HANDBOOK 
OF THE 
HOSPITAL CORPS 
UNITED STATES NAVY 
1939 
PUBLISHED BY 
THE BUREAU OF MEDICINE AND SURGERY 
UNDER THE AUTHORITY OP 
THE SECRETARY OF THE NAVY 
UNITED STATES 
GOVERNMENT PRINTING OFFICE 
WASHINGTON : 1939 
For sale by the Superintendent of Documents, Washington, D. C. - - - - Price $1.75 (Buckram) Bureau of Medicine and Surgery, 
Navy Department, 
Washington, D. July 1, 1939. 
The Handbook of the Hospital Corps, United States Navy, 1939, is a revised 
edition of the former Handbook of the Hospital Corps, United States Navy, 
1930, and is compiled from articles prepared by members of the Medical, 
Dental, Hospital, and Nurse Corps, U. S. Navy, and reviewed and revised by 
Commander W. J. C. Agnew, Medical Corps, and Chief Pharmacist N. L. 
Saunders, U. S. Navy. It is published for the instruction and guidance of 
members of the Medical Department of the United States Navy and for use at 
the Hospital Corps Schools. 
The use in this volume of certain portions of the text of the United States 
Pharmacopoeia is by virtue of permission received from the Board of Trustees 
of the United States Pharmacopoeial Convention. The said Board of Trustees 
is not responsible for any inaccuracy of quotation nor for any errors in the 
statement of quantities or percentage of strengths. 
Permission to use for comment parts of the National Formulary, Sixth Edi- 
tion, in this volume has been granted by the Committee on Publications by 
authority of the American Pharmaceutical Association. 
Authority for use of New and Nonofflcial Remedies, 1935 Edition, has been 
granted by the American Medical Association. 
Ross T. McIntire. 
Sura eon General, U. S. Navu. Page 
Foreword v 
Chapter I. History of the Hospital Corps 1 
II. Anatomy and Physiology 5 
III. Section 1. Minor Surgery and First Aid 85 
Section 2. Bandages and Bandaging 131 
Section 3. Splints and Appliances 148 
Section 4. Emergency Dental Treatment 165 
IV. Section 1. Materia Medica and Therapeutics 177 
Section 2. Toxicology 257 
V. Section 1. Nursing 271 
Section 2. Ward Management 344 
Section 3. Operating Room and Surgical Technique 356 
VI. Section 1. Hygiene and Sanitation 371 
Section 2. Allergy 469 
Section 3. Genito-urinary and Venereal Diseases 490 
Section 4. Prevention op Venereal Diseases 511 
Section 5. Industrial Medicine and Industrial Hazards. 514 
Section 6. Field Sanitation 521 
Section 7. Duty With Marine Corps Expeditionary 
Forces. _ 564 
Section 8. Landing Force 570 
Section 9. Shore Patrol 574 
VII. Diets and Messing for the Sick 679 
VIII. Pharmacy 599 
IX. Chemistry 643 
X. Anaesthesia 735 
XL Section 1. Administration and General Clerical Pro- 
cedures 749 
Section 2. Hospital Supplies and Property Account- 
ability 774 
Section 3. Commissary Supervision 804 
Section 4. Deaths and Medico-Legal Matters 833 
XII. Hospital Corps Technical Specialties. 
Section 1. Aviation Medicine 847 
Section 2. Basal Metabolism „ 849 
Section 3. Blood Grouping and Matching 856 
Section 4. Chemical Warfare 862 
Section 5. Diving and Submarine Duty 872 
Section 6. Electrocardiography 879 
Section 7. Embalming ; 882 
Section 8. Independent Duty 887 
Section 9. Laboratory Procedures and Technique 889 
Section 10. Physical Therapy 917 
Section 11. Recruiting - 936 
Section 12. X-ray 940 
Index 969 
TABLE OF CONTENTS FOREWORD 
In this 1939 edition of the Handbook of the Hospital Corps, U. S. Navy, 
the subject matter has been revised, enlarged, and brought up-to-date, as nearly 
as possible, with the sciences which are briefly discussed in the various chapters 
and sections. 
The handbook is intended to serve as a general guide and reference book for 
the hospital corpsmen of the Navy, especially those performing duty independ- 
ent of medical officers, and as a textbook for their instruction in the Hospital 
Corps Schools and elsewhere. It contains information and instructions con- 
cerning the duties of the Hospital Corps of the Navy, but hospital corpsmen, 
particularly those in the upper ratings, are urged to make frequent reference 
to the U. S. Navy Regulations, the Manual of the Medical Department, U. S. 
Navy, the manuals of other Navy Department bureaus, circular letters, etc., 
for additional information and instructions. 
The principal subjects have been arranged in the order in which they occur 
in examinations for advancement in rating. As these subjects necessarily are 
presented in epitomized form, readers of the handbook should realize that the 
information contained in it must be supplemented by reference to the standard 
textbooks and professional journals usually available in the medical libraries 
of hospitals, ships, and stations. 
The Bureau of Medicine and Surgery herewith expresses appreciation to the 
following-named members of the Medical Department, U. S. Navy for the time 
and effort spent in preparing, reviewing, and revising the material for this 
book: 
Captain J. Harper, (MC), U. S. Navy — 
Commander G. B. McArthur, (MC), U. S. 
Navy 
Anatomy and Physiology. 
Commander M. D. Willcutts, (MC), IT. S. Navy_ 
Minor Surgery and First Aid. 
Bandages and Bandaging. 
Captain H. E. Harvey, (DC), U. S. Navy 
Captain W. L. Darnall, (DC), U. S. Navy 
Commander R. S. Davis, (DC), U. S. Navy 
Emergency Dental Treatment. 
Materia Medica and Therapeu- 
tics. 
Pharmacy. 
Chief Pharmacist E. G. Swann, U. S. Navy—- 
Chief Pharmacist A. T. Schwartz, U. S, Navy_ 
Pharmacist P. S. Gault, U. S. Navy 
•Toxicology. 
Chief Nurse J. Ferris, U. S. Navy Nursing. 
Chief Nurse P. W. Hoyle, U. S. Navy Ward Management. 
Commander G. A. Eckert, (MC), U. S. Navy_ Operating Room and Surgical 
Technique. 
Hygiene and Sanitation. 
Prevention of Venereal Diseases. 
Lieutenant O. L. Burton, (MC), U. S. Navy 
Lieut. Commander F. M. Rohow, (MC), U. S. 
Navy Allergy. 
Commander M. S. Mathis, (MC), U. S. Navy— Genito-urinary and Venereal 
Diseases. VI 
FOREWORD 
Commander H. L.*Shinn, (MC), U. S. Navy— Industrial Medicine and Indus- 
trial Hazards. 
Captain AV. L. Mann, (MC), U. S. Navy Field Sanitation. 
Commander W. T. Brown, (MC), U. S. Navy— Duty with Marine Corps Expe- 
ditionary Forces. 
Commander L. D. Arbuckle, (MC), U. S. Navy- 
'Landing Force. 
Shore Patrol. 
Nurse R. Dunbar, U. S. Navy Diets and Messing for the Sick. 
Lieut. Commander 0. L. Bozarth, (MO), U. S. 
Navy 
Pharmacist’s mate second class, J. F. Reid, 
U. S. Navy 
>Chemistry. 
Captain F. L. Conklin, (MC), U. S'. Navy Anaesthesia. 
Chief Pharmacist N. L. Saunders, U. S. Navy__ Administration and General 
Clerical Procedures. 
Division of Finance, Bureau of Medicine 
and Surgery. 
Hospital Supplies and Property 
Accountability. 
Chief Pharmacist J. H. Bell, U. S. Navy Commissary Supervision. 
Captain C. W. O. Bunker, (MO), U. S. Navy— 
Chief Pharmacist R. Aikman, U. S. Navy 
Deaths and Medico-Legal Mat- 
ters. 
Commander J. C. Adams, (MC), U. S. Navy Aviation Medicine. 
Commander J. M. McCants, (MC), U. S. Navy_ Basal Metabolism. 
Commander H. E. Ragle, (MC), U. S. Navy Blood Grouping and Matching. 
Commander B. H. Adams, (MC), U. S. Navy— Chemical Warfare. 
Commander F. S. Johnson, (MC), U. S. Navy Diving and Submarine Duty. 
Captain C. R. Baker, (MC), U. S. Navy Electrocadiography. 
Embalming. (Based on the 
Manual of the Medical De- 
partment, U. S. Navy.) 
Chief Pharmacist O. P. Dean, U. S. Navy Independent Duty. 
Commander O. Wildman, (MC), U. S. Navy Laboratory Procedures and 
Technique. 
Lieutenant O. C. Welch, (MO), U. S. Navy Physical Therapy. 
Captain G. E. Thomas, (MC), U. S. Navy Recruiting. 
Commander W. A. Fort, (MO), U. S. Navy 
Commander F. W. Muller, (MC), U. S. Navy- 
X-ray. 
Appreciation and thanks are herewith expressed for the courtesy of the 
American Red Gross, the General Electric X-ray Corporation, and the follow- 
ing publishers in permitting the reproduction and use of certain illustrations 
appearing in this book: William Wood & Co., for figures 8, 9, 12, 15, 17, 18, 24, 
27, 30, 32, 33, 37, 41, 47, and 52; Lea and Febiger for figures 10, 11, 16, 29, 40, 
44, 56, 66, 67, 69, 70, 71, 77, 78, 81, and 123; W. B. Saunders & Co., for figures 
49, 50, 57, 65, and 147; P. Blakiston’s Son & Co., for figures 13, 14, 20, 23, 48, 
124, 137, 138, 167, 168, 169, 170, 171, 172, 173, 174, 175, 176, 177, and 178; J. B. 
Lippincott & Co., for figures 72, 146, and 148; and The Macmillan Co., for 
figure 153. 
The courtesy of the Medical Department, U. S. Army in permitting use of 
the text of and the reproduction and use of the illustrations in the Manual of 
Splints and Appliances of the U. S. Army, is acknowledged. 
The assistance of Pharmacist’s mate first class 0. E. Otwell, Jr., U. S. Navy, 
in preparing the index and typewriting much of the manuscript and of Chief 
Pharmacist’s mate, J. A. McCalley, U. S. Navy, and Pharmacist’s mate third class 
M. J. Hadden, U. S. Navy, in preparing a number of the sketches and illustra- 
tions is acknowledged. CHAPTER I 
HISTORY OF THE HOSPITAL CORPS OF THE UNITED 
STATES NAVY 
Prior to 1898 the duties attendant upon the care of the sick and injured 
of the Naval Establishment were performed by certain individuals whose 
appointment or enlistment was provided for from time to time, under various 
designations and titles, by order of the Navy Department. 
In the earliest days of the Navy, afloat, the care of the sick and injured 
devolved upon the surgeon and the surgeon’s mate, with the assistance of 
such members of the crew as were detailed to help in emergencies. 
An act of Congress, approved March 2, 1799, provided: “A convenient 
place shall be set apart for the sick and hurt men, to which they are to be 
removed * * * and some of the crew shall be appointed to attend them, 
and keep the place clean.” The place assigned on board ships for the care 
of the sick, in accordance with the above act, was usually referred to as the 
“cockpit” and in later years it was designated as the “sickbay.” 
The “loblolly boy” was the title designating the man or boy first specifi- 
cally detailed to assist in the care of the sick and injured. The name probably 
originated in the British Navy, as it appears in some of the early writings on 
that service. The first oflicial use of the title in the United States Navy 
appears in the Naval Regulations published in 1814 where it is stated: “The 
loblolly boy is to serve the surgeon and surgeon’s mate.” 
The following is quoted from United States Naval Regulations, 1818: “The 
surgeon shall be allowed a faithful attendant to issue, under his direction, 
all supplies and provisions and hospital stores, and to attend the prepara- 
tion of nourishment for the sick. 
“The surgeon’s mates shall be particularly careful in directing the loblolly 
boy to keep the cockpit clean, and every article therein belonging to the Med- 
ical Department. 
“The surgeon shall prescribe for casual cases on the gun deck every morn- 
ing at 9 o’clock, due notice having been previously given by his loblolly boy 
by the ringing of a bell.” 
The loblolly boy was succeeded by a male “nurse” in accordance with a 
general order of the Navy Department of June 16, 1861, which stated: “There 
shall be allowed to each vessel commissioned for sea service, with a comple- 
ment of less than two hundred, one nurse, and with two hundred and over 
two nurses * * * to be appointed by the surgeon and approved by the 
commander of the ship, and to be borne upon the ship’s books for special 
service upon the sick.” 
