TM 8-260 
WAR DEPARTMENT 
TECHNICAL MANUAL 
FIXED HOSPITALS OF THE 
' MEDICAL DEPARTMENT 
(GENERAL AND STATION HOSPITALS) 
July 16,1941 TM 8-260 
C 1 
TECHNICAL MANUAL 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT (GENERAL 
AND STATION HOSPITALS) 
Changes 
No. 1 
WAR DEPARTMENT, 
Washington, March 31, 1942. 
TM 8-260, July 16,1941, is changed as follows: 
6. Supply.—a. The initial supplies * * * may be directed. 
In order to visualize the amount of supplies and equipment necessary 
to equip a general hospital, reference is made to the following approxi- 
mate figures: Net weight, 408,488 pounds; shipping weight, 754 
tons; volume, 30,000 cubic feet; freight cars required, 13.6; trucks 
1%-ton, 73.3. The number of separate packages required to pack 
the initial supplies for a general hospital is 2,474, but if the individual 
items are counted the total runs up to 100,000. 
[A. G. 062.11 (12-30-41).] (Cl, Mar..31, 1942.) 
20. Function.—The functions are— 
d. Information given out.—Information concerning the condi- 
tion of sick and wounded, necessary to allay the anxiety of 
friends, is given freely under the instructions of the com- 
manding officer, except that in no instance is the diagnosis 
or information which might be used as a basis for a claim 
against the Government furnished. Such requests are re- 
ferred to the adjutant or the executive officer. 
[A. G. 062.11 (12-80-41).] (Cl, Mar. 31, 1942.) 
42. Admission of patients.—a. General.— (1) All patients are 
admitted through the receiving and disposition office, where the re- 
quired admission data are made of record and assignment to a proper 
ward effected. In emergency the patient may be taken direct to the 
ward and the necessary admission data obtained later. 
[A. G. 062.11 (12-30 41).] (Cl, Mar. 31, 1942.) 
55. Property. 
b. Exchange and replacement. 
(2) All supplies classed as “supervised” by The Surgeon General 
which have become unserviceable through fair wear and tear in the 
public service are accompanied with a certificate in quadruplicate TM 8-260 
C 1 
TECHNICAL MANUAL 
signed by the responsible officer covering the unserviceability. This 
certificate gives all information required by paragraph 3b, Medical 
Department Supply Catalog. 
[A. G. 062.11 (12-30-41).! (Cl, Mar. 31, 1942.) 
59. Transfer of property. 
b. Upon receipt of orders for change of station or upon change of 
duties which require transfer of accountability, the medical supply 
officer will transfer the property to his successor in accordance 
with the provisions of AK 35-6680. In the event that his author- 
ized relief has not reported prior to the departure of the medical 
supply officer, an officer of the Medical Department is temporarily 
appointed to assume medical accountability, receipt being taken as 
required in AR 35-6680. 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942. 
70. Procedure for other than separation from service or 
transfer to another hospital. 
b. Patients on enlisted status. 
(2) Prior to the discharge of enlisted patients other than from 
command, the commanding officer, detachment of patients, furnishes 
the patient with a clearance form and instructs him to have it 
initialed by the heads of the departments concerned and return the 
form to the detachment of patients office, where it is filed in his 201 
file. 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 81, 1942.) 
71. Separation from service or transfer to another hos- 
pital.—a. Officers.— (1) When the adjutant * * * and returns 
it to the ward officer. He also approves the clinical record, has pre- 
pared from it an abstract to accompany patient being transferred to 
other hospital, and then transmits the clinical record to the registrar 
to be forwarded to the other hospital. 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
96. Line of duty boards.—a. AR 345—415 directs that battle 
casualties, injuries received while operating or riding in Gov- 
ernment vehicles or airplanes, and injuries received while on 
maneuvers, during authorized athletic exercises, or other- 
2 TM 8-260 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT C 1 
wise while engaged in the execution of military duty, will be 
considered to have been incurred in line of duty, provided mis- 
conduct or gross negligence is not a contributory factor. In 
such cases not involving misconduct or gross negligence, the 
line of duty will be determined by the commanding officer or 
the next superior officer and the surgeon. In every case of in- 
jury, which in the opinion of the surgeon is likely to result in a partial 
or complete disability and eventually be made the basis of a claim 
against the Government, and which was incurred while on pass, 
furlough, leave, or as a result of misconduct or gross negli- 
gence, the commanding officer upon recommendation of the surgeon 
will convene a board of officers to investigate and report upon the 
circumstances attending the injury (AE 345—415). 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
98. Registrar. 
b. Supervision of clerical work.—The registrar coordinates all mat- 
ters relating to the discharge of enlisted patients on certificates of 
disability. He is responsible that the entries on the certificate of 
disability are correct and that upon completion of the discharge the 
certificate of disability and allied papers are disposed of as directed 
by section II, AR 615-360. 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
Appendix I 
CHECK LIST FOR MEDICAL (HOSPITAL) INSPECTOR 
2. Environmental sanitation. 
b. Public buildings. 
(4) Bakeries. 
(i) Are towels or other cloths in use? (AR 40-205.) 
d. Disposal of garbage, manure, dead animals, and other refuse. 
(2) Is garbage collector permitted to transfer garbage from can to 
can during collections at kitchens, thus creating a polluted condition 
of the soil? (AR 40-205.) 
3 TM 8-260 
C l 
TECHNICAL MANUAL 
e. Food supplies and their preparation. 
(8) Is raw milk sold on the post ? (Cli. XI, Army Medical Bulletin 
No. 23.) 
(11) Is milk used on the post from cows giving a positive agglu- 
tination test? (Ch. XI, Army Medical Bulletin No. 23.) 
(33) Are dish cloths in use? (AR 40-205.) 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
Appendix II 
CHECK LIST FOR COMMANDING OFFICER OR SURGEON 
23/. Helpless patients are not kept above second floor of hospital 
(AR 40-590). 
[A. G. 062.11 (12-30-41).] (C 1, Mar. 31. 1942.) 
37e. Are officers on duty at the hospital subsisted at the hospital 
mess? (AR 40-590.) 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
47. Are civilian physicians in Army hospitals authorized to sign 
official papers pertaining to military personnel? (Par. 8, circular 
letter No. 1, S. G. O., 1940.) 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
Appendix III 
CHECK LIST FOR REGISTRAR 
51. Injuries are reported as required (par. 10 g and A, circular 
letter No. 1, S. G. O., 1940). 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
Appendix IV 
CHECK LIST FOR MEDICAL SUPPLY OFFICER 
4c. Are issues made at any hour of the day or night if a request is 
made? (AR 40-590.) 
7. Is an accumulation of nonstandard supplies on hand? (Cir- 
cular letter No. 1, S. G. O.. 1940.) 
[A. G. 062.11 (Cl, Mar. 31, 1942.) 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
4 TM 8-260 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT C 1 
8. Is a record of surplus property kept? (AR 40-1705.) 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
12. 
b. Is it customary to keep any of the narcotics or alcohol listed below 
stored in unit equipment ? 
d. Is a list of the above items kept in the equipment chests to 
avoid danger of delay or shortage when a unit takes the field ? 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1042.) 
17d. Do records show excessive exchange of biologicals? (Par, 64, 
circular letter No. 1, S. G. O., 1940.) 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
20. Are separate meters installed to record the electric current used 
for X-ray machines, centrifuges, and other such purposes? 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
39. Is hospital laundry put out to private laundries on contract or 
informal agreement? (AR 40-590.) 
44b. Is there an accumulation of obsolete or damaged medical 
books? (AR 40-1705.) 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
45b. Was payment made from the hospital fund? (AR 40-590.) 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
Appendix V 
CHECK LIST FOR DIRECTOR OF DIETETICS (MESS 
OFFICER) 
2h. Are containers for poisons such as rat poisons, roach powders, 
etc., kept in the mess room? (AR 40-590.) 
9a. Mess officer has copies of TM 10-405 and 10—410. 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
5 TM 8-260 
C l 
TECHNICAL MANUAL 
Appendix VI 
CHECK LIST FOR COMMANDING OFFICER, MEDICAL 
DETACHMENT 
23. Are enlisted men permitted to wear the white uniform when 
not actually engaged in an appropriate duty in the hospital? (AR 
600-40.) 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
Appendix VII 
CHECK LIST FOR PRINCIPAL CHIEF NURSE 
19. Is it possible to grant annual leave to the nurses without crip- 
pling the service ? 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
21. Are expenditures from the hospital fund made for furnishings 
for nurses’ recreation rooms or for other purposes? (AR 210-50, and 
par. 15, circular letter No. 1, S. G. O., 1940.) 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
24. Does the principal chief nurse maintain a council book to 
account for moneys received from miscellaneous sources in violation 
of existing regulations? (Par. 15, circular letter No. 1, S. G. O., 1940.) 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
Appendix VIII 
CHECK LIST FOR CHIEF OF SURGICAL SERVICE 
2. Genito-urinary section. 
/(2) (b) Are patients with gonorrhoea retained in hospital until 
satisfactorily cured ? 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
4. Surgical wards. 
h (3) Is soiled clothing of patients laundered at Government 
expense as a part of the hospital laundry? (AR 40-590.) 
s(l) Dietitian and head nurse are responsible for the service of 
meals. 
6 TM 8-260 
C 1 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(9) Are attendants permitted to eat in the wards or diet kitchens? 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
Appendix XI 
CHECK LIST FOE CHIEF OF DENTAL SERVICE 
5. Are enlisted men assigned to dental service regarded as being 
on special duty and under special instruction, and not required to 
attend any other form of instruction? (AR 40-15.) 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
Appendix XII 
CHECK LIST FOR CHIEF OF ROENTGENOLOGICAL 
SERVICE 
61. Are films stored in rooms which are shared with other activities? 
(A. G. 062.11 (12-30—41).] (Cl, Mar. 31, 1942.) 
Appendix XIV 
CHECK LIST FOR OFFICER IN CHARGE OF PHARMACY 
12. Have unduly large amounts of alcoholic liquors been prescribed 
at one time for any one person? (AR 40-590.) 
[A. G. 062.11 (12—30—41).] (Cl, Mar. 31, 1942.) 
22. Are prescriptions refilled without a written order calling for a 
refill by number? (TM 8-233.) 
[A. G. 062.11 (12-30-41).] (Cl, Mar. 31, 1942.) 
order of the Secretary of War : 
G. C. MARSHALL, 
Chief of Staff. 
Official, : 
J. A. ULIO, 
Major General, 
The Adjutant General. 
7 
U. S. GOVERNMENT PRINTING OFFtCCs TM 8-260 
C 3 
TECHNICAL MANUAL 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(GENERAL AND STATION HOSPITALS) 
Changes 
No. 2 
War Department, 
Washington, February 9, 1943. 
TM 8-260, July 16,1941, is changed as follows: 
12. Administrative service. 
/. Principal chief nurse.—The principal chief nurse has general 
supervision over all Army nurses on duty at the hospital, arranges 
the hours of duty, their assignment, and is responsible for their 
discipline both on and off duty. (She brings to * * * and app. 
VII). 
[A. G. 062.11 (2-1-43).] (C 2, Feb. 9,1943.) 
36. Messes for patient officers.—The director of dietetics causes 
a separate mess to be maintained for all patients on an officer status. 
Ambulant patients on an officer status on regular diets should be 
furnished table service. 
37. Nurses’ funds.—Kescinded, 
[A. G. 062.11 (2-1-43).] (C 2, Feb. 9, 1943.) 
[A. G. 062.11 (2-1-43).] (C 2, Feb. 9. 1943.) 
Bx ORDER OF THE SECRETARY OF War; 
G. C. MAKSHALL, 
Chief of Staff. 
Official : 
J. A. ULIO, 
Major General, 
The Adjutant General. 
512105°—48 
B. *. GOVERNMENT PRINTING OFFICE) t(4S TM 8-260 
C 3 
TECHNICAL MANUAL 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(GENERAL AND STATION HOSPITALS) 
Changes 
No. 3 
WAR DEPARTMENT, 
Washington 25, D. C., 8 January 1944. 
TM 8-260,16 July 1941, is changed as follows: 
179. Examinations. 
b. Procedure. 
(2) Wassermann test.—Blood specimens for * * * laboratory 
before 9:00 AM. Requests for Wassermann tests are prepared on 
W. D., M. D. Form No. 55L-3. 
(3) * * ♦. 
[A. G. 300.7 (4 Dec 43).] (C 3, 8 Jan 44.) 
254. Miscellaneous urological procedures. 
k. Venereal disease.—Rescinded. 
[A. G. 300.7 (4 Dec 43).] (C 3, 8 Jan 44.) 
Appendix VIII 
CHECK LIST FOR CHIEF OF SURGICAL SERVICE 
2. Genito-urinary section.—Rescinded. 
[A. G. 300.7 (4 Dec 43).] (C 3, 8 Jan 44.) 
By obdeb of the Secbetaby of Wab: 
G. C. MARSHALL, 
Chief of Staff. 
Official : 
J. A. ULIO, 
Major General, 
The Adjutant General. 
568627*—44 
U. «. GOVERNMENT PRINTING OFFICE: 1944 TM 8-260 
TECHNICAL MANUAL 
No. 8-260 
DEPARTMENT, 
Washington, July 16,1&41. 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(GENERAL AND STATION HOSPITALS) 
Prepared under direction of 
The Surgeon General 
Chapter 1, Fundamental considerations. Paragraphs 
Section I. General orientation 1-7 
II. Organization of general hospital 8-14 
III. Establishment of general hospital 15-17 
Chapter 2. Administrative procedure. 
Section I. General . 18 
II. Information office 19-21 
III. Dietetic department 22-39 
IV. Receiving and disposition officer1 40-50 
V. Medical supply department 51-60 
VI. Admission of patients 61-68 
VII. Discharge of patients 69-76 
VIII. Seriously ill patients 77-82 
IX. Patients’ funds and valuables 83-90 
X. Disease or injury 91-96 
XI. Action on discharge for disability 97-100 
XII. Deaths 101-107 
XIII. Clothing and baggage of patients 108-115 
XIV. Medical detachment 116-122 
XV. Administrative officer of the day 123-132 
XVI. General supply and utilities 133-138 
Chapter 3. Professional services. 
Section I. General 139-144 
II. Ward officer 145-157 
III. Detention ward 158-164 
IV. Neuropsychiatric section 165-176 
V. Laboratory service 177-183 
VI. Roentgenological service 184-188 
VII. Dental service 189-198 
VIII. Army Nurse Corps and nursing service 199-204 
IX. Dispensary 205-209 
X. Pharmacy 210-216 
XL Professional officers of the day 217-223 TM 8-260 
Chapter 4, Professional standing orders. Paragraphs 
Section I. General 224 
II. Medical service 225-232 
III. General surgery 233-243 
IV. Orthopedic surgery 244-248 
V. Genito-urinary surgery 249-254 
VI. Eye, ear, nose, and throat surgery 255-256 
VII. Dental and oral surgery 257-262 
VIII. Roentgenology 263-267 
IX. Physical therapy (fever therapy) section 268-271 
X. Acute poisonings, their antidotes and 
treatment 272 
Chapter 5. Station hospital 273-276 
Appendixes. Check lists. 
I, Medical (hospital) inspector 1-6 
II. Commanding officer or surgeon 1-47 
III. Registrar 1-52 
IV. Medical supply officer 1-51 
Y, Director of dietetics (mess officer) 1-13 
VI. Commanding officer, medical detachment— 1-36 
VII. Principal chief nurse 1-24 
VIII. Chief of surgical service 1-4 
IX. Chief of medical service 1-2 
X. Officer in charge of laboratory 1-21 
XI. Chief of dental service 1-24 
XII. Chief of Roentgenological service 1-7 
XIII. Officer in charge of dispensary 1-11 
XIV. Officer in charge of pharmacy 1-41 
Page 
Index 257 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
l 
Chapter 1 
FUNDAMENTAL CONSIDERATIONS 
Paragraphs 
Section I. General orientation 1-7 
II. Organization of general hospital 8-14 
III. Establishment of general hospital 15-17 
Section I 
GENERAL ORIENTATION 
Paragraph 
General provisions 1 
Designation and identification 2 
Functions and control 3 
Purpose - 4 
Distribution and time of establishment 5 
Supply 6 
Groupings of general hospital 7 
1. General provisions.—a. Main classes.—Hospitals provided by 
and for the Army in peace or war are divided into two main 
classes: 
(1) Stationary or fixed (the “fixed establishments” of the Geneva 
Convention). 
(2) Field or mobile (the “mobile sanitary formations” of the 
Geneva Convention). 
b. Types.— (1) Fixed hospitals.—In time of peace or war at home 
or abroad, only two types of fixed hospitals are maintained for per- 
manent or definitive hospitalization: 
(a) Station hospitals (at times called post or camp hospitals). 
(b) General hospitals (including those formerly called depart 
ment or base hospitals). 
(2) Mobile hospitals.—In time of actual or threatened hostilities 
or whenever in peace troops are in the field where fixed hospitals 
are not available, readily accessible, or sufficient to meet the needs, 
the following types of mobile units (see FM 8-5) provided for in 
Tables of Organization are established for temporary or emergency 
hospitalization: 
(a) Clearing stations (formerly called field hospitals and hospital 
stations). 
(5) Surgical hospitals (formerly called mobile hospitals). 
(c) Evacuation hospitals. 
(d) Convalescent hospitals (formerly called convalescent depots). 
3 TM 8-260 
2-3 
MEDICAL DEPARTMENT 
2. Designation and identification.—a. Fixed hospitals.—(1) 
In peacetime.—Fixed hospitals in operation are not given a numerical 
designation. 
(a) A station hospital is identified by giving the type, title of the 
hospital, and its location, for example, Station Hospital, Fort 
Benning, Georgia. 
(h) A general hospital is identified by giving the type, title of 
the hospital, and its location, and in addition thereto the name of 
a deceased medical officer of the Army of the United States whose 
services were of a distinguished character, for example, Walter Reed 
General Hospital, Army Medical Center, Washington, D. C. 
(2) In wartime.—(a) Fixed hospitals located in the zone of the 
interior are designated as prescribed in (1) above. 
(h) Fixed hospitals located in a theater of operations are desig- 
nated and identified only by their number, type, and title. Their 
location is not given. For example, 6th Station Hospital; 110th 
General Hospital; 7th Veterinary General Hospital. 
(c) Fixed hospitals bearing a numerical designation are given a 
number in a consecutive series from one upward for each type. 
(3) Names for general hospitals.—As required from time to time 
appropriate names recommended by The Surgeon General for such 
new general hospitals as may be established in the zone of the in- 
terior are, upon approval of the Secretary of War, announced in 
War Department orders. 
b. Mobile hospitals.—Mobile hospitals are designated by giving 
their number, type and title, without location. The number is as- 
signed by the War Department and is consecutive for each type. For 
example, 2d Surgical Hospital; 5th Evacuation Hospital (see FM 
8-5); 11th Veterinary Evacuation Hospital. 
3. Functions and control.—a. Fixed hospitals.—The normal field 
of usefulness for fixed hospitals is in the communications zone and 
in the zone of the interior and not in the combat zone. 
(1) Station hospitals.—A station hospital normally receives pa- 
tients only from the station to which it pertains. In exceptional in- 
stances it may serve the needs of a circumscribed area, or may be 
designated to receive special cases from any place without a corps area 
or other military command under the control of whose commander it 
functions. A station hospital in peace or war functions under such 
local, district, section, or corps area control as may be prescribed by 
the superior commander under whose jurisdiction it is being 
administered. 
4 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
3-4 
(2) General hospitals.— (a) A general hospital is designed to 
serve general and special rather than local and ordinary needs. Those 
in the zone of the interior are located at such places as may be recom- 
mended by The Surgeon General and approved by the War 
Department. 
(5) The control of general hospitals by higher authority is so ar- 
ranged that it is subjected to a minimum of administrative interfer- 
ence in its work. Since the work of a general hospital is largely of 
a professional nature it has been found that the service can best be 
carried on untrammeled by direct military control. Within the con- 
tinental limits of the United States the general hospitals function 
under the control of The Surgeon General, subject to the exemptions 
prescribed in AR 170-10. The senior medical officer on duty with a 
general hospital commands it and, within the continental limits of 
the United States, is not subject to the orders of a local commander 
other than the commanding general of the corps area in which the 
hospital is located, to whom specific authority may be delegated by 
AR 170-10. General hospitals in the insular possessions and those 
in a theater of operations function under the control of the depart- 
ment or tactical commanders within whose jurisdiction they may be 
located. 
h. Mobile hospitals.—Mobile hospitals are provided to meet the 
needs of troops in the field or in campaign where it is impracticable 
to establish fixed hospitals. They also serve as relay points in the 
evacuation of patients to fixed hospitals where definite treatment can 
be given most advantageously. Their normal field of usefulness is 
in the combat zone. They function under the control of the tactical 
or territorial commander under whom they may be assigned by proper 
authority (see FM 8-5), 
4. Purpose.—General hospitals are designed to— 
a. Afford better facilities than can be provided at the ordinary sta- 
tion or other hospitals for the study, observation, and treatment of 
serious, complicated, or obscure cases. For this reason, general hos- 
pitals are equipped with the most modern apparatus and assigned 
especially qualified personnel. 
h. Afford opportunities for the performance of the more difficult 
or formidable surgical operations, facilities for which may be lacking 
at station or mobile hospitals. 
c. Study and finally dispose of cases that may have long resisted 
treatment elsewhere, and to determine questions of the existence, cause, 
extent, and permanence of mental and physical disabilities of long 
standing or unusual obscurity. 
5 TM 8-260 
4-5 
MEDICAL DEPARTMENT 
d. Instruct and train junior Medical Department officers in general 
professional and administrative duties. 
e. Form the nucleus for the initial hospitalization needs of the zone 
of the interior in time of war. 
/. Receive and give definitive treatment to patients from other hos- 
pitals in the theater of operations, particularly mobile units in the 
combat area. 
5. Distribution and time of establishment.—a. General hos- 
pitals of the theater of operations are priority units in a general mo- 
bilization plan and will be established whenever the armed 
forces proceed to the theater of operations. The number employed 
in the theater of operations depends upon the proximity of the zone 
of the interior thereto. If these adjoin—no sea paths separating 
them—general hospitals are usually established in the communication 
zone only at the rate of one per division. Within hospitalization 
allowances in terms of beds, the balance needed and not allocated to 
the theater of operations is established in territory pertaining to the 
zone of the interior. (See MR 4-2 and FM 100-10.) 
b. Each general hospital in the theater of operations has a normal 
capacity of 1,000 beds and is provided with personnel who, in emer- 
gencies and by crisis expansion under tentage, may care for 2,000 pa- 
tients if the period of stress is not too prolonged. General hospitals 
receive cases by hospital trains, airplanes, or ambulances direct from 
the evacuation hospitals at the front and from other general hospitals 
making retrograde secondary evacuation, as well as cases originating 
in the communications zone. Being completely equipped from a medi- 
cal and surgical standpoint they give treatment to all types of cases 
sent to them, forwarding to the zone of the interior only such cases 
as require special treatment or are not likely to be fit for service for 
a considerable period of time, or will probably be permanently inca- 
pacitated for further duty. However, where their capacity is being 
taxed or an extension of active fighting is in immediate prospect, they 
must either be evacuated of suitable cases or reinforced by expansion 
of accommodations already existing. No individual capable of fur- 
ther duty in the immediate future should ever be sent farther to the 
rear than a general hospital in the communications zone since experi- 
ence has shown that the services of a great proportion of cases coming 
into the zone of the interior will probably be lost for the campaign 
if not for the war. 
c. No standard capacity or equipment is prescribed for fixed hos- 
pitals in time of peace, nor ordinarily in the case of those pertaining to 
the zone of the interior in time of war. Their capacity and equip- 
6 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
5-7 
ment vary according to and are governed by local as well as general 
requirements. 
6. Supply.—a. The initial supplies required for the establishment 
of a general hospital are assembled in the supply depots in the zone of 
the interior or the communications zone as the case may be. They 
may be requisitioned by the commanding officer in the form of a 
request for “one general hospital” when the unit is ordered to duty 
at the site finally selected. Tentative training equipment tables have 
been prepared for the use of general hospitals while undergoing train- 
ing and this equipment will be left at training station sites or returned 
to depots as may be directed. In order to visualize the amount of 
supplies and equipment necessary to equip a general hospital refer- 
ence is made to the following approximate figures: Net weight, 220,083 
pounds; shipping weight, 324 tons; volume, 13,000 cubic feet; freight 
cars required, 7.3; trucks, 73.3. The number of separate 
packages required to pack the initial supplies for a general hospital 
is 2,474, but if the individual items are counted the total runs up to 
100,000. 
h. Supplies required for the maintenance of a general hospital are 
obtained periodically on requisition by the supply officer from the 
Medical Department sections of the supply depots of the communi- 
cations zone or zone of the interior. Certain supplies such as food 
stuffs may be obtained by local procurement. Special articles such 
as nonstandard surgical or laboratory instruments may be furnished 
by the American Red Cross. 
7. Groupings of general hospital.—When possible two or more 
general hospitals with a convalescent camp (capacity of 1,000) are 
grouped together under an overhead known as the hospital center. 
This arrangement has the advantage of economy of administration, 
and offers the opportunity for specialization and pooling of trans- 
portation facilities. From an administration point of view, it is 
highly desirable to pool or otherwise centralize such features as quar- 
termaster and medical supplies, laundries, bakeries, water transport, 
power, heat, military police, and fire prevention. Professionally, the 
hospital center is advantageous in that it permits the special assign- 
ment of one general hospital to any desired specialty or group of cases. 
7 TM 8-260 
8-10 
MEDICAL DEPARTMENT 
Section II 
ORGANIZATION OF GENERAL HOSPITAL 
Basis and divisions 8 
Headquarters 9 
Commanding officer 10 
Unit staff 11 
Administrative service 12 
Professional service 13 
Training 14 
Paragraph 
8. Basis and divisions.—The general organization of numbered 
general hospitals is in conformity with T/O 8-507 and with provisions 
of AR 40-590. The organization falls naturally into three divisions, 
the headquarters, the administrative, and the professional services. 
The two services are not subordinate command elements but rather 
a grouping of elements possessing related functions. The chain of 
command is from the hospital commander directly to the commander 
of the separate functional elements of the two major services. 
9. Headquarters.—The headquarters consists of the unit com- 
mander, the senior officer of the Medical Corps assigned and present 
for duty (see par. 10), his staff (see par. 11), and the personnel nec- 
essary to assist in the general administration of the unit and its 
installation. 
10. Commanding officer.—a. The commanding officer of a general 
hospital is responsible for its proper discipline and administration, 
including the care and preparation of the necessary reports, registers, 
and records, as well as for the care and safeguarding of all Govern- 
ment property that may come into his possession, for the proper ex- 
penditure of supplies and funds, and for the preparation of requisi- 
tions, returns, and pay rolls of the hospital. While the commanding 
officer is not charged with the execution of duties properly delegated 
by him to an assistant, yet he is responsible for exercising such super- 
vision over duties thus delegated as to insure their prompt and efficient 
performance by the designated subordinate. The responsibility of the 
commanding officer for the action of his assistants is something that 
must always be borne in mind. At the same time, the commanding 
officer must not exercise this supervision to the extent of operating a 
functional element that has been assigned to a subordinate. 
5. The commanding officer is responsible for the military and techni- 
cal training of all elements of his command. He must— 
(1) Insure the attainment of proper training objectives prior to the 
time his unit goes to the theater of operations. 
8 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
10-11 
(2) Establish policies regarding the various procedures involved 
in the establishment and operation of the hospital, and assign 
appropriate personnel to the various divisions (see app. II). 
11. Unit staff.—a. Executive officer.—The executive officer is 
charged under the direction of the commanding officer with the co- 
COMMANDING OFFICER. 
OR STATION SURGEON 
ADAM Ml STRATI VE 
OFFICER OF THE DAY 
VETERINARY 
SERVICE 
A 
D 
M 
I 
N 
I 
S 
T 
fl 
A 
T 
I 
V 
E 
p 
R 
0 
F 
E 
S 
S 
1 
o 
N 
A 
L 
PROFESSIONAL 
OFFICER OF THE DAY 
MEDICAL 
INSPECTOR. 
GENERAL SURGERY 
REGISTRAR. 
CO. DET..PATIENTS 
ORTHOPEDICS 
SURGICAL SERVICE 
SEPTIC 
MED! CAL 
SUPPLY OFFICER. 
UROLOGY 
MESS 
OFFICER^ 
EVE - EAR.-NOSE 
AND THROAT 
ROENTGENOLOGICAL 
SERVICE 
SENER.AL MEDICINE 
COMMANDING OFFICER. 
DET..MED. DEPT 
COMMUNICABLE-^ 
DISEASE 
PRINCIPAL 
CHIEF NURSE. 
MEDICAL SERVICE 
NEUROPSYCHIATRY 
OFFICER. IN CHG 
OF UTILITIES 
GAST R.O'1 NTESTINAL 
CARDIOVASCULAR. 
LABORATORY 
SERVICE 
OFFICERS 
DENTAL SERVICE 
PHARMACY 
DISPENSARY AND 
OUT-PATIENT SER- 
VICE. FORMERLY 
ATTENDING SURG 
PROPHYLAXIS 
&EN.EXAM>TREAT. 
Figure 1.—Organization of a hospital (to be used as a guide only). 
ordination of all activities of the hospital and such additional duties 
as may be prescribed by the commanding officer. All questions aris- 
ing in the hospital on which a decision must be rendered, unless they 
are of a major character or are ones of policy, are decided by the 
9 TM 8-260 
11-12 
MEDICAL DEPARTMENT 
executive officer in the name of the commanding officer. Until the 
executive officer is thoroughly conversant with the policies of the 
commanding officer, all questions should be submitted to the com- 
manding officer if there is any possibility of doubt as to what his de- 
sires in the matter may be. The decision of the commanding officer 
is final and the executive officer must carry it out. Loyalty must 
always be the keyword of this position. 
h. Adjutant.—The adjutant performs the duties of his office as pre- 
scribed in AR 90-50 (see also FM 101-5). He has charge of civil- 
ian employees and is responsible for the proper operation of an 
office for information. He has charge of all incoming and outgoing 
correspondence, orders, circulars, and has general control of all hos- 
pital records. He verifies and issues all orders and details, includ- 
ing administrative assignments both special and by roster of officers 
and civilian employees. He should keep a check on the audit of all 
public funds and submit a report of audit, together with a statement 
of all funds to the commanding officer as soon as possible after the 
end of each month. 
c. Medical supply officer.—The medical supply officer is charged 
with the procurement, storage, and issue of all medical supplies at the 
hospital, and is accountable for all medical property, except where 
other accountability is specifically designated by proper authority. 
He submits the required requisitions, etc., and maintains the neces- 
sary property and other records pertaining to his office which may be 
required by existing regulations. (See AR 40-1705. See also pars. 
51-GO and app. IV.) 
d. Chaplain.—See TM 16-205, 
e. Personnel officer.—The personnel officer is the assistant adjutant 
and is charged with the administration of all personnel matters ex- 
cept those retained by the medical detachment and the detachment of 
patients (see AR 345-5). It is suggested that the lieutenant, Medi- 
cal Administrative Corps, in the registrar and detachment of patients 
section be charged with this office. Collectively, his clerical assistants 
are designated the unit personnel section and are furnished from the 
detachment Medical Department, supplemented if necessary by per- 
sonnel of the unit headquarters. 
12. Administrative service.—a. Registrar.—The registrar per- 
forms the duties outlined in AR 40-590 and such additional duties 
as may be prescribed by the commanding officer. He has charge 
of sick and wounded records and reports. He exercises adminis- 
trative jurisdiction over all matters pertaining to deaths, casualty 
reports, and disposition of remains, and makes such reports in con- 
10 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
12 
nection therewith as may be required by existing regulations (AR 
40-1025). He prepares the necessary notification to the nearest rela- 
tive or friend of casualties within the hospital. 
h. Director of dietetics.—The director of dietetics has charge of and 
is responsible for the administration of all that pertains to the hos- 
pital messes. He is the custodian of the hospital fund and as such 
is responsible that it is administered in accordance with existing 
regulations (see pars. 22-41, and app. V). 
c. Commanding officer, detachment of 'patients.—The commanding 
officer, detachment of patients, exercises immediate command over all 
patients and has charge of all records, reports, and correspondence 
pertaining thereto. He also has charge of all money and valuables 
belonging to patients. He is, in addition, in charge of the patients’ 
baggage room (see pars. 83-90 and 108-115). 
d. Commanding officer, medical detachment.—The commanding 
officer, medical detachment, exercises immediate command over all 
enlisted personnel in the Medical Department on duty at the hos- 
pital, supplying such details, temporary or permanent, to different 
wards or departments of the hospital as may be required. He is 
responsible for the discipline, training, equipment, uniform, and 
quartering of all men of his detachment (see pars. 116-122 and 
app. VI). 
e. Receiving and disposition officer.—The receiving and disposition 
officer is responsible for the admission and disposition of all patients 
to and from the hospital. He receives, examines, classifies, and sends 
to the proper wards all incoming patients, exercising due care and 
precaution in the prompt isolation of all communicable diseases. He 
keeps informed at all times concerning the number of beds available 
in the various wards and foresees and provides for expected arrivals. 
He supervises the transportation of sick or wounded to and from the 
hospital. He temporarily receives and safeguards the money and 
valuables of incoming patients and receives and receipts for the bag- 
gage of patients prior to release to commanding officer, detachment 
of patients. He prepares all required forms, records, and notifica- 
tions in connection with the admission of patients. He makes all 
arrangements for patients leaving the hospital. When a convoy of 
patients is being evacuated from the hospital, he should check the 
convoy by name and see that necessary records and papers are 
complete and go with the shipment (see pars. 40-50). 
/. Principal chief nurse.—The principal chief nurse has general 
supervision over all Army nurses on duty at the hospital, arranges 
the hours of duty, their assignment, has supervision over their messes. 
11 TM 8-260 
12-13 
MEDICAL DEPARTMENT 
and is responsible for their discipline both on and off duty. She 
brings to the attention of the commanding officer any serious breach 
of discipline on the part of a nurse or other occupant of the nurses’ 
quarters. The principal chief nurse is in charge of the nurses’ quar- 
ters, the property contained therein, is responsible for the comfort 
and well-being of the nurses under her, and for the proper keeping 
of the necessary records pertaining to Army nurses (see pars. 199-204 
and app. VII). 
g. Hospital inspector.—The hospital inspector acts as medical 
inspector of the hospital (AR 40-270), and makes such routine and 
special inspections and investigations as may be prescribed by the 
commanding officer. He makes a monthly check of all alcoholics, 
narcotics, and habit-forming drugs in the pharmacy and in the hands 
of the medical supply officer, reporting the fact of inspection and 
existing irregularities to the commanding officer. He inspects and 
checks, once each month, the narcotic books in all wards and depart- 
ments, noting facts and dates of inspection immediately after the last 
entries in the books. In conformity with the provisions of paragraph 
106?, AR 210-10, he makes an inventory at least once a month of such 
articles in the hands of accountable and responsible officers as may 
be designated by the commanding officer, and upon completion 
thereof reports the fact of inventory and irregularities so discovered 
to the commanding officer. He makes frequent inspections of all 
offices and departments of the hospital to insure that the regulations 
governing their operations are on file and are being complied with 
(see app, I). 
13. Professional service (see ch. 3).—a. General.—(1) The pro- 
fessional service represents a grouping of certain functional ele- 
ments of the hospital and is not an organic element of the unit. 
Normally, each service, medical, etc., is an independent element of 
the hospital and the chief thereof directly responsible to the unit 
commander. The commander may subordinate certain auxiliary 
service(s) to one of the major services. For example, the physical 
therapy section may be placed under the command of the chief of 
the medical or surgical service. These are decisions for the unit 
commander and do not change the various functions of the services 
involved. 
(2) The professional service is responsible for the care and 
treatment of all patients admitted to the hospital from the 
time they are relinquished by the receiving and disposition officer 
until they are returned to duty or turned over for transfer to a con- 
valescent or another general hospital. The professional service is 
12 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
13-14 
the basic functional element of the unit, and the headquarters and 
the administrative service merely furnish those aids necessary to 
permit the execution of appropriate procedures by that service. 
b. Services.—The professional service is normally made up of five 
principal services as follows: 
(1) Medical service.—The medical service is made up of six sec- 
tions as follows: 
(a) Gastroenterology. 
(h) Neuropsychiatry. 
(c) General medical. 
{d) Cardiovascular. 
(e) Communicable disease. 
(/) Officer’s. 
(2) Surgical service.—The surgical service is made up of five 
sections as follows: 
(a) Orthopedic. 
(&) Urologic. 
(c) Eye, ear, nose, and throat. 
(d) Septic surgery. 
(e) General surgery. 
(3) Laboratory service.—See paragraphs 177-183. 
(4) Roentgenological service.—See paragraphs 184-188. 
(5) Dental service.—See paragraphs 189-198. 
c. Chief.—All of the above-mentioned professional services are under 
charge of an officer who is known as the chief of service. Each section 
is under the charge of an officer known as chief of section. 
Chiefs of services are responsible directly to the commanding officer 
for the administration of their service, and chiefs of sections are 
responsible to the chiefs of service for the administration of their sec- 
tions. The chiefs of services act as consultants in the hospital. Each 
service keeps a record of patients treated as out-patients and submits 
appropriate information to the registrar for “card for record” in all 
cases where the condition may have a future bearing on the case. (See 
AK 40-1025.) 
14. Training.—a. Responsibility.—The unit commander is re- 
sponsible for all training. 
b. Management.—Since there is no plans and training officer on the 
unit staff, the actual management of individual training devolves upon 
the detachment comander. Acting within the policies and directives 
of the unit commander and subject to the latter’s approval, he pre- 
pares the unit training programs and schedules, assigns instructors, 
and exercises general supervision. The unit commander in turn makes TM 8-260 
14-15 
MEDICAL DEPARTMENT 
such training inspections as he deems necessary to insure the proper 
progress of training and attainment of the prescribed objectives. 
Group training is managed by the section and service commanders; 
unit training by the unit commander. 
c. Individual.—See appendix, FM 8-5. 
d. Specialist.—See appendix, FM 8-5. 
e. Unit.—All phases of training are important to the general hos- 
pital but none is so vital as the unit training. The equipment and 
varied duties demand the systematic and coordinated functioning of 
all elements if the whole is to act as one body. 
Section III 
ESTABLISHMENT OF GENERAL HOSPITAL 
Selection of sites 15 
Buildings 16 
Lay-out 17 
Paragraph 
15. Selection of sites.—a. The distribution of general hospitals 
in the communications zone is planned by advance studies of the theater 
of operations. The chief surgeon, GHQ, selects the sites in conformity 
with GHQ policies and after consultation with the assistant chief of 
staff, G-4, GHQ. 
h. In locating general hospitals in the communications zone, the guid- 
ing consideration is to have them established on or immediately off 
the main arteries of railway traffic and preferably on those radiating 
from a regulating station serving the forces at the front. General 
hospitals should be echeloned from front to rear. Within the com- 
munications zone a certain number, depending upon the size of the 
whole force, should be located as near the troops they are intended to 
serve as is warranted by considerations of security and ready access by 
hospital train, bus, airplane, or ambulance. 
g. The establishment of a general hospital creates a heavy demand 
for shelter. This is provided either by taking over existing buildings 
such as schools, hotels, barracks, industrial plants, and former hos- 
pitals, or by new construction. Tentage will rarely be used except 
for the purpose of crisis expansion. When buildings are taken over 
for hospital purposes many alterations, additions, and repairs are 
usually necessary to render them habitable and suitable for the work. 
Whenever temporary construction is undertaken it must be of the 
simplest standardized type. This becomes readily obvious since a 
general hospital consists of approximately 62 buildings: 33 wards, 
administration, surgical, receiving and forwarding and bath buildings, 
14 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
15-16 
messes, and the usual personnel buildings and detached latrines and 
baths. The ward buildings should be identical with exceptions noted 
in paragraph 16. Expensive fixed installations and major items of 
nonstandard equipment, sewerage, water mains, private rooms, large 
cooking equipment, etc., must be held to the minimum with the object 
of reducing time and cost on both construction and abandonment. 
(See fig. 2.) 
d. To economize in heating and lighting and structural material the 
buildings are grouped as closely as consideration of fire safety permits. 
In the lay-out of a general hospital unit, a vacant space is always 
left at the outer end of each ward for the erection of tentage in emer- 
gencies to meet the so-called crisis expansion needs. When this crisis 
expansion is being employed the more serious cases are retained in the 
ward proper and the slighter or ambulant cases graduated from day 
to day into the tented section of the ward. 
16. Buildings.—Housing facilities for the sick in general hospitals 
of the zone of the interior when newly constructed should provide— 
a. Wards.— (1) Combination.—The combination ward has 26 beds, 
10 private (6 with private bath) and 16 open with adjoining toilet sep- 
arate from adjoining bath and lavatory; patient’s clothing and bag- 
gage room; utility room; serving kitchen; linen room and nurses’ 
toilet; office; examining room; open porch and glassed-in solarium. 
Wards of this type provide for seriously ill, isolation, and segregation. 
As the size of the hospital increases above 500 beds, the proportion 
of combination wards is reduced and standard type wards predominate 
with two detention type wards. 
(2) Standard.—The standard ward has 33 beds, 2 semiprivate and 
31 open with adjoining toilet separate from adjoining bath and lava- 
tory, Offices and utilities are otherwise the same as the combination 
ward. These buildings are intended for the noncontagious and con- 
valescent patients. 
(3) Detention.—The detention ward has 25 beds, 9 private (4 
with private bath) and 16 open with adjoining toilet separate from 
adjoining bath and lavatory; patients’ clothing and baggage room; 
utility room; serving kitchen; linen room and nurses’ toilet; office 
examining room, and two wire-meshed porches. These buildings are 
intended for closed N. P. cases and prisoners. 
(4) Number.—In a general hospital of 1,000 beds there will usually 
be 10 combination, 21 standard, and 2 to 4 detention type wards. 
b. Personnel.—Both officers’ and nurses’ quarters should be exten- 
sible buildings. Accommodations should consist of simple 1- and 
2-bed rooms, common toilets and showers, and a common living room 
15 TM 8-260 
16 
MEDICAL DEPARTMENT 
in all buildings. The medical detachment is housed in barracks on 
the basis of 125-man blocks. A 250-man block consists of four bar- 
racks (63-man capacity with inside lavatories), one mess hall, one 
recreation building, and one administration and supply building. For 
units such as a general hospital with a 500-man detachment, a vari- 
ation of the standard block is provided such as a 500-man mess hall 
of special design and additional 63-man barracks. 
o. Messes.— (1) In a general hospital it is necessary to have at least 
three messing units, one for enlisted detachment, one for all commis- 
sioned personnel, and one for enlisted patients. Seating arrangement 
must be such as to permit necessary or desirable expansion. In esti- 
mating the basic messing requirements, the following assumptions 
may be made: 
(a) 10 percent of hospital beds may be occupied by officers and 
nurses. ' 
(h) 50 percent of enlisted sick may walk to mess hall. 
(c) 50 percent of officers and nurses may walk to mess hall. - 
(d) 3 percent of medical detachment and 4 percent of nurses will 
be sick in hospital. 
(2) Messing requirements in a 1,000-bed hospital are as follows: 
Mess 
Kitchen, cooking capacity 
Mess hall 
Enlisted patients (plan 1-2) _ 
Required, 900 
To mess hall 900 — 450 = 450. 
For enlisted sick, 1,000 
Provided, 1,000 
Seating capacity = 304. 
-100 = 900. 
Cafeteria service, rate per 
hour = 900. 
Serving time=30 minutes. 
Medical detachment (Plan 
Required, 485 
To mess hall = 485. 
I). 
500-15 = 485... 
Provided, 500 
Seating capacity = 240. 
Cafeteria service, rate per 
hour=300. 
Serving time=l hour, 37 min- 
utes. 
Commissioned (Plan I-ll)_ 
Required, 293 
To mess hall 73 + (120-5) 
For duty officers, 73 
+ (100-50) = 238. 
For duty nurses, 120 ... 
Provided, 275 
Seating capacity = 192. 
For commissioned 
Cafeteria service, rate per 
sick, 100 
hour=240. 
293 
Serving time=l hour. 
16 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
16-17 
d. Administrative ami professional.—In hospitals up to 250 beds 
administrative, professional, and technical work are provided for in 
one large central administrative building. At 1,000-bed hospitals all 
three functions, administrative, professional, and technical, have sepa- 
rate buildings. Provision for reception and forwarding of the sick is 
made in the administrative building with separate entrance and exit. 
Reception as now contemplated does not include initial bath, clothing 
change, storage, or observation wards. Provision is made for recep- 
tion, including all records, collection of valuables, and ward assign- 
ment. Initial bath, issue of hospital clothing, and storage of patient’s 
clothing are provided in each ward. Thus decentralized individual 
attention may be given at once and with less effort by any one group; 
confusion is reduced and clothing properly stored in each patient’s 
W’ard is always at hand. 
17. Lay-out.—The lay-out of buildings shown in figure 2 should 
be followed if local terrain permits. It is considered the most suit- 
able for satisfactory operation. At places where the local terrain 
does not permit adherence, local authorities will prepare new lay-outs 
made in accordance with at least the following three of the funda- 
mentals which govern all lay-outs: 
a. Buildings having to do with all sick, that is, main mess, surgery 
clinics, administrative buildings, etc., are centrally located. 
b. Ward housing principally for the ambulant who, if near enough, 
can walk to the above facilities, that is, standard wards, form the first 
concentric building group immediately surrounding the central group. 
c. Wards housing communicable diseases, the segregated, the se- 
riously ill requiring quiet, and others unable to walk to the central 
facilities referred to, that is, combination wards, form the next or outer 
concentric building group. 
17 TM 8-260 
17 
MEDICAL DEPARTMENT 
Figure 2.—Building lay-out, typical 1,000-bed general hospital. 
18 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
18-19 
Chapter 2 
ADMINISTRATIVE PROCEDURE 
Section I. General 18 
II. Information office 19-21 
III. Dietetic department 22-39 
IV. Deceiving and disposition officer 10-50 
V. Medical supply department 51-60 
VI. Admission of patients 61-68 
VII. Discharge of patients 69-76 
VIII. Seriously ill patients 77-82 
IX. Patients’ funds and valuables 83-90 
Disease or injury 91-96 
XI. Action on discharge for disability 97-100 
XII. Deaths 101-107 
XIII. Clothing and baggage of patients 108-115 
XIV. Medical detachment 116-122 
XV. Administrative officer of the day 123-132 
XVI. General supply and utilities 133-138 
Paragraphs 
Section I 
GENERAL 
Paragraph 
General 18 
18. General.—The administrative procedures outlined herein are 
basic and somewhat in detail. The procedures should serve as a 
guide for unit administration and be modified to meet the varying 
conditions with which the unit may be confronted. 
Section II 
INFORMATION OFFICE 
Organization 19 
Function 20 
Report of administrative officer of the day 21 
Paragraph 
19. Organization.—The information office for the purpose of 
administration is under the adjutant. A noncommissioned officer is 
detailed in charge with such enlisted assistants as may be necessary. 
This office is kept open 24 hours each day. 
19 TM 8-260 
20-21 
MEDICAL DEPARTMENT 
20. Function.—The functions are— 
a. Index of 'patients.—In order that a ready reference may be 
available, a Kardex card is prepared for each and every patient ad- 
mitted. Care is exercised that all the data recorded are correct. 
These cards are filed alphabetically according to last name in dic- 
tionary index order. Any change in wards or other data are noted 
immediately on this card. These cards remain in the “live file” until 
the patient is returned to duty, discharged, dies, or is otherwise dis- 
posed of, when the card is filed in a “dead file” in the same manner 
as prescribed for the live file where it is kept for 3 months for 
reference. 
h. Rosters of duty personnel.—A roster of duty personnel, mili- 
tary and civilian, is kept up to date for reference. 
c. Roster of seriously ill patients.—A roster of patients who have 
been reported as seriously ill is kept and no name will be removed 
until a death notice has been received, or on the request of the com- 
manding officer, detatchment of patients, who is responsible that no 
patient who has been reported as seriously ill remains on the roster 
after recovering sufficiently to warrant the removal of the name from 
the list. 
d. Information given out.—All information requested is given 
freely, except that in no instance is diagnosis furnished. Requests 
for diagnosis are referred to the adjutant or the executive officer. 
e. Packages, telegrams, special delivery letters, etc.; received.—All 
packages, telegrams, special delivery letters, flowers, etc., received 
for a patient who is in the hospital, are receipted for, entered in a 
book provided for this purpose, and delivered to the patient with 
the least practical delay. Receipt from the patient or the nurse in 
charge of the ward is obtained in this book. 
/. Function under administrative officer of the day.—During the 
hours that the administrative offices of the hospital are closed, the 
personnel perform such duties in and about the hospital as may be 
directed by the administrative officer of the day as well as any 
clerical work that may be required. 
g. Telegrams.—A book is maintained in the information office 
with a copy of the standard forms for routine telegrams "which must 
necessarily be transmitted during hours that administrative offices 
of the hospital are closed. All telegrams sent out during these hours 
conform to the appropriate form indicated in each case. Replies 
to all telegrams, except official business, are sent collect. 
21. Report of administrative officer of the day.—The re- 
port of the administrative officer of the day is prepared in the infor- 
20 TM 8-fcSO 
21-23 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
mation office. All changes in duty personnel are recorded under the 
appropriate heading. 
Section III 
DIETETIC DEPARTMENT 
Paragraph 
Organization 22 
Director of dietetics 23 
Chief dietitian 24 
Records 25 
Subsistence, medicine, and miscellaneous charges 26 
Purchase of food supplies 27 
Night cook 28 
Payment for supplies 29 
Bank deposits 30 
Meals 31 
Food handlers 32 
Inventory of supplies 33 
Property responsibility 34 
Cafeteria system 35 
Messes 36 
Nurses’ funds 37 
Responsibility of ward officer 38 
Hospital council 39 
22. Organization.—All messes at the hospital are under the imme- 
diate supervision of an officer designated by the commanding officer, 
who is known as the “director of dietetics” (mess officer). He may 
delegate the direct supervision of the nurses’ mess to the principal chief 
nurse who is responsible for all activities pertaining to it. He has 
such commissioned assistants, dietitians, and civilian employees as 
the commanding officer may designate (par. 17b and d, AR 40-590). 
Ward diet kitchens to which a dietitian is assigned to duty function 
under the direct control of the director of dietetics who is responsible 
for their police, sanitation, and efficient operation. He is also re- 
sponsible for the property pertaining thereto. Ward diet kitchens 
in which a dietitian is not assigned to duty function under the direct 
control of the ward officer. 
23. Director of dietetics.—The director of dietetics has charge of 
and is responsible for the general administration of all messes in the 
hospital. He will comply with paragraph IT, AR 40-590. He is the 
custodian of the hospital fund, and as such is responsible that it is 
expended in accordance with existing regulations (par. 17, AR 40-590 
and AR 210-50). He is charged with the responsibility for the selec- 
tion, purchase, care, storage, issue, preparation, and serving of all 
food supplies. He sees that the equipment for the handling and serv- 
21 TM 8-260 
23-25 
MEDICAL DEPARTMENT 
ing of food is sufficient, clean, and properly cared for. He has charge 
of the police and sanitation of the department. He assumes property 
responsibility unless the commanding officer directs otherwise. He 
may delegate any of his duties to a commissioned assistant who is 
responsible to him for the proper execution of such delegated duties. 
24. Chief dietitian.—The chief dietitian, under the director of 
dietetics, is responsible for the entire food service to all patients and 
others authorized to mess at the hospital. She must submit bills 
of fare for all patients to the director of dietetics for approval. She 
maintains supervision over the dietitians under her charge and is 
directly responsible for their conduct and efficiency. She assigns 
them to specific duties and holds them responsible for the proper 
performance thereof. She makes recommendations to the director in 
regard to purchases of food supplies and mess equipment. 
25. Records.—The following records are maintained by the 
director of dietetics: 
a. Stock cards.-—For all articles in stock, cards are prepared and 
purchases and issues are noted thereon. 
h. Inventory list.—The inventory list is completely itemized to show 
all articles of food remaining on hand in the storeroom at the end 
of each month, together with the money value and total cost. 
c. Monthly statement of cost.—In this book are recorded the cost 
of operating each mess, the total number fed during the month, and 
the cost per capita. 
d. Bills of fare.—Bills of fare are prepared daily. Signed copies 
are furnished the commanding officer, wards, kitchen, and dining 
rooms. 
e. Mess accownt.—Daily transactions of the mess are accounted for 
on the Mess Account (W. D., M. D. Form No. 74) for each mess, 
and a consolidated account is kept on this form for the entire dietetic 
department. 
f. Hospital fund statement.—The hospital fund statement is pre- 
pared monthly in accordance with AR 210-50. Retained copies of the 
hospital fund statement and mess account, with pertinent vouchers, 
are filed with the records of the mess. 
g. Cash hook.—A cash book is kept of all cash receipts, and shows 
the source and disposition. 
h. File of patients5 receipts.—A duplicate of the receipts furnished 
all pay patients upon payment of their accounts. 
i. Record of pay patients.—A card is kept for each pay patient in the 
hospital showing the name, status, date of admission, date of discharge, 
rate of charges per day, date payment for subsistence and medicine 
22 TM 8-260 
25-27 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
charges was made, and the amounts for subsistence and for medicine 
separately. This record is maintained in two files: 
(1) A file consisting of patients in the hospital and unpaid accounts, 
(2) A file consisting of those discharged from hospital and accounts 
paid. 
j. Records of durable property.—All durable property belonging 
to the Hospital Fund is entered on Stock Record Cards (W. D., 
Q. M. C. Form No. 424), showing the date, voucher number, and quan- 
tity. A memorandum receipt is prepared by the director of dietetics 
and signed by the person holding the property and filed with the 
stock record cards. An abstract of these receipts is kept on Account 
of Property on Memorandum Receipt (W. D., Q. M. C. Form No. 
488), showing the location of each article of durable property. Trans- 
fers of responsibility are made whenever custody of property changes. 
k. Bark account.—The bank account comprises deposit books, can- 
celed checks, retained stubs, and bank statements. 
26. Subsistence, medicine, and miscellaneous charges.—The 
director of dietetics makes collection of all subsistence indebtedness 
due the hospital fund by pay patients, and is responsible for the 
proper maintenance of all accounts and records pertaining thereto. 
He also receives, accounts for, and disposes of all funds paid as medi- 
cine and miscellaneous charges by patients in hospital who are not 
entitled to care and treatment at the expense of Army appropriations. 
He renders a statement to pay patients on the last day of each month 
showing the patient’s indebtedness, and when paid he furnishes an 
itemized, numbered, and signed receipt. All patients remaining in 
hospital on the last day of the month are required to pay their in- 
debtedness in full before the fifth day of the following month. In 
all cases where patients desire to make payment and are physically un- 
able to leave their ward, the ward officer arranges for the prompt pay- 
ment of their bills to the director of dietetics. All other patients are 
required to make their payment at the office of director of dietetics. 
Pay patients who are discharged from the hospital pay their indebted- 
ness on the day of their departure. The director of dietetics institutes 
the necessary steps in accordance with Army Regulations for the col- 
lection of moneys due the hospital fund by pay patients for which 
settlement cannot be obtained. 
27. Purchase of food supplies.—The director of dietetics, or his 
commissioned assistant, personally makes all purchases of food sup- 
plies required by the messes. He assures himself that the supplies 
charged to the hospital fund are actually received, safely stored, 
and issued for proper use. He maintains an accurate record of sup- 
23 TM 8-260 
27-34 
MEDICAL DEPARTMENT 
plies received and of those issued to the various messes. All com- 
ponents of the ration of the organization mess are purchased from 
the quartermaster when such components are available. 
28. Night cook.—The director of dietetics details a night cook 
from the personnel assigned to him. The night cook is on duty from 
6; 00 PM to 4:30 AM, at which time he is relieved by the day 
cook. He remains awake and does not leave the mess during his 
tour of duty. He prepares the night meal for the men on night 
duty. He will not allow anyone in the kitchen except the personnel 
actually on duty. The night personnel, including enlisted men, 
nurses, and members of the guard, are served in the dining room 
designated for that purpose between 11:00 PM to 12:30 AM. No 
persons not actually on duty are served unless authorized by proper 
authority. The night cook allows no property, supplies, or subsist- 
ence stores to be taken from the mess during his tour of duty, and 
reports any unusual occurrences to the administrative officer of the 
day and to the director of dietetics. 
29. Payment for supplies.—The director of dietetics makes 
payment for all supplies purchased and obtains a receipt therefor. 
30. Bank deposits.—The director of dietetics deposits in the au- 
thorized bank to the credit of the hospital fund, General 
Hospital, all moneys received. He is authorized to keep a small 
amount of cash on hand with which to make change for pay patients 
in the settlement of their indebtedness. 
31. Meals.—a. Promptness.—Meals are served promptly at the 
prescribed hours, exceptions to be made only upon proper author- 
ization. 
h. Hours.—The hours for serving meals in the various messes 
of the hospital are prescribed from time to time in memorandum 
orders. 
32. Food handlers.—The director of dietetics is responsible for 
the observance of AR 40-205 governing the examination of perma- 
nent food handlers. 
33. Inventory of supplies.—The director of dietetics, or his com- 
missioned assistant, makes a physical inventory of all supplies on 
hand on the last day of each month, and enters the quantity of 
each item, unit cost, value of each item, and the total value on the 
inventory list. 
34. Property responsibility.—The director of dietetics is re- 
sponsible for all supplies. On the first day of each month the di- 
rector of dietetics, or his commissioned assistant, causes a physical 
check to be made of all property for which he is responsible. On 
24 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
34-36 
completion he reports the results to the accountable officer. Short- 
ages which cannot be adjusted will be surveyed without delay. 
35. Cafeteria system.—All enlisted duty personnel and patients 
on an enlisted status who are on a regular diet and whose condition 
permits are served by the cafeteria system. Patients whose physical 
condition is such as to preclude being served this way receive table 
service. The director of dietetics provides a sufficient number of 
tables and properly trained attendants for such patients. 
36. Messes.—a. Patient officers.—The director of dietetics causes 
a separate mess to be maintained for all patients on an officer status. 
Ambulant patients on an officer status on regular diets should be 
furnished table service. 
b. Nurses.— (1) The nurses’ mess is a part of the dietetic depart- 
ment, and functions normally under the delegated authority of the 
principal chief nurse. She is responsible for the selection, purchase, 
storage, issue, preparation, and serving of food for this mess. All 
bills contracted by her must be sent promptly to the custodian of the 
hospital fund for payment. She may receive reimbursement for cash 
purchases made by her, or an authorized assistant, by forwarding the 
receipt with a letter of transmittal to the custodian of the hospital 
fund. 
(2) A member of the Army Nurse Corps may be detailed in direct 
charge of the mess. This nurse may personally make purchases of 
supplies required or may request that they be made through the 
director of dietetics. She is responsible for their economical use. 
She checks the daily bills and keeps records of all her transactions. 
She directs and is responsible for the work of the employees in the 
kitchens and dining rooms. 
(3) Army nurses, special nurses, dietitians, physical therapy aides, 
and such other employees as may be authorized are subsisted in the 
nurses’ mess. At the end of each month or upon departure from the 
hospital by reason of transfer, leave extending over the end of the 
month, etc., Army nurses, special nurses, physical therapy aides, and 
all others subsisted at the nurses’ mess, pay into the hospital fund 
for each day they have been furnished meals the amount prescribed in 
Army Regulations. A statement showing clearly the amounts due 
from the above groups, number of days, per diem rates, and amount 
of credit allowed for mess attendants subsisted in the nurses’ mess 
is submitted to the director of dietetics by the principal chief nurse at 
the end of each month, together with the vouchers to be paid by him. 
The total amount of the vouchers will not exceed the total amount of 
credits. 
25 TM 8-260 
36-39 
MEDICAL DEPARTMENT 
(4) Hours for meals in the nurses’ mess are prescribed by the 
principal chief nurse. 
37. Nurses’ funds.—a. Funds accruing to the nurses’ mess from 
commutation of rations, donations from guests, messing charges from 
aides, technicians, and other civilian employees may be used to provide 
means for contributing to the welfare, comfort, pleasure, contentment, 
and physical and mental improvement of the members of the nurses’ 
mess. 
h. The custodian of the hospital fund keeps a record of all funds 
accruing from this source and keeps the principal chief nurse in- 
formed of the amount available for recreational and other purposes 
as indicated in a above. 
c. The principal chief nurse may procure, within the limits pre- 
scribed by AR 210-50, such articles as may be required for the pur- 
poses mentioned above, submitting the bills therefor to the custodian, 
hospital fund, or, if she prefers, may purchase the articles, secure 
receipt therefor, submit them to the director of dietetics and secure 
reimbursement for the amount so expended. When such action is 
taken, request for payment or for reimbursement is made. 
38. Responsibility of ward officer.—Nothing in this manual 
will be interpreted as preventing the ward officer from making period- 
ical inspection of the food served to patients, the appearance of trays, 
etc. Such inspections will be made at frequent intervals and irregu- 
larities or defects which may be found to exist reported immediately 
to the director of dietetics. 
39. Hospital council.—a. The hospital council consists of the 
three senior officers present and on duty with the unit to which the 
fund pertains. 
h. The hospital council is governed by the provisions of AR 210-50. 
Section IY 
RECEIVING AND DISPOSITION OFFICER 
Paragraph 
Function 40 
Receiving and disposition officer 41 
Admission of patients 42 
Discharge of patients 43 
Evacuation of patients by boat or rail 44 
Inspection of enlisted men returned to duty 45 
Notification of patient’s arrival . 46 
Ambulance service 47 
Out-patients 49 
Absence of receiving and disposition officer 50 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
40-42 
40. Function.—The receiving and disposition office is under the 
immediate supervision of an officer of the Medical Corps who is desig- 
nated as the receiving and disposition officer. During his absence from 
the office his duties are assumed by the medical officer of the day. The 
admission and disposition of all patients are accomplished through 
the receiving and disposition office. The ambulance service at the 
hospital is regulated by the receiving and disposition officer. 
41. Receiving and disposition officer.—The receiving and dis- 
position officer is responsible for— 
a. Admission of all patients to hospital. 
b. Final discharge of patients from hospital. 
c. Regulation of the ambulance service provided by the hospital. 
d. Preparation and rendition of prescribed reports and forms per- 
taining to his office. 
e. Strict observance of regulations governing funds, money, and 
valuables of patients upon their admission to hospital. 
/, Proper care and medical treatment of patients from the time of 
their arrival in the receiving and disposition office until the profes- 
sional officer of the day or the ward officer has assumed charge of the 
case. 
g. Admission of only those patients to the hospital who are entitled 
to treatment according to Army Regulations or whose treatment is 
authorized by the Secretary of War. Only in extreme necessity will 
persons not entitled to admission to Army hospital be admitted. (For 
list of persons entitled to treatment see paragraph 6, AR 40-590.) 
h. Deposit of sufficient funds in special cases to cover hospital 
charges. 
42. Admission of patients.—a. General.—(1) All patients are 
admitted through the receiving and disposition office, where the re- 
quired admission data are made of record an assignment to a proper 
ward effected. In emergency the patient may be taken direct to the 
ward and the necessary admission data obtained later. 
(2) Patients reporting for admission are examined and placed in 
a ward without delay. 
(3) Patients with communicable diseases arriving by ambulance 
are not permitted to leave the ambulance or enter the receiving and 
disposition office, but after being seen by the receiving and disposition 
officer are sent direct to the communicable disease section. Ambula- 
tory patients with communicable disease reporting to the receiving 
and disposition office are conducted by the shortest way to the commu- 
nicable disease section by an orderly who will prevent the patient from 
coming in contact with other patients. 
27 TM 8-260 
42-44 
MEDICAL DEPARTMENT 
(4) The receiving and disposition officer in the case of each patient 
admitted to hospital sees that he is admitted to the proper ward for 
treatment. 
(5) When insane cases or prisoners are admitted, their attendants 
or guard escort them to the proper section or ward accompanied by 
an orderly from the receiving and disposition office. 
(6) Patients admitted to the hospital are conducted to the proper 
ward by an orderly who, in all cases, carries any baggage the patient 
may have. 
b. Baggage.—Patients admitted from trains or boats are asked by 
the receiving and disposition officer whether or not they have baggage 
other than that which accompanied them at the time of admission. 
If so, they are requested to deliver the checks to the receiving and dis- 
position officer. (See pars. 109 and 112.) 
c. Arrival by boat or rail.—The receiving and disposition officer 
provides the necessary ambulance service and attendants for patients 
arriving by boat or rail. When he is advised that a number of patients 
will arrive he makes preparations in advance for their reception and 
admission to wards. When patients are scheduled to arrive at hours 
other than those scheduled for the receiving and disposition officer, the 
latter arranges for the necessary transportation and attendants, and 
advises the medical officer of the day accordingly. The receiving and 
disposition officer takes measures to assure that separate ambulances 
are provided for communicable diseases. 
43. Discharge of patients.—a. The final discharge of patients is 
accomplished as directed in paragraph 70. 
b. A record of all discharges from the hospital is entered by the 
receiving and disposition officer on the admission and departure sheet, 
the data therefor being obtained from the disposition slips of dis- 
charged patients. After entry has been made the disposition slip 
is transmitted to the registrar for permanent file. 
44. Evacuation of patients by boat or rail.—The receiving and 
disposition officer is responsible for the proper evacuation to train or 
boat of all patients transferred to other hospitals, their homes, or 
elsewhere. He familiarizes himself with the details of the evacuation 
and is responsible for its conduct until the patients and attendants 
are actually on the boat or train. Attendants detailed to accompany 
patients report to the receiving and disposition officer in advance of 
their departure for instructions regarding their specific duties. Pa- 
tients to be transferred without attendants report to him for instruc- 
tion. In either event he provides the necessary local transportation. 
In the case of evacuations scheduled for hours when the receiving and 
28 TM 8-260 
44-48 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
disposition officer is off duty, he advises the medical officer of the day 
and informs him of the details for the evacuation. 
45. Inspection of enlisted men returned to duty.—The com- 
manding officer, detachment of patients, inspects all enlisted men re- 
turned to duty from the hospital and sees that none are permitted 
to leave in improper uniform. Particular care is taken that no 
patients are permitted to leave for a colder climate without adequate 
clothing. 
46. Notification of patient’s arrival.—The noncommissioned 
officer or clerk on duty at the time of arrival of a patient for ad- 
mission to hospital immediately notifies the receiving and disposition 
officer or in his absence, the medical officer of the day. 
47. Ambulance service.—Ambulance service at the hospital is 
furnished under the direction of the receiving and disposition officer 
or in his absence, the medical officer of the day. Ambulances will not 
be ordered out by noncommissioned officers on duty in the receiving 
and disposition office without authority of the receiving and disposi- 
tion officer or in his absence, the medical officer of the day, unless 
the emergency is so great that the delay in obtaining such authority 
is inadvisable. In such cases report is made to the proper officer 
at the earliest opportunity. 
48. Reports.—The receiving and disposition officer is responsible 
for the preparation and disposition of the following records: 
a. The forms prepared on the admission of all patients: 
(1) Clinical Record, Brief (W. D., M. D. Form No. 55A), prepared 
in triplicate and initialed by the admitting officer. The original is 
sent to the ward with the patient, the duplicate to the registrar, and 
the triplicate to the information office, thence to the chaplain and 
director of the Red Cross. The duplicate and triplicate copies may 
be on blank second sheets of approximately the same size as the 
form. 
(2) Ward roster card, prepared in triplicate and accompanying 
patient to the ward, two copies to be used for ward rosters and one 
for use with the clinical record jacket. 
(3) Deposit slip, patient’s funds and valuables, prepared single 
copy if no deposit is made; in triplicate if deposit is made. All cop- 
ies of the form are signed by the patient and the admitting officer. 
In case deposit is made the triplicate copy is given the patient as 
his receipt, the original and duplicate to the custodian patient’s fund 
with the deposit. If no deposit is made the deposit slip single copy 
signed by the patient and admitting officer is delivered to the custo- 
dian patient’s funds and valuables. 
29 TM 8-360 
48-50 
MEDICAL DEPARTMENT 
b. The reports prepared daily or as otherwise directed: 
(1) Admission and departure sheet. A record of patients who 
have been admitted; who have departed; who have been transferred, 
with number of the ward transferred from and transferred to, and a 
record of patients whose status has been otherwise changed. This 
report covers the period from midnight of one day to midnight of 
the following day, and is disposed of in accordance with instructions 
issued from time to time. 
(2) Patient’s daily classification report. 
