
11. Form of the drug.—This controls largely the rate of absorption, as all 
substances must be reduced to solution before entering the circulation. 
12. Time of administration.—Drugs given before a meal are more quickly 
absorbed than those administered upon a full stomach. 
13. Mode of administration.—As a rule drugs administered hypodermically 
are used in much smaller quantities. 
14. The frequency of administration.—It is obvious that the dose of a drug 
is less if administered frequently than if administered at long intervals. 
Medicinal substances may be introduced into the circulation by any one of 
the following methods: 
By mouth.—This is the most common of all methods and is usually the most 
desirable except when very rapid action is required. 
Subcutaneously.—-This method frequently is used when rapid action is desired 
or when the stomach will destroy the virtue of the drug if given by mouth. 
By rectum.—This method is used when it is impossible to administer drugs 
by mouth because of vomiting, semi or unconsciousness, delirum, or certain 
disease of the gastrointestinal tract. 
By inunction.—This consists of applying ointments or oily combinations to the 
skin and rubbing them in. 
Intravascularly.—By this means preparations of drugs are introduced directly 
into a vein. 
Inhalation.—By this method medicated vapors or drugs, such as ether or 
chloroform, are inhaled into the respiratory system. 
Fumigation.—In this manner easily volatilized drugs are applied directly to 
the skin, except the head, by means of a vapor bath. 
By hypodermoelysis.—This consists of introducing solutions of saline into the 
loose tissues about the breasts, abdomen, or below the scapulae. 
Intramuscularly.—This consists of injecting readily absorbable, sterile prepa- 
rations of drugs into the muscle tissue. 
In order to obtain the greatest benefit of their action, as a general rule, 
hitters are administered before meals; alkalies, if to increase the flow of 
gastric juice, before meals; if to neutralize the acidity of the gastric juice, 
after meals; acids, one-half to one hour before meals; laxatives, before retiring; 
active cathartics, the first thing in the morning; hypnotics, from one-half to 
two hours before sleep is required; slowly acting drugs (digitalis), at long 
intervals; vapidly acting drugs (ammonia, nitroglycerine) at very short in- 
tervals ; such drugs as mercury, arsenic, iron, iodides, not on an empty 
stomach, but from one-half to one hour after meals. 
Following is a brief description of drugs in common use, grouped in the 
various classes to which they belong. In addition to the medicines listed on the 
Supply Table of the Medical Department, United States Navy, several impor- 
tant drugs used, more or less, in the treatment of disease also are given. 
INORGANIC MATERIA MEDICA. 
The official Latin and English titles, the common names or synonyms, and 
the symbolic formulas, if any, appear in italics in the following descriptions of 
medicinal substances. Those official in the Pharmacopoeia are indicated by the 
letters U. S. P. following the names, and drugs recognized by the National 
Formulary by the letters N. F. 
The nonmetals and some of their compounds. 
The Halogens.—The halogen elements are fluorine, chlorine, bromine, and 
iodine. Owing to the readiness with which they combine with metals to form 
47829°— 23 27 412 
HOSPITAL CORPS HANDBOOK. 
salts which are much alike and resemble common salt in their properties, the 
name halogen (meaning salt producer) has been applied to this group of ele- 
ments. In their chemical and physical properties the halogen elements are 
closely related. They are classed as negative elements because they are electro- 
negative in their properties, combining with electropositive elements (metals) 
to form stable compounds (salts). 
Chlorum, Chlorine, Cl.—Cldorine is not recognized by the Pharmacopoeia, but 
a number of compounds containing chlorine in loose chemical union from 
which it can be set free easily are official, and one of these is on the Supply 
Table, chlorinated lime. 
Cldorine is a yellowish green gas, having a suffocating odor, and when in- 
haled acts as a corrosive poison to the mucous membrane of the air passages. 
It is a deadly poison and was used during the World War as a poisonous gas. 
It is chemically very active, and this property is taken advantage of in the use 
of chlorine as a disinfectant and bleaching agent. 
Calx Chlorinata, Chlorinated Lime (Chloride of Lime), U. S. P.—A product 
resulting from the action of chlorine upon calcium hydroxide and containing 
not less than 30 per cent of available chlorine. Preserve it in air-tight con- 
tainers, in a cool and dry place. 
Properties: It occurs as a white or grayish white granular powder having 
the odor of chlorine. It becomes moist and gradually decomposes on exposure 
to the air. When in that condition this substance must not be used or dispensed. 
When treated, with an acid, chlorine is liberated freely. It has been proved 
by experiment that chlorinated lime at 98° F. loses 96 per cent of its efficiency 
measured as “ available chlorine,” in eight weeks, and at a higher temperature 
the loss is greater. The decomposition is evidently largely due to the moisture 
in the bleaching powder, as dry powder keeps better than the moist. This rapid 
loss of chlorine can be overcome to a great extent by mixing quicklime (CaO) 
with the chlorinated lime in the proportion of three parts of quicklime to seven 
parts of chlorinated lime. This is sufficient to absorb the moisture and keep 
the chlorinated lime dry. 
Action and Uses : It is used in the preparation of chlorinated soda, U. S. P., 
and chlorated potassa, N. F. Extensively used as a bleaching agent. Its prin- 
ciple use in medicine is as a disinfectant and deodorant. In the field with 
troops it is used as a disinfectant for excreta and for the disinfection of 
water; 1 gram is sufficient to purify 40 gallons of water. 
Chlorazene (Chloramine-T), Sodium Para-toluene-sulpho-chloramide CH3- 
C6H4S02NaNCl-{-3H20.—It is an active germicide acting like the hypochlorites, 
but less irritating. It does not coagulate or precipitate proteins, and is non- 
toxic and noncaustic. 
Uses: It is used in the treatment of infected wounds where a nonirritating 
germicide is desired in aqueous solution from 0.1 to 4 per cent. 
Diehl oramine-T, Para-toluene-sulphone-dichloramide, CII3. C& H,. S O W C h.—It 
contains about 29.5 per cent of available chlorine. 
Properties : It is a pale yellowish, crystalline powder, having a strong 
chlorous odor; is insoluble in water, but soluble in chlorcosane, a chlorinated 
and liquified paraffin wax manufactured especially as a solvent for dichlora- 
mine-T. 
Action and Uses: Solutions of dichloramine-T made with chlorcosane in 
strengths from 1 to 5 per cent are employed in surgery as an antiseptic. 
Weaker solutions are employed for the treatment of nose and throat affections. 
The solutions should be kept in glass-stoppered, amber bottles, and protected 
from high temperature and direct sunlight. MATERIA MEDICA. 
413 
Iodum, Iodine, /., U. S. P.—It contains not less than 99.5 per cent of I. Pre- 
serve it in glass-stoppered bottles, in a cool place. 
Properties : It occurs as heavy, bluish-black, brittle, rhombic plates, having 
a metallic luster, a distinctive odor, and a sharp, acid taste. Specific gravity, 
4.66. It is soluble in 2,950 parts of water, 12.5 c. c. of alcohol, 80 c. c. of 
glycerin, and is freely soluble in chloroform, ether, or aqueous solutions of 
iodides (potassium iodide). With starch paste it gives a deep-blue color. The 
color of iodine is discharged by sodium hyposulphite (used to remove iodine 
stains). 
Preparation : It is obtained from Chilean saltpeter, where it occurs as sodium 
iodate mixed with sodium nitrate, but is obtained chiefly from the ashes of 
certain seaweed known as kelp (sodium iodide). 
Action and Uses : See tincture of iodine. It is used in making tincture of 
iodine, U. S. P., compound solution of iodine, U. S. P., and iodine ointment, 
U. S. P. 
Average dose: 0.005 gm., or one-twelfth grain. 
Tinctura Iodi, Tincture of Iodine, U. S. P.—An alcoholic solution of iodine 
and potassium iodide. One hundred c. c. contains not less than 6.5 gm. nor 
more than 7.5 gm. of I., and not less than 4.5 gm. nor more than 5.5 gm. of KI. 
Preparation : See U. S. P. 
Action and Uses: It is applied externally as a counterirritant, 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 opera- 
tions. 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 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. - Iodine 
stains can be removed from linen with a solution of sodium hyposulphite. 
Average dose: 0.1 c. c. or l\ minims (diluted with water). 
Oxygen, nitrogen, and sulphur. 
Oxygenum, Oxygen, O., U. S. P.—It contains not less than 95 per cent by 
volume of O. Por convenience it usually is compressed in metal cylinders. 
Properties : It is a colorless, odorless, tasteless gas, and supports combustion 
more readily than air. It is soluble in 34 volumes of water and in 3.6 volumes 
of alcohol. 
Preparation : Oxygen is prepared extemporaneously by the action of water 
on sodium peroxide. The action is made to take place in a suitable metallic 
container and the oxygen is generated and liberated when it is needed. Oxygen 
freshly made is more efficient than that stored in cylinders. Lungmotors and 
pulmotors are supplied with sodium peroxide generators for making oxygen. 
The reaction that takes place is Na202+H20=2Na0H-|-0. 
Action and Uses : It is administered by inhalation whenever the amount of 
oxygen that the patient is able to take from the air is insufficient, as in cardiac 
diseases, pulmonary oedema, pneumonia, asphyxia from toxic gases, drowning, 
etc. It forms a definite compound with the haemoglobin of the blood, giving 
the blood its bright-red color. It frequently is used with nitrous oxide in 
anaesthesia to prevent cyanosis. 414 
HOSPITAL CORPS HANDBOOK. 
Aqua, Water, II20., U. S. P. (ordinary drinking water),—Water is a colorless, 
limpid liquid practically tasteless and odorless. It is neutral to litmus. (See 
U. S. P. for standard of purity.) Ordinary water very often contains, in 
solution or suspension, traces of salts, organic matter, and gases. These im- 
purities do not render it unfit for drinking purposes or for making many 
pharmaceutical preparations for immediate use, but their presence is a serious 
objection in certain cases in which water is used as a solvent. 
Aqua Destillata, Distilled Water, U. S. I*.—The Pharmacopoeia requires that 
distilled water he practically free from all other matter, and that it be com- 
posed entirely of IPO. When water is directed to he used in the formulas 
of the U. S. Pharmacopoeia and the National Formulary, distilled water nearly 
always is specified. Distilled water should be kept in glass-stoppered bottles 
which have been rinsed with hot distilled water before being filled. 
A qua Destillata Sterilizata, Sterilised Distilled Water, U. S. P.—It is made 
by sterilizing freshly distilled water in a flask made of hard glass (which 
previously has been cleaned and sterilized as directed by the Pharmacopoeia), 
into the mouth of which has been introduced a pledget of sterilized purified 
cotton. Sterilization is accomplished by boiling the water for 30 minutes and 
allowing it to cool without removing the cotton. After it cools the mouth 
of the flask is tightly covered with a piece of paper to prevent contamination 
through the air. Sterilized distilled water is used largely in making solutions 
for intravenous injections, and to insure against infection it should be used 
within 48 hours after it is made. As an added precaution it is well to use 
double-distilled water in making up sterilized distilled water. 
Liquor Hydrogenii Dioxidi, Solution of Hydrogen Dioxide, H202 (Solution of 
Hydrogen Peroxide, Aqua Hydrogenii Dioxidi), U. S. P.—An aqueous solution 
containing not less than 3 per cent by weight of H202 (34.02), corresponding to 
not less than 10 volumes of available oxygen. Preserve it in a cool place 
protected from light. Only slight pressure should be used in removing the 
stopper from the bottle. 
Preparation : It is made by the action of barium dioxide on phosphoric 
acid, Ba02+H3P04=Ba(HP04)+H202. 
Properties : Hydrogen dioxide is decomposed easily into water and oxygen 
and its bleaching and antiseptic properties are due to the oxygen which it 
gives up. This decomposition takes place rapidly in the presence of decom- 
posing organic matter. In contact with pus it gives off oxygen so rapidly 
that effervescence is produced. 
Uses and Dosage: It is of great value in cleaning wounds and ulcers. It 
should not be injected into cavities unless there is a free outlet for the escap- 
ing oxygen. It is used extensively as a mouth wash and gargle. Its antiseptic 
properties are of short duration because its energy quickly is spent. It rarely 
is given internally. 
Average dose: 4 c. c. or 1 fluid dram. 
Nitrogenii Monoxidum, Nitrogen Monoxide, N20 (Nitrous Oxide, Laughing 
Gas), U. S. P.—It is nitrogen monoxide gas (N20). 
Properties : It is a colorless gas, having a slight characteristic odor and a 
sweetish taste. It is very soluble in water at low temperature, and supports 
the combustion of many substances. 
Action and Uses : It is a general anaesthetic and is used both in surgery 
and in dentistry. It also is used in conjunction with ether for anaesthesia 
purposes, producing anaesthesia in from one to three minutes, It usually is 
given mixed with oxygen to avoid narcosis. MATERIA MEPTCA. 
415 
Sulphur sublimation, Sublimed Sulphur, S, (Flowers of Sulphur), U. S. P.— 
It contains, when dried to constant weight over suphuric acid, not less than 
99.5 per cent of S. 
Properties : It is a fine, yellow powder, having a slight characteristic odor 
and faintly acid taste. It is insoluble in water, nearly insoluble in alcohol, 
slightly soluble in ether, and partly soluble in chloroform, carbon disulphide, 
and olive oil. 
Preparation : Sulphur is obtained in the United States principally from 
sulphur mines located in Louisiana, Texas, Utah, California, and Nevada, where 
it exists in the free state (uncombined chemically). In Louisiana and Texas 
it is mined by forcing steam under high pressure between the walls of a 
double-walled iron pipe into the deposits, thus melting the sulphur, and 
the pressure of the steam forces the molten sulphur out through the inner 
pipe. It then is washed and purified by sublimation (sublimed sulphur). 
Sulphur nearly always is contaminated with arsenic and before it is fit 
for internal use it must be treated with dilute ammonia water, which not 
only removes arsenic but also the acids of sulphur, after which it is known 
as washed sulphur. Washed sulphur is used internally and sublimed sulphur 
externally. 
Action and Uses: Internally, sulphur (washed) is used as a laxative. 
Compound licorice powder which is used as a laxative contains washed 
sulphur. Externally, sulphur (sublimed) is used as a parasiticide, in the 
form of the ointment (U. S. P.). Sulphur ointment is an efficient remedy in 
the treatment of scabies. Sulphur dioxide gas is generated by burning sulphur 
in the air (oxygen). Five pounds of sulphur wall generate sufficient sulphur 
dioxide to disinfect 1,000 cubic feet of air space. 
Average dose: 4 gm. or 1 dram (washed sulphur). 
Inorganic or mineral acids. 
These compounds all contain hydrogen which is replaceable by metals 
forming salts, have a characteristic sour taste and corrosive action, and 
change the color of blue litmus to red. When acted upon by a base (alkali) 
they are neutralized and in turn neutralize the base, forming a salt and 
water. This is why an acid is used as an antidote for poisoning by a base, 
and a base as the antidote for acid poisoning. An acid is defined as a com- 
pound of hydrogen with an electronegative element or radicle. Sulphur (S) 
is an electronegative element and when it is combined with hydrogen we have 
HaS, hydrosulpliuric acid; SO* is the electronegative sulphate radicle, and 
when it is combined with hydrogen we have ILSCh, sulphuric acid. The 
strong inorganic acids should be handled with great care because they are 
very corrosive and poisonous. When given internally they should be very 
highly diluted, and should be taken through a glass tube to prevent injury 
to the teeth, and followed by rinsing the mouth with a solution of sodium 
bicarbonate. The chemical antidote for acid poisoning is any mild alkalil 
as, lime water, milk of magnesia, chalk, bicarbonate of soda, etc. 
Acidum Hydrochloricum, Hydrochloric Acid, HCl. (Muriatic Acid),U. S. P.— 
An aqueous solution containing not less than 31 per cent nor more than 33 
per cent of HCl. Preserve it in glass-stoppered bottles. It should be noted 
that about 68 per cent of the liquid is water and only 32 per cent (by weight) 
is hydrochloric acid (gas). Absolute HCl is a gas and this preparation is 
a solution of HCl gas in water. 
Preparation: It is made by acting on sodium chloride (common salt) with 
sulphuric acid. 2NaCl+H,S04+2HCl. 416 
HOSPITAL CORPS HANDBOOK. 
Properties : It is a colorless, fuming liquid having a pungent odor and an 
intensely acid taste. The fumes and odor disappear on adding the acid to twice 
its volume of water. It is strongly acid to litmus. Salts of hydrochloric acid 
are known as chlorides (sodium chloride) or as muriates (NEUCl, ammonium 
muriate). An aqueous solution containing not less than 9.5 per cent nor more 
than 10.5 per cent IIC1 is known as dilute hydrochloric acid. 
Action and Uses: Hydrochloric acid is a normal constituent of the gastric 
juice and sometimes is administered to make up any deficiency of this sub- 
stance in the gastric juice. Its principal use is in the manufacture of chlorides 
(salts), many of which are used in medicines. It also is used with nitric acid 
in making nitrohydrochloric acid. 
Average dose: 1 c. c. or 15 minims of the dilute acid. It should be diluted 
with one fluidounce of water and taken through a glass tube. 
Acidum Nitricum, Nitric Acid, HN03 (Aqua Fortis), U. S. P.—An aqueous 
solution containing not less than 67 per cent nor more than 69 per cent of 
HNOs. Preserve it in dark amber colored, glass-stoppered bottles, and protect 
it from light. 
Properties : Nitric acid is a colorless, fuming liquid, very caustic and corro- 
sive, and has a peculiar, somewhat suffocating odor. It should be handled with 
extreme care. 
Preparation : Made by the action of sulphuric acid on sodium nitrate. 
NaNC>3+H2SCh=NaHS04+HN03. 
Action and Uses: Nitric acid rarely is given internally. It is used in the 
manufacture of salts of nitric acid (nitrates) and in the manufacture of ex- 
plosives (trinitro-phenol, glyceryl trinitrate, trinitro-toluol, etc.) It is an 
extensively used oxidizing agent, breaking down in the presence of oxidizable 
substances, as follows: 2HN02=H20+N202+30. Applied to tissues it acts as 
an energetic caustic and frequently is used for cauterization and to remove 
warts. It is used with hydrochloric acid in the preparation of nitrohydro- 
chloric acid (not given internally), 
Acidum Sulphuricum, Sulphuric acid, H2SC>4 (Oil of Vitriol), U. S. P.—A 
liquid containing not less than 93 per cent nor more than 95 per cent of H2S04. 
Preserve it in glass-stoppered bottles. 
Properties : A colorless, odorless liquid, of oily consistency, very caustic 
and corrosive; strongly acid to litmus even when highly diluted. Specific 
gravity about 1.83 at 25° C. Miscible with water or alcohol, with the evolu- 
tion of much heat; the acid must be added with great caution to the diluent. 
In mixing water and sulphuric acid the acid always should be added to the 
water, and not the water to the acid. When mixed in a glass vessel the acid 
should be added slowly to avoid a sudden increase of temperature with possi- 
bility of breaking the glass vessel. Because of its great affinity for water it is 
used as a desiccating agent. Being one of the strongest acids known, it is 
capable of decomposing salts of other acids, forming salts of sulphuric acid, 
and setting free the other acids. This principle already has been demonstrated 
in the making of hydrochloric and nitric acids. (The chemical principle here 
displayed is that whenever a stronger acid acts on a salt of a weaker acid, a- 
salt of the former is formed, and the weaker acid is set free.) 
Preparation : There are several methods now employed in the manufacture 
of sulphuric acid, the principles involved being practically the same. Sulphur 
is burned with,the oxygen of the air forming sulphur dioxide; the sulphur 
dioxide is oxidized by the action of either an oxidizing agent (nitric acid) or 
a catalytic agent (platinum sponge) to sulphur trioxide. The sulphur trioxide 
then is brought in contact with steam in a leaden chamber (sulphuric acid does MATERIA MEDICA. 
417 
not act on lead), forming sulphuric acid. The simplest expression of the re- 
actions involved is as follows: 
(1) S+02=S02. 
(2) 2S02+N20=2S03+N202. 
(3) S0»+H,0=H2S0«. 
Dilute sulphuric acid is an aqueous solution containing not less than 9.5 per 
cent nor more than 10.5 per cent of H2S04. 
Average dose of the dilute acid is 1 c. c. or 15 minima 
Action and Uses: Sulphuric acid rarely is given internally. Its principal 
use is in manufacturing other preparations. Not only is it used in the prepara- 
tion of salts (sulphates) of sulphuric acid, but also in the manufacture of acids 
from their salts. 
Acidurn Sulphuric Aromaticum, Aromatic Sulphuric Acid (Elixir o/ 
Vitriol) U. S. P.—Aromatic sulphuric acid contains free sulphuric acid and ethyl 
sulphuric acid (C2H5HS04), together equivalent to not less than 19 per cent 
nor more than 21 per cent of H2S04. Preserve it in glass stoppered bottles. 
Properties : It is a clear, reddish-brown liquid, having a pleasant aromatic 
odor and is strongly acid to litmus. 
Preparation : It is made by mixing sulphuric acid, ethyl alcohol, and 
aromatics. 
Action and Uses : Used for night sweats in tuberculosis cases. 
Average dose: 1 c. c. or 15 minims. 
Acidurn Boricum, Boric Acid, 1I?,BOa (Boraoic Acid), U. S. P.—It contains, 
when dried to constant weight in a desiccator over sulphuric acid, not less 
than 99.5 per cent of H3B03. 
Properties : Boric acid occurs in transparent, colorless scales, of a some- 
what pearly luster, or as a white bulky powder; slightly unctuous to the 
touch, odorless, having a faintly bitter taste and is permament in the air. 
One gram of boric acid dissolves in 18 c. c. of water, 18 c. c. of alcohol, and in 4 
c. c. of glycerin, at 25° C. It is much more soluble in hot water or hot alcohol. 
Boric acid volatilizes from a boiling aqueous or alcoholic solution. It is faintly 
acid to litmus, being one of the weakest known acids. 
Preparation : It is made from sodium borate (borax) which is found in 
the United States in dried-out lakes in California. Sodium borate is treated 
with hydrochloric acid setting free the boric acid. Na2B407.10H20+2HCl= 
2NaCl+4H3B03+5H20. 
Action and Uses: It is used most extensively as a mild antiseptic. Its 
concentrated aqueous solution (5 per cent) can be used in any of the body 
cavities or orifices. It is used as an antiseptic dressing in surgery. Boric 
acid solution is used as an eye wash. It also may be used in the form 
of an ointment or as a dusting powder. It has been used as a food preservative 
but its use for this purpose is being restricted by the State and national food 
and drug acts. 
Average dose: 0.5 gm. or 8 grains (rarely used internally). 
The alkali elements and their compounds. 
The alkali metals are potassium, sodium, lithium, and the radicle ammonium. 
Chemically they are strongly electropositive, being directly opposite to the halo- 
gens. They are monovalent, soft, waxlike in consistence, having a low melting 
point, readily oxidize in the air and decompose water forming strong hydrox- 
ides (alkalies). These strong alkalies are very caustic and poisonous. Nearly 
all the salts of these alkalies (formed by their union with acids) are soluble in 418 
HOSPITAL CORPS HANDBOOK. 
water. Potassium, sodium, and lithium as such have no special medicinal action 
of value. The medicinal properties of their chemical compounds are exerted 
by the acid radicles with which they are combined; therefore the medicinal 
properties of the alkali salts vary greatly. Tlic chemical antidote for the 
strong alkalies is any weak acid, as citric acid, vinegar, dilute acetic acid, etc. 
When acids and alkalies are brought together in solution they neutralize each 
other forming new compounds (salts). In this way they act as antidotes for 
each other. 
Potassii Hydroxidum, Potassium Hydroxide, KOII (Caustic Potash, Lye, 
Potassium Hydrate), U. S. P.—It contains not less than 85 per cent of KOH. 
Preserve it in well closed containers. If bottles are used they must be made 
of hard glass. 
Properties : Potassium hydroxide occurs in dry, white, or nearly white 
flakes, fussed masses, or sticks; is hard and brittle and odorless. Great caution 
is necessary in handling it, as it rapidly destroys organic tissue. When exposed 
to the air it rapidly absorbs carbon dioxide and moisture, and deliquesces. It 
is very soluble in water, alcohol, and glycerin. (All the salts of potassium are 
soluble in water except potassium bitartrate.) It is strongly alkaline to red 
litmus, turning it blue even in a very dilute solution. 
Preparation: It is made by electrolysis (passing an electric current through 
potassium chloride). 
Action and Uses : Pure potassium hydroxide is not given internally, but a 5 
per cent solution sometimes is administered (dose 1 c. c.) as an antacid. If a 
large quantity should be swallowed accidentally, give vinegar or lemon juice 
as the antidote. Potassium hydroxide is used in making soap (soft soap). 
Lye may be composed of potassium hydroxide, although it usually contains 
sodium hydroxide, a cheaper substance. It sometimes is used as a caustic, but 
its principal use in medicine is in the manufacture of potassium salts. 
Potassii Acetas, Potassium Acetate, KC2H3O2, U. S. P.—It contains, when 
dried to constant weight at 150° C., not less than 99 per cent of KC=H302. 
Preserve it in air-tight containers. 
Properties : It is very deliquescent on exposure to the air, and is very soluble 
in both water and alcohol. An aqueous solution is alkaline to litmus. 
Preparation : It is made by the action of acetic acid on potassium bicar- 
bonate. KHC03+CILCOOH=CH3COOK+C02+H20. 
Action and Uses : Used as a diuretic, diaphoretic, and to render the urine 
alkaline. In large doses it acts as a laxative. It is decomposed in the system, 
forming carbonates. 
Average dose: 1 gm. or 15 grains. 
Potassii Bicarbonus, Potassium Bicarbonate, KHC03, U. S. P.—It contains, 
when dried to constant weight in a desiccator over sulphuric acid, not less 
than 99 per cent of KHC03. Preserve it in well closed containers. 
Properties : It is very deliquescent on exposure to air. It is very soluble in 
water, but almost insoluble in alcohol. When a solution of potassium bicar- 
bonate is heated it is converted into potassium carbonate. An aqueous solution 
is slightly alkaline to litmus. 
Preparation : It is made by passing carbon dioxide into a solution of potas- 
sium carbonate until it is saturated. K2C03+C02+H20=2 KHC03. 
Action and Uses: Its action when given internally is very much like that 
of potassium acetate. It renders the blood and urine alkaline. In manufac- 
turing pharmacy it is used in the preparation of many of the other potassium 
salts. 
Average dose: 1 gm. or 15 grains. MATERIA MEDI(’A. 
419 
Potassii Bitartras, Potassium Bitartrate, KHCJIiOe (Cream of Tartar), 
IT. S. P.—It contains, when dried to constant weight at 100° C., no less than 99.5 
per cent of KHCiELCe. Preserve it in well-closed containers. 
Properties : Occurs as a colorless or slightly opaque, gritty powder, odorless, 
and having a pleasant acidulous taste. It is very slightly soluble in water 
(the only sparingly soluble potassium salt in common use) and insoluble in 
alcohol. A saturated solution is acid to litmus. 
Preparation : It is made by purifying tartar, a substance deposited in wine 
casks during fermentation of grape juice in making grape wines. 
Action and Uses : Occasionally given as a hydrogogue cathartic. It is one of 
the constituents of baking powders. In baking powder it acts slowly on 
bicarbonate of sodium, liberating carbon dioxide, which becomes entangled in 
the dough and causes it to rise. It sometimes is used as a diuretic. 
Average dose: 2 gm. or 30 grains. 
Potassii Bromidum, Potassium Bromide, KBr, IT. S. P.—It contains, when 
dried to constant weight at 100° C., not less than 98.5 per cent of KBr. Pre- 
serve it in well-closed containers. 
Properties : Occurs as colorless or white cubical crystals or granular powder, 
odorless, and having a strongly alkaline taste. It is very soluble in water and 
glycerin and slightly soluble in alcohol. Its aqueous solution is faintly alkaline 
to litmus. 
Preparation.—It is made by passing bromine into a hot solution of potassium 
hydroxide when the following reaction takes place: 6KOH+3Br2=5KBr+ 
KBr03+3H20. The solution is evaporated to dryness and the residue is heated 
with charcoal (carbon) to redness when the bromate formed in the above reac- 
tion is reduced by the carbon to bromide, as follows: 2KBr03+3C2=2KBr+6C0. 
Potassium iodide and sodium bromide are made by an analogous process. 
Action and Uses : Used as a nerve sedative and hypnotic. 
Average dose: 1 gm. or 15 grains. 
Potassii Chloras, Potassium Chlorate, KClOs, U. S. P.—It contains not less 
than 99 per cent of KClOs. Preserve it in well-closed containers. Great 
caution should be observed in handling it, as dangerous explosions are liable to 
occur when it is heated or subjected to concussion or trituration with organic 
substances (cork, tannin, dust, sugar, etc.) or with sulphur, sulphides, hypo- 
sulphites, or other easily oxidizable substances. 
Properties : It occurs as colorless crystals or a white granular powder, odor- 
less, and having a peculiar cooling taste. It is soluble in 11.5 parts of water, 
soluble in glycerin, and insoluble in alcohol. It is capable of yielding oxygen 
when heated. 
Preparation : It is made by boiling together a solution of potassium chloride 
and calcium hypochlorite. 
Action and Uses : Applied locally in aqueous solution it acts as an antiseptic 
and stimulant to mucous membranes. It is decomposed easily by septic matter, 
yielding nascent oxygen, to which it owes its antiseptic properties. It is used 
in the following intlammatory conditions of mucous membranes: Catarrhal in- 
flammations of the mouth and fauces, ulcerative and mercurial stomatitis, 
nursing sore mouth, and tonsillitis. When given internally in large doses it 
is liable to cause destruction of the red blood cells. 
Average dose: 0.25 gm. or 4 grains (rarely used internally). 
Potassii et Sodii Tratras, Potassium and Sodium Tartrate (Rochelle Salt), 
U. S. P.—It contains not less than 73.73 per cent nor more than 77.39 per cent 
of anhydrous potassium and sodium tartrate, corresponding to not less than 99 420 
HOSPITAL CORPS HANDBOOK. 
per cent of the crystallized salt (KNaC4H4Oo.4H20). Preserve it in well-closed 
containers. 
Properties : Occurs as colorless, transparent crystals or white granular 
powder, odorless, and having a saline taste. Very soluble in water and almost 
insoluble in alcohol and slightly efflorescent in dry air. Its aqueous solution is 
slightly alkaline to litmus. 
Preparation : Made by neutralizing potassium bitartrate with sodium car- 
bonate. 2C2H2 (OH) 2COOK.COOH+Na2C03=2C2II2 (OH) 2COOK.COONa+H20 + 
C02. 
Action and Uses : Rochelle salt is an extensively used purgative in the form 
of Seidlitz Powder, U. S. P. (A seidlitz powder consists of two powders, one 
wrapped in white paper, and the other wrapped in blue paper. The contents 
of the blue paper are: Rochelle salt (115 grains), and sodium bicarbonate (38 
grains). The white paper contains 33 grains of tartaric acid. When admin- 
istered the contents of the two powders are dissolved separately, each in a half 
a glass of water, and then they are poured together and taken while effer- 
vescing. The effectiveness is caused by the action of the tartaric acid on 
the bicarbonate of sodium as follows: C2H2(0H)2(C00H)2+NaHC03= 
C2II2(0H)2C00Na.C00H+C02+H20. In this reaction sodium bitartrate is 
formed. 
Average dose: 1 set of two powders; 10 gm. or 21 drams. 
Potassii Citras, Potassium Citrate, U. S. P.—It contains, when dried to con- 
stant weight in a desiccator over sulphuric acid, not less than 99 per cent of 
C3H4(OH).(COOK)3+H20. Preserve it in well closed containers. 
Properties : Occurs as transparent prismatic crystals or a granular powder, 
odorless, and having a cooling taste. It is very soluble in water and glycerin, 
and almost insoluble in alcohol. An aqueous solution is alkaline to litmus. It 
is deliquescent when exposed to moist air; therefore it should he kept in well 
closed containers. 
Preparation: It can be made by adding bicarbonate of potassium to a solu- 
tion of citric acid until effervescence ceases. C3H4(OH). (C00H)2+3KHC03= 
C3H4 (OH). (COOK) 3+3H20+3C02. 
Action and Uses : It is used as a diuretic and to render the urine alkaline. 
Its medicinal properties are very much like those of potassium acetate. Potas- 
sium citrate is not found on the supply table but it can be made, if necessary, 
as directed above. 
Average dose: 1 gm. or 15 grains. 
Potassii 1 odium, Potassium Iodide, KI., U. S. P.—It contains, when dried to 
constant weight at 100° C., not less than 99 per cent of KI. Preserve it in well 
closed containers. 
Properties : It is very soluble in water and glycerin; slightly soluble in 
alcohol. Slightly deliquescent in moist air. Its aqueous solution is slightly 
alkaline to litmus. 
Preparation : It is made by the action of iodine on an aqueous solution of 
potassium hydroxide. (1.) (5K0H+3I2=5KI+KI03+3H20. (2.) 2KIO:1+3C2= 
2KI+6CO. 
Action and Uses: A valuable and much used alterative. It is used in the 
treatment of syphilis and rheumatism. It also is used for chronic lead, mer- 
cury, and arsenic poisoning, forming with these metals double soluble salts 
which are eliminated easily. 
Average dose: 0.3 gm. or 5 grains. 
Potassii Permanganas, Potassium Permanganate, KMnO4, U. S. P.—It con- 
tains, when dried to constant weight in a desiccator over sulphuric acid, not MATERIA MEDICA. 
421 
less than 99 per cent of KMnCh. Preserve it in glass-stoppered bottles. Potas- 
sium permanganate when in solution or in the dry condition must not be 
brought into contact with organic or other readily oxidizable substances. 
Properties : It occurs as slender prisms, of a dark purple color, odorless and 
having a disagreeable astringent taste. It is permanent in the air. It is soluble 
in 13.5 parts of water. An alcoholic solution can not he made because it is de- 
composed 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 property makes it 
a valuable antiseptic and disinfectant. 
Preparation : It is made by fusing together a mixture of potassium hy- 
droxide, manganese dioxide, and potassium chlorate, forming potassium 
manganate. When potassium manganate is boiled with water, potassium 
permanganate is formed. (1.) 3Mn02+6K0H+KC103=3K2Mn04+KCl+3H>0. 
(2.) 3K2Mn04+2H20=2KMnC>4+Mn02+4K0H. 
Action and Uses : It is used as an antiseptic irrigating fluid, especially 
for the urethra and bladder, in strengths of from to 1-10,000. It sel- 
dom is used externally, largely on account of the objectionable stain which 
it leaves. It is used in the treatment of poisoning by venomous snakes by 
injection into the wound. It also is used in the treatment of morphine 
poisoning. It has been used with formaldehyde solution to volatilize for- 
maldehyde gas in disinfection of rooms, but it has been displaced for this 
purpose by barium dioxide, a cheaper substance. 
Average dose: 0.06 gm. or 1 grain. 
Sodii Hydroxidum, Sodium Hydroxide, NaOH (Caustic Soda, Sodium 
Hydrate), PT. S. P.—It contains not less than 90 per cent of NaOH. Preserve it 
in well-closed containers. If bottles are used as cointainers they must be 
made of hard glass. 
Properties : It occurs in dry, white or nearly white fused masses or sticks, 
hard and brittle, showing a crystalline fracture. It is odorless and has a 
caustic taste. Exposed to the air, it deliquesces, absorbs carbon dioxide, and 
becomes covered with a coating of sodium carbonate. Great caution is neces- 
sary in using it, as it rapidly destroys organic tissue. It is very soluble in water 
and alcohol. It closely resembles potassium hydroxide in its properties, being 
a very strong alkali. 
Preparation : It is made by electrolysis of sodium chloride; also by the action 
of slaked lime on a solution of sodium carbonate. 
2Na0H+CaC03.) 
Action and Uses : It is used in the preparation of compound cresol solution, 
solution of sodium hydroxide, and magma magnesia. It seldom, is used in- 
ternally, because it is too caustic. The dose of solution of sodium hydroxide 
(which is a 4.5 per cent aqueous solution of NaOH) is 1 c. c. or 15 minims; 
used as an antacid. As a caustic it may be used like potassium hydroxide. 
The antidote is vinegar, dilute acetic acid, citric acid, lemon juice, etc. 
Sodium hydroxide is used extensively in a crude, impure form for household 
cleaning under the name of lye. 
Sodii Renzoas, Sodium Benzoate, U. S. P.—It contains, when dried to con- 
stant weight at 110° C., not less than 99 per cent of C(iH5.COONa. Preserve 
it in well-closed containers. 
Properties : It occurs as a white, amorphous, granular or crystalline powder, 
odorless and having a sweetish taste. It is very soluble in water and slightly 
soluble in alcohol. Its aqueous solution is slightly alkaline to litmus. 422 
HOSPTTAU OOBPR HANDBOOK. 
Preparation : It is made by the action of sodium carbonate on benzoic 
acid: 2CuH5C00H+Na2C03=2C6H5C00Na+H20+C02. 
Action and Uses : Occasionally given in acute rheumatic fever when 
salicylates can not be tolerated by the stomach. It is used extensively 
as a food preservative in canned goods, catsup, etc., and it is claimed that 
in small quantities it does no harm; this, however, is a question over which 
there has been much controversy. 
Average dose: 1 gm. or 15 grains. 
Sodii Bicarbonas, Sodium Bicarbonate, NaRCOs (Bicarbonate of Soda, 
Baking Soda) U. S. P.—It contains, when dried to constant weight in a 
desiccator over sulphuric acid, not less than 99 per cent of NaHCOs. Preserve 
it in well-closed containers in a cool place. 
Properties : It is a white, opaque powder, odorless and having a cooling, 
mildly alkaline taste. It is permanent in dry air, but slowly decomposes in 
moist air. When its aqueous solution is heated, even mildly, it loses carbon 
dioxide and is converted into sodium carbonate as follows: 2NaHC03, which, 
when heated, gives Na2C03+H20+C02. It is fairly soluble in water, and 
insoluble in alcohol. Its aqueous solution is alkaline to litmus. 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 bicarbonate and ammonium chloride. Sodium bicarbonate 
is precipitated (being less soluble) and the ammonium chloride remains in solu- 
tion. The reaction may be expressed: NaCl+NH3+C02-f H2O=NaH0O3+ 
NH4C1. This process also may be used in making sodium carbonate. After 
making the bicarbonate this may be heated, driving off carbon dioxide and 
water, leaving behind sodium 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 usually is com- 
bined 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 ” very often is applied to 
this compound, but this is an indefinite term and might mean sodium car- 
bonate or even caustic soda. 
Average dose: 1 gm. or 15 grains. 
Sodii Boras, Sodium Borate (Borax, Sodium Tetraborate, Sodium Pyrobo- 
rate), U. S. P.—It contains not less than 52.32 per cent nor more than 54.92 
per cent of anhydrous sodium borate (sodium biborate or tetraborate), cor- 
responding to not less than 99 per cent of the crystallized salt (Na2B4Or+10 
H20). Preserve it in well-closed containers. 
Properties : It occurs as colorless, transparent prisms, or as a white powder, 
odorless, and having a sweetish alkaline taste. It is slightly efflorescent in 
warm, dry air. It is fairly soluble in water, very soluble in glycerin, and in- MATERIA MEDICA. 
423 
soluble in alcohol. Its aqueous solution is alkaline to litmus. It has the 
properties of an alkali but is milder than sodium carbonate or bicarbonate. 
When mixed with glycerin it decomposes alkali bicarbonates with effervescence 
(this accounts for the effervescence in the preparation of Dobell’s solution). 
An aqueous solution shows an alkaline reaction toward litmus, but when 
dissolved in glycerin it gives an acid reaction, and when the glycerin solution 
is largely diluted with water the reaction is changed back to alkaline. 
Preparation: Sodium borate is found native (as sodium borate) as a crys- 
talline deposit in the blue mud at the bottom of the Borax Lake in California, 
and in lakes in other parts of the world. It can be made from crude boric acid 
by treating with sodium carbonate. 
Action and Uses : Sodium borate possesses mild antiseptic properties, and 
because of this property it is used very often in alkaline mouth washes and 
gargles. It is one of the ingredients in compound solution of sodium borate, 
N. F. (Dobell’s solution). It rarely is used internally. As a household clean- 
ing agent (borax) it is used extensively where a mild alkali is desired in the 
cleaning of delicate fabrics. It also is used as a food preservative. 
Average dose: 0.5 gm. or 8 grains. 
Sodii Bromidum, Sodium Bromide, NaBr., U. S. P.—It contains, when dried 
t.o constant weight at 100° C., not less than 98.5 per cent of pure NaBr. Pre- 
serve it in well-closed containers. 
Properties : It occurs as colorless, or white, cubical crystals, or as a white 
powder, odorless, and having a saline taste. It is very soluble in water and 
fairly soluble in alcohol. Its aqueous solution is neutral or faintly alkaline 
to litmus. It is a very stable salt. 
Preparation : It can be made by methods like those employed in making 
potassium bromide, using NaOH instead of KOH. 
Action and Uses : It is used as a hypnotic and nerve sedative. Its action 
is much like that of potassium bromide, but less irritating to the stomach and 
less depressing. 
Average dose: 1 gm. or 15 grains. 
Sodii Carbonas Monohydratus, Monohydrated Sodium Carbonate, Na3C03-\- 
HzO, U. S. P.—It contains not less than 99.5 per cent of Na2C03+H20. Preserve 
it in well-closed containers. 
Properties : It is a white, crystalline, granular powder, odorless and having 
a strong alkaline taste and reaction. When exposed to the air, under ordi- 
nary conditions, it absorbs only a slight percentage of moisture; exposed to 
warm, dry air at or above 50° 0., the salt effloresces, and at 100° C. it becomes 
anhydrous. It is very soluble in water and glycerin, and is insoluble in alcohol. 
Preparation : There are three methods by which sodium carbonate may be 
made: LeBlanc’s process, the Cryolite process, and the Solvay process. The 
Solvay process has been explained under sodium carbonate. (The chemical 
reactions involved in the LeBlanc and the Cryolite process are too compli- 
cated to treat in this book. The student is referred to standard textbooks on 
pharmacy for further information.) 
Action and Uses : Because of its strong alkaline reaction and irritating 
effect on the stomach sodium carbonate seldom is given internally; sodium bicar- 
bonate is preferred when the antacid effect of soda is desired. It is used exten- 
sively in the arts, entering into the manufacture of soap, glass, sodium, sodium 
compounds, etc. It sometimes is used in the proportion of 100 grams to 30 
gallons of water in the preparation of alkaline baths. Added-to water in which 
instruments are being boiled (1 teaspoonful to a gallon of water), it prevents 
their rusting (sodium bicarbonate and borax will do the same thing). It is 424 
HOSPITAL CORPS HANDBOOK. 
used in washing when a strong alkali is desired. (“Washing soda” is a term 
applied to sodium carbonate containing 10 molecules of water of crystallization.) 
Average dose: 0.25 gm. or 4 grains. 
Sodii Chloridum, Sodium Chloride, NaCl (Common Salt), U. S. P.—It con- 
tains, when dried to constant weight at 110° C., not less than 99 per cent of 
pure NaCl. Preserve it in well-closed containers. 
Propekties : Sodium chloride, one of the most stable salts known, is formed 
by the union of a strong base (sodium, electropositive) forming element with a 
strong acid (chlorine, electronegative) forming element. It occurs as colorless, 
transparent cubical crystals or white crystalline powder, odorless and having a 
saline taste. Its aqueous solution is neutral to litmus. It is very soluble in 
water, fairly soluble in glycerin, and slightly soluble in alcohol. 
Preparation : It occurs in the native state as rock salt in large deposits 
throughout the globe. Sea water contains about 3 per cent of this salt mixed 
with other salts. The waters of Great Salt Lake in Utah contain about 20 per 
cent of NaCl. It must be purified and freed from other salts before it is fit 
for medicinal or domestic use. 
Action and Uses : A teaspoonful to a glassful of tepid water is used as an 
emetic. As a condiment it is almost a daily necessity in the human economy. 
It is found in all fluids and tissues of the body except the enamel of the teeth. 
A weak aqueous solution is used as a gargle and nasal douche. It is used in 
the preparation of physiological solution of sodium chloride, U. S. P. This 
solution contains in every 1,000 c. c. 8.5 grams of sodium chloride, and is com- 
monly known as normal salt solution. When this solution is to be injected 
intravenously it should be made with distilled water, filtered, and sterilized 
in an autoclave under steam pressure, at a temperature of 115° C. for 30 
minutes, or by boiling it for one hour. Before sterilization the mouth of the 
flask should he stoppered with a pledget of sterilized purified cotton, and the 
stopper and upper part of the flask covered with a piece of paper tied down 
around the top of the flask. This solution should not be used 48 hours after 
sterilization. Nearly all drugs that are injected into the system, either 
hypodermically or intravenously, are dissolved in normal salt solution, or one 
slightly weaker, in order that they will be isotonic (same density as the blood) 
when injected into the circulation. 
Average dose: 16 gm. or 240 grains dissolved in warm water as an emetic. 
Sodii Citras, Sodium Citrate, U. S. P.—It contains not less than 98 per cent 
of CsH^OlI) (C00Na)3+2H20. Preserve it in well-closed containers. 
Properties: Occurs as a white granular powder,odorless,and having a cooling 
saline taste. It is very soluble in water, and is insoluble in alcohol. An 
aqueous solution is slightly alkaline to litmus. It has the property of holding 
in solution certain insoluble substances, a property possessed by other alkaline 
citrates. 
Preparation : It is made by the action of citric acid on sodium carbonate, 
2C3H4 (OH) (C00H)3+3Na2C03=2CsH4(0H) (C00Na)3+3C02+3H20. 
Action and Uses: An aqueous solution has the property of preventing coagu- 
lation of the blood and delaying the curdling of milk. A solution containing 2 
grains of sodium citrate and 20 grains of sodium chloride to 1 fluid ounce of 
water (Wright’s solution) is used for the irrigation of wounds and as a local 
application for furunculosis. For modifying cow’s milk in infant feeding to 
prevent the formation of large curds, 1 grain of sodium citrate to 1 fluid ounce 
of milk may be used. Its action in preventing coagulation of the blood and 
delaying milk curdling is supposed to be due to the formation of calcium citrate, 
which does not ionize and is therefore inactive. 
Average dose: 1 gm. or 15 grains. MATERIA MEDICA. 
425 
Sodii phosphas, Sodium Phosphate, Na2IIPOi+12 I120, U. S. P.—It contains 
not less than 39.25 per cent nor more than 44 per cent of anhydrous sodium 
phosphate (di-sodium-ortho-pliosphate), corresponding to not less than 99 per 
cent of the crystallized salt (Na2HP04-fl2 H20). Preserve it in well-closed 
containers in a cool place. 
Properties : Occurs as large, colorless prisms or granular, crystalline salt, 
odorless, and having a cooling alkaline taste. The crystals effloresce in air. 
It is very soluble in water and insoluble in alcohol. An aqueous solution is 
alkaline to litmus. If sodium phosphate is stored in a warm storeroom, much 
of the water of crystallization separates and the sodium phosphate settles in 
the bottom of the bottle, forming a hard mass that can not be removed without 
breaking the bottle. This hard mass, having lost most of its water of crystal- 
lization, is much stronger than the crystalline salt. 
Preparation : Sodium phosphate is made from the inorganic part of animal 
bones. Bones contain a large amount of calcium phosphate (Ca3(P04)2), which 
by a series of reactions is converted into sodium phosphate. Sodium phosphate, 
if not properly prepared, may contain arsenic as an impurity through the use 
of impure sulphuric acid in its manufacture. 
Action and Uses : It is used as a saline cathartic, acting much like mag- 
nesium sulphate. It is administered best dissolved in warm water and given 
before breakfast. It is considered an excellent remedy in catarrhal jaundice 
and chronic gastric catarrh. 
Average dose: 4 gm. or 60 grains. 
Sodii Salicylas, Sodium Salicylate, NaCiIhCh, U. S. P.—It contains, when 
dried to constant weight at 100° C., not less than 99.5 per cent of pure NaC7H503. 
Preserve it in well-closed containers, protected from heat and light. 
Properties : Occurs as a white powder or scales, or as a white powder with 
a pink tinge, odorless, and having a sweet saline taste. Soluble in 0.9 part 
of water, 9.2 parts of alcohol, and soluble in glycerin. An aqueous solution is 
neutral or faintly acid to litmus. 
Preparation : It is prepared by neutralizing a solution of sodium carbonate 
with salicylic acid, 2CsH4(0H)CO0H+Na2C03=2C«H4(0H)C00Na+H20+C02. 
Action and Uses: It is used as an anti rheumatic, analgesic, and antipyretic. 
It is a valuable remedy in the treatment of rheumatism, tonsillitis, and in- 
fluenza. 
Average dose: 1 gm. or 15 grains. 
Sodii Thiosulphas, Sodium Thiosulphate, Na-iS-iO-i+SHtO {Hypo, Sodium 
Hyposulphite), U. S. P.—It contains not less than 63.07 per cent nor more 
than 67.48 per cent of anhydrous sodium thiosulphate, corresponding to not 
less than 99 per cent of the crystallized salt (NaaS203+5H20). Preserve it 
in well-closed containers. 
Properties : Occurs as colorless, transparent prisms, odorless and having a 
cooling, later a bitter taste. It is permanent in the air below 33° C., but 
effloresces in dry air above that temperature; slightly deliquescent in moist 
air. Soluble in 0.5 part of water and insoluble in alcohol. When an aqueous 
solution is boiled the salt is decomposed rapidly. When brought in contact 
with a solution of iodine it immediately decolorizes the iod:ne, forming new 
compounds. It is capable of dissolving the halogen compounds of silver. 
AgBr+Na2S20s=NaAgS203+NaBr. 
Preparation : It is made by treating calcium thiosulphate with sodium 
carbonate, CaS203+Na2r,03=CaC0s-t-Na2S203, 426 
HOSPITAL CORPS HANDBOOK. 
Action and Uses : An aqueous solution of 1 in 10 may be used for various 
parasitic diseases of the skin. In the absence of starch it may be used for 
iodine poisoning. It is ilie best agent for removing iodine stains from linen. 
It is used extensively in photography as a fixing bath. 
Average dose: 1 gm. or 15 grains. 
Lithii Citrus, Lithium Citrate, U. S. P.—It contains not less than 98.5 per 
cent of CatMOH) (C00Li)3+4H20. Preserve it in air-tight containers. 
Properties : It is a white granular powder, odorless, and has a cooling 
faintly alkaline taste. It is deliquescent on exposure to moist air. Soluble 
in 1.4 parts of water, and is very slighty soluble in alcohol. It imparts a 
crimson color to a nonluminous flame. 
Preparation: It is made by treating lithium carbonate with citric acid; 
3Li2C08+2C3H4(0H) (COOH)3=2C3H4(OH) (C00Li)3+3H20+3C02. 
Action and Uses : It is used as an antirheumatic, diuretic, and antilithic. 
Given internally it renders the urine strongly alkaline. It is employed in 
making the widely used “Lithia Tablets.” Its action does not differ greatly 
from that of the other alkaline citrates. 
Average dose: 0.5 gm. or 8 grains. 
Aqua Ammonia; Fortior, Stronger Ammonia Water, U. S. P.—An aqueous 
solution of ammonia (NH3) containing not less than 27 per cent nor more 
than 29 per cent by weight of NH3. This solution deteriorates on keeping, 
and must be tested frequently. Preserve it in a cool place in partially filled 
bottles made of hard glass free from lead. Great caution should be used in 
handling this liquid, and it must never be tasted unless very highly diluted. 
Properties : It has an excessively pungent, characteristic odor and a very 
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 (NH3) is liberated and held in the upper part 
of the bottle; therefore 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 distillation ammonia is one of the 
products formed. The gases formed are passed through an acid solution 
(sulphuric or hydrochloric) and an ammonium salt is formed (ammonium 
sulphate or chloride, according to the acid used). This salt then is heated 
with lime, ammonia (NH3) 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 internally. It 
is used in making the weaker solution of ammonia, known as ammonia water. 
Ammonia water is an aqueous solution of ammonia (NHs) containing not less 
than 9.5 per cent nor more than 10.5 per cent by weight of NIL. This solution 
is used in making aromatic spirits of ammonia and ammonia liniment. The 
antidote for ammonia water is the same as for other alkaline hydroxides (iveak 
acids). Inhalations of ammonia gas stimulate the heart and respiratory 
center. CEdema of the glottis, resulting in obstructed breathing, might result 
in giving inhalations of concentrated ammonia gas; therefore care should be 
exercised in giving inhalations to an unconscious patient. 
Ammonii Chloridum, Ammonium Chloride, NHiCl (Sal Ammoniac, Am- 
monium Muriate), U. S. P.—It contains, when dried to constant weight at 100°, 
not less than 99.5 per cent of NH4C1. MATERIA MEDICA. 
427 
Properties : It is soluble in 2.6 parts of water, 100 parts of alcohol, and 8 
parts of glycerin. On heating it does not melt, but passes directly to the 
gaseous state. It is a white, granular powder, having no odor, and a cooling, 
saline taste. 
Preparation : It is made by passing ammonia gas, generated at the gas 
works during the destructive distillation of coal in the manufacture of illumi- 
nating gas, into hydrochloric acid: NH3+HC1==NH4C1. 
Action and Uses: It is a valuable stimulant expectorant and often is used in 
cough mixtures (Brown mixture with ammonium chloride). 
Average dose: 0.3 to 1 gm. or 5 to 15 grains. 
Ammonii Carbonas, Ammonium Carbonate, U. S. P.—-It consists of varying 
proportions of a mixture of acid ammonium carbonate (NH4HC03) and am- 
monium carbamate (NH4NH2CO2) and yields not less than 30 per cent nor 
more than 32 per cent of NH3. Preserve it in well-closed containers in a cool 
place. For medicinal purposes use only the translucent portions. 
Properties : It occurs in white, hard, translucent, striated masses, having an 
ammoniacal odor. On exposure .to the air the salt looses both ammonia and 
carbon dioxide, becoming opaque, and finally is converted into friable, porous 
lumps or a white powder. It is soluble in four parts of water and is decom- 
posed by hot water with the elimination of carbon dioxide and ammonia. 
Alcohol dissolves the carbamate, but leaves the acid ammonium carbonate. An 
aqueous solution is alkaline to litmus. 
Preparation : It is made by the sublimation of a mixture of ammonium 
sulphate and calcium carbonate, 2(NH4)2S04+2CaC03=2CaS04+NH4HC0s.NH4 
NH2C02+NH3+H20. 
Action and Uses: It is used in making aromatic spirit of ammonia and 
solution of ammonium acetate. It is a stimulant expectorant and heart stimu- 
lant, and is used in expectorant mixtures and smelling salts. It should never 
be given in powdered form because it is irritating. Mixed with an equal bulk 
of stronger ammonia water and scented with oil of lavender, it constitutes 
the common smelling salts. 
Average dose: 0.3 gm., or 5 grains. 
Spiritus Ammonias Aromaticus, Aromatic Spirit of Ammonia, U. S. P.—It 
contains ammonium carbonate, ammonia water, oil of lemon, oil of lavender, 
oil of myristica, alcohol, and water. For details regarding preparation see the 
U. S. P. It will be noted in the method of preparation that ammonium car- 
bonate is mixed with the ammonia water and allowed to stand for 12 hours 
in order that the ammonium carbonate may take on water and become normal 
ammonium carbonate, and the acid ammonium carbonate may take on ammonia 
and become normal ammonium carbonate. When freshly made it is colorless, 
but on exposure to light it gradually acquires a yellow color. 
Action and Uses : It is used as a stimulant in cases of fainting, for headache 
attended with nausea, and for acid eructations. It should be administered well 
diluted with water. 
Average dose: 2 c. c. or 30 minims. 
The alkaline earth elements and their compounds. 
The alkaline earth elements are magnesium, calcium, strontium, and barium. 
They are called alkaline earth elements because their oxides have marked 
alkaline (basic) properties, and the compounds of these elements are found 
abundantly in the earth. They are all divalent and are strongly electropositive. 
Their compounds are not nearly as soluble as the compounds of the alkali 
47829°—23 28 428 
HOSPITAL CORPS HANDBOOK. 
elements; in fact, many of their compounds are insoluble in water. The 
hydroxides, carbonates, and sulphates (except magnesium sulphate) are in- 
soluble or only slightly soluble in water. Their alkaline properties are not as 
intense as in the case of the alkali elements (sodium, potassium, lithium), 
and their hydroxides are classed as mild alkalies (milk of magnesia and lime 
water). 
Magnesii Carbonas, Magnesium Carbonate, U. S. P.—A mixture of hydrated 
magnesium carbonate and magnesium hydroxide, corresponding to not less than 
39.2 per cent of MgO and containing not more than 0.8 per cent of CaO. 
Propekties : It occurs as a light, white, bulky powder, odorless, and having a 
slight earthy taste. It is practically insoluble in water and alcohol. 
Preparation : It is made by mixing cold dilute solutions of magnesium sul- 
phate and sodium carbonate: 5MgS04+5Na2C0s+H20=4MgC03.Mg(0H)2+ 
5Na2SCh+C02. 
Action and Uses : It is used in making solution of magnesium citrate and 
magnesia magma. It is given internally as an antacid and as an antidote for 
acid poisoning. 
Average dose: 3 gm. or 45 grains. 
Magnesii Sulphas, Magnesium Sulphate, MgSO4 (Epsom Salts).—U. S. P.—It 
contains not less than 48.59 per cent nor more than 53.45 per cent of anhydrous 
magnesium sulphate, corresponding to not less than 99.5 per cent of the crystal- 
lized salt (MgSC>4+7H20). Preserve it in well-closed containers. 
Properties : It occurs as small, colorless needles or prisms, without odor, and 
having a cooling, saline, and bitter taste. It is soluble in one part of water, 
almost insoluble in alcohol, and is slowly efflorescent in warm air. 
Preparation : One of the methods of making magnesium sulphate is by the 
action of sulphuric acid on magnesium carbonate (mineral magnesite), MgC03+ 
H2S04=MgS04+H20+C02. 
Action and Uses : It is an extensively used saline cathartic. It should be 
given before breakfast in a saturated aqueous solution. It acts both by pre- 
venting absorption of fluid from the bowel and by drawing more fluid from 
the blood into the intestines. Applied externally in saturated solution on lint 
to swollen joints in acute arthritis, and to swollen testicles in orchitis, 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 
sulphate. 
Average dose: 15 gm. or 4 drams. 
Talcum Purificatum, Purified Talc, U. S. P.—A purified, native hydrous 
magnesium silicate sometimes containing a small amount of aluminium silicate. 
Properties: It is a fine white powder which adheres to the skin, is free 
from grittiness and is slippery to the touch. It is odorless and tasteless and 
is insoluble in water or alcohol. When used as a filtering medium it should 
not be finer than No. 100 powder. 
Preparation : It is prepared by treating ordinary talcum with several wash- 
ings of dilute hydrochloric acid, which dissolves out aluminium, iron, and 
other salts of magnesium. 
Action and Uses : It forms the base of nearly all cosmetic powders. It 
is an excellent dusting powder, being a very fine, white powder, which adheres 
to the skin, is free from grittiness, slippery to the touch, odorless, and taste- 
less. It is used in pharmaceutical operations as a filtering medium. 
Calx, Calcium Oxide, CaO (Lime, Quicklime), U. S. P.—It contains, when 
freshly ignited to constant weight with a blast lamp, not less than 95 per cent MATERIA MEDICA. 
429 
of CaO. It looses not more than 10 per cent of its weight on ignition. Preserve 
it in air-tight containers in a dry place. 
Properties : It occurs in hard, white or grayish white masses or granules, 
or as a white powder, odorless, and having a caustic taste. When moistened 
with water calcium oxide becomes heated and is gradually converted into 
a white powder (calcium hydroxide or slaked lime; Ca0+H20=Ca(0H)2). 
When this is mixed with four times its weight of water it becomes a 
smooth magma (milk of lime). A solution made by dissolving slaked lime 
in water is known as solution of calcium hydroxide (lime water). It is 
soluble in 840 mils of water, insoluble in alcohol, and soluble in glycerin. 
Preparation: It is made by calcination (heating highly) of limestone 
(CaC03) ; CaCOs+heat—CaO+C02. 
Action and Uses: The principal use of lime in medicine is in making lime- 
water. Many manufacturers supply a highly purified form of lime for this 
purpose. The process of making limewater is very much abbreviated when 
this purified form of lime is used. All that is necessary is to place the lime 
in distilled water and the operation is completed. In the U. S. P. process, 
the lime first must be purified by a long and tedious process of washing. 
Limewater is used as an antacid, antiemetic, and as a chemical antidote for 
acid poisoning. 
Average dose: 15 c. c. or 4 fluid drams of the limewater. 
Crete Prceparata, Prepared Chalk, CaCo3 {Drop Chalk), U. S. P.—A 
native form of calcium carbonate freed from most of its impurities by elutri- 
ation and containing, when dried to constant weight at 200° C., not less 
than 97 per cent of CaCOs. 
Properties : Insoluble in water and alcohol. It occurs as “ conical drops ” 
containing a very fine grayish white amorphous powder, odorless and tasteless. 
Preparation : Made by elutriation of chalk. 
Action and Uses : It is used in compound chalk powder and in chalk 
mixture. It is a nonirritating astringent and antacid. It is useful in the 
treatment of diarrhoea due to intestinal fermentation. 
Average dose: 1 gm. or 15 grains. 
Barii Dioxidum, Barium Dioxide, Ba02. (Barium Peroxide).—Commercial 
anhydrous barium dioxide. It should be kept in well closed containers. 
Properties : Almost insoluble in cold water, with which it forms a hydrate 
having an alkaline reaction. A solution of this hydrate in water is known as 
baryta water. When acted on by strong mineral acids a salt of the acid and 
hydrogen dioxide are formed (method for making solution of hydrogen dioxide). 
Preparation : It is made by conducting oxygen over barium oxide heated to 
redness. Ba0+0=Ba02. 
Action and Uses: It is used, in place of potassium permanganate, in the 
gaseous disinfection of rooms with formaldehyde. It is an oxidizing agent and 
when brought in contact with formaldehyde solution some of the formaldehyde 
is oxidized, generating sufficient heat to volatilize the bulk of the formaldehyde 
contained in the solution. 
Compounds of zinc. 
Zinci Oxidum, Zinc Oxide, ZnO, U. S. P.—It contains, when freshly ignited, 
not less than 99 per cent of ZnO. 
Properties : It is a very fine, amorphous, white powder, free from gritty 
particles, without odor or taste. It gradually absorbs carbon dioxide from the 
air; is insoluble in water or alcohol, but soluble in ammonia water and in 
solution of ammonium carbonate. 430 
HOSPITAL CORPS HANDBOOK. 
Preparation : It is made by calcination of pure zinc carbonate; 
2ZnCOs.3Zn (OH) 2+heat=5Zn0+3H20+2C02. 
Action and Uses: The four outstanding medicinal properties of zinc oxide 
are: nontoxic, protective, mildly astringent, and slightly antiseptic. It may be 
employed either in the form of a dusting powder, in an ointment, or sus- 
pended in an aqueous mixture. The most popular of these is zinc oxide oint- 
ment, which is composed of 20 per cent zinc oxide and 80 per cent benzoinated 
lard. Zinc oxide is given rarely internally. 
Zinci Sulphas, Zinc Sulphate, (White Vitriol), V. S. P.—It 
contains not less than 55.86 per cent nor more than 58.65 per cent of anhydrous 
zinc sulphate, corresponding to not less than 99.5 per cent of the crystallized 
salt (ZnSCh+TIUO). Preserve it in well-closed containers. 
Properties : It is a granular, crystalline powder, odorless, and having an 
astringent and metallic taste. It is efflorescent in dry air. Soluble in 0.6 
parts of water, 2.5 parts of glycerin, and insoluble in alcohol. 
Preparation : Made by treating metallic zinc with dilute sulphuric acid; 
Zn+H2S04=ZnS04-fH2. 
Action and Uses : It is employed as an astringent and emetic. A weak 
aqueous solution 1-400 may be used as an eye wash, gargle, or urethral injection 
in gonorrhoea. It acts as a prompt emetic in 15-grain doses but, as other drugs 
are preferred, it seldom is used. It is used in the Navy principally as an 
astringent eye wash, 1 grain dissolved in 1 fluid ounce of distilled water. 
Average dose: 1 gm. or 15 grains. (As an emetic.) 
Compounds of aluminium. 
Alumen, Alum, U. S. P.—It contains not less than 99.5 per cent of 
A1NH4(S04)2+12H20; or A1K( S04)2-f 12H20. The label of the container must 
indicate whether the salt is ammonium alum or potassium alum. 
Properties : It occurs as a white powder, odorless, and having a strongly 
astringent taste. Soluble in 7.2 parts of water, insoluble in alcohol, and 
fairly soluble in glycerin. Potassium alum is more soluble in water than 
ammonium alum. An aqueous solution of alum is acid to litmus. Ammonium 
alum can be distinguished from potassium alum by heating a small quantity 
of a sample with lime. If it is ammonium alum, ammonia will be set free 
from the mixture. When a hot concentrated solution of alum is poured into 
a hot concentrated solution of an alkaline carbonate the carbonate is decom- 
posed with the liberation of C02 (similar to the action of an acid on a car- 
bonate). This reaction is taken advantage of in the manufacture of cheap 
baking powders; alum mixed with sodium bicarbonate is mixed with the dough 
used in making bread. When the dough begins to bake the reaction starts, 
liberating C02, which, in rising, carries the dough with it for a certain distance. 
Preparation: Made principally from aluminium clay (silicate) by treatment 
with sulphuric acid and then adding potassium or ammonium sulphate, forming 
the double salt. 
Action and Uses : It is used as an astringent both internally and externally. 
Used as a local styptic in epistaxis, external haemorrhages, and bleeding from 
mucous membranes, to which the powder can be applied directly. In nose 
bleeding a saturated solution on pledgets of cotton sometimes is used in the 
nares. Barbers use it for bleeding caused by shaving. Alum is used in 
making exsiccated alum (burnt alum), which is alum deprived of its water 
of crystallization. The properties of exsiccated alum are the same as those 
of alum except that they are more intensified. 
Average dose: 0.5 gm., or 8 grains. MATERIA MEDICA. 
431 
Cataplasma Kaolini, Cataplasm of Kaolin (Clay poultice), N. F.—A sub- 
stitute for antiplilogistine. Contains kaolin (aluminium silicate), boric acid, 
thymol, methyl salicylate, oil of peppermint, and glycerin. It must be 
thoroughly and carefully mixed, and preserved in air-tight containers. 
Action and Uses : It acts as a mild counterirritant and exosmotic. It is 
applied both to superficial and deep-seated inflammations to relieve conges- 
tion, promote absorption, and relieve pain. 
Compounds of iron. 
Iron forms two series of chemical compounds, one, in which it has a valence 
of three (3), known as ferric compounds; the other, in which iron has a valence 
of two (2), known as ferrous compounds. The ferric compounds are dis- 
tinguished by their brown color, the ferrous compounds are green. The 
ferric compounds are fairly stable; the tendency of the ferrous compounds is 
to change to the ferric condition, especially in the presence of oxidizing agents. 
The ferric compounds are oxidizing agents; the ferrous compounds are re- 
ducing agents. Ferrous compounds are made by the action of an acid on an 
electronegative element (iodine) on metallic iron, excluding the air (oxygen), 
which is an oxidizing agent, to prevent oxidation to the ferric state. Ferric 
compounds are made by oxidizing ferrous compounds. The principal effect 
of iron on the system is that it increases the amount of hiemoglobin in the 
blood (luematinic) resulting in an improvement in the functions of the 
various organs of the body, to which its tonic effect is due. Both locally and 
internally iron acts as an astringent. The astringent properties of the dif- 
ferent compounds vary, some being very active astringents while others are 
very mild. Most of the compounds of iron are soluble in water. The oxide, 
hydroxide, and carbonate are insoluble. 
Ferri Pyrophosphas Solubilis, Soluble Ferric Pyrophosphate.—It contains not 
less than 10 per cent of metallic iron. Preserve in well-closed, amber-colored 
bottles, protected from light. 
Properties : Occurs as thin, apple-green, transparent scales, odorless, saline 
taste, soluble in water, insoluble in alcohol, and contains an amount of salt 
corresponding to 10 per cent of the metallic iron. 
Action and Uses: It is an excellent iron preparation because of its mild 
taste, solubility, and the large amount of iron which it contains. 
Average dose: 0.2 gm., or 3 grains. 
Tincture Ferri Chloridi, Tincture of Ferric Chloride (Tincture of Chloride 
of Iron), U. S. P.—A hydroalcoholic solution containing ferric chloride 
(Fe(’h) (about 13 per cent) corresponding to not less than 4.48 per cent of Fe. 
Protect tincture of ferric chloride from light. 
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 mixing 350 c. c. of solution of ferric chloride 
with sufficient alcohol to make 1,000 c. c. The mixture is placed in amber- 
colored, glass-stoppered bottles, and kept for three months before dispensing. 
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). 
Average dose: 0.5 c. c., or 8 minims. 
Tincture Ferri Citro-Chloridi, Tincture of Ferric Citro-Chloride (Tasteless 
Tincture of Ferric Chloride, Tasteless Tincture of Iron), N. F.—It is a hydro- 432 
HOSPITAL CORPS HANDBOOK. 
alcoholic solution made by dissolving sodium citrate in solution of ferric chlo- 
ride and adding a small amount of alcohol and much water. It resembles in 
properties the scale salts of iron, except that it is a solution. It contains the 
same per cent of metallic iron that tincture of ferric chloride contains but in 
a different form. 
Action and Uses : It is used in making elixir of iron, quinine, and strych- 
nine, N. F. Its medicinal properties are practically the same as those of 
tincture of ferric chloride, U. S. P., except that it is milder. 
Average dose: 0.5 c. c., or 8 minims. 
Pilulce Ferri Carbonatis, Pills of Ferrous Carbonate {Bland's Pills), U. S. P.— 
Each pill contains not less than 0.06 gram (1 grain) of FeC03. 
Preparation : Made by the action of potassium carbonate on ferrous sulphate, 
FeS04+K2C03=FeC03+K2S04. The pills do not keep unless well coated to 
exclude oxygen. If kept on hand for a long time the ferrous carbonate is 
changed to the ferric state. When these pills are made in the dispensary they 
should be used as soon as possible after their preparation. They never should 
be prepared and kept in stock for issue. These pills are on the supply table. 
Action and Uses: Valuable iron tonic. Used in the treatment of anaemias. 
Average dose: 2 pills, which contain 2 grains of ferrous carbonate. 
Compounds of arsenic. 
Liquor Potassii Arsenitis, Solution of Potassium Arsenite (Fowler's Solution, 
Liquor arsenicalis Fowler i, P. I.), U. S. P.—An aqueous solution containing 
potassium arsenite, corresponding in amount to not less than 0.975 per cent 
nor more than 1.025 per cent of AS2O3. Preserve the solution in amber-colored 
bottles. 
Properties : A clear, faintly opalescent liquid, with a pink color, and a slight 
odor of lavender. It is alkaline to litmus. 
Preparation : It is made by boiling together potassium bicarbonate and 
arsenic trioxide in the proportion to give a finished solution having the above 
strength. It is held that the following reaction takes place: As203+4 
KIIC03=2K2HAs03+H20+4C02. 
Action and Uses: It is a useful remedy against protozoal affections. Used 
in the treatment of malaria and relapsing fever; in the treatment of certain 
chronic skin affections, as psoriasis, lichen planus, chronic eczema, chronic 
urticaria, etc. It stimulates the action of the blood-forming organs, especially 
the bone marrow, to which its alterative and tonic properties are largely due. 
It is a poison and must be handled with great care. 
Average dose: 0.2 c. c., or 3 minims. 
Arsphenamina, Arsphenamine, Salvarsan, “ 606.”—Also known under such 
trade names as arsenobezol and arsaniinol. It is diamino-dihydroxyl-arseno- 
benzene-liydrochloride. Corresponds to 31.57 per cent arsenic. 
Properties : A yellowish, crystalline, hygroscopic powder, very unstable in 
air, and put up in sealed ampules. 
Action and Uses : A specific remedy for syphilis in all stages, but it is the 
more efficient the more recent the infection; it is also useful in various spirril- 
lar diseases, such as relapsing fever, Vincent’s angina, etc. 
Average dose: 0.3 to 0.6 gm., or 5 to 9 grains, administered intravenously. 
Neoarsphenamina, Neoarsphenamine, Neosalvarsan.—The name applied to a 
mixture, sodium-diamino-dihydroxy-arsenobenzene-methanal-sulphoxylate with 
inert, inorganic salts. The arsenic content of 3 parts of neoarsphenamine is 
approximately equal to 2 parts of arsphenamine. 
Properties : Yellowish, crystalline, hygroscopic powder, and very unstable 
in air. MATERIA MEDICA. 
433 
Action and Uses : Essentially the same as those of arsphenamine, although 
many observers claim better results. It differs from arsphenamine 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. 
Average dose: 0.6 to 0.9 gin., or 9 to 14 grains. 
Compounds of antimony. 
Antimomi et Potassii Tartras, Antimony and Potassium Tartrate (Anti- 
monyl Potassium Tartrate, Tartrated Antimony, Tartar Emetic), U. S. P.— 
It contains not less than 98.5 per cent of C2H2(OH)2.COOK.COO (SbO) +£ H20. 
Preserve it in well-closed containers. 
Properties : Occurs as a white powder or colorless transparent crystals 
which become opaque on exposure to air. Disagreeable metallic taste, odor- 
less. The crystals effloresce on exposure to air. Soluble in 12 parts of cold 
water, 3 parts of boiling water, 15 parts of glycerin, and insoluble in alcohol. 
Its aqueous solution is acid to litmus. 
Preparation : It is made by boiling antimony oxide with potassium bitartrate. 
2C2H2 (OH) 2.COOH.COOK+Sb203=2C2H2 (OH) 2.COO (SbO) .COOK+H20. 
Action and Uses: It is used as an expectorant and (rarely) emetic. It 
is one of the ingredients contained in compound mixture of glycyrrhiza, U. S. P. 
(Brown mixture). 
Average dose: As an expectorant and diaphoretic, 0.005 gm. or t2 grain; as 
an emetic, 0.03 to 0.065 gm., or \ to 1 grain. 
Compounds of bismuth. 
Bisrnuthi Submtras, Bismuth Subnitrate, U. S. P.—A basic bismuth nitrate 
of varying chemical composition, which, when dried for 24 hours in a desic- 
cator over sulphuric acid, yields, upon ignition, not less than 79 per cent of 
bismuth oxide (Bi203). 
Properties : A heavy white powder, odorless, tasteless, and slightly hygro- 
scopic. Almost insoluble in water and alcohol, readily soluble in hydrochloric 
or nitric acid. It is slightly acid in reaction. 
Preparation : It is made by dissolving metallic lismuth in nitric acid and 
treating the resulting solution with sodium carbonate which precipitates the 
bismuth as subcarbonate (here the bismuth is freed from arsenic) ; the sub- 
carbonate is redissolved with nitric acid, forming bismuth nitrate, which is 
converted to the subnitrate by treatment witli ammonia water; the precipitate 
then is collected, washed, and dried. 
Action and Uses: It is used internally in the treatment of gastric and intes- 
tinal disorders as a sedative astringent, especially in diarrhoea and putrefactive 
conditions. In large doses it coats the mucous membranes of the intestines 
and acts as a protective. Very large doses are given in X-ray work for the 
purpose of outlining the stomach and intestines. However, bismuth subcar- 
bonate is better than the subnitrate for this purpose because it is less toxic. 
When applied to the skin on wounds or mucous membranes it acts as a pro- 
tective, astringent, and antiseptic. It is used in the preparation of bismuth 
magma, U. S. P. 
Average dose: 0.32 to 2 gm., or 5 to 30 grains. 
Bisrnuthi Subyallas, Bismuth Subgallate {Dermatol), U. S. P.—A basic bis- 
muth gal late of varying chemical composition which, when dried to constant 
weight at 100° C., yields upon ignition not less than 52 per cent nor more than 
57 per cent of bismuth oxide (BhOs), 434 
HOSPITAL COEPS HANDBOOK. 
Properties : A bright yellow, amorphous powder, odorless and tasteless. 
Insoluble in water or alcohol. 
Preparation : It is made by treating an acetic acid solution of bismuth ni- 
trate with gallic acid. 
Action and Uses : Its action and uses are similar to those of bismuth suh- 
nitrate. It is used externally as a dusting powder, under the name of dermatol. 
Average dose: 0.5 gm., or 8 grains. 
Compounds of lead. 
Plumbi Acetas, Lead Acetate, (Sugar of Lead), U. S. P.—It contains not less 
than 85.31 per cent nor more than 89.57 per cent of anhydrous lead acetate, 
corresponding to not less than 99.5 per cent of the crystallized salt (CH3.COO)2 
Pb+3H20. Preserve it in well-closed containers. 
Properties : It occurs as heavy, white, granular crystals, faintly acetous odor, 
and a sweetish, astringent, metallic taste; efflorescent and absorbs carbon 
dioxide from the air; therefore it must be kept in well-closed containers. It 
is soluble in 1.4 parts of water, 38 parts of alcohol, and is freely soluble in 
glycerin. An aqueous solution is alkaline to litmus. 
Preparation : It is made by treating lead oxide with acetic acid. PbO+ 
2CH3.COOH= (CHsCOO) jPb+H20. 
Action and Uses: It is used internally combined with opium (lead and 
opium pill containing 1 grain each), as a sedative astringent in diarrhoea. It is 
used in the preparation of lotion of lead and opium, N. F., which is used ex- 
ternally as a sedative astringent application to sprains and bruises. A 1 per 
cent solution in alcohol is used externally for ivy poisoning. 
Average dose: 0.06 gm. or 1 grain. 
Compounds of mercury. 
Hydrargyrum, Mercury, Hg. (Quicksilver) IT. S. P.—It contains not less than 
99.5 per cent of Hg. Preserve it in strong, well-closed containers. 
Properties : A shining, silver-white, liquid metal, odorless and tasteless. It 
solidifies at—40° C. and boils at 358° C. The specific gravity is 13.5; in- 
soluble in ordinary solvents, but readily soluble in nitric acid. Mercury forms 
two series of compounds: Mercurous, in which mercury has a valence of one, 
and mercuric, in which it has a valence of two. 
Preparation : It is made by roasting sulphide of mercury (cinnabar), forming 
mercury and sulphur dioxide. 
Action and Uses: In its massive form mercury has very little action on the 
system, but when reduced to a fine state of subdivision it is capable of absorp- 
tion either by .the skin or mucous membranes and produces the physiological 
effects of its salts. It is contained in a fine state of subdivision, diluted with 
various vehicles in the following preparations: Mercury with Chalk, U. S. P.; 
Mass of Mercury, U. S. P.; Mercurial Ointment, U. S. P.; Diluted Mercurial 
Ointment, U. S. P.; and Mercury Petroxolin, N. F. 
Massa Hydrargyri, Mass of Mercury (Blue Mass, Blue Pill), U. S. P.—It 
contains not less than 32 per cent nor more than 34 per cent of Hg. Preserve 
the product in well-closed containers. 
Properties : It contains metallic mercury in a very fine state of subdivision, 
incorporated with oleate of mercury, glycyrrhiza, althaea, glycerin, and honey 
of rose. The mercury must be so fine that it is not visible under a lens magni- 
fying 10 diameters. 
Preparation : See U. S. P. 
Action and Uses : It is used as purgative and cliolagogue. 
Average dose: 0.25 gm. or 4 grains. MATERIA MEDICA. 
435 
Vnguentum Hydrargyri, Mercurial Ointment, U. S. P.—A mixture of 50 per 
cent metallic mercury incorporated with oleate of mercury, prepared suet, and 
benzoinated lard. The mercury should he so finely divided that it is not visible 
under a lens magnifying 10 diameters. 
Preparation : See U. S. P. 
Action and Uses: It is used in the preparation of diluted mercurial oint- 
ment, U. S. P. The constitutional effects of mercury are obtained by rubbing 
the ointment on the skin, from which a part of the mercury is absorbed. Mer- 
cury inunctions are used in the treatment of syphilis; 2 grams of the oint- 
ment should be rubbed into a chosen area of the skin at night, followed by 
cleaning the part in the morning. A new area should be selected for the fol- 
lowing night to avoid irritation of the skin. Dilution of the ointment with 
hydrous wool fat facilitates absorption and prevents irritation. Dilute mer- 
curial ointment is used as a parasiticide in the destruction of crab lice. It 
is used also in the treatment of glandular swellings. 
Oleatum Hydrargyri, Oleate of Mercury, U. S. P.—It is a preparation made 
by heating yellow mercuric oxide with oleic acid, resulting in the formation 
of a mercury salt of oleic acid (mercury soap) dissolved in an excess of oleic 
acid. It should be preserved in tightly closed containers' protected from strong 
light, and it should not be dispensed if globules of mercury are visible at the 
bottom of the container. 
Preparation : See U. S. P. 
Action and Uses : It is used in the preparation of mercurial ointment, 
IT. S. P. and may be used for the same purposes the ointment is used for. It 
rarely is used alone. 
Hydrargyri O.ridum Flavum, Yellow Mercuric Oxide, U. S. P.—It contains, 
when dried to constant weight of 150° C., not less than 99.5 per cent of HgO. 
Preserve it in well-closed containers, protected from light. 
Properties : A light orange-yellow amorphous heavy powder; odorless and 
having a metallic taste; turns darker on exposure to light, and is almost 
insoluble in water; insoluble in alcohol. 
Preparation : Made by precipitating a solution of mercuric chloride with 
sodium hydroxide: HgCl2+2NaOH=HgO+H20+2NaCl. 
Action and Uses : It is not given internally. Externally in the form of an 
ointment (2 grains to an ounce of petrolatum or wool fat) it is used in the 
1 reatment of conjunctivitis, blepharitis, etc. 
Hydrargyri Chloridum Coirosivuni, Corrosive Mercuric Chloride, HgCl2 (Bi- 
chloride of Mercury, Corrosive Sublimate,Mercuric Chloride,Perchloride of Mer- 
cury), U. S. P.—It contains, when dried to constant weight in a desiccator over 
sulphuric acid, not less than 99.5 per cent of HgCl2. Preserve it in well-closed 
containers. It is a poison and great caution should be used in tasting this 
substance. 
Properties : It occurs as heavy, colorless, rhombic crystals, or crystalline 
masses, or as a white powder, odorless, permanent in the air, and having a 
metallic taste. Soluble in 13.5 parts of water, 3.8 parts of alcohol, 12 parts 
of glycerin, and 22 parts of ether. Its aqueous solution is acid to litmus, which 
becomes neutral upon the addition of sodium chloride. Its solubility in water 
is enhanced by the addition of sodium chloride or ammonium chloride. If an 
aqueous solution is exposed to light, it undergoes partial decomposition, with 
precipitation of calomel. This can be prevented by the addition of ammonium 
chloride or a few drops of hydrochloric acid. 
Preparation : It is made by heating a mixture of mercuric sulphate and 
sodium chloride in a retort. A reaction takes place forming mercuric chloride 436 
HOSPITAL CORPS HANDBOOK. 
and sodium sulphate. The mercuric chloride is volatilized by the heat and 
condensed in a separate container (sublimation), while the sodium sulphate 
remains in the retort. HgS04+2NaCl=HgCl2+Na2S04. 
Action and Uses : Its chief use is as a disinfectant and antiseptic. It may he 
used in aqueous solution in strengths ranging from 1-1,000 to 1-10,000. It 
does not have a great penetrating disinfectant action because it combines 
chemically with organic matter. It is very irritant to the skin and must be 
cautiously used. When used for irrigation of body cavities (vagina), or when 
applied to the skin, it may be absorbed in sufficient quantity to produce toxic 
effects. It is given intramuscularly in the treatment of syphilis. When mixed 
with an excess of potassium iodide, it forms in solution, mercuric potassium 
iodide (HgI2.2KI), which is given by mouth in the treatment of syphilis and 
is known as specific mixture. Bichloride of mercury is prepared in tablet 
form (poison tablets of corrosive mercuric chloride, U. S. P.) as a convenient 
method for making up solutions of bichloride. Each tablet contains 0.5 gram 
of bichloride and 0.5 gram of sodium chloride, and is colored blue with 
sodium indigotin-disulplionate. When one of these tablets is dissolved in 500 
c. c. (1 pint) of water, it makes a 1-1,000 solution; 1 tablet to a quart of 
water makes a 1-2,000 solution, etc. Toxicology: Administer tvhite of an egg, 
folloived by emetic. Opium may be given to relieve the pain. Calcium sul- 
phide, both by mouth and intravenously, has been suggested as an antidote. 
Average dose: 0.003 gram or 1/20 grain. 
Hydrargyri Chloridum Mite, Mild Mercurous Chloride, HgCl, (Calomel, 
Mercurous Chloride, Protochloride of Mercury, Subchloride of Mercury), 
U. S. P.—It contains, when dried to constant weight in a desiccator over 
sulphuric acid, not less than 99.6 per cent of HgCl. Preserve it in well-closed 
containers, protected from light. 
Properties : It is a white impalpable powder, turning yellowish white on 
being triturated with pressure; odorless, tasteless, and permanent in the air. 
Insoluble in water, alcohol, ether, dr cold dilute acids. It should not contain 
the slightest trace of bichloride of mercury. It undergoes changes when ex- 
posed to light, or in contact with alkaline chlorides, bromides, or iodides, re- 
sulting in the production of mercuric salts which are toxic. 
Preparation : The process for making calomel is similar to that for making 
bichloride except that metallic mercury is added. Mercury, mercuric sulphate, 
and sodium chloride are heated together in a retort, resulting in the formation 
of calomel, which is sublimed and condensed in a separate container. Hg+ 
HgSQ4+2NaCl=2HgCl+Na2So4. After sublimation the calomel is washed 
several times with distilled water to free it from bichloride of mercury. 
Action and uses : Used externally as an antiseptic dusting powder and in 
ointments (33J per cent) as a venereal prophylactic. Internally it is used as 
an alterative, cathartic, and diuretic. When calomel is given for its pur- 
gative effect it should be followed from four to six hours after administration 
by a normal dose of epsom salts. 
Average dose: Laxative, 0.15 gm. or 2.5 grains. Alterative, 0.015 gm. or 
i grain. 
Unguentum Hydrargyri Nitratis, Ointment of Mercuric Nitrate (Citrine 
Ointment), U. S. P.—It is made from nitric acid, mercury, and lard. Two 
reactions are involved in the preparation of this ointment: (1) Nitric acid 
acts on the mercury, forming mercuric nitrate; (2) another portion of the nitric 
acid acts on the lard, forming a substance called elaidin. Finally the mer- 
curic nitrate is incorporated with the elaidin. Contact of metallic instruments 
must be avoided because of the presence of free nitric acid. MATERIA MEDICA. 
437 
Action and uses : It is a stimulating application to chronic and parasitic 
skin diseases. If used extensively it should he diluted. Toxic symptoms from 
absorption should he watched for. 
Hydrargyri Salicylas, Mercuric Salicylate (Mercuric Subsalicylate), U. S. 
P.—A compound of mercury and salicylic acid containing not less than 54 per 
cent nor more than 59.5 per cent of Hg. Preserve it in well closed containers 
protected from light. 
Properties : A white, slightly yellowish or slightly pinkish powder; odorless 
and tasteless; insoluble in water or alcohol. Soluble in warm solutions of 
alkali halides forming double salts. 
Preparation : It is made by heating yellow mercuric oxide with salicylic 
acid and a little water until a white mixture results. HgO+C,,Hi(OH).COOH= 
(CJP (OH) .COO) 2Hg+H20. 
Action and Uses : Used in the treatment of syphilis. It is given intramus- 
cularly suspended in liquid petrolatum (1 grain to 10 minims of oil). It pos- 
sesses the advantage of being less irritant than the other salts of mercury, 
both to the intestinal tract and when given intramuscularly. 
Average dose: 0.004 gm. or 1/15 grain. (More than this may be given.) 
Hydrargyrum Ammoniatum, Ammoniated Mercury, HgNH/'l (White Pre- 
cipitate), U. S. P.—It contains mercurammonium chloride (HgNH2Cl) cor- 
responding to not less than 78 per cent nor more than 80 per cent of Hg. 
Preserve it in well-closed containers, protected from light. 
Properties : A white, amorphous powder, odorless, and having an earthy, 
afterwards styptic, metallic taste; permanent in the air; insoluble in water 
or alcohol. 
Preparation : Made by precipitating a solution of mercuric chloride with 
ammonia water. HgCl2+2NH40H=HgNH2Cl+2H20+NH4Cl. 
Action and Uses : Taken internally it acts as an irritant poison. It is 
used externally in the form of an ointment (from 2 to 10 per cent) in the treat- 
ment of parasitic skin diseases. It acts as an antiseptic and local stimulant. 
Ointment of Ammoniated Mercury (White Precipitate Ointment), U. S. P., 
contains 10 per cent ammoniated mercury with white petrolatum and hydrous 
wool fat. 
Hydrargyrum Suceinimidum, Mercuric Succinimide.—It is a white crystal- 
line powder, soluble in 20 parts of cold water and in 5 parts of hot water. 
This salt, as well as its solution, should be protected from light. 
Action and Uses: It is given hypodermically in the treatment of syphilis 
and pyorrhoea. 
Average dose: By hypodermic, % grain. It is on the supply table in s-grain 
hypodermic tablets. 
Hydrargyri lodidum Flavum, Yellow Mercurous Iodide, Hgl (Mercurous 
Iodide, Protoiodide of Mercury, Yelloiv Iodide of Mercury), U. S. P.—It 
contains, when dried to constant weight in a desiccator over sulphuric acid, 
not less than 99 per cent of Hgl. Preserve it in well-closed containers, pro- 
tected from light. 
Properties: A bright yellow amorphous powder, odorless and tasteless. It 
undergoes decomposition into mercury and mercuric iodide when exposed to 
light. It is nearly insoluble in water, insoluble in alcohol and ether. 
Preparation : Made by treating mercurous nitrate with potassium iodide, 
HgN O3+KI=Hgl+KN On. 
Action and Uses : It is given by mouth in pill form to obtain the constitu- 
tional effects of mercury. 438 
HOSPITAL, COUPS HANDBOOK. 
Average dose: 0.01 gm. or 4 grain. It is on the supply table in 0.01 gm. or 
4-grain pills. 
Compounds of silver. 
Argenti Nitras, Silver Nitrate, AgNOs, U. S. P.—It contains, when finely pow- 
dered and dried to constant weight in a desiccator over sulphuric acid, in the 
dark, not less than 99.8 per cent of AgN03. Preserve it in dark amber-colored 
vials, protected from light. 
Properties : Occurs in colorless, transparent, tabular, rhombic crystals, be- 
coming 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 80 parts of alcohol. 
Preparation : It is made by dissolving silver in nitric acid with the aid of 
heat, 3Ag+4HN03=3AgN03+2H20+N0. 
Action and Uses : Silver nitrate is an antiseptic and disinfectant even in 
a very weak solution (1-1,000). Weak solutions are astringent and stimulat- 
ing to mucous membranes, and strong solutions are caustic. Solutions of silver 
nitrate always should be made with distilled water. It is used externally as a 
caustic and stimulant to tissues that heal slowly; internally, as an astringent 
and stimulant in the treatment of gastric ulcer. To ulcerated tonsils, appli- 
cation is made of solution containing from 2 to 10 per cent, followed by 
rinsing the mouth with salt solution. Silver nitrate is given best internally 
in pill form. The pill should be made by mixing the drug with kaolin and 
petrolatum. 
Average dose: 0.01 gm. or 4 grain. It must be used with great caution. 
Antidote: Sodium chloride (salt). 
Argenti Nitras Fuses, Molded Silver Nitrate (Fused Silver Nitrate, Lunar 
Caustic), U. S. P.—It contains not less than 94.5 per cent of AgNCh. Pre- 
serve it in dark amber-colored vials protected from light. 
Properties : It is a white, hard solid, generally in the form of pencils or 
cones, having the characteristic properties of silver nitrate. 
Preparation : It is made by fusing together, at as low a temperature as 
possible, 4 grams of hydrochloric acid with 100 grams of silver nitrate; the 
fused mass then is molded. Silver chloride is formed by the action of some 
of the silver nitrate on the hydrochloric acid, and when the mixture is cooled 
it makes a solid mass. 
Action and Uses: It is used as a caustic in the removal of warts, excessive 
granulations, etc. 
Argentum Protemicum., Silver Protein — It is a protein compound of silver 
containing about 8 per cent of silver. 
Properties : It is a brown, amorphous powder, soluble in water. It is not 
precipitated from solution by sodium chloride. It is decomposed by and de- 
composes a solution of mercuric chloride (bichloride of mercury) ; therefore, if 
penis syringes stained with this solution are kept in a bichloride solution, it is 
only a question of a short time before all the bichloride in the solution will 
be decomposed and the solution no longer will be antiseptic. 
Action and Uses : It is used as an injection in gonorrhoeal prophylaxis and 
treatment in one-half per cent aqueous solution. In the preparation of silver 
proteid solutions the powder should be sprinkled on distilled water in a gradu- 
ate having a wide mouth, and it should be allowed to dissolve without stirring. 
Argentum Colloidale, Colloidal Silver.—It is a colloidal compound of silver 
oxide with a derived protein, containing 20 to 25 per cent of silver. MATERIA MEDICA. 
439 
Properties : It occurs in dark, brown scales, very soluble in water (forming 
colloidal suspension rather than true molecular solution). Like protein silver, it 
decomposes bichloride of mercury solutions and in turn is decomposed by the 
bichloride. Its stains may be removed by bichloride of mercury solution, 2 to 30 
per cent in strength. 
Action and Uses : It is slightly antiseptic and nonirritating to mucous mem- 
branes. It is used in the treatment of inflamed sensitive mucous membranes, 
particularly in gonorrhoea, conjunctivitis, and other infections of the urethra, 
eye, ear, nose, and throat. Solutions should be made with distilled water. 
Compounds of copper. 
Cupri Sulphas, Copper Sulphate, CuSO4 (Blue Vitriol, Cupric Sulphate), 
U. S. P.—It contains not less than 62.97 per cent nor more than 66.79 per cent 
of anhydrous copper sulphate, corresponding to not less than 98.5 per cent of 
the crystallized salt (CuSCh+SILO). Preserve it in well-closed containers. 
Properties : It occurs as deep-blue crystals, or as a blue, granular powder; 
odorless, having a metallic taste; slowly efflorescent in dry air; soluble in 2.5 
parts of water, 500 parts of alcohol, and 2.8 parts of glycerin. Its aqueous solu- 
tion is acid to litmus. 
Preparation : It is made by the action of sulphuric acid on copper. Cu+ 
2II,.S04=CuS04+S02+2H20. 
Action and Uses : Internally it is used as an emetic, astringent, and antidote 
for phosphorus poisoning. In small doses it acts as an astringent, while in 
large doses it is an irritant and is nauseating. It is astringent and antiseptic 
even in strength of 1 to 1,000. Its aqueous solution is very destructive to the 
lower forms of plant life. It is used in the preparation of Feliling’s solution, 
a reagent used in testing for the presence of sugar in urine. 
Average dose: 0.25 gm. or 4 grains as an emetic; 0.01 gm. or i grain as an 
astringent. 
ORGANIC MATERIA MEDICA. 
In the study of inorganic materia medica it was found that most of the sub- 
stances were obtained or derived from the mineral kingdom. In the study of 
organic materia medica it will be found that most of the substances are ob- 
tained or derived from the vegetable and animal kingdoms or made syntheti- 
cally. Organic materia medica is the study of those compounds of carbon that 
are used in medicine. In this chapter only those used in the Medical Depart- 
ment of the Navy are discussed. The substances have been divided into groups, 
as far as practicable, according to a chemical classification. 
Hydrocarbons. 
Hydrocarbons are chemical compounds formed by the union of the elements 
hydrogen and carbon. There are hundreds of these compounds but only a few 
are on the supply table. For details concerning the general properties of 
the hydrocarbons the student is referred to textbooks on chemistry. 
Petrolatum, Petrolatum (Petrolatum Ointment, Petroleum Jelly), U. S. P.— 
A purified mixture of semisolid hydrocarbons, obtained from petroleum. 
Properties : It is an unctuous mass; yellowish to light amber in color; trans- 
parent in thin layers; amorphous, and free from odor and taste. It is insoluble 
in water, almost insoluble in alcohol, soluble in ether, chloroform, oil of turpen- 
tine, benzene, 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 (does not saponify) when brought in con- 
tact with strong acids or alkalies. 440 
HOSPITAL CORPS HANDBOOK. 
Preparation : It is an intermediate product in the distillation of crude petro- 
leum. 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 dressing, and as a 
base for ointments. The absorption and rapidity of action of drugs is retarded 
when incorporated with petrolatum; therefore it should not be used as an oint- 
ment 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. 
Petrolatum Liquidum, Liquid Petrolatum (Mineral Oil, Liquid Paraffin), 
U. S. P.—A mixture of liquid hydrocarbons obtained from petroleum. 
Preserve it in well-closed containers, protected from light. The U. S. P. 
recognizes two kinds of liquid petrolatum; heavy liquid petrolatum having a 
viscosity of not less than 3.1, which is intended to be used as a laxative; light 
liquid petrolatum having a viscosity of not more than 3.0 and intended to be 
used as a solvent in making sprays. 
Properties : Both varieties are colorless, transparent, oily liquids; free or 
nearly free from fluorescence, odorless and tasteless when cold; insoluble in 
water or alcohol, but soluble in ether, chloroform, or in fixed or volatile oils. 
Dissolves menthol, camphor, and volatile oils. 
Preparation : It is made from crude petroleum after removal of the lighter 
hydrocarbons (gasoline, kerosene, etc.) by distilling the residue between 330° 
and 390° C. It should be noted that the definition does not state that it is a 
mixture of hydrocarbons of any particular chemical series. 
Action and Uses: Largely used in the treatment of constipation. Its action 
is mechanical, as it is not absorbed. It simply oils the entire intestinal tract 
and facilitates the passage of the faecal mass. Used as a vehicle in the prepara- 
tion of the oil sprays for the nose and throat and in the preparation of petrox- 
olins (N. F. preparations). 
Average dose: 15 mils or 4 fluid drams). 
Paraffinum, Paraffin, U. S. P.—A purified mixture of solid hydrocarbons, 
usually obtained from petroleum. 
Properties: It is a colorless or white, more or less translucent mass, crys- 
talline when separating from solution, without odor or taste, and slightly greasy 
to the touch. It is insoluble in water or alcohol, but freely soluble in ether, 
benzene, volatile oils, and most fixed oils when warm. Like vaseline, it is chem- 
ically inactive and resistant to the action of other chemicals. It melts be- 
tween 50° and 57° C. 
Preparation : It is obtained from crude petroleum after all lighter sub- 
stances are distilled off. It stands next to vaseline. 
Action and Uses: It is used, in ointments in hot climates to raise their 
melting points; in making paraffin paper; for sealing bottles; in making 
candles; and in the preparation of paraffin-wax compounds (Parresine). 
Parresine is a compound containing paraffin, gum elemi, Japan wax, asphalt, 
and eucalyptol; it melts at 49° C. and is used as a surgical dressing for burns. 
Ammonii Ichthyo-sulphonas {Sulphonated Oil, Ichthyol, Ichthynat, etc.).—- 
Ammonium ichthyol sulphonate is a product resulting from the sulphonation 
of the tarlike distillate obtained from “asphalt stone,” a bituminous shale 
found in the Tyrol, and then converting the sulphonated product into an 
ammonium compound. It is not a hydrocarbon but is a hydrocarbon derivative. MATERIA MEDICA. 
441 
Action and Uses: It is used in ointments in strengths from 10 to 40 per 
cent for the local treatment of erysipelas, acne vulgaris, chronic eczema, and 
furunculosis. 
Halogen derivatives of hydrocarbons. 
Halogen derivatives of hydrocarbons are compounds formed by substituting 
one or more halogen atoms (chlorine, bromine, fluorine, or iodine) for a corre- 
sponding number of hydrogen atoms in hydrocarbon compounds. The substitu- 
tion may be done directly or indirectly. (See textbooks on chemistry.) The 
simplest hydrocarbon known is methane, CH4, which contains four hydrogen 
atoms united to one carbon atom. If we substitute three chlorine atoms in place 
of three of the hydrogen atoms in methane, we have a compound known as tri- 
chlor methane, CHCh (chloroform) ; or if we make the substitution with three 
iodine atoms, we have a compound known as triiodomethane, CHI3 (iodoform). 
If we substitute one chlorine atom for one hydrogen atom in ethane (G>H6), we 
have a compound known as monochlorethane, C2HBC1 (ethyl chloride), etc. 
Chlorofomwm, Chloroform, CHCh, U. S. P.—A liquid consisting of not less 
than 99 per cent nor more than 99.4 per cent by weight of CHCh and not less 
than 0.6 per cent nor more than 1 per cent of alcohol. Preserve it in well- 
stoppered bottles in a cool place protected from light. Caution: Care should 
be used in vaporizing chloroform in the presence of a naked flame, as noxious 
gases are produced. 
Properties: A clear, colorless, mobile liquid, of a characteristic, ethereal 
odor and burning, sweet taste. Soluble in 210 parts of water; miscible with 
alcohol, ether, benzene, petroleum, benzin, or with fixed or volatile oils. Specific 
gravity, 1.474 to 1.478 at 25° C. It is volatile at a low temperature and boils at 
61° C. It is not inflammable, but its heated vapor burns with a green flame. 
Chloroform is decomposed when exposed to light and air, liberating chlorine, 
hydrochloric acid, phosgene, and other compounds. The presence of a small 
amount of alcohol tends to prevent this decomposition. Chloroform that has 
been exposed to light and air should not be used for amesthesia. 
Preparation : It is made by the action of chlorinated lime on either acetone 
or ethyl chloride. 
Action and Uses : Used in surgery as a general anaesthetic by inhalation; 
internally as a carminative and sedative; externally as a rubefacient and vesi- 
cant. It is used in the preparation of chloroform water, U. S. P., chloroform 
liniment, U. S. P., and spirit of chloroform, U. S. P. 
Average dose: 0.3 c. c. of 5 minims. 
Iodoformum, Iodoform, CHh, U. S. P.—Triiodomethane, usually obtained 
by the action of iodine upon alcohol or acetone in the presence of an alkali or 
alkali carbonate. Preserve it in well-closed containers in a cool place, protected 
from light. 
Properties : It occurs as a fine, lemon-yellow powder or in lustrous crystals 
of the hexagonal system having a peculiar, very penetrating and persistent 
odor and an unpleasant, slightly sweetish taste suggestive of iodine. It is 
nearly insoluble in water, but soluble in 60 parts of alcohol, 80 parts of glyc- 
erin, 10 parts of chloroform, 7.5 parts of ether, and in 34 c. c. of olive oil. 
The unpleasant odor may be partially disguised in ointments by the addition of 
5 drops to the ounce of oil of peppermint. The odor of iodoform on utensils 
may be removed partially by wiping them off with oil of turpentine, followed 
by washing with soap and water. 
Preparation : Made by the action of iodine upon alcohol or acetone in the 
presence of an alkali or alkali carbonate. 442 
HOSPITAL CORPS HANDBOOK. 
Action and Uses: It is used externally in the form of dusting powder, oint- 
ment, or iodoform gauze as an antiseptic and stimulating dressing to wounds 
and ulcers. Its antiseptic properties are due to iodine, of which it contains 
about 96 per cent. Iodoform gauze may be made by saturating surgical gauze 
with a 5 per cent solution of iodoform in ether and allowing to dry. 
Dosage: 0.25 gm. or 4 grains. (Rarely given internally.) 
AEthylis Chloridum, Ethyl Chloride (CH3CH2C1), U. S. P.—Monochlorethane. 
Preserve it in hermetically sealed containers in a cool place, remote from fire 
and protected from light. 
Properties : At low temperatures or under pressure ethyl chloride is a color- 
less, mobile, very volatile liquid, having a characteristic ethereal odor and a 
burning taste. It boils between 12° and 13° C. It burns with a smoky, greenish 
flame witli the production of hydrochloric acid. When liberated at room tem- 
perature from its sealed container it vaporizes at once. The gas is very inflam- 
mable and must not be used in proximity to fire. 
Preparation : Ethyl chloride is made by passing hydrochloric acid gas into 
cold absolute alcohol. C2H50H+HC1=C2H5C1+H20. 
Action and Uses : When inhaled it produces general amesthesia promptly 
and may be used for operations that require only a few minutes. Sprayed on 
a part of the body it produces refrigeration and is used as a local anaesthetic 
in minor operations. 
Alcohols. 
Alcohols are compounds formed by the replacement of one or more hydrogen 
atoms of a hydrocarbon (except benzene) 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 methyl alcohol (CH3OH) or wood 
alcohol results; if one hydroxyl group is substituted for one hydrogen atom 
in ethane (C2He) an alcohol known as ethyl alcohol (C2H5OH) or grain alcohol 
is obtained; if three hydroxyl groups are substituted for three hydrogen atoms 
in propane (C3H5) an alcohol known as triatomic propyl alcohol (Calls (OH) 3) 
or glycerin occurs. Alcohols are designated monatomic, diatomic, triatomic, 
etc., accordingly as they contain one, two, three, etc., hydroxyl (OH) groups. 
Alcohols are related closely to hydroxides or bases in inorganic chemistry, and 
sometimes they are referred to as organic hydroxides. 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. 
Alcohol, Alcohol, C2HsOH, U. S. P.—A liquid containing not less than 92.3 
per cent by weight or 94.9 per cent by volume, at 15.56° C., of C2H6OH. 
Preserve it in well-closed containers in a cool place, remote from fire. 
Properties : It is a transparent, colorless, mobile, and volatile liquid, having 
a slight characteristic odor and a burning taste. Miscible in all proportions 
with water, ether, and chloroform. Specific gravity 0.816 at 15.56° C. (the 
United States Government standard temperature for alcohol), 0.810 at 25° C. 
It is easily volatilized at low temperature and boils at 78° C. It is inflam- 
mable and burns with a pale blue, smokeless flame. 
Preparation : Alcohol is made by the fermentation of starch contained in 
grain. In making U. S. P. alcohol rectified spirit is macerated with dehydrat- 
ing agents (quicklime) to remove water, and then is distilled. (For details 
see dispensatory.) 
Action and Uses: Alcohol is used as a diffusible stimulant and hypnotic. 
Large doses cause intoxication by depression and, finally, paralysis of the cen- 
tral nervous system. Externally alcohol is used as a refrigerant in giving 443 
MATERIA MEDICA. 
baths and alcohol rubs. It is a valuable antiseptic and is used extensively in 
surgery. In pharmacy it is used as a solvent in making spirits, tinctures, 
elixirs, and fluid extracts. Denatured alcohol should be made as directed 
by the Bureau of Supplies and Accounts circular letter No. 27-1921. Average 
dose: 10 c. c. or 2.5 fluid drachms. 
Alcohol Dilutum, Dilute Alcohol, U. S. P.—A liquid containing from 41 to 42 
per cent by weight, or from 48.4 to 49.5 per cent by volume at 15.56° C. of 
C2H5OH. Preserve it in well-closed containers in a cool place, remote from 
fire. 
Preparation : It is made by mixing equal volumes of U. S. P. alcohol and 
distilled water. When 500 c. c. of alcohol and 500 c. c. of distilled water are 
mixed, instead of getting 1,000 c. c. of dilute alcohol only 970 c. c. are made. 
Alcohol Dehydratum, Dehydrated, Alcohol, U. S. P.—A liquid commonly 
known as absolute alcohol and containing not less than 99 per cent by weight 
of C2H5OH. Preserve it in well-closed containers, in a cool place, remote from 
fire. If the stopper is removed, it should be securely replaced as soon as pos- 
sible to prevent the absorption of water from the air. 
Preparation : It is made from ordinary alcohol by redistillation after perco- 
lation through lime. There is still remaining 1 per cent of water, which is 
allowed. 
Action and Uses: Absolute alcohol is used in microscopical work. 
Alcohol MethyUc, Methyl Alcohol, CHiOH (Wood Alcohol, Wood Naphtha, 
Wood Spirit, Carbinol) .—Methyl alcohol is made by the destructive distillation 
of wood. 
Action and Uses : It is used in microscopical work. It is an excellent solv- 
ent, but is unfit for use in pharmacy because it is a dangerous poison, pro- 
ducing blindness and death. It is used in denaturing ethyl alcohol and in 
making formaldehyde. 
Glycerinum, Glycerin CjHs(OH)3 {Glycerol), U. S. P.—A liquid obtained by 
the hydrolysis of vegetable or animal fats, or fixed oils; purified by distilla- 
tion, and containing not less than 95 per cent of the trihydric alcohol 
C3H5(OH)3 or CH2OH.OHOH.OH2OH. Preserve it in well-closed containers. 
Properties : It is a clear, colorless liquid, of a thick, syrupy consistence, hav- 
ing not more than a slight, characteristic odor; sweet to the taste and produc- 
ing a sense of warmth in the mouth; when it is exposed to the air it absorbs 
moisture. It is miscible with water or alcohol in all proportions; insoluble in 
chloroform, ether, benzene, or fixed or volatile oils. 
Preparation : Glycerin is a by-product in the manufacture of soap. When- 
ever an alkali acts on a fixed oil or an animal fat a soap and glycerin are 
formed. The process is called saponification. 
Action and Uses : It is extensively used in pharmacy as a solvent. It pos- 
sesses the advantages of easily mixing with alcohol and water; is slightly anti- 
septic and preservative; has a sweet taste, and will dissolve many medicinal 
substances. It is used in making glycerin suppositories, glycerinated gelatin, 
and glycerites. It tends to keep substances from becoming hard. Given 
internally as a laxative (rarely). 
Average dose: 4 c. c., or 1 fluidram. 
Aldehydes and aldehyde derivatives. 
The word aldehyde is derived from alcohol dehydrogenatum, meaning alcohol 
from which hydrogen has been extracted, and referring to the method of pre- 
paring aldehydes. If two atoms of hydrogen are extracted from methyl alco- 
47829°—23 29 444 
HOSPITAL CORPS HANDBOOK. 
hoi (CHsOH—H2=H.COH), formic aldehyde or formaldehyde is formed. The 
extraction of the hydrogen usually is accomplished by bringing some sub- 
stance in contact with the alcohol that has a greater attraction for the hydro- 
gen than has the carbon. Such a substance is oxygen, and the process of ex- 
tracting the hydrogen is called oxidation; therefore it is said that formaldehyde 
is made by the oxidation of methyl alcohol. When an aldehyde is oxidized 
(this time the oxygen is added to the carbon instead of taking something from 
it), it is converted into an acid (H.C0H+0=H.C00H) ; when acetic aldehyde 
is oxidized it is converted into acetic acid: (CH3.C0H+0=CH3.C00H). 
The aldehyde group is COH and is contained in all aldehydes. 
Liquor Formaldehydi, Solution of Formaldehyde, Ii.COH (Formalin). 
U. S. P.—An aqueous solution containing not less than 37 per cent by weight 
of H.COH with varying amounts of methyl alcohol to prevent polymerization. 
Preserve it in a moderately warm place, protected from light. 
Properties : It is a clear, colorless, or nearly colorless liquid having a pungent 
odor and a caustic taste; its vapor acts as an irritant upon mucous mem- 
branes. It is miscible with water or alcohol. On long standing, especially 
in the cold, solution of formaldehyde sometimes loses its transparency, the 
cloudiness being due to the separation of paraformaldehyde (polymerization). 
Chemically it is a reducing agent. 
Preparation : It is made by the oxidation of methyl alcohol. 
CH30H+0=H.COH+H,0. 
Action and Uses: It is a powerful antiseptic and disinfectant. It acts as 
a disinfectant in aqeous solution in strengths of from 1 to 2 per cent (per cent 
here refers to the amount of absolute (H.COH) formaldehyde). This strength 
may be used in the disinfection of the hands, linen, or surgical instruments 
(having cutting edges). A 1 to 10 solution in alcohol is used for the preser- 
vation of tissue. A solution composed of 12.5 c. c. of formalin, 5 gm. of borax, 
and water to make 100 c. c. is used as an embalming fluid. It is used as 
a room disinfectant with barium dioxide. Five hundred c. c. of formalin mixed 
with 250 gm. of barium dioxide in a suitable container will generate sufficient 
formaldehyde gas to disinfect 1,000 cubic feet of air space. Formaldehyde is 
one of the few true deodorants. 
