Medical and Surgical 
Technician’s Manual 
j, \M'< •j-v-v • ••>. . , * • ' 
Medical Department 
Enlisted Technicians School 
Brooke General Hospital 
Ft. Sam Houston, Texas 
4th Edition, Revised 1 Jan. 1944. 
676- -SAASFD-t-15-44—2.004 MEDICAL AND SURGICAL 
TECHNICIANS MANUAL 
MEDICAL EZPARTMRTT 3TLISTHD TSGHHI CIAHS SCHOOL 
BROOKS GIHRRAL HOSPITAL 
FORT SAM HOUSTON, TRX^S 
INDEX 
CHAPTER TITLE PaGE 
I AIUh/TOHY AHD PHYSIOLOGY 1 
II MILITARY FIRST AID 40 
III DEFEMSS AlAIDST CHEMIG.A WARFARE 82 
IV HYGIENE AMD SATITAFION 106 
V SOCIAL HYGIRDS 166 
vi nursing ’ iss 
VII OPERATING ROOM AND SURGICAL TECHNIQJJS 249 
IX PUBLIC PROPERTY 375 
X . MANUAL OF tiATHSKATI OS 385 
PiiOOUCEO BY PU|L WAT IONS SECTION, :>DZT5 
4TH EDITION' 
REVISED I J/.f! 1944 ANATOMY AND PHYSIOLOGY ANATOLIY AND PHYSIOLOGY 
Introduction t 
In order for the medical soldier to intelligently perform his 
numerous duties in connection with sick and wounded, it is neces- 
sary that he should understand something of the structure of the 
human body and the functions of its various organs. The course 
in anatomy, as given at this School, is of necessity briefer than 
that given in a Medical School; however, there is enough given 
here so that students who pay attention and take adequate notice 
will have a thorough knowledge of the basic principles of anatomy. 
Throughout the text there will be found spaces after each section 
for notes. Each student should use this space so that his ulti- 
mate knowledge of anatomy will be more thorough. 
Definitions? 
Cell A cell is the simplest unit from which all living 
things are built up. Each cell has an outer mem- 
brane, cytoplasm and a nucleus. 
Tissue A tissue is a group of cells, similar in origin, 
structure and function, together with substance 
between the cells. 
Organ An organ is a group of tissues which are united 
together in one unit for the performance of a 
special function or work, 
A System A system is a group of organs associated togeth- 
er to perform a special function. Nine systems 
are found in the human body. Their names with 
the functions of each are briefly expressed as 
follows: 
Skeletal System Support 
Respiratory System To provide oxygen and to 
get rid of carbon dioxide. 
Alimentary System To receive, digest and ab- 
sorb the food which is to 
be used by the colls. 
Muscular System Contraction which results 
in motion. 
Vascular System Distribution of the body 
fluids to all the colls. 
Excretory System To eliminate the waste 
products that result from 
cell activit2r. 
•1- Ilervous System To control and insure 
co-ordination in the 
working of all the sys- 
tems in the body. Con- 
tains the centers for 
all the sensations, in- 
telligence, and thought 
that we recognize as the 
highest functions of life. 
Reproductive System To insure the continuance 
of the race by the pro- 
duction of other beings# 
Endocrine System Glands of internal secre- 
tion, these glands secrete 
certain chemical substances 
called hormones directly 
into the blood stream 
which have to do with 
growth and development 
of the body. 
It is important to remember that these different systems are 
closely interrelated, and dependent on each other. While each forms 
a complete unit especially adapted for the performance of some func- 
tion, yet that function cannot be properly performed without the 
assistance and cooperation of other systems. The most perfect 
skeleton is not capable of support unless assisted by the muscular 
and nervous systems. Any interference with the circulatory sys- 
tem also affects the work of the excretory system, etc. 
Anatomy - Study of the structure of the body and relation of the 
different tissues and organs of the body to one another. 
Physiology - Treats of the function of living bodies and use and 
activity of various organs in life. 
Anatomical Position - Is the one in which an individual stands 
erect vdth arms at the sides and palms 
forward. 
Dorsal - Refers to the back, where the vertebral column is loca- 
ted; ventral refers to the opposite, or belly-side. 
Cranial - Refers to the hoad-end of the body; caudal refers to 
the opposite end. 
Superior - Refers to the region of the body which is uppermost in 
the standing position; inferior refers to the opposite, 
/interior - Refers to the region of the body which is forward in 
normal progression; posterior refers to the opposite. 
In man, cranial and superior are synonymous; dorsal 
and posterior are synonymous; ventral and an torior 
are synonymous; and caudal and inferior are synonymous. 80NES-BLACK 
ARTERIES - RED 
POINTS FOR APPLYING 
TOURNIQUET 
! PRESSURE POINTS FOR 
CONTROL OF BLEEDING 
SKELETON ’“ITH ARTERIES AND POINTS OF DIGITAL PRESSURE Medial - Means nearer to the midline (midsaggital plane) of the 
body; lateral means farther from the midline of the body. 
Internal - Refers to the center of mass of the part considered; 
external refers to the opposite. 
Proximal - Means nearer to the source or point of attachment; 
distal means farther from the source or point of 
attachment. These terms are used only in connection 
with the extremities (limbs). 
Central - Refers to the main or principal part, located intern- 
ally; peripheral refers to the extensions from the 
main part toward the surface of the body. These 
terms are used principally in connection with the 
nervous system or circulations. 
Parietal - Refers to the walls of a cavity; visceral refers to 
the viscus or organ in relation to the cavity. 
Fundamental Planes - The body may be divided for convenience in 
description by the following planes: A saggital 
piano is one which passes from dorsal to ventral, and 
divides the body into right and loft portions. The 
raidsaggital or median plane divides the body into 
equal right and left portions, A transverse plane 
is one which passes crosswise through the body and 
divides it into cranial and caudal portions. A 
frontal plane is one which divides the body into 
ventral and dorsal portions* 
1, Skeleton - the bony framework of the body which gives shape, 
provides stability, and protects the organs. 
A. Bonos. 
1. Composition - 1/3 animal matter - gelatin. 
2/3 mineral natter - line. 
Bone end - cancellous and spongy. 
Shaft - compact and dense, contains marrow. 
2. Covering - periosteum - nourishes the bone, loss of 
periosteum - death of bone. 
3. Cartilage or gristle - elastic substance, covers ends 
of long bones, ends of ribs, 
A. Number - about 200 without 32 teeth. 
5. Classified. 
a. Lug - femur, humerus. 
b. Short - tarsal, metacarpal, 
c. Flat - skull, pelvis, 
d. Irregular - pelvis, vertebrae. 
6. Structure of Skeleton, 
a. Skull. 
(l) Cranium - contains brain, composed of S 
bones, frontal, occipital, 2 pariotals, 
2 temporals, ethmoid, sphenoid. 
■4 (2) Faco - 14 bones - Important are 2 nasal 
bones, 2 maxilla, 1 mandible, 
(3) Structures within skull, 
(a) Sinuses, 
(la) Frontal. 
(2b) Ethmoid. 
(3c) Sphenoid,- 
(4d) iiixillary, 
(b) Mastoid Cells - in mastoid bone be* 
hind ears, 
(c) Foramen Magnum - large hole in lower 
part of occipital bone - spinal cord 
connects to brain, 
b. Vertebral Column - backbone, or spine (vertebrae - 
separate bones in column), 
(1) Cervical (nock) - 7 support head, 
(2) Thoracic (chest) - 12, support ribs, chest • 
and upper extremities, 
(3) Lumbar (back) - 5, support trunk, 
(4) Sacrum (pelvis) - 5, support pelvis. 
(5) Coccyx (tail bone) - 4 
Through vertebral arches - passes the spinal 
cord, fracture of spine might injure cord. 
c. Thorax (chest). 
(1) 12 ribs on each side - come together in fr ent 
to join sternum or breast bone, 
(2) 7 true ribs, 5 false ribs. 
(3) Sternum - breast b-ne - 3 parts; manubrium, 
gladi olus, xyphoid. 
(4) .Clavicle - S shaped.- helps make up shoulder 
and support of shoulder (collar bone). 
(5) Scapula - flat - helps to form shoulder, has 
’ glenoid cavity for head of humerus (shoulder 
blade). 
d. Arm, forearm and hand. 
(1) Humerus - head - helps to form shoulder joint, 
through surgical neck, more easily fractured - 
lower end helps make up elbow joint. Surgical 
neck below tuberosities, 
(2) Radius - Celle’s Fracture above wrist joint, 
radius* and ulna, 
(3) Ulna - elbow - olecranon, help make up elbow 
and wrist joint, 
(4) Carpus - wrist - 8 bones. 
(5) Metacarpal - hand - 5 bones. 
(6) Phalanges - fingers, 3 rows, except thumb has 
two, 
e. .Pelvis, r basin - 2 innominate bones and sacrum in 
back. Innominate bones made up of ilium, ischium and 
pubis. f. femur - longest bone in body (thigh); upper portion- 
head and pelvis make up hip joint - ball and socket 
joint. Low portion of femur, patella, and upper por- 
tion of tibia and fibula, make up knee joint, 
g. Patella - knee cap. 
h. Tibia and fibula - leg, 
i. Tarsus, metatarsus -and phalanges - foot. 
j. Teeth - 32 permanent, 2 crops - milk and permanent* 
(1) Structure - enamel, dentine; cement, pulp. 
(a) 8 front teeth incisors. 
(b) 4- canine. 
(c) 8 bicuspid. 
(d) 12 molars (upper, 3 roots; lower, 2 
roots). 
/Enamel 
Crown 
— Pulp Cavity 
— Neck 
i—• Dentin 
. —.Root 
1 
— Canal in Root 
TOOTH 
NOTES 
B. Joints - where 2 bones meet and move on each other. Ends 
covered with cartilage, enclosed by a joint capsule and 
lined with synovial membrane which is filled with fluid. 
Joint bound together by ligaments and strengthened by sur- 
rounding muscles. Ligaments are strong flexible bands of 
fibrous tissue, that help to hold bones together at the 
joints, 
1. Kinds. 
a. baj.1 and socket - shoulder and hip, 
b. Hinged joints - knee. 
c. Sutured - skull, 
2, Dislocations - brno ends of a joint misplaced and remain 
out of place. Sprain - (temporary dislocation) - muscles, 
ligaments and blood vessels arc also tom. THE MlTSCL3 SYSTEM 
7 NOTES 
C. Muscles - fleshy parts of body, main organs of motion. 
The muscles in their action upon the bones produce var- 
ious special motions; bending a limb is called flexion, 
straightening it is extension; turning the palm down is 
pronation, turning it up supination; motion of the limb 
on its long axis is rotation, abduction is throwing a 
limb out from the body, while drawing it toward the body 
is adduction. 
1. Function - to move various parts and tissue of body. 
Contract (shorten); relax (lengthen). 
a. Bone broken - muscle pull shortens bone, causes 
over-riding and deformity. 
b. Tendons - tapering end of muscle attaching to 
bone. 
2. Types. 
a. Voluntary - stemo-mastoid, biceps, diaphragm, 
b. Involuntary - heart, intestines, bladder, 
3. Connective Tissue - connects together all other 
tissues ana is support for blood vessels, nerves 
and fat. 
NOTES MEDIAL VIE'" OF FOOT LIGAMENTS OF THE RIGHT FOOT 
LIGAMENTS OF THE PLANTAR SURFACE OF THE RIGHT FOOT D. Skin - tough, elastic membrane, covers entire body, con- 
tinous at various orifices ■with mucous membrane, 
1. layers. 
a. Epidermis - cuticle 
b. Dermis or Derma - true skin, 
2. Derna - contains blood vessels, nerve, sebaceous 
and sweat glands* 
3* Appendages of skin - hair and nails, modified cuticle* 
/+• Functions* 
a* Protection - bacteria, undue evaporation, injury* 
b* Receive nerve ends - organ of touch* 
c. Excretory - waste. 
d* Temperature regulator, 
e* Some power of absorption. 
Red represents blood 
vessels carrying 
oxygen and food 
Structure of Capillary 
Blue represents blood 
vessels carrying little 
oxygen and food but 
much waste poi son 
CAPILLARY CIRCULATION OF THE SKIN E. Circulatory System - includes the lymphatic system, blood 
and blood vascular system, and is concerned with onward 
and continuous movement of the blood and lymph* 
1, Lymphatic system - lymphatic and lacteal vessels and 
lymphati c glands * 
a. Lymphatic vessels - like veins all over the body 
have valves litre veins - contain lyranh (colorless 
fluid). 
lacteals - lymphatic vessels about intestines 
(contain milky fluid during digestion.) 
b. Lymph glands - vary in size - filters for lymph 
before it enters blood; lymph enters blood by way 
of thoracic and lymphatic duct. 
Lymph glands - resist invasion of body by disease 
germs* 
Kernels of lymph glands found in arm pits, groin 
(bubo) etc, 
c. Lymph is fluid which comes in contact with tissues 
directly; it is the "middleman” between blood and 
tissues* 
Resembles blood in which rod blood cells are few 
in number. LYMPHATIC SYSTE.. OF TRUNK, GENITALS 
AND UPPER L I .MBS 
DIAGRAM ILLUSTRATING - STRUCTURE OF 
LYMPH NODE 
LYMPH NODES AND VESSELS 
OF LOWER LIMB 2. Blood - red in color. Bright in arteries. Dark red 
in veins. 
a. Fluid - 1/20 to 1/14 of body weight, 1 1/2 gals, 
to body plasma and cells or corpuscles, 
(1) Cells 
(a) Red -4.-5 million to cub, millimeter - 
flat disc, concave sides, oxygon carrier. 
Are formed in red bone marrow, 
(b) white -7-8 thousand to cubic milli- 
meter - round, scavenger. 
(la) Non granular leukocytes are lympho- 
cytes and monocytes formed in Lym- 
phoid tissue. 
(2b) Granular leukocytes'originate in red 
bone marrow. 
Leukocytosis increase in white blood 
cells. Leukopenia a decrease in 
white blood colls, 
(c) Platelets - necessary for coagulation, 
250,000 to cubic millimeter, 
(2) Plasma - serum and fibrin, 
(a) Serum - contains nourishing elements of 
blood, albumin, fats, sugar, salts and 
. gases, 
(b) fibrin - aids clotting - normal clotting 
time 3 to 3 1/2 mins. 
b. Functions. 
(1) Carries nutrition and oxygon to tissues of 
body, 
(2) Removes waste products of tissues, 
(3) Protects against bacterial invasion. 
(4) Maintains proper temperature and moisture 
of body, 
3. Heart - conical hollow muscle, lying between lungs 
and behind sternum, enclosed in fibrous sack - peri- 
cardium, Size of fist; weight, 3/4 pound. Apex 
at 5th interspace. Divided in 4 chambers, 2 auri- 
cles and 2 ventricles. Right side-venous, left, 
arterial. 
System circulation - in order to maintain a con- 
stant circulate0 of the blood, a complete system 
exists, constantly acting pump, the heart, arteries 
carry blood*to all parts of body, capillaries deliv- 
er the blooa to tissues, and take up waste products 
into veins, which return the.'impure blood to the 
right side of heart, l/2 minute for entire trip. Subsidiary system, known as pulmonary circulation, 
whore arteries taka impure blood from the right 
side of heart to lungs, into capillaries. Here 
it is purified, losing carbonic acid and waste 
matters and takes on a load of oxygen and passes 
through the pulmonary veins to left side of heart, 
then the systemic circulation* 
Coronary circulation - heart muscle derives its 
blood supply from the right and left coronary 
arteries arising just above the origin of the 
aorta from ascending portion of the arch, 
a. Valves. 
(1) Liitral - between left auricle and 
left ventricle. 
(2) Aortic - lies between left ventricle 
and aortai 
(3) Tricuspid - between right auricle and 
right ventricle, 
(4) Pulmonary -.from right ventricle. 
Heart rate -60-80 adults; children 
and infants 100 to 130, 
MHHAUC CJRCUUII.0J1 OF BLOOD NOTES 
4. Vessels. 
a. Arteries - carry blood amy from the heart - 
elastic, muscular tubes, thick mils, without 
valves, have pulsation, lie deep, (blood from 
cut artery spurts and is bright red) freely 
communicate and branch freely, thus arteries 
become gradually smaller to terminate in capil- 
laries. 
b. Capillaries - resemble minute hairs and serve 
an inter-change between blood and tissue and then 
to veins* 
c. Veins - carry blood to the heart - thin wall, no 
elasticity, with valves, blood dark rod, flows 
in continuous stream, veins superficial. Veins 
obstructed, result - enlarged veins - varicose 
veins in leg, scrotum varicocele, about anus, 
hemorrhoids or piles. 
(1) 3 sets. 
(a) Pulmonary Veins - convey arterial blood 
from lungs to heart* 
(b) Systemic - deep - accompanies arteries. 
Superficial - under skin, 
(c) Portal - 4 large veins collect the ven- 
ous blood from the viscera of digestion 
through liver via hepatic vein to right 
auricle. TY3 CIRCIIjATCHY SYST3-: F. Respiratory System, 
1, Composition - consists of larynx, trachea, bronchi> lungs 
md accessory passageways - nasal cavity and pharynx, 
a, Nasal Cavity - divided into right and left parts by 
nasal septum; septum composed of cartilage anterior- 
ly and bone posteriorly, is separated from mouth by 
palate* The cavity is divided into meatuses by nasal 
turbinates, ‘hero are 3 turbinates and 3 meatuses on 
each side of the nose. 
(1) Function's of tho nose. 
(a) ’’farms and moistens the air. 
(b) Hairs strain the air, 
(c) Location of sense organs of smell, 
(d) Faranasal Sinuses and Nasolacrimal duct 
communicate with nasal cavity* 
(2) Pharynx - a vertical tubular passage which ex- 
tends from the base of the cranium posterior to 
the nasal cavity to tho beginning of the eso- 
phagus at the loner end of the cricoid carti- 
lage. anteriorly, it communicates with nasal 
cavity, beneath this the oral cavity and below 
tho laryngeal cavity. The opening of the Eus- 
tachian tubes are present on the lateral walls 
of the naso-pharynx, the posterior wall of 
naso-pharynx contains adenoids. In the lateral 
wall of the oral pharynx, on either side, the 
tonsils are located. 
(3) Larynx - composed of cartilages, thyroid carti- 
lage (Adam’s Apple) and cricoid cartilage, held 
together by ligaments and muscle. Larynx con- 
tains the vocal cords and lies between the 
base of the tongue and trachea, opening to 
Larynx; is protected by epiglottis. Aie thy- 
roid gland lies below the thyroid cartilage or 
Adam’s Apple, 
(A) Trachea or windpipe - composed of cartilage - 
cartilage ring, C-shaped, not complete poster- 
iorly - cartilage serves to prevent collapse of 
trachea, 
(5) Bronchi - cartilage rings - as trachea and 
larynx. Eight and left bronchi divide and 
continue to divide like thrno branches, and 
finally terminate into terminal bronchus and 
air cells or sacs like bunch of grapes — this 
is lung proper. 
(6) Lungs - essential organs of respiration, with 
heart between - fill chest cavity. Right and 
left lungs - right 3 lobes, loft 2 lobes, 
covered by pleura!. 
Visceral pleura is adherent to lungs, parietal 
pleura lines the walls of the pleural cavity. (7) Mediastinum - region between mediastinal portions 
of the two pleural sacs. Is bounded anteriorly 
by sternum, posteriorly by vertebral column, 
laterally by lungs# “ithin the mediastinum 
are placed the heart, aortic arch, arteries 
and veins, part of the superior vena cava, 
trachea, esophagus, thoracic duct, nerves 
(phrenic and vagus), gland, lymph 
nodes, areolar tissue* 
2, Function* . ■ 
a. Respiration - alternating expansion and contrac- 
tion of chest - drawing air in and forcing it 
out - inspiration and expiration* Rate - IB 
in adults, 
. (1) Mechanics of respiration - diaphragm, con- 
tracts, capacity of chest increases, air 
rushes in - this is inspiration; diaphragm 
relaxes, chest wall collapses, air forced 
out - this is expiration. If respiration 
increased, intercostal muscles and other 
muscles play part as abdominal and chest 
muscles,, - outdoor - 21 parts oxygen, 
nitrogen 79 parts; oxygon - necessary for 
life, : Respiration - oxygen taken in lungs, 
carbon dioxide given off. 
fg_SPl.RA_IORY SYSTEM DIAGRAM OF THE DIGESTIVE SYSTEM 
SHOVING THE CONTINUITY OF ALL 
ITS PARTS 0. Digestive System - consists of alimentary canal, salivary 
glands, liver and pancreas, 
1, Alimentary cmal; mouth, pharynx, esophagus, stomach, 
small intestines, large intestine, muscular tube, 30 
foot long from lips to anus, 
a. Mouth - mastication of food and mixed with saliva, 
slight digestion conversion of starch to sugar. 
Saliva comes from 3 salivary glands; parotid submax- 
illary and sublingual. Structures within mouth - 
teeth, tongue, in back of mouth, fleshy curtain, 
palate; from center of palate, uvula, on either 
side and behind palate are tonsils. After food is 
masticated it is pushed by the* tongue into the 
pharynx; thence through 9 inch muscular tube - 
esophagus or gullet, into stomach, 
b. Stomach - muscular bag lined with mucous membrane, 
thrown up in numerous folds called rugae, which 
gives more surface. Gastric glands lie in the mu- 
cosa, Two types - one produces hydrochloric acid, 
the other pepsin or protease. Pear shaped, large 
end to the left, and lying in the upper part of 
abdomen, behind ribs, separated from thoracic 
cavity by the diaphragm. Two openings, one connected 
with esophagus called cardiac end, and other connect- 
ed with small intestines called pyloric orifice, 
c. Small Intestines - 25 feet long. Narrowest part of 
the digestive tract, occupying the central and lower 
parts of the abdominal and pelvic cavity, suspended 
from the spine by a fold of peritoneum called mesen- 
tery, terminates in valvular opening into large in- 
testines, divided into duodenum, jejunum, ileum, 
d. Large Intestines - 5 feet long. Commences in right 
groin (cecum) - appendix extends downward from cecum. 
Cecum as it passes up right side of abdomen is as- 
cending colon, under liver, turns and crosses to left 
in front of stomach, transverse colon, in left upper 
abdomen it turns downward, descending colon, in left 
groin curves like letter S sigmoid flexure, which 
ends in rectum, descending to right and backward to 
anus. Covering of intestines and lining abdominal 
cavity smooth shining membrane - peritoneum, 0- 
mentum - fatty apron made up of peritoneum and con- 
tains fat, lies over and covers intestines. Mesen- 
tery - peritoneal folds binding intestines loosely 
to abdominal wall behind, Meak areas in abdominal 
wall due to blood vessels passing out of abdominal 
cavity, 'Teak places arc umbilicus or navel, inguin- 
al canal where vessels pass to testicles, femoral 
canal for vessels in the thigh. Hernia may result - 
umbilical, inguinal and femoral. 0UJ3RAM OF PJRTAL ANJ5 BILIARY. SYSTEMS 
e. Liver - largest gland in body, weight 4 to 4 1/2 
lbs. Lies behind ribs - divided into 2 lobes. Gall- 
bladder and its duct, situated on under surface of 
liver, duct empties into small intestine* 
f. Biliary System - Hie biliary system consists of the 
bile ducts both inside the liver and outside of it, 
and the gall bladder, the right and left hepatic 
ducts, one from each lobe of the liver join to form 
the common hepatic duct. The gall bladder, you 
might say. Is a largo outpouching of the common he- 
patic duct* 1'hc gall bladder is connected to the 
common hepatic duct by a narrow duct called the cystic 
duct. From the function of the cystic duct, the com- 
mon hepatic duct down, it is known as the common bile 
duct. The common bile duct and the pancreatic duct 
join to enter the duodenum together about 4 inches 
from the pyloric sphincter of the stomach* The gall 
bladder is a thin muscular bag lined with mucous 
membrane, where the bile, which is formed in the 
liver, is concentrated and stored until needed for 
digestion, -kx addition a thin mucous is added to 
the bile by the mucous glands of the gall bladder, 
(1) Functions of Liver and .Biliary System, 
(a) Storage of sugar (glycogen). 
(b) Production of urea, secretion of bile* 
Pile helps emulsify and digest fats, 
stimulates the intestinal muscles to con- 
traction, acts as laxative, prevents pu- 
trefaction. of intestinal contents. g. Spleen - to loft of stomach and behind ribs - dark 
in color, size of small hand. 
(1) Function - none for digestion* 
(a) Reservoir for blood storage during diges- 
tion. 
(b) Production of leukocytes, destroys R.B.C, 
(c) Production of uric acid. 
h. Pancreas - placed deeply behind stomach, extends 
transversely across abdomen, slender tongue-shaped 
gland - 6 in. by 3/4 in. In cream color; duct which 
terminates 'into small intestines with common duct. 
The head of the pancreas lies in the first bend of 
the duodenum and the tail lies against the spleen. 
The pancreas has tw separate types of glandular 
tissue. One type secretes digestive juices into 
the pancreatic duct and the other typo, the islets 
of langerhans, seefeto insulin directly into the 
blood stream. Insulin is the substance which has 
to do with carbohydrate metabolism and it is the 
lack of it that causes Diabetes Mcllitus»i'hus, the 
pancreas is a gland of both internal and external 
secretion. 
NOTES piiygiology of digestion 
Digestion is the process of .Totting foods .into soluble f rm, 
so as to fit thorn for absorption into the blood, by noons of which 
they may bo carried to all the tissues. This alteration is brought 
about by enzyme 3. 
An enzyme is an organic catalyst, produced by a living organ- 
ism. An enzyme) -increases the speed of a reaction without .adding 
in any 'way to the energy changes involved in the reaction or tak- 
ing part in the formation of the end products, 
Enzyme action is specifxts. That is a certain enzyme mil act 
on one type of food stunf al’Sn® and no other. Enzymes also have 
an optimum temperature find optimum reaction. The optimum temper- 
ature of course, is body temperature. The optimum reaction is 
acid for the gastric enzymes and alkaline for the intestinal and 
pancreatic enzymes. 
The types of food may b« classed as inorganic and organic. 
The inorganic foods are water and salts, which need no digestion. 
The organic foods are: carbohydrates ’ Xsugars and starches), fats, 
and proteins. In addition there are accessory foods (also organic) 
which are known as vitamins. 
Digestion begins in the mouth by the process of chewing the 
food and mixing it with salivary on3.7110 amylase which begins the 
digestion of starch. After the voluntary act of swallowing, 
which has already been discussed, th bolus of food is passed 
down the esophagus by the involuntary muscles to the; stomach by 
peristolic waves. In the* stomach gastric enzymes, protease or 
pepsin and rennln with the aid of hydrochloric acid, be gin the 
break down of proteins and fats respectively; this is done as 
the food is churned about and mixed with the gastric juice. 
The presence of food in the stomach sets up reflexes which 
cause bile to bo released from the gall bladder and pancreatic 
juice from the pancreas into the duodenum, “hon the food in the 
stomach is well mixed with gastric juice, the pyloric valve opens 
and the food passes into the duodenum. 
In the duodenum and small intestine the food is mixed with 
the bile, intestinal and pancreatic juice and digestion is complet- 
ed, The bile emulsifies the fats so that they can be broken down 
into fatty acids and glycerol by pancreatic lipase. The proteins 
are farther broken down into imino acids by pancreatic and in- 
testinal proteases. Thu digestion of starches and complex sugars 
into glucose is completed by various enzymes from both the pan- 
creas end small intestine. Now the fatty acids, amino acids and glucose are ready for 
absorption. This takes place through the small capillaries which 
lie in the villi of the small intestine. The majority of the fat- 
ty acids are taken up by small lymphatics, called lacteals, also 
situated in the villi and as chyle is emptied into blood stream 
through the thoracic duct. 
The digested, as well as the undigested food and water, is 
passed along the small intestine by peristaltic waves. By the 
time the contents of the small intestine reach the ileo-caecal 
valve, digestion and absorption of the food products is complete. 
In the large intestine the undigested and unabsorbablo food 
is also passed along by peristalsis, but at a much slower rate; 
talcing from 24 to 36 hours to pass through. In the large intes- 
tine the excess water is absorbed and more or less dry formed 
stools are produced. Anything which increases the rate of pas- 
sage through the colon will give a watery stool or diarrhea. 
There are numerous bacteria which normally live in the in- 
testinal tract chiefly in the colon. These are chiefly the Ba-’ 
cillus Coli group and a few gas forming bacilli, as long as 
those bacteria remain within the intestinal tract, they do no 
harm, but once free in the peritoneal cavity, as from a rup- 
tured appendix or gun shot wound of the abdomen, they set up a 
very serious inflammation called peritonitis, which causes 
death more often thin not. 
Dcfecation. The dried feces having accumulated in the rectum, 
sets up a defecation reflex. The internal sphincter is automati- 
cally released. At the convenience of the individual, the ex- 
tern:!, voluntary, sphincter is released, the internal abdominal 
pressure is increased by tightening the voluntary abdominal mus- 
cles and the contraction of the diaphragm. At the same time, 
the levator ani, a voluntary muscle, which is attached to the 
anal or voluntary sphincter, is contracted, thus lifting the 
lower end of the rectum up over the formed stool so that it is 
expelled. 
NOTES 
■2/. Lung Capi11 ar i es 
All greatly enlarged 
msm 9i umi .ikssa vj^s 
AND TUBULES 
N0T3S H, Urinary Apparatus - consists of kidneys, which secrete urine 
and the ureters which convey it to the bladder accumulates and 
discharges through urethra# 
1, Kidney - one on each side of lumbar vertebrae in back of 
the abdominal cavity behind the peritoneum. They are A in, 
long by 2 1/2 in. wide and 11/2 in, thick, weight about 5 
oz,, are bean shaped, with concave side turned toward 
spine, convex side outward* Hilum - depression near cen- 
ter of concave side serves for vessels to enter and leave, 
a. Structure. 
(1) Cortex - outer part - secreting part* 
(2) Medulla - aggregation of urinary tubules on 
their way to pelvis of kidney; by arrangement 
of blood vessels, the arterial blood is brought 
directly to the glomerulus. It is during its 
circulation through the glomerulus that the 
blood filters some of its water and dissolved 
substances. Then tubules reabsorb some of its 
dissolved substances, 
(3) Pelvis - on the inner side of each kidney is a 
deep depression containing a funnel - shaped 
sac - the pelvis which receives termination of 
urinary tubules,. 
2, Ureters - 2 muscular membranous tubes, lb in, long, extend- 
ing from kidney pelvis to urinary bladder, 
3, Bladder - muscular bag, serves as reservoir for urine, 
situated in the pelvic cavity behind the pubes, held in 
position by ligaments; moderately filled, cont ains about 
1 pt,, has rounded form. When full, it rises into abdomen 
and can bo felt. The neck of the bladder is embraced by 
the prostate gland, which in old men becomes enlarged and 
obstructs flow of urine to the outside, 
4, Urethra - 3 to 9 in, long, extends from the nock of blad- 
der to the meatus, urethra under pubes describes a curve 
with concavity upward. 
5, Urine - water solution of uric acid, coloring matter, and 
salts mostly, urates, phosphates, carbarates, and chlorides, 
Man passes about 3 pts, a day. This contains 1 l/2 oz, 
of solids. Yellowish color, acid and S,G. 1015 to 1025, 
Urea - most important - more than 1 Oz,, being excreted 
daily. Urine, when passed is clear, may become cloudy 
and sediment form - on heating, if cloudiness disappears, 
it is due to urates, if acid added and disappears, due 
to phosphates. Abnormal constituents of urine in disease 
are albumin, sugar, bile, blood and pus, 
6, Suprarenal Glands - two small flattened bodies, yellowish 
in color, •one immediately above each kidney. Nothing to 
do ?ath excretion of urine. Function is to sustain mus- 
cular tone especially blood vessels, adrenalin is pro- 
duced by this gland; the lack of this gland causes death 
and disease of it is known as Addison's Disease, SAGITTAL SECTION OF THE LC'ER PART OF THE MALE TRUNK I. The Male Organs of Reproduction, 
1, Penis. 
(a) The penis is the orgen of copulation and contains 
three cylinder-like structures of erectile tissue, 
containing multiple spaces or lacunae which become 
engorged with blood, via the internal pudic arteries, 
and produce the condition known as erection. Two 
of those cylindrical structures are known as the 
corpora cavernosa and one, through which the ure- 
thra passes, is called the corpus spongiosum, 
(1) The urethra serves the double purpose of urina- 
tion and the ejaculation of semen during the 
sexual act. The enlargement at the distal 
end of the penis is called the glans penis, 
2, Prostate Gland, 
(a) The prostate gland is about the size of a horse chest- 
nut and surrounds the* neck of the bladder. It con- 
tains numerous tubules and secretory epithelia, and 
elaborates a secretion which mixes with that of the 
seminal vesicles, and spermatozoa from the testes, 
to form the semen* 
• (b) functions, 
(1) Lubrication, 
(2) ‘ Propulsion of spermatozoa, 
(3) Nutritional media for spermatozoa, 
(4) Neutralization factor for vaginal secretions# 
(c) In some men this gland becomes large and hypertro- 
phied so that it interferes with urination. In 
these cases surgical measures may bo necessary to 
give relief; cither by removal, resection of part 
of the enlargement through the penis with a special 
instrument called a resectoscope, or by moans of an 
open operation when the enlarged gland is (enucleat- 
ed) removed, 
3• Seminal 7esides s 
The seminal vesicles arc two small multiple sac-like 
structures located on the lower back portion of the 
bladder, posterior to the prostate, and function as 
reservoirs for the spermatazoa. They also elaborate 
a secretion which helps make up the semen. 
4. Vas boil;runss 
The vas deferens are two muscular tubules that con- 
duct semen from the testes to the Seminal Vesicles 
and Prostate* They join with the seminal ducts 
to form the ejaculatory ducts. 
5, Testes, 
(a) The testes, or testicles, arc the gl'inds of 
reproduction and -are located in the sac known 
as the scrotum. They are encapsulated with a 
-28- sheath, known as the tunica albuginea, which 
partitions the testes into about 1/+0 segments, 
each containing from 1 to 3 tortuous tubules 
of highly specialized epithelium, known as the 
germinating opitholia - this consists of two 
typos, 
(1) The germinating or spermatogenic, which 
produces the spermatozoa. 
(2) The supportive cells (Sertoli) from which 
the tails of the spormats are derived, 
' (b) The testis also has on internal secretion that 
is necessary for the development of the secon- 
dary characteristics of the male, such as form, 
structure, voice, beard, etc. 
6, Epididymis: 
On the back of the testicle and part of its 
structure; it is a convoluted tubular mass, 
connecting the tubules of the testis with that 
of the Vaa Deferens, and is I mown as the epidi- 
dymis, It is in this structure that the sper- 
matozoon matures in route to the seminal vesi- 
cles for storage, or exit via ejaculation* 
7, The Spermatozoon or Spormati 
Is the male fertilization seed. It develops in 
the spermatogenic epithelia of the testes, and 
as a rule, is very prolific. The average dis- 
charge will contain from ten thousand to a 
million or more* It averages *05 m jn, long and 
consists of three parts: 
(a) Head which contains the chromatin. 
(b) Middle piece, contains the centresone. 
(c) Tail, only use is flagellation or loco- 
motion* 
NOTES 
-29- J. The Female Organs of Reproduction. 
1, Labia Fajora and Minora - large and small lips. They are 
protective and sensory. 
2, Clitoris: a homologue of the penis, but in comparison 
is more richly supplied with nerves - functions chiefly 
sensory. 
3. Vagina: the depository vault where from the semen travels 
up into the womb, 
4. The womb or uterus: the birth chamber wherein the fer- 
tilized ovum usually becomes entrenched and normally de- 
velops for nine months, obtaining nourishment and blood 
for growth from the mother through special vessels that 
develop in the walls of the uterus. 
5. Fallopian tubes or oviducts: are two tubes, homologous 
(similar in function to Vas Deferens in the male) that 
conduct the ovum, or female egg, from the ovary where 
it is developed and extruded, to the uterus. Fertiliza- 
tion of the ovum, by the spermat, takes place, as a rule, 
in these tubes, and takes about 9 days to complete the 
descent to the uterus. 
6, Ovary: the ovaries are homologous to the testes, and like 
the testes have a dual function. They elaborate an intern- 
al secretion which is largely responsible for the female 
secondary characteristics, such as form, voice, skin, hair, 
etc. They also produce, via the Graafian follicles, the 
female eggs or ova. About once every 28 days in the aver- 
age woman one of those eggs matures and is extruded from 
the ovary. If not fertilized by the male seed, they be- 
come part of the process known as menstruation. If fer- 
tilized by the male seed, it becomes the mother or chief 
unit of reproduction, ihe head and middle piece of the 
male seed enters the ovum via the germinal spot, whereas 
the tail, having, served its purpose, is cast away at time 
ox entry. The ovum is quite large compared to the spermat, 
it being 1/125 inch (0,2mm) in diameter. It is estimated 
that about 35,000 ova are present in both ovaries of the 
average normal woman. 
NOTES 
-30-  PINEAL 
DIAGRAM ILLUSTRATING THE MORE IMPORTANT INTER- 
RELATIONSHIPS OF THE ENDOCRINE GLANDS. 
INDICATES SYNERGISM OR STIMULATION 
INDICATES ANTAGONISM OR INHIBITION 
ARROWS POINT IN THE DIRECTION OF SUCH REACTIONS 
QUESTION MARKS INDICATE POSSIBILITIES WITHOUT ADE- 
QUATE EVIDENCE, . 
31 K, The Endocrine System - or the glands of internal secretion 
are the islet cells of the pancreas, thyroid gland, para- 
thyroid glands, suprarenal or adrenal glands, the hypo- 
physis cerebri or pituitary, and certain tissues of the 
gonads or t.stes and ovaries. Those glands secrete cer- 
tain chemical substances, called hormones, directly into 
the blood which have to do with the growth and develop- 
ment of the body and its control in relation to its en- 
vironment. 
NOTES 
L. Nervous System and Special Senses - consists of brain, 
spinal cord -and nerves. This constitutes the cerebro- 
spinal system: ganglia and connecting nerves - autono- 
mic system. 
1. Brain - situated in the cranium or skull - is "seat” 
of int llect and mil, 
a. Parts: - cerebrum, cerebellum, pons and medulla. 
(1) Cerebrum - soft, pulpy, oval mess, divided 
into two hemispheres by a fissure; the 
hemispheres are connected by <, dense layer 
of transverse fibers, called corpus callo- 
sum. Brain surface has numerous grooves or 
sulci, between which are the convolutions. 
Cortex or exterior - gray matter, medulla 
or interior white matter. : /hito matter is 
a collection of nerves connecting various 
parts of brain and spinal cord, Cray mat- 
ter is the seat of mind, contains different 
centers (visual, auditory, etc.) Within 
brain are cavities - ventricles contain 
fluid. Brain - delicate and easily in- 
jured (fractures of skull, apoplexy.) 
(2) Cerebellum - little brain - mass of ner- 
vous tissue, maintains equilibrium of body. 
-32- DIAGRAM OF THE AUTONOMIC SYSTEM 
SYMPATHETIC NERVES « *■ - YELLOl" 
PARASYMPATHETIC NERVES - - BLUE 
CRANIAL AMO SPINAL NcSvES - - - - BLUE 
SYMPATHETIC NERVES AND GANGLIA - YELLOW 
- S3 - (3) Pons - connecting link between cerebrum and 
medulla oblongata - enlarged upper end of 
spinal cord, lying just vdthin cranium, 
contains important nerve centers - control- 
ling action of heart, blood vessels, respi- 
ration* hervos from brain cross over to 
opposite side of cord. Injury above this 
causes paralysis on opposite side of body, 
b* meninges or Ixembranes, 
(1) Dura mater - lining of cranium and spinal 
canal, strong, fibrous membrane; protects 
and suspends the brain* 
(2) Arachnoid - serous membrane, invests brain 
and spinal cord, 
(3) Fia mater - very vascular membrane, invests 
brain deep in the convolutions; supplies 
blood to brain, 
2, Spinal Cord - enclosed in meninges or membrane like 
the brain - is tail-like column of nervous tissue - 
composed of nerves - interior - central column gray 
matter, A pair of nerves leaves it opposite each 
vertebra (corvial in two groups) each nerve has a 
posterior (sensory) and anterior (motor) branch. 
Upper cervical group supplies face and neck and 
interior chest - important branch - phrenic - 
diaphragm. Lower group - brachial plexus - supplies 
upper extremity. Thoracic nerves of dorsal, supply 
chest wall, lumbar and sacral nerves to pelvis and 
lower extremities. All nerves except face pass 
through spinal cord - severance ox cord causes 
paralysis below that point, 
a. Nerves, 
(1) Kotor - convey impulses from brain directing 
motion - muscle movement, if motor nerve cut, 
paralysis of muscle, 
(2) Sensory - carry sensation impulses to the 
brain, if sensory nerve is cut, loss of 
sensation, Serves may bo made up of motor 
and sensory fibers; i,e., 5th nerve. Re- 
flex action - not necessary to refer to 
brain for action - automatic, 
ll. Special Sensest touch, taste, smell, hearing and sight. 
Smell, taste, hearin, and sight presided over by special 
cranial nerves - come directly from brain, not through 
spinal cord, 
1, Touch - skin - more developed - ends of fingers - 
pain, temperature and pressure, 
2, Taste - mouth, tongue, substance should be in solution; 
sweet, bitter and salt. 
-34- 3* Smell - nose, upper nasal cavity through olfactory nerve, 
4, Hearing - ear, through auditory nerve, 
a, T5ar consists of: 
(1) External ear, 
(2) Auditory canal, 
(3) Tympanum or drum membrane. 
I, Cornea 
2 Conjunctiva 
3 Anterior chamber 
4, Iris 
3-. Posterior chamber j 
6- Crysta11 5ne lens 
7- Oil iary muscle 
8 Sclera 
9' Retina j 
10- Optic nerve 
I I Fat of orbi t 
12- Medial hi 
13- Lateral M 
14 Inferior M 
15- Superior M 
l6, Inferior oblique Mi 
17- Superior obiique Mi 
18- Levator M 
19 Orbicylaris 
20- Frontal bone 
21- Cortex of cerebrunl 
22- Superior tarsus { 
23- Inferior tarsus i 
KEY 
Greater wing of 
sphenoid 
-35- KEY TO EAR 
3* External ear 
2, Auditory canal 
3* Cartilage 
4, Tympanum 
3' Middle ear with ossicle 
hammer, anvil, stirrup 
k* Inner ear ~ cochlea 
7* Auditory nerve endings 
8-, Auditory a rid vestibular 
nerve, 
9* Ampullae (3) of 
vestibular canal, 
10-, Vestibular canals 
tl* Pharyngeal Eus» 
tachian tube 
12i Mastoid bone. 
13i Cerebral cor x 
"..rey matter”" 
note convolutions 
increase area* 
14* White matter ~ 
nerve fibers-. 
YELLOW - NERVES 
Red *-> Mu sc I e s 
DIAGRAMS OF EAR & EVE 
- ME SAL ASPECT OF BRAIN SECTIONED IN THE MEDIAN SAGGITTAL PLANE 
AND ITS RELATIONSHIP TO THE SKULL AND FACE 
BASAL ASPECT OF THE BRAIN SHOWING SUPERFICIAL ORIGIN OF CRANIAL NERVES 
-37- (4) Middl e ear. 
(5) Small bones (ossicles) 
(6) Internal ear. 
(7) Eustachian tube - leading from middle ear to 
the throat. 
5. Sight - consists in the perception cf light, color, 
form, size and distance, resident - eye. 
a. Eye - situated in the orbit, nrotected by bony 
orbit and lids; covered in front by thin vas- 
cular membrane, also lines the lids - conjunctiva- 
light enters through cornea; behind cornea a 
curtain of muscular fibers, variously colored, 
the iris. The black nunil is hole through the 
iris through which the light nasses to 
crystalline lens. Light is focused on retina, 
retina being an expansion of the ontic nerve, 
which transmits the impression to the brain. The 
dense white outer coat of eye, beneath conjunctiva 
is sclera. Eye is like a camera - focusing done 
by changes in the convexity of lens. Effective 
bj' contraction of the ciliary muscle and muscles 
of accomodation, which when inadequate results in 
near sightedness or far sightednees. Image 
focuses either in front or behind retina. Distant 
vision is focused by relaxation of the ciliary 
muscle - lens widens and thins; close vision is 
focused by ciliary muscle action - lens thickens 
from front to rear. Blindness may be due to 
opacities of eye ball itself; damage to retina, 
ontic nerve of the optic radiation or occipital 
cortex. ■ ‘ 
DOTES 
-36- PROCESS 
MOUTH 
STOMACH 
SMALL IHTSSTIHS 
LARGS IHTESTIHE 
M3CHAHICAL 
DIGESTION 
C7j»-r.Aj, 
EICESTICJ 
Carbohydrates 
Teeth 
Saliva begins 
digestion of 
carbohydrates 
Peristalsis 
(liver - bile) 
(Pancreas-Trynrin, 
Amyl on sin t Steansin) 
Hone added 
(Duodenum, Jejunum, ileum) 
Peri stalsis 
Pancreatic and intestinal 
Juices, complete digestion 
here. 
Peristalsis 
Hone 
here. 
Proteins 
Hone 
Pensin. rennin and 
hvdro chioric aci d 
begin digestion of 
•oroteins here. 
Pancreatic and. intestinal 
Juices, comnlete digestion 
here. 
Hone 
Tats 
Hone 
Hone 
Bile begins digestion of fats 
here. 
Hone 
A3SORPTIOH3 
Hone 
Water, alcohol, 
(glucose if eaten) 
and some drugs here. 
Pancreatic and intestinal 
Juices, complete digestion 
here. 
Glucose, blood protein 
(albumin) and blocd fat 
absorbed here as rapidly 
as they become digested. 
Also vitamins, minerals 
and water. 
Excess water 
removed here 
MATOMT ASHD PHYSIOLOGY 
-39- MILITARY FIRST AID I. INTRODUCTION 
First aid is the immediate, temporary treatment given in case 
of accident or sudden illness, before the services of a medical 
officer can be obtained. In many cases this temporary service 
saves a life and in all cases, one of the primary aims of intel- 
ligent first aid is the relief of mental and physical suffering 
which reduces the possibility of shock and places the patient in 
the medical officers hands in a much better condition to receive 
further treatment. In the present type of warfare, in which 
patients must often be transported hundreds of miles before defi- 
nitive treatment can be given, or in jungle warfare where the dis- 
tances may not be great but evacuation may nevertheless take many 
hours or even days, it is especially important for technicians to 
apply proper first aid in order to enable wounded men to survive 
the arduous trips. 
There are certain general principles to remember in the first 
aid care of an injured person, 
A, Keep the patient lying down with the head level until the 
patient's injuries have been determined. Many injured 
people attempt to sit up or walk, and this may cause ser- 
ious complications if the patient has a fracture, severe 
hemorrhage or any type of serious injury. Certain condi- 
tions call for particular positions of the patient, and 
these will be taken up later, 
B. Examine the patient for hemorrhage, cessation of respi- 
ration and evidence of poisoning. These conditions take 
precedence in this order over everything else and demand 
immediate treatment. Another war injury requiring imme- 
diate attention is a sucking wound of the chest - this 
will be discussed later. Other injuries to be looked 
for, include wounds, bums, fractures and dislocations, 
C, Remove enough clothing to get a clear idea of the extent 
of the injury, preferably ripping the clothing along the 
seams, but cutting it if necessary. Removing clothing 
in the usual way may do groat harm, especially in fractures. 
Do not remove too much clothing - exposure to cold may 
precipitate the condition of shock. 
D. t)o not get excited. Act quickly but efficiently. Decide 
as soon as possible what has to bo done and which of the 
patient's injuries needs attention first, 
E, Keep the patient warm. This can often be done while the 
patient's injuries are being cared for, A blanket over 
the patient may do him as much good as the dressing you 
apply to his wounds, 
F. Do not let the patient see his own injury, if possible, 
and ro-assure him. Try to convince him that his injury 
is not serious and that he will recover. In some cases 
a cigarette will make a patient feel better, and those 
little things are important in determining a patient's 
•40' final outcome and preventing shock* 
G* Keep bystanders away from the injured. 
H* Do not touch open wounds or bums with your fingers or 
dirty objects. This will cause serious infections and 
may cost the patient his life* 
I. Do not give an unconscious patient liquids. They may 
strangle him or else may run down into his lungs and 
cause pneumonia or lung abscesses* 
d* .Finally, do not move a patient until the full extent of 
his injuries has been determined. This is especially im- 
portant in case of fractures* Remember that fractures 
should be splinted where they lie. Likewise, hemorrhage 
must be controlled before the patient is moved* 
II* CONTUSIONS 
One of the simplest types of injury you will deal with is the 
contusion or bruise, A common example of this injury is the 
ordinary "black eye". It is a subcutaneous or closed injury 
in which the skin is not broken* There is little danger of 
infection, but swelling and black and blue discoloration may 
occur as a result of blood leaking from the injured capillar- 
ies* Later this blood breaks down and the color changes to 
a greenish yellow. In some cases, where a larger blood ves- 
-sel is broken the blood may collect in a pocket which may 
contain as much as a cupful or more* Such collections of 
blood within the tissues are known as hematomas. 
The first aid treatment is directed at the control of subcu- 
taneous bleeding. This is done by'applying a cold or iced com- 
press with firm oven pressure, or a pressure bandage. The 
part should also be elevated to decrease the blood pressure 
within the vessels. Later'when the bleeding has ceased, hot 
compresses will hasten the. absorption of the blood* Light 
massage at this stage is also helpful* 
III* -WOUNDS 
A ’wound is a break' in the skin or in the mucous membrane lin- 
ing one of the body cavities* They may be classified into 
four chief types* 
A. Abrasions - In these the skin or mucous membrane has been 
rubbed off and a common example is the '’mat burn” c’r ’’floor 
burn”* Those •wounds do not bleed very much, but because of 
the large area involved, are liable to infection* They 
should be cleaned well with soap and water and painted with 
an antiseptic such as 1$ gentian violet* Sulfanilamide 
powder can bo used on these w funds also, and a sterile 
dressing applied* 
-4.1- B. Incised -Zounds - These are produced by sharp cutting in- 
struments such as knives, razors or broken glass. They 
tend to bleed freely especially when arteries are cut. 
A blood vessel which is cut cleanly across, bleeds more 
freely than a vessel which is lacerated or torn. This 
is due to the fact that blood clots more rapidly on a 
rough, uneven surface. Because of the bleeding in in- 
cised wounds, most of the bacteria may be washed out 
of the wound, and so they are less likely to become 
infected, 
C. Lac;:’rated or Torn Wounds - such as produced by a shell 
fragment. Here the chief danger is infection, due to 
the fact that dirt and bacteria are often ground into 
the wound. Some of the tissue may be torn away from 
its blood supply and killed, and this dead tissue acts 
as a good culture media for bacteria. . There may also 
be pockets -in such wounds which are sealed off from the 
entrance of air, and in these pockets anaerobic bacter- 
ia, such as those of gas gangrene and tetanus, may grow, 
D. Puncture Wounds - These may be caused by any penetrat- 
ing instrument, such as nails, wire, bullets etc. 
The opening of the wound seals off and as a result 
anaerobic infections such as tetanus and gas gangrene 
are the chiuf dangers. 
In general, war wounds differ from the majority of wounds 
seen in civilian life by their multiplicity, the frequent 
occurrence of severe shock and the serious extent of tis- 
sue disruption. The last mentioned factor, especially, 
predisposes to early‘and virulent infection. The velocity 
of aerial bomb particles, for example, is about 5,000 feet 
per second. Such a fragment may make a small wound of 
entrance but cause extensive tissue destruction when its 
kinetic energy is suddenly reduced by impinging on bone,' 
and in the worst cases there may be a small skin wound, 
with effects on deeper structures resembling what might 
be expected from an internal explosion. In the case 
of bullets, the severity of the wound may depend on the 
distance from the firing point to the wounded individual, 
since at the beginning and end of the*trajectory a bullet 
develops a wobble which increases its destructive power 
when it strikes. Bullets may also disintegrate*within the 
body and the fragments produced will cause many times the 
damage one would expect. Another thing to remember about 
projectile injury 'is that damage may not be confined to 
the point of impact. For example, a bone may fracture a 
considerable distance from where it is hit. 
,/o, IV, FIRST AID TREATMENT OF A 17DUND 
A*’ Stop hemorrhage. (This is discussed later), 
B, Frost the wound with sulfanilamide powder. This powder 
is supplied in sterile paper shaker packages. It should 
not be applied too thickly because it may then delay 
wound healing. The former treatment of the wound by 
painting it with mild tincture of iodine is seldom used 
now because of tissue damage and blistering which it pro- 
duces, If used, it should always be washed off with al- 
cohol before bandaging, 
C, Apply a sterile gauze dressing, covering the entire wound 
and binding the edge of the dressing down snugly so that 
dirt can not work into the wound, 
D, Splint if there is any possibility of a fracture being 
present. Large flesh wounds should also be splinted 
whether or not fracture is present, 
E, The wounded man is to take orally the sulfa drug which 
he carries with him. This is either 90 grains of sul- 
fanilamide or 60 grains of sulfadiazine. The tablets 
are to be taken one at a time with water. They are not 
administered if the soldier is unconscious or if he is 
suffering from a penetrating abdominal wound, 
F, Morphine grains 1/4- is given hypodermically for pain. 
If the patient has a head wound, is unconscious, or 
severely shocked with shallow respiration, this should 
be omitted, 
G, Treat the patient for shock. This will be described in 
detail in a later section, 
H, Evacuate as soon as possible. The wounded soldier must 
be in the hands of a surgeon within 6 to B hours if 
severe infection is to be prevented. 
V, DEBRIDEMENT 
The first 6 to 8 hours after a vjound is inflicted, has been 
considered the period of contamination, although some men 
consider it as short as one hour. During this stage, bac- 
teria are in the wound but have not invaded the tissues to 
cause infection. It is believed that by the use of sulfa 
drugs, this period can be lengthened to between 12 and 24 
hours. The aim of the first aid man is to get his patient 
to a surge on before this 11 golden period*' elapses, for during 
this period, the surgeon can clean out the w ound bjythe 
operation known as debridement,' and prevent infection. Once 
infection occurs in a wound, this operation can not be done. 
In a debridement (usually performed in evacuation hospitals 
or by mobile surgical units) the following things are done: 
A, Dead tissue is excised, the wound usually being opened 
by incision. 
-A3- B, Foreign bodies such as shell fragments or bullets, dirt, 
stones, shreds of clothing etc, are removed* 
C, Dead space or blind pockets in the wound are obliterated, 
D, Loose bone fragments are removed, 
S, The wound is irrigated with saline, 
F. Sulfa drug is placed in the wound and in most cases the 
wound is packed open with sterile vaseline gauze, 
G, If the wound is of a limb, a plaster cast is then applied 
with padding over bony prominences. 
Precautions against tetanus and gas gangrene are taken at 
the earliest opportunity. This consists of a ''booster shot'1 
of lee. of tetanus toxoid and 10-15 thousand units of gas 
gan gren e an tit oxin• 
VI. 
HEMORRHAGE 
Hemorrhage is one of the most serious complications of 
wounds and is responsible for most of the deaths on the 
battlefield. 'The most serious is arterial hemorrhage - 
bleeding from the pulmonary artery or aorta for example 
may cause death in 15 to 30 seconds. 
A, Arterial Hemorrhage - In this type of bleeding, the 
blood is bright red in color and spurts with each beat 
of the heart. If nothing is done for this typo of 
bleeding, the hemorrhage may still stop as a result 
of the fall in blood pressure due to loss of blood 
and shock, and the formation of a clot over the open- 
ing in the vessel* Often the artery itself will con- 
tract and so limit the loss of blood* Should the pa- 
tient recover from shock, receive a stimulant, or 
move about, the blood pressure may rise and the clot 
may be dislodged with recurrence of bleeding known as 
intermediate hemorrhage as contrasted with primary 
hemorrhage which occurs immediately on receipt of the 
wound, 
A third type of arterial hemorrhage is the secondary 
type which may occur a day or more later due to slip- 
ping of a ligature, or extension of wound infection 
into the arterial wall. 
In the control of arterial hemorrhage, there are sev- 
eral means available, These are: 
a. Pressure points, 
b. Pressure bandage. 
c. Tourniquet* 
d. Homostat and ligature* 
Arterial pressure points are points where large arteries 
-44- can be compressed against a bone. The main pressure 
points are the following: 
1# Temporal - 3.ocated just in front of the ear# Pres- 
sure here controls arterial bleeding above the eye 
and the scalp, 
2# Facial - located about one inch in front of tho angle 
of the lower jaw. Pressure here controls arterial 
bleeding in the face below the level of tho eye* 
3. Carotid - tho fingers are placed against the side 
of the larynx, the thumb behind tho nock and pres- 
sure exerted between them# This controls hemorr- 
hage from the branches of tho carotid artery, such 
as those in the floor of the mouth and throat# 
4# Subclavian - pressure is exerted behind the inner 
third of the collar bane down against tho first rib# 
This controls hemorrhage from the extreme upper part 
of the arm, tho arm pit or shoulder# 
5. Brachial - pressure is applied along the inner side 
of the arm about half-way between tho shoulder and 
elbow# This is used for arterial hemorrhage in the 
hand, forearm, and arm. 
6# Femoral - apply pressure just below the middle of the 
groin with the heel of the hand. This is used for 
hemorrhage from the thigh, leg or foot# 
7# Popliteal - located behind the knee# This pressure 
point is not as satisfactory as the others but can 
be used in hemorrhage from the leg or foot# 
The pressure points listed above will control most severe 
arterial hemorrhages except those in the chest and abdo- 
men, However, since the medical department soldier will 
probably have other men to treat, he must devise some 
other method of controlling the hemorrhage more perman- 
ently# This is done either with a pressure bandage or 
a tourniquet. The pressure bandage is preferred if it 
is effective# It consists simply of a thick gauze pack, 
thick enough to fill the wound cavity and still protect 
above the surface of the wound, so that-a tight circu- 
lar bandage around the extremity will exert strong pres- 
sure at the base of the wound where the bleeding artery 
is located* This is always worth trying before a tourni- 
quet is applied since a tourniquet is a dangerous instru- 
ment and requires more attention, 
A tourniquet is a constricting band and there arc v irious 
types# TUo principle* of all tourniquets is a< pad c ver tho 
artery to bring the pressure on the artery and take it off 
the veins, a band around the limb and ever the pad, and 
some moans of tightening the band. The common improvised 
tourniquet is the so-called Spanish windlass, in which 
any smooth, hard object such as a padded stone or a roller 
-A5~ bandage is used as a compress; for the band, a handkerchief 
a 'waist belt or a bandage may be used. To tighten the band, 
a stick, bayonet or scabbard is passed under the band and 
twisted until bleeding ceases, and the ends tied to the limb 
to prevent the band from becoming untwisted. Applying a 
tourniquet may be a dangerous procedure arid should not be 
used if bleeding can be stopped by any other means. The dan- 
gers of a tourniquet are that if applied tightly enough to 
control arterial hemorrhage it will cause pain and swelling 
of the limb and if left on long/enough, may cause gangrene or 
death of the part below the constricting band. It should 
therefore, be watched and released at about half hour inter- 
vals, The tourniquet itself should be at least an inch wide. 
If on loosening the tourniquet, bleeding starts again, tigh- 
ten it. Never cover a tourniquet with a bandage or a splint 
as it may be forgotten, when the bleeding stops and not un- 
til then, should stimulants be given. The best places to ap- 
ply tourniquets are: 
a. Around the upper arm about a hands breadth below the arm- 
pit. 
b. Around the thigh about the sarnie distance below the groin, 
B, Venous Hemorrhage - The bleeding here comes in a steady stream 
and is dark in color. Because of the low pressure in the veins 
it is easier to control. The part should be elevated and a 
pressure bandage applied. Tight clothing constricting the flow 
of blood from the part to the heart should be removed or loosen- 
ed, In laceration of veins in the neck, often there is enough 
suction produced by negative pressure in the chest, to suck 
air into the veins. This may cause death in a short time un- 
less compression is promptly applied, 
C* Capillary Hemorrhage - In this type of bleeding there is steady 
oozing of red blood from the wounded surface. This bleeding 
usually stops by formation of clot within a few minutes. It 
can be aided by application of a gauze dressing, the rough sur- 
face of trio gauze speeding up the formation of a clot, 
D. Special Types of Hemorrhage - 
1, Nosebleed or epistaxis - this is usually a form of capil- 
lary hemorrhage and the bleeding in most cases comes from 
a small area on the upper, anterior portion of the nasal 
septum. The patient should sit up and cold applications 
placed on the back of the neck and over the root of the 
nose, A cold cempress between the upper lip and gum is al- 
so helpful. Constricting clothing around the neck should 
be loosened. If this does not check the bleeding, a small 
gauze compress placed inside the nose and held against the 
bleeding area by pressure on the outside of the nose should 
be tried* If none of these measures are successful, a medical 
officer will have to cauterize the bleeding vessel or pack 
the nose. 
-/+6~ 2, Bleeding from tooth-socket, following an extraction 
may be excessive. Fill the tooth socket with a small 
gauze pack and have the patient bite down, on a gauze 
compress, or bandage the jaws together for 20 minutes. 
3, Bleeding from the lips - grasp lips between thumb and 
fingers on each side of the wound, as the arteries to 
the lips come from both sides. 
Bleeding from the scalp is often excessive even though 
only capillary in type. Apply pressure over the wound 
with a compress, and bandage. 
S Bleeding from the lungs - the blood coughed up is 
bright red and frothy. Keep the patient perfectly 
quiet in a semi-recumbent position and apply ice bags 
to the chest. In some cases morphine is indicated. 
6, Bleeding from the Stomach - blood that has been in 
the stomach for some time takes on the appearance of 
coffee grounds. Ronamber that blood in the vomitus 
might originally have come from a nose bleed and been 
swallowed. Beep the patient quiet and apply'an ice 
bag. Morphine is often indicated to quiet the patient. 
7. Blood in the stools. Blood which comes from-the sto- 
mach and small intestine is usually black and tarry 
In color. Blood from the upper part of the large in- 
testine is dark rod in color and nixed with the stool. 
In hemorrhoids or piles, the blood is usually bright 
rod and streaked over the surface of the stool. The 
treatment is the same as given for hemorrhage of the 
stomach. 
In severe blooding, patients usually become very restless 
and apprehensive, become very thirsty, and soon develop air 
hunger and extreme pallor. If the hemorrhage is not stopped, 
circulatory failure ;ind shock occur and the patient may soon 
die. In cases of internal bleeding, those symptoms are very 
important in making the diagnosis. 
VIII,SHOCK 
A, Definition - Shock is a profound depression of all phy- 
sical and mental processes due to decrease in the circu- 
lating plasma and usually resulting from injury or se- 
vere bleeding. There are two types of shock, the neuro- 
genic type and the circulatory typd. In the neurogenic 
type, the symptoms are milder, and this type usually 
responds to simple remedies such as heat, shock posi- 
tion, stimulants, or morphine for the relief of pain. 
The type wo are ospecially interested in is the circu- 
latory type, since this is very often fatal unless it 
is promptly treated. Shock is especially important as 
a cause of death in burns and fractures* Chest and 
„/ r7— abdominal rounds likewise are often complicated by shock, 
and any other injury is apt to produce this condition. 
Profuse bleeding and exposure to cold always add to the 
seriousness of shock. Certain individuals seem to be 
predisposed to shock, even from slight injuries. 
B, Mechanism of Shock - the exact mode of onset of shock 
is not completely understood. One theory contends that 
as a result of the injury, there is an "insult** to the 
nervous system. As a result, the nerves lose their 
control over the blood vessels, and the blood vessels 
in the abdomen and the muscles all over the body di- 
late. This results in a stagnation of a large volume 
of blood in these regions and a fall in the blood pres- 
sure. This blood that is pooled in the abdomen and 
muscles moves sluggishly and does not return to the 
heart in sufficient amounts and as a result the heart 
beats faster and the pulse is weak. Because of the poor 
circulation, the blood does not carry a sufficient sup- 
ply of oxygen to the tissues and as a result the capil- 
lary blood vessels are damaged. This causes them to 
leak; the fluid part of the blood, or plasma, oozes 
out of these capillaries, while the red blood cells re- 
main behind and consequently the blood becomes thicker, 
the hematocrit (that is, the percentage of the blood 
that consists of red corpuscles) Increases. This fur- 
ther slows up the circulation, and thus the anoxia in- 
creases, Thus a vicious cycle is set up and unless 
proper treatment is given to break this cycle, the 
patient will succumb* The two organs first affected 
by shock are the brain and heart which under ordinary 
conditions require a large amount of oxygen. 
C. Symptoms of Shock - 
1, Patient lies In ji drowsy condition with limbs 
limp, but generally is not totally unconscious. 
2, The face is pale and cold. The lips, finger nails 
and ears may have a bluish tinge. 
3, The eyes are glassy, pupils may be dilated. 
A. Cold perspiration of forehead and palms is present. 
5. Pulse is rapid and weak. Respirations are shallow 
and sighing. 
6. A chill may develop, 
7. Nausea and vomiting may be seen, 
8. The veins of the skin are collapsed and when emptied, 
fill slowly. 
9. The sensibility of a patient in shock is lowered 
and pain is not felt as acutely as in a normal 
condition. He may not complain although he is 
severely injured. 
-48- D, Treatment of Shock - 
1. Heat - the patient should be kept comfortably 
warm, Tlds can be done by the use of blankets, 
hot water bottles, chemical hot water bottles, 
latems placed under a litter and other neons. 
Remember, the skin of a patient in shock burns 
easily, and any hot applications used should be 
well padded. Excess heat is harmful. Thu best 
index of the amount of heat to apply is the pa- 
tients otm comfort. The rectal temperature 
may also bo checked. 
2. Position - the shock or Trendelenburg position 
is one in which the body is tilted so that the 
head is 13 inches below the level of the feet. 
This increases blood flow to the vital organs, 
3. Stimulants - the usual first aid stimulant is 
aromatic spirits of ammonia, about one teaspoon 
in a half glass of water. Coffee and tea con- 
tain caffeine and are of value. In hospitals, 
hypodermic stimulants such as caffeine sodio- 
benzoate, coranine or adrenalin are used, 
A, I'orphino - this should be given for the relief 
of pain. In severe shock, whore the patient is 
unconscious, and breathing poorly it is best not 
to administer it, 
5* Oxygon - by face mask or nasal tube is an ex- 
cellent aid in the treatment of shock. It com- 
bats the anoxia which is one of the main factors 
in shock, 
6, Plasma - this is probably the most effective of 
the remedies for shock. It restores the blood 
volume, dilutes the thickened blood and raises 
the blood pressure. Plasma is probably chiefly 
' responsible for the low mortality rate that wo 
now see in battle casualties. It is used ex- 
tensively as a preventive of shock, and makes 
possible earlier and safer operations on wounded 
soldiers, 
7, Saline, glucose* or blood intravenously are also 
used but their effect is not as prolonged as 
that of plasma. These solutions quickly leak 
out of the damaged capillaries and nay be com- 
pletely lost from the blood stream within-an 
hour. 
~/+9- PNEUMOTHORAX 
CAUSES AND 
SOURCES 
1 LUNG PUNCTURE BY RIB FRAGMENT 
2 TEAR OF ADHESIONS (SPONTANEOUS PNEUMOTHORAX) 
3 PENETRATING WOUND (CHEST NALL AND OR LUNG) 
VALVULAR OR TENSION' 
PNEUMOTHORAX 
OPEN OR SUCKING 
PNEUMOTHORAX 
-50- VIII. VAR INJURIES OF THE GUEST. 
Injuries of the chest take precedence in first aid treat- 
ment over any other injury except hemorrhage elsewhere in 
the body* Hechanical derangement of the thoracic organs 
and hemorrhage within the chest are the early consequences 
of a chest injury while later, infection may be a serious 
problem. To understand chest injuries, the technician 
should review the anatomy and physiology of the chest. 
Remember that 25% of the patients with chest injuries die 
between the field and the collecting station and many 
of these could be saved by proper first aid. 
A. Sucking wound of the Ghost 'Vail - Normally on res- 
piration, the ribs move outward and upward and the 
diaphragm contracts and moves downward. This in- 
creases the negative pressure between the lungs and 
chest wall and as a result air is sucked into the 
lungs through the mouth and trachea. If the chest 
wall is injured and an opening is produced into the 
pleural space, air will also be sucked into this 
opening on inspiration. This produces the condi- 
tion known as pneumothorax and the lung is collapsed 
on that side. The patient then develops dyspnoea 
and cyanosis and usually becomes anxious and rest- 
less. Shock is often present, 
1. Treatment - The opening in the chest wall should 
be plugged immediately. Sulfanilamide powder and 
a gr.use pack is covered with an airtight material 
such as a piece of rubber raincoat, sealed with 
adhesive tape, or simply by adhesive tape if noth- 
ing else is available. The entire chest wall should 
then be strapped on the injured side. 
2. Prop patient in a semi-sitting position if con- 
scious. 
3. If unconscious, place in shock position* 
/+. Morphine. 
5. Treat Shock, 
6. administer sulfa drugs, 
B. Tension (or pressure) Pneumo thorax. 
In some cases, the wound in the chest wall may act 
as a valve, allowing air to enter but not leave. Or 
a similar valve like wound may occur in the lung which 
allows air to enter the pleural space but does not 
permit it to leave. In. these cases* air accumulates 
about the lung under considerable pressure, and as a 
result the mediastinum is forced towards the opposite 
side, compressing the good lung and embarrassing the 
the heart action. Severe dyspnoea, cyanosis and shock 
result. 
■511 Treatment: as for sucking wound. In addition a needle 
must bo inserted into the pleural space to 1st out the 
air, and left in place anchored by adhesive tape. The 
2nd or 3rd interspace, lateral to mid-clavicular line 
is best, 
G. ”Stove - in chest” - This injury consists of multiple 
rib fractures, often on two planes, anteriorly and 
laterally, or anteriorly and posteriorly, usually lim- 
ited to one side of the chest* The crushed side, be- 
cause of its loss of rib support, cannot enlarge with 
inspiration and in fact is sucked in with inspiration* 
As a result the unoxygenated air in the lung of the 
injured side is sucked into the functioning lung. The 
reverse occurs in expiration. This produces marked 
dyspnoea and cyanosis, and the severe pain on breath- 
ing also lessons the depth of respiration and lessens 
the oxygen supply* 
Treatment: 
1* Morphine* 
2, Strap chest with a completely encircling wide 
adhesive bandage at the level of the costal 
margin, or if this is not effective, a tight 
adhesive band applied in expiration around 
the injured side of the chost, extending 3 
inches beyond the midline anteriorly and 
posteriorly* d 
3* Sulfa drugs by mouth to prevent pneumonia* 
A. Aspirate secretions in the trachea* 
3* Treat Shock. 
6, Semi-sitting position, or patient lying on 
injured side* 
D, Hemothorax - Because of the large number of vessels 
within the chest, considerable bleeding may occur in- 
ternally in chest wounds* A collection of blood in 
the chost cavity is known as hemothorax* In some 
cases, after a considerable amount of blood collects, 
it compresses the bleeding vessel and the hemorrhage 
stops* The symptoms are those of severe hemorrhage, 
shock and some1 respiratory distress* 
Treatment: Morphine, absolute rest, external heat* 
Aspiration of blood is usually done when the patient 
reaches a hospital. The blood stays liquid for four 
days and the chest is not aspirated before that time 
unless cardiac or' respiratory distress makes it neces- 
sary. Early evacuation of these patients is essen- 
tial* 
S* Traumatic asphyxia - Crushing injuries of the chest wall 
causes collapse of the veins within the chest and blood 
is forced back from the right side of the ho irt into 
the veins of the nock and face* The head and neck show 
a deep violet-blue discoloration, with swelling of eye 
-52- lids, and lips and small hemorrhages in the skin and 
conjunctivao. The skin is dry and hot* Respirations 
are stertorous. Pulse is strong. Temporary or per- 
manent blindness may result. 
Treatment: Morphine, absolute rest, head and should- 
ers elevated, oxygen, 
F, Blast Injury - This injury occurs in persons who are . 
in the vicinity of an exploding bomb. This injury 
may occur* 100 feet or more from the bomb, and is not 
duo to bomb fragments but is caused by the wave of 
positive air pressure-, followed by a wave of low pros- 
sure, which strike the chest wall. Heavy clothing or 
a partition such as a wall often protect from this 
injury. Patients may show no external evidence of 
injury other than bloody froth at the mouth and nos- 
trils, Shallow respiration, prostration and grave 
shock are also seen. The injury to the lungs con- 
sists of scattered hemorrhages throughout the lung 
tissue, (Similar injuries may be produced in water 
by explosion of bombs or -mines nearby. In water, the 
injuries may bo produced at greater distances and are 
more liable to involve abdominal organs), ..Rupture of 
the eardrums is commonly associated. 
Treatment: Morphine, semi-sitting position, oxygen. 
No intravenous fluids except concentrated blood serum, 
G, Emphysema - Following chest injuries, bronchial com- 
munications may exist between torn lung and subcutan- 
eous tissues or mediastin urn. The most serious type 
is mediastinal emphysema. Air may collect here under 
pressure and cause dyspneoa, inability to swallow, 
cyanosis, cardiac compression and blockage of the 
veins. The air eventually appears in the neck and 
thu contaminating bacteria in this air may cause 
s-.rious infection. 
Treatment: If symptoms are severe, surgical incision 
in the neck to release air, or surgical repair of the 
tom lung, 
H, Cardiac Tamponade - Injury to surface of the heart 
of pericardium may cause blood to collect around 
the heart under pressure and compress the heart. 
Symptoms: Cyanosis, weak pulse, falling systolic 
and rising diastolic blood pressure, and engorged 
veins in the neck, shock. 
Treatments Immediate aspiration of blood from 
pericardial sac. 
-53- IX, ABDOMINAL INJURIES 
Abdominal wounds are among the most serious seen in ‘wartime. 
These may be caused by bullets, shrapnel, bayonets or knives, 
and a great variety of other objects. There are two chief 
types of abdominal wounds; those that penetrate only the ab- 
dominal wall and do not injure internal organs or large 
blood vessels, and those that enter the peritoneal cavity 
and may in addition injure vital organs and large vessels. 
The first type is not as serious as the second, and the 
treatment is as outlined under the first aid treatment of 
wounds. The second type is often fatal and requires spe- 
cial care. These patients almost always require surgical 
operation to repair the internal damage, and one cf the 
chief factors that determines the eventual outcome is the 
length of time that’ elapses before surgical' operation is 
done. Of the patients who do not die immediately after 
the injury, it is estimated that 95 p or more will survive 
if operated on in one hour, whereas if operation is delayed 
10 hours or longer, less than 60 % will recover. The mor- 
tality increases as this period is lengthened, and the chief 
factor causing death is peritonitis. The value of mobile 
surgical units which can reach these men within a short 
time after injury is quite evident* 
The chief complications in abdominal wounds are: - 
A. Hemorrhage which is difficult to control except by 
operation. 
B. Shock which is very severe and difficult to control 
especially if hemorrhage is present* 
C. Peritonitis - which occurs later and is the cause of 
death in most of the patients who survive the period 
immediately after the injury. Infection of the peri- 
toneum can occur from bacterial contamination introduc- 
ed by the bullet, shrapnel'or bayonet from outside the 
body. The bullet or shrapnel itself may bo sterile be- 
cause of the intense heat produced when firing occurs, 
but may carry contaminated shreds of clothing 'or other 
foreign material into the wound. Infection may also 
result from perforation of one of the hollow organs 
within the abdominal cavity, such as the stomach, 
large or small intestine, gall bladder or bile ducts, 
the contents of which are hardly ever sterile. The 
large intestine in particular is always loaded with 
bacteria. lacerations of the bladder or urinary 
passages may cause extravasation of urine which is 
irritating and causes inilamation and may become 
secondarily infected. It is obvious tlv.it a soldier 
who empties his largo intestine and his bladder, and 
who eats only a small meal before going into combat, 
decreases the size of his stomach, large intestine 
and bladder and so lessens the possibility of an injury 
-54- to these three organs. The small Intestine and liver 
however, cannot be protected in this way and wounds of 
these organs are very common. The liver when injured, 
bleeds freely and produces severs shock. 
First Aid Treatment of Abdominal Wounds - 
1. Treat for shock, 
2. Keep patient quiet as possible, 
3. Morphine grs, 1/4 for pain and. restlessness, 
4. Absolutely nothing by mouth, not even sulfa drugs. 
This rule is laid down for two reasons. First, 
anything given by mouth may leak into the peri- 
toneal cavity through lacerations of hollow organs, 
and so spread infection. Second, since these 
patients will require an anesthetic for surgical 
operations within a short time, it is better to 
keep the stomach empty, 
5. If any abdominal organ protrudes, cover it with a 
warm, wet cloth; preferably sterile saline solution 
on a sterile gauze pad and keep it moist. Sulfanila- 
mide powder should be frosted over the protruding 
organ, 
6. An ice bag to the abdomen may help arrest internal 
hemorrhage• 
7. Evacuate as soon as possible. If possible, plasma 
should be given early. 
X. BURNS 
At Pearl Harbor, about one half of the casualties seen wore 
suffering from burns. The technician will see or hear about 
a great number of methods of treating bums, all of which 
have their merits and their disadvantages* Various local 
applications such as tannic acid, gentian violet, triple 
dye, sulfadiazine spray, tannic or gentian violet ointments, 
and others have enjoyed popularity. Much emphasis has been 
placed, in the past, on the local application used, but it 
is now realized that the general treatment of the patient, 
particularly the treatment of shock, is of the greater im- 
portance, while local treatment should be aimed at the pre- 
vention of infection; and mild applications which do not 
harm the regenerating skin, should be used, 
A, Glassification of Bums, 
1, First Degree - Skin is reddened. Simple sunburn 
is a good example, 
2, Second Degree - Skin is blistered, 
3, Third Degree - Destruction of tissue occurs, 
B. Complications of severe Burns. 
1, Shock - This is responsible for 60$ of all deaths 
from bums and consequently first aid treatment must 
be primarily directed at this complication. 
•*55— 2, Infection - This accounts for most of the remaining 
deaths, A largo proportion of bums are sterile or 
nearly sterile alien they occur. Infection in most 
cases is due to improper handling of these cases, 
much of it due to contamination from the nose and 
throat of attendants# 
3, Toxemia, 
A, Anuria, 
5, Duodenal ulcer, 
6, Hepatitis and Jaundice, 
7, Scarring and contractures - this can be minimized 
by proper treatment, 
B, Tetanus and gas gangrene, 
C, First Aid Treatment, 
1, Treatment of Shock, This should be treated promptly. 
The important measures have already been discussed 
under shock. In bums there may be loss of consider- 
able serum through the injured skin or into the dam- 
aged tissue, resulting in a concentration of the 
blood , for this reason, intravenous plasma is of the 
greatest importance and often as much as 12 Wilts 
(3600 cc) may be required in the first 24 hours, 
P ationt with 10$ of his body burned needs about 1000 
cc of plasma, with 20$ burned’, he needs 2000 cc, 
another method used for astiriting plasma need is 
based on tho hematocrit, Th« hematocrit is a sim- 
ple estimation of the percent of the blood which, 
consists of rod cells. The normal is 45$, In gen- 
eral, a patient should receive 100 cc of plasma 
for each point the hematocrit is above normal. 
Concentrated human serum albumin is often used in 
place of plasma, ‘-/hole blood may be required in 
patients who develop anamia, 5$ glucose in sterile 
distilled water is recommended and saline solution 
is given in cases where minerals are lost through 
the skin or by vomiting* 
2, Local First*Aid Treatment. 
a. Cover the burned surface with boric acid ointment, 
sterile vaseline or 5$ sulfadiazine ointment, 
b. Cover this with strips of 44 nosh gauze, 
c. Over this place a smooth thick layer of sterile 
gauze dressing or similar sterile padding, 
(sterile mechanics waste can bo used,) 
e* Firmly apply a * gauze !or muslin bandage, 
Cora should be taken that tho burned surface is not 
contaminated by the hands of tho first aid man, or by 
tho breath* If possible a mask or handkerchief should 
bo worn over the nose and mouth, or at least, the mouth 
-56- should be kept closed. If the patient can be taken to 
a hospital or dressing station promptly, it is suffi- 
cient to cover the burned surface with sterile dress- 
ings or triangular bandages and confine your efforts 
to the treatment of shock, 
3* Relief of Pain - 
Bums are the most painful type of injury a person can 
sustain. For this reason morphine should be given in 
adequate dosage, and an initial dose of l/2 grain is 
recommended. In the presence of pronounced anoxia, 
large doses are dangerous, and in such a case l/4 
grain is sufficient, 'There the respirations are 
fourteen and above, morphine may safely be given in 
most cases, 
4. Prophylaxis Against Infection* 
a. Sulfadiazine is the drug of choice with an initial 
close of 60 grains. Sulfanilamide can be used in a 
dose of 90 grains. Subsequent doses are given under 
' the direction of a medical officer, since the kidneys 
may be damaged in these cases by sulfa drugs, 
b. Tetanus toxoid 1 co in all patients with 2nd or 3rd 
degree burns, 
c. Gas bacillus antitoxin may be given* 
The treatment outlined above applies to all burns whether due 
to heat, chemicals or electricity* In chemical burns, the 
chemical should of course be neutralized or removed from the 
skin before the above treatment is applied. In chemical 
bums the first attempt should be to dilute the chemical with 
copious amounts of water, and then a weak neutralizing agent, 
Minor first degree burns may require simply local application 
of boric ointment, vaseline, baking soda paste, butysin pi- 
crate ointment or numerous other similar remedies. 
XI, MEAT STROKE, KSAT EXHAUSTION AND HEAT GRidiPS 
Troops exposed to temperatures of 90° F or over are subject 
to these conditions* Heat stroke is a condition in which the 
temperature regulating mechanism of the body fails and the 
body temperature rises to high levels* In heat exhaustion 
the condition is similar to shock and is due to loss of 
salt because of excessive perspiration* Combinations of 
the two conditions may be seen* Heat cramps are also due 
to salt loss. Troops brought to a hot climate should be 
given a 4 - 7 day period for acclimatization with gradually 
increasing amounts of work and limited exposure during the 
mid-day hours. Such a schedule of work would be as follows: 
■Vhen maximum air temperature is 105° F or over. 
First Day 0700 - 0900 and 1.500 - 1600 
Second Day 0700 - 1000 and 1500 - 1600 
Third Day 0700 - 1000 and 1400 - 1600 
Fourth Day 0700 - 1000 and 1330 - 1600 
Fifth Day 0700 - 1100 and 1330 - I63O 
Sixth Day Regular Duty, 
-57- The (ivorIcing period should consist of alternating one half 
hour periods of •work and rust. The work should bo the 
equivalent of marching, with a 20 lb, pack 2,5 miles per 
hour. 
For one week before and after entry into a hot climate, 
troops should bo given adequate rest and alcohol should 
be prohibited, . Restriction of water intake in a hot 
climate is not good policy, and the requirement per man 
will range from 2 quarts per 24 hours when working at 
night in the cold season to 2 1/2 to 3 gallons per 24 
■hours when working by day in the hot season. 
Salt intake( should be increased when working in hot 
climates, is best done by taking extra salt on 
food, or adding salt to drinking water to make a 1% 
solution as followsj 
a, 1 lb, salt to 100 gals, water, 
b, 0,3 lb. sa.lt to a Lyster bag, 
c, l/4 Teaspoon.ful to a canteen of water, 
d, Two 10 grain salt tablets in one quart of water. 
1, Heat Stroke or Sun Stroke. 
A. Symptoms, 
, This condition often appears with^dramatic sud- 
denness, characterized by collapse, delirium, 
unconsciousness or coma. 
Certain symptoms and physical findings are 
characteristic, 
(1) Dimini shod sweating• 
(2) Headache. 
(3) ■ Dizziness. 
