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THE
^  vAR
                    n/         587
HOSPITAL  STEWARD'S
MANUAL:
U..-  ,?•-,
FOR THE INSTRUCTION OF
HOSPITAL STEWAEDS, WAED-MASTEES, AND ATTEND-
      ANTS, IN THEHt SEVEEAL DUTIES.
PREPARED IN STRICT ACCORDANCE WITH EXISTING REGULATIONS
   AND THE CUSTOMS OF SERVICE IN THE ARMIES OF THE
          UNITED STATES OF AMERICA,


  AND RENDERED AUTHORITATIVE BY ORDER OF THE SURGEON-GENERAL.
  JOSEPH JANVIER WOODWARD, M.D.
ASSISTANT SURGEON U.S.A., MEMBER OF THE ACADEMY OF NATURAL SCIENCES
           OF PHILADELPHIA, ETC.
     PHILADELPHIA:
J. B.  LIPPINCOTT & CO.
         1862. 
     Entered according to Act of Congress, in the year 1862, by

              JOSEPH JANVIER WOODWARD,                              V

in the Clerk's OflBce of the District Court of the United States for the
                     District of Columbia.
!
( 
PEEEACE.
  The preparation of this little work was sug-
gested to the author by the Surgeon-General.
It was hastily written  to supply an  existing
want.   Had  it  been  otherwise,  more  time
would have been given to its composition, and
perhaps a  more  complete  work would  have
been the result.   It is hoped, however, that it
will prove useful to surgeons as  well  as  at-
tendants, and  that  it will be found a material
aid in the laborious duties of the Medical Staff
in hospitals and in the field.
                    J.  J. Woodward,
                     Assistant Surgeon U.S.A.
  Washington, Sept. 10,1862.
3 
OFFICIAL ORDERS.
                         Surgeon-General's Office,
                       Washington City, August 5, 1862.
  Surgeons J. K. Barnes and J. R. Smith, U.S. Army,
are hereby appointed a Board to examine and re-
port upon a work entitled " The Hospital Steward's
Manual," presented by Assistant Surgeon J. J. Wood-
ward, TJ. S. Army.
                      William A. Hammond,
                          Surgeon-General U.S.A.
                         Surgeon-General's Office,
                      Washington City, August 19, 1862.
  The Board  having critically examined the work
presented by  Assistant Surgeon  J. J. Woodward
U.S.A., entitled " The  Hospital Steward's Manual,"
report that this work is written in strict accordance
with  the regulations of the army and the customs
of the service; that the book supplies a deficiency
which has been long  felt; and respectfully  recom-
mend that it be  adopted for  the  instruction of hos-
pital stewards, and as  an authority in all military
hospitals in the United  States.
                       Joseph K. Barnes,
                                Surgeon  U.S.A.
                       Joseph R. Smith,
                                Surgeon  U.S.A. 
OFFICIAL  ORDERS.
5
                       Surgeon-General's Office,
                   Washington City, September 10, 1862.
  "The  Hospital  Steward's  Manual,"  prepared  by
Assistant Surgeon J.  J. Woodward, U.S. Army, hav-
ing been approved by a Board of Medical Officers, is
adopted  as  a guide to  hospital  stewards and other
attendants, and will be strictly adhered to by them in
the discharge of their duties.
                      "William A. Hammond,
                          Surg eon-General  U.S.A.
l* 
 
CONTENTS.
        PART I.—HOSPITAL ATTENDANTS.
                                                 PAGE
CHAP. I.—Hospital Stewards................................... 13
    Sec. 1.—The Rank of Hospital Stewards.................. 13
     "  2.—The Pay of Hospital Stewards..................... 16
     "  3.—The Enlistment and Appointment of Hospital
             Stewards............................................. 17
     "  4.—The Uniform of Hospital Stewards............... 25

CHAP. II.—Other Hospital Attendants..................... 29
    Sec. 1.—Enlisted Men  as Hospital Attendants..... 29
     "  2.—The Hospital Corps................................... 32
     "  3.—Female Nurses......................................... 38
     "  4.—Laundresses............................................. 41

CHAP. III.—General Outline of  the Duties of Stew-
        ards AND OTHER HOSPITAL ATTENDANTS............ 42
    Sec. 1.—Number  of  Stewards and other Attendants
             allowed in Hospitals  and in the Field........ 42
     "  2.—Outline of the Duties of Stewards................ 43
     «  3.—Outline of the Duties of Ward-Masters......... 47
     "  4.—Outline of the Duties of Nurses.................. 54
     "  5.—Cooks and Laundresses.............................. 67
     "  6.—Duties of Hospital Attendants in Battle........ 67
                                              7 
8
CONTENTS.
 PART  IL—DISCIPLINE,  POLICE,  AND  GENERAL
      SUPERVISION OF MILITARY HOSPITALS.
                                                    PAGE
CHAP. I.—General  Discipline of Hospitals..............  77
    Sec. 1.—Roll Calls..............................................  77
     "  2.—Daily Order of Hospital Duties.........•.........  78
     "  3.—The Steward's Visits of Inspection.............  82
     "  4.—Sunday Morning Inspection......................  83
     "  5.—Muster of Hospital Attendants and of Soldiers
              in Hospital absent from their Companies..  84
     "  6.—The Guard.............................................  92
     "  7.—The Guard-House....................................  93
     "  8.—Rules and Regulations for the Government of
              the Hospital.......................................  94

CHAP. II.—Police and General Supervision of Hos-
        pitals.........................................................  98
    Sec 1.—The Cleanliness of the  Hospital.................  98
     "  2.—Ventilation............................................ 101
     "  3.—Warming............................................... 105
     "  4.—Lighting................................................ 108
     "  5.—The Latrine........................................... 110
     "  6.—Baths and Lavatories............................... 112
     "  7.—The Wards of the Hospital, their Arrange-
             ment and Administration....................... 115
     "  8.—The Office of the Hospital......................... 121
     "  9.—The Knapsack-Room................................ 127
     " 10.—The Laundry.......................................... 129
     " 11.—The Linen-Room..................................... 132

CHAP. III.—Admissions, Discharges, Deaths, etc........ 134
    Sec. 1.—Admission of Patients.............................. 134
     "  2.—Return to Duty, Transfer to other Hospitals,
             Furloughs, Discharges, and Desertions..... 140
     "  3.—Of  Deaths....'................................... 143 
CONTENTS.                    9
     PART III.—FOOD AND ITS  PREPARATION.
                                                   PAQH
CHAP. I.—Provision Returns, Hospital Stores, Pur-
        chases for the Hospital, the  Hospital Fund
        and its Management.................................... 155
    Sec. 1.—Preliminary........................................... 155
     "  2.—The Ration............................................. 156
     "  3.—Provision Returns.................................... 162
     "  4.—Hospital Stores....................................... 166
     "  5.—Purchases for the Hospital........................ 166
     "  6.—The Hospital Fund, its Management........... 172
     "  7.—The Care of Provisions and Hospital Stores.. 179

CHAP. IL—Of the Diet-Table................................ 183
    Sec. 1.—Full Diet.......,....................................... 184
     "  2.—Half  Diet.............................................. 190
     «  3.—Low Diet............................................... 191
     "  4.—Extra Diet............................................. 192
     "  5.—Specimen of Diet Table............................ 193
     «  6.—Diet Table for Field Hospitals................... 201

CHAP. III.—Of the Kitchen  and  its Management.... 203
    Sec. 1.—General Management of  the Kitchen.......... 203
     «  2.—Fires and Fuel in General and Post Hospitals 210
     "  3.—Fires and Fuel in Camp  Hospitals.............. 214

CHAP. IV.—Cooking in Hospitals............................ 219
    Sec. 1.—General Remarks.................................... 219
     "  2.—Receipts adapted to the Ordinary Diet in
              Hospitals........................................... 222
     "  3.—Receipts for Extra Diets........................... 240

            PART IV.—THE DISPENSARY.

CHAP. I.—General Arrangement and Management of
        the Dispensary........................................... 263
    SEC. 1.—Requisitions for Medical Supplies............... 263 
 10                  CONTENTS.
                                                   PAGE
    Sec. 2.—The Supply Table................................... 267
     "  3.—Semi-Annual Returns.............................. 267
     "  4.—Arrangement of the Dispensary................. 270
     "  5.—Care of Instruments................................ 274

CHAP. II.—Hints on Pharmacy for Hospital  Stew-
        ards........................................................... 278
    Sec. 1.—Remarks on Prescriptions......................... 278
     "  2.—Compounding and Distribution of Prescrip-
              tions ................................................. 285


PART  V.—HINTS ON MINOR SURGERY AND DRESS-
         INGS FOR HOSPITAL STEWARDS.

CHAP. I.—On Dressings.......................................... 297
    Sec. 1.—General Preparations for Dressings............ 297
     "  2.—On the Dressing of Wounds...................... 299
     "  3.—On the Roller Bandage and its Applications 304

CHAP. II.—Operations in Minor Surgery, performed
       by  the Hospital  Steward........................... 313
    Sec. 1.—Cupping................................................  313
    • " 2.—Leeching..............................................  317
     "  3.—Extraction of Teeth.................................  319
     " 4.—Injections..............................................  322 
      PART I.




HOSPITAL ATTENDANTS. 
NOTE.
  The hospital attendants authorized by law
may be enumerated as follows :—
     1. Hospital Stewards.
     2. Ward-Masters.
     3. Nurses.
     4. Female Nurses.
     5. Cooks.
     6. Laundresses.  (Called also Matrons in
         " Army Regulations.")
  Each of these classes will  be made the sub-
ject  of separate remark.
12 
                  THE

HOSPITAL STEWARD'S MANUAL.
              CHAPTER  I.

           Hospital  Stewards,
 SECTION I.—THE RANK OF HOSPITAL STEWARDS.

  The hospital steward is a non-commissioned
officer ; he ranks with ordnance sergeants, and
next above  the first sergeant of a company.*
He is therefore entitled by his rank to obedience
from all enlisted men who may be in the  hos-
pital, whether  patients, ward-masters, nurses,
or employes, who must cheerfully and promptly
comply with all his reasonable and lawful com-
mands.  In his relations to the medical officers,
or to commissioned officers generally, however,
he must never forget  that he  is an enlisted
man, and owes prompt and ready obedience to
the lawful commands of his military superiors.

  * Revised Regulations for the Army, 1861, Art. II, g 4.
                    2              13 
14     THE HOSPITAL STEWARD'S MANUAL.

  In all matters pertaining to discipline, the
military laws applying to the hospital steward
are the same as for any other soldier,  and he
is bound, to the same extent, to comply with
army regulations, and with the articles of war.
  For disobedience of orders, neglect of duty,
drunkenness, or any other military offence, the
hospital steward  may be placed in arrest by
the  commanding  officer, or other competent
authority, and may be tried and punished  by
court-martial, as in the case of other enlisted
men.  A single exception in favor of  the hos-
pital steward  is  intended  especially for  the
protection  of those w,ho originally enlisted as
such.  It  is  laid down in the following regu-
lation :—
  " The jurisdiction  and authority of courts-
martial are the same with reference to hospital
stewards as in the  cases of other enlisted men.
When, however, a hospital steward is sentenced
by an inferior court to be reduced to the ranks,*
such sentence, though it may be approved  by
the reviewing officer, will not be  carried into
effect until the case  has been referred to the
Secretary  of War for final action.   In these
* That is, the rank of a private soldier. 
      THE  HOSPITAL STEWARD'S MANUAL.    15

cases of reduction, the application of the man
for discharge from  service, though not recog-
nized as of right, will generally be regarded
with favor, if his offence has not been  of too
serious a nature, and especially when he has not
been recently promoted  from the ranks."*   It
is, however, provided that  hospital stewards
are not to  be tried  by regimental or  garrison
courts-martial, unless by special permission of
the department commandeivj-
   Where several hospital stewards are serving
together, as frequently  happens in the great
general hospitals, their relative rank is decided
by the seniority of their warrants, as  in the
case of other non-commissioned officers.  This,
however, is  not  construed to prevent the sur-
geon in  charge  from  selecting the hospital
steward regarded  by him as the most active
and efficient for the position of  chief steward,
and confiding to his charge the general care of
the hospital.  The  chief steward is  ex officio
the ranking steward for the time-being, and
must be obeyed and respected accordingly by the
other stewards, as well as by the ward-masters,
nurses, and patients.
      * Revised Regulations, 1861, Art, XLIV. \ 1292.
      t Revised Regulations, Art. XXXVIII. § 895. 
 16    THE HOSPITAL STEWARD'S MANUAL.


  SECTION II.--THE PAY OF HOSPITAL STEWARDS.
   The pay of a hospital steward appointed by
 the Secretary of War was formerly that of an
 ordnance sergeant, $22 a month,  with one ra-
 tion a day, and  the clothing allowance of an
 enlisted man.  By an act of Congress of April
 16, 1862, entitled "An Act to reorganize  and
 increase  the  efficiency of the medical depart-
 ment of the army," the pay has, however, been
 increased from $22 to $30 per month, which
 is the present rate, the other  allowances re-
 maining the same.
  In  barracks  he  is  entitled  to  one room
 as quarters, to half a cord  of wood monthly
 from  May 1  to  September 30, and one  cord
 for  each  month  from October  1  to April 30.
 The ration is issued only in kind, and is not
 commuted in  money.
  The clothing  allowance need not be drawn
in full; and any savings in this respect are paid
to the steward in the final settlement of his
accounts.
  Acting  hospital stewards (see  next  section)
receive but $20 a month, except when serving
at posts of more than four  companies, when
they receive  $22 per  month;  their  rations, 
      THE  HOSPITAL STEWARD'S MANUAL.    17

clothing,  allowances,  &c. are  the  same  as
stewards regularly appointed.
  The steward is paid on a hospital muster
roll, on which are paid also the medical cadets,
female nurses, matrons, and  all  soldiers  in
hospital, sick or on duty,  who are detached
from their companies.
  These muster rolls  must be  made out in
the forms furnished from the  Adjutant-Gene-
ral's office, and  according to  the directions
expressed on them.*
  The surgeon in charge is responsible for the
accuracy of the rolls, which must be signed by
him and the mustering officer.
  Should he  re-enlist, the hospital steward is
entitled to the same extra pay as other enlisted
men.  (See next section.)


SECTION III.--OF THE ENLISTMENT AND  APPOINT-
         MENT OF HOSPITAL STEWARDS.
  Hospital stewards may be  appointed from
the enlisted men of the army, or may be spe-
cially enlisted.   The appointment  is,  in every
case, made by the  Secretary of War.
* See Hospital Muster Roll, Part II. chap. II. \ 8.
                2* 
18    THE HOSPITAL STEWARD'S MANUAL.

  Non-commissioned officers  or  soldiers  may
be appointed  hospital stewards, on the recom-
mendation of the senior medical officer of the
hospital, post, or command.  This recommend-
ation must be endorsed  by the company com-
mander, and the commanding officer of the
post or detachment, and forwarded by the lat-
ter to the Adjutant-General of the army.
   "As  the object of these  more permanent
appointments is to procure the services of a
more competent body of hospital stewards, no
soldier, nor citizen, must henceforth be recom-
mended for appointment, who is not known to
be temperate, honest, and in every way relia-
ble, as well  as sufficiently  intelligent, and
skilled  in pharmacy, for the  proper  discharge
of the responsible duties likely to be devolved
upon him."*
 -  Hospital  stewards  may also be enlisted, as
such, from civil life.  Applications, in the hand-
writing of the  candidate, should be  addressed
to the Surgeon-General, accompanied by testi-
monials as to character and competency.  The
enlistment is for the term of three years.
   At the expiration of his enlistment,  should
* Revised Regulations, Art. XLIV. g 1288. 
THE HOSPITAL STEWARD'S  MANUAL.    19
he desire it, the hospital steward may be re-en-
listed by the commanding officer, on the recom-
mendation of the medical officer.  He is then
entitled, as are all enlisted men on re-enlist-
ing, to $2 per month additional pay, and $1
per month for each subsequent period of five
years' service, provided  he  re-enlists within
one month after the expiration of his term of
service.  When  enlisted men are  appointed
hospital stewards, the appointment is for  the
remaining unexpired term of service.  ' When
enlisted men  of the volunteer service are  ap-
pointed hospital stewards in the regular army,
they  must first be discharged  from service.
   In  addition, it is provided,  to meet the cur-
rent  wants of the service, and  especially of
troops in the field or distant posts, that  the
commanding officer may, on the  recommenda-
tion of the  medical officer, detail a soldier to
act as temporary steward.
   These  temporary stewards  are generally
designated as Acting  Hospital  Stewards.   At
posts of more than four companies they receive
$22 per month and the allowances of hospital
steward;  with  smaller  bodies  of  troops,  the
pay and allowances of a sergeant of infantry*
      * $20 per month. See act July 5,1838, sec. 12. 
 20    THE HOSPITAL STEWARD'S MANUAL.

   These  temporary  appointments  may  be
 regarded  as " affording the means of a careful
 probation of all soldiers  so detailed, who are
 ambitious of one day deserving a permanent
 appointment."*
   The candidate for enlistment or appointment
 as hospital  steward should be not less than
 eighteen nor more than thirty-five years of age.
 He must  be able-bodied and free from disease.
 Previous to his enlistment  he is inspected by
 a medieal officer, in the same manner  as any
 other recruit, and will  be rejected  if  found
 laboring under any disease or disability which
 would reject a recruit.  He should be of honest
 and upright character, of temperate habits, and
 good  general  intelligence.  He must have  a
 competent knowledge of the English language,
 and be able to write legibly and spell correctly.
 This point must be satisfactorily ascertained
 before he can be enlisted, as without this quali-
 fication it will be impossible for him to keep the
books and records, or to attend to the general
business of the hospital.   In addition, he must
have sufficient practical knowledge of pharmacy
to enable him to take  exclusive charge of the
* Revised Regulations, Art, XLIV. § 1289, note. 
      THE HOSPITAL STEWARD'S  MANUAL.    21

dispensary,  must be  practically acquainted
with such points of minor surgery as the appli-
cation of bandages and dressings, the extrac-
tion of teeth, and the  application of cups and
leeches,  and must have  such knowledge of
cooking  as  will  enable  him  to superintend
efficiently this  important branch of  hospital
service.
   He should be industrious, temperate, patient,
and good-tempered, and actuated by an honor-
able desire  to minister  to the extent.of his
ability to the necessities and  comforts of the
sick  and wounded  soldiers  who are placed
under his charge.
   On receiving  his appointment, the hospital
steward  receives, from the office of the Adju-
tant-General, a warrant made out in the follow-
ing form: 
22     THE  HOSPITAL  STEWARD'S  MANUAL.
HOSPITAL  STEWARD  AT----.
To all who shall see these presents, greeting:

   Know ye, that this is to certify that--------------, of
the -------  Regiment  of -------,  having been  recom-
mended as a  fit  person to  receive  the appointment of
Hospital Steioard, the Secretary of War has selected him,
in conformity with  the  second  section of the  Act of the
16th of August, eighteen hundred and fifty-six, entitled " An
Act providing for a necessary increase and better organiza-
tion of the Medical and Hospital Department of the Army:"
And he is hereby appointed accordingly, with all the rights,
privileges, immunities, and allowances appertaining to said
appointment, and  with the rank of a sergeant of ordnance.
He is, therefore, strictly charged carefully and diligently
to perform and execute all duties belonging to said appoint-
ment, in conformity with the rules and  regulations of the
service.  And he is to be respected accordingly.
        Given at the--------------, City of Washington,
           this----day of-------, 18----.
By command, 
      THE  HOSPITAL STEWARD'S MANUAL.    23

  " The accounts of pay, clothing, &c, of hos-
pital  stewards must be kept by the  medical
officers under whose immediate direction they
are serving, who are also responsible for certi-
fied statements of  such accounts, and correct
descriptive lists of such stewards, to accompany
them in case of transfer;  as also  that their
final statements and certificate of discharge are
accurately made out, when they are at length
discharged from the service."*
   The following is the form of  the descriptive
roll and account of pay and clothing:— -
* Revised Reg., Art. XLIV. \ 1293. 
Muster and Descriptive Roll, and Account of Pay and Clothing of-
	Names.	Rank.	Description.						Where Born.		. 1 a _o 03 o, s ©	Enlisted.				Last Paid.		B0UNTV		
No.			<		'8 W	d o b'S o ®		■a a M	j2 bo	o >, o o HO		a	-a	a o >> m	o 'u	S?fe	.a . > v oS	'3		Remarks.
																				
										.»									
	2		<t.	0 ^	■3 .		CJO p	oj	i	o	03 o		t-<					Date of	By whom
	s d	O 03	%*	op	S"S	™	M	G	oj oo	03	rt B1"	■a 3	is					Issue.	Issued.
	O <E																		
	£S	o S	*&	U m	£■2	M	CO	CQ	£g	©	©m		P						
																			
to
i-3

f1


H
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go"
I certify that the above is a correct transcript from the records of this office. 
THE HOSPITAL  STEWARD'S MANUAL.    25
  SECTION  IV.--OF THE UNIFORM OF  HOSPITAL
                  STEWARDS.
  The hospital  steward should always wear
his undress uniform in the  hospital, except on
those occasions,  such as musters and inspec-
tions, on which it is necessary for him to ap-
pear in  full dress.  This  point is of  more
importance than at first sight  appears.   The
strictest military discipline is absolutely neces-
sary in a military hospital; and it  will be too
generally found that an unmilitary neglect of
regulations in regard to dress coexists with a
general neglect of discipline and  regulation in
regard to other duties.
   The  uniform  of the  hospital steward  " for
fatigue purposes," that is, for all ordinary duties,
consists of the blouse, or sack-coat, and trousers,
prescribed  by regulations for all foot  soldiers.
The trousers are to have upon  the outer  seam
of  each leg a stripe of crimson worsted  lace,
one and one-half inch  wide.   It is advisable
that the half chevron  described for  the full
uniform of the  hospital  steward  should also
be worn upon the  undress coat.  He should
take enough pride in his  personal  appearance
                      3 
26    THE  HOSPITAL  STEWARD'S MANUAL.

to keep his clothes  neat  and his boots clean
and well blacked.
  The undress cap is the regulation forage cap,
similar to that of other enlisted men.
  The full uniform of a  hospital steward con-
sists of—
  1.  Uniform coat, which is  a dark-blue  cloth
single-breasted frock,  the  same  as  that pre-
scribed by army regulations for all enlisted foot
men; except  that the cord  or welt  of  cloth
which edges the cuffs and  collar is  crimson,
instead of  being sky-blue as for infantry, or
yellow as for engineers.
  2.  Trousers of dark-blue cloth, with a stripe
of crimson  lace one and  one-half inch  wide
down and over the outer seam.
  3. Hat, a black felt  hat, the same as that of
all enlisted men.  The cord  of buff and green
mixed, the  wreath in front of brass, with the
letters U. S. in Roman, of white metal.   Brim
to be looped  up to  side  of  hat with a  brass
eagle, having  a hook  attached to the bottom
to secure the brim.   The feather to  be  worn
on the side opposite the loop.
  3.  Cravat or stock, black leather, the same as
that of all  enlisted men. 
      THE  HOSPITAL  STEWARD'S MANUAL.^    27

  4. Boots  or shoes, the same  issued to all en-
listed men.
  5. Sash, "red worsted sash, with  worsted
bullion  fringe ends; to go twice around the
waist, and to tie behind the left hip,  pendent
part not to extend more than eighteen inches
below the tie."
  6. Stcord belt and plate, the  same as for  all
non-commissioned officers.
  7. Sword, the same as for non-commissioned
officers.
  8. Chevrons, " a half chevron of the follow-
ing description, viz.:  of emerald-green cloth,
one  and  three-fourths inches wide,  running
obliquely  downward  from  the  outer to the
inner seam of  the sleeve,  and at an  angle of
about thirty degrees with a horizontal, parallel
to and one-eighth of an inch distant from both
the upper and  lower edge, an embroidery of
yellow silk one-eighth of an inch wide, and in
the centre a 'caduceus' two inches long, em-
broidered  also with  yellow  silk,  the  head
towards the outer seam of the sleeve."*
   To  indicate   service,  the  additional  half
chevrons allowed for all  non-commissioned
* Revised Reg., Art. LI. g 1553. 
28    THE HOSPITAL  STEWARD'S  MANUAL.

officers, viz., at  the  expiration of  five years'
service, a diagonal  half chevron one-half an
inch wide, to be worn upon both sleeves of the
uniform coat, below  the elbow,  extending from
seam to  seam, the front end nearest the  cuff,
and one-half an inch above the point of the cuff,
to be of the same color as the edging on the
coat (crimson).  In like manner, an additional
half chevron, above  and parallel to  the first,
for every subsequent five years of  faithful
service.  Distance between each chevron, one-
fourth of an inch.
   Overcoat,  the same as for enlisted men.
   Cloves.—On full-dress occasions, white cotton
gloves should be worn.
  Scales.—On each  shoulder of the uniform
coat is worn a metallic scale,  the same as worn
by all non-commissioned officers and enlisted
men. 
THE HOSPITAL STEWARD'S MANUAL.    29
               CHAPTER  II.

          Other Hospital Attendants.

  Besides the  stewards, the following  classes
of hospital  attendants may be  enumerated:
enlisted  men,  civilians, the  hospital corps,
female  nurses,  and laundresses  (matrons  of
army regulations).
  The male attendants were  formerly all en-
listed men,  detailed for the duty by the com-
manding officer  on  the recommendation of the
surgeon.
  Recently,  however, the Secretary  of  War
has authorized the employment in certain cases
of civilians as  cooks  and  nurses, in  general
hospitals only;  and thus a new body of hos-
pital  attendants has  been  created, which is
designated the " Hospital Corps."

  SECTION I.--OF ENLISTED MEN AS HOSPITAL
                ATTENDANTS.
  Enlisted men selected as hospital attendants
may  be either'  non-commissioned  officers  or
                     3* 
30    THE HOSPITAL STEWARD'S MANUAL.

private  soldiers.  It is usual for non-commis-
sioned officers to be employed as ward-masters,
or in  some similar responsible positions, only,
and private soldiers for all other duty.
  In either case, the enlisted man, besides his
ordinary pay  and emoluments, is entitled to
twenty-five cents daily "extra duty pay," which
is paid by the paymaster on a roll made out by
the surgeon, after the form on p. 31.
  The pay and emoluments of these enlisted
men as  soldiers  are  obtained  from  the pay-
master,  on their descriptive lists,  or on the
hospital muster roll,  duly made  out by the
surgeon, on forms furnished from the Adjutant
General's office.*
  The distribution of these attendants as cooks,
nurses, &c, and the assignment to each of his
duties, is made by the  surgeon.
  Enlisted men thus employed  are under the
orders of  the  surgeon, to whom they are to
look up as their commanding officer.   They
are also  under  the  orders of  the  hospital
steward, to all whose  lawful commands they
must  yield prompt obedience.   They are  ex-
empt  from all other  duty,  but "shall attend
the parades for muster and weekly inspections
* See Part II. Chap. I. Sect. 5. 
CO
o
P3




C/2



H
i—i
Pi
cc
o
W

w
W
i?o#  0/ Soldiers employed on extra duty as Cooks and Nurses in the Hospital at

                 during the month of------, 186—, by------------, Surgeon.
	Names.	Rank or designation.	>> a 03 O. a ©	0) a 'So	By whose order employed.	Nature of service.	Term of service.			Rate of pay or compensation.			How employed.
No.							a 0 u ft	d	O	Per diem.	Dolls.	Cts.	Remarks.
										Cts.			
											/		
   I certify that the above is a correct roll of the enlisted men employed on extra duty, under my direction, during the month
0f_____(186—, and that the remarks opposite their names are accurate and just.

        Examined:                                                                               „
                         -----------, Commanding.                                      -----------> burgeon. 
32    THE  HOSPITAL STEWARD'S MANUAL.

of their companies at the post, unless specially
excused by the commanding officer."*
  Sobriety, intelligence,  and  cheerful  obedi-
ence to all lawful commands are indispensable
qualifications for hospital attendants, and those
who show capacity and industry are generally
selected by the surgeon for  promotion to the
higher grades of ward-master and steward.

     SECTION II.--OF  THE  HOSPITAL CORPS.
  Civilians may be employed as hospital  at-
tendants by the Surgeon-General, and by such
surgeons as have received from him the neces-
sary authority.   Their pay, emoluments, and
the regulations adopted with regard to them
are duly  set  forth in  the following  circular
issued by the Surgeon-General on the subject:—

               OIECULAK  No. 4.
             Surgeon-General's Office, June 5, 1862.
  The Secretary of War having authorized in
certain cases the employment of civilians as
cooks and nurses for duty in general hospitals,
(only,) the following rules and  instructions are
published for the information of all concerned:
* Revised Reg., Art. XLIV. § 1257. 
THE HOSPITAL STEWARD'S  MANUAL.    33
Regulations for the Hospital Corps of the United
                States Army.
  The men of  the hospital corps  will  each
receive  $20 50  per month, besides clothing,
rations, and medical attendance.
  They will be  under military discipline, and
subject  only  to the orders  of  the  medical
authorities, and will wear the undress uniform
of a private soldier, with a green half chevron
on the left fore-arm.
  Their duties will be either nursing  the sick
and wounded  of the army in  hospitals, cook-
ing, or any other duties with the sick, at the
discretion of the medical officers.
  They will be  divided into squads  of eleven,
one of whom will be responsible for the effici-
ency of the rest.  One squad will be  allowed
to every one hundred patients.
  At the usual roll-calls, the chief of the squad
will answer for the rest to the hospital steward.
who will thus learn the number of vacant beds
in each ward, and all -other particulars  con-
cerning the condition and wants of the hospital,
which he will  report to the medical "officer of
the day."   The  term of the service of the hos- 
 34     THE  HOSPITAL  STEWARD'S MANUAL.-

 pital corps  will  be according to the necessities
 of the  service, or during good conduct.
   The amount of pay and clothing received by
 each nurse, with date, will be recorded on their
 contract, which will  be as a descriptive list to
 go with the nurse.
   The  senior medical  officer in  charge  will
 make a monthly pay-roll of the hospital corps
 similar to Form 12, Medical Regulations, ex-
 cept the  rank  and designation, and transmit
 the  same  for  payment to the nearest medical
 disbursing officer.
   Surgeons  in  charge  of  general  hospitals.
 when so authorized, may make contracts with
 persons for  such service  according to the pro-
 visions set forth herein.
                   William  A.  Hammond,
                             Surgeon- General.

  Note.—It  is  hereby enjoined upon all medical officers that
 they shall not avail themselves of this special  authority of the
 War Department without first receiving permission of the Sur-
 geon-General to do so, on making a full statement of the facts
 in the case, and clearly setting forth the reasons why the per-
 mission should be granted, except in cases of immediate neces-
 sity and  urgency, and then 'the commanding officer  must
 approve.  In such exceptional cases the facts will be promptly
reported to the  Surgeon-General with the necessary explana-
tions, together with a request that permission  be given to con-
 tinue the employment if the necessity still exists. 
      THE HOSPITAL STEWARD'S  MANUAL.    35

  Civilians employed should possess the phy-
sical qualifications necessary for recruits. They
should be of good general intelligence, temper-
ate and industrious habits, and should be fully
imbued with the idea of the importance of their
calling, and of the responsibility of the duties
which they assume.
  The  same  strict obedience  is exacted from
them as from enlisted men.
  Civilians employed as  nurses  or cooks  are
contracted with by the officer employing them,
in accordance with the  following form:—

Form  of Contract with a Civilian, to act  as
             Hospital Attendant.

   I______________9 hereby agree to  serve in
the army of the United States, in the capacity
of nurse, and to perform  such other duties in
connection with the sick and  wounded of the
army as may be required of me by the medical
authorities, and to obey all orders emanating
from them;  said service  to continue for  the
period  of one  year, unless sooner discharged;
and I will accept, in payment for said service,
$20 50, besides clothing,  rations, and medical
attendance, for each and  every month I shall 
36    THE HOSPITAL STEWARD'S MANUAL.

continue to perform the services above stated;
and I further  agree that $2 shall  be retained
from my monthly pay till this contract ceases.
                  ------------.  [seal.]
Signed, sealed, and delivered \
      in presence of       j
                  ------------.  [SEAL.]

   They are paid by  a medical disbursing offi-
cer, on a roll  made out by the surgeon, in the
same  form as  that for enlisted men,* except
that the columns for  rank, regiment, and com-
pany  are omitted.   The following is the form
employed:—
* See sect. 1 of this chapter. 
CO
Roll of Men  of the Hospital Corps of the U. S. Army employed  in the General Hospital at

                      ------------, during the month of------, 186—.
«



w
H
CQ



<
Eh
t—i
Ph
t/3
o
a


w
a
Eh
	Name.	By whose order employed.	Nature of service.	Term of service.			Rate of pay or compensation.			We the subsc have received o	•ibers do hereby acknowledge to	
												
No.				a o u ft	d EH	>> o d	Per diem.	Dolls.	Cts.	full of our pay for the period herein expressed, having signed duplicates hereof,—viz.:		
										Signer's name.	Witness.	Remarks.
												
   I certify that the above is a correct roll of the hospital corps employed under my direction, during the month of-

the sum set opposite their names is accurate and just.

        (Duplicate.)
-, and that
-, Surgeon. 
38    THE HOSPITAL  STEWARD'S MANUAL.


        SECTION III.--OF FEMALE NURSES.

  Female nurses are employed in general hos-
pitals, at the  discretion  of  the surgeon  in
charge, or of the Surgeon-General.   Their pay
is 40 cents and one ration daily, with quarters
and  fuel.  The  ration  may  be  either  com-
muted or drawn in kind.
  They are paid on the  hospital muster roll,
with the stewards, cadets, &c*
  It will generally be found convenient, where
female nurses are employed, for the surgeon to
appoint the most intelligent and reliable to be
the directress of female nurses, whose duty it
shall  be to  supervise, to  oversee  the washing
and the distribution  of clean clothes, the linen-
room and its appurtenances, the  issue of deli-
cacies for the sick, and the extra-diet kitchen
for their preparation.
  In  the performance  of these duties,  she
should heartily co-operate with  the steward,
and  strictly  obey the orders  of  the  medical
officers.
  The remaining female  nurses will in  every
case have  their  special  duties designated,
* See Hospital Muster Roll. 
      THE HOSPITAL STEWARD'S MANUAL.    39

through  the directress,  by  the surgeon  in
charge; they  may be conveniently  assigned
to the care of the cleanliness of patients as to
dress  and  person, the  supervision,  prepara-
tion,  and administration of extra diets and
beverages, and such watching  and other care
of the sick as the  medical officers may direct.
In  addition, one  or more nurses may be em-
ployed in  the  linen-room, in  mending and
taking care of clothing, &c. &c.
   Women employed in this capacity should be
intelligent, industrious, and of  irreproachable
character.   They should have a just  apprecia-
tion  of the importance of their duties, and
should devote  themselves  heartily  to their
proper performance.
   During the present war, great exertions have
been made to  supply female  nurses  of  the
proper character to military hospitals, by Miss
D. L. Dix, so well known for her philanthropic
endeavors to ameliorate the condition of the
insane.  Miss Dix has been authorized by the
War Department to  employ female nurses for
army hospitals;  and, as  it is impossible for her
to supervise in person all the hospitals, she  is
 authorized  to delegate her authority to subor-
dinate agents, not to exceed one for  each city 
40    THE HOSPITAL  STEWARD'S MANUAL.

or military district.  Women wishing employ-
ment as nurses must apply to Miss Dix, or to
her  authorized  agents,  and  medical officers
requiring women  nurses are directed by the
Surgeon-General to apply to Miss Dix, or to her
authorized agent  for  the place where their
hospitals are located.
  Exception is made to this rule only in cases
of urgent need.
  Female nurses thus employed may be  dis-
charged by the medical officer in charge of the
hospital  to which  they are assigned, if found
incompetent, insubordinate, or otherwise unfit
for their vocation.*
  Besides the nurses furnished by Miss Dix,
Sisters of Charity, and the members of other
religious orders, have largely volunteered for
the duty of nurses  during the present war, and,
by  their devotion, strict obedience  to direc-
tions, and irreproachable lives, have proved of
the greatest  service to those hospitals which
have  been fortunate enough to secure their
services.   They can be employed  only under
special instructions from the Surgeon-General's
office.
  * See Circular No. 7, Surgeon-General's Office, Washington
D.C., July 14, 1862. 
      THE HOSPITAL STEWARD'S MANUAL.    41


        SECTION IV.--OF LAUNDRESSES.
  The laundresses for the hospital (matrons of
army regulations) are employed by the surgeon
at the rate of one to every twenty patients.
  Their pay is six dollars a month, with one
ration per day.
  They are paid on the  hospital muster roll.
(F.  2.)  Soldiers' wives  are selected for this
duty  wherever practicable.   Where the laun-
dresses come to the hospital to wash, the hours
of work are regulated by the surgeon; where
the clothes are given out  to wash, the  time
allowed for their completion is  regulated by
the same authority.
4* 
42    THE HOSPITAL STEWARD'S MANUAL.
             CHAPTER III.

General Outline of the Duties of Stewards and other
             Hospital Attendants,

SECTION  I.--NUMBER OF  STEWARDS AND OTHER
  HOSPITAL ATTENDANTS ALLOWED  IN  HOSPITALS
  AND IN THE FIELD.
  The number of hospital attendants is fixed
by army regulations as follows :
  " Ordinarily, hospital attendants are allowed
as follows: to a general hospital, one steward,
one nurse  as ward-master, one  nurse to ten
patients, one  matron to twenty,  and one cook
to thirty;  to a hospital where the  command
exceeds  five companies, one steward and ward-
master,  one  cook, two  matrons,  and  four
nurses;  to a post or garrison of one company,
one steward and ward-master, one nurse, one
cook,  and  one matron, and for every  two
companies more, one nurse; at arsenals, where
the number of enlisted men  is not less than
fourteen, one matron is allowed.
  " The allowance of hospital attendants for
troops in the field will be:  for one company, 
      THE HOSPITAL STEWARD'S MANUAL.   43

one  steward,  one  nurse, and one cook; for
each additional company, one nurse; and for
commands of over five  companies, one addi-
tional cook."*
  It will be observed that the word ordinarily
is used in connection with this regulation; and
practically, in general hospitals and elsewhere,
when any special circumstances render a larger
number of attendants necessary, they can gene-
rally be obtained  by the  surgeon on  repre-
senting the case to the medical director.
  Thus, for example, in  general hospitals of
more than  one  hundred and fifty  patients,
more than  one  hospital steward is usually
allowed.