Chloralum Hydratum, Hydrated Chloral (Chloral, Chloral Hydrate), U. S. P.— 
A compound of trichloraldehyde or chloral, with the elements of one molecule of 
water. It contains not less than 99.5 per cent of CCls-COH+HA). Preserve it 
in tightly stoppered bottles, in a cool place, protected from light. 
Properties : It occurs in colorless, transparent crystals which do not readily 
attract moisture. It has an aromatic, penetrating, and slightly acrid odor, and 
a bitterish, caustic taste. It is slowly volatilized when exposed to the air. It is 
soluble in 0.25 part of water, 1.3 parts of alcohol, 2 pai’ts of chloroform, and 
1.5 parts of ether; very soluble in olive oil, freely soluble in oil of turpentine. 
It is decomposed by alkalies, liberating chloroform. 
Preparation : It is made by passing chlorine gas through absolute ethyl 
alcohol, resulting first in the conversion of alcohol to acetaldehyde, and then 
the acetaldehyde is converted into trichloraldehyde (chloral). 
(1) CH8CH20H+C12=CH3C0H+2HC1. 
(2) CH3COH+3Cl2=CCl3COH+3HCl. 
Action and Uses : It is a powerful nerve sedative and hypnotic and is used in 
insomnia, hysteria, the various forms of insanity, and delirium tremens. It 
usually is given with bromides. It is used to cause muscular relaxation in 
tetanus and strychnine poisoning, when large doses are necessary. It is a habit- 445 
MATERIA MEDICA. 
forming drug and should be used cautiously. It is one of the 11 drugs men- 
tioned in the Federal Pure Food and Drugs Act. The amount contained in any 
preparation must appear on the label when it enters interstate commerce. 
Average dose: 0.5 gm. or 8 grains. 
Hexamethylenamina, Hexamethylenamine, CaH12Ni (Hexamethylene-tetra- 
'mine), U. S. P.—A condensation product of ammonia and formaldehyde. Pre- 
serve it in well-closed containers. 
Properties : It occurs as colorless, lustrous, odorless crystals, or a white, 
crystalline powder; soluble in 1.5 parts of water and in 12.5 parts of alcohol. 
Its aqueous solution is alkaline to litmus. 
Preparation : It is made by the action of ammonia on formaldehyde. 
Action and Uses : It is a diuretic and antiseptic to the genito-urinary tract, 
as well as antiseptic for various body fluids, such as joint fluids, pleural fluids, 
etc. Its antiseptic action is due to formaldehyde liberated in body fluids. 
Average dose: 0.25 gm. or 4 grains. 
Ethers. 
Ethers may be defined as oxides of hydrocarbon radicles. There are simple 
ethers and mixed ethers. Simple ethers are formed by the union of two like 
hydrocarbon radicles with one oxygen atom; C2H5—O—C2H5 is diethyl ether 
(ether) ; compound ethers are formed by the union of two unlike hydrocarbon 
radicles with one oxygen atom, CH3—O—CAP is methyl ethyl ether. Ethers in 
organic chemistry are analogous to oxides in inorganic chemistry. The term 
very 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. (See textbook on 
chemistry.) 
/Ether, Ether (C2Ht)20 (Sulphuric Ether), U. S. P.—A liquid containing not 
less than 95.5 per cent nor more than 97.5 per cent of ethyl oxide (C2H5)20, the 
remainder consisting of alcohol containing a little water. Preserve it in par- 
tially filled, well-closed containers, in a cool place, remote from fire, and pro- 
tected from daylight. When ether is to be used for anaesthesia it is to be dis- 
pensed only in small, well-closed containers and is not to be used for this 
purpose if the container has been opened longer than 24 hours. 
Properties : Ether is a transparent, colorless, mobile liquid, having a char- 
acteristic odor and a burning sweetish taste. It is soluble in 12 parts of 
water and is miscible with alcohol, chloroform, petroleum benzin, benzene, or 
fixed and volatile oils. It boils at about 35° C. It is highly volatile and 
inflammable. Its vapor when mixed with air and ignited will explode vio- 
lently. It is slowly oxidized by the action of air, moisture, and sunlight. 
Preparation : It is made by the action of sulphuric acid on alcohol. 
CJPOII + IPSO* = CPEPHSCh + HA), and GJFHSCh + C2H5OH = (C2H5)20 + 
H2SCh. 
Action and Uses : It is administered by inhalation to produce general anaes- 
thesia. In the administration of ether great care should be exercised to see 
that a flame is not brought near the vapor. In pharmacy it is used as a solvent 
in the preparation of oleoresins and in the assay of alkaloids. Given inter- 
nally it acts as a cardiac stimulant, carminative, and antispasmodic. 
Average dose: 1 c. c. or 15 minims. 
Phenol and phenol derivatives. 
Phenols may be defined as compounds formed by the substitution of one or 
more hydroxyl (OH) groups for a corresponding number of hydrogen atoms 
that are connected directly with carbon atoms in the benzene nucleus (CsHs). 446 
HOSPITAL CORPS HANDBOOK. 
A phenol formed by substituting one hydrogen atom in benzene (CeHe) with 
one hydroxyl (OH) group is known as a monatomic phenol (C0H5OH), ordi- 
nary phenol; the substitution of two hydroxyls for two hydrogens would give 
a diatomic phenol (CsEMOHh), resorcinol; the substitution of three hydroxyls 
for three hydrogens would give a triatomic phenol pyrogallol. 
The substitution of three nitro groups for three of the hydrogen atoms in 
phenol (CoHsOH) gives a compound known as trinitro-phenol (C6H2(N02)30H), 
picric acid, etc. It should be understood clearly that phenols are a distinct 
class of compounds. The term “ phenol ” is the name given to the most impor- 
tant member in this class, just as alcohol is the name applied to the most im- 
portant member in the class of alcohol and the term “ ether ” to the most im- 
portant member of the class of ethers. 
Some of the phenols are liquids and some are solids; they all have a charac- 
teristic odor; they act like weak acids, forming salts with strong alkalies, but 
they do not decompose carbonates, and their reaction to litmus is neutral or 
only faintly acid. They are nearly all very poisonous; most of them are disin- 
fectants or antiseptics; are soluble in alcohol and sparingly soluble in water. 
Some are found in the vegetable kingdom (thymol) and some are formed when 
complex carbon compounds are subjected to destructive distillation; wood tar 
and coal tar, the residues resulting from the destructive distillation of wood 
and coal, contain phenols (phenol and cresol). A general measure against the 
caustic action of phenols (externally) is ethyl alcohol (grain alcohol), tvhich 
dilutes the phenol, thereby weakening its action as well as making it easier to 
remove. As an internal antidote alcohol should not be used, because an alco- 
holic solution of phenol is rapidly absorbed. 
Phenol, Phenol, CeHsOH (Carbolic acid), U. S. P.—It is obtained from coal- 
tar or made synthetically. It contains not less than 97 per cent of CbH5OH. 
Preserve it in well-closed containers, protected from light. 
'Properties : It occurs as colorless, interlaced or separate needle-shaped crys- 
tals, or as a white, crystalline mass, sometimes acquiring a red tint, having a 
characteristic, somewhat aromatic odor. When undiluted it cauterizes and 
wldtens the skin and mucous membrane. It is soluble in 15 parts of water; 
very soluble in alcohol, glycerin, chloroform, ether, or in fixed or volatile oils. 
When heated it melts, forming a highly refractive liquid. It also is liquefied by 
the addition of about 8 per cent of water. 
Preparation : It is obtained from coal tar by fractional distillation and sub- 
sequent purification. It also is made synthetically. 
Action and Uses. See Liquefied Phenol. 
Phenol Liquefactum, Liquefied Phenol (Liquefied carbolic acid), U. S. P.—A 
liquid containing not less than 87 per cent of CeHsOH and about 12 per cent of 
water. Preserve it in well-closed containers, protected from the light. 
Properties ; It is a colorless liquid, which may develop a red tint upon keep- 
ing, having a characteristic, somewhat aromatic odor. When undiluted it cau- 
terizes the skin and mucous membrane. It is miscible with ether, alcohol, or 
glycerin. When it is diluted with an equal volume of glycerin the mixture is 
miscible with water. 
Preparation : It is made by melting crystallized phenol on a water bath. 
It then is poured into a tared. vessel and weighed, and to every 9 grams of phe- 
nol is added 1 gram (1 c. c.) of distilled water, mixed thoroughly. An easier 
but less accurate method is to melt a bottle of the crystals on a water bath, 
add enough hot water to nearly fill the hottle, and shake thoroughly. 
Action and Uses: It is a valuable antiseptic and disinfectant. A 5 per cent 
solution may be used for the disinfection of the hands, soiled linen, stools, MATERIA MEDIC A. 
447 
urine, bedpans, urinals, etc. In concentrated form it acts as a caustic and local 
anaesthetic. Applied to a tooth cavity on a piece of cotton, it relieves toothache. 
If the pure phenol is spilled on the skin or in the mouth, it should be washed 
off immediately with alcohol. The concentrated phenol coagulates albumin, 
but its weaker aqueous solutions do not. Concentrated liquefied phenol is used 
for the disinfection of cutting-edged instruments which are damaged by boiling; 
after taking the instruments out of the phenol they are rinsed in alcohol to 
remove all the phenol. 
Average dose: 0.05 c. c. or 1 minim. 
Cresol, Cresol (Tricresol), U. S. P.—A mixture of isomeric cresols, C0H4.OH. 
CH3, obtained from coal tar. Preserve it in well-closed containers, protected 
from light. 
Properties : It occurs as a colorless or yellowish to brown-yellow, highly re- 
fractive liquid, becoming darker or assuming a reddish tint with age and on 
exposure to light, and having a phenol-like, sometimes empyreumatic odor. It 
is soluble in 50 parts of water; miscible with alcohol, ether, glycerin, benzene, 
or petroleum' benzin. It also is dissolved by solutions of the fixed alkali 
hydroxides and soap solutions (compound cresol solution). 
Preparation : It is obtained from the phenol distillates of coal tar. 
Action and Uses : The action of cresol is similar to that of phenol, except 
that it is stronger. It is a good disinfectant in the strength of 2 per cent 
solution for urinals, bedpans, stools, sputum cups, etc. It is used principally 
in the form of compound cresol solution, U. S. P., for disinfection of utensils, 
hands, and in obstetrical work, in strengths from 1 to 3 per cent. The poison- 
ous effects of cresol are similar to those of phenol. Compound cresol solution 
may be prepared extemporaneously by thoroughly mixing equal parts of cresol 
and soft soap and letting the mixture stand at least 24 hours. The resulting 
mixture forms a clear solution when dissolved in water. 
Trinitrophenol, Trinitrophenol (Calf2(OH) (N02)3 (Picric acid), U. S. P.— 
Preserve it in well-stoppered bottles, in a cool place, remote from fire. Caution: 
For safety in transportation it usually is mixed with about 20 per cent of 
water. 
Properties : It occurs in pale yellow, rhombic prisms or scales; odorless, 
and having an intensely bitter taste. It explodes when heated rapidly and 
when subjected to percussion. It is soluble in 78 parts of water, 12 parts of 
alcohol, 35 parts of chloroform, 65 parts of ether, and in 10 parts of benzene. 
Its aqueous solution is acid to litmus. 
Preparation : It is made by the action of nitric acid on phenol, resulting in 
the substitution of the nitro groups (N02) for three hydrogen atoms in phenol. 
Action and Uses : It is astringent and antiseptic. Its saturated aqueous 
solution is used mainly in the treatment of burns. Gauze saturated with the 
solution is applied to the burned area. A 5 per cent alcoholic solution is used 
(like tincture of iodine) in the first-aid-treatment of wounds as a disinfectant. 
Resorcinol, Resorcinol, CdIi(OH)2 (Resorcin), U. S. P.—Metadihydroxyben- 
zene. It contains not less than 99.5 per cent of CoEUtOHU. Preserve it in 
well-closed containers, protected from light. 
Properties : It occurs as colorless, or nearly colorless, needle-shaped crys- 
tals; or as a powder, having a faint peculiar odor and a sweetish, followed by 
bitter, taste. It acquires a pink tint on exposure to air and light. It is 
soluble in 0.9 parts of water, 0.9 parts of alcohol, freely soluble in glycerin or 
ether, slightly soluble in chloroform. 448 
HOSPITAL CORPS HANDBOOK. 
Action and Uses: It is antiseptic and antizymotic. It seldom is given inter- 
nally. It is used in the form of an aqueous solution, and an ointment in the 
treatment of subacute and chronic skin diseases. 
Creosotum, Creosote (Creosote), U. S. P.—A mixture of phenols and phenol 
derivatives, chiefly guaiacol and cresol, obtained during the distillation of wood 
tar. Preserve it in tightly stoppered, dark amber-colored bottles. 
Properties : It is an almost colorless or yellowish, highly refractive, oily 
liquid, having a penetrating, smoky odor, and a burning caustic taste; it does 
not readily become brown on exposure to light. It is slightly soluble in water, 
and is miscible with alcohol, ether, or fixed or volatile oils. It is inflammable. 
Action and Uses: It is given internally as an antiemetic, intestinal anti- 
septic, and stimulant expectorant. The poisonous symptoms are like those of 
carbolic acid and the treatment is the same. Locally it acts as an anaesthetic 
and antiseptic which makes it suitable for use in dental practice. 
Average dose: 0.25 c. c. or 4 minims. When given freely it should be ad- 
ministered in emulsion or dissolved in milk in order to overcome its irritating 
local effect. 
Creosoti Carbonas, Creosote Carbonate, U. S. P.—A mixture of carbonates of 
various constituents of creosote, chiefly guaicol and creosol. 
Properties : It is a clear, colorless or yellowish, viscid liquid, odorless and 
tasteless, or having a slight odor of creosote. It is insoluble in water and 
freely soluble in alcohol or fixed oils. 
Action and Uses : Being less irritating it is a good substitute for creosote 
internally. 
Average dose: 1 gm. or 15 grains. 
Guaiacol, Guaiacol (Methyl-orthodioxybenzene) U. S. P.—The monomethyl- 
ether (CeH4(OH)OCH3) of ortho-dihydroxy benzene, obtained from wood-tar 
creosote, or prepared synthetically. Preserve it in well-closed containers, 
protected from light. 
Properties : It is a colorless or yellowish, strongly refractive liquid or a 
crystalline solid having an agreeable aromatic odor. It is soluble in 53 parts 
of water, 0.8 parts of glycerin, and is miscible with alcohol, chloroform, ether, 
or acetic acid. Solid guaiacol melts at 28° C. 
Preparation : It is made by the fractional distillation of beecli-wood tar 
creosote. It also is made synthetically. 
Action and Uses : It is used externally as an antipyretic by applying locally 
on the skin. 1 to 3 c. c. painted on the chest, thigh, or abdomen of a fever 
patient will cause a fall of several degrees in the temperature of the body in 
an hour followed by excessive sweating and depression. It produces partial 
local anaesthesia when applied externally and sometimes is used for super- 
ficial neuralgias. 
Average dose: 0.5 c. c. or 8 minims. 
Acetanilidum, Acetanilid (Acetanilide, Antifebrin), U. S. P.—The mono- 
acetyl derivative (CeHsNH.CILCO) of aniline. 
Properties : Acetanilide is an odorless, crystalline powder having a slightly 
burning taste; permanent in the air. It is soluble in 190 parts of water, 3.4 
parts of alcohol, and 5 parts of glycerin. 
Action and Uses : It is antipyretic, analgesic, and cardiac depressant. 
Used principally as a headache remedy. It has a tendency to destroy red cor- 
puscles. It is used in solution of hydrogen dioxide as a preservative. 
Average dose: 0.2 gm. or 3 grains. 
Antipyrina, Antipyrvne (Phenazone), IT. 8. P.—Phenyldimethylpyrazolon 
(03HN20(CH3)2.C6He) . Preserve it in well-closed containers. MATERIA MEDICA. 
449 
Properties : It is* a white, nearly odorless crystalline powder with a slightly 
bitter taste. It is soluble in less than one part of water. 
Action and Uses : It is analgesic, antipyretic, and cardiac depressant. 
Average dose: 0.3 gm. or 5 grains. 
Acetphenetidinum, Acetphenetidin (Phenacetin), U. S. I*.—The monoacetyl 
derivative (CeH4(OC2H6).NH.CHsCO) of para-amidophenetol. 
Properties : It occurs as a white powder, odorless, and having a bitter taste. 
It is soluble in 1,310 parts of water and 15 parts of alcohol. 
Action and Uses : It is antipyretic, analgesic, and cardiac depressant. It is 
used extensively as a headache remedy. 
Average dose: 0.3 gm. or 5 grains. 
Organic acids and their esters. 
Organic acids are compounds formed by the union of a hydrocarbon radicle 
with a carboxyl group (COOH). They also are called carboxylic acids. They 
are not made by directly connecting the carboxyl group to a hydrocarbon 
radicle but by the oxidation of an alcohol to an aldehyde, and further oxida- 
tion of the aldehyde to an organic acid. The reactions taking place in the 
formation of acetic acid from ethyl alcohol may be expressed as follows: 
r2H5.0H+0=CH3.C0H+H20. Then If the acid 
contains only one carboxyl group (COOH) it is a monobasic acid; if it con- 
tains two, it is a dibasic acid; if it contains three, it is tribasic, etc. The 
only hydrogen that is replaceable by a metal or basic radicle in an organic 
acid is the hydrogen in the carboxyl group. 
They possess the general properties of inorganic acids; they are sour to' the 
taste, usually soluble in water; have a strong acid reaction to litmus. Some 
are liquids and some are solids. They are not as corrosive as the inorganic 
acids, some being very mild in their acid properties. They decompose carbo- 
nates and combine with metals and basic radicles to form salts. 
Esters are compounds formed by the union of an organic and inorganic acid 
with a basic hydrocarbon radicle. Erroneously they sometimes are called 
ethers. Examples of esters are ethyl acetate, ethyl chloride, phenyl salicylate, 
methyl salicylate, ethyl sulphate, etc. They frequently are called organic 
salts. 
Acidum Aceticum Glaciate, Glacial Acetic Acid, GHs.COOH, U. S. P.—A 
liquid containing not less than 99 per cent of CHs.COOH. Preserve it in glass- 
stoppered bottles. 
Properties : It is a clear, colorless liquid with a strong, vinegar-like odor 
and a very pungent, acid taste. It is miscible with water or alcohol. 
Preparation : It is one of the products resulting from the destructive dis- 
tillation of wood. It may be made by oxidation of alcohol. 
Action and Uses: It is a very energetic acid and acts as a caustic. It is 
used principally in the preparations of the weaker acids (acetic acid, U. S. P., 
36 to 37 per cent, and dilute acetic acid, U. S. P., 5.7 to 6.3 per cent). It is 
used in the preparation of salts of acetic acid (acetates). 
Average dose: 2 c. c. or 30 minims of the dilute acid. 
Acidum Citricum, Citric Acid, U. S. P.—A tribasic organic acid usually 
obtained from the juice of limes or lemons. It contains not less than 99.5 per 
cent of C3H4OH) (C00H)3+H20. Preserve it in well-closed containers. 
Properties : It occurs as colorless, translucent prisms or as a white powder, 
odorless and having an acid taste, and is efflorescent in warm air. It is soluble 
in 0.5 part of water and 1.8 parts of alcohol. 450 
HOSPITAL CORPS HANDBOOK. 
Action and Uses: It is used in the preparation of citrates (solution of mag- 
nesium citrate, U. S. I*.) and in the preparation of effervescent salts. It 
may he used as a substitute for lemon juice. 
Average dose: 0.5 gm. or 8 grains. 
Acidum Salicylicum, Salicyclic Acid, U. S. P.—Orthohydroxybenzoic acid. 
It exists naturally in combination in various plants but generally is prepared 
synthetically. It contains, when dried to constant weight in a desiccator over 
sulphuric acid, not less than 99.3 per cent of CoIU (OH) COOH. Preserve it in 
well-closed containers. 
Properties : It occurs in fine prismatic needles or in a bulky crystalline 
powder having a sweetish, afterwards acrid taste. Synthetic salicylic acid is 
white and odorless; when prepared from methyl salicylate it may have a slight 
yellow tint and a slight gaultherialike odor. It is soluble in 460 parts of 
water, 2.7 parts of alcohol, and 3 parts of ether. 
Action and Uses : Used as an antipyretic and anti rheumatic. It is used 
principally in the preparation of the salicylates (Phenyl salicylate, U. S. P., 
sodium salicylate, U. S. P., and acetylsalicylic acid) which are preferred for 
internal use. It is used externally for the treatment of skin diseases in the 
form of ointment, alcoholic solution, and dusting powder. It is contained in 
many corn collodions. 
Average dose: 0.75 gm. or 12 grains. 
Acidum Acetylsalicylicum, Acetylsalicylic Acid (Aspirin).—The acetic-acid 
ester, (C«H4.0(CH3CO).COOH) of salicylic acid. 
Properties : It is a white crystalline powder, odorless, and having an acid 
taste and reaction. It is sparingly soluble in water and freely soluble in 
alcohol. Its aqueous solution gradually decomposes into acetic and salicylic 
acids. 
Action and Uses : Its action is like that of salicylic acid and the salicylates. 
It is used extensively as an antipyretic and antirhemuatic. 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. 
Average dose: 0.3 gm. or 5 grains. 
Phenylis Salicylas, Phenyl Salicylate (Salol), U. S. P.—The phenyl ester 
(CcH4(OH)COOC(iH5) of salicylic acid. Preserve it in well-closed containers 
in a cool place. 
Properties : A white crystalline powder, having an aromatic odor and a 
characteristic taste. It is practically insoluble in water, soluble in six parts of 
alcohol, very soluble in chloroform, ether, or fixed or volatile oils. 
Preparation : It is made by the action of dehydrating agents on a mixture 
of phenol and salicylic acid. 
Action and Uses : It is used as an intestinal antiseptic. In the intestines 
it is decomposed into its component parts of phenol and salicyic acid, both of 
which exert their antiseptic action in the intestines. It is given with bismuth 
subnitrate for diarrhoea. It passes through the stomach unchanged, but 
breaks down in the intestines, and because of this property it is used for coat- 
ing enteric pills, protecting them from the action of the stomach juices. 
Average dose: 0.3 gm. or 5 grains. 
Acidum Tannicum, Tannic Acid (Tannin, Gallotaivnio Acid), U. S. P.—A 
tannin usually obtained from nutgalls. Preserve it in well-closed containers 
in a cool place, protected from light. 
Properties : It is a yellowish-white to light brown, amorphous powder, turn- 
ing darker on exposure to light, nearly odorless, and having a strong astringent MATERIA MEDICA, 
451 
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 chemical antidote in certain cases of alkaloidal poisoning. 
Average dose: 0.5 gm. or 8 grains. 
Acidum Tartaricum, Tartaric Acid, U. S. P.—A dibasic organic acid usually 
obtained from wine lees or argol. It contains not less than 99.5 per cent of 
C2H2(OH)2(COOH)2. 
Properties : It occurs in colorless, translucent prisms, or as a white granular 
powder, odorless, and having an acid taste. It is soluble in 0.75 parts of water, 
3.3 parts of alcohol, and almost insoluble in chloroform and ether. 
Preparation : It is made from the deposit in wine casks, which is com- 
posed principally of acid potassium tartrate. This acid potassium tartrate is 
converted into normal calcium tartrate (insoluble) in order to remove other 
impurities, then the pure calcium tartrate is treated with sulphuric acid, form- 
ing calcium sulphate and tartaric acid. The calcium sulphate is precipitated 
and the tartaric acid remains insoluble, from which it is obtained by filtration 
and evaporation. 
Action and Uses : It is used in the preparation of effervescent salts and 
drinks. It is contained in the white packet of a Seidlitz powder. Salts of 
tartaric acid are laxative (cream of tartar and Rochelle salt). 
Average dose: 0.5 gm. or 8 grains. (Rarely given internally.) 
Acidum Phenyldnchoninicum, Phenylcinchoninic Acid (Phenyl-quinoline- 
carboxylic acid), U. S. P.—An organic acid, phenyl-quinoline-carboxylic acid 
(C0H5.M5N.COOH). 
Properties : It occurs in small colorless needles or as a white or yellowish- 
white micro-crystalline powder, odorless or having a slight odor resembling 
benzoic acid, and a bitter taste. It is permanent in the air. It is insoluble in 
cold water, but slightly soluble in hot water; slightly soluble in cold alcohol, 
but readily soluble in hot alcohol. 
Action and Uses : This compound is sold under the trade name of atophan. 
It stimulates the kidneys to excrete more urine and has a selective action on 
the excretion of uric acid, which is increased in greater ratio than the increase 
in the amount of urine. Because of this selective action in increasing uric 
acid elimination it is used in the treatment of gout. 
Average dose: 0.5 gms. or 8 grains. 
Amylis Nitris, Amyl Nitrite, U. S. P.—A liquid containing not less than 80 
per cent of C5HuN02. Preserve it in hermetically sealed glass bulbs or glass- 
stoppered vials, in a cool place, protected from light. 
Properties : It is a clear, yellowish liquid, of a peculiar ethereal fruitlike 
odor and a pungent, aromatic taste. It is almost insoluble in water, but is 
miscible with alcohol or ether. It is very volatile even at low temperatures 
and is inflammable. 
Action and Uses: Amyl nitrite, like other nitrites (glyceryl nitrite, etc.), 
is a vasodilator (dilates the blood vessels). Amyl nitrite is given by in- 
halation to relax spasms of blood vessels in angina pectoris, asthma, and 
other painful affections due to arterial spasm. It is supplied to the Navy in 
the form of glass pearls (ampules) containing five minims each. When it is 
to be administered the pearl is crushed in a handkerchief and the volatile amyl 
nitrite inhaled. Its action is almost instantaneous. 
Average dose: 0.2 c. c. or 3 minims by inhalation. 452 
HOSPITAL, COKPS HANDBOOK. 
Spvritus Mtheris Nitrosi, Spirit of Nitrous Ether (Sweet Spirit of Nitre), 
U. S. P.—An alcoholic solution of ethyl nitrite (C2H5NO2) containing not less 
than 3.5 per cent nor more than 5 per cent of C2H5N02. Preserve it in small, 
well-stoppered, dark amber colored bottles, in a cool and dark place, remote 
from fire. 
Properties : It is a clear, mobile, volatile, and inflammable liquid of a pale 
yellow or faintly greenish-yellow tint, having a fragrant, ethereal, and pun- 
gent odor, free from acridity, and a sharp, burning taste. When kept for a 
long time it acquires an acid reaction. 
Preparation : See U. S. P. 
Action and Uses : It is a diuretic and diaphoretic. It is one of the ingre- 
dients contained in Brown Mixture. It frequently is given with solution of 
ammonium acetate. 
Average dose: 2 c. c. or 30 minims. 
Benzylis Benzoas, Benzyl Benzoate, CJEXJOOOtRt.—A colorless, oily liquid, 
having an unpleasant taste. Insoluble in water; freely soluble in alcohol. 
Preparation : Made by distillation of balsam of peru, which contains about 
60 per cent of benzyl benzoate. 
Action and Uses: Acts as an antispasmodic to involuntary muscles. Used 
to relieve pains due to spasm in gall-stone colic and abdominal cramps. It 
also is used as a palliative in the treatment of whooping cough and asthma. 
Is administered in the form of an emulsion. The following directions for 
making the emulsion are given in the supply table: “To 78 c. c. of ethyl 
alcohol, in which 2 grams of soap has been dissolved, add 20 grams of the 
drug to make an emulsion. The dose of this emulsion is 1.5 to 2 c. c.” 
Volatile oils, volatile oil drugs, and preparations made from volatile drugs. 
Volatile oils are a class of substances having in common the properties of 
being volatile; almost insoluble in water; most of them are lighter than water: 
soluble in ether and alcohol; having a highly characteristic odor, and possess- 
ing antiseptic properties. They do not leave a permanent stain on paper like 
that left by a fixed oil. Most of them are obtained from plants where they 
exist naturally or are formed when the plant is brought in contact with water. 
They vary greatly in their chemical composition. The following classes of 
chemical compounds are found in volatile oils: Hydrocarbons, alcohols, alde- 
hydes, esters, ketones, phenols, and phenol derivatives, sulphur compounds, etc. 
All these classes are not found in any one oil but a volatile oil may contain 
one or more compounds belonging to one or more of the above classes. Oil 
of peppermint contains menthol which is an alcohol; oil of thyme contains 
thymol which is a phenol; oil of gaultheria contains methyl salicylate which 
is an ester, etc. The medicinal properties of the volatile oils vary greatly, due 
to the difference in their chemical composition. 
Oleum Mentlm Piperito;, Oil of Peppermint (Peppermint Oil), U. S. P.—A 
volatile oil distilled from the flowering plant of Mentha Piperita, rectified by 
steam distillation, and yielding not less than 5 per cent of esters, calculated 
as menthyl acetate (CioHi9C2H302) , and not less than 50 per cent of total 
menthol (C10H10OH), free and as esters. Preserve it in well-stoppered amber- 
colored bottles, in a cool place, protected from light. 
Properties : It is a colorless liquid, having a strong odor of peppermint and a 
pungent taste, followed by a sensation of cold when air is drawn into the 
mouth (menthol). It is very slightly soluble in water, and is soluble in 4 
parts of 70 per cent alcohol. MATERIA MEDICA. 
453 
Action and Uses : It is used as a flavoring, and as an aromatic stimulant 
and carminative. It is contained in soda-mint tablets. 
Average dose: 0.2 c. c. or 3 minims. 
Menthol, Menthol, U. S. P.—A secondary alcohol (C10H19OH), obtained from 
oil of peppermint or other mint oils. Preserve it in well-closed containers in 
a cool place. 
Propekties : It occurs in colorless, acicular or prismatic crystals, having a 
strong odor and taste of peppermint. When tasted it produces a sensation of 
warmth followed by cold when air is drawn into the mouth. It is slightly 
soluble in water; very soluble in alcohol, chloroform, ether, or in petroleum 
benzin; freely soluble in liquid petrolatum, fixed or volatile oils. When tri- 
turated with about an equal weight of camphor, thymol, or hydrated chloral 
the mixture becomes liquid. 
Preparation : It is made by placing oil of peppermint in a freezing mixture; 
when the temperature reaches —22° C. the menthol precipitates from the oil. 
Action and Uses: Externally it is applied to the skin as a local anaesthetic 
and cooling application for the relief of superficial neuralgias. It is extensively 
used in nose and throat sprays. It is applied in solution or ointment for the 
relief of itching skin diseases. 
Average dose: 0.06 gm. or 1 grain. 
Spirit us Aurantii Compositus, Compound Spirit of Orange, U. S. P.—It con- 
tains oil of orange, oil of lemon, oil of coriander, oil of anise, and alcohol. It 
should be kept in completely filled, well-stoppered bottles in a cool dark place. 
Action and Uses : It is used as a flavoring and in the preparation of aromatic 
elixir. 
Oleum Caryophylli, Oil of Clove (Oil of Cloves, Clove Oil), U. S. P.—A vola- 
tile oil distilled from the flower-buds of Eugenia Aromatiea and Jambosa 
Caryophyllus, and yielding not less than 82 per cent, by volume, of eugenol 
(C8H3(OH) (OCH3)C3H5). Preserve it in well-stoppered, amber-colored bottles 
in a cool place, protected from light. 
Properties: It is a colorless or pale yellow liquid, becoming darker and 
thicker by age and the exposure to air, having the odor and taste of clove. 
It is soluble in two parts of 70 per cent alcohol. 
Action and Uses : Internally it acts as a stimulant and carminative. Ex- 
ternally it is employed as a local anaesthetic, parasiticide, and counterirritant. 
In dental practice it is used to stop toothache by applying it, on a piece of 
cotton, to a previously cleaned tootli cavity. In microscopy it is used to clear 
tissues for mounting. 
Average dose: 0.2 c. c. or 3 minims. (When given internally it should be 
diluted with five times its volume of cottonseed oil.) 
Eugenol, Eugenol, U. S. P.—An unsaturated, aromatic phenol, CBH3(OH) 
(OCH3)C3Hs, obtained from oil of clove and from other sources. Preserve 
it in well-closed containers, in a cool place, protected from light. 
Properties : It is a colorless or pale yellow, thin liquid, having a strongly 
aromatic odor of clove, and a pungent and spicy taste. It becomes darker and 
thicker on exposure to air. It is soluble in 2 parts of 70 per cent alcohol; 
miscible in alcohol, chloroform, ether, or fixed oils. 
Action and Uses : It is used in dental practice as a substitute for oil of 
clove. 
Average dose: 0.2 c. c. or 3 minims. 
Tinctura Cardamomi Composita, Compound Tincture of Cardamom, U. S. P.— 
It contains the aromatic, carminative principles from cardamom seed, saigon cin- 454 
HOSPITAL CORPS HANDBOOK. 
namon, and caraway. It is colored red with cochineal. The menstruum is 
dilute alcohol containing a little glycerin. 
Action and Uses : It is used as a carminative and flavoring agent. 
Average dose: 0.4 c. c. or 1 fluid dram. 
Oleum Picis Liquidce Rectificatum, Rectified Oil of Tar, U. S. P.—A rectified 
volatile oil distilled from tar. 
Properties : It is a thick liquid having a reddish brown color and a strong 
empyreumatic odor and taste. It is soluble in alcohol and insoluble in water. 
Preparation : It is made from wood tar by subjecting it to distillation and 
collecting that portion of the distillate which is lighter than water. It is a 
mixture of phenols, hydrocarbons, acetic acid, and oil of turpentine. 
Action and Uses: It is given internally in the treatment of chronic bron- 
chitis. It is administered in the form of an emulsion; externally it is used in 
the treatment of skin diseases in the form' of an ointment. 
Average dose: 0.2 c. c. or 3 minims. 
Eucalyptol, Eucalyptol (Cineol), U. S. P.—An organic compound (C,0HiSO) 
obtained from the volatile oil of Eucalyptus Globulus and from other sources. 
Preserve it in well-closed containers, in a cool place protected from light. 
Properties : It is a colorless, oily liquid, having a characteristic, aromatic 
and distinctly camphorac-eous odor, and a pungent, spicy taste. It is very 
slightly soluble in water, miscible with alcohol, chloroform, ether, glacial acetic 
acid, or fixed or volatile oils. 
Action and Uses : It is a stimulant expectorant, mild antiseptic, and anthel- 
mintic. It is given in the treatment of chronic bronchitis and pulmonary tuber- 
culosis. A mixture of 2 parts eucalyptol, 4 parts chloroform, and 45 parts of 
castor oil is used internally (given in two doses) in the treatment of uncinariasis 
(hookworm). Used locally in throat and nasal sprays and in the treatment of 
chronic skin diseases. 
Average dose: 0.3 c. c. or 5 minims. 
Fluid extract urn Zingiberis, Fluidextract of Ginger, U. S. P.—Each c. c. of the 
fluidextract represents the medicinal activity of 1 gram of the air-dried and 
powdered drug (ginger). The active substances in ginger are a volatile 
oil and a substance called gingerol. 
Action and Uses : It is used in the preparation of syrup of ginger. It 
acts as a warm, stimulating carminative when taken internally and is a valu- 
able remedy in the treatment of abdominal cramps. 
Average dose: 1.0 c. c. or 15 minims (diluted with water). 
Camphora, Camphor, U. S. P.—A ketone -(CsHieCO) obtained from Cinna- 
momum Camphora. Preserve it in well-closed containers in a cool place. 
Properties : It occurs as white, translucent masses or granules of a tough 
consistence, having a penetrating, characteristic odor and a pungent, aromatic 
taste. It is readily pulverizable in the presence of a little alcohol, ether, or 
chloroform. It is slightly soluble in water and freely soluble in alcohol, 
chloroform, ether, or in fixed or volatile oils. 
Preparation : It is obtained by treating the branches and chipped wood of 
the camphor tree with steam. The camphor in the wood is volatilized by the 
hot steam and then condensed. 
Action and Uses : It is a circulatory stimulant, mild antiseptic, slightly 
rubefacient, and carminative. As a circulatory stimulant it should be given 
hypodermically in sterilized oil. It is used as a mild antiseptic in nose and 
throat sprays, as a rubefacient in liniments, and as a carminative in diarrhoea 
mixtures (Squibb’s diarrhoea mixture). The official preparations containing 
camphor are: Camphor water, belladonna liniment, camphor liniment, chloro- MATERIA MEDICA, 
455 
form liniment, soap liniment, spirit of camphor, and camphorated tincture of 
opium. 
Average doses: By moutli 0.2 gm. or 3 grains; by hypodermic 0.1 gm. or 1$ 
grains. 
Methylis Salicylas, Methyl Salicylate (Oil of Teaberry, Oil of Winter green, 
Oil of Siveet Birch), U. S. P.—It contains not less than 98 per cent of 
0,H4(0H)C00.CH3. It is produced synthetically or is obtained by distillation 
from Gaultheria procumbens or from Betula lenta. The label must indicate 
whether the methyl salicylate has been made synthetically or distilled from 
either of the above-mentioned plants. Preserve it in well-stoppered amber- 
colored bottles in a cool place, protected from light. 
Properties : It is a colorless, yellowish or reddish liquid, having the char- 
acteristic odor and taste of gaultheria. It is sparingly soluble in water, 
miscible with alcohol and glacial acetic acid, and is soluble in 6 parts of 
70 per cent alcohol. 
Action and Uses : It is antirheumatic and slightly antiseptic. Given in- 
ternally its antirheumatic action is like that of the other salicylates. It is 
rapidly absorbed when rubbed on the skin or applied to the skin on a cloth. 
It is applied locally for the relief of rheumatic pains in the joints. 
Average dose: 0.75 c. c. or 12 minims. 
Thymol, Thymol, U. S. P.—A phenol C(sH3(CH3) (OH) (C3H7) occurring in the 
volatile oil of Thymus vulgaris and in some other volatile oils. Preserve it in 
well-closed containers. 
Properties : It .occurs in large, colorless, translucent prisms, having an aro- 
matic, thymelike odor and a pungent, aromatic taste, with a slight caustic 
effect upon the lips. It is soluble in 1,010 parts of water, 1 part of alcohol, 
0.7 parts of chloroform, 1.5 parts of ether, 1.7 parts of olive oil, and in glacial 
acetic acid or in fixed or volatile oils. When triturated with about an equal 
weight of camphor or menthol, the mixture liquifies. 
Action and Uses: Thymol is used as an anthelmintic and antiseptic. As an 
antiseptic it is employed in mouth washes, gargles, and sprays. As an anthel- 
mintic it is given for the cure of hookworm disease. Oils should not he given 
while thymol is in the intestinal tract because they cause it to be absorbed, 
with resulting symptoms of poisoning. Its administration should be preceded 
and followed by administrations of magnesium sulphate. 
Average dose: Antiseptic, 0.125 gm. or 2 grains; anthelmintic, 1 gm. or 15 
grains. 
Thymolis Iodidum, Thymol Iodide (Aristol), U. S. P.—Chiefly dithymol- 
diiodide (C6H2.CH3. C3H7.OI)2. It contains, when dried to constant weight in a 
dessiceator over sulphuric acid, not less than 43 per cent of iodine. Preserve 
it in well-closed containers, protected from light. 
Properties : It is a reddish-brown, or reddish-yellow bulky powder with a 
very slight, aromatic odor. It is insoluble in water or glycerin; slightly 
soluble in alcohol and very soluble in chloroform, ether, or in fixed or volatile 
oils. 
Preparation : It may be made by adding an aqueous solution of iodine and 
potassium iodide to an aqueous solution of sodium hydroxide and thymol 
with constant stirring. Thymol iodide is precipitated from this mixture. 
Action and Uses : It is a valuable antiseptic dusting powder. It is used 
in surgery as a substitute for iodoform, and as an external application to 
ulcers and skin diseases, either in the form of dry powder or ointment. It 
commonly is known as aristol. 456 
HOSPITAL OOEPS HANDBOOK. 
Emplastrum Sinapis, Mustard Plaster (Mustard Paper), U. S. P.—A uniform 
mixture of powdered black mustard (deprived of its fixed oil) and a solution 
of rubber, spread on paper, cotton cloth, or other fabric. It should be one 
square decimeter (16 square inches) in size and contain not less than 2.5 
grams of black mustard deprived of its fixed oil. 
Properties: When moistened thoroughly with tepid (not hot) water and 
applied to the skin, the plaster produces a decided warmth and reddening of 
the skin within five minutes. The irritating effect is produced by the volatile 
oil of mustard. This oil is liberated when mustard is mixed with water. 
Action and Uses: It is an extensively used counterirritant. It is used 
for the relief of congestion and pain in the chest, abdomen, joints, or muscles. 
Emplastrum Capsid, Capsicum Plaster, U. S. P.—It is composed of a mixture 
of oleoresin of capsicum and rubber plaster. Each 15 square centimeters of 
the spread plaster should contain 0.25 gm. of oleoresin of capsicum. 
Action and Uses : It is used as a rubefacient. 
Tinctura Capsici, Tincture of Capsicum, U. S. P.—It is a 10 per cent tincture, 
made by exhausting the active principles contained in cayenne pepper with 
alcohol. It has a light reddish color and the fiery taste of cayenne pepper. 
Action and Uses : Taken internally it stimulates the secretions of the 
salivary, gastric, and intestinal glands. It is especially valuable in gastritis 
due to alcoholism. 
Average dose: 0.5 c. c. or 8 minims. 
Oleum Santali, Oil of Santal (Santalwood Oil, Oil of Sandalwood), U. S. P.— 
A volatile oil distilled from the wood of Santalum album, yielding not less 
than 90 per cent of alcohols, calculated asl santalol (CidIEgO). Preserve it in 
well-stoppered, amber-colored bottles in a cool place, protected from light. 
Properties : It is a pale yellow, thick liquid; soluble in 5 parts of 70 per cent 
alcohol. 
Action and Uses: It is given internally as a stimulant and disinfectant to 
the mucous membranes of the genito-urinary tract. In overdoses it is very 
irritating to the genito-urinary tract, and therefore should he given with care 
Its principal use is in the treatment of chronic gonorrhoea. 
Average dose: 0.5 c. c. or 8 minims (in capsules, three times a day). 
Fluidextractum Buchu, Fluidextract of Bitch it, U. S. P.—One c. c. of the 
fluid extract represents the medicinal activity of 1 gram of the air-dried and 
powdered drug (buchu). Buchu is the dried leaves of Barosma betulina, a 
small shrubby plant growing in Cape Colony. Its active principles are a volatile 
oil and a resin. 
Action and Uses : Its activity depends upon the volatile oil, which is elimi- 
nated by the kidneys and acts as a tonic and disinfectant to the mucous mem- 
brane of the genito-urinary tract. It is used in the treatment of chronic inflam- 
matory conditions of the bladder. 
Average does: 2 c. c. or 30 minims. 
Fluidextractum Pruni Virginiance, Fluidextract of Wild Cherry, A. F.—One 
c. c. of fluid extract of wild cherry contains the active medicinal virtues of 
1 gram of air-dried and powdered wild cherry bark. Wild cherry is the stem 
hark of Prunus serotina, collected in autumn and carefully dried. The bark 
should be kept in well-closed containers, protected from light. The bark con- 
tains a glucoside, which in contact with water and under the influence of an 
enzyme present in the bark splits up into benzaldehyde (oil of bitter almond) 
and hydrocyanic acid, and these are the substances to which wild cherry owes 
its medicinal virtue. MATERIA MEDICA. 
457 
Action and Uses : Fluid extract of wild cherry is used in making syrup of 
wild cherry, given internally as a sedative expectorant. 
Average dose: 2 c. c. or 30 minims. 
Resins, oleo-resins, gum-resins, balsams, and their preparations. 
Resins generally are considered to be oxidation products of the terpene 
group of volatile oils, are complex in composition and apparently have as their 
chief constituents resin acids, resin esters, and resenes (of which but little 
is known). Those which are acid in character form resin soap when dis- 
solved in alkalies. They are brittle, nonerystalline solids, fusible but not 
volatile, insoluble in water, soluble in alcohol, ether, chloroform, carbon 
disulphide, fixed or volatile oils, ammonia and fixed alkalies, and soften and 
melt at moderate temperature. They may be divided into three groups: True 
Resins (described above), Oleo-resins and Balsams, and Gum-resins. 
Oleo-resins are natural mixtures or solutions of resins in volatile oils. 
Balsams are those liquid or soft products which contain benzoic and cinnamic 
acids, or an analogous acid, in addition to the resin; generally are spoken of 
as resinous or oleo-resinous exudates, and have the so-called balsamic odor. 
Gum-resins are natural mixtures of gums (substances having a composition 
similar to starch) and resins, and are found as milky exudations from plants. 
When rubbed up with water, gum-resins form an emulsion, the gummy sub- 
stance dissolving to form a mucilage which holds the resin in suspension. 
Oleum Terebinthince, Oil of Turpentine (Spirits of Turpentine), U. S. P.— 
The volatile oil distilled with water from the concrete oleo-resin obtained from 
Piwus palustris or from other species of Pinus. Preserve it in well-closed con- 
tainers. 
Properties : It is a colorless liquid having a characteristic odor and taste, 
both of which become stronger and less pleasant on aging or exposure to the air. 
Almost insoluble in water; soluble in 5 parts of alcohol, and freely soluble in 
oils. 
Action and Uses : The rectified oil of turpentine, U. S. P., should be used 
internally and oil of turpentine externally. When given internally it acts as 
a diuretic, expectorant, and anthelmintic. Externally it is used as a counter- 
irritant and rubefacient. 
Average dose: 0.3 c. c. or 5 minims (of the rectified oil). 
Terebenum, Terebene, U. S. P.—A liquid consisting of dipentene and other 
hydrocarbons, obtained by the action of concentrated sulphuric acid on oil of 
turpentine. Preserve it in well-closed containers, protected from light. 
Properties : It is a colorless, thin liquid, having a thymelike odor and a 
terebinthinate taste. It is soluble in 3 parts of alcohol and slightly soluble in 
water. On exposure to light it becomes resinified and acquires an acid reaction. 
Action and Uses : It is a stimulant to mucous membranes. It is given inter- 
nally as a stimulating expectorant, especially in the treatment of chronic bron- 
chitis. It is best given in capsules or on sugar. 
Average dose: 0.25 c. c. or 4 minims. 
Terpini Hydras, Terpin Hydrate, U. S. P.—The hydrate (CioHiS(OH)2+H20) 
of the dihydric alcohol terpin. Preserve it in well-closed containers, in a cool 
place. 
Properties : It is a colorless, lustrous, odorless powder, having a slight 
aromatic and bitter taste. It is soluble in 200 parts of water and in 13 
parts of alcohol. 
Preparation : It is made by the action of nitric acid on a mixture of alcohol 
and rectified oil of turpentine, 458 
HOSPITAL CORPS HANDBOOK. 
Action and Uses : It has a stimulating action upon mucous membranes. Its 
action is expectorant, diuretic, and slightly antiseptic. Its principal use is 
as an expectorant in the treatment of chronic bronchitis. It is administered 
in the form of an elixir. 
Average dose: 0.25 gm. or 4 grains. 
Tinctura Myrrhm, Tincture of Myrrh, U. S. P.—It is made by extracting (by 
maceration) the soluble principles from 200 grams of powdered myrrh with 
sufficient alcohol to obtain 1,000 c. c. of finished tincture. 
Properties : It is a dark reddish-brown liquid, having the balsamic odor of 
myrrh, and a bitter, aromatic taste. When mixed with water the resin 
contained in the alcoholic solution is precipitated. Myrrh is a gum resin. It 
contains 3 per cent of an oxygenated volatile oil, a bitter principle, 30 per cent 
of gum, and 60 per cent of resin. 
Action and Uses : It is an astringent. It is rarely used internally. It is 
principally used locally as a mouth wash, diluted with water in the propor- 
tion of about 1 to 20, in the treatment of stomatitis, spongy gums, sore throat, 
ptyalism, etc. 
Average dose: 1 c. c. or 15 minims. 
Balsamun Peruvianum, Balsam of Peru (Peru Balsam), U. S. P.—A balsam 
obtained from Toluifera Pereirw. It contains 60 per cent of benzyl benzoate 
and about 30 per cent of resin. 
Properties : It is a viscid liquid of a dark-brown color having an agreeable, 
vanilla-like odor, and a bitter, acrid taste. It is almost insoluble in water, 
soluble in alcohol or chloroform', and partly soluble in ether. 
Action and Uses : A 5 per cent solution in castor oil is used as a stimu- 
lating dressing for sluggish granulations and.chronic indolent ulcers. It is a 
valuable parasiticide in ringworm, pediculosis (crab lice), and scabies; for 
this purpose it is used in the form of an ointment consisting of 20 parts 
balsam Peru, 50 parts cotton seed oil, and 100 parts of petrolatum. In the 
treatment of scabies it is used like sulphur ointment (hot bath before, etc.). 
There may be added to this ointment 10 per cent of sulphur to increase its 
efficiency in the treatment of scabies. 
Tinctura Benzoini Composita, Compound Tincture of Benzoin (Friar's Bal- 
sam), U. S. P.—It is a dark-brown alcoholic liquid, made by extracting, by 
maceration, the alcohol-soluble principles from benzoin, 10 grams; aloes* 2 
grams; storax, 8 grams; and balsam of tolu, 4 grams, with sufficient alcohol 
to make 100 c. c. of finished tincture. 
Action and Uses: It is used in steam atomizers as an inhalant in the treat- 
ment of croupous affections of the throat and bronchi. If a steam atomizer is 
not available, the inhalations may be given by adding a teaspoonful of tincture 
to a glassful of boiling wmter and inhaling the vapor. It also is used as a 
protective for ulcers, fissures of the lips and anus, bedsores, cracked nipples, 
etc. It rarely is used internally. 
Average dose: 2 c. c. or 30 minims. 
Oleoresina Aspidiii, Oleoresin of Aspidium (Oleoresin of Male Fern), 
U. S. P.—Made by extracting the ether soluble principles from Aspidium by 
percolation with a menstruum consisting of ether. After percolation the ether 
is evaporated off, leaving the oleoresin of aspidium. It should be preserved 
in well-stoppered bottles. On standing, there is deposited in the bottom of 
the bottle a granular crystalline substance which should be thoroughly mixed 
with the liquid portion before use. 
Action and Uses: Used as a tseniacide (kills tapeworms). Castor oil or 
other fixed oils should not be given while oleoresin of aspidium is in the MATERIA MEDICA. 
459 
intestinal tract, because they cause absorption of the oleoresin and thus may 
cause toxic symptoms. 
Average dose: 2 gm. or 30 grains. Only one dose a day. 
Fixed oils, fats, and soaps. 
Fixed oils are so called because they leave a stain on paper or cloth that 
will not wash out, nor will it volatilize when subjected to mild heat. In this 
respect they differ from volatile oils. Solid substances that leave a similar 
stain are called fats. Fixed oils are found principally in the vegetable kingdom, 
and the fats are obtained from the animal kingdom. Fixed oils and fats are 
classed together because of the close chemical relationship that exists between 
them. They are composed principally of mixtures of glycerides of organic acids 
(esters). The principal acids that are combined with glyceryl (C3H5) radicles 
in these glycerides are: Oleic, palmitic, stearic, linoleic, and ricinoleic. The 
glycerides of these acids are liquids, except those of stearic and palmitic acids. 
Most fats and oils in common use are composed of glycerides of two or more 
of the above acids. The consistence of a fat or oil is governed by the proportion 
in which the solid and liquid glycerides are contained in it. Cottonseed oil is 
composed principally of glyceryl oleate (olein), while beef tallow, a solid, is 
composed principally of glyceryl stearate (stearin), etc. If the basic glyceryl 
(C3H5) radicle in a glyceride is displaced by an alkali metal, like sodium, 
sodium stearate, sodium oleate, or sodium palmitate (soaps) are formed accord- 
ing to the acid in the glyceride; the glyceryl (C3H5) radicle is set free to com- 
bine with hydroxyl (OH) groups that were attached to the sodium, forming 
glycerin. This reaction is known as saponification. Rancidity is a condition 
in fixed oils and fats due to decomposition of the glycerides under the influence 
of air (oxygen), heat, and albuminous matter, resulting in the liberation of the 
fatty acids and generation of volatile acids that have a distinct odor. 
Oleum Gossypii Seminis, Cottonseed Oil, U. S. P.—A fixed oil obtained from 
seeds of cultivated varieties of Gossypium herbacium, or other species of 
Gossypium. It is made by expression. 
Properties : It is a pale yellow, oily liquid, odorless or nearly odorless, and 
having a bland taste. It is almost insoluble in water; slightly soluble in 
alcohol; and is miscible with ether, chloroform, and petroleum benzin. It is 
readily saponified by strong solutions of alkalies forming soap. 
Action and Uses: It is used in the preparation of liniments. Cottonseed oil 
and its derivatives are used extensively as food products. It also is used in 
large quantities in the manufacture of soap. 
Average dose: 8 c. c., or 2 fluid drams. 
Oleum Ricini, 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 insoluble 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 intes- 
tines. Its disagreeable taste may be disguised 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 c. c., or 4 fluid drams. 
47829°—23 30 460 
HOSPITAL CORPS HANDBOOK. 
Oleum Morrhuw, Cod Liver Oil (Oleum Jecoris Aselli), U. S. P.—A fixed oil 
obtained from the fresh livers of Oadus morrhua (codfish) and other species of 
Qadus (hake, haddock, etc.). Preserve it in a cool place in well-closed con- 
tainers which have been thoroughly dried before filling. 
Properties : It is a pale yellow, 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 wasting dis- 
eases. The ease with which it is assimilated makes it an excellent food. Its 
beneficial and curative effects are due principally to the presence of a large 
amount of fat-soluble “A” vitamine. 
Average dose: 10 c. c. or 21 fluid drams. 
Oleum Theobromatis, Oil of Theobroma (Cacao Butter, Butter of Cocoa), 
U. S. P.—A concrete fixed oil obtained from the roasted seeds of Theobroma 
Cacao. 
Properties : It is a yellowish-white solid, having a faint, agreeable odor, 
and a bland, chocolate-like taste. It is insoluble in water, slightly soluble 
in alcohol, and freely soluble in ether or chloroform. It melts between 30° 
and 35° C. (86° and 95° F). 
Action and Uses : It is used as a vehicle in the preparation of suppositories 
because it melts slightly below the temperature of the body, sets free any 
medicinal substance incorporated with it, and allows the medicine to come in 
contact with the mucous membranes. It also is used in the preparation of skin 
food (ointmentlike preparation) and as a lubricant in massage. It is not 
given internally. 
Adeps, 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 imper- 
vious to fat. Adeps benzoinatus (benzoinated lard), U. S. P., is a lard that 
has been treated with benzoin to prevent it from turning rancid. In the 
preparation of benzoinated lard for use in warm climates the Pharmacopoeia 
directs that 50 grams of white wax be added to every 950 grams of lard in order 
to raise its melting point. 
Action and Uses ; Benzoinated lard is used principally as an ointment 
base. It will permit the incorporation of from 10 to 20 per cent of its weight 
of water. Next to lanolin it is the best base to use in an ointment when it 
is desired that the active medicine in the ointment be absorbed through the 
skin. 
Adeps Lance Hydrosus, Hydrous Wool Fat (Lanolin), U. S. P.—The puri- 
fied fat of the wool of the sheep, combined with not less than 25 per cent nor 
more than 30 per cent of water. Preserve it in a cool place in well-closed con- 
tainers which are impervious to fat. 
Properties: It is a yellowish-white, or nearly white, ointment-like mass, 
having not more than a slight odor. It is insoluble in water, but it mixes with 
its own weight of water without losing its ointmentlike character. 
Action.and Uses: It is used principally as an ointment base. It will per- 
mit 100 per cent of its weight of water to be incorporated with it, which 
makes it an excellent base to use when a large volume of an aqueous liquid 
is to he incorporated into an ointment. It also possesses the property of 
allowing drugs incorporated with it to be rapidly absorbed through the skin. 
Unlike lard and most other animal fats it does not turn rancid. 
Cera Alba, White Wax, U. 8. F.—It is yellow wax which has been bleached. MATERIA MEDICA. 
461 
Properties: It is a yellowish-white solid, somewhat translucent in thin layers, 
having a faint characteristic odor, practically tastless, and is free from ran- 
cidity. 
Action and Uses: It is used to stiffen ointments in warm climates, and it 
also is used in the preparation of cerates (stiff ointments). It is sometimes 
adulterated with paraffin. 
Sapo, Soap, U. S. P.—Soap prepared from olive oil and sodium hydroxide. 
Preserve dried or powdered soap in well-closed containers. 
Properties : It occurs as a white or whitish solid in the form of bars, 
hard, yet easily cut when fresh, or as a fine yellowish-white powder, having 
a faint, peculiar odor, free from rancidity, and a disagreeable alkaline taste. 
It is soluble in water and in alcohol. 
Action and Uses : It is used as a pill excipient in the preparation of pills 
containing resinous drugs. It is used also in liniments and plasters. 
Sapo Mollis, Soft Soap, U. S. P.—It is soap made by the action of potassium 
hydroxide on cottonseed oil. 
Properties: It is a soft, unctuous, yellowish-white to brownish-yellow mass, 
having a slight characteristic odor and an alkaline taste. It is soluble in 
water and alcohol. 
Action and Uses: It is used in the preparation of compound cresol solution 
and liniment of soft soap (tincture of green soap). Tincture of green soap is 
used extensively for surgical cleansing. 
Linimentum Saponis, Soap Liniment, U. S. P.—Soap liniment is supplied to 
the Navy in powdered form consisting of soap, camphor, and oil of rosemary. 
The liniment is made from this powder by dissolving it in 70 per cent alcohol, 
allowing it to stand 24 hours and filtering. 
Action and Uses: It is applied externally with massage as a rubefacient 
and also is used as a vehicle in the preparation of other more active liniments 
(chloroform liniment). 
Amylaceous and mucilaginous substances. 
Amylum, Starch, CaHi0Os (Cornstarch), U. S. P.—The starch separated from 
the grain of Zea Mays. 
Properties : It occurs in the form of a fine powder or irregular, angular, 
white masses, inodorous, and having a slight characteristic taste. It is insoluble 
in cold water or in alcohol. The individual grains are colored deep blue by 
iodine test solution. Cornstarch can be distinguished from other kinds of 
starch by the shape and size of the grain and the relative position of the 
hilum when viewed under a microscope. Boiled starch gives deeper blue reac- 
tion with iodine than raw starch. 
Action and Uses: It is used externally in dusting powders; internally as 
a demulcent; and in the form of starch paste in water as a vehicle for the 
administration of drugs by rectum. Starch paste is the best antidote for iodine 
poisoning. 
Acacia, Acacia (Gum Arabic), U. S. P.—The dried gummy exudation of 
Acacia Senegal and other African species of acacia. 
Properties : It occurs in colorless or pale yellowish opaque, inodorous tears, 
which are completely soluble in water. These tears are reduced to a granular 
powder and supplied under the name granular acacia. Acacia is very sensi- 
tive to certain reagents. It is precipitated from aqueous solutions by alcohol, 
tincture of ferric chloride, solution of lead subacetate, and saturated solution 
of borax, and should not be prescribed with these substances. 462 
HOSPITAL CORPS HANDBOOK. 
Action and Uses: It is used as a demulcent and as an emulsifying agent; 
also as an excipient in pill making. Mucilages and syrups made with acacia 
do not keep well unless sterilized. 
Sugar and saccharine substances. 
Saccharum, Sugar (Sucrose), U. S. P.—Sucrose (OkJUAU) is obtained from 
cultivated varieties of Saccharum Officinarum and from Beta Vulgaris and 
from other sources. 
Pkopekties : It occurs in white, hard, dry crystals, or as a white, crystalline 
powder, odorless, and having a sweet taste. It is permanent in the air. It is 
soluble in 0.5 parts of water, 170 parts of alcohol, and is insoluble in chloro- 
form or ether. Its aqueous solution saturated at 25 0. has a specific gravity 
of about 1.340. Sucrose, by the action of ferments or dilute acids, is converted 
into invert sugar, which is composed of equal parts of lsevulose and dextrose, 
which are both fermentable. 
Action and Uses: The most important use of sugar in medicine is in the 
preparation of sweet pharmaceutical preparations (syrups, elixirs, etc.). In 
the preparation of simple syrup it is important that a high grade of sugar be 
used and that a concentrated syrup be made. A concentrated syrup keeps better 
than one that is not concentrated. A supply of fresh syrup should not be mixed 
with an old syrup. It is better to throw away the old syrup and wash the 
bottle thoroughly with hot water before filling with newly made syrup. 
Extractum Glycyrrhizce Purum, Pure Extract of Glycyrrhiza, U. S. P.—The 
pure extract from the root of Glycyrrhiza glabra typica. It is made from the 
powdered root by extracting the soluble principles in the powder with weak 
ammonia water. It is a dark brown powder having a sweet taste. 
Action and Uses : It is used internally as a demulcent and to disguise the 
disagreeable taste of other drugs. It is one of the ingredients in compound mix- 
ture of glycyrrhiza. 
Mistura Glycyrrhizce Composita, Compound Mixture of Glycyrrhiza (Brown 
Mixture), U. S. P.—Pure extract of glycyrrhiza, 30 grams (30 gm.) ; syrup, 50 
cubic centimeters (50 c. c.) ; acacia, granulated, 30 grams (30 gm.) ; antimony 
and potassium tartrate, 240 milligrams (0.240 gm.) ; camphorated tincture of 
opium, 120 cubic centimeters (120 c. c.) ; spirit of nitrous ether, 30 cubic centi- 
meters (30 c. c.) ; water, a sufficient quantity to make 1,000 cubic centimeters 
(1,000 c. c.). 
Directions: Rub the pure extract of glycyrrhiza and acacia in a mortar with 
500 c. c. of warm water until they are dissolved. Allow the solution to cool, 
transfer it to a graduated vessel, add the antimony and potassium tartrate, dis- 
solved in 12 c. c. of hot water, then the other ingredients, and rinse the mortar 
with enough water to make the product measure 1,000 c. c. Mix the whole 
thoroughly. 
Average dose: 10 c. c. or 2£ fluid drams. 
Pulvis Glycyrrhizce Compositus Powder, Compound Powder of Glycyrrhiza 
(Compound Licorice Powder), U. S. P.—It contains senna, glycyrrhiza, washed 
sulphur, oil of fennel, and sugar. 
Action and Uses: It is used as a laxative and purgative. It is valuable in 
the treatment of constipation occurring in cases of haemorrhoids. 
Average dose: 4 gm. or 1 dram, administered with milk. 
Glucosides, drugs containing glucosides and preparations made from glucosidal 
drugs. 
Glucosides are substances existing in plants which under the influence of 
dilute acids or enzymes are decomposed fhydrolized) into a sugar (glucose) 
and one or more complex substances. The English names for the glucosides end MATERIA MEDICA. 
463 
in in, as digitalin, strophanthin, amygdalin, salicin, etc. Medicinally, glucosides 
are very active bodies. They are difficult to isolate from the drugs containing 
them without splitting them up into something different. Glucosidal drugs 
are drugs that contain glucosides. Owing to the difficulty in extracting and 
isolating the glucosides contained in glucosidal drugs, they can not be assayed 
by chemical means. Biological assays (strength determined by testing the 
drug on an animal) have been provided for certain glucosidal drugs (digitalis, 
stropliantlius, and squill). 
Digitalis, Digitalis (Foxglove), U. S. P.—The carefully dried leaves of Digi- 
talis purpurea, without the presence or admixture of more than 2 per cent of 
stems, flowers, or other foreign matter. If made into the official tincture and 
assayed biologically, the minimum lethal dose should not be greater than 0.006 
c. c. of the tincture, or the equivalent in tincture of 0.0000005 gram of ouabain 
for each gram of body weight of a frog. Digitalis should be preserved in tightly 
closed containers, protected from light. 
Properties : It contains a number of glucosidal principles, the most important 
of which are: Digitoxin, digitalin, and digitalein. 
Action and Uses: It is a powerful heart stimulant, producing greater force 
of contraction of the heart muscles and reducing the number of beats per 
minute, with increased arterial pressure. Because of the increased arterial 
pressure, it acts as a powerful diuretic. 
Average dose: 0.06 gram or 1 grain. 
Tinetura Digitalis, Tincture of Digitalis, U. S. P.—If assayed biologically, 
the minimum lethal dose should not be greater than 0.006 c. c. of the tincture, or 
the equivalent in tincture of 0.0000005 gram of ouabain for each gram of body 
weight of a frog. It is a 10 per cent tincture. 
Action and Uses: The use of the tincture is the same as the powder. 
Average dose: 0.5 c. c. or 8 minims. 
Strophanthus, Strophanthus, U. S. P.—The dried ripe seeds of Stropliantlius 
Kombd or Stropliantlius hispidus, deprived of the long awns. If made into the 
official tincture and assayed biologically, the minimum lethal dose should not 
be greater than 0.00006 c. c. of tincture, or the equivalent in tincture of 
0.0000005 gram of ouabain for each gram of body weight of a frog. Preserve 
strophanthus in tightly closed containers, adding a few drops of chloroform or 
carbon tetrachloride from time to time to prevent attack by insects. 
Properties : It contains a glucoside—strophanthin. 
Action and Uses : See tincture of strophanthus, which is on the supply table. 
Average dose: 0.06 gm. or 1 grain. 
Tinetura Strophanthi, Tincture of Strophanthus, U. S. P.—If assayed bio- 
logically, the minimum lethal dose should not be greater than 0.00006 c. c. of 
tincture, or the equivalent in tincture of 0.0000005 gram of ouabain for each 
gram of body weight of a frog. It is a 10 per cent tincture. The active prin- 
ciple in this tincture is the glucoside strophanthin. 
Action and Uses: It acts on the circulation like digitalis. It increases the 
force and volume of the heart beat but decreases its frequency. Like digitalis, 
it is a very poisonous drug and must be used with caution. 
Average dose: 0.5 c. c. or 8 minims. 
Santoninum, Santonin, U. S. P.—The inner anhydride or lactone of santonic 
acid obtained from Artemisia pauciflora. Preserve it in well-closed containers, 
protected from light. 
Properties : It occurs in colorless, shining, flattened rhombic prisms or as a 
crystalline powder; odorless and nearly tasteless at first, but afterwards devel- 
oping a bitter taste; permanent in the air, but becomes yellow on exposure to 
light. It is very slightly soluble in water and soluble in 43 parts of alcohol. 464 
HOSPITAL CORPS HANDBOOK. 
Action and Uses : It is used principally as an anthelmintic for the removal 
from the intestines of Ascaris lumbricoides (round worms). It makes objects 
appear to the patient as if viewed through a yellow glass (xanthopsia). 
Average dose: 0.06 gm. or 1 grain. (It is supplied to the Navy in one-half- 
grain tablets. 
Tincture Gentiance Composita, Compound Tincture of Gentian, U. S. P.—It 
contains in 1,000 c. c. the glycerin-hydro-alcoholic soluble principles from 100 
grams gentian, the active principle of which is the glucoside gentiopicrin, 40 
grams bitter orange peel, and 10 grams of cardamon seed. 
Action and Uses: It is used as a bitter tonic. 
Average dose: 4 c. c. or 1 fluidram. 
Vegetable drugs containing cathartic principles and their preparations. 
Resina Scammonice, Resin of Scammony, U. S. P.—It is a resin obtained from 
scammony root. Scammony root is the dried root of Convolvulus 'Scammonice, 
yielding not less than 8 per cent of the total resins of scammony root. 
Action and Uses : It is a drastic liydragogue cathartic. Neither scammony 
root nor resin of scammony are on the supply table, but the resin is contained 
in vegetable cathartic pills. 
Average dose: 0.2 gm. or 3 grains. One cathartic pill contains one-tenth of 
a grain. 
Resina Jalapce, Resin of Jalap, U. S. P.—It is a resin obtained from Jalap, 
the dried tuberous root of Exogonium Purga, and yielding not less than 7 per 
cent of resin. 
Action and Uses : It is a drastic purgative. It is one of the ingredients 
contained in vegetable cathartic pills. 
Average dose: 0.125 gm. or 2 grains. 
Resina Podophylli, Resin of podophyllum, U. S. P.—It is a resin obtained from 
the rhizome and root of Podophyllum (May Apple). Podophyllum is the dried 
rhizome and roots of Podophyllum peltatum, yielding not less than 3 per cent 
of resin. 
Action and Uses: It is a cholagogue purgative. Resin of podophyllum is 
on the supply table in one-tenth-grain tablets. It also is contained in vegetable 
cathartic pills. 
Average dose: 0.01 gm. or one-sixth grain. 
Extractum Colocynthidis, Extract of Colocynth, U. S. P.—It is an extract 
obtained from colocynth and is four times as strong as colocynth. Colocynth 
is the dried pulp of the fruit of CitruUns Colocynthis (bitter apple), and con- 
tains a purgative glucoside, colocynthin. 
Action and Uses : It is a drastic purgative. It is contained in vegetable 
cathartic pills. 
Average dose: 0.03 gm. or one-half grain. One cathartic pill contains about 
one-tenth of a grain. 
Aloe, Aloes, U. S. P.—The inspissated juice of the leaves of Aloe Perryi, 
yielding Socotrine Aloes; or Aloe vera, yielding Curasao Aloes; or Aloe ferox, 
yielding Cape Aloes. 
Action and Uses : It is used as a cathartic. It is one of the ingredients 
contained in vegetable cathartic pills. Aloin, one of the active principles of 
aloes, is contained in compound laxative pills, N. F. 
Average dose: Aloes, 0.25 gm. or 4 grains; aloin, 0.015 gm. or one-fourth grain. 
Extractum Leptandrw, Extract of Leptrandra (Culver's Rodt), N. F.—It is 
an extract obtained from Leptrandra. One gram of extract represents 4 
grams of leptrandra. Leptrandra is the dried rhizomes and roots of Veronica 
virginica. MATERIA MEDICA, 
465 
Action and Uses : It is used as a cathartic. It is contained in vegetable 
cathartic pills. 
Average dose: 0.25 gm. or 4 grains. 
Elaterinum, Elaterin, U. S. P.—A neutral principle obtained from Elaterium, 
a substance deposited by the juice of Ecballium Elaterium, the “squirting 
cucumber.” 
Action and Uses: It is a cholagogue purgative. It is supplied to the Navy 
in the form of a trituration (the only official trituration) in tablets containing 
one-tenth grain each. 
Fluidextractum Rhei, Fluid-extract of Rhubarb, U. S. P.—Made by extract- 
ing the active principles of rhubarb with a menstruum consisting of 4 volumes 
of alcohol and 1 volume of water. 
Action and Uses : Acts principally on the large intestines by producing 
frequent fluid stools accompanied by griping. The stools frequently are colored 
yellow with bile. On account of the rheotannic acid which it contains, rhubarb 
constipates after its purgative action. As a laxative it is particularly efficient 
in treating summer diarrhoeas of children, because after its purgative effect 
has been produced it checks the diarrhoea. 
Average dose: 1 c. c. or 15 minims. 
Extractum Cascarce Sagradce, Extract of Cascara Sagrada, U. S. P.—It is 
an extract obtained from Cascara Sagrada. One gram of extract represents 3 
grams of cascara sagrada. Cascara Sagrada (Chittem or Sacred Bark) is the 
dried bark of the trunk and branches of Rhamnus Pvrshiana, the California 
Buckthorn. Unlike most extracts it is made by exhausting the drug with 
boiling water. 
Action and Uses: It is a valuable laxative, acting mainly on the lower 
bowel. It is used in the treatment of chronic constipation. It is supplied to 
the Navy in tablet form. 
Average dose: 0.25 gm. or 4 grains. 
Fluidextractum Cascarce Sagradce Aromaticum, Aromatic Fluidextract of 
Cascara Sagrada, 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 percolation while it is mixed with magnesium oxide. It is 
aromatized and sweetened with pure extract of glycyrrhiza, saccharin, oil 
of anise, oil of cinnamon, oil of coriander, and methyl salicylate. It contains 
about 25 per cent alcohol, 20 per cent glycerin, and 50 per cent water. 
Action and Uses : It is preferred as a laxative over the other preparation 
of cascara because of its pleasant taste. It is used in making Elixir of Cas- 
cara Sagrada, N. F., and Compound Elixir of Cascara Sagrada, N. F. 
Average dose: 2 c. c. or 30 minims. 
Protein products obtained from animal substances and insects. 
The proteins are complex organic substances containing the elements oxygen, 
hydrogen, carbon, and nitrogen; most of them contain sulphur; some, phos- 
phorus and iron. They also may contain other elements; are found in plant 
and animal life, and easily undergo chemical changes when subjected to the 
influence of ferments or variations in temperature. 
Pepsinum, Pepsin, U. S. P.—A mixture containing a proteolytic ferment or 
enzyme, obtained from the glandular layer of the fresh stomach of the hog. 
It digests not less than 3,000 times its own weight of freshly coagulated and 
disintegrated egg albumin. Pepsin of a higher digestive power may I>e brought 
to this standard by admixture with pepsin of a lower digestive strength or 
with sugar of milk. Preserve it in well closed containers. 466 
HOSPITAL CORPS HANDBOOK. 
Properties: It occurs in lustrous, white, pale yellow or yellowish, trans- 
parent or translucent scales, grains or spongy masses, or as a tine, white, or 
cream colored, amorphous powder; free from any offensive odor, and having a 
slightly acid or saline taste. It is not more than slightly hygroscopic. It is 
soluble in 50 parts of water and is nearly insoluble in alcohol. When in 
solution it is incompatible with alkalies, alkali earths, and alkali carbonates. 
The presence of more than 0.5 per cent of hydrochloric acid in pepsin solu- 
tion retards its proteolytic activity. 
Action and Uses : Pepsin is a normal constituent of the gastric juice, and, 
as indicated above, its function is to digest albuminous matter. It is given 
when there is a deficiency of pepsin in the gastric juice. There are a large 
number of National Formulary elixirs and liquids containing pepsin. Pepsin 
and panoreatin never should be administered together; nor should pepsin be 
administered with sodium bicarbonate, which renders it inert. 
Average dose: 0.5 gm. or 8 grains. 
Suprarenalum Siccum, Dried Suprarenals (Desiccated Suprarenal Glands), 
U. S. P.—The suprarenal glands of animals (sheep or ox) which are used by 
man for food, cleaned, dried, freed from fat, powdered, and containing not less 
than 0.4 per cent nor more than 0.6 per cent of epinephrine, the active principle 
of the suprarenal gland. One part of dried suprarenals represents approxi- 
mately six parts of fresh gland, free from fat. If assayed biologically 1 gram 
of dried suprarenals contains the equivalent of 10 milligrams of lsevomethyl- 
amino-ethanolcatechol (adrenalin). 
Properties : It is a light-yellow powder, having a slight characteristic odor; 
partially soluble in water. The active substance contained in dried suprarenals 
is epinephrine (adrenalin). Epinephrine possesses properties resembling the 
alkaloids. It is basic in character (alkaline to litmus) and combines with 
acids to form salts (adrenalin chloride). Epinephrine also is prepared syn- 
thetically. 
Action and Uses: The dried suprarenals are not supplied to the Navy, but 
a 1-1,000 solution of adrenalin chloride in normal pnlt solution is on the sup- 
ply table. When solution of adrenalin chloride is administered hypodermically 
it raises the blood pressure (vaso-constriction) and acts as a heart stimulant. 
When applied locally to mucous membranes it contracts the small vessels, 
relieves congestion, and stops bleeding (haemostasis). Solution of adrenalin 
chloride is employed principally, mixed with solutions of local anaesthetics, in 
the proportion of 1 part of solution of adrenalin chloride to 20 parts of the 
anaesthetic solution (making an adrenalin strength of 1-20,000). It prevents 
the absorption of the anaesthetic (cocaine or procaine) by restricting the cir- 
culation, thereby confining the action of the amesthotic to the area to which 
it is applied, intensifying its anaesthetic effect, and preventing its toxic effect 
on the system. Epinephrine is supplied for dental use in tablet form under the 
name Suprarenin, mixed with procaine (novocaine). Each tablet contains i 
grain of procaine and t£ots grain of L-suprarenin. 
Liquor Hypophysis, Solution of Hypophysis (Solution of the Pituitary 
Body), U. S. P.—A solution containing the water-soluble principle, or principles 
from the fresh posterior lobe of the pituitary body of cattle. Extract the 
finely minced material with slightly acidulated water, boil the solution for 
10 minutes and filter it. Sterilize this filtrate and preserve it in a sterile con- 
dition in glass containers. 
Action and Uses : It is used as a heart stimulant in shock or collapse. 
It is used also in labor to increase the contractions of the uterus. 
Average dose: 1 c. c. or 15 minims. MATERIA MEDICA. 
467 
Cantharis, Cantharides (Spanish Flies, Russian Flies), U. S. P.—The dried 
beetles, Cantharis vesicatoria, yielding not less than 0.6 per cent of cantharidin. 
Preserve cantharides in tightly closed containers, adding a few drops of chloro- 
form or carbon tetrachloride, from time to time, to prevent attack by insects. 
Action and Uses : Cantharides owes its blistering properties to the active 
substance cantharidin. When given internally it is very irritating to the 
intestinal tract and is especially irritating to the genito-urinary organs during 
the elimination from the system. Externally it is used principally as a vesicant 
and counter-irritant and is supplied to the Navy in the form of a collodion. 
Collodium Cantharidatum, Caniharidal Collodion (Blistering Collodion, 
Vesicating Collodion), U. S. P.—It is a yellowish-green liquid, having an 
ethereal odor. Made by treating cantharides with glacial acetic acid, acetone, 
and chloroform and subsequent evaporation of the solvents. The residue con- 
taining the active principles of cantharides (cantharidin) is dissolved in 
flexible collodion. 
Action and Uses : It is used as a blistering agent by painting it on the skin. 
Alkaloids, alkaloidal salts, and alkaloidal drugs. 
Alkaloids are physiologically active principles found in the vegetable king- 
dom or produced synthetically and having a complex composition. They all 
contain N, C, and H, and the majority also contain O; most of those which 
do not being found as oily liquids. Because they contain nitrogen, are built 
on the ammonia type of bases, and act as derived ammonias in their method 
of forming salts, they frequently are spoken of as nitrogenous plant bases. 
They are derivatives principally of pyridine, quinoline, methane, or similar 
ringed bodies. The term, alkaloid means like an alkali, with which substances, 
however, they must not be confused. Substances reacting to many of the 
alkaloidal tests are found in decayed animal tissue (probably produced in the 
process of decay) and are known as ptomaines or “cadaveric alkaloids.” 
Alkaloids are regarded as decomposition products of proteins, nucleins, etc., in 
the plant cells during the process of growth, which have condensed with the 
substances present in plants. 
In the vegetable kingdom their occurrence is confined to a few plant families 
as follows: Apocynacese, Leguminosse, Liliacese, Loganacese, Papaveracese, 
Ranunculacese, Rubidiacese, Rutaceie, Solanacese, and Umbelliferse. They exist 
in all parts of plants, usually in the form of salts, as tannates, malates, quinates, 
meconates, etc. They can be extracted from drugs containing them, and are 
the active principles of the drags in which they reside. 
Some alkaloids are solids (amides), and some are liquids (amines). They 
are alkaline in their reaction and resemble inorganic bases in their chemical 
behavior, especially ammonia, in that they combine directly with acids to form 
salts. Their basic properties vary in intensity; some are strongly alkaline, and 
others are very weak. They are nearly all poisonous and have a bitter taste. 
With a few exceptions they are insoluble in water, but are soluble in alcohol, 
ether, chloroform, and petroleum benzin. The solubility of their salts is the 
reverse, being soluble in water but insoluble or slightly soluble in alcohol and 
insoluble in chloroform, ether, and petroleum benzin. Most of them are precipi- 
tated in aqueous solution from their salts upon the addition of alkalies or 
agents having an alkaline reaction. The alkaloids are decomposed by strong 
reducing or oxidizing agents (reason for the use of potassium permanganate 
in morphine poisoning). They are precipitated from their aqueous solution by 
mercuric potassium iodide, gold chloride, picric acid, tannic acid, sodium hydrox- 
ide, potassium hydroxide, alkali carbonates, alkali salicylates, benzoates, iodides, 
and bromides. 468 
HOSPITAL CORPS HANDBOOK. 
They vary greatly in their action on the system; some are stimulants, while 
others are depressants, etc. Some of the most valuable remedies used in medi- 
cine, as well as most of the narcotic habit-forming drugs, belong to this class. 
It is important to differentiate between alkaloids, alkaloidal salts, and alkaloidal 
drugs. Alkaloids are the basic substances; morphine is an alkaloid. Alkaloidal 
salts are compounds (salts or esters) formed by the union of the basic alkaloid 
with an acid; morphine sulphate is an alkaloidal salt formed by the union of 
morphine with sulphuric acid. Alkaloidal drugs are drugs (parts of plants) 
containing alkaloids; opium is an alkaloidal drug because it contains the 
alkaloid morphine; cinchona is an alkaloidal drug because it contains the 
alkaloid quinine. 
In order to distinguish alkaloids from glucosides a different terminology, 
which has been carried in the Pharmacopoeial nomenclature, has been adopted 
for each class. The ending ine (Latin ina) is applied to alkaloids, and the 
ending in (Latin inum) is given to glucosides. 
The following alkaloids and alkaloidal salts are official or on the supply 
table; those on the supply table appearing in italics: Morphine, morphine sul- 
phate, codeine, codeine sulphate, codein phosphate, apomorphine hydrochloride, 
ethylmorphine hydrochloride, diacetyl morphine, diacetylmorphine hydrochlo- 
ride, cotarnine hydrochloride, quinine, quinine sulphate, quinine bisulphate, 
quinine hydrochloride, quinine hydrobromide, quinine chlor-hydrosulphate (non- 
official), quinine salicylate, quinine tannate, quinine and urea hydrochloride, 
cinchonine sulphate, cinchonidine sulphate, strychnine, strychnine nitrate, 
strychnine sulphate, physostigmine salicylate, physostigmme sulphate (non- 
official), atropine, atropine sulphate, homatropine hydrobromide, scopolamine 
hydrobromide, hyoscyamine hydrobromide, pilocarpine hydrochloride, pilocarpine 
nitrate, aconitine, hydrastine, hydrastinine hydrochloride, pelletierine tannate, 
emetine hydrochloride, cocaine, cocaine hydrochloride, betaeucaine hydrochlo- 
ride, caffeine, caffeine citrate, caffeine sodio-bensoate, theobromine sodio- 
salicylate, sparteine sulphate, and colchicine. 
The following alkaloidal drugs and preparations made from alkaloidal drugs 
are on the supply table: Powdered opium, tincture of opium, pill of opium and 
lead acetate, camphorated tincture of opium, powder of ipecac and opium, com- 
pound tincture of cinchona, tincture of nux vomica, fluid extract of ergot, ex- 
tract of belladonna leaves, fluid extract of hyoscyamus, tincture of aconite, 
powdered ipecac, fluid extract of ipecac, belladonna plaster. 
Opium, Opium, U. S. P.—The air-dried milky exudation obtained by incising 
tbe unripe capsules of Papaver somniferum and its variety album, and yielding 
in its normal, moist condition not less than 9.5 per cent of anhydrous morphine. 
This form of opium is not used medicinally nor is it on tbe supply table, but 
it is used in making powdered opium and granulated opium, and these two 
preparations of opium are used in making the other opium preparations. 
Opii Pulvis, Powdered Opium, U. S. P.—Opium dried at a temperature not 
exceeding 70° C., reduced to a very fine powder, and yielding not less than 
10 per cent nor more than 10.5 per cent of anhydrous morphine. Powdered 
opium of a higher morphine percentage may be brought within the required 
limits by admixture with powdered opium of a lower percentage, or with some 
inert diluent. Preserve it in well-closed containers. 
Properties : It is a chocolate-colored powder, having a heavy narcotic odor 
and a bitter, characteristic taste. 
Constituents : Opium contains more than 20 different alkaloids, the most 
important of which are morphine and codeine. MATERIA MEDICA. 
469 
Action and Uses : Opium and its preparation when given internally are 
depressant to the central nervous system, analgesic, and constipating. Opium 
has no local effect other than that produced after absorption. The effects 
produced by opium preparations are due principally to morphine. All the 
opium preparations, alkaloids obtained from opium, and derivatives of these 
alkaloids are subject to the restrictions imposed by the Harrison narcotic act. 
They are habit-forming drugs. 
Average dose: 0.06 gm. or 1 grain. 
Pulvis Ipecacuanha? et Opii, Powder of Ipecac and Opium, (Dover’s Powder), 
U. S. P.—It is made by mixing 10 per cent opium powder, 10 per cent ipecac 
powder, and 80 per cent sugar of milk. Ten grains of this powder contains 
1 grain of powdered opium, 1 grain of powdered ipecac, and 8 grains of milk 
sugar. 
Action and Uses: It is used as an analgesic and diaphoretic. It is on the 
supply table both in powder and tablet form. 
Average dose: 0.05 gm. or 8 grains. 
Tinctura Opii, Tincture of Opium (Laudanum), U. S. P.—One hundred c. c. 
of tincture of opium yields not less than 0.95 grams nor more than 1.05 grams 
of anhydrous morphine. It is made by extracting the active principles from 
granulated opium with dilute alcohol. 
Action and Uses : It is a convenient form for the administration of opium. 
It is used in the preparation of lead and opium wash. It is given in diarrhoea 
for its sedative and constipating effect on the intestinal tract. It produces the 
characteristic effects of opium when given internally. 
Average dose: 0.5 c. c. or 8 minims. 
Tinctura Opii Camphorata, Camphorated Tincture of Opium (Paregoric), 
U. S. P.—It is made by extracting the active principles from powdered opium, 
4 grams; benzoic acid, 4 grams; camphor, 4 grams; and oil of anise, 4 c. c., 
with a menstruum of dilute alcohol containing a little glycerin. It is the 
weakest and one of the most used of the opium preparations. 
Action and Uses : It possesses analgesic and carminative properties. It is 
one of the ingredients in Brown Mixture (checks cough). It is used to relieve 
abdominal pain due to flatus (gas in the intestines), to check diarrhoea, etc. 
Average dose: 4 c. c. or 1 fluidram. 
Pilulce Opii et Plumbi, Pill of Opium and Lead (N. F.).—Each pill contains 1 
grain of lead acetate and 1 grain of opium. 
Action and Uses: It combines the constipating effect of opium with the 
astringent effect of lead acetate. It is used in cases of nersistent diarrhoea. 
Average dose: 1 pill. 
Morphina; Sulphas, Morphine Sulphate, U. S. P.—The sulphate of the alkaloid 
morphine. Preserve it in well-dosed containers, protected from light. 
Properties : It occurs in white, feathery, acicular, silky crystals, or in 
cubical masses; 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 narcotic. It is depressant to the central 
nervous system, relieves pain, produces sleep, and tends to cause constipation. 
It is a dangerous habit-forming drug and should never be prescribed in re- 
peated doses except by a doctor. In case of acute poisoning by morphine, wash 
out the stomach with potassium permanganate solution and give stimulants. 
Average dose: 0.008 gm. or i grain. 
Codeina, Codeine (Methylmorphime), U. S. P.—An alkaloid obtained from 
opium, or prepared from morphine by methylation. Preserve it in well-closed 
containers, protected from light. 470 
HOSPITAL CORPS HANDBOOK. 
Properties : It occurs in colorless, translucent, rhombic prisms or as a crys- 
talline powder; odorless, and is slightly efflorescent in warm air. It is soluble 
in 120 parts of water and 2 parts of alcohol. Its aqueous solution is alkaline 
to litmus. 
Action and Uses: It is sedative, analgesic, and hypnotic. Its action is 
somewhat like that of morphine but less intense. It is largely used as a 
sedative, in the treatment of coughs, to lessen the irritation of the respiratory 
tract. 
Average dose: 0.03 gm. or | grain. 
Codeince Sulphas, Codeine Sulphate, U. S. P.—The sulphate of the alkaloid 
codeine. Preserve it in well-closed containers, protected from light. 
Properties : It occurs in long, glistening, white, needle-shaped crystals or 
rhombic prisms, or as a crystalline powder; odorless and efflorescent in the 
air. It is soluble in 30 parts of water and very slightly soluble in alcohol. 
Action and Uses: Same as codeine. 
Average dose: 0.03 gm. or \ grain. 
Apomorpliince Hydrochloridum, Apomorphine Hydrochloride, U. S. P.—The 
hydrochloride of an alkaloid prepared from morphine by the abstraction of one 
molecule of water. Preserve it, protected from light, in small, well-stoppered 
vials, which previously have been rinsed with diluted hydrochloric acid and 
dried. Apomorphine hydrochloride, if it imparts at once an emerald-green 
color to 100 parts of distilled water when shaken with it in a test tube, is 
unfit for use. 
Properties : It occurs in minute white or grayish-white, glistening, monoclinic 
prisms; odorless, and acquiring a greenish tint upon exposure to light and 
air. It is soluble in 50 parts of water and in 50 parts of alcohol. 
Action and Uses: It is emetic, expectorant, and depressant. Its principal 
use is as an emetic in cases where the stomach tube can not be passed or 
emetics can not be given by mouth. It is administered hypodermically. 
Average dose: Emetic, hypodermic, 0.005 to 0.0065 gram or fa to ts grain. It 
is supplied to the Navy in fa grain hypodermic tablets. 
Diacetylmorphdnce Hydrochloridum, Diacetylmorphine Hydrochloride, U. S. 
P.—The hydrochloride of the alkaloid diacetylmorphine (heroin). Preserve 
it in well-closed containers, protected from light. 
Properties : It is a white, crystalline powder without odor. It is soluble in 
two parts of water; also soluble in alcohol. 
Action and Uses : It is sedative and slightly analgesic. It is used as a cough 
sedative and frequently is prescribed in cough mixtures. It is a habit-forming 
drug and is falling into disuse because of this fact. 
Average dose: 0.003 gram or fa grain. 
Cinchona Rubra, Red Cinchona (Red Peruvian Bark), U. S. P.—The dried 
bark of Cinchona succirubra, or of its hybrids, yielding not less than 5 per cent 
of the alkaloids of red cinchona. The cinchona tree is grown along the Andes 
Mountains in South America. Cinchona is not on the supply table, but it is the 
source of quinine, and is used in making compound tincture of cinchona. 
Tmctura Cinchona? Composita, Compound Tincture of Cinchona, U. S. P.— 
One hundred mils of compound tincture of cinchona yields not less than 0.4 
gram nor more than 0.5 gram of the alkaloids of cinchona. 
Preparation : It is made by extracting the active principles from 100 grams 
of red cinchona; 80 grams bitter orange peel; and 20 grams of serpentaria with MATERIA MEDICA. 
471 
a menstruum composed of alcohol, water, and glycerin and collecting 1,000 c. c. 
of percolate. See U. S. P. 
Action and Uses : It is a valuable bitter tonic and antimalarial. 
Average dose: 4 c. c. or 1 fluidram. 
Quinince Sulphas, Quinine Sulphate, U. S. P.—The sulphate of the alkaloid 
quinine. Preserve it in well-closed containers, protected from light. 
Properties : It occurs in white, silky, light, flexible, glistening crystals, mak- 
ing a very light and easily compressible mass; odorless and having a persistent, 
very bitter taste. It is soluble in 725 parts of water, 107 parts of alcohol, and 
30 parts of glycerin. It is freely soluble in water to which has been added a 
small amount of mineral 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 sulphate is practically insoluble in water. If an aqueous 
solution is desired, it may be made by adding to the quinine sulphate mixed with 
the water in a graduate, dilute sulphuric or hydrochloric acid drop by drop 
until a solution is produced. An acid salt is formed in solution which is very 
soluble in water. 
Average dose: Tonic, 0.1 gram or li grains; antimalarial, at least 1 gram 
or 15 grains daily. 
Quinince Hydrochloridum, Quinine Hydrochloride, U. S. P.—The hydrochloride 
of the alkaloid quinine. Preserve it in well-closed containers, protected from 
light. 
Properties : It occurs in white, silky, glistening needles; odorless, and having 
a very bitter taste. It is soluble in 18 parts of water (more soluble than the 
sulphate), 0.8 part of alcohol, and in 7 parts of glycerin. 
Action and Uses : The action and use of quinine hydrochloride is the same 
as the sulphate. It was added to the supply table for use in making elixir 
of iron, quinine, and strychnine, N. F. because it is more soluble than the 
sulphate. 
Average dose: Tonic, 0.1 gram or li grains; antimalarial, 1 gram or 15 
grains daily. 
Quinince Chlorhydrosulphas, Quinine Chlorhydrosulphate.—It is made by dis- 
solving 10 parts of quinine sulphate in 3.3 parts of 25 per cent hydrochloric 
acid and allowing the solution to crystallize during spontaneous evaporation. 
Action and Uses : It is supplied to the Navy in hypodermic tablets, contain- 
ing 1 grain each, to be used for the hypodermic administration of quinine. This 
salt is selected for this purpose because it is more soluble than the other 
quinine salts, being soluble in 1 part of water. 
Average dose: 0.06 gram or 1 grain. 
Atropince Sulphas, Atropine Sulphate, U. S. P.—The sulphate of the alka- 
loid atropine. 
Properties : It occurs as a white, crystalline powder or in microscopical 
needles and prisms; efflorescent in dry air; and odorless. Great caution should 
be used in tasting it, and then only in very dilute solution. It is soluble in 
0.4 parts of water, and 5 parts of alcohol. 
Average dose: 0.0005 gram or 1/120 grain. 
Emplastrum Belladonna, Belladonna Plaster, U. S. P.—An adhesive plaster 
containing 30 per cent of extract of belladonna leaves and yielding not less 
than 0.35 per cent nor more than 0.40 per cent of the alkaloids from bella- 
donna leaves. 472 
HOSPITAL, OOKPS HANDBOOK. 
Action and Uses : It is applied to tlie skin to secure the local anodyne 
effect of belladonna. It is used for the relief of rheumatic and neuralgic 
pains. 
Belladonna1 Folia, Belladonna Leaves {Deadly Nightshade Leaves) U. S. P.— 
The dried leaves and tops of Atropa Belladonna,, without the presence or admix- 
ture of more than 10 per cent of its stems or other foreign matter, and yielding 
not less than 0.3 per cent of the total alkaloids of belladonna leaves. Bella- 
donna leaves are not supplied to the Navy but they are used in making extract 
of belladonna and are the source of atropine. Belladonna leaves contain the 
mydriatic (pupil dilating) alkaloids of atropine, hyoscyamine, and belladon- 
nine. 
Action and Uses : See the Extract. 
Average dose: 0.06 gram or 1 grain. 
Extractum Belladonna Foliorum, Extract of Belladonna Leaves, U. S. P.—- 
Extract of belladona leaves yields not less than 1.18 per cent nor more than 
1.32 per cent of the alkaloids of belladonna leaves. One gram of the extract 
represents about 4 grams of belladonna leaves. It is dark green in color and 
of a pilular consistence. Extract of belladonna leaves may be used in making 
tincture of belladonna. It is used in making belladonna plaster, and belladonna 
ointment. 
Action and Uses : It is used internally as an anodyne and antispasmodic. 
In large doses it produces dryness of the throat, dilates the pupils, diminishes 
the secretion of urine, causes difficulty in swallowing, and checks perspiration. 
It prevents griping of the intestines and is used in the compound laxative pill 
for this purpose. It is used locally in plasters, ointments, and suppositories 
for its anodyne effect. 
Average dose: 0.015 gram or i grain. 
Physostigmina Sulphas, Physostigmine Sulphate, Eserine Sulphate.—The 
sulphate of an alkaloid obtained from physostigma. Preserve it in small, 
sealed containers, protected from light. 
Properties : It occurs in minute white crystals, becoming yellow on ex- 
posure to light and air. It is very deliquescent and readily soluble in water. 
Action and Use: It is a myotic, and is used in the treatment of eye dis- 
eases for the purpose of contracting the pupil. It may be used to hasten 
recovery from the effects of mydriatics. It is supplied to the Navy in sealed 
tubes containing 1 grain each, also in the form of hypodermic tablets con- 
taining 1/60 grain each. 
Average dose: 0.001 gram or 1/60 grain. 
Strychnines Sulphas, Strychnine Sulphate, U. S. P.—The sulphate of the 
alkaloid strychnine. Preserve it in well-closed containers. 
Properties : It occurs in colorless or white, prismatic crystals, or as a white 
crystalline powder; odorless, efflorescent in dry air, and having an intensely 
bitter taste. It is soluble in 32 parts of water, and 81 parts of alcohol. Great 
caution must be used in tasting it, and then only in very dilute solutions. 
Action and Uses: It is a powerful stimulant directly to the spinal cord and 
indirectly to nearly all the organs of the body. It is a powerful neurotic 
poison, and must be administered cautiously. It is supplied to the Navy in the 
form of a powder in 1-gram bottles for use in making elixir of iron, quinine, 
and strychnine. It also is supplied in hypodermic tablets. One tablet contains 
1/60 of a grain and another 1/30 of a grain. It is contained in the iron, quinine, 
arsenic, and strychnine tablet on the supply table. It is used as a respiratory 
and circulatory stimulant, is used also as a bitter tonic, and frequently is com- 
bined with iron and quinine in tonics, elixirs, and tablets. 
Average dose: 0.0015 gram or 1/40 grain. 473 
MATERIA MEDICA. 
Tincture of Nucis Vomica;, Tincture of Nux Vomica, U. S. P.—One hundred 
c. c. of tincture of nux vomica yields not less than 0.237 gram nor more than 
0.203 gram of the alkaloids of nux vomica. It is approximately a 10 per cent 
tincture, but the exact strength is based on the assay. 
Action and Uses: It possesses the stimulating and tonic properties of nux 
vomica. Because of its intensely bitter taste, it is used as a bitter tonic. 
Average dose: 0.5 c. c. or 8 minims, which is equivalent to about 1/120 grain 
of strychnine. 
Nux Vomica, Nux Vomica, U. S. P.—The dried ripe seeds of Strychnos Nux- 
vomica, yielding not less than 2.5 per cent of the alkaloids of' nux vomica. 
Strychnos nux-vomica is an Asiatic plant. The alkaloids contained in nux- 
vomica are strychnine and brucine. It is not on the supply table, but is used 
in the preparation of tincture of nux vomica, and is contained in a tablet mixed 
with capsicum. 
Action and Uses : The action of nux vomica is the same as that of strychnine, 
which is its most active principle. It is a direct stimulant to the spinal cord, 
and indirectly a stimulant to nearly all the organs of the body, thereby acting 
as a tonic. In large doses it is a poison, producing overstimulation and convul- 
sions. Chloroform inhalations and chloral hydrate internally are given to re- 
lieve the convulsions. 
Average dose: Tincture of nux-vomica, 0.5 c. c. or 8 minims. 
Homatropince Hydrobromidum, Homatropine Hydrobromide, U. S. P.—The 
hydrobromide of homatropine, an alkaloid obtained by the condensation of 
tropine and mandelic acid. Preserve it in well-closed containers, protected from 
light. It is an artificial alkaloid (synthetic). 
Properties : It occurs as a white, odorless, crystalline powder. Great caution 
must be observed in tasting it, using only very dilute solutions. Its solutions 
when locally applied dilate the pupil of the eye. It is soluble in 6 parts of 
water. 
Action and Uses : The action of homatropine is nearly identical with that 
of atropine. A 1 per cent solution instilled into the eye produces dilatation 
of the pupil in less than an hour, and the effect wears off within 48 hours. 
This property gives it a decided advantage over atropine, which requires a 
longer time to dilate the pupil and a much longer time to recover from its 
effect. It is supplied to the Navy in small bottles containing 1 grain each. 
Average dose: 0.0005 gram or 1/120 grain (seldom used internally). 
Hyoscyamus, Hyoscyamus {Henbane), U. S. P.—The dried leaves and flow- 
ering or fruiting tops of Hyoscyamus niger, yielding not less than 0.065 per 
cent of the alkaloids of hyoscyamus. Hyoscyamus is not on the supply table 
but it is used in making the fluid extract of hyoscyamus, and it is one of the 
sources of scopolamine (hyoscine). The alkaloids contained in hyoscyamus 
are liyoscyamine and hyoscine (scopolamine). 
Action and Uses : It is related closely to belladonna in its action, but is 
more sedative to the nervous system (due to the hyoscine which it contains). 
Hyoscyamus is supplied to the Navy in the form of a fluid extract, and its 
active principle hyoscine is supplied in hypodermic tablets under the name 
scopolamine hydrobromide. 
Average dose: Tincture of hyoscyamus, 0.6 to 2 c. c. or 10 to 30 minims. 
(Seldom given in powder form.) 
Fluidextractum Hyoscyamus, Fluidextract of Hyoscyamus (Fluidextract of 
Henbane), U. S. P.—One hundred c. c. of fluid extract of hyoscyamus yields 
not less than 0.055 nor more than 0.075 gram of the alkaloids of hyoscyamus. 474 
HOSPITAL CORPS HANDBOOK. 
Action and Uses : It is used as a hypnotic, nervous sedative, and analgesic. 
Given with purgatives it prevents griping effect. 
Average dose: 0.2 c. c. or 3 minims. 
Scopolamince Hydrobromidum, Scopolamine Hydrobromide (Hyoscine Hydro- 
bromide), U. S. P.—The hydrobromide of lsevorotatory scopolamine, also known 
as hyoscine, obtained from various plants of the Solanacese. Preserve it in 
well-closed containers protected from the light. 
Properties : It occurs in colorless, transparent, rhombic crystals, sometimes 
of large size, odorless, slightly elilorescent. Great caution must be observed in 
tasting it and then only in very dilute solutions. It is soluble in 1.5 parts of 
water. 
Action and Uses : It is a powerful cerebral depressant and hypnotic. It is 
given to produce sleep, in cases of mania. It also is given with morphine as a 
preliminary to the use of ether anaesthesia. It is supjilied to the Navy in 
hypodermic tablets containing 0.0003 gram or 1/200 grain, each. 
Average dose: 0.0003 gram or 1/200 grain. 
Pilocarpus, Pilocarpus (Jaborandi), U. S. P.—The dried leaflets of Pilo- 
carpus Jaborandi yielding not less than 0.6 per cent of the alkaloids of pilo- 
carpus. Pilocarpus is not on the supply table but it is the source from which 
pilocarpine is obtained. It contains a number of alkaloids, the most important 
of which is pilocarpine. 
Pilocarpines Hydrochloridum, Pilocarpine Hydrochloride, U. S. P.—The 
hydrochloride of an alkaloid obtained from pilocarpus. Preserve it in well- 
closed containers protected from light. 
Properties : It occurs in colorless, translucent crystals, odorless, and having 
a faintly bitter taste; hygroscopic on exposure to the air. It is soluble in 
0.3 parts of water. 
Action and Uses : It is used as a diaphoretic. It is supplied to the Navy 
in the form of hypodermic tablets containing £ grain each. 
Average dose: 0.005 gram or A grain (hypodermically). 
Aconitum, Aconite (Monkshood), U. S. P.—The dried tuberous roots of 
Aconitum Napellus, yielding not less than 0.5 per cent of the ether-soluble 
alkaloids of aconite. If made into a fluid extract and assayed biologically the 
minimum lethal dose should not be greater than 0.00004 c. c. for each gram 
of body weight of guinea pig. Aconite is not on the supply table but is 
used in making tincture of aconite. Aconite contains the very active alkaloid 
aconitine. 
Tinctura Aconiti, Tincture of Aconite, U. S. P.—One hundred c. c. of tincture 
yields not less than 0.045 gram nor more than 0.055 gram of the ether- 
soluble alkaloids of aconite. If assayed biologically the minimum lethal dose 
should not be greater than 0.0004 c. c. for each gram of body weight of guinea 
pig. It is approximately a 10 per cent tincture. 
Action and Uses : Aconite slows the pulse and lowers the blood pressure. 
It is used internally as a circulatory depressant, diaphoretic, and antipyretic in 
fevers of short duration. It is a very poisonous tincture and must be ad- 
ministered cautiously. 
Average dose: 0.3 c. c. or 5 minims. 
Ipecacuanha, Ipecac, U. S. P.—The dried root of Cephaelis ipecacuanha, 
yielding not less than 1.75 per cent of the ether-soluble alkaloids of ipecac, 
dried and finely powdered. Ipecac contains several alkaloids, the most im- 
portant of which is emetine. 
Action and Uses : In large doses it acts as an emetic partly through its 
local irritant action. In small doses it stimulates the secretions of the 475 
MATERIA MEDICA. 
respiratory tract. Combined with opium (Dover’s powder) it acts as a diapho- 
retic. It is specific against amoebic dysentery, given in the form of enteric 
pills (salol coated). It is used in the preparation of fluid extract of ipecac, 
and powder of ipecac and opium. 
Average dose: Expectorant, 0.06 gram or 1 grain; emetic, 1.0 gram or 15 
grains. 
Fluidextracturn Ipecacuanhas, Fluidextract of Ipecac, U. S. P.—One hun- 
dred c. c. of fluid extract of ipecac yields not less than 1.8 grams nor more 
than 2.2 grams of the ether-soluble alkaloids of ipecac. 
Action and Use: The action and use of the fluid extract is the same as that 
of powered ipecac. The principal use of the fluid extract is in making the 
syrup of ipecac. 
Average dose: Expectorant 0.05 c. c. or 1 minim ; emetic, 1.0 c. c. or 15 minims. 
Emetince Hydrochloridum,, Emetine Hydrochloride, U. S. P.—The hydro- 
chloride of the alkaloid emetine, obtained from ipecac. It contains variable 
amounts of water of crystallization. Preserve it in dark amber-colored vials 
protected from light. 
Properties : It occurs as a white crystalline powder, without odor ; darkens on 
exposure to the air; and is freely soluble in water. 
Action and Uses : It is used in the treatment of pyorrhoea and amoebic 
dysentery, administered hypodermically. It is supplied to the Navy in the 
form of hypodermic tablets containing J of a grain each. 
Average dose: 0.02 gram or J grain. 
Coca, Coca (nonofficial).—The dried leaflets of Erythroxylon Coca, known 
commercially as Huanuco Coca or as Truxillo Coca, yielding not less than 0.5 
per cent of the etlier-soluble alkaloids of coca. It is cultivated in South 
America, Mexico, and the West Indies. Most of the coca leaves come from 
Peru, Bolivia, and Ecuador. It contains a number of alkaloids, the most 
important of which is cocaine. Coca leaves, its preparations, and derivatives, 
which includes cocaine, are restricted in their sale and use hy the Harrison 
Narcotic Act Coca leaves are not on the supply table nor are they recognized 
by the Pharmacopoeia or National Formulary, and are of interest only as the 
source of cocaine. 
Cocaince Hydrochloridum, Cocaine Hydrochloride, U. S. I’.—The hydrochloride 
of the alkaloid cocaine. 
Properties : It occurs in colorless, transparent, monoclinic prisms; in flaky, 
lustrous leaflets; or as a white crystalline powder; odorless and permanent 
in the air; soluble in 0.4 c. c. of water; soluble in glycerin and slightly so in 
alcohol. Cocaine solutions are decomposed by the heat of boiling water or in 
the presence of even slight traces of alkali. 
Action and Uses: When applied locally, cocaine paralyzes the peripheral 
nerves, causing loss of sensation. When injected around a nerve sheath or 
into a nerve it produces anmtliesia in the area supplied by the sensory fibers 
of that nerve. When absorbed into the system it first produces stimulation, 
followed by depression of the central nervous system. The principal use of 
cocaine is as a local amesthetic. It can be used for deadening sensation in the 
eye when foreign bodies are to be removed. It is employed in solutions ranging 
from 1 to 5 per cent, made with distilled water. The absorption of cocaine is 
largely prevented by mixing 1 part of solution of adrenalin chloride with 20 
47829°—23 31 476 
HOSPITAL, CORPS HANDBOOK. 
parts of cocaine solution. Cocaine is a dangerous iiabit-forming drug and must 
be used cautiously to avoid starting the habit. 
Average dose: 0.015 gm. or \ grain. 
Procaina, Procaine (Novocaine).—The monohydrochloride of para-amino- 
benzoyl-diethyl-amino-ethanol. Procaine and novocaine are identical. A nota- 
tion in the supply table states that procaine is manufactured in the United 
States under license issued by the Federal Trade Commission as the equivalent 
of “ novocaine.” 
Properties : It occurs as fine, colorless needles and is soluble in an equal 
weight of water. It is precipitated from its aqueous solutions by alkali 
hydroxides and carbonates, but is not precipitated by sodium bicarbonate. 
The aqueous solution of procaine may be heated to boiling without decom- 
position, which is a decided advantage over cocaine, in that procaine may 
be thoroughly sterilized. 
Action and Uses : It is used as a local anaesthetic, dissolved in distilled 
water, in strengths from 1 to 5 per cent. It has very little effect when applied 
externally to mucous membranes. When injected its action is similar to that 
of cocaine. 
Caffeine Citrate, Citrated Caffeine, U. S. P.—Citrated caffeine contains, when 
dried to constant weight at 80° C., not less than 48 per cent of anhydrous 
caffeine. 
Properties : It occurs as a white powder, odorless and having a slightly 
bitter, acid taste. It gives a clear syrupy solution with a small quantity of 
water, but caffeine precipitates on dilution. This precipitate redissolves on 
the further addition of water. 
Action and Uses.—It is used as a cerebral and cardiac stimulant, and as 
a diuretic. It is contained in coffee and tea. It is supplied to the Navy in 
the form of 1 grain tablets, and in powder. 
Average dose: 0.3 gm. or 5 grains. 
Caffeinoe Sodio-Bemoas, Caffeine Sodio-Benzoate, U. S. P.—A mixture of 
caffeine and sodium benzoate. It contains, when dried to constant weight at 
80° C., not less than 46 per cent nor more than 50 per cent of anhydrous 
caffeine; the remainder being sodium benzoate. Preserve it in well-closed 
containers. 
Properties : It occurs as a white powder, is odorless, and has a slightly 
bitter taste. It is soluble in 1.1 parts of water. 
Action and Uses : It is used for the same purposes that citrated caffeine 
is used for. It is preferred to caffeine citrate for hypodermic administration 
because it is more soluble in water. It is supplied to the Navy in hypodermic 
tablets containing 1 grain each. 
Average dose: 0.2 gm. or 3 grains. 
Ergota, Ergot (Ergot of Rye), U. S. P.—The carefully dried sclerotium of 
Claviceps purpurea replacing the grain of rye, Secale cereale, without the 
presence or admixture of more than 5 per cent of seeds, fruits or other foreign 
matter. Ergot is not on the supply table but is used in making the fluid 
extract of ergot. 
Fluidextractum Ergotce, Fluidextract of Ergot, U. S. P. 
Action and Uses : It is a powerful vasoconstrictor. It is used as an ecbolic, 
producing contractions of the uterus. It also is used to control haemorrhage. 
Average dose: 2 c. c. or 30 minims. MATERIA MEDICA. 
477 
CLASSIFICATION OF DRUGS ON THE SUPPLY TABLE ACCORDING 
TO THEIR THERAPEUTIC USE. 
1. Drugs applied for their local action to the skin, wounds, or visible mucous 
membranes. 
Corrosives or caustics. 
Potassium hydroxide. 
Silver nitrate. 
Nitric acid. 
Sulphuric acid. 
Burnt alum. 
Ammoniated mercury. 
Phenol. 
Sodium hydroxide. 
Moulded silver nitrate. 
Glacial acetic acid. 
Disinfectants and antiseptics. 
Solution of hydrogen dioxide. 
Potassium permanganate. 
Phenol. 
Bichloride of mercury. 
Calomel. 
Silver nitrate. 
Boric acid. 
Iodine. 
Iodoform. 
Cresol. 
Compound solution of cresol. 
Solution of chlorinated soda. 
Chlorasene. 
Salicylic acid. 
Thymol. 
Eucalyptol. 
Picric acid. 
Tincture of iodine. 
Solution of formaldehyde. 
Sulphur. 
Silver protein. 
Colloidal silver. 
Local anodynes arid analgesics for 
pain and itching. 
Potassium bicarbonate. 
Cocaine hydrochloride. 
Carbolic acid. 
Atropine sulphate. 
Tincture of aconite. 
Eugenol. 
Oil of clove. 
Creosote. 
Sodium bicarbonate. 
Astringents. 
Tannic acid. 
Tincture of ferric chloride. 
Bismuth subnitrate. 
Lead acetate. 
Zinc sulphate. 
Zinc oxide. 
Copper sulphate. 
Alum. 
Alcohol. 
Bismuth subgallate. 
Styptics. 
Burnt alum. 
Silver nitrate. 
Moulded silver nitrate. 
To contract vessels and reduce hemor- 
rhage and swelling. 
Solution of adrenalin chloride. 
Emollients and protectives. 
Benzoinated lard. 
Petrolatum. 
Liquid petrolatum. 
Paraffin wax compound. 