About the year 1873 the title of “bayman” came into use, and this title 
was recognized officially in the United States Naval Regulations published 
in 1876, and it remained in effect until the organization of the Hospital Corps 
of the Navy in 1898. 
Daymen were enlisted as landsmen for general service, and rated bayman 
by the commanding officer on the recommendation of the surgeon, or senior 
inedical officer. The number was regulated by the complement of the vessel. 2 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The record of the advent of surgeon’s stewards in the Navy is more or less 
obscure, but this seems to have been shortly after the Bureau of Medicine 
and Surgery was established in 1842. The following is an extract from a 
letter found in the old files of the bureau under date of May 5, 1843. 
“A circular' is now under consideration to allow a surgeon’s steward to all 
hospitals and vessels, without necessity to sign articles, but to be appointed.” 
The Medical Journal of the U. S. S. Rapidan, 1844, bears a notation that 
an applicant for surgeon’s steward was found disqualified for appointment on 
account of physical disability. 
Originally surgeon’s stewards were enlisted as landsmen or seamen, and 
were appointed by the commanding officer on the recommendation of the 
surgeon of the vessel. They were classed as petty officers and could be dis- 
rated for incompetency or misbehavior. 
By general order of the Navy Department, November 11, 1861, their status 
was changed to “appointed petty officer”; appointments were made for the 
“duration of the cruise” and they were subject to discharge for misbehavior, 
“the fact of misbehavior to be established by a summary court.” 
The title of surgeon’s steward was changed to apothecary by circular order 
of the Navy Department, dated December 8, 1866. This order reads: “The 
designation of persons serving as surgeon’s steward is changed to that of 
apothecary, and they will be appointed for duty in the Medical Department 
of the Navy, ashore and afloat, in the same manner as surgeon’s stewards 
have heretofore been appointed. Apothecaries of the first class will rank with 
boatswains, * * *, Apothecaries of the second class will rank with boat- 
swain’s mates in charge, * * *, Apothecaries of the third class will rank 
with boatswain’s mates.” 
United States Naval Regulations, 1893, article 1683, prescribed that: 
“Apothecaries for shore stations shall, with the approval of the Secretary of 
the Navy, be appointed by the Chief of the Bureau of Medicine and Surgery.” 
United States Naval Regulations, 1896, article 797, prescribed that: “A 
candidate for examination and first enlistment as apothecary must be a gradu- 
ate of some recognized college of pharmacy.” 
The title of “apothecary” was changed to “hospital steward” by act of 
Congress of June 17, 1898. 
The Hospital Corps of the United States Navy came into existence as an 
organized unit of the Medical Department under the provisions of an act of 
Congress, approved June 17, 1898. 
This act established the grade of pharmacist, and the ratings of hospital 
steward, hospital apprentice, first class, and hospital apprentice; provided for 
appointments to the grade of pharmacist, and the enlisted ratings; fixed the 
pay and allowances; and specified the duties to be performed. 
An act of Congress, approved August 22, 1912, provided that pharmacists 
after 6 years from date of warrant and after satisfactorily passing the pre- 
scribed examination should be commissioned chief pharmacists, and when so 
commissioned, have the rank, pay, and allowances of a chief boatswain. 
The present organization of the Hospital Corps is in accordance with an 
act of Congress, approved August 29, 1916, and it is considered of sufficient 
importance, as a matter of general information to all hospital corpsmen, to 
quote the text of this act relating to the Hospital Corps in full. 
“Hereafter the authorized strength of the Hospital Corps of the Navy shall equal 
three and one-half percentum of the authorized enlisted strength of the Navy 
and Marine Corps, and shall be in addition thereto, and as soon as the neces- 
sary transfers or appointments may be effected the Hospital Corps of the United HISTORY OF THE HOSPITAL CORPS 
3 
States Navy shall consist of the following grades and ratings: Chief pharmacists, 
pharmacists, and enlisted men classified as chief pharmacist’s mates; pharmacist’s 
mates, first class; pharmacist’s mates, second class; pharmacist’s mates, third 
class; hospital apprentices, first class; and hospital apprentices, second class; 
such classifications in enlisted ratings to correspond respectively to the en- 
listed ratings, seaman branch, of chief petty officers; petty officers, first class; 
petty officers, second class; petty officers, third class; seaman, first class; and 
seaman, second class: Provided, That enlisted men of other ratings in the Navy 
and in the Marine Corps shall be eligible for transfer to the Hospital Corps, 
and men of that corps to other ratings in the Navy and the Marine Corps. 
“The President may hereafter, from time to time, appoint as many phar- 
macists as may be deemed necessary, from the rating of chief pharmacist’s 
mate, subject to such moral, physical, and professional examinations and re- 
quirements as to length of service as the Secretary of the Navy may prescribe; 
Provided, That the pharmacists now in the Hospital Corps of the United States 
Navy or hereafter appointed therein in accordance with the provisions of this 
act shall have the same rank, pay, and allowances as are now or may hereafter 
be allowed other warrant officers. 
“Pharmacists shall, after 6 years from the date of warrant, be commissioned 
chief pharmacists after passing satisfactorily such examinations as the Secre- 
tary of the Navy may prescribe, and shall, when so commissioned, have the 
same rank, pay, and allowances as now or may hereafter be allowed other 
commissioned warrant officers: Provided, That the pharmacists at present in 
the service who have served or may hereafter serve 6 or more years in that 
grade shall be eligible for promotion to the grade of chief pharmacist upon 
satisfactorily passing the examinations provided for in this act. 
“The Secretary of the Navy is hereby empowered to limit and fix the numbers 
in the various ratings. 
“Section three of an act entitled ‘An act to organize a Hospital Corps of the 
Navy of the United States; to define its duties and regulate its pay,’ approved 
June seventeenth, eighteen hundred and ninety-eight, be, and the same is hereby, 
repealed, and the pay, allowances, and emoluments of the enlisted men of the 
Hospital Corps shall be the same as are now, or may hereafter be, allowed 
for respective corresponding ratings, except the rating of turret captain of the 
first class in the seaman branch of the Navy: Provided, That the pay of the 
rating of the chief pharmacist’s mate shall be the same as that now allowed 
for the existing rating of hospital steward. 
“Hospital and ambulance service with such commands and at such places 
as may be prescribed by the Secretary of the Navy, shall be performed by 
members of said corps, and the corps shall be a constituent part of the Medical 
Department of the Navy; and the enlisted men thereof shall be a part of the 
enlisted force provided by law for the Navy. 
“Officers and enlisted men of the Medical Department of the Navy, serving 
with a body of marines detached for service with the Army in accordance with 
the provisions of section sixteen hundred and twenty-one of the Revised Statutes, 
shall, while so serving, be subject to the rules and articles of war prescribed 
for the government of the Army in the same manner as the officers and men 
of the Marine Corps while so serving.” CHAPTER II 
ANATOMY AND PHYSIOLOGY 
General introduction. 
If the hospital corpsman is to intelligently perform his duties in caring for 
the sick and injured he must not only have a good, general knowledge of the 
structure of the human body but he must also know considerable about the 
complicated mechanism that constitutes human life. In this chapter human 
anatomy and some simple physiology will be presented in as brief a way as is 
consistent with providing the elementary information which the hospital 
corpsman needs in his work and a ready source to which he can turn for 
study and review. Between the structure and function of the various parts 
of the body there exists an intimate relationship that cannot possibly be 
covered in an abridged chapter such as this must necessarily be. For the 
hospital corpsman in whom there is aroused a real interest in the anatomy 
and physiology of the human body fuller text-books must be consulted and 
studied. In this chapter anatomy will be discussed more completely than 
physiology, the discussion of which will principally concern the essentials of 
function. 
All objects existing in Nature are commonly classified into three grand 
divisions or groups called the animal, vegetable, and mineral kingdoms. Ob- 
jects in the mineral kingdom are without life, are known as inorganic, and are 
made up of inorganic matter. Objects belonging to the animal and the vegeta- 
ble kingdoms are known as organic, are made up of organic matter, and possess 
life, that quality or character which distinguishes an animal or a plant from 
inorganic or from dead organic bodies. By organic matter is implied the 
organization or arrangement of materials in the way that can be accomplished 
only through the processes of life. 
Any living thing, whether animal or vegetable, is spoken of as an organism. 
Animal organisms are distinguished from vegetable organisms by fundamental 
differences in their processes of life. Stated in a very general way, vegetable 
life builds up substances in the organism from water vapors and carbon diox- 
ide in the air and from solutions of mineral salts in the soil, while animal life 
absorbs complex substances such as proteins and carbohydrates and brings 
about their oxidation in the organism with absorbed oxygen. Animal organ- 
isms possess the attributes of sensation and voluntary motion, while vegetable 
organisms, though exhibiting irritability in response to stimuli, are generally 
without voluntary motion or true sense perception; animal organisms receive 
and digest solid food in an internal cavity previous to its absorption and use, 
while vegetable organisms make their own food from simple raw materials 
and utilize it directly within the tissues of the organism; at least part of the 
food required by animal organisms must be protein matter derived from the 
bodies of other animal organisms or from vegetable organisms; the life proc- 
esses of an animal organism must be such that oxygen is absorbed and carbon 
dioxide produced during its life. 
The building up of substances in the vegetable organism, or plant, from 
simple raw materials, is a process dependent on the presence of a green-colored 
pigment called chlorophyll in the plant and on the radiant energy of the sun. 6 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
In a chemical sense this process, which is known as photosynthesis, is one of 
reduction. At the same time synthesis, or reconstruction, takes place, and 
two of the products of the process are proteins and carbohydrates, both of 
which are required in the life processes of animal organisms. 
The oxidation of substances in the animal organisms, or animal, is, chemi- 
cally, a decomposition process, and two of the products are carbon dioxide and 
water vapor, both of which are required in the life processes of plants. For 
this process the presence of absorbed oxygen in the animal is necessary. 
The animal uses portions of plants, either dead or alive, to obtain proteins 
and carbohydrates. These it decomposes and returns to the air and soil as 
animal waste products in the form of carbon dioxide and water. The plant, 
through its green coloring matter and the light rays of the sun, recovers the 
carbon dioxide and water, synthesizes them into proteins and carbohydrates, 
and at the same time returns oxygen to the air. It is therefore quite evident 
that the life processes of plants and animals are closely related and necessary 
to each other. 
The life processes of animals and plants are largely chemical in nature and 
are proceeding continually in living cells. They are concerned in the building 
up and destruction of protoplasm, the essential substance of living cells, inci- 
dental to the manifestation of vital phenomena, and when considered collec- 
tively are spoken of as metaholism. 
The living organisms called animals are classified according to their natural 
relationships, the organization of their bodies, and their characteristics or 
attributes. In this classification the division of vertebrates (those with a 
backbone) stands first, and the highest class of vertebrate animals is that 
known as the mammalia (those which nourish their young with milk). 
One of the members of the class of mammalia is man, considered to be the 
highest type of animal existing or known to have existed. Of all animals 
man is the only one possessing the power of articulate speech and it is largely 
because of this power that man has the capacity of abstract reasoning, the 
extraordinary mental development that is the most characteristic difference be- 
tween man and other animals. Man is commonly spoken of as a human, or a 
human being, and it is the structure and life processes of the human being 
that will be dealt with in this chapter. 
The human body is composed of a combination of several systems of organs 
contained within a supporting framework and the whole surrounded with an 
external covering. The systems of organs fulfill special functions and are di- 
vided into their component tissues which are collections of the fundamental life 
unit, the animal cell. The study of the human body is divided into a number of 
closely related sciences which are named according to the structures or parts of 
the body with which they deal. 
Broadly speaking, anatomy is the science which treats of the structure of 
animals or plants. General anatomy deals with the tissues and their properties 
regardless of the organs into which they are formed. Because the characters 
of these tissues are to be made out only with the aid of the microscope, general 
anatomy is practically synonymous with histology. Gross anatomy deals only 
with the structures and characters discernible with the naked eye. 