SECTION II.—OUTLINE OF THE DUTIES OF HOSPITAL
                  STEWARDS.
  In the field,  in  post  hospitals,  and  in
general  hospitals of moderate size, but one
steward  is  generally  allowed.    His  duties
embrace all  those described in  this work  as
belonging  to  hospital   stewards.    He has,
under the  surgeon,  the general  supervision
of the hospital, regulates its police, discipline,
* Revised Reg., Art. XLIV. g 1258. 
44    THE HOSPITAL STEWARD'S  MANUAL.

ventilation, lighting, and  warming, attends to
the provision returns, carries out the surgeon's
instructions as to the management of the hos-
pital fund, makes the purchases for the hospi-
tal and takes care of the stores, sees that the
cooking is properly executed, the property of
the hospital  duly cared  for, and, in  fact, is
responsible  to  the  surgeon for the  general
administration of the institution.
  Besides  these  duties,  he takes charge  of
the dispensary, puts up the prescriptions, and
performs all  those  duties described in  the
chapter on  the  dispensary and its  manage-
ment, as well as  renders  to the surgeon  such
assistance as may be necessary in dressings
and minor surgery.
  These duties,  however,  are  so  extensive
that during the present war it has been found
expedient to  authorize more than one  steward
in general hospitals of a  hundred and  fifty
patients or upwards.
  Where two hospital  stewards are thus  as-
signed to a  general  hospital,  one should  be
put in exclusive charge of the dispensary, and
should  relieve the  other  of  all except the
strictly administrative duties of the house.
  Where three hospital stewards are assigned 
      THE  HOSPITAL STEWARD'S MANUAL.   45

to a general hospital, one should be  put in
charge of the cooking department.  His duty
should be to supervise the cooks and  all per-
taining to the  kitchen, to receive and take
charge of the provisions when they arrive at
the  hospital, and  be  responsible for their
economical use.   One should have charge of
the dispensary, &c, and a  third attend  to the
administrative duties of the house.
   Where more  than three hospital stewards
are allowed,  an  additional  steward may be de-
tailed for the dispensary, another to assist in the
administrative duties of the house, and so on.
   As a  general rule, three hospital stewards
will be found quite sufficient for hospitals of
five hundred patients.
   The hospital  steward  charged with  the ad-
ministrative  duties of the  house is designated
the  chief  steward.   He  receives obedience
from all non-commissioned officers,  enlisted
men, and  citizen  nurses in the  hospital,  and
is immediately  responsible to the surgeon in
charge for the performance of his duties.
   The details of the several duties of  hospital
stewards will be found throughout the  volume.
   In addition to these duties, there is a special
duty directed  in  regulations, to  which  the 
46    THE HOSPITAL STEWARD'S  MANUAL.

attention  of hospital stewards  is especially
called, because  of late it has been too much
neglected, and great inconvenience has resulted
in consequence.
  It is provided in regulations that " hospital
stewards, whenever stationed in places whence
no post return is made to the Adjutant-Gene-
ral's office, or when on  furlough, will at the
end of every month report themselves  by letter
to the Adjutant-General  and Surgeon-General,
as well as to the  medical director of the mili-
tary department  in which they may  be serv-
ing ;  to each of whom  they will also report
each assignment to duty, or change of station,
ordered in  their case,  noting carefully  the
number, date, and source of the order direct-
ing the same.   They will also report  monthly
when on furlough to the medical officer in charge
of the hospital to which  they are attached."*
  Careful compliance with this regulation will
save much  inconvenience to the steward, as
well as to the authorities.  It is the only con-
venient way of knowing the whereabouts of any
individual steward.  It is therefore urged upon
their attention, not merely as a military duty,
but as a matter of convenience  to themselves.
         * Revised Reg., Art. XLIV.  \ 1292. 
      THE  HOSPITAL STEWARD'S MANUAL.    47

  SECTION III.--OUTLINE OF THE DUTIES OF THE
                WARD-MASTER.
  The duties of the ward-master are, to a cer-
tain extent, described in  army  regulations, in
which it is ordered that the surgeon " will re-
quire the  ward-master to take charge of the
effects of the  patients; to  register  them in a
book; to have  them numbered and labelled
with the patient's name,  rank, and company;
to receive from the steward the furniture, bed-
ding, cooking-utensils, &c. for use,  and keep a
record of  them, and how  distributed to the
wards and kitchens; and once a week to take
an inventory of the articles in use, and report
to him any loss or  damage to them, and to
return to the steward such  as are not required
for use."*
   It will  be  seen  here  that two  duties  are
specially assigned to the  ward-master.  First,
the  care  of the effects of patients.   Second,
the care of the hospital furniture and utensils.
   In order that the ward-master  may take
charge of the effects of patients, he has assigned
to him the care of the knapsack-room.f

          * Revised Reg., Art. XLIV. g 1246.
          t See Part II. Chap. II. Sec. 9. 
48    THE HOSPITAL STEWARD'S MANUAL.

  On the reception of patients, their effects are
at once turned over  to  the ward-master, ex-
cepting only money,  watches,  or other valu-
ables, which are given to the surgeon for safe
keeping.
  The ward-master examines them, makes  a
list on  the  back of the patient's ticket,  and
enters all in  a  book kept for the  purpose, in
accordance with the form on p.  49.
  After entering the list of articles in his book,
the ward-master will cause them to be neatly
packed in the knapsack, have the overcoat and
blankets properly folded and strapped upon it,
and affix to the package a label, on which is
written the name, rank, and company of the
owner, with the number of his  ward and bed.
It is then to  be carried to the  knapsack-room
and placed upon the appropriate shelf.
  Muskets, sabres, pistols, &c. are to  be simi-
larly labelled and  placed on the arms-rack in
the knapsack-room.
  When the patient  leaves  the hospital, his
effects are  to be duly returned  to him, except
when he is  discharged from service, in which
case arms  and other  United States property
are to be  retained by the ward-master, the
government property thus accumulating in the 
OS
Ward-master's Account of Clothing, Arms, Equipments,  &c, of Patients in Hospital.
Rank.
Regiment
or corps.
 When
delivered.
Remarks,
  Remarks will note
to whom the articles "^
were delivered, what
money, &c, were left
by those  who die;
and to whom  they
were given. 
50    THE HOSPITAL  STEWARD'S MANUAL.

hospital  to be  turned over from time to time,
on  orders received  from the  surgeon, to the
Ordnance department.
  When the patient dies in hospital, the ward-
master is to furnish the surgeon with  a  state-
ment of his  effects, copied from  his account-
book, and is to retain  them in his possession
until he  receives orders from the surgeon as to
their disposition.*
  Where no legal claimant  appears  for pro-
perty accumulating,  either from deceased  or
deserted soldiers, or from sources  unknown, it
is to be retained until orders are received for
its disposition from proper authority.
  In order that the ward-master may property
care for  the hospital furniture for which he is
responsible, he must keep a record of it, and
of its distribution to the office, wards, kitchen,
&c. &c.
  This record  is kept  in accordance with the
following form:—
Revised Regulations, Art. XVII. 
THE HOSPITAL  STEWARDS MANUAL.
51
1	No. of ward or kitchen.
•	Bunks.
	Bedsacks.
	Sheets.
	Blankets.
	Kettles.
	Spoons.
	Knives.
	Forks.
	&c.
	Ac.
	
1	
	
	
	
	
	
	
	
	Lost.
	Worn out.
	Destroyed by order.
	Returned to steward.
The remarks will state how articles have been lost, and by whom destroyed, or the per-sons suspected, &c.	B p ST
 
52    THE HOSPITAL STEWARD'S  MANUAL.

  The above is the form suggested in regula-
tions.  The following  form, however, will be
adopted as more convenient in large hospitals.
  Each page of a small blank-book is  to be
devoted to a separate ward, kitchen, office, or
other apartment, and  is to  be ruled in accord-
ance with the following form:—
Ward No.
Names of articles.	a	a	3 o a o	T3 £ 2o "S >, ft		Remarks.
Here enter the names only of ar-ticles of furniture actually in the apartment.						The remarks to state how articles have been lost, and by whom destroyed, or the person sus-pected.
  Each page is to be headed with the name
of the ward or apartment to which it belongs.
In making out the original inventory, or  re-
cording the original issues, the names of those
articles  only  are  to  be entered  which  are 
      THE  HOSPITAL STEWARD'S MANUAL.     53

actually in the  apartment concerned, leaving
the rest blank to record subsequent additions.
  The chief nurse, cook, or other attendant in
charge of a ward or apartment, should be  fur-
nished with a copy of the ward-master's inven-
tory for  his  particular ward.  As  the  ward-
master is responsible for the due preservation
of all the hospital property, so, in like manner,
is the chief nurse or other attendant, in charge
of a particular  apartment, responsible to the
ward-master  for the articles  intrusted to his
care, as  set  forth in the inventory furnished
him.
  Once every week the ward-master is to go
over the hospital with his book, and to com-
pare the list for  which each ward, &c. is re-
sponsible,  with  the  articles actually present.
All  articles  not needed for current use are to
be  returned  to  the steward.  Loss or damage
is to be duly reported to the surgeon.
  In a hospital  of considerable size, the ward-
master may  need assistance in the perform-
ance of  these duties;  in  which case,  one or
more hospital attendants may be   designated
by  the surgeon in  charge  as assistant ward-
masters.
5* 
 54    THE HOSPITAL STEWARD'S MANUAL.


 SECTION IV.--OUTLINE OF THE DUTIES OF NURSES.

   The duties of nurses are the same, whether
 they  belong to  the  hospital  corps or  are
 enlisted men temporarily detailed for the pur-
 pose.
   Each ward has its nurses specially assigned
 to it by the surgeon in charge.  One of these
 is designated by him as the  chief nurse, who
 is held responsible by the ward-master for the
 care of the furniture, utensils, and other hos-
 pital  property, and by the  steward  for  the
 discipline, police, and  general administration
 of the ward.
   At  the option of the surgeon,  a female
 nurse may be assigned to this duty.
   The chief nurse will see that the beds are
duly made up in  the morning; that chamber-
pots, bed-pans, and  urinals are emptied when-
ever used; that  the ward is properly swept
 and cleaned daily;  that  the meals of  those
patients  who  are confined  to  bed  are fur-
nished them at the proper  hour;  that  those
patients who go to  the common table are as-
 sembled at the dinner-hour,  to  march to the
 dining-hall;  that the medicines are sent for 
      THE  HOSPITAL  STEWARD'S MANUAL.     55

when notification of their readiness is received
from  the  dispensary;  that  they are  admi-
nistered  to the patient; that the  ward is pro-
perly ventilated,  free  from  all  close or un-
pleasant odors, properly lighted at night, and
in the winter-time properly warmed; and that
all  the  police  regulations  established by the
surgeon "in charge  are  scrupulously  complied
with.  He will maintain order and discipline
among the attendants and patients, and report
all  neglect of duty,  disobedience of orders,
absentees, &c, to the steward.
  He will attend  the  several roll-calls, and
there make to  the steward report of the con-
dition of the ward, of absentees, &c.
  When the surgeon visits the ward, he will
accompany him from bed to  bed  with a slate
or memorandum-book, in  which he will note
the diet, directions as to the administration of
medicine,  and other  specific directions with
regard to each patient;  and he will be held
responsible that these directions  are properly
carried out.
   These duties are responsible and important,
and require sobriety, fidelity, and intelligence
on the part of the attendant to whom they are
intrusted.   Too great care cannot, therefore, 
56    THE HOSPITAL STEWARD'S MANUAL.

be exercised in the selection of the chief nurse,
who should be at once degraded by the  sur-
geon if he proves incompetent or negligent.
  In small wards of  ten  or  fifteen  beds, the
chief nurse may, in addition to these duties,
assume the care of a share of the patients.   In
wards of twenty beds and upwards, however,
it will be found advisable to  assign  to  him
only the general supervision and responsibility
above outlined.
  The beds in each  ward are to be  divided
equally among the remaining nurses, each of
whom is to be responsible for all that pertains
to those placed under his charge.
  He will see  that convalescents who are  able
make their beds immediately  after rising in
the morning, and will  himself make those beds
whose occupants are unable to  do so.  Where
patients are confined to bed, their beds should
likewise be carefully made up daily, or oftener
when their comfort requires it.
  Where the patient is able, he may rise from
the bed and sit in a chair, or lie in an adjacent
bed, as the case may be, while his bed is being
made.  But where this is impossible, as in
severe cases of fevers, wounds with  fractures,
&c, the making of the bed becomes a matter 
      THE HOSPITAL STEWARD'S MANUAL.     57

of some  difficulty as  well as of importance.
To neglect it, besides rendering the patient
uncomfortable, would be to make cleanliness
impossible, and  to predispose to excoriations
and to bed-sores.   But caution is necessary in
executing the task.   The  pillow may be  re-
moved from  under the head, shaken up, the
case changed when necessary,  and replaced.
The bed-covers  may be removed, the bottom
sheet smoothed,  drawn upon first on one side
and then on the other, so as to remove wrin-
kles, all  crumbs, &c. which may have accumu-
lated on  it brushed away, and then the  upper
sheet,  blankets,  and coverlet replaced neatly
and rapidly.
   Where it is necessary to change the bottom
sheet, this may readily be done by pinning the
clean sheet to the margin of the dirty one, so
that as  the  one is  gently drawn away the
other is  carried  into place.   The pins should
be placed with their heads towards the direc-
tion in which the sheet is to be drawn;  other-
wise  their points are liable to catch  in the
mattress, or the clothes and flesh of the patient.
   In cases of fractures of the lower extremi-
ties, and other  severe injuries, where harm
might result from an incautious movement, 
58    THE HOSPITAL STEWARD'S MANUAL.

this  duty should only  be performed  in the
presence of the attending surgeon.
  The nurse is also immediately responsible
for  the personal cleanliness of the  patients
under his charge.  He will see that, when they
are able to do so, they wash themselves daily,
and change their under-clothes at least once a
week.  Where the  patient is unable to wash
himself and change his clothes,  these  duties
must be performed for him by the nurse.
  The nurse must therefore daily wash the
hands  and faces and comb the hair of  those
patients who are unable  to wait on themselves.
This duty  should be performed gently and
thoroughly, and without spilling water  upon
the  bed  or floor.   Where patients  are long
confined  to bed, as in cases of fractures, the
feet, limbs, and body should also be washed
from time to time.  A  sponge will  be  found
useful  in these  cases, both  in  applying soap
and in subsequently removing it.
  General sponging of  the  body should not,
however, be  resorted to  in fevers  or  other
acute diseases, except with the permission of
the surgeon.   Where patients are obliged to
use  the  bed-pan,  urinal, or chamber-pot or
chair, the nurse should  furnish it to them on 
      THE HOSPITAL  STEWARD'S MANUAL.    59

the want being made known, and immediately
after it is used carry it out of the ward, empty
it, cleanse it, and restore it to its place.  On
no  account should  vessels containing excre-
ment or  urine be allowed to remain even for a
few minutes in the ward.
  Attention to this particular is so indispensa-
ble in a sanitary point of view, that the chief
nurse should  hold  each nurse strictly respon-
sible for  the faithful performance of the duty.
   Where,  from  involuntary  evacuations  of
urine or  faeces, the patient soils his clothes or
his bed,  as frequently happens in low forms of
fever, in injuries accompanied by paralysis,
&c, they should be immediately changed.  For
the same reason, a piece of oiled silk, oil-cloth,
or  gutta-percha  cloth,  should  be  introduced
between the sheet and the mattress, in cases
where such an accident may be anticipated, to
protect the  mattress from injury.
   In suppurating wounds, or in  cases  where
water dressings are applied, a piece  of oiled
silk or gutta-percha cloth should always be
employed to protect the bedclothes.
   Bedclothes stained with pus or blood should
be immediately changed, and economy is to be
consulted  by protecting the  bedclothes  and 
60    THE HOSPITAL  STEWARD'S MANUAL.

clothes  of the patient from being  soiled, and
not by retaining  foul linen, &c. about him  to
avoid frequent changes.   Absolute cleanliness
is indispensable to secure the health of wards.
  Another point  of  importance is,  to  see that
patients are kept free from lice  and other ver-
min.  This  is, to a  great extent,  secured by
attention to  personal cleanliness.   But  some
other points may be  mentioned.
  Bedbugs  are best  avoided by cleanliness  of
the beds, secured by occasional wiping with
soap and water,  especially in  all  joints and
crevices.  They are  less likely to be found  in
iron bedsteads, where the  mattress rests on
wooden or iron slats, than in wooden cots with
sacking-bottoms :  where they  exist, they may
be  destroyed by  washing the crevices with a
solution of corrosive  sublimate in alcohol, after
destruction of all visible on search.
  Lice may be removed by the use of the fine-
toothed comb, of strong  soap  and  water, and,
where necessary, of  weak mercurial ointment,
or  of ointment  or infusion of   fish-berries,
(Cocculus indicus, one drachm of the powder to
the ounce of lard, or one  ounce to  the pint of
boiling  water.)   Infusion or  tincture of nux
vomica also answers the same purpose. 
THE HOSPITAL STEWARD'S  MANUAL.    61
  These medicinal  agents,  however,  should
never be resorted to without the consent of the '
surgeon; and where infusion of fish-berries, or
of nux vomica, is  employed, the greatest care
should be exercised that it is not accidentally
employed internally, as it is a deadly poison.
  It is also the duty of the nurse to admi-
nister  the  medicines to the patients,  and in
other respects to  carry out the directions of
the surgeon.  He should, therefore, with the
chief nurse, accompany the  surgeon  in his
visits  to  the patients  under  his  care,  and
either  himself  write  upon  a  slate or  in  a
memorandum-book the surgeon's directions for
each, or should have  free access to the book
of the chief nurse in which this record is made.
  The nurse should remember  that absolute
obedience  in these  respects  is his military
duty,  and  that every  time  he disobeys or
neglects the  surgeon's  directions  as  to the
care of the patient in any particular, he risks
unnecessarily the  life of a fellow-creature.   It
is not for  him  to judge of the propriety or
importance of the measures directed: for this
the surgeon is responsible : blind and complete
obedience is necessarily required of him, and
for this he will be held strictly responsible.
                      6 
62    THE HOSPITAL STEWARD'S MANUAL.

  The nurse will also  see that those of his
patients  go to the common  table  for  their
meals who  are  authorized  to do  so  by the
surgeon,  and these only.   He will distribute
to the others the  diet  allowed  for each by the
surgeon,  and, where the patient is unable to
feed himself, will with  his own hands admi-
nister the food in accordance with directions
received.  The same obedience  to the  sur-
geon's orders is required here as in the admi-
nistration of remedies, and for the same reason.
The nurse cannot know in  any case how fatal
may be the results of neglect or disobedience.
  It will be seen that for the proper perform-
ance of these duties the nurse should in every
case be able to read and write.

  In addition to the special duties which each
nurse owes to the patients under his  charge,
there are certain  general duties in every ward,
which are distributed among the nurses, each
of whom is to be held responsible for the due
performance of the duties assigned him.
  Thus, to one should be assigned  the sweep-
ing and cleaning  of the floor, walls, and win-
dows, to  another  the  maintenance of the fires
and the  superintendence and  management of 
      THE HOSPITAL STEWARD'S  MANUAL.    63

the lights, to a third the cleanliness of the
bath-room, lavatory, and water-closets attached
to the ward, &c.
   Two or more nurses are to be detailed daily
to carry food from the kitchen to the ward,
one or more  to bring the medicines  from the
dispensary to the ward, two or more to relieve
each  other on  duty  as  night nurses where
these are required by the emergency of par-
ticular cases or the general directions of the
surgeon.
   The chief nurse, with the permission of the
surgeon, may make this  distribution of duty,
and  should  keep  in  a memorandum-book  a
list of the attendants under his  orders, with
the duties assigned to each, in order that no
disputes may arise as  to who is responsible for
any of the business of the ward.
   Night nurses may  be  either the  ordinary
attendants of the ward  detailed  in turn for
that  purpose, or a special set of attendants or
night watchers detailed for that duty only.
   In a great institution, the latter is the best
plan.  One night nurse should be assigned to
each ward, and one to the general supervision
of the  whole  house,  whose duty it shall  be
to go over the house every hour during the 
THE HOSPITAL STEWARD'S  MANUAL.
 night, inspect the fires and lights, and see that
 the several night nurses are attending to their
 duties.
   The night nurses go on duty at tattoo, and
 are relieved  at reveille.  They have the day
 to themselves for rest and sleep.
   Where there are no special night nurses, the
 ordinary attendants  of the house  take  turns
 in performing this duty.  For this purpose a
 roster should be made out by the steward, and
 each detailed in his turn, with a corresponding
 period of rest to follow his tour of duty.
   Besides  the nurses proper, certain  attend-
 ants  may be  detailed, at the discretion of the
 surgeon, for duty in the office, as  clerks, &c,
 as assistants  in the dispensary, as assistants
 to the ward-master,  and for such other duties
 as are not otherwise provided  for.   Each of
 these attendants has his special duties speci-
 fically assigned  him by the surgeon, to whom,
 as well  as to  the  steward  or ward-master
 under whose  orders he  may  be placed, he is
 responsible for their proper performance.
  A list should be  kept in the office of all
the attendants in  the  house,  with  the duties
assigned  to each, which may be made out in
the following form :__ 
CO
<)



«

w
H
CQ

<1
H
M
O-i
CQ
O
a
w
a
EH
.LisJ 0/ Hospital Attendants.
Name.
Regiment
 or Corps.
Company.
  When
appointed.
By whose
authority.
Duty.
Remarks.
  Here state the ward
or place where on duty,
whether as nurse, and
in what ward, attend-
ant on office  or else-
where,  assistant   to
ward-master, or in dis-
pensary.
  Here mention when
relieved  from duty, «o
and why, and such
other matters  as ne-
cessary. 
66    THE HOSPITAL  STEWARD'S  MANUAL.

  From this list a memorandum of hospital at-
tendants maybe made up, which should be hung
in a conspicuous place in the office, and should
be corrected whenever any changes are made.
Names.
Stewards.	
In office.	
In dispensary.	
In kitchen.	
In knapsack-room.	
Ward 1.	
Ward 2.	
Ward 3.	
&c.	
&c.	
&c	
 
      THE HOSPITAL  STEWARD'S MANUAL.    07


SECTION V.--DUTIES OF COOKS AND LAUNDRESSES.
  The duties of cooks and laundresses will be
described in full in the articles on the kitchen
and laundry, (q. v.)

SECTION VI.--DUTIES OF HOSPITAL ATTENDANTS IN
                  BATTLE.

  The duties of the  hospital attendants in
battle  are of the highest importance, and on
their faithful execution the successful succor-
ing of  the wounded  must in a great measure
depend.  The surgeon must,  therefore, exact
the strictest  discipline during an engagement,
and  the  slightest disobedience of orders or
neglect of duty  must  be punished in an ex-
emplary manner.
  The attendants may  be divided  into  two
classes: those who remain at the  depots esta-
blished at the  rear  of the line of battle, and
those who go upon the field.
  Those who remain at the depots are selected
for this purpose  by  the  surgeon in charge of
the depot.
  One or more  experienced stewards, one or
more cooks, and a sufficient number of nurses 
68    THE HOSPITAL STEWARD'S  MANUAL.

will be detailed for this purpose.  The number
of attendants needed will vary with the num-
ber of surgeons assigned to the  depot for duty,
and the probable number of wounded: it is
in every case determined by  the surgeon in
charge of the depot.
  The depot established, the hospital steward
at once proceeds to open such panniers and
chests as may be necessary to  get out a suffi
cient  number of bandages,  dressings,  stimu-
lants, and opiates, or other articles required by
the surgeons.
  If  the depot  is  near  the scene  of  actual
conflict, no  more should  be laid  out than is
absolutely necessary for actual use, in  order
that,  if it  becomes advisable  to  change  the
location of  the depot, it may be effected with
as little loss of time as possible.
  Instrument-cases should be  laid out and
unlocked, but instruments should not be laid
out, except by the surgeon, as they are needed
for particular operations; and, for  the  same
reasons, so  soon  as the surgeon is  done with
any instrument, it should be at once carefully
cleaned and replaced in the case.
   A  house, barn, or  other building, is gene-
rally selected as a depot,  if it is practicable to 
      THE HOSPITAL STEWARD'S MANUAL.    09

do so.  When this is the case, the attendants
should at once be set to work by the steward
in cleaning and preparing it for  the reception
of the  wounded.   The  cooks,  meanwhile,
should make a fire, and prepare tea  and soup
for their refreshment.
  Water is to be brought, both for drinking pur-
poses and for the surgeons' use.   Sponges are
to be soaked, and every necessary preparation
made.
  When the wounded  begin to arrive, some
of the attendants assist in removing them from
the  ambulances and  carrying them to  the
places assigned by the surgeon; while others
wait  on the surgeons  during the operations
and  dressings, and render such  assistance as
may be required of them.
  At the principal depots in  the  rear,  the
same preparations are  made, but on a  larger
scale.  In every case, the special arrangements
are ordered by  the medical officers, and the
assignments of the several duties to the  assist-
ants are made by the same authority.
   The hospital  attendants who go  upon the
field  may be  divided into two classes: those
who  accompany the medical officers, who go
upon the field for the immediate succor  of the 
70    THE HOSPITAL STEWARD'S MANUAL.

wounded, and those who accompany the am-
bulances and litters to help the wounded into
them, or bear the hand-stretchers.
  Each medical officer should be accompanied
upon the field by an  orderly, who carries the
hospital knapsack, in which is placed a supply
of instruments,  dressings, &c. for immediate
use.   When  the  surgeon stops  to  give his
services  to a wTounded man, the orderly at
once unslings his  knapsack  and prepares to
hand out to the surgeon the articles needed in
dressing the patient.
  The medical officer should also be  accom-
panied by two  intelligent attendants,  one of
them  a  hospital steward where possible, to
assist him  in any operation  he may perform
upon the field.
  The ambulances are to be accompanied by a
sufficient number  of  attendants, with  hand-
stretchers, to  pick  up the wounded and carry
them from  positions inaccessible to the ambu-
lances, or where it is not advisable that these
should go, to  the nearest ambulances, or field
depot.
  In lifting the wounded and placing them
upon the stretchers,  the  greatest tenderness
should be used, especially where there is reason 
      THE HOSPITAL STEWARD'S MANUAL.    71

to believe  that  bones  are fractured.   The
stretchers are each to be carried by two  stout
men, who  are to take pains to walk so  that,
while the foremost steps  off' with his right foot,
the other may  step  off with  his left, as  by
so doing the patient is less  likely to be jolted,
and the stretcher is tilted less, than where this
precaution is neglected.   When the  patient is
to be placed in the ambulance, the attendants
carefully place the litter upon the ground, in
the rear of  the  ambulance, draw out the am-
bulance-litter on which he is to lie, place it by
the side of the stretcher, gently transfer him
to it, and carefully  raise it from the ground
and slide it back into its place in the vehicle.
At least three men are necessary for this pur-
pose, one on each side of the end of the  litter
first introduced  into the ambulance, and  one
at the  other end.   Care should  be  taken not
to  tilt the  litter, or jar  it unnecessarily in
getting it into place, and,  after having placed
it, to secure it so that it cannot slip  out in the
movements of the vehicle.
    The  ambulance-driver  should  keep  his
horses perfectly  quiet while patients are being
introduced,  and should move carefully, so as 
72    THE HOSPITAL STEWARD'S MANUAL.

to avoid jolting  as  much as possible while
going to the depot.
  Arrived at the depot, the  ambulance is to
be backed up as near the entrance as possible,
the litters, with the patients upon them, are to
be drawn out one by one, and carried  to the
place assigned them,  the  patients  removed,
the litters replaced, and the ambulance starts
off once more for a fresh load.
  The number of hospital attendants allowed
in the field  being  usually found  insufficient
for  this purpose,  an additional detail is gene-
rally required.   The  musicians  are  usually
selected; but, in addition to these, an adequate
number of temporary assistants will generally
be furnished by the commanding officer, at the
request of the surgeon.
  The principle endeavored to be established
is that the number of men actually on  that
duty should  be sufficiently large  to give all
reasonable assistance  during  the engagement,
in order that  there  may be  no  excuse for
soldiers to leave the  ranks  under the  pre-
tence  that  they  are   needed to  assist the
wounded.
  Hospital attendants  and  soldiers specially
detailed  to  the  ambulance  corps  during an 
      THE  HOSPITAL STEWARD'S MANUAL.     73

engagement should remember that their duty
is strictly a military one, and that there is no
more excuse for cowardice or for disobedience
of orders in their case than there is in that of
any  other  soldiers on duty on the field of
battle.
» 
 
             PART II.

DISCIPLINE, POLICE, AND GENERAL SUPER-
    VISION OF MILITARY HOSPITALS. 
 
CHAPTER  I.
     The General Discipline in the Hospital.

  A military hospital requires administration
according to the strictest military discipline.
Nothing short of this will secure efficiency.
The surgeon holds the chief steward respon-
sible for the condition of  every part of the
institution under his charge.  The steward, on
the other hand, holds  his several subordinates
responsible  for  the due performance of their
duties.   The details of these various duties are
found throughout this work: here, therefore, we
limit ourselves  to certain general regulations
which will be found necessary to maintain order.

        SECTION  I.--OF THE  ROLL-CALLS.
  A roll-call of  all the stewards, ward-masters,
nurses,  cooks, and other  attendants  or  extra-
duty men, should be held at least twice daily,
—at reveille and tattoo.  A noon roll-call is also
desirable.  The stewards should be called first,
where practicable;  the nurses  in  charge  of
                      7*              77 
78     THE HOSPITAL STEWARD'S MANUAL.

wards should  be called  next.   Each,  as he
answers to his name, should report whether all
the patients under his care are present or not,
—a fact which he must ascertain, by  actual
inspection, before leaving  the ward  to  go to
roll-call.  These roll-calls are of great import-
ance in large hospitals: they should, therefore,
be strictly regarded as a military duty, and all
attendants not present should be punished as
absent without leave, unless excused on account
of special duty.


SECTION II.--DAILY ORDER OF  HOSPITAL DUTIES.
  The  following schedule will be found con-
venient for the business of the hospital:—

  1. Reveille, at 6 J a.m. in winter, and 5 a.m.
in summer.  Morning roll-call, fifteen minutes
after.
  2. Breakfast-call, 7 a.m. in winter,  and 6
A.M. in summer.
  3. Surgeon's' call, 9 a.m. in winter, and 8 J
in summer.
  4. Dinner, 12 m., preceded  by noon roll-call
when so ordered.
  5. Surgeon's evening call, 5 p.m. 
      THE  HOSPITAL STEWARD'S MANUAL.    79

  6. Supper, 6 p.m.
  7. Tattoo and evening roll-call, 8 p.m.
  8. Taps  (lights extinguished), 9 p.m.

  These calls  should,  whenever possible, be
sounded upon  a bugle  or  beaten on  a drum,
in order that all patients and attendants may
be informed.   The hours for each call will, in
every case, be  regulated  by the surgeon in
charge.
  At reveille,   all  attendants,  and  such  con-
valescents  as  are  able to  do  so, will  rise,
wash and dress; after which each convalescent
patient who is able will  make his own bed;
the  attendants will make theirs,  and  will
immediately proceed each about  his several
duties,  such  as sweeping  the floors, the pass-
ages, &c,  cleaning the  spittoons, and similar
work.
   At breakfast-call, those convalescents  who
are  able will  go to  the dining-hall to break-
fast, together with the attendants, except those
whose  duty it is to attend to the distribution
of food to patients confined to  bed.   This dis-
tribution  should  be made while the  conva-
lescents are  absent at their  breakfast,—the
preparations having been previously completed, 
80    THE  HOSPITAL  STEWARD'S  MANUAL.

so that the distribution may commence imme-
diately after they leave the room.
  The convalescent  patients  should not  be
allowed  to straggle  irregularly  through  the
house to their breakfast or any of their other
meals.
  They should be drawn up in order  in each
ward by the chief nurse, who  should  call  the
roll, to see that all those directed by the surgeon
to take their meals at the general table  are
there, and no others; after which they should
be marched, by one of the attendants, from the
ward, through the passages, to  the dining-hall.
After breakfast  they^ should be marched back
in the same order.
  The attendants employed in  the distribution
of food to patients in bed should receive their
breakfast immediately after all the  patients
have received theirs.   The chief nurse of each
ward will see that immediately after breakfast
the ward is put in  order  for the visit of the
surgeon.   No  patient should be  allowed to
leave his  ward after breakfast,  except  for
necessary purposes, before the surgeon's visit.
   At surgeon's call, the  several surgeons pro-
ceed  at  once to visit the wards  under their
charge, examining each  patient carefully,  and 
      THE HOSPITAL  STEWARD'S MANUAL.    81

causing the prescription and diet for each to
be entered in the prescription and diet book.
The prescription  and diet book goes to  the
steward in charge of the dispensary, who puts
up  the medicines, attaching to each  bottle,
box, or package  a label, on  which is written
the number of the ward and bed, the name of
the patient, date of the prescription, with the
directions as to dose, time of taking, &c.
  The chief nurse of each ward should keep a
slate, on which he should enter opposite  the
name of each patient the diet allowed, with
any specific directions which may be given by
the surgeon in individual,instances.
  At dinner and supper call, the same general
order is  to  be followed  as was described for
breakfast-call.
  At surgeon's evening call, the regular second
visits of the surgeon  are made to those patients
who require it, in the same manner as in  the
morning.
  At tattoo, all patients must make their pre-
parations for retiring, and  all must be in  bed
at nine o'clock, when taps should be sounded
and unnecessary lights extinguished. 
82    THE  HOSPITAL STEWARD'S MANUAL.


SECTION III.--THE STEWARD'S  VISITS OF  INSPEC-
                    TION.
  Besides the visits which he necessarily pays
to different parts  of the  house in the execu-
tion of his  several duties, the chief steward
should pay every part of the hospital a formal
visit twice or three times  daily.
  The middle of the morning, the middle of
the afternoon, and at evening, between taps
and tattoo,  are  good times  for  these visits.
To  these may be added a visit about  half an
hour after taps, to inspect the condition of the
lights and fires.
  At these  regular visits, the steward should
note the condition of every  thing, and  espe-
cially the  order, the cleanliness,  the  ventila-
tion,  the  lighting, and the  warming  of the
building: the state of the kitchen and dining-
room, of the  bath-rooms  and the latrines,  is
also to  be  carefully observed.   Any negli-
gence  or  violation of duty  must  be at once
corrected;  and whenever repairs are  needed
or gross violations of discipline have occurred
it should be at once reported to  the  surgeon
in charge. 
      THE HOSPITAL STEWARD'S MANUAL.    83

SECTION IV.--OF  SUNDAY MORNING INSPECTIONS.
  In  post  hospitals it is usual for the com-
manding officer to complete his Sunday morn-
ing inspection by inspecting the hospital and
its appendages in company with the surgeon.
In general hospitals the Sunday morning in-
spection  is usually conducted by the surgeon
in charge.  The proper time for such inspec-
tions  is  between  the  hours  at  which  the
attending surgeons have completed their visits
and dinner-call,—say between ten and twelve
o'clock.  The steward  should go through the
hospital  immediately  before  the  inspection
commences, and  see that all  things are  pro-
perly prepared.
  To prepare for  inspection.   The hospital
should be neat and clean; those patients who
are sitting up should  be neatly dressed in
uniform, their  faces and hands  clean,  hair
neatly brushed,  and shoes well blacked.   The
attendants and stewards should appear in full-
dress uniform according to their rank, except
where the inspecting  officer  may  previously
have ordered  that undress uniform  only need
be employed.
   The inspecting officer visits all parts of the 
 84    THE HOSPITAL STEWARD'S MANUAL.

 hospital,  the  store-rooms, dispensary, kitchen,
 knapsack-room,  bath-rooms,  latrines,  &c, as
 well as the several wards.
   The steward enters  each ward  before  him
 and commands attention, on which  all patients
 who are  able to do so, rise and stand in the
 position  of  attention  until  the  inspecting
 officer has passed out.


 SECTION V.--ON THE MUSTER OF  HOSPITAL ATTEND-
   ANTS AND  OF  SOLDIERS ABSENT FROM THEIR
   COMPANIES IN HOSPITAL.
   On the last day of the months of February,
 April,  June,  August, October, and December,
 the enlisted hospital attendants  and soldiers,
 both sick  and  on duty, are mustered for their
 pay.   In  the  field, and at post hospitals, the
 mustering officer who  musters the troops or
 garrison to which the hospital is attached per-
 forms  this duty.   In  general hospitals  it is
 usually performed by the surgeon in charge.
   The muster roll having been previously pre-
pared under the supervision of the steward, the
 attendants, and the patients who are able to do
so, are  duly assembled on muster day, and the
roll called in  the  presence of the mustering 
      THE HOSPITAL  STEWARD'S  MANUAL.    85

officer, a mark being put before the name of
each individual present. Subsequently the seve-
ral wards are visited seriatim, and the muster
roll  completed by checking upon the roll the
names of the patients in bed in each.
   The form of the muster roll, with the direc-
tions for making it  out, are given on pp. 86,
87, following.
8 
Muster Roll of Steward,  Ward-Master, Cooks, Nurses, Matrons, and detached  Soldiers, sick, in
  the Hospital of------------, Army of the  United States, from the ---- day of------,
  18—, when last mustered, to the----day of------, 18—.
	Names present and absent.	How mustered in the Army.							Attached to				Bounty.		Names present.	
No.		Rank.	a cj p. a o O	"3 « a ■& ft	Enlisted.				hospital.				Paid.	Due.		Remarks. (See p. 88.)
					a	u .a	a o a	•a ft	a		I u 03 "S P. 03 ft	*a	Dolls.	Dolls.		
																
05
a

a
o
CO



CO
W


Co



> 
THE  HOSPITAL STEWARD'S MANUAL.
87
	K		
			
		Period paid for.	
	o		
	S>		
	«^		
	O o	Pay per	
	F	month.	
	w		
			
			
	F°	Amount of pay.	
	o		
	ST		
	o		
			
			
	?	Retained pay.	
	Q		
			
	O	hi	
		8	w
	?	P*	o c 0
	a	«	
			
	F	0)	
		Total amount due.	
			
		Amount of stoppages.	
			
		Balance paid.	
			