Lanolin. 
White wax. 
Cocoa butter. 
Cottonseed oil. 
Glycerite of boroglycerin. 
Glycerite of starch. 
Purified talcum. 
Chalk. 
Starch. 
Zinc oxide. 
Cataplasm of kaolin. 
Local ancesthetics. 
Ethyl chloride. 
Cocaine hydrochloride. 
Menthol. 
Procaine. 
2. Drugs used for affections of the alimentary tract 478 
HOSPITAL CORPS HANDBOOK. 
MOUTH AND THROAT. 
Demulcents. 
Acacia. 
Starch. 
Pure extract of glycyrrhiza. 
Potassium chlorate. 
Ammonium chloride with cubeb and 
glycyrrhiza (tab.). 
Glycerin. 
Astringents. 
Tannic acid. 
Alum. 
Tincture of myrrh. 
Antiseptics. 
Boric acid. 
Thymol. 
Eucalyptol. 
To lessen salivation. 
Atropine sulphate. 
Flavoring substances. 
Sugar. 
Citric acid. 
Oil of peppermint. 
Methyl salicylate. 
STOMACH. 
Digestives. 
Pepsin. 
Hydrochloric acid. 
Emetics. 
Sodium chloride. 
Apomorphine hydrochloride. 
Ipecac. 
Fluid extract of ipecac. 
Tartar emetic. 
Copper sulphate. 
Zinc sulphate. 
To lessen irritation and vomiting. 
Opium. 
Chloral hydrate. 
Potassium bromide. 
Sodium bromide. 
Lime water. 
Bismuth subnitrate. 
Demulcents. 
Cocaine hydrochloride. 
Codeine sulphate. 
Menthol. 
Morphine sulphate. 
To lessen acidity, antacids. 
Potassium bicarbonate. 
Sodium bicarbonate. 
Magnesium carbonate. 
Milk of magnesia. 
Lime water. 
Prepared chalk. 
To increase secretions, bitters. 
Compound tincture of gentian. 
Tincture of nux vomica. 
Strychnine sulphate. 
Compound tincture of cinchona. 
Quinine sulphate. 
Quinine hydrochloride. 
Carminatives. 
Compound tincture of cardamom. 
Ether. 
Oil of peppermint. 
Tincture of capsicum. 
Fluid extract of ginger. 
Chloroform. 
Ammonium carbonate. 
Camphor. 
Oil of clove. 
Tincture of myrrh. 
Bismuth subgallate. 
Extract of belladonna. 
Fluid extract of hyoscyamus. MATERIA MEDICA. 
479 
INTESTINES. 
To promote evacuation—purgatives. 
Sodium phosphate. 
Castor oil. 
Compound licorice powder. 
Vegetable cathartic pill. 
Compound laxative pill. 
Magnesium sulphate. 
Rochelle salt. 
Seidlitz powder. 
Solution of magnesium citrate. 
Liquid petrolatum. 
Calomel. 
Mass of mercury. 
Physostigmine sulphate. 
Resin of podophyllum. 
Cascara sagrada. 
Potassium bitartrate. 
To destroy parasites—anthelmintics. 
Santonin. 
Thymol. 
Chloroform. 
Oil of turpentine. 
Oleoresin of male fern. 
Disinfectants and antiseptics. 
Salol. 
Eucalyptol. 
To lessen movement and relax spasm. 
Powdered opium. 
Morphine sulphate. 
Lead acetate. 
Bismuth suhnitrate. 
Tincture of opium. 
Tannic acid. 
Pill of lead and opium. 
Atropine sulphate. 
3. Drugs used for their effect on the circulation. 
To strengthen contraction. 
Tincture of digitalis. 
Tincture of strophantlius. 
Digitalin. 
In auricular fibrillation. 
Tincture of digitalis. 
Tincture of strophanthus. 
Digitalin. 
HEART. 
To accelerate the pulse. 
Atrophine sulphate. 
Caffeine citrate. 
Caffeine sodio-benzoas. 
Camphor. 
To slow the pulse. 
Tincture of digitalis. 
Tincture of strophantlius. 
Digitalin. 
Tincture of aconite. 
VESSELS. 
To contract caliber and raise blood 
pressure. 
Tincture of digitalis. 
Tincture of strophantlius. 
Digitalin. 
Strychnine sulphate. 
Caffeine citrate. 
Fluidextract of ergot. 
Solution of adrenalin chloride. 
Solution of hypophysis. 
To relax blood vessels and lower blood 
pressure. 
Amyl nitrite. 
Nitroglycerin. 
Spirit of nitrous ether. 
Purgatives. 480 
HOSPITAL CORPS HANDBOOK. 
To arrest internal haemorrhage. 
To remove fluid (dropsy). 
Potassium acetate. 
Spirit of nitrous ether. 
Magnesium sulphate. 
Calomel. 
Vegetable cathartic pill. 
Castor oil. 
Powdered opium. 
Tincture of opium. 
Morphine sulphate. 
Calcium chloride. 
4. Drugs used for their effects on the genito-urinary system. 
To increase the flow of urine 
(diuretics). 
Caffeine citrate. 
Solution of hypophysis. 
Potassium acetate. 
Lithium citrate. 
Calomel. 
Spirit of nitrous ether. 
Solution of ammonium acetate. 
To render the urine less acid.. 
Potassium bicarbonate. 
Sodium bicarbonate. 
Potassium acetate. 
Sodium citrate. 
To make the urine more acid. 
Dilute hydrochloric acid. 
To render the urine antiseptic. 
Aspirin. 
Hexamethyl nam ine. 
Salol. 
Sodium salicylate. 
Sodium borate. 
Fluid extract of buchu. 
Sodium benzoate. 
Santal wood oil. 
Salicylic acid. 
To promote contractions of the uterus. 
Fluid extract of ergot. 
Quinine sulphate. 
Solution of hypophysis. 
To stimulate the respiratory center. 
Atropine sulphate. 
Caffeine sodio-benzoas. 
Strychnine sulphate. 
Oxygen. 
Ammonia. 
Aromatic spirit of ammonia. 
Camphor. 
To reduce the irritability of the nerve 
center in cough. 
Powdered opium. 
Tincture of opium. 
Morphine sulphate. 
Codeine sulphate. 
Heroin. 
Chloral hydrate. 
Sodium bromide. 
To increase and liquefy the bronchial 
secretions. 
Powdered ipecac. 
Fluid extract of ipecac. 
5. Drugs used for their effects on the respiratory system. 
Antimony and potassium tartrate. 
Apomorphine hydrochloride. 
Ammonium carbonate. 
Potassium iodide. 
Compound tincture of benzoin. 
Ammonium chloride. 
Cubeb. 
Terpin hydrate. 
To lessen the secretions of the bronchi. 
Atropine sulphate. 
Belladonna extract. 
To relax bronchial spasm in asthma. 
Amyl nitrite. 
Extract of belladonna. 
Atropine sulphate. 
Solution of adrenalin chloride. 
Potassium iodide. 
Nitroglycerin. 
Pulmonary disinfectants. 
Creosote. 
Guaiacol. 
Creosote carbonate. 
Rectified oil of tar. MATERIA MEDICA. 
481 
6. Drugs used for their effects on the central nervous system. 
STIMULANTS 
(a) To the spinal cord. 
Strychnine sulphate. 
(b) To the brain and medulla oblon- 
gata. 
Caffeine citrate. 
Caffeine sodio-benzoas. 
Camphor. 
Atropine sulphate. 
DEPRESSANTS 
(a) To paralyze sensation■—general 
anaesthetics. 
Ether. 
Chloroform. 
Ethyl chloride. 
Nitrous oxide. 
(b) To induce sleep and rest—hypnot- 
ics or narcotics. 
Powdered opium. 
Morphine sulphate. 
Codeine sulphate. 
Scopolamine hydrobromide. 
Sulphonethylmethanum. 
Barbital. 
(b) To induce sleep and rest—hypnot- 
ics or narcotics—Continued. 
Chloral hydrate. 
Potassium bromide. 
Sodium bromide. 
Chlorodyne tablets. 
(c) To relieve pain. 
Powdered opium. 
Morphine sulphate. 
Codeine sulphate. 
Acetylsalicylic acid. 
Acetanilid. 
Phenacetine. 
Antipyrine. 
7. Drugs used to reduce fever temperature. 
Acetylsalicylic acid. 
Acetanilide. 
Phenacetine. 
Tincture of aconite. 
Sodium salicylate. 
Solution of ammonium acetate. 
Guaiacol. 
Ipecac. 
Quinine sulphate. 
8. Drugs used for their effect on the blood. 
(a) To increase the haemoglobin: 
Tincture of ferric chloride. 
Pill of ferrous carbonate. 
Solution of iron and ammonium 
acetate. 
Elixir of iron, quinine, and 
strychnine. 
Solution of potassium arsenite. 
Soluble ferric pyrophosphate. 
Tincture of citro-chloride of 
iron. 
(a) To increase tlic hcemaglobin—Con. 
Tablets of iron, quinine, arsenic, 
•and strychnine. 
(l)) To render the blood alkaline: 
Potassium acetate. 
Potassium bicarbonate. 
Sodium bicarbonate. 
Sodium carbonate. 
Sodium citrate. 
9. Drugs used for specific diseases. 
In malaria. 
Quinine sulphate. 
Quinine hydrochloride. 
Quinine chlor-hydrosulphate. 
Solution of potassium arsenite. 
Elixir of iron, quinine, and 
strychnine. 
In syphilis. 
Mercuric chloride. 
Mercurous chloride. 
In syphilis—Continued. 
Mercurous iodide (pills) yellow. 
Mercurial ointment. 
Mercuric salicylate. 
Oleate of mercury. 
Potassium iodide. 
Arsphenamine. 
Neo-arsphenamine. 
In diphtheria. 
Antidiphtheritic serum. 482 
HOSPITAL CORPS HANDBOOK. 
In tetanus. 
In rheumatic fever—Continued. 
Sodium salicylate. 
Methyl salicylate. 
Acidum plienylcinclioninicum. 
In myxcedema and some other thyroid 
diseases. 
Potassium iodide. 
In trypanosomiasis. 
Antimony and potassium tartrate. 
In gout. 
Acid phenylcinchoninicuni. 
Antitetanic serum. 
Chloral hydrate. 
In cerebrospinal fever. 
Antimeningococcus serum. 
In amoebic dysentery. 
Powdered ipecac. 
Emetine hydrochloride. 
In rheumatic fever. 
Acetyl salicylic acid. 
Salicylic acid. 
10. Drugs used for their effect on the skin. 
Irritants. 
Oil of turpentine. 
Mustard plaster. 
Capsicum plaster. 
Cantharidal collodion. 
Tincture of iodine. 
Ammonia. 
Liniment of soap. 
Liniment of chloroform. 
Tincture of aconite. 
Disinfectant or irritant ointments in 
parasitic skin diseases. 
Mercurial ointment. 
Sulphur ointment. 
Tar ointment. 
Balsam of Peru ointment. 
Resorcinol ointment. 
Thymol ointment. 
Disinfectant or irritant ointments in 
parasitic skin diseases—Continued. 
Ichthyol ointment. 
Salicylic acid ointment. 
Ammoniated mercury ointment. 
Drugs administered internally to in- 
crease the secretions of perspira- 
tion (diaphoretics or sudorifics). 
Powdered ipecac. 
Powder of ipecac and opium. 
Pilocarpine hydrochloride. 
Antimony and potassium tartrate. 
Spirit of nitrous ether. 
Drugs administered internally to les- 
sen secretion of perspiration. 
Extract of belladonna. 
Atrophine sulphate. 
Drugs dilating the pupil and relaxing 
the accommodation—mydriatics. 
Atropine sulphate. 
Homatropine hydrobromide. 
Cocaine hydrochloride. 
Drugs contracting the pupil of the 
eye—myotics. 
Pilocarpine hydrochloride. 
Physostigmine sulphate. 
Antiseptics and astringents. 
Boric acid. 
Zinc sulphate. 
Colloidal silver. 
12. Drugs used locally for their effects on the eye. 
Drugs used for the disinfection of 
rooms and inanimate objects. 
Chlorinated lime. 
Sulphur (sulphur dioxide). 
Solution of formaldehyde. 
Cresol. 
Bichloride of mercury. 
Barium dioxide (with solution of 
formaldehyde). 
Compound solution of cresol. 
HARRISON NARCOTIC ACT. 
The Harrison narcotic act (see chapter on Pharmacy) restricts the use of 
opium or coca leaves, their salts, derivatives, or preparations. The drugs and DRUG ADDICTION. 
483 
preparations listed on the Supply Table of the Medical Department, United 
States Navy, which are subject to the restrictions set forth by this act are: 
Opium. 
Codeine sulphate. 
Diacetylmorphine hydrochloride. 
Apomorpliine hydrochloride. 
Chlorodyne tablets. 
Coca leaves. 
Cocaine hydrochloride. 
Procaine. 
Powdered opium. 
Pill of opium and lead acetate. 
Powder of opium and ipecac. 
Tincture of opium. 
Camphorated tincture of opium. 
Morphine sulphate. 
Codeine. 
References 
United States Pharmacopoeia. 
Materia Medica, Pharmacology and Therapeutics.—Bastedo. 
Materia Medica and Therapeutics.—Potter. 
Pharmacology of Useful Drugs.—Hatcher-Wilbert. 
Materia Medica for Nurses.—Paul. 
Principles of Therapeutics.—Osborne. 
Useful Drugs.—American Medical Association. 
National Standard Dispensatory.—Hare, Caspari, Rusby. 
Pharmacology and Therapeutics.—Cushny. 
United States Dispensatory.—Remington and Wood. 
New and Non-Official Remedies.—American Medical Association. 
Materia Medica and Therapeutics.—Wilcox. 
Pharmaceutical and Medical Chemistry.—Sadtler and Coblentz. 
Principles of Pharmacy.—Arny. 
Practice of Pharmacy.—Remington. 
National Formulary.—American Pharmaceutical Association. 
Drug Addiction.1 
Drug addiction may be defined as the habitual use of a drug or drugs for 
other than medicinal purposes. 
A drug addict is an individual who has acquired the habit of taking drugs 
to satisfy a craving which has been developed and who, as a rule, is more or 
less uncomfortable when deprived of the drug over longer than the usual period. 
The confirmed drug habitue, when he comes under the observation of the 
medical officer, as a rule has been taking the drug for a year or more and is 
well posted as to the source of supply, the amount of drug necessary to produce 
the desired effect in his particular case and the frequency with which he must 
repeat the dose. 
There is a type of drug addict, however, who takes the drug more or less 
irregularly and who indulges in occasional “ sprees ” whenever he feels a 
desire or when some unusual situation arises in his life which he feels unable 
to face squarely. This type of addict not infrequently is met with in the early 
stages of his addiction and the longer lie indulges the more he tends to become 
a confirmed habitue. 
Drugs used by addicts. 
Drugs used by addicts cover a great variety and include the so-called 
narcotics, the soporifics or hypnotics, and the drugs of the anaesthetic group. 
Opium.—Probably the most striking example of the drug habit is the use of 
opium, its alkaloids and derivatives. 
1 Prepared by Lieut. Commander W. A. Bloedorn, Medical Corps, United States Navy. 484 
HOSPITAL CORPS HANDBOOK. 
The crude drug opium contains a number of alkaloids, .of which the chief 
is morphine. The physiological action of opium is due principally to the 
morphine it contains. The effects of opium addiction, and the alkaloids of 
opium may be considered under the same heading. 
Opium is taken either by smoking or swallowing, and in Oriental countries 
these methods are the usual means of ingestion. In this country and in 
most European .countries morphine or heroin are the chief habit-forming 
drugs of the opium series. 
The alkaloids of opium may be taken by hypodermic injection, by swallowing, 
or by snuffing up the nostrils. 
The effect of opium and its derivatives, when taken in sufficient dosage, is 
sedative and the patient actually may go to sleep following its use. There is 
usually associated contraction of the pupils and an inhibitory effect on the 
activity of the glandular organs, as evidenced by dryness of the mouth and 
throat and the skin as well as constipation and digestive disturbances. 
Cocaine.—The use of cocaine, though of comparatively recent date in this 
country, is an ancient practice in South America, where for generations it 
has been in vogue among the Indians. 
Cocaine and its salts are absorbed freely and have a stimulating or excitant 
effect upon the central nervous system. In many cases they produce a tem- 
porary sense of exhilaration, with the disappearance of fatigue and a feeling 
of buoyancy. Large doses of the drug may stimulate to the point of excite- 
ment and there may be marked restlessness, tremors, and even convulsions, 
while, on the mental side, there may be incoherence, delirium, and persistent 
sleeplessness. A tolerance is developed rapidly. 
Soporifics.—Among the soporifics must be mentioned chloral hydrate, paralde- 
hyde, sulphonal, trional, and veronal. These drugs frequently are used for 
sleeplessness, and while they differ greatly in their tendency to form a habit, 
yet none of them are entirely free from this danger. The harm which results 
from the use of this class of drugs usually is due to their depressant action 
upon the heart and circulation, resulting occasionally in fainting or collapse. 
While it is true that these effects are comparatively infrequent and seem in 
many cases to depend upon individual susceptibility, they occur with sufficient 
frequency to urge caution in their use. 
Anaesthetics.—Under this heading we may place chloroform, ether, and 
alcohol. The use of these drugs may result in habit formation. The effect 
of the alcohol habit is well known. It may manifest itself during periods 
of acute alcoholism by the well-known evidences of inebriety and in the cases 
of chronic alcoholism by mental impairment as well as physical deterioration. 
Probably the use of chloroform and ether never will constitute a real source 
of danger in the naval service, as the habit does not appear to be widespread 
and the effects of continual use of these drugs are usually too noticeable to 
allow the patient to conceal the fact aboard ship or in a naval community. 
The principal drugs, perhaps, which will be used among the naval personnel 
are opium and its derivatives, principally morphine and heroin, cocaine, and 
representatives of the soporific class, especially chloral hydrate or veronal. 
Etiology. 
The number of drug addicts existing in this country at present has been 
variously estimated at from 100,000 to 1,000,000. It is probably safe to say 
that the correct figure lies somewhere between these two extremes, and it is 
at once apparent that the problem of drug addiction is a serious one both from 
a sociologic and economic standpoint. DRUG ADDICTION. 
485 
Both sexes are susceptible to drug addiction, although if we can judge from 
the numbers of those admitted to institutions for treatment, the number of 
male addicts exceeds the number of female addicts. 
From the standpoint of intelligence and social standing, it may be said that 
no class of individuals is free from drug addiction. Every class of society is 
represented, from the denizen of the underworld to the so-called pillar of 
society. 
The age at which drug addiction begins is particularly significant, and we 
find from examination of large numbers of addicts that from 20 to 30 per cent 
began the use of drugs while they were still minors. 
The environment of the individual has a marked bearing on his tendency to 
drug addiction. Individuals who are associated with addicts and principally 
those who live in congested, overcrowded, and insanitary surroundings are 
particularly liable to contract the habit. The drug addict himself may he 
regarded as a focus of infection who through contact with susceptible indi- 
viduals tends to spread the habit. There are two reasons for this attitude on 
the part of the addict: First is the desire for company, and, second, the 
financial gain derived from selling the drug to recruits. 
While it is no doubt true that an appreciable number of addicts acquire the 
habit through the persistent use of drugs for the relief of pain or as the result 
of some disease, it is believed that this number constitutes a relatively small 
percentage of the total number of addicts. 
Association with the drug and with individuals who are users of the drug 
is considered a potent and fertile source of addiction. These facts make it 
especially important that addicts in the Navy, either aboard ship or in the 
training stations, should he apprehended and eliminated from the service. 
Symptoms. 
It is a well-known fact that an addict will attempt to conceal the fact of 
his addiction by every conceivable means. One might think, at first glance, 
that these efforts on his part would he of no avail and that his predicament 
would be recognized easily by the medical officer as well as by his friends and 
associates. The mental picture which the average person has of the drug 
addict is an individual more or less emaciated, with sunken cheeks, sallow 
complexion, who nervously starts at the slightest sound, whose limbs and body 
show the marks of numerous needle punctures and who always carries in his 
pocket a hypodermic syringe and the necessary ammunition. While this pic- 
ture may serve to identify the addict in some respects and particularly in 
the later stages of his addiction, it fails absolutely to identify the average drug 
addict. 
If an addict is careful as to dosage and time and place of taking the drug, 
he may go along for years without his associates or even members of his im- 
mediate family being aware of the fact that he is an addict. 
The symptoms and signs of drug addiction may he very meager and difficult 
to elicit and it requires the utmost skill to establish sufficient evidence to war- 
rant a diagnosis of addiction. 
There are two periods in the daily life of the addict during which he is 
particularly liable to detection and these periods are apt to become more 
frequent the longer he indulges. 
The first period is that immediately following the administration of the 
drug and while the addict is getting the full physiological effect. If he has not 
been careful as to dosage he may take more than the usual amount, following 
which he will develop symptoms of an overdose of the particular drug in which 486 
HOSPITAL CORPS HANDBOOK. 
he indulges. If he is taking one of the narcotic or soporific drugs he may 
become drowsy or he found asleep at some unusual time or place when his pre- 
dicament will be quite noticeable. 
An overdose of cocaine frequently produces hyperexcitahility, extreme nerv- 
ousness; sometimes delirium and convulsions. 
The second period during which symptoms may be noticeable is ushered in 
by a feeling of slight nervousness or uneasiness, which is a warning to the 
addict that it is time for another dose. If this period is prolonged, he begins 
to suffer more or less acutely with cramps and muscular pain, his nervousness 
increases, and he develops symptoms of sudden withdrawal of the drug. In 
the Navy this is a particularly important sign to look for, as men often may he 
taken away from the source of supply when leaving port or changing stations. 
Diagnosis. 
Close observation of an individual suspected of the drug habit over a suffi- 
cient period of time in most cases will establish or rule out the question of 
addiction. Changes in mood and hearing may be noted from time to time, as, 
for instance, when a quiet, reticent and possibly more or less morose individual 
leaves a group of men and then returns in a short time cheerful and in high 
spirits. It is possible that this change in his mental attitude may be due to 
the fact that he has taken some drug during his absence. 
Again, following an overdose of the drug, the diagnosis may be easy and 
also deprivation of the drug may bring on more or less acute symptoms, 
depending on the stage of addiction and the individual may become nervous, 
uneasy, and definitely abnormal in his actions and mental attitude. 
The small pupil, associated with opium or morphine addiction, is usually 
quite noticeable, while the mydriatic effect of cocaine, together with flushing of 
the face and the tendency to hyperexcitahility, make the cocaine habitu6 liable 
to detection. 
If an individual is a confirmed drug addict and it is possible to confine him 
or have him kept under constant watch, so that it is impossible for him to 
take the drug without being seen, he usually will develop symptoms of with- 
drawal of the drug after a variable period of from one to several days. In 
applying this test, however, it is essential that the patient be deprived of any 
outside cooperation in obtaining the drug and that he be separated from any 
of the drug which he may have in his possession. The addict under these 
circumstances is particularly ingenious and will devise innumerable schemes 
for keeping in contact with his reserve drug supply, so that the utmost care 
must he used in preventing drugs from reaching him. 
The symptoms of withdrawal of the drug usually begin with a feeling of 
uneasiness and nervousness on the part of the patient. He may pace the 
deck, his features become drawn, and it becomes apparent that he is actually 
suffering. He may develop abdominal cramps or muscular cramps and may go 
into a condition of actual collapse. 
However, if this test should prove negative, it is not an absolute indication 
that the patient is not an addict, as many individuals in the early stages of 
their addiction may take the drug only spasmodically or at irregular intervals 
and not suffer the acute symptoms of sudden withdrawal of the drug. 
Probably the commonest and easiest way for the addict to indulge in drugs 
aboard ship, where the quarters are crowded and privacy is difficult to obtain, 
is by sniffing the drug up his nostrils. This method of administration re- 
quires no paraphernalia and leaves no particular mark upon the individual. 
It can be done quickly, easily, and effectively. The patient is able to gauge 487 
DRUG ADDICTION. 
with a fair degree of accuracy the amount of drug he needs, and most of the 
narcotic drugs lend themselves admirably to this practice. 
A thorough physical examination may reveal no needle marks on the body 
of the individual, although it is possible that some hypersemia or irritation of 
the nasal mucosa may be demonstrable. 
At the present time heroin seems to he the drug in most common use, and 
in the absence of data pointing to any special drug it would be well to keep 
this particular drug in mind. 
Treatment. 
In the great majority of cases drug addicts in the naval service have con- 
tracted the habit before their entry into the service, and it is the usual practice 
once an addict has been identified to transfer him at once to a naval hospital 
and to terminate his service by medical survey. Any attempt to cure the 
patient of his addiction with an idea of restoring him to duty is considered 
unwise. 
The usual treatment now employed in most institutions for the care of drug 
addicts is the gradual withdrawal of the drug. In other words, the patient is 
given each day a slightly less amount of the drug that he is taking until finally 
he is getting none of the drug. This method of treatment usually can be car- 
ried out even in cases of confirmed addiction with comparatively little suffering 
on the part of the patient, and it is a fairly easy matter to advance a drug 
addict to the point where he is taking no more of the drug. However, this 
does not indicate that the patient is cured of the drug habit, as probably the 
great majority of these cases, upon discharge from an institution, eventually 
drift back into their old habits. This is particularly true if the individual, 
upon discharge from the institution, returns to his old haunts and associates, 
where the drug immediately is available and where he even may obtain it with- 
out cost for the time being. 
It is not considered advisable to attempt the cure of the drug habitug in the 
Navy with the object of restoring him to a duty status, and the patient in whom 
the fact of drug addiction has been definitely established is considered unde- 
sirable for the naval service. CHAPTER IX. 
TOXICOLOGY.1 
Toxicology is that branch of medical science which treats of the nature, 
effects, detection, properties, and antidotes of poisons. 
A poison is a substance which, when absorbed into the body fluids of an 
ordinarily healthy organism, is capable of producing death or seriously affect- 
ing health. 
The effects of poisons may be local or remote. By local effect is meant the 
direct action on the part to which the poison is applied, such as corrosion and 
irritation. By remote effect is meant the action of the poison on some organ 
remote from the seat of application. Some have both a local and remote effect, 
and sometimes a poison shows no effect, or only a slight one, until several 
doses have been taken, when suddenly an effect is produced nearly equal to 
that to be expected if the whole amount had been taken at once. This is known 
as cumulative effect. 
There are several conditions of the individual which modify the effect of 
poisons, the principal ones being (1) age (young children generally are more 
susceptible to poisons than adults), (2) idiosyncraey (some persons show an 
unusual sensitiveness to certain poisons), (3) tolerance (some persons have a 
natural tolerance for certain poisons which is not the result of habitual use), 
(4) habit (most persons by habitual use finally may become so accustomed to 
the effects that poisoning does not result from the taking of large doses), and 
(5) disease (some diseases increase and others lessen the action of poisons). 
Poisoning may be either acute or chronic. Acute poisoning is the condition 
brought on by the individual taking one overdose of poison. Chronic poisoning 
is the condition brought on by the individual taking repeated doses of a poison 
or as the result of the absorption of the poison over a long period of time. 
Matchmakers, barometer and thermometer makers, painters, and wall paperers 
are some of the classes of people subject to chronic poisoning from phosphorus, 
mercury, lead, and arsenic, respectively. 
For the convenience of study the following general classification of poisons 
according to the chief effects produced is given: 
Corrosives.—Substances which by contact rapidly destroy or decompose the 
body tissues. Examples: Hydrochloric, nitric, and sulphuric acids in concen- 
trated form, oxalic acid, phenol, strong alkalies and their carbonates. 
Irritants.—Agents that do not directly destroy the tissues but set up an 
inflammatory process at the seat of application. Examples: Potassium nitrate, 
zinc chloride, zinc sulphate, ferrous sulphate, silver nitrate, arsenic, iodine, and 
phosphorus. 
Neurotics.—Poisons which act on the brain, spinal cord, and the general 
nervous system. Examples: Opium, prussic acid, ether, chloroform, aconite, 
nux vomica, belladonna, ethyl and methyl alcohols. 
1 Prepared by the faculty of the United States Naval Hospital Corps Training School, 
San Francisco, Calif., and reviewed by Chief Pharmacist C. Schaffer, United States Navy. 
489 490 
HOSPITAL CORPS HANDBOOK. 
In addition to this classification, which is probably the one most commonly 
met with, a more modern and scientific one is as follows: (1) Inorganic poisons, 
(2) gaseous poisons, (3) alkaloidal poisons, (4) nonalkaloidal organic poisons, 
and (5) food poisons. Only two of these will be discussed in this chapter, 
which are: 
Gaseous poisons.—Gases which when inhaled form chemical compounds with 
the haemoglobin of the blood and destroy its capability as a carrier of oxygen. 
Examples: Hydrochloric-acid gas, sulphuric-acid gas, nitrous vapors, ammonia 
gas, carbonic-acid gas, carbon-monoxide gas, bromine, and the vapors of anaes- 
thetics. 
Food poisons.—These may be poisonous metallic or organic substances intro- 
duced by carelessness, accident, or intention into wholesome food; poisonous 
substances naturally present in the vegetable or animal tissues used as food; 
pathogenic bacteria in the food, or poisonous substances produced in food by 
the changes resulting from the action of bacteria. Examples of each of the 
above classes are: Arsenic, lead, tin, zinc, and copper introduced from con- 
tainers, soldering, chemical action, and for purposes of adulteration ; the poisons 
found in mushrooms, sometimes in rhubarb, and ordinarily edible roots and 
tubers, certain species of fish and the flesh and roe of some fish during the 
spawning season; the causative agents of diphtheria, tuberculosis, scarlet fever, 
and typhoid fever in milk, of typhoid fever in or upon bread, sausage, oysters, 
and other foods, of botulism in or upon uncooked sausages, ripe olives, and 
other fruits and vegetables, and the ingestion of meat containing encysted 
worms or the larvae of worms; and the poisons resulting from the decay or 
decomposition of food substances and which commonly are known as ptomaines. 
The general symptoms of poisoning by poisons of any of the classes above are 
given immediately below. In addition to these the symptoms of individual 
poisons appear in the table describing those poisons. 
Corrosives.—Immediately there is an acid, caustic burning pain in the 
mouth, with severe burning pain in the oesophagus and stomach. This is fol- 
lowed by retching and vomiting of the stomach contents mixed with dark- 
colored liquid and shreds of mucous membrane from the mouth, oesophagus, 
and stomach; the inside of the mouth is corroded and the lips present the 
characteristic stain if an acid has been used. Swallowing is very difficult; 
respiration is impeded; the abdomen is tender and distended with gas; the tem- 
perature is high; and the countenance is expressive of anxiety and great 
suffering. 
Irritants.—Nausea, vomiting, and purging (frequently the vomited matter 
and stools contain blood) ; pain and cramps in the abdomen. In some cases 
there is inflammation of the urinary tract. 
Neurotics.—As it is a difficult matter to give general symptoms of this class 
of poisons, they are here classified under— 
(а) Depressants which are characterized by a period of exhilaration fol- 
lowed by drowsiness and stupor; slow and stertorous breathing; cold, clammy 
skin; livid countenance, slow pulse, muscular relaxation; dilated or contracted 
pupils, insensibility to external impressions, and 
(б) Excitants. Characterized by rapid and feeble pulse; delirium, hot and 
dry skin; a sense of suffocation and inability to breathe; shuddering, and 
jerking of muscles; dilated or contracted pupils; disordered vision; sometimes 
convulsions and tetanus (as in the case of strychnine poisoning). 
Gaseous poisoning.—Irritation and corrosion of the respiratory tract, with 
resultant bronchitis (either mild or severe) ; irritation of the eyes, mouth, 
stomach, and ki Ineys. TOXICOLOGY. 
491 
Food poisoning.—Gastrointestinal distress, nausea, vomiting, diarrhoea, urti- 
caria, circulatory and nervous disturbances are the general symptoms of food 
poisoning and they may vary from mild discomfort to violent disturbance of 
the normal body functions. 
The treatment of poisoning consists of (1) removal of the poisonous sub- 
stance from the stomach, (2) administration of antidotes, (3) elimination of 
the poison from the circulation, and (4) neutralization of the systemic effects 
of the poison. Only the first two parts of the treatment will be discussed 
here, the other two being particularly within the province of the medical officer. 
Removal of the poison from the stomach may be accomplished by the use of 
emetics, agents used to produce vomiting, and washing out of the stomach 
with a stomach tube. 
There are two kinds of emetics: (a) Local, which act by irritating the ends 
of the gastric, oesophageal, and pharyngeal nerves, and (ft) systemic, which 
act on the vomiting center in the medulla through the medium of the circu- 
lation. 
Commonly used emetics are powdered ipecac, 30 grains; ground mustard, 2£ 
drams; tartar emetic, | to 1 grain; zinc sulphate, 10 to 20 grains; copper 
sulphate, 5 to 7i grains; fluid extract of ipecac, 15 to 30 minims; tepid water, 
large quantity; alum, 60 grains to 8 fluid ounces of water; use of index finger; 
apomorphine hydrochloride (hypodermically), XV to i grain. 
Antidotes are agents which counteract the effects of a poison, and are classi- 
fied as: (a) Chemical antidotes, which combine directly with the poisons and 
render them inert or harmless or produce a more insoluble compound and thus 
delay the absorption of poisons, and (b) physiological antidotes, which coun- 
teract the effects of poisons on the system. 
The duties of an attendant in a case of poisoning are: 
1. To prolong the life of the individual if possible. 
2. To quickly get the bulk of the poison out of the stomach. 
3. To antidote the remainder of the poison left in the stomach. 
4. To eliminate from the system that portion of the poison which has 
been absorbed. 
5. To treat the symptoms as they arise. 
6. To take possession of all foods, medicines, vomited matter, faeces, 
urine, and anything that may be of value in determining whether 
the poison was taken accidentally or intentionally, or whether 
criminally administered. 
TABLE OF POISONS, SYMPTOMS AND TREATMENT. 
Aconite. (Neurotic.) 
Symptoms : Anxious countenance; cold clammy skin; perspiration; great 
muscular weakness; dim sight; shallow, irregular and labored breathing; 
anaesthesia in a general way all over the body; and death from paralysis of 
the heart and respiration. 
Treatment : Place the patient in a recumbent position; administer some 
form of tannin, preferably tea, or strong coffee, or potassium permanganate (20 
grains to the pint of water) as a chemical antidote. Apply heat to the ex- 
tremities ; use stomach tube to empty the stomach; administer such stimulants 
as brandy or aromatic spirit of ammonia. Physiological antagonists are caf- 
feine, atropine, morphine, ether, ammonia, and amyl nitrate. 
47829°—23- 32 492 
HOSPITAL CORPS HANDBOOK. 
Alcohol, ethyl. (Neurotic.) 
Symptoms : Exhilaration, staggering gait, deep sleep with stertorous breath- 
ing, acute gastritis and profound depression. Delirium tremens frequently 
occurs after an alcoholic debauch. 
Treatment: Emetics or the use of the lavage tube, purgatives, proper diet, 
external heat. 
The morbid conditions with which acute alcoholism may be confounded 
are: Apoplexy, opium narcosis, concussion of the brain, uraemia, epilepsy, and 
even acute pneumonia. The differential diagnosis is difficult to make in a 
state of deep coma. The pupils in alcoholism may be either dilated or 
contracted. 
Alcohol, methyl. (Neurotic.) 
Symptoms : Frimary, dizziness, perhaps nausea and vomiting, some dis- 
turbance of vision, with befogging of the brain; later, widely dilated pupils 
with perhaps blindness, weakened circulation, coma and death. 
Treatment : Immediate evacuation of the stomach by means of a stomach 
tube followed by washing the stomach with a very dilute potassium perman- 
ganate solution, then warm water; administer two or three ounces of a 
solution of magnesium sulphate (Epsom salts) before removing the stomach 
tube; administer stimulants; apply external heat. It is beneficial at times 
to do a venesection, remove a quantity of blood and administer physiological 
saline solution intravenously. (This should be done by medical officers only.) 
Stupor from wood alcohol poisoning is treated by introducing into the system 
large doses of sodium bicarbonate and sodium citrate solutions, either by 
mouth or by rectum. 
Arsenic. (Irritant.) 
Symptoms : Faintness and depression come on in about one-half hour; intense 
pain in the region of the stomach; tenderness of abdomen on slight pressure, 
nausea and vomiting increase by every act of swallowing; purging, bloody 
stools; cold, clammy skin; feeble pulse. 
Treatment : Emetics; wash out stomach. Then follow with a wineglassful 
of recently prepared ferric hydroxide with magnesium oxide, but reliance must 
he placed on copious gastric lavage frequently repeated as the poison is not 
freely soluble. Warmth to extremities. 
Physiological antagonists to combat collapse are caffeine and digitalis. 
Atropine. (Neurotic.) 
Symptoms : Redness or rash of the skin; nose, mouth, throat and bronchi 
become dry; voice becomes hoarse; swallowing difficult; heart action rapid; 
pupils dilated; vision disordered; predisposition to laugh and talk loudly. 
There may be wild and maniacal delirum; and mental depression; suppres- 
sion of the urine; convulsions; death occurs usually from asphyxia. 
Treatment: Wash out stomach with a solution of potassium permanganate 
(20 grains to 1 pint of water) ; if not available give strong tea and an emetic. 
Apply an ice cap to the head; stimulate with strong coffee and eliminate the 
poison absorbed by the use of cathartics and diuretics. 
Physiological antagonists are morphine (cautiously administered), ether 
to control spasms, and caffeine for its effect on the heart and brain; pilocarpine, 
Belladonna. (Neurotic.) 
Symptoms : Same as atropine. 
Treatment: Same as atropine. TOXICOLOGY. 
493 
Bichloride of mercury. (Corrosive.) 
Symptoms : Burning pain in moutli, throat, and abdomen; metallic taste in 
mouth; face flushed; abdomen tender; vomiting; bloody stools; tongue and 
lips shriveled and white; constriction of throat; quick, irregular pulse; cold 
extremities; suppressed urine; syncope; convulsions and death. If the 
patient recovers, death may occur in a few weeks on account of irritation of 
the kidneys with resulting uraemia. * 
Treatment: First administer the chemical antidote, which is albumin (the 
white of one egg for each 4 grains of the poison taken) ; promote vomiting 
by the use of copious draughts of albumin water ; then administer demulcent 
drinks, milk or ice water. Too much albumin should not be given as al- 
buminate of mercury is resolvable in an excess of albumin. 
Caustic alkalies. (Corrosive.) 
Symptoms : See general symptoms of corrosives. 
Treatment: Same as for hydrochloric and other mineral acids except that 
to neutralize the alkali a dilute solution of an acid is used. It must be re- 
membered that dilute hydrocyanic (prussic) acid must not be used. 
Cocaine. (Neurotic.) 
Symptoms : Excitement, talkativeness, hallucinations, followed by marked 
depression; small and rapid pulse; slow respiration; cyanosis, dilated pupils; 
collapse. 
Treatment : Wash out the stomach with a solution of potassium permanga- 
nate (20 grains to 1 pint of water) or tannic acid or tea. Keep patient in 
recumbent position; apply external heat; artificial respiration if necessary. 
Physiological antagonists are morphine, amyl nitrite, chloral, chloroform, 
and ether. 
Digitalis. (Neurotic.) 
Symptoms : Muscular weakness; sneezing; nausea ; vomiting; colic and purg- 
ing ; headache; irregular heart action; vertigo, and disordered vision; respira- 
tion rapid and feeble; cyanotic skin; coma and convulsions. Death occurs by 
sudden paralysis of the heart. 
Treatment: Wash out the stomach with tannic acid solution or tea or 
potassium permanganate (20 grains to 1 pint of water). Patient to be kept 
quiet and in a recumbent position. Warmth to extremities. 
Physiological antagonists are aconite for the effects of a large dose and 
opium for the effects of its long continued use. Saponin and senegin are con- 
sidered to be its most complete physiological antagonists. 
Food poisoning. 
Symptoms : Those due to the special nature of the poisoning substance are 
described elsewhere in this and other chapters. 
Treatment : Must be adapted to the individual conditions found. If early 
treatment is possible, remove harmful contents from alimentary tract by use 
of stomach tube or emetics, high colon flushing, and active catharsis if there 
is no reason to suspect the presence of appendicitis or perforation of the in- 
testine. Saline infusion given hypodermically or intravenously should be used 
to aid in the elimination of the poisonous or noxious substances from tbe 
circulation. (This should be done by medical officers only.) 
Heroin. (Neurotic.) 
See Morphine. 494 
HOSPITAL CORPS HANDBOOK. 
Hydrochloric acid. (Corrosive.) 
Symptoms : Pain throughout digestive tract; vomiting; feeble pulse; cold, 
clammy skin; collapse; dried crusts of burnt tissue about mouth; yellow 
stains on clothing but none on the skin. 
Treatment : Weak solution of alkalies, washing soda, soapsuds, etc., to neu- 
tralize the acid; do not use stomach tube. Give olive oil, barley water, linseed 
tea, mucilage of acacia, albumin or milk to protect the membrane and stim- 
ulants to combat the resulting depressed condition of vital powers. 
Hydrocyanic (prussic) acid. (Neurotic.) 
Symptoms : Sudden unconsciousness; slow, labored respirations ; slow pulse; 
staring eyes; purple face; general convulsions, then relaxation and collapse; 
odor of peach kernels on breath; death may be almost instantaneous. 
Treatment : Stomach tube if possible. Dilute ammonia; opium, to relieve 
pain, alternate cold and warm affusions; atropine and heart stimulants; 
artificial respiration. 
Hyoscyamus. (Neurotic.) 
Symptoms and treatment same as atropine and belladonna. 
Iodine. (Irritant.) 
Symptoms: Acrid taste in mouth ; pain and sense of great warmth in throat; 
intense thirst; vomiting and purging (vomited matter contains traces of 
iodine); vertigo; cyanosis; swollen eyelids; convulsive movements and col- 
lapse. 
Treatment: Free administration of starch in water or any starchy sub- 
stance : induce vomiting; give demulcent drinks; stimulants, hypodermically; 
external heat; careful nursing. 
Irritant gases. 
Symptoms : Irritant gases produce irritation and corrosion of the respiratory 
tract, causing bronchitis, which may be more or less severe. Irritation of the 
eyes, mouth, stomach, and kidneys also are produced. 
Treatment : Remove the patient from the source of the gas; give inhalations 
of ammonium and begin artificial respiration at once. When free respiration is 
established, give magnesium oxide or the dilute alkalies. 
Lead. 
Symptoms: A sense of constriction about the throat; cramps; stiffness of 
abdominal muscles; blue line around the gums; paralysis of upper limbs: 
dropped wrist; vomiting of white flaky matter and constipation. 
Treatment : Free administration of soluble sulphates, followed by milk and 
raw eggs; give emetics and use stomach tube; opium to allay irritation. 
Chronic poisoning is best treated by iodides to saturation of the system, sodium 
iodide or calcium iodide being the best. (Painters are subject to chronic lead 
poisoning.) 
Morphine. (Neurotic.) 
Symptoms : Begin with giddiness, drowsiness, and stupor. Usually there is 
a period of exhilaration followed by a period of depression; slow, stertorous 
breathing; cold, clammy skin; livid countenance; slow pulse; muscular relaxa- 
tion; pupils contracted (pin point) ; total insensibility to external impressions; 
deep sleep from which, if the patient be aroused, there will be an irresistible 
predisposition to go back to sleep. Death occurs by paralysis of the respiratory 
center, TOXICOLOGY. 
495 
Treatment : First remove the poison from the stomach by the use of the 
stomach tube or emetics. The stomach wash, if used, should contain 20 
grains of potassium permanganate to the pint of water. After the stomach 
lias been washed out with this solution, a little (about 1 fluid ounce) should 
be left in the stomach. In the absence of potassium permanganate an emetic 
should be administered hypodermically (emetics by mouth are generally use- 
less), and after evacuation of the stomach the use of tannic acid in some 
form. Cathartics and diuretics should be administered to prevent absorption. 
Caffeine or strong coffee is very efficient. Efforts should be made to keep the 
patient awake, but no violence should be used. Oxygen and artificial respira- 
tion, if necessary. 
Physiological antagonists are caffeine, cocaine, ammonia, strychnine, amyl 
nitrite. Atropine grain) may be used, hut only one dose should be given. 
Nitric acid. (Corrosive.) 
Symptoms : Same as for hydrochloric acid, except that there are likely to be 
yellow stains about the face and lips. 
Treatment : See hydrochloric acid. 
Nux vomica. (Neurotic.) 
See strychnine. 
Opium. (Neurotic.) 
See morphine. 
Oxalic acid. (Corrosive.) 
Symptoms: Burning pain in mouth, throat, and stomach; destruction of 
membrane by contact; intense thirst; difficulty in speaking and swallowing; 
tetanic convulsions; coma and collapse; clothing stains dark brown to red; 
tissues are stained white or brown. 
Treatment : Do not use the stomach tube; give chalk, limewater, or if 
necessary use plaster off the walls, powdered and mixed with water. Follow 
with mucilaginous drinks and oils. Do not tine alkalies of sodium or potassium 
io neutralize this acid. 
Phenol (carbolic acid). (Corrosive.) 
Symptoms : White burns about mouth, lips, tongue, and throat. Burning 
pain in the mouth, throat, and stomach; patient becomes comatose rapidly; 
stertorous breathing; contracted pupils; subnormal temperature; collapse. 
Treatment : Neutralize the acid by the administration of magnesium sul- 
phate or sodium sulphate (any soluble sulphate) first. Then administer emetics 
and follow with stimulants, such as ether, atropine, or coffee; give demulcent 
drinks; apply hot-water bags and warm blankets. Do not give alcohol, oils, or 
glycerin, as they will cause the absorption of the drug. Alcohol may be used 
for the local burns. 
Strychnine-. (Neurotic.) 
Symptoms : A sense of suffocation and inability to breathe; shuddering and 
jerking of the muscles; sense of stiffness about the neck; twitching and jerking 
of lower limbs and quivering of entire body; convulsions—the body becoming 
rigid and curved forward, backward, or to one side; the features assume a 
peculiar grin called the “ risus sardonicus ” ; rapid pulse; tetanus. Patient re- 
mains conscious until the end and is fully aware of what is going on about him. 
Treatment : Emetics administered until free vomiting is induced. Potas- 
sium permanganate (20 grains to the pint of water) as a chemical antagonist; 
if this is not at hand, use tannin in any form. Chloroform inhalations to relieve 496 
HOSPITAL CORPS HANDBOOK. 
pain and quiet spasms. Chloral hydrate and potassium bromide in large doses 
are useful. Patient must be kept in a recumbent position during treatment 
and must be kept in a dark room remote from all noises. 
Sulphuric acid. (Corrosive.) 
Symptoms : Same as hydrochloric acid, except that tissues about mouth and 
face are burned very dark brown or black. 
Treatment : See hydrochloric acid. 
Trinitrotoluene (T. N. T.) poisoning. 
Because of the extensive use of this substance on board ships and in naval 
magazines ashore, poisoning caused by it is not uncommon. 
Symptoms : The skin of the hands, arms, and exposed parts become seriously 
irritated and inflamed. When the fumes are inhaled the respiratory tract is 
irritated and there is a destruction of the blood corpuscles, with a loss of 
haemoglobin resulting in anaemia. The patient complains of headache, nausea, 
vomiting, vertigo, and general muscular weakness. Bile pigments are present 
in the urine and the skin and hair frequently turn yellow. Chronic poisoning 
results in a temporary enlargement of the liver, with subsequent atrophy, and 
in degeneration of the kidneys. Prophylactic measures consist of applying a 
solution of shellac, castor oil, and alcohol to the exposed parts of the skin, 
or, better, cover the arms with stockings and the hands with gloves impreg- 
nated with this solution. The entire face should be covered with a special 
mask, containing glass or other transparent noninflammable material, so that 
there may be no interference with vision. 
Treatment: The poison may be removed from the skin with a solution of 
sodium hyposulphite. Remove the patient from the vicinity of the substance, 
provide absolute rest, fresh air, and simple diet. Large amounts of water 
with large doses of sodium citrate and sodium bicarbonate should be given. 
Restrict the meat intake, give small doses of iron daily, and regulate the 
bowels. 
Gasoline and benzin poisoning. 
Gasoline poisoning frequently results from exposure to the fumes in motoi 
launches and in places which are confined and shut off from free access to the 
outside air. Men attempting to siphon gasoline from a container by means of 
a hose frequently swallow an amount Which is harmful. 
Symptoms : From the fumes; at first, giddiness, a feeling of contraction of the 
head with severe headache, later, partial or complete insensibility, facial 
cyanosis or flushing, and a tendency to mania during the return to con- 
sciousness. 
Treatment : Remove the patient to the open air, remove all gasoline-soaked 
clothing, apply external heat if necessary. Administer stimulants (by enema 
if necessary) and treat symptomatically. (See below under treatment for 
carbon monoxide poisoning.) 
Symptoms from the ingestion of gasoline resemble those caused by acute 
alcoholism, the patient is very apt to develop mania and later become uncon- 
scious. This condition should be treated by emptying the stomach by means 
of a stomach tube, followed by washing the stomach with very dilute potassium 
permanganate solution, then with warm water. It is advisable to administer 
two ounces of a solution of magnesium sulphate before withdrawing the stom- 
ach tube. Treat symptomatically by applying external heat, stimulants when 
indicated, etc. TOXICOLOGY. 
497 
Note.—Carbon monoxide is contained in the fumes of gasoline and benzin, 
and when inhaled results in the formation of carbon monoxide haemoglobin. 
The treatment indicated is: (1) Remove the patient from atmosphere contain- 
ing monoxide; (2) administer oxygen as quickly as possible and in as pure a 
form as is obtainable, preferably from a cylinder of oxygen through an inhaler 
mask; (3) if breathing is feeble, start artificial respiration at once by prone- 
posture method; (4) keep the patient flat, quiet, and warm; (5) afterwards 
give plenty of rest. 
The following table gives the most prominent symptoms of poisoning by some 
of the more common poisons: 
Symptoms. 
Lead us to suspect poisoning by— 
Poison suddenly fatal 
Hydrocyanic acid; potassium cyanide; phenol; oxalic acid: 
poisonous gases. 
Corrosive acids or alkalies; arsenic; antimony. 
Strychnine. 
Alcohol; opium (preparations); chloral hydrate; carbon monoxide 
or dioxide. 
Alcohol; atropine; belladonna: hvoscyamus; cannabis indica; 
camphor. 
Opiates (chronic); cocaine (chronic). 
Belladonna; gelsemium. 
Methyl (wood) alcohol. 
Quinine: salicylic acid, chenopodium. 
Mercurials; aconite; pilocarpine. 
|Atropine; homatropine; gelsemium; hyoscyamus. 
Opiates; aconite; pilocarpine; salicylic acid and salicylates. 
Atropine; cocaine; scopolamine. 
Carbon dioxide; coal-tar products. 
Mercury; lead; arsenic. 
Phosphorus; potassium chlorate or nitrate. 
Bromides or iodides internally; croton oil, poison oak or ivy 
externally. 
Aconite; beginning lead palsy. 
Corrosive acids; alkalies; phenol; bichloride of mercury. 
Nitric acid (changing to brown). 
Iodine; bromine; potassium permanganate. 
Copper salts; Paris green. 
Arsenic: antimony; mercuric salts; ptomaines. 
Apomorphine; aconite. 
Lead; opiates. 
Opiates; digitalis (at first); physostigmine. 
Atropine; hyoscyamus; cocaine. 
Aconite; digitalis; physostigmine; salicylic acid; carbon dioxide. 
Lead; mercury; alcohol. 
Santonin; picric acid. 
Sulphonal; trional. 
Phenol; tar; creosote.- 
Oxalic acid; atropine; potassium chlorate or nitrate. 
Mineral acids; oxalic acid. 
Turpentine; copaiba: cubeb. 
Collapse, with cold clammy skin and 
rapid pulse. 
Coma 
Mental hebetude 
Double vision 
Ringing in the ears 
Pupils— 
Skin— 
Moist 
Cyanotic...'. 
Yellow ' 
Eruptions 
Numbness and tingling 
Discoloration of tongue and mem- 
branes of mouth and throat— 
White 
Obstinate constipation 
Pulse: 
Urine: 
THE MANAGEMENT OF A POISON CASE, THE NATURE OF THE 
POISON BEING UNKNOWN.2 
In a case of poisoning when the nature of the poison is known the antidote 
and general treatment to be followed is often indicated with precision. How- 
ever, cases frequently are met with when it is almost impossible to obtain much 
or any information relative to the nature or type of poison taken. Any delay 
in treatment may result in serious consequences. Therefore every hospital 
2 Prepared by Chief Pharmacist C. Schaffer, United States Navy. 498 
HOSPITAL CORPS HANDBOOK. 
corpsman should possess some practical knowledge of how to manage a poison- 
ing case when the nature of the poison is unknown. 
For the purpose of general treatment in unknown poisons, the case may be 
considered as one of two kinds; it may be either a case where the local effects 
of the poison have injured the mucous lining of the mouth, oesophagus, and 
stomach to an extent contraindicating the use of instruments or emetics for 
evacuating the stomach; or, it may be a case where the poison has had hut 
little or no local effect on the mucous lining of the alimentary tract, and there- 
fore one in which it would be safe to use a stomach tube or an emetic. 
Poisons coming under the classification of “ Corrosites ” generally produce 
conditions such as mentioned in the first instance. They have a more or less 
injurious and even destructive effect on the lining of the mouth and stomach, 
and naturally in such cases the introduction of any sort of instrument, even a 
soft rubber stomach tube, may result in a perforation in the weakened wall; in 
such conditions, even rupture of the stomach may he caused by emesis. Poisons 
classified under “ Irritants ” and “ Neurotics ” have generally no special local 
or injurious action on the mucous membrane of the mouth and stomach, and 
therefore in such cases the stomach may be evacuated and washed by the aid 
of a stomach tube, or in the absence of a stomach tube the use of emetics could 
be resorted to without fear of injury. * 
Even when the exact nature of the poison is unknown, one seldom finds it 
difficult to determine whether the offensive material belongs under the classi- 
fication of “ Corrosives ” or not; a corrosive leaves unmistakable signs about 
the lips and mouth. When the local condition points to a corrosive poison, the 
evidence usually indicates also whether it is of the acid or alkali type. In the 
case of an acid, the general treatment is the same as that outlined above under 
“ Hydrochloric acid,” while the general treatment for almost any strong alkali 
is outlined above under “ Caustic alkali.” In neither case is the stomach tube 
or emetics employed. 
In cases where there are no signs of injury to the lining of the mouth, the 
probabilities are that the poison is one of the so-called “ Irritants ” or “ Neu- 
rotics ”; that is, the poison may be a salt of one of the poisonous metals, as 
arsenic, mercury, copper, tin, zinc, silver; or it may be one of the alkaloidal 
drugs of opium, belladonna, nux vomica, or perhaps one of the many alkaloids, 
among the more common of which may be mentioned morphine, codeine, co- 
caine, heroin, atropine, and strychnine, although in an unknown case it would 
hardly be strychnine, for the symptoms in a case of strychnine poisoning are 
very characteristic. The patient may be Suffering from poisoning by one of the 
drugs known as glucosides, of which the active principles of digitalis are ex- 
amples ; or, the case may be one of poisoning by grain alcohol, wood alcohol, 
chloral, a cyanide, phosphorus, iodine (leaves stains on lips), or phenol (the 
undiluted form has corrosive action). 
Almost the entire range of possibilities for poisons coming under either the 
classification of “ Irritants ” or “ Neurotics,” may be treated with a general 
antidote having properties of precipitating them, or of physically or chemically 
combining with those poisons in a manner to reduce their toxicity and, in some 
instances, to convert them into altogether harmless compounds. The following is 
considered an excellent general antidote: Take one tablespoonful of magnesium 
oxide, 1 tablespoonful of tannin (tannic acid), 3 tablespoonfuls of powdered 
charcoal, and a small amount of water and mix together into a paste, thin 
the paste by further addition of water, about half filling an ordinary 
glass tumbler. This general antidote is administered in doses of from 1 to 2 
ounces each, Wash the stomach with lukewarm water or saline solution be- TOXICOLOGY. 
499 
tween doses of the antidote, which should be repeated at intervals of 10 
minutes so long as may appear necessary. Occasionally, after washing out the 
stomach and between doses of antidote, give the patient a thin paste of starch, 
the white of two eggs or other albuminous substance. 
Always use the stomach tube when possible under the circumstances; the 
stomach tube facilitates the administration of antidotes as well as the washing 
out of the stomach at short and frequent intervals, and permits the handling 
of the case in a positive manner, in so far as it places under control the adminis- 
tration of emergency treatment. When the stomach tube is not used, the 
patient is required to assist and work on himself; he must swallow large vol- 
umes of antidotal mixtures, saline solution, warm water, and besides he must 
take emetics to promote vomiting. All such efforts on the part of the patient 
have a tendency to weaken him and thereby lower his general resistance. 
However, when for any reason the stomach tube is not employed, antidotes 
must be taken by mouth and removed by emesis, which may in some cases be 
brought on by the tickling of the fauces but more often requires the use of 
emetics, the following being a very effective one and very easily prepared: 
About 2 teaspoonfuls of mustard in glass of warm water. Soapy water 
is an excellent emetic, made by dissolving castile soap in water, this also lias 
antidotal action on a number of metallic salts, principally mercuric chloride. 
Two teaspoonfuls of table salt dissolved in a glass full of warm water is some- 
times used as an emetic with good effect. 
After removing the residual poison from the stomach by the use of the 
stomach tube or emetics, magnesium sulphate should be given in small doses 
until a total of about 1J ounces have been taken. No oils should be given 
unless it is certain that the patient is not suffering from an oil-soluble poison 
such as phosphorus or phenol. 
The above outline relative to the management of poison cases when the 
nature of the poison is not known covers only those steps that have to do 
with the removal of unabsorbed portions of poison, the residual poison, from 
the stomach, but the hospital corpsman should not lose sight of the fact that the 
treatment also calls for the application of proper measures to counteract that 
portion of the poison that may have been absorbed and carried in the system 
of circulation. No definite outline of treatment can be laid down for combat- 
ing the possibilities which may arise from absorbed poisons; this part of the 
treatment is based entirely on the symptoms the case presents. Efforts to 
hasten the elimination of absorbed poison would include the giving of large 
quantities of water, the use of hot packs to stimulate skin action, probably the 
use of enemas if deemed advisable under the circumstances. 
The hospital corpsman should endeavor to alleviate symptoms and distress 
of the patient by such means as come within his knowledge and experience in 
the general care of the sick, using hot water bags, ice bags, etc., as indicated. 
Physiological antagonists should not be administered in the absence of definite 
information as to the nature of the poison ingested. Medication should be 
limited to drugs whose physiological action is clearly understood by the hospi- 
tal corpsman. 
References. 
Medical Jurisprudence and Toxicology.—Glaister. 
Preventive Medicine Section of Naval Medical Bulletins. 
Legal Medicine and Toxicology.—Peterson, Haines, and Webster. CHAPTER X. 
BACTERIOLOGY, BLOOD WORK, AND IMMUNITY.1 
This section on bacteriology and haematology is not intended to serve as a 
working manual for laboratory use, but rather to outline the principles 
involved, the general methods, and something of the application of the more 
common procedures. Details of technique that are absolutely essential for 
the proper performance of any test are 
available in the manuals of laboratory 
work that are supplied to the medical 
department of all ships and stations. 
The microscope.—The most important sin- 
gle piece of apparatus in a .laboratory is 
the microscope, and it must be used and 
cared for accordingly. It is used to mag- 
nify and so make visible to the eye very 
small bodies, such as bacteria, the eggs 
of intestinal parasites, and the material 
found in urine sediments. A simple 
microscope is nothing more than a single 
magnifying lens. A compound microscope, 
which is the type used in medical labora- 
tories, consists of a number of such lenses 
arranged in line so as to give a very great 
magnification, even up to 1,000 times the 
actual size. Complete and detailed descrip- 
tions of microscopes are to be found in all 
books on laboratory work. The working 
parts of the instrument are illustrated in 
figure 179. 
Before attempting to use a microscope 
for the first time one should read over a 
description of its parts and their functions 
so that it will be possible to adjust the 
light and the lenses properly. There are a 
few important things to keep in mind re- 
garding its use, and they are: Never leave 
the microscope exposed to direct sunlight, 
excessive heat, or splashing water; never 
use ether, alcohol, or xylol to clean it, as they all destroy the finish; never pick 
it up by any of the movable parts; never leave immersion oil on the lens or 
objective, as it is called, but wipe it off immediately after use with a fine, soft 
cloth or with special lens paper; when not in use see that it is well covered to 
protect it from dust. 
Fig. 179.—Parts of microscope: E, 
Eyepiece; D, drawtube; R, rack; 
PH, pinion head; T, body tube; 
MH, micrometer head; RN, revolv- 
ing nose piece; 0, objectives; MS, 
mechanical stage; S, stage; II, 
handle; SS, sub-stage; I, inclination 
joint; P, pillar; M, mirror; B, base. 
(Stitt.) 
1 Prepared by Lieut. J. H. Chambers, Medical Corps, United States Navy. 
501 502 
HOSPITAL COUPS HANDBOOK. 
Micrometry is the measurement of microscopic bodies. The unit Is Galled 
tlie micron and is one one-tliousandth part of a millimeter, or 1/25,000 of ah 
inch. A glass disk, with a scale etched on it, is inserted in the eyepiece 
of the microscope and there it is at the level at which the image of the object 
on the stage is brought to a focus. The lines of the scale seem to cut the 
object and the number of divisions of the scale covered by the object are noted. 
The scale must be standardized for each objective of each microscope it is 
used with. Since the value in microns of one division is thus known and, 
knowing how many divisions are covered by the object, its size is determined 
by multiplying these values. 
Culture media are the materials used for the growth of bacteria in the labor- 
atory. Simple media are so made that they simulate to greater or lesser degree 
Fig. 180.—1, Filling tubes; 2, plugging tubes; 3, inoculating tubes; 4, culture flask 
plate; 5, Durham fermentation, tube; 6, Smith fermentation tube; 7, pharyngeal 
loop for meningococcus pharynx cultures; 8, West tube for same. (Stitt.) 
the conditions present in the human body, where the bacteria have been 
growing. The basis of most media is bouillon or broth which is a solution 
of meat juice, salt, and peptone in water and having a definite degree of 
acidity. The acidity may be determined by titration, as described in the 
section on chemistry. The more modern and satisfactory method is to de- 
termine the hydrogen ion concentration or its pa value. The usual pa value 
is about 7.5, approximating that of blood. A few bacteria require media 
of other values for their cultivation. Simple nutrient broth may be modified 
by the addition of agar, making it solid, and known as nutrient agar. To 
the latter blood may be added, producing blood agar. In the same way other 
body fluids, such as hydrocele fluid, may be added, making the enriched media 
required by some of the more delicate organisms. Other substances are used 
as media, such as milk, broth with sugars added, coagulated blood serum 
(Lofflers, particularly useful for B. diphtherice), and many others used for BACTERIOLOGY, BLOOD WORK, AND IMMUNITY. 
503 
special purposes. Milk is used to determine whether the organism produces 
acid by fermenting the lactose of the milk (shown by a change in the litmus 
indicator) and whether it produces enzymes that will coagulate the milk. 
Sugar broth is used in fermentation tubes (Fig. 180) and always contains an 
indicator such as litmus. If an organism produces acid, the indicator changes 
color. If it produces gas as well, some of the gas is collected in the closed 
branch of the tube. The various activities of organisms on culture media, 
such as the appearance of the colony, production of acid and gas in one sugar 
and not in another, have been classified and serve to identify the specific 
organism. Media, after preparation, is put up in tubes—fermentation tubes, 
flat glass dishes with covers known as Petri dishes, or in flasks, and is then 
sterilized. 
Sterilization is accomplished by means of heat, either from streaming steam 
in an Arnold sterilizer or by steam under pressure in an autoclave. Glassware 
often is sterilized by dry heat. Fractional sterilization is repeated steriliza- 
tion at 1 to 24 hour intervals and is employed to kill bacteria developing 
from spores. As the dust of the air is loaded with bacteria, all media must be 
kept covered or, if in tubes, plugged with cotton from the time first made. 
Bacteria are very small single-celled bodies, visible only through a micro- 
scope. They are distributed almost universally in soil, air, water, and in the 
human body. The mouth and throat contain enormous numbers; milk and 
butter contain millions. The large intestine contains countless numbers, and 
a large part of the solid matter of the faeces is made up of bacteria. It is 
evident, therefore, that not all of these bacteria produce disease, and some of 
them are harmless or even distinctly beneficial to the body and are called 
nonpathogenic. Many bacteria are known to produce disease, and these are 
called pathogenic. In order to study bacteria they are grown on culture 
media, the different organisms separated out and then grown in pure culture 
for identification. As the majority of bacteria of medical interest grow in 
the human body the media employed for laboratory growth must be kept at 
body temperature; hence cultures are kept at a constant temperature of 37.5° C. 
This is known as incubation and usually is continued for 24-hour periods. 
Bacteria are classified according to the appearance of colonies, the shape 
and arrangement of the individual cells, their color when stained by appro- 
priate methods, whether or not they are motile (have the ability to move from 
place to place in fluid) by their action on milk and sugar bouillon and by their 
action on experimental animals. The three usual types are the round organ- 
isms, or cocci, rod shaped, or bacilli, and spiral forms, or spirillce. All of 
them are killed by boiling, many of them by lower temperature if prolonged 
sufficiently. Some grow only in the presence of oxygen and are called aerobes, 
while others require an atmosphere free of oxygen and are called anaerobes. 
They reproduce by fission or simple splitting into parts. Some of them pro- 
duce bodies called spores that are much more resistant to high temperatures, 
drying, and cold than the bacteria and serve to produce new organisms when 
material containing them again is placed in surroundings favorable to bac- 
terial growths. 
Stains are substances used to color bacteria and tissue cells so that their 
morphology may be studied microscopically. They are usually solutions of 
anilin dyes in water or alcohol, but a few are derived from vegetable sub- 
stances. The more common stains are hsematoxylin and eosin, used for tissue 
staining, and methylene blue, carbol fuchsin, gentian violet, and Bismarck 
brown for bacteria. Each of these is made up for use in definite strength, 
alone or in combination with another dye. For some purposes several stains 504 
HOSPITAL CORPS HANDBOOK. 
are applied successively, as part of the material will take up and retain one 
stain while other parts will react with another dye. This is the principle of 
Gram’s method and of acid-fast staining for tubercle bacilli. 
Smears are thin spreads of pus, blood, bacteria, or similar material on a 
glass slide. They may be made from material from the throat, from sputum, 
from an abscess, or of blood. The first essential for a proper bacteriological 
examination is a good smear, and the chief difficulty is to get it thin enough. 
If a culture is to he examined, place a loopful and not a drop of distilled 
water on a perfectly clean glass slide and with a sterile platinum wire rub 
up some of the bacteria in the water, spreading it over as large an area as 
Fig. 181.—1, 2, 3, 4, Making blood smears on slide; 5, smear ready for staining—grease 
marks prevent Wright stain from running over slide; 6, U-shaped glass tubing to hold 
slide in staining; 7, right hand holding two cover glasses—one cover glass is being 
touched to drop of blood from ear ; 8, cover glasses transferred to left hand in prepar- 
ing to place one cover glass on another and spread film; 0, separating cover glasses by 
sliding one from the other. (Stitt.) 
possible. If the bacteria are in fluid media, the water is not needed. For 
examination of pus use a cotton swab or a loop and spread out just enough of 
the material to make a visible film on the slide. Smears of sputum should be 
made from fresh material—that is, material recently coughed up from the 
lungs—and as free of mouth secretions or saliva as possible and collected in a 
clean container. For the smear select a thick lump of mucus and avoid the 
frothy, watery saliva. Smears are allowed to dry in the air and then are 
fixed to the slide by passing through a flame two or three times. Blood smears 
should not he fixed by such heating. The smear then is ready for staining 
with whatever dye is indicated, Gram’s method, employing anilin gentian 
violet, Gram’s iodine solution, alcohol, water, and Bismarck brown, being the 
best routine process. BACTERIOLOGY, BLOOD WORK, AND IMMUNITY. 
505 
A complete Mood count includes the determination of the number of red and 
white cells in 1 cubic millimeter of blood, the percentage of haemaglobin, and a 
differential count which detei-mines the percentage of each type of white cell 
present. Cells are so numerous in the blood that it must be diluted to sepa- 
rate them and permit the counting of individual cells. The dilution is accom- 
plished in special pipettes, first taking up blood and then the proper diluting 
fluid. The pipettes ai-e so graduated that known dilutions may be made. One 
part of blood to 200 parts of fluid, or a dilution of 1:200 for the red pipette 
and 1: 20 for the white. The pipettes must he clean and dry before use, and 
this is accomplished by washing out with water, sucking alcohol through to 
wash out the water, then ether to take out alcohol, and then air to evaporate 
the ethei-. The bulb of the pipette or mixing chamber contains a glass head to 
aid in thoroughly mixing the diluted blood; and if cleaned properly, the bead 
will not stick to the sides of the bulb. After taking up blood and diluting 
fluid, the pipette must be shaken vigorously for about a minute to thoroughly 
mix the blood and fluid. A drop of the mixture is obtained by discarding the 
clear fluid from the stem of the pipette and is placed on the niled surface of 
a hcemacytometer or counting chamber. The latter must be scrupulously clean. 
It should be washed in cool water and dried with a soft .cloth. Never wash 
with hot water, acid, alcohol, ether, or xylol, as these tend to dissolve the 
cement holding the parts together. 
When the proper-sized drop is applied and covered with a thick cover glass 
provided with the apparatus, there is formed a layer of fluid exactly 0.1 mm. in 
depth and containing an even distribution of red or white cells, as the case may 
be. The fluid rests on a surface that is ruled into squares 1 millimeter on a 
side, and further subdivided into smaller squares. The counting chamber is 
allowed to stand a few minutes to permit the cells to settle, and then is 
examined under the microscope. The number of cells in one or more squares is 
counted, and as the size of each square is known and the depth of fluid the 
number of cells in 1 cubic millimeter can he determined according to the 
following formula: The number of cells counted times dilution times area of 
each square times 10 or the factor required to give a depth of 1 millimeter, all 
to be divided by the number of squares counted. 
a red-cell count this is expressed: 
No. of It. B. C.X 200X400X10 
g0 =No. of It. B. C. per cu. mm. of blood. 
P'br a white-cell count it becomes: 
No. of W. B. C.X20XIX10 
—— j =No. of W. B. C. per cu. mm. of blood. 
A differential count is made on a stained smear of undiluted blood. Smears 
are made on slides or cover slips that are clean and free of all grease. Smears 
on slides are made by drawing out a drop of blood on one slide by means of the 
end of another slide. With cover slips, a drop of blood is taken up on the center 
of one and a second dropped on it. The blood spreads out rapidly in a thin film 
and then the slips are separated by a sliding motion. Both methods are illus- 
trated in figure 181. 
The smears are dried in the air and then stained with one of the blood stains. 
The majority of the latter are modifications of the Itomanowsky method and 
are solutions of dyes in methyl alcohol. With alcoholic stains no fixation is 
required before the stain is applied, the alcohol fixing the cells. Water is 506 
HOSPITAL CORPS HANDBOOK. 
added to the stain on the smear and allowed to react, washed off with water, 
and allowed to dry. Never blot blood films. If other types of stain are used, 
the films must be fixed before applying the stain. Examination is made with 
the oil immersion objective of the microscope and a count of 100 cells made. 
The number of each type of white cell then gives the percentage of each. 
In disease there is usually an alteration of the percentage of the various 
types, and in certain diseases abnormal or pathologic cells appear. Among the 
latter are the myeloblasts and myelocytes of myelogenous leukemia and the 
lymphoblasts of lymphatic leukemia. The stained smear also is used to demon- 
strate the presence of malarial parasites, the staining qualities of the red cells, 
and their shape, size, and whether or not any of them show nuclei. 
Hwmaglobin is the coloring matter of the red cells and is estimated by com- 
paring the color of a drop of whole blood or of chemically treated blood with 
appropriate color scales and reporting as per cent of normal. 
Blood cultures are made to determine whether bacteria are present in the 
blood stream, thus serving as an index of the nature of the disease in some 
cases. Ordinarily about 10 to 20 c. c. of blood is required. It is taken from a 
vein by means of a needle and syringe or a needle connected by sterile tubing 
with a flask, observing strict asepsis throughout. The skin over the vein must 
be prepared according to any standard surgical technique and protected from 
contamination prior to the taking of the blood. The blood is received in sterile 
containers and transferred to appropriate media. Usually it is added to bouillon 
and in varying proportions to melted agar that has been cooled below 45° 0. 
and then is poured into Petri dishes and incubated. 
Blood for the Wassermann reaction, Noguchi reaction, or for chemical exami- 
nation is taken in the same manner, preparing the patient’s arm, constricting 
above with a tourniquet, and puncturing a vein with a needle. Here, since 
absolute asepsis of the blood is not required, the blood may be permitted to run 
from the end of the needle into a tube, but it is better to collect it in a closed 
system of apparatus. 
Dark-field examinations usually are made on serum from sores on the genitalia 
to detect the Treponema pallidum, the organism causing syphilis. For this 
purpose a special substage condenser is put into the place of the ordinary Abbe 
condenser of the microscope. It is so constructed that light rays are prevented 
from passing directly from the mirror to the objective by a light-proof black 
surface. Light is reflected by means of mirrors around the sides of this dark 
field and so illuminates the organisms or cells that may be present in the fluid 
on the slide. Ordinary daylight is not sufficient, and special lamps ordinarily 
are required. 
To make the preparation, the suspected sore is cleaned of all accumulated 
secretions with sterile gauze and salt solution. Then it is rubbed sufficiently 
to promote a flow of serum but not to draw blood. A drop of this material 
is placed on a slide and immediately covered by a cover glass and examined 
while still moist. The Treponema pallidum is examined in a dark-field prepa- 
ration because it does not take the ordinary dyes, and when stained by one of 
the more complicated methods loses many of its characteristics. Other organ- 
isms may be seen in the dark-field preparation, but as they are stained easily, 
this method is not employed. There are a number of spiral-shaped organisms 
that occur in ulcerative lesions, so great care must be exercised in making a 
positive report of Treponema pallidum. 
Immunity is the term applied to that power which prevents the gaining of a 
foothold by disease organisms in the animal body, or which neutralizes their 
harmful products or destroys the parasites. Its effectiveness depends upon BACTERIOLOGY, BLOOD WORK, AND IMMUNITY. 
507 
two main factors—the power of resistance of the human body and the aggres- 
siveness or virulence of the invading organism. Immunity may be inherent or 
acquired. Inherent immunity is present from birth and is represented best by 
the immunity of certain animals to specific infections. It is of theoretical 
interest but of little practical value in diseases of human beings. Acquired 
immunity is that which results from an attack of a disease, called naturally 
acquired immunity; or from inoculation of the individual with killed specific 
organisms or their products and known as artificially acquired immunity. 
Not all diseases confer immunity by their attack, nor is it possible to produce 
artificial immunity to all diseases. 
Artificially acquired immunity may be active or passive. When the body 
is infected by disease, or when the causative organisms of a disease are in- 
jected into the body, substances are produced that combat that disease, leading 
to cure and in some cases to the production of prolonged immunity to that 
disease. These agents that combat the disease are known as antibodies, and 
if antibodies against a specific disease are produced in the body the immunity 
is known as active immunity. If the antibodies are produced in one animal 
and the serum of that animal then injected into another, they produce an 
immunity; but since the cells of the second individual played no part in the 
formation of the antibodies, the immunity is called passive. 
Antibodies are of many types, and the following may be demonstrated in 
the blood serum: Agglutinins, precipitins, opsonins, and bacteriolysins or cyto- 
lysins. Certain bacteria produce soluble poisons known as toxins, which are 
neutralized by antitoxins formed by the body to produce cure of the disease. 
Toxins and antitoxins have their most familiar application in diphtheria. 
Tiie danger of diphtheria usually is due to the toxin produced by the bacteria 
aud absorbed by the body. Toxins may be produced in laboratory cultures 
and antitoxins in animal bodies, and the two standardized against each other 
and so measured in terms of units. The unit of toxin is that amount that will 
kill a 250-gram guinea pig in just four days and is called the Minimum Lethal 
Dose or M. L. D. The unit of antitoxin for human use is 100 times the amount 
required to neutralize one M. L. D. Many thousand units of antitoxin may be 
required for the treatment of an attack. 
Some individuals have an immunity to diphtheria because of the presence 
in their body of the specific immune bodies, or diphtheria antitoxin. The 
Schick test is a means of determining whether or not an individual is immune 
to diphtheria. The dose for this test is of one M. L. D., which is a very 
small amount of toxin. It is so prepared that the proper amount of toxin is 
contained in 0.2 c. c. of solution, and this amount is injected by means of a 
very fine needle into the skin and not beneath it. If this intracutaneous 
injection is made properly, there will be a small weal formed by the fluid at 
the site of injection. The toxin may be destroyed by heating to 60° C., but 
this, of course, does not destroy the protein material in the solution. Certain 
individuals are sensitive to injected protein even when no toxin is present 
and may give a reaction due to the protein alone. For this reason it is neces- 
sary to give a control injection of heated toxin, usually on the opposite arm. 
If immunity exists, the antitoxin of the body immediately will neutralize 
the toxin and there will be no reaction. If there is no immunity, the toxin 
will act as an irritant and will cause redness and slight swelling at the site of 
injection. If a reaction appears, it may he due to the protein and not the 
toxin, but in this case there will be a similar reaction at the site of the con- 
trol injection. If there is a reaction to the toxin and to the protein, the true 
47829°—23 33 508 
HOSPITAL CORPS HANDBOOK. 
reaction to the toxin will reach its maximum intensity by the fourth day and 
will subside slowly, leaving a small brownish, scaling area, thus distinguishing 
it from the pseudo-reaction due to the protein. A positive reaction therefore 
indicates that the individual is not immune. If no reaction appears, there is 
sufficient antitoxin present to render him immune. 
The immunity given by the injection of diphtheria antitoxin is passive and 
of brief duration, lasting only two or three weeks. More recently mixtures of 
toxin and antitoxin have been injected, and as this causes the production of 
specific antibodies the immunity is more lasting. It is highly efficient in the 
prevention of diphtheria in children. 
In the treatment of disease blood serum from an animal that has been im- 
munized against that specific disease often is injected as a curative measure. 
This is known as Serum Therapy. Specific immune serum is used extensively 
in the treatment of diphtheria and of meningitis when the latter is due to the 
meningococcus. It has been employed in the treatment or prevention of 
many other diseases such as pneumonia, dysentery, cholera, and tetanus, but 
not with the same remarkably good results. Specific serum may be given as 
a protective or prophylactic measure, and in this connection, tetanus antitoxic 
serum has been of the greatest importance and value. 
Immune serum is made by giving repeated injections of the specific causative 
bacteria or their soluble toxins into animals, horses commonly being employed. 
The animal becomes immune, and its serum contains specific antibodies, which 
are collected by bleeding the animal and separating oft the serum. This serum 
when injected into man or another animal will afford protection against that 
disease, but no other. The injection may be subcutaneous, intramuscular, in- 
travenous, intraspinal, subdural, or into the sheath of a nerve, depending upon 
the type of infection or the indications for the individual patient. Consider- 
able skill in technique, and knowledge of the nature and function of a serum 
is required for its proper administration. 
The use of serum, either normal horse serum or of specific immune horse 
serum, often is followed by annoying symptoms and occasionally by severe or 
even fatal reactions. There are two distinct types of reaction or serum sick- 
ness ; one a comparatively mild form and the other very severe and usually 
spoken of as anaphylactic shock. Serum sickness is due to the serum itself 
and not its contained antibodies, and may appear within a day or two of the 
injection but more often about a week later. The patient usually complains 
of headache, fever, joint and muscle pains, oedema, and particularly of a rash 
or of itching weals. Most of these mild attacks of serum sickness clear up 
readily with rest, mild skin lotions, and catharsis. Adrenalin very often will 
relieve the urticaria. 
Severe reactions occurring immediately after the injection, or anaphylactic 
reactions represent the very severe form of serum disease. Anaphylaxis means 
the opposite of immunity, or, the patient instead of having any protection 
against the serum, is more susceptible than normal to that serum, or is 
hypersensitive. One injection of a serum such as diphtheria antitoxin may 
“ sensitize ” him so that another injection a few weeks later may produce a 
very severe reaction. Individuals suffering from asthma, particularly when 
their asthmatic attacks are provoked by contact with horses, are usually hyper- 
sensitive, and will give severe reactions when serum is injected. Before ad- 
ministration of serum it is necessary to inquire of the patient whether he has 
had previous injections or has ever suffered from asthma. The condition 
known as status lymphaticus almost invariably leads to severe or fatal reactions 
after injection of serum. If there is any suspicion of sensitization, a very BACTERIOLOGY, BLOOD WORK, AND IMMUNITY. 
509 
minute dose (1/50 c. c.) of the serum should be injected subcutaneously. A 
local reaction, usually an urticarial weal appearing within a few minutes at the 
site of injection, indicates hypersensitiveness. Such an individual usually 
may he “ desensitized ” by repeated subcutaneous injections at short intervals 
of small doses that are gradually increased. 
Anaphylactic shock comes on very rapidly and is marked by restlessness, 
anxiety, dyspnoea, and marked prostration. Fortunately the cases in which 
this goes on to a rapidly fatal ending are very rare, but since they do occur, 
they must be kept in mind and serums should be injected only under proper 
supervision. 
Other varieties of anaphylaxis or susceptibility are seen in individuals said 
to have an idiosyncracy for certain foods, drugs, or other material, such as 
plant pollens or animal dandruff, hair, or feathers. Reactions to these produce 
varied symptoms, such as asthma, hay fever, urticaria, or even severe prostra- 
tion. 
An antigen is any substance that promotes the formation of antibodies and 
may be bacterial or cellular in nature. 
Agglutinins are those antibodies found in the serum that cause suspensions 
of bacteria to come together and form clumps. They are employed in the 
laboratory for two purposes: To identify an organism when the specific 
agglutinin is known to be present in the serum, or, to identify the agglutinin 
in the serum when the specific organism is at hand. The first method is the 
one employed in the Widal reaction for the diagnosis of typhoid fever. In this 
test the diluted serum of the patient is mixed with a suspension of the specific 
organism (B. typhosus). If the patient has typhoid fever, he will have pro- 
duced specific antibodies and among them agglutinins. So, if the culture of 
B. typhosus is agglutinated, it means that the patient has typhoid fever, or has 
been very recently immunized by vaccine against the disease. The second 
method is used to determine the type of Pneumococcus present in cases of 
pneumonia. The organism is recovered in pure culture from the sputum and 
then mixed with serum known to contain the specific agglutinins for the differ- 
ent types. The serum with which agglutination occurs shows which type of 
Pneumococcus it is. 
Precipitins are those antibodies that have the power of producing a precipi- 
tate when the serum containing them is mixed with a clear broth filtrate or a 
solution of specific organisms. 
Opsonins are antibodies that have the power of preparing their specific 
organisms for phagocytosis or ingestion by the leucocytes. 
Bacteriolysins and cytolysins have the power of dissolving their specific 
organisms and cells respectively. 
All of these antibodies are specific in that they will react only with the 
particular antigen that caused their production. 
There have been many theories advanced to explain how the antibodies are 
formed and how they unite with the antigen. The most widely accepted theory 
is that of Ehrlich. His explanation is that the body cells are damaged by the 
antigen and in response develop substances that are capable of combining with 
the antigen to neutralize it. In the production of an active immunity by 
disease or by inoculation these antibodies, called receptors, are produced in 
great excess over the immediate need for the proper handling of the amount of 
antigen present and are thrown off into the blood, and as long as they persist 
the individual is protected against any further damage by that antigen, or he 
has an immunity against that disease. Receptors are divided into three 
groups or orders. Those of the first order include the antitoxins which unite 510 
HOSPITAL CORPS HANDBOOK. 
directly with the toxin or antigen and neutralize it. In the second order are 
the agglutinins which have the power of clumping their specific bacteria. 
The receptors of the third order of amboceptors are regarded as forming a 
combining link between the antigen and a substance constantly present in the 
blood called complement or alexin. While complement is always present it does 
not have the power to combine with an antigen unless it is joined to the antigen 
by a specific amboceptor. 
The amboceptor is the antibody used in the Wassermann reaction for the 
diagnosis of syphilis. In this test an antigen is mixed with complement and 
the patient’s serum. If the patient has syphilis, his serum will contain the 
specific amboceptor against syphilis and the antigen and complement will be 
united, producing fixation of complement. To determine whether fixation 
of complement has occurred, red blood cells and an amboceptor specific for 
such sells is added. In the presence of syphilis the complement will be fixed 
and will be unable to attack the red cells and hence produces no haemolysis. 
This is a positive Wassermann reaction. If the patient does not have syphilis, 
the complement will be free, as there is no specific amboceptor in the serum 
to unite it to the antigen, and it will be joined to the red cells by the specific 
haemolytic amboceptor, producing haemolysis, or a negative Wassermann reac- 
tion. The Wassermann reaction is known as a complement fixation test, 
and by employing the proper antigen such tests may be used in the diagnosis 
of other diseases, such as tuberculosis and gonorrhoea. 
The term' vaccination originally was used in connection with cowpox or 
vaccinia, when employed to produce an immunity to smallpox, but bacterial 
preparations now are referred to frequently as vaccines. Bacterial vaccines 
are suspensions of killed organisms that have been counted. When vaccines are 
introduced into the body the organisms dissolve and produce substances that 
stimulate the production of antibodies for that disease. Autogenous vaccines 
are those made from cultures of the organisms obtained from a patient’s 
own disease lesions. Stock vaccines are those made from cultures of specific 
organisms that have been carried in the laboratory. Vaccines are employed 
as a prophylactic measure to prevent disease, or as a curative measure in an 
established infection. The best example of the prophylactic bacterial vaccine 
is the triple typhoid vaccine, a suspension of killed typhoid, paratyphoid A, 
and paratyphoid B bacilli, which practically has eliminated these diseases 
from the military services where it is given routinely. In treatment with 
vaccines the object is to promote the production of more antibodies and thus 
bring about recovery, but their use is not always successful. 
References. 
Practical Bacteriology, Blood Work and Parasitology.—Stitt. 
Bacteriology.—Hiss and Zinsser. 
Diagnostic Methods, Chemical, Bacteriological and Microscopical. (Sixth edition.)— 
Webster. 
Animal Parasites of Man.1 
GENERAL CONSIDERATIONS. 
While there are many lower forms of animal life that are parasitic for man, 
only the most common ones will be considered in this chapter. Before discuss- 
ing the systematic relationships, structure, and life history of these parasites, 
there are certain terms employed in animal parasitology which it is necessary 
to understand. Among these are: 
1 Prepared by J. Harper, Lieutenant, Medical Corps, United States Navy, animal parasites or man. 
511 
1. Hosts.—The animal in which a parasite undergoes its sexual life is called 
the definite host, that in which it passes its nonsexual existence the interme- 
diate host. For example: Man is the intermediate host of the malarial para- 
site, the mosquito the definite host. 
2. True parasitism.—By this is understood the condition where the parasite 
does harm to the host, deriving all the benefit of the association. A good 
example of this is the hookworm infecting man. 
3. Mutualism.—In such an association there is mutual benefit to each party of 
the association. An instance of this would be the oyster crab found inside the 
oyster shell. 
4. Commensalism.—Where there is benefit to the parasites but no injury to 
the host. An example of this would be the Entamoeba coli in the intestines of 
man. 
5. Ectoparasites.—Those living upon the body of the host. Example: In- 
festation with lice. 
6. Endoparasites.—Those living within the body of the host. Example: 
Infection with hookworms. 
7. Male parasites are designated by the sign of Mars ( $ ) ; the female by the 
sign of Venus ( 9 ). 
8. The name of a parasite consists of its generic and specific names. The 
first or the generic name always commences with a capital. Example: 
Acanthia lectularia, the name of the bedbug. 
CLASSIFICATION. 
Practically all animal parasites of man belong to the following zoological 
phyla, or branches: (1) Protozoa (one-celled animals); (2) platyhelminthes 
(flat worms) ; (3) nemathelminthes (round worms) ; and (4) arthropoda 
(mites, ticks, and insects). 
Protozoa. 
These are one-celled animals and are made up of protoplasm, which is divided 
into cytoplasm and a nucleus. There are four groups or classes of protozoa, 
(1) rhizopoda, (2) mastigophora, (3) infusoria, and (4) sporozoa. (Fig. 182.) 
Rhisopoda.—This class of protozoa moves and secures food by throwing out 
protoplasmic projections called pseudopodia, or false feet. Entamoeba histolyt- 
ica, one of the parasitic intestinal amoeba of man, is the important member of 
this class. It exists in two stages, motile and cysted. Man acts as the definitive 
host. An intermediate host is not required. It is transmitted by cysts in food 
or water. Flies may act as carriers. It causes the disease known as amoebic 
dysentery. Diagnosis is made by finding the motile or encysted amoeba in the 
stools. 
Mastigophora.—This class sometimes is called the flagellata and includes 
those protozoa that move and obtain food by means of whiplike appendages, or 
flagella. Trypanosoma gambievse is an important member of this group. This 
parasite is fish-shaped, has two nuclei and a long flagellum. It lives in the 
blood and tissues of man. For its development two hosts are required: A fly 
(Olossina palpalis), the definitive host, and man, the intermediate host. It is 
transmitted by the fly biting man. It causes the disease known as trypano- 
somiasis, or sleeping sickness, a disease found chiefly in Africa. Diagnosis is 
made by finding the trypanosome in the blood or tissues of man. 
Note : Many zoologists include in this class the Proflagellata (spiral or cork- 
screw shaped organisms), about which there is considerable controversy as to 
whether they are animals or plants. Among the important members of this 512 
HOSPITAL CORPS HANDBOOK. 
group are: (1) Treponema pallidum, the cause of syphilis. This parasite is 
transmitted by direct contact, usually venereal. The parasite is found by 
making a smear or dark-field examination of serum from a chancre; (2) 
Leptospira icteroides, the cause of yellow fever. This parasite requires two 
hosts for its development, man acting as a definitive host and a mosquito 
(Acdes cegypti) the intermediate host. Twelve days are required for its proper 
development in the mosquito, therefore a mosquito biting a man suffering from 
yellow fever can not infect another man for approximately 12 days. The 
parasites are found by special culturing; and (3) Borrelia recurrentis, the or- 
ganism causing European relapsing fever. Man is the intermediate host, and 
the body louse (Pediculus vestimenti) the definitive host. An African form 
of this disease is caused by Borrelia duttoni, which is transmitted by a tick 
Fig. 182.—-Parasitic protozoa of man: 1, Adult Entamoeba histolytica; la, encysted 
E. histolytica; 2, Plasmodium malariae, A, B, C, D, various stages; 3, Trypanosome 
gambiense; 4, a, Treponema pallidum; b, Borrelia refringens; 5, Balantidium coli; 
6, Trichomonas intestinalis; 7, a, adult Giardia intestinalis; b, encysted G. intestinalis. 
(Stitt.) 
(Ornitliodorus moubata). Diagnosis is made by finding the parasite in a 
blood smear. 
Infusoria.—This group frequently is called the ciliata on account of the fine, 
liairlike fringe or cilia that surrounds them. These cilia aid in movement and 
securing food. Balantidium coli, a rather large intestinal protozoan, is the 
only member of this group of importance to man. It is transmitted similarly 
to Entamoeba, and causes dysentery. Diagnosis is made by finding the parasite 
in the stool. 
Sporozoa.—These protozoa have neither cilia, flagella, nor other organs for 
movement. They live parasitically in the tissue cells of the host, and reproduce 
by forming spores. The ones that live in the red blood cells, Hcemosporidia, 
are of the most interest medically because they include the parasites that 
cause malaria. There are three types of malarial parasites of man: (1) ANIMAL PARASITES OF MAN. 
513 
Plasmodium malarice, the cause of quartan malaria; (2) Plasmodium vivax, 
the cause of benign tertian malaria; and (3) Plasmodium falciparum, the 
cause of malignant tertian malaria. These parasites require two hosts for 
their development, the definitive host, a mosquito (Anopheles) and man, the 
intermediate host. The development in the mosquito requires 10 to 14 days, 
thus an anopheles mosquito biting a man suffering from malaria can not 
infect another man until after this time has elapsed. Diagnosis is made by 
examining a blood smear for the presence of these parasites. 
Platyhelminthe s. 
These parasites are known as the flat worms, and they are divided into two 
classes: (1) the trematodes or flukes, and (2) the cestodes or tapeworms. 
Trematodes or flukes are generally leaflike in shape and vary considerably 
in size. Characteristic of them is the possession of suckers, by which they 
hold on to the skin or alimentary tract of their host. They develop from 
eggs and the larval stage usually is passed in a snail. Some flukes require, 
in addition to the snail, a second intermediate host, usually a fish. Man the 
definite host, contracts the parasites by eating insufficiently cooked fish or 
Fig. 183.—Important trematodes (flukes) of man. (Stitt.) 
by bathing in or drinking infected water. The flukes of importance to man 
are (Fig. 183) : (1) Fasciolopsis buski. This parasite lives in the intestines and 
the diagnosis is made by finding the fluke or its eggs in the stools; (2) Clon- 
orchis endemicas. An important liver fluke, the eggs of which likewise are 
found in the stools; (3) Paragonimus icestermanni, the fluke that lives 
in the lungs. The diagnosis being made by finding the eggs in the fresh 
sputum; and (4) Schistosomes. These are the blood flukes, of which there 
are three kinds , Schistosoma heematobium, S. japonicum, and S. mansoni. 
Unlike the other flukes, they are not hermaphroditic, but have separate sex. 
Diagnosis is made by finding the eggs in the faeces or in the case of S. hae- 
matobium in both urine and faeces. 
Cestodes. 
These worms commonly are called tapeworms. They consist of a head and 
a series of segments. One might consider them a series of flukes united in 
one long ribbon-like colony. The head, which is a little larger than a pin head, 
is provided with suckers or hooks, or sometimes both, to enable them to hold 
on to the intestines. The segments may number several hundred or more. 
Some tapeworms attain the length of 25 to 30 feet. In treating cases of 
tapeworm infection, it is important that the head be expelled, otherwise, in 514 
HOSPTTAL CORPS HANDBOOK. 
about two months, a full-grown worm again will develop. Among the im- 
portant tapeworms of man are: (1) Twnia saginata. This is the common and 
widely distributed beef tapeworm. Its head has four large suckers, but no 
booklets and often is called the unarmed tapeworm. The segments have a 
uterus showing 15 to 30 branches. The genital pores are lateral and alternate. 
Several hundred segments may be present, and the worm varies from 10 to 
25 feet in length. Man is the definite host and cattle the intermediate host. 
Infection is brought about by eating insufficiently cooked beef; (2) Tcenia 
solium. This is the so-called pork tapeworm and is not as common as the beef 
tapeworm. Its head shows, in addition to suckers, a rostellum crowned by 
hooklets, for this reason often being called the armed tapeworm. The seg- 
ments have a uterus showing only 5 to 10 branches. Man is the definite host 
and the hog the intermediate host. Infection is contracted by eating in- 
Fig. 3 84.—Adult and larval stages of cestoda of man. (Stitt.) 
sufficiently cooked pork; and (3) Hymenolepis nana. This is one of the 
most common tapeworms and is called the dwarf tapeworm on account of 
its small size. It reaches only a quarter to a half inch in length. Its head 
has four segments, and a rostellum, with a single row of hooklets encircling 
it. There are about 150 to 200 segments. The genital pores are lateral and 
all on the same side. Man acts as both the definite and intermediate host. 
As many as a thousand worms may be present at one time. Infection is 
caused by swallowing the eggs. 
The diagnosis of these worms is made by finding their segments or their 
eggs in the stools. (Fig. 184.) 
Nemathelminthes. 
These worms are known as roundworms on account of being tubular or 
filiform in shape. They are not segmented and are covered by a cuticle or 
skin, which is frequently ringed. An alimentary canal is usually present and ANIMAL PARASITES OP MAN. 
515 
Complete. The sexes as a rule are separate. The male usually can be recog- 
nized by its smaller size, its curved posterior end, and at times exhibiting an 
umbrellalike expansion called the copulatory bursa. The most common round- 
worms are: (1) Ascaris lumbricoides, the round or eel worm. This is prob- 
ably the most common parasite of man, especially children. They average 
about 6 inches in length and are grayish to reddish in color. An intermediate 
host is not required. Infection takes place through food or drink or by fingers 
of children who have been playing where soil pollution exists. The adults live 
in the intestines; 2. Hookworms. (Fig. 185.) These round worms are of con- 
Fig. 185.—la, Copulatory bursa of Necator americanus, showing the deep cleft dividing 
the branches of the dorsal ray and the bipartite tips of the brandies; also showing the 
fusion of the spicules to terminate in a single barb. Scale 1/10 mm. lb, Branches of 
dorsal ray magnified. 2a, The buccal capsule of N. americanus. 2b, The same 
magnified. 3a, Cop. bursa of Ancylostoma duodenale, showing shallow clefts be- 
tween branches of the dorsal ray and the tridigitate terminations. Spicules hair- 
like. 3b, The dorsal ray magnified. 4a, The buccal capsule of A. duodenale, 
showing the much larger mouth opening and the prominent hooklike ventral teeth. 4b, 
The same magnified. 5a, Egg of N. americanus. 5b, Egg of A. duodenale* 6a, Rhab- 
ditiform larva of Strongyloides as seen in fresh faeces. 6b, Rhabditiform larva of 
hookworm in faeces 8 to 12 hours after passage of stool. (Stitt.) 
siderable importance from a medical standpoint. Human infection comes almost 
entirely from two types of hookworms, Ancylostoma duodenale, the Old World 
species, and Necator americanus, which generally is called the New World spe- 
cies. They average about one-half inch in length. The males are distinguished 
from the females by their expanded posterior end. The large open mouth of 
the Old World hookworm has four clasp-like teeth on the ventral side and two 
noblike teeth on the dorsal aspect. The New World hookworm has a smaller, 
round mouth, and the ventral teeth are replaced by plates. It also has a promi- 
nent dorsal tooth projecting into the mouth cavity. Man acts as the definitive 
host. An intermediate host is not required. Infection takes place by larva in 
polluted soil penetrating the skin. From here the larva make their way to the 516 
HOSPITAL CORPS HANDBOOK. 
intestines, where they develop into adults; (3) Trichuris trichiura. This 
usually is called the whipworm on account of the thickened body resembling the 
handle and the narrow neck the lash. It is one of the most common parasites 
in both temperate and tropical climates. They average about 2 inches in length. 
It does not require an intermediate host. 
The diagnosis of these three round worms is made by finding the adults 
or their ova in the stools. (Fig. 186.) (4) Oxyuris vermicularis. This para- 
site commonly is known as the pin or seat worm and is more frequent in 
children than in adults. The male is about one-sixteenth of an inch and the 
female about one-half inch in length. The male has an incurved tail with 
a single spicule, and the female a long tapering tail. The female, loaded 
with eggs, wanders out of the rectum, and as the result of scratching the 
Fig. 186.—Nematode ova. (Stitt.) 
fingers become contaminated with the eggs, which may be carried to the 
mouth and cause a fresh infection. Thus an intermediate host is not required. 
Diagnosis usually is made by examining the stools for the white, threadlike 
females which usually are expelled after a purgative; (5) Trichinella spiralis. 
The cause of trichinosis. The adults live in the intestines and are about one- 
sixteentli of an inch in length. The female does not lay eggs, but gives off 
larvae directly. These larvae wander to the muscles of the body. Man acts as 
the definitive host and hogs as the intermediate host. Infection is contracted 
by eating insufficiently cooked pork. Diagnosis is made in the first five days 
of the disease by finding the adults in the stools, after that time by finding the 
larvae in the blood or muscles; (6) Filaria bancrofti. This is the most im- 
portant of filarial worms and causes an infection common in tropical coun- 
tries. The adult worms live in the lymphatics and ai*e about 2 inches in 
length. The female normally does not lay eggs, but gives off larvae, which ANIMAL PARASITES OF MAN. 
517 
enter the blood stream. Characteristic of this parasite is the appearance of 
the larvae in the blood stream only when the patient sleeps. Man is the 
definitive host, and the mosquito, especially the Culex quinquefasciatus, the 
intermediate host. It takes about three weeks for the larvae to develop properly 
in the mosquito before tliey can infect 
another man. Diagnosis is made by the 
presence of the larvae in the blood stream. 
Arthropoda. 
The other branch of animals with 
which we are particularly concerned is 
known as the arthropoda, and of these, 
from a medical standpoint, we are inter- 
ested in two classes only, the arachnoids 
and the insects. 
Arachnoids.—This class includes the 
mites and ticks, which differ from the 
insects in having a head and thorax fused together and possessing four pairs 
of legs instead of three. A common parasite belonging to this group is the 
Sarcoptes scabei, the human itch mite. This minute whitish mite causes a 
skin disease known as scabies. The disease is brought about by the female 
Fig. 187.—Ticks: 1, Ornithodoros mou- 
bata; 2, Dermacentor andersoni. 
(Stitt.) 
Fig. 188.-—Life cycle of the Anopheles, Culex, and Aedes mosquitoes. (Stitt.) 
mite burrowing into the skin, where eggs are laid, from which come young 
mites that are to spread the infection. Diagnosis is made by examining skin 
scrapings under the microscope for the presence of the mites or their eggs. 
The tick family of arachnoids is of great and increasing importance medi- 
cally. It is of interest that it was with the tick transmission of a disease of 
cattle in Texas that the zoological principle of transmission of diseases by 518 
HOSPITAL CORPS HANDBOOK. 
means of arthropod hosts was established. Ticks are much larger than miteS, 
readily being seen by the unaided eye. They are wholly parasitic in their 
habits. Some of them live on their host practically all their lives, dropping 
to the ground to deposit their eggs. Among the ticks of importance are 
(Fig. 187) : (1) Ornithodoros moubata. This tick has a hard, rough skin, and 
on looking down on its back the head can not be seen. It lives in the huts of 
Fig. 189.—Anatomy of mosquito: 1, Cross section, of proboscis; 2, anatomy of mos- 
quito, longitudinal section ; 3, tip of proboscis: a, labrum epipharynx; b, hypopharynx; 
c, mandible ; d, maxilla. (Stitt.) 
the natives of Africa and has habits very similar to the bedbug, feeding at 
night and hiding during the day. It transmits a protozoan, Borrelia duttoni, 
which causes South African tick fever; (2) Dermacentor andersoni. A tick 
found in the western part of the United States. It can be roughly distin- 
guished from the 0. moubata on account of its smooth skin and the head 
parts projecting beyond its body out- 
line. It transmits the spotted fever of 
the Rocky Mountains. 
Insecto.—In this class we have the 
mosquitoes, flies, fleas, lice, and bed- 
bugs. These parasites have three well- 
marked divisions of body—head, tho- 
rax, and abdomen; three pairs of legs 
and one pair of antennae. 
The Culicidce or mosquitoes are of the greatest importance medically, not only 
from their influence upon health in general by reason of interference with 
sleep and possibly from direct transmission of disease but, more specifically, 
they are the only means by which it at present appears possible to bring about 
infection with such diseases as malaria, yellow fever, filariasis, and possibly 
dengue. In the life history of mosquitoes (Fig. 188) the female lays eggs in 
water or in places where water is apt to collect, otherwise they will not hatch. 
In from one to four days a larva or wriggler emerges and comes to the sur- 
face to breathe. These larvae are of two types—the siphonate and the asipho- 
Fig. 190.—Resting positions of Anopheles 
and Culex mosquitoes. (Stitt.) 
Anopheles. 
Culex. ANIMAL PARASITES OF MAN. 
519 
nate. The siphonate are so called on account of having a breathing tube pro- 
jecting from the tail end of the abdomen. When seen at rest this tube pro- 
jects above the surface of the water and the head end of the larva hangs 
down at an angle. The larva of the mosquito that transmits fllaria (Culex) 
has a long, narrow siphon, and the larva of the 
yellow-fever mosquito (Aedes) has a short, barrel- 
shaped siphon. The asiphonate do not have this 
tube, but possess breathing slits and at rest float 
parallel to the surface of the water. This is the larva 
of the mosquito that transmits malaria (Anophe- 
les). This larva has another characteristic 
feature, namely, fan-shaped hairs on each side of its 
abdominal segments, called palmate hairs. After 
about a period of a week the larva enters a non- 
growing, nonfeeding stage called the pupa, or nymph, 
from which in about three days the adult mosqudo 
releases itself and flies away. 
It is desirable that the anatomical characteristics 
of mosquitoes be known to those who may have to 
examine them. (Fig. 189.) In examining an adult 
mosquito we note that there are three divisions of 
the body—head, thorax, and abdomen. The head 
shows a stout projection, called the proboscis, which 
contains the biting parts. In mosquitoes of medical 
interest this proboscis is long and straight. In 
males the biting parts are not strong enough to 
pierce the human skin; thus it is known that only the female bites. On each 
side of the proboscis are the palps, or sensory organs, and to the outer side of 
these are the antennae, or feelers. The male mosquitoes can be distinguished by 
the heavily feathered antennae. The thorax supports the three pairs of legs and 
one pair of wings. The wings have a 
characteristic arrangement of the veins 
and show scales. Mosquito-like insects 
do not have scales on their wings. The 
abdomen has nine segments, and on the 
last segment of the male are claspers. 
While there are about a dozen varie- 
ties or genera of mosquitoes, we are 
mainly interested, from a medical stand- 
point, in but three of these genera, the 
Anopheles, the malaria mosquito, the 
Aedes, the yellow-fever mosquito, and 
the Culex, the fllaria mosquito. To defi- 
nitely differentiate these mosquitoes it 
is necessary to use elaborate keys and 
tables. But to tell whether a mosquito 
is a probable malaria or yellow-fever 
transmitter is a comparatively easy mat- 
ter. The first step is to obtain a female, remembering that the antenna* of the 
female are sparsely and not heavily feathered, as in the case of the male. The 
males also show claspers on tail end of abdomen. Having secured a female, 
note the length of the palps. (Fig. 191.) If they are as long as the proboscis 
and clubbed and the wings of the mosquito are spotted, it is an Anopheles. 
If the palps are not as long as the proboscis and it is a small, black mosquito 
Fig. 191.—Mosquito heads 
showing heavily feathered 
male antenna and the 
long palps of the An- 
opheles female and the 
short palps of the Culex 
female. (Stitt.) 
Fig. 192.—Types of fleas and jigger: 
1 and 2, Male and female Xenopsylla 
cheopsis ; 3, head of Ceratophyllus: 
4 and 5, male and egg-distended 
female of Sarcopsylla penetrans. 
(Stitt.) 520 
HOSPITAL CORPS HANDBOOK. 
with silver or white markings on the back of its thorax, it is an Aedes. A 
mosquito with short palps, without these markings, is probably a Culex. 
The Pulicidce or fleas have come into prominence on account of their im- 
portance in connection with the spread of plague. In this case the transmis- 
sion of the disease is mechanical, that is, by biting and depositing faecal mat- 
ter containing the bacillus in the wound. The bacillus causing the disease is 
merely carried without change in the flea host. This is in contrast to what is 
known as a biological transmission such as we have in the case of malaria 
and yellow fever where the protozoan that causes these diseases undergoes 
a change in the mosquito host. 
The PedicuMdw or lice are of three varieties. The one living on the head is 
called the Pediculus capitis, the one on the body the Pediculus vestimenti, and 
the one living in the hairy region about the pubis, popularly known as crab- 
louse, the Phthirius pubis. The body 
louse lays it eggs in the seams of the 
underclothing and is important on ac- 
count of transmitting European relaps- 
ing fever and trench fever. 
Flies.—The fly best known is the ordi- 
nary house fly Musca domestica. Its 
mouth parts are fitted for sucking and 
not biting. Its food must be in a liquid 
or semisolid state before it can be 
sucked up into its stomach. If it wishes 
to feed on any solid substance such as 
sugar it first pours out saliva to liquify 
it. Many people think that the house 
fly can bite, but careful examination of 
such a biting fly will usually show it to 
be the stable fly Stomoxys calcitrans. 
Perhaps the most dangerous parts of a 
fly are the pads or pulvilhe on its feet. By means of these it can carry much 
filth frequently containing bacteria which cause typhoid fever and other diseases. 
Another important fly belonging to the same family as the house fly is the 
tsetse fly (Glossina palpalis), which transmits the T. gambiense, the cause of 
African sleeping sickness. Some flies like the flesh fly (Sarcophaga carnaria) 
can cause considerable discomfort by laying their eggs in wounds or cavities 
like the nose, ear, etc., their eggs developing into larvae or maggots. 
POISONOUS SNAKES. 
The families of the class Reptilia■ to which poisonous snakes belong are the 
colubrine family (Colubridce) and the viperine family (Viperidce). 
The Colubrine family includes the Florida coral snakes, sea-snakes, and 
cobras, the Florida and sonoran coral snakes being the only poisonous mem- 
bers of this family in the United States. The Viperine family, however, has 
among its members the most important poisonous snakes in America, namely, 
the “pit vipers” (rattlesnake, copperhead, and water moccasin). 
The poisonous snakes of the United States can be distinguished by the 
pupil of the eye. 
Fig. 193.—Types of lice: 1, Pediculus 
capitis; 2, Pediculus vestimenti; 2a, 
protruded rostum of Pediculus; 3, 
Phthirius pubis; 4, Acanthia lectu- 
laria; 5, Acanthia rotundata; 6, Con- 
orhinus megistus. (Stitt.) 
Pit present; single row of ventral scales, postanal; adult' 
head more or less triangular and a prominent constric- 
tion behind head. 
(A) Vertical 
■Pit vipers (all poisonous). 
!B) Circular. 
Pit absent; double row of ventral scales, postanal; and—) 
(1) Color: Yellow, black, yellow, red, in bands J 
(2) Color: Black, yellow, black, red, in bands False corals (not poisonous). 
(3) Color: All others Not poisonous. 
[•Coral snakes (poisonous). HOSPITAL CORPS HANDBOOK. 
521 
Urinalysis and Blood Chemistryn 
Two of the most important branches of medical science are blood chemistry 
and urinalysis. Knowledge of these subjects and the results obtained by ac- 
curate procedures in regard to technique, observation, and the recording of 
findings are of inestimable value in making diagnosis and indicating treat- 
ments of various diseases. 
Hospital corpsmen assigned to duty in the clinical laboratory should bear 
in mind the necessity of careful and accurate technique in making notes, ob- 
servations, and preparing records. Carelessness or errors may result in in- 
correct diagnosis and consequent delay in affording relief to patients. 
The blood bathes all the tissues of the body. Following well-known physical and 
chemical laws it carries food and fuel to the cells and removes the waste 
products. It supplies oxygen and carries away carbon dioxide. Indirectly it 
helps to keep- the body at a nearly constant temperature and by a beautiful 
mechanism, at present very little understood, it regulates the acid-base balance 
of the body. Moderate changes of temperature and comparatively slight changes 
in acidity or alkalinity may cause death. It carries hormones or chemical 
messengers, the product of the glands of internal secretion. Hormones regu- 
late many activities of the organism and may, by their absence or increased 
production, cause disease. F'or example, diabetes mellitus is due to lack of 
a hormone from the pancreas, and toxic goiter is due to increased secretion 
of the thyroid gland. Certain of these hormones as adrenalin and thyroxin 
have been isolated and their chemical structure and physiological action de- 
termined. 
Blood chemistry enables us to measure the amounts of a few of the sub- 
stances in the blood, some of which are present in exceedingly small quan- 
tities. Methods have been developed to determine the presence of certain of 
these substances in concentrations as low as 1 milligram per 100 c. c. of blood. 
The methods can not be described here, but it is sufficient to say that several 
waste products such as urea, creatinine, and uric acid can be determined with 
accuracy. The oxygen-carrying power of the blood can be measured exactly, 
its reaction determined, and other analyses made which indicate probable dan- 
gerous changes in acidity or alkalinity. Some work, mostly experimental, has 
been done on the determination of hormones. This is a fascinating study, 
as yet in its infancy, and it is hoped that within a short time it will be more 
fully developed. 
For analysis blood is collected in the usual manner from a vein in the arm. 