Human anatomy is the study of the structure of the body of man and the 
relation of its parts, one to another. It is divided into descriptive anatomy, 
which deals with the character, form, size, and position of organs and parts, 
surgical anatomy, which treats of the situation and relative position of organs 
and parts as affecting their liability to injury and their accessibility to surgi- 
cal operations, and topographical anatomy, which treats of the anatomy of par- ANATOMY AND PHYSIOLOGY 
7 
ticuiar regions or parts of the body with reference to medical diagnosis and to 
surgery. It may be divided also into osteology, arthrology, myology, neurology, 
angiology, and splanchnology, or the anatomy of the systems of the body. 
Physiology is the study of the functions and activities of the various parts 
and organs of living bodies, and is sometimes described as “the physics and 
chemistry of living matter.” It is that branch of the science of biology which 
deals with the processes, activities, and phenomena incidental to and character- 
istic of life or of living organisms. These processes and phenomena include 
many that are chemical, physical, and mechanical, as well as others apparently 
of a peculiar nature, but those which are purely mental are not usually included 
in the ordinary scope of physiology, being considered under psychology, the 
science of mind. 
Embryology is the study of the origin and development of the body and its 
organs. 
Histology is the study of the minute structure of the normal tissues of the 
body. It is sometimes called microscopical anatomy and is a synonym for 
general anatomy. 
Pathology is the study of the changes in structure and function of the various 
parts and organs of the living body that occur in disease. 
Biology is the general study of all forms of life. In its broadest sense it in- 
cludes botany, the science of vegetable life, zoology, the science of animal life, 
cytology, the science of cell-formation and cell-life, anatomy, physiology, and 
allied sciences. It involves the study of the origin, development, structure, 
functions, and distribution of plants and animals, and the more generally 
occurring phenomena accompanying their life, growth, and reproduction. As 
man is but a complex animal organism it becomes apparent that in studying 
human anatomy and physiology one is but studying branches of general biology, 
and a real understanding of human anatomy and physiology must be prefaced 
by some knowledge of elementary biological principles. Certain of those prin- 
ciples have been very briefly discussed in the paragraphs pertaining to living 
organisms and their life processes, and the fundamental unit of life, the cell, 
will next be considered. 
The cell is the structural unit of which animals and plants are built up. 
Usually microscopic in size, it consists of a small mass of protoplasm called the 
cell body, or cytoplasm, in which is a smaller body of modified protoplasm 
called the nucleus, and is enclosed in a more or less resistant outer covering, 
the cell wall. The cell wall in animal cells, when present, is usually of soft, 
nitrogenous material, while in plant cells it is composed almost wholly of cel- 
lulose. The hard parts of animal tissues are materials secreted by the cells 
and are not a part of the cells. 
Protoplasm is the viscid, jelly-like material which constitutes the essential 
substance of living cells and upon which all the vital functions of nutrition, 
secretion, growth, reproduction, irritability, and motility depend. It is regarded 
as the only form of matter in which, or by which, the phenomena of life are 
manifested, and is hence often called the physical basis of life. 
The simplest forms of both animal and vegetable life are made up of only 
one cell. Yeast and bacteria are unicellular vegetable organisms; the amoeba 
is a unicellular animal organism. In an organism composed of only one cell 
that cell must necessarily have the full variety of characteristics that will 
enable it to carry out all the processes of life of the organism. Such a cell is 
called a simple cell, an unspecialized or undifferentiated cell. An organism so 
constituted reproduces by a simple and equal division of its cell into two cells, 
each of which grows and is capable of again dividing. 8 
HANDBOOK OF THE HOSPITAL COUPS, U. S. NAYY 
Cells vary in the shape, size and structure of the protoplasm, in the shape, 
size and location, and sometimes in the number, of the nucleus within the 
cell, and in staining qualities. 
In more complex forms of life the single organism is made up of many cells 
with varying characteristics. Certain groups of cells are specialized to per- 
form special functions, one group specialized in performing one function, other 
groups differentiated to perform other special functions, with consequent varia- 
tions in structure and composition. In a given organism masses or groups of 
specialized cells similar in structure and function are called tissues. A 
delimited mass of highly specialized tissue is termed an organ. 
The human body is made up of animal cells, all of which, with the exception 
of the red blood cells, consist of the cytoplasm, nucleus, and usually the cell 
wall. The nucleus is highly specialized in structure and function, is enclosed 
in a delicate membrane, and inside of it is a network of material called 
chromatin. In the cytoplasm and near the nucleus is a minute structure called 
the centrosome which is concerned with the changes which take place when 
the cell reproduces (fig. 1). 
Figure 1.—Simple animal cell. (U. S. Naval Medical School.) 
The cell wall, or plasma membrane, when present as a distinct layer, is a 
very thin, condensed film surrounding the cytoplasm, from which it differs in 
some way. Frequently it can be recognized only because certain substances can 
and others cannot penetrate it. 
Animal cells all are able to grow and mature, they can be stimulated into 
activity, which property is known as irritability or excitability, and they can 
reproduce. 
It is known that protoplasm consists chiefly of proteins, salts, and water, 
and for the growth of cells these substances must be supplied in a form 
that can be absorbed and used. A fluid called tissue fluid, which is derived 
mainly from the blood and contains the food substances required, bathes the 
cells and is their source of nutrition. If for any reason they are deprived 
of tissue fluid cells cease to grow and die. After reaching maturity cells 
may remain indefinitely in that state or may reproduce. 
Cell irritability may be caused by mechanical, chemical, and nervous forms 
of stimulation, the action of heat and light, etc. Singly, the cause is called 
a stimulus, collectively, they are called stimuli. The result of cell stimulation 
may be noted as a movement or alteration of the shape of the cell, as in ANATOMY AND PHYSIOLOGY 
9 
muscular movements, by the liberation of substances secreted by the cell, 
as in the flow of digestive juices, and in other ways. The stimuli exciting 
the cell into activity usually are the impulses carried by nerves to the cell, 
or the action of chemical substances which reach the cell from the blood 
through the tissue fluid. 
The reproduction of cells in the human body occurs during the period 
when the organ or tissue of which the cell is a part is growing and lasts 
until the maximum growth of the whole body has been reached. After that 
cells may reproduce to replace those destroyed by injury or disease or that have 
become worn out. Cell reproduction takes place by the parent cell dividing 
equally into two daughter cells. Each daughter cell contains half the substances 
in the parent cell and exhibits all the properties of the parent cell. It is 
thought that new cells inherit the characteristics of the parent cell through 
the chromatin in the nucleus. 
When a cell reproduces by division the process begins by the chromatin 
in the nucleus elongating into structures called chromosomes and the centrosome 
near the nucleus developing two star-shaped structures called asters, each of 
which has a central mass that becomes the centrosome in the new cell, and 
radiating fibers called aster rays. The fibers between the two central masses 
of the asters begin to form a structure shaped like and called a spindle, the 
membrane enclosing the nucleus bursts and the chromosomes become attached 
to the fibers of the spindle. By the time development of the spindle is 
completed the chromosomes have been drawn into the equator of the spindle 
and begun to split into equal halves. The halves then separate and the 
spindle begins to divide at its equator, the chromosomes group themselves 
at the spindle poles, the aster rays disappear, and the cell body begins to 
divide. When division of the cell body is finished two new cells have been 
formed and the process of reproduction is complete (fig. 2). 
Cell reproduction by this form of division in which there are extensive 
preliminary changes in the nucleus is known as mitosis or mitotic division. 
Bacteria reproduce by a simpler form of division called amitosis or amitotic 
division, which is also called fission. 
In man the parent cell is known as the ovum, or egg. After leaving the ovary 
of the mother the ovum unites with the male germ cell or spermatozoon, and 
the union is called the fertilization of the ovum. Immediately after this union 
cell reproduction begins. The fertilized ovum divides into 2 daughter cells, 
which then divide to make 4, the 4 to make 8, £he 8 to make 16, etc. As this 
division or segmentation goes on, there occurs a gradual differentiation in the cells 
produced, so that there are cells of several different types, each capable of re- 
producing others of its kind. Through this process of fertilization, segmenta- 
tion, differentiation, and growth there is finally, brought about the complex 
animal organism known as man. 
In a preceding paragraph it was stated that when the life processes of 
animals and plants are considered collectively they are spoken of as metab- 
olism. In these life processes the cells are involved. During periods of cell 
activity certain parts of the cellular substance become broken down, or 
destroyed or decomposed. This is sometimes spoken of as destructive 
metabolism but is usually called katabolism. To replace the loss or repair the 
breakdown of cellular substance the cell takes up nutrient material in a 
process called assimilation and uses it to build up new protoplasm by the 
process known as anabolism. 
Tissues, as stated before, are masses or groups of specialized cells similar in 
structure and function. Tissues have their own characteristic intercellular 10 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Hft00tN-S9 
Figure 2.—Cell reproduction by mitotic division. 1, Normal cell before commencement of 
process of reproduction showing network of chromatin in nucleus, and adjacent centro- 
some; 2, Chromatin elongated into chromosomes and centrosome developing asters and 
aster rays; 3, Nuclear membrane broken, spindle developing, and chromosomes attached 
to spindle fibers; 4, Spindle fully developed, with chromosomes in equator; 5, Chromo- 
somes splitting into halves; 6, Chromosomes separated and spindle beginning to divide 
at equator; 7, Chromosomes grouped at spindle poles, aster rays disappearing and cell 
body beginning to divide; 8, Cell body divided and reproduction process complete with 
two daughter cells formed. (U. S. Naval Medical School.) ANATOMY AND PHYSIOLOGY 
11 
substance which joins the cells in it together. Although a tissue may be modi- 
fied by situation it can always be identified when studied microscopically. The 
tissues in the adult human body are usually classified into five main groups: 
1. Epithelial tissue; 2. Connective tissue; 3. Muscular tissue; 4. Blood and 
lymph; and 5. Nervous tissue. Each tissue is characterized by certain 
peculiarities of structure and function. 
The free surface of the skin, the linings of the digestive, respiratory, and 
urinary tracts, the linings of blood and lymph vessels and serous cavities, and 
certain important secreting glands as the liver, kidneys, etc., are made up of 
epithelial tissue, or epithelium (fig. 3). Having such different services to per- 
form the cells in epithelial 
tissue are generally di- 
vided according to ar- 
rangement and shape into 
five principal classes as 
cuboidal, columnar, flat, 
squamous, and ciliated. 
and according to function 
into glandular or secret- 
ing, and protective. The 
epithelium forming the 
various linings spoken of 
is commonly known as 
endothelium. When the 
cells are arranged in 
single layers epithelial 
tissue is called simple and 
when they are arranged in 
distinct layers one above 
another it is called strati- 
fied. Unlike other tissues 
the cells in epithelial 
tissue are joined together 
by thickened lymph in- 
stead of intercellular sub- 
stance. 
The epithelial cells 
known as ciliated have 
hair-like appendanges on their free edges whose function is to propel fluid or 
particles. These ciliated cells also are generally columnar. Other epithelial 
cells can produce the viscid substance called mucus and the tissues where these 
cells are located are known as mucous membranes. 
Connective tissue is the supporting tissue of the body and has a general dis- 
tribution (fig. 4). In this tissue the cells are scanty and the intercellular 
substance is considerable. The principal forms of connective tissue are: 1. 
Adipose, or fat, in which fat-cells are lodged in meshes of areolar tissue and 
fat replaces most of the cytoplasm; 2. Areolar, found beneath the skin and 
between muscle fibers and also called loose fibrous, in which the cells are 
enmeshed in a loose network of delicate, elastic fibers interlacing in every 
direction; 3. Cartilaginous, often called gristle, in which the cells lie in cavi- 
ties of an intercellular substance called the matrix which may be finely 
granular and translucent, be mixed with white fibrous tissue, or contain a 
network of yellow elastic fibers; 4. Elastic, found in the trachea and bronchi. 
Figure 3.—Epithelial tissue. a, Cuboidal; h, ciliated 
columnar; c, flat; d, stratified squamous. (U. S. Naval 
Medical School.) 
154294°—39 2 12 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
the inner coats of blood vessels, and elsewhere in the body, in which the inter- 
cellular substance consists of yellow, elastic fibers branching and uniting with 
one another; 5. Fibrous, found in tendons and ligaments and also called dense 
fibrous, in which the intercellular substance consists of bundles of closely 
Hftooetf-s<3 
Figure 4.—Connective tissue, a, Adipose ; l>, areolar; c, cartilaginous ; d, elastic; e, fibrous. 