(4) Irritibility, 
(5) Visual disturbancovS such as dim or purplish 
vision, 
(6) Nausea and vomiting, 
(7) Dryness of skin, which is very hot, face is 
flushed. 
(R) Elevated body temperature (106° to 110° F 
rectally). 
(9) Rapid pulse (160 - ICO), 
(10) Increased depth of respiration, 
B, .Treatment - 
, The single, most important objective in treatment 
is the lowering of the body temperature and this 
must be initiated immediately and continued during 
the transfer of the patient to a hospital, 
(1) Remove all the patients clothes except for 
shorts and sprinkle the entire body with cool 
or tepid water. Ice water should not bo used, 
A hand spray such as a Flit gun is good for 
this purpose, since with a fine spray the 
-58- water evaporates more rapidly and produces a better 
cooling effect. The patient should be placed in the 
shajjc during treatment. 
(2) Fan fshe patient. During transportation, the door of 
the ambulance should be left open so that the current 
of air passing over the patient’s body evaporates 
the water. Electric fans are best. 
(3) Briskly rub the arms, legs and trunk to increase 
circulation to the skin. An ice bag can be applied 
to the head. 
(A) The rectal temperature should be checked every ten 
minutes. When it reaches 102° F, the cooling treat- 
ment should bo stopped since often the temperature 
will continue to fall and may reach dangerously 
low levels. If the rectal temperature should fall 
below 94° F, the patient should be cautiously 
warmed until the temperature is normal, 
(5) Saline solution should be given intravenously or 
subcutaneously. When the patient is able to drink, 
,1% salt solution should be given freely by mouth, 
(6) If cyanosis is present, oxygen should be given by 
face mask. In some cases, artificial respiration 
may be necessary. 
(7) Stimulants are not given. If sedatives are neces- 
sary, barbiturates can be given, Iheso are also 
given in case of conculsions, 
(8) Patients who survive to the second day usually re- 
cover, though a rectal temperature of 102° to 103° 
F may persist for several days, along with such sym- 
toms as mental disturbance, excitement and delusions. 
Headache may last for several weeks. Relapses can 
occur during the first few days, so the patient must 
be carefully watched and his temperature frequently 
checked, 
(9) One attack of heat stroke predisposes the individual 
to a second attack, so the patient should be careful 
about further exposure to excess heat. 
B„ Heat Exhaustion - Symptoms - 
a. Headache. 
b. Loss of appetite. 
c. Drowziness, 
d. Extreme weakne s s. 
e. Visual dis turbances, 
f. Dizziness. 
g. Inabilitjr to walk, 
h. Cramps of limb and abdominal muscles, 
i. Faintness or unconsciousness. 
-59- 2, Physical findings: 
a. Skin is cold and .clammy. Profuse perspiration, 
b. Pupils dilated, 
c. Face is pale, 
d. Rectal temperature is normal or slightly ele- 
vated, 99 - 101°F, 
o. Blood pressure is lowered. Pulse is weak and 
rapid, 
3, Treatment -. 
The most important thing in treatment is adminis- 
tration of salt, 
a. Remove the patient to a cool place where he may 
rest and receive large quantities of salt solu- 
tion, 
b. ,1$ Saline solution (made up as described ear - 
Her) by mouth, 
. c. If the collapse is severe, physiological saline 
solution should be given intravenously, 
d. In some cases, the temperature may be subnor- 
mal, and external heat may bo necessary, 
e. Stimulants can be given, 
f. Keep the patient lying down with head level 
or low until he recovers. 
C, Heat Cramps 
This condition is due to a deficit of salt in the body, 
and consists of painful spasms of the voluntary muscles 
in the extremities and abdominal wall. They may be ex- 
cruciating and completely disabling. The treatment con- 
sists of administration of physiological saline solution 
intravenously and ,1$ salt solution by mouth. 
XII. FROST BITE. AND IMMERSION FOOT 
A. FROST BITS 
This occurs most commonly at temperatures below -10°C 
(14°F) especially when a strong wind is blowing. 
1, Symptoms - 
a. Skin assumes a dull, yellowish pallor. 
b. Numbness or a prickling sensation associated 
with formation of ice crystals in the tissues, 
c. If deeper tissues are not al.so frozen, there 
is a senaation of a moveable, plaque or coin 
buried in the- skin. With deep freezing the 
tissues are solid and immovable, 
d. Edema and hemorrhage may occur in severe cases 
when the. part is thawed. Often the skin on 
thawing resembles a severe burn, 
e. Prolonged exposure to cold causes the indivi- 
dual to become numb and drowsy, his eyesight 
fails and ho becomes unconscious. Respiration 
may cease. 
-60- 2. Treatment 
a. If frost-bitten part is on face, ears or trunk, 
cover with the warm ungloved hand. If a hand is 
involved, insert it within the shirt, up against 
the body. If a foot is involved, remove the 
shoe and sock and place it within the shirt and 
against the body of another man. 
b. v/armth greater than body temperature should ne- 
ver be applied. 
c. Massage, if used, should be very gentle and no 
coarse material used. Rubbing with snow is 
harmful. Massage should not be directly over 
the frost-bitten area, but should be a strok- 
ing of the extremity toward the body. Paint 
the part with 1:5000 merthiolate or 1:1000 
acriflavine, wrap in sterile dressings, cover 
warmly and put at complete rest, 
d. farm drinks, food and clothing. Artificial res- 
piration. Stimulants and oxygen may be neces- 
sary in case of prolonged exposure to cold. In 
these cases also, rapid warming of the whole 
body should be avoided, 
B. Immersion Foot - 
This condition is seen in men afloat in life boats for 
long periods of time with their feet immersed in cold 
sea water, A similar condition known as ”Trench foot*1 
was seen in the last war, 
1, Symptoms - 
a. Feet are cold, waxy white and swollen, with 
cyan ot i c a re a s , 
b. Feet are insensitive to touch or pain and feel 
woody. 
c. Feet became red, swollen, painful, blistered 
or gangrenous if suddenly warmed, 
2, Treatment - 
a. Prophylactic - boots or constricting clothing 
should be removed. Oil or grease should be 
thickly applied. Don’t allow the patient to 
walk. No massage, 
b. Treatment of the case. Swab foot with alcohol, 
leave pledgets of alcohol between toes, apply 
ice bags. Elevate the feet on pillows about 
B - 12 inches. No massage. General supportive 
treatment, 
c. A pressure bandage is sometimes used. 
XIII. DOG BITE ADD SNAKE BITE 
A, Dog 3ito - 
Dog bite is dangerous chiefly because of the possibility 
of rabies or hydrophobia, a serious, fatal disease which 
is caused by a filterable virus. In any case of dog 
bite, the first thing to do is catch the dog, preferably 
alive. If the dog is killed, his head should be kept 
-61- for microscopic examination. If alive, the dog should 
bo observed for 10 days, in which time he rill develop 
symptoms if rabid. If the dog is found to bo rabid, the 
patient must rocoivo the Pasteur treatment, otheraise ho 
will develop rabies in 20-60 days. The bite should bo 
treated as follows* 
1, Treatment - 
a. ’lash the wound thoroughly with soap and water. 
b. Cauterize the wound either with fuming nitric acid 
followed by immediate application of baking soda, 
or carbolic acid, cleaned off immediately with 
95$ alcohol* 
c. Apply sulfanilamide powder and .* sterile dressing, 
B. Snake Bite - 
The poisonous snakes of the United States are the coral 
snake and the pit vipers (including rattlesnakes, cop- 
per-heads and cotton-mouth moccasins). The coral snake 
is small and slender and has black and rod bends divided 
by narrow yellow bands, encircling the body. The pit vi- 
pers have stout bodies, thin necks and flat triangular 
heads. There is a blind pit between the eye and nostril 
on each side of the head, Thu grooved orh ollow fangs 
fold back against the roof of the mouth, and are eleva- 
ted when the snake strikes. 
Snake venom contains two types of toxin, 
a, Bourntoxin - causes paralysis, check, respiratory 
failure, 
b. Hemolysin - breaks down red blood cells and injures 
blood vessel walls. 
Some snakes have more of one typo of venom than the other. 
For example, the coral snake venom is largely neurotoxic 
while rattle-snake venom is chiefly hemolysin, 
1. Symptoms of poisonous snake bite, 
a. Pain is severe, 
b. Swelling, 
c. Shock and weakness, 
d. Paralysis and respiratory failure,* Bloody urine 
(hemoglobin in' urine), 
e. Death may occur during the first 24-36 hours, 
f. Tetanus may follow, 
2, First Aid Treatment - 
a. Apply tourniquet above the site of the bite. It 
should be tight enough to obstruct veins and lympha- 
tics but not the arteries. Release it for 5 or 10 sec- 
onds every 15 minutes, 
b. Have patient lie down, 
c. Sterilize knife or razor blade in a flame. Sterilise 
the skin with iodine and make cross incisions l/2 x 
1/2 inch or longer at each fang mark, through the 
skin and into subcutaneous tissues (l/B x 1/4 inch 
deep. 
-62- b. Have patient lie down. 
c. Sterilize knife or razor blade in a flame. 
Sterilize the skin with iodine and make 
cross incisions l/2 x. l/2 inch or longer 
at each fang mark, through the skin and 
into subcutaneous tissues (l/8xi/A inch 
deep,) 
d. Apply suction over these wounds with suc- 
tion cup, mouth, or bottle in which suc- 
tion is obtained by burning a small piece 
of paper inside. 
e. Give shock treatment - No alcohol. 
f. No morphine - Barbiturates can be given, 
g. Strychnine 1/10 grain is sometimes used 
for respiratory failure, 
h. 5 % glucose or transfusions may be neces- 
sary. 
i. Make additional cross-incisions and apply 
suction if swelllng spreads. 
When not applying suction over the wounds, 
potassium permanganate or epsom salts corn- 
pro sses should be applied. 
k. Tetanus precautions - Antivenoms are avail- 
able against certain types of snake, 
G, Black Widow Spider Bite - 
These are quite poisonous and can be recognized by 
the crimson hourglass marking on the under side of 
the abdomen. The bite causes severe pain and vior- 
ient muscle cramps, especially of the abdomen, with 
fever and sweating, 
1, Treatment - 
a. Tourniquet and incision as for snake bite, 
b. Keep patient quiet and warm. Hot baths. 
c. Morphine gr, 1//+ to gr. l/2. 
d. Calcium gluconate intravenously. 10 co of 
a 10% solution. 
D. Tarantula- Bite - 
Not very poisonous but Infection’may occur in the 
bite* 
Sulfanilamide powder may be of help. If infection 
occurs, hot compresses are used, 
S, Tick Bite - 
Ticks often are carriers of serious diseases and 
in removing ticks, it is important not to crush 
them or leave the'head in the skin. Apply a few 
drops of chloroform or ether and gently withdraw 
it, A lighted cigarrette or hot pin held near the 
tick will often cause it to loosen its hold on 
the skin. 
F, Bee, Masp or Hornet Bites - 
Press out the sting and apply a compress of dilute 
ammonia water or baking soda paste. 
-63- XIV. PUSMA 
The use of plasma has revolutionised the treatment of shock, 
hemorrhage, and burns. The saving ox" life in this war through 
the use of plasma can hardly be estimated and its value is 
so great that the Army and Navy has accumulated large stores 
of this material. In simple terms, plasma is the liquid 
part of citrated blood from which the rod blood cells have 
been removed. The blood is obtained from volunteer donors 
by the American Red Cross, the plasma separated, frozen 
and evaporated under partial vacuum, dried and packaged 
ready for use. Plasma is a straw colored fluid; when dried 
it is reduced to a straw-colored powder. In the latter 
form it will last indefinitely at ordinary temperatures and 
for that reason It is easily available at all times for 
first aid treatment of shock, hemorrhage and bums. The 
Standard Army and Navy package of dried plasma consists of 
two bottles, stoppered with vaccine type rubber stoppers 
and intravenous equipment in two sealed metal cans. The 
two metal cans are packaged in a tape sealed, water proofed 
fiber board box, 'One of the bottles contains the dried plas- 
ma sealed under 29 inches of vacuum - (in order to preserve 
this vacuum, the metal can in which it comes is also sealed 
under 25 inches of vacuum). The other bottle contains 
300 cc, of sterile distilled water. The rubber tubing and 
needles are sterile and to prevent contamination of those 
needles, they are covered with glass caps. The plasma is 
made ready for use by opening the cans with the keys at- 
tached to the top of each. The double ended needle is in- 
serted into the stopper of the bottle containing the dis- 
tilled water. This bottle is then inverted and the other 
end of the needle is plunged into the stopper of the dried 
plasma bottle. 
The vacuum in this bottle causes the water to flow in and the 
plasma goes into solution in about two minutes, 'Then the wa- 
ter does not flow into the plasma bottle freely, the needle 
of the airway should be inserted into the stopper of the wa- 
ter bottle. This will allow displacement of the water with 
the air and thus speed up the flow. 
The airway and intravenous set are then connected to the 
plasma bottle and the plasma is ready to administer after 
clearing all the air out of the tube. The intravenous tubing 
is fitted with a small gauze filter to strain out shreds of 
fibrin, while the airway is likewise fitted with a cotton fil- 
ter to cleanse the air which is sucked into uhe bottle. It 
is not necessary to type plasma because it is pooled from at 
least twelve donors and therefore its agglutinins are diluted 
and neutralized. This results in a great saving of time when 
it is used in first aid work, and for patients who have lost 
a large volume of blood, plasma can b« given immediately to 
-6/r* tide the patient over until a donor is typed and his blood 
cross matched for a blood transfusion. The length of time 
that these various agents will act in maintaining the cir- 
culating blood volume is as follows: 
’Thole blood Six to eight hours or more. 
Plasma ------- - About three hours. 
Saline or glucose Less than one hour. 
XV. FRACTURES 
A. Definition: 
a fracture is a break in the continuity of a bone. It 
is not necessary that the fragments bo separated. In 
many fractures the bone may only bo "cracked”. 
B. General Classifications 
1. Simple Fractures - 
In this oype there is a break in the bone but no 
communication with the exterior surface of the skin. 
2. Compound Fractures - 
In this type, there is direct communication of the 
fracture with the exterior surface of the skin. A 
bone fragment may protrude through the skin, or there 
may be a wound channel, such as produced by a bullet 
or shrapnel fragment, which extends from the surface 
of the skin down to the break in the bone. This lat- 
ter type is the type most commonly seen in battle 
casualties. In the last war, more than 30$ of all 
battle casualties resulting from gunshot-wounds in 
the experience cf the American Expeditionary Force 
were compound fractures. The mortality In this type 
of Injury should bo low if these men are given prompt 
first aid treatment and proper measures taken to pre~» 
vent shock and infection. It is in this type of 
wound that debridement is so essential to prevent in- 
fection, and early evacuation of these patients is 
one of the chief aims of the first aid man. An io- 
dine blister occurring on the skin over a simple 
fracture necessitates treatment of the injury as a 
compound fracture. 
C. Classification of Fractures with Regard to Position, 
Number, and Shape of Bone Fragments. 
1. Transverse - 
■A break into two fragments which is usually in a 
straight line, more or less at right angles to the 
long axis of the bone. 
2, Spiral - 
Two fragments, but the break line is in a spiral or 
S shape. These are produced by twisting injuries as 
seen among ski troops, or by torsion produced by mus- 
cular contraction,* 
-65- 3. Serrated - 
Two fragments broken with a saw-tooth edge along the 
break line, 
A. Comminuted - 
Throe or more fragments resulting from the break, 
5. Impacted - 
The broken ends are jammed together so that they more 
or less telescope each other, 
6. Greenstick - 
An incomplete break of the bone usually resulting 
in the convex surface breaking while the concave sur- 
face remains intact. This is seen more commonly in 
children in whom the bones are more clastic, 
7. Depressed Fractures - 
This type occurs in flat bones such as the skull, A 
fragment is driven below the normal surface of the 
bone, 
8. Pathological - 
These fractures are the result of a disease process 
within the bone causing a gradual weakening. Done 
cyst or bone tumors c:n weaken a bone in this way 
and the stress required to fracture it may bo slight, 
such as the simple act of turning over in bed and 
catching an art- or leg in the sheets. 
9* Complicated - 
Any of these above mentioned types plus injury to 
vital 'structures such as nerves and arteries, 
D, Symptoms of Fracture - 
1, The patient' frequently feels or hears the bone 
snap. 
2, Pain and tenderness at the point of the break, 
3, Deformity in some cases. 
A. Partial or complete loss of motion is often present 
in adjacent joints, 
5, Swelling and discoloration-. 
6, Crepitus or grating may be felt (although attempts 
to obtain this sign should not bo made). 
7, Um.veness in the bone, 
8, Shock. 
9, In compound fracture a bone fragment may protrude 
through the skin, or there may-be a wound channel 
extending down to the bone, Thu bone nay not be 
visible at the base of the wound. 
10, Symptoms in Special' Types of Fracture• 
a. Fracture of the Skull. 
Unconsciousness, swelling or laceration of scalp, 
bleeding or leakage of spinal fluid from nose, 
mouth and ears, difference in siao of pupils, 
blackoning of.tissues'under the eyes, changes 
in pulse and respiration, paralysis or twitch- 
ing of muscles. 
-66- b. Fracture of the Spine - 
Pain or deformity at the site of fracture. 
If the spinal cord is injured there may be para- 
lysis or loss of sensation below the site of the 
fracture. Loss of control of bladder and bowel, 
c. Fracture of Lower Jaw - 
Pain on movement of jaw, irregularity of teeth, 
inability to swallow or talk in some cases. 
Bleeding and drooling of saliva from the mouth. 
In cases of bilateral fracture, the soft tis- 
sues may drop back and strangle the patient and 
one of the most important things in treatment is 
to clear the upper air passages by airway or 
traction on the jaw, 
d. Fracture of the Clavicle - 
Injured shoulder is at lower level than uninjured. 
Patient unable to raise arm above shoulder and sup- 
ports elbow with hand of sound limb. Fractured 
ends can usually be felt, 
e. Fracture of Rib - 
Pain especially on breathing or coughing. 
The broken rib" is tender and hand pressure over 
the sternum produces pain at the site of the 
fracture. The break can be felt sometimes, 
Thu patient usually holds his hand tightly over 
the break. If the lung is punctured, coughing 
up of bright red, frothy blood may occur. 
E, First Aid Treatment of Fractures - 
1, General Procedures, 
a. Splint all fractures where they lie, 
b. Morphine l/U grain and shock treatment, 
c. Always arrest hemorrhage and apply sulfanila- 
mide powder and sterile dressings to the wound 
in case of compound fractures. If the bone 
protrudes from wound., apply sulfanilamide 
powder before applying traction and mark patient's 
record clearly so that the surgeon will know the 
fracture has been compounded. The measures des- 
cribed under wound treatment hold here, 
d. In applying splints first apply sufficient 
traction to the extremity to restore proper 
alignment and be sure the splint extends be- 
yond the joints above and below? the fracture, 
e. In applying splints, bo sure bony prominences 
are well padded, 
f. Place patient on litter and secure the injured 
part with sufficient support that no motion wall 
be present while transporting the litter, 
g. Dress the litter properly to conserve patients 
body heat. 
-67- h. Bvacuate as soon as possible, particularly com- 
pound fractures which all require debridement. 
Tetanus toxoid sad gas gangrene anti-serum will 
bo given. 
i, IT possible, all compound fractures of long bones 
should have a traction - countertraction typo of 
splint, 
2, Rocommondod Splinting of Simple Fractures Frier to 
Transportation• 
a. Qlaviclo - 
Figure of eight bands,go around shoulders, cross- 
ing over the spine and with a sling at the wrist. 
Stockinette is best for this purpose. alien the 
patient is lying down, a pillow should be placed 
between the shoulder blades. 
b. Fracture of Surgical Feck of Humerus - 
Prist sling. Keep patient in sitting position. 
0. Fracture of Shaft of Humerus - 
Chest pad between chest and humerus, with double 
sling or Velpeau type bandage, A well padded 
external splint helps immobiliso. Ilurray-Jones 
splint no longer used because of pressure on 
axillary nerves. Traction, is unnecessary, 
d. Fracture of albon - 
ladder splint bent and fitted to posterior sur- 
face of humerus and.ulnar surface of forearm. 
Cut out wire at point of elbow, a cardboard 
posterior right angle splint or melded plastic 
splint can be used, -Support any of those splints 
with a wrist sling. 
c. Fracture of Forearm, Hina and Radius - 
Anterior and -posterior molded plaster splints, 
including the elbow, or anterior and posterior 
board splints, well padded, supported by a sling 
extending from elbow to tips of fingers, 
f. Fracture of who 'Frist - 
Board splints or anterior end posterior molded 
planter splints. 
£. Carpus and metacarpus - 
Skin fitting unpadded molded plaster splints, 
h. Phalanges - 
Roller bandage fastened beneath fingers or mold- 
ed plaster. 
1. Fracture of rock of F'onur - 
array traction (Thomas) splint with leg internal- 
ly rotated. 
g. Fracture of Shaft of Femur - 
Array t r a c t i on s \a lin t, 
-68- k# Knee Joint - 
Army traction splint with Ime.e flexed 20 to 30 
degrees and with long pad under flexor surface, 
l. -Tibia and Fibula - 
larder splint extending to upper third .of thigh, 
or plaster splint# Pad well under the knee and 
above the Os Gaids on. each side of the tendo 
ochillss# • 
m. Ankle - 
ladder or molded plaster splint from toes to a- 
bovo the knee# 
n. Gs Galois - 
Ladder or molded plaster splint from toes to 
the knee, 
o# Metatarsus — 
Folded plaster splints# 
p, Opine - 
Dorsal and Lumbar, Stretcher in hyporexton si on, 
not or. a soft bed#, A folded blanket placed be- 
neath the kyphos will have a tendency, to reduce 
the fracture and prevent cord injury* A plaster 
Jacket in hyperextension is preferable when equip- 
ment is available# The simplest method of moving 
those patients short distances is face down on a 
blanket, carriers grasping the four corners of 
the blanket. 
Cervical Spiro - A voluminous cotton collar, 
small pillow or gauze roll tight around the neck, 
supporting the occiput and chin# Catheterizo in 
case of paralysis, 
q. Pelvis - 
Bilateral plaster Spica - 
The above mentioned splinting methods are not strictly first 
aid procedures. On. lie battlefield the medical corps man 
must rely on his ingenuity and improvise his own splints# 
However, a knowledge of the above procedures is Valuable 
to the trained technician# 
P# Healing of Bones - 
If infection dees not occur, most bones will show 
gbod healing in A-6 weeks. At the time of fracture, 
blooding occurs at the ends of the fragments. This 
blood f ..ms - Jolly like clot into which grow blood 
vessels and connective tissue cells, known as fibro- 
blasts# This connective tissue forms a firm fibrous 
union between the be-no ends end later calcium salts 
are deposited on this fibrous mesh work to form bony 
callus which adds rigidity to the union. At this 
time the bones again are strongly united and in time 
the excess calcium absorbs, the bone smooths off and 
the medullary canal reforms# 
r-69- XVI. DISLOCATIONS 
A, Definition - 
Dnen a bone goto out of place at a joint, and regains 
out of place, the injury produced is called a disloca- 
tion, Ahe joints are enclosed in flexible sacs known 
as joint capsules and are reinforced by heavy bands of 
white connective tissue extending from one bone to an- 
other and known as ligaments. In ever;/ dislocation 
these structures are stretched or tom, and after the 
bones are put back in place, the joints should be sup- 
ported and motion restricted for some time in order to 
give these structures a chance to heal. Injuries to 
ligaments are known as sprains, 
B. Common Locations and Symptoms - 
1, Shoulder squared off, arm held out to side, loss of 
carrying angle, axilla filled out, 
2, ringers - 
Phalanx is dislocated to dorsal surface of more 
proximal phalanx, 
3, xlbow - 
Joint fixed in semi-flexed position and displaced 
bones, project prominently behind. 
A, i j aw — 
Louth held wide open and cannot be closed, 
5, Trist, Hip, Knee and ankle may also be dislocated, 
G. deduction of Dislocations - 
It is always best for dislocations to be reduced by a 
medical officer since fractures and other damage are 
often produced by unskilled reduction. An anaesthetic 
such as sodium pentothal or nitrous oxide is often ne- 
cessary for the relief of pain and muscle spasm. How- 
ever under certain circumstances, the technician may 
have to reduce dislocations himself and this can be 
done in the simpler cases. 
If Shoulder - 
Take off one shoe and place your heel up near the 
patient's armpit with patient lying down. Then 
apply traction at an angle of 10-15 degrees ab- 
duction, After reduction, immobilize either with 
a Velpeau bondage or a double sling, that is, a 
triangular bandage around the nock supporting the 
forearm, another holding the humerus against the 
ribs. This method*of reduction is not without 
c on s i d erable dan gcr• 
2. Lower Jaw - 
Patient in a chair, pad thumbs well and press down 
and back on molar teeth, lifting up on chin with 
fingers until mandible..snaps back into place. 
Support jaw with A tailed or Barton bandage. 
-70- 3, Elbow - 
Place knee in bend of elbow, pull arm forewarn a- 
gainst Imee and slowly and forcibly bend forearm 
to right angle. Bandage in this position, 
4, lingers - 
Reduce by steady traction in straight line with the 
finger. Do not attempt reduction of second joint 
of the thumb, 
5, Knee - 
Flex the thigh and apply traction, 
6, Pfrist, hip and ankle should not bo reduced by the 
technician. In dislocated hip, place a pillow or 
support under the injured limb. In some disloca- 
tions, severe pain may require morphine. Cold com- 
presses over the injured joints are helpful. 
XVII. SPRAINS 
1, Definition - 
A sprain is a tearing or stretching of the ligaments 
around a joint, 
a. Put the affected member at rest. Elevate, 
b. Gold packs will limit effusion and swelling, 
c. After twenty four hours, when swelling has 
subsided, hot compresses will increase the 
circulation and stimulate healing. The strength 
of the joint can then be increased by tho use of 
proper adhesive plaster strapping. This will be 
demonstrated to you. 
XVIII. STRAINS 
1, Definition - 
A strain Is an injury to a muscle or tendon in which 
the fibers are stretched or torn, pain, stiffness 
and pain on movement are the symptoms. 
The treatment consists of; 
a. Heat. 
b. Put the injured muscle at rest. Adhesive strap- 
ping is useful, 
c. Gentle massage to aid the return flow of blood 
in the veins, 
d. Liniments may be of value.. 
-71- XIX. ARTIFICIAL RESPIRATION 
Certain accidents, the raost frequent of “which are drowning, 
electrical shock and gas poisoning, cause cessation of 
breathing. Other causes include drug poisoning (such as 
morphine or barbiturates) prolonged exposure to cold, blov/s 
on the head and neck, chest injuries and certain types of 
infection. In all cases, it is important to rule out an 
obstruction of the upper air passages, since in these 
cases artificial respiration is useless. The tongue 
should be pulled forward since this may fall back into 
the throat particularly if the patient is unconscious. 
If a foreign body is present in the pharynx, larynx or 
trachea, an attempt should be made to remove it. Try a 
sharp blow on the back with the body suspended head down, 
or wiping or suction if available. It may bo necessary to 
establish an artificial airway with a rubber tube passed 
-72- behind the tongue to the larynx* Tracheotomy is a last re- 
sort, and can be performed with a pocket knife if necessary* 
There are two chief methods of applying artificial respira- 
tion; 
A* The Prone-pressure or Schaefer liethod. 
1. Lay the patient face down, one arm extended direct- 
ly overhead, the other bent at the elbow with the 
face turned to one side and resting on the hand or 
forearm, so that the nose and mouth are free for 
.breathing, 
2. Kneel, straddling the patient's hips, with the knees 
.just below the patients hip bones or. the opening of 
the pants pockets* Place the palms of the hands on 
the small of the patient's back with the fingers 
over the patient's ribs, the little fingers just 
touching the lowest ribs, the thumbs along side the 
fingers and the tips of the fingers just out of 
sight. 
3. While slowly counting "one", "two" and with the arms 
. held straight, swing slowly foreword, so that the 
weight of the body is gradually, but not violently, 
brought to bear on the patient* (60 lbs, of pres- 
sure is usually sufficient). This should take 2 
to 3 seconds* 
4* While counting "three" swing back to remove the pres- 
sure, 
5. Virile counting "four", "five", rest, 
6. Repeat these operations, so that 12 to 15 complete 
cycles are made per minute* In other words the com- 
plete cycle of compression and release should take 
4 to 5 seconds, 
7. As soon as artificial respiration has been started, 
and while it is being continued, an assistant 
should loosen all tight clothing about the patient's 
nock, chest and waist and wrap the patient with a 
blanket, 
8. Continue artificial respiration ’without interrup- 
tion until natural breathing is restored or until 
rigor mortis has set in; do not stop merely because 
the patient appears to bo dead. Some persons have 
been revived by artificial respiration after 20 to 
30 minutes of submersion, 
9. If natural breathing stops after being restored, 
use this method of resuscitation again* 
10, Keep the patient lying down after breathing is res- 
tored. Stimulants such as aromatic spirits of am- 
monia, coffee or tea can be given after the patient 
re gain s c or: s ci ousn e s s * 
11. In changing operators, the rhythm of respiration 
must not be broken. 
•731 B. ■ Eve's Rocking Method - 
This method works entirely by the force of gravity and 
had been adopted on British warships as the method of 
choice. It is claimed that in drowning the inspiratory 
recoil is lost, chiefly because of flaccidity of *tho 
diaphragm, and consequently Schaefer's method'nay not 
work. 
Procedure: 
1. Lay the victim face down on a stretcher and wrap 
well with blankets above.and below, 
2. v/rists and ankles are lashed,to thu handles* 
3. Hoist the litter to a wooden saw horse or sling 
which acts as a pivot on which the litter can be 
tilted with either head or feet down. 
A, The first tilt is head down and at an angle of 
30° from the horizontal. The weight of the ab- 
dominal organs crossing, on the diaphragm pro- 
duces full expiration and also forces aortic 
blood through the coronary'arteries,,and emp- 
ties the stomach and lungs of water. 
5. Full inspiration is produced by tilting the 
footend down to 50°. 
6. d'urther rocking is done a dozen times a minute 
through an angle of 45° each way. 
7. The method is safe and can be done by anyone. 
During any delay in getting a litter, Schaefer’s 
Method should be used until the rocking can bo 
started, 
S. This method would be valuable in cases compli- 
cated by rib fracture or -chest injury where di- 
rect compression of the thorax is contra-indi- 
cated. 
XX. UITCOMSCIOU3NESS 
A# Definition - 
Unconsciousness nay be duo to -many causes and it 
would bo impossible to teach the technician hov; 
to recognise all those causes in the short tine 
alloted- to this course. That we will attempt to 
do. is teach you a general plan of procedure to 
follow in the" handling of any unconscious patient. 
The first thing to. do when an unconscious person 
'is found is to rule out the following conditions 
since each requires a special treatment. 
1. Stopping of breathing. 
Look for electrical contacts, escaping gas etc. 
2. Hemorrhage. 
3. Poisoning. • • 
Examine the surroundings for empty bottles etc# 
Examine the patient's mouth# 
74- 4. Sunstroke. 
5. Head Injury. 
Look for evidence of a fall. Examine the scalp 
for cuts or bruises. 
In some cases the cause of unconsciousness mil be 
in doubt and these can be given satisfactory first 
aid treatment by roughly dividing them into the 
three following groups on the basis of easily de- 
termined symptoms. 
1• Re d Uncons ciousness. 
Symptomss Red or flushed face and a strong 
pulse. 
Treatments Rut in a lying position, head 
slightly raised and keep the patient 
quiet. Apply cold applications to 
the head. Loosen any tight cloth- 
ing around the neck. Give no sti- 
mulants and apply just enough heat 
to keep the patient warm. Trans- 
port carefully in a lying position. 
2, "tfhite Unconsciousness, 
Symptoms? Pale face a ni fast weak pulse. 
Other symptoms of shock. 
Treatment: Keep quiet in a lying position with 
the head level or low. Apply ex- 
ternal heat. Use inhalation stimu- 
lants if there is no bleeding and 
no head injury. Transport very 
carefully in a lying position, 
3, Blue Un cons ci ousn e s s • 
This group includes the cases requiring arti- 
ficial respiration and the treatment has al- 
ready been discussed under artificial respi- 
ration. 
Some of the common causes of unconsciousness are 
listed below, 
1, apoplexy or Stroke - 
This condition is due to the rupture of a dis- 
eased blood vessel in the brain. The pressure 
of the blood on the brain causes unconscious- 
ness and in addition some of these symptoms: 
a. Face usually rad, but may be ashen gray, 
b. Pulse strong and slow, 
c. Pupils may be unequal in size. 
d. One side of body may be limp. Mouth may be 
drawn to one side, 
e. Snoring respiration. 
The treatment is as outlined under red unconscious- 
ness. 
•75' 2, Alcoholism - 
It is possible for individuals to die following the 
drinking of large quantities of alcohol. These 
patients shorj slow noisy breathing, cyanosis, rapid 
feeble pulse, incontinence and sometimes convulsions. 
Treatment; 
a. Insert a stomach tube and ■•wash the stomach -with 
warm water of 5% sodium bicarbonate solution, 
b. Keep the patient warm with blankets and hot water 
bottles, 
c. Inhalation of oxygen and carbon dioxide is helpful. 
d. Stimulants. 
3, Skull fracture and Concussion, 
Treat these patients as described under red unconscious- 
ness, In cases due to bullet or shrapnel wound, com- 
pound fractures of the skull will be seen, and in some 
of these, brain tissue may actually bulge from the 
wound, I’oese cases are not necessarily hopeless - 
some make complete recoveries, so the technician would 
do well to treat these cases promptly, applying sulfa- 
nilamide powder and a sterile dressing to the wound 
and transporting the patient to a hospital promptly. 
4, ‘Shock - 
5• Hemorrhage - 
6. Sunstroke - 
7. Heat exhaustion - 
5, Prolonged exposure to cold, 
9, Poisonous drugs, 
10, Fainting - This condition is due to a sudden failure 
of the blood supply to the brain. The patient should 
be placed in shock position, his clothing loosened and 
an ammonia inhalant used. Gold water sprinkled on the 
face is of help. A patient who begins to feel faint, 
should lie down or place his head between his knees. 
11, Epileptic Convulsions - 
These are severe convulsions during which the patient 
falls down, becomes rigid at first and then develops 
twitching and Jerking of the limbs and face. There 
may be loss of bladder and bowel control during the 
attack. Following the attack, the patient usually 
passes into a deep sleep, or coma which may last 
several hours. 
Treatment; 
‘During the attack, prevent the patient from hurting 
himself and especially from biting his tongue. This 
is best done by placing a padded stick between his 
teeth. Do not try to restrain the patient. After 
the convulsion, allow the patient to sleep. 
12, Diabetic coma. 
13, Uremia. 
-76- XXI. POISONS 
The'principal point to bo remembered in the treatment of 
poisoning is that poisons, when diluted, are not absorbed 
as rapidly as when they are in a concentrated form. In 
addition to diluting the poison-it should be cleaned out 
of the stomach either by causing vomiting or by putting 
down a stomach tube and washing out the stomach. There 
are two types of poisons for which emetics or stomach tube 
are not used, and these are acid or alkali poisoning. In 
these two types of poisoning there is a danger of ruptur- 
ing the esophagus. 
The following emetics are useful in most types of poisoning. 
A. Soap suds. 
3. Salt water* 
C. Soda water. 
D. Luke warn: water, 
E. Milk - especially for corrosive poisons. 
Four to seven glassfuls should be given, preferably luke- 
warm. If vomiting does not occur, the back of the throat 
should be tickled, A teaspoonful of mustard powder in a 
glass of warm water can also be tried to induce vomiting, 
"fhen the stomach has been well washed out, the antidote, 
if known can be given. A,large dose of epsom salts can 
be safely given later to cleanse the poison from the gas- 
trointestinal tract. Following are some of the specific 
measures to employ in certain types of poisoning. 
A. Acids - 
1, Neutralise with an alkali such as magnesia, chalk, 
white wall plaster, sodium bicarbonate or lime water. 
2, Give a demulcent such as milk, olive oil or egg 
white, 
3, Keep the patient warm, Morphine 1 //+ grain for 
pain, 
A« No emetics or stomach tube. 
B, Alkalies - 
1, Neutralize with a weak acid such as lemon juice 
or vinegar, 
2, Keep the patient warm, 
3, ho stomach tube or emetic, 
A, demulcent such as milk or egg white, 
G, Barbiturates 
1, Pass a stomach tube and wash the stomach, or give 
an emetic, 
2, Give a largo dose of epsom salts, 
3, Keep the patient warm* 
A# Stimulants and oxygen if available. 
-77- D, Cyanide, 
1, Pass a stomach tube and wash out with 1,5/ solution 
of hydrogen peroxide, ' 
2, .. Apply artificial respiration if necessary, 
3, Get medical assistance immediately. There are, 
specific antidotes available which must be given 
intravenously. These are sodium nitrite and sodium 
thiosulfate, 
E, Iodine, 
1, ' Give a starchy preparation, such as a heaping 
tablespoonful of cornstarch or flour stirred into 
a pint of boiling water, the mixture being allowed 
to cool, 
2, "Tash stomach until the washings are no longer blue, 
- 3. Morphine if necessary for pain, 
A, Treat shock. Plasma and transfusions if necessary, 
F, Morphine - 
1, dash the stomach with ,05$ potassium permanganate 
solution, 
2, Inject intravenously 71/2 grains of caffeine 
s oa i o-bon z oat e, 
3, Inhalations of 10/ carbon dioxide and 90/ oxygon, 
A, Artificial respiration if necessary. 
5, Epsom salts,' 
6. Treat shock, 
G, Carbolic acid and Lysol, 
1, Pass*a stomach tube and wash out the stomach with 
olive oil or other edible oils. If no oil is; a- 
yailable, use tap water or soap suds, 
2, '5% g1ucose s olution intravenously, 
3, 10/ carbon dioxide and '90/ oxygen or artificial 
respiration, if necessary, 
A# If there is a surface burn wash it off with 95/ 
alcohol, - v. . 
H, Phosphorus (in rat paste or matches), 
1, Pass a stomach tube and wash out the stomach with 
500 cc of 0,5/ solution of copper sulfate, 
2, Repeat at 15 minute intervals, 
3, Give magnesium sulfate as a purge (1 ounce), 
A, Morphine sulfate for pain, 
5, Eventually give'a-demulcent such as starch, milk or 
eggs, 
I, Silver Nitrate, 
1, Nash out with salt solution, 
J, Strychine. 
1,. Inject intravenously 7 1/2 grains of sodium amytal, 
*2. Pass a stomach tube and wash out the stomach with 
a 0.1/, solution of potassium permanganate, 
K, Mercury ’Bichloride, 
1, Give large quantities of egg white mixed with milk 
or water, 
2, Pass a stomach tube and wash thoroughly. 
-73- 3. Saline solution intravenously. 
X. Treat shock. Plasma and transfusions if necessary, 
XXII, GAS GANGRENE AND SERUM PROPHYLAXIS 
A. Gas gangrene is such an important problem in the treat- 
ment of mar -wounds that some mention should bo made of 
this serious complication. The anaerobic bacteria caus- 
ing this condition thrive in vet cultivated soil and 
wounds contaminated with this material are very apt 
to develop this type of infection, but any contaminat- 
ed wound can become infected in this way, 
•Gas gangrene is somewhat more common in the lower ex- 
tremity than the upper. It has a tendency to follow 
fascial planes and hence frequently involves a num- 
ber of muscles of the same group. In advanced cases 
the limb is swollen and crepitant to the touch and 
the skin is moist and discolored, while a thin, foul 
smelling, bloody discharge with a musty or rotten 
egg odor exudes from the wound. The patient appears 
acutely ill with rapid, thready pulse and sunken 
cheeks, but mentally alert. 
The involved muscles pass through various stages of 
dissolution signified by a gradual change in color 
from brick red through yellow to a greenish black. 
In earlier cases the symptoms are less evident and 
the patient may complain of increased pain in the 
wound but show only swelling of the limb with the 
over-lying skin tense and pale, or discolored, 
X-Ray examination often reveals gas bubbles under 
the skin, . 
As in any infection, preventive treatment is of more 
value than treatment after the infection has occurred. 
Prophylactic treatment in gas gangrene includes proper 
treatment of the wound, including debridement, local 
and oral use of one of thq sulfa drugs, and the use 
• of anti-gas gangrene serum. In treatment of an es- 
tablished, case of gas gangrene the following measures 
have their place. 
1. Excision of involved muscles, or adequate expo- 
sure of infected tissue. 
2. X-Ray treatment, 
3. Zinc peroxide or other oxidizing agents, such as 
hydrogen peroxide and potassium permanganate in 
the wound, 
X. Sulfathiazole, 
5, Gas gangrene antitoxin, 
6. Amputation, 
-79- B. Serum Prophylaxis - 
Gas gangrene antitoxin is prepared from the blood of 
horses "which have been injected with the toxic products 
of these bacteria. The horses produce in their blood 
stream this protein substance, known as anti-toxin, 
which has the power of neutralizing the toxins of who 
bacteria, "/hen a sufficient quantity has been formed, 
the horses are bled and the serum which contains the 
antitoxin, is separated from the horse blood. Gas 
gangrene antitoxin then, is horse serum. Since many 
people will have serious reactions, even death, when 
horse serum is injected under their skin, certain 
precautions are always taken before the injection 
is made, 
1, Ask the patient if he is allergic, that is, if 
he has ever had hay fever, asthma, eczema, hives 
or similar conditions. Ask him particularly if 
he is ’allergic to horses, that is, if he sneezes 
or wheezes or breaks out in a rash when he is 
near a horse. These people are especially lia- 
ble to have a fatal reaction from horse serum. 
People who have previously had horse serum nay 
also react to a second dose, 
2, In this test-, horse serum is diluted one part in 
ten with normal saline solution, A drop is in- 
jected intra-cutaneously into the skin of the fore- 
arm, Xf, in 20 to 30 minutes, a pale irregular 
swelling surrounded by redness, appears, the pa- 
tient is sensitive to horse serum. 
3, Eye Test - 
Take the same 1 to 10 dilution of horse serum 
and place one drop on the inner side of the lower 
lid. After 20'to 30 minutes compare with the op- 
posite eye. If the eye is red, and there is 
swelling and watering, the patient is sensitive to 
horse serum. 
If the patient is negative to the above tests, it is pro- 
bably safe to administer the full dose of antitoxin, usu- 
ally 10 to 15,000 units. If any of the tests are positive, 
the antitoxin must be administered by a medical officer, 
if he considers it essential, and usually in fractional 
doses, "Thenever horse serum is administered to a patient, 
a syringe containing 1 cc of 1:1000 adrenalin should be 
at hand for use in case of serum reaction. 
C. Tetanus - 
Every soldier in the armed forces of the United States, 
now receives immunizing injections of tetanus toxoid. 
Toxoid is a substance prepared by chemically treating 
the poisonous toxin produced by tetanus.bacteria in 
-80- such a way that its harmful properties are to a great 
extent lost. However, when it is injected into a hu- 
man individual, it is still strong enough to cause 
that person to produce antitoxin. This is known as 
active immunity in contrast to passive immunity as 
used in prophylaxis against gas gangrene, where the 
antitoxin is "borrowed” from a horse. 
In the last war toxoid was not as yet developed and 
as to protect the soldiers from "lock jaw" or tetanus, 
antitoxin was used, as it still is for gas gangrene. 
In this war, every soldier will have a permanent 
immunity to tetanus before he goes into battle and 
at the time he is injured, he will receive an addi- 
tional dose or "booster shot" of 1 cc of tetanus 
toxoid. Please note that tetanus toxoid is not pre- 
pared from horse serum and it is not necessary to 
test a patient before administering it. 
Serum and toxoid prophylaxis are very useful but one 
must not depend on them entirely for protection a- 
gainst gas gangrene and tetanus. The proper care of 
the wound is still the most important factor in pre- 
venting these diseases and the technician has a great 
part in the application of proper first aid treatment 
and swift evacuation of the patient to a surgical 
station where treatment of the wound can be carried 
out • 
-81- DEFSNSS AGAIF3T CHSIIIGAL WAHFARS 
iJtjj ' 
USDIGAL ASPECT AJ-JD FIRST AID 
TRLATJ^TT op QAg^A3UALTIS3 PART CNE 
DEFENSE AGAINST CHEMICAL WARFARE 
The object of training in defense against chemical warfare 
is to prepare the Array of the United States to resist with a mini- 
mum of casualties any attack that may be made against it by an 
enemy employing noxious gases or other chemical agents. 
To deal with chemical warfare casualties, it is necessary 
to possess knowledge of the uses of chemical weapons and an ac- 
curate knowledge of the injuries which nay be produced. 
I. Limitation of Apparatus - 
Present day protection against gas is not absolute, varies 
with the type of gas used and practical adaptation of pro- 
tective equipment. Protection* is high in lung irritants 
to moderate in skin vesicants. Gas mask is 100$ effective 
against lung irritants, whereas, gas mask and protective 
clothing are absolutely necessary for skin vesicants. 
II. Gas Discipline -and Training - 
Gas attacks will always cause some casualties, so the object 
of gas discipline is to reduce casualties to minimum, Chemi- 
cal warfare depends for greatest success on surprise and em- 
ployment against poorly trained troops. 
III. Chemical Agents - 
Includes those chemicals and chemical compounds, whether 
gases, liquids or solids, used in chemical warfare. 
IV. Classification of Warfare Chemicals - 
A. Physical State 
1. Gases - Chlorine, Phosgene 
2. Liquids - Mustard, Lewisite, Chlorpiorin 
3. Solids - Diphenylchlorarsine, Diphenylaminechlorar- 
sine, dhlorarcetophenone, 
B, Tactical Uses 
1, Direct casualty agents 
at Phosgene 
b, Mustard 
c, Chlorpiorin 
d, Lewisite 
o. Nitrogen Mustard 
2, Harassing Agents 
a. Diphenylchlorarsino 
b, Chloracetophenone 
3, Screening agents 
a. Phosphorus 
b. Smoke Mixtures 
-32 A. Incendiary Agents 
a. Phosphorus 
b. Thermit 
C. Physiological Effects 
1, Lung Irritants 
a. Phosgene 
b. Chlorine 
c. Ghlorpicrin 
2* St e mutators 
a. Diphenylaminechlorarsine (Adarnsite) 
b, Diphonylchlorarsine 
3, Lacrimators 
a. Brombenzylcyanide 
b. Ghloracetophenone 
c. Ghloracetophenone Solution 
A, Vesicants 
a. Mustard 
b. Lewisite 
c. Nitrogen mustards 
5* Nervous System Poisons 
a. Hydrocyanic acid 
6, Asphyxiating or suffocating 
a. Carbon Monoxide 
7. Incendiaries (Refer to Chart) 
a. Phosphorus 
b. Thermit 
D, Persistency 
1, Persistent chemical - one which will maintain an ef- 
fective vapor concentration in the air at point of 
release for more than 10 minutes, 
a. Mustard 
b. Lewisite 
% 
2, Non-persistent chemical - effectiveness less than 10 
minutes, 
a. Chlorine 
b. Phosgene 
V, Tactical Uses. 
A. Disable personnel, reduce its fighting efficiency, create 
panic, reduce morale. 
B* Interdict area to occupation or passage of troops* 
G. Damage or destroy materiel, contaminates food, roads, e- 
quipment, delays repairs. 
D. Smoke to screen and blind. 
-33- VI, Method of Employment 
A, Artillery 
1. Shells - 75 mm, - 155 mm, - 105 mm 
B, airplane 
•1, Bombs 
2. Sprays 
C, Liquids and bombs placed in position, 
D, Light mortar projectiles and projector bombs. 
E, Gas candles and cylinders, 
F, Hand and rifle grenades. 
VII. Protection Against Chemical Agents 
A. Gas Mask, 
1* Individual protection against chemicals which attack 
the lungs and eyes, nose and throat, no protection 
against rest cl* body, "Till not protect against 
CARBON MONOXIDE, AMMONIA GAS, so a special canister 
is necessary against these, 
B. Protective Clothing, 
1, Covers body, gloves for hands and boots for feet, 
used by soldiers working in gassed area and hand- 
ling gassed patients; can only be worn for limited 
periods, 
2, Impregnated clothing - includes - underwear, socks 
shirt, trousers, hood, gloves, and shoes. 
3, Cellophane hood - to cover clothing - extends to 
shoe tops from head* 
G, Collective Protection, 
1, Gas proof shelters, bomb shelters, room in cellar, 
or room in building; 20 square feet per person, with 
9 foot coiling, will allow one person to stay in 
room so constructed for 10 hours, 
2, Alarm devices - whistles, sirens, bells, etc, 
3, Chemicals for destroying chemical agents. (Decon- 
tamination). 
a. Earth - earth, sand, ashes, sawdust; layer 3 
inches thick - doesn’t destroy agent - forms 
a seal - more effective if wetted down by water. 
b. Hater - effective against lewisite, but reaction 
product, a non-volatile solid which is toxic and 
causes blisters on skin. Hater is not effective 
against mustard - too slow. If good drainage 
present, mustard may be washed down, 
c. Chloride of Lime or bleaching powder mixed with 
water on earth, destroys vesicants containing 
arsenic produce poisonous product, 
d. Aeration and weathering — natural decontamination, 
ordinarily are too slow* 
e. Incineration (burning) - practical method, but 
care must be taken to prevent vapor or smoke com- 
ing in contact with non-protected persons. 
-a*- f. Solvents - gasoline, kerosene, alcohol, carbon 
tetrachloride; used to remove excess vesicants - 
do not destroy chemical agents, but dissolve it 
so it is more easily removed, 
g. Won-corrosive decontaminating agent, 
/+, Mobile bathing units, 
5. Protective covers for materiel, 
6. Protective ointments, 
a. To apply to exposed surface of body, 
b. To apply to shoes, clothing, etc. 
c. To drop in eye - M 1 eye solution. 
VIII. Procedure during a gas attack. 
A. When a gas attack is in progress, 
1, Alarm given, mask adjusted, doors of gas shelter 
closed, fires put out, ’materiel protected. 
2. Casualties removed and given First Aid, 
IX. Prevention of Gas Casualties, 
A. Chemical agents are heavier than air, therefore, settle 
in shell holes, depressions in the earth, in dugouts, 
trenches, so most important measure to prevent casual- 
ties is to seek high ground and open spaces, free from 
gas. 
In moving out of a gas cloud it is best ‘to proceed cross 
wind. If gas cloud envelopes a dwelling, close all doors 
and windows tightly, put out fires, plug all chimneys and 
go to upper floor, (Third floor or above will be fairly 
safe)• 
Gas mask prevents gas effects on eyes, face and lungs 
and should be adjusted at first odor of gas and not 
removed until ordered. 
If no gas mask available, improvise one - breathe through 
handkerchief saturated with 'a solution of. baking soda, 
soap suds or urine; clean cloth or cotton will serve if 
s no handkerchief is available, as all gases except carbon 
monoxide and ammonia gas, are acid in reaction, 
B, Natural conditions favoring use of chemical agents - 
Such as - velocity of wind, dew, early morning hours 
or early night, no rain, 
X. Six Basic Principles for Identification of Chemical Agents 
by odor, 
A. .Do not inhale deeply. Only the nose can smell. Sniff, 
B, Sniff only once. Repeated smelling dulls the senses of 
Smell, ... . , 
0, First smell, then think. The memory of odors can bo 
trained by practice 
-85- D, Every perception of odor must he named. Learn odors by 
memory of things smelled, rather than by the name of 
something else, A thing is odorless only when no per- 
ception of odor is obtained, 
E, After each test, breathe out strongly through the nose 
several times. Do not smell a new sample until the old 
perception of odor has vanished* 
F, Do not smoko when sniffing for gas. 
XI, Evacuation of Gas Casualties, general principles, 
A, At Aid Stations, 
1, Examine mask and if gas abounds, retain it on patient. 
Remove equipment and loosen clothing. Remove cloth- 
ing if It is contaminated with mustard gas, and'wrap 
in clean blanket. If affected with mustard gas, 
wash eyes with soda bicarbonate solution (2%), Apply 
dressing to wounds, 
2, See that patient avoids unnecessary movements if 
suffering from a lung irritant. Keep him warm and 
quiet. Encourage vomiting by giving- tepid salt wa- 
ter, if safe to remove mask, 
3, Inspect emergency medical tag and make proper nota- 
tion thereon, 
4, Expedite evacuation to collecting station, 
B. At Collecting Stations* 
1, Change clothing and thoroughly bathe mustard cases 
if possible, 
2, Wash eyes of mustard cases* 
3* Completely dernustardize whenever time and facilities 
permit* 
4, Adjust dressings, 
5, Give special treatments as indicated including ad- 
ministration of oxygen, and bleeding in lung cases, 
6, Prepare patient for evacuation, 
C. At special degassing stations, 
1, Administer neutralizing chemicals and de-gas cloth- 
ing by group method, 
D. At Hospital Stations. 
1, Sort. 
2, Classify. 
3. Segregate, 
4. Bathe, 
5. Retain critical cases for observation, 
6. Dernustardize if not previously and thoroughly done, 
7, Bleed and administer oxygon as indicated, 
8, "Then fit for transportation, evacuate to roar. 
-»86- TYPE OF INCENDIARY 
! 
I 
SIZE 
1 
COMPOSITION i METHOD OF EXTINGUISHING 
1 
1 
. . J_ _l 
Small "Electron1* 
bombs 
1 kilogram 
(2.2 pounds) 
Cylinder of combustible magnesium 
alloy containing thermit mixture to 
Ignite the magnesium alloy* May 
contain an explosive charge. 
Spray (not a stream) 
of water. Cover with 
sand. Remove with long- 
handled shovel to a 
metal container with 
layer of sand In bottom. 
Medium and large 
"Electron" i?ombs. 
2-25 kilogram 
(4,5 to 55 pounds) 1 
Same as above. All large incendiary 
bombs will contain some explosive. 
Same general methods as 
above but experienced 
fire fighters are re- 
quired to handle the 
largest bombs of this 
type. 
Thermit 
15 kilograms (33 
pounds) 
50 kJ1ogram (132 
pounds) 
■ 
Non-inflammable c?sv containing mix- 
ture of Iron oxide and aluminum 
(thermit) ignited by a "first fire" 
charge that |s Ignited either by 
impact or fuse. May contain an 
explosive charge, 
■ 
Burning thermit cannot 
be extinguished. Molten 
Iron produced nay be 
cooled to reduce spread 
of fire. 
White phosphorus 
bombs. 
30 pound (may be of 
any size) 
• 
1 
White phosphorus with an explosive 
charge to Ignite end scatter the 
phosphorus upon impact. 
Water w i11 extinguish 
burning phosphorus. 
Copper sulfate solution, 
i f available, i s even 
more effective. Remove 
all fragments to a safe 
place and burn. Avoid 
handling the fragments 
with bare hands. 
Multiple Effect Bombs. 
12 kilogram (2b.5 
pounds) 
Separate incendiary units of phos- 
phorus and magnesium alloy which 
scatter upon impact and ignition, 
' 
The burning magnesium 
units can be handled in 
the same manner as the 
electron bombs,Burning 
phosphorus can be ex- 
tinguished with water 
and then should be re- 
moyed to a safe place 
while wet. 
Oil bombs. 
Large drums. 
Fuel oil or solidified gasoline. 
May contain other combustible sub- 
stances, Scattered and ignited by a 
black powder burster charge upon 
impact. 
Smother with sand. 
"Incendiary leaves" 
1 Approximately 4x4 
inch squares, 
! 
Moist squares of cardboard or nitro- 
cellulose coated with phosphorus 
which Ignite as they become dry. 
Immerse In water or 
copper sulfate solution 
Burn in soma safe place 
Be sore that all are 
collected as one un- 
recovered square may 
cause a serious fire. 
-37- CHAR/.CTSRISTIGS OF ?RHCIP/X CHETIC'X AGENTS 
Lung Irritants 
Name and symbol 
Phosgene (CC-) 
Chlorine (CL) 
1 Chlorpicrin 
• 
Odor 
Green corn, new cut 
hay 
Pungent 
Sweetish3 fly pa per 
Color and stats 
in field 
First white, then 
changing to color- 
less gas. 
Greenish yellow gas 
Oily liquid chang- 
ing slowly in open 
to colorless gas. 
Effects on body 
Choking, coughing, 
hurried breathing, 
pains in chest due 
to Injury of lower 
lungs. A few 
breaths in average 
field concentration 
produce a casualty. 
Effects progress 
slowly. 
Ccughing, smarting 
of eyes,discomfort 
in chest followed by 
nausea and vomiting. 
A 2-minute exposure 
to average concen- 
tration produces a" 
crsualty. 
! watering and irri- 
tation of eyes, 
c oughing,nausea, 
vomiting lung irri- 
tation, Approx1- 
mately 1/U as toxic 
as phosgene. 
Persistency in open 
ground 
5 to 10 minutes in 
summer5 about 20 
minutes in winter 
about 5 minutes 
2 hours in summer; 
about 12 hours in 
winter. 
Action on food 
\ 
Contaminates. In 
some cases poison 
removed by heating 
and ventilation but 
taste remains bad. 
About the same as 
phosgene, 
, 
/bout the same as 
phosgene. 
Action on metal 
Metal dry, none? if 
wet, vigorous 
corrosion 
Same as for phosgene, 
Slight tarnish. 
Hot; used 
For casualty effect* 
In cylinders, pro- 
jectors, medium 
artillery mortars, 
or aviation bombs 
. 
■ 
For casualty effect. 
In cylinders cr pro- 
jectors as substi- 
tute for phosgene 
or mixed with phos- 
gene. 
For harassing and 
casualty effect. 
In shell, bombs or 
spray, as substi- 
tute for or mixed 
with other agents. 
Protection needed 
Gas mask 
Gas mask 
Gas mask 
First aid treatment 
Remove victim from gassed atmosphere; place at absolute rest 
lying down5 do not allow to walk; keep warm with blankets, 
hot water bottle; give hot coffee or ten - no alcoholic stim- 
ulants; oxygen required in severe cases; evacuate. Artificial 
respiration is not to be performed on lung irritant gas 
casualties. 
-GG- CHARACTERISTICS OF PRINCIPAL CHEMICAL AGENTS 
, Vesicants 
Name & Symbol 
Mustard Gas ( IS) 
i 
I 
j Nitrogen dastards 
l 
• Lewisite (HI) 
01 or 
Garlic or horseradish 
i 
Indistinct-fishy or 
soapy - Detected by 
Vesicant detectors, 
crayon, paint, paper, 
etc. 
Geraniums, then 
biting 
Color & State 
Dark brown liquid. 
ii Liquid to low molting 
Dark Brown Liquid, 
in Field, 
changing slowly to 
! solids, colorless to 
changing slowly to 
colorless gas. 
pale yellow. 
colorless gas. 
Effects on Body 
Blisters skin. Symp- 
toms delayed 2 to A 
hours. If exposed, 
eyes burn and inflame. 
Skin in contact with 
gas or liquid, disco- 
lors, followed by 
blisters and sores. 
If breathed, hoarse 
cough develops pains 
in chest, general in- 
i Vesicants, necrotiz- 
ing irritants to all 
exposed tiss\les, Des- 
troys leukocytes of 
the blood, lymphatic 
tissue, blood form- 
| ing organs and cer- 
tain areas of centra] 
nervous system, liild 
exposure will proba- 
bly not cause notica- 
Skin shows slight 
irritation in If 
minutes followed 
by grayish disco- 
loration and blist- 
ers in 30 minutes 
to 1 hour, system- 
ic poisoning, vom- 
iting, If breathed 
powerful lung ir- 
ritant, effects 
1 
flanmation of lungs. 
bio systemic effects. 
develop in l/2 
hour. If unprotect- 
ed, eyes are irri- 
tated immediately. 
Persistency in 
Summer; 3 to A days 
Host volatate per- 
Summer; 24 hours 
Open Ground 
'Vinter; several weeks 
i 
sist less than 2 
hours. 
ainter; several 
weeks. 
Action on Food 
Renders unfit for 
Renders unfit for iPoisons; food can 
i 
I 
use. | 
use. 
not be purified. 
Action on Metal 1 
Very slight, 
J 
Probably same as 
mustard. 
Very slight. 
How Used j 
1 
( 
For casualty effect 1 
or to deny ground, i 
In artillery or mor- 
tar shell, airplane 
bombs or spray, and 
Casualty agent, same 
as mustard, 
i 
i 
I 
i 
1 
Same as mustard 
gas. 
1 
j 
other land mines. 
I 
i 
Protection 
Gas mask and protec-' 
Service gas mask. 
Gas mask and protec- 
Needed ! 
,■ 
\ 
tivo clothing. 
Protective and im- 
permeable clothing, j 
t ive c1othing. 
•89-  oy ra-mcrm. nnan:chT. ftf>T-N2a .. 
Ve s 1 points (Continued) . 
Name & Symbol 
Mustard Gas (HS) 
i 
Nitrogen Mustards 
Lewisite (HI) 
Protection Y ? 
Rubber gloves and rub- 
! 
1 First aid must be 
Needed,(con’t) 
berized fabrics are 
penetrated with great- 
er rapidity than with 
mustard. 
almost immediate. 
Treatment similar 
to that for mustard. 
Greatest danger is 
First Aid 
Treatment 
Remove from gassed 
area; remove conta- 
! absorption of ar- 
Gas mask and remove 
from gassed area in- 
senic. First ap- 
ply 5% solution 
minated clothing. If 
mediately. Liquid 
aqueous sodium hy- 
only portions of 
splashed clothing 
droxide (caustic 
clothes splashed by 
should be removed. 
soda). Following 
liquidj cut thesc 
Eyes - washed with 
this, or if sodium 
away, Ii lace expos- 
water repeatedly for 
hydroxide not avail- 
sd to gas, wash eyes 
and rinse nose and 
live minutes. 
Skin - I.I-/,. ointment 
able, cleanse vapor 
bums with soap and 
throat with sat uni oc 
applied to skin as 
water, cover thick- 
boric acid, weak bale- 
for vesicant agents. 
ly with ferric hy- 
ing soda or common 
salt solution. If 
This ointment merely 
dilutes this vesi- • 
drate paste and 
gauze. In case of 
gas breathed, treat 
cant, does not des- 
liquid bum after 
as lung irritant cas- 
troy. 
applying sodium 
ualty. First aid 
fash - with soap and 
Hydroxide, swab with 
must be prompt. Vapor 
water, 11 redness 
u 3 
oil as for mustard 
burns lessened or 
oJ 'ohe skin lias ap- 
then dress with 
prevented by imm.edi- 
pearod, do not use 
paste as above. 
Evacuate all casual- 
ate hot bath;cleans- 
ointment but' was : 
ing with kerosene or 
with soap and water. 
ties. 
gasoline before using 
If necessary to 
soap desirable, areas 
drain blisters, 
wet with liouid mus- 
drain under strict 
tard should be imrne- 
aseptic techr ique. j 
dlately and repeat- 
In vapor contamina- i 
edly scabbed with 
tion of the skin, 
kerosene, gasoline, 
eye, or respiratory 
any oil, alcohol, 
tract, it is too 
carbon tetrachloride 
late for effective 
(pyrene) or weak so- 
pr ophylaxis, Eye 
lution chloride of 
and nose drops item 
lime and water, using 
number A may be used 
fresh cloth each 
for relief of eye 
time. After this 
or nasal pain. Itch- 
use hot water and 
ing of the skin may 
soap. All cloths 
bo allayed by use of 
used should be bum- 
pantocaine ointment, 
ed. Evacuate all 
item number 8, 
casualties. 
i \ 
-90- CHARACTERISTICS OF PRINCIPAL CHEMICAL AGETTS - (Continued) 
Irritants 
Name and symbol 
Adamsite (DM) 
Chloracetophenone 
(CK) 
Tear Gas Solution 
(CNS) 
Odor 
Not definite;slight- 
ly like coal smoke 
Like apple bloss- 
oms 
Like fly paper 
Color and state in 
field 
Yellow smoke cloud; 
becomes invisible 
before chemical is 
dissipated 
Bluish gray smoke 
from burning 
powder 
Colorless liquid, 
changing to 
colorless gas. 
Effects on body 
Immediate sneezing, 
followed by’head- 
ache, nausea, vomit- 
ing, temporary 
physical debility. 
Piercing irri- 
tation of eyes 
to produce tears 
Piercing irri- 
tation of eyes, 
tears, followed 
by nausea, vomit- 
ing. 
Persistency in open 
ground 
About $ minutes 
About 5 minutes 
Summer; 1 hour 
Winter; 6 hours 
Action on food 
Poisons 
• 
. 
Gives disagree- 
able odor 
Contaminates. In 
some cases food 
made potable by 
heating and 
ventilation. 
Action on metal 
Tarnishes slightly 
Tarnishes steel 
slightly 
Tarnishes steel 
slightly. 
How used 
For harassing. 
In candles. 
For harassing. 
In grenades. 
For harassing. 
In artillery and 
mortar shell; 
airplane bombs or 
spray. 
Protection needed 
Gas mask with 
good filter 
Gas mask with 
good filter 
Gas mask. 
First aid treatment 
Place at rest,loo- 
sen clothing;bathe 
nose and throat 
with salt water, or 
baking soda solu- 
tion, and exposed 
body surface with 
soap and water;keep 
away from heat. 
Breathing from 
bottle containing 
chloride of lime is 
helpful;do net eva- 
cuate mild cases. 
Have men leave'gassed area and face 
wind; if this is not sufficient, 
bathe eyes with weak solution of 
boric acid or bicarbonate of soda 
(baking soda), do not rub eyes. Do 
not evacuate. 
1 -91- CHARACTERISTICS CF CREMCAL AGENTS - (Continued) 
Screening Srackes 
Name and symbol 
i 
| ':rhite Phosphorus 
i HC Mixture (MO) 
Sulfur Trioxide 
i iv^) 
I 
Solution (FS) 
Odor 
| Phosphorus matches 
Acrid. suffocating 
Acrid or Acid 
Color and state In 
• Solid which changes 
Solid, oroducing 
Liquid changing 
field 
j to flame and white 
white smoke in 
to white smoke 
| smoke on contact with 
i air. 
( 
burning. 
on contact with 
air. 
Effects on body 
| Pmoko, none; parti- 
None 
Smoke, mild 
j cles produce severe 
orickline of 
j heat burns which heal 
! very slowly 
| 
skin, non- 
inj unions . 
Persistency in open 
; ~moke drifts with 
Drifts with wind. 
Drifts with wind. 
ground 
wind; solid particles 
Smoke remains at 
Persists only 
j give off smoke until 
point of release 
while container 
j consumed, about 1 or 
| 2 minutes after shell 
i bursts. 
during burning 
time of munition. 
is discharging. 
action on food 
* Smoke gives dis- 
Gives disagreeable 
Liquid rendered 
agreeable odor. 
odor. 
unfit to use; 
smoke gives 
disagreeable odor 
Action on metal 
None 
None, if dry 
Vigorous 
corrosion in pre- 
sence of mois- 
ture. Liquid 
droplets damage 
paint work. 
How used 
For screening,incen- 
In smoke pots. 
Screening, In 
diary or casualty 
candles or 
airnlene spray. 
effect.In artillery & 
mortar shell, air- 
plane bombs 
grenades. 
Used in artillery 
and mortar shell 
and cylinders for 
simulation of gas 
in training 
Protection needed 
For smoke, none, for 
burning particles 
none provided 
None 
Generally none. 
First aid treatment 
Stop burning by im- 
mersion of affected 
part in water, or use 
wet cloths or mud; 
then pick cut phos- 
None required 
None required un- 
less splashes 
wi th 1iqui d.Men 
handling sub- 
stances should 
phorus particles and 
wear masks and 
treat 
gloves.If cloth- 
1 
ing splashes,re- 
-92- 
move same*Liquid 
cm doay should 
iirst be wined CHARACTERISTICS OF C"EriC/J. AGENT? (Continued) 
Screening Smokes (Con't 
Name and symbol 
White Phosphorus 
HC Mixture (HC) 
Sulphur Trioxide 
(wp) 
Solution (FS) 
As ordinal heat 
off with dry cloth, 
burns. If copper 
then water applied. 
sulfate solution 
’"hen smoke is 
available, its appli- 
laid by airplanes 
cation will stop 
in training, per- 
burning by coating 
sonnel and equip- 
the particles with 
ment should be at 
copper so they can 
least 300 yards 
be picked out of 
away from 3ine of 
flesh. Evacuate 
flight. 
severe cases. 
1 
-93- TRAINING GAS MASK M.1A1 
NOTE j 
TRAINING TYPE 
CANISTER AFFORDS SAME 
TYPE PROTECrI ON AS 
THE SERVICE TYPE 
CANISTER 
C H EMI CA L W A RA G £ NT S 
COM’ON NAME 
C 'J SYMBOL 
ODOR IN AJR . 
VESICANTS: 
HS 
Persistent 
1 
Garlic “ Horseradish 
Mustard r,a» 
M- 
Persi stent 
Geraniums « Biting 
Lewisite 
ED 
Persistent 
Biting - Stinging 
EthyIdichlorarsin 
LUNG IRRITANTS! 
1 
! 
Pho? ere 
CG 
fon«Persi stent 
New cut hay *» corn 
Chlorine 
CL 
Non-Persi stent 
Pungent 
Chlorplcrln 
PS 
Persistent 
Flypaper «=■ sweetish 
LACRIMATORSi 
1 
G hi 1 oracetophenone 
CM 
Mon-Per si stent 
i Locus blossoms 
Tear Gas Sol at Ion 
CMS Mon Persistent 
F1 ypaper 
.IRRITANT SKOKES* 
i 
Adamsite 
DNi 
Mon--'Per si stent 
Coal smoke 
Sneeze Gas 
. DA 
Mon‘Persistent 
Indefinite odor 
SCREENING SMOKES: 
t 
1 
' h i te phosphorus 
IVP 
Non-Persistent 
Phosphorus matches 
♦ Sulphur Trioxide Solution 
FS 
f'on -Persistent 
j Acid odor 
KexachIorethane 
HC 
Mon-Pers i stent 
Suffocating when very 
j dense 
INCENDIARY: 
Therm 11 
TH 
Non-Pers i stent 
No definite odor 
1 
- 94 - UNITED STATES SERVICE GAS.rj^L. 
GAS MASK CANISTER 
. 95 THE 4,2 INCH 
CHEMICAL MORTAR 
RIFLED, MUZZLE LOADING 
DESIGNED FOR HIGH ANGLE 
FIRE, RANGE’FROM SOO T6 
2,400 YDS. 
THE 4.2 IN. 
CHELA I CAL 
MORTAR 
r ! t r-1 1 1 
o j J n L L 
SHELL WEIGHS APPROXIMATELY 
25 POUNDS: CARRIES AN AVERAGE 
OF ABOUT o POUNDS OF CHEMICAL 
AGEA'T, 
-96- See that a i! 
joints are 
closed and that 
there are no 
openings 
SHELF LZTAI3 • 
AltEAFGEMERT CF GAS 
■RT. AWITOT <3 
Frames not closer 
than 4 feet at top 
for Medical Station/ 
8 feet 
HOST Z01TTAL GALLERY 
PROJECTING ESERANCB 
BLANK2P DETAIL 
-07- LIVERS PROJECTOR 
THIS IS A WEAPON OF LIMITED RANGE AND MOBILITY BUT OF 
HIGH EFFICIENCY, ITS RANGE IS 1,450 YARDS- THE RANGE 
IS CONTROLLED BY THE PROPELLING CHARGE USED, IT IS IN- 
STALLED AMD FIRED WITH AN ELEVATION OF 45°, 
GENERALLY MIRED IN GROUPS CF 20 
PROJECTORS CONNECTED IN SERIES 
LEAD WIRES 
EXPLODER BOX 
OR BLASTING 
MAC HINE , 
♦FUZE LI I CONSISTS OF PRIMER, TIME FUSE 
AMD DETONATOR 
♦♦BURSTER TUBE Ml 
METHOD OF WIRING PROJECTORS 
TO HIT A TARGET PITH A RIFLE ONE MUST 
NOT ONLY SEE IT BUT ACCURATELY AIM AT 
IT. FOG, HAZE AND EARLY DA’AN HAVE LONG 
BEEN USED FOR CONCEALMENT, SURPRISE AND 
TO REDUCE CASUALTIES If! AN ATTACK. SMOKE 
GIVES THE SAME EFFECT AS FOG OUT CAN BE 
CONTROLLED AS TO TIME AMO PLACE, SMOKE 
IS USUALLY FIRED BY ARTILLERY OR CHEMICAL 
TROOPS, ‘"HITE PHOSPHORUS (UP) PRODUCES 
THE BEST SMOKE AMD IN ADDITION '.ILL CAUSE 
GRASS AMO WOODS FIRES AMD IF A PIECE OF 
THE BURNING PARTICLE STRIKES THE BODY, 
IT MILL CAUSE A SEVERE BURN, 
THESE TR OOF 3 MAKE 
3? HITS 
12? HITS 
3? HITS 
OFFENSIVE FIRE IS 
FOUR TIMES AS EF- 
FECTIVE AG DEFEN- 
SIVE FIRE 
THESE TROOPS MAKE 
12? HITS 
SMOKE ON FIRERS 
SMOKE ON TARGETS 
LINE OF DEPARTURE 
CHEMICAL MORTARS FART TTO 
MEDICAL ASPECTS AIjD FIRST AID TREATMENT OF GaS CASUALTIES 
I, LUNG IRRITANT'S 
1, Phosgene (C,G,) 
a. Symptoms and Effects, 
Delayed usually two hours, vary with concentration* 
Usually irritation of nose and throat with coughing, 
difficult breathing, pains in chest, later pulmonary 
edema. 
b. First Aid Treatment. 
Remove the patient from gas atmosphere, if possible. 
Never remove gas mask until -patient is removed from 
gas area. All patients gassed or suspected of being 
gassed with lung irritants should never bo allowed 
to walk. 
Danger period - first AS hours. 
Loosen clothing, treat for shock, absolute rest and 
warmth, hot drinks (coffee, tea, cocoa, etc., no 
alcoholic drinks,) In blue cases - bleed - give 
oxygen, 
In gra2r cases - don't bleed - give oxygen and heart 
stimulants. No artificial respiration. 
Evacuate in prone position. 
2, Chlorpicrin (P.S,) 
a. Symptoms and Effects. 
Similar to Phosgene but more irritant and lacrimting. 
More apt to produce nausea and vomiting. Pulmonary 
edema may follow. 
Less toxic than Phosgene. 
b. First Treatment, 
Same as for Phosgene - in addition, wash splashes on 
skin with sodium carbonate or alcoholic sodium sulfite 
solution, 
3, Chlorine (CL) 
a. Symptoms and Effects, 
Similar to Phosgene but more irritant to the upper 
respiratory tract and less toxic. 
Coughing more pronounced than with Phosgene or Chlor- 
picrin, 
Pulmonary edema may follow, 
b. First Aid Treatment. 
Same as for Phosgene, 
A, Nitric Acid Vapors. 
a,' Symptoms and Effects, 
Similar to Phosgene, Irritation to nose, throat and 
lungs, later pulmonary edema. 
-99- b. First Aid Treatment, 
Same as for Phosgene, 
5, Ammonia, 
a. Symptoms and Effects, 
Prompt, marked irritation of eyes, nose, throat and 
lungs; effective concentration may cause temporary 
reflex stoppage of respiration. Bronchitis, laryn- 
gitis and pneumonia may follow, 
b. First Aid Treatment, 
Artificial respiration, inhalation of weak (acetic 
acid) vapor, 
NOTE: Service gas mask canister does not protect against 
ammonia; special canister is necessary. 
II. VESICANTS. 
1* Mustard (H.S.) 
af Symptoms and Effects, 
May be dolaved - average time of development of 
symptoms is about four to eight hours, 
(1) Syes - The eyes are very liable to injury, 
whether from liquid or vapor. Though there may 
be some delay in appearance of signs, such delay 
is less than in other areas of the body, A few 
hours after exposure, inflammation (conjunctivi- 
tis) sets in with smarting, watering and rapidly 
gets worse, and there is much pain, especially 
on exposure to light (photophobia), with discharges 
coming from between the swollen lids. Actual 
destruction of the eye and consequent blindness 
is rare,, but there may be some impairment of vision 
due to scars, 
(2) Respiratory System - Inflammation of the throat 
and windpipe (trachea) as a result of breathing air 
contaminated by the vapor of these liquids is fairly 
common. It produces dry and burning mouth and 
throat, with harsh, ringing cough. This cough is 
very characteristic and very distressing. Partial 
loss of the voice due to inflammation of the throat 
(laryngitis)is common. In most severe cases burn- 
ing of the lungs may produce pneumonia. 
(3) Digestive System - Inflammation of the stomach, 
with pa in and vomiting nay occur. This is the re- 
sult of swallowing contaminated saliva or the swal- 
lowing of contaminated food or drink. It is not 
serious as a rule, 
(A) Skin - Injury to the.skin develops in three 
states: reddening (erythema) with a fine rash not 
unlike ,!hives?!, blistering, and finally ulceration. 
-100- How far the casualty progresses toward the final 
stage depends on the original concentration of 
the chemical agent and the length of the patient's 
exposure to the poison. In case of contamination 
by liquid> blistering always occurs if stops are 
not taken at once to counter-act the effects. The 
areas of skin most likely to suffer from exposures 
to vapor are those which are normally moist, such 
as the bend of the elbows and knees, the armpit 
(axilla), the crotch, and the inner side of the 
thighs. The genitals are particularly liable to 
attack, 
b. First Aid Treatment - 
Remove.from gassed area, remove contaminated cloth- 
ing, If only portions of clothing splashed by liquid, 
cut those away, treat skin area underlying contamina- 
ted clothing. . • 
(1) ayes - Irrigate immediately with 2)i sodium • 
bicarbonate solution or saturated boric acid solu- 
tion or normal saline solution* Repeat irrigations 
several times, wo cocaine, no covering, except dark 
glasses, 
(2) Respirator;/ System - If gas is breathed, treat 
as lung irritant casualty, 
(3) Digestive System - Pain in stomach and vomiting 
..can be temporarily relieved by warm sodium bicarbon- 
rate solution* 
(A) Skin - If liquid, remove excess with cloth 
sponges, Vfcsh with solution of dichloramine T, in 
triacetin; *if not available, wash area with kerosene 
alcohol, gasoline (without lead), carbon tetrachlo- 
ride, or hot water and soap. Use IW* ointment, 
bleach paste or weak solution of chloride .of line 
(bleach solution), using fresh cloth each tine. 
After this use hot water and soap - If redness of 
skin has developed, no K-A ointment, nor bleach 
solution is used. Blister should not be opened. 
If in hospital 'under aseptic technique and blisters 
are uncomfortible, blisters may be drained. Treat 
as ordinary heat burns, all contaminated clothing 
. should be burned or buried, 
2, Nitrogen mustards, 
a. Synptoms and Iffocts, 
..Similar to mustard and in addition have a systemic 
action i.e, destroys leukocytes, lymphoid tissue, 
blood forming org<ans, and certain areas in central 
nervous system, * . ... 
-101- (1) Eyes - vary greatly in their power to damage the 
eye* Some do greater damage to the eyes than mustard 
and soma less. Action similar to mustard. 
(2) Respiratory System - Action similar to mustard, 
less volatile, may be less dangerous in field than 
mustard. More volatile members are 1/3 to l/2 as 
damaging to respiratory system than mustard, 
(3) Digestive System - Severe irritation and areas 
of destroyed tissue are found when the agent is 
swallowed • 
(A) Skin - More resistant to vapors of these agents. 
In severe exposures, action is similar to mustard; 
redness, blisters, ulceration (blisters are more 
shallow than with mustard,) 
b. First Aid Treatment* 
Gas mask* Remove from gassed area. Liquid splashed 
clothing should be removed, treat skin area underly- 
ing contaminated clothing, 
(1) Eyes - 'lash with water immediately for several 
minutes or if available 2% sodium bicarbonate, satur- 
ated boric acid solution, normal saline solution, 
(2) Respiratory System - If gas has been breathed, 
treat as lung irritant casualty. 
(3) Digestive System - Pain in stomach and vomiting 
can be relieved by giving weak sodium bicarbonate 
solution. 
(/+) Skin - 11-4 ointment applied to skin as for 
other vesicants agents, Hash with water and soap. 
If redness of skin has appeared, do not use oint- 
ment, but wash with soap and water. If blisters 
develop and necessary to drain, do so under strict 
aseptic technique* 
3, Lewisite, 
a. Symptoms and Effects - more severe and more rapid than 
Mustard* 
(1) Eyes - If unprotected, eyes irritated imme- 
diately, Similar to mustard. 
(2) Respiratory System - If breathed, powerful lung 
effect"in 1/2 hour, "Bronchitis and pneumonia may re- 
sult. Action similar to mustard. 
(3) Digestive System - Action similar to mustard, 
(4; Skin - Shows slight irritation in 15 minutes 
followed by grayish discoloration and blister - 
ing in 30 minutes to one hour, later ulceration, 
b. First Aid Treatment: Must be immediate. Treat similar 
to mustard, 
(1) Eyes - Same treatment as for mustard, or M-l 
solution. 
-102- (2) Respiratory System - If gas is breathed, treat 
as lung irritant casualty, 
(3) Digestive System - Sane treatment as for mustard.' 
(A) Skin - If liquid, remove excess with cloth sponge, 
swab with hydrogen peroxide (S%). If not available, 
wash with 5% sodium hydroxide solution, then soap and 
water. If sodium hydroxide is not available, cleanse 
vapor burns with soap and water, cover this with 
ferric hydrate paste and gauze. Blisters should be 
opened and fluid must bo prevented from contaminating 
other skin areas, 
A* Ethyldichlorarsine (ED) 
a. Symptoms and Effects, 
Irritation, redness and burning of the skin; inflam- 
mation of eyes and eye lids; irritation of respiratory 
tract with marked sneezing, 
b. First Aid Treatment, 
General treatment same as for Lewisite, 
Ill, LACRIMAT0R3 
1, Tear Gas Solution (Chloracotophenone, Chlorpicrin, Chloro- 
form) (CDS). 
a. Symptoms and Effects, 
Immediate tearing and pain and fear of the light, 
prickling or itching of the skin, 
b. First *id Treatment, 
Face wind with eyes open; in more severe cases, wash 
. eyes with 2% sodium carbonate or saturated boric acid 
solution, DO NO? RUB OR BANDAGE EYES, Persistent 
pain may be relieved by instilling 2% butyn sulfate. 
If necessary, skin nay be washed with sodium bicar- 
bonate solution. 
2, Chloracotophenone (CM) 
a. Symptoms and Effects. 
Similar to CDS, with perhaps less action on the skin, 
b. First aid Treatment, 
Same as for Tear‘Gas Solution, 
3, Brombenzylcyanide {CA) 
a. Symptoms and Effects. 
Severe tearing and nasal irritation, 
b. First Aid Treatment, 
Same as for Tear Gas Solution, 
IV. STSRNUTATORS (Toxic Smokes) 
1, Diphenylaminechlorarsj.no (Adamsite) (Dll) 
a. Symptoms and Sffoots. 
Snoozing, with burning, aching pains in nose, throat, 
chest, sinuses, followed by headache, sinus pains, 
nausea and often mental depression. 