It is necessary in chemical work to prevent clotting of the blood. In order 
that this may be accomplished neutral potassium oxalate in the proportion of 
2 milligrams for each c. c. of blood is placed in the flask in which the blood 
sample is to be collected. For a complete chemical analysis collect about 15 
c. c. A convenient way of adding the proper amount of oxalate is as follows: 
Take a dropping bottle and determine how many drops it delivers to make 1 
c. c. Then make a solution so that each drop represents 2.5 milligrams of 
potassium oxalate. Add 10 drops from the dropper to the fiask to be used 
for collecting the blood. This is sufficient for 10-15 c. c. of blood. For 
example if the dropper delivered 30 drops to the c. c., 1 c. c. would contain 
75 milligrams of potassium oxalate. To make up 100 c. c. weigh out accu- 
rately 7.5 grams of neutral potassium oxalate, transfer to a 100 c. c. measuring 
flask, and fill to the mark with water. For gas analysis collect about 8 c. c. 
under paraffin oil. Take a centrifuge tube, add 7 drops of the neutral potas- 
1 Prepared by Lieut. D. Corey, Medical Corps, United States Navy. 522 
HOSPITAL CORPS HANDBOOK. 
sium oxalate solution and 2 to 3 c. c. of paraffin oil. Allow the blood to flow 
from the needle through a glass tube, the exit of which is beneath the oil. 
With a small stirring rod mix the blood gently with the oxalate solution, avoid- 
ing mixing the blood with the oil. Blood analyses should be done within a few 
hours after collection of the sample. 
Details of the procedures required in conducting blood chemistry examina- 
tions are described fully in the reference books available at any laboratory 
and in those listed at the end of this chapter. 
The urine is an aqueous solution of organic and inorganic substances secreted 
and excreted by the kidneys. The substances are either waste products from 
the body metabolism or are products derived directly from food materials 
taken into the body. Some of the organic constituents are urea, uric acid, and 
ammonia; some of the inorganic—chlorides, phosphates, and sulphates. Cer- 
tain substances appear in the urine only in pathological conditions, as pro- 
teins, sugars, acetone, bile, haemoglobin, etc. The presence of these substances 
can be determined by examination, and the detection of them aids greatly in 
diagnosis and treatment of disease conditions. The urine also contains numer- 
ous microscopic structures. 
The composition of urine varies at different hours of the day, and for this 
reason it is preferable to make quantitative tests upon a sample of the mixed 
24-hour specimen. Qualitative tests for albumin, sugar, etc., may be made 
upon any specimen, not necessarily a 24-hour specimen. A 24-hour specimen 
of urine should be collected in a clean container and kept cool, preferably on 
ice, until examined. Decomposition of the urine thus is retarded or prevented. 
Occasionally 5 grams of boric acid to each 4 ounces of urine, or 1 drop of 
formalin to each 4 ounces, are used as preservatives. Larger amounts of pre- 
servatives may interfere with the reactions or cause precipitates. 
Urine for examination should be clear and may be made so by filtering. 
Cloudiness due to the presence of bacteria may be remedied by adding a small 
amount of purified talc to the specimen, thoroughly shaking and filtering. 
The following is suggested as a routine urine examination. 
(1) Measure the amount.—The 24-hour specimen, normally, should be 
from 1,000 to 1,500 c. c., 40 to 50 ounces. This amount depends upon the 
quantity of fluids ingested. 
(2) Note the color.—This varies in health and depends upon the quantity 
voided. The usual color is yellow or reddish-yellow. The presence of blood 
or bile will affect the color. A pale greenish urine suggests diabetes. 
(3) Note the transparency.—Freshly passed urine is usually clear but upon 
standing becomes cloudy. Large quantities of amorphous phosphates, amor- 
phous urates, pus, blood, and bacteria produce sediments or cloudy appear- 
ances. 
(4) Note the odor.—An aromatic odor is due to volatile acids; ammoniacal 
to decomposition; fruity to acetone; and certain characteristic odors are pro- 
duced by asparagus, etc. 
(5) Test for reaction.—Acid urine turns blue litmus paper red, alkaline urine 
turns red litmus paper blue. If the urine is neutral in reaction, no apparent 
change is produced in the litmus papers. Normally urine is acid in reaction 
hut becomes alkaline upon standing. 
(6) Test to determine the specific gravity.—Normally this is 1.010 to 1.020 
A urinometer is the most convenient means of determining the specific gravity 
of urine. A special container is filled with urine and a urinometer placed 
in the container. The urinometer should not touch the sides or bottom of URINALYSIS AND BLOOD CHEMISTRY. 
523 
the container and should be read at the bottom of the meniscus. Diabetes 
causes urine to have a high specific gravity. 
(7) Test for the presence of albimiin.—The presence of albumin in the 
urine may indicate a transitory condition or physiological albuminuria, such 
as may be caused by excessive ingestion of proteins, prolonged cold baths, 
excessive muscular exercise in those unaccustomed to it, and to pregnancy, 
or to albuminuria caused by a pathological condition, as in organic changes 
or disease of the kidney. 
In making a test for the presence of albumin it is essential that the urine 
be made clear either by filtration or by centrifugation. Heat test: Fill a clean 
test tube two-thirds full of clear urine. Hold the bottom of the test tube and 
apply heat to the upper portion of the contained urine until boiling is produced, 
then add 3 to 5 drops of a 5 per cent acetic acid solution and reboil. The 
presence of a cloud after the reboiling indicates albumin. Often a cloudy ap- 
pearance, due to the presence of phosphates or carbonates, appears when the 
urine is first heated to boiling; this, however, disappears when acetic acid is 
added. Comparison between a sample of the urine and that resulting after the 
complete test has been made will help to show the degree of cloudiness. 
Roughly speaking, albumin may be reported to be present as a slight trace 
when the cloudiness is barely visible; as a trace when a distinct cloud is visible, 
and as a heavy trace when a heavier cloud is visible. If albumin is present to 
a marked degree the urine being tested may become solid. The heat test 
depends upon the fact that albumin is coagulated by heating. 
(S) Test for the presence of sugar.—Transitory glycosuria is unimportant 
and frequently occurs after general anesthesia, the administration of certain 
drugs, in pregnancy, and in head injuries. Persistent glycosuria is diagnostic 
of diabetes and is caused by a disturbance in the pancreas or by an injury to 
the floor of the fourth ventricle of the brain. Fehling’s test consists of taking 
equal parts of the two Fehling’s solutions, mixing together, adding 3 or 4 
volumes of water and heating until boiling is produced. When this solution 
reaches the boiling point the urine to be tested should be added a little at a 
time and the solution heated but not boiled between additions. The quantity 
of urine added should not exceed the quantity of the reagent used. A heavy 
red or yellow precipitate indicates the presence of glucose (sugar). Benedict’s 
test: This test is a more sensitive one than Fehling’s test and gradually is 
replacing it. The reaction depends upon the reduction of alkaline copper 
solutions of glucose, forming cuprous oxide and metallic copper. In Benedict’s 
test the alkalinity of the solution and the conditions of the test are so adjusted 
that very small amounts of glucose are detected and other reducing bodies 
present in the urine will not interfere with the reaction. Benedict’s solution 
as described by Todd consists of: 
Copper sulphate (pure crystallized) gm 17.3 
Sodium or potassium citrate gm 173. 0 
Sodium carbonate (crystallized) gm 200.0 
(Or 100 grams of the anhydrous salt.) 
Distilled water, to make c. c— 1, 000. 0 
The citrate and carbonate should be dissolved in 700 c. c. of water, heated 
gently, then filtered. The copper sulphate should be dissolved in 100 c. c. of 
water and poured slowly into the first solution, stirring constantly. The solu- 
tion then should be cooled and made up to one liter. This reagent will keep 
indefinitely. 
47829°—23 34 524 
HOSPITAL CORPS HANDBOOK. 
In making tlie test, take 5 c. c. of Benedict’s reagent in a clear test tube, and 
add 8 or 10 drops (not more) of urine, using a pipette. If convenient, add a 
few glass beads to prevent bumping, heat to boiling and retain at that tem- 
perature for two minutes, then allow to cool slowly. If glucose is present a 
red, yellow, or green precipitate will be produced. Bluish precipitates, which 
sometimes result upon cooling, are due to the presence of urates and should be 
disregarded. 
(0) Examine the specimen of urine microscopically.—Centrifuge a portion of 
the specimen and remove the sediment by means of a pipette. This is accom- 
plished by inserting a clean pipette (the large end of which is closed by placing 
over it a dry finger tip) into the container down to and into the sediment. 
By carefully loosening the finger tip but not entirely removing it, a small por- 
tion of the sediment will be collected in the pipette. Replace the finger tip, 
remove the pipette and after wiping off the urine which adheres to the tube, 
allow the sediment to collect on a clean glass slide by carefully loosening the 
finger tip. The sediment then may be examined microscopically either uncov- 
ered or covered with a cover glass. In acid urine may be found: Uric acid 
crystals, amorphous urate deposits, calcium oxalate crystals, leucin, tyrosin, 
and cystin crystals, and fat globules; in alkaline urine : Amorphous phosphates, 
calcium carbonate deposits, and ammonium urate crystals. 
The following organized structures may be found in urinary sediments: 
Tube casts, epithelial cells, bacteria, red and white blood cells, spermatozoa, and 
animal parasites. Details regarding the microscopical examination of urine 
are contained in the reference books enumerated at the end of this chapter. 
If albumin or sugar are found to be present in the urine, the amounts should 
be determined quantitatively, as should also the amounts of urea, uric acid, 
creatinine, etc. These advanced laboratory procedures are described fully in 
the reference books available in any laboratory and in the books listed below. 
References. 
Practical Bacteriology, Bloodwork and Parasitology (seventh edition).—E, R. Stitt. 
Laboratory Manual of Biological Chemistry (third edition).—O. Folin. 
Practical Chemical Analysis of Blood.—V. L. Myers. 
Physiological Chemistry (third edition).—A. P. Mathews. 
Diagnostic Methods—Chemical, Bacteriological, and Microscopical (sixth edition).—R. W. 
Webster. 
Clinical Diagnosis.—J. C. Todd. CHAPTER XI. 
SPECIAL ACTIVITIES AND INFORMATION. 
Duty Independent of Medical Officers.1 
To carry out the duties with which it is charged in articles 457 and 458, 
Navy Regulations, the Bureau of Medicine and Surgery has trained chief 
pharmacist’s mates and pharmacist’s mates, first class, for duty as the repre- 
sentatives of the medical department on board vessels having crews up to 125 
men, and at shore stations where the total personnel is not sufficient to warrant 
the assignment of a medical officer. 
The vessels to which independent duty hospital corpsmen usually are 
assigned are destroyers, mine layers, mine sweepers, tugs, oilers, colliers, and 
cargo ships; the stations on shore are isolated radio stations, small detach- 
ments of marines on outpost duty, etc. 
Chief pharmacist’s mates or pharmacist’s mates, first class, are not offered 
as substitutes for qualified medical officers, but rather as first-aid men who 
are capable of relieving the commanding officer of most, if not all, of the de- 
tailed management of the sick and injured. 
Owing to the large demand and the length of time required to train men 
properly for this duty, difficulty is experienced in providing a sufficient num- 
ber of hospital corpsmen qualified for duty independent of a medical officer. 
Every endeavor is made to establish and maintain a high standard of efficiency 
in these ratings, and only such men as are thoroughly trained and who have 
demonstrated their qualifications by written and practical examinations are 
recommended for advancement to these ratings. In view of these facts, the 
Bureau of Medicine and Surgery feels that the commanding officers of vessels 
and shore stations to which no medical officer is attached, whose experience, 
general education, judgment, and mental training especially fit them for the 
assumption of responsibility in emergencies, ordinarily may rely on these men 
for valuable and trained assistance in first-aid work when more skilled medical 
services can not be secured. 
Hospital corpsmen assigned to duty independent of a medical officer and 
where medical officers are not available are cautioned to bear in mind the 
fact that the commanding officer of the ship or station is directly responsible 
for the proper care and dispostion of the sick and injured. It is a paramount 
duty of a hospital corpsman so situated to make such recommendations to 
the commanding officer regarding the care and disposition of the sick and in- 
jured as seem advisable. These recommendations should embrace such 
points as obtaining the services of a medical officer or qualified medical 
practitioner, temporary assistance of other members of the crew, and the 
question of transferring patients to places or institutions where they may re- 
ceive treatment which is necessary but impossible to administer at their 
present stations. 
1 Prepared by Chief Pharmacist N. L. Saunders, United States Navy. 526 
HOSPITAL COKPS HANDBOOK. 
Second only to the care of those actually sick or injured is the responsibility 
of independent-duty hospital corpsmen with regard to the application of 
hygienic and sanitary measures. A daily inspection of the ship or station is 
necessary to accomplish this, and should not be made until after all cleaning 
stations have been policed. 
In making this daily inspection particular attention should be given to 
places where dirt can accumulate, such as corners, angle-irons, mess gear, 
mess and clothes lockers, fans, ventilators, blowers, ice boxes, vegetable lock- 
ers, wash bowls, urinals, drains, scuppers, and gratings—in fact, any place 
where an effort must be made to attain cleanliness. The condition of the 
cooking utensils, pots and pans, the galley range and the deck beneath it 
should be observed; the bottoms of mess tables and bunks, especially the 
hunk frames, should be inspected; in storerooms the stowage of unauthorized 
articles, such as wash buckets, swabs, dirty or wet clothes, should not be 
permitted, and one should be sure that the bilges of storerooms aboard ship 
are dry and clean. Ashore, in addition to the above, care must be exercised 
in the disposal of waste and garbage, the accumulation of stagnant water, 
drainage, protection of water containers, removal of undergrowth, manure, 
leaves, etc., cutting weeds and long grass, and the methods used in the disposal 
of human excreta. 
In short, it is most important that the hospital corpsman on independent 
duty constantly be on the alert to observe anything and everything that in any 
way might be detrimental to the health and welfare of those with whom he 
is serving and who depend upon him for protection against disease. Dirt, 
tilth, grease, and decayed or decaying matter are dangerous to health; all 
can be removed by the use of water, soap, kerosene, and “ elbow grease ”; and 
all can be prevented by careful observation and frequent inspection. 
In the absence of medical officers it devolves upon the hospital corpsmen 
representing the medical department to inspect the food prepared for the crew, 
as to wholesomeness and cleanliness, the fruit and other articles of food and 
drink offered for sale by boats alongside, and all fresh provisions purchased 
for the general mess. After such inspections a report should be made to the 
proper officer as to the conditions found, with such recommendations as are 
considered necessary. There should be no hesitancy in recommending rejec- 
tion or refusal of permission to sell if the inspection shows them to be unsatis- 
factory. Instructions governing such inspections are contained in articles 
868(4), 1156, 1157, 1158, 1159, 1320, and 1324, Navy Regulations. 
On duty independent of a medical officer hospital corpsmen primarily are 
expected to: 
(a) Care for the ordinary ailments of the crew of the vessel or station to 
which they are attached. 
(&) Administer first aid to any serious case that may occur. 
(c) Maintain a sanitary supervision of the vessel or station, and make suit- 
able recommendations to the commanding officer. 
(d) Maintain a proper amount of medical supplies to meet ordinary condi- 
tions. 
(e) Prepare for forwarding the necessary forms of the P>ureau of Medicine 
and Surgery and keep the required medical records. 
(f) Investigate the health conditions in ports visited or in adjacent cities 
and make a report to the commanding officer with such recommendations 
as may be deemed pertinent. 
Whenever contact with medical officers is possible, independent duty hos- 
pital corpsmen should visit them for council and advice. Frequent consulta- DUTY INDEPENDENT OF MEDICAL OFFICERS. 
527 
tion with the commanding officer is desirable. They should inform the com- 
manding officer of any suspected contagious or infectious disease that may 
appear, and inform him promptly when a patient is in need of the services 
of a doctor. Hospital corpsmen on independent duty are expected at all 
times to be ready to exert themselves to the utmost to assist any person 
on board in need of assistance by reason of illness or injury, and, so far as 
may be practicable, to segregate in the sick bay or other designated place 
any member of the crew who is on the sick list. They are expected to 
calmly, quietly, and efficiently aid the commanding officer in the maintenance 
of the morale of the crew in the presence of disease or injury on board. 
In so far as is practicable the Bureau of Medicine and Surgery does not 
recommend any hospital corpsman below the rating of pharmacist’s mate, first 
class, for duty independent of a medical officer. 
In adopting this policy assurance is felt that only experienced and well- 
qualified hospital corpsmen will be placed in positions where it is necessary 
for them to assume responsibility for the care and treatment of the sick and 
injured in the absence of a medical officer. 
Because of the training, instruction, and experience of men in the Hospital 
Corps, especially in the upper ratings, the Bureau of Medicine and Surgery 
believes that many times life or limb may be saved that might, without their 
intelligent first-aid care, he jeopardized. 
While all men assigned to this important duty probably do not feel the 
responsibility of their position in the same manner, the experience of many 
years in dealing with the problem of providing medical care and attention for 
small numbers of men causes the Bureau of Medicine and Surgery to be satis- 
fied that in nearly every instance they will measure up to the high standard 
long required of the hospital corpsman assigned to duty as the sole representa- 
tive of the medical department. 
Practically every small station or vessel in the Navy is attached to or comes 
under the administration of some unit to which medical officers are assigned, 
either as district medical officers or fleet or squadron medical officers. Hos- 
pital corpsmen assigned to these stations should familiarize themselves with 
the local arrangements and act accordingly. 
For hospital corpsmen detailed to duty independent of a medical officer 
the following points should be observed: 
(1) If practicable, upon reporting for duty, communicate immediately with 
the medical officer having supervision of the medical department of the vessel or 
station. 
(2) Accurately check the inventory of medical department property (if pos- 
sible with the man being relieved) and report any discrepancies to the com- 
manding officer and the medical officer. Do not accomplish a transfer of prop- 
erty unless prepared to assume responsibility for the property reported on the 
inventory. 
(3) Hold sick call daily at some convenient hour in the morning, not 
later than 9 a. m., unless other arrangements have been made by the com- 
manding officer. At this time all members of the crew who are ill or inca- 
pacitated should report or should be visited. 
(4) Examine all health records and make accurate check as to whether or 
not the members of the crew have been vaccinated against smallpox and 
typhoid fever, and vaccinate immediately any who may require it. 
(5) Check health records against the muster roll and assure yourself that 
they are complete and correct. If errors or omissions are found, correct them 528 
HOSPITAL CORPS HANDBOOK. 
at once. If any health records are missing immediate steps should be taken 
to obtain them or open new ones. 
(6) Make daily entries in medical journal of matters concerning the medical 
department; prepare and forward reports and returns as required. 
INDEPENDENT DUTY AFLOAT. 
At sick call all cases of minor nature should be attended to. Cases requiring 
the attention of a medical officer should be handled as circumstances permit. 
All cases of injury or illness should be reported to the commanding officer. 
Emergency cases should be given first aid, and if serious any medical officer 
present should be notified at once. 
Except in emergency cases that require immediate attention, the advice and 
services of a medical officer should he procured before transferring a patient 
to a hospital, and if possible the hospital corpsman should accompany patients 
to the hospital. 
When men are brought or sent to a medical officer for physical examination 
prior to discharge, transfer, etc., all the necessary papers should he complete 
and ready for the signature of the medical officer. All these routine examina- 
tions should be taken care of during the morning hours and should not be per- 
mitted to straggle in to the medical officer at all hours of the day. 
A medical journal must be kept on each vessel to which a hospital corpsman 
is assigned for duty. It is suggested that this he kept in a blank book, small 
quarto, both for convenience and economy. This journal always should be 
ready for inspection and should be kept in accordance with the Manual for the 
Medical Department. 
The care of medical department property is of prime importance. Hospital 
corpsmen should keep medical stores in a neat and orderly manner and see that 
stock records are accurate and correspond with the stores. Special attention 
must be given to the proper safeguarding of poisons, narcotics, and alcohol. 
When absent the keys should be turned over to a commissioned officer. 
Any stores considered to be in excess or not liable to he used or likely to 
deteriorate may be transferred to some other medical department activity and 
Form D (Transfer of Property) made out. No unnecessary stores should be 
requisitioned for or kept on hand. The stock should be kept as low as con- 
sistent with the nature of the duty being performed. 
Damaged stores should not be destroyed or transferred but should be sur- 
veyed on board the vessel, the request for survey being made at such time as it 
is likely a board of survey can he appointed. 
Before a hospital corpsman is discharged or transferred either temporarily 
or permanently from his vessel, he should make an inventory of medical de- 
partment stores and prepare Form D (Transfer of Property), which should be 
signed by his relief. If not relieved by a hospital corpsman, the commanding 
officer should sign Form D. (See par. 3133, Manual of the Medical Depart- 
ment.) His own transfer cards should be prepared and the data necessary for 
the preparation of bureau forms should be left where they will he available for 
the successor. 
No patient should be transferred to a hospital (except in emergency) 
without first having been seen and examined by a medical officer. Hospital 
tickets and health records ordinarily should be signed by the medical officer 
making the transfer. Hospital corpsmen on independent duty when within reach 
of a medical officer are not expected to make routine transfers of patients to 
hospitals. When patients are transferred to a hospital, they should be ac- 
companied by all necessary papers, including transfer pay accounts and service DUTY INDEPENDENT OF MEDICAL OFFICERS. 
529 
records, and personal baggage. A letter requesting a man’s return to a vessel 
when ready for duty should be sent to the hospital at the time of transfer, if his 
return is desired by the commanding officer. 
Emergency or contagious cases may be transferred to a hospital at any time 
regardless of the preceding statements, which apply mainly to ordinary cases. 
Patients requiring treatments or examinations in hospitals, such as refrac- 
tion, blood tests, X-ray, etc., should be sent to the hospital only on such days 
as are set apart for these examinations. 
Medical department reports and returns are to be prepared and signed by 
the hospital corpsman on independent duty and forwarded through official 
channels. All reports should be made promptly and not left until the last. 
Monthly reports should be made out as soon as possible after the end of the 
month, and others as directed. Care must be taken to see that copies as 
required by fleet and other regulations are sent out. 
Correctness, neatness, and promptness are essentials in preparing reports. 
A slight amount of care and thought expended on these forms saves considera- 
ble labor if the report goes through without having to be returned for correc- 
tion. No efficient and painstaking hospital corpsman ever should have to have 
his forms corrected. 
Care should be exercised to see that— 
(a) On requisition Form 4, on surveys, on inventories, and on transfers of 
property the items listed appear under their respective classification headings 
as given in the Supply Table. 
(&) On Form Ca (surveys) the quantities must be shown in numerals and 
not merely marked “ X.” In the case of items listed as “ missing ” a signed 
footnote as to the responsibility for the loss should appear on the face of the 
report. When items are missing from a pocket case, venereal case, or 
other composite article the individual items from these cases must be listed 
instead of the complete unit. 
Example: 
Case, pocket; items from— 
1. Bistoury, straight No. 1 
2. Scissors, straight No. 1 
3. Tenotome No. 1 
(c) On Form F (rough) and Form F (smooth) the diagnosis always should 
be precisely as given in the nomenclature of diseases. That pamphlet or the 
Manual of the Medical Department should be consulted freely so as to get 
the exact arrangement of words and correct spelling, the key letter, diagnosis 
number, etc. “ Undetermined ” never must be used without the wTord “ diag- 
nosis.” When the entry is for an injury, do not forget to enter the location, 
causative agent and key letter, and the specialty letter when it is required. 
(d) On Form K, or Form F revised, be sure that the ‘‘Taken up” column 
corresponds with the “ Disposition ” column, also that the number of cases 
corresponds with the number reported on Form F. 
When supplies are needed they usually may be obtained from any vessel 
near, a naval hospital, or a naval dispensary upon request, but regular sub- 
mission of requisitions for supplies on the medical supply depot should be 
made. 
The foregoing information has been general and is for the use of all hospital 
corpsmen on independent duty. That which follows is applicable more espe- 
cially to hospital corpsmen serving on destroyers and outlines the general rou- 
tine and instructions to be expected in destroyer squadrons. It is based upon 530 
HOSPITAL CORPS HANDBOOK. 
the system of organization used in the destroyer squadrons operating in Atlantic 
waters as developed by the destroyer squadrons’ medical officer in 1921. 
The destroyer squadrons’ medical officer is the medical aid to tiie destroyer 
squadrons’ commander, and has direct supervision of all medical department 
activities in the destroyer squadrons. He is assigned quarters and has his office 
on board the flagship of the destroyer squadrons. 
In addition to duties similar to those of a fleet surgeon, as described in the 
Manual of the Medical Department, he supervises the assignment of medical 
officers and hospital corpsmen, making recommendations to the personnel 
officer on the staff of the commander. 
He prepares for the signature of the chief of staff a monthly schedule of ves- 
sels having medical guard duty and makes changes in this schedule when the 
necessity arises. He prepares a weekly prophylactic duty schedule for chief 
pharmacist’s mates and pharmacist’s mates, first class, on independent duty, 
and monthly for tenders and the flagship for hospital corpsmen of lower ratings. 
He supervises requests from destroyers for medical stores that are to be 
supplied from tenders. 
At any time he may make unofficial inspections of vessels in company with 
the squadron medical officer. 
A chief pharmacist usually is assigned as his assistant when all divisions 
of the destroyer squadrons are in active commission. 
Squadron medical officers.—A medical officer is assigned to each squadron 
of the 50 per cent complement vessels, and for each division of the operative 
squadron. 
The squadron commander may order the squadron medical officer to report to 
any vessel within the squadron for the assignment of quarters. Usually he is 
quartered on board the squadron flag boat. 
The best conception of the duties of the squadron medical officer is to consider 
the squadron as a unit and each vessel as an integral part of that unit. His 
activities must not in any way be confined to the vessel on which he is quartered. 
He has charge of the medical department personnel within the squadron as well 
as the usual matters pertaining to health and sanitation as defined in the 
Navy Regulations and manuals. He receives orders from the squadron com- 
mander and makes his recommendations to him. He may make recommen- 
dations also to the commanding officers of destroyers. 
His relation to destroyer officers corresponds to that of a medical officer and 
division officers on board a larger vessel. A courteous and harmonious rela- 
tionship should be maintained with commanding officers and other destroyer 
officers and no occasion should be given for assumption or usurpation of author- 
ity rightfully belonging elsewhere. No visit of an unofficial nature should be 
made to a vessel, except to visit the sick, without reporting to the commanding 
officer of the vessel upon arrival on board. 
The squadron medical officer holds daily sick call on board the vessel on 
which he is quartered, at a convenient hour in the morning but not later than 
9 o’clock. The hour for sick call should be published to the squadron and 
strictly adhered to. Patients from all vessels in the squadron requiring atten- 
tion and not too ill to bear the transportation should report to the medical 
officer at this time. Health records should accompany patients. After the 
regular sick call the medical officer visits all nonambulant sick. Nonambulant 
patients should not be kept aboard destroyers but should be sent to a tender 
for treatment or transferred to a hospital. 
The squadron medical officer should make frequent (unofficial) sanitary 
inspections of the destroyers and assure himself that vessels are being kept 
up to standard, and invite the attention of the commanding officer of the DUTY INDEPENDENT OF MEDICAL OFFICERS. 
531 
vessel visited to such recommendations as he wishes to make. These recom- 
mendations should be incorporated in his semimonthly report of sanitary 
conditions to the squadron commander. On these inspections especial attention 
should be paid to the sick bay and medical storeroom, assuring himself that 
stock records are being kept, that economy is being used in the issue of 
stores, that stores are properly stowed and that means are taken for their 
security in the absence of the hospital corpsman. He should see that narcotics, 
alcohol, and poisons are under lock and key or otherwise properly safeguarded, 
and that health records and other records are being properly written up, are 
complete and filed in a safe place in a careful manner. 
He should personally see that all personnel have been safeguarded against 
smallpox and typhoid fever and that appropriate entries have been made in 
their health records. 
He should make arrangements to carry out monthly venereal inspections in 
which the hospital corpsmen should assist. 
The squadron medical officer through the squadron commander has authority 
to move or transfer hospital corpsmen within the squadron. All hospital 
corpsmen originally assigned to duty in a squadron by the destroyer squadrons’ 
commander are ordered to report to the squadron commander for such duty 
as he may assign or for some particular duty. Further changes within the 
squadron are made by the squadron commander. 
When the vessel to which the squadron medical officer or a hospital corps- 
man is attached is to lay up or be absent from squadron for a long or in- 
definite period he should request the squadron commander for change of duty 
to an active boat so that his services will not be lost to the squadron. 
When a squadron medical officer goes on and returns from leave he should 
inform the destroyer squadrons’ medical officer by memorandum so that details 
to boards, medical guard, and other duties will not be interfered with. 
Hospital corpsmen of the ratings of chief pharmacist’s mate and pharmacist’s 
mate, first class (see Bureau of Navigation Manual, Arts. D-6162-63-64), 
usually are assigned to independent duty on board a destroyer. In addition 
to his duties on board the vessel to which he is attached, when several 
destroyers are tied up to one buoy, a hospital corpsman may be the medical 
department representative on board the other destroyers at his buoy, and as 
such should hold himself responsible for medical department reports and returns 
from these vessels and for the upkeep of storerooms! and other medical depart- 
ment activities, just as if it were the vessel to which he is attached. If more 
than one hospital corpsman is at a buoy, this additional duty is assigned by 
the squadron medical officer. 
Under the direction of the squadron medical officer, an examination of the 
crew of the vessel for communicable and venereal disease should be made 
at least once each month. A daily sanitary inspection of vessels and report of 
findings to the respective commanding officers concerned should be made. These 
inspections may be supplemented by making a memorandum report on sani- 
tary conditions to the squadron medical officer, either verbally or written. If 
written, it should be forwarded via the commanding officer. 
The squadron medical officer is the proper officer to handle all cases of illness 
and all physical examinations of the men in the squadron. No men should 
he sent to tenders for these purposes except on recommendation of the squadron 
medical officer and then only for such examination as is beyond his scope on 
board destroyers. 532 
HOSPITAL CORPS HANDBOOK. 
In the absence of the squadron medical ollicer, the guard medical officer acts. 
In an emergency, any medical officer may he called, or any man manifestly in 
need of emergency medical assistance may be sent to the tenders. 
In any event, medical assistance will not be refused by any medical officer. 
Reports and returns from vessels to which no hospital corpsman is attached 
should be prepared by the hospital corpsman at the same buoy or by a hospital 
corpsman designated by the squadron medical officer. 
The letter in lieu of reports should he submitted only when the vessel without 
a hospital corpsman on board is absent from the buoy or base or is not in 
touch with any representative of the medical department. A hospital corpsman 
usually is assigned to repair groups at navy yards and is expected to make all 
routine reports and returns from the vessels in the repair group. 
Reports and returns should he routed through the squadron medical officer, 
who verifies and places his initials near the signature line and forwards them 
to the proper destination. Convenience demands that all papers from a squad- 
ron be sent in at the same time. Corrections should he made by the squadron 
medical officer, returning them to the sender if necessary. During the absence 
of destroyers from the base or in the absence of the squadron medical officer, 
reports may he sent direct from the vessel to destination. 
There usually are unofficial reports required from destroyers and as a rule 
these will be: 
(a) Semimonthly report to squadron commander on sanitary conditions of 
vessels of squadron. This report is intended to show to squadron commanders 
the current sanitary condition of all vessels as viewed on the frequent in- 
spections of the squadron medical officer. In this report the vessels visited 
should be mentioned by name. 
(&) A semimonthly list (1st. and 15th. of month) submitted to the destroyer 
squadrons’ medical officer, showing the distribution and changes in hospital 
corpsmen of the squadron. Each man is listed with full name, rate, ship, and 
buoy to which attached and date of expiration of enlistment. This is in addi- 
tion to the usual transfer cards, which always shall be prepared in accordance 
with paragraph 403, Manual for the Medical Department, immediately in cases 
of arrivals, departures, promotions, discharges, desertions, etc., and forwarded 
to the Bureau of Medicine and Surgery. 
(c) Each day a signal is sent by the squadron medical officer to the vessels 
of the squadron, giving the name of the vessel of the force having the medical 
guard duty. Squadron medical officers also keep the hospital corpsmen of the 
squadron advised regarding medical guard ships. 
Destroyer tenders act as supply ships for the destroyers and make requi- 
sitions on the Naval Medical Supply Depot accordingly. They fill authorized 
requests for medical stores from destroyers. 
As a routine procedure, destroyers make requests on their tenders through 
the squadron medical officer, but if nonexpendable articles are required, through 
the destroyer squadrons’ medical officer. 
The squadron medical officer carefully scrutinizes these requests and elimi- 
nates items or decreases the amounts considered in excess or may disapprove 
the entire request if deemed advisable. 
The tender that will supply the stores requested is designated by the de- 
stroyer squadrons’ medical officer. 
Official requisitions on the Naval Medical Supply Depot should be sub- 
mitted only when the articles desired can not be procured from the tenders 
and should be signed or initialed by the squadron medical officer when present, ship’s LANDING FORCE AND SHORE PATROL. 
533 
and accompanied by a letter signed by him stating that the articles desired are 
not procurable from stores on the tenders. 
SPECIMEN FORMS FOR LETTER REPORTS. 
(Sample letter in lieu of reports.) 
u. s. s 
Place 
Date 
From : Commanding officer. 
To : Chief of the Bureau of Medicine and Surgery. 
Subject: Letter in lieu of medical department reports and returns for month ended 
1. There is no medical officer or hospital corpsman attached to this vessel. 
2. The sick of this vessel were treated during the month on the U. S. S 
(or at the United States naval station, yard, or hospital) at 
3. Complement (number of officers and men on board). Total 
(Signature.) 
(Sample monthly report of communicable diseases.) 
u. s. s 
Place 
Date 
From : Medical officer. 
To : Chief of the Bureau of Medicine and Surgery. 
Via : Commanding officer. 
Subject: Report of communicable diseases and other data for the month ended 
[Only original admissions.] 
1. Class VIII— 
Cerebrospinal fever 1 
Influenza 12 
etc., as they occur or state 
“ None.” 
2. Class IX— 
“ None.” 
3. Class X— 
Malaria 1 
4. Class XI— 
“ None.” 
5. Class XII— 
Chancroid 4 
Gon,. inf. Urethra 2 
Gon. inf. Epid 1 
Syphilis 4 
6. Class XIII— 
“ None.” 
7. Number of admissions (including above) for all diseases 
8. Number of admissions for injuries and poisons. 
9. Total all causes (items 7 plus 8) 
10. Complement (number of officers and men on board) , 
(Signature.) 
Duty with the Ship’s Landing Force and on Shore Patrol.1 
WITH THE SHIP’S LANDING FORCE. 
A permanently organized landing force, consisting of infantry, artillery, and 
other auxiliary units, is maintained on each ship, and is known as the ship’s 
battalion. It varies in size and composition according to the type of ship. 
For a ship of the first rate it consists normally of one company of marines, two 
companies of bluejacket infantry, one company of bluejacket artillery, the bat- 
talion commander and staff, and certain special details, such as the pioneers, 
signalmen, cooks and messmen, the ambulance party, and officers’ servants. 
The ambulance party, which is commanded by the battalion surgeon, 
usually the junior medical officer of the ship, is composed ordinarily of two 
litter bearers from the line of each company, or, preferably, an equal number 
from the ship’s engineering divisions, with a chief pharmacist’s mate and as 
1 Prepared by Lieut. Commander W. M. Kerr, Medical Corps, United States Navy. 534 
HOSPITAL CORPS HANDBOOK. 
many hospital corpsmen of the lower ratings as the circumstances may 
demand. During an engagement, in order to reduce the number of ineffective 
men to a minimum, messmen, orderlies, and others not actually engaged in 
their own legitimate duties are, when practicable, employed to reinforce the 
litter bearers. They should recover the arms and ammunition of disabled men, 
assist in carrying the wounded, and perform such other duties as the battalion 
surgeon may direct. 
The equipment of the ambulance party depends largely upon the nature of 
the battalion's duty on shore. Ordinarily the litter bearers and hospital corps- 
men carry no weapons, but wear the Geneva cross on the left arm. Men de- 
tailed to assist the litter bearers should lay aside their arms and wear the 
Geneva-cross brassard. Against a savage or uncivilized enemy, however, the 
men of the ambulance party carry pistols and omit the brassard. 
The battalion may be assembled for landing either fully or lightly equipped. 
When fully equipped each member of the ambulance party wears the uni- 
form prescribed and carries a pack carrier (packed), haversack, rubber blanket 
(poncho), cartridge belt, filled canteen, and leggings. There is no provision for 
carrying the overcoat on the pack. When weather conditions make it necessary 
to carry the overcoat it has to be worn. 
The haversack contains rations, knife, fork, spoon, meat can, bacon can, 
and condiment can; also a towel, soap, comb, toothbrush, tooth powder or 
paste, sewing kit, matches and tobacco and pipe, if desired. The poncho is 
folded to suitable size and carried in the haversack on top of the rations. 
The pack carrier when completely assembled should contain one-lialf of a 
shelter tent with the accompanying tent pins and pole, a blanket, one pair of 
trousers and one jumper, one pair of drawers and one undershirt, two pairs of 
socks, a white hat and a comfortable pair of high shoes. 
When pack carriers are not provided, the most necessary of the above-men- 
tioned articles are carried in the blanket neatly rolled lengthwise, covered with 
the poncho and stopped with clothes stops, the roll placed over the left shoulder 
with both ends of the roll secured together under the right arm. 
When the battalion is lightly equipped the men carry filled canteens and car- 
tridge belt and wear leggings. The blanket and poncho or the pack carrier with 
haversack may be prescribed if circumstances require it. 
The special equipment of the ambulance party is as follows: 
(a) One litter for each two bearers. 
(&) A Geneva-cross brassard for each man. 
(c) A Hospital Corps pouch for each hospital corpsnian (large for chief 
pharmacist’s mate; small for others). 
(d) A Geneva-cross flag on a staff. 
The expeditionary medical and surgical chests and the medical emergency 
boat boxes are available for use with the landing force. 
Ample preparations will be made by the battalion surgeon for an additional 
supply of instruments, dressings, and other equipment for an expedition in 
accordance with the length and character of the service and he invariably will 
make an inspection of all equipment prior to embarkation to see that medicines, 
instruments, dressings, and the men’s clothing are ample and in proper 
condition. 
Each member of the ambulance party should wear his identification tag 
attached to the neck. 
Frequently, at sea or in port, the ship’s battalion is formed for inspection 
or drill. The ambulance party assembles at a place on deck designated in the ship’s landing force and shore patrol. 
535 
ship’s organization scheme. Members of the party should report promptly 
in clean uniform and with the equipment specified. The party is mustered 
by the chief pharmacist’s mate, who reports the result of the muster to the 
battalion surgeon, who in turn makes a report to the battalion adjutant. 
When the battalion surgeon is away from the ambulance party’s place of 
assembly, the party is in charge of the chief pharmacist’s mate, who should 
see that the men keep in formation, and refrain from loud talking or other 
disorder. 
If the battalion is formed for inspection of the equipment, the pack carriers 
are unstrapped, the packs removed, unrolled and arranged as explained in 
the Hospital Corps Drill Book. 
The occasion often is used as a period of instruction, during which the bat- 
talion surgeon, the chief pharmacist’s mate, or other members of the Hospital 
Corps may exercise the litter bearers in various methods of controlling 
haemorrhage, applying occlusive dressings to wounds, splinting fractures, and 
transporting the wounded. 
When the battalion is to leave the ship, the ambulance party may, for the 
purposes of landing, be split up and detailed to the various boats making the 
landing, or it may be landed as a unit in a hospital boat which shall carry no 
arms whatever, and shall carry a Geneva-cross flag on a staff in the bow, except 
when operating against an uncivilized enemy. 
On landing, the ship’s battalion may join battalions from other ships to 
form a regiment, which in turn may be associated with other regiments to 
form a brigade. Both the regiment and brigade have a medical organization, 
which is outlined in the Manual of the Medical Department, United States 
Navy. Ordinarily the ambulance party of each battalion will operate with 
that battalion. If the battalion goes into camp, the ambulance party is con- 
cerned with the care of the sick and the sanitation of the camp site. Record 
of all patients treated must be made. Loose leaves from health records, Form 
F (cards) and diagnosis tags will be, ordinarily, the only material needed in 
a landing force for keeping these records. Upon return to the ship the medical 
entries should be inserted in the proper health records. 
Should the battalion participate in an engagement the battalion surgeon will 
establish an aid post in a sheltered spot as near as possible to the firing line. 
From this station the litter bearers, under the direction of hospital corpsmen, 
will make their way to the firing line, apply first-aid treatment, administer 
anodynes and restoratives, and, when opportunity is afforded, return with the 
seriously wounded to the station where the battalion surgeon and his assist- 
ants may institute further treatment and arrange for their transportation to 
the rear. 
The ship’s battalion sometimes is landed for parades or reviews. On these 
occasions the ambulance party follows the battalion, each litter being carried 
by four bearers, the litters being horizontal and carried abreast of each other. 
It is landed not simply for parade, but to administer first-aid treatment in 
cases of sunstroke, accident, or sickness. 
ON SHORE PATROL. 
Whenever a fleet or vessels of the United States Navy visit a United States or 
foreign port it is customary to land a body of sailors known as the shore patrol. 
The purpose of this patrol is to preserve order among the men who are 
ashore on liberty and to enforce whatever regulations concerning the port the 
senior officer present may issue. A medical officer and some hospital corpsmen 536 
HOSPITAL CORPS HANDBOOK. 
usually are detailed for duty with the shore patrol and become an integral 
part of it. The duty of the medical detachment of a shore patrol is to render 
emergency medical and surgical treatment to men ashore on liberty from the 
vessels present and to members of the shore patrol who may be injured or 
become ill. 
The ease with which this duty may be performed depends greatly upon 
the nature of the port in which liberty is granted. In a well-organized com- 
munity possessing an efficient police force, public hospitals and ample facilities 
for handling large liberty parties, such as are found in any well-organized 
municipality, the problem is easy to solve. But in cities having few attrac- 
tions for the men, no welfare activities, numerous liquor stores, houses of 
prostitution, and an inefficient police force the problem presents a different 
aspect. It is a port of this type which will be considered in the present 
article, when visited by a fleet. 
The personnel of the medical detachment of the shore patrol should consist 
of one medical officer and four well-trained, reliable pharmacist’s mates. 
Each man should carry ashore with him his field equipment, viz., a poncho, 
belt and canteen, extra shoes and leggings, a change of underwear and socks, 
an extra suit of whites or blues, hammock, mattress, cot, two blankets, mos- 
quito net, necessary toilet articles, two towels, shoeblacking, a notebook, and 
pencil or fountain pen. The detachment should have a bucket for water, a 
washbasin, and a supply of toilet paper. 
In many ports the members of the shore patrol will be quartered in a hotel, 
or in a comfortable military barracks or in a police station, but one never 
knows what is ahead of him when liberty is given in a strange port, so each 
pharmacist’s mate detailed to duty with the shore patrol should go ashore 
prepared to camp out in whatever quarters are available. He may find himself 
lodged in an empty warehouse or in the baggage room of a railway station. 
Before leaving the ship it is necessary to assemble certain material for use 
in connection with the treatment of sick or injured among the liberty party. 
As conditions ashore are more or less unknown a fairly complete field equip- 
ment will be necessary, in which must be the following: 
1. A Geneva-cross flag and staff to mark the main dressing station. 
2. The medical and surgical expeditionary cases. 
3. A mess table upon which to place the expeditionary cases and other ap- 
pliances at the main dressing station. 
4. Three folding cots. 
5. Three pillows with pillowcases. 
6. Three blankets. 
7. Two Stoke’s splint stretchers, each having a pillow and two blankets. It 
is advisable to place a tag bearing the name of the ship on each of these 
stretchers and on each blanket as they may be used for the transportation of 
men to the hospital ship and easily become lost unless tagged. 
8. Two buckets for water. 
9. Four washbasins (two for main dressing station and two for early-treat- 
ment station). 
10. Five hundred c. c. Tr. Iodine. 
11. An ample supply of sterile dressings and bandages. Materials to make 
tincture of iodine and compressed dressing material are to be found in the 
expeditionary cases, but it is better to use a freshly sterilized supply of dress- 
ings and to disturb the cases as little as possible as it might be impossible to 
renew supplies used from them for some time. ship’s LANDING FORCE AND SHORE PATROL. 
537 
12. A blank book to be used for a journal in which is to be entered an ac- 
count of all the detachment’s activities, especially notes of all cases treated 
and examinations made. 
13. A package of shipping tags. 
14. Material for early venereal treatment and report blanks which when 
filled out are sent to the medical officer of the applicant’s ship. 
The quarters for the shore patrol generally are selected by an officer of the 
train, which usually arrives in advance of the fleet. Therefore when the patrol 
party lands, it is marched at once with its equipment to the quarters selected. 
It is a good rule in Navy life never to become separated from one’s baggage, 
so on this march from the dock to the quarters see that all the medical depart- 
ment equipment is brought along and none left on the dock. Most of the mate- 
rial brought ashore can be packed in the two splint stretchers and carried safely 
with the aid of men from the patrol, who will be detailed by the senior patrol 
officer on request. 
Having arrived at the patrol quarters, the sleeping accommodations for the 
pharmacist’s mates are arranged for. These probably wffll be with the rest of 
the patrol, and the comfort each man gets depends upon his adaptability for 
service in the field. Next comes the question of food. In some ports the shore 
patrol will be subsisted from some vessel and the cooked food sent ashore. 
Usually, however, each man’s ration is commuted and he is allowed not more 
than 75 cents for each meal. A survey of the neighborhood will reveal the 
best eating places. Remember that no member of a shore patrol is permitted 
to drink any alcoholic beverage while on duty. 
The next step is to establish the main dressing station, where seriously 
injured men may be brought for first-aid treatment. This station should be as 
near the landing place as possible and should be marked by the Geneva-cross 
flag. Having secured a suitable location, set up the three cots and the mess 
table, upon which place the expeditionary cases and two of the wash basins, 
together with other dressing material. This table will be found very useful as 
a dressing stand. Secure a supply of fresh water and make up whatever anti- 
septic hand solution the medical officer uses, covering it with a clean towel. 
The splint stretchers should be prepared for use and placed out of the way. 
One pharmacist’s mate is detailed to care for the main dressing station. 
The prophylactic or, more properly speaking, the venereal early-treatment 
station likewise should be established near the landing place and if possible 
adjacent to the main dressing station. Experience has shown that these two 
stations should not be combined, because if there is opportunity for much ex- 
posure to venereal disease in the port it is likely that a large crowd of noisy 
men will visit the early-treatment station and if the dressing station be in the 
same place its proper functioning will be interfered with. This station must be 
in charge of one pharmacist’s mate, who will prepare and supervise the treat- 
ment and fill out the treatment report blanks. He should be assisted by at 
least two members of the shore patrol, whose duty is to preserve order. The 
early treatment of venereal disease is most important and must be faithfully 
and conscientiously carried out. It is not agreeable duty, as the patients often 
are under the influence of liquor, foul-mouthed, and disorderly, but if venereal 
disease is prevented by the treatment it is worth all the effort expended. 
A dressing station equipped with a Hospital Corps pouch and a supply of 
sterile dressings, iodine, and bandages, and in charge of one pharmacist’s 
mate should be established at the landing place, as it is to be expected that 
many men will present themselves with minor wounds which require sterilizing 
and dressing before embarking for their ships. All cases of serious injury, such 538 
HOSPITAL COKPS HANDBOOK. 
as fractures, severe haemorrhage, large lacerated wounds, etc., appearing at this 
station should be sent to the main dressing station for treatment because at the 
landing there will be more or less confusion caused by embarking men, many 
of whom may be intoxicated. 
At the landing place a space should be reserved for the reception of severely 
intoxicated men. This space should be so located as to safeguard the men 
placed in it. Many of these men will be unconscious or semiconscious, others 
will be noisy or talkative, while others will be fighting drunk. If these men 
be permitted to wander about at will there is danger of their falling off the 
dock into the water or onto the landing float. The space selected for the 
retention of drunken men should be in charge of a competent chief petty officer 
of the shore patrol. He should have sufficient assistants to preserve order. 
The fourth pharmacist’s mate should act as relief for meals and as assist- 
ant to the medical officer. Experience has shown that none of the stations 
mentioned above should be left unmanned while the liberty party is ashore. 
One never knows when a serious accident will happen. A man may be run over 
by a trolley car or shot or stabbed at any time. Liberty in a port such as we 
are discussing generally begins at noon and expires at 8 p. m., but it probably 
will be 11:30 before the dock is cleared of the last stragglers, and until all of 
the liberty party has embarked the medical detachment must keep their dress- 
ing stations open because the patrol in their final search of the streets for the 
night may find some men injured or unconscious. 
As soon as possible after landing the medical officer of the shore patrol 
should make a sanitary survey of the port. This survey should include an inves- 
tigation of the food and water supply of the port, the diseases prevalent, and the 
neighborhoods harboring contagious diseases or houses of prostitution. With 
the information so gained through the cooperation of the senior patrol officer 
he should prevent as much as possible the exposure of the liberty party to 
disease by suitable recommendation for the restriction of infected localities. 
There are several special points relating to the activities of the medical de- 
partment which are well to bear in mind. Frequently men are brought down 
to the landing place profoundly intoxicated and often unconscious. Each of 
them should be examined carefully by the medical officer, as the unconscious- 
ness may be due to a head injury which necessitates immediate transportation 
to the hospital ship. An attempt should be made to identify every unconscious 
man. Examination often will show that he has no identification tag and his 
clothing will bear several names; therefore it becomes necessary to learn 
his name and the name of his ship from his shipmates who may be around. 
Write this information on a shipping tag and tie it securely to his clothing, 
then have him placed in the space reserved for intoxicated men. This will 
facilitate his return to his ship. Men will be brought to the medical officer 
for examination to determine whether they are under the influence of liquor. 
If the man is found under the influence of liquor, careful notes should be made 
in a notebook kept for this purpose of all the details of the case—the man’s 
name, his rate, his ship, peculiarities, or marks by which he may be identified, 
and the signs or symptoms upon which the decision that he is intoxicated is 
made. Then get some officer or chief petty officer from his ship to identify 
him and record that officer’s name for future reference. All this is necessary, 
because men often give wrong names and have no identification tag or proper 
marks upon their clothing, and the medical officer in all probability will be 
called as a witness by a court-martial in the case weeks after, and unless he 
has kept a very clear record of each case and has the identity of each man 
pronounced under the influence of liquor clearly in mind he will not be able 
to give clear testimony in court. MARINE CORPS EXPEDITIONARY FORCES. 
539 
Men seriously injured may be expected at the main dressing station at any 
time, and provisions for their care always must be in readiness. Great care 
must be taken to identify each badly injured man and to place upon him a 
tag bearing his name, rate, and the name of his ship. All severely injured men 
after having been given the necessary first-aid treatment should be sent im- 
mediately to the hospital ship, where there are medical officers always on duty. 
If an injured man should be sent to his own ship, it is possible that the medi- 
cal officers of that vessel might be ashore and the professional attention re- 
quired would be lacking. Severely injured men are best transported in the 
splint stretcher, and may be sent to the hospital ship in either a patrol boat or 
a liberty boat, which may be diverted from its regular duty by order of the 
senior patrol officer. When an injured man is sent to the hospital ship a mem- 
ber of the medical detachment should accompany him to care for him en route 
and to insure the prompt return of the stretcher to the dressing station. 
Duty with Marine Corps Expeditionary Forces.1 
The hospital corpsman serving with Marines has many and varied duties. 
He becomes primarily a soldier and may be detailed with the medical de- 
tachment of the combat units; as a nurse in the hospital company of the 
medical battalion; a clerk in the administrative section; a litter bearer in 
the sanitary company; or as an ambulance driver in the ambulance company. 
He must be physically robust and capable of quickly adapting himself to all 
the conditions of a soldier’s life. 
The act of August 29, 1916, provides, in part, as follows: “ Officers and en- 
listed men of the Medical Department of the Navy, serving with a- body of 
Marines detached for service with the Army in accordance with the provisions 
of section sixteen hundred and twenty-one of the Revised Statutes, shall, 
while so serving, be subject to the rules and articles of war prescribed for 
the government of the Army in the same manner as the officers and men 
of the Marine Corps while so serving.” 
The responsibility and functions of the medical department with marines 
may be summarized as: The conservation of the fighting strength of the 
force. 
This is accomplished by: 
(a) Supervision of sanitation and hygiene. 
(ft) Prevention of epidemics. 
(c) Management of epidemics when they occur. 
(d) Collection, evacuation, hospitalization of sick, injured, and wounded. 
(e) Prompt return of sick and wounded to their organization, and 
elimination of the permanently unfit. 
(f) Procurement, storage, and distribution of medical supplies. 
The medical department of a Marine Corps post is organized as follows: 
1. An administrative headquarters, or post surgeon’s office with the follow- 
ing duties: 
(a) Coordination of all the medical activities. 
(ft) Preparation and forwarding of all medical department reports 
and returns. 
(c) Preservation of medical department files. 
(d) Procurement, stowage, and issue of medical supplies. 
1 Prepared by Lieut. Commander W. Chambers, Medical Corps,. United States Navy. 
47829°—23 35 540 
HOSPITAL CORPS HANDBOOK. 
The post surgeon is the advisor to the commanding general on all mat- 
ters pertaining to sanitation and the health of the post. He is the command- 
ing officer of all the medical department personnel of the station. 
2. The sanitary inspector has the following duties: 
(A) Supervision of the sanitation of the post. 
(B) Preparation of data and charts relative to: 
(a) Sick rate. 
(&) Incidence of venereal disease. 
(c) Epidemics. 
(d) Sanitary work contemplated or undertaken. 
(e) Disease carriers. 
(f) Food. 
(g) Water. 
(h) Epidemiology. 
(C) Maintenance of contact with local civil health authorities. 
3. Dispensaries maintained in each regimental area with a medical officer 
in charge who is responsible for the sanitation of that area; keeps health 
records of regimental personnel; provides temporary care of sick and injured; 
instructs his subordinates in first aid; advises the regimental commander on 
matters pertaining to sanitation of the regimental area and on matters affecting 
the health of the organization; instructs the regimental personnel in personal 
hygiene and first aid. 
4. A sick quarters maintained to furnish hospital treatment for the sick and 
injured and similar to a naval hospital in organization. 
ORGANIZATION OF MEDICAL DEPARTMENT WITH A MARINE EX- 
PEDITIONARY FORCE OF ABOUT THE STRENGTH OF ONE INFAN- 
TRY BRIGADE WITH ATTACHED ARTILLERY. ENGINEER, AIR 
SERVICE, AND OTHER SPECIAL TROOPS. 
The whole medical department is under the control of the force surgeon 
who is responsible for the sanitation of the occupied area; the collection, 
evacuation, and hospitalization of all sick and wounded; preparation of 
reports, records, and returns; procurement, storage, and distribution of medical 
and surgical stores; training and coordination of all the medical units of the 
force. 
For convenience the organization may be shown by briefly considering the 
various medical units from the front to the rear beginning with that of the 
infantry regiment. (Fig. 194.) 
The medical detachment of an infantry regiment is composed of a regimental 
surgeon with sufficient junior medical officers to allow at least one for each 
battalion and the headquarters detachment, and a group of hospital corpsmen 
sufficient in number to allow its subdivision into four smaller groups for duty 
with the above-mentioned units of a regiment. Each battalion group again is 
divided for duty as first-aid men, litter bearers, and aid-station men. 
In combat this detachment furnishes first aid to, and transportation to aid 
stations for the wounded, and provides for their temporary care until they can 
be evacuated to hospitals. With this object in view, aid stations usually are 
established behind each battalion and at regimental headquarters. The hos- 
pital. corpsmen serving as first-aid men go forward with their companies and 
apply first-aid dressings to the wounded. If the whole force is advancing 
rapidly, the aid stations are not established until the situation becomes some- 
what more stationary, and the wounded who have been given first aid are left 
in groups to be evacuated by other medical units following. MARINE CORPS EXPEDITIONARY FORCES. 
541 
After the lirst-aid man has completed his initial task of applying first aid, he 
directs the slightly wounded to the aid stations and the litter bearers transport 
the nonambulant cases. 
At the aid stations they are given stimulating food and drink, fractures are 
immobilized, haemorrhage arrested, and those going to the hospitals are prop- 
erly sorted and marked, while trivial cases are returned to their units at the 
front. 
The aid stations are established as close to the front as the situation permits, 
taking advantage of any available shelter from rifle and artillery fire, such as 
Infantry 
Regiment 
[Infantry 
[Regiment 
Artillery 
Battalion 
Engineer 
Battalion 
Aviation 
Service 
(Med.D&t. 
’Med.Dot. 
(Jfied.Det. 
(MeX.Det. 
MedCDet. 
FORCE 
SURGEON 
Executive 
Officer 
Service 
Company 
Sanitary 
Inspector 
Staff 
Section 
Medical* 
Supply 
Section 
Laboratory 
Section 
Quartermaster 
Supply 
Section 
Sanitary 
Company 
Ambulance 
Company 
Hospital 
Company 
Field 
Medical 
Supply 
Depot 
Evacuation 
Eospital 
Fig. 194.—Organization of medical department for one infantry brigade, Marine Corps 
Expeditionary Force. 
dugouts, ravines, and deserted cellars. These places of course should he avoided 
in the presence of enemy gas. 
As the functions of the regimental medical detachment require it to keep close 
contact with its regiment it must keep as clear of wounded as possible at all 
times. 
The medical detachment of a regiment furnishes small groups of hospital 
corpsmen for detachments of their regiments when they are serving as advance, 542 
HOSPITAL CORPS HANDBOOK. 
flunk, or rear guards, or on other detached duty. Their duties are similar to 
those described above. 
During combat the regimental detachment covers the whole area occupied 
by its organization, from the aid station forward to the battle line. It is 
essential that all its activities be confined to this area and that its efforts 
be coordinated by the regimental surgeon, who is informed from time to time 
by runners or other means of communication from the battalion aid station, 
of any change in their location. The regimental surgeon keeps contact with 
the medical units in his rear by means of litter bearers from the collecting 
stations, by runners, or through his regimental post of command. Routes to aid 
stations may be shown by some means such as hanging pieces of bandage at 
intervals along the route. Their location should be shown to those in the rear 
by indicating their map position. 
Dispensary service is established in the regiment when not in combat. 
Behind the regimental medical detachment is the medical battalion, which 
consists of a headquarters; a service company; a sanitary company; an ambu- 
lance company; and a hospital company. 
In a general way its functions may be defined as the coordinating center of 
medical correspondence of the whole force; keeping records; requisitioning for 
medical and quartermaster supplies, and distribution of the same. Its chief 
function, however, is the collection, evacuation, and temporary hospitalization 
of the sick and wounded. 
The service company is divided into four sections, known as the staff section 
(correspondence and preservation of records); the medical supply section; 
the quartermaster supply section; and the laboratory section. 
The sanitary company with the two remaining companies form the relay 
for evacuation of all sick and wounded from front to rear by establishing 
collecting stations, ambulance stations, and hospital stations. It is divided 
into two or more sections and each of these in turn is subdivided into a 
Jitter-bearer group and a collecting-station group. (See Fig. 195.) 
In combat the collecting-station group establishes a collecting station at a 
point giving protection from enemy fire, which should be as near to the 
regimental and battalion-aid stations as possible. This station should be 
equipped with surgical dressings in abundance, medicines, hot food, and 
water for the wounded. Its function is to sort the wounded, reapply dressings 
if necessary, and prevent shock. 
When the collecting station is established the litter-bearer group brings 
in the wounded from the regimental and battalion aid stations. 
On the march, when not in the presence of an enemy, collecting stations are 
established along the route to provide temporary shelter for men falling 
out from illness or injury. These stations are evacuated by the ambulance 
company following the troops and the casualties are carried to the camp- 
hospital station. 
The sanitary company supervises the sanitation of the whole area in camp. 
The ambulance company establishes the ambulance station (Fig. 195) ordi- 
narily about midway between the collecting station and the hospital station. 
It is merely a control point, which, when established, sends forward one or 
two ambulances to carry the nonwalking wounded from the collecting station 
to the hopital station, and then returns to the ambulance station. When loaded 
ambulances pass the ambulance station on their way to the rear, others from 
this control center are sent forward to replace them by the regulating officer. 
Treatment of the wounded ordinarily is not attempted between the collecting 
station and the ambulance station. MARINE CORPS EXPEDITIONARY FORCES. 
543 
On the march units of the ambulance company follow the marching troops, 
pick up casualties, and evacuate the collecting stations previously established 
along the route. 
The hospital company is a relatively lightly equipped hospital, capable of free 
movement in the field, and establishes a hospital station to the rear of the 
F S-0 II I LIRE 
Reg. lied. Det. 
Zone 
.Staff Sect. 
(Ser.Co.) 
Force Led.Hqtrs. & 
Bata. Ked.Hqtrs. 
HOSPITAL STATION. 
(Eosp.Sta.Reserve.) 
Expeditionary Force 
Headquarters. 
lied.Supply Seat. 
(Ser.Co.) 
laboratory Sect. 
(Ser.Co.) 
(Reserve) 
Evacuation Hospital 
Field Ledical 
Supply Depot * 
Quartermaster Depot' 
LEGEND. 
Aid Station. 
Aid Station. 
Fig. 195.—Internal organization of medical department with one infantry brigade, 
Marine Corps Expeditionary Force, showing distribution of different units. 
ambulance station, thus forming a relay in the evacuation system from front 
to rear. For this purpose the hospital company is divided into two or more 
sections. In combat, a section establishes a hospital station where all sick, 
injured, or wounded cases are received and properly cared for. Surgical 
operations are performed when necessary, but the hospital company as a 
whole must at all times, to be fully effective, be capable of evacuating all 
wounded, so that the organization can advance as an active part of the 544 
HOSPITAL CORPS HANDBOOK. 
field force. This would be done, when the distance is not great, by evacuating 
to a hospital ship or a base hospital. When a unit of the hospital company 
which has established a hospital station fills up, another section establishes 
a new station and the first takes no more cases, but clears itself and then 
stands by to form a new hospital station. Thus during an advance the units 
of the hospital company would “ leapfrog ” each other. 
This completes a brief outline of the mobile portion of the medical depart- 
ment of an expeditionary force. Under certain circumstances, however, if the 
distance between the hospital station and the base becomes too great, as in an 
advance, another medical unit must provide hospital treatment in order that 
the hospital company may remain mobile. This service is performed by the 
evacuation hospital, which is organized with headquarters and various sub- 
divisions similar to those of a naval hospital. As its equipment is relatively 
elaborate, it moves only with the aid of a large number of trucks or by rail. 
It is intended to give the complete or definitive treatment ordinarily given by 
the hospital ship or base hospital, and is used only under the condition men- 
tioned above. 
The field medical supply depot carries sufficient medical and surgical stores 
to resupply the medical supply section of the medical battalion for a given period. 
This relatively frequent resupply is necessary in order that the supply section 
of the medical battalion may remain mobile. This depot also carries more 
elaborate dispensary equipment for regimental medical detachments and hos- 
pital equipment for the hospital company, which they may be able to use to 
advantage under certain conditions, as during the occupation of an enemy 
city, in a semipermanent camp, or in a defensive position from which no 
advance is intended. 
Roentgenology.1 
In a single chapter dealing with roentgenology, it manifestly is impossible 
to attempt to explain all the details of technique and of diagnosis as applied 
to the study of X-rays. This chapter can act only as a sort of foundation for 
the beginner and show him some of the things that X-rays can or can not do. 
Roentgenology is the study of roentgen rays and their application in the 
treatment and diagnosis of disease of the human body. 
The discovery of X-rays was made more or less accidentally, by Prof. W. K. 
Roentgen, of Wurzburg, Bavaria, in the year 1895. While looking for invisible 
light rays, he turned an electric current through a glass vacuum tube. This 
tube was completely covered with black paper so as to prevent the passage of 
light. To his great surprise he noticed that a fluorescent screen, about 9 feet 
away, shone out brightly. There was no apparent source of illumination, 
except the tube, as there was no other light in the room. He also noticed that 
objects placed between the screen and the tube cast a shadow on the screen. 
By this observation he decided that the unknown ray must come from the 
tube. The ray came to be known as the unknown or “ X-ray ” and received 
its scientific name, the “ Roentgen ray,” from its discoverer. 
X-ray physics. 
Electric current, similar to matter of all kinds, solid, liquid, or gaseous, can 
be subdivided into units. Just as matter can be subdivided into molecules and 
theoretically into atoms, so can an electric current be subdivided theoretically 
into electrons. 
1 Prepared by Lieut. It. W. Hutchinson, Medical Corps, United States Navy. EOEXTGEXOLOGY. 
545 
Let us consider the primary unit of electricity to be a minute particle called 
an electron. The ampere is the unit quantity of current. Just as we can meas- 
ure the quantity of water flowing along a pipe in one second, so the ampere is 
the unit of quantity of current flowing past one point in a wire in one second. 
Voltage is the unit measurement of current pressure and can be measured in 
units or volts just as the pressure of water can be measured flowing along a 
pipe. 
When a stream of electrons is passed between the terminals of a glass tube, 
which is practically a complete vacuum, and its passage suddenly is inter- 
rupted, or, in other words, it hits something in its path, X-rays are produced. 
The X-ray tubes in use to-day are of three kinds: (1) The gas tube, pro- 
ducing the finest type of X-rays but rapidly becoming obsolete, due to its diffi- 
culty of control; (2) the Coolidge tube, so named for its inventor, a very 
reliable tube which is in common use at the present time; (3) the radiator 
tube, a self-cooling tube which can be run for any length of time without 
overheating. 
In order not to confuse the beginner, only one type of tube will be explained 
in any detail, namely, the Coolidge tube. Tbe Coolidge tube consists of a glass 
sphere with two glass arms, one projecting on either side (Fig. 196), having elec- 
trical connections at their ends, called 
terminals. These terminals are known, 
respectively, as the cathode and the 
anode terminals. By reference to the 
illustration it will be seen that the ends 
of the terminals inside the tube are not 
connected, but that there is a definite gap 
between them. The cathode terminal 
projecting into the glass globe ends in a 
small coil of tungsten wire, which can 
be connected to a small storage battery 
so that it lights up and is heated in the 
same manner as the ordinary electric 
light is lighted and gives off heat. When a high-tension current passes through 
the X-ray tube this coil of wire gives off the electrons which pass across the gap 
between the terminals and produce the X-rays. The anode terminal consists of 
a solid rod of metal. The inner end is composed of tungsten, a metal chosen 
because of its high melting point and low vapor pressure density. The face of 
the inner end of the anode is inclined at an angle of 45° in order to direct the 
X-rays in the proper direction. This inner end of the anode terminal, known 
as the target, forms a sort of target against which the electrons strike when 
X-rays are formed. The formation of X-rays will be understood better by 
studying the details of figure 197. 
Characteristics of X-rays.—X-rays are invisible, travel with the speed of 
light, and pass through matter according to its density. Tbe more dense the 
substance the less readily the rays will penetrate it; lead, for instance, offers 
great resistance to the passage of X-rays, whereas aluminium allows the pas- 
sage of these rays much more readily. X-rays, like other rays, differ in length; 
the shorter the ray the more penetrating it is; the more powerful the current 
used in producing the X-rays the shorter the rays within certain limits. The 
long rays are called soft rays and the shorter rays are called hard rays. 
The X-ray machine.—There are many machines on the market at the present 
time and their characteristics vary greatly; however, all have certain char- 
Fig. 196.—Coolidge tube : 1, Cathode ter- 
minal ; 2, electron focusing cone; 3, 
solid tungsten target; 4, molybdenum 
supporting rod; 5, anode terminal. 
(U. S. Army X-ray Manual.) 546 
HOSPITAL CORPS HANDBOOK. 
acteristics in common. Practically all standard machines are manufactured 
to run on a 220-volt alternating current; an exception is in the case of machines 
used on board hospital ships and in naval hospitals, which are made to use 
a 110-volt direct current or a 200-volt direct or alternating current. 
The transformer.—The important part of an X-ray machine is the trans- 
former, which is to the X-ray machine what the engine is to the auto- 
mobile. The 220-volt current is not 
of sufficiently high tension to produce 
X-rays. A very high electric tension is 
necessary to cause the stream of elec- 
trons to pass across the gap from the 
cathode to the anode terminal. A trans- 
former is a device for changing a cur- 
rent from low pressure or tension to high 
pressure or tension, and consists of two 
coils of wire wound around a common 
iron core. (Fig. 198.) The coils are 
completely insulated from each other by 
being coated with oil or wax. One of 
these coils is connected to the main line, 
from which the power is obtained, and 
the other to the X-ray tube. When the 
current flows through the first coil of 
wire, another current, known as an in- 
duced current, the voltage of which is 
in proportion to the number of turns of wire in the second coil compared with 
the number of turns in the first coil, passes through the second coil to the X-ray 
tube. The current flowing in the first coil of wire is known as the primary cur- 
rent and the current flowing from the second coil of wire to the X-ray tube 
is known as the secondary current. The primary coil has a capacity of 220 
volts, 60 amperes; the secondary a capacity of 100,000 volts, 70 milliamperes. 
The motor.—The current induced in 
the secondary coil of the transformer 
is alternating, i. e., it changes its phase 
at a certain fixed rate, becoming nega- 
tive, then positive, so many times a 
minute. A device is necessary to so 
change the path of the current that 
all negative elements will pass to the 
negative side of the tube and all the 
positive elements to the positive side. 
This device is included in every X-ray 
machine and is known as a rectifier. 
A common type of rectifier is in the 
form of a disk, revolved by a motor run- 
ning at a fixed speed. The motor ordinarily used is a synchronous motor mak- 
ing 1,800 revolutions per minute. 
The rotary converter.—When the current supplied to an X-ray machine is 
a direct current, a rotary converter is necessary in order that it may be changed 
to an alternating current; a transformer operating only when its primary 
is supplied with alternating current. The operation of a rotary converter is 
based upon the fact that the current flowing through the armature of a direct- 
current motor is alternating. This current is picked up by the brushes and 
Fig. 197.—Gas tube: 1, Cathode termi- 
nal ; 2, cathode of aluminium; 3, con- 
nections for softening; 4, softening 
material; 5, sealing off tip; 6, aux- 
iliary anode; 7, copper block; 8, tung- 
sten button; 9, anode terminal; 10, 
anode arm; 11, cathode arm; 12, elec- 
trons ; 13, path of X-rays. (U. S. Army 
X-ray Manual.) 
PiG. 198.—Diagram of wiring of X-ray 
transformer. ROENTGENOLOGY. 
547 
furnishes the power for operation of the X-ray machine; the alternating cur- 
rent obtained being only about 70 per cent of the direct current. 
Overhead wiring.—High-tension current, unlike low-tension current, re- 
quires very careful construction of the wiring and insulation in order that 
the operator and the patient may be protected. Low-tension current will pass 
into the body of a person actually touching an uninsulated wire of the primary. 
Contact is not even necessary in the case 
of the secondary, since, as wTe have 
already seen, the secondary possesses suffi- 
cient pressure to jump the gap between 
the terminals of an X-ray tube. The 
danger of current jumping the gap be- 
tween the wire of the secondary and a 
person too near the wire is very great. 
The wires passing to the X-ray tube from 
the machine usually are strung overhead 
at a safe distance above the heads of 
anyone moving or standing about the 
room. Metal tubing one-half inch in 
diameter, attached to the ceiling with 
heavy insulators, now is being used to 
carry the current to the X-ray tube instead of flexible wire. From this metal 
tubing, flexible wires mounted on reels run down from above to the X-ray tube. 
They are out of the way of the patient and reduce the chance of accidental 
contact with patient or bystander. 
The control apparatus.—It is necessary to have some method of control of 
the high-tension current, because in some forms of X-ray work it is desirable 
to use much less current than in others. 
This control is furnished, at the present 
time, by the rheostat and the autotrans- 
former. 
The rheostat.— (Fig. 199.) When an 
electric current flows along a wire, a 
portion of the current is consumed, due 
to the resistance of the wire to the flow. 
The rheostat makes use of this principle 
in that it consists of a number of coils of 
wire through which the current is made 
to flow. The more coils of wire the cur- 
rent flows through the more it is used 
up and the smaller the amount which 
reaches the X-ray tube. Each coil is 
connected to a control button, and, by 
means of a dial on the front of the 
machine, the current can be turned into 
as many coils of wire as is necessary to reduce it properly. The property of 
consuming current is known as resistance, and various kinds of metals have 
different resistances, or, in other words, consume more or less electric current. 
The unit of resistance is known as the ohm. 
The auto-transformer.— (Fig. 200.) The auto-transformer is a somewhat 
more recent apparatus which allows more perfect control of both the amper- 
age and the voltage of the current. It consists of a coil of wire wound 
around an iron core with taps at proper intervals to control buttons. It is a 
Fig. 199.—Diagram of wiring of a rheo- 
stat. (Christie, modified.) 
Fig. 200.—Diagram of wiring of an auto- 
transformer. (U. S. Army X-ray Man- 
ual.) 548 
HOSPITAL CORPS HANDBOOK. 
transformer similar to the main transformer except that it consists of only one 
coil of wire. The auto-transformer works by the principle of self-inductance. 
The entire coil is the primary and the secondary is the portion of the same 
coil to the control buttons on a dial located in the front of the machine. If 
alternating current be applied to the entire coil, there will be voltage induced in 
any part of the coil bearing the same relation to the applied voltage that the 
number of turns of this part of the coil bears to the number of turns in the 
whole coil. The ratio between the number of turns in the primary and sec- 
ondary currents is changed by setting the control lever on the various buttons 
on the dial. 
The filament circuit.—(Fig. 201.) The filament circuit is the small coil of 
tungsten wire or filament, as it is called, which is located in the focusing cone 
at the inner end of the cathode (Fig. 196), and which is heated by a small stor- 
age battery. The two wires may be seen in the cathode arm passing to the 
terminal. Two wires pass from the cathode terminal to the storage battery. 
Fig. 201.—Diagram of the circuit of an X-ray machine: M. S., Main switch ; A. T., auto- 
transformer ; R., rheostat; M. T., main transformer; P., primary; S., secondary; 
F. Con., filament control; F. Cir., filament circuit. (U. S. Army X-ray Manual.) 
One of the wires also carries the main current for the formation of the X-rays 
from the transformer, it being a principle of electricity that two different elec- 
trical currents may travel on the same wire at the same time independent of 
each other. The electric current from the storage battery heats the filament, 
the amount of heat being regulated by a small rheostat in the circuit. The 
amount of heat in this small filament controls the amount of electrons given 
off at the cathode. Hence we have a means of governing the amount and 
kind of X-rays given off by the tube. 
The X-ray table. 
Any wooden table of sufficient length and a convenient height may be made 
to serve as a table upon which to place the patient for taking X-ray films. 
Most of the tables now in use, however, are what are known as “ tilt tables,” 
that is, they can be turned from a horizontal to a vertical position to allow 
the patient to be examined in practically any position. Most tables are used 
both for fluoroscopy and for taking films. The tables have a lead box, con- ROEXTGEXOLOGY. 
549 
taining an X-ray tube, underneath, which can be moved the length and width 
of the table. The tables also may contain a device for taking stereoscopic 
plates. 
Fluoroscopy. 
Fluoroscopy is the study of opaque objects by means of X-rays and the 
fluoroscopic screen, and depends on the fact that under the influence of X-rays 
certain substances become highly fluorescent. The fluorescent screen consists 
of a layer of platino-barium cyanide spread on cardboard and protected by 
lead glass, mounted in a frame. When such a screen is held up in front of 
a patient with X-rays passing through him from the back, his body will cast 
shadows on the screen according to the density of the portion examined. 
It is necessarjr for the person operating the fluoroscope to do so in total dark- 
ness in order that the shadows on the screen may be observed. The room 
should be darkened for at least five or ten minutes previous to the examination 
and the operator should remain in darkness for a similar length of time to 
accommodate his eyes. 
As the fluoroscopy will be done in darkness, the control of the machine is 
obtained by a foot switch placed near the operator. Should there be necessity 
for light during the examination a ruby light, fastened overhead, is controlled 
by a foot switch, lied light does not destroy the accommodation, as does white 
light, and so may be used during the fluoroscopic examination. The room is 
darkened by double black curtains hung over the windows, thus allowing no 
light to enter the room. 
The lead box containing the X-ray tube under the table is light proof and 
is lead lined. In front of the box is a diaphragm, movable in two directions, 
to permit the cutting down of the size of the image on the screen and so pro- 
ducing a sharper edge. 
The X-ray current used in fluoroscopy is much smaller in quantity than 
that used for taking films. A 3-milliampere current, 60,000 voltage, usually will 
be sufficient. 
The operator should be protected against X-ray burns by a lead-impreg- 
nated apron and gloves. For details, see paragraphs on dangers and protec- 
tion. 
Roentgenography. 
A Roentgen or X-ray acts upon sensitized plates in a manner similar to ordi- 
nary light and thus Roentgenography has much in common with photography. 
At the present time films, coated on both sides with a sensitized gelatin, have 
taken the place of glass plates, the reasons being that the films are less ex- 
pensive, not so bulky, do not break, and are probably faster in their action 
than the glass plates. The sensitized coating covering the films consists of 
gelatin, containing a silver salt, generally the bromide. The gelatin is laid 
evenly on both sides of the film, and is identical with that used in photography 
except that the gelatin on the X-ray films is laid on much more thickly. 
When light or X-rays come in contact with the sensitized gelatin, or emul- 
sion as it is called, a chemical action takes place with reduction of the silver 
salts. In order to bring out the image, it is necessary to place the films in a 
developing solution. This must be done in a dark room illuminated only 
by a ruby light which does not act on the sensitive emulsion. Ordinary white 
light would ruin the film, even though it already has been exposed. The 
developing solution may be bought already prepared or its various chemicals 
may be obtained and the solution prepared from them. The main chemical 550 
HOSPITAL CORPS HANDBOOK. 
which makes the picture appear on the film does so by reducing the silver salt 
which has been exposed to X-rays to metallic silver. An alkali is added to 
hasten this action; the bromide is added so that the action will not pi*ogress 
too rapidly, and finally sodium sulphite, which preserves the solution by prevent- 
ing oxidation of the reducer, is added. 
A developer which has been recommended by the Army X-ray Manual and 
which has been found to be of value is here given : 
Water (warm) gallon 1 
Sodium sulphite (dry) ounces 8 
Hydroquinone do 1$ 
Sodium carbonate (dry) do 8 
Potassium bromide dram 1 
Mix in order named. 
After the film has been developed to the correct degree of dark and light (the 
exact degree can be learned only by practical experience), it is washed care- 
fully but quickly in cold water and put in the fixing bath. A considerable 
amount of unreduced silver bromide remaining on the film must be removed 
by the fixing bath, which also contains chemicals for hardening the film. A 
popular fixing bath is given : 
“A.” 
Pure water ounces— 96 
Hypo pounds 2 
Sulphide of soda ounces— 2 
“ B.” 
Pure water ounces 32 
Chrome alum do 2 
Sulphuric acid (C. P.) ounce i 
Mix “A” and “ B ” separately in the order named, then slowly 
pour “ B ” into “A,” stirring continuously. Following complete 
fixation, the film is washed thoroughly in fresh water and dried. 
The dark room,.—The dark room should be made as nearly light proof as 
possible, all ordinary light being excluded. An ordinary ruby light carefully 
shaded will not act upon the sensitive film and will give enough light for 
work in the room. Supplies, especially unexposed films, should be kept at a 
distance from the tank containing the developer and fixing solution. Tanks for 
development of films have three compartments, entirely separated from one 
another. The central compartment contains running water; one of the other 
compartments (usually the one to the i-ight) contains developing solution, and 
the remaining tank on the other side of the water compartment contains the fix- 
ing bath. These compartments are large enough to accommodate several 14 by 
17 inch films at a time, and approximately 5 gallons of solution are used to fill 
each compartment. Tanks should be either lead lined or else constructed with 
a noncorrosive material. Enameled metal tanks are not very satisfactory. 
The dark room also is used in loading X-ray films into their cardboard holders. 
It is obvious that this can not be done in the presence of light. 
Stereoscopic roentgenography.—X-ray films are necessarily flat pictures, that 
is, they show length and width but no depth. It is often very important to 
have the sense of depth in order to locate a shadow in the picture to determine ROEXTGEXOLOGY. 
551 
its proximity to the front or the back of part examined. For this purpose 
stereoscopic films are taken. Two films of the part to be X-rayed are exposed 
in exactly the same position, the patient being cautioned not to move during 
these two exposures. If a stereoscopic exposure of the lungs is made, the pa- 
tient must hold his breath during the taking of both films. The X-ray tube 
is moved laterally a short distance for the second exposure. We then have 
two films of exactly the same part but taken from slightly different view points, 
the tube having been moved about 3 inches or the distance between the pupils 
of the eyes, before making the second exposure. The two films are placed, 
when dry, in a stereoscope consisting of two illuminating boxes mounted on 
a stand with two mirrors placed halfway between the illuminating boxes. The 
person examining the films looks into the mirrors and moves them backward 
and forward until the images come together. The image thus seen is as if from 
one film except that it has depth as well as length and width. Stereoscopy 
is especially important in the localization of foreign bodies and in obscure 
fractures. 
X-ray accessories. 
Intensifying screens.—The intensifying screen is one of the greatest aids in 
modern X-ray work. This screen does just what its name implies; it inten- 
sifies the action of the X-rays on the film, thus shortening the time of exposure. 
This is highly important especially when many films are taken of the same 
patient and the patient thus is exposed to radiation for a considerable length 
of time. When exposures of the thicker parts of the body are made, an in- 
tensifying screen greatly shortens the time. The intensifying screen consists 
of a thin layer of calcium tungstate upon a piece of cardboard. The newer 
form of screen is protected by a coating of varnish over this layer, thus elimi- 
nating the danger of ruining the sensitive layer by fingerprints or dirt. These 
screens are known as “ washable screens.” 
As a rule the screens are fastened in a metal holder, called a cassette, two 
screens being placed in each holder. The sensitive sides of these screens are 
turned inward and the film placed between so that they are in actual contact 
with the emulsion of the film. The loading of the cassette, of course, must be 
done in the dark room to prevent the light from destroying the film. The 
cassette with the two screens enclosed is known as a “ double screen,” which 
ordinarily will reduce the time of exposure to about one-half to one-quarter 
of the time required without the screen. Double screens now are being used 
for exposures of the head, chest, kidneys, gastrointestinal tract, pelvis, and 
upper legs. 
The Potter-Bucky diaphragm has contributed much to the perfection of X-ray 
films. Its action is based on the fact that when X-rays pass through the 
patient, the density of the body is such that some of the rays are absorbed, 
some pass through the body, and still others, on striking the dense tissues, 
are retarded and form so-called secondary rays which are given off at an angle 
from the path of the original rays. This scattering, as it is called, is 
responsible for much of the haziness seen in exposures of the thick portions of 
the body. The diaphragm consists of a grid, made of upright plates of lead, 
which moves across the film during exposure. The primary rays at right 
angles to the film pass through the openings between the grid, and all secondary 
rays coming off at an angle are stopped by the lead grids. The diaphragm, 
encased in a wooden case shaped to fit the body curve, is placed underneath the 
part to be taken with the X-ray tube, which is placed above the patient. The 
X-ray film, usually in a cassette, is placed in the holder underneath the wooden 552 
HOSPITAL CORPS HANDBOOK. 
case, and the motion of the diaphragm is obtained by means of a spring. The 
spring is released by a lever and a small hell indicates the proper time to 
commence exposure of the plate and to stop it. The diaphragm must be 
moving at a certain rate of speed or an image of the lead grids will appear 
on the film, very excellent roentgenograms are obtained by the use of this 
apparatus. 
X-Ray therapy. 
X-rays now are used in the treatment of many diseases of the human body. 
These diseases may be divided into two classes, the superficial, which includes 
diseases of the skin; and the deep, which includes all of the diseases under- 
lying the skin and those of the deeper structures. As has been mentioned 
previously, X-rays as they leave the tube are not all of the same length, but 
vary, some being soft (nonpenetrating rays), while others are hard (more 
penetrating rays). These different rays have different actions on the tissues; 
the softer rays having more action upon the skin and the superficial tissues, 
but not penetrating to the deeper structures; while the harder rays penetrate 
to the deeper structures. The softer rays have a greater tendency to cause 
an X-ray burn than do the harder rays. For this reason, when we desire to 
treat the deeper structures, the softer rays are filtered out so that the skin will 
not he burned during the treatment. Certain metals, if X-rays are passed 
through them, will absorb a portion of the rays, the softer rays being absorbed 
first. Of these metals the one most commonly used is aluminium ; another, now 
coming into use, is copper. 
In treatment of diseases of the skin, filters are not used, but in treatment of 
deeper structures an aluminium or copper filter is placed between the X-ray 
tube and the patient. Filters are made of varying thickness, from 1 to 
10 millimeters in the case of aluminium. The longer we wish the treatment 
to he the thicker filter we use. 
There are many diseases of the skin which X-ray therapy will benefit and 
some diseases it will completely cure, such as warts, acne, blackheads, certain 
types of skin cancer, nonmalignant tumors of the skin, certain types of chronic 
eczema, psoriasis, ringworm of the scalp and heard, and some infectious con- 
ditions of the akin. Not all of these are cured, but are certainly benefited. 
Psoriasis, for example, after a few treatments, will disappear completely, 
but practically always returns. Only comparatively short treatments are 
necessary for skin affections, because the rays do not have any tissue to 
pass through before they reach the diseased areas. 
In the case of diseases of the deeper structures, X-rays at first were thought 
to be a cure for practically everything, but we now have learned to be more 
conservative in this regard. X-rays or radium are about the only agents that 
will reach many organs and structures which can not be operated upon. In 
the case of cancer, the X-rays, if given in sufficient doses, will kill the abnormal 
cells and stop the cancer growth; the deeper the growth, however, the more dif- 
ficult it is to reach and the larger the amount of treatment required. 
The unit of dosage is the “ erythema dose,” which is an amount of X-rays 
sufficient to produce a faint reddening of the skin. The usual procedure is to 
attempt to give just short of this amount; in some diseases, however, the pro- 
duction of this erythema is desired. If more than the erythema dose of 
X-rays is administered to a patient, unfiltered, in any region of the body, an 
X-ray burn will result. The severity of the burn depends on the amount of 
X-rays administered over the limit. X-ray burns are classified by degrees 
similar to other burns as: First degree or faint erythema, second degree With ROEXTGEXOLOGY. 
553 
partial destruction of the skin, and third degree with complete destruction of 
the skin and sometimes extending down into underlying fat and muscles. The 
distressing feature of the X-ray burn is that it does not respond readily to 
treatment, often lasting for weeks or months in spite of all treatment and pro- 
ducing permanent injury to the skin. The X-ray burn does not come on im- 
mediately after the exposure to the rays but usually appears from iO days to 
a month thereafter. There is no means to prevent a burn after tire ex- 
posure has been made. At the present time, with modern apparatus, there is 
no necessity for the occurence of X-ray bums. 
Dangers and precautions. 
Electric current dangers.—Electrical current in the ordinary circuit for 
lighting and heating in a home is not dangerous to life. Actual contact with 
the wires carrying the current is necessary before an electrical shock will be 
obtained and then it is merely unpleasant and not dangerous to life. This is 
due to the fact that the current is a low-tension current. In the case of the 
X-ray apparatus, all the current flowing through the primary of the main 
transformer is low tension and the wire may be touched without fear of any 
serious accident. The current flowing through the secondary of the main 
transformer is of high tension, is very dangerous to handle, and contact with 
the wires is not necessary to get an electrical shock. When the machine is in 
operation this high-tension current is flowing through the wires running to the 
X-ray tube. This current varies in voltage, but the average is about 60,000 
volts. Such a current will pass across a gap of 5 inches, which means that 
a person placing any part of his body within 5 inches of any part of this wire 
endangers himself to a serious electrical shock. The minimum distance usually 
is set at twice the spark gap distance, or, in the case of the 5-inch gap, 
10 inches from the wire. The best rule for beginners is to stand several feet 
away from the machine and wires when the machine is in operation. 
Dangers from X-rays.—The dangers to the skin of the operator and to the 
patient require careful consideration in order to prevent serious injuries. 
X-ray burns already have been mentioned in connection with therapy. Care 
must be taken not to expose the patient to a sufficient amount of X-rays to burn 
the skin unless this effect is desired in treatment. Idiosyncrasy on the part 
of the patient and carelessness on the part of the operator are the only causes 
for burning a patient. Some people seem to be extremely sensitive to X-rays;; 
in fact, abnormally so, and may be burned by a dosage which would not affect 
an ordinary person. However, these cases are rare and more cases of burns 
are due to the operator’s carelessness. 
There is, however, a very real danger to the operator. The patient receives 
only the amount of X-rays necessary for the making of the films or for the 
treatment desired, whereas the operator unless protected, is being constantly 
exposed. The action of X-rays is cumulative; that is, exposure to rays does 
not have to be all at one time. A short exposure every few days, provided the 
sum total is sufficient, will cause just as severe a burn as will a large dose 
administered at one time. For the protection of the operator, the control stand 
of the X-ray machine usually is enclosed in a booth lined with lead sufficiently 
thick to entirely shut out the X-rays. When fluoroscoping a patient, the 
operator wears a rubber apron impregnated with lead. This protects his body 
very efficiently. His hands should be covered with rubber gloves impregnated 
with lead. 
The pioneers in the use of X-rays had no idea of their action, and in conse- 
quence many of them received severe burns; some were very much mutilated, 554 
HOSPITAL CORPS HANDBOOK. 
losing fingers and even hands, while others made the supreme sacrifice. The 
modern operator does not encounter great risks as long as he keeps himself 
carefully protected. There always is a great temptation to palpate with the 
bare hand in the range of the rays and to neglect the wearing of the rather 
bulky apron and gloves. 
References. 
U. S. Army X-Ray Manual. 
The Principles and Practice of Roentgen Technique.—Hirsch. 
A Manual of X-Ray Technique.—Christie. 
Chemical Warfare.1 
The subject of chemical warfare is a matter of considerable importance to 
the Hospital Corps of the Navy for several reasons. While an authentic in- 
stance of the use of poison gas at sea is lacking, there are reports that indicate 
such a use by the Germans in the World War, and it is possible that it may be 
used in the naval battles of the future. Hospital corpsmen are subject to 
detail with the Marine Corps in operations ashore, in which case their problems 
are identical in most respects with those of the Hospital Corps of the Army. 
Furthermore, our hospitals no doubt will carry as patients men suffering from 
the after effects of war-gas poisoning who formerly were attached to and re- 
ceived their injuries during service in the Army or the Marine Corps. 
Poison gas is by no means a new weapon. Perhaps the first organized effort 
to use poison gas as an offensive weapon was when the Spartans, in 431 B. C., 
attempted to suffocate the defenders of the beseiged cities of Platea and 
Belium, thus rendering the attack less difficult. The Spartans burned great 
quantities of wood, pitch, and sulphur under the walls of these cities. They 
also melted pitch, sulphur, and charcoal together in great kettles and blew 
the fumes toward the defenders by means of bellows. 
“ Greek fire ” was used by the Greeks under the leadership of Constantine 
against the Saracens about 673 A. D., and by the Saracens against the Chris- 
tians during the Crusades. As far as can be ascertained, Greek fire contained 
not only readily inflammable material such as pitch, resin, and petroleum, but 
ulso sulphur and quicklime. If thrown upon water the reaction of water 
and quicklime produced heat sufficient to ignite the petroleum, which on its 
part developed enough heat to ignite the other combustible substances. The light 
hydrocarbons driven off from the petroleum, especially benzine, formed an explo- 
sive mixture with the air. As a result of explosions, enormous clouds of smoke 
and soot developed, and the sulphur volatilized in the combustion produced clouds 
of suffocating sulphur dioxide. It was very difficult to extinguish the flames be- 
cause water poured on the fire only served to spread the flaming petroleum and 
thus increased the fire. Greek fire, as used by the Saracens against the Cru- 
saders in the thirteenth century, may be classed as a forerunner of the flame 
thrower used by the Germans in the World War. Large syringes and pumps 
fashioned into the shape of dragons or other monsters with wide-open jaws 
were used to eject this or other burning liquids, especially petroleum, toward 
the enemy, who usually fled, terrified by the flames or stupefied by the gases. 
During the Crimean War, Admiral Lord Dundonald, one of Great Britain’s 
greatest sea leaders, submitted a plan for the reduction of Sebastopol by the 
use of poison gas. His plan was to vaporize large quantities of sulphur under 
the walls of the city and suffocate the garrison. The British Government, 
1 Prepared by Lieut. G. H. Mankin, Medical Corps, United States Navy. CHEMICAL WARFARE. 
555 
while admitting that the plan was perfectly feasible and undoubtedly would 
secure the capitulation of the stronghold, would not permit its execution as it 
was considered that the effects would be so horrible that no honorable com- 
batant would use the means to produce them. 
The tirst use of po'son gas in the recent war horrified the civilized world and 
produced a tremendous moral effect, not only upon the troops engaged, but 
throughout all countries. It was near Ypres on the 22nd. of April, 1915, that 
the first chlorine gas cloud attack was launched. The attack was on about 
a thousand-yard front and included the junction point of the French and 
British Armies. The British right was held by a regiment of Canadians 
and the French left by a regiment of Turcos, colonial troops. The 
attack was a complete surprise to the Allies. No protection whatever 
against this form of attack had been provided. Those who did not fall back 
or attempt some simple protective measures, as breathing through water-soaked 
cloth, became casualties. There is no way of determining accurately the num- 
ber of casualties, but it has been estimated that about 7,000 were affected, of 
whom 350 died, a mortality of 5 per cent. 
In the second attack delivered there was a smaller number of casualties, but 
a higher percentage of deaths. This may be ascribed to the fact that the 
concentration of chlorine gas was higher and the time of the attack longer, for 
the purpose of wearing down whatever protection had been provided. Wherever 
chemical protection was defective or exhausted, due to long exposure to gas, 
the resulting casualty was severe. 
Between December 19, 1915, and August 8, 1916, five cloud or drift gas 
attacks were made against the British. The same method of releasing the 
gas was used as in the former attacks, except that higher concentrations 
were obtained and the time was somewhat shorter. In addition, the toxicity of 
the cloud was increased by mixing phosgene with the chlorine. Phosgene is 
a lung irritant having, predominantly, the faculty of producing its results 
late, and does not cause the spasmodic cough, when breathed, as does chlorine. 
It is approximately eight times more toxic, volume for volume, than chlorine. 
Large amounts may be breathed without producing the distressing symptoms 
that ordinarily serve as a warning. 
During the World War cloud or drift gas attacks were produced by the simul- 
taneous release of liquid chlorine or phosgene or mixtures of these materials 
from iron cylinders in the front line trenches. These liquids became gases or 
vapors when the pressure was released and were carried by the wind over the 
object to be gassed. The cylinders usually were placed in holes dug in the floor 
of the trench at intervals of 1 meter. The valves were covered with sandbags 
for protection against shell fire. In addition, there usually was a layer of earth 
or burlap impregnated with chemicals destined to neutralize any escaping 
poison gas. When an attack was to be launched the protective covering of 
sandbags was removed, the valve guard unscrewed, a lead pipe of sufficient 
length to reach over the parapet was attached to the cylinder and, with a 
favorable wind present, the valve was opened and the gas allowed to be 
carried along the ground by the wind toward the enemy. Almost without 
exception, all poison gases used in the recent war were heavier than air. This 
explains why gas was found in highest concentration after a gas attack in shell 
holes, dugouts, ravines, valleys, and trenches. Gas clouds frequently would 
flow around slight eminences so as to form island's which were free from gas. 
After August, 1916. cloud gas attacks were used less frequently, not at all 
against the British, a few against the French, and quite a number against the 
47829°—23 36 556 
HOSPITAL CORPS HANDBOOK, 
Bussians. In one engagement two entire Siberian regiments, the Fifty-second 
and the Fifty-third, were wiped out. The partial abandonment of this form 
of gas attack may he ascribed to several facts. The gas cloud attacks were 
found to possess several disadvantages. Preparation for one entailed a large 
amount of work, considerable time, immense amounts of material, and if the 
enemy carried out a successful raid and discovered what was intended, the 
work of days was lost. The cloud attack is wasteful, it is dangerous to one’s 
own troops, and is dependent upon the whims of the wind. A wind of too 
slow a velocity does not provide the necessary element of surprise, while a 
wind of too high a velocity does not allow the gas to remain over the object 
long enough to be effective. 
To deliver a cloud gas attack it is important to know the state of the gas 
preparedness and the gas discipline of the opposing troops. Efficient and effec- 
tive gas defense can not be gained in a day; it requires long periods of train- 
ing. The British found themselves, at one time, opposed by a German naval 
division, which recently had occupied a sector of the line in Flanders. This 
division was provided with poor respirators, a poor system of gas alarms, and 
they were not trained in gas defense. It was decided to gas them as soon as 
possible. Accordingly the gas engineers occupied the trenches opposite the 
naval division. The Germans became suspicious and raided the trenches to get 
information. They found out what was planned, but could not hold the ground 
that they had gained. Immediately they began an intensive course of training 
in gas defense. Although they had a week in which to accomplish this before 
there was a favorable wind for the attack, it turned out that they were not 
sufficiently trained, and it is reported that there were about 1,500 casualties 
out of a total of 6,000 men exposed to the gas, and there was a very high per- 
centage of deaths. 
Cloud gas attacks were used only where there was reasonable expecta- 
tion of good results; for example, against poorly trained troops or troops 
that had only recently arrived on the lines. The American Army received a few 
attacks of this nature when they first arrived on the firing lines. 
Very approximately, the concentration of the gas cloud is inversely propor- 
tional to the square of the distance between the two lines. This provides a 
considerable element of danger to the troops releasing the gas. Nearly always 
there is some one affected while working around the valves on the cylinders. 
Weather conditions are important in all gas warfare, but especially so in 
the case of cloud gas. If a wind is too strong, the gas is dispersed : if too weak it 
moves the cloud over toward the enemy so slowly that there is no element of 
surprise, besides a low velocity wind is notoriously changeable, and the results 
are often very disastrous to the attacking party. For example, the Germans 
attempted to gas a certain sector occupied by the British and the wind was of 
very low velocity. The gas rolled over the British trenches, the wind shifted 
and the gas rolled back over the German trenches and the Germans were seen 
moving many men out of the trenches the next day. Documents show that 
about 1,100 Germans were gassed through this shift in the wind. 
Projector discharges caused results that were similar to those produced by 
cloud gas attacks. The British were impressed with the fact that the con- 
centration in a gas cloud attack was greatest just in front of the trenches 
from which the gas is discharged. To obviate this defect, they used gas 
projectiles which were discharged from Stokes mortars. The amount of gas 
that could be sent over in this manner was truly remarkable. These mortars 
were able to deliver about 20 charges a minute. CHEMICAL WARFARE. 
557 
Soon it became necessary to throw over larger amounts of gas in a very 
short time and the use of the Livens projector and canisters of gas fulfilled 
this need. A large number of these projectors were sunk into the ground at an 
angle of 45°. The range was varied by the size of the charge of black powder 
that was placed at the bottom. The canisters or drums contained phosgene 
usually and were exploded by contact fuse and booster charge. The discharge 
of these drums from the projectors was accomplished simultaneously by elec- 
tricity, as is customary in blasting. 
MEDICAL ASPECTS OF CHEMICAL WARFARE. 
The important poisonous gases used in chemical warfare are few in number, 
but during a war new ones or new mixtures may be expected at any time. To 
better understand the actions of these gases they will be divided or classified 
according to their physiological action on man. It is impossible to draw hard 
and fast lines of distinction as the groups overlap somewhat in their effects. 
1. Lung irritants. Examples: Chlorine, phosgene, chlorpicrine. 
2. Lachrymatory gases (tear gases). Examples: Xylyl bromide, benzyl 
bromide, brom-benzyl cyanide. 
3. Sternutatory gases (sneeze gases). Examples: Di-phenyl-chlor arsine, 
di-phenyl-cyan arsine. 
4. Vesicant gases. Examples: Mustard gas, Lewisite. 
5. Direct poisons of the nervous system. Example: Hydrocyanic acid. 
6. Explosion gases. Examples: Carbon monoxide, oxides of nitrogen. 
Generally speaking, all of the gases in a given group will manifest similar 
actions and produce similar effects; therefore, with slight modifications, a 
single description for a particular group will suffice for all the members of 
that division. However, it must be clearly borne in mind that no absolute dis- 
tinction can be made among the different groups, for phosgene, chlorine, and 
especially chlorpicrine, though primarily lung irritants, are also very effective 
lachrymators; and conversely, substances such as brom-benzyl cyanide, which, 
when present in small amounts, cause extreme lachrymation, act, in addition, 
as lung irritants at higher concentrations. 
General symptoms produced by lung irritants. 
With all of these gases, as a rule, nausea, retching, and vomiting are promi- 
nent features in the early stages of poisoning, especially in those who are 
severely affected by the gas. This may be due to the direct irritation of the 
back of the throat, and perhaps also of the stomach, owing to some of the 
gas being swallowed, or it may be the direct sequence of violent spasms of 
coughing. 
If the case has been exposed to a high concentration of the gas, exudation 
of the fluid into the alveoli of the lungs soon commences, and as the quantity 
of the fluid increases asphyxial symptoms begin to appear since the fluid inter- 
feres with the respiratory exchange between the blood and the air in the lungs. 
Want of oxygen becomes, in fact, the dominating feature. Of the severe cases, 
some show extreme restlessness and anxiety, others a semicoma with a mutter- 
ing delirium, from which as a rule they can be aroused to answer questions. 
Often consciousness is retained until quite near the end. Headache, pain be- 
hind the sternum and in the epigastrim are practically invariable, the breathing 
remains rapid (from 40 to even 80 per minute) and labored, but as a rule it is 
fairly shallow; it may be accompanied by occasional fits of coughing and retch- 
ing, more often than not expectoration is scanty even though the lungs are full 558 
HOSPITAL CORPS HANDBOOK. 
of oedema, but occasionally there is an abundant discharge of the watery fluid 
often streaked, with blood. 
Even if there is no expectoration during life, foam almost invariably issues 
from the mouth and nostrils after death. 
The cases in which pulmonary oedema develops to a serious extent tend to 
fall into two groups. The first group—blue type of asphyxia—comprises cases 
which show definite venous engorgement; the face is congested and deeply 
cyanosed, the lips and tongue are a full blue color, and there may be visible 
distention of the superficial veins of the face, neck, or chest. There is usually 
a considerable degree of true liyperpnoea, i. e., the breathing is increased not 
only in frequency, but the actual amount of air reaching the lungs per min- 
ute is markedly above normal. Cough may be present, and expectoration of 
large quantities of thin frothy fluid is more likely to occur in this group than 
in the other. The pulse rate is usually little over 100 per minute and is full 
and of good tension. Second—the gray type of asphyxia. Cases in this group 
show an ashen pallor rather than deep cyanosis, the lips being pale and leaden 
colored, and they are in a general state of collapse. Respiration is rapid, but 
the increase in rate is partly compensated by the shallow character of the 
breathing so that the true liyperpnoea is slight. Though the lungs are intensely 
oedematous, there is often little expectoration and cough is infrequent. The 
pulse is very rapid (130-140 per minute), weak, and running. The prognosis is 
much worse than in the first group. 
Cases of the second group predominate in phosgene poisonin'g, but many 
intermediate types are seen. Sometimes a case which, at an earlier stage has 
shown congestive cyanosis with a full pulse, gradually will assume a gray 
pallor, while the pulse accelerates and weakens. 
The delay in the appearance of severe symptoms.—Though acute pulmonary 
oedema may develop with great rapidity after exposure to a very strong dose 
of phosgene, it is of the utmost importance to recognize that in the case of less 
massive doses a very striking delay, even amounting to hours, frequently 
elapses between exposure to the gas and the onset of severe symptoms, and that 
during this interval the case may complain only of slight discomfort and may 
appear to be in good condition. This delayed action characterizes many of the 
lung irritant gases. 
Treatment of poisoning by lung irritant gases. 
Certain features of the treatment can be carried out only by a medical officer. 
However, there are certain general rules that every hospital corpsman should be 
familar with in the care of gassed cases. For sake of completeness and in 
order that the hospital corpsman may be better able to cooperate with and assist 
the medical officer the details of treatment will be enumerated. In general, 
therapeutic measures are carried out in the following manner: 
(a) Rest. 
(b) Blood letting. 
(c) Inhalation of oxj^gen. 
(d) Warmth. 
(c) Diet. 
It is of primary importance that oxygen need be reduced to a minimum by 
compulsory, absolute and prolonged rest. Under no conditions should evacua- 
tion be conducted otherwise than by stretcher or ambulances. 
Blood letting.—Even at the first-line dressing station the patient who presents 
pulmonary oedema, signs of suffocation and of cyanosis, with frothing at the lips, 
should be bled as soon as possible. Blood letting is as necessary for oedema 
as is the ligature for arterial haemorrhage. It requires no special apparatus. CHEMICAL WARFARE. 
559 
It must be early and copious and from 300 to 500 grams of blood should be re- 
moved. 
In cases presenting signs of advanced cyanosis it may be difficult to remove 
over 50 grams of blood. The administering of 0.25 gram of caffein may assist. 
Oxygen inhalation—With the signs of oxygen want, it is entirely natural 
to consider the administration of oxygen. The administration of oxygen 
should he carried out carefully at low pressure, and whenever possible the 
gas should he filtered through water. The administration of oxygen otherwise 
than hy inhalation lias been tried and found wanting. Rectal injection produces 
no effects, as the oxygen is not absorbed. Intravenous injections not only 
demand special apparatus, but, as they frequently result in plugging of the 
arteries, are dangerous. 
Oxygen injections.—Subcutaneous and intramuscular injections have often 
been tried, without success, for the reason that a sufficient amount can not 
he introduced by this method. 
Warmth.—It is of primary importance that the patient he kept at a com- 
fortably warm temperature. 
Diet.—During the first few days, dieting is indicated. Nourishment should 
lie in the form of drinks, such as coffee or weak tea. Gastric disturbances may 
he combatted by administration of sodium bicarbonate. 
Lachrymatory gases. 
General symptoms and treatment.—Lachrymatory gases, such as xylyl 
bromide and brombenzyl cyanide, are used for the purpose of putting men out 
of action by interfering with their vision, and not with the idea of producing 
serious casualties. Small traces of these substances cause profuse lachryma- 
tion, smarting of the eyes and spasm of the eyelids, making it impossible for the 
individual affected to keep his eyes open. These gases produce their intended 
results with much lower concentrations than is required in the case of the 
other types of gases. Some of these lachrymatory or tear gases are effective 
when present in a concentration of 1 part of gas in 25,000,000 parts of air. 
Stronger concentrations cause irritation of the respiratory passages, nausea, 
and vomiting. On leaving the poisonous atmosphere the symptoms subside in 
the matter of half an hour or more, depending upon the gas encountered, 
and no subsequent toxic effects are noted other than a slight redness of the 
eyelids and a moderate infection of the conjunctiva. 
Irrigation of the conjunctival sac with sodium bicarbonate solution tends to 
allay the smarting sensation and to hasten the return to normal. The sodium 
bicarbonate solution is most efficacious in a 2\ per cent solution. The eyes 
should he protected from the light hut should not be tightly bandaged. 
Sternutatory gases (sneeze gases). 
General symptoms and treatment.—Gases of this class, typified by di- 
phenyl-chlor arsine, are very effective, in low concentrations, in producing 
congestion of the upper air passages and a marked flow of serum from the 
nose and at times distressing sneezing attacks. These attacks are not as com- 
mon or as characteristic as the popular naming of the gas would indicate. 
Another effect which appears early and continues throughout the time that 
the individual is exposed to the gas is marked lachrymation. In higher con- 
centrations there is to be noted burning and smarting sensations in the chest, 
with consequent cough and expectoration. In still higher concentrations, gases 
of this type may become true lung irritants in their effects and produce 
death in this manner. 560 
HOSPITAL CORPS HANDBOOK. 
Treatment is the same as for those suffering from the effects of lachrymatory 
gases, namely, wearing of the regulation mask while compelled to remain 
in the poisonous atmosphere and seeking of nonpoisonous atmopsphere when 
possible; alleviation of the eye symptoms by irrigation of the eye with 
sodium bicarbonate solution. In case the higher concentrations have been 
breathed without the protection afforded by the regulation Navy standard 
mask and lung symptoms appear, the case then is treated as indicated under 
“ lung irritants.” 
Vesicant gases (blistering gases). 
Symptoms.—Mustard gas, or dichloretliyl sulphide, possesses two properties 
which differentiate it from other warfare gases and render it a particularly 
difficult weapon to protect oneself against. These properties are persistence 
and insidiousness. 
A single inhalation of the ordinary lung-irritant war gases, such as chlorine, 
phosgene, and clilorpicrin, causes immediate irritation and institutes a de- 
fensive reflex at once. Not so with mustard gas. The action of this poison is 
not accompanied at first with any painful sensation. The only warning is a 
faint garlic odor, which is mixed with that of mustard. Nevertheless the gas 
is causing changes in the skin, eyes, and respiratory tract that later will be 
attended with severe symptoms. Those who are unfamiliar with this property 
of mustard gas frequently fall into the error of thinking that the absence of 
primary irritation indicates a concentration which is too low to be harmful. 
The explosion of a mustard-gas shell, commonly designated “ yellow cross 
shell ” on account of its markings, sprinkles the surrounding area with a heavy 
liquid that tends to evaporate very slowly in cold weather and quite slowly even 
in warm weather. Consequently, contaminated objects remain impregnated and 
dangerous for a long period afterward. The heavy liquid soaks into any 
porous material and continues to give off toxic and blistering vapors. Hence, 
in the absence of an actual bombardment there is always the possibility that 
there will be casualties among troops that occupy the shelled area. This has 
been known to happen as long as two weeks after a bombardment. The gas is 
more persistent in cold weather than in warm weather, as might be expected. 
When dealing with lung-irritant gases one is apt to gauge the effective- 
ness of the gas by its killing power. It is necessary to regard mustard gas in 
a different light. Its value lies in its casualty producing power. 
On the average the first symptoms appear 6 to 12 hours after exposure, but 
with high concentration lesions have been observed less than 2 hours after con- 
tact. In other reports the time is given as averaging 24 to 36 hours. 
The clinical picture of mustard-gas poisoning, in general outline, is about 
as follows: Several hours after exposure the man complains of nausea, head- 
ache, and a feeling of fatigue. There also is noted a smarting of the eyes, a 
watery discharge, and a swelling of the eyelids. Erythema of the skin appears 
about the same time as the eye symptoms, usually about the face, chest, but- 
tocks, and between the thighs. As a result of the misinterpretation of this 
initial erythema nearly all of the first cases were regarded in the first hours 
as cases of scarlatina and isolated as such. Intensive blisters may develop, 
the usual site for these being the back, buttocks, scrotum, and wrists. 
Inflammatory manifestations of the respiratory passages begin to appear 
about the second day after exposure, and are characterized by pharyngitis, 
laryngitis, tracheitis, and bronchitis. The earliest symptoms referable to the 
lesions in the air passages are hoarseness and cough. Often the cough is 
painful and incessant. The outstanding fact in connection with these lesions CHEMICAL WARFARE. 
561 
is the formation of a false membrane lining the trachea and bronchi. This is 
the result of the direct action of the gas. The patient brings up thick purulent 
or bloody sputum, fragments of the false membrane, or even a cast of a portion 
of the trachea or bronchi. 
The British, French, and American masks protected against any concentra- 
tion of mustard gas attained in the field, therefore most of the cases admitted 
for treatment in the allied forces showed only skin lesions and conjunctivitis. 
Although these lesions were distressing in the symptoms they produced and 
kept a man on the sick list for several weeks, rarely, if ever, did they, in the 
absence of involvement of the respiratory organs, cause death, A fatal out- 
come usually is the result of the direct action of the gas on the respiratory 
passages or to a secondary infection in the lungs. 
In the American Army there were 71,470 admissions as the result of poison 
gas; 27,119 were mustard-gas cases;2 34,046 were admitted as having been 
affected by “ other gases ”—that is, not classed under the heading of arsine, 
chlorine, phosgene, or yperite. It is believed that a large number of cases of 
mustard-gas poisoning may be found under the various headings mentioned 
above. 
Mustard gas caused the loss of 1,286,784 days to the American Expeditionary 
Forces, as compared with 12,545,442 days lost as the result of all battle in- 
juries. From this it would appear that mustard gas must be placed in the 
foremost rank as a producer of casualties. The Germans originally placed 
mustard gas in shells of 77 m. m., but later they employed shells of all calibers 
as gas carriers. 
Treatment.—(1) Preventive measures: Since exposure to mustard gas is fol- 
lowed by an interval of several hours before symptoms appear, there is often 
an opportunity to carry out the measures designed to prevent or lessen the 
severity of the subsequent symptoms. It is of utmost importance that advan- 
tage be taken of this opportunity. The preventive measures consist of: 
(a) Removal of all clothing and sponging the body with kerosene, a solvent 
for mustard gas, followed by thorough washing with soap and warm water. 