(U. S. Naval Medical School.) 
packed parallel white fibers bound firmly together and with some areolar 
tissue between the bundles; 6. Lymphoid, found in the tonsils, spleen, and 
lymphatic glands and also called reticular, in which the intercellular substance 
is largely fluid and consists of a loose network of white fibers containing 
lymphoid cells; and 7. Osseous, in which the intercellular substance is in ANATOMY AND PHYSIOLOGY 
13 
layers and may be regarded as white fibrous tissue in which calcium and other- 
mineral salts have been deposited and made it very hard. 
Muscular tissue is the tissue of which muscles are formed (fig. 5). It is 
composed of cells which have been modified and elongated to form thread-like 
muscle fibers held together by delicate connective tissue. Muscle fibers have a 
reddish color, are lightly covered by elastic, connective-tissue sheaths, are bound 
together in bundles or fasciculi by delicate connective-tissue envelopes, and 
those bundles grouped together into larger bundles or sheets to form, various 
muscles. Muscular tissue has the following properties: Irritability, or response 
to stimulations usually received from nerves; contractility, the power to become 
shorter and thicker; tonicity, a mild, sustained contraction giving the skeletal 
muscles firmness and maintaining a slight steady pull on their attachments; 
and extensibility, ability to be stretched. Muscular tissue is of three distinct 
types and the characteristics of each are imparted to the muscles they form. 
The muscles of the skeleton are known as striated, striped, or voluntary, and 
Figure 5.—Muscular tissue, a, Striated; 6, nonstriated; c, cardiac. (U. S. Naval Medical 
School.) 
the individual cells of this type are elongated, multinuclear, contain transverse 
striations peculiar to them, and can be controlled by the will; the muscles of 
hollow internal organs, blood vessels, etc., are known as nonstriated, unstriped, 
or involuntary, and the individual cells are plain, flattened, without striations, 
and cannot be controlled by the will; the muscle of the heart is known as 
cardiac, striated or striped but involuntary, and has short, mononucleated cells 
which branch and unite with adjacent cells, and have striations which are 
different from those in the skeletal muscles. 
Blood and lymph may be considered as tissues consisting of free cells in a 
fluid intercellular substance which does not join the cells together. 
Nervous tissue, composed of nerve cells, nerve fibers, and an intercellular 
supporting tissue, is the most highly specialized tissue in the body and will 
be discussed more fully in the section dealing with the nervous system. 
Having discussed the masses or groups of cells called tissues the delimited, 
or bounded, masses of tissues termed organs will next be briefly considered. 
An organ is that part or structure in an animal organism which is adapted 
for the performance of some specific function, or functions, as the heart, the 
kidneys, etc. In most multicellular organisms, as in man, the essential and 
active part of an organ is made up of the particular form of specialized tissue 
on which the function of the organ depends, while other tissues serve for the 
support, nutrition, control, etc., of the organ. 
Groups of organs which act together and collectively have a common function 
in contributing toward one of the more important and complex vital functions 
are known as systems, as the digestive system, the nervous system, etc. 14 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
In order to understand anatomical descriptions the meaning of the following 
words should be known: Anterior, in front; posterior, to the back; superior, 
higher; inferior, lower; internal, within, inside; external, outside; lateral, at 
the side; medial, median, in the middle; ventral, the abdominal side; dorsal, 
on the back; proximal, nearest to a point; distal, farthest from a point. 
THE BONES AND JOINTS 
Osteology is the study of the structure of bones. It also includes the study 
of the cartilages and ligaments which bind bones together. 
Arthrology or syndes- 
mology is the study of 
the joints or articula- 
tions. It takes into con- 
sideration the parts 
forming the joints and 
the mechanism of each 
joint. 
The skeleton is the 
bony framework of the 
body (fig. 6). Its func- 
tion is to support and 
give shape to the body, 
to protect certain vital 
organs, to afford attach- 
ments for tendons, mus- 
cles, and ligaments, and 
to act as joined levers by 
which movements may 
be accomplished. 
Bone, or osseous tis- 
sue, has been stated to 
be one of the connective 
tissues in which there 
are deposits of calcium 
and other mineral salts. 
These salts normally 
constitute about 67 per 
cent of the weight of 
bone but their amount 
increases as the body 
ages with the result that 
bones become harder and 
more brittle. By dissolv- 
ing out the mineral salts 
or inorganic matter in 
bone by means of dilute 
mineral acid an organic 
substance called ossein 
remains, and this substance, which is perfectly flexible, can be bent and twisted 
without difficulty. 
Bones consist of a hard, outer shell called the compact tissue, and an inner, 
spongy, and porous part called cancellous tissue. In long bones a cavity called 
the medullary canal extends the whole length of the shaft. This cavity and 
1. Cranium'. 
2. Vertebral 
column. 
3. Clavicle. 
6. Scapula. 
4. Ribs. 
5. Sternum. 
7. Humerus. 
8. Radius. 
9. Ulna. 
10. Carpus. 
11. Metacarpus. 
12. Phalanges. 
14. Femur. 
15. Patella. 
16. Tibia. 
17. Fibula. 
18. Tarsus. 
13. Pelvis. 
19. Metatarsus. 
20. Phalanges. 
Figuee 6.—The skeleton. (Manual of Instruction, Royal 
Naval Sick Berth Staff.) 
ttMJM ANATOMY AND PHYSIOLOGY 
15 
the spaces in the cancellous tissue are filled with a substance called marrow 
which is of two types, yellow and red. Yellow marrow is composed chiefly 
of fat; red marrow contains little fat but is abundantly supplied with blood 
and in it are also found reddish-colored, nucleated cells called erythroblasts 
from which red blood cells are formed. The ends and facets of bones are 
covered with a special variety of cartilage which is called articular cartilage 
and forms the articulating surfaces and enters into the formation of joints. 
Those parts of bones not covered by articular cartilage are covered with a 
thin, vascular membrane of fibrous tissue called periosteum which, when it 
reaches the articular cartilage, continues as the perichondrium, a fibrous 
connective tissue covering the surface of the cartilage. Periosteum has the 
power of generating new bone and does so in the normal growth of bone or 
when the original bone has been destroyed. Bones are nourished from capil- 
laries in the periosteum which dip down into small pits on the bone surface 
and from small arteries, one or more to each bone, which enter through small 
openings called nutrient foramince and branch out into the marrow and bone 
tissue, passing through the compact tissue in 
small passages called canals, those located in 
the center of concentric rings of compact tissue 
being known as Haversian canals (fig. 7). 
Bones are classified by shape as: Long, 
which have two extremities and a shaft of 
compact tissue, thickest in the middle where 
the bone is the most slender and the strain 
the greatest, and containing the central medul- 
lary canal, as the femur, the humerus, etc.; 
short, which are small, irregularly shaped, and 
made of cancellous tissue throughout except 
for a thin layer of compact tissue covering 
the surface, as the bones of the wrist and the 
ankles; flat, which have broad or elongated 
flat plates of compact tissue enclosing a vari- 
able amount of cancellous tissue and afford extensive protection and broad sur- 
faces for the attachment of muscles, as some of the bones of the skull, the ster- 
num, the shoulder blades, and the pelvic bones; and irregular, which cannot be 
placed in any of the other classes because of their peculiar shape and consist 
largely of cancellous tissue with a thin layer of compact tissue covering the sur- 
face, as the vertebrae, the mandible, the hyoid. 
Two hundred and six distinct bones make up the skeleton of the adult. In 
the child there are more, some of which fuse together during growth. In the 
table following no sesamoid bones (small bones developed in tendons at points 
of much pressure) except the patellae are included. 
Figure 7.—Transverse section of 
compact tissue of bone, showing 
concentric rings and Haversian 
canals. Magnified about 150 
diameters. (Sbarpey.) 
The Bones of the Skeleton 
Bones of the skull 22 
Bones of the ears (auditory ossicles) 6 
Hyoid bone 1 
Bones of the vertebral column 26 
The sternum 1 
The ribs 24 
Bones of the upper extremities 64 
Bones of the lower extremities (including the patellae) 62 
Total 206 16 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The meaning of the following words used in describing bones should be 
known: Process, a prominence; tuberosity, a large process; tubercle, a small 
process; spine, a sharp, slender process; condyle, a rounded, knuckle-like 
process; crest, a narrow ridge; bead, a portion of bone supported on a con- 
stricted part or neck; fossa, a depression or pit, a cavity; notch, a deep inden- 
tation ; groove, a furrow or channel; sinus, a cavity within a bone; antrum, 
a hollow space in a bone; foramen, a perforation or opening; fissure, a groove. 
The bones. 
The skull is the bony framework of the head, is elliptical in- shape, and 
Is commonly divided into two parts, the cranium and the face (tig. 8). The 
cranium is made up of various flat bones which are united in irregular lines 
called sutures, and form the cranial cavity which is more or less oval in 
shape and in life holds the brain. The upper wall of this cavity is called 
the vault of the skull; the floor is 
called the base of the skull and 
has three distinct fossa; or hol- 
lows, the anterior cranial fossa, 
the posterior cranial fossa, and 
the middle cranial fossa. In the 
base of the skull are many small 
foramina; for the passage of nerves 
and blood vessels to and from the 
brain. Just posterior to its mid- 
dle the base has a large round 
opening, the foramen magnum, 
through which the spinal cord, its 
coverings, certain cranial nerves, 
and the vertebral arteries emerge. 
In front and below the cranium 
are the bones of the face which 
form two orbital cavities, one on 
each side of the root of the nose, 
for the eyes, the nasal cavity for 
the passages of the nose, and the 
oral cavity for the mouth. 
When the skull is viewed from 
the side there is seen, just behind the orbital cavity of the eye, a broad depression, 
the temporal fossa, the whole area of which in life affords attachment for the 
temporal muscle, which closes the jaw. The temporal fossa is limited below by 
a bony arch, the zygomatic arch, or zygoma. Just below and posterior to the 
zygomatic arch is an opening leading into the bone, the external auditory canal, 
below and behind which is a bony prominence called the mastoid process. This 
contains the mastoid air cells, the seat of the inflammation in mastoid disease. 
Viewing the skull from below, the foramen magnum is seen just posterior 
to the middle with an articular surface on either side for articulation with 
the atlas, the first cervical vertebra. Anteriorly on either side are the zygo- 
matic arches, and directly in front, bordered on three sides by the teeth of 
the upper jaw, is the roof of the oral cavity, the hard palate. Just above the 
hard palate and opening backward are the posterior nasal apertures. 
Figure 8.-—Skull: a, Nasal bones; b, superior 
maxilla; c, mandible; d, occipital bone; e, 
temporal bone; f, parietal bone; g, frontal 
bone. (Mason.) ANATOMY AND PHYSIOLOGY 
17 
The Bones of the Cranium 
Occipital 1 
Frontal 1 
Parietal 2 
Temporal 2 
Sphenoid 1 
Ethmoid 1 
Bones of the ear 3X2=6 
Total 14 
The occipital bone forms the posterior part of the vault and the posterior 
fossa of the base. It contains the foramen magnum. 
The frontal bone is the bone of the forehead and forms the whole anterior 
part of the vault. At its lower anterior border it extends abruptly backward 
on either side to form the roof of the orbital cavity and at the same time 
the very front part of the floor of the cranial cavity. Just internal to the 
upper orbital margin on either side it contains large air cells, the frontal 
sinuses, which have openings leading into the nasal cavity. 
The parietal bones articulate with each other in the mid-line, with the 
occipital behind and the frontal in front, thus completing the upper part of 
the vault. 
The temporal bones are located one on each side of the base. Each has a 
squamous (flat, scale-like) portion extending upward to form a part of the side 
of the vault and at the same time a part of the floor of the temporal fossa. 
A process extends forward to form the zygomatic arch, and posteriorly, extend- 
ing downward, is the heavy mastoid process. Extending inward and forming 
a large part of the floor of the middle fossa of the base is the petrous (stony 
hard) portion of the bone. This portion contains the organ of hearing and 
the external auditory canal leading into the ear. 
Each middle ear contains three small bones named from their shape, 
malleus (hammer), incus (anvil), and stapes (stirrup). 
The sphenoid lies in the base of the skull, between the frontal bone in 
front, the occipital bone behind, and the temporal bone at either side and behind. 
The ethmoid lies anterior to the sphenoid. One part of the bone forms a 
small portion of the floor of the anterior fossa, lying in the mid-line between 
the orbital parts of the frontal bone. From this part three processes extend 
downward—a perpendicular plate in the mid-line to form the upper part of the 
nasal septum, and a process on each side to form the upper lateral wall of the 
nasal cavity. 