-103- b. First Aid Treatment, 
Inhale chlorine fumes through nose and mouth from 
bleach bottle; acetylsalicylic acid may be taken 
orally to relieve pain. Physical restraint and 
sedatives may be necessary to prevent self-injury, 
due to marked mental depression, 
2, Diphenychlorarsine (DA) 
a. Symptoms and Effects, 
Same as for Adamsite (DM) 
b. First Treatment, 
Same as for Adamsite (DM) 
V, SYSTEMIC POISONS 
1, Hydrocyanic Acid (HON); Prussic Acid, 
a, Symptoms and Effects, 
Low concentration of vapor may cause giddiness or 
headache; effective' vapor concentrations of the 
liquid rapidly produces convulsions, unconsciousness, 
or death from tissue asphyxia or medullary paralysis, 
b. First Aid Treatment, 
Inhale amyl nitrite. Give artificial respiration 
if necessary. Sodium nitrite, sodium thiosulfite, 
or methylene blue should bo given intravenously, 
2, Arsine (AsH-^) 
a. Symptoms and Effects, 
Shivering, weakness, giddiness, nausea, vomiting, 
headache, gray color, collapse; hemolysis, anemia, 
anuria, uremia, 
b. First Aid Treatment, 
Absolute rest; evacuate in prone position. Ferric 
hydroxide or arsenic antidote by mouth may be 
tried. Give large amounts of fluid, blood trans- 
fusions, and try to promote diuresis, 
3, Hydrogen Sulfide (HpS) 
a. Symptoms and Effects, 
Irritation of eyes, nose, respiratory tract; 
bronchitis; high concentrations cause unconscious- 
ness and death, 
b. First Aid Treatment, 
Absolute rest; artificial. Give oxygen-carbon 
dioxide and blood transfusions, 
A, Carbon Monoxide (GO) 
a. Symptoms and Effects, 
Dizziness, headache, weakness, nausea and vomiting, 
feeling of constriction in thorax, followed by 
drowsiness, visual disturbances, stupor, uncon- 
sciousness, weakened pulse and respiration, and 
death. 
-104- b, First Aid Treatment. 
Artificial respiration, administration of oxygen 
or oxygen-carbon dioxide; venesection with trans- 
fusion of healthy blood may be valuable. 
VI. INCENDIARIES 
1* IThite Phosphorus (T«T) 
a. Symptoms and Effects, 
Severe bums depending on size of articles and 
length of contact. 
b. First Aid Treatment. 
Covered burning surfaces with water or preferable 
5$ copper sulfate solution, and remove phosphorus 
particles with forceps. Further treatment same' as 
for ordinary burns, 
2, Thermit (TH) 
a. Symptoms and Effects, 
Same as with white phosphorus. 
b. First Aid Treatment. 
Spray burning areas with water, and remove pieces 
of material. Further treatment, same as for or— 
d inary burns*. 
3. Electron Bomb- 
The electron bomb is a magnesium case filled with fast 
burning thermit, The thermit sets fire to the magnesium 
case which is the effective incendiary material in this 
bomb. Electron bombs are being widely used in the pre- 
sent European conflict*) 
a. Symptoms and Effects. 
More severe penetrating burns than with white phos- 
phorus or thermit, as it continues to burn in tis- 
sues in presence of moisture, 
b. First Aid Treatment, 
Remove burning material. Treatment of injuries that 
of ordinary burns. 
SUMMARY OF FIRST AID PROCEDURE FOR CHEMICAL WARFARE AGENTS 
USE GAS MASK AS FIRST STEP 
FOR MUSTARD ON SKIN 
1. Remove and discard all contaminated clothing. 
2. Remove excess mustard on skin rath cotton waste or cloth. 
3. Apply protective ointment, MA, and rub in for 20 sec ends; 
remove and reapply, repeating A or 5 times, 
A. Pfash thoroughly with soap and water. 
-105- 5* Use only soap and water if redness has appeared. Do not use 
protective ointment, M4, after redness or blisters have de- 
veloped* 
FOR LStTISITB ON SKIN 
1, Remove and discard all contaminated clothing. 
2, Remove excess lewisite on skin, 
3, Apply 8% hydrogen peroxide frequently for 4 or 5 minutes, 
4, Wash thoroughly with soap and water, 
5, Protective ointment, M4> is applied, removed, and reap- 
plied, repeating 4 or 5 times, if H.5O2 is not available. 
It should be used within 5 minutes after exposure* 
FOR MUSTARD IK EYES 
1, Wash immediately with water from canteen and continuously 
for 5 to 10 minutes. Use canteen cap as an eye cup* 
2. Remove to hospital or medical officer. 
FOR LEWISITE IN EYES 
1. Use eye solution M-l; 2 to 4 drops in each eye. Do not 
repeat, 
2. Treat as for mustard if eye solution M-l is not available. 
FOR NITROGEN MUSTxRD HN - 2, HN -3 
1, Use soap with an abundance of water, 
2, For eye treatment use same procedure as for mustard gas. 
FOR LUNG IRRITANTS - CHLORINE, PHOSGENE, 
v.NQ CHLORPIGHIN CASUALTIES 
1, Put at absolute rest in prone position, 
2, Cover with blankets, overcoats, or other material to keep 
patient warm, 
3, Give warm, drinks such as tea, coffee, or cocoa. No alcohol, 
4, Remove to hospital as litter case. 
FOR T&Jl GAS - CN, CNS, CNB 
1, Wash eyes with water from canteen if there is still burning 
in eyes after coming out of the area, 
2, Tear gas should bo removed from skin by l+% sodium sulphite 
in 50$ slcohol, or washed with soap and water. 
-106- FOR IRRITANT SMOKES - DM, DA 
1, 'fear mask as long as there is danger of exposure. 
2, Take aspirin for headache, 
3, Irrigate nose and throat with 2 % sodium bicarbonate solution. 
4, Do not leave unit. 
THITE PHOSPHORUS - IIP 
1, Immerse in water or :cover with 5% copper sulfate solution, 
2, Remove to medical department for removal of particles and 
treatment of burn. 
-107- H3TGIEME AND SANITATION 
AND 
SOCIAL HTOISNE PART ONE 
HYGIENE AND SANITATION 
In the military service we interpret the term ’•hygiene'1 
as a science having a personal application to an individual and 
the term ’’sanitation” as the act of applying the laws of hygiene 
to groups of individuals. 
I. Personal hygiene refers to those measures or precautions which 
every person should observe for the purpose of maintaining his 
own health and physical well being. It requires the applica- 
tion of a few common-sense rules, the observance of wholesome 
habits, and the avoidance of excesses of all kinds. 
Hygiene and Sanitation is the preventive medicine which carries 
out the functions of the Medical Department in the dictum ”To 
Conserve Fighting Strength”, This function is performed by 
selection of healthy men who are thereafter maintained in healthy 
fighting strength by hygiene and sanitation® Care of the sick 
and wounded is but the second half of the responsibility which 
occurs when preventive medicine is inadequate. 
The Commanding Officers are directly concerned with, and res- 
ponsible for health and strength of their own commands. 
The Medical Department is charged with instituting and super- 
vising training in and maintenance of Hygiene and Sanitation, 
A. Simple Rules for Maintaining Health, 
1# Stay away from any person having disease unless it is 
your duty to care for him, 
2. Be sure to use your mosquito bar when mosquitos are 
present. 
3. Flies and cockroaches carry disease and leave it on 
food. Get rid of flies every way; fly traps, fly paper, 
fly swatters. Keep doors and window screens closed, 
garbage cans covered. Scraps of food should be placed 
in garbage cans and not left lying 'around. 
4. Do not drink any water unless you are sure it is safe 
and pure. Drink plenty of water at intervals during 
the day. Don’t overdrink, especially when overheated 
after exertion. Drink from your own glass or cup, or 
from a bubbling fountain - it is possible to catch 
disease from other person's pipes, musical instruments, 
drinking cup, shaving brush, etc. Do not drink or eat 
in restaurants or soda fountains, unless you are cer- 
tain they are clean, 
5. Bathe frequently, wash hands thoroughly before eating 
and after using toilet. 
-108- 6, Brush teeth once or twice daily and before going to 
bed. Have dental officer check teeth twice each year. 
7, Take sufficient length of time to eat your meals- 
chew all good thoroughly. 
8, Acquire the habit of'having bowels move regularly once 
each day; use toilet to urinate or move bowels. Urine 
or feces deposited on the ground attracts flies and 
later flies deposit germs on food, or rainwater may 
carry germs into wells and streams, contaminating 
water supply. 
9, Mattresses and bedding should be hung out in the 'sun 
for at least two hours, once each week and more often, 
if possible. Red bugs should be watched for and if 
found, destroyed. 
10, All squad rooms must be thoroughly ventilated, es- 
pecially at night. All such rooms should be thorough- 
ly aired daily. 
11, Keep rooms clean. ’Then sweeping them, use something 
to prevent raising ‘dust. 
12, Have your underwear, shirts and socks washed fre- 
quently and change them at least twice a week. Be 
on the lookout for body lice and crab lice, 
13, When your clothing or shoes become wot, change as 
soon as possible. Sitting around in wet clothes or 
with wet feet is almost certain to give you a ncold?’ 
or possibly pneumonia. 
14, Wear clothing of proper weight for the climate in 
which you are serving. Wear an overcoat when out- 
doors in cold weather. Clothing should fit loosely, 
15, Keep your hair cut short and wash it frequently. 
Keep your fingernails clean. 
16, Do not drink intoxicating liquor. It may contain 
poison such as wood alcohol, -alcoholism leads to 
sexual indulgence, 
17# Avoid venereal diseases. They'constitute one of the 
greatest dangers to which the soldier is exposed, 
IS, Clothing - protection of body from heat in summer, 
cold in winter and chilling effects of rain and 
wind, 
a. Wool - poor conductor of heat and good absorber 
of moisture; keeps in heat of body in winter and 
. keeps out sun in summer, 
b. Cotton and linen - good conductors and poor ab- 
sorbers of moisture'- excellent in summer, 
c. Color - no influence on temperature of body ex- 
cept in direct sun rays; black and dark colors 
absorb' sun rays; white and yellow reflect them* 
d. Texture - loosely woven material is warmer; 
hence, warmth of fur and feather. 
-109- • TOE NAILS PROPERLY CUT 
SHOE FITTING 
EFFECT OF A SHOE TOO SHORT 
CORRECT 
TOO NARROW 
TOO WIDE 
EFFECT OF A POINTED TOE-SHOE 
A GOOD FOOT IN A WELL FITTED 
SHOE 
CORRECT 
T-00 SHORT 
-no- 19* Care of the feet, 
a. The most important factor in the marching ability 
of the soldier is the proper care of the feet. 
Serious defects of the feet can be prevented by 
properly fitted shoes and socks. Sore feet 'are 
generally due to carelessness, neglect or ignor- 
ance , 
(1) Shoes: only field shoes issued by the Q.II, 
should be worn in the field by the soldier, 
and they must be properly fitted. Don’t wear 
new shoes on a march; break shoes in first, 
(2) Socks: only woolen socks should be worn 
for marching. Cotton socks shouldn’t be worn 
for marching unless ordered by Medical officer. 
Socks should be large enough to permit free 
movement of the toes, but not so loose as to 
permit wrinkling. Darned socks or socks with 
holes are not fit for marching, 
(3) Clean feet are important. Feet should be 
washed and socks changed each day; especially 
important on a march. After a march, feet 
should be washed and clean socks put on, and 
shoes changed. Until feet are hardened, dust 
with foot powder before arid after each day’s 
march; applying lard to the feet before a 
march may prevent irritation of the feet, 
(A) If blisters have appeared on the feet, they 
should be painted with iodine and emptied by 
pricking them at the lower edge with a pin 
which has been passed through a flame. Serious 
abrasions should be treated at dispensary or 
aid station, 
(5) Too nails should bo kept short and clean. 
Should be cut straight across and not on a 
curve, 
(6) Ringworm or ’’Athlete's Foot” — foot infection. 
Prevention is most important, but when cases 
develop, thorough treatment should be admin- 
istered, 
B, Rules for Avoiding Disease during Field Service, The 
following rules apply in the field and equally as well 
in permanent camps or stations, 
1, Do not drink water which has not been declared po- 
table or pure by a Medical officer, 
2, Do not soil ground with stools or urine. Use la- 
trine • 
3, Be sure mess kit is washed in soapy water after 
being used, . 
4, Use mosquito bar in regions where mosquitos are 
present, 
5, Do not sit or lie directly on damp ground, 
6, Ditch the tents as soon as put up, 
7, Prepare bed before dark. 
-Ill- 8, Never use cups, pipes, cigars, gas masks, etc,, 
which are used by ethers. 
9, Where a supply of water is adequate, drink plenty. 
On the march, use sparingly. Don’t drink large 
quantities of water when overheated* 
10, Move bowels daily, 
11, Wear clothing of proper weight for the climate, 
12, Keep hair cut short and fingernails clean, 
13, Never throw pieces of food or refuse around camp, 
14-, If possible, avoid all contact with diseased persons, 
15, Avoid venereal diseases, 
II. Communicable Diseases 
A, Definition; communicable diseases are those diseases 
which can be transmitted from one person to another. The 
term, ’’communicable”, is synonymous with 
’’contagious” or ’’epidemic disease”. 
1, Importance; this group accounts for a considerable 
part of the admissions to sick report, both in peace 
and in war. 
2, Cause: by the growth on or within the body by certain 
organisms commonly called "germs” or by viruses, 
3, Glassification, 
a. Respiratory -* those diseases in which the casual 
agents are el3.mine.tQd in discharges from the 
mouth, noso, throat and lungs, 
b. Intestinal - those diseases in which the causal 
agents are eliminated in the urine and faces• 
c. - those diseases which are transmitted 
by blood-sucking insects, 
d. Venereal - these diseases which are usually 
transmitted during sexual contact. 
e. Miscellaneous - those diseases which are preventable 
but which do not readily fall into the above groups. 
Among those are tetanus, (lockjaw), rabies 
(Hydrophobia), scabies, trichophytosis (ringworm) 
and anthrax, 
A. Spread of Communicable Diseases. 
a. Sources 
(1) Case - person actually ill with a disease, 
(2) Carrier - a person who, although not ill, 
is giving off from his body organisms capable 
cf causing disease - typhoid, diphtheria, etc, 
(3) Animals - infected animals - Rocky Mountain 
Spotted Fever, 
(4.) Blood sucking insects - mosquitos, lice and 
ticks - transmit causal agent or disease from 
p•rson to person, 
b. Transmitting agencies. 
US (1) Contact - either by direct contact or 
close association between a case or carrier, 
and one who is susceptible to the disease. 
Respiratory and venereal diseases are usually 
transmitted by contact. 
(2) Water and food - causal organism eliminated 
from the body in the feces and urine of case 
or carrier, and through water and food 
transmitted to susceptible individual. 
Intestinal diseases are transmitted through 
water and food, 
(3) Unusual or Multiple Agencies - many diseases 
are usually transmitted by indirect contact, 
and are also transmissible by food and water, 
or vice versa. Diseases that may be 
transmitted by food and water, as.well as by 
hands, mess kits, etc., are diphtheria, septic 
sere throat, scarlet fever, tuberculosis, 
typhoid and paratyphoid, dysentery and diarrhea. 
5. Susceptibility and Immunity 
a. A susceptible person i>s one who will develop the 
disease if infected with specific organisms or 
viruses. 
b. A person is immune to a given disease when the 
tissues of his body have developed the power to 
combat and overcome the specific organisms or 
viruses. 
c. An individual may be rendered immune or non-sus- 
ceptible to certain diseases by an attack of the 
disease. Examples': scarlet fever, measles, 
mumps, etc, 
d. Vaccination against small pox and typhoid fever 
renders immunity to those diseases for a limited 
period and then vaccination must be repeated, 
0. Natural immunity is the ability to overcome small 
doses of disease organisms and not develop the 
disease, 
f. An attack of a disease or vaccination gives only 
temporary immunity in many of the communicable 
diseases. 
6, Control of Communicable Diseases 
a. Control of sources - supervision of cases and 
carriers with a view to preventing the transference 
of the causal agents to others. 
b. Control of transmitting agencies, 
(1) Proper ventilation of barracks and tents. 
(2) Prevention of overcrowding, 
(3) purification of water, 
(4) Proper sanitation of messes. 
(5) Proper waste disposal, 
(6) Control of disease bearing insects. 
-11"- c. Protection of susceptibles 
(1) Improve health of all individuals. 
(2) Vaccination against small pox, typhoid fever, 
d. Individual education? instruction of all individuals 
in the fundamentals of personal hygiene and the 
rigid observance by them of its rules. 
III. Respiratory Diseases are more prevalent in winter and spring, 
and when large groups of recruits are assembled* They spread 
in the secretions of the respiratory tract and may be 
transmitted through air, hands, food, mess equipment or any 
other substances which come in contact with secretions of the 
mouth and nose. 
A. Classification. , 
Mumps, measles, diphtheria, scarlet fever, common 
respiratory diseases (cold, acute laryngitis, acute 
tonsillitis and acute bronchitis), influenza, pneumonia, 
meningitis (cerebrospinal), pulmonary tuberculosis, whooping 
cough, plague and poliomyelitis. 
B. Control Mensures 
1. Proper ventilation. 
a. Ventilation is the adjustment of atmospheric 
conditions so as to promote health, comfort and 
efficiency. 
b. The ill effects of poor ventilation above are due 
to heat, moisture and stagnation of the air 
surrounding, the body. 
c. Proper ventilation of an occupied barracks or 
quarters requires that the air be moved through 
the room; there must be a proper balance between 
heat, moisture and air movement, to effect good 
ventilation, v 
2. Proper bed spacing. 
In barracks each man should have a floor space) of 
60 sq. feet and an air space of 720 cubic feet. Place 
beds sc that sleeping occupants will not spray 
secretions from nose and throat. Cubicles are made 
either by screens, sheets or shelter halves. 
3. Prevention of overcrowding; the control of crowding 
or close contact is the most important factor in the 
control of respiratory diseases. 
-4, Barracks and tent cleanliness, 
a. Certain sanitary precautions are essential to 
cleanliness and the following should be prohibited, 
(1) Spitting on the floor. 
(2) Dry sweeping of the floors, 
(3) Careless coughing and sneezing. 
(4) Use of common towel and drinking cup. 
5. Suitable clothing and bedding? fatigue or chilling will 
in many instances lower the resistance of the individual, 
Sufficient bedding to prevent cM1 ? ny or the body 
must be used, 
■ 6, Mess sanitation; mess gear and utensils should be 
thoroughly sterilized* PRINCIPAL 
TRAN3M13SI ON 
AGENCIES 
CONTROL OF 
TRANSMISSION 
AGENCIES 
PROTECTION 
OF 
SU3CEFTISLES 
CONTACT 
BY 
air 
HANDS 
FOOD 
AND 
MESS 
EQUIPMENT 
AIR 
IMMUNIZATION 
ISOLATION OF CASES 
AND CARRIERS 
Ventilation of 
Barracks 
Bed spacing in squad 
root. 
Cubicled beds 
Prevention of 
crowding 
QUARANTINE OF 
CONTACTS 
WARM CLOTHING 
PERSONAL CLEANLINESS 
CASE 
OR 
CARRIER 
HANDS 
Individual, personal 
cleanliness 
FOOD' AMD MEGS 
EQUIPMENT 
Disinfection of 
dishes 
and mess equipment 
Sanitation of 
kitchens 
C leanliness and 
supervision of 
food Hanoicrs 
GENERAL FACTORS JjT THE CONTROL OF RESP IRATORY DISEASES. CASE 
OR 
CARR IER 
TRANSMISSION AGENCIES 
WATER 
FOOD 
FLIES 
HANDS 
GENERAL FACTORS IN THE CONTROL OF INTESTINAL 
DISEASES, 
CONTROL OF 
TRANSMISSION AGENCIES 
WATER 
Protection of raw water by proper 
sewage disposal* 
Purification of water supply* 
Protection of purified water* 
FOOD 
Supervision of sanitary conditions under 
which food is produced, transported and 
stored. 
Meat inspection* 
Pasteurization of Milk* 
Elimination of contaminated food supplies 
by inspection* 
Physical examination of food handlers to 
eliminate carriers and sick* 
Cleanliness of individual food handlers* 
Sanitation of kitchens, 
FLIES 
Control of breeding places* 
Protection of food from flies. 
Destruction of adult flies, 
HANDS 
individual, personal cleanliness 
IMMUNIZATION 
against Typhoid and 
Paratyphoid Fevers 
PROTECTED 
TROOPS TYPHOID FEVER ADMISSIONS 
Years: 1898 - 1935 
Enlisted Men in United States 
Army 
Rates Per IGOO Strength Per Annum 
tyoluntary Prophylactic 
|'i Vaccination Type 
J i 
I ! 
■ 
Universal Prophylactic 
Vacqinatipn Type 
I POLLUTION OF WELL BY SEEPAGE FROM PIT PR IVY 
PJP.ILQJ-l.ftH ftE 5M1X SI FflOFEB USE OF STREAM FROM :MH1CH." XATER Jj* TAKEN FOR 
VARIOUS PURPOSES. SIMPLE FILTER USING TWO BARRELS,ADAPTABLE TO FIELD USE. 
THE SMALLER BARREL JS SET INSIDE THE LARGER AND THE FILTER LAYERS ARRANGED 
AROUND IT, WATER ENTERS THE FILTER OUTSIDE THE SMALL BARREL AND BY PROCESS 
Or '//ATER SEEKING ITS OEM LEVEL COMES UP INSIDE THE SHALL BARREL AS FILTERED 
WATER, FOLLOWING ROUTE INDICATED BY ARROWS, 
DIAGRAMMATIC SECTION OF TYPICAL SAND FILTER SHOWING PERFORATED LATERAL DRAINS 
DELIVERING FILTERED WATER AT THE BOTTOM. WATER STEP1LI ZING BAG. 
I. The technique Is as follows: 
a. Fill the bag, suspended on a tripod, to within four inches of the top, 
b. Draw a small quantity of water through one of the faucets into a canteen 
cup, 
c. Break an ampule of calcium hypochlorite into the canteen cup, stir with 
a clean stick until a thin paste is formed, then fill the cup two«*thirds 
fulI of water, 
d. Empty the above solution into the water bag and stir thoroughly with a 
clean stick long enough to reach to the bottom, 
e. Draw about 1/3 canteen cup of water from each of the faucets and pour it 
back into the water bag, 
f. Wait ten minutes, then wash out one of the faucets by allowing a small 
amount of water to run through onto the ground. Fill a clean canteen cup 
2/3 full of water from the same faucet, 
ot Add one cc, (!3 drops) of orthotolidjne testing solution to the water in 
the cup. Pail 2 minutes and note the color produced. Below is a guide 
for reading the reaction between free chlorine and orthotolidloej 
:jo color - insufficient chlorine. Add more calcium hypochlorite, 
Canary Yellow - insufficient chlorine. Add more,calcium hypochlorite. 
Deep Yellow - Satisfactory chlorination, being about one part per million 
(ppm) of chlorine. 
Orange Red - Over-chJorinated; add more water and retest. 
Bluish Green - Alkaline or hard water. Add few more drops of orthotoltdine 
to get a correct color reading, 
h» Allow to stand 3$ minutes after satisfactory chlorination has been 
accomplished. The unpleasant taste of over-chlorinated water is diminished 
by allowing it to stand several hours before using. It is a good plan to 
chlorinate water in the evening for the next day's use. MOBILE WATER PURIFICATION UNIT SHOWING INLET HOSE AND THE FILTER 
WASTE LIME. 
ELEVATED WATER STORAGE TANK FOR USE IN THE FIELD WITH THE MOBILE 
PURIFICATION UNIT. THIS TANK HOLDS APPROXIMATELY 400 GALLONS OF 
WATER. 7. Recruits; incoming recruits should be kept apart 
from other troops at least 2 weeks. 
8. Hospitalization; all cases of illness with symptoms 
accompanied by a temperature of 100° F., or above, will 
be suspects and hospitalized, 
9. Immunization; with the exception of diphtheria and 
scarlet fever, the present status of immunization 
against other diseases in this group is one of 
experimentation. 
IV. Intestinal Diseases 
A. Definition; tho intestinal diseases are those in which 
the causal agents are eliminated from the body in tho feces 
and urine, 
B. Classification; typhoid fever, paratyphoid fever, common 
diarrhea, bacillary dysentery, protozoal dysentery,cholera, 
helminthic infestations (worms), undulant fever, food 
infection, botulism, 
C. Control Measures; 
1, General; effective control of intestinal diseases is 
based on the control of environmental conditions with 
a view to preventing tho transmission of the causal 
organisms by water and food, 
2. Routine measures, 
a. Purification and protection of water supplies, 
b. Proper inspection and protection of food supplies, 
c. Proper mess sanitation - physical examination of 
food handlers. 
d. Proper waste disposal, 
e. Fly control, 
f. Immunization - typhoid and paratyphoid, cholera, 
bacillary dysentery. 
g. Rigid personal hygiene of all individuals, 
h. Rigid discInline in matters of sanitation, 
D. Concurrent and. Terminal Disinfection. 
1. Feces -and urine of patients with intestinal diseases 
must be disinfected. 
2. Any article which might be soiled by excreta must be 
disinfected, 
3. Patients should have separate dishes and eating utensils 
should be boiled after use. Food left ever by these 
patients should be destroyed, 
Um All sheets, pajamas, towels or similar articles should 
b e d i s i nf e c t ed, 
5. Terminal disinfection should consist generally of 
thorough cleaning of ward or room and disinfection of 
the bedding. 
E. D'ater and its Purification, 
1. Amount of water needed by average man varies according 
to exercise, temperature, etc. In the field or 
temporary camp, 2 to 5 gallons per day per man are 
required. In permanent camp, it varies from 50 to 200 
gallons per day. 2, Viator Source, 
a. Surface raters - ponds, rivers, small streams, 
b. Ground rater - veils or springs, 
3. Purification, 
a. Boiling or distillation, 
b. Chemical treatment - chlorination or use of iodine, 
c. Filtration, 
F, Disposal of 'Tastes; essential in the control of communicable 
diseases, especially intestinal group. 
1, Classification; 
a. Human wastes - excreta, solid rind liquid and bath 
water• 
b. Kitchen wastes - liquid and solid, 
c. Animal wastes (manure) 
d. Rubbish, 
2, Disposal of human wastes; most important in transmission 
of intestinal diseases, 
a. Latrines - seats or space are provided to accomodate 
5 to 10$ of the commend at one time, each man allowed 
2 feet of latrine space, 
b. Latrines should be flyproofed, 
c. Latrines should not be dug below ground water level, 
or dug in clay, as liquids are not absorbed, 
d. Disposal by drying. Dried in sunlight and when dry, 
removed, burned or used to fill low areas, 
e. Composting; is the close packing of manure on a 
platform. It is recommended for semi-permanent 
camps. The efficiency of this method is due to 
the heat generated within the center of the manure 
pile which is l/+0° F. to 160° F. Thereby, fly larvae 
are destroyed, (fly larvae being killed at 115 u F,) 
f. Burning; requires large amount of wood and oil un- 
less manure is thoroughly dried; impracticable in 
wot climate, 
A, Disposal of Kitchen "Taste, 
a. Kitchen waste consists of the food remnants accumu- 
lated after meals and in the preparation thereof, 
as well as the water in which the kitchen utensils 
and mess gear have been washed. Solids, l/2 lb, 
per person per day; liquids 200 to 1000 gallons 
per company of 200 men per day, are averages, 
b. Garbage Disposal, 
(1) burial; on march or bivouac, in trench 2 to 
3 feet deep, which should not be within 100 
feet of any source of water used for drinking 
or cooking, 
(2) Sale or gift; may sell or give garbage to 
farmer. Must be divided into edible and non- 
edible portions at the kitchens, Non-edible 
articles aro; coffee grounds, tea leaves, 
eggshells, banana peels and stalks, fish heads 
and scales, citron rinds, tin cans, paper and 
other rubbish. LATR INE BOX SHOEING DIFFERENT SECTIONS, 
FLYPROOFING LATRINE FIT. A- Oil soaked burlap 
extending completely around pit; 8 - opening of pit} 
C n sidewall of excavation in which burlap is placed. 
METHOD OF FLYEROOFING LATRINE PIT PITH OILED SURLAF. 
A - Layer of earth replaced and tamped down over 
oil soaked burlap} B - oiled burlap exposed before 
replacement of earth} C - opening of pit. 1. Standard Latrine Box. 
2. Trough Urina1. 
3. Pipe leading from urinal trough to 
latrine pit. 
A. Latrine Fa i1 
3. Hinged Doors 
C, Self-closing Lids. 
straddle trench latrp-e "■Undercut 
ft 
flemove 
COMPOST PLATFORM » - This platform Is constructed by leveling off an area of ground, 50 feet 
long, and 20 feet wide, digging a trench around the area, 12 inches deep with vertical sides. 
Constructing a second trench, very shallow, not over 3 inches deep and 4 Inches wide, and 
located just within the edge of the platform. The manure is placed on the platform as 
follows* Beginning at one corner, place the manure on an area 3 1/2 ft, long and 10 ft, wide, 
piling it to a height of 4 to 5 feet, packing it down very tightly and dressing the sides 
neatly. The sides must, at alt times, be kept vertical. The second day's supply of manure is 
placed on the adjacent corner In a similar manner. On the third day, the supply of manure is 
placed immediately adjacent to the first pile and on the fourth day, adjacent to xhe second 
pile and on the fifth day the supply is piled on top of the first pile. The manure is thus 
placed on the platform in the succeeding small sections, as shown in the diagram. This is done 
for the purpose of confining tire fly breeding to the smallest possible area. The manure should 
be kept mojst so cs to promote decomposition. The sidos of the pile should be sprayed daily 
with a mixture of cresot, kerosene and fuel oil. Crude oil or a light road oil is used in 
the trenches, the earth in the trench being kept visibly moist with oil. In the preparation 
of the platform, all vegetation should be removed for a distance of 2 feet from the edges, 
the earth here tamped down firmly and oiled thoroughly; similarly, the earth beyond the 
trenches should be freed from vegetation, packed down and oiled. The trenches are to be 
kept clean at all times, A platform this size should care for the manure of 100 animals 
for two months. (3) Hog feeding: this is not feasible unless there are at 
least 500 troops in camp for considerable period of 
, time. This mil care for 10 to If hogs. 
(4) Reduction: cost of reduction plant renders it impracti- 
cable for camp or cantonment# 
(f) Close incineration: closed incinerators are of two 
types: low temperature - 1400°?, and high temporature- 
1B00°F. 
(6) Semi-closed incinerator; is more easily built than clos- 
ed type, and is protetod from rain -and wind. Incline 
plane incinerator - a type, semi-closed and will consume 
the garbage from about 1000 troops and is easily con- 
structed# 
(?) Open incinerators: garbage nay be disposed of by open 
incineration. The multiple shelf or rock pile inciner- 
ators# 
(8) The company incinerator of choice is the barrel and 
trench incinerator: this consists of a barrel-like 
stack which is placed over the intersection of two 
cress trenches, 1 foot wide, 10 feet long, crossed at 
right angles. The tranches slope from surface of ground 
at each end to 18 inches at center of intersection. 
Other types of company incinerators are; rock pit which 
is not economical to operate on account of fuel consump- 
tion; the drying pan incinerator may bo used if it is 
difficult to dispose of liquid kitchen wastes. 
(°) Garbage collection and stands: garbage should be col- 
lected in standard galvanised iron cans with tightly 
fitting lids. In scud-permanent camps garbage stands 
should bo built adjacent to the kitchens and on solid 
concrete blocks, 
5. Disposal of Liquid 'Tastes. 
a, .There sowers are available, liquid kitchen wastes may be 
disposed of by dumptirjginto sewers. Most camps find this is 
not possible, so liquid, waste must be disposed of in the 
soil; to prevent clogging and to facilitate absorption, 
greases should be removed before being discharged into pit 
or.trench. 
(1) in bivouac: liquids are disposed of in trenches or 
pits, 
(2) Soakage pits: same as urine soakago pit except that 
it is equipped with a grease trap instead of urine 
trough. 
(3) Filter grease trap: pail or can with holes punched 
in the bottom and pail filled with straw,' Ash barrel 
grease trap is also used. Barrel has 30 holes punched 
in bottom, 8 inches of coarse gravel or wood ashes, 
then 8 inches of fine sand cr ashes - top covered with 
burlap as strainer. (4) Baffle grease trap; half barrel or box divided 
into unequal chambers by a wooden baffle extend- 
ing to within 1 inch of the bottom; larger sec- 
tion, about 2/3 of the barrel, is the influent 
and the smaller the efficient chamber. A strain- 
er is placed over the influent section and the 
smaller, the effluent chamber, may be covered by 
a strainer, 
(5) Disposal of bath and wash water; if sewers are 
not available, bath and wash water is disposed 
of in soakage pits or trenches, and the water 
should pass through grease trap before it enters 
pit or trench. 
(6) Rubbish; tin cans and burned bones may be disposed of 
on dumps; all rubbish that can be burned should be. 
Tin cans and boxes must be flattened to prevent accu- 
mulation of water. Dumps should be located several 
hundred yards from occupied tents. » 
G* Fly Control, 
1. Flies; house fly - frequently transmits intestinal 
diseases, accomplished in a mechanical manner through 
contact with human excreta; then carries this to food 
or eating utensils. 
a. Life cycle of fly; in development the fly passes 
through four stages; egg; larva, pupa and adult. 
Eggs are white, oval, glistening bodies, deposited 
by adult female, 150 to 200, in warm, moist organic 
material. Example; horse Egg stage, 12 
hours,. Larvae or maggots are then hatched which 
are white, wormlike creatures. They are very mo- 
tile and feed on organic material, reaching ma- 
turity in 2 to 8 days; when mature, the larvae 
migrate to a dry cool place and pupate. Pupa - 
dark brown, hard outer surface. This stage lasts 
2 to 8 days. Adult fly emerges from the pupal 
case and is ready to fly as soon as its wings harden. 
The female reaches sexual maturity and begins to 
deposit eggs in 3 to 20 days after emerging from the 
pupal case. Under favorable conditions, the period 
from the egg to adult may be as short as 1 week. 
Adult fly range of flight is 200 to 1000 yards, 
2. Destruction of adult flies: adult flies may be des- 
troyed by the use of fly traps, fly paper, poison sprays 
and swatting. These measures are temporary ones, and 
the elimination of breeding places and destruction of 
of immature forms of the insect are more important, 
a. Types of fly traps, 
(1) Square trap ) 
(2) Round trap' ) more elective 
(3) Box trap 
(4) Triangular trap - more practical SOAKAGE TRENCH - A- Central square area; 8 - radiating lateral trenches* 
C -pail grease trap. 
BAFFLE GREASE TRAP 
GARBAGE DRAINER ROCK FILE l,\C!NFRATOR SHOVING DRAFT HOLES AT THE 
.JUNCTION OF THE ’.'.’ALL AND BOTTOM CF THE FIT. 
U1. IMAL SCAKAQE PIT 
KITCHEN SCAKAGE FIT CROSS TRENCH INCINERATOR SHOWING METHOD 
OF CONSTRUCTION. 
A trench is dug li feet, 8 inches long, 2 feet, 9 inches wide, and 1 foot, o inches deep, 
as the firebox is below the level of the ground at one end. The rock shown in the figure supports 
a piece of corrugated iron which is level for the first 20 inches and then slopes down to the 
grate. 
INCLINED PLANE INCINERATOR, IN LONGITUDINAL AND CROSS SECTIONS, TO INDICATE PLAN OF CONSTRUCTION. BARREL Af.O THE PC’* I INC I HER A ICR i I TH BARREL I AOE CF BRICK 
vTtfTC 'a*'0'Trench "garbage "i?;cT:.eiaatcjr*" a-fi r. e *tre’nches» b*» .»ate * 
BARSl C-A’OCOEN BARREL, ITH SURROUND IN? CLAY, i.HICH IS BURNED 01!T, 
LEAVING THE CLAY MOLD INTACT, 
BARREL MO TRENCH IMf I HERAT OF. VITH BARREL MADE FROM GALVANIZED 
IRON SAR8AGE CAR FROM 791 Cl! THE BOTTOM HAS BEEN 
REMOVED, FLY CONTROL 
Fly control is accomplished by an understanding of the life 
cycle of the fly and thereby attacking one or more of its stages? 
the breeding, larvae or adults. 
A. Breeding Places 
1. Manure - dispose of by contract, incineration or compost. In 
oermanent quarters contract or incineration may be advisable, 
must be carefully policed to insure complete disposal 
without delay. For composting of manure, see the section on 
T”aste Disposal, 
2. Human Excreta - permanent quarters require sanitary policing, 
permanent and semi-permanent latrine must be flyproof - 
see section on Waste Disposal. 
3. Garbage and refuse - permanent quarters may dispose of 
garbage by contract incineration, but rigid policing must 
insure complete prompt disposal of all garbage and refuse. 
B. Adult Flies - Destruction of; 
1. Swatting, 
2. " 
3. Fly sprays, flit, etc, 
A. Fly papers - many of them and fresh. 
5. Fly traps - very useful, but must be used in large numbers, 
and policed intelligently. See below: 
groups of traps in well-lighted positions, out of reach of strong 
winds, end bait them with odors that are not offensive to personnel, such 
as? sugar fermentations - molasses and yeast; sugar and vinegar, etc. 
All fly traps require constant attention to be effective. They must be 
emptied*and frequently cleaned, repaired and baited. Electric traps must 
be dismantled, cleaned and checked for short circuits. Place fly traps, 
giving attention to the following: Manure heaps, kitchen and mess halls, 
latrine, dairies, etc., dumps, incinerators, stables. b, Fly traps should be elevated on a stand, placed 
near breeding places such as manure piles or 
latrines, or in the vicinity of mess halls, kitchens 
or dumps, and should be baited with bait that will 
attract flies but not be a nuisance* 
H* Mess Sanitation, 
1, Company mess is a very potent factor in the transmis- 
sion of intestinal disease and to a lesser degree of 
respiratory infection* 
2, Food handlers, 
a. Food handler examination - must be examined by 
medical officer before beginning duty in the mess, 
and each six months thereafter, 
b. Daily observation - temporary and permanent food 
handlers should be observed daily for communicable 
disea ses, 
c* Cleanliness - all mess personnel wear clean cloth- 
ing and have clean hands at all times; fingernails 
are cut short; hands are washed after visiting 
latrine, 
3, Inspection of food, 
a* All food should be inspected for freshness and 
quality when received at the mess, and while in 
storage and before consumption. Canned foods 
should be inspected for leakage and gas formation 
within the can. Fresh meats should, be inspected 
for slimy deposits ©n the surface or indications 
of decomposition in or near the joints or along 
the bones. 
b. Fresh meats, meat products, and canned foods are 
materials in which bacteria tend to grow rapidly 
and if contaminated, are dangerous to health of 
troops, Severe illness can result from contamin- 
ated food, » 
A, Storage of Food, 
a. Food supplies should be protected from insects as 
flies, roaches, dust and dirt, rats and mice. 
Perishable foods should be stored at a temperature 
of 55° F,, or less; also in storage of foods, part- 
icularly meat, avoid packing or hanging so closely 
that ventilation is impaired, 
b. Temporary camps, 
(1) Food may be stored in water tight containers 
and immersed in springs or streams, care be- 
ing taken to prevent contamination. Food may 
be buried below the surface of the ground 
where temperature is lower, lining pit with 
burlap and boards on the bottom, 
(2) Suspended food container: consists of a 
screened box that permits free circulation of 
air but prevents contamination by insects. The 
cooling effect may be increased by wrapping box with burlap -which is kept damp. 
(3) Underground ice box or cooling box is a simple 
device consisting of a double-walled box sunk 
in the ground with outer lid slightly above 
ground* The outer box is 5 feet long, 4 
feet '.vide and 4- feet deep; ;inner box, 4 feet 
long, 3 feet wide and 3 feet deep, 
(4) In semi-permanent camps, fresh or cured meats, 
milk and vegetables may be kept in underground 
storage room, similar to the old fashioned 
root cellar. 
(5) Bread boxes or storage should be well ventila- 
ted, but screened to prevent access of flies 
to the food. 
5. Preparation of food requires that the food be properly pre- 
pared and served, and a suitable variety provided. Thorough 
cooking and immediate serving are best safeguards against 
the transmission of communicable diseases by food. Bacteria 
will grow rapidly in many cooked foods, even when placed in 
an ice box. This is particularly true of meat dishes. 
If re-served, they should bo thoroughly heated. All vege- 
tables that are to be eaten raw and which cannot be 
peeled, should be thoroughly washed in running water before 
serving. 
6. Caro of eating and cooking utensils; all eating and cooking 
utensils should be sterilized immediately after use by wash- 
ing in hot soapy water, then rinsing in hot, clear water, 
then aired and dried. Devices for washing mess kits in 
camps or field; (a) three G, I, cans are placed over 
trench 8 feet long, 1 foot wide and 1 foot deep; fire is 
built in trench, Two cans have soapy water, ana third, 
hot, clean water; (b) another device if fire trench 11 
feet long, 2 feot wide, 4 feet deep, with stack built at 
one end. Pit is filled with stones within one foot from 
the top. Throe water containers - oil drums cut longitu- 
dinally 4 inches above center line are placed over fire 
box, iron pipes threaded into bung holes, and after wash- 
ing mess equipment, iron pipes are removed and water es- 
capes in soakago pit. 
7. Hess talbes; made so middle leaf or board is removable, 
to permit cleaning. Tables are scrubbed with soap and 
water after meals, 
3. Flies; screens should be kept repaired, doors closed, 
flies in mess hall destroyed by traps, fly paper, sprays 
and swatting. FIRE TRENCH AND CANS FOR WASHING MESS KITS. 
(/ASHING MESS KITS. 
Manure & Garbage 
Incinerator 
Ash and can dunp- 
500 yds. from camp 
0IAQRAM OF PROPER SANITARY LAYOUT FOR A BATTALION CAMD« V. Insect-borne Diseases 
A, Definition? one in which a blood-sucking insect is the 
only agent by which the causal organisms are transmitted 
from person to person or from animal to man, 
I. Tabulation of Vectors - the following tabulation of 
insect-borne diseases with their vectors (a vector 
is an insect carrier in which the disease germs undergo 
an essential phase of their life cycle) induces these 
diseases of particular interest to the Army’ 
Disease 
Principal Vector 
Malaria 
Yellow Fever 
Dengue 
'hilaremia 
Rocky Mountain Spotted Fever 
Relapsing Fever 
Typhus Fever (epidemic) 
Typhus Fever (endemic) 
Bubonic plague 
Filariasis 
Epidemic Encephalitis 
Anopheles mo squ1to 
(several species) 
Aedes egypti mosquito 
Aedes egypti and aedes 
■albopictus mosquito 
Flies, ticks, lice and 
fleas, (Also contact 
with infected material) 
Ticks 
Lice and Ticks 
Body louse 
FIeas (usually) 
Rat flea. 
Several varieties of 
mosquitos and biting 
flies. 
Aedes and probably < 
other mosquitos 
2. The above diseases are only prevalent in regions where 
environmental conditions are favorable J?or the continued 
ex?stance and maintenance of the insect, 
TiThere the cycle of transmission includes an animal 
host of the infectious agent, or of the transmitting 
insect, the prevalence of the disease concerned is 
modified or entirely absent, depending on presence of 
animal hosts. 
3. Trench fever, Typhus fever and Relapsing fever, depend 
on their transmission by the human louse, which is an 
absolute parasite on man. Consequently, these diseases 
are potentially the most dangerous to military forces. 
Transmissions depends upon the vector first sucking 
blood from an infected person or animal, later biting 
a susceptible individual. Infection may also occur 
from insect’s saliva, or by its feces, glandular se- 
cretions or body fluids of the insect when ground into 
the skin by scratching. The organisms of diseases such as Bubonic 
Plague may be transferred to man without undergoing 
any change within the body of the insect, but in 
others as malaria, the disease must pass through a 
stage of development in the body of the insect before 
the insect can infect another person. 
5. Preventive measures to be taken against these insect- 
borne diseases include protecting the patient from 
being bitten by insects capable of transmitting the 
disease, and protecting healthy persons from the bites 
of insects which have been infected, the eradication 
of all insects capable of transmitting the disease 
and the eradication of the specific germ from the body 
of patients. 
6. Control Measures for Mosquitos. 
a. Mosquito control: mosquitos not only transmit 
diseases as Malaria, Dengue, Yellow Fever and 
Filariasis, but are a source of discomfort. The 
most important is Malaria. 
b. Life cycle of mosquito? four stages in life cycle 
of the mosquito? egg, larva, pupa and the adult. 
The first three stages are passed in water. The 
adult is a free-flying insect. Males are vege- 
tarians; females are bloodsuckers and thus act as 
transmitters of disease. The time necessary for 
egg development is about three days; larva - 10 
days; and pupa - 3 days; mosquitos may breed in 
practically any water which persists longer than 10 
days, in ponds, swamps, drains, roof gutters, tin 
cans, etc. Range of flight is 1 mile, more with 
favorable wind. 
c. Group characteristics: the three groups of mos- 
quitos which are concerned, in the transmission of 
disease are Anopheles, Aedes and Culex. Each of 
these groups contains several species whose 
characteristics vary somewhat. It is sufficient 
to the scope of this manual to list the general 
characteristics of the three main groups, 
(1) Anopheles 
(a) Transmits Malaria (not all species of 
Anopheles). 
(b) Bites at dusk, night and dawn, 
(c) Breeds chiefly in water away from 
habitations, preferring ponds, streams 
and swamps, 
(d) Eggs are boat-shaped, are laid singly, 
and tend to collect on the water in 
triangular patterns. The adult may live 
1 to 3 months. 
(e) Larvae lie parallel to the surface of the 
water and feed at the surface, 
(f) Adults have long palpi and spotted wings 
and rest at an angle of 45° to the 
surface. Eggs of Culex Mosquito 
(«fl3 raft) 
Eggs of Anopheles 
Mosquito, 
Egos of Gulex Mosquito 
Eggs of Anopheles Mosquito 
showing floats. 
KNAPSACK OIL SPRAtER 
Larva of Ano;. holes 
ilesquI to. 
Larvs or 
Culex .''osquito. 
Pupa of Anopheles Mosquito 
Pupa of Culex ffiosquivo. 
EQUIPMENT FOR MIXING AND APPLYING PARIS GREEN 
LAPVIC IDE. 
Anophfles-Fumnle 
Anophe I eS-fAs I e 
Galax-Female 
Culex-fyiaIc 
Calicin i 
METHOD OF PRODUCING DUST CLOUD OF PARIS GREEN 
LARV 1C IDE • ITH HAND-OPERATED DUST BLOWER. 
AnopheIes 
mosquitoes, RESTING POSITIONS. (2) Aedes 
(a) Transmits Dengue, Yellow Fever and 
Pilariasis. 
(b) Bites during the day. 
(c) Breeds chiefly in collections of water 
in and about habitations (rain barrels, 
buckets, gutters), 
(d) Eggs are slender and are laid singly on 
water, 
(e) Larvae hang at an angle in the water, feed 
below the surface of the water, and breathe 
at the surface. 
(f) Adults have short palpi, wings clear of 
spots, and bodies striped with silver color. 
They rest parallel to the surface, 
(3) Culex. 
(a) Transmits Pilariasis, 
(b) Bites at dusk, night and dawn, 
(c) Breeds chiefly in and about habitations, 
but also in stagnant water, in swamps 
and cesspools. 
(d) Eggs are cemented in rafts on surface of 
water. 
(e) Larvae hang at an angle in the water but 
have longer breathing tube than Aedes. 
(f) Adults have same resting position and same 
short palpi as Aedes, but their bodies 
have no stripes. 
d. Mosquito Control Measures, 
(1) Elimination of breeding places, 
(2) Destruction of mosquito larvae and adults, 
(3) Protection of man from the bites of mosquitos, 
(4.) Isolation of cases and carriers to prevent 
infection of mosquitos, 
(5) Treatment of cases and carriers, 
e. Responsibility for Mosquito Control. 
(1) Mosquito surveys are ordinarily a function of 
the Medical Department. 
(2) Commanding officers are responsible for the 
execution of mosquito control measures, 
f. Elimination of Breeding Places, 
(1) Filling - this is effective. It is practical 
for small depressions where streams overflow 
or storm water collects. Earth, rocks, garbage, 
cinders, rubbish and old manure may be used as 
a fill, 
(2) Drainage - this is applicable in the case of 
small ponds of water or swamps, either by 
surface or by sub-surface drainage. Surface 
drainage can be accomplished by open U-shaped ditches. These ditches may be lined With 
tile or cement. Unless lined, attention is 
required to keep out vegetation. Sub- 
surface drainage - either by a trench filled 
with small rocks or by a line of loosely joined 
tile under the surface of the ground, 
(3) Stream training. This is effective but requires 
considerable labor. Stream edges should be 
straightened; pot holes removed; grass and 
underbrush removed for a distance of 4 feet both 
sides of stream. 
(4) Emptying water containers. Containers should 
be emptied weekly. Frequent inspections should 
be made for collections of water in tin cans, 
gutters, or v/here water collects, 
G. Destruction of Larvae, 
1. These measures are all of a temporary nature and should 
be repeated.every 7 to 10 days. Common larvicides are 
crude oil, waste motor oil, kerosene, paris green and 
Panama larvicide, 
a. Oiling - a continuous film of oil must be maintained 
on the surface of the water for 2 to 3 hours in order 
to kill larvae. About l/2 pt„, of oil is used to 
each 100 square feet of water surface. Crude oil, 
fuel oil, waste motor oil or various mixtures of these 
oils may also be used. There are various methods of 
applying oil, 
(1) Khansack sprayer consists of a container for 
oil, a pump and a snray nozzle. 
(2) A water can - slow method, 
(3) Drip oiler may be used in slow moving streams, 
(4) Submerged oiler may be used either in streams 
or ponds. 
b. Paris green is mixed with 100 parts of road dust or 
fine ashes before application and used against adult 
mosquito which feeds on stream or water surface. 
This mixture is applied by band, by hand blowers, or 
by spreading from airplane, 
c. Panama larvicide - a phenol larvicide. The volume 
of water to be treated must be known. It may be 
applied with spray or poured into the water and it 
will not destroy fish, 
d. Destruction by natural enemies - fish, such as the 
top feeding minnow eat larvae and are valuable in 
ponds and slow streams, 
e. Destruction of adults. 
(1) Swatting - fly swatter or folded paper, 
(2) Spraying - valuable in buildings. 
(3) Hand catching - slow and difficult, used to 
secure specimens. f. Protection of Individual* 
(1) Protection from mosquitos is necessary for 
both patients and healthy individuals, as it 
controls disease and frees from discomfort. 
(2) Screening - is only of value if maintained in 
perfect repair* 
(3) Mosquito nets. Mosquito riots or bars are to 
be used on beds in all areas whore mosquito- 
borne diseases are endemic* 
(4) Repellents, These are mixtures which when 
applied to the skin partially or completely 
repel mosquitos* Use 1 part of epsem salts, 
10 parts water; oil of citronella and cam- 
phor and oil of cedar wood. 
g. Medicinal prophylaxis - quinine or atabrine are 
valuable means of preventing the development of 
Malaria among troops in areas where Malaria is 
highly prevalent and where satisfactory protection 
from mosquitos cannot bo secured. Dose of quinine 
should be 5 to 10 grains each day, 
7. Control of Lice, 
a. Diseases transmitted. Lice transmit typhus 
fever, trench fever and relapsing fever* 
b. Classification of lice, 
(1) Pediculus humanus corporis ("body louse”, 
”cootee"), This one is chiefly responsi- 
ble for transmission of louso-bome di- 
sease s * 
(2} Pediculus humanus capitis - head louse, 
(3; Phthirius pubis (crab louse) 
c* Life Cycle 
(1) Egg stage - eggs are attached to the hairs 
of the body and head, fibers of clothing by 
cement excreted by the female. They are 
opaque, yellowish, ovoid in shape and pin 
point in size* Egg hatches in about 8 days 
at temperature-of 86° to 90° F, 
(2) Larval stage - larvae are whitish in color 
and pin head in size. This stage lasts a- 
bout 9 daj^s, 
(3) Adult stages - adult female, starts to lay 
eggs within a day after development; 5 to 
10 per day for 30 days, 
d. Characteristics of Lice, 
(1) All three types must live on human blood 
for existence and will die if deprived of 
it. In higher temperature more food is 
required and they die more quickly if 
food is not available, 
(2) Lice are disseminated by adult lice or eggs 
being dropped off the body in straw, debris, 
blankets, clothing or on latrine seats; crab 
lice by sexual contact. (3) Lice and eggs are killed in 5 minutes b-7 
dry heat of 131° F, and 1 minute by 155° F,; 
killed in 30 seconds by boiling water. 
(4.) Lice do not transmit disease by act of biting. 
They defecate as they feed. The disease 
viruses are in the excreta and are scratched 
into the skin by the human host, 
e. Delousing - must be universally effective throughout 
unit, 
(1) All individuals must bathe thoroughly and 
shave various marts of body if necessary. 
(2) Clothing and equipment must be deloused, 
(3) Latrines, beds and any objects possibly harbor- 
ing lice must be disinfected or destroyed, 
(4) Clean clothing must be issued to all individuals. 
f. Bathing, 
(1) Improvised shower bath. 
(a) A water sterilizing bag is suspended from 
a scaffold on a tree limb. Stone filled 
soakage pit constructed beneath shower. 
(2) Large tin can with perforated bottom may be 
suspended from a tree and platform - one man 
pours water in the can while another bathes, 
(3) Barrel with valve in the bottom may be used. 
This is made by a plunger which fits in a can 
and is controlled by means of a lever and 
handle within the reach of bather, 
g. Shaving is necessary when eggs are present on hairs, 
as eggs are difficult to remove, 
h. Sprays are not advisable, 
i. Head lice - if head lice are present, loosen the 
eggs from the hair by the thorough application of 
vinegar followed by shampooing the scalp with hot 
soapy water containing of kerosene5 hair should 
be combed with a fine toothed comb to remove nits not 
removed by washing: when possible the hair should be 
clipped short, 
j. disinfestation of clothing and equipment, 
(1) Steam will not seriously affect cotton or 
woolen cloth, but will damage leather, felt 
or webbing. Boiling, water will shrink yoolen 
cloth. Dry heat is practically harmless for 
all articles except wool, which it will damage 
somewhat, 
(2) Available methods for delousing; 
(a) Mobile disinfestor Cq.M, function) four- 
wheeled trailer type and are usually steam 
pressure disinfesters. After clothing is 
placed in the disinfestor, a vacuum of 10 
to 15 inches is created, than steam is 
turned into the inner chamber until a Adult Wood Tick 
Body Louso 
Crab Lousfe 
Bed Bug 
PIS1NFEST0R. SERBIAN BARREL TYPE 
DISINFESTOR, SERBIAN BARREL TYPE, SHOWING 
WATER PAN AND GRATING IN THE BOTTOM OF 
THE BARREL. 
Tank supports 
THE SERBIAN BARREL FOR DISINFESTATION 
OF CLOTHING, MOBILE CISINFESTORS - - These are of the four-vheel trailer type and are usually steam pressure 
dlsinfestors although a current steam disinfestor Is manufactured 
..(thresh type). The pressure type consists of a horizontal steam 
chamber around which tfiere is an outer jacket which is assembled as 
a unit with a boiler. After the clothing is placed In the disinfestor, 
a vacuum of 10 to 15 Inches is created after which steam Is turned 
in until a positive pressure of 15 pounds is attained, this being 
held for about 20 minutes. At the end of this time the steam is 
released and a vacuum of 10 to 15 is produced in order to dry the 
clothing. This vacuum |s held for about 5 minutes. Clothing should be 
placed in loosely in order that the steam may penetrate* positive pressure of 15 pounds is obtained. 
Pressure is held for 20 minutes, steam re- 
leased and a vacuum of 10 to 15 inches is 
held 5 minutes to dry the clothing. 
(b) Servian Barrel Type - this is a company 
installation and consists of a barrel in 
which the clothes are placed to be dis- 
infected. The lower part contains a re- 
cepticle for water which is placed on an 
improvised firebox, 
(c) G.I. can is usually most practicable, for 
no separate container for water is neces- 
sary, 
(d) Clothing and equipment may be placed in 
ovens, boxes and cans which are subjected 
to dry heat. After removing as many lice 
as it is possible by hand, clothes are 
pressed with a flat iron, 'There practi- 
cable, clothing made of cotton, linen, 
and silk, may be boiled for five minutes. 
Leather belts, shoes and hats which cannot 
be disinfested by other means, should be 
immersed in a 5% cresol solution for 30 
minutes, 
(e) Storage of infested clothing and equipment 
will accomplish disinfestation by depriv- 
ing the lice of a food supply. Store in 
a dry place 30 days. 
8, Control of Ticks. 
a. Diseases transmitted - ticks are able to transmit 
the causal agents of Rocky Mountain Spotted Fever, 
Relapsing Fever, Tularemia, through the egg stage 
to the progeny, any stage of which is capable of 
inoculating the host with the causative agent* 
b. Habits and characteristics - life cycle of tick con- 
sists of egg, larvae, nymph and adult. Tick deposits 
several thousand eggs on the ground. Egg stage is 3 
to A weeks. Larvae seek a warm-blooded host upon 
which they feed for 2 to A days, drop to ground, re- 
main dormant for several weeks. They molt and be- 
come nymphs which again seek a warm-blooded animal 
upon which to feed for A to 8 days. Nymph then drops 
to the ground\ after several weeks, molting occurs and 
adult emerges. Adult finds a host and attaches itself. 
Adult ticks can live 2 years without food and cold 
weather will not kill them. 
c. Control measures - control of tick-bome diseases by 
ridding the country of ticks is difficult. Buildings 
of little value infested with ticks, should be burned 
or kerosene or cresol insecticide may be used. Con- 
trol of the tick is mainly through control of wild 
animal hosts and eradication of smaller animals in 
tick infested country or area is desirable. d. All individuals in tick infested localities should 
frequently examine their exposed skin area . 
and promptly remove the ticks. 
9. Control of Bedbugs 
a. Bedbugs exist where they can live in close asso- 
ciation with man; they have been suspected of 
transmitting relapsing fever and leishmaniosis. 
However, since they are blood-sucking insects 
they may transmit any disease in which there is a 
blood stream infection, 
b. Habits and Characteristics - life cycle of bedbugs 
consists of egg, larvae and adult stages. Eggs are 
deposited in cracks and crevices and hatch in 4 to 
10 days in warm weather; larvae are yellowish white 
and resemble adults; blood is necessary for the 
development of the larvae and they are developed 
to adult stage in 6 to 11 weeks. Bedbugs feed at 
night and may survive 6 months or longer without 
food. All forms killed at a temperature of 113° F, 
or temperature below freezing. Bedbugs are spread 
by clothing, bedding, baggage or furniture. They 
hide in any crevice of wooden or metal structure, 
c. Control Measures 
(1) Fumigation - this is the most effective way to 
destroy bedbugs, provided a penetrating gas is 
used, such as, hydrocyanic acid gas'; however, 
this gas is dangerous. Sulfur may be used for 
fumigation. Fumigation should not be attempted 
by untrained personnel, 
(2) Liquid insecticides are effective if thoroughly 
and repeatedly used. An effective mixture is 
kerosene containing lOw cresol or 5% turpentine. 
Kerosene alone can be used; steam may be used 
for cloth and beddings; dry cleaning and hot 
water; hand picking, brushing and shaking, also 
flaming the steel cots with blow torch is 
effective. 
10, Control of Roaches and Ants. 
a. Roaches and ants do not transmit any insect-borne 
disease, but may transmit intestinal diseases by 
contamination of food. 
b. Control Measures 
(1) Deprive ants and roaches of food supply by clean- 
liness of mess and by protection of food 
supplies through refrigerators and screened 
cabinets, 
(2) Sodium fluoride placed in cracks and crevices 
or spraying with liquid insecticide are 
efficient. This is best done at night, 
(3) Ants are destroyed by destruction of nest; by 
use of boiling water or kerosene. 11. Control of Fleas 
a, Several varieties of fleas are vectors cf Bubonic 
Plague and Endemic Typhus Fever, Various small 
animals, particularly, rodents serve as reservoirs 
of infection from which fleas may transmit Bubonic 
Plague or Endemic Typhus Fever to man. The rat 
flea is the most common vector. Fleas sometimes 
select man as host when he comes in direct contact 
with small animal hosts, 
b. Control Measures, 
(1) Elimination of Animal Hosts 
(a) Pet animals as oats and dogs mar be freed 
of fleas by washing in emulsion 
of kerosene. 
(b) Pats - arc a reservoir of infection of 
Bubonic Plague and Typhus Fever and also 
a factor in spread of other diseases. 
Rats are destroyed by trapping and 
poisoning, fumigation, use of natural 
enemies and rat-proof buildings, 
(2) Destruction of fleas is accomplished by 
(a) Fumigation as for bedbugs, 
(b) Spraying and scrubbing - fleas are 
destroyed by scrubbing with soapy water 
containing 105S kerosene and 5f- cresol. 
VI, Miscellaneous Diseases 
These diseases include Scabies, Smallpox, Chickenpox, 
Tetanus, Rabies, Gas Gangrene, Ringworm and Plant Dermatitis, 
Scabies - is a skin disease produced by the action of 
certain .small animal parasites called "itch mites". 
The parasites are transferred from one patient to another 
through contact. To prevent Scabies, cleanliness is essential 
and those infested should be isolated, have their skin treated 
and their clothing, bedding, etc., disinfested. 
Smallpox - the specific organism which is unknown, is 
probably transmitted from one person to another by direct 
contact, and by contact with articles soiled with the discharges 
of infected individuals, and perhaps by flies. Preventive 
measures against Smallpox include prophylactic vaccination of 
all individuals 5 and. isolation of the patient until all lesions 
are completely healed. 
Chickenpox - a mild disease, is probably transmitted in 
the same manner as Smallpox, and resembles slight cases of the 
latter, suffering from Chickenpox should be isolated 
until the lesions are completely healed. Tetanus - or lockjaw, is caused by the tetanus bacillus, 
which ordinarily gains access to the human body through a wound. 
Preventive measures against lockjaw include personal cleanli- 
ness? the prompt treatment of all wounds, particularly gunshot 
and punctured wounds, and the administration of tetanus anti- 
toxin. Because the soil of a battlefield, especially in 
cultivated areas is contaminated with the tetanus bacillus, 
regulations require that all men wounded in action be given 
1500 units of tetanus antitoxin, and that the fact of its 
administration be entered on the emergency medical tag, field 
medical card, etc. Subsequent doses are given, if necessary. 
Patients with any other kind of wounds, suspected of being 
infected with the tetanus bacillus, are given similar prophy- 
lactic doses of anti-tetanic serum. 
Rabies, or hydrophobia, is transmitted from the lower animals 
usually the dog, to man by the injection of the saliva into 
wounds which have been produced by bites of the rabid animal. 
In man, about forty days elapse between the time of being bitten 
and the development of the disease. Fortunately, this long 
incubation period affords ample opportunity for the administration 
of anti-rabic vaccine, more commonly known as the Pasteur 
Treatment, a method of prophylaxis against the development of the 
disease which has proven highly satisfactory. 
In addition to the vaccine, other preventive measures 
include muzzling and leashing of all dogs, and carefully observing 
and examining the animal suspected of having Rabies, Fhen a 
clinical diagnosis of Rabies in the animal is confirmed, he is 
killed and his brain is examined for specific evidence of the 
disease. As a matter of routine, all bites produced by animals 
should be thoroughly cauterized with nitric acid and otherwise 
surgically treated. 
There is now commercially available an anti-rabic vaccine, 
which, if administered universally and annually to dogs as a 
prophylactic measure, would go far towards eradicating this 
dreaded disease. This treatment does no harm to the dog. 
Gas Gangrene is an acute infection, occurring in Targe 
macerated v/ounds contaminated with human or animal waste found 
in soil. The infection is associated with compound fractures and 
large crushing or tearing wounds that come in contact with the 
soil, but it has occasionally followed puncture wounds or small- 
abrasions. Once the disease develops it is extremely difficult 
to control. The mortality is very high. 
Prevention - every extensive wound should receive the best 
of attention, the patient being placed in a hospital. 
Treatment - in mild cases, the wound should be cleansed of 
all discolored, frayed or devitalized muscle or skin tissue. It 
may be necessary to sacrifice entire muscles. The wound should 
be left open. Irrigation and cleaning of the wound should be 
frequent. In advanced cases, extensive excision or amputation 
may be necessary. 
Anti-toxic sera should be used as a prophylactic in all 
wounds where contamination with gas bacilli is probable. Ringworm - the terms n trichophytosis’* or ringworm compose 
a group of skin infections duo to parasitic fungi. Numerous 
different fungi may be responsible for those infections and 
all parts of the human body may be involved, i.e,, Tinea 
Cruris or Dhobie.itch which is ringworm of the inguinal region, 
or groins. Tinea Gircinata is ringworm of the body. 
Dermatophytesis (athlete’s foot) is ringworm of hands and feet. 
All of these infections tend to become chronic, and all thrive 
in warm weather or in other conditions which result in 
perspiration. They are common in all walks of life. They 
may be mild or severe and disabling. 
Control Measures for all forms of ringworm infection are 
the same. The main object is to prevent the bare skins of 
noninfacted individuals from coming in contact with any objects 
wdiich may have been contaminated by infected persons. 
Treatment - All cases should be promptly and adequately 
treated; self-treatment will often aggravate the condition, 
Proper care of the feat is important in the prevention and con- 
trol of ringworm of the feet. All bathhouses should be 
equipped with foot baths, containing solution to prevent this 
infection; however, the most effective control measure is 
disinfection of bathhouses, floors and equipment and by the 
disinfection of towels, swimming or gymnasium equipment. Dis- 
infection by boiling, by solutions of calcium hypochlorite, 1 
oz, to 1 gal. of water; 2% crescl solution may be used. Shoes 
are treated by 1% thymol in gasoline or alcohol. 
Plant Dermatitis - (Poison ivy, poison oak, poison sumac). 
These are the common plants that produce skin irritation in 
susceptible persons. Harmful part of the plant is the resinous 
sap or oil which exudes from all injured surfaces. Tho symptoms 
which appear within 24 hours after contact, are generally 
severe intense, burning and itching and a feeling of increased 
tension of the skin. 
Control Measures 
1. Learn oo recognize the plant and then avoid it, 
2. Wear gloves while at work, 
3. Change outer clothing and gloves before associating 
with other men. 
4. Burn poisonous plants away from camp and sc the wind 
is blowing smoko away from camp, 
5. Choose camp sites where poisonous olants are not present. 
Personal Measures - contaminated clothing and implements 
should be well wasned with water (soda water, if possible) or 
exposed to direct rays of the sun for several hours. 
All parts of the body that have been exposed to the plants 
should be well washed with a strong soap solution or alcohol, 
gasoline or kerosene may be used. Washing must be prompt or 
poisons will spread. 
If blistoro appear, see a 1 o*f 1~er and receive 
medical treatment. , • TRANSMISSION INCUBATION »a. ISOLATION 
DISEASE INFECTIVE SOURCE AVENUE OF PERIOD b. QUARANTINE 
Measles 
Filtrable Virus 
Discharges of 
mouth and nose 
Contact: 
direct 
indirect 
10 days 
*.,a.2 weeks after 
onset. 
b,2 weeks after 
cessation of 
symptoms in last 
case. 
Mumps 
Filtrable Virus 
Discharges of 
mouth 
Contact: 
direct 
indirect 
12 to 26 days, 
usually IS, 
a. swelling 
3 asts. 
b. 
Diphtheria 
Diphtheria 
bacillus 
Discharges of 
nose apd throat 
Contact; 
direct 
indirect 
food: milk 
milk products 
2 to 5 days 
e.Until cultures 
are avirulent, 
t,Until cultures 
are avirulent 
Scarlet Fever 
Streptococcus 
Scarlatina© 
Discharges of nose, 
throat, errs, 
abscesses, wounds 
Contact: 
direct 
indirect 
Food; 
milk 
milk products 
2 to 7 days, 
usually 4. 
a. days from 
onset, 
b. days from 
last exposure. 
Septic Sore 
Throat 
Streptococcus 
Epideraicus 
Discharges of 
throat and noso. 
Udder of infected 
cow. 
Contact; 
direct 
indirect 
Food: 
milk products. 
1 to 3 days. 
a. Course of 
disease, 
b. days 
Influenza 
Undetermined 
Discharges of 
throat,mouth and 
nose 
Contact: 
direct 
indirect 
24 to 72 lours 
a, Acute stage. 
b. 
a. Isolation of patient; b. Quarantine of conticts. 
INFORMATION RELATIVE TO COMMUNICABLE .DISEASES, DISEASE 
INFECTIVE 
AGENT 
SOURCE 
T RAFSf ■■ If SION 
AVENUE OF 
INC 13ATION 
PERIOD 
*a. ISOLATION 
b. QUARANTINE 
Common Respira- 
tory Disease. 
(Colds, sinus ' - 
ti s,laryngitis, 
bronchitis, etc.) 
Viruses, 
Streptococcus 
and others. 
Discharge of 
Hose and Throat 
Contacts 
direct 
indirect 
Food; milk 
milk products 
1 tc 3 days 
a. Duration of disease 
b. 
Whooping Cough 
3. pertussis 
Discharges of 
Nose and Throat 
Contact; 
direct 
indirect 
10 days 
a.Duration of 
disease. 
fe.12 days. 
Pneumonia 
Pneumococcus, 
Streptococcus 
and others 
Discharges of 
Nose and Throat. 
Contact; 
direct 
indirect 
1 to 5 lays 
a, Course of disease 
b. 
Pulmonary T.B. 
Koch’s bacillus 
Discharges of 
Hcse and Throat 
Contact; 
direct 
indirect 
Foodsmilk and 
meats 
Several weeks 
tc several 
months 
a.Active cases 
L.lone 
Tularemia, 
Psittacosis, 
Bubonic Plague 
Bacillus 
lularense, 
Rickettsiae, B. 
Pestis 
Normally the bite 
of blood-sucking 
insects,but occa- 
sionally the dis- 
charges of nose 
Blood suciing in- 
sects, sometimes 
the direct and in- 
direct with 
pulmonary types of 
these cases. 
1 to 5 
days 
i.Duration of 
diseases 
b,7 days. 
Meningococcic 
Menlngitis 
Diplococcus in— 
tracellularis 
meningitis 
Discharges of 
mouth and nose 
Contacts 
direct 
indirect 
2 to 10 days, 
usually 7. 
a. days after 
onset 
b, days 
INFORMATION RELATIVE TO GCMMUNICABLE DISEASES DI SFASE 
INFECTIVE 
A GENT 
SOURCE 
tea:: Shi ssi on 
AVEiUE OF 
INCUBATION 
PERIOD 
*a. ISOLATION 
b. QUARANTINE 
Poliomyelitis 
(infantile 
■nara.lysis) 
j Undetermined, 
• nrobably fil- 
1trable virus 
i 
t 
DischargBs of 
;nose, throat 
'and bowels 
I 
| 
1 
i • Contact: 
direct 
indirect 
Food; 
milk 
Uncertaini 
(probably 5 to 
10 days.usu- 
ally 6 days.: 
a. 2 weeks from onset. 
b. 14 days from last 
exposure. 
Tynhoid Fever 
\Typhoid 
;bacillus 
l 
i 
t 
f 
Bowel discharge 
and urine 
Water 
Food 
Contact: 
direct 
7 to 22 days, 
usually 10 to 
14 
a. Until 2 successive 
stool cultures are 
negative. 
b. Hone. 
Dysentery 
Bacillary 
' Flexner-Y 
jBacillus, Shiga- 
l Kruse bacillus 
I 
i 
4 - - -.. -. . 
Bowel discharge 
Wat er 
Food 
Contact: 
direct 
indirect 
2 to 7 days 
a, 2-6 days after 
recovery, 
b. None. 
Dysentery 
Am eld c 
T~~ , 
; Sndamoeoa 
Histolytica. 
t 
t 
j j 
Bowel discharges 
Wat er 
Food 
Contact; 
direct 
indirect 
20 to 95 days 
a. Prove nationt is no 
longer a carrier, 
b. None. 
Dengue 
j Filtrable virus 
! 
t 
Blood of man 
Bite of in- 
fected mos- 
ouito, Aedes 
Sgypti 
4 to 5 days. 
a. During course of 
disease. 
b. None, 
INFORMATION RELATIVE SO COMMUNICABLE DISEASES . INFORMATION RELATIVE TO CCMHUNIGABLE DISEASES 
DISEASE 
INFECTIVE 
AGENT 
SOURCE 
TRANSMIT SION 
AVENUE OF 
INCUBATION 
PERIOD 
«a. ISOLATION 
b. QUARANTINE 
Malaria, 3 
typer-;4 -:rtian, 
quartan, 
acstivo-au- 
Plasmodium 
malariae, 3 
types 
Blood of man 
Bite of irfected 
mosquito. 
Anopheles 
Varies; usually 
1 lays in 
tertian type 
a. During duration of 
disease. 
b, Noie. 
Plague, 2 
typos ? Bubonic, 
Pneumonic 
Bacillus pestis 
Blood of man & 
rodents; rats 
commonly 
Bite of infected 
rat flea,Acci- 
dental ,by litas 
of inftofec ani- 
mals vber<huf s, file; 
Contant;diteot. 
3 to 14 days 
5 
a. During course of 
disease. 
b. 7 dayt. 
Typhus Fever, 
Epidemic 
Rickettsia, 
provazeki 
Blood 
Infected Idca 
5 to 20 days, 
usually 12. 
a. During course of 
disease. 
b, 2 weeks. 
Relapsing 
Fever 
Spirochetes, 
several varie- 
ties 
Blood 
Infected lice 
and ticks. 
Contact; 
direct. 
3 to 12 days, 
usually 5 to 7. 
a. During course cf 
disease. 
b, 2 weeks. 
f 
Rocky Mountain 
| vSpotted Fever 
i * 
Probably 
Rickettsia 
Blood of in- 
fected animals 
and infected 
ticks. 
Infected ticks 
and mites. 
3 to 10 days, 
usually 7, 
a. During course cf 
disease. 
b. None, 
1 Tularemia 
| (Rabbit Fever) 
j 
i 
Bacterium 
tularense 
Fild rabbits, 
chipmunks, 
ground squiirels 
and quail.Flies, 
ticks. 
Infected flies 
and ticks. 
Contact; 
direct. 
24 hours to 9 
days, usually 3. 
a. During course of 
di sease, 
b, Noie, INFECTIVE TRAKSt'ISEION INCUBATION *a- ISOLATION 
DISEASE AGENT S0TOCE AVENUE (F ”EHIOD b. QDAEANTISE 
Undulant 
Fever 
Brucella 
Melitensis 
Milk of cow and 
goat. Bowel 
discharges and 
urine? cow, 
goat, hog. 
Food. 
Milk. 
Contact: 
direct 
6 to 16 days. 
a, During period of 
communicabi1i ty, 
b. None, 
Tetanus 
(Lockjaw) 
Tetanus 
Bacillus 
Animal manure. 
Soil - Street 
dust. 
Inoculation 
Wound Infection. 
A days to 3 
weeks. 
a. None 
b. None, 
INFORMATION RELATIVE TO OCR MUNICABLE DISEASES 
•156 PART T10 
SOCIAL ffiXIRME 
The chief ultimate desire of the average normal man and ■woman 
is to marry and have a healthy family of their own* This possibili- 
ty can be readily destroyed by certain infections known as venereal 
diseases. 
Lfe know that a healthy body makes a more efficient man, whereas 
a diseased body may destroy that efficiency. Of the various diseases 
mankind is heir to, the venereal infections are pre-eminent as the 
destroyers of parenthood. More than 50% of sterility is due to 
Gonorrhea alone; whereas, Sjrphilis is responsible for so many di- 
seased conditions that the famous physician, Osier, called it "the 
captain of the diseases of death,” ho one wants venereal disease, 
yet venereal disease is quite probable when one persists in "taking 
a chance,” 
In order to understand the extent of possible damage due to 
venereal infection, a brief resume of the normal functions and 
anatomical structure of the sex organs is herewith given for com- 
parative study. 
I, The Sex Organs. 
A. The Male. 
1, Penis - is the organ of copulation and contains three 
cylinder-like structures of erectile tissue, contain- 
ing multiple spaces or lacunae which become filled with 
blood from the internal pudic arteries. This filling 
with blood produces the condition known as erection. 
Two of these cylindrical structures are known as the 
corpora cavernosa and one through which the urethra 
passes, is called the corpus spongiosum, 
a. The urethra serves the double purpose of urination 
and ejaculation of semen during the sexual act. The 
enlargement at the end of the penis is known as the 
glans. It contains numerous sensory bodies known 
as Pacinian Corpuscles which receive sexual stimuli 
during copulation. These stimuli go to the sex cen- 
ter in the spinal cord by way of the pudendal nerve. 
The glans penis is usually covered by the foreskin 
or prepuce, unless circumcised for sanitary purposes. 
2, Prostate Gland - is about the size and shape of a ftorse 
chestnut and surrounds the neck of the bladder. It is 
chiefly a glandular structure and consists of several 
divisions known as lobes. Those contain numerous tubu- 
les and secretory epithelium. The prostatic secretion 
together with the contents of the seminal vesicles make 
up the semen. In ft large percentage of cider men this gland 
becomes large cr hypertrophied and interferes with 
urination. In these cases, sometimes it becomes 
necessary to remove it surgically in entirety or to 
partially remove the enlargement through the penis, 
by an operation employing special instruments known as 
a prostatic resection, 
3, Seminal Vesicles - are two sac-like structures located 
posterior to the pro-state bn the lower sac portion of 
the bladder. The chief function is that of a reservoir 
for the spermatozoa after they leave the testes and 
until ejaculated. The seminal vesicles also secrete a 
fluid which is added to that of the spermatozoa and 
prostatic secretion to form, the semen. 
/+., Vas Deferens - are two muscular tube-like structures 
that conduct the spermatozoa from the testes to the 
seminal vesicles. The Junction of these tubas forms the 
ejaculatory duct which terminates in the prostatic 
urethra. The sensation at the time of ejaculation known 
as an orgasm is largely due to the peristaltic pulsation 
of the Vas Deferens, 
5. The Testicles - -re the glands of reproduction. They 
are located in the sac or bag known as the scrotum. They 
are highly specialized organs serving a dual function. 
Besides producing spermatozoa necessary for reproduction 
or parenthood, they also elaborate an internal secretion 
that is necessary for the secondary characteristics of 
the man, such as voice, masculine stature, beard and 
hair distribution. 
Each testicle is covered by a fibrous sheath which 
also divides it into about 150 segments; each one con- 
taining from one to three tortuous tubules lined with 
specialized germinating epithelium from which the male 
seed or spermatozoon is developed. 
On the back portion of the testis and part of it is 
a convoluted tubular structure known as the epididymis. 
As the spermatozoa pass through it to the seminal 
vesicles their development continues. Destruction of 
the epididymis, and vas'deferens by disease or other 
methods, accounts for most sterility in the male, 
6. The Spermatozoon - sometimes called the male seed, is 
produced in the germinating epithelium of the testes. 
It averages about 1/500 of an inch (.05 mm) in * length 
and consists of (1) a head containing the chromatin 
elements; (2) a body or middle piece which contains the 
centrosomo and (3) a tail which serves the function of 
locomotion only. 
B. The Female 
1. The Labia Majora and Minora - these are lip-like 
structures located on either side of the vagina. Their 
functions are chiefly sensory and protective. Within both labia major?, is a gland known as Bartholin’s 
Gland, the secretion of which empties, via a duct, 
into the vagina. The labia majora join at their 
upper portion in an elevated fatty mound known as 
the mens veneris. This is covered with hair as a 
protective measure, 
2. The Clitoris this is a miniature penis, minus the 
urethra, and therefore, is called a homologue of 
the male penis. Its only function apparently is that 
of a sensory organ. 
3. The Vagina - this is tho female copulation organ and 
depository vault. The spermatozoa travel up in the 
uterus from the vagina whore they arc deposited at the 
time of ejaculation, 
4. Tho Uterus or Womb - this is the birth chamber wherein 
the fertilized ovum becomes entrenched and normally 
develops for nine months. Nourishment and blood supply 
for the fetus is obtained from the mother through 
special blood vessels that develop in the walls of the 
uterus. At term, or after nine months development, 
the mother gives birth to a child. 
5. The Fallopian Tubes or Oviducts - are two tubular struc- 
tures located on either side of the top or fundus of the 
uterus. They conduct the ovum to the uterus by moans 
of a rhythmic pulsation of their walls, 
6. The Ovary - the ovaries are similar in function to those 
of the testes. That is, they produce the ovum, as well 
as an internal secretion necessary for the development 
of the female secondary characteristics, such as the 
female stature, voice and hair growth and distribution, 
7. The Ovum. - is the female egg of reproduction. It is 
about 1/125 of an inch (0.2 mm) in diameter and 
develops in the Graafian Follicles of the ovary on an 
average of one about every 2F days. In each ovary it 
is estimated there are about 35,000 of these follicles. 
As a rule the ovum becomes fertilized in the infundibular 
portion of the Fallopian Tube from whence it passes 
down into the uterus for subsequent development. THE VENEREA! DISEASE MENACE 
Of all the diseases in the medical category, the venereal 
diseases stand out as the most prominent destroyers of human 
vitality, family possibilities and even life. To single disease 
is as responsible for destroying parenthood ability as Gonorrhea, 
On the other hand, Syphilis may invade all the various organs of 
the body and nervous systems producing degeneration and even 
death. Syphilis alone is credited wltk causing about half a 
million deaths a year. 
The percentage of population previously infected with Syphilis 
according to statistics recently compiled by Hr. Thomas Parran, 
Surgeon General of the United States Public Health Service, 
indicates that from SS to 14-5 of every 1000 persons in various 
sections of the United States have Syphilis, An impression of its 
chronicity or tendency of the infection to remain active in a 
person’s body may be obtained from the figures of Kaustein which 
suggest that twenty times more persons have Syphilis than contract 
it each year. 
From the economic standpoint, Villlams estimates that tan 
men insane from Syphilis represent a net loss based on life 
expectancy of Reference: ’’Modern Clinical Syphilology” 
by Stokes. Estimating 12% of insanity is due to Syphilis, in the 
ISO,000 persons insane in the United States in 1910, the economic 
loss due to Syphilis alone based on earning capacity and cost of 
treatment was 1-467,000,000, (All statistics are from ’’Modern 
Syphilology” by Stokes.) 
PROSTITUTION - Host common course of venereal infection is from 
the prostitute, either professional or amateur. As a rule, the 
street walker is more apt to be infected than the professional 
prostitute, as the latter, in some cases, is subject to medical 
examination; whereas, the street walker seldom submits to examination 
unless forced to. In a survey of prostitutes in one of our large 
cities, more than 20% of prostitutes examined had either Gonorrhea 
or Syphilis or both. It is safe to say that all prostitutes, sooner 
or later become infected so the best preventative is abstinence. 
VENEREAL DISEASES 
The four most common venereal diseases we will briefly consider 
are Syphilis, Gonorrhea, Chancroid and Lymphogranuloma Venereum. 
A, Syphilis 
1. Approximately half a million people die yearly from some 
syphilitic infection. Syphilis may develop quite early 
after infection and be manifested by definite diseased conditions, It may not show up for a number of years 
after the infection is contracted. The victim may be 
ignorant of any syphilitic condition until in the course 
of a general examination a Hassermann blood test may 
give him his first information. 
2. Syphilis can also be transmitted congenitally to the new 
born and manifest itself early or later during the 
development of the child, robbing him of his heritage 
of good health. 
a. Etiology - the specific organism that causes Syphilis 
is called the spirochete pallida. It was first 
identified in March, 1905, by Fritz Schaudinn and E, 
Hoffmann, (Schaudinn, the parasitologist and Hoffmann, 
the syphilologist). It is a corkscrew-shaped 
organism from L to 20 microns in length, having spiral 
turns equally spaced and with flagella at either pole. 
It is capable of moving in three directions, namely, 
in direction of the poles, sideways and rotating on 
its axis. It is found in moist lesions, especially 
the chancre and recognized by a Oarkfield microscopic 
examination, 
b. Stages of Syphilis 
(1) Primary stage - the lesion of this stage usually 
appears two to six weeks after the infection is 
contracted. It is a punched out ulcerated area 
with indurated borders known as the chancre or 
hard chancre, rrhen of sexual origin, the chancre 
usually appears on the genitalia, penis or pubic 
region in the male and labia or pubic region in 
the female. 