(3) Daily report of hospital bed status. 
49. Out-patients.—a. Eeports of examination in cases referred 
for consultation by medical officers, other than members of the hos- 
pital staff, to chiefs of service are made to the receiving officer by 
informal memorandum upon completion of the examination. 
b. From the memorandum received, the receiving officer prepares 
a report of the case in duplicate for the medical officer concerned for 
signature of the executive officer. 
c. When hospitalization is indicated the duplicate of the report 
with the informal memorandum received from the examining officer 
is placed in the suspended file, receiving office. Upon admission of 
patient, report is forwarded to the sergeant major’s office for file in 
patient’s 201 file. If hospitalization is not deemed necessary the dupli- 
cate is noted immediately by the receiving officer and forwarded to 
the sergeant major’s office for file. 
50. Absence of receiving and disposition officer.—During the 
hours other than those prescribed for the receiving and disposition 
officer the medical officer of the day assumes and is responsible for the 
duties of the receiving and disposition officer. 
Section Y 
MEDICAL SUPPLY DEPARTMENT 
Paragraph 
Organization 51 
General duties 52 
Supplies, requisition, and issue 53 
Alcohol, narcotics, and habit-forming drugs 54 
Property 55 
Inventories and reports 56 
Repair and renovation of Medical Department equipment 57 
Purchase of materials in open market 58 
Transfer of property 59 
Requisition by medical supply officer 60 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
51-53 
51. Organization.—The medical supply department is a part of 
the administrative division of the hospital and is under the imme- 
diate supervision of an officer designated by the commanding officer. 
He is known as the medical supply officer and is directly responsible 
for the efficient conduct of the department. 
52. General duties.—a. Procurement, storage, issue, and account- 
ability for all medical supplies, equipment, and all Army blank forms 
and such local blank forms as may be authorized by the commanding 
officer. 
h. Maintenance and operation of such utilities as may be authorized 
for the repair and upkeep of Medical Department property. 
c. Expenditure of all allotments for the purchase and upkeep of 
medical supplies. 
d. Preparation and maintenance of such memorandum receipts, 
inventories, property reports, returns, and stock record system as 
are prescribed by proper authority. 
53. Supplies, requisition, and issue.—a. Requisition.— (1) Ex- 
pendable.— (a) Requisitions for expendable supplies are prepared 
on the typewriter whenever practicable, using the nomenclature, item 
number, and unit as listed in the Medical Department Supply Catalog. 
Requisitions are signed by officers in charge of departments, wards, etc., 
and forwarded to the medical supply officer on days that may be 
specified by the commanding officer. 
(h) In an emergency in which the need could not have been 
foreseen, requisitions may be submitted at any time. Such requisi- 
tions are prepared as directed and marked “Emergency.” 
(2) Nonexpendahle.—Requisitions for nonexpendable medical 
property are made in the manner prescribed in (1) above, except 
they will be prepared in duplicate on Issue Slip, Nonexpendable 
Medical Property (W. D., M. D. Form No. 16b). The original copies 
of the requisition are retained by the medical supply and the dupli- 
cate returned to the responsible officer for file as a voucher to memo- 
randum receipt for nonexpendable property. 
b. Issue.—(1) The medical supply officer inspects all requisitions 
and reduces excessive amounts requisitioned to meet the allowances 
prescribed by The Surgeon General. 
(2) Regular issues are made at the medical supply department at 
specified times. Supplies not called for within the specified hours 
are returned to stock. 
(8) Issues of drugs are made to the pharmacy and dispensed by that 
department on prescriptions. Exceptions to this rule are made only 
in the case of articles stored for the use of a specific service. TM 8-260 
53-55 
MEDICAL DEPARTMENT 
(4) Articles entering into the composition of surgical dressings are 
issued in bulk to the surgical dressing room. All dressings are pre- 
pared and sterilized in the preparation room pertaining to that sec- 
tion and issued to wards, departments, etc., as required. 
54. Alcohol, narcotics, and habit-forming drugs.—a. The 
medical supply officer is directly charged with the safekeeping of all 
stores of ethyl alcohol, absolute alcohol, alcoholic liquors, narcotics, 
and habit-forming drugs until they are issued to the pharmacy or 
other departments authorized to draw such supplies. He receives 
and issues these supplies in person. All reserve supply of these articles 
is kept locked in safes in the room especially provided for that pur- 
pose in the medical storeroom. All keys and safe combinations are 
kept at all times by the medical supply officer personally. He keeps 
a detailed account of his issues on Return of Medical Property Slip 
(W. D., M. D. Form No. 17a), keeping as vouchers requisition Issue 
Slip, Expendable Medical Property (W. D., M. D. Form No. 16a) 
upon which issues were made. 
b. Issues of ethyl alcohol, alcoholic liquors, narcotics, and habit-form- 
ing drugs are made only to the officer in charge of the pharmacy upon 
requisition signed by him. 
c. Alcohols, alcoholic liquors, narcotics, and habit-forming drugs in 
the possession of the medical supply officer are checked once each 
month by an officer designated by the commanding officer. Written 
report of the findings is made to the commanding officer immediately 
thereafter. 
55. Property.—a. Responsibility.—The medical supply officer 
maintains the account of property on memorandum receipt as pre- 
scribed in paragraph 5<z(l), AR 35-6520. These receipts are pre- 
pared in duplicate, renewed semiannually or when property respon- 
sibility is transferred. Memorandum receipts presented to respon- 
sible officers are checked immediately by them and the original signed 
and returned to the medical supply officer within 72 hours, the dupli- 
cate to be filed in the ward or department. All notations of the re- 
sponsible officer are made on the duplicate. In no case are original 
copies changed or notations made by other than the accountable officer. 
Transfers made for convenience during short leaves of absence or 
within a short time subsequent to issue of a new memorandum receipt 
are made by receipt of new officers on reverse of old receipt. 
b. Exchange and replacement.—(1) Unserviceable nonexpendable 
property for exchange is turned in to the medical supply office at 
specific hours. Property is listed on Exchange Slip, Nonexpendable 
Medical Property (W. D., M. D. Form No. 16d) in single copy and 
32 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
55 
is certified by the responsible officer that the article or articles were 
worn out through fair wear and tear in the public service. W. D., 
M. D. Form No. 16d is submitted to the medical supply officer. Medical 
property becoming unserviceable through other than the above condi- 
tions is acted on in accordance with paragraphs 1 and 2, AR 35-6640. 
Similar action is taken when property is lost. 
(2) All supplies classed as “expensive” by The Surgeon General 
which have become unserviceable through fair wear and tear in the 
public service are accompanied with a certificate in quadruplicate 
signed by the responsible officer covering the unserviceability. This 
certificate gives all information required by paragraph 36, Medical 
Department Supply Catalog. 
(3) Duplicate copies of Statement of Expenditure of Special Den- 
tal Materials (W. D., M. D. Form No. 18b) are furnished by the 
chief of dental service covering monthly expenditure of dental gold. 
(4) Nonexpendable property no longer required for current use 
is turned in to the medical supply office. This property is listed 
on Credit Slip, Nonexpendable Medical Property (W. D., M. D. 
Form No. 16c), in duplicate, signed by the responsible officer and 
submitted to the medical supply officer for approval and credit. 
The medical supply officer signs the duplicate copy of W. D., M. D. 
Form No. 16c, and returns it to the responsible officer for file with his 
memorandum receipts. 
c. Monthly check.— (1) Officers having property on memorandum 
receipt check all property for which they are responsible on the 
first day of each month. Report of such check, prepared in dupli- 
cate, listing all overages and shortages found, is made and the 
original forwarded to the adjutant not later than 12:00 noon the 
following day, the duplicate to be retained by the responsible officer. 
(2) The adjutant forwards these reports to the medical supply 
officer who consolidates the lists of overages and shortages as pre- 
pared by the responsible officer, making such adjustments as are 
possible, and reports his action to the commanding officer. 
(3) Under existing regulations accountable officers are required 
to take up as “found at post” all property in excess of that listed 
on their stock record accounts. To avoid duplication of accounta- 
bility, responsible officers are directed to report all articles in excess 
of their responsibility in order that adjustments may be made of 
shortages found in other departments. In the event that adjust- 
ments cannot be made of property lost, the responsible officer is 
directed to proceed as set forth in AR 35-6640. TM 8-260 
55-58 
MEDICAL DEPARTMENT 
(4) The medical supply officer or his assistant from time to time 
checks wards and departments to determine the accuracy of check 
reported by such ward or department. The officer in charge of ward 
or department accompanies the medical supply officer while check is 
being made and renders such assistance as may be required to secure 
an accurate check. The result of this check is considered final and 
is reported to the commanding officer by the medical supply officer. 
56. Inventories and reports.—a. The annual inventory of med- 
ical supplies as required by current War Department orders, as well 
as special inventories and reports of property required from time 
to time, are prepared and signed by the medical supply officer and 
forwarded by him through the commanding officer to The Surgeon 
General of the Army, 
h. The medical supply officer prepares and submits to the com- 
manding officer a semiannual statement of cost of medical services, 
as prescribed by paragraph 4, Ali 40-1705, covering 6-month periods 
ending June 30 and December 31 of each year. This report is sub- 
mitted the 10th day of July and January of each year covering the 
periods just preceding, or as soon thereafter as complete information 
can be furnished. 
57. Repair and renovation of Medical Department equip- 
ment.—Whenever the responsible officer desires repair or renovation 
of any articles of Medical Department equipment, including instru- 
ments, he causes the article to be turned in to the medical supply 
officer at the Medical Department storeroom, with a statement of 
work desired. The medical supply officer, upon receipt of such 
article, either exchanges it for a serviceable article of the same char- 
acter or causes the necessary repairs to be made. No article of 
medical equipment is sent to a repair shop by any person other than 
the medical supply officer. 
58. Purchase of materials in open market.—a. Eequests for 
purchases of material required by services are made in memorandum 
form to the medical supply officer by the chief of service concerned. 
Except in case of emergency, the medical supply officer obtains the 
approval of the commanding officer or his representative before 
purchases are made. 
h. Purchases of supplies from Medical Department appropriations 
are not made by any one other than the medical supply officer. Pur- 
chases made other than in the authorized manner or orders given 
in anticipation of future deliveries are charged to the account of the 
person or persons giving such orders. FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
58-60 
c. Monthly report of expenditures against proper appropriation 
titles are made by the medical supply officer, signed by him as to 
their correctness, and submitted to the commanding officer by noon 
on the 5th day of the month next succeeding, or as soon thereafter 
as complete report can be furnished. This report is as of the last 
day of the previous month. 
d. Report of the medical and hospital department allotments ex- 
pended by the medical supply officer are reported quarterly. This 
report supported by accompanying vouchers is forwarded through 
the commanding officer by the 5th day of the succeeding month, or 
as soon thereafter as complete information can be furnished. Simi- 
lar reports are made at the end of the fiscal year as soon as accom- 
panying vouchers can be secured. 
59. Transfer of property.—a. When property responsibility in 
a ward or department is ordered transferred from one officer to 
another, the responsible officer, accompanied by his successor, per- 
sonally checks all property on memorandum receipt. 
h. Upon receipt of orders for change of station or upon change 
of duties which require transfer of accountability, the medical sup- 
ply officer requests the Finance Officer, U. S. Army, Washington, 
D. C., for an audit of his accountability. In the event that his au- 
thorized relief has not reported prior to the departure of the medical 
supply officer, an officer of the Medical Department is temporarily 
appointed to assume medical accountability, receipt being taken as 
required in paragraph 1, AR 35-6680. 
c. When the accountable officer is relieved of his accountability by 
reason of leave, illness, special duty from station, or other authorized 
temporary absence in which it is not deemed necessary to make com- 
plete change of accountability, he makes such certificates as are speci- 
fied in paragraph 1, AR 35-6680. 
60. Requisition by medical supply officer.—a. The medical 
supply officer is charged with the timely requisitioning for such 
amounts of medical supplies as are needed for the requirements of 
the hospital. He requests such data from the services as he may 
deem necessary and chiefs of services give such assistance as he may 
require in the preparation of these requisitions. 
h. Quarterly nonstandard requisitions for nonstandard drugs, in- 
struments, special appliances, and equipment are submitted by the 
medical supply officer. He calls on the chiefs of services for an 
estimate of the supplies needed, consolidates these requests, and 
submits his requisition to the commanding officer. Chiefs of services 
are directed to reduce their requests for nonstandard articles to the 
35 TM 8-260 
60-64 
MEDICAL DEPARTMENT 
minimum required by absolute necessity. Requests for proprietary 
medicines, instruments, and appliances for which a suitable substitute 
is listed on the medical supply table are prohibited. 
Section VI 
ADMISSION OF PATIENTS 
Paragraph 
Supervision 61 
Personnel entitled to admission 62 
Funds, valuables, clothing, and baggage 63 
Channels; examination 64 
Arrival by rail or boat 65 
Reports rendered upon admission direct from other stations 66 
Records 67 
Procedure on certain types 68 
61. Supervision.—The receiving and disposition officer has charge 
of the admission to hospital and assignment to proper wards of all 
patients. His duties are assumed by the medical officer of the day 
when the receiving and disposition officer is absent (see pars. 40 
and 41). 
62. Personnel entitled to admission.—Personnel entitled to 
admission to hospital are enumerated in paragraph 6, AR 40-590. 
63. Funds, valuables, clothing, and baggage.—Upon admis- 
sion of patients to hospital, the procedure relative to funds, valu- 
ables, clothing, and baggage followed is as prescribed in sections IX 
and XIII (par. 8c(1), AR 40-590), 
64. Channels; examination.—a. All patients are admitted 
through the receiving and disposition office where the required ad- 
mission data are made of record (par. 66), and assignment to proper 
ward effected. In emergency cases the patient may be taken directly 
to the ward and necessary admission data obtained later. 
h. Patients other than those on the status of officers, emergency 
cases, and cases (see par. 67) who report to the receiving and disposi- 
tion office for admission are examined after which they are required 
to deposit all personal clothing and hand baggage, except the arti- 
cles specified in paragraph 111, in the patients’ baggage room and 
receive in exchange for such personal clothing the following articles 
of hospital clothing: One suit of pajamas, one convalescent suit, if 
available, and one bathrobe. They are then assigned to an appro- 
priate ward without delay. 
c. A list is maintained in the receiving and disposition office desig- 
nating the types of cases normally admitted to each ward to be 
used as a guide to assist in making the proper ward assignments 
36 TM 8-260 
64-68 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
and to obviate transfers or adjustment later. Wards accept without 
question patients assigned thereto by the receiving and disposition 
officer. Any reassignment that may appear necessary is elfected 
as prescribed by the commanding officer. 
d. Patients admitted to hospital are examined physically without 
delay by the receiving and disposition officer or his representative, 
and in his absence by the medical officer of the day. Such orders 
are given as may be necessary relative to the treatment, care, etc., 
unless arrangements for the patient’s admission have been made 
in advance. After assignment has been made to a ward, the patient 
is conducted thereto by an attendant from the receiving and disposi- 
tion office,- who in all cases carries the patient’s baggage. 
65. Arrival by rail or boat.—See paragraph 42c. 
66. Reports rendered upon admission direct from other sta- 
tions.—a. By receiving and disposition officer.—Whenever an officer, 
warrant officer, enlisted man, or other militarized person from another 
post, camp, or station is admitted direct, the fact, date, and time of 
admission, together with a notation as to status of patient as dis- 
closed by interrogation at time of admission, are entered on the 
admission sheet. Such records, orders, or other papers which can 
be furnished by the patient and which serve to explain his status are 
turned over to the adjutant as soon as practicable. 
h. By registrar.—On the morning after admission of cases referred 
to in a above, the registrar dispatches by mail formal notification of 
the admission to the patient’s commanding officer or other proper 
authority. In cases where it appears that the report should be dis- 
patched by telegraph or radio, the facts are reported to the adjutant 
for appropriate action. 
67. Records.—The receiving and disposition officer is responsible 
for the preparation and disposition of the records as prescribed in 
paragraph 48. 
68. Procedure on certain types.—a. Patients with communicable 
diseases are not permitted to leave ambulance or enter the receiving 
and disposition office, but after having been seen by the receiving and 
disposition officer are sent directly to the isolation ward. 
h. When prisoners or insane cases are admitted, their guard or 
attendants escort them to the proper ward accompanied by an orderly 
from the receiving and disposition office. 
c. Upon the admission of emergency surgical cases where operative 
procedure is indicated during hours other than those when the oper- 
ating room is open, the receiving and disposition officer causes the 
emergency operating room personnel, including nurses and enlisted 
37 TM 8-260 
68-70 
MEDICAL DEPARTMENT 
men, to be notified immediately in order that the operating room 
may be made ready to function. 
Section VII 
Paragraph 
Procedure for other than separation from service or transfer to another 
hospital 70 
Sepai’ation from service or transfer to another hospital 71 
Leave or furlough 72 
Absence without leave— 73 
Hospital to quarters status 74 
Records; admission and disposition list : 75 
Clearance 76 
DISCHARGE OF PATIENTS 
69. Recording,—The receiving and disposition officer supervises 
the recording of the discharge of patients from the hospital. 
70. Procedure for other than separation from service or 
transfer to another hospital.—When it has been determined that 
a patient is to be discharged from the hospital, the procedure out- 
lined below will be followed: 
a. Patients on officer status.— (1) Upon completion of treatment 
the ward officer closes the clinical record by bringing the progress 
notes up to date, and initiates a single copy of the disposition slip. 
The clinical record and disposition slip are sent by the ward officer 
to the chief of the service concerned. 
(2) Upon receipt of the clinical record and the disposition slip, 
the chief of the service carefully checks the clinical record and makes 
final decision as to whether the patient should be discharged from 
hospital. When he is of the opinion that patient requires further 
hospitalization he returns the papers to the ward officer with a memo- 
randum of instruction. In the event he approves of the discharge, 
the disposition slip is initialed by him and forwarded to the adjutant. 
If board proceedings are necessary the disposition slip is retained by 
the chief of service until such proceedings are accomplished. The 
board proceedings and the disposition slip are then forwarded to the 
adjutant. When the disposition slip is forwarded to the adjutant, 
the clinical record is returned to the ward officer with appropriate no- 
tations thereon, and is held by him until the patient’s discharge is 
effected. 
(3) Upon receipt of the disposition slip by the adjutant, orders are 
requested if necessary. When the necessary orders have been re- 
ceived, or immediately in cases where orders are not necessary, the 
adjutant notifies the ward officer to send the patient to the sergeant 
38 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
70 
major’s office for settlement of his accounts and to acknowledge re- 
ceipt of liis orders. The patient is then discharged from the hos- 
pital. Upon discharge from hospital the adjutant forwards the 
completed disposition slip to the receiving and disposition officer. 
The ward officer, when notified by the adjutant to send the patient 
to his office for discharge, closes the clinical record as soon as 
practicable and sends it to the registrar. 
h. Patients on enlisted status.— (1) Upon completion of the treat- 
ment the ward officer closes the clinical record and initiates a single 
copy of the disposition slip. The clinical record and disposition slip 
are then sent to the chief of the service concerned. Upon receipt 
of the clinical record and disposition slip the chief of service care- 
fully checks the clinical record and makes final decision as to whether 
the patient should be discharged from the hospital. When he is 
of the opinion that the patient requires further hospitalization he 
returns the papers to the ward officer with a memorandum of in- 
struction. In the event he approves of the discharge, request for 
orders for enlisted men are prepared for the signature of the ad- 
jutant and forwarded to the adjutant’s office. The approved dis- 
position slip and clinical record are forwarded to the commanding 
officer, detachment of patients, by the chief of service. 
(2) Prior to the discharge of enlisted patients other than from 
command, the commanding officer, detachment of patients, furnishes 
the patient with a clearance form, Notice of Separation from the 
Service, and instructs him to have it initialed by the heads of the 
departments concerned and return the form to the detachment of 
patients office, where it is filed in his 201 file. 
(3) Upon receipt of special orders by the commanding officer, 
detachment of patients, for enlisted men, or immediately upon re- 
ceipt of disposition slip in other cases, he notifies the ward officer 
to send the patient to the office of the commanding officer, detachment 
of patients, who secures the necessary transportation for the patients 
from the quartermaster; prepares a clearance on Patient’s Property 
Card (W. D., M. D. Form No. 75); instructs the patient to proceed 
to the baggage room to procure his clothing and return to the office 
of the commanding officer, detachment of patients. He then on his 
return receives his transportation and is discharged. 
(4) The commanding officer, detachment of patients, retains all 
disposition slips and clinical records until the patients are discharged. 
He then causes them to be forwarded by 4:00 PM the same day, 
the completed disposition slip to the receiving and disposition officer, 
and the clinical records to the registrar. 
39 TM 8-360 
71 
MEDICAL DEPARTMENT 
71. Separation from service or transfer to another hos- 
pital.—a. Officers.—(1) When the adjutant receives proper military 
information that an officer patient is to be separated from the serv- 
ice or transferred to another hospital, he notifies the ward officer 
concerned. The ward officer closes the clinical record, initiates a 
disposition slip, and sends them together to the chief of the service 
concerned. The chief of the service carefully checks the clinical 
record, and if he approves he so marks the disposition slip and re- 
turns it to the ward officer. He also approves the clinical record, 
has prepared from it an abstract to accompany patient being trans- 
ferred to other hospital, and then transmits the clinical record to 
the registrar. 
(2) When the adjutant is ready for the discharge or transfer of 
the officer he has the ward officer send the officer with the disposition 
slip to the office of the sergeant major where the officer is required 
to settle his accounts. When the patient is a litter case, accounts 
may be settled as described in paragraph 26. The disposition slip 
then is completed by the adjutant who notes on the disposition slip 
the exact time of departure of the officer. The completed disposition 
slip is forwarded by the adjutant to the receiving and disposition 
officer who uses it as his authority to drop the officer from the records 
of the hospital. 
(3) In the case of an officer who is retired from active service or 
a Reserve officer who is relieved from active duty and remains a 
patient in the hospital the clinical record and disposition slip are 
disposed of as in (1) above except that no abstract is made. When 
the actual time of transfer of status has arrived, the adjutant notifies 
the wyard officer and calls for the disposition slip. He then marks the 
disposition slip to show the actual disposition of the officer and 
transmits it to the receiving and disposition office. 
b. Enlisted men.—(1) When an approved CDD or a request for 
orders to transfer an enlisted man to another hospital is received by 
the commanding officer, detachment of patients, he immediately calls 
the ward officer conecerned, informs the ward officer of the probable 
date of discharge or transfer of the patient, and requests that the 
complete clinical record and disposition slip be forwarded as soon 
as practicable to the chief of the service concerned. The ward officer 
then completes the clinical record, initiates the disposition slip, and 
forwards them together to the chief of service concerned. The chief 
of the service carefully checks the clinical record. An abstract of 
the clinical record for cases transferred to other hospitals is prepared 
40 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
71-72 
in his office from the clinical record to accompany cases to be trans- 
ferred. He forwards the approved disposition slip and clinical 
record to the commanding officer, detachment of patients, where they 
are held until the discharge or transfer has been completed. 
(2) The commanding officer, detachment of patients, proceeds to 
prepare the necessary final papers for enlisted men and has them 
ready for delivery to the patient on his discharge or to the hospital 
to which he is being transferred on the date of transfer. 
(3) On the date that the patient is actually discharged or trans- 
ferred the commanding officer, detachment of patients, completes the 
disposition slip, stating on it whether the patient is actually leaving 
this hospital or remaining under the authority of AR 40-590 as a re- 
tired enlisted man or as a beneficiary of the Veterans Administration. 
At the same time he transmits the clinical record to the registrar. 
c. Action by receiving and disposition officer.—When the com- 
pleted disposition slip is received by the receiving and disposition 
officer from either the commanding officer, detachment of patients, or 
the adjutant, it is his authority for dropping the patient from the 
records of the hospital. When the disposition slip shows that pa- 
tient is remaining in hospital as a retired officer, Reserve officer not 
on active duty under AR 40-590, as a retired enlisted man, or as a 
beneficiary of the Veterans Administration, he prepares on the fol- 
lowing day a new W. D., M. D. Form No, 55A, giving the patient a new 
register number, and disposes of this new W. D., M. D. Form No. 55A 
as in paragraph 48. 
72. Leave or furlough.—a. When a military patient is author- 
ized to depart on leave or furlough, the ward officer concerned brings 
the clinical record up to date, prepares a disposition slip, and sends 
both the clinical record and the disposition slip by an attendant with 
the patient to the receiving and disposition office. The disposition 
slip is appropriately marked to show the time patient departs on 
leave or furlough and the time of his expected return, and is attached 
to the clinical record. The patient is instructed that on his return 
he reports first to the receiving and disposition office. The clinical 
record is retained by the receiving and disposition officer until the 
return of the patient, at which time it is forwarded to the ward to 
which the patient may be assigned. 
b. If the patient fails to return on time and no extension of his 
time is authorized by the commanding officer, an appropriate entry 
is made on the disposition slip to show the patient as AWOL, an 
entry to the same effect is made on the admission and departure 
sheet and the case is handled as described for AWOL cases in 
paragraph 73. 
41 TM 8-260 
73-75 
MEDICAL DEPARTMENT 
73. Absence without leave.—a. Whenever a patient of any status 
leaves the hospital without leave, the wTard officer brings the clinical 
record to date and makes a single copy of the disposition slip, enter- 
ing thereon the time and day of the patient’s departure. He im- 
mediately transmits both the clinical record and the disposition slip 
to the receiving and disposition officer, who retains the clinical rec- 
ord for military patients 30 days. If the patient has not reported 
witliin this time, the receiving and disposition officer drops him from 
all records of the hospital and transmits the clinical record to the 
registrar. 
5. If the patient returns to the hospital within the time indicated 
in a above he is disposed of as indicated at the time, and the clinical 
record is sent to the ward to which he is assigned. 
74. Hospital to quarters status.—When it is desired to change 
the status of a military patient from “hospital” to “quarters,” the 
ward officer brings the clinical record to date, makes such entries 
therein as may be appropriate, and prepares a single copy of the 
disposition slip so altered as to show plainly that the patient is 
going on a quarters status, after which he transmits both records to 
the chief of service. If the chief of service determines that the 
patient can be treated properly in quarters, he approves the disposi- 
tion slip and forwards same with clinical record to the sergeant 
major, who makes the proper record and forwards the papers to 
the officer in charge of the dispensary. If the patient is an officer 
responsible for his own subsistence, his subsistence account is set- 
tled in the same manner as specified in paragraph 26. At an ap- 
pointed time the ward officer directs the patient to report to the 
officer in charge of the dispensary, who gives him the necessary 
instructions to report each day and any other pertinent profes- 
sional direction. He sends the disposition slip with appropriate 
remarks to the receiving and disposition officer and holds the clini- 
cal record himself. The receiving and disposition officer takes such 
information as he needs from the disposition slip and returns it. 
When the case is completed the officer in charge of the dispensary 
completes the disposition slip and clinical record and disposes of 
them as directed in paragraph 705(4). 
75. Records; admission and disposition list.—In accordance 
with the instructions contained herein, a disposition slip is furnished 
the receiving and disposition officer in all cases where a patient de- 
parts from the hospital except in case of death. The receiving and 
disposition officer takes steps to assure himself that the admission 
and disposition sheet is promptly and accurately prepared and that 
42 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
75-77 
it shows all discharges for the preceding 24 hours. He obtains 
informally from the registrar and administrative officer of the day 
the data relating to deceased patients. If the receiving and dis- 
position officer is informed that a patient for whom he has a proper 
disposition slip has not been discharged, he communicates with the 
ward officer and makes appropriate adj ustment. 
76. Clearance.—Except such clearance as may be required by the 
commanding officer, detachment of patients, and the adjutant in the 
case of military patients, patients are not required to obtain clear- 
ance before departure inasmuch as the receipt for subsistence charges 
furnished by the director of dietetics to pay patients is prescribed 
in lieu thereof. 
Section VIII 
SERIOUSLY ILL PATIENTS 
Paragraph 
Report by ward officer 77 
Information office action 78 
Registrar’s action 79 
Cessation of condition 80 
List 81 
Transfer to another ward 82 
77. Report by ward officer.—In every case when recovery from 
illness or operation is not expected or is considered doubtful, the 
ward officer in charge of the case enters the patient’s name on the list 
of seriously ill as prescribed in paragraph 80 below, and then pre- 
pares and signs a Report of a Seriously 111 Case. Particular atten- 
tion is given to the name, relationship, and address of the person to 
be notified in case of emergency. This information is transmitted 
immediately to the administrative officer of the day for the action 
indicated in paragraph 78. As soon as possible after a patient’s name 
is placed on the seriously ill list, the ward officer makes an attempt 
to induce him to turn over his money and valuables for safekeeping 
to his relatives if they are present, or to the registrar. Tact will 
be used in handling this matter so as not unduly to alarm the patient. 
In the event that the patient declines to turn over his money and 
valuables to relatives or to the registrar, the ward officer makes it 
clear to him and to his relatives that the hospital will not assume 
responsibility for any loss sustained. If the patient is semicomatose 
or unconscious, the ward officer collects money and valuables in pos- 
isession of the patient and turns them in to the registrar for safe- 
keeping. In the absence of the ward officer, the above procedure is 
43 TM 8-260 
77-80 
MEDICAL DEPARTMENT 
carried out by the professional officer of the day or any other medical 
officer who may be called in attendance. 
78. Information office action.—a. Noncommissioned officer in 
charge.— (1) Upon receipt of a report of a seriously ill case during 
office hours, it is noted promptly and initialed by the noncommis- 
sioned officer in charge of the information office, with notation of 
time received, after which action he immediately delivers it to the 
registrar for further appropriate action, and advises the indicated 
chaplain of the patient’s condition. He keeps posted in a conspicu- 
ous place in the information office a list showing the name, status, 
and ward of all patients in whose cases such reports have been received. 
(2) Upon receipt of a report of a seriously ill case during other 
than office hours, the noncommissioned officer in charge of the infor- 
mation office proceeds as directed in (1) above except that the report 
is delivered immediately to the administrative officer of the day. 
h. Administrative officer of day.—Upon receipt of a report of a 
seriously ill case, the administrative officer of the day promptly 
notes and initials the report and, if immediate action is indicated, he 
personally verifies the name and address of the person to be notified 
with that shown in the information office index card and notifies the 
designated relative or friend by telegram of the patient’s condition. 
The report of seriously ill case, together with a copy of telegram 
sent, is transmitted to the registrar by the administrative officer of 
the day. 
79. Registrar’s action.—Upon receipt of a report of a seriously 
ill case, the registrar immediately places the patient’s name on the 
list of seriously ill cases maintained in his office, notifies the informa- 
tion office, and sees that the patient’s name is placed on the list of 
seriously ill maintained in that office. He then takes such action 
toward notifying the relatives or friends as may be indicated, after 
which the form, accompanied by a copy of the telegram or letter 
of notification, is retained in a live file until final disposition of the 
case has been made. In the event of patient’s death the form is 
appended to the death records of the case. 
80. Cessation of condition.—When a patient who has been re- 
ported seriously ill (par. 77) is considered out of danger, the ward 
officer in charge of the case removes his name from the list of seriously 
ill maintained in the ward office and then prepares and signs a 
Report of Removal from Seriously 111 List and forwards the report 
to the registrar. Upon receipt of the form, the registrar immediately 
removes the name of the patient from the seriously ill list main- 
tained in his office and notifies the relative or friend previously ad- 
44 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
80-83 
vised of the patient’s condition. He also informs the noncommis- 
sioned officer in charge of the information office, who removes the 
patient’s name from the list of seriously ill. 
81. List.—a. A list of seriously ill is maintained in—• 
(1) Information office. 
(2) Registrar’s office. 
(3) Each ward office. 
h. The lists maintained in the information office and registrar’s 
office carry the names of all patients who have been reported seriously 
ill until such a time as report of removal from seriously ill list is 
received. 
c. Ward officers keep a list of all patients in their wards who have 
been reported seriously ill in conformity with a above. This list is 
prepared and is conspicuously displayed at all times on the nurse’s 
(desk, and checked daily by the ward officer to see that it is kept 
up to date and that the names of those patients who are no longer 
seriously ill have been removed from the list and that they have been 
reported as prescribed in paragraph 80. If there are no seriously 
sick in a ward, remark to that effect is entered on the form. 
82. Transfer to another ward.—When a patient carried on the 
seriously ill list is transferred to another ward, the transferring 
officer removes his name from the list maintained in his ward and 
makes the following notation in a conspicuous place on the face 
of the request for transfer of patient which accompanies the patient: 
“Patient on seriously ill list.” The ward officer of the ward to which 
the patient is transferred places the patient’s name on the seriously 
ill list of that ward as soon as possible after the transfer is completed. 
Section IX 
PATIENTS’ FUNDS AND VALUABLES 
Paragraph 
Custodian 83 
Audit 84 
Information furnished on admission 85 
Deposit certificate 86 
Subsequent deposits while in hospital 87 
Withdrawal 88 
Deceased patients 89 
Financial transactions with patients 90 
83. Custodian.—The registrar is the custodian of patients’ funds 
and valuables, and is personally responsible for safeguarding them 
after they have been delivered to him. Patients’ funds are deposited 
45 TM 8-260 
83-86 
MEDICAL DEPARTMENT 
in a local bank and disbursed in the form of checks by the custodian 
personally. 
84. Audit.—a. At the end of each month the hospital inspector 
audits the patients’ funds and valuables. The duties of the auditing 
officer are to— 
(1) Audit the fund account, examine into sources from which the 
fund has accrued, and into all disbursements so as to assure himself 
that all funds deposited have been properly acounted for and that 
disbursements have been properly made. 
(2) Verify the balance of the fund shown as remaining on hand. 
(3) Verify the deposit of and return of valuables to patients. 
(4) Verify the list of valuables noted as remaining on hand. 
h. Upon the completion of the audit, the auditing officer places a 
certificate above his signature in the cash book kept by the custodian 
of patients’ funds and valuables certifying that he has audited the 
fund and verified the funds and valuables on hand, and that he has 
found them to be correct; or he notes any irregularity found and 
reports it to the commanding officer. 
85. Information furnished on admission.—Upon admission 
to hospital all patients whose physical and mental condition is such 
that they can understand are asked by the receiving and disposition 
officer, or in his absence the medical officer of the day, as to whether 
they have any funds and valuables in their possesion which they 
desire to deposit with the custodian of patients’ funds and valuables 
for safekeeping. They should be urged to safeguard their funds and 
valuables in this manner, and will be distinctly informed that the 
hospital authorities will not be responsible for loss of either funds 
or valuables not so deposited. 
86. Deposit certificate.—In accomplishment of deposit certificates 
by patient and admitting officer the following procedure is followed: 
a. For patient desiring to make deposits.—Patients desiring to make 
deposits sign a deposit form in triplicate, acknowledging that they 
have been informed relative to making deposits and itemizing sepa- 
rately thereon the funds and valuables they wish to deposit. The ad- 
mitting officer signs all copies of the receipt for the articles deposited 
and delivers the duplicate copy to the patient. The original and 
triplicate copies, accompanied by the money and valuables listed 
thereon, are transmitted by the admitting officer personally to the 
custodian of patients’ funds and valuables as soon as practicable. 
The custodian acknowledges receipt by signature on each copy, re- 
turning the triplicate copy to the officer originally receiving the 
deposit, and files the original copy for future reference. 
46 TM 8-260 
86 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
b. For patients having no money or valuables in their possession.— 
Patients having no money or valuables in their possession are neverthe- 
less required to sign the deposit form, acknowledging that they have 
been informed relative to making deposits. The word “None” is noted 
under the appropriate heading on the form. In such cases only one 
copy of the form is prepared and signed by the admitting officer, 
and it is submitted to the custodian of patients’ funds and valuables 
by the admitting officer not later than 9:00 AM the following day. 
c. For mentally or physically incapable.—When patients are ad- 
mitted who appear to be incapable, mentally or physically, of follow- 
ing the procedure outlined in a and b above, the following procedure 
is followed: 
(1) A careful and thorough search of patient’s person and effects 
is made by the admitting officer personally, who takes therefrom any 
money or valuables which he may find. This search ordinarily is 
conducted in the presence of a witness whose signature is obtained 
on the form. 
(2) Attendants accompanying mentally or physically incapable 
patients for admission are asked whether or not money and valuables 
belonging to patient are in their possession. Any articles delivered 
by attendants, together with those found on patient’s person, are 
itemized on local deposit form in quadruplicate, which is signed by 
the attendant when there is one, and receipted by the admitting officer. 
The form is suitably altered for the purpose indicated and a notation 
is made thereon as to the reason for the patient not executing the 
form. In addition, notation is made of the name and status of at- 
tendant. The duplicate copy is furnished the attendant. The orig- 
inal, triplicate, and quadruplicate copies, together with the money 
and valuables, are taken by the officer accomplishing the form as 
soon as practicable to the custodian of patients’ funds and valuables, 
who receipts and returns the quadruplicate copy to the officer originally 
receiving the deposit, delivers the triplicate copy to the ward to 
which the patient is assigned, and files the original for future refer- 
ence. When no funds and valuables are delivered by attendants or 
found on patient’s person, but one copy of the form is accomplished 
by the admitting officer, in which case the word “None” is noted under 
the appropriate heading on the form, and the form signed by the 
attendant and the admitting officer. It is sent to the custodian of 
patients’ funds and valuables not later than 9:00 AM the following 
day. 
(3) When patients are unaccompanied by attendants, the procedure 
is the same as prescribed in (1) and (2) above, except that when 
47 TM 8-260 
86 
MEDICAL DEPARTMENT 
money and valuables are found on the patient’s person, the admit- 
ting officer accomplishes the form in triplicate only, all copies being 
taken to the custodian of patients’ funds and valuables who signs all 
copies, returns the triplicate to the officer originally receiving the 
deposit, delivers the duplicate to the ward to which patient is assigned, 
and files the original for future reference. 
(4) In the event of the transfer of a patient from an open to a 
closed ward, the ward officer of the ward from which the patient is 
transferred, or in the absence of the proper ward officer, the officer of 
the day of the service responsible for the care of the patient, makes a 
search of the patient’s person, clothing, bed, bedside table, and of 
the ward for money and valuables belonging to the patient. Any 
money or valuables found are itemized in triplicate and signed by the 
officer making the search. This search ordinarily is made in the 
presence of a witness who also signs the forms. After this action 
the forms, together with any money or valuables found, are delivered 
in person by the officer to the custodian of patients’ funds and valu- 
ables, who signs all copies, returns the triplicate to the officer making 
the search, delivers the duplicate to the ward to which the patient is 
transferred, and files the original for future reference. 
(5) In the event of the transfer of a patient to the guard house or 
detention ward, the prison officer, or in his absence, the administra- 
tive officer of the day, carries out the provisions of (4) above, except 
that the duplicate copy is given to the patient by the officer making it. 
(6) Prior to an operation involving the use of a general anesthetic 
or in any circumstances where the patient is rendered unable or incom- 
petent to care for such money and valuables as he may have in his 
possession, the ward officer of the ward to which the patient is as- 
signed, or in his absence the officer of the day of the service responsible 
for the care of the patient, takes from the patient all such money 
and valuables. Such money and valuables taken from the patient are 
itemized on the deposit form in triplicate and all copies of the form 
signed by the patient and by the officer making it, the duplicate to be 
given to the patient. After this action the forms, together with any 
money or valuables found, are disposed of as described above. 
(7) Whenever a patient is reported as seriously ill or is incom- 
petent for any reason to care for his money and valuables, the ward 
officer of the ward to which the patient is assigned makes an imme- 
diate search of the patient’s person, bed, bedside table, clothing, and 
of the ward for any money and valuables belonging to the patient 
and then proceeds as described above. 
48 TM 8-260 
87-89 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
87. Subsequent deposits while in hospital.—a. Patients who 
desire to deposit money or valuables during their stay in the hospital, 
if their physical condition permits, makes such deposit personally 
with the custodian of patients’ funds and valuables. If deposit was 
made on the patient’s admission he brings with him the deposit form 
which he holds as a receipt and any supplementary deposit is entered 
in the appropriate place on that form and signed by the custodian of 
patients’ funds and valuables. If the patient has not previously made 
deposit he accomplishes with the custodian of patients’ funds and 
valuables a deposit form in duplicate, receiving from the custodian 
the signed duplicate form as his receipt. 
h. Patients whose physical condition prevents them from making 
deposit in person make it through their ward officers. If the patient 
has not previously deposited with the ward officer he makes a local 
deposit form in triplicate as directed in paragraph 86a. If he has pre- 
viously deposited he delivers to the ward officer the funds and valu- 
ables he desires to deposit, together with his retained deposit form. 
In each case the ward officer delivers in person to the custodian, 
patients’ funds and valuables, the original and duplicate deposit form 
which he made with the patient or the deposit form which he received 
from the patient, together with the funds and valuables. The custo- 
dian in the first case signs the triplicate and returns it to the ward 
officer. In the second case, he enters the supplementary deposit in the 
appropriate place on the form and initials it. 
88. Withdrawal.—a. Patients desiring to withdraw their personal 
funds and valuables do so in person if their physical and mental con- 
dition permits, delivering their deposit form to custodian and signing 
for funds and valuables withdrawn. The ward officer of the ward 
to which the patient has been assigned is required to identify the 
patient by placing his signature in the appropriate place on the form 
unless the patient is personally known to the custodian of patients’ 
funds and valuables. 
&. Patients desiring to withdraw funds or valuables who are not 
physically able to come personally to the office of the custodian of 
patients’ funds and valuables deliver the deposit receipt to their ward 
officers in person. The ward officer in turn represents the patient in 
the office of the custodian of patients’ funds and valuables, makes the 
requested withdrawal, and signs for it. 
89. Deceased patients.—Upon the death of a patient the ward 
officer, or in his absence the officer of the day of the service responsible 
for the case, makes an immediate search of the deceased person, his 
bed, bedside table, and of the ward for clothing, money, valuables, or 
49 TM 8-260 
89-92 
MEDICAL DEPARTMENT 
other effects belonging to the patient. Any money or valuables found 
are itemized on a deposit form in duplicate, and the form signed by 
the officer making the search. This search ordinarily is made in the 
presence of a witness who also signs the form. After this action the 
forms, together with any money and valuables found, are delivered 
immediately in person by the officer making them to the custodian of 
patients’ funds and valuables, who signs both copies, delivers the dupli- 
cate to the officer who presented them, and files the original for future 
reference. If death occurs during closed office hours, the officer will 
deliver them at 9 AM the following day. 
90. Financial transactions with patients.—No enlisted man 
or civilian employee of the command will have any financial transac- 
tions whatsoever with patients. Under no circumstances will money 
or valuables of patients be received or delivered by them. 
Section X 
Paragraph 
General provisions 91 
Two or more disabilities 92 
Military patient placed on nonpay status 93 
Procedure upon disagreement 94 
Absence from duty on account of injury due to own misconduct 95 
Line of duty boards 96 
DISEASE OR INJURY 
91. General provisions.—AR 35-1440 prohibits pay, as distin- 
guished from allowances, to any person in the military or naval service 
for the period of absence from duty in excess of 24 hours if the absence 
is due to disease as distinguished from injury resulting from his own 
intemperate use of drugs or alcoholic liquors, or from veneral disease 
acquired through misconduct, provided the absence from duty due to 
veneral disease is within 1 year following the appearance of the initial 
symptoms and regardless of whether the initial symptoms appeared 
prior to or subsequent to enlistment, except that each person whose 
pay is forfeited for a period in excess of 1 month at any one time is paid 
for necessary personal expenses $5 for each full month during which 
his pay is forfeited. 
92. Two or more disabilities.—When a patient is hospitalized 
for two or more disabilities one of which comes within the purview 
of AE, 35-1440, the major disability determines his pay status. In 
such cases if the need for hospitalization for the major disability ceases 
and the patient remains in hospital for treatment of the lesser con- 
dition, the date of cessation of treatment for the major condition is the 
50 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
92-93 
date of the change in the pay status of the patient, and is so reported 
by the ward officer. Yeneral diseases contracted while a patient is in 
hospital does not place the patient on a nonpay status until such time 
as the original cause of his admission to hospital has reached the stage 
where hospitalization is no longer required for the cause of admission, 
when the patient goes on a nonpay status for the further hospitaliza- 
tion required for the disease placing him on the nonpay status. 
93. Military patient placed on nonpay status.—a. Proce- 
dure.—When it has been determined that a military patient is hos- 
pitalized for a disease within the purview of AR 35-1440, the ward 
officer immediately notifies the patient. The patient is informed 
that if he objects to being placed on a nonpay status he may pre- 
sent his objections in writing and furnish therewith any evidence 
or facts which he may desire to have considered. In the event ob- 
jections are presented they are forwarded, together with all medical 
papers in the case, through the chief of the service to the command- 
ing officer for final decision. If objections are presented and for- 
warded as prescribed the patient nevertheless is placed on a nonpay 
status and reported to the commanding officer, detachment of 
patients, in the same manner as indicated in 6 below pending final 
decision in the case. Patients placed on a nonpay status acknowl- 
edge notification of such fact in a signed statement on the progress 
sheet of the clinical record in the following form: 
“I have been notified that under the provisions of AR 
35-1440, I have been placed on a nonpay status. 
(Signed) John Doe (R-5,217,413) 
Pvt., Co. C., 20th Inf.” 
h. Reports.— (1) By ward officers.—When a military patient is 
placed on a nonpay status, the ward officer immediately furnishes 
the commanding officer, detachment of patients, a signed report of 
the diagnosis, a statement that the disease is not in line of duty, 
AR 35-1440 applies, and the date stoppage of pay became effective. 
The ward officer also makes report to the commanding officer, de- 
tachment of patients, if the nonpay status of a military patient 
terminates, with the date, and whether or not the patient requires 
further hospitalization for a condition not involving pay stoppage. 
(2) By commanding officer, detachment of patients.—(a) Upon 
the receipt of either of the reports referred to in (1) above per- 
taining to military patients other than enlisted men, and when the 
patient is returned to duty, the commanding officer, detachment of 
51 TM 8-260 
93-96 
MEDICAL DEPARTMENT 
patients, prepares a letter for the signature of the adjutant to The 
Adjutant General setting forth the appropriate data. 
(h) Upon receipt of either of the reports referred to in (1) above 
in the case of an enlisted man and when the patient is returned to 
duty, the commanding officer, detachment of patients, causes the 
necessary entries to be made on the records of the enlisted man 
concerned. In the event the records of the enlisted man concerned 
are not in the custody of the commanding officer, detachment of 
patients, or in the case of an enlisted man belonging to one of the 
duty detachments, the commanding officer, detachment of patients, 
notifies the proper commanding officer. 
94. Procedure upon disagreement.—If the ward officer has rea- 
son to doubt the justice of the findings determined at the station 
from which a patient is transferred in a case where a patient has 
been received by formal transfer, he forwards a report of his find- 
ings and recommendations to the commanding officer, detachment 
of patients. Upon receipt of the findings of the ward officer the 
commanding officer, detachment of patients, requests a board of 
officers as prescribed in paragraph 32>, All 345-415. The findings 
of the board when approved by the commanding officer are final in 
the case. 
95. Absence from duty on account of injury due to own mis- 
conduct.—Article of War 107 directs that an enlisted man absent 
from duty because of injury the result of his own misconduct be 
continued in the service after his return to a duty status and after 
his enlistment would normally have expired for such period as 
will with the time he had served prior to his disability amount to 
the full term of his enlistment. When a ward officer has determined 
that an enlisted man in his ward is suffering from an injury as dis- 
tinguished from disease which was incurred through the patient’s 
own misconduct he proceeds as directed in paragraph 96. 
96. Line of duty boards.—a. All 3454T5 (par. 1<?(4)(Z>)) 
directs that in every case of injury, except battle casualty, which 
in the opinion of the surgeon is likely to result in a partial or com- 
plete disability and eventually be made the basis of a claim against 
the Government, the commanding officer upon recommendation of the 
surgeon will convene a board of officers to investigate and report 
upon the circumstances attending the injury. 
h. When a ward officer believes a case in his ward comes within 
the purview of a above, he reports the facts with his recommenda- 
tion through the chief of the service to the commanding officer, de- 
tachment of patients. Upon receipt of the report of the ward 
52 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
96-98 
officer by the commanding officer, detachment of patients, he 
requests the commanding officer to convene a board of officers 
if the case in question was admitted from command. If the 
case was admitted from another command either by formal 
or informal transfer the commanding officer, detachment of patients, 
unless he has reason to believe a board of officers has been convened 
prepares a letter for the signature of the adjutant to the enlisted 
man’s commanding officer requesting a board of officers be con- 
vened. The letter requesting a board will state the nature and 
location of the injuries for which the enlisted man is hospitalized. 
c. Upon receipt of the approved proceedings of a board of officers 
the commanding officer, detachment of patients, causes the necessary 
entries to be made on the records of the enlisted man and furnishes 
the ward officer with a copy of the findings of the board. The 
ward officer makes the necessary entries on the clinical record. Upon 
completion of treatment the ward officer immediately notifies the 
commanding officer, detachment of patients, of the fact and date 
of completion of treatment. Upon receipt of that report by the 
commanding officer, detachment of patients, he causes the necessary 
entries to be made on the records of the enlisted man. 
Section XI 
Paragraph 
Ward officer 97 
Registrar 98 
Approved certificate of disability 99 
Enlisted members of permanent command 100 
ACTION ON DISCHARGE FOR DISABILITY 
97. Ward officer.—When a ward officer is of the opinion that a 
case in his ward has a disability which permanently unfits him for 
further military service he obtains from the registrar all clinicial 
records of the enlisted man’s previous admissions to the hospital, and 
a statement from the commanding officer, detachment of patients, 
showing the date the enlistment will expire. When the case has 
reached maximum improvement or 30 days preceding the date of 
the ETS, the ward officer furnishes the registrar through the chief 
of service data for preparing certificate of disability for discharge. 
All clinical records in the case are forwarded to the chief of service. 
The chief of service, if he approves the action of the ward officer, 
initials and forwards to the registrar. 
98. Registrar.—a. Action.—The registrar, upon receipt of clinical 
records, obtains any further information relative to cause of dis- 
53 TM 8-260 
98-100 
MEDICAL DEPARTMENT 
ability and line of duty that may appear necessary. Such addi- 
tional evidence when obtained is filed with and becomes a part 
of the medical records of the case. The registrar notifies the ward 
officer of the ward in which the patient is located of the time, date, 
and place of the meeting of the disability board, and issues instruc- 
tions for the patient to appear before the Board. The command- 
ing officer, detachment of patients, prepares and signs the first 
page of Certificate of Disability for Discharge (W. D., A. G. O. 
Form No. 40). The second page of W. D., A. G. O. Form No. 40 is 
completed by the registrar and signed by the members of the disability 
board. The forwarding indorsement is prepared by the registrar for 
the signature of the adjutant. After action by the disability board the 
clinical records are returned to the ward concerned. 
h. Supervision of clerical work.—The registrar coordinates all 
matters relating to the discharge of enlisted patients on certificates 
of disability. He is responsible that the entries on the certificate of 
disability are correct and that upon completion of the discharge the 
certificate of disability and allied papers are disposed of as directed 
by section 11, AR 615-360. 
99. Approved certificate of disability.—Upon the receipt of an 
approved certificate of disability for discharge the commanding of- 
ficer, detachment of patients, effects the discharge of the patient and 
takes the necessary action to comply with paragraph 16, AR 615-360. 
100. Enlisted members of permanent command.—When the 
discharge for disability of an enlisted member of the permanent 
command is contemplated his detachment commander indorses the 
enlisted man’s service record as prescribed by existing regulations 
to the commanding officer, detachment of patients, and at the same 
time transfers all personal effects which have been in store in his 
custody to the patient’s baggage room and obtains a receipt therefor. 
The commanding officer, detachment of patients, disposes of the case 
in the same manner as other cases in hospital. 
Section XII 
Paragraph 
Administrative and clerical jurisdiction 101 
Notification 102 
Procedure 103 
Death report 104 
Action by registrar 105 
Responsibility of chief of laboratory service 106 
Effects of deceased 107 
DEATHS 
54 TM 8-260 
101-105 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
101. Administrative and clerical jurisdiction.—The registrar 
exercises administrative and clerical jurisdiction over all details in 
connection with deaths which occur in the hospital. This duty in- 
cludes the preparation and rendition of the necessary certificates, 
routine reports, and records incident thereto. In the performance 
of the aforementioned duties, the registrar is governed by the pro- 
visions of existing Army Regulations and such other pertinent official 
orders and instructions as may be issued. 
102. Notification.—In case of approaching death of a patient, the 
nurse in charge notifies the noncommissioned officer in charge of the 
information office who notifies the indicated chaplain. 
103. Procedure.—If death of a patient occurs, the body is not 
removed from the ward until death has been pronounced by a 
medical officer. Before removal of remains from the ward, three 
death tags properly prepared and signed by the medical officer in 
attendance at time of death are securely tied, one to the right toe 
and one to the right wrist of the cadaver. Before the body is re- 
moved from the ward, it is thoroughly washed, eyes and mouth 
properly closed, all openings properly plugged to prevent discharge, 
and wrapped in clean sheets so as to prevent exposure of any part 
of the body. The third death tag is securely attached to the out- 
side of the sheets. Upon completion of the above, the remains are 
removed without delay from the ward to the morgue with as little 
disturbance as possible. Transportation of the body to the morgue 
is as directed by the medical officer in attendance. 
104. Death report.—Immediately upon death of a patient the 
medical officer in attendance is responsible for the death report. If the 
death occurs during hours in which the registrar’s office is closed, the 
administrative officer of the day is notified. Particular care is exer- 
cised that the name and address of the nearest relative, as shown on 
W. D., M. D. Form No. 55A, is given as the person to be notified. 
105. Action by registrar.—Upon receipt of a death report, the 
registrar takes such immediate action toward notifying or interviewing 
relatives or friends of the deceased, notifying the undertaker, arrang- 
ing for post mortem examination, arranging for burial or disposition 
of remains, advising the chief of the laboratory service of the death, 
and such other appropriate action as may be indicated for each indi- 
vidual case. As soon as the registrar has obtained the data imme- 
diately necessary, they are transmitted to the appropriate chief of 
service who verifies the cause of death and the contributory cause, 
returning all data to the registrar who prepares the death certificate 
55 TM 8-260 
105-107 
MEDICAL DEPARTMENT 
and accomplishes all other details incident to completion of the case, 
after which a report is filed with the medical records of the case. 
106. Responsibility of chief of laboratory service.—The chief 
of the laboratory service is responsible for the protection and proper 
care of bodies of deceased persons from the time a body is received 
in the morgue until it is disposed of in accordance with existing in- 
structions. In all cases where remains are prepared at Government 
expense he assures himself that the remains are prepared in accordance 
with sanitary regulations and is responsible for the preparation of the 
remains for burial or shipment, including verification of the employ- 
ment by the undertaker of effective and scientific embalming processes, 
including vessel injection and ligation after autopsy, and sees that the 
body is properly and completely clothed and ready to be placed in the 
casket. He makes a final inspection immediately before disposition 
of a body and verifies the identity of the deceased and the disposition 
thereof. He submits a signed report in each individual case to the effect 
that he has inspected the remains, that the remains have been properly 
prepared and clothed, and that he has verified the identity of the 
deceased at time of disposition. This report is transmitted to the 
registrar and filed with the medical record of the case. The removal 
of remains from the hospital will not be authorized by other than the 
registrar unless under exceptional circumstances or when relatives of 
the deceased, after having been informed of this regulation, demand 
the removal. Under no circumstances, however, will a certificate of 
death be signed by other than the registrar, the chief, or the assistant 
chief of the medical or surgical service. 
107. Effects of deceased.—Upon the death of a patient, the ward 
officer, or in his absence the officer of the day of the service 
responsible for the care of the patient, makes an immediate search 
of the deceased’s person, bed, bedside table, and of the ward for 
clothing, money, valuables, or other effects belonging to the patient. 
(See par. 89.) Clothing and effects other than money and valu- 
ables that are found are listed on Patients’ Property Card (W. D., 
M. D. Form No. 75), in duplicate, which is signed by the officer mak- 
ing the search, after which the forms, together with such clothing 
and effects found, are delivered to the patients’ baggage room. The 
registrar is charged with the proper disposal of the clothing, money, 
valuables, and effects of deceased patients, and in his capacity as sum- 
mary court officer carries out the provisions of the Manual for 
Courts-Martial as may be indicated in the case of persons subject 
to military law, and in all other cases as may be appropriate and 
in accordance with the existing law. Money and valuables of de- 
56 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
107-109 
ceased patients are released by the custodian of patients’ funds and 
valuables, and clothing, effects, and baggage of deceased patients 
are released from the patients’ baggage room only on the written 
order of the registrar. 
Section XIII 
Paragraph 
Baggage room 108 
Disposition of clothing and effects on admission 109 
Wear of hospital clothing 110 
Retention of clothing and property 111 
Baggage when admitted from train or boat 112 
Withdrawal from baggage room 113 
Officers 114 
Check of baggage room records 115 
CLOTHING AND BAGGAGE OF PATIENTS 
108. Baggage room.—The patients’ baggage room functions 
under the immediate jurisdiction of the commanding officer, de- 
tachment of patients, who is responsible for the safeguarding, proper 
storage, disposition, and necessary records of all effects which are 
delivered thereto. In hospitals where there is no baggage room the 
ward officer is charged with these responsibilities. 
109. Disposition of clothing and effects on admission.—a. 
Except when enlisted status patients are admitted directly to the 
wards, all clothing and hand baggage in their possession are imme- 
diately delivered by them with the assistance of personnel from 
the receiving office to the patients’ baggage room. All such clothing 
and equipment of patients, including the articles comprising hand 
baggage except as provided in paragraph 111, are inventoried by the 
attendant on duty in the baggage room, who carefully lists articles 
on W. D., M. D. Form No. 75, in duplicate. Specific description is 
noted in the case of unusual items to permit ready identification in 
the future. The patient is required to sign both copies of the in- 
ventory, acknowledging its correctness. If he is unable to do so, 
appropriate notation is made thereon by the person making the in- 
ventory. The attendant on duty in the patients’ baggage room stamps 
with the “Received” stamp and signs each copy of the inventory. The 
duplicate is delivered to the patient and the original is held on file in 
the patients’ baggage room. 
6. (1) When patients are admitted direct to wards or in those 
cases where the emergency is such that it is not practicable to have 
the personal clothing and handbaggage turned in at the patients’ 
baggage room, all clothing and handbaggage in their possession are 
57 TM 8-260 
109-110 
MEDICAL DEPARTMENT 
delivered with the patient to the proper ward by the personnel of 
the receiving office. In such instances all clothing and equipment 
of patients, including the articles comprising handbaggage, except as 
provided in paragraph 110 below, are inventoried by the wardmaster, 
who carefully lists same on W. D,, M, D. Form No. 75, in duplicate. 
Specific description is noted in the cases of unusual items to permit 
ready identification in future. If the condition of the patient does 
not preclude, he is required to sign both copies of the inventory, 
acknowledging its correctness. If he is unable to do so, appropriate 
notation is made thereon by the person making the inventory Ex- 
cept in cases of patients admitted to the communicable disease section 
(see (2) below), both copies of W. D., M. D. Form No. 75, together 
with the effects, are sent immediately to the patients’ baggage room 
if it is during the hours when the patients’ baggage room is open, 
and if the patients’ baggage room is not open as soon after its next 
opening as possible. In the latter case, the wardmaster who inventories 
the clothing and equipment turns it over to the ward nurse and she is 
responsible for its retention under lock and key in the linen room or 
other locked depository of the ward until the baggage room is again 
open, Under no circumstances will clothing be kept in ward linen 
closets except for the very temporary period when it is not prac- 
ticable to have the patients’ baggage room open (see a above). 
(2) Clothing received in the communicable disease section is 
handled as in (1) above, except that after it has been properly 
inventoried, such articles as the ward officer designates are delivered 
to the hospital laundry for disinfection. A receipt from the laundry 
is taken for all items so delivered. The ward attendant calls at the 
laundry at the designated time to receive these items after they have 
been disinfected. He then checks the items against the receipt he 
received. If found correct he takes the disinfected items received 
from the laundry, together with all other effects of the patient which 
have been otherwise disinfected, to the baggage room where he 
disposes of them as described in a above. 
110. Wear of hospital clothing.—a. When an enlisted status 
patient has delivered his clothing and personal effects to the patients’ 
baggage room, he is furnished one suit of hospital pajamas and 
bathrobe, and a receipt is taken by the attendant at the patients’ 
baggage room. He may be permitted to retain his shoes, undercloth- 
ing, two pairs of socks, waist belt, and the necessary toilet articles. 
These personal items are not included in the inventory (see par. 
111). 
58 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
110-111 
6. Patients on an enlisted status admitted direct to wards, if their 
mental and physical conditions permit, are required to sign a receipt 
for a suit of hospital pajamas when the same is issued to them on 
the ward. If they are not able to sign such a receipt, a notation to 
that effect is made. When clothing and effects are delivered to the 
patients’ baggage room, this receipt is delivered with the clothing 
to the patients’ baggage room and the attendant who delivers them 
receives from the attendant in return one suit of hospital pajamas. 
This is delivered to the ward to replace those issued to the patient. 
c. Patients on an enlisted status are prohibited from wearing other 
than hospital clothing while in any building pertaining to the hospi- 
tal, except that convalescent patients, other than those confined in 
the neuropsychiatric section, may wear such personal underclothes, 
shoes, socks, waist belts, and head covering as they have in their 
possession. 
d. Ambulant patients on an enlisted status while in the ward are 
clothed habitually in pajamas, socks, slippers or shoes, or if avail- 
able, in a convalescent suit which must be clean and in good state 
of repair and buttoned at all times. 
e. When an ambulant patient on an enlisted status leaves his ward, 
the Medical Department convalescent suit, if available, is worn over 
the pajamas. Patients requiring the protection of additional cloth- 
ing are permitted to wear the bathrobe over the convalescent suit. 
Except as noted below, this is the patient’s dress at all times on the 
grounds and in the building to which he has access, except going 
from and returning to the reservation on authorized pass. 
/. Patients wear their personal outer clothing when leaving and 
returning to the reservation on authorized pass. 
111. Retention of clothing and property.—Except as noted 
hereafter, no articles of personal clothing or property are retained 
in the wards by patients on an enlisted status during stay in hospital. 
Patients are required to turn in to the patients’ baggage room any 
such articles found in their possession by any of the ward personnel 
on duty in the ward. Patients whose physical and mental conditions 
permit them to leave the ward may be granted permission by the 
ward officer to retain the following articles: 
1 pair of shoes. 
1 hat or cap. 
2 pairs of socks. 
2 suits of underclothing. 
1 waist belt. 
Necessary toilet articles. 
59 TM 8-360 
111-113 
MEDICAL DEPARTMENT 
Patients are informed when such permission is granted that these 
articles are for their personal comfort and that they are responsible 
for any subsequent loss. 
112. Baggage when admitted from train or boat.—a. Patients 
admitted from trains or boats are asked at the receiving office whether 
or not they have any baggage other than that which accompanied 
them at the time of admission. If so, they are requested to deliver 
the baggage checks therefor to the receiving office where a record 
showing the check number, full name, grade, and organization of 
patient is made in a book kept for that purpose. These checks are 
promptly delivered to the attendant at the patients’ baggage room 
who receipts in the book for them. He likewise keeps in the patients’ 
baggage room a book where he records the check numbers, full name, 
grade, and organization of the patient, and delivers these checks to 
the quartermaster baggage driver on his next trip, having him receipt 
for them in the book at the patients’ baggage room. 
b. (1) When such baggage is received from the quartermaster the 
patient, if he is ambulant, is required to come to the patients’ baggage 
room where he inspects such baggage and assists in the inventory of 
any baggage which is not sealed by his own lock and key. He and the 
attendant together see that all additional items are added to both copies 
of the W. D., M. D. Form No. 75, and acknowledge these additions by 
their initials opposite the items listed on each copy. 
(2) If the patient is not physically or mentally able to do so, an 
attendant from the ward in which he is confined is required to come 
to the patients’ baggage room wdiere he sees the locked containers and 
assists with the inventory of effects not locked, and sees that all items 
are added to W. D., M. D. Form No. 75. Both the attendant from the 
ward and the attendant at the baggage room acknowledge receipt of 
these additional items by their initials opposite the items on each copy 
of W. D., M. D. Form No. 75. 
113. Withdrawal from baggage room.—a. Clothing of patients 
departing on pass or furlough may be withdrawn by the patients on 
presentation of approved pass or furlough. When such withdrawals 
are made, if they take with them all items listed on W. D., M. D. Form 
No. 75, the duplicate copy of the form receipted and signed by the 
patient is returned to the patients’ baggage room. If they make a 
partial withdrawal, taking with them only such items as they need for 
wearing apparel while on pass or furlough, a receipt is given to the 
attendant at the patients’ baggage room for articles withdrawn. Upon 
the return of patients from such absence, if their return is between 
8:00 AM and 12:00 midnight, they return their clothing imme- 
60 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
113-115 
d lately to the patients’ baggage room. If their return is between 
12:00 midnight and 8:00 AM, they take their clothing with them 
to their wards but return it to the patients’ baggage room immediately 
after 8; 00 AM of the same day. In either case the attendant on 
duty in the patients’ baggage room again takes charge of the clothing 
which was withdrawn and returns to the patient the receipt which 
he gave for it. 
b. Patients are required when discharged from the hospital to take 
with them all of their clothing and personal effects. When they are 
ready to depart they present to the attendant at the patients’ baggage 
room the duplicate copy of W. D., M. D. Form No. 75 receipted by 
themselves, together with a written notification from the office of the 
commanding officer, detachment of patients, stating that they are pre- 
pared to leave the hospital. 
c. All patients going on pass or furlough or being discharged from 
the hospital are required to deliver at the patients’ baggage room one 
suit of hospital pajamas and one bathrobe for which they receive their 
receipt. 
d. Upon the death of a patient, all money and valuables are secured 
by the ward officer and turned over immediately to the custodian of 
patients’ fund (see pars. 89 and 107), 
e. Clothing of patients may be withdrawn for purposes other than 
indicated in «, b, <?, and d above only on presentation of a request ap- 
proved by the ward officer and the commanding officer, detachment of 
patients. When clothing is withdrawn by patients for the purpose of 
cleaning, the wTard officer sees that the clothing is returned promptly 
to the baggage room as soon as the cleaning is completed. 
114. Officers.—a. While patients on officer status are not required 
to deposit their clothing in the patients’ baggage room, the facilities of 
the baggage room are available to them for safekeeping of trunks and 
handbaggage, and they may deposit clothing and other effects not 
classed as valuables in the same manner described above. 
b. In addition, patients on officer status arriving by train or boat 
are asked if they have additional baggage. When they are found 
to have such baggage it is handled in the manner directed above. 
c. Patients on officer status having clothing and effects stored in 
the patients’ baggage room withdraw them as prescribed above. 
115. Check of baggage room records.—The admission and dis- 
position sheet furnished for patients’ baggage room is checked daily 
by the attendant in charge thereof to ascertain if any patient has 
departed, leaving his baggage behind. When baggage of this nature 
61 TM 8-260 
115-117 
MEDICAL DEPARTMENT 
is found, report is furnished immediately the commanding officer, 
detachment of patients, for appropriate action. 
Section XIV 
Paragraph 
Jurisdiction 116 
Organization 117 
Wardmasters 118 
Salutes 119 
Sick call 120 
Noncommissioned officer in charge of quarters 121 
Emergency roster 122 
MEDICAL DETACHMENT 
116. Jurisdiction.—All members of the medical detachment on 
duty at the hospital function under the immediate supervision of the 
commanding officer, medical detachment. 
117. Organization.—The organization of the medical detachment 
is composed of two services, administrative and professional. The 
routine assignments for these two services are made in the office of the 
detachment commander. 
a. Administrative service.—The administrative service consists of 
all enlisted personnel, Medical Department, on duty in the several 
offices and departments of the hospital, whose duties are strictly non- 
professional. This service functions directly under the charge of the 
first sergeant, medical detachment, who receives his instructions from 
the commanding officer, medical detachment. 
h. Professional service.— (1) The professional service consists of 
all enlisted personnel, Medical Department, on duty in the profes- 
sional service of the hospital, including ward attendants, men on 
duty in the clinics, laboratories, etc. This service functions directly 
under the charge of a competent noncommissioned officer who is fur- 
nished the necessary assistants to permit supervision over the serv- 
ice during the 24-hour period. The hours of duty for each noncom- 
missioned officer are regulated and prescribed by the commanding 
officer, medical detachment, under whom the service functions. The 
professional service cooperates with the ward officers and nurses to the 
end that most efficient enlisted men are supplied for the professional 
duties devolving upon this class of personnel. 