The Bones of the Face 
Maxillae 2 
Palate bones 2 
Vomer 1 
Inferior turbinated bones . 2 
Nasal bones 2 
Lacrimal bones T 2 
Malar or zygomatic bones 2 
Mandible 1 
Hyoid /— 1 
Total 15 18 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The two maxillae unite to form the upper jaw. In the body of each is a 
large air cell, the maxillary sinus or antrum of Highmore. The lower border 
of the bone is the alveolar process and in this the upper teeth are embedded. 
Running horizontally inward from just above the alveolar process is a thin 
plate of bone that unites with its fellow of the opposite side to form all but 
the very posterior part of the hard palate. Above the hard palate the medial 
aspect of the bone forms the lateral wall of the nasal cavity. 
Each palate bone is L-shaped, the horizontal part forming the posterior por- 
tion of the hard palate and the vertical part forming the lower posterior portion 
of the lateral wall of the nasal cavity. 
The vomer is a thin flat bone that forms the lower posterior part of the nasal 
septum. 
The inferior turbinated bones are two small shell-like bones, lying along 
each lower lateral wall of the nasal cavity, forming a sort of curved shelf. 
The nasal bones are two small flat pieces of bone, one 
on each side of the root of the nose, that join in the mid- 
line to form the bridge of the nose. 
The lacrimal bones are two small bones that form a 
part of the wall of the orbital cavity at its inner and lower 
angle, one on each side. 
The malar bones are the cheek bones and underlie the 
most prominent part of the cheek. 
The mandible is the horseshoe shaped bone of the lower 
jaw. The horizontal part of the bone is called the body, 
and the upper part of the body, which supports the teeth, 
is called the alveolar process. The vertical part of the 
bone on each side is called the ramus. The juncture of 
the ramus and the body is called the angle of the jaw. 
Each ramus is topped by two processes—the condyloid 
process behind, for articulation with the temporal bone, 
and the coronoid process in front, for the insertion of the 
temporal muscle. 
The hyoid bone is a small U-shaped bone lying anteriorly 
in the neck and serving for the attachment of various 
muscles of the throat and tongue. 
The Bones of the Neck and Trunk 
Vertebrae (true) 24 
Sacrum 1 
Coccyx 1 
Sternum 1 
Ribs 24 
Total 51 
The spinal column consists of 24 movable or true verte- 
brae, the sacrum and the coccyx (fig. 9). Each of the 
latter two hones are made up of vertebral segments (false or fixed vertebrae) 
that are fused in adult life. 
The true vertebrae are irregular bones placed one on top of another with 
cartilage between, and named according to their location. There are 7 cervical, 
12 thoracic or dorsal and 5 lumbar vertebrae. 
Piguee 9.—Spinal col- 
umn : a, Cervical; 
h, dorsal; c, lumbar ; 
d, sacrum ; e, coccyx. 
(Mason.) ANATOMY AND PHYSIOLOGY 
19 
The form of the individual vertebrae, at different levels, varies somewhat, 
but a typical vertebra may be described as consisting of a body, cylindrical in 
form; a vertebral arch, enclosing the vertebral foramen; and three processes 
that act as levers for the attachment of muscles. These three processes spring 
from the vertebral arch—one on each side, the 
transverse process, and one posteriorly, the spinous 
process (fig. 10). The spinous process may be felt 
underneath the skin in the mid-line of the back. 
There are four articular processes that also spring 
from the arch. 
The sacrum is roughly triangular in shape and is 
formed by the fusion of five false vertebrae. It 
articulates on each side with a hip bone to form, 
with the coccyx, the posterior wall of the pelvis. 
The coccyx is the lower extremity of the spinal 
column and consists of four, sometimes five, verte- 
bral segments fused together. It corresponds to the 
tail of lower animals. 
The thorax is a conical elongated bony cage formed by the sternum and 
costal cartilages in front, the 12 ribs on each side, and the bodies of the 12 
thoracic vertebrae behind. It contains and 
protects the principal organs of circulation 
and respiration (fig. 11). 
The sternum occupies the middle of the 
upper part of the chest wall in front. It is 
divided into an upper part, the manubrium, 
a small lower part, the xiphoid process, 
and between these a body. It articulates 
above with the clavicles and on each side 
with the cartilages of the first seven ribs. 
The ribs, of which there are 12 pairs, 
form a series of curved bony bands that 
support the chest wall. Behind, they artic- 
ulate wfith the thoracic vertebrae. In front, 
each rib is provided with a costal cartilage. 
The first seven ribs articulate with the 
sternum by means of their cartilages and 
are called true ribs. The lower 5 ribs are 
not supported and are called false ribs. 
The eighth, ninth, and tenth are united by 
their cartilages to the cartilages of the 
seventh, while the last 2 are free at their 
anterior ends and are called floating ribs. 
The Bones of an Upper Extremity 
Clavicle 1 
Scapula.. 1 
Humerus 1 
Ulna 1 
Radius . 1 
Carpal bones 8 
Metacarpal bones 5 
Phalanges 14 
Total 32X2=64 
Figure 10.—Seventh cervi- 
cal vertebra. (Gray.) 
Figure 11.—The thorax. Ventral 
view. (Gray.) 20 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The clavicle (collar bone) consists of a rounded curved shaft with enlarged 
ends. Medially it articulates with the sternum and laterally with the acromion 
process of the scapula (fig. 12). 
The scapula (shoulder blade) is a flat bone of roughly triangular shape. 
From its posterior surface there springs a shelf-like process, the spine. At the 
outer end of the spine is the acromion 
process, with an articular facet for the 
clavicle. At the extreme lateral root of 
the spine is a constriction of the upper 
lateral angle of the bone. This constric- 
tion is the neck, and beyond it is the 
head. The head supports the glenoid 
cavity, for articulation with the head of the humerus, and above this is a beak- 
like projection, the coracoid process (fig. 13). 
The| humerus is the bone of the arm (fig. 14). It articulates proximally 
with the glenoid cavity of the scapula and distally with the ulna and the 
radius. It is made up of a head, an anatomical neck, a surgical neck, a shaft, 
and a distal extremity. The distal extremity has on each side a prominence, 
the medial and the lateral epicondyles. Below these are two articular facets, 
one for the ulna and one for the radius. 
The ulna is placed on the medial side (little-finger side) of the forearm (fig. 
15). It is a long bone, much larger at its proximal end, where it has a promi- 
ment process, the olecranon. This forms the point of the elbow. The ulna 
articulates with the radius at both ends and with the humerus proximally. 
At its very distal extremity is a styloid process, which can be felt beneath 
the skin on the inside of the wrist. 
Figure 12.—The clavicle. (Mason.) 
Figure 13.—Posterior aspect 
of right scapula. (Potter.) 
Figure 14.—Humerus. 
(Potter.) 
Figure 15.—Radius 
and ulna. (Ma- 
son.) 
The radius is placed on the lateral side (thumb side) of the forearm (fig. 
15). It is a long bone, much larger below than above. It articulates above 
with the humerus and the ulna and below with the carpal bones and the ulna. 
On its lower end it has a styloid process that can be felt beneath the skin on 
the outside of the wrist, ANATOMY AND PHYSIOLOGY 
21 
The carpal bones are small six-sided bones arranged in the wrist or carpus in 
two rows. The distal row, or row nearest the finger tips, contains, beginning 
from the radial side of the wrist, the greater multangular, lesser multangular, 
capitate, and hamate bones. The proximal row, or row nearest the elbow, con- 
tains, beginning from the radial side of the wrist, the navicular, lunate, trian- 
gular, and pisiform bones. 
The metacarpal bones are located in the palm. The proximal end of each 
is called the base and it articulates with the carpus. The shaft extends 
through the palm, and the head, or distal end, articulates with the proximal 
phalanx of the corresponding digit. The metacarpals are numbered from 1 to 
5, beginning at the thumb side. 
There are three phalanges in each finger and two in the thumb. The phalanx 
at the end of the digit is called the distal phalanx, the one next to the hand 
the proximal phalanx, and the one between, the middle phalanx. 
The Bones of a Lower Extremity 
Innominate bone 1 
Femur 1 
Patella 1 
Tibia , 1 
Fibula 1 
Metatarsal bones 5 
Tarsal bones 7 
Phalanges 14 
Total 31X2=62 
The innominate bone (hip bone) is made up of three parts, the ilium, the 
ischium, and the pubis. In adult life these three parts are fused together. 
The pubis lies below and in front, joining with the pubic part of the opposite 
bone to form the symphysis pubis. The 
ischium lies below and to the back, while 
above and posteriorly is the large flat 
portion of the bone, the ilium. At its 
central part the 
bone is heavy and 
on its outer aspect 
there is a deep 
cavity, the acetab- 
ulum, for articula- 
lation with the 
head of the femur. 
Just below the ace- 
tabulum is a large opening, the obturator foramen. Poste- 
riorly the iliac portion of each bone articulates with the 
sacrum, and, with coccyx, forms the pelvis (fig. 16). 
The femur is the bone of the thigh and the longest bone 
of the body (fig. 17). It is composed of a proximal end, a 
distal end, and a shaft. The proximal end is made up of a 
head, a neck, and two processes called the greater and 
lesser trochanters. The head fits into the acetabulum to 
form the hip joint. The distal end is made up of two 
condyles which articulate with the tibia. 
The patella, a sesamoid bone, overlies the front of the knee joint and is in the 
tendon of the quadriceps muscle. 
Figure 16.—Pelvis (adult.) (Gray.) 
Figure 17.—Femur. 
(Mason.) 22 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The tibia, or shin bone, is the larger of the two bones of the leg and it lies 
to the inner side (fig. 18). The proximal end of the bone has the medial and 
lateral condyles for articulation with the femur. The lateral side of the outer 
condyle articulates with the fibula. The distal extremity is smaller than the 
proximal. Medially it presents a prominence, the internal 
malleolus, distally an articular surface for the talus, and 
laterally a smaller articular surface for the fibula. 
The fibula is the slender bone lying on the outer side of 
the leg (fig. 18). It has two enlarged ends. The upper 
end articulates with the tibia alone. The lower end articu- 
lates with the tibia and also with the talus. The outer 
prominent portion of the lower end of the bone is called 
the lateral malleolus. It can be felt beneath the skin. 
There are seven tarsal bones in each ankle, the talus, 
which articulates with the tibia and fibula to form the 
ankle joint, the calcaneus, the heel bone, the navicular, a 
boat-shaped bone; the first, second, and third cuneiform, 
and the cuboid bones. 
The metatarsal bones are similar to the metacarpal but 
are slightly longer and heavier. 
The phalanges of the toes are similar to those of the 
fingers but are shorter. 
The joints. 
Joints, or articulations, are the connections by which the various bones of 
the skeleton come together. There are two types of joints, the immovable, 
whose object is to preserve the rigidity of the bones joined together, and the 
movable, whose object is to permit movement of the bones joined together, and 
which may be either freely or partly movable. The best example of the immov- 
able joint is in the skull where the bones are “dovetailed” together; the hip and 
shoulder joints are examples of freely movable joints; and the articulations 
of the pubic bones in the pelvis and the lower ends of the tibia and fibula 
are examples of partly movable joints. 
The substances which enter into the formation of joints vary with the 
character of the joint. In every joint there are two or more skeletal elements 
(bone or cartilage) and a uniting substance or medium, the amount and kind 
of which depends on the type of the joint. The uniting substance in immov- 
able joints is a very thin layer of fibrous tissue which corresponds to and 
is continuous with the periosteum, or is of cartilage, while in movable joints 
it is fibrous and fibrocartilaginous material, and cartilage. 
Movable joints have a cavity separating the bones entering into them. 
Cartilage covers the articulating surfaces of the bones in movable joints and 
in some joints there are also discs of cartilage in the joint cavities. The 
bones entering into the joint are held together by strong bands of fibrous 
tissue called ligaments, which pass from one bone to the other on every side of 
the joint and form a capsule which is the external boundary of the joint 
cavity. This fibrous capsule is lined with synovial membrane which secretes 
a substance called synovial fluid that is retained in the cavity and serves to 
lubricate the joint (fig. 19). 