Chancres may develop on the lips from kissing 
a syphilitic or from the use of infected drinking 
cups or smoking cigarettes previously smoked by 
a syphilitic. They may also result from accidental 
infection on the fingers or other parts of the 
body with infected instruments. 
(2) Secondary stage - the secondary stage appears one 
to two months after the chancre appears or two 
to three months after infection and is manifested 
chiefly by certain skin lesions which are quite 
similar in appearance to other skin diseases. 
Preceding or accompanying these lesions, certain 
general symptoms may develop such as malaise, 
aching pains in bones and joints which are worse 
at night. Anemia may develop. Mucous patches may 
develop in the mouth. Hearing and sight may become 
impaired. The glands become enlarged and hair 
falls out in patches. Usually in this stage of 
the disease, it is net definitely diagnosed without 
a positive test to prove its identity. (3) Tertiary stag© - ebout two years after a 
syphilitic infection, various lesions develop 
which affect the skin and deeper tissues, 
especially the bones and viscera. 
The chief lesions that develop are gumma, 
fibrosis and ulceration, which do not tend to 
heal and cause degeneration and destruction of 
tissues involved. Of the viscera, the 
testes, liver, spleen, heart and lungs are most 
commonly involved. Bones may become thin and 
brittle and fracture easily or produce the 
characteristic knee joint enlargement known as 
Charcot’s joint. 
In the case of thu> spinal cord a gummatous 
lesion develops, causing a chronic inflammation 
of the enclosing membrane, which may result in 
locomotor ataxia (tabes dorsalis). Gummata may 
also affect the bones of the skull, as well as 
the, soft tissues. In case of brain involvement, 
a softening may take place producing a form of 
insanity known as paresis. 
3. Congenital Syphilis 
a. Syphilis may also be transmitted to the new-born before 
or during birth and manifest itself about three months 
after birth or later in life. Both mental and 
physical changes may take place. Gradual deafness, 
blindness and characteristic teeth development are 
common in the child, 
b. Stokes in Modern Clinical Syphilology claims that 
congenital Syphilis, a term widely used in place of 
herodo-syphilis may be applied more strictly to that 
type of the disease which follows the infection of the 
fetus in passing through the birth canal. Congenital 
Syphilis is thus a form of acquired Syphilis. Its 
course differs considerably from that of the prenatal 
or heredo-syphilitic type. Stokes says that the latter 
involves an overwhelming of the child with the or- 
ganisms whose thoroughness often surpasses anything 
seen in the acquired form of the disease. Pinard and 
Hock (1920) claimed to have demonstrated the 
spirochetes in the semen in three out of eleven patients, 
whereas, Engman and Eberscn found them in the semen in 
two cut of seventeen patients. 
c. Congenital Syphilis may be transmitted to the child in 
either of the following ?;ays; 
(1) Paternal - the infection accompanies the semen; 
about 4-0$. of the children thus infected are 
either stillborn or die in early infancy, 
(2) Maternal - the mother had Syphilis before con- 
ception, the ovum becoming primarily infected. 
Child mortalitjr is about S0$, (3) Fixed Infection - both parents have Syphilis 
and transmit it to the new born child. Mortality 
is approximately 90$, 
(4) Pest Conceptional Syphilis - the mother becomes 
syphilitic after conception has taken place and 
transmits the infection through the placenta. 
B. Gonorrhea 
1. Gonorrhea or Feisserian infection is the most prevalent 
of the venereal diseases. It is estimated that approxi- 
mately 60$ to 70$ of the peculation has or has had 
Gonorrhea infection. 
2. Gonorrhea is caused by a specific non-motile parasitic 
biscuit-shaped gram-negative organism known as the 
diplococcus of Neisser or the gonococcus. 
3. The gonococcus was identified first by Neisser in 1S79. 
Then the stained smear is,studied under the microscope, 
the gonococcus is seen in acute cases within the pus cells, 
hence called intracellular and look very much like coffee 
beans with flattened surfaces adjacent, 
4. Gonorrheal urethritis appears three to six days after 
infection with smarting on urination, itching penis and 
scanty discharge. Later the discharge becomes more 
profuse and micturition may become more painful, especially 
if ulceration of the muccous lining of the urethra takes 
place. Associated symptoms usually are malaise, pain in 
the small of the back, tenderness in the perineum and 
constipation. Direct complications are prostatitis, 
cystitis, seminal vesiculitis and epididymo-orchitis. 
The most common complications from absorption of the gono- 
toxin or the blood stream invasion of the goneecus, or 
mixed infection, are gonorrheal rheumatism, endocarditis, 
lumbago, sciatica and neuritis. Accidental infection of 
the eyes produces a specific conjunctivitis, which, if not 
cured, may produce ulceration or even blindness. In new 
born babies, physicians put medicine (silver nitrate or 
argyrol) into the eyes to prevent ophthalmia neonatorum,, 
or blindness of the new born from gonorrheal infection 
received from the mother in the birth canal. 
5. Gonorrheal infection is responsible for more than 50$ 
of sterility in men by its destruction and closure of the 
spermogenic tubules, the epididymis or the Vas Deferens. 
In women it is responsible for about 90$ of sterility and 
70% of all pus operations of the abdomen. 
C. Chancroid 
Chancroid or soft chancre usually occurs on the penis in 
the male and labia in the female. It is caused by the strep- 
tobacillus of Ducrey or a mixed infection and appears as one 
or more papulopustular lesions which appear two to three days 
after infection. These rapidly break down into multiple soft 
bordered ulcerated areas, somewhat painful to touch and have 
more or less purulent discharge. A common complication is 
abscessed involvement of the inguinal glands known as Bubo. D, Lymphogranuloma Venereum 
This infection may occur as a small trivial lesion in 
the genitalia or rectum and is due to a filtrablc virus* 
From the initial sore it may become a systemic disease involving 
the glandular system. Multiple areas of softening may develop, 
as well as strictures and fistula formation, involving the 
genitalia as well as the rectum. The specific diagnosis is 
made by the Frei Test, 
COMPLICATIONS OF VENEREAL DISEASES AND ASSOCIATED CONDITIONS 
STRICTURES - they may occur in any part' of the urethra, but 
occur chiefly in the more vascular portions like the penile and 
membranous urethra. They result from either a severe infection, 
usually Gonorrhea, or strong medication, causing a pronounced 
inflammatory condition of the lining of the urethra with ulceration, 
after which scar-like tissue develops, causing a contracture of the 
urethra. When persistent, careful dilation with sounds is necessary 
at definite intervals; first to dilate the constriction, then to 
keep it open. 
HYPOSPADIAS - sometimes a congenital defect of the urethra 
develops whereby the urethral opening is beneath the location of the 
normal opening - this is called hypospadias* 
EPISPADIAS - similar to hypospadias, but opening is above. 
BUBU - this is a pustular infection of the inguinal glands 
and is a common complication of the venereal infections! 
lymphogranuloma venereum, granuloma inguinale and chancroids. 
VARICOCELE - this is an enlargement of veins in the scrotum 
resembling a "bunch of worms”. The vein walls are over-distended 
and engorged with blood. This is not due to venereal infection and 
is not a serious condition. Surgery is one of the chief corrective 
measures for this condition. 
HYDROCELE - this is a watery accumulation in the scrotum between 
the linings. It is usually secondary to injury and although not 
serious, may be annoying at times. Aspiration with proper asepsis 
will give relief, but permanent relief is obtained by means of 
surgery or in some cases, by injection of certain medication into 
the sac. It is important not to confuse hydrocele with a complete 
inguinal hernia into the scrotum, but differentiation can be 
readily made by transillumination of light. In the case of hydrocele, 
light from a flash light placed against the scrotum can be seen 
through the timer mass or swelling: whereas, in case of hernia, it 
cannot. PEDICULOSIS (Crabs) - an infestation in the hairy portions 
of the genitalia and rectum with a louse similar to a body louse, 
which is contracted by body contact with someone having them 
or which may be acquired from infested places, such as toilet 
seats. They may be gotten rid of by either shaving the hair in 
infested areas, or use of calomel powder, or blue ointment, or a 
coppcjr solution, such as Cuprex, 
SKIN DISEASES - various types of skin diseases resemble 
similar lesions in Syphilis and to the untrained eye may easily 
be mistaken for Syphilis, Clinical diagnosis in these cases is 
usually made more certain by the Wassermann blood test. 
ARTHRITIS - there are various forms of arthritis, caused by 
different infections. However, it is one of the most common 
complications of a severe case of Gonorrhea, especially "when the 
infection gets into the blood," In these cases, usually the 
knees, wrists or ankles are first affected, after which general 
involvement may take place. Treatment in these cases is two-fold, 
first that of the specific infection, Gonorrhea, and secondly, 
the complication, Arthritis. Baths, packs, diathermy, diet, 
internal medication and sometimes vaccines- are used. However, 
"fever therapy" and. the high frequency baking apparatus shortens 
its duration. Usually the condition is quite painful and the 
treatment takes a long time. 
NOTE; WASSEHMANN BLOOD TEST - is a test for syphilitic infection 
based upon a complement fixation which prevents hemolysis 
or breaking down of red blood colls, 
When the red blood colls are not broken down, there is 
a negative hemolysis or positive syphilitic reaction. 
If the blood cells are broken doTTn, there is a positive 
hemolysis or negative syphilitic reaction. Materials 
required in making a Wassermann test are; 
1, Antigen from a beef heart. 
2, Blood serum from the patient, 
3, Red blood cells from sheep, 
A, Amboceptor from rabbit, 
• 5. Complement from guinea pig, 
FAHN TEST - a modification of the Wassermann test. It is 
a precipitation test for Syphilis, 
KOLMEH1S TEST - a modification of the Wassermann wherein 
a specific complement fixation method is done. TRSATfrlEET 
A. Prophylaxis 
1. Regulations require that an enlisted man report immediately 
or as soon as possible after exposure to the prophylactic 
station for prophylactic treatment. If not, and he 
acquires a venereal infection, be is liable for punishment 
and is hospitalized without pay for a course of treatment. 
Prophylaxis, if taken within an hour after exposure, is 
90% effective and only 5n# effective if taken in three 
hours. After that, the efficacy rapidly decreases, 
2, Prophylaxis is given at station, 
a. Regulation report made out. 
b. Genitals washed with groan ■•cap celution, 
c. Genitals washed with Bichloride of Mercury (1-2000) 
solution, 
d. Injection of 2% T>rctargol solution into the urethra - 
hold about 5 minutes. 
e. Genitals treated with calomel salve, 
f. Protective covering over genitals. 
B, General 
1. It is universally agreed that Syphilis should be treated two 
years or more, depending upon the Hassermann reaction. Of 
the various drugs used, three stand out as more or less 
specific; arsenicals, bismuth and mercurials, 
2. In treatment of Gonorrhea, more diverse methods may be used. 
Some prefer the combined treatment of internal medication 
with urethral injections or irrigations. Some depend upon 
internal medication alone; whereas, others give the internal 
medication together with some form of a vaccine. Various 
drugs are used in its treatment, but during the past three 
or four years one or more of the sulfonamides have been used 
with considerable degree of success. Improper or unwise 
use of these drugs may produce harmful effects due- to their 
toxic effects upon the blood and circulatory systems, 
3. Chancroids and Lymphogranuloma are treated locally, primarily 
but the sulfonamides are also used internally, especially 
in the treatment of Lymphogranuloma Venereum. 
A soldier who contracts venereal infection should not temporize 
or jeopardize his health through self-treatment or experimental 
treatment. Ke should go on sick call immediately and take the 
prescribed treatment as thoroughly as he wpuld in case of any other 
serious type of infection. 
•165* NURSING 
AND 
OPERATING ROOM AND SURGICAL TECHNIQUE PART ONE 
NURSING 
INTRODUCTION TO NURSING 
A. The purpose of this training you are to receive is to prepare 
you as ’‘Technicians", so you can efficiently nurse medical and 
surgical patients. A surgical patient is one who has undergone 
an operation, been badly burned, or injured (i.e,, gun-shot 
wound or broken leg). All other patients are classified as 
medical patients, 
B. Essentials of good nursing methods, 
1, Any nursing method used must be scientifically sound. That 
is to say, it must be based on such sciences as Anatomy, 
Physiology, Bacteriology, etci 
2, Any nursing method used must be acceptable to the patient. 
It must be (a) safe, (b) effective and (c) carried out in 
a manner that provides him with all the comfort possible, 
3, The technician carrying out the treatment must know (a) 
why it is given, (b) how it is given, (c) what symptoms to 
expect during and after the treatment, and (d) results to 
be expected from the treatment, 
C» Points to be remembered: 
1, Support carefully and securely the patient's body when 
necessary to move him, 
2, Adjust and watch carefully any mechanical devices used on 
the patient (i,e., oxygen mask), 
3, Prevent fires by keeping matches and other inflammable 
materials from irresponsible patients, 
4., Take care to keep inflammable anesthetics such as ether from 
sparks and open flames, 
5, Avoid using force in handling tissues during dressings and 
treatments, 
6, Avoid long continued pressure on patient's body due to 
splints, bandages, and position in bod, 
7, Use correct degree of heat or cold these agents are 
applied, 
8, Carefully check and be sure the medicine you are giving the 
patiqnt is exactly what is ordered and that you have the 
correct dosage, 
9, your own body and dress clean and neat, wash your hands 
well with soap and brushes, or a disinfectant between care 
of patients and treatments, 
10. Use proper sterilisation methods and technique to protect 
yourself, as well as the patient, 
11. Have your ward properly lighted and ventilated, (i.e,, warm 
when bathing and cool when sleeping), 
12. Keep your ward "QUIET", 
13# Keep your equipment clean and in good condition so it is al- 
ways ready for use at :a moment’s notice. 14. Keep an eternal •watch for untoward or dangerous symptoms on all 
your patients and accurately record such on the patient’s o'-art. 
1$, Keep your patient mentally at ease. This means that every 
treatment you give must be done efficiently so as to develop 
the patient's confidence. Lake your movements gentle, deft, 
sure, and yet firm. Do your work in an orderly, well planned 
manner, so that you leave your patient improved to the great- 
est possible degree, physically and mentally. Tell him what 
you are about to do, arid what symptoms he can reasonably ex- 
pect from your treatment (i.e,, in giving a hypodermic, tell 
him he will feel only a pin prick and not to jump and so pre- 
vent breaking a needle.) 
SYMPTOMS 
DEFINITION} A symptom is any evidence of a patient’s condition. 
TIPESs 1, Objective - an objective symptom is anything you can 
tell about a patient’s condition with one of your 
five senses, (Sight, hearing, touch, taste, or smell), 
i.e,, you can see a swollen area of skin; you can hoar 
the way a patient breathes; you can feel the ends of a 
broken bone grate together; you can smell the odor of 
a patient’s breath. 
The vast majority of symptoms are objective 
symptoms« 
2, Subjective - a subjective symptom is anything about 
a patient's condition of which the patient complains, 
and w hich you cannot tell with one of your five sen- 
ses; i.e,, pain, itching, tenderness, chilly feeling, 
feeling of warmth, nausea (desire to vomit), 
OBSERVATION OF SYMPTOMS: The observation of symptoms is part of the 
technicians work that he carries out the entire time he is on duty. 
The technician observes symptoms when ho walks through the ward, 
gives a bed bath, administers a hypodermic, and whenever carrying 
out any of his other duties. This is important because the techni- 
cian is one individual who is with the .patient the greater part of 
the day. The medical officer sees the patient for a few minutes 
two or three times each day, thus it becomes thu -responsibility of 
the technician to determine any change in the patient's condition 
and report to the medical officer when necessary, 
’THAT TO OBSERVE: Macro are three main groups of symptoms that the 
technician must loam as he becomes more and more efficient in his 
work: 
1, Symptoms caused by the disease with which the patient 
suffers. 
2, Symptoms relating to nursing care, i.e,, cranr-s that re- 
sult from tec rapid administration of enema lid, 
3, Symptoms caused by the medicine given to the patient, 
i.e,, morphine produces slow breathing, drowsiness and 
pin-point pupils. Quinine causes ringing in the ears 
and drunk-headedness. Each student is to read over the following material several times: 
Medical Department Soldiers1 Handbood, paragraph #200, "Symptoms," 
pages 202 through 206, inclusive. 
TEMPERATURE: Every living Tier son has a certain normal temperature 
(body heat), This temperature or body heat is largely produced when 
the food you eat is metabolized (burned up or used) by the body 
cells. This temperature in health remains fairly uniform. In many 
diseases, the body temperature changes from its normal. Whenever the 
body temperature goes above the normal, the patient is said to have 
"fever0 or 11 elevation of temperature". This change can be caused by 
several different conditions, the most important of which is infection 
by bacteria (germs). Whenever the body temperature goes below normal, 
the patient is said to have a "subnormal" temperature; There are 
several different conditions which cause subnormal temperature, the 
most important of which is "shock". Whenever you find a patient with a 
subnormal temperature, you will consider the patient in shock until 
proved otherwise. 
A patient’s temperature is determined by the use of a thermometer. 
The bulb of the thermometer contains mercury (quicksilver)* The heat 
of the patient’s body causes the mercury to expand and rise in the 
stem. By means of the lines on the stem, we tell the patient’s 
temperature by reading the line to which the mercury has risen. Each 
long line represents one degree of heat. Each short line represents 
two-tenths (2/10 or ,2) of a degree of heat, A degree is a certain 
amount of heat and is our way of measuring heat. The degree is always 
abbreviated by the following sign (°), 
When a thermometer is not in use, it stands in a sterilizing 
solution. The sterilizing solution may be 70$ alcohol or 1-1000 
solution of Bichloride of Mercury, A thermometer must remain in one 
of these solutions one hour before it is considered sterile. The 
thermometer must always be sterile before using. At Brooke General 
Hospital a 25$ solution of cresol is used for sterilizing thermometers. 
Ten minutes in this solution is considered sufficient for sterilization, 
and before placing in patient’s mouth, rinse off with alcohol and 
tap water. There are three sites in the human body where the 
temperature is commonly taken, i.e,, in the mouth, the rectum, and 
the axilla (arm pit). 
1* Mouth (orally) - an oral thermometer is removed from the 
sterilizing: solution and washed in tap water. After shaking 
down the mercury, it is placed under the ■patient1 s tongue 
and the patient instructed to keep his lips closed tightly 
for three minutes. The normal “body temperature when taken 
orally is 98,6° F. After reading, the thermometer is wiped 
off and replaced in the sterilizing solution* 2. Rectum (rectal) - A rectal thermometer is removed from the 
sterilizing solution and washed with tap water. The-bulb 
end is lubricated r,ith lubricating jolly or mineral oil 
and inserted about one inch into the anus. During the 
five minutes the thermometer remains in the rectum, it is 
held in the technician’s fingers so that it can be quickly 
removed if the patient should attempt to move about. Normal 
body temperature when taken by rectum is 19.6° F, After 
reading, the thermometer is wiped clean with cotton and 
replaced in the sterilizing solution. The rectal route is 
used where it is difficult to take an oral temperature in 
such cases as follows: 
a. Unconcious patients, 
b. Delirious patients. 
c. pationts having difficulty in breathing. 
3. Fkin (axillary) - an oral thermometer is removed, from the 
sterilizing solution and washed with tap water. After shaking 
the mercury down, it i* placed in the axilla and ••olio arm 
lowered against the chest, leaving the thermometer in place 
for five minutes. After reading, it is replaced in the 
sterilizing solution. Normal, body temperature baton in this 
manner is 97.6° F. Of the three ways to take temperature, 
this is the least accurate of them all and thus wo always 
take an oral or rectal temperature, if possible, 
Whenever recording a temperature reading on the patient's 
chart or when giving a patient’s temperature reading verbally, 
it is absolutely essential to state in which of the three 
sites it was taken. 
Factors .Causing Inaccurate Temperature Ponding; 
1. Failure to keep the thermometer under the tongue, 
2. Failure to keep the thermometer in the mouth throe minutes 
or in the rectum five minutes. 
3. Mouth-breathing or holding the mouth open while the 
thermometer is present. 
4. Ice or ico vat or in mouth just before insorting the 
thermometer, 
5. Patient deliberately* placing the thermometer against radiator, 
ice bag, hot water bottle, etc, 
6. Inaccurate thermometer. 
Factors Influencing Temperature; 
1. Infection. 
2. Shock. 
3. Drugs. 
4. Exposure to extremes of cold or heat. 5. Exposure to heat producing electrical current. 
6. Conditions of some of the glands of internal secretion, 
(i.e,, thyroid), 
7. Vaccines, 
PULSE? This is the boat of an artery, mhe system of elastic pipes 
carry blood from the heart to the various organs of the body 
are called arteries. Every time the heart boats, it pushes into the 
arteries a large amount of blood, which causes the elastic arteries 
to ’expand. Then the arteries contract which serves to move the 
blood further along in the circulatory system. This rise and fall 
of the artery which occurs with each heart boat is called the "pulse”* 
‘pulse may be determined by placing your fingers on any artery 
close enough to the surface of the body to bo felt. Most of the 
arteries are placed de-op in the body and there are but three or four 
that can bo easily felt. The most frequent place to take the pulse 
is in the wrist at the base of the thumb. Here wo can feel the 
Radial Artery which carries blood to the hand. It is usually felt by 
placing the tips of the forefinger and middle finger on the artery. 
It is not possible to use your thumb to fool the pulse beat because 
there is a fair sizes'artery in your thumb; the boat of. .which might 
bo counted in case the beat of the patientrs pulse- is’very work or 
thready, ' ‘ 
Whenever you ta£e the patient’s pulse, you miist notice three 
factors: 
1, RATE - by the rate we mean how fast or how slow the pulse is 
beating. It is determined by counting the number of times 
the artery beats in one minute, 'Tie pulse rate of a normal 
person at rest is 72 beats per minute, 
2, STRENGTH - by this we mean the force with,which the expanding 
artePy hits your finger. The force, or strength or volume 
can be described by the words "wea1 ", normal” and “strong11, 
nThready pulse is a weal pulse. “Full”- pulsfe is a strong 
pulse, 
3, HKYTHI! - This concerns two characteristics of the pulse; 
a. The spacing or lapse of time between beats- ‘ 
b/ The force or strength with which the expanding artery 
hits your finger. 
Rhythm is described by the two words "Regular" 
and "Irregular". /• , n 
A pulse of regular rhythm ,is one with timing 
between beats all alike and the strength of the beats 
alike. An irregular pulse is one where the time inter- 
vals between beats vary, or the strength of the beats 
vary, or both of these changes from the normal exist. There is one type of pulse often seen following operations or 
injuries that is usually a danger symptom and must be reported im- 
mediately. Tith this pulse, as time passes, the rate becomes fas- 
ter and faster. It is a symptom of great danger when at the same 
time it becomes progressively weaker (thready). It is most serious 
when added to the above change in rate and strength; the rhythm be- 
comes irregular. 
Normally the pulse rate will increase 5 to 10 beats per min- 
ute with each degree rise of temperature above the normal. 
RESPIRATION - By respiration is meant breathing, Tvhenever you ob- 
serve a patient's breathing you must notice five factors. 
1, Rate - the normal rate of breathing of a man at rest is 
IB times per minute. It is counted by holding a watch 
in your hand and counting the number of times his chest 
rises and falls in one minute. 
2. Depth - By this we mean how much his chest rises and falls 
with each breath. It can be described by the words: 
"shallow'1, "normal" and "deep", 
3* Rhythm - this concerns two characteristics of the breathing; 
a, f he time interval between breaths, 
b. The depth of the breathing. 
Rhythm can be described in two words: "regular" or 
"irregular". In regular rhythm all breaths are the 
same depth and the time intervals between breaths are 
all alike. In irregular rhythm the depths of the 
breaths may differ, the time interval between breaths 
may differ, or both of the above may bo present. 
A. Ease - this has to do with the amount of effort the patient 
has to exert in order to breathe. Ease can be described 
by the words, "easy" (normal) or "labored" (Dyspnea), 
5, Pain - this may be described by the two words, "painless" 
or "painful". 
Apnea - is lack of breathing, A patient will go for thirty or 
sixty seconds without breathing in apnea. 
Dyspnea - labored breathing or great difficulty in breathing. 
Most cases of dyspnea are greatly aided by placing 
the patient in a sitting or semi-sitting position. 
Cheyne-Stokes Breathing - an irregular type of breathing where 
the breaths are very shallow, become progressively 
deeper, then progressively shallow and finally apnea. 
It is usually a symptom of approaching death. 
Apnea 
Apno a 
Apnea 31 OOP PRESSURE - by blood pressure is meant the force with which th# 
blood flows through idle arteries. The heart is the pump and each 
time it beats, it pushes the blood within it into the arteries with 
a great amount of force. 
The three main factors an ’which bleed pressure denend: 
1, The strength of the heart beat - the stronger the heart 
beat, the greater the force (blood pressure) it exerts on 
the blood as it is pushed into the arteries. The weaker 
the heart beat, the less the force. 
2, The elasticity of the arteries or the beat of the arteries - 
Since a large amount of blood is forced into the arteries 
each time the heart beats, the elastic walls must stretch 
to receive it. Then the elastic walls contract and force 
the blood further along the arterial system. 
3, The amount of blood made available for the heart to pump - 
the average man has between five to seven quarts of blood, 
depending on his size. Should this blood volume decrease, 
the blood pressure falls, A good example of this is seen 
in the ordinary water pump. If the pump does not have the 
necessary amount of water available to pump,the stream, as 
it comes from the pump, is small and has but little force. 
Increase the water to the pump and the stream produced by 
the pump is larger and has greater pressure to it. In 
hemorrhage, the blood available for the heart to pump de- 
creases and so the blood pressure falls. In shock., the blood 
available for the heart to pump also decreases and so the 
blood pressure falls. In shock, the blood is pooled in the 
tiny capillaries which have dilated and so have greatly 
increased in size, thus making the amount of blood available 
for the heart to pump much less than normal. Also in shock, 
the amount of blood is decreased by some of the fluid part 
of the blood passing through the walls of the capillaries 
out into the tissues. 
Kow to Take the ’s Blood pressure: The cuff is placed 
about the arm well, above the elbow. Sufficient air is pumped into 
the cuff sc that its oressura will cut off the flow of blood through 
the Brachial Artery, Listen with the stethoscope, placed gently yet 
firmly on the anterior elbow surface. The air is slowly released 
from the cuff by means of the valve attached to the rubber oul’o, As 
the air pressure in the cuff falls, it finally reaches a point where 
the blood pressure in the Brachial Artery is able to force a small 
amount of blood past the constriction caused by the air cuff. At 
this point, a loud definite thud is hoard each time a small amount 
of the blood is forced past the constricting air cuff, with each 
heart boat. The first reading is taken at this point and it is called 
the “systolic” blood pressure. For men in the army it will normally 
be between 105 and 14.0, As more air is released from the cuff, and more blood 
is forced by the blood pressure past the constricting air cuff. 
As this occurs, the thud heard with each heart beat becomes louder. 
Suddenly this loud thud will change to a very definite weak thud 
and the second reading is taken at this point. This reading is 
called the "diastolic11 blood pressure. Its value in a normal man 
of army age is from 60 to 90, 
Finally when the needle falls another ten or fifteen points, the 
pressure in the cuff becomes so low it causes no obstruction at 
all to the flow of blood through the brachial artery, and at this 
point the soft thud heard with each heart beat disappears. The 
two blood pressure readings are recorded as a fraction1: 
Systolic 115 (Average) 
Diastolic 70 (Average) GENERAL CARE AND COMFORT OF THE PATIENT 
I. BED MAKING 
A. The Closed Hospital Beds a hospital bed not in use is called 
a ’’closed bed", and is made ub in the following manner; 
1. Materials required; 
a. Four cotton sheets , 
b. One rubber sheet 
c. One mattress cover 
d. One pillow case 
2. Turn the mattress from head to foot and cover with 
mattress cover. 
3. Cover the mattress with a cotton sheet, wide hem to 
the head of the bed, folding it under at the head, 
foot and sides, leaving square corners. If the sheet 
is too short to fold under at both head and foot, fold 
it under at the head. This will keep the sheet from 
slipping toward the foot of the bed and' wrinkling. 
A. The "draw sheet" is applied only if the patient is 
likely to soil the bed. The draw sheet is made of a 
rubber sheet covered by a cotton sheet. Its purpose 
is to protect the mattress and to move the Patient, 
mhe rubber sheet is ‘placed on the bed extending from 
the level of the patient's shoulders to a level well 
below his hips. It is covered with a folded cotton 
sheet with the folded edge toward the head of the bed. 
Rubber objects are never allowed to come in contact 
with the patient's si in. 
.5. A blanket encased in two cotton sheets to cover the 
patient is now placed on the bed, ’’lace one sheet on 
the bed with the wide hem to the head, ’’lace the 
blanket on top of this sheet, pulling it down about six 
inches from the head of the bed. Cover the blanket with 
another cotton sheet, which extends about six inches 
above the,blanket at the head. Fold the top sheet under 
the blanket’s upper edge. Fold the under sheet over 
the blanket and top sheet at the blanket’s upper edge. 
This protects the blanket’s upper edge from spilled 
fluids or saliva. All throe items are folded under 
the mattress at the foot with square corners.‘ 
6. The pillow is rolled between.the hands to‘loosen the 
filling, and then placed in a pillow case by holding the 
pillow under your arm (never in the mouth). If the 
pillow case is too large, fold it in at the under side 
of the pillow. Place the’.pillow on the bed with its 
opening away from the entrance of the'ward, 
B. T"hen to Change the Bod Chests, 
n At-least twice a week, 
2, Between patients, 
3, ’"henever soiled, 
U. Following a sponge bath. C, How to Change Sheets on an Occupied Bed: 
1, Have at the bed side the following supplies: 
a. Four cotton sheets, 
b. One rubber sheet. 
c. Pillow case, 
2, Loosen the sheets all around the bed. Remove all the covers 
from the patient except one cotton sheet. Working in pairs, 
a technician stands on each side of the bed to keep patient 
from rolling out of the bed. Place the patient on his side 
on one edge of the bed in the following manner: 
a. Straighten out the lower limbs, and cross one leg over 
the other so that the upper points towards the side of 
the bed to which you desire to move the patient, 
b. The upper extremity on the same side is placed across 
the patient's chest so that the hand points towards 
the side of the bed to which you desire to move the 
patient, 
c. The other arm is straightened out on the desired side 
of the bed so that the patient will not roll upon it. 
Place one of your hands under the shoulder, and the 
other hand under the hip, and gently lift, 
3, Remove the pillow. Start on the opposite side of the 
bed from the patient, roll the sheets into a tight roll 
close to the patient’s body. Place a clean sheet on the 
uncovered side of the bed and fold it under the mattress 
with square corners. Place the draw sheet on the uncover- 
ed half of the bed in the same manner. Roll the remainder 
of the clean sheets into a small roll along side of the 
patient's body. Move the patient over to the clean side 
of the bed, remove the soiled sheets, unroll the clean and 
fold them under the mattress with square corners. Change 
pillow case and place the pillow on the bod, Spread a 
clean sheet over the patient and remove the old one. Place 
the blanket back on the bed and cover it with a clean 
sheet. Fold all three items covering the patient under 
the mattress with square corners, taking care that they 
do not press too tightly against the patient's feet. Do 
not throw soiled sheets on the floor when making the bed. 
II, BATHS 
A. Baths are given to hospital patients for several reasons, 
such as follows: 
1, To get the patient’s body clean. 
2, To make the patient perspire (sweat). 
3, To bring down a high elevation of temperature, 
4, To quiet the patient down (induce sleep, relax ner- 
vousness). 
5, To stimulate the patient’s circulation. B, Baths are classified by the temperature of the agent used 
to bathe the patient: 
1, Cold Bath - 60°F, to 70 F, 
2, Tepid Bath - Q0°F, 
3, Hot Bath - lio°F. 
C. The Sponge Bath: 
1, The sponge bath is given to the patient in his bed, to 
cleanse his body. It is best given early in the morning 
before breakfast, or the last thing at night before go-J 
ing to sleep. If it is necessary at some other time of 
the day> wait at least one hour after meals. Great care 
should be exercised in giving the bath to the very sick, 
since their body resistance is low and respiratory in- 
fections may develop because of exposure to cold. The 
room temperature should be around 70° F, Ihe windows 
are closed to prevent drafts, and curtains drawn around 
the bed* 
2, The following items are necessary: 
a. Tub of water (UQo F,) 
b. Kidney or emesis basin, 
c. Large rubber sheet, 
d. Cotton sheet, 
e. Bath towel and hand towel, 
f. Tooth paste and brush. 
g. Soap and wash cloth, 
h. Rubbing solution (70$ alcohol - 30$ boric acid) 300 cc, 
i. Talcum powder, 
j. Mouth wash, 
k. Nail file or orange-wood stick. 
3, Protect the bed with a bath towel under or next to the 
area being washed. Keep tho patient covered except for 
that part being bathed. Start with tho head and work 
down to the pubic region, then start at tho feet and 
work up to the pubic region, washing the pubic region 
last. Brush the patient's teeth with an up and down 
movement on all surfaces. Then rinse out the mouth with 
mouth solution, Snave the patient, if necessary, then 
wash the face, ears and neck with a small amount of soap, 
taking care to remove all the soap with the wash cloth 
and dry the skin well. 
Clean the patient's finger nails with nail file or 
orange-stick and trim the nails short, Wash one upper 
limb with soap, water and wash cloth and dry well. Do 
the same with the other upper limb. Now wash and dry the 
chest, abdomen and back down to the pubic region. Then 
start on the feet, exposing only one limb at a time. 
Trim the toe nails square across, and clean underneath 
them with a nail file. Wash and dry each limb in turn. 
Lastly wash and dry the pubic region (scrotum, penis, 
etc,) and perineum (around the anus). Now that the skin of the entire body is cleaned, the 
patient is given an alcohol rub and his back powdered. Turn 
the patient on his abdomen or side to expose the back. Pour 
the alcohol-boric acid solution into the palm of your hand 
and apply to the skin with a brisk massage until dry. All 
the posterior surfaces of the patient (neck, chest, shoul- 
ders, lower back, buttocks and limbs) are rubbed and mas- 
saged with the solution, 
DThen doing the back, begin at the spine with one 
hand on each side and work the palms outward with a cir- 
cular motion, thus moving the underlying muscles. Continue 
in this fashion until the entire back has been massaged. 
Following the rub, apply talcum powder freely to the 
patient's body, especially those parts in contact with 
the bed. This will keep the skin dry by absorbing his 
sweat. 
D. The Sweat Bath: the sweat bath is given to a patient in a 
bath tub or in his own bed for the purpose of making the pa- 
tient perspire (sweat) to rid his body of toxic'materials. 
1. Tub Sweat Bath - fill the tube half full with water at 
110° F. To be sure your water is of the correct temper- 
ature, use the bath thermometer. The patient is slowly 
lowered into the tub feet first until he is* submerged 
up to his neck. An ice bag or cold compresses are placed 
on his head. The length of time the patient remains in 
the tub of hot water varies from 10 to 20 minutes. What 
you are trying to accomplish is to getthe patient to per- 
spire well 1/2 to 1 hour, in which time he would be able 
to sweat one liter of perspiration out of his system. The 
sweating process is started by the hot water. Hatch his 
face, and when this skin area has freely perspired for 
10 minutes, you can be- sure that the sweating process is 
well established over the rest of the body. Remove the 
patient, after this 10 minute period of perspiration; 
do not dry, but wrap him in dry blankets1 in bed. Now 
that the save a ting process has started, keep him in these 
blankets for 1/2 hour to I'hour (as long as tb process 
continues). During this period, give the patient hot 
fluids to drank, unless there is a definite order to the 
contrary. After this period, move the patient to a dry 
bed for one hour. Then give the patient a sponge bath 
and alcohol rub to clean his skin. 
Throughout the whole procedure, and especially 
during the 10 to 20 minutes the patient is in the tub 
water, watch carefully for untoward sysmptoras. Espe- 
cially, notice the pulse, ,If it becomes very rapid or 
weak,■or both, it is best to remove him from the hot 
water at once and wrap him in the warm blankets. Should 
the patient complain of feeling faint, or very weak, it 
is best to remove him from the hot tub, even if the 
sweating process has not become well established. 2, Hot Air Bod Bath - protect the mattress by a rubber sheet 
covered by a cotton sheet. Strip the patient and place on 
the protected mattress. Place over his body a cradle so as 
to form a tent with a sheet or blanket. Only the patient's 
head is outside the tent. Hang on the cradle four to six 
electric light bulbs of ordinary size to heat the air about 
his body. Place along side the patient in bed a bath ther- 
mometer so that you can always tell how hot the air is a- 
bout his body. When the air about his body reaches a tempor- 
of 110°F, to ll5°i',, turn off or loosen in their sockets e- 
nough of the electric light bulbs so that the temperature 
goes no higher. Watch for the start of the sweating pro- 
cess, and time it so that the patient perspires about 1 
hour. During this period, give him hot liquids to drink 
and keep cold compresses or ice bag to his head. Also watch 
well for untoward symptoms such as rapid pulse or fooling 
of faintness (which might be a signal to stop the treatment,) 
At the termination of the treatment, place the patient in a 
dry bed, give him a sponge bath and alcohol rub and powder 
his body, 
E, The Cold Rath - the cold bath is given to the patient for the 
purpose of reducing his temperature, 
1, Cold tub bath - the cold tub bath is also called the "Brand" 
bath, 'Mil a bath tub half full of water around 90°F. Lower 
the patient into the tub slowly, to avoid shocking him, feet 
first. Have all of his body covered by the tepid water ex- 
cept his head and neck. Ice or ice water is now added to the 
tub to reduce the temperature of the water until his oral 
temperature reaches 100°F, or less. The duration of the 
bath is 15 minutes or less. During this period, while the 
patient is in the cold water, his body surfaces are vigor- 
ously massaged. Rub vigorously any skin surface you can 
reach under the water. This massage servos to bring the 
flow of blood to the skin so that the cold water may more 
quickly bring down the temperature of his body, 1 Latch for 
untoward symptoms such as blue lips or fingertips, marked 
shivering of the body muscles, marked chattering of the 
teeth, and the patient complaining of being too cold or 
that he is going to have a chill. Should such symptoms 
appear, it is best to discontinue the bath even if the de- 
sired temperature has not been reached, 
2, Coldpacks - protect the mattress with a rubber sheet cover- 
ed by a cotton sheet. Two folded cotton sheets, dipped in 
water at 70°F, and rung out> are placed under and over the 
patient's body. Remove and redip these sheets as soon as 
they lose their chill (about every 5 to 10 minutes), A 
half hour of those packs produces the effect of 10 to 15 
in the tub of cold water. Continue the packs until the tem- 
perature orally is 100°F, or less, provided no untoward 
symptoms develop. It is not practical to massage the skin 
surfaces when using the sheets. II. BED SORES 
A. Definition; a bod sore is an ulcerated area cn the patient's 
body due to pressure from a long period of confinement in 
bed. Other names for the same condition are "Decubitis" 
and "Pressure Seres". They are especially likely to occur 
in the poorly nourished patients or those with long 
exhausting illness and poor circulation. 
B. Symptoms: early is seen a blanched area that quickly turns 
red when the pressure is relieved. These areas are most 
likely to be noted over bony regions (heels, hips, shoulder 
blades, lower spine, elbows, back of head). At this same 
time, the subjective symptoms of numbness, tingling or 
soreness may be present. They may bother the> patient to such 
a small degree that you may have to ask him if he senses such. 
There is little or no pain associated with this condition. 
Do not wait for the patient to complain of pain before being 
on the watch for bedsores. If the pressure is not relieved, 
the poor circulation of blood to the area will remain, c?.nd 
the next symptom to develop is a small break in the skin. 
This means that some of the skin cells have died from lack 
of proper blood supply and have separated from the rest of 
the skin. If the pressure is not relieved, the break becomes 
larger making a large ulcer. 
C. Causes; 
1. Constant pressure on an area (thus preventing proper blood 
flow into the area), . ' 
2. Prolonged illness confining the patient to bed, 
3. Moisture (sweat, urine, stool, bath water, pus and 
other discharges). . 
A* Heat. 
5. Friction (wrinkled sheets, crumbs). 
6. circulation as in heart disease, kidney disease, 
lack of exercise. 
7. .Obesity (fat) and emaciation (wasted). 
D. Prevention: 
1. Watch for the early symptoms, especially over the bony 
prominences, 
2. Change patient's position in bed every hour or so, 
3. Proper bathing to keep the skin clean and dry, 
A. Proper alcohol rubs to toughen the skin, cut down 
perspiration and provide exercise. 
5. Proper bed making and keep sheets free of wrinkles. Keep 
bed clean and dry. 
6. Proper powdering of the body after baths and rubs to 
adsorb the sweat. 
7. Prompt cleansing of the skin as soon as it is soiled by 
urine, stool, pus, etc* 
8. Use of rubber rings, air mattresses, cotton doughnuts, 
pillows, etc. to relieve pressure on any area that shows 
the early symptoms. E, Treatment: the best treatment is to PREVENT them from 
developing. In the early stages before the skin is broken, 
all the treatment necessary is to relieve the pressure 
from the area, so that it may receive proper blood supply, 
and the symptoms will promptly disappear. In the later 
stages where there is a definite break in the skin or a 
large ulcer: 
1. Relieve all pressure, 
2. Cover with a sterile dressing to keep out all germs. 
Balsam of a 5% Sulfathiazole or Sulfanilamide 
ointment, 5% boric acid ointment, 5% Scarlet Red Ointment, 
etc., may be spread on the sterile dressing before 
applying to act as an antiseptic and to keep the dress- 
ing from sticking to the raw flesh, 
3. Keep away from this bandaged area when giving baths, 
alcohol rubs and massage. 
III. CARE OF THE MOUTH 
A. Instructions: 
1. Careful attention must be given to the oral cavity 
of the sick patient, for normally the mouth harbors many 
varieties of germs. In sickness, the body's powers 
of resistance to these germs may become so lowered that 
the germs can invade the mouth tissues to cause severe 
infection, 
2. Brush the teeth after each meal, using a dentifrice 
(paste or powder) once or twice daily. Brush downward, 
away from the gums (never toward the gums), 
3. Give the patient an alkaline mouth wash to use after 
each brushing of the teeth. If none of the regular ward 
mouth wash is available, use baking soda (1 teaspconful 
to the glass) and water as a mouth wash,. 
A, Use dental floss to remove particles of food stuck 
between the teeth. 
5. In cases of "Oral Sepsis1’ or poor oral hygiene, the gums 
become swollen, red, very tender and bleed easily. Pus 
and food debris collect around the teeth, A foul 
odor (halitosis) of the breath is present. When such a 
condition exists, you cannot use a tooth brush and 
dentifrice because of the tender gums; in place you 
must use cotton swabs to clean the mouth and apply mild 
antiseptics to the infected tissues. The follovdng are 
of values 
a. Hydrogen Peroxide (Ho0o) mixed with water - half and 
half. This is used as u mouth wash or swabbed over 
the mouth tissues with a cotton swab. 
b. Sodium Perborate - one or two teaspoonsful .dissolved 
in a glassful of warm water, used as a mouth wash or 
applied with cotton swabs, 
c. Chewing gum helps keep the teeth clean of food 
debris and pus. IV. CARE OF THE LIPS 
In the very sick patient the lips tend to become dried, 
swollen, cracked and tender. To combat this condition, the 
lips are painted several times daily with a mixture of glycerine 
and lemon juice, on a cotton swab. The mixture is prepared by 
placing about 1 teaspoonful of lemon juice in an ounce of 
glycerine. This mixture can be used on the tissues of the 
interior of the mouth also. 
V. CARE OF THE NASAL CAVITY. 
To prevent the nasal mucus membranes from drying out and 
cracking, and to clear the nose of dried and crusted mucus, 
mineral oil on a cotton swab is applied severe.' times daily* 
VI. CARE OF THE-HAIR; keep the patient's hair out. This may be 
necessary but once every two weeks; keep the patient1s hair 
washed. This may be necessary but once each week. Keep the 
patient’s face shaven. This is usually dona each day or every 
other day, 
A. Treatment for Head Lice; The proper name for the head 
louse is ’’Pediculus Capitis”. The adult is the size of a 
head of a pin (1 mm. or 1/25 of an inch,) oval in shape and 
gray in color. The adult lays eggs, which are called ”nits”, 
and secretes a glue, to fasten the nits firmly to the hair 
of the patient’s head. The nits look just like tiny flecks 
of dandruff. The treatment is as follows; 
1. Shampoo the head well to wash out most cf the adults, 
2. Apply Tincture of Larkspur or Kerosene and oil (half and 
half) overnight (wrapping the head in a towel to protect 
the pillow). This destroys adults but does nothing to nits, 
3. Shampoo to-remove the Larkspur or oil' the next‘.morning, - 
4., S6ak, head in pan of warm vinegar. This dissolves the 
glue and so loosens the nits, 
5. FINS COMB and shampoo out the loosened nits. 
6. Check the head well every 2 or 3 days for the next two 
weeks for evidence of recurrence of the infestation. The 
eggs were not destroyed, but merely loosened by the acid 
vinegar. If a few are left behind, within 2 weeks they 
will develop into adults. 
VII. TREATMENT FOR BODY LICE* The proper name for the body louse is 
’’Pediculus Corporus”. The adult lives in the seams of the under- 
wear, and so when the clothing is removed, all of the adults are 
removed. The eggs are deposited on the body’s hair, but are not 
glued to the hair, A hot water and soap bath (shower) will 
remove all the eggs. Steam or hot water will destroy the adults 
in the'clothes. 
VIII. TREATMENT FOR PUBIC LICE; The proper name for the pubic louse 
is ’’Pediculus nubis”. The adult and eggs are found in the hair 
of the pubic region. Steam or boil the clothing. Apply Blue 
Ointment (33$ Mercury Ointment) for several days (l week) in 
a row. IX. BED PAN 
A.. Instructions: 
1. The clean dry bed pans are kept in the utility room on 
a bed pan rack or in a warming closet. If the pan has 
not been kept in a warming closet, it is placed under a 
flow of hot water, dried, and brought to the bed side 
covered with a bed pan cover. Screen the bed and remove 
the pajama trunks or pull the hospital gown well above 
the patient’s knees. Stand at the side of the bed on a 
line with patient’s hips, place your left hand under 
the small of his back and lift. Slip the ban into 
position with your right hand. The pan should comfortably 
support the buttocks. If the patient is emaciated 
(wasted) or has a bed sore, the bed pan cover is folded 
to form a pad and placed between the patient's lower back 
and the bed pan. It is very difficult for the patient 
to expel his feces when lying flat on his back. By 
elevating the knees and propping the patient into a semi- 
sitting or sitting position, he will be able to evacuate 
his bowels with greater ease. If the patient is able to 
clean his anus, place a roll of toilet tissue in his hand 
as soon as he is on the bed pan. If he is unable to 
clean his anus, the technician must clean it for him. 
This is best done before removing the bed pan by spread- 
ing the knees far apart to expose the anus. If necessary, 
use warm water, soap and wash cloth after using the 
toilet tissue. As soon as the patient is finished and 
the anus cleaned, remove the bed pan. Never leave the 
patient sitting on a bed oan while you go off to do some 
other task. To remove the bed pan, lift the small of the 
patient’s back with your left hand, slip the bed pan 
cover off, if one has been used, and remove the pan from 
underneath the patient with your right hand. Cover the 
bed pan and remove from the ward at once. Before cleaning 
the bed pan, look at its contents so that you may 
properly record any abnormalities such as blood, pus, 
mucus, parasites and unusual coloring. Note also the 
amount, odor and consistency of the stool. If ever in 
doubt, save the specimen for the medical officer’s 
inspection. 
2. JTo clean the bed pan.-.- Open the bed pan steri- • 
zer by stepping on its foot peddle, . slip the bed pan and 
its contents into the sterilizer and close the top, 
Press the hand lever to start the hot water and steam 
spray. The bed pan is removed from the sterilizer in 15 
to 30 minutes time, and placed in a warming cabinet or 
on the rack. T%ere bed pan sterilizers are not available, 
wash out the pan first with cold water and then scrub 
with hot, soapy water and a brush. If the patient has 
had mineral oil, it will be necessary to use plenty of 11 clbcn grease” in addition to the above. If the 
pan is to be used by mere than one patient, it is 
placed in boiling* water for 15 minutes to sterilize. 
If unable to sterilize by boiling, place pan in a 
chemical antiseptic such as 5% cresol or lyscl, 2% 
formalin, or 1-1000 mercury bichloride solution for 
1/2 hour. If the patient has a communicabl* disease 
such as typhoid fever, it is necessary to decontaminate 
the stool beforo emptying the bed nan. Break up the 
feces with a tongue depressor and cover with chlorinated 
lime. Let stand for 1 hour before flushing the feces 
into the sewage system. 
After removing the pan from the bed side, r . :ove 
the screens and air out the room well. If the patient 
cleaned his own anus, give him a basin of hot water, 
soap and a towel, sc that he may wash his hands at once. 
If you cleaned the patient’s anus, it is not necessary 
to do the above, but when you have finished with the 
bed pan, wash your own hands with hot water, soap and 
a brush. You are now ready to record on the patient’s 
chart the fact that he has had a bowel movement. This 
is done by recording the time, the amount, the appearance 
and consistency of the feces. 
X. URINAL 
The urinal is a glass or metal container designed to receive 
the urine from a bed patient, common]- call them '’duels", 
Th.e urinal is brought to the bed side; covered a oh a cloth. 
It is placed between the patient's logs and the patient's penis 
placed into it. After voiding, note the color, odor and the 
amount of the urine. After the urinal is emptied it is cleaned 
by first rinsing with cold water and then hot water. If the 
urinal is used by more than one patient it must be sterilized 
after it is cleaned. Containers that have had body discharges 
in them (urine, feces, blood, pus, etc.) are always washed with 
cold water first. All body discharges contain protein. This 
protein is best removed’with cold water. If hot we;-or is first 
used, the protein is caused to stick to the walls of the 
container and is very difficult to remove. 
After disposing of the specimen and-washing your hands, 
record in the patient's chart the time of voiding, the amount 
and appearance of the urine, A small amount of blood gives 
urine a smoky appearance. A large amount of blood causes ohe 
urine to appear red. 
Never leave a bedpan or urinal on the floor by the 
patient's bed, even if it is clean. XI. COLLECTION OF SPECIMENS 
A, You should know how to collect the following specimens; 
1, Sputum 4. Vomitus 
2, Urine 5, Blood 
3, Stool 6, Smears 
B, Instructions; 
1* Keep all the specimens in a cool place that are not 
sent to the laboratory at once, 
2, L'ash your hands well after collecting and handling 
all specimens. At Brooke General Hospital all spe- 
cimens are marked in the following manner: each spe- 
cimen is given a number which is recorded on the spe- 
cimen bottle with a red wax pencil as was placed on 
the bottle; All three items are sent.to the labora- 
tory, After the specimen is examined, and the speci- 
men slips completed, one is filed in the laboratory 
and the other is sent back to the ward to be pasted 
in the patient's chart, A sterile specimen is one 
collected so that no outside germs gain access to it. 
Thus, it must be collected in a sterile bottle, with 
sterile technique, A specimen may contain many dead- 
ly germs and yet it is called a "sterile specimen". 
These terras came from the patient’s body, 
U* Sputum - is material that comes from the lungs. It is not 
saliva (mouth fluid). Sputum specimens are always collect- 
ed with sterile technique so that no outside germs get in 
to them, and are therefore, "sterile specimen". The pa- 
tient is told to cough up sputum from "deep down" in the 
lungs, and to clear the sputum from the back of his throat 
directly into a small, wide-mouth, sterile glass jar, with- 
out touching the mouth of the bottle with his lips. The 
bottle is then covered with a sterile gauze or cork. 
Try to get at least one teaspoonful of sputum for the 
specimen, 
D, Urine 
1, The urine is passed directly into a clean urine bottle. 
Collect at least four ounces (120 cc,). If he can only 
void a few cc,, collect what you can and send to the 
laboratory. If tlx- patient is a bed patient, to avoid 
soiling the sheets, you may have to collect the spe- 
cimen in a clean urinal and transfer it to the bottle. 
2, If a sterile urine specimen is ordered, it is collect- 
ed by passing sterile catheter into the patient's 
bladder, and permitting the urine to flow into a ster- 
ile urine specimen bottle. The bottle is covered with 
a sterile gauze or cork and sent at once to the labor- 
atory. 3. If a ”24- hour urine specimen” is to be collected, 
use o large clean jar and keep, it in a cool place during 
the 24* hour period. Select the 24- hour period to suit 
yourself. It is best to start at 8 s 00 A.M. and collect 
the specimen until the same time the following day. 
The idea Is to collect all urine produced by the 
kidneys during this 24- hour period. The patient voids 
at the start (8;00 A.M. today) and this urine is* 
discarded, thus starting with an empty bladder. All 
urine passed for the next 24- hours (up to and including 
, 8;00 A.M.- tomorrow) is saved in the large ja-r. The 
last specimen.is collected exactly 24- hours after the 
start. The- whole specimen is sent to the laboratory. 
Formalin-(2% to 5%) is added to urine t -ocimens as a 
preservative. 10 to 15- drops is sufficient for a large 
jar. Chloroform may be used as-a substitute for 
formalin. 
E. Stool or Feces - a mass- of.stool about half as big as your 
thumb is picked up from the bed pan with a clean tongue 
depressor and deposited.into a clean, small, wide-mouth, 
glass, jar. The sputum jar is covered with gauze or cork 
•and sent to the laboratory properly labeled, 
F. Vomitus - vomitus is transferred from the basin in which 
1- the patient-has vomited, to a clean wide-mouth glass jar 
(urine specimen bottle). Cover the jar with gauze or 
corlj, label properly, and send to the laboratory. Collect 
120 cc. if possible, 
G. Blood - there are three main ways to collect blood specimens? 
1. .In the first method.a test tube of blood is collected 
for such tests as the T,rassermann or Kahn tests. The 
skin of the anterior surface of the elbow is sterilized 
with iodine and alcohol.• A tourniquet is placed about 
, the arm above the elbow. A sterile needle is inserted 
into a vein and the test tube held at the hub of the 
needle to collect the blood. Often a 10 cc. syringe is 
attached to the needle and the blood drawn into the 
syringe, and then transferred to the test.tube. ‘Usually 
about 10 cc. cf blood is collected. This blood will clot 
in the, test tube. . 
2. In the second, method blood is collected so that it will 
, not clot. Blood kept in a liquid form is necessary 
■ for many tests such as blood sugar determinations. 
Ten (10) cc. of blood is collected in a syringe and 
transferred to a small glass bottle th* contains a 
few crystals cf an oxalate or citrate to keep the 
blood front clotting. 3* The third method is the blood smear. The tip of the 
middle finger or ear lobe is wiped off with alcohol 
and stabbed with a hypodermic needle so that a drop 
of blood appears on the skin surface* One end of the 
flat surface of a glass slide is touched to the drop 
so that the blood is transferred to the slide. The 
edge of another glass slide, held at a 4-5 degree angle 
to the first one, is placed in the drop of blood. 
Then the top slide is drawn across the bottom thus 
smearing tho drop of blood over the flat surface of 
the bottom slide. After standing a few minutes, the 
blood will dry, and it then can be stained with dyes, 
and examined under a microscope* 
Hi Smears - smears are made of blood, pus or other body fluids 
or discharges. To make a smear of pus a sterile cotton 
swab is dipped into tho pus so that the pus moistens tho 
cotton. Then the moistened swab is drawn across the flat 
surface of a clean glass slide, smearing a thin layer of 
the pus on the glass surface* After drying for a few min- 
utes, the smears can be stained with dyes and examined 
with a microscope. XII. THE HYING *ATIEMT 
Dying patients should be moved to a separate room. If 
this is not practical, surround the bed with screens, so 
that other patients will net see the dying person, 
A. Symptoms of Death; 
1. Absence of breathing - if you see no movement of the 
patient’s chest, place your hand lightly on the chest 
to feel for a possible slight movement. 
2. Absence of Heart Beat - place your ear to the 3 eft side 
of the patient's sternum (against his skin) and listen. 
It is best to use a stethoscope, placing the bell 
between two ribs to the left of the . .. 
patient’s sternum, 
3. Absence of - feel for the pulse at the wrist with 
the tips of your forefinger and middle finger, 
4. Dilatation of - (saucer pupil) - by the pupil is 
meant the black hole in the center of the eye, The 
,firis” is the colored muscle curtain that surrounds 
the pupil. In death the pupil is surrounded by a 
very narrow rim of colored iris. If the patient is 
still alive, when a light is flashed into his eye, the 
colored curtain (iris) will contract down, and make 
a much smaller pupil. If any change at all occurs in 
the size of the pupil when the light is flashed into 
the eye, the patient is alive. If there is no change 
in the dilated pupil, that patient is dead. 
5. Later, the body becomes cold, rigor mortis sets in, the 
eyeball becomes very soft, and finally the body begins 
to decompose. 
B. Care of the Body 
After death has occurred, the body is bathed and wrapped 
in a clean sheet. It is then placed in the morgue 
refrigerator. To prevent the soiling of the skin surfaces 
by fluids from the various body cavities (i.o,, mouth, 
na,res, rectum), all openings are plugged with cotton. A 
large piece of cotton is tied about the penis with roller 
bandage to catch any urine that might spill from the 
bladder. 
In the morgue, the legs are straightened out and the 
ankles tied together with roller bandage. The jaw is tied 
up with roller bandage or a 4--tailed bandage so that the 
mouth is closed. The arms are straightened cut, a.ud the 
wrists tied together over the abdomen. XIII.ADMINISTRATION OF MEDICINES 
There are nine ways frequently used to administer 
medicine: 
Cutaneously by applying to skin surface. 
Orally - swallowed by mouth, 
Rectally - placed into the rectum. 
Intra-nasally - placed into the nose. 
Subcutaneously - injected under the skin (hypodermically). 
Intravenously - injected into a vein. 
Inhalations - inhale into the lungs. 
Intramuscularly - injected into a muscle. 
Intradermally - injected into the skin. 
A. Cutaneous Route 
There are many drugs used for healing skin conditions 
applied cutaneously, but these will not be discussed, 
1. To sterilize skins 
a. Scrub well with hot water and soap, and dry, 
b. Paint with Tincture of Iodine, full strength (7%), 
or half strength (3 l/2%)» 
c. Remove the Tincture of Iodine with 70% alcohol, 
to prevent blistering of the skin. 
B. Oral Route 
1. Take great care to avoid mistakes. Compare the label 
of the bottle with the order written in the order 
book to be. sure you have the correct medicine and 
correct dose, 
2. Carefully measure your dose from the bottle, 
3. Use a ’’graduate’1 to measure liquid medicines, 
4. Pour the medicine from the bottle on the side opposite 
the label. 
5. Use a medicine glass to carry the medicine to the 
patient’s bed side. 
6. Watch the patient take the medicine. Medicine should 
NE7TR be left with the patient to be taken by himself. 
7. All medicines are well diluted with water and 
followed by water to increase their absorption, unless 
the medical officer orders otherwise. Cough medicine 
is the one exception to this rule. Have the patient 
drink freely before taking the cough mixture and do 
not let him drink for at least a half hour after taking 
the mixture. 
8. Record in the patient’s chart the time, the name of the 
medicine and the dose given, (Never make this record 
before giving the medicine), 
9. Before giving a drug with a disagreeable taste, let the 
patient hold ice chips in his mouth to anesthetize the 
taste buds of his tongue. 10, Never awaken a sleeping patient for medicine unless 
the order is written in such a manner that you have 
no choice in the matter; q.2,h., q,6.h,, ac, pc, 
stat, and hs are all examples of ways in which the 
order could be written, sc that you would have to 
awaken a sleeping patient to administer medicine. 
11, The best way to give castor oil is to put the dose in 
a half glass of orange juice. At the patient’s bed- 
side add a quarter or half teaspoonful of baking soda 
(sodium bicarbonate). Administer while fizzing, 
12, Powders, if small, are nlaced on the back of the 
tongue and washed down with water. If large, stir in 
a glass of water and swallow before it settles in the 
glass. 
C, Subcutaneous Route? a subcutaneous injection is the 
introduction of fluid underneath the skin. 
1, Hypodermic Injection. 
a. Hie hypodermic syringe (2 cc, capacity) is 
sterilized by boiling in water for 20 minutes. It 
is kept sterile by removing from the water with 
■sterile forceps and immersing in a jar cf 70% alco- 
hol till needed. A hypodermic needle (3./4n to 
l/2” long and about 25 gauge) is placed in a 
tablespoonful of distilled water after removing 
the stilette. An alcohol lamp is used to heat the 
spoon until the water has boiled for one to three 
minutes. Stop before all the water boils away. 
The needle is now considered sterile and is removed 
from the water with sterile forceps and placed on 
a dry sterile sponge or alcohol, sponge until ready 
for use, 
b. The syringe is removed from the jar of alcohol with 
a sterile forceps, and the plunger inserted into 
the barrel, taking, care not to contaminate the 
plunger or the tip of the barrel. Work the plunger 
up and down several times to expel the alcohol 
inside the barrel, ’’Tash cut the barrel with a 
half cc, of sterile water from tablespoon. Discard 
this wash water and fill the syringe with 1 cc, 
of water from the spoon. Any remaining water in the 
spoon is discarded, and the 1 cc, in the syringe 
is expelled back into the spoon. The proper number 
of tablets to make up the dose ordered is dropped 
from the bottle into the spoon, using the cork to 
prevent extra tablets from spilling out, 
c. By filling the syringe and expelling the water 
from it, the drug goes into solution readily. Every 
drop of the liquid is drawn into the syringe, the 
needle attached by means of a sterile forceps, and 
an alcohol sponge is used to protect the needle 
until ready for injection. Air is expelled by 
advancing the plunger with the needle up, until a 
drop of solution appears at its tip. d. The best site for injection is the outer 
rear surface of the upper arm. The skin is 
cleansed by the alcohol sponge applied vith a 
spiral motion beginning at the site of injection 
and progressing outward until an area of about 
three inches has been prepared. Pick up the soft 
tissues between left thumb and forefinger, and 
with the bevel up, the needle is quickly inserted 
under the skin in a direction almost parallel 
to the skin surface (45 degree angle). The 
solution is injected, the needle withdrawn, and 
the injection site massaged with the alcohol 
sponge. 
e. Rinse out the syringe and needle with tap water, 
dry by sucking air into the syringe and expelling 
with the plunger. Insert wire stiletto into 
needle and replace on the tray. The plunger and 
barrel are fastened together with a rubber band, 
sterilized by boiling, and then replaced in the 
Jar of 70% alcohol, handling with sterile forceps, 
f. It is best to tell the patient what to expect 
before you insert the needle, so that bo will not 
Jump and break the needle. It is very important 
to draw into the syringe every drop of the 
solution in the spoon in which the drug has been 
dissolved. It is also important to lose as little 
of the solution as possible when expelling air 
from the syringe, and to inject all of the solution 
under the patient's skin, so that the complete 
dosv- has been given. Before sterilizing needle, 
check it for a "Burr". This is a bent point. If 
you think the inserted needle is in a blood vessel, 
partially withdraw and reinsert, 
2, The Administration of Morphine Sulfate. - Probably the 
most frequently administered drug by the above method 
is Morphine Sulfate. It is important that you know 
the following symptoms, to determine when it is 
safe to administer H.M.S. 
a. Symptoms that indicate morphine sulfate; 
(1) Severe pain, 
(2) Marked restlessness. 
b. Symptoms that contraindicate morphine sulfate; 
(1) Slow respiratory rate (less than 12 to 14 
times per minute), 
(2) Contracted punil (pin point). 
(3) Drowsiness, deep sleep or coma. 3. The Hypodermoclysis - this is the subcutaneous 
injection of a large amount of fluid (usually 1000 
cc,). The fluid is allowed to flow from a reservoir 
through a rubber tube and two needles into the 
subcutaneous connective tissue of the lower lateral 
chest wall or the medial aspect of the thighs. The 
tissues are gently massaged to spread the fluid out 
over a greater surface and so increase the rate of 
absorption. By injecting the fluid in two sites 
(usually 500 cc, in each site), a liter can usually 
be given in an hour’s time, 
a. The fluids most frequently used are: 
(1) Normal Saline (,85$ solution of table salt 
in sterile water),. 
(2) Glucose (never ever 5$ solution in sterile 
water or saline), 
(3) B gm, of sulfanilamide in 1000 cc. of saline 
to make an ,8$ solution. The medical officer 
will order this given in divided doses. 
b. After preparing the skin at the site of injection 
with an antiseptic, the site is draped with 
sterile towels, exposing only the prepared areas. 
Take up the sterile apparatus, so as not to 
contaminate the opening to the reservoir or the 
needles, and pour some of the sterile solution 
into the reservoir with sterile precautions, Air 
is expelled from the tubing by the solution. The 
rubber tube is clamped to prevent escape of the 
fluid. The needles are inserted into the prepared 
areas, covered with sterile gauze, and held in 
position with strips of adhesive. The clamp is 
removed so that the solution will flow. The tips 
of the needles lie in the loose subcutaneous tissue. 
. The fluid is placed in the reservoirs at a tem- 
perature of 110°F,, so that after passing through 
the rubber tubing, it reaches the tissue at body 
temperature. The temperature of the solution is 
maintained by surrounding the reservoir with hot 
water bottles. In some hospitals, no effort is 
made to keep the solution warmed above body 
temperature, A sterile cover should be draped over 
the top of the reservoir, and full aseptic 
precautions observed each time the solution is 
replenished. The reservoir hangs about two feet 
above the site of injection. Watch the site of 
injection. If the area is blanched, firm wo 
touch, and painful, the flow must be shut off by 
clamping the rubber tubing, and the area, gently 
massaged to spread out, and so hasten the absorption 
of the fluid. Then the clamp may be removed, and 
the flow again started. D, Intravenous Route. 
1. The Intravenous Infusion (’’Venoclysis”, "Intravenous”, 
”I,V,”): this is the injection of a large amount of 
fluid into a vein. The amount is usually 1000 cc, 
a. The solutions most frequently used ares 
(1) Normal Saline (.85% solution of salt in 
sterile water), 
(2) Glucose Solution {% to 50% solutions in 
sterile water), 
(3) Normal saline and % glucose combined, 
(4-) Blood (whole) and Plasma. 
b. The arm to be used is loosely splinted to a padded 
board with 3 inch roller bandage applied well 
above and below the elbow. Take care not to put 
this roller bandage on so tight that it acts as 
a tourniquet, A rubber tourniquet is placed 
underneath the upper arm but not tied. The 
anterior elbow surface is prepared with an anti- 
septic on a sterile cotton ball or gauze pledget 
held in a sterile forceps. Drape the area with 
two sterile towels leaving the prepared area 
exposed. The sterile cap from the warm (110°F,) 
flask of solution is removed and the rubber tubing 
and sterile needle attached to the bottle with 
sterile precautions. If a burette is to be used, 
the warm sterile solution is poured into it with 
sterile technique, and the open top of the burette 
covered with a sterile piece of gauze (An x 4-”). 
The flask or burette is hung’ on a standard along 
, side the arm, at the desired height (usually about 
2 feet above the level of the elbow), and the 
air expelled from the tubing and needle. The 
rubber tubing is now clamped so that the fluid 
cannot flow. The tourniquet is tightened, so that 
the elbow veins distend with blood and the needle 
inserted with the bevel up into the lumen of a 
vein. As scon as the needle enters the vein, the 
dark blood can be seen passing back into the 
rubber tubing, T*Tien this happens, you know the 
needle is in proper position. The tourniquet on 
the upper arm and the clamp on the rubber tubing 
are released. The needle is propped up by means 
of a small piece of sterile gauze under its hub, 
and fastened in place by a strip of adhesive 
tape over the hub. The needle usually used is a 
20 gauge needle, 1 l/2,f to 2M long. About 20 
minutes is taken to give 500 cc, of fluid. In 
shock a liter of the fluid may be given In a 
/ half hour’s time. c. The technician must not leave the patient's side 
while the treatment is being given. He must make 
and record frequent observations of the pulse, 
respiration and color. If a burette is used, it is 
replenished with sterile technique so that it does 
not become empty, thus permitting air to enter the 
vein. The rate of flow must be observed and 
regulated as ordered by the medical officer. A 
Hoffman clamp on the rubber tubing makes an easy 
way to control the rate of flow. The height the 
burette or flask hangs above the arm also controls 
the rate of flow. Watch the site of injection 
closely, and if a collection of the fluid is noted 
at the needle's point in the subcutaneous tissue, 
shut off the flow, and call the medical officer to 
reinsert the needle in the vein. At the end of 
the treatment, take care to clamp off the flow 
before all of the fluid runs into the vein, so as 
to prevent the entry of air into the blood stream, 
2. The Continuous Intravenous Infusion (Intravenous Drip). 
In this treatment the intravenous infusion is set up 
so that the fluid flows into the patient's vein drop 
by drop over a long period of time (one or more days). 
The solution is usually given at a rate of about 150 cc, 
per hour (about 35 to 10 drops per minute). This rate 
can be greatly increased if so ordered by the medical 
officer. The apparatus is as described for the regular 
intravenous infusion, with the addition of a Murphy 
bulb (drin bulb, drop bulb) between the flask and the 
needle. This is a glass bulb so constructed that the 
fluid flows through it drop by drop. The rate of 
flow of the drops can be controlled by a Hoffman clamp 
on the rubber tubing above the Murphy oulb, 
3- The Blood Transfusion - this is a special form of 
"Intravenous Infusion". The following method is called 
the "Citrate" or "Indirect" method of blood transfusion. 
The anti-coagulant used is Sodium Citrate (2.55? 
solution), The blood is taken from the donor through a 
large caliber needle (15 gauge) into a flask containing 
50 cc. of 2 \/2% Sodium Citrate Solution, Meanwhile, 
the recipient has had a regular intravenous infusion 
started with about 100 cc. normal saline. The needle 
used in the recipient's arm is also one of large caliber 
(probably 4- or 5 times as large as the regular intra- 
venous needle). The citrated blood, which has been 
kept warm by gentle agitation in a basin of water at 
110°F., is added to the burette partially filled with the 
normal saline flowing into the patient's vein. In 
cleaning the apparatus at the end of the transfusion, 
great care must be taken to carefully wash in cold water 
all articles used. Force cold water through the 
needles and through the rubber tubing, as soon ns the 
treatment is finished. E. The Intramuscular Route - In this route the needle is 
placed deep in the muscle of the buttock with a stab-like 
motion. The needle used is 2 l/2 to 3 inches long. The 
longer (3”) is the better. The site of injection is always 
in the upper-outer quadrant of the buttock. After 
sterilising the skin, the needle is stabbed into this area 
to the hub and a syringe attached. Suction is applied by 
pulling back on the plunger. If any blood appears in the 
■ syringe, pull the needle out half way or so, change its 
direction, and reinsert in a new site. Since there are 
many large blood vessels deep in the buttock muscles, always 
check in the above manner, so as not to inject the medi- 
cation into a vein. After injecting the solution ordered, 
pull the needle out with a quick pull, and massage the 
site of injection with the alcohol sponge. This route of 
administration is used only occasionally. Its main use is 
for the administration of medicines containing Bismuth 
(a heavy metal used in the treatment of most cases of 
Syphilis). 
F. The Inhalation Route" drugs such as Ether, Chloroform, 
Oxygen are given in this manner. The Steam Inhalation is 
a method of treatment for inflammation in any part of the 
respiratory tract. 
The treatment is carried out by placing about 1 liter 
of water in a shallow pan, and boiling the water. The 
patient holds his head over the pan to inhale the fumes. 
There are many drugs that can be added to the water to add 
to the effect of the steam. Of these, Compound Tincture of 
Benzoin is the most important. Add about 1 ounce (30 cc.) 
to each liter of boiling water. The medical officer’s 
order will always state how often to give the steam 
inhalation and hew long to continue each treatment. By 
throwing a sheet over the patient’s head and the boiling 
water, the fumes will be concentrated and make for a more 
efficient treatment, 
G. The Rectal Rouae 
1. Suppositories - are bullet-shaped objects made of 
medicine in cocoa butter, designed for rectal ad- 
ministration of medications. The tin-foil or paper 
wrapping is removed, tlio suppository lubricated with 
water or mineral oil and inserted into the anus, pointed 
end first. The body heat melts the cocoa butter, and 
so liberates the drug, which can now come in contact 
with the lining membrane of the rectum, 
2. Enemas - an enema is the placing of fluid into the 
rectum. a. There are two main types: 
(X) Evacuating Enemas - given to clean out the lower 
large bowel. 
In giving the Evacuating Enema, protect 
the mattress with a rubber sheet. Place the 
patient on the edge of the bed on his left side 
of the pelvis, and the enema fluid will run down- 
hill better than uphill, - If it is impossible to 
place the patient on his left side, give the 
enema in the dorsal recumbent position, (that is 
flat on his back with knees drawn up). Unless- 
it is impossible for the patient to retain the 
fluid, the bed pan should not be placed under 
the patient until after the injection of the 
entire amount of fluid. The apparatus is assem- 
bled, consisting of the enema can connected to 
. a rectal tube, Cne to two liters of enema fluid 
is placed in the enema can, and the air expelled 
from the tubing and rectal tube. Lubricate the 
end of the rectal tube with mineral .11 or lub- 
brieating jelly, and insert the tuba just into 
the anus. Permit ' a small amount of enema fluid 
to run in and then insert the tube in for a total 
of three to six inches. The can is held about 
2 feet above the level of the anus, Run the 1 
to 2 liters of enema fluid into the rectum slow- 
ly. Take at least 5 minutes, A larger amount 
can be given and retained by the slow injection. 
If discomfort occurs (i.e,, pain or cramps in 
the lower abdomen), stop the flow momentarily 
and then continue, after the fluid has been 
given, the tube is pinched and slowly withdrawn. 
It is now desirable for the patient to retain 
the enema fluid for 5 to 10 minutes, if possible. 
The technician can assist the patient to retain 
the enema by pressing the two buttocks together. 
The patient can assist in holding the enema by 
bending his knees towards his chest, taking deep 
breaths through his mouth, and tightening his 
own muscles to attempt to hold it. ’Then ready to have the patient expel the 
enema, let him use the latrine, if possible* 
If he is not permitted out of bed, put the bed 
pan under the patient, and prop him up in a 
semi-sitting position, or if permitted, sit 
the patient up on the bed pan* 
If the patient is able to clean his anus, 
hand him a roll of toilet tissue* If the patient 
is so weak that he is unable to accomplish this 
by himself, the technician will clean the peri- 
neum, If necessary, soap, water and wash cloth 
may be used after the tissue. 
The enema produces its results largely by 
stimulating peristalsis. The injected fluid 
distends the rectum, .The stretching of the 
large bowel produces a very active, wave-like 
movement of the muscle wall known as "Peris- 
talsis” • This muscle movement serves to expel 
the enema and the stool (feces) in the lower 
large intestine. 
Often irritants are added to the enema to 
produce very active peristalsis. The one most 
frequently used is soap. The enema is called 
the "Soap Suds Enema", Enough mild soap as 
Ivory or Castile is dissolved in hot water to 
make a soapy solution. Never use laundry soap 
for it is too' irritating. Other irritants add- 
ed are: Turpentine - 1 bo 4 drams to the enema; 
Glycerine - 2 to 4 ounces to the enema. Inspect 
the contents of the bed pan for blood, pus, mucus, 
parasites, amount and color of the feces, etc, 
following the enema, clean all apparatus and re- 
cord the results. State on the' chart the time, 
amount and type of enema given, and results pro- 
duced, 
’Then the patient is unable to expell the 
enema, if only one liter of fluid has been given 
inject a second liter into the rectum. If this 
is not successful, it may bo necessary to si- 
phon off the enema fluid by inserting a rectal 
tube into the rectum. In most cases no harm 
is done if the patient should be unable to expel 
a plain water enema, but if an irritant has been 
added to the fluid, it is important that the ene- 
ma fluid be expelled or siphoned from the 
(2) Retention Enema - the retention enema is carried 
out in a manner similar to the evacuating enema 
with those main differences; 
(a) Only a small amount of fluid can be inject- 
ed (100 cc. to 200 cc,), A larger amount 
will cause distention of the bowel wall and 
thus peristalsis end expulsion of the fluid. (b) The enema must be injected very slowly. 
Take 10 minutes to inject the 100 cc, 
of fluid so as not to produce distention 
and peristalsis, 
(c) A small rubber tube (16 F. catheter) is 
used in place of the large rectal tube; 
for the large rectal tube, by stretching 
the anus sphincter muscle open, stimulates 
peristalsis, 
(d) Fvery effort is made to have the patient 
‘ hold the enema and not expel it. 
If the patient has not had a bowel movement in 
the six to eight hours previous, it is best to 
precede the retention enema by an evacuating 
enema. Following this, wait one hour for the 
peristalsis to quiet down before injecting the 
retention enema. All retention enemas should 
be held at least one hour, to be reasonably sure 
that the drug or food present was absorbed. 
Often the addition of starch to the enema fluid 
to make it thicker will assist the patient in 
holding his retention enema. Starch water being 
thicker than plain water, it is less likely to 
ooze out of the anus. 
3, Proctoclysis (Murphy Drip) 
Water introduced into the rectum in quantities not 
large enough to distend the bowel, is absorbed and so 
added to the blood. The aim is to introduce a small 
amount of fluid slowly into the rectum. By this method 
2 to 3 liters may be given in a 24 hour period. The 
apparatus used consists of the enema can attached to a 
small (16 F) catheter by rubber tubing. The tube leading 
to the catheter is fitted with a Murphy bulb (drip bulb 
or drop bulb) so that the fluid'will flow drop by drop, 
A Hoffman clamp on the tubing above the Murphy bulb 
controls the rate of flow. The solution used (it does 
•not have to be sterile) is placed in the enema can at a 
temperature of 110°F. Permit the fluid to expel the air 
from the apparatus. Insert the catheter from four to 
six inches into the rectum and fasten in place by ad- 
hesive straps to the buttock. The flow is best given at 
the rate of 500 cc. per hour, Permit the flow for one 
hour, then close the Hoffman clamp so there is no flow 
for the following hour. Continue in this manner of an 
hour on and an hour off, A cleansing enema should always 
precede the administration of proctoclysis, The- 
solutions most frequently used are; 
a. Tap water 
b. Normal Saline (Physiological salt solution ~.B5% 
solution of NaGl in H^O). 
c. 5% Glucose Solution, XIV, GASTRIC LAVAGE AND SAVAGE 
A. Definition; Lavage - means to wash out or irrigate, 
Gavage - means to fe©d through a tube, 
1. Gastric Lavage (nasal method) is a procedure fre- 
quently carried cut on the wards. A nDuodenal11 or 
"Levine11 tube is used. The tube is passed through 
the patient’s nose, into his throat and thus into 
the esophagus and stomach. Through the tube, the 
stomach cavity can be lavaged, or food pieced into 
it (gavage). The duodenal tube is A feet long and 
1A- F. in caliber, The blunt end, which is inserted 
into the patient's nose, has A openings. About IF 
inches from the blunt end is a black ring around the 
tube. T?rhen the tube is inserted -so that this black 
ring is at the skin margin of the nose, the blunt end 
is at the junction of the esophagus and, the stomach. 
Four inches beyond the first black ring is a second 
ring, ™hen the tubs is inserted sc that this ring 
is at the entrance to the nose, the blunt end is well 
into the stomach lumen. Four inches beyond the second 
ring is a third, and finally a fourth. If the tube is 
inserted to the third black ring, the blunt end of the 
tube is just beyond the stomach in the small intestine. 
The first cart of the small intestine is called the 
"Duodenum”, Thus does this tube get its name, for 
in most cases when the tube is inserted, it is placed 
into the lumen of the duodenum. ,,!Then the tube is 
inserted to the fourth and last black mark, the blunt 
end is several inches into the duodenum. 
The Duodenal Tube is well lubricated with 
lubricating jolly. It is inserted along the floor of 
the nose about 3 inches. If trouble is encountered, 
try the other side of the nose, for often one side of 
the nose may be obstructed by a crooked septum, "lien 
the tube is in position, give the patient a glass of 
water to drink through a glass drinking tube. As 
he drinks, push the tube into his nose. The tube and 
water will both pass from the back of the throat 
into the esophagus and thus into the stomach. Cnee 
the tube is in place, the patient can breathe, talk, 
eat, etc., without °ny trouble. The tuba is held in 
place by strapping with adhesive to the skin of the 
cheek. 
Since this tube is very small, it is possible 
for it to enter the trachea and lungs. This is a very 
rare occurrance. Always check, to bo sure that you 
are in the stomach before injecting any fluid into the 
tube. If fluid should be injected into the lung, a 
lung abscess or pneumonia would develop. a. Hold the end to ycur ear and listen. You will hear a 
whistling sound with each breath if the tube is in the 
lungs. If in the stomach, you will hear either nothing 
or a gurgling sound as stomach peristalsis churns the 
gastric fluids, 
b. t>Then the tube enters the trachea, the patient may cough 
or turn cyanotic. These are not reliable symptoms, 
for the tube can enter the lung without their occurrence, 
c’, With a syringe, suck back on the tube. If in the lungs, 
the syringe will fill with air. If in the stomach, the 
syringe will fill with gastric fluid. 1!Tith the tube in 
the stomach, the patient can be fed liquids through 
tube (gavage), or the stomach may be washed out (lavage), 
d. To get the blunt end of the tube to enter the duodenum, 
the tube is inserted to the first black mark. Then it 
is advanced l/2 to 1 inch every 10 minutes, until the 
tube has been inserted beyond the third black ring. The 
blunt end should then be well into the duodenum. If 
the tube is placed down to the third or fourth mark all 
at one time, it will coil un in the stomach and never 
get into the'small intestine. Often, inserting the tube 
an inch every 10 minutes, the tube will coil up into a 
ball in the stomach. Therefore, the following test is 
made to determine just where the blunt end of the tube 
lies. Fluid is aspirated and tested with blue "Litmus 
If the fluid turns the blue colored litmus 
paper to a red color, then the fluid is acid, and the end 
of the tube lies in the stomach cavity. The hydrochloric 
acid secreted by the stomach lining makes the gastric 
fluid acid in reaction. If the aspirated fluid has no 
effect on the color of the blue litmus paper, you can 
assume that the fluid is alkaline (basic), and therefore, 
came from the small intestine (duodenum , The fluid in 
the small intestine is alkaline (basic) from the bile. 
Better yet, get some RED litmus paper, and if the end 
of the tube is in the duodenum, the alkaline fluid from 
the small intestine will turn the red litmus paper to a 
blue color, 
"Acids turn Blue Litmus Red". 
"Bases turn Red Litmus Blue", 
2, The Duodenal Decompression or Wangensteen Suction Apparatus. 
Where it is desirable to decompress (empty) the small 
intestine of gas, fluid and toxic material present, it is 
best accomplished by means of the duodenal tube, and the 
apparatus diagramed (Wangensteen Suction), This apparatus 
may be set up and kept operating for several days. It 
requires constant attention to keep the narrow lumen of the 
duodenal tube from plugging with thick mucus or food 
particles, "'lien such an apparatus Is in place, do not nermit ..Water 
The degree of negative pressure 
producing the partial vacuum 
in the duodenal tube varies 
directly with this vertical 
distance, (Two feet, six inches 
has been found satisfactory) 
WANGENSTEEN SUCTION APPARATUS NEV AND SIMPLE TYPE OF BOTTLE ARRANGEMENT FOR GASTRIC AND DUODENAL SUCTION 
DRAINAGE (GERLINGER), Bottle (d) is the trap bottle, and suction is created 
by siphonage from bottle (f) on the table to bottle (h) on the floor. To 
start the siphoning, the clamp on tube (c) is closed and the rubber tube (e) 
Is disconnected from the short glass tube on bottle (f). By blowing into 
this short glass tube, siphon drainage is started end tube (e) is again 
connected. When bottle (fj becomes empty, it is simply replaced by bottle 
(h), which is now full, and after blowing into tube (l) to begin the 
siphonage, tube (c) is attached and suction drainage is continued. If the 
exchange between bottles (f) and (h) is made before the water level in 
bottle (f) gets below the level in the long class tube, the siphonage 
already established will be maintained and will not have to be restarted. 