		W	
		as	
			
			
			
		3	
		i	
■ Cm
^

a. 
88     THE HOSPITAL STEWARD'S  MANUAL.
                            NOTES.
   1.  Under the head  of " Remarks," the date of any  soldier's
 joining, whether originally, or from any absence; all changes of
 rank,  by promotion, appointment, or reduction, with  date of same,
 and No., date,  &c, of order; all  authorized  stoppages, fines, sen-
 tences, with No., date, &c, of order, &c.: in case of absence, the
 nature and  commencement of, No.,  date, &c, of order, and period
 assigned  for  same (to be repeated  on every roll while it  lasts); if
 wounded in battle, or injured on duty,—if sick or confined,  a remark
 to that effect,  &c. &c,—must be carefully stated opposite to the
 name of the person concerned, with every thing else necessary, either
 to account fully for every individual,—to guide the paymaster,—or
 insure justice to the soldier and to the United States.
   2. In noting stoppages to be made for loss or damage to public
 property, the gross amount due for Ordnance, Horse Equipments,
 Clothing, &c, will be separately stated in the order enumerated in
 par. 1187, G. R.
   3. Additional pay, due under Sec. 2,  Act of Aug. 4, 1854, will
 be thus noted,—viz.: " For 1st re-enlist.  $2 pr. mo. ;" or,  " For 2d
 re-enlist. $3 pr. mo.;" or, " For 3d re-enlist.  $4 pr. mo.,1'  &c, &c.
 That due  under Sec. 3 of the same act, thus :  "  For cert, of merit, $2
pr. mo."   That due under Sec. 4 of the same act, thus : "In lieu of
 comm. $2  pr. mo."
  4. The instalments of Bounty due, under Sec. 3, Act of June 17,
 1850, are  paid as follows:  Ta^, |, £, \, at  the end of the 1st, 2d,
 3d, and 4th years, respectively, the remainder at the expiration
 of enlistment;  and will, under the  head  of " Remarks," be noted
 thus: "Ret'd Bounty due, 1st (or 2d, 3d, fyc.) inst. $----." See
 G. 0. 20 of 1850.  Besides which, in the columns headed "Bounty
 Paid" and "Bounty Due," must be entered, in figures, the whole
 amount hitherto paid, and the whole amount yet due, on account of
 said bounty.
  5.  The  "three  months' extra pay," for re-enlistment,  under
 Sec.  29, Act of July 5, 1838, being paid by the recruiting officer,
 should not be noted on the muster rolls.
  6.  The roll of those belonging to the hospital  will be immediately 
         THE  HOSPITAL  STEWARD'S  MANUAL.      89

followed by that of those who, since  last muster, have ceased to
belong to it.   These will be classed in the following order,—viz.:
Discharged,  Transferred,  Died,  Deserted;  and the utmost particu-
larity will be observed in the remarks concerning them.  Date  and
place will, in every case, be given;  and No., date, &c, of orders, or
description of authority,  be always carefully specified.    Soldiers
discharged and re-enlisted, or who have deserted and  been retaken,
since last muster,  have their place in both of the above  rolls.
  7. The remark  "discharge and final statements given" will be
made opposite to the name  of  every discharged soldier to whom
such papers have actually been given.   But the blank spaces under
the head of " Last Paid" are to be filled as usual.
  8. In all cases of "re-enlistment" prior to the expiration of the
term of service, the discharge on the old enlistment will be  given
at the time the,soldier "re-enlists,"—from  and on which day his
pay on the new enlistment will  commence.
  9. Within three  days after each  regular muster, the  mustering
officer or commandant of the post will transmit to the Adjutant-
General a copy of the muster roll of each company.   Blanks will
be  supplied  from the  Adjutant-General's  office, and  will  be
acknowledged on the first  muster  roll  forwarded  after  their
receipt.
8* 
90
THE HOSPITAL  STEWARDS MANUAL.
  The roll has appended to it  this recapitu-
lation :—
RECAPITULATION.			■a u	s ■a	o O	S3	a o S	o H	a a H	•a a a ja a o ■o u 3 B M a & 3 <** o d
So			--	--		--	--			
		Sick								
ft ft		In arrest or confinement... On detached service.........	--	--	--	--	--			
ft										
H										
ft			--	--	--	--	--			
		Sick................................ In arrest or confinement...								
*i										
										
STRENGTH—Peesent and Absent.										
	w s ■ o 1-5	'Recruits from depots........ Enlisted in hospital.........	--	--	--	--	--			
ft ft H										
										
ft					--		--			
y										
										
	H o PS « ' ft	By sentence of G.C. Martial								
ft O										
55 '										
ttl										
£				--	--	--				
M <l ft ft										
	n									
							--			
H ft										
<(										
										
 
      THE HOSPITAL  STEWARD'S  MANUAL.    91

  The whole is certified to in the following
form:—
  I certify, on honor, that this Muster  Roll
is made out  in the  manner required by the
printed notes; that  it exhibits the true state
of the Hospital  Department  for  the  period
herein mentioned;  that the  "Remarks" set
opposite each name are accurate and just; and
that the  "Recapitulation"  exhibits in every
particular the true state  of the hospital, as re-
quired by the Regulations and the Rules and
Articles of War.
              Surgeon in charge of Hospital.

Station :-------------

Date :--------—-----------

  I  certify,  on honor, that I have carefully
examined this Muster Roll; that I have mus-
tered and minutely inspected the hospital at-
tendants;  and  that the police and  general
condition of the Hospital Department is found
to be as follows :
Inspector and Mustering Officer. 
92    THE HOSPITAL STEWARD'S MANUAL.
         SECTION VI.--OF THE GUARD.
  In camps and post hospitals the guard is
furnished from the troops for whose benefit the
hospital is  established;  it is under the orders
of the officer of the day, and need not, there-
fore, be made the subject of remark in this
place.
  In detached general hospitals only, however,
the guard, consisting of  one or more non-com-
missioned officers, and a sufficient number of
privates, according to the number  of  posts, is
furnished to the hospital on the application of
the surgeon to the commanding officer,  with
orders  to report  to the  surgeon under whose
command they remain.
  The number of posts is determined by the
surgeon.   There  should always be  a  sentinel
posted at each entrance to the hospital,  with
orders  to allow  no patients or attendants to
leave the building, except when furnished with
a written pass, signed by the surgeon.   Orders
should also be given  to admit no one, except
patients or attendants returning from pass; new
patients arriving with proper orders for admis-
sion ; persons known  to  have business in the 
      THE  HOSPITAL SETWARD'S MANUAL.    9o

hospital; the medical officers and those wish-
ing to  see  them;  and visitors on the visiting
days and hours only.
   Besides  these, sentinels may be  placed  on
such other posts as in the opinion of the sur-
geon may be necessary.
   The guard should live in the hospital, or in
tents erected near it, as  is most convenient in
the opinion of the surgeon.
   They are taken up on  the hospital provision
return, and obtain  their meals at the general
table for the  convalescents and attendants.

      SECTION VII.--OF THE GUARD-HOUSE.
   In  all general hospitals of any size, there
should be a place set aside for the confinement
of those guilty of drunkenness, disobedience to
orders, or other military offences.
   Where possible, this should be  in a separate
building, and is then called the  guard-house;
a sentinel should  be posted  before  the door.
Where this is not possible, a room  should be
employed for the purpose, and is known as the
guard-room.
   No patients or  attendants should be con-
fined  except  on order of the  medical officers, 
94    THE  HOSPITAL STEWARD'S MANUAL.

or by the steward, who will immediately report
the case to the surgeon in charge: all other at-
tendants must report delinquents  to the  sur-
geon, or steward, for punishment, and  not
confine them themselves.
  In these punishments the surgeon is, of
course, guided by the  same laws and  regula-
tions as  apply in other  cases to the punish-
ment of the offences of enlisted men by com-
manding officers.

SECTION VIII.—RULES AND REGULATIONS FOR  THE
      GOVERNMENT OF MILITARY HOSPITALS.
  In every hospital, a code of rules and regu-
lations should be  drawn up by the surgeon in
charge, printed upon large cards, and  affixed
to the walls in each ward, and in other con-
spicuous places.   The following is  an illustra-
tion of the form which may be employed.   It
should receive such modifications as local causes
may make  necessary to adapt it to any given
hospital 
      THE HOSPITAL STEWARD'S MANUAL.    95


Rules and Regulations for the Government of
  the United  States Army General Hospital at
  1. No patient will  be allowed to leave the
hospital without permission from the surgeon
in charge.   The  same rule  will  hold with
respect to nurses and other attendants.
  2. No pass will  be issued  except between
the hours  of 10 A. m. and  12 m., except  in
urgent cases.  The pass will be shown  to the
sentinel  on post, and  retained  by  the  person
receiving it  until  his return, when it will  be
given to  the sentinel.
  3. No smoking,  swearing,  or loud talking
will  be permitted in the wards and passages
of this hospital; and spitting on the floor,  or
defacing  the building in any way, is positively
forbidden.
  4. The beds will be made every morning  by
the attendants, or  oftener, if necessary.  Pa-
tients able to do so will, however, make their
own beds.
   5. No patient will occupy  his bed without
undressing.
   6. Every patient, who is able, will wash his
face and hands at least every morning, and 
96    THE HOSPITAL STEWARD'S MANUAL.

keep the rest of his body in a cleanly condition.
Those who are unable to  do this will have it
done for them by the  attendants.  Every pa-
tient  whose condition  does not  forbid it will
take a bath on his admission into the hospital.
  7. During the morning visit of the medical
officer, every  patient  and nurse must  be in
the ward;  nor will the former leave it before.
his  visit.   Patients who are able, will  rise
when the  medical officer enters the ward, and
remain  standing at the  sides  of  their beds
until prescribed for or  otherwise ordered.
  8. No loud noises or improper  language will
be  allowed  in the wards at any  time.   All
talking  will cease  at  8i p.m.,  when  all  pa-
tients and nurses,  except those  of the  latter
on duty, will go to bed.
  9. All lights in the hospital, except those in
the offices  and surgery, will be  lowered at 9
p.m.  All  other lights will be  extinguished
at taps, unless otherwise directed  by the at-
tending medical officer.
  10. No patients or nurses will be allowed to
enter the office, surgery, or kitchen, unless on
business connected with their duties.   Loung-
ing about the halls is also forbidden.
  11. No persons will  be  allowed to enter  the 
      THE HOSPITAL STEWARD'S MANUAL.    97

hospital without special permission from the
surgeon in charge, or the medical officer of the
day.
  12. No provisions or  spirituous  liquors of
any kind shall be brought within the hospital
without permission of the medical  officer of
the day.  Nor will any relatives or friends of
patients be  allowed to  give such  articles to
them, without permission from the medical
officers of the ward.
  13. Patients will give prompt obedience to
the steward, ward-master, and  nurses, in all
lawful commands.  Any infractions of disci-
pline, disobedience of orders, drunkenness, or
disorderly conduct, will be promptly punished.
9 
98    THE HOSPITAL  STEWARD'S MANUAL.
              CHAPTER II.

   Police and General Supervision in Hospitals.

  SECTION I.—CLEANLINESS  OF THE HOSPITAL.
  The hospital, hospital grounds,  and all its
appurtenances, must be maintained in a state
of cleanliness as complete as possible.
  Cleanliness  of the  floors is to be obtained
by scrubbing or sweeping.
  The whole hospital should be carefully  and
completely  swept  at  least  once  daily,  and
as much oftener as dirt or litter  accumulating
in particular  localities renders  it  necessary.
The wards are swept by one of the attendants,
the chief nurse being  responsible for the  pro-
per performance of the duty; the  kitchen, by
one  of its attendants, the  chief  cook being
responsible;  the dining-room, by  one of the
attendants  assigned  to duty there;  and the
halls,  passages, stairs, offices, &c, by  attend-
ants specially assigned to the duty. 
      THE HOSPITAL STEWARD'S MANUAL.    99

  For  the  proper performance  of this  duty
throughout the hospital, the steward must  re-
member that he is responsible,  and he  must
hold subordinates  charged with  its execution
to a strict accountability.
   Sweeping should be effectual,  but should be
executed in such a manner as  not to fill the
atmosphere with dust.
   The broom should not be recklessly  used,
but should be carried steadily and gently over
the floor, bearing the dust before it.   Where
there is much dust, the floor may be sprinkled
before  being swept,  or the broom  may  be
dipped lightly  into  water.  The  dirt should
not be swept from wards or other apartments
into the passages,  but should be carried  away
in dust-pans.
   Scrubbing is  not so generally available as
sweeping: the objection to it is  that it leaves
the floor damp for a considerable time  after-
wards.  It is, however, to be resorted to when-
ever necessary to effect cleanliness.  Sand may
be  used to advantage in scrubbing well-made
floors.   The  reckless use of  water is to  be
avoided.   It soaks through the cracks of the
floor into apartments below, if there  are any,
and leaves  unnecessary  dampness   behind. 
100   THE HOSPITAL STEWARD'S  MANUAL.

Where the condition of the  floor is not very
bad, the use of a wet  mop may be substituted
for scrubbing, requiring  less  time for  its  exe-
cution, and not leaving so much dampness.
   Either scrubbing or mopping  should, when-
ever possible, be done in clear, dry weather,
(on good drying-days.)
   Certain portions of the  hospitals  require
special attention to preserve their cleanliness.
   The kitchen should be  swept out after each
meal, or as much oftener as necessary.
   The dining-room, after each meal.
   The water-closets should be not only swept,
but mopped or scrubbed, daily.
  The walks around  the hospitals should be
swept  daily.   No garbage or filth should be
allowed  to  collect in any place around the
buildings.
   Not merely the floors, but  the walls, the
ceilings, and the windows of the hospital re-
quire to be kept carefully clean.
   The walls should be dusted from time to time,
and kept free from dirt and cobwebs.  Writing
upon or otherwise disfiguring the walls or wood-
work must be strictly prohibited.  White-wash-
ing must be resorted  to  whenever necessary
to maintain neatness.  The whitewash should 
      THE HOSPITAL  STEWARD'S MANUAL.   101

not merely be composed of lime and water, but
should have salt or glue added to it, to make it
less liable to rub or crack off.
  Painted woodwork should be wiped, when-
ever soiled, with a damp cloth, and scrubbed
when necessary.
  The windows should  be washed whenever
their condition indicates the necessity.  Once a
week is, generally, often enough.  Here, as with
regard to scrubbing, a caution may be  given
against the reckless and excessive use of water.


          SECTION II.--VENTILATION.
  The steward is also responsible to  the sur-
geon for  the effective condition of the means of
ventilation,  whatever these may be.
  In the best-constructed hospitals, ridge-venti-
lation, conjoined with ventilators flush with
the floor, is the plan resorted to.  The  steward
should notice, whenever he enters a ward, that
the  floor-ventilators  are sufficiently open  to
secure a constant change of the air of the apart-
ment.   In rainy weather the ventilators on the
windward side of the building  should be so par-
tially or  completely closed as to prevent rain
from beating in upon the floor of the apartment.
                     9* 
102    THE HOSPITAL STEWARD'S MANUAL.

  Where  other  means  of  ventilation are re-
sorted  to, attention  is  to be paid  to their
construction; and if the steward does not under-
stand  the principle upon which they act, he
should apply to  the surgeon for such  explana-
tions as will enable him intelligently to under-
take their regulation.
  In hotels, private houses, and other buildings
temporarily used  as hospitals, in which no
means of  ventilation  except the  windows,
doors, and fireplaces exist, special care is neces-
sary.   In the summer-time the windows should
be raised  at the bottom and let down  at the
top.   The doors should be kept open.   The
fireplaces  and chimneys should be free from
obstructions.
  In  the  winter the windows should  be let
down at the  top, but not  so  far as to  render
the ward  too cold.
  The cleanliness and ventilation of the wards
should be such that a  person entering them
from  the open  air  should not perceive  the
slightest close or unpleasant odor.   Whenever
the  steward,  in going  his rounds,  perceives
such an odor, its cause should be investigated,
and the  necessary steps  at  once   taken  to
remedy it. 
      THE HOSPITAL STEWARD'S MANUAL.    103

  A few statements may here be made to give
the steward an idea of the amount of ventila-
tion required to obtain the best results.
  Each patient in hospital should have allotted
to him  from one  thousand to fifteen hundred
cubic feet of space.  A thousand cubic feet will
be secured by  allowing to each  bed a floor-
surface  six feet wide  by twelve  long, in an
apartment in  which  the  ceiling is  thirteen
and eight-ninths feet high.
   Twelve  hundred cubic feet will be  secured
by allowing  each bed  a floor-surface of seven
feet by twelve in an apartment  fourteen and
two-sevenths feet high.
   Thus, in a ward twenty-four feet wide and
of  either of  the  above heights, there  may be
two rows of beds, one on each side of the ward,
the beds separated from each other by at least
three or four  feet.   Where the  ceilings  are
lower, a greater floor-surface  should be allowed
to  each bed.
   The  number of beds in each ward is, there-
fore, of serious importance.   It  should be in
every case determined by the surgeon, and,
once having been established, should  not  be
deviated from  except by his  express orders.
    It is, however, of no avail to obtain  for the 
104   THE HOSPITAL STEWARD'S MANUAL.

patient  sufficient cubic space unless the venti-
lation is such as to obtain the requisite change
of air.   It has been calculated that each patient
takes into his lungs, and throws out contami-
nated and unfit  to  be  breathed again, from
three to four hundred cubic feet per hour.  If
to this large element of contamination be added
the deterioration of the atmosphere of the ward,
resulting from the cutaneous exhalations of the
sick, and the effluvia from suppurating wounds,
offensive discharges, &c, it will be seen at a
glance  that the air  of  a hospital-ward must
become rapidly unfit for use.  The great object
of ventilation is to produce such a steady and
constant change of air  as will  cause  the con-
tinual   renewal of  the contaminated ward-
atmosphere by fresh  supplies from without.  It
has been estimated that for this purpose each
patient requires a supply of fresh  air at the
rate of at least double  the cubic space above
mentioned, or from two to three thousand cubic
feet, per hour.
   These conditions cannot be neglected or over-
looked  without inevitable injury to the sick,
manifested  in the type of disease, as well  as
by slowness of recovery and increase of mor-
tality.   . 
      THE  HOSPITAL STEWARD'S MANUAL.   105

  In certain cases the use of disinfectants will
be needed in addition to careful  cleanliness
and  ventilation,—especially in wards contain-
ing patients with malignant fevers or  with
suppurating wounds.  In all  such  cases,  how-
ever, the use of disinfectants should be ordered
by the  surgeon,  and  not resorted to by the
steward or other  nurses  upon their own re-
sponsibility.
  Hospital tents  should  be ventilated by rip-
ping one or more seams near  the ridge-pole of
the tent, the rips to be about eighteen inches
long:  the  gap may  be  propped  open  by  a
notched stick.   Rain is prevented  from enter-
ing by the tent fly.
  This  precaution should always be taken in
hospital tents which are  full  of patients; but
it  is  especially necessary when the tent is
heated in the winter-time, either by a stove 01
the trenched fireplace described in  the  nexl
section.

 SECTION III.--THE WARMING OF THE HOSPITAL.
  The steward is responsible, during the colder
portion of the year, for the proper management
of the means employed to warm the hospital.
In order that this may be satisfactorily and 
106   THE HOSPITAL STEWARD'S MANUAL.

efficiently done, a thermometer should hang in
every ward.  The proper temperature should
be indicated by the surgeon.   About 70° to
72° Fahrenheit is that usually ordered.
  This temperature may be obtained  in well-
organized general hospitals by properly con-
structed  furnaces, or by a steam heating-appa-
ratus.  In the  great majority of the general
hospitals at present organized in the United
States, however, it is effected by stoves.
  The more complicated and complete means
of warming will, therefore, be passed by in the
present work, with the remark that, if they
be  adopted  in any  general  hospital, they
should be so regulated  as  to keep  the wards
steadily at the required temperature, neither
being, on the one hand, so managed as to have
them at times  unnecessarily  warm,  nor, on
the other, so neglected as to allow them to
cool  more than at  the  most a very  few de-
grees below  the standard.
  Stoves used for warming hospitals may be
made for burning either wood or coal.  The
latter are preferable where coal  can  conve-
niently be obtained.
  The chief nurse of  each  ward is responsible
to the steward for the due maintenance of the 
      THE HOSPITAL STEWARD'S MANUAL.   107

fires and the temperature of the  wards.   Fuel
is carried  from the place in which it is stored,
by one  or more of the attendants, under the
order of the chief nurse.
  Care  must be taken to keep the stoves neat
and well blacked, to avoid dropping fragments
of fuel upon the floor about the  stoves, and to
remove the ashes from time to  time, as it be-
comes necessary, making always as little dust
as possible.
  To counteract the unnatural dryness of the
atmosphere  produced  by the use  of stoves, a
vessel of water should be set on the top of
each.
  The stoves  in the  wards should on no  ac-
count be used for cooking.
  Hospital tents may also be warmed by stoves.
It is  perhaps  preferable to warm  them in the
following manner: —
  A trench  is dug through the middle of the
tent, about eighteen inches deep, and twelve to
sixteen wide.  This trench should extend about
four feet beyond the tent at either extremity.
The trench is covered over with pieces of sheet-
iron, supported by iron cross-bars,  the iron for
this purpose to be obtained from  the quarter-
master  on special requisition by the surgeon. 
108   THE  HOSPITAL STEWARD'S  MANUAL.

A chimney is built of sods or mud at the high-
est extremity of the tent;  a pit about two and
a half feet deep and three long  by two wide is
sunk  at  the  other  for a fireplace.   A wood
fire being now built in this pit, the draft car-
ries the flame and smoke along  the  trench be-
neath the hospital tent, which is thus not only
warmed,  but  the  ground on which it stands is
thoroughly dried.
  The fire will serve also to cook for the hos-
pital.
  Care must be taken not to overheat the tent,
which is  likely to happen  when this method is
used, unless ventilation at the  top of the tent
is resorted to, as described in the last section.

     SECTION IV.—LIGHTING THE HOSPITAL.

  Hospitals may be illuminated by candles, by
lamps, or by gas.
  Gas is beyond question the most satisfactory
method of illumination.  As usually employed,
it is  also the most expensive.   This is  to a
great extent the result of unnecessary extrava-
gance ; and the gas-lights should therefore be
carefully supervised  by  the  stewards.   No
more gas-jets  should  be illuminated than are 
      THE HOSPITAL  STEWARD'S  MANUAL.   109

absolutely necessary for the business of the
house, and  these should have no more gas
turned on than is necessary.  At nine o'clock
all the burners should be extinguished except
a single one in each  ward, which should be so
regulated as to give but a feeble  flame, like
that of a candle, and a few in the passages and
on the staircases, to enable attendants on duty
to go about the buildings.  The  gas-bill  is
paid out of the hospital fund.
  Lamps suspended  from the ceiling, or  fixed
upon the wall at convenient places, are, next
to gas, the most  desirable means of illumina-
tion.  Camphene or burning-fluid lamps should
be avoided  as  dangerous, and  whale-oil, lard-
oil,  or coal-oil lamps preferred.   Coal oil has
recently been extensively used for illuminating
purposes, and furnishes perhaps the  cheapest
and most satisfactory illuminating fluid.   The
oil is paid for out of  the hospital fund.
  Where lamps  are  used,  they  should  be
cleaned, trimmed, and filled daily.  This may
be done by the attendants in  the  ward; but
in a  hospital of any size it is much  better
to detail one or more attendants, whose special
duty it  shall be to collect daily all  the  lamps
of the hospital, clean, trim, and fill them, and
                     10 
110   THE HOSPITAL STEWARD'S  MANUAL.

to return them to their places, for the due exe-
cution of which duties they are responsible to
the steward.
  Where  neither gas nor  lamps can  conve-
niently be obtained,  it becomes necessary to
use candles.   Candles  for  this purpose  are
drawn from  the commissary on the hospital
provision return.  Adamantine candles are to
be preferred for  general use; but a small stock
of sperm candles should be  kept on  hand for
special purposes, as, for instance, the occasion
of any surgical operations necessarily per-
formed at night.

          SECTION V.--THE LATRINES.
   The latrines  require careful attention, and
their supervision is  an  important part of the
duties of the hospital steward.
   In every  general hospital there should be
well-constructed water-closets attached to each
ward.  These should be kept scrupulously dry
and clean, the urinals and seats free from filth,
and the apparatus at all times in good work-
ing order.   Any defects or breakage should be
at once reported to the surgeon.   The water-
closet should at all times  be free from any
offensive smell. 
      THE  HOSPITAL  STEWARD'S MANUAL.   Ill

  It will be  found advisable in large institu-
tions to keep an attendant constantly on guard
before the entrance of each water-closet, whose
duty it shall  be to inspect its condition after
every patient,  in order that  all neglects  of
propriety or  cleanliness may be  fixed at once
upon the guilty party.
  In temporary hospitals it is not always pos-
sible to  secure such costly  accommodations:
a very  good substitute may then  be made,
as follows:  a  small frame  building is  con-
structed  outside of  the hospital building;  in
this is placed a trough twelve to twenty feet
long, lined with zinc and covered with a mov-
able lid, in which from four to ten oval holes
are cut.
  One end of the trough should be higher than
the other.   At the  higher end is a  faucet to
let  in  water;  at the lower,  a pipe, six  to
eight inches in diameter,  which should run
obliquely to  a deep sink dug down to the
gravel, and carefully covered.   Lime or some
other disinfectant should be  thrown  into this
sink at least  once a week, and when it is filled
to within six feet of the  surface it should  be
abandoned, filled  in with  earth, mixed with
lime, and a new sink constructed. Such sinks 
112   THE HOSPITAL STEWARD'S MANUAL.

should never be  dug in the neighborhood of
wells.
  In camp hospitals even this simple arrange-
ment is not  practicable,  and ordinary  camp
sinks must be used.   These  should be dug at
some distance from the hospital tents.   They
should be each about ten feet long, two feet
wide, and six deep.   A crotched stick is driven
into  the  ground  at each  end, and  a pole laid
across to serve as a seat.  Every day a little
earth is thrown in to cover the ordure of the
day  previous, and when  filled to within two
feet  of the surface the sink should be  aban-
doned, filled  up with  lime and earth, and a
new  sink constructed.
  Where  possible, a  small  shed  should be
erected  over  each sink,  to protect patients
during inclement weather.  Where lumber can-
not be obtained for  this  purpose, a screen of
boughs should be erected, to protect the spot
from observation.


 SECTION VI.--OF  THE BATHS  AND LAVATORIES.
  Wherever  possible,  general hospitals,  even
when only intended for temporary  use, should
be furnished with a  bath-room;  and in per- 
      THE HOSPITAL STEWARD'S MANUAL.   113

manent  institutions  a bath-room  should be
attached to each ward.  It should be supplied,
wherever possible, with  both hot and  cold
water.   Cast-iron tubs answer  an excellent
purpose, and are readily kept in order, particu-
larly if from time to time they receive  a  coat
of paint.
  The bath-room  must be  kept  cleanly  and
free  from  all  unnecessary  slops,  the bath-
tubs neat  and  free from  dirt of  any kind.
Patients should not be allowed to use the bath
indiscriminately; the surgeon should indicate
those who may use the ordinary  cold bath,
those who need the tepid bath, and those  who
should have the hot bath,  and the frequency
with which baths may be permitted.
  For  the great majority of patients, espe-
cially in cold  weather,  the bath  should be
tepid, the temperature being about 80° Fahren-
heit.  Where a warm bath is given, the greatest
care should be taken to avoid unnecessary ex-
posure of the patient  to cold on leaving the
bath.   The  bath-room should, if possible, be
well warmed, the doors and windows  closed
to avoid drafts.  When the patient leaves the
bath, he should be wrapped at once in a warm
blanket and put to bed.  Water should not be
                     10* 
114    THE HOSPITAL STEWARD'S MANUAL.

allowed to stand in the bath-tubs after it has
been used  for  a  bath.   It  should  be  im-
mediately emptied  and the tub rinsed out, to
prevent the sediment deposited from adhering
to the bottom of the tub and rendering it per-
manently unclean.
   The Lavatories are intended for convalescent
patients  and attendants to wash their hands
and  faces on  rising in  the morning, or  at
other times, when necessary to preserve clean-
liness.
   They  should  be in  a separate  apartment
from the  bath-room,  whenever  practicable.
Where the hospital is not fitted  up with a
complete  lavatory, specially designed  for  the
purpose,  a room should be  prepared,  with a
long table  or shelf, on  which tin  basins, with
soap, towels, &c, may be placed for this pur-
pose.  Convalescents able to go to the  dining-
room for meals should be obliged to wash their
hands  and faces, and comb their hair, daily,
before  going to breakfast.
   The same  cleanliness so necessary every-
where  in a hospital should be manifest in the
lavatory.   After the morning washing, the
basins  should  be rinsed and  dried, the shelf
cleaned, the soap put into a vessel or  vessels 
      THE HOSPITAL STEWARD'S MANUAL.   115

designed for its reception, and the shelf and
floor carefully dried.
  Patients unable to leave their beds should
have  their hands and faces washed daily by
the nurses.   General sponging of the  surface
and washing of the feet  should  be practised
often  enough to maintain cleanliness.


SECTION VII.--THE WARDS OF THE HOSPITAL, THEIR
      ARRANGEMENT AND ADMINISTRATION.
  Hospital wards are of various sizes, and may
accommodate  from a  very few  to  a great
number of patients.   From twenty to fifty is
probably the most convenient number.  The
number of patients in any given ward is to be
determined by the surgeon; and it is the duty
of the steward to place in the ward the num-
ber of beds  thus directed.   The surgeon will
base  his  allotment of  beds upon  an actual
measurement of the apartment, allowing from
one thousand to fifteen hundred cubic feet of
space per bed wherever practicable.
  The bedsteads, which are usually of iron in
United States military  hospitals, should not in
any case be  less than three feet  apart,  even
when the  height of  the  apartment  gives 
116   THE  HOSPITAL  STEWARD'S MANUAL.

the necessary cubic space if they are closer
together.
  The bed-furniture consists of a mattress or
bedsack, sheets, blankets, a coverlet, pillow,
and pillow-case.
  The best mattresses are undoubtedly those
stuffed with  hair.  They are  the most com-
fortable, the  most durable, and are less liable
to become impregnated with unhealthy ex-
halations  proceeding from the patients, and
thus to give rise to disease in those subse-
quently  occupying  them, than  any others.
Their  great  comparative  expense, however,
prevents  their  adoption in  such  extensive
establishments  as those  created  by the exist-
ing war; and they are not, therefore, generally
met with.
  Where, however, they have been furnished,
special care should be used for their preserva-
tion, oiled silk or oil-cloth or gutta-percha cloth
being introduced between the sheet and the
mattress in all  cases in which the discharge
from wounds, or the probability of hemorrhage,
or any other cause, renders them liable to be
soiled.
  The  mattress  usually  furnished  by  the
medical purveyor consists of a ticking stuffed 
      THE HOSPITAL STEWARD'S  MANUAL.   117

with corn-shucks either alone  or  mixed with
straw.   This is much  less durable than the
hair mattress.  It is also much less expensive,
and answers usually a very good purpose.
  When it is soiled, or after it has been used
by a patient laboring  under typhoid or typhus
fever, it should not be burned, as is frequently
done, but, the  contents having been emptied
and destroyed, the tick, if its condition is good,
should be retained, washed and  boiled, and
subsequently used as  a bedsack.
  Bedsacks are probably quite  as useful as the
mattresses last described.  They are  certainly
less expensive.   They should be  filled with
clean  straw, carefully introduced, so as  to
break  up the stems as little as possible.   The
great advantage  of bedsacks  over  any kind
of mattresses is  that they may be frequently
emptied,  the  sack washed  and  its  contents
renewed.   This,  on  the other hand, implies
continual attention  and  considerable  labor;
and there can be no doubt that neglected bed-
sacks form as uncomfortable and unwholesome
a couch  as could possibly be furnished a sick
man.
   Where bedsacks are used, the straw should
be  renewed at least once  a  month for conva- 
118   THE HOSPITAL STEWARD'S MANUAL.

lescents,  attendants, and  ordinary  cases, and
as much oftener for fever-cases, suppurating
wounds,  &c, as the nature of the case may
require.
  When the  bedsack is emptied, it should
never be filled again until it is washed and
boiled.
  "In barracks, twelve  pounds of straw  for
bedding will be allowed to each man, servant,
and company woman.
  " The  allowance and  change of straw  for
the sick is regulated by the surgeon."*
  Straw for this purpose  is obtained from the
quartermaster on  a requisition signed by the
surgeon.
  Two sheets are allowed to each bed.   For
convalescents and attendants it will  be suffi-
cient if the  lower sheet is removed each week
and is replaced by the upper, which is  to be
replaced  by a clean one.   But for fever-cases,
or where there are offensive discharges, the
sheets should be changed as often as  they  are
soiled or  as the change is  directed  by the
surgeon.
  Each  bed should  be  furnished with one
* Revised Reg., Art. XLII. \\ 1126-1127 
      THE HOSPITAL STEWARD'S MANUAL.  119

blanket in summer-time and two in winter, or
with such  additional ones as may be directed
by the surgeon in special cases.  The blankets
should  be  changed  and washed as often  as
they become soiled.
  Each  bed  is  furnished  with  a coverlet,
which is usually of a  woven  white material.
It should  be  changed  whenever it becomes
soiled.
  To keep  the white  coverlet clean, patients
should  never  be allowed to lie down on the
bed with their clothes  on.
   One  pillow is  allowed to each bed, except
in special   cases,  where  additional ones are
ordered by the attending surgeon.  The pillow-
case should be changed once a week, or as
often as it is soiled.
   The  beds of all patients  who are able to go
to  their meals in the  mess-halls should  be
made  up  by  themselves  immediately after
reveille.  Those of patients  unable to leave
their beds  should be  made up from time to
time, as the nature of the case may permit.
   Each bed should  have attached to it or sus-
 pended above it a ticket, on which is recorded
 the name,  rank,  regiment  and company, dis-
 ease, and date of admission of the patient, and 
120   THE HOSPITAL STEWARD'S MANUAL.

on the reverse of which is a list of his personal
effects.  For the form of this ticket, see Part II.
chap. iii. sect. 1.
  Mosquito-nets should,  so far as practicable,
be furnished  to  every bed  in  those seasons
and  localities  in  which  they  are  desirable.
They should  be  kept carefully clean and in
good repair.
  The ward should also be  furnished with a
number of small  tables or  stands, upon which
may  be placed  the  medicines,  &c.  of the
patients.  One to every two  beds is usually a
sufficient number.   Each serves, therefore, for
two  patients.  These  tables  should be kept
scrupulously clean,  and nothing should  be
allowed upon them except such  articles as are
actually in use.
  Chairs to the number of one to every bed,
or at least one to every two beds, are generally
supplied.  These and  the tables should have
definite places assigned  them,  out  of which
they  should  never  be  found  except when
actually in use.
  The spittoons, chamber-pots,  and chamber-
chairs should  likewise  be the subject of care-
ful supervision.  Spittoons should be emptied
and washed out thoroughly every day; cham- 
      THE HOSPITAL  STEWARD'S  MANUAL.   121

ber-pots, bed-pans, urinals, and the receptacle
of chamber-chairs, every time they are used.
  In  hospitals in which water-closets  are not
attached to  each  ward, every  ward should
have  a  small  room partitioned off, into which
patients may  go to use the  chamber chairs  or
pots,  whenever practicable, in  order that the
odor which accompanies  the evacuations may
not be diffused throughout the ward.
  The floor of the ward should be constantly
kept  clean and neat, no litter or dirt being for
a moment allowed upon it; nor should pa-
tients' clothes be suffered beneath the beds.
  Each ward  has allowed to it a certain num-
ber of attendants, which varies with the num-
ber of patients, one to every ten patients being
the allowance of  army regulations.*
  The duties  of  these attendants are detailed
in Part I. chap. iii. sect.  4.

  SECTION VIII.--THE OFFICE  OF THE HOSPITAL.
  An apartment convenient to the entrance
of the  hospital is set aside as the office,  in
which the records and papers of the institution
are kept, and where general business-matters
* Revised Reg., Art. XLIX. \ 1258.
           11 
122   THE HOSPITAL  STEWARD'S MANUAL.

connected with the establishment are  trans-
acted.
  The  regulations  direct  that  "the   senior
medical officer of each hospital, post, regiment,
or detachment will keep the following records,
and deliver them to  his successor.  A register
of patients; a  prescription book; a diet  book;
a case  book; a meteorological register;  copies
of his  requisitions, annual returns, and quar-
terly reports of sick and wounded;  and  an
order and letter book,  in which  will be tran-
scribed all  orders and letters relating  to his
duties.
  " He will make  up the muster  and pay rolls
of the medical  cadets, hospital steward, female
nurses, and matrons,  and  of all soldiers  in
hospital, sick or on duty, detached from their
companies, on  the forms furnished from the
Adjutant-General's office, and according  to the
directions expressed  on them. He will make
the rolls of the  cooks and nurses for extra-duty
pay, which will be  paid by the paymaster, in
the absence of  a medical disbursing officer, as
in other cases of expenditures for the medical
department."*
* Revised Reg., Art. XLIV. \\ 1254-1256. 
      THE HOSPITAL  STEWARD'S MANUAL.   123

  Practically, a large part of these records are
kept either by one of the stewards,  or by one
or more attendants  selected  by the surgeon
for the purpose, and who are, in fact, the clerks
of the hospital,—an office which is not formally
recognized by law or regulations.
  A few  remarks may be made on each of
these heads.

           The Register of Patients.
  This  record  should be kept in a  book pro-
perly ruled  for the  purpose in accordance
with the form prescribed by regulations.  Such
books Can, under ordinary circumstances, be
obtained from the medical purveyor on requi-
sition by the surgeon.   The  form  is  as fol-
lows :— 
	!2J B GO
	Rank.
	Regiment or corps.
	Company.
	o o B 5'
	Admitted.
	Returned to duty.
	Deserted.
	Discharged from service.
	Sent to general hospital.
	On furlough.
	Died.
	Ward.
	Bed.
	Pi B
■ivnNVK 84<ravj\iais ivimsoh am
frSI 
      THE HOSPITAL STEWARD'S MANUAL.   125

  This register should be carefully kept.  The
names of patients  should be entered imme-
diately on  their  admission, with  their rank,
regiment, and company, and the number of the
ward and bed.   The  diagnosis should not be
entered until subsequently, and never by the
steward or clerk upon his own responsibility, but
only on instructions received from the surgeons.
  The steward should look over the register
once, weekly, and, whenever omissions exist in
the diagnosis, should  present the book to the
surgeons in charge of the several wards, for
the necessary entries.
  The subsequent columns, of course, can only
be filled up on the termination of the case.
  The register thus kept furnishes  the  data
from which the monthly and quarterly reports
of sick and wounded are made out.
  In  large general hospitals some additional
means should,  however,  be resorted to,  to
enable friends  or others  looking  for indivi-
dual patients to find them without difficulty.
  To effect this  purpose,  an alphabetical in-
dex  to the  register must be  kept,  in which
will  be entered the name, regiment, and  com-
pany of  each patient, with the page of the
register on which  his name is to be found. 
 126   THE HOSPITAL STEWARD'S  MANUAL.

   As the Prescription, and Diet Book, as well as
 the  Case Book, are kept by the surgeon in per-
 son, it is not necessary to discuss them in this
 work.
   The Meteorological Register.—Keeping  this
 register is a duty which, although supposed to
 be  performed  by  the  surgeon,  is  frequently
 executed  by the  hospital steward  under  his
 supervision.  Books properly ruled for this pur-
 pose are obtained  on the surgeon's  requisition
 upon the medical purveyor. Where the meteo-
 rological record is kept by the steward, the sur-
 geon will always make full explanations as to
 the  manner in which this duty is  performed,
 and  will supervise his procedures from time to
 time, to ascertain their correctness. The subject
 need not, therefore, be entered into in detail.
  The  copies of  requisitions, annual returns,
 and  quarterly reports of sick and wounded are
 to be kept carefully on file.
   The Order and Letter Book is to retain copies,
not merely of all letters and reports received,
but of all written  by the surgeon in charge, on
official business.
  Besides these records prescribed  in regula-
tions,  it will be  found  convenient to keep
among the hospital books three  separate lists 
      THE HOSPITAL STEWARD'S MANUAL.   127

of discharges, furloughs, and deaths.  In a large
hospital  each of these subjects should have a
special book devoted to it.*
  The Muster and Pay Rolls of the cadets, hos-
pital stewards, female nurses, matrons, and of
soldiers in hospital, sick or on duty, are made
out every two months by one of the clerks or
hospital  stewards.   When it is completed, it is
signed by the surgeon in charge, after having
carefully inspected it, and mustered the patients
and attendants to satisfy himself that the rolls
are perfectly correct.
  For the  forms of these  several rolls, see
Part I.
   Of Passes.—Patients or attendants desiring
to leave the  hospital for any purpose,  must
obtain a  written pass from the  surgeon on duty
as officer of the  day, or from  the surgeon in
charge,  under such rules  and regulations as
may be established for each hospital.