According to their type of movement, movable joints are known as gliding, 
as those between the articular processes of the vertebrae, hinge, as the elbow, 
knee, finger, and toe joints, ball and socket, in which the round head of one 
bone fits into a cup-like cavity in another as in the hip and shoulder joints, 
rotary, in which one bone rotates on one which is stationary, as the first and 
Figure 18.—Tibia and 
fibula. (Mason.) ANATOMY AND PHYSIOLOGY 
23 
HAOOE.N-39 
Figure 19.—Anterior, a, posterior, 6, and lateral, c, views of left knee joint ; d, schem'a of a movable joint showing; 1, capsular ligaments ; 2, articular 
cartilages continuous with periosteum ; 3, disc; and 4, spaces lined with synovial membrane and containing synovial fluid. 24 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
second vertebrae, and condyloid, in which an oval head fits into a shallow ellip- 
tical cavity, as in the joints between the fingers and the hand. 
Joints permit movements of the skeletal parts with each other. These move- 
ments are accomplished by means of the muscles and the kinds of movement 
are as follows: 
Flexion—Bending, as in raising the forearm on the arm. 
Extension—Straightening or unbending. 
Abduction—Moving away from the mid-line of the body. 
Adduction—Moving toward the mid-line of the body. 
Rotation—Turning on its own axis, as in turning the head. 
Peonation—Turning downward, as in turning the palm of the hand downward. 
Supination—Turning upward, as in turning the palm of the hand upward. 
Eversion—Turning outward. 
Inversion—Turning inward. 
Myology is the study of the structure and functions of muscles. 
Muscles are structures composed chiefly of muscular tissue and all motion 
of any sort in the body, whether conscious or unconscious, is due to the action 
of muscles. They constitute a large part of the fleshy portions of the body, 
enter into the structures of many of the internal organs, form from 40 to 50 
per cent of the body weight, and vary in shape according to the work they have 
to do. 
All the muscles attached to the bones of the skeleton are of the voluntary 
type and are termed skeletal muscles. Those used in breathing, while ordinarily 
acting without conscious effort of the will, may be controlled and breathing 
accelerated, slowed, or stopped, as desired. A typical skeletal muscle consists 
of a fleshy mass of parallel bundles of muscle fibers bound together by a sheath 
of fibrous tissue called the epimysium, each bundle or fasciculus of fibers be- 
ing surrounded by a delicate connective-tissue envelope called the perimysium, 
and each fiber being lightly covered by an elastic, connective-tissue sheath called 
the sarcolemma. At the ends of the muscle the epimysium and the perimysium 
unite with the tendons by which the muscle is attached to the bone. The 
attachment of a skeletal muscle which is fixed or stationary during use is known 
as the origin and the one which moves as the insertion. Many muscles have 
an insertion far from the fleshy belly. 
Tendons are made up of closely packed, parallel bundles of nonelastic, dense 
fibrous tissue, with a very small amount of areolar tissue separating the bundles. 
They unite with the periosteum of bones to form secure attachments of muscles 
and differ in shape in different muscles, some being round and thick while others 
are flat and thin. When tendons are of the latter shape they are called 
aponeuroses. Their lack of bulk makes their presence about joints desirable 
as joint movements are easier accomplished than if bulky muscles were present. 
Muscles seldom act alone and the performance of a very simple motion is 
usually due to the action of a whole group of muscles. Muscles and groups of 
muscles are named according to the type of motion they produce, as the 
extensor muscles of the hand, and the adductor muscles of the thigh, and for 
each group of muscles that produces one type of motion there is another group 
that produces the opposite type of motion. To keep muscles in position and 
place during movement they are held together by layers of areolar tissue called 
fascia}. 
The fasciae vary in density, structure, and thickness, in some places forming 
considerable masses, and are of two types called superficial and deep. The 
superficial type lies immediately beneath the skin and usually contains consider- 
able fat. Blood and lymph vessels and nerves of the skin are also found in 
THE MUSCLES ANATOMY AND PHYSIOLOGY 
25 
Figure 20.—Superficial muscles of the body. (After Brubaker.) 26 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
it. The deep type Is dense and tough and in addition to covering muscles, 
covers delicate and specialized structures such as organs and blood vessels. In 
many places sheets of it lie between adjacent groups of muscles thereby per- 
mitting the different groups to act independently and still remain in place. 
Each muscle has a nerve supply and it is usually through the action of its 
nerve that a muscle is brought into activity and its action coordinated with 
that of other muscles. Such a nerve is called a motor nerve and if one is 
destroyed by disease or injury the muscle usually becomes inactive and wastes 
away. In addition to the norm'al stimulation of muscles through their nerves, 
they may also be activated by mechanical, chemical, or electrical stimulation 
of the muscles themselves, and by the application of heat and cold. 
When a muscle contracts it uses a certain amount of energy to do a certain 
amount of work. In doing this work the protoplasm in the muscle cells breaks 
down and chemical waste products, which are toxic, are produced. If these 
waste products accumulate the phenomena of fatigue result, and in some cases 
muscular cramps may occur. To supply the energy required and restore the 
muscle protoplasm, carbohydrates are taken from the blood and oxidized in the 
muscle. During contraction, or work, carbon dioxide and water are formed 
by oxidation, and removed by the blood which also brings the oxygen necessary 
for the restoration of muscle protoplasm. In ordinary activities the blood 
supply to muscles is increased, thereby increasing the supply of food materials, 
carrying away waste products more quickly, and enabling the muscles to build 
up and restore their efficiency. 
When-muscle substance dies it becomes solid and rigid, and loses its power 
to react to stimulation. The stiffening and hardening of the muscles after 
death is due to this phenomenon, which is called rigor mortis. 
The muscles of the body are divided into the following groups: those of the 
head and face; of the neck; of the trunk, which is subdivided into those of 
chest, thorax, abdomen, back and perineum; those of the upper extremity; 
and those of the lower extremity (fig. 20). 
The muscles of the head and face consist of numerous groups of small 
muscles which act in the movements of the eyes, the face, the scalp and 
assist in mastication, deglutition, talking and expression. 
The muscles oi the neck move the head from side to side, backward and 
forward, and rotate it. Some of these muscles act as auxiliary muscles of 
respiration, assist in deglutition, in speaking, and in other complicated move- 
ments of the head and neck. 
The muscles of the hack are divided into five layers, the superficial layer 
and four deep layers. They act on the spinal column to keep the trunk in 
an erect posture, and permit movements from side to side, forward and back- 
ward, and a moderate amount of turning. Those of the chest and thorax, 
including the diaphragm, the great muscle which separates the thoracic and 
the abdominal cavities, are chiefly respiratory muscles. These muscles, with 
the exception of the diaphragm, assist in movements of the trunk, the neck 
and the upper extremities. The muscles of the abdomen are the external 
oblique, the internal oblique, the rectus abdominis, and the transversus abdo- 
minis. The rectus abdominis is a paired muscle situated on each side of the 
median line of the abdomen within the fibrous aponeurosis of the oblique 
muscles. It extends from the symphysis pubis to the thoracic wall. These 
muscles form the sides and front of the abdominal wall. They assist in mictu- 
rition and defecation by compressing the abdominal viscerse. They also 
assist in respiration and emesis, flex the thorax on the pelvis and aid in lateral 
flexion and rotation of the spine. HAD0£(V_59 
Figure 21—ANTERIOR VIEW OF RELATION OF 
SKELETAL MUSCLES TO SKELETON 
(U. S. Naval Medical School) hAOOEW .39 
FIGURE 22—POSTERIOR VIEW OF RELATION OF 
SKELETAL MUSCLES TO SKELETON 
(U. S. Naval medical School) A 1ST ATOMY AND PHYSIOLOGY 
27 
The inguinal ligament (Poupart’s) is a thickened band of fibers of the 
aponeurosis of the external oblique muscle, extending from the anterior 
superior spine of the ilium to the spine of the pubis. Just above this ligament 
and parallel to it is the inguinal canal through which pass the spermatic cord 
in the male, and the round ligament of the uterus in the female. The inner 
opening in the transversus muscle is called the internal inguinal ring; the 
outer opening in the tendon of the external oblique muscle is called the 
external inguinal ring. These openings form weak places in the abdominal 
wall, and are the frequent sites of a protrusion of parts of the viscera which 
is called a hernia or rupture. Other weak places are the umbilicus, and the 
femoral ring which serves as a passage for the blood vessels to the lower 
extremity. 
The muscles of the perineum are those surrounding the base of the repro- 
ductive organs and the rectum and form the floor of the pelvis. Their action 
is to assist in micturition and deflation. 
The muscles of the upper extremity are divided into those of the shoulder, 
which act to move that joint; those of the arm; those of the forearm; and 
those of the hand. 
The muscles on the front of the arm flex the forearm; those on the back 
extend it. The same principle applies generally to the muscles which arise 
from the bones of the forearm and are attached to the bones of the hands or 
fingers. Some of these muscles however act to pronate the hand (turn palmar 
surface down) and others to supinate the hand (turn the palmar surface up). 
The muscles of the palm and the back of the hand, flex, extend, adduct, abduct 
and circumduct the fingers and the thumbs. 
The muscles of the lower extremity are divided into those of the hip; the 
thigh; the leg; and the foot. The muscles on the anterior side of the hip flex 
the thigh on the abdomen, those on the posterior extend, those on the medial 
side adduct and those on the lateral side abduct. Combinations of these actions 
produce circumduction of the lower extremity. 
The muscles of the posterior portion of the thigh flex the leg on the thigh. 
Those of the anterior portion extend the leg. The muscles having origin on the 
anterior surface and on the posterior surface of the bones of the leg, flex, ex- 
tend, and circumduct the foot. The muscles of the dorsal and the ventral sur- 
faces of the foot extend and flex the toes respectively. 
It is not possible to present a complete study of the individual skeletal 
muscles in this chapter, but to show the way they should be studied a few 
that form important anatomical landmarks and typify the action of muscles in 
general will be individually described. 
The temporal muscle. 
Origin: From the whole area of the temporal fossa. 
Insertion; The coronoid process of the mandible. 
The muscle is fan-shaped, and its principal action is to close the jaw. 
The sternocleidomastoid muscle is an important landmark in the neck and 
can be easily demonstrated by bending the head forward and to the opposite 
side. 
Origin: The manubrium of the sternum and the medial third of the upper 
surface of the clavicle. 
Insertion: The mastoid process of the temporal bone. 
Action: When acting alone flexes head laterally and rotates it to the opposite 
side. Both acting together bend the head forward. (If muscles in the back of 
the neck hold the head extended they may act as extraordinary muscles of 
inspiration by raising the sternum and the clavicles.) 
154294°—39 3 28 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The biceps muscle is located on the front of the arm. 
Origin: By two heads, which accounts for its name. The tendon of the short 
head is attached to the tip of the coracoid process. The tendon of the long 
head is attached just above the upper rim of the glenoid cavity and passes 
through the capsule of the shoulder joint. 
Insertion: By a tendon which attaches to the tubercle of the radius. 
Action: Draws the arm forward, flexes the elbow, and supinates the forearm. 
The triceps muscle is located on the back of the arm. 
Origin: By three heads, hence its name; the long head from the scapula, the 
lateral head from the upper part of the humerus, and the medial head from the 
lower posterior surface of the humerus. 
Insertion: By a tendon to the olecranon process of the ulna. 
Action: To extend the elbow and to adduct the arm. 
The deltoid muscle forms the prominence of the shoulder. 
Origin: From the lateral part of the shoulder girdle. 
Insertion: The outer surface of the shaft of the humerus at about its middle 
(the deltoid tuberosity). 
Action: To raise (abduct) the arm. 
The diaphragm is the muscular wall which separates the abdominal cavity 
from the thoracic cavity. It is vaulted upward. Its fibers arise from the bony 
cartilaginous chest wall, converge, and are inserted into the fibrous central por- 
tion. When the fibers contract they pull the central portion downward. 
SPECIAL MEMBRANES AND GLANDS IN GENERAL 
A membrane is an enveloping or lining tissue of the body. The chief mem- 
branes are classified as: Serous, synovial, mucous and cutaneous. 
Serous membranes are thin, transparent, fairly strong and elastic. Their 
surfaces are moistened by a fluid resembling serum. They are found lining 
closed cavities and passages which do not communicate with the exterior. 
These membranes consist of two layers; the endothelium, a modified epithelium, 
and the corium, a thin layer of fibrous tissue and blood and lymph vessels. 