(2) The duties of the noncommissioned officer in charge of the 
professional service are— 
(a) To make all emergency details and assignments, and exercise 
supervision over all enlisted men, Medical Department professional 
62 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
117-120 
service, under the jurisdiction of the commanding officer, medical de- 
tachment. He makes frequent checks of such personnel to assure him- 
self that all men detailed are actually on duty, performing their re- 
spective work satisfactorily, and that they are neat, clean, and in 
proper uniform at all times. He also checks on the personnel and 
makes a report to the detachment commander as to their work and 
their military conduct. 
(b) The noncommissioned officers in charge during the night tour 
of duty make such complete rounds of the wards during the night as 
they deem necessary and as may be prescribed from time to time. 
118. Wardmasters.—a. In wards where members of the Army 
Nurse Corps are not assigned, a suitable enlisted man, Medical Depart- 
ment, is assigned as wardmaster. The duties and responsibilities are 
identical with those of a nurse (see par. 203). 
b. In wards to which Army nurses are assigned the duties of ward- 
masters are as follows: 
(1) He is immediately in charge of the enlisted men assigned to 
the ward and responsible that they remain at their places of duty; are 
neat and clean about their person, in proper uniform, and properly 
perform the work to which they are assigned. 
(2) He is specifically charged with responsibility for the police of 
lavatories, the segregation, transportation, and exchange of soiled and 
clean linen; the transportation and delivery of patients from one part 
of the hospital to another; the disposition and exchange of surplus 
and unserviceable property, and the securing of the necessary supplies 
and equipment from the medical supply office, the pharmacy, and 
other portions of the hospital. 
(3) He performs such other duties as may be designated by the 
ward officer or nurse. 
(4) Nothing in the above will be construed to interfere in any way 
with the authority of the nurse on the ward or other Army nurse. 
119. Salutes.—See FM 21-50, and FM 21-100. All corridors and 
hallways are “indoors” and the exchange of salutes is not required. 
Detachment commanders will see that all enlisted men are familiar 
with the requirements of the above-mentioned manuals. 
120. Sick call.—Members of the medical detachment, who desire 
medical attendance report to the office of the commanding 
officer, medical detachment, at such hours as may be designated by the 
commanding officer in order that their names may be placed on the 
sick report for examination by the proper medical officer. When their 
condition is so acute as to indicate the need of immediate attention, 
63 TM 8-260 
120-123 
MEDICAL DEPARTMENT 
they will be authorized to report immediately to the commanding 
officer, medical detachment, for the above action. 
121. Noncommissioned officer in charge of quarters.—The 
commanding officer, medical detachment, details a permanent non- 
commissioned officer in charge of quarters. The hours of duty are 
from 7:00 AM to 7:00 PM, and from 7:00 PM to 7:00 AM. 
The duties of the noncommissioned officer in charge of quarters are to 
preserve order and discipline in the barracks of the medical detach- 
ment. He makes such inspection as to sanitation and police as the 
commanding officer, medical detachment, may prescribe. He is in 
charge of the billeting of the detachment. In his office he maintains 
a file of the members of the detachment, showing their bed number 
and place of duty. When members of the detachment absent them- 
selves without leave, he at once notifies the detachment commander 
who secures the effects of the absentee (see AR 615-290). He notifies 
the enlisted members of the operating room staff and the enlisted 
men on emergency duty in the laboratory when their services are 
needed. He wakens the cooks at the proper time and makes the 
rounds of the barracks to see that the other members of the detachment 
are up and in condition to perform their duties at the proper time. 
122. Emergency roster.—The commanding officer, medical de- 
tachment, prepares daily a roster of six or more privates or privates 
first class, Medical Department, who are available for emergency 
duty. This roster is sent to the office of the noncommissioned officer 
in charge of quarters where it is posted. A copy also is posted on 
the detachment bulletin board. The men so detailed do not leave the 
immediate area during their tour of duty, and keep the noncom- 
missioned officer in charge of quarters notified of their whereabouts. 
Section XV 
ADMINISTRATIVE OFFICER OF THE DAY 
Paragraph 
Detail 123 
Tour of duty 124 
General duties 125 
Inspection 126 
Fire marshal 127 
Duty detachment 128 
Confinement of persons 129 
Meal inspection 130 
Escaped insane patient or prisoner 131 
Reports 132 
123. Detail.—a. The administrative officer of the day is detailed 
by the adjutant of a general hospital from a roster consisting of all 
64 TM 8-260 
123-126 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
officers designated for this duty. Notification of detail is furnished 
each officer 24 hours in advance. 
b. Duty as officer of the day takes precedence over regular duties 
in cases of emergency only. 
124. Tour of duty.—The tour of duty of the administrative officer 
of the day begins at 9:00 AM and continues for 24 hours. At the 
beginning of the tour the new and old administrative officers of 
the day report to the commanding officer or his representative. Dur- 
ing his tour of duty the administrative officer of the day remains 
within the limits of the reservation and sleeps in the room provided 
for his use. The administrative officer of the day keeps the informa- 
tion office constantly informed of his whereabouts. During his tour 
of duty the administrative officer of the day wears the prescribed 
brassard on the left arm. 
125. General duties.—During the absence of the commanding 
officer, the executive officer and the adjutant of a general hospital, 
the administrative officer of the day is in charge of the administration 
of the hospital and will be responsible for its safety and good conduct. 
The duties of the administrative officer of the day are of wide range 
and most important in character, and each officer assigned as admin- 
istrative officer of the day familiarizes himself with his duties as 
prescribed in orders and regulations and is responsible for their 
proper execution. He is observant and is alert to prevent fire, theft, 
waste, misconduct, or neglect. He immediately corrects any breach of 
orders or regulations noted by him. He brings to the attention of 
the authorized representative of the commanding officer of the hos- 
pital any cases of serious illness or injury or any dereliction of which 
he may have cognizance while discharging his official duties. He 
responds promptly to any calls made upon him. 
126. Inspection.—At least twice during his tour of duty, once 
between 8:00 PM and midnight and once between midnight and 
reveille, the administrative officer of the day inspects the entire hos- 
pital area, except the occupied wards. At each inspection he checks 
the prisoners in the closed or open wards, and sees that all are 
properly accounted for. On each inspection he visits all parts of 
the hospital area and inspects the garage, power plant, and the 
detachment barracks. During his inspections he ascertains that reg- 
ulations as to conduct are observed and notes the condition of the 
premises inspected by him as to police and sanitation, and corrects 
any noted violation of regulations. He extends his inspection to 
include such wards as he may consider necessary in the discharge 
of his duties. 
65 TM 8-260 
127-131 
MEDICAL DEPARTMENT 
127. Fire marshal.—The administrative officer of the day is an 
assistant to the fire marshal, and during the absence of the fire 
marshal and the assistant fire marshal he acts as fire marshal. He 
insures that the night fire patrol of the area is being made. In case 
of fire or alarm of any kind he at once takes steps to insure the 
safety of life and public property and to preserve order. He reports 
in detail any fire which occurs during his tour of duty. 
128. Duty detachment.—During the absence of the detachment 
commander and his commissioned assistants, the administrative of- 
ficer of the day is in charge and in emergency takes whatever steps 
he considers necessary to insure efficiency, good conduct, and dis- 
cipline of the detachment. When an enlisted man required for duty 
is absent or circumstances require that he be relieved from duty, 
if necessary he is replaced by the administrative officer of the day 
from a roster of men available for this duty, furnished by the com- 
manding officer, medical detachment, posted in the officer of the day’s 
office. 
129. Confinement of persons.—The administrative officer of 
the day, when in his judgment it is necessary, confines any enlisted 
man or civilian who may be present in the hospital area or in the 
detention ward for safekeeping until proper action can be taken. 
Any officer on duty at a general hospital is authorized, when in his 
judgment it is necessary, to place patients in the detention ward. 
In each instance the person to be confined is sent to the detention 
ward under appropriate guard who is given an informal memoran- 
dum for delivery to the detention ward officer, requesting the person 
be placed in detention. In each instance the officer directing the 
confinement immediately furnishes the administrative officer of the 
day a report showing the name of the person placed in detention, 
the attendant circumstances, and other pertinent data, together with 
list of witnesses. In each instance the administrative officer of the 
day enters on his report names of persons confined or placed in deten- 
tion, the attendant circumstances, and all 'pertinent data, together 
with list of witnesses, necessary to make proper disposition of the 
case. 
130. Meal inspection.—The administrative officer of the day in- 
spects one meal each day in the officers’ mess. He inspects and eats 
two meals in the patients’ mess and one meal and night lunch in 
the detachment mess. He reports to the service, and on the quantity, 
quality, and variations from the bill of fare of each meal inspected. 
131. Escaped insane patient or prisoner.—In case of the escape 
of an insane patient or a prisoner the administrative officer of the 
66 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
131-133 
day promptly and thoroughly investigates the circumstances and 
makes every effort to apprehend the patient or prisoner, including 
notification of the civil authorities, and makes a complete report on 
his Officer of the Day Report. 
132. Reports.—The reports of the administrative officer of the day 
are typewritten on the prescribed local form. As this report is 
filed as a part of the permanent records of the hospital, all con- 
cerned are directed that the data entered thereon are both complete 
and accurate. Unusual occurrences and violations of regulations are 
recorded under “Remarks.” These data will be complete and names 
of witnesses, offenders, and the circumstances recorded fully and ac- 
curately. Under “Changes of Status—Duty Personnel” are entered 
all changes of status relating to permanent members of the command. 
Sufficient copies of data relative to the change of status are pre- 
pared for distribution to all offices concerned. 
Section XYI 
GENERAL SUPPLY AND UTILITIES 
Paragraph 
Functions 133 
Supplies 134 
Collection and disposition of salvage and waste materials 135 
Maintenance and repair of buildings and equipment 136 
Maintenance and operation of utilities 137 
Transportation 138 
133. Functions.—Normally, Quartermaster Corps personnel are 
provided for general supply functions and for the maintenance of 
utilities. The duties of the officer in charge of this section of a gen- 
eral hospital are— 
a. The procurement, storage, issue of, and accounting for all sup- 
plies and equipment necessary to the maintenance and operation of 
the hospital, with the exception of those supplies and equipment 
properly procured, stored, issued, and accounted for by the medical 
supply officer. 
h. The supervision, maintenance, and operation of utilities. 
c. The maintenance and operation of buildings, roads, walks, 
grounds, lighting, heating, water, sewer, and telephone systems. 
d. The storage and disposition of all salvage and waste materials. 
e. When operating separate from a hospital center, he is responsible 
for the maintenance, repair, and operation of all motor transpor- 
tation. 
/. Such other duties as may be specifically assigned him from time 
to time by the commanding officer. 
67 TM 8-260 
134 
MEDICAL DEPARTMENT 
134. Supplies.—a. The officer in charge of general supplies and 
utilities is charged with the procurement of such supplies and equip- 
ment of the quartermaster department as are required for the proper 
supply and equipment of the detachment medical patients, and for 
the maintenance and operation of all activities charged to this section. 
h. All issues of supplies and equipment by the general supply and 
utilities section are governed by the following: 
(1) Clothing for enlisted men is issued on requisitions submitted 
by the detachment commander, medical detachment, on Requisition 
and Receipt for Clothing in Bulk (W. D., Q. M. C. Form No. 409) 
for bulk issues and on Individual Clothing Slip (W. D., A. G. O. 
Form No. 35) for individual issues. Requisitions are prepared in 
duplicate, and in the case of bulk issues are submitted to the com- 
manding officer of the hospital for approval prior to issue. When 
issues have been effected, the duplicate copy signed by the quarter- 
master is returned to the commander, medical detachment, for file. 
The original is retained by the quartermaster as a voucher to his 
stock record account (see AR 35-6560 and AR 35-6720). 
(2) Nonexpendable supplies and equipment other than clothing 
need not be covered by formal requisition, but are issued on written 
informational request. Issues are made on Memorandum Receipt 
(W. D., Q. M. C. Form No, 487), which is prepared in duplicate, the 
original being signed by the person to whom issues are made and 
retained by the quartermaster, and the duplicate (unsigned) copy de- 
livered to the responsible person. 
(3) All issues of expendable supplies and equipment are made on 
requisitions submitted in duplicate and approved by the commanding 
officer of the hospital as follows, with the exception of those supplies 
used for post utilities ((c) below) : 
(a) Issues of cleaning and preserving materials, stationery, etc., 
are made at such times as ordered by the commanding officer on 
requisitions submitted in duplicate on Requisition and Receipt for 
Brooms, Brushes, Matches, Mops, Toilet Paper, Soap, etc. (W. D., 
Q. M. C. Form No. 411), Requisition and Receipt for Stationery and 
Office Supplies (W. D., Q. M. C. Form No. 412), Requisition and 
Receipt for Cleaning and Preserving Materials (W. D., Q. M. C. 
Form No. 413), and Requisition and Receipt for China and Glass- 
ware (W. D., Q. M. C. Form No. 414), and approved by the com- 
manding officer of the hospital. Requisitions are based on allowances 
announced from time to time in memorandum orders and Tables of 
Allowances. When supplies are issued they are receipted for on 
original requisitions and the original is retained by the quartermaster 
68 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
134 
as a credit voucher to his accounts, and the duplicate is delivered 
to the responsible person to whom supplies are issued. 
(b) All other issues of expendable articles, with the exception of 
those in (c) below, are made on Requisition (W. D., Q. M. C, Form 
No. 400), submitted as occasion demands. These requisitions are 
approved by the commanding officer and disposed of as provided in 
[a] above. 
(<?) All expendable supplies issued for the use of post utilities 
are shipped to the utilities officer at the end of each month on 
Shipping Ticket (posts, camps, and stations) (W. D., Q. M. C. 
Form No. 434) which is approved by the commanding officer of the 
hospital. It is then used as a credit voucher to the stock record 
account of the quartermaster. 
c. The receiving of supplies and equipment by the quartermaster 
from organizations and individuals is governed by the following: 
(1) When it is desired to turn in serviceable, nonexpendable prop- 
erty, it is turned in to the quartermaster and credit given for it 
on W. D., Q. M. C. Form No. 487. When unserviceable, nonex- 
pendable property is turned in it is accompanied by a certificate 
of the responsible person setting forth the circumstances by which 
it was rendered unserviceable, and upon which the responsible per- 
son relies to relieve himself of the responsibility for the unserviceable 
condition. 
(2) All expendable property when no longer required is turned 
in to the quartermaster for salvage or reclamation accompanied by 
a list of such property, and in case of clothing which has been 
charged against enlisted men’s clothing allowance and has been 
dropped from accountability, the list contains the name and organ- 
ization of the enlisted men to whom the clothing pertained. One 
copy of the list is authenticated by the quartermaster and returned 
to the organization commander for file with the records of the 
enlisted men for action of the inspector. 
(3) All supplies received by the quartermaster from depots, trans- 
ferred from other stations, or procured locally are received and 
handled in accordance with existing regulations and the following 
instructions: 
(a) All articles received immediately upon receipt are carefully 
examined as to quality and serviceability, and checked as to quantity 
under the supervision of a commissioned officer. 
(b) Upon compliance with (a) above, the person receiving the 
supplies acknowledges receipt by entering his signature on the pre- 
scribed Tally Sheet, Incoming (W. D., Q. M. C. Form No. 489) 
69 TM 8-260 
134-135 
MEDICAL DEPARTMENT 
covering the shipment in case of supplies purchased by this office, 
or initialing the shipping ticket covering shipment of supplies from 
a depot or other station. In the case of supplies purchased, the 
tally sheet, incoming, must be attached to the receiving report when 
it is submitted to the quartermaster for signature. When shipments 
are received from depots or other stations, the person in charge of 
property must initial the shipping ticket before submitting it to 
the quartermaster for signature. No supplies are signed for by the 
quartermaster until the above instructions have been fully complied 
with. 
(c) All necessary papers pertaining to the receipt of property 
are prepared under the supervision of the principal clerk of the 
property section. 
(d) Proper notations should be made on the talley sheet, incoming, 
or shipping ticket of any shortage, damaged goods, etc. 
(e) The quartermaster designates in writing the personnel who 
are authorized to receipt for property for their respective depart- 
ments. 
d. (1) Providing a sales commissary is authorized, such quantities 
of authorized sales articles as are required to meet the demands of the 
personnel of the command are stocked. 
(2) Sales are made only to those authorized by regulations to make 
purchases. 
(3) The hours for sales are set by the commanding officer. 
(4) Deliveries are made to personnel as directed by the command- 
ing officer. 
(5) Sales are made to patients only on orders of the ward surgeon. 
(6) Providing a bakery for the hospital is authorized, it is under 
the direct supervision of the commanding officer. It is operated 
under the provisions of AR 30-22C0, Issues of bread are made to 
organizations direct from the bakery by the chief baker who is re- 
sponsible to the officer in charge of the commissary for the proper 
keeping of records of issues, supplies, and baking. Sale of bread 
to individuals will be direct from the commissary when authorized 
by the commanding officer. 
135. Collection and disposition of salvage and waste mate- 
rials.—The following instructions will govern the collection and dis- 
position of salvage and waste materials: 
a. The quartermaster, acting in the capacity of salvage officer, is 
charged with the collection and disposition of all salvage, waste ma- 
terials, and unserviceable supplies accumulated at station. 
70 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
135-136 
h. Regulations governing this class of supplies require that all 
unserviceable articles of public property, both expendable and non- 
expendable, be collected and turned over to the salvage officer for 
disposition. 
(1) Nonexpendable property stored and issued by the Quarter- 
master Corps, when unserviceable, is turned over to the quartermaster 
accompanied by a certificate of the responsible officer, in quadrupli- 
cate, setting forth the circumstances by which the property was 
rendered unserviceable. 
(2) All expendable articles of public property when unserviceable 
or no longer required, and all collection of waste materials are turned 
over to the salvage officer accompanied by a list, in duplicate, showing 
the quantity of each article delivered, duplicate copy to be signed by an 
authorized representative of the salvage officer and turned over to the 
person making delivery. 
(3) (a) All salvage and waste materials received are disposed of in 
accordance with existing Army Regulations and to best interest of the 
service. 
(h) Garbage from the messes operated by the hospital is disposed 
of by sale or otherwise, whichever is most advantageous to the 
Government. 
136. Maintenance and repair of buildings and equipment.— 
The quartermaster is responsible for the proper maintenance and re- 
pair of all buildings, roads, grounds; also water, sewer, heating, and 
lighting systems of the hospital, and for the timely submission of 
estimates for adequate funds for this purpose in accordance with exist- 
ing regulations. The following instructions will govern the mainte- 
nance and repair of buildings and equipment. 
a. Requests for repairs to buildings, equipment, etc. pertaining to 
utilities are made on the quartermaster as follows: 
(1) Ordinary or routine repairs are requested by verbal, telephone, 
or informal request direct with the utilities clerk in the quartermaster’s 
office who issues a Work Order (W. D., Q. M. C. Form No. 106), in- 
forming the person placing the request that action will be taken. 
(2) Requests for emergency repairs during regular office hours are 
made verbally, in person, or by telephone to the utilities clerk, or in 
his absence to the chief clerk or utilities foreman. Emergency request 
will not be made in order to gain precedence over other necessary 
repairs. 
(3) Any unusual repairs that may become necessary after office 
hours are referred to the quartermaster, chief clerk, or foreman of 
utilities at their quarters. TM 8-260 
136-138 
MEDICAL DEPARTMENT 
h. The quartermaster arranges a priority on all requests received for 
repairs. Such priority on all requests will be in accordance with the 
approval of the commanding officer. 
c. The quartermaster is responsible for repairs to all equipment 
stored and issued by the Quartermaster Corps and such other arm or 
service supplies as the commanding officer may direct. The quarter- 
master does not receive requests for repairs to medical equipment. 
These requests are made on the medical supply officer, who is account- 
able for that class of equipment. 
d. If within a reasonable length of time requests for repairs do not 
receive proper attention or repairs are unsatisfactory, a report of such 
fact is made to the quartermaster. 
e. No changes in any of the utilities systems in the buildings are 
made without prior authority of the commanding officer or the quarter- 
master. 
137. Maintenance and operation of utilities.—The quarter- 
master is responsible for the proper maintenance and operation of 
utilities pertaining to the Quartermaster Corps (and Signal Corps if 
any), and for the submission of adequate estimates of funds required 
for this purpose in accordance with existing regulations; also, for the 
submission of requisitions for fuel and other supplies required for 
maintenance and operations. 
a. Special instructions are issued as to personnel, their duties, etc., 
for the efficient operation and maintenance of power plants at such 
time as they are taken over by the Army for the purpose of estab- 
lishing a general hospital. 
h. The quartermaster usually is appointed fire marshal by the com- 
manding officer and instructions as to fire prevention and action neces- 
sary in case of fire are issued at such time as buildings are taken over 
by the Army for hospital purposes. 
c. The ice plant is under the superivsion of the quartermaster and 
deliveries are made as directed by the commanding officer. 
d. The various workshops operated under the supervision of the 
quartermaster are governed by the following instructions: 
The foremen of all utilities shops such as plumbing shop, electrical 
shop, painting shop, etc., are responsible for the proper functioning 
of their respective shops and for the conservation and use of all 
materials and supplies furnished them for the performance of their 
duties. 
138. Transportation.—a. The quartermaster is responsible for 
the maintenance and operation of all motor transportation consisting 
of ambulances, passenger vehicles, trucks, etc., and for the issuance 
72 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
138 
of such requests for rail transportation as are required for travel on 
competent orders of personnel of the hospital, including patients 
returning to duty; for the preparation and arrangement of ship- 
ment of all freight or express shipments, including public and per- 
sonal property, the shipment of which is authorized by regulations. 
b. The following instructions govern the issuance of rail transpor- 
tation to personnel departing the hospital and preparation and ship- 
ment of household goods and other property from the hospital. 
(1) The quartermaster, upon receipt of competent orders, issues 
transportation requests to cover such rail transportation and sleeping 
car accommodations required for personnel departing the hospital. 
He is guided in the issuance of such transportation by instructions 
contained in AR 30-905, 30-910, 30-920, and 30-925. 
(2) All individuals contemplating travel on an official status should 
acquaint themselves with instructions contained in the above-men- 
tioned Army Regulations. 
(3) The quartermaster, in addition to the issuance of transporta- 
tion requests for travel and sleeping-car accommodations, including 
dependents where authorized, makes all necessary reservations when- 
ever requested to do so by the traveler. 
(4) The quartermaster, in the case of movement of tuberculous, 
insane, and other patients, prepares itineraries, secures through res- 
ervations, and makes such arrangements with the carriers as are 
necessary to insure the utmost comfort for the travelers. 
(5) Whenever the shipment of remains of a deceased person with 
an attendant is authorized, the quartermaster issues the necessary 
transportation requests to cover the transportation of the remains 
and attendant as provided in AR 30-920, 30-955, and 30-1830. 
(6) Whenever the shipment of remains by express is directed the 
quartermaster makes the necessary arrangements with the carrier 
for shipment. Shipment of remains by express is to be covered by 
a Government bill of lading. 
(7) The undertaker employed by the quartermaster is held responsi- 
ble that all remains for shipment are prepared in accordance with 
existing laws. 
(8) All public property for shipment from the hospital is turned 
over to the quartermaster for shipment, accompanied by a request 
for shipment, containing the proper address of consignee and such 
other information as is necessary for him to take intelligent action 
and insure shipment. 
(9) The quartermaster is governed in handling the shipment of 
personal property by instructions contained in AR 30-960. 
73 TM 8-260 
139-140 
MEDICAL DEPARTMENT 
Chapter 3 
PROFESSIONAL SERVICES 
Paragraphs 
Section I. General 139-144 
II. Ward officer 145-157 
III. Detention ward 158-164 
IV. Neuropsychiatric section 165-176 
V. Laboratory service 177-183 
VI. Roentgenological service 181—188 
VII. Dental service 189-198 
VIII. Army Nurse Corps and nursing service 199-204 
IX. Dispensary 205-209 
X. Pharmacy 210-216 
XI. Professional officers of the day 217-223 
Section I 
Paragraph 
Constitution 139 
Chief of service 140 
Chiefs of sections 141 
Reports 142 
Police and sanitation 143 
Consultations 144 
GENERAL 
139. Constitution.—The medical, surgical, laboratory, roentgeno- 
logical, and dental services constitute the professional division. They 
may be divided into sections as desired by the chief of service and 
approved by the commanding officer within the limitations of person- 
nel outlined in Table of Organization 8-507. 
140. Chief of service.—The chief of each service maintains super- 
vision over the entire service, and makes recommendation for the 
assignment of assistants allotted him. He is responsible for the ad- 
ministration, sanitation, and police of wards, section, and other activi- 
ties pertaining to his service. The chief of the service is also 
responsible that the clinical record is complete and correct before 
transmitting it to the registrar. 
74 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
141-144 
141. Chiefs of sections.—Each of the sections is conducted by a 
designated medical officer who is known as the chief of section. He 
is responsible to the chief of the service for the administration and 
operation of his section and the care and treatment of all cases in 
that section. 
142. Reports.—The chief of the medical service and the chief of 
the surgical service submit at the end of each month a consolidated 
report in duplicate of the number of out-patients treated and the 
number of treatments administered to out-patients in the various 
sections of their services. With this object in view they cause every 
chief of section in which out-patients are treated to maintain an out- 
patient index in conformity with the requirements of AR 40-1025. 
143. Police and sanitation.—a. Chiefs of professional services 
and the heads of administrative departments are responsible for the 
police and sanitation of all activities pertaining to their services or 
departments. They institute such measures as may be necessary to 
maintain departments and services of the hospital in a condition con- 
stantly ready for inspection. 
b. Chiefs of professional services hold chiefs of sections and ward 
officers responsible for the police and sanitation of their clinic rooms 
or wards. With this object in view, chiefs of services require them to 
make at least one daily inspection of their wards or clinics, and to take 
immediate action to correct the irregularities discovered. 
144. Consultations.—a. Each chief of service considers all “re- 
quests for consultation” made to and "within his service, approving or 
disapproving as he deems best- In cases of approval, he designates the 
consultant by name. 
b. Consultation is not ordinarily requested until a complete history 
has been taken and a thorough physical examination has been made, 
together with such routine laboratory data as would be helpful to the 
consultant in forming an opinion on the case. Emergency requests for 
consultations are considered and acted upon with the least practicable 
delay. 
c. Medical consultants, after completing their examinations, enter 
their opinions in writing upon appropriate blanks to be attached to 
the patient’s clinical record, together with any recommendations which 
they may desire to make. 
75 TM 8-260 
145-146 
MEDICAL DEPARTMENT 
Section II 
Paragraph 
General 145 
Administration 146 
Patients 147 
Medicine and medical treatment record 148 
Alcohol and narcotics 149 
Visitors 150 
Bulletin boards 151 
Ward attendants 152 
Property 153 
Diagnosis report 154 
Directory board 155 
Report of unusual occurrence 156 
Release of information 157 
WARD OFFICER 
145. General.—Ward officers are assigned to duty by the chief of 
service. They are responsible to the chief of service for the adminis- 
tration, sanitation, equipment, and discipline of their wards, the treat- 
ment of patients therein, and the proper performance of duty by assist- 
ant ward officers, nurses, and attendants, including civilian employees. 
Unless excused by proper authority or required by their duties to be 
elsewhere, they are present in their wards during hours designated by 
the commanding officer. They visit their wards sufficiently often dur- 
ing the period the night personnel are on duty to assure themselves 
that patients are being properly cared for, that the night personnel are 
efficient, and that the ward is being conducted in conformity with regu- 
lations. They hold formal sick call at 9:00 AM daily, or as soon 
thereafter as practicable, at which time they personally see each patient 
in the ward and make inquiries of the patients to satisfy themselves as 
to their condition. 
146. Administration.—a. Ward administration is a serious and 
extremely important duty of a ward officer, a responsibility which can- 
not be subordinated. The professional attention, care, and treatment 
of patients are of primary importance, but such care and treatment 
cannot be properly accomplished unless efficient administrative meth- 
ods are maintained. 
6. Absolute cleanliness, orderliness, and quiet are the first essentials 
of ward administration, and can be obtained only by the constant vigi- 
lance of officers, noncommissioned officers, nurses, and others in 
authority. 
c. Careful and thorough inspections must be made at least once 
daily, and immediate action taken to bring about the correction of 
76 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
146 
irregularities so discovered. Ambulatory patients whose physical con- 
dition permits are required to assist in the ward police provided they 
are designated for that purpose by the ward officer. 
d. The discovery and elimination of vermin requires constant atten- 
tion of ward officers. Roaches and bedbugs are constantly present and 
must be combated continuously. Roaches are to be found more com- 
monly in diet kitchens and toilets, and are readily discoverable during 
the night hours. They can be eliminated by the distribution of sodium 
fluoride or other insecticide. Bedbugs are usually found along the 
seams of mattresses and in the bed springs. When bedbugs are dis- 
covered the fact should be reported immediately to the hospital in- 
spector who prescribes the method to be used for their elimination. 
e. Ward officers assure themselves that patients have sufficient toilet 
articles (comb and brush, tooth brush, tooth paste and shaving uten- 
sils) in their possession, that their teeth are cleaned at least once 
daily, and that they bathe or are bathed at proper intervals. 
/. Patients other than those on an officer status, are required to 
wear hospital outer clothing while in the hospital. Except in the 
case of patients on an officer status, personal clothing, with the ex- 
ception of shoes, socks, underclothes, and head covering, is deposited 
in the hospital clothing room. Patients wear a bathrobe properly 
belted while away from their wards unless convalescent suits are 
available. Ward officers are responsible that hospital clothing worn 
by patients is serviceable, neat, and scrupulously clean. 
g. Clinical thermometers when not in use are kept completely im- 
mersed in 2 percent solution of phenol. Before being used thermom- 
eters are taken from the phenol solution and completely immersed in 
denatured alcohol and thoroughly washed and wiped off with cotton 
before being placed in patient’s mouth. After removal from pa- 
tient’s mouth, thermometers are thoroughly washed and returned 
to the phenol solution. This procedure is repeated after each suc- 
cessive patient. Any other method of sterilizing clinical thermom- 
eters is prohibited. 
h. Lavatories are maintained in a constant state of cleanliness and 
order. Steps are taken to prevent accumulation of soiled towels, 
pajamas, etc. A bucket partially filled with water is kept habitu- 
ally in a convenient place in each lavatory for the reception of 
refuse such as cigarette butts. Bedpan covers (fabric) are used to 
conceal bedpans and urinals ■when in transit to and from the patient 
or whenever it is necessary to leave the utensil in the vicinity of the 
patient’s bed. A sufficient number of bedpan covers are kept neatly 
folded and ready for use on each rack containing bedpans or urinals. 
77 TM 8-260 
147-148 
MEDICAL DEPARTMENT 
147. Patients.—a. Control.—(1) Ward officers should impress 
upon their patients that they are interested in their welfare, anxious 
to make them comfortable, and to improve their physical condition. 
They should endeavor to explain to them the necessity and impor- 
tance of certain ward regulations, diagnostic procedures, therapeutic 
procedures, etc., to the end that the patients are relieved of the mys- 
tery, fear, and suspicion so often present in the minds of those who 
are subjected to a hospital environment. They should not hesitate 
to discuss the patient’s condition with him, and to give him such 
information relative to the progress of his case, results of laboratory 
procedures, diagnoses, etc., as may assist him to gain an insight into 
his physical condition. The majority of patients appreciate frank- 
ness in these matters and will cooperate accordingly. 
(2) Ward officers are responsible for the discipline of patients in 
their wards. Patients committing minor offenses will be punished 
by confinement to bed, restriction of privileges, etc. Major offenses or 
repeated minor offenses will be reported to the commanding officer, 
detachment of patients, for disciplinary action. 
h. Complaints.—Ward officers carefully investigate all complaints 
made to them by patients no matter how trivial the complaint may 
appear to be, and in the event the complaint is justified take imme- 
diate steps to correct the irregularity. Irregularities that are be- 
yond the power of the ward officer to correct are immediately reported 
to the adjutant. 
c. Privacy.—Ward officers assert every effort to preserve the privacy 
of patients insofar as possible. Patients in open wards are pro- 
tected by screens while undergoing dressings, spinal punctures, veni- 
punctures, etc., while being bathed, and while the bedpan is being 
used. 
148. Medicine and medical treatment record.—a. Medicines 
and medical treatment of patients are prescribed only by medical 
officers. Dental treatment is prescribed by dental officers. A book 
of record is maintained in each ward known as a “ward order book”, 
containing treatment record and nurses’ report sheets, temperature, 
and pulse and respiration sheets. Methods of maintaining this book 
are as prescribed from time to time in hospital memoranda. 
h. A medication sheet is maintained in every ward of the hospital 
in which patients are receiving medication. This form show’s the 
name of the patient, the character of the medication, and time of 
administration, entries of which are made in a space provided for 
that purpose on the form. This form is kept habitually fixed to 
the inner side of the door of the w7ard medicine cabinet. The nurse 
78 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
148-153 
in charge of the ward is responsible that it is kept up-to-date at 
all times. 
149. Alcohol and narcotics.—All morphine, cocaine, codeine, 
alcohol, and alcoholic liquors, and other habit-forming drugs, to 
include barbital, luminal, sulphonal, trional, and similar products, 
are kept securely locked and the amounts on hand limited to actual 
necessity. The keys are kept habitually in the personal possession 
of a member of the Army Nurse Corps or a medical officer. In every 
ward where morphine, cocaine, codeine, and whisky are dispensed a 
record is maintained. Ward officers assure themselves that this record 
is properly and accurately kept and on the 10th, 20th, and last day of 
each month audit the record and certify as to its correctness. 
150. Visitors.—Ward officers are responsible that visitors are not 
permitted in wards at hours other than the regular visiting hours 
unless permission for the visit has been previously obtained. 
151. Bulletin boards.—Ward bulletin boards are for the purpose 
of disseminating information and orders to patients. They should 
contain no matter other than necessary to meet this requirement. The 
contents of these bulletin boards will be neatly arranged and kept free 
from obsolete and extraneous matter. 
152. Ward attendants.—a. Ward attendants are assigned to 
wards by the detachment commander in numbers specified by the com- 
manding officer. One ward attendant is designated as wardmaster by 
the detachment commander. Under the supervision of the ward officer 
and ward nurses, wardmasters have general charge of the ward attend- 
ants, and are held responsible that they perform their duties satis- 
factorily, are neat and clean about their person, and are in the pre- 
scribed uniform at all times. Ward officers instruct ward attendants in 
their duties and require them to exercise gentleness, kindness, and 
tolerance in dealing with patients. 
b. Ward officers give their personal attention to the supervision of 
duties which require that ward personnel leave their wards and so 
direct and coordinate the movements of personnel as to avoid unnec- 
essary absences from their wards, particularly before the hour of 
10:00 AM. 
153. Property.—a. Ward officers are responsible for all property 
in their wards. Transfer of responsibility is in accordance with para- 
graph 59. If no shortage is discovered the succeeding officer signs 
and forwards the memorandum receipt to the medical supply officer 
within 48 hours after he has assumed charge of the ward. When a 
shortage exists report is made to the medical supply officer, who adjusts 
such discrepancies as are possible; the remainder are placed on report 
79 TM 8-260 
153-156 
MEDICAL DEPARTMENT 
of survey by the former ward officer. Overages found are listed and 
turned in to the medical supply officer for adjustment. 
b. Requisitions for supplies are signed by the ward officer and for- 
warded to the medical supply officer and the ward officer is held account- 
able that only such articles are requested as are needed. Requisitions 
are prepared on the typewriter when practicable and include the item 
number and conform to the nomenclature published in the Medical 
Department Supply Catalog. Requisitions are based on the needs of 1 
week and supplies will not be accumulated. Emergency requisitions 
are not forwarded for supplies unless such emergency actually exists 
and then only for such amount as required to meet the emergency. 
c. Property is checked on the first day of each month, except when 
this day falls on Sunday or a holiday, in which case the check is made 
on the following day. Result of the check showing all shortages and 
overages is sent to the adjutant by noon of the following day. 
d. Requests for purchase of nonstandard supplies are made to chief 
of service in accordance with paragraph 60. 
e. Ward officers are responsible for the proper care and economi- 
cal use of all property in their wards. Breakage and damage not 
due to fair wear and tear is acted on in accordance with AR 85-6640. 
/. The use of hospital bedding and clothing for cleaning purposes is 
forbidden. 
154. Diagnosis report.—a. As soon as a diagnosis of a patient is 
established, the ward officer completes a diagnosis card and transmits 
it without delay to the registrar. Similar action is taken whenever 
there is an addition or a change in diagnosis; an operation or 
complication which should be reported (AR 40-1025). 
b. Diagnosis will conform as far as practicable to the nomenclature 
of diseases as set forth in AR 40-1025. 
155. Directory board.—A ward directory board of the standard 
type issued by the medical supply officer is maintained in the ward 
officer’s office in every ward of the hospital. This board shows the 
register number, surname, Christian name, grade, organization, re- 
ligion, and date of admission of the patient. Slips furnished by the 
receiving office are used for this purpose. Ward officers are respon- 
sible that this directory is kept accurately up-to-date at all times. 
156. Report of unusual occurrence*—a. Report is made of any 
unusual occurrence in which a patient is concerned, that is, suicide 
or attempted suicide, falling from bed, injury inflicted by another 
patient, injury due to accident within the hospital, burns from hot 
water bottle or electric appliance, error in the administration of medi- 
cation, etc. In short, any unusual occurrence which might have been 
80 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
156—157 
detrimental to the patient or might constitute a reason for justifiable 
complaint. 
h. This report is prepared in duplicate, Report of Unusual Occur- 
rence, as soon as possible after the occurrence. One copy is sent with- 
out delay to the adjutant, and the other to the chief of service con- 
cerned. If the occurrence to be reported is at a time other than duty 
hours, the reports are submitted at 9:00 AM the following morning. 
c. If the unusual occurrence is in a ward, reports are prepared and 
forwarded by the ward officer, or in his absence, by the nurse in 
charge. In other instances report is prepared and forwarded by the 
officer or nurse who first has cognizance of the occurrence. 
157. Release of information.—a. Requests for information re- 
garding patients by newspapers, press bureaus, radio stations, and 
similar organizations are courteously referred to the executive officer 
or the adjutant for reply. All 'proper information regarding the 
condition of patients is freely given to the above-noted organizations 
upon their request. When information of this character is given by 
other than the executive officer or the adjutant, a brief statement in 
writing covering the information given and to whom is furnished 
the adjutant so that the information given out by all parties will be 
as uniform as possible. The question as to what is proper informa- 
tion must be left to the good judgment of the person imparting it, 
but this should be interpreted liberally. 
~b. When calls are received over the telephone for information re- 
garding patients, they are referred to a commissioned officer for 
answer. 
c. Requests received outside of regular duty hours are referred to 
the appropriate professional officer. If, at the time calling, the in- 
formation is not available or the proper officer is engaged in the 
care of a patient, the party calling should be asked to call back in 
about 20 minutes and notified that he will then be given the infor- 
mation requested. 
Section III 
DETENTION WARD 
Paragraph 
Ward officer 158 
Wardmaster 159 
Admission procedure 160 
Daily inspection 161 
Medicine 162 
Meals 163 
Clinical treatment 164 TM 8-260 
158-160 
MEDICAL DEPARTMENT 
158. Ward officer.—An officer of the Medical Corps is designated 
as ward officer. The officer so designated is responsible for the ex- 
amination, care, treatment, diet, and comfort of all patients assigned 
to the ward. He is responsible that sufficient and proper instruments, 
appliances, dressings, and drugs are on hand to facilitate the ex- 
amination and treatment of patients in the ward and to prevent the 
necessity of reporting patients to clinics. If a patient requires treat- 
ment that can be given only by a specialist or if consultation is 
desired, the ward officer is authorized to refer such patients to the 
appropriate service or section for examination or treatment in accord- 
ance with existing regulations. Such references are kept to a mini- 
mum consistent with the proper treatment or examination of patients. 
Officers designated as consultants and those treating prisoner patients 
hold the consultations and administer treatments in the detention 
ward whenever practicable. The ward officer is not relieved of the 
responsibility for the care and treatment of patients referred to other 
services or sections but keeps himself fully informed as to the progress 
of the case and assures that the prescribed treatment is regularly 
received. He is responsible that all pertinent data relating to the 
physical examination, the care and treatment of the patient are 
recorded in the clinical record in accordance with existing instructions. 
159. Wardmaster.—A competent member of the Medical Depart- 
ment is detailed as wardmaster. He is provided with such assistance 
as may be necessary. He is responsible to the ward officer for the 
execution of all instructions relating to the professional care and 
treatment of patients. 
160. Admission procedure.—All prisoner patients admitted to 
hospital are placed in the detention ward by the admitting officer 
who furnishes the ward officer written orders for their detention. 
Upon admission patients don hospital clothing and all clothing or bag- 
gage in their possession is taken from them, listed on W. D., M. D. Form 
No. T5 and stored in the patients’ baggage room. Clothing or bag- 
gage of any description is not permitted to remain in the detention 
ward. In the presence of the ward officer, or in his absence, the 
administrative officer of the day, all persons admitted to the ward 
are searched and any funds, valuables, matches, knives, weapons, or 
other dangerous articles of any description are taken from them, 
listed in accordance with paragraph 86, and turned over to the 
custodian of patients’ funds and valuables until discharged from 
hospital. Clothing and baggage taken from the patient are inven- 
toried by the wardmaster who, in the presence of the ward officer or 
82 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
160-164 
the administrative officer of the day, carefully lists the articles on 
W. D., M. D. Form No. 75, in duplicate. Specific description is 
noted in cases of unusual items to permit ready identification. The 
officer witnessing the inventory verifies and signs both copies. Both 
copies are sent to the patients’ baggage room. The noncommissioned 
officer in charge of the patients’ baggage room checks the clothing 
and if correct with the patient’s property card signs both copies. 
The original is filed in the patients’ baggage room and the duplicate 
returned to the ward officer. 
161. Daily inspection.—Under the direction of the ward officer 
a search of the entire ward is made daily for matches, weapons, or 
other dangerous objects that prisioners may have concealed. The 
windows, doors, and all parts of the ward are thoroughly inspected 
at least twice daily. 
162. Medicine.—No medicine is given to patients for self-admin- 
istration. Each dose of medicine prescribed is administered by the 
wardmaster or his assistant. No medicines or bottles are left in the 
ward. A book of record is maintained in the ward known as the 
“ward book” in which the ward officer' or other officer prescribing 
records all orders for medicines and treatment. All entries are 
authenticated by the proper officer’s initials or signature. A narcotic 
and alcoholic register is maintained in the ward. Only sufficient 
medicines, drugs, and other preparations are kept on hand to meet 
the immediate requirements of the ward and all such drugs and 
other preparations are securely locked in the medicine cabinet which 
is kept in the locked ward office. 
163. Meals.—Meals are served in the ward, except that the ward 
officer may authorize convalescent patients to eat in the mess hall, 
in wffiich case a guard is provided. Patients under observation for 
mental disease, insane, or having communicable dieseases are not 
permitted to go to the mess hall. 
164. Clinical treatment.—Patients referred to services or sections 
are examined and treated in the detention ward unless it is wholly 
impossible to administer properly the treatment therein, in which 
case the officer responsible for the examination or treatment notifies 
the ward officer as to the hour he desires the patient. The ward 
officer arranges that such patients are promptly reported and the 
officer responsible for the examination or treatment arranges so that 
it is given immediately upon the arrival of the patient. The ward 
officer notifies headquarters whenever treatment is not given 
promptly at the designated hour. Officers treating patients in the 
83 TM 8-260 
164-167 
MEDICAL DEPARTMENT 
detention ward visit such patients at least once daily and keep the 
ward officer informed as to the progress of the case and take all 
steps necessary to expedite the discharge from hospital of such 
patients. 
Section IV 
NEUROPSYCHIATRIC SECTION 
Paragraph 
Organization 165 
Wards 166 
Enlisted attendants 167 
Admission procedure 168 
Daily inspection 169 
Check of patients and keys 170 
Medicines and poisons 171 
Treatment of patients 172 
Visitors in closed wards 173 
Night nurse 174 
Shaving and hair cutting 175 
Prisoner status patients 176 
165. Organization.—The neuropsychiatric section operates as a 
part of the medical service under the direction of the chief of medical 
service. The senior medical officer on duty with the section is known 
as the chief of the neuropsychiatric section, and with his commissioned 
assistants is responsible for the care and treatment of all neuropsy- 
chiatric cases in the hospital. If cases are in wards other than those 
of the neuropsychiatric section, the chief of section cooperates with the 
ward officer directly in charge of those patients, giving such advice 
and assistance as may be necessary. 
166. Wards.—a. Such wards as are designated by the command- 
ing officer are closed (locked) wards for the treatment of mental 
patients. 
h. Such open (unlocked) wards as are designated by the command- 
ing officer are used for the treatment of suitable neuropsychiatric 
patients. 
c. Responsibility for conduct of closed wards is that of the nurse 
in charge, or in her absence, the wardmaster, who is held responsible 
for the execution of any special instructions of the ward officer, and 
for the proper observance of all routine regulations or general in- 
structions pertaining to either the personnel on duty on such ward or 
the conduct of the ward. 
167. Enlisted attendants.—The commanding officer, medical de- 
tachment, is charged with the assignment of a sufficient number of 
enlisted men as attendants. Enlisted men are selected because of their 
84 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
167-170 
adaptability for this special duty. They are assigned with a view 
to permanency and are changed only for cogent reasons. There is at 
least one noncommissioned officer on duty in this section at all times. 
No ward is left without at least the minimum safe number of attend- 
ants as determined by the chief of section. No attendant leaves his 
ward during duty hours until he has been granted such permission by 
the wardmaster, and no wardmaster leaves his ward except by author- 
ity from the noncommissioned officer in charge of section. 
168. Admission procedure.—Patients admitted through the re- 
ceiving office and from other wards are delivered at the office of chief 
of neuropsychiatric section. In cases of patients admitted to closed 
wards the admission routine pertaining to the search for valuables (as 
prescribed in par. 86) is carried out by a medical officer on duty in this 
section, or, in his absence, by the medical officer of the day, and all 
matches, weapons, or dangerous instruments are removed and disposed 
of as prescribed by regulations dealing with property of patients. 
169. Daily inspection.—An inspection of all parts of each closed 
ward is made daily between 7:00 AM and 9:00 AM by the nurse 
in charge and the wardmaster for all property or dangerous objects 
which patients may have concealed. The windows, doors, and all 
parts of the ward are thoroughly inspected at frequent intervals 
each day by them to insure that the security of the ward is being 
maintained. 
170. Check of patients and keys.—a. Patients.— (1) Nurses 
and wardmasters of all wards, upon coming on duty, assure them- 
selves that all patients are present and make immediate report to 
the noncommissioned officer in charge of section of any absentees, 
and further note same on daily morning report of ward. Upon relief 
of the day noncommissioned officer by the night noncommissioned 
officer, they together make a careful check of all patients on closed 
wards and the same procedure applies on relief of the night non- 
commissioned officer by the day noncommissioned officer. In addition 
to the above, the patients on the closed wards are checked and the 
number verified by the wardmaster hourly, day and night. 
(2) No matches are furnished patients on closed wards or allowed 
in their possession. 
(3) The wardmaster searches patients for weapons or implements 
upon their return to the closed wards after any period of absence. 
(4) All incoming packages or bundles intended for patients are 
searched by a nurse or noncommissioned officer in the presence of the 
patient, and all forbidden articles removed and disposed of in accord- 
ance with existing regulations. 
85 TM 8-260 
170-172 
MEDICAL DEPARTMENT 
1). Keys.— (1) The noncommissioned officer in charge of section is 
responsible for the issue and record of keys to locked wards. Surplus 
keys are kept in a locked compartment in section office. 
(2) Enlisted attendants are cautioned against the careless handling 
or loss of keys and care is taken to prevent any patient obtaining 
possession of keys. Loss of keys is reported immediately to the non- 
commissioned officer in charge. 
171. Medicines and poisons.—All medicines and poisons are 
kept in securely locked cabinets and the key is kept in the possession 
of the nurse or noncommissioned officer. No medicines are given to 
patients for self-administration. Each dose prescribed is adminis- 
tered by a nurse or by a noncommissioned officer. Patients are not 
permitted in ward offices where medicines are kept unless the ward 
officer or nurse is present. 
172. Treatment of patients.—a. It must be carefully borne in 
mind that patients in this section (and especially in closed wards) 
are mentally ill. They are to be treated with consideration and 
kindness at all times. Attendants are forbidden to strike or mal- 
treat a patient in any manner and any attendant so offending is 
punished. Each attendant reporting for duty on this section signs 
a statement that he has read and understands the regulations 
pertaining to this section. 
h. Under no circumstances are arms, clubs, or weapons of any 
description permitted on a closed ward. 
c. No form of mechanical restraint, seclusion, or cold showers is 
applied as punishment. Restraint or seclusion for therapeutic rea- 
sons is applied only upon the written order of a medical officer, 
and under the direction and supervision of the nurse in charge. The 
nurse keeps a record of the time of applying and of removing the 
restraint or seclusion. Nurses and enlisted attendants familiarize 
themselves with the use of the restraint apparatus. A patient in 
restraint or seclusion is carefully watched. 
d. In case of sudden violence of a patient or of injury to a patient 
or to an attendant, a medical officer will be notified immediately. 
e. No patient from a closed ward leaves the neuropsychiatric sec- 
tion except with permission of a medical officer and in the custody 
of one or more attendants. Not more than two patients leave the 
closed neuropsychiatric section in charge of one attendant. The 
attendant is thoroughly instructed not to lose sight of his patient 
at any time until he is returned to the neuropsychiatric section un- 
less relieved of his responsibility by an officer or a noncommissioned 
officer on duty in that section. No officer, nurse, or attendant in 
86 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
172-177 
any clinic or department where cases are sent will give instructions 
contrary to the above. 
/. No patient is taken from the closed neuropsychiatric section 
without knowledge of the nurse in charge or ward nurse, and she 
enters in a record book the name of the patient, time of departure, 
time of return, destination, and name of approving medical officer. 
173. Visitors in closed wards.—Patients on closed wards ordi- 
narily meet visitors in the visitors’ room, such visits to be under 
observation of an attendant when deemed necessary by the ward 
medical officer. 
174. Night nurse.—The night nurse in charge remains in the 
office of the closed ward when not actively engaged in her ward 
duties. The night wardmasters and attendants at all times remain 
on ward proper unless relieved by the noncommissioned officer. 
175. Shaving and hair cutting.—Shaving and hair cutting of 
patients on closed wards are done by an attendant detailed for duty 
and in no case is a patient permitted possession of barber equipment. 
176. Prisoner status patients.—Patients on a prisoner status or 
those awaiting general court martial charges confined on the closed 
neuropsychiatric section are not sent off the section except to visit 
a clinic or for other authorized official purposes. In such cases each 
is accompanied individually by one or more attendants, the number 
to be determined by an officer. 
Section "V 
LABORATORY SERVICE 
Paragraph 
Chief of service 177 
Emergency detail 178 
Examinations 179 
Blood transfusions 180 
Autopsies 181 
Preservation of specimens 182 
Disposition of bodies 183 
177. Chief of service.—The senior medical officer assigned to the 
laboratory service is known as the chief of laboratory service. His 
duties in general are— 
a. General charge of the laboratory. 
h. To supervise the performance of such examinations as are re- 
quested by ward officers, and report findings directly to the ward 
officer concerned. 
c. General charge of the morgue, including care of the bodies of 
deceased persons (until turned over to the proper undertaker), per- 
87 TM 8-260 
177-179 
MEDICAL DEPARTMENT 
formance of post mortem and biopsy examinations, preparation of 
protocols and biopsy reports, and the preservation, classification, 
and disposition of gross specimens (see also par. 106). 
178. Emergency detail.—There is at least one commissioned 
officer in the laboratory during the period of regular duty, and a 
competent enlisted technician is on emergency duty throughout the 
24 hours. 
179. Examinations,—a. Record.—A record of all examinations 
made is maintained in the laboratory. Blood donor index cards, 
autopsy protocols, and card index of surgical pathological reports 
and basal metabolism reports are permanent. All other duplicate 
laboratory reports are kept for a period of 3 months and then 
destroyed. 
b. Procedure.— (1) General.— {a) Requests for laboratory exami- 
nations are made in duplicate on the Medical Department blank 
forms provided for that purpose. (W. D., M. D. Forms Nos. 55L, 
55L-2, 55L-3, 55L-5, 55L-T, 55L-8, 55L-9, and 55M.) Requests for 
examinations not included in the printed Medical Department forms 
are made on W. D., M. D. Form No. 55L (Clinical Record, Labora- 
tory Reports). A check mark beside any particular item or items ap- 
pearing on the form may be used to indicate which examinations are 
desired, or additional items may be added when required. Requests 
which are not checked by item are given the routine examinations. 
The officer requesting the examinations checks and authenticates 
every request by signing his initials. 
(b) Routine specimens and patients requiring laboratory tests are 
sent to the laboratory not later than 9:30 AM except Sundays and 
holidays. 
(c) Requests for emergency examinations receive prompt-attention 
and have precedence over routine work. All such requests are ini- 
tialed by the responsible officer requesting the examination. 
(2) Wassermann test.—Blood specimens for routine Wassermann 
tests are collected on designated days. Patients in the hospital whose 
condition permits are sent to the laboratory between 7:30 and 9:30 
AM except as noted in (1)(5) above. The blood of bed patients 
and all female patients in the hospital is collected in the wards by 
laboratory personnel. Requests for bed patients bear the notation 
“bed patient” and the number of the bed, and are forwarded to the 
laboratory before 9:00 AM. Requests for Wassermann tests are 
prepared on W. D., M. D. Form No. 55L-3. All first requests for 
Wassermann tests are accompanied by the Wassermann card, Record 
88 TM 8-260 
C 3 
TECHNICAL MANUAL 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(GENERAL AND STATION HOSPITALS) 
Changes 
No. 3 
WAR DEPARTMENT, 
Washington 25, D. 0., 8 January 1944. 
TM 8-260, 16 July 1941, is changed as follows: 
179. Examinations. 
b. Procedure. 
(2) Wassermann test.—Blood specimens for * * * laboratory 
before 9:00 AM. Requests for Wassermann tests are prepared on 
W. D., M. D, Form No. 55L-3. 
* * * 
[A. G. 800.7 (4 Dec 4?).] (C 3, 8 Jan 44.) 
254. Miscellaneous urological procedures. 
k. Venereal disease.—Rescinded. 
[A. G. 300.7 (4 Dec 43).] (C 3. 8 Jan 44.) 
Appendix VIII 
CHECK LIST FOR CHIEF OF SURGICAL SERVICE 
2. Genito-urinary section.—Rescinded. 
[A. Q. 300.7 (4 Dec 43).] (C 3, 8 Jan 44.) 
By obdee of the Seceetaey of Wab : 
G. C. MARSHALL, 
Chief of Staff. 
Official : 
J. A. ULIO, 
Major General, 
The Adjutant General. 
U. S. GOVERNMENT PRINTING OFFICE: 1944 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
179-180 
of Serological Reactions for Syphilis (W. D., M. D. Form No. 97), 
properly executed and signed by a medical officer. 
(3) Spinal -fluid.—Spinal fluid for serological examinations is col- 
lected by an officer designated by the chief of the section concerned. 
Specimens accompanied by the proper request are delivered to the 
laboratory immediately after removal from the body. 
(4) Darhfield examination,—Patients requiring darkfield exami- 
nations are reported to the laboratory, 
(5) Tissues for histopathologic examination.—All tissues are ac- 
companied by W. D., M. I). Form No. 55M properly executed. All 
tissues are placed in 10 percent formalin (4 percent formaldehyde 
solution) which can be obtained at the laboratory. Specimens so 
preserved are delivered in person to a member of the laboratory 
staff. Specimens too large for the ordinary specimen bottles are 
wrapped in moist gauze and paper and delivered to the laboratory 
as soon as practicable after removal. When frozen sections are 
desired the pathologist is notified in person as far in advance as 
practicable. 
(6) Basal metaholism determinations.—Requests for basal metabo- 
lism determinations are prepared on W. D., M. D. Form No. 55L and 
are sent to the chief of service concerned for approval before submit- 
ting them to the laboratory. The chief of the laboratory service, or his 
representative, informs the patient’s ward officer of the date and hour 
for the determination. 
c. Use of proper containers.—Proper containers for the collection 
of specimens are used in every case. Such containers may be ob- 
tained at the laboratory only in sufficient numbers to supply immedi- 
ate needs. All specimens are labeled with name of the patient and 
ward. The use of adhesive plaster is prohibited for this purpose. 
180. Blood transfusions.—a. Full responsibility for the inaugu- 
ration and control of an efficient method of providing blood donors 
is placed on the chief of laboratory service. He selects a sufficient 
number of donors and keeps an available list of them in his office. 
He assures himself that the required monthly physical and periodic 
serological examinations are made, and prepares written instruc- 
tions governing the method of selection of donors, the necessary 
medical supervision, and the manner of keeping records. For this 
purpose a card index system is established. 
h. Physical examinations of donors at the time of donation are 
made by an available medical officer who over his signature notes 
the results in the space provided on the transfusion record. 
89 TM 8-260 
180-183 
MEDICAL DEPARTMENT 
c. Requests for blood transfusions are prepared in triplicate and 
sent to the chief of laboratory service. Upon receipt of such request 
the chief of laboratory service, or his representative, types the 
patient. He then secures a suitable donor and accomplishes the nec- 
essary cross check of types and such other serological procedures as 
may be indicated. 
d. The officer requesting the transfusion has the indicated physical 
examination accomplished with emphasis on the presence of venereal 
or other disease. In each instance the temperature is taken. Results, 
including cause for rejection if found, are entered over his signature. 
He then ascertains from the chief of the surgical service or his repre- 
sentative the name of the medical officer who is to perform the trans- 
fusion, and the time and place of operation. At the time designated 
he sends the donor and the patient to the place indicated. 
181. Autopsies.—Post mortem examinations are made by the chief 
of the laboratory service or his assistant on the written authority of 
the commanding officer. 
182. Preservation of specimens.—Valuable and interesting 
specimens obtained in operation or autopsies are preserved and for- 
warded to the Army Medical Museum accompanied by pertinent data 
(AR 40-310). 
183. Disposition of bodies.—a. Bodies of deceased persons are 
prepared properly and removed to the morgue as required by para- 
graph 103. Bodies of deceased persons committed to the morgue are 
placed there in correct posture. Care is exercised to prevent turning 
of the head, extreme flexion or extension of the neck, or malposition of 
extremities. Undue pressure by winding sheets, especially about the 
face, is avoided. During routine duty hours this is a responsibility of 
the chief of laboratory service. Outside of routine duty hours the re- 
sponsibility rests on the officer who determines the fact of death. The 
chief of the laboratory service or his representative is responsible for 
the care of bodies held in the morgue, and turns them over to the 
undertaker only on the written authority of the registrar or the admin- 
istrative officer of the day. 
b. The person removing the bodies from the morgue acknowledges 
receipt thereof upon the registrar’s order authorizing removal. This 
record is filed in the laboratory. 
90 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
184-187 
Section YI 
Paragraph 
Chief of service 184 
Examinations 185 
Records and roentgenograms 186 
Roentgen and radium therapy 187 
Preparation of patient 188 
ROENTGENOLOGICAL SERVICE 
184. Chief of service.—The senior officer assigned to duty in the 
Service is in charge thereof and is known as the chief of the roentgeno- 
logical service. He is directly responsible for its efficiency. 
185. Examinations.—a. Requests.—Requests for examination are 
prepared in duplicate on W. D., M. D, Form No. 55 K-2. The officer 
requesting the examination states the part to be examined, the pro- 
visional diagnosis, and signs the request. Requests for emergency or 
bedside examinations are plainly marked “emergency” or “bedside” on 
the face of the form. Requests for dental roentgenological examina- 
tions are sent to the chief of the dental service. Requests for all other 
examinations are sent to the roentgenological service in accordance 
with instructions and the schedule of examinations prepared by the 
chief of the service. 
h. Reports.—Reports of examinations are prepared in duplicate, 
one copy being sent to the officer requesting the examination for file 
with the patient’s clinical record, and the other copy filed in the 
roentgenological service. 
186. Records and roentgenograms.—A record of every roentgen 
examination, roentgen therapy, and radium therapy is filed in the 
roentgenological service. Authority for the destruction of old 
roentgenograms is obtained from the commanding officer. Reports 
and roentgenograms are not furnished to patients without the 
authority of the commanding officer. Demonstration of roentgeno- 
grams by the chief of the service or his assistant is held at a desig- 
nated hour. Officers are urged to take advantage of this consulta- 
tion hour. 
187. Roentgen and radium therapy.—a. Roentgen.—Requests 
for roentgen therapy are prepared on W. D., M. D. Form No. 55 K-3 
and forwarded to the chief of the roentgenological service. The 
clinical record is sent by messenger to the chief of the service when 
ihe patient reports for the first treatment. Upon completion of a 
series of treatments the chief of the service or his assistant sends to 
the ward officer a record of the treatment. 
91 TM 8-260 
187-190 
MEDICAL DEPARTMENT 
h. Radium.—The chief of the roentgenological service or his com- 
missioned assistant has charge of all radium and personally super- 
vises all radium therapy. The radium when not in use is kept in 
the radium safe. Requests for radium therapy are prepared on W. 
D., M. D. Form No. 55 K-3 and forwarded to the chief of the service. 
Upon completion of a series of treatments the officer supervising the 
treatment sends to the ward officer a record of the treatment. The 
ward officer assumes responsibility for the care of radium when it is 
in use on the wards. In such cases the chief of the roentgenological 
service or his assistant sends by messenger to the ward officer a 
radium treatment card to be attached to the foot of the patient’s bed 
and instructions for the care of the radium and the patient. 
188. Preparation of patient.—The preparation of patients for 
the various roentgenological examinations is as directed by the chief 
of the roentgenological service (see sec. VIII, ch. 4). 
Section VII 
Paragraph 
Organization 189 
Chief of service 190 
Chief of section 191 
Property officer 192 
Dental treatment 193 
Emergency officer 194 
Appointments 195 
Special cases 196 
Responsibility for dental patients in hospital 197 
Reports 198 
DENTAL SERVICE 
189. Organization.—The dental service constitutes a unit of the 
professional division of the hospital. It includes all officers of the 
Dental Corps, members of the Army Nurse Corps, enlisted men 
assigned to the dental service, and such other personnel as may be 
assigned to it by proper authority. The dental service is subdivided 
into the following sections: 
a. Operative. 
h. Prosthetic. 
c. Oral surgery. 
190. Chief of service.—The senior officer assigned to duty in the 
dental service is in charge of that service and is known as the chief 
of the dental service. His duties and responsibilities in general are— 
a.. General supervision over the entire service. 
h. The issuing of such orders and formulation of such regulations 
for the operation of the service as he may consider necessary. 
92 FIXED HOSPITALS OF. THE MEDICAL DEPARTMENT 
TM 8-260 
190-193 
c. The assignment of officers on that service to specific duties. 
d. Responsibility for the administration, sanitation, and police of 
operating rooms, clinics, and other activities pertaining to his service. 
e. Responsibility for the technical training of enlisted and civilian 
personnel assigned to the dental service. 
f. Responsibility for the performance of the annual survey of 
enlisted men of the various duty detachments as prescribed in 
AR 40-510. 
191. Chief of section.—Each of the sections listed in paragraph 
189 is conducted by a designated dental officer who is known as the 
chief of section. He is responsible to the chief of service for the 
administration and operation of his section and for the care and 
treatment of all cases in that section. 
192. Property officer.—An officer of the Dental Corps is detailed 
by orders from headquarters on recommendation of the chief of the 
service to assume responsibility for property, drugs, and materials 
issued to the dental service. 
193. Dental treatment.—a. Precedence.—Precedence in dental 
treatment is given as prescribed in AR 40-510, under the following 
conditions: 
(1) Persons requiring emergency treatment. 
(2) Persons not requiring emergency treatment. 
(a) Patients in hospital for dental treatment only. 
(b) Patients in hospital with dental involvement a factor in their 
hospitalization. 
(c) All other persons requiring treatment. 
b. Examination of patients in hospital.—Except cases of emer- 
gency, patients in hospital who require dental examination and 
report or dental treatment are sent to the dental clinic daily accom- 
panied by dental consultation request. This request shows patient’s 
name, status, etc., whether referred for treatment or examination 
or both, the patient’s diagnosis, his probable duration of hospitaliza- 
tion, together with any remarks pertinent to the case with special 
reference to the presence of syphilis in the infectious state, whether 
the case is of an emergency nature and requires immediate attention, 
and whether bedside examination is required. This form is not 
entrusted to the patient but delivered to the office of the chief of the 
dental service at the time the patient reports. Upon completion of 
the examination of patient, the dental officer making the examina- 
tion notes the result on both the original and duplicate of the dental 
consultation request, returns the original to the ward officer and files 
the duplicate with the records of the dental service. The routine 
93 TM 8-360 
193-197 
MEDICAL DEPARTMENT 
dental examination of patients in hospital is not contemplated and 
is not requested unless there is an occasion for such examination. 
Leaves, furloughs, or passes which might interfere with dental treat- 
ment are not granted without consultation with the chief of the 
dental service. 
g. Out-patients.— (1) Officers and members of the Army Nurse 
Corps on duty at the hospital who require dental treatment report 
directly to the chief of the dental service. 
(2) Enlisted men of the various duty detachments who require 
dental treatment have their names placed on the daily sick report 
and report to the officer in charge of dispensary. That officer refers 
the enlisted men to the chief of the dental service and at the same 
time transmits to the chief of dental service a copy of dental con- 
sultation request in duplicate as prescribed in h above. 
194. Emergency officer.—A dental officer is detailed by roster by 
the chief of the dental service for the purpose of examining patients 
referred to the dental service for examination, for the treatment of 
emergencies, and for the survey of enlisted men of the command as 
required by Army Regulations. His tour of duty is for 24 hours 
commencing at 9:00 AM. During his tour of duty he keeps the 
information office constantly informed where he can be reached by 
telephone. 
195. Appointments.—The chief of the dental service notifies the 
ward officer when patients in hospitals are given dental appointments. 
Ward officers are responsible that patients under their charge for 
whom dental appointments are made are required to report to the 
dental clinic promptly at the designated hour, or if such patient 
is unable to keep the appointment, are responsible that the chief of 
the dental service is so notified in advance. 
196. Special cases.—a. Patients with suspected fracture of the 
jaw are referred to the dental service immediately upon admission. 
In the event the patient is admitted at other than duty hours, the 
dental emergency officer is notified. 
h. When a patient is admitted to the ward for dental treatment 
only, the ward officer immediately notifies the chief of the dental 
service who expedites treatment with a view to his early discharge. 
197. Responsibility for dental patients in hospital.—The 
ward officer of the ward to which a patient in hospital for “dental 
treatment only” has been assigned is responsible for the discipline, 
care, etc., of the patient, and for the preparation and maintenance of 
the patient’s clinical record. 
94 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
198-201 
198. Reports.—a. The chief of the dental service advises the 
ward office 1 day in advance of completion of treatment of a patient 
in hospital for dental treatment only in order that the ward officer 
may take the necessary steps for discharge of the patient from 
hospital. 
h. Upon completion of treatment in each case the chief of the 
dental service furnishes the ward officer with a copy of the patient’s 
dental record on which is entered a summary of dental treatment 
given. This dental record is attached to and becomes a part of the 
patient’s clinical record. 
c. Immediately following the treatment for the eradication of 
dental foci of infection, the chief of the dental service forwards a 
report to the ward officer concerned on W. D., M. D. Form No. 55F, 
giving the dental diagnosis and treatment. 
Section VIII 
ARMY NURSE CORPS AND NURSING SERVICE 
Paragraph 
Status 199 
Arrival procedure 200 
Principal chief nurse 201 
Hours of duty 202 
Nursing service, personnel duties, and reports 203 
Relief procedure 204 
199. Status.—Relative to medical and sanitary matters and work 
in connection with the sick, members of the Army Nurse Corps and 
other nurses employed are to be regarded as having authority in and 
about military hospitals next after the officers of the Medical Depart- 
ment, and are at all times to be obeyed accordingly and to receive the 
respect due to their position. 
200. Arrival procedure.—Upon arrival at the hospital, all nurses 
report immediately to the principal chief nurse for instructions and 
assignment to duty. 
201. Principal chief nurse.—The principal chief nurse has super- 
vision over all members of the Army Nurse Corps and the nursing 
service of the hospital. She is obeyed and respected accordingly. 