During the exchange of bottles (f) and (h), the clamp on tube (c) is closed. the patient milk, ice-cream or unstrained fruit juices, 
for the milk curds and fruit pulp easily plug the lumen 
of the small tube. The short arm of the glass °Yn tube 
is for the attachment of a syringe of tap water for irri- 
gating purposes. As soon as the water flows from the top 
bottle to the bottom bottle, the top bottle must be refilled, 
so as to maintain constant suction* 3* Gastric Lavage (era.! method) - means the washing 
out of the stomach. The regular gastric tube is used. 
This tube is size 30 F. (l/2” outside diameter). One 
end is blunt-pointed and is inserted through the mouth, 
throat and esophagus into the stomach '* vity. It is 
marked with a white ring IP inches from the end. The 
other end has a funnel attached. 
The lavage is best given in a sitting position, 
but if necessary it can be done with the patient flat on 
his back. "Protect the patient and bed with r rubber 
sheet over the patient. Have a large slop basin at the 
bedside to receive the lavage fluid. The gastric tube 
is chilled by placing in ice water or ice chips before 
passing. The irrigating fluid will always be specified 
by the medical officer. It is usually plai tap water 
(at body temoerature - 100°F.), or water to /hich 
bicarbonate of soda has been added ( 'sfT to the liter). 
The amount of fluid used varies. The lavage should be 
continued till the irrigating fluid returns vitb an 
appearance exactly as when it was poured into t? - funnel. 
Thus it is best to have at the bedside about 2 g..*ions 
of fluid, although in most cases one gallon is sufficient 
to do a good lavage. Before starting, place an emesis 
basin in the patient’s hands, for many will vomit while 
the tube is passed or immediately afterwards. If vomit- 
ing does occur, there is no occasion for alarm because 
this partially empties the stomach cavity, and thus 
less lavaging will be necessary to finish the job. Should 
the patient be intoxicated by alcohol or otherwise 
uncooperative, it may be necessary to hold him in 
restraint while doing the lavage. Since this type of 
patient can easily bitethe gastric tube, it is necessary 
to use some type of mouth gag. A simple way to prevent 
the patient from biting the tube is to nut S or 10 
tongue depressors together, and place 3m between 
molars on one side of his mouth, so homing his jaws 
apart. 
Before passing the tube, tell the patient what you 
are going to do, and explain to him that as the tube is 
passed (which takes but 5 seconds or less) he will have 
trouble catching his breath, but that as sow as 
it is down, he can breathe normally, 
’Then ready to pass the chilled tube, have the patient 
open his mouth, and take deep breaths. Thda will 
relax the patient. Usually when a patient .3 told to 
open his mouth, he does so, as widely as possible. This 
partially closes off the throat passageway to the 
esophagus; sc be sure that the mouth is open about half 
way. Instruct the patient to stop taking deep breaths 
when you place the tube in his mouth, and to"sw; ’ "ow 
his Adam's Apple”, The tube is inserted, aimed a.i.ong the roof of the mouth. The curvature of the roof 
of the mouth will carry it into the esophagus. Insert 
the tube until the white ring is at the patient’s lips. 
You can then be sure that the blunt end of the tube 
is 2 to 3 inches into the stomach of the average man. 
The tube in position, you are now readv to lavage 
the stomach. Lower the funnel end of the tube to the 
slop Jar on the floor, to permit any fluid in the 
stomach to drain out. Often the presence of the tube 
will set up violent reverse peristalsis and the fluid 
will be forced out of the funnel with considerable 
force. Pour about one pint of lavaging fluid into the 
stomach, and before it all runs out of the funnel, 
pinch off the tube just below the funnel. When the 
funnel is lowered to the slop jar (to a point below 
the level of the stomach) siphonsge is set in action 
to recover the fluid from the stomach. This process 
is repeated several times, till the lavaging fluid 
returns clear. During the time the gastric tube is in 
place, the patient may retch, and even vomit. This 
cannot be helped, so proceed with the lavage. When you 
have the patient’s full cooperation, you can let him 
hold the gastric tube near his lips. He will be able to 
hold it so that it does hot-make pressure on his tongue or 
the rear of his threat. This will reduce the desire to 
vomit. m.. ftaSIQfX AG0JTS USED IN NURSING 
A* Sfftt w If heat la applied to an area of the body, the 
capillaries in that area are dilated open* and the blood 
flow is greatly Increased to the area. Thus* heat produces 
fn increased blood flow into the area and an increase in 
the blood flow out of the area. Since the healing of 
inflammation depends on the flow of blood to the inflammed 
area, wide use Is made of heat to bring about that increase. 
Dry heat {hot water bottle or lamp) is good. Wet heat (wet 
dressings or soaks) ia better, 
H* Methods for Use of Wet Heat 
a," not Compress - hot compresses are pieces of cloth 
dipped into a hot solution and applied to the 
inflammed area. As soon as the cloth has lost its 
heat, it ip redipped into the hot solution and 
reapplied to the Inflammed area. When a medical 
officer orders hot compresses applied to some part 
Of the patient*s body, he will always state the name 
and strength of the solution to be used* how long 
each application of compresses shall last, and how 
often to repeat the treatment, 
I*et us assume we have a pafllent with a large 
boll on the back of his neck* The medical officer has 
written the following order: Hot compresses of sat, 
sol# of for 1 hour q,2,h, to inflammed area 
of posterior cervical region. To carry out this 
order| get a basin large enough to hold, a liter of 
solution. Boil this for 20 minutes so that it is 
sterile. Place in this sterile basin a liter of 
sterile water, and heat to H0°F, on a hot plate. If 
a hot plate is not available, set the flask of ster- 
ile water in a basin of hot water till it has reached 
a temperature of 110°F.; then pour the hot sterile 
water Into the sterile basin. 
To this liter of sterile water is added Mag- 
nesium Sulfate (Epsom Salts) crystals and the 
solution stirred with a sterile tongue depressor, 
until no more crystals will dissolve, A saturated 
solution of MgSO. has now been prepared. Place In 
the sterile solution A to 6 gauze compresses {A x 4)- 
If these are not available use a small sterile 
towel, Put on sterile rubber gloves, remove the 
compresses from the sterile solution, press out the 
excess solution, and apply to the inflammed area. 
In 2 or 3 minutes, the compress will have lost much 
of its heat, remove, redip into the sterile solution, 
and reapply to the area, Continue in this manner 
for one hour. Let the patient rest for two hours, 
and repeat the whole process, making up a fresh 
sterile solution each time. The vast majority of applications of wet 
heat to the skin surfaces of the body are prepared 
with a temperature of 11C°F, You should bo able 
to determine when a solution has a temperature 
of 110°F. without the use of a thermometer. Water 
at 110°p, dropped on the brack of the hand or on 
the anterior surface of the forearm has a comfort- 
able, hot sensation on this skin surface. Try 
this three or four times so that you can tell when 
a solution is 110°F, U.se a sterile asepto 
syringe to remove the sterile solution from the 
basin and drop a few drops on the back of your hand 
for the test, 
b. Hot Soaks (immersion Bath) - in this method of 
application of wet heat, the sterile solution 
ordered is placed in a sterile basin, and the 
inflaramed area of the body placed into this solu- 
tion (immersed). The medical officer will order the 
name and strength cf the solution, how long each 
.immersion bath will last and when the hot soak is 
to be repeated. You must prepare the solution in 
a sterile manner, and have it of the correct 
temperature (110°F.). 
When the area to have the hot soak is covered 
with a dressing, the dressing will be removed, and 
then another sterile dressing reapplied after the 
immersion bath has been completed. During the hot 
soak, the temperature of.the solution must be 
maintained at 110°F, This is most easily done by 
placing the sterile solution on a hot plate. If 
this is not practicable, add as needed, more 
sterile solution at 130°F, or 140°F. to the sterile 
basin to bring the original back up to 110°F, 
c, Hot Massive Yet Dressing - in this method of 
application of wet heat to the patient’,s body, the 
inflammed area is covered with a massive sterile 
dressing. The dressing is soaked with the solution 
ordered at 110°F. and the whole wrapped in a rubber 
or oil silk sheet to protect the bed, and to help 
retain the heat in the dressing. Every hour the 
dressing is exposed,, and more solution at 110°F, is 
poured over it, so as to maintain' the proper tem- 
perature cf the dressing. Usually one or more hot 
water bottles (filled half way with water at 120*F,) 
are.placed within the rubber or oil silk sheet so 
that their weight is on the bed (never on the 
patient). These bottles help maintain the dress- 
ing's temperature at 11QCF. In those* cases "where there is a break in the 
patients skin, absolute sterile technique must be 
used when applying and caring for the Massive bet 
Dressing. Put on sterile gloves when applying the 
sterile dressing. Use sterile cotton to make the 
dressing massive. If a large bath towel is used 
as the outer layer of the dressing to add to the 
size o.f the dressing, it too must be sterile. 
The rubber or oil silk sheet used as the outermost 
layer of the dressing must also be sterile, be- 
fore using, wash well with scan, hot water and a 
brush. Place in 1-1000 to 1-10,000 HgClg, or a 
weak eresol solution for an hour or two to steril- 
ize, or better yet, autoclave- the sheet. In this 
manner you can be sure the rubber or oil silk sheet 
used is sterile, 'Then pouring on hot solution at 
the one hour intervals, use sterile precautions, and 
do not touch the dressing with your bare hands. If 
you must handle the dressing, put on sterile rubber 
gloves. As a general rule, the massive dressing is 
completely changed every 2/+ hours. If there is 
much discharge or .pus (etc), from the area, the 
medical officer may order the dressing changed more 
frequently, 
d, Mustard Plaster - mix three parts of flour with one 
part mustard powder in a dry form. Add enough tepid 
water to make a thick paste. Spread the paste on 
a piece of muslin, making it large enough to cover 
the desired aroa (usually 6 inches squar... is largo 
enough) and about 1/4. inch thick. Place on a hot 
water bottle to warm the plaster, then apply to the 
skin. It is usually left on about 10 minutes, and 
never over 20 minutes. The best rule for removing 
the plaster is to remove when the skin wonder the 
plaster becomes rod. If left on too long a burn 
will result. After removing the plaster, grease 
the skin with mineral oil, 
(Note: one teaspoonful of mustard powder in a 
glassful of warm water will so irritate 
the gastric mucosa as to cause marked 
emesis (vomiting), 
2, Methods for Use of Dip/ Meat 
al Uot water bottle - is prepared by half filling with 
water at 120°P, I'hen the air is expelled by placing 
the bottle on its side, and the top tightly closed. 
The hot water bottle is always covered with a cloth 
covered before placing on the patient’s skin, men 
not in use, dry and inflate so that the sides will 
not touch. b, Electric Pad - especially used to apply dry heat to 
large surfaces for a long period of time. Do not 
permit the pad to get wet. If used with wet dress- 
ings, it must be rubber covered or oil silk covered, 
c* Bake Oven or Lamps - these are in many si-es and 
shapes, adaptable for the application of heat to 
various parts of the body. The heat is usually 
generated by electric light bulbs. Usually the 
part to be baked is wrapped in cotton or flannel 
to prevent blistering. The chief hazard is the 
danger of burning, therefore, the technician must 
stay with the patient, and at the first symptoms 
of burning (i.e., pain and marked redness of the 
area), the application is discontinued, 
B, Gold - is used in the very earliest stages of inflammation. 
It causes a constriction of the vessels in the inflammed 
area. It also inhibits bacterial growth, and serves to 
check hemorrhage from, very small blood vessels. Gold re- 
lieves pain by anesthetizing the nerve endings in the skin. 
1, Method for Use of Moist Cold 
a. Cold lit Compresses - the solution ordered by the 
medical officer (usually water), is kept cold by 
placing the vessel in a basin of ice, or placing 
pieces of ice in the solution. This tyoe of com- 
press is changed as soon as it loses its chill - 
every 3 to 4 minutes. Do not continue longer than 
10 to 15 minutes at a time. If a bluish discolora- 
tion of the skin appears, stop at once. Gold com- 
presses are especially useful in prevention of spel- 
ling of sprains, bruises (and black eyes). 
2, Method for Use of Dry Gold 
a, lee Bug - break the ice into small pieces (about 1” 
square). Remove air from the bag before tightly 
closing. Cover with a cloth cover before placing 
in contact with the patient’s skin, ice bag 
is usually used l/2 to 1 hour on the part and then 
removed for a similar period so as to prevent 
’’frost-bite”, or ’’iceburn”. XVI. pRE-OPERATIVE CARE 
Medical officers differ greatly in the detail of 
preparation of the surgical patient, but the general principles 
remain the same; 
To cleanse the patient externally and irf rnally; 
To cause the least possible amount of physical and mental 
exhaustion in so doing. 
A. Bath - the patient should have a warm tub bath the night 
before the operation. If impossible to give this, 
substitute a sponge bath in bed. 
B. Mouth and Teeth - the teeth .are brushed well at least 
twice a day and the mouth rinsed with a mild antiseptic 
solution (i,e., Dobell’s Solution, or any other alkaline 
mouth wash), at least three times daily to prevent oral 
sepsis, Shortly before taking to the operating room, 
remove false teeth, bridges, gum, tobacco, etc, from the 
patient!s mouth, 
C. Diet - is usually a highly nutritious diet for several 
days preceding (contains- such foods as meat, eggs-, cooked 
cereals, bread, butter, vegetables, ice cream-, candy, etc. 
The night before the operation, the evening meal is 
usually an ordinary soft diet. Water should be given 
freely up to 4- or 5 hours of the time of operation. For 
many patients who are dehydrated, it may be necessary to 
force fluids by mouth up to an hour or two before the 
operation. 
p. Bowels ~ many medical officers will order a laxative (i.e,, 
milk of magnesia 60.) or an enema (usually plain tap 
water or S.S. enema,) or both, the night before the 
operation, as many others, will -desire to have 
the patient’s intestinal tract left alone, and will 
order neither. The vast majority of cases will get an 
enema the morning of the operation•(about three hours 
before the operation time), as ordered Try the medical 
officer, 
E. Cpe rative Site - this site is prepared the night before 
the operation, after the tub bath. The region of the 
operative field is scrubbed well with hot water and soap. 
Old adhesive and grease may be removed with a sponge 
moistened with ether cr benzine. With a new blade and a 
safety razor, shave the operative site carefully. The 
area shaven should extend one foot in all directions from 
the site of the incision. After shaving, was/ ail loose 
hair from the skin. This is all in the way of preparation 
of the operative sits required by most medical officers. 
Some may order further care, such as the painting of the 
shaven area with an antiseptic end then covering the 
painted area with a sterile towel or dressing. If ordered to use Tincture of Iodine, the skin must be 
perfectly dry before applying, and the drug removed with 
70% alcohol on a sterile swab after it drys (in 3 to 4 
minutes). If used on the abdomen, prevent any excess 
trickling down in the groin, as this may cause a burn. 
In summer, if the Iodine is not well removed, it may 
blister a "sweaty skin", 
F. Sedatives - as a general rule the medical officer will 
order a sedative to be given orally and h,s. the night 
before the operation so that the patient will have a sound 
night’s sleep. In most cases, the patient will also be 
given a sedative shortly before the operation, so that it 
will take less anesthetic agent to induce and maintain 
anesthesia,and also to reduce the excitement stage of the 
induction. There are a great many sedatives given alone 
or in combination in the hour or two before the operation. 
The medical officer will order the drug or drugs, the dose 
and time of administration, 
Morphine + Atropine are the usual preoperative 
drugs given by hypodermic injection. Usual doses are 
Morphine Sulfate - ,016 (l/4 Gr,); Atropine Sulfate - ,0004- 
(1/150 Gr.) These are given 1 hour before operation, 
G, Bladder - all patients (except urological cases) should 
void l/2 hour before going to the operating room. Let 
him use the latrine or the urinal, Uhen unable to void, 
the technician should notify the medical officer of this 
fact, and also the time and amount of the last voiding of 
urine. In some cases, the medical officer will want the 
patient's bladder emptied by catheterization before 
taking to surgery. XVII.’POST-CPEHATIVE CARS 
A. Post-Oreretive Bed (Ether Bed) 
vThile the patient is undergoing the operation, his 
ward bed is prepared (as demonstrated in the classroom) 
as the ’’Post-Operative Bed”, Before placing the patient 
in this bed, remove all hot water bottles from the bed* 
The patient is moved from the litter to the bed by means 
of the draw sheet on the litter, and covered with blankets 
to keep warm. If the weather is hot, it is not necessary 
to use blankets over the patient (unless in shock). In 
hot weather, blankets cause unnecessary sweating and thus 
the loss of fluid and body salts. The pillow is not 
placed under the patient's head until the patient is fully 
conscious and no longer nauseated or vomiting. It is best, 
if the patient is nauseated or vomiting, to place a large 
towel under the patient's head and shoulders to protect 
the bed, and to have an emesis basin ban- , 
B. The First Hour. 
In the minutes that immediately follow the operation 
(while the patient is moved.to his ward and until he 
recovers consciousness), the Technician should be on guard 
for uhe first serious complication - obstruction to 
respiration. This complication occurs only in those who 
have had a general anesthetic. Due to the relaxed muscles 
of the pharynx, when the patient lies on his back, the 
lower jaw and tongue fall backward, closing the passageway 
to the lungs, When this occurs, the breathirn Is dyspneic, 
irregular, end often very noisy. The patient chokes, and 
cyanosis appears. The treatment is very simple. Lift up 
on the lower jaw sc as to close the mouth and push the 
lower teeth in front of the upper. Rarely is it necessary 
to grasp the tongue with a gauze sponge and pull i*!: forward. 
Usually the lower jaw has to be held up until the patient 
recovers from the anesthetic enough to hold up his own 
jaw. Often, placing the patient on one side, and propping 
there with pillows, will be all that is needed to keep 
the respiratory tract open. 
The breathing can also be obstructed by a collection 
of thick mucus in the throat. Turning the head (and at 
times the body also) to one side will help this mucus 
drain out of the mouth. 
The breathing can be obstructed by vomitus in the 
pharynx and mouth, so if the patient should vomit, turn the 
head sharply to one side and place the emesis basin under 
his mouth, to assist the drainage. Often, it will be 
necessary to turn the vomiting patient or his side to 
prevent vomitus from collecting in the tin at. The Technician remains with the patient as he 
recovers from the anesthesia. The Technician must not 
leave the bed side until the patient is fully conscious 
(the patient must know who he is, where he is and what 
has happened to him). The bed is kept flat unless ordered 
otherwise. When the patient is moved into his bed, 
the temperature is taken and recorded. The pulse is 
taken and recorded every $ minutes until he is conscious, 
and then every half hour for 3 more hours. If the patient 
is conscious on his return from surgery, take the pulse 
every $ minutes for l/2 hour and then every 1/2 hour for 
3 hours. Take and record the respiration q,l/2 h. for 
the first 3 hours, and then q.i.d, Wake the temperature 
q.i.h. for the first 3 hours and, then q.i.d, 
C. After the First Hour 
1. Take the temperature, respiration and pulse and record 
as directed above, 
2. Keep the patient quiet. Use restraint sheets if 
necessary. Administer opiates as directed by the 
medical officer to induce sleep and free patient from 
pain. Always check for symptoms of overdosage before 
administering Morphine Sulfate or any other opiate. 
The usual dose of Morphine Sulfate is ,016 (or ,01$), 
If the pain is real severe, the medical officer may 
order the dose of MhS. to be ,03 (or ,032), The ,016 
dose of M.S, is supposed to keep a patient free of 
pain for 6 to S hours. However, sometimes, it is 
_ necessary to repeat the dose in 2 or 3 hours or sooner, 
for no two patients respond exactly alike to Morphine 
pcst-onerativoly. Many patients develop delirium 
when given M.S,,.Kyosoine, Amyto1 and other sedatives 
pro and post-oporatively. These patients have been 
known to tear off their dressings, walk cut of the 
hospital in their bed clothes, fall from their bed 
or window and break one or more bones, etc, 
3. Moisten .Tips to relieve thirst, and permit frequent 
rinsing of the mouth mouth wash, until water 
can be given freely. 
4. Inspect dressings for blood, abnormal drainage, etc. 
Reinforce dressings if necessary. 
$, Carry out post-operative orders such as, set up 
Wangensteen Cuction.Apparatus, connect drainage tubes 
.and bo tt1o s, ot c, 
6. T:fatcb for and report any alarming or peculiar symptoms, 
i,G., marked paler or cyanosis of skin, lips, etc,, 
skin cold and clammy, or very hot and moist, delirium, 
etc., severe hiccough, paralyses, marked vomiting 
(especially if it has a focal odor). 7. Change the patient's position in bed every hour or 
two (or more often if ho becomes uncomfortable), 
to prevent decubitus and hydrostatic pneumonia. 
Place small pillows or other pads under bony pro- 
minences and lower back, a large pillow placed 
against the patient's back makes a good support 
for the patient lying on his side, 
8. Fowlerfs Position - if this position has been ordered, 
raise the head oif the bed off of the floor 12 inches, 
A pillow should be placed at the foot of the bed to 
prevent pressure of the feet against the metal bed 
frame. Pillows placed under the knees A . elevate 
them, will make the patient more comfora.Pole :md 
help to keep him from slipping towards the foot of 
the bed. If the patient is in a Gatch bed, it is 
easy to put him into this semi-sitting position 
(Fowler's position). However, tlx- short patient 
is comfortable in this bed when in Fowler's position. 
To maintain Fowler's position, it is necessary to fre- 
quently lift the patient up in bed and readjust the 
pillows, for all will tend to slip to the foot of 
the bed, 
9. Permit water to drink in email amounts when nausea 
ceases. Unless otherwise ordered, most patients are 
permitted water within the first 8 hours. It is best 
to start w ith small pieces of ice hold in patient's 
mouth. If the patient does not vomit, increase the 
frequent teaspoon size amounts of water to larger 
amounts, as tolerated. In most cases, the post- 
operative patient will be put on a liquid diet for 
the first two or three days, fho only items per- 
mitted on this liquid post-operative diet are; ice 
chips, water, broth, weak tea and black coffee. At 
the end of the second day (or on the third post- 
operative day) in most cases, the medical officer 
will order an enema. This sets up active peristal- 
sis of the intestine so that the patient has a bow- 
el movement. After the bowels have moved, the pa- 
tient is permitted a soft diet. This consists of 
• soft foods (cooked cereals, fruit juices, vjgeta- 
ble juices, eggs, rice, ice-cream, milk, all other 
liquids (no beer or alcoholic beverage ■ puddings, 
custard, junket, crackers or toast and milk, etc. 
Patients having dry mouths, especially -those ex- 
tremely ill, should have chewing gun to stimulate 
salivary secretion and to help prevent parotitis. Fowler position. Note (1) pillows under arms 
which add to the patient's comfort. Often pillows 
are inserted at the patient's back .and feet to give 
added support. 
Patient turned on side in Fowler position. The 
break in the bed at the knee is reduced. The patient 
is turned on his side, his arms being supported on 
a pillow (1) in front of him. (2) A large pillow 
under the shoulders and a smaller one under the head 
adds to the patient's comfort. The back (3) and 
buttocks (4-) are supported by pillows. ($) A 
pillow between the knees is a valuable addition. ILLUSTRATING THE EFFECT OF FOFLER POSITION IN A CASE OF 
PERITONITIS IVITH PELVIC DRAINAGE. 
ILLUSTRATING THE PUDDLING OF PUS BENEATH THE DIAPHRAGM 
IN A CASE OF PERITONITIS TREATED IN THE HORIZONTAL 
POSITION. ILLUSTRATING EFFECT OF GRAVITY IN DRAINAGE OF CHEST WOUNDS, 
PATIENT IN HORIZONTAL POSITION! DRAINAGE FROM EMPYEMA CAVITY 
POOR. PATIENT IN FOWLER OR SITTING POSITION; DEPENDENT 
DRAINAGE OBTAINED. 
EMPYEMA - DRAINAGE BY THE CLOSED METHOD. NOTE DRAINAGE TUBE 
UNDER THE FLUID IN COLLECTION BOTTLE. INSERT DRAWING SHOW'S 
DETAILS OF SAFETY PIN ANCHORAGE OF TUBE. 10, Watch the bowels. After the bowels have moved 
(usually on the third day) and the soft diet begun, 
if the bowels do not move spontaneously every day, 
or every other day, a cleansing enema is usually 
given. If proper care is not taken of the bowels, 
an ’’impacted” rectum will result. As a rule, 
cathartics are net given for 1 week after most 
operations, and if drainage has been inserted, they 
are not given for a much longer time, 
11, Watch the bladder. If the patient cannot void post- 
pperatively, he must be catheterized, This is 
usually done B to 10 hours after the operation. Often 
the medical officer will direct a wait of 12 or even 
IB hours before doing the first catheterization. 
Once the patient has been catheterized, if ho cannot 
void, it must then be repeated q.B.h. (and never 
let the time run over B hours uni. . ' ordered so by 
the medical officer), until he is able to empty his 
own bladder. Exhaust all means of getting the 
patient to void before catheterization. Let a water 
faucet flow with a loud splash and have the patient 
concentrate his thoughts on the sound of running 
water, with his penis placed in a urinal. Place the 
patient’s two hands in basins of warm water, with 
his penis in a urinal. Place a hot water bottle over 
the lower abdomen. Place warm water in the urinal, 
and place the penis in the urinal so that it is 
partially covered by the water, 
12, After the first 2L hours, most patients can be put 
in a semi-sitting position in bed. The average case 
will sit out of bed on the 5th to the 7th day. How- 
ever, some medical officers may order a similar 
case out of bed on the 2nd or 3rd day. On the first 
day out of bed, the patient is seated in a chair at 
the bed side about 15 minutes. Each succeeding day, 
he remains out of bed for a longer period, as his 
strength permits. Hernia repair cases (Herniotomy) 
are the one main exception to this rule. They are not 
usually permitted out of bed for 12 to 11, days, 
13, Skin sutures are usually removed on the 5th to 7th 
day. 
1A. To relieve ”gas pains” and slight distention of the 
abdomen, insert the lubricated rectal tube into the 
anus, and place tho free end into a urinal between 
the patient’s legs. Use it for twenty minutes in, 
then 1 to 2 hours out, and repeat till the patient 
is able to expel flatus (gas) by himself. 
15. Frequent alcohol rubs and massage. 16* Watch for st-Operative Complications 
a. Obstruction to respiration, (See The First Hour)* 
b. Shook 
c. Hemorrhage 
d. Pain 
e. Restlessness and sleeplessness, 
(1) Give gentle back and neck massage, 
(2) Dim the lights and well ventilate the room, 
(3) Give warm milk, cocoa and crackers, etc,, 
if accustomed to food at bedtime, 
(4-) Sedatives as Bromides, 2, (gr,XXX) 
Luminal ,1 (gr,~7~ss) 
Codeine ,06 (gr -f* ) 
(If due to pain) 
Barbiturates (as luminal, amytal, nembutal, 
phenobarbital, etc,). 
f. Decubitus Ulcers 
g. Delirium 
Toxic delirium is due to a general toxemia 
and most often occurs in general peritonitis cases 
and other septic conditions (severe). Usually 
the patient is very sick with high elevation of 
temperature, rapid pulse, flushed face, etc. 
The patient shows mental confusion, moves in- 
cessantly, disarranges the bed clothes, attempts 
to get out of bed, etc. 
Traumatic Delirium is due to sudden trauma 
of any sort. There may be maniacal excitement, 
mental confusion with hallucinations, etc. 
Delirium Tremens occurs in the habitual 
alcoholic who has undergone surgery or trauma. 
Usually after a few days of restlessness, nervous- 
ness, sleeplessness and slight mental confusion, 
the patient loses entire control of his mental 
functions and becomes maniacal. He will talk 
incessantly, hallucinations of fear and perse- 
cution will torment him, and often he may injure 
himself or others, Finally after hours of mental 
torture, the patient becomes stuporous. Strong 
sedative drugs as Morphine Sulfate, Chloral, and 
. Paraldehyde,may be needed to keep patient quiet. 
It is usually best to give this type of patient 
whiskey. 
(1) Methods of Restraint used for all 'eases of 
Delirium: 
(a) Side boards on bed, 
(b) Cotton sheets over patient’s chest, 
abdomen and thighs, tied or pinned to 
bed frame. 
(c) Ankles and wrists fastened to bed frame 
by straps and cuffs, or muslin roller 
bandage, 
(d) Sedatives by mouth, rectum or hypodermic, 
(e) Canvas restraint blanket. h, Tound Complications 
(1) Infection occurs when pathogenic bacteria 
have gained access to the wound* The first 
symptoms of inflammation usually show at 
the end of 36 to 4B hours post-operatively* 
The pulse rate increases and the temperature 
rises. Locally, the wound becomes tender, 
swollen, warm and often red. At times, 
if the infection is deep these local 
symptoms will not be evident. The treatment 
is usually to remove one or mors shin 
sutures, separate the wound edges with a 
hemestat and insert a rubber or gauss 
drain* Often the wound is flushed with a 
mild antiseptic solution using a st .rile 
asepto (rubber bulb) glass syringe* 
(2) Hemorrhage (Hematoma) 
Any undue bleeding on the dressing 
should be reported to the medical officer 
at once. At times, concealed bleeding 
occurs in the incision beneath the skin. 
This type of blooding usually stops spon- 
taneously and results in a clot in the wound* 
If the hematoma is large, it is usually 
drained, by removing one or more skin sutures. 
(3) Rupture of Wound 
This is a serious complication in 
abdominal wounds. It results from the giv- 
ing away of sutures due tv infection, 
distention, cough, etc, rupture may 
occur suddenly with the escape of coils 
of intestine on to the. abdominal wall. Pain 
and vomiting are associated. The wound 
edges may part slowly so that the intestines 
escape gradually or not at all with few 
accompanying symptoms. The protrading coils 
of intestine should be covered with large 
sterile gauze pad or pack and sompressed 
with adhesive bands until the edical 
officer can replace the intestine coils 
and sew up the wound, 
i. Respiratory Complications; the most frequent 
post-operative complications to occur. Patients 
with some respiratory disease (i.e., nose cold, 
sore throat) before operation, are likely to 
develop these serious complications, 
Preventive Measures? 
nr Keep patient warm after the operation, 
i.e,, warm room, warm bed, dry bedding and 
garments, hot water bottles. (2) full aeration of the lungs. The 
patient's breathing will be very shallow 
because the movement of deep breathing causes 
pain in the operative area, 
(a) Instruct patient to take 10 or 12 deep 
breaths every 1/2 to 1 hour. 
(b) Mechanical apparatus such as blow-bottles 
may be used each hour to expand the lungs 
fully, 
(c) Turn the patient from side to side 
frequently, i.e., every l/2 to 1 hour, 
(d) Get the patient out of bed as early as 
possible poet-cperatively, as directed 
by the surgeon. 
Complications (1) Bronchitis (most frequent complication) 
characterized by cough that brings up con- 
siderable mucus, but without marked temperature 
and pulse elevation. Steam inhalations are 
of great value here. 
(2) Bronchorneum^nia (second in frequency) 
•Symptoms for Bronchitis plus high elevation 
of temperature and rapid pulse, 
(3) Pleurisy - characterized by acute, knife-like 
pain in the chest on the affected side, which 
is especially severe when the patient takes 
a deep breath. ,Therefore, the respiration is 
rapid and shallow, temperature and pulse 
elevated, A tight adhesive chest strapping 
with the chest in full expiration, relieves 
the pain. 
(4.) Lobar Pneumonia (a less frequent complication) 
usually ushered in by a chill and high ele- 
vation of temperature, pulse and respiratory 
rate. There may be little or much cough and 
the patient is definitely seriously sick, 
(’5) Fydrcstatic Pneumonia (Hypostatic* Pulmonary 
Congestion-) >- occurs in the very weak patient. 
Due to poor simulation of blood through the 
lungs, blood stagnates at the bases of both 
lungs. The‘symptoms are those of broncho- 
pneumonia - early slight cough, slight 
elevation of temperature, pulse, respiratory 
rate. 
(6) Babelism - a blood clot forms in a 
blood vessel, becomes dislodged from its 
original site and is carried along with the 
blood. After passing through the heart, it 
is forced into and blocks a pulmonary artery. 
The symptoms are among the most sudden 
and startling. A patient passing a normal 
convalescence suddenly crys out with sharp 
stabbing pain in the chest, becomes breathless, 
cyanotic and anxious. Tho pulse becomes rapid, weak and 
irregular and cold sweat appears. 
If death does not occur in 30 minutes, 
there is good chance of recovery. 
This complication may occur at any time 
after the operation, but especially occurs 
in the second week, when tho patient becomes 
more active. It may be that the movement 
dislodges the clot. 
Treatment consists of administration 
of oxygen, Morphine Sulfate and sitting 
the patient tip in bed, 
j, Femoral Phlebitis or Thrombosis 
Fie femoral vein in the leg becomes inflammed 
and the blood within its lumen clots. The cause 
is usually depressed circulation following the 
operation resulting in a slov/in . >f blood flow. 
Concentration of the blood due to fluid loss also 
results in slowing of the blood flow. Injury 
to the vein by tight straps or means of restraint 
may play a part in the cause. The symptoms start 
with pain and tenderness in the calf and slight 
fever. A day or two later painful swelling of the 
entire leg develops progressively. The swelling 
is due to edema of the tissues, 
k, Parotitis - the parotid gland may bo infected by 
germs from the mouth that invade it through its 
excretory duct. It occurs up to 2 weeks pcst- 
operatively. The symptoms are those of a very 
acute infection. The patient becomes very sick, 
high elevation of temperature and a swelling in 
front of one or both ears. The swelling becomes 
rapidly larger and very tender. The pain is 
intense and the patient cannot chew or open his 
mouth. The Technician can prevent this compli- 
cation by; 
(1) Keeping the patient’s mouth scrupulously 
clean with mouth washes and teeth brushing, 
(2) Let the patient chew gum or bard candies 
po s t-ope ratively. 
(3) Keep the mouth moist at all times. If the 
patient breathes through his mouth, several 
layers of gauze soaked in equal parts of 
water and glycerine and placed over this 
orifice will help, 
l, Vomiting - in vomiting the stomach drains best 
in a sitting position or with t patient lying 
on his right side. Hot applications to abdomen 
and sips of hot tea and lemon may help. (1) During the first two or three Postoperative 
hours: this vomiting is due to the 
anesthetic and usually lasts less than 2 
hours. It requires no special treatment 
other than as given in ’’The First Hour”, 
frequent use of mouth wash and withholding 
fluids till all nausea and vomiting has 
passed. 
(2) Continuous through the first 24- Post- 
operative hours. This vomiting may be due 
to; 
(a) The anesthetic agent (especially ether.) 
Give this patient a large glass of warm 
water with l/2 teaspoonful of FaHCCL • 
They will vomit this immediately, bring 
up much mucus. After one of two such 
lavages, the vomiting will usually 
c ease. 
(b) Acidosis or Ketosis - due to pre- 
operative starvation, anesthesia and 
diabetes, acidosis develops with vomiting. 
These patients have a ’’fruity" odor 
of acetone to the breath, and the urine 
contains acetone and diacetic acid. The 
treatment is intravenous glucose and 
fluids and often insulin. 
(c) Peritonitis - this patient is usually 
very sick and toxic, abdomen usually 
distended, high fever and rapid pulse. 
The treatment is duodenal decompression 
by the Wangensteen Suction Apparatus, 
(d) Paralysis of Intestinal Activity - due 
to injury of the abdominal organs the 
absence of peristalsis lasts for a 
period longer than usual. Hot appli- 
cations to the abdomen and Wangensteen 
Suction is used for treatment. 
(e) Idiosyncracy - Morphine Sulfate and 
other drugs often cause vomiting soon 
. after being administered. 
(3) Prolonged After the First Post-operative Day. 
Vomiting may be excessive and prolonged for 
3 to 7 days, retarding recovery and threaten- 
ing the patient’s life. This vomiting is of 
a very serious type, and may be due to; 
(a) Intestinal Obstruction 
(b) Acute Dilatation of Stomach 
(c) Uremia or Kidney Insufficiency 
(d) Hemorrhage in operations on the stomach. 
(e) Peritonitis. 
(f) Acidosis 
(g) Tetany or Alkalosis. m. Abdominal Distention 
Flatulence or distention occurs duo to absence 
of peristalsis from handling of the intestines or 
trauma to the contents of the peritoneal cavity. 
The intestinal tract is distended with gas*’ It is 
usually relieved by use of the: 
(1) Rectal Tu.be 
(2) Small (1 pint) evacuating enemas, 
(3) Heat applied to abdomen, 
(4d Such drugs as follows to stimulate peristalsis* 
Eserine Salicylate ,0006 (gr, 1/100) 
Strychnine .002 (gr, l/30) 
Pituitrin 1. cc. 
1, cc, 
Prostigraine 1, cc. 
■ (5) I.V. of Hypertonic Saline (5% to 3Oh) 100-300 cc, 
(6) Spinal Anesthesia 
(7) vrangensteen Suction Apparatus. 
n. ~peritonitis 
The peritoneum is the thin, smooth, shiny cover- 
ing of the walls cf the abdominal cavit-- end. the 
organs contained in the cavity. 'Then this 
membrane is inflammed, the condition is called 
,meritonitis55. It results from acute appendicitis, 
ruptured peptic ulcer, gun shot wound of abdomen, 
inflammation cf the gall bladder, pancreas, etc. The 
patient is usually very sick, with high fever, rapid 
pulse, and distended abdomen. This patient needs 
Fowler*s .position, Wangensteen Suction, fluids 
intravenously, and HM? to keep the intestines at 
rest, ’"hen peritonitis produces marked distention, 
the outcome is usually fatal, 
o. Acute Dilatation of the Stomach 
In this complication, on the 2nd or 3rd post- 
operative days, the muscle of the stomach walls 
relax so that the stomach cavity is greatly increased 
in size and filled with gas and fluid. The upper 
abdomen is distended and the pati r vomits small 
■ amounts of foul smelling, brownish fluid frequently 
and without effort. The patient becomes very thirsty, 
and often hiccough develops. The treatment consists 
.cf Wangensteen Ruction, fluids intravenously, and 
the patidnt is placed on his right side with the 
foot of the bed elevated. Often the condition results 
in death, 
p. Intestinal Obstruction 
■ This complication usually occurs after operations 
cr':-in,]ury to the lower abdomen. Usually a loop of 
small intestine becomes kinked duo to adhesions or 
by being involved in the drainage tract. The symptoms usually appear several days after the operation, 
3 to 5. The patient may have had his enema on the 
third day and be fed a soft diet for a day or two. 
Then he complains of sharp, colioy pains in loner 
abdomen. There is usually no fever or pulse 
elevation. An enema, heat to abdomen, and changing 
patient's position from side to side with elevation 
of the feet may relieve the unkinked loop of gut. 
Usually this is unsuccessful, and the pain becomes 
worse, the abdomen distends and vomiting develops. 
If the obstruction is not relieved by sfrgery, 
death results, 
q. Hiccough or Singultus 
■ Hiccough may become a serious complication due 
to the nervous and physical exhaustion it can 
produce. It is produced by a spasm of the diaphragm. 
The spasm of the diaphragm results from irritation 
of the Phrenic Nerve. The nerve may be stimulated 
by a distended stomach, peritonitis, abscess under 
the diaphragm, distended abdomen, pleurisy, chest 
tumor, toxemia, uremia, intestinal obstruction, 
irritation from drainage tubes, etc, 
(1) Treatment: 
(a) Remove the cause. 
(b) Drink l/2 glass of water with NaHCO* 
(c) Sucl' a lemon. !-' 
(d) Hold the breath while taking large swallows 
of cold wa'ter, 
(e) Massage along course of the Phrenic Nerves 
in the neck. 
(f) Colon Dioxide (CCb,) inhalations by mask 
or by rebreathing with a paper bag held 
tightly over the face. 
(g) ‘Administer H.M.S. and Atropine gulfate. XVIII.CATHETERIZATION 
This procedure requires as careful aseptic technique as a 
surgical operation. Get all supplies at the bed side. The tray 
should include; 
Small basin to place between patient’s legs to receive urine. 
Sterile cup of green soap and 3 cotton pledgees (balls). 
Sterile cup of 1-100) solution with 3 sterile cotton 
pledgets. 
Sterile towel wrapped in muslin. 
Sterile lubricating jelly in a tube. 
Two or more sterile rubber catheters (16 or 18 French), in 
sterile-pan or wrapped in sterile towel. 
One or two sterile forceps or hemostats. 
One sterile rubber glove in sterile glove holder. 
Method; Place the small basin between the patient’s thighs 
to receive the urine. Scrub your hands well with soap, hot water 
and brushes for at least 3 minutes. Tell the patient to place his 
hands behind his head and to keep them there until you have 
finished. Tell him what you are going to do. Place the sterile 
towel over his lower limbs well away from the pubic region. Hold 
the shaft of the penis with one hand, well away from the head. 
Scrub the head of the penis well with the three cotton balls in the 
sterile cup of green soap. These can be handled with your fingers. 
Then, wipe off the head of the penis well with the three sterile 
cotton pledgets from the sterile cup of HgClg* These pledgets are 
handled with a forceps or hemostat, and never your fingers. 
Handling the sterile towel by its edges, pull it up close to 
the pubic region, taking care not to contaminate the upper surface. 
place the sterilized head of the penis on the top of the sterile 
towel. Squeeze a 1 or 2 inch ribbon of lubricating jelly from the 
sterile tube on to the top of the sterile towel, using sterile 
precautions so as not to contaminate the tube. Put on one sterile 
glove. 
Pick up a catheter with the gloved hand, dip the blunt end 
into the sterile, lubricating jelly, and insert the penis. 
The penis is held by the shaft with the bare hand, Keeping well 
away from the head of the penis. When the catheter has been 
inserted some 5 to 6 inches (depending on the length of the penis), 
it will usually meet an obstruction. This obstruction is caused 
by the tightly closed sphincter muscle at the base of the bladder. 
A little steady, gentle pressure on the catheter will cause it to 
relax in a few seconds, and the catheter will slip into the 
bladder. The urine will flow freely when the catheter enters the 
bladder. If a sterile urine specimen is desired, the sterile end of 
the catheter is held ever a sterile urine specimen bottle, and 
the urine permitted to flow from the catheter directly into the 
sterile bottle, Yfoen 100 to 150 cc. of sterile urine has been 
collected, the bottle is closed with a sterile cork, or covered 
with a sterile gauze sponge (4,f x A") and a rubber band. 
If a rubber glove is not available, the sterile catheter can 
be picked up and held with a sterile hemestat or thumb forceps 
for insertion. Many mfedical officers will permit the technician 
to pick up the sterile catheter, separated from his fingers by 
2 or 3 sterile gauze sponges (A" x 4.")> when rubber gloves aro not 
available. 
1. The Bladder Instillation? 
To instill fluid into the bladder (Bladder Instill- 
ation) means fluid is injected into the bladder through 
a catheter, and then the catheter removed so as to leave 
the fluid behind in tho bladder. 
Often when a patient has to be catheterized more than 
once, the medical officer will order some mild antiseptic 
solution to be instilled into the bladder, as an added 
caution against possible infection, Ke will always write 
the name of the medicine, the strength of the solution 
and the amount to be instilled. Get the correct medication 
in a sterile medicine glass, and before inserting the 
catheter, transfer the solution into a sterile rubber 
bulb syringe (asepto syringe). ™hen the bladder has been 
drained, place the syringe on the end of the catheter, and 
holding the syringe so as not to inject any air into 
the bladder, transfer the antiseptic into the bladder. 
Stop the injection before all of the solution enters the 
bladder so as to avoid the injection of air into the 
bladder; pinch off the catheter and pull out of the 
urethra. 
2. The Retention Catheter (indwelling Catheter) 
Often the catheter is inserted into the bladder and 
fastened there with string or tape and adhesive tape, 
so that the bladder is kept dry. This type of catheter 
may be left in position for days or weeks. The technique 
of fastening the retention catheter in place will be 
demonstrated on the practice ward, 
3. The Bladder Irrigation. 
Often when the patient has a retention or indwelling 
catheter, the medical officer will write an order for 
bladder irrigations, to keep the bladder and catheter clean. 
Ho will always write the name of the medicine, and 
strength of solution to use. He will not state the amount 
or the temperature to use. when preparing the solution, 
it is customary to prepare about 500 cc, for the bladder 
irrigation, although in most cases, you will need but half 
this amount (about 1 cup). The temperature of the solution 
is about body temperature ClOO°F, to 105°F,). Prepare the 500 cc. of ordered solution of the correct 
strength, using the stock solution found in the medicine 
cupboard, sterile water and a sterile basin, so that the 
resulting solution is sterile. Use a small rubber bulb 
syringe (1 to 2 ounce syringe is suitable). Inject the 
syringeful of irrigating fluid into the catheter, and 
permit it to return at once into a basin between the 
patient’s thighs. Continue the irrigation until the 
irrigating fluid returns clear. 
If the end of the catheter to v/hich the syringe is 
attached is grossly contaminated, wrap it for 10 minutes 
in a sterile sponge wet with 70$ alcohol before starting 
the irrigation. XII. 
THE DRESSING OF ROUNDS 
Rigid aseptis is the most important requisite for the 
successful care of wounds. Clean wounds (those made aseptically) 
are usually blosed by sutures, after careful ligation of all 
bleeding points. All ether wounds are potentially infected, and 
cannot be closed until every effort has been made to remove all 
devitalized tissue and infection, A formal operation is therefore 
performed for the purpose of cutting out the infected and de- 
vitalized tissue. This operation is called ’’debridement”. Often 
a small drain is inserted before suturing such a wound, to prevent 
the collection of blood and lymph, which would retard healing if 
allowed to remain in the wound. 
Wounds are usually dressed with several layers of sterile gauze 
held in place by bandages or adhesive tape. Clean wounds without 
drainage seal within 24- hours by the coagulation of lymph between 
their edges. Such wounds need no dressing until the time for 
removal of sutures, unless some wound complication develops. Clean 
wounds are often drained when absolute hemostasis is difficult to 
obtain, Such wounds are dressed in 24. to 4-B hours, and the drain 
removed, for hemostasis will be complete by that time. Infected 
are dressed at least once each day. Infected wounds may 
have to be dressed two or three, or more, times daily if the 
dressing is grossly soiled. 
The Clean Wound (Aseptic or Sterile Wound). 
When changing the dressing, moisten the adhesive with benzine 
to loosen it, so that it is easily removed by pulling on it 
horizontal to the skin surface. The old dressing is removed and 
placed in a paper bag so that it can be easily disposed of by 
burning. If this dressing is soiled with discharge, handle it with 
a forceps or hemostat and not your hands. Everything that goes 
near the wound must be sterile. If a drain is to be removed, grasp 
it with a sterile forceps or hemostat. If skin sutures are to be 
removed, grasp them, and cut with sterile instruments (forceps and 
scissors). If the wound is to be swabbed with alcohol or other 
antiseptic, use sterile cotton pledgets or sterile 2” x 2”’s held 
in sterile forceps or hemostat. 
Sterile gauze compresses to form the new dressing are placed 
on the wound handled with sterile instruments. If a large dressing 
is desired, after first applying 3 or 4- gauze compresses, a sterile 
”ABD” pad is applied,This pad is also called the ”Abdominal” pad or 
’’combine”. They are-made of cotton folded in a laver of gauze. 
The adhesive tape is usually used in wide (3”; strips for 
chest and abdominal dressings. The top strip is usually placed 
half on the skin and half on the dressing, so that the patient 
cannot lift up the upper edge of the dressing. The other strips are 
placed to expose gauze between them to allow inspection of the top 
surface of the dressing. If frequent dressing are to be needed, use 
the Montgomerjr tape dressing. With this dressing, the adhesive 
tapes are tied over the top of the dressing with gauze or string 
ties, thus making it unnecessary to remove the adhesive from the 
skin each time the dressing is changed. The Draining '"found (Dirty, Septic, Infected ""found) 
The dressing of the wound provided with drainage is carried 
out as described for the sterile wound, taking every precaution 
to prevent the spread of the patient’s germs elsewhere on the 
patient, to yourself or to others. The vast majority of wounds 
with drainage, have that drainage because they are infected with 
germs. If the dressing is stuck to the edges of the wound, 
loosen it by moistening with I-LCU. To do this,, you must use a 
sterile asepto syringe and a small sterile basin to hold the K C , 
Hold an emesis or kidney basin to prevent the solution from 2 
soiling the bed. Often such wounds are irrigated with HO or 
other antiseptic solutions, using the same sterile materials, 
and placing the tip of the syringe into the wound to well wash out 
the pus. 
The drainage from infected wounds is often irritating to the 
surrounding skin. Vaseline gauze or other ointments (i,o., Zinc 
Oxide Ointment) are used to protect this skin. Wounds infected 
with virulent pathogenic bacteria (i,e,, gas bacillus in gas 
gangrene cases), call for absolute sterile technique, for if the 
Technician permits a break in his dressing technique, ho is 
endangering himself and others with a death producing germ. 
1. Wear gloves when doing the dressings in such cases. 
2. Do not touch the dressing'cr any object that goes near 
the wound with your gloved hands. Handle all objects 
used in the dressing with forceps br hemostats, 
3. As soon as the old dressing is removed, place it at once 
in a paper bag cr wrap in newspaper so that it can be 
burned as soon as the dressing is finished, 
4-, All instruments used to do the dressing are placed in a 
pan or basin as they are discarded, and at the end of the 
dressing, washed with gloves on, and placed at once in 
boiling water for 30 minutes or autoclaved at once, 
5, If possible, isolate such patients, and have a separate 
dressing tray or cart used only for these cases, where 
possible, the best technique is to have one technician care 
for these seriously infected cases, and this Technician 
should net be permitted to care for the clean cases, 
6, Bed clothing, pajamas, etc., from such cases, should be 
sterilised by placing in 1-50 Lysol or Cresol Solutions 
for 1 hour before being placed in boiling, soapy water for 
washing, 
7, Scrub your hands well with soap, hot water and brushes when 
finished with the dressing. 
In the case of the gas bacillus, since it is an inhabitant of 
the human intestinal tract, it is liable to be an infecting organism 
in wounds of the lower limbs and pelvic region of the body, es- 
pecially if the‘patient is incontinent. In such cases, special care 
must be taken to keep the bed clean and dry, and a close watch kept 
of the patient to clean the bod and the patient as soon as there 
has been a fecal discharge from the bowel, wounds and dressings 
must be protected in such cases by means of sheets of oil silk 
applied over the dressing, and wide strips of adhesive uo seal the 
edges of the oil silk sheet to the skin. DRESSING CART 
Group I - Dressings 
(1) 1 can 2” x 2!! (sterile) £ause sponges, 
(2) 1 can of AH x A" (sterile) gauze sponges, 
(3) 1 can of A” x 9" (sterile) gauze sponges, 
(A) 1 can Abdominal Pads (sterile) (Combines or A.B.D.’s), 
(5) Iodoform Gauze (1 inch) in bottle. 
(6) Vaseline gauze in various sizes (sterile), 
(7) Large rubber drains in sterile bottle, 
(B) Small rubber drains in sterile bottle, 
(9) Roller Bandage (2" and 3,f). 
(10) Absorbent Cotton (sterile) in covered can or muslin. 
Group II - Antiseptics 
(1) Alcohol 70$ (500 cc,) 
(2) Iodine, 3 l/2$ or 1% ( ). 
(3) Tincture of Mg rthi elate A-Ait ), 
(4j Gentian Violet, 1% ( '\fz v'). 
(5) Balsam of Peru (2 to fc ounces), 
(6) Hydrogen Peroxide (HoOj) (500 cc,), 
(7) Dakin’s Solution (500 cc, in dark bottle), 
(B) Boric Acid, 5% (500 cc, in sterile bottle), 
(9) Powdered Sulfanilamide (usually put up dn sterile test tubes) 
(10) Silver Nitrate (Lunar Caustic) in stick form, 
(11) Sulfanilamide Ointment, 10$, 
(12) Scarlet Red Ointment, 5$. 
(13) Boric Acid Ointment, 5$, 
Group III - Instruments 
(1) Sterile pan and cover containing: (a) Tissue forceps 
(one or more) (b) Suture scissors 
(c) Homostats 
(d) Probes 
Group IV - Miscellaneous 
(1) 1 sterile pan and cover containing: (a) Tongue depressors 
(b) Eye droppers 
(c) Medicine glasses 
(d) 1 ounce rubber bulb 
glass syringe(asepto) 
(2) Bandage scissors 
(3) Can containing sterile: (a) Cotton swabs 
(b) Cotton pledgets 
(c) Tongue depressors 
(4) Adhesive tape, 3” (5) Emesis basin (kidney or pus basin), 
(6) Safety razor and extra blades. 
(7) Sterile towels (wrapped in muslin). 
(?) Ether (1/4 lb, cans), 
(9) Compound Tincture.of Benzoin, (4 ounce bottle). 
•(10) Large paper bags to receive soiled dressings, etc. 
(11) Small sterile basin for irrigating solutions (wrapped 
in muslin) XX. COMMUNICABLE DISEASES 
A. Definition - an infectious or communicable ‘disease is 
one which can ‘be transmitted from one person to another 
and one caused by living organisms. 
B, Methods of Transmission 
1. Direct contact. Touching some person who has the 
disease, 
2. Indirect contact - personal belongings, clothing, 
papers, books, etc. 
3. Droplet infection - breathing, coughing*, sneezing, 
etc. This is the way in which the respiratory 
diseases and most of the so-called "diseases of 
childhood” are transmitted? measles, mumps, 
diphtheria, etc, 
A* Excreta - intestinal diseases and diarrheal’ diseases. 
5* Insects - malaria - spotted fever and many tropical 
diseases, etc, 
6. Food and water - Typhoid, etc. 
C. Clinical Aspects. 
1. Each disease has a, definite clinical picture, is 
caused'by a definite organism, is transmitted in a 
rather definite manner, and a large number of them 
produce immunity, ' 
2. These diseases are all communicable, usually produce 
fever and various degrees of toxemia. 
3. They are frequently accompanied by, or they may 
leave complications. 
Some of them run a definite course, and the duration 
is not greatly affected by medicine. However, the 
degree of severity and complications are affected 
by medication. 
5. Many of these diseases can be prevented, 
D, Methods of Prevention. 
1. Isolation -.separation of one patient from another 
except where both have the same disease. No visitors.: 
furniture, books and other articles not removed from 
the room, unless sterilized. Nurses and technicians 
should not go to other.parts 'of hospital while 
working in isolation - some exceptions. 
2. Vaccination - Small - Pgphcid - Diphtheria, etc. 
3. Immunes - those people who have either had the disease, 
or by repeated small doses o*f the- causative organism, 
or by vaccination, are not capable of having the 
disease. Immunity may be either active or passive. 
Active immunity is built up by a reaction in the 
body to the disease, usually by having the disease or 
by vaccination. It’ is produced by reaction to a 
toxin. Passive immunity is quick and usually lasts a 
short time. It is brought about by giving the 
patient some sort of antitoxin. E, Technique of Isolation 
1. The patient, or patients having the same disease are 
isolated in a ward or room. 
2. The technician usually wears a cap, a mask and a gown. 
These are for his own protection, and to prevent him 
from becoming contaminated so that he may transmit 
the infecting organism to others from clothing, etc, 
3. Only immunes should bo assigned to work on a conta- 
gious ward, except in an emergency. 
/+, Before leaving a ward for work in another part of the 
hospital, the technician should be tested for beia0 a 
carrier. A carrier is a person who harbors the di- 
sease and may transmit it to others without becoming 
ill himself. 
F, Unit of Isolation 
1. The disease is the unit of isolation. Where there are 
many cases of the same disease, all cases of the same 
disease are put together. For example, measles cases 
are not mixed with mumps cases. 
2. The same surgical gown nay be worn to administer to 
all patients with same disease, as there is no danger 
of Across infection". 
3. All utensils, i.e,, dishes, trays, cutlery, bathtubs, 
thermometers, bedpans, urinals, rectal tubes, etc., 
are carefully marked and isolated and disinfected 
after use and are kept in that ward - n a permitted to 
leave the ward, 
A. All bed linen and gowns are disinfected. Technician 
must "scrub-up" before entering and after leaving the 
ward, 
5. Nothing is removed from the unit before being sterilized, 
6, A cap, gown and mask are worn with all diseases, as: 
meningitis, diphtheria, measles, influenza, pneumonia, 
scarlet fever and plague, 
G, Procedure for Putting on a Surgical Gown to Treat Patient, 
1. The gown with long sleeves should be hanging up at a 
convenient place near a sink with running water, if 
possible, or a wash basin .and water with disinfectants 
and soap within reach. The gown is hung with the right 
side outward. Two brushes are kept constantly in a 
disinfecting solution (lysol) for washing before .vetting 
on a gown, 
2. As the technician enters the isolated unit he first puts 
on his surgery cap and over it ties on his face mask, 
3. The hands are then scrubbed for three (3) minutes each 
hand, first one and then the other. A clean brush is 
used for each hand. Soap and warm water are agents used* 
In some cases it is permissible to just dip the hands 
in a Lysol solution before and after caring for the 
patient, such as in mild cases of infection, i.e,, 
mumps and measles. 4-. The hands are than dried one at a time with paper 
towels. The towels are discarded in the waste basket 
or similar container, to be burned, 
5. The technician then takes the gown from the hanger 
by grasping it by the inside (uncontaminated), slips 
first one arm in and then the other. The ties are then 
tied from top to bottom in back and the belt is also 
tied bringing the ends to the front, if possible. This 
lessens the chance of contamination of the belt. The 
technician proceeds with his duties, 
H. Removing the Gown 
1, Scrub hands as before, 
2, Loosen all ties. 
3, Remove gown by drawing out one hand, then the other, 
allowing clean hands only to come in contact with 
inner part of gown, 
U. When gown is off, hang on usual hanger, nail or clothes 
tree as before, with outer surface to outside. 
5. Remove cap and mask. 
6. Wash hands well, again with soap and water or dip in 
disinfecting solution and dry, 
I. sterilizing or Disinfecting of Utensils, 
1, Composition of the article must be considered. Anything 
that can be steam sterilized or boiled in hot water 
should be done so, i.e., dishes, bedpans, urinals, rec- 
tal tubes, etc. Dishes are boiled 10 minutes; other 
items 20 minutes. 
2, Thermometers are placed in alcohol for at least 30 
minutes. 
3, Combs can be steam sterilized 20 minutes, or placed in 
a bichloride solution, 1-$000 for 30 minutes, 
-4. Stethoscopes, etc., are 'wiped off with alcohol and a 
clean cloth; allowed to dry or placed in the sun. 
5. If any article cannot be steam sterilized, boiled, or 
placed in a disinfection solution, it may be aired 12 
hours in the sunshine and considered clean, 
6, In dusting a room, utensils may be dusted off with a 
damp cloth, which has been moistened with carbolic 
acid, 1-4-0 or bichloride of mercury, 1-1000, 
J, Disinfecting Linen. 
All linen from isolated patients is kept in a separate 
laundry bag and sent to the laundry marked "contaminated”. 
There it is placed at once in boiling soapy water, 
K, Excreta Disposal, 
All urine and feces are emptied immediately and the 
bedpan sterilized in a steam sterilizer or placed in a 
1-4-0 solution of carbolic acid. Any specimens sent to the 
laboratory are marked "contaminatedn and a clean wrapper 
of some kind, i.e,, a paper bag or paper towel, is wrapped 
around the outside of the container. Chlorinated lime, 
3-5$ is used to disinfect body discharges. Feces is broken 
up, covered with lime, and allowed to stand at least one 
hour before flushing into the sewage system. L. Precautions for,Technicians 
1. P&ch must consider his own health, as well as the 
patient’s., 'It is necessary to be very cautious of 
one’s individual technique in regard to bodily 
contamination, 
2. Factors to remember. 
a. Try not to get close to the patient who sneezes. 
Scrub with soapy water should a patient sneeze in 
your face, 
b‘. Build up your own bodily resistance by the right 
kind of food, exercise, fresh air, rest and sleep, 
c. Avoid worry, fatigue, exposure to cold, consti- 
pation, cuts, abrasions, scratches, common colds 
or anything which may have a tendency to lower 
your resistance, 
d. In nursing pneumonia, patients avoid infections 
of the mouth, nose or throat, enlarged diseased 
tonsils. If you have a cold or respiratory 
infection, keep away from pneumonia cases, 
e. Cultivate the habit of not puttiv -your hands to 
your face or putting such article- as pens, 
pencils or pins into your mouth. 
f. Gargle or nose spray may be used very effectively 
in preventing diseases from spreading. 
g. VJash hands with soap and water often. 
h. Keep fingernails trimmed and clean. 
i. Masks are worn for all respiratory cases and all 
highly contagious cases, 
j. When contaminated, if it''is necessary to turn a 
faucet or open a drawer, the hand should be 
covered with a clean paper towel. XXI. EY3, NOSE AND THROAT 
A. Arsing of the Eye 
1, Eye Drops 
Tilt patient’s head backward, and incline slightly 
to the side so that the solution mil run away from 
the tear duct* In most cases it is well to press the 
inner angle of the eye after instilling the drops to 
prevent the excess of the solution from entering the 
nose. Depress the lower lid with the fingers of one 
hand and a bit of cotton. Toll the patient to look 
upward, and drop the solution on the everted lid. 
After placing one or two drops in the eye, release 
the lid, and catch any excess of the fluid that runs 
on the cheek with the cotton. Take care that the 
dropper does not touch any part of the eye or lids, 
2, Eye Irrigations 
These are usually used on cases of inflammation 
to remove the discharges from the eye. The medical 
officer will always order the name of the solution 
to be used and its strength. He will not state how 
much or what temperature to use. Usually 150 to 
250 cc, of solution will suffice (about l/2 to 1 
cupful), The temperature is always close to body tem- 
perature, about 100°F, The apparatus used may be a 
medicine dropper, a small, rubber bulb, glass syringe 
(asepto) or the glass tip of the medicine dropper 
attached to an irrigation can with a rubber tube. 
The apparatus and solution must be sterile. 
Sit the patient up with the head tilted backward, 
and inclined to the side to be treated. The patient 
holds a kidney or emesis basin against the side of 
his face to catch the fluid as it drains from the eye. 
Stand in front of the patient, and with a sterile 
pledget (cotton) wipe the discharge from the eyelids 
and lashes, with a movement away from the nose. After 
cleaning the outside of the lids in this manner, hold 
them open with one hand, and flush the eye with a 
gentle stream of fluid, directing the stream away 
from the nose. If the stream is directed toward the 
nose there is every danger of infecting the other 
(good) eye. Continue to,irrigate until the eye is 
free of secretion. Use little or no force. Touch 
no part of the eye ball, lids or lashes with the 
tip of the dropper or syringe used. For your own 
protection, wear rubber glo.ves to protect your hands 
from the discharges. 3. Hot Compresses 
Cover the patient's chest with towel, Anoint 
the skin of the cheek, lower forehead and oyc lids 
with mineral oil, vaseline, or other bland ointment, 
Prepare in a sterile brain, the sterile solution of 
the correct strength as ordered by the medical 
officer. Usually 500 cc. to 1 liter is more than 
enough. Heat the sterile solution to 110cp, and 
use a hot plat.; at the bedside to keep it at the 
correct temperature. The most frequently used 
solution is Boric Acid (2% to 5%)* 
Place in the basin 3 or 4 sterile gauze com- 
presses (4" x 4sr) • Squeeze the excess solution from 
2 cr 3 of the compresses, apply to the eye, and leave 
in place till it cools. In the vast majority of 
cases it is best to remove the compress and redip in 
the hot solution after one minute. The procea." is 
continued in most cases for 15 minutes 2 to 3 
hours. The medical officer will always order how 
long to continue the treatment and how often to repeat 
the treatment. 
After the treatment, dry the eyelids and skin 
of the cheek with cotton pledgets. If infection end 
discharge is present, wear rubber gloves for your own 
protection when carrying out this type of treatment, 
4* Removal of Foreign Bodies 
Locate the body, first by looking behind the 
lower lid. Evert the lower lid by pullin', down on the 
skin of the upper cheek, and having the patient 
look upward. If the body is not located be ind this 
lid, examine the upper eye, by turni - the upper 
eyelid inside out. To do this, star . in front of the 
patient, and instruct him to look at his feet. Grasp 
the lash of the upper eyelid with one hand, -lace a 
matchstick, swabstick, etc,, across the upper part 
of the lid. Pull out and up on the eyelash and push 
down with the small stick. This will evert (turn 
inside out) the upper eyelid. 
The foreign body may be removed by touching it 
with a dry sterile cotton swab, or better yet, have 
it moistened with, boric acid solution or normal saline. 
If the foreign body consists of many tine- -denes, it 
is best to remove by irrigating the eye. If the body 
does not come away easily, it is probably embedded in 
the outer layer of the eye ball or the eyelid, and 
must be removed by the medical officer. Embedded, 
foreign bodies are usually hot when they strike, the 
eye, and thus burn into the eye or lid surface, 
5• Fye Ointments 
Eye ointments are applied to the eye much like 
eye drops. Evert the lower eyelid and squeeze a 
ribbon of eye ointment about 1/2 inch long on to the 
inner surface of the lower eyelid. Do not touch the 
eyelid with the tube. B. Nursing of the Ear 
1. Ear Irrigations 
The ear canal is about 1 to 1 l/2 inches long* 
It is a blind passageway for the inner end of the 
canal is completely closed by the ear drum* To 
straighten this canal, pull up and back. This is 
done for all irrigations* 
a, Irrigations for the Removal of Discharge 
The medical officer will always order the 
name and strength of the solution to be used* He 
will not state how much solution or what temper- 
ature to use. This the Technician should know. 
The solutions are prepared so that they feel 
warm to the ear, a temperature close to body tem- 
perature (100°F, to 105°F#). The usual amount 
prepared is 2/{p cc, (1 cupful). The apparatus 
used may be the small red, rubber ear syringe, 
or a small rubber bulb glass syringe (lisepto) 
or a medicine glass tip attached to an irrigating 
can by means of a rubber tube. The solution 
and the apparatus must be sterile* Seat the 
patient in a chair with his head inclined slight- 
ly to the affected side, cover the shoulder with 
a towel to protect the clothing and have him hold 
an emesis or kidney basin tight to his body just 
under the ear* Place the tip of the irrigating 
apparatus in tlie opening of the ear canal, so 
as not to block the return flow. The flow should 
be very gentle, ±f the irrigating can is used, 
hang it about 1 foot above the level of the ear. 
Continue the irrigation until the irrigating fluid 
returns clear. The medical officer will always 
order the number of such irrigations he wishes 
the patient to receive each day. 
Following the irrigation, dry the e xternal 
ear with a cotton pledget. If the discharge is 
profuse, keep the patient lying with the infected 
ear downward, so as to get good drainage between 
irrlegations, Never plug with cotton the ear can- 
al of an infected'1 (dralrTingf ear. This serves as 
a plug to dam back the.pus, and will result in 
destruction of the ear drum, the ear bones and 
deafness* If the ear must be dressed, because 
the discharge is profuse, place 2 or 3 sterile 
gauze compresses (4U x 4”) on the outside of the 
ear, and fasten in place by roller bandage about 
the head. b. Irrigation for the Removal of Cerumen 
Cerumen' ('ear wax) is removed by washing 
out with a forceful stream of plain water. 
First soften the mass of cerumen by using 
warm oil, or warm glycerine as ear 
* drops. After instilling the drops, wait 
15 minutes or a half hour and then irrigate 
• with tap water. Use tap water at body tem- 
perature (about 100°F), Use the large (T 'b/ ) 
metal ear, syringe (Kramer syringe). Protect 
the patient's clothing with a towel over his 
shoulder and a basin under the ear to catch 
the returning fluid. Pull the ear lobe up 
and back to straighten out tho ear canal# 
Place the long tip of the syringe into the 
opening of the1 ear canal, but do not block 
the canal# Aim the syringe so ti .t the 
fluid hits the posterior wall oi ;he oar 
■ •■ canal first. Never Inject the fluid straight 
into the canal, for it may strike the drum 
and rupture it. If the fluid first hits the 
posterior wall of the canal, its force is re- 
♦ duced before it reaches the drum. Continue 
* irrigating untill the mass returns with the 
irrigating fluid. It may require a liter 
or two of fluid to dislodge the cerumen mass. 
C, Throat irrigation 
The; medical officer Trill always write tho name and 
the strength of the solution to be used. The Technician 
should know the temperature and amemnt to prepare* In 
most cases 2 to 4 liters of solution at 120°F, is prepared# 
Tho apparatus used consists of a glass medicine 
dropper tip attached to the irrigating can by means of a 
ruboer tube. The apparatus and solution are sterile. The 
patient is seated in fronttof a sink, and the irrigating 
can set on a shelf 2 feet above the level of his throat. 
If the patient is confined to bed, nave him hang his head 
over the edge of the bed, place a slop jar on the floor to 
receive tho return flow of the irrigating fluid, and hang 
the irrigating can on a standard two feet above the level 
of the patient's head# 
Direct tlx patient to bpnd his head over tho sink or 
slop jar, and to place the medicine dropper glass tip 
well into his. mouth, aimed at the back of his throat. The 
fluid flows .from the tip, hits the back of the patient's 
throat and then falls downward out of the patient's mouth 
into the sink or slop jar. While the solution flows over 
tho.. throat tissues, the patient must hold hie .reath# 
Direct him to pinch the rubber tube with his holding fingers to shut off the flow of irrigating fluid when 
he has to breathe. Then direct him to let the irrigating 
fluid flow while he holds his breath. This process is 
continued until the throat has been irrigated for 15 to 
20 minutes. Often the patient will tire in 8 or 10 
minutes time, and then the treatment will have to be 
discontinued. The treatment is used in cases of in- 
flammation of the throat tissues, and its main function 
is to apply heat to the area. The longer it can be 
continued at one time, without exhausting the patient, 
the better the treatment will be. The medical officer will 
always direct the number of times each day the treatment 
is to be carried out. 
Often the patient may complain that the temperature 
of the solution feels hot or cold to his throat. The 
patient's own feeling of heat and cold is a good guide to 
determine the temperature of the throat irrigation, for 
often the irrigation may be given at 130°F, or 140°F. 
"Give as hot as the petlent can comfortably stand". THROAT IRRIGATION mi. DIETS 
A, Medical Diets - Medical Diets are classified as to 
consistency. 
1. Liquid Diet - A liquid diet is fluid, blend, easily 
digested are1 hrs low residue. The patient is fed 
about every 2 hours from B: 00 A.*:. to 8•00 ?,M* 
Included are? 
a. Cereal gruels 
b. Milk 
Co Broths 
d. Tea, coffee, cocoa 
0. Fruit juices 
f. soups 
g. Ice cream (plain) 
h. Egg nog 
1. Ginger ale, etc. 
j. Tomato juice, 
2. Soft Diet - A soft diet is a liquid diet plus a few 
easily digested solids. The patient is fed every 
3 to \ hours, from P'OO A.M. to G;00 P,M, Included 
npg* 
a. Cooked cereals (oatmeal, Farina, Cream of rheat) 
b. Milk toast 
c. Crackers in milk 
d. Eggs - poached, soft-boiled, soft-scrambled 
e. Addings - tapioca, gelatin desserts, Julio, 
cream puddings 
f. Custards - baked or boiled 
g. Junket 
h. All items in liquid diet 
i. Fruits - oranges, stewed fruits, baked apples, 
canned poaches and pears, etc. 
1. Vegetable purees - beets, carrots, beans, poas, 
spinach, squash 
k. Potatoes - baked or boiled or mashed 
l. Macaroni and spaghetti, noodles 
m. Ri c e 
n. Cheese - crer.ro and cottage, 
3. Regular or Colid Diet - A regular diet is a normal’ 
diet with all fried, highly seasoned and indigestible 
foods omitted. The patient is fed three times 
daily. Included are? 
Fruits - raw or cooked (no melons) 
b. Vegetables - raw or cooked (no turnips, etc.) 
c. Cereals 
d. Bacon, beef, lamb chons, liver, fowl, fish 
(no pork or veal) 
e. Cake, cookies, breads 
f. All items of soft, and liquid diets. B. Post-0perative Diet 
1, Abdominal Cases (except stomach and bo*ol cases) 
a. First day - after S hours, if nr nausea, allow 
tea, tap water and warm broth, 1'’ MILK, no 
fruit juice, 
b. Second day - sane as first dry, 
c. 'Third day - after enema has been effective, 
give soft diet. 
d. Fourth day - sam® *s third day, 
e. Fifth to seventh day - solid or regular diet. 
2. Stomach and Boyel Cases - operations on stomach, 
intestine, gunshot wounds of the abdomen, etc, 
a. First, second and third days - give the patient 
nothing by mouth. Use the Murphy Drip (except 
in colon and rectal cases) and vepoclysis 
to administer food and fluid. 
b. Fourth day - allow 1 ounce quantities of tea, 
tap water, strained orange juice every half hour, 
or other fluids as ordered by medical officer. 
c. Fifth day ~ increase the same liquids as above 
to 4. ounces every'- 2 hours. 
d. Sixth day - add fruit juices and clear, non- 
iyri tat %ng broths. 
e. Seventh‘day - add cereal gruels to the diet, 
milk, Ida cream, custard, etc. XXIH. ABBREVIATIONS 
1. ac -20 minutes before meals, 
2. pc - immediately after meals (1 to 5 minutes) 
3. hs - bed time 
4. b.i.d, - twice daily (10:00 A.M. and 4:00 ?/",) 
5. t.i.d. - 3 times daily (10:00 A.M.;2?00 P,M, and 6:00 
P.M.) 
6. q.i.d, - 4 times daily (8:00 A,M.;12:00 noon: 4:00 
P.M. and 8:00 P.M.) 
7. q.2.h, - every two hours, i.e., 6:00 A.M,;8;00 A.M.; 
10*00 A.M, 
8. q,6,h. - every six hours, i.e., 6:00 A.M, $12, s 00 noon; 
6:00 P.M, 
9. prn - as required (as necessary) 
10. 8,0.s. -if necessary 
11. stat - immediately (at once) 
12. ad lib - freely 
13. ung, - ointment 
14. tinct, - tincture 
15. Sat.8ol, or 8.8,- saturated solution (also means soap-suds when 
refering to an enema). 
16. gtt - drop 
17. m. - drop (minum) 
18. aa - of each 
19. et - and 
20. is - half 
21. c - with 22. qsad - add sufficient quantity to make. 
23. dlv, - divide 
24. Sig. - give the following directions 
25. Hx - take 
26. Mr - dram (4 cc.) (teaspoonful) 
27. My' - ounce (30 cc.) 
CM 
28. H.M.S. - hypodermic injection of Morphine Sulfate 
29. qs ~ sufficient quantity 
30. - v,:ater 
31• 2 ” Hydrogen Peroxide 
32. AgNOa - Silver Nitrate 
33. - Potassium permanganate 
34. - Magnesium Sulfate (Epson Salts) 
35. HC1 - Hycrochlcric Acid 
36. NaCl - Sodium. Chloride (Table Salt) ( lino is 3 lit 
dissolved in vator) 
37. HgClg - Mercury Bichloride 
38. NaBr ~ Sodium Bromide XXIV,. DRUGS 
Drugs come in the form of solids (tablets, pills and capsules) 
and liquids. The dose cf solid drugs in most cases is one tablet 
or one pill or one capsule. If you calculate the doso ordered 
to be several tablets, capsules or pills, there is (1) probably 
something wrong with your calculations; (2) you have misread the 
order or the size of the tablet on the label of the bottle. 
Liquids are prepared so that 4 cc. (grT ) contain the usual 
dose. Some liquid medicines are given in minum doses /i#e., 
gtt XV). If the medicine comas in a small bottle ), it is 
probably to.be minum doses. If it comes a large # 
bottle it is most likely to be given in 
size doses, 0 O 
A. Analgesics 
1. Aspirin (Acetylsalicylic Acid) Tablet - ,3 Gm. (5 gr.); 
Dose - ,3 Gm, to l.Gm. (5 gr, to 15 gr.) 
2. A.P.C. Capsule -'Dose - 1 to 2 capsules, (both 1, 
and 2. are given to ease mild pain, reduce high 
elevation of temperature and induce sweating), 
3. Codeine Sulfate - Tablet - ,032 and .06 Gm.; Dose - 
.032 to ,06 Gm. (1/2 gr, to 1 gr,), (Given to ease 
pain, induce sleep and stop cough). It is a narcotic 
like Morphine Sulfate, but not so habit forming. It 
is used orally and subcutaneously. 
4. Morphine Sulfate - Tablet - ,016 Gm,; Dose - ,016 to 
.032 Gm. ( 1/4 gr. to 1/2 gr.) (Given to ease severe 
pain, quiet restlessness, delirium and induce sleep). 
Depresses respiration and peristalsis, thus causing 
slow breathing and constipation; used orally and 
subcutaneously, 
B. Sedatives and Hypnotics - (to induce sleep and relax 
nervousness - do not ease pain). 
1. Phenobarbital (luminal) - Tablet - ,03 Gm. to ,1 Gra.; 
Dose - .03 Gm. to ,1 Gm. (l/2 gr, to 1 l/2 gr.). 
Elixir of Phenobarbital contains .016 Gm. (1/4- gr.) 
to the dram. 
2. Nembutal, Amytal. - Capsules - ,1 Gra.; Dose - ,1 Gm, 
to .2 Gm. (1 1/2 gr. to 3 gr.). 
3. Bromides (NaBr, KBr, NHyBr) - Tablet - .3 Gm.; Dose - 
,3 Gm. to 3. Gm, (5 gr. to 4-5 gr.). Elixir of Bromides 
usually contain 1 Gm, (15 gr,) to each dram. 
4. Paraldehyde - Dose - 15 cc, to 30 cc. 
5. Chloral Hydrate - Tablet - ,3 Gm.; Dose - 1. Gm. 
(15 gr.) C, Stimulants 
IT Ephedrine Sulfate - Capsule - ,025 Gm, a . ,05 Gm.; 
Dose"- ,025 Gm. to .05 Gn. (3/3 gr. to 3A gr.) 
( given orally and subcutaneously) Used as nose spray 
to shrink nasal membranes in a 1/ solution* 
2. Ad ran alin or Epinephrine - 1-1000 solution - >o::o - 
,3co. to 1, cc. T3 in', to 15 ia*) (given subcutaneously). 
Increased blood pressure, relieves asthma, increases 
heart, pulse and respiratory rates and is a general 
stimulant. 
D* Depressants 
1, Atropine Sulfate - Tablet - ,0006 Grn, (,6 mg,) (l/lOO gr) 
Dose - ,0003 Gm, (,3wg.) to ,001 Gra, (1 mg,) 
1/200 gr, to I/50 gr, (given orally and subcutaneously), 
Depresses intestinal peristalsis, checks mucus flow, 
checks salivary flow, checks gastric secretion and 
dilates the pupil. Stimulates cerebral centers (as 
respiratory and cardiac cantor). Used w ith Morphine 
Sulfate pro-operatively to check mucus flow and counter- 
act some of the depression of the Morphine on the ce- 
rebral centers, 
2, Hyoscine Hydrobromide - Tablet - ,0006 Gm, (,6mg.) 
, ." (1/100 gr.) - Dose -/,0003 Gn, (,3.ng,) to ,001 Gm, 
(lirag,) 1/200 gr. to I/50 gr. The-action of this 
drug is much like that of Atropine Sulfate, However, 
it is a. cerebral depressant and so is often used with 
Morphine pro-operatively to induce sleep, relax the 
’patient, etc. The . Technician 'must .closely watch t hose 
paticnts who have had Hyoscino pre-oporatively, for 
they often become mentally confused, do" ’ Lous and can 
easily harm themselves while under the influence of the 
drug. 
E, Dowel Evacuants 
IT Cascara Sagrada - mildly irritates the mucosa lining 
of the colon to stimulate peristalsis. 
Fluid Extract of Cascara Sagrada - Dose - 2 cc. j 
Extract of Cascara Sagrada «- pill - .12 Gra. 5 Dose - 
1 or 2 pills. 
2. Castor Oil - irritates the mucosa of the small in- 
to s tine 'to stimulate peristalsis*- Dose - 15 cc. to 
30 cc. 
3. Mineral Oil — passes through the intestinal tract 
unchanged, and so acts as a lubricant and softens trie 
feces. Dose - 15 cc, to 30 cc, 
A* ’Magnesium 'Sulfate ( Epsom Salt's ) - Dose. - 15, Grn. 
mth much water. F. Malaria Drugs 
1, Quinine- Sulfate ~ Capsule or tablet - .3 Gm. (5 gr,)j 
Dose - 2 to A capsules or tablets daily. Causes 
ringing in the ears, dizziness, mental confusion and 
deafness. If above symptoms are severe, reduce the 
size of the dose or stop the drug, 
2, Atabrine - Tablet - ,1 Gm, (1 1/2 gr,)‘ Dose - 15 
tablets taken 1 t,i,d. for 5 days. PART mo 
OPERATING ROOM AND SURGICAL TECHNIQUE 
INTRODUCTION 
The intention of this booklet is to present the problems 
involved in Operating Room and Surgical Technique, The greater 
the knowledge of these principles the,Technician has, the tetter 
able he is to carry out necessary duties and assist in the oper- 
ating room. 
The various detailed routines in the way of equipment 
and procedures are largely based on past experience and1informa- 
tion obtained from the best authorities' on the subject, Nixed 
routines are not necessarily applicable to every patient or in- 
stitution, Large permanent United States Army Medical Installa- 
tions have naturally developed routines of their own and many of 
the smaller ones have neither the facilities nor the space for 
certain routines. Nevertheless, routines, as worked out in a 
prominent institution over a number of years, may be of consider- 
able help in serving as a foundation or a comparison for other 
institutions. The routines given here have developed from the 
accumulation of work by various people over many years, but have 
been, and will continue to be, changed as circumstances and con- 
ditions require, 
Vfe are striving to teach you the ideal, Many of the 
principles set forth in this booklet will, of necessity, have 
to be modified when you return to your command. Remember, how- 
ever, ’‘Strive for the Ideal,” CHAPTER I 
surgical BACTERIOLOGY 
Surgical bacteriology is one of the most important single 
subjects that is taught to the Technician. It is one 01 the 
subjects you must know before you can become a good Technician, 
so listen well and do not hesitate to ask questions. 
Cnee the basic principles of surgical bacteriology are 
understood, it is not difficult for the Technician to understand 
the teaching of the practical application of these principles. 
If the subject is not understood, the Technician's mind will be 
in such confusion as how to perform many of his daily duties that 
he will be guilty of many errors in technique which may endanger 
not only his own life, but also the lives of his patients. Every- 
one associated in any capacity with the practice of surgery, must 
possess an alertness against bacteria which is alma t automatic 
or reflex. 
Technicians must study the principles of surgical bacteriology 
to learn: 
1. How to prevent the growth of bacteria. 
2. How to kill bacteria, 
3. How to prevent bacteria from being transferred from one 
person to another, 
A. How to prevent the entrance of bacteria into the body, 
5, How to apply these principles of bacteriology o their 
everyday work. 
BACTERIA 
From the beginning of time, until the seventeenth century, 
little was known about bacteria. A Dutchman, Anton von Leeu iihoek, 
in 16?3, using a microscope ex his own manufacture, was probably 
the first to describe living micro-organisms. 
If we could trace back to their ultimate origin the development 
of all living things on earth of both animal and plant kingdoms, 
we would reach the minute, simple organisms consisting of a 
single cell. These are the lowest forms of life that exist on the 
earth. 
For the purposes of study, these organisms have been divided 
into two classes or groups. The organisms belonging to the vege- 
table kingdom are called bacteria. Those belonging to the animal 
kingdom are called protozoa. 
Bacteria then are minute, single celled, vegetable organisms, 
so small they can be seen only with the aid of a microscope, which 
magnifies or enlarges them 1000 times. Bacteria mav occur alone or 
in large groups called colonies. However, each bae a.rium is 
completely independent. The terms, Microbe and Germ mean the same 
as Bacterium, The bacteria with which we are concerned in surgery fall 
into two main groups: 
1. Coccus (plural: Cocci) (kokkos = a berry). The round, 
spheroidal or ball-shaped bacteria. 