They are divided into the following three classes: 
Serous membranes proper, which consist of a closed sac, one part of which is 
attached to the walls of the cavity which it lines, and the other reflected over 
the surface of the organs contained in that cavity. This class includes the 
pleurae, which cover the lungs and line the thoracic cavity; the pericardium 
which covers the heart; the peritoneum which lines the abdominal wall, and 
clothes its contained viscera; the lining membrane of the vascular system; the 
internal coat of the heart, blood vessels and lymphatics; the capsule of Tenon, 
back of the eyeball; and the arachnoid coat of the meninges. The serous mem- 
branes serve as a protective covering by forming a smooth slippery lining and 
secreting a serum which acts as a lubricating fluid. 
Synovial membranes are associated with joints and muscles and secrete a 
viscid glairy fluid called synovial or joint fluid. These membranes are articu- 
lar, which surround and lubricate the joints; vaginal, which form the sheaths 
of tendons abont some joints; and bursal, which form simple sacs interposed 
between soft tissue and bone. The latter may be deep seated between muscle 
or tendon and bone, or superficial between skin and bone, for example, the 
patellar bursae. 
Mucous membranes line the cavities which communicate with the exterior. 
Their surfaces are coated over and protected by mucus. The mucous membranes 
of the body may be divided into the gastro-pulmonary, and the genito-urinary. ANATOMY AND PHYSIOLOGY 
29 
The gastro-pulmonary mucous membrane covers the inside of the alimentary 
tract and the air passages and all cavities communicating with them. This 
includes the accessory sinuses of the nose; the lacrimal ducts; the conjunctiva; 
the auditory canals, including the middle ear and the mastoid cells; the common 
bile duct; the gall bladder; the biliary duets; the pancreatic duct; and the sali- 
vary ducts. The genito-urinary mucous membrane furnishes the inside lining 
of the urethra; the bladder; the ureters; the pelvis and tubules of the kidney; 
and all of the genital ducts including the prostatic, the seminal and the ductus 
deferens. 
Cutaneous membrane is the external covering of the body, or skin. Its 
structure and functions will be discussed later. 
A gland is an organ which secretes something essential to the system or 
excretes waste materials the retention of which would be injurious to the body. 
Glands are of three types: Simple, compound, and ductless. Simple glands 
are generally tubular or sacular in structure and open to the surface by a 
single duct, their secretions being thrown directly onto a free surface. Com- 
pound glands are glands the structure of which is subdivided into smaller tubu- 
lar or sacular structures which open by smaller ducts into a main duct. Their 
structure may be compared to a bunch of grapes, the branching stem of which 
corresponds to the ducts of the gland and the grapes to the groups of gland 
tissue called lobules. The secretions of compound glands are carried off through 
their ducts. Ductless glands are glandular structures which have no ducts and 
whose secretions are discharged directly into the blood or lymph. 
THE BLOOD AND THE BLOOD VASCULAR SYSTEM 
Blood is the fluid tissue which is contained and circulates in the blood vascu- 
lar system of the body. This system consists of the heart, arteries, capillaries, 
and veins, and in it the blood is kept circulating by the force of the heart beat. 
In the adult the quantity of blood is estimated to be about one-thirteenth of 
the body weight or about 6 quarts in an average adult weighing 160 pounds. It 
is a reddish colored, viscid, opaque fluid slightly heavier than water, normally 
having a specific gravity averaging 'about 1.055 and a slightly alkaline reaction. 
In composition blood consists of a fluid portion, the plasma or blood plasma, in 
which are suspended the “formed elements,” the red blood cells, the white 
blood cells, and the blood platelets. The blood cells are also known as blood 
corpuscles and the blood platelets as thrombocytes. In blood the cells are not 
joined together by intercellular substance as in other tissues but float freely 
in the plasma. 
The functions of the blood are numerous and all are important and neces- 
sary to the well-being of the body. In performing its functions blood: 
1. Serves as a medium for the exchange of gases, carrying oxygen to the 
tissue cells and removing carbon dioxide from them; 
2. Serves as a medium for the interchange of nutritive and waste mate- 
rials, carrying food materials absorbed from the digestive tract to the 
tissue cells and removing waste materials from them for elimination 
by the excretory organs; 
3. Serves as a medium for the transmission of hormones; 
4. Aids in equalizing and maintaining body temperature; 
5. Aids in protecting the body against infection by contributing cellular 
and body-fluid factors to the defense mechanism of the body known 
as immunity; 
6. Guards against hsemorrhage by clotting when shed; and 
7. Maintains the all-important acid-base equilibrium or balance of the body. 30 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Healthy blood (plasma and blood cells) consists of about 78 per cent water 
and 22 per cent solids, and contains a great variety of substances, most of 
which are found in the plasma. 
Blood plasma is the fluid portion of the blood and when free from blood cells 
is a clear, straw-colored liquid having a specific gravity of about 1.026 and a 
slightly alkaline reaction. The term blood plasma should not be confused 
with the term blood serum for the two terms refer to quite different sub- 
stances, Blood plasma is the liquid part of blood before coagulation takes 
place. When blood escapes from its vessels it usually coagulates, or clots, 
and as the clot forms it generally shrinks and squeezes out a clear, yellowish 
liquid known as blood serum, which may be defined as the liquid part of 
blood after coagulation takes place. By filtration the plasma passes through 
the walls of the capillaries into the tissues where it is known as lymph. 
The composition of blood plasma is about 90 to 92 per cent water and about 
8 to 9 per cent solids. In addition to water its constituents may be listed as 
follows: 
1. Gases: Oxygen, carbon dioxide, and nitrogen ; 
2. Proteins: Fibrinogen, globulins, albumins, and cell proteins, excluding 
haemoglobin; 
3. Pigments: Haemoglobin, in red blood cells, bilirubin, in serum, etc.; 
4. Nonprotein nitrogenous bodies: Urea, uric acid, creatine, creatinine, am- 
ino acids, ammonium salts, and an unidentified fraction; 
5. Nonnitrogenous bodies: Sugar, lactates, phenols, chlolesterol and 
“lipoids” such as fats, soaps, and the phosphatides (phospholipoids) ; 
together with the intermediate products of fat metabolism (“acetone 
bodies”) ; 
6. Inorganic salts: The chlorides, carbonates, sulfates, and phosphates of 
sodium, potassium, calcium, magnesium, and iron; 
7. Enzymes and antienzymes: Glycolase, lipase, enterase, oxidase, antipro- 
tease, etc.; and 
8. Special substances: Hormones, immune bodies, opsonins, complement, etc. 
Acid-base equilibrium. 
The normal metabolic processes of the body result in the continuous produc- 
tion of acid end-products which tend to alter the reaction of the blood when 
added to it, i. e., make it less alkaline. Oxidation in all tissues produces carbon 
dioxide which has acid properties, muscular activity produces lactic acid, and 
sulfuric and phosphoric acids are formed in the oxidation of proteins containing 
sulfur and phosphorus. In spite of such acid substances being constantly added 
to the blood its slightly alkaline reaction remains remarkably uniform and 
constant because the physiological activities of the body are so adjusted that 
variations in the reaction are kept within narrow limits. The maximum varia- 
tion in reaction that is not dangerous to life is only eight-tenths of a point. 
Keeping the alkaline reaction of the blood within those limits is known as 
maintaining the acid-base equilibrium or balance and is accomplished by 
neutralization of the acid products as soon as they are formed in the tissues, 
by the prompt elimination of excess acid through the regulating action of the 
lungs and kidneys, and by the presence in the blood of substances called buffers. 
A buffer is any substance which when present in a solution tends to prevent 
the reaction of the solution from changing on the addition of acid or alkali. 
All buffers are mixtures of a weak acid and its basic salts, or a weak base and 
its acid salts, and among the substances present in the blood which act as 
buffers carbonic acid and its bicarbonate salts and haemoglobin and its basic salts ANATOMY AND PHYSIOLOGY 
31 
are of chief importance; proteins in the plasma have some buffer action, and 
also the phosphates. 
The action of buffers in maintaining the acid-base equilibrium is a very com- 
plicated process and only a brief explanation can be given here. This action, 
which is spoken of as buffering, depends on the presence of substances in the 
blood and tissues which convert strong acids into weaker ones by chemical 
reaction. One of these substances is sodium, an alkali, which reacts chemi- 
cally with weak acids such as carbonic acid and phosphoric acid, and with 
proteins to form the alkaline salts sodium bicarbonate, sodium phosphate, and 
the sodium salts of the proteins. These salts in turn react with stronger acids 
to form sodium salts of the stronger acids and at the same time liberate the 
weaker acids. In this way the effect of the stronger acids is greatly weakened 
and there is prevented an increase in acidity which would tend to make the 
reaction of the blood less alkaline. 
The combination of sodium with a weak acid, mainly as sodium bicarbonate, 
constitutes the principal buffering mechanism of the blood, and the amount 
of sodium that is so combined and available for use in neutralizing stronger 
acids is spoken of as the alkali reserve. 
The principal acid added to the blood as the result of the metabolic processes 
in the body is carbonic acid, considerable of which is formed when carbon 
dioxide enters the blood from the tissues. As soon as this acid is formed 
most of it combines with the sodium chloride present in the blood plasma 
and forms sodium bicarbonate, the remainder diffuses into the red blood cells 
where it unites with the potassium present as potassium hsemoglobinate and 
forms potassium bicarbonate. The chlorine liberated in the formation of 
sodium bicarbonate passes to the red blood cells where it combines with the 
luemoglobin. The result of these reactions is an increase in the amount of 
bicarbonates available for the neutralization of acids. 
On reaching the lungs the blood becomes oxygenated or purified and the 
haemoglobin gives up the chlorine it had taken up. The liberated chlorine 
passes into the blood-plasma, reacts with the sodium bicarbonate to form 
sodium chloride and liberates carbon dioxide which is exhaled. Should there 
be any tendency toward an increase in the acidity of the blood such as would 
follow an increase in carbon dioxide the respiratory center is stimulated and 
respiration becomes more rapid with consequent increased elimination of carbon 
dioxide. 
As the neutralization of acids cannot be accomplished without lowering 
the alkali reserve and as acids are constantly being added to the body in 
foods and by the acids formed within the body, to prevent lowering the alkali re- 
serve to a point where it is dangerous it is necessary to eliminate the acids 
without losing a corresponding amount of alkali, or base. This is largely done 
through the secretory and excretory functions of the kidneys, which play an 
important part in maintaining the normal acid-base balance or equilibrium 
of the blood by excreting the excess of acids above the normal equilibrium. 
The normal acid reaction of urine as compared with the slightly alkaline 
reaction of blood is due to the selective ability of the kidneys to excrete weak 
acids and acid salts and at tlfe same time hold back a large part of the alkali 
base with which they are combined in the blood. The part which is held 
back is used to replenish the alkali reserve. Acid elimination takes place 
through the kidneys principally in the form of acid phosphates, and in some 
conditions as much as 50 per cent of the acid excreted may be free acid. 
Should the alkali base begin to be depleted in spite of this excretion of acid 
the kidneys break up urea which is accompanied by the production of ammonia. 32 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The ammonia so formed is then used instead of alkali base to neutralize much 
of the acid excreted which appears hi the form of ammonium salts. Even 
strong acids like hydrochloric and sulfuric are sometimes excreted as ammonium 
salts. 
This neutralizing mechanism may be so overtaxed or its activities so dis- 
turbed by the ingestion of unusual amounts of acid or alkali or as a result 
of disease that there occurs a noticeable change in the reaction of the blood 
and resulting conditions known as acidosis or alkalosis. Any marked change 
of reaction is fatal unless quickly corrected or compensated. 
Acid-base equilibrium or balance is also discussed in the section on Labora- 
tory Procedures and Technique. 
Immunity. 
The body possesses a defense mechanism termed immunity by which it can 
resist and overcome infection. (See section on Hygiene and Sanitation.) By 
immunity is meant the ability of the body to protect itself against injury by 
harmful bacteria or by the poisonous products of bacteria called toxins. In this 
defense mechanism the blood and lymph play an important part. The protec- 
tive function of the blood in immunity is partly due to the blood plasma and 
partly to the white blood cells. 
Any substance which, when injected into an organism, is capable of stimu- 
lating the production of a substance antagonistic to the substance injected is 
known as an antigen, and the substance produced is known as an antibody. 