She has charge of the instruction, assignment, discipline, performance 
of duty, and conduct while on duty of members of the Army Nurse 
Corps. She has charge of the assignment, performance of duty, and 
conduct of female help employed for housekeeping purposes. She is 
responsible for— 
95 TM 8-260 
201-203 
MEDICAL DEPARTMENT 
a. Requisition, preservation, and disposition of equipment and 
public property for the nurses’ quarters. 
b. Sanitation and police in nurses’ quarters. 
c. Preparation and disposition of the records of her department. 
d. Such other duties as are assigned her by Army Regulations. 
202. Hours of duty.—The hours of duty for all members of the 
Army Nurse Corps and other nurses employed are as prescribed by 
the principal chief nurse. 
203. Nursing service, personnel duties, and reports.—a. 
Supervisors.—(1) General duties.—Qualified members of the Army 
Nurse Corps are detailed when necessary as assistants to the prin- 
cipal chief nurse to supervise the nursing service of the hospital 
during the day or night tours of duty. Hours of duty are as pre- 
scribed by the principal chief nurse. 
(2) Day.—The day supervisors perform such duties as may be re- 
quired of them by the principal chief nurse. 
(3) Night.—The senior night supervisor is responsible for the 
nursing service during her period of duty. Nurses apply to the night 
supervisor for instruction when necessary, and inform her as soon as 
practicable of any emergencies arising in their respective wards. 
Upon being relieved from duty in the morning she makes a written 
report of any unusual incidents of the night, and derelictions of duty 
on the part of the night nurses. 
1). Head nurse.—The head nurse of the ward serves as its respon- 
sible nursing head. Under the direction of the ward officer she has 
charge of the ward, patients, nurses, enlisted personnel, and other 
persons assisting in the nursing care of the sick, and is obeyed and 
respected accordingly. Her hours of duty are the same as those of 
the other nurses, but ordinarily she is required to perform night duty 
only 1 month in 6. The head nurse sends the report of the nurses’ 
time on duty to the principal chief nurse daily not later than 7:30 
AM on the form provided for the purpose. She reports to the prin- 
cipal chief nurse concerning the efficiency of the nurses under her. 
She is responsible for— 
(1) Receiving and recording of all orders relating to the care and 
treatment of patients in her ward. 
(2) Proper administration of all medicines and treatments. 
(3) Procurement of and proper serving of all foods in the wards 
to which no dietitians are assigned for duty. 
(4) Careful, accurate, and legible preparation of all ward rec- 
ords and routine reports as required. In this connection, particular 
care is taken in maintaining the ward narcotic register. 
96 TM 8-260 
203-204 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(5) Safeguarding of keys of ward cabinets containing liquor, 
opiates, and poisons. 
(6) Checking and care of the ward property, and preparation of 
the requisitions for needed supplies for the consideration and signa- 
ture of the ward officer. 
(7) Cleanliness and order of the ward and its adjoining rooms. 
(8) Care of patients’ effects, other than money and valuables, until 
transferred to the proper custodian. 
c. Nurses.—Nurses perform such duties as may be required of 
them by the head nurses of their respective wards under the direction 
of the ward officer. They make a report of the work of their ward 
to the principal chief nurse at 7:00 AM and 6:00 PM daily on 
the form provided for the purpose. In order to minimize the num- 
ber of night calls of the professional officer of the day, night nurses 
make every effort to obtain full instructions from him in regard to 
such matters as may be necessary when he makes his evening rounds, 
or before 10:00 PM if possible. 
204. Relief procedure.—a. Person in charge of ward.—Nurses 
relieving others in charge of wards accomplish and sign the state- 
ment on the back of the Ward Morning Report showing the date 
and time they assumed charge and the number of patients to be 
accounted for as shown by the ward records. In closed wards, an 
actual physical count of all patients is made before the statement 
referred to is accomplished. In other wards of the hospital a similar 
check is made upon relief of person in charge between the hours 
of 6:30 PM and 9:00 AM only. Steps are taken to account satis- 
factorily for absentees from check, and when they cannot be properly 
accounted for report is furnished the ward officer, or in his absence 
the administrative officer of the day. 
h. From duty.—On departure from hospital, either by transfer or 
on leave, all nurses report to the principal chief nurse’s office for a 
clearance slip which must be completed as directed and returned to 
the principal chief nurse before departure. The address of all nurses 
going on leave must also be furnished the principal chief nurse. 
Section IX 
DISPENSARY 
Paragraph 
Function 205 
Officer in charge 206 
Medical attendance 207 
Records 208 
Special duties of officer in charge 209 
97 TM 8-260 
205-208 
MEDICAL DEPARTMENT 
205. Function.—The dispensary functions as a station dispensary 
for the command. 
206. Officer in charge.—The senior medical officer assigned to 
duty in the dispensary is in charge thereof and is known as the officer 
in charge of the dispensary. He maintains general supervision over 
all activities of the dispensary and is directly responsible for its effi- 
ciency. He assigns to their specific duties the personnel allotted to 
his sections and holds them responsible for their proper performance. 
207. Medical attendance.—a. During hours other than those pre- 
scribed for the dispensary and in his absence, the duties of the officer 
in charge pertaining to medical attendance for persons applying at 
the dispensary are assumed by the medical officer of the day, 
h. The officer in charge of the dispensary arranges that medical at- 
tendance is available for authorized persons calling during the 
prescribed hours. 
c. The officer in charge of the dispensary is authorized to refer 
out-patients to the various professional services and sections of the 
hospital for examination and treatment. 
d. No professional service or section of the hospital treats out- 
patients other than those properly referred thereto by the officer 
in charge of the dispensary, 
e. Medical attendance is confined to members of the command 
authorized thereto by regulations, except that any emergency case 
brought to the dispensary is properly attended and disposition made 
as indicated. Only in emergency are persons not entitled to admis- 
sion to Army hospitals admitted to hospital. 
/. The officer in charge is responsible that the emergency dressing 
room is properly equipped and in readiness at all times for the re- 
ception and care of emergency cases. 
208. Records.—a. The officer in charge of the dispensary main- 
tains an out-patient index as prescribed in AR 40-1025 and FM 8-45, 
and is responsible for the proper indexing of the names and record- 
ing of all pertinent data concerning all persons treated. 
b. Patients referred by him to other professional services or sec- 
tions are accompanied by a request for consultation or treatment on 
the consultation request form. The officer examining the patient or 
giving the treatment notes on the form his opinion of the case and 
treatment given, returning the form to the officer in charge of the 
dispensary, who properly records the matter thereon. 
c. On the last day of each month the officer in charge of the dis- 
pensary submits a report to the commanding officer containing the 
following information: 
98 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
208-209 
(1) Number of patients treated (by classes). 
(2) Number of treatments (by classes). 
(3) Number of physical examinations conducted (by classes). 
(4) Number of persons carried in quarters (by classes). 
(5) Summary of work, to include number of office visits, quarters 
visits, etc. 
(G) Number and type of emergency cases treated, 
d. A book is provided and kept in the emergency dressing room 
in which the officer treating an emergency case records all appro- 
priate data relating to each case treated. As this book in many cases 
is referred to later for data required in the settlement of claims re- 
lating to the patient, every effort should be made to obtain a com- 
plete report of the patient’s name, names of witnesses, circumstances, 
extent of injury, treatment given, and the name of the officer or offi- 
cers giving the treatment. 
209. Special duties of officer in charge.—In addition to his 
duties incident to the operation of the dispensary, the officer in 
charge— 
а. Provides medical attendance for officers, nurses, enlisted men, 
and others quartered at station. 
б. Holds sick call daily at a designated hour for enlisted personnel 
on duty at station. 
c. Makes physical examinations of persons referred to him by 
proper authority. 
d. Makes physical inspection (All 615-250) of enlisted personnel 
on duty at station, reporting the result to the commanding officer 
giving the date on which held, the number of men inspected, the 
names of absentees, if any, the number of venereal cases found, the 
disposition of such cases, together with any other information of which 
the commanding officer should be cognizant. 
e. Furnishes medical attendance to all patients marked “quarters” 
from hospital. He records in their clinical records the treatment 
prescribed, the progress of the case, and such other data as should be 
of record. He maintains a list of such patients, together with their 
home addresses, and requires them to report daily to the dispensary, 
except in the case of officers from the command on a quarters status, 
whose condition is such as to make a visit to the dispensary 
inadvisable. 
/. Administers to such persons as may be entitled thereto such pro- 
phylactic, vaccination, and immunization for the prevention of commu- 
nicable diseases as may be authorized. 
99 TM 8-260 
210-214 
MEDICAL DEPARTMENT 
Section X 
PHARMACY 
Paragraph 
Operation 210 
Officer in charge 211 
Noncommissioned officer in charge 212 
Emergency detail 213 
Prescriptions 214 
Label preparation 215 
Authority for dispensing medicine 216 
210. Operation.—The management and operation of the pharmacy 
is in conformity with paragraph 18, AR 40-590, and all personnel 
assigned to the department will acquaint themselves with the provi- 
sions of this paragraph. 
211. Officer in charge.—A medical officer is detailed as officer in 
charge of the pharmacy. He maintains personal supervision over 
the pharmacy and is directly responsible for its efficiency. He causes 
the necessary records to be maintained in the case of alcoholic liquors 
and narcotics, and makes the necessary checks and verifications 
required by existing regulations (AR 40-590). 
312. Noncommissioned officer in charge.—A qualified noncom- 
missioned officer of the medical detachment is assigned in immediate 
charge of the pharmacy and is directly responsible to the officer in 
charge for its proper operation. He is furnished such assistants 
from the medical detachment as may be necessary. The noncom- 
missioned officer in charge of the pharmacy is responsible that the 
prescriptions are compounded in accordance with the U. S. Pharma- 
copea, Dispensatory, and the National Formulary; that due care is 
taken in compounding; that prescriptions in which the prescribed 
dose exceeds physiological limits are not issued without verification 
by the prescribe!’; that prescriptions are properly filled and labels 
are prepared in conformity with paragraphs 214 and 215. 
213. Emergency detail.—The officer in charge of the pharmacy 
details daily from the personnel allotted him a competent attendant 
for emergency duty during the period the pharmacy is closed. The 
name of the attendant so detailed is furnished the information office 
daily. The attendant so detailed does not leave the hospital area 
during his tour of duty and keeps the noncommissioned officer in 
charge of the information office constantly informed of his where- 
abouts. 
314. Prescriptions.—a. Notations.—All prescriptions are written 
in the metric system and signed by a medical officer, except those 
100 TM 8-260 
214-216 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
signed by officers of the dental and veterinary services for dental or 
veterinary patients, respectively, which are filled without reference 
to a medical officer. The noncommissioned officer in charge files all 
prescriptions as prescribed in existing regulations (AR 40-590). 
d. Compounding.—Before filling any prescription, the compound- 
ing pharmacist makes sure that— 
(1) The prescription is properly dated; is written for a definite 
person, ward, or clinic; it bears the patient’s name and ward number 
or name of clinic or designation of ward. 
(2) It contains directions for use unless it calls for original and 
unbroken package of a drug, or a drug which constitutes part of the 
stock in the ward medicine cabinets. 
(3) The wording of the prescription is clear and unmistakable and 
that the dose of the active drug is not excessive. 
(4) The prescription is signed by a medical officer or an officer of 
the Dental or Veterinary Corps for medical supplies needed in their 
respective services. 
215. Label preparation.—Before issuing a compound prescrip- 
tion, the compounder assures himself that the label shows— 
a. Serial number of the prescription and the date compounded. 
h. Name of the person, ward, or clinic for which intended. 
c. Directions as written on the prescription, or in the event that no 
directions are written, the contents of the container, the name of the 
officer who wrote the prescription, and the initials of the pharmacist 
who filled the prescription. 
d. That all poisons as defined by paragraph 18<z(3), AR 40-590, are 
properly labeled with a poison label. 
216. Authority for dispensing1 medicine.—Except in cases of 
emergency, no drug or medicine of any kind is dispensed from the 
pharmacy except on a prescription signed by an officer of the Medical 
Corps, the Dental Corps, or the Veterinary Corps. No prescription is 
refilled except on a written prescription calling for such refilling, the 
prescription number being given. 
Section XI 
PROFESSIONAL OFFICERS OF THE DAY 
Paragraph 
Detail 217 
Tour of duty 218 
Duties 219 
Record of tour 220 
Special instructions 221 
Administrative officer of the day 222 
Alternate officers of the day 223 
101 TM 8-260 
217-219 
MEDICAL DEPARTMENT 
217. Detail.—Two officers of the Medical Corps, in addition to 
other duties, are detailed as medical officer of the day and surgical 
officer of the day. A roster for this purpose is kept by the adjutant, 
and officers subject to detail are formally notified 24 hours in advance. 
The interchange of tours of duty as officers of the day, wholly or in 
part, is prohibited, except by permission of the commanding officer 
or his representative. 
218. Tour of duty.—a. General.—The tour of duty for the medi- 
cal officers of the day begins at 9:00 AM and continues for 24 hours. 
During this period the officers of the day remain within the limits of 
the hospital reservation. They keep the information office informed of 
their whereabouts at all times during their tours of duty. They sleep 
in the rooms provided for this purpose. During tour of duty officers 
of the day wear the prescribed brassard on the left arm. 
~b. Commencement and completion.—The tour of duty of the offi- 
cers of the day automatically begins at 9:00 AM of the day they 
are detailed for such duty and automatically ends at 9:00 AM the 
following day. The new and old officers of the day do not formally 
report at the commencement or completion of a tour. 
219. Duties.—a. The officers of the day are charged with the 
proper care of all patients in hospital assigned to their respective 
services during the absence of the ward officer and will be available 
for professional advice and service at all times during their tour 
of duty. 
h. During the absence of the receiving and disposition officer, the 
medical officer of the day examines each patient on admission, makes 
the proper ward assignment, and prescribes such treatment as is in- 
dicated until the proper ward officer or the surgical officer of the 
day has assumed charge of the case. 
c. The medical officer of the day assumes all duties of the receiving 
and disposition officer and those of the officer in charge of the 
dispensary during their absence. 
d. The medical officer of the day notifies the surgical officer of 
the day upon the admission to hospital of a patient assigned to a 
surgical ward. 
e. They make at least two complete inspections of their services 
during their tour of duty, one between 8:00 PM and midnight, and 
one between midnight and reveille. On each inspection they visit 
each ward, see all seriously ill patients, and ascertain that the hos- 
pital rules as to conduct are being observed and that the ward per- 
sonnel are on duty and properly performing their duties. During the 
inspection they note the condition of the wards in regard to police 
102 TM 8-260 
219-223 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
and sanitation and correct any violation of hospital regulations 
noted. 
/. They answer all emergency calls promptly and if there is any 
doubt as to proper procedure they consult with the chief of the 
service or his assistant. 
g. During the absence of ward officers, they determine all cases 
of death occurring on the service during their tour of duty, and see 
that the body is tagged with the name and other identifying data; 
that remains are properly prepared and promptly removed to the 
morgue; and that notice of death is prepared and transmitted as 
prescribed. They make an immediate search of the deceased per- 
sonas bed, bedside table, and of the ward for clothing, money, valuables, 
or other effects belonging to the patient (see par. 89). 
h. They take such other steps as they may consider necessary to 
assure the proper care and treatment of patients of the service during 
the absence of ward officers. 
220. Record of tour.—The officers of the day upon completion of 
their tour of duty record in a book provided for the purpose in the 
office of the chief of the service the following: 
a. Deaths and attending circumstances. 
b. Serious cases attended and treatment administered. 
c. Calls received from wards, noting the name of patient attended, 
the ward and treatment prescribed. 
d. Names of patients and designation of wards of all seriously ill 
cases admitted to the service during his tour of duty. 
e. Any matter he considers of interest to the chief of service. 
221. Special instructions.—The chiefs of service instruct the 
officers of the day as to the patients in the service who, in their opinion, 
will require special attention during the absence of the ward officer. 
222. Administrative officer of the day (attention of, assistance 
to).—The officers of the day report to the administrative officer of the 
day any violation of the hospital regulations noted, together with the 
action taken by them. In case of emergency, when the administrative 
officer of the day is already occupied or in need of assistance, the officers 
of the day are notified and take such action to assist the administrative 
officer of the day as may be necessary. 
223. Alternate officers of the day.—Two officers of the Medical 
Corps are detailed as alternate officers of the day. The officers so 
detailed ordinarily are the officers detailed as officers of the day for the 
day following. They keep themselves available for duty as officers of 
the day in emergency. 
103 TM 8-260 
224-225 
MEDICAL DEPARTMENT 
Chapter 4 
PROFESSIONAL STANDING ORDERS 
Paragraphs 
Section I. General 224 
II. Medical service 225-232 
III. General surgery 233-243 
IV. Orthopedic surgery 244-248 
V. Genito-urinary surgery 249-254 
VI. Eye, ear, nose, and throat surgery 255-256 
VII. Dental and oral surgery 257-262 
VIII. Roentgenology 263-267 
IX. Physical therapy (fever therapy) section 268-271 
X. Acute poisonings, their antidotes and treatment 272 
Section I 
Paragraph 
General 224 
GENERAL 
224. General.—The compilation of professional standing orders 
is intended as a reference and guide to acceptable practices. It is not 
complete for all known methods of treatment nor is it intended that 
the compilation be restrictive to the medical or nursing staff of either 
a general or station hospital in the performance of their duties. Modi- 
fication of any or all of the standing orders should be made by the 
medical or surgical staff as new methods or practices of proven value 
become available. 
Section II 
MEDICAL SERVICE 
Paragraph 
Clinical records 225 
Outline of history-taking 226 
Physical examination 227 
Diagnosis impression 228 
Routine procedure on admission 229 
Diagnostic procedure 230 
Therapeutic procedure 231 
Miscellaneous 232 
225. Clinical records.—a. General.—The clinical history and the 
physical examination of the patient are the basis for the institution of 
proper diagnosis and treatment and hence must be carefully made and 
104 TM 8-260 
225-226 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
recorded. Hasty, more or less superficial history taking, often results 
in failure of diagnosis. The use of such words as negative are avoided, 
and the actual findings after thorough examination are carefully 
recorded. 
b. Purpose.—History-taking affords the opportunity to obtain first- 
hand information as to the manifestations of diseases and their clinical 
causes. Furthermore, it is one of the most important fundamentals of 
diagnostic procedure. A careful correlation of the symptomatology 
and the physical and laboratory findings should lead to fairly accurate 
conclusions as to the proper diagnosis, a clear conception of which is 
necessary for the intelligent treatment of the abnormal condition or 
diseases. 
226. Outline of history-taking1.—Except in the family history 
and previous medical history, avoid the use of diagnostic terms 
throughout the history and physical examination. 
a. Family.—Health, causes of death, ages of blood relatives, includ- 
ing husband or wife. Ascertain full details and especially inquire as 
to nervous and metabolic disorders, ductless glands, blood diseases, 
tuberculosis, cancer, etc. 
h. Social.—Occupations and habits, home and working environ- 
ment, kind and quantity of food, regularity of meals, mastication, alco- 
holics, substitutes, drugs, tea, coffee, tobacco, note regarding their 
consumption, and make definite statements as to amounts used. 
Investigation of sexual, marital, and social relationship when indicated. 
c. Previous medical.—Condition from infancy in chronological 
order. Inquire as to scarlet fever, measles, whooping cough, typhoid 
fever, malaria (caution), sepsis, erysipelas, diphtheria, sore throats, 
chorea, rheumatism (inflammatory), influenza, heart disease pleurisy, 
pneumonia, gout, lead poisoning, exposure to epidemics. In the his- 
tory of any diseases obtained, note duration, complications, and seque- 
lae, that is, in scarlet fever, ear trouble, and nephritis; in inflamma- 
tory rheumatism, condition of joints and injuries, when and cause. In 
women, note the number of pregnancies, abortions, and miscarriages 
induced or accidental. Note symptoms which are considered not con- 
nected with present illness, classified under the parts of the body. 
Always obtain full information concerning all positive symptoms. 
For convenience of those who wish to refer to one part of this section, 
symptoms should be listed in anatomical order, beginning with gen- 
eral symptoms and following with the various symptoms from the 
head to the extremities. Obtain full information about previous 
operations. 
105 TM 8-260 
226 
MEDICAL DEPARTMENT 
(1) General symptoms.—Weakness, alterations of weight, chills, 
fever, thirst, night sweats. 
(2) Head.—Headache, vertigo, sleep, faintness. 
(3) Eyes.—Lacrimation, photophobia, pain, vision, glasses. 
(4) Nose.—Nasal or post nasal secretions, epistaxis, symptoms of 
obstruction. 
(5) Mouth, teeth, gums.—History of previous illnesses affecting 
the oral mucosa ; history of excessive caries, of sore and bleeding 
gums, of ill-fitting crowns or bridges; care given the teeth. 
(6) Throat.—Frequent sore throats, hoarseness. 
(7) Lungs.—Dyspnea, cough, expectoration, pain in chest, source 
of sputum, hemoptysis. 
(8) Heart.—Palpitation, pain, dyspnea, and oedema. 
(9) G. I. tract.—State of appetite, nausea, vomiting, frequency 
and character of bowel movements, relation of pain to food intake and 
bowel movements, hematemesis, melena, hemorrhoids (make inquiry 
concerning). 
(10) G. U. tract.—Urination, frequency, amount, pain, nocturia, 
urgency, urethral discharge, genital lesions. 
(11) Menses.—Frequency, character, duration, date of last period, 
vaginal discharge in intermenstrual period. 
(12) Extremities.—Sensations in bones, joints, etc., oedema. 
d. Chief complaint.—Get brief statement of dominant symptoms 
in the patient’s own words. Avoid general expressions such as 
‘‘stomach trouble,” “heart trouble,” etc. 
e. Present illness.— (1) Begin with the earliest symptoms which 
can be connected with the present illness; for example, if patient com- 
plains of dyspnea and oedema of a month’s duration which is con- 
sidered to come from rheumatic heart disease, commence history with 
his attack of rheumatic fever 15 years ago. Put all symptoms in 
chronological order; for example, do not trace one symptom up to 
the present, then return to another. Indicate date of onset (not day 
of week); probable causes in opinion of patient, relatives, etc.; for 
example, trauma, “cold,” mental or physical overwork, mental shock, 
exposure to infection and unusual hygienic conditions. Note mode 
of onset; for example, whether sudden or gradual. First symptoms; 
for example, weakness, chills, fever, pain (location and character), 
symptoms in stomach or bowels such as vomiting or diarrhea. Later 
course, try to have patient describe his case in chronological order 
and in his own way, but seek accuracy and fullness. Indicate in addi- 
tion modifications in the course of the disease as influenced by 
treatment or otherwise. If medicines have been given or special inves- TM 8-260 
226-227 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
tigations made, attempt to identify them as they may be an element in 
the present condition or indicate the diagnosis of previous physicians. 
(2) After the symptoms have been described up to the time of ad- 
mission, include a negative statement with regard to other symptoms 
which often accompany the disease which it is considered the patient 
has; for example, if the symptoms point to tuberculosis add, “No 
night sweats” or “hemoptysis,” etc.; if of tabes, “No chancre, eruption, 
exposure,” etc. In gastric histories be sure to include a complete 
description of dietary habits; in asthmatic inquire carefully into ex- 
posure to new or unusual proteins, animals of all sorts, feathers and 
mattresses, new geographical locations, etc. 
227. Physical examination.—A careful physical examination 
presupposes that the patient is stripped, as abnormalities of structure 
or of function are often overlooked if this is not carried out. Due 
consideration should always be given to privacy and the feelings of 
the patient when this is done. Give particular attention to the part 
of the body suggested by the chief complaint. Do not devote too 
much space to the body in general. 
a. Temperature, pulse, respiration (TPR), blood pressure. 
b. Body in general.—Habitus; height, frame; small, medium, or 
large, slender or heavy; symmetrical or not with details in latter case. 
c. Panniculus.—Muscular, lymph glands, vertebrae, ribs, long bones, 
joints, feet (flat or not) ; gait, station, tendon reflexes, tremors. Gen- 
eral appearances; expression, mental condition, orientation, speech, 
memory, attention. 
d. Skin.—Color of face, body, extremities, and visible mucous mem- 
brane, presence of cyanosis, icterus; warmth or coldness of skin, dry- 
ness or moisture, elastic or inelastic; oedema; eruptions, ulcers; striae; 
scars, subcutaneous nodules; hair on head and other parts; nails. 
e. Head.—Shape of skull. 
/. Eyes.—Reaction of pupils to light and in accommodation, 
equality; extra ocular movements; sclerae; intra-ocular tension; 
exophthalmos. 
g. Ears.—Discharge, condition of external canal and tympanum, 
panurn. 
h. Nose.—Discharge, accessory sinuses, tenderness. 
i. Mouth.—Condition of oral mucosa. 
j. Teeth.—Unserviceable or irritating dental prostheses, oral dis- 
turbances due to dentition; peridontoclasia, suppurative; tophi; other 
clinical evidence of dental infection or of oral disease. 
h. Tongue.—Soft palate and gums; bleeding, pallor, injection, coat- 
ing, state of moisture. 
107 TM 8-260 
227-230 
MEDICAL DEPARTMENT 
l. Tamils.—Buried, exudate, size, atrophied, hypertrophied. 
m. Pharynx.—Adenoid tissue, lingual tonsil. 
n. Neck.—Shape, size, pulsation of vessels, tumors, cysts, fistulae, 
scars (origin), larynx. Size, palpability, and visibility of thyroid. 
o. Thorax.—Shape, size, type of respiration. Diaphragmatic phe- 
nomena, lagging, retractions. Note observation on palpation, percus- 
sion, and auscultation of lungs. 
p. Heart.—Inspection; position and character of the cardiac im- 
pulse, palpation, thrills. Note findings on percussion and ausculta- 
tion. Indicate rhythm, character of sounds; character, time in the 
cardiac cycle, and transmission of murmurs. Radial pulse, palpation 
of vessel wall, rate (increase on sitting up). Note other vascular 
phenomena such as pulsation in other’ arteries, veins, epigastrium, 
liver, capillaries. 
q. Abdomen.—Form, size, floating tenth rib, visible peristalsis, 
masses (change position). Auscultation for peristaltic sounds and 
succussion splash. Note findings in the gall bladder region, liver, 
spleen and kidneys, urinary bladder, pylorus, appendiceal region. 
Determine presence and position of hernial sites. Examine all scars 
for firmness, hernia, etc. 
r. Perineum.—Hemorrhoids, prostate. Character of seminal vesi- 
cles, hydrocele, induration, testes or cords. 
s. Nervous system.—If a neurological syndrome is present, make a 
complete record of neurological examination. 
228. Diagnosis impression.—Upon the completion of the his- 
tory and physical examination the impression gained from such ex- 
aminations is recorded on W. D., M. D, Form No. 55F. This serves 
as a tenative diagnosis until changed or modified by the ward officer. 
229. Boutine procedure on admission.—Routine procedure on 
admission for medical cases is as prescribed by the chief of section. 
230. Diagnostic procedure.—a. Basal metabolism test.— (1) 
Age, height, and weight without clothing is obtained by charge 
nurse the evening before test. 
(2) Temperature, pulse, and respiration taken by nurse at 8:00 
PM and G: 00 AM. 
(3) Patient in bed by 8:00 PM the night before test is made. 
(4) Bathroom privilege may be granted up to 7:00 AM. Patient 
remains quietly in bed after midnight and until test is made which 
will be about 7:30 or 8: 00 AM. 
(5) No smoking after midnight. 
(6) Breakfast is served to patient after test has been made. 
(7) These instructions are given to patient the evening before the 
test. 
108 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
230 
h. Blood chemistry test.— (1) No breakfast is given ambulatory or 
bed patients until after blood has been taken. No food or liquids 
after midnight. 
(2) Ambulatory patients report to laboratory at 7: 00 AM. 
(3) Bed patients and all female patients have blood taken in their 
rooms by the laboratory technician or by the ward officer when nec- 
essary. To avoid multiple punctures, blood for serological examina- 
tion, chemistry and culture, if indicated, should be taken at the same 
time. 
c. Gastric analysis.—Instructions to— 
(1) Patients.— (a) Nothing by mouth after midnight before the 
test in the morning. 
(h) No smoking from 7:00 PM, night before until after test 
is made. 
(c) Report to gastric analysis room at 7:00 AM. 
(2) Nurse.— (a) Have patient swallow tube. 
{h) Remove fasting contents of stomach and enter quantity on slip. 
(c) Give three arrowroot cookies with 400 cc. water. 
(d) Withdraw specimens every 15 minutes until six specimens be- 
sides fasting specimen are obtained. 
(e) If test is negative for free acid in all specimens and it is 
considered advisable to check the results with histamine; another 
request is submitted for that purpose. 
(/) When histamine is given, the fact is noted on the laboratory 
request form. 
{g) All tubes are labeled with patient’s name and numbered in 
the order taken before being sent to the laboratory for titration. 
d. Gastric fractional analysis with histamine.— (1) Give same in- 
structions to patient as in c( 1) above. 
(2) Ward officer requesting fractional analysis with histamine 
notes the fact on the request. It is important that there is no 
contra-indication to the use of the drug and this is a responsibility 
of the patient’s ward officer. 
(3) Instructions to nurse are— 
(a) Take fasting specimen, label and record on fractional slip. 
(h) Take blood pressure and record. 
(c) Give 0.5 mg. ergam-ine acid phosphate intramuscularly. 
{d) Take subsequent specimens every 15 minutes until six speci- 
mens are taken. 
(e) Take blood pressure 30 minutes after histamine is given and 
record. 
(/) Look for local reaction at site of injection and if present 
also record. 
109 TM 8-260 
230 
MEDICAL DEPARTMENT 
(g) Patient must lie in bed while test is being done. 
e. Proctoscopic examination.— (1) Contact chief of section and 
patient is given appointment. 
(2) Patient continues usual diet. No laxatives are given. 
(3) At 7:00 AM, day of examination, give two small (pt.) warm 
water or saline enemas in recumbent position. In selected cases a 
quart of 1 or 2 percent S. S. enema may be given (see par. 231 o 
for preparation of enemata). 
(4) On the day of examination have patient report to chief of 
section at 9: 30 AM. 
/. Glucose tolerance test.—Use micro method for children and 
elderly people. 
(1) Nothing to eat or drink from midnight until after test is 
completed. 
(2) Patient reports at laboratory at 7:00 AM, taking two lemons 
with him. Amount of sugar given computed by ward officer (usually 
1.5 grams per kilo body weight). Blood specimens taken fasting and 
at 1-hour, 2-hour, and 3-hour periods. 
g. Urine concentration test.— (1) At 5:00 PM the patient is 
given usual supper. If on a low protein diet, two poached or soft- 
boiled eggs are added to the meal. This meal is to include no more 
than WO cc. of fluid. 
(2) After eating supper no food or drink allowed until completion 
of test at 10:00 AM on following day. 
(3) At bedtime patient instructed to empty the bladder and dis- 
card the urine. Any urine passed during the night is also discarded. 
(4) At 7:00 AM the following morning the patient empties 
the bladder, saving the entire specimen in one bottle marked No. 1. 
(5) At 8:00 AM patient again empties the bladder, saving the 
entire specimen in bottle No. 2. 
(6) At 9:00 AM patient again empties the bladder, saving the 
entire specimen in bottle No. 3. 
(7) The three bottles properly labeled with the name of the 
patient are then sent to the laboratory for taking specific gravity, 
or this may be done in the ward if responsible assistant is available 
to do so. 
h. Urine dilution test.— (1) For supper night before the test the 
diet to which patient is accustomed. 
(2) No breakfast the morning of the test. 
(3) At 8:00 AM the patient empties bladder, discarding the urine; 
then give 1,000 cc. water to drink within 10 minutes (four glasses). 
110 TM 8-260 
230 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(4) Remain at rest for 4 hours and urinate in properly labeled 
bottle, emptying bladder each time and saving the entire specimen in 
proper bottle. Bottle No. 1 at 9:00 AM; bottle No. 2 at 9:30 AM; 
bottle No. 3 at 10:00 AM; bottle No. 4 at 10:30 AM; bottle No. 5 
at 11: 00 AM; bottle No. 6 at 12: 00 noon. 
(5) Amount in each bottle and the specific gravity of each specimen 
is then measured and recorded. 
i. Encephalography.— (1) Preparation of patient.—(a) Remains 
in bed from the evening before the test. 
(b) S. S. enema given the night before the test. 
(c) Luminal 0.065 gram (1 gr.) or sodium amytal 0.195 gram 
(3 gr.) by mouth the night before the test. 
(d) In event an additional use of an avertin anesthesia is advisable, 
the preparation of patient and administration of avertin is made 
under the direction and supervision of the surgical service. 
(2) Equipment.— (a) Sterile spinal puncture tray. In addition, 
have at hand a spinal pressure manometer and on the tray a sterile 
10-cc. Luer syringe. 
(b) At hand have one hypodermic of caffeine-sodium-benzoate 
0.487 gram (7y2 gr.) and a second hypodermic of 1 cc. (15 minims) 
of 1 to hooo solution of adrenalin. 
(3) Personnel.— (a) One medical officer. 
(b) One nurse. 
(c) Two assistants. The nurse assists the operator and also keeps 
an accurate written record of the actual number of cc. of spinal fluid 
withdrawn and number of cc. of air injected. The two attendants 
are needed to support and care for the patient under the direction 
of the operator. 
(4) Performance of test.—Done at X-ray section to avoid moving 
patient any more than necessary before taking X-rays. 
(«) Spinal puncture made with a narrow gage platinum iridium 
spinal puncture needle under the usual aseptic precautions, with the 
patient in the sitting position. 
(b) Queckenstedt’s test made. 
(c) 15 cc. spinal fluid withdrawn. 
(d) 10 cc. air injected with Luer syringe. 
(e) Alternately withdraw 10 cc. spinal fluid and inject 10 cc. air 
several times. 
(/) Then continue process, withdrawing 5 cc. of spinal fluid and 
injecting 5 cc. air. At intervals during this process head is rotated 
slowly from side to side and forward and backward. Withdrawals 
and injections are continued until there is no further flow of fluid 
111 TM 8-260 
230 
MEDICAL DEPARTMENT 
or until very fine bubbles come from the needle. The needle is with- 
drawn and puncture wound closed with sterile dressing. Check 
of amounts injected and withdrawn must be accurately kept to be 
sure more air is not injected than fluid withdrawn. 
(g) X-rays should include right and left lateral views and AP 
and PA views of skull. Patient is kept in an erect position at the 
X-ray clinic until first views are developed sufficiently to determine 
if they are satisfactory. Upon completion of X-rays patient is 
immediately returned to the ward, placed in a shock bed with the 
foot of the bed elevated. During the whole procedure patient should 
be kept carefully protected from chilliness. 
(A) Bed patient for at least 72 hours. 
{i) Regular sedation as indicated for 72 hours. 
j. Phenolsul phonephthalein test.—(1) Void urine, then drink 3 
glasses of water. 8: 30 AM. 
(2) Give exactly 1 cc. of dye by vein y2 hour later. 9: 00 AM. 
(3) 1 hour and 5 minutes after dye is given, void and save speci- 
men in bottle marked 1st hour. 
(4) 2 hours and 5 minutes after dye is given, void and save speci- 
men in bottle marked 2d hour. 
(5) Do not drink any water after beginning of test and do not 
void between specimens. 
k. Throat culture.— (1) Obtain sterile swab in test tube and Loeff- 
ler’s tube from laboratory if not found on ward. 
(2) Inoculate swab thoroughly from tonsil fossae, posterior pha- 
ryngeal wall and uvula when indicated. 
(3) Remove paraffin stopper from Loeffler’s tube after heating 
gently. 
(4) Gently inoculate Loeffler’s slant without breaking its surface. 
(5) Return swab to sterile tube, plugging same with sterile cotton 
plug. 
(C) W rite patient’s name on label on Loeffler’s tube and wrap both 
tubes in W. D., M. D, Form No. 55L, prepared in duplicate. 
(7) Send immediately to laboratory, night or day. 
l. Urea clearance test—(1) An ordinary breakfast is given except 
that the patient must not have coffee, tea, or citrus fruits. 
(2) The patient remains quiet. At about 8:00 AM the patient 
empties bladder, discarding this specimen. Time of voiding noted 
by hour and minute. Patient drinks glass of water after urinating. 
(3) Exactly 1 hour after first urination, patient again empties 
bladder, saving entire specimen. Time of voiding noted by hour and 
minute. Patient drinks glass of water after urinating. 
112 TIfl 8-260 
230 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(4) 5 cc. of blood taken from a vein into oxalate within 10 minutes 
before or after second urination mentioned in 3 above. Time of 
specimen noted by hour and minute. 
(5) Exactly 1 hour after second urination patient again empties 
bladder, saving entire specimen. Time noted by hour and minute. 
(6) Both of the urine specimens and the blood specimen are sent 
to the laboratory with a record showing the time each specimen was 
obtained. 
(7) The clinical laboratory should be notified the day before the 
test is to be made. 
m. Oral cholecystography.—See section VIII. 
n. Biliary drainage (Meltzer-Lyon test).—(1) Passage of tube to 
stomach.— (a) Patient fasts 12 to 15 hours and reports for test at 
7:00 AM without breakfast. 
(b) Patient swallows tube to 22-inch mark. 
(c) Aspirate stomach content and save in first tube for study of 
amount, color, gross consistency, microscopic and chemical findings 
(usually 15 to 40 cc.) 
(2) Passage of tube to the duodenum.—(a) Patient lies down on 
a bed and turns well on his right side and swallows tube to the 29- 
inch mark very slowly. 
(b) Insert end of Rehfuss tube in second test tube, keeping rack 
on chair below level of stomach and observe same from time to time 
until an alkaline fluid is obtained. Test by litmus paper. This fluid 
is duodenal content and should be saved in second tube for study of 
amount, color, microscopical examination, occult blood, pancreatic 
ferment determination, etc. Usually 10 cc. or less. If bile is ob- 
tained before magnesium sulphate is instilled the common duct 
spincter is open and part of the bile (A) has escaped and cannot be 
differentially estimated. 
(3) Drainage of bile.— {a) Instill 75 cc. of 33 percent magnesium 
sulphate (body temperature) into duodenum slowly by gravity; pinch 
the tube to hold its syphonage and attach to drainage bottle or tube. 
May substitute 25 cc. concentrated magnesium S04 diluted to 75 cc. 
with water. The bile will flow out without aspirations. 
{b) Collect the bile in separate containers as follows: 
1. A.—Light golden yellow bile coming from the gall ducts. 
Save in tube 3 (common, cystic, hepatic) (usually 5 to 
30 cc.). 
2. B.—Dark golden yellow bile coming from the gall bladder. 
Save in tube 4 (usually 30 to 75 cc.). 
113 TM 8-260 
230 
MEDICAL DEPARTMENT 
3. C.—Light, thin, yellow bile coming from the liver (usually 
30 cc. or more). Save in tube 5. 
(c) If gastric juice gets into the bile the color may become greenish 
(oxidation to biliverdin), turbid, and sometimes effervescent due to 
action of HCL upon the salts. 
(d) The total duration of the test will vary between 1 and 3 hours. 
If liver drainage is essential in treatment it may be continued for 6 
hours. 
(4) Examination of hile.— (a) Gross or microscopic examination. 
Make note of— 
1. Amounts of A, B, and C bile. 
2. Color. 
3. Clear or turbid. 
Jf. Presence or absence of white or bile stained flakes. 
5. Precipitates (from admixture with gastric juice). 
6. Viscosity (mucous). 
7. Blood. 
(h) Microscopic examination of fresh and stained smears (within 
hour of collection). 
1. Epithelial cells (may be degenerated “shadow cells”). 
2. Leukocytes. 
3. Mucous (long, waxy, curled strands). 
J/.. Crystals (cholesterin, leucin, tyrosin, calcium bilirubin). 
5. Pigments (bilirubin calcium: lustrous orange masses, some- 
times like sand). 
6. Bacteria. 
7. Precipitates (gastric juice effect on bile salts: granules). 
S. Parasites or ova (lamblia, chilomastix, ameba, hook worms, 
round worms, etc.). 
(5) Interpretation of results.— (a) Failure to get tube into 
duodenum may be due to— 
1. Pylorospasm. 
2. Gastroptosis and gastric atony. 
3. Organic disease of stomach and duodenum, extragastric 
tumors, etc. 
(5) Chronic cholecystitis or biliary tract disease: pus and bacteria 
in the bile. 
(c) Gall stones: a heavy pigment sediment or findings of crystals 
(cholesterin, calcium bilirubin). 
(d) Gall bladder stasis: large amounts of deep colored viscid bile. 
(e) Parasitosis; most parasites in B fraction if gall bladder is 
infected. 
114 TM 8-260 
230-231 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(/) Blockage of cystic duct: absence of B fraction. 
o. Feces examination {warm specimen) for amebae.—(1) Careful 
attention must be given to the collection of the specimen of feces 
and delivery to the laboratory. In chronic cases in whom it may 
be difficult to get a satisfactory specimen give patient 45 cc. mag- 
nesium sulphate before breakfast. As soon as catharsis occurs have 
patient pass specimen in a bedpan previously made warm by hot 
water, take the feces to laboratory immediately, and bring same 
to attention of laboratory personnel as an emergency examination. 
Chronic dysentery cases usually receive four such tests before they 
are considered negative for ameba. In acute cases where no cathartic 
is needed, collect specimen with the same care above outlined. 
(2) The laboratory report should show the character of the stool, 
the presence or absence of R. B. C., W. B. C., mucous, parasites and 
cysts. 
Caution.—It is not sufficient to report on presence or absence of 
parasites only. It is very important to know if the stool is pale 
(lacking bile), or tarry (containing old blood), watery or scybalous, 
if gross exudate is present or not, etc. 
231. Therapeutic procedure.—a. Administration of intravenous 
hypertonic salt solution in thromboangiitis obliterans {in selected 
cases).— (1) The quantity used is 300 cc. and the strength 3 to 5 
percent. 
(2) The solution warmed to body temperature is given by intra- 
venous infusion, gravity method, requiring about 15 minutes to give 
the entire amount. 
(3) A course of twelve of these injections may be given twice 
weekly, and repeated after an interval of 6 weeks. During this 
time a course of twelve injections of typhoid vaccine is given. (See 
g below.) 
(4) During a course of treatment with hypertonic salt it is im- 
portant to have occasional blood counts to avoid a secondary 
anemia. 
(6) Patients should remain in bed for at least 4 hours after the 
injection, and should abstain from drinking water during this 
period. 
b. Gold wet pack.—(1) One rubber sheet, four ordinary sheets, 
four blankets, one bath towel. 
(2) Rubber sheet spread smoothly on bed. 
(3) Ordinary sheets soaked in ice water, wrung out well, and 
spread smoothly on bed. 
(4) Patient supine (on back) with arms raised above head. 
115 TM 8-260 
231 
MEDICAL DEPARTMENT 
(5) First sheet wrapped tightly about patient’s body, legs, and 
feet. 
(6) Patient’s arms lowered to side. 
(7) The remaining sheets one by one wrapped tightly about 
patient mummy fashion. 
(8) Blankets one by one wrapped tightly about patient. 
(9) Bath towel soaked in ice water, wrung out, and wrapped 
around patient’s head, leaving mouth and nostrils clear. 
(10) Push fluids while in pack. 
(11) TPR q 30 minutes. 
(12) Watch closely for sudden temperature rise. 
(13) Leave in pack from 30 minutes to 1 y2 hours, depending upon 
sedative effect obtained and patient’s reactions. 
(14) Ordinarily packs may be given three or four times within 
24 hours. 
c. Malarial inoculation.—(1) Luer 10-cc. syringe. 
(2) Large gage needles as required. 
(3) Tourniquet, iodine, alcohol. 
(4) Clean donor’s arm with iodine and alcohol and apply tour- 
niquet. 
(5) Clean patient’s arm and shoulder just below scapula with 
iodine and alcohol. 
(6) Withdraw from 5 to 10 cc. donor’s blood. 
(7) Change needles on hypodermic and inject 3 cc. of blood intra- 
venously into patient. 
(8) Add 2 cc. of air to remaining blood, and inject blood and air 
intramuscularly under scapula. 
(9) Massage gently to promote maceration and absorption of 
injected blood. 
(10) The air is added to promote maceration and irritation. 
(11) The incubation period of quartan malaria given by this 
method is from 1 week to 4 months. 
(12) Blood can be treated as for indirect transfusion and if kept 
On ice will retain its malarial potency for 24 to 48 hours. 
d. Postural drainage.— (1) The treatment is carried out by first 
placing the patient for 10 minutes on the healthy side to permit 
drainage of the purulent material into the larger bronchi and if 
the abscess is in the upper lobe, the patient should sit erect for 10 
minutes before lying on the healthy side. 
(2) Then the patient’s trunk should be inverted by having him 
lie crosswise on the bed with the groins at the edge of the bed, so 
that the body is bent at the hips and the head is at or near the floor, 
116 TM 8-260 
231 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
with the body vertical; an attendant should hold the thighs as they 
lie across the bed. The position is to be maintained from 3 minutes 
at first up to 5 minutes. A pus basin should be available, although 
coughing and expectoration are seldom promoted until patient is 
again back in bed. 
(3) This procedure should be done four times a day, y2 hour 
before meals (because of possible emesis), and at bedtime. 
e. Summation typhoid inoculation (for protein shock for whatever 
purpose).— (1) Fresh triple typhoid vaccine of 100 million bacteria 
per cc. made up in normal salt. 
(2) Small gage needles as required, 10-cc. hypodermic, tourniquet, 
iodine, and alcohol. 
(3) Dosage varies with patients and with each individual patient 
from time to time, so small dosage is indicated until patient’s 
tolerance is learned. 
(4) % cc. of the vaccine dilution or 25 million typhoid bacteria, 
to which is added sterile salt solution qs. 5 cc. 
(5) Inject slowly intravenously. 
(6) TPR q 30 minutes. The strength of next dose depends on 
temperature reaction. 
(7) Patient usually has chill, followed by rise in temperature in 
from 15 minutes to 2 hours. 
(8) The next injection is given not sooner than 3 hours following 
first, and not at all if the fever following the first injection rises to 
103° F. 
(9) The second injection is usually followed by a sudden sharp 
rise of temperature. 
(10) Push fluids during fever reaction. 
(11) After temperature drops to 102° give codeine sulphate 0.032 
for headache. 
(12) Bed patient for 24 hours. 
(13) Treatments can be given ordinarily twice weekly, gradually 
increased dosage being required. 
(14) A temperature of at least 104° F. is desirable where this type 
of treatment is indicated. 
/. Immediate treatment of hemorrhage from upper gastro-intestinal 
tract (for use when patient is admitted during the absence of ward 
officer).— (1) Patient must be seen by the medical officer of the day. 
(2) Absolute bed rest. 
(3) Emergency complete blood count. 
(4) Blood pressure and pulse taken and recorded hourly. 
117 TM 8-260 
231 
MEDICAL DEPARTMENT 
(5) Morphine gram 0.016 (14 gr.) (medical officer must see 
patient before this is given). Morphine may be repeated if neces- 
sary to get the patient quiet. 
(6) Give nothing by mouth. 
(7) Ice bag to abdomen. 
(8) Minimum amount of physical examination will be done. Dis- 
turb patient as little as possible. 
(9) All vomitus and feces specimens to be saved for inspection. 
(10) If condition of patient appears alarming as evidenced by red 
cell count, hemoglobin, blood pressure, and pulse, have the patient 
typed and select a blood donor for transfusion. A small transfusion 
of 250 cc. whole blood is preferred. 
g. Nonspecific protein therapy.—(1) A course of typhoid vaccine 
therapy consists of twelve intravenous injections, two injections being 
given each week. The course therefore requires six weeks. The 
dosage is as follows: 
{a) A preliminary dose of 10 million bacilli is given intravenously 
as a test dose. If the patient proves not to be hypersensitive the fol- 
lowing schedule is suggested: 
Million bacteria 
Injection intravenously 
1 25 
2 50 
3 100 
4 150 
5 200 
6 250 
7 300 
8 400 
9 500 
10 600 
11 800 
12 1,000 
(6) The increase in dosage is approximate and may be more or 
less rapid, depending upon the individual reactions. 
(2) A minimum temperature of 102° is desired in Buerger’s dis- 
ease and a maximum of 103°. In acute arthritis, however, higher 
temperatures are desired; a minimum of 103° in the nonspecific type 
and 104° to 105° in the gonococcic type. If the desired temperature 
is not obtained with the injection listed, the summation method is used. 
See e above. 
(3) The typhoid vaccine now supplied by the Army Medical Center 
is the “triple typhoid vaccine.” Each cubic centimeter of this vaccine 
contains— 
(a) 1,000 million typhoid bacilli. 
118 TM 8-260 
231 
TIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(b) 250 million para A bacilli. 
(c) 250 million para B bacilli. 
h. Treatment of pneumonia.—In regard to the following outline of 
treatment of pneumonia cases, it should always be borne in mind that 
it is the individual patient and not the disease that is under treatment; 
therefore, certain modifications in any plan of treatment are always 
permissible. 
(1) Routine procedure.—(a) Upon admission, patient’s history is 
taken briefly (including interrogation relative to previous allergic 
states: history of hay fever, asthma, sensitivity to horse dander, pre- 
vious administration of serum and reactions), and such physical ex- 
amination is made as the physical condition justifies. 
(b) Absolute bed rest; possibly a private attendant. 
(c) Complete blood count at once and daily until further orders. 
(d) Test for serum sensitiveness as shown below if serum is to be 
used. 
(e) Sputum to laboratory in sterile petri dish with form marked 
emergency for typing. For method of proper collection see paragraph 
232e. 
(/) Emergency bedside X-ray of chest. 
(g) Give serum or sulfathiazole as indicated. 
(A) Routine urinalysis, Kahn and other laboratory examinations 
as indicated. 
{i) Have patient fed by attendant. 
(j) Blood culture should be obtained on admission and then as 
indicated. 
(&) Enema (plain water or saline) should be used daily if nec- 
essary. Prevent abdominal distention. 
(l) Seriously ill notice is initiated, if indicated. 
(m) Temperature, pulse, and respiration recorded on graphic 
chart every 4 hours. Blood pressure should also be recorded fre- 
quently, especially if serum is given. 
(n) Keep windows open but protect from direct drafts by use of 
screens. 
(o) Report to Board of Health. 
(p) See that patient obtains sufficient sleep. 
(q) Use liquid diet for first few days, small amounts at short 
intervals. No iced fluids as these tend to cause distention. Measure 
fluid intake and output. Intake should be 2,500 cc. to 3,000 cc. daily, 
depending on the urinary output. The urine output should be at 
least 800 cc. to 1,000 cc. in adults. 
119 TM 8-260 
231 
MEDICAL DEPARTMENT 
(r) Do not use digitalis or cardiac stimulants unless specifically 
indicated by falling blood pressure and increasing heart rate. Use 
oxygen early if indicated by some cyanosis and hyperpnea. When 
oxygen is used the procedure of its administration should be carefully 
controlled and supervised. 
(2) Serum therapy.—(a) Serum is available for use in all types 
of pneumonia, but is most efficacious in types I, II, IV, V, VII, 
VIII, and XIV. Both horse serum and rabbit serum are obtainable 
for treatment. The technique of administering horse serum and 
rabbit serum is the same. 
(b) Have hypodermic syringe prepared, and in the patient’s room, 
of 1 cc. of epinephrine 1:1,000 for use in treating allergic reactions. 
(e) The following sensitivity tests are to be performed prior to 
serum administration: 
1. Conjunctival test.—For this purpose a drop of 1 to 10 
dilution of normal horse serum is instilled into one con- 
junctival sac. A positive reaction appears within 13 
minutes, manifesting itself by hyperemia of the conjunc- 
tiva, dilated conjunctival vessels, increased lachrymation, 
and sometimes itching. A conju/nctivcd reaction consti- 
tutes a definite contraindication to serum therapy. If the 
conjunctival reaction is severe it may be neutralized by 
the instillation of epinephrine solution 1 to 1,000 in the 
conjunctival sac. Of the three reactions employed for 
sensitivity to horse serum the conjunctival is the most 
reliable in ruling out anaphylaxis, except perhaps in cry- 
ing children when the drop of serum instilled in the con- 
junctival sac is likely to be washed out by the tears as 
soon as put in. (A small capillary tube with 1 to 10 
horse serum is furnished with each package of antipneu- 
mococcic serum.) This test is not usually performed 
when administering rabbit serum, since the skin and intra- 
venous tests are more reliable. 
2. Skin test.—For this purpose 0.1 cc. each of 1 to 10 and 1 to 20 
dilution of normal horse serum (controlled by 0.1 cc. of 
normal saline) is injected intradermally. The reaction is 
read in 30 minutes. If strongly positive, the benefit to be 
expected from serum must be weighed against the danger 
of serious reaction. If it is decided to give serum in the 
presence of a strong reaction it must be given with caution. 
If the case is urgent it may be given provided the patient 
is desensitized by the giving of serum in divided doses at 
1-hour intervals, beginning with 0.1 cc. under the skin, 
120 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
231 
0.2 cc., 0.5 cc., and 1.0 cc. From this point, if no reaction 
occurs, the intravenous injections may be started in the 
same amounts as above, and after 1.0 cc. is given intraven- 
ously with no reaction, the amount is doubled at each in- 
jection until the full dose has been given. If a reaction 
occurs, half of the epinephrine 0.5 cc. (7.5 minims) is 
given subcutaneously, repeated in 10 to 15 minutes if neces- 
sary, and if the reaction is severe or if no relief is obtained 
with the epinephrine, morphine and atropine are given 
subcutaneously. 
3. Intravenous test.—5 cc. of a 1 to 50 dilution of rabbit serum 
in normal saline is slowly injected intravenously. Check 
the blood pressure before the test and 5 minutes after the 
test. If the blood pressure falls 20 millimeters of mercury 
or more, serum is contraindicated. 
(d) Dosage of serum.—If all tests are negative, give— 
1. 10,000 units proper type antipneumococcus serum intraven- 
ously, undiluted and very slowly (at least 10 minutes), with 
0.3 cc. (5 minims) of epinephrine solution (1 to 1,000) in 
the serum. 
2. If no reaction in 2 horn's, give 20,000 units of serum intraven- 
ously, slowly. Then repeat every 2 hours until total dosage 
is given. 
3. The total dosage should vary from 60,000 to 200,000 units, de- 
pending upon the day of illness, extent of involvement, com- 
plications, progress of the case, age, and condition of the 
patient. 
(e) Heactions encountered are of three types, anaphylactic, urti- 
carial, and thermal. 
1. Anaphylactic reactions are manifested by apprehension, 
tachycardia, choking sensation in chest, cyanosis or edema 
of the larynx. Death may follow in a few minutes. The 
treatment consists of the immediate administration of 0.5 
cc. to 1.0 cc. (7.5 minims to 15 minims) of 1 to 1,000 epine- 
phrine hydrochloride subcutaneously and/or 3 minims to 5 
minims intravenously, to be repeated if necessary. Mor- 
phine and atropine should also be given if indicated. 
2. Urticarial reactions are of two types, the immediate and the 
delayed. The former appears about 15 minutes after the 
serum administration and is manifested by flushing of the 
face, rapid pulse, apprehension, and an urticarial rash. 
The treatment is essentially the same as for the anaphy- 
lactic reaction. The delayed reaction or “serum sickness” 
121 TM 8-360 
231 
MEDICAL DEPARTMENT 
usually appears from 5 to 15 days after the administration 
of the serum. It is manifested by urticaria, intense itching 
of the skin, diarrhea, muscle and joint pains. The urti- 
caria is best treated with epinephrine, potassium chloride, 
sodium bicarbonate, or calamine lotion applications, alcohol 
rubs, etc. The muscle and joint pains usually respond to 
salicylates and/or codeine. Morphine has to be given in 
some cases to control the intense itching, pain, etc. Cathar- 
sis as indicated. 
3. Thermal reactions manifest themselves by chills and sudden 
elevation of temperature, usually 1 hour to 2 hours follow- 
ing the serum administration. The treatment consists in 
the application of external heat at time of chills. Mor- 
phine, 0.010 (% gr.), and/or nitroglycerine, 0.00065 (Vigo 
gr.), may be indicated and beneficial for the apprehension 
and discomfort. 
(3) Chemotherapy.—(a) For pneumococcic pneumonia give sulfa- 
thiazole after the above-enumerated routine procedures have been car- 
ried out. The following schedule is recommended: 
1. For adults (patients over 14 years of age), give 4.0 grams 
stat., followed by 1.0 gram every 4 hours, day and night 
until the patient’s temperature has been normal for 72 
hours. Then discontinue the drug. 
2. In children the initial dose should be based on 0.15 gram per 
kilo (up to 25 kilo body weight), and the total daily dose is 
calculated on that basis. The total daily dose after the 
initial dose should be divided into four equal parts, and 
one dose given every 6 hours until the temperature has 
been normal for 36 hours. 
3. During drug therapy and for a few days thereafter: 
(a) Daily complete blood count (watch for hemolytic 
anemia or agranulocytosis.) 
(b) Blood for sulfathiazole content daily, or three times 
a week as indicated. Concentrations of 3 to 6 
milligram percent of free drug are considered ade- 
quate in the average uncomplicated case. 
(c) Sulfathiazole reactions may include nausea, vomit- 
ing, headache, rash, cyanosis, delirium, fever, 
hemolytic anemia, jaundice, and agranulocytosis. 
Patients should be carefully watched for such re- 
actions so that appropriate treatment may be insti- 
tuted promptly. 
122 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
231 
(5) Other sulfonamide compounds (sulfanilamide, sulfapyridine 
etc.) may be necessary in certain special cases and will be ordered as 
indicated. See circular letter No. 81, S. G. O., 1940. 
(4) Oxygen therapy.—(a) Oxygen tents, tanks, analyzers, and 
equipment are ready for use at all times in a designated place. This 
office also provides a roster of properly qualified enlisted attendants 
who are available to set up and operate these tents whenever necessary. 
(2>) Oxygen makes breathing easier. It lowers the pulse and 
respiration and often lowers the temperature. It increases the arterial 
oxygen saturation and relieves cyanosis. It prolongs life, thereby 
affording the patient more time in which to build up his resistance 
to overcome the infection. The chief indication for oxygen in pneu- 
monia is cyanosis. It has been found that slight cyanosis of fin- 
gertips and of lips corresponds to about 10 percent oxygen desaturation 
and that when cyanosis is marked the blood is more than 20 percent 
desaturated. The oxygen content of atmospheric air is 21 percent; 
in treating pneumonia with oxygen the aim is to increase the oxygen 
supply to 50 percent in the tent. 
(c) All officers and nurses should be familiar with the operation 
of oxygen equipment and analyzers. 
i. Treatment of diabetic coma.—The following procedures are of- 
fered as a guide in the treatment of diabetic coma. There is no 
definite rule for determining the amount of insulin or the amount of 
fluid necessary. Each patient will have to be considered as an 
individual problem. 
(1) Urinalysis.—Examine a specimen of urine immediately for 
sugar, acetone, and diacetic acid. Catheterize if necessary. 
(2) Blood chemistry.—Obtain blood for blood sugar, C02 com- 
bining power, and urea nitrogen. 
(3) Insulin.—If definitely a case of diabetic coma, give an initial 
dose of 20 to 100 units (average, 40 units) of regular insulin. Occa- 
sionally it will be necessary to give a portion of the insulin dosage 
intravenously. Insulin should be given every 30 to 60 minutes until 
the patient shows some improvement. The results of urinalysis can 
be used as a guide for giving insulin, 5 units of insulin being given 
for every 1+ of glycosuria. The bladder should be completely emp- 
tied each time urine is obtained when giving insulin according to 
urinary findings. If there is no definite improvement in 3 hours, 
larger doses of insulin should be given. It is very essential to give 
an adequate amount of insulin and it is a good practice to give insulin 
buffered by glucose in saline, intravenously when there is marked 
acidosis. The amount of insulin required in 24 hours varies greatly. 
123 TM 8-260 
231 
MEDICAL DEPARTMENT 
It may vary from 60 to 1,000 units. The average amount necessary 
in 24 hours is 200 to 250 units. The danger of hypoglycemic reactions 
has been greatly overemphasized. Obtain blood sugars at intervals 
of 4 to 8 hours until the patient is out of coma. The micro method 
should be used for children and elderly people. In view of the de- 
layed reaction of protamine zinc insulin, only regular insulin should 
he used. 
(4) Fluids.—Normal saline solution should be given liberally. If 
the patient is badly dehydrated, 2,000 cc. to 3,000 cc. of saline should 
be given intravenously in the first 12 hours. The average require- 
ment for all cases of diabetic coma varies between 2,000 cc. and 
4,000 cc. in 24 hours. This saline can be given intravenously, sub- 
cutaneously, or by protoclysis. After the blood sugar has been low- 
ered, glucose in saline can be given. The patient should receive 
approximately 50 grams of soluble carbohydrate (glucose, orange 
juice, sweetened drinks, etc.) buffered with insulin during the first 
12 hours and a similar amount during the second 12 hours. After the 
patient is able, fluids by mouth can be given. This should be given 
at a rate not to exceed 100 cc. every hour. If the condition remains 
serious, the C02 combining power remaining low and the insulin 
medication seemingly ineffective, the use of 250 cc. of 5 percent 
solution of sodium bicarbonate intravenously is indicated. 
(5) General measures.—Shock is combated by placing the patient 
in a warm bed and the use of blankets and hot water bottles. Gas- 
tric lavage is indicated in practically all cases, and 200 cc. to 300 cc. 
of 5 percent solution of sodium bicarbonate should be allowed to re- 
main in the stomach. Initial treatment should also include catheter- 
ization and an enema. 
(6) Circulatory failure and anuria.—Caffeine-sodium benzoate and 
digitalis by hypo can be used as circulatory stimulants. Hypertonic 
solutions of glucose (100 cc. of a 25-percent solution) or a 10-percent 
solution of sodium chloride (100 cc.) have been reported as being 
successful in combating anuria. 
CO Diabetic coma is a medical emergency. The patient will re- 
main under the observation of the responsible medical officer until 
danger of relapse into coma is past. 
j. Treatment of pulmonary hemorrhage.— (1) A patient with 
hemoptysis should be put to bed at absolute rest and should remain 
there for 5 days following the disappearance of blood from sputum. 
(2) A patient with pulmonary hemorrhage should be immediately 
placed in bed, made comfortable and kept absolutely quiet, not even 
being allowed to talk. A supine position with head of bed elevated 
is preferable. 
124 TM 8-260 
231 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(3) Pie should be reassured as to condition as the avoidance of 
mental tension and emotion is an important factor in the treatment. 
(4) He should be advised to avoid or control all unproductive 
cough. If excessive unproductive cough persists, 0.032 gram (i/2 gr.) 
doses of codeine dissolved on the back of the tongue may be used. 
(5) Cracked ice may be given by mouth, but little fluid otherwise. 
(6) Also a powTder consisting of sodium bromide and sodium chlo- 
ride, 0.975 gram (15 gr.) each. These remedies may be repeated 
in y2 hour, if indicated. 
(7) Morphine should never be used in pulmonary hemorrhage save 
to quiet extreme excitement or to control cough which has failed to 
yield to other measures. 
h. Treatment with tryparsamide.— (1) Recommendations for treat- 
ment with tryparsamide are made by the neuropsychiatric section of 
the medical service. 
(2) Prior to treatment the patient is given a complete physical 
examination, to include blood and serology. 
(3) Eye examination, to include fundus and visual fields is made 
prior to each and every treatment. 
(4) The administration of tryparsamide is made by a commis- 
sioned officer from the G. U. section. 
I. Treatment of Cerebrospinal meningitis.— (1) Test patient for 
sensitivity to serum, using skin and conjunctival tests (see A(2) (c) 1 
and 2 above). 
(2) Have two sterile culture tubes to send specimens of spinal 
fluid to laboratory. 
(3) Make out requests for examination of spinal fluid. 
(4) Prepare two hypodermics, one with 0.016 gram (% gr.) mor- 
phine and the other with 1 cc. 1 to 1,000 adrenalin. 
(5) Use local anesthesia for spinal puncture, at least for the first. 
(6) Ho lumbar puncture. Send first few cc. to laboratory for smear, 
culture, cell count, and on first specimen, in addition, agglutination 
of organisms from culture against therapeutic sera. 
(7) Read sensitization tests again before administering serum in 
the vein, if serum is to be used. (See circular letter No. 81, S. G. O., 
1940.) 
(8) Mix 100 cc. of serum with equal quantity of warm saline solu- 
tion and inject slowly in vein by gravity. As the injection is started, 
give one-third of the adrenalin under the skin and save the rest for 
emergency. 
(9) Special attendant remains with patient. 
(10) Send in seriously ill notice. 
125 TM 8-260 
231 
MEDICAL DEPARTMENT 
(11) Report case to Board of Health. 
(12) Routine laboratory procedures: white and differential count, 
urine and culture from nares and from throat for meningococcus. 
(13) Sulfanilamide will be used, using essentially the same dosage 
and precautions as prescribed in other severe infectious conditions, 
(See circular letter No. 81, S. G. O., 1940.) 
m. Treatment of status asthmaticus.— (1) Epinephrine 1 to 1,000 
subcutaneously 0.8 to 1.0 cc. every hour until relief is apparent but 
not more than four such consecutive doses. May give 0.07 to 0.15 
cc. intravenously diluted to 2 cc. with normal saline. 
(2) Combinations of epinephrine (0.3 cc.) and pituitrin (0.5 cc.) or 
epinephrine (0.3 cc.) and aminophyllin (1 ampoule 0.5 gm.) intra- 
muscularly. 
(3) Adequate fluid intake, orally or intravenously; glucose 100 to 
150 grams daily, orally, and 0.3 to 0.6 epinephrine, three or four 
times daily subcutaneously. Glucose 10 percent intravenously if 
necessary. 
(4) Sedation. Barbiturates. Dilaudid 0.001 repeated once if nec- 
essary. Morphine 0.004, with caution. 
(5) Avertin anesthesia, rectal 50 to 70 mgm per kilo body weight. 
(6) Ether in olive oil, equal parts, by rectum 150 cc. to 200 cc. 
(7) Sodium iodide intravenously 20 cc. ampoule (2 gr.). 
(8) Digitalis leaves 0.100 gram to 0.200 gram orally in older asth- 
matics with rapid, feeble pulse. 
(9) Caffeine sodium benzoate 0.5 gram subcutaneously or caffeine 
citrate 0.3 gram to 0.5 gram orally. 
(10) Whisky, 60 cc. to 90 cc. several times daily. 
(11) Continuous intravenous administration of 5-percent glucose 
with 1 to 200,000 epinephrin (constant drip method). 
(12) Oxygen tent (or oxygen 20 percent and helium 80 percent, 
if latter is available). 
(13) Cleansing enema, if necessary, with moderate food intake, 
relaxation and sleep, allergic cleanliness insofar as practicable. 
n. Treatment with vitamin K.— (1) The method of administering 
vitamin K depends upon the degree of deficiency of this vitamin as 
measured by the prothrombin “time” (Quick, Smith or modified 
Howell method.) (Modification of Howell’s method (American 
Journal of Medical Sciences, September, 1940).) 
(2) Cases of obstructive jaundice, hepatitis, etc., which show nor- 
mal values require only prophylactic treatment and may be given 
synthetic vitamin K and bile salts orally. 
126 TM 8-260 
231-232 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(3) Patients with definitely prolonged prothrombin time and those 
who are actively bleeding from the second and third classifications. 
The former may be started on oral therapy but if they fail to respond 
in a short time, must be given liquid concentrate of vitamin K and 
bile salts by means of the duodenal tube. The latter (actively bleed- 
ing cases) require the intravenous administration immediately, and 
may also require blood transfusions to tide them over the period of 
greatest danger. In the tube method, 2 to 4 grams of bile salts are 
dissolved in 250 to 500 cc. of warm saline solution and to this are 
added 0.3 to 2.00 grams of the concentrated vitamin K. The mixture 
is shaken frequently and allowed to flow slowly through the tube 
over a period of about 30 minutes. When such large doses are used, 
the prothrombin time usually becomes normal within 6 to 12 hours, 
but in an exceptional case it may be necessary to repeat the procedure 
one or more times before the hemorrhage can be controlled. 
o. Enemata.— (1) Types.— (a) Plain water.—Warmed to body 
temperature (99° F.), 
(&) Saline.—8 grams (2 level teaspoonfuls) of ordinary salt to 
1 quart of warm water (99° F.). 
(c) Soap suds.—1 percent to 2 percent solution of a white, bland, 
nonirritating soap; 1 teaspoonful of powdered soap in 1 quart of 
warm, water (99° F.). 