2. Bacillus (plural: bacilli) (baculus = a rod). The rod- 
shaped bacteria. 
Cocci 
The ball-shaped group contain many of the bacteria which 
are characterized by the formation of pus (pyogenic bacteria). 
The chief members of this group can be classified roughly into 
two classes, according to the arrangement they always take when 
viewed with the microscope, 
1. Staphylococcus (Staphyl = a bunch of grapes). These 
cocci group themselves in grape-like clusters and are the 
chief organisms which form thick, yellowish or white pus. 
Staphylococci are the cause of most boils, carbuncles, 
some infections of the fingers and hands, and "stitch 
abscesses" about a surgical wound, 
2. Streptococcus ("trepto = twisted). Cocci which are 
arranged in chains or bead-like formation, and form a thin, 
watery type of pus. The streptococcus is to be expected 
in unclean surroundings, soiled clothing and dirty skin. 
Therefore, it is to be expected in the wounds of warfare. 
Bacilli 
The rod-shaped organisms are likewise divided into two 
groups. The ones that are more frequently encountered following 
surgical wounds and combat injuries are: 
1. Bacillus rr'8tani - a non-pus producing bacillus, which 
causes the disease known as Tetanus (lockjaw). It is 
found in many soils and in the feces of horses, cows and 
human beings. 
Staphylococcus 
Baci11 us Tetani 
Streptococcus 2. Bacillus - one of a group of bacilli which infect 
dead or dying tissues and is characterized by the formation 
of gas in them. It and its companions are found in cases 
of that dreaded wound infection, Gas Gang; -e. These 
organisms are also commonly found in many . jils* 
3. Bacillus Coli - a large group of bacilli which normally 
live in the intestinal tract of the human being, 11 his 
bacillus, commonly associated with intestinal wounds, 
produces a light brown pus with a fecal cdor. 
Bac i 11 us '7e I ch 1 i 
Bac iI I us Coli 
4, Bacillus Pyocyaneua - a bacterium which produces green 
pus with a musty odor. It is found in intestinal discharges 
and is a secondary invader cf chronic wounds containing 
pus. It is most often found in chronic discharges from 
the chest, the bones and the peritpneum. 
REPRODUCTION CF BACTERIA 
Bacteria may reproduce by a process known as fission or simple 
division. This means that one bacterium divides in 2 equal parts. 
Some organisms, of which the Bacillus Tetani and Bacillus ’"elchii 
are good examples, have the ability to form spores. These can be 
considered to be the seed or the reproductive element of the 
bacterium. These spores are much harder to kill by heat and chemi- 
cals than are other bacteria. "Tien the spores enter the human body, 
they develop into the vegetative or adult- growing form f the 
organism. 
Spore 
Spore?"" 
Various sizes, shapes and 
positions of bacterial 
spores. Bacteria also can be placed into two classes, depending 
on whether or not they can live in the presence of free oxygen. 
1. Aerobic (aer = air + bios * life)? Aerobic bacteria 
grow only in the presence of free air or oxygen. 
2. Anaerobic (an = absence + aerobic); Anaerobic bacteria 
cannot live in the presence of free air or oxygen. 
Most of the species of streptococci and staphylococci are 
aerobic. The Bacillus Tetani and Bacillus Welchii, however, are 
anaerobic. This is extremely important in the prophylactic and 
definitive treatment of war wound infections. These organisms 
may contaminate any deep, contused-lacerated, or punctured wound. 
Distribution of Bacteria. 
Bacteria flourish in moist surroundings at a temperature at 
or near that of the bod". Under less favorable circumstances 
they may continue to exist, without multiplying, for long periods. 
All but the spore-bearing bacteria are usually soon destroyed 
however by sunlight and dryness. 
These minute organisms then are constantly present in the air 
we breathe, the water we drink and the food we'eat. Living things 
can make no contacts of any sort which do not expose them in 
some degree,to bacterial contamination. 
Certain varieties of bacteria, such as the common 
staphylococci and less frequently, the streptococci are to be 
found in the normally clean skin. Any wound of the surface may, 
therefore, be contaminated with either. The mouth, tonsils and 
throat harbor many sorts of bacteria, particularly streptococci. 
The intestinal tract, especially the colon, is loaded with 
bacteria, notably the Bacillus Colon Group and also the ever 
present streptococci. In some instances man picks up bacteria 
from contact with soil contaminated by animal discharges, as for 
instance, in the well manured farm land which harbors the anaerobic 
bacilli of Tetanus and Gas Gangrene« At'other times, contamination 
seems to come from floating particles in the air - a phenomenon 
which forces the wearing of masks upon the staff of an operating 
room. 
All bacteria do not cause disease. It is with the compara- 
tive few that do cause disease, termed pathogenic (pathos « 
suffering + gennae = I produce), that we are concerned. Approxi- 
mately 250 living agents of vegetable and animal origin are 
known to produce disease in man. Of this total group, at least 
56 are bacteria. How Bacteria Cause Disease. 
, Under the ordinary conditions of health the human body is 
resistant to the action of the multitudes of bacteria. Put let 
them gain entrance through a break in the protective covering of 
our bodies produced by injury, or let exposure, over fatigue, 
shook, hemorrhage, starvation or a constitutional disease, lower 
the natural resistance to their action, and infection occurs. 
Finding warmth, moisture and food in the body tissues, the 
bacteria grow and multiply rapidly. Certain of these bactria, 
as they grow, throw off highly poisonous substances which are 
taken up by the body and causa disease. This type of toxin 
is termed an o^otoxin. The Bacillus Tetani is an example of a 
micro-organism, forming this type of poison. Other bacteria 
store up these toxic substances in their bodies, which are set 
free as they die and disintegrate. Such substances are called 
endotoxins. Some strains of Staphylococci and Streptococci are 
examples of micro-organisms forming this type' of toxin or poison. 
These poisonous substances, toxins, when absorbed by the body, 
cause disease. 
Contamination. Infection and Inflammation. 
Contamination? The initial implanting or seeding of the 
bacteria into the wound, is termed "Contamination”. ’That germs 
are present are apt to be concentrated in spots; here and there, 
on the surface or in the cavity of the wound. 
Infection; For the first L or B hours an undisturbed con- 
taminated wound may be expected to show little change, ' At the end 
of this time, secretions appear which spread the bacteria to all 
parts of the wound where they proceed to multiply rapidly, grow, 
invade the tissue beneath the ?;ound surface, and,give off their 
toxins. This invasion of the tissues of the body by pathogenic 
organisms in such a way as to favor their growth and permit 
their toxins to injure the tissues, is called "Infection", 
"Time Lag"; The period between the contamination stage and 
the infection stage is spoken of as the- "Time Lag" or incubation 
period. Every effort is made to treat war wounds before the "time 
lag" has elapsed. The duration of the period before infection 
becomes established depends largely on factors influencing the 
tissue resistance, i.e,, (1) the potency cf the bacterial toxins; 
(2) the number-of bacteria and their aggressiveness; (3) the 
extent and degree of tissue damage; (A) whether or not one of the 
sulfonamide compounds (sulfanilamide, sulfathiazole. or sulfadia- 
zine) is used orally and/or locally in the wound, and (3) the 
severity of any shock or hemorrhage. Inflammation: can be defined as the condition into which 
tissues enter as a reaction to an irritation or injury. The 
injuring agent may be any one of several kinds. Bacteria, a blow, 
acids and caustic alkalies, heat and cold, and electricity, all 
are able to cause this tissue reaction. Bacteria are by far the 
most common and most serious of the injuring agents. If the tissue 
reaction to the invading bacteria is rapid in appearance, it is 
spoken of as an "acute" inflammation. When the tissue reaction 
comes on in a stealthy manner and is continued over a long period of 
time, the inflammation is said to be "chronic". 
Local Symptoms of Acute Inflammation; most forms of acute 
inflammation with which we deal surgically are caused by bacteria. 
The cardinal local symptoms of an acute inflammation are redness, 
swelling, heat, pain and loss of function of the part involved. 
These local symptoms are caused by an engorgement of the small 
blood vessels of the injured area with a resulting increased blood 
supply, and an escape of blood serum and particularly, the white 
blood cells from these vessels into the surrounding tissues. The 
increased blood supply accounts for the heat and redness while the 
outpouring of blood fluids and cells accounts for the swelling, 
and by causing tension on the delicate nerve endings, pain is pro- 
duced. 
The white blood cells reaching the area, attempt to attack, 
kill and eat the offending bacteria. The blood serum which has 
escaped contains substances (antitoxins and anti-bodies, etc,) 
which also attempt to render the bacteria harmless. Usually the 
bacterial toxins are at first too much for the early defensive 
Measures with the result that many white blood cells and local 
tissue calls are killed. These dead, white blood cells, dead and 
living bacteria, with the blood and tissue fluids around them, 
form what is called PUS. 
Surrounding this area of dead cells, the body attempts to 
build a protective wall of closely packed tissue and white blood 
cells. This protective barrier must be respected by anyone dealing 
with an acute inflammation. When pus is enclosed by such a wall 
an ABSCESS is formed. This abscess, at first small, grows larger 
and if it approaches the unbroken skin, may appear as a small 
raised dot on the skin surface. The abscess is then said to have 
’•pointed" or "come to a head". The surgeon will usually incise and 
drain an abscess without disturbing its protective wall. 
ABSCESSj D1AGRa'm OF T 1S§0E CHANGE3 (WOOLF) Frank pus formation, with a rapid solution of tissues 
and a free outpouring cf white blood cells, is usually caused by 
Staphylococci. Streptococci cause a more spread-out typo of 
inflammation characterized by swelling and death of the affected 
tissues, rather than an abundant formation of pus. 
General Symptoms of Inflammation. 
The general or constitutional symptoms of i acute 
inflammation are caused by the absorption of toxic substances 
by the blood from the inflammed area. The usual symptoms are 
fever, increase in pulse and respiratory rate, headache, hot 
dry skin, flushed cheeks, loss cf appetite, thirst, coated tongue, 
constipation and scanty, highly colored urine. 
If the toxic absorption is rapid, there may be chills 
followed by sweating and even delirium. 
Pus formation in the body almost always causes a multipli- 
cation of white blood cells. Normally in number fro; >'00 to 
10,000 per cubic millimeter, the white cells may increase to 
30,000, 40,000 or even to 60,000. The total count usually 
parallels the severity of the inflammation and the patient’s 
natural resistance to disease. 
Complications of Acute Inf 1 animation. 
Occasionally the defensive measures of the body are in- 
adequate to overcome the infection. Consequently, we get ■ 
absorption into the blood of a large amount of very poisonous 
products. 
If only the toxins are absorbed, the condition is called 
a TOXEMIA. 
When bacteria and their toxins ar., absorbed into the blood 
stream, we have a SEPTICEMIA. 
If pus is discharged into the blood stream, a PYURIA has 
occurred. 
The above complications are commonly called, by the layman, 
’’blood poisoning”. These conditions show the general symptoms 
of an acute inflammation with an increased sever' Chills, 
sweats and a temperature which shows abrupt rise,'; and rapid falls 
one or more times daily are characteristic. 
Repair of Wounds. 
bounds which are not contaminated by bacteria end are made 
with a minimum of tissue destruction, heal rapidly with little 
tissue reaction. 
In cases in which pus formation (suppuration) has occurred, 
the process of repair is loss simple and longer delays I, Gradually 
the dead materials rare cast off and escape, and the wound cavity 
fills with a red, soft tissue which bleeds easily. It is 
composed of small, hair-like blood capillaries and fine fibrous tissue strands, and is termed GRANULATION TISSUE, These fibrous 
tissue strands intertwine with each other to form the scar. The 
greater the delay in healing and the deeper and more extensive 
the granulation tissues, the more dense and contracted will be 
the resulting scar. Healing is complete when skin cells grow 
over these granulations.With loss of large areas of skin, healing 
will not take place and some type of "skin graft" must be done. 
Occasionally two already granulating surfaces may be 
sutured together, the growing cells from the two sides blending 
and becoming organized into one scar. Large infected war 
wounds may be closed in this fashion ("secondary suture"). 
The presence of foreign material interferes with repair. 
Small metallic fragments, lead shot or even bullets may remain 
enclosed and harmless for an indefinite period. Larger or rough 
bodies are seldom tolerated, and since they most likely carry 
bacteria into the tissues, usually become a source of acute 
inflammation with pas formation. CHAPTER II. 
ASEPSIS AND ANTISEPSIS 
The history of modern surgery really begins with the time 
when it was discovered that wounds could be made without the entrance 
of bacteria into them. As early as 1P36 it was known that the 
decomposition of animal and vegetable tissues, a process termed 
PUTREFACTION, was caused by living micro-organisms and that this 
putrefactive process could be stopped by heat. It was not until 
the middle of the nineteenth century, however, tha his knowledge 
was verified and put to some practical use. Louis . aster.r, the 
renowned French chemist, found that a nourishing fluid like broth, 
purified by boiling, would remain clear and pure for years if 
protected from the germ - and spore - bearing dust of the air, 
though it would putrefy if atmospheric dust could reach :1k. This 
principle has been widely applied and a method of partial heat 
sterilization is known today as PASTEURIZATION. 
Before Pasteur’s brilliant work most surgical wounds rotted 
and stank. Surgery was usually limited to amputation, procedures 
on the body surfaces and an occasional invasion of one o til© body 
cavities. Surgery as we know it today with all its special fields, 
such as brain surgery, chest surgery and the intricate procedures 
of the plastic surgeon, was beyond the wildest dreams of members cf 
the medical profession. The death rate following surger of most 
any type, reached as high as 60 to SO per cent. Surgical wa -:s were 
rampant with infection. The pus of an acute suppurating surgical 
wound as it ruptured upon the surface of the body, was called 
"laudable pus", for its appearance marked a localization of the 
process, an escape of the inflammatory products and beginning of 
healing. In contrast to this were the common gangrenous, wide 
spreading putrefactions with the thin watery discharge that usually 
had a fatal ending. 
It was Lister, an English surgeon, who in the period around 
1865-1667, applied Pasteur’s findings to surgery. Realizing that 
the bacteria were carried into the tissues by external contact, a 
treatment of contaminated wounds with solutions which were poisonous 
to the bacteria was instituted. These solutions were termed 
ANTISEPTICS, Carbolic acid (phenol) solution was selected as an 
antiseptic because of its known deodorant action upon sewage. 
Lister’s expectations that attempted purification ■. contaminated 
wounds with carbolic solution and subsequent protecoxon with sheet 
tin would do away with infection, was soon realized. 
The next step was the development of an elaborate technic for 
operation on clean wounds, using carbolic solution on tbs patient’s 
skin and wound, the surgeon’s hands, and all the materiaxo used at 
the operation. An attempt was made to destroy the germs ii the 
surrounding air by the use of a crrbolic acid spray. It was lord Lister who opened the door to the unlimited 
possibilities of modern surgical procedure. The main objection 
to Lister's ANTISEPTIC SURGERY was that the antiseptic solution 
purified the operative field, but also caused death of many 
tissue cells and prevented ideal healing. 
*”lth the advance of knowledge, it was found that the materials 
used in and about a surgical wound could be completely freed of 
all bacterial life, the adult vegetative organisms and even the 
hardy spore forms, by subjecting them to high temperatures 
(STERILIZATION). This protection of wounds, purposefully or 
accidentally made, against the invasion of bacteria was termed 
ASEPSIS. It became apparent that as each element which came in 
contact with a wound was freed from bacteria (Asepsis), the 
necessity for the use of chemical solutions (Antisepsis) in the 
wound itself was quite unnecessary. The ANTISEPTIC SURGERY of 
Lister's period gave way in favor of the newer and more efficient 
ASEPTIC SURGERY." 
The Principles of /.septic Surgery. 
"The successful practice of aseptic surgery requires a strict 
observance of pre-operative sterilization of surgical materials, 
of rigid precautions against bacterial contamination during the 
course of the operation, and of guarding the wound from infection 
afterwards until such time as it is healed". 
Pro-Operative (Before the Operation). 
The procedures done before the operation consist of; 
1. Killing all bacteria by heat or chemicals (STERILIZATION), 
on all surgical, materials that are to come in contact with the 
wound or are to be handled by the surgeon and his assistants. 
Those materials must be kept free of bacterial life (STERILE), 
2. The preparation of the surgeon and his assistants and 
nurses before touching any of the above mentioned sterile 
materials. This preparation is termed nscrubbing up". Mb.ile the 
hands and forearms are not rendered absolutely sterile, they can 
be made rs clean as possible by scrubbing with soap and water, 
immersion in antiseptics, and the hands covered with sterile 
rubber gloves. 
3. Covering the head and nose and mouth of each operator 
with a cap and mask. A long-sleeved sterile operating gown covers 
the non-starile light clothing rorn by the operating personnel. 
4. "Preparing" the operative area by removing hair, surface 
fats and dirt and the application of a chemical agent to render the 
bacteria harmless. 5. Covering the rest of the patient* s body, other than the 
operative site, with sterile coverings as drapes. 
During the Operation. 
The surgeon and his assistants touch nothing that has not 
been rendered and kept sterile from bacteria), Pollster! le 
assistants do not touch and contaminate anything that is sterile. 
Post-Operative (After the Operation), 
The wound is protected from possible bacterial contamination 
by means of sterile dressings. Care is taken to prevent contact 
of anything that is not sterile with the unhealed wound. 
ANTISEPTICS 
Sepsis (decay)s Poisoning by the products of a putrefactive 
process. 
Antiseptic; A chemical agent which prevents the growth of 
bacteria without necessarily destroying them. 
Germicide; Any agent that kills bacteria. 
Disinfectant; An agent, usually a chemical, which "a?troys 
pathogenic (disease-producing) bacteria. 
Antiseptics are used in surgery under three main sets of 
conditions; (Eliason). 
1. Application to the akin. "Antiseptics are applied to 
the skin in c wide area about the operative area to destroy its 
normal and accidental bacterial inhabitants, and so prevent the 
entrance and development of infection from the source in thc 
operativ’c wound". 
2. application to the Tissues. Antiseptics are occasionally 
applied to tissues which are contaminated with bacteria or infected 
with the object, of .assisting the normal resisting powers of the 
tissues to destroy the germs and their products. An ideal 
antiseptic would be one that rendered the open tissues free of 
bacteria without causing damage to the tissue cells. However, to 
date;, the ideal antiseptic has not been, introduced. Most of the 
better known antiseptics in killing the bacteria, also tend to 
destroy the body tissue cells. The use of antisopt. cs in dealing 
with contaminated tissues is rapidly falling into' sfavor, The 
use of the sulfonamide drugs (sulfanilamide, sulfathiazcle and 
sulfadiazine), locally in contaminated wounds, does prevent the growth of bacteria, however, without tho deleterious effects 
of the antiseptics. Every soldier will carry 5 grams of crystalline 
sulfanilamide for the above purpose, 
3. Chemical Sterilization of Instruments and Surgical 
Materials (to be discussed in Chapter IV). 
The mere common antiseptics (some have mild germicidal 
powers) used on the skin in surgery are? 
a. 70% alcohol - alcohol causes pain when applied 
to open wounds and irritates mucous surfaces (eye, urethra, etc,)* 
b. Tincture of Iodine - 3 to 7% solution. Iodine 
solutions often irritate the shin. It is never used on wet 
surfaces, the palms, soles, armpits, or perineum. If tho patient 
is perspiring, iodine should not be used on the face, scrotum 
and other tender parts of the shin. The iodine is allowed to 
dry and then removed with 70f alcohol. The bottle should be 
tightly corked and the solution renewed frequently, 
c. Tincture of Merthiclate - an alcohol-acetone, 
colored (pink) solution for skin preparation. Water (aqueous) 
solutions of merthiclate, 1:1000 to 1510,000 are also used 
occasionally in wounds and for irrigations of various parts of the 
body (bladder, kidney, etc.), 
d. Tincture of Mercretone - a colored mixture of 
alcohol, acetone, croscl, bichloride of mercury, water and 
acid fuchsin, 
o. Metaphen - a yellow solution of a crystalline 
compound of mercury with croscl. 
The most important point in operating room technique is 
absolute cleanliness end adherence tc the principles of asepsis 
on the part of everyone concerned. The personnel of an operating 
room, either in a fixed or field installation,functions as a 
team and a “break51 in technique by any one member of this team 
ruins the final result, which is, of course, a successful 
operative procedure followed by rapid healing of the wound. 
Remember, never be-afraid to admit that you have “broken 
technique”, i.e,, contaminated the sterile materials or 
contaminated yourself, if 3/011. are sterile. CHAPTER III. 
OPERATING TOOT Ar?T E^riPHShT 
'The operating room Is really the center of surgical treatment. 
The patient is in the operating room for only an hour r so, 
but whatever is done there my forever affect his life, health and 
happiness. Fov* this reason every available effort shoo be made 
to save time and effort during the operation and reduce the risk 
as far as possible. 
The working In the tperating Division -mould have 
a good understanding of aseptic and antiseptic surgery and above 
all most be a man of great carefulness, conscientious in c.tails. 
As you ramember, vou were told that surgical infaction“ usually 
come from contact with something that is not surgical!- ■; cle-n and 
not from the surrounding air. 
The operating room itself .should be clean and free from dust. 
The floors, celling, windows and doers of an operating room are 
usually so constructed that they rill admit and retain the least 
amount of dust and permit easy cleaning. The room must be dis- 
infected frequently and no dusting must ever be permitted. The 
proper procedure is to mop the floors and wipe the valla with 
cloths moistened In some disinfectant or germicide. 
Ventilation should be adequate but care should be taken that 
there are no draughts. An even temperature from 72°F, to 20°F, 
should be maintained. Although this may seem a bit warm to you 
who have outer clothing, remember that the patimt i.s quiet and 
relaxed, parts of his body exposed and other mart- covered so that 
he may perspire and chilling must be carefully ay. led, Soma cases 
of pneumonia which have developed fed lowing an operation have been 
due, no doubt, to faulty ventilation in the operating “••com during 
the operation. Maintaining the proper humidipy or amount of 
moisture in the air, will make conditions mere pleasan" lor all. 
Equipmentt 
Tho operating table and the large overhead lights are the hue 
about which all activity in the operating room revolve . Various 
types of tables are in use but the ones that can satisfactorily 
bo adjusted to the surgeon’s needs with the least discomfort to 
the patient, is the most efficient. The only way to learn elm- 
workings of an operating table is to work on it >ersou lly. I hope 
that each of you avails himself of the opportunity to become 
thoroughly familiar with tho operating table. Learn the vr . 1 us 
positions required for the different surgical operations and how to 
get tho patient into those positions with the least disturbance to 
him and to the operating team. It is very annoying to the surgeon 
to have someone fiddling around with the operating table instead 
of obtaining the proper position in the shortest amount of time. The artificial light is a very important piece of equipment. 
It should provi.de a maximum of light and a minimum of heat and 
be easily adjustable. Learn too, how to adjust the light. Nothing 
will gripe the surgeon quicker than to have someone inexpertly 
manipulating his light while he is operating. The light should be 
focused in such a way, and protected, that there is no glare 
reaching the eyes cf the operating team. 
There are usually two instrument tables; The larger one for 
reserve and extra instruments, needles, solutions, etc., and the 
smaller one containing the instruments for immediate use. The 
larger table (10 x 3) is placed off to the side of the operating 
team. In this hospital the Technician carries sterile supplies, 
instruments, etc., from the reserve table to the smaller instrument 
table with the aid of sterile "pick-up” forceps. Another technique 
is to have the reserve instrument tabic close enough to the 
operating table that the scrub-nurse can get her own sterile 
reserve instruments and supplies. The smaller table is adjustable 
in height and the top will slip over the table and patient so 
that the instruments are within easy roach of the operating team. 
This table can be adjusted or moved easily any time it is 
necessary to change the position of the patient. 
There is also a moderate sized table (5 x 3) on which are 
placed the sterile gowns and gloves for the operating team. 
There should also be at least two waste basins or pans on 
the floor, preferably in standards on rollers, to receive the soiled 
sponges and towels. It is best to have at least one waste basin 
on either side of the operating table for the convenience of the 
surgeon and his assistants. 
An immersion or ’’splash*1 basin containing sterile water should 
also be placed on each side of the operating table. In this the 
surgeon and his assistants will cleanse their gloved hands of 
blood and fats, etc. These splash basins are usually contained in 
waist-high standards, preferably on wheels, 
A small preparation table is helpful, containing the necessary 
solutions and instruments for preparing the field. This table 
is removed from the operating room as soon as the preparation is 
completed. 
A small table is provided the anesthetist for his small 
amount of equipment. A stool is also provided the anesthetist. 
Adequate cabinet space is provided for wrapped sterile 
supplies and the unsterile supplies such as adhesive, bandages, 
bandage scissors and plaster. 
Low benches varrying in height and length are required for the 
use of the team. The table may not be sufficiently adjustable, the 
patient may be very large, or the surgeon or other members of the 
team may be short, so that one or more will require a bench to 
stand on to make the operative field more accessible for him. 
Cff to one side of the operating room there are usually 
standards to hold the drums in which tov/els, gowns and other supplies 
have been sterilized. These drums are circular metal containers Overhead L ight 
1st Asst. 
2nd Asst.] 
Cabinet 
Anasthet i st 
Inst. Table 
Surgeon 
Scrub Nurse 
Waste Saslnj 
runs 
Anesthet 5 st' si 
Table 
l"aste Basin 
Splash Basin 
Prep. 
Table 
Gowns 
G loves 
Reserve Inst. 
Table 
Technician with a double side in which there are perforations. These 
perforations are open when the drum is in the sterilizers to admit 
the steam, and closed when the drum is removed from the sterilizer, 
by sliding the adjustable side, and keeping the contents sterile. 
When these drums are in use in the operating room, there is a 
lid attachment on the standard which permits opening and closing 
the top on each' drum by means of a foot pedal,' The Technician 
brings the drum from the sterilizer and places it in the standard. 
Before the Operation: 
The operating room and furnishings are not sterilized, but 
are washed at regular intervals and wiped off each morning. After 
certain operations, especially those where streptococcus 
infection is present, the floors, cabinets and other furnishing 
ordinarily left in the room are scrubbed with cresol solution. 
The overhead light is cleaned by the surgical technician every 
morning as it is directly over the operative field and dust can 
filter down especially if the light is adjustable and is moved 
during the operation. The entire fixture, including exposed wiring, 
is cleaned with a cloth moistened with a germicide or disinfectant 
and then dried and polished with a dry cloth. At intervals the 
inside of the light is cleaned to remove the dust collected there, 
which would interfere with the free passage of the light rays. 
The room has been previously cleaned and the Technician 
should check to see that there is no collection of dust on the 
furniture, window' sills or equipment. After the room .has been set 
up for operation, all empty wrappings, containers and other 
unnecessary articles should be removed, 
Th.e setting up of,the various tables is dune before the 
operation. As far as possible the tables for the succeeding 
operations are set up the first thing in the morning to avoid delay 
between operations. (Where instruments have to be used again 
for the next operation, all but a few can be removed when the 
surgeon begins to close the wound so that they can be sterilized 
and ready for the next patient). 
After the Operation: 
Planned cleaning and clearing.of the room will save consider- 
able time: 
1. Tables are stripped, cleaned and dried. 
2. Empty or contaminated articles stacked on nurse’s tables, 
ready to be taken out. 
3. Floor basins emptied into one basin and' this removed. 
A, Used linen placed in the linen hamper which is removed 
from the operating room to a room where the linen can be properly 
sorted and cared for. 
5. Lights are turned off and all electrical apparatus is 
disconnected. 6. Instruments are collected in a pan, put in the sir, md 
washed with running cold water. They may be then autoclaved 
for ten minutes (10), scrubbed, dried and lightly oiled or in some 
hospitals, the autoclaving is omitted, 
7. Sterile and unsterile supplies are checked and 
insufficient or missing articles are replaced. The dates on the 
sterile supplies are checked and those over five (5) days old 
are removed to be resterilized. 
Additional Equipment; 
Besides the standard operating room equipment, special, 
types of operations will require additional equipment. 
Thyroid Cases; In addition to standard equipment, there 
should bo a special thyroid sand bag, long enough -each from 
shoulder to shoulder, and a special ether screen whi permits better 
access to the neck. 
Chest Cases; 'The patient’s position will be such as to prevent 
use of the usual arm restraint so two hand ties are prepared. 
Additional Articles Needed; 
2 large pillows 
2 small pillows 
Medium sized sand bag 
Shoulder brace wit . attachment 
to adjust parallel o table. 
Special ether screen and 
special foot screen. 
Kidney Cases; In addition to standard equipment; 
Universal table shoulder brace 
Kidney back rest 
Crank for kidney break or elevetor 
Two hand ties 
One large pi lie?; 
Two anesthetists rolls 
One long sand bag 
Two small pillows 
.Roll of 2 inch adhesive. 
Orthopedic Cases; The equipment will depend on the region to 
be operated upon, the type of operation and the position required 
for the operation. For the lower extremities, the patient us 
usually horizontal and the sandbags of various sizes are used to 
elevate the field to the necessary height or posit!"' . If it is 
an arm or hand operation, an arm board covered with rubber sheeting 
and pillow case is prepared. If the operation is on the spine, then 
a prone position or a jackknife position is used, and for this are 
needed; Two anesthetist1s rolls 
One larue pillow or additional small pillow 
Two hand ties 
Neurosurgery: No preparation is dene until the patient is 
brought to the anesthetizing room. If it is a head case the hair 
is clipped and the scalp shaved, and the area is sponged v/iiph 
green soap and water and alcohol, 
1 set of sterile scrub basins 
2.packages of sterile sponges 
1 flask of sterile green soap 
1 flask of sterile water 
1 flask of 70$ ethyl alcohol 
2 straight razors 
1 electric,clipper 
1 large floor basin 
The type of table required for neurosurgery will depend on 
the operation, as to whether it is a cerebellar, cerebral, or 
spinal case. The head cases will require a special head rest 
and shoulder braces. Operations utilizing the upright position 
will require a special operating chair or table with a special 
head rest attachment. 
The operating room itself is just one. of the many rooms which 
usually go to make up the Operating Division. In the majority 
of hospitals more than one operating room proper will be found. 
Grouped in the Operating Division in strategic places wo find 
a dressing room for surgeons and a dressing room for nurses and 
one for technicians. In these rooms the street clothes are 
changed for the conventional operating room garb. Close by the 
operating room is the scrub-up room in which the surgeon and his 
assistants and the sterile or scrub nurse cleanse their hands 
preparatory to putting on their sterile gowns and gloves. This 
room contains wash basins, soap containers, sterile brushes and 
caps and masks. The work rooms for the technicians in which all 
linen is wrapped, gloves washed and packed, instruments cleaned 
postoporatively, solutions prepared for sterilization, etc., is 
in the Operating Division, Also contained in this area .is the 
larger Sterilization Room in which most of the supplies are 
rendered aseptic. Each operating room may have a small adjoining 
room containing a small electric water sterilizer or autoclave. 
It is here that resterilization of instruments, rubber drains, 
etc,, can also be accomplished here. 
Larger hospitals have an Anesthetizing Room into which the 
patisnt is brought from his room or ward, Here, away from the 
clatter of instruments and other exciting noises, the patient is 
put to sleep and then transported into the operating room. Some 
men fool that it is unwise to surround the operating room with 
an air of mystery, thus leading the patient to think it is a 
horrible sight and that he cannot be taken there until after he 
is asleep. Feeling that the modern operating room is interesting 
and attractive and a view of it encouraging to the patient, some 
doctors administer the anesthetic in the operating room proper. CHAPTER l\r. 
SURGICAL STERILIZATION 
Sterilization is the destruction of all bacterial life, both 
pathogenic and non—pathogenic. Hot only the vogetat.' forms which 
are easily killed, but the vitality of the spores muse do destroy- 
ed so that there ■will remain no possible chance of immediate or 
remote growth at the seat of the operation* 
The problem of sterilization of surgical instruments and sup- 
plies should resolve itself into one of real sterilization mid not 
of relative sterilization, as commonly practiced, Vo have the 
means at hand now of destroying the most resistant germs and their 
spores, but at times, we grow careless or develop u false sense 
of security because average, but somewhat lax, procedures seen to 
meet average requirements* Adequate equipment should bo o.. hand 
and there must be a definite knowledge of the fundamentals, ‘With- 
out these any sterilizing performance will include an element of 
(longer. rJe should always provide for sterilization that is ade- 
quate for the unusual occasion even at the sacrifice of economy 
and speed. 
Heat in one of its various forms provides the only means of 
actual sterilization. However, other methods of sterilization 
used today are mechanical, chemical and physical. 
Mechanical Cleansing, 
wo mechanical means can absolutely rid a surface of all bac- 
terial life so it should not be called sterilization. However, 
a thorough scrub-with a mild soap or doturgont,' will remove from 
the skin great numbers of the organisms pr jaunt on its surface. 
This procedure is applied to cleanse the operative area, the hands 
and forearms of the surgeon and his assist ns and technicians, 
and occasionally in preparing a recently contaminated wound for 
operative procedures (debridement or wound excision). 
Sterilization by Ghumic il agents 
Chemicals vere the first agents used for destroying bacteria 
in the operating room. The effectiveness of these agents depends 
upon the chemical used and its strength. In many cases they do 
not insure complete sterilization, but merely produce a partial 
or temporary arrest of the ctivity of the bacteria contained on 
thb materials. No doubt there are chemicals which, if maintained 
at proper strength, will servo for sterilization of delicate in- 
struments, but modem aseptic surgery with its emphasis on ; ro- 
ver tion, requires sterilization‘by adequate thermal (boat) methods 
wheneve~ possible. Avoid'chemical sterilization whenever possible. It is new possible to sterilize practically 
all types c.f instruments, previously sterilized in chemicals, 
in a pressure steam sterilizer with no apparent injury, 
A few of the common chemical agents used to sterilize instru- 
ments are listed below: 
1. 10% alcohol (by weight) (SI.5% by volume). Contrary to 
popular belief, 70% alcohol is not a good sterilizing agent. 
2. Cresol - a saponated solution containing 50% Cresol and 
50% soap solution. This solution is dark and sticky and is usually 
mixed with 70% alcohol, using 70 parts of the saponated Cresol 
Sclution and 30 parts, by volume, of 10% alcohol. Instruments 
sterilized in this solution must be washed off in 10% alcohol 
before being used on the body or handled by the sterile personnel. 
Time Limitations: 30 minutes for clean instruments, 
or instruments used in a non-infected "clean” case. This is the 
minimum. 60 minutes for instruments used on an infected or "dirty” 
case. It is better to autoclave these instruments whenever 
possible, IB hours for instruments used in cases of gas gangrene 
or tetanus. The only real safe method of dealing with instruments 
and materials contaminated with the spore-forming bacilli of 
tetanus and gas gangrene, is pressure steam sterilization, 
3. Mercury Oxvcvanide - used in a 1;500 or 1:1000 solution. 
This is the common chemical used by the urologist to "sterilize" 
his cystoscopes, etc. It does not produce complete sterilization, 
but is the best chemical available for the purpose. 
15 minutes is the minimum time required while a 
period of 30 minutes should usually be used, 
A. Phenol (Carbolic Acid) - occasionally used in a 2% to 
5% solution. Time is the same as that given above for Cresol. 
It is occasionally used in the sterilization of sutures, 
5. Bichloride of Mercury (Mercuric Chloride) - is a white 
crystalline substance that gives a clear solution in water. For 
hospital use it is commonly colored with a dye. It is extremely 
poisonous. The tablets in common use contain 0,5 graa of, 
bichloride of mercury. One of these tablets added to a pint 
(500 cc.) of water makes a 1:1000 solution which is a cheap and 
fairly effective antiseptic. Metal instruments are corroded by 
bichloride of mercury. Heat Sterilization 
Man has used heat as a sterilization agent for hundreds of 
■years. It was an ancient custom to pass knives through a flame 
to purify them. Dry heat, in the form of hot air, was an agent 
employed by primitive man for drying food when the o was a great 
abundance and thus preserving it until a time when it became 
scarce and difficult to secure from the natural sources of supply. 
The processes were not even thought of as processes of sterilization; 
but in reality they were the beginnings of our present day 
processes of heat sterilisation. Early workers demonstrated that 
heat, in its various forms, was a very effective agent for 
destroying the bacteria which caused infections and disease. 
Since that time it has been the agent most commonly used, and has 
been applied in the form of the flame,- hot dry air, bow' ng water 
and moist heat or steam, with or without pressure. 
Sterilization by Flame 
The actual flame is the rest effective, but due to its 
destructive properties, is the least used of all the agents "or 
securing surgical sterilization. 
Sterilization by Dry Heat 
Dry heat sterilization is carried out in hot air ovens. It is, 
in fact, sterilization by hot air. Its most common use is in the 
laboratory, for the sterilization of glassware, cotton batting 
and similar materials. This method sterilizes by heat, alone and 
obviously is applicable only to those products which are not 
destroyed by heat. This method also excludes water and any water 
contained in the articles is promptly driven off, as steam. 
Surgical supplies, such as vaseline, oils, bonewax and bulk 
talcum powder, should be sterilized by dry heat, rather than with 
steam under pressure. This statement permits disc, sion, since in 
the majority of hospitals vaseline and oils are sterilized by 
pressure steam with more or less success. The point is that 
bacteria and spores buried in oil or vaseline are shut off from the 
moisture of the steam, end the heat alone absorbed by these pro- 
ducts can never rise in any normal pressure steam sterilizer, to 
a temperature sufficient for dry heat sterilization. The maximum 
temperature of the autoclave should never exceed 250°F,, and at 
this temperature an exposure of many hours would be needed to 
destroy the spores. That greater difficulty is not ex- ..vienced in 
the use of such products, incompletely sterilized,, is accounted for 
in the probability that the substances do not promote.the growth 
of bacteria, and are commonly secured in nearly, If not quite, 
sterile conditions from manufacturers. 
For the above requirements the hot air oven is used in * hich 
the temperature is maintained at 300 - 350°F. for an hour or more. Sterilization by Moist Heat 
Sterilization by racist heat is the method that is now used 
in most hospitals for securing the necessary sterile supplies 
for surgical use. 
Moist heat is more penetrating than ary heat, .not so 
destructive of the materials and substances to be sterilized and 
effectively kills disease-producing bacteria in a very much 
shorter time. It may be applied in the form of; 
1. Boiling water 
2. Freely flowing (atmospheric) steam, 
3. Steam under pressure 
With boiling water and freely flowing steam the temperature 
never rises above 212°F. Much higher temperatures can be secured 
through the agency of steam under pressure. 
Atmospheric Steam Sterilization - this means the un- 
confined (not under pressure"}” steam from boiling water as employed 
in the Arnold sterilizer. It has been repeatedly shown that 
although free steam will destroy all vegetative forms of the 
pathogenic bacteria, some spores will withstand this steam, (never 
greater than 212°F,) for many hours of continuous exposure. 
Obviously for surgical purposes, it has no value. 
°ressure Steam Sterilization - The bacteria destroying 
power of steam is composed of two factors, both of which are 
essential; (1) heat and (2) moisture. Heat is actually the 
destructive factor, but the moisture acts as a necessarv conductor 
for the heat. The presence of this moisture also explains why 
saturated steam is preferable to hot dry air. The steam contains 
moisture, while hot dry air drives off moisture and dehydrates 
the material. 
The purpose in using steam under pressure is to develop 
higher temperatures than can be obtained without pressure. 
Pressure of itself has nothing to' do with the destructive factor 
of steam. As pointed out above, unconfined steam, i.e«, steam 
at atmospheric pressure, does not provide complete surgical 
sterilization, so sterilization of surgical supplies is attempted 
only at the higher temperatures of pressure steam. The tem- 
perature range from 2/+0°F, to 254-°F. is considered as adequate 
for good surgical sterilization. 
We cannot readily measure the amount of moisture in steam 
but we can and do measure the temperature of the steam, and that 
is the factor around which the efficiency of the sterilizer hinges 
basically. If the sterilizer is working properly, the temperature 
of the steam is held within certain defined limits by regulation 
of the pressure, but under no circumstances should the pressure factor be used as the gauge of sterilization. because it does 
net always felloe that adequate sterilising temperatures will 
result from pressures represented to be adequate. 
How Penetration of ftearn. Occurs - all sur. '.cal 
materials to be sterilised should be classified as e ..thor porous 
or nen-porous. of the former would be gauze, muslin 
covers and drapes and surgical gems•' Surgical instalments and 
metal utensils are good examples cf non-perous articles. Briefly, 
steam sterilization Implies for all porous substances, com leto 
penetration and permeation v/ith steam, or for non-porous 
sub stances, actual Msurface contact11 with steam. 
Steam heats anyth!n y. that it contacts by a process of 
condensation in which moisture is left in or on the materials, 
exactly equivalent In quantity to the amount of the heat 
absorbed from the steam* If net obstructed by air, contained 
in the sterilising chamber, the entire mass will heat to the 
temperature of the steam. If the steam is obstructed by air, 
serious handicaps to sterilisation will arise. Host of the 
failures of an autoclave to turn out sterile materials are 
usually due to incomplete expulsion of air from the sterilizing 
chamber. No two substances can occupy the same space at the 
same time, so the air must be pushed out before the steam can 
occupy its place. Air Is contained in the chamber, between the 
packs and inside the packs themselves. All air must be expelled 
before steam can occupy its place and penetrate o the center of 
the pack. 
The oresonce of air in the sterilizing chamber will 
prevent the temperature In the chamber from reaching that degree 
of heat which corresponds to the steam pressure indicated by the 
pressure gauge, When air and steam occupy the same chamber, the 
total pressure in the chamber is equal to the sum cf the partial 
pressures cf both the steam and air present - but, the temperature 
will correspond to the partial pressure of the steam only. 
Total pressure = steam pressure + air pressure. 
Total temperature .s temperature correeending tc 
steam pressure only. 
For example, if all air is not removed from the 
sterilizing chamber and steam is allowed to enter it, until the 
pressure gauge registers IB pounds (figure given in books as 
adequate pressure for sterilizing), this 18 pounds of pressure 
is not all steam pressure, but that 6 pounds are due to tl- air 
present and that 12 pounds are produced by the steam. The tem- 
perature then would correspond, in proportion, to the; 12 pounds 
of steam pressure and would be inadequate for surgical steriliza- 
tion, This proves the mistake of depending upon pressure as a. 
criterion for sterilization, rather than temperature. The 
sterilizing effect of the steam and the period cf exposure are 
based upon the attainment cf adequate sterilizing temper?tune 
in the coolest part of the chamber. LONGITUDINAL SECTION OF MODERN STERILIZER. STEAM IS DELIVERED FROM 
THE SOURCE TO THE STEAM JACKET, THROUGH A PRESSURE REGULATOR WHICH 
AUTOMATICALLY MAINTAINS THE DESIRED RANGE, THE SAME PRINCIPLE APPLIES 
FOR STEAM HEAT (AS INDICATED; OR FOR GAS OR ELECTRICALLY HEATED 
STERILIZERS. The. actual temperatures attained in the pressure steam 
sterilizer under ordinary conditions of pro per and improper 
usage aro given in the following table 
TABLS I. 
Temperatures with Various Amounts of Air Discharge 
— 
Gauge Pressure 
Pure Gteans 
2/3 ’ s Air Dis- 11/2. Air lia-r 
V.o Air 
in bounds 'Complete AJ.rj charged (20H 
charm '' (I5f{ 
Discharged 
— 
D.i sobarrs 
] 
vac 
j ...J 
m&S F4MST 
£ 
! 220°F. 
212°?. 
202°F, 
162°F. 
10 
i 240 
228 
220 
193 
15 
! 250 
240 
234 
212 
20 
1 259 
250 
245 
228 
25 
! 267 
259 
254 
240 
30 
j 275 
267 
263 
u— 
250 
The pressure steam sterilizer consists essentially of an 
outer metal cylinder and an .inner metal cylinder forming a -team 
jacket,the whole closed with a tight-fitting door. It is rovided 
with pressure gauges, an operating valve, a safety cr ’’pop ff” 
valve, a thermometer, thermostatic valve, an exhaust line with 
a waste trap, a steam supply system, with a pressure regulator, 
and g removable tray for loading, (See diagram of Pressure 
Steam Sterilizer) 
With the modern temperature controlled pressure steam 
sterilizer, the air is evacuated by the gravity method. The steam 
may be supplied from a central point as in our larged fixed 
hospitals, or by water heated to the boiling point by a gasoline 
stove, provided to field outfits, When the steam is admitted to 
the chamber, after the steam jacket has been pre-heated, the air, 
being twice as heavy, will gravitate to the lower areas. The 
steam floats to the top of the chamber, and net readily mixing 
with air, exerts a blanketing effect to compress ’’a.a air downward, 
'fhe flow of steam is also always downward. The . . continues to 
flow from the bottom screened outlet of the inner chamber, through 
the thermometer chamber and the thermostatic valve to the vent, 
until hot steam finally follows the air and causes the thermostatic 
valve to close> Thereafter, the thermostatic valve will only open 
briefly to discharge cooler condensate and air pcckoto-as they 
gravitate from the contained supplies to it. Mjthcd of Operating su.ro Steam StGrilizatj.cn!! 
1. Clecu out the strainer on the inside of the sterilizer 
at the entrance to th- discharge outlet. Remove all lint, 
shreds of cotton and sediment until the pores of the screen 
are open, 
2. Turn on heat and secure jacket pressure of 15-17 
pounds. Place load in sterilizer, close and lock door, 
3. ,?rith jacket pressure 15-17 pounds, turn operating 
valve to "sterilize" - admit steam to the sterilizing chamber. 
If the discharge system is unrestricted, the temperature 
shown by the indicating thermometer (and the recording thermo- 
meter, if one is used) should advance gradually to 25C-254-°F, 
Timing of the period of exposure can safely be made as soon as 
this temperature has advanced to 24-0f;F, The interval of time 
needed to build up to this temperature should be about 2-4- 
mi nut es . This temperature sail never be attained unless the 
discharge system is sufficiently free for the evacuation of 
essentially all air. 
If the temperature does not advance to 24-0 degrees 
within a period of 2-4- minutes, the sluggish action may be duo to 
a partial clogging of the screen in the entrance to the discharge 
outlet in the bottom of the sterilizer. If this screen is 
clear, then there will usually be found a sticky mass of sediment 
mixed with glucose or vaseline, which has accumulated in the 
thermostatic valve, which should, of course, be cleaned out. 
This sort of stoppage should occur only at long intervals. The 
sluggish action may be due to a fatigued condition of the 
thermostatic valve, in which case the valve element should be 
renewed, or a new valve substituted. 
If the temperature does not advance to 24-0 degrees at 
all, that is definite indication of a badly clogged discharge 
line, or the fault may be found in a defective thermostatic 
valve. Under no condition should attempt be made to use the 
sterilizer at all, unless the discharge line temperature has 
advanced to 24-0 degrees before timing the period of exposure. 
If the discharge line temperature'advances barely to 
24-0 degrees F. when the pressure is maintained at 15-17 pounds, 
check first the accuracy of the chamber pressure gauge. If this 
seems to be correct, the interruption will probably be due to a 
faulty thermostatic valve - one of those which closes off too 
soon. It should bo promptly replaced. Temperatures should 
advance within 4--F minutes to approximately 250-254- degrees F. 4. Time the period of exposure when the thermometer 
indicates 240°F. Check this point with the mercury thermometer, 
then the recording thermometer, if.one is provided. Care should 
be taken to regulate the heat control sc that the jacket pressure 
is dependably maintained at 15-17 pounds throughout the 
sterilizing period, 
5. The Recommended Periods of Exposure will be 
discussed in the next chapter. 
6. At close of period of exposure for all materials 
except solutions (do not turn off heat until goods are ready to 
remove from chamber), turn operating valve to exhaust chamber 
pressure. ’dien chamber gauge shows" zero pressur e turn operating 
valve to ’’vacuum” position for 3 minutes, then n operating 
valve to "off” and open vacuum breaker valve, (Some sterilizers 
automatically control breaking of vacuum when the operating 
valve is turned to "off”). As soon as the chamber gauge shows 
zero pressure, unlock the door but do not open it, merely loosen 
it slightly - just enough to permit vapor to escape. Leave the 
doer ’’CRACKED” in this manner for 5 minutes for light lr ids, 
or 10 minutes for heavy loads. Than open the door and remove the 
goods. The heat may now be turned off unless another lead is 
to be sterilized at once, 
7. At close of period of exposure for all solutions, 
leave the operating valve at ’’sterilize” just as during t' e period 
of exposure. Turn off all heat. Wait until the chamber gauge 
shows zero pressure. Then only, open door and remove flasks. 
Limitations and ’’Period of Exposure” - the period of 
exposure should be timed as beginning when the thermometer registers 
240°F. Actually the temperature in the chamber is about 5° higher 
for the thermometer is at the coolest place in the system - the 
discharge line. 
The one regulation range for every surgical sterilization 
performance is fixed at 250-254cF, maximum temperature, as 
indicated by the thermometer. 
The above temperatures (250-254°F.) correspond to 15-17 
pounds actual steam pressure. These pressures should, bo auto- 
matically maintained. Tbs interest of the operator should be 
centered on the maintenance of the temperature as measured by 
the thermometer (’’discharge line temperature”) which is indicative 
of the two essential factors* (1) that the air d* charge system 
(outflow) is or is not functioning properly; (2 easurement of 
the temperature of positively the coldest medium surrounding the 
load (materials in chamber) - and keeping that temperature within, 
the prescribed safe range. Care of Pressure Steam Sterilizer - A thorough 
inspection of all gauges and valves should be made by the 
Engineer of the hospital at regular intervals, to keep all 
sterilizing accessories working at their highest efficiency. 
Steam pressure gauge should be' gauged occasionally against the 
standard gauge for the gauge that is known to register steam 
pressure correctly. If they are found to be registering in- 
correctly they should be repaired immediately or replaced with 
new gauges. The Pop Valves should always be checked against 
steam gauges that are in good condition. They should be set to 
blow off at a steam pressure of 20 to 22 pounds. Any adjustments 
of thy Fop Valves should be made by an Engineer, These 
precautions must be taken, otherwise a situation is likely to 
be created that may endanger the safety of those operating and 
working near the sterilizer. Such care and attention will 
contribute greatly to the satisfactory service rendered by the 
sterilizing equipment of any hospital. 
The usual cause for interruption to the thermostatic 
controlled pressure steam sterilization has been found to be the 
clogging of the discharge line with sediments, A thin film of 
fine shreds of cotton over a screened surface will shut off 
almost completely the flow of air. Some provision should be made 
to prevent clogging at some inaccessible point such as the opening 
of the thermostatic valve. A large, fine meshed screen should be 
placed on the inside of the sterilizer. This can be easily taken 
out without tools and cleaned daily. Should the thermometer 
fail to indicate the desired range of temperature, when proper 
pressure is applied, that will show the operator that the cleanout 
screen needs cleaning. This is done immediately. It also may 
mean that the thermostatic valve has frozen shut or is broken. 
In any event, failure to attain the prescribed temperature 
indicates a fault which must be fixed before attempting surgical 
sterilization. 
Sterilization Detectors - (Diack Controls) - when an 
apparently normal performance of a pressure steam sterilizer 
fails to produce sterile results, the trouble may be traced 
usually to one or more of three sources, (1) faulty performance 
of the machine5 (2) careless handling of the machine? (3) care- 
less preparation and leading of materials. The use of in- 
completely sterilized goods will endanger patients’ lives, so 
the defect must be detected before the goods are used. 
The most practical and safest form of sterilization 
detector is the Diack Control. It consists of a tablet of 
chemical substance, hermatically sealed (air driven off) in a 
very small glass tube. It is not subject to any change whatsoever. 
except temperature. The tablet fuses, or melts - changes shape - 
if exposed to temperature of 250°F. for 2.8 to 3.2 minutes, or 
at 2A6°F. for 27 to 35 minutes. At 2A2°F, it was not found 
melted after 150 minutes of exposure. These characteristics assure 
safe surgical sterilization - in the area of the chamber in which 
the control is located. The coolest section of any sterilizer is always the 
lowest area, and the hardest part of the load for the steam to 
penetrate is the dense center part of the most tightly wrapped 
package located on the bottom of the sterilizer. This then should 
be the location of your sterilization detector. If the sterilizer 
is air-clogged and not working properly, the difference in 
temperature between the top and the bottom of a uniform load can 
easily be 50 degrees; or the difference in temperature between the 
outside covering of a heavy pack and the center c that pack may 
be as much as 50 degrees for a prolonged period cl time. 
Routinely, the Diack Control should be placed in the 
center of the largest pack In the load. The attached thread of the 
control should be conducted cut through the cover so that the 
control can be withdrawn after a known period of exposure without 
contaminating the contents or disturbing the wrapper. Place the 
pack on the bottom of the sterilizer near the center of the machine. 
Inspect the control immediately before any of the load 
is taken away. If the control is not fused (melted), cmething 
definitely has gone wrong. The trouble can and must be traced - 
usually to one or more of the three sources of difficulty stated 
above. Of course, the entire load should be resterilized and 
checked by a fresh control. The Diack Control has been frequently 
checked and always proved efficient so it is not fair to assume 
that it is faulty if it fails to fuse. Look elsewhere for la 
cause of the poor performance. 
The Boiling Method 
Boiling water is the simplest method of surgical sterilization 
and used chiefly for sterilizing instruments (except those with 
lenses), metal utensils and enamelware. Sodium Carbonate (1%) 
may be used in the water to prevent rusting and corrosion, and it 
also is said to raise the boiling point of water (212°F.) about 
5°F. 
Physical Means of Sterilization 
■ The most recent method for sterilization has ultra- 
violet light. Ultraviolet lights are placed abov the operating 
table in an attempt to sterilize the air and thus ensure a 
completely sterile environment. CHAPTER V. 
THE PREPARATION AND STERILIZATION OF SURGICAL SUPPLIES 
The preparation of surgical supplies and their sterilization 
is carried out in the operating division. The two procedures may 
be done in a Central Supply Room, or in separate rooms; ?;orlr room 
and sterilizing room. The preparation of gauze for sponges and 
dressings, their wrapping and storing following sterilization; 
also the proper assembling,.wrapping for sterilization and storage 
of special equipment (intravenous sets, etc,)-and storage of special 
equipment for emergency use is performed in the supply or ’’work 
room”. Also, the wrapping of gowns, gloves, drapes and utensils 
is done in this room. 
As much of the technician's work involves procedures carried 
out in the work room and sterilizing room, ho must be familiar 
with (1) the preparation of materials for sterilization; (2) 
recommended periods of exposure, and (3) methods of loading the 
pressure steam sterilizer. 
The efficiency of the newer thermostatic controlled steri- 
lizers can be maintained at one hundred per cent efficiency, if the 
simple operating directions are followed (Chap,IV.). However, strict 
attention must be paid to the details of the proper preparation of 
materials and the loading of these materials in the chamber;otherwise 
the most* highly efficient machine will lose much of its value, If 
the character of the load and its arrangement in the sterilizer 
is uniform, a known safe exposure period can be prescribed, but if 
the methods are not uniform and not in accord with correct principles 
then every changing lead becomes another problem. 
In the pressure steam sterilizer the movement of air cut of 
packs and the penetration of steam which follows, always occurs in 
a downward direction, since air is more than twice heavier than 
steam. There is no sidewise movement of the air and steam in the 
chamber after pressure has been developed, (Chap.IV.), These facts 
greatly influence the methods of wrapping packages and arranging 
them in the sterilizer. The load must be arranged so every ad- 
vantage can be taken of the downward flow of steam, Plr.ce all goods 
in the chamber so that if they contained water or were saturated 
with water, it could easily drain out. This means that flat packs 
of gowns, sheets and towels just the same as the enamelware iar, 
should rest on edge in the chamber, not flat side down. If there 
are many flat packs in the load, they should never be compressed to- 
gether. That merely handicaps the sterilizer. Arrange ever-v dense 
pack so that there is some steam space between it and adjacent packs. 
P-ACKAGES MADE UP OF MANY LAVERS 
OF DENSE FABRIC SUCH AS TABLE COVERS, 
SHEETS, GO’ NS, SHOULD ALV-AYS SE 
PLACED IN STERILIZER ON EDGE TO 
PERMIT RAPID DOWNWARD PASSAGE OF 
AIR FROM THE PACKAGE AMD THE 
CORRESPONDING ENTRANCE OF STEAM. 
THE ARROWS INDICATE HOW PENE- 
TRATION OCCURS OR IS RESISTED. 
'"rong 
Right Table Covers, Gowns, Drape Sheets and Laparotomy Sheets,etc. 
Table Covers (or shoots): used to cover over the tables in 
the op. rating room. It is usually of heavy muslin 103" x 72" 
and in preparation is folded twice on itself, tf ako four 
thicknesses (5411 x 3^u). 
Drape sheets are muslin sheets about 108" x 72" and are 
used in draping the patient for the operation. To prepare it 
for sterilization, it is first folded upon itself crossways 
making two thicknesses 54" x 72", and is then fan-folded in 
twu directions, as shown below: 
Laparotomy Sheets: 
1. Large: muslin shoot 108" x 72". a strip of muslin 
12M x 72" is sown across the sheet 3D’r from one end. Then an 
opening 4" x 8" is ma.de in the center of the muslin strip.' 
For sterilisation the large laparotomy sheet is 
fan-folded in.a manner described below: Strip No, 2 is brought directly over Strip Ho, 1, Ho, 4 
over No, 3> thus ending up with Ho, 5 on top, °trip Ho, 6 is then 
folded over No. 5, No, B over No, 7 and Ho, 10 over Ho, 9. 
This results in a long narrow strip 'with the opening on the bottom. 
Strip Ho, 2 is folded over No, 1, No, /+ over No, 3, No, 6 
over No. 5 and No. 8 over No, 7, The article is now ready for Trap- 
ping or placing in a drum, 
2, Laparotomy sheet - small - two thicknesses of muslin 
36" x 36” in the center of which is an opening 2n x 2”, These are 
folded in a manner similar to the large lap sheet. 
Operating Gowns 8 these are usually of a standard type in the 
Army and are worn by all the operating team. 
The gown is first inspected to sou if it contains any 
holes, if all the ties are present and if the gauntlets are in 
place. 
Folding of gown for sterilisation: The technician's 
hands are placed in the arm holes and the two shoulder seams are 
brought together. Then the portion of the gown draped over the 
left hand is inverted over the right hand, thus making the gown 
turn in-sido-out, The gown is then folded once on itself length- 
wise, Starting at the neckband the gown is fan-folded, making a 
rectangular package. All ties are well tucked in. 
Towels: May be of either regular toweling but may be of 
muslin IB” x 9”. Folded crosstd.se and cross'vise again for sterili- 
zation. 
Surgical Dressings: Surgical dressings are made from gauze, 
cotton flannel, linen, etc. They may be purchased already made 
up or be made by the technician in the supply room. 
1, Flat gauze dressings or sponges commonly called flats 
are of various sizes, 2" x 2", A" x An and A” x B" and are usually 
of from 6 to 8 thicknesses of gauze. All raw edges are turned in, 
2, Larger flats may bo rolled into a ball and termed a "fluff*1, 
3, Abdominal "tapes" (taped sponges), packs or sponges are 
used within the abdominal cavity, particularly for "packing-off" 
vdth intestines, etc,, from the operative sito. They are usually 
made of 8 thicknesses of plain gauze with all the raw edges turned 
in and sewed. To avoid leaving them in the abdomen, a tape is 
sown to one corner and to this a metal ring is secured. The usual 
sizes are 6" x 18", A" x 18" and 12" x 12".  4-, Abdominal pads are made of absorbent cotton trapped in 
an outer covering of gauze. The common sites of pads are 8” x 
10” and 12" x 16”. They are used in wound dressings, particu- 
larly of the abdomen, for coverage, absorbing fluids and 
protection from pressure. 
Table covers, gowns, drapes, sheets, towels, pillow cases 
and surgical dressings may be wrapped in muslin or placed in a 
drum container for sterilization. 
If muslin is used, remember to use two thicknesses. The 
double thickness cover offers no considerable resistance to the 
escape of air or the intake of steam, and is amply protective. 
More than two thicknesses for covers is unnecessary. Canvas 
should never be used as a cover or for lining a "drum”, as it is 
very tightly woven and will seriously retard sterilization. The 
method of wrapping should eliminate any opportunity for loose 
ends to work out in ordinary, handling, so that any part of the 
contents is exposed, pack also should be wrapped in such a 
manner that it can be easily opened without contaminating any of 
its contents. Do not wrap dense materials too tightlyJ 
WRAPPING OF PACKAGE WITH DOUBLE THICKNESS OF MUSLIN As stated above, gowns, sheets, covers, ete., should be 
fan-folded into rectangular pads rather than rv -led, These 
articles are made from fairly dense, tightly woven fabrics 
through which air and steam can be dissipated rather slowly. 
If rolled into a tight mass there is danger of trapping air in 
the inner folds. Folded flat, it is always easy to stack the 
packs on edge in order for the air to be evacuated. If there 
are a number of flat packages of dense materials to be sterilised 
in one load, stack them in the sterilizer on the tray in the 
bottom, on edge. Put the lighter, more porous packages (gauze, 
etc.) in the top of the chamber. 
A. Heavy dense packages of flat 
materials on edge in the bottom 
of the steri1 izer. 
(underwood) 
B. Wrong method of loading 
ster!1i zer. 
(UNDERWOOD) Gauze sponges, or pads of gauze in any form are easily 
sterilized. Gauze is so loosely woven that in large masses and 
considerably compressed, it offers very little resistance to the 
escape of air and the entrance of steam. In loading sterilizers, 
it is desirable to use packages of this kind with which to separate 
unusually heavy masses of gowns, sheets and the like. 
Do not permit the use of abnormally heavy or dense packs. 
The practice of using large, dense bundles, involves too many 
hazards. The largest pack should not exceed 12n x 12n x IB” or 20” 
in size for routine work,' 
Avoid crowding materials in the sterilizer. In the ordinary 
load of loose packages, those not carried in drums, there will 
usually be found a mixed variety of heavy dense packs of gowns, 
sheets, drapes, etc., and smaller packages of light and very porous 
materials. A system must be followed each time and when the 
chamber has been filled in this manner, do not crowd in any more 
packs. 
Place the large, flat packs on edge at the bottom of the 
chamber. Thin flat packs can be crowded together quite compactly. 
The larger packs can be separated from each other by loosely woven 
packs of gauze, etc. Leave plenty of open spaces through the load 
so that steam can circulate to all parts freely. No pack, not 
even a light one, should be in actual tight contact with the top 
wall of the chamber. A flat pack should not be in contact with 
the side walls of the sterilizer because it will be pocketed against 
steam contact except as the steam is admitted from other surfaces. 
A. Open end of sterilizing 
chamber. The heavy packs, 
placed on edge are separated 
by light packs of loose 
material. (UNDERWOOD) 
B. Longitudinal section of the 
loaded chamber, (ULDERV‘000) Drums or Containers - the drum may be utilized to sterilize 
most of the drapes, sheets, towels, etc. needed for an 
operation, A sample list is given below; 
1. The "ABD » Drum 
a. One (1) drum lining. 
b. One (1) large laparotomy sheet. 
c. One (1) spinal sheet (small lap sheet), 
d. Two (2) drape sheets. 
e. Twenty (20) hand towels. 
f. Two (2) skin towels. 
g. One (1) bath towel. 
h. Tjuo (2) large abdominal sponges. 
i. Six (6) small abdominal sponges. 
j. Twenty-four (24) 4” x 4M flat gauze sponges. 
k. Four (4) pillow cases (or covers for small instru- 
ment table), 
l. One (1) Diack control placed in center of packed drum., 
m. One (1) table cover. 
The lining of the drum should be of double thickness muslin 
in the shape of a bag, closed at the bottom and with sides about 
ten inches deeper than the drum. Folding over the extended top 
eliminates danger of contamination in handling and provides a 
convenient method of safeguarding the handling of sterile 
materials from the drum (edges brought down over drum edges), 
• The articles are placed in the drum in the rder listed, in 
such a manner as to take advantage of the down, *d flow of the 
steam. Tight packing, stuffing of the drum with mors material 
than it is intended to hold, handicaps sterilisation seriously 
and may double the exposure period. Flat materials should be 
laid in the drum flat side down - never rolled. Dense fabrics 
should not be compressed against the sides so as to shut off the 
port holes. Place the rectangular folded sheets., cover, towels, 
etc., in the center of the drum and fill in.the side with gauze 
sponges or other light porous substances. 
Drums are placed on edge in the sterilizer, th open-port 
holes in the side walls facilitating the discharge of air from 
the bottom and the intake of steam at top. When the drum is to 
be removed from the sterilizer, the portholes are closed to 
prevent the intake of dust-laden air. None are absolutely 
dust proof, however. *. 
be of double thickness muslin 
DRUMS 
A. Wrong method of placing drum in 
chamber. Air is pocketed in 
drum if it is placed flat side 
down. (UNDERWOOD) 
B. Right method. Steam 
wil1 circulate freely 
through a drum 
lying on edge, 
(underwood) Paper wrappers, heavy paper bags or Kraft wrapping paper, 
may be used to enclose certain supplies, such as gauze, sponges 
and cotton pledgets used on the ward. However, general 
surgical supplies should not be wrapped in paper because it is 
so easily ruptured. 
Enamelware - Jars with loose fitting covers - these Jars 
are used mainly for containing gauze strios or cotton pledgets 
or other light surgical supplies. Always place these jars on 
edge for in the upright position all air contained will be 
pocketed and effective sterilization will not result. The 
covers of all the jars should be loose fitting and if screw 
covers are used, they must be loosened up in the sterilizer. 
Some type of cover must be used to prevent contamination when the 
load is removed. 
Tie the covers on loosely with a muslin cover or piece of 
gauze and place the jars always on their sides. In this 
position the air will gravitate out and the steam will enter 
freely, as indicated by the figure below. 
ENAMELR'ARE JARS 
(UNDER’,7 00 
Wrong 
Right 
Rubber Table Covers or Drapes - These are probably the 
most difficult materials to sterilize found in the surgery. If 
at all possible, refrain from the use of rubber drapes. The 
problem here is to prevent air from being pocketed in the center 
folds and in getting steam to these points. 
They should be folded once on the narrow dimension with 
the surfaces inside the fold, well separated by a muslin 
covered cotton pad about half an inch thick. Then insert the 
folded, sheet in a double thickness muslin bag long enough to 
contain the full length of the sheet, with ample margin at 
the open end for a folded closure. Roll the package loosely 
and place it in the sterilizer on top of all other packages 
to avoid any compression. Recommended of Exposure - (For bulk supplies, such 
as gowns, sheets, towels, various dressings and drums th t are 
loosely opeked). 
If the packs are kept within defined limits as to size, 
if the wrappers are made from muslin and only two thicknesses 
are used, if the load is placed in the sterilizer properly, there 
is no occasion to continue the exposure period beyond thirty 
(30) minutes, - starting the timing at 240°F,, with a maximum 
temperature of 254°F, If it takes longer than 30 minutes to 
sterilize a pack, for routine work, the pack is too large. Fully 
packed drums should be exposed for 4-5 minutes. 
Vaseline, bulk talcum powder and bonewax - these should be 
sent to the laboratory and sterilized in the hot air oven for one 
hour at 300° - 350°F. 
Rubber Gloves - cleaning and sterilization- 
1. Inspect for holes, tears, etc, 
2. Wash thoroughly with warm water and tincture of green 
soap. 
3. Rinse thoroughly in warm 'water, 
4. Immerse in boiling water for 3 minutes, 
5. Fry thoroughly in warm, dry air on a glove rack, 3e 
sure that every part of the inside of the glove is rry, 
6. Sprinkle thoroughly inside and out with taZ -.um, 
7. Insert in each glove, at the palm, a small wad of gauze 
impregnated with talcum for the surgeon’s use,. This pad extends 
as far as, but net into, the fingers. 
8. Turn back the wrist of the glove about 2” ovsr a thin 
pad of gauze, 
9. A pair of gloves is then nlaced in a roomy doubZ. muslin 
pack which is made like a billfold, with a pocket for one glove 
on either side of the median line. The glove is placed longi- 
tudinal with little finger closest to opening of pocket. The 
end of each opening of the pocket should be sewed up for a space 
of 1 l/2” to protect against contaminating contacts at the ends 
in handling. 
10, Tie strings should be provided at each end of the pack. 
Rubber gloves in double 
thickness muslin wrapper. An instrument sterilizer tray serves as an excellent 
container for packs of rubber gloves which should always be placed 
on edge, as indicated in the previous diagram. Gloves should 
always be sterilized by themselves to avoid tightly massed 
packing. 
Fifteen (15) to twenty (20) minutes exposure to 24-0°- 250° F., 
with the pressure maintained at 15-17 pounds, is recommended. 
Longer periods or higher temperatures cannot be tolerated by 
the gloves. 
Packs of rubber gloves set 
In a large instrument 
tray. 
Sterilization of Utensils: 
Utensils are made usually of enameled iron or some non- 
corrosive material, so that there is no danger of rusting. 
Utensils may be boiled for 20-30 minutes, but this method 
deposits scale, leaving the surface appearing dirty. A better 
method is pressure steam sterilization. Each utensil should be 
wrapped individually or nested with muslin between each article 
in double thickness. The muslin covers permit safe storage and 
transportation. 
Each utensil (or rest of utensils) should be turned on its 
side so that any water contained in it will all drain cut. Avoid 
placing utensils above the supplies. Preferably, sterilize 
utensils by themselves for an exposure period of fifteen (15) 
minutes to 20 minutes. If it is more convenient, they can be 
sterilised with the dressings, drapes, etc., for thirty (30) 
minutes. Single utensils in double muslin covers.only require 
10 minutes exposure. 
Sterilization of Rubber Tubing; 
Adhering to the general rule for sterilization, if the tubing 
is so arranged in the sterilizer that any water contained in it 
would all flow out, then air will similarly flow out and steam 
will immediately take its place. Avoid any compression of the 
tubing. 
The tubing may be wrapped loosely around a towel rolled into 
a cylinder and fastened (without pinching) with safety pins. 
The sterilizing temperature should range between 24-0 and 250°F. 
and the period of exposure should not exceed 15 minutes. 15 to 
17 pounds of pressure should be automatically maintained. Sterilization of Suture and Ligature Materials? 
Suture - a surgical stitch or seam. Used loosely, it refers 
to the materials used in suturing. It is placed with the aid of 
a surgical needle. 
Ligature - a thread'or wire for tying a vessel or 
strangulating a part, A needle is not used in placin'/ a ligature. 
Suture-ligature - a hemostatic suture. 
There are two principal kinds of sutures and ligatures, 
absorbable and non-absorbable. An absorbable suture or ligature 
is one which becomes dissolved in the body fluids and disappears 
in a certain length of time. A non-abscrbable suture will not 
dissolve. 
Absorbable Sutures and Ligatures; 
1. Cat gut 
a. 
b. Chromic " ’ ■ • 
Cat gut sutures are made from the submucous coat of the 
intestine of sheep. They are usually used in the deeper 
structures, such as subcutaneous tissue, fascia, muscles, 
peritoneum and1within a cavity. Plain cat gut is sup/osed to last 
from eight to ten days in the tissue. A chromic gut,is prepared 
by treating plain cat gut with a chromic acid preparation. This 
tenders it less vulnerable to the body fluids and chromic gut 
will last from ten to twenty days in the tissue. 
Gut sutures come in various sizes, rang" ; from No, 
000 to 3. 
An atraumatic intestinal suture is a gut suture to which 
a.needle is attached (by the manufacturer) in such a manner that 
the perforation made by the needle is not enlarged by the entrance 
of the suture itself (ordinary .suture is doubled at ewe of needle). 
2. Kangaroo tendon, which is made from the tail of a kangaroo 
is absorbable, but is stronger and heavier than gut and lasts 
about thirty days in the tissue. It comes in fine, medium and 
coarse. Kangaroo tendon is used in the repair of lar , severed 
tendons, recurrent hernias and in bone operations. 
Gut sutures are usually issued in glass tubes which, 
if narked boilable, may be boiled or autoclaved. If marked 
unboilable, they should be first washed well with green soon, and 
soaked in a 5% solution of Phenol for 12 hours. If phenol 
crescl is used, the tubes should be removed from this solution 
and placed in 70% alcohol just prior to the operation. IIon-absorbable Sutures; 
1. Silk, cotton and linen comes in sizes from No* 000 to 
No* 8* Silk and cotton are used extensively in the skin, while 
some surgeons also utilize it in the deeper tissues* These 
materials arc wound loosely on paraffined wooden spools and ex- 
posed for a period of thirty (30) minutes with a maximum temper- 
ature of 250-254UF, If silk sutures are artificially waxed, 
the -wax definitely should be sterilized in the hot air oven for 
one hour at 320CF* 
•Silk, ate., also may be boiled twenty (20) minutes* 
However, this process weakens the material* Only small quantities 
of silk, linen, etc., should be sterilized at one time, as they 
will not stand frequent sterilization, 
2* Silkworm Gut - is made from the small silk gland of the 
silkworm and is non-absorbable. It comes in fine, medium and 
coarse, it is used chiefly in so-called 11 tension’• sutures, which 
are placed to prevent disruption of viscera, t ■> relieve pull along 
the incision line, and the like, Silkworm gut should be submerged 
into distilled water in a suitable vessel rind autoclaved for 30 
minutes at a maximum temperature of 250-254'F* 
Silkworm gut may also be boiled for 30 minutes and then 
stored in a solution of tincture of iodine and glycerine, (70 
parts of tincture of iodine and ,30 parts of glycerine), 
3, Wire - is usually made of an alloy or silver. It can be 
measured into the desired lengths needed for each suture, placed 
in a small paper envelope and autoclaved for 15 minutes at 250- 
254°F. This is the best method, biro may also bo sterilized 
by boiling for 20 minutes or immersing in saponated ere sol for 
30 minutes, and then rinsed in r?0% alcohol before use, 
4, Horsehair - is heavily contaminated with spores and the 
usual autoclaving 'procedure may be inadequate. The sutures should 
be secured from the manufacturer only In the sterile form, A 
common method employed by the manufacturers is to cleanse the hair 
thoroughly and then sterilize with dry heat sterilization (hot air 
oven), 
3* Skin Clips (Michel clips) - these are small sharp-pronged 
metallic clamps of easily bended metal used to hold the skin edges 
of the incision together, in place of silk or cotton. 
The number needed for an operation arc placed on a ,,Un 
shaped piece of wire and autoclaved for ten minutes at 250-2$4°F., 
or boiled for twenty (20) minutes. Nailbrushes. Crangewood sticks and Files; 
First,the brushes should be thoroughly washed. Place 
brushes in a perforated instrument tray, bottom side up, with 
nothing on top but a muslin cover ever the tray. Sterilize 
10 minutes (no more) at a maximum temperature of 240-250°F. 
Brushes can also be boiled for 20 minutes (without compression) 
and kept sterile in a mild solution of saponated cresol* 
Drains: 
Drains may be either tubular or capillary> or e. combination 
of both. Thin latex rubber drains, the so-called Penrose drain, 
and .soft red rubber drains, are the most commonly used of the 
tubular type. Tubular glass drains are still used b; some 
surgeons. . . . 
The Drain (latex) and soft rubber drains, may be boi. ed 
for twenty minutes or autoclaved. To prepare them for tine 
sterilizer, they may be rolled loosely (lengthwise) in gauze 
impregnated with talcum and placed in an open enamelv/are on. 
No two surfaces of the rubber should touch, or it will vu niz«. 
Expose the drains to .a temperature of 240 to 250CF, for fifteen 
minutes (15-17 pounds pressure). 
Gauze drains constitute the most popular and widely used of 
the caciliary type.f 
Plain gauze packing (1" to 3M in width) may be rolled to the 
desired length, wrapped in a double thickness muslin cover and 
autoclaved for 30-minutes at 240 to 250°F. Gauze (l/2H to 1"). 
may also be loosely fan-folded into a jar or test tube and 
sterilized .in the pressure steam sterilizer as above. 
Iodoform gauze; this can be obtained in sterile form 
from the manufacturer, unless the demand be heavy. Iodoform 
powder will not stand sterilization, so it is necessary to .prepare 
this drainage material under strict aseptic technique. The 
technician scrubs, has on cap and mask, sterile > ;n and gloves, 
and uses sterile table drapes. A paste is made the iodoform 
powder and sterile glycerine (hot air oven for one hour at .320°F,), 
and alcohol is added until the paste is dissolved and the 
solution is uniformly yellow. The gauze is wet in sterile water 
and the excess ’wrung dry. Dip the gauze in iodoform solution until 
saturated, and then squeeze out the excess but do not wring dry. 
Place in sterile bottles and seal tightly (cork, with adhesive or 
paraffin). 
Clrarette drains are a combination of the tubular and. capillary 
type. They are' made by surrounding a strip- of gauze :.th latex 
rubber, gutt*i percha, etc., or by placing.a strip of gauze in the 
tubular portion of a hollow Penrose Drain. They are sterilized 
exactly like the open latex or gutta percha tubular drains (Penrose). 
Rubber dam is rolled, loosely with gauze separatin the 
surfaces and sterilized in the pressure steam sterilizer for 15 
minutes at 240 to 250°F. CHAPTER VI. 
THE CARE AND STERILIZATION OF SURGICAL INSTRUMENTS 
There are many different kinds of surgical instruments. 
It is not necessary for you to memorize long lists of instruments. 
The array of instruments displayed in surgical catalogues is 
bewildering and no description is furnished as to their proper 
use. 
Instruments are best studied by means of a simple 
classification. There are five basic types of surgical tools? 
1. Cutting Instruments. 
2. Hemostatic Instruments. 
3. Holding or Retracting Instruments. 
4., Suturing Instruments, 
Each new instrument encountered by the technician should be 
put in its proper place in the above grouping. There is a 
common tendency among surgeons to call instruments by the last 
name of the surgeon who devised or modified the instrument. 
This is a bad, practice and should be forgotten. The Poan, Kelly, 
Locher, Ochsner, Mixter, Crile, Mayo, Halstead, and Garmaldt 
forceps need only be known to the technician a.s varieties of 
hemostatic instruments. Similarly, the technician need not know 
a Hagedorn from an Emmet, Skene, or Keith needle, but it is 
important to know the difference between a cutting and a round- 
pointed needle. 
Cutting Instruments; 
1. Scalpel (operating knife) - an excellent knife is the 
Bard-Barker scalpel which consists of a rustless metal handle 
with detachable blades. Blades are supplied in many shapes 
suitable for various operations. 
2. Scissors - these may be curved or straight, long or 
short, heavy or light, with a sharp or blunt nose, with plain 
or dissecting blades. For general utility, medium-sized 
scissors, straight or curved, with dissecting blades, meet most 
r equi r ement s, 
3. Chisels - used in. operations on bone, 
h. Bone cutting forceps. 
5. Saws and Drills. 
6. Curettes - sharp and dull. This is a kind of scraper 
or spoon for removing growths or other matter from the walls of 
cavities. Hemostatic Instruments (Angiotryptic, or crushing clamps). 
A hemostatic instrument is one used to arrest the flow of 
blood. These instruments are placed on either the cut ends of 
blood vessels or ere placed on the vessel before it is severed 
between the clamps. They are all crushing instrr- onto. A 
ligature or suture ligature of cat gut or silk placed below 
the clamp which is then removed. 
It is not absolutely essential that one be familiar with 
the various types of joints, jaws, curves, and locks which 
constitute the distinguishing characteristics of the hemostatic 
forceps. They are all hinged, crushing Instruments '• ith a self- 
locking device on the handles to prevent the clamp from slipping 
off the bleeding vessel. 
Holding or Retracting Instruments: 
1. Retractors - these are instruments for holding back the 
edges of the wound, "hose may have smooth ends (blunt 
retractors) or claws (sharp retractors), be flexible or non- 
flexible, and self-retaining or ncelf-retaining• 
2. Holding Forceps* 
a. Tissue Forceps - these instruments are used to hold 
the soft tissues while they rre being sutured, 
dissected or excised (cut away). The forceps may bo 
either plain or with teeth (mouse-toothed), Instru- 
ments with teeth are used for general work, because 
of the greater security of their grasp, while only 
plain forceps are employed in handling blood vessels, 
nerves and. similar tissues. 
b. Dressing Forceps - plain forceps, so-called because 
they are used to apply sterile dressings on a wound, 
c. Intestinal holding forceps - spring type* hinged type, 
d. Bone holding forcers - hinged instruments used to 
bold bone while operator is working -a it, 
3. Retracting Clamps - hinged damns used .* the retraction 
of tissues. A clamp with a single tooth is referred to as a 
tenaculum; one with many teeth, as a volsellum. 
Suturing Instrument3*, 
1. Needle Holder - hinged instruments not unlike a large 
hemostatic forcep to hold a curved needle while suturing, 
2. Surgical Needles - these are supplied in marc styles, 
differing in regard to shape, length, type of eye, ana type of tip 
Needles may be cutting or round, straight or curved. 
a. Round needles - a round needle means that the tip is 
round or non-cutting, and not that the needle is round 
or curved in shape. This type of needle is used for 
transfixing tissues, suturing within a wound d 
suturing near vessels. CUTTING INSTRUMENTS 
Scalpel (operating knife) 
with removable blade 
Curette 
Curved Operating Scissors 
(Mlxtor*s) 
Straight Dissecting 
Scissors (kayo's) 
Bandage Scissors 
(li star’s) 
HEMOSTATIC INSTRUMENTS 
Hemostatic Forceps 
Stra ight 
(Rochester-Pean *s) 
Hemostatic Forceps 
T oothed 
(Rocheste^-Ochsne^,s) 
Hemostatic Forceps 
Curved 
(Rochester-Pcan1s) HOLDING AND RETRACTING INSTRUMENTS 
Retractor 
Sherp 
(Schultz’s) 
Holding Forceps 
Dressing Forceps 
Holding Forceps 
Intestinal and Marginal 
Tissue Forceps (Allis’) 
Holding Forceps 
Tissue Forceps 
(KcIi y’s) 
Holding Forceps 
To'.vtl Forceps 
Retractor 
Blunt Malleable 
(Parker’s) 
This retractor nay 
be Jent as the surgeon 
des i res. 
Holding Forceps 
Uterine Tenaculum Forceps (pozzi’s) SUTURING INSTRUMENTS 
Probing Instruments b. Cutting needles - sharp pointed needles used in 
suturing tough tissue such as the skin, 
c. Curved - the full-curved variety is preferable, 
on account of the greeter ease in suturing within 
small deep spaces. 
d. Straight.' 
Probing Instruments: 
1, Probes - the probe is a fine straight malleable 
instrument having a bulb-like tip, 'These probes may be hooked or 
bent at will to aid in following a crooked pathway of a sinus or 
fistula, 
2. Grooved Director - special type of probe, having a 
blunt end and a canal along its long axis. This is used in probing 
an abscess so that pus may flow out along the canal; to guide the 
malleable probe and also to control the pathway and depth of an 
incision, during certain operations performed without direct 
vision-. 
The Dissecting Set - the instrument * reoulred for an 
operation vary according to the nature of the -operation and. the 
surgeon. The following set serves as a foundation from which to 
build for most of the operations, 
1, Two-inch.and one-inch metal ribbon, malleable, blunt 
retractor or spatula. 
2, Two Kelly blunt retractors, different sizes, 
3, Murphy rake sharp retractors (4 and 6 prongs), 
4, Sponge stick of each, 
5, Grooved director, 
6, Ordinary probe. 
7, Right pnd left aneurysm needles, 
8, Berd-Parker knife handle Ho, 4 and To. 20 blade. 
Bard-Parker knife, handle Ho, 3 with Ho. 11 blade, 
9, Straight dissecting (Mayo) scissors 41, of each, 
10, Curved dissecting (Mayo) scissors 41, of each. 