      SECTION IX.—THE KNAPSACK-ROOM.
  The knapsack-room is a place set  apart for
the safe  keeping, not only-of  the knapsacks,
* See Part II. chap. iii. 
128   THE HOSPITAL STEWARD'S  MANUAL.

but of the overcoats, blankets, and other pro-
perty of the patients, and of their arms and
accoutrements when  they are  brought with
them to the  hospital.
  It should  be a secure apartment, of sufficient
size, shelved on all sides and furnished with an
arms-rack for the arms.
  Certain shelves should  be set aside for each
ward.   On  these the  knapsacks  should be
neatly arranged.  Each  should  be carefully
and regularly packed, the articles having been
first well cleaned or washed, if necessary.  A
label should be attached, having written legibly
upon it the  name of the owner, with  his regi-
ment and company.   Great-coats and blankets
should be neatly folded and strapped upon the
knapsack.
  Arms  should  be  placed in  order upon the
arms-rack, and a similar label attached to each
musket, sabre, belt, &c.
  Patients on going to hospital should, how-
ever, when possible, leave  their  arms and
accoutrements with their companies,  and on
no account take  ammunition into the hospital.*
  The care of the kaiapsack-room, the reception
* Revised Regulations, Art. XLIV. \ 1251. 
      THE HOSPITAL STEWARD'S MANUAL.   129

of the articles from the patient,  and their due
delivery to him when he leaves the  hospital,
are duties for the proper performance  of which
the ward-master  to whom they  are  intrusted
is responsible to the steward.   The knapsack-
room should  be opened  from  time  to time,
swept, dusted, and well aired.

          SECTION X.--THE LAUNDRY.
   The  washing  of  hospitals is  a subject  of
very considerable  importance,  and  requires
careful supervision.   Whenever practicable, it
should be done in the hospital,  in a room  set
aside for that  purpose and designated as the
laundry.  The washing should  never be given
out when it  can be avoided.  Want of punc-
tuality and of responsibility on  the part of the
laundresses are the objections.
   The laundresses are appointed by the surgeon
in charge of a general hospital.  Soldiers' wives
 should have the preference.   They receive for
their services  $6 per month, with one ration
 per day.
   Laundresses are usually employed  in general
 hospitals in  the proportion  of one to every
 twenty beds.  In the practical duties of their 
130   THE HOSPITAL STEWARD'S MANUAL.

service the best results will be attained if the
matron in charge of the linen-room issues  a
certain number  of pieces to each as her day's
task, holding her responsible  for their  proper
condition when returned.
  Washing for a great hospital is probably best
and most economically effected by steam, as is
practised in various British military and naval
establishments.
  At the present time, however, there are few
establishments   in the   United  States which
possess  the necessary apparatus for this  pur-
pose, and the washing has to be effected  in a
much simpler manner.
  Large-sized caldrons, holding  about  fifty
gallons, with a small furnace  attached,  are
issued  by the medical purveyors or the quar-
termaster, for  the purpose  of boiling  those
articles which  require  this  treatment.  The
washing is effected in  troughs made for the
purpose, or in ordinary wash-tubs, as the case
may be.  Washing-machines  of various  sorts
are used in some of the hospitals.  The  pro-
cesses will necessarily vary so much in accord-
ance with the apparatus sujoplied to the hospital,
that no general rules can be laid down in  this
place.   It need  only be said  that the clothes 
      THE HOSPITAL  STEWARD'S MANUAL.   131

are to be washed clean, without exposing them
to unnecessary violence,  carefully dried, and
neatly ironed.
   The furniture of the laundry should consist,
according to the  size of  the  hospital, of one
or more clothes-boilers (fifty-gallon caldrons),
with furnace attached, one or more stoves for
heating smoothing-irons, for  which  a special
stove is issued by the medical  purveyor, and of
a sufficient number of wash-tubs, which may be
either fixed troughs  of wood  lined with  tin or
zinc, with the  faucets for hot and cold  water
supply immediately  over them, or, where this
is not  attainable, may  be simply round tubs
of the  ordinary pattern, set  upon benches of
convenient size.
   There will be  needed, besides, wash-boards,
ironing-boards, ironing-tables, and smoothing-
irons.
   The laundry should be in  charge of one of
the laundresses,  designated for the purpose.
She should  be responsible for its order and
neatness, should give general superintendence
to the work, and be authorized  to  issue the
necessary directions to insure its efficient exe-
cution. 
132   THE HOSPITAL  STEWARD'S MANUAL.
        SECTION XI.--THE  LINEN-ROOM.
  The room in which the clean bedclothes,
under-clothes, &c. are stored when not in use,
is  generally  called the linen-room;  and this
designation   may  be  conveniently  retained,
although a large majority of the articles stored
away are  made  of  muslin or other materials,
and not of linen.
  The linen-room  should be shelved round
conveniently for the reception  of the articles
stored, and  should be furnished with a lock
and key for security.  It  should be placed in
charge of a  female nurse, with one or more
assistants, according to the size of  the insti-
tution.
  On taking charge of the  linen-room,  the
nurse should be furnished with a list of the
articles intrusted to her care, which she should
verify by personal  inspection.   Subsequently,
she  should  keep  a  memorandum-book,  in
which the chief nurse of each  ward should be
charged with all  articles issued to him for his
ward, and credited by  all soiled articles  re-
ceived from  him  at the soiled-clothes closet,
which should also be under her charge, so that
she  shall superintend  on the  one  hand the 
      THE  HOSPITAL STEWARD'S MANUAL.   133

issue  of clean articles to the ward, and their
return soiled, and on the  other the issue of
soiled articles to the laundresses, and their re-
turn clean.
   But in neither case should she allow articles
to go out of her hand without a memorandum
made, setting forth the number of each article
issued, and the  person responsible.
   The  chief articles which will  thus  pass
through her  hands are—
   Sheets, coverlets, blankets, bed-sacks, pillow-
cases, towels, mosquito-nets, and hospital suits,
consisting  of shirts,  drawers, and socks.  All
these  articles  should be marked U. S. Hosp.
Dept., with indelible ink.
   Besides  these articles of hospital property, it
is usual for the soiled clothes of patients to be
washed in the laundry.  *•
   The female  nurse in charge  of the linen-
room, with her assistants,  should also be re-
quired to  see that the articles are in a proper
state of repair, and, if not, to mend them  care-
fully before  issuing.
12 
134   THE HOSPITAL STEWARD'S MANUAL.
              CHAPTER III.

      Admissions, Discharges, Deaths, &c.

      SECTION I.--ADMISSION OF PATIENTS.
  Patients are  to  be received into hospitals
only when sent there by competent authority,
except in extreme cases, in the discretion of the
surgeon.
  Each patient should be accompanied by the
written order for his admission,  and by his
descriptive list.
  The  patients  are  received  either by the
steward, or by a medical officer detailed for
that duty (the medical officer of the day).
  If the patient is able to walk, he is  taken
into the office, and his name, rank, regiment,
or corps, and the date of admission, entered in
the  hospital register.  His  effects  are then
turned over to the ward-master (and his mo-
ney or any valuables given to the  surgeon for
safe keeping);  after which he is taken  to the
bath-room, thoroughly cleansed, his head and
clothes  examined for vermin,  and measures
taken for their destruction if any are observed. 
      THE HOSPITAL STEWARD'S MANUAL.   135

He is then taken to the ward and bed assigned
to him.
   A ticket has meantime been made out for
him in the office, which contains on its face his
name,  rank, regiment or corps, company, and
date of admission, with a blank space, on which
the surgeon may enter the diagnosis.
   On the reverse  is  a list of his  effects.   A
convenient form for  these  tickets is  as  fol-
lows :— 
136   the  hospital steward's  manual.
           (Face of the Ticket.)
             Number  of Bed :
Name:
Company:
Regiment :
Disease or Injury.
Date of Admission.
Date of Discharge.
Where Sent, and by what Authority. 
THE HOSPITAL  STEWARD'S MANUAL.




            {Reverse.)
CLOTHING, &o.
No.
Knapsacks. . .		Drawers, prs.
Great Coat. . .		Bootees, prs.
Blanket. . . .		Boots, prs. .
Uniform Coat.		Stockings, prs
Undress Coat.		Money. . .
. Trousers. . .		
Shirts.....		
12* 
 138   THE HOSPITAL STEWARD'S MANUAL.

   This ticket, properly filled up, is  placed at
 the head of the patient's bed", where it  is to
 remain so long as he remains in hospital.  It
 may simply be  fastened  to  the  wall with  a
 tack; but it is more convenient to have a little
 tin plate, with the edges on three sides turned
 over,  so as to form a frame,  into which the
 ticket may be slipped.   The frame to be fas-
 tened  to  the  head-piece of the bed, or  hung
 upon  the wall above it.
   Tickets printed in blank for this purpose, as
 well as the frames, may be purchased by the
 surgeon out of the hospital fund, when  not
 supplied by the purveyor.
   When  the  patient is  unable  to walk, the
 steps  to be taken  are  essentially the same,
 modified only in accordance with the necessity
 of the case.  He is to be taken carefully from
 the ambulance in which he was brought to the
 hospital, by gently  drawing out the litter on
 which he lies, and laying it upon the ground.
 He is then transferred to a hand-stretcher and
 carried into the hospital.  If his condition is
 such that it is not advisable to bathe him,—of
which, whenever practicable, a medical officer
should be the  judge,—he  should  be carried at
once to the ward and  bed assigned him, un- 
      THE  HOSPITAL  STEWARD'S MANUAL.   139

dressed,  and put  into the bed, taking such
measures to secure cleanliness, by washing the
head, hands,  and feet, changing the under-
clothes, &c,  as may  be  possible  under the
circumstances.   If  the  patient  is  severely
wounded, and especially if bones are fractured,
the greatest care should  be employed in han-
dling him,  and in carrying the stretcher.  The
stretcher should be  carried by two  strong at-
tendants, who should be directed to  step off in
such a manner  that when the foremost puts
his right foot forward  the  hindmost shall put
forward  his left: by so doing, much unneces-
sary jolting and tilting of the stretcher will  be
avoided.
   If  stairs are to be ascended, the foremost
bearer should lower his  end of the stretcher,
while  the  hindmost  elevates his  in such  a
manner as to  keep the patient as nearly on a
level as possible.   The reverse is  to be done
if stairs are to be descended.
   The patient received into hospital should, if
thereby separated from his company so as not
to be mustered with  it for pay, be accompanied
with his descriptive list and account of pay and
clothing.  If  this does not come with him, the
steward should at once  bring the  fact to  the 
140   THE HOSPITAL STEWARD'S MANUAL.

notice of the surgeon, who will address a note
on  the subject to the company commander,
whose duty it is to furnish it.
  The descriptive lists  and accounts  of  pay
and clothing of soldiers received into hospital
are to be carefully filed away in the office of
the hospital, in order that the surgeon, as re-
quired by regulations, may enter thereon  "all
payments, stoppages, and issues of clothing to
him in hospital."*
  The form of the descriptive list and account
of pay and  clothing is the  same for enlisted
men as for hospital stewards.-j-

SECTION II.—RETURN TO DUTY--TRANSFER TO THEIR
    HOSPITALS—FURLOUGHS AND DISCHARGES.
  The patient thus received  into hospital may
either recover, remain incurable, or at least
permanently disabled, or may die.
  If he recovers, he will  be sent back imme-
diately to his company by the  surgeon, unless
otherwise directed by proper authority.  When
sent back to his company, the date is entered in
the register under the head " returned to duty."

          * Revised Reg., Art. XLIV. g 1250.
          t See Part I.  Chap. I. \ 3. 
      THE  HOSPITAL STEWARD'S MANUAL.   141

  Sometimes, on account  of the  crowded or
unhealthy  state of the  hospital, he is trans-
ferred  to another hospital.  This is  usually
done by order of the medical director of the
military district, on application of the  surgeon
in charge, or otherwise.  In  this  case, the
date should be entered  in the register under
the head  " sent  to  general  hospital,"  and  a
memorandum should be made in  the  column
of remarks of the hospital to which he is sent
and the authority by which the transfer was
made.
  When it is deemed desirable in tedious cases,
or during  convalescence, the patient  may be
allowed  to leave the hospital on furlough.
The furlough is obtained on application made
to the commanding officer by the  surgeon, ac-
companied by a certificate of the nature of the
complaint  in consequence of which the appli-
cation is made, and setting forth the time which,
in the surgeon's opinion,  must elapse before he
will be  fit for duty.  When a patient leaves
the hospital  on furlough, the  date should be
entered in  the hospital register  in  the  column
" on furlough." The time for which the furlough
is granted should be entered in the column of
remarks. 
142   THE HOSPITAL STEWARD'S  MANUAL.

   If the patient is believed by the surgeon to
be suffering from such a complaint or disability
as  to  justify his discharge  from service,  he
makes out a " certificate of  disability for dis-
charge," in accordance with the prescribed form,
Med. Regulations, Form 13, and forwards it to
the  proper  authority,  as directed  in  army
regulations.*
   When the patient is discharged from service,
the date will be entered in the register in the
column  " discharged  from  service,"  and the
reasons set forth in  the  certificate of disability
are to be  entered in the column of remarks.
   When the patient leaves the  hospital, " the
medical officer shall certify and remit his de-
scriptive list, showing the state of his accounts.
If he  is discharged from  service in  hospital,
the surgeon shall make  out his final statement
for pay and clothing."f
  Patients may also occasionally desert from
hospital.  Every patient who remains absent
from  hospital, without  leave, for more  than
three days, should be regarded as  a  deserter.
A separate column in the  register of  patients,
* Revised Reg., Art. XIX.
f Revised Reg., Art. XLIV. g 1250. 
      THE  HOSPITAL STEWARD'S MANUAL.   143

marked "deserted" is prepared for the entry
of the date of desertion.

           SECTION III.--OF DEATHS.
   When a patient dies in hospital, the corpse
should not be allowed to remain  in the ward,
but  be  at once removed  to  some convenient
place assigned for its reception.
   Almost  all  general hospitals have an apart-
ment or separate building  (the dead-house) set
aside for this  purpose.
   The  greatest decency and decorum should
characterize these measures, and every respect
should be paid by the attendants to the corpse.
   If desired, the body may be delivered to the
friends of the  deceased by the surgeon.   If not,
he at once applies to the quartermaster for
means of burial.
   When a patient dies in hospital, the surgeon
is directed, by regulations, to take charge  of
his effects in trust for his legal representatives,
and to "make  the reports  required  in the
general regulations concerning  soldiers  who
die absent from  their companies."*

  * Revised Regulations, Art. XLIV. \ 1250.  See also Art.
XVII. § 152. 
 144   THE HOSPITAL STEWARD'S MANUAL.

   The date of death is to  be entered on the
 hospital register, in the column marked died.
   The following regulations have been issued
 by the War Department on the subject:—

 Regulations for Military Burials and the Regis-
  tration of Deceased Soldiers and their Graves.
   The friends of deceased soldiers desire that
 accurate and  permanent registration be made
 of date, place  of burial,  transfers of corpse, and
 official orders  respecting interment, to enable
 them to find  the  grave, and such records  as
 are important for purposes of identification.
   To attain these ends—
   First. The  hospital in which the soldier dies
 must preserve a sufficient and proper record.
   Second. The Adjutant-General's office should
 receive a perfect duplicate of the same, as the
 records of that office would be more permanent
 than those of  the hospitals or the cemeteries.
   Third.  The sextons, whether of churches or
 of military or other public  cemeteries, should
 have  permanent records, which  shall always
 be accessible to the friends of the deceased.
   The records of each of these officers should
be kept alphabetically indexed for reference.
  Each grave should have its  number, in the 
      THE HOSPITAL STEWARD'S MANUAL.   145

order of interments, distinctly indicated upon
a post or plank of cedar or some other enduring
wood.  The  name  of deceased,  the date of
death, and his company  or regimental corps
initials, should, if possible, be engraved upon
the said post or plank.  This should be effected
with an iron letter-brand or stamp.  These posts
or head-boards, and the lettering of the name,
&c, will be provided by the quartermaster of
the department or military post where  the
hospital is located or where the death occurs.

      THE DUTY OF MILITARY SURGEONS.
   In accordance with the accompanying order
of the Secretary of War, it becomes the  duty
of the senior surgeon for the hospital or the
military company in which  a  soldier dies, im-
mediately  after the  death, to cause the  copies
of Record—1, 2, and 3—to be accurately made
out, and to forward copy No. 3 to  the quarter-
master, or, in the absence of a quartermaster,
to the commanding officer  of the division  or
company  in which the death has occurred.
   Copy No. 2 shall be forwarded without delay
to  the Adjutant-General at Washington, by
the surgeon,  or by such other officer as the
commander may designate.  Generally, except
                     13 
146   THE  HOSPITAL  STEWARD'S MANUAL.

in the District of Columbia, it will be the sur-
geon's duty to forward copy No. 2 to the local
adjutant or  commanding officer,  who, after
noting the contents, will place his signature
upon the  face  of the surgeon's notification
attached, and immediately forward it  to  the
Adj utant-General.
   Whenever a military hospital is finally bro-
ken up or vacated, the hospital records  should
all be transmitted  to  the  Surgeon-General's
office at Washington, and they must ever be
open to  the  inspection of the friends  of the
deceased.

           THE  DUTY OF SEXTONS.

   The sexton must be directed to preserve the
records  and  the orders sent to him by  the
quartermaster.   He  must also be required to
attend to the planting of the head-board or post
furnished by the quartermaster for the grave
of the deceased.
   In all  cemeteries in which deceased soldiers
are interred,  the burials should, if practicable,
be made in regular series, occupying a separate
plat  of ground;  but if otherwise  and promis-
cuously interred, the numbers and description 
      THE HOSPITAL  STEWARD'S  MANUAL.   147

of the locality of the grave should be carefully
recorded by the sexton.
  The sexton should be required to notify the
physician of the hospital of the number and
locality of the grave before he takes the corpse.

  In the case  of a  military burial  at an en-
campment or upon  a march, without the aid
of a sexton, it shall be the duty of the  com-
manding officer of the military corps to which
the deceased belonged to cause his remains to
be properly interred, and  to provide  suitable
means  for marking  the  grave  and erecting
a head-board with the proper  inscription  or
stamped record.   And, in the absence  of  a
sexton, it shall be the duty of the adjutant or
the commander of the said military corps  to
preserve the sexton's copy of record; and it
will  also be  the duty of  the surgeon to said
corps to preserve the hospital  copy  of said
record with the same care, and  subject to the
same conditions, as similar records  in general
or post  hospitals.

  In accordance with the foregoing regulations,
the following forms are furnished :— 
148    THE  HOSPITAL STEWARD'S  MANUAL.
Hospital Record, subject  to the  order of the  Surgeon-
           General of the  United States Army.
                           No. 1.
          RECORD OP  DEATH AND INTERMENT.
Name and number of person interred
Number and locality of the grave......
Hospital number of the deceased......
Regiment, rank, and company.........
Residence before enlistment............
Conjugal condition (and if married, "}
  the residence of the widow).......j
Cause of death...........................~)
Age of the deceased.......
Nativity......................
References and remarks.
Date of death and burial.
186
  Duplicates sent to the Adjutant-General of the United States
Army,  and to  the Sexton of the ........................................................
Cemetery.
Memoranda: 
THE  HOSPITAL  STEWARDS  MANUAL.
uy
Copy of Record for the' Adjutant-General,  U. S.A.
                        No. 2.
       RECORD OF DEATH AND INTERMENT.
Name and number of person interred
Number and locality of the grave......
Hospital number of the deceased......
Regiment, rank, and company.........
Residence before enlistment............
Conjugal condition (and if married, ")
  the residence of the widow).......j
Cause of death...........................~)
Age of the deceased.
Nativity.................
References and remarks.
Date of death and burial.
186
[A duplicate of this Record has been forwarded to the  Sexton, and another
                     remains at this Hospital.]
  To ...........................................................
Sir:
  It becomes my duty  to  inform you that the  person above
described died at this hospital as herein  stated; and that it is
desired his  remains should be  interred with the usual military
honors.
                        Respectfully,
Surgeon U. S. Army.
Military Hospital,.................................................
  This copy of Record is to be transmitted to the Adjutant-General at Washing-
ton immediately after the place of burial and  the number of the grave have
been ascertained and registered. The above notification is to remain attached.
                              13* 
150   THE HOSPITAL STEWARD'S MANUAL.
    Quartermasters Notification of Death.

To.....................................
Sir:
   I have the honor to inform you that.................
.................., a...................of Company .................., Regi-
ment..................., died at this Hospital...............................,
and I would request  you to make the neces-
sary preparation  for  the  interment of  his
remains  as  soon  as  practicable.   The hour
for the funeral is appointed at......................................
                        .....................................?
                     Surgeon U. S. Army.
.....................................>
   ........................., 186 .
4* 
THE  HOSPITAL  STEWARDS  MANUAL.
151
The Sexton's Record and the Order for Burial.
                     No. 3.
     RECORD  OP DEATH AND  INTERMENT.
To
Name and number of person interred
Number and locality of the grave......
Hospital number of the deceased......
Regiment, rank, and company.........
Residence before enlistment............
Conjugal condition, (and if married, "J
  the residence of the widow)....... )
Cause of death...........................")
Age of the deceased.......
Nativity......................
Remarks and references.
Date of death and burial.
186
The Sexton of.
  You will receive, and  immediately inter, the remains of the
person above described, and preserve this record, and also attend
to the setting of the head-board at the grave, as provided by the
Government and ordered  by the Secretary of War.
[Burial from the
Quartermaster.
  This order for the burial is to remain attached to the Sexton's copy of Record
as part of the record. 
 
PART III.
FOOD FOR THE HOSPITAL AND ITS PREPA
 RATION.—THE KITCHEN  AND  ITS MAN-
 AGEMENT.
153 
 
CHAPTER I.
Provision Keturns—Hospital Stores—Purchases for
  the Hospital—The Hospital Fund and its Man-
  agement.
          SECTION I.--PRELIMINARY.
  The financial principle upon which the hos-
pitals of the United States armies are managed
is, that sick soldiers  in  hospital ought not to
cost more to the government  than soldiers in
the field; and, practically, it is found that the
fund created by savings upon  the full ration is
amply sufficient, if properly managed, to suffice
for the purchase of all those little comforts and
delicacies which are necessaries for the sick.
   The mode of procedure upon  this subject
directed in the Revised  Regulations is as fol-
lows :—
   The hospital is credited on the books of the
commissary from which it draws its  rations
by the whole number of complete rations due
throughout  the month  at the contract or cost
price.   It draws from  the  commissary only
 so  much of each article issued by him as is
                                     155 
156   THE HOSPITAL STEWARD'S  MANUAL.

actually required for the use of the sick  and
the attendants:  this  is charged against  the
hospital at  the contract or  cost price.   The
balance left, after deducting the total cost of
provisions actually issued to the hospital from
the total  cost  of the rations  to which it is
entitled, constitutes  the " hospital fund,"  and
this  or any portion  of it may be expended
under the direction of the medical officer for
any  articles necessary either  for  the diet or
for the  comfort of the sick  which  are not au-
thorized to be otherwise furnished.
  As the economical management of the rations
and the consequent creation of a hospital fund
depends to  a great extent upon the steward,
an expose" of the details of the  system is here
introduced,  which, it is believed, will be found
sufficiently complete.

        SECTION  II.—OF THE RATION.
  The ration authorized by army regulations
is  composed of  the  following  articles  and
quantities:—

                THE  RATION.
  " The ration is three-fourths of  a pound of
pork or bacon, or one and  a fourth pound of 
      THE  HOSPITAL STEWARD'S MANUAL.   157

fresh or salt beef;  twenty-two ounces of bread
or flour, or one pound  of hard  bread, or one
and a fourth pound of  corn meal; and at the
rate, to  every  one hundred  rations,  of eight
quarts of beans or peas  and ten pounds of rice
or hominy;  ten pounds of green coffee, or
eight pounds of roasted and  ground coffee, or
one and a half pound of tea; fifteen pounds of
sugar; four quarts of vinegar; one pound of
sperm  candles,  or one  and  a fourth pound
of adamantine  candles, or  one and a half
pound of tallow candles ; four pounds of soap,
and  two quarts of salt.  In addition to the
foregoing, there is allowed twice per week one
gallon  of molasses per  one  hundred  rations,
and thrice  per week, if  practicable, an issue of
potatoes, at the rate of one pound  per  man.
When beans,  peas, rice, hominy, or potatoes
cannot  be  issued  in  the proportions given
above, an  equivalent in value shall  be issued
in some other  proper food.  Desiccated  pota-
toes, or desiccated mixed vegetables, at the
rate, per one hundred rations, of one hundred
and fifty ounces of the  former, or one hundred
ounces  of  the  latter, may be substituted for
beans, peas, rice, hominy, or fresh  potatoes,
when these articles cannot be issued; or, upon
                     u 
158   THE HOSPITAL STEWARD'S MANUAL.
the requisition of the  proper officer and when
the supply on hand will admit of it, they may
be  issued at the foregoing rate, twice per week,
in  lieu of beans  or peas, or in  lieu of rice or
hominy.   Fresh  beef  may be issued  as often
as the commanding officer  of any detachment
or  regiment may require it, when practicable,
in place of salt meat."*

  Note.—"After  the  present insurrection shall cease, the
ration shall be as provided by law and regulations on the first
day of July, eighteen hundred and  sixty-one."  (Section 13,
Act approved August 3, 1861.)  To wit, as follows:—
  " The ration is three-fourths of a pound of pork or bacon, or
one and a fourth pound of fresh or salt beef;  eighteen ounces
of bread or flour, or twelve ounces of hard bread, or one and a
fourth pound of corn  meal; and at the rate, to one hundred
rations, of eight quarts of beans, or in lieu thereof, ten pounds
of rice, or in lieu thereof, twice per week, one hundred and
fifty ounces of desiccated potatoes, and one hundred ounces of
mixed vegetables; ten  pounds of coffee, or in lieu thereof, one
and one-half pound of tea; fifteen pounds of sugar ; four quarts
of vinegar; one pound of sperm candles, or one and one-fourth
pound of adamantine  candles, or one  and one-half pound of
tallow candles ; four pounds of soap,  and two quarts of salt."f
* New Regulations of Subsistence Department, 1862.
f Revised Army Reg. 1861, Art. XLIII. § 1191. 
THE  HOSPITAL STEWARD'S  MANUAL.   159
   According  to existing laws,  therefore, the
ration for the duration of the rebellion may be
tabulated as follows :—
Articles.
Either may be drawn,
 or a part of each.
 Thus, of 100 rations,
 60 may be fresh beef,
 and 40 pprk or  ba-
 con.
Pork..........
Bacon........
Salt beef.....
fresh beef..
„■,.      i.  j     (Bread
Either may be drawn, J Fiour
 or a part o each.   >
(Hard bread..
(Rice....
\BeanB.
        ....... , f Desiccated pota-
May be substituted   toes
 for rice or beans, if i De8ic.ted mixed
 desired.         [  vegetables.....
If practicable...........  Potatoes...........
Tea may be substi- f
 tuted for coffee, on  Coffee...............
 requisition of the j Tea..................
 proper officer.     (.
                Sugar...............
                Vinegar............
                Sperm candles...
                Adamantine
Either....................-j  candies.........
                Tallow candles..
                Soap................
                Salt..................
For	
one man.	
#lb.	Daily.
lilb.	Daily.
22 oz.	Daily.
lib.	Daily.
1.6 oz. 0.64 gills.	Daily. Daily.
1.5 oz.	Bi-weekly.
1 oz. 1 lb.	Bi-weekly. Tri-weekly.
1.6 oz. 0.24 oz.	Daily. Daily.
2.4 oz. 0.32 gills. 0.16 oz.	Daily. Daily. Daily.
0.20 oz. 0.24 oz. 0.64 oz. 0.16 gills.	Daily. Daily. Daily. Daily.
  For
100 men.
 75 lbs.

125 lbs.
137* lbs.
100 lbs.
10 lbs.
 8 quarts.
  6 lbs. 4 oz.
100 lbs.

 10 lbs.
  1 lb. 8 oz.

 15 lbs.
  4 quarts.
  lib.

  1£ lbs.
  H lbs.
  4 lbs.
  2 quarts.
   Occasional  issues  (extra)  of  molasses  are
made  of two  quarts  to  one  hundred  rations.
Peas or hominy are sometimes issued  instead
of  rice or  beans. •  The following table shows
the quantities in bulk of each article in from 1
to  100,000 rations: 
160            THE  HOSPITAL  STEWARD'^  MANUAL.

                                 Table showing the  Quantity in Bulk of any
03	PORK.			BEEF.		FLOUR.			BEANS OR PEAS.			RICE, HOMINY, AND *GREEN COFFEE.		TEA.	
O < o a M p	M	■a 0 3 o ft	o a 3 o	■a c 3 o ft	o a 3 o		•a a 3 o ft	a 3 O	J3 3 n	c3 3 ar	3	■a 3 3 O ft	a 3 o	|	a 3 o
1	3 37 375	1 2 3 3 4 5 6 6 15 22 30 37 45 52 60 67 75 150 100	12 8 4 12 8 4 12 8 8 8 8 8	1 2 3 5 6 7 8 10 11 12 25 37 50 62 75 87 100 112 125 1,250 12,500 125,000	4 8 12 4 8 12 4 8 8 8 8 8	7 70 701	1 2 4 5 0 8 9 11 12 13 27 41 55 68 82 96 110 123 137 3 30 104	6 12 2 8 14 4 10 6 12 8 4 12 8 4 12 8			0.64 1.28 1.92 2.56 3.20 3.84 4.48 5.12 5.76 6.40 4.80 3.20 1.60		1.6 3.2 4.8 6.4 8.0 9.6 11.2 12.8 14.4	1 1 1 1 15 150 1500	0.24 0.48 0.72 0.96 1.20 1.44 1.68 1.92 2.16 2.4 4.8 7 2 9.6 12.0 14.4 0.8 3.2 5.6 8.0
2															
3															
4															
5															
6															
7															
8															
9															
10												1 2 3 4 5 6 7 8 9 10 100 1,000 10,000			
20 30 40 50									2 25 250	l 2 3 4 4 5 6 7 8 16					
60 70											6 40 4.80 3.20 1.60				
80															
90															
100															
1,000															
10,000															
100,000															|
															!
   Note.—Fresh potatoes are issued, three times per week, at one pound to the ration; fresh
flour, when on hand for issue, 12i pounds to the 100 rations in lieu of beans or peas; molasses, one
   * Boasted or ground coffee is issued at the rate of eight pounds to the 100 rations.
   t Sperm candles are issued at the rate of one pound, and tallow candles at the rate of one pound 
              THE  HOSPITAL STEWARDS MANUAL.

Number of Rations, from 1 to  100,000.
161
					fADAMAN-										
SUGAR.		VINEGAR AND			TINE		SOAP.		SALT.			DESICCATED		MIXED	
		MOLASSES.			CANDLES.							POTATOES.		VEGETABLES.	
		a			•a		■a					■3		■a	
								o							
	c									OS			a		
		05	p		o			3	3	3				o	
ft	o	o	a	O 0.32 0.64 0.96 1.28 1.00 1.92 2.24	ft	O 0.2 0.4 0.6 0.8 1.0 1.2 1.4 16	ft	O	ft	c	O	ft	©	ft	o
	2.4 4.8 7.2 9.6 12.0 14.4 0.8 3.2 5.6 8.0							0.64 1.28 1.92 2.56 3.20 3.84 4.48 5 12			0.16 0.32 0.48 0.64 0.80 0.96 1.12 1.28		1.5 3.0 4.5 6.0 7.5 9.0 10.5 12.0		1
															9,
															3
															4
															5
															fi
1 1 1 1 3															7
															8
						H					1 44		13 5		9
						•>					1.60		15.0		10
				6.40		4.		12.80			3.20	1	14.0	1	4
4 6 7 9	8.0 8.0			1.60		6	1	3.20			4.80	2	130	1	14
			l 2 2	4.80		8. 10-	1 2	9.60			6.40	3 4	12.0 11 0	2 3	8
										1					fl
				3.20		12.		6.40		1	1.60	5	10.0	3	12
10	8.0		2	6.40	......	14.	2	12.80		1	3.20	6	9.0	4	6
12			3	1.60	1		3	3.20		1	4.80	7	8.0	5	
13	8.0		3	4.80	1	2.	3	9.60		1	6.40	8	7.0	5	10
15		1 10 100 1000			1 12 125	4. 8.	4 40 400		fi	2 20 8		9 93 937	6.0 12.0 8.0	6 62 625	4
															8
1,500!, ..															
					1250	......	4000		62	16		9,375		6,250 !	
15,000															
onions, when on hand for issue, three bushels in lieu of one bushel of beans or peas; bean
gallon to the 100 rations, twice per week.
and a half, to the 100 rations.
14* 
162   THE  HOSPITAL STEWARD'S MANUAL.
      SECTION III.--OF PROVISION RETURNS.
   Provisions  are drawn for the hospital from
the commissary on a provision return,* blank
forms for which are furnished by the commis-
sary for that purpose.
   It  should represent the total  quantity of
each article to which the hospital is  entitled,
the quantity of each actually drawn, and the
quantity of each  retained by the  commissary,
which is to be credited to the hospital by him.
   The provision return must  be signed by the
surgeon in  charge,  and by the commanding
officer having authority to direct the issue.
   The following is the form:—
* Form 13, Subsistence Depart., Revised Reg., p. 267. 
Provision  Return  of the General Hospital  at--------, for —<----days, commencing the
                day of------, 186—,  and  ending the----day of------, 186—.
		d			a	RATIONS OF—																			
																									
	a	5 o			d											03	T3								
STATION.	—	?		« 4-<	ft											3	C3								REMARKS.
		o					t*-I	s																	
					aS		a>	ft							a to	O	3			s	a>				
	S 3	3 3	"3 o	s 3	S 3	o ft	n	•5 ft	3 ft	C s ft	ft	a> is o O	oj H	oS to		S u ft	S ■a	p. « o 92	"3 CO	o "3 o ft		<§			
																									Here specify the
Total rations																									number of ca-
																									dets, stewards.
						~ "	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	--	
Total actually drawn.........																									guards,attend-
	--	--	--	--	--	__	__	__	__	__	_	._	__	__	__	__	__	__	__	__	__	__	__	__	ants, patients.
																									and total.
																									
																								|	
    The A. C. S. will issue on the above return.
                                                                                  ----------, Surgeon U. S. A.
                     ----------, Commanding Officer.

Notes.—This return will embrace only the actual number present in hospital, including the sick, stewards, attendants, and all entitled
           to a ration.  Returns for hospital matrons will be made separately, mentioning the name of each matron. 
 .164   THE HOSPITAL STEWARD'S MANUAL.

   The  provision return is made out by the
 hospital steward, and is based upon his know-
 ledge of the actual needs of the hospital: some
 experience is needed to enable him to draw
 the  proper  quantity of each article,  and no
 absolute rule can be laid down, as the amount
 needed will vary to  a considerable extent, in
 accordance with the proportion of severe cases
 of disease or injury in the hospital.   In all
 doubtful cases  it is better  to draw too much
 than too  little; for  the patients must never be
 stinted, in any  thing  for the sake of  making
 hospital fund,  and, if there is  a surplus,  so
 much less may be drawn on the next return.
 After having made out the provision  return,
 it is  carried by the hospital  steward to the
 surgeon for his approval and  signature, and
 afterwards to the commanding officer.
   The return, having been approved, is carried
 by  the steward with the  hospital wagon  to
 the commissary, the provisions  obtained and
 brought to the hospital.
  Duplicate  copies  of the  provision  returns
 should be kept  on file by the steward, in order
 that they may be compared with the monthly
statement of the hospital fund, furnished by
the commissary to the surgeon. 
      THE HOSPITAL STEWARD'S MANUAL.   165

  At all posts where there is an army bakery,
it is usual for the hospital to draw bread in-
stead of  flour.  This  is effected as follows:—
When drawing the ration, the steward receives
from the commissary  an order for  the number
of rations of bread his provision return calls
for;  one ration of flour being regarded as the
equivalent of a ration of bread, weight  for
weight.  The steward carries the order to the
bakery  and  receives  the bread.  Where the
bakery bakes daily, it is usual for the steward
to draw each day only the number of loaves
required for the  following twenty-four hours,
instead of drawing the whole amount at once.
  In like manner, when  fresh  beef is drawn,
the  steward does not  generally  receive the
fresh beef from the commissary, but an order
for it, which he carries to the shamble, desig-
nated by the commissary, and there receives
the beef.  In warm weather the steward should
not draw at once  the whole amount, but, learn-
ing the days on which animals are butchered,
should procure each butchering-day the portion
necessary to last  to the  next.   If butchering
is done  daily, the meat  should be procured
daily, using each  day meat killed the day
before. 
166   THE  HOSPITAL  STEWARD'S  MANUAL.
       SECTION IV.--OF HOSPITAL STORES.
  Besides what can be obtained from the com-
missary, certain  articles needed for the diet
of the sick are obtained from the medical pur-
veyor, under the title of hospital stores. These
articles are enumerated in  "regulations"  as
arrow-root,  barley, cinnamon, cloves, cocoa,
farina, ground Jamaica ginger, nutmegs, tea,
whiskey, and  wine.
  These articles are  obtained  by requisitions
on the medical purveyor, made by the surgeon
and  approved  by the  medical director or the
Surgeon-General, in accordance with the regu-
lations  which will  be   hereafter  described
under the head  of " Requisitions for Medical
and Hospital Suppliesy


  SECTION V.—OF PURCHASES FOR THE HOSPITAL.