(d) Purgative or compound. 
1. Small evacuant enema. 
Magnesium sulphate 60 gm. 
Glycerine 30 cc. 
Water 120 cc. 
2. Large purgative enema. 
Magnesium sulphate 60 gm. 
Glycerine 60 cc. 
Oil of turpentine 4 cc. 
Hot soap suds (1 percent) 500 cc. 
(2) Methods of administration.— (a) If the rectum only is to be 
emptied, 1 pint of the enema is injected rapidly with the patient in 
the sitting posture (for patients not too debilitated to sit up). 
(h) For cleansing the entire bowel, 1 quart of the enema should 
be used with the patient recumbent or better still in the knee-chest 
position (if not too debilitated) and the solution given very slowly 
to prevent cramping. 
232. Miscellaneous.—a. Communicable diseases quarantine 'pe- 
riods (see FM 21-10 and FM 8-40).—(1) Measles, 10 days (mini- 
mum). German measles, 10 days. 
127 TM 8-260 
232 
MEDICAL DEPARTMENT 
(2) Mumps, 21 days (minimum). 
(3) Scarlet fever, 3 weeks (minimum). 
(4) Chickenpox, all lesions must be healed. Minimum 10 days. 
(5) Epidemic meningitis. Three consecutive negative cultures 
from nose (both sides) and from throat for meningococci, 5 days 
apart, taken before discharge. 
(6) Typhoid group of diseases, 3 consecutive negative cultures from 
stool and from urine at 5-day intervals. (Post surgeon should be 
notified to prevent the assignment of the patient to duties involving 
the handling of food.) 
(7) Dysentery, amoebic or bacillary, same as for typhoid. 
(8) Diphtheria, five consecutive negative cultures from nose and 
throat at 3-day intervals. 
(9) Smallpox, until lesions healed. 
b. Cbmmvmcable diseases reportable to Boards of Health.—(1) 
Amoebic dysentery. 
(2) Chickenpox. 
(3) Diphtheria. 
(4) Epidemic meningitis and meningococcemia. 
(5) Erysipelas. 
(6) Influenza. 
(7) Measles. 
(8) Pellagra. 
(9) Pneumonia. 
(10) Poliomyelitis. 
(11) Rocky Mountain spotted fever. 
(12) Scarlet fever. 
(13) Smallpox. 
(14) Tuberculosis. 
(15) Tularemia. 
(16) Typhoid fever. 
(17) Typhus. 
(18) Undulant fever. 
(19) Venereal diseases. 
(20) Whooping cough. 
c. Table of normal values in blood examinations.—All amounts 
for blood chemistries are in milligrams per 100 cc. of whole blood 
unless otherwise stated, and these values are for bloods taken in the 
morning after a fast of at least 10 hours. 
128 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
232 
Normal 
Remarks 
Nonprotein nitrogen 
25-35 
During digestion there is a rise of 
about 4 mg. per 100 cc. Anything 
below 30 mg. is to be considered 
normal, but values up to 35 mg. are 
to be found without any evidence 
of kidney retention. 
Urea nitrogen 
12-17 
During digestion of a full meal con- 
taining meat, a rise of 2 or 3 or 
more mg. occurs. In the usual run 
of clinical cases, values as high as 
20 mg. may be encountered. 
Creatinine __ 
1-2 
In a selected series of normals the 
upper limit may be as low as 1.7 
mg.; 2 mg. is the more common 
upper limit of normal. 
Uric acid 
2-4 
The figures given are based on Bene- 
dict’s method which gives some- 
what higher figures than does that 
of Folin and Wu. Values as high 
as 4.5 mg. are frequently found in 
bloods, all the other values of which 
are well within normal range. 
Sugar 
80-120 
During the absorptive period after 
food there is marked increase, de- 
pendent on the carbohydrate con- 
tent of the food. The extent of 
this rise after a standard carbo- 
hydrate meal is the basis of the 
“sugar tolerance test.” 
Chlorides 
450-500 
Figures for plasma are somewhat 
higher than those for whole blood; 
575 to 625 mg. per 100 cc. 
Cholesterol _ __ 
140-190 
Bloor gives an average figure of 210 
mg. per 100 cc. and others regard 
the normal as lying even higher. 
It is probable, however, that 
150 mg. is a fairly representative 
normal standard. 
Calcium 
9-11 
These values are for the serum alone 
and represent the total calcium 
present in the serum after clotting 
and separation of the clot. 
Phosphorus 
3-4. 5 
These values are for the inorganic 
phosphorus of the serum after sepa- 
ration from the clot. 
Alkali reserve (C02 com- 
53-77 
bining power of the 
volumes 
blood plasma). 
percent 
129 TM 8-360 
232 
MEDICAL DEPARTMENT 
Normal 
Remarks 
Alkali reserve (alveolar 
CO2 tension). 
van den Bergh 
5-5. 5 
volumes 
0. 4-0. 8 
These figures are based on the Frid- 
ericia method, which represents 
arterial rather than venous carbon 
dioxide tension. 
A van den Bergh unit is equivalent 
to 1 part of bilirubin in 200,000 
parts of serum. The quantitive 
estimation is made by the indirect 
test only. 
An icterus index below the normal 
Icterus index 
4—6 
Total serum proteins 
6. 5-7. 5 
limit of 4 has so far been found only 
in cases of secondary anemia. An 
icterus index of 15 is necessary for 
jaundice to be evident clinically. 
Hence, an index between 6 and 15 
is termed “latent jaundice.” 
Low in nephritis with oedema. 
Low in nephrosis. 
In lipoid nephrosis the globulin is 
usually normal and the reduction 
is in serum albumin giving an in- 
verse ratio. 
In extreme cases variation of 0.2 to 
0.5 may occur. 
For adults, 10 units is upper limit of 
normal. For children, 15-20. 
Howell method, 10-20 minutes. The 
quotient of Herwitz and Lucas ob- 
tained by dividing the unknown by 
the prothrombin time of a nor- 
mal person, the normal being 1.0. 
Begins in 3 to 6 hours; should be com- 
plete in 24 hours. 
1 to 3 minutes. 
Serum albumin 
percent 
4. 5-5. 5 
Serum globulin 
percent 
2. 2-2. 5 
Albumin-globulin ratio pH 
of blood. 
Phosphatase _ _ _ _ 
percent 
2-2. 3 
7. 51-7. 33 
Prothrombin _ 
Clot retraction time 
Bleeding time. 
Coagulation time _ _ 
1 to 4 minutes. 
Reticulocytes 
0.5 to 2.0 percent. 
150,000 to 300,000. 
Cutler method with graph. At the 
end of one hour normal equals men 
0-8 mm., women 0-10 mm. 
Segmented neutrophiles, 50 to 70 per- 
cent. No myelocyte forms should 
be present. 
Platelet count__ __ ___ 
Sedimentation. _ 
Shilling count 
130 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
232 
d. Normal values for cerebrospinal fluid (Wechsler, 1939).— (1) 
Fluid is clear, watery, colorless, alkaline. 
(2) Pressure, patient recumbent, 100-150 mm. water; patient sit- 
ting, 200-250 mm. water. Queckenstedt, jugular pressure causes 
sharp rise of pressure to 350-500 mm. water or to 25-5 mm. mercury, 
followed by sharp fall on release of jugular pressure. 
(3) Specific gravity 1,006 to 1,008. 
(4) Cells, 0-5 per cubic millimeter over 5 abnormal. 
(5) Sodium chloride, 720-750 mgm. per 100 cc. 
(6) Globulin, none. 
(7) Albumin, trace (2-5 mgm. per 100 cc.). 
(8) Total protein, 25-40 mgm. per 100 cc. 
(9) Nonprotein nitrogen, 12-18 mgm. per 100 cc. 
(10) Glucose, 50-80 mgm. per 100 cc. 
(11) Wassermann and Kahn, negative in all dilutions. 
(12) Colloidal gold reaction, 0000000000. 
e. Sputum collection in pneumonia cases for pneumococcus typing.— 
(1) (a) The importance of proper collection of sputum for typing 
and examination cannot be overemphasized. Encourage the patient 
to cooperate and make sure the sputum is a “coughed up” specimen 
from bronchi and lungs and not “hawked up” post nasal secretions. 
This must he personally supervised by the nurse or doctor. 
{b) In children one should not depend on coughed up secretions 
but the specimen should be obtained by aspiration with catheter and 
30-cc. syringe. The technique is as follows: One attendant should 
hold the child’s hands and keep the head steady as the operator inserts 
a tongue depressor toward throat to hold the tongue down and initiate 
cough reflex. As the child coughs the catheter is gently inserted a 
short distance in the open respiratory passages. At this moment 
another assistant quickly manipulates the plunger of the syringe at- 
tached to catheter. By pulling the plunger out quickly and returning 
it somewhat more slowly several times, a specimen is usually ob- 
tained. The mucous will adhere to the catheter and it must be forcibly 
ejected by the syringe into sputum container. 
(2) Send the sputum to the laboratory in a sterile petri dish. The 
sputum record should be marked emergency and the information re- 
quested should include— 
(a) Gross appearance (bloody, rusty, etc.). 
(b) Gram stain for predominant type of organism. 
(c) Culture. 
(d) Pneumococcus typing. 
131 TM 8-260 
232-233 
MEDICAL DEPARTMENT 
(3) It is very important to decide at once if mixed infection is 
present or not as use of serum, chemotherapy, or combination of 
these will depend largely on this decision. If doubt exists or if spe- 
cific serum therapy has been ineffectual, retyping or recheck for 
mixed infection is important. 
(4) A blood culture should be taken at the same time. If it is 
positive a check on the type of organism found in the sputum will 
be available in 18 to 24 hours. 
Section III 
GENERAL SURGERY 
Paragraph 
General routine upon admission 233 
Preparation of patient for operation 234 
Post-operative care 235 
Special post-operative diets 236 
Post-operative care of hemorrhoid and rectal cases 237 
Technique for intravenous infusion 238 
Severe head injuries, concussion, severe contusion, skull fractures, etc 239 
Report of operation and request for pathological examination 240 
Anesthesia and operating room 241 
Immediate post-operative routine 242 
En route from operating room to bed 243 
233. General routine upon admission.—a. Ward routine on 
day of admission.— (1) Take and record temperature, pulse, respira- 
tion. 
(2) Notify ward officer or officer of the day of admission and ap- 
parent condition. 
(3) Bath: Tub or shower for ambulant cases. Sponge for seriously 
ill. Omit bath in any case in which nurse in charge has a doubt as to 
its advisability. 
(4) Weigh and record weight after bath unless condition of pa- 
tient contraindicates. 
(5) Bed for all patients until otherwise ordered by ward officer 
or officer of the day. 
(6) Urine: Save first urine from emergency cases for gross inspec- 
tion by ward officer or officer of the day, and send to laboratory for 
examination. 
(7) Diet: Emergency cases nothing by mouth until seen by ward 
officer or officer of the day. 
(8) Abdominal cases nothing by mouth until otherwise ordered by 
ward officer. 
(9) Liquid diet for all other cases until differently ordered by ward 
officer. 
132 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
233 
b. Antitetanic serum.— (1) All cases admitted with wounds or burns 
are given antitetanic serum, observing the following technique: 
(2) Approximately 1 minim of the serum to be injected will be 
injected intradermally with a small skin needle. The raising of a 
wheal in the skin 1 millimeter in diameter corresponds approximately 
to 1 minim of the solution. At the end of 15 minutes if there is no 
reaction around the site of the intradermal injection, the patient can 
be considered not hypersensitive to the serum and the amount desired 
can be injected intramuscularly or hypodermically at once. If there 
is a reaction around the site of the intradermal injection, the patient 
can be considered hypersensitive to the serum and a desensitizing dose 
of y2 cc. will be injected, followed in 2 hours by the amount to be used. 
(3) The above is a simple test and, unless the case is a “horse asth- 
matic,” is considered safe for practical purposes, bearing in mind that 
the dose and desensitizing dose for children is in accordance to age 
and weight. 
c. Laboratory examinations.—Laboratory examinations are re- 
quested as follows: 
(1) Routine.—(a) Urine, morning after admission. 
(b) Blood count, red, white, differential, and hemoglobin. 
(c) Blood Wassermann. 
(d) Blood coagulation time all nose, throat, and genito-urinary 
patients. 
(2) As indicated.— {a) Urine, special examination. 
(b) Sputum. 
(c) Feces. 
(d) Nose and throat cultures. 
(e) Blood chemistry. 
(/) Blood typing. 
(y.) Blood culture. 
(A) Stomach analysis. 
(«) Gastro-intestinal series. 
(j) Barium enemas. 
(h) Other examinations. 
Care will be exercised to insure that requests for laboratory exami- 
nations are specific and that the information asked for will be of value 
in the study of the case. 
d. Special examinations.—(1) Rectal.—A digital examination is 
made in all abdominal and pelvic eases and in other cases as indicated. 
Proctoscopic or sigmoidoscopic examinations are made as indicated. 
(2) External genitalia.—Examined in all male cases. 
(3) Vaginal— Made as indicated. No vaginal examination in 
obstetrical cases. 
133 TM 8-260 
233-234 
MEDICAL DEPARTMENT 
(4) Blood 'pressure.—Taken and recorded in all cases at the origi- 
nal physical examination and thereafter as indicated. 
(5) Eye, ear, nose, and throat.—The examination is made and 
recorded in each case at the original physical examination. If 
special examination is indicated, the case is referred to the eye, ear, 
nose, and throat section. 
(6) Dental.—When indicated examination is requested of the den- 
tal service. 
e. Care of patients.— (1) Temperature, pulse, and respiration every 
4 hours from 7: 00 AM to 7: 00 PM, inclusive, until otherwise ordered 
by the ward officer. 
(2) Baths, daily. 
(a) Sponges for bed patients. 
(b) Shower or tub for patients as ordered by ward officer. 
(3) Diets: The diet in each case is ordered by the ward officer. 
The regular diets, liquid, light, and full, are prepared with careful 
attention to the usual needs. "When special diets are required the 
articles desired will be designated. 
(4) Medication is given only on the order of a medical officer. 
This includes cathartics and enemas. 
(5) Teeth of all surgical cases are examined often enough by 
the ward officer to satisfy him that the proper mouth hygiene is being 
carried out. 
(6) Hot water bags and ice caps are not used without suitable 
covers. 
(7) Ice caps prohibited for post-operative abdominal cases, except 
on written order of operating surgeon. 
(8) All dressings on cases in open wards are done behind screens 
with the attendants properly gowned, and wearing rubber gloves. 
234. Preparation of patient for operation.—a. When a patient 
is listed for operation he is sent to operating room the day before 
operation for proper shaving (see par. 241). 
b. The ward nurse sees that teeth are cleansed and assures herself 
that urine and blood counts are reported back by the laboratory. 
c. The ward officer prepares a preoperative examination report 
which accompanies patient to operating room. 
d. The night before operation the patient is given a light diet for 
supper and cup of hot chocolate or ovaltine at 8; 00 PM, or if pre- 
ferred, well-sweetened orange juice or cup of hot milk. 
e. Preoperative medication, depending on type of anesthesia, is 
ordered by ward officer (see par. 241). 
134 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
234-235 
f. Patient is instructed to void urine before going to operating 
room, and ward nurse assures herself that false teeth, plates, gum, 
and glasses are removed from patient. 
g. Preoperative preparation of rectal and colon cases for resection 
only: 
(1) After the diagnosis of a colon lesion is established, the patient 
is hospitalized 3 to 5 days prior to operation. 
(2) Patient is given a high caloric, low residue diet. 
(3) In most cases a saline cathartic, S. S. magnesium sulphate or a 
double Seidlitz powder is given, followed by thorough cleansing of 
the colon by warm compound or Nobel’s enema in morning and simple 
enema in afternoon. These enemas are continued daily until opera- 
tion. If enemas are not expelled the day of operation they are 
siphoned off. 
(4) Intravenous or subdermal glucose solution in sufficient quan- 
tities is given twice daily preceding operation. 
(5) Three days (72 hours) prior to operation 1 cc. of Bargen’s 
vaccine mixed with 10 cc. normal saline solution is given intraperi- 
toneally, using a 10-cc. Luer syringe, a blunt spinal needle, with strict 
aseptic precautions, and given on the side opposite to that of 
operation. 
235. Post-operative care (after patient is returned to bed).—a. 
Not left alone until sufficiently conscious to care for himself. 
b. Have basin for vomiting, towel, gauze, tongue forceps, and mouth 
gag on bedside table ready for emergency while patient is coming 
out of anesthetic. 
c. Patient is kept warm but not to be dehydrated by profuse sweat- 
ing upon return to the ward. 
d. Patient when returned to bed is put in a semi-Fowler position, 
except after a spinal anesthesia has been given, when the patient has 
the head lowered. 
e. Proctoclysis 25-50 drops per minute, on 2 hours and off 1 hour, of 
normal saline solution with 1 percent sodium bicarbonate (except 
after rectal operations) unless otherwise ordered. 
/. Catheterization. It is always advisable to delay catheterization 
and encourage patient to void, even to 18 hours. 
g. Give hot water or hot tea freely by mouth as soon as nausea 
ceases (except in stomach cases). 
h. Morphine is ordered as indicated for each case by the operating 
surgeon or by the ward officer. 
i. Measure and record fluid intake by mouth, rectum, hypodermoc- 
lysisj and proctoclysis until discontinued by order of ward officer. 
135 TM 8-260 
235 
MEDICAL DEPARTMENT 
j. After gastric or duodenal ulcer cases, drain stomach by stomach 
tube first night and twice daily thereafter when indicated by dilata- 
tion of stomach. 
k. Measure and record urine. 
l. Measure and record amount of vomitus. 
m. Nausea or vomiting, if excessive insert duodenal tube attached 
to vacuum bottle. 
n. Patient during first 48 hours post-operative is turned from side 
to side assisted by nurse (unless instructed to the contrary). 
o. Gas pains and distention: Enemas are not given prior to 48 
hours, unless ordered by the operating surgeon. A gas tube may be 
inserted, except in rectal cases, to relieve distention, and the following 
mixture to be sipped by patient may be given during first 48 hours 
for gas pains: 
Spirits peppermint, 4 cc. 
Sodium bicarbonate, 0.60 
Hot water, 60 cc. 
Enema effective for gas after 48 hours, designated Nobel’s enema, 
is prepared as follows: 
Turpentine, 4cc. 
Glycerine, 30 cc. 
Saturated solution magnesium sulphate, 90 cc. 
Warm water, 90 cc. 
p. No cathartic. 48 hours after operation {except gastric or rectal 
cases), give Nobel’s enema, and if results are not satisfactory follow 
2 hours later with simple enema. In rectal cases, see paragraph 237. 
q. Force fluids the first 3 days after operation, at least 2,000 cc. 
to 3,000 cc. each 24 hours by mouth and rectum, supplemented by 
intravenous of saline or 5 percent to 10 percent glucose or saline by 
hypodermoclysis. This is an important part of post-operative treat- 
ment. 
r. Diet: Hot water or hot tea may be given p. r. n. On second day 
hot beef or chicken broth may be added. If the required fluids, 
2,000 cc. to 3,000 cc. are given as indicated in e and g above, no 
other nourishment is necessary until after the bowels have moved 
as a result of the enema. 
s. Post-operative toxic goitre cases are given 10 to 20 drops Lugols 
solution in 45 cc. grape juice as soon as able to swallow after opera- 
tion and repeated every 4 hours for first 24 hours, then 10 drops 
every 4 hours for second 24 hours, and then as surgeon directs. 
Iced water, cold gingerale p. r. n. 
136 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
235-236 
t. Shock: Look for cause and treat as indicated: Raise foot of 
bed and warm blankets. 1,000 to 2,000 cc. 5 percent glucose intra- 
venously. Blood transfusion when indicated. Adrenalin M 15 of 
1 to 1,000 solution by hypo. 
u. Removal of sutures: Ordinarily, unless soiled, dressings in clean 
cases are not changed until sutures are to be removed. Muscle split 
appendix incisions on the 8th day, and patient to sit up in bed lean- 
ing against back rest, and the following day up in a chair and the 
10th day to walk. 
(1) Hernia cases.—Sutures out on the 9th day, but patient is not 
allowed to sit up until 18th day in bed. 19th day in chair, and the 
20th day may walk. 
(2) Right rectus or paramedian incision.—Sutures out 10th day 
and to sit up in bed. 11th day to sit in chair, and 12th day to 
walk. 
(3) Midline incision.—Sutures out 12th day, and sit up in bed 
12th and 13th days, up in a chair 14th and 15th days, and to walk 
the 16th day. 
v. Drainage cases are dressed as ordered in each case. 
w. A progress note in clinical record records any wound not heal- 
ing by primary union. 
236. Special post-operative diets.—a. Routine.— (1) Hot tea 
or hot water for the first 24 hours. 
(2) Hot water, hot tea, hot beef or chicken broth for second 24 
hours. 
(3) Liquid for the third 24 hours. 
(4) Soft for the fourth and fifth 24 hours. 
(5) Light for the sixth 24 hours. 
h. Gastric cases.— (1) First 24 hours: 
(a) 5 percent glucose, intravenous, 1,000 cc. night and morning. 
(h) Proctoclysis, on 2 hours, off 1 hour (normal saline). 
(c) Hot water or tea, 6 to 10 cc. q. 20 minutes if desired. 
(2) Second 24 hours: 
(a) 5 percent glucose intravenous, 1,000 cc. night and morning. 
(6) Proctoclysis, normal saline, on 2 hours, off 1 hour. 
{c) Hot water or tea, 6 to 10 cc. q. 20 minutes if desired. 
(3) Third 24 hours: 
{a) 8:00 AM Strained broth of oatmeal, barley, or rice— 60 cc. 
(b) 10:00 AM Orange juice sweetened to taste 20 cc. 
(c) 12:00 M Strained broth 60 cc. 
(d) 2:00 PM Orange juice ' 20 cc. 
(e) 4:00 PM Strained broth 60 cc. 
(/) 6:00 PM Orange juice 20 cc. 
137 TM 8-260 
236 
MEDICAL DEPARTMENT 
(g) 9:00 PM Orange juice 20 cc. 
(A) Hot water 20 cc. q. 15 minutes if desired. 
(4) Fourth 24 hours: 
(а) 6:00 AM Orange juice sweetened to taste 30 cc. 
(б) 8:00 AM Strained broth of oatmeal, barley, rice, or 
peas 60 cc. 
(c) 9:00 AM Orange juice 30 cc. 
(d) 11:00 AM Orange albumin 30 cc. 
(e) 12:00 M Strained broth 30 cc. 
(/) 2:00 PM Orange albumin 30 cc. 
(g) 3:00 PM Orange juice 30 cc. 
(A) 4: 00 PM Strained broth 60 cc. 
(i) 6:00 PM Orange juice 30 cc. 
(j) 9:00 PM Orange juice 30 cc. 
(A) Hot water 30 cc. q. 30 minutes. 
(5) Fifth 24 hours: 
(a) 6:00 AM Orange juice, sweetened 100 cc. 
(b) 9:00 AM Strained gruel of oatmeal, barley, or rice 60 cc. 
With strained stewed prunes, apple sauce, 
or apricots 30 cc. 
(c) 12:00 M Strained puree of peas, string beans, carrots, 
spinach, or cauliflower 60 cc. 
Beef juice 20 cc. 
Fruit ice 16 gm. 
Butter 2 gm. 
(d) 2:00 PM Orange juice, sweetened 100 cc. 
(e) 4: 00 PM Strained gruel of oatmeal, barley, or rice 60 cc. 
With strained stewed prunes, apple sauce, 
or apricots 30 cc. 
(/) 8:00 PM Orange juice 100 cc. 
(6) Sixth and seventh days: 
(a) 6:00 AM Orange juice, sweetened 150 cc. 
(b) 9:00 AM Gruel and puree 100 cc. 
(c) 12:00 M Puree 100 cc. 
Beef juice 30 cc. 
Fruit ice 30 gm. 
(d) 2:00 PM Orange juice 100 cc. 
(e) 4:00 PM Gruel and fruit 100 cc. 
(/) 6:00 PM Orange juice 100 cc. 
(y) 8:00 PM Orange juice 100 cc. 
138 TM 8-260 
236-237 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(7) Eighth and ninth days: 
(a) Breakfast; Wheatena, farina, cream of wheat, thor- 
oughly cooked and strained 200 cc. 
Strained stewed fruit 36-48 gm. 
Hot tea 200 cc. 
(b) 9:00 AM Orange juice 120 cc. 
{c) Dinner: Baked potato, small and mealy, with 
square of butter and a little salt. 
Strained spinach, carrots, peas, string 
beaus, asparagus, or cauliflower 150 cc. 
Beef juice 30 cc. 
Vegetable may be decreased and an 
equal amount of zweiback or arrow- 
root crackers soaked in beef juice 
substituted. 
Fruit juice 60 cc. 
(d) 2:00 PM Orange juice 120 cc. 
(e) Supper: Same as breakfast but add 100 cc. of 
custard junket or gelatine. 
(/) 8:00 PM Orange juice 120 cc. 
(8) Tenth day, etc.: 
(a) Same as ninth day but add soft-boiled or poached egg with a 
small piece of double toast and butter for breakfast. 
(b) Add lamb chop, chicken, first, 10 cc. jelly or marmalade with a 
small piece of double toast for dinner or supper. Strain vegetables 
and cereals until the fourteenth day. 
c. Gastric resection cases.— (1) First seven days, same diet as all 
gastric cases. 
(2) Beginning eighth day: 
(a) Breakfast: Same as all gastric cases, half 'portion. 
(b) 7; 30 AM Fruit juice 150 cc. 
(c) 9:30 AM Eggnog (with zweiback) 150 cc. 
(d) Lunch: Same as gastric cases, half 'portion. 
(e) 2:00 PM Fruit juice (with zweiback) 150 cc. 
(/) 4:30 PM Supper as for gastric cases, half portion. 
(g) 6:30 PM Fruit juice 150 cc. 
(A) 8:30 PM Cocoa (with toast) 150 cc. 
237. Post-operative care of hemorrhoid and rectal cases.—a. 
First 24 hours: 
(1) Hot water and hot tea in moderate quantities allowed at once. 
(2) No fluids by rectum. 
(3) Hypo morphine sulphate, 0.016 gram (% gr.) p. r. n. for pain. 
139 TM 8-360 
337-238 
MEDICAL DEPARTMENT 
h. Second 24 hours: 
(1) Surgical liquids, orange juice, fruit juices, hot tea, hot beef tea, 
or broth. 
(2) For pain or tenesmus give 1 grain codeine, 5 gr. aspirin. 
c. Third 24 hours: 
(1) 6: 00 AM Mineral oil, 20 cc. Repeat at 8:00 PM. 
(2) Oatmeal gruel, fruit juices, hot coffee, strained soup. 
(3) Continue aspirin and codeine for pain. 
d. Fourth 24 hours: 
(1) 6:00 AM Mineral oil, 20 cc. Repeat oil at 8:00 PM and add 
8 cc. cascara. 
(2) Continue diet of third 24-hour period. 
(3) Codeine and aspirin for pain. 
e. Fifth 24 hours: 
(1) 6: 00 AM and 8: 00 PM. Mineral oil, 20 cc., with 10 cc. cascara. 
(2) Add any cooked cereal, baked potato, boiled rice, stewed prunes, 
and baked apple to diet. 
(3) Continue codeine and aspirin for pain. (If given after bowels 
have moved it will stop tenesmus.) 
/. Sixth 24 hours: If bowels have moved, give light diet. Patient 
may go to bathroom during sixth 24-hour period. 
g. Seventh 24 hours: Officer and women patients may be discharged 
with instruction to continue mineral oil, use damp cloth after bowel 
movement; give patient three or four doses of codeine and aspirin to 
take home to be taken if he has tenesmus after bowel movement. En- 
listed men and those on enlisted status should remain in hospital about 
10 days. 
238. Technique for intravenous infusion.—a Patient to be 
screened. 
h. Medical officer to wear clean gown and sterile gloves. 
c. Glassware and tubing to be sterile and clean. 
d. Read the label carefully on solution to be given and be sure it is 
the correct solution, and that it is a fresh sterile solution. 
e. Put folded bath towel under patient’s arm. 
/. Apply light tourniquet to patient’s arm. 
g. Paint patient’s arm with iodine. 
h. Put about 100 cc. of the solution to be given (saline or glucose) in 
the flask and rinse the flask out with this solution and allow to run out 
through the tubing to cleanse the tube. 
i. Fill flask half full with the solution to be given and get all the air 
out by lowering the flask while the tube is elevated; repeat if necessary. 
140 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
238-240 
j. Have nurse hold the flask and tube while the medical officer punc- 
tures the vein. Be sure the needle is open before the vein is punctured. 
Be sure that the needle is well within the vein, then take off tourniquet. 
Jc. Allow a few drops of solution to run out of the tube to get all air 
out, then connect with needle. 
l. The medical officer is not to lea/ue the 'patient while intravenous is 
being given. 
m. Upon chilly sensations, weakness, or other evidence of reaction, 
the infusion is stopped at once. 
n. The blood pressure is taken before infusion is started, and the 
blood pressure apparatus left on. The pressure is taken when the 
infusion is half completed, and again upon completion. When the 
pressure is taken during the infusion, if there is a marked rise or 
fall in the pressure, the infusion is stopped. 
o. The intravenous infusion must be given slowly. At least 15 
minutes must be allowed for each 500 cc. of infusion. 
p. Intravenous therapy is a serious procedure and should be so 
considered. It must be given carefully and correctly. 
239. Severe head injuries, concussion, severe contusion, 
skull fractures, etc.—a. Patient to be put in warm bed on admis- 
sion to ward, clothing removed with as little disturbance as possible. 
h. Blood pressure taken and recorded. 
c. Ear and fundus examination made as soon as possible. 
d. Ward officer will report case, with essential data to the office, 
chief of surgical service. 
e. All early treatment will be conservative. 
/. A consultant from the neuropsychiatric section will be called. 
g. Patient will not be sent to X-ray section until approved by an 
operating surgeon and consultant. 
240. Report of operation and request for pathological ex- 
amination.—a. The operating report in every instance is signed by 
the operating surgeon. The diagnosis to be clear and concise and, 
where multiple conditions, numbered 1, 2, 3, etc., and conform to 
standard nomenclature. Operations also to be numbered 1, 2, 3, etc., 
stating simply name of operation. Qualifying remarks concerning 
diagnosis and operative procedure will be extended on reverse side 
of Operation Report (W. D., M. D. Form 55 0-2). 
~b. All operating surgeons personally prepare and sign requests 
for pathological examination, or direct one of their assistant surgeons 
to prepare it, with especial attention to a brief description of the 
specimen and the clinical diagnosis. This information aids the 
pathologist in reaching his conclusions. 
141 TM 8-260 
241 
MEDICAL DEPARTMENT 
241. Anesthesia and operating room.—a. Shaving, preopera- 
tive.—Shaving bj personnel from operating room day previous to 
operation except in emergency. After shaving wash field thoroughly 
with green soap and water. In emergency cases parts will be shaved 
with dry lather and cleansed with alcohol or ether. No water will 
be used on skin (reason is that it makes iodine less effective). 
h. Anesthetists trained in taking blood pressure.—Anesthetists in 
operating room will be trained in taking blood pressure. Special 
blood pressure apparatus attached prior to anesthesia enables anes- 
thetists to take pressure at regular intervals during operation. 
c. Preoperative preparation and premedication.—(1) Spinal anes- 
thesia.— (a) Light supper; nothing by mouth after midnight. 
(b) S. S. enema at 9: 00 PM and 6: 00 AM. 
(c) Sodium amytal 0.195 grams (3 gr.) at 9:00 PM and in the 
morning 2 hours before the time set for operation. 
{d) Hypodermic of morphine 0.016 gram (14 gr.) with scopolamin 
0.0004 gram (%50 gr.) 1 hour before operation. 
(2) Gas oxygen anesthesia.—Same as the above except for medica- 
tion. Give morphine 0.016 gram (14 gr.) with atropine 0.0004 gram 
(i/i50 gr.) 1 hour prior to operation. 
(3) Avertin anesthesia.— (a) Record weight, height, and age, give 
B. M. R. if known. No laxative for 24 hours before day set for opera- 
tion. S. S. enema at bedtime. Twenty minutes after S. S. enema 
give clear water enema. Allow patient to go to toilet to expell enema 
if able to do so. 
(b) Sodium amytal 0.195 gram (3 gr.) at bedtime. 
(c) Hypo morphine 0.010 gram (% gr.) 1 hour before time set 
for operation. 
(d) Give no enema in AM. 
(e) Light supper; nothing by mouth after midnight. 
(4) Colonic ether.— (a) No laxative for 24 hours before operation. 
Nothing by mouth after midnight. Tea and toast for supper. 
(b) Two hours after supper give S. S. enema followed at 20-minute 
intervals by two clear water enemata. If unconscious or uncooper- 
ative give colonic irrigation until return is clear. 
(<?) Thirty minutes after last enema, give sodium amytal 0.195 
gram (3 gr.) by mouth. 
(d) In morning exclude visitors. 
(e) Give clear water enema 2 hours before operation. 
(/) One and one-half hours before operation give hypodermic of 
morphine 0.008 gram (% gr.) intramuscularly and a suppository of 
chloretone 0.640 gram (10 gr.) is inserted. One hour before opera- 
142 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
241-242 
tion another hypodermic of morphine 0.008 gram {y8 gr.) with at- 
ropine 0.0004 gram (%50 gr.) is given and the ether-oil mixture is 
instilled. 
(5) Ether anesthesia.—Same preparation as for spinal above, ex- 
cept for premedication. Give morphine 0.016 gram (14 gr.) (average 
dose) with atropine 0.0004 gram (%50 gr.) 1 hour before operation. 
In emergency cases to be done at once, give morphine 0.016 gram 
gr.) and atropine 0.00065 gram (%00 gr.) at once. 
d. Preparation in operating room.— (1) Surgeons and nurses.— 
Hands and arms: 
(a) Clean nails. 
(b) Wash hands quickly with plain soap and water. 
(e) Take sterile brush, dip in green soap and scrub hands, arms, 
and elbows for 3 minutes, especial attention to scrubbing around nails 
and between fingers. Rinse off in running water. 
(d) Use orange stick to clean nails. 
(e) Take a fresh brush and repeat as in (c) above, except the elbows. 
(/) Hands and wrists immersed in ethyl alcohol, 
(g) Gowns and gloves: Sterile gown will be put on before wiping 
hands with sterile towel. 
(h) Sterile powder is shaken on surgeon’s hands by operating 
nurse. 
(i) Dry sterile gloves are held for surgeons by operating nurse. 
(2) Patient.—Skin preparation on table just prior to operation: 
(a) Two coats of Sy2 percent tincture iodine, each coat to be dried 
with hot air dryer. In the vagina 1% percent tincture iodine will be 
used. 
(b) Remove iodine with alcohol or sponge stick. 
242. Immediate post-operative routine.—a. Lighten anesthesia 
as soon as possible. Rebreathe for 15 minutes with oxygen and car- 
bon dioxide 5 percent until respirations are distinctly simulated, in- 
creasing in rate as well as depth. In laparotomies, may begin as 
soon as the peritoneum is closed. Leave in airway until reflexes are 
reestablished. Prevent aspiration of vomitus or tongue. In avertin 
cases, hold up jaw until reflexes return to prevent dropping back of 
tongue. Keep on back and leave in airway. 
h. Record pulse and blood pressure as the patient is about to leave 
the table. 
c. Transfer from table to warm litter with great gentleness and 
avoid exposure. 
d. Have basin for vomiting on litter, also towel, gauze, tongue 
forceps, and mouth gag. 
143 TM 8-260 
242-244 
MEDICAL DEPARTMENT 
e. Body and head well wrapped with heated blankets for transpor- 
tation through corridors to ward. 
243. En route from operating room to bed,—a. Keep warm. 
b. Watch to see that patient does not swallow his tongue or regur- 
gitate and strangle while coming out of ether. 
c. Patient not left by operating room orderly and anesthetist until 
in bed and turned over to ward nurse. 
d. Great care exercised in transferring patient from litter to bed. 
Section IV 
Paragraph 
Emergency treatment of severe injuries 244 
Preoperative preparation 245 
Post-operative care 246 
Plaster casts 247 
Traction cases 248 
ORTHOPEDIC SURGERY 
244. Emergency treatment of severe injuries.—In all major 
acute fractures or fresh wounds with tendon injury, notify the 
ward officer on call. 
a. Examination.—Immediately upon admission such cases should 
be examined for extent and severity of injuries, location of possible 
fractures or dislocations, presence of shock. When examining for 
fractures do not attempt to elicit crepitus, etc. Inspection and gentle 
palpation will be sufficient to make the diagnosis in most cases. 
X-rays will supply the necessary information. 
b. Fractures.—Fractures should be immobilized immediately by the 
use of appropriate splints. Splinting reduces pain and shock and 
prevents further displacement of the fragments, thus preventing 
further damage to muscles, nerves, and blood vessels. The use of 
splints in specific fractures is given in d below. 
c. X-ray.—Anterior-posterior and lateral X-rays should be taken 
in all suspected fractures or dislocations as soon as patients are 
admitted. Reduction of dislocations should not be attempted until 
after X-rays have been taken. If the patient is in serious condition, 
bedside X-rays should be taken. 
d. Emergency splinting of specific fractures.—(1) Clavicle.— 
Clavicular T-splint. 
(2) Scapula, shoulder joint, and humerus.—Aeroplane splint with 
45° to 60° abduction at the shoulder. 
(3) Elbow joint.—Right angle aluminum splint with a sling. 
(4) Forearm and hand.—Wood coaptation or aluminum splints. 
144 TM 8-260 
244-245 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(5) Hip, femur, and knee joint.—Half ring splint with adhesive 
or ace adherent skin traction. 
(6) Leg, ankle, and foot.—Cabot splint. 
(7) Pelvis.—Keep patient supine on hard bed. Tight binder or 
adhesive plaster about pelvis for support. Determine if there has 
been injury to the bladder or urethra. 
(8) Spine.—Special care must be taken in handling patient for 
X-ray to maintain hyperextension. In all fresh fractures with cord 
symptoms notify ward officer at once. 
(9) Cervical spine.—Place neck in hyperextension on a Bradford 
frame or with a blanket roll under the mattress and apply head 
traction. 
(10) Lumbar and thoracic spine.—Place patient on adjustable bed 
with head to foot of bed and elevate the knee support moderately. 
e. Treatment of lacerated wounds and compound fractures.—If 
wounds were incurred within the last 6 hours, thorough debride- 
ment and primary closure. If wounds are between 6 and 2-1 hours 
old, thorough debridement and closure with drainage. Wounds over 
24 hours old should be considered infected and so treated. Admin- 
ister A. T. S. (1,500 units) to all cases of lacerated wounds. (Use 
intradermal test and desensitize if necessary.) When indicated 
gas bacillus antitoxin should be administered. 
/. Nerves and tendons.—In fractures, especially of the arms, the 
function of the motor nerves should be tested at the time of admis- 
sion. In all wounds of the extremities careful examination should 
be made to determine nerve or tendon injury. Recent tendon in- 
juries should receive prompt treatment. Tendons and nerves should 
be sutured with silk. 
g. Fresh wounds.—Fresh wounds should be freely irrigated with 
warm saline. 
245. Preoperative preparation.—Preparation of site of opera- 
tion : 
a Forty-eight hours preceding operation thoroughly cleanse the 
part with soap and water. Shave and remove all soap with ether. 
Apply occlusive sterile dressing. On the day preceding operation 
apply Zy2 percent iodine, allow to remain 5 minutes and remove 
with special thiosulphate solution and again apply sterile occlusive 
dressing. 
h. In cases operated in emergency, use no water but shave dry 
and cleanse with benzine and ether. 
c. Preoperative medication for anesthesia same as general surgery. 
145 TM 8-260 
246-247 
MEDICAL DEPARTMENT 
246. Post-operative care.—a. Fluids as soon as tolerated, begin- 
ning with small amounts; may have tap water, tea, and fruit juices. 
h. Soft diet when desired unless otherwise ordered. Regular diet 
after 3 days. 
c. In major operative procedures record urinary output for 48 
hours. 
d. Spinal anesthetic cases may have one pillow after 8 hours except 
after spinocaine and except when otherwise ordered. 
e. Extremities with new casts will be elevated 30° and examined 
frequently for color, temperature, and sensation. Any unusual local 
discomfort from casts for splints that is severe enough to keep parient 
awake will be called to the attention of ward officer or surgical officer 
of the day, 
/. Morphine 0.016 gram (1/4 gr.) for pain as necessary every 3-4 
hours during first 24 hours, and for severe pain when needed during 
second 24 hours. For less severe pain and after 48 hours give codeine 
0.065 gram (1 gr.) as indicated. Every effort should be made to 
relieve the patient’s discomfort during the post-operative period. 
g. Seidlitz powder 48 hours after operation. Mineral oil and cas- 
cara daily thereafter as necessary. Decrease or discontinue cascara 
dosage according to individual requirements. If bowels do not move 
after seidlitz powders, give enema. Enema may be given any time for 
distention or discomfort (preceded by 15 minutes by 1 cc. pituitrin 
on order of medical officer). 
h. Temperature, pulse, and respiration taken and recorded on 
graphic chart until discontinued by ward officer, 
i. No visitors while patient is in the recovery room. 
247. Plaster casts.—a. Extremities.—Extremities with casts 
should be elevated and supported in comfortable position. Cast 
should be kept uncovered until dry, 
h. Pressure.—Complaints of local discomfort should be promptly 
investigated and windows cut in the cast when necessary. The heel, 
malleoli, and lateral surface of the foot in the lower extremity and 
the medial epicondyle in the upper extremity are common sites of 
pressure. Nerve pressure on the peroneal nerve and radial nerves 
are common, and any evidence of weakness of extension of the foot or 
hand should be promptly investigated. 
c. Body casts.—Before application the patient should be prepared 
with an enema with or without pitressin, and the same measures 
should be used after application to relieve distension. Casts should 
be supported to prevent breaking. 
146 TM 8-260 
248-249 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
248. Traction cases.—Traction apparatus and fracture beds re- 
quire constant inspection and supervision. All the ward personnel 
must be alert to discover defects. Patients’ complaints must be inves- 
tigated. Apparently minor maladjustment in splints and traction 
may cause more discomfort than fractures and operations, and often 
the patient can be made comfortable with little effort. 
a. Fracture beds.—Bed frames will be protected from metal clamps 
with rubber tubing. Clamps will be in proper position and tight. 
b. Splints.— (1) The ring of the half ring splint should fit firmly 
against the ischial tuberosity. The ring and the skin it contacts 
must be cleansed and inspected daily by the ward nurse. 
(2) The extremith should be well supported with adequate padding. 
(3) The foot support should fit properly to prevent plantar flexion 
deformity. 
c. Traction.— (1) Weights must not bo released or changed except 
with permission of the ward officer. Traction must not be interrupted 
in fracture cases. Traction on post-operative knee cases or on ampu- 
tation stumps may be briefly interrupted for nursing care. 
(2) Weights must swing free at all times and not rest on the bed 
or on the floor. 
Section V 
Paragraphs 
Diagnostic procedures 249 
Operation preparation 250 
Post-operative care 251 
Urological instruments 252 
Special care of prostate obstruction cases 253 
Miscellaneous urological procedures 254 
GENITO URINARY SURGERY 
249. Diagnostic procedures.—Preparation for— 
a. KUB, cystogram, lumbar spine.— (1) Cascara 8 cc. or castor oil 
45 cc. at 8:00 PM. 
(2) S. S. enema at 8:00 PM preceding night and 6:00 AM day 
of examination. 
(3) Light breakfast. 
b. Cystoscopy and endoscopy.—(1) Light breakfast. 
(2) S. S. enema at 6: 00 AM day of examination. 
c. Urogram, pyeloscopy, vesiculogram.—(1) Cascara 8 cc. or castor 
oil 45 cc. at 8: 00 PM preceding night. 
(2) S. S. enema at 8:00 PM preceding night and 6:00 AM day 
of examination. 
(3) Light breakfast. 
147 TM 8-260 
249-250 
MEDICAL DEPARTMENT 
(4) 200 cc. water every hour after 5:00 AM. 
(5) Precede cystoscopy 3 days with urinary antiseptics. 
(6) Morphine sulphate 0.016 gram and atropine 0.00065 gram *4 
hour before procedure. 
(7) Urogram and pyeloscopy postoperative treatment: 
(a) Hot bath 20 minutes on return from cystoscopy room. 
(5) Rest in bed 24 hours. 
(c) Hot application. Codeine, morphine, and atropine, as neces- 
sary for pain. 
(d) Urinary antiseptics 3 days following examination. 
(e) Fluid intake minimum 3,000 cc. daily for 3 days. 
d. Excretory urograph.—(1) Cascara 8 cc. or castor oil 45 cc. at 
8: 00 PM preceding night. 
(2) S. S. Enema at 8:00 PM preceding night and 6:00 AM day 
of examination. 
(3) Nothing by mouth after midnight. 
250. Operation preparation.—a. General.— (1) Rest in bed 3 
days preceding operation. 
(2) Dental prophylaxis and ward care of mouth. 
(3) Complete blood and urine examination 48 hours before opera- 
tion. 
(4) S. S. enema at 8:00 PM day before operation and 6:00 AM 
day of operation. 
(5) Light supper day before operation. 
(6) Fluids freely until midnight. Nothing by mouth after mid- 
night. 
(7) Sodium amytal 0.194 gram or nembutal 0.032 gram at bedtime 
and y2 hour before operation. 
(8) Morphine sulfate 0.016 gram scopolamine hydrobromide 0.0004 
gram before sending patient to operating room. 
b. Special preoperative requirements and preparation.— (1) Pre- 
operative requirements for cases of prostate hyperplasia and bladder 
neck obstruction: 
(a) Complete blood examination, including coagulating time. 
(b) Complete urinalysis. 
(c) Wassermann reaction, 
(d) Blood chemistry, urea nitrogen, sugar, C02. 
(e) Residual urine determination. 
(/) Catheterization specimen or urine culture. 
(g) Prostate examination and smear to laboratory, 
(h) PSP renal function. Concentration and dilution tests. 
(*) X-ray kidney and bladder. 
(j) Cystogram as indicated. 
148 TM 8-260 
250-251 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(&) Excretory urogram as indicated. 
(1) Examination for the elimination of foci of infection. 
(m) Minimum total fluid intake 3,000 cc. daily (oral, rectal, and 
intravenous). Keep record of fluid intake and output. 
(2) Preparation of patient for urethral instrumentation, cystos- 
copy, sounds, dilation, etc. 
(a) Morphine 0.016 gram and atropine 0.00065 gram before instru- 
mentation. 
(b) Cleanse external genitalia widely with solution of green soap 
and water. Remove soap and dry with sterile towel or gauze. 
(c) Apply bichloride solution 1 to 1,000 to external genitalia with 
gauze. 
(d) Drape patient with sterile towels or special sheets according 
to the extent of the instrumentation. 
(e) Inject 15 cc. 1 to 500 nupercaine solution into urethra and 
retain for 10 minutes. 
(/) Catheterize with flexible rubber catheter, determine residual, 
obtain specimen for culture, and irrigate with boric acid solution 
and leave 200 cc. in bladder. 
251. Post-operative care.—a. General.— (1) Elevate foot of bed 
25 cm. for 4 hours following spinal anesthesia unless conditions 
contraindicate. 
(2) Small amount of water by mouth first and second days. 
(3) Change position every 3 hours when awake. 
(4) Deep breathing exercise every y2 hour when awake. 
(5) Morphine 0.016 gram and atropine 0.00065 gram hypo p. r. n. 
(6) S. S. enema third post-operative morning. 
(7) Fluid intake minimum 3,000 cc. daily, oral, proctoclysis, 
intravenous. 
(8) Prostatectomy cases, give no enema, no proctoclysis. 
(9) Liquid petrolatum and cascara p. r. n. after fifth day. 
(10) Initiate appropriate treatment of ileus when it occurs. 
b. Special treatment.—(1) Nephrolysis.—{a) Keep patient on 
back or operative side first 10 days. 
(b) Elevate foot of bed 25 cm. during first 3 days. 
(c) Keep patient in bed for 2 weeks. 
(d) Urogram, renal function, and blood chemistry 5 weeks post- 
operative. 
(2) Prostatectomy and transurethral resection.—(a) Observe for 
hemorrhage. 
(b) No enema. No proctoclysis. 
(c) Castor oil 45 cc, on morning of third (3d) day. 
149 TM 8-260 
251-252 
MEDICAL DEPARTMENT 
(d) Change dressings p. r. n, to keep patient dry. 
(3) Durapimcture.—(a) Elevate foot of bed 25 cm. for 2 hours. 
(o) Keep patient in bed for 24 hours. 
(c) Force fluids 5,000 cc. minimum intake. 
(d) Light diet. 
(e) Aspirin, codeine, or morphine as needed for headache. 
(4) Nephrolithiasis.— (a) General routine for genito-urinary cases 
and clear infection of kidney. Special examination for and measures 
to eliminate focal infection. 
(h) General routine and elevate foot of bed 25 cm. for 3 days. 
Keep patient on back or operated side for 10 days. Bed for 2 weeks. 
(c) Determination of chemical analysis of calculi and dietary 
measures to correct causative metabolic defects. (High vitamin diet 
and acid ash). 
(d) Two weeks after patient has been up and about make urogram, 
renal function, and blood chemistry, verifying serum calcium and 
serum phosphorus. 
(e) Irrigation of kidney pelvis with 1 percent phosphoric acid 
weekly after third week. 
(/) Appropriate urinary antiseptics. 
c. Postoperative diet.— (1) First and second days, nothing by mouth 
except tea and hot water. 
(2) Third day, surgical liquids. 
(3) Fourth day, surgical soft, 
(4) Fifth day, medical soft. 
(5) Sixth day, light diet. 
d. Care after urethral instrumentation.—Irrigate bladder and in- 
still 30 cc. y2 percent to 1 percent mercurochrome or 1 to 3,000 
acriflavine. 
252. Urological instruments.—a. Metal instruments.—(1) Metal 
instruments without lights, lenses, or delicate mechanism can be 
boiled. 
(2) Other metal instruments and web catheters, bougies, etc.: 
{a) Immerse 20 minutes or longer in 4 percent formalin solution. 
(b) Rinse in sterile water. 
b. Uretheral catheters.— (1) Drip a 4 percent formallin solution 
through them 20 minutes by siphon. 
(2) Drip sterile water through them 20 minutes by siphon. 
(3) Immerse 20 minutes in 4 percent formalin solution. 
(4) Immerse 20 minutes in sterile water. 
(5) With sterile gloves inject a few cc. of sterile water in each. 
c. Rubber catheters, gloves, etc.—Can be boiled. 
150 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
253 
253. Special care of prostate obstruction cases.—a. Preopera- 
tive.—General routine for gcnito-urinary cases with following special 
examination: 
(1) Routine physical examination. Note cardiovascular renal con- 
dition (EKG). 
(2) Check for focal infection and institute necessary treatment. 
(3) Complete blood examination, including coagulating time and 
type of blood for donor selection. 
(4) Blood chemistry weekly until normal, urea nitrogen, sugar, 
C02, or until no improvement is attained. 
(5) Wassermann reaction. 
(6) Urinalysis complete twice weekly. 
(7) Determination of residual urine. 
(8) Specimen of urine for culture. 
(9) Rectal and prostate examination with microscopic examination 
of secretion. 
(10) PSP renal function weekly until contraindicated. 
(11) Cystogram and cystometric pressure. 
(12) Cystoscopic examination unless contraindicated. 
(13) Blood pressure daily. 
(14) Bladder drainage and irrigation as necessary for urinary 
retention infection. 
(15) Urinary antiseptics. 
(16) Daily estimate of fluid intake and fluid output, minimum 
daily intake 3,000 cc. fluids. 
(17) Continue preoperative preparation until maximum renal 
function and optimum cardiovascular condition have been attained 
and the vesicle infection has been cleared. Keep patient up and about 
as much as practicable. 
b. Post-operative.— (1) Suprapubic prostatectomy.— (a) Morphine 
0.008 grams as ordered by ward officer. 
(b) Examine carefully for hemorrhage. 
(c) Combat shock; lower head; apply hot applications. If systolic 
blood pressure falls below 80, give 1,000 cc. 5 percent glucose intra- 
venously. 
(d) Record daily intake and output of water. 
(e) Examine frequently to ascertain that bladder drainage is main- 
tained. 
(/) Avoid enema and proctoclysis. 
(g) Maintain bladder drainage by Connell apparatus. 
(h) Maintain fluid intake by oral, hypodermal, and intravenous 
administration. 
151 TM 8-260 
253 
MEDICAL DEPARTMENT 
(i) If no hemorrhage occurs, release traction on Pilcher bag at 
end 2 hours, release fluid in bag at 18 hours. 
(j) On morning of second day remove Pilcher bag, suprapubic 
tube, and prevesical drain and place inlaying urethral catheter. 
(k) After second day irrigate with 30 cc. 10 percent argyrol or 
1/2,000 acriflavine solution or y2 percent mercurochrome. 
(l) Fowler’s position as soon as practicable. 
(m) Patient up in chair fifth or sixth day. 
(n) Remove silkworm sutures on ninth or tenth day, 
(o) General post-operative care regarding diet and bowels, etc. 
(p) Discontinue self-retaining catheter tenth to fourteenth day. 
(q) Check blood, urine, and renal function before discharge from 
hospital or earlier if necessary. 
(r) Cystogram, cystoscopy, and cystometric study before discharge 
from hospital. 
(s) Examine cardiovascular system after convalescence and com- 
pare with preoperative condition. 
(t) Begin urethral dilation third to fifth week. 
(2) Perineal prostatectomy.— {a) Examine every y2 hour to as- 
certain if drainage is satisfactory. 
(h) Remove perineal gauze at end of 24 hours to 48 hours. 
(c) Remove perineal drain at end of 48 hours. 
(d) Remove urethral catheter at end of fifth to seventh day. 
(3) Management of transurethral resection of prostate.— (a) Rest 
in bed first 2 days. Up in chair on third day. 
(b) Release traction on the hemostatic bag catheter end of 2 hours. 
(c) Observe every 30 minutes for hemorrhage during first 6 hours. 
If moderate hemorrhage occurs, control by bladder irrigation for the 
removal of clots and by traction on the hemostatic bag catheter. 
(d) Avoid bladder irrigation in cases in which hemorrhage does 
not occur. 
(e) Remove self-retaining catheter at end of second to fourth day. 
Catheterize 6 hours after catheter is removed; if more than 100 cc. 
residual urine leave catheter in place. 
(/) Catheterize daily after self-retaining catheter is removed as 
long as residual urine persists. 
(g) Avoid purgation, enemata, and proctoclysis. Give mineral oil 
and fluid extract of cascara as indicated after third day. 
(h) Maintain fluid intake 3,000 cc. minimum daily. 
(i) Administer sedatives as indicated, morphine and atropine, 
sodium amytal. 
(;) Give urinary antiseptics as indicated and tolerated. 
152 TM 8-360 
253-254 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(k) Blood count, including hemoglobin and coagulating time, 
should be done daily during first 3 days. 
(l) Renal function and blood chemistry recheck should be done 
during second week. 
(m) Cystoscopic and cystographic examination should be done at 
end of third post-operative week. 
254. Miscellaneous urological procedures.—a. Method of 
catheterization of bladder.— (1) Cleanse external genitalia with soap 
solution, dry with sterile gauze, then cleanse with 50 percent alcohol. 
(2) Apply towels above and below external genitalia. 
(3) Lubricate sterile catheter in the lubricating jelly and insert 
with sterile forceps. 
(4) After withdrawing urine, inject through catheter 30 cc. of 
1 to 2,000 acriflavine, inject the last 5 cc. into urethra as catheter is 
withdrawn. 
(5) Sterile rubber gloves will be worn during the above procedure. 
b. Urinary antiseptics.— (1) Urotropin.— (a) Urotropin 2 grams 
1 hour AC. 
(b) Ammonia nitrate 2 grams 1 hour PC. 
(2) Mandelic acid.—12 grams daily. 
(3) Sulfanilimide.—S to 5 grams daily. 
(4) Neutral acriflavine.—0.5 gram daily. Regulate fluid intake 
as necessary. 
c. Blood and urine examination..—Made twice weekly unless other- 
wise ordered. 
d. Collecting specimen for urine culture.— (1) Prepare as for 
catheterization. 
(2) Discard first portion of specimen. 
(3) Collect last portion in sterile container. 
e. Provocative Wasserman.—After neosalvarsan is given, specimens 
are due as follows: 
Specimen No. Time due 
1 24 hours. 
2 48 hours. 
3 72 hours. 
4 5th day. 
5 7th day. 
6 9th day. 
/. Method of giving enema.—Enema to be given with patient in 
bed with hips elevated. Give slowly. 
g. Urine concentration test.— (1) 6:00 PM the patient is given 
his usual supper. If he is on a low protein diet, two eggs are added 
153 TM 8-260 
254 
MEDICAL DEPARTMENT 
to this meal; they should be soft-boiled. This meal is to include no 
more than WO cc. of fluids. 
(2) After eating supper, no food or drink is allowed until the 
completion of the test at 10: 00 AM on the following day. 
(3) Bedtime patient is instructed to empty the bladder and discard 
the urine. Any urine during the night will also be discarded. 5:00 
AM the following morning the patient should empty bladder, 
saving the entire specimen in one bottle marked No. 1. 6:00 AM 
he again is to empty the bladder, saving the entire specimen in bottle 
marked No. 2. 7:00 AM he again empties the bladder, saving the 
entire specimen in bottle marked No. 3. 
h. PSP and dilution tests.—Give no water before PSP. The 
patient is not allowed breakfast or drink in the morning of the test. 
He is instructed to remain in bed for the entire period of the test. 
Empty the bladder at 7:00 AM. At 7:30 AM he is given exactly 
1,500 cc. of wTater which he is required to drink within 10 minutes. 
He is furnished with five urine specimen bottles, properly labeled 
as shown below, and instructed to empty the bladder at the hour 
shown on each bottle, saving the entire specimen in the proper bottle. 
After giving PSP: 
No. 1, y2 hour. 
No. 2, 1 hour. 
No. 3, 2 hours. 
No. 4, 3 hours. 
No. 5, 4!/2 hours. 
i. Care of drainage.— (1) Kidney.—Nephrolysis, nephrectomy for 
tuberculosis (kidney, pelvis, or ureter not opened). Remove drains 
at end of 24 hours. 
(2) Nephrolithotomy, pelviolithotomy, and ureterotomy.—Remove 
drains at end of 4th or 6th day. 
(3) Bladder.—Remove prevesical drains at end of 24 or 48 hours. 
Remove paravesical drain at end of 48 to 72 hours. 
(4) Perineal.—Remove hemostatic pack at end of 24 to 48 hours. 
Remove perineal drain tubes at end of 48 to 72 hours. 
(5) Ureteral catheters.— {a) Urethral catheters used for drainage 
or ureteral splints should be removed at end of 48 to 72 hours. 
(b) Urethral catheters should be changed every 3 days. 
j. Administration of tryparsamide.—See paragraph 231 k. 
k. Venereal disease.—Venereal patients are isolated in the hospital 
for treatment and messing facilities. Each patient is given indi- 
vidual attention and treatment. See circular letter No. 18, S. G. O., 
1941. 
154 TM 8-280 
255-256 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
Section VI 
EYE, EAR, NOSE, AND THROAT SURGERY 
Paragraph 
I’reoperative routine 255 
Post-operative routine 256 
255. Preoperative routine.—a. General.—See paragraph 234. 
b. Tonsillectomy.— (1) Adults, local anesthesia.— (a) Light supper 
night before and no breakfast the day of operation. 
(b) S. S. enema at 8: 00 PM day before. 
(c) Sodium amytal 0.194 gram (3 gr.) 2 hours before operation. 
Morphine sylphate 0.016 gram (14 gr.) and hyoscine hydrobromide 
0.000C5 gram (Moo gr-) hypo 1 hour before operation. (Patients 
under 18 years of age and those who are small or frail should receive 
two-thirds of the adult hypo.) 
(2) Children, general anesthesia.— (a) Light supper; no breakfast. 
{b) S. S. enema at 8: 00 PM day before, 
c. Nasal cases, local anesthesia.— (1) Light supper night before and 
no breakfast day of operation. 
(2) S. S. enema at 8: 00 PM day before. 
(3) Sodium amytal 0.194 gram (3 gr.) 2 hours before operation. 
Morphine sulphate 0.016 gram (14 gr.) and hyoscine hydrobromide 
0.00065 gram (Moo gr-) hypo 1 hour before operation. (Patients 
under 18 years of age and those who are small or frail should receive 
two-thirds of the adult hypo.) 
d. Mastoidectomy, 'peroral endoscopy, and other operations.— (1) 
Treatment is prescribed by ward officer prior to operating, depending 
upon type of anesthesia, nature of operation, and condition of patient. 
(2) An X-ray of chest is taken prior to mastoidectomy, 
e. Eye cases, local anesthesia.—Same as b{l) above unless other- 
wise directed. 
256. Post-operative routine.—a. Tonsillectomy.—(1) 
Adults.— (a) Keep patient as quiet as possible in bed. 
(h) Diet, liquids, water, after 2 hours. Milk, orange juice, or 
ice cream after 5:00 PM. Soft diet next day. Thereafter the diet 
may be increased, depending upon patient’s condition. 
(c) Keep patient in bed until second day. 
(d) Milk of magnesia or other laxative the second night after op- 
eration. 
(e) Mouth wash or gargle of warm normal saline, or other stock 
preparation beginning the second day. 
(/) Codeine sulphate 0.032 grams {y2 gr.) by mouth at 9:00 
PM day of operation. 
155 TM 8-260 
256 
MEDICAL DEPARTMENT 
(g) Codeine sulphate 0.032 grams (y2 gr.) and aspirin 0.324 grams 
(5 gr.) p. r. n. beginning second day. 
(A) Military patients will not be returned to duty until after 1 
week from date of operation. 
(2) Children.— (a) Watch carefully until reaction from anesthesia, 
and watch particularly for hemorrhage at all times. 
(&) Diet, liquids, water after 2 hours. Milk, orange juice, or ice 
cream after 5: 00 PM. Soft diet next day. Thereafter the diet may 
be increased, depending upon patient’s condition. 
(c) Milk of magnesia next day, dose depending upon age and 
size of child. 
(■d) Children will be retained in hospital for at least 24 hours after 
operation. 
h. Nasal cases.— (1) Keep patient as quiet as possible in bed. 
(2) Ice compresses to nose for 2 hours after operation. 
(3) Remove nasal packing next morning unless otherwise directed. 
After its removal keep patient in bed for at least 2 hours and longer 
if indicated. 
(4) Diet, liquids, water after 2 hours. Milk, orange juice, or ice 
cream after 5: 00 PM. Soft diet next day. Thereafter the diet may 
be increased, depending upon patient’s condition. 
(5) Laxative second night. 
(6) Codeine sulphate 0.032 grams (y2 gr.) by mouth at 9:00 PM 
day of operation. 
(7) Military patients will not be returned to duty until after 1 week 
from date of operation. 
c. Eye cases.— (1) Patient to be carefully transferred to bed with a 
nurse or attendant holding the head. 
(2) The patient, particularly following intraocular operations such 
as for cataract, will refrain from all effort or unnecessary movement. 
(3) Keep patient on back for 24 hours following cataract operations. 
After this the patient may be turned on the unoperated side. 
(4) Liquid diet for 24 hours and soft diet thereafter until out of bed. 
(5) Cataract cases are to be strictly bed patients until otherwise 
directed. 
Section VII 
DENTAL AND ORAL SURGERY 
Paragraph 
Jaw fractures 257 
Alveolar abscess 258 
Stomatitis 259 
Pulpitis (toothache) 260 
Post-operative care in ward 261 
Diet 262 
156 TM 8-360 
257-261 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
257. Jaw fractures.—a. If a head bandage is in position, or if it 
is necessary to apply one to stabilize and support the fragments and 
the overlying soft tissues, the bandage should be so placed and so 
adjusted as to avoid any distal or backward traction on the mandible. 
The bandage should act as a cradle and as a stabilizing support. 
b. Do not send to main X-ray laboratory for jaw pictures; these 
will be taken in the dental X-ray laboratory. 
c. Keep patient in semi-inclined position, head elevated. 
d. Avoid use of hydrogen peroxide as a mouth wash. Use warm 
hypertonic saline solution. 
258. Alveolar abscess.—a. Avoid application of external heat. 
b. Check elimination and have bowels moving freely. 
259. Stomatitis.—a. Vincent's.— (1) Have patient rinse mouth 
thoroughly with sodium perborate, one teaspoonful to one-half glass 
of warm water. Use three times daily. 
(2) Direct patient to brush teeth with soft brush and tooth paste 
after each meal. 
(3) Place patient on soft diet, including orange juice. 
(4) Report daily to dental clinic. 
b. Mercurial.— (1) The administration of mercury must be discon- 
tinued. 
(2) Direct patient to brush teeth with soft brush and tooth paste 
after each meal. 
(3) Check degree of elimination and have bowels moving freely. 
(4) Report daily to dental clinic. 
260. Pulpitis (toothache).—Paint the gum with tincture of 
iodine. Give patient aspirin 0.640 grams (10 gr.) unless contra- 
indicated. Pack cavity lightly and carefully with a pledget of cotton 
saturated with oil of cloves. 
261. Post-operative care in ward.—a. Removal of impacted 
teeth, multiple extractions, and alveolectomy, and other intraoral 
surgical operations; 
(1) Ice cap to affected parts immediately following return to ward 
for a period of 4 hours (intermittant application, on 30 minutes and 
off 30 minutes). 
(2) No mouth wash or rinsing for 4 hours (patient can have water 
to quench thirst). 
(3) After 4 hours discontinue ice cap and provide warm hyper- 
tonic saline mouth wash. Following 3 days provide warm hypertonic 
saline mouth wash after meals only. 
(4) Aspirin 0.324 gram (5 gr.) and codeine sulphate 0.032 gram 
(y2 gr.) q. 4 hours, p. r. n. during first night if indicated for relief 
of pain. 
157 TM 8-260 
261-263 
MEDICAL DEPARTMENT 
(5) Soft or liquid diet for necessary number of days. For 
edentulous cases, soft diet to be continued until dentures are provided, 
(6) Patient to return to dental clinic each morning at 9:00 until 
otherwise instructed. 
6. Fractures of jaw: 
(1) Direct patients to rinse mouth with warm hypertonic saline 
solution after each feeding. 
(2) Direct patient to clean teeth with tooth brush as efficiently as 
possible a minimum of three times a day. 
(3) Place patient on liquid diet, unless otherwise prescribed, with 
feeding from 7 : 00 AM to 9 : 00 PM at 2-hour intervals. 
(4) If patient should strangle due to nausea or other causes, cut 
the vertical wires holding jaws together or remove intermaxillary elas- 
tics which are more commonly used for intermaxillary traction and 
fixation. Each patient with intermaxillar wires is provided with a 
small pair of scissors for this purpose which should be suspended by 
a cord around the neck at all times. 
(5) Record patient’s weight weekly. 
263. Diet.—Diets to be served on the ward are routinely prescribed 
by the dental service as regular, soft, or liquid. Diets at the mess 
hall are prescribed as regular or special jaw diet. 
Section VIII 
ROENTGENOLOGY 
Paragraph 
Gall bladder 263 
Gastrointestinal i 264 
Barium enema 265 
Abdominal region, lumbar spine, sacroiliacs, KUB 266 
Myelography 267 
263. Gall bladder.—a. Oral dye.-—The dye is supplied by the 
pharmacy. 
(1) Single dose technique (routine for all cases).— (a) Evening meal 
at 5:00 PM, consisting of fruit, vegetables, potatoes or rice, tea or 
coffee, sugar, water, bread or crackers. Do not eat cream, butter, other 
fats, or meat. 
(b) Immediately after the evening meal dissolve the dye in a half 
glass of grape juice and drink all. Tinctura opii camphorata may be 
given to control diarrhea. 
(c) Enema of clear water at 7: 00 AM the morning of the exami- 
nation. Repeat once if necessary to secure clear return flow, but only 
once. 
158 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
263-264 
(d) No breakfast, but may have water ad lib, clear tea or black 
coffee with sugar, but no milk or cream. Report at X-ray section at 
8: 00 AM and 11:00 AM. 
(e) On return to ward after examination at 11:00 AM, have the 
patient eat well-buttered toast, two soft-boiled eggs, and a glass of 
top milk. 
(/) Return to X-ray section 1 hour after eating the toast, eggs, 
and milk. 
(2) Double dose technique (give the second dose only when re- 
quested by the X-ray section).— (a) The first dose is given according 
to instructions in (1) above. 