The skin then should be rinsed with sodium-bicarbonate solution. Scrubbing 
or friction should be avoided. 
(b) Irrigation of the eyes with 2\ per cent sodium-bicarbonate solution or 
with 1 to 4,000 potassium-permanganate solution. Irrigations should be re- 
peated at three-hour intervals. 
(c) Irrigations of the nose, mouth, and pharynx, using sodium-bicarbonate 
solution. 
(d) Administration of sodium bicarbonate by mouth to prevent digestive dis- 
turbances and to combat the general toxic action. 
(e) Use of protective clothing and protective gloves by all those who may 
come in contact with mustard gas or mustard-gas cases. 
(2) Curative measures: (a) Treatment of the conjunctivitis. Repeat the 
irrigations referred to above. It is at times necessary to instill a few drops 
of 2 per cent cocaine solution in the eyes every three or four hours if the 
patient experiences much discomfort. 
If there is suppuration, instill a few drops of 1 per cent collargol solution or 
silvol solution in a strength of 5 to 20 per cent. This should be done every 
three or four hours. The eyes should not be occluded by a tight bandage; a 
compress hanging in front of the eye to protect it from the light is all that is 
required. 
a Report of Surgeon General, U. S. Army, 1919. 562 
HOSPITAL CORPS HANDBOOK. 
(6) Treatment of the skin lesions. The erythemas, first-degree burns, require 
only protection from friction and pressure and the application of a dusting 
powder. The following is recommended : 
Talc 2 parts. 
Calcium carbonate 1 part. 
Magnesium carbonate 1 part. 
Zinc oxide 1 part. 
Blisters should be opened aseptically by puncturing opposite ends and then 
coating the surface with an ambrine spray. In the absence of an ambrine spray, 
a watery paste, such as the following, gives good results: Talc, calcium car- 
bonate, lime water, and glycerin, equal parts. 
If the skin lesions become infected, the treatment consists of the usual surgi- 
cal procedures. 
The painful lesions of the genitals are relieved by hot wet dressings of normal 
salt solution left on for 20 minutes and following by drying, powder, and pro- 
tection. 
(c) Treatment of the respiratory tract lesions. The patient should be kept 
absolutely quiet. Spasms of coughing should be avoided by using codeine, 
heroin, or a sedative cough mixture under the direction of the medical officer, 
if there be one present. Hot applications to the chest and neck give relief. 
(d) Treatment of gastro-intestinal disturbances. A liquid diet and the in- 
ternal administration of sodium bicarbonate by mouth are the only measures 
of value. Other symptoms are cared for as they arise. 
Direct poisons of the nervous system. 
General symptoms and treatment.—The action of hydrocyanic acid, the only 
member of this group used in chemical warfare, is very rapid. After one 
breath of air containing sufficient concentration of that product, oppression 
and suffering at the temples and at the back of the neck are noted. Ver- 
tigo is present, the head is thrown back and prostration quickly follows. 
The body assumes an outstreched, stiffened attitude. Respiration ceases com- 
pletely. This gas appears to act directly upon the respiratory center to para- 
lyze it. Owing to the fact that this gas is lighter than air and was quickly- 
dissipated by the air currents, it was used but little during the World War. 
The French used it in a combination of poisonous materials called “ Vincen- 
nite.” It was sent over to the enemy in shells, but never proved of much 
military value. 
The swift and horrible nature of hydrocyanic acid poisoning generally fore- 
stalls intervention. First-aid treatment is a matter of minutes and consists 
in the removal of the patient to an atmosphere free from gas. If available, 
oxygen should be administered by inhalation. Stimulants, such as strychnine 
and caffeine, are indicated. 
Explosion gases. 
Carbon monoxide is not employed as a war gas, but is simply identical to 
the combustion of gunpowder. It is found, with the oxides of nitrogen, wher- 
ever firearms are in use. The German gas-casualty statistics seem to indicate 
that a larger number of casualties are traceable to the explosion gases, at least 
in the German Army, than was formerly thought. This substance is a colorless, 
odorless, and tasteless gas, lighter than air and diffuses rapidly in the open 
air. An explosion in a closed space such as a turret, compartment, or room, 
however, produces dangerous concentrations quite frequently, depending on 
the relative size of the compartment and the projectile. DEATHS AND MEDICOLEGAL MATTERS. 
563 
Symptoms: Probably the first symptom noted in a case of moderate severity 
is dizziness, languor, headache, weakness, and loss of appetite. Where the in- 
toxication is more severe there is dizziness, also severe headache, vomiting, 
convulsions, dilated pupils, and the face is, as a rule, livid. 
Treatment: Oxygen inhalation, with a view to displacing the carbon 
monoxide in its combination with the haemoglobin of the blood, is indicated 
where available. This, of course, should be carried out after the patient has 
been removed from the contaminated atmosphere. If there is an absence of 
voluntary respiration, artificial respiration by the Schafer method should be 
resorted to. Friction is applied to the region of the heart. The diet should 
be restricted to liquids, but no liquids should be given by mouth until it is 
absolutely established that the patient is conscious. 
The oxides of nitrogen rarely ever occur in such amounts in explosion gases 
as to cause symptoms calling for treatment beyond that administered for 
poisoning by the more deadly gas, carbon monoxide. 
References. 
Pathology of War Gas Poisoning.—C. M. Winternitz. 
Archives of Internal Medicine, XXIV, 683.—It. S. Berghoff. 
Journal of the Royal Army Medical Corps, XXXV, 80, 83, July, 1920.—C. G. Douglas. 
Report of the Surgeon General of the U. S. Army, 1919. 
Chemical Warfare.—A. A. Fries and C. .T. West. 
Deaths and Medicolegal Matters.1 
Silence. 
The first rule of conduct for the hospital corpsman is to maintain a close 
guard upon his words and his actions. If he thinks twice before he speaks 
and then speaks not at all, he often will have cause to congratulate himself 
upon his good judgment. 
Sad experience teaches this lesson in due course of time, or else the 
individual will find himself no longer connected with medical activities. The 
young man just entering upon a career in the Hospital Corps should try to 
acquire the habit as soon as possible. Moreover, the old saying that actions 
speak louder than words must not be forgotten. Information can be imparted 
intentionally or unintentionally by an appearance of excitement or a shrug 
of the shoulders as clearly as by voice. 
This does not mean that matters are not to be discussed with persons who 
should know of them, but it does mean that idle gossip is to be avoided. The 
senior hospital corpsman and the medical officer are entitled to a knowledge 
of everything pertaining to the medical department that comes to the attention 
of the junior hospital corpsman. Take your problems to them. Whether the 
information should go further is a matter to be left to the judgment of the 
medical officer. The hospital corpsman acting alone is responsible to the 
person in charge. 
The very foundation of a successful medical department is based upon con- 
fidence. We often have glimpses into the innermost thoughts and habits of 
our patients that are denied to others, and it is only under such conditions that 
we can properly minister unto them. We want a man to know that he can 
come to us, feeling that what he says or does will reach only those who are 
1 Prepared by Lieut. Commander C. W. O. Bunker,, Medical Corps, United States Navy. 564 
HOSPITAL, COUPS HANDBOOK. 
to help him. The minute that he thinks that any of us have abused his confi- 
dence we have lost our opportunity to aid him and have placed the medical 
department under a cloud. 
But you also must be close-mouthed about other things than patients. 
Extend the habit to cover all the activities of the medical department. This is 
not for the reason that they are so secret, but because the person to whom 
you talk probably will not understand fully. He has not been trained medically 
and is not qualified to pass judgment. You have merely provided something 
upon which the imagination can work, and there is no telling where the inci- 
dent will end. This applies not only to sanitary measures or ordinary occur- 
rences, but particularly to accidents occurring in the sick-bay or operating 
room, to deaths from other than natural causes, etc. The medical officer bears 
the responsibility and it is for him to handle the situation. 
The prohibition against talkativeness is to be emphasized especially in con- 
nection with this chapter. The hospital corpsman, by reason of his duties, 
comes intimately in contact with situations that afford rich material for gos- 
sip. Operations, deaths, autopsies—all, in time, may become largely matters of 
routine to him. To others, however, they are unusual, and their details serve 
to gratify a merely morbid curiosity. The talkative hospital corpsman is 
always certain of a large and attentive audience, but not necessarily one of 
the highest order of intelligence. His story soon becomes entirely distorted as 
it is passed along. But the matter does not end there. He has betrayed a 
confidence and loses in large measure the respect of his fellows. Certainly 
they will not entrust him with their own troubles. The distortion of his tale 
may bring his department into disrepute. His value as a witness is lessened, 
for he may have said something in his enthusiasm as a story-teller that he 
would not feel justified in repeating under oath. He may have handicapped 
the investigation of some criminal act and thereby caused much inconvenience 
to the course of justice. And, last but not least, he may have made public 
something that, for the good of the service, should have been kept quiet. 
So, by your words and your bearing, always strive to create confidence in the 
efficiency of your medical department. Make others feel that there they will 
find competent treatment for their ills and solution of their sanitary problems; 
that you are incommunicative, not because you are unsociable, but for the reason 
that you mind your own business. No matter whether things are going right 
or wrong, be calm, close-lipped, cheerful, and efficient. In other words, live 
up to the best traditions of the Hospital Corps. 
Property. 
The duties of the hospital corpsman often make him responsible for the prop- 
erty of others, and he will save himself and others much trouble by being very 
careful. Few things cause as much worry and ill-feeling as an accusa- 
tion by a patient or next of kin that some possession has been lost or stolen. 
The Manual of the Medical Department, United States Navy, 1922 (para- 
graphs 1872 and 8420), prescribes the routine to be followed relative to the 
effects of a patient being transferred. The original inventory on the hospital 
ticket (Form G) is very important, as it is the very basis of the transaction, and 
also because the patient may not see all of his property again for days or 
months, or, perhaps, never. And, when he does take charge of them again, there 
must be no question as to whether the list is correct. So prepare it carefully, 
and with your own eyes see every item that you enter. Do not simply ask the 
patient what he has and put down what he says. DEATHS AND MEDICOLEGAL MATTERS. 
565 
The patient usually is able to assist with the inventory, but occasionally he 
can not do so because he is too ill or is insane. You then must double your 
precautions and should have a witness to the inventory. 
In the ward the patient often keeps certain valuables with him, such as a 
watch, jewelry, small change, etc. He should be advised to place them in safe- 
keeping, but usually does not do so. You will develop an excellent habit if you 
have a good idea of what is in his possession. He may claim that something 
is missing, or he may become unconscious, or he may die. You are then in a 
position to speak authoritatively as to whether everything is on hand that should 
be. (See par. 1795, Manual of the Medical Department, U. S. Navy, 1922.) 
Often there is occasion to take charge of personal property, including valu- 
ables. This occurs upon death, or when a corpse is found, or when a patient 
for some reason can no longer guard his property. Ordinarily it should be done 
immediately, for valuables have a curious habit of soon disappearing. Do not 
wait an hour or so, but see that the property is placed as soon as possible under 
the care of the proper person. (See section 6 of chapter 19, Manual for the 
Medical Department, U. S. Navy, 1922.) 
Dispensing. 
Matters of life and death are always under your hand. This will be novel 
at first, but soon becomes familiar and tends to be mere routine. The hospital 
corpsman must closely guard himself against the development of such an atti- 
tude. He is surrounded by death-dealing agents and uses them constantly. 
The mistake that results in death or serious illness is not merely a sad occur- 
rence. It makes you criminally responsible. 
Every endeavor is made to supply all reasonable means of avoiding mistakes 
in the dispensing of drugs and the use of poisons. The regulations specify that 
the dangerous ones shall be placed in special bottles or kept under lock and 
key so that there may be no mistake. The poison bottles can be recognized 
easily in the light or in the dark. Failure to detect the poison bottle can be due 
only to gross carelessness. 
Hold your drugs and chemicals in deep respect, and cultivate at the outset 
the habits of care and precision. Be sure you are wide-awake when you use 
one. Inspect the container, read the label, and be certain that it is the one 
specified by the prescription or by your instructions. Settle any doubt by 
inquiry of the proper person. Label the containers promptly, and never think 
that you can guess the nature of the contents when there is no label. Never do 
any guessing. 
One of the greatest sources of trouble is the care of alcohol and narcotics. 
It is in their care and use that you are particularly liable to the law. The 
Manual of the Medical Department, U. S. Navy, 1922, in paragraphs 737, 738, 
739, 755, 756, 1157, 1699, 1723, 1794, 2064, discusses this subject, and the 
hospital corpsman must be thoroughly familiar with it. The very number of 
references indicates its importance. 
The insane. 
Another situation, in which the hospital corpsman shoulders great responsi- 
bility and is very liable to come in contact with the law, is in the care of 
the insane. The very nature of his calling, naturally, will insure the best of 
care for the patient. But the problem goes deeper. It must be realized that 
an insane person is not responsible for his acts. He is a sick man, and does 
not think in all things in the same manner as you and I. Our duty is to protect 
others who may come in contact with him, and also to guard him against 
himself. 566 
HOSPITAL CORPS HANDBOOK. 
Usually you have some person who has the responsibility for the welfare of 
the patient, and your instructions will be definite and complete. But it is 
your duty to use your common sense to the utmost. The person who is men- 
tally unbalanced is extremely likely to injure himself seriously. Keep him 
under constant observation. Remove articles that are dangerous. Do not toko 
any chances. 
It may fall to you to guard.him while traveling, or while he takes exercise on 
the deck of a ship, or in the grounds of an institution. Then you must be trebly 
careful. He may attack others, or try to escape, or attempt to commit suicide. It 
will happen unexpectedly and most suddenly, and he may avail himself success- 
fully of some opportunity that you failed to consider or did not think of im- 
portance. Remember that his condition may lead him to think or reason in a 
different manner than you would. 
Your best procedure is to cultivate the friendship and respect of the patient. 
How to do so is a problem in each case, but usually it can be done, and your 
success in handling him will depend upon your ability to do so. And never 
forget that he is a sick man. He may make a nuisance of himself or attack 
you, but he is not really responsible. Your duty is to control him, but it must 
be done by as gentle means as possible. Never lose your temper. 
Dying declarations. 
You may happen some time to be the one to whom a person at death’s door 
makes a statement of importance; that is, a dying declaration. It may have to do 
with matters of money, property, or some criminal incident. Under any cir- 
cumstances it is an expression of the thoughts and desires of a dying person. 
In it may lie the clue to the solution of some problem of crime. Therefore you 
should exercise every care to understand it correctly and fully. 
To have full weight in law, however, and to be admissible as evidence before 
a court, the dying declaration must be made and recorded under certain defi- 
nite conditions. You assume, then, real responsibilities when circumstances 
compel you to receive such statements. And it is your duty to know how to 
insure that they be of legal value, and to make them so. 
The person making the statement must be convinced that his death is soon 
to occur—he must have no expectation or hope of recovery. Assure yourself 
that this is his attitude, and also, to the best of your ability, as to whether 
his mind is clear and rational. Then explain to him the importance of the 
statement he is about to make. 
The statement must be voluntary; that is, not forced. Write it in his own 
words as he makes it, and be very careful not to include anything that he does 
not say. Do not put down what you think he should have said. If it can be 
done, have the person swear to his words before proper authority. 
A declaration made thus will be of value in the eyes of the law, but you 
should not hesitate to take any such declaration under any circumstances. 
Take it in writing, and remember which of the above conditions has or has not 
been fulfilled. 
Signs of death. 
We all are familiar with the tales of persons being buried alive. Such occur- 
rences are rare, and the responsibility probably would never fall upon a 
hospital corpsman. The occasion may arise, however, when timely measures 
would save life that wrongly was supposed to be extinct. The proper equip- 
ment of the hospital corpsman should, then, include a working knowledge of 
how to recognize death. He then will be in a position to apply first-aid treat- DEATHS AND MEDICOLEGAL MATTERS. 
567 
ment and possibly save a life that would have been lost had lie erroneously 
considered the person to be dead, and done nothing until the arrival of others. 
The decision as to whether the person is dead ordinarily is made by a medi- 
cal officer. It is only when you are acting alone that you will be obliged to 
make it. 
Death is considered to be present when the heart no longer beats and when 
respiration has ceased for more than 20 minutes. Both conditions must be 
present, and their proof is not always as simple as you may think. Do not 
rely upon any single test, but consider the results of all. No one test is con- 
clusive. 
Test for the heart’s action by feeling the pulse, and by feeling and listening 
over the heart. A stethoscope should be used for listening. If no pulse or heart 
beat is heard or felt, further evidence may be afforded by holding the hand, 
vith the fingers extended and close together, against a bright light, and com- 
paring the result with your own hand. After death the redness that you can see 
in your hand is usually absent, the hand in question looking dull or opaque. 
Tie a cord or wrap a rubber band tightly about a finger near where it joins the 
hand. If the blood is circulating the finger will become swollen and bluish 
•within a few minutes; no change is found when death is present. But re- 
member that, if the cord is too tight, the blood going into the finger through 
the arteries may be stopped as well as that flowing out through the veins. 
Swelling and bluish color is secured when the pressure is just enough to stop 
the return venous flow but not sufficient to prevent the arterial. 
Test the respiration by watching the chest for movement and by listening 
over the windpipe (trachea) in the neck, preferably using a stethoscope. 
Examine for at least 20 minutes. Have a good illumination, and you will 
find that a cross light (one that throws some shadows) is best. A further test 
is made by holding a very cold mirror before the mouth and nose. Moisture 
will collect if there is breathing. 
The preceding examination is usually sufficient, and covers the early signs of 
death. The more important of the later signs are— 
1. Changes in the cornea of the eye. 
2. Cooling of the body. 
3. Pallor of the body. 
4. Rigor mortis. 
5. Cadaveric lividity (suggillation). 
6. Putrefaction, saponification, or mummification. 
The corneal changes consist of loss of sensation, loss of transparency, and 
wrinkling. To be of real use, one must know the condition of the cornese 
before death. 
The temperature of the body must be judged by the use of a thermometer 
placed in the rectum. Do not rely upon your hand. Occasionally, the tem- 
perature rises for a time after death, but cooling soon begins, and its rate 
and extent will depend upon many things. It usually will be about 4° F. per 
hour for the first three hours, 3° per hour for the next six hours, and then 
rather more than 1° per hour. 
A corpse usually has a peculiar ashy color that is suggestive but not con- 
clusive as regards death. 
Rigor mortis is a stiffening of the muscles and results in rigidity of the body. 
It usually appears within 2 to 8 hours after death and lasts from 16 to 24 hours, 
but both onset and duration are subject to wide variations. It extends com- 
monly from the eyes gradually down over the body, and disappears in the 568 
HOSPITAL CORPS HANDBOOK. 
same order. The muscular spasm and rigidity that occurs in some cases of 
poisoning may resemble it. 
By cadaveric lividity is meant the purplish or reddish-violet colored spots 
that appear in about 12 hours after death, and are due to the settling of the 
blood into the parts of the body that are lowest as it lies. These spots often 
are mistaken for bruises. Upon cutting, however, bruises will show consider- 
able blood or even a clot, while the spots under consideration will not do so. 
They are positive proof of death. 
Putrefaction, saponification, and mummification are, of course, absolute 
proof of death. Putrefaction (rotting) does not appear until rigor mortis has 
gone, and its onset usually occurs within a few hours to many days, depending 
upon the circumstances. Saponification and mummification are late incidents, 
and unusual. They preserve the body for long periods of time. Saponification 
means the conversion of the corpse into a fatty or waxy substance called 
adipocere. Mummification consists in the complete drying of the body. 
Care of the dead. 
The hospital corpsman should familiarize himself with the general pro- 
cedure in cases of death, studying particularly chapter 19 (p. 318 and suc- 
ceeding pages) of the Manual of the Medical Department, United States Navy, 
1922. 
Frequently you will be obliged to take charge of the body of a person who has 
just died. Your first duty in such a case is to consider the living. Remove 
all traces of death as soon as possible. A death is very depressing to other 
patients, and one should try to avoid having it occur in their presence, as in a 
ward. The medical officer usually will order a patient on the eve of death 
transferred to a private room, if possible. When this can not be done, the bed 
should be well screened. 
The imaginative or morbid patient who realizes that a death has occurred in 
his vicinity will imagine himself as possibly dying and his body being treated 
as he sees you treat this one. So bear yourself well in hand, and be quiet, 
calm, orderly, and, above all, respectful. Make others do the same. There is 
no place at such a scene for noise or tomfoolery. Let us respect our dead. 
And this should apply not only for the moment but at all times until and after 
the remains have been removed from the institution. 
When the patient has been pronounced dead, take charge of the remains 
arid, possibly, the personal property, if no person in authority is available 
immediately. Gather the property together, store it safely for the moment, 
and make a list of it and transfer it as soon as possible to the proper person. 
(See par. 1795, Manual of the Medical Department, U. S. Navy, 1922.) 
Certain things (given below in detail) must be done for the corpse, but, 
unless it lies in a private room, these are accomplished best in the morgue. 
Before the body is removed from the bed, fasten securely upon it a tag that 
bears the full name and rating of the person, the ward where death occurred, 
and the date and exact time of same. Removable teeth must be sent with the 
body. If death has been due to a contagious or infectious disease, the body 
must be wrapped in a sheet wet with 5 per cent phenol (the official embalming 
fluid is preferable, if it is available) before being transferred. When the body 
has been removed, disposition is to be made of the bedding, and the bed, bed- 
springs, bedside table, etc., need attention. This varies with the customs of 
the institution and with your instructions, but the use of soap and hot water 
and a disinfectant is essential. It is a good general routine, however, to 
remove all bedding, including the mattress, if the death occurred in a DEATHS AND MEDICOLEGAL MATTERS. 
569 
ward. No patient likes to believe that be may be obliged to use such a 
mattress. Disinfect the bedding, to still the wagging tongues if for no more im- 
portant reason, and wipe the furniture with some suitable disinfectant. 
The body must be “ laid out ” as soon as possible. Rigor mortis may begin 
quickly, and its presence renders proper care difficult. But early attention is 
desirable for other reasons, as well—prevention of discharges and soiling from 
the anus, the penis, the vagina, the mouth, and the nose, or other openings. 
Pack these openings tightly with cotton. A little salt in the cotton may be of 
help. Discharge from the penis is best prevented by tying a length of bandage 
tightly about it. The packing for the mouth should go well back into the throat. 
Insert any artificial teeth. Place the body on its back, and straighten the 
limbs, holding the knees together with a loose, broad bandage. Place the 
hands across the chest or abdomen, and secure the wrists together loosely with 
a broad bandage. The head should be slightly elevated by means of a pad or 
block. The mouth must be closed. It is better to hold the jaw in position by 
means of a support, such as a folded towel, beneath the chin, rather than use a 
bandage. The eyes must be closed. If they do not remain so, place wet 
pledgets of cotton upon the lids, or, if necesary, insert a very small piece of 
dampened cotton beneath the upper lid. Finally, cover the body with a clean 
sheet, or, if necessary, rewrap it in the sheet that has been wet with phenol. 
Deaths from unnatural causes. 
The first rule of conduct, when one finds the remains of a person who ap- 
parently has met his death from violence or other unnatural causes, is to avoid 
any disturbance of the body or of objects in the vicinity. Assure yourself that 
the person really is dead, and then see to it that nothing is disturbed until those 
in authority so direct. This applies to others as well as to the hospital corps- 
man, but, as he probably will be in charge, his will be the responsibility. 
Avoid unnecessary handling of objects about the corpse, especially such 
as may bear fingerprints. 
Your only reasonable excuse for disturbing anything will be to ascertain 
whether or not the person is dead. And, before doing so, you must form a 
clear mental picture of the condition and position of the body before dis- 
turbance. Meanwhile, you will have notified the medical officer or other 
person in authority. If no messenger is available and you must leave the 
remains, endeavor to prevent possible tampering by others, as by locking 
the room. Return and reassume charge as soon as possible. 
You probably will arrive at the scene early, and you must try to make 
yourself a useful witness. Imprint clearly upon your memory the position 
and condition of the body and of objects in its vicinity. This requii'es that 
you use your common sense to the utmost. Prepare a private record of the 
results of your inspection at the earliest possible moment. Memory is treach- 
erous, and later you may be very thankful for such notes. 
Previous remarks relative to valuables apply here also. Inventory those 
that are visible, and then you will be in a position to help if the question 
arises later as to whether something has been lost or stolen. 
Your habits of silence will be of particular importance in connection with 
unnatural deaths. Beyond its value in general, as already discussed, here you 
must anticipate a probable call to the witness stand. Your knowledge is 
clear in your memory, as well as clearly stated in your notes. If you discuss 
the matter with unauthorized persons, you will hear all sorts of suggestions 
and comments, and, before long, your own knowledge may become so contami- 
nated that you doubt whether you really saw what you thought you did. 570 
HOSPITAL CORPS HANDBOOK. 
And unconsciously you even may permit the opinions of others to replace 
your own. The court is not interested in this hearsay evidence—the thoughts 
of other persons. It desires what you know of your own knowledge, and 
you must strive to preserve that intact and clear-cut. 
Identification of the dead. 
This problem usually will fall to the lot of persons other than the hospital 
corpsman. Still, he may find himself so situated that he must give an opinion, 
and he should be familiar with the means that may be employed. 
The records kept in the naval service are usually very complete as to the 
physical characteristics of each individual. There are the health record, 
the service record, and the fingerprints. The portion of the health record 
that is devoted to the teeth is of great importance. 
There is also the identification tag. But even the findings of such a tag with 
the body must not be considered conclusive evidence of identity. The char- 
acterisitcs listed in the above-mentioned records of the individual specified 
by the tag must check with those of the corpse before identification can be 
considered as established. A finger print also must be made, and compared 
with that on the tag. 
The procedure to be followed, then, involves a careful examination of 
the body for the points recorded concerning some missing person. Not only 
marks, moles, and scars must be considered, but also external measurements, 
color of hair and of eyes, deformities, etc. It is especially important to 
compare the teeth closely with the description in the dental abstract. 
It is surprising how obscure scars, moles, freckles, and birthmarks can be- 
come after death, even when decomposition has not occurred. The latter, of 
course, adds to the difficulty. So, the search must be very carefully made, 
and it is all-important to have a good light. It is for this reason that the 
dental record is of such able assistance. The peculiarities of the teeth are very 
reliable and permanent. 
It is the finger prints, however, which will settle any doubt. The epidermis 
is very resistant to decomposition. As long as it is present, it will be rare 
that serviceable prints can not be secured if proper care is exercised. Even 
when the skin is shriveled, good results usually can be obtained by carefully 
following the directions given in paragraphs 1489, 1491, and 2924, Manual of 
the Medical Department, U. S. Navy, 1922 and in subsequent circular letters 
from the Bureau of Medicine and Surgery. 
Occasionally, the remains consist only of a number of bones. The teeth 
will help in such a case. Otherwise, the identification will be beyond the 
ability of the hospital corpsman. If other aid can not be secured, his problem 
will be to determine how many bodies are represented by the bones. This is 
not so difficult if many bones are present. Look for duplicate bones, but 
remember that there are two sides to the body. 
Post-mortem examinations. 
After death, a body often is opened for examination, the proceeding being 
known as a post-mortem examination (also called necropsy, necroscopy, or 
autopsy). 
The duties of the hospital corpsman at such an examination are those of 
an assistant. It lies, however, within his power to make the task run smoothly, 
or to have it unsatisfactory. We exercise great care of our instruments in 
the operating room, but the same can not be said of those in the morgue. Your 
first duty is to have them in proper condition—cutting edges sharp, forceps 
that grasp, joints that are snug, etc. DEATHS AND MEDICOLEGAL MATTERS. 
571 
A commendable attitude on your part is to strive to fit yourself to perform 
the autopsy with your own hands. This, of course, means close observation 
of others at work, and intensive application. Study your anatomy, and also 
the sections to be found upon autopsies in textbooks. In time, you may attain 
the necessary proficiency, and you will have benefited yourself in knowledge 
and also in efficiency as a hospital corpsman. Moreover, the instruments in 
your care will receive proper attention because you have had to use them. 
It will be your duty to prepare the room, instruments, utensils, etc., and to 
care for them when the examination is finished. It probably will be your duty 
also to close the openings (incisions) that have been made in the corpse, and 
you may be directed to embalm and dress the body, under supervision. Just 
as in the operating room, no two medical officers will pursue precisely the same 
method, and you should ask beforehand for instructions as to doubtful details. 
As regards the room where the examination is made, have it neat, clean, 
and comfortable. Be sure that the lights are in good working order. A port- 
able light will be found useful at times, as well as a flashlight. Regulate the 
heat, and also the ventilation. There is a great tendency to neglect these last- 
mentioned details, and the result is that often some of those present “ catch 
cold.” So, provide for the escape of odors, but do not do so at the expense of 
a proper warmth and freedom from drafts. 
Have the water supply working properly. If there is piping for hot water, 
see to it that hot water is available. The plumbing needs care, and you should 
remember that the traps may retain fluids which will decompose and cause 
foul odors. It is well to flush them with some hypochlorite of lime (Calx chlori- 
nata) mixed in water after each use of the room. 
Check your scales occasionally to be certain that they weigh accurately. 
You should also exercise due economy in your work. Good hand towels, 
absorbent gauze, and absorbent cotton are expensive. They may be needed for 
certain purposes, but certainly never for cleaning or mopping about the room 
or about the corpse. Old, surveyed linen is available for such purposes. Sec- 
tions of crash toweling also can be used to advantage for less filthy tasks. 
Certain equipment, in addition to the furniture of the room, must be pro- 
vided, and, if possible, it is preferable to have a locker for storage of the 
same rather than to attempt to secure it in a hurry just prior to the examination. 
At that time, you may not have much notice. The medical officer will indicate 
his special desires as regards equipment, and will advise you if any unusual 
procedures are contemplated. The list below includes articles that should be 
available as a matter of routine for the examination itself. Cleaning gear 
for general use will be in addition. 
Three rubber aprons. 
Four gowns. 
Rubber gloves for three persons. (Provide an extra pair for each person, and have 
them of the size and weight desired by those who will use them.) 
Six hand towels. (For use at the sink by persons who may desire to cleanse their 
skin.) 
Soap. (For the hands.) 
Two sheets. (For covering the corpse.) 
Cotton, absorbent. (To be used sparingly.) 
Gauze, absorbent. (To be used sparingly.) 
Bandages, gauze. (Assorted sizes.) 
Necroscopic case of the Supply Table of the Medical Department, U. S. Navy, 1922. 
(Be certain that each article is in good working order.) 
Head block. (Used beneath the neck of the corpse to bold the head forward while re- 
moving the brain.) 
47829°—23 37 572 
HOSPITAL CORPS HANDBOOK. 
Three sponges, about the size of a man’s head. (These are very useful for mop- 
ping about the corpse. Great care, however, is necessary in order to keep them in 
sanitary condition. Cleanse them thoroughly with water after use, and store them in 
a large jar of 2 per cent formalin.) 
Twine. (A ball of same for use in tying during the post-mortem examination.) 
Board. 1 inch thick by 18 inches square, and smooth. (For use in sectioning 
organs.) 
Needles and thread. (For use in closing cuts in the corpse. These are selected 
according to the desires of the person doing the work.) 
Trays, enameled. Two sets of three each, nested, as in the Supply Table of the 
Medical Department, U. S. Navy, 1922. (For holding and local transportation of organs, 
etc.) 
Three buckets, agate, as in the Supply Table of the Medical Department, U. S. Navy, 
1922. (One for use at the drain of the table, one for rinsing sponges, and one for 
general utility.) 
Memorandum pad and pencil. (For taking notes during the examination.) 
Outfit for tissues or fluids that are to be saved for histological or bacteriological 
examination. (See below.) 
Outfit for material saved for chemical examination. (See below.) 
Outfit for disinfection of cuts, punctures, or abrasions occurring during the examina- 
tion. (See below.) 
The corpse having been placed upon the table prior to the necropsy and 
covered with a sheet, clear the vicinity of idly curious spectators, and then 
make your preparations. Your equipment is at hand, and you have regulated 
details of heat, ventilation, water, etc. 
Arrange the contents of the necroscopic case and the sponges upon a cloth- 
covered table where they will he convenient to the hand of the pathologist 
(the person who is performing the necropsy). The linen, trays, and other 
materials are placed upon another table where you can reach them. Place 
a bucket where it will catch the drainage from the table. When the time 
for the examination arrives, remove the sheet from the corpse, put on your 
rubber apron, gown, and gloves, and he prepared to assist as you may be 
directed. 
The skin of those working at a necropsy may be broken accidentally by 
needles, instruments, and otherwise. Such wounds may become infected and 
be very serious. The medical officer will prescribe the proper treatment, but 
you should have at hand some things for immediate disinfection, including a 
200 c. c. bottle of tincture of iodine, wooden applicators, absorbent cotton, small 
pads of sterile gauze in muslin packages, and gauze bandages. 
When the necropsy is finished, the openings that have been made must be 
closed and the corpse cleansed and dried. The closing is to be done neatly 
by means of needle and thread and a simple running stitch. Your aim is to 
leave the body presentable, not only as a matter of pride, but also because it 
probably will be viewed later by friends or relatives. It would be si waste of 
time to try to give directions for this, as no two bodies will require exactly 
the same treatment. It is a matter of common sense and experience, and the 
medical officer will advise you. 
Sponge all cavities until dry. The organs, such as the brain, lungs, heart, 
and those of the abdominal cavity usually have been removed. It is best not 
to return them to the body before closing. Instead fill the cavities with ab- 
sorbent cotton soaked in embalming fluid. If important bones have been 
removed, pieces of wood can be wired in their place. When the skull has 
been opened to examine the brain, special care must be exercised to prevent 
the skullcap from slipping after the scalp has been sewed. This can be done 
by means of sutures (stitches) through soft parts or drill holes before closing 
the skin, Double-ended tacks are also useful for the purpose- If the body is DEATHS AND MEDICOLEGAL MATTERS. 
573 
uot embalmed or dressed immediately, cover with a clean sheet as at the start 
of the examination. 
Embalming usually is done at about this stage, probably most satisfactorily 
before the openings have been closed. The remains then are prepared for 
burial by dressing and placing in the casket or coffin. Full directions for these 
procedures are given in the section on embalming, as well as in the Manual 
of the Medical Department, U. S. Navy, 1922, section 3 of chapter 19. Circu- 
lar letters concerning them also appear from time to time from the Bureau of 
Medicine and Surgery. You must study the directions given, and be able 
to follow them implicitly. 
It can not be emphasized too strongly that every care must be exercised to 
make the body presentable. Probably no other single thing, when not perfectly 
done, can occasion more distress to friends and relatives, and cause more 
trouble for those responsible. Friends and relatives are extremely critical, 
and you must spare no precautions that may prevent criticism. Use the 
razor upon those who have been accustomed to shaving as you would for 
yourself. Wash the body with soap and water until clean. It is well to give 
the hair a shampoo. Clean and trim the nails. And a few toilet articles, 
such as a little talcum and something to make the hair lie smoothly, are of 
real help. Arrange the hair so as to hide any cuts that have been made in 
the scalp. Clothing and linen must be clean and neat, and should be ar- 
ranged so as to hide features that may be distressing. 
After the work in connection with the body is completed, the room and 
equipment must be cleaned and put in order. This is largely an ordinary 
cleaning procedure. The care of certain articles of equipment already has 
been specified. Your instruments should be in perfect condition before storage, 
and covered with a thin coat of vaseline. If you leave them thus, you 
avoid trouble in case they are needed in a hurry. If the post-mortem examina- 
tion has been of a person dead from a contagious or infectious disease, the 
usual precautions listed elsewhere in this book must be observed—the room, 
contents, and yourself being treated or disinfected to prevent spread of the 
disease. An occasional fumigation is a useful routine measure. 
Mention has been made of an outfit for tissues or fluids that are to be saved 
for microscopical examination or for preservation of large specimens. For the 
latter purpose you will receive instructions from the medical officer. Usually 
they are carried to the laboratory in trays, closely covered. You can, however, 
keep certain things on hand for the specimens for microscopical examination, 
and by so doing will save much trouble, because the decision to save something 
usually will be made on the spot and the incidentals will be wanted in a hurry. 
It may be desired to secure some sample, usually fluid, under aseptic precau- 
tions, and therefore certain articles of the equipment must be stored in sterile 
condition. A free flame, such as that of a Bunsen burner, is of use under 
such circumstances. Between it and the tincture of iodine, that you have on 
hand for wounds, there should be no difficulty in securing a suitable specimen. 
The list of articles given below usually will handle the situation. It is well, 
however, to consult the medical officer in charge of the laboratory on the 
subject, as he may have some other preference. 
One test-tube rack. 
Ten test tubes, sterile, and plugged with cotton. 
Twenty slides, glass' (clean, flamed, and protected from dirt). 
One platinum loop, in a handle. 
Twelve sterile swabs, two packages of six each. (Wooden applicators with a small 
amount of cotton wrapped around one end. Make a muslin-covered package and 
sterilize.) 574 
HOSPITAL CORPS HANDBOOK. 
Syringes, all glass, 10 c. c. capacity, in sterile package. (One syringe with two large- 
bore needles in each package. The needles should contain their wires.) 
Ten wide-mouthed, of about 50 c. c. capacity, with corks. 
One bottle, containing 1,000 c. c. of 10 per cent formalin (liquor formaldehydi). (For 
use in the bottles above for the preservation of small pieces of tissue.) 
Pencil, wax. (For writing upon glass.) 
The occasion also arises when it is necessary to preserve portions of the 
corpse for chemical examination, usually for poisons. This is practically 
always a legal matter and the procedure must be surrounded with every pre- 
caution. Either accidentally or intentionally, there may be tampering with the 
specimens; therefore every care must be exercised to have them reach tbe 
chemist in proper condition—nothing having been added to them or removed 
from them. Not only must the medical officer and yourself be satisfied as to 
this, but you must be able to convince a jury. This can be accomplished only 
when all concerned can, upon their oath, testify that the necessary precautions 
have been observed. 
It follows that your work must be protected by seals, and at that a seal 
that can not be imitated readily or one that can be used only by those in au- 
thority. Unauthorized tampering with the specimens then would be known. 
One also must try to permit no opportunity for the same by means of the 
strictest safeguarding under lock and key. 
A medical officer ordinarily will supervise your work in this connection. It 
is well, however, always to be prepared for the emergency. It often comes 
unexpectedly and the containers can not be prepared at a moment’s notice. 
Many precautions are necessary for this. So prepare them in advance and 
seal them effectively. Seal them in a package and keep them under lock 
and key. 
The organs that practically always are saved for chemical examination are 
the stomach and duodenum with their contents, the intestines, the liver, the 
kidneys, and the brain. Often, also, other organs as well as the urine—in fact, 
any portion of the body may be saved for chemical examination. So you must 
have containers large enough to hold such material. There should be a bottle 
or jar for each organ to be saved, and the different organs should be placed in 
separate containers—not all together. The containers must be thoroughly 
washed with soap and water, treated with strong sulphuric acid, and finally, 
thoroughly rinsed with distilled water. When prepared wrap each one sepa- 
rately in firm, stout paper and secure the paper with tape or stout twine 
passed over and around the jar several times and in all directions. Seal each 
package with wax at many points. 
A reasonable outfit then will consist of the following: 
Ten jars, wide-mouthed, preferably glass-stoppered, assorted sizes. (There should be 
no rubber or metal at the joints or elsewhere that could come in contact with the 
contents. Joints are closed with paraffin, after the specimens are in the jars.) 
Five bottles, glass-stoppered, assorted sizes from 1,000 c. c. capacity down. 
Five catheters, new, of assorted sizes. (These are to be cleaned in the same manner 
as the glassware and stored similarly in perfectly clean bottles. They are used for 
securing the urine or other fluids.) 
Distilled water. (Secure a large bottle for the purpose from the laboratory the same 
day as the examination.) 
Paraffin. (Several cakes.) 
Rinse the containers with distilled water just before the material is placed 
in them. Then they are covered, the joints closed with a very liberal amount of 
paraffin, labeled, and immediately sealed as before. If they are to be kept for 
a time or shipped some distance the best practice is to keep them constantly 
at as low a temperature as possible. If this can not be done a liberal quantity RECRUITING. 
575 
of pure 95 per cent alcohol should be added to the contents and 500 c. c. of 
the same alcohol placed in a perfectly clean bottle and sent with them. 
Make an inventory of the number and contents of each container. A copy 
of the inventory is sent along when a duly authorized person makes the ship- 
ment and a copy of the imprint of the seal should be included. 
The matter of shipping specimens of medical interest is not as simple as one 
might think. The express companies and the postal authorities place many 
restrictions upon such packages, and one may get into trouble if he violates 
the regulations. Therefore before making such a shipment be sure that you 
are doing it properly. Consult the local express company. The Manual of the 
Medical Department, U. S. Navy, 1922, section 2, chapter 22, discusses the 
matter, especially as regards the mails. It would be a waste of space to re- 
peat it here, hut you must familiarize yourself with the contents of the Manual 
in this connection. 
References. 
Medical Jurisprudence—Edwin W. Dwight. 
A Textbook of Legal Medicine and Toxicology.—Peterson and Haines. 
Recruiting.1 
For the Navy to carry on its work efficiently, it is necessary to have and 
maintain a capable and efficient personnel. A large percentage of the commis- 
sioned officers are supplied by the Naval Academy; some of the commissioned 
officers and most of the warrant officers and enlisted men are supplied 
originally by the Navy recruiting stations. 
In order that enlistment may be possible to all without the necessity of trav- 
eling long distances from their homes for the purpose of examination, recruiting 
stations are located in various large cities throughout the United States. 
The efficiency of the Navy is dependent on the men accepted at the various re- 
cruiting stations. If only ambitious, capable, healthy men of good character 
are accepted, the possibilities for efficiency are unlimited; otherwise there will 
he many misfits and more or less friction and inefficiency. 
Generally the complement of a recruiting station consists of: 
(1) The officer in charge of the station, usually a line officer who has been in 
the Navy a number of years. 
(2) The medical officer, whose duty it is to examine carefully every applicant 
as to his physical and mental fitness and adaptability for the Navy. 
(3) One or two yeomen for the regular office work. 
(4) A hospital corpsman, usually a chief pharmacist’s mate or pharmacist’s 
mate, first class, who assists the medical officer in all examinations and in mak- 
ing out health records and other medical department reports and returns. 
(5) A varying number of petty officers, who are known either as salesmen, 
canvassers, or outside men. These men are the ones who solicit the prospective 
recruit and carry on the general salesmanship, commonly spoken of as “ selling 
the Navy.” These men may be stationed at the main recruiting station or in 
some distant city in charge of a substation. Before being sent to a substation 
the men are given an intensive course of instruction on the physical examina- 
tion of recruits by the medical officer at the main station. This is done in order 
that only men physically fit will be sent to the main station for final examination 
and acceptance. 
1 Prepared by Lieut. T. O. Summers, Medical Corps, United States Navy. 576 
HOSPITAL CORPS HANDBOOK. 
The duties of a hospital corpsman at a recruiting station are entirely differ- 
ent from any other type of duty. His principal duties are at the main office, 
where he assists in the examinations and does the clerical work of the Medical 
Department. The medical officer is the only one authorized to make physical 
examinations. The hospital corpsman prepares the applicant for examination, 
assists in weighing, taking height, chest measurements, color tests, testing 
vision and hearing, and recording on the proper form all scars found on the ap- 
plicant. He takes the applicant’s finger prints, usually after the medical officer 
has completed the examination. 
While doing tiffs work the hospital corpsman has an excellent opportunity to 
get an insight into the general habits of the man; the applicant frequently tell- 
ing him things that he withholds from the recruiting or medical officer. Thus, 
the hospital corpsman sometimes can render valuable assistance in helping 
recognize cases of undesirables attempting to enlist. 
To protect the interests of the Navy and be sure that only desirable men 
are accepted, everyone must work together in accordance with definite prin- 
ciples, each endeavoring to help the other in selecting only suitable men. 
The previous experience of hospital corpsmen in the hospitals, sick bays, and 
on general duty, ashore and afloat, usually is a most valuable asset. If they 
have any doubt as to the applicant’s fitness for the service, they should give 
such information to the medical officer. 
Each medical officer has a definite plan for conducting the examination in 
which all the requirements set down in Navy Regulations and the Manual of 
the Medical Department are complied with. It is necessary that the hospital 
corpsmen familiarize themselves with these instructions so that they may 
render all possible assistance with a minimum of delay. 
The medical property of the station must be safeguarded and all reports 
sent in promptly. Some dispensing and, at times, attendance on men attached 
to the station who are sick in their quarters is required. As a rule, such men 
are transferred to a naval or a civilian hospital, but this is not always 
practicable. 
In the general activities of a recruiting office it often is necessary to assist 
and receive assistance. That the work may run smoothly, each man should 
familiarize himself with all the work being done at the stations, thus pro- 
moting general cooperation and efficiency. The hospital corpsman should be 
able to carry on the yeoman’s work should he be sick or on leave, and the 
yeoman, in turn, should he able to take up the work of his coworker. This is 
practical and can be done without friction. 
A varying number of men are needed for the Hospital Corps from time to 
time. In selecting desirable men for this branch of the service, the hospital 
corpsman at the i-ecruiting station can do valuable work for the Navy. He 
can be a salesman in the city and can help interest those applying at the main 
station with no definite rating in mind. 
Should hospital corpsmen on recruiting duty be interested in any special work, 
such as X-ray or laboratory work, there are specialists in most cities who are 
glad to give, without charge, special opportunities for instruction and experi- 
ence. Usually the assistance received is considered as covering the fees for 
this instruction. 
From the above a general idea can be gathered as to what is expected of 
men at the recruiting station during office hours. However, their duties are not 
ended when they leave the office and much is expected of them in mingling 
with the civilian population after office hours. RECRUITING. 
577 
As many of the recruiting stations are in inland cities, few of the people 
met with know much about the general activities of the Navy. The opinion 
many people have of Navy men in general is based upon the few they meet 
personally. Therefore, men on recruiting duty at all times must be most 
careful as to their general appearance and conduct. Subsistence being 
provided, living quarters in a desirable section of the city should be chosen, 
and every effort made to meet and form intimate friendships with people of 
culture. 
That he may be able to talk to them intelligently and give definite answers to 
any questions concerning the Navy, the man on recruiting duty should familiar- 
ize himself with all the activities of the Navy, know about the different trade 
schools open to enlisted men and the opportunities available for learning a 
trade; also the average advancement in ratings and pay. 
In addition to the knowledge gained by personal experience, men detailed to 
recruiting duty should read all the literature on recruiting, published by the 
Bureau of Navigation and attend all instructions given salesmen by the officer 
in charge of the station. 
Applicants generally believe that the men on recruiting duty are in the 
Navy from choice and conscientiously can recommend such a career to those 
with whom they come in contact. Only those men who have been in the Navy 
a number of years, and are convinced that the opportunities offered justify 
them in recommending the Navy for a career, are fitted for this important duty. 
Such men are usually ambitious and capable, their conduct is above reproach, 
and they can be trusted to do the proper thing at all times. Their conduct re- 
flects honor on the Navy at all times, and they attract men of a similar type, 
interesting them to the extent that many, appreciating the opportunities offered, 
apply for enlistment in the Navy, CHAPTER XII. 
ADMINISTRATION.1 
General Plan, Arrangement, and Management of Naval Hospitals. 
From a legal standpoint, naval medical facilities can be designated as a 
“ hospital ” only when they have been specifically established as such under 
an appropriation by Congress. However, field hospitals and Navy base hos- 
pitals for foreign duty, may, by competent authority, be classified as naval 
hospitals. All other medical facilities can be designated as dispensaries. 
The ever-forward advancement made in hospital construction reflects itself 
in the many types of architecture found in our naval hospitals, but the floor 
plan as here illustrated is considered by the Bureau of Medicine and Surgery as 
an excellent arrangement for a hospital. This arrangement, adopted a number 
of years ago, still has the hearty approval of the Bureau of Medicine and 
Surgery. While many of the utility rooms which were designed originally for 
a particular purpose are not used as such at the present time, the general 
plan of the hospital has not been altered materially. 
In its general outline this type of hospital resembles a “ T.” The admin- 
istration building occupies the front and center, with the wards situated on 
each side and the operating and subsistence building in the rear, all of which 
are connected to the central buildings by corridors. 
In the basement are located various storerooms, disinfecting plant, re- 
creation, hydrotherapeutic, wash, toilet, and X-ray rooms, kitchen, dispensary, 
laboratory, etc. 
On the first floor are the administrative and executive offices, two wards with 
dressing, quiet, and toilet rooms, diet kitchen, and solaria attached, and the 
general mess hall and pantry are to the rear of the central building. 
On the second floor are two wards—counterparts of the wards below—rooms, 
toilets, dining rooms for sick officers, a dressing room, a room for nurses, and 
a diet kitchen. In the rear are the operating, sterilizing, etherizing, dressing, 
wash, and recovery rooms. 
On the third floor are rooms and toilets for sick officers, a dressing room, a 
room for nurses, a diet kitchen, and a large reception room; also other utility 
rooms. 
In addition to the main, or hospital building, each hospital is equipped with 
other buildings necessary for the proper maintenance of the hospital, such as 
quarters for staff, power plant, laundry, garage, etc. 
The modern hospital of to-day is divided into the following services: Ad- 
ministration, surgical, medical, specialists, and laboratory (bacteriological, 
serological, and X-ray). These departments directly concern the treatment 
afforded its patients. Except for a brief general consideration of the admin- 
istration of naval hospitals, none of these services will be discussed in this 
1 prepared by Chief Pharmacist H. L. Gall, United States Navy. 
579 580 
HOSPITAL CORPS HANDBOOK:. 
section. For a complete description see Chapter XII, Manual of the Medical 
Department. 
Naval hospitals are commanded by an officer of the Medical Corps of the 
United States Navy, usually of the rank of captain, who is responsible to the 
Bureau of Medicine and Surgery for the care and treatment of the patients and 
for the discipline, cleanliness, and economic management of the institution, 
and in return exacts from subordinates, employees, and patients a proper 
obedience to his orders and to the laws and regulations of the Navy. All per- 
sons belonging to the Navy or Marine Corps who may be attached to the hos- 
pital or civilian employees in the hospital perform such duties as may be 
assigned to them by the commanding officer. The general policies regarding 
the administration of naval hospitals are formulated in the Navy Department, 
but the commanding officer is responsible to the Bureau of Medicine and 
Surgery for the accomplishment of these policies in such manner as he may 
deem most suitable to local conditions. The general orders regarding the 
Fig. 202.—Floor plan of “ T ” type naval hospital. 
operation of a naval hospital are in the main very similar at all institutions, 
as they are governed by the policies of the Navy Department; but the working 
details of these policies differ at the various hospitals, due to location, capacity, 
arrangement, etc. The policies of the Bureau of Medicine and Surgery and the 
Navy Department are sufficiently flexible to allow for these varying conditions, 
and over which the commanding officer is given complete control. 
The medical officer next in rank to the commanding officer, unless otherwise 
ordered by the Navy Department, performs the duties of executive officer of the 
hospital. He is responsible to the commanding officer for the general func- 
tioning of the institution. The orders issued by the executive officer are the 
orders of the commanding officer, therefore he always is well informed con- 
cerning the orders and policies of the commanding officer. Subject to the 
approval of the commanding officer, the executive officer directs all matters 
as regards duty assigned to personnel, discipline, leave, liberty, cleanliness, 
good order, etc., of the hospital. As he is the direct representative of the 
commanding officer, all requests or communications of any nature intended for 
the commanding officer must be taken up with him before being submitted to the NAVAL HOSPITALS 
581 
commanding officer. Military etiquette demands that permission be obtained 
from tlie executive officer to communicate directly with the commanding officer. 
This is done in order that the executive officer may be informed regarding all 
matters pertinent to his office and at times relieve the commanding officer 
of minor details which can be adjusted by him. In the absence of the com- 
manding officer, the executive officer is recognized as the commanding officer 
and performs such duty during his absence. 
All other medical officers attached to a naval hospital are designated as 
junior medical officers. They are assigned to the various activities of the 
hospital by the executive officer with the approval of the commanding officer. 
The assignment of these officers to duty in the wards, operating room, X-ray 
department, laboratory, etc., places them in charge of work performed within 
the activity concerned, and they are directly responsible to the executive and 
commanding officers for the proper performance of their duties, and in 
turn exact of the hospital corpsmen and nurses under them strict attention 
to duty and proper performance of all orders isued by the commanding officer. 
The junior medical officers alternate in duty as officer of the day. An officer 
so acting is the representative of the commanding officer and is responsible 
to him for compliance with orders and the maintenance of good order and dis- 
cipline in the hospital. If the commanding officer and executive officer be ab- 
sent from the hospital, he is responsible for the efficient management of the 
hospital and has the authority necessary for the enforcement of the orders 
and regulations governing the hospital during their absence. In the absence 
of an officer assigned as a ward officer, the officer of the day is charged with 
the proper care of the sick in the ward concerned, and all information regard- 
ing patients, which under ordinary conditions would be taken up with the 
ward officer, is communicated to the officer of the day, who issues orders accord- 
ingly. Hospital corpsmen take up all matters pertaining to the treatment of 
patients directly with the medical officer of the ward, or in his absence the 
officer of the day, and all details regarding patients’ liberty, leave, work, etc., 
must be approved by the ward officer before being submitted to the executive 
officer. All patients admitted to a naval hospital are received by the officer 
of the day or his representative; he also is informed of all discharges involving 
patients; and all attachments, transfers, or discharges of staff must be passed 
through him. 
The duty of replenishment of supplies, the upkeep, expenditure, accounta- 
bility, and survey of property, management of the commissary department, and 
the correspondence and clerical work of the administrative offices of a naval 
hospital is performed by chief pharmacists and pharmacists. However, the 
commanding officer may direct that these officers perform other duties not men- 
tioned here. In order to accomplish this work, hospital corpsmen and civilian 
clerks are detailed in the offices concerned, under the direct charge of the 
pharmacist. In connection with the accountability of property great care 
has to be exercised at all times by hospital corpsmen, as it must be remem- 
bered that all equipment and supplies of the medical department are Govern- 
ment property and the laws governing their care and preservation are stringent 
and binding. 
Hospital corpsmen may be detailed for duty in any activity of the hospital 
as the commanding officer may direct. As it is the policy of the Bureau of 
Medicine and Surgery that hospital corpsmen’s duty shall be such as pertains 
directly with the care of the sick, all hospital corpsmen on duty in a naval 
hospital should thoroughly acquaint themselves with the orders and regulations 
governing the hospital, in order that they can carry out faithfully such duties 582 
HOSPITAL CORPS HANDBOOK. 
as may be assigned them and that all instructions concerning the treatment of 
patients consigned to their care be conscientiously accomplished. A chief 
pharmacist’s mate customarily is detailed for duty as the master at arms of the 
hospital. He is responsible to the executive officer, and in his absence to the 
officer of the day, for such duties as may have been assigned him by the execu- 
tive officer as regards the maintenance of discipline and order in the hospital 
and the various utility buildings of the hospital. From a layman’s viewpoint, 
the duties of a hospital corpsman at naval hospitals may, at times, seem dis- 
agreeable, but such duties are often most important from a nursing standpoint, 
and the accomplishment of such duties in the manner directed by the medical 
officer concerned will make much for the efficiency of the hospital and will he 
recognized only as part of that intricate machinery called management. 
The nursing service of a naval hospital is under the direct supervision of 
the chief nurse. She instructs nurses in their duties, particularly as they 
pertain to the naval service, and sees that the orders of the executive officer and 
ward officers are performed by the nurses under her. Nurses in charge of 
wards, operating rooms, diet kitchens, or linen rooms are given the necessary 
authority over patients and hospital corpsmen for the purpose of direct care 
of the sick and of ward or other work. They are held responsible for their 
conduct, attention to duty, and practical instruction in the details assigned 
to them. The work assigned hospital corpsmen in our naval hospitals is con- 
sidered as a training for the work to follow when they are assigned to duty 
on board men-of-war and on independent duty, when the instructions obtained 
in the hospital will be fully appreciated. 
Civil employees at naval hospitals are divided into groups under different 
departments of the institution, the heads of each group being responsible to 
the executive officer for the proper performance of duty. 
The hospital has various special departments, such as dispensary, linen 
room, diet kitchen, etc., which are indirectly concerned in the treatment of 
the sick, but are necessary adjuncts to the hospital. These departments are 
in direct charge of a nurse or hospital corpsman, who is responsible to the 
executive officer for the proper performance of duty as directed by the com- 
manding officer. 
Organization, Clerical Duties and Procedures.1 
Upon the officers and enlisted men of the Hospital Corps the medical de- 
partment of the Navy depends largely for the proper performance of routine 
administrative and clerical duties. Though the most important duty of the 
Hospital Corps is the care and comfort of the sick and wounded, as ad- 
vancement in rating occurs its members necessarily become more familiar with- 
the administrative and clerical duties essential to a proper performance of 
the duties with which the medical department is charged, and assume re- 
sponsibility not only for the accuracy of this work but for so organizing 
and supervising the clerical force that a maximum of efficiency is maintained. 
To satisfactorily perform these duties, hospital corpsmen must: 
(1) Be conversant with the Navy as regards its organization and personnel, 
its history, and the laws and regulations governing the Naval Establishment; 
(2) Be thoroughly familiar with the history and organization of the medical 
department, the laws and regulations governing its duties, the sources and ap- 
plication of monies under its control, and the relationship of the medical de- 
partment to the Naval Establishment: 
1 Prepared by Chief Pharmacist N. L. Saunders, United States Navy. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
583 
(3) Have a full knowledge of the duties of the medical department ashore 
in naval hospitals and at other shore stations and afloat on the various 
types of vessels forming the fleets; 
(4) Understand office management and the Navy Regulations and bureau 
manuals governing the performance of clerical and administrative duties. 
DEPARTMENT OF THE NAVY. 
The President, by the Constitution, is the Commander in Chief of the Navy. 
The Navy Department is one of the ten executive departments of the United 
States Government, and is charged with the general control and administra- 
tion of the Navy. 
At the head of this department is the Secretary of the Navy, a civil officer, 
and a member of the Cabinet. He is appointed by the President, by and 
with the advice and consent of the Senate, and performs such duty as the 
President of the Unite.d States may assign him and has the general superintend- 
ence of construction, manning, armament, equipment, and employment of vessels 
of war. 
The Secretary’s deputy is the Assistant Secretary of the Navy. 
NAVY DEPARTMENT BUREAUS. 
For purposes of administration and distribution of duties the Navy Depart- 
ment is divided into the Office of Naval Operations and eight bureaus, each 
charged with certain specific duties and in charge of an officer of the Navy 
appointed by the President of the United States, by and with the advice and 
consent of the Senate. The chiefs of the several bureaus of the Navy De- 
partment are appointed for four years and have the rank of rear admiral 
(upper half) while performing such duties. They receive the pay and allow- 
ances of a major general in the Army. The chief of naval operations holds 
the rank of admiral. 
Following is a list of these bureaus and the title of officers in charge of them: 
Office of Naval Operations Chief of Naval Operations. 
Navigation Chief of the Bureau. 
Yards and Docks Chief of the Bureau. 
Ordnance Chief of the Bureau. 
Construction and Repair Chief Constructor and Chief 
of the Bureau. 
Engineering Engineer in Chief and Chief 
of the Bureau. 
Medicine and Surgery Surgeon General and Chief 
of the Bureau. 
Supplies and Accounts Paymaster General and Chief 
of the Bureau. 
Aeronautics Chief of the Bureau. 
These are charged with the following duties: 
Office of Naval Operations. 
During the temporary absence of the Secretary and the Assistant Secretary 
of the Navy the Chief of Naval Operations is next in succession to act as Sec- 
retary of the Navy. (Act March 3, 1915.) The Chief of Naval Operations, 
while so serving as such, has the rank and title of admiral, to take rank next 
after the Admiral of the Navy (act August 29, 1916). 584 
HOSPITAL CORPS HANDBOOK. 
The Chief of Naval Operations, under the direction of the Secretary of the 
Navy, is charged with the operations of the fleet and witli the preparation 
and readiness of plans for its use in war. (Act March 3, 1915.) This includes 
the direction of the Naval War College, the Office of Naval Intelligence, the 
Office of Gunnery Exercises and Engineering Performances, the operation of 
the Radio Service and of other systems of communication, the operations 
of the Aeronautic Service, of Mines and Mining, of the Naval Defense Dis- 
tricts, Naval Militia, and of the Coast Guard when operating with the Navy; 
the direction of all strategic and tactical matters, organization, maneuvers, 
target practice, drills and exercises, and of the training of the fleet for war; 
and the preparation, revision, and enforcement of all tactics, drill books, signal 
codes, and cipher codes. 
The Chief of Naval Operations is charged with the preparation, revision, 
and record of Regulations for the Government of the Navy and General Orders. 
He advises the Secretary concerning the movements and operations of vessels 
of the Navy and prepares all orders issued by the Secretary in regard thereto 
and keeps the records of service of all fleets, squadrons, and ships. He advises 
the Secretary in regard to the military features of all new ships and any 
proposed extensive alterations of a ship which will affect her military value; 
the location, capacity, and protection of navy yards and naval stations, in- 
cluding all features which affect the military value of dry docks, including 
their location; also as to matters pertaining to fuel reservations and depots, 
the location of radio stations, reserves of ordnance and ammunition, fuel, 
stores, and other supplies of whatsoever nature, with a view to meeting effec- 
tively the demands of the fleet. He furnishes the General Board with full 
information regarding them, and advises the Secretary on all business of the 
department in regard to foreign relations. 
In preparing and maintaining in readiness plans for the use of the fleet in 
war he freely consults with and has the advice and assistance of the various 
bureaus, boards, and offices of the department, including the Marine Corps 
Headquarters, in matters coming under their cognizance. After the approval 
of any given war plans by the Secretary it is the duty of the Chief of Naval 
Operations to assign to the bureaus, boards, and offices such parts of these plans 
as may be needed for the intelligent carrying out of their respective duties 
in regard to them. 
The Chief of Naval Operations is charged with matters pertaining to the 
operation of aircraft and from time to time witnesses the operations of the 
fleet as an observer. 
He has two principal senior assistants, officers not below the grade of captain, 
one as assistant for operations and the other as assistant for materiel and he is 
ex officio a member of the general board. 
Under the Office of Naval Operations are the following: 
Communication Office.—The Director of Naval Communications is charged 
with matters pertaining to the operations of the entire radio, telegraph, tele- 
phone, and cable systems of communication within the naval service and is 
responsible for the handling of all telegraphic and radio communications to 
and from the Navy Department. In his administration of the foregoing he 
has general charge of the operation, organization, and administration of com- 
munication service. He cooperates with officials designated by the Secretary 
of Commerce in reference to the proposed location of commercial radio stations, 
the licensing of operators, the control of the operation of commercial radio 
stations under the law and the assignment of wave lengths for use by com- 
mercial stations which will comply with the law and prevent interference with 
the radio work of the naval communication service. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
585 
The communication office, under the Director of Naval Communications, 
handles all the despatch work of the Navy Department. A commissioned officer 
is on watch in the communication office at all times, night and day, and is 
responsible for the routing, coding, and decoding of all despatches. He is 
responsible for the proper delivery of all received official messages. The assist- 
ant communication officer on watch keeps himself informed of the general 
despatches received outside of departmental hours, and is responsible that 
despatches of importance requiring immediate action are communicated as soon 
as possible to the proper office. 
Office of Naval Intelligence.—Under the Director of Naval Intelligence this 
office is charged with the collection, classification, publication, and dissemination 
of such information at home and abroad as will be useful to the Chief of Naval 
Operations and to the various bureaus of the Navy Department in the formula- 
tion of plans for war and in the development of personnel and materiel. It 
directs all naval attaches abroad and cooperates with other executive depart- 
ments of the Government in bringing to justice persons engaged in activities 
against the United States. 
Office of Gunnery Exercises and Engineering Performances.—The Office of 
Gunnery Exercises and Engineering Performances is charged with the duties, 
under the Chief of Naval Operations, of formulating and issuing to the service 
rules and instructions for all forms of gunnery and engineering exercises and 
operations; the collection, analysis, and review of data in regard to gunnery 
and steaming performances of naval craft; the review of battle inspections of 
ships for the Chief of Naval Operations in connection with the preparation and 
maintenance of the fleet for war. 
Bureau of navigation. 
The duties of the Bureau of Navigation comprise the issue, record, and 
enforcement of the orders of the Secretary to the individual officers of the 
Navy; the training and education of line officers and of enlisted men (except 
those of the Hospital Corps) at schools and stations and in vessels maintained 
for that purpose; the upkeep and operation of the Naval Academy, of technical 
schools for line officers, of the apprentice-seaman establishments, of schools for 
the technical education of enlisted men and of the Naval Home at Philadelphia, 
Pa.; the upkeep and payment of the operating expenses of the Naval War 
College; the enlistment, assignment to duty, and discharge of all enlisted 
persons. It has under its direction the organization and administration of the 
Naval Reserve Force and provides for its mobilization, and provides trans- 
portation for all enlisted persons under its cognizance. 
It establishes the complement of all ships in commission and shore stations 
and keeps the records of service of all officers and men, preparing an annual 
Navy Register for publication, embodying therein the data as to fleets, squad- 
rons, and ships which are furnished by the Chief of Naval Operations. In 
order that the provisions of this paragraph may be carried out. all communica- 
tions to or from ships in commission relating to the personnel of such 
ships are forwarded through this bureau, whatever their origin. 
It is charged with all matters pertaining to applications for appointments 
and commissions in the Navy and with the preparation of such appointments 
and commissions for signature. 
It is charged with the preparation, revision, and enforcement of all regu- 
lations governing uniform, and the distribution of all orders and regulations 
of a general or circular character. 
Questions of naval discipline, rewards, and punishments are submitted 
by this bureau for the action of the Secretary of the Navy. The records 586 
HOSPITAL CORPS HANDBOOK. 
of all general courts-martial ancl courts of inquiry involving the personnel 
of the Navy before final action are referred to this bureau for comment 
as to disciplinary features. It receives and brings to the attention of the 
Secretary of the Navy all applications from officers for duty or leave. 
It receives all reports of services performed by individual officers or men, 
and is charged with the enforcement of regulations and instructions re- 
garding naval ceremonies and naval etiquette. 
It is charged with the upkeep and operation of the Hydrographic Of- 
fice, the Naval Observatory, Nautical Almanac, and compass offices, and 
with all that relates to the collection, dissemination, and supply of navi- 
gational data and the supply and upkeep of navigational instruments. It 
has charge of all ocean and lake surveys and ships’ and crews’ libraries; 
it defrays the expenses of pilotage of all ships in commission. 
Under the Bureau of Navigation are the following: 
Naval Observatory.—The Naval Observatory at Washington, D. C., and the 
Navy Chronometer Time Station at the navy yard, Mare Island, Calif., furnish 
the country with the standard time each day, both by telegraph and radio, and 
the adjacent oceans by radio, the former supplying that part of the country 
east of the Rocky Mountains and the latter that part west. The Naval Observa- 
tory supervises the outfits of instruments for the naval service and keeps up 
continuous fundamental observations of the heavenly bodies for the use of the 
Nautical Almanac Office, which prepares the American Ephemeris and Nautical 
Almanac each year for. the use of navigators, surveyors, and others requiring 
the positions and movements of the heavenly bodies. 
Hydrographic Office.—The Hydrographic Office is charged with marine surveys 
in foreign waters and with the collection and dissemination of hydrographic 
and navigational data; the preparation and printing of maps and charts relat- 
ing to and required in navigation; the preparation of navigators’ sailing direc- 
tions or pilots, and manuals of instruction for the use of all vessels of the 
United States and for the benefit and use of navigators generally; the furnish- 
ing of the foregoing to the Navy and other public services; and their sale to 
the mercantile marine and the public at cost. 
Bureau of Yards and Docks. 
The duties of the Bureau of Yards and Docks comprise all that relates to 
the design and construction of the public works and public utilities of the 
Navy such as dry docks, marine railways, building ways, harbor works, quay 
walls, piers, wharves, slips, dredging, landings, floating and stationary cranes, 
power plants, coaling and fuel plants, heating, lighting, telephone, water, sewer, 
and railroad systems, roads, walks and grounds, bridges, radio towers, and all 
buildings, for whatever purpose needed, under the Navy and Marine Corps. 
It provides for the upkeep and operation of the same, except at naval ord- 
nance establishments, naval training stations, the Naval Observatory, the Naval 
War College and the Naval Academy, naval hospitals and medical supply depots, 
marine posts, radio stations, and the engineering experiment station. It designs 
and makes the estimates for public works after consulting as to their operating 
features with the bureau or office for whose use they are primarily intended. 
It has charge of all means of transportation, such as derricks, shears, locomo- 
tives, locomotive cranes, cars, motor trucks, and all vehicles, horses, teams, 
and necessary operators and teamsters in the navy yards and naval sta- 
tions. It provides the furniture for all buildings, except at the naval maga- 
zines, hospitals, the Naval Academy, and marine posts. It provides clerks for 
the offices of the commandant, captain of the yard, and public works officer. In ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
587 
general, the work of the bureau is carried out by commissioned officers of the 
Corps of Civil Engineers, United States Navy, whose major duties comprise the 
construction and maintenance of the public works of the Navy. 
Bureau of Ordnance. 
The duties of the Bureau of Ordnance comprise all that relates to the upkeep, 
repair, and operation of the naval gun factory, naval ordnance plants, naval 
torpedo stations, naval proving grounds, naval ammunition depots, naval maga- 
zines on shore, and naval mine depots; to the manufacture of offensive and 
defensive arms and apparatus (including torpedoes and armor), all ammuni- 
tion, and war explosives. It requires for or manufactures all machinery, appa- 
ratus, equipment, material, and supplies required by or for use with the above. 
It determines the interior dimensions of revolving turrets and their require- 
ments as regards rotation. 
As work proceeds it inspects the installation of the permanent fixtures of the 
armament and its accessories on board ship, and the methods of stowing, 
handling, and transporting ammunition and torpedoes, all of which work must 
be performed to its satisfaction. It designs and constructs all turret ammuni- 
tion hoists, determines the requirements of all ammunition hoists, and the 
method of construction of armories and ammunition rooms on shipboard, 
and in conjunction with the Bureau of Construction and Repair, determines 
upon their location and that of all ammunition hoists outside of turrets. It 
installs all parts of the armament and its accessories which are not perma- 
nently attached to any portion of the structure of the hull, excepting turret 
guns, turret mounts, and ammunition hoists, and such other mounts as require 
simultaneous structural work in connection with the installation or removal. 
It confers with the Bureau of Construction and Repair respecting the arrange- 
ments for centering the turrets and character of the roller paths and their 
supports. 
It has cognizance of all electrically operated ammunition hoists, rammers, 
and gun-elevating gear in turrets; of electric training and elevating gear for 
gun mounts not in turrets; of electrically operated air compressors for charging 
torpedoes; and of all range finders and battle-order and range transmitters 
and indicators. 
Bureau of Construction and Repair. 
The duties of the Bureau of Construction and Repair comprise the responsi- 
bility for the structural strength and stability of all ships for the Navy; all 
that relates to designing, building, fitting, and repairing the hulls of ships, 
turrets, and electrical turret-turning machinery, spars, capstans, windlasses, 
deck winches, boat cranes, steering engines and telemotors therefor, and hull 
ventilating apparatus (except portable fans) ; and, after consultation with the 
Bureau of Ordnance and according to the requirements thereof as determined 
by that bureau, the designing, construction, and installation of independent 
ammunition hoists, the same to conform to the requirements of the Bureau of 
Ordnance as to power, speed, and control, and the installation of the permanent 
fixtures of all ammunition hoists and their appurtenances; placing and securing 
armor; placing and securing on board ship, to the satisfaction of the Bureau 
of Ordnance, the permanent fixtures of the armament and its accessories as 
manufactured and supplied by that bureau; installing the turret guns, turret 
mounts, and turret ammunition hoists, and such other mounts as require simul- 
taneous structural work in connection with installation and removal. It also 
47829°—23 38 588 
HOSPITAL CORPS HANDBOOK. 
designs, after conference with the Bureau of Ordnance, the arrangements for 
centering the turrets, the character of the roller paths and their supports. 
The Bureau of Ordnance is afforded every opportunity to inspect the installa- 
tion of the armament and accessories supplied hy that bureau. 
It has charge of the docking of ships and is charged with the operating and 
cleaning of dry docks. 
It is responsible for the care and preservation of ships not in commission. 
It has cognizance of electric launches and other boats supplied with electric 
motive power. 
It has charge of the manufacture of anchors and cables; the supplying and 
tilting of rope, cordage, sails, awnings, and other canvas, and flags and bunting; 
it supplies to the satisfaction of the Bureau of Supplies and Accounts galley 
ranges, steam cookers, and other permanent galley fittings, and installs and 
repairs the same. 
It supplies and installs in consultation with the Bureau of Engineering, all 
voice tubes and means of mechanical signal communications. 
Bureau of Engineering. 
The duties of the Bureau of Engineering comprise all that relates to design- 
ing, building, fitting out, and repairing machinery used for the propulsion of 
naval ships; the steam pumps, steam heaters, distilling apparatus, refrigerating 
apparatus, all steam connections of ships, and the steam machinery necessary 
for actuating the apparatus by which turrets are turned. 
It inspects all fuel for the fleet and has cognizance of the entire system of 
interior communications. It is specifically charged with the design, supply, 
installation, maintenance, and repair of all means of interior and exterior elec- 
tric signal communications (except range finders and battle-order and range 
transmitters and indicators), and of all electrical appliances of whatsoever 
nature on board naval vessels, except motors and their controlling apparatus 
used to operate the machinery belonging to the other bureaus. 
It supplies and installs fill conduit and molding or plans for such installation 
after consultation with the Bureau of Construction and Repair and subject to 
the approval of that bureau. 
It has supervision and control of the upkeep and operation of the engineering 
experiment station. 
It designs the various shops at navy yards and stations where its own work 
is executed so far as their internal arrangements are concerned. 
Bureau of Medicine and Surgery. 
“ The Bureau of Medicine and Surgery shall have charge of the upkeep and 
operation of all hospitals and of the force employed there; it shall advise with 
respect to all questions connected with hygiene and sanitation affecting the 
service and, to this end, shall have opportunity for necessary inspection; it 
shall provide for physical examinations; it shall pass upon the competency, 
from a professional standpoint, of all men in the Hospital Corps for enlistment, 
enrollment, and promotion by means of examinations conducted under its su- 
pervision or under forms prescribed by it; it shall recommend and have 
information as to the assignment and duties of all enlisted men of the Hospital 
Corps; it shall recommend to the Bureau of Navigation the complement of 
medical officers, dental officers, nurses, and hospital corpsmen for hospitals 
and hospital ships, and shall have power to appoint and remove all nurses in 
the Nurse Corps, subject to the approval of the Secretary of the Navy.” (Art. 
457 (1), N. R.) ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
589 
“ Except as otherwise provided for, the duties of the Bureau of Medicine 
and Surgery shall include the upkeep and operation of medical supply depots, 
medical laboratories, naval hospitals, dispensaries, technical schools for the 
Medical, Dental, and Hospital Corps; and the administration of the Nurse 
Corps.” (Art. 457 (2), N. R.) 
“It shall approve the design of hospital ships in so far as relates to their 
efficiency for the care of the sick and wounded.” (Art. 457 (3), N. R.) 
“ It shall require for all supplies, medicines, and instruments used in the 
medical department of the Navy. It shall have control of the preparation, 
reception, storage, care, custody, transfer, and issue of all supplies of every 
kind used in the medical department for its own purposes.” (Art. 457 
(4), N. R.) 
“ The Bureau of Medicine and Surgery is charged with the duty of inspecting 
the sanitary condition of the Navy and making recommendations in reference 
thereto; of advising with the department and other bureaus in reference to the 
sanitary features of ships under construction and in commission; regarding 
berthing, ventilation, location of quarters for the care and treatment of the 
sick and injured; of all provisions for the care of the wounded in battle; and, 
in the case of shore stations, of advising in regard to health conditions, depend- 
ing on location, the hygienic construction, and care of public buildings, espe- 
cially barracks and other habitations, such as camps. It shall advise in regard 
to water supplies used for drinking, cooking, and bathing purposes, and drainage 
and the disposal of wastes, so far as these affect the health of the Navy. It 
shall provide for the care of the sick and wounded, the physical examination 
of officers and enlisted men, with a view to the selection or retention of those 
only whose physical condition is such as to maintain or improve the military 
efficiency of the service if admitted or retained therein, the management and 
control of naval hospitals and of the internal organization and administration 
of hospital ships, the instruction of the personnel of the Hospital Corps and 
Nurse Corps, and the furnishing of all medical and hospital supplies. It shall 
advise in matters pertaining to clothing and food so far as these affect the 
health of the Navy. It shall safeguard the personnel by the employment of 
the best methods of hygiene and sanitation, both afloat and ashore, with a view 
to maintaining the highest possible percentage of the personnel ready for 
service at all times. It shall adopt for use all such devices or procedures as 
may be developed in the sciences of medicine and surgery which will in any 
way tend to an increase in military efficiency.” (Art. 458 (1), N. R.) 
“All technical schools which are, or may be, established for the education of 
medical and dental officers or members of the Hospital Corps and Nurse Corps 
shall be under the supervision and control of the Bureau of Medicine and Sur- 
gery.” (Art. 458 (2), N. R.) 
Bureau of Supplies and Accounts. 
The duties of the Bureau of Supplies and Accounts comprise all that relates 
to the purchase, reception, storage, care, custody, transfer, shipment, issue of, 
and accounting for all supplies and property of the Naval Establishment except 
medical supplies (but including their purchase) and supplies for the Marine 
Corps ; the procuring of provisions, clothing, and small stores, and material under 
the Navy Supply Account. This fund, which is administered by the Bureau of 
Supplies and Accounts, governs the charging, crediting, receipt, purchase, trans- 
fer, manufacture, repair, issue, and consumption of all stores for the Naval Es- 
tablishment except for a few items which are specifically exempted. The direc- 
tion of naval clothing factories and their cost of operation also come under the 
control of this bureau. 590 
HOSPITAL CORPS HANDBOOK. 
It procures all coal and fuel for steamers’ and ships’ use, including expenses 
for transportation, storage, and handling the same; and water for all purposes 
on board naval vessels, including the expense of transportation and storage of 
the same. 
The duties also comprise all that relates to the supply of funds for Navy 
disbursing officers; payment for articles and services for which contract and 
agreement haye been made; responsibility for the keeping of the property and 
the money accounts of the Naval Establishment, including accounts of all manu- 
facturing and operating expense at the navy yards and stations, the direction 
of naval cost accounting, and the audit of property returns. 
It prepares the estimates for the appropriation for freight, fuel, provisions, 
and clothing for the Navy, the maintenance of the supply, accounting, and dis- 
bursing departments at navy yards and stations, and for the pay of all officers 
and enlisted men of the Navy. 
Bureau of Aeronautics. 
The duties of the Bureau of Aeronautics comprise all that relates to designing, 
building, fitting out, and repairing naval and Marine Corps aircraft, except 
that the bureau recommends to each bureau of the Navy Department the 
nature and priority of experimental development and production of aeronau- 
tical material under that bureau’s cognizance. 
When designs are to be prepared for a new type of aircraft the Bureau of 
Aeronautics has duties in respect to the General Board similar to those pre- 
scribed for the Bureau of Construction and Repair in article 402, United 
States Navy Regulations, 1920. 
It makes special provision in its organization to enable it to furnish the 
information covering all aeronautic planning, operations, and administration 
that may be called for by the Chief of Naval Operations. 
It makes recommendations to the Bureau of Navigation and the Major 
General Commandant, United States Marine Corps, for the detail of officers 
for duty in connection with aeronautics, for the distribution in the various 
ratings and ranks of the enlisted personnel required for aeronautic duties, 
and on all matters pertaining to aeronautic activities. 
The Bureau of Aeronautics has cognizance over the policy of the upkeep 
and operation of: 
(a) Naval aircraft factories. 
(&) Naval aeronautic experimental stations. 
(c) Helium plants in so far as they come under naval cognizance. 
Experimental and test work of other bureaus affecting aeronautical material 
is made in accordance with requests of the bureau. The installation of ord- 
nance material and navigational instruments in aircraft and the repairs 
of public works utilities at aeronautic shore establishments, their upkeep and 
operation are under the cognizance of the Bureau of Aeronautics. 
The Judge Advocate General of the Navy. 
Attached to the Secretary of the Navy’s office is the office of the Judge Advo- 
cate General. The Judge Advocate General of the Navy is appointed by the 
President for four years, by and with the consent of the Senate, from officers 
of the Navy or Marine Corps, and, while so serving, has the rank of rear 
admiral (upper half) in the Navy or major general in the Marine Corps, as 
the case may be. 
In accordance with the statute creating his office, the Judge Advocate General 
is charged with the handling and has cognizance of all matters of law arising ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
591 
in the Navy Department. This includes the revision and reporting upon the 
legal features and recording of the proceedings of all courts-martial, courts of 
inquiry, boards of investigation and inquest, and boards for the examination 
of officers for retirement and promotion in the naval service; the preparation 
of charges and specifications for general courts-martial; the preparation of 
precepts for and the making of changes in membership of departmental exam- 
ining boards, retiring boards, courts of inquiry, boards of investigation, and 
general courts-martial; the preparation of court-martial orders promulgating 
the final action of the reviewing authority in general court-martial cases, except 
those of enlisted men convened by officers other than the Secretary of the 
Navy; the examining and reporting upon all questions relating to rank and 
precedence, to promotion and retirement, to the administration of naval prisons 
and prisoners, including prisoners of war, to removal of the mark of desertion, 
to correction of records of service of naval personnel, to pardons and to certifi- 
cation of discharge in true name; the interpretation of statutes; the drafting 
of proposed legislation originating in the Navy Department; the examination 
and reporting upon all bills and resolutions introduced in Congress and referred 
to the Navy Department for report; proceedings in civil courts by or against 
the Government or its officers; the summoning and subpoenaing of witnesses; 
the preparation of and handling of questions of law relating to advertisements, 
proposals and contracts, insurance, leases, patents, the sufficiency of official 
contracts, bonds, and other guaranties; claims by or against the Government; 
and the conducting of correspondence relating to the above, including the prepa- 
ration for submission to the Attorney General of all questions which the Secre- 
tary of the Navy may direct to be so submitted. 
It is also the duty of the Judge Advocate General to investigate and report 
upon all questions relating to pay and allowances of naval personnel and pre- 
pare references to the general accounting officers of the Treasury; and to 
study international law and examine and report upon questions of international 
law as arising. 
He is charged, under the special instructions of the Secretary of the Navy, 
with the searching of titles, purchase, sale, transfer, and other questions affect- 
ing lands and buildings pertaining to the Navy and with the care and preserva- 
tion of all muniments of title to land acquired for naval purposes. The 
correspondence respecting the foregoing duties, and rendering opinion upon the 
matter or question of law referred to him by the Secretary or Assistant Secre- 
tary of the Navy. 
PERSONNEL OF THE NAVY. 
To comprehend clearly matters pertaining to the personnel of the Navy it 
is necessary to understand the general divisions of this personnel and the 
several corps comprising it, as well as the different ranks and grades of the 
officers and the many ratings held by the enlisted men. 
The personnel of the Navy is composed of officers and enlisted men, their 
numbers varying in accordance with the authorized strength of the Navy 
allowed by law or by funds appropriated for pay of the Navy, and regulated 
largely by service requirements. 
An officer is one appointed to a certain rank and authority by the President 
of the United States by and with the advice and consent of the Senate. In the 
Navy an officer is appointed by either commission or warrant. This divides the 
officers as a whole into two classes, commissioned officers and warrant officers. 
An officer’s tenure in the Navy is for life, unless sooner terminated by 
removal, resignation, disability, or other casualty. 592 
HOSPITAL CORPS HANDBOOK. 
The enlisted men of the Navy, as the term indicates, are enlisted or engaged 
for periods of service and discharged from the service at the expiration of such 
enlistment. At the expiration of an enlistment they can reenlist or extend 
the current enlistment for a variable period of from one to four years. 
Commissioned officers of the line. 
Commissioned officers of the line are those who succeed to a command and 
who automatically assume command in order of seniority, even in the presence 
of staff officers of a higher rank. 
Officers of the fine in the Navy, with few exceptions, are graduates from the 
United States Naval Academy at Annapolis, Md., where they receive training 
by the Government in the duties essential to naval science. 
While attending the Naval Academy they rank as midshipmen; midshipmen, 
though not commissioned, enjoy certain privileges and consideration as officers 
of the Navy. Upon graduation midshipmen are commissioned ensigns. 
The commissioned officers of the line in the Navy have the rank of admiral, 
vice admiral, rear admiral, captain, commander, lieutenant commander, lieu- 
tenant, lieutenant (junior grade) and ensign, corresponding to the ranks of 
general, lieutenant general, major general, colonel, lieutenant colonel, major, 
captain, first lieutenant, and second lieutenant, respectively, in the Army. 
Commissioned officers of the staff. 
The staff is a body of officers, not succeeding to command but entrusted with 
special duties peculiar to their training. They may be classed as specialists 
by reason of the training in particular professions received, in civil life, by most 
of them, and are appointed in the Navy after passing a professional examina- 
tion. An exception to this is the Naval Construction Corps, which is made up 
principally of officers selected from the graduates of the Naval Academy. 
The commissioned staff of the Navy comprises medical officers, dentai officers, 
supply officers, chaplains, professors of mathematics, naval constructors, and 
civil engineers. These officers are divided into corps in accordance with the 
designation of their professions as indicated, i. e., Medical Corps, Dental 
Corps, Supply Corps, Corps of Chaplains, Corps of Professors of Mathematics, 
Construction Corps, and Civil Engineer Corps. 
The Medical and Dental Corps of the Navy, of particular interest to hospital 
corpsmen, are comprised of medical and dental officers having the following 
grades and ranks: 
at , -r,- fRear Admiral. 
[ Captain. 
Medical Inspector Commander. 
Surgeon Lieutenant Commander. 
Passed Assistant Surgeon Lieutenant. 
Assistant Surgeon 1T. , , ,. , . 
. . . J „ (Lieutenant (junior grade). 
Acting Assistant Surgeon J 
Dental Surgeon Lieutenant Commander. 
Passed Assistant Dental Surgeon Lieutenant. 
Assistant Dental Surgeon Lieutenant (junior grade). 
Dental officers while not promoted above the rank of lieutenant commander 
may, after serving the prescribed time in the rank, receive the pay and allow- 
ances of a commander and captain. 
Warrant officers. 
Warrant officers in the Navy are of two classes: Commissioned or chief 
warrant officers, appointed by the President, by and with the advice and con- ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
593 
sent of the Senate, ranking with, but after, ensign; and warrant officers, ap- 
pointed by the Secretary of the Navy, and ranking with, but after, midshipman. 
There are seven corps of warrant officers, as follows: Boatswains, gunners, 
and machinists, who belong to the line, and carpenters, sailmakers, pharmacists, 
and pay clerks, who belong to the staff. After six years’ service as such, and 
after passing satisfactorily such examination as the Secretary of the Navy may 
prescribe, warrant officers are promoted to the grade of commissioned war- 
rant officers, and are then known as chief boatswains, chief gunners, etc. 
Commissioned warrant officers with creditable records, after 6 and 12 years’ 
service as such, receive the pay and allowances of the second and third pay 
periods, respectively. Chief boatswains, chief gunners, or chief machinists, 
and boatswains, gunners, or machinists are eligible for examination for appoint- 
ment as ensign and may be appointed as such, not to exceed 12 in any one 
year. Acting pay clerks, pay clerks, and chief pay clerks are eligible for 
examination for appointment as assistant paymaster. 
Enlisted personnel. 
As previously mentioned, all enlisted men enter the Navy for a stated period 
of service. 
The enlisted personnel of the Navy is divided into six branches—seaman, 
artificer, special, commissary, messman, and aviation. The tabulation below 
shows the distribution and precedence of ratings by classes, with the abbrevia- 
tion of each rating as directed to be used by the Bureau of Navigation: 
Chief Petty Officers. 
Chief boatswain’s mate C. B. M. 
Chief gunner’s mate C. G. M. 
Chief turret captain C. T. C. 
Chief torpedoman C. T. M. 
SEAMAN ERANCH. 
Chief quartermaster C. Q. M. 
Chief signalman C. S. M. 
Chief fire controlman C. F.C. 
ARTIFICER BRANCH. 
Chief machinist’s mate C. M. M. 
Chief motor machinist’s mate C. Mo. M. M. 
Aviation chief machinist’s mate.. .A. C. M. M. 
Chief water tender C. W. T. 
Chief electrician’s mate C. E. M. 
Chief radioman C. R. M. 
Chief carpenter’s mate C. C. M. 
Chief shipfitter C. S. F. 
Aviation chief carpenter’s mate A. C. C. M. 
Aviation chief metalsmith A. C. M. 
Aviation chief rigger A. C. R. 
Chief printer C. Prtr. 
SPECIAL BRANCH. 
Chief yeoman C. Y. 
Chief storekeeper. C. S. K. 
Chief commissary steward C. C. Std. 
Chief photographer C. P. 
Bandmaster B. Mstr, 
Chief pharmacist’s mate - C. Ph. M. 
Petty Officers, First Class. 
SEAMAN BRANCH. 
Boatswain’s mate, first class B. M. lc. 
Gunner’s mate, first class G. M. lc. 
Turret captain, first class T. C. lc. 
Torpedoman, first class T. M. lc. 
Quartermaster, first class Q. M. lc. 
Signalman, first class S. M. lc. 
Fire controlman, first elsas F. C. lc, 
Machinist’s mate, first class M. M. lc. 
Motor machinist’s mate, first class. Mo. M. M. lc. 
Aviation machinist’s mate, first 
class A. M. M. lc. 
Engineman, first class.., Eng. lc. 
Water tender, first class W. T. lc. 
Electrician’s mate, first class E- M. lc. 
Radioman, first class. R. M. lc. 
Carpenter’s mate, first class........ C. M. le. 
Shipfitter, first class g. F. lc. 
Coppersmith, first class. Csmth. lc. 
ARTIFICER BRANCH. 
Blacksmith, first class Bsmth. lc. 
Boilermaker, first class Bmkr. lc. 
Molder, first class Mldr. lc. 
Patternmaker, first class Pmkr. lc. 
Aviation carpenter’s mate, first 
class A. C, M. lc. 
Aviation metalsmith, first class A. M. le. 
Aviation rigger, first class A. R. lc, 
Printer, first class Prtr. lc, 
Painter, first class Ptr. lc, 
; Sailmaker’s mate, first class S. M. M, lc. 594 
HOSPITAL CORPS HANDBOOK. 
Yeoman, first class Y. lc. 
Storekeeper, first class S. K. lc. 
Commissary steward C. Std. 
Photographer, first class P. lc. 
SPECIAL BRANCH. 
First musician 1st. Mus. 
Ship’s cook, first class S. C. lc. 
Baker, first class Bkr. lc. 
Pharmacist’s mate, first class Ph. M. lc 
Petty Officers, Second Class. 
Boatswain’s mate, second class B. M. 2c. 
Gunner’s mate, second class G. M. 2c. 
Torpedoman, second class T. M. 2c. 
SEAMAN BRANCH. 
Quartermaster, second class Q. M. 2c. 
Signalman, second class S. M. 2c. 
Machinist’s mate, second class M. M. 2c. 
Motor machinist’s mate, second 
class Mo. M. M. 2c. 
Aviation machinist’s mate, second 
class A. M. M. 2c. 
Engineman, second class Eng. 2c. 
Water tender, second class W. T. 2c. 
Electrician’s mate, second class E. M. 2c. 
Radioman, second class R. M. 2c. 
Carpenter’s mate, second class C. M. 2c. 
Shipfitter, second class S. F. 2c. 
Coppersmith, second class Csmth. 2c. 
ARTIFICER BRANCH. 
Blacksmith, second class Bsmth. 2c. 
Boilermaker, second class Bmkr. 2c. 
Molder, second class Mldr. 2c. 
Patternmaker, second class...’ Pmkr. 2c. 
Aviation carpenter’s mate, second 
class A.C.M.2c. 
Aviation metalsmith, second class. A. M. 2c. 
Aviation rigger, second class A. R. 2c. 
Printer, second class Prtr. 2c. 
Painter, second class Ptr. 2c. 
Sailmaker’s mate, second class S. M. M. 2c. 
Yeoman, second class Y. 2c. 
Storekeeper, second class S. K. 2e. 
Photographer, second class P. 2c. 
SPECIAL BRANCH. 
Ship’s cook, second class S. C. 2c. 
Baker, second class Bkr. 2c. 
Pharmacist’s mate, second class... Ph. M. 2c. 
Petty Officers, third class. 
Coxswain Cox. 
Gunner’s mate, third class G. M. 3c. 
Torpedoman, third class T. M. 3c. 
SEAMAN BRANCH. 
Quartermaster, third class Q. M. 3c. 
Signalman, third class S. M. 3c. 
Electrician's mate, third class E. M. 3c. 
Radioman, third class R. M. 3c. 
Carpenter’s mate, third class C. M. 3c. 
Shipfitter, third class S. F. 3c. 
Aviation carpenter’s mate, third 
class A. C. M. 3c. 
ARTIFICER BRANCH. 
Aviation metalsmith, third class... A. M. 3c. 
Aviation rigger, third class A. R. 3c. 
Printer, third class Prtr. 3c. 
Painter, third class Ptr. 3c. 
Sailmaker’s mate , third class S. M. M. 3c. 
Yeoman, third class. Y. 3c. 
Storekeeper, third class S. IC. 3c. 
Photographer, third class P. 3c. 
SPECIAL BRANCH. 
Ship’s cook, third class S. C. 3c. 
Baker, third class Bkr. 3c. 
Pharmacist’s mate, third class....'. Ph. M. 3c. 
Nonrated Men, First Class. 
SEAMAN BRANCH. 
Seaman, first class Sea. lc 
ARTIFICER BRANCH. 
Fireman, first class F. lc. 
SPECIAL BRANCH. 
Bugler, first class Bug. lc. J Musician, first class Mus. lc. 
Hospital apprentice, first class H. A. lc. 
Nonrated Men, Second Class, 
seaman branch. 
Seaman, second class Sea. 2c. 
ARTIFICER BRANCH. 
Fireman, second class F. 2c. 
SPECIAL BRANCH. 
Bugler, second class Bug. 2c. | Musician, second class Mus. 2c. 
Hospital apprentice, second class H. A. 2c. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
595 
Nonrated Men, Third Class. 
SEAMAN BRANCH. 
Apprentice seaman A. S. 
ARTIFICER BRANCH. 
Fireman, third class F. 3e. 
MESSMAN BRANCH. 
Cabin steward Cab. Std. 
Cabin cook Cab. Ck. 
Wardroom steward W. R. Std. 
Wardroom cook W. R. Ck. 
Steerage steward Stg. Std. 
Steerage cook Stg. Ck. 
Warrant officer’s steward W. O. Std. 
Warrant officer’s cook W. O. Ck. 
Mess attendant, first class M. Att. lc. 
Mess attendant, second class M. Att. 2c. 
Mess attendant, third class M. Att. 3c. 
The titles of the Marine Corps enlisted personnel as abbreviated by the 
Medical Department are as follows: 
Sergeant (all grades) Sgt. 
Corporal Corp. 
Private Pvt. 
Apprentice Marine App. 
Drummer Drum. 
Trumpeter Tpt. 
The ranks of officers, the several staff corps and the titles of members of 
the Nurse Corps (female) are abbreviated by the Medical Department as fol- 
lows : 
Admiral Adm. 
Vice Admiral VAdm. 
Rear Admiral RAdm. 
Captain (U. S. N.) Capt. 
Commander Comdr. 
Lieutenant Commander Lt-Comdr. 
Lieutenant Lt. 
Lieutenant (junior grade) Lt-jg. 
Ensign Ens. 
Midshipman Mid-lc, etc. 
Chief Boatswain ChBtsn. 
Boatswain Btsn. 
Chief Gunner ChGun. 
Gunner Gun. 
Chief Machinist ChMach. 
Machinist Mach. 
Chief Carpenter ChCarp. 
Carpenter Carp. 
Chief Sailmaker ChSlmkr. 
Sailmaker Slmkr. 
Chief Pharmacist ChPharm. 
Pharmacist Pharm. 
Chief Pay Clerk ChPayClk. 
Pay Clerk PayClk. 
Acting Pay Clerk ActPayClk. 
Major general (U. S. M. C.) MajGM. 
Brigadier general (U. S. M. C.) BrGM. 
Colonel (U. S. M. C.) ColM. 
Lieutenant colonel (U. S. M. C.) LtCM. 
Major (U. S. M. C.) MajM. 
Captain (U. S. M. C.) CaptM. 
First lieutenant (U. S. M. C.) 1-Lt. 
Second lieutenant (U. S. M. C.) 2-Lt. 
Marine gunner (U. S. M. C.) Mar. Gun. 
Quartermaster clerk (U. S. M. C.).. QMClk. 
Pay clerk (U. S. M. C.) PayClkM. 
(The abbreviations, in parentheses, immediately follow the abbreviation of the rank.) 
STAFF CORPS. 
Medical Corps (MC). 
Medical Corps (dental surgeons)... (MCDS). 
Supply Corps (SC). 
Chaplain Corps (ChC). 
Construction Corps (CC). 
Public Health Service (PHS). 
Civil Engineer Corps (CEC). 
Professors of Mathematics (Math). 
Retired (Ret). 
Coast Guard Service (CGS). 
Lighthouse Service (LHS). 
Superintendent Supt. 
Chief Nurse Ch. Nurse. 
NURSE CORPS (F.). 
Nurse Nurse. 
THE FLEET AND THE NAVAL STATIONS FOR ITS UPKEEP. 
Primarily, the Navy is the fleet, composed of the combatant ships and 
their auxiliaries. 
The vessels of the fleet comprise battleships, cruisers and light cruisers, 
aircraft carriers, mine layers, mine sweepers, destroyers, submarines, patrol 
vessels (gunboats, etc.), destroyer, submarine and aircraft tenders, repair 596 
HOSPITAL CORPS HANDBOOK, 
ships, store ships, colliers, oilers, ammunition and cargo ships, transports, 
hospital ships, and fleet tugs. 
The principal naval force is the United States Fleet, and those forces 
not assigned to the United States Fleet are organized as separate commands 
as follows; 
Asiatic Fleet. 
Naval Forces, Europe. 
Special Service Squadron. 
Submarine Divisions, Atlantic. 
Submarine Divisions, Pacific. 
Naval District Forces. 
The United States Fleet is composed of the following fleets and forces: 
(1) Battle Fleet, (2) Scouting Fleet, (3) Control Force, and (4) Fleet Base 
Force, each of which consists of units of vessels of different types. 
Although afloat, the fleet and its auxiliaries must place great dependence 
on shore stations for many repairs, for supplies and equipment, and for 
personnel so that the maximum of efficiency may he maintained. As a direct 
result of this dependence of the fleet, the Navy Department has under its 
control a number of naval stations both within and without the continental 
limits of the United States. The most important are enumerated below. 
Navy yards or naval stations. 
Portsmouth, N. H.; Boston, Mass.; Newport, It. I.; New York, N. Y.; Phila- 
delphia, Pa.; Washington, D. C.; Norfolk, Va.; Charleston, S. C.; Mare Island, 
Calif.; Puget Sound, Wash.; Pearl Harbor, T. H.; Samoa, Guam, Cavite, and 
Olongapo, P. I.; Virgin Islands of United States; Guantanamo Bay, Cuba. 
Naval operating bases. 
Hampton Roads, Va.; Key West, Fla.; San Diego, Calif.; San Francisco, 
Calif.; Canal Zone; Pearl Harbor, T. H. 
Naval training stations. 
Newport, R. I.; Hampton Roads, Va.; Great Lakes, 111.; San Diego, Calif. 
Submarine bases. 
New London, Conn.; Hampton Roads, Va. 
Naval torpedo stations. 
Newport, It. I.; Alexandria, Va.; Keyport, Wash. 
Naval proving ground. 
Dahlgren, Va. 
Naval powder factory. 
Indianhead, Md. 
Naval mine depot. 
Yorktown, Va. 
Ammunition depots. 
Hingham, Mass.; Iona Island, N. Y.; Dover, N. J,; Fort Mifflin, Pa.; St. 
Juliens Creek, Va.; Mare Island, Calif.; Puget Sound, Wash. 
In addition to the stations enumerated above, the following activities are 
controlled by the Navy Department: 
Naval Academy, Annapolis, Md. 
Naval Gun Factory, Washington, D. C, 
Naval Experimental and Research Laboratory, Bellevue, D, C. 
Naval Ordnance Plants, Baldwin, Long Island; and South Charleston, W. Va. 
Naval Supply Depot, South Brooklyn, N. Y, ORGANIZATION, clerical duties and procedures. 
597 
The following definitions from United States Navy Regulations clearly state 
the composition and object of shore stations, strategy, tactics, and naval policy: 
“ A naval base is, generically, a center from which men-of-war can operate 
and be maintained, and may be of a permanent or temporary character, depend- 
ing upon whether its constructed naval accommodations are of a fixed or 
transient nature.” (Art. 2050 («), N. R.) 
“ Naval bases are divided geographically into two classes, home bases and 
outlying bases, and these are themselves divided by their facilities into main 
bases, subsidiary bases, and bases for particular types of naval craft. (De- 
stroyer bases, submarine bases, aviation bases, etc.).” (Art. 2050 (b), N. R.) 
“A main base is one within the continental territory of the country, from 
which the fleet can operate at all times and which is designed to maintain 
the fleet in all respects, both in peace and war.” (Art. 2050 (c), N. R.) 
“A main outlying base is one without the continental limits of the country, 
having as many of the attributes of a main home base as practicable, and 
designed to be a strong point of support for the fleet and from which it can be 
maintained for limited periods in war.” (Art. 2050 (d), N. R.) 
“A subsidiary base (home or outlying) is one that contains some of the 
fixed elements of a main base and which, while not capable of supporting and 
maintaining'the whole fleet, may so care for portions of it.” (Art. 2050 (e), 
N. R.) 
“A destroyer, submarine, aviation, or other base for particular types of 
naval craft is one from which the type in question can operate and be main- 
tained. It may or may not form part of a main or subsidiary base.” (Art. 
2050 (/), N. R.) 
“An outlying base of a temporary character used in war for the fleet 
or portions of it is termed as advanced base.” (Art. 2050 (g), N. R.) 
“ The characters, composition, and strength of naval bases will depend upon 
the necessities of service, at all times.” (Art. 2050 (h), N. R.) 
“A naval station is the location of a particular form of naval activity, 
and may or may not form part of a naval base.” (Art. 2050 (i), N. R.) 
“ A naval depot is the location where naval personnel or materiel is stored 
and delivered, and may or may not form a part of a naval base.” (Art. 
2050 (j), N. R.) 
“ Strategy applies to the distribution of naval forces, their armament and 
supplies in preparation for war or in the prosecution of war. It includes 
logistics. It refers to naval movements and dispositions made before contact 
with enemy’s forces.” (Art. 2051. N. R.) 
“ Tactics applies to all naval movements and operations made after contact 
with the enemy’s forces. The term ‘ contact ’ is here employed in a broad 
sense, meaning such proximity to the enemy as affects fleet formation and 
renders a battle imminent.” (Art. 2052, N. R.) 
“ Naval policy.—Everything that includes the fixed condition of preparation 
for war; that is, the strength, character, and composition of the Navy, fortifi- 
cation of ports and bases, etc. (This will be based upon our political relations 
and the probability of war with different powers. It will also be influenced 
by the conclusions of a comprehensive study of the political relations between 
other powers throughout the world and their influence upon coalitions and 
allowances.”) (Art. 2053, N. R.) 
THE UNITED STATES MARINE CORPS. 
The United States Marine Corps is a military branch of the Navy under con- 
trol of the Secretary of the Navy, and is subject to the laws and regulations for 598 
HOSPITAL CORPS HANDBOOK. 
the government of the Navy. The United States Marine Corps may, by order of 
the President of the United States, be detached for service with the United 
States Army, when it becomes subject to the rules and articles of war pre- 
scribed for the government of the Army. 
The headquarters of the United States Marine Corps is in Washington, D. C. 
The head of the Marine Corps is designated as the major general commandant 
of the Marine Corps, has the rank of major general, and is appointed from 
officers in the Marine Corps by the President, by and with the advice and con- 
sent of the Senate, for four years. 
The commandant of the Marine Corps is responsible to the Secretary of the 
Navy for the general efficiency and discipline of the corps. He makes such dis- 
tribution of officers and men for duty in the several shore stations as appear 
to him to be most advisable for the interests of the service; furnishes detach- 
ments for vessels of the Navy, according to the authorized scale of allowance; 
under the direction of the Secretary of the Navy issues orders for the movements 
of officers and troops and such other orders and instructions for their guidance 
as may be necessary, and has charge and exercises general supervision and con- 
trol of the recruiting service of the corps and of the necessary expenses thereof, 
including the establishment of recruiting stations. 
The duties of the United States Marine Corps are defined by an Executive 
order of November 12, 1908, as follows: “To garrison the different navy yards 
and naval stations, both within and beyond the continental limits of the 
United States. 
“ To furnish the first line of mobile defense of naval bases and naval 
stations beyond the continental limits of the United States. 
“ To man such naval stations and to aid in manning, if necessary, such other 
defenses as may be erected for the defense of naval bases and naval stations 
beyond the continental limits of the United States. 
“ To garrison the Isthmian Canal Zone, Panama.2 
“ To furnish such garrisons and expeditionary forces for duties beyond the 
seas as may be necessary in time of peace.” 
THE BUREAU OF MEDICINE AND SURGERY. 
From before the inception of our Government to August 31, 1842, the history 
of the medical department of the Navy is interwoven with that of other 
branches of the service. 
In 1775 the Continental Congress organized the Navy. Thus it will be seen 
that our Navy has existed longer than the Government and was established 
prior to the Declaration of Independence. Military control of the earliest 
vessels of the Navy was directly under the Continental Congress and was 
conducted through its naval committee. 
Under our present form of government the executive department known as 
the Department of War was created by act of Congress in 1789. This de- 
partment controlled the Navy as well as the Army. By the act of Congress 
of April 30, 1798, another executive department, denominated the Department of 
the Navy, was established. But the Navy Department was not divided into 
bureaus, consisting only of one office, whose head then, as now, was the Secre- 
tary of the Navy. 
2 The marine battalion stationed in the Canal Zone was withdrawn May 1, 1914, and 
has not been replaced. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
599 
Each vessel of the Navy in these historical days carried at least one 
surgeon, and some of the larger ships a surgeon and surgeon’s mate. Surgeons 
usually held commissions, and the surgeon’s mates received warrants. These 
members of the medical profession serving in the Navy seem to have had little, 
if any, relationship to one another (which is not to he wondered at when 
one realizes that at that time there was no medical corps and no organization 
in the Navy Department directly responsible for the supervision of them or 
their work), and their rank and status was not well defined. 
The first attempt to regulate the medical establishment and provide a sys- 
tematic organization occurred in 1799, when Congress authorized the following 
officers in the medical establishment of the United States: “A physician gen- 
eral who shall be charged with the superintendence and direction of all mili- 
tary hospitals, and generally of all medical and chirurgical practice or service 
concerning the Army or Navy of the United States, and of all persons who 
shall be employed in and about the same, in camps, garrisons, and hospitals; 
an apothecary general, and one or more deputies, who shall he charged with 
the safe-keeping and delivery of all medicines, instruments, dressings, and 
other articles for the use of the hospital and Army; a purveyor, who shall 
be charged with providing medicines, stores, and whatsoever else may be 
necessary in relation to said practice or service.” 
In 1815 Congress authorized the President to appoint three naval officers as 
a board of commissioners for the Navy, to be attached to the Secretary’s office 
and, under his direction, to discharge the ministerial duties of his office. Here 
may be seen the first step toward the creation of the present day chiefs of 
bureaus. In 1832 two post captains were added to the board of commissioners 
for the Navy, making five members on the committee. 
Then came the reorganization of the Navy Department, when by the act of 
August 31, 1842, the board of commissioners for the Navy was abolished and 
five bureaus were created to conduct the business of the Navy Department. 
The Secretary of the Navy by this act was directed to assign the duties of 
the newly created bureaus in the following words: “ Sec. 5. And be it further 
enacted, That the Secretary of the Navy shall assign and distribute among the 
said bureaus such of the duties of the Navy Department as he shall judge to be 
expedient and proper; and all the duties of the said bureaus shall be performed 
under the authority of the Secretary of the Navy, and their orders shall be 
considered as emanating from him and shall have full force and effect as such.” 
One of the bureaus created by this act, and by it responsible for conducting 
a part of the business of the Navy Department, was the Bureau of Medicine 
and Surgery, and its existence as a separate and distinct bureau in the Navy 
Department dates from August 31, 1842. 
At that time there were 60 surgeons in the Navy and the first chief of the 
Bureau of Medicine and Surgery was selected from them. Upon the man so 
selected rested the burden of planning the organization of the newly created 
bureau, of developing a medical corps, of coordinating the activities of the 
surgeons and surgeon’s mates, and other personnel, and formulating the neces- 
sary regulations to govern and control this branch of the Navy Department. 
Viewed from the standpoint of later years it must be conceded that a wise 
selection was made in choosing as the first Chief of the Bureau of Medicine 
and Surgery, Surg. William Paul Crillon Barton. By education, training, and 
naval experience he was peculiarly fitted to organize and administer the new 
bureau, and to him must be accorded full credit for the work which he per- 
formed under adverse and trying conditions in establishing the bureau upon 
a firm foundation. 600 
HOSPITAL CORPS HANDBOOK. 
Following is a list of the names of the chiefs of the Bureau of Medicine and 
Surgery and the Surgeons General, United States Navy, from 1842 to date. 
Chief of Bureau. (Act of August 31, 18J)2.) 
William Paul Crillon Barton Sept. 2,1842, to Apr. 1,1844. 
Thomas Harris Apr. 1,1844, to Sept. 30,1853. 
William Whelan Oct. 1,1853, to June 11,1865. 
Phineas J. Horwitz July 1,1865, to June 30,1869. 
Chief of Bureau, with relative rank and pay of commodore and title of Surgeon 
General. (Act of March 3, 1871.) 
William Maxwell Wood July 1,1869, to Oct. 31,1871. 
Jonathan M. Foltz Nov. 1,1871, to June 8,1872. 
James C. Palmer June 10,1872, to July 8,1873. 
Joseph Beale July 9,1873, to Feb. 2,1877. 
William Grier Feb. 3,1877, to Oct. 5,1878. 
J. Winthrop Taylor Oct. 28,1878, to Aug. 19,1879. 
Philip S. Wales Aug. 20,1879, to Jan. 27,1884. 
Francis M. Gunnell Apr. 1,1884, to Apr. 1,1888. 
John Mills Browne Apr. 2,1888, to May 10,1893. 
James Rufus Tryon May 11,1893, to Sept. 7,1897. 
Newton L. Bates Oct. 1,1897, to Oct. 18,1897. 
Chief of Bureau, with the rank of rear admiral, title of Surgeon General, and 
pay and allowances of brigadier general in the Army. (Act of March 3, 
1899.) 
William Knickerbocker Van Reypen Oct. 23,1897, to Jan. 25,1902. 
Presley Marion Rixey Feb. 5,1902, to Feb. 4,1910. 
Charles Francis Stokes Feb. 7,1910, to Feb. 6,1914. 
Chief of Bureau, with the rank of rear admiral, title of Surgeon General, and 
pay and allowances of major general in the Army. (Act of July 1, 1918.) 
William Clarence Braisted Feb. 7,1914, to Nov. 29,1920. 
Edward Rhodes Stitt Nov. 30, 1920 (present incumbent). 
The duties of the Bureau of Medicine and Surgery as defined by the United 
States Navy Regulations, articles 457 and 458, are given on pages 588 and 589. 
To carry out these duties, officers and enlisted men of the Medical Depart- 
ment of the Navy necessarily will be found wherever the activities of the Navy 
lead. 
The primary duty of the medical department of the Navy is to preserve the 
Navy’s personnel from impairment by reason of sickness or injury, and to 
return men so incapacitated to active duty in the shortest period consistent 
with circumstances. To accomplish this object more readily, naval hospitals 
have been established at the geographical points where concentration of naval 
activities occurs and the Bureau of Medicine and Surgery is charged with 
their upkeep and operation under the general charge and superintendence of 
the Secretary of the Navy. Officers and enlisted men of the Navy and Marine 
Corps, afloat or ashore, in need of hospital treatment are transferred to the 
naval hospital most convenient to the ship or station on which they are serving 
at the time. To provide hospital care for the personnel of the fleets when 
transfer to a naval hospital is not possible, modern hospital ships are available. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
601 
It is in naval hospitals that the medical department’s utility as a conserving 
force of the personnel of the Navy becomes most apparent, where its sphere 
of usefulness is best demonstrated, and where all that pertains to the sick 
and injured finds its fullest development. 