  All articles  needed  for the subsistence of the
sick  in hospital,  which cannot  be obtained
from the commissary or the medical purveyor,
are purchased out of the hospital fund, out of
which are also purchased all such other arti-
cles needed for the comfort  of  the  sick as are 
      THE  HOSPITAL STEWARD'S MANUAL.   167

not authorized  to be  obtained  in any other
way.
  Purchases for the subsistence of the sick may
be divided into two classes.
  First, purchases necessary to  complete the
ordinary "full diet table" as  adopted by the
surgeon in charge for his  hospital, such as
milk, butter, fresh vegetables,  e.g.  cabbage,
onions,  turnips,  &c,  mustard,  pepper,  dried
fruit, sour-krout, and all similar articles.  Ice
comes also under  this head.
  Secondly, purchases necessary for the "extra
diet"  ordered by the surgeon  in special  cases,
such  as eggs, oysters,  chickens,  fresh  fruit,
oranges, lemons, malt liquors, &c.  &c.
  These articles will  be referred to hereafter,
in connection with the question of " Diet and
Cooking."
  Purchases for the comfort of  the sick may
include a great variety of articles, as purchases
of oil. or expenditures  for gas for  lighting the
hospital, hospital furniture  which cannot  be
obtained by requisition  on  the medical pur-
veyor, as window-shades, water-coolers, &c. &c,
printed  blanks for passes,  discharges,  labels,
printed rules and regulations, &c.  &c.
  The  authority for making  these  purchases 
168   THE  HOSPITAL STEWARD'S MANUAL.

is  granted  in regulations in the  following
terms:—
   " The hospital fund, or any portion of it, may
be expended  by the commissary,  on  the  re-
quisition of  the medical  officer,  in the pur-
chase of  any  article for the subsistence or
comfort  of  the sick,  not  authorized to  be
otherwise furnished."*
   Practically, the purchases for the diet of the
hospital are  generally made  for large  general
hospitals in the following manner:—
   A purveyor for the hospital is designated by
the surgeon in charge.  The purveyor  should,
if possible, be some respectable produce-dealer
in  the  neighborhood of  the  hospital.  Each
morning, or as often as necessary, the  steward
makes out a list of the articles needed,  obtains
the  approval  of the surgeon in charge, and
sends it to the dealer, who procures the articles
and  sends them to  the  hospital.   A special
memorandum-book should be kept by the stew-
ard,  in which he should  keep copies  of these
lists for  comparison with the  articles  actually
furnished on  their arrival, as well as for com-
parison   with  the  monthly  bill.   It  will be
* Revised Reg., Art. XLIII. £ 1195. 
      THE HOSPITAL  STEWARD'S MANUAL.   169

found most economical to make purchases of
all articles not immediately perishable in suf-
ficiently large quantities to obtain the advan-
tage of wholesale price.   At the end of the
month  a  bill is  made  out in duplicate, and
approved  by  the medical  officer  in charge,
according to the following form :—
15 
170    THE  HOSPITAL  STEWARD'S  MANUAL.
The United States

                To....................................................................   Dr.
186 .	$	Dolls.	Cts.
			
			
  I certify, on honor, that the above-snecified articles were pur-

chased on my requisition for the use of the sick in hospital under

my charge.
,. Surgeon
  Received at  ....................................................this

...................................., 186—, from Lieut...............

A.C.S., U.S.A.,...............................Dollars and.......

in full of the above account.
     (signed in duplicate.)


  Notes.—" No officer or agent in the military service shall purchase from any
other person in the military service."
  Purchases for a hospital from subsistence funds may be made by a commissary
to the extent only of the " hospital fund" due such hospital, and must be limited to
articles " for the subsistence or comfort of the sick not authorized to be otherwise
furnished."
  Medicines, regular supplies of the Quartermaster's Department, Ac. &c, must
not be obtained from the hospital fund.
day of
Cents, 
      THE HOSPITAL STEWARD'S  MANUAL.   171

  This duplicate bill, duly approved, is given
to the dealer, who receipts it, presents it to the
commissary, and receives the money.
  Printed blanks for  this purpose can usually
be obtained from the  commissary.
  Milk for the hospital is usually best obtained
from some respectable  dealer in that article,
to be designated  by the surgeon  in charge.
He should be paid monthly,  in the  manner
above  described.  Ice for the  hospital should
likewise be procured, when possible, from an ice-
dealer, who should furnish daily the required
quantity, and be paid in the same manner.
  If any of the  articles thus purchased be fur-
nished of inferior quality, or if the quantity be
not fully that agreed upon and charged, or if
the charges exceed the marke1>price of any
article, the circumstance should be reported at
once by the steward to the surgeon in charge,
who will take such action as the circumstances
of the case demand.
   Too much  care cannot be exercised by the
steward  in this particular.   All articles re-
ceived should be at  once compared with his
memorandum-book, and, if any doubt exist as
to the quantity of any thing, it should be  at
once weighed or  measured.  Milk  should  be 
172   THE HOSPITAL STEWARD'S MANUAL.

received in vessels of uniform  size, and, if not
received by the  steward in person, the attend-
ant charged with that duty should be instructed
to report  to  the steward, daily, immediately
after its receipt, whether the quantity is  cor-
rect and the quality good.   Any reported de-
ficiency should be at once investigated by the
steward, and, if found to exist, should be im-
mediately reported to the surgeon.
  Unless this is done, the hospital is liable to
constant imposition.

SEC. VI.--THE HOSPITAL FUND--ITS MANAGEMENT.
  The  management of the  provision returns,
and of the purchases for the hospital, is an im-
portant and  responsible part of the duties of
the hospital steward.   If it be carefully  per-
formed, the hospital fund will be found, under
ordinary  circumstances, more than  adequate
for all the necessities of the hospital,—so much
so that it is directed in regulations, that,
  " At large depots or general hospitals, this
fund may be partly expended for the benefit
of dependent  posts or  detachments, on requi-
sitions  approved by  the medical  director or
senior surgeon of the district."   And that, on
the first of January, each  year, one-fourth of 
      THE  HOSPITAL STEWARD'S  MANUAL.   178

every "hospital fund," if less than $150, and
one-half if more, will be dropped by the com-
missary from the fund, and  will be paid over
to the treasurer of  the Soldiers' Home by the
Commissary-General.
   Other purchases  for the hospital than those
for the diet of the patients should be made
only on the direction of the surgeon, and are
to be paid for in the same manner.
   The steward should keep  on file copies of all
these bills, for  comparison with the " monthly
statement of the hospital fund."
   Under certain circumstances the commissary
has been authorized  by the Commissary-General
to pay over the hospital  fund in money to the
surgeon for expenditure.  This course is objec-
tionable, as the surgeon  becomes thus  respon-
sible for public money, and is  burdened with
the preparation of all the returns and vouchers
required by regulations of disbursing officers.
   A copy  of the monthly  statement of the
hospital fund  is to be  made by the steward
from the abstract presented by the commissary
for the signature of the surgeon in  charge.
This  should  be done  as soon  as practicable
after the close of the month, in  the following
form :—
                     15* 
174   THE HOSPITAL STEWARD'S MANUAL.
A Monthly Statement of the Hospital Fund at------, for
             the month of------, 186—.
					Dolls.	Cts.
Da.					10 73	00 95
493 rations, being whole amount due this month, at 15 cents per						
Cr. ISSUED. By the following provisions, at contract prices:						
			Dolls.	Cts.	83 43	95
	its per lb... its per lb... its per lb... its per lb... its per lb... per bush... its per lb... its per lb... its per lb... ts per lb... ts per qt... its per lb... its per lb... its per lb... its per qt...		2 7 ' 8 9 3 2 2	25 50 75 35 75 84 50 70 36 36 27 35 60 32 6		
						
						
3 pounds of Adamantine Candles.at 20 cei						
						
PURCHASED.	Dolls.	cts:				
	1	00 36 50 50 28 75				
						
						
						
						
	3	39	40	06		45
					40	50
						
■, Surgeon 
    .   THE HOSPITAL STEWARD'S MANUAL.   175

   A copy of the  monthly  "statement of the
hospital fund" must be filed among the records
of the hospital, and a copy furnished to the
surgeon in charge to transmit to the Surgeon-
General.*
   The amount of the hospital fund will vary
under  different circumstances, and the theory
is that, ordinarily, it will vary with the wants
of the  hospital.  Thus, if the hospital contains
a large proportion of serious cases, there will
be a great saving  on the ration, and  a  large
hospital fund, on  which  the  drafts  for extra
diets  and  other comforts for the sick will be
proportionately large.  If, on the other hand,
the hospital principally contains convalescents,
there will be comparatively little saving  on
the ration, and consequently a small hospital
fund, but, at the  same time, the necessities
for extras  to be  purchased will also be com-
paratively small.
   Two causes, however, will  be found to  in-
fluence the hospital fund, besides the character
of the cases in the hospital.   The first is the
cost-price of the ration at the post; the second
is the economy  with  which  the  purchases
* Revised Reg., Art. XLIV. g 1264. 
 176   THE HOSPITAL STEWARD'S MANUAL.

 for the hospital and the hospital-kitchen are
 managed.  As to the first cause, it  is  very
 evident that the amount of saving  in dollars
 will be much larger at a post where  the ration
 is estimated  at  twenty-two cents, than where
 it is  estimated  at  fifteen cents.   But,  prac-
 tically, it will   be  found that  this  cause
 does  not  materially influence  the  amount
 of purchases that can be made with the hos-
 pital fund, for  where the cost>price of  the
 ration is  small,  there will generally be found
 cheap markets for the purchase of. the extras
 needed, and, on the contrary,  dear markets
 where the cost^price of the ration is high.
   The chief cause, therefore, practically, which
 influences the size of the hospital fund in its
 relation to the  actual wants  of the hospital,
 will be found to be  the economy displayed in
 the administration of the hospital.   Economy
is secured by keeping the provisions and stores
 of the hospital  under lock and key, so  as to
 prevent  all  unauthorized expenditure;  by
 keeping  a strict account of  all authorized
expenditures,  and  comparing from  time to
time the  daily expenditures with each other
 and  the number of patients, so  as to  become
 at once  aware  of  any  inadvertent extrava- 
      THE HOSPITAL STEWARD'S MANUAL.   177

gance ; by prudence in drawing or purchasing
perishable  articles, such as  fresh meat,  &c,
which should be so managed that, while there
is enough for all purposes, none should be left
over to spoil;  by skill and economy in the
management of the kitchen; (on the whole,
it may be said  that  bad cooking  is more ex-
travagant than good cooking, requiring larger
quantities  of ingredients,  and giving wrorse
results;) by economy with the gas,  lamps, or
other means resorted to to light the hospital;
and, finally, by taking care to make the pur-
chases for the  hospital of honest dealers, and
to pay for  them no  more than  the market-
price.   Twenty-five  to fifty per  cent, of the
hospital  fund, or even more, may be lost by
making the  purchases of an improper person.
   The hospital fund, in a properly managed
hospital, should amount to from one-fourth to
one-half of the total cost  of the rations to
which the number of patients and attendants
in the hospital are entitled.
   Thus, in a hospital  for five hundred patients,
at a  post where  the ration  is estimated at
eighteen cents cost-price for each full ration, the
monthly savings should be at least $650, and,
under favorable circumstances, may swell to 
178   THE HOSPITAL STEWARD'S MANUAL.

$1400, or even  more.   When a hospital is
first established,  the whole of this sum should
not be expended, the excess of savings over
expenditures  being allowed to accumulate till
it forms a sum at least as large as the monthly
savings, after which there need never be any
hesitation in  expending  each  month, for  the
comfort of the sick,  all the  savings of  the
month previous.
  That the above estimate is not  excessive
may  be  proved by  a  single  example  from
among many.   In  the Seminary  Hospital,
Georgetown, D.C., under the efficient manage-
ment  of  Assistant  Surgeon (now Surgeon) J.
R. Smith, U.S.A., during the year subsequent
to its  establishment, in July, 1861, the number
of patients was from  one hundred and thirty
to one hundred  and  fifty, the average cost-
price  of  the  ration eighteen cents,  and  the
monthly  savings from  $350 to $450.   The
average monthly expenditures, after the first
few months, were about the same; the balance
due the hospital at the close of each month,
on  the monthly statement of the hospital
fund,  from $300 to $500.
  This would correspond to a monthly saving 
       THE HOSPITAL STEWARD'S MANUAL.  179

of nearly $1500 in a hospital for five hundred
patients.
   The same favorable  results have been ob-
tained elsewhere whenever due economy and
care  have  been  employed  in the  manage-
ment.

  SECTION VII.--OF THE CARE OF PROVISIONS AND
             HOSPITAL STORES.
   Hospital stores, and those parts of the ration
which are  not speedily perishable, such  as
coffee, sugar, beans,  rice, &c. &c,  should  be
kept  by the steward, when possible,  in a store-
room, under lock  and  key.  The store-room
should be properly shelved, and  the articles
should be stored in a systematic  and orderly
manner.  The strictest cleanliness  is necessary,
and boxes and barrels should be kept covered
to exclude dust and dirt.
   Fresh meat, fresh fruit and vegetables, and
the like  perishable articles should be kept in
a separate  place.  In  all  large  hospitals  a
pantry should be specially set aside  for this
purpose,  in which during  the  summer-time
the ice should also be kept.   Where the hos-
pital  is not large enough to require  a separate
room  or building for this  purpose, a family 
 180   THE HOSPITAL STEWARD'S  MANUAL.

 refrigerator, of a  size proportioned to the ne-
 cessities of the case, may be purchased, by di-
 rection of the  surgeon,  out of  the hospital
 fund, and will answer the purpose excellently.
 The pantry or refrigerator, like  the store-room,
 should be kept locked.
   The  hospital steward  is responsible to  the
 surgeon for  the proper care and economical
 use  of  the provisions and  hospital  supplies:
 This is  especially  enjoined  in   regulations,
 which provide that  the  senior  medical  officer
 of a hospital  "will require the steward to take
 due  care of the  hospital  stores and supplies;
 to enter in a book, daily, the issues to  the
 ward-masters, cooks,  and nurses; to prepare
the provision returns, and receive and  distri-
bute the rations."
   The book here directed should  be  ruled in
accordance with the form prescribed  by regu-
lations*  It  should  be kept in the store-room,
and each article entered at the time  of issue.
 The following is the form prescribed:—
* Med. Regulations, Form 6. 
THE  HOSPITAL STEWARDS MANUAL.
181
		DATE.
	a* CO	Rice.
*»	a* CO	Sugar.
	o	Tea.
	to	Wine.
		Brandy.
.	a-	Coffee.
	PP p	&c.
♦	p	&c.
	p	&c.
		
•		
1		a !> W CO 1
IL
8*
S-
16 
 182   THE HOSPITAL STEWARD'S MANUAL.

   The book should be ruled so as to give a
 column  to  each article kept on  hand,  and
 leave a few blank columns over for extras.
   Issues  should  be made  daily, at some de-
 finite and convenient hour.  Articles  needed
 for the ration should be issued to the cook, or,
 in  a  large  general hospital, to the hospital
 steward having charge of the kitchen.   Where
 there is more than one kitchen, the steward or
 cook  having  charge of each should receive
 his  share  separately,  and  each  should  be
 charged with it separately upon the steward's
 book.
   Issues  of hospital stores upon the extra-diet
 list, or of liquors, are to be charged  to  the
 nurse  who  receives them.   The  stewards,
 cooks, and nurses receiving  these articles are
responsible to the chief steward for  their pro-
per use and distribution. 
THE HOSPITAL  STEWARD'S MANUAL.   183
               CHAPTER II.

              Of the Diet Table.

  Under  direction  of the  surgeon, a  regular
diet  table  should  be  established in every
hospital.   For convenience'  sake,  the  diet
should be divided into three classes,—full, half,
and  low,—which are to be designated in the
diet  and  prescription book by the letters  F.,
H., and L. In prescribing daily for each patient,
the surgeon is directed  in the medical regu-
lations to write, with the prescription for each,
one of these letters, to indicate which class of
diet  he shall have.   The steward is therefore
able, by consulting  the record, to know at once
how many patients, daily, each class of diet is
to be prepared for.
   To these three classes of diet must be added
the  articles  of extra diet, including  liquors,
which must be specially ordered daily by the
surgeon for each patient requiring them. 
184   THE  HOSPITAL STEWARD'S MANUAL.
           SECTION I.--OF FULL DIET.

  To establish a proper diet table for hospital
patients requiring full diet, is a problem which
still exercises the best abilities of scientific
dietitians,  and  the  discussion  of which it is
not possible to enter into in this place.   The
actual  problem presented to the hospital stew-
ard  in this country is to utilize to the utmost
extent the articles of diet which he can obtain
from the  commissary and medical purveyor,
and those which the surgeon authorizes him to
purchase with the hospital fund.
  With proper care in the management of the
hospital fund, it is possible to make these sup-
plies of such a character  that the  diet of a
United States military hospital may readily be
made equal or superior to  that of any of  the
hospitals in the world.
  To do this, greater care  than  hitherto must
be exercised in the purchases, in the arrange-
ment of the  diet table, and  especially in  the
cooking, of our military hospitals.
  There should be three meals daily.
  Breakfast at six o'clock during the summer
and seven during  the  winter months. 
      THE HOSPITAL STEWARD'S MANUALI.  185

  Dinner at twelve o'clock during the summer
and half-past twelve in the winter months.
  Supper at six.
  Breakfast should consist of well-made coffee,
of reasonable strength, with milk and sugar, of
bread and butter,  and of some relish,  which
should vary daily.
  The coffee should be made according  to the
receipt hereafter given, and should have the
milk  and  sugar  added to  it in  the kitchen.
One pint should be  served to each patient.
Pains should  be taken to have it well made
and served hot.
  Half an ounce of butter should be served  to
each patient.
  A slice of bread, of about  six ounces' weight,
should be laid by each plate; but the patients
should not be limited to this quantity.
  A  dozen additional  slices, of  about three
ounces each, may be placed in  plates,  at con-
venient intervals, along the table of the mess-
room, and each one  allowed to help himself
according to  his appetite.   This plan will  be
found more economical, as well  as more satis-
factory,  than the  plan of  adopting a fixed
ration—say eight ounces—and giving it to each
patient irrespective  of his  appetite.  In this
                     16* 
186    THE HOSPITAL STEWARD'S MANUAL.

case, while  certain patients are  not satisfied,
and complain that they are  stinted, the great
majority waste a portion of their share.
  The relish should consist of either cold meat,
bacon, or meat stew with  onions or potatoes,
salt or fresh fish, or any similar article, which
maybe directed by the surgeon to be placed upon
the diet table.   Each patient should have  his
share of the breakfast relish put upon his plate.
About four  ounces of cold meat, eight ounces
of hash  or  meat  stew, eight ounces  of cod-
fish hash, four ounces of salt or four ounces of
fresh fish, are proper quantities for each patient.
  It is advised that but a single  relish be pro-
vided for the whole full diet list for any one
day, and that in the diet table for a week the
relish  be different upon each day,—the prin-,
ciple of the importance of variety,  as well as
quantity and nutritive value, in a diet, having
been fully established in past experience.
  Receipts  for  preparing  several dishes suit-
able for breakfast relishes will be given in the
chapter on  cooking*
  Dinner presents a  more  difficult problem,
and one  which must be met by the  surgeon in
* Part III. chap. iv. 
      THE  HOSPITAL  STEWARD'S MANUAL.   187

charge in accordance with the possibilities of
each hospital locality.
  In  a  general way, it may be said that the
dinner should consist of some well-made soup,
of meat, and of vegetables.  Bread in slices of
two or three ounces  each  should be  put upon
the table, that each  patient who wishes may
eat one  or  more slices with his soup.   Beef
soup is  the most generally available, as  beef is
the only fresh meat  at present issued  by the
commissary.  But mutton soup, and, in some
hospital locations, chicken soup, may be  advan-
tageously substituted by drawing so much less
beef from the commissary, and purchasing the
mutton or fowls with the  hospital fund.
  Good vegetable  soup may be made without
using any fresh meat, thus allowing the fresh
meat for the day to  be baked  or roasted.   A
number of receipts for different forms of soup
will be  found  in the  article on cooking.
  Too much pains cannot be  bestowed in see-
ing that the soup is  well made, as its nutritive
value, as well as  its palatability, depends  to
a great  extent  on  the mode  in which it  is
prepared.
  About a pint and  a half of soup may be
served to each patient at dinner. 
 188   THE HOSPITAL  STEWARD'S MANUAL.

   Once or twice a week a well-made stew of
 meat and vegetables, such as onions and pota-
 toes, may be served instead of soup.
   The meat from the soup may be served for
 dinner on certain designated days of the week,
 but, as this meat  is far inferior in nutritive
 value to meat which has not been thus used,
 it is a grave error to depend  upon it for the
 daily dinner.  On  days on which  other meat
 is supplied for dinner, the meat from the soup,
 when it is made of  fresh meat, may be used
 cold,  as  a breakfast relish, on  the following
 day, or may be made into a stew for the same
 purpose, with a little  salt meat  to give  it
 flavor, and proper quantities  of potatoes or
 onions.
   Thus,  for example,  soup made  of  fresh
 meat  may be  served four days  in the week,
 vegetable soup, as pea or bean soup,  made
 with salt meat, on two days, and meat stew
 with potatoes and onions on one  day.
   Roast or baked fresh meat may be served on
 the same days with the vegetable soup.  The
 meat from the soup may be used on two days
 at dinner;  on two  days it may  be used cold,
 or stewed  for next  day's breakfast,  and  its
place taken at dinner by salt meat, baked or 
      THE  HOSPITAL STEWARD'S MANUAL.   189

broiled.  Fried  meat should  be avoided  as
much as possible.
   The day meat stew is substituted for soup,
some plain pudding should be served.
   The quantities of  these several articles  of
diet which should  be allowed to each patient
may be stated as follows :—
   Roast or baked meat, or of boiled meat from
the soup, 8 oz.   Baked, boiled, or broiled salt
meat, 6 oz.   Meat stew with onions or potatoes,
1 pint.   Pudding, 6 oz.
   Potatoes, boiled or roasted, should be served
three or four times a week; other vegetables,
as  turnips boiled,  or baked  beans,  cabbage
boiled or raw (cold-slaugh), spinach, sour-krout,
&c, on other days.  The quantity should  be
for each patient at  each meal  about  eight
ounces of potatoes or of other vegetables.
   It is  believed by the  author  of this work
that a pint of some  mild malt liquor might ad-
vantageously, and  without too great  expense,
be added to the  dinner of a general hospital in
most localities.   To do this, however, the malt
liquor (ale, or lager-bier) should be purchased
by the  cask  or  casks, and drawn as needed,
bottled  malt liquors  being much more expen-
sive, without being better.  This is,  however, 
190   THE  HOSPITAL  STEWARD'S MANUAL.

a subject which must be determined  in every
general hospital by  the  state of the  hospital
fund and the views of the surgeon in charge.
  Supper should consist of well-made tea, not
too strong,  served, like the coffee at breakfast,
with milk  and sugar:  one  pint  should  be
allowed to each patient, with bread and butter
in the same quantity as directed for break-
fast.
  To this  may be  added, occasionally, well-
stewed  dried  fruit,  or the  bread and butter
may be substituted by a proper allowance of
mush and molasses, or mush and milk,—mush
one pint, with one  pint of milk to each patient,
or molasses  at the rate of about one gallon to
the hundred men, allowing each to help him-
self according to his taste.


          SECTION  II.--OF HALF-DIET.
  Half-diet is intended for those patients whose
condition is such as to require a smaller quan-
tity of nutriment  than is afforded  by the  full
diet.  The articles entering into its composi-
tion, and the  quantities  of each in any case,
will be directed by the surgeon  in charge.   It
should approximate the following conditions:— 
      THE  HOSPITAL STEWARD'S MANUAL.   191

  Breakfast.—Tea, with milk and sugar, about
one  pint;  bread, not to exceed  six ounces;
butter, half an ounce.
  Dinner.—Similar to full diet, but  the quan-
tities smaller, say—
     Soup,   ....     1  pint.
     Meat,   .    .    .     .     6  oz.
     Potatoes, or other vegetables, 6  oz.
  Supper.—Tea, bread and butter, as for break-
fast.  Mush  and milk, or molasses, may occa-
sionally  be  substituted  for  the  bread  and
butter.
           SECTION III.--OF LOW DIET.
  Low diet is intended for patients  requiring
still less nutriment, and for whom  the soup,
meat, and  vegetables furnished those  on full
or half diet would be too difficult of digestion.
  The precise composition of the low diet of
any hospital will be directed by the surgeon in
charge.  Some  such  scale  as  the  following
should be approximated :—
  Breakfast.—Tea and  toast, with or without
some form of water-gruel, as directed by the
surgeon for individual cases.   Say, tea, I pint;
bread, toasted, 5 oz., or 3 oz. if gruel is furnished;
gruel (oatmeal or other), 1 pint. 
192   THE  HOSPITAL STEWARD'S MANUAL.

  Dinner.—Mutton, beef, or chicken broth, 1
pint, with   arrow-root, panada,  farina,  corn-
starch, rice pudding, or some similar article.
  Supper.—The same as  breakfast.

         SECTION IV.--OF  EXTRA DIET.
  Under the head of extra diet  may be in-
cluded  extras ordered  by the  surgeon  for
patients  put  upon either  of  the  above diet
scales, and  those special  cases in which, for a
particular purpose,  a diet  entirely unlike either
of them is  directed.
  Extras are most generally  ordered for pa-
tients  whose  condition is such that  they are
put upon low diet.   They include eggs, poached,
boiled,  beaten raw,  or  otherwise  prepared;
oysters, raw or cooked; chickens; fresh fruit;
custards; jellies, or any similar articles which
may be directed by the surgeon.  Under this
head also may be included malt liquors, wines,
and distilled  liquors.   Liquors may very fre-
quently be  advantageously ordered  as extras
to patients upon half, or even upon full, diet.
  In  certain cases,  however, none  of  these
forms of diet  are adapted to the case. Thus,
in certain fever cases  the diet may be ordered
to consist entirely of beef essence, or beef tea, 
      THE HOSPITAL  STEWARD'S MANUAL.   193

with wine whey, or milk punch, given at stated
intervals, or, as in certain wounds about  the
face interfering with mastication, it  may be
necessary that  the whole diet should  be  in  a
liquid form, consisting of soups, gruels, and the
like (spoon-diet).   These forms of diet must
always  be specially ordered by the  surgeon;
and there is hence no  necessity of discussing
them in detail in this place.   A number of re-
ceipts for preparing extras  of various kinds
will be  found in the article on cooking.

     SECTION V.--SPECIMEN OF DIET-TABLE.
   The  following  diet table  is presented as a
specimen of what may be effected by reason-
able care on the part of the hospital steward
when  his  efforts are  directed by a surgeon
aware of the resources of the service.  It is the
diet table actually adopted  and carried out in
the   Seminary  Hospital,  Georgetown,  D.C.,
under the  care  of Assistant Surgeon  (now
Surgeon) J. R.. Smith, U.S.A.
   The same diet table, with some trifling modi-
fications, has been adopted  in the Judiciary
Square  Hospital (for 250 patients), under di-
rection  of Assistant Surgeon (now  Medical
Inspector) E. P. Vollum, U.S.A.
                     17 
Diet Table of the Seminary Hospital,  Georgetown, D. C, successfully adopted also by the
                     Judiciary Square Hospital, Washington, D.C.
FULL DIET.
SUNDAY.	MONDAY.	TUESDAY.	WEDNESDAY.	THURSDAY.	FRIDAY.	SATURDAY.
£ ( Bread and Butter. p> 1 Coffee. * -{ ■4 Cold Meat. w K pa I	Bread and But-ter. Coffee. Hash.	Coffee. Fried Mush and Molasses	Bread and Butter. Coffee. Codfish.	Bread and But-ter. Coffee. Hominy.	Bread and Butter. Coffee. Eggs (2 apiece).	Coffee. Fried Mush and Molasses.
C Soup. h Boiled Meat. g | Potatoes. (_ Bread Pudding.	Irish Stew. Bread.	Soup. Boast Beef. Vegetables. Bread.	Pork and Beans. Potatoes. Bread Pudding.	Chicken Soup. Potatoes. Bread. Bice.	Mutton Stew. Vegetables. Bread.	Soup. Boast Beef. Potatoes. Bread.
(" Bread and Butter. S j Tea" fc ] Dried fruit, stewed. 00 I	Coffee. Mush and Milk or Molasses.	Bread and But-ter. Tea. Cold Beef.	Bread and Butter. Tea. Dried fruit,stewed.	Bread and Mo-lasses. Coffee. Hash.	Coffee. Mush and Milk or Molasses.	Bread and But-ter. Cold Beef.
CO 
       THE HOSPITAL STEWARD'S MANUAL,  195

  Another form of diet table is that  adopted
in the general hospital in West Philadelphia,
by Surgeon I. I. Hayes, U.S.V.
  In  this form the several articles which may
be had for each  meal are printed.  Each day
the surgeon  in  charge fills up  the  diet table
for the next day, indicating the articles to be
used for each meal by drawing a line  through
those not selected, and writing  opposite each
article the number of rations to be issued, and
the quantity in bulk of the  materials  to  be
employed. The form is sufficiently comprehen-
sive to explain itself.   It is especially  adapted
to large hospitals,  such as that in West Phila-
delphia, which is  intended  for  over 2000 pa-
tients. 
196   THE  HOSPITAL  STEWARD'S MANUAL.
Diet  Table of United States Army General
	FULL DIET.	Quan-tity in bulk.	HALF DIET.	Quan-tity in bulk.
	No. of Rations.		No. of Rations.	
< W «! W M	Fresh Beef, Pork, Ham, Mutton, Butter, Milk, Bread, Coffee, Sugar, Molasses, Hash,		Bread or Toast, Milk, Sugar, Tea, Butter,	
H Pi	Soup, Fresh Beef, Corned Beef, Pork, Mutton, Beans, Potatoes, Vegetables, Hominy, Rice, Mush, Pudding, Bread, Mustard,		Soup, Vegetables, Hominy, Rice, Mush, Pudding, Bread,	
w Ph Ph P	Fresh Beef, Bread, Mush, Milk, Butter, Cheese, Molasses, Sauce, Sugar, | Tea,		Bread, Butter, Cheese, Mush, Milk, Sugar, Molasses, Sauce, Tea,	
 
THE HOSPITAL STEWARD'S MANUAL.    197
Hospital, West Philadelphia, Pa., for------186—.
LOW DIET.	Quan-	EXTRA DIET.		Quan-
	tity in		No. of each.	tity
				in
No. of Rations.	bulk.	No. of Rations.		bulk.
Bread, half,		Mutton Broth,		
Gruel,		Beef Essence,		
Barley Water,		Eggs,		
Tea,		Butter,		
Sugar,		Milk,		
Milk,		Tea, Sugar, Mutton, Chickens, Oysters, Pudding, Crackers, Butter, Sugar,		
Bread,				
Butter,		Tea,		
Rice,		Wine Whey,		
Arrow-Root,		Milk Punch,		
Gruel,		Porter,		
Barley Water, Cocoa,		Cocoa, Tea,		
Tea,				
Sugar,				
Milk,				
Gruel,				
Arrow-Root,				
Rice Water,				
Tea,				
Sugar,				
Milk,				
 
		SUPPER.	DINNER.	BREAKFAST.			
as &* <rHM <C -5 " 0)	o E	Full, Half, Low, Extra,	Full, Half, Low, Extra, Total,	1-3 o E	Full, Half, Low, Extra,		
						lbs.	Pork.
						lbs.	Fresh Beef.
						lbs.	Corned Beef.
						lbs.	Mutton.
						lbs.	Ham.
						lbs.	Chickens.
						doz.	Eggs.
						qts.	Oysters.
						pks.	Beans.
						pks.	Peas.
						lbs.	Rice.
						lbs.	Hominy.
						lbs.	Barley.
						lbs.	Arrow-Root.
						pks.	Corn Meal.
						lbs.	Flour.
						lbs.	Bread.
						pks.	Potatoes.
						qts.	Salt.
						qts.	Vinegar.
						lbs.	Sugar.
						qts.	Molasses.
						lbs.	Vegetables.
						lbs.	Mustard.
						lbs.	Butter.
						qts.	Milk.
						lbs.	Cheese.
						lbs.	Cocoa.
						lbs.	Coffee.
						lbs.	Black Tea.
						lbs.	Green Tea.
						lbs.	Oatmeal.
						lbs.	Crackers.
							
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      THE  HOSPITAL STEWARD'S MANUAL.  199

  It is  believed that in all  general  and post
hospitals, except those on the western frontier,
a scale of diet similar  and equal to that above
discussed may be  maintained.    For frontier
posts, however, no absolute rules can  be laid
down.  The surgeon of the post soon becomes
familiar with the resources of the locality, and,
having  done so, the  best  diet  scale  should
be  adopted which the possibilities of the case
will admit of.  All possible gradations will be
found, from posts  at  which fresh vegetables
and fresh meat of all kinds can be obtained at
prices so low that the hospital fund can pro-
cure  all the surgeon  may desire, with even
greater facility than in or  near great cities,
to  posts  at which it  is almost impossible to
procure  any provisions  except commissary
stores and hospital stores, and in which, conse-
quently, the diet can be made very little better
than it should be in the regimental hospitals
of troops engaged in an actual campaign.
   The  possibilities of the diet table in the field
hospitals of regiments or detachments engaged
in  marches or campaigns are, of course, much
more  limited  than in the case of general or
post hospitals.   Where troops  are camped for
a considerable length of time in the neighbor- 
200    THE HOSPITAL STEWARD'S MANUAL.

hood of great cities, as happened, for example,
to the  army of the Potomac during the fall and
winter of 1861-62, it is possible and  desirable
to create a hospital fund, and purchase  milk,
butter, eggs, fresh vegetables, and other articles
of diet for the use of such patients as the sur-
geon  desires  to treat in the camp  hospital.
Where, however, the  troops  are  engaged  in
marches and  the labors of active campaigns,
this will generally be found impracticable, and
the steward will usually be  directed by the
surgeon to draw the full ration, and  to utilize
it and such hospital stores as are furnished by
the medical  purveyor  for field service to the
utmost extent.
   The  problem presented to the steward  in
these cases is a much more difficult one than
in the  case of post or general  hospitals, and
one in which he must constantly call  upon the
surgeon for advice.  The following principles
may, however, be laid  down for his guidance:
   Wherever regular cooking is possible, and
the  full  ration  can  be  drawn,  an attempt
should be  made to comply with the following
diet table, or with some similar table  prepared
for the steward by the surgeon:— 
THE HOSPITAL STEWARD'S  MANUAL.   201
 SECTION VI.--DIET TABLE FOR FIELD HOSPITALS.
Full diet table for a field hospital, where the hos-
  pital is wholly dependent on the Commissary
  and the "hospital stores."
  Breakfast.—Tea   or  coffee,  1   pint,  with
sugar, but without  milk.   Soft  bread, 8 oz. if
furnished, or 6  oz. of hard bread, which may
be  served  dry, or  prepared  by soaking  and
stewing.
  Dinner.—Soup, made of fresh meat, if it is sup-
plied ; if not, of salt meat.  Beans or peas may
be used in making the soup, or a very excellent
and palatable soup may be made of the desic-
cated vegetables which form a part of the ration.
(See receipts.)   The meat to be served with the
soup. Where fresh potatoes are issued, meat stew
may be occasionally served instead of the  soup
and meat,  or the soup may  be omitted,  and
the meat roasted or broiled.
  Supper.—The same as breakfast.
  Half diet.—The same as full diet, but with a
smaller allowance of soup and meat.
  Low diet.—Breakfast  and supper, the same;
meat broth for dinner, or,  instead, arrow-root,
farina, or boiled rice. 
202   THE HOSPITAL  STEWARD'S MANUAL.

   Where the condition of the patient is such
as to require  other  diet, or  extras, he should
be sent to the general hospital at the base of
operations.   When,  from the nature of  the
service, it  is not possible to cook regularly, or
to draw the full  ration, it is best not to attempt
to treat in the field those who are sick enough
to enter  hospital at all, but to send  them at
once to the general hospitals in the rear.
   Directions for cooking in the field  will  be
given in the next chapter (Section III.). 
THE HOSPITAL STEWARD'S MANUAL.   203
              CHAPTER III.

      Of the Kitchen and its Management.

  SECTION I.--GENERAL  MANAGEMENT OF THE
                  KITCHEN.
  The kitchen, like every other part of the
general hospital, is under the orders of the
chief steward, who is  responsible to the sur-
geon for its proper management.   The  chief
cook is,  in like  manner,  responsible to the
steward.
  It is usual in a large hospital to assign one
hospital steward to the  exclusive duty of super-
intending the kitchen.   Where this is the case,
he is responsible to the chief steward, in the
same manner as the cook.
  The cooks  are  hospital attendants, either
enlisted  men or  civilians  employed  as  men-
tioned in  Part I.
  According to regulations, one cook is allowed
to every thirty patients, which would give  ten to
a hospital of three hundred men.   This num- 
204   THE  HOSPITAL  STEWARD'S  MANUAL.

ber will generally be found more than sufficient
for the exigencies of the service.
   One of the cooks should be selected by the
surgeon as  chief cook, and should have charge
of the management of all the business of the
kitchen.   Where a steward is put in charge of
the kitchen, the chief cook is responsible to this
steward; but where no steward is specially
assigned to the kitchen, the chief cook is imme-
diately responsible to the chief steward of the
hospital.
   It is the business of the steward assigned to
the charge of the kitchen of a general hospital,
or of the chief cook, where no steward is assigned
to the kitchen, to receive from the chief steward
the rations and purchases for the diet of each
day: he should receive from him, at the same
time, the number of full diets, the number of low
diets, and the number and kind of extras to be
prepared for the day.  He should assign the seve-
ral cooks each to some particular duty, for the
execution of which they are to be responsible.
He should see that  order and  discipline are
maintained  in the  kitchen, and  that  each
executes the tasks assigned to him.  He should
have the receipts adopted in the hospital for
soup,  for stews, &c,  neatly copied upon cards 
THE HOSPITAL STEWARD'S  MANUAL.   205
and  hung up in some convenient  place in the
kitchen for the  information  of those whose
duty it is  to prepare them.   These  receipts
should only be adopted after due consultation
with the surgeon in charge of the hospital, but
once selected should be rigidly adhered to.
  He should also exercise supervision over the
fires, see that they are properly managed, and
that no unnecessary waste of fuel  occurs.
  The  kitchen of a general  hospital should
always be kept  perfectly clean and in strict
order.   Besides the range or stoves, it should
have in it one or more large tables for the pre-
paration of articles of diet.  Upon the walls
should be a sufficient number of shelves to re-
ceive the kitchen-utensils, those of each kind
having their special places assigned to them, in
which they  should  always be found, except
when in use.   Order, always  indispensable in
a kitchen, is especially necessary  in that of a
large establishment.
  The  steward or chief cook in charge of the
kitchen  is  responsible  that the meals  are in
readiness at the  hours  assigned  for  each, as
well as for their quality.   The greatest punc-
tuality is demanded  on this head.   It  is also
his  duty to supervise the distribution  of  the
                      18 
206   THE HOSPITAL  STEWARD'S MANUAL.

food from the  kitchen.   This is  effected in
various modes, in accordance with the plan of
the hospital, which varies in different locations.
  Thus, where a general hospital has a  single
large dining-room for convalescents on full diet,
the chief cook issues to the attendants detailed
to attend the dining-room the full quantity of
coffee, of soup, of  bread, &c. prepared for the
number of patients allowed by the surgeon to
dine at this table.   This is  carried in bulk to
the  dining-hall, and there  distributed,  under
the  supervision of a responsible  attendant, to
the  several  places,  before  the  patients are
allowed to enter the room.   Where, however,
the hospital consists of a number of detached
pavilions, each  with its own dining-room, he
issues  to the  attendants sent from each, the
cooked rations to which the number of patients
dining in each are entitled, to be distributed in
the same manner.
   The diet for patients confined  to their beds
is distributed  on the same general  principles.
The several articles are issued in bulk  to the
chief nurse of each ward, or attendants detailed
for the purpose, the quantity to be determined
by the number of patients allowed each article
of diet. 
      THE HOSPITAL  STEWARD'S  MANUAL.   207

  Thus, if in a given ward ten patients  are
allowed soup  according to the full diet table,
the steward of the kitchen, or the chief cook,
issues fifteen  pints of soup to the nurse, who
carries it in a  suitable vessel to the ward, where
it is divided by measure, each patient  receiv-
ing in the  tin cup or soup-dish used for the
purpose the quantity allowed him; and so with
other articles.
  Strict order should be maintained in these
issues, and  the most careful supervision  em-
ployed  to see that  each patient receives his
share.
  Meat should be divided into rations,  and
bread cut into slices, before leaving the kitchen.
  On no account should patients be allowed to
come in person to the kitchen for their rations;
nor  should they  be allowed to visit  in the
kitchen, where it should invariably be the rule
to admit none except those whose business de-
mands their presence.
   Whenever it is  practicable, it is advisable to
have a separate kitchen for the preparation of
extras.  This kitchen, where female nurses are
employed, may generally be put with advan-
tage  under the  supervision  of a competent
woman assigned by the surgeon for this duty. 
208   THE HOSPITAL STEWARD'S MANUAL.