(b) After the X-ray examination at 8:00 AM above), 
those patients found to require the second dose of the dye will be re- 
ported by the X-ray section to the medical officer concerned. 
(c) Thereafter the examination of these special cases will be con- 
ducted as follows: 
1. Do not eat cream, butter, other fats, or meat. 
2. Eat lunch and evening meal consisting of fruit, vegetables, 
potatoes or rice, tea or coffee, sugar, water, bread or 
crackers. 
3. Immediately after the evening meal dissolve the second dose 
of the dye in half glass of grape juice and drink all. 
If.. After the second dose of the dye follow the instructions in 
(!)(<?) to (/), inclusive. 
b. Intravenous dye.—Ward officer arranges with the chief of the 
gastro-intestinal section for administration of the dye. 
(1) Administration of dye at 4:00 PM. 
(2) Remain in bed until following morning. 
(3) No supper. (May drink water.) 
(4) No breakfast following morning. 
(5) No laxatives. 
(6) Enema of clear warm water at 7:00 AM the morning of the 
examination. Repeat if necessary until return flow is clear. 
(7) Report at X-ray section at 8:00 AM. 
(8) After the examination at 8:00 AM these patients will not be 
given the “fatty meal” (well-buttered toast, two soft-boiled eggs, and a 
glass of top milk) until instructions are received from the X-ray sec- 
tion. 
(9) Return to X-ray section 1 hour after the fatty meal. 
264. G-astro-intestinal.—a. No cathartic to be taken during the 
24 hours before the series is begun and none until the series is com- 
pleted. 
159 TM 8-260 
264-268 
MEDICAL DEPARTMENT 
b. Nothing by mouth from midnight preceding the first examination 
until after the second examination. 
c. Report to X-ray section at 8 : 30 AM and 3: 00 PM. 
d. The usual meals are permitted after the 3:00 PM examination. 
e. The 24-hour examination will not be made unless requested by the 
ward officer. 
265. Barium enema.—a. Castor oil (amount to be prescribed by 
ward officer) the evening before examination. If castor oil is contra- 
indicated compound licorice powder may be given (approval of ward 
officer required). 
~b. Patient may have toast and tea for supper. 
c. Enema of clear water at 7:00 AM the morning of the examina- 
tion, Repeat if necessary until the return flow is clear. 
d. No breakfast, but may drink water, tea, or coffee. 
e. Report to X-ray section at 8:30 AM. 
266. Abdominal region, lumbar spine, sacroiliacs, KUB.—a. 
Castor oil or compound licorice powder. 
h. Patient may have toast and tea for supper; no breakfast; may 
drink water, tea or coffee. 
c. Clear warm water enema 1 hour before examination (approval 
of ward officer required.) 
267. Myelography.—a. Sodium amytal, 0.195 gram orally the 
night before. 
h. No breakfast; liquids as desired. 
c. Sodium amytal, 0.195 gram orally 2 hours before the examination. 
d. Shave the hair in the region of the lumbar spine; if cisternal 
puncture is contemplated shave the hair at the base of the neck 
up to the external occipital protuberance. 
Section IX 
PHYSICAL THERAPY (FEVER THERAPY) SECTION 
Paragraph 
Class of patients treated 268 
Procedure to obtain treatment 269 
Preoperative preparation 270 
Treatment 271 
268. Class of patients treated.—The officer in charge of fever 
therapy determines the suitability and dosage of artificial fever in each 
case submitted. In general this procedure has been found of greatest 
benefit in— 
a. Gonorrheal infection. 
h. Syphilis, cerebrospinal. 
160 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
268-270 
c. Rheumatic fever. 
d. Chorea. 
e. Arthritis (infectious). 
/. Iritis and other exudative lesions of the eye. 
269. Procedure to obtain treatment.—a. Requests for treat- 
ment are accomplished in duplicate and forwarded with the complete 
clinical record to the officer in charge of fever therapy. The request is 
submitted through the respective chief of service. 
h. The diagnosis is stated in full on the request for treatment. The 
clinical record of the patient under consideration is brought up to date 
prior to submitting the request for treatment and will contain the 
following data: 
(1) Complete diagnosis. 
(2) Complete urinalysis report (including acetone and diacetic 
acid determinations). 
(3) Report of complete blood count. 
(4) Report of blood chemistry to include sugar, urea nitrogen, and 
chlorides. 
(5) Report of 6-foot X-ray of heart and lungs. 
(6) Electrocardiographic report. 
(7) Report of kidney function with the phenolsulphonephthalein 
test. 
(8) A statement should be made on the request for treatment that 
the foregoing diagnostic procedures have been completed. 
c. Patients referred are reexamined by the officer in charge of fever 
therapy who makes final determination of the advisability of this 
therapeutic procedure as well as the patient’s fitness for it. 
d. In the event that the case is suitable for treatment the clinical 
record and duplicate copy of request for treatment are returned to the 
ward officer. The date of initial treatment is indicated in the appro- 
priate space on the form. 
270. Preoperative preparation.—a. The clay preceding appoint- 
ment for a fever treatment the patient is given orally either (1) or 
(2) below, but not tooth: 
(1) One level teaspoonfnl of ordinary table sail, dissolved in a 
glass of tap water to be taken in the forenoon and repeated in the 
afternoon. The ward nurse or attendant will explain to the patient 
that the glass of salt solution will not be taken all at one time, but 
only a swallow at a time so that one glass will last throughout the 
entire forenoon and the other glass throughout the entire afternoon. 
(2) Twelve 1-gram enteric coated tablets of salt (NaCl) equally 
spaced as to dosage and 1,500 to 2,000 cc. of water during the day. 
161 TM 8-360 
270-271 
MEDICAL DEPARTMENT 
h. A soapsuds enema is given the night before treatment. 
c. At 6:00 AM a colonic cleansing enema until the returns are 
clear is given with plain warm tap water. 
d. Breakfast, consisting of tea or coffee and one slice of toast, or 
three soda crackers, may be permitted, or at the patient’s option, may 
be omitted entirely. 
e. The patient is sent to the fever therapy section at 7:30 AM. 
271. Treatment.—a. The officer in charge of fever therapy de- 
termines the length of each fever treatment, the number of treat- 
ments to be given in each case, and the frequency of treatments. 
h. During the induction and maintenance of fever he is in constant 
attendance and assures that complete records of the patient’s con- 
dition and temperature are properly recorded on the appropriate 
forms. One copy of Fever Therapy Record is completed and for- 
warded to the ward officer immediately following each fever treat- 
ment and becomes part of the permanent clinical record. 
c. Post-operative care.— (1) Liquids ad lib. 
(2) Diet as requested by patient unless otherwise specified by the 
officer in charge of fever therapy. 
(3) Aspirin 0.65 gram (10 gr.) may be given, or ice cap to head 
for headache. 
(4) Take and record temperature, pulse, and respirations every 
hour for 4 hours after patient arrives on the ward following a fever 
treatment. 
(5) If patient’s oral temperature exceeds 100° F. 2 hours after ar- 
rival on the ward, or if the temperature drops to 95° F., or the pa- 
tient’s condition appears unsatisfactory to the nurse, the officer in 
charge of fever therapy is notified. 
d. Routine medications for patients undergoing fever therapy.— 
(1) Beginning on the day prior to the conditioning or trial fever 
treatment and continuing daily throughout the entire course of fever 
therapy, Brewer’s yeast is given as follows: One teaspoonful dis- 
solved in small amount of water three times daily after each meal. 
(2) Commencing on the day following each fever treatment, be- 
ginning with the before breakfast dose, and continuing for eight 
doses only, dilute hydrochloric acid is administered as follows: Ten 
drops in small amount of water three times daily before meals. 
162 TM 8-260 
272 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
Section X 
ACUTE POISONINGS, THEIR ANTIDOTES 
AND TREATMENT 
Paragraph 
Acute poisonings, their antidotes and treatment 272 
272. Acute poisonings, their antidotes and treatment. 
Poisoning 
Symptoms 
Antidote and treatment 
Acetanilide, antipyrin, 
Face cyanosed. 
Lavage. 
acetphenotidin (phe- 
Vomiting occasional. 
Cathartic. 
nacetin). 
Skin, cold, profuse sweat- 
Recumbent position. 
ing. Rash simulating 
Stimulation: 
measles, scarlatina or 
Brandy. 
pemphigus. 
Whisky. 
Collapse, feeble and irregu- 
Ammonia. 
lar pulse, slow respira- 
Epinephrine. 
tion. 
CO2 inhalation with 
oxygen. 
External heat. 
Aconite. 
Tingling and numbness of 
Immediate gastric lavage 
tongue and mouth and 
with H20 followed by 0.1 
sense of formication of 
percent (1 to 1,000) po- 
the body. 
tassium permanganate, 
Nausea, vomiting. 
250 cc. 
Diarrhea with epigastric 
Avoid emetics. 
pain. 
Cathartics. 
Dyspnea. 
Stimulants: 
Pulse irregular and weak. 
Caffeine. 
Skin cold and clammy. 
Adrenalin. 
Features bloodless. 
Aromatic spirits of am- 
Giddiness, staggering walk, 
monia. 
feeling of heaviness. 
Whisky. 
Mind remains clear. 
Carbon dioxide and ox- 
Circulatory collapse. 
ygen inhalation if 
Low blood pressure. 
indicated. 
External heat. 
Recumbent position with 
head lower than feet. 
Alcohol (ethyl) 
Ataxia, coma, decreased 
Gastric lavage, weak al- 
respiration. 
kali, sodium bicarbonate 
Abolition of superficial and 
(1 dr. to 1 pt.). 
deep reflexes. 
Coffee by mouth or rectum, 
Vomiting. 
or both. 
Cerebral symptoms. 
C02 and oxygen inhalation. 
Dilated pupils. 
Stimulants: 
Rapid pulse. 
Strychnine sulphate 
Breathing slow and sterto- 
(1/30 gr.). 
rous. 
Camphor in oil. 
163 TM 8-260 
272 
MEDICAL DEPARTMENT 
Poisoning 
Symptoms 
Antidote and treatment 
Alcohol (ethyl) 
Pallor of face. 
Stimulants—Continued. 
Atropine sulphate 
04 gr.). 
Aromatic spirits of am- 
monia. 
Caffeine. 
External heat. 
Massage. 
Opium derivatives are ab- 
solutely contraindicated 
and barbiturates must be 
used with extreme cau- 
tion. 
Alcohol (methyl) 
Dizziness. 
Immediate gastric lavage 
and emetic followed by 
Methyl alcohol is 
Headache and vertigo. 
used extensively 
Staggering gait. 
thorough catharsis (mag- 
as a combustible, 
Colic, nausea, and vomit- 
nesium sulphate). 
as a solvent for 
ing. 
Stimulants. 
gums, dyes, res- 
Dimness of vision progress- 
Externa] heat. 
ins, and shellacs. 
ing to blindness. 
Alkalies freely. 
It is found in var- 
Delirium, unconscious- 
Morphine for pain. 
nish and varnish 
ness, coma, convulsions, 
Pilocarpine sweats and hot 
removers, hat dye, 
and death. 
packs. 
etc. 
Spinal puncture for in- 
creased intracranial pres- 
sure. 
Acid and alkalies 
Burning pain from mouth 
to stomach. 
Do not use a stomach tube. 
Antidotes for— 
Evidence of escharotic ac- 
Acids.— M agnesia, 
tion about lips and 
chalk, colloidal 
mouth. 
aluminum hydrox- 
Difficulty in swallowing. 
ide, magnesium ox- 
Vomiting and purging of 
ide, milk of mag- 
mucus and blood. 
nesia. 
Skin cold and clammy. 
Alkalies.—Dilute vin- 
Pulse feeble, anxious conn- 
egar, lemon juice, or 
tenance. 
other dilute acid 
Rapid exhaustion. 
with plenty of H20. 
Dyspnea. 
100 to 500 cc. of 0.5 
Collapse. 
percent Hcl. 
Note.—Antidotes are useless unless 
the patient is seen a few minutes 
after the accident. 
Convulsions. 
250 cc. olive oil by mouth. 
Unconsciousness or coma. 
Demulcents such as gelatin, 
acacia, or flour in H20. 
Stimulant, hypodermically 
if necessary. 
164 FIXED HOSPITALS OP THE MEDICAL DEPARTMENT 
TM 8-260 
272 
Poisoning 
Symptoms 
Antidote and treatment 
Acid and alkalies 
External heat. 
Note.—If an hour or two has passed 
the treatment must be limited to 
1. Aspiration of the thick secre- 
tions from the mouth; 2. The ad- 
ministration of fluids with a medi- 
cine dropper and small quantities 
of olive oil as an emollient to eroded 
surface. 
The dangers of a lavage in these cases 
should not be forgotten. 
Ammonia (caustic) 
Gastro-intestinal symp- 
Do not use stomach tube. 
toms as in corrosive 
Antidotes: 
poisoning. 
Vinegar (1 tablespoon- 
Purging, usually with 
ful in a glass of 
pain and straining. 
H20). 
Body in cold sweat. 
Orange or lemon juice. 
Pulse rapid and weak. 
Olive oil, 240 cc. 
Dilute hydrochloric 
acid, 2-4 cc. well 
diluted. 
Immediate tracheotomy if 
symptoms of strangula- 
tion. 
Symptomatic treatment. 
Large quantities of water. 
Antimony (tarter 
Astringent metallic taste 
Empty stomach with siphon 
emetic). 
in the mouth. 
tube. 
Heat and sense of constric- 
Simple emetics. 
tion in throat. 
Strong boiled tea or tannic 
Severe pain in stomach. 
acid. 
Incessant vomiting. 
Stimulants for collapse: 
Diarrhea. 
Strychnine. 
Faintness and profound 
Ammonia. 
depression. 
Sedatives, when patient is 
Small, rapid, and weak 
pulse. 
Cold, clammy perspira- 
tion. 
out of immediate danger. 
w 
Intense giddiness followed 
by insensibility and 
death. 
Apomorphine 
Prolonged excessive vom- 
Aromatic spirits of am- 
iting. 
monia in H20 or in- 
Exhaustion and collapse. 
halation. 
Keep patient recumbent. 
External heat. TM 8-260 
272 
MEDICAL DEPARTMENT 
Poisoning 
Symptoms 
Antidote and treatment 
Arsenic 
Symptoms usually occur 
within Yi hour to 1 hour 
after ingestion with a 
sweetish, metallic taste 
and a sensation of heat 
in the mouth and throat. 
Later there is— 
Vomiting, profuse. 
Painful diarrhea. Stools 
may contain blood and 
also have the appear- 
ance of the rice-water 
type found in cholera. 
Urine scanty and suppress- 
ed, frequently albumi- 
nous. 
Headache. 
Chilliness. 
Fever. 
Cough. 
Cramps in the abdomen 
and limbs. 
Rapid, feeble pulse, dysp- 
nea, and sometimes con- 
vulsions preceding 
death. 
Collapse may come early 
from direct effect on 
heart or brain, with 
little pain or gastro- 
intestinal symptoms. 
Fatal cases have oc- 
curred as early as 20 min- 
utes, but patients usu- 
ally survive 10 to 48 
hours or live for a week 
or more and die of 
secondary effects. 
Thirst. 
Sense of constriction in 
throat rendering swal- 
lowing difficult. 
Cyanosis. 
Coma. 
Repeated lavage with stom- 
ach tube, or emetics, 
and USP ferri hydrox- 
idum with magnesii ox- 
idum every 15 minutes 
in 30-cc. doses until three 
to six doses have been 
given. Evacuate from 
stomach in a short while 
and follow with— 
Cathartic (caster oil or 
saline). 
Milk diet. 
Opium for vomiting and 
diarrhea. 
Intravenous fluids. 
Stimulants, caffeine and 
strychnine. 
External heat. 
Follow-up treatment should 
include renal studies for 
evidence of nephritis. 
Note.—Solutions of iron salts such 
as tincture of iron chloride, to- 
gether with magnesium carbon- 
ate, sodium carbonate, or any 
alkali may be used. Milk and 
chalk powder after lavage may 
help. 
166 TM 8-260 
272 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
Poisoning 
Symptoms 
Antidote and treatment 
Arsphenamine 
Vasomotor collapse (nitri- 
External heat. 
toid crisis). 
Adrenalin chloride and mor- 
Chills and fever. 
phine sulfate. 
Angioneurotic edema or 
Force fluid if no kidney 
urticaria. 
damage. 
Exfoliative dermatitis. 
Sodium thiosulphate intra- 
Severe jaundice and tox- 
venous (10 cc. 10-per- 
emia, nausea, and vom- 
cent solution). 
iting. 
Sodium dehydrocholate (5 
Epileptiform convulsions. 
cc. 20-percent solution 
Coma. 
intravenous). 
Atropine—Belladonna. 
Dryness of mouth. 
Lavage with 1 to 1,000 
Difficulty in swallowing 
solution of potassium per- 
and articulation. 
manganate. 
Skin flushed. 
Ice cap for delirum. 
Thirst. 
Morphine or barbiturates 
Temperature elevated. 
(during state of excite- 
Rapid pulse. 
ment only). 
Dilated pupils. 
Stimulants for depression 
Purging. 
Pilocarpine. 
Delirium. 
Catheterization. 
Barbiturates 
Coma (deep). 
Cover patient warmly (ex- 
Circulatory collapse. 
ternal heat). 
Pulmonary oedema. 
Gastric lavage if conscious 
Cold skin and cyanosis. 
keep head lower than 
Flaccid paralysis. 
body; if unconscious, apo- 
Absence of reflexes. 
morphine subcutaneous. 
Presence of barbiturate in 
(Avoid if marked de- 
blood, urine or stomach 
pression.) 
washings. (Koppanyi 
Catheterize. 
et al test.) 
Enema and then isotonic 
Blood pressure low. 
glucose by rectum. 
Pulse small and rapid. 
Strychnine intravenous 
every 2 hours Ko~Ho 
grain until reflexes re- 
turn. 
Caffeine, sodium benzoate. 
Picrotoxin in 3-10 mgm. 
dose intravenously every 
20 minutes to 1 hour un- 
til increase of respiration, 
rise of blood pressure, or 
slight twitching of facial 
muscles. (Physiological 
antidote.) 
Camphor, subcutaneous. 
Fluids, intravenous. 
Ephedrine. 
167 TM 8-260 
272 
MEDICAL DEPARTMENT 
Poisoning 
Symptoms 
Antidote and treatment 
Barbiturates 
Venesection (400-500 cc.) 
if tendency to conges- 
tion. 
Oxygen and C02. 
20 cc. of 30 percent alcohol 
intravenously. 
Camphor 
Nausea and vomiting. 
Characteristic odor to 
breath. 
Burning pain in stomach. 
Colic. 
Giddiness. 
Face flushed. 
Pulse rapid and weak. 
Delirium. 
Collapse. 
Coma. 
Convulsions. 
Gastric lavage with warm 
water, (avoid oil and 
alcohol) or apomorphine 
by hypodermic. 
High enema. 
Bartital for excitement, in- 
travenously if necessary 
for convulsions. 
External heat. 
Caffeine or digitalis hypo- 
dermically. 
Carbon dioxide, 02 in- 
halations. 
Cantharidies 
Burning in throat and 
stomach. 
Difficulty in swallowing. 
Vomiting and diarrhea. 
Salivation and swelling of 
salivary glands. 
Burning in urethra. 
Frequent micturition. 
Pulse weak and slow. 
Collapse. 
Urine, casts, albumin, and 
red blood cells. 
Evacuation of stomach. 
Lavage with tepid water. 
Saline cathartic. 
Warm demulcent drinks 
(barley H20). 
No oil by mouth. 
Morphine sulphate for pain. 
Treat as a potential neph- 
ritis. 
Carbon bisulphide 
Odor of carbon bisulphide 
on breath. 
Dilated and fixed pupil. 
Respiratory embarrass- 
ment with cyanosis of lips. 
Shock. 
Unconsciousness. 
Siphon tube and free lavage 
of stomach. 
Stimulants, hypodermi- 
cally and per rectum. 
Artificial respiration. 
Carbon monoxide._ . 
Comatose. 
Skin reddish cyanotic 
color, lips scarlet red 
and cheeks flushed. 
Brownish stippling of 
skin. 
Temperature above nor- 
mal. 
Artificial respiration. 
Oxygen tent (C02 5 per- 
cent to 7 percent; 02 70 
percent to 80 percent). 
Cardiac stimulants. 
Sodium bicarbonate 4 per- 
cent and glucose (in- 
travenous or rectum). 
Absolute rest. 
168 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
273 
Poisoning 
Symptoms 
Antidote and treatment 
Carbon tetrachloride __ 
Nausea and vomiting. 
Immediate gastric lavage. 
Pain in epigastrium. 
Emetics. 
Faintness. 
Respiratory stimulants: 
Loss of consciousness. 
C02 and 02 inhalation. 
Convulsions. 
Artificial respiration. 
Sedation for convulsion. 
External heat. 
Avoid all oils and fats. 
Calcium chloride by mouth 
(only intravenous in 
moribund cases). 
Chemical burns of eye_ 
The primary and most im- 
portant treatment of 
Note.—While this subject 
chemical burns of the eye 
does not come directly 
under poisons, it is be- 
lieved that use may be 
regardless of the chemi- 
cal with acid or a base is 
made in an emergency of 
prolonged copious irriga- 
these simple directions for 
tion with water. Remove 
the treatment of the above- 
named condition and the 
resultant injury minimized 
debris after prolonged 
irrigation and apply ster- 
and a certain percentage of 
ile ointment. Bandage. 
eyesight saved. 
Efforts at neutralization 
often result in additional 
injury to the cornea and 
should not be attempted 
when the patient is first 
seen. 
Chloral hydrate 
Drowsiness merging into 
Use syphon tube with free 
unconsciousness. 
lavage. 
Slow, labored respiration. 
External heat. 
Cyanosis of lips. 
Strychnine, subcutaneously. 
Weak pulse. 
Ether, hypodermically. 
Subnormal temperature. 
Stimulants per rectum; caf- 
Contracted pupils. 
feine. 
Failure of heart. 
Artificial respiration if 
Delirium. 
necessary. 
# 
Vomiting, collapse, and 
coma. 
Avoid alcohol. 
Cinchophen (atophan). 
Poisoning generally sub- 
Gastric lavage. 
acute or chronic, but 
Glucose 10 percent, sodium 
toxic symptoms may be- 
lactate 2 percent intra- 
come rapidly severe dur- 
venously. 1,000 to 3,000 
ing or in absence of ad- 
cc. daily. 
- 
ministration of drug. 
Duodenal drainage. 
169 TM 8-260 
272 
MEDICAL DEPARTMENT 
Poisoning 
Symptoms 
Antidote and treatment 
Cinchophen (atophan). 
Cutaneous manifestations, 
High carbohydrate diet, 
pruritis, angioneurotic 
supplemented by between 
edema, urticaria, rash. 
feeding. Candy, Karo 
Anaphylactoid reaction, 
syrup. 
rapid pulse and lowered 
Stimulants (caffeine or dig- 
blood pressure. 
Gastro-intestinal: Ulcer of 
mouth, nausea, vomit- 
ing, and diarrhea. 
Liver involvement: Jaun- 
dice. 
talis) if necessary. 
Cocaine 
Dyspnea. 
Empty stomach with siphon 
Pallor of face, anxiety, 
tube. 
fainting. 
Lavage with dilute solution 
Dilatation and immobility 
of potassium permanga- 
of pupils. 
nate, 1 to 1,000 solution, 
or tannic acid, 5 grams. 
Rapid unconsciousness. 
(Above only in cases of 
Convulsions and apnoea. 
oral administration.) 
Pulse abnormally rapid at 
Strychnine }io grain and 
first, quickly slows down 
inhalation of ammonia. 
and becomes intermit- 
Coramine, 1-2 ce. intra- 
tent and feeble. 
venously. 
Asphyxial manifestations 
Sodium amytol, 10-percent 
in fatal cases. 
solution, 3 grain intrave- 
If death does not occur in 
nously. 
a few minutes, recovery 
Artificial respiration and 
always follows. 
02 in threatened asphyxia. 
Copper (blue stone) 
Pain in mouth, throat, and 
Siphon tube. 
stomach. 
Free lavage with albumi- 
Bluish or greenish discolor- 
nous and demulcent 
ation of membrane of 
fluids (egg white and 
mouth. 
acacia). 
Vomiting, blue or green 
Antidote, potassium ferro- 
vomit us. 
cyanide 0.65-gram doses 
Diarrhea accompanied by 
collicky abdominal 
pains. 
Convulsions, paralysis. 
in warm H20. 
Coma. 
Death. 
Cyanides _ 
Violent convulsive seizures. 
Immediate use of siphon 
Insensibility. 
tube. 
Odor of prussic acid on 
Freed lavage with warm 
breath or in vomitus. 
H20 alone or containing 
Face cyanotic. 
10-percent sodium thio- 
Dyspnea. 
sulphate or mixture of 
170 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
272 
Poisoning 
Symptoms 
Antidote and treatment 
Cyanides 
Foam or froth at the 
ferrous and ferric sul- 
mouth. 
phates followed by po- 
Jaws tightly clenched. 
tassium carbonate (Prus- 
Respirations jerky (hie- 
sian blue). 
coughing). 
Hydrogen peroxide diluted 
Pulse small and rapid. 
1 to 16 may be used. 
Emetics if tube not avail- 
able. 
Eyes staring and fixed *dth 
Stimulants: 
marked dilatation of 
Strychnine. 
pupils. (May occur fol- 
Caffeine. 
lowing fumigation of 
Ammonia inhalations. 
ships or buildings; pho- 
Artificial respiration and Oa 
tography; electroplating; 
and C02 (7 percent). 
gilding.) 
Atropine hypodermically. 
If patient survives 1 hour, 
Sodium thiosulphate, 20- 
recovery may occur. 
percent solution, 10 cc. 
intravenously. 
Metylene Blue (1 cc. of 0.1 
percent Mercks medicinal 
methylene blue in Ringers 
solution per kilo of body 
weight) intravenously. 
Probably best treatment.—1. 
Immediate administra- 
tion of amylnitrite by in- 
halation, repeating every 2 
to 3 minutes until ready 
to give nitrite intraven- 
ously. 2. Intravenous in- 
jection of sodium nitrite, 
6 to 10 mgm. per kilo- 
gram of body weight, fol- 
lowed by intravenous in- 
jection of sodium thio- 
sulphate, 0.5 gram per 
# 
kilogram of body weight 
(it is important that the 
two substances should 
not be mixed in the 
syringe). 3. Gastric lav- 
age, if poison was taken 
by mouth. 4. Continuous 
observation of patient 
for 48 hours with repeti- 
tion of the antidotes in 
half dosage in 1 hour if 
symptoms threaten to 
171 TM 8-260 
272 
MEDICAL DEPARTMENT 
Poisoning 
Symptoms 
Antidote and treatment 
Cyanides 
return and in any case, a 
repetition (half dose) in 2 
hours for prophylactic 
purposes. 
Digitalis 
Nausea, vomiting, follow- 
ed by abdominal pains 
and diarrhea. 
Pulse slow. 
Feeling of faintness and 
precordial oppression. 
Respiration, slow and sigh- 
ing. 
Drowsiness which proceeds 
to coma. 
Coupled beats and some- 
times runs of ventricular 
tachycardia. 
Convulsions may precede 
death. 
Stop administration of the 
drug. 
Gastric lavage with 1 to 
1,000 solution potassium 
permanganate or 1 per- 
cent tannic acid. 
Atropine, hypodermically. 
Aminophylin. 
External heat. 
Glucose intravenously. 
Ergotamine tartrate 
Pain in stomach. 
Use of siphon tube. 
(ergot). 
Nausea and vomiting with 
or without blood. 
Thirst, numbness and ting- 
ling of hands and feet. 
Weak, rapid pulse. 
Feeling of oppression in 
chest. 
Subnormal temperature. 
Coldness of body. 
Cramps, convulsive move- 
ments. 
Stupor delirium and coma. 
Lavage with warm H20 or 
diluted tannic acid (1 
percent). 
Purgation with magnesium 
sulphate or castor oil. 
Stimulants: 
Brandy. 
Ammonia diluted with 
h2o. 
Amyl nitrite. 
External heat. 
Inhalation of oxygen and 
carbon dioxide. 
Formaldehyde 
Odor. 
Sore mouth. 
Dysphagia. 
Severe abdominal pain. 
Unconsciousness and col- 
lapse. 
Later, diarrhea and tenes- 
mus. 
Empty stomach with si- 
phon tube. 
Lavage with tepid water. 
Ammonia internally; 4-cc. 
doses of aromatic spirits 
of ammonia or 2-cc. doses 
of diluted ammonia in 
250 cc. of H20. 
Chlorine, bromine, 
Intense burning and pain 
Gastric lavage with flour, 
and iodine (especi- 
in mouth, throat, gullet, 
soup, or thin starch paste 
ally iodine). 
and stomach. Corrosive 
lesions and staining may 
be seen in mouth and 
throat. Swelling of these 
parts. 
in water. May lavage 
with solution of 1 per- 
cent sodium thiosulphate. 
Apply external heat. 
Stimulants if indicated. 
172 TM 8-260 
272 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
Poisoning 
Symptoms 
Antidote and treatment 
Chlorine, bromide, 
Vomiting, and sometimes, 
Sodium thiosulphate 1 to 
and iodine. 
purging. 
Signs of shock. 
Violent, convulsive, and 
irrespressible coughing. 
Dyspnea; thirst; giddiness; 
faintness; convulsions. 
Stools may contain blood. 
10 grams by mouth as 
antidote. Well diluted. 
Sodium bicarbonate as fol- 
low-up treatment. 
General symptomatic 
measures. 
Lead (inhalation, in- 
Metallic, astringent taste 
Empty stomach by emetics 
gestion, and through 
in mouth. 
or by gastric lavage with 
skin). 
Burning, pricking, or dry 
sensation in throat, gul- 
let, and stomach. 
Thirst. 
Abdominal pain, colic. 
Nausea and vomiting. 
Diarrhea, giddiness, stu- 
por, faintness and con- 
vulsions. 
May have constipation or 
delirium. 
Stools are black if and 
when passed. 
water containing Na2SO< 
(4 to 6 oz.), magnesia, or 
dilute H2SO4. 
Demulcent drinks. 
Cathartic after lavage. 
Apply external heat. 
Calcium gluconate intra- 
venously. 
Symptomatic. 
Vitamin C and high cal- 
cium later in chronic 
stage. 
Opiate for colic. 
Mercury (corrosive 
Metallic, acrid taste in 
Treatment in detail.—1. Im- 
sublimate, bichlo- 
mouth. 
mediate gastric lavage 
ride, mercuric chlo- 
Sense of constriction or 
with a saturated solution 
ride, mercuric oxide 
suffocation in throat. 
of sodium bicarbonate, 
(red precipitate), 
Burning heat down gullet 
temperature 100° F. This 
ammoniated mer- 
into stomach. 
is continued until the 
cury (white precipi- 
Tongue may be white 
return fluid is clear. The 
tate), and other irri- 
and shriveled. 
lavage is repeated every 
tant salts of mer- 
Violent pain in region of 
12 hours for the first 5 
cury). 
stomach, increased by 
pressure which initiates 
nausea and vomiting. 
Profuse diarrhea with se- 
vere tenesmus. 
Skin cold and clammy. 
Pulse small, feeble, and 
rapid, may be irregular. 
May get swelling of glottis 
with asphyxia. 
Respirations difficult. 
days and is continued 
over a longer period if 
the chemical analysis of 
the washings show mer- 
cury. 2. Morphine sul- 
phate is administered im- 
mediately after the pri- 
mary gastric lavage. 
This is repeated at inter- 
vals dependent upon the 
degree of shock, vomit- 
ing, and pain; but the 
fundamental should be to 
relieve discomfort, retch- 
ing, and shock. 3. So- 
dium bicarbonate, 500 cc. 
173 TM 8-260 
372 
MEDICAL DEPARTMENT 
Poisoning 
Symptoms 
Antidote and treatment 
Mercury 
of a 5-percent solution, is 
j 
given intravenously im- 
mediately after the lav- 
age, and 1,000 cc. of nor- 
mal saline solution ad- 
ministered subcutaneo usly. 
As long as vomiting per- 
sists the same amount of 
each solution is repeated 
every 12 hours. 4. So- 
dium bicarbonate 5 grams 
is given orally every 3 
hours during the day and 
every 4 hours during the 
night. The amount of 
bicarbonate may be var- 
ied provided the urine is 
kept alkaline to litmus. 
5. The total daily fluid 
intake must be at least 
5,000 cc. for an adult, and 
this amount must be 
maintained by oral, sub- 
cutaneous, or intravenous 
route, dependent upon 
the ability of the patient 
to retain the substances 
taken orally. Preference 
is always given the oral 
method. 6. The daily 
diet is orange juice 500 
cc., milk 1,000 cc., and 
beta lactose 100 grams. 
One egg daily is added as 
soon as vomiting is con- 
trolled. The feedings 
should be given every 3 
hours. If vomiting inter- 
rupts the feeding sched- 
ule, 10-percent glucose 
solution is given intra- 
venously in amounts suf- 
ficient to maintain an in- 
take of at least 1,000 
calories. The bicarbon- 
ate solution can be made 
with the glucose solution 
and the injection given 
by the intravenous “drip” 
174 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
TM 8-260 
272 
Poisoning 
Symptoms 
Antidote and treatment 
Mercury __ 
method. After the first 
week adequate nutrition 
and medication are in 
some cases interrupted 
by the development of a 
severe stomatitis and 
esophagitis. 7. A colonic 
irrigation, using 5-percent 
sodium bicarbonate solu- 
tion is given daily and is 
continued until recovery 
is assured. 
Morphine and other 
Period of excitation and 
May use emetics if not 
members of opium 
period of narcosis. First 
narcotized. 
group (opium, mor- 
seldom seen in poison 
Gastric lavage with solution 
phine, codeine, eth- 
cases. 
of KMn04(l to 1,000 so- 
ylmorphine hydro- 
Overpowering condition of 
lution). Repeat lavage in 
chloride, dionin, 
drowsiness, gradual in 
Yi hour. May repeat 
heroin). 
onset. 
several times thereafter. 
Cyanosis. 
Some of the KMn04 solu- 
Profound insensibility so 
tion should be left in 
that no stimulus can 
stomach after the lavage. 
arouse; coma. 
Medicinal charcoal may be 
Relaxation of muscles. 
given by mouth. 
Pulse small and weak. 
Keep patient warm and 
Breathing labored, noisy, 
awake. 
may be irregular; later 
Atropine sulphate (.0065 
becomes slow and shal- 
gm) may be given. 
low. 
Stimulate with coffee (2 
Convulsions. 
cups, strong), caffeine, 
Skin pale, cold, and be- 
sodium benzoate by hy- 
dewed with clammy 
podermic, strychnine, or 
perspiration. 
coramine. 
Pupils contracted to almost 
Artificial respiration if nec- 
pinpoint size. They 
essary. 5 - percent C02 
may dilate terminally. 
and oxygen mixture or 
Death may succeed deep- 
ening of narcosis or may 
be preceded (especially 
in children) by convul- 
sions. 
Symptoms may remit for 
a time, but return in all 
their original severity. 
oxygen alone. 
Mushrooms 
General malaise. 
Emetics or gastric lavage. 
Profound asthenia, pros- 
Bed rest. 
tration. 
Application of heat. 
175 1M 8-2G0 
272 
MEDICAL DEPARTMENT 
Poisoning 
Symptoms 
Antidote and treatment 
Mushrooms _ 
Nausea, vomiting, and 
Saline purge. 
diarrhea. 
Medicinal charcoal ortannin. 
Severe abdominal pains, 
colic. 
Bolus alba, repeatedly. 
Convulsions and coma. 
Saline and glucose by 
Contracted pupils, fixed. 
mouth and per rectum. 
Salivation, lacrimation, 
Force fluids; diuresis. 
and perspiration (pro- 
Caffeine, strychnine, cora- 
fuse). Pulse slow. 
mine, analeptics, and 
Jaundice (hemolysis) and 
sedatives, morphine, at- 
renal damage. 
ropine, blood trans- 
Spasms, paralysis, agita- 
fusions as indicated by 
tion, cramps in calves. 
the symptoms of the 
Stertorous respiration. 
Extremities cold. 
individual case. 
Nicotine. _ 
Nausea and vomiting. 
Induce vomiting by giving 
Convulsions. 
large quantities of warm 
Dyspnea; quickened res- 
water apomophine 
piration. 
(0.0065 gm), or zinc sul- 
Collapse, coma. 
phate. 
Headache, giddiness, diz- 
Gastric lavage with 1 to 
ziness, numbness, dis- 
1,000 KMn04 solution in 
turbance of vision, tor- 
warm water. 
por, faintness, intense 
Bed rest for 24 hours. 
depression, weakness, 
Force fluids. 
cold extremities, saliva- 
Saline diuretics. 
tion, nasal discharge. 
Saline purges. 
Feeble, rapid and irregular 
Caffeine, strychnine, or 
pulse, pallor, cyanosis. 
atropine as indicated in 
Tremors, weak tendon 
individual case. Also aro- 
reflexes, dermographic 
reaction, anisocoria, 
matic spirits of ammonia. 
apathy. 
Medicinal charcoal may be 
T-wave reversed, E. K. G. 
used. 
Tachycardia, bradycardia, 
Keep patient quiet and in 
leukocytosis, glycosuria. 
horizontal position. 
Pupils first contracted, 
External heat, artificial res- 
then dilated. 
piration, if indicated. 
Oils (turpentine, euca- 
Characteristic odor on 
Gastric lavage ■with tepid 
lyptus, savin, Juni- 
breath. 
water or with solution of 
per, pennyroyal, 
Burning in mouth and 
NaHCos. Wash until 
tansy, or winter- 
stomach. 
odor of oil is gone. 
green). 
Nausea and vomiting. 
May give emetics. 
Colic and diarrhea. 
Purgative dose of MgSo4. 
Giddiness, drowsiness, un- 
Application of heat. 
consciousness, coma. 
Demulcent drinks (starch 
Thirst, hematuria, jaun- 
or flour in water, white 
dice. 
of egg, oatmeal, arrow- 
Pulse fast, thready, feeble. 
root, or acacia in water). TM 8-260 
272 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
Poisoning 
Symptoms 
Antidote and treatment 
Oils 
Skin moist and clammy, 
cold, and blue. 
Pupils dilated and im- 
mobile. 
Methemoglobinemia, he- 
maturia. 
Sometimes uterine hemor- 
rhage or abortion. 
Force fluids. 
Keep patient recumbent. 
Morphine as needed for 
pain. 
Sedatives, stimulants, and 
intravenous fluids as in- 
dicated in individual case. 
Barbiturates for excitation. 
Later treatment for nephri- 
tis and hepatitis. 
Oxalic acid (potas- 
Burning acrid taste on 
Gastric lavage, KMnO* so- 
sium binoxalate, hat 
swallowing. 
lution. (1 to 1,000 solu- 
bleach, ink eradi- 
Severe and continuous 
tion.) 
cator). 
vomiting, sometimes 
bloody. 
Burning sensation in gul- 
let and stomach. 
Sense of suffocation, loss 
of voice. 
Livid countenance; cold, 
clammy skin. 
Hurried respirations; pulse 
rapid, weak. 
Pain and tenderness in 
abdomen. 
Purging and tenesmus. 
Convulsions, headache, 
collapse, coma. 
Administer chalk, or lime, 
with milk; or other de- 
mulcent drinks in small, 
concentrated quantities. 
Milk of magnesia. 
Magnesium carbonate in 
large amounts of water. 
Intravenous CaCl4, calcium 
lactate or gluconate. 
Leave some KMn04 solu- 
tion in stomach. 
Apply heat to body. 
Stimulants if necessary. 
Paris green (arsenite 
Symptoms usually appear 
Abundant gastric lavage 
and acetate of cop- 
in from % hour to 1 
with warm water. Infu- 
per). 
hour. Burning heat and 
constriction or choking 
in throat, rendering 
swallowing difficult. 
Nausea and incessant 
vomiting and purging. 
The vomiting matter 
sion of solution of sodium 
chloride if necessary. 
Tincture of opium for 
diarrhea and colic. Caf- 
feine, strychnine or atro- 
pine, as needed, for cir- 
culatory and respiratory 
may be green from bile, 
or, in the case of arsenic, 
black from the admix- 
ture of soda, or blue 
from indigo. Pain in the 
stomach and abdomen. 
Cramps in the calves of 
the legs. Urine may be 
suppressed. There may 
be delirium or paralysis. 
Collapse; skin cold and 
stimulation. Milk diet. 
Treat as for potential 
nephritis. 
177 TM 8-260 
272 
MEDICAL DEPARTMENT 
Poisoning 
Symptoms 
Antidote and treatment 
Paris green _ 
Phenol (carbolic acid, 
clammy, sometimes 
showing eczematous 
rash. Pulse small, quick 
and irregular, or imper- 
ceptible. 
Characteristic odor on 
Evacuation of stomach by 
cresol, lysoi, crealin). 
breath. 
emetics or lavage. Can 
Phosphorus (rat poi- 
Intense burning in mouth 
throat, and stomach. 
Nausea and vomiting. 
Burns on lips or in mouth. 
Coldness and clamminess 
of skin; small thready 
pulse. 
Abdominal pain. 
Stertorous, labored, or hur- 
ried breathing. 
Early onset of insensibility; 
subnormal temperature. 
Faintness, collapse. Pulse 
slow and weak. Urine 
scanty with smoky color. 
Early symptoms are— 
put MgSO* in the lavage 
water, leave some in 
stomach. 
Animal charcoal. 
Demulcent drinks. 
Rectal feeding for a few 
days. 
Stimulants as indicated by 
symptoms. 
Apply external heat. 
Artificial respiration or par- 
enteral fluids as indi- 
cated. 
For external burns, use 
alcohol locally. 
200 cc. of 0.2-percent solu- 
son paste). 
Pain in stomach, slight at 
tion of copper sulphate 
first, severe later. 
Vomiting. 
Garlic taste in mouth, 
garlic odor on breath. 
Great thirst, burning sen- 
by mouth. Lavage with 
from 5 to 10 liters of the 
same solution followed 
by lavage with 1 liter of 
0.1-percent potassium 
sation in throat and 
gullet. 
permanganate, followed 
by the administration of 
Vomitus dark, coffee-col- 
ored, has garlic odor, 
phosphorescent in the 
dark. 
Shock. 
Late symptoms are (possi- 
bly after an intermission 
of 3 or 4 days)— 
Convulsions and coma. 
Jaundice, severe; liver, 
and perhaps spleen en- 
larged. Distended ab- 
domen. 
Hemorrhages from nose 
and other mucous mem- 
branes. 
100 cc. of liquid petro- 
latum. No fats or oils 
should be given, as they 
aid absorption. Exter- 
nal heat. Treatment 
continued for liver injury, 
high carbohydrate diet; 
dextrose and insulin (5 
percent dextrose in Ring- 
ers solution). 
178 TLI 8-260 
272 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
Poisoning 
Symptoms 
Antidoto and treatment 
Phosphorus 
Great prostration, feeble 
pulse, muscular twitch- 
ings. 
Hyperpyrexia. 
Quinine and quinidine. 
General asthenia; weak- 
ness in limbs. 
Tinnitus aurium, deafness. 
Nausea, vomiting, and se- 
vere abdominal pain. 
Great excitation, hallucina- 
tions, delirium, hyperes- 
thesia or anesthesia of 
extremities, muscular 
Produce vomiting with 
emetics or lavage, stom- 
ach. 
Intramuscular injection of 
acetylcholine (2 mg.). 
Inhalations of amyl nitrite. 
Strychnine (1 mg.). 
Caffeine. 
Tannic acid by mouth. 
• 
contractions with clonic 
Use KM11O4 (1 to 1,000) as 
or tonic convulsions, ex- 
aggeration of reflexes, 
semicoma with lucid mo- 
ments. 
Intense headaches with 
limitation of vision (espe- 
cially retraction of visual 
fields). Later deafness 
and blindness. 
Hypotension, small pulse, 
bradycardia. 
lavage. 
Sedatives if indicated. 
Barbital by mouth if ex- 
citation persists. 
Salvarsan oral (for 
Rigors. 
Emetic (ZnSO< or mustard 
intravenous see ars- 
Pyrexia. 
water to which hydrated 
phenamine). 
Prostration. 
Headache, giddiness. 
Anorexia, vomiting, colic 
diarrhea. 
Jaundice (later). 
Rapid pulse, cardiac symp- 
toms, difficult breathing. 
Psychic and motor rest- 
lessness. 
Bladder symptoms. 
ferric oxide (freshly pre- 
pared) has been added). 
Allow some of solution to 
remain in stomach. 
Can use milk of magnesia 
or even NaHC03. 
Epsom salts. 
Glucose and saline intra- 
venously. 
Demulcent drinks later. 
Skin eruptions (herpes, ur- 
ticaria, etc.). 
Oedema and cyanosis of face. 
Tonic and clonic convul- 
sions of limbs. 
Thirst; dry throat and 
larynx. 
Symptomatic therapy. 
Sodium fluoride (roach 
Sudden development of 
The important considera- 
powder). 
nausea and vomiting, 
accompanied by burn- 
ing, cramp-like abdomi- 
nal pains and diarrhea. 
tion in the treatment cf 
sodium fluoride poison- 
ing is the employment 
of calcium containing 
179 TM 8-260 
272 
MEDICAL DEPARTMENT 
Poisoning 
Symptoms 
Antidote and treatment 
Sodium fluoride. 
Clonic convulsions have 
substances in order to 
occurred in occasional 
convert the soluble so- 
cases. A peculiar gray- 
dium salt to insoluble 
ish blue cyanosis has 
calcium fluoride. This is 
been observed in some 
best accomplished by 
cases, possibly due to 
copious, repeated gastric 
the formation of fluor- 
lavage with lime water 
methemoglobin. Death 
or a weak solution of cal- 
is apparently due to the 
cium chloride, and by the 
direct action in the car- 
intravenous injection of 
dio-respiratory centers 
calcium chloride or intra- 
in the medulla. The 
muscular injection of cal- 
blood and urine may be 
cium gluconate. In addi- 
analyzed chemically for 
tion, for cyanosis’ and 
the presence of sodium 
collapse, oxygen inhala- 
fluoride. 
tions, coramine and atro- 
pine. 
Strychnine (nux vom- 
Bitter taste in mouth. 
Give by mouth or with 
ica, dog buttons, 
Lividity of face. 
stomach tube, suspen- 
picrotoxin, fishber- 
Sensation of suffocation. 
sion of medicinal char- 
ries brucin) 
Jerking or twitching of the 
coal, 2 tablespoonsful in 
muscles of the body, 
glass of water, or tannin 
neck, and limbs followed 
in water. Use KMnO< 
by severe tetanic con- 
solution (1 to 1,000 for 
vulsion of all the muscles 
gastric lavage). 
of the body—opisthoto- 
Artificial respiration if it 
nus. 
becomes necessary. 
Breathing becomes difficult 
Do not use emetics. 
and imperfect; cyanosis 
For sedation use barbitu- 
of face develops. 
rates as follows: 1. When 
Risus sardonicus; eyes star- 
sodium amytal or sodi- 
ing and wild looking. 
um pentobarbital is used 
Trismus (passes off during 
just enough of the intra- 
periods between con- 
venous preparation is 
vulsions but this is not 
given to put the patient 
true in tetanus). 
to sleep, or, if in con- 
Senses preserved; has great 
vulsions, to stop them. 
pain. 
(The patient will usually 
go to sleep.) 2. When 
phenobarbital sodium is 
used, a quantity just 
sufficient to stop convul- 
sions should be given, 
even though sleep is not 
induced. 3. When the 
patient shows further 
symptoms of strychnine 
poisoning, as indicated 
by heightened reflexes, 
180 TM 8-260 
272 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
Poisoning 
Symptoms 
Antidote and treatment 
Strychnine _ 
complaints about noises 
marked response to slight 
stimuli, or convulsions, 
the antidote should be 
repeated. 4. Gastric 
lavage is unnecessary and 
not advisable but may be 
done after the patient is 
asleep if adequate help is 
available to prevent in- 
jury or aspiration of ma- 
terial from the stomach. 
5. Physiologic solution of 
sodium chloride may be 
given intravenously, but 
this is not necessary. 6. 
Quiet, dark surroundings 
are recommended. 7. One 
should distinguish be- 
tween the effects of the 
barbiturate and the ac- 
tion of strychnine when 
repeating the injection. 
This may occasionally 
present a real difficulty, 
and when doubt exists it 
is wise to await a mild con- 
vulsion before giving the 
second or third dose of 
barbiturate. 8. The dose 
to be given cannot be cal- 
culated unless definitely 
certain of the amount of 
strychnine ingested, the 
amount of strychnine ab- 
sorbed, and the weight of 
the patient. Idiosyn- 
crasy to either the poison 
or the antidote may then 
change it. 9. Morphine 
is not indicated and apo- 
morphine may prove dan- 
gerous in that aspiration 
of material from the 
stomach may occur. 10. 
Ether may well be used 
to control convulsions 
until a soluble barbitu- 
rate can be given. If 
0 TM 8-360 
272 
MEDICAL DEPARTMENT 
Poisoning 
Symptoms 
Antidote and treatment 
Strychnine 
an intravenous prepara- 
tion is not available and 
the patient is not in con- 
vulsions, amytal, pheno- 
barbital, pentobarbital, 
or other barbiturates may 
be given by mouth, the 
amount not to exceed the 
equivalent of 15 grains 
of sodium amytal for an 
adult. The intravenous 
preparation can then be 
given later, if necessary. 
182 TM 8-260 
273-275 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
Charter 5 
STATION HOSPITAL 
Paragraph 
Function 273 
Designation and identification 274 
Organization 275 
Similarity between general and station hospitals 276 
273. Function.—a. A station hospital normally receives patients 
only from the station to which it pertains. In exceptional instances 
it may, however, serve the needs of a circumscribed area, or may be 
designated to receive special cases from any place within a corps area 
or other military command under the control of whose commander 
it functions. A station hospital in peace or war functions under 
local, district, section, or corps area control as may be prescribed 
by the superior commander under whose jurisdiction it is being 
administered. 
h. For utilization in a theater of operations, a station hospital has 
a normal capacity of 250 beds. In the zone of the interior, station 
hospitals vary in size from 25 to 2,000 beds, depending upon the 
local demands for hospitalization. 
274. Designation and identification.—See paragraph 2. 
275. Organization.—The general organization of a station hos- 
pital is in conformity with AR 40-590 and limitations of existing 
Tables of Organization. 
а. The organization consists of two major divisions: 
(1) Administrative. 
(2) Professional. 
б. The administrative division consists of personnel and activities 
as follows: 
(1) Commanding officer. 
(2) Medical inspector. 
(3) Registrar (including commanding officer, detachment of 
patients). 
(4) Medical supply officer. 
(5) Mess officer. 
(6) Commanding officer, medical detachment. 
(7) Chief nurse. 
(8) Officer in charge of utilities. 
All personnel are under the immediate supervision ot the com- 
manding officer. Those in charge of each activity are responsible 
183 TM 8-260 
275-276 
MEDICAL DEPARTMENT 
directly to him for the proper conduct and administration of their 
respective departments, 
c. The professional division may consist of services subdivided 
into various sections and clinics as follows (see fig. 1) : 
(1) Surgical service: 
Anesthesia. 
General surgery. 
Orthopedics. 
Obstetrics and gynecology. 
Urology. 
Eye, ear, nose, and throat. 
Roentgenology and physiotherapy. 
(2) Medical service; 
General medicine. 
Contagious. 
Neuropsychiatry. 
Detention. 
Dermatology. 
(3) Laboratory service. 
(4) Dentai service. 
(5) Dispensary and out-patient service (formerly attending sur- 
geon). 
276. Similarity between general and station hospitals.—The 
administrative and professional procedures of a station hospital differ 
from those outlined for a general hospital only in minor details. These 
differences are those occasioned by a different type of command con- 
trol, and type of patient. The actual methods of treatment, record 
keeping, and administration are similar. The procedure outlined as 
applicable to general hospitals may be modified to meet those condi- 
tions existing in station hospitals. See AK 40-590 and preceding 
chapters, this manual. 
184 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. 
Appendixes I to XIV, inclusive, contain check lists for the use of 
the various unit staff offices in station or general hospitals. These 
lists will provide a uniform method of periodic check for those respon- 
sible for hospital administration, and will aid medical officers without 
prior military experience in not only what should be expected, what to 
look for, what is important or trivial, how to make comparisons, but 
also where to find a solution to the problems with which they will be 
confronted. All references to Army Regulations, Field Manuals or 
Technical Manuals, War Department Circulars, circular letters, Office 
of The Surgeon General, etc., are quoted as of April 1, 1941. Due 
care will be exercised that changes to the publications listed and cur- 
rent additions are consulted for later methods or procedures. 
185 App. I 
1-2 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
Appendix I 
CHECK LIST FOR MEDICAL (HOSPITAL) INSPECTOR 
1. Command.—a. Composition of the command (component 
parts) and the number of officers, warrant officers, nurses, and enlisted 
men in each organization (AR 40-1025). 
Organization Officers Warrant officers Nurses Enlisted Prisoners Civilians Total 
b. Mean strength of the command for the last month (AR 40-275). 
Military Civilian 
2. Environmental sanitation.—a. Drainage system.—Includes 
grounds and efficiency of drainage from a sanitary point of view and 
sewage disposal system. 
(1) Any material changes in the topographical features which 
would atfect the drainage system. If so, state changes. 
(2) Any changes in the methods used to dispose of excreta, to 
include the sewerage system and sewage disposal plant, since date of 
last December sanitary report. If so, state the change (AR 40-205 
and AR 40-275). 
(8) Methods of sewage disposal satisfactory. If not, state changes 
to be recommended (AR 40-275). 
(4) System and the sewage disposal plant is satisfactory. If not, 
state changes to be recommended (AR 40-275). 
b. Public buildings.—Includes barracks, hospital, quarters, etc., 
guard house, mess halls and kitchens, bakeries, exchanges, barber 
shops, commissaries, meat markets, theaters, swimming pools, stables, 
picket lines and corrals, and service clubs. 
(1) Barracks, hospital, quarters, etc.— {a) Any changes in the 
buildings since the last medical inspection. If so, state changes (AR 
40-275). 
(b) Barracks, hospital, quarters, and other buildings are suitable 
and maintained in a sanitary condition (AR 40-275). 
(c) Barracks buildings are suitable for habitation from the stand- 
point of health and sanitation. If not, state deficiencies and recom- 
mendations (AR 40-205). 
(d) Each man sleeping in a squad room or dormitory has at least 
60 square feet of floor space and 720 cubic feet of air space computing 
a maximum ceiling height of 12 feet (AR 40-205). 
187 App. I 
2 
MEDICAL DEPARTMENT 
{e) Each dormitory has been surveyed and the authorized capacity 
of men has been stenciled upon the doors (AR 40-205). 
(/) Beds are grouped too closely together in order to obtain space 
for other purposes (AR 40-205). 
(g) If less than 5 feet of space exists between side bars of adjacent 
beds head and foot sleeping is required (AR 40-205). 
(A) Sleeping rooms adequately ventilated both by day and nighr 
(AR 40-205). 
(i) Floors of sleeping rooms show evidence of having been scrubbed 
with soap and water at frequent intervals (AR 40-205). 
(j) Company commanders require that bedding be aired at least 
once a week (AR 40-205), 
(Jc) Beds in squad rooms are clean (AR 40-205). 
(1) During the summer season screens are used in all occupied 
buildings to prevent ingress of flies and mosquitoes (AR 40-205). 
(m) Toilet bowls are in good condition, seat covers attached, and 
without accumulations of sediment (AR 30-1760). 
(n) Toilet flushing apparatus is in working order (AR 30-1760). 
(o) Urinal troughs are adjusted properly as to height and pitch, 
with flushing facilities present, and kept in a sanitary condition 
(AR 30-1760). 
{p) There are sufficient working shower heads for the strength of 
the organization (AR 30-1760). 
(q) Lattice stands and the floors and walls of shower baths are 
scrubbed clean, and without evidence of slime or dirt (AR 30-1760). 
(r) Wash bowls are clean, and with hot and cold water faucets 
working properly (AR 30-1760). 
(s) Appropriate foot baths are provided near showers. 
(t) Foot baths are properly cared for (Circular No, 47, W. D., 
1938). 
(2) Guard home.— (a) Sleeping rooms at the guard house are 
clean and well ventilated (AR 40-205). 
(6) Heating system is adequate (AR 40-205). 
(c) Suitable facilities are present at the guard house for bathing, 
toilets, and laundry (AR 30-1760). 
(d) Beds of prisoners are in good condition and clean (AR 40- 
205). 
(e) Their bedding is clean and sufficient (AR 40-205). 
(/) Each prisoner has sheets, pillow slip, towel, and toilet articles 
(AR 600-375). 
(g) Orders are in effect at the guard house to insure that bedding 
is aired at least once a week (AR 40-205). 
188 App. I 
2 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(A) Beds used by sentries are clean (AR 40-205). 
(i) What bedding they bring with them to guard house when 
reporting for guard duty. 
(j) It is evident that the walls and the floors in the guard house 
have been scrubbed recently (AR 40-205). 
(A) Beds of prisoners are grouped too closely, or tiers of bunks 
are placed less than 5 feet between side bars (AR 40-205). 
(Z) There is a minimum of at least 500 cubic feet of air space for 
each prisoner (AR 40-205). 
(m) Prisoners who are placed in solitary confinement are allowed 
sufficient air space (AR 40-205). 
(n) There is any evidence of vermin or of insects in the guard 
house (AR 40-205). 
(o) If so, measures taken to exterminate them (AR 40-205). 
(p) Any recommendations to improve sanitary conditions at the 
guard house (AR 40-205). 
(3) Mess halls and kitchens.— (a) General sanitary condition of 
kitchens, mess halls, refrigerators, and store rooms (AR 40-205). 
(b) Company kitchens and mess rooms are kept scrupulously clean 
at all times (AR 40-205). 
(c) Mess rooms are tightly screened, and with screen doors that 
close automatically (AR 40-205). 
{d) Any evidence of the presence of flies, roaches, or ants in the 
mess rooms (AR 40-205). 
(4) Bakeries.— (a) Bakery is kept scrupulously clean at all times 
(AR 40-205). 
(b) Men on duty in the bakery bathe frequently, wear clean cloth- 
ing, and when practicable wear the white uniform (AR 40-205). 
(c) These men are inspected frequently to see that before going 
on duty they have clean hands, wdth nails short and free from dirt, 
and that their clothing is clean (AR 40-205). 
(d) Personnel on duty have been examined by a medical officer, 
certified as being free from communicable disease, and a list of such 
persons with the results of the examinations noted posted in the 
bakery (AR 40-205). 
(e) Bakery is tightly screened and equipped with doors that close 
automatically (AR 40-205), 
(/) Any evidence of the presence of flies, roaches, or ants in the 
bakery (AR 40-205). 
(g) Flour, sugar, yeast, etc., are protected from dust (AR 40-205). 
(A) Mixing boards, machines, and utensils are clean and free from 
dust or dirt (AR 40-205). 
189 App. I 
2 
MEDICAL DEPARTMENT 
(i) Towels or other cloths are in use (AR 40-205). 
(5) Post exchange.—(a) Post exchange is clean and operated and 
maintained in a sanitary manner (AR 40-205). 
(6) Personnel on duty serving food, such as ice cream, milk, bot- 
tled goods, and other food stuffs, have been examined and certified 
by a medical officer as being free from communicable diseases 
(AR 40-205). 
(c) List of permanent food handlers and certificates from a medical 
officer as to their being free from communicable diseases is posted 
in the exchange (AR 40-205). 
(d) Ice cream containers, soda fountains, and other food con- 
tainers are clean, free from corrosion or dirt, and kept tightly closed 
when not in use (AR 40-205). 
(e) Facilities are available for the proper cleansing of glasses, 
spoons, and other utensils used in dispensing foods and drinks 
(AR 40-205). 
(/) Candies, fruits, and other foodstuffs are protected from dust 
and insects (AR 40-205), 
(g) Any recommendations to improve sanitary conditions at the 
post exchange (AR 40-205). 
(h) Post exchange sells the individual prophylactic kit (AR 40-235 
and circular letter No. 4, S. G. O., 1940). 
(i) Prophylactic equipment sold by the post exchange is inspected 
and meets specifications (circular letter No. 4, S. G. O., 1940). 
(6) Barber shop.— (a) All barbers on the post have read and 
they are complying with the provisions of paragraph 9, AR 40-205. 
(b) Each barber is required to undergo a monthly physical in- 
spection and such other tests as may be necessary to insure his 
freedom from communicable disease (AR 40-205). 
(c) Barbers are required to keep their persons and clothing clean, 
and while attending patrons wear a clean, washable outercoat or 
uniform (AR 40-205). 
(d) Wash their hands thoroughly with soap and water before 
attending each patron (AR 40-205). 
(e) Barbers are prohibited from selling or giving away, without 
the written approval of the surgeon, medicinal preparations for the 
hair or skin, to be used outside the barber shop, or attempting, 
under any circumstances to treat pimples, warts, moles, or similar 
lesions of the skin or scalp (AR 40-205). 
(/) Use of styptic pencils or lump or solid styptics is prohibited 
(AR 40-205). 
190 App. I 
2 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(g) Interior of the barber shop is in a clean and sanitary condition 
(AR 40-205). 
(A) Provisions have been made for an adequate supply of hot 
water and for the disposal of waste water (AR 40-205). 
(i) Cuspidors are used and they are cleaned and disinfected daily 
(AR 40-205). 
(j) A freshly laundered towel is used for each patron (AR 40-205). 
(k) Head rest of barber chairs is provided with a sheet of paper 
or clean towel for each patron (AR 40-205). 
(l) All brushes, combs, razors, clippers, shears, scissors, tweezers, 
buffers, massage and scalp appliances, etc., are cleaned, then sterilized 
after each separate use in an antiseptic solution such as 5-percent 
lysol for at least 3 minutes (AR 40-205). 
(m) Use of powder puffs, sponges, and neck dusters is prohibited 
(AR 40-205). 
(n) Use of shaving cups in common is prohibited (AR 40-205). 
(o) A copy of paragraph 9, AR 40-205, is posted in each barber 
shop (AR 40-205). 
{p) Any recommendations for sanitary improvement of barber 
shops (AR 40-205). 
(7) Commissary.— (a) Commissary is kept scrupulously clean at 
all times (AR 40-205). 
(b) See (4)(c) above. 
(c) Permanent food handlers are examined by a medical officer, 
certified as free from communicable disease, and a list of such persons 
with the result of the examination posted (AR 40-205). 
(d) Room used as a commissary is tightly screened, with doors 
that close automatically (AR 40-205). 
(e) Any evidence of flies, roaches, or ants in the commissary 
(AR 40 -205). 
(/) All food is protected from dust (AR 40-205). 
(g) Ice boxes and refrigerators are elevated to permit cleansing 
and inspection underneath (AR 40-205). 
(A) Ice boxes are clean (AR 40-205). 
(i) Counters, blocks, and utensils are clean and free from dirt or 
corrosion (AR 40-205). 
(j) Any recommendations to improve the sanitary condition of the 
commissary (AR 40-205). 
(8) Meat market.—(«) Meat market is clean and maintained in a 
sanitary condition (AR 40-205). 
(b) See (4) (c) above. 
(c) See (4) (d) above. 
191 App. I 
2 
MEDICAL DEPARTMENT 
(d) Room used as a market is tightly screened and equipped with 
screen doors that close automatically (AR 40-205). 
(e) Any evidence of the presence of flies, roaches, or ants (AR 
40-205). 
(/) All food is protected from dust (AR 40-205). 
(g) Ice boxes and refrigerators are elevated at such height from 
the floor as permits cleaning and inspection underneath (AR 40-205). 
(A) Ice boxes are scrupulously clean (AR 40-205). 
(i) Knives are clean and free from accumulations of dirt (AR 
40-205). 
(j) Meat block and the counter are scrubbed clean (AR 40-205). 
(A) Towels or other cloths are in use (AR 40-205). 
(9) Theater and service club.— (a) Post theater and service club 
are well ventilated (AR 40-205). 
(b) Both buildings are kept in a generally sanitary condition 
(AR 40-205). 
(c) Constant attention is paid to the problem of keeping down 
dust in these buildings (AR 40-205). 
(d) Toilets and toilet fixtures are clean and serviceable (AR 
30-1760). 
(e) Evidence of a common drinking glass being used in either 
building (AR 40-205). 
(10) Swimming 'pool.— (a) Number and type of swimming poois 
in use (AR 40-275). 
(&) Post orders are in effect govering the operation and sanitation 
of swimming pools (regulations for bathers and regulations and in- 
structions for pool attendants) (AR 40-205 and Army Medical 
Bulletin No. 23). 
(c) Surgeon furnishes the officer in charge of the swimming pool 
the names of all persons who are known to have an infectious disease, 
or who are known to be or are suspected of being carriers of infection 
in order that they may be prohibited from entering the pool enclosure 
(AR 40-205 and Army Medical Bulletin No. 23). 
(d) Bathhouses are equipped with foot baths containing a solution 
of calcium hypochlorite so located that the bathers must use them 
when entering and leaving the shower baths (Army Medical Bulletin 
No. 23). 
(e) Lay-out of entrances and exits of the pool in relation to dressing 
rooms, shower bathrooms, and toilets enforces the proper routing of 
the bathers so that coming from a dressing room a bather will be re- 
quired to pass the toilets and go through the shower before arriving 
at the pool entrance. And bathers are required to leave the pool 
192 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. I 
2 
through a separate exit leading to shower baths, toilets, ami dressing 
room. If bathers reenter the pool after visiting the toilet they are 
required to pass through the shower bath (Army Medical Bulletin 
No. 23). 
(/) Material used in the tank provides a tight tank with smooth 
and easily cleaned surfaces (Army Medical Bulletin No. 23). 
(g) Pool is provided with an outlet at the deepest point of sufficient 
size to permit proper drainage (Army Medical Bulletin No. 23). 
(A) Pool has all the desirable features noted beloAv (Army Medical 
Bulletin No. 23) : 
1. Smooth surfacing, 
2. Tank bottom with proper slope (1 foot to each 15 feet up to 
6-foot depth mark). 
3. Scum gutters. 
4- Bottom and sides of pool lined with light or white material. 
5. Proper marking to show depth. 
6. Steps and ladders. 
7. Runways. 
8. Wholly enclosed by fence or wall. 
0. A bathhouse with— 
(a) Lockers. 
(b) Dressing rooms. 
(c) Toilet facilities. 
(d) Shower baths. 
(e) Office for attendants and for issue of bathing suits. 
(f) Foot baths. 
(g) Drinking fountain. 
(h) Diving equipment. 
(i) A recirculation system. 
(j) Chlorination apparatus. 
(k) Suction cleaner. 
(i) Peak, or total bathing load (Army Medical Bulletin No. 23). 
(j) Any remarks or recommendations to improve the sanitary con- 
ditions or operation of the swimming pool (AR 40-205). 
(11) Stable, picket line, and corral.— (a) Stables are kept clean and 
dry at all times to abate the fly nuisance (AR 40-2080). 
(b) Manure, soiled bedding, and refuse are removed daily and dis- 
posed of (AR 40-2080). 
(c) Picket lines and corrals are policed and swept clean daily (AR 
40-2080). 
(d) Attention is paid to ground around watering troughs to see 
that it is kept clean and dry (AR 40-2080). 
193 App. I 
2 
MEDICAL DEPARTMENT 
[e) Picket line is burned over or sprayed once a week in fly season 
(AR 40-2080). 
(/) Fly traps and fly poisons are used around the stables in fly 
season (AR 40-2080). 
(g) Any recommendations to improve sanitary conditions around 
the stables, picket lines, and corrals (AR 40-205 and AR 40-2080). 
c. Water supply system.— (1) Any material change in the source 
of supply, methods of purification, potability, and adequacy of the 
water supply since date of the last December sanitary report (AR 
40-275). 
(2) Date and result of the last bacteriological test of the water 
supply (AR 40-205). 
(3) Bacteriological tests of water are made monthly as required 
(AR 40-810). 
(4) When last chemical test of the water was made (AR 40-310). 
(5) Precautions as to collecting, shipping, and labeling of water 
specimens are observed (AR 40-310). 
d. Disposal of garbage, manure, dead animals, and other refuse.— 
(1) Method used to dispose of garbage (AR 30-2175 and AR 40- 
205). 
(2) Garbage collector is permitted to transfer garbage from can 
to can during collections at kitchens, thus creating a polluted con- 
dition of the soil (AR 40-205). 