The naval hospitals controlled by the Bureau of Medicine and Surgery and 
at present in commission are located at: Portsmouth, N. H.; Chelsea, Mass.; 
Newport, R. I.; New York, N. lr.; League Island, Pa.; Annapolis, Md.; Wash- 
ington, D. C.; Norfolk, Ya.; Parris Island, S. C.; Charleston, S. C.; Key West, 
Fla.; Pensacola, Fla.; Great Lakes, 111.; San Diego, Calif.; Mare Island, 
Calif.; Puget Sound, Wash.; Pearl Harbor, Hawaii; Guam; Canacao, P. I., and 
Yokohama, Japan. The naval hospital at New Orleans, La., is not in commis- 
sion. In addition to the above naval hospitals, at the submarine base at 
New London, Conn., and at the Marine Barracks, Quantico, Ya., establishments 
commonly known as sick quarters provide for the care of the sick and injured 
at these places in a manner similar to naval hospitals. 
In addition to the hospitals directly under the cognizance of the Bureau of 
Medicine and Surgery there are special hospitals at which Navy and Marine 
Corps patients may receive treatment. One is the Army and Navy General Hos- 
pital at Hot Springs, Ark., where relief reasonably may be expected for rheu- 
matic conditions after the acute or inflammatory stages, conditions resulting 
from gout, rheumatism, or metallic or malarial poisoning, chronic skin diseases, 
certain functional diseases, and some other diseases. In the Fitzsimons General 
Hospital, United States Army, at Denver, Colo., cases of pulmonary tubercu- 
losis may receive treatment. Insane cases are cared for at St. Elizabeths Hos- 
pital, Washington, D. C. (formerly known as the Government Hospital for the 
Insane), and at the State hospitals for insane persons at Mendocino and Napa, 
Calif. Patients at these latter institutions may be transferred to St. Elizabeths 
Hospital. At Philadelphia, Pa., “ a permanent asylum for disabled and decrepit 
Navy officers, seamen, and marines ” has been established and is known as the 
United States Naval Home. Here persons who have served 20 years in the 
Navy or Marine Corps and are disabled from earning their living by manual 
labor, who have served nearly that length of time with creditable records and 
been discharged for disability, or who have served a number of years with an 
exceedingly meritorious record and have been disabled in the line of duty, may 
be admitted upon authority of the Secretary of the Navy. 
When naval hospitals are not convenient, the hospitals and contract stations 
of the United States Public Health Service are available for the treatment of 
the Navy’s sick, and in emergency patients may be transferred to a civil hos- 
pital, as provided for in article 1143. United States Navy Regulations. 
THE SOURCE AND DISBURSEMENT OF MONIES PERTAINING TO 
THE BUREAU OF MEDICINE AND SURGERY. 
Annual appropriations. 
Congress annually appropriates money for the expenses of the Navy, and this 
money is placed under the cognizance of the bureaus concerned for economical 
expenditure. One of the most important duties devolving upon the admin- 
istrative head of the Bureau of Medicine and Surgery is the application to the 
proper purposes of the monies under its control. This most important duty 
is performed through the finance division of the Bureau of Medicine and Sur- 
gery. 602 
HOSPITAL CORPS HANDBOOK. 
By means of the monies, services, supplies, medicines, instruments, etc., are 
procured for the medical department of the Navy on ships, stations, and at 
hospitals. As such supplies and services may be obtained only by means of 
requisitions and vouchers it is very important that hospital corpsmen whose 
duty it becomes to prepare requisitions and vouchers for supplies, etc., have 
a clear comprehension of the source and applicability of monies under cogni- 
zance of the bureau. 
While the Bureau of Medicine and Surgery has control over certain monies 
to defray necessary expenses incident to the various duties with which it is 
charged, it should be understood distinctly that the actual disbursement is 
not made by any officer connected with that bureau. This, as does the dis- 
bursement of all money expended for the Navy, devolves upon disbursing officers 
of the Supply Corps under the Bureau of Supplies and Accounts, and in some 
few instances upon the general accounting officers of the Treasury Department. 
Monies controlled by the Bureau of Medicine and Surgery are received from 
two general sources, i. e., annual appropriations made by Congress and the 
Naval Hospital Fund. 
Annual appropriations are made by Congress for the expenses during the 
fiscal year for which made. These appropriations are based upon careful esti- 
mates prepared by the several bureaus for the Secretary of the Navy, and 
transmited by him to the Director of the Budget who submits them to Congress 
through the President of the United Staes. 
The annual appropriations included in tne naval appropriation bill that 
pertain to the Bureau of Medicine and Surgery are classified under the follow- 
ing fixed titles: 
(«) Medical department. 
(b) Contingent, Bureau of Medicine and Surgery. 
(c) Bringing home remains of officers, and so forth. 
(d) Care of hospital patients. 
(e) Salaries, Navy Department. 
The detailed object of expenditures under the fixed titles can be found in 
each annual digest of appropriations. The full phraseology of the several 
bureau appropriations for the fiscal year 1924 immediately follow. The exact 
wording may be changed from year to year to meet exigencies of the service. 
(a) “Medical Department. For surgeon’s necessaries for vessels in com- 
mission, navy yards, naval stations, and Marine Corps; and for the civil estab- 
lishment at the several naval hospitals, navy yards, naval medical supply depots 
Naval Medical School and Dispensary, Washington, and Naval Academy, $1,760,- 
000: Provided, That the sum to be paid out of this appropriation, under the 
direction of the Secretary of the Navy, for clerical service in naval hospitals, 
dispensaries, medical supply depots, and Naval Medical School, for the fiscal 
year ending June 30, 1924, shall not exceed $150,000. 
(&) “ Contingent, Bureau of Medicine and Surgery. For tolls and ferriages; 
care, transportation, and burial of the dead, including officers who die within 
the United States, and supernumerary patients who die in naval hospitals; 
purchase of cemetery lots; purchase of books and stationery, binding of medi- 
cal records, unbound books, and pamphlets; hygienic and sanitary investigation 
and illustration; sanitary, hygienic, and special instruction, including the print- 
ing and issuing of naval medical bulletins and supplements; purchase and re- 
pairs of nonpassenger-carrying wagons, automobile ambulances, and harness; 
purchase of and feed for horses and cows; maintenance, repair, and operation 
of two passenger-carrying motor vehicles for naval dispensary, Washington, ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
603 
District of Columbia, and one motor-propelled vehicle for official use only for 
the medical officer on out-patient medical service at the Naval Academy; trees, 
plants, care of grounds, garden tools, and seeds; incidental articles for the 
Naval Medical School and naval dispensary, Washington, naval medical supply 
depots, sick quarters at Naval Academy and marine barracks; washing for 
medical department at Naval Medical School and naval dispensary, Washington, 
naval medical supply depots, sick quarters at Naval Academy and marine 
barracks, dispensaries at navy yards and naval stations, and ships; and for 
minor repairs on buildings and grounds of the United States Naval Medical 
School and naval medical supply depots; rent of rooms for naval dispensary, 
Washington, District of Columbia, not to exceed $1,200; for the care, main- 
tenance, and treatment of the insane of the Navy and Marine Corps on the 
Pacific coast, including supernumeraries held for transfer to the Government 
Hospital for the Insane; for dental outfits and dental material, and all other 
necessary contingent expenses; in all, $365,000. 
(c) “ Bringing home remains of officers, and so forth. To enable the Secre- 
tary of the Navy, in his discretion, to cause to be transferred to their homes 
the remains of officers and enlisted men of the Navy and Marine Corps, of 
members of the Nurse Corps, of civilian officers and crews of naval auxiliaries, 
and of officers and enlisted men of the Naval Militia and National Naval Vol- 
unteers and the Naval Reserve Force when on active service with the Navy, 
who die or are killed in action ashore or afloat, and also to enable the Secretary 
of the Navy, in his discretion, to cause to be transported to their homes the 
remains of civilian employees who die outside of the continental limits of the 
United States, $40,000: Provided, That the sum herein appropriated shall be 
available for payment for transportation of tbe remains of officers and men 
who have died while on duty at any time since April 21, 1898. 
(d) “Care of hospital patients. For the care, maintenance, and treatment 
of patients, including supernumeraries, in naval and other than naval hos- 
pitals, $100,000. 
(e) “ Salaries, Navy Department. For employees in the Bureau of Medicine 
and Surgery, $60,000: Provided, That no person shall be employed hereunder 
at a rate of compensation exceeding $1,800 per annum, except the following: 
One (chief clerk), $2,250, and two at $2,000 each.” 
Naval hospital fund.3 
The Naval Hospital Fund dates its separate existence as sucli from an act 
of Congress approved February 26, 1811. In this same law Congress provided 
for the establishment of naval hospitals and directed that $50,000 be appro- 
priated out of the unexpended balance of the Marine Hospital Fund (created 
on July 16, 1798) for the purpose of a Naval Hospital Fund. It originally 
was controlled by the “ Commissioners of Navy Hospitals,” a board composed 
of the Secretaries of the Navy, the Treasury, and War, but by the act of July 
10, 1832, Congress made the Secretary of the Navy the sole trustee of this 
fund. 
The monies of this fund are deposited in the United States Treasury and 
expenditures from it are safeguarded by the same laws, regulations, and pro- 
cedures as govern the expenditures of appropriations belonging to the United 
States Government. 
8 For a complete description of tlie Naval Hospital Fund, refer to Chapter 21, Manual 
of the Medical Deportment, 1922. 
47829°—23 39 604 
HOSPITAL CORPS HANDBOOK. 
•The several sources of revenue of the Naval Hospital Fund are: 
(a) Twenty (20) cents per month “hospital tax” deducted from the pay 
of each officer, seaman, and marine, including members of the Nurse Corps 
and Naval Auxiliax-y Service. (Sec. 4808, It. S.) 
(b) The value of one ration per day during the period that each patient 
remains in a naval hospital. (Sec. 4812, It. S.) 
(c) The pensions of naval patients and supernumeraries while under treat- 
ment in naval hospitals. (Sec. 4813, It. S.) 
(d) The balance of all fines imposed by sentence of court-martial after pay- 
ment for transportation of discharged prisoners to their homes has been made. 
(Sec. 4809, It. S., and act of March 3, 1909.) 
(e) All foi’feitures on account of desertions. (Act approved June 7, 1900.) 
(f) The value of one ration per day for each member of the personnel sub- 
sisted in a naval hospital. 
(g) The proceeds from sales of naval hospital property. 
(Ti) Payments made for the care of navy yard employees while in naval 
hospitals as patients of the Employees Compensation Commission. 
Except as Congress provides for certain expenses by specific appropriation, 
as for the pay of civil employees under “ Medical Department,” and the care, 
ti’ansportation, and burial of the dead under “ Contingent,” every expense for 
the proper establishment and maintenance of a naval hospital may be paid 
from the Naval Hospital Fund. 
Appropriation numbers. 
Numbers for the separate appropriations under the cognizance of each 
bui’eau are assigned by the Bureau of Supplies and Accounts. The first figure 
of an appropriation number indicates the fiscal year, the second the bureau, 
and the third and fourth the specific appropriation. Thus, reading from right 
to left, the number 3801 indicates the appi-opriation, medical department, con- 
trolled by the Bureau of Medicine and Surgery, for the fiscal year 1923, while 
the number 3815 indicates the Naval Hospital Fund, controlled by the Bureau 
of Medicine and Surgery, for the fiscal year 1923. 
ORGANIZATION OF THE BUREAU OF MEDICINE AND SURGERY. 
The outline given herewith shows the present organization of the Bureau 
of Medicine and Surgery for the conduct of the necessary business entrusted 
to its care. The i*eciprocal illations of this bureau with the other bureaus 
of the Navy Department ai*e evident after study of the duties of those bureaus 
as heretofore described. 
The Surgeon General of the Navy is the Chief of the Bureau of Medicine 
and Surgery and its administrative head. Upon him devolves the formulation 
of general policies and the maintenance of contact with: 
(a) The medical divisions of the fleets through the fleet surgeons. 
(b) The medical departments of naval stations through the senior medical 
officers. 
(c) Naval hospitals, naval medical supply depots, naval Medical and Hospital 
Corps ti’aining schools, and separate naval dispensaries or sick quarters 
through their commanding or senior medical officers. 
The assistant to the bureau acts as the executive, has general supervision of 
the- entire organization and work of the bureau, assists in the development of 
general policies, and in the absence of the Surgeon General becomes the acting 
chief of the bux*eau and signs all mail or official correspondence. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
605 
The chief clerk has general supervision of the operation of the various 
bureau offices and becomes the acting chief of the bureau in the absence of both 
the chief of bureau and assistant to bureau. 
For ease of administration and to facilitate the transactions of business, the 
bureau is divided into divisions and sections. The present divisions of the 
bureau, the division chiefs, and section heads, and the work for which each is 
responsible is shown in the tabulation below. 
Division of administration.—Chief of Division : Chief Clerk. 
(a) Public works section.—Head of section : Chief of division. 
1. General cognizance of and cooperation with Bureau of Yards and Docks 
concerning all construction authorized or proposed. 
(b) Mail, general files and correspondence section.—Head of section: Chief of 
division. 
1. All general correspondence; reference to previous correspondence; stor- 
age of old files and records; files of blueprints of ships and station 
buildings; card indices arranged under station, subject, name of per- 
son, and in chronological order; receipt, distribution and forwarding 
of all mail. 
(c) Office supplies and printing section.—Head of section : Civilian clerk. 
1. Requisitions for and issue of office supplies and equipment; printing 
and binding of medical department bulletins, supplements, forms, 
medical records, etc. ; printing or multigraphing of circular letters, 
special reports, etc. 
(d) Civil personnel and care of the dead section.—Head of section: Civilian clerk. 
1. Assignments of stenographers, clerks, and messengers; personal data; 
efficiency records; time sheets; annual leave; sick leave, etc. ; ap- 
pointments at hospitals, sick quarters, supply depots, dispensaries, 
and medical school; Civil Service matters ; retirements ; wage scale ; 
reclassification ; complements; correspondence relating to civil estab- 
lishment. 
2. Notices of death of personnel; correspondence with next of kin; ship- 
ment of remains ; funeral arrangements ; burial records. 
Division of finances.—Chief of division : Chief pharmacist, U. S. Navy. 
(a) Budget section.—Head of section : Chief of division. 
1. Preparation of estimates; administration of appropriations and Naval 
Hospital Fund ; allocation of funds to hospitals, ships and stations ; 
laws, regulations, and instructions governing the submission of esti- 
mates, expenditure, and receipt of money, and Budget circulars; 
under the direction of the Chief of Bureau, arranges the allotment or 
apportionment of funds, whether made by time or object; informa- 
tion as to current status of obligations, allotments and apportion- 
ments. 
(b) Accounting section.—Head of section : Pharmacist, U. S. Navy. 
1. Preparation and filing of allotments ; examination and filing of reports 
of expenditures; general ledgers and day books; preparation of fi- 
nancial data ; accounting procedures ; receipts and credits ; obligations 
incurred or authorized; balances available for future obligation; 
charges made against appropriations; monthly check of charges and 
their correctness, against authorizations and obligations. 
(c) Auditing and claims section.—Head of section : Civilian clerk. 
1. Adjustment of claims for medical expenses, hospital care, etc.; prepara- 
tion of vouchers and public bills in payment of' claims; reimburse- 
ment of appropriations for expenses incurred on account of other 
Government departments ; transfer of funds. 
(d) Requisition section.—Head of section : Pharmacist, U. S. Navy. 
1. Receipt and action on all requisitions for supplies and services ; trans- 
fer of materiel between Medical Department activities; surveys on 
Medical Department property; record of nonexpendable property at 
Medical Department activities; recording and filing of requisitions, 
public bills, property surveys, and inventories of property, corre- 
spondence relative to above. 606 
HOSPITAL CORPS HANDBOOK. 
Division of personnel.—Chief of division : Commander, M. C., U. S. Navy. 
(a) Medical Corps section.—Head of section : Chief of division. 
1. Complements; appointments; enrollments, assignments; standards for 
examinations; examining boards ; instruction ; promotions ; resigna- 
tions. 
(b) Hospital Corps section.—Head of section : Lieutenant, M. C., U. S. Navy. 
Assistants : Chief Pharmacist, U. S. Navy ; Pharmacist, U. S. Navy. 
t. Chief pharmacists and pharmacists : Complements ; appointments ; enroll- 
ments ; assignments; standards for examinations; examining boards ; 
instruction ; promotions ; resignations. 
2. Enlisted personnel : Complements ; enlistments ; enrollments ; discharges ; 
transfers; advancements and changes in rating; standards for exami- 
nations ; standards for instruction ; professional competency. 
3. Editing and publishing of: Hospital Corps Quarterly; Hospital Corps 
Handbook ; Drill Book for the Hospital Corps. 
(c) Nurse Corps section.—Head of section : Superintendent, Nurse Corps, U. S. 
Navy. Assistants: Two chief nurses, U. S. Navy. 
1. Complements ; appointments ; enrollments ; assignments ; examinations 
and requirements ; promotions ; discharges ; resignations ; transfers. 
Division of rehabilitation and morale.—Chief of division : Lieutenant Commander, M. C., 
U. S. Navy. 
(a) Occupational therapy section.—Dead of section : Chief of division. 
1. Occupational therapy in naval hospitals for United States Veterans’ 
Bureau patients. 
(b) Liaison section.—Head of section: Chief of division. 
1. Maintains liaison with American Red Cross, United States Veterans’ 
Bureau, morale division of Bureau of Navigation. 
Division of instruction and publications.—Chief of division : Commander, M. C., U. S. 
Navy. 
(a) Instruction section.—Head of section : Chief of division. 
1. Maintains liaison with : Naval Medical School, School of Dental Medi- 
cine ; School of Aviation Medicine; School of Field Operations with 
Marines. 
2. In charge of: Regular and special courses ; instruction at Army, Navy, 
and civilian institutions other than above. 
(b) War plans and research section.—Head of section: Chief of division. As- 
sistant : Lieutenant, M. C., U. S. Navy. 
1. Collection and dissemination of information regarding advances and 
researches in scientific matters. 
2. In charge of matters dealing with and researches in aviation, chemi- 
cal warfare, submarines and submarine diving. 
3. War plans of Medical Department. 
(c) Publications section.—Head of section : Lieut. Commander, M. C., U. S. Navy. 
1. Editing and publishing of: Naval Medical Bulletin and Supplements; 
Annual Report of the Surgeon General; Manual of the Medical De- 
partment. 
2. Censorship of articles written by Medical Department personnel for 
publication ; review of current periodical medical literature; collection 
of pamphlet publications on hygiene, medical biography, etc. ; collec- 
tion of photographs and other official papers bearing on the Medical 
Department; preparation of articles for purposes of publicity; transla- 
tions from foreign languages. 
Division of dentistry.—Chief of division : Lieutenant Commander, D. C., U. S. Navy. 
(a) Personnel section.—Head of section : Chief of division. 
1. Complements ; appointments ; enrollments ; assignments; standards for 
examinations; examining boards ; instruction ; promotions ; resigna- 
tions ; liaison with division of personnel; duties of dental officers. 
(&) Materiel section.—Head of section: Chief of division. 
1. Allowances of dental instruments and supplies on supply table; liaison 
with requisition section of division of finances. 
(c) Inspection section.—Head of section : Chief of division. 
1. Inspection of dental activities ashore and afloat. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES 
607 
Division of physical requirements.—Chief of division : Commander, M. C., U. S. Navy. 
(а) Physical requirements section.—Head of section: Chief of division. Assistant: 
Lieutenant,. M. C., U. S. Navy. 
1. Physical examinations’ of personnel; promotions; medical surveys; 
waivers of physical disabilities; reports of death ; line of duty. 
(б) Medical and health records section.—Head of section: Chief pharmacist, U. S. 
Navy. Assistants: Chief pharmacist, U. S. Navy ; pharmacist, U. S. Navy. 
t. Health records, personnel files; casualty reports ; casualty lists; pension 
certificates; Veterans’ Bureau certificates; data for: Medical examin- 
ing boards; naval retiring boards, insurance and beneficial organiza- 
tions ; death gratuities; library of: Medical histories; medical jour- 
nals ; statistical records. 
Division oif preventive medicine.—Chief of division: Lieutenant Commander, M. C., U. S. 
Navy. 
(a) Communicable diseases section.—Head of section : Chief of division. 
1. Epidemiological reports and studies, of affairs relating to the control of 
communicable diseases; advice on sanitation of buildings and ships; 
use of prophylactic vaccines and sera ; quarantine and disinfection ; 
laboratory questions relating to preventive medicine. 
(b) Hygiene and sanitation section.—Head of section : Chief of division. 
1. Water supply, sewerage, drainage, disposal of garbage and refuse; ex- 
termination of insects and vermin; prevention of occupational dis- 
eases ; messing, bathing, and toilet facilities; food problems ; sanita- 
tion of buildings, housing problems, detention and isolation facilities; 
sanitation and hygiene of ships; dissemination of information relative 
to health conditions in civilian communities adjacent to naval stations; 
cooperation with Federal, State, local, and other health agencies. 
(c) Public health education section.—Head of section : Chief of division. 
1. Publication of weekly bulletin ; educational advertising measures ; graphic 
presentation of vital statistics. 
(d) Vital statistics section.—Head of section : Chief pharmacist, U. S. Navy. 
1. Collection and compilation of vital statistics ; checking and filing of sta- 
tistical reports and Form F cards. 
Division of inspections.—Chief of division : Rear Admiral, M. O., U. S. Navy. Assistant: 
Chief pharmacist, U. S. Navy. 
1. General inspection tours of stations and activities of the medical de- 
partment ; general sanitary reports ; recommendations as to improve- 
ments of policy. 
Though having separate commanding officers the Naval Medical School and 
the Naval Dispensary activities are carried on in close cooperation and in ac- 
cordance with the policies of the Bureau of Medicine and Surgery. 
At the Naval Medical School medical and dental officers receive courses of 
instruction in medical officers’ duties, aviation medical officers’ duties, and 
dental officers’ duties. Hospital corpsmen receive instruction in laboratory 
technique and procedures and in mechanical dentistry. 
The Naval Dispensary provides treatment for naval personnel attached to the 
Navy Department and their families, renders first-aid treatment and care to 
the civil employees of the Navy Department and conducts special physical and 
other examinations. 
MEDICAL DEPARTMENT PERSONNEL. 
Comprising the personnel of the medical department are the members of 
four corps, the Medical, Dental, Hospital, and Nurse Corps. The Medical 
Corps is composed of medical officers, the Dental Corps of dental officers, the 
Hospital Corps of chief pharmacists, pharmacists, and enlisted men, and the 
Nurse Corps of trained nurses. 
Medical and dental officers and nurses are appointed from civil life, the 
former by the President, by and with the advice and consent of the Senate, 
the latter by the Surgeon General with the approval of the Secretary of the Navy, 
with the exception of the superintendent who is appointed by the Secretary 608 
HOSPITAL CORPS HANDBOOK. 
of the Navy. Hospital corpsmen are enlisted or change their rating from other 
branches of the service to Hospital Corps ratings. Pharmacists (warrant 
officers) are appointed from enlisted men by the Secretary of the Navy and 
chief pharmacists (commissioned warrant officers) are appointed to that grade 
from pharmacists, being appointed by the President, by and with the advice and 
consent of the Senate. 
For full information concerning the grades and ratings, appointments, promo- 
tions, and advancements, and the duties of the members of these corps, refer- 
ence should be made to chapters 2 to 10, inclusive, and sections 2 to 9, inclusive, 
of chapter 12, of the Manual of the Medical Department. 
ADMINISTRATION OF NAVAL HOSPITALS. 
Section 1 of chapter 12, Manual of the Medical Department, explains the es- 
tablishment and management of naval hospitals. 
As will be noticed in paragraph 1606 of the section above mentioned, the 
Bureau of Medicine and Surgery has charge of the operation of all hospitals 
and of the force employed there. In order that commanding officers may ad- 
minister naval hospitals successfully they must have the necessary personnel 
to accomplish that end. 
In the organization of the Bureau of Medicine and Surgery as given in this 
chapter, among the duties of certain divisions appears complements. This 
means that that division or section is charged with providing the complements 
of officer, enlisted, nursing, and civilian personnel for naval hospital and other 
activities of the medical department. 
Naval hospitals vary in size and, therefore, can care for varying numbers of 
patients. Thus they sometimes are spoken of as 100, 200, or perhaps 1,000 bed 
hospitals. On this bed capacity is determined the complements of the personnel 
of naval hospitals. The minimum medical-officer personnel for a 500-bed naval 
hospital as shown by the experience of years is considered to be as follows: 
1 Captain, Medical Corps Commanding officer. 
1 Commander, Medical Corps Executive officer. 
1 Commander or Lieutenant Com- 
mander, Medical Corps 
Chief of medical service. 
1 Commander or Lieutenant Corn-] 
mander, Medical Corps j 
Chief of surgical service. 
13 Lieutenants or Lieutenants, junior! 
grade, Medical Corps 1 
Ward officers; X-ray; laboratory; 
eye, ear, nose, and throat: urolo- 
gical ; and other special duties. 
Chief pharmacists and pharmacists, with the duties to be performed by 
each, are required as follows for a 500-bed hospital: 
Chief clerk of the hospital, and assist- 
ant to the commanding officer; gen- 
eral supervision of operation of hos- 
pital offices, and other administra- 
tive details. 
Chief pharmacist- 
Chief pharmacist or pharmacist Accounting and property officer. 
Chief pharmacist or pharmacist Record and personnel officer. 
Chief pharmacist or pharmacist Commissary officer. 
First lieutenant of hospital, assistant 
to executive officer, in charge of in- 
struction of hospital corpsmen. 
Chief pharmacist or pharmacist— ORGANIZATION, CLERICAL DUTIES AND PROCEDURES, 
609 
The complement of hospital corpsmen for a 500-bed hospital is based upon 
several factors. By law the authorized strength of the Hospital Corps is 31 per 
cent of the strength of the Navy and Marine Corps (see par. 302, Manual of the 
Medical Department), and the number thus obtained must be distributed in the 
various ratings in such a manner as to provide for the proper performance of the 
duties of the Hospital Corps, a rational flow of advancement in rating, and for 
training and instruction. Experience has shown that these conditions can be 
met satisfactorily by a percentage distribution in ratings as follows, which 
(taking 31 per cent of 86,000 and 19.500 Navy and Marine Corps enlisted person- 
nel) provides the numbers in the tabulation below: 
Rating. 
Per cent. 
Number. 
14 
516 
15 
22 
812 
28 
1 034 
14 
517 
258 
7 
100 
3,692 
These percentages ordinarily will furnish sufficient numbers in each rating 
to provide for the complements of hospital corpsmen on board ship with medi- 
GREW 
RATING 
Adminis trative 
CPbM 
PhMlc 
PhM2c 
PhM3c 
HAlc 
TOTAL 
Clerical Department (Personnel) 
1 
2 
0 
2 
3 
8 
Clerical Department (Materiel) 
1 
1 
0 
4 
0 
6 
Conmissary Department 
1 
1 
2 
4 
0 
8 
Master at Arms 
1 
0 
0 
0 
0 
1 
Assistant Master at Arms 
0 
0 
2 
0 
0 
2 
Dispensary 
1 
0 
2 
0 
1 
4 
Laboratory 
0 
1 
1 
0 
1 
3 
X-ray 
1 
0 
0 
1 
0 
2 
Physiotherapy 
0 
0 
2 
0 
2 
4 
Linen Room 
0 
0 
0 
0 
4 
4 
Total Administrative Crew 
6 
5 
9 
11 
11 
42 
Nursing 
Medical Wards (4) 
0 
4 
6 
9 
5 
24 
Surgical Wards (4) 
0 
4 
6 
9 
5 
24 
Venereal Wards (2) 
0 
2 
4 
0 
2 
8 
Sick Officers* Quarters 
0 
0 
4 
4 
0 
8 
Contagious Wards 
1 
3 
3 
6 
0 
13 
Operating Room 
0 
2 
1 
2 
1 
6 
Total Nursing Crew 
1 
15 
24 
30 
13 
83 
GRAND TOTAL 
7 
20 
33 
41 
24 
125 
Fig. 203.—Duty distribution of hospital corpsmen in a 500-bed naval hospital. 
cal officers or independent of medical officers on expeditionary duty with the 
marines and at activities ashore within and beyond the continental limits of 
the United States. 
In assigning the complements of hospital corpsmen the Bureau of Medicine 
and Surgery is guided hy the number of men in the crew, the personnel cared 
for, whether sick-bay or first-aid treatment is rendered, the nature of the 
duty performed, and the bed capacity. Ordinarily, one hospital corpsman 
is provided for each 100 of the crew of an active vessel, except on independent 610 
HOSPITAL CORPS HANDBOOK. 
Ho. 
Beds 
Crew 
CPhil 
FhMlc 
Phl42c 
PbM3c 
HAlC 
10# 
Addl. 
TOTAL 
100 
Admin. 
3 
4 
4 
4 
4 
2 
21 
Nursing 
0 
4 
8 
8 
2 
2 
24 
TOTAL 
3 
8 
12 
12 
6 
4 
45 
200 
Admin. 
4 
4 
5 
5 
5 
2 
25 
Hursing 
0 
6 
13 
13 
4 
4 
40 
TOTAL 
4 
10 
18 
18 
9 
6 
65 
300 
Admin. 
5 
4 
6 
6 
6 
3 
30 
Hursing 
1 
9 
14 
18 
4 
5 
51 
TOTAL 
6 
13 
20 
24 
10 
8 
81 
400 
Admin. 
6 
5 
8 
7 
7 
3 
36 
Nursing 
1 
12 
16 
23 
8 
6 
64 
TOTAL 
7 
17 
24 
30 
16 
9 
100 
500 
Admin. 
6 
5 
9 
9 
9 
4 
42 
Nursing 
1 
15 
21 
27 
11 
8 
83 
TOTAL 
7 
20 
30 
36 
20 
12 
125 
600 
Admin. 
6 
5 
9 
10 
10 
4 
44 
Hursing 
2 
16 
24 
32 
12 
9 
95 
TOTAL 
6 
21 
33 
42 
22 
13 
139 
700 
Admin. 
7 
6 
10 
10 
10 
4 
47 
Hursing 
2 
16 
26 
38 
16 
10 
108 
TOTAL 
9 
22 
36 
48 
26 
14 
155 
800 
Admin. 
7 
7 
10 
11 
12 
5 
51 
Nursing 
2 
18 
30 
44 
18 
11 
121 
TOTAL 
9 
25 
40 
55 
30 
16 
172 
900 
Admin. 
8 
6 
10 
12 
12 
5 
55 
Nursing 
2 
18 
34 
46 
18 
12 
130 
TOTAL 
10 
26 
44 
58 
30 
17 
185 
1000 
Admin. 
8 
8 
12 
14 
16 
6 
64 
Nursing 
2 
20 
36 
50 
20 
13 
141 
TOTAL 
10 
28 
48 
64 
36 
19 
205 
Fig. 204.—Complements of hospital corpsmen for naval hospitals of 100 to 1,000 beds. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
611 
duty where one hospital corpsman is assigned and the crew does not exceed 125, 
and one hospital corpsman to approximately every five patients in hospitals. 
The complements of naval hospitals are divided into what is known as the 
administrative and nursing crews. To the number in each crew is added 10 
per cent, distributed in the ratings of pharmacist’s mate, second and third 
class, and hospital apprentice, first class, to allow for sickness, leave, or absence 
from a duty status for other reasons.. 
Administrative creic.—The administrative crew consists of -men assigned to 
duties where their retention is desirable in promoting efficiency in the operation 
of the hospital. This crew, considered an overhead necessity, is incapable of 
being altered without disturbing the internal organization of the institution, 
and once men were assigned to it, every endeavor is made to allow them to 
remain there until they complete their current tour of shore duty, and reliefs 
generally are furnished for the higher rated men before transfer. Changes in 
the number of patients do not affect the number in the administrative crew. 
Nursing crew.—The nursing crew may fluctuate with the number of patients 
but seldom is reduced below the complement authorized by the Bureau of 
Navigation. It consists of men assigned to duty in the various wards and the 
operating room. 
Shown herewith are two tables giving the duty distribution of hospital 
corpsmen in a 500-bed naval hospital, and the complements of naval hospitals 
of 100 to 1,000 bed capacities. The duty distribution shows only those details 
considered actually essential in the proper functioning of a 500-bed naval 
hospital; such details as may be desirable but not absolutely necessary not 
appearing and the complements given are considered by the Bureau of Medicine 
and Surgery to be the minimum required to maintain the efficiency of the 
medical department and afford the proper care for the sick of the Navy and 
Marine Corps in naval hospitals. 
Other hospitals. 
In addition to permanent naval hospitals, there are mobile hospitals for ex- 
peditionary service with the marines and Navy Base Hospital units for service 
wherever required. The organization of mobile hospitals is given in the section 
on Duty with Marine Corps Expeditionary Forces. 
Navy base hospital units are numbered, and the name by which they are 
known is United States Navy Base Hospital No. 1, etc. These units are 
organized by a medical officer of the Naval Reserve Force having the rank of 
commander. This officer, under the supervision of the Bureau of Medicine and 
Surgery, acts as the head and has entire charge of the organization until the 
unit is called into active service, when he is relieved as officer in charge by 
a medical officer of the Regular Navy having the rank of captain, and the 
organizer becomes chief of either the medical or surgical service. 
A medical officer of the Naval Reserve Force having the rank of commander 
or lieutenant commander acts as assistant to the organizer and in his ab- 
sence is considered as being in charge of the unit. When the unit is called 
into active service he is relieved by a medical officer of the regular Navy hav- 
ing the rank of commander, and becomes, by agreement with the organizer, 
chief of either the medical or surgical service. 
The enlisted personnel of Navy base hospitals usually is composed mainly 
of members of the Naval Reserve Force, and their enrollment is delayed 
until a call to active service is imminent. 
Nurses for duty with these units are selected by the organizer, enrolled 
by the American Red Cross Society, and assigned to duty with the particular 
unit whose organizer has requested them. When called into active service 612 
HOSPITAL CORPS HANDBOOK 
all nurses assigned to the unit are transferred to and enrolled in the Nurse 
Corps Reserve, U. S. Navy. 
Navy Base Hospital Units. 
ORGANIZATION. 
Navy base hospitals are organized on the basis of 500-bed hospitals in the 
medical department of the United States Navy. Tables of organization for 
a base hospital of this capacity authorize: 22 commissioned officers (3 of whom 
will be regular Navy officers), 5 chief pharmacists or pharmacists (4 of whom 
will be regular Navy chief pharmacists or pharmacists), 1 pay clerk (regular 
Navy), 60 nurses, 214 enlisted men (47 of whom will be regular Navy). 
The rank and number of the various commissioned officers, warrant officers, 
nurses and enlisted men are as follows: 
Commissioned officers (22) : 
Medical officers, U. S. Navy (regular Navy) — 
1 captain (Medical Corps). 
1 commander (Medical Corps). 
1 lieutenant (Supply Corps). 
Medical officers, U. S. Naval Reserve Force— 
2 commanders (Medical Corps). 
5 lieutenant commanders (Medical Corps). 
10 lieutenants (Medical Corps). 
Dental officers, U. S. Naval Reserve Force— 
2 lieutenants (Dental Corps). 
The organization of Navy base hospitals is divided into administrative and 
professional divisions. 
1. Administrative: 
1 captain, M. C., U. S. Navy, in command. 
1 commander, M. C., U. S. Navy, executive officer. 
1 lieutenant, S. C., U. S. Navy, supply officer. 
4 chief pharmacists or pharmacists, U. S. Navy. 
1 pay clerk, U. S. Navy, assistant to supply officer. 
2. Professional: 
Surgical service (10 medical officers, U. S. Naval Reserve Force) — 
1 chief Commander. 
4 general surgeons 2 lieutenant commanders, 2 lieu- 
tenants. 
1 orthopedic surgeon Lieutenant. 
1 G. U. surgeon Lieutenant. 
2 eye, ear, nose, and throat surgeons 2 lieutenants. 
1 Roentgenologist Lieutenant. 
Medical service (5 medical officers, U. S. Naval Reserve Force) — 
1 chief Commander. 
3 assistants 2 lieutenant commanders, 1 lieu- 
tenant. 
1 psychiatrist Lieutenant. 
Dental service (2 dental officers, U. S. Naval Reserve Force) — 
2 lieutenants. 
Dispensary— 
1 chief pharmacist or pharmacist, U. S. Naval Reserve Force. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
613 
2. Professional—Continued. 
Laboratory service (2 medical officers, U. S. Naval Reserve Force) — 
1 chief Lieutenant commander. 
1 assistant Lieutenant. 
Nurses (60 Nurses, U. S. Naval Reserve Force) — 
1 chief nurse. 
2 assistant chief nurses. 
57 nurses. 
Dietetic service— 
1 dietitian (not necessarily a nurse). 
Enlisted personnel, 214 (47 regular Navy) : 
Hospital corpsmen— 
(a) Administrative crew (42) — 
6 chief pharmacist’s mates (regular Navy). 
5 pharmacist’s mates, first class. 
9 pharmacist’s mates, second class. 
11 pharmacist’s mates, third class. 
11 hospital apprentices, first class. 
(2 of the 11 pharmacist’s mates, third class, are to he 
designated as assistants to the dental officers.) 
(5) Nursing crew (83) — 
1 chief pharmacist’s mate. 
15 pharmacist’s mates, first class. 
24 pharmacist’s mates, second class. 
30 pharmacist’s mates, third class. 
13 hospital apprentices, first class. 
Yeomen (7) — 
2 chief yeomen (1 regular Navy). 
2 yeomen, first class. 
3 yeomen, second class. 
1 chief yeoman assigned to commanding officer. 
1 chief yeoman (regular Navy) assigned to supply officer. 
1 yeoman, first class, assigned to executive officer’s office. 
1 yeoman, second class, assigned to supply officer’s office. 
1 yeoman, first class, assigned to record office. 
1 yeoman, second class, assigned to chief of surgical service. 
1 yeoman, second class, assigned to chief of medical service. 
Cooks, etc. (13) — 
1 chief commissary steward. 
3 ship’s cooks, first class (1 chief cook, 1 in charge of each watch). 
5 ship’s cooks, second class (1 butcher, 2 meat cooks, 2 vegetable 
cooks). 
4 ship’s cooks, third class. 
Bakers (2) — 
1 baker, first class. 
1 baker, second class. 
Electricians (3) — 
1 chief electrician’s mate. 
2 electrician’s mates, second class. 
Blacksmiths (1) — 
1 blacksmith, second class. 
Plumbers (2) — 
1 ship’s fitter, first class. 
1 ship’s fitter, second class. 614 
hospital corps handbook. 
Enlisted personnel, 214 (47 regular Navy)—Continued. 
Machinists (12) — 
2 chief machinist’s mates. 
2 machinist’s mates, first class. 
8 machinist’s mates, second class. 
(1 chief machinist’s mate to have charge of transportation; 1 
chief machinist’s mate to have charge of transportation repair. 
Machinist’s mates to be drivers and assistant drivers for all 
motor transportation.) 
Seamen for guard, messengers, and messmen (40) — 
1 boatswain’s mate, first class. 
2 coxswains. 
(Others to he seamen, second class, apprentice seamen, and mess 
attendants, all regular Navy.) 
Firemen (4) — 
1 fireman, first class. 
3 firemen, second class. 
Carpenters (3) — 
1 chief carpenter’s mate. 
2 carpenter’s mates, second class. 
Painters (2)— 
2 painters, second class. 
Details of hospital corpsmen for duty in connection with X-ray work, 
laboratory work, physiotherapy, or other special branches of medicine are to be 
made by the executive officer. 
CLERICAL WORK IN THE MEDICAL DEPARTMENT OF THE NAVY. 
The clerical work in the medical department of the Navy required of 
hospital corpsmen may be explained most advantageously if separated into 
three divisions, as (1) general correspondence—i. e., letters, endorsements, etc.; 
(2) requisition and voucher forms for the procurement of supplies and services; 
(3) reports and returns other than requisition and voucher forms. 
Correspondence. 
Correspondence or written communication in the Navy may be divided into 
three general classes, which are official, semiofficial, and unofficial. 
(a) Official correspondence is communication between officers of the Navy 
and the offices and bureaus of the Navy Department; commanders in chief; 
commandants; vessels of the Navy; naval stations; ships and stations; and 
with other executive departments by the office of the Secretary of the Navy. 
The subject matter usually embraces information concerning the activities, 
duties, and policies of the Navy, recommendations, reports, and knowledge of 
conditions in foreign countries which are of value in the transaction of public 
business. 
(b) Semiofficial correspondence usually is the communication of information 
in a partly official manner to a bureau or office in the Navy Department by offi- 
cers under the direct cognizance of that bureau or office. 
(c) Unofficial correspondence is all communication not considered official or 
semiofficial. 
Official correspondence and information is of three types—secret, confidential, 
and nonconfidential. 
(a) “Secret” matter is correspondence or information which should be 
known only to the person addressed or to other persons to whom he is specifi- 
cally authorized to communicate it. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
615 
(b) “Confidential” matter is correspondence or information which would 
prove of value to an enemy (or in time of peace to a foreign government), tmt 
which does not relate to measures or weapons which the United States is 
preparing to use against him and is not vital to the secrecy of present or 
future policy. 
(c) “ Nonconfidential ” matter is correspondence or information which 
relates to methods of procedure regularly followed and to other subjects a full 
knowledge of which could by no possibility be of use to an enemy. (See Art. 
2005, N. R.) 
Official correspondence within the naval service is carried on in the manner 
prescribed in detail by the Navy Regulations (chapter 52, art. 2003, et seq.). 
While the substance of official correspondence concerning the medical depart- 
ment of the Navy is determined by the officers charged with such duty, its 
transcription into official form for signature and forwarding usually is 
entrusted to hospital corpsmen. For one preparing correspondence, it is most 
important to remember to keep a copy of every letter or endorsement prepared 
and to have a systematic method of numbering and filing all such papers, so 
that they can be referred to readily. 
A hospital corpsman detailed to perform clerical work should have access to 
a copy of the Naval Regulations, and the instructions in chapter 52 thereof 
should be referred to whenever there is any doubt as to the proper form to be 
used or the method of procedure to be followed, the intention here being to 
describe only so much of the official instructions as will make clear the essen- 
tial features of service correspondence by letter or endorsement. 
Correspondence must be courteous in tone and free from expressions of a 
personal nature, but courtesy shall be indicated by the substance and feeling 
rather than by artificially polite phrases and formulas. 
So far as is possible, and with due consideration of the public interests, the 
number of letters written and their length should be minimized. Accuracy, 
simplicity, and conciseness, especially in official correspondence, and confining 
letters to the one subject at hand without omitting necessary details and 
arranging the paragraphs of letters in logical sequence is most essential. If 
adding to the clearness of a letter, the use of accompanying diagrams, tables 
and sketches is permissible, but they should never be embodied in the letter. 
Communications from subordinates are sent to their superior officers for trans- 
mittal. If in proper form and language, the superior officer forwards them as 
soon after receipt as practicable, stating thereon in writing, by endorsement or 
otherwise, his opinion in relation to every part of the subject contained in the 
communication. 
To such papers as are complete in themselves and do not require an expres- 
sion of opinion from the office through which they are transmitted, the term 
“ forwarded ” may be affixed and such papers transmitted under the endorse- 
ment of an officer of the staff, by direction of the commander in chief, the 
commandant, or the senior officer present. 
As a general rule, letters shall be answered by letters and not by endorse- 
ment. This does not prevent the use of stamped or written endorsements on 
papers or reports copies of which are not retained, or the use of endorsements 
on papers necessarily referred to several bureaus or offices. This is intended 
to prevent unnecessary clerical work. When the original is answered by a 
separate letter each office has a complete record of the correspondence with- 
out extra work. Separate letters shall be written on separate subjects unless 
the subjects are of a like nature. The subject matter in a letter should be 
divided into paragraphs in logical sequence, each containing statements com- 616 
HOSPITAL CORPS HANDBOOK. 
plete in themselves but all relative and pertinent to the subject at hand, and 
the paragraphs numbered. 
All communications, except such as require neither action nor reply, shall 
be acknowledged. 
Letters and endorsements shall he numbered and shall be typewritten if 
practicable, using noncopying ribbons and making a sufficient number of car- 
bon copies for filing or other purposes. If correspondence can not be type- 
written, it should be written legibly and contain no erasures or interlineations. 
Carbon copies shall show the office of origin and the name of the signing 
officer shall be typewritten or stamped on all copies. In preparing letters, en- 
dorsements, and reports which go through another office or other offices, the 
office preparing the original will make on thin white paper a copy for each 
office through which the correspondence is to pass before it reaches its final 
destination. These copies will be marked for the appropriate office. 
Letter paper habitually is used for official correspondence in the Navy, 
whether letters or endorsements. For the original or first cop3r, it is white linen 
typewriter paper, 8 by 101 inches in size, weighing approximately 41 pounds 
per ream of 500 sheets of that size. For file copies, a green tinted paper of 
the same size and weighing about 3 pounds per ream is used. Thin paper 
other than green is used for additional carbon copies. 
Typewriter cap, used only in special cases, shall be 8 by 13 inches in size, 
but otherwise similar to letter paper. 
The paper used for letters and endorsements has two holes punched in it, 
the center of the holes one-half inch from the top of the sheet and 2| inches 
apart and equidistant from the center of the sheet. These holes permit the 
sheets to be fastened together uniformly. 
The first sheet of a letter or a report shall be placed on the bottom and 
additional sheets in regular order, so that the last sheet is on top. Enclosures, 
if any, shall be placed on the bottom, and the whole securely fastened together 
with paper fasteners, the ends of which shall be on the top so that the upper 
sheet may be removed to place endorsements thereon, or add additional sheets. 
When a following endorsement begins on a new sheet the subject shall he 
repeated. Each page of letters and endorsements shall be numbered consecu- 
tively throughout, and the numbers shall be placed in the middle of the 
page about one-half inch from the bottom. 
When necessary, letter paper shall be folded in three and typewriter cap in 
four equal folds parallel to the writing. 
“(1) The forms prescribed in this article shall apply to all correspondence 
within the naval service, with the State naval militia organizations, and with 
such departments as may adopt a similar form of correspondence, but not with 
departments, officials, and persons that have not adopted these or similar forms. 
“(2) Letters shall begin with the ship or station, place, and date, grouped 
and spaced as indicated in the examples in paragraph 27. The upper line of 
the heading shall be at least 11 inches from the top of the page. In the case 
of endorsements which start on a new page, or any letter or endorsement con- 
tinued on a new page, there shall also be left clear at least 11 inches at the 
top for binding purposes. 
‘(3) Tiie official designation of all vessels of the Navy shall be the name 
of the vessel preceded by the letters U. S. S. The word1 flagship ’ shall follow the 
name of the vessel in the heading of a communication emanating from the 
office of a flag officer. 
“(4) Special subletterheads may be used at shore stations to designate the 
different offices of the station, and by officers on detached duty ashore, but ORGANIZATION, CLERICAL DUTIES AND PROCEDURES 
617 
shall not be used to designate the different heads of departments on board 
ship. (See Example B and the last two examples under C.) 
“(5) In communications dated on board a vessel at sea, the latitude and 
longitude shall be stated if exactness be necessary, otherwise the expression 
‘ Passage, to—’ shall be used. 
“(6) Following the heading and date in letters and endorsements either the 
official designation or the name and rank of the writer preceded by the word 
‘ From ’ shall be written at the left side of the page as indicated in examples 
in paragraph 27. 
“(7) On the line below 4 From,’ and preceded by 4 To ’ at the left of the page, 
shall appear the official designation of the office or official addressed; following 
this the channel through which the communication is to pass; these offices to 
be designated by numerals indicating the sequence of routing. 
“(8) Following the address, the subject of the correspondence, briefed, shall 
be written across the page, preceded by 4 Subject.’ 
“(9) The brief of the subject should be written in about the same form and 
terms as would be used in indexing the communication in filing; for example, 
4 Delaware; feed pumps ; recommends change in type.’ 4 Navy Yard, New York ; 
Dry dock No. 1; reports damage to caisson struck by tug.’ 
“(10) The subject shall not be repeated at the beginning of an endorsement, 
except when required by the filing system of the writer’s office to identify the 
file copy, or when the endorsement begins on a new sheet, in which case it 
shall always be repeated. 
“(11) After the subject the references to previous correspondence on the 
same subject, if any, shall be briefly indicated, preceded by 4 Reference,’ as 
shown in the form in paragraph 27. 
“(12) In acknowledging, answering, or referring to official communications, 
the file number (letters as well as figures) and date shall be included in 
the 4 Reference.’ References shall be lettered in small letters, and may be 
referred to in the communication as 4 Reference (a),’ etc. 
“(13) When a plan that has been given a file number is referred to in the 
correspondence, this number should be stated in connection with such reference. 
“(14) Following 4 Reference,’ if any, the number of enclosures shall be stated, 
preceded by 4 Enclosure,’ at the left of the page, as indicated in the example in 
paragraph 27. 
“(15) The use of numbered enclosure slips attached to the enclosures is 
authorized, and in case they are used the serial number of the slip or slips 
should be given after the word 4 Enclosures.’ (See Example B.) 
“(16) When necessary, the method of forwarding enclosures, whether en- 
closed under separate cover or by express, shall be indicated. The absence of 
4 Reference ’ or 4 Enclosure ’ will indicate that no reference or enclosure accom- 
panies the communication. 
“(17) The file number of the letter or endorsement shall be placed in the 
upper left corner, about 1 inch from the top and 1 inch from the left edge of 
the page; the abbreviation or initials of the section or division preparing the 
correspondence to follow on the same line as the file number. 
“(18) The body of letters and endorsements shall be written single spaced, 
with one double space between paragraphs. Each endorsement shall, where 
possible, be written on the same sheet as the preceding letter or endorsement, 
with a space of about one-half inch intervening. 
“(19) Paragraphs in letters and endorsements or other official papers shall 
be numbered. Subparagraphs shall be lettered thus: (a), (b), etc. 
“ (20) The body of the letter shall begin and end without any ceremonial 
form or expression, such as 4 Sir,’ 41 have the honor to report,’ 4 Very respect- 618 
HOSPITAL CORPS HANDBOOK. 
fully,’ etc., and shall be followed by the signature of the writer without desig- 
nation of rank, title, or office. Information will be imparted, reports made, 
and questions asked directly, dispensing with such introductory phrases as 
4 The bureau informs you that,’ 4 Information is requested as to,’ 4 It is directed,’ 
etc. 
44 (21) In the body of the letter U. S. Navy shall be abbreviated to U. S. N., 
U. S. Naval Reserve Force to U. S. N. R. F., U. S. Marine Corps to U. S. M. C., 
and U. S. Marine Corps Reserve to U. S. M. C. R. In the case of names of officers 
of the Staff Corps the designations as given in article 148 shall be abbreviated 
as follows: Medical Corps to M. C., Supply Corps to S. C., Medical Corps Dental 
Surgeons to M. C. D. S., Construction Corps to C. C., Civil Engineer Corps 
to C. E. C., Chaplain Corps to Ch. C., Professors of Mathematics to Math. 
44 (22) When any article referred to in a communication is forwarded under 
separate cover it shall be tagged and plainly marked in the following manner: 
4 From: Commanding Officer, U. S. S. , accompanying letter (or en- 
dorsement) No , date ’ If possible this shall appear also on the box 
or package carrying the enclosure. 
44 (23) Stamps showing the date of receipt of papers shall be so placed as 
not to occupy any writing space. If stamps constituting pro forma endorsements, 
such as 4 Received and forwarded,’ 4 Referred for action,’ etc., are used, they 
will be placed on the face of pages as though written in a more formal manner, 
and will be numbered as indicated in example. 
44 (24) Endorsements, whether written or stamped, except those referred to in 
the next paragraph, shall be placed in regular order, beginning on the last page 
of the letter, immediately below the signature, if there be room there, if not, ad- 
ditional full sized sheets shall be appended to the letter to accommodate them. 
Endorsement slips shall not be used, except on correspondence with other de- 
partments using such slips. 
44 (25) All endorsements affecting pay, mileage, transportation, and travel- 
ing expenses shall be placed on the face of the original order involving travel, 
if practicable, otherwise on the back of the order. Such endorsements shall 
never be placed on sheets which might be detached from the original order. 
44 (26) Only one page of the sheet shall be written upon, and a margin of 
three-fourths inch shall be left on each side and at the bottom of the sheet. 
44 (27) The following are examples of the forms of correspondence prescribed 
in this article: 
Example A. 
No. 122-3. U. S. Navy Yakd, Philadelphia, 
30 June, I92i0. 
From : Commandant, Navy Yard, Philadelphia. 
To: Commanding officer, U. S. S. Southwark. 
Via: (1) Construction officer. 
(2) Engineer officer. 
Subject: U. S. S. Southwark—Repairs to boat crane. 
References: (a) Comdg. Off. let. No. 576-D, of 27 April, 20. 
(b) Dept. let. 2345-432, of 30 April, 20. 
Enclosures (herewith) : (a) Blueprint No. 1234 showing proposed arrangement 
of boat crane. 
(b) Copy of previous correspondence on this subject. 
1. The repairs to the boat crane of the U. S. S. Southivark are to be under- 
taken by the ship’s force. The yard force will give such assistance as may be 
necessary in this connection, and you will please he governed accordingly. 
A. B. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
619 
1st. endorsement. 
No. 324-8-OD. U. S. Navy Yard, Philadelphia, 
Construction Department, 
1 July, 1920. 
From: Construction officer. 
To: Commanding officer, U. S. S. Southwark. 
Via: Engineer officer. 
Subject: U. S. S. Southwark—Repairs to boat crane. 
1. The commanding officer lias been consulted concerning the desired repairs, 
and the necessary material therefor under the construction department will be 
furnished. 
2. Estimated cost: 
Labor $10 
Material 80 
Indirect 40 
Total 130 
C. D. 
2nd. endorsement. 
No. 411-237-PW 
U. S. Navy Yard, Philadelphia, 
Engineering Department, 
5 July, 1920. 
From: Engineer officer. 
To: Commanding officer, U. S. S. Southwark. 
Subject: U. S. S. Southwark—Repairs to boat crane. 
1. The construction officer and commanding officer have been consulted, and 
the necessary material under the engineering department for the proposed 
repairs will be furnished. 
2. Estimated cost: 
Labor $8 
Material 60 
Indirect 30 
Total 98 
E. F. 
Example B. 
1382-67-C. O. 
Navy Yard, Puget Sound, Wash., 
Hull Division, 
6 May, 1920. 
From: Construction officer. 
To: Commandant. 
Subject: Quick-drying paint. 
References: (a) Bureau C. & R. letter 4048-A-306 of 14 March, 20. 
(b) Bureau C. & R. letter 4048-A-139 of 27 July, 19. 
(c) Bureau C. & R. letter 1808-B-912 of 12 Feb., 20. 
Enclosures: No. 13821 and No. 13822. 
1. I request that the Bureau of Construction and Repair furnish formula 
for manufacturing slate-color, quick-drying paint mentioned in the first para- 
graph of reference (c). 
47829°—23 40 620 
HOSPITAL CORPS HANDBOOK. 
2. Also request information as to the proper formula for boot topping on 
battleships. The second paragraph of reference (c) states that black, quick- 
drying paint is used for boot topping on vessels painted slate color. Refer- 
ence (b) gives black boot topping formula for use on torpedo boats, destroyers, 
and colliers, but states nothing about modifying previous instructions regard- 
ing boot topping for battleships, the last instructions received on that point 
being in reference (c). Attention invited to enclosure No. 13822 showing 
samples of boot topping used on ships at the yard and that mixed according to 
reference (c). 
A B 
1st. endorsement. 
12879-136-c. 
Navy Yakd, Puget Sound, Wash., 
7 May, 1920. 
From: Commandant. 
To: Bureau of Construction and Repair. 
Subject: Quick-drying paint. 
Enclosure: No. 13822. 
1. Approved and forwarded. 
E F G 
Example C. 
(Form of letterheads and subletterheads.) 
Navy Department, 
Bureau oe Construction and Repair, 
Washington, 1). C., 1 July, 1912. 
IT. S. S. Connecticut, 
Hampton Roads, Va., 1 July, 1912. 
United States Atlantic Fleet, 
U. S. S. Connecticut, Flagship, 
Navy Yard, New York, 1 July, 1912. 
U. S. S. Connecticut, 
Passage, New York to Hampton Roads, 
1 July, 1912. 
Navy Yard, New York, 
Captain of the Yard’s Office, 
1 July, 1912. 
Navy Yard, Boston, 
' Hull Division, 
1 July, 1912. 
Navy Yard, Norfolk, 
Machinery Division, 
1 January, 1913." 
To expedite public business between offices of tlie department or within any 
command, mail is regarded as consisting of three classes—urgent, important, 
and ordinary. Urgent mail is given precedence over all other, and in order ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
621 
that it readily may be distinguished, it has affixed to it a red slip, 2 by 3 
inches in size, with “ URGENT ” printed thereon. “ Important ” mail receives 
precedence after urgent mail and bears a blue slip with the word “ Important ” 
thereon. In general, ordinary mail is handled in the order in which received. 
Whenever the amount of business of an office justifies it as an economical 
measure, printed letterheads and forms for official correspondence may be 
used. Such forms should conform to the instructions in chapter 52, Navy 
Regulations, whenever applicable, and should be on sheets of standard size 
(letter or cap) or multiples thereof when practicable. 
All papers of whatever nature which by law or regulation must be signed, 
approved, or forwarded by an officer commanding a fleet, squadron, division, 
or station, the commandant of a naval station, the senior officer present, or the 
commanding officer of a ship, actually must be signed by such officer in his own 
handwriting. In his absence they shall be signed by the line officer next in 
rank and actually in command at the time, and the word “Acting ” shall be 
written or stamped after his signature, but the title of the official from whom 
the communication emanated, as indicated after the word “ From ” at the 
beginning of the paper, shall not be modified. The name of the officer signing 
also shall be typewritten or stamped. Thus, in the absence of the Chief of the 
Bureau of Navigation, the words “ Bureau of Navigation ” still would appear 
in the letterhead, and the acting chief of bureau would write “Acting ” after 
his signature. “Acting ” shall not be used by officers left in command of ships 
or divisions. 
When the officers in charge of sections of a bureau or office are authorized to 
sign mail of their section, they write or stamp the words “ By direction ” after 
their signature, and the title of the bureau or office shall appear in the pre- 
scribed place at the head of the communication. 
Communications generally are addressed to those who by regulation or 
law have cognizance of the subject presented or are authorized to take action 
thereon. 
Official communications intended for officers holding positions with recognized 
titles are addressed to them by title and not by name , as “ The Com- 
mandant,” “The Commander in Chief, Fleet (or Squadron),” “The 
Commander, Squadron (or Division),” “The Commanding Officer.” 
Officers left in temporary command of a station, fleet, squadron, or division, 
or in general, of any command, are addressed as if they were the regular 
commanding officer, on the principle that it is the office and not the person that 
is addressed. The temporary incumbent transacts the business so that the 
necessary copies and records shall be preserved in the files of the absent 
superior officer’s office, using stationery of that office when practicable. 
Official mail received on board ship, or at any station, shall be opened 
at once by the officer actually in command for the time being, or his designated 
representative, and all papers requiring prompt action given immediate at- 
tention. 
Official communications for the Navy Department or any of its bureaus or 
offices are addressed directly to the bureau or office which has cognizance 
over the subject matter. 
It is prohibited to address communications to “ The Navy Department ” 
or to “ The Navy Department ( ).” 
The following are examples of authorized addresses: 
The Secretary of the Navy. 
The Assistant Secretary of the Navy. 
The Chief of Naval Operations. 622 
HOSPITAL corps handbook. 
The President of the General Board. 
The Chief of the Bureau of . 
The Major General Commandant, Marine Corps. 
The Judge Advocate General. 
The Chief Clerk of the Department. 
When papers are addressed erroneously and reach any bureau or office 
under the jurisdiction of the Navy Department they are turned over to the 
bureau or office to which they should have been properly addressed without 
action thereon. 
No written communication is official which has not been forwarded 
through the prescribed channels and with the endorsements of the officers 
through whom it should have been forwarded. 
PERSONNEL OFFICE 
Chief Pharmacist or 
Pharmacist 
iHeoeiving Clerk] 
[Stenographer 
Med. & Surg. 
Reports & Returns 
Transfer Clerk 
Navigation 
Reports & Returns 
Veterans • Bureau 
Clerk 
Understudy- 
Understudy 
File Clerk 
MATERIEL OFFICE 
Chief Pharmacist or 
Pharmacist 
[property Clerk] 
[Stenographer] 
[Accounting Clerk] 
Inventory Clerk 
Requisition & Vouoher 
Cleric 
Istoreroom Keeper! 
|Storeroom Keeper 
Fig. 205.—Suggested organization of personnel and materiel offices in 500-bed naval 
hospitals. 
All officers are required to file and preserve all official documents received 
and copies of all official letters and endorsements sent. 
Suitable files containing copies of all orders given and official letters 
written and the original of all letters received on public service in all offices 
on board naval vessels and at shore stations shall be kept and preserved. 
Commanding officers may take copies of orders or letters sent and received. 
The system of filing shall be such as to safeguard all official papers and 
to render them readily accessible to reference. A flat filing system shall 
be used when practicable. 
Organization of clerical force. 
The clerical work required of the medical department of a ship or hospital 
is carried on by members of the Hospital Corps. When hospital corpsmen are 
on independent duty the preparation and forwarding of the various reports 
and returns required is entirely in their care, and unless they have prepared 
themselves for this work it is very confusing to the bureau and entails an ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
623 
unnecessary work in the attempt to gather accurate data from incorrect and 
carelessly made reports. 
The duties in a naval hospital comprise all that relates to the replenishment 
of supplies, the upkeep, expenditure, and survey of property, the commissary 
department and the correspondence and clerical work of the record section 
incident to the above, as well as the filing of all permanent records. The rec- 
ord section usually is divided into two offices—personnel and materiel. Cleri- 
cal work in the commissary department necessarily becomes a part of the 
materiel office records. 
These offices, each having a pharmacist in charge and a sufficient number of 
hospital corpsmen and civil employees to properly carry on the work, are under 
the general supervision of the executive officer. 
The outlines illustrated are suggestions only as to the organizations which 
are considered capable of handling the work of these offices in a 500-bed hos- 
pital. Selection of the personnel is dependent upon that available. 
Aboard ship the clerical work comprises all the work required at naval 
hospitals, except commissary, and is not divided. A chief pharmacist’s mate is 
usually in charge, the whole under the supervison of the senior medical officer. 
The Bureau of Medicine and Surgery filing system. 
The filing system adopted by the Bureau of Medicine and Surgery is based 
upon a system first devised by Capt. M. F. Gates, Medical Corps United States 
Navy. It is recommended for use at all medical department activities and pos- 
sesses the folowing advantages: 
(а) Uniformity. The system is capable of adaptation to meet the require- 
ments of all naval hospitals, other shore stations, and ships, thereby doing away 
with the necessity of men going from one station to another being required to 
learn a new system of filing, having to familiarize themselves only with the 
minor differences due to local needs. 
(б) Flexibility. It can he expanded or modified to meet local requirements 
and readily permits of cross filing. 
(c) Accessibility. Correspondence always is obtained easily and not mis- 
placed or lost readily. 
(d) Automatism. Briefing of correspondence is unnecessary as the system 
is self-indexing. 
(e) Divisibility. The system can be separated to permit the maintenance of 
files for any class of subject matter, as personnel, materiel, etc. 
(f) Ease of comprehension. By carefully following the permanent index 
inexperienced men easily can comprehend the system and locate or file corre- 
spondence. 
As will be seen from the example given below this filing system consists, 
fundamentally, of two grand divisions—personnel and materiel—representing 
as the names indicate, correspondence pertaining to those subjects and hav- 
ing the respective key letters of P and M. 
After preparing the permanent index and marking the cardboard folders in 
which correspondence is filed to meet local requirements, the correspondence 
is secured to one side of the folder by means of a suitable paper fastener. 
The subjects should be separated by heavy index division cards. Once filed, 
correspondence should never be removed from the folder for reference, as the 
folder should be used as a bound book, 624 
HOSPITAL CORPS HANDBOOK. 
SUBJECT.4 SUBHEAD.6 
1. Medical officers. Duty 1. Appointment. Reporting for duty. 
2. Promotion. Examinations. Fitness reports, 
etc. 
3. Orders. Detachment, etc. 
4. Conduct. Adverse reports. 
5. Health records. Physical tests. 
6. Leave. 
7. Discharges. Deaths. Retirements. 
8. Duties. -Details. Instruction. 
9. Pay. Finances. Effects. Mail, etc. 
0. Miscellaneous. • 
A. Inquiries from outside sources. 
B. Special commanding officer’s file. 
C. 
PERSONNEL SECTION. KEY LETTER “ P.” 
2. Hospital Corps. Duty 1. Enlistments. Reporting for duty. 
2. Advancement in rating. Examinations. Effi- 
ciency. Special qualifications. 
3. Transfers. Orders. 
4. Conduct. Courts-martial. Punishments. 
5. Health records. Physical condition. 
6. Leave. 
7. Discharges, etc. Deaths. Surveys. 
8. Duties. Details. Instruction. 
9. Pay. Finances. Pay accounts. Allotments. 
Insurance. Mail, etc. 
0. Miscellaneous. 
A. Inquiries from outside sources. 
B. Organization. Vacancies. Complement. 
C. • 
3. Nurse Corps. Duty 
(This file should be in custody 
of chief nurse. See sec. 15, chap. 
5, Manual of the Medical Depart- 
ment.) 
—1. Appointment. Reporting. 
2. Promotion. Examination. Efficiency. 
3. Transfers. Orders. 
4. Conduct. 
5. Health records. Physical examinations. 
Physical condition, etc. 
6. Leave. 
7. Discharges. Deaths. Surveys. 
8. Duties. Details. Instruction. 
9. Pay. Finances. Accounts. Mail, etc. 
0. Miscellaneous. 
A. Inquiries from outside sources. 
B. Organization. Vacancies. Complements. 
C. 
4. Patients, enlisted, Navy and Marine—1. Admission. 
2. Transfer from hospital. 
3. Discharge from service. Surveys. 
4. Conduct. Punishment. Courts. 
5. Health records. Physical condition. 
6. Leave. 
7. Death. Burial. Shipment of remains. 
8. Inquiries from outside sources. 
9. Pay. Finances. Effects. Mail. Allotments. 
Insurance. Pay accounts. 
0. Miscellaneous. 
A. Misconduct reports. 
B. Subsistence. 
C. 
* Add new subject when the need becomes apparent or alter those given to meet local 
conditions or needs. 
6 Subhead numbers can be added, and subhead numbers left blank on this outline may 
be filled in when necessary. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
625 
SUBJECT. 
SUBHEAD. 
5. Patients, officers, Navy and Marine 
and Navy nurses. 
1. Admission. 
2. Transfer from hospital. 
3. Discharge from service. Surveys. 
4. Conduct. Punishment. Courts. 
5. Health records. Physical condition. (These 
• are confidential in case of nurses.) 
6. Leave. 
7. Death. Burial. Shipment of remains. 
8. Inquiries from outside sources. 
9. Pay. Finances. Effects. Allotments. In- 
surance. Pay accounts, etc. 
0. Miscellaneous. 
A. Misconduct reports. 
B. Subsistence. 
C. 
6. Patients, supernumerary 1. Admission. 
2. Transfer from hospital. 
3. Discharge from service. Surveys. 
4. Conduct. Punishment. 
5. Health records. Physical condition. 
6. Leave. 
7. Death. Burial. Shipment of remains. 
8. Inquiries from outside sources. 
9. Pay. Finances. Effects, etc. 
0. Miscellaneous. 
A. Subsistence. 
B. 
7. Civilian employees 1. Employment of. 
2. Pay. 
3. Leave. 
4. Retirement. 
5. Compensation for injuries. 
6. Department reports. 
7. Miscellaneous. 
8. 
8. Instructions, reports and returns. 
Forms. Civil authorities. 
1. Bureau of Medicine and Surgery circular let- 
ters. 
2. Bureau of Navigation circular letters. 
3. Commandant’s orders. 
4. Commanding officer’s orders. 
5. Miscellaneous orders. 
6. Reports and returns, Medicine and Surgery. 
7. Reports and returns, Navigation. 
8. Reports and returns, civil authorities. Vital 
statistics, quarantine, etc. 
9. Sanitary reports. 
0. Miscellaneous. 
A. Public health officer’s reports. 
B. 
materiel file, key letter 1 m.” 
1. Reservation 1. Land and grounds. Acreage. 
2. Walks. Fences. Roads. 
3. Trees. Vegetation. Seeds. 
4. Sewerage system. 
5. Crematory. 
6. Water, supply. 
7. Tennis courts and playgrounds. 
8. Miscellaneous. 
9. 626 
HOSPITAL CORPS HANDBOOK. 
SUBJECT. 
SUBHEAD. 
2. Buildings and construction. Repairs.!.. Main building, and repairs to. 
2. Adjoining wards. 
3. Mess halls. 
4. Power house. 
5. Laundry. 
6. 
7. (Use subhead for each additional structure of 
importance.) 
3. Quarters, and fittings for 1. Commanding officer’s. 
2. Executive officer’s. 
3. Junior medical officers’. 
4. Pharmacists’. 
5. Nurses’. 
6. Hospital Corps’. 
7. Civil employees’. 
8. 
4. Cemetery and care of dead 1. Cemetery. Plans and plots. 
2. Headstones. 
3. Digging graves. 
4. Caskets. 
5. Disinterment. 
6. Embalming and contracts with undertakers. 
7. Transportation. Ferriage and tolls for dead. 
8. 
5. Hospital departments and equipment.l. Furniture and furnishings. 
2. Dispensary. Equipment and medicines. 
3. Laboratory and equipment. 
4. Operating room and equipment. 
5. Hydrotherapy and equipment. 
6. Library and equipment. 
7. Offices and equipment. Blank forms. Print- 
ing and all supplies. 
8. Laundry and equipment. Washing. Linen. 
9. X-ray and equipment. 
0. 
0. Ambulance and delivery service. 1* Motor vehicles. 
Live stock. 2. Repairs. 
3. Gasoline. Oil. 
4. Other vehicles. 
5. Horses and other live stock. 
6. Hay. Grain. Provender. Harness. Vet- 
erinary. 
7. Freight and ferriage. Tolls. 
8. 
7. Power plant and utilities 1- Machinery and equipment. Power house. 
2. Electric current. 
3. Tools, all classes. 
4. Telephones. 
5. Fire protection apparatus. 
6. Communications system. 
7. Refrigerating system. 
8. 
8. Commissary 
(This file usually is kept in the 
commissary office.) 
_1. Equipment. 
2. Ice and fuel. 
3. Provisions, supply department. 
4. Provisions, open purchase. 
5. Deliveries. Shipments. Dealers’ bills. 
6. Rejections. Unsatisfactory service. 
7. Miscellaneous. 
8. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
627 
SUBJECT. SUBHEAD. 
9. Civil hospitals under contract 1. Use a subnumber for each civil hospital under 
contract and file all business correspond- 
ence pertaining to that hospital under the 
appropriate subnumber. 
10. Requisitions and returns® 1. Current open-purchase requisitions. 
2. Blanket requisitions (open purchase). 
3. Medicine and surgery requisitions, Forms B 
and 4. 
4. Stub requisitions. 
5. Job orders. 
6. Dealers’ bills. 
7. Vouchers. 
8. Bills of lading. Shipments. 
9. Property surveys, Form Ca. 
0. Property inventories, Form D. 
A. 
Most stations having special files for forms which are satisfactory, it is not 
necessary that bureau forms he filed with the general correspondence. 
As examples of how this system is used the following are given: 
1. It is desired to write a letter relating to the advancement in rating of a 
hospital corpsman. Reference to the index, personnel section, shows that the 
subject number for Hospital Corps is 2, and the subhead number pertaining to 
their advancement in rating is .also 2. Therefore the file number to be placed 
on the correspondence is P-22. (P for Personnel, 2 for Hospital Corps, and 2, 
Advancement in rating.) 
2. Again, a circular letter from the Bureau of Medicine and Surgery pertain- 
ing to the advancement in rating of hospital corpsmen is received. Here is a 
double subject (a) Circular letter, Bureau of Medicine and Surgery; and (b) 
Advancement in rating, Hospital Corps. It is very important that all circular 
letters he kept in numerical order on a special file; therefore the letter should 
be placed under the file number P-71 (circular letters, Bureau of Medicine and 
Surgery), but a copy of this letter also should be made and placed under the 
file number P-22 (Advancement in rating, Hospital Corps). For letters which 
are not important and which go under more than one subject it is not neces- 
sary to copy the whole letter but simply brief it, filing the brief under the 
additional subject. 
3. Now, for example, under the “ Materiel file.” It is desired to write a 
letter regarding the construction of an addition to the commanding officer’s 
quarters, or one is received. The “ M ” index gives the subject number 3 
(quarters) and the subhead 1 (commanding officer’s quarters). The file num- 
ber then is M-31. 
Thus, at the end of a year there is in the files a series of booklets, each book- 
let containing all the correspondence under a given subject for the entire year. 
The cardboard folders act effectively as binders and may be lettered on the front 
in the same manner as a book is titled. 
6 Need not be used unless correspondence relating to requisitions, vouchers, etc., is 
filed with the general correspondence. 628 
HOSPITAL CORPS HANDBOOK. 
BLANK FORMS AND RETURNS OF THE MEDICAL DEPARTMENT OF 
THE NAVY OTHER THAN REQUISITION AND VOUCHER FORMS. 
To secure uniformity and accuracy of the reports and returns connected 
with the duties of the medical department of the Navy certain blank forms 
for specific purposes have been established. To designate these forms they 
are lettered or numbered, and they usually bear other letters indicating that 
they belong to the Bureau of Medicine and Surgery. 
The data contained in these reports are the basis for all of the bureau’s 
statistical compilations, and become permanent and highly important records 
of the Navy Department. The Bureau of Medicine and Surgery is compelled 
to rely upon them for the medical histories of the officers and enlisted men of 
the Navy when requested to furnish specific information of importance de- 
manded by other departmental bureaus and of vital concern to the individual. 
It therefore is obvious that these reports must be without error. In combin- 
ing and tabulating these reports an error in any one makes the whole faulty 
and impairs any deductions made from such statistics. 
To assure the uniformity and accuracy desired and to aid those who prepare 
these forms, detailed instructions for preparing each particular form are 
printed on the form itself, or the information desired is fully indicated in the 
printing and wording of the form. A great difficulty with printed instructions 
of this character is that men for whose guidance they are intended do not 
read them and of course do not comply strictly with the directions given. Only 
by strict compliance with instructions can mistakes and needless correspondence 
be avoided. Before attempting to prepare any bureau form or report it is 
therefore essential to read carefully the instructions pertaining to the form 
and to understand their meaning. 
As these forms, as well as the instructions for preparing them, are subject 
to change, the form itself should be resorted to for the necessary directions 
in its preparation. 
REQUISITION AND VOUCHER FORMS. 
In procuring supplies in the medical department of the Navy it is necessary 
to determine the source from which the supplies are to come. That is, are 
they carried in stock or can they be furnished conveniently by a naval medical 
supply depot; are they kept in stock for issue by a supply officer; or will 
it be necessary to purchase them in an open market? To procure supplies 
from any of these sources a requisition is required, and the source from which 
they are to be obtained decides the proper form of requisition to be submitted. 
The several forms in use by the medical department of the Navy therefore 
may be classed as follows: 
1. Supply depot Form B. 
Form B-dental. 
Form Ba. 
Form 4. 
2. Open purchase Medicine and Surgery Form No. 1 (supplies 
and services on shore). 
Supplies and Accounts Form No. 44 (supplies 
and services afloat). 
3. Supply Officer Stub requisition. 
Supplies and Accounts forms, ashore and 
afloat. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
629 
The Bureau of Medicine and Surgery maintains naval medical supply depots 
at Brooklyn, N. Y., Mare Island, Calif., and Canacao, P. I., from which most 
of tiie medical supplies used in the Navy are furnished. Medical supplies 
are purchased in large quantities by the Bureau of Supplies and Accounts 
on requisitions submitted by the supply depot at Brooklyn, N. Y., and ap- 
proved in the usual way by the Bureau of Medicine and Surgery. Ship- 
ments are sent from Brooklyn to the other depots, because of the greater 
facilities for purchase in the eastern United States. These supplies are 
stored and issued to the medical departments of the several ships and stations 
from time to time upon approved requisitions. 
An open-purchase requisition, as the name indicates, is one under which the 
supplies are to be purchased in the open market after competition. Certain 
classes of medical supplies are exempt by law from newspaper advertisement, 
but none may be purchased except by the proper representative of the Bureau 
of Supplies and Accounts after competition between two or more dealers by 
means of proposals or bids, and all purchases and payments are made by 
that bureau. 
Any stores carried in stock by a supply officer for issue in the service 
may be procured on stub requisitions (S. & A. form) prepared and submitted 
by the head of the department concerned. 
Requisitions concerning the medical department of a ship, hospital, or other 
shore station, are numbered in series throughout the fiscal year, which begins 
on July 1 and ends on June 30 of the following year. On June 30 of each year, 
therefore, the series for one fiscal year becomes complete, and series for the 
next begins on July 1. Requisitions chargeable against the Naval Hospital 
Fund or the appropriations, Medical Department, Contingent, Medicine and 
Surgery, Bringing Home Remains of Officers, etc., and Care of Hospital Pa- 
tients, have one series of consecutive numbers; open-purchase requisitions, 
whether prepared on S. & A. Form 44 or N. M. S. Form 1, are included in the 
regular numerical series; and all requisitions on medical supply depots are car- 
ried in another numerical series, the numbers preceded by the letters S. D. Stub 
requisitions are numbered in accordance with instructions of the local supply de- 
partment on which the requisition is made. Requisitions involving appropria- 
tions other than those mentioned above are forwarded, unnumbered. If a 
requisition is canceled its number shall not be used again during the fiscal year. 
Duplication of requisition numbers in one fiscal year is a common occurrence 
and should be scrupulously avoided. Such duplication of numbers causes con- 
fusion both in the bureau and in the offices handling the requisitions, compli- 
cates any correspondence that may become necessary in connection with such 
requisitions, and duplication is an evidence of inexcusable carelessness in the 
clerical department concerned. 
Items of requisitions are numbered at the left and item numbers of public 
bills must be identical, item for item, with the requisition item numbers. 
Requisition for stores from a supply depot. 
A supply table and field supply table of the medical department of the 
Navy are issued by the bureau as a basis for preparing requisitions for stores 
from supply depots. They contain a printed list, arranged alphabetically and 
by classes, of supplies kept on hand for issue, with allowances based on the 
complement of men on a ship or station. The field supply table contains a list 
of all articles necessary for the equipment of a field hospital, regimental hos- 
pital, battalion, and company. This field supply table is to be inserted and 
securely fastened to the supply table. 630 
HOSPITAL CORPS HANDBOOK. 
Every office where requisitions of the medical department are prepared 
should have a copy of the supply table (with the field supply table inserted) 
available for reference. 
Full instructions for preparing requisitions for stores to be drawn from a 
supply depot are printed on the several forms, and these instructions must 
be followed in each instance. Additional information is contained in chapter 
20 of the Manual of the Medical Department. 
A brief description only of these requisition forms is given here. 
Form B contains a printed list of the medical supplies as given in part one of 
the supply table, and is intended for use when a large number of articles is 
required. 
Form B-dental contains a printed list of dental supplies listed in part two 
of the supply table, and is intended for the use of dental officers only. 
Form 4 is a blank form to be used when a limited number of articles 
in the supply table is required; also for indispensable articles not on Form B 
which can be furnished most conveniently by a supply depot. Separate requisi- 
tions must, however, be prepared in each instance for articles listed in parts 
one, two, and three of the supply table and for articles not listed in the supply 
table. The latter requirement is important and should be adhered to strictly, 
for the reason that supply depot accounts are kept in accordance with this 
classification. When a Form 4 requisition is submitted for articles not on the 
supply table it should be accompanied by a letter explaining the necessity for 
such articles. 
Form Ba is a special requisition form embracing a supplementary list of 
articles (on charge but not included, in the supply table) in store at the 
naval medical supply depot. 
These four separate forms, B, B-dental, Ba, and 4, are prepared in quad- 
ruplicate (and retained copy), giving the number of the requisition, and 
marked “ First,” “ Second,” “ Third,” “ Fourth.” The name of the appropria- 
tion is not entered by the maker. They should be forwarded for approval as 
directed on the forms. No money values are to be entered by the maker 
on the face of any supply depot requisition, since the stores are purchased in 
the open market on requisitions for the supply depot and their issue value de- 
termined in that way. When priced in the supply depot the first and second 
are returned to the maker of the requisition as invoices, and he is to enter 
the values on the third. After receipt of the stores the forms are signed by 
the receiving officer, and they then become vouchers. The “ first ” is returned 
to the supply depot, the “ second ” to the bureau, and the “ third ” is retained 
for the files of the ship or station. The “ fourth,” retained in the bureau on 
approval of the requisition, is destroyed when the receipted second has been 
received and filed. 
A supply depot must have some authority and a system of accountability for 
making expenditures from their stock. The “ first ” of every approved requisi- 
tion is, then, not only the authority for the issue of the stores enumerated 
thereon, but becomes, when receipted, a voucher in the supply depot’s system of 
accounting for the expenditure of their stock. 
Material and stores are procurable only on requisitions approved by compe- 
tent authority, except where the bureau directs that requests shall be made by 
letter. The following articles, for example, must be requested by letter and 
not by requisition; Biological supplies, blood stains, culture tubes, X-ray films. 
Open Purchase Requisitions. 
Medicine and Surgery requisition Form 1 is used for all purchases of supplies 
and services on shore for the Medical Department of the Navy. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
631 
Supplies and Accounts requisition Form 44 is used by the Medical Depart- 
ment of the Navy for all purchases of supplies and services afloat. 
Blank forms are used that indicate the information required concerning the 
necessity and character of and the quantity and estimated cost of the supplies 
or services to be purchased. 
Each requisition is accompanied by as many memorandum copies as may be 
required. The estimated cost of each item and the total is entered upon the 
memorandum copies only. The original bears the necessary signatures, and, 
except in the cases of formal contracts, accompanies the original of the public 
bill, and finally lodges with the General Accounting Office of the Treasury, 
Military Division. One memorandum copy of the requisition remains in the 
Bureau of Medicine and Surgery, two in the Bureau of Supplies and Accounts, 
and one in the office of the purchasing pay officer. 
Requisitions must give such accurate information as will enable the 
purchasing pay officers and the bidder to understand readily what is required, 
and its items must be arranged so that the articles of a similar nature may 
be grouped. Articles or services coming under different appropriations may 
not be combined on one requisition. Proprietary articles must not be called 
for when it can be avoided, but when called for, the officer making the 
requisition must certifiy that the “articles and no others will answer the 
necessities of the service.” 
A hospital corpsman preparing requisitions for open purchase should 
be familiar with section 3, chapter 43, Navy Regulations, and the instruc- 
tions contained therein must be carefully followed. 
Copies of all instructions issued from time to time by the Bureau of 
Supplies and Accounts relative to the preparation of open purchase requi- 
sitions should be filed, so that they may be available for reference. 
Particular attention should be given the question of procuring materials 
under standard specifications, and requisitions should adhere to such speci- 
fications so far as is practicable. 
Supplies from supply officers on stub requisitions. 
Stub requisitions on a supply officer, ashore or afloat, are prepared by the 
head of the medical department on the prescribed forms (S. & A.) and do not 
require the approval of the Bureau of Medicine and Surgery, although funds 
must be allotted by the bureau prior to the preparation of the requisition. 
For this reason and the further fact that this arrangement is local, stub re- 
quisitions are not numbered in the regular series of the fiscal year. They 
are filed as vouchers when the transaction has been completed. 
Whenever practicable, advantage should be taken of this means of secur- 
ing needed supplies that are carried in stock by a supply officer. These sup- 
plies are purchased in large lots at a reduced cost; they are standard goods 
find their quality can be depended upon. Furthermore, this method of procural 
is direct and so avoids the delay consequent upon the bureau’s approval of a 
more formal requisition and the purchase and delivery of supplies thereunder. 
Public bills. 
When supplies purchased under an open-purchase requisition have been 
received and accepted, payment for them must be made. 
Public bills are prepared on the appropriate blank forms. Medicine and 
Surgery bill Form 5 is used with requisition Form 1; Supplies and Accounts 
Dill Form 51a is used with requisition Form 44. These blank forms have 
been submitted to the Comptroller of the Treasury, whose approval of 
same as to completeness is required by law before they may be used. An 632 
HOSPITAL CORPS HANDBOOK. 
original and a sufficient number of memorandum copies are required. The 
original, accompanied by the original of the requisition, finally lodges with 
the General Accounting Office of the Treasury, Military Division. One 
memorandum copy remains in the Bureau of Medicine and Surgery, two 
in the Bureau of Supplies and Accounts, one with the disbursing officer who 
makes the payment, one with the accounting officer of the navy yard, and one, 
stamped “ Dealer’s Copy,” accompanies the check to the payee as an identi- 
fication of the payment. The office in which the requisition and the public 
bill originate retains copies of each, which are recorded in the charge register. 
Signatures are affixed only on the original copy of a public bill. Tbe memo- 
randum copies are true copies, except that the places for signature are 
filled by stamping or typing therein tbe names. 
As articles on a requisition may be procured from several dealers, two or 
more public bills may be necessary in connection with but one requisition. In 
such instances the original of the requisition accompanies the first public bill 
made, and notation of its disposition is appropriately made on all subsequent 
public bills under tbe requisition. This notation states the number, date, deal- 
er’s name, and amount of the voucher to which the original of the requisition 
is attached. 
Medical officers are responsible for the correctness of the certificate of in- 
spection and acceptance and the purchasing pay officers for the correctness of 
the certificate as to method of purchase and as to prices. It is required that both 
exercise special care not only as to the accuracy of the figures, but also that 
the appropriation involved shall be correctly stated in title and fiscal year. 
The requisition and voucher forms have been carefully prepared to meet 
every legal requirement, and it is forbidden that the phraseology of the forms 
be altered when either supplies or services are furnished or performed. 
Special exigency public bills. 
Medicine and surgery bill Form 6 (on shore only). This voucher form is 
for use at hospitals and at shore stations in case of sudden emergency, such as 
broken water, steam or gas pipes; falling walls or ceilings; broken beating or 
cooking apparatus; and in all cases where the work must he done immediately; 
also for the purchase of articles not provided for on approved requisitions for 
the care and welfare of the sick which are needed immediately; and for funeral 
expenses. It shall never be used if time will permit the procurement of the 
articles or services on an approved requisition. 
Special exigencies arise in the care of the sick and the preservation of hos- 
pital buildings when supplies or services can not be obtained under the au- 
thority of existing contracts or requisitions. In recognition of this fact and to 
provide for payment for such supplies or services by public bill without war- 
rant of statute law, the Second Comptroller of the Treasury prepared the form 
of public bill known as “ Special exigency public bill ” for special use by the 
medical department of the Navy. 
The exigency clause on Form 6 is filled out by the senior medical officer of 
the hospital or station, who assumes the entire responsibility for procuring the 
supplies and services paid for on special exigency vouchers. It then is for- 
warded to the Surgeon General for approval, and subsequently transmitted to 
the Bureau of Supplies and Accounts for the same action as prescribed for 
other public bills. 
Special supplies and method of procural. 
Typhoid prophylactic, vaccines, and serums are procurable upon application 
by letter or telegram to the nearest naval medical supply depot. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
633 
Blood stain (in sealed tubes containing 0.075 gm. and methyl alcohol 25 c. c.) 
is procurable upon application to the Naval Medical Supply Depots at Brooklyn, 
N. Y., and Mare Island, Calif. 
Culture media is procurable upon application by letter or telegram to the 
Naval Medical Supply Depot, Brooklyn, N. Y. 
Amboceptor paper, antigen, bacterial cultures, bacterial emulsions, mailing 
cases, bottles, and vials for the forwarding of samples or specimens are pro- 
curable upon application by letter or telegram to the Naval Medical School, 
Washington, D. C. 
Alcohol is procured, by hospitals only, from the Supply Department ashore 
in quantities of not less than 5 gallons. 
Transfer of labor from a navy yard is obtained by request on the Bureau of 
Medicine and Surgery, which allots the necessary funds and authorizes the 
commandant of the yard concerned to furnish the labor required. 
To obtain supplies under Navy Pay Office contracts the senior medical officer 
makes order upon the contractor. 
Articles supplied on annual contract of the Bureau of Yards and Docks. 
When it becomes necessary to prepare a requisition at a naval hospital or 
shore station for furniture, etc., the contract schedule covering annual contracts 
entered into by the Bureau of Yards and Docks, a copy of which may be 
found in the office of the public works officer of the station, should be examined 
to ascertain whether the items supplied under the annual contract will fulfill 
requirements. 
Articles desired under such contract should appear on a separate requisition 
I>repared in the usual way on Form 1, and in making selections from the con- 
tract the following information should be given in every instance on the face 
of the requisition and in the order here indicated: 
(a) Item number of contract. 
(b) Name of article required. 
(c) Pattern number of article required. 
(d) Kind of wood of article required. 
(e) Upholstering number, when applicable. 
This information is necessary to make clear to the Bureau of Yards and 
Docks what is desired when placing the order with the contractor. 
The contractor is directed by the Bureau of Yards and Docks to ship the 
articles to the hospital or medical department of the station concerned. If in- 
spection of the articles proves satisfactory, preparation of the necessary voucher 
or vouchers for the payment of the stores is made by the medical department 
in the prescribed bill form and in the usual way. 
Departmental contracts. 
When a formal departmental contract is entered into by the Government for 
material or services for the medical department of the Navy and the work is 
carried on under the supervision of the Bureau of Yards and Docks, vouchers 
for the payment of bills under the contract are prepared by the public works 
officer having direct supervision of the work, and copies of all vouchers to 
complete the files of the medical department of the station concerned should 
be procured from the office preparing the vouchers. 
It is very important that a full set of vouchers for each contract be recorded 
and filed, so that a complete record of the cost, date of completion, etc., of the 
work will show in the accounting records. 634 
HOSPITAL CORPS HANDBOOK. 
ACCOUNTING AND PROPERTY ACCOUNTABILITY. 
By the United States Navy Regulations officers are l-equired to avoid any 
unnecessary expenditure of public money or stores, and so far as may be in 
their power prevent the same in others, and to attend to the care and preser- 
vation of all Government property in their charge. 
An accurate account of all Government property under the cognizance of the 
medical department of the Navy must be kept, and an inventory, itemized for 
nonexpendable items and by classes for expendable items, made and forwarded 
to the Bui-eau of Medicine and Surgery on July 1 of each year. 
Government property is of two classes—expendable and nonexpendable. Medi- 
cines, hospital stores, and certain surgical appliances, dressings, hospital and 
nursing appliances, etc., are classed as expendable property, and no itemized 
inventory is required by the bureau, but report of the value of the expendable 
property on hand must be made. Nonexpendable property is property that is not 
consumable; that is, not easily breakable (such as hospital furniture), or not 
retidily made unlit for service by continued use (such as surgical instruments). 
Reference to the Supply Table of the medical department, United States Navy, 
should be made in determining to which class an article belongs. 
Medical department property may be transferred, under certain conditions 
fully explained in section 4, chapter 20, Manual of the Medical Department, 
from one officer to another, to merchant ships in distress or foreign ships of 
war, from one ship in commission to another, and from a shore station to a 
ship or vice versa. 
When nonexpendable property is lost or damaged so as to be unfit for further 
use, it shall be surveyed for the purpose of establishing and reporting the facts 
aixd making recommendations as to the disposal of the property. In the case 
of property lost, the responsibility for the loss shall be ascertained and report 
made thereon. In connection with surveys on property, reference should be 
made to section 5, chapter 20, Manual of the Medical Department, or to in- 
sti’uctions issued by the Bureau of Medicine and Surgery. 
That each commanding officer of a naval hospital may know at any time 
what has been expended or received, what the hospital is expending or receiv- 
ing and will expend or receive and the reason therefor, and thereby enable 
the Bureau of Medicine and Surgery and the commanding officer to determine 
promptly the capital invested and the actual cost of maintenance and operation 
for any period of time is the principle on which the present system of naval 
hospital accounting is based. 
A chief pharmacist or pharmacist known as the accounting and property 
officer is in charge of this department and is directly responsible for its proper 
functioning. The accounting and property officer definitely and permanently is 
assigned in the organization of a hospital. In addition to such other duties 
as may be assigned him, the duties of the accounting and property officer are 
summarized below. 
(a) Acts as assistant to the commanding and executive officers in financial 
and property matters. 
(&) Is accountable to the commanding and executive officers for all 
equipment and stores in his charge, exercising personal and careful supervision 
over their condition, and the economical expenditure thereof, reporting any 
deficiencies through the executive officer to the commanding officer. 
(c) Prepares requisitions, public bills, invoices, requests for allotments, and 
all other forms and reports pertaining to financial matters. 
(d) Under-the direction of the commanding and executive officers, issues 
and accounts for all stores and equipment. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
635 
(e) Maintains the proper records of equipment issued to the several depart- 
ments of the hospital, obtaining and retaining in file custody receipts therefor, 
reporting any deficiencies through the executive officer to the commanding 
officer. 
(f) Submits through the executive officer to the commanding officer at the 
end of each month the Expense Analysis Statement, condition of allotments 
and requisitions, a statement as to the balances available or prospective over- 
obligations, if any, with the reasons therefor. 
(<j) Takes actual inventory of stores on hand at the end of each quarter, 
reporting in detail through the executive officer to the commanding officer 
any deficiencies in the amounts as shown on the books and as shown by actual 
inventory. The commanding officer’s approval is his authority to adjust the 
books to conform to the inventory, such adjustments to be made in the books 
as described under inventory adjustments in the instructions concerning the 
accounting system. 
(h) Upon detachment or relief makes a complete inventory of stores in 
company with his successor and effects a complete transfer to his suc- 
cessor, reporting the same to the commanding officer. 
(/) Keeps himself informed of the laws, regulations, and instructions govern- 
ing the submission of financial reports, etc. 
Tiie system is intended to be elastic so that it may suit the needs of all 
hospitals, regardless of size or number of departments into which the hospital 
may lie divided, or the number of items issued or used by each department. 
In order to economize, that is, to practice economies that are of definite 
value, it must be known just what is being done at the present time, how 
it is being done, how it compares with other naval hospitals, and the results 
obtained. If this is not known, any effort to economize is not based on sufficient 
knowledge to secure results. 
The work of a hospital is so complicated, and requires so many departments 
and so many kinds of work, that even approximate figures for the cost of 
any given item or department can not be obtained without a system of ac- 
counting independent of cash transactions. This system is not simply a total 
of bills paid or vouchers passed but represents the value of supplies actually 
issued and wages actually earned, and separate appropriations and costs. 
To separate appropriations and costs the accounting system is divided into 
two parts: 
(1) A record of expenditures made during a fiscal year that includes only 
actual expenditures from current appropriations. 
(2) A cost accounting system that has no reference to actual cash expendi- 
tures from current appropriations except as they appear in the charge register 
(which takes the place of the former bill book) and shows the actual issues 
of supplies and of wages accrued during a certain period of time. 
Owing to the complex transactions involved in the business of hospitals, 
double entry bookkeeping is the best method of recording them. The three 
principal reasons for this are: First, because of the element of time which 
enters into the transactions; second, because there are internal and external 
checks which guard against error and help to prevent fraud; and third, to 
obtain proper statements of operating cost. Double entry bookkeeping gives 
the assets and capital in full, together with gains or losses and their sources. 
Every transaction necessitates the debiting of one account and crediting of 
another. 
47829°—23 41 636 
HOSPITAL CORPS HANDBOOK. 
Double entry bookkeeping is based on the theory of an accountability to 
capital which always exactly equals the amount of assets. After the initial 
balance or equilibrium is secured no change in the form of assets or capital, 
no additions to the fund nor subtractions from it, in fact, no business trans- 
action whatsoever, can affect the theoretical balance thus obtained. 
In the initial entry the equilibrium is brought into the books, that is the 
debit and credit side are in balance. In all subsequent entries, equal amounts 
likewise must be carried to the debit and credit columns. From this principle 
comes the double entry bookkeeping rule that for every debit there must he 
a corresponding credit. 
The details of the proper accounts to be debited and credited are given in 
the instructions governing the use of this system issued by the Bureau of 
Medicine and Surgery. 
The term capital, as used in this system, represents the money invested 
in the institution. 
Two distinct elements are found in accounts during an accounting period, 
real and nominal elements. 
Ileal elements consist primarily of asset values, but there lias been included 
in the classification of real accounts the accounts that record capital. The 
books at the time of opening and after closing at the end of an accounting 
period (the fiscal year is considered as an accounting period) therefore contain 
real accounts only. 
Nominal elements are statistical in their nature and record receipts and 
expenses in various classifications. The nominal elements are created as the 
accounting period progresses, and they are closed out at the end of the account- 
ing period. 
The following forms are provided for the operation of the cost-accounting 
system: Journal, charge register, expense-analysis register, expense-analysis 
statement, stock ledger, equipment ledger (present stock cards), commissary 
ledger (present ledger), general ledger, recapitulation of ledger accounts. 
The journal. 
The journal is one of the books of original entry and takes care of all items 
that can not be entered directly into the charge register, such as opening entry, 
transfer vouchers received and issued, surveys, inventory adjustments, contin- 
gencies and losses, summary entries at the end of the month, etc. 
The charge register. 
The charge register is the other book of original entry in which the voucher 
and its distribution is recorded. Every purchase transaction, whether of capital 
items of hospital property, supplies, or services of any kind, when received 
from a medical supply depot, supply department of the Navy, or paid for on 
public bill or pay roll, is entered in this register. 
The expense-analysis register. 
The expense-analysis register is an analysis of the expense incurred by each 
department in a hospital by classes of supplies. 
The expense-analysis statement 
This statement is a recapitulation of the expense-analysis register, and is 
arranged so that each month comparisons may be made with previous months. 
The stock ledger. 
The stock ledger is an itemized record of the receipt and expenditure of all 
expendable supplies. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
637 
The equipment ledger. 
The equipment ledger is an itemized record of the receipt and expenditure of 
all nonexpendable articles of equipment. 
The commissary ledger. 
The commissary ledger is an itemized record of the accounts of the com- 
missary department, both as to quantity and casli value of stores. 
The general ledger. 
The general ledger, containing 13 accounts that are practically controlling 
accounts, is designed to show the summary of all hospital expenses as sub- 
classified and distributed in the expense-analysis register. 
The accounting system used for other shore stations and for vessels afloat is 
much simpler, and does not require any detailed explanation here other than 
that it is based on the same principles as the system for naval hospitals. 
OTHER REPORTS AND RETURNS. 
In transacting the business of the Medical Department of the Navy many 
reports and returns other than those described above are required. These are 
lettered forms, hospital forms, Hospital Corps forms, and miscellaneous forms. 
General and detailed instruction concerning their preparation and use is given 
in chapters 23 and 24, Manual of the Medical Department and changes therein, 
and in Bureau of Medicine and Surgery circular letters. 
Identification records. 
While not Bureau of Medicine and Surgery forms, hospital corpsmen are con- 
cerned in the preparation of identification records, which consist of the finger 
prints and personal description in the case of every man enlisting in the Navy 
and Marine Corps. They are forwarded to the Bureau of Navigation and to the 
Major General Commandant respectively. The finger print and identification 
record is not required upon reenlistment or upon discharge for undesirability. 
The form adopted for the recording of finger prints and personal description 
(Form N. Nav. 2 for naval personnel and Form N. M. C. 330 for marines) 
carries the finger-print record on one side and the personal description on the 
other. 
In addition to the above records for identification, hospital corpsmen fre- 
quently are required to prepare identification tags, which are made of monel 
metal and worn by all persons in the naval service, in time of war or other 
emergency, suspended around the neck. 
Paragraphs 1488 to 1499, chapter 11, of the Manual of the Medical Depart- 
ment, and articles D-1000 to 1131, Bureau of Navigation Manual, contain de- 
tailed information concerning the preparation and use of these records. 
HOSPITAL CORPS FORMS. 
A short description of the various Hospital Corps forms is given to show 
their purpose. These forms are identified by the letters N. M. S. H. C. and 
the number appearing on each. If the words which these letters indicate 
were written in full they would be Navy, Medicine and Surgery, Hospital Corps. 638 
HOSPITAL CORPS HANDBOOK. 
Form. 
Name. 
Use. 
N.M. S. H.C. 1 
Examination report 
To enable the Bureau of Medicine and Surgery to judge 
of the fitness of hospital corpsmen for advancement in 
rating and have a permanent record of such examina- 
tions. 
N.M.S.H.C.2 
Qualification report (en- 
listed personnel). 
To enable the Bureau of Medicine and Surgery to have 
information of the duties performed by hospital corps- 
men and the duties for which they are especially quali- 
fied by training and experience. 
To enable the Bureau of Medicine and Surgery to have 
information of the duties performed by chief pharma- 
cists and pharmacists and the duties for which they 
are especially qualified by training and experience. 
N. M. S. H. C. 2 
Qualification report (chief 
(pink). 
pharmacists and pharma- 
cists). 
N.M.S.ELC.3 
Transfer and disposition 
card. 
To enable the Bureau of Medicine and Surgery to have 
notice of any change of status or station of all members 
of the Hospital Corps when occurring and thereby 
keep accurate individual records of them. 
N.M. S. H.C.4 
Roster report of the Hos- 
pital Corps. 
To enable the Bureau of Medicine and Surgery to have 
full and complete information as to present station, 
status, and duties being performed in the case of all 
hospital corpsmen, and a means to check information 
received on Form N. M. S. H. C. 3 as to accuracy. 
N.M. S. H.C. 5 
Statement of qualifications 
for chief pharmacist’s 
mate and pharmacist’s 
mate, first class. 
To enable the Bureau of Medicine and Surgery to have 
special information regarding the qualifications of 
hospital corpsmen for advancement to these ratings 
N.M.S.H.C.6.... 
Report of examination for 
pharmacist (provisional), 
Naval Reserve Force. 
To enable the Bureau of Medicine and Surgery to have 
permanent records of qualifications of pharmacists, 
Naval Reserve Force. 
N.M. S. H.C. 7 
Certificate of graduation, 
Hospital Corps Training 
School. 
To enable men completing course of instruction to have 
certificate showing completion of course and graduar 
tion, and the Bureau of Medicine and Surgery to have 
a permanent record of men graduating, with the 
average percentage attained during the course. 
N.M. S. H.C.7a... 
Certificate of graduation, 
Pharmacist’s Mates School. 
To enable men completing advanced course of instruc- 
tion to have certificate showing completion of course 
and graduation, and the Bureau of Medicine and Sur- 
gery to have a permanent record of men graduating, 
with the average percentage attained during the 
course. 
The following tabulation shows the various forms which members of the Hos- 
pital Corps may be required to prepare, when they must be made out, and when 
forwarded. Whenever any doubt exists concerning the use of a form reference 
should be made to the Navy Regulations, the manuals of the various bureaus, 
and circular letters or other instructions issued to the service from time to 
time. It should be remembered that while the forms listed are required at 
present, changes frequently occur in those necessary to he submitted, with the 
result that additions or deletions in this table may have to he made. 
1. Arrival, Duty, Navy : 
Endorse orders and return. 
Entry on pay account. 
Entry Journal of the Medical Department. 
Entry muster card. 
Entry in health record. 
Entry N. M. S. H. C. 4. 
Entry on morning report. 
Make N. M. S. H. C. 3. 
Make N. Nav. 48 and 48a. 
Make jacket. 
PAPERS TO ACCOMPANY 
Enlistment record. 
Health record. 
I’ay accounts. 
C. S, C., if any. 
2. Arrival, Patient, Navy : 
Entry Journal of the Medical Department. 
Entry hospital register. 
Entry on pay account. 
Entry muster card. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
639 
2. Arrival, Patient, Navy—Continued. 
Entry on morning report. 
Entry Form I (rough). 
Entry health record. 
Entry N. M. S. H. C. 4, if hospital eorpsman. 
Make jacket. 
Make N. M. S. H. C. 3, if hospital eorpsman. 
Make Form F. 
Make N. Nav. 48 and 48a. 
Make N. Nav. 29. 
Make misconduct report if necessary. 
PAPERS TO ACCOMPANY 
Enlistment record. 
Health record. 
Pay accounts. 
C. S. C., if any. 
Gunnery record, if any. 
Hospital ticket. 
3. Arrival, Patient, Marine : 
Entry Journal of the Medical Department. 
Entry hospital register. 
Entry health record. 
Entry on morning report. 
Entry on muster card. 
Entry Form I (rough). 
Make Form F. 
Make jacket. 
Make misconduct report if necessary. 
PAPERS TO ACCOMPANY 
Health record. 
Hospital ticket. 
Conduct report. 
4. Arrival, Officer, Duty : 
Endorse orders and return. Make the required number of copies. 
Entry in health record. 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry on N. M. S. H. C. 4 if Chief Pharmacist or Pharmacist. 
Make jacket. 
Make muster card. 
Make N. Nav. 64. 
Make N. M. S. H. C. 3 if Chief Pharmacist or Pharmacist. 
Make request for quarters to commanding officer. 
File health record. If not with officer, write for same. 
5. Arrival, Officer, Patient, Navy : 
Endorse orders, if any. 
Entry on morning report. 
Entry Journal of the Medical Department. 
Entry hospital register. 
Entry Form I (rough). 
Entry health record. 
Entry on N. M. S. H. C. 4 if chief pharmacist or pharmacist. 
Make jacket. 
Make muster card. 
Make Form F. 
Make N. M. S. H. F. 1. 
Make N. M. S. H. C. 3 if chief pharmacist or pharmacist. 
Make misconduct report if necessary. 
Make Form S and send to supply officer. 
PAPERS TO ACCOMPANY 
Health record. 
Hospital ticket. 
6. Arrival, Officer, Patient, Marine : 
Endorse orders, if any. 
Entry on morning report. 
Entry Journal of the Medical Department. 
Entry hospital register. 640 
HOSPITAL CORPS HANDBOOK 
6. Arrival, Officer, Patient, Marine—Continued. 
Entry Form I (rough). 
Entry health record. 
Make jacket. 
Make muster card. 
Make Form F. 
Make N. M. S. H. F. 1 (1 copy to Headquarters, TJ. S. M. C.). 
Make misconduct report if necessary. 
Make Form S and send to supply officer or Marine paymaster having accounts. 
papers to accompany— 
Health record. 
Hospital ticket. 
7. Arrival,, Nurse, Duty : 
* Endorse orders. 
Entry Journal of the Medical Department. 
Entry memorandum for monthly return. 
Chief nurse forwards information slip. 
Copy of orders to supply officer. 
Make S. & A. 56. 
papers to accompany 
Health record. If not with nurse, write for same. 
8. Arrival,, Nurse, Patient : 
Entry Journal of the Medical Department. 
Entry hospital register. 
Entry Form I (rough). 
Entry health record. 
Entry memorandum for monthly return. 
Make muster card. 
Make Form F. 
Make Form S and send to supply officer. 
Chief nurse forwards information slip. 
PAPERS TO ACCOMPANY 
Health record. 
Hospital ticket. 
9. Arrival, Supernumerary, Patient: 
Letter to M. and S. admission of supernumerary, giving name in full, date, and 
place of birth. 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register. 
Entry Form I (rough). 
Make jacket. 
Make muster card. 
Make medical history sheet giving name in full, date and place of birth. 
Make Form F. 
Make Form S and send to supply officer in the case of retired officer and enlisted 
men of the Navy and Marine Corps, and in the case of civilian employees. 
Make N. M. S. H. F. 1 in the case of retired officer. 
Notify the governor of Naval Home, Philadelphia, Pa., in the case of a bene- 
ficiary. 
Notify the Honorable Commissioner of Pensions, Pension Washington, 
D. C., in case of admission of pensioner patient, giving full name, rate, and 
pension number. 
Make Form 52 in the case of IT. S. Army patient. 
10. Departure, Officer, Duty : 
Endorse orders and make necessary copies. 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry on N. M. S. H. C. 4 in the case of chief pharmacist or pharmacist. 
Close health record. 
Close jacket. 
Close muster card. 
Make fitness report. 
Make N. M. S. H. C. 2 in case of a chief pharmacist or pharmacist. 
Make N. M. S. II. C. 3 in case of a chief pharmacist or pharmacist. 
Make N. Nav. 64. 
Make S. & A. 34 and 34a. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
641 
11. Departure, Navy, Duty : 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry muster card. 
Issue orders. 
Close health record. 
Close enlistment record. 
Close C. S. C., If any. 
Close jacket. 
Make N. M. S. H. F. 3. 
Make N. M. S. II. F. 4. 
Make N. M. S. II. F. 5. 
Make N. M. S. H. F. 7. 
Make N. M. S. II. C. 2. 
Make N. M. S. H. C. 3. 
Make entry on N. M. S. II. C. 4. 
Make N. Nav. 8 and 8a. 
Make S. & A. 34 and 34a if necessary. 
12. Departure, Nurse, Duty : 
Endorse orders and make necessary copies. 
Entry Journal of the Medical Department. 
Entry memo, for monthly return. 
Close health record. 
Make S. & A. 34 and 34a. 
Chief nurse sends information slip. 
13. Departure, Officer, Patient, Navy : 
Endorse orders, if any. 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register. 
Entry Form I (rough). 
Close muster card. 
Close health record. 
Close Form F. 
Close jacket. 
Make N. M. S. H. F. 2. 
Make misconduct report if necessary. 
Make Form T and send to supply officer. 
Make N. M. S. H. C. 2 if chief pharmacist or pharmacist. 
Make N. M. S. If. C. 3 if chief pharmacist or pharmacist. 
Make entry on N. M. S. H. C. 4 if chief pharmacist or pharmacist. 
Make N. Nav. 64. 
Make S. & A. 34 and 34a if necessary. 
14. Departure, Officer, Patient, Marine: 
Endorse orders if any. 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register. 
Entry Form I (rough). 
Close muster card. 
Close health record. 
Close Form F card. 
Close jacket. 
Make N. M. S. H. F. 2 (1 copy to Headquarters, U. S. M. C.). 
Make misconduct report if necessary. 
Make Form T and send to supply officer or Marine paymaster having accounts. 
Transportation of household goods made by Quartermaster, U. S. M. C. 
15. Departure, Navy, Patient: 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register. 
Entry Form I (rough). 
Close health record. 
Close jacket. 
Close. Form F. 
Close enlistment record. 642 
hospital corps handbook. 
15. Departure, Navy, Patient—Continued. 
Close C. S. C. if any. 
Close muster card. 
Close gunnery record if any. 
Make N. *M. S. H. C. 2 if hospital eorpsman. 
Make N. M. S. H. C. 3 if hospital corpsihan. 
Make entry on N. M. S. H. C. 4 if hospital eorpsman. 
Make N. M. S. H. F: 3. 
Make N. M. S. H. F. 4. 
Make N. M. S. H. F. 5. 
Make N. M. S. H. F. 7. 
Make misconduct rt'port if necessary. 
Make N. Nav. 8 and 8a. 
Make S. & A. 34 and 34a if necessary. 
10. Departure!, Marine, Patient: 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register. 
Entry Form I (rough). 
Close health record. 
Close muster card. 
Close Form F. 
Close jacket. 
Make misconduct report if necessary. 
Transportation of household goods made by Quartermaster, U. S. M. C. 
17. Departure, Nurse, Patient: 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register. 
Entry Form I (rough). 
Entry memoranda monthly return. 
Close health record. 
Close Form F. 
Make Form T and send to supply officer. 
Make S. & A. 34 and 34a if necessary. 
Chief nurse sends information slip. 
18. Departure, Supernumerary, Patient: 
Letter to Bureau of Medicine and Surgery giving full name with date and place 
of birth. 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry in hospital register. 
Entry Form I (rough). 
Close medical history sheet and forward to Bureau of Medicine and Surgery. 
Close muster card. 
Close Form F. (Do not forward to Bureau of Medicine and Surgery.) 
Close jacket. 