  All remarks as to order, punctuality, and
cleanliness  applied  to  the general  kitchen
apply here with equal force.
  Cleanliness is indispensable in the kitchen.
The floors should be kept dry and well cleaned.
The tables should present the strictest pro-
priety, and the utensils should be clean and in
good condition.   Slops  should be received in
a large  vessel—say a  half-hogshead—outside
of the kitchen, which should be emptied daily
in summer-time, and at least twice a week in
winter.  Where it  is  possible  to sell these
slops,  as for feeding pigs, &c, the  steward
should do so, and use the proceeds as hospital
fund.
  A few remarks on the  mode of maintain-
ing  the cleanliness  of utensils will not  be
amiss.
  Iron  utensils  are  very generally  used  for
cooking meats.   The boilers for soup, the fry-
ing-pans, stew-pans, &c,  are  often of  this
material.   They should  be cleaned  imme-
diately after using, and before they are put
away for the day.   Soap or ley should be used
to remove the grease, after which  they  should
be  carefully dried, as very little moisture will
cause them to rust in a short time. 
      THE  HOSPITAL  STEWARD'S MANUAL.   209

  Before  using, they  should be carefully in-
spected to  see that  they are clean,  and  be
rinsed out with a little scalding water.   Fine
sand  may be  used with advantage to  scour
these utensils, especially when they have been
rusted.
  Iron vessels are sometimes tinned on the
interior, and sometimes  lined  with porcelain.
These surfaces will require the same care as in
the case of vessels wholly made of these ma-
terials respectively.
   Copper vessels should never be used in cook-
ing,  unless well  lined with tin.   The  lining
should be  carefully  inspected, and  renewed
whenever the copper begins to show.  Grease
is to be removed by soap or ley.   The copper,
as well as the tin lining, may be polished with
the finest sand, or with fine brick-dust.
   Tin vessels of every kind, after having been
cleansed  of all grease, may be polished with
fine sand or with whiting.  Warm water should
be used in cleansing tins.
   Wooden utensils are also to be kept  neat by
scouring with the finest sand.
  The knives,  forks,  spoons, plates,   cups,
and other table-utensils  should be  thoroughly
cleansed and put away after each meal;  cook-
                     is* 
210   THE  HOSPITAL  STEWARD'S MANUAL.

ing-utensils, after each time  of  using.   The
strictest cleanliness is necessary,  and too great
care cannot be used  to attain this end.

SECTION II.--OF FIRES AND FUEL IN GENERAL AND
               POST  HOSPITALS.
   A good "range" heated with coal is unques-
tionably the  best  means  of cooking  for  a
general hospital, where it is possible to obtain
it.   Where it is supplied, there is no reason
why the best results as to  the cuisine should
not be attained.
   One or  more properly constructed cooking-
stoves answer nearly the same purpose: they
are somewhat inferior in convenience and eco-
nomy, but, on the  whole, an  excellent sub-
stitute where a range cannot be had.
   These cooking-stoves may  be made to burn
either wood or coal.   They should  be so con-
structed as to give ovens for baking as well as
conveniences for boiling, and cooking over  an
open fire.
   Whether ranges or  stoves be employed, the
cooking-utensils, such as  caldrons  for soup,
coffee,  baking-pans, &c,  should  be procured
with them, to secure their being properly con- 
      THE HOSPITAL  STEWARD'S  MANUAL.   211

structed, as to form and size, to suit the amount
of fire in each case.
  These utensils should be—large iron caldrons
for boiling soup or meat, holding from  ten to
twenty  gallons,  large block-tin  boilers  for
coffee and tea, with a faucet about two  inches
from the bottom, and  holding about the same
quantities, with stew-pans, gridirons, &c. &c.
  Too much care cannot be exercised  in the
management of the fires.   The success of the
cooking is to a great extent dependent upon it.
Thus, in  the  preparation of soups,  a slow,
moderate fire, steadily kept up, is indispen-
sable; while for roasting or baking, a brisk, hot
fire is equally necessary.   The  management
of the several varieties of ranges and  stoves is
best acquired  by practice and  by steady en-
deavors to maintain the degree of heat neces-
sary for the cooking actually  going  on.  No
general rules can, therefore, be laid  down in
the brief space of this  volume, and much must
depend in every case upon the discretion of the
cook, over whom the steward must  keep up
a  proper  superintendence, never forgetting
that, while the cooks  are  responsible to him,
he is  responsible to the surgeon, for  the con 
212   THE HOSPITAL STEWARD'S MANUAL.

dition of the kitchen  and the  quality of the
cooking.
   Fuel  for the hospital, whether  wood or
coal,  is to  be  obtained of the quartermaster,
on a  requisition signed  by the  surgeon  and
approved by the commanding officer.
   The following form is that directed in  re-
gulations :—*
* Revised Reg., Quartermaster's Depart., Form No. 30, p. 208.
15 
THE  HOSPITAL  STEWARD'S  MANUAL.   213
           FORM OF  REQUISITION FOR FUEL.

Requisition for Fuel for the Hospital  at -------, for the
                 month of-------,  186
		WOOD.		COAL.		REMARKS.
	Cord.	Feet.	Inches.	Bushels.	Pounds.	
						Number
						of fires.
Total...						
  I certify, on honor, that the above requisition is correct and
just, and that I have not drawn fuel for any part of the time
above charged.
                                          Surgeon U.S.A.

  Received at.................................., the..........of .................. 186  ,
0f...................................................., Assistant Quartermaster U.S.A.,
.....................cords......................feet.........................inches of wood
and ........................................................of coal, in  full  of the above
requisition.

                                          Surgeon U.S.A.

(Copies of this requisition should be kept on file by the Steward.) 
214   THE  HOSPITAL  STEWARD'S MANUAL.

  Fuel is to be drawn monthly.  It should be
kept in a  place appropriated  to the purpose,
convenient to the kitchen.  If wood, it should
be neatly piled after having been cut or sawed
into lengths such as needed for use.  If coal, it
should be kept under cover, as it deteriorates
from exposure.


SECTION III.--FIRES AND FUEL IN CAMP-HOSPITALS.

  The best cooking apparatus in the camp-
hospital is a good camp cooking-stove. Very fre-
quently, however,  this is not attainable.   The
hospital  steward is  then obliged to resort to
other means,  which  are  more  or less imper-
fect.   The  plan  generally   resorted to  is
that usually employed by our soldiers in the
field.   It is very  simple.  A trench eighteen
inches wide, and nine or ten deep, is cut  of a
length which varies in accordance with the
amount of cooking to be done.  A forked stake
is driven into  the ground  at each end of the
trench, and  a pole laid  across  in  the forks.
From  this pole the kettles for boiling soup,
coffee, &c.  are  suspended.   Pieces of meat for
roasting may be suspended  by strings.   Pans
for stewing are placed over the fire, supported 
      THE HOSPITAL  STEWARD'S MANUAL.   215

upon  properly  placed stones, or, in  locations
where—as often happens in this country—these
cannot be obtained, upon sods cut about twelve
inches square, and properly piled on each side
of the trench for this purpose.
   The figure illustrates the plan.
  Where it is possible to line the trench with
brick and build a chimney at one end, it will
be found an improvement; but even then the
plan is a very imperfect one.  (See figure).
  The objection to these plans is that changes
in the  direction of the  wind  interfere  con-
stantly with the steadiness of the fire. 
216   THE HOSPITAL STEWARD'S MANUAL.

  To obviate this difficulty is the great prac-
tical question in building extemporaneous field-
fires.   The plan of the Turkish soldiers in the
Russian war is  commended by Miss Nightin-
gale  as attaining this end :*—
  " The   Turkish soldier cuts a trench,  six
inches deep and six wide, in  a curve against a
bank, natural or  artifical,  not less  than two
feet high.  He cuts a few trenches of like size
in the earth, radiating inward from  the curvi-
linear trench: he places his  kettles upon  the
intersection of these  trenches, and  the result
is a steady draught leading upward against the
bank; no blast of air blows  through any one
trench so as to disturb the fire."
  I have  never seen this plan tried; but it is
simple,  rational, and  appears likely to attain
the desired objects.
  Another plan, and well adapted to a clayey
soil,  is that adopted by the salt-boilers  of New
York.   A hole three feet square and two deep
is dug in the slope of a hill.   From this a shaft
is run laterally about one foot  square and six
long: at the extreme end of this a shaft is sunk

  * Notes on Matters Affecting the Health, Efficiency, and Hos-
pital Administration of the British" Army.  By Florence Nightin-
gale.  London, 1858.  Printed for private distribution ; pp. 402. 
      THE HOSPITAL STEWARD'S MANUAL.   217

vertically, and a chimney built: three holes, of
such diameter that the camp-kettles will not
sink through, are  pierced  at  equal  distances
along the horizontal shaft.  The fire is  built
in the square hole, the draught is borne through
the lateral shaft to the  chimney.  The kettles
for coffee, soup, &c. are  set over the holes; the
immediate fire may be  used for roasting  and
boiling.   (See figure on p. 218).
   The  accompanying illustrative  diagram is
from the little pamphlet by Capt. J. M. Sander-
son, C.  S.  of  volunteers, on "camp-fires  and
camp-cooking," which was recently distributed
from the  Commissary-General's office.
   Lastly, very satisfactory cooking on a small
scale  may be done over fires  arranged as de-
scribed  in the remarks on warming hospital
tents.*
   Fuel  for camp-hospitals is  either  obtained,
as in barracks, by requisition on  the quar-
termaster, or by  cutting  wood  in neighbor-
ing forests, or  collecting  it  from whatever
source  may offer  in individual cases.    The
duty of collecting it belongs  to the police of
* See Part II. chap. ii. sect. iii.
l-.i 
218   THE  HOSPITAL STEWARD'S MANUAL.
Outside View.
the regiment or brigade to which the hospital
belongs,  who, while  collecting  wood for  the
general cooking of the command, collects it also
for the hospital.   The order for this purpose is
given  by the commanding officer,  at the  re-
quest of the surgeon. 
THE HOSPITAL STEWARD'S  MANUAL.   219
               CHAPTER IV.

             Cooking in Hospitals.

         SECTION I.--GENERAL REMARKS.
   Perhaps no  subject is more worthy of atten-
 tion in a hospital than the quality of the food
 and the character  of the  cooking.   In the
 latter  there  is certainly greater room for im-
 provement in  United States  army hospitals
 than in the former.   The rations furnished by
 the  commissary  department  are generally of
 good quality and  in good condition; the  articles
 purchased with the  hospital fund  ought cer-
 tainly  to  be of  good quality;  but, however
 good the raw articles may be, bad cooking will
 impair  their nutritive value,  as well  as the
 relish with which they  are eaten by the pa-
 tients.
  Cooking serves for two distinct purposes.
 In the  first place, it serves so to  modify the
food by the heat employed as to  cause it to be
more readily dissolved during digestion.  But
in the second place, also, it serves, by rendering 
220   THE  HOSPITAL STEWARDS MANUAL.

the food more palatable, to incite the digestive
secretions,  and thus not only to increase the
appetite, but also the energy of digestion.
  Now, on the  one  hand, the heat  may be
erroneously so employed as  to have the effect
rather of rendering articles of food insoluble,
and therefore difficult of digestion, or of  pro-
ducing destructive changes, as where the food
is more or  less burned; and, on the other hand,
the food may be so cooked as to be unpalat-
able, which will have the effect not merely of
diminishing the  appetite and causing the pa-
tient  to eat  less  food than  he  should,  but
impairs directly his digestive  energies, so that
he does not digest what he does eat, as well as
he would have done had it been properly  pre-
pared.
  As an illustration of the erroneous manage-
ment of heat, may be cited the preparation
of soups, in which,  if a brisk ebullition be kept
up from the first, the exterior of the pieces of
meat is rapidly hardened, and the full strength
is never taken up into the  soup as  it is where
the water  put in  cold is  gradually  brought
nearly, but not quite, to the boiling-point,  and
allowed to  simmer for several hours.
  In  other cases a hot fire is required, as in 
       THE HOSPITAL STEWARD'S MANUAL.   221

roasting, where if the fire is brisk the  outside
of the piece rapidly becomes crisp, and all the
juices are kept in, while if the fire is slow the
juices leak gradually away, and the meat  is
left tasteless and insipid.
   With the hope of contributing somewhat to
the improvement of the  cooking in the hos-
pitals of the United States army, a number of
receipts for ordinary and extra  diet are here
given.  Most of these receipts are those of the
celebrated M. Soyer, and Itave  not only been
thoroughly tested during the Crimean War, but
have most of them received an approval, based
upon  actual experience, by United States army
surgeons.
   The use of these  or similar receipts will
insure the palatability and proper preparation
of the food.   As to its palatability, the steward
may adopt a very simple rule.   The food must
be regarded as deficient  in this  respect unless
it gives satisfaction to the patients.   Of course,
there  are some grumblers who  will find fault
under  all circumstances; but where the cook-
ing is generally complained of, it must be bad,
and the  steward should at once consult with
the cooks, and, if necessary, with the surgeon,
as to the means of improving it.
i >.)« 
222   THE HOSPITAL STEWARD'S MANUAL.


SECTION II.--RECEIPTS ADAPTED TO THE  ORDINARY
              DIET IN HOSPITALS.
   No. 1.  Coffee for ten men.—(Soyers method.) *
—Put 9 pints of water into  a canteen, sauce-
pan (or other vessel) on the  fire;  when boil-
ing, add  7i oz.  of  coffee;   mix  them well
together with a spoon  or piece of wood; leave
on the fire a few minutes  longer, or  until just
beginning to  boil.  Take it  off, and pour in
1 pint of cold water; let the whole remain ten
minutes, or a little longer;  the dregs will fall
to the  bottom, and the coffee will  be clear.
Pour it from  one vessel into  another, leaving
the dregs  at the  bottom; add 2 teaspoonfuls
of sugar to the pint.   If milk is  to be had,
make 2 pints less of coffee, and add that much
milk ;  boiled milk is preferable.

   Remarks.—This  receipt,   properly  carried
out, would give 10  pints of coffee, or 1 pint per
man.  The allowance  of coffee in  the army
ration is 1 lb. to ten men.
  * Most of the following receipts are taken, with little or no
alteration, from " Soyer's Culinary Campaign." By  Alexis
Soyer.  London, 1857. 
      THE  HOSPITAL STEWARD'S MANUAL.   223

  This quantity  would give  8 oz. to 10 pints
of coffee for  breakfast, and the same for  sup-
per, or a little more than M. Soyer's allowance.
If tea is used for supper, only half the ration
of coffee should  be drawn, and tea drawn for
the rest.  To calculate the quantity of coffee
to be drawn  upon the provision return in a
hospital  where  coffee is  used for breakfast
only, the following rule may be given.  Divide
the number of patients and attendants alloweol to
use coffee by two:  the result is the number of
rations of coffee required per  day.
   In great hospitals the coffee is usually made
in large caldrons or boilers, holding each enough
for fifty or one hundred men.
  The following modified receipt may be used:—

   No. 2. Hospital receipt for coffee for fifty men,
allowing 1 pint to each.—Ingredients needed.—
Water, 5 gallons, milk, 11 gallon,  sugar, 3& lbs.
Directions.—Put into the boiler 35 pints of
water (4  gallons  and 3  pints); bring it to
a  boil.   When boiling, add  2? lbs. of coffee;
stir well until ebullition has thoroughly recom-
menced, say  for four or five minutes; then
lift the boiler off the  fire,  and pour in  5 pints
(2£ quarts) of cold water.   Let it stand about 
224   THE  HOSPITAL STEWARD'S MANUAL.

ten minutes,  when the  coffee may  be care-
fully poured or drawn  off into the coffee-pots,
leaving the dregs behind.   To every two quarts
drawn off  add a pint  of milk (boiled milk is
best) and 3 oz. of sugar.  A seven or eight gallon
coffee-boiler answers very  well  for  this pur-
pose.   If coffee for a  hundred men  is to be
cooked   in  a  single   vessel,  use double  the
quantity.

   Remarks.—Two points in these receipts are
of practical importance.   First, the  coffee  is
not to be introduced until the water is boiling,
nor is it to be  boiled too long.   If this  is
neglected, the aroma is destroyed, and the coffee
is muddy  and  insipid.  Secondly, the subse-
quent addition of cold  water causes the dregs
to subside more rapidly, and "clears" the coffee.

   No. 3. Tea for  eighty  men.—(21. Soyers re-
ceipt.)—Put 40 quarts of water in a boiler t©
boil; place the rations of tea in a fine  net very
loose, or in a large perforated ball;  give one
minute to boil;  take out the fire, if too much;
shut down the cover: in ten minutes it is ready
for use. 
      THE HOSPITAL  STEWARD'S  MANUAL.   225

  No. 4. Tea for fifty men.—(Hospital Receipt
based on Soyers Receipt.)—Ingredients needed.—
20 quarts of water, 5 of milk, 6 oz. of tea, and
3i pounds of sugar.   Directions.—Put into the
boiler 20 quarts of water, 2 \ gallons.   Bring it
to a boil.   When boiling, introduce 6 oz. of tea
tied up loosely in a bag of bobinet or mosquito
netting,-to prevent the leaves becoming diffused
throughout the liquor.  Allow  it to boil one or
two minutes;  then lift the boiler off the fire,
and allow it to  stand on the stove or range,
but not over the coals, for ten or fifteen minutes
to draw.  While drawing, the boiler should be
covered.   Stir in now 5  quarts of milk and 3i
pounds of sugar, and the  tea is ready for  the
table.

  Remarks.—The aim of this process is not to
boil the  tea, but to allow it  to macerate (or
draw) in boiling water.

  No. 5. Codfish Hash.—Put  the salt fish to
soak over  night  in  lukewarm water,  fleshy
side downward.   Next morning put it in a pot
with fresh water, and simmer till it is tender.
Pick the  flesh from the  skin, rejecting  the
bones; chop it fine, and  mix with three times 
226   THE  HOSPITAL  STEWARD'S MANUAL.

its weight of boiled potatoes, moistening the
mixture  with pork  scraps  and dip (i.e.  pork
cut up fine and tried out).   The  addition of
some milk will be found a great improvement.
About 12  pounds of fish and 36  of potatoes
prepared in this way will  make a good break
fast relish for one  hundred men.
  No. 6.  Beef Soup for fifty men.—Soyer's Army
Receipt.—Ingredients needed.—Cold water, 7i
gals., fresh beef, 50 lbs., rice, 3 lbs., fresh vege-
tables  (viz. carrots,  onions, turnips, potatoes,
parsley, &c.&c), 8  lbs. (or desiccated vegetables,
Ih lbs.), 10 small tablespoonfuls of salt, 1 table-
spoonful  of pepper.   Directions.—Put all the
ingredients, except the rice, into the boiler;  gra-
dually bring it to a boil; then  add the rice, and
simmer three hours, when it  will be ready to
serve.   Before  serving,  the  fat  should  be
skimmed off and kept in a clean vessel; it  will
serve as an excellent substitute for butter for
many cooking  purposes.   The meat  may be
eaten with the soup, or, if other meat is given
at dinner,  may be kept for breakfast relishes.
  Remarks.—This soup, which is given by M.
Soyer  among his army receipts, is  perhaps in-
ferior, on the whole, to the next receipt. 
       THE HOSPITAL STEWARD'S MANUAL.   227

   No. 7.  Semi-stewed Beef  and  Soup for one
hundred men.—(Soyers Hospital  Receipt.)—In-
gredients  needed.—Cold  water, 130  pints (16i
gallons), fresh beef, 70 lbs. (in pieces of 4 or
5 lbs.), mixed fresh vegetables, 12 lbs. (carrots,
onions, parsley, turnips, potatoes, &c, according
to taste or convenience), barley, or  rice, 9 lbs.
6 oz.,  salt, 1 lb. 7 oz., flour 1  lb. 4 oz., sugar,
1 lb. 4 oz., pepper, 1 oz.  Directions.—Put all
the ingredients into  the caldron at once, ex-
cept the  flour; set  it on the fire,  and, when
beginning to boil, diminish the heat and simmer
gently for two hours and a half; then add to
the soup the flour, which has been first mixed
with enough water to form  a light batter; stir
well together with a large spoon; boil another
half-hour; skim off the fat;  take  out the meat,
and serve the soup  and meat separate.  The
soup  should be stirred  now  and then  while
making, to prevent burning, or sticking to the
sides of the caldron.

  Remarks.—The joints are cooked whole, and
afterwards cut up into equal  portions, one for
each man.  The meat cooked in this way is
more nutritious.   Where fresh vegetables can- 
228   the  hospital steward's manual.

not  be  obtained,  3 lbs.  of mixed  desiccated
vegetables  may be substituted for 12 of fresh.
   Variations.—The addition of a quarter of a
pound of curry powder,  or of half a pint of
burnt-sugar water, gives an agreeable diversity
in appearance and flavor.

   No. 8. Semi-stewed Mutton and Soup for on,e
hundred men.—(Soyers Hospital Receipt.)—In-
gredients.—The same  as  in the last receipt,
except that mutton is substituted for beef.
   Proceed  the  same as for beef, except that, as
mutton needs less cooking than beef, the joints
should be taken out before the flour is added,
and  kept warm in a  suitable pan till time for
serving.

   No. 9. Plain Irish Stew  for fifty men.—
(Soyers Receipt.)—Ingredients.—Fresh mutton
or beef, 50 lbs., large onions, 8 lbs., whole po-
tatoes, 12 lbs.,  8 tablespoonfuls of salt, 3 table-
spoonfuls  of pepper; water, a sufficient quan-
tity.  Directions.—Cut  the meat into pieces of
a quarter of a pound each; put the ingredients
into  the pan with enough water to  cover them
all.   Set it on the fire,  and keep  up  gentle
ebullition,  stirring  occasionally, for an  hour 
      THE HOSPITAL STEWARD'S MANUAL.   229

and a half for mutton, and two hours for beef.
Then mash some of the  potatoes to thicken
the gravy, and serve.
   Variations.—Fresh  veal, or  pork,  may be
used instead, when convenient.

   No. 10.  " Soyers Food" for fifty men.—Ingre-
dients.—Fresh beef, 50 lbs., onions, 7 lbs., flour,
li lbs., 10 tablespoonfuls of salt, 2 tablespoon-
fuls of pepper, 4 tablespoonfuls of sugar, water,
18 quarts.  Directions.—Cut the beef into pieces
of a quarter of a pound each, slice the onions,
and introduce all the solid ingredients except the
flour, with a little of the water, into the boiler.
Set it  on the  fire and let it stew, stirring oc-
casionally, for twenty  to thirty minutes, or till
it forms a thick gravy; then add a pound and
a half of flour; mix well together, and add the
rest of  the water; stir  well for a  minute or
two; regulate the  stove to a  moderate heat,
and let simmer for  about two hours.
   Variations.—A pound of rice may be added
to great  advantage, also plain  dumplings, and
potatoes, or mixed  vegetables.

  No. 11.  Suet Dumplings for- Soups or Stews.—
(Soyers Receipt.)—Ingredients.—Half a pound
                     20 
230  THE  HOSPITAL  STEWARD'S MANUAL.

of flour, half  a  teaspoonful  of salt, a quarter
of a pound of chopped fat  pork (or of beef
suet), and  eight tablespoonfuls of water, with
two onions chopped fine, if convenient.   Direc-
tions.—Mix well into  a  thick  paste;  divide
into pieces of convenient size;  roll  them in
flour  and put into  the soup, or stew,  about
half an hour before it is done.

  Remarks.—A few dumplings  made in  this
manner, and scattered through the soup, are a
great addition,  but  they should not  be too
abundant.

  No. 12.  To  boil Salt Beef (or Pork) for fifty
men.—(Soyers Receipt.)—Put 50 lbs. of meat
in pieces of 3 or 4 lbs. each into  a boiler; fill
the boiler with water, and let the meat soak
all night.  Next morning wash the meat well,
and pour away the salt water.  Fill the boiler
with fresh water; boil gently three hours,  and
serve.   Skim  off the fat, which,  when cold, is
an excellent substitute for butter.
  For salt pork, proceed as above, or  boil half
beef and half pork.   The pieces of beef should
be smaller than those of pork, as  beef requires
longer to cook.   Where salt meat cannot be 
      THE  HOSPITAL  STEWARD'S MANUAL.    231

soaked  all night, it should be  parboiled for
twenty minutes, and then the water poured off,
fresh poured  on, and the cooking commenced.

  No. 13.  Soup from the Liquor  in which  Salt
Pork has been boiled.—The liquor in which salt
pork has been boiled can  be made  into a very
good soup with  peas, or beans.   Add to the
liquor  in which 50 lbs. of salt pork  has been
cooked  5 lbs. split peas, i lb. brown sugar, 2
tablespoonfuls of pepper, and  10 onions;  sim-
mer gently till the peas are reduced to a pulp,
and serve.   Broken biscuit may be introduced.
This  will  make  an excellent  mess.   Beans
properly soaked may be  substituted for  the
peas.
   No. 14.—Stewed Salt Beef and Pork for one
hundred men.—Ingredients.—Well-soaked beef,
30 lbs. cut into pieces of i lb. each, pork, 20 lbs.,
sugar, 14  lbs., onions,  sliced,  8  lbs.  water, 25
quarts, rice,  4 lbs.  Directions.—Introduce all
the ingredients into a boiler; simmer gently for
three hours; skim the fat off the top, and serve.

   Remarks.—The beef and pork must be well
soaked over  night, according to the  directions
given in Receipt No. 12. 
232   THE HOSPITAL  STEWARD'S MANUAL.

  No. 15. Bean soup  for one hundred men.
Ingredients.—8 quarts of beans, 30 lbs. of pork,
half a dozen  onions, salt, i lb., pepper, 1  oz.,
water, 120  pints  (15  gallons).   Directions.—
Soak the beans over night in cold water.  Cut
the pork  into pieces  of  from three  to five
pounds each.
  At eight o'clock in the morning the beans are
to be put  into a caldron  filled with  water,
and boiled for two hours and a half, when  the
water is to be poured off and the beans are to
be added  to the  pork-liquor  next to be  de-
scribed.  The  pork  is  to  be  introduced into
another caldron, at quarter-past eight o'clock,
and boiled briskly for an hour, when the liquid
is to be poured off and replaced by clean hot
water, 120 pints to 30 lbs. of pork.  The pork
is now to be boiled an hour and a half longer,
when it is to be taken out and laid  aside to be
served separately.   The beans are then added
to the liquid in which the pork was boiled, with
the salt, pepper, and the onions (chopped  or
sliced).   After fifteen  minutes'  more  boiling,
the beans are to  be mashed with a  wooden
spoon  made for the  purpose, and the  soup,
which is now ready, is to  be served with  a
slice of pork in a separate dish. 
      THE HOSPITAL STEWARD'S MANUAL.   233

  No. 16.  Bean Soup for one hundred  men.
— (American Army Receipt.)—Ingredients.—8
quarts of beans, 20 lbs. of pork, half a dozen
onions, salt, \ lb., pepper, 1 oz., water, 120 pints
(15 gallons). Directions.—Soak the beans over
night.  Early in the morning put  them into a
caldron with the salt and water, and boil steadily
for  three hours, or  until the beans are so well
done that they  can  be strained through a sieve,
leaving their  skins on the sieve.   They are
then  to  be so  strained, after which the  pork,
cut in slices, the onions, chopped fine, and the
pepper, are to be added, and the boiling con-
tinued two to three hours longer, or  till the
pork  is done tender, when the  soup is ready.
  In  making this  soup, good soft water is re-
quired.  At posts  where  the  water  is  hard,
rain-water must be substituted.   The  caldron
must be  clean and  free from grease, and grease
in every shape must be avoided until the beans
are done.

   No. 17. Browning for Soups.—Put  i lb. of
moist sugar into an iron pan, and melt it over
a moderate  fire,   stirring it continually  till
quite  black, which will take about twenty-five
minutes; it must color by degrees, as too sud-
                      20** 
 234   THE HOSPITAL STEWARDS MANUAL.

 den a heat will make it bitter:  then add  2
 quarts of water, and in ten minutes the sugar
 will be dissolved.   You may then bottle it for
 use.  It will keep good for a month, and will
 always be found very useful.

   No. 18. Baked Pork and Beans.—The beans
 and pork, having been soaked over night, are
 boiled separately in the morning for about two
 hours.  The pork is then put into pans, sur-
 rounded and  covered by  the  beans,  a  little
 pepper added, and baked one hour by a mode-
 rate fire.

   No. 19.  Corned  Beef  and  Cabbage.—The
 beef, having been soaked in fresh water over
 night, is  placed in  a caldron  and simmered
 over a moderate fire for two hours and a half,
 skimming carefully every fifteen   or  twenty
 minutes.  As much cabbage as the water will
 cover is then introduced, and  the*ebullition is
 to be continued gently for an hour and a half.

   No. 20. Boiled Potatoes.—Wash the potatoes,
 and  put them with their skins on into the
caldron: throw  in a  handful of salt,  and fill
the vessel with cold water.   Put it on  the fire, 
      THE HOSPITAL STEWARD'S MANUAL.   235

and bring it to a boil.   When the water boils,
throw in a little cold water to check it: do so
two or three  times.  When the potatoes are
very nearly cooked, pour off all the water, and
stand the  kettle over the fire till the steam
evaporates.   This process will  make the po-
tatoes mealy.

  No. 21. Indian Mush for one hundred men.—
(American Army  Receipt.)—Ingredients.—In-
dian meal, 20 lbs., water, 70 pints (81 gallons),
salt,  6 oz.   Moisten slightly the  meal  with
water.  It will require about one  gallon and
three-fourths for this purpose.   Have the rest
of the water—say  7 gallons—in  the caldron
boiling; add the salt, then stir in the moistened
meal. The stirring should be continued  after
all the meal is in, to prevent  burning.  From
twenty minutes to half an hour will be found
long  enough to boil.   The above quantities
will make 1D0 pints of mush, or a little more.
One  pint may be served to each  man,  with
molasses or milk.   If milk,  one  pint should
be allowed to  each  patient; if molasses, one
gallon to one hundred men.
  Remarks.—If the meal is stirred in dry, the
mush will be lumpy. 
236   THE  hospital  steward's manual.

  No. 22. Plain Boiled Rice.—(Soyers Recent.)
—Rice,  i  lb., water, 2  quarts,  salt,  1 tea-
spoonful,  or  in  that proportion  for   larger
quantities.  Put  the salt and water into the
stew-pan or  boiler.   When  boiling, add  the
rice, previously  well  washed.   Boil  for  ten
minutes, or till each  grain becomes rather soft.
Drain it on a colander. Slightly grease the pot
with butter; put the  rice back into it; let it
swell  slowly for  about twenty minutes near
the fire or in a slow  oven; each grain will then
swell  up and be well separated.  It is then
ready for use.

               No. 23. Bread.
  When the hospital  is  not situated  near  a
Government  bakery, it is desirable for it to be
able to bake its own bread.   For this  purpose
the " Shiraz oven" may be obtained by requi-
sition on the Chief of the Commissariat.  One
of these ovens will  be found ample to do the
baking for about three hundred patients.  The
following receipts are copied  from the little
pamphlet on Camp  Fires and Camp Cookery,
by  Captain J. M. Sanderson, C. S. of Volun-
teers*
Camp Fires and Camp Cookery ; or, Culinary Hints for the 
       the hospital steward's manual.   237

  " To maJtt  Yeast.—Fill a kettle three-fourths
full of clean, clear water; place it over a brisk
fire,  and, when it boils, add three good hand-
fuls of hops;  then put into the yeast-tub four
pounds of flour, and strain into  it, from the
kettle, enough of the hot " hop-water" to make
a paste, working it until it  is perfectly free
from lumps.   By  this  time the  hops  in the
kettle will be sufficiently boiled, and  must be
strained into the yeast-tub, and stirred with  a
wooden paddle until thoroughly amalgamated.
Let it stand until it cools a little,—about blood-
heat,—and add three pints of cracked malt and
two quarts of stock yeast, mixing it  all well
together to prevent any lumps  remaining, and
setting  it away in  some quiet,  warm place,
where  it will remain  undisturbed, for fifteen
hours; then  it must be strained  before using.
Care must be taken always to keep enough on
hand for stock for the next making.

   " To make Bread.—The first process is to pre-
Soldiers, including Receipts for making Bread in "the Portable
Field Oven" furnished by the  Subsistence Department.  By
Captain J. M. Sanderson,  C.S. of Volunteers.  Published for
distribution to the troops, Head-Quarters "Army of the Poto-
mac,-' January, 1862. 
 238  THE hospital  steward's manual.

 pare the ferment.  This is formed by boiling
 thoroughly a peck and a half of potatoes, with
 their skins on, which you place in a barrel
 kept exclusively for that purpose, adding six
 pounds  of flour,  and mashing them well to-
 gether.   This is called  "scalding the flour."
 Then add cold water until it is cool enough to
 enable you to put your hands in, and break up
 the potatoes as fine as possible, so as  to obtain
 all their virtue.   Then add about six pailfuls
 of warm water, and  six quarts of yeast.   Stir
 it well together, and place it in  a warm  spot,
 where  it  will not be disturbed.  Two  good-
 sized tubs, made of salt or sugar barrels, would
 be  the  best  receptacle  for it, as it requires
 space to work in.   This should be  made at
night, and will be ready for use in the morning
 after it is  carefully strained.
  "The second process is making the dough.
 This is done by sifting into the trough a barrel
and a half of flour, one-third of which is pinned
or blocked up at one end  by the "pin-board"
or wooden slide.   To this you add three and a
half pounds of salt and three and a half  pail-
fuls of  "ferment," with  four pailfuls of hot
water,—not so hot, however, as to scald  your
ferment (in summer, cold water is  used in- 
      the hospital steward's manual.  239

stead of hot),—and mix well together, knead-
ing thoroughly and faithfully, adding to it gra-
dually all the  flour in the trough until it is of
one consistency.  It must then be placed at
one end of the trough, and again pinned in by
the slide, leaving space enough, however, to
allow it to prove.  To effect this requires at
least  two  hours,  when it  will be  ready to
"work off," which is done  by "throwing" it out
of the trough, in masses, on to the table or
cover on  the  other side of the room or tent.
It  is then cut  into  pieces  and weighed, or
"scaled  off,"  and immediately moulded into
shapes or loaves.  This requires one man to
scale, one to form into loaves, and a third to
" pan it away," where it remains for at least
forty minutes before  placing it in  the oven.
In the mean  time the ovens  are heated, the
coals and ashes drawn out, and  the  interior
thoroughly swabbed out,  top and  bottom.  If
too hot, wet the swab and dampen  the oven.
The pans containing the dough are then set in,
by means of  the heel or wooden spade,  the
doors  closed,  and the  hot coals  and  ashes
placed against them, in order to heat all sides
equally.  Fifty minutes is  the  time generally 
240   THE HOSPITAL  STEWARD'S MANUAL.

required to bake the usual-sized  army loaves;
if larger, a longer period will be required.
  " The amount of ferment made in accordance
with this receipt will be  sufficient for three
batches of 288  loaves each.  The first batch
will require four hours in preparing and baking;
the second and third, two hours each.
  " Potatoes, hops, and malt should always be
kept on  hand, and a portion of the yeast in-
variably retained as  stock.   To commence
with, it will  be necessary to obtain  brewer's
yeast;  but  after making  the first essay  you
can always be independent."

    SECTION III.--RECEIPTS FOR  EXTRA DIETS.
              (Soyer's Receipts.)
  No. 1. Beef Tea.  Receipt for 6  pints.—Cut
3 lbs. of beef into pieces the size  of  walnuts,
and  chop up the bones, if  any;  put it  into a
convenient-sized kettle  with h  lb. of mixed
vegetables, such as  onions, leeks,  celery,  tur-
nips, carrots  (or one or two  of these, if all
cannot  be obtained), 1 oz.  of salt, a little  pep-
per, 1 teaspoonful of sugar, 2 oz. of butter, and
h pint of water.  Set it on a sharp fire for ten
minutes or a quarter of an hour, stirring  now
and then with  a spoon, till it forms  a rather 
      THE  HOSPITAL STEWARD'S MANUAL.   241

thick gravy at bottom, but not brown; then
add 7 pints of hot or cold water,—but hot is
preferable.  When boiling, let it simmer gently
for an  hour;  skim off all  the fat, strain it
through a sieve, and serve.

   No. 2. Thick Beef Tea.—Dissolve a large tea-
spoonful of arrow-root  in a  gill of water, and
pour it into the beef tea above described twenty
minutes before passing  through the sieve.

   No. 3. Beef Tea with  Calves'-foot Jelly or Isin-
glass.—Add £ oz. calves'-foot gelatine or isin-
glass to the above quantity of beef tea, when
cooking, previous to serving.

   No. 4. Mutton  and Veal  Tea.—Mutton and
veal will  make  good tea by proceeding  pre-
cisely the same  as above.    The addition of
a  small quantity of aromatic herbs is always
desirable.   If no fresh  vegetables are at hand,
use 2 oz. of mixed  preserved vegetables to any
of the above receipts.

   No. 5.  Chicken Broth.—Put in a stew-pan a
fowl, 3  pints of water, 2 teaspoonfuls of rice,
1  teaspoonful of salt, a middle-sized onion, or
                     21 
242   THE HOSPITAL STEWARD'S  MANUAL.

2 oz. of mixed vegetables; boil the whole gently
for three-quarters of an hour:  if an old fowl,
simmer from one hour and a half to two hours,
adding 1 pint more water; skim off the fat, and
serve.

  Note.—A light  mutton broth may be made
precisely the same, by using a pound and a half
of scrag of mutton instead of fowl.