(3) Garbage cans are thoroughly sterilized or washed before being 
returned to the stand (AR 30-2175, AR 40-205, and ch. XVI, Army 
Medical Bulletin No. 23). 
(4) Garbage cans are kept tightly covered and placed upon satis- 
factory stands (AR 40-205). 
(5) Garbage is properly segregated (AR 30-2175 and AR 40-205). 
(6) Post orders forbid the whitewashing of garbage cans (AR 
40-205). 
(7) Any recommendations to improve sanitary conditions at the 
garbage stands, along the route of transportation, or at the place 
of final disposal (AR 40-205). 
(8) Method used to dispose of manure (AR 30-2175 and AR 40- 
205). 
(9) Stable manure is removed daily to the place designated for its 
final disposal (AR 40-205). 
(10) Any recommendations to improve the system of disposal of 
manure from a sanitary standpoint (AR 40-205, and ch. XVII, 
Army Medical Bulletin No. 23). 
(11) Method used to dispose of dead animals (AR 30-2175). 
194 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. I 
2 
(12) Method used to dispose of refuse such as sweepings, dirt, ashes, 
etc. (AR 30-2175). 
e. Food supplies and their preparation.— (1) There is proper 
variety of food supplies available for messes (AR 40-205). 
(2) Quality of the food supplies is good (AR 40-205). 
(3) Food supplies are adequate (AR 40-275). 
(4) Approved methods of dishwashing are used (AR 40-205). 
(5) Milk sold on the post is of good quality (AR 40-2035). 
(6) All milk sold on the post is pasteurized (AR 40-2035). 
(7) If so, all pasteurization plants are fully up to standards 
(ch. XI, Army Medical Bulletin No. 23, and AR 40-2230). 
(8) Raw milk is sold on the post (ch. XI, Army Medical Bulletin 
No. 23). 
(9) All cows are tuberculin tested (AR 40-2230). 
(10) All cows are given the agglutination test against abortion 
disease (ch. XI, Army Medical Bulletin No. 23). 
(11) Milk is used on the post from cows giving a positive 
agglutination test (ch. XI, Army Medical Bulletin No. 23). 
(12) Personal hygiene of permanent food handlers is maintained 
at a high standard (AR 40-205 and AR 40-2230). 
(13) Permanent food handlers are examined regularly for 
evidence of any communicable disease (AR 40-205). 
(14) Storage of food supplies is satisfactory (AR 40-205). 
(15) Foods are prepared and served in a sanitary manner (AR 
40-205). 
(16) All meats, meat foods, and dairy products are inspected by 
a veterinary officer prior to delivery to the consumer (AR 40-205). 
(17) Food supplies are protected against sun, heat, dust, insects, 
rodents, and other damaging or contaminating agencies (AR 40-205). 
(18) A medical officer has inspected the food and drink establish- 
ments adjacent to the post which are frequented by members of the 
command (AR 40-205). 
(19) Ice, bread, and fresh meat are issued daily when practicable 
(AR 40-205). 
(20) Vehicles for transporting bread, fresh meat, and other ex- 
posed supplies are kept scrupulously clean (AR 40-205). 
(21) Each organization or mess has clean paulins, cloths, or bags 
which will fully protect such exposed supplies from contamination 
by handling, exposure, or by contact with the vehicle (AR 40-205). 
(22) Bread in transit is carried in covered basket, clean bed sacks, 
or similar devices to avoid contamination (AR 40-205). 
(23) Company kitchens and mess rooms are kept scrupulously clean 
at all times (AR 40-205). 
195 App. I 
2 
MEDICAL DEPARTMENT 
(24) Men on duty in the mess bathe frequently, wear clean cloth- 
ing, and when practicable wear the white uniform (AR 40-205). 
(25) Men on duty in the mess rooms are inspected frequently to 
see that before going on duty they have clean hands and that nails are 
free from dirt (AR 40-205). 
(26) Permanent food handlers are reported by letter to the surgeon 
for examination and certification before being placed on such duty 
(AR 40-205). 
(27) A list of such permanent food handlers with the results of the 
examination noted thereon is posted in the kitchen (AR 40-205). 
(28) All food receptables, dishes, and table articles are protected 
from insects (AR 40-205). 
(29) All food is protected from dust (AR 40-205). 
(30) Ice boxes and refrigerators are elevated at such height above 
the floor as will permit cleaning and inspection underneath (AR 
40-205). 
(31) Ice boxes are kept scrupulously clean (AR 40-205). 
(32) Dishes and utensils are washed with soap and hot water and 
rinsed with hot water after each meal (AR 40-205). 
(33) Dish cloths are in use (AR 40-205). 
(34) When fresh meats are received at a mess and sanitary defects 
are found, a medical officer is called at once (AR 40-205). 
(35) Any recommendations to improve the food supply (AR 
40-205). 
/. Eradication of disease-hearing or other insects.— (1) Indigenous 
disease-transmitting insects and other insects that constitute a pest 
(mosquitoes, flies, fleas, etc.) prevalent (AR 40-275). 
(2) Species of the important disease-bearing insects and those 
which cause discomfort found at the station (AR 40-275). 
(3) In case that the species of such insects could not be determined 
specimens have been collected and sent to the Army Medical Museum 
for identification (AR 40-275 and AR 40-410). 
(4) In what months these insects are most prevalent (AR 40-275). 
(5) Measures used for their control (AR 40-205). 
(6) Conditions on the post or adjacent thereto which favor the 
breeding of mosquitoes (AR 40-205). 
(7) Measures taken or are recommended to be taken to abate or 
eliminate the conditions referred to above (AR 40-205). 
(8) Unusual conditions on the post or adjacent thereto which 
favor the breeding of flies (AR 40-205). 
(9) Measures taken or are recommended to be taken to eliminate 
or abate the conditions which promote the breeding of flies (AR 
40-205). 
196 App. I 
2-4 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
g. Clothing.—(1) Issue of clothing is suitable for the prevailing 
climatic conditions (AR 40-275). 
(2) Type of clothing issued has had any effect on the health of 
the command (AR 40-275). 
3. General statistics, military personnel.—a. Enter the health 
statistics as noted in the table below: 
Year 
Rate per 1,000 per annum for the 
command 
Admissions, all causes; 
Diseases only 
Injuries only 
Deaths, all causes; 
Diseases only 
Injuries only 
Admission, “new” venereal disease 
Prophylactic rate __ 
b. How marked variations in the table above can be accounted for 
(AR 40-275). 
c. Give number of cases and annual admission rate per 1,000 for 
injuries produced by external causes other than wounds received in 
action for the past year (AR, 40-1080). 
4. Personal hygiene.—a. What the general health of the com- 
mand has been during the past year (AR 40-275). 
b. Any undue incidence of foot troubles or malformations during 
the past year (AR 40-275). 
c. Commissioned officers witness the fitting of issue shoes and sat- 
isfy themselves that the feet of their men are kept in normal condi- 
tion for marching (AR 40-205 and AR 850-125). 
d. Quartermaster has established a suitable place where shoes may 
be fitted to men and records made and verified, and a try-on set, 
consisting of a complete series of each size and width, is furnished 
for issue (AR 850-125). 
e. Last dental survey of the command indicates a large proportion 
of men who require dental attention (AR 40-510). 
/. Sanitary order of the post prescribes that men will— 
(1) Bathe at least once a week. 
(2) Wash the hands before each meal and after visiting a latrine 
or toilet. 
(3) Clean the teeth with a brush at least once a day. 
(4) Keep the nails cut short and clean. 
(5) Have the hair cut short. 
197 App. I 
4-6 
MEDICAL DEPARTMENT 
(6) Keep their clothing and bedding clean, 
(7) Keep soiled clothing in barracks bags (AH 40-205 and 40- 
275). 
g. At the prescribed physical inspections the medical officer pays 
particular attention to the points mentioned above (AR 615-250). 
h. Number of men discharged for disability during the past year 
(AR 40-275 and AR 615-360). 
i. Discuss the reasons for such discharges for disability. 
j. How many of such discharges were for causes of service origin. 
k. How many causes existed prior to enlistment. 
l. The command is completely protected by immunization against 
(AR 40-275) — 
(1) Smallpox. 
(2) Typhoid. 
m. Any special immunization measures instituted during the past 
year (AR 40-275). 
n. Record is kept to show that the command is protected against 
smallpox and typhoid fevers (AR 40-215), 
o. Present dental classification of the command (AR 40-510). 
5. Undue prevalence of acute communicable disease.—a. 
Any outbreaks of acute communicable disease at the station during the 
past year (AR 40-275). 
b. Origin was determined (AR 40-275). 
c. It was determined how the disease was disseminated (AR 40-275). 
d. What the usual course of the epidemic was (AR 40-275), 
e. Measures instituted for the control of the epidemic (AR 40-275). 
6. New or improved administrative measures and sanitary 
appliances.—a. Sanitary appliances now in use in the command are 
satisfactory (AR 40-275). 
b. Any new or improved types of sanitary appliances subjected to 
experimental use during the past year (AR 40-275). 
c. If so, results obtained (AR 40-275). 
d. Any such devices reported on during the past year. If so, give 
dates (AR 40-275). 
198 App. II 
1-5 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
Appendix II 
CHECK LIST FOR COMMANDING OFFICER OR 
SURGEON 
1. Hospital bed capacity (AR 40-1080). 
Normal beds 
Emergency 
Expansion capacity 
2. o. Buildings occupied for hospital purposes are satisfactory and 
of a capacity sufficient to meet normal needs (AR 40-585). 
h. If the answer to a above is in the negative, detail what is re- 
quired, stating the status of projects now authorized (AR 40-585). 
c. A record is kept of repairs, alterations, and improvements to the 
hospital, showing nature of project, date approved by station sur- 
geon, date completed, and total cost (AR 40-585), 
d. Any of the floors in the hospital painted in violation of orders 
(AR 40-585). 
e. Wooden steps and veranda and porch floors protected by paint 
(AR 40-585). 
/. Instructions pertaining to construction and repair of hospitals 
are complied with (par. 16, circular letter No. 1, S. G. O., 1940). 
3. a. Actual and authorized strength of the Medical Department 
personnel this date shown under the headings given below: 
(1) Officers by name, grade, and corps. 
(2) Army Nurse Corps by number. 
(3) Enlisted men by grade and number. 
(4) Civilian employees by designation and number. 
h. Civilian employees are appointed, promoted, etc., in accordance 
with instructions in section VI, circular letter No. 1, S. G. O., 1940, 
and other references referred to therein. 
4. Mean strength of the command this date (AR 40-275 and AR 
40-1025). 
Officers 
Enlisted 
Army Nurse Corps 
Civilians 
Warrant officers 
5. Commanding officer of the hospital has organized the profes- 
sional and other activities of his hospital into services and prescribed 
their number, the lines of control over them, and their relationship to 
each other (AR 40-590). 
199 App. II 
6-16 
MEDICAL DEPARTMENT 
6. What services and activities have been organized (AH 40-590). 
7. What duties have not been delegated by the commanding officer 
to his assistants (AR 40-590). 
8. a. There is an official Table of Organization for the medical 
detachment (AR 310-60). 
h. There is a published letter showing the personnel authorized by 
grade and number (AR 310-60). 
c. A graphic chart has been published showing the organization 
of the hospital and the duties of the personnel (AR 40-590). 
d. Hospital regulations are complete and posted up to date (AR 
40-590). 
9. Current Table of Basic Allowances for the Medical Department 
is on file in the hospital (sec. Ill, AR 310-60). 
10. Commanding officer has drawn up regulations for the hospital 
and caused them to be posted in appropriate places so as to be easily 
seen and read by those persons to whom they are applicable (AR 
40-590). 
11. Commanding officer has prepared a training schedule for medi- 
cal personnel of the hospital, stating the objective or standards to be 
attained and the time available for the purpose. 
12. Up-to-date files of the following publications are maintained 
(AR 310-10, AR 310-50, and FM 21-6) : 
a. Army Regulations. 
h. Technical Manuals. 
c. Field Manuals. 
d. Field Service Regulations (FM 100-5 and FM 100-10). 
e. Mobilization Regulations. 
/. General Orders, Bulletins, and War Department Circulars. 
g. Circular letters, Surgeon General’s Office. 
A. Orders, circulars, and memoranda of the corps area. 
i. Orders, circulars, and memoranda of the post, camp, or station. 
j. War Department training circulars. 
13. System used to distribute orders, memoranda, information, etc., 
to officers on duty at the hospital. 
14. Medical officers in their lectures on sex hygiene are instructed 
to warn all concerned of the dangers of self-medication with sulfanil- 
amide (S. G. O. circular letters Nos. 13, 1938; 35 and 52, 1939; 17, 
1940). 
15. Mobilization plans for which the surgeon is responsible are 
up-to-date (MR). 
16. How “secret,” “confidential,” and “restricted” documents and 
files are kept (AR 380-5). 
200 App. II 
17-23 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
17. a. Commanding officer of the hospital guards the knowledge 
of the combination of the hospital safe with the utmost care (AR 
40-590). 
h. Makes report by confidential letter direct to The Surgeon Gen- 
eral of any changes in the combination of the hospital safe (AR 
40-590 and AR 380-5). 
c. When the combination was last changed (AR 40-590). 
18. Decimal system of filing is in use at the hospital (War De- 
partment Correspondence File Book). 
19. Precedent and policy file is maintained under Number 008 
(War Department Correspondence File Book). 
20. Retained copies of reports and returns, letters, etc., which are 
not useful in the transaction of current business, which are over 
8 years old, have been reported to The Surgeon General within 1 
year after the 8-year period has ended for disposition (AR 40-1005). 
21. A Duty Roster, W. D., A. G. O. Form No. 6, is maintained for 
details of officer of the day, noncommissioned officer in charge of 
quarters, and emergency details (AR 345-25). 
22. a. Duties of the medical officer of the day are clearly defined 
in hospital orders or regulations. 
1). Hospital regulations require that the officer of the day will— 
(1) Leave instructions where he may be found when away from 
the hospital, 
(2) Make a written or verbal report to the commanding officer of 
his tour of duty. 
(3) Make periodic inspections of the hospital and grounds. 
(4) Take charge in case of fire until the arrival of the fire mar- 
shal. 
(5) Inspect the guard and emergency details. 
(6) Maintain good order and discipline. 
(7) Enforce the hospital regulations. 
(8) Be responsible for the verification and safeguarding of pris- 
oner patients. 
(9) See all operative cases of the day. 
(10) Be responsible for the proper preparation of the body in case 
of death. 
(11) Have prepared the Clinical Record, Brief, W. D., M. D. Form 
No. 55A, in all cases admitted to hospital. 
(12) Inspect all ward order books to determine that treatment are 
being carried out (AR 40-590). 
23. a. Commanding officer institutes proper measures for fire pro- 
tection and prevention such as enforcing measures prescribed by 
201 App. II 
23-29 
MEDICAL DEPARTMENT 
higher authority, the appointment of a fire marshal, the formulation 
of hospital fire regulations, periodic fire drill, inspections, etc. (AR 
40-590). 
h. Oil, paint, grease, gasoline, waste, and other inflammable ma- 
terials kept in a separate building with adequate fire protection by 
the use of sand, chemical, etc. (AR 40-590 and AR 700-10). 
c. Hospital fire regulations prescribe— 
(1) Duties of individuals and groups. 
(2) Place of assembly. 
(3) Order of rescue and protection— 
(«) Patients. 
(h) Property. 
(c) Records. 
(d) Buildings. 
d. How often fire drill has been held at the hospital (AR 40-590). 
e. Fire escapes are in good condition and ample to clear the build- 
ing quickly in case of fire (AR 40-590). 
/. Helpless patients ever kept above the second floor of the hos- 
pital (AR 40-590). 
24. Commanding officer inspects or directs the inspection of the en- 
tire hospital daily, and once each week inspects or causes to be 
inspected the medical detachment (AR 40-590). 
25. There is a loose sheet binder containing the duplicates of sani- 
tary reports (with official indorsements), and the duplicate Report 
Sheets of Sick and Wounded (W. D., M, D. Form No. 51) filed in 
single chronological sequence and permanently preserved as the 
medical history of the post (AR 40-1005). 
26. Forwarding indorsements of the post commander and return 
indorsements of higher authorities have been transferred to the 
binder copy (AR 40-1005). 
27. It is clearly understood by all concerned that information con- 
cerning the condition of sick patients necessary to allay the anxiety 
of friends will be freely imparted. Commanding officer has issued 
instructions in this matter (AR 40-590). 
28. Commanding officer has issued instructions that will prevent 
the furnishing of information which can be made the basis of claims 
against the United States (AR 35-7020 and AR 345-415). 
29. a. Whenever the condition of a patient reaches the stage which 
seriously endangers life, the Army chaplain on duty at the station is 
notified promptly (AR 40-590). 
h. Chaplain makes regular visits to the men in confinement in the 
prison ward to give them advice and offer consolation (AR 60-5). 
202 App. II 
29-37 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
c. Chaplain makes regular visits to the sick in hospital for such 
spiritual and welfare ministrations as he may be able to give (AR 
CO-5). 
d. Chaplain encourages correspondence between soldiers and their 
relatives and friends, especially on the part of the sick in hospital 
(AR CO-5). 
e. If no Army chaplain is on duty at the station, the commanding 
officer, under AR 210-10, makes reasonable effort to provide religions 
guidance and services, especially for the seriously ill (AR 60-5). 
30. A report is filed at the hospital of the fact of inspection of 
remains prior to interment or shipment (AR 40-590). 
31. An alphabetical immunization file is maintained (AR 40-215). 
32. Surgeon orders conducted a daily inspection of contacts when 
the first case of measles, mumps, diphtheria, scarlet fever, influenza, 
epidemic meningitis, etc., appears in an organization (AR 40-220), 
33. Surgeon orders hospitalization of all cases of illness with catar- 
rhal symptoms accompanied by a temperature of 100° F. or above 
(AR 40-220). 
34. Surgeon is familiar with local civil laws in regard to quaran- 
tine, reporting births, deaths, and communicable diseases, etc. (AR 
40-1080). 
35. Surgeon directs the collection of mosquitoes during the mos- 
quito season to determine the type of such insect prevalent at his sta- 
tion (AR 40-205), 
36. It is clearly understood at the station that officers and enlisted 
men ordered to permanent detached service, or who are being trans- 
ferred to a station where no dental officer is available, will report to 
the dental surgeon for treatment and inspection prior to departure 
(AR 40-510). 
37. a. Commanding officer constantly supervises the mess and exer- 
cises every precaution to prevent waste and misuse (AR 40-590). 
h. Uses the utmost care when assigning personnel to mess manage- 
ment to assign only those of known probity and good habits (AR 
40-590). 
c. By frequent inspections he sees that waste or wrongful diversion 
of supplies or funds is not permitted, and that the mess is so man- 
aged that neither patients nor duty personnel will have just grounds 
of complaint over the quality or quantity of their food (AR 40-590). 
d. He inspects the Mess Account (W. D., M. D. Form No. 74) at 
frequent intervals so as to keep constantly informed on the status 
of the mess accounts (AR 40-590). 
e. Officers on duty at the hospital are subsisted at the hospital 
mess (AR 40-590). 
203 App. II 
38-47 
MEDICAL DEPARTMENT 
38. Any hospital property used for other than Medical Department 
purposes (AR 40-590). 
39. Commanding officer causes an inventory of such articles of 
medical property as he may designate to be made from time to time 
by a disinterested Medical Department officer in order to assure him- 
self that the inventory and stock record balances are in accord 
(AR 35-6520 and AR 40-1705). 
40. Each administrative department or activity maintains a chart 
or index of the various regulations, orders, instructions, etc., per- 
taining to the administration of their respective department for 
ready reference purposes. 
41. Clinical records show the date and hour of the patient’s 
admission. 
42. How long patients are in the hospital before a history and physi- 
cal examination are made. 
43. An impression of the patient’s condition is entered on the clini- 
cal record at the time of taking history and physical examination. 
44. What the longest interval is between notations on progress sheet 
of each clinical record. 
45. Enumerate irregularities or discrepancies reported by the in- 
spector general on his last inspection. 
46. Irregularities or discrepancies reported by the inspector general 
have been corrected. 
47. Civilian physicians in Army hospitals are authorized to sign 
official papers pertaining to military personnel (par. 8, circular letter 
No. 1, S. G. O., 1940). 
204 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. Ill 
l-Q 
Appendix III 
CHECK LIST FOR REGISTRAR 
1. Patient strength this date, classified as follows: 
Officers 
Nurses 
Warrant Officers 
(AR 40-590 and AR 40-1005). 
2. The active clinical records (W. D., M. D. Form No. 55 series) 
and the cards of the register of sick and wounded (W, D., M. D. Form 
No, 52) are filed in numerical sequence (AR 40-1025, FM 8-45). 
3. a. A “current file” of register cards arranged in dictionary order 
is maintained (AR 40-1025, FM 8-45). 
b. A “permanent file” of register cards by register number is main- 
tained (AR 40-1025, FM 8-45). 
c. Permanent file is unbroken, or cards of the past years have been 
transferred to an inactive file in numerical sequence (AR 40-1025, 
FM 8-45). 
d. The register of sick and wounded, the file of clinical records, and 
the medical history of the post are permanently preserved (AR 40- 
1005). 
e. Exactly where the files of inactive register cards and clinical 
records are stored (AR 40-1005). 
/. Containers for inactive register cards and clinical records are 
marked properly with the contents, secure from dust and damage 
(AR 40-1005). 
4. a. The reports of sick and wounded are always forwarded to 
the corps area surgeon on or before the 5th of the next succeeding 
month (AR 40-1025, FM 8-45). 
b. What has prevented the reports of sick and wounded being 
mailed on the date specified (AR 40-1025, FM 8-45). 
5. A register card (W. D., M. D. Form No. 52) and a clinical record 
brief (W. D., M. D. Form No. 65A) is started before the patient is 
admitted to a ward (AR 40-1025, FM 8-45). 
6. a. A clinical record made up for serious cases treated in quarters 
(AR 40-1025, FM 8-45). 
b. Clinical records are kept and reports rendered, as required, of all 
unusual or interesting clinical observations in connection with the 
use of sulfanilamide (S. G. O. circular letters No. 13, 1938, and No. 
17, 1940). 
Enlisted 
U. S. Veterans Administration 
Civilians 
205 App. Ill 
7-17 
MEDICAL DEPARTMENT 
7. A nominal card index of the sick is kept on W. D., M. D. Form 
No. 52a, one to each patient, and alphabetically and permanently filed 
(AR 40-1025, FM 8-45). 
Note.—Check the last three admissions to see if the entry of register number 
was placed on the index card. 
8. There is a “diagnosis index” of all diseases or injuries treated 
and all operations performed, recorded by the use of the numbers 
shown in AR 40-1025, FAX 8-45. 
9. A “disability index” is maintained for all cases discharged on 
certificate of disability (AR 40-1025, FM 8-45). 
10. A “death index” is maintained for all cases that terminate in 
death (AR 40-1025, FM 8-45). 
11. An “outpatient index” is maintained in two sections, the cur- 
rent and the general file (AR 40-1025, FM 8-45). 
12. Births and deaths occurring at the station are reported to the 
Bureau of Census and civil authorities (AR 40-1080). 
13. Statistical tables are prepared from the data on Statistical Re- 
port—First and Second Sections (W. D., M. D. Form No. 86ab) 
and kept current for— 
a. Strength of command. 
b. Annual mean noneffective rate. 
c. Number of cases and annual admission rate per 1,000 for— 
(1) All causes. 
(2) Diseases onlj. 
(3) Venereal diseases. 
(4) Common respiratory diseases. 
(5) Diarrheal diseases. 
(G) Injuries produced by external causes other than wounds re- 
ceived in action. 
(7) Such other diseases as conditions warrant or may be designated 
by higher authority. 
(AR 40-1080). 
14. Current graphic statistical charts are maintained on Vital Sta- 
tistics Chart (W. D., M. D. Form No. 85), showing the current 
annual rate per 1,000 by weeks or months for the items listed in 
paragraph 13 (AR 40-1080). 
15. Transfer of a patient from one ward to another at once is re- 
ported to the registrar (AR 40-590). 
16. A “location index of patients” is kept in the registrar’s office 
(AR 40-590). 
17. a. Complete records of autopsies are kept at the hospital (AR 
40-590). 
206 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. Ill 
17-26 
h. Copies of all autopsy protocols are sent to the Curator, Army 
Medical Museum (AR 40-590). 
c. How many deaths occurred during the past calendar year and 
what the percentage of autopsies was. 
18. When a patient who has been formally or informally trans- 
ferred to the hospital and discharged to duty7, his commanding officer 
is notified by letter, through the surgeon of his station, giving this 
information: 
a. The name of the patient. 
h. The duration of stay in hospital. 
c. Whether the illness or injury treated was incurred in line of 
duty. 
d. Whether the illness or injury was due to the patient’s own 
misconduct. 
(AR 40-590). 
19. The above rule is followed when a patient is transferred from 
hospital to quarters under the same circumstances (AR 40-590). 
20. A follow-up file of cases discharged at the station because of 
disability is maintained in order that the report of discharge from 
the organization commander may be sent to The Surgeon General 
(AR 615-360). 
21. Patients are informed by the admitting officer, or registrar, 
that the hospital will receive money or valuables for safekeeping and 
that the patient will receive a receipt signed by a commissioned officer 
(AR 40-590). 
22. In the event that a patient is unconscious when admitted, the 
admitting officer searches the patient for money or valuables in 
the presence of a witness, and a receipt is given for the articles which 
are to be safeguarded (AR 40-590). 
23. Money or jewelry invariably is deposited in a bank or in a safe, 
and other articles and papers in a locked compartment (AR 40-590). 
24. Orders are in effect, and well understood, that enlisted men 
will never receive money or valuables for safekeeping (AR 40-590). 
25. The registrar, as custodian of the patients’ funds, keeps a book 
of receipt blanks with stubs, receipts and stubs numbered serially 
(AR 40-590). 
26. Registrar gives each patient a receipt listing the money and 
valuables received from him for safekeeping, and he lists them on 
the corresponding stub which the patient signs indicating that the 
list is correct and shows all his money and valuables at the time of 
deposit (AR 40-590). 
207 App. Ill 
27-38 
MEDICAL DEPARTMENT 
27. Custodian deposits all money in the hospital safe or in a local 
bank to the credit of “patients’ fund” (AR 40-590). 
28. Custodian keeps a patients’ fund cash account wherein is debited 
all money received from and credited all money returned to patients 
(AR 40-590). 
29. The above cash account is balanced at least once a month (AR 
40-690). 
30. Custodian of the patients’ fund has a ledger, preferably a loose- 
leaf book, in which he keeps the individual account of the money 
and valuables of each patient, which account is balanced at least 
once a month (AR 40-590). 
31. When a patient desires to withdraw money or valuables he is 
required to present his receipt on which the custodian notes on the 
back and on the stub the date and amount of withdrawal, requiring 
the patient to initial or sign both (AR 40-590). 
32. In case of withdrawal of all the patient’s deposits the custodian 
takes up the receipt and attaches it to the stub (AR 40-590). 
33. The patient is required to initial the entries on the individual 
ledger when he withdraws money or valuables (AR 40-590). 
34. Standing orders are in effect that in no case will money or valu- 
ables of a patient be turned over to an enlisted man for transmission 
(AR 40-590). 
35. The patients’ fund has been audited by an officer other than the 
custodian at the end of each month (AR 40-590). 
36. Upon admission of a patient to the hospital his personal effects, 
other than money or valuables, are listed in duplicate on Patient’s 
Property Card (W. D., M. D. Form No. 75) in his presence (or in 
the presence of a witness if the patient is unconscious or insane), 
signed by the patient (if conscious), bundled and tagged for iden- 
tification, using Patient’s Property Tag (W. I)., M. D. Form No. 76), 
and properly and securely stored (AR 40-590). 
37. The soiled clothing is always washed as a part of the hospital 
laundry before being stored (AR 40-590). 
38. Whenever the death of a person occurs at the hospital an official 
report in writing is made to— 
a. Station commander giving required information. 
b. Corps area surgeon if the deceased is a Medical Department 
officer, Army nurse, or Medical Department enlisted man above the 
grade of sergeant, giving date, time, place, and cause of death. 
c. The Surgeon General, a duplicate of the report in b above (AR 
40-590). 
208 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. Ill 
39-48 
39. When a patient has reached a stage which seriously endangers 
life, the person designated by the patient to be notified in case of 
emergency always is notified (AR 40-590). 
40. a. The Surgeon’s Morning Reports of Sick (W. D., M. D. Form 
No. 71) indicates that it has been made out each day, using one line 
for each separate company or detachment, and each column footed 
for each day opposite the word “total” in the column “company and 
regiment and corps,” and signed each day by a medical officer on the 
line immediately below the total, using one line only for his signa- 
ture and title (AR 40-1005). 
6. The organization commander has entered each day in the proper 
column the strength of the command for the day, separately for officers 
and enlisted men, white and colored, Filipinos and Puerto Ricans 
(AR 40-1005). 
41. How many cases have been recorded during the past month 
as follows: 
Hospital Quarters 
Military . 
All others- . 
Civilian 
(AR 40-1025 and FM 8-45). 
42. The name, date of admission, diagnosis, and probable date of 
disposition of all cases now in hospital more than 2 months 
(AR 40-1025 and FM 8'-45). 
Name Date of admission Diagnosis Probable Disposition 
43. A Malarial Register (W. D., M. D. Form Xo. 56). See circu- 
lar letter Xo. 63, S. G. O., 1941, for discontinuance of Malarial 
Register. 
44. Any accumulation of obsolete, damaged, or unserviceable prop- 
erty on hand (AR 40-1705 and AR 700-10). 
45. Registrar maintains a tile of property held on T\r. D., M. D. 
Form Xo. 16b (AR 40-1705). 
46. All medical property in the sick and wounded office has been 
examined and verified by a commissioned officer of the Medical 
Department within the last 6 months (AR 40-1705 and AR 35-6520). 
47. Form Xo. 86c is rendered weekly for officer personnel only dur- 
ing periods of troop concentrations for training (par. 7, circular 
letter Xo. 1, S. G. O., 1940). 
48. Clinical records furnished by the Medical Department to agen- 
cies other than The Adjutant General, are abstracted according to 
instructions (par. 9, circular letter Xo. 1, S. G. O., 1940). 
209 App. Ill 
49-52 
MEDICAL DEPARTMENT 
49. Names and serial numbers of patients reported on sick and 
wounded cards are verified (par. 10, circular letter No. 1, S. G. O., 
1940). 
50. Syphilis cases are classified and reported (par. 10d and e, cir- 
cular letter No. 1, S. G. O., 1940). 
51. Injuries are reported and coded as required (par. 10<7 and h} 
circular letter No. 1, S. G. O., 1940). 
52. Sick and wounded reports are prepared in accordance with in- 
structions (par. 10, circular letter No. 1, S. G. O., 1940). 
210 App, IV 
1-12 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
Appendix IV 
CHECK LIST FOE MEDICAL SUPPLY OFFICEE 
1. Storerooms are clean, neatly arranged, and properly protected 
from fire, theft, and other damages (AR 700-10). 
2. Who is intrusted with keys to the storerooms, closets, and lockers 
(AR 700-10 and AR 35-6520). 
3. Personnel are adecpiate and well instructed in their duties (AR 
40-500). 
4. a. Standing orders are in effect prescribing the dates and manner 
of issues, the turning in, and exchange of medical supplies. 
h. How often routine issues are made. 
c. Issues are made at any hour of the day or night if a request is 
made (AR 40-590). 
5. Any accumulation of obsolete, damaged, or unserviceable prop- 
erty on hand (AR 700-10). 
6. Stocks of obsolete Medical Department blank forms are on hand 
(AR 40-1705 and AR 30-2145). 
7. An accumulation of nonstandard supplies is on hand (circular 
letter Xo. 1, S. G. O., 1940). 
8. A record of surplus property is kept (AR 40-1705). 
9. Rotation of stocks is practiced; namely, containers for supplies 
which have been stored for some time are placed in front of new stock 
and issued first (AR 700-10). 
10. a. A record is kept of the medical property issued to depart- 
ments and individuals on W. D., M. D. Form No. 16b (AR 40-1705). 
h. Any medical property issued to individuals and kept an undue 
length of time (AR 35-6520). 
c. Any hospital equipment in use outside of the hospital for other 
than strictly professional purposes. 
11. Date of the last complete physical inventory of medical supplies 
(AR 40-1705). 
12. a. Any of the deteriorating medical supplies listed below stored 
in unit equipments as noted: 
(1) Dental dispensary equipment (new pattern) : 
1 chest, MD Xo. 60 dental (95025). 
Procaine epinephrine hypo tab. 
Polisher, rubber cup. 
Rubber, dam. 
211 App. IV 
12 
MEDICAL DEPARTMENT 
Syringe, water. 
Rubber, red. 
Basin, rubber. 
(2) Regimental headquarters medical equipment (new pattern) 
(97646) : 
1 chest, MD No. 1 (99280). 
Blaster, adhesive. 
Apron, rubberized. 
Basin, rubber. 
1 chest, MD No. 2 (99281). 
Digitalis hypo solution. 
Procaine hydrochloride epinephrine. 
Epinephrine soluble salt. 
Apomorphine hydrochloride. 
Ether. 
Ethyl chloride. 
Catheters, urethral (4), 
Syringe, urethral, prophylaxis. 
Tube, stomach. 
Dropper, medicine. 
Gloves, medium size. 
Gloves, rubber, pouch for. 
Plaster, adhesive. 
Battery, dry cell. 
Basin, rubber. 
Bag, hot water, and syringe. 
1 blanket, set, small (99098). 
Blanket, rubber. 
(3) Battalion medical equipment (new pattern) (97507). Same 
as (2) above. 
(4) Veterinary dispensary equipment, small (new pattern) 
(97710) : 
1 chest, MD No. 80 veterinary (98070). 
Ammonium carbonate lumps. 
Chloral hydrate. 
Apron, rubber. 
Catheter, horse. 
Tube, stomach, 
1 chest, MD No. 81 veterinary (98080). 
Battery, dry cell. 
212 App. IV 
12-14 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
1 deck, field, company. 
Bands, rubber. 
Erasers. 
Paste. 
(5) Veterinary dispensary equipment, large (new pattern) (97703). 
Same as (4) above. 
b. It is customary to keep any of the narcotics or alcohol listed 
below stored in unit equipment : 
(1) Regimental headquarters medical equipment (new pattern) 
(97646) : 
Chest, MD No. 2 (99281). 
Alcohol, ethyl. 
Morphine. 
Codeine. 
(2) Battalion medical equipment (new pattern) (97507). Same 
as (1) above. 
(3) Veterinary dispensary equipment, small (new pattern) 
97710) : 
Chest, MD No. 80 veterinary (98070). 
Alcohol, ethyl. 
(4) Veterinary dispensary equipment large (new pattern) 
(97703). Same as (3) above. 
c. Sufficient quantities of the above-mentioned deteriorating sup- 
plies and narcotics are kept on hand in the storeroom to stock com- 
pletely the unit equipments of the combat organizations at the 
station. 
d. List of the above items is kept in the equipment chests to avoid 
danger of delay or shortage when a unit takes the field. 
13. The medical supply officer experienced any difficulty in securing 
the kinds and quantities of medical supplies required since the date 
of last inspection (AR 40-1705 and circular letter No. 1, S. G. O., 
1940). 
14. a. The money allowance for expendable medical supplies has 
been sufficient to cover the needs of the hospital during the past year 
(circular letter No. 1, S. G. O., 1940). 
b. Every item of expendable supplies that is placed on requisition 
is carefully scrutinized to see if any item— 
(1) Is in excess of current needs. 
(2) Can be dispensed with (items should not be requested simply 
because they are listed in the Medical Department Supply Catalog). 
c. How many emergency requisitions have been submitted during 
the past 12 months (AR 40-1705). 
213 App. IV 
15-24 
MEDICAL DEPARTMENT 
15. Smallpox vaccine is invariably stored in a refrigerator in direct 
contact with ice, or in the freezing unit of a mechanical refrigerator 
(AR 40-215). 
16. T ime limitation of any stock of vaccines or serums has expired 
(AR 40-215). 
17. a. Vaccines and serums now on hand. When vaccines are sup- 
plied in bottles, time-expired stocks are returned to the Army Medical 
School, unless otherwise indicated. Empty bottles also returned (AR 
40-215). 
h. Utmost care is taken by all concerned to prevent accumulation of 
excess stocks of biologicals. 
c. Biologicals on hand are less than 1 year old. In the case of NS 
antipneumococcic sera, 6 months. 
d. Records show excessive exchange of biologicals (par. 64, circular 
letter No. 1, S. G. O., 1940). 
18. The Medical Department Supply Catalog is posted up to date, 
to include all changes in nomenclature, prices, etc. 
19. The medical supply officer has a file of— 
a. Circular letter No. 1, S. G. O., 1940, and those listed in paragraph 
39 of this circular letter. 
h. Army Regulations pertaining to finance and supply. 
c. Procurement Circulars. 
d. Extracts from Army Medical Bulletins pertaining to finance and 
supply; copies of pertinent decisions of the S. G. O. etc., properly 
bound and indexed for reference purposes (policy file). 
20. Separate meters are installed to record the electric current 
used for X-ray machines, centrifuges, and other such purposes. 
21. W. D., M. I). Form No. 16a, is used to request supplies for 
pharmacy, wards, etc. 
22. The following forms invariably are used to request, return, and 
exchange nonexpendable property: 
a. Issue Slip, Nonexpendable Medical Property (W. D., M. D. Form 
No. 16b). 
h. Credit Slip, Nonexpendable Medical Property (W. D., M. D. 
Form No. 16c). 
c. Exchange Slip, Nonexpendable Medical Property (W. D., INI. D. 
Form No. 16d). 
23. The medical supply officer retains the originals of W. D., M. D. 
Forms Nos. 16b, 16c, and 16d to file with the Memorandum Receipts 
(W. D., Q. M. C. Form No. 487) (AR 40-1705). 
24. Date of the last inspection of organizational equipment, field 
chests, and other field equipment (AR 40-1705). 
214 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. IV 
25-31 
25. A journal is maintained to show the monthly totals of the value 
cf receipts of medical supplies and of expenditures, as required (AR 
40-1705). 
26. The medical property of which the several officers are responsi- 
ble has been examined every 6 months by a commissioned officer of 
the Medical Department and by him verified by stock record cards, 
receiving reports, shipping tickets, etc. (AR 40-1705 and AR 35- 
6520). 
27. Complete and serviceable field equipment and supplies are on 
hand for each unit in the garrison according to Tables of Basic Allow- 
ances and Tables of Allowances of the Medical Department as modi- 
fied (AR 310-60). 
28. A record is maintained in the storeroom of receipts and ex- 
penditures of alcohol, alcoholic liquors, opium, and the salts, deriva- 
tives, and preparations of opium and coca leaves in the maimer 
prescribed for the pharmacy (AR 40-1705 and AR 40-590). 
29. a. Balances of alcohol and narcotics are correct (AR 40-590). 
h. In whose possession the keys to the alcohol and narcotic room 
are kept. Anyone else have possession of these keys at any time 
(AR 700-10 and AR 35-6520). 
30. Entries on the return of medical property slip (W. D,, M. D. 
Form No. 17a) are correct for each of the drugs noted below, since 
date of last inspection: 
10480 Alcohol, ethyl, 1 qt. USP. 
10490 Alcohol, ethyl, 5 gal. USP. 
10500 Alcohol, dehydrated, 1 pt. USP. 
11450 Cocaine, hydrochloride, *4 oz. USP. 
11480 Codeine, sulfate, 1 oz. USP. 
11490 Codeine, sulfate, 14-grain tablet, 500, USP. 
12940 Morphine, sulfate, 1 oz. USP. 
12950 Morphine, sulfate, %-grain hypo tablets, 20, USP. 
12955 Morphine, sulfate, 14-grain hypo tablets, 10, USP. 
12960 Morphine, sulfate, 2-grain hypo tablets, 10, USP. 
13230 Opium, 1 oz. powder, USP. 
14850 Tincture, opium, y4 pt. USP. 
14860 Tincture, opium, camphorated, 1 pt. USP. 
14940 Whisky, 1 qt. USP. 
14945 Wine, sherry, 1 qt. 
Nonstandard items corresponding to the above. 
(AR 40-590.) 
31. The medical supply officer is familiar with instruction regard- 
ing the shipment of containers for alrolohic liquors (sec. V, AR 
30-955 and AR 40-1705). 
215 App. IV 
32-37 
MEDICAL DEPARTMENT 
32. Alcohols, alcoholic liquors, opium, and the derivatives of coca 
leaves are issued only to the pharmacy and in unit containers, only 
on the written order of a medical officer (All 40-1705). 
33. Blankets in storage are protected from moths (All 40-1705). 
34. Ilubber goods are properly protected by the use of talc, etc. 
35. Before submitting his requisition the medical supply officer ob- 
tains from each chief of service or department a list of the supplies 
required by his department for the period covered by the requisition 
(AR 40-1705). 
36. A record is kept of each Medical Department typewriter on 
hand showing— 
a. Make of machine. 
b. Model number. 
c. Serial number. 
d. Width of carriage. 
e. Date placed in service. 
/. Total expenditures for repairs. 
(All 40-1705.) 
37. a. Medical supply officer is required to maintain an inspection 
and servicing card for all Medical Department equipment having 
storage batteries or moving parts requiring oiling such as— 
51740 Compressor unit. 
72770 Dishwasher, electric. 
72775 Dishwasher, electric. 
72835 Extractor, juice, orange and lemon. 
732G0 Mixer. 
734G0 Peeler, vegetable. 
73470 Peeler, vegetable. 
73980 Sheer, meat. 
74910 Sweeper, carpet, electric. 
74834 Polisher, floor. 
78045 Fountain, drinking. 
78515 Machine, sewing, 
79170 Sterilizers, electric. 
78180 Sterilizers, electric, etc, 
b. These charts show— 
(1) Item number and name, or name only of item, if nonstandard. 
(2) Location of item. 
(3) Date of issue. 
(4) Service to be rendered, and remarks (under remarks state any 
peculiarity of item and service to be rendered). 
(5) Periodic inspections (date). 
(G) Date, nature, and cost of each repair or replacement of parts. 
216 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. IV 
37-48 
c. A duplicate card has been furnished the service man. 
d. All such items are inspected and serviced at least once each 
month. 
e. A record is kept of each Medical Department refrigerator on 
hand showing— 
(1) Make and capacity in cubic feet. 
(2) Date of receipt. 
(3) Location. 
(4) Date, nature, and cost of each repair. 
(5) Time out of service. 
(AR 40-1705.) 
/, Electric refrigerators having adjustments which permit regula- 
tion of the temperatures should not be adjusted to the lowest 
temperature. (This results in almost continued operation of the 
motor and unit and will cause excess cost for repairs.) 
38. The medical supply officer maintains a list showing where 
emergency purchases of vaccines and serums can be made. 
39. Hospital laundry is put out to private laundries on contract or 
informal agreement (AR 40-590), 
40. W hat the cost of laundry was for each month of the last G 
months (AR 40-590). 
41. IV hat the cost of laundry is per patient day. 
42. Average number of pieces of laundry used per patient during 
the last 12 months is greater than six per patient per day. 
43. Sphygmomanometers (other than mercurial) are tested at fre- 
quent intervals and steps taken to have them corrected (AR 40-1705). 
44. a. An accession book for medical library books is maintained 
(AR 35-G800). 
b. There is an accumulation of obsolete or damaged medical books 
(AR 40-1705). 
45. a. It has been necessary to purchase ice from the quartermaster 
for the preservation of foodstuffs during the past 12 months. 
b. Payment was made from the hospital fund (AR 40-590). 
46. How ice is procured for such uses as ice packs, medical photo- 
graphic work, and the preservation of biologicals (AR 40-590). 
47. Plans have been submitted to provide an approved storeroom 
for X-ray films. 
48. a. Wiring in the present storage space for X-ray films conforms 
to the N. E. A. code. 
b. Only guarded incandescent lamps are permitted in the X-ray 
storage room. 
c. Extension lamp cords are used. 
d. “no smoking” signs are posted. 
217 App. IV 
48-51 
MEDICAL DEPARTMENT 
e. Film is removed at least 2 feet from steam pipes, radiators, 
chimneys, or other sources of heat. 
f. Chemical fire extinguishers (not using carbon tetrachloride) are 
provided. 
g. Negatives in storage are kept in heavy manila envelopes or 
in cardboard boxes, not exceeding six films to the envelope or 25 to 
a box. 
h. X-ray storage room is not used for any other purpose. 
i. X-ray storage room is in the hospital or in a separate building 
(circular letter No. 1, S. G. O., 1930). 
j. Disposition made of used X-ray films (circular letter No. 14, 
S. G. O., 1936). 
49. There is a conservation of micro slides, cover slips, and other 
supplies (circular letter No. 32, S. G. O,, 1940). 
50. Supplies are stored on shelves in the same order as they appear 
on the supply tables (AK 700-10). 
51. Provisions of section V, paragraphs 39 to 77, inclusive, circular 
letter No. 1, S. G. O., 1940, pertaining to finance and supply are being 
complied with. 
218 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. V 
1-3 
Appendix V 
CHECK LIST FOR DIRECTOR OF DIETETICS 
(MESS OFFICER) 
1. a. Organization of the mess force (AR 40-590). 
h. Mess personnel are sufficient and well qualified (AR 40-590), 
c. There is a certificate posted in the kitchen that each permanent 
food handler has been examined by a medical officer and is free from 
communicable disease (AR 40-205). 
d. Cooks and mess attendants always wear white uniform and 
cap while on duty and keep their hair cut short, nails short and 
clean, and their person clean (AR 40-205). 
e. Number of cooks (AR 810-60). 
f. Ratings held by cooks (AR 310-60 and AR 615-20). 
g. Cooks clean and efficient (AR 40-205 and AR 615-20). 
h. Gratuities paid to cooks or other mess attendants (AR 210-50). 
2. a. Any hospital property used for other than Medical Depart- 
ment purposes. If so, specify. (AR 40-590). 
h. All property is protected from danger from theft, fire, and other 
damage (AR 40-590). 
c. Any accumulation of obsolete, damaged, or unserviceable prop- 
erty is on hand (AR 40-1705 and AR 700-10). 
d. Any property or supplies on hand not required for current use 
(AR 40-1705). 
e. Mess officer maintains a file of property held on Memorandum 
Receipt (W. D., Q. M. C. Form No. 487) (AR 40-1705), 
/. Mess supplies and equipment are adequate and satisfactory 
(AR 40-1705, Medical Department Supply Catalog, and circular let- 
ter No. 1, S. G. O., 1940). 
g. All medical property in the mess has been examined and verified 
by a commissioned officer of the Medical Department within the last 
6 months (AR 40-1705 and AR 35-6520). 
h. Containers for poisons such as rat poisons, roach powders, etc. 
are kept in the mess room (AR 40-590). 
3. a. Average number of duty status men to be fed daily (section V, 
AR 345-400). 
h. Average number of patients who eat in the mess hall daily 
(AR 40-1005). 
c. Average number of patients who receive their food in the wards 
daily (AR 40-1005). 
219 App. V 
3-5 
MEDICAL DEPARTMENT 
d. At what hour the mess officer receives notification of daily patient 
strength, showing the subsistence classification of patients (AR 
40-590). 
4. a. Diet kitchens have been established by the commanding officer 
(AR 40-590). 
b. Rules for its management have been prescribed by the command- 
ing officer (AR 40-590). 
c. Bills of fare for diets prescribed by or under the supervision of 
the commanding officer have been made out and posted in the kitchens 
(AR 40-590). 
d. Diet Cards (W. D., M. D. Form No. 73) are filled out by each 
ward officer daily, immediately after he has made his first visit to the 
ward and covering the requirements of the ward patients for the en- 
suing 24 hours (AR 40-590). 
e. Additional cards for newly admitted patients are made out 
promptly and sent to the mess officer without delay (AR 40-590). 
/. Facilities for serving and sending meals to ward patients are 
adequate (AR 40-590). 
g. Food intended to be served hot is always delivered to the patient 
in that condition (TM 10-405). 
5. a. From what sources moneys are received which are credited to 
the hospital fund at this station (AR 210-50). 
b. What the monthly balances have been each month during the 
past 12 months (AR 210-50). 
c. Payments made from the hospital fund for any of the following 
items: 
(1) Electric time clock service. 
(2) Personal telephone service. 
(3) Cooking utensils. 
(4) Ice or electricity for Medical Department use, (AR 210-50, 
decision of S. G. O., and circular letter No. 1, S. G. O., 1940). 
d. Hospital fund council audits the fund, examines receipts and ex- 
penditures, and makes recommendations as to the policies under which 
the fund is to operate (AR 210-50). 
e. Charges are made as noted below for patients not entitled to 
commutation of rations (AR 40-590) : 
(1) Officers and warrant officers at $1.00 per day. 
(2) Officers and warrant officers of the Navy at $1.00 per day. 
(3) Civilians on the status of officers at $1.25 per day. 
(4) Army nurses at $1.00 per day. 
(5) Enlisted men of the Navy and retired enlisted men of the Army 
an amount equal to the commuted rate. 
220 App. V 
5-7 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(C) Civilians on the status of enlisted men an amount per day equal 
to the commuted rate plus $0.10 per day. 
/. It has been necessary to report to The Surgeon General any cases 
of unpaid subsistence accounts of patients during the last 12 months 
(AR 40-590). 
g. Accounts for the hospitalization of personnel of the Navy, 
Marine Corps, U. S. Public Health Service, the Coast and Geodetic 
Survey, and the Coast Guard, who are entitled to treatment at Gov- 
ernment expense, are mailed so as to reach The Surgeon General’s 
Office not later than the 15th of the month following discharge from 
hospital (retired Naval and Marine Corps personnel excepted) 
(par. 69, circular letter No. 1, S. G. O., 1940). 
h. Amount of subsistence accounts now due and overdue. List sep- 
arately (AR 40-590). 
i. Who receives and handles subsistence moneys for the mess 
account (AR 40-590). 
j. All funds received for the subsistence of patients are placed in the 
hospital fund (AR 40-590). 
k. Any unserviceable durable property purchased from the hospital 
fund now on hand. If so, itemize (AR 210-50, and instructions on 
W. D., M. I). Form No. 49). 
l. What the amount is of the usual dividends received from the post 
exchange (AR 210-65), 
6. a. Mess account (W. D., M. I). Form No. 74) is kept up to date 
from day to day (AR 40-590). 
h. Enumerate the sources from which foods and mess supplies have 
been purchased during the last completed month (AR 210-50). 
c. A stock record card or other system is used to account for sup- 
plies received and issued (AR 40-590). 
d. Who makes purchases and orders the mess supplies (AR 40-590). 
e. Every delivery of supplies to the mess is scrutinized as to amount 
and quality (AR 40-590). 
/. Food storerooms are guarded by lock and key, bars and gratings 
(AR 40-590). 
g. To whom the keys of the storeroom are intrusted (AR 40-590). 
7. a. Mess rooms, kitchen, pantries, and storerooms are clean and 
well arranged (AR 40-205). 
h. What system is in use to insure that the mess officer knows that 
certain dishes and utensils have been used by patients with communi- 
cable diseases in order that such dishes will not be stored or used before 
being sterilized (AR 40-590). 
c. Venereal patients are fed at separate tables and from separate 
dishes (AR 40-245). 
221 App. V 
7-13 
MEDICAL DEPARTMENT 
d. Meat is suspended in the refrigerator in such manner that it can- 
not touch Avails, partitions, or other material to avoid the formation 
of mold (AR 40-205). 
e. Meat and dairy products are inspected by a veterinary officer 
when delivered (AR 40-205). 
8. See paragraph 2<7(1) to (7), inclusive, appendix I. 
9. a. Mess officer has copies of TM 10-405. 
b. TM 10-405 is used as a guide in the preparation and serving of 
foods (AR 40-590). 
10. a. Menus are so arranged that a diet is supplied that will con- 
tain balanced and adequate amounts of protein, fat, carbohydrates, 
vitamins, and mineral salts (AR 40-205). 
h. Weekly menus are so varied that no essential article of diet is 
ignored because of faulty preparation or too continuous or frequent 
use (ch. VIII, Army Medical Bulletin No. 23), 
c. How often the following foods are served (AR 40-590 and TM 
10-405); 
(1) Butter. 
(2) Fresh milk. 
(3) Desserts. 
(4) Fresh fruits. 
(5) Fresh vegetables. 
(6) Bread puddings. 
(7) Meat, 
(8) Bologna. 
d. What variety of breadstuff is served (TM 10-405). 
11. Garbage cans are inspected regularly to detect any evidence of 
wastage (AR 40-590). 
13. a. What the hours are for each meal. 
b. A check is made by the mess officer to see that each meal is served 
exactly on time. 
c. More than one sitting at any meal. 
d. How many men eat at the second sitting. 
e. How many men eat at the first sitting. 
/. What the time interval is between the two sittings (AR 40-590). 
13. Hospital fund is managed in accordance with special instruc- 
tions of The Surgeon General (par. 15, circular letter No. 1, S. G. O., 
1940). 
222 App. VI 
1-6 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
Appendix VI 
CHECK LIST FOR COMMANDING OFFICER, MEDICAL 
DETACHMENT 
1. a. How many enlisted men this date are on— 
(1) Furlough. 
(2) Pass. 
(3) AWOL. 
(4) DS. 
(5) Special duty (specify), 
(C) Restriction. 
(7) In confinement. 
(8) Other nonduty status. 
h. If any men are awaiting trial any delay in the matter (AW TO). 
c. How many enlisted men of the detachment have been tried by 
courts martial during the past 12 months. 
General court martial 
Special court martial 
Summary court martial 
Total 
d. How many of the enlisted men of the detachment have been 
awarded company punishment under the 104th Article of War during 
the past 12 months. 
2. Attach a roster of the detachment showing individuals by— 
a. Department, such as X-ray, mess, etc., 
h. Grades and ratings, 
(AR 40-590, AR 345-55, and AR 345-900). 
3. Records of medical personnel are handled at the hospital by the 
commanding officer, medical detachment, or by unit personnel section, 
4. Complete records of immunization are entered in the service 
records (All 40-215 and AR 345-125). 
5. a. Record is made in each service record when the course of sex 
morality is completed (AR 40-235 and AR 345-125). 
h. Enlisted men of the detachment have been informed that death 
or disability resulting from the unauthorized use of sulfanilamide in 
the treatment of venereal disease are considered not in line of duty 
(S. G. O., circular letters Nos. 13,1938, and IT, 1940). 
6. Notation appears in each service record that certain Articles of 
War have been read and explained within 6 months (AW 110 and 
AR 345-125). 
223 App. VI 
7-15 
MEDICAL DEPARTMENT 
7. Record of company punishments is kept in a separate account 
(AR 345-125). 
8. Record is made of the size of shoes worn by each enlisted man 
(AR 850-125). 
9. Commanding officer, medical detachment, has secured a supply 
of the necessary blank forms for application for pension; familiar- 
ized himself with the pension law, and offered to execute a pension 
application for each enlisted man discharged on certificate of dis- 
ability (AR 615-3G0). 
10. Daily sick report is sent to the detachment commander as 
soon as possible after an entry of “No; AR 35-1440” has been made 
in order that he may make a provisional notation on the pay rolls 
and on the service record of the patient and affix his initials in the 
column “Date” on the sick report opposite the name of the soldier 
in the first entry in which the notation “No; AR 35-1440” appears 
(AR 345-415). 
11. In case of enlisted men carried on sick report with an entry of 
“No; AR 35-1440” and after final action has been taken, the detach- 
ment commander makes the necessary entries on the pay rolls and 
on the service record of the patient, and affixes his initials in the 
“Date” column on the sick report opposite the name of the patient 
in the last entry in which the notation “No; AR 35-1440” appears 
(AR 345-415). 
12. Use of TM 8-220 for instructions and reference purposes is 
encouraged. 
13. The detachment as a whole has completed its basic military 
training to include— 
a. Basic disciplinary training of a soldier, 
b. Physical training, personal hygiene, and first aid. 
c. Interior economy and administration. 
d. Shelter, supply, and movement. 
e. Security. 
/. Signal communication. 
g. Protective measures against chemical agents. 
h. Expert care of equipment and transport. 
i. Tactics and technique of the Medical Department. 
j. Cooperative duties as part of the combat train (MTP 8-1). 
14. Detachment commander has prepared training plans for the 
training of the unit, either a training program or a training schedule. 
15. Every man in the detachment has completed a course of in- 
struction to the degree that he is proficient in— 
a. Knowledge of Articles of War pertaining to enlisted men. 
b. Knowledge of Army Regulations pertaining to enlisted men. 
224 App. VI 
15-28 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
c. Knowledge of local orders pertaining to enlisted men. 
d. Military courtesy and customs of the service. 
e. Knowledge of uniform regulations pertaining to enlisted men. 
/. Personal hygiene and sanitation. 
16. a. A troop school is maintained as a function of command for 
all members of the detachment (AE 350-5), 
6. How many men during the past year have been issued a certi- 
ficate of proficiency in subjects covered in the troop school program 
(AE 350-5 and AE 40-1005). 
17. a. Every member of the detachment has attended one course 
of instruction in sex hygiene (AE 40-235). 
h. Instruction in sex hygiene and the prevention and control of 
venereal disease is given to all enlisted men at least twice each year 
(AE 40-235). 
18. Facilities provided on the post in general, and in the hospital 
in particular, for the recreation of the detachment (AE 210-50). 
19. A commissioned officer superintends the fitting of issue shoes 
by the shoe-fitting apparatus (AE 40-205 and AE 850-125). 
20. Members of the detachment have been typed as blood donors 
and a list maintained of individuals who are available as donors (AE 
40-1715). 
21. All men of the detachment are capable of rendering first aid 
in the post and in the field (FM 21-10), 
22. Enlisted men are permitted to use Medical Department linens, 
supplies, equipment, or appliances in their rooms or on their person 
(AE 40-590). 
23. Enlisted men are permitted to wear the white uniform when 
not actually engaged in an appropriate duty in the hospital (AE 
600-40). 
24. Copies of hospital regulations are posted in conspicuous places 
for the information and guidance of members of the detachment 
(AE 40-590). 
25. What the new case rate is per 1,000 per annum for venereal dis- 
ease for each month of the preceding 12 months for the detachment 
(AE 40-235). 
26. a. There is at least 60 square feet of floor space and 720 cubic 
feet of air space for each man occupying a bed in the squad rooms. 
h. If not, is head and foot sleeping practiced (AE 40-205). 
27. White uniforms of the enlisted attendants are laundered as a 
part of the hospital laundry (AE 40-590). 
28. Garrison shoes with rubber heels are furnished men on duty 
in wards and departments of the hospital. 
225 App. VI 
29-36 
MEDICAL DEPARTMENT 
29. Prescribed Articles of War are read and explained within 6 
days after enlistment or reenlistment and once each 6 months there- 
after (AW 110). 
30. Every enlisted man of the detachment is inspected by a medical 
officer each month. Noncommissioned officers of the first three grades 
may be excused (AR 615-250). 
31. In addition to the monthly physical inspection noted above, 
the commanding officer occasionally orders a special venereal in- 
spection upon recommendation of the surgeon of all enlisted men, 
except noncommissioned officers of the first three grades and married 
men of good character for the purpose of detecting cases of venereal 
diseases (AR 615-250). 
32. Any complaints in regard to the detachment mess (AR 40-590). 
33. a. Each man’s bed and wall locker are properly marked for 
identification (AR 40-590), 
h. Personal equipment is properly displayed on the end iron of 
the bunk (AR 40-590). 
c. Soiled clothing is kept only in the barracks bag (AR 40-205). 
d. Sketches are posted in conspicuous places showing how equip- 
ment should be displayed for inspection (EM 21-15 and FM 21-100). 
e. Any types of insects prevalent in the squad rooms (AR 40-205). 
34. a. Men on night duty are sleeping in a secluded, quiet place. 
h. A check is made to determine that night men get proper sleep 
during the daytime. 
35. Administration of the medical detachment is in conformity 
with the general provisions of AR 245-5 insofar as applicable. 
36. Detachment storerooms are clean, neatly arranged, and individ- 
ual equipment properly stored and tagged. 
226 App. VII 
1-10 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
Appendix VII 
CHECK LIST FOR PRINCIPAL CHIEF NURSE 
1. Grade and number of nurses on duty at the hospital (AR 40-20). 
2. Principal chief nurse acts directly under the immediate orders 
of the commanding officer of the hospital in regard to all matters 
pertaining to the general supervision of the nursing service and 
to the nurses’ quarters (AR 40-20). 
3. Commanding officer refers all official correspondence relating to 
the nurse personnel to the principal chief nurse for notation or 
recommendation (AR 40-20). 
4. Principal chief nurse familiarizes herself with Army Regula- 
tions insofar as they relate to the Army Nurse Corps, and instructs 
the nurses under her supervision in the regulations pertaining to 
them, and in their duties peculiar to Army work, and when necessary 
in all matters pertaining to their nursing wmrk (AR 40-20). 
5. Commanding officer has required the principal chief nurse to 
supervise the instruction of enlisted men of the Medical Depart- 
ment on ward duty in practical nursing (AR 40-20). 
6. Principal chief nurse prepares the records, reports, returns, etc., 
concerning nurses, and indorses or initials all official papers submitted 
in connection with the nurses and requiring the signature of the medi- 
cal officer in command (AR 40-20). 
7. She sees that nurses properly perform their duties and makes 
herself responsible for the maintenance of discipline among them, 
both while on duty and in quarters (AR 40-20). 
8. She arranges the hours of duty, rest periods, and assignments 
of all nurses, arranges for the comfort and general well-being of the 
nurses under her charge, and reports to the commanding officer any 
matters which injuriously affect the same (AR 40-20). 
9. Principal chief nurse assigns a nurse to supervise the nursing 
service of the hospital at night, and to report to the principal chief 
nurse upon relief any unusual incidents of the night’s work and any 
deredictions of duty on the part of the night nurses (AR 40-20). 
10. Principal chief nurse designates one nurse for each ward to 
act as its responsible head under the following regulations: 
a. To be in charge of the ward, the nurses, the enlisted personnel, 
and other persons assisting in the nursing care of patients, and of the 
patients, under the direction of the ward officer. 
227 App. VII 
10-21 
MEDICAL DEPARTMENT 
h. To receive from the ward officer all orders relating to the care 
and treatment of the patients in the ward, and to record the orders 
for the guidance of both day nurses and night nurses. 
c. To be responsible for the proper nursing of the patients, the 
proper serving of all food in the ward, the administration of medicines 
and other treatment prescribed, the cleanliness and order of the ward, 
the safety of the effects of the patients until they have been turned 
over to the proper custodian, the prompt transmittal of prescriptions 
to the pharmacy, and the prompt delivery of the diet orders to the 
mess office (AR 40-20), 
11. Nurses are required to perform duties the same as in civilian 
hospitals of like general character, with a day’s work not to exceed 
8 hours; and are not required, except in an emergency, to serve on 
night duty oftener than 1 month in every 3 months (AR 40-20). 
12. Nurses’ quarters provide one dining room, one kitchen, one sit- 
ting room, and the necessary toilet rooms for the common use of all 
nurses, and a separate bedroom for each nurse; and, if more than 
five nurses are on duty, an office and a separate sitting room for the 
principal chief nurse (AR 40-20), 
13. Suitable furniture and care for the nurses’ quarters are pro- 
vided (AR 40-20). 
14. Sheets, towels, pillowcases, table linens, and other washable 
articles are laundered as a part of the hospital linen (AR 40-20). 
15. Suitable meals and proper messing facilities, including neces- 
sary equipment, and service for nurses on duty are provided (AR 
40-20). 
16. Each nurse, promptly at the end of each month, or when de- 
parting from the station on transfer, leave of absence, etc., pays into 
the hospital fund a designated amount for credit to the nurses’ mess, 
for each day she has been furnished meals therein, the amount pre- 
scribed in AR 40-20. 
17. Any accumulation of supplies or equipment on hand in the 
nurses’ quarters in excess of present requirements (AR 40-1705). 
18. Any obsolete, damaged, or unserviceable supplies or equipment 
on hand (AR 40-1705 and AR 700-10). 
19. It is possible to grant annual leave to the nurses without crip- 
pling the service. 
20. Principal chief nurse maintains a record of nonexpendable 
supplies on W. D,, M. D. Form No. 16b ( AR 40-1705). 
21. Expenditures from the hospital fund are made for furnishings 
for nurses’ recreation rooms or for other purposes (AR 210-50, and 
par. 15, circular letter No. 1, S. G. O., 1940). 
228 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. VII 
22-24 
22. What system is used to insure that the nurses receive due credit 
for funds turned in by them to the hospital fund from all sources 
(commutation of rations, donations accruing from their guests, mess- 
ing charges for aides, technicians, and other civilians authorized to 
subsist at the nurses’ mess) (par. 15, circular letter No. 1, S. G. O., 
1940). 
23. Any of the above credits used to provide means for contributing 
to the welfare, comfort, pleasure, contentment, and mental and physi- 
cal improvement of members of the nurses’ mess. If so, whether 
such expenditures exceed their credits (par. 15, circular letter No. 1, 
S. G. O., 1940). 
24. Principal chief nurse maintains a council book to account for 
moneys received from miscellaneous sources in violation of existing 
regulations (par. 15, circular letter No. 1, S. G. O., 1940). 
229 App. VIII 
1-2 
MEDICAL DEPARTMENT 
Appendix VIII 
CHECK LIST FOR CHIEF OF SURGICAL SERVICE 
1. General.—a. Organization of the surgical service (AR 40-590). 
b. How often a complete inspection of entire service is made by 
chief of surgical service. 
c. How often professional conferences are held. 
d. How transfers of patients from one ward to another ward are 
handled (AR 40-590). 
e. Copies of hospital rules are posted in convenient places where 
they may be seen by patients and duty personnel. 
2. Genito-urinary section.—a. (1) A syphilitic register is on file 
at the hospital for every militarized person of the command who has 
syphilis. 
(2) Complete entries have been made under the following head- 
ings: 
(а) Date and place of infection. 
(б) Source of infection. 
(c) Prophylaxis. 
(d) Date of appearance and exact location of primary lesions. 
(e) Incubation period. 
(/) Other lesions. 
(g) Complicating venereal diseases. 
(h) Dark field examinations. 
(3) Certificate has been signed by the patient acknowledging that 
he has been informed of the nature of syphilis and that he is convinced 
that he has syphilis, etc. 
(4) Data as to “general physical examination and pertinent facts 
of past history” have been fully recorded. 
(5) Comments as to the progress of the disease and record of later 
physical examinations appear under “later physical examinations 
and progress of case”. 
(6) Blood serum reactions have been recorded as double plus, plus, 
plus-minus, and minus (or negative). 
(7) Entries have been made to cover all therapeutic measures taken. 
(8) Every entry has been signed where indicated by a medical 
officer. 
(9) In the case of registered personnel being transferred the register 
has been forwarded to the surgeon of the new station. 
230 App. VIII 
2 
FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
(10) In the case of separation from the service (discharge and does 
not reenlist or dies) or a cure, the registers have been sent to The 
Surgeon General. 
(11) How many members of the command are recorded on syphilitic 
registers. 
(12) How many are taking active treatment. 
(13) How many are on a rest period. 
(14) Syphilis is being managed in accordance with instructions of 
The Surgeon General (circular letter No. 18, S. G. O., 1941). 
(15) How many syphilitic registers have been sent to The Surgeon 
General in the past 12 months (AR 40-235). 
h. (1) Prophylactic station is conveniently located in a separate 
room, sufficiently lighted, wTell painted, clean, and properly equipped. 
(2) It has running water available over a trough or individual 
sinks. 
(3) A high degree of privacy is insured. 
(4) Liquid soap is kept on hand in suitable, accessible containers. 
(5) A fresh (1 to 1,000) bichloride solution is kept in containers 
properly labeled as to contents so located that it may be readily used 
as a wash at the sink or trough. 
(6) It is kept under lock and key when not in use. 
(7) How many syringes are kept on hand. 
(8) Standard blunt type is used. 
(9) How syringes are sterilized. 
(10) Wooden spatulas (tongue depressors) are on hand for use in 
ointment jars. 
(11) Solution of protargol is kept fresh in a dark, marked, and 
dated bottle. 
(12) How the protargol solution is made up, from weighed stock 
kept in the station or made up in the pharmacy. 
(13) How often the protargol solution is prepared. 
(14) Any wastage of protargol. 
(15) Calomel ointment is kept on hand at all times. 
(16) Roll paper on hand is used for towels, etc. 
(17) Regulations are posted for the conduct of the station. 