11, Small straight hemostatic forceps (Hemostats) 412, of each, 
12, Ochsner Hemostatic Forceps - large straight, 46, of each, 
13, Curved Kelly Hemostatic Forceps 412, of each, 
14, Towel clips #12, of each, 
15, Medium-sized needle holder of each, 
16, Allis Forceps - (intestinal holding forcers) #8, of each, 
17, Five-inch tissue forceps, 1x2 teeth, 
18, Five-inch smooth tissue forceps. 
19, Heedle kit containing all types of needles (etrright, 
round intestinal, straight cutting, curved round in- 
testinal, curved cutting, Mayo needles), , 
20, Plain cnd chromic cat-gut (0 to silk or Mich-1 
clips fov the skin, 
21, Medicine glasses #3, of each. 
22, Assorted glass syringes and needles, 
■ 23, Laparotomy rings, #12, of each, 
(Special instruments would be added to the dissecting 
set depending, upon the type of operation), Care of Surgical Instruments: 
Wien not in use, instruments should be kept in a dry, fairly 
air-tight cabinet. The cabinet should be in a dry room which is 
free from chemicals. 
After the Operation: Immediately after an operation the 
forceps, retractors and similar metallic instruments are: 
1, Washed well with running cold water to remove any blood 
clots, 
2, Scoured with a powder like Bon Ami, 
3, Sterilized: 
a. Autoclaving. 
b. Boiling. 
c. Chemically, 
4.. Dried carefully, paying particular attention to hinges and 
locked surfaces. Rusting will occur if the instrument is 
exposed to the air when moist, 
5. (This step is optional and not advised by us) Covered with 
a thin film of oil. All traces of oil must be removed from the 
instrument before it is sterilized. 
6. Stored in dry storage cabinet. Surgical needles are 
cleaned, scrubbed with Bon Ami, cleansed with benzene and ether, 
and sharpened, 
7. After use in septic operation: Soiled instruments from 
a septic case may be soaked in 5% saponated cresol solution for 
one hour before being washed, A better procedure, especially if 
the case be one involving the spore-forming bacteria of Tetanus 
or Gas Gangrene, is to bring the soiled instruments directly to 
the autoclave and wash and sterilize them there. They are placed 
in a porcelain or monel metal basin, jointed instruments open, and 
covered with the hottest water available and add 15 cc, (tablet- 
spoonful ) of tri-sodium-phosphate solution or Calgonite or Soilax, 
Place tray in autoclave by itself and expose it for 15 to 20 
minutes at a maximum temperature of 250-254°F. At the close of 
the period of exposure, open up the exhaust and let the pressure 
escape as rapidly as possible. Wait until chamber gauge has shown 
zero pressure for a few minutes before opening door. Remove 
from sterilizer, pour off water and while instruments are still 
wot, wipe them off. No further cleansing is necessary, (Underwood). 
Before the Operation 
1. All oil should be removed from the instrument, 
2. Sterilization of the instruments. Sterilization of Instruments 
At the present time four methods of sterilizing instruments 
are known* Each method has its followers who will loudly swear• 
that It is the best and only proper method to sterilize 
instruments. 'rTe pres ;nt all four, but In booming tores state 
that we believe autoclaving (pressure steam steriliz on) to 
be the best procedure. 
1. The.Bolling Method: Instruments should be boil ' for at 
least twenty minutes, Err emergency sterilization, bn • only with 
the desire of the surgeon, the period of boiling may be reduced 
to ten minutes. Ths period should never be reduced beyon . his 
point, 
Many authorities advocate the use of 1/2 per cent soda 
(rather than plain water) in an effort to reduce the acidity of 
the water and prevent rusting and corrosion. Soda leaves a 
deposit on the instruments which should be wiped off or rinsed 
off in sterile water before use - paving the way for a possible 
break in technique and contamination of the instruments. 
The natural impurities (minerals) in the water deposit 
in the sterilizer end on tho Instruments, This means a thorough 
scouring every time the instruments are washed and even so, the 
deposits are never completely removed from joints and crevices, 
A film remains, difficult to detect which is injurious to sharp 
edges and points. 
2. Oil Sterilization of Instruments: Oil crilization 
should be considered to be a form of dry heat. At the temperature 
commonly employed (300 to 320°?’,) the exposure period should 
continue for a full hour. It has been shewn that spores are killed 
in fifteen minutes at 330 to 34-7°F, but this temperature breaks 
down even the best grades of oil. We do not recommend, .ha oil 
sterilization of instruments. 
3. Chemical Sterilization, of Instruments: Delicate instru- 
ments and sharp or cutting instruments may be ster.il., :• d in 
chemicals with caution. However, for general surgical purposes, 
other means of sterilization are preferable. Seventy per cent 
alcohol, 1:20 phenol, fifty per cent saponated cresol soap.added), 
a Berd-Parker solution (a commercial product), are the chemicals 
commonly employed in sterilization. Bichloride of Mercury and 
other corrosive chemicals should be avoided. 
The instruments should be1 completely submerged in the 
chemical for 3° minutes. Tt is usually a good plan to keep the 
scalpel blades, ate,, in the solution at all times when not in use. 4-. Pressure Steam Sterilization of Instruments; Pressure 
steam sterilization is absolute in a brief period of exposure. 
There is no scale formation on the instruments as in the boiling 
method. Delicate instruments can be sterilized with less damage 
to sharp edges and points, 'Tith instruments there is no 
penetration of the steam. The steam sterilizes by surface contact. 
A muslin cover or towel should be placed in the bottom of 
the instrument tray which supports the first layer of instruments. 
These are covered with muslin supporting the next layer, and so on 
until the tray is filled, with a final muslin cover over all. 
The muslin absorbs the drops of moisture which form on the instru- 
ments after the steam is turned off in the sterilizer, Needles 
can be sewn into a piece of muslin and wrapped. 
The recommended period, of exposure in the autoclave is 
ten minutes with a maximum temperature of from 250 to 254-°F, For 
emergency sterilization the period can be shortened to five 
minutes. Wrapped instruments are exposed 15 to 20 minutes. 
Sham or Cutting Instruments 
Dissecting scissors, scalpels and delicate eye, ear, nose 
and throat instruments fall into this category. 
This type of instrument can be sterilized by chemicals or by 
pressure steam sterilization, 
Bard-Parker solution or a 50$ saponated solution of cresol 
may be used. The instrument should be completely immersed (pre- 
ferably stored) in the solution for thirty minutes as a minimum. 
Sixty minutes is a better time period. As these solutions are 
irritating to the mucus membranes of the nose and also the con- 
junctiva e, the instruments may be placed in 70$ ethyl alcohol 
just before the operation. 
Contrary to popular belief, sharp instruments can be safely 
autoclaved without ruining the cutting edge. The delicate edges or 
points should be protected by cotton or gauze covers to prevent 
mechanical injury, and also to absorb free moisture, which will 
otherwise cling to them and leave tarnish spots. Scalpel blades 
can be placed in a small medicine bottle, protected with cotton, 
the whole wrapped in muslin and sterilized for 15 to 20 minutes at 
maximum temperature of 250 to 254-°F. 
Glass Syringes 
The syringe should be rinsed immediately after using and 
some clean water forced through the needle, 'This is particularly 
true if blood was drawn into the syringe, A stilette (piece of 
wire) is then placed in the needle after making sure that the point 
is in good shape. If not, the needle may be sharpened on a 
whetstone and cleaned with Bon—Ami, followed by benzene and ether. The syringe should be taken apart and the parts washed 
thoroughly. It is then dried and the parts wrapped separately, 
and the whole wrapped in double thickness musl:' , It is then 
exposed to 250-254°F, for 30 minutes, at fiftee: uc seventeen 
(15 - 17) pounds pressure. 
An alternate method is to wrap the syringe in muslin with 
the barrel and plunger separated, and boil it for twenty (20) 
minutes. 
Glass syringes (particularly the hypodermic type) ‘-ay also 
be sterilized with dry heat (hot air oven). 
Glass bulb syringes may be sterilized in a like manner. 
Hypodermic Needles 
Hypodermic needles can be sterilized in an autoclave or in 
the hot air oven. The needle with a stylet in the bore is pieced 
in a special test tube, or protected with cotton, and- stoppered 
with cotton (tightly if hot air oven is used). Sterilize "or 20 
minutes in the autoclave and for 1 hour at 320°F, in the i.ou air 
oven. CHAPTER VII. 
CARE AND STERILIZATION OF SPECIAL 
INSTRUMENTS 
In the foregoing chapter the basic surgical instruments 
were discussed. In addition to these basic instruments many 
special instruments have evolved from the specialization of 
surgery. Among the most complex and important'special surgical 
instruments are the telescopic type. As the name implies, these 
instruments contain a telescope or lens system. All are used 
in examining body cavities and in particular the interior of 
interval hollow organs. Instruments used to the same purpose 
but utilizing direct vision rather than a lens system, are known 
as endoscopic instruments. 
Examples of Telescopic Instruments; 
1, Cystoscope - for examination of bladder, 
2, Thoracoscope - for examination of pleural cavity. 
3. Peritoneoscope - for examination of contents of peri- 
toneal cavity, 
4. Gastroscope - for examination of interior of stomach. 
Ibcamnles of Endoscopic Instnuments; 
1. Bronchoscope - for the examination of interior of 
stomach, 
2. Proctoscope - for examination of the rectum. 
3. Laryngoscope - for examination (direct vision) of the 
larynx (voice box), 
4. Anosccpe - for examination of the anus. 
The telescopic instruments in particular are highly complex 
and contain many details which through lack of attention can 
cause delays and aggravation to the surgeon. Fine-tenths of the 
difficulties encountered in the use of these instruments can 
be eliminated by an active procedure which prescribes careful 
attention to all details involved in the care, handling and 
preparation for use. These details whould be well learned by 
the technician. 
To explain the mechanics and essential elements of a 
telescopic instrument, we will describe the cystoscope. 
Mechanics; within the confines of an instrument, small 
enough to be passed through the urethra to the bladder, there is 
placed a complex arrangement, providing for light, irrigating 
system, vision and operation instruments or electrodes, A complete 
electrical circuit, of which the lamp (bulb) is a part, is present 
in the.tubular portion of the cystoscope. The instruments THE CY'STOSCOPE have to be kept watertight as short and open circuits are almost 
entirely due to moisture leading into the electrical system. 
The technician must be sure the instrument is always kept 
watertight. The delicate lens system or telescope must also 
be kept watertight. 
Essential Elements of a Cystoscope; 
1. Sheath - this is tubular in nature, metallic and usually 
carries the lamp. This part of the instrument is in intimate 
contact ¥/ith the mucus membrane of the urethra and should be 
carefully examined for any rough spots or abrasions. The sheath 
also contains the stop-cocks for the irrigating system* 
2. Obturator - this part occludes the opening (fenestra) in. 
the tubular sheath. The obturator should be placed in the sheath 
and the beak and fenestra examined for any protruding edges or 
sharp contours which would damage the tissues. 
3. Telescope - this telescope is removable and contains an 
ocular (eye-piece), and a Highly complicated optical system 
composed of many lenses and prisms which 'must be handled gently 
and with knowing care. It is through this portion of the 
instrument that the surgeon views the bladder. A convertible 
type of telescope is usually provided which allows the passage of 
one or two ureteral catheters or instruments. 
The utmost care should be used to prevent a confusion of the 
parts belonging to one instrument with those of a similar instru- 
ment. In case an interchange of parts has occurred, no force 
should ever be used to fit corresponding parts together. Confusion 
of this nature can be avoided by carefully grouping all elements 
of one cystoscope together or by placing a distinctive mark on 
the parts. Do not mark the tubular portion of the sheath, 
however. Confine any identification marks to the lock or adjacent 
parts. 
The efficiency of any telescopic instrument depends to a 
large extent on the cystoscopic accessories used with it, A 
thorough knowledge of their working principles is important to 
the technician 
1, Illuminating Current Source 
a. Dry coll battery box, 
b. Transformer - ground free current reducing, 
2, Irrigating -System - water or a mild antiseptic solution 
(2% Boric) is used as an irrigating medium. This is allowed to 
run through the cystoscope, thus dilating the bladder and flatten- 
ing cut its folds, enabling the operator to view its entirety. The system consists of essentially one or two glass 
percolators (jars) and gravity tubing leading to the 
cystoscope, A clamp or stop-cock is usually provided. Two 
percolators connected to a single gravity tube by means 
of a glass ”Y ” tube, insure a more constant supply 
of irrigating media and to a large extent eliminate 
unnecessary delay. 
Preparation of Telescopic Equipment for Use 
An impaired telescopic instrument means mechanical inter- 
ference - distressing to both the patient and t’- surgeon, 
with all the units, cystoscope, irrigator and light system 
properly arranged, it is necessary to test the assembled 
instrument before the examination of the patient is begun. The 
light system is probably most important. The surgeon usually 
checks this system before the instrument is passed to the 
bladder, but if he fails to do so and the light does not work 
properly, with the instrument passed, be assured that the surgeon 
will be mighty angry with the technician responsible, 
1, Steps in testing the light system, 
a. After being certain-that the current regulator on 
the battery box or transformer is set at its lowest 
point, connect the rubber covered cystoscope cord 
to the battery and to the rotating contact on the 
cystoscope, 
b. The regulator is then advanced until the light 
assumes the proper brilliancy. Observe the lamp 
filament closely while increasing the current, when 
the light suddenly changes from a reddish tint to 
white, the limit of safe current has been reached. 
Sterilization of Telescopic Instruments 
Before the proper procedure of sterilization of these 
highly complex instruments is discussed, the following "don’ts” 
are listed to avoid damage to the instrument. ,These statements 
are true for any telescopic instrument, 
1. Don’t boil any part of a telescopic inr'rumont which 
contains lamps or lensss. 
2. Don’t place the instruments in alcohol. This will 
dissolve out the cement around the lens, 
3. Don’t place the instrument in carbolic acid, 
k* Don’t use benzine or ether to clean the lens. 
The sterilization of telescopic instruments can be divided 
into three (3) steps; cleaning -the instruments; immersion in 
the sterilizing solution; sterile storage in a formaldehyde 
vapor cabinet. CYSTOSCOPE SET-UP 
PercoIator 
with Irrigating 
Media, FARTS TO BE EXAMINED (NUMBERED IN THE ORDER OF THEIR 
IMPORTANT) IF CYSTOSCOPE FAILS TO LIGHT PROPERLY. 
(ACMI BULLETIN) 1. Cleaning the Instruments: 
a. After being used, the instruments are dissembled 
and rinsed in cold water, 
b. All parts are thoroughly washed with cotton dipped 
in tincture of green soap, the crevices scrubbed 
with a soft brush, and the interior of the sheath 
swabbed out with green soap or a cotton-tipped 
cleaning rod and Rinsed in running water. This is 
done to remove all oils, lubricating jelly, blood 
or secretions from the instruments, 
c. To remove dried deposits of blood or lubricating 
jelly from the lenses, the end of a toothpick can 
be used. This may be moistened slightly with wa- 
ter - never use alcohol, ether, phenol or benzine, 
d. Be sure to open all stop-cocks during the cleans- 
ing process and see that they remain open during 
the entire sterilization process, 
2. Immersion in the Sterilizing Solution; 
a. Place a towel or any similar resilient material in 
the sterilizing tray to prevent nicks, dents and 
surface abrasions, 
b. Complete immersion of everything needed - obturators, 
telescopes, rubber light cord, rubber tips, etc,, 
in either 1:1000 Mercury Qxycyanide or a 1:3800 
solution of phenylmercurie acetate (Cystan) for 15 
to 30 minutes. Never use an aluminum tray with 
Cystan, Endoscopic tubes and sheaths that do not 
carry lights or lenses, and other metal parts such 
as obturators and stop-cocks, may be sterilized by 
autoclaving or boiling, 
3. Storage in Formaldehyde Vapor: 
a. The instrument should be first cleaned and sterili- 
zed in Cystan, dried carefully and placed in the 
vapor cabinet, 
b. Do not place moist instruments in a formaldehyde 
vapor cabinet, 
c. Initial formalin sterilization (without previous 
immersion in a sterilizing solution) requires 2 hours. 
d. Instruments should be rinsed in sterile water, 
before using, to remove all traces of formaldehyde, 
e. After sterilization in oxycyanide of mercury or 
Cystan, the instruments may be dried carefully and 
placed in a formaldehyde storage cabinet. Caro and Maintenance of Catheters, Sounds and Bougies 
Catheters are tubular surgical instruments for discharging 
fluids from a body cavity or for distending a body passage. 
The word is used more frequently, however, in reference to the 
urethral and ureteral catheters. Urethral catheters, as the 
term implies, are used in the urethra, the passageway from 
the bladder out through the penis. Its commonest uses 
perhaps are? 
1, To obtain a sterile specimen of urine, particularly 
in the female, 
2. To evacuate and' determine the amount •••'* residual urine 
in the male. 
Other uses are (1) instillation of medicines, (2) bladder 
irrigation, (3) determination of the bladder capacity, (4-) 
cystometry; (5) cystography and (6):-continuous bladder drainage. 
Red, soft fubber, latex rubber, metal, v/ov'en silk, impregnated 
with gum and glass, are the materials commonly used in the 
manufacture of urethral catheters. The French scale is usually 
used in grading the size of catheters; the unit of measure being 
l/3 mm. Ex.; a 30 Fr, catheter = 10 mm, in dlamctc-r. Catheters 
are usually manufactured in sizes from No, 10 French to No. 26 
French, 
Red Rubber (India) - red soft rubber catheters are relatively 
inexpensive, durable .and practicable and arc the type, rest 
commonly used at the present. They consist of a hollow cube with 
one funnel-shaped end‘and a laterally (on the side) placed 
eye near the other end, which is closed, and rounded or shaped 
like an olive (olivary). Numerous modifications of this’shape 
have been introduced, 
1. Cleaning; Red rubber (soft) catheters are cleaned 
immediately after use, by rinsing in'cold running water, immers- 
ing in soapy water and then thoroughly washed. The lumen 
(hollow part of the tube) is cleansed by forcing water through 
it with a syringe, 
2, Sterilization; they may bo then sterilized by; 
a. Boiling for at least 5 minutes (net more than 10). 
b. Immersion in IslOOO mercury oxyc.vaiJ.de for 15 
minutes, 
c. Pressure steam (autoclave). 
d. 2 hours in a formalin cabinet (preferably overnight). 
e. Combinations of the preceding. Soft Rubber Urethral Catheter 
Silk Coven Solid Threaded Bougie with Filiform... 
Natural Curve Sound 
Silk Coven Coude (Olive Tip) Catheter 
Silk '.’.oven Bougie Olive Tip 
Urete raI 
Catheter 
Silk Voven Bougie with Acorn Tip Latex Rubber Catheters and Accessories! 
1. Cleaning! latex rubber catheters should be washed 
with cold water and then green soap (scrubbed with a . >ft brush) 
as soon as possible after use. Water should bo forced through 
the lumen with a syringe. 
2, Sterilization! this may be accomplished by: 
a. Pressure Steam. 
(1) 10-15 minutes at 2/+8°F, (15 lbs. pressure) 
for latex articles used in surgical cases. 
(2) 10 minutes at 2A0°F, (10 lbs. pressure) for 
latex articles used in other than surgical 
cases. Rigorous care must be exorcised to 
remove all air from the pressure sterilizer. 
(See Chapter on Surgical Sterilization). 
b. Immersion in mercury oxycyanide for 15 minutes, 
c. Boiling water,, for 15 minutes - the water should 
be boiling before the catheters are immersed, 
Don1ts for Soft Rubber Goods (ACTS) 
Don’t let soft rubber instruments be around in direct or 
diffused sunlight or even in bright artificial light. Keep them 
in a dark place. 
Don’t put heavy articles on them to cause sharp folds. 
Don’t expose to oxidizing agents (chlorine, sodium 
hypochlorite, chloramine, iodine, etc,). 
Don’t leave in any disinfectant solution. 
Don’t expose to oils, fats or greasos. Never use vaseline 
or any other material having an oil base on the articles. 
Don’t let the rubber contact with the bottom of a direct' 
heated vessel or heating unit during boiling, as it nay, in places, 
be exposed to temperatures higher than the boiling pc t of water. 
Don’t sterilize in a mixture of steam and air. Flush 
the air out of the autoclave. 
Don’t place rubber goods in formalin gas sterilizer or 
formalin humidor unless they are completely dry, 
Wovon-Fabrio Urethral Catheters! 
These catheters are hollow tubular instru merits made of a 
woven fabric (usually silk) which is impregnated i ith a special 
gum and carefully baked in an oven. They are safer than m-tal 
catheters and more rigid than soft rubber ones, but even with 
good care their useful life is shorter than the rubber and metal 
ones, Woven catheters come in various shapes and sizes and are 
of particular value in passing a moderate obstruction at the 
bladder neck. 1. Cleaning: - silk woven urethral catheters should be 
thoroughly cleansed with soap and water and dried with gauze 
or a clean, soft towel. Make sure that all particles of 
lubricant, blood, pus, etc., have been removed. Water may be 
forced through the lumen with the aid of a syringe, 
2. Sterilization: 
a. 15 minute immersion in 1:1000 mercury oxycyanide 
solution after which they are drained, dried and 
placed in sterile basins in the formalin cabinet. 
Should be rinsed in sterile water before using, 
. b. An alternate method of sterilizing silk woven 
catheters is immersion in 1:1000 mercury oxycyanide 
for 15 minutes, boiling for 1 1/2 minutes and then 
placing them in a formalin cabinet or expose them 
to steam under pressure. However, manjr makes of 
silk woven catheters will not .stand boiling or 
autoclaving, so we do not recommend this procedure 
for Army installations. 
Metal and Glass Catheters: are cleaned and sterilized in 
the same manner as are the ones of soft rubber. 
Ureteral Catheters: these instruments are long, flexible, 
hollow tubes made of woven silk covered with shellac and usually 
have a solid, rounded tip. One or two eyes,near the tip, and an 
opening at the other end of the instrument, permit the passage 
of urine from the kidney pelvis or ureter through the lumen 
(opening) of the catheter, to a container placed at the open 
end. Of course, a cystoscope is necessary to pass ureteral 
catheters, the catheters being passed through the cystoscope and 
thence into the ureter via the ureteral orifices on the bladder 
floor. 
Ordinary ureteral catheters vary in size from No, 3 to 
No. 12 French, Nos. 5, 6 and 7 French, being the sizes more 
frequently used. They are usually divided into centimeter lengths 
by marks on their outer surface. Ureteral catheters may be . 
plain or impregnated with bismuth salts so as to make them x-ray 
opaque (will show up on the x-ray film). The latter are useful 
in locating stones in the ureter, 
1. Cleaning: 
a. Immediately after use a non-corroding stylet should 
be inserted in the catheter to prevent the lumen from 
becoming clogged with blood, pus or lubricant, 
b. The catheter is then immersed in soapy water and its 
outside surface thoroughly washed, 
c. The stylet is now removed and the lumen (tube) 
cleansed by repeatedly forcing soapy water through 
it with a syringe. 2. Sterilization of Ureteral Catheters? 
a. The catheter (or catheters) is .placed in a tall 
jar (a graduate works well) filled with In1000 
mercury oxycyanide (or Cystan) which is siphoned 
through it by suction, one end of the catheter 
being in the fluid and the rest of the instrument 
draining over the edge of a jar into a receptacle. 
b. After the sterilizing solution has drained freely 
through the lumen for 15 minutes, the catheter 
is completely immersed in mercury ycyanide 
1:1000 for 15 minutes to insure complete sterili- 
zation (inner and outer surfaces). 
c. Cold sterile water is forced through the lumen 
followed by air, 
d. It is allowed to dry and placed in a sterile 
humidor or formalin cabinet overnight, 
e. Before using they should be rinsed off with sterile 
water (if formalin is used). 
3, Care? ureteral catheters should be frequoi uly inspected 
for limp sections showing a deterioration (rottening) 
of the woven bases. These should be discarded. The ( 
surface also should be inspected for the presence of 
cracks or abrasions which might irritate the mucus 
membrane of the ureter. 
Sounds; 
Sounds are solid metal instruments, straight for females, 
but of varying shapes for males, the different curves being 
merely for the .purpose of more readily passing certain types of 
obstruction and distortion of the urethra. Sounds are 
manufactured in graduated sizes from a No, 10 French, to a No, 
■'36 French. The principal use of the sound is to dilate 
strictures (narrow areas) of the male urethra. A sound may have 
a thread at its tip, so it may be attached to a filiform bougie 
which has been passed (see Filiforms). 
Sounds are washed thoroughly with soapy water, rinsed and 
either boiled for 20 minutes or autoclaved (like any metal 
instrument). 
Bougies? 
Bougies are solid, flexible instruments made of gum- 
impregnated woven fabric. Bulbed bougies, with acorn or olive 
tips come in various sizes. They are used to localize, 
calibrate and dilate strictures of the urethra (anterior). 
Bougies also may have a ’’male11 thread so they may be attached 
to a filiform which has been passed in an occluded urethra. 
Ureteral bougies are used to ’localize and dilate structures or 
other occlusions of the ureter. Filiforms; 
A filiform is a fine, wire-like instrument, properly a 
bougie, to which is usually attached a "follower" (sound or 
bougie) or dilator. This fine filiform is first passed by 
the tight occlusion, (narrow strictured area) in the urethra 
and then the more rigid "follower" (bougie or metal sound.) 
is attached and follows in its wake, Filiforms have a female 
thread to fit over the male thread on the metal catheter or 
sound. The most satisfactory filiforms are made of whalebone 
or rubberized silk-woven fabric. 
Care, Gleaning arid Sterilization of Bougies and Filiforms; 
Great care must be taken to have the filiforms associated 
with their proper followers for the standard use in the size 
of the thread is not uniform, (German, English, and French 
standards are used). No force should ever be used nor should 
the threads hang loosely together. As the filiform curls up 
in the bladder when the follower is in the urethra, if the two 
parts become separated (usually at the thread), an operation 
might be necessary to retrieve it from the bladder. 
Bougies and filiforms are sterilized with the same methods 
recommended for the sterilization of silk woven (woven 
fabric) urethral catheters. CHAPTER VIII. 
SURGICAL TECHNIQUE 
Modern surgery is a combination of aseptic and antiseptic 
surgery (Chap,II). Everything used at the time of the operation 
must be free from pathogenic bacteria (surgically clean)-. 
Constant vigilance is necessary before, during and after 
operation and no "breaks” or failures in surgical techniq .e 
must occur - or if they do occur, be allowed to pass uncorrected. 
Asepsis in the Operating Room; 
1. Surgical sterilization of gowns and gloves of the 
operating team and all instruments and materials that come in 
contact with the surgical wound or are handled by the surgeon 
and his assistants. 
2. ■precautions in scrubbing the hands and forearms of 
the surgeon and his assistants, 
3. Precautions in putting on sterile gowns and gloves. 
A. Careful preparation (chemical sterilization) of the 
patient* a-skin (the operative field). 
5, Precaution against contamination by 6: and flies,etc, 
6, Prevention of perspiration dropping from the face and 
neck of the surgeon and his assistants. 
7, During the operation the surgeon and his assistants 
must not touch anything that is net sterile. The smallest 
”Break” in technique may turn a mechanically perfect operation 
into an ultimate complete failure. 
Technicians, before they can be said to be efficient in 
the Operating Room, should be familiar with the foil '.ring 
points of Surgical Technique; 
1, Surgical Sterilization (Chap,IV). 
2, Operating room caps; these care caps of unbleached 
muslin in several .styles and sizes. They must be placed cm the 
head so as to come well over the occipital protubranoe, c rering 
all of tho hair. The cap is not sterile. 
3. Face masks are made of oblongs of gauze or other 
material with 4 tapes which are tied at the top of the head and 
the back of the neck. Both the nose and the mouth must be 
covered by the mask. The operating room cap and. mas]' are put on 
by everyone working in the operating room before they enter the 
room. Those of the operating room personnel that ”scrub-up” 
put on the cap and mask before starting the ”scrubbing-up” 
procedure, 
4. "Scrubbing-Up” - many different methods have been 
recommended and while none are capable of making the hands germ 
free, most of them will give satisfactory results. In all the 
methods there are two stops; first, mechanical cleaning with 
soap, water, brush and nail stick; second, chemical sterilization 
(soap also affords some chemical sterilization'. An excellent method of mechanical cleansing is as 
follows; 
a. Mails are trimmed, 
b. Hands, forearms and arms to a point three inches above 
the elbow are washed off with green soap and tepid 
water. 
c. Remove all dirt from beneath nails with an "orange rood11 
stick or nail file, allowing water to run over the 
hands during the process. 
d. Starting at the tips of the fingers, the hands, forearms 
and arms, to a point two inches above the elbows, are 
scrubbed with a sterile brush, green soap and running 
warm water. This washing should be done methodically 
sc that each side (the finger has four sides) of the 
fingers, the hands and forearms, etc,, are scrubbed 
thoroughly, 2 1/2 minutes should be spent on each 
hand and forearm. AH soap rinsed in running water, 
e. Nails again cleaned with a sterile "orange wood" stick 
under running water, 
f. Step d repeated with another sterile brush, except that 
fingers, hand and forearm only are scrubbed, Do not 
go above the elbow this time, 
g. After thoroughly rinsing off all soap with the aid of 
copious amounts of running water, the upper extremities 
are held in position with the elbows flexed and the 
hands about level with the tip of the nose. This 
position is assumed so that the water will drip from the 
elbows rather than nan down the forearm and off the 
hands. 
The person who is scrubbing wo is now ready for 
chemical sterilisation of the hands and forearms. 
Numerous solutions have been, and still are, used for 
this purpose. Bichloride of mercury, 70% alcohol, 
cresol preparations, iodine, followed by alcohol, etc.*., 
are just a' few of the many. These solutions may be 
contained in basins in the operating room. The hands 
and forearms are usually completely immersed for two 
minutes or they may be just thoroughly covered with the 
solution (gauze, sprays, etc,), 
5. After scrubbing and rinsing in the chemical solution, the 
hands and forearms may be dried with a sterile towel, the hands 
only may be dried, or neither may be dried, A sterile gown is 
then put on. 
6, Patting on sterile .gown unassisted; 
a. Pick up entire gown off the table, being careful not 
to touch any portion of the gown except the back of 
the neck band. b. Holding back of neck brnd with both hands, "How 
the remainder of the gown to unfold itself 
(gravity). Make certain that no portion of the 
gown touches the floor or cny surrounding objects. 
c. Holding the rear of neck band with the right hand, 
the left hand is placed in the left arm hole and 
run down the sleeve as far as it will go. Then, 
do the same with the right. Make no attempt to 
pull the sleeves up on the arms - this as a 
break in technique. Hold upper extremities up, 
d. Unsterile nurse or technician will’ then fasten 
the ties on the gown after she has pulled the 
sleeves of the gown by placing her hands on the 
inside of the upper portion of the sleeve. In 
tying up the waist band, the unsterile technician 
must not allow the ends of the ti«- to fly about 
thus contaminating the remaining :)rjJ.e parts 
of the gown. 
7. Putting on Sterile Gown Assisted; 
a. The sterile nurse, holds the front of two gown by 
the shoulders with the neck band folde’ back over 
her gloved hands. The back (inside) of gown is 
thus towards the person who is ready to put on the 
gown. 
b. The hands are then placed in the arm i; ' es end run 
into the sleeve with a downward and ou . ard motion, 
being careful not to touch the person holding the 
gown, 
c. The remaining steps are the same as Step d above, 
(putting on gown unassisted), 
8, Putting on Gloves Unassisted; 
a. Gloves should be shaken out of the pocket on to a 
sterile table, 
b. Gauze removed from palms, without touching inside 
of the gloves, 
c. Hands well powdered, making sure inner sides of 
fingers are powdered, 
d. The right glove is picked up- by the oppe?’ part of 
the folded cuff with the left hand. The fingers 
of the right hand are then placed in the glove, 
which is pulled on to the hand by the left hand. 
The cuff should not be unfolded (to cover over 
gown at wrist), until left hand has been gloved, 
e. The fingers of the gloved right hr-y are then 
slipped under the upper portion c Jae. left glove. 
The fingers of the left hand are placed in the 
glove' which is pulled up by the right band. Be 
careful not to touch the inside of the left glove 
with the' gloved right hand, . ■ f. The cuff of the right glove is pulled over the 
wrist by putting the fingers of the gloved left 
hand in the cuff at the dorsum of the hand (back) 
and then pulling up, 
9. Putting on Gloves Assisted? 
a. The sterile technician or nurse will first remove 
gauze from the inner palms of the gloves. 
b. Then the right glove is grasped in such a manner 
that the palm is away from the person being 
gloved, With the top of the glove spread widely, 
the powdered hand is then placed in the glove, 
the fingers set in their proper places and the 
glove snapped on the hand by a downward motion 
of the hand while the assistant is pulling up. 
c. The left hand is gloved in a similar manner. 
10, Preparation of Operative Fields 
This is a matter of major importance. The area has 
usually been well shaved and cleansed with green soap the 
night before the operation by the technician on the ward. 
However, the area should be examined to see if all hair was 
removed. The shaving may sometimes be done in the operating 
room. If a general or spinal anesthetic, etc., is used, 
the skin preparation is done after the patient is anesthetized. 
With local infiltration or nerve block, the field is prepared 
before the injection of the anesthetic agent. 
Many solutions and combinations of solutions are used 
to chemically sterilize the skin of the field of operation. 
The solution used may be capable of destroying the bacteria 
without destroying the tissues and be economical, A simple 
method is to scrub the skin with a gauze "prep” sponge wet 
with ether to remove grease and moisture and then paintthe 
skin with same solution like 3,2$ Tincture of Iodine (followed 
by 70$ alcohol after iodine dries), Scott’s Solution, 
Merthiolate or Mercrctone. 
In "prepping", one should always start in the middle 
of the field and progress outward to the edges, never moving 
centerward again with the same sconge. Only use as much 
solution as is needed; do not allow it to run around to the 
back (if you are preparing for an abdominal operation) or 
to puddle so as to wot the drapes,' Be especially careful 
with iodine; make sure that you remove it with alcohol. 
Prepare a wide area. 11. Draping; 
The patient is draped with drape sheets, 
towels and laparotomy sheet (or similar sheet, depending on 
type of operation) by the scrub nurse and the first or second 
assistant. One drape sheet is placed from the operativ site 
over the lower extremities and one goes from the opera! 
site to cover over the upper part of the body (except face). 
These drape sheets are wide enough to hang well over the sides 
of the operating room rable. Next, towels are placed, about 
the operative site and held in place with towel clamps. The 
laparotomy sheet is then placed with the short end (from the 
opening) being the head end. In this manner, only a small area 
of prepared skin is left exposed. 
12. Sponge Count; 
One of the most important duties of the scrub 
nurse and circulating nurse (or technician) during an operation 
where a cavity is opened, is to keep count of the sponges used. 
The scrub nurse and circulating nurse must have some tally 
system whereby the number of sponges used and the number of 
sponges left unused on the table exactly equal die number of 
sponges &iven to the scrub nurse. The sponge count should be 
correct before the abdominal cavity is closed for sponges and 
instruments have been left in the cavity, A good plan is never 
to use small sponges after the peritoneal cavity has been 
opened and to have large sponges with, rings on them for use in 
the abdomen, 
CommonnBreakstt in -Surgical Technique; 
1. Hair not covered by cap. 
2. Nose not covered by mask. 
3. Sutures allowed to hang below the field of operation. 
Only the top side of the draped patient, in the vicinity of 
the operative site, is considered as being actually sterile, 
4-, Gloved hands allowed to fall to side. 
5. Instruments passed behind someone*s back - no excuse 
for this failure in technique. 
6. Contamination at head of table, 
7. Attempting to prevent instruments from slipping off the 
side of the tabic. Once- the instrument is past the actual 
top of the operative field, it is not considered sterile any 
longer, . 
Operating Room Personnel; 
1. Operator - surgeon ) 
2. First Assistant ■ ) - Medical Officers 
3. Second Assistant' )' 
/+. Scrub-nurse - female nurse or technic: an, 
5. Technician (1 or 2) - enlisted men, 
6. Operating Division Supervisor - female nurse, 
7. Anesthetist - trained nurse or medical officer. The preceding set up may be modified, depending on the 
size of the installation and the surgeon’s desires. 
The operating surgeon is in complete charge of the 
operating room. He is responsible for the patient’s life and 
for the successful outcome of the operation. He is held 
accountable for any mistakes and accidents, no matter whose 
fault it may be. 
The first assistant usually stands directly across 
from the surgeon, clamps bleeding vessels,, places ligatures 
(or removes clamps after surgeon places them), and in general 
helps the surgeon throughout the operation. 
The second assistant cuts the suture and ligature ends, 
and sponges the blood in the wound, retracts the wound edges 
and again in general helps cut the first assistant and the 
surgeon. He assumes a position alongside of the first 
assistant across from the scrub-nurse. 
Duties of the ”Scrub-Nurse”; in the large stations a 
member of the Army Nurse Corps, or a civilian nurse, will 
probably be the scrub-nurse. However, in many stations, 
particularly in the field, the technician will act as the 
scrub-nurse. The following are the duties of the scrub-nurse, 
listed mors or less in chronological order. 
1, Selects the instruments and surgical supplies to be 
sterilized. 
2, Removes outer clothes; puts on operating room 
clothes (includes cap and mask) and proceeds to scrub-up. 
Puts on sterile gown and gloves, 
3, Drapes, with sterile table cover, toweling or pillow 
cases, the small instrument table, the reserve instrument 
table, the table for gowns and gloves, the ”prep” table, the 
spinal anesthetic table (if spinal is to be used) and the basin 
(splash) standards. Two thicknesses of material must be used, 
4, Arranges sterile instruments (brought by technician) 
on the small adjustable) instrument table and the reserve 
instrument table. These are covered with a sterile towel until 
needed. 
General Arrangement of Instruments on 
Small Instrument Table 
Holding 
and 
Retracting 
3 
(The handles of the 
instruments are direct- 
ed toward the operator 
and the instruments 
arc placed, as nearly 
as possible, in the 
order they will be 
used. 
Suturing 
and 
Probing 
4 
2 
Homestatic 
1 
Cutting 5. Arranges contents of the sterile packages natch were 
placed on the table (and opened) by Circulating Ted ician. 
6. Prepares needles, sutures and ligatures. Sutures and 
ligatures are kept in a dry tonel and .dipped in water for a 
few seconds immediately before handing them to operator, 
7. Accounts (with the Circulating Technician) for all 
sponges on the tables. 
8. Contents of basin and utensil set placed in thei 
proper places. 
9. Assists the surgeon and his assistants into their 
gowns and gloves, 
10. Assists with the spinal anesthetic (if spinal anesthesia 
is to be used), 
11. Assists in preparing the field of operation (operative 
site) in the manner described above, 
12. Assists in draping the patient with drape sheets, 
towels and laparotomy sheet, 
13. Masses the scalpel to the surgeon - the operation 
begins. 
14. Passes all instruments, sponges, sutures, ligatures, 
etc., to the surgeon and his assistants. Anticipates the 
surgeon* s needs. Ample supplies, warm solution”, etc,, must be 
on hand. If something is needed, the Circulate . Technician 
is at hand to assist, 
15. Account for all sponges - before the abdominal (or any) 
cavity is closed. Check this count with the Circulating 
Technician, 
16. Assists with the surgical dressing, 
17. Soiled instruments collected and taken to the work room 
to be cleaned and sterilized. 
Duties of the Technician in the Operating Rooms the 
technician.takes the place usually of the so-called circulating 
Nurse of the civilian hospital. He does not scrub-up or put on 
a gown and gloves (unless he is the scrub-nurse), but dc 3 
have on a cap and mask properly pi a ced. • 
1, Furniture and equipment placed in the proper ore . and 
the walls, overhead lights, tables, etc., are wiped down, using 
a cloth moistened with crosol solution. These are never dusted. 
2, Sterilizes instruments, etc,, that were selected by 
the scrub-nurse. 
3, Places the necessary packs of supplies, gloves, gowns, 
etc., on the proper tables and opens them at the scrub—nurse1s 
request, 
4-. Assists Anesthetist. 
5. Sterile instruments, in trays, are brought in and turned 
over to the scrub-nursc, 
6, Checks sponge count with scrub-nurse. 7. Ties up gown of surgeon and his assistants. 
8. Keeps floor clean of soiled sponges, instruments, 
etc., during the operation. 
9. Wipes perspiration from brow, face and neck of the 
operator and his assistants. This is done with a piece of 
gauze or towel, making sure there are no loose ends to 
contaminate the surgeon’s gown. If one of the operating team 
does have perspiration, which is liable to drop on the field, 
the Technician should approach him from behind and touch him 
on the back. This would be a signal for the person to turn 
his face toward you. Then mop from the front mid-line around 
to the back. The head is then turned toward the other 
direction and the procedure is repeated. Never wipe off the 
forehead while the surgeon is leaning over the operating table. 
If glasses are worn and heed cleaning, remove them, clean them 
and replace them. 
10. Refrainsfrom loud talking, laughing, joking, etc., in 
the operating room. 
11. Remainsin the operating room at all times and antici- 
pates the needs of the scrub-nurse. Hands sterile supplies and 
instruments to the scrub-nurse with the aid of ”pick—up or 
handling” forceps. Never hold the ,rpick-up” forceps with the 
point upward, for this causes the sterilizing solution (in 
which it is kept,) to roll up over the handle and hand, which 
are unsterile. In lowering the point again, this solution runs 
down and contaminates the sterile portion of the instrument. 
In pouring solution, remove the gauze cap and pour a 
bit of the solution out into a floor receptacle before pouring 
the solution into a sterile basin, etc. This will tend to 
cleanse the lip of the flask and thus reduce the chance of 
contamination, 
12. Checks sponge count with scrub-nurse before the ab- 
dominal (or any) cavity is closed. 
13. Has adhesive strips or ties ready for use on the 
surgical dressing and assists in placing them, 
14. Assists anesthetist in returning patient to the ward, 
15. Cleans room after the operation, 
a. All tables are stripped, cleaned and dried, 
b. Contaminated articles 'are stacked, ready to take out. 
c. Floor basins are emptied into one basin and the 
contents removed from the room. 
d. Used linen is collected and placed in a wheeled 
hamper,' It is then taken to the work room and 
sorted for laundering. 
e. Lights are turned off and all electrical apparatus 
disconnected. To the Operating division Supervisor is delegated the 
authority necessary for the routine administration of the 
operating suite. This appointment is usually held by a member 
of the Army Nurse Corps, It Involves numerous details such 
as the care and accounting of all property, sterilisation of 
instruments, surgical supplies and solutions (usually for the 
whole hospital),preparation for operations, supervision and 
instruction of technicians, and keeping everything running 
smoothly at all times. 
The Anesthetist may be a nurse who has received special 
training or a medical officer. He or she is responsible to the 
operating surgeon for the general condition of 3 patient 
during the administration of the anesthetic, spinal 
anesthesia is chosen the surgeon or one of his assistants may 
administer the anesthetic agent. An anesthetist or experienced 
nurse or technician should sit at the patient’s head during 
the operation and keep check at frequent intervals cf the blood 
pressure, pulse and respirations. 
Preparation for Operation 
Each one of the operating room personnel remove his outer 
clothes and puts on his operating room clothes, cap and mask. 
The .surgeon, first assistant, second assistant and scrub-nurse 
will scrub up and don sterile gowns and gloves. The cir- 
culating technician, anesthetist and the operating division 
supervisor, wear caps and masks but do not scrub up or pvt on 
sterile gowns.and gloves, 
1. Scrub-nurse selects instruments and supplies needed 
for the operation and asks the technician to sterilise the 
non-sterile articles, 
2. Technician then arranges and cleans the room and its 
contained equipment. 
3. Technician brings packages of sterile goods from the 
supply room and puts them on the proper tables, 
A. Surgeon and his assistants and the ”scrub or sterile” 
nurse proceed to the wash room to scrub up. The scrub-nurse 
will usually scrub before the surgeon, etc,, for he, or she, 
has many duties to perform after he, or she, has donned a 
sterile gown and gloves, 
5. Scrub-nurse dons sterile gown and glov ■ from a 
package (on the proper table), which has boon v nod by the 
Circulating Technician, 
6. Tables, basin standards, etc,, are draped, 
7. Trays cf sterile instruments are brought in from the 
sterilizer by the -technician and arranged on the sterile 
instrument tables by the scrub-nurse. Sutures and ligatures 
fixed and placed in a dry towel. 8. Basin and utensil set opened and contents placed 
in their proper places* 
9. Remainder of sterile packages opened by the 
technician and their contents properly placed on the reserve 
table. 
10. Spinal tray is set up, if spinal anesthesia is to 
be used. 
11. All tables and stands containing sterile articles 
are draped with sterile towels or table covers until the 
articles are to be used, 
12. The patient is brought into the operating room. 
Anesthetic is administered. Technician stands by if general 
anesthetic is being administered or holds the patient in the 
proper position, if a spinal is being given. 
13. Surgeon and his assistants have scrubbed and enter 
the operating room ready to be assisted into sterile gowns 
and gloves. The second assistant may, put on only a pair of 
gloves which 'he changes after ’’prepping" the patient. If the 
first assistant or surgeon has administered the spinal 
anesthetic, he will probably change his gown and gloves for 
new ones before beginning the operation proper. 
14-. Operative sits (patient's skin) prepared by the second 
assistant in the manner described above. 
15. Patient (and operating table) draped by one of the 
assistants and the scrub-nurse. 
16. The small instrument table is rolled into place as 
are the basin stands. The small instrument table (without 
instruments) may be placed above the patient1s thighs and 
included in the general draping of the patient, following which 
the instruments are arranged properly. 
■ 17. Surgeon end' his assistants assume their proper places. 
18, Scrub-nurse hands the scalpel to the surgeon and 
the operation proceeds. CHAPTER IX. 
ANESTHESIA 
The introduction of anesthesia and the development of 
various anesthetic agents has been one of the greatest aids in 
the rapid progress of surgery. Opium and alcohol seemed t o have 
been the chief means by •which ancient surgeons dulled the pain 
of surgical operations. 
The real beginning of surgical anesthesia was in 104.6 
when Morton first demonstrated the administration of ether in 
Boston, Dr, Crawford Tv, Long of Jefferson, Georgia, in IT'D, 
noticed that the Mgay blades'* about his home who inhaled other, 
at the then common "ether frolics", became insensible to pain. 
Ho administered the drug to a patient and removed a tumor of 
the nock. Ho did not, however, publish his discovery, so Morton 
gets official credit for being the first, A month after Morton's 
demonstration, Oliver Wendell Holmes coined the word "anesthesia" 
to describe this state.of insensibility to touch. The following 
year, 1847, chloroform was used successfully by Sir James Y, 
Simpson of Edinburgh, Scotland, Chloroform has since been found 
to produce serious disease of the liver and lias boon practically 
eliminated as an anesthetic agent. 
Local anesthesia was first introduced in 1884 by Karl 
Keller of Vienna who Used a solution of cocaine in the eye. 
Spinal anesthesia was first introduced into this country 
in 1900 but due to the high death rate was shunned until about 
1928, when improved technique greatly reduced the death rate and 
the use of spinal anesthesia has increased rapidly. 
The anesthetic properties of nitrous oxide were discover- 
ed in 1799 by Sir Humphrey Davy, but little was .done with it until 
the latter part of the nineteenth century. The year. "'925, marked 
the beginning of a series of developments in ones thee;’ There 
followed new gases and drugs to be used for anesthesia'(ethylene, 
1925; avertain, 1929; cyclopropane, 1934; cvipal, 1934; sodium 
pentothal, 1937), 
Anesthesia is now a very definite field of medicine man- 
ned by physicians who devote all their time and energies to tho 
subject. 
Definitions; 
Anesthesia; means tho complete loss of feeling or sensa- 
tion of part or the whole of the body. It is artificially induced 
by the administration of some drug. 
General Anesthesia: a total loss of consciousness due to 
the effects of the anesthetic agent on the central nervous syst.,. , 
Such a condition may be produced by the absorption of the chemical 
into the blood stream by: 1. Inhalation of gas-es and ether, 
2. Absorption of drugs placed in the rectum* 
3. Intravenous injections of certain drugs. 
Local Anesthesias is the complete less of sensation to 
pain and other 'external, stimuli, in a limited (or local) area. 
This is secured by paralyzing the nerve ends with (1) freezing 
with Ethyl Chloride; (2) introducing a drug like novocain© 
directly into the tissues; (3) obtaining what is known-as 
Regional Anesthesia by spinal, sacral, paravertebral, or brachial 
injections of novocaine or similar agents. In Regional 
Anesthesia the anesthetizing fluid is injected about the nerve or 
nerves carrying sensation from a certain area. 
The choice of the anesthetic will depend on the type of 
operation planned and the patient.1 s age and general physical 
condition. An anesthetic to be ideal must? 
1. Be easily taken into the system, 
2. Produce the least danger to life, 
3. Afford the maximum freedom from pain, shock and 
po s t-ope native c ora pi i cations. 
i. Permit the necessary relaxation during the operation. 
In the general hospitals .and larger station hospitals, the 
anesthetic will be administered by a medical officer or a nurse- 
anesthetic, In the field units and in-the smaller permanent 
installations, however, the technician .may act as assistant 
anesthetist or in rare cases, take entire charge of t-.e anesthetic. 
The administration of the anesthetic should be done by one not 
only shilled in the mechanical administration of the agent, 
but also experienced in the systemic and physical changes which 
occur or may occur. He should have the basis knowledge to enable 
him to recognize complications early and treat them promptly. 
It is easily understood that we cannot-make anesthetists of you 
with one or two short lectures. We intend only to acquaint you 
with the various anesthetic agents and the mods of their 
administration, 
Types of Anesthesia and Anesthetic Agents 
1, General Anesthesia - ar stated above, general anesthesia 
represents a total loss of consciousness of such a degree that 
an operation can be performed-without suffering and interfering 
movements on the patient’s part. All the chemicals used reach 
the central nervous system "(actually the entire nervous system) 
via the blood stream. a. Inhalation - the- volatile anesthetics liko 
other, chloroform, nitrous oxide, ethylene and cyclopropane 
are introduced into the blood stream by inhalation. That 
is, the gas is inhaled, goes to the lungs and is picked up 
there by the pulmonary circulation, carried from the lungs 
to the heart and thence to the central nervous system via the 
general circulation. 
Ether is administered by the drop ether mask, 
the serai-closed or towel cone, the closed method with a gas 
machine face mask or the insufflation methods, intrapharyngeal 
and intratracheal (by the use of tubes). Equipment necessary 
for the administration of ether is (l) towel cones (2) 
large-sized metal or rubber oral airway (3) tongue forceps 
(4-) vaseline (5) a piece of rubber dam large enough to fit 
over the eyes (6) castor oil to place in patient’s eyes 
(7) glass finished rubber nasal tube with angular, smooth- 
edged tip (8) l/2 pound of chemically pure ether (') cotton 
(l) safety pin (11) cork to fit into mouth of ether can (12) 
knife. 
Gas Anesthesia; 
(1) Nitrous Oxide. 
(2) Ethylene. 
(3) Cyclopropane. 
The above cases are usually given in - 
conjunction with oxygen and carbon dioxide. 
The gases may be used alone or in conjunction 
with ether. The development of efficient gas 
machines has placed the gas mixtures with 
• or without ether, or with novocaine infil- 
tration, in the first rank, as the most 
serviceable means of anesthesia in the most 
severe types of operation, 
b. Rectal Anesthesia - drugs placed in the rectum 
are absorbed into the general circulation and exert their 
effects on the central nervous system, 
(1) Avertin (Tribromcthyl alcove ) - this drug 
produces anesthesia and is supplemented with 
ether or one of the gases. The dosage is 
usually 80-100 milligrams of avortin per 
kilogram of body weight. Each cc, of avertin 
fluid represents 1 gram of avertin dissolved 
in 1 cc. of amylone hydrate, 
(2) Avortin Equipment; 
(a) Avertain fluid. 
(b) Congo-red for testing solution, 
(c) 10 cc. syringe with 18 gauge- spinal 
needle, 
(d) Avertin table of dosages. 
(e) 30 ounce graduate, 
(f) Glass flask for mixing. 
(g) Thermometer. 
(h) Rectal tube and funnel. (3) Ether in oil also may be administered via 
the rectum (Gwathmey Analgesia). 
(4-) Evipal and Pentothal are occasionally used 
as rectal anesthetics and produce basal 
anesthesia, 
c. Intravenous Anesthesia - the chemicals are 
introduced directly into the circulation by injection into a 
superficial vein and are carried to the central nervous system 
where they exert their influence. The drug most used at 
present is a barbiturates Pentothal (Pentothal sodium). 
Pentothal is now being used in long major operations and works 
well in conjunction with local infiltration of novocaine, 
Pentothal is quite practicable for Use in the field. It is 
particularly advantageous for field work. 
Pentothal; 
(1) Sterile table, V 
(2) Two (2) sterile towels, 
(3) Ampule of (1.0 Gram) 
(4) 20 cc. glass syringe with a 20 gauge 
intravenous needle, 
(5) 100 cc. of sterile distilled water, 
(6) 4n x 4,f gauze sponges. 
(7) Sterile medicine glass. 
(S) Padded arm board, 
(9) Adhesive tape. 
(10) Sterilizing solution (Tincture Merthiolate, 
Iodine and Alcohol, etc,), 
(11) Atropine sulfate and/or toxin with 2 cc, 
syringe and hypodermic needle. Atropine 
Sulfate (,004 or .006 Gm.) is usually given 
pre-operatively. The important complication 
here is respiratory depression and/or 
laryngeal spasm, 
2. Local Anesthesia; 
a. Local Infiltration -* this means the introduction 
into the tissues over a circumscribed area of a drug, usually 
novocaine or procaine (1/2 - 2 per cent), which paralyzes the 
superficial nerve endings, A 10 cc. syringe and needles 
(hypodermic to #21) are all that is needed. 
b. Regional Anesthesia - secured by blocking large 
sensory nerves. The drug is injected about the nerves carrying 
sensation from a particular area. (1) Spinal Anesthesia - in this type of 
anesthesia, drugs are introo. 1A beneath the 
dura mater of the spinal cord in the lumbar 
region and paralyze chiefly the posterior 
sensory nerve roots. Accordingly, this affords 
insensibi lity to those areas ccrrosnonding to 
the distribution of the affected nerves. 
Remember that the patient is not unconscious 
after a spinal anesthetic. It is not a general 
anesthetic. Many drugs are used as spinal 
anesthetics with perhaps novocain0 crystals 
being the most popular, Strovaine, tropccaine, 
spinocaine, neccaine, nupercaine, metycaine 
and pontocaine, are others in use at the 
present time. Each has its advocates and 
objectors, A vasoccnstricting drug is usually 
given before the anesthetic is adminis ured, 
(a) Equipment for Spinal Anesthesia; 
Sterile table. 
Ampules of the anesthetic agent, 
10 cc, and"5 cc. syringes. 
1 ln and 1 I l/2" hypodermic needles, 
1 20 gauge needle. 
1 19 gauge steel 3 l/2n spinal needle. 
2 towels, 
t 1 spinal sheet 
Small gauze sponges. 
Sponge forceps. 
Container for 1% novocains, 
(b) Administration of Spinal Anesthetic. 
(l-a)The patient is placed on his side 
with the shoulder and I • cocks flush with 
and perpendicular to the edge of the 
operating table, the knees drawn up toward 
the patient's chin. The patient is held 
firmly by the technician - with one hand 
on the neck and the other hand and forearm 
behind the flexed knees, 
(2-b)The skin of the lower bad- is pre- 
pared by the use of some antiseptic 
sterilizing solution (iodine and alcohol, 
Scott's Solution, Mercretone or Tincture 
of Merthiolate). 
(3-c)At the center of the depression 
between the third and fourth (or second 
and third) vertebrae, 1% novocaine is 
injected subcutaneously for local anes- 
thesia. This space (3rd) usually 
corresponds to the line of the iliac 
crests. (4,-d) lumbar puncture is done using the 
3 l/2n spinal needle, 
(5-q)As soon as spinal fluid is obtained 
as much as is needed for dilution of tho 
novocaine crystals is withdrawn. If a 
liquid anesthetic agent is to be used, the 
spinal fluid withdrawn (same amount as the 
drug to be injected) may be discarded, or 
in some cases no spinal fluid is withdrawn. 
(6-f)The anesthetic agent or drug is 
injected through the spinal needle into the 
spinal canal at the rate of 0,5 cc, per 
second. 
(7—g)Spinal needle withdrawn and small 
sterile dressing applied over the puncture 
wound. 
(B-h)Patient*s legs extended, and if the 
drug used was lighter than spinal fluid, he 
is turned on his abdomen. If the drug is 
heavier than spinal fluid, he is turned on 
his back. This is done to bathe the 
posterior sensory nerve roots with the drug. 
The patient is usually left level unless a 
very low anesthetic (operations on anus, 
perineum, lower extremities) is desired. 
By adjusting the level of the operating 
table (depending on the weight of the drug) 
tho desired level of anesthesia can be 
obtained, 
(9-i)The level of anesthesia is now tested 
by applying a pin from the lower extremity 
upward and watching tho facial expressions 
of the patient. Within 2 to 5 minutes the 
desired height of the anesthesia is obtained. 
Patient placed in position desired for 
operation. In 15 minutes Trendelenburg 
Position (head -well below feet) may be 
allowed, if desired. 
Complications; the important compli- 
cation here is primary shock dth a fall 
in blood pressure and a weak, rapid pulse, 
nausea and vomiting. This should be 
treated with Ephedrine Sulfate, oxygen in- 
halation and intravenous infusions. 
(2) Nerve-Block - an example of this would be the 
infiltration of the region of tho inferior 
dental nerve to render anesthetic one side of 
the mandible. This is utilized in extracting 
teeth. 
7.7-1- A. Infiltration with novocalne of the lumbar interspace, 
B. The spinal needle passipg through the Dura, 
C. Position of the patient for insertion.of the needle. 
(Homan*s Surgery) {3, Paravertebral Anesthesia — spltic.1 nerves as 
thoy leave the vertebral foramina are blocked, 
thus producing a large one-sided anesthetic 
zone. 
(4) Sacral Anesthesia — nerves leaving the sacral 
foramina aro blocked with an anesthetic agent. 
Preparation for Common Anesthetic Emergencies 
J-. Have routine circulatory and respiratory stimulants 
on hand, 
a. Circulatory Stimulants, 
(1) Adrenalin (Epinephrine). 
(2) Coramine, 
(3) Neosynephrin. 
(A) Ephedrins Sulfate, 
(5) Pituitrin, 
b. Respiratory Stimulants; 
(1) Caffeine-sodium-bensoate, 
(2) Pierotoxin. 
(3) Coramine, 
(l) Metrazol, 
(5) Atropine Sulfate. 
2. Have intravenous outfit with .1 Op Glucose in water nearby. 
3. For respiratory failure, 
a, artificial Respiration — Silvester’s method of 
raising arms above the head until air ceases to 
enter the lungs, then bringing arms down to side, 
may be used. Also alternate pressure may be 
applied under the drapes to the lower ribs, 
(1) Oxygen - carbon dioxide machine, 
(2) Respiratory stimulants, 
(3) Pull tongue out of mouth with tongue forcep, 
A. Cardiac Failure, 
a. Surgeon massages heart. 
b. Adrenalin directly into heart bv usinv a 3 l/p” 
needle, ° 
c. Routine circulatory stimulants, 
5. Shock, 
a, routine treatment with blood transfusion, hypertonia 
glucose Intravenously, elevation of lower part of 
body, warmth and circulatory stimulants (vaso- 
constrictors). 
Pre-Anesthetic Care of the Patient 
1. Patients are usually brought to the operating division 
on a stretcher or in their own bed. They may be brought 
directly to the operating room or placed in a small ante room 
off the operating room known as the anesthetic room. 2. If the patient is conscious, and it will not harm him 
to do so, he may transfer himself from the stretcher to the 
operating table. The stretcher and the table are placed side 
by side and each is carefully held in that position while the 
patient moves. It usually takes two people - one to hold the 
stretcher against tho table and the other one (on the opposite 
side) to see that the patient does net fall during tho transfer. 
3, If the patient cannot or should not move himself, 
sufficient help should be obtained to lift the patient and 
transfer him gently to the table. Again caro saculo. oe 
that neither the stretcher nor the table wil eve, that an 
arm is not permitted to drop, or that the neo is not twisted 
or allowed to drop back. Serious results have occurred, when 
these precautions have been neglected, especially if the patient 
is relaxed from the pre-anesthetic sedative or narcotic, or a 
basal anesthetic (avertin), 
A. After the patient is placed on the table he should be 
made as comfortable as possible, whether asleep or awake, 
while he may not feel the discomfort if asleep, a 3irlined 
position or uneven pad or unnecessary pressure may cause 
discomfort when the patient awakens. The position 'one patient 
is placed in before the anesthetic is started is known as the 
dorsal recumbent. 
Previously a draw sheet folded on itself in sue.. a 
manner to act as an arm restraint has been placed on t 
operating table under the patient’s back. T ro small 
are placed as a head rest,. A soft pad covered with rubber 
should be placed in the lumbar region of all patients being on 
their backs. The room is kept quiet and the patient- disturbed 
as little as possible. Someone should remain with the pacient 
constantly and this is the cluty of the technician. 
5, L patient who has had sufficient preliminary medicotior 
(or basal anesthetic) to make him drowsy may be restrained 
immediately with the arm., restraint, and a knee restraint placed 
just above the knees. Ho is not responsible nor conscious of 
his actions, and this will prevent him falling off cuj table 
or his arms and lower extremities from dropping over the edge 
of the table. 
6, If conscious, the patient may arrive ~n the operating 
or anesthetizing room nervous, frightened and even hysterical. 
The technician can comfort him and allay his fears yaw bly by 
a pleasant manner and an explanation of what Is going to be 
done. Care of the Patient r.t the Start of the anesthetic(Induction) 
1. The anesthetist will usually explain quietly what he 
or she is going to do, then places the mask over the patient’s 
face. The technician then fastens the restraints - the knee 
strap beinc placed first, over the lower thighs Just above 
the knees, the technician being certain that the strap will not 
interfere with the manipulation of the table. If a buckle 
is present, be sure that it does not press'down on the patient 
anywhere and is not tight enough to interfere with the circu- 
lation. The knee strap will prevent the patient from injuring 
himself, if the excitement state of anesthesia is reached 
quickly and he struggles, 
2. The arm restraints may be placed before the anesthetic 
is started or after the arms have relaxed from the effects of 
the anesthetic agent. This will depend upon the individual 
giving the anesthetic - his or her personal preference. The 
arms are placed between the folds of the restraint with the 
fingers straight and flat. The tips of the fingers are left 
exposed so that blueness (sign of poor circulation) can ba 
watched for. An awkward position of the arms or too tight a 
restraint might interfere with the circulation arte have serious 
results. 
3. If leather wrist cuffs are used, they are slipped on 
the patient’s wrist before the anesthetic is started and 
tightened later when the patient is relaxed. These hand ties 
or wrist cuffs are placed on the wrists in such a manner that 
they will not slip or tighten around the wrist. The technician 
remains in attendance at the head of the table to help in any 
way needed. The patient may require further restraint because 
of his violent struggle while going under the anesthetic, 
A. If thes patient is to receive spinal anesthesia, he 
is instructed to turn on his side with shoulders and buttocks 
flush with and perpendicular to the edge of the table. As soon 
as the spinal anesthetic is administered, the anesthetist 
extends the lower extremities and instructs the patient to turn 
on his back or abdomen (depending upon the weight of the drug 
used), 
5, The avertin patient is instructed to turn on his left 
side for the introduction of the rectal tube, and after the 
administration of the avertin fluid, to turn on his back. 6. If the patient is to be put in a position other than 
the dorsal recumbent (after anesthetic is administered), all 
required equipment should be on hand before the anesthetic 
is begun, and as soon as the anesthetist gives consent, the 
patient is placed in the required position, 
7. All of the above procedures should be performed as 
quietly and quickly as possible to avoid unnecessary delay 
which would prolong the time the patient is under the 
anesthetic. 
Surgical Positions 
The technician should be familiar with the various 
positions necessary to give the best access to th operative 
field. Any good position requires the followings 
1. The parts or field to be operated must be prominent 
and accessible. 
2. There should be no interference with the circulation 
to any part due to an awkward position or to construction, nor 
undue pressure on any part of the patient, 
3. There should be no interference with respiration 
as might occur from an awkward position, pressure of tb . arms 
on the chest, or from constriction of the gown about L- ■ neck, 
A. There should be no pressure on any nerves. Improper 
position of the patient’s arms has been the cause of serious 
paralyses, 
5. The patient should be in as comfortable a position 
as possible, especially when conscious, and awkward strained 
positions should be avoided, even when the patient is asleep. 
Care of the Patient After Anesthesia. 
1, The artificial airways, nasal tube, intra thoracic 
tube and mouth airways, should be left in place until 
establishment of throat reflexes. Leaving them thus prevents 
the accumulation in the mouth and throat of mucous and vomitus 
to be aspirated (sucked) into the lungs. In avertin cases 
the jaw should be held up until the reflexes turn suffi- 
ciently to prevent dropping back of the tongu-, and airways 
should be left in place until the restoration of throat 
reflexes has taken place, 
2. In transferring the patient from the operating table 
to bed or stretcher, great care should again be tc en to prevent 
injury of the arms, legs or head, ana any great strain on the 
area operated. The patient should be lifted on a full draw 
sheet extending from head to feet. The patient should be 
sufficiently covered with blankets to prevent chilling while 
being transported through the hospital corridors t. bis ward. 3. Unconscious patients should be placed in bed, 
on either side, with face to the mattress and the upper 
shoulder forward with both arms extended forward, lower 
leg flexed and back, upper leg extended and forward, until 
conscious, then the head of the bed should bo slightly 
elevated. 
4, Patients in a conscious condition following 
spinal or regional anesthesia are put into bed flat on 
their backs. If the spinal anesthetic is lighter than 
the spinal fluid, the foot of the bed is elevated for 
six (6) hours (from the tine of injection). However, 
if the spinal anesthetic agent is heavier than the spinal 
fluid, the bed is kept level for at least four hours and 
then the head may be slightly elevated. 
337 COMMON ANESTHETIC CONSIDERATIONS AND EMERGENCIES 
The following outline will serve to emphasize some of the 
clinical states, signs or symptoms which may occur during the 
various phases of general anesthesia and which require attention 
by the anesthesiologist and the Technician. 
— not seen 
may occur 
System Involved 
Before During 
Indue- Induc- 
tion ticn .. 
During 
< Main- 
161*12. HG 6 
During 
Erner- 
After 
Recov 
_ . 
A. Central Nervous System 
1. Excitement ......... 
2. Delirium ......... 
3. Convulsions 
A. Coma (Unconsciousness) , . . 
5. psychoses 
a if 
mm 
if if 
if if 
MM 
MM 
% ■K" 
## 
MM 
MM 
MM 
M if 
B, Cardiovascular System 
1, Vascular depression(fainting) 
if if 
MM 
M M 
if if 
2. Circulatory collapse(shock) 
if if 
— 
MM 
if if 
3. Extreme sudden hypertension 
— 
if if 
MM 
if# 
— 
A. Significant cardiac 
arrhythmias 
if if 
if if 
#if 
5. Cardiac decompensation 
(heart failure) . 
„ rm 
. L 
#if 
if if 
6. Thrombosis-coronary> cerebral 
— 
K* 7«r 
— 
if if 
7. Emboli(floating bleed clots 
in circulatory system) , , , 
— 
# # 
— 
if if 
C. Respiratory System 
1. Rapid Rate « 
$0 70 
if M 
2. Depression to apnea(absence) 
— 
— 
MM 
if if 
3. Dyspnea 
if if 
if if 
MM 
if if 
‘/5r 
/+, Cheyne-Stokes 
— 
— 
M M 
if if 
5. Eronchiolar spasm 
— 
if if 
MM 
—— 
— 
6. Hiccough ......... 
— 
— 
MM 
— 
if if 
7. Pneumonia 
— 
— 
—— 
— 
$0 70 
8. Collapse of lung 
— 
— 
— 
— 
if if 
D, Gastro-Intestinal 
1, Nausea 
if# 
4(* 
ft 
2. Retching 
MM 
— 
if if 
3. Emesis 
Ic $<• 
MM 
M v 
if if 
A. Diarrhea 
— 
MM 
— 
5. Distention , 
— 
— 
">(* -)o 
if if 
E, Genito-Urinary Tract 
1. Oliguria(small amt. of urine) 
70 $0 
MM 
■>0 70 
2. Anuria (absence of urine) 
— 
MM 
MM 
if if 
3. Polyuria(large amt. of urine) 
if if 
MM 
— 
— 
— 
A. Incontinence(inability to 
hold urine) 
mm mm 
MM 
— — 
70 70 
if if 
F. Miscellaneous 
1. Kypopyrexia( subnormal tem- 
perature) 
MM 
MM 
if if 
2. Hyperpyrexia (fever) .... 
,— 
mmmm 
MM 
MM 
if if 
3. Diaphoresis (sweating) . . . 
. 
— — 
MM 
## 
if if GLOSSARY 
Prefixes and Suffixes 
A prefix is one or more letters placed or attached to 
the beginning of a word to modify its meaning. A suffix is one 
or mere letters added to the end of a word to modify its meaning. 
A knowledge of the meanings of these additions will aid greatly 
in interpreting the expression or word used. 
In designating the type of operation to be performed on 
an organ various suffixes are combined with the name of the organ. 
The common prefixes and suffixes of use to this course are given 
below, with their interpretation. 
Prefixes 
A - signifying without or not, as aseptic, meaning not septic, 
free from septic material. 
Anti - signifying against or opposite; as anti-septic, meaning 
a substance used against septic matter, 
post - meaning after or behind; as post-operative, after operation, 
Pre - signifying before; as preoperative, before operation. 
Suffixes 
Ectomy - from the Greek word meaning to cut out or remove5 as 
cystectomy, removal of the bladder; gastrectomy, removal of the 
stomach. An operation ending in "ectomy" may be partial, meaning 
that part of the organ has been removed, or total, signifying 
that the whole organ has been excised, 
Itis - Indicates inflammation of the parts or organ to which the 
termination is attached; as urethritis, inflammation of the 
urethra. 
Lithiasis - from the Greek, meaning stone. Thus, nephrolithiasis 
means stones in the kidney, 
Orrhaphy - from the Greek, meaning suture; used to designate 
repair of a part, as herniorrhaphy, repair of a hernia (rupture). 
Ostomy - the formation of a permanent or semi-permanent opening, 
for drainage of a part. Ex; cystostomy, the formation of a 
more or less permanent opening into the bladder with the aid of 
a rubber tube or catheter. Ctoray - from the Greek word moaning to cut; and is used to 
indicate an incision into an organ, which is closed after 
the operation, thus, cystotomy is an incision into the bladder, 
such as is done to remove a bladder stone (cystolithiasis), 
and the wound is then sutured, 
pexy --from the Greek, meaning to.fasten; ti-,j nephropexy means 
to fasten.the kidney, as is done in ptosis (low lying) of 
the kidney. 
Plasty - to form; herniaplasty indicates a plastic operation 
on a hernia (rupture). REFERENCES 
The following references were drawn upon freely 
and are listed for the students' benefit: 
1. Brooks and Castile - Textbook of Surgical Nursing 
2. Care and Maintenance of Cystoscope - Catalogue 
of American Cystoscope Makers, Inc., New York City. 
3. Eliason, Ferguson and Farrand - Surgical Nursing. 
4-. Homans - Textbook of Surgery, 
5. Medical Department .Soldier1s Handbook - Chapter 
3, Section 1. 
6. Underwood - Textbook of Sterilisation, ADMINISTRATION OF MILITARY HOSPITALS 
AND 
PUBLIC PROPERTY PART one 
ADMINISTRATION OF MILITARY HOSPITALS 
FUNCTION 
The ultimate aim in the management of a hospital is to 
provide the best professional care of the sick and 'Injured, 
TYPES OF MILITARY HOSPITALS 
In Tar, 
1. mobile Hospitals - they form a constituent part of the 
mobile forces. They are established in the combat zone ; 
and comprises 
a. Evacuation hospitals, 
b. -Surgical hospitals, 
c. Convalescent hospitals, 
(T. Clearing stations - operated by clearing companies 
of medical regiments, medical battalions or medical 
squadrons, 
2, Fixed or Non-Nobile Hospitals - they serve the same pur- 
pose in war or in peace. They are established in the 
zone of the interior and the communications zone. Three 
or more general hospitals may he grouped -at one place 
into an administrative and Clinical organization known 
as "Hospital Center", A part of the Hospital Center 
may form a "convalescence Gamp". In the Fixed or 
Non-Nobile Hospitals are classed: 
' ' a. Station hospitals, 
b. General hospitals, 
B, In Peace - military hospitals in time of peace are of two 
general types: 
1. Station Hospitals - they function under local comman- 
ders, 
2, General Hospitals - they function, in peace time, under 
the immediate direction of the Surgeon General, 
ADMINISTRATION OF FIXED HOSPITALS 
For convenience of administration and in the interest of 
.professional efficiency, the Commanding Officer (Surgeon) of 
‘each Army Hospital, organizes the professional, and other acti- 
vities of his hospital into services -and proscribes the number 
and the line of control over them and their relationship to 
each other. In the absence of the Commanding Officer, tho 
Registrar, or some medical Officer designated by the Command- 
ing Officer, may command the detachment of patients, 
THE ADMINISTRATIVE SERVICE 
The Administrative Service of a fixed hospital includes 
such personnel and activities as the Commanding Officer may 
proscribe. A. Personnel: 
1. Commanding Officer, 
2. Executive Officer. 
3. Adjutant. 
/+. Personnel Officer. 
5. Registrar. 
6. Officer of the Day, 
7. Chaplain. 
8. Chief Nurse. 
9. Mess Officer, 
B. Activities. 
1. Admission and discharge of patients. 
2, Hospital inspection. 
i3• Detachment, Medical Department. 
A. Hospital Mess. 
5. Fire control. 
6. Summary court. 
7. Recruiting, 
8. Post Exchange. 
9. Training of detachment. 
TITLES OF DUTY PERSONNEL 
TYTT'rV 
w* <J -L X 
Commanding Hospital (Surgeon) 
In charge of a service 
Commissioned assistant on a service 
Officer in charge of records of sick and wounded 
Officer in charge of a ward 
Commissioned assistant in a ward 
Nurse in charge of nurse staff 
Nurse in charge of a ward 
Principal enlisted assistant in a ward 
Other enlisted assistant in a ward 
TITLE 
Commanding Officer 
Chief of Service 
Asst, Chief 
Registrar 
ward Officer 
Assistant Ward Officer 
Chief Purse 
Head Nurse 
VTardmaster 
™ard Attendant 
DUTIES CF THE COMMANDING OFFICER OF A HOSPITAL 
A. General. 
1. He is responsible for the administration, delegation of duties, 
discipline and efficient operation of the hospital, 
2. Ke is responsible for the proper preparation of all records, 
reports and registers. 
3. He is responsible for the care and safekeeping of all public 
property which may come under his command. 
/+. He is responsible for the proper expenditure of- inds and supplies. 
5. He is responsible for the preparation of requisiUj.ons, returns 
and pay rolls of the hospital, 
6. He is responsible for the fire control of the hospital buildings. B. Patients, 
1, He determines -what patients are admitted and discharged 
from the hospital, 
3. Me or a commissioned assistant, commands the detachment 
of patients, 
3, He is responsible for supervising the care and treatmont 
of all patients, 
4, When a patient is seriously ill, the commanding officer 
communicates the fact to the person designated by the 
patient, as well as to inform the chaplain on duty* 
5, He provides for ward assignment according to the patient's 
complaint, 
6, In case of death, the required report is made by the corn- 
man din g 01 f i co r, 
C, Personnel. 
1, The Commanding Officer commands them as a detachment, 
2, He assigns them to appropriate duty, 
3, Ho reports their proper returns in the capacity they 
serve, 
4* He requires proper performance of duty by the entire 
hospital personnel, 
5, He requires and enforces proper regulations as to san- 
itary, disciplinary and other requirements of the hospital. 
D, Inspections, 
I4 The Commanding Officer inspects or directs inspection 
of the hospitals daily and of the detachment, medical 
Department, each Saturday, 
PERSONS 73HO DAY BE ADMITTED TO ARMY HOSPITALS 
1, All persons in active military duty, 
2, Persons belonging to the navy 3 nd *dr Force, 
3, Persons belonging to governmental departments, such 
as, Civil Service, beneficiaries of U, 3, Veterans’ 
Administration Bureau, and certain civilians employed 
in government service. 
HOSPITAL ORGANISATION 
The general organisation conforms to Army Peculations 
40-590 and consists of two major divisions1 
A, Admini str a tive, 
1, The administrative division consists of personnel end 
activities as follows* 
a. Commanding Officer, 
Id, Executive Officer, 
o’. Adjutant, 
d. Personnel Officer, 
e. Registrar. 
.344 f. Officer of the Day. 
<r. Chaplain, 
h. Chief Nurse. 
i. Mess Officer. 
B, Professional division consists of services subdivided into 
sections and clinics as follows: 
a. Surgical Service. 
(1) Anesthesia* 
(2) General Surgery. 
(3) Septic Surgery, 
(4) Obstetrics and Gynecology. 
(5) Urology and Venereal Diseases. 
(6) Eye, oar, nose and throat. 
(7) Roentgenology • 
(8) P! iys 1 o t he rapy • 
b. Medical Service. 
(1) General Medicine. 
(a) Cardiovascular• 
(b) Oastro-intostinal. 
(2) Contagious Diseases. 
(3) Neuropsychiatry. 
(/,) De rmatolo gy. 
(5) Detention. 
c. Laboratery Service. 
d. Dental Service. 
o’. Out-Patient Service. 
(1) Pro-natal Clini c. 
(2) Pediatric Clinic. 
(3) General laminations and Treatnents. 
(u) Prophylaxis, 
(5) Pharmacy. 
HOSPITAL BUILDINGS 
The Commandirg Officer is responsible for hospital buildings 
ard must not .permit them to be used for other purposes such as 
quarters, mess, etc., except for patients, personnel and civilians 
on duty. If doomed absolutely necessary, mess and quarters for 
officers on duty may be permitted. 
FIRS CONTROL 
The Commanding Officer is responsible for instituting proper 
measures for prevention of fires. He may include measures pre- 
scribed by higher authorities such as appointment of competent 
fire marshal, formulation of adequate regulations for prevention 
of fire and neriodic fire drills, etc. 
REPORTS, RECORDS AND RETURNS 
The Commanding Officer is responsible for proper and timely 
rendition of all reports and returns pertaining to th ospital 
as -well as official records thereof. SURGICAL SERVICE 
The Chief of the Surgical Service will be responsible for the care 
of all patients in the Surgical Department of the hospital. He will 
ordinarily servo as operating surgeon and will be directly in charge of 
the patients in the officers' and women's wards. He will be responsible 
for the presence at all times, in all sections of his department, of 
sterile equipment, appropriate apparatus and sterile solutions, etc. 
EDIGAL SERVICE 
The Senior Medical Officer assigned to the medical service will be 
known as the Chief of the Medical Service, 
He is responsible for the proper conduct of all sections and wards 
included in his service and will make such inspections and require such 
reports as may be necessary, 
I.ABC RATCF.Y SERVICE 
The Senior Medical Officer assigned to the laboratory is known as 
the Chief of the Laboratory Service, He is responsible for proper 
maintenance of the service, including the character and accuracy of all 
work done in his service. 
The laboratory will furnish the following services for the hospital; 
1. Routine examinations of urine, feces and sputum, 
2. Darkfield examinations. 
3. Blood counts, blood chemistry determinations, 
A. . Collection and shipment of blood for Wassermann test, cerebrospinal 
fluid for examinations and specimens of tissue for histo- 
pathologic al ex a mi nat io n, 
5, Examination of water, 
6. Selection of blood donors, 
'7. Preparation of Dakin's Solution, 
B. Maintain the supply of Molegicals and insulin. 
9, nerform auto ps i e s. 
WARD OFFICER 
The Ward Officer has charge of the ward to which he is assigned. 
He is responsible to the Chief of Service for; 
1. The care, comfort, diets'and treatments of all the patients 
therein, 
2. For the proper performance of duties of nurses, enlisted men 
and other attendants in compliance with hospital regulations. 
3. For the economy of all government supplies and materiel, 
A, For the cleanliness and sanitation of the ward and surrounding 
grounds. 5. For the discipline and general conduct of the ward, 
6, Ho makes a complete inspection of his ward and grounds 
each morning# 
THE REGISTRAR 
1, The registrar has charge of all medical and surgical 
records and sues that careful and accurate clinical 
histories, statistical tables, etc,, are kept, 
2, Ho prepares all reports and returns pertaining to the 
sick and wounded, 
3, If too coinmanding officer does not assume direct com- 
mand of the detachment of patients, the registrar may 
have that function, if designated by the Commanding 
Officer, 
A, In this capacity ho has charge of the serve• records, 
accounts, and returns of patients, 
5. The registrar has a responsibility in connection with 
patients’ money and valuables, namelyi 
a. Upon admission of patient to the hospital, patient 
is informed the hospital will receive for safekeep- 
ing money, valuables, jewelry, keepsakes, etc,, for 
which a receipt is issued by a commissioned officer, 
b. In case patient is unconscious, a witness must be 
present when money and valuables are removed for 
safekeeping, 
c. Money, valuables, etc., are receipted for and ra- 
ce ivod by the registrar, 
d. Articles of considerable value are deposited in a 
bank or locked in hospital safe, 
e. Articles of lesser value may be stored in locked 
compartments in a well safeguarded room, 
f. .ahlisted men arc not permitted to receive money or 
valuables from patients for safeguarding* 
£, b/hen a patient is discharged, transferred or dies, 
his money and valuables are disposed of in accor- 
dance with regulations for disposal of effects 
and public property, 
6. Lathed of Accounting for Money tnd Valuables: 
a. Custodian or registrar keeps a book of receipt 
blanks and stubs (numbered serially), 
. b. Registrar gives patient receipt listing money and 
~ valuables given him for safekeeping and patient 
signs duplicate stub, 
c. Money is deposited in bank or safe credited to 
"patient's fund", 
d. Custodian keeps patient’s cash account aich is 
balanced each month or when audited,' 
o. Custodian keeps account of patient's money and 
valuables in a ledger, 
f. Patients withdrawing money or valuables must pre- 
sent receipt, Custodian notes on back of receipt 
and stub, date and amount of money withdrawn. £• Fhers money or valuables are withdrawn, patient is required 
to initial entries on his individual account in the ledger, 
h. The Commanding Officer designates an officer other than 
the registrar to audit patient’s funds at the end of each 
month. 
PUBLIC PROPERTY 
1. When practical patients on being sent to the hospital leave arms 
and accoutrements with their organization. 
2. When brought to hospital, property is safeguarded as prescribed 
by regulations. 
3. If patient’s disability is slight, requiring but a few days, 
the property is kept intact, tagged and stored, and returned 
to him on return to duty; other-vise, if practical, it is turned 
over to his Company Officer whose receipt is required. 
4, If not practical to turn property over to his Company Officer, 
the office at the hospital takes up Medical Department property 
in soldiers’ possession and forwards receipt thereof to the 
accountable officer. 
5. If hospital property officer is accountable for quartermaster 
or ordnance property, he takes up on quartermaster or ordnance 
papers all property belonging to those departments brought, in 
by the patient; otherwise, ho transfers such property to nearest 
representatives of said departments whose receipts are required* 
6. Patient’s Commanding Officer is immediately notified of all of 
above action. 
PERSONAL EFFECTS OTHER THAN MONEY AND VALUABLES 
1, Upon admission to the hospital these are checked and listed on 
patient’s property card in his presence, and bundled and tagged 
for identification. If conscious, the patient signs the 
property card. 
2. Soiled clothing is washed as part of hospital laundry and 
disinfected, if necessary, before stored. 
3. Original property card is filed with hospital records and 
duplicate held by patient or kept at his bedside. 