Make Form T and send to supply officer in the case of retired officer and enlisted 
men of the U. S. Navy and Marine Corps and in the case of civilian employees. 
Make N. M. S. H. F. 2 in the case of retired officers. Notify the Governor of 
Naval Home, Philadelphia, Pa., in the case of a beneficiary. 
Notify the Honorable Commissioner Oif Pensions, Pension Office, Washington, 
D. C., in case of a pensioner, giving full name, rate, and pension number. 
Make Form 52 in case of U. S. Army patient. 
19. Death, Officer, Navy or Marine Corps : 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register. 
Entry Form I (rough). 
Entry autopsy book. 
Entry burial record. 
Close health record. 
Close jacket. 
Close Form F. See that diagnosis agrees with primary cause on Form N. 
Make Form T and send to supply officer or Marine paymaster having accounts. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
643 
19. Death, Officer, Navy or Marine Corps—Continued. 
Make city or county death report. 
Make N. M. S. H. F. 61. 
Make N. M. S. H. C. 2 if Chief Pharmacist or Pharmacist. 
Make N. M. S. H. C. 3 if Chief Pharmacist or Pharmacist. 
Make entry on N. M. S. H. C. 4 if Chief Pharmacist or Pharmacist. 
Make Form N. 
Make S. and A. 34 and 34a, if necessary. Quartermaster, U. S. M. C. will ship 
household effects in case of Marine Corps officer. 
Make inventory of effects. 
Make N. Nav. 64 (Navy officer). 
Despatch to next of kin, Secretary of the Navy, and Bureau of Medicine and Sur- 
gery. Despatch to Headquarters, U. S. M. C. in case of Marine Corps officer. 
Notify commandant in the case of Navy officer and commanding officer, Marine 
Barracks, in the case of marine officer. (See chap. 19, Manual of the Medical 
Department.) 
20. Death, Navy : 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register. 
Entry Form I (rough). 
Entry autopsy book. 
Entry burial record. 
Entry muster card. 
Close health record. 
Close jacket. 
Close Form F. See that diagnosis agrees with primary cause of death on Form N. 
Close enlistment record. 
Close C. S. C., if any. • 
Close gunnery record, if any. 
Make N. M. S. H. C. 2 if hospital corpsman. 
Make N. M. S. II. C. 3 if hospital corpsman. 
Make entry on N. M. S. H. C. 4 if hospital corpsman. 
Make N. M. S. II. F. 61. 
Make S. and A. 35d. 
Make entry on S. and A. 35. 
Make Form N. 
Make city or county death report. 
Make N. Nav. 48 and 48a. 
Make S. & A. 34 and 34a, if necessary. 
Make S. & A. 330, if necessary. 
Despatch to next of kin. Secretary of the Navy, and Bureau of Medicine and 
Surgery. Notify commandant. (See chap. 19, Manual of the Medical De- 
partment.) 
21. Death, Marine: 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register. 
Entry Form I (rough). 
Entry autopsy book. 
Entry burial record. 
Close health record. 
Close jacket. 
Close Form F. See that diagnosis agrees with primary cause on Form N. 
Make city or county death report. 
Make Form N. 
Make inventory of effects and receipt. 
Make N. M. S. II. F. 61. 
Despatch to headquarters, U. S. M. C., next of kin, Secretary of the Navy, and 
Bureau of Medicine and Surgery. (See chap. 19, Manual of the Medical De- 
partment. ) 
Notify commanding officer, Marine Barracks. 
Have Quartermaster, U. S. M. C., ship household effects if necessary. 
22. Death, Nurse Corps : 
Entry journal of the Medical Department. 
Entry on morning report. 
Entry hospital register. 644 
HOSPITAL CORPS HANDBOOK 
22. Death, Nurse Corps—Continued. 
Entry Form I (rough I. 
Entry autopsy book. 
Entry burial record. ' 
Close health record. 
Close Form F. See that diagnosis agrees with primary cause on Form N. 
Make memorandum for monthly return. 
Make Form T and send to supply officer. 
Make N. M. S. H. F. 61. 
Make S. & A. 34 and 34a if necessary. 
Make inventory of effects and receipt. 
Make city or county death report. 
Make Form N. 
Despatch to next of kin, Secretary of the Navy and Bureau of Medicine and 
Surgery. 
Notify supply officer having accounts. 
23. Death, Supernumerary : 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register. 
Entry Form I (rough). 
Entry autopsy book. 
Entry burial record. 
Close medical history sheet and forward to Bureau of Medicine and Surgery. 
Close jacket. , 
Close Form F. (Do not send to Bureau of Medicine and Surgery.) 
Close muster card. 
Close Form 52 in the case of U. S. Army patient and forward to Bureau of 
Medicine and Sungery. 
Make Form N. 
Make city or county death report. 
Make inventory of effects and receipt. 
Make Auditor’s Expense Claim in the case of retired and enlisted men of the 
U. S. Navy and Marine Corps. 
Make Form T and send to supply officer in case of retired officer and enlisted 
men of the U. S. Navy and Marine Corps and civilian employees. 
Make N. M. S. H. F. 61. 
Despatch to next of kin, Secretary of the Navy and Bureau of Medicine and 
Surgery, and Headquarters, U. S. M. C., in the case of Marine Corps personnel. 
(See chap. 19, Manual of the Medical Department.) 
Notify Commandant in case of Navy personnel, and commanding officer, Marine 
Barracks, in the ease of Marine Corps personnel. 
Notify the Governor, Naval Home, Philadelphia, Pa., in the case of a beneficiary. 
Notify the Honorable Commissioner of Pensions, Pension Office, Washington, 
D. C., in the case of a pensioner. 
Notify Army Post having records in the case of a IT. S, Army patient. 
24. Desertion : 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register, if patient. 
Entry muster card. 
Entry on N. M. S. H. C. 4 if hospital eorpsman. 
Entry Form I (rough) if a patient. 
Close health record. 
Close packet. 
Close service record. 
Close C. S. C., if any. 
Close Form F, if a patient. 
Make N. M. S. H. C. 2 if hospital eorpsman. 
Make N. M. S. H. C. 3 if hospital eorpsman. 
Make N. Nav. 48 and 48a, 65 and 67. 
Make S. & A. 35c and 330. 
Make entry on S. & A. 35. 
Make descriptive list and send to all receiving ships. 
If a marine, discharge to duty and he will be declared a deserter from the marine 
barracks. 
If a marine, make inventory of effects and forward to the marine barracks. 
Inform Bureau of Navigation of desertion by letter. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
645 
25. Deserter, Reporting on Board : 
Make N. Nav. 7. 
Make N. Nav. 60. 
Make N. Nav. 48 and 48a. 
Make S. & A. 351i. 
Make entry on S. & A. 35. 
Make N. M. S. H. C. 3 if hospital corpsman. 
Make entry on N. M. S. H. C. 4 if hospital corpsman. 
Make request to Bureau of Medicine and Surgery for health record. 
If a patient, make necessary hospital forms as required for a new arrival 
26. Discharge, Expiration of Enlistment, Navy : 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register, if a patient. 
Entry muster card. 
Entry Form I (rough) if a patient. 
Close health record. 
Close jacket. 
Close service record. 
Close C. S. C., if any. 
Make Form F, if a patien_. 
Make discharge if no C. S. C. 
Make N. Nav. 62 if necessary. 
Make S. & A. 35d. 
Make entry on S. & A. 35. 
Make N. Nav. 48 and 48a. 
Make N. M. S. H. C. 2 if hospital corpsman. 
Make N. M. S. H. C. 3 if hospital corpsman. 
Make entry on N. M. S. H. C. 4 if hospital corpsman. 
27. Discharge, Expiration of Enlistment, Marine: 
Entry Journal of the Medical Department. 
Entry hospital register. 
Entry Form I (rough). 
Close health record. 
Close Form F. 
Send to marine barracks for discharge. 
28. Discharge, Retirement, Navy : 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register, if a patient. 
Entry Form I (rough). 
Close health record. 
Close Form F, if a patient. 
Close service record. 
Close gunnery record, if any. 
Close C. S. C. 
Close muster card. 
Close jacket. 
Make S. & A. 35d. 
Make entry on S. & A. 35. 
Make S. & A. 34 and 34a if necessary. 
Make N. Nav. 48 and 48a. 
Mpke N. M. S. II. C. 2 if hospital corpsman. 
Make N. M. S. H. C. 3 if hospital corpsman. 
Make entry on N. M. S. H. C. 4 if hospital corpsman. 
Make N. M. S. H. F. 4. 
Endorse orders. 
29. Discharge, Sentence of Summary Court-Martial: 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register, if a patient. 
Entry Form I, if a patient. 
Close health record. 
Close service record. 
Close C. S. C., if any. 646 
HOSPITAL CORPS HANDBOOK. 
29. Discharge, Sentence of Summary Court-Martial—Continued. 
Close muster card. 
Close 'Form F, if a patient. 
Close jacket. 
Make S. & A. 35d. 
Make entry on S. & A. 35. 
Make discharge if no C. S. C. 
Make N. Nav. 48 ad 48a. 
Make N. M. S. H. C. 2 if hospital corpsman. 
Make N. M. S. H. C. 3 if hospital corpsman. 
Make entry on N. M. S. H. C. 4 if hospital corpsman. 
30. Discharge, Sentence of Summary Court-Martial, Marine Patient: 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register. 
Entry Form I (rough). 
Close muster card. 
Close health record. 
Close Form F. 
Close jacket. 
Send to marine barracks for discharge. 
31. Discharge> Navy Patient, Medical Survey (I. S.) ; 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register. 
Entry Form I (rough). 
Close health record. 
Close service record. 
Close C. S. C., if any. 
Close muster card. 
Close gunnery record, if any. 
Close Form F. See that diagnosis agrees with that for which surveyed. 
Close jacket. 
Make S. & A. 35d. 
Make entry on S. & A. 35. 
Make N. Nav. 48 and 48a. 
Make discharge if no C. S. C. 
Make war service certificate if necessary. 
Make N. M. S. II. C. 2 if hospital corpsman. 
Make N. M. S. H. C. 3 if hospital corpsman. 
Make entry on N. M. S. H. C. 4 if hospital corpsman. 
Endorse report of survey. 
Transportation to home, not to place of enlistment. 
32. Discharge, Marine Patient, Medical Survey (I. S.) : 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register. 
Entry Form I (rough). 
Close health record. 
Close Form F. See that diagnosis agrees with that for which surveyed, 
Close jacket. 
Endorse report of survey. 
Transfer to marine barracks for discharge. 
33. Discharge, Officer, Medical Survey (I. S.) : 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register. 
Entry Form I (rough). 
Close muster card. 
Close health record. 
Close Form F. See that diagnosis agrees with that for which surveyed. 
Close jacket. 
Make N. M. S. H. C. 2 if chief pharmacist or pharmacist. 
Make N. M. S. H. C. 3 if chief pharmacist or pharmacist. 
Make entry on N. M. S. II. C. 4 if chief pharmacist or pharmacist. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
647 
33. Discharge, Officer, Medical Survey (I. S.)—Continued. 
Make Form T and send to supply officer. 
If ordered before a retiring board, transfer there with a “ T ” and upon return 
“ BA ” and when actually discharged give “ I. S.” 
Endorse retirement orders. 
34. Enlistment, Extension of, or Reenlistment : 
Make N. Nav. 351 (shipping articles). 
Make N. Nav. 15 (consent of parents) if necessary. 
Make N. Nav 54 (rejection) if necessary. 
Make N. Nav. 7 (description slip). 
Make N. Nav. 2 (finger print record). 
Make N. Nav. 48 and 48a. 
Make N. Nav. 323 if extension. 
Make health record if necessary. 
Make Form X. 
Make N. M. S. H. C. 3 if hospital corpsman. 
Make entry on N. M. S. II. C. 4 if hospital corpsman. 
Make S. & A. 35 I. 
Make entry on S. & A. 35. 
Send N. Nav. 6 to Bureau of Navigation if reenlistment. 
35. Leave, Navy : 
Entry Journal of the Medical Department. 
Entry service record. 
Entry muster card. 
Make leave papers. 
Make N. M. S. H. C. 3 if hospital corpsman. 
Make entry on N. M. S. H. C. 4 if hospital corpsman. 
Make S. & A. 35d for men who draw subsistence. 
Make entry on S_ & A. 35. 
Patients should be discharged to duty when granted leave. 
36. Leave, Marine, Patient: 
See No. 35, delete service record. 
37. Leave, Nurse : 
Make request to Bureau of Medicine and Surgery for over ten days. 
Entry Journal of the Medical Department. 
Entry rough record of nurse. 
If sick leave, proceed as in No. 17. 
38. Leave, Absence Without, Navy : 
Entry Journal of the Medical Department. 
Entery on morning report. 
Entry service record. 
Entry muster card. 
Make N. M. S. II. C. 3 if hospital corpsman. 
Make entry on N. M. S. H. C. 4 if hospital corpsman. 
Make S. & A. 35e. 
Make entry on S. &. A. 35. 
39. Leave, Absence Without, Marine, Patient: 
Entry Journal of the Medical Department. 
Entry on morning report. 
Notify marine barracks. 
Absence over ten days return to barracks with a “ D.” (He will be declared 
a deserter by officials at the barracks.) 
40. Leave, Absence Without, Supernumerary: 
Entry Journal of the Medical Department. 
Entry on morning report. 
Entry hospital register. 
Discharge as “ D.” 
Notify Governor, Naval Home,»Philadelphia, Pa., if a beneficiary. 
41. Leave, Officer : 
Request leave from Bureau of Navigation if over ten days and travel time. 
Entry Journal of the Medical Department. 
Make Form F, if a patient (“ T ” to sick leave). 
Make report of leave of absence, Form N. Nav. 296, upon return. 648 
HOSPITALf COUPS HANDBOOK. 
42. Transfer, Patient, to Fitzsimons General Hospital: 
See Nos. 13, 14, 15, 16, 17, and 18 ; in addition, to be surveyed with a view of 
. transfer to Fitzsimons General Hospital. Inform the commanding officer by 
timely despatch when transfers are to be made, giving names, ranks, or rates, 
stretcher case or not, date and hour of departure, route and probable date of 
arrival at Denver, Colo. 
43. Transfer, Officer, Navy, Hospital for the Insane : 
See No. 10, and in addition, 
Make Department of the Interior form. 
Endorse report of survey. 
Make hospital ticket. 
Make copy of report of survey for the Hospital for the Insane. 
Order for admission furnished by Bureau of Medicine and Surgery. 
Letter to next of kin. 
44. Transfer, Officer, Marine, Hospital for the Insane : 
See Nos. 14 and 43. 
45. Transfer, Navy Enlisted, Hospital for the Insane: 
See Nos. 11 and 43. 
46. Transfer, Marine Enlisted, Hospital for the Insane : 
See Nos. 16 and 43. 
47. Transfer, Supernumerary, Hospital for the Insane: 
See Nos. 18 and 43. 
48. Rating, Recommending for Advancement in ; other than Chief Pharmacist’s 
Mate and Pharmacist’s Mate, first class: 
Make N. M. S. H. C. 1 to be signed by all members of the board. 
49. Rating, Recommending Advancement in; Chief Pharmacist’s Mate and Pharmacist’s 
Mate, first class: 
Make N. M. S. II. C. 1. 
Make N. M. S. H. C. 5. 
Make N. Nav. 21. 
Make N. Nav. 524. 
All questions and answers to the Bureau of Medicine and Surgery. 
50. Rating, Advancement in, Hospital Corps : 
Make N. M. S. II. C. 3. 
Make entry on N. M. S. II. C. 4. 
Make entry on muster card. 
Make entry on health record. 
Make entry in service record. 
Make N. Nav. 48 and 48a. 
Make S. & A. 35a. 
Make entry on S. & A. 35. 
51. Rating, Reduction in: 
Make N. M. S. H. C. 3 if hospital corpsman. 
Make entry on N. M. S. H. C. 4 if hospital corpsman. 
Make entry in service record. 
Make entry on health record. 
Make entry on muster card. 
Make N. Nav. 48 and 48a. 
Make S. & A. 35a. 
Make entry on S. & A. 35. 
52. Employees, Miscellaneous, Rules and Regulations : 
See sec. 10, Manual of the Medical Department. 
Pay roll submitted on the 1st. and 16tli. of each month. 
53. Requisitions, Headstones : 
Made in duplicate on forms provided on July 1st. 
54. Vaccines,, Serums, and Bacteriological Supplies : 
From naval medical supply depots by letter or telegram. 
55. Shipment of Remains : 
Obtain transit permit and transit label from health authorities. 
Make Government bill of lading (N. M. S. II. F. 60). 
1 copy to consignee. 
2 copies for express company at place of shipment. 
1 copy for express company at place of arrival. 
1 copy for hospital files with cost. 
1 copy to be securely pasted on top of shipping casket and covered by shellac 
or varnish. ORGANIZATION, CLERICAL DUTIES AND PROCEDURES. 
649 
55. Shipment of Remains—Continued. 
Special label prohibiting collection of express charges from consignee obtained 
from the express agent and attached to outside case. 
Entry Journal of the Medical Department. 
56. Telegrams : 
Make out in triplicate (N. M. S. H. F. 31 and 51). 
Original sent to telegraph office. 
Green copy filed. 
Yellow copy mailed to addressee in case of being sent to a Government office. 
Originals to be attached to monthly bill of telegraph company. 
Telegrams to be numbered as follows: Message preceeded by hospital number 
followed by 2 figures showing day of month; viz. : 76 (hospital No.) 03, (third 
day of month). Message signed by the hours 1 to 23 and the minutes 1 to 59 
as follows : 1 : 15 p. m. will be written 1315, 1: 15 a. m. will be written 0115. 
57. Returns, Daily : 
Admission and discharge memorandum. 
Form F cards of patients disposed of in any manner. 
Liberty list. 
Ration memorandum. 
Receipt and expenditure vouchers. 
58. Returns, Weekly : 
Communicable diseases, letter from shore stations, telegram from certain stations. 
N. M. S. II. C. 4, from certain stations. 
Form I. 
59. Returns on the 15th of Each Month : 
N. Nav. 25. 
60. Returns on the 1st and 16th of Each Month : 
Pay roll, civilian. 
61. Returns on the 28th. of Each Month : 
List of marines recommended for pay. 
62. Returns on the Last Day of Each Month : 
N. Nav. 25. 
N. Nav. 37. 
Letter to Bureau of Navigation showing the number of men furnished subsistence 
allowance. 
Form F. 
Form K-dental. 
N. M. S. H. C. 4 (roster report). 
N. M. S. IT. F. 36 (ration memorandum). 
N. M. S. H. F. 49. 
Sanitary report. 
Report of nurses. 
Efficiency report (nurses). 
Nurses’ monthly returns. 
Communicable diseases. 
Summary of stub requisitions, S. & A. 178. 
Pay-roll summary. 
Report of expenditures. 
The recapitulation. 
63. Returns, Quarterly : 
Letter to Bureau of Navigation, roster of enlisted men aboard. 
Mark service records. 
Labor roll summary. 
N. M. S. H. F. 56. 
Nurses’ •efficiency report. 
64. Returns, Semiannual: 
Forms B and Ba, and B—dental (Mar. 1 and Sept 1 from hospitals). 
Report of fitness of oflicers (Apr. 1 and Oct. 1). 
Efficiency list of employees. 
Requisition for mess gear (June 30 and Dec. 31). 
65. Returns, Annual : 
Form P. (Dec. 31.) 
Form X. (Dec. 31.) 650 
HOSPITAL CORPS HANDBOOK 
65. Returns, Annual—Continued. 
Sanitary report. (See sec. 5, chap. 17, Manual of the Medical Department.) 
Forms D and Da. (July 1.) 
List of unmarked graves. (June 30.) 
Lal>or-saving devices. (June 30.) 
Report of physical examination of officers. (January.) 
Health record sheets of officers. (Jan 1.) 
Close all Form F cards as continued to next year. (Dec. 31.) 
Make new Form F cards. (Jan. 1.) 
Estimate of expenditures, letter. (Mar. 15.) 
Request for allotments. 
66. When Necessary : 
N. Nav. 17b. 
N. Nav. 443, Report of iitness of officers; upon detachment of officers or com- 
manding officer. 
N. Nav. 521, beneficiary slip. 
N. M. S. H. C. 2. 
N. M. H. C. 3. 
N. M. S. O and 41. 
N. M. S. Ca and Ca-1. 
N. M. S. D and Da. 
N. M. S. L. 
N. M. S. M. 
N. M. S. 1, la, 4, and 4a. 
N. M. S. 5 and 5a. 
N. M. S. H. F. 45 and 54. 
N. M. S. B, Ba, and B-dental. 
N. M. S. Sp. and Spa. 
Report of epidemics. 
Journal of the Medical Department. 
S. & A. 44. 
S. & A. 51a. 
References. 
Handy Book for the Hospital Corps, 1917. 
U. S. Navy Regulations. 
Manual of the Medical Department. 
Bureau of Navigation Manual. 
Commissary Department at Naval Hospitals.1 
The commissary department of naval hospitals is under the direct supervi- 
sion of the commissary officer, who is a chief pharmacist or pharmacist as- 
signed to this duty by the commanding officer. The commissary officer is di- 
rectly responsible to the executive officer for the proper administration of the 
commissary department. A sufficient number of hospital corpsmen are as- 
signed to this department to assist in carrying on the work. The personnel 
of the department includes the commissary officer, hospital corpsmen, and 
such ratings of civilian employees as may be necessary and are allowed as a 
complement by the Bureau of Medicine and Surgery. 
A schedule of ratings and pay is issued yearly by the Secretary of the Navy 
for this class of employees under the Naval Establishment, and they are 
known as the “ Excepted Group ”; that is, they are excepted by Executive 
Order from the rales and regulations of the Civil Service. The pay of this 
group is fixed yearly by the Secretary of the Navy upon the recommendation 
of a wage board. 
The accompanying organization chart is applicable to most 500-bed naval 
hospitals and may be used as a basis of organization. 
1 Prepared by Chief Pharmacist F. A. Payne, United States Navy. COMMISSARY DEPARTMENT, NAVAL HOSPITALS. 
651 
ORGANIZATION OF COMMISSARY DEPARTMENT. 
Office.—The commissary office should be located centrally in the subsistence 
building, if such a building exists, and contain desks for the commissary of- 
ficer, commissary steward, and the clerk. Here most of the clerical work of 
the department is performed, and it should be furnished with one or more 
typewriters, an adding machine, and a telephone with city connection. In 
this office are kept the commissary ledger, the dealers’ jacket file, commissary 
department correspondence file, and the provision stock card file. All orders 
and requisitions for food are prepared here. All matters pertaining to the 
commissary department are routed through this office for action. 
Issuing storeroom.—The issuing storeroom is a room equipped with shelves, 
bins, and racks for the storage of food in small amounts for immediate issue 
to the kitchens, wards, and messes. The main hospital refrigerator is con- 
sidered a part of the issuing storeroom for administrative purposes and is 
(Executive Officer 
jCommissary Officer! 
Chief Nurse 
Clerk 
(Pharm. Hate) 
Commissary Steward 
(Chief Pharm.Mate) 
Housekeeper 
Dietitian or 
Diet Nurse 
MAIN KITCHEN 
Chief Cook 
First Cook 
Second Cook 
Kitohemnen 
(Hess Atts.) 
Yardman 
(Hess Att.) 
ISSUING STOREROOM 
Storeroom Keeper 
(Pharm. Mate! 
NURSES' MESS 
First Cook 
Second Cook 
Mess Atts. 
Maids 
DISC KIT CESS 
First Cook 
Second Cook 
Hess Atts. or 
Haids 
DRY PROVISION 
■STOREROOM 
Storeroom Keeper 
(Pharm. Mate) 
SICK 
HESS 
Hess Hall 
Hasters-at-Anns 
(Pharm.Hates) 
First Cook 
Second Cook 
Hess Atts. or 
Maids 
HESS HALLS 
Chief Mess Atts. 
Waiters 
(Hess Atts.) 
Dish Washers 
(Hess Atts.) 
BUTCHER SHOP 
Heat Cutter 
Fig, 206.—Suggested organization of commissary department in 500-bed naval hospitals. 
under the charge of the storekeeper. All provisions issued to kitchens, butcher 
shop, messes, wards, etc., pass directly or indirectly through the issuing 
room. It is restocked by issues from the dry provision storeroom and by de- 
liveries of fresh provisions from the contractors, and issues from it are made 
only on the authority of requisitions approved for issue by the commissary 
officer. It usually is located in the subsistence building in close proximity to 
the main kitchen. The stock in it has been expended in the commissary ledger, 
therefore it is not carried as an asset for inventory purposes. 
Dry provision storeroom.—The dry provision storeroom is a room in which 
is kept the reserve stock of dry provisions. It holds from two to three 
months’ supply of provisions of a character that neither deteriorate rapidly 
nor require refrigeration. All provisions in this storeroom are carried as 
being “ on charge.” It is the value of this stock, and this stock only, that is 
determined monthly by taking inventory and considered as a cash asset for 
accounting purposes. The stock in it is replenished by requisitions monthly, 
or when necessary, on the nearest provision depot of the supply department of 
47829°—23 42 652 
HOSPITAL CORPS HANDBOOK. 
the Navy, and from orders placed against existing contracts for special dry 
provisions not carried in stock in provision depots. 
Main kitchen.—The main kitchen is the one in which the food for the 
general mess (regular diets) is prepared. It is a separate section from the 
mess halls for administrative purposes, and is under the immediate supervision 
of the chief cook and includes the main kitchen proper, the hakery, the 
vegetable preparation room, and such other accessory rooms as may exist, and 
all of the equipment therein. From this point is distributed the regular 
diets to the wards and mess halls. 
Diet kitchen.—The diet kitchen is not a part of the commissary department, 
but a discussion of its function will be instructive. Under the general super- 
vision of the chief nurse, it is here that the food for the very sick is prepared 
or for sick patients for which food other than the regular diet has been 
prescribed by a medical officer. The diet kitchen usually is located in the 
subsistence building in the vicinity of the main kitchen. It is under the im- 
mediate supervision of the dietitian, or a nurse specially trained in dietetics, 
and has a personnel of one or more cooks with a sufficient number of mess 
attendants to perform the rough work and cleaning. The dietitian may 
have as an assistant another dietitian or a hospital corpsman, so that the 
service will be continuous. In this kitchen are prepared the liquid diets, 
soft diets, convalescent diets, and in addition such diabetic, salt free, meat free, 
or other special diets as may be ordered by medical officers for individual 
patients. The cooked diets are distributed from this point directly to the 
wards, as called for on “ Special Diet ” sheets, N. M. S. Hospital Form 40. 
Food from this kitchen is never served in the mess halls. 
General mess halls.—The mess halls are for the service of food to convalescent 
patients who are ambulatory, hospital corpsmen, civilian employees, and the 
marine guard, if one is attached to the hospital. Separate mess rooms are main- 
tained for the four divisions of personnel mentioned. A chief mess attendant is 
in charge of the dining-room service and has as his assistant as many mess 
attendants as may be required to wait on the tables and keep the mess halls 
clean. Usually one mess attendant to every 20 persons is sufficient. The dish- 
washing room and the mess attendants who wash the dishes are usually 
under the supervision of the chief mess attendants. The chief mess at- 
tendant works under the supervision of the commissary steward and has 
no control over the patients and others who eat in the mess halls, as 
they are under the supervision of a master-at-arms detailed for that purpose. 
A master-at-arms is on duty in the mess halls during each meal to see that 
order is preserved and that the rules in force at the hospital are carried 
out. 
Sick officers’ mess.—The sick officers’ mess is maintained in their quarters. 
Usually these quarters are provided with a mess room and kitchen, and 
a separate force of cooks and mess attendants. Or, lacking this, the food 
is prepared in the main kitchen or the diet kitchen, carried in containers 
to the sick officers’ quarters and served either in the dining room or on trays 
in the patient’s room. The nurse in charge of the sick officer’s quarters is 
in charge of this mess, under the supervision of the chief nurse. 
Staff officers’ mess.—The staff officers’ mess generally is located in the sick 
officers’ quarters and uses the same facilties and personnel as the sick officers’ 
mess. 
Nurses’ mess.—The nurses’ mess is conducted in much the same manner as 
the sick officers’ mess. There is a dining room and kitchen provided in their 
quarters with sufficient cooks and mess attendants to run the mess. The house- COMMISSARY DEPARTMENT, NAVAL HOSPITALS. 
653 
keeper in the nurses’ quarters is in charge of this mess under the general 
supervision of the chief nurse. 
MENUS, 
Forms used.—In writing menus, S. and A. Form No. 333 (or a similar form) 
may be used. Menus should be written for three classes of diets: Regular, 
convalescent, and soft. They should be prepared not later than Tuesday of 
each week and include seven days—Monday to the following Sunday. They are 
submitted to the commanding officer through the executive officer for final 
approval. After being approved they should not be changed except for some 
very good reason, such as inability to obtain certain articles of provisions, etc. 
The writing of regular diet menus only will be discussed in this chapter. 
For a discussion of soft diets, convalescent diets, and special diets, see the 
chapter on Foods and Dietetics in this book. 
Regular diet menu.—The points to be kept in mind in preparing menus are, 
first, to feed men in such a manner as to satisfy their bodily requirements; 
second, to feed them in such a manner as to be pleasing to their senses, thus 
stimulating their appetites; third, to feed them economically. 
A proper regular diet menu should be changed every week to give it variety. 
No matter how carefully a menu is planned or how well the food is cooked and 
served, if it is repeated too often it will not give satisfaction. Most persons 
will tire of chicken and ice cream in the same manner as they do of stew 
and prunes, if repeated too often or at short intervals. 
Before proceeding with this chapter the student should thoroughly familiarize 
himself with the context of the chapter on “ Foods and Dietetics ” in this book. 
A monotonous diet is liable to lead to loss of appetite if not to so-called food- 
deficiency diseases, such as scurvy, pellagra, and beriberi. Both in the interest 
of a man’s digestive functions and the proper metabolism of his body, different 
kinds of foods should be served in such proportion that the proportion of the 
various foodstuffs, protein, fats, and carbohydrates, are ingested in approxi- 
mately the proportion of one part of fat, two parts of protein, and eight parts of 
carbohydrates. 
It has been found that man does the best when he ingests animal and 
vegetable food in the proportion of 20 per cent animal and 80 per cent 
vegetable. 
A man requires from 3,000 to 5,000 calories of foodstuffs per day in the 
proportion given above, and knowing that 1 gram of protein yields four 
calories, 1 gram of fat eight calories, and 1 gram of carbohydrates four 
calories, the caloric value of menus should be figured out from time to time 
in order to check up the dietary as to whether it is of the proper combination. 
When uncooked rations are being served on the basis of a well-balanced 
ration, quantities should be issued 25 per cent in excess to allow for waste. 
Experience has shown that with care, waste, such as that made in peeling 
potatoes and that due to food left on plates, etc., can be kept down to that 
figure. It will be found that if different kinds of food are served in accordance 
with the principles of a well-balanced ration, food will not be wasted to any 
great extent by being left on plates. 
It has been found very advantageous to work up a menu by first arranging 
the dinners for each day, starting in with the meats and building around the 
main dish as one goes along. By first deciding what meat to run for each day’s 
dinner, it is easier to obtain a rotation in meats, and it also enables one to 
work in left-over portions for suppers and breakfasts. 654 
HOSPITAL CORPS HANDBOOK. 
In addition to the required amounts of ordinary meats, starchy vegetables, 
cereals, beverages, etc., some article of fresh fruit, preferably raw, and also 
some variety of green leafy vegetable should appear each day on the menu. 
In the summer the selection of these articles is comparatively easy, but in the 
winter most of them are too expensive for routine use. Therefore the follow- 
ing list is suggested as being best from a combined food value and economic 
point of view for late fall, winter, and early spring use: 
Fresh fruits.—Oranges, lemons, grapefruit, apples, bananas. 
Fresh vegetables.—Tomatoes, spinach, lettuce, cabbage, string beans, carrots, 
cauliflower. 
It is a good rule to follow in preparing menus never to open a can when the 
same article of food is procurable in the market in its fresh condition, provided 
the fresh article can be purchased at a reasonable price and the personnel of 
the commissary department is sufficient to prepare the article. It takes 
more cooks and mess attendants to prepare fresh articles for serving than it 
does to open cans. Likewise, it is very much easier for the cooks to open cans 
than it is to get the mess attendants to prepare the fresh articles. Conse- 
quently the kitchen requires constant supervision by the commissary officer to 
see that the fresh articles are procured and prepared rather than having 
canned goods to cover the menu drawn from the dry provision storeroom. 
Then, if it is intended to have fresh string beans for a certain meal the words 
“ Fresh string beans ” should be written on the menu and not the words “ string 
beans.” 
Colors of foods.—The color combinations presented when the finished meal is 
on the plate should be considered in preparing menus. Avoid having foods in 
the same meal of the same color, as a variety of colors stimulates the appetite. 
A dinner consisting of cream of potato soup, roast pork, mashed potatoes, stewed 
dried lima beans, vanilla ice cream, and bread, would be all white in color, but 
if the soup were changed to vegetable soup, the lima beans to tomato salad, 
apple sauce served with the roast pork, and the vanilla ice cream changed to 
chocolate, the color monotony would be broken up very well. 
Caloric values.—In order to have a standard as a basis for preparing menus 
at hospitals in regard to their caloric or fuel value, the caloric value of a 
“ Fresh provision,” U. S. Navy ration (given in Gatewood’s “ Hygiene,” as 3,563 
calories per day per man) may be taken. It must be understood that the aver- 
age caloric value for all food consumed in a hospital will be greater than this 
figure because of the special diets, special messes, and for other reasons. If 
this standard is accepted for the regular diets the U. S. Navy ration table, as 
given in the Manual of the Supply Corps, U. S. Navy, 1922, paragraph 1760. 
may be used as a standard for comparative purposes. For instance, one and 
three-quarters pounds of fresh meat per day per man is allowed; also one 
and three-quarters pounds of fresh vegetables; two ounces of butter; four 
ounces of sugar, etc. By computing the amounts of the various items of pro- 
visions used in a hospital a very accurate idea may be had of whether or not 
excessive amounts of the various items of foods are being used in the menus. 
The table given herewith is based on information contained in bulletin No. 
28 of the United States Department of Agriculture, “ The Chemical Composition 
of American Food Material; ” “ Diet in Health and Disease,” by Friedenwald 
and Ruhrah; and “ Feeding the Family,” by Rose. 
No claim is made for mathematical accuracy in presenting this table, as the 
matter of standardization of weights and measures is exceedingly difficult, 
especially when an attempt is made to make them agree with average portions. 
It is believed, however, that this table will be found useful in balancing COMMISSARY DEPARTMENT, NAVAL HOSPITALS. 
655 
menus, so that they may be kept somewhere near the standard selected—that 
of 3,563 calories per day per man. Where no figures appear in the tables of 
calorie percentages, no data have been available on which to base compu- 
tations. 
“Average portions ” as referred to in the table are considered to be the 
average amounts required or expected by the average man of good health at one 
meal in the general mess at naval hospitals. 
The abbreviations used in the table are explained as follows: 
tsp teaspoonful. 
tbsp tablespoonful. 
lge large. 
med medium. 
sml small. 
dia diameter. 
lb pound. 
qt quart. 
si slice. 
pc piece. 
av average. 
TABLE OF FOODS USUALLY FOUND ON NAVAL HOSPITAL MENUS, 
SHOWING SIZE OF AVERAGE PORTIONS EXPRESSED IN COMMON 
HOUSEHOLD MEASURE, WEIGHTS OF PORTIONS, CALORIC VALUES, 
AND PERCENTAGE OF PROTEIN, FAT, AND CARBOHYDRATE 
CALORIES. 
Beverages. 
Ounces. 
Calo- 
ries. 
Pro- 
tein. 
Fat. 
Car- 
bohy- 
drate. 
Cocoa (1 cup milk, 2 tsp. cocoa, 
2 tsp. sugar). 
Eggnog 
9.5 
250 
16 
44 
40 
7.4 
200 
21 
48 
31 
7.0 
70 
100 
8.0 
0 
8.0 
0 
Breads, Biscuits, Muffins. 
Note.—Add 160 calories to caloric values of breads, etc., listed below, if butter (0.8 oz.) is served with 
the breads. 
1.3 
100 
11 
27 
62 
1.8 
100 
10 
10 
80 
3 si. Vs" x 2" x 3M" 
1.4 
100 
14 
6 
80 
Bread," corn, old New England- 
1 pc. 2Yz" x 2" x 1" 
2.0 
200 
8 
30 
62 
2 si. 4" x 4" x 
1.6 
100 
U 
6 
80 
2 si. 2V£" x 2?4"‘x 
2.8 
200 
16 
3 
81 
2 si. 2"~x 2” x*i".;.-. 
2.4 
200 
10 
24 
66 
0.8 
100 
10 
22 
68 
0.8 
100 
10 
26 
64 
0.9 
100 
10 
20 
70 
0.8 
100 
7 
49 
44 
5.4 
300 
14 
25 
61 
3.2 
266 
13 
25 
62 
1 sandwich 
9.0 
600 
15 
69 
16 
3.6 
165 
13 
43 
44 
Toasti French 
2 si. 3" x 3'' x 
2.8 
200 
10 
48 
42 
Cakes, Etc. 
1 pc. 1 yi" x 2" x 2l/i" 
1.3 
100 
12 
1 
87 
1 pc. ljl" x3M" x 1" 
1.6 
200 
5 
11 
84 
1 pc. 2J4” x 5”*x %" 
1.8 
200 
5 
41 
54 
1.6 
200 
6 
45 
49 
1 pc. V/i" x 1J4" x 
1.8 
200 
6 
26 
68 
2.4 
200 
8 
22 
70 
2.0 
200 
8 
32 
60 
3 cookies 2H" dia.. ” 
2.7 
150 
6 
33 
61 
1 pc. x 2" 
0.9 
100 
11 
19 
70 
Icing7“ White Mountain” 
Vy tbsp". 
0.5 
50 
1 
99 656 
HOSPITAL CORPS HANDBOOK. 
TABLE OF FOODS USUALLY FOUND ON NAVAL HOSPITAL MENUS, 
ETC.—Continued. 
Ounces. 
Calo- 
ries. 
Pro- 
tein. 
Fat. 
Car- 
bohy- 
drate. 
\l/2 tt>Sp 
1.2 
100 
100 
1.2 
100 
3 
97 
0.9 
100 
100 
0.9 
100 
100 
0.9 
100 
100 
Sugars and Syrups. 
Cereals. 
Note.—Add 100 calories to caloric value of any cereal given below to allow for milk (4 oz.) and sugar 
(2 tsp) if served. 
0.8 
80 
6 
4 
90 
6.0 
100 
10 
5 
85 
6.0 
100 
12 
4 
84 
1.0 
100 
12 
2 
86 
6.8 
100 
9 
1 
90 
5.2 
100 
15 
2 
83 
1.2 
100 
10 
45 
45 
3.6 
100 
10 
36 
54 
7.9 
100 
17 
16 
67 
cups 
1.0 
100 
9 
1 
90 
1.0 
100 
15 
3 
82 
4.0 
100 
9 
1 
90 
Shreilded wheat 
rbiscuit 
0.9 
100 
13 
5 
82 
Puddings, Ice Creams, Etc. 
7.2 
200 
1 
1 
98 
6.6 
300 
13 
44 
43 
5.0 
250 
3 
35 
62 
5.0 
250 
5.4 
200 
8 
33 
59 
l"pc.*2" x x 1%" 
1.1 
100 
7 
26 
67 
6.6 
200 
17 
39 
44 
3.1 
100 
100 
3.8 
100 
9 
91 
3.8 
200 
4 
12 
84 
% 
3.0 
180 
4 
51 
45 
2.2 
125 
10 
90 
4.2 
200 
1 
99 
2.0 
120 
12 
27 
61 
2.2 
100 
10 
90 
Vanilla ice cream (1 qt. 20 per 
X qt 
3.2 
200 
4 
63 
33 
cent cream; % cup sugar; VA 
tbsp. Vanilla extract). 
A lb 
0.8 
160 
1 
99 
Cheese, American, full cream.. 
1 pc. 2" x 1" x %" 
0.9 
100 
25 
72 
3 
1.2 
40 
76 
9 
15 
0.25 
25 
5 
86 
9 
0.7 
75 
2 
95 
3 
0.45 
50 
2 
95 
3 
0.7 
65 
11 
23 
66 
0.5 
25 
23 
51 
26 
Milk’ fresh 
1 cup 
8.1 
160 
19 
52 
29 
Dairy Products. 
Eggs and Cheese Dishes. 
4.0 
150 
36 
64 
4. 2 
200 
20 
76 
4 
2.1 
100 
17 
39 
44 
Welsh rarebit 
3tbsp. rarebit and 1 si. toast.. 
2.6 
200 
22 
57 
21 COMMISSARY DEPARTMENT, NAVAL HOSPITALS. 657 
TABLE OF FOODS USUALLY FOUND ON NAVAL HOSPITAL MENUS, 
ETC.—Continued. 
Fkuits. 
Ounces. 
Calo- 
ries. 
Pro- 
tein. 
Fat. 
Car- 
bohy- 
drate. 
Apple, baked, with 2 tbsp. 
1 med. sized apple 
3.5 
150 
1 
3 
96 
sugar. 
5.0 
200 
1 
31 
68 
5.0 
65 
3 
5 
92 
3.5 
100 
1 
3 
96 
Apricots, canned 
4.8 
100 
5 
95 
Apricots, dried, stewed 
juice. 
2.7 
100 
4 
2 
94 
4.5 
80 
5 
6 
89 
12.2 
200 
9 
16 
75 
4.4 
200 
2 
4 
94 
9.0 
6 
94 
1.5 
100 
1 
99 
1.5 
100 
1 
99 
Grapefruit 
Hi large 
6.0 
80 
3.5 
100 
100 
4.9 
100 
5 
15 
80 
3.7 
100 
5 
15 
80 
Huckleberries, fresh 
4.7 
100 
3 
7 
90 
3.8 
35 
9 
15 
76 
0.8 
50 
1 
83 
16 
Orangesl 
9.5 
100 
7 
2 
91 
Peaches, fresh 
10.5 
100 
6 
3 
91 
Peaches' canned 
21ge. halves and 3 tbsp. juice.. 
7.5 
100 
6 
2 
92 
3.5 
100 
2 
98 
Pears, fresh 
6.3 
100 
4 
6 
90 
3.0 
65 
2 
4 
94 
2.3 
100 
1 
4 
95 
4.1 
50 
4 
6 
90 
2.2 
50 
5 
95 
Prunes, stewed 
5.6 
200 
2 
98 
1.1 
100 
3 
9 
88 
5.0 
90 
10 
14 
76 
1.7 
ICO 
1 
2 
91 
6.6 
75 
10 
14 
76 
Watermelon, edible portion... 
Large portion 
11.7 
100 
5 
6 
89 
Meats, Cooked. 
Beef, corned (less % fat con- 
i si. iy2" x iy2" xs/,v 
3.0 
100 
53 
47 
tent). 
2.3 
100 
20 
62 
18 
Beef', hamburger steak, broiled- 
2 cakes, 2y2" dia. x thick.. 
4.0 
200 
55 
45 
2 1. 2)4" x 2}4" x 
2.0 
200 
21 
68 
11 
1 si. 4"*x 6" x J4". 
3.0 
200 
40 
60 
6.8 
400 
10 
43 
47 
1 si. 5" x 5" x 
3.2 
200 
46 
54 
3.3 
150 
90 
10 
3.3 
200 
62 
38 
4.0 
200 
48 
52 
1 pc. 4)4" x 134" x *4" 
4.0 
300 
31 
69 
7.5 
250 
16 
45 
39 
2.2 
200 
31 
67 
2 
3.8 
200 
40 
60 
x)4”. 
1 si. 3)4" x 4)4" x 34" 
3.6 
200 
41 
59 
l si. 3""x 334;,rx 34"! 
3.6 
300 
33 
67 
0.5 
100 
13 
87 
2.6 
200 
29 
71 
4.0 
300 
33 
67 
4.0 
250 
33 
67 
Pork'sausage, broiled 
3 sausages, 3" long, 34” dia— 
2.2 
200 
20 
78 
2 
Poultry: 
3.2 
100 
80 
20 
4.0 
250 
51 
49 
4.0 
340 
40 
60 
1. 6 
200 
9 
48 
43 
5.0 
250 
30 
52 
18 
1 si. 2" x 234" x 34" 
5.0 
250 
71 
29 
4.2 
200 
47 
53 
450 
12.0 
350 
50 per cent potatoes. 658 
HOSPITAL CORPS HANDBOOK. 
TABLE OF FOODS USUALLY FOUND ON NAVAL HOSPITAL MENUS, 
ETC.—Continued. 
Fish and Shellfish. 
Ounces. 
Calo- 
ries. 
Pro- 
tein. 
Fat. 
Car- 
bohy- 
drate. 
Bluefish 
1 serving 
3.8 
150 
72 
28 
3.4 
200 
14 
65 
21 
Codfish, creamed 
2.5 
100 
32 
46 
22 
Halibut steak, broiled 
1 pc. 3" x 2J4" x 1" 
3.0 
100 
61 
39 
Mackerel, Spanish, broiled 
1 serving. ..* 
3.9 
150 
* 56 
44 
Salmon, canned.. J 
2.0 
125 
45 
55 
Salmon’ creamed, on toast 
Yi cup salmon and 1 si. toast.. 
4.8 
200 
22 
42 
36 
4.2 
200 
37 
52 
11 
3-6 sardines 
1.7 
100 
46 
54 
Clams. 
6 clams or Y cup 
7:6 
100 
8 
36 
2.8 
65 
86 
12 
2 
7.2 
100 
49 
24 
27 
3.2 
100 
91 
8 
1 
54 of a 9" pie 
4.8 
300 
3 
41 
56 
4.8 
340 
2 
18 
80 
4.3 
225 
9 
32 
59 
4.5 
450 
5 
27 
68 
% of a 9" pie 
450 
8 
39 
53 
4.5 
450 
3 
27 
70 
5.0 
300 
5 
18 
77 
4.0 
225 
10 
25 
65 
4.0 
200 
10 
25 
65 
Pies. 
4.0 
150 
12 
36 
52 
1.4 
50 
6 
78 
16 
Cheeseand pineapple salad... 
3.4 
200 
9 
58 
33 
3.2 
200 
12 
86 
2 
3.5 
250 
14 
85 
i 
0.6 
100 
100 
cup and 1 tbsp. dressing— 
3.0 
200 
3 
75 
22 
2.4 
200 
1 
95 
4 
dressing. 
0.5 
100 
1 
97 
2 
3.4 
200 
3 
68 
29 
3.0 
150 
4 
81 
15 
5.4 
200 
3 
86 
11 
3.0 
250 
4 
76 
20 
Salads and Dressings. 
8.0 
100 
17 
27 
8.0 
25 
84 
8 
8 
7.2 
200 
11 
61 
28 
7.8 
200 
12 
38 
50 
7.8 
150 
16 
46 
38 
9.0 
200 
16 
63 
21 
8.5 
200 
15 
38 
47 
10.0 
250 
26 
2 
72 
9.0 
135 
12 
15T 
76 
Tomato, cream of 
1 cup 
8.5 
260 
11 
63 
26 
Soups. COMMISSARY DEPARTMENT, NAVAL HOSPITALS. 
659 
TABLE OF FOODS USUALLY FOUND ON NAVAL HOSPITAL MENUS, 
ETC.—Continued. 
Vegetables. 
Ounces. 
Calo- 
ries. 
Pro- 
tein. 
Fat. 
Car- 
bohy- 
drate. 
Asparagus 
4.0 
25 
32 
8 
60 
Beans, baked 
8.0 
300 
21 
18 
61 
4.9 
100 
26 
18 
56 
69 
BeansJ lima, dhed 
1.0 
100 
26 
5 
Beansj string 
3.6 
45 
22 
7 
71 
2.0 
25 
14 
2 
84 
71 
85 
62 
71 
43 
78 
79 
69 
61 
81 
2.0 
20 
20 
9 
Carrots. 
2.0 
20 
10 
5 
2.0 
20 
23 
15 
1.0 
6 
24 
5 
3.4 
100 
16 
41 
3.6 
100 
11 
11 
9.0 
100 
12 
9 
2.4 
10 
19 
12 
1.0 
6 
25 
14 
2.0 
25 
13 
6 
1 serving 
3.0 
60 
2.5 
100 
8 
59 
33 
71 
45 
68 
89 
89 
88 
3.0 
65 
26 
3 
2.7 
100 
18 
37 
Peppers, stuffed, meat and 
• 6.0 
250 
11 
21 
6.0 
200 
6 
5 
4.0 
200 
4 
7 
5.0 
165 
11 
1 
5.4 
150 
11 
1 
88 
5.4 
200 
9 
50 
41 
45 
61 
6.0 
200 
7 
48 
white", escalloped— 
3.5 
100 
9 
30 
5.0 
200 
2.0 
16 
18 
3 
79 
80 
20 
76 
71 
68 
42 
82 
8.0 
40 
12 
8 
7.6 
100 
10 
70 
5.3 
150 
15 
9 
4.4 
30 
21 
8 
5.0 
35 
16 
16 
4.0 
100 
13 
45 
1.4 
100 
13 
5 
Miscellaneous. 
1 serving (estimated) 
1.0 
200 
10 
82 
8 
0.6 
100 
4 
77 
19 
0.6 
100 
19 
69 
12 660 
HOSPITAL CORPS HANDBOOK. 
SAMPLE WINTER MENU FOR THE GENERAL MESS, SHOWING APPROXIMATE 
CALORIC VALUES OF THE ITEMS. 
Sunday. Saturday. Friday. Thursday. Wednesday. Tuesday. Monday. 
Breakfast. 
Dinner. 
Supper. 
Com flakes and milk 180 
Hamburger steak 200 
Baked potatoes 165 
Com bread and butter... 360 
Roast loin of pork 300 
Boiled sweet potatoes 200 
Fresh apple sauce 100 
String Dean and lettuce 
Boston baked beans 300 
French-fried potatoes 150 
Fruit salad 200 
Brown bread and butter. 260 
Tea and milk 160 
905 
Pumpkin pie 200 
Bread, butter, coffee 260 
1,160 
1,070 
Baked apples and cream. 200 
Pork sausage 200 
Griddle cakes 100 
Porterhouse steak, gravy.. 300 
Fried onions 60 
Mashed potatoes 200 
Oyster stew 200 
Crackers 100 
Cold sliced meats 200 
Potato salad 200 
Bread, butter, coffee 260 
860 
Custard pudding 200 
Bread, butter, coffee 260 
1,020 
Spiced pears 100 
Bread and butter 260 
Cocoa 250 
1,310 
Shredded wheatandmilk 200 
Fried eggs 150 
Fried bacon 100 
Hot rolls and butter 260 
Coffee 
Cream of tomato soup 260 
Roast lamb, mint sauce... 200 
Roast brown potatoes 165 
Stewed canned peas 65 
Meat croquettes 250 
Creole rice 100 
Cabbage salad 50 
Brown Betty pudding... 250 
710 
Bread, butter, coffee 260 
1,050 
910 
Oranges 100 
Creamed chipped beef on 
toast 300 
Fried potatoes 120 
Chicken potpie 300 
Baked sweet potatoes 200 
Baked squash 100 
Fruited rice pudding 120 
Pork chops 300 
Cottage fried potatoes... 150 
Combination salad 200 
Stewed apricots with 
520 
980 
Bread and butter 260 
Tea and milk 160 
1,170 
Rolled oats and milk 200 
Fresh meat hash 200 
Soft boiled eggs 75 
Hot rolls and butter 260 
Coffee 
Bean soup 250 
Boiled fresh salmon 150 
Hollandaise sauce 50 
Mashed potatoes 200 
Clam chowder 225 
Baked macaroni and 
cheese 200 
Asparagus salad 200 
735 
Fresh apple pie, cheese 300 
Bread, butter, coffee 260 
1,310 
Ginger bread 200 
Bread and butter 260 
Cocoa 250 
1,335 
Puffed wheat and milk.. 200 
Broiled pork sausage 200 
Creamed potatoes 200 
Bread, butter, coffee 260 
860 
Pot roast of beef. 200 
Brown gravy 50 
Boiled potatoes 150 
Creamed turnips 100 
Bread custard with raisins. 260 
Bread, butter, coffee 260 
1,020 
Codfish cakes 200 
Tomato sauce 50 
Spinach with egg 100 
Bananas 100 
Bread, butter, tea 260 
710 
Grapefruit 80 
Broiled ham 200 
Scrambled eggs 200 
Hot rolls and butter 260 
Asparagus soup 125 
Roast chicken 250 
Mashed potatoes 200 
Sage dressing 200 
Shrimp salad 150 
Creamed potatoes 200 
A merican cheese 100 
Sliced pineapple 100 
740 
Celery and olives 50 
Vanilla ice cream 200 
Bread, butter, coffee 260 
1,385 
Bread and butter 260 
Cocoa 250 
1,210 COMMISSARY DEPARTMENT, NAVAL, HOSPITALS. 
661 
When the caloric values are totaled by days, allowing 600 calories each day 
for incidental articles of food used in cooking and flavoring, such as sugar and 
milk in the coffee and tea, flour and cornstarch used by the cooks as “ thicken- 
ing,” etc., it will be found that the menu given above will total as follows: 
Monday .1 3, 735 
Tuesday 3, 790 
Wednesday 3, 270 
Thursday 3, 270 
Friday 3, 980 
Saturday 3,190 
Sunday 3, 953 
Average for 1 day 3, 595 
In order to show the approximate amounts of the various nonstock items to 
order for a menu the following list is suggested, based on a complement of 400 
rations: 
Amount. Delivery day. 
600 pounds beef in sides (2 sides) Monday. 
300 pounds loins of beef Monday. 
300 pounds loins of pork : Saturday before. 
250 pounds of fowl, dressed and drawn Wednesday. 
300 pounds chicken, dressed and drawn Saturday. 
400 pounds of lamb, carcasses Tuesday. 
150 pounds salmon Thursday. 
10 gallons clams Friday, a. m. 
10 gallons oysters Tuesday, a. m. 
40 pounds codfish, shredded Friday. 
150 pounds pumpkins Saturday before. 
5 pounds mint Tuesday. 
200 pounds squasb Wednesday. 
150 pounds turnips Friday. 
60 pounds cake Saturday. 
No estimates will be given for the remaining items of food on the menu, as 
they all are items which should be carried as stock items, and sufficient amounts 
of tbem should be in store at all times to meet ordinary demands. 
The two sides of beef should be cut up and used as follows: 
2 rounds 
2 sirloin butts 
2 chucks 
2 shoulder clods 
Use as pot roast for Saturday dinner. 
2 loins Use as beefsteak for Tuesday dinner. 
2 eight-rib cuts Use as cold sliced meats for Tuesday supper. 
The briskets, cross ribs, plates, navels, rumps, and flanks remaining can be 
used as hamburger steak on Monday. The two loins of beef trimmed out of 
the two sides may be added to the 300 pounds of loins ordered for Monday and 
cut up into steaks for the Tuesday dinner. The lamb carcasses should be cut 
up into legs, shoulders, racks, and loins. The legs and shoulders to be used 
as roast lamb for Wednesday and the loins and racks saved for issue to the 
special diets as lamb chops. There will be sufficient meats left over during 
the week to provide left-over meats from which to make the croquettes Wednes- 
day and fresh-meat hash on Friday. 662 
HOSPITAL CORPS HANDBOOK. 
CUTS OF MEATS.2 
“ The methods of cutting sides of beef, veal, mutton, and pork into parts, and 
the terms used for the different ‘ cuts,’ as these parts are commonly called, 
1. Neck. 
2. Chuck. 
3. Ribs. 
4. Shoulder clod. 
5. Fore shank. 
6. Brisket. 
7. Cross ribs. 
8. Plate. 
9. Navel. 
10. Loin. 
11. Flank. 
12. Rump. 
13. Round. 
14. Second cut round. 
15. Hind shank. 
Fig. 207.—Diagrams of cuts of beef. (U. S. Department of Agriculture Bulletin No. 28.) 
vary in different localities. The analyses here reported apply to cuts as indi- 
cated by the following diagrams. These show the positions of the different 
cuts, both in the live animal and the dressed carcass as found in the markets. 
3 Department of Agriculture Bulletin No. 28. COMMISSARY DEPARTMENT, NAVAL HOSPITALS. 
663 
The lines of division between different cuts will vary slightly, according to the 
usage of the local market, even where the general method of cutting is as 
here indicated. The names of the same cuts likewise vary in different parts 
of the country. 
“ The cuts of beef.—The general method of cutting up a side of beef is illus- 
trated in figure 207, which shows the relative position of the cuts in the animal 
and in a dressed side. The neck piece is frequently cut so as to include more 
of the chuck than is represented by the diagrams. The shoulder clod is usually 
cut without bone, while the shoulder (not indicated in diagram) would include 
more or less of the slioulder blade and of the upper end of the fore shank. 
Shoulder steak is cut from the chuck. In many localities the plate is made to 
include all the parts of the fore quarter designated on the diagrams as brisket, 
cross ribs, plate, and navel, and different portions of the plate as thus cut are 
spoken of as the ‘ brisket end of plate ’ and ‘ navel end of plate.’ This part 
1. Neck. 
2. Chuck. 
3. Shoulder. 
4. Fore shank. 
5. Breast. 
6. Eibs. 
7. Loin. 
8. Flank. 
9. Leg. 
10. Hind shank. 
Fig. 208.—Diagrams- of cuts of veal. (U. S, Department of Agriculture Bulletin No. 28.) 
of the animal is largely used for corning. The ribs are frequently divided 
into first, second, and third cuts, the latter lying nearest the chuck and being 
slightly less desirable than the former. The chuck is sometimes subdivided 
in a similar manner, the third cut of the chuck being nearest the neck. The 
names applied to different portions of the loin vary considerably in different 
localities. The part nearest the ribs is frequently called ‘ small end of loin ’ 
or ‘ short steak.’ The other end of the loin is called ‘ hip sirloin ’ or ‘ sirloin.’ 
Between the short and the sirloin is a portion quite generally called the ‘ ten- 
derloin,’ for the reason that the real tenderloin, the very tender strip of meat 
lying inside the loin, is found most fully developed in this cut. Porterhouse/ 
steak is a term most frequently applied to either the short steak or the tender- 
loin. It is not uncommon to find the flank cut so as to include more of the. 
loin than is indicated in the figures, in which case the upper portion is called 
‘ flank steak.’ The larger part of the flank is, however, very frequently corned, 
as is also the case with the rump. In some markets the rump is cut so as to 
include a portion of the loin, which is then sold as ‘ rump steak.’ The portion 
of the round on the inside of the leg is regarded as more tender than on the 664 
HOSPITAL CORPS HANDBOOK. 
outside, and is frequently preferred to tlie latter. As the leg lies upon the 
butcher’s table this inside of the round is usually on the upper or top side, and 
is therefore called ‘ top round.’ Occasionally the plate is called the ' rattle.’ 
“The cuts of veal.—The method of cutting up a side of veal differs consider- 
ably from that employed with beef. This is illustrated by figure 208, which 
shows the relative position of the cuts in the animal and in a dressed side. 
The chuck is much smaller in proportion, and frequently no distinction is made 
betweeen the chuck and the neck. The chuck is often cut so as to include a 
considerable of the portion here designated as shoulder, following more nearly 
the method adopted for subdividing beef. The shoulder of veal as here indi- 
cated includes, besides the portion corresponding to the shoulder in beef, the 
larger part of what is here classed as chuck in the adult animal. The under 
1. Neck. 
2. Chuck. 
3. Shoulder. 
4. Flank. 
5. Loin. 
6. Leg. 
Fig. 209.—Diagrams of cuts of lamb and mutton. (U. S. Department of Agriculture 
Bulletin No. 28.) 
part of the fore quarter, corresponding to the plate in the beef, is often desig- 
nated as breast of veal. The part of the veal corresponding to the rump of 
beef is here included with the loin, but is often cut to form part of the leg. 
In many localities the fore and hind shanks of veal are called the ‘ knuckles.’ 
“ The cuts of lamb and mutton.—Figure 209 shows the relative position of the 
cuts in a dressed side of mutton or lamb and in a live animal. The cuts in a 
side of lamb and mutton number but six, three in each quarter. The chuck 
includes the ribs as far as the end of the shoulder blades, beyond which comes 
the loin. The flank is made to include all the under side of the animal. Some 
butchers, however, make a larger number of cuts in the fore quarter, including 
a portion of the cuts marked ‘ loin ’ and ‘ chuck ’ in figure 209, to make a cut 
designated as ‘ rib,’ and a portion of the ‘ flank ’ and ‘ shoulder ’ to make a cut 
designated as ‘ brisket.’ The term ‘ chops ’ is ordinarily used to designate por- COMMISSARY DEPARTMENT, NAVAL HOSPITALS. 
665 
tions of either the loin, ribs, chuck or shoulder, which are either cut or 
‘ chopped ’ by the butcher into pieces suitable for frying or broiling. The 
chuck and ribs are sometimes called the ‘ rack.’ 
“The cuts of pork.—The method of cutting up a side of pork differs consider- 
ably from that employed with other meats. A large portion of the carcass of a 
dressed pig consists of almost clear fat. This furnishes the cuts which are 
used for ‘ salt pork ’ and bacon. Figure 210 illustrates a common method of 
cutting up pork, showing the relative position of the cuts in the animal and in 
the dressed side. The cut designated as ‘ back cut ’ is almost clear fat, and 
is used for salting and pickling. The ‘ middle cut ’ is the portion quite gener- 
ally used for bacon and for ‘lean ends’ salt pork. The belly is salted or 
pickled or may be made into sausages. 
1. Head. 
2. Shoulder. 
3. Back. 
4. Middle cut, 
5. Belly. 
6. Ham. 
7. Ribs. 
8. Loin. 
Fig. 210.—Diagrams of cuts of pork. (U. S. Department of Agriculture Bulletin No. 28.1 
“ Beneath the ‘ back cut ’ are the ribs and loin, from which are obtained 
‘ spareribs,’ ‘ chops,’ and roasting pieces, here designated by dotted lines. The 
hams and shoulders are more frequently cured, but are also sold fresh as pork 
‘ steak.’ The tenderloin proper is a comparatively lean and very small strip 
of meat lying under the bones of the loin and usually weighing a fraction of a 
pound. Some fat is usually trimmed off from the hams and shoulders which 
is called ‘ ham and shoulder fat ’ and is often used for sausages, etc. What is 
called ‘ leaf lard,’ at least in some localities, comes from the inside of the back. 
It is the kidney fat. 
“As stated above, cuts as shown in the diagrams herewith correspond to 
those of which analyses are reported in the table beyond, but do not attempt to 
show the different methods of cutting followed in markets in different parts of 
the United States.” 666 
HOSPITAL CORPS HANDBOOK. 
PROVISIONS AND HOW THEY ARE PROCURED. 
Provisions may be divided into two classes: Dry provisions and fresh pro- 
visions. Dry provisions may be subdivided into two classes for the purpose of 
this discussion: Dry provisions, Navy standard, and dry provisions, special, for 
hospitals only. 
Dry provisions, Navy standard.—Dry provisions, Navy standard, are those 
items of groceries that have been standardized by the Navy Department, defined 
by printed specifications (see “ Index of Specifications issued by the Navy De- 
partment ” issued quarterly by the Bureau of Supplies and Accounts) and car- 
ried in stock by all naval provision depots. 
To obtain provisions of this character requisition is made on the nearest 
provision depot using S. and A. Form No. 30. 
In order to obtain fresh provisions and dry provisions, special, for hospitals 
only, it is necessary to furnish the local supply officer, annually, by the first 
of March, a list showing the estimated amounts of these two classes of pro- 
visions that will be needed to meet the requirements of the hospital during 
the following fiscal year. This list should show the amounts required by months 
If the list is prepared properly and carefully and the season rotation of fruits 
and vegetables taken into consideration, very little difficulty will be ex- 
perienced in obtaining the various kinds of fresh provisions as they appear 
in the local markets. 
Basing future requirements on this list the supply officer makes requisition 
on the Bureau of Supplies and Accounts for these amounts plus such amounts 
as may be required and are authorized for other naval activities within the 
district, and upon the approval of the bureau, he makes monthly contracts 
to furnish these items. After the contracts are made, each activity con- 
cerned is supplied with a “ Schedule of Provision Contracts ” for the following 
month. This schedule shows the names, addresses, and telephone lnunbers of 
all firms holding contracts during the month, together with the contract 
numbers and unit prices. In addition to the list of provisions contracted for 
delivery to the “ General Service,” i. e., ships and stations, there will be 
given a list of items for the use of “ Hospitals Only.” Naval hospitals may 
order from both lists. This latter list shows such items of dry provisions, 
special, for hospitals only, as have been included in the original estimate 
furnished the supply officer, referred to above. Orders against these monthly 
contracts then may be made direct to the contractor, using N. M. S. Hospital 
Form No. 23 for this purpose. The contractor is allowed at least 24 hours’ 
notice before delivery can be required. 
For purposes of keeping stock, provisions may be classified as stock items 
and nonstock items. 
(a) Stock items are those items of provisions, both fresh and dry, Navy 
Standard and Special, as are kept on hand at all times, such as all dry pro- 
visions, fresh fruits that are issued to wards daily (oranges, lemons, apples, 
bananas, etc.), eggs, all ordinary vegetables (potatoes, onions, lettuce, etc.), 
loins of beef (for steaks on short orders), hams, bacon, chicken (for special 
diets), bread, butter, milk, cream, etc. 
(b) Nonstock items are items of fresh provisions that are ordered only 
when the menu calls for an article for one meal only and the particular article 
is not carried as a stock item. 
Stock items may be carried on the medical department standard Property and 
Stock Card, as issued by medical supply depots. A minimum quantity of stock 
should be decided upon and that amount entered on the stock card. If the COMMISSARY DEPARTMENT, NAVAL HOSPITALS. 
667 
cards are gone over weekly and orders placed for all items which are below the 
minimum quantity entered, the chance of running short of stock items is 
reduced to a minimum. Running short of stock items is a very common fault 
and one that is almost inexcusable if the system outlined above is consistently 
followed. 
FOOD INSPECTION. 
All fresh provisions received are required to be inspected by the com- 
missary officer and the officer of the day. The inspection is made to 
determine whether or not the articles delivered conform to the following 
requirements: Agreement with the amounts ordered; delivery at the time 
stated in the order; in good condition at the time of delivery and in every 
way fit for human consumption; and in conformity in all respects with the 
specifications as written into the formal contract or order issued by the supply 
officer authorizing the transaction. 
No detailed discussion of requirements and specifications will be made, but 
a few general rules are given, so that the fundamentals of food inspection may 
be available. 
Meat-s*.—All items of meats and meat food products are required by naval 
regulations to be inspected by an inspector of the Bureau of Animal Industry, 
Department of Agriculture. The meats are required to be stamped by the 
inspector and a certificate issued by him stating that the meats or products 
described on the invoice have been passed by the Department of Agriculture 
and that they are also in accordance with naval specifications. This certificate 
should he signed by the inspector. 
Sex recognition.—The Navy contract specifications for fresh and various 
other meats excludes from acceptance meats from bulls, boars, stags, and in 
most cases cows. For this reason reference to the recognition of sex in the 
dressed carcasses has a practical value in this discussion. “ The bull is charac- 
terized by the massive development of his muscles, especially the neck and 
shoulder musculature, also by the dark color of the musculature and the scarcity 
of fat tissue. Finally, the inguinal canal is open. 
“The ox (steer) is distinguished from the hull by the weaker development 
of the shoulder and neck musculature, by its thick panniculus adiposus, and by 
the possession of a mass of scrotal fat tissue (cod-fat) which completely 
conceals the inguinal ring (a positive and recognizable anatomical point in the 
hind quarter of all adult males is the ischio-penal ligament, which appears as 
a circular white fibrous patch in the posterior region of the ischio-pubic 
symphysis). 
“ The carcasses of cows are more angular in their various outlines than are 
those of steer carcasses. There is a marked curvature to the ribs. The cut 
termed ‘round’ is flatter; the shanks are thinner and the mass of ‘cod fat’ 
which is seen in the steer is absent in cow carcasses. Very often the udder is 
carefully removed from fat cow carcasses and fat skewered over the cut sur- 
face in order to give them the appearance of steers. This attempted deception, 
however, is easily recognized by the mammary tissue which remains and by 
the supramammary lymph glands covering this tissue. 
“ Close examination will disclose the true character of the small udder on 
young heifers, which, on account of heavy fat infiltration, resembles the mass 
of scrotal fat of steers. 
47829°—23 43 668 
HOSPITAL CORPS HANDBOOK. 
“ In sheep, the slauglitered buck is distinguished from the ewe and wether 
by the strongly developed musculature of the neck, withers, and shoulder. The 
meat of bucks may also possess a disagreeable odor, but, as a rule, this is rare. 
“ The distinction of importance as regards hogs is between boars and stags 
on the one hand and sows and barrows on the other. The meat of the boar 
is coarse and possesses a darker color and the shoulder (or shield) is extremely 
hard. The meat of the service boar usually has a specific odor best described 
as a urinous or strong sexual odor. Under the Federal meat inspection regu- 
lations, meat or carcasses having this odor are condemned as unfit for food. 
“ Meat which is suspected of being from a boar or from a recently castrated 
service boar, should be tested for odor. This test is made by placing a sample 
of meat or raw fat in water in a covered vessel and bringing it to a boil and 
testing for odor from time to time while beating, or the sample may be heated 
in a frying pan. In some cases the urinous or boar-sex odor will be found 
very pronounced and disagreeable; in others it may be faint, but whenever the 
odor exists to such degree that its presence can be declared the meat should be 
rejected as unfit for human food. 
“ Characteristics of good meat.—In all cases the carcass should be that 
of a well-nourished animal without signs of attenuation or wasting; good 
meat is firm and elastic to the touch without oedema or emphysema, that 
is, does not pit or crackle on pressure. It should be juicy, but not wet nor 
flabby; the color should be uniform without brown or discolored patches. 
“ Good beef is of a bright red color, marbled with fat; veal is always 
paler and less firm to the touch. Mutton is dullish red and firm, the fat hard 
and white. In both beef and mutton a uniform yellowness of the carcass 
may be associated with health conditions. The carcass of the pig should 
be plump: The flesh is naturally pale and the fat somewhat soft; the skin 
should not set in folds or wrinkles and should be without stains or blotches. 
However, slight bruises and scratches are not infrequently present in good 
carcasses. 
“ In all cases when sufficient time has elapsed for the carcass to cool and set, 
the fat of cattle and sheep should be firm and the suet hard, containing no watery 
jelly or juice, free from blood stains and creamy white or yellowish in color. 
The odor should be sweet and agreeable. A skewer thrust deeply into the flesh 
should have no unpleasant odor when withdrawn. 
“The pleura and the peritoneum (the white, shiny membrane lining the 
chest and thoracic and abdominal cavities) should be free from adhesions 
and staining and free from ’evidence that anything has been stripped away; 
also particular attention should be paid to the connective tissues about the 
flanks, shoulders, diaphragm and region of the kidneys; signs of wetness, 
cedema, imperfect setting and evidence of disease in the lymph glands should 
be absent. 
“ Bull beef, it should be remembered is usually and normally dark in color, 
but in other cases marked darkness of the flesh is to be regarded with 
suspicion. (From Osterhag.) 
Fresh meats defined.—The word “ fresh,” whenever occurring in Navy specifi- 
cations for meat and meat-food products, is interpreted to include chilled fresh 
products which are not and have not been frozen. Conversely, products which 
are, or have been frozen can not be accepted as fresh. Meats that have been 
frozen and subsequently thawed out are dull in color and the blood from it is 
thin and pale in color (due to separation of the fibrin and serum upon freez- 
ing). If a specimen of the blood is mounted on a glass slide and examined 
under a microscope using a low-power lens the red corpuscles will present a COMMISSARY DEPARTMENT, NAVAL HOSPITALS. 
669 
crinkled appearance or the edges will appear scalloped if the meat is or has 
been frozen. 
Thawed-out poultry.—Frozen poultry that has been thawed out may be 
detected by the appearance of the lung tissue. If the fowl ever has been 
frozen the lung tissue will be dark in color and congested in appearance, but 
if it has never been frozen the lung will be pink in color and without the 
congested appearance. The lung from a fresh fowl, if slightly compressed 
between the tingers, will crackle (due to the air cells bursting under pressure). 
A thawed-out lung will not give this crackling sensation because the air cells 
already have been ruptured in the process of freezing. 
Eggs.—Every hospital has a monthly contract for “ Strictly fresh eggs.” 
The specifications may be very definite or the description “ strictly fresh ” 
only may be used. The following discussion will be helpful to those who are 
not familiar with the distinguishing characteristics of a fresh egg. 
Several methods of determining the freshness of eggs have been suggested in 
various books and pamphlets on the subject, such as placing them in water and 
noting the angle which they assume and whether or not they float. This 
method depends on the fact that in newly laid eggs the contents fill the egg, 
and since the specific gravity of the egg is greater than water, the egg there- 
fore assumes a horizontal position at the bottom of the vessel when immersed. 
Depending on the length of time that the egg lias been laid, due to evaporation 
of water from the contents through the porous shell, the egg assumes various 
angles from a horizontal position up to a vertical one. An egg that has lost 
sufficient moisture so that the specific gravity is less than water will float. 
Also an egg that has undergone decomposition to such an extent that gases 
have been liberated within the egg will always float. 
This method has the disadvantage of being slow and inaccurate and is not 
always a true indication of the age of the egg. Eggs that have been placed in 
cold storage very soon after being laid, provided the storage rooms are kept 
sufficiently humid, may remain in good condition for several mouths without 
sufficient evaporation of contents to make any noticeable difference in the float- 
ing angle. On the other hand, they can not be classed as strictly fresh eggs 
and may have a slightly disagreeable flavor. 
It is considered very desirable for every hospital to have an egg-candling 
device. They may be made in the hospital carpenter shop or a very satisfac- 
tory one may be purchased at little cost. One that can be used in daylight, 
thereby eliminating the necessity of a dark room, is the most desirable. A 
suitable type consists of a small sheet-steel box enclosing a 60-watt electric light. 
There is an opening, about 1| inches in diameter in one side of the box, with a 
shield extension on the top and sides about the opening to exclude rays of day- 
light. The inside of the shield is painted black to prevent reflected rays from 
striking the opening. Through the top of the shield is an opening surrounded 
by another shield similar in shape to the light shield on an ordinary parlor 
stereoscope. By holding an egg against the small opening and looking down 
through the upper opening a very clear view of the contents of the egg may 
be had. 
Any shrinkage of the egg is evidenced by an air bubble at one end. The 
yolk in a fresh egg will show up as a light shadow. A heavy shadow usually 
indicates that the egg is stale. The various degrees of staleness may be judged 
by the heaviness of the shadow. A rotten egg always will show black. Hatched 
eggs, referred to in Navy Department Specifications No. 56-E-ld, are fertile 
eggs that have been kept in a warm place sufficiently long after laying to start 670 
HOSPITAL CORPS HANDBOOK. 
the development of the embryo. This shows up under the candle as a small 
dark spot. 
Broken-yolked eggs are eggs that have been kept in a warm place long enough 
for the capsule of the yolk to partially disintegrate and become weakened 
through bacterial action to such an extent that it breaks and allows the yolk 
to mix with the white of the egg. This condition under the candle appears 
as a floating shadow throughout the entire contents of the egg rather than 
being localized, as is the case in a normal fresh egg. 
A strictly fresh egg should appear under the candle as almost entirely trans- 
lucent. The only opacity should be the slight shadow cast by a normal fresh 
yolk. The air bubble should not be over 5 per cent of the egg contents. Eggs 
that do not meet these requirements should be regarded with suspicion and 
opened on a saucer. If, after opening, the yolk has a decidedly mottled appear- 
ance, does not stand up to almost the shape of a hemisphere, or breaks upon 
careful opening of the shell, the egg may be considered to be stale. The appear- 
ance of the white of the egg is also very helpful in egg inspection. In a fresh 
egg the white consists of two parts, a viscid, jellylike part and a thin, watery 
part. In storage eggs that have been held for several months and in stale eggs 
that never have been in storage but have been held for several days or a few 
weeks in a warm place the jellylike part of the white disintegrates into a thin, 
watery fluid. 
In the inspection of eggs at a naval hospital one rarely is called upon to dif- 
ferentiate between fresh eggs and eggs that are distinctly rotten, but almost 
daily one must be able to tell the difference between strictly fresh eggs and eggs 
that are slightly stale. Those that are slightly stale certainly are not strictly 
fresh and therefore should be rejected. 
At this point the student should familiarize himself with, the text of the 
pamphlet issued by the Bureau of Supplies and Accounts, title: “ General 
Specifications and Conditions of Delivery Applying to Provisions Contracts,” 
dated October 1, 1921. A copy of this pamphlet should be in every commissary 
office. It forms a part of the specifications of all food contracts and orders. 
Milk and cream.—Samples of milk and cream, both thin cream (20 per cent 
milk fat) and double cream (40 per cent milk fat), should be collected fre- 
quently, at least weekly, and sent to the hospital laboratory for analysis. 
Usually a Babcock test to determine the milk-fat content will be the only 
test necessary. In collecting samples of milk and cream care should be taken 
to collect average samples. If the milk is in cans, the milk should be poured 
from one can to another at least six times, so that the cream will be thoroughly 
mixed and evenly distributed throughout the milk, and then about a pint col- 
lected in a clean bottle as a simple. If the milk is in quart bottles, send a 
whole bottle to the laboratory. The same precautions should be taken in col- 
lecting samples of cream. 
Fish.—The inspection of fish is difficult unless the person inspecting it is 
familiar with the various kinds. A study of a dictionary or a natural history 
that describes and gives illustrations of the different species of the fish family 
will prove very helpful. varieties frequently are delivered for the more 
expensive kinds; pollock for blueflsh, flounder for baby halibut, croakers for 
Virginia spots, Boston mackerel for Spanish mackei’el; etc. Frozen fish that 
has been thawed out is frequently delivered for fresh-caught fish. Fish that 
have been frozen lose their delicate flavor. Fresh-caught fish present the 
following characteristics: the gills are red; the eye is bright; the blood is 
bright red, and the flesh is firm. In fish that have been frozen, held in storage 
and subsequently thawed out, the gills are pale, the eyes dull, the blood dark COMMISSARY DEPARTMENT, NAVAL HOSPITALS. 
671 
in color, and the flesh is usually soft with a slightly disagreeable color, even if 
it is still edible. To show the points of differentiation between fresh, stale, 
and putrefied fish, the following table from Meat Hygiene, by Edelmann, 
Mohler, and Eichhorn, is given. 
Condition. 
Scales. 
Eyes. 
Gills. 
Body in general and 
meat. 
Specific 
gravity. 
Glittering, free 
from slime, 
Standing out... 
Gills, lids, and 
mouth closed. 
Solid; placing fish 
horizontally on the 
Sink in water. 
firmly adher- 
hand it does not 
ent. 
bend. Meat firm, 
elastic, tight on 
bones. 
Not fresh, 
More or less 
Red bordered, 
Lids open or 
Bonv, bends easily, es- 
Swim on the 
stale for 
easily remov- 
sunken; cor- 
can be easily 
pecially at tail end; 
water. 
sometime. 
able, slightly 
nea cloudy. 
opened; gills 
occasionally bloat- 
slimy or 
smeary. 
pale, yellow 
dirty, or gray- 
ing of the abdomen, 
which may be bluish 
ish red, cov- 
discolored. Finger 
ered with the 
impressions are eas- 
same kind of 
ily made, and re- 
fluid; odor 
main; meat is soft, 
disagreeable. 
can be easily re- 
moved from the 
bone. 
Putrefied... 
Very loose, cov- 
Breaking down; 
Very off-col- 
Withered, flabby, soft. 
Do. 
ered with a 
are frequent- 
ored; ex- 
pale, bloated. The 
smeary, slime- 
ly removed. 
tremely of- 
meat is sloppy. 
like mass cf 
fensive odor. 
disagreeable 
odor. 
Shell fish.—In the inspection of crabs and lobsters there is but one rule to 
follow and that is, do not accept them unless they are alive. Ptomaines de- 
velop very quickly in crabs and lobsters. It should be remembered that the 
shells of dead oysters and clams are open. The juice of opened oysters and 
clams should be almost clear and not stringy; any stringy or milky appearance 
of the juice is a cause for rejection as it indicates bacterial growth. The 
oysters and clams should be slightly salty to the taste; a decided fresh taste 
indicates adulteration by “floating” or by being in direct contact with ice. 
Floated oysters are oysters that have been taken up from their natural beds 
and either laid down in fresh or brackish water, or placed in floats at the 
mouth of a fresh-water stream for a few weeks. When salt-water oysters are 
placed in fresh or brackish water the salt in the oyster tissue is dissolved out 
by the fresh water and the oyster becomes inflated with fresh water (due to 
osmosis) and increases in size so that when the bivalves are opened the oyster- 
man is enabled to obtain from 10 to 20 per cent more oyster meat from the 
same quantity of oysters in the shell, thereby increasing his profits at the 
expense of the innocent purchaser. Foating destroys the delicate flavor of 
the oyster and renders it more liable to contamination by sewage from the 
stream. Ice in direct contact with the oysters destroys the flavor in the same 
manner but does not contaminate the oyster unless the ice itself is contami- 
nated. Clams are not generally “ floated.” 
The inspection of fruit and vegetables will not be discussed as the standard 
specifications are very clear and variations from the standards are quite 
apparent as almost everyone can distinguish between the good, the indifferent, 
and the bad. 
Food adulteration.—The following abstract from the Federal pure food laws 
will serve as a guide in the inspection of all items of foods but more particularly 
in the inspection of dry provisions, special, purchased direct from the contractor. 
All items of Navy standard dry provisions obtained on requisition from pro- 672 
HOSPITAL CORPS HANDBOOK. 
vision depots of the Navy have been inspected at the time of their original 
purchase by the Navy and, therefore, inspection for quantity received is the 
only inspection necessary when they are received at a hospital. 
Adulteration of food consists in practices, some fraudulent, and others techni- 
cal in nature. Some are injurious to health, but most of them have an 
economic rather than a sanitary significance. 
Methods of adulteration: 
1. The removal of nutritive substances. 
2. The addition of injurious substances. 
3. The fraudulent substitution of cheaper articles. 
4. Misbranding. 
5. The sale of food that is filthy, decomposed, or putrid. 
The more common adulterations are: Cotton seed oil for olive oil; starch or 
sugar in cocoa and chocolate; caramel, pea meal or chiekory in coffee; cheap 
fats or cotton seed oil in lard; saccharin for cane sugar; cereals in sausages; 
bran in flour; oleomargarin as butter; distilled and colored vinegar as pure 
cider vinegar; etc. 
A food is considered adulterated, according to the Pure Food and Drugs Act 
of 1906: 
1. If any substance has been mixed and packed with it so as to reduce or 
lower or injuriously affect its quality or strength. 
2. If any substance has been substituted wholly or in part for the article. 
3. If any valuable constituent of the article has been wholly or in part 
abstracted. 
4. If it is mixed, colored, powdered, coated, or stained in any manner whereby 
damage or inferiority is concealed. 
5. If it contains any poisonous or other added deleterious ingredient which 
may render such article injurious to health. 
6. If it contains in whole or in part a filthy, decomposed, or putrid animal 
or vegetable substance or any portion of an animal unfit for food, whether 
manufactured or not, or if it is the product of a diseased animal, or one that 
has died otherwise than by slaughter. 
7. Misbranding is regarded as a form of adulteration under the Pure Food 
and Drugs Act. 
Food preservation.—-The methods used in the preservation of foods are: 
Cold, drying, salting, smoking, canning, preserving, and chemical treatment. 
Cold.—Cold is an antiseptic rather than a germicide. Cold temperatures 
kill few bacteria, but prevent the growth and multiplication of most of them. 
No microorganisms pathogenic to man will grow or multiply at the temperature 
of the refrigerator, but many saprophytic bacteria and molds will, even as low 
as zero centigrade. Most pathogenic bacteria withstand freezing, but suffer a 
quantitative reduction. Most animal parasites die in cold storage. At a tem- 
perature of 9° F. trichinse will die in 20 days. The longer an article remains 
in cold storage the relatively safer it is. The proper preservation temperature 
varies for different foods. Meat and poultry for long keeping should be kept 
frozen at a temperature of 25° F. To keep them for short periods in a chilled 
condition the temperature should be 33° F. Milk and eggs in the shell are 
injured by freezing. Milk keeps best at 35° F. and eggs at 32° F. Fish for 
long keeping usually are frozen, then dipped in water and refrozen, then stored 
at 20° F. This coating of ice prevents loss of water due to surface evaporation. 
Articles may be kept in cold storage for a long time; fish for two years. 
Meat, poultry, eggs, and vegetables may be kept for months. Undrawn poultry COMMISSARY DEPARTMENT, NAVAL HOSPITALS. 
673 
keeps better in cold storage tlmn drawn, and drawn poultry decomposes more 
rapidly after removal from the refrigerator. 
Cold imparts no new taste, nor does it seriously alter the natural flavor. 
It does not diminish the digestibility nor cause any loss of nutritive value. 
Drying.—Drying is a primitive method of preserving meats, fruits, vegetables, 
and other food substances. It furnishes an ideal antiseptic condition, for bac- 
teria require moisture for their growth, and drying removes this. Furthermore, 
dried foods usually are cooked before being eaten. It is not adapted as well to 
meats as to fruits and vegetables. Dried meats lose their natural flavor. Dried 
eggs and milk keep their nutritive value. 
Salting and pickling.—In salting the brine should contain from 18 to 25 per 
cent salt. In pickling, brine, vinegar, and weak acids are used. These sub- 
stances should be considered antiseptic rather than germicidal. Trichinae die 
after prolonged pickling. 
Smoking—Smoking consists in drying the food and adding to it certain sub- 
stances in the smoke, such as acetic acid, creosote, formaldehyde, etc. These 
are considered germicidal, but it must be remembered that the penetration is 
only partial; for example, in smoking sausages, if they are large in diameter, 
the smoke does not penetrate to the whole of the contents and they may become 
dangerous in regard to the various parasites and the products of decomposition 
contained therein, as smoked meats often are eaten raw. 
Canning.—Canning consists in the application, in a practical way, of the 
well-known laboratory method of fractional sterilization. A second steriliza- 
tion usually is made after a day or two to permit the germination of all spores, 
when these are killed. Canned foods are sterile and safer than the fresh 
article. Fortunately improperly sterilized canned foods are easily detected by 
tbe gas that will form and cause a bulging of the can, or by the odors that are 
produced. Canned goods are safe and quite as nutritious as the fresh article. 
There is great danger of contamination from the container. Erosion of the tin 
plate may occur, and the tin salts then are introduced into the contents. Glass 
containers eliminate this danger. 
Preserving.—Preserving consists in the addition of sugar and cooking. For 
this reason the food article must be considered as free from infection. Various 
acids and salts are added as chemical preservatives, as salicylic acid, benzoic 
acid, and benzoate of soda. 
Chemical preservatives.—Chemical preservatives may be considered as anti- 
septic substances, and not all of them are injurious to the health. There is an 
economic side to this question. Most people object to any chemical or drug 
substance being used as a preservative, but accept any substance derived from 
natural sources. The least harmful is benzoic acid and sodium benzoate. 
The chemicals used most commonly are: Benzoic acid and sodium benzoate, 
borax and boric acid, formaldehyde, salicylic acid, sodium and potassium ni- 
trate, potassium permanganate, sodium fluorid, hydrofluoric acid, sulphites, 
sodium bicarbonate, hydrogen peroxide, and arsenic. 
ISSUE OF PROVISIONS. 
The dietitian in the diet kitchen, the chief cook in the main kitchen, the 
housekeeper in the nurses quarters, and the person in charge of any other 
special mess, prepares a food requisition daily (N. M. S. Hospital Form No. 47 
may be used for this purpose) and submits it to the commissary officer every 
morning. The requisitions are based on the menus prepared in advance, except 
in the case of the diet kitchen where standard menus for special diets can 674 
HOSPITAL CORPS HANDBOOK. 
rarely be used because of the constant variation in this class of diets. The 
requisitions should call for sufficient food for three meals—supper, and break-* 
fast and dinner for the following day. After the requisitions are approved by 
the commissary officer they are sent to the issuing storeroom for issue at 
stated hours. The hours of issue should be arranged so that they operate 
to the best advantage, both to the section drawing the provisions and to the 
commissary department. All eggs, oranges, milk, cream, etc., issued to the 
wards on diet sheets should be issued by the diet kitchen and not the issuing 
storeroom. No uncooked food should be issued to any section or hospital de- 
partment, except by the method outlined above. In other words, all food is 
issued through the issuing storeroom, and no food is issued from there except 
upon the authority of a requisition signed by tlie commissary officer. This 
permits the commissary officer to have absolute control over all issues of food. 
STOCK KEEPING AND ACCOUNTING. 
Naval Hospital Fund.—All provisions purchased or requisitioned from sup- 
ply officers for use at naval hospitals are made a charge against the Naval 
Hospital Fund. (See page 603 of this book.) Whenever an enlisted man is 
admitted to a naval hospital or transferred to one for duty, an exchange of 
appropriations occurs in the Navy Department and the annual appropriation 
“ Provisions, Navy ” is debited and the naval hospital fund is credited with 
such an amount for each day the man is subsisted by the hospital, as is an- 
nually fixed by Congress. For the fiscal year 1924 the amount is 75 cents for 
patients and for all others the average cost of subsistence. Whenever an officer 
is subsisted in a naval hospital his pay account is checked at the fixed 
rate per day and this amount credited to the naval hospital fund. When- 
ever a staff officer of the hospital or a civilian employee wishes to purchase 
his meals at a hospital the same amount is checked against his pay account 
and made a credit to the naval hospital fund; the full rate per day if three 
meals are eaten or one-third the full rate if one meal per day is eaten (the 
purchase of two meals per day is not permitted). 
The system of keeping accounts in the commissary department of naval 
hospitals is essentially one of daily balance of receipts and expenditures, both 
as to quantities of stores and the cash values thereof, with a summary of the 
whole at the end of each month. This gives an accurate knowledge of commis- 
sary stores on hand at all times as well as their value, shows the expendi- 
tures of any item at a glance, and with the ration memoranda affords a ready 
means of computing the average per diem cost of subsistence. 
The receipt and expenditure voucher, N. M. S. H. Form No. 37, contains the 
transaction of commissary stores received and expended and the cash value 
thereof for one day. The entries are taken from dealers’ bills and supply 
officers’ invoices and from the rough memoranda of stores issued (on hand) 
from the storeroom. Stores on delivery should be accompanied by duplicate 
invoices, and these initialed by the officer responsible for the proper inspection 
and weighing of the stores. One invoice is returned to the dealer, the other 
filed in the dealers’ jacket file of the hospital and used, as before stated, in 
preparing the daily receipt and expenditure voucher and also for checking 
dealers’ bills at time of payment. The completed voucher for the day is 
submitted on the following morning, through the executive officer, to the com- 
manding officer of the hospital, and upon its return a transcript of the en- 
tries thereon is made in the commissary ledger, the quantities received and 
expended under the respective headings and the cash value of the day’s re- COMMISSARY DEPARTMENT, NAVAL HOSPITALS. 
675 
ceipts and expenditures in the appropriate columns to the extreme right on 
the last page for the month concerned. 
The commissary ledger is a loose-leaf system ledger with two distinct kinds 
of pages, those containing the “ Cash values ” columns being supplied in more 
limited quantity, only one of these pages being used each month, the last for 
the month concerned. The cash extensions for each day’s transactions are 
here entered. A study of these pages makes their use plain. It will be noted 
in the commissary ledger that each item contains separate columns for the 
witry of receipts and expenditures, marked “ R ” and “ E,” respectively. To 
distinguish more clearly between the two, receipts are entered with black ink, 
expenditures with red ink. To prepare the commissary ledger for entries, 
write the name of the different articles purchased and on hand under the 
column “ Items.” Enter unit and unit price in the two columns below the 
item name. 
On the last day of each month an inventory is taken and the amounts on 
hand entered under “ Brought forward ” for the succeeding month, calculating 
their value always on the actual value of the stores. When supplies are 
received and placed in store for issue at some future date (such items having 
a different unit price from those already on hand) a new unit value for the 
total then in store will be determined in the following manner: If on a 
certain date there are in store six (6) bags of corn meal worth $1 per bag, 
and ten (10) more bags are received invoiced at $2 per bag, the new issue 
value per bag will be $1,625. Fill in at the end of each month columns on the 
bottom of the pages. Enter under “ Carried over from last month ” stores 
remaining from previous month. The amounts on line “ Received this month,” 
obtained by deducting the “ Carried over from last month ” column from the 
totals, has to correspond with the totals of dealers’ or supply officer’s bills. 
Under column “ Unexpended ” will appear the difference between the receipt 
and expenditure columns, and under column “ Inventory ” the actual amount 
on hand as found by the inventory. The difference between these two columns 
gives the “ Loss on issue.” The money value of the “ Loss on issue ” column 
plus “ Total expenditures ” gives the “ Total cost of subsistence.” Since 
provision vouchers are paid monthly by the hospitals, the following easy method 
of proving the correctness of the totals in the “ Cash values ” columns should be 
employed. To the sum total of vouchers for stores obtained during the month 
add the value of the stores brought forward from the previous month; this 
represents the absolutely correct value of receipts. If the sum so obtained 
differs from the sum total of the daily receipts, as it may, due to frac- 
tional differences and possible clerical errors, write under the total “ Cor- 
rected totals ” and the sum found in that way, using red ink. By deducting 
the value of stores found on hand by inventory from the above sum the 
absolutely correct total for expenditures will be found, and the same, if 
differing from the totals obtained from the totals of the daily entries, should 
be entered in the same way as “ Corrected total.” By dividing the corrected 
total of expenditures by the total number of rations, obtained from ration 
memoranda, the “ Average cost of subsistence per diem ” is obtained. Only 
provision items are to be carried in the commissary ledger. 
At the end of the month the commissary officer furnishes the accounting and 
property officer with the total value of supplies expended during the month, 
classified as follows: Dairy products; meats, poultry, and fish; groceries and 
provisions; fruits and vegetables. He further furnishes this officer with the 
total value of stores on hand in order that it may be checked against the 676 
HOSPITAL CORPS HANDBOOK. 
stores account of the accounting system. The commissary ledger and that 
part of the stores account which represents commissary supplies must agree. 
The ration return, N. M. S. H. Form No. 36, is filled in from day to day 
according to the changes resulting from admission and discharge of patients, 
transfer of hospital corpsmen, employment and discharge of civilian employees, 
etc. The sum total of columns 1 to 9, inclusive, less sum total of columns 
10 to 14, inclusive, will give the actual number of rations issued. To find 
the average cost of subsistence for any given time divide the total of expendi- 
tures taken from the commissary ledger by the sum total of rations issued 
during the corresponding time. 
In order that the Bureau of Medicine and Surgery may have current in- 
formation as to the average cost per man per day for subsistence at hos- 
pitals it is required that each hospital submit, on the first of each month, a 
ration return prepared on N. M. S. H. Form No. 36. This report shows the 
total number of ration days of the following classes of persons subsisted by 
the hospital for the month. 
Column 1.—Patient officers, Navy. 
Column 2.—Patient enlisted men, Navy. 
Column 3.—Patient officers, Marine Corps. 
Column 4.—Patient enlisted men, Marine Corps. 
Column 5.—Supernumeraries, Veterans’ Bureau. 
Column 5.—Supernumeraries, Employees’ Compensation Commission. 
Column 5.—Supernumeraries, others. 
Column 6.—Hospital Corps. 
Column 7.—Nurse Corps. 
Column 8.—Marine Guard. 
Column 9.—Civilian employees. 
Column 10.—Blank. 
Column 11.—Blank. 
Column 12.—Total number of each class (columns 1 to 9, inclusive) who were 
absent with leave. 
Column 13.—Total number of each class (columns 1 to 9, inclusive) who were 
absent without leave. 
Column 14.-—Total number of each class (columns 1 to 9, inclusive) who sub- 
sisted themselves. 
The last column shows the actual number subsisted by classes, which is 
determined by subtracting the totals of columns 12, 13, and 14 for each class, 
from the numbers shown in columns 1 to 9, respectively. 
All the columns are then totaled at the foot, and the subtotal of columns 12, 
13, and 14 subtracted from the subtotal of columns 1 to 9, inclusive, should 
equal the subtotal of the last column. This gives the total of all persons sub- 
sisted by the hospital during the month, expressed in subsistence days. To 
this number is added the total number of admissions of Veterans’ Bureau 
patients during the month. In the case of Veterans’ Bureau patients both 
the day of admission and the day of discharge are counted as subsistence 
days, which is not true for any other class of persons subsisted. This gives 
the grand total of actual number of subsistence days for the month. 
The “total cost of subsistence” (obtained from the the commissary ledger) 
divided by the grand total of actual number of subsistence days, gives tbe 
average cost of subsistence per diem for the month. 
Payment of monthly hills.—At the end of each month each firm that has 
furnished provisions during the month furnishes the hospital with an invoice 
in triplicate showing the quantity, unit price, and value of each item of pro- 
visions purchased and the total value of all items furnished. The clause 
“Certified correct and just, payment not received ” is written across the 
face of the invoice and signed by a member or official of the firm, giving his COMMISSARY DEPARTMENT, NAVAL HOSPITALS. 
677 
title. When these invoices are received they are checked carefully against the 
total quantities received and recorded in the commissary ledger and against the 
copy of the contract on tile as regards units of quantity and price and for 
errors in extension and addition of extensions. Fractions of cents in excess of 
5 mills are allowed the contractor, fractions less than 5 mills are dropped. 
If any errors are found in the invoices they should be returned to the con- 
tractor with a letter pointing out the errors found and requesting cor- 
rected invoices. However, the words corrected invoice or similar phases 
should not appear on the final invoice rendered. Invoices so marked will 
not be passed for payment by the Navy Department. 
Public bills.—When a correct invoice has been received a public bill (on 
shore) Medicine and Surgery Form No. 5 is made out, original and seven copies. 
One copy is filed, together with a copy of the contractor’s invoice. The original 
and six copies, together with the original and one copy of the contractor’s in- 
voice, is forwarded to the local supply officer for approval and recording. He 
then forwards the public bill to the local disbursing officer, who actually pays 
the bill by forwarding a check for the amount of the bill to the contractor who 
originally presented it. 
Provisions invoiced by supply officers.—Provisions obtained from Navy pro- 
vision depots or the supply departments of navy yards on requisition, Supplies 
and Accounts Form No. 30, are followed up by an “ Expenditure ” invoice 
(Supplies and Accounts Form No. 71) in quadruplicate. When the provisions 
have been received and the invoice checked the original and one copy is signed 
by the commanding officer and returned to the supply officer who issued the 
provisions. When this transaction has been completed the accomplished in- 
voice becomes a charge against the hospital in the same manner as a purchase 
against a contract with a private firm. 
COMMISSARY FILES. 
Dealers’ jacket file.—The dealers’ jacket file is a series of envelope jackets 
with the name of each firm from which provisions are purchased on the jacket. 
The jackets are filed alphabetically, using the initial letter of the first name 
appearing in the firm’s name as the key letter, thus: The name Smith, Browne 
6 Co., would be filed under the key letter “ S.” In each jacket is filed a copy 
of all order and inspection blanks (N. M. S. II. Form No. 23) for provisions to 
firms holding provision contracts during the current month. In each firm’s 
jacket is filed the retained copy of all daily delivery invoices receipted for 
during the month. When a correct monthly invoice has been received from the 
firm the retained copies of all “ order and inspection blanks ” are taken out 
of the dealers’ jacket file and totaled and cheeked against the monthly invoice. 
When the public bill in payment of the monthly invoice has been prepared the 
retained copy of the public bill and all copies of the orders for the month are 
clipped together, marked with the month and year to which they pertain, and 
permanently filed in the dealer’s individual jacket. A copy of all correspondence 
with firms in reference to provision orders or contracts is filed in the dealers’ 
jacket file. 
Provision requisition file.—A file copy of each provision requisition on pro- 
vision depots or navy yard supply departments is retained in a separate file. 
The requisitions are numbered serially throughout a fiscal year. All corre- 
spondence in reference to a shipment of provisions is filed with the retained 
copy of the requisition to which it pertains. The copy of the accomplished 
invoice and a copy of the bill of lading on which the stores were shipped is also 
filed with the copy of the requisition. 678 
HOSPITAL CORPS HANDBOOK. 
Ration memoranda file.—A separate file is maintained in which are filed 
copies of all monthly ration memoranda (N. M. S. H. Form No. 36) forwarded 
to the liureau of Medicine and Surgery above described. Copies of these re- 
ports are filed chronologically according to months. 
Stock card file.—A stock card file is kept of all stock items, indexed alpha- 
betically. The medical department “ Property and Stock Card ” may be used 
and is recommended. All issues from the dry provision storeroom are deducted 
from the amounts on hand and all receipts of stock items are added thereto, 
giving dates, etc., as indicated on the cards. 
The above-mentioned four files are the only ones necessary to keep in a 
commissary office. 
DUTIES OF COMMISSARY DEPARTMENT PERSONNEL. 
Commissary officer.—The commissary officer, a chief pharmacist or phar- 
macist, is responsible for: (1) The purchase of all provisions received by a 
naval hospital for use in any of its various departments and for the prepara- 
tion and serving of food for the general mess; (2) the care of provisions and 
the judicious expenditure of funds for their purchase; (3) the organization 
and efficient functioning of the commissary department; (4) keeping the ac- 
counts of the commissary department and administering all its affairs; (5) 
general supervision over all persons employed in the service of the general 
mess; and (6) for the accounting of all articles of property and equipment in 
the commissary department. He should inspect the storerooms frequently to 
see that the provision stores are properly stowed and the storerooms dry, 
clean, and well ventilated. Deterioration in stores being a direct loss to the 
mess, great care must be exercised in their selection, and no greater quantity 
bought at one time than may be expected to keep in good condition. The 
commissary officer should inspect all provisions received, in person, and notify 
the officer of the day of all stores received, and report to him whenever any 
rejections are made for nonconformance with the specifications, so that an 
entry to that effect may be made in the Medical Journal. He should cause 
the commissary steward to keep a stock account of all provision stores on hand 
that have not been expended. From time to time he should make recommenda- 
tions to the executive officer, with the idea of promoting efficiency or economy, 
and whenever the interests of the commissary department require any change 
which he himself is not authorized to make. He should report flagrant cases 
of incompetency among the personnel under his supervision, either civilian 
employees or enlisted men, to the executive officer for such disciplinary action 
as may be necessary. In addition to the above, the commissary officer, while 
not in any way responsible for the operation of the nurses’ or sick officers’ 
messes, or the diet kitchen, or the preparation or serving of food therein, 
observes the carrying on of work in these activities and makes such recom- 
mendations or suggestions for improvement, economy, or correction of faults 
as he may consider necessary to the person or persons in charge or the execu- 
tive officer, as the conditions warrant. 
Commissary steward.—The commissary steward (usually a chief pharma- 
cist’s mate) is the chief petty officer in charge, under the commissary officer, of 
the general mess. He is entitled to respect and obedience from all persons of 
inferior rating and from civilian employees in the department while in the 
performance of his duties. He is responsible for the proper execution of the 
orders of the commissary officer and may be called on to prepare the weekly 
menu for the approval of the commissary officer. He has general supervision 
over the storekeepers and storerooms, main kitchen, and mess halls. He pays COMMISSARY DEPARTMENT, NAVAL HOSPITALS. 
679 
particular attention to garbage collection and food waste, reporting any excesses 
to the commissary officer. He supervises the issue of all foods and the serving 
of the food in the general mess halls. When provisions are received he should 
be present to assist in the inspection and weighing and should take charge 
of the provisions accepted and see that they are properly stowed and accounted 
tor. He personally should keep the stock cards of provisions on charge in the 
dry provision storeroom and make estimates of provisions required so that 
orders or requisitions may be prepared by the clerk for the signature of the 
commissary and executive officers. He prepares the “ Receipt and Expendi- 
ture Voucher” daily, or furnishes the data from which the clerk may prepare 
it. In the absence of the commissary officer the commissary steward assumes 
the duties of the former. 
Clerk.—The commissary clerk (usually a pharmacist’s mate) is held re- 
sponsible to the commissary officer for making the proper entries in the com- 
missary ledger; the preparation of orders and requisitions for provisions; the 
checking of monthly dealers’ invoices and preparation of public bills in pay- 
ment thereof; accomplishing provision invoices from provision depots; filing; 
and the typewriting of all correspondence incident to the commissary depart- 
ment. He may be required to prepare the smooth Receipt and Expenditure 
Vouchers daily and to perform such other special or routine work as may be 
assigned him. 
Storeroom keepers.—The duties of the storekeepers (usually pharmacist’s 
mates) are as follows: Have alternate day’s duty in the commissary depart- 
ment ; make all issues of provisions from the issuing storerooms on requisitions 
approved by the commissary officer only; keep the storerooms clean and 
orderly; prepare lists of provisions necessary to restock the issuing storeroom 
shelves from the dry provision storeroom for approval by the commissary 
steward. Keeps the commissary steward informed daily of the nonstock items 
on hand by daily inventor}7. 
Chief cook.—The chief cook is in immediate charge of the main kitchen in 
large hospitals and acts in the capacity of a chef in a hotel. He is held strictly 
responsible for the cleanliness of the kitchen and accessory rooms and the 
utensils and equipment pertaining to them; for the maintenance of discipline 
and personal cleanliness of his assistants; for the proper preparation of food 
requisitions for the issuing storeroom; for the proper preparation and cooking 
of the food; and for having the meals ready at the prescribed hours. He should 
pay particular attention to all articles of food that have been cooked in excess 
of actual requirements and see that they are recovered and properly preserved 
for future use. He should keep the commissary steward informed as to the 
amounts of such articles, so that the menu may be arranged to include them. 
The chief cook supervises the work of all cooks, bakers, and mess attendants 
connected with the main kitchen of the hospital. He supervises the mess at- 
tendant who acts in the capacity of yardman. 
First cooks.—First cooks, under supervision in large hospital kitchens, pre- 
pare and cook food, or in a smaller hospital have entire supervision of the 
kitchen and bakery service; requisition food and kitchen supplies; supervise 
employees assisting in the preparation of food and in cleaning the kitchen, 
accessory rooms, and equipment; and perform related work as required. 
Second cooks.—Second cooks, under immediate supervision in a hospital 
kitchen, assist in the preparation and cooking of the food; direct and work 
-with other employees engaged in the care and preparation of food for cooking; 
assist in cleaning the kitchen, accessory rooms, and equipment; serve the cooked 
food from the kitchen; and perform such related work as may be required. 680 
HOSPITAL CORPS HANDBOOK. 
Bakers.—Bakers, under general supervision, make bread, cakes, and pastry; 
work with and direct employees engaged in baking; clean and care for the 
bakery and its equipment; requisition and account for bakery supplies; and 
perform such related work as may be required. 
Mess hall masters-at-arms.—The mess hall masters-at-arms (usually pharma- 
cist’s mates) are responsible for the maintenance of discipline in their respec- 
tive mess halls during meal hours; direct patients, hospital corpsmen, civilian 
employees and others to the proper mess halls; receive complaints and report 
the same to the commissary officer; assist the storeroom keepers in the han- 
dling, stowage, or issuance of provisions; and perform such other special or 
routine work as may be assigned them. 
Chief mess attendants.—Chief mess attendants, under supervision, direct and 
supervise employees, or patients, engaged in serving food in mess halls, dormi- 
tories, and wards, or in ordinary culinary work in connection with the serving 
of food. They are responsible for the appearance and cleanliness of the mess 
halls, their equipment, and furnishings. They perform such additional related 
work as may be required. 
Mess attendants.—Mess attendants, under immediate supervision, perform 
ordinary culinary work in a kitchen, pantry, or mess hall, such as washing and 
drying dishes, cleaning and polishing metal utensils, cutlery, and silverware; 
scrubbing floors; washing walls, windows and woodwork; assisting in the 
preparation of vegetables and other food for cooking; serving meals in mess 
halls, dormitories, and wards; cleaning mess halls and equipment; act as yard- 
men out of doors in the rear of the kitchen and as such keep the garbage cans 
and rear of the kitchen in a clean and sanitary condition; and perform re- 
lated work as may be required. 
Meat cutter.—The meat cutter, under supervision, cuts up and prepares meats, 
fish, and poultry for cooking; works with and directs other employees engaged 
in meat cutting; requisitions, inspects, stores, and issues such supplies as may 
be required; cleans and keeps in a sanitary condition and is held responsible 
for the meat room, tools, refrigerators, and other equipment; and performs 
related work as required. 
Pantrymen.—The pantrymen are civilian employees who work in the same 
capacity and perform the same duties as the storekeepers, before mentioned, 
whenever for any reason hospital corpsmen are not detailed for this duty. 
THE COMMISSARY DEPARTMENT IN NAVY BASE HOSPITALS.3 
As has been seen in the description of Navy base hospitals on page 611, the 
personnel of the commissary department consists of enlisted men under the 
supervision of the commissary officer. For a 500-bed Navy base hospital the 
organization in general may be as follows. 
The commissary officer is a chief pharmacist or pharmacist and his duties 
are in effect the same as in a naval hospital. The commissary clerk, usually a 
pharmacist’s mate, has duties similar to those previously shown as being per- 
formed by him. 
Directly under the supervision of the commissary officer is the chief com- 
missary steward who is responsible for the assignment of the other personnel 
to their respective duties, the arrangement of watch and liberty lists, the prepa- 
ration and service of food, the cleanliness and upkeep of all galley, balieshop, 
and mess equipment and the maintenance of stocks of dry and fresh provisions 
as well as their procurement. 
3 Prepared by Chief Pharmacist N. L. Saunders, United States Navy. COMMISSARY DEPARTMENT, NAVAL HOSPITALS. 
681 
A ship’s cook, first class, is assigned duty as chief cook. In addition to being 
in actual charge of the galley and bakesliop, his duties are very similar to those 
of a chief cook as previously described in this chapter. 
The duties of the butcher, usually a ship’s cook, second class, are the same 
as those given for the meat cutter. 
The commissary steward, chief cook, and butcher are on duty every day, but 
the remaining ship’s cooks and the mess attendants are divided into watches. 
The watch for cooks begins at 1 p. m. on alternate days and in each watch 
are one ship’s cook, first class, who is in charge of the watch, two ship’s cooks, 
second class, known as the meat and vegetable cooks, and charged with the 
preparation of those items of the menu, and two ship’s cooks, third class, 
who assist the other cooks in the preparation of food and perform such other 
duties as may be assigned them. Each watcli is responsible for the cleanli- 
ness of the galley and adjoining rooms, and the general duties of the members 
of the watch may be considered to be as described above. 
The bakers, one baker, first class, and one baker, second class, are in charge 
of the bake shop, if there be one. and their duties in general have been de- 
scribed before. They are not assigned to watches, as the nature of their 
duties usually requires them to be present on duty every day. 
Mess attendants are divided into watches for purposes of liberty only, 
their duties, which are the same as shown before in this chapter, requir- 
ing them to be present for every meal, and it being desirable to have some 
always available for the emergent serving of food. 
Owing to the character of duty performed by a Navy base hospital, the 
possible necessity and desire of officer personnel to maintain individual messes, 
the greater ease with which supply officers often can obtain supplies, and 
the authority of supply officers to sell to officers’ messes, it may be desirable 
to depart somewhat from the usual method of conducting the accounting 
system for commissary stores and equipment. A system similar to the one 
shown below, but necessarily dependent upon local conditions, may be used 
satisfactorily. 
The supply officer purchases and accounts for all provisions, and equip- 
ment other than the initial outfit, obtained in emergency. The commissary 
ledger is used for a record of all receipts and expenditures of provisions, 
and books are opened for keeping a record of sales of provisions to messes 
and the receipt of new equipment not received on medical department requi- 
sitions. The ration memorandum is kept as directed in the Manual of the 
Medical Department, but the receipt and expenditure voucher may not be 
used, or, if used, should contain under expenditures only those items actually 
used hy the hospital. 
On the last calendar day of the month an inventory of all stores on hand 
is taken and should show both the quantity and value of each item thereon. 
The sales to messes are totaled and added to the inventory and the sum of 
both substracted from the total quantity and value of the inventory for the 
preceding month plus the receipts during the current month. The answers 
obtained by this subtraction are the quantity and value of the provisions 
actually used by the hospital. 
The supply officer then prepares an itemized expenditure invoice (S. & 
A. Form No. 71) covering these items of provisions, and the commanding officer 
acknowledges their receipt thereon. Equipment purchased by the supply 
officer is transferred to the medical department in a similar manner. 