  No. 6. Beef Essence.—Cut 1 pound of lean
but tender beef into small dice, and introduce
them into a bottle, which is  to be corked and
stood in a pot of water; boil for three hours;
then strain off the liquor by putting the  meat,
after all that can  be is poured off, in a linen
bag and expressing.  A little pepper and salt
may be added.

  No. 7. Siceet Rice.—Add to 4 lb. of rice plain
boiled, as  directed in Receipt No. 22, p. 236, 1
oz. of butter, 2 tablespoonfuls of sugar, a little
cinnamon, a quarter of a pint of milk;  stir it
with a fork,  and serve.  A little currant jelly or
jam may be added to the rice.

  No. 8. Rice with Gravy.—Add to the same 
       THE HOSPITAL STEWARD'S  MANUAL.   243

quantity of rice 4 tablespoonfuls of the essence
of beef, a little fresh butter, half a teaspoonful
of salt; stir together with a fork, and serve.

   No. 9.  Plain Oatmeal.—Put in a pan £ lb.
of oatmeal, li oz. of sugar, half a teaspoonful
of salt, and 3 pints of water;  boil slowly for
twenty minutes, stirring continually, and serve.
A quarter of a pint of boiled milk, an ounce of
butter, and a little pounded cinnamon or spice,
added previous to serving, is a good variation.

   No. 10.  Calves'-Foot Jelly.—Put in a proper-
sized stew-pan 2£ oz. of calves'-foot gelatine, 4
oz. of white sugar, 4 whites of eggs and shells,
the peel of a lemon, the juice of 3  middle-sized
lemons, half a pint of marsala or sherry wine.
• Beat all well together with the egg-beater for
a few minutes; then add 4\ pints of cold water;
set it on  a slow fire, and keep whipping it till
boiling.   Set it on the  corner  of the stove,
partly covered with the lid,  upon which you
place a few pieces of burning charcoal; let it
simmer gently for ten minutes, and  strain it
through a jelly-bag.  It is then ready to be put
in ice or some cool place.
   For orange  jelly, use only  1 lemon and  2 
244   THE HOSPITAL STEWARD'S  MANUAL.

oranges.   Any delicate flavor  may be intro-
duced.

  No. 11. Farina Pudding.—Boil  3  pints of
milk, into which, while boiling,  sprinkle slowly
one-quarter  of a pound  of  farina (Hecker's
farina).  Continue  the boiling three-quarters
of an hour.   Turn  it into a jelly-mould, and
place it on ice or in cold water to stiffen.  It
may be eaten with pulverized sugar.
  The boiling should be conducted in a double
boiler, or in  a saucepan set into a pan of water
to boil in such a way that the bottom of the
saucepan does not touch the bottom  of the pan:
this is to avoid burning.

  No.  12.  Corn Starch  Blanc-Mange.—Beat
6  tablespoonfuls of  corn  starch   (Duryea's*
Maizena)  thoroughly wdth 3 eggs; add to it  1
quart of milk nearly boiling,  and  previously
salted a little :  allow it to boil a few minutes,
stirring briskly.  Flavor with lemon or vanilla,
and  pour into a mould to stiffen.  It may be
sweetened before cooking, or may be cooked
without sweetening, and eaten  with pulverized
sugar or  a sauce. 
      THE HOSPITAL  STEWARD'S MANUAL.   245

  No.  13.   Boiled  Custard  (Corn Starch).—
Heat 1 quart of milk nearly to boiling; add
2  tablespoonfuls of corn  starch  previously
mixed with  a little  milk, 3 eggs well beaten,
with 4 tablespoonfuls of powdered sugar, half
a teaspoonful of salt, and a small piece of butter.
Flavor with lemon or vanilla.   Let it boil up
once or twice, stirring briskly, and  it is done.
To be eaten cold.

   No. 14.  Calves-Foot Jelly, from Calves' Feet.—
This jelly requires to be made the day previous
to being used, requiring to be very hard  to
extract the  fat.
   Take 2 calves' feet, cut them up, and boil in 3
quarts of water; as soon as it boils, remove it
to the corner of the fire and simmer for five
hours, keeping it skimmed; pass through a hair
sieve into a  basin, and let it remain until quite
hard;  then  remove  the oil  and fat, and wipe
the top dry.  Place in  a stew-pan  \  pint  of
water, 1 pint of sherry, h lb. of lump sugar,
the juice of 4 lemons, the rinds of 2, and the
whites and  shells of 5  eggs;  whisk until the
sugar is melted; then add the jelly, place it on
the fire, and  whisk until boiling; pass it through
a  jelly-bag, pouring that  back  again  which
                     21* 
246   THE HOSPITAL STEWARD'S  MANUAL.

comes through first, until quite clear : it is then
ready for use.   Vary the flavor according to
fancy.
   Oxrfeet or cow-heel may be used instead of
calves' feet, where these cannot be had;  but
they require an hour  more  simmering.   In
summer, ice must be used to set the jelly.

   No. 15. Sago Jelly.—Put  into  a pan 3  oz.
of sago, U oz. of sugar, half a lemon-peel  cut
very thin, £ teaspoonful of ground cinnamon,
or a small stick of the same; put to it 3 pints
of water and a little salt; boil  ten minutes, or
a little longer, stirring continually, until rather
thick;  then add a little port, sherry, or marsala
wine : mix well, and serve hot or cold.

   No. 16. Arrow-Root Milk.—Put into a  pan
4 oz. of arrow-root, 3 oz. of sugar, the peel of
half a lemon, £ teaspoonful of salt, 2£ pints of
milk;  set  it  on the fire, stir  round gently,
boil for ten  minutes, and serve.  If no lemons
are at hand, a little essence of any kind will do.
   When short of milk, use half water: half an
ounce of fresh butter is an improvement before
serving. 
      THE HOSPITAL STEWARD'S MANUAL.   247

  No. 17.  Thick Arrow-Root Panada.—Put in
a pan 5 oz. of arrow-root, 2 J oz. of white sugar,
the peel of half a lemon, £ teaspoonful of salt,
4 pints of water;  mix all well, set on the fire,
boil for ten minutes : it is then ready.  Milk is
preferable to water if at hand.

  No. 18.  Arrow-Root Water.—Put into a pan
3 oz. of arrow-root, 2 oz. of white sugar, the
peel of a lemon, £ teaspoonful of salt, 4 pints of
water;  mix well, set on the fire, boil for ten
minutes : it is then ready to serve, either hot or
cold.

   No. 19.  Rice Water.—Put 7 pints of water
to boil; add to it 2 oz. of rice well washed, 2
oz. of sugar,  the peel of two-thirds of a lemon ;
boil  gently for three-quarters of an hour;  it will
reduce to 5 pints:  strain through  a colander: it
is then ready.                 «

   No. 20.  Barley Water.—Put into a saucepan
7 pints of water, 2 oz. of barley, which stir now
and then while boiling; add 2 oz. of white sugar,
and the rind of half a lemon thinly peeled;  let
it boil gently for about two hours, without
covering it: pass it through a sieve or colander: 
248   THE  HOSPITAL STEWARD'S MANUAL.

it is  then ready.  The barley and lemon may
be left in it.

  No.  21.  Soyers Plain  Lemonade.—Thinly
peel  the third part of a lemon, which put in a
bowl with 2 tablespoonfuls of sugar;  roll the
lemon in your hand upon the table to soften it,
cut it into two lengthwise, squeeze the juice over
the peel, &c, stir round  for a minute with a
spoon to form  a sort  of  syrup;  pour over a
pint  of water, mix well, and remove the pips:
it is  then ready for use.
  If a very large lemon, fresh and full of juice,
you may make a pint and a half, to a quart, add-
ing sugar and peel in proportion to the increase
of water. The juice only of the lemon and sugar
will  make lemonade, but will then be deprived
of the aroma which the rind contains.

  No. 22. Semi-Citric Lemonade.—Receipt for
50 Pints.—Put 1 oz. of citric acid to dissolve
in a  pint of water; peel 20 lemons thinly, and
put  the peel  in a large vessel with 3 lbs. 2 oz.
of white sugar well broken; roll each lemon on
the table to soften it, which will facilitate the
extraction of the juice; cut them into two, and
press out the juice into  a colander  or sieve 
THE HOSPITAL STEWARD'S MANUAL.   249
- over the peel and sugar; then pour half a pint
 of water through the colander, so as to leave
 no  juice remaining;  triturate the sugar, juice,
 and peel together for a minute or two with a
 spoon, so as to form a sort  of syrup and ex-
 tract the  aroma from  the peel;  add the dis-
 solved  citric acid, mix all well together, pour
 on 50 pints of cold water, stir all well together:
 it is then ready  A little ice in summer is a
 great addition.

    No. 23. Soyer's Cheap Crimean Lemonade.—
  Put into a bowl 2 tablespoonfuls of sugar, i table-
  spoonful of lime-juice; mix well for one minute;
  add 1 pint of water, and the beverage is ready.
  A little rum is an agreeable addition.

    No. 24. Tartaric Lemonade.—Dissolve 1 oz.
  of  crystallized  tartaric  acid in a pint of cold
  water,  which put in a large vessel:  when dis-
  solved, add 1 lb. 9 oz. of white or brown sugar
  (the former is preferable); mix well to  form a
  thick syrup; add to it 24 pints of cold water,
  slowly mixing well:  it is then ready.
    A similar  beverage may be made of citric
  acid, using, however, only 20 pints of water to
  each ounce. 
250   THE HOSPITAL STEWARD'S MANUAL.

  No. 25.  Cheap  Plain Rice Pudding with-
out  eggs or milk.—Put on the fire, in a mode-
rate-sized  saucepan, 12 pints of water: when
boiling, add to it 1 lb. of rice, 4 oz. of  brown
sugar, 1 large teaspoonful of salt, and the rind
of a lemon thinly  peeled; boil gently for half
an hour, then strain all the  water from the
rice; add to the  rice  3  oz. of sugar, 4  table-
spoonfuls  of flour, §  teaspoonful  of pounded
cinnamon; stir it  on the fire carefully for five
or ten minutes; put  it in a tin or a pie-dish,
and bake.
  The rice water poured off, as above directed,
may be made into a beverage, the juice of a
lemon being introduced to give it flavor.

  No. 26. Rich Rice  Pudding.—Put h lb.  of
washed rice  in a stew-pan, 3  pints of milk, 1
pint of water, 3 oz.  of sugar, 1  lemon-peel, 1
oz. of fresh butter; boil  gently  half an hour,
or until the rice is  tender; add  4 eggs well
beaten, mix well, bake quickly for half an hour,
and serve.

  No. 27. Boiled Rice Semi-Curried  (suitable
for  cases  of commencing  diarrhoea).—Put 1
quart of water in a pot or saucepan; when boil- 
      THE HOSPITAL STEWARD'S MANUAL.   251 |
                                            I,
ing,  add J  lb. of well-washed rice;  boil fast
for ten  minutes;  then drain the rice on a
colander, put it in a saucepan greased slightly
with butter, let it swell slowly near the fire, or
in a slow oven, till tender;  each grain will then
be light and well separated; add a quarter of a
teaspoonful of  curry-powder, mix  together
lightly with a fork, and serve.

   No. 28.  Batter Pudding.—Break 2 fresh eggs
in a basin, beat them well; add one tablespoon-
ful and a half of flour, which beat up with your
eggs with a fork  until no lumps remain;  add
a gill of milk'and a teaspoonful of salt; butter
a bowl, pour  in  the  mixture, put some water
in a stew-pan, enough to immerge half-way up
the cup or  bowl: boil for twenty minutes, or
till the  pudding is well set; pass a knife to
loosen it, turn out on  a plate, pour pounded
sugar over it, with or without a little butter,
and serve.

   No. 29.  Bread-and-Butter Pudding.—Butter
a tart^dish well,  and sprinkle  some currants
all round it;  then lay in a few slices of bread-
and-butter; boil 1 pint of milk, pour it on 2
eggs well whipped, and then on the bread-and- 
252  THE  HOSPITAL STEWARD'S MANUAL.

butter:  bake in  a hot  oven for half an hour.
The currants may be  omitted when not con-
venient.

   No. 30.  Bread Pudding.—Boil 1  pint  of
milk, with a piece of cinnamon and lemon-
peel; pour it on 2 oz. of bread-crumbs, then
add 2 eggs,  i  oz. of currants,  and a  little
sugar: steam it in a buttered mould, or pan,
for one hour.

   No. 31.  Custard Pudding.—Boil  1 pint of
milk  with  a small piece of lemon-peel and
half a bay-leaf for three minutes; then pour
these on to 3 eggs; mix it with 1 oz. of sugar
well  together, and  pour it into a  buttered
mould or  pan:  set this  in a stew-pan with
some  water, steam it for  twenty-five  minutes,
turn it out  on a  plate, and serve.

   No. 32.  Stewed Macaroni.—Put in  a stew-
pan 2 quarts of water, half a tablespoonful of
salt, 2 oz. of butter;  set on the fire;  when
boiling, add 1 lb. of macaroni, broken up rather
small; when boiled  very soft, throw off the
water; mix well into  the  macaroni a  table-
spoonful of flour, add enough milk to  make it 
      THE HOSPITAL STEWARD'S MANUAL.   253

of the consistency of melted butter, boil gently
twenty  minutes,  add  in  a  tablespoonful of
either brown  or  white sugar, or honey,  and
serve.
   A little  cinnamon,  nutmeg, lemon-peel, or
orange-flower water may be introduced to im-
part a flavor; stir quick.   A gill of milk or
cream may be thrown in three minutes before
serving.  Nothing can be more light and nutri-
tious than macaroni done in this way.

   No. 33. Macaroni Pudding.—Put 2 pints of
water to boil; add, when boiling, 2 oz. of maca-
roni, broken  in small  pieces; boil till  tender;
draw off the water, and add half a tablespoonful
of flour, 2 oz. of white sugar, a quarter of a
pint of milk, and  boil together for ten minutes;
beat an egg up, add it to the other ingredients
with a nut of butter:  mix well, and  bake, or
steam.  It can be served plain,  and may be
flavored with either cinnamon, lemon, or some
essence.

   No. 34. Sago Pudding.—Put in a pan 4 oz.
of sago, 2 oz. of  sugar, half a lemon-peel, or a
little cinnamon,  a small nut of fresh butter,
and half a pint of milk; boil for a few minutes,
                     22 
254   the Hospital steward's manual.

or until  rather  thick, stirring  all the  while.
Beat up  2 eggs, and  mix quickly with the
same: it  is then ready for either baking or
steaming.

  No.  35.  Tapioca Pudding.—Put in a pan 2
oz. of tapioca, lh pint of milk, 1 oz. of white
or brown sugar, and  a little salt; set on the
fire; boil gently for fifteen minutes, or until
the tapioca is tender,  stirring now and then to
prevent its sticking to the bottom, or burning;
then add 2 eggs well beaten: steam, or bake,
and serve.  It will take about twenty minutes
steaming, or a  quarter of an  hour   baking
slightly.   Flavor  with either lemon, cinna-
mon, or any other essence.

  No.  36. Toast and  Water.—Cut a piece of
crusty bread, about £ lb. in weight, place it
upon  a toasting-fork,  and hold  it about  six
inches from the fire; turn  it often, and keep
moving it gently until of a light  yellow color;
then place it nearer  the  fire, and when  of  a
good  brown  chocolate color, put it in a jug
and pour over 3 pints of boiling  water; cover
the jug until cold, then strain  it into a clean
vessel, and it is ready for use.  Never leave the 
      THE  HOSPITAL  STEWARD'S MANUAL.   255

toast in it, for in  summer it would cause fer-
mentation in a short time.
  A piece  of  apple,  slowly toasted till it gets
quite black, and added to the above, makes a
very nice and refreshing drink for invalids.

  No. 37.—Figs and  Apple  Beverage.—Have
2 quarts of water boiling, into which throw 6
dry figs previously  opened, and  2 apples, cut
into six or eight slices each;  let the whole boil
together twenty minutes, then pour them into
a basin to cool: pass through a sieve.  The
figs, if drained, will be good to eat with a little
sugar, or jam.

  No.  38.—Egg Soup.—Beat an egg perfectly
light, beating white  and yolk  at first  sepa-
rately,  and when  light  mixing  them well
together; add a teaspoonful of powdered sugar,
a little nutmeg, and while stirring briskly pour
in a wineglassful of boiling  water,  and then
add a wineglassful of sherry wine.

   No. 39.  Omelets  with Fine  Herbs. — Six
eggs will make a nice omelet for two persons.
Break them carefully into a bowl, as a tainted
egg will spoil all the  rest; add  three-quarters 
256   THE  HOSPITAL STEWARD'S MANUAL.

of a tablespoonful of salt, a quarter ditto of pep-
per, two of chopped parsley, and half  a one of
fine-chopped onions.  Beat them well.  Put 2
oz. of butter in a clean frying-pan, place it on the
fire, and, when the butter is very hot, pour in
the eggs,  which  keep  mixing  quick  with  a
spoon until all is delicately set; then let it slip
to the edge of the pan en masse, laying  hold
of the handle and raising it slantwise, which
will  give   an  elongated form to the  omelet;
turning the edges, let it set a minute: turn on
a dish, and serve.

  No. 40.  For Bacon or Ham Omelets.—Cut
2 oz. of ham or bacon, not too salt, in  small
dice;  fry two  or three  minutes in the butter
before putting in the  eggs, and  proceed as
above.

   No. 41.  Boiled Eggs.—The water should be
boiling before  the  eggs are introduced. • Three
minutes is long enough for soft-boiled and five
for hard-boiled eggs.

   No. 42.  Fried  Steaks.—Cut the steak in
pieces of 8 oz. each; flatten them to the thick-
ness of three-quarters of an inch, taking care 
      THE HOSPITAL  STEWARD'S  MANUAL.   257

that each piece contains a little fat.  Put a
clean frying-pan on the fire, with half an ounce
of butter, which  when browned  a little  is
ready to receive the  steak; keep it on a rather
quick fire, turning it^several times, and, when
cooking, season  each side with one-fourth of a
teaspoonful  of salt and a pinch of pepper.  Six
minutes will do the  steak; and by pressing it
with a fork or the  finger you can  ascertain
if it is equally done through.  When done,
suspend the steak over the pan, to  allow the
melted fat,  if any, which  clings to the meat,
to fall back into the pan.

   No. 43.  Fried Chops.—Have a  fine  chop
weighing 8 oz., and three-quarters of an inch in
thickness, without too much bone or fat.   Cook
the  same as the  steak, turning  two or  three
times  until  well browned on either side.  The
fire  for both should  be  brisk, as the surface of
the  meat becomes thereby carbonized  and re-
tains the juice.

   No. 44.  Broiled Chops and Steaks.—To broil
either, place them on a gridiron over a  sharp
fire and turn  two or three  times while  cook-
                     22* 
 258   THE HOSPITAL STEWARD'S  MANUAL.

 ing.  Six minutes will  do either.  Season as
 for fried steaks.
   More is lost in weight by broiling than by
 frying; but the flavor is  better, and the meat is
 more succulent.

   No. 45. Roast  and Grilled  Fowls.—Fowls
 should be roasted whole, and divided into diets
 according to  size.
   They should also be grilled whole, being
 divided up the back and trussed as usual  for
 grilling.  Rub over a little butter, and grill on
 a moderate fire, turning several times and keep-
 ing a light yellow color.   When  partly done,
 season with a small teaspoonful of salt and a
 little pepper.  When done,  rub over a little
 fresh butter:  serve whole or in portions.

   No. 46.  Fried  Fish.—Any  kind of  fish,
 though  fried  in fat, when  properly done, does
 not retain the slightest  particle of fat which
 would be prejudicial to the  patient.  This is
 avoided by having the fat at a proper degree
of heat,  which can be  ascertained when  it
begins  to smoke,  and when all  boiling  has
ceased.   If you then dip your finger in water
and  let a  drop fall into the fat,  it will hiss 
      THE HOSPITAL STEWARD'S  MANUAL.   259

loudly,  if properly heated.  Fat over-heated
is  equally unfit  for  use, which fact  can be
ascertained  by the quantity of  black  smoke
emitted by the fat, and by its  making a disa-
greeable smell.
  You may always ascertain when fish is done,
as  then the  flesh separates from  the bone
easily with  the aid of a  fork, if tried in  the
thickest part.   Take care  that it does  not
over-do, which takes all  the nutriment from
the fish.

  No. 47. Broiled Fish.—Trim as for  frying,
and dip in flour; butter very lightly over;  put
on  a gridiron, previously well greased, to pre-
vent sticking, over a  very slow fire; turn once.
Eight to ten minutes will do a  fish of as many
ounces' weight.

  Note.—This is the lightest and the most
difficult way in which fish can  be dressed. 
 
   PART IV.




THE DISPENSARY.
261 
 
CHAPTER I.
  General Arrangement and Management of the
                 Dispensary.

SECTION I.—REQUISITIONS FOR MEDICAL SUPPLIES.

  Requisitions for medical supplies are made
out in duplicate  by the senior medical  officer
of each hospital, post, or command.  " If the
supplies are to be obtained from the principal
purveying depots, the requisitions will be made
upon  the Surgeon-General, on the 31st day of
December annually; if from departments or
field-depots, they will be made upon the medi-
cal director, at such times and for such periods
as he  may direct."*
  Although these general rules are laid down,
however, it is to be understood that many cir-
cumstances  may exhaust the supplies sooner
than was contemplated at the time of making
the requisition;  and, as no medical officer will

         * Revised Reg., Art. XLIV. \ 1231.
                                     263 
264   THE HOSPITAL STEWARD'S MANUAL.

be held blameless who permits his supplies to
become exhausted  without providing for re-
plenishing them, it may become necessary at
any time to make a special requisition to sup-
ply deficiencies.
  " In every case of special requisition, a dupli-
cate of the requisition shall at the same time
be transmitted to the Surgeon-General, for his
information, giving the name and station of
the officer upon whom it is made."*
  The following is the form  of a requisition
for medical supplies :—
* Revised Reg., Art. XLIV. g 1235. 
CO

CM
 <




 a



"a




 w
 H
 03

 hJ
 <4
 H

 Pm
 W
 o
 w

 w
 ffl
 H
                         Requisition for Medical and Hospital Supplies.


                Station,.......................................................   Period,  ............................................

Command.—Officers,..............  Enlisted men,.............  All others entitled to medicines, .............  Total,
Articles, and Characters or Quantities.	On hand.	Wanted.	Articles, and Characters or Quantities.	On hand.	Wanted.
					
&c. &c.					
Date
-, Surgeon U.S.A.
   N.B.__Requisitions will exhibit the quantity of each and every article "on hand," whether more be wanted

'or not.  They will be transmitted in duplicate, and by different mails. 
266   THE HOSPITAL STEWARD'S  MANUAL.

  On frontier and other posts  remote from a
medical purveyor, it may occasionally become
necessary to purchase medical supplies.   A
special requisition is then made by the surgeon
on a quartermaster, with  the approval of the
commanding officer.   The quartermaster makes
the purchase and furnishes the articles called
for.  The forms for  this purpose are but rarely
needed, and are not, therefore, reproduced  in
this place,  but may be found in the Revised
Regulations for the  Army, Art. XLIV., Forms
2 and 3.
  The special duty  of  the hospital steward  in
connection with these  requisitions is to keep
himself informed of the  stock of medicines,
dressings, and hospital stores on hand,  and  to
notify  the  surgeon  when the  supply of any
article—and especially  of any important article
—approaches  exhaustion, in order that there
may be time to replenish the stock by requi-
sition before it is completely expended.
  Besides this, it is frequently convenient for
the hospital steward to make  out the requi-
sitions in accordance with the foregoing form,
and carry them to the surgeon for his approval
and signature. 
      THE HOSPITAL  STEWARD'S MANUAL.   267


        SECTION II.--THE  SUPPLY TABLE.
  The medical  supplies and their  quantities
are laid down  in the  standard supply tables,
and  not left to  the discretion of individual
surgeons.
  The supply table contained in the " Revised
Regulations for 1861," however, has been found
in practice to present so  man)' deficiencies and
imperfections that it has been abandoned, and
a new and carefully-prepared supply table sub-
stituted by order of the Surgeon-General.
  When surgeons desire  in any case, or for any
special  reasons, articles  or quantities not laid
down in this supply table, their requisitions,
accompanied by the reasons  therefor, must  be
sent to the Surgeon-General for his approval.
  The revised  supply table  of 1862 has just
been  printed,  and will be  immediately dis-
tributed to medical officers.

      SECTION III.—SEMI-ANNUAL RETURNS.
  Medical officers in charge of medical supplies
were directed, by Revised Regulations, to make
duplicate returns of  them  annually to  the
Surgeon-General on the 31st of  December.
By a circular from the  Surgeon-General's office, 
268   THE  HOSPITAL STEWARD'S  MANUAL.

dated May 5, 1862, this has  been modified,
however, and the duplicate  returns are to be
made semi-annually, on June 30 and December
31, to the medical director of the military dis-
trict in which they are serving, as well as to
the Surgeon-General.   Similar returns are also
to be made by all medical officers when relieved
from the duty to which their returns relate.
  The returns must set forth the quantity of
each article received, expended, and remaining
on hand.   They are also, under the head of
Remarks, to show the condition of the stores,
and particularly of  the instruments, bedding,
and furniture.   The following is the form to
be employed:— 
THE  HOSPITAL STEWARD'S MANUAL.   269
	Articles, and Characters or Quantities.
	On hand at last return.
	Received since last return.
	Total.
Expended with the sick.	
	Issued.
	Lost or destroyed by un-avoidable accident.
	Worn out, or unfit for use.
	Total-expended, &c.
	On hand.
	Remarks.
2;;* 
270   THE HOSPITAL STEWARD'S MANUAL.

  These returns  are usually made out by the
hospital  steward  in charge of the dispensary,
and submitted to  the surgeon for approval and
signature.  In  order to make out the return
correctly, the steward  should keep in the dis-
pensary a memorandum-book in which, from
time to  time, he  should enter all articles lost
or destroyed by  unavoidable  accident,  and
those worn out  or unfit for service.  The quan-
tities on  hand are to be determined by taking
carefully an account of stock at the time of
making the return; and, if the dispensary has
been properly managed, the difference between
the total quantity of  each article expended,
and  the quantities returned as issued, lost, or
destroyed, and worn  out  or unfit for service,
will represent the quantity expended with the
sick.

SECTION IV.--ARRANGEMENT OF THE DISPENSARY.
  The various  medicines, &c. kept in the dis-
pensary must be arranged in some convenient
order to facilitate dispensing.   Every article
should have its place, and should be kept in it
except when actually in use.
  The room selected for the dispensary should
be dry, well lighted, and conveniently situated 
      THE  HOSPITAL STEWARD'S MANUAL.  271

in relation  to  the other parts of the house.
Where  possible,  water should  be introduced
by pipes, with  a small sink and waste-pipe for
the discharge of slops.  Shelves should be put
up adapted to  the various sizes of the bottles
and other original packages in which drugs are
received from the purveyor, with a convenient
number of drawers and closets.
  A definite system should be kept in view in
the arrangement of the stores upon the shelves
and in the drawers and closets.   Various plans
of classification  have been proposed: perhaps
the most satisfactory is as follows:—
   The  several forms of preparations should be
put together,—tinctures in one place, fluid ex-
tracts in another, extracts in a third, volatile
oils  in  a  fourth, and so  on.   The  powerful
alkaloids,   morphia,  strychnia, veratria, &c,
should  be kept  carefully in  a separate place,
which  should  be secured with a lock and key.
   The  liquors kept in the dispensary should
also be kept under lock and key.
   The  several articles of each class may be
arranged alphabetically, or in such other order
as is regarded as convenient.   Where possible,
it is best, as a general rule, to put the whole stock
 upon the  shelves: by this  plan only will it be 
272   THE HOSPITAL STEWARD'S MANUAL.

possible to know readily what the  stock  on
hand  is, and when  the  supply of any article
has been  so nearly exhausted as to make  it
proper to require for more.  Room  may be
made  by putting the bottles several deep upon
the shelves, taking care to put  in the back
rows bottles containing the same article only
as those in front of them.   Thus, for example,
if there are a dozen bottles of tincture of opium,
they may be  arranged in  three rows  of four
each,  or, if the  shelves  are wide enough, in
four rows  of three each.  One  bottle  only
should be opened at a time, a second not being
uncorked  until  the first is exhausted, when
the empty bottle should be removed from the
shelves and transferred  to a  closet  specially
assigned as a receptacle  for empty bottles.  To
insure this, only one bottle at a time should
have the original paper  wrapper removed.
   The same remarks apply to  jars containing
cerates, extracts, and so on.
   The bottles and jars should be put upon the
shelves, with the labels turned  out,  so that
they may be seen at a glance.
   The stock of liquors  should not be  kept in
the dispensary,  but in  the room devoted to
hospital stores,—a small supply, enough at the 
      THE HOSPITAL STEWARD'S MANUAL.   273

most for a few days only, being kept on hand
in the liquor-closet of the dispensary.
   Sponge, adhesive  plaster, bandages,  lint,
muslin, and all similar articles, should be kept
in separate  drawers,  each  labelled with  its
contents.
   The pestles  and mortars, pill-tiles and pill-
machines, spatulas, &c, should be kept in a
closet or  on shelves especially  assigned  to
them.  They should never  be put away foul,
but should invariably be cleansed thoroughly
after using.
   The dispensary should be furnished with a
counter or table of convenient height, on which
the scales and weights should be placed, and
on which the various manipulations necessary
in putting up prescriptions are performed.
   The  scales  should  be kept   scrupulously
clean  and free  from  dust, as well  as  from
stains  and  rust:  otherwise all  accuracy in
weighing is impossible.
   The  water-faucet  and the  sink should be
behind the counter.
   No one should be allowed behind the coun-
ter but the  steward in charge of the dispen-
sary and  his assistants.
   All parts of the dispensary should be kept 
 274  THE  HOSPITAL  STEWARD'S MANUAL.

 scrupulously clean.  The bottles and jars on
 the shelves should be dusted off with a feather
 brush daily, and from time to time they should
 be wiped with a damp  cloth, as should also
 the shelf on which they stand.  In performing
 this duty,  the attendant executing  it should
 begin at the topmost row of  shelves, and, re-
 moving all the  articles  from one  shelf  at  a
 time, should  first wipe off the shelf, and, sub-
 sequently wiping off the bottles  and jars, re-
 place them each  as  it is cleansed in the same
 order as before.   The steward in charge of
 the dispensary should have at least one assist-
 ant, whose  duty it shall be to clean the pestles
 and mortars, pill-tiles, spatulas, &c.  &c, keep
 the shelves and room clean, and make himself
 generally useful.


  SECTION V.--CARE OF SURGICAL INSTRUMENTS.
  Surgical  instruments  may be  kept by the
surgeon  under his  own personal  care, but
frequently, also, their care is intrusted to the
steward  in charge  of  the  dispensary.   The
following precautions may be hinted :—
  Surgical  instruments  should be invariably
cleaned immediately after using.  Tepid water 
      THE  HOSPITAL  STEWARD'S MANUAL.   275

answers very well for this purpose : hot water
is injurious to the handles; with cold it is more
difficult to remove dried blood. A little castile
soap may be employed to get rid of the grease.
After washing, they should be wiped perfectly
dry, and, if  stained, may  be rubbed  with a
chamois-skin on which is placed a little rouge
or tripoli.  They should then be drawn a few
times over a razor-strop, wiped with  a clean
chamois, and replaced in their cases.
   Under no circumstances  should more than a
few hours be allowed  to elapse, after using in-
struments, before they are cleansed. The proper
time, however, when possible, is  immediately
after the surgeon has done with them.
   When the edges become  dull,  the instru-
ments may be honed in the following manner:—
   A  little oil  being put upon  the hone, the
knife is taken in  the right hand, while the
hone is steadied with the left; the blade is laid
obliquely, and, being held  steadily at an angle
of say thirty degrees, is drawn  over the stone
edge foremost, from heel to point, with a steady
motion; the blade is then reversed, so as  to
bring the other side to the  stone, and drawn
back in the same manner,  also, from heel  to
point. 
276   THE HOSPITAL  STEWARD'S MANUAL.

   This is repeated a number of times, until the
requisite edge is obtained, when  it is finished
by drawing it a few times  over a razor-strop.
The character of the edge is determined by the
angle at which the blade is held.   If the angle
is  great, a blunt edge, suitable for  cutting dense
resisting structures, is obtained.  If the  angle
is  small, a fine, delicate edge, suitable for  dis-
sections of the soft parts, is given.   The blade,
however,  should not be laid  flat upon  the
stone,  except in instruments  where it has  a
back thick enough to  give  the proper  angle.
If, for example, a scalpel be sharpened by lay-
ing the blade  flat  upon the  stone, the edge
becomes too  thin, and is liable to be bent or
broken in use, constituting what  is sometimes
described  as a wire edge.
   Instruments  not  in  use  should be kept in
their cases, the cases locked and covered by
the gutta-percha or leather  pouch in which it
belongs.   Once  a  month they should be  ex-
amined, and any commencing rust be removed
by the use of a little rouge or tripoli, as above
directed.   On the sea-coast, where the tendency
to  rust is great, it  is advisable to smear  the
blades with a little mercurial ointment.
   Instruments  should  be kept  in  a dry place, 
      THE HOSPITAL  STEWARD'S MANUAL.   277

under  lock  and  key,  and not allowed  to  be
handled by any unauthorized  person.
  Care of the surgical instruments is especially
necessary, not only because  without it they
soon become unfit for service,  but also because
it is directed that "these instruments will  be
accounted for  to  the Surgeon-General on the
31st day of December annually, in a special
return, in which the  true condition of each
must be stated; and, if any be lost or damaged,
a report of the facts  and  circumstances attend-
ing such loss or damage must  be given."*
* Revised Reg., Art. XLIV. § 1304.
24 
278   THE HOSPITAL STEWARD'S MANUAL.
              CHAPTER II.

   Hints on Pharmacy for Hospital Stewards,

    SECTION I.--REMARKS ON PRESCRIPTIONS.
  Upon the steward in charge of the drug-
store devolves  the responsibility of compound-
ing the prescriptions of the  medical officers.
The following brief remarks on this  subject
may perhaps, therefore, be found useful.
  The prescription is  headed with the name
of the patient  for whom it is intended.   Then
follows the  list of ingredients and quantities,
preceded by the  character ^, which is an ab-
breviation of the Latin word recipe, " take." The
officinal names of the  several ingredients are
employed.   The steward will,  however, gene-
rally notice  a difference between the termina-
tion of the officinal name and that of the name
employed in the prescription.   This is owing
to the names being written in the Latin geni-
tive case, the verb recipe governing the genitive.
  Thus, the surgeon writes, ]^ Chloroformi gj,
instead of " Chloroformum," which is the nomi- 
      THE  HOSPITAL  STEWARD'S  MANUAL.   279

native, chloroformi being in the genitive case,
and meaning " of chloroform?'
  Thus, also, ty, Zinci sulphatis grs. xx : Zinci
sulphas being the nominative.
  A still greater difficulty in  the way of the
steward occurs from the fact that surgeons
very frequently abbreviate the officinal names
for convenience, in writing their prescriptions,
writing, for example, Hyd. chl. mit. for Hy-
drargyri  chloridum  mite; Potas. Iod., for Po-
tassse iodidum, &c. &c.   As these abbreviations
are,  unfortunately,  not always made  in the
same manner by different surgeons, a very long
list of abbreviations might here be given, with-
out exhausting the subject; and as it is directed
in army  regulations that no  person shall be
enlisted a  hospital  steward unless he is suffi-
ciently skilled in pharmacy for  the proper per-
formance  of his duties, it  is  presumed that
such a list would be unnecessary here.   Most
of the abbreviations, moreover,  at once explain
themselves to any one familiar with the offici-
nal names of the articles, as the steward should
certainly be with those on the  army supply
table.  The general  rule may, however, be laid
down, that the  steward should under no cir-
cumstances allow himself to put up a prescrip- 
280   THE  HOSPITAL STEWARD'S MANUAL.
 tion containing any abbreviation of the mean-
 ing of which he entertains the slightest doubt.
 In all such cases he should go at once  to the
 surgeon for an explanation.  By so doing, he not
 only avoids, at the time, mistakes which might
 be fatal, but gradually becomes thoroughly ac-
 quainted with all. the abbreviations employed
 by the surgeon under whom he serves.
  The  quantities of  the  several  ingredients
 employed  are  indicated by the usual symbols
 with Roman numerals affixed.   Thus:—
       Weights.                Measures.
   gr. a grain;            gtt. a drop;
    9, a scruple;           Iffy, a minim;
    3, a drachm;          f^, a fluidrachm;
    3, an ounce;           fg, a fluidounce;
   lb, a pound.             0, a pint;
                        Cong, a gallon.
  The Roman  numerals  follow these  signs,
thus:—gvj, y.e. six drachms;  fgxj, i.e. eleven
fluidounces.
  The following tables may be given for refer-
ence :—
              Apothecaries' Weight.
   Pounds.    Ounces.   Drachms.   Scruples.    Grains.
    ft 1  =  12  =  96 = 288  =  5760
             3  1=   8 =  24  =   480
                    3 1 =    3  =    60
                            9  1  = er. 20 
      THE HOSPITAL STEWARD'S MANUAL.   281

               Avoirdupois Weight.
     Pound.      Ounces.    Drachms.   Grains (Apothecaries').
     lb 1   ==   16   =   256   =  7000
              oz. 1   =    16   =   437.5
                        dr. 1   =    27.34375
  Weighing for prescriptions is always done in
accordance with apothecaries' weight.  Medical
purveyors in the U.S. Army, however, are  in
the habit of employing, in the issue of medical
stores, a pound which corresponds neither with
the apothecaries' pound nor with that of avoir-
dupois weight. It is composed of sixteen ounces
apothecaries'  weight, and contains, therefore,
7680 grains,—being 1920 grains heavier than
the apothecaries'pound, and 680 grains heavier
than the  avoirdupois pound.