(18) Regulations are posted for the technique of prophylaxis. 
(19) Blank forms are on hand to record the treatment. 
(20) Who is directly in charge of the station. 
(21) Station is inspected each morning. 
(22) Every man detailed to duty in the station is instructed in the 
procedure and technique of prophylaxis. 
(23) He understands that the cleansing operation should be given 
the importance of a surgical procedure. 
231 App. VIII 
2 
MEDICAL DEPARTMENT 
(24) Above also applies to emergency men who may be required to 
administer the treatment at night. 
(25) File of retained prophylaxis records, W. D., M, D. Form No. 77, 
indicates that every form is complete, bears the notation as to the ab- 
sence of venereal disease, has the signature of the attendant and of the 
patient, and bears the initials of a medical officer. 
(26) It is a rule that patients will always be examined for evidence 
of venereal disease prior to the administration of prophylaxis (AR 40- 
235 and Army Medical Bulletin No. 23). 
c. (1) How frequently lectures are given to all enlisted men by 
medical officers (AR 40-235). 
(2) What steps have been taken to inform the command about ven- 
ereal prophylaxis (AR 40-235). 
(3) Instructions pertaining to individual prophylaxis (individual 
prophylactic packet) are being complied with (AR 40-235, and cir- 
cular letter No. 4, S. G. O., 1940). 
(4) What the new case rate is per 1,000 per annum for venereal 
disease for the command for the past month. 
(5) What the prophylactic rate is per 1,000 for the past month. 
(6) How many of the cases of venereal disease reported during the 
past month were contracted in the vicinity of the post. 
(7) Men are tried by court martial if they fail to report venereal dis- 
ease. 
(8) Any marked difference in venereal rates for various units of 
the command. 
(9) What means are used to restrict venereal cases to the post while 
in the infectious stage (AR 40-235). 
d. Physical inspections are held monthly and without notice (AR 
615-250). 
e. (1) How many cases of gonorrhoea now in hospital. 
(2) How many cases of syphilis now in hospital. 
(3) How many cases of chancroid now in hospital. 
(4) How many cases of gonorrhoea now taking out-patient treat- 
ment. 
(5) How many cases of syphilis now taking out-patient treatment 
(AR 40-235). 
/. (1) What the general character is of treatment for hospitalized 
cases of— 
{a) Gonorrhoea. 
(b) Syphilis. 
(c) Chancroid. 
(See circular letter, No. 18, S. G. O., 1941.) 
(2) (a) Usual duration of stay in hospital for cases of gonorrhoea. 
232 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. VIII 
2-3 
(b) Patients with gonorrhoea are retained in hospital until fully 
cured. 
(3) General character of treatment for out-patient cases of gon- 
orrhoea. 
(4) If such patients are marked duty before a complete cure is 
effected what method is used to insure their restriction to limits or 
quarantine. 
(5) What check is made to insure that all patients are given proper 
and regular treatment. 
(6) How often such patients receive treatment. 
(7) What record is kept of out-patient treatments for gonorrhoea. 
(8) How often such patients are seen by a medical officer. 
(9) Who gives irrigations and injections for patients with gonor- 
rhoea. 
(10) Types of syringes used for injections. 
(11) Attendants on this service are properly instructed. 
(12) Place used for out-patient treatment of cases of gonorrhoea 
is suitable. 
g. (1) Tests used to determine a final cure in cases of gonorrhoea. 
(2) When a venereal patient is cured how his organization com- 
mander is notified. 
(3) Equipment, including instillator and apparatus for irrigation, 
is available. 
(4) Irrigation, dilatation, instillation, and prostatic massage is 
employed in appropriate cases. 
(6) Any evidence of indifference or negligence manifested in treat- 
ing venereal cases, or it is considered that all venereal cases receive 
painstaking and appropriate treatment. 
(6) Complications of gonorrhoea exist with undue frequency and 
what proportion of acute cases become chronic. 
(7) Vaccines are used, and what are results. 
(8) Silver salts, if used, are always freshly prepared. 
(9) Venereal patients are carefully questioned with a view of 
identification of infected prostitutes (AH 40-235). 
3. Operating section.—a. Organization of the operating service 
(AR 40-590). 
b. Medical supplies are adequate and satisfactory (AR 40-1705, 
Medical Department Supply Catalog, and circular letter No. 1, 
S. G. O., 1940). 
c. All medical property is secure from theft, fire, and other damage 
(AR 40-590). 
d. Any accumulation of supplies or equipment on hand above 
present needs (AR 40-1705). 
233 App. VIII 
3 
MEDICAL DEPARTMENT 
e. Any obsolete, damaged, or unserviceable property on hand (AR 
40-1705 and AR 700-10). 
f. There is a file of property held on memorandum receipt (W. D., 
M. D. Form No. 16b) (AR 40-1705). 
g. Medical property has been examined and verified by a commis- 
sioned officer of the Medical Department during the last 6 months 
(AR 40-1705). 
h. Alcohols, narcotics, and potent poisons are kept under lock and 
key (AR 40-590). 
i. Catheters and other rubber goods are protected by the use of 
talc. 
j. Greatest care is used with electrical heating units to avoid burn- 
ing out the heating coils (AR 40-1705). 
k. Responsible medical officer checks the surgical instruments 
monthly as required (AR 40-1705). 
l. Regulations and instructions for the guidance of the operators 
and attendants are posted (AR 40-590). 
m. Any inflammable material exposed to the danger of fire in any 
of the rooms of this service (AR 700-10). 
n. (1) How many major operations performed during the last 
month. 
(2) How many minor operations performed during the last month. 
(3) How many obstretrical cases handled during the last 6 months. 
(4) Any cases of puerperal sepsis. 
(5) Any cases of post-operative pneumonia during the last 6 
months. 
(6) Any cases of G. C. ophtalmia. 
(7) Any cases of post-operative infections during the last 6 
months. 
o. (1) Operating personnel are satisfactory and sufficient. 
(2) Anesthetist has been specially trained for the work. 
(3) Operating and dressing room attendants are well qualified. 
(4) Attendants have a clear understanding of the technique of 
aseptic operating. 
p. (1) Routine instructions are mblished for preparation of pa- 
tients before major operations. 
(2) Routine instructions are published for the after care of 
patients following a major operation (AR 40-590). 
q. (1) Types of sterilizing equipment in use. 
(2) Fractures are treated in accordance with instructions (circular 
letter No. 22, S. G. O., 1940). 
234 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. VIII 
3-4 
(3) Glucose solutions for intravenous use are being properly pre- 
pared (circular letter No. 2, S. G. O., 1940). 
(4) What equipment is made ready to care for any emergency 
arising during a major operation. 
4. Surgical wards.—a. Organization of the surgical service (AR 
40-590). 
5. See paragraph 35 to h, above. 
c. A file is maintained of the nonexpendable medical supplies in 
use in the ward on W. D,, M. D. Form No. 16b (AR 40-1705). 
d. Ward officer checks the surgical instruments monthly as required 
(AR 40-1705). 
e. Any inflammable material exposed to the danger of fire in any 
of the wards or closets (AR 700-10 and AR 40-590). 
/. (1) The head nurse, under the ward officer, is placed in charge 
of the ward, of the nurses, of the enlisted personnel and others who 
assist in the care of patients (AR 40-20 and AR 40-590). 
(2) She records all instructions from the ward officer for the 
guidance of both day and night nurses (AR 40-20 and AR 40-590). 
(3) She is held responsible for the proper nursing of patients, 
serving of all food, the administration of medicines, and the clean- 
liness and order of the ward and of the public property therein 
(AR 40-20 and AR 40-590). 
g. (1) In the absence of members of the Army Nurse Corps, the 
enlisted attendant (w’ardmaster) is in charge of the ward, and he 
has responsibility in the same degree and manner as a head nurse 
(AR 40-590). 
(2) Enlisted attendants are required to comply with the instruc- 
tions of nurses in the execution of their offices (AR 40-590). 
(3) Smoking by ward personnel while on duty in wards is pro- 
hibited (AR 40-590). 
(4) Enlisted attendants wear the white uniform at all times when 
on duty in wards (AR 40-590). 
(5) Enlisted men on duty are forbidden to collect or hold money 
or other valuables belonging to patients or to have financial trans- 
actions with them (AR 40-590). 
h. (1) Upon admission to the ward the patient is advised to deposit 
his money and valuables for safekeeping in the safe provided for that 
purpose, and that he keeps valuables in the ward at his own risk 
(AR 40-590). 
(2) In case a patient is unconscious or seriously ill, the ward 
officer secures his valuables at once, in the presence of a witness, and 
secures a receipt therefor from the custodian (AR 40-590). 
235 App. VIII 
4 
MEDICAL DEPARTMENT 
(3) Soiled clothing of patients is laundered at Government expense 
as a part of the hospital laundry (AR 40-590). 
(4) Patient’s clean clothing is listed in duplicate on W. D., M. D. 
Form No. 75 in his presence (or in the presence of a witness in case the 
patient is unconscious or insane), signed by the patient (if conscious), 
bundled and tagged and properly and securely stored (AR 40-590). 
i. (1) Patients are properly dressed in hospital clothing. 
(2) Patient’s temperature, pulse, and respiration are taken and 
recorded at once on W. D,, M. D. Form No. 55 G-l, showing the time 
the patient was admitted to the ward. 
(3) Patient is bathed, clothed in hospital clothing, and put to bed 
upon arrival unless otherwise instructed by a responsible medical 
officer. 
(4) If a patient shows any indication for prompt medical or 
surgical attention the nurse informs the ward officer or responsible 
medical officer. 
(5) What the standing instructions are relative to nourishment 
pending the prescribing of a diet by a medical officer. 
(6) How long patients are in the ward before a complete detailed 
history and a physical examination are made. 
j. (1) Until what hour of the day patients are required to remain 
in their wards. 
(2) Use of profane language, loud talking, singing, or boisterous 
actions are forbidden in the ward. 
(3) Patients are permitted to smoke in the wards. If so, what 
portion of the ward and at what hour. 
(4) Gambling is forbidden. 
(5) How often ambulatory patients are required to bathe and 
change their hospital clothing. 
(6) Patients are prohibited to use towels, basins, toilet articles, 
or articles of clothing belonging to other patients. 
(7) Patients are required to report to the ward officer any inat- 
tention regarding care and treatment, or any dissatisfaction regard- 
ing the character, quantity, or manner of serving of food. 
(8) In what manner infractions of discipline by patients are 
handled (AR 40-590). 
(9) (a) When death is imminent the patient is properly segregated 
from other patients. 
(h) In case of death, the body is examined by a responsible medi- 
cal officer before being removed from the ward. 
(c) Remains are promptly removed to the morgue. 
236 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. VIII 
4 
(d) Body is properly tagged, washed, orifices properly cared for, 
clothed in clean linen, and the remains wrapped in a clean sheet 
(AR 40-590). 
h. A ward morning report is prepared covering all cases admitted, 
disposed of, or transferred to or from the ward in the previous 24 
hours, ending at midnight (AR 40-590). 
l. What hour daily diet request and mess storeroom request arc 
signed and sent to the mess officer (AR 40-590). 
m. Complete clinical histories (W. D., M. D. Form No. 55-series) are 
available for use (AR 40-1025). 
n. Clinical records are forwarded to the registrar for a check 24 
hours before the patient is discharged from hospital, 
o. All orders for medicine or treatment are recorded in the ward 
order book by the nurse receiving the orders and the book is signed 
by the ward officer before he leaves the ward. 
p. In checking narcotics and alcohols the ward officer’s order book 
is checked against the record of administration of medicine to 
patients. 
q. At what hours of the day routine pulse rates, temperatures, 
and respiration are taken. 
r. Clinical records of patients are kept in places where patients 
or visitors may have access to same. 
s. (1) Dietitian head nurse is responsible for the service of meals. 
(2) She is required to make full report when food is not satisfac- 
tory. 
(3) She attempts to rectify immediately any mistakes observed. 
(4) Proper tray service is provided for all bed patients. 
(5) Tray service is attractive, food appetizing, and promptly 
served upon reaching the ward. 
(6) There is a sufficient variety and quantity in each meal. 
(7) Food is properly cooked, 
(8) Any waste. 
(9) Attendants are permitted to eat in the wards or diet kitchens. 
(10) Ward officer personally inspects the service of one meal daily 
in his ward. 
(11) Ward officer specifically states the patients who will go to 
the dining room for meals. 
(12) System used to transport food to the ward. 
(13) Measures taken to insure that foods will be served hot to 
the bed patients. 
(14) Bills of fare for diets prescribed by the commanding officer 
are made out and posted in the ward office (AR 40-590). 
237 App. VIII 
4 
MEDICAL DEPARTMENT 
t. (1) Ward officer makes a complete and detailed inspection 
daily, including sanitation, neatness, upkeep, and repair of equip- 
ment, outside police of ward areas, and the general administration 
of his ward. 
(2) What action he takes to correct defects and deficiencies noted 
at the inspection (AR 40-590). 
238 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. IX 
1 
Appendix IX 
CHECK LIST FOE CHIEF OF MEDICAL SEEVICE 
1. General.—a. Organization of the medical service (AR 40-590). 
6. (1) How often a complete inspection is made by chief of med- 
ical service of the entire service. 
(2) How frequently professional conferences are held. 
c. Copies of hospital rules are posted in convenient places where 
they may be seen by patients and duty personnel (AR 40-590). 
d. (1) Patients with communicable diseases are isolated individu- 
ally or in groups (AR 40-245). 
(2) A special section of the hospital is set aside for their manage- 
ment (AR 40-245). 
(3) Cubicle frames are provided (AR 40-245). 
(4) Patients with communicable diseases are restricted to the 
portion of the hospital set aside for their treatment during the com- 
municable stage (AR 40-245). 
(5) Visiting is prohibited between patients with the various classes 
of communicable diseases (AR 40-245). 
(6) Beds, mattresses, and linen of such patients are properly dis- 
infected wThen the patient is released from the ward (AR 40-245). 
(7) Cases with respiratory tract infection are required to use paper 
napkins or pieces of gauze as handkerchiefs and these articles are 
burned after use (AR 40-245). 
(8) Their dishes, knives, forks, etc., are sterilized after use (AR 
40-245). 
(9) Patients with venereal diseases in a communicable stage are 
isolated from all other patients (AR 40-245). 
e. Ward attendants are fully instructed in methods of protection 
from diseases for themselves and for others (AR 40-245), 
/. A suitable, properly secured room is set aside for the care of 
mental cases (AR 600-500). 
g. Keys to mental wards and prison ward are so handled that these 
wards can be entered quickly at any time in case of fire, disorder, or 
for search (AR 40-590). 
h. A Morning Report of Ward (W. H., M. D. Form No. 72) is accom- 
panied by diagnosis slips for the new admissions furnished the regis- 
trar each morning (AR 40-590). 
i. How transfers of patients from one ward to another ward are 
handled (AR 40-590). 
239 App. IX 
1-2 
MEDICAL DEPARTMENT 
j. Prompt action is taken to dispose of patients actually determined 
insane (AR 600-500). 
k. Prison ward is suitable and properly secured by locks and keys 
(AR 600-375). 
2. Medical ward.—a. Organization of the medical ward section 
(AR 40-590). 
h. See paragraph 4, appendix VIII. FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. X 
1-17 
Appendix X 
CHECK LIST FOR OFFICER IN CHARGE OF 
LABORATORY 
1. Room or building used as a laboratory is suitable. If not, state 
requirements (AE 40-585 and AR 40-590). 
2. Personnel assigned to duty in the laboratory are sufficient, well 
trained, and satisfactory (AR 40-590). 
3. Laboratory equipment and supplies are sufficient and satisfac- 
tory. If not, state requirements (AR 40-1705, Medical Department 
Supply Catalog, and circular letter No. 1, S. G. O., 1940). 
4. Greatest care is used in handling electrical heating units in order 
to avoid burning out of heating coils (AR 40-1705). 
5. Potent poisons and alcohols are kept under lock and key (AR 
40-590). 
6. Ethyl alcohol is accounted for on W. D., M. D. Form No. 17a as 
in a pharmacy (AR 40-590). 
7. Any accumulation of supplies or equipment on hand in excess of 
present requirements (AR 40-1705). 
8. Any obsolete, damaged, or unserviceable supplies or equipment 
on hand (AR 40-1705 and AR 700-10). 
9. Officer in charge maintains a record on W. D., M. D. Form No. 
16b of nonexpendable supplies (AR 40-1705). 
10. Officer in charge checks his instruments monthly (AR 40-1705). 
11. Medical property in the laboratory has been examined by a 
commissioned officer of the Medical Department and verified by refer- 
ence to records within the last 6 months (AR 35-6520 and AR 40-1705). 
12. All medical property is protected from the danger of fire, theft, 
and damage (AR 40-590). 
13. Rubber goods are protected by the use of talc. 
14. Any inflammable material stored in the laboratory that is not 
properly protected from the danger of fire (AR 700-10). 
15. a. Laboratory animals are suitably housed and protected. 
h. Laboratory animals are in good condition. 
c. What funds are available for their upkeep. 
16. How often the water in the swimming pool is examined. 
17. a. What examinations are made at the laboratory. 
h. What types of examinations are not made at the laboratory but 
are sent to other Government agencies. 
241 App. X 
18-21 
MEDICAL DEPARTMENT 
18. a. A list of voluntary blood donors, by types, is kept on file at 
the laboratory. 
b. How often these donors are examined for syphilis (AR 40-1715). 
19. Arrangements are made so that the laboratory officer or one of 
his qualified assistants is available at all times for blood counts, etc. 
20. a. All suspected venereal sores examined by dark field method 
for spirochetae pallida. 
b. If the first examination is negative, other examinations are made 
later (circular letter No. 1, S. G. O,, 1940). 
21. a. All autopsies are performed by an officer assigned to the lab- 
oratory service. 
b. Chief of laboratory service is held responsible for all bodies from 
the time they are delivered from the ward until they are turned over 
to the undertaker. 
c. A receipt is obtained from the undertaker for all bodies turned 
over to him. 
d. Bodies are inspected immediately after death and again after 
they are properly clothed and ready to be placed in the casket (AR 
30-1820). 
e. A certificate of the inspection, signed by an officer of the labora- 
tory service, stating whether or not the body is properly prepared and 
properly clothed for burial, is filed in the hospital records. 
/. A copy of the records of each autopsy is forwarded direct to the 
Curator, Army Medical Museum (AR 40-590). 
g. Tissue pathology is handled in accordance with The Surgeon 
General’s instructions (par. 24, circular letter No. 1, S. G. O., 1940). 
242 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. XI 
1-8 
Appendix XI 
CHECK LIST FOR CHIEF OF DENTAL SERVICE 
1. Rooms set aside for the dental clinic are suitable, well lighted, 
clean and neat in appearance (AR 40-15 and AR 40-590). 
2. Opinion of the dental surgeon is secured in writing when the 
construction, improvement, or upkeep of the dental clinic is under 
consideration. In such cases the dental surgeon forwards a copy 
of his recommendations through channels to The Surgeon General 
(AR 40-15 and AR 40-585). 
3. A suitable waiting room has been set aside for dental patients 
(AR 40-15). 
4. Dental personnel are sufficient. If not, detail the need for addi- 
tional personnel (AR 40-15). 
5. Enlisted men assigned to dental service are regarded as being 
on special duty and under special instruction, and not required to 
attend any other form of instruction (AR 40-15). 
6. Dental surgeon has prepared schedules for the technical training 
of his enlisted assistants, including hours of duty with the dental 
service, dental first-aid measures, care of public property, etc. (AR 
40-15). 
7. Regulations have been drawn up for the dental service, including 
hours of duty, property regulations, sanitation, the keeping of rec- 
ords etc. (AR 40-590). 
8. a. Dental surgeon regularly makes such inspections and checks 
of dental supplies and equipment as will insure that the property 
is in serviceable condition at all times (AR 40-1705). 
h. He inspects his instruments once a month (AR 40-1705). 
c. He maintains a file showing the nonexpendable property for 
which he is responsible (AR 40-1705). 
d. Dental supplies are satisfactory as to kind, quantity, and quality 
(AR 40-15, AR 40-1705, and Medical Department Supply Catalog). 
e. Dental surgeon pays special attention to the safekeeping and 
proper use of poisons, narcotics, alcohol, and substances containing 
alcohol (AR 40-15 and AR 40-590). 
/. Poisons, narcotics, and alcohols are kept under lock and key 
(AR 40-15 and AR 40-590). 
g. Who is intrusted with the key to the poison cabinet (AR 40-15 
and AR 40-590). App. XI 
8-11 
MEDICAL DEPARTMENT 
h. Gold plate, gold for casting, gold solder, and gold lingual bars 
are kept in a safe, except when small quantities for daily use are 
kept in a safe place in the dental clinic (AR 40-15). 
i. If a dental officer is relieved from duty he turns over his stock 
of special dental material either to the medical supply officer or 
to his successor, obtaining and distributing copies of the receipts 
(AR 40-15). 
j. When unserviceable gold accumulates, it is mailed in a regis- 
tered package to the distributing depot for the corps area, in weights 
not to exceed 6 pennyweight (AR 40-1705). 
k. Any unserviceable gold on hand (AR 40-1705). 
l. Dental clinic is properly protected from theft, fire, and other 
damage (AR 40-590). 
m. Any accumulation of property or supplies on hand (AR 40- 
1705). 
n. Any obsolete, damaged, or unserviceable property on hand in 
the dental clinic (AR 40-1705 and AR 700-10). 
o. Medical property in the dental clinic has been examined and 
verified by a commissioned officer of the Medical Department within 
the last 6 months (AR 35-6520 and AR 40-1705). 
p. It is understood by all concerned that the greatest care must 
be used with heating units to avoid burning out of the heating coils 
(AR 40-1705). 
9. All inflammable material is protected from the danger of fire 
(AR 700-10). 
10. a. Dental surgeon makes an oral inspection at the time the 
surgeon conducts the monthly physical inspection (AR 40-15 and 
AR 615-250). 
h. A dental survey is made of every patient who is hospitalized 
(AR 40-15). 
c. Date of the last complete dental survey of the command (AR 
40-510). 
d. Present dental classification of the command. 
Class I Class II Class III Class IV 
(AR 40-510). 
e. Appointments are made in accordance with the result of the 
classification (AR 40-510). 
11. What administrative action is taken to insure that the following 
persons report to the dental surgeon for examination and necessary 
dental treatment: 
a. Persons ordered to permanent detached service. 
244 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. XI 
11-19 
b. Persons who may be performing detached service while attend- 
ing summer training camps and such other times as they may be 
at the station (AH 40-510). 
12. In examining or treating persons who may be performing de- 
tached service while attending summer training camps the dental 
surgeon forwards a statement of conditions found and defects cor- 
rected, if any, and in case the treatment is not completed the reasons 
therefor, to the corps area surgeon of the corps area in which the 
individual is stationed (AR 40-510). 
13. a. Dental surgeon keeps an appointment book. 
b. Method used in making appointments with military personnel. 
c. What percent of personnel fails to keep appointment. 
d. Dental treatment is accorded to all who are entitled to receive it. 
e. There is a daily emergency hour, and how it relates to sick call. 
/. How many hours during the coming week are taken up with 
appointments. 
g. Regulations are in force requiring that the name, grade, etc., of 
every militarized person in need of dental attention be placed on the 
daily sick report (W. D., A. G. O. Form No. 5), and the individual 
required to report at the hospital or dispensary (enlisted men on sick 
call) before dental treatment is rendered by the dental service (AH 
40-505, AR 40-510, AR 40-1025, and AR 345-415). 
14. Dental surgeon has trained his enlisted assistants to keep the 
records of the clinic (AR 40-15). 
15. a. How many full dentures made during each month of the 
past year. 
b. How many partial dentures. 
c. Any unreasonable delay in furnishing dentures. 
16. A record is kept of dental X-ray exposures (AR 40-15). 
17. There is a current file and a permanent file of register cards of 
dental patients (W. D., M. D. Form No. 79) (AR 40-1010). 
18. In cases where patients were hospitalized for dental treatment 
only, the chief of dental service furnishes the ward officer with a 
copy of the patient’s case record to be attached to the patient’s 
clinical record. 
19. Patients in the hospital who require dental examination and 
report or dental treatment are sent to the dental clinic with a report 
from the ward officer showing name, etc., and whether referred for 
dental examination or treatment, or both, the patient’s diagnosis, his 
probable duration of hospitalization, together with any remarks per- 
tinent to the case, with special reference to the presence of syphilis 
in the infectious stage. 
245 App. XI 
20-24 
MEDICAL DEPARTMENT 
20. At the close of each month the following reports are fastened 
together and filed as “Dental history, Fort , for the month of 
53 
a. W. D., M. D. Form No. 57. 
1. W. D., M. D. Form No. 18b. 
c. Report of dental opinions on clinic. 
d. Schedules of instruction for enlisted assistants, 
e. Memoranda recommended for incorporation in sanitary order. 
/. Special reports and articles for publication. 
g. Other pertinent data. 
(AR 40-1010). 
21. At the close of each calendar year an index has been made of 
all subjects listed above and filed as “Index to the dental history, 
Fort , year of ” (AR 40-1010). 
22. Dental surgeon keeps himself informed of existing or antici- 
pated conditions with reference to their influence on dento-oral health, 
and he communicates such of this information as has a bearing upon 
military administration to the surgeon and recommends to him meas- 
ures deemed advisable (AR 40-15), 
23. Dental reports are checked as to accuracy (par. 12, circular let- 
ter No. 1, S. G. O., 1940). 
24. Instructions regarding central dental laboratories are being 
complied with (par. 11, circular letter No. 1, S. G. O., 1940, and 
references quoted therein). 
246 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. XII 
1-6 
Appendix XII 
CHECK LIST FOR CHIEF OF ROENTGENOLOGICAL 
SERVICE 
1. a. Personnel assigned to duty in the department are adequate. 
h. Personnel are competent. 
c. Conduct and appearance of the personnel are satisfactory (AH 
40-590). 
2. a. Hospital property used for other than Medical Department 
purposes (AR 40-590). 
h. Property is protected from theft, fire, and other damage (AR 
40-590). 
c. Any accumulation of property or supplies on hand above present 
needs (AR 40-1705). 
d. Any obsolete, damaged, or unserviceable property on hand (AR 
40-1705 and AR 700-10). 
e. A file is kept showing property held on Memorandum Receipt 
(W. D., Q. M. C. Form No. 487) (AR 40-1705). 
/. Supplies are adequate and satisfactory (AR 40-1705, Medical 
Department Supply Catalog, and circular letter No. 1, S. G. O., 1940). 
g. Medical property in use has been examined and verified by a com- 
missioned officer of the Medical Department every 6 months (AR 
35-6520 and AR 40-1705). 
h. Potent poisons are kept under lock and key and labeled as such 
(AR 40-590). 
i. Instruments of every description are checked monthly by a com- 
missioned officer (AR 40-1705). 
j. Daily average number of X-ray pictures taken during past 
month. Small size. Medium size. Large size. Fluoroscopic ex- 
aminations. X-ray treatments. 
3. In view of fire hazards, accumulations of used X-ray films in 
evidence. 
4. Plans have been submitted to The Surgeon General for the 
proper storage of X-ray films. 
5. Standing instructions have been posted for the guidance of the 
technician, especially in regard to fire hazards, the storage of films, 
etc. (AR 40-590). 
6. a. All electric wiring complies with the N. E. A. Code, especially 
in regard to the use of insulators, conduits, stand-offs, fuse blocks, 
switches, etc. 
247 App. XII 
6-7 
MEDICAL DEPARTMENT 
h. Only screened incandescent lamps are used. 
c. Any portable lights on extension cords in evidence. 
d. Diffusing glass in the illuminator ever becomes heated. 
e. “no smoking” signs are posted. 
/. Any film kept within 2 feet of steam pipes, radiators, or other 
sources of heat. 
g. Fire extinguishing appliances are readily available. 
h. Any of the fire extinguishers in the department contain carbon 
tetrachloride, which will develop phosgene gas. 
i. Films are in casettes or other containers in the operating room 
at any time other than while operating. 
j. Film negatives in storage or in the process of handling are kept 
in heavy manila envelopes, or in cardboard boxes, not to exceed six 
films to the envelope or 25 to a box. 
k. Films in the laboratory in excess of 100 pounds to one vented 
cabinet, or 200 pounds in two vented cabinets, are kept separated by 
at least 15 feet. 
l. Films are stored in rooms which are shared with other activities, 
m. Any accumulation of combustible material in the X-ray lab- 
oratory. 
n. How deteriorated X-ray films are disposed of. 
7. Equipment and space allotted for X-ray department are satis- 
factory. 
248 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. XIII 
1-3 
Appendix XIII 
CHECK LIST FOR OFFICER IN CHARGE OF 
DISPENSARY 
1. Out-patient service furnishes medical attendance to all persons 
entitled thereto (AR 40-505). 
2. a. At what hour sick call is held each day (AR 40-505). 
h. It is a rule that every militarized person in need of medical at- 
tention will be placed on daily sick report (W. D., A. G. O. Form 
No. 5) (AR 345-415). 
c. As a rule the organization or detachment daily sick report 
entries are completely filled out, including the line of duty (yes, no), 
and signed by the organization or detachment commander before 
being sent to the hospital or dispensary. 
d. First entry for each occasion is made on the line immediately 
following the signature of the organization or detachment commander 
and medical officer to the preceding entry (AR 345-415). 
e. Organization or detachment commander invariably places an 
interrogation point (?) in the proper column when he cannot state 
definitely at the time whether or not the disease or injury was in- 
curred in line of duty (AR 345-415). 
/. Surgeon in every case of injury considers whether or not the 
case may result in partial or complete permanent physical disability 
and be made the basis of a claim against the Government (AR 345- 
415). 
g. If he believes that it may so result, he immediately takes steps 
to request the action of a board of officers (AR 345—415). 
h. A noncommissioned officer of the organization or detachment 
brings the daily sick report to the place of holding sick call and 
waits to return the daily sick report (AR 345-415). 
i. Entries in the daily sick reports show name, grade, and Army 
serial number (AR 345-415). 
j. When the organization or detachment commander or the medical 
officer determines that the injury to an enlisted man resulted from 
his own misconduct, the notation “No; 107 AW” is made in the 
line of duty column (AR 345-415). 
h. Similarly, if an absence from duty of an enlisted man is caused 
by venereal disease due to his own misconduct, the initial symptoms 
249 App. XIII 
2-6 
MEDICAL DEPARTMENT 
of which appeared more than a year prior to such absence, the nota- 
tion “No; 107 AW” appears (AR 345-415). 
l. In case of an entry where the organization or detachment com- 
mander or the medical officer is of the opinion that the sickness of 
an officer or enlisted man was due to causes, as noted, “the effects of 
a disease which is directly attributable to and immediately follows 
his own intemperate use of alcoholic liquor or habit-forming drugs,” 
this entry appears in the line of duty column, “No; AR 35-1440” 
(AR 345-415). 
m. When an entry of “No; AR 35-1440” or “No; 107 AW” is 
made on the organization or detachment daily sick report, the indi- 
vidual is given an opportunity to protest the findings to the command- 
ing officer (AR 345MT5). 
n. In case that the organization or detachment commander and the 
surgeon do not agree upon the line of duty status, the daily sick report 
is presented to the commanding officer for his decision to be placed in 
the “disposition” column and signed with his official signature (AR 
345-415). 
o. In all cases of the entry “No; AR 35-1440” the initials of the 
organization or detachment commander appear opposite both the 
original entry and final entry of the current case (AR 345-415). 
p. Erasures appear on the daily sick report in violation of orders 
(AR 345-415). 
q. When an incorrect entry has been made, a line is drawn through 
the entry and the initials of the officer making the elimination placed 
on the margin of the page (AR 345—415). 
r. The signature, grade, and organization or arm or service of the 
organization or detachment commander and medical officer are placed 
on the line immediately below the last entry for each occasion, each 
officer signing helow the items of his report (AR 345-415). 
3. The medical officer in charge of the out-patient service conducts 
the prescribed physical examination of enlisted men (AR 615-250). 
4. An out-patient index is kept in the out-patient service for all 
patients treated but not admitted to the hospital. 
5. How out-patient records are disposed of when no longer required 
for current use (AR 40-1005). 
6. A record is kept of the number of patients treated, number of 
treatments, examinations, etc., for use with the report sheet (W. D., 
M. IX Form No. 51) at the end of the month, and under these headings: 
a. Out-patients; 
(1) Military. 
(2) Training unit. 
(3) Civilian. 
250 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. XIII 
6-11 
(4) Others (specify). 
h. Physical examinations: 
(1) Appointment, promotion, and annual of officers, etc. 
(2) Enlistment and reenlistment in Regular Army. 
(3) Appointment to United States Military Academy. 
(4) Appointment, promotion, or others, Officers’ Reserve Corps. 
(5) Reserve Officers’ Training Corps. 
(6) Citizens’ Military Training Camps. 
(7) Enlisted Reserve Corps. 
(8) Others (specify). 
c. Vaccination, etc.: 
(1) Typhoid immunizations. 
(2) Smallpox vaccinations. 
(3) Schick tests. 
(4) Diphtheria toxin antitoxin. 
(5) Others (specify). 
(AR 40-1025). 
7. How many patients were seen in the out-patient service during 
the last completed month (AR 40-1025). 
8. A summary of the work to include number of office visits, quar- 
ters visits, number of persons carried in quarters (by classes) is 
furnished the surgeon on the last day of each month (AR 40-1025). 
9. The chief of each professional service is required to submit on 
the first day of each month a report to the medical officer in charge 
of the out-patient service showing the total number of treatments 
given out-patients during the preceding month in the various 
services and clinics under their jurisdiction. 
10. a. Medical property for which the medical officer in charge is 
responsible has been examined and verified by a commissioned 
officer of the Medical Department during the last 6 months (AR 
35-6520 and AR 40-1705). 
h. Medical officer in charge checks the instruments for which he 
is responsible monthly (AR 40-1705). 
c. A record is kept on Form No, 16b of the supplies for which 
the medical officer in charge is responsible (AR 40-1705), 
d. Medical officer in charge safeguards the potent poisons, alcohol, 
alcoholic liquors, narcotics, and habit-forming drugs wdiich he may 
carry in emergency cases by the use of lock and key (AR 40-590). 
11. It is clearly understood by medical officers on duty that sulfa- 
nilamide will be employed only when the patient is kept under 
careful medical supervision in hospital and that it will not be ad- 
ministered to out-patients (par. 4, S. G. O. circular letters No. 13, 
1938, and No. 17, 1940). 
251 App. XIV 
1-15 
MEDICAL DEPARTMENT 
Appendix XIV 
CHECK LIST FOR OFFICER IN CHARGE OF PHARMACY 
1. Commanding officer of the hospital exercises personal super- 
vision over the pharmacy or he has detailed a subordinate Medical 
Department officer for this duty (AR 40-590). 
2. The pharmacy is generally clean, well lighted, and it presents a 
neat appearance (AR 40-590) 
3. Pharmacist on duty appears to be well qualified for his duties 
(AR 40-590). 
4. What members of the detachment are permitted to compound 
prescriptions and under what circumstances (AR 40-590). 
5. All prescriptions are written in the metric system (AR 40-590). 
6. A separate prescription file is kept for prescriptions containing 
alcohol, alcoholic liquors, and for medicines containing opium or any 
of the salts, derivatives, or preparations of opium or coca leaves 
(AR 40-590). 
7. A separate prescription file is kept for prescriptions for civilians 
(AR 40-590). 
8. All other prescriptions are filed in a separate book (AR 40-590). 
9. Labels placed on containers for medicines issued from the pharm- 
acy bear complete instructions to the patient and notations to 
identify the prescriber and prescription (TM 8-233). 
10. Initials of the pharmacist who filled the prescription are en- 
tered on each prescription (TM 8-233). 
11. a. Officer in charge of the pharmacy assumes responsibility for 
safeguarding the use of the key. 
h. Exactly to whom the keys of the poison cabinet are intrusted. 
c. Who has the keys when the pharmacist is off duty (AR 40-590). 
12. Unduly large amounts of alcoholic liquors have been prescribed 
at one time for any one person (AR 40-590). 
13. A permanent record is kept of the pharmacy receipts and ex- 
penditures for each article such as alcohol, alcoholic liquors, and 
all habit-forming drugs on W. D., M. D. Form No. TTa (AR 40-590). 
14. The slips (W. D., M. D. Form No, 17a) have been checked once 
a month by a Medical Department officer, balanced and verified, and 
the facts with the balance he found noted over his signature (AR 
40-590). 
15. On each slip mentioned above, the date of receipt from the 
storeroom is noted in the left-hand column, and the amount in the 
252 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. XIV 
15-20 
proper metric unit entered in the debit column; the expenditures 
noted by date, prescription number in the left hand column with 
the amount expended in compounding the prescription in the credit 
column (AR 40-590), 
16. A separate slip is kept for each form in which the above-named 
drugs are furnished. For instance, morphine is issued in four forms: 
12940 Morphine sulfate, 1 oz. USP, powder. 
12950 Morphine sulfate, %-grain hypo tablets, 20, USP. 
12955 Morphine sulfate, 14-grain hypo tablets, 20, USP. 
12960 Morphine sulfate, 2-grain hypo tablets, 10, USP. 
(AR 40-590 and AR 40-1705). 
17. The entries on W. D., M. D. Form No. 17a are correct for each 
of the drugs noted below, since date of the last medical inspection. 
(Secure a list of the issues from the storeroom and check expenditures 
from the prescription files.) (AR 40-590). 
10480 Alcohol, ethyl, 1 qt. USP. 
10490 Alcohol, ethyl, 5 gal. USP. 
10500 Alcohol, dehydrated, 1 pt. USP. 
11450 Cocaine, hydrochloride, oz. USP. 
11480 Codeine, sulfate, 1 oz. USP. 
11490 Codeine, sulfate, tablet, 500, USP. 
12940 Morphine, sulfate, 1 oz. USP. 
12950 Morphine, sulfate, %-grain hypo tablets, 20, USP. 
12955 Morphine, sulfate, 14-grain hypo tablets, 20, USP. 
12960 Morphine, sulfate, 2-grain hypo tablets, 10, USP. 
13220 Opium, 1 oz. powder, USP. 
14850 Tincture, opium 14 pt. USP. 
14860 Tincture, opium, camphorated, 1 pt. USP. 
14940 Whisky, 1 qt. USP. 
Nonstandard items corresponding to the above. 
18. The poison label is placed on every container wdien the contents 
thereof may be dangerous to health or human life (TM 8-233). 
19. Potent poisons, that is, “any substance (drug, chemical, or 
reagent) which is likely to destroy human life or seriously endanger 
health when applied externally to the body or when taken internally 
in a dose of less than one teaspoonful (4 cc., or in the solid state, 4 
gm.)”, alcohol, alcoholic liquors, and all habit-forming drugs are kept 
under lock and key (AR 40-590). 
20. The following-named drugs, etc., are kept under lock and key, 
or are any of them exposed on the shelves or kept in drawers: 
Acid, nitric. Acid, phosphoric. 
Acid, oxalic. Acid, sulphuric. 
253 App. XIV 
20-27 
MEDICAL DEPARTMENT 
Alcohol, methyl. 
Amyl nitrite. 
Antimony and 
potassium tartrate. 
Apomorphine. 
Arsenic. 
Atropine. 
Barbital or veronal. 
Cantharides. 
Chloral hydrate. 
Cresol. 
Digitalis. 
FI. ext. belladonna. 
FI. ext. nux vomica. 
Glyceryl trinitrate 
Homatropine. 
Iodine. 
Mercury. 
Nux vomica. 
Phenol. 
Physostigmine. 
Potass, hydroxide. 
Procaine. 
Scopolomine. 
Silver nitrate. 
Sod. hydroxide. 
Strophanthin. 
Strychnine. 
Tinct. aconite. 
Tinct. belladonna. 
Tinct. digitalis. 
Tinct. nux vomica. 
Alcohol, ethyl. 
Cocaine. 
Codeine. 
Morphine. 
Opium. 
Whisky. 
Other liquors. 
21. A prescription is made out every time that medicine is issued, 
as is customary in good practice. 
22. Prescriptions are refilled without a written order calling for a 
refill by number (TM 8-233). 
23. A refill date and number are placed on the old prescription 
(TM 8-233). 
24. In cases other than militarized personnel, a notation is placed 
on each prescription immediately after the name of the individual so 
as to enable the pharmacist to determine the status; for example, 
“John Smith, civilian employee, Q. M. C.” 
25. When prescribing for civilian employees of the United States 
and civilians as out-patients (dependents of military personnel ex- 
cepted), medical officers are required to enter on each such prescription 
the amount to be collected. 
26. Medicine charges for patients in hospital who are not entitled 
to medical relief at the expense of the War Department appropriations, 
such as certain civilian employees and other civilians, are collected 
promptly at the rate of 50 cents per diem, listed on War Department 
Form No. 322, deposited at the end of each month with nearest dis- 
bursing officer, and The Surgeon General notified of the fact by letter 
(AR 40-590). 
27. Is this station an isolated place within the meaning of para- 
graph 18c (3), AR 40-590. 
254 FIXED HOSPITALS OF THE MEDICAL DEPARTMENT 
App. XIV 
28-36 
28. If this station is considered an isolated place is it customary to 
issue medicines to civilians, make charges and collect the same, noti- 
fying The Surgeon General of the circumstances in each case (AR 
40-590). 
29. Medicine charges for civilian employees not in hospital are 
collected at the rate of 50 cents per prescription in ordinary cases and 
in the case of expensive medicines, dressings, appliances, etc., at such 
increased rate as will reimburse the United States for their cost (AR 
40-590). 
30. When civilian employees are hospitalized because of injury in- 
curred in the performance of duty and their medical care has not 
been assumed by the Army as a part of their compensation, bills for 
medicine charges are mailed direct to the United States Employee’s 
Compensation Commission and the receipt of the funds from the 
Commission taken up on War Department Form No. 322, and de- 
posited (AR 40-590). 
31. a. A chart or table is kept in a conspicuous place in the phar- 
macy showing antidotes for such ordinary poisons as follows (TM 8- 
233): 
Acids: 
Carbolic. 
Hydrocyanic. 
Oxalic. 
Aconite. 
Alcohols. 
Alkalies. 
Alkaloids. 
Antimony. 
Arsenic. 
Corrosive sublimate. 
Iodine 
Lead salts. 
Opium and morphine. 
Phosphorus. 
Snake venoms, etc. 
h. Antidotes to specific poisons are properly labeled, kept in a con- 
venient place for emergency use (TM 8-233). 
32. All medicine containers are clearly and properly labeled (TM 
8-233). 
33. A list of prescriptions (stock formulas) for pharmaceutical 
preparations carried in stock is available at the pharmacy for the in- 
formation of medical officers. 
34. The pharmacy is required to keep continually on hand as far 
as practicable a complete supply of all medicines supplied for use of 
the hospital. 
35. Any accumulation of supplies or equipment on hand in excess 
of present requirements (AR 40-1705), 
36. Any obsolete, damaged, or unserviceable supplies or equipment 
on hand (AR 40-1705 and AR 700-10). 
255 App. XIV 
37-41 
MEDICAL DEPARTMENT 
37. The officer in charge maintains a record of nonexpendable sup- 
plies on W. D., M. D. Form No. 16b (AR 40-1705). 
38. Medical property in the pharmacy has been examined by a com- 
missioned officer of the Medical Department and verified by reference 
to records within the last 6 months (AR 35-6520 and AR 40-1705). 
39. Any inflammable material stored in the pharmacy that is not 
properly protected from the danger of fire (AR 700-10). 
40. Proper precaution is taken in regard to smoking while handling 
inflammable supplies (AR 40-590). 
41. Proper precautions are observed to safeguard adequately sulf- 
anilamide to prevent unauthorized use (par. 6, circular letter No. 13, 
S. D. O., 1938, and circular letter No. 17, S. G. O., 1940). TM 8-360 
INDEX 
Paragraphs Pages 
Absence from duty on account of injury due to own misconduct. 95 62 
Absence of receiving and disposition officer 50 30 
Absence without leave, discharge of patients 73 42 
Acute poisonings, antidotes and treatment 272 163 
Administration, ward 146 76 
Administrative and clerical jurisdiction, deaths 101 55 
Administrative officer of the day: 
Confinement of persons... 129 66 
Detail 123 64 
Duty detachment. 128 66 
Escaped insane patient or prisoner, responsibilities 131 66 
General duties 125 65 
Fire marshal 127 66 
Inspections by 126 65 
Meat inspection 130 66 
Officers of the day, attention to and assistance of 222 103 
Reports 132 67 
Tour of duty 124 65 
Administrative service, general hospitals 12 10 
Admission of patients: 
Arrival by boat or rail 42, 65 27, 37 
Channels 64 36 
Detention wards 160 82 
Disposition of clothing and effects 109 57 
Examination 64 36 
Neuropsychiatric section 168 85 
Personnel entitled to admission 62 36 
Procedure on certain types 68 37 
Records 67 37 
Reports rendered upon admission from other stations 66 37 
Routine, general 233 132 
Supervision 61 36 
Alcohol, narcotics, and habit-forming drugs 54, 149 32, 79 
Alternate officers of the day 223 103 
Alveolar abscess 258 157 
Ambulance service 47 29 
Anesthesia 241 142 
Appointments, dental 195 94 
Approved certificate of disability 99 54 
Arrival procedure, nurses 200 95 
Army Nurse Corps and nursing service: 
Arrival procedure.. 200 95 
Duties and reports 203 96 
Hours of duty 202 96 
Principal chief nurse 201 95 
Relief procedure 204 97 
Status 199 95 
INDEX 
257 TM 8-260 
INDEX 
Paragraphs Pages 
Attendants, enlisted men, neuropsychiatric section 167 84 
Audit, patients’ funds and valuables 84 46 
Autopsies 181 90 
Baggage: 
Check of baggage room records 115 61 
Disposition on admission 109 57 
Officers 114 61 
Patients admitted from train or boat 112 60 
Room 108 57 
Withdrawal 113 60 
Bank deposits 30 24 
Barium enema - 265 160 
Basis and divisions, general hospitals 8 8 
Blood examinations, table of normal values in 232 127 
Blood transfusions 180 89 
Bodies, disposition 183 90 
Buildings, general hospitals 16 15 
Buildings and equipment, maintenance and repair 136 71 
Bulletin boards 151 79 
Cafeteria system 35 25 
Cerebro-spinal fluid, normal values for 232 127 
Certificate of disability 99 54 
Channels, admission of patients 64 36 
Check lists; 
Chiefs of—- 
Dental service App. XI 241 
Medical service App. IX 237 
Roentgenological service App. XII 245 
Surgical service App. VIII 228 
Commanding officer, medical detachment App. VI 221 
Commanding officer or surgeon App. II 197 
Director of dietetics App. V 217 
Medical (hospital) inspector App. I 185 
Medical supply officer App. IV 209 
Officer in charge of—- 
Dispensary App. XIII 247 
Laboratory App. X 239 
Pharmacy App. XIV 250 
Principal chief nurse App. VII 225 
Registrar App. Ill 203 
Chief dietitian 24 22 
Chiefs of sections 141 75 
Dental 191 93 
Chiefs of service 140 74 
Dental - 190 92 
Check list for App. XI 241 
Laboratory 106, 177 56, 87 
Medical, check list for App. IX 237 
Roentgenological 184 91 
Check list for App. XII 245 
Surgical, check list for App. VIII 228 
258 TM 8-260 
INDEX 
Paragraphs Pages 
Class of patients treated, fever therapy. 268 160 
Classes and types, hospitals 1 3 
Clearance, discharge of patients 76 43 
Clinical records 225 104 
Clinical treatment, detention ward 164 83 
Clothing, patients: 
Baggage room 108 67 
Check of records 115 d gj 
Disposition on admission 109 67 
Hospital, wear of 110 58 
Officers 114 61 
Retention 111 59 
Withdrawal from baggage room 113 60 
Collection and disposition of salvage and waste materials 135 70 
Commanding officer, general hospital 10 8 
Inspections, check list for App. II + 197 
Communicable diseases 232 127 
Concussion 239 141 
Confinement of persons by administrative officer of the day 129 66 
Consultations 144 75 
Contusion 239 141 
Council, hospital 39 26 
Custodian, patients’ funds and valuables 83 45 
Deaths: 
Action by registrar 105 65 
Administrative and clerical jurisdiction 101 55 
Autopsies 181 90 
Disposition of bodies 183 90 
Effects of deceased 107 56 
Notification 102 65 
Procedure in__ 103 55 
Report of 104 55 
Responsibility, chief of laboratory service 106 56 
Dental and oral surgery; 
Alveolar abscess 258 157 
Diet 262 158 
Jaw fractures 257 157 
Post-operative care 261 157 
Pulpitis (toothache) 260 157 
Stomatitis 259 157 
Dental service: 
Appointments 195 94 
Chief 190 92 
Chief of section 191 93 
Emergency officer 194 94 
Organization 189 92 
Property officer 192 93 
Reports 198 95 
Responsibility for dental patients in hospital 197 94 
Special cases 196 94 
Treatment 193 93 
259 TM 8-260 
INDEX 
Paragraphs Pages 
Deposit certificate, patients' funds and valuables 86 46 
Designation, hospitals 2 4 
Detention ward: 
Admission procedure 160 82 
Clinical treatment 164 83 
Daily inspection 161 83 
Meals. _ 163 83 
Medicine 162 83 
Wardmaster 150 82 
Ward officer 158 82 
Detail: 
Administrative officer of the day 123 64 
Professional officers of the day 217 102 
Diagnosis: 
Impression 228 108 
Report 154 80 
Diagnostic procedure 230 108 
Genito-urinary surgery 249 147 
Diet, special post-operative 236, 262 137, 158 
Dietetic department (See also Director of dietetics): 
Bank deposits 30 24 
Cafeteria system 35 25 
Chief dietitian 24 22 
Director of dietetics 23 21 
Food handlers 32 24 
Hospital council 39 26 
Inventory of supplies 33 24 
Meals 31 24 
Messes 36 25 
Night cook 28 24 
Nurses’ fund 37 26 
Organization 22 21 
Payment for supplies 29 24 
Property responsibility 34 24 
Purchase of food supplies 27 23 
Records 25 22 
Responsibility of ward officer 38 26 
Subsistence, medicine, and miscellaneous charges 26 23 
Director of dietetics; 
Bank deposits.' 30 24 
Cafeteria system, duties in 35 25 
Food handlers, supervision by 32 24 
Inspections, check list for App. V 217 
Inventory of supplies 33 24 
Messes, duties in 36 25 
Night cook, detailed by 28 24 
Payment for supplies 29 24 
Property responsibility 34 24 
Purchase of food supplies 27 23 
Records kept 25 22 
Subsistance, medicine, and miscellaneous charges 26 23 
260 TM 8-260 
INDEX 
Paragraphs Pages 
Directory board 155 80 
Disabilities, two or more, determination of pay status 92 50 
Disability, action on discharge for: 
Approved certificate of disability 99 54 
Enlisted members of permanent command 100 54 
Registrar 98 53 
Ward officer 97 53 
Discharge of patients 43,69-76 '28,38 
Absence without leave 73 42 
Clearance 76 43 
Disability, action on 97-100 53 
Hospital to quarters status 74 42 
Leave or furlough 72 41 
Recording 69 38 
Records 75 42 
Separation from service or transfer to another hospital 71 40 
Other than 70 38 
Dispensary: 
Function 205 98 
Medical attendance 207 98 
Officer in charge 207, 209 98, 99 
Records 208 98 
Disposition: 
Bodies 183 90 
Clothing and effects of patients upon admission 109 57 
Distribution and time of establishment, general hospitals 5 6 
Duties: 
Administrative officer of the day 125 65 
Nurses 203 96 
Professional officers of the day 219 102 
Duty detachment, administrative officer of the day 128 66 
Emergency: 
Detail: 
Laboratory 178 88 
Pharmacy 213 100 
Officer, dental service 194 94 
Roster, medical detachment 122 64 
Treatment of severe injuries 244 144 
Enlisted members of permanent command, discharge for dis- 
ability 100 54 
Enlisted men returned to duty, inspection 45 29 
Escaped insane patient or pi’isoner 131 66 
Evacuation of patients by boat or rail 44 28 
Examinations: 
Laboratory 179 88 
Patients admitted to hospital 64 36 
Physical 227 {. 107 
Roentgenological service 185 91 
Eye, ear, nose, and throat surgery 255,256 155 
261 TM 8-260 
INDEX 
Paragraphs Pages 
Financial transactions with patients 90 50 
Fire marshal 127 66 
Food handlers 32 24 
Food supplies, purchase of 27 23 
Functions; 
Dispensary 205 98 
Information office 20 20 
Quartermaster Corps supply 133 67 
Receiving and disposition officer 40 27 
Station hospitals 273 183 
Functions and control, hospitals 3 4 
Funds and valuables, patients’: 
Audit 84 46 
Custodian 83 45 
Deceased 89, 107 49, 56 
Deposit certificate 86 46 
Financial transactions with patients 90 50 
Subsequent deposits while in hospital 87 49 
Withdrawal 88 49 
Gall bladder 263 158 
Gastro-intestinal 264 159 
General hospitals: 
Distribution and time of establishment 5 6 
Establishment; 
Buildings 16 15 
Lay-out 17 17 
Selection of sites 15 14 
Grouping of 7 7 
Organization: 
Administrative service 12 10 
Basis and divisions 8 8 
Commanding officer 10 8 
Headquarters 9 8 
Professional service 13 12 
Training 14 13 
Unit staff 11 9 
Purpose 4 5 
Supply 6 7 
Genito-urinary surgery: 
Diagnostic procedures 249 147 
Miscellaneous procedures 254 153 
Operation preparation 250 148 
Post-operative care 251 149 
Special care of prostate obstruction cases 253 151 
Urological instruments 252 150 
Grouping of general hospitals 7 7 
Habit-forming drugs 54 32 
Hair cutting, patients in closed wards 175 87 
Head injuries 239 141 
Headquarters, general hospital 9 8 
262 TM 8-260 
INDEX 
Paragraphs Pages 
Hemorrhoid cases, post-operating care 237 139 
History-taking, outline 226 105 
Hospital council 39 26 
Hospital to quarters status, discharge of patients 74 42 
Hospitals: 
Classes and types 1 3 
Control 3 4 
Designation 2 4 
General. {See General hospitals.) 
I’unctions 3 4 
Identification 2 4 
Station. (See Station hospital.) 
Hours of duty, nurses 202 96 
Identification, hospitals 2 4 
Information office: , 
Action, seriously ill cases 78 44 
Function 20 20 
Organization 19 19 
Report of administrative officer of the day 21 20 
Information, release of 157 81 
Insane. {See Neuropsychiatric section.) 
Inspections: 
Administrative officer of the day 126, 130 65, 66 
Check lists. {See Check lists.) 
Detention ward 161 83 
Enlisted men returned to duty 45 29 
Neuropsychiatric section 169 85 
Intravenous infusions, technique 238 140 
Inventory of supplies 33, 56 34, 24 
Jaw fractures *-_■ 257 157 
Jurisdiction, medical detachment 116 62 
Keys, neuropsychiatric section, check of 170 85 
Label preparation, pharmacy 215 101 
Laboratory service: 
Autopsies 181 90 
Blood transfusions 180 89 
Chief 177 87 
Disposition of bodies 183 90 
Emergency detail 178 88 
Examinations 179 88 
Preservation of specimens 182 90 
Lay-out, general hospital 17 17 
Leave or furlough, discharge of patient 72 41 
Line of duty boards 96 52 
List of seriously ill patients 81 45 
Maintenance: 
Buildings and equipment 136 71 
Utilities 137 72 
263 TM 8-260 
INDEX 
Paragraphs Pages 
Meals; 
Detention ward 163 83 
Hour of serving 31 24 
Inspection 130 66 
Medical attendance, dispensary 207 98 
Medical detachment: 
Commanding officer, check list for App. VI 221 
Emergency roster 122 64 
Jurisdiction 116 62 
Noncommissioned officer in charge of quarters 121 64 
Organization 117 62 
Salutes 119 63 
Sick call 120 63 
Wardmasters- 118 63 
Medical inspector, check list for App. I 185 
Medical service; 
Clinical records 225 104 
Communicable diseases 232 127 
Diagnosis impression 228 108 
Diagnostic procedure 230 108 
Normal values for cerebro-spinal fluid 232 127 
Outline of history-taking 226 105 
Physical examinations 227 107 
Routine procedure on admission 229 108 
Sputum collection in pneumonia cases 232 127 
Table of normal values in blood examination 232 127 
Therapeutic procedure 231 115 
Medical supply department: 
Alcohol, issue, requisition, and safeguarding 54 32 
Duties, general 52 31 
Habit-forming drugs, issue, requisition, and safeguarding. _ 54 32 
Inventories and reports 56 34 
Narcotics, issue, requisition, and safeguarding 54 32 
Organization 51 31 
Property 65 32 
Purchase of materials in open market 58 34 
Repair and renovation of Medical Department equipment- 57 34 
Requisition by medical supply officer 60 35 
Supplies, requisition and issue 53 31 
Transfer of property 59 35 
Medical supply officer: 
Inspections, check list for App. IV 209 
Requisition of supplies by 60 35 
Medicine and medical treatment record 148 78 
Medicines; 
Detention ward 162 83 
Dispensary, authority for 216 101 
Neuropsychiatric section 171 86 
Messes 36 25 
264 TM 8-260 
INDEX 
Paragraphs Pages 
Misconduct, patients absence from duty on account of, injuries 
due to 95 52 
Myelography 267 160 
Narcotics 54, 149 32, 79 
Neuropsychiatric section: 
Admission procedure 168 85 
Check of patients and keys 170 85 
Enlisted attendants 167 - 84 
Inspection, daily 169 85 
Medicines and poisons, safeguarding 171 86 
Night nurse 174 87 
Organization 165 84 
Prisoner status patients 176 87 
Shaving and hair cutting of patients 175 87 
Treatment of patients 172 86 
Visitors in closed wards 173 87 
Wards 166 84 
Night cook 28 24 
Night nurse 174 87 
Noncommissioned officer: 
In charge of pharmacy 212 100 
In charge of quarters 121 64 
Nonpay status, military patient placed on 93 51 
Notification: 
Deaths 102 55 
Patient’s arrival 46 29 
Nurses {See also Army Nurse Corps and nursing service): 
Fund 37 26 
Night, closed wards 174 87 
Officer in charge: 
Dispensary 206 98 
Check list for App. XIII 247 
Special duties 209 99 
Laboratory, check list for App. X 239 
Pharmacy 211 100 
Check list for App. XIV 250 
Officers clothing and baggage 114 61 
Operating room 241 142 
Operation, pharmacy 210 100 
Operation, preparation for 234 134 
Genito-urinary surgery 250 148 
Organization: 
Dental service 189 92 
Dietetic department 22 21 
General hospitals 8-14 8 
Information office 19 19 
Medical detachment 117 62 
Medical supply department 51 31 
Neuropsychiatric section 165 84 
Station hospital 275 183 
265 TM 8-260 
INDEX 
Orthopedic surgery: Paragraphs Pages 
Emergency treatment of severe injuries 244 144 
Plaster casts--. 247 146 
Post-operative care 246 146 
Preoperative preparation 245 145 
Traction cases 248 147 
Outline of history-taking 226 105 
Out-patients 49 30 
Pathological examination, request for 240 141 
Patients; 
Admission 42, 61-68 27, 36 
Arrival, notification of 46 29 
Clothing and baggage 108-115 57 
Deaths 101-107 55 
Dental: 
Responsibility for 197 94 
Treatment 193 93 
Discharge 69-76 38 
For disability 97-100 53 
Disease or injury 91-96 50 
Evacuation by boat or rail 44 28 
Funds and valuables 83-90 45 
Mentally ill: 
Check of 170 85 
Prisoner status 176 87 
Shaving and hair cutting 175 87 
Treatment 172 86 
Post-operative care. (See Post-operative care.) 
Preparation for operation 234, 250 134, 148 
Seriously ill 77-82 43 
Ward officers, control, etc. of 147 78 
Payment for supplies 29 24 
Personnel entitled to admission to hospitals 62 36 
Pharmacy; 
Authority for dispensing medicine 216 101 
Emergency detail 213 100 
Label preparation 215 101 
Noncommissioned officer in charge 212 100 
Officer in charge 211 100 
Operation 210 100 
Prescriptions 214 100 
Physical examination 227 107 
Physical therapy. (See Therapy.) 
Plaster casts 247 146 
Poison, safeguarding in neuropsychiatric section 171 86 
Poisonings, antidotes and treatment 272 163 
Police and sanitation 143 75 TM 8-260 
INDEX 
Post-operative: Paragraphs Pages 
Care 235 185 
Enroute from operating room to bed 243 144 
Eye, ear, nose, and throat surgery 256 155 
Dental surgery 261 157 
Genito-urinary surgery 251 149 
Hemorrhoid and rectal cases 237 139 
Immediate 242 143 
o 
Orthopedic surgery 246 146 
Diets 236, 262 137, 158 
Preoperative preparation: 
Eye, ear, nose, and throat surgery 255 155 
Fever therapy 270 161 
Orthopedic surgery 245 145 
Preparation of patient for operation 234 134 
Genito-urinary surgery 250 148 
Prescriptions 214 100 
Principal chief nurse 201 95 
Check list for App. VII 225 
Prisoner status patients, neuropsychiatric section 176 87 
Professional officers of the day: 
Alternate 223 103 
Administrative (See also Administrative officers of the day) _ 222 103 
Detail 217 102 
Duties 219 102 
Record of tour 220 103 
Special instructions 221 103 
Tour of duty 218 102 
Property: 
Director of dietetics 34 24 
Medical supply officer 55 32 
Officer, dental service 192 93 
Ward officers 153 79 
Prostate obstruction cases, special care 253 151 
Pulpitis (toothache) 260 157 
Purchase: 
Food supplies 27 23 
Materials on open market 58 34 
Purpose, general hospitals 4 5 
Quartermaster Corps supply functions 133 67 
Receiving and disposition officer: 
Absence of 50 30 
Admission of patients 42 27 
Ambulance service 47 29 
Discharge of patients 43 28 
Evacuation of patients by boat or rail 44 28 
Function 40, 41 27 
Inspection of enlisted men returned to duty 45 29 
Notification of patient’s arrival 46 29 
Out-patients 49 30 
Reports 48 29 
267 TM 8-260 
INDEX 
Paragraphs Pages 
Recording discharge of patients. 69 38 
Records {See also Reports): 
Admission and disposition list 75 42 
Baggage room, check of 115 61 
Director of dietetics 25 22 
Dispensary 208 98 
Medicine and medical treatment 148 78 
Officers of the day 220 103 
Roentgenological service 186 91 
Rectal cases, post-operative care 237 139 
Registrar’s action; 
Deaths 105 55 
Discharge for disability 98 53 
Inspections, check list for App. Ill 203 
Seriously ill case 79 44 
Release of information 157 81 
Relief procedure, nurses 204 97 
Repair and renovation of medical department equipment 57 34 
Repair of buildings 136 71 
Reports: 
Administrative officer of the day 21, 132 20, 67 
Chiefs of medical and surgical services 141 75 
Deaths 104 55 
Dental service 198 95 
Diagnosis 154 80 
Medical supply officer 66 34 
Nurses 203 96 
Operations 240 141 
Patients admitted from other stations 66 37 
Receiving and disposition officer 48 29 
Seriously ill patients, by ward officer 77 43 
Unusual occurrence 156 80 
Request for pathological examination 240 141 
Requisition and issue, supplies 53, 60 31, 35 
Retention of clothing and property 111 69 
Roentgen and radium therapy 187 91 
Roentgenograms 186 91 
Roentgenological service; 
Chief 184 91 
Examinations 185 91 
Preparation of patients 188 92 
Records and roentgenograms 186 91 
Roentgen and radium therapy 187 91 
Roentgenology: 
Abdominal region, lumbar spine, sacroiliacs, KUB 266 160 
Barium enema 265 160 
Gall bladder 263 158 
Castro-intestinal 264 159 
Myelography 267 160 
268 TM 8-260 
INDEX 
Paragraphs Pages 
Salutes, enlisted men of medical detachment 119 63 
Salvage and waste materials, collection and disposition 135 70 
Separation from service or transfer to another station, discharge 
of patients 71 40 
Seriously ill patients; 
Cessation of condition 80 44 
Information office, action by 78 44 
List of 81 45 
Registrar’s action 79 44 
Report by ward officer 77 43 
Transfer to another ward 82 45 
Severe injuries, treatment 239, 244 141, 144 
Shaving and hair cutting, patients in closed wards 175 87 
Sick call 120 63 
Similarity between general and station hospitals 276 184 
Sites, general hospitals, selection of 15 14 
Skull fractures 239 141 
Special dental cases 196 94 
Specimens, preservation 182 90 
Sputum collection in pneumonia cases 232 127 
Staff, general hospitals 11 9 
Station hospital: 
Designation and identification 2, 274 4, 183 
Function 273 183 
Organization 275 183 
Similarity to general hospitals 276 184 
Status, members of Army Nurse Corps 199 95 
Stomatitis 259 157 
Subsequent deposits of funds and valuables while in hospital. _ 87 49 
Subsistence, medicine, and miscellaneous charges 26 23 
Supervision, admission of patients 61 36 
Supplies: 
Food, purchase of 27 23 
Inventory 33 24 
Payment for 29 24 
Requisition and issue 53, 134 31, 68 
Supply, general hospitals 6 7 
Surgery: 
Dental and oral 257-262 156 
Eye, ear, nose, and throat 255, 256 155 
General: 
Anesthesia and operating room 241 142 
Diets, special post-operative 236 137 
En route from operating room to bed 243 144 
Immediate post-operative routine 242 143 
Intravenous infusion 238 140 
Post-operative care. (See Post-operative care.) 
Preparation of patient for operation 234 134 
Report of operation and request for pathological ex- 
amination 240 141 
269 TM 8-260 
INDEX 
Surgery—Continued. 
General—Continued. Paragraphs Pages 
Routine upon admission 233 132 
Severe head injuries, concussion, contusion, skull frac- 
tures, etc 239 141 
Genito-urinary 249-254 147 
Orthopedic 244-248 144 
Table of normal values in blood examinations 232 127 
Therapeutic procedure 231 115 
Therapy: 
Fever: 
Class of patients treated 268 160 
Preoperative preparation 270 161 
Procedure to obtain treatment 269 161 
Treatment 271 161 
Radium 187 91 
Roentgen 187 91 
Time of establishment, general hospitals 5 6 
Toothache 260 157 
Tour of duty: 
Administrative officer of the day 124 65 
Professional officer of the day 218 102 
Traction cases 248 147 
Training, general hospitals 14 13 
Transfer; 
Property 59 85 
Seriously ill to another ward 82 45 
Transportation 138 72 
Treatment of patients: 
Acute poisonings . 272 163 
Dental 193 93 
Fever therapy 271 162 
Neuropsychiatric section 172 86 
Unit staff, general hospital 11 9 
Urological instruments 252 150 
Urological procedures, miscellaneous 254 153 
Utilities, maintenance and operation 137 72 
Valuables, patients. (See Funds and valuables, patients.) 
Visitors: 
Closed wards 173 87 
Ward officer responsibility 150 79 
Ward attendants 152 79 
Wardmasters 118,159 63,82 
Ward officer 45 76 
Action on discharge for disability 97 53 
Administration 146 76 
Alcohol and narcotics, responsibility for 149 79 
Bulletin board 151 79 
Detention ward.. 158 82 
270 TM S—260 
INDEX 
W ard officer—Continued. Paragraphs Pages 
Diagnosis report 154 80 
Directory board 155 80 
Inspection of food, etc 38 26 
Medicine and medical treatment record 148 78 
Patients, control etc. by 147 78 
Property, responsibilities 153 79 
Release of information by 157 81 
Report of seriously ill patients 77 43 
Report of unusual occurrence 156 80 
Visitors, responsibility for 150 79 
Wards, treatment of mental patients 166 84 
Waste materials, collection and disposition 135 70 
Wear of hospital clothing 110 58 
Withdrawal: 
Clothing and baggage from baggage room 113 60 
Funds and valuables 88 49 
[A. G. 062.11 (4-10-41).] 
Br ORDER OF THE SECRETARY OF WAR I 
G. C. MARSHALL, 
Chief of Staff. 
Official : 
E. S. ADAMS, 
Major General, 
The Adjutant General. 
Distribution: 
X. 
(For explanation of symbols, see FM 21-G.) 
UNITED STATES 
GOVERNMENT PRINTING OFFICE 
WASHINGTON : 1941 
For sale by the Superintendent of Documents, Washington, D. C. - - Price 25 cents