It is not expected that purchase of equipment by the supply officer will 
be made when it is possible to prepare requisitions for the same in the regular 
manner. INDEX 
Page. 
Abbreviations on prescriptions 404 
Abdomen: 
Acute conditions of 93 
Wounds of 71 
Abdominal massage 195 
Abducens nerves 47 
Abduction, joint 15 
Ablution 206 
Abscess: 
Inguinal glands (venereal) 345 
Treatment of 58 
Absorption, in digestion 32 
Acacia (gum arabic) 462 
Accessories, X-ray 551 
Accommodation 51 
Astigmatism 51 
Defects of 51 
Hypermetropia 51 
Myopia 51 
Presbyopia 51 
Accounting: 
Medical department 634 
Property officer 634 
Stock keeping and 674 
Accounting system: 
Expense analysis statement 636 
Journal 636 
Ledgers 636,637 
Registers 636 
Acetanilid 448 
Acetphenetidin 449 
Acetylsalicylic acid 450 
Acid-s 402 
Acetic, glacial 449 
Acetylsalicylic 450 
Boric 417 
Carbolic (phenol) 446 
Citric 449 
Hydrochloric 415 
Hydrogen 368 
Inorganic 415 
Table of 381 
Mineral 415 
Molecule of 368 
Nitric 416 
Organic, and their esters 449 
Oxy— 
Table of 381 
Phenylcinclioninic 451 
Phosphorous 371 
Picric 447 
Salicylic 450 
Strength of 368 
Sulphuric 416 
Aromatic 417 
Tannic 450 
Tartaric 451 
Ternary, table of 381 
47829°—23 44 
Page. 
Acidimetry and alkalimetry: 
Alkali 377 
Indicator 377 
Titration 377,378 
V olumetric solutions 377 
Aconite 474 
Poisoning by 491 
Tincture of 474 
Addiction, drug 483 
Detection of 485 
Diagnosis 486 
Symptoms of A 485 
Treatment for 487 
Addicts, drug: 
Classes of 485 
Number of 484 
Addison’s disease 38 
Addresses, bureaus or offices 621 
Adduction, joint 15 
Adeps (lard) 460 
Adhesion, definition of 356 
Adhesive plaster 171 
Administration of medicines 410 
By inhalation 411 
By inunction 411 
By mouth 411 
By rectum ’ 411 
Hypodermoclysis 411 
Intramuscularly 411 
Intravascularly 411 
Modes of 411 
Rules for 411 
Subcutaneously 411 
Administration of naval hospitals 608 
Adulteration, food 671 
Aedes mosquito 519 
Aeration of blood 32 
ASrobes 503 
Aerobic bacteria 65 
Aeronautics, Bureau of 590 
Agar, medium 502 
Agglutinins 507,509,510 
Aid stations, expeditionary force 541 
Air: 
Atmospheric pressure 277 
Carbon dioxide in 276 
Chemical constituents of 276 
Composition of 275 
Microorganisms in 278 
Nitrogen in 276 
Physical properties of 276 
Poisonous gases in 278 
Relation to health 275 
Albumin, presence in urine 523 
Alcohol-s: 
Definition of 442 
Dehydrated 443 
Dilute 443 
Ethyl, poisoning by 492 
683 684 
INDEX 
Anaesthesia—Continued. Page. 
Respiration of patient in 181 
Specialists in 179 
Spinal 191 
Stovaine 192 
Table for anaesthetist 182 
Treatment of emergencies in 188 
Tropococaine .. 192 
Anaesthetic-s 407 
Agents 182 
Administration of 178 
Chloroform 185 
Combinations of 187 
Ether 183 
Ethyl chloride 187 
Nitrous oxide 187 
Drug addiction 483 
Local 190 
Anaesthetist: 
Equipment for 181 
Responsibilities of 179 
Anaesthetizing room, equipment of 165 
Analgesia (See Anaesthesia). 
Analgesics 407,477 
Local 477 
Analysis: 
Blood 521 
Chemical 354 
Water 288 
Anaphrodisiacs 407 
Anaphylactic shock 508,509 
Anaphylaxis 508 
Anatomy: 
Comparative 5 
Definition of 5 
Microscopical 5 
Anhydrotics .' 407 
Ankle bones 14 
Annual contract, Bureau of Yardsand Docks. 633 
Anode terminals 545 
Anodynes 407 
Local 477 
Anopheles mosquito 519 
Antacids 407,478 
Anthelmintics 407,479 
Antibodies 507 
Antidotes 407,491 
Antiemetics 407 
Antigen: 
Procuring of 633 
Antimony: 
And potassium tartrate 433 
Compounds of 433 
Antiperiodics 407 
Antiphlogistics 407 
Antipyretics 407 
Antipyrine 448 
Antiseptic-s 167,408,477,478,482 
Dressing 66 
Antisialics 408 
Antispasmodics 408 
Antisyphilitics 408 
Antitoxins 507 
Aorta 26 
Arch of 26 
Ascending 26 
Descending 26 
Alcohol-s—Continued. Page. 
For sterilization 169 
Glycerin 443 
Methyl 443 
Poisoning by 492 
Procuring of 633 
U. S. P 442 
Alcoholism, unconsciousness caused by 92 
Aldehydes: 
Definition of 443 
Formaldehyde, solution of. 444 
Hydrated chloral 444 
Alexin, blood 510 
Alimentary tract 39 
Alimentation, duodenal 229 
Alkali-es 402,417 
Chemical action of 377 
Elements 374 
Alkaline earths 374,427 
Alkaloidal: 1 
Drugs 467 
Salts 467 
Alkaloids 402,467 
Allotropic modifications 374 
Aloes 464 
Alteratives 407 
Alum 430 
Aluminium: 
Alum 430 
Cataplasm of kaolin 431 
Compounds of 430 
Amboceptor-s 510 
Paper, procuring of 633 
Ambulance company, regimental medical 
detachment 542 
Ambulance party 533 
Ammonia: 
Aromatic spirit of 427 
Water 396 
Stronger 426 
Ammoniated mercury 437 
Ammonium 380 
Carbonate 427 
Chloride 426 
Ammunition depots 596 
Amorphous 374 
Amyl nitrite 451 
Amylopsin 37 
Anaemia, diet in 230 
Anaerobes 503 
Anaerobic bacteria 65 
Anaesthesia: 
Agents used in 182 
Care of patients 174,179 
Afteroperation 188 
Cocaine 190 
Definition of term 178 
Equipment for administering 181 
Eucaine 190 
General 178,180 
Administration of 183 
Local 178,190 
Preparation of patient 191 
Novocaine 190,191,192 
Preparation of patient 180 
Procaine 190 
Quinine and urea hydrochloride 190,191 INDEX 
685 
Aorta—Continued. Page. 
Description of 26 
Thoracic *26 
Aperient-s : 408 
Aphrodisiacs 408 
Apncea 32 
Apomorphine hydrochloride 470 
Apoplexy 92 
Appendicitis, acute • 94 
Appointment: 
Dental officers 607 
Medical officers , 607 
Nurses 607 
Of chief pharmacists 608 
O f pharmacists 60S 
Appropriations, annual: 
Bringing home remains of officers, etc 603 
Care of Hospital Patients 603 
Contingent, Bureau of Medicine and 
Surgery 602 
Medical Department 602 
Naval Hospital Fund 603 
Numbers of 604 
Salaries, Navy Department 603 
Aqueous humor 50 
Arachnoids 517 
Arithmetic, pharmaceutical 388 
Aromatic-s 408 
Bitters 408 
Sulphuric acid 417 
Arsphenamine 432 
Treatment of syphilis 336 
Arsenic: 
Arsphenamine 432 
Compounds of 432 
Neoarsphcnamine 432 
Neosalvarsan 432 
Poisoning by 492 
Potassium arsenite, solution of 432 
Salvarsan 432 
Arterial: 
Bleeding from lips 63 
Haemorrhage 61 
Arm, forearm, or hand 63 
Armpit 63 
Face 63 
Neck 63 
Thigh, leg, or foot 63 
Artery-ies: 
Aorta 26 
Coeliae axis 27 
Common carotid 26 
Common iliac 28 
Coronary 26 
Description of 24 
External carotid 26 
Inferior mesenteric 27 
Inferior phrenic 27 
Innominate 26 
Internal carotid 26 
Lumbar 28 
Middle sacral 28 
Parietal group 27 
Spermatic 27 
Subclavian 26 
Superior mesenteric 27 
Suprarenal 27 
Artery-ies—Continued. Page. 
Ulnar 26 
Visceral group 27 
Arthology, definition of 6 
Arthropoda 517 
Artificial respiration 89 
Ascaris lumbricoides 515 
Asepsis in operating room 166 
Aseptic dressing 66 
Asiphonate mosquito 519 
Asphyxia 32,88 
Aspirin 450 
Assistant Secretary of the Navy 583 
Astigmatism 51 
Astringents 408.477,482 
Atmospheric pressure, effects of 277,278 
Atomic: 
Weight 356 
Weights, table of 379 
Atoms 355 
Atropine, poisoning by 492 
Atropine sulphate 471 
Auditory nerves 47 
Autoclave • 168 
Autocondensation 221 
Autogenous vaccines 510 
Autotransformer, X-ray 547 
Autopsy 570 
Avogadro,law of 375 
Axones 43 
Bacilli 503 
Bacillus: 
Aerogenescapsulatus 167 
Anthracis 167 
Coli communis 167 
Mallei 167 
Tetani 167 
Tuberculosis 167 
Bacteria: 
Aerobes 503 
Anaerobes 503 
Bacilli 503 
Cocci 503 
Nonpathogenic 503 
Pathogenic 503 
Pneumococcus 167 
Pyogenic 167 
Spirilla* 503 
Staphylococcus 167 
Streptococcus 167 
Bacterial: 
Cultures, emulsions, procuring of 633 
Vaccines 510 
Bacteriology 501 
Definition of 383 
Stains used in 503 
Bacteriolysins 507 
Bacon as food 227 
Balance-s 386 
Compound lever 387 
Double beam 387 
Single beam 386 
Torsion 387 
Balanitis 331 
Balantidium coli 512 
Balsam-s 457 
Of Peru 458 686 
INDEX, 
Bandage-s 98 
Application of 101 
Barton 106 
Circular 101 
Complete, of hand 103 
Demigauntlet 103 
Double “T” 108 
Extremity 100 
Eye 107 
Figure of eight., 102,103 
Foot 105 
Gauntlet 103 
Lower extremity 104 
Many-tailed 108 
Materials used for 99 
Oblique 101 
Plaster of Paris 108 
Recurrent 101 
Recurrent of head 106 
Roller 99 
Removal 100 
Sayre dressing 107 
Spicaoffoot 104 
Spica of groin 104 
Spica of right shoulder 104 
Spiral 101 
Spiral re verse 102 
Starched 109 
“T” 108 
Triangular 109 
Types of 99 
Usein surgery 171 
Velpeau 105 
Bandaging.. 98 
General rules for 99 
Barium 427 
Dioxide 429 
Barton bandage 106 
Base-s: 
Chemical 371 
Hospital, commissary department— 
Organization of 680 
Personnel of 680 
Metals 374 
Basic salts 371 
Basophiles 21 
Bath-s: 
Bed, preparation for 157 
Bicarbonate of soda 160 
Bran 160 
Brand 207 
Classes of. 157 
Cleansing 157 
Cold 158 
Application of 158 
Friction 207 
Collapse during 158 
Electric light 214 
Foot 159 
Hammock or continuous 209 
Hot 159 
Medicated 160 
Method of giving 160 
Operative cases 149 
Salt glow 160 
Sheet 206 
Sitz 160 
Bath-s—Continued. 
Starch.' 160 
Sulphur 160 
Temperature of 157 
Towel 206 
Tub 158 
Uses of 157 
Whirlpool 211 
Battalion, ship’s 533 
Bed-s: 
Ether 135 
Fracture 135 
Making 134 
Wards 117,120 
Bedbugs, elimination of 274 
Beef: 
As food 227 
Cuts of 663 
Belladonna: 
Leaves 472 
Extract of 472 
Ointment 402 
Plaster 471 
Poisoning by 492 
Benedict’s test 523 
Benzoin, compound tincture of 458 
Benzyl: 
Benzoate 452 
Bromide gas 557 
Benzylis benzoas 452 
Beriberi 285 
Bichloride of mercury 435 
Disinfectant 267 
Poisoning by 493 
Sterilization by 169 
Bier’s cup 132 
Bile: 
Description of 35 
Duct 35 
Binary compounds 361 
Bismark brown stain 503 
Bismuth: 
Subgallate 433 
Subnitrate 433 
Bitters 478 
Aromatic 408 
Simple 408 
Bladder irrigation 153 
Blaud’s pills 432 
Bleeding from scalp 63 
Blisters 132 
Blood: 
Aeration of 32 
Analysis 521 
Cells 20 
Basophiles 21 
Eosinophiles 21 
Leucocytes 20 
Neutrophiles 21 
Polymorphonuclear leucocytes 21 
Chemistry and urinalysis 521 
Circulation of 25 
Coagulation 22 
Complement 510 
Composition of 19 
Corpuscles, white 20 INDEX 
687 
Blood—Continued. Page. 
Count: 
Complete 505 
Differential 505 
Method of making 505 
Cultures 506 
Description of 19 
Fibrinogen 21 
Functions of 19,521 
Haemoglobin 20 
Haemolysis 22 
Lymph, definition of 22 
Lymphocytes 20 
Method of procuring specimen 521 
Paraglobulin 21 
Phagocytosis 20 
Plasma 21 
Platelets 21 
Pressure 25 
Prothrombin 22 
Pulse pressure 26 
Red cells 20 
Sero-albumin 21 
Stain, procuring of 633 
Thrombin 22 
Vascular system, organs of 23 
Work: 
Blood count 505 
Cultures 506 
Smears 504 
Syphilis, detection of (Wassermann 
reaction) 506 
Blue mass 434 
Boil or furuncle 58 
Bone-s: 
Acetabulum 13 
Calcaneus 13,14 
Classification of 8 
Clavicle 11 
Condyle 8 
Coronoid process 12 
Cranium 9 
Crest 8 
Cuboid 13 
Cuneiform 13 
Definition of 6 
Development of 7 
Ethmoid 9 
Femur (thigh bone) 13 
Fibula (calf bone) 14 
Frontal 9 
Head 8 
Hip bone 13 
Humerus 11 
Hyoid 8 
Ilium 13 
Incus 9 
Ischium 13 
Lachrymal 9 
Malar 9 
Malleus 9 
Mandible 9 
Marrow 6 
Metacarpal 12 
Metatarsal 14 
Nasal 9 
Navicular 13 
Bone-s—Continued. Page. 
Occipital 9 
Of hand 12 
Head 9 
Lower extremity 13 
Sternum 10 
Thorax 10 
Trunk 10 
Upper extremity 11 
Olecranon process 12 
Os coxae (hip hone) 13 
Ossa carpi 12 
Palates 9 
Parietal 9 
Patella (knee cap) 14 
Pelvis 13 
Periosteum 7 
Phalanges 12 
Process, defined 8 
Pubic 13 
Radius 12 
Ribs 10 
Scapula 11 
Sphenoid 9 
Spine 8 
Stapes 9 
Styloid process 12 
Symphysis pubis 13 
Talus 14 
Tarsal 14 
Temporal 9 
Tibia (shin bone) 14 
Tubercle 8 
Tuberosity 8 
Turbinates 9 
Ulna 12 
Vertebra} 10 
Vomer 9 
Zygomatic 9 
Borax, use in cold cream 402 
Boric acid 417 
Solution 169 
Borrelia recurrentis 512 
duttoni 512 
Botany, definition of 383 
Bottles and vials, for mailing, procuring of.. 633 
Bowels, care of 296 
Boyle’s law 376 
Brain: 
Arachnoid, the 45 
Cerebellum 45 
Cerebrum 45 
Compression of 92 
Concussion of 91 
Description of 44 
Divisions of 45 
Dura mater 44 
Fissures 46 
Medulla oblongata 46 
Pia mater 44 
PonsVarollii 45 
Brand bath 207 
B right ’sdisease 92 
Bringing home remains of officers, etc., ap- 
propriation 603 
Brittleness, definition of 355 
Bromine 411 688 
INDEX, 
Page. 
Brom-benzyl cyanide gas 557,559 
Bronchi 30 
Bronchitis, acute 143 
Brown mixture 462 
Bruise 71 
Buccal cavity 32 
Buchu, fluidextract of 456 
Bureau-s, Navy Department 583 
Of Aeronautics 590 
Construction and Repair 587 
-Engineering 588 
Medicine and Surgery 588 
Appropriations, annual :.. 601 
Chiefs of 600 
Dispensary, Naval 607 
Divisions of 605 
Dutiesof 588,589,600 
Finances of 601 
History of 59S 
Naval hospitals 601 
Organization of. 604 
School, Naval Medical 607 
Surgeons general 600 
Navigation 585 
Ordnance 587 
Supplies and Accounts 589 
Yards and Docks 586 
Bums and scalds 84 
Treatment of 85 
Caffeine sodio-benzoate 476 
Caffeine, citrated 476 
Caisson disease 277 
Calcination 390 
Calcium 427 
In foods. 226 
Oxide 428 
Caloric values 654 
Calorie: 
Definition of. 225 
Camp: 
Site, selection of. 323 
Waste- 
Disposal of 313 
Horse litter 317 
Liquid 316 
Water supply in 290 
Camphor 454 
Liniment 397 
Camphorated tincture of opium 469 
Canaliculi 49 
Canning of food 673 
Canteens, care of. 313 
Cantharidal collodion 467 
Cantharides 467 
Capillaries, description of 24 
Capsicum: 
Plaster 456 
Tincture of 456 
Carbolic acid 446 
Disinfectant : 267 
Poisoning by 495 
Sterilization by 169 
Carbonate radicle. 369 
Page. 
Carbohydrates 223 
Disaccharides 224 
Monosaccharides 224 
Polysaccharides 224 
Carbol fuchsin stain 503 
Carbon dioxide, in air 276 
Carbon monoxide gas 1 557,562 
Carbonization 390 
Carbuncle 58 
Cardamom, compound tincture of 453 
Cardiac: 
Depressants 408 
Stimulants 408 
Care and cleaning of wards 118 
Care of hospital patients, appropriation 603 
Carminatives 408,478 
Carrier, communicable disease 238 
Cascara sagrada, extract of 465 
Aromatic fluidextract of 465 
Cassette, X-ray 551 
Castor oil 459 
Cataplasm of kaolin 431 
Cathartics 408 
Aperients 408 
Cholagogues 408 
Hydrogogues 408 
Laxatives 408 
Purgatives— 
Drastic 408 
Saline 408 
Simple 408 
Catheterization 153 
Cathode terminals 545 
Caustic alkalies, poisoning by 493 
Caustics 408,477 
Cell-s: 
Blood 20 
Columnar 6 
Chromatin 5 
Cytoplasm 5 
Definition of 5 
Epithelial 6 
Neuro-epithelial 6 
Nucleus 5 
Protoplasm 5 
Specialized 6 
Squamous 6 
Cementum 110 
Centigrade scale 390 
Cerates 400 
Cereals as food. 228 
Cerebellum 45 
Cerebral: 
Depressants 408 
Excitants 408 
Nerves 47 
Cerebrospinal: 
Fever 240 
Nervous system 43 
Cerebrum .45 
Cestodes 513 
Chalk, prepared 429 
Chancre: 
Extragenital . 334 
Genital 334 INDEX 
689 
Page. 
Chancroid 257 
Abscess, inguinal glands 345 
Appearance of 343 
Infection by 343 
Treatment of 344 
Characteristics of: 
Perspiration 39 
Urine 39 
Charles’ law 376 
Chart, clinical 123 
Chemical: 
Affinity, definition of 356 
Change 353 
Compound 353,354 
Formulas 357 
Incompatibility 405 
Notation 357 
Preparations 395 
Preservatives of food 673 
Solution 392 
Sterilization 169 
Symbols 357 
Warfare 554 
Chlorine gas 555 
Cloud or drift gas 555 
Direct poisons of nervous system.. 557,562 
Explosion gases 557,562 
Gases, poisonous 557 
Lachrymatory gases (tear gases)... 557,559 
Lung irritants 567 
Medical aspects of 557 
Phosgene 557 
Poison gas, used in World War 555 
Poison gas, use of 554 
Sternutatory gases (sneeze gases)... 557,559 
Vesicant gases 557,560 
Chemistry 353 
Acid-s.. 367,402 
Phosphorous, graphic formula of 370 
Sulphuric, graphic formula of 370 
Table of 381 
Acidimetry and alkalimetry 377 
Adhesion 356 
Analysis 354 
Atomic weight 356 
Atoms 355 
Bases 371 
Blood 521 
Brittleness 355 
Cohesion 355,356 
Compounds 354 
Binary 361 
Naming of 360 
Ternary 361 
Definition of 354 
Ductility 355 
Elements : 354 
Acid forming 369 
Table of 379 
Energy 355 
Force 355 
Hardness 355 
Hydroxyl 380 
Laws and theories 375 
Law of constant proportions 354 
Malleability 355 
Page. 
Chemistry—Continued. 
Mass 355 
Matter, definition of 354 
Molecular weight 357 
Molecules 355 
Newton’s law 355 
N omenclature 360 
Polyvalence 359 
Salts 371,381 
Synthesis 354 
Tenacity 355 
Valence.... 358 
Weights, atomic, table of 379 
Chicken pox 141,261 
Chief pharmacists, appointment of 608 
Chief of Naval Operations, duties of 583 
Chief warrant officers 592 
Chiefs of Bureau of Medicine and Surgery 600 
Chilblain 86 
Chills 98 
Chloramine-T 412 
Chlorazene 412 
Chlorinated lime 412 
Disinfectant 268 
Chlorination of water 291,313 
Chlorine: 
Gas 555 
Poisoning by 557 
Chloroform 441 
Administration of 186 
Liniment 398 
Physiological action 186 
Use as anaesthetic 182,185 
Chlorpicrine, poisoning by 557 
Choking, treatment for 90 
Cholagogues 408 
Cholera 250 
Choroid 50 
Chromatin 5 
Chyme 36 
Cilia 6 
Ciliary process 50 
Cinchona: 
Compound tincture of 470 
Red 470 
Circulating fluids 19 
Circulation: 
Drugs affecting 479 
Of blood 25 
Pulmonary 25 
Systemic 25 
Circulatory system, general 25 
Circumduction, joint 15 
Citric acid 449 
Civil employees, naval hospitals 582 
Commissary department: 
Ratings 650 
Pay 650 
Clarification 393 
Clavicle 11 
Fracture of 81 
Cleanliness, wards 118 
Clerical: 
Force, organization of 622 
Work, medical department 614 690 
INDEX 
Page. 
Clinical: 
Chart 123 
Notes 125 
Thermometer 120 
Clothing: 
Cotton 297 
Fur 297 
Infected 298 
Leather 297 
Linen 298 
Paper 298 
Silk 297 
Wool 297 
Clotting of blood 22 
Coagulation of blood 22 
Coca leaves, restriction in use 483 
Cocaine: 
Anaesthetic 190 
Hydrochloride 475 
Overdosage 191 
Poisoning by 191,493 
Solutions 190 
Sterilization of 190 
Use by drug addicts 484 
Cocci 503 
Cochlea 51 
Cockroaches, elimination of 274 
Cocoa 475 
Butter 401,460 
Cod liver oil 460 
Codeine 469 
Sulphate 470 
Cceliac axis 27 
Cohesion, definition of 355,356 
Colation ' 392 
Cold-s 97 
Applications 132 
Compresses 133 
Cream, preparation of 402 
Pack 158 
Colic: 
Gall-stone 95 
Kidney-stone 95 
Collecting stations, regimental medical de- 
tachment 542 
Code’s fracture 81 
Collodions 396 
Colloidal silver., 438 
Colloids 395 
Columnar cells 6 
Colocynth, extract of 464 
Commensalism 511 
Comminution 391 
Commissary: 
Department, naval hospitals— 
Accounting and stock keeping 674 
Bakers 680 
Base hospital 680 
Bills, monthly payment of 676 
Caloric values 654 
Chief cook 679 
Civilian employees 650 
Clerk, duties of 679 
Cuts of meats 662 
First cooks 679 
Page. 
Commissary—Continued. 
D epartment—C ontinued. 
Food: 
Colors of 654 
Inspection 667 
Kitchens 652 
Masters-at-arms, mess hall 680 
Meat cutter 680 
Mdnus 653 
Table of foods found on 655 
Mess attendant-s 680 
Chief 680 
Mess halls 652 
Organization 651 
Pantrymen 680 
Personnel 678 
Duties of 678 
Provisions: 
How procured 666 
Issue of 673 
Second cooks 679 
Storerooms 651 
Storeroom keepers 679 
Files 677 
Ledger 637,675 
Officer 650 
Duties of 678 
Steward, duties of 678 
Commissioned: 
Officers 592 
Warrant officers 592 
Common iliac artery 28 
Communicable disease-s 139 
Carrier 238 
Cleaning 238 
Contact 238 
Means of transmission 238 
Modes of transmission 237 
On independent duty, examination for.. 531 
Prevention and control of 237,265 
Source of infection 237 
Communication office 584 
Comparative anatomy, definition of 5 
Complement-s: 
Blood 510 
Hospital Corps 609 
Of naval hospitals 608 
Compound-s: 
Binary 361 
Chemical 354 
Dislocation 75 
Ternary 361 
Compound tincture of cinchona 470 
Compression of the brain 92 
Concurrent disinfection 238 
Concussion of the brain 91 
Condiments in foods 226 
Conduct of hospital corpsmen 563 
Cone method administration of ether 185 
Constipation, diet in 230 
Constitutional treatment, haemorrhage 63 
Construction and Repair, Bureau of 587 
Contingent, Bureau of Medicine and Surgery, 
appropriation 602 
Contracts, provisions, schedule of 666 IKDEX, 
691 
Page. 
Contusion 71 
Convulsions 97 
Cooking of meat 227 
Coolidge tubes 545 
Copper: 
Blue vitriol, cupric sulphate 439 
Compounds of 439 
Sulphate 439 
Sterilization of water by 290 
Cornea 50 
Cornstarch 461 
Corpuscles, white 20 
Correctives 408 
Correspondence, Medical Department 614 
Corrosive-s 477 
Mercuric chloride 435 
Poisoning by 498 
Poisons 489,490 
Cortex of suprarenals, fimction of 38 
Cottonseed oil 459 
Counterirritants 130 
Cowling’s rule 410 
Cranial nerves 47 
Abducens 47 
Auditory 47 
Facial 47 
Glossopharyngeal 47 
Hypoglossal 47 
Oculomotor 47 
Olfactory 47 
Optic .' 47 
Pneumogastric 47 
Spinal accessory 47 
Trigeminal 47 
Trochlear 47 
Cranium 9 
Cresol 447 
Creosote 448 
Carbonate 448 
Crystallization: 
Colloids 395 
Crystalloids 395 
Definition of 394 
Dialysis 394 
Interstitial water 394 
Osmosis 394 
Water of 394 
Crystals 393,394 
Culex mosquito 519 
Culicidse 518 
Culture media 502 
Agar .502 
Loffler’s 502 
Procuring of 633 
Simple nutrient broth 502 
Sterilization of. 503 
Cupping 132 
Current: 
Constant galvanic 218 
D’Arsonval 221 
Faradic 219 
High frequency— 
Method of application 221 
Method of producing 220 
Induced 546 
Page. 
Current—Continued. 
Interrupted galvanic 219 
Primary 546 
Secondary 546 
Sinusoidal 219 
Cutaneous membrane 19 
Cuticle 40 
Cuts of meats: 
Beef. 663 
Lamb 664 
Mutton 664 
Pork 665 
Veal 664 
Cyanogen 380 
Cytolysins 507 
Cytoplasm 5 
Daily routine duties, wards 117 
Dakin’s solution . 169 
Dalton’s law 375 
Dark room, X-ray 550 
D’Arsonval current 221 
Dead: 
Autopsy 570 
Care of the 568 
Deaths from unnatural causes 569 
Dental record, value of 570 
Finger prints of the 570 
Identification of the 570 
Postmortem examinations of the 570 
Preparation of body 569,573 
Death-s: 
Examination for 567 
Medicolegal matters 563 
Preparation of forms 644 
Signs of. 566 
Unnatural causes, conduct in 569 
Decantation 392 
Decoction 395 
Defaecation 32 
Deficiency diseases. (See Diseases.) 
Deflagration 390 
Deglutition 32 
Deliriants 408 
Delousing 238 
Demulcents 408,478 
Dendrites 43 
Dengue 254 
Dental: 
First aid no 
Hygiene 296 
Officers— 
Appointment of 607 
Hanks and grades of. 592 
Record, value of in deaths 570 
Dentine no 
Dentistry: 
Abscess, treatment for 112 
Extraction of tooth 113 
First aid 112 
Gum boils 113 
Infection and inflammation 112 
Temporary filling material 114 
Vincent’s angina . 114 
Deodorants 408 
Deodorizer 167 692 
INDEX, 
Page. 
Department of the Navy 583 
Assistant Secretary of the Navy 583 
Bureaus of 583 
Chief of Naval Operations 583 
Communication office 583 
Office of— 
Gunnery exercises and engineering 
performances 585 
Naval Intelligence 585 
Secretary of the Navy 583 
Departmental contracts 633 
Depressants 481 
Poisoning by , 490 
Derma 40 
Dermacentor andersoni 518 
Dermatol 433 
Deserter, return of, preparation of forms 645 
Desertion, preparation of forms 644 
Dessication 391 
Destroyer squadron medical officer, duties of. 530 
Diabetes, diet in 230 
Diacetylmorphine hydrochloride (Heroin)... 470 
Dialysis 394 
Diaphoretics 408,482 
Diarrhoea 97 
Diet in 230 
Diathermy, technique of giving 221 
Dichloramine-T 412 
Dicrotic pulse 123 
Diet-s: 
Anaemia 230 
Antiscorbutic 226 
Cardiac diseases 230 
Classification of 231 
Constipation 230 
Diabetes 230 
Diarrhoea 230 
Fevers 231 
Food, serving of 229 
Gastric ulcer 230 
Gout 230 
In diseases 229 
Karell 231 
Lenhartz 230 
Liquid.. 231 
Nephritis 230 
Obesity 231 
Planning of 226 
Postoperative cases 149 
Regular 232 
Sippy 230 
Soft 231 
Tuberculosis 231 
Dietetics. (See Food and Dietetics.) 
Differential blood count 505 
Digestants 408 
Digestion: 
Absorption 32 
Definition of 32 
Deglutition 32 
Disturbance of 286 
Enzymes 32 
Insalivation 32 
Mastication 32 
Peristalsis 32 
Pharmaceutical 395 
Page. 
Digestion—Continued. 
Process of 36 
Tanks, sewage disposal 293 
Dige'stive-s 478 
System 32 
Digitalis: 
Poisoning by 493 
Tincture of 463 
Dimorphous 374 
Diphenyl-chlorarsine gas 557,559 
Diphenyl-cyanarsine gas 557 
Diphtheria 144,241 
Disaccharides 224 
Discharge, preparation of forms 645 
Disease-s: 
Bacillary dysentery 142 
Beriberi 285 
Bronchitis, acute 143 
Care in handling 139 
Caisson 277 
Chicken pox 141 
Cholera 142 
Common eruptive 137 
Communicable 137,139 
On independent duty 527,531 
Diphtheria 144 
Endocarditis, acute 145 
Eruptive 139 
Erysipelas 143 
Food deficiency 285 
Influenza 144 
Malaria 142 
Measles 139 
Meningitis 145 
Miscellaneous 261 
Mumps 141 
N ephritis, acute 146 
Of lower animals which may be trans- 
mitted to man 260 
Pellagra 285 
Physical signs of 138 
Pneumonia 144 
Respiratory tract 143 
Rheumatic fever 146 
Rickets 285 
Scarlet fever 140 
Scurvy 285 
Septicaemia 143 
Small pox 140 
Suppurative tonsillitis 145 
Symptoms of 138 
Objective 138 
Subjective 138 
Tetanus 143 
Tonsillitis, follicular 145 
Transmitted by— 
Direct contact 257 
Discharges from intestinal tract 250 
Discharges from mouth and nose 240 
Insects and other arthropods 142,254 
Tuberculosis 144 
Typhoid fever 141 
Typhus 143 
Venereal 324 
Examination of crew 531 
Vincent’s angina 145 INDEX 
693 
Disease-s—Continued. Page. 
Water borne 137,141 
Xerophthalmia 285 
Yellow fever 142 
Disinfectant-s 408,477,479 
Bichloride of mercury 267 
Boiling 265 
Burning 265 
Carbolic acid 267 
Chemical solutions 267 
Chlorinated lime.... 268 
Formaldehyde 269 
Formalin 268 
Gaseous 268 
Hydrocyanic-acid gas 270 
Lime 268 
Phenol 267 
Physical 265 
Potassium mercuric iodide 267 
Pulmonary 480 
Steam 266 
Sulphur dioxide 268 
Sunlight 265 
Surgical use of 167 
Disinfection: 
Concurrent 238 
Terminal 239 
Dislocation 73 
Complicated 76 
Compound 75 
Elbow 75 
Finger joints 74 
Hip 75 
Jaw 74 
Knee 75 
Shoulder 74 
Treatment for 73 
Dispensary-ies: 
Marine Corps posts 540 
Naval 607 
Dispensatory, description of 384 
Dispensing 565 
Distillation 390 
Destructive 391 
Fractional 390 
Distilled water 287,414 
Diuretics 408,480 
Dosage 410 
Douche-s: 
And irrigations 161 
Ear 162 
Eye 162 
Hydrotherapy 211,212 
Circular 211 
Fan 211 
Jet 211 
Scottish or alternate .* 212 
Shower 211 
Pharyngeal 161 
Drains, surgical 171 
Dressing-s 1 66 
Antiseptic 66 
Aseptic 66 
Dry, sterile 66 
First-aid packet 66 
Kinds of 156 
Station, shore patrol .537 
Dressing-s—Continued. Page. 
Surgical. (See surgical dressings.) 
Wet 66 
Antiseptic 66,68 
Dried suprarenals 466 
Drug-s: 
Action, influenced by conditions 410 
Addiction 483 
Definition of 483 
Addicts— 
Classes of 485 
Number of 484 
Administration of. •. 410 
Affecting: 
Blood 410 
Circulation 479 
Heart 479 
Vessels 479 
Alkaloid al 467 
Anaesthetics 407,481,484 
Analgesics 407,477 
Anodynes 407,477 
Antacids 407,478 
Anthelmintics 407,479 
Antiemetics 407 
Antipyretics 407 
Antiseptics 167,408,477,478,482 
Antispasmodics 408 
Astringents 408,477,482 
Bitters 408,478 
Carminatives 408,478 
Caustics 408,477 
Cocaine, use by addicts 484 
Corrosives 477 
Demulcents 408,478 
Depressants 481 
Diaphoretics 408,482 
Digestants 408 
Digestives 478 
Disinfectants 408,477,479 
Diuretics 408,480 
Emetics 408,478 
Emollients 477 
Escharotics 408 
Expectorants 408 
Flavoring substances 478 
Habit, manner of acquiring 485 
Haemostatics 408 
Hypnotics 409,481 
Irritants 409,482 
Mydriatics 409,482 
Myoties 409,482 
Narcotics 409,481 
On supply table, classification of 477 
Opium, use by addicts 484 
Protectives 477 
Pulmonary: 
Disinfectants 480 
Sedatives 409 
Purgatives 409,479 
Soporifics 409.484 
Specifics 409 
Starchy and mucilaginous 461 
Stimulants 407,481 
Styptics 409,477 
Sudorifics 482 
Used by addicts 483 694 
INDEX 
Drug-s—Continued. Page. 
Vegetable, containing cathartic princi- 
ples 464 
Drying of food 673 
Ductility, definition of 355 
Ductless glands 38 
Ductue deferens (vas deferens) 42 
Duodenal: 
Alimentation 229 
Ulcer 95 
Duty-ies: 
Ambulance party— 
Equipment of 533 
Pack carrier 534 
Battalion of ship 535 
Bureau of Medicine and Surgery 588,589,600 
Concerning infectious and contagious 
diseases 527 
Expeditionary force 539 
Health records, care of 527 
Hospital corpsmen: 
Administrative and clerical 582 
Independent of medical officers 525 
Landing force 534 
Medical journal, independent duty.. 528 
Medicolegal matters 563 
Patients, care of 529 
Transfer of 528 
Personnel, naval hospital 581 
Property accountability 528 
Property, transfer of 528 
Recruiting 575 
Reports, preparation of 529 
Sanitary investigations 526 
Shore patrol 533,535 
Sick call) 527 
Stores, care of 528 
With ship’s landing force 533 
Dying declarations 566 
Dysentery: 
Amoebic 251 
Bacillary 251 
Dyspnoea 32 
Ear: 
Ache 98 
Cochlea 51 
Description of 51 
Douche 162 
Endolymph 51 
Middle 51 
Removal of foreign bodies from 87 
Earth-s: 
Alkaline 374 
Elements: 
Barium 427 
Calcium 427 
Magnesium 427 
Strontium 427 
Ectoparasites 511 
Effects, patients’- 564 
Effleurage 193 
Eggs: 
As food 227 
Coddled 233 
Poached 233 
Eggs—Continued. Page. 
Scrambled 234 
Soft cooked 233 
Elaterin 465 
Elbow, dislocation of 75 
Electric: 
Pads 133 
Shock 91 
Electrical properties of elements 361 
Electricity, characteristics of 361 
Electrocoagulation 221 
Electrode treatments: 
Non vacuum 221 
Vacuum 221 
Electrolysis 361 
Electrolytes 361 
Electrolytic dissociation 361,362 
Electrotherapy 218 
Autocondensation 221 
Diathermy, technique of giving 221 
Electrocoagulation 221 
Electrode treatments 221 
Elements 354 
Acid forming 369 
Alio tropic modifications 374 
Amorphous forms of 374 
Chemical formulas of. 357 
Chemical symbols of 363 
Classification of 373 
Crystalline form of 373 
Dimorphous forms of 374 
Direct combination 364 
Displacement 364 
Double decomposition 364 
Electrical properties of 361 
Electrolysis 361 
Electrolytic dissociation 361,362 
Equations 363 
Formulas, chemical, writing of 369 
General consideration of 372 
Halogen 411 
Ion 362 
Ionization 361 
Isomorphous forms of 374 
Metals 373,374 
Nonmetals 373 
Osmotic pressure 362 
Oxidation 375 
Oxidizing agents 375 
Polymorphous forms of 374 
Radicle-s 367,368 
Reactions 363 
Reversible.... 366 
Reducing agents 375 
Reduction 375 
Simple decomposition 364 
Substitution 364 
Table of 379 
Elixirs 396 
Elutriation 391 
Embalming 347 
Embryology, definition of 5 
Emetics 40S,478 
Emetine hydrochloride 475 
Emollients 477 INDEX 
695 
Page. 
Emulsions 396 
Enamel 110 
Endocarditis, acute 145 
Endocardium 23 
Endolymph 51 
Endoparasites 511 
Enemata 150 
Classes of 150 
Nutrient, method of administering 228 
Energy: 
Definition of 355 
Value of food 224 
Engineering, Bureau of. 588 
Enlisted personnel, ratings 593 
Enlistment, preparation of forms 647 
Entamoeba histolytica 511 
Enteroclysis 148,151 
Enzymes 32 
Action of 37 
Eosin stain 503 
Eosinophiles 21 
Epidermis 40 
Epididymitis 331 
Treatment of 331 
Epilepsy or fits 91 
Epitsaxis (nose bleed) 61 
Epithelial cells , 6 
Equations, chemical 363 
Equipment: 
Ledger 637 
Postmortem examinations 571 
Shore patrol 536 
Specimens, postmortem examinations... 573 
Erepsin 37 
Ergot, fluidextract of 476 
Eruptive diseases 139 
Erysipelas 143 
Erythema dose, X-ray 552 
Erythroblasts 7 
Escharotics 408 
Essential oils 403 
Esters of organic acids 449 
Etamoebacoli 511 
Ether: 
Administration of 185 
Bed 135 
Sulphuric 445 
Use as anaesthetic 182 
Ethers: 
Definition of 445 
Ethmoid bone 9 
Ethyl chloride 442 
Use as anaesthetic : 182,187 
Eucaine, use as anaesthetic 190 
Eucalyptol 454 
Examinations, dark field 506 
For treponema pallidum 506 
Eugenol 453 
Excitants, poisoning by 490 
Excretory organs: 
Alimentary tract 39 
Functions of 39 
Lungs 39 
Skin 39 
Urinary system 39 
Page. 
Executive officer, Naval Hospitals 580 
Exercise, effect on health 296 
Excretions 39 
Expectorants 40S 
E:. iitionary force duties 529 
Expe ' analysis register 636 
Expense ialysis statement 636 
Expedition ~y forces: 
Duties with 539 
First-aid man 541 
Force surgeon 540 
Medical department organization 540 
Regimental- 
Medical detachment 541 
Surgeon 540 
Explosion gases: 
Carbon monoxide 557,562 
Oxides of nitrogen 557,563 
Expression 395 
Exsiccation 391 
Extensibility, muscle 16 
Extension, joint 15 
Extract-s 400 
Belladonna leaves 472 
Cascara sagrada 465 
Colocynth 464 
Leptandra 464 
Extraction, drugs: 
Decoction 395 
Digestion 395 
Expression.. 395 
Infusion 395 
Maceration 395 
Menstruum. 395 
Percolation 395 
Eye: 
Aqueous humor 50 
Choroid 50 
Ciliary process 50 
Cornea 50 
Description of 50 
Douche 162 
Hyaloid membrane 50 
Iris 50 
Lens, crystalline 50 
Lids 49 
Muscles of 50 
Pupil 50 
Removal of foreign bodies from 87 
Retina 50 
Sclera 50 
Strain 283 
Vitreous body 50 
Wounds of 71 
Facial nerves 47 
Fahrenheit scale 390 
Faradic current 219 
Fasciolopsis buski 373 
Fats 459 
Source of 224 
Unsaponifiable 403 
Febrifuges 408 
Feeding: 
Special methods of 228 
Feet, care of 323 
Fehhng’s test 523 696 
INDEX 
Femur: Page. 
Description of 13 
Fracture of 82 
Ferric: 
Chloride, tincture of 431 
Citrochloride, tincture of 31 
Pyrophosphate, soluble 431 
Fever-s: 
Care of patient 96 
Definition of 52 
Diet in 231 
Fiber, nerve 43 
Fibrinogen 21 
Fibula, description of 14 
Field medical supply depot, regimental medi- 
cal detaenment 544 
Field sanitation 311 
Filament circuit, X-ray 548 
Filaria: 
Bancrofti 516 
Mosquito 519 
Files: 
Commissary 677 
Provision requisition 677 
Ration memoranda 678 
Stock card 678 
Filing system, Medical Department 623 
Filters, water. 290 
Filtration 393 
Water 290 
Finger-s: 
Bones of 12 
Fracture of 82 
Joints, dislocation of 74 
Prints, of dead 570 
First aid: 
Definition of. 57 
Dressing 66 
In dentistry 112 
Man, expeditionary force 541 
Packet 66 
First-aid treatment of: 
Abdomen, acute conditions of 93 
Abscess 58 
Apoplexy 92 
Appendicitis, acute 94 
Asphyxia 89 
Boil or furuncle 58 
Bright’s disease 93 
Bruise 72 
Carbuncle 58 
Chills 98 
Cold 97 
Compression of brain 92 
Concussion of brain 92 
Contusion 72 
Convulsions 97 
Diarrhoea 97 
Dislocation 73 
Earache 98 
Epilepsy or fits 91 
Fractures 77 
Gallstone colic 95 
Gastric or duodenal ulcer, perforated 95 
Haemorrhage 61 
Headache 97 
Heat exhaustion 84 
Heat stroke 84 
First-aid treatment of—Continued. Page. 
Hiccough 97 
Hysterical unconsciousness 92 
Inflammation , 57 
Intestinal obstruction, acute 94 
Kidney-stone colic 95 
Poisoning, acute abdominal symptoms.. 96 
Poisonous insect bites 70 
Removal of foreign bodies 86 
Shock 60 
Electric 91 
Snake bites 70 
Sore throat 98 
Sprain 72 
Strain 72 
Suffocation 89 
Unconsciousness 90 
Unconsciousness caused by alcoholism... 93 
Uraemia 93 
W ounds 65 
First aid and minor surgery 57 
Fish as food 227 
Fixation of complement 510 
Fixed oils and fats 403,459 
Flavoring substances 478 
Flavors in foods 226 
Fleas 520 
Destruction of 273 
Fleet, organization of 595 
Flexion, joint 15 
"Flies 520 
Fluidextract-s 397 
Buchu 456 
Cascara sagrada, aromatic 465 
Ergot 476 
Ipecac 475 
Ginger 454 
Hyoscyamus 473 
Rhubarb 465 
Wild cherry 456 
Fluorine 411 
Fluoroscopy 549 
Follicular tonsillitis 145 
Fomentations 210 
Food-s: 
Adulteration 671 
Amount 284 
And dietetics 222 
Animal 227 
Bacon 227 
Beef 227 
Beverages 226 
Calcium in 226 
Canning 673 
Carbohydrates 223 
Cereals 228 
Chemical preservatives 673 
Classification of 223 
Cold, preservation by 672 
Colors of 654 
Composition 285 
Condiments. 226 
Definition of 222 
Drying 673 
Eggs 227 
Energy value of 224 
Fats 224 
Fish 227 
Flavors 226 INDEX, 
697 
Food-s—Continued. . Page. 
Fruits 228 
Green vegetables 228 
Ham 227 
Inorganic 223 
Inspection 667 
Eggs 669 
Fish.... 670 
Meats 667 
Milk and cream 670 
Poultry, thawed out 669 
Shellfish 671 
Its relation to health and disease 283 
Lamb 227 
Legumes 228 
Meat 227 
Milk 227 
Mutton 227 
Nuts 228 
Organic 223 
Parasites, animal and plant in 284 
Phosphorus in 226 
Poisons 490 
Accidentally or purposely added 
to 284 
Natural 284 
Special 284 
Pork 227 
Poultry 227 
Preservation 672 
Preserving 673 
Proteins 223 
Metabolism of 223 
Requirements of individuals 225 
Roots and tubers 228 
Salting and pickling of 673 
Salts 223 
Serving of 229 
Smoking 673 
Toxins.. 284 
Veal 227 
Vegetable 228 
Viscera, animal 227 
Vitamines 226,285 
Foot: 
Bath 159 
Fracture of 83 
Foramen magnum 9 
Foramina 7,9 
Force, definition of 355 
Force surgeon, expeditionary 540 
Forearm, fracture of bones of 81 
Foreign bodies, removal of 86 
Foreword V 
Form-s: 
Arrival- 
Duty— 
Navy 638 
Nurse Corps 640 
Officer 639 
Patient— 
Marine 639 
Marine officer 639 
Navy 638 
Navy officer 639 
Nurse Corps 640 
Supernumerary 640 
F orrn-s—Continued. Page. 
B 630 
Ba 630 
B-dental 630 
Civilian employees 648 
Death— 
Marine 643 
Navy . 643 
Nurse Corps 643 
Officer, Navy or Marine Corps 642 
Supernumerary 644 
Departure- 
Duty— 
Navy 641 
Nurse Corps , 641 
Officer 640 
Patient— 
Marine 642 
Marine officer 641 
Navy 641 
Navy officer 641 
Nurse Corps 642 
Supernumerary 642 
Deserter, reporting on board 645 
Desertion 644 
Discharge- 
Expiration of enlistment— 
Marine 645 
Navy 645 
Patient- 
Marine, I. S 646 
Navy, I. S 646 
Officer, I. S 646 
Retirement, Navy 645 
Sentence, summary court-martial 645 
Marine patient 646 
Enlistment, extension of, or reenlistment. 647 
F 529 
Hospital Corps 637 
K 529 
Leave- 
Absence without— 
Navy 647 
Patient, marine 647 
Supernumerary 647 
Marine, patient.. 647 
Navy 647 
Nurse Corps 647 
Officer 647 
Preparation of 638 
Prescribed for letters 616 
Rating— 
Advancement in 648 
Reduction in 648 
Remains, shipment of 648 
Requisitions, headstones 648 
Returns 649 
Telegrams 649 
Transfer— 
Marine enlisted, hospital insane 648 
Navy enlisted, hospital insane 648 
Officer, marine, hospital insane 648 
Officer, Navy, hospital insane 648 
Patient to Fitzsimmons General Hos- 
pital 648 
Supernumerary, hospital insane 648 
1 630 698 
INDEX, 
Form-s—Continued. Page. 
4 630 
N. M. S. H. 36, ration return 676 
N. M. S. H. 37, receipt and expenditure 
voucher 674 
S. and A. 44 631 
Formaldehyde 169 
Disinfectant 269 
Solution of 444 
Sterilization by 169 
Formalin, disinfectant 268 
Formula-se: 
Chemical 357 
Empirical 358 
Graphic 358 
Rational 358 
Stereochemic 358 
Structural 358 
For radicle 368 
Writing of 369 
Formulary. (See N ati onal.) 
Foreign bodies, removal of 86 
Fowler’s position 189 
Fracture-s: 
Bed 135 
Bones of forearm 81 
Clavicle 81 
Colle’s 81 
Comminuted 76 
Complete 76 
Complicated 76 
Compound 76 
Diagnosis of 77 
Femur 82 
Fingers 82 
Foot 83 
Humerus 81 
Impacted 76 
Incomplete or green stick 76 
Leg 83 
Lower jaw, symptoms and treatment— 80 
Metacarpals 82 
Multiple 76 
Nose, symptoms and treatment 80 
Patella 82 
Pelvis 82 
Pott’s 83 
Rib, symptoms and treatment... 80 
Setting of 78 
Skull 79 
Spine 79 
Splints 78 
Treatment for— 
Compound 78 
Simple 77 
Friction 194 
Frontal bone 9 
Fruits as food 228 
Fumigation 239,411 
Preparation of spaces 272 
Ships v 271,272 
Fusion 390 
Galenic preparations 395 
Gall bladder, description of 35 
Gall-stone colic 95 
Ganglia... 43 
Ganglionic nervous system 43 
Garbage, disposal of 295 
Gas-es: Page. 
Cloud or drift 555 
Funnel 273 
Poison 554 
Gaseous poisons 490 
Gasoline and benzine poisoning 496 
Gastric: 
Juice— 
Description of. 36 
Hydrochloric acid 36 
Lipase 36 
Pepsin 36 
Peptones 36 
Proteoses 36 
Rennin 36 
Tonics 409 
Ulcer, diet in 230 
Gastro-pulmonary membrane 19 
Gauze dressings 170 
Gavage 155 
Gay Lussac’slaw 376 
General ledger 637 
Genital organ s, male 42 
Genito-urinary membrane 19 
Gentian: 
Compound tincture of 464 
Violet stain 503 
German measles 242 
Ginger, fluidextract of 454 
Glacial acetic acid 449 
Gland-s 18 
Compound 19 
Ductless 19,38 
Lachrymal 49 
Pancreas 34 
Parathyroid 38 
Functions of 38 
Pineal body 39 
Pituitary body 39 
Simple 19 
Suprarenal 38 
Function of 38 
Sweat 40 
Testicles 42 
Thymus 38 
Thyroid 38 
Function of 38 
Types of . 19 
Gleet 327 
Glossina palpalis 520 
Glossopharyngeal nerves 47 
Glucose 399 
Glucosides 403,462 
Glycerin 399,402 
Suppositories 40 
Glycerite-s. 397 
Of starch 402 
Glycogen 35 
• Sourceof 35,37 
Glycyrrhiza: 
Compound mixture of 462 
Compound powder of 462 
Pure extract of 462 
Gonorrhoea 258,326 
Chronic 327 
Diagnosis of 326 
Epididymitis 328 
Gleet 327 INDEX, 
699 
Glycyrrhiza—Continued. Page. 
Incubation period 326 
Infection by, effects of ; 325,326 
Prostatitis 328 
Stricture of urethra 329 
Symptoms of 327 
Treatment of 329 
Gonorrhoeal ophthalmia and treatment 332 
Gout: 
Diet in 230 
Grain weight 385 
Gram’s method of staining 504 
Granulation ; 391 
Green vegetables as food 228 
Guard duty, medical 532 
Guaiacol 448 
Gum arabic 461 
Gumboils 113 
Gunshot wounds 71 
Gymnastics, medical 197 
Haematology 501 
Hematoxylin and eosin stain 503 
Haemoglobin 20,506 
Haemolysis 22 
Haemoptysis 64 
Haemorrhage 60 
Arterial 61 
Capillary 61 
Consecutive or intermediate 64 
Constitutional treatment for 63 
Epistaxis (nose bleed) ; 61 
From lips 63 
From scalp 63 
Internal 64 
Lung 64 
Pressure 62 
Primary 64 
Secondary 64 
Stomach 64 
Tourniquet, use of, in 62 
Treatment for 61 
Venous 61 
Haemostatics 408 
Halogen: 
Derivatives— 
Chloroform 441 
Ethyl chloride 442 
Iodoform 441 
Elements 411 
Ham as food 227 
Hand 12 
Hardness, definition of 355 
Harrison narcotic law 405,482 
Headache 97 
Headstones, requisitions for 648 
Health records, care of 527 
Heart: 
Action of 24 
Blood supply of 24 
Description of 23 
Drugs affecting 479 
Endocardium 23 
Murmurs 24 
Myocardium 23 
Nerve supply 24 
Pericardium 23 
47829°—23 45 
Heart—Continued. Page. 
Stenosis 24 
Valves 24 
Heat: 
Calcination ! 390 
Carbonization 390 
Definition of 389 
D eflagration 390 
Desiccation 391 
Distillation 390 
Exhaustion 84 
Exsiccation 391 
Fusion 390 
Granulation 391 
Ignition 390 
Incineration 390 
Method of measuring 389 
Regulation of body 52 
Stroke 83 
Sublimation 390 
Torrefaction 390 
Vaporization 390 
Heating: 
Direct 280 
Direct-indirect 280 
Indirect 280 
Methods used in 280 
Henry’s law 377 
Hepatic: 
Duct 35 
Stimulants 409 
Hernia 18 
Heroin 470 
Poisoning by 493 
Use by drug addicts 487 
Herpes 346 
Hexamethylenamine 445 
Hiccough 97 
High frequency current 220 
Method of— 
Application 221 
Producing 220 
Hip: 
Bone 13 
Dislocation of 75 
Histology, definition of 5 
History of Hospital Corps l 
H omatropine hydrobromide 473 
Honeys 398 
Hookworm-s •. 515 
Disease 252 
Hormones 521 
Hospital company, regimental medical de- 
tachment 543 
Hospital Corps, complements 609 
Hospital corpsmen: 
Conduct of 563 
Duties of 525,582 
Death, examination for 567 
Dispensing 565 
Dying declarations 566 
Insane, care of 565 
Poisons, handling of 565 
Professional ethics 116 
Qualifications necessary for 115,116 
Hospital ticket 564 700 
INDEX, 
Page. 
Hospitals, naval 601 
Accounting— 
And property officer 634 
System..* 636 
Administration of 608 
Civil employees at 582 
Commanding officer 580 
Commissary department at 650 
Complements 608 
Designation as 579 
Executive officer 580 
Field 579 
General plans, arrangement and manage- 
ment of 579 
Hospital corpsmen 581 
Medical officers 581 
Navy base 579 
Nurses 582 
Personnel, duties of 581 
Hospitals, Navy Base: 
Organization of 612 
Personnel of 611 
Hosts, animal parasites 511 
Hot: 
Applications 133 
Pack 159 
Water bags 133 
Housing: 
Congestion of population 282 
Living conditions on board ship 282 
Of naval personnel 281 
Overcrowding 281 
Standards for barracks 282 
Humerus 11 
Fracture of 81 
Hyaloid membrane 50 
Hydrated chloral 444 
Hydrocarbons 439 
Definition of 439 
Halogen derivatives of 441 
Ichthyol 440 
Liquid petrolatum 440 
Paraffin 440 
Petrolatum 439 
Sulphonated oil 440 
Hydrochloric acid 415 
Gastric juice 36 
Poisoning by 494 
Hydrocyanic acid: 
Gas- 
Disinfectant 270 
Poison 557,562 
Poisoning by 494 
Hydrogen 380 
Acids 368 
Dioxide, solution 414 
Hydrogogues 408 
Hydrographic Office 586 
Hydrotherapy: 
Ablution 206 
Baths 206 
Conditions of skin affecting 204 
Effect of cold 205 
Reaction in 205 
Technique of .’ 205 
Wet pack 208 
Page. 
Hydrous wool fat 460 
Hydroxyl 380 
Hygiene: 
And sanitation 237 
Personal- 
Bowels, care of 296 
Clothing 297 
Definition of 296 
Dental 296 
Exercise, effect on health 296 
Mental state, effect on health 296 
Hymenolepsis nana 514 
Hyoscyamus 473 
Fluid extract of 473 
Poisoning by .494 
Hypermetropia 51 
Hypnotics 409,481 
Hypodermic: 
Injection, method of giving 128 
Outfit 128 
Solution, filtering of 392 
Hypodermoclysis 148,411 
Hypoglossal nerves 47 
Hypophysis, solution of 466 
Hysterical unconciousness 92 
Ice caps 133 
Ichthyol 440 
Identification: 
Of dead 570 
Records 637 
Tags 534,637 
Idiosyncrasy 410,509 
Food 286 
Ignition 390 
Illumination. (See Light). 
Imhoff tanks, sewage disposal 294 
Immunity 507 
Acquired 507 
Active 507 
Agglutinins 507 
Antibodies 507 
Antitoxins 507 
Bacteriolysins 507 
Cytolysins 507 
Inherent 507 
Opsonins 507 
Passive 507 
Precipitins 507 
Serums 508 
Schick test 507 
Toxins 507 
Incineration 390 
Incinerators, specifications of . 316 
Incisura radialis 12 
Semilunaris 12 
Incompatibility: 
Chemical 405 
Definition of 405 
Pharmaceutical . 405 
Therapeutic 405 
Independent duty 525 
Indicator, chemical 377 
Infected clothing 298 
Infection of wounds 166,167 
Inferior: 
Mesenteric artery 27 
Phrenic artery 27 INDEX. 
701 
Page. 
Inflammation 166 
Treatment of 57 
Influenza 144,242 
Infusion 395,397 
Saline 229 
Infusoria 512 
Inguinal ligament (Poupart’s) 18 
Inhalation, administration of drugs by 411 
Initial lesion, syphilis .* 334 
Injuries: 
Asphyxia 88 
Burns and scalds 84 
Cold or chilling 86 
Contusions 71 
Dislocations 73 
Foreign bodies 86 
Fractures 76 
Haemorrhage 60 
Heat- 
Exhaustion 84 
Stroke 83 
Inflammation 57 
Shock 59 
Sprains 71 
Strains. 71 
Suffocation 88 
Sunstroke 83 
Unconsciousness 90 
Wounds 64 
Innominate vein 29 
Inorganic: 
Acids 415 
Table of 381 
Foods 223 
Materia medica 411 
Insalivation 32 
Insane, care of 565 
Insect-s: 
Bites 69 
Control of, in camp 318 
Diseases transmitted by 142 
Flies 318 
Lice 321 
Mosquitoes 319 
Inspection, food 667 
Instruments, surgical, care of 173 
Intensifying screens, X-ray 551 
Internal haemorrhage 64 
Interstitial water 394 
Intestinal obstruction, acute 94 
Intestines: 
. Description of 33 
Large 34 
Small 33 
Intramuscular: 
Administration of drugs 411 
Injection of mercury 342 
Intravascular: 
Administration of drugs 411 
Injection..... 229 
Inunction-s 411 
Nutrient 229 
Inventory 675 
Invertin 37 
Iodide of iron, syrup of.., 398 
Page. 
Iodine 413 
Ointment 402 
Poisoning by 494 
Sterilization by 169 
Tincture of 413 
Iodoform 441 
Sterilization by 169 
Ionization 361 
Ipecac 474 
Fluidextract of 475 
Iris 50 
Iron: 
Chloride, tincture of 431 
Citrochloride, tincture of 431 
Compounds of 431 
Pyrophosphate, soluble 431 
Irrigation: 
Bladder 153 
Nasal 161 
Saline 229 
Wounds 168 
Irritability, muscle 16 
Irritant-s 409,482 
Gases, poisoning by 494 
Poisoning by 498 
Poisons 490 
Isolation 239 
Isomorphous 374 
Jaborandi 474 
Jaw: 
Dislocation of 74 
Fracture, symptoms and treatment of... 80 
Joint-s: 
Abduction 15 
Adduction 15 
Circumduction 15 
Extension 15 
Flexion 15 
Immovable 14 
Movable 14 
Movements of 15 
Rotation 15 
Journal, accounting system 636 
Judge Advocate General of the Navy 590 
Jugular veins 29 
Karelldiet 231 
Kidney-s 40 
Stone colic 95 
Kitchen, naval hospitals: 
Diet 652 
Main... 652 
Knee, dislocation of 75 
Kocher’s method for reduction of dislocation 
of shoulder 75 
Laboratory specimens, post-mortem examina- 
tions: 
Equipment for preserving 574 
Regulations for mailing 575 
Lachrymal: 
Apparatus 49 
Bone 9 
Canaliculi .' 49 
Glands 49 
Nasal duct 49 
Sac— 49 702 
INDEX. 
Lachrymatory gases (tear gases), poison: Page. 
Benzyl bromide 557 
Brom-benzyl cyanide 557,559 
Xylyl bromide 557,559 
Lactase 37 
Lamb: 
As food.... 227 
Cuts of 664 
Landing force, duties with. ..J 534 
Lanolin 460 
Lard 401,460 
Larynx 30 
Latin words used in pharmacy 404 
Latrine-s: 
Care of 315 
Frontage 314 
Location 315 
Types of. 315 
Lavage 154 
Laws and theories: 
Avogadro’s 375 
Boyle’s 376 
Charles’ 376 
Chemical and physical equilibrium 377 
Constant proportions 353 
Dalton’s 353,375 
Gay Lussac’s 376 
Henry’s 377 
Molecular theory 375 
Multiple proportions 375 
Newton’s 355 
Laxatives 408 
Lead: 
Acetate 334 
Poisoning by 494 
Leather clothing 297 
Leave, forms for 647 
Ledger: 
Commissary 637,675 
Equipment 637 
General 637 
Stock 636 
Leg, fracture of 83 
Legumes, as food 228 
Lenhartzdiet 230 
Lens, crystalline 50 
Lepers, quarantine of 275 
Leptospira icteroides 512 
Leptandra, extract of 4G4 
Letters, forms prescribed for 616 
Leucocytes 20 
Levigation 391 
Lewisite gas 557 
Lice 520 
Destruction of 273 
Licorice: 
Powder, compound 462 
Ligatures 172 
Light-ing: 
And illumination 282 
Direct 283 
Eyestrain caused by 283 
Indirect 283 
Lights, location of 283 
Living spaces 283 
Natural 282 
Light-ing—Continued. Page. 
Operating room 163 
Relation to health 282 
Sick rooms 283 
Wards 283 
Lime: 
Chlorinated 412 
Disinfectant 268 
Linen: 
Clothing 298 
Operating room: 
Caps 170 
Gowns 171 
Masks 170 
Removal of stains, from 118 
Liniment-s 397 
Amonia 398 
Camphor 397 
Chloroform 398 
Lime 398 
Soap 398,461 
Lipase 36 
Liquid: 
Diet 231 
Measure 387 
Petrolatum 440 
Lithium citrate 426 
Liver: 
Description of 35 
Functions of 35 
Living spaces, lighting of 283 
Loffler’s medium 502 
Lotion 392 
Lozenges 401 
Lumbar: 
Arteries 28 
Lung-s 31,39 
Haemorrhage from 64 
Irritants, poison gases: 
Chlorine .557 
Chlorpicrine 557 
General symptoms o.' 557 
Phosgene 557 
Treatment of poisoning by 558 
Lymph: 
Blood, definition of 22 
Vascular system: 
Description of 29 
Thoracic duct 29 
Lymphocytes 20 
Maceration 395 
Magmas 398 
Magnesium -427 
Carbonate 428 
Sulphate 428 
Mail-ing: 
Cases, procuring of 633 
Classes of 620 
Malaria 142,255 
Benign tertian 513 
Malignant tertian 513 
Quartan 513 
Malleability, definition of 355 
Maltase 37 
March, water supply on 290 INDEX 
703 
Page. 
Marching, field sanitation 321 
Marine Corps: 
Description of 597 
Titles 595 
Maritime quarantine 274 
Marrow 6 
Massage: 
Abdominal 195 
Contraindications to 197 
General 194 
General rules for 197 
Manipulations of 193 
Mass-es: 
Definition of. 355 
Pharmaceutical preparations 400 
Masters-at-arms, mess hall 680 
Mastication 32 
Mastigophora 511 
Materia medica: 
Definition of 383,407 
Inorganic 411 
Organic 439 
Matter: 
Characteristics of 354 
Definition of 354 
Measles 139,243 
Measure-s 386 
Liquid : 387 
Tables of •. 385 
t-s: 
As food 227 
Inspection of 667 
Media, culture 502 
Medical: 
Department— 
Accounting 634 
Appropriations 602 
Clerical force, organization of 622 
Clerical work 614 
Duties with shore patrol 536 
Filing system 623 
Personnel 607 
Property accountability 634 
Public bills 631 
Supplies, procuring of 628 
Journal,independent duty, care of 528 
Officer-s— 
Appointment of 607 
Destroyer squadrons, duties of. 530 
Naval hospitals 581 
Ranks and grades of 592 
Squadron, duties of 530 
Medicated baths 160 
Medicine-s: 
Abbreviations on prescriptions 404 
Administration of 125 
By mouth 126 
Hypodermic method of giving 128 
Hypodermic outfit 128 
Oxygen inhalations 127 
Preventive. (See Preventive medicine.) 
Steam inhalations 127 
Subcutaneous injections 127 
Medicine and Surgery, Bureau of 588,598 
Medicolegal matters 563 
Medulla oblongata 46 
Page. 
Membranes 18 
Cutaneous 19 
Mucous 19 
Serous 18 
Synovial 19 
Meningitis 147 
Menstruum 395 
Menthol 453 
Menus: 
Forms used for 653 
Regular diet 653 
Table of foods found on 655 
Mercurial ointment 402,435 
Mercury: 
Ammoniated 437 
Bichloride of 435 
Citrine ointment 436 
Compounds of 434 
Intramuscular injection of 342 
Inunction of 342 
Mass of 434 
Ointment of 402,435 
Mild chloride of 436 
Oleate of 435 
Salicylate of 437 
Succinamide of 437 
Vapor arc lamp 217 
Yellow oxide of 435 
Yellow iodide of 437 
Mesenteric veins 29 
Mess attendants, naval hospitals 680 
Mess-es (naval hospitals): 
Halls 652 
Nurses’ 652 
Sick officers’ 652 
Staff officers’ 652 
Metabolism, disturbance of 286 
Metacarpal bones 12 
Metals: 
Base 374 
Elements 373 
Noble 374 
Metatarsal bones 14 
Methyl: 
Alcohol 443 
Salicylate 455 
Methylene blue stain 503 
Metric system 385 
Metrology, definition of 384 
Micrometry 502 
Microorganisms in air 278 
Microscope, care of. 501 
Micturition 42 
Milk: 
Pasteurization of 227 
Peptonized 232 
Sterilization of 227 
Middle: 
Ear 51 
Sacral artery 28 
Mine depots 596 
Mineral acids 415 
Mineralogy, definition of 383 
Mites 517 
Mixtures, pharmaceutical 398 
Molecular theory 375 704 
INDEX, 
Page. 
Molecules 355 
Monosaccharides 224 
Morgue, care of 571 
Morphine: 
Poisoning by 494 
Sulphate 469 
Mosquito-es: 
Aedes 519 
Anopheles 519 
Asiphonate 519 
Control in camp 319 
Culex 519 
Filaria 519 
Siphonate 519 
Motor: 
Depressants 409 
Excitants 409 
Mountain sickness 278 
Mouth, description of 32 
Mucilages 398 
Mucous membrane 19 
Mumps 141,245 
Murmurs, heart 24 
Musca domestica 520 
Muscle-s: 
Cardiac 16 
Contractility 16 
Definition of 15 
Division of 16 
Extensibility 16 
Inguinal ligament (Poupart’s) 18 
Irritability 16 
Non-striated (involuntary) 16 
Of— 
Eye 50 
Head and face 16 
Lower extremity 18 
Neck 16 
Trunk 16 
Upper extremity 18 
Properties of 16 
Rigor mortis 16 
Striated (voluntary) 15 
Substance, changes in 16 
Tissue 15 
Tonicity 16 
Muscular system : 15 
Mustard: 
Gas 557,560 
Plasters 131,456 
Mutton: 
Cuts of 664 
As food 227 
Mutualism 511 
Mydriatics , :.. 409,482 
Myology 15 
Myopia 51 
Myotics 409,482 
Narcotic-s 409,481 
Harrison Act or law 405,482 
Nasal: 
Chambers 30 
Duct 49 
National formulary, descriptirifi of 384 
Natural preparations 402 
Page. 
Naval: 
Base— 
Advance 597 
Aviation 597 
Defined 597 
Destroyer 597 
Main 597 
Main outlying 597 
Outlying 597 
Submarine 597 
Subsidiary 597 
Depot, defined 597 
Hospitals. (See Hospitals.) 
Hospital fund 003,674 
Intelligence, office of 585 
Observatory 586 
Operating bases 596 
Policy, defined 597 
Station-s 596 
Defined , 597 
For upkeep of fleet 595 
Torpedo 596 
Training 596 
Strategy, defined 597 
Tactics, defined 597 
Navigation, Bureau of: 
Duties of • 585 
Hydrographic Office 586 
Naval Observatory 586 
Navy: 
Base hospitals 611 
Department 583 
Yards 596 
Necator americanus 515 
Needles 68 
Nemathelminthes 514 
N eoarsphenamine 432 
Treatment of syphilis 340 
Neosalvarsan 432 
Nephritis: 
Acute 146 
Diet in 230 
Nerve-s 43 
Afferent 44,48 
Center 44 
Cerebral 47 
Cranial 47 
Description of 43 
Efferent 48 
Fiber 43 
Impulses 43 
Mixed 44 
Motor 44 
Reflex action 48 
Sensory 44 
Spinal 47 
Tissue i 43 
Vaso-motor 44 
Nervous system 43 
Axones 43 
Cerebrospinal 43 
Dendrites 43 
Division of 43 
Ganglionic. 43 
Neurones 43 
Sympathetic 43,48 INDEX 
705 
Page. 
Neuroepithelial cells 6 
Neurones 43 
Neurotic-s 409 
Poisoning by 498 
Poisons 489,490 
Neutrophiles 21 
Newton’s law 355 
Nitre, sweet spirit of 452 
Nitric acid 416 
Poisoning by 495 
Nitrogen: 
In air 276 
Monoxide 414 
Nitrous oxide, use as anaesthetic 182,187 
Noblemetals 374 
Nonelectrolytes 362 
Nonmetals, elements 373 
Non vacuum electrode treatment 221 
Normal: 
Salt-s 371 
Solution 168,190,424 
Volumetric solutions 378 
Nose: 
Fracture of, symptoms and treatment... 80 
Removal of foreign bodies from 87 
Novoeaine •. : 476 
Use as anaesthetic 190,191,192 
Nucleus 5 
Nurse-s: 
Appointment of 607 
Corps, titles 595 
Naval hospitals 582 
Navy base hospitals 611 
Operating room 176 
Surgical 176 
Nursing 115 
Care, general 139 
Of diseases— 
Communicable 139 
Restraining apparatus 137 
Surgical- 
Bed sores 160 
Douche-s 161 
Ear 162 
Eye 162 
Pharyngeal 161 
Dressings 155 
Irrigation-s 161 
Nasal 161 
Preparation for operation 146 
Wards, management and general super- 
vision of 116 
Nutriants 409 
Nutrient-s 409 
Enema ta 228 
Inunctions 229 
Nuts as food 228 
Nux vomica 473 
Poisoning by 495 
Tincture of 473 
Obesity, diet in 231 
Oculomotor nerves 47 
CEsophagus, description of 33 
Oflicer-s 591 
Accounting and property 634 
Chief warrant 592 
Page. 
O ffice r-s—Continued. 
Commissioned— 
Of the line 592 
Of the staff 592 
Warrant 592 
Ranks and grades of— 
Abbreviations for 595 
Dental 592 
Medical 592 
Warrant : 592 
Oil-s: 
Castor . 459 
Clove 453 
Cod liver 460 
Cotton seed 459 
Essential 403 
Fixed 403,459 
Peppermint 452 
Santalwood 456 
Sweet birch 455 
Tar, rectified 454 
Theobroma 460 
Turpentine 457 
Volatile , 403 
Wintergreen 455 
Ointment-s 401 
Belladonna 402 
Iodine. 402 
Potassium iodide used in 402 
Mercurial 402 
Oxide of mercury 402 
Oleate-s 398 
Of mercury 402,435 
Oleoresina aspidii 458 
Oleoresins 398,457 
Olfactory nerves 47 
Operating: 
Bases, naval 596 
Room- 
Adjoining rooms 165 
Anaesthetizing room 165 
Asepsis 166 
Care of patient on operating table 174 
Cleanliness 164 
Cleaning gear room 165 
Conduct of personnel 178 
Equipment 164 
Heating 164 
Hospital corpsmen 176 
Instrument room 166 
Lighting of 163 
Nurse 176 
Personnel of 175 
Preparation of— 
Hands 174 
Patient 174 
Size of 163 
Sterilizing room 165 
Storeroom 166 
Surgeon 175 
First assistant 175 
Second assistant 176 
Surgical- 
Dressings room 166 
Nurse 176 
Table 164 706 
INDEX, 
Page. 
O perating—Continued. 
Ventilation 164 
Wash room 165 
Operating room and surgical technique 163 
Operation: 
Hours for 163 
Mouth, preparation for 147 
Preparation f or 176 
Preparation of patient for 146,180 
Surgical— 
Abdomen, preparation for 147 
Abdominal, inf ection present 149 
Baths 149 
Bladder irrigation 153 
Catheterization 153 
Diet— 
Before operation 147 
Post-operative 149 
Enemata 150 
Enteroclysis 148 
Technique of giving 151 
Gavage, nasal 155 
Hypodermoclysis 148,152 
Lavage 154 
Nausea, control of 148 
Post-operative care 147,148 
Proctoclysis 148,151 
Rectum, preparation for 147 
Suppository, rectal 151 
Urine, examination of 148 
Opium: 
And ipecac, powder of 469 
And lead, pill of 469 
Camphorated tincture of 469 
Poisoning by 495 
Powdered.... 468 
Restriction in use 483 
Tincture of 469 
Use by drug addicts 484 
Opsonins 507,509 
Optic: 
Foramen 49 
Nerves 47 
Orange, compound spirit of 453 
Orbit: 
Optic foramen of 49 
Sphenoidal fissure of 49 
Ordnance, Bureau of 587 
Organic foods 223 
Organization: 
Clerical duties and procedures 582 
Medical department, expeditionary force. 540 
Navy base hospitals 612 
Ornithodoros moubata 518 
Osmosis 394 
Osmotic pressure 362 
Osteology, definition of 6 
Oxalic acid, poisoning by 495 
Oxidation 375 
Oxidizing agents 375 
Oxide-s of: 
Carbon 273 
Mercury ointment 402 
Nitrogen, gases 557,563 
Oxy-aeids, table of 381 
Page. 
Oxygen 413 
Acids 368 
Inhalations 127 
Oxyuris vermicularis 516 
Ozone, sterilization of water by 290 
Pack-s: 
Cold 158 
Hot 159 
Surgical dressings 170 
Wet 208 
Packet, first-aid "66 
Pancreas 34 
Pancreatic juice: 
Amyl opsin 37 
Description of 37 
Steapsin 37 
Trypsin 37 
Paper clothing 298 
Paraffin 440 
Paraglobulin 21 
Paragonimus westermanni 513 
Paraphimosis. 331 
Parasites: 
Animal 284 
Arachnoids , 517 
Arthropoda 517 
Cestodes 513 
Classification of 511 
Commensalism 511 
Culicidae 518 
Ectoparasites 511 
Endoparasites 511 
Female 511 
Fleas 520 
Flies : 520 
Hosts 511 
Infusoria 512 
Insecta 518 
Lice 520 
Male 511 
Mastigophora 511 
Mosquitoes 518 
Mutualism 511 
Nemathelminthes 514 
Of man 510 
Pediculidse 520 
Platyhelminthes 513 
Protozoa 511 
Pulicidse .'. 520 
Rhizopoda 511 
Spirillae 503 
Sporozoa 512 
Ticks 518 
True parasitism 511 
Worms 513 
Plant 284 
Parasiticides 409 
Parathyroid glands, function of 38 
Paratyphoid fever 253 
Patella: 
Description of 14 
Fracture of 82 
Path ogcnic bacteria 503 
Pathology, definition of 5 INDEX, 
707 
Patienb-s: Page. 
Admission to ward 116 
Care ol 129 
mouth 130 
Confidence of 564 
Effects 564 
Inventory 564 
Hospital ticket 564 
Moving and lifting 136 
Property, custody of 564 
Transfer of 528 
Valuables 565 
Pay, civilian employees, commissary depart- 
ment, naval hospitals 650 
Pediculidse 520 
Pediculus— 
Capitis 520 
Vestimenti 520 
Pellagra 285 
Pelvis 13 
Fracture of 82 
Penis 43 
Pepsin 36,465 
Peptones 36 
Percolation . 393 
Percolate 394 
Percolator 394 
Pericardium 23 
Peridental membrane 110 
Periosteum 7 
Peristalsis 32 
Peritoneum 36 
Personnel: 
Commissary Department, naval hos- 
pitals 678 
Medical Department 607 
Navy base hospitals 611 
Of the Navy- 
Enlisted 593 
Officer 591 
Perspiration 39 
Petrissage 194 
Petrolatum 439 
Phagocytosis 20 
Phalanges , 12 
Pharmaceutical: 
Arithmetic 388 
Incompatibility 405 
Preparations 395 
Cerates 400 
Chemical 395 
Cold cream 402 
Collodions 396 
Elixirs 396 
Emulsions 396 
Extracts 400 
Fluidextracts 397 
Galenic 395 
Glycerite-s 397 
Of starch 402 
Honeys 398 
Infusions 397 
Liniments 397 
Liquid 395,396 
Lozenges 401 
Magmas 398 
Masses 400 
Pharmaceutical—Continued. Page. 
Preparations—Continued. 
Mixtures 398 
Mucilages 398 
Natural 395,402 
Ointments 401 
Oleates 398 
Oleoresins 398 
Pills 400 
Plasters 400 
Powders 400 
Resins 400 
Solid 395,400 
Solutions 398 
Spirits 398 
Suppositories 400,401 
Syrups 398 
Tinctures 399 
Vinegars 396 
Waters 396 
Pharmacists, appointment of 608 
Pharmacognosy, definition of 383 
Pharmacopoeia: 
Description of 383 
Purity rubric 384 
Pharmacy: 
Definition of 383 
Practical 383 
Theoretical 383 
Pharyngeal douche 161 
Pharynx 33 
Phenacetin 449 
Phenol-s 446 
Acetanilid 448 
Acetphenetidin . 449 
And derivatives 445 
Antidote for 446 
Antipyrine 448 
Carbolic acid 446 
Poisoning by 495 
Cresol 447 
Creosote 448 
Carbonate 448 
Disinfectant 267 
Guaicol 448 
Liquefied 446 
Picrjc acid 447 
Resorcinol 447 
Tricresol 447 
Trinitrophenol 447 
Phenyl salicylate 450 
Phenylcinchoninic acid 451 
Phimosis 331 
Phosgene 555 
Poison 557 
Phosphorus: 
Acid 371 
In foods 226 
Physical change 353 
Phthirius pubis 520 
Physics, definition of 383 
Physiological salt solution 168,190 
Physiology, definition of 5 
Physiotherapy: 
Definition of 193 
Eflleurage • 193 
Friction 194 708 
INDEX, 
Physiotherapy—Continued. Page. 
Gymnastics, medical 197 
Massage: 
General 194 
Manipulations of 193 
Petrissage 194 
Tapotement 194 
Physostigmine sulphate 472 
Picric acid 447 
Pill-s 400 
Of ferrous carbonate 432 
Of lead acetate and opium 469 
Pilocarpine hydrochloride, 474 
Pilocarpus 474 
Pineal body 39 
Pipettes 387 
Pituitary body 39 
Plague 256 
Plasma, blood 21 
Plasmodium: 
Falciparum 513 
Malarial 513 
Vivax 513 
Plaster-s 400 
Of Paris bandage 108 
Application of 109 
Removal of 109 
Platelets 21 
Platyhelminthes 513 
Pleura 31 
Plexuses 43 
Pneumococcus 167 
Pneumogastric nerves 47 
Pneumonia 144,246 
Jacket 134 
Poison-s: 
Accidentally or purposely added to food. 284 
Classification of 489 
Corrosives 489,490 
Definition of 489 
Effects of 489 
Food 490 
Gas— 
UseinWorldWar 555 
Use of 554 
Gaseous 590 
Handling of %. 565 
Irritants 489,490 
Natural, food 284 
Neurotics 489,490 
Special, food. 284 
Poisoning: 
Aconite 491 
Acute... 489 
Acute abdominal symptoms 96 
Alcohol: 
Ethyl 492 
Methyl 492 
Antidotes 491 
Arsenic 492 
Atropine 492 
Belladonna 492 
Bichloride of mercury 493 
Caustic alkalies 493 
Chronic..* 489 
Cocaine 191,493 
Colubrine snake 70 
Poisoning—Continued. Page. 
Corrosive 498 
Depressants 490 
Digitalis 493 
Emetics 491 
Excitants 490 
Food 491,493 
Gaseous 490 
Gasoline and benzine 496 
Heroin 493 
Hydrochloric acid 494 
Hydrocyanic acid 494 
Hyoscyamus 494 
Iodine 494 
Irritant 498 
Gases 494 
Lead 494 
Management of case, poison unknown... 497 
Morphine 494 
Neurotic 498 
Nitric acid 495 
Nux vomica 495 
Opium 495 
Oxalic acid 495 
Phenol (carbolic acid) 495 
Stomach tube, use in 499 
Strychnine 495 
Sulphuric acid 496 
Symptoms: 
General 490 
Table of 497 
Treatment of , 491,497 
Trinitrotoluene 496 
Viperine snake 70 
Poisonous: 
Gases 90 
Wounds 69 
Policy, naval, defined 597 
Polymorphous 374 
Polymorphonuclear leucocytes 21 
Polysaccharides 224 
Polyvalence 359 
Pons Varolii 45 
Pork: 
As food 227 
Cuts of 665 
Posology, definition of 383 
Portal system of circulation 29 
Post-mortem examinations , 570 
Equipment for 571 
Specimens 573 
Laboratory specimens 574 
Method of procedure 572 
Post-operative care 147,148,188 
Post surgeon-s: 
Marine Corps posts 540 
Office 539 
Potassium: 
Acetate 418 
And sodium tartrate 419 
Arsenite, solution of 432 
Bicarbonate 418 
Bitartrate 419 
Bromide 419 
Chlorate 419 
Citrate 420 
Hydroxide 418 INDEX, 
709 
Page. 
Potassium—Continued. 
Iodide 420 
Used in iodine ointment 402 
Used in tincture of iodine 399 
Mercuric iodide, disinfectant 267 
Permanganate 420 
Sterilization by 169 
Pott’s fracture 83 
Poultices 131 
Poultry as food 227 
Powder-s 400 
Fineness of 391 
Ipecac and opium 469 
Practical pharmacy 383 
Precipitation 393 
Precipitant 393 
Precipitate 393 
Precipitins 507,509 
Prepared chalk 429 
Presbyopia 51 
Prescriptions: 
Definition of 403 
Filling of 404 
Model of 403 
Preservation, food 672 
Preservatives, chemical 673 
Preserving food 673 
Prevention and control, communicable dis- 
eases, methods used in 265 
Preventive medicine 237 
Definition of 237 
Education in personal cleanliness 239 
Fumigation 239 
Isolation 239 
Quarantine 239 
Renovation 239 
Report of a disease 239 
Susceptibles 239 
Primary: 
Haemorrhage 64 
Stage, syphilis 333 
Procaine 476 
Use as anaesthetic 190 
Proctoclysis 148 
Property: 
Accountability 634 
Care of 528 
Medical Department: 
Accounting and property office 634 
Survey of 634 
Transfer of 634 
Patients’, custody of 564 
Transfer of 528 
Prophylactic-s 409 
Measures, general 138 
Measures, personal. 138 
Station, shore patrol 537 
Treatment, venereal diseases 346 
Prostate gland 43 
Prostatitis 328 
Treatment of 332 
Protectives 477 
Protein-s 223 
Metabolism of. 223 
Products from animal substances and 
insects 465 
Sources of 223 
Page. 
Proteoses...' 36 
Prothrombin 22 
Protoplasm 5 
Protozoa 511 
Provision-s: 
Contracts, schedule of 666 
Dry 666 
How procured 666 
Issue of 673 
Invoiced by supply officers 677 
Nonstock items 666 
Requisition file 677 
Stock items 666 
Public bills 631,677 
Special exigency 632 
Pulicidse 520 
Pulmonary: 
Artery 25 
Disinfectants 480 
Sedatives 409,480 
Veins 28 
Pulp cavity no 
Pulse 121 
Description of 122,123 
Pressure 26 
Pupil of eye 50 
Purgatives 409,479 
Drastic 408 
Saline 408 
Simple 408 
Purification, water 288,313 
Purified talc 428 
Purity rubric 384 
Putrefaction 167 
Pyogenic bacteria 167 
Pyrethrum 273 
Quarantine 239 
Lepers 275 
Maritime 274 
Quartz lamp, operation of 217 
Quicksilver 434 
Quinine: 
And urea hydrochloride 190,191 
Chlorhydrosulphate 471 
Hydrochloride 471 
Sulphate 471 
Rabid animal wounds 69 
Rabies ; 260 
Radiant heat and light 212 
Baths 214 
Deep therapy lamps 215 
Heat applicators 215 
Ultra-violet rays 215 
Radicle-s 367 
Carbonate 369 
Formula for 368 
Radius 12 
Rain water 286 
Rating-s: 
Advancement in, forms for 648 
Civilian employees, commissary depart- 
ment, naval hospitals 650 
Enlisted personnel 593 
Ration memoranda 678 
Rats, extermination of 273 
Reactions, chemical 363 
Reaumur scale 300 710 
INDEX, 
Page. 
Recipes: 
Beef juice 234 
Chocolate- 
Shake 233 
Syrup 233 
Cocoa 232 
Junket 235 
Coffee 233 
Custard 234 
Egg-s 233,234 
Nog 232 
Milk- 
Malted, chocolate or cocoa 233 
Peptonized 232 
Orangeade 232 
Orange jelly 235 
Tea, beef, with hydrochloric acid 234 
Receptors 509 
Recruiting stations, complement of 575 
Rectified oil of tar 454 
Rectifier, X-ray 546 
Red: 
Cells 20 
Cinchona 470 
Reducing agents 375 
Reduction 375 
By traction or extension, shoulder dislo- 
cation 75 
Reflex action 48 
Refrigerants 409 
Refuse: 
Ashore 295 
Disposal of 295 
Dry rubbish 295 
Garbage 295 
Manure 296 
Ships 295 
Regimental: 
Medical detachment— 
Ambulance company 542 
Collecting stations 542 
Field medical supply depot 544 
Hospital company 543 
Organization of. .. 542 
Sanitary company. 542 
Service company 542 
Surgeon, expeditionary force 540 
Register, accounting system: 
Charge 636 
Expense analysis 636 
Regular diet 232 
Regulations for mailing laboratory specimens. 575 
Remains: 
Forms for shipment of. 648 
Preparation of: 
Arterial injection, embalming 348 
Cavity inj ection, embalming 350 
Fluid, embalming 350 
Removal of foreign bodies 86 
From ear 87 
Eye 87 
Nose 87 
Skin 88 
Stomach and intestines 88 
Throat 88 
Page. 
Renal depressants 409 
Rennin 36 
Renovation 239 
Reports: 
And returns 637 
Annual 649 
Daily 1 649 
Hospital Corps forms 637 
Monthly ' 649 
Quarterly 649 
Sanitary 582 
Semi-annual 649 
Weekly 649 
When necessary 650 
1st. and 16th. of month 649 
15th. of month 649 
28th. of month 649 
N. M. S. H. 36 676 
Preparation of form— 
F 529 
K 529 
Requisition-s: 
Headstones 648 
On supply depots 629 
Open purchase 629 
Stub 629,631 
Resin-S 400,457 
Jalap 464 
Podophyllum 464 
Scammony 464 
Resorcin 447 
Respiration 123 
Apncea 32 
Asphyxia 32 
Cycle of 31 
Dyspnoea 32 
Types of 32 
Respiratory: 
Depressants 409 
Stimulants 409 
System: 
Bronchi 30 
Larynx 30 
Lungs . 31 
Nasal chambers 30 
Organs of. 30 
Pharynx 30 
Pleura 31 
Trachea 30 
Tract, diseases of 143 
Restraining apparatus 137 
Resuscitation of apparently drowned 89 
Retina 50 
Rheostat, X-ray 547 
Rheumatic fever 146 
Rhizopoda 511 
Rhubarb, fluidextract of 465 
Rib-s 10 
Fracture, symptoms and treatment 80 
Rickets 285 
Treatment by ultra-violet rays 217 
Rigor mortis 16 
Roentgenography 549 
Roentgenology. (See X-ray). 
Roller bandages 99 INDEX 
711 
Page. 
Roots and tubers for food 228 
Rotary convertor, X-ray 546 
Rotation, joint....- 15 
Rubber gloves, use in surgery 171 
Rubefacients 131 
Sac, lachrymal 49 
Saccharine and sugar substances 462 
Salaries, Navy Department, appropriation .. 603 
Salicylic acid 450 
Saline: 
Infusion 229 
Irrigation 229 
Salivary glands, description of 33 
Salol 450 
Salt: 
Normal solution 168 
Physiological solution 190,424 
Use in food 223 
Salting and pickling of food 673 
Salts 371,381 
Acid 371 
Alkaloidal 467 
Basic 371 
Double 371 
Normal 371 
Salvarsan 432 
Sanitary: 
Company, regimental medical detach- 
ment 542 
Devices, field- 
incinerators 314 
Latrines 314 
Urinals 314 
Inspector, Marine Corps posts 540 
Investigations, on independent duty 526 
Reports 532 
Survey, shore patrol 538 
Sanitation. (See Hygiene and sanitation.) 
Field- 
Camp site, selection of 323 
Feet, care of 323 
Insect control 318 
Marching 321 
Value of 312 
Waste 313 
Collection 313 
Disposal 313 
Water 312 
Santal, oil of 456 
Santonin 463 
Scapula 11 
Sarcophaga carnaria 520 
Sarcoptes scabiei 517 
Scarlet fever 140,246 
Saturated solution 392 
Sayre dressing 107 
Schaffer’s method 89 
Schistosomes 513 
School, naval medical 607 
Sclera 50 
Scopolamine hydrobromide 474 
Scurvy 285 
Secondary: 
Haemorrhage 64 
Stage, syphilis 333,335 
Secretary of the Navy 583 
Sedatives. 407 
Page. 
Sediment, definition of 393 
Sedimentation, water 288 
Seminal vesicles 42 
Senses, special 49 
Separation, fluids from solids 392 
Sepsis 167 
Septic: 
Sore throat 247 
Tanks 293 
Septicaemia 143 
Sero-albumin 21 
Serous membranes 18 
Serum-s: 
Agglutinins 609,510 
Amboceptors in 510 
Anaphylaxis 508,509 
Antidiphtheritic 481 
Antigen 509 
Antitoxins 509 
Bacteriolysins 509 
Cytolysins 509 
Fixation of complement 510 
Immune 508 
Opsonins 509 
Pneumococcus 509 
Precipitins 509 
Procuring of 632 
Receptors 509 
Shock, anaphylactic 508,509 
Sickness 508 
Status lymphaticus 508 
Syphilis, diagnosis 510 
Tetanus antitoxin 508 
Therapy 508 
Immunity 508 
Vaccination 510 
Vaccines 510 
Service company, regimental medical detach- 
ment 542 
Sewage: 
Digestion tanks 293 
Dilution 292 
Disposal of 292 
Dry. system 295 
ImhofE tanks 294 
Purification , 294 
Septic tanks 293 
Treatment 293 
Water carriage system 292 
Sexual organs, male 326 
Shick test 507 
Ships: 
Disposal of refuse on 295 
Fumigation of 271 
Ventilation- 
Artificial 279 
Combined system 280 
Exhaust system 280 
Natural 279 
Plenum system 279 
Supply system 279 
Shock 59 
Anaphylactic serum 508,509 
Electric 91 
Symptoms of 50 
Treatment of 60 712 
INDEX, 
Shore patrol: Page. 
Dressing station 537 
Duty with 533 
Equipment for 536 
Medical detachment 536 
Prophylactic station 537 
Sanitary survey 538 
Shoulder dislocation 74 
Kocher’s method of reduction 75 
Reduction by traction or extension 75 
Stimson’s method of reduction 74 
Sialogogues 409 
Sick call: 
Duties at 527 
Ward 117 
Sick quarters, Marine Corps posts 540 
Siedlitz powder 420 
Silk clothing 297 
Silver: 
Colloidal 438 
Compounds of 438 
Molded nitrate 438 
Nitrate 438 
Protein 438 
Silvol 438 
Simple: 
Syrup 398 
Solution 392 
Sinusoidal current 219 
Siphonate mosquito 519 
Sippy diet 230 
Sitz bath '. 160 
Skeleton: 
Definition of 6 
Divisions of 8 
Skin 40 
Cuticle.... 40 
Derma 40 
Description of 40 
Diseases, treatment by ultraviolet rays.. 216 
Effects of ultraviolet rays on 216 
Epidermis 40 
Removal of foreign bodies from 88 
Skull, treatment for fracture of 79 
Sleep 52 
Smallpox 140,262 
Smears, blood work 504,505 
Smell, sense of 51 
Smoking of food 673 
Snake-s: 
Bites 69 
Treatment of 70 
Poisonous 520 
Colubrine family 520 
Viperine family 520 
Soap-s 403,459 
Liniment 398,461 
Soft 461 
Sodium: 
Benzoate 421 
Bicarbonate 422 
Borate 422 
Bromide 423 
Carbonate (monohydrated) 423 
Chloride 424 
Citrate 424 
Hydroxide 421 
Phosphate 425 
Sodium—Continued. Page. 
Salicylate 425 
Thiosulphate 425 
Soft diet 231 
Solute 392 
Solution-s: 
Chemical 392 
Definition of 392 
Eyewash, filtration of 392 
Hypodermic 392 
Hypophysis 466 
Pharmaceutical 398 
Saturated 392 
Simple 392 
Solvents 392 
Solvents 392 
Soporifics 409,484 
Drug addiction 484 
Sore throat 98 
Sores, bed 160 
Special: 
Exigency public bills 632 
Senses 48 
Specialized cells 6 
Specific gravity: 
Definition of 387 
Of urine 522 
Specific volume, definition of 388 
Specifics 409 
Speech, function of 52 
Spermatic artery 27 
Spinal: 
Accessory nerves 47 
Anaesthesia 191 
Cord 46 
Nerves 47 
Spine, fracture of 79 
Spirillse 503 
Spirit of nitrous ether 452 
Spirits 398 
Spleen, description of 37 
Splints: 
Coaptation 78 
Materials used for 78 
Sponges, surgical dressings 170 
Sporozoa 512 
Sprain 72 
Treatment of 72 
Squadron medical officer, duties of 530 
Squamous cells 6 
Stains, bacteriological 503 
Acid fast 504 
Bismarck brown 503 
Carbolfuchsin 503 
Eosin 503 
Gentian violet 503 
Gram’s 504 
Haematoxylin 503 
Methylene blue 503 
Staphylococcus 167 
Starch, corn 461 
Starchy and mucilaginous substances 461 
Statement, expense analysis 636 
Static electricity 221 
Stations, miscellaneous naval 596 
Statistical method, terms defined 299 INDEX, 
713 
Page. 
Statistics, vital 299 
Interpretation of 309 
Status lymphaticus 508 
Steapsin 37 
Stenosis 24 
Stereoscopic roentgenography 550 
Sterilization 168 
Alcohol 169 
Asepsis in operating rocm 166 
Autoclave 166,168 
Bichloride of mercury 169 
Boric-acid solution 169 
Carbolic acid 169 
Chemical 169 
Cocaine solution 190 
Dakin’s solution 169 
Equipment, Navy standard 165 
Formaldehyde 169 
Iodine 169 
Iodoform 169 
Irrigation of wounds 168 
Mechanical 168 
Media 503 
Methods 168 
Operating-room linen 171 
Potassium permanganate 169 
Room 165 
Thermal 168 
Water- 
Chlorinated lime 290 
Copper sulphate 290 
Ozone 290 
Ultrarviolet rays 290 
Sterilized distilled water 414 
Sternum 10 
Sternutatory gases (sneeze gases): 
Di-phenyl-chlor arsine 557,559 
Di-phenyl-cyan arsine 557 
Stimpson’s method for reduction of disloca- 
tion 74 
Stimulants 407,481 
Stock: 
Card 678 
Ledger 636 
Solution of mercuric chloride 392 
Stomach: 
And intestines, removal of foreign bodies 
from 88 
Description of 33 
Haemorrhage from 64 
Tube, use in poisoning 499 
Stomachics 409 
Stomoxys calcitrans 520 
Storeroom: 
Commissary department, naval hospitals. 
Dry provision 651 
Issuing 651 
Stores, care of 528 
Stovaine, use in anaesthesia 192 
Strain 72 
Treatment of 72 
Strategy, naval, defined 597 
Streptococcus 167 
Strontium 427 
Strophanthus 463 
Tincture of. , 463 
Page. 
Strychnine: 
Poisoning by 495 
Sulphate 472 
Stupes 131 
Turpentine 131 
Styptics 409,477 
Subclavian vein. 29 
Subcutaneous: 
Administration of drugs 411 
Feeding 229 
Injections 127 
Sublimation 390 
Submarine bases 596 
Sucrose 462 
Sudorifics 482 
Suffocation 88 
Artificial respiration in 89 
Choking, treatment for 90 
Hanging or strangling, treatment for 90 
Poisonous gases 90 
Resuscitation of apparently drowned 89 
Schaffer’s method 89 
Treatment for 89 
Sugar: 
And saccharine substances.-... 462 
Of lead 434 
Presence in urine 523 
Sulphonated oil 440 
Sulphur: 
Sublimed 415 
Dioxide, disinfectant 268 
Sulphuric acid, graphic formula of 370 
Poisoning by 496 
Water mixed with 396 
Sunstroke 83 
Superior mesenteric artery 27 
Supplies and Accounts, Bureau of 589 
Supplies, procuring of: 
Alcohol 633 
Amboceptor paper 633 
Annual contract, Bureau of Yards and 633 
Docks 633 
Antigen ;... 633 
Bacterial cultures, emulsions 633 
Blood stain 633 
Bottles and vials, for mailing 633 
Culture media 633 
Departmental contracts 633 
Forms 633 
Mailing cases 633 
Requisitions 628,629 
Serums 632 
Special ,. 632 
Transfer of labor from navy yard 633 
Typhoid prophylactic 632 
Vaccines 632 
Supply table, classification of drugs on 477 
Suppository-ies 400 
Rectal 151 
Suppuration 167 
Suppurative tonsillitis 145 
Suprarenal-s: 
Artery 27 
Dried 466 
Glands 38 
Surface water— 287 714 
INDEX, 
Page. 
Surgeons general 600 
Surgery (See operating room and surgical tech- 
nique). 
Surgical: 
Dressings 155 
Drainage material 171 
Forms of 170 
Gauze dressings 170 
Kinds of 156 
Materials used 169 
Packs 170 
Procedure in applying 156 
Sponges 170 
Strips 170 
Nursing 146 
Technique (See operating room and surgi- 
cal technique). 
Survey: 
Medical department property 634 
Medical, for drug addiction 487 
Suture-s 68,172 
Needles for 68 
Removal from skin 156 
Sweat: 
Characteristics of 39 
Glands 40 
Sweet birch, oil of 455 
Symbols, chemical 357 
Sympathetic nervous system 43 
Symptoms, poisoning 490 
Table of 497 
Syndesmology, definition of 6 
Synovial membrane 19 
Synthesis 354 
Syphilis 259 
Arsphenamine 336 
Administration of 339 
Chancre 334 
Detection of, by serum reaction 506 
Diagnosis of, by serum reaction 510 
Infection, sources of 334 
Initial lesion 334 
Mercury— 
Intramuscul ar in j ection 342 
Inunction 342 
Neoarsphenamine 340 
Administration of 342 
Stage: 
Primary 333 
Secondary 333,335 
Tertiary 334,335 
Treatment of 336,481 
Treponema pallidum 333,334,344 
Syrups 398 
Glucose 399 
Iodide of iron 398 
Ipecac, glycerin used in 399 
Simple 398 
Systemic veins 28 
Table: 
Of inorganic acids 381 
Atomic weights 379 
Measures 385 
Weights 385 
X-ray 548 
Tactics,naval, defined 597 
Page. 
Taenia saginata 514 
Taenia solium 514 
Tseniacides 409 
Talc, purified 428 
Tannic acid 450 
Tape worms 513 
Tapotement 194 
Target, X-ray 545 
Tartaric acid 451 
Taste: 
Buds 51 
Sense of 51 
Teeth: 
Cementum 110 
Changes in structure Ill 
Cleaning of Ill 
Crown 110 
Decay of ill 
Dental pulp ill 
Dentine no 
Dentinal tubules 110 
Divisions of Ill 
Enamel 110 
Filling, temporary 114 
Fundamental parts 110 
Neck .' 110 
Odontoblasts 110 
Peridental membrane 110 
Pulp cavity 110 
Root 110 
Structure of no 
Telegrams, forms of 649 
Temperature: 
Of— 
Patient 120 
Wards 118 
Tenacity, definition of 355 
Terebene 457 
Terminal disinfection 239 
Ternary compounds 361 
Terpfn hydrate 457 
Tertiary stage, syphilis 334,335 
Testes 42 
Testicles 42 
Tetanus 143,264 
Antitoxin serum 508 
Theoretical pharmacy 383 
Therapeutic-s: 
Definition of 407 
Incompatibility 405 
Therapy, X-ray: 
Deep 552 
Electric current dangers 553 
Erythema dose 552 
Superficial 552 
Thermometer: 
Clinical 120 
Scales used in marking 390 
Thoracic duct 29 
Thorax 10 
Throat, removal of foreign bodies from 88 
Thrombin 22 
Thymol 455 
Iodide 455 
Thymus gland 38 
Thyroid gland 38 
Tibia, description of 14 INDEX, 
715 
Page. 
Ticks 518 
Tincture-s 399 
Aconite 474 
Camphorated opium 469 
Capsicum 456 
Cinchona, compound 470 
Digitalis 463 
Gentian, compound ' 464 
Iodine 399,413 
Potassium iodide used in 399 
Myrrh 458 
Nux vomica 473 
Opium 469 
Strophanthus 463 
Tissue-s: 
Adipose 6 
Areolar 6 
Cartilaginous 6 
Connective 6 
Epithelial..' 6 
Fiber 6 
Fibrous 6 
Fluid 6 
Lymphoid 6 
Muscle 15 
Muscular 6 
Nervous 6 
Osseous 6 
Varieties of 6 
Titration 377,378 
Tongue, description of 33 
Tonicity, muscle 16 
Tonics 409 
Tonsillitis, follicular 145 
Torpedo stations, naval 596 
Torrefaction 390 
Torsion balance 387 
Tourniquet, use of 62 
Toxicology 489 
Definition of 383,489 
Poison 489 
Toxins 507 
Food 284 
Trachea 30 
Trachoma 264 
Training stations, naval 596 
Transfer: 
Medical department property 634 
Patients, to special hospitals, forms for.. 648 
Transformer, X-ray 546 
Trematodes 513 
Treponema pallidum 333,334,344,506 
Trichinella spiralis 516 
Trichinosis 261 
Trichiuris trichiura 516 
Tricresol 447 
Trigeminal nerves 47 
Trinitrophenol 447 
Trinitrotoluene poisoning 496 
Trituration 391 
Trochlear nerve 47 
Tropococaine, use in ansethesia 192 
Trypanosoma gambiense 511 
Trypsin 37 
47829—23 16 
Page. 
Tuberculosis 144 
Diet in 231 
Other than pulmonary 248 
Pulmonary 248 
Treatment by ultra-violet rays 216 
Tubes, X-ray: 
Coolidge 545 
Gas 545 
Terminals— 
Anode 545 
Cathode 545 
Turpentine: 
Oil of. 457 
Stupes 131 
Type processes 397 
Typhoid: 
Fever 141,253 
Prophylactic, procuring of 632 
Typhus 143 
Fever 256 
Ulcer, perforated, gastric or duodenal 95 
Ulna 12 
Ultra-violet rays: 
Mercury vapor arc lamp 217 
Quartz lamp, operation of 217 
Rickets, treatment by 217 
Skin— 
Diseases, treatment by 216 
Effect on 216 
Sources of 216 
Sterilization of water by 290 
Tuberculosis, treatment by 216 
Wounds, treatment by 217 
Unconsciousness 90 
Caused by alcoholism 93 
Hysterical 92 
Unsaponifiable fats 403 
Uraemia 92 
Ureters 41 
Urethra 42 
Urinalysis 522 
And blood chemistry 521 
Urinary: 
Bladder 42 
System 40 
Kidneys » 40 
Organs of 40 
Ureters 41 
Urethra 42 
Urinary bladder 42 
Urine: 
Albumin, presence in 523 
Characteristics of 39 
Color 522 
Composition of 522 
Description of 522 
Examination before operation 148 
Examination of 522 
For examination 522 
Microscopical examination of 524 
Odor 522 
Reaction 522 
Specific gravity 522 
Sugar, presence in 523 
Transparency 522 716 
INDEX, 
Page. 
Uratropine 445 
Vaccination 510 
Smallpox, methods of 262 
Vaccine-s: • 
Autogenous 510 
Bacterial 510 
Procuring of 632 
Stock 510 
Vacuum electrode treatments 221 
Valence 358 
Valuables, patients’ 565 
Valves, heart 24 
Vaporization 390 
Vascular system 19 
Organs of 23 
Veal: 
As food 227 
Cuts of 664 
Vegetable: 
Drugs containing cathartic principles... 464 
Foods 228 
Vein-s: 
Description of 25,28 
Division of 28 
Forearm and arm 29 
Innominate 29 
Jugular 29 
Mesenteric 29 
Neck, great superficial 29 
Portal system 29 
Pulmonary . 28 
Subclavian 29 
Systemic 28 
Vena azygos 29 
Venae cavae 29 
Velpeau bandage 105 
Vena azygos 29 
Venae cavae 29 
Venereal: 
Diseases 324 
Balanitis 331 
Chancroid 343 
Effects of 324 
Epididymitis 331 
Examination of crew 531 
Gonorrhoea 326 
Symptoms of 327 
Gonorrhoeal ophthalmia 332 
Herpes 346 
Paraphimosis 331 
Phimosis 331 
Prevention of 346 
Prophylactic treatments 346 
Prostatitis 332 
Syphilis 333 
Venereal warts 345 
Treatment of 345 
Wards 116 
Venous haemorrhage 61 
Ventilation: 
Artificial, on shore 279 
Definition of 278 
Natural, ashore 279 
Of houses 279 
O f operating room 164 
Of wards 118 
Of ships 279 
Test for 280 
Page. 
Vermicides 409 
Vermifuges 409 
Vermin, destruction of 273 
Vertebrae io 
Vertebral column 10 
Vesical: 
Sedatives 410 
Tonics 410 
Vesicant-s 131 
Gases, poison: 
Lewisite 557 
Mustard 557,560 
Vincent’s angina 114,145 
Vinegars 396 
Viscera, animal, for food 227 
Vital statistics. (See Statistics.) 
Vitamines 285 
In foods 226 
Vitreous body 50 
Volatile oils 403,452 
Volume. (See Specific): 
Volumetric solutions 377 
Normal 378 
Double 378 
Hundredth 378 
Tenth 378 
Wards: 
Care and cleaning of 118 
Cleaning material 118 
Cleanliness of 118 
Daily routine duties in 117 
Lighting of 283 
Management and general supervision of.. 116 
Patients, admission of 116 
Sick call 117 
Temperature of 118 
Venereal 116 
Ventilation of 118 
Warrant officers 592 
Water-s . 396,414 
Ammonia 396 
Stronger 426 
Analysis, sanitary 288 
Artesian wells 287 
Borne diseases 141 
Chlorination of 291 
Definition of 414 
Distilled 287,414 
Field sanitation- 
Canteens, care of. 313 
Chlorination 313 
Daily allowance 312 
Purification 313 
Source 312 
Storage, collection, and distribution.. 313 
Filters 290 
Filtration, sand 290 
Ground 287 
Of crystallization 391 
Official, manufacture of 393 
Purification of 288 
Rain 286 
Relation to health and disease 286 
Sedimentation 288 
Shallow wells 287 
Source of supply 286 INDEX 
717 
Water-s—Continued. Page. 
Sterilization 290 
Sterilized, distilled 414 
Sulphuric acid, mixed with 396 
Supply, on march and in camp 290 
Surface 287 
Wax, white 460 
Weighing, definition of 385 
Weight-s: 
Atomic 356 
Table of 379 
Definition of. 385 
Molecular 357 
Table of 385 
Wells: 
Artesian 287 
Shallow 287 
Wet: 
Dressings 133 
Pack 208 
Whooping cough 249 
Wild cherry, fluidextract of. 456 
Wintergreen, oil of 455 
Wool clothing 297 
Worms: 
Ascaris lumbricoides 515 
Cestodes '.. 513 
Clonorchis endemicus 513 
Fasciolopsis buski 513 
Filaria bancrofti 516 
Flat 513 
Flukes 513 
Hookworms 515 
Hymenolepis nana 514 
Nemathelminthes 514 
Oxyuris vermieularis 516 
Paragonimus westermanni 513 
Pin or seat 516 
Round 514 
Schistosomes 513 
Taenia saginata 514 
Taenia solium 514 
Tape... 513 
Trematodes 513 
Trichinella spiralis 516 
Trichuris trichiura 516 
Wound-s 64 
Abdominal 71 
Aerobic bacteria present in 65 
Anaerobic bacteria present in 65 
Clean or aseptic 64 
Contused 64 
Crushing 65 
Eye 71 
From rabid animal 69 
Gunshot 65,71 
Wound-s—Continued. Page. 
Healing: 
First intention 65 
S econd intention 65 
Incised 64 
Infected or septic 64 
Insect bites 70 
Lacerated 64 
Penetrating, chest 71 
Poisoned..' 64 
Poisoning: 
Colubrine snake » 70 
Viperine snake 70 
Poisonous 69 
Punctured 65 
Snake bites 69 
Sutures 68 
Treatment— 
By ultra-violet rays 217 
General principles 65,67 
Xerophthalmia 285 
X-ray: 
Accessories 551 
Cassette...'. 551 
Characteristics of 545 
Dangers from 553 
Darkroom 550 
Definition of 544 
Fluoroscopy 549 
Intensifying screens 551 
Machine 545 
Autotransformer 547 
Control apparatus 547 
Filament circuit 548 
Motor 546 
Rheostat 547 
Rotary converter 546 
Transformer 546 
Wiring, overhead 547 
Physics 544 
Roentgenography 549 
Stereoscopic 550 
Table 548 
Therapy 552 
Tubes 545 
Xylyl bromide gas 557,559 
Yards and Docks, Bureau of 586 
Yellow: 
Fever 142,257 
Wax 401 
Young’s rule 410 
Zinc: 
Compounds of 429 
Oxide 429 
Sulphate 430 
Zingiberis, fluidextract of 454 
Zoology, definition of 383 ADDITIONAL COPIES 
OF THIS PUBLICATION MAY BE PROCURED FROM 
THE SUPERINTENDENT OF DOCUMENTS 
GOVERNMENT PRINTING OFFICE 
WASHINGTON, D. C. 
AT 
$1.00 PER COPY 
PURCHASER AGREES NOT TO RESELL OR DISTRIBUTE THIS 
COPY FOR PROFIT.—PUB. RES. 57, APPROVED MAY 11, 1922