              Apothecaries' Measure.
     Gallon.     Pints. Fluidounces.  Fluidrachms.   Minims.
    Cong. 1  = 8 = 128 = 1024  = 61440
            O. 1 =  16 =   128  =  7680   .
                    fg 1 =    8  =   480
                             ffcl  =  R160
  The  following remarks  may be added with
regard to certain domestic  measures frequently
alluded to in the administration of remedies.
  A teacup is estimated to contain  about four
fluidounces or one  gill.  A wineglass, two fluid-
                      24* 
 282   THE HOSPITAL STEWARD'S MANUAL.

 ounces.  A tablespoon,  half a fluidounce.  A
 teaspoon, a fluidrachm.
   The steward may here be cautioned  against
 the frequent mistake of identifying  the  drop
 with  the  minim.   The minim is a fixed  and
 unchangeable  measure, which varies neither
 with the nature of the liquid nor the manner
 in which it is poured out.   The drop,  on the
 other hand, is exceedingly variable, differing in
 size considerably for different liquids,  and  even
 for the same  liquid,  in  accordance with the
 shape of the bottle from which it is poured, and
 many other circumstances.
   As an illustration of the variation caused by
 the nature of the liquid, it may be stated that
 in the experiments of Mr. E. Durand,  of Phila-
 delphia, on this subject, it was found that while
 150 drops of sulphuric ether were necessary to
make a fluidrachm, it required 132 of the  tinc-
ture of the chloride of iron, 120  of  aromatic
sulphuric  acid, 120 of laudanum,  78  of black
drop,  57 of Fowler's  solution, and but 45 of
distilled water, for the same purpose.
   The list of the articles and their quantities
is  followed in  the prescription  by short di-
rections as to compounding  it.   These  are
generally written in Latin,  and are frequently 
THE HOSPITAL  STEWARD'S MANUAL.    283
abbreviated.  The following are the abbrevia-
tions most commonly employed :—

M.—Misce.—Mix.
Ft. pulv.—Fiat pulvis.—Make a powder.
Ft. pulv. xij.—Fiant pulveres xij.—Make twelve
   powders.
Ft. pulv. et divid. in chart, xij.—Fiat"
  pulvis et divide in chartulas xij.     Make
Ft. pulv. in ch. xij. div.—Fiat pulvis )■ twelve
   in chartulas xij. dividenda.       powders.
Ft. ch. xij.—Fiant chartula3 xij.
Ft. solid.—Fiat solutio.—Make a solution.
Ft. inject.—Fiat injectio.—Make an injection
   (for urethra).
Ft. collyr.—Fiat  collyrium.—Make an eye-
   wash.
Ft. enema.—Fiat enema.—Make an injection
   (for rectum).
Ft. mas.—Fiat  massa.—Make a mass.
Ft. pil. xij.—Fiant pilulse  xij.
Ft. mas. in pil. xij. div.—Fiat massa
   in pilulas xij. dividenda.
Ft. mas. etdiv. in pil. xij.—Fiat massa
   et divide in pilulas xij.
Ft. infus.—Fiat infusum.—Make an infusion.
Ft. haust.—Fiat haustus.—Make a draught.
Make
twelve
 pills. 
 284   THE HOSPITAL STEWARD'S MANUAL.

 Ft. garg.—Fiat gargarisma.—Make a gargle.
 Ft. mist.—Fiat mistura.—Make a mixture.
 Ft. emuls.—Fiat emulsio.—Make an emulsion.
 Ft. ung.—Fiat unguentum.—Make  an  oint-
   ment.
 Ft. linim.—Fiat  linimentum.—Make  a lini-
   ment.
 Ft. troch. xxiv.—Fiant trochisci xxiv.—Make
   twenty-four lozenges.

   After the directions  as  to  compounding,
 follow those as to administration.  These are
 always written in English, the direction being
prefixed by the abbreviation S.—Signatura.
   The directions are followed by the date and
the signature of the medical officer.
   The prescription, therefore, consists properly
of three parts:—
   1. The list of ingredients and quantities pre-
fixed by the sign 1^.
   2. The directions as to compounding,—gene-
rally a Latin abbreviation.
   3. The directions for administration.  These
are preceded by the name of the patient, and
followed by the date and the signature of the
medical officer. 
      THE  HOSPITAL STEWARD'S MANUAL.   285


SECTION II.--COMPOUNDING AND DISTRIBUTION OF
                PRESCRIPTIONS.
  Having  read the prescription,  the  steward
proceeds to compound  it, varying his process
according as it is a solution, a mixture,  pow-
ders, or pills, &c, that he is to prepare.
  Where the prescription consists  of liquids
only, they are measured seriatim in the gradu-
ated measure and  poured into the phial which
is  to  receive them, when the process is  com-
pleted  by  corking and gently agitating the
mixture.
  In  performing  this duty,  but one bottle
should  be  taken down from  the  shelves at a
time.   The  measure should  be held by the
thumb  and finger of  the left hand, and the
stopper should be  seized by the little finger of
the same hand.  The bottle is held in pouring
with  the right hand.   The  measure is  held
well up before  the eye, so as to observe the
quantity with  accuracy; and, when it is ob-
tained,  the stopper is replaced, and the bottle
put back in its place upon the shelf before pro-
ceeding to  the next ingredient.
  Where the  ingredients  of the  prescription
are partly  solids and partly liquids, the quan- 
286   THE HOSPITAL STEWARD'S MANUAL.

tities of the solids  are  to be determined  by
weight.
   If the solids are saline or other soluble sub-
stances,  and a  solution is to be made, it is
generally best  to  bruise  them  in  a  mortar
with the liquids until their solution is effected,
after which the product is transferred to a phial.
   Where insoluble solid matters  are to be sus-
pended in the form of a mixture or emulsion,
the mortar becomes still more important.  The
ingredients  are to be rubbed  steadily together
until a smooth and uniform liquid is obtained,
and the label of the phial into which the mix-
ture is introduced should contain directions to
shake well before administration.
   When the prescription directs the prepara-
tion of  any given  number  of  'powders,  the
ingredients  in  powder are carefully weighed
out and thoroughly mixed together on a pill-
tile with, a spatula, or, preferably, in a mortar.
The mixture having been  completed, the pro-
duct is to be divided into the  number of equal
parts called for by the prescription, the division
being effected by the scales or the eye,  accord-
ing to the nature of the ingredients and the
importance of accuracy.  Each portion  is then
transferred to the paper in which it is to  be 
      THE  HOSPITAL STEWARD'S MANUAL.   287

folded.  The  papers for each  set of powders
should be neatly cut and of equal size.   The
folding is effected in the following manner.  A
crease is made by folding over the edge  along
the long side  of the paper, at  about one-third
of an inch from the margin.  The opposite edge
is then laid in this crease, and the paper folded
over  longitudinally, so as to give the proper
width.   The  ends are  then folded over  a
spatula, to make the flaps of a proper width.
   Uniformity in  the  size of the  powders is
exceedingly  desirable.   It  may  readily  be
attained by cutting out a small wooden  gauge
of the desired size, by which both the length
and width of the  powder may accurately  be
determined.
   In the preparation of Pills, the materials for
the whole  number of pills,  as  directed by the
prescription, are first to be weighed separately,
then worked  into  a mass of the proper con
sistence, and afterwards divided into the num
ber of pills called for.
   To make a pill-mass where  the ingredients
are  all dry powders,  without increasing un-
necessarily the size of the pills, requires often
considerable ingenuity.
   In the case of  certain vegetable powders. 
288   THE HOSPITAL STEWARD'S  MANUAL.

such as aloes, rhubarb, and opium, a mass suit-
able for rolling into pills may readily be formed
by the aid merely of a small quantity of water,
the powder being beat into a mass in a mortar
during the gradual addition of the fluid.
  Where, however, the powder is of an unad-
hesive character, as  is  the  case,  for example,
with many vegetable powders and metallic salts,
some  adhesive ingredient  must  be added  to
them to enable a mass of pillular consistence
to be formed.
  Molasses answers  an excellent  purpose  in
very many cases.  It must be added carefully,
as an excess will make the pill-mass too v fluid
for manipulation.  Gum arabic in small quan-
tities  may be  added where the molasses  does
not give the mass sufficient cohesion.   It is
frequently used  alone for  this  purpose, either
in the form of powder or of thick mucilage, but
is objectionable, as the pills produced by its use
are apt to become excessively hard on drying.
  For many vegetable powders  castile soap
answers  very  well, a small  quantity  readily
imparting the necessary consistence.  Resinous
powders are particularly adapted  to its use.
  Where the  prescription presents among its
constituents one or more semi-solid extracts, it 
      THE  HOSPITAL  STEWARD'S MANUAL.   289

will frequently be found that these impart suffi-
cient tenacity, and that by simply beating the
ingredients  together a suitable  mass  is ob-
tained.  But it sometimes happens, on the one
hand, that the quantity of the soft extract is too
small for the purpose, and then the addition of
some such  articles as those above  enumerated
becomes necessary;  and, on the other hand, the
extract may be of such quality and consistence
as to make the mass entirely too soft to be rolled
into pills.   In the latter case the addition  of
some dry powder, which shall not interfere with
the medicinal value of the prescription, becomes
necessary.   Powdered liquorice-root or wheat
flour are well adapted for this purpose.
  Where the materials  to be made into pills
are wholly semi-solid or liquid, the addition  of
some dry powder becomes yet more necessary.
Wheat  flour is very generally available, and is
on the whole preferable to the crumb of bread,
which is recommended by many pharmaceutists.
Powdered liquorice-root, arrow-root, starch, and
gum. arabic are also used for the same purpose.
  Other articles  may be necessary in  special
cases,  as,  for  example,  magnesia in  making
pills out of balsam of copaiva.
  Many other articles are used by pharmaceu-
                     25 
 290   THE HOSPITAL STEWARD'S MANUAL.

 tists in giving elegance and consistence to pills.
 It is not, however,  considered desirable to enu-
 merate them  in this place, because in  most
 general hospitals treatises  on  pharmacy are
 accessible, and because those above mentioned
 comprise the chief that will be found accessible
 to  the hospital steward  in the field and at
 remote posts.
   The pill-mass, having been properly formed,
 is next to be divided into the number of pills
 directed.   This may be done either by a spatula
 upon a pill-tile, or with a pill-machine.
   In the  first case  the pill-mass is rolled out
 upon the  tile into a cylinder corresponding in
 length to the number of pills to be made, which
 is ascertained   by measuring it upon a scale
 which is marked upon the surface of the tile.
 The rolling may be commenced with the hand
 and finished with the spatula.  The cylinder
is then cut by the  spatula  into  equal pieces,
one for each pill, in accordance with the same
scale, which is  generally ruled up to 18 or 24
pills.   The pills  are then finished by rolling
them separately between the fingers or on the
palm of the hand.
  In general hospitals the steward is furnished
with a pill-machine, by which  pills may be 
       THE HOSPITAL STEWARD'S MANUAL.   291

made  neatly with considerable  rapidity.  It
consists of a smooth base-piece, in one part of
which a number of parallel grooves  (18 to 24)
are made, and of a roller with a handle on each
end, the  back  of which is  smooth and  the
under  surface grooved to correspond with the
grooves in the base-piece.  The pill-mass hav-
ing been rolled  on the smooth surface of the
base-piece with  the back of  the roller until it
is long enough to cover as many grooves as it
is to  make  pills,  the  cutting surface of the
grooves is adjusted, and by the motion of the
roller the cylinder is at once divided into the
requisite number of pills, which, if  the opera-
tion has been properly conducted, will  be so
round as to require no further rolling.
  The pills,  having been completed either by
hand or the machine, are, if very moist, to be
spread out upon a sheet of paper with the edges
turned up, or upon the bottom of a shallow box,
to dry somewhat: they are finally introduced
into a pill-box,  Jif for dispensing, or into a
bottle if made to keep on  hand.  In either
case, some dry powder, such as starch, liquorice-
root, or pulverized sugar, should be introduced
to keep them from sticking together.
  Where ointments and cerates are prescribed 
 292   THE HOSPITAL STEWARD'S MANUAL.

 containing several  ingredients, they may very
 often be compounded upon the pill-tile by means
 of  the spatula.  Occasionally,  however,  the
 employment of heat is necessary to make the
 ingredients combine.
  Cerate  of Spanish flies may  be spread for
 blisters by means of a spatula slightly warmed.
 Perhaps the best substance to spread it upon
 is ordinary adhesive  plaster,  spreading  the
 cerate so that  a margin of half an  inch is left
 uncovered.  This will serve to keep the blister
 in its place.
  Plasters proper, usually require heat to spread
 them upon  the prepared sheep-skin  which is
 furnished  for  that  purpose.  The heat is best
 obtained by means  of a hot iron of the proper
 shape (plaster-iron).  Care must  be taken not
to heat the  iron too hot, or the sheep-skin is
 shrivelled and the  adhesiveness of the plaster
 diminished.
  The prescription, having been put  up, must
not, whatever  its nature,  be allowed  to leave
the dispensary without a label.   The labels
usually employed  in  civil practice  are  not
 adapted to military hospitals, where the label
 should at once indicate whom the prescription
is for, and give information to the nurse as to 
      THE HOSPITAL STEWARD'S  MANUAL.   293

its administration, and to the surgeon as to its
composition.   The label must therefore be, in
fact, a copy of the prescription, and should be
made out in the following form:—
	FOR	PRIVATE JAMES SIMPSON,		
	R-	WARD 2, BED 14.		
		-Pulveris opii, grs. vj.		
		Cupri sulphatis, grs. iv		
		Ft. mas. in pil.	xxiv div.	
	S. One	pill to be taken every three hours.		
2, 16	1862.		Surgeon,	U.S.A.
  This label should be  written  upon a neat
slip of white paper, about two inches wide by
five or six long.   It may be pasted upon bot-
tles if considered desirable; but, as the same
bottles in  a military hospital are  to be used
again and  again, it will save labor in clean-
ing the bottles to tie  the labels upon them.
The corners of  the  label may  be folded ob-
liquely at one end, so  as to form a point, and
this may be tied to the neck of the phial by a
thread.  The label for pill-boxes may be se-
cured in the same way to the bottom part of
the box, leaving the lid free.   For packages
                    25* 
294   THE  HOSPITAL STEWARD'S MANUAL.

of powders or other packages, the label should
be pasted upon the paper wrapper.
   In  putting up prescriptions, those for each
ward  should  be put  up together,  attending
to the wards seriatim in the order in which
their  prescription-books  come to the dispen-
sary  in  the morning.  So soon as  the pre-
scriptions  for  any  ward are complete,  the
chief nurse of the ward is to  be  notified, and
will send an attendant to bring the medicines
to the ward, where they will be distributed to
the beds  to which they belong, and  admi-
nistered strictly in accordance with directions. 
             PART  V.

HINTS ON MINOR SURGERY AND DRESSINGS
       FOR HOSPITAL STEWARDS.
* 
 
CHAPTER I.
                On Dressings,
   SECTION I.—GENERAL  PREPARATIONS FOR
                 DRESSINGS.

  To facilitate the dressing of wounds, it will
generally be found convenient in  hospitals to
keep on hand  one or more trays for dressings,
which may be prepared in the following man-
ner:—
  A shallow box should be made, two feet long
by eighteen inches wide  and four inches deep,
divided into equal halves by a partition which
rises in the centre to the height of eight inches,
and has an opening cut in it in such a manner
as to serve for a handle.
  In this box should be placed  and kept con-
stantly on  hand the  following  articles,  in
quantities which will  vary with the  number
of dressings to be performed daily in any par-
ticular hospital:—
  Patent lint, neatly rolled;  some  charpie, or
packed lint; an assortment of roller-bandages
                                     297 
298   THE HOSPITAL STEWARD'S MANUAL.

of  various widths;  adhesive  plaster cut into
strips three-fourths of an inch wide, also a roll
uncut; isinglass plaster; two bundles of liga-
tures ten  inches  long,  composed each  of a
single  thickness of saddler's silk  well waxed,
and one of ligatures of two thicknesses twisted
together,  each bundle consisting of at  least
a dozen ligatures  laid side by side, and sur-
rounded  for about half their length by a roll
of paper fastened by a pin, so that the ligatures
may be drawn out one at a time as wanted; a
large pair of scissors; a sheet  of patent lint
eighteen  inches square, neatly spread on one
side with  simple cerate; a pincushion amply
provided  with pins at  one  end, with  from
three to a dozen surgical needles ready-threaded
at the other; a pocket-set of instruments; three
to a dozen towels; and some sponges.
  Besides this tray of dressings, basins  with
warm water, a bucket to receive  soiled dress-
ings, and a tin can filled with boiling water to
heat the adhesive plaster, will be needed.
  The surgeon who makes the  dressings will
generally need one attendant to carry the tray,
and one for the basins and sponges, the bucket
for  soiled  dressings, &c.
  The attendant who  carries  the tray should 
      THE  HOSPITAL STEWARD'S MANUAL.   299

make himself thoroughly familiar with its con-
tents and their respective places, and should
be able at once  to hand to the surgeon any
article in it he may ask for, and to  return it
to its place when he has done with it.
   The attendant who manages the sponges
should keep  constantly  ready for the surgeon
a clean basin of tepid water, with  two or more
well-soaked sponges, and as fast as one is soiled
replace  it with another, empty out the soiled
water, and wash the soiled  sponges, so as to
be ready  for  the next  patient, at the  same
time  keeping an  eye to the surgeon so as to
hand him the can to heat  adhesive plaster
whenever he needs it.


   SECTION II.--ON THE DRESSING OF WOUNDS.
   In the army hospitals of the United States as
at present organized, the dressings are usually
made by the surgeons, assistant surgeons, and
medical cadets, and  comparatively seldom by
the hospital stewards: no elaborate treatise on
dressings  is, therefore, required in this place.
But as occasionally, and especially in the field
and at remote  posts, a certain  portion of the
dressings are necessarily made by the hospital 
 300   THE HOSPITAL STEWARD'S MANUAL.

 steward, a few practical  hints on  the subject
 may be appropriate in this work.
   The arrest of hemorrhage and the treatment
 of fractures, the introduction of sutures, and
 other steps requiring  surgical skill and judg-
 ment, must, of  course, receive  the  personal
 attention of a medical officer.   The  remarks
 here to be made are, therefore, limited to the
 dressings proper.
   The dressing most generally found available
 for  all wounds, whether  incised, lacerated,
 gun-shot, or  caused by surgical operations,  is
 the water-dressing, either cold or warm, accord-
 ing to circumstances.
   As a general rule, it may be said that cold-
 water dressings should  be employed whenever
 the design of  the  application is to limit the
. degree of inflammation; warm-water dressings,
 where the design is to favor suppuration: at
 the same time, it  should be understood that
 whenever the  cold-water dressing is decidedly
 disagreeable  to  the patient, and especially
 when it causes shiverings or rigors, it should
 be at once discontinued and the warm-water
 dressing substituted.
   The experience of our army surgeons is also
 in favor of dressings of the simplest kind, and 
      THE  HOSPITAL STEWARD'S MANUAL.   301

opposed  to all complicated systems  of band-
aging.  The roller-bandage especially is liable
to abuses,  and  should never  be  employed
except in  cases of  fracture  and where it is
desirable to produce a certain degree of press-
ure.
   The various complicated and beautiful band-
ages described and  figured in the treatises on
minor surgery will be found in  practice,  if
applied to  the treatment of wounds, to be not
only  troublesome and  tedious, but  in  their
results unclean, uncomfortable,  and positively
injurious.
   The cold-water dressing  as applied to a gun-
shot wound  should  consist simply of a  small
piece of lint folded double,  saturated with
cold water, and retained over  the  orifice of
the wound by a couple of strips  of isinglass
or adhesive plaster.   In  incised  or  other
wounds in  which adhesive  strips are necessary
to retain the lips of the wound in apposition,
the water-dressing may be applied above the
strips  and  retained in  the  same  manner.
Usually no bandages of any kind are necessary.
   Where a greater degree of cold is necessary,
and especially where much inflammatory action
is  developed in the limb around  the wound,
                     26 
302    THE HOSPITAL STEWARD'S MANUAL.

irrigation should  be resorted to.   This is best
effected by covering the parts to be irrigated
with  a double  thickness  of wet lint;  cold
water—ice-water, if desirable—is to be placed
in a  basin on a small table  near the bedside;
one or more strands of cotton lamp-wick are
to be arranged with one end in the  basin and
the other laid upon the wet lint, or a strip or
two of linen bandage  may be used if lamp-
wick cannot be obtained.  By capillary action,
a constant supply  of cold water  is taken up
from the basin and deposited on the lint cover-
ing the limb.  The limb sliould  be placed on
a piece of oiled silk or gutta-percha cloth  so
arranged that all the  superfluous water may
be drained into a bucket placed at the bedside.
  This simple mode of irrigation is quite  as
good for  most cases as any of the  complex
forms of apparatus designed for this purpose.
  Where a greater  degree of cold is necessary,
a bladder  may be filled with pounded ice and
laid upon  the parts.   This, however,  should
never be done except by the express directions
of the  surgeon; and the greatest watchfulness
and care should be  employed to avoid freezing
the surface.
  The lint employed in these watei dressings 
      THE  HOSPITAL  STEWARD'S  MANUAL.   303

should be changed at least once daily, or oftener
in cases of profuse or offensive discharges.
   Where the warm-water dressing is employed,
it  may be applied in  the same manner as dress-
ings of cold  water;  but it will here be found
that it is convenient to cover the wet lint with
a piece of oiled silk or gutta-percha cloth before
applying the adhesive strips : by so doing, the
warmth  is  much longer retained.  Four or five
thicknesses of lint saturated with warm water
and thus  covered  will  be found to retain
warmth and  moisture as long  and efficiently
as any poultice.   Poultices are, moreover, un-
cleanly,  disagreeable, and are  very generally
discarded by army surgeons  in the treatment
of wounds.
   In healing wounds,  when   granulation is
fairly  under way  and  the  suppuration is
no longer profuse,  lint  spread with simple
cerate, retained  in  place  by adhesive strips,
forms  a  simple and appropriate  dressing.  It is
also a dressing frequently resorted to imme-
diately after  amputation and other operations,
before suppuration has set in. 
304   THE HOSPITAL STEWARD'S MANUAL.
SECTION III.--OF THE  ROLLER-BANDAGE  AND  ITS
                APPLICATIONS.
  Although, as above remarked, the  roller is
to be avoided as much as possible in the treat-
ment of ordinary wounds, yet it is very gene-
rally needed in dressing fractures, and may be
required in many cases, as of chronic ulcers, &c,
where  a certain degree of pressure is desirable.
A few remarks are, therefore, made on the roller
and its application.
  The roller-bandage is composed of a  strip
of muslin,  usually one   to  four inches  in
width  and  three  to seven  yards in length.
This is formed  into a uniform and compact roll
by beginning at one end and rolling it towards
the other.  Assorted roller-bandages of various
widths and lengths, ready rolled, are furnished
with the medical supplies of the army.   Of late
a very elegant  article, rolled with the  greatest
precision  by a steam  apparatus,  has  been
supplied.
  Rollers may, however, be readily made,  if
not on hand, by tearing muslin into  strips of
the proper width and rolling them according
to the  following directions, which are also  ap- 
      THE HOSPITAL STEWARD'S MANUAL.   305

plicable in re-rolling bandages which have been
used and washed.
  To form a roller with the hands, begin at
one end and fold the extremity upon itself seve-
ral times, until a small cylinder of some solidity
is obtained; then the ends of this cylinder are
held and it is revolved between the thumb and
forefinger of the right hand, while the strip is
passed smoothly between the thumb and fore-
finger of the left hand, in such a manner  as
to give a little tension.  A good and uniform
bandage can thus be made.
  But in a large hospital, where many band-
ages are used,  and where  most of them are
                     26* 
306   THE HOSPITAL STEWARD'S MANUAL.

washed and re-rolled  after using, the labor of
making rollers in this  manner would be far too
great.  A simple machine may in this case be
constructed  for the purpose by any carpenter,
which  will  much  facilitate the process.  An
axis of iron  or strong wood (oak or hickory) is
made eight or  ten  inches long, and  about a
quarter of  an inch in diameter at  its thickest
end, with  a slight taper towards the other
extremity.   At the thickest extremity is a
handle  to   serve  as  a  crank.   This is  to
be  passed  through holes  in  two  uprights,
six  or eight   inches  apart,  set up in a
square piece of board in such a manner that it 
      THE  HOSPITAL  STEWARD'S  MANUAL.   307

can be readily made to revolve by the handle.
One  or more cross-pieces of wood or wire are
so placed that the strip is smoothed by pass-
ing between them before it reaches the axis on
which it is rolled.   The figure explains itself.
With such a machine a single  attendant can
roll a large number of bandages in a compara-
tively short time.
   In applying the roller, the free extremity is
laid with its external side next to the surface of
the limb, where it is held by the fingers of the
left  hand  until it is fixed by the subsequent
turns, the  bandage  being gradually unrolled
as it is applied by the right hand.   When the
dressing is completed, the extremity  of  the
bandage is secured by a  pin.
   The roller receives various names, according
to the mode of its application.
   The  circular bandage is  formed by passing
the roller  circularly around  the part so that
each turn covers in  nearly or completely that
preceding it.  This  is also spoken of as " a few
circular turns of the roller."
   When the roller ascends the limb obliquely,
each turn  partly overlapping that which pre-
cedes, it is spoken of as  the spiral bandage, or
"spiral turns of the  roller." 
308   THE HOSPITAL STEWARD'S MANUAL.

  The most usual application, however, when
a limb is to be covered in, is the reversed band-
age,  or "reversed turns of  the roller."   This
is made as follows.   The initial extremity of
the bandage  having been fixed  by a few cir-
cular turns, the reverses are made as follows:—
the upper edge of the bandage  being fixed
with two fingers of the left  hand, the  right, 
      THE  HOSPITAL  STEWARD'S  MANUAL.   309

which has  been  holding the  roller  in the
supine position,  is  to  be pronated, and the
bandage carried gently around the limb in this
position  until  it  reaches the  corresponding
point in the next turn, where the process is to
be repeated; and so on  up the limb.  The
figures will explain this process.
  Two of the most frequently-employed and
important  applications of the  reversed band-
age are the spiral of the upper and  the spiral
of the lower extremities.
  The spiral of the upper extremity requires a
roller two  and a half inches wide  and seven
or eight yards long.
  It is applied as  follows.   Make a few cir-
cular turns around the wrist, beginning on the
radial and  passing  towards the  ulnar  side;
then carry the  roller over the  palm and back
of the hand to reach the ends of the fingers,
and ascend by simple spiral  turns as far as the
thumb.   The ball of the  thumb and wrist are
then to be covered in by figure-of-8 turns, the
forearm ascended by spiral reversed turns to
the elbow, which is also  to be covered in by
figure-of-8  turns,  and the  arm  ascended in
the same manner as the forearm to  the shoul- 
310    THE HOSPITAL STEWARD'S MANUAL.
 
      THE HOSPITAL  STEWARD'S  MANUAL.   311

der, where the free end of the bandage may be
secured by a pin.  (See the figure).
   The spiral of the  lower extremity requires a
bandage of  the  same  dimensions, or perhaps
half an inch wider,  as  that  of the  upper
extremity.
   Make a few circular turns around the ankle,
beginning at the outer and passing towards the
inner side;  then, on reaching the internal mal-
leolus,  wind around  it  and over the  tendo
achillis, just above  the  heel, over the  space
between the external malleolus and the  heel,
and cross the sole of the foot to the great toe.
Ascend by  spiral turns from  thence to the
instep,  from which wind around the inner side
between the inner malleolus and the point of
the  heel, over the tendo achillis, to the outer
side of the  ankle above the malleolus, thence
over the instep  and point of the heel back to
the  instep, and make a figure-of-8 turn around
the  ankle, the instep, and the sole, after which
ascend the  leg by spiral  reversed turns to the
knee.   (See figure).
   If the knee and thigh are to be covered, take
another roller, and, beginning below the knee,
cover  it in with figure-of-8 turns, and ascend
the leg by spiral reversed turns to the groin. 
312   THE HOSPITAL STEWARD'S MANUAL.

   Besides the roller-bandage, pieces of muslin
of various sizes and shapes may be employed
as  bandages.   The most generally  available
form  is a square of muslin folded into a tri-
angle or like a cravat.   For detailed accounts
of the application of these or other bandages,
the hospital steward may consult "Sargent's
Minor Surgery," which is now furnished with
medical supplies to the army hospitals. 
THE HOSPITAL STEWARD'S MANUAL.   313
              CHAPTER II.

  Operations in Minor Surgery performed by the
              Hospital Steward.

            SECTION I.—CUPPING.
  By the term  "cupping" is understood the
application to  the surface of the body,  at con-
venient points, of one or more small cup-shaped
vessels of glass or  thin metal,  from the  cavi-
ties  of which the air has  been exhausted.
Two methods  are employed,—"dry cupping,"
or the application  of "dry  cups," and "wet
cupping," or  the  application of "wet cups,"
called also sometimes "cut cups."
  Dry cupping is effected by simply applying
to the surface to be  cupped the  number  of
cups ordered, in such a manner as to produce
a partial vacuum in  the cavity of each, into
which  the integuments are forced by  the  at-
mospheric pressure  without.
  The manner in which this vacuum  is pro-
duced will depend entirely upon the character
                     27 
314   THE HOSPITAL STEWARD'S MANUAL.

of the cupping-apparatus furnished.   Thus, it
may be produced by a small air-pump made to
fit upon the summit of each cup, in which is a
small orifice furnished with  a  valve opening
outward.  Or it may be produced by a very
ingenious apparatus recently brought into use,
in which each cup has attached to its bottom
a globe of India-rubber.  This is  simply com-
pressed with the hand when the cup is applied,
and  then, the pressure of the hand  being re-
moved, the expansion of the  globe by its elas-
ticity to its  natural form produces the neces-
sary rarefaction of the included air.
   The hospital steward, however, seldom has
these more elegant methods of  cupping at
his command,  the cupping-apparatus  usually
furnished to him, both in hospital and in the
field, consisting simply of from six to a dozen
plain cupping glasses or tins, and a scarificator.
   The vacuum is created in  these ordinary cup-
ping glasses or tins  by means of  the  heat
generated by the combustion  of alcohol.   The
inner surface  of the  cup  may be moistened
with alcohol, which is ignited, and, while  still
burning, applied to the  skin; or a  pellet of
cotton or strip of paper, moistened with alcohol
and  ignited, may be dropped into  the cup, 
      THE  HOSPITAL  STEWARD'S MANUAL.   315

which is to be applied while still burning.   In
either case, the flame is extinguished as soon
as the  cup is placed upon the  skin, by  the
rapid abstraction  of the oxygen of the con-
tained air : so that there is no danger of burn-
ing the  skin.
   The object of "dry cups" ' is merely to pro-
duce congestion of the  surface, with a certain
degree of ecchymosis, that is, discoloration from
blood effused in  the integuments  in  conse-
quence  of the rupture of minute vessels during
the  process.  Glass  cups will,  therefore,  be
found more useful when they can be obtained,
because with them  the degree of turgescence
can  readily be observed  during the process.
   Wet  cupping requires, besides the conges-
tion thus produced, that the  congested surface
should  be  incised in a number of places with a
scarificator, and a certain flow  of blood pro-
voked from these incisions by a reapplication
of the  cups.  In applying wet, or  cut cups,
therefore, the number prescribed are first to be
applied in  the same manner as in dry cupping,
and then,  after they have produced a certain
amount of congestion,—say  after five  or  ten
minutes' application,—they are to be removed 
316   THE  HOSPITAL  STEWARD'S MANUAL.

one  at  a time, the  scarificator  used, and  the
cups reapplied.
   The scarificator  is an instrument by means
of which twelve to sixteen slight incisions  can
be made  simultaneously,  by as  many little
lancet-blades, over a surface about the size of
the cup.  It is furnished with a screw, by means
of which the distance to which the lancet-blades
protrude, and  the  consequent depth of the in-
cisions,  are regulated.
  It is  used by placing it upon the surface to
be scarified, after  having first set the  blades
back  by pressing upon a  lever made for that
purpose, and then, touching the spring, all  the
incisions are instantly  and neatly made.
  The cup, having now been reapplied, is to be
kept  on until  about an ounce of blood  has
flowed  into it.  And  here  again glass cups
present advantages over  those of metal, since
with them the quantity  of blood can readily
be discerned, and the cup removed as soon as
enough is taken.
  Cut cups are, therefore, a  method of local
blood-letting.
   The operation being completed and the cups
all removed, the surface is to be cleansed from
blood, and a piece of dry muslin, or, if there is 
      THE  HOSPITAL STEWARD'S MANUAL.   317

much smarting,  a cloth spread with  simple
cerate, applied.
  When cupping is  to  be performed on the
chest of thin persons, or upon the abdomen in
cases of enteritis or peritonitis, it will be found
that the previous application of a warm foment-
ation, or of a poultice, to the parts, will greatly
diminish their sensibility and the pain of the
operation.

            SECTION II.--LEECHING.
  Two kinds of leeches  are employed in this
country,—European  and American.   Neither
of them are placed upon the supply table of the
army.  In certain situations, however,  they
are readily collected, and American leeches can
be purchased in  most localities at  a moderate
expense from the hospital fund.
  In the application  of leeches, the surface to
which they are to be applied must first be pre-
pared by washing it carefully with warm water.
If the part is  hairy, it should be shaved.  To
make the  leeches take hold more readily, the
parts on which it is designed for them to fasten
may be moistened with sugar  and water, or,
still better, with blood drawn from the tip of
                      27* 
318   THE HOSPITAL STEWARD'S MANUAL.

the finger.   The  leeches are to be applied a
few at a time, and  as  these take hold others
added, until the whole number directed  have
fastened upon the part.  As each fills, he lets
go his hold and falls off; but if from any cause
it is desired to remove them, or any of them,
sooner, they may be made to let go their hold
by putting common salt upon them.   The leech
should not be  pulled  off by violence,  lest a
portion of its head  be  broken off and remain
in the wound, thus causing unnecessary irrita-
tion and killing the  animal.
  The American leech may be estimated as
drawing about  a drachm of blood,  or even a
little more : from six to eight will represent an
ounce.  The  European leech is much larger,
and may be estimated  at two or three to the
ounce of blood.
  After the leeches  are removed, bleeding may
be encouraged, if so directed, by applications
of warm water or of a warm poultice,  or it
may be checked, after carefully washing the
part with cold water, by  simple exposure to
the air.  Sometimes, however, the bleeding is
quite  profuse,  and  may resist this  simple
measure, in which case a sharp-pointed  stick 
      THE HOSPITAL STEWARD'S MANUAL.   319

of nitrate of silver, introduced into the little
bleeding orifices,  will  generally  be  found
efficient.
   Leeches may be kept on hand  in good con-
dition,  for a  long  time,  in  tubs  filled with
water, at the bottom of which  turf or  peat is
placed : the water  should be changed about
once a week.   After they have been used, some
means  should  be employed to evacuate the
blood they have gorged: otherwise, they gene-
rally die.   This may be done by sprinkling
them with salt,  or  pouring salt  water upon
them, which causes them  to eject the contents
of their stomachs.  A better plan, perhaps, is
to make with  a thumb-lancet two small punc-
tures on the  back  of the leech, one on  each
side of the median line: through these the
blood  escapes, and  the  little wound subse-
quently heals.  After using, leeches should  be
kept in a vessel separate from  the others for
two or three  weeks, after which those which
survive may be again employed.

       SECTION III.--EXTRACTION OF TEETH.

   For  the extraction of teeth, a case of dental
instruments is furnished with the medical sup- 
320   THE  HOSPITAL  STEWARD'S MANUAL.

plies.  This case contains a gum-lancet, forceps,
a key, and an elevator.
   The Gum-Lancet is used prior to grasping the
tooth with the extracting  instrument, for the
purpose of separating the gum from the tooth.
  Forceps of three shapes only are usually fur-
nished,—one straight,  for the incisors and cus-
pids; one curved, for the bicuspids and molars,
and  one with pointed  blades, for the extrac-
tion  of stumps.
   The Key is usually  furnished with two  or
three movable claws,  so  as to accommodate
both sides of either jaw, and large as well  as
small teeth.
   The Elevator is simply  a lever with a sharp
notched  extremity, which is used  in the ex-
traction of stumps.
  In the extraction of  teeth by the forceps, the
gum of the tooth  to be removed  is first well
separated by means of the gum-lancet.   Then
the tooth is grasped by the forceps, taking care
to apply the blades  well  down upon  its neck,
as near as possible to the alveolar process.  The
forceps are to be closed upon the tooth firmly
enough to prevent them from slipping, but not
with such  force as to crush it,—a precaution
especially to be attended  to if it is much de- 
      THE HOSPITAL STEWARD'S MANUAL.   321

cayed.  In the extraction of the  incisors, the
cuspids, and  the bicuspids, a slight movement
of rotation is now to be  made, having for its
object to  loosen the tooth from its connections
before exerting the traction which is to extract
it.  In the case of the molars, however, a,s rota-
tion would be likely to break one or  more of
the fangs, a  lateral, rocking motion  is to be
substituted.
   The extraction of teeth  by the key should not
ordinarily be practised: it is a clumsy instru-
ment>ndis liable to break the teeth, bruise and
lacerate the gum, and do other mischief.  Occa-
sionally,  however, with the limited supply of
dental instruments furnished to  the  hospital
steward,  its  use may become necessary, espe-
cially in  cases where  the tooth is in such a
state of decay as not to offer a good hold to the
grasp of the  forceps.
   In the use of the key, the gum having been
well  separated, the claw is  to be adjusted so
that  its point is well pressed down between the
gum  and the neck of the tooth; the handle of
the key is then turned  so as to bring the ful-
crum against the gum on the opposite  side, and
the tooth grasped  in this way is to  be lifted
perpendicularly, or nearly so, from its socket. 
322   THE HOSPITAL STEWARD'S MANUAL.
          SECTION IV.--INJECTIONS.

  Enemata,  or  injections by the rectum, may
be directed  by the surgeon not merely to pro-
cure the action of the  bowels, but for various
medicinal purposes.
  The  beak of the syringe or enema-pump
should be warmed and  well  anointed with oil
or lard.   It should be  gently and  cautiously
introduced, especially where  the patient suffers
from piles, or other diseases of the rectum; the
fluid should be thrown in gradually and without
violence, and, when the quantity directed has
been introduced, a few moments should be per-
mitted to elapse before  the beak is withdrawn,
lest on  its too  rapid removal the fluid, or a
part of it, should escape with it.
  A large syringe, made of hard  India-rub-
ber, is furnished with the medical supplies for
this  purpose.   Where  bulky enemata are  di-
rected, however, it will  be found better to use
the force-pump, which is furnished among the
medical supplies with  attachments  by means
of which it may be used either as a stomach-
pump or for injection. 
THE HOSPITAL STEWARD'S MANUAL.   323
  With this  apparatus  a steady and continu-
ous  stream may be thrown in.   Printed  di-
rections  for  its  use accompany  the instru-
ment.
  The ordinary injection to procure the eva-
cuation of the bowels consists of a tablespoon-
ful of common salt  and the same of molasses
dissolved in a pint of  warm water.  This is
what is  generally understood when a patient
is directed to have "an injection."   The com-
position of any other enema must be specially
directed by the surgeon.
   Injections by the urethra  are frequently em-
ployed, especially in cases of gonorrhoea.  For
this purpose,  small syringes  of  hard India-
rubber,  or of glass, containing about half  an
ounce, are furnished with the medical supplies.
 The syringe being filled, its beak is  to be oiled
 and introduced very gently into  the urethra,
 and held in position by the thumb and last
 three fingers of the right hand, while the piston
 is pushed down  by the right forefinger,  the
 left hand being meanwhile employed in sup-
 porting the penis in position.
   Various solutions are employed in this man-
 ner.  None of  them,  however, should ever
 be resorted to except  on  the prescription of 
324   THE HOSPITAL STEWARD'S MANUAL.
a  medical officer.   In  any  case, it  will be
generally found  advisable  to wash out the
urethra by the use of a syringeful of luke-
warm water, before  throwing in the medicated
solution.
THE END. 
 
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