U. When patient returns to duty or is furloughed or discharged, 
and leaves hospital, the Property Officer restores effects and 
takes receint therefor. 
5, When patient dies or deserts, effects are disposed of as indicated 
in AR 615-300, 
6. In case of transfer to another hospital, his effects are restored 
and receipted for by the patient. 
7. If unable to take care of them, the effects are entrusted to 
the senior officer or enlisted man accompanying him. 
-?48- files 
The attendant in ch&rga of the* patients’ clothing and baggage 
room, under the direction of the commanding officer, detachment of 
patients, will be responsible for the proper keeping of all records, 
and the safekeeping and care of all property in the storeroom. Records 
kept in the patients’ clothing and baggage room will include, 
JIVE FILE 
A file of cards for the effects of patients in hose;, del, to be known 
as the lira File, 
DEAD FITE 
A file of cards for patients who have left the hospital ari have 
taken their effects with them, to bo known as tbs Dead File, 
SUSPENDED FILE 
A file of cords for patients who have left the hospital and have not 
taken their effects with them, to be known as the Suspended File, 
index: location box 
A suitable location index is maintained by the registrar of edi 
hospital showing the name of each patient, the date of his admission, 
and the ward where he is being treated, 
KEPICAL OFFICER OF IFF DAI 
The- Hodical Officer who is to serve as Officer of the Day is notified 
by a 7/ritten order the day before. His tour of duty is 24- hours, commence 
ing at 8s30 A.M, "hilo sc detailed, ho acts in an administrative 
capacity for or in the absence of the Surgeon, to safeguard patients, 
government property, and perform the necessary professional duties for 
and in the absence of officers of the professional services, 
A. Duties of the Medical Officer of the Day - they are of wide range 
and most important in character. It is his duty to *ive such 
orders and make such recommendations as may be to v .. best interest 
of the institution and for the time .being to see that no patient 
is neglected or that any. irregularities occur which might bring 
discredit upon the institution or upon the Medical Department as a 
whole. In general £is duties are as follows? 
1, He will taka the necessary steps to insure the proper conduct 
of all persons on, duty. 
2, During his tour of duty he will remain -on the reservation at all 
times and whenever he leaves the hospital for any purpose, 
will notify the noncommissioned officer in charge of quarters 
where he may be located during such absence. 3, He will nake inquiry- at the registrar’s office regarding 
the total number of patients in the hospital, the 'number 
in each contagious, genito-urinary and detention ward, 
A* He •dll obtain from the chiefs of service the names and 
locations of seriously ill patients and any pertinent 
instructions regarding them, 
■ 5, He will determine at once, after going on duty, the name 
of the noncommissioned officer in charge of quarters and 
will give the noncommissioned officer such instructions 
concerning his duties as may be necessary, 
B, Inspections, 
1, Hospital, 
a. The Officer of the Day accompanied by the noncommis- 
sioned officer in charge of quarters will make at 
least two (2) inspections of the hospital during the 
tour of duty, one being between 6:00 P.li, and 12:00 
midnight, and one between midnight and 6:00 A,M.^ 
2, Patients, 
a. Ha makes inspection during the night of all the 
patients in each.ward, and gives such emergency 
treatment as may be required, 
3, Moss, 
a. The Medical Officer of the Day will inspect at 
least one meal daily served to patients in the 
moss hall and in the wards. He will report upon 
the character of the food served, if unsatisfactory, 
A* Fire Control. 
a. In the event of an outbreak of fire, the Medical 
Officer of the Day will immediately assume charge 
until the fire marshal or the chief of the fire 
department arrives, taking steps in the meantime 
to sound the alarm, put out the fire, and remove 
patients, if indicated, 
5, Deaths, 
a. In case of death, in the absence of the Ward Of- 
ficer, the Medical-Officer of•the Day will examine 
the body personally and superintend its removal to 
the morgue. He will nake a record of the deceased’s 
name, rank, organisation and address of the nearest 
relative, and properly tag the body for identifica- 
tion., He will take precaution to insure safekeep- 
ing of the body. He will collect all money and 
valuables and other effects of the deceased, list 
them in duplicate and deliver them to the registrar, 
taking the registrar’s receipt on the duplicate . 
copy of the list. He will see that the nearest re- 
lative and proper authorities are notified, exer- 
cising caution so there will not be a duplication 
of notification. THE HOSPITAL MEGS 
» 
A. Mess Management. 
1, At large hospitals, Commanding Officer may put mess under 
supervision of a junior officer, 
2, Food supplies and rations are issued by Quartermaster Corps 
or come from hospital gardens and articles purchased from the 
hospital fund, 
3, If rations are not sufficient for hospital needs, Commanding 
Officer makes application for additional rations through 
the Adjutant General, 
A. Hospital mess constantly supervised by the Commanding or Mess 
Officer, He requires all bills to be paid at the end of each 
month, 
5. Bills of fare and prescribed diets made out under supervision 
of the Commanding Officer or Mess Officer, and posted in wards 
and kitchens, 
6. Ward. Officer after rounds fills out diet* card from 73 M.D,, 
covering diet requirement for 2A hours. 
7. Hospital mess placed under immediate charge of c petent non- 
commissioned officer, the mess sergeant, 
B. Mess Sergeant. 
1. The mess sergeant supervises the mess, cooking and serving of 
food. 
2. He is responsible for the cleanliness of the kitchen, mess halls, 
and storerooms and for the orderliness and cleanliness of cooking 
utensils. 
3. He prepares a daily list of articles needed for the m ss and 
submits it to the mess officer, 
A. He is in.charge of cooks and F.P.'s and is responsible for their 
conduct, work and cleanliness.* 
C. Moss Officer. 
1. Has charge of and is responsible for the general administration 
of all messes that pertain to the hospital. 
2. He is charged with the responsibility of selecting, purchasing, 
care, issue, preparation and serving of all food supplies, 
except for the nurses' mess, which functions under the immediate 
supervision of the chief nurse, 
3. He will see that the equipment for handling, preparing and 
serving food is adequate, clean and properly•cared for, 
A. He is custodian of the hospital fund and as such will keep 
account for and disburse the fund in accordance with existing 
regulations. 
5. He keeps concise and complete records of all transactions, 
inventories, and cash disbursements, of the mess. GOr.:TTATTOM OF RATIONS 
A. Classes, 
1. The ration of any of the following classes, while a 
patient in a hospital, dispensary, hospital station, 
hospital ship, army transport, hospital train, or con- 
valescent camp, pertaining to the array, is commuted 
at the rate indicated in B. 
a. Enlisted men in the active service of the United 
States (including enlisted men of the Philippine 
Scouts). 
b. Enlisted men of the National Guard, National Guard 
Reserve, or Enlisted Reserve Corps admitted from 
training camps or service schools. 
£, Discharged soldiers undergoing treatment, 
d. Applicants for enlistment. 
Civilian employees of the army who are entitled to 
subsistence at public expense, 
f. Prisoners. 
g. Destitute persons admitted to hospital, 
B. Rates. 
1, At tubercular establishments, actual cost, j)luo 90$; 
all others actual ration cost, plus 50$. 
2, Reserve officers training corps while in hospital has 
same rate ration allowance as for trainees under in- 
struction at such camp. 
3* National Guard and National Guard Reserves (officers) 
entitled to ration at government expense while in hos- 
pital which is commuted at rate of ration charge for 
officers of Regular Army. 
C. Vouchers Covering Commutation, 
1. Vouchers covering the commutation referred to above are 
prepared by the custodian of the hospital fund of the 
Medical Department unit concerned. 
SUBSISTENCE AND MEDICINE CHARGES 
A. Subsistence Charges, 
1, The following is the schedule of rates for subsistence 
charges for patients in Medical department establish- 
ments (except the Army and Navy and Fitzsimons General 
Hospitals) who are not entitled to commutation of ra- 
tions, Rates for patients in the Army and Navy and 
Fitzsimons General Hospital are found in AR 40-605 and 
40-610. 
a. lor officers, warrant officer of the United States 
Navy and Marines and nurses, $1,00 a day, except in 
hospital stations where the rate is an amount equal 
to the commutation rate prescribed, plus 10 cents a 
day. Also for civilians on the status of officers, 
$1.00 e day, except in hospital stations. 
Also Red Cross workers, physiotherapy aides and 
dietitians' pay *>1,00 per day in fixed hospitals, 
b. For retired enlisted men of tho Army, Navy and Marine Corps 
and for civilians on the status of enlisted men, an amount 
equal to tho garrison r-'tlon plus 501, plus 10 cents a 
day., plus 25 cents for enlisted status and 50 cents 
for officers' status per day for maid service, (Circular 
Letter No. 13, S.T.o/, dated February 20, 1941). 
B, Medicine Charges 
1. ■Medicine.(including dressings) charges are made for patients 
in Medical Department establishments who are not entitled to 
medical care and treatment at tho expense of Army appropriations, 
including officers and enlisted men of the Navy and Marine Corps, 
civilian employees and civilians. 
2, Tho rate of medicine (including dressings) cha; as for patients 
in Medical Department establishments is 50 cents per day, unless 
tho actual cost of the medicine (including dressings) exceeds 
that.amount, in which event the rate bo actual cost of the 
medicines (including dressings), 
MEDICAL INSPECTOR > 
1. Tho Medical Inspector will make frequent inspections of all 
offices, departments, services and.wards to determine whether 
or net the hospital and other regulations are being complied 
with.. 
2. He will observe and report upon such matters as may come to 
his attention■with a view to the correction of irregularities, 
and will promote general efficiency, • 
3. He will scrutinize* closely all matters affecting directly or 
indirectly the health.of the command. ... 
4. He will keep' such records as will permit accurate-and complete 
reports of sanitary conditions and actions taken or recommended, 
5. His duties as«Medical Inspector of the command rre fully set 
forth in AR 40-270, "The Medical Inspector". 
THE CHIEF NURSE ' " 
A. General. '• : 
• 1, The Chief Nurse is under the immediate jurisdiction of the 
Commanding Officer, 
2. She will have general supervision of the nursing service in 
all wards and services in which members of tho Army Nurse Corps 
are on duty. 
3. She will be in charge of the nurses’ quarters a. the nurses* 
mess, 
4. Oho will be- responsible for the orderly condition of all 
departments in tho nurses' quarters and for all property 
contained therein. 5. She will report promptly any repairs which may be required at 
the nurses’ quarters. 
B. Instruction. 
1. She will familiarize herself with Army Regulations insofar as 
they relate to the Armj- Nurse Corps, and will instruct the 
nurses under her supervision in such regulations and in the 
duties peculiar to army work, 
2, When required by the Commanding Officer, she will supervise 
the instruction in practical nursing of the Medical Department 
enlisted men on ward duty. 
C. Supervision of Nurses. 
1. She will exact the proper performance of duties, and is responsible 
for discipline among the nurses, both on and off duty. 
2. She will report any neglect of duty, serious breach of 
discipline, misconduct to the Commanding Officer, 
3. She is responsible for the comfort and well-being of the nurses 
under her charge, and will promptly report to the Commanding 
Officer any matters which unfavorably affect the same. 
4. She will arrange the hours of duty and assignment of all nurses, 
subject to the approval of the Commanding Officer, and will be 
responsible for the execution of all orders relating thereto. 
5. She will also bring to his attention, at once, any cases of 
illness among the nurses. 
D. Records and Preparations of Reports, etc, 
1. She will be responsible for the proper keeping of the required 
records of the members of tho Army Nurse Corps and will prepare 
the pay vouchers, reports, returns, and official correspondence 
pertaining thereto. 
DUTIES OF THE HEAD NURSE 
1. The Chief Nurse will designate one nurse for each ward to act as 
its responsible nursing head. 
2. Under the direction of the ward officer the head nurse will be 
in charge of the ward, patients, nurses, enlisted personnel and 
other oersons assisting in nursing care of the patients, and 
will be respected and obeyed accordingly. 
3. She will advise the Chief Nurse concerning the efficiency of 
nurses under her, and will report upon efficiency of the enlisted 
personnel in the ward to the ward officer, 
4-. Her hours of duty will be same as other nurses, 
$. She will be responsible for: 
a. The receiving and recording of all orders relating to 
the care and treatment of patients in her ward, 
b. The proper administration of all medicines and treatment. 
."54- c. The proper serving of all foods in the ward. 
cT. The careful, accurate, and legible preparation of 
all ward records and routine reports required. In 
this connection particular care will be taken in 
maintaining the ward narcotic register, 
0, The procurement of such medicines from the pharmacy 
daily as are required by the ward officer. The Head 
Hurso will keep opiates, narcotics, alcohol and al- 
coholic liquors under lock and key at all times, re- 
taining the key in her personal possession. She 
will keep an account of all receipts and expenditure 
of such drugs in a book provided for tlr purpose, 
account will be balanced monthly shoeing all 
receipts and expenditures and the balance on hand, 
f. The checking and care of ward property and prepara- 
tion of requisitions for needed supplies for the 
signature of the ward officer. Such articles as 
are needed for use in the ward will be drawn from 
the proper supply department at the prescribed 
time and receipt given for same. All property 
not in use in the ward will be kept in the store- 
room. Surplus property will be turned in to the 
proper supply department. 
g. The cleanliness, orderliness of the ward, other 
rooms and space connected with the ward activities. 
The linen storeroom will be kept in a neat and 
clean condition at all times. It will be kept 
locked. Ahe head nurse will keep the key to the 
linen storeroom in her personal possession, 
h. The proper observance of the hospital regulations 
■raid rules for patients, 
1. The proper bathing of patients in the ward, all 
patients in hospital should receive baths twice 
a week and bod patients at least every second 
day unless contraindicated. 
The recording of the exact hour and minute of ad- 
mission on Form 55 j an the case of each patient ad- 
mitted to the hospital and the tine the patient is 
first seen by a medical officer, 
DUTIES OF PURSES 
1. The duty of any army nurse shall be such as s usually 
performed by a trained nurse in civil hospital of like 
character as far as is practicable. Their tour of 
duty will not ordinarily exceed eight hours per day. 
2. A nurse will not be required, except under stress of 
emergency, to serve more than one month in three on 
night duty. 3. Day nurses are at all times responsible to the head nurse 
for the nursing service in the wards to which assigned, 
under the direction of the ward officer, 
4. Night nurses are responsible during the night to the su- 
pervising night nurse, if there is one; otherwise, they 
are directly responsible to the Chief Nurse for the 
nursing service in their respective wards. In either 
event, the night nurses, on being relieved by the day 
nurses, will make a written report of their work to the 
supervising night nurse or the Chief Nurse, as the case 
may be. 
DUTIES OF TJARDNASTER 
This position is usually held by a noncommissioned officer. 
Ho is directly responsible to the head nurse, and in turn to the 
ward surgeon* His duties .are usually directed by the head nurse, 
and he is in charge of the enlisted men of the ward* It shall 
bo his duties to supervise and direct the proper policing of the 
ward, the proper conduct of the enlisted personnel and patients. 
He is in no manner responsible for administration of any type of 
medications except enemas, and then only upon direction of the 
proper authority, Unite frequently he is in charge of linen 
exchange, the proper care of ward fixtures, furniture, floors, 
etc. He may also be detailed to see that the requisition for 
medicine and supplies are obtained at the proper time. Ho assists 
in the collection of patients' clothing upon admission, and their 
return from storage upon the patients’ discharge. He may assist 
in undressing or dressing of patients, and also administering 
to their comforts in a general manner. He may direct the en- 
listed personnel to assist in any of the ward duties that he may 
feel that they are capable of performing* 
DUTIES OF ENLISTED PERSONNEL 
The unlisted personnel are usually chosen for ward work be- 
cause of some past experience or particular adaptability. I'hey 
ordinarily have no special duties, but assist in the general ward 
work,, or they are directed by the ward master, head nurse, or 
ward surgeon. 
ROUTINE ORDER OF PATIENTS ENTERING A MILITARY HOSPITAL^ 
Patients entering hospital are either Ambulatory (walking) or 
Ambulance (carried cases)/ They enter the hospital through the 
Receiving Office of Outpatient Department or the First Aid Depart- 
ment. 
In either case preliminary examination and first aid treat- 
ment may be given and necessary data for the admittance record 
slip ("AD., H.D. Form No, 54a) are made out in triplicate and 
signed by the patient. He retains one; one is kept on file and 
the other sent to the Registrar’s Office. The money and valuables 
are deposited to the patient’s credit and placed in the hospital 
safe. In case the patient's condition warrants hospitalization, he is 
sent to the ward most suitable for his condition, accompanied by the 
admittance report slip, 55 a I:,D. 
In case of serious illness the patient may go direct to the ward 
where admittance card is made out and omorgency surgical cases may 
go direct to surgery, if condition indicates the necessity for im- 
mediate surgery. 
At the ward the patient is given hospital linen. His linens 
are sent to the laundry and his clothing tagged and stored until 
needed* if necessary he is bathed, but as a rule, no treatment 
given until he is seen by the Ward Medical Officer, who makes a 
complete physical examination and orders necessary treatment and 
tests. 
The clinical record blanks of the 55 series, necessary for 
each particular case, are filled in by the medical officer or 
nurse or attendant appointed by him. 
Special forms as for Surgery or X-Ray are completed as indi- 
cated by patient's physical findings. 
Necessary laboratory forms are usually made out by the head 
nurse. 
Daily physical examination determines progress made by the 
patient. This information is recorded on the progress report 55, 
If complications develop or surgical measures are necessary, 
the ward officer calls in the Chief of Service who makes recom- 
mendations, At that time the required slips arc made out by the 
ward officer. 
If the patient convalesces satisfactorily and can be dis- 
charged from the hospital, the Commanding Officer, or his repre- 
sentative, discharges him, either to duty; to quarters for further 
convalescence; to another ward, if necessary, for further obser- 
vation and treatment; bo another hospital in case of insanity 
(with the approval of the burgeon General); or discharge from 
duty as in case of permanent disability - subject to +ho ap- 
proval of the Surgeon General, 
In the event of death of soldier, the attendant or nurse 
ward officer, or if he is not on duty, the officer 
of the day, who examines the body and determines whether or not 
the patient has died. If so, the Death Report is made out ar;d 
sent to the Registrar. The body is sent to the morgue where 
it comes under the supervision of the Chief of Laboratory Ser- 
vice who directs its' preparation for burial. The various a- 
peratures are plugged with cotton to prevent escape of secretions 
or fluids. It is washed, shaved, dressed and properly tag ed, 
(usually one on big toe and one on the thumb), unless" autopsy 
is requested. In this case the autopsy is done by the Labor- 
atory Cacti on. This precedes the preparations for burial. 
The deceased's relatives are notified by the Commanding Officer 
who also notifies the chaplain and undertaker. All transpor- 
tation in connection with burial is furnished by the quarter- 
master department. LAUNDRY AMD LIHijK EXCHANGE 
\ 
1. The Medical Supply Officer is in charge of laundering the 
hospital linen. He will maintain a sufficient supply of 
clean linen at the linen exchange to meet the regular re- 
quirements. 
2. An enlisted man of the Detachment, helical Department on 
duty in 'ward service or department, mil attend to the ex- 
change of soiled linen for clean linen and not delegate the 
duty to a patient, 
3, The hospital laundry consists of: 
a, linen clothing and bedding of nodical Department, 
b. hashable linens of patients being treated, 
c. ’shite coats and trousers of enlisted men, 
d, Uniforms of army nurses. 
£, hashable linens of employed civilians. 
PHARMACY MAUAGSMEUT 
The management and operation of the pharmacy at the hospital 
mil be in conformity with paragraph 18, AP, 40-390, 
The Medical Officer in charge, or some medical officer appoint- 
ed by the Commanding Officer, of the outpatient service, mil, in 
addition to’his other duties, be in charge of the pharmacy. He is 
responsible for its management and proper operation. He mill cause 
thw necessary records to be maintained in case of alcohol, alcoholic 
liquors and narcotics. Ho will be responsible for collection of medi- 
cine charges prescribed by AR 40-590 for civilians not entitled to 
medicine at public expense, Ahese drugs must be kept under lock and 
key at all times. There will be also a 11 Poison” locker kept in the 
pharmacy with sufficient space for emergency amounts of alcohol, al- 
coholic liquors and narcotics for the use of the medical officer of 
the day. 
Keys to the alcohol and narcotic vault will be hold in the per- 
sonal possession of the medical supply officer. Hone are kept on the 
keyboard, keys to the pharmacy poison locker will bo issued to the 
pharmacy officer. Duplicate keys will be kept in the hospital safe 
and not on keyboard. 
THE MORGUE 
The chief of the laboratory service is in charge of the morgue. 
He is responsible for all bodies from the time they are received from 
the wards until they are delivered to the undertaker. 
He inspects ell bodies before turning them over to the undertaker 
and again at the undertaker’s establishment after preparations arc 
completed for shipment or burial. 
A certificate of inspection will be submitted by the laboratory 
officer, stating whether or not remains are prepared and properly 
dressed for burial* 
358 HOSPITAL FUt’D 
The hospital fund is maintained in everTr hospital for the purpose 
of providing mess for the hospital personnel and patients, and 
authorized and legitimate recreation and entertainment. 
The sources from which the hospital fund are derived are; Ration 
allowances of patients and enlisted men on duty; dividends from the 
post exchange; sales from the garden; money received for the subsistence 
of officers and civilians treated in hospital; the sale cf property 
purchased with the hospital fund or products pertaining to the hospital 
fund; nurses subsisted in u mess conducted by the commanding officer. 
The hospital fund is kept by the commanding officer or by the mess 
officer, or by an officer detailed by th® commanding officer fcr unis 
duty, who is held responsible for the loss of any portion of the fund 
not deposited in a bank or the hospital safe. Expenditures therefrom 
are limited to the purchase of food or other articles for the benefit 
of patients and enlisted men on duty in the hospital. Savings on food 
supplies (rations) may bo spent only for the purchase of food for the 
messes, 
A statement of the hosuital fund is prepared monthly and audited by 
the hospital council, the. proceedings of which are recorded on the retained 
statement, of the hospital fund. Articles such as musical instruments and 
athletic appliances, purchased with the hospital fund, are known as 
'"durable property11 and remain the property of the hospital fund, being 
accounted for on the return. All hospital fund statements are finally 
approved and filed in the Surgeon General’s Office. 
PATIENT'S FUND 
The custodian will deposit all money in the hospital safe or a local 
bank to the credit of ’’Patient’s Fund", Honey deposited in a bank will 
draw no interest unless the patients to whom it belongs signify in 
writing their consent to the transfer cf any accrued interest to the 
hospital fund. The custodian will keep a patient's fund cash account 
wherein will be debited all money received from, and credited all money 
returned to patients. This cash account will be balanced at 'east once a 
month end then audited. 
Any patient desiring to withdraw money or valuables will be required 
to present his receipt. The custodian will note on the back $£ the 
receipt and on the stub the date and,amount of the withdrawal, and will 
require the patient to initial or sign both. In case of withdrawal of 
all the patient's deposits, the custodian will take up the receipt end 
attach it to the proper stub. Likewise, a patient on withdrawing money or 
valuables will be required to initial the entries thereof on his individual 
account in the ledger. In no case- wi!3 money or valuables belonging to 
a patient be turned over to an enlisted man for transmission to the patient. 
The commanding officer of the hospital will designate an officer other 
than the custodian to audit the patient’s funds at the end of each month. HOSPITAL RULES 
Tne Commanding Officer or hospital is responsible for formulation 
ana enforcement of the rules, 
B, General Rules. 
1* °^IlcersJ11} cnar£9 of public property must keep accurate account 
oi it and its distribution. 
rach person in charge of a hospital department is responsible 
for property of that department. 
3. Property in possession of men must be left in good order? 
damaged articles must be accounted for. 
4. A person assigned to hospital must familiarize himself with 
rules governing it. 
5. All non-coms and privates of detachment must be present at all 
lormations, unless excused. 
6. All men for cmty in kitchen and mess room will be on duty at 
least an hour before reveille, 
7. Immediately after reveille each man must arrange bed and personal 
belongings in orderly manner (clothes cleaned, shoes brushed, 
etc.). 9 
c. Beds overhauled and cleaned each week-and mattresses aired 
covers changed after monthly inspection. 
9. Card with name of soldier attached to foot of bed. 
Squad room always kept in orderly manner, 
. men to pay attention to personal cleanliness, - bathe at least 
once a week, 
12. members cf detachment wear prescribed uniforms when on duty at 
station, when in wards have ward clothing1, and when on fatigue 
duty, wear fatigue clothing. 
ho member of detachment can leave hospital except by permission 
cx proper autnonty, or in case of emergency. 
14. Immediately after breakfast, hospital is policed and cleaned, 
ready for inspection by the Commanding Officer. 
i-5. No member of hospital personnel permitted to borrow from or have 
linancial dealings with patients, 
lo. A non-commissioned officer in charge of quarters is detailed 
ailN roster from non-commissioned officers on duty. 
-i-/. Non-commissioned officer in charge of quarters makes inspection 
cf all wards and quarters at such time as the Commanding Officer 
of hospital directs and reports; 
— • unauthorized absentees and non—commissioned officers in 
charge of detachment, 
o. Sees no unauthorized lights a.re burning, 
Oc Gives alarm in case cf fire and proceeds as ordered in fire 
regulations. 
—• responsible for efficient duty of the general guard on 
hospital grounds at least once every hour. RULE? FOR ATIENTS 
A. Patients are under the. command of the surgeon of the uospital; they 
are under the direct command of the ward officer, a; in the absence 
of the j.atter, the head nurse. In wards where there are no nurses 
on duty, they are under the jurisdiction of the ward master or non- 
commissioned officer in charge, 
B. Rules for patients will be posted in each ward and should be read 
by all patients, who will be held accountable for their observance. 
C. Patient’s Effecx-st money and valuables will be kept with the 
Registrar or an officer designated by the surgeon who will give a 
receipt for money or valuables left in his trust. The hospital is 
not responsible for losses unless turned over to the proper authority, 
Patients receiving money or other valuables while in the hospital must 
deposit these likewise with the proper authority. 
D. Hospital clothing and toilet articles for patients - clothing '3 
provided for patients while in the hospital. All clothing brought to 
the hospital must be turned in to the clothing and baggage room. 
Patients coming to the hospital must bring with them their toilet 
articles, consisting of razor, shaving soap, tooth brush, tooth 
powder, comb and hair brush. No other articles will be brought. 
Towels and toilet soap will be furnished by the hospital, * 
E. Patients are forbidden to have any financial dealings with hospital 
enlisted personnel. 
F. Conduct of Patients - loud noises, boisterous or improper action, the 
use of profane language, and gambling are forbidden; and no food, 
intoxicants, narcotic drugs, or other articles of drink, except as 
prescribed or authorized, will be permitted into the hospital or 
used therein by patients or personnel, 
G. Patients messing in the mess hall will remain in their wards until 
notified meals are ready to be served. They will then report quietly 
to the mess hall, 
H. Passes - absence.of patients - patients must remain in the v;ard except 
when authorized to leave by the ward officer. Patients absent without 
authority are A.F.O.L, Patients placed in isolation wards are 
responsible for maintenance of isolation. 
I. Ward telephone - telephones will not be used except for official 
business between 7; 00 A.M, and 7;00 P.M, Patients will not be per- 
mitted to use phones unless authorized by ward surgeon. All un- 
official calls must then be limited to 3 minutes, 
J. liou •Hen cf ward rules and other regulations are punishable by 
discirdj *ry action in the case of enlisted men; or in the case cf 
civil. a ns, a.el from the hojsmifoi under author** t** cf Army 
Regulations. L* Each ambulant patient is responsible for the police of his own'bed 
ana its surroundings. He will keep his person and clothing clean 
and neat, his hair cut, bis face shaved, and shoes clean, 
L. Patients are forbidden to use towels, basins, toilet articles, 
eating utensils or articles of clothing belonging to other patients, 
?7i.RD 
it. Patients admitted to the Detention ward will receive care from the 
proper service to which they belong. The officer of the ward will 
notify the chief of the service concerned of the admission of such 
patient, and will see that all patients in his ward receive proper 
treatment. 
B. Each patient in the Detention *?ard aall be seen by the enlisted 
attendant once each hour and at such other times as deemed necessary 
by the ward officer, 
0, Responsibility for prisoner patients - the ward officer will assume 
responsibility for prisoner patients sick in the Detention Ward. If 
necessary he will call upon the Prison officer for a guard. On 
departure from the hospital the ward officer will notify the medical 
officer of the day of prisoner patients, if any, and the O.D. will 
then assume responsibility for-each prisoner until the return of the 
ward officer. 
D. No natient will be admitted to or confined to the Detention Ward 
except on authority of a medical officer. All patients thus admitted 
will remain in that place, except when permitted to leave by the 
ward officer. 
E, Medicines will not be left within the ward for self-administration, 
but will be administered personally by the head nurse or ward master. 
r. No person except medical officers, nurses, and attendants on duty in 
this hospital will be permitted to enter detention wards. No person 
shall be permitted to loiter in the vicinity of a detention ward. 
G. A careful search of all prisoner patients shall be made prior to con- 
finement. He will net bo permitted to have in his possession any 
articles to affect his release or other articles which may cause bodily 
harm, Ho tobacco or matches will be allowed, A daily search 
including all possible hiding places shall be made for such articles, 
K. All attendants are forbidden to strike or maltreat patients. Any 
attendant using fores upon a patient will be punished, or else he must 
prove the action was necessary to defend his own life or to prevent 
the escape of the prisoner. I. The ward master while on duty will carry one set of keys to the 
Detention Ward, The other s t will be in possession of the 
non-commissioned officer in charge of quarters, 
J. In case of escape of a prisoner the ward officer, the post officer 
of the day and the prison officer will be notified at once and 
efforts made to apprehend him. An investigation as to the 
circumstances surrounding his escape is made and a written report 
is made to the surgeon, 
Fcms 
Specific report forms are necessary to. record essential data 
concerning patients obtaining hospitalization. Some of the most common 
forms used are tabulated in the following outline. 
Clinical outlines are intended to cover all necessary information 
concerning the patient to enable the medical officer to proscribe the 
suitable treatment. All patients entering military hospitals must have 
55a and 55,j blanks completed. The ethers vary according to needs as 
determined by the medical officer. 
A clinical record of each patient will bo started ns soon as 
practicable after admission, using such lettered blanks of MD Form.55 
as the importance and nature of the case demands. They must show an 
accurate, concise record of the patient’s previous history, condition 
on admission, daily treatment while in hospital, and condition on ease 
from the hospital. Similar records will be kept on cases sick in 
quarters. Records of all laboratory examinations will be attached in the 
proper place. In case of transfer from one ward to another the record 
will be completed to date, noting thereon the exact time of transfer, 
the ward to which transferred, and the condition of the patient. The 
record so completed will bo delivered to the new ward. Note will bo made 
by the transferring officer as to whether or net the patient should be 
returned to the original service for further study after completion by the 
service to which transfer is being made. 
The ward master will, after proper checking of Clinical Records, 
send the same to the sick and wounded office, to arrive not later than 
2?00 R,M, the day preceding departure of catlent to duty status. All 
sheets of the Clinical Record will be completed, arranged in proper 
sequence, fastened together, and signed by the ward office • at the 
required time. 
As soon as a diagnosis is mode, it will be entered on the Clinical 
Record, M,D. Form 55, and the Registrar notified. Changes in diagnosis, 
complications, and sequelae ’’dll be noted on M,D. Form 55f and 55g and 
the Registrar will be furnished with a diagnosis of all cases remaining 
under treatment and not previously diagnosed. ♦ 
Heme of Report 
i 
Interval 
V.D. 
K.D. 
j_... Dorm ..Ho. 
Humber of 
Copies 
Scope of 
Report 
Made Out By 
, 
Distributions 
i Surgeon’s Morning 
Daily 
1 
j 
iAR 40-1005 
1 
Rsnort of Sick 
Senior Medi- 
Commanding 
; Report of Sick 
71 
of the Command 
cal Officer | Officer 
j . | 
Ward Morning Report 
I Daily 
iAR 40-590 
2 
. _ . 
Report of the ward 
Ward Officer i Registrar 
j 
72 
accompanied by dia- 
Ward Riles 
i 
■ 
gnosis cards; 
i 
S 
i 
4 
: 
clinical records 
and departures to 
other wards 
- 
. 
! 
i Consolidated Ward 
:Daily 
AH 40-590 
r 
2 
— 
Consolidated Re- 
Registrar 
— 
The Surgeon 
Morning Report 
72a 
port of all wards 
on one form for 
Rile One 
1 
more ranid com- 
parison 
- - 
(Report Sheet for 
;Monthly 
AH 40-1025 
4 
Designation!ueriod 
Senior Medi- 
Original-Corns 
1 Re-oort of Sick and 
j on or 
51 
comnonent marts 
cal Officer 
Area Surgeon; 
; Wounded 
| 
i 
j 
I 
\ 
f 
1 
i 
i 
!before 
:5th of 
; next 
|month 
! ! 
j I 
J i 
of the command; 
variations in 
command mean 
strength;natlent 
days; out-patients 
examinati on s,et c, 
or Registrar 
Copy-Surgeon 
General direct; 
c opy- G o mman di ng 
Officer of 
Ho spi tal;copy- 
Regi strar1 s 
file. 
■ Report Card (attached 1 As case; 
AR 40-1025 
2 
Exact cony of 
Registrar 
Accompanies 
I to Form 51) 
j i s com- 
52 
register cards of 
Rorm 51 which 
1 
| -Dieted t 
r 1 
j 
] 
i 
each case reported 
is sent to 
Corns Area 
1 1 
• 
! 
i 
Surgeon 
SSSBTTIAL REPORT FORMS USED IH ADIOTI STRATI OR OF MILITARY HOSPITALS Name of Report 
I 
1 
Interval 
I). 
Form Fo. 
Number 
of 
Copies 
i 
Scope of Report 
Made Cut _By 
1 n 
Distributions 
Patient’s Property 
Card 
i 
on ad- 
mission 
of pat- 
ient to 
hospital 
| AR 40-590 
75 
2 
Personal effects 
(other than money 
and valuables) 
Ad- ’ ssion 
Officer 
Hospital 
office; dup- 
licate to 
patient 
♦ ' 
Clinical; Record Brief; 
a clinic al record of 
each pal lent admitted 
to ho3p:' tal, giving 
patient’s history; 
also coi tains space 
for fim I disposition 
Upon ad- 
mission 
of nat~ 
ient to 
hospital 
and as 
case pro- 
gresses 
during 
hosoiia- 
AH 4-0-1025 
55a 
55b 
55c-l 
55f 
55g-l 
55h-l 
55h-2 
1 
* 
Clinical Record 
Brief-Chief Complaint 
etc. Physical exam- 
ination; Progress 
Notes; Treatment; 
Temperature-Treat- 
ment ; Nurse’s Not es;; 
Temperature Graphic 
Chart 
Admission 
Officer; Diag- 
nosis or dis- 
position 
signed by Ward 
Surgeon 
Sent to the * 
Registrar’s 
Office only 
when patient 
departs. At 
that time, is 
signed by 
Ward Surgeon 
Clinical Record 
Progress 
Analysis 
of pro- 
gress of 
case 
from day 
to day 
A.R 4-0-1025 
5 5g 
2 
Always completed be- 
fore transfer from 
one ward to another 
or one hospital to 
another 
Ward Surgeon 
Original- 
attached to 
clinical re- 
cord; dupli- 
cate filed 
on transport 
Index Record of 
patier ts 
f 
Upon ad- 
mission 
of pat- 
ient in- 
to hos- 
pital 
AR 4-0-1025 
52a 
1 
: 
Register Index 
Hospital office 
Hospital 
office 
ESSSSTTIAJ REPORT FORM? U3iD IN ADMINISTRATICW CF MILITARY HOSPITALS 
?55- 1 
1 
i 
Name of Report 
i 
Internal 
W' T) t 
M. D. 
Form ho. 
lumber 
of 
Conies 
Scope of Report 
Made Out By 
Distributions 
Feekly Venereal 
Each 
AR 4-0-235 
3 
Resume of venereal 
Senior Medical 
Original; one 
| Report 
i 
Satur- 
day 
morning 
letterform 
cases occurring in the 
command during the 
week 
Officer 
to Post 
Commanderioner 
to Registrar's 
file 
Northly Venereal 
Monthly 
AR 40-235 
4 
Resume of venereal 
Senior Medical 
To the Post 
Report 
* 
on or 
before 
5th of 
next 
month 
letterform 
(see par. 6 
AR 40-235) 
[ 
cases occurring in the 
command during month? 
cases treated during 
month; number of days 
lost from venereal 
disease' comparative 
rates for the com- 
ponents of 8 command 
in the incidence of 
venereal disease and 
the number of 
prophylaxe s adminis- 
tererl to the command 
Officer 
Commander in 
triplicate for 
distribution 
to Corps 
Surgeon,Corps 
Area Commander 
and Surgeon 
General; copy 
to Registrar's 
file 
for the month 
ESSEFTIAI HITCRT PCKMr USED IN ADMINISTRATION CF MILITARY HOSPITALS 
• 366- Fame of Report 
Interval 
! 
r. d. 
M. D, 
Form No, 
Number 
of 
03 
Scope of Report 
Made Cut By 
1 
Distributions 
...... 
Weekly Statistical 
Report 
Weekly 
: 
r R 4-0-1 OS 0 
? 6ab 
: 
| 
o 
J 
[ 
Resume of diseases anc 
injuries occurring in 
the command during the 
week? the number of 
patients admitted and 
discharged during 
week? breakdown of 
number of communicable 
diseases occurring by 
name and other per- 
tinent data relative 
to- health conditions 
Registrar r-» 
Senior Medi- 
cal Officer 
Original to 
Corps Surgeon 
duplicate to 
Surgeon 
General direct; 
copy to 
Registrar’s 
file 
Monthly Sanitary 
Monthly 
AH 4-0-275 
j- u 
r 
Resume of sanitary 
Senior Medical 
Original and 
Report 
on or 
1ottorfora 
and health conditions 
Officer 
2 conies to 
before 
of the; command for 
Pest Commander 
jthe 5th 
month spoolfied, with 
for distri- 
of next 
r. commendations from 
bution to 
month 
the Senior Medical 
Corps Area 
Officer for such 
Command erj 
changes as may improve 
Registrar’s 
general sanitary or 
file 
health conditions of 
j 
Post or command to- 
i 
( 
gather with report of 
i 
any epidemics,unusual 
incidents of unsani- 
tary conditions and a 
report of new methods 
or equipment placed 
into operation for im- 
provsmart of general 
sanitary conditions 
rtjpcrt used r adkini-tratiot: cr military hospitals 
r.367, Name of Report 
Interval 
| w. D. 
A.G.C. 
Form No. 
Number 
of 
Copies 
Scope of Report 
Made Cut By 
Distributions 
Da ily Sick Report 
Da ily 
AR 3-45-/45 
r; 
1 
1?7here patient is first 
listed by his company 
— 
Company 
Commander and 
Surgeon 
Company 
Office 
Hi port of Death 
Upon 
death 
of • 
patient 
AR 600-550 
52 
U 
Death of patient 
Surgeon or 
Commanding 
Officer 
Original and 
1 copy to 
Adj, Generalj 
1 copy for 
hospital 
file? 1 copy 
to pf tient’s 
Commanding 
Officer when 
death occurs 
away from 
home,station 
or pest. 
ESSENTIAL REPORT FOR?™ USED IN ADMINI5TRATICN OF MILITARY HOSPITALS 
-368. QjxAf'V 
.2- plLa±t. Aijl\™ ktJft, "/W. 
■to iiJLij*. .At* A <i nti f)L iLtf. stUffit. 
v/ 
. & ■ tJ. 
—— i-- — - - -. — . — T. - 
j - & ~y i 
/O (i a-ksi 7 IV / n/lJJLsL 
.1 
7 .tilt’. 
i* .fry •£ d/up, 
iU+xA* rv /o.oo sc 
c2- / P • 
" 1 v / y. m ~ 
Ut*Ly* m 6£.ft X* ■y 
-- ttt: K £ -p 
, r % ltL i‘ • S5 $/v\J- \r\&. 
~~ r -f 
ct /-- ' - — 
Jl-IS- * 1 
/'3 i,/:/i i, A-J kiljo m J< /- ittL Ij-vvUlJ 
Ut 7j. JS. 
369- 1/jtuf (r'tf t lli.4 kt (tldt-xn— 
A' 
a icq A u. 3j 
(lAll± — 
- -'-‘tf ail-CC w r'-v. 
:l‘l i-ktwUiL 
&7:U - )U~i> C 
jj.iicu-Uy iti /he, *6 
/ 
~W LjialLzJILA c.0 3Z c ftJh-C. 7loJ9i.i: 
')hc-\.f>k. .£52. -s' f/./fi.C. Uo."£ c7Xh -7 <y U''Z£/^.M. 
'lixtrlfik. -Of b® -j //. 7#. 0. /jo. X lei pa.'vvu 
hj. ' Uc.l. & £:oo Pjl 
7/1. i- .czx® L/.'M Q. )Lc. % cUh ■/ e 7'vc F./it 
2Ul aJr-Ci. tb X-ifiTO £fVCyn**' ftC\ baivL) 
. —, •— — 1— 
l_Oh'tc f~!c>~ 
' ’'k '■• X. 
c/ti ■-*■ ri- ''J-aA £JL t 
i 6 ' ) (Lthiifiwi.ty (j-'i ASP (A- !/. S2\*I,A!. Al. £~. 
,'c/fe <g.‘ R ii, 
£■ - 
CriJ: • M ______ ’ 
£-0 
I £■%. 7:a-o (J_ft7lk V/ 
- y i&JUsl.jt' 9-00 /? 
~~Zj *T* r\ 
- OLztr 
zbsL^fL^^C /??~*(1 
7 
(L . /V ijL c $/). S- , oSjj /C: eo/I Pf. A2//&4., 
: GO A lt-. / / 7?1 .. J 
Syfr) Qy -'o >'‘‘/' ~ 
o y7 /&C ~Z\ ~7~£. /c ;<*t£> 
_ ~ 7 
4>yi-y -■ (jp 9 ‘ P.&). 
!'tJ. tfy J' (y / ■*/. -V O vy—t~7- ;rO,'Jt_. 't-' 
j~ -?' * y*r 
r'f ~^~ 
c - J> , Q / 6 _j£d i ± :S~ & ■ 1 
/ ' 
V 
J* ,— 
~ j yc^fe1 cP / 
i -}~y-'~-' T fy .'c?~& 
- /£?X /<?.'/3'/ ___ 
— 
>dP<. /tXLQc-ftc. 's c. £ C$^ 
Ijb ~TT v rj Ta 
( 
3 - 
<3w> £ r 
# . <7>- ~ ADMISSION SHEET 
NO. REG. NO. NAME RANK OT?fi 
6 V 
, r y /I ( -y 
**■ <'0 v to I /9 Pi 
(E^o&- 
*. iS Mv.' 
6 S 
<% y/6 
Sc-y>utuCtt“ 7i.'ir.-7'^c- 
(?-Jt. 
s 
K 'SS& ’^-r'-i-'V^ 
L 6 
<// ?V 
., ZOcm/i&fi <if. 
i/i ytf- 
A— 
7 jtf tu-fisC St A 
6 7 
v f/o 3 
OH. 
6 F 
Jt <-/ ///W 
> ‘V ‘ £" 
.i*JOS€rf \ . "\CO i-l£L C > 
X - i -/ 
5 i.'tr^ 
ikH&O. 
0 9 
£4/'Z3 
w. 
—~r—-— 
.-v yu*7 
,' 0 
4U3., 't'Jti 4'. 
! 
1 
\ DISCHARGE BOOK 
SOURCE DATE DIAGNOSIS DISP. DATE 
1 I 
- $s~ *1 / 
! I 
j / ~ *y ~ V /1 
1UtoUtj\ 
/ 1 C?- t&~niL 
- 3:~4f j 
W ; 
0 . . hJ. 
- r y~ 
‘42 
~ - /-< • <// i 
j 1 
"i r, 
■--- ■ v/ 
•? - £ > 
((> 4- A- 
. 
' *»f‘" 3~* *f • 
t t. 't*' ( ... 
--•? - d:A '... 
W- -X/--'! 'fJc.sr' J',. 
d 
£xXja \ K 
oMixC vl /> 
/r • 
- .3 - / 
i 
L .. .1. . . . 
— 
r 
■ 1 
i 
i 
i 
* 
... 
! 
, - - - - 
-- - . - . 
- . . .: ! _, 
■ 
- - - - - - - 
r 
» 
! 
rr. .... .. j , - ... 
j 
1 i IOA,C-t'-tt C/ /2> r,f>n ir, L L„ „ -. „ o 
; , x A / r[yu }Aj .uO% 
fh&'}){£' )vts <h>tiLs. . tJL\/ ) liA-td# „ 
**>- lo.upji $_ c^Ld^dJU 
, P3A n g.^uU| 
X - -\:_A / KttiL -h-ertv f-iipimia cu 40 ~ Ml 
X- &--41 ,Q3a j:esAflf 37 tU.ftXi</&/£* 
£. X..J-! Ciauxt -cit g.’ocAM &s " 11 
g. • •’j- 4 / ’03 X b'.jO P/fl 1-] " 
SrxJSxlLJL 1! 
— — £ih—susu>ji.. Jf "—-. 
±Js_-±[_ W rU±L-kz iJlo_TJl_Ai ~' “ X 
fi-o-C) ii / 
AAtiXiu 9l&-rrU,- Clrnt,- V/v/V-i &aJjy QjjxiJUs '%tAMjO 
X-t /c>aL j9/ft 'TUaaal 
-47 
''■*~'\ / ✓'■'■' /"'>C t? 3 5L- £/ < ‘ 
Xl) fl / LjLsrylJL 
L' l l-'- '— '-•- rl > — 
&J.H ■ &r±t: f^xL- 
X o&l tOnX Uivnju feat' 7?^J/ 
374 PUBLIC PROPERTY PUBLIC PROPERTY 
PART TWO 
I. Introduction, 
A, Subject covers wide list of supplies and property for entire 
army, 
B* Standardiaction of methods and "business principles, 
C* Responsibility of all personnel of Medical Department for 
full usage v*lue to be obtained from all supplies. 
D. Economical use, 
E, Surplus and shortages, 
E. Care in storage of new supplies - deplete old stock first, 
G. Formal amount of supplies requisitioned, 
II. Accountability and Responsibility, 
A, Accountability devolves upon the person who has property in 
possession, or for issue and is required to maintain property 
account thereof. 
B, Responsibility of property is delegated to that person who 
holds property on memorandum receipt, 
C, General responsibility on all officers concerned, 
D, Sales articles in salesrooms are inventoried monthly, 
E, When inventory does not tally, over, short and damage reports, 
and reports of survey are prepared, 
E, Surgeon of each station renders a. report to Surgeon General on 
June 30th and December 31st of money value of Medical Depart- 
ment supplies, 
III. Supply Officer: is designated for each branch of service for each 
station and maintains property accountability records, 
IE. Property Records, 
A, Complete record of all articles of Government property under 
accountability is made on stock record forms, showing quanti- 
ties on hand, on order, received, or issued. This is kept on 
W,D,Q„M,C, Eorm 58 or on authorized modification, 
B, In order thatlocation and Quantity of property may at all 
times be known, there is kept at each organization supply 
office a general record or account of such property, 
V. Accounting of property in time of war - in time of war accounting 
of property of all kinds in hand and issued in theater of operations 
ceases. When organization passes out of theater of operations, the 
Commanding Officer has complete inventory made and a new account 
prepared, 
VI, Classification of Property and Equipment, (See first two pages of 
Medical Supply Catalogue). 
A, Expendable property consists of articles consumed in mainte- 
nance and upkeep of the service; such is dropped from ac- 
countability upon expenditure, 
B, Eon-expendable property indudes all other articles. Such 
property cannot be dropped from accountability without formal 
transfer or property voucher. 
375 Tableware, kitchen utensils, china and glassware of Q.M.C. 
issue, when lost or damaged through carelessness, are charged 
to those responsible for breakage. Allowance for breakage 
for china and glassware, 20f annually, 5% quarterly, of 
total value of allowance to that organization. Such supplies 
are dropped from accountability upon certificate of responsible 
officer. Articles lost or stolen should be surveyed and 
responsibility fixed therefor, 
VII, Branch Responsibility. 
A. Medical Department responsible for procurement, storage and 
issue of medical, dental and veterinary supplies and equipment, 
B. Rurgeon of each station or command, designates one Medical 
Department officer or Medical Supply officer, who becomes the 
responsible officer for Medical Department Supplies at that 
station or command. 
.C* The classification, nomenclature, and item numbers prescribed 
in .Supply Table of Medical Department, are employed in preparing 
all papers pertaining to standard- medical items. 
VIII, General Requisitions, 
A. Requisition for sufficient equipment pertaining to any of the 
supply branches, are made on W.D, Q.M.C, Form A'i . 
B. Organizational equipment should be obtained through organiza- 
tional supply officer, who obtains these through station supply 
officer. 
IX, Requisition for Medical Supplies. 
A. Requisitions are prepared by Medical Supply Officer of the 
station after obtaining from the chief of each service cf the 
Medical Department at his station, a list of the supplies 
required for the period covered by the requisition. 
B. Requisitions are submitted in triplicate, only one form being 
forwarded. 
C. when necessary, department and corps area surgeons and Commanding 
Officers of general hospitals are authorized to forward emergency 
requisitions for biological products only direct to their 
issue depots, one copy of the requisition showing action taken, 
being forwarded to The Surgeon General, 
D. All requisitions are numbered serially, a new series being 
started at the beginning of each year, 
F. Each requisition signed by medical supply officer and signed by 
the surgeon, or in case of general hospital,* the Commanding 
Officer, 
F. Semi-Annual Requisitions. From, all camns, posts and stations 
these are submitted March 31st and. September 30th, and include 
all standard items (except deteriorating items) and blank forms 
for the period covered, 
6* Quarterly Requisitions, These are submitted on March 31st, Juno 
36th, September 30th and December 31st. One requisition is 
submitted for standard items and another for non-standard items 
required during the quarter covered. This requisition covers 
only deteriorating items: marked (1) in the not ■* column. H. Emergency Requisitions. These are submitted only -when 
urgently needed and are accompanied by a letter of transmittal 
signed by the surgeon, giving full details as to the 
emergency. Such biological products as may be required in 
an emergency are obtained by emergency requisition forwarded 
in the same manner. If the situation is sufficiently urgent 
local purchases may be made and full report as to the 
necessity for such action forwarded. 
I, Action on Requisitions. 
1. Requisitions are forwarded in triplicate to the service 
command or department surgeon, who after acting upon the 
requisition, returns one copy to the requisitioning 
office (showing thereon the depot of issue and amounts 
approved), forwards one cop}'- to the depot designated to 
make the issue, and retains one copy for his own files. 
2, All copies for non-standard-items and emergency requisi- 
tions, except for biological products authorized for 
issue, are forwarded by service command surgeon by indorse- 
ment to the Surgeon General. 
General - The Medical Department Supply Catalog, containing a list 
of the standard items of medical supplies which are stored and issued by 
the Medical Department, is published for the information and guidance 
of all concerned. In the appendix, may be found a list of the contents 
of assembled cases, chests, etc., used by the several components of the 
Medical Department at stations and in field service. Contained therein 
are several formulae of pharmaceutical preparations, also certain War 
Department and Medical Department blank forms. 
Classification - Items are classified according to function or 
commodity. The first digit of the item indicates the class to which the 
item pertains. Classes and subclasses are as follows; 
Class 1. 10010-15,44-0 Drugs, chemicals, biological stains. 
15900-1.B280 Biological products. 
Class 2. 20010-20420 Surgical dressings. 
Class 3. 30010-35590 Surgical instruments. 
36010-30910 Surgical appliances, miscellaneous diagnos- 
tic instruments and surgical supplies. 
Class 4. 40010-44910 Laboratory equipment and supplies. 
Class 5. 50020-57030 Dental equipment and supplies. 
Class 6, 60020-61730 X-Ray equipment and supplies. 
Class 7. 70000-71012 Furniture/ 
71020-71390 Physiotherapy equipment. 
71510-717B0 Hospital linen and bedding, 
72010-74320 Moss equipment and supplies. 
- 74510-74955 Cleaning and preserving equipment and 
supplies, 
75020-76700 Stationery and miscellaneous office 
' equipment and supplies. 
77010-79550 Miscellaneous hospital equipment and 
supplies. 
Class B. B0010-61413 Veterinary equipment and supplies. 
Class 9. 91010-99630 Field equipment and supplies. 3. Explanatory remarks. 
a. Expendable items within the meaning of AH 35-6620 are 
indicated by the letter f,X” in the column following the 
item number. 
b. Controlled items, as contemplated by AR 20-35, are 
indicated by the sign ,!Cn, in the column following the 
item number. Requests for the disposition of such 
items should state: 
Classification under paragraph 5, AR 35-664-0, 
Date of receipt and source. 
Manufacturer, model, serial number, etc, 
hature and manner of unserviceability. 
Estimated cost of repair. (See AR 4-0-1705, par.5c), 
c. The numerals entered in the column following the item 
number indicate the following: 
(1) Considered deteriorating, 
(2) Refer to appendix for description of item, formula, 
contents of case, etc. 
(3) Requisitions should state manufacturer, type, 
description, size, and serial number of item or 
part required. 
(4-) Requisitions should state voltage, correct DC or 
AC (If AO, cycle and phase). 
(5) Item will not be issued to hospita]s smaller than 
50 beds. 
d. The fact that allowances are shown for expendable items 
will not affect existing instructions where issues are 
controlled by money credits to individual stations. Those 
allowance figures are given as a guide for use where 
experience in past issues is net available. 
e. Allowances in classes other than Class 5 (Dental equipment 
and supplies), Class ft (Veterinary equipment and 
supplies), and Class 9 (Field equipment and supplies), 
represent the average six month’s use for pc-ts having 
military strengths of 1,000, 5,000, and 20,000, including 
any requirements of the Dental and Veterinary services 
(see subparagraphs g and h for special instructions 
relative to supplies for these services). Translated 
into bed capacities, these strengths may be regarded as 
representing 50,250 and 1000, respectively. In figuring 
allowances, when the proportion results in a fractional 
part of a number the fractional part will be considered 
as 1, 
(1) Requisitions other than those from general hospitals 
will show separately, military, civilian, and 
animal strength, but the sum of the first two will 
be used to compute allowances. Stations having a 
strength less than 1,000 will figure their allowances 
in proportion to their size from the allowance shown 
for a pest of 1000. For example, a post having 
500 strength would be allowed 500/1000 or l/2 of 
200 in the case of item 70090. Stations having a 
strength greather than 1000, but less than 5000, will 
figure their allowances in proportion to their size 
from the allowance shown for a po._ ef 5000, (2) General hospitals of smaller or larger bed capacity 
than 1000 will figure their allowances in proportion 
to that shown for a 1000 bed General Hospital in 
the 20,000 column. For example, in determining 
allowances, a general hospital having 250 beds\ would bo 
allowed 250/1000 or 1/4 of 5000 in the case of item 
70090. 
f. Allowances for items of dental equipment and supplies (Class 
5) are based upon the number of dental officers on duty at 
posts, 
g. Allowances for items of veterinary equipment and supplies 
(Glass 8) are based upon an animal strength of 1000, 
h. The letters MSG,f in the allowance columns indicate that prior 
authority must be obtained from The Surgeon General to 
requisition. The necessity for such items will be clearly 
stated. 
i. The letter ,fLM in the allowance columns opposite certain 
items in Class 4 indicates that issues, in such quantities 
as may be required, will be limited to stations doing 
laboratory work. The issue of items so designated to 
stations other than these will be made only upon prior 
authority from The Surgeon General and the need for such 
items will be clearly stated, 
j. The letter "Rn in the allowance columns opposite certain items 
indicates those which will be issued only to complete an 
assembled chest or case, or to replace a part pertaining to 
another item, 
k. A row of dashes in the allowance columns indicates that 
issues of the item will be made until existing stocks are 
exhausted, 
l. The prices quoted herein will govern in all cases of charges 
on pay rolls, sales, reports of survey, inventory, and 
inspection reports, transfers, inventories, requisitions, 
shipping tickets, and other papers in which prices are used. 
In the case of sales or transfers to other services, branches 
of the nTar Department, the National Guard and civilian 
components of the army, 3 per cent of the value of the 
supplies as listed, to cover cost of packing and handling, 
will be charged, 
m. The letters ,!DLn in the allowance columns indicate that 
issues, in such quantities as may be required, will be 
limited, to Central Dental Laboratories or Dental Laboratories 
at general hospitals and approved station hospitals, 
4. Non-standard items - Replacement and spare? parts for standard 
items are net usually listed in this catalog and should be 
, secured on quarterly non-standard requisition in the manner 
directed by AR 40-1705 and current circular letters issued from 
this office from time to time, * ‘ 
5. Trrors in this catalog should be promptly reported to The 
Surgeon General. Form 16a 
llerlical Department, U.S.Army 
Form lob 
Hedical Department, II.3.Army 
ISSUE SLIP 
ISSUE S^xr 
EXPENDABLE HEDICAL PROPERTY 
F 01 -1EXPSU DAP LK HEDICAL PROPERTY . 
To the iviedic-il Supply Officer: 
Please issue tha following for use in: 
rf,. . j . %r 
t-x/ibiuSCLz... *JJB. 
. t 
To tao Nodical Supply Officer; 
Please issue the following for use in: 
I ITS!' i ARTICLES j UNIT : QUAflTITIES 
•<»-c ■ xu&aj i i fir ’re '' 
I/A&’k '4' I Hflf'D WIRED 
I ' j C' • / ; Sj 
H 7 i •’ 
• . ; • _ ■ 
ARTICLES 
43zs* h 
i 
/)wt 
QUANTITY 
.£r 
/r' 
%&*• 
I certify that I have personally 
verified the quantities on hand, that 
the amounts shewn, arc correct, and 
that the quantity requested is neces- 
sary to meet act\j*£jf r <**<^s • ■ 
Officer 
i*L 21iarScL 
Officer in Charge 
hedical: Supply 'Oxfleer 
JL... 
Hedical 'Supply Officer 
& Rfardnaster 
(&AA^'d*uj£jhtL 
-iL JU..:-..V/. 
/?V/ 
INSTRUCTIONS 
1, This request will be made cut and 
signed by the officer in charge of the 
department of the hospital for which 
the articles are needed. The names 
of the articles will be written as 
they appear in the Medical Department 
Supply Catalogue, 
2, The slip will bo completed by the 
receipt of the Mardmastor, who will 
insert the date* It will then be 
filed at the Medical Supply Office, 
INSTRUCTIONS 
This request mil bo nado out and sign- 
ed in duplicate by the officer in charge 
of the department of the hospital for which 
the articles are needed. The names of the 
articles will be written as they appear in 
the Medical Department Supply Catalogue, 
2, Both the original and the duplicate 
slips will bo completed by the roc apt of 
the wardnastcr, who will insert the date. 
The original will then bo filed at the 
Medical Supply Office, and the duplicate 
returned to the officer who made out the 
request for file, with his retained memo- 
run dura re ce ipt. Form 1.6 c 
Medical Department, U.S.Army 
CREDIT SLIP 
MEDICAL PROPERTY 
Form l6d 
Medical Department, U.S.Army 
CREDIT SLIP yill oiA/ 
NONEXPENDABLE MEDICAL PROPERTY 
To the Property Officer: The 
following articles no longer needed 
are turned in from 
To the Property Officer: Please 
exchange serviceable property for the 
fo1lowing from 
ARTICLES 
QUANTITIES 
/ 
>5~ 
ARTICLES 
QUALITIES 
/ 
w? 
/ // 
<y 
£gp-v / ■ /? / 
(?W 
,53 
I o 
i 
j 
4?'/£ o 
fQt-l /(} A A V-/ / 
'Officer in Charge 
f Officer in Charge 
Approved y y,'. ;3 • J 
l_ Property Officer 
Exchange approved; 
Property Officer 
Received into storage; / y • j 
✓•Storekeeper 
Received serviceable articles; 
Date _____ 
Mardnastor 
INSTRUCTIONS 
1, This list will be made out and signed 
in duplicate by the officer in charge of 
the department of the hospital where the 
property has boon in use. The names of 
the articles will be written as they ap- 
pear in tue supply table Manual for the 
I Medical Departments 
2, If the property to be turned in is un~ 
i serviceable from any cause other than fair 
■ wear and tear in the service, a statement 
|will be attached showing what action has 
been taken to ibx responsibility* 
3, Bo+h the original aid the duplicate 
slips will be c ■mplst-ed by the receipt of 
the storekeeper., who will insert the date* 
I The original will then be returned to the 
officer turning in the property, for file 
with his retained memorandum receipt, and 
the duplicate will be filed at the Medical 
Property Office. 
III STRUCTICN S 
1, This request will be made out and 
signed by the officer in charge of the 
department of the hospital for which 
the serviceable property is needed. The 
names of the articles will be written 
as they appear in the Supply Table Man- 
ual for the nodical Department, 
2, If the property to bo turned in is 
unserviceable froii any cause ether than 
fair wear and tear in the service, a 
staten nt will be attached showing 
what action has been taken to fix res- 
■pcnsibility, 
3, The slip will bo completed by the 
receipt of the -Tardmaster, who will in- 
sert the date. It will then be filed 
at the Medical Property Office, 
•381 EXPEMUJBLE SUPPLY LIST 
Surgical Supplies Clans III 
Item Uo, Item Unit Unit price Issued 
31080 Catheter, urethral rubber 16 F on. .09 
33011 Needle, intestinal size 2 3/4n on. .0/+ 
30197 Str. Bandaye, rubber 2 l/2 on, ,65 
4.O63O Bottle reagent, alcohol on. .20 
43955 Slide Hero, 75 x 30, ill, cnt. .50 
1/?- fr. 
Stationery end idneellanoor3 Office Equipment 
and Suppliers 
75730 Inkstand ca. .11' 
75930 Pad, desk ea. .95 KCN-EXPENDABLE SUPPLY LIST 
Hospital Supplies Class VII 
Hospital Llnan and Bedding 
7X550 Bedspread oa. 2.S4 
71720 Shoot Qa. >90 
Bfess Equipment and Supplies 
72170 Soup bowl, enamel ware ea# #q6 
72775 Dishwashing machine, small, electric ea.-479.00 
Cleaning Equipment and Supplies 
74-620 Bucket e2u 
74700 Mop Handle oa4 KEDICaL supply office 
Brooke General Hospital 
Fort Sain Houston, Texas 
F3/jen 
March 21, 1941. 
M/R No. 1-M: 
’Yard No, 1, New Hospital: 
CONSOLIDATED MEMORANDUM RECEIPT 
No. 1-H 
25 each 70050 Bod, hospital 
18 each 70060 Bed, adjustable 
1 each 70330 Carriage, wheeled • 
10 each 70605 Lamp, adjustable for bed 
200 each 71720 Sheet 
68 each 71770 • Towel, bath 
1 each 72020 Egg beater, dover 
1 each 77360 Can, G,I,, 33 gallon 
NOTE: This memorandum receipt consists of 1 page, and cancels all 
other memorandum receipts, credit and debit slips, of previous 
dates. Please sign and return the original copy to the Lie deal 
Supply Officer at the earliest practicable date. Do not -Re, 
any alterations or erasures on this receipt. 
./-M- &J.r / 
. ■ 'td!*■*' dm «—«»U<. . ■/" 11» ' —■ - 
J0.p3ph.~N1, Padock, 
Major, Medical Corps, 
Medical Supply Officer, 
I acknowledge to having received the above listed property and 
•will be responsible for same, until turned over to the Medical Supply- 
Officer, unless otherwise relieved by competent authority. 
/t.a- ■' 
Dwain K, Smi 4, 
1st, Lieut,, Medical Corps, MANUAL OF I^ATIISMaTICS THE ROMAN SYSTEM OF NOTATION 
(1) Definition; The Roman °ystem of Notation is one of the oldest 
systems of notation used. It is composed of letters 
instead of numbers. 
(2) The letters and what they represent in the Arabic System (our 
common, ordinary system of numbers) are: 
Roman Numerals Arabic Numerals 
I 1 . 
V - 5 
X - 10 
I - 50 
C - 100 
D - 500 
M - 1000 
(3) Rules of the Roman System of Notation: 
1. Smaller letter to the right of a larger one means - ADD. 
2. Smaller letter to the left of a larger one means - SUBTRACT 
3. Never use more than three of the same letters in a row. 
EXAMPLES 
Rule 1. To write 6 in the Roman System, the smaller letter 
is placed to the right of the larger letter. 
5/1 = 6 VI = 6 
Rule 2. To write 4 in the Roman °ystem, the smaller letter 
is placed to the left of the larger letter, 
5-1*4- IV = 4 
Rule 3. To write 4 in the Roman System, you cannot add up 
four P's. ' 
IIII = 4 (incorrect) IV = 4 (correct) 
1000 4.00 90 2 
1492 M CD , XC II MCDXCII 
1000 900 40 2 
1942 M CM XL ' II MCMXLII 
385 FRACTIONS 
(1) Definition? a fraction is any part of one unit (any part of a 
■whole), 
(2) Typos of fractions? (a) Common fractions* 
(b) Decimal fractions, 
COM ION FRACTIONS 
A common fraction is made up of two numbers or terms and a dividing 
line. The top number is called the numerator, and the bottom number is 
called the denominator. 
Example? Numerator? 2 
Dividing lino ? 
Denominator? 3 
There are four processes which can be carried out with fractions. 
These are the same ones which can be dene with whole numbers? 
1, Addition, 
2, Subtraction, 
3, Multiplication, 
A. Division, 
The addition of fractions when the denominators of all are the same. 
To add fractions with the same denominators, add only the 
numerators (top numbers) - the denominator (bottom number) 
of the answer is the same as those of the other fractions. 
Example i 1 / 1 / 1 _3__ 
A A A ~ A 
The addition of fractions when the deneninatora are not the same. 
To add fractions with different denominators, the fractions 
must be changed so that all the denominators are the sane# 
To do this, the denominators are multiplied together to 
find a C0I1I0N DENOMINATOR - that is, a number which can be 
divided evenly by every one of the original denominators# 
Than each fraction is converted to a new fraction with this 
common denominator as its denominator, ,J-o do this, each 
denominator is divided into the common denominator. Then 
multiply each numerator by the number of times its denominator 
goes into the common denominator. The results obtained from 
these multiplications are used for the new numerators, From 
here on proceed as in the addition of fractions when the 
denominators of all are the same# 
386 Example; __1_ + 1 + ' 1 = 
2 ~3 “l 
12 + + 6__ *= 26 = 13 = 11_ 
21 21 21 21 12 12 
Subtract5.cn of common fractions when the denominators are the same. 
Subtract the numerator of the smaller fraction from the numerator 
of the larger fraction. The denominator stays the same. 
\ 
Example; 3 - 1 = 2 
111 
Subtraction of common fractions where the denominators are not the same* 
In the same way as in adding, convert each fraction into a new ope 
sc that all fractions have the same denominators. Then subtract 
the smaller numerator from the larger numerator and place the 
result over the common denominator. 
Example: 1 - 1 = 3 - 2 = 1 • 
2 3 6 6 ”6 
The multiplication of common fractions. 
Multiply the numerators together and place the result as a new 
numerator. Then multiply the denominators together and place 
the result as a new denominator. 
Example; 2 x x 1 = or1 1 
3 S 5 120 5 
The division of common fractions. 
Invert (turn upside down) the second fraction - the one which 
is to do the dividing. "Tien proceed as in multiplication. 
Example* 1 -i 1 = ? 
3 * 9 
JL x _9_ - » 3 
3 13 • DECIMAL FRACTIONS 
Definition; A part of a unit expressed as a number containing a decimal 
point. 
Thousands 1000. Si000.00 
hundreds 100. 100,00 
Tens 10. 10.00 
Units 1. 1.00 
Tenths .1 .10 a dime 
Hundredths .01 .01 a cent 
Thousandths .001 .001 a mill 
Ten Thousandths .0001 .0001 a tenth of a mill 
IN WRITING DECIMAL FRACTIONS, ALWAYS HLACE THE DECIMAL ’TINTS IN A 
VERTICAL COLUMN. 
The first place to the right of the decimal point is called TENTHS 
The second place to the right of the decimal point is called HUNDREDTHS 
The third place to the right of the decimal point is called THOUSANDTHS 
The fourth place to the right of the decimal point is called TEN THOUSANDTHS. 
Units 
Decimal r>t. 
Tenths 
Hundredths 
Thousandths 
Ten 
Thousandths 
1 . 2 3 4 5 
ADDITION OF DECINAL FRACTIONS; 
the decimal points in a vertical column and then place the 
decimal point in the answer below the last decimal point. 
1.076 
.324- 
.1 
1.500 
.123 
.234- 
.3A5 
.702 
AL7"AYQ nLACE THE SIGN DEMOTE "HAT OF FRPCLEM YOU ARE wORFING 
TO AVOID ERRORS. 
SUBTRACTION OF DECIMAL FRACTIONS. 
place the smaller number under the larger, keeping all decimal 
points in a row and subtract. DECIMAL FRACTIONS (Cont'd) 
.903 
- -2L. 
.153 
15.962 
-*432 
15.509 
MULTIPLICATION OF DECIMAL FRACTIONS 
Multiply the §ame as for a whole number, then point off from right to 
left as many>oecimal places in the answer as there are in the problem. 
1.706 
x .003 
•005116 
.309 
x .790 
.244110 
DIVISION OF DECIMAL FRACTIONS. 
Count the number of places to the right of the decimal point in 
the number that is to do- the dividing. Move the decimal point in 
the number that is to be divided up the same number of places to 
the right. Show this new site for the decimal point by an inverted 
v» ace e answerfs decimal point directly over the inverted 
V, (A). Then proceed as in regular long division, ignoring all 
decimal points| being careful to keep each number in the answer 
over its corresponding one in the problem. 
10.695 f 2.3 3 ? 
2.3J10.6.95 
2.371095 
9 2 
U9 ’ 
1 3 8 
. 1.1 5 
\ 115 
TO CHANGE A COMMON FRACTION TO A DECIMAL FRACTION 
Divide the numerator by the denominator. 
0*£— 
1 2) 1.0 
2 
Common 
fraction 
1 
2 
Decimal 
* fraction 
* .5 PERCENTAGE 
{%) 
Definition; 
Percentage means ’’Mart's £>er Hundred". The Percent sign is - %, 
Wherever you see this sign, substitute the one word "HUNDREDTHS" for 
it. The percent sign - % - is nothing more than an "abbreviation for 
the word "HUNDREDTHS", just as "Mr." is the abbreviation for the word 
"Mister". 
Example: 10$ is 10 hundredths 
10 hundredths written as a decimal fraction is .10, 
or -written as a common fraction, is 10 
100 
Problem: Take 10$ of 100 apples. 
Solution: To work with % you always multiply. Thus: 
.10 x 100 apples = 10 apples 
100 apples 
x .10 
000 
100 
10.00 apples 
Scale to ctudy and Understand 
1% = 1 hundredths = .01 • 
75% * 75 hundredths = .75 
•5$ * .5, hundredths -.005 
1 $ ».5$ » .5 hundredths = .005 
2 
There are many ways of writing any given percent. For example, take 1%. 
1% is equal to 1 hundredths - 1 hundredth written as a common fraction, 
is 1 . 
100 
1 hundredth written as a decimal fraction is .01 
The common fraction 1 means "1 part out of 100M. 
100 
In place of the words ’’part out of", we can use any of the 
following, thus: 1. 1 to 100 
2. 1 - 100 
3. 1 of 100 
4. 1 in 100 
Now to list every way possible to write 1%, we have the following: 
1. 1% 
2. 1 hundredth 
3. .01 
4. 1 
100 
390- 5. 1 part out of 100 
6. 1 to 100 
7. 1 in 100 
8. 1 of 100 
9. 1 - 100 
The important ones to learn and to be able to write for any given 
percent are numbers 1, 3 and 9. 
Example; 
Number 1. - 75% 
Number 3. - .75 
Number 9. - 75 - 100 
Number 1. * ,1% 
Number 3. - .001 
Number 9. - .1 - 100 or 1 - 1000 
l 
CONVERSIONS OF TERMS USED TO DESCRIBE STRENGTH OF SOLUTIONS 
Convert: 
A. 1-100 into percent. 
1-100 * _1_ = .01 « 1% 
100 
B. 1-500 into percent. 
1-500 = 1 » .002 « .2% ‘ ' 
500 
C. 1-1500 = 1 * .00066 = .066% 
1500 •• THE METRIC SYSTEM 
1. The Metric System is an accurate way to make measurements used the 
world over. One can weigh a pound of butter and describe its weight 
in ounces and pounds; a],so one can weigh butter in Grams and 
Kilograms. (Metric System). One can measure the length of a piece 
of lumber and describe it in inches, feet, or yards; also one can 
measure it in millimeters, meters and kilometers. (Metric System). 
One can measure out a bottle of milk and describe it in fluid ounces 
and quarts; also one can measure it in nqlliliters. cubic centimeters 
and liters. (Metric System). The Metric System is used in the army 
to measure all medicines. Based upon the decimal system, it is very 
much like our coin system. 
2. THE UNIT OF HEIGHT IS THE "GRAM". 
THE UNIT OF LENGTH IS THE "METER". 
THE UNIT OF CAPACITY IS THE "LITER". 
3. Sub-divisions of the units are expressed by the adding of following 
terras; --- ■ 
Deci - means 1/10 of a unit, i.e,, a decigram, decimeter, deciliter, 
A decigram is one-tenth of one Gram. 
Centi- means 1/100 of a unit, i.e., centigram, centimeter, centiliter. 
A centimeter is one-hundredth of a Meter, 
Milli- means 1/1000 of a unit, i.e., milligram, millimeter, millileter, 
A milliliter is one-thousandth of a liter. 
Multiples of the units are expressed by adding..the following terms; 
D©ka - means 10 times a unit, i.e., Dekagram is 10 Grams. 
Hactc- means 100 times a unit, i.e,, Hectogram is 100 Grams. 
Kilo - means 1000 times a unit, i.e., Kilogram is 1000 Grams, 
5• Length Volume Weight 
Kilometer. Km. Kiloliter, Kl, Kilogram. Kg. 1000.0 
Hectometer Hectoliter 100.0 
Dekaraeter Dekaliter 10,0 
Meter. M. Liter. L. Gram. Gm. 1,0 
Decimeter Deciliter 0,1 
Centimeter, cm, * Centiliter 0,01 
Millimeter, mm. Milliliter, ml. Milligram.mg. 0,001 
NOTE; Memorize in their correct relationship only the words and numbers 
underlined in the above scale. 
6. How did the inventors of the Metric System decide on just how long a 
"Meter" should be? 
■S92i They measured one-fourth (1/4.) of the distance around the earth 
(through both poles) and sub-divided that length into 10 million 
parts. One of these 10 million parts was the length selected to be 
called ’’one meter1*. 
How did they decide the size of a ’’liter”? 
They took one-tenth (1/10) of a ’’meter” and built a box, 1/10 of a 
meter long, 1/10 of a meter high, 1/10 of a meter wide. They said, 
this shall be the unit of capacity and called it ’’one liter”. 
How did they decide on just how much a gram should weigh? 
They filled the box called ’’one liter” with plain water. They then 
removed (1/1000) one-thousandth part of that liter of water and weighed 
it. The weight of this small amount of water was chosen as ’’one gram”. 
Therefore, since l/lOOO of a "liter” of water weighs one ’’gram”$ then 
one ’’milliliter” weighs one ’’gram”. 
7. If we build a box 1 centimeter long, by one centimeter high, by one 
centimeter wide, it would contain ’’one cubic centimeter”, (c.c.). 
We know this is sc,for we have the rule; 
"length” times ’’width” times ’’height” equals ’’cubic contents”. 
1 x w x h = cubic contents. 
1 cm. times 1 cm. times 1 cm, equals 1 cubic centimeter (c.c,). 
This box filled with water contains 1 cubic centimeter (c.c.) of 
water and it weighs ’’one gram”. Thus, since one ’’milliliter” of water 
weighs”one gram”, and since ’’one cubic centimeter” of water weighs ’’one 
gram,then”one milliliter” of water is equal to ’’one cubic centimeter” 
of water for both are equal to the same thing, and things equal to the 
same thing are equal to each other. Thus, we can use "cubic centimeter” 
in olace of the term "milliliter” and vice versa. 
8. METRIC SYSTEM EQUIVALENTS 
a. LENGTH 1 meter * 39 inches 
25 millimeters = 1 inch 
2.6 centimeters * 1 inch 
1 Kilometer = 5/8 mile 
b. HEIGHT 1 kilogram - 2.2 pounds or 2 l/5 lbs, 
30 grams = 1 ounce 
1 gram = 15 grains 
c. CAPACITY 1 liter = 1000 milliliters 
or cubic centimeters 
30 c.c. =1 fluid ounce 
1 c.c. =15 minims (drops) 9. The Metric System is used in the army to measure medicine doses. In 
civi] .isu life the pharmacists and most doctors use the "Apothecary 
System'. 
APOTHECARIES SYSTEM; 
a. LIQUID MEASURE 
60 minims, m (drop) = 1 fluidrachm 
8 fluidrachms • = 1 fluidounce 
16 fluidounces = 1 pint 
2 pints = 1 quart 
4- quarts - 1 gallon 
b. WEIGHT MEASURE 
437 grains (gr.) = 1 ounce 
16 ounces = 1 pound 
1 grain is the weight of 1 minim of water, 
10. APPROXIMATE MEASURES 
1 glassful = B ounces (24-G cc.) 
1 teaspoonful » L, cubic centimeters (cc.) or 1 fluidrachm 
1 tablespoon =16 cc. or 4 fluidrachras. THE AEMY GLUCOSE FLASK 
Glucose (sugar) dissolved in sterile water is frequently ad- 
ministered to surgical patients. Whenever crystals are dissolved in 
water, the resulting mixture is called a "SOLUTION1*. Thus, when 
glucose crystals are dissolved in water we call the mixture a "glucose 
solution". The army furnishes the medical corps with glucose in the 
form of a solution and not as solid crystals of sugar. The solution 
comes in but one strength. It is half glucose and half water, thus it 
is 50% glucose and 50%> water. This half and half mixture of glucose 
and water comes in rubbered stoppered bottles, each containing 50 cubic 
centimeters of the solution. The bottle is prepared by placing into it 
25 grams of glucose crystals and then adding sterile water to the 50 
cubic centimeter mark, thus producing 50 cubic centimeters of a 50% 
glucose solution. 
PREPARATION OF SOLUTIONS 
1. GLUCOSE SOLUTIONS. 
Prepare 1000 cc. or gfams of 5% glucose solution using the army 
flasks of 25 grams of glucose in 50 cc, of solution. 
The solution is made up of water and glucose. The first step is 
to find out how much glucose is in 1000 cc, of 5% glucose solution. 
Gm 
Use the formula - % x or = Active agent 
cc 
Gm 
If we take 5% of 1000 or we will have the amount of glucose 
cc 
Gm 
Thus: 5% x 1000 or s 50 grams of solid glucose crystals needed to 
cc make up the desired solution. 
Where can we get 50 grams of glucose from? It must come from the 
flasks furnished by the army. Each flask contains 50 cc, of 50% 
glucose; or, expressed in grams, 25 grams of glucose. To get the 
needed 50 grams of glucose we must take 2 flasks. Therefore, we take 
a liter (1000 cc.) container, pour into it 2 of the army flasks, 
giving us in the liter container 50 grams of glucose in 100 cc, of 
solution. (Each army flask contains 50 cc. of solution.) If we now 
fill the liter container up to the 1000 cc, mark with sterile water, 
we will have our final solution. Thus, by adding 900 cc, of sterile 
water (for we have in the container 100 cc. of solution when we 
add the 2 army glucose flasks), we will have 1000 cc. of 5%> glucose 
solution. 
395 2. SALT SOLUTIONS-such as Silver Nitrate (kgNOj), Potassium Permangan- 
ate (KlINO/+), Argyrol, Procaine, Saline Solutions, 
a. Problem No, li 
Prepare 1000 cc, of 1-1000 solution of using a 
10 % stock solution, 
THE FIRST STEP IS TO CHANGE THE 1-1000 to percent. 
1-1000 = 1/1000 = .001 = .1% 
Gm. 
FORMULA: % x or = Active Agent, 
cc. 
Gm. 
.1% of 1000 or = THE AMOUNT OF SOLID CRYSTALS OF 
cc. in the solution to be made, 
Gm. 
.001 x 1000 or = 1 gram of solid AgN03 Crystals 
cc. 
Now the problem is ”How many cc. of our stock solution must 
vve take to give the needed 1 gram of Crystals?’1 
The stock solution is a 10% solution, and an unknown amount of it 
contains 1 gram of solid crystals, Therefore, we can write 
the following equations: 
Gm 
% x or = Active agent 
cc 
10% x ?cc = 1 gram of AgNOq 
,10 x ?cc - 1 gram 
?CG - 1 
.10 
? cc = 10 
?cc = 10 cc. 
Therefore 10 cc, of the stock solution contains 1 gram of 
solid AgNOq crystals. 
Thus, we take 10 cc, of the stock solution and add 990 cc, of 
water to make up 1000 cc, of a 1-1000 (•1%) solution of .igNOq, 
b. Problem No, 2: 
Prepare 250 cubic centimeters of 1$ Procaine (Novocaine), 
using 2 l/2 gram charts  is a colorless crystal, which, dissolved 
in sterile water, produces the Procaine Solution,) 
Since procaine solutions quickly lose their strength 
on standing, they are usually not prepared until 
they are actually needed. The pharmacy will weigh 
the procaine crystals in small amounts and wrap them 
in small pieces of cellophane or paper envelopes. 
These small packages of crystals are called "CHARTS", 
The charts can be prepared in any desired weight, 
cc. 
% x or = A. A. 
Gm, 
cc. 
1% x 250 or « A,A, (The amount of solid crystals of 
Gm. procaine needed for the solution 
to be prepared.) 
.01 x 250 Gm. = 2.5 Gm. of solid procaine crystals. 
Therefore, take 1 chart (2.5 Gm.) of procaine crystals 
and add sterile water to a total volumn of 250 cc. 
This will make 250 cc, of 1% novocaine, 
Problem No. 3s 
Prepare 60 cc, of 1/2% procaine solution using 1 gram charts, 
c.c, 
% x or * A. A. 
Gm. 
l/2% x 60 cc, = A,A. 
.5% -X 60 cc = A.A. 
,005 x 60 Gm. =.3 Gm. of procaine crystals needed to 
prepare the 60 cc. of 1/2$ solution. 
Thus, less than 1 chart of procaine crystals is needed. Since 
we have no way to accurately measure out a part of a chart, it 
is necessary to take a whole chart and make the entire chart 
into a l/2% solution, 
cc. 
% x or = A. A, 
Gm. / 
1/2% x ?cc. = 1 Gm. of active agent (procaine crystals) 
dissolved in an unknown number of cubic 
centimeters of sterile water (?cc.) 
will produce a l/2% solution, 
.005 x ?cc. = 1 Gm, 
JL 
?cc. = ,005 
? cc = 200 
? s 200 cc. 
Thus, 1 gram of procaine crystals dissolved in 200 cc, of 
sterile ?;ater produces 200 cc. of 1/255 procaine solution. cor'VERsior of grains to grams 
Convert 1/4 grain to grans-. 
15 gr. * .1 gram 
1 gr. = 1/15 gram (1/15 - .06'/) 
1 gr. « ,067 Gm. 
\/U gr. s l/A x ,067 Gm, .• .016 Gm. 
1A gr, = ,03.5 Gm. 
Convert 7/8 grain to Metric System, 
7/8 gr. = 7/8 x .067 Gm. * 7 x .067 * .058 Gm. 
7/8 gr. = .058 Gm. 8 
Convert 1/150 grain to grams. 
1/150 ,gr.= 1/150 x .067 = .067 = .0O0A Gm. 
150 
Convert 5 grains to Metric System. 
5 gr. s 5 x .06 Gm, = .30 Gm, or ,3 Gm.