When foreign substances such as bacteria or their toxins enter the blood they 
act as antigens and stimulate the production in the blood plasma of specifically 
antagonistic antibodies. There are various types of antibodies and they are 
usually designated according to the maimer in which they act against the invad- 
ing substance. Some of the more important types are known as bacteriolysins, 
which kill the bacteria themselves, agglutinins, which cause the bacteria to 
settle together in clumps, precipitins, which cause precipitation of the bacteria, 
and antitoxins, which neutralize the poisons produced by bacteria. 
Also produced in the blood plasma are substances called opsonins which so 
change bacteria that they can be more easily ingested by the white blood cells. 
Through their power of amoeboid movement the white blood cells are able to 
surround bacteria and ingest and destroy them. Often the white cells are 
themselves destroyed and the dead ones may be removed by other cells. When 
killed in large numbers the white cells form a large part of the solid or semi- 
solid matter called pus that is found in an abscess. 
Transmission of hormones. 
The glands of internal secretion, commonly called ductless glands, produce 
substances termed internal secretions or hormones which play a most important 
part in body functions. Because these glands have no ducts their secretions are 
absorbed into the blood through the walls of the capillaries present in the sub- 
stance of the glands and are then carried by the blood to the parts of the body 
where their action or effect is to be produced. 
As a rule the ductless glands are not located near the organs with which 
they are functionally associated and consequently the hormones may be car- 
ried considerable distances in order to produce their effects. Some hormones 
which have a more or less general systemic action are continually carried to 
all parts of the body. 
By this distribution of hormones the blood serves as a means of providing 
the coordinated function and harmonious working of the body so necessary to 
its well-being. ANATOMY AND PHYSIOLOGY 
33 
Blood coagulation. 
One of the most striking properties of blood is its power to coagulate or clot. 
Undisturbed blood circulates in the blood vascular system of the healthy body 
without showing any tendency to clot, but on escaping from the blood vessels 
it normally begins to clot immediately. Clotting is the body’s method of pre- 
venting excessive loss of blood in the unavoidable injuries met with in ordinary 
life. 
In the process of clotting both physical and chemical factors are involved. 
When blood escapes from blood vessels it leaves its natural environment and 
its normal physical state is changed by exposure to changes in temperature, by 
changes in its gas and acid-base balances, and by contact with objects foreign 
to its natural surroundings such as air and the skin. The chemical factors are 
those having to do with the formation of the clot. 
The blood which forms a clot is at first perfectly fluid but soon becomes 
viscous and then “sets” into a soft jelly which quickly becomes firm enough to 
act as a plug. The clot becomes more compact and gradually shrinks in volume, 
at the same time squeezing out blood serum. The essential part of the clot is 
an insoluble protein substance called fibrin which is not present in normal blood 
but is produced from substances in the blood plasma, blood cells, and tissues 
when formation of a clot is necessary. 
Among the protein constituents of the blood plasma was named fibrinogen 
which is the essential chemical factor in the formation of fibrin. Fibrinogen is 
a protein of the globulin type probably produced in the liver, and by itself is 
inert or inactive. In the generally accepted theory of clotting, when fibrinogen 
comes in contact with thrombin, a so-called fibrin ferment formed from pro- 
thrombin (or thrombogen) by the action of calcium salts, they interact and 
fibrin formation occurs. For prothrombin to be converted into thrombin by 
the action of calcium salts a third substance known as cephalin (or throm- 
bokinase) must be present. This substance, called a thromboplastic agent, 
neutralizes the substance heparin which ordinarily prevents the activation of 
prothrombin, and is released from the injured tissues and from blood platelets 
which quickly disintegrate when exposed to air. 
As fibrin is formed fine threads, fibrils, or needles of it traverse the escaping 
blood in various directions and encircle groups of blood cells. The meshes of 
this fibrin network draw closer together, the cells are packed more tightly 
together, blood serum is squeezed out, and a clot or coagulum is formed. 
The process of clotting may be expressed diagrammatically as follows: 
Cephalin >Prothrombin + Calcium salts = Thrombin 
| Thrombin + Fibrinogen = Fibrin 
Heparin 
The formation of a clot closes the opening of wounded blood vessels and 
prevents great loss of blood. A clot also closes the opening in a wound and is 
the basis for the growth of new tissue in the process of healing. The clotting 
power differs in different individuals and normally 3 to 5 minutes is sufficient 
time for a clot to form, but in rare cases even trivial wounds may cause 
severe and dangerous bleeding. The condition in which clotting of the blood 
is delayed is known as hcemophilia and a person having this condition is 
known as a hcemophiliac. 
The formed elements of the blood. 
Red blood cells, or erythrocytes, are circular, biconcave discs or bodies with- 
out a nucleus that give to the blood its characteristic color (fig. 23). They are 
about %200 of an inch in diameter and in the adult male number about 5,000,000 34 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Figure 23.—Types of blood cells ; a and 6, red blood cells ; c, polymorphonuclear basophile ; d, polymorphonuclear eosinophile; e and f, small lympho- 
cytes ; g, large lymphocyte; h, neutrophilic myelocyte; i, primitive type of myelocyte; j and k, monocytes; I, polymorphonuclear neutrophile; m, 
clump of normal platelets. (Stitt, Clough, and Clough, modified.) ANATOMY AND PHYSIOLOGY 
35 
per cubic millimeter of blood. Their red color is due to the presence in them 
of hemoglobin, a substance composed of an iron salt and a protein and which 
has the power of combining easily with oxygen to form oxyhemoglobin, a loose 
chemical combination of oxygen and haemoglobin by which oxygen is carried 
from the lungs to the body tissues. Haemoglobin also possesses the power of 
readily combining with carbon dioxide and carries it from the tissues to the 
lungs. The affinity of oxygen and carbon dioxide for haemoglobin depends upon 
the concentration of these gases at the point of exchange. In the lungs, 
oxygen being at a greater concentration than carbon dioxide, the haemoglobin 
exchanges its carbon dioxide for oxygen and forms oxyhaemoglobin, but in the 
body tissues carbon dioxide is at a greater concentration than oxygen and the 
haemoglobin exchanges its oxygen for carbon dioxide forming carb-hemoglobin. 
In the adult, red blood cells are reproduced in the red marrow of bone. The 
cells there produced have a nucleus which they lose before entering the blood 
stream. A large number of red blood cells are destroyed daily, in what manner 
it is not definitely known. It may take place in the liver, the spleen, or in the 
lymph nodes, and it is probable that many are broken to pieces by the buffetings 
they receive in the circulation. It is known, however, that a certain amount 
of hsematin, a decomposition product of haemoglobin, is excreted in the bile, a 
fact which apparently substantiates the belief that some red blood cells are 
destroyed in the liver. Red blood cells depend upon the percentage of salt 
or sodium chloride present in the blood plasma for the maintenance of their 
form. Normally the amount of salt is equivalent to about a nine-tenths of 1 
per cent solution of sodium chloride which fluid is isotonic or has the same 
osmotic pressure as the tissue fluids. If the percentage of salt is less the 
red cells will absorb water, swell, and burst, and their haemoglobin is discharged. 
This is called hemolysis and it may be caused by certain bacterial products 
called hemolysins. If the percentage of salt is above the normal, water is 
extracted from the red cells and they shrivel or become crenated. These facts 
must be remembered in intravenous medications. 
In the human being the color of the blood in the arteries is bright red, 
because the haemoglobin in it is combined with oxygen, or is oxygenated; in 
the veins the color of the blood is dark red because the haemoglobin has given 
off its oxygen and exchanged it for carbon dioxide. 
White blood cells, or leucocytes, are nucleated blood cells and vary in size 
and shape (fig. 23). They are, in fact, almost colorless, are somewhat larger 
than red cells, and number about six to eight thousand per cubic millimeter 
of blood under normal conditions. This number may increase for various 
reasons and such an increase is called leucocytosis. Certain pathological con- 
ditions such as acute infections, malignant growths, poisonings, etc., usually 
cause an increase in the number of white cells. When the number of white 
cells drops below the normal standard the condition is known as leucopenia 
and is found in certain uncomplicated infections, poisonings, debilitations, etc. 
The principal function of the white cells is to combat disease. This they 
do by contributing to the formation of antibodies and by ingesting and destroy- 
ing bacteria, a process called phagocytosis. They also aid in the absorption 
of digested fat and proteins, and in the clotting of blood. Leucocytes have 
the striking property of amoeboid movement which enables them to alter 
their shape, ingest and destroy bacteria, and to move themselves and pass 
through the walls of blood vessels into the surrounding tissues. This passing 
into tissues is known as migration and is one of the phenomena of 
inflammation. 36 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
White blood cells are divided into three distinct groups known as granulo- 
cytes, lymphocytes, and monocytes, which differ from one another in origin, 
structure, and function. There are three varieties of granulocytes called 
neutrophilcs, eosinophiles, and hasophiles, all of which are polymorphonuclear 
(having more than one irregularly shaped nucleus). Lymphocytes are known 
as large and small. 
When stained for microscopical examination and differential counting, white 
blood cells show many variations of color in the nucleus and cytoplasm, and 
it is by these variations that the different kinds of white cells are recog- 
nized. When a differential count made in acute infections shows an increase 
in the percentage of immature white cells it is considered roughly proportional 
to the severity of the infection. Such an increase of immature white cells 
is due to the fact that infections promptly cause a demand for additional 
white cells to combat the infecting organism and as the reserve supply of 
mature or fully formed white cells is relatively small the demand for the 
increase is met by the production of new cells, many of which enter the 
circulation before their development is completed. 
Blood platelets, or thrombocytes, are round or oval bodies in the blood that 
consist only of cytoplasm (fig. 23). They vary greatly in size and shape, 
have no nucleus, are smaller than red blood cells, and number from 300,000 
to 800,000 per cubic millimeter of blood, according to the method used to count 
them. They are an essential element in 
blood coagulation or clotting, mixing with 
fibrin to form a firm clot, and are be- 
lieved to be fragments of the cytoplasm 
of multinuclear giant cells of the bone 
marrow (megakaryocytes) that have been 
pinched or broken off. 
The blood-vascular system. 
The organs of the blood vascular system 
are the heart, the arteries, the capillaries, 
and the veins. These form a closed system 
of tubes called vessels through which the 
blood circulates and reaches all parts of 
the body, and a muscular pump which 
propels the blood through the vessels. 
The heart is a hollow, muscular organ 
located in the front and center of the 
thoracic cavity of the chest, between the 
lungs, with a large part of it lying directly 
back of the sternum or breast bone. It is 
about the size of a closed fist and closely 
resembles a strawberry in shape. The base 
of the heart points upward, backward, and 
to the right, and the pointed end, or apex, 
points downward, forward, and to the left 
(fig. 24). 
The heart is enclosed in an inverted sac of fibro-serous membrane called 
the pericardium, the inner layer of which adheres closely to the musculature of 
the heart. The outer surface of the pericardium turns back over the inner layer 
and forms a cavity which contains a small quantity of fluid known as the 
pericardial fluid that lubricates the surfaces of the pericardium and prevents 
Figure 24.—The heart. (Mason.) ANATOMY AND PHYSIOLOGY 
37 
friction during the movements of the heart. The inside of the heart is lined 
with a delicate serous membrane called the endocardium. 
The main portion of the heart is composed of muscular tissue called the myo- 
cardium. This muscular tissue is of a type found only in the heart, being 
striated or striped, but involuntary. Some of the muscles of the heart run 
transversely, others longitudinally, others obliquely, while those in the apex 
make a spiral turn or twist. This intricate arrangement makes possible 
an even and complete closing of the heart cavities during contraction. 
The interior of the heart is completely separated into right and left halves 
by a longitudinal muscular septum, and each half is divided into an upper, re- 
ceiving chamber, the auricle, and a lower, ejecting chamber, the ventricle. 
Consequently, there are four cavities in the heart. Each auricle communicates 
with its corresponding ventricle by means of an oval aperture called the auri- 
cula-ventricular opening or valve. During foetal life there is an open- 
ing between the auricles of the heart known as the foramen ovale, which, 
however, closes immediately after birth. The walls of the auricles are much 
thinner than those of the ventricles and the wail of the left ventricle is much 
thicker than that of the right ventricle. This difference in development is 
because the ventricles perform a greater amount of work than the auricles and 
the left ventricle performs more work than the right. 
Each of the four cavities of the heart is lined with endocardium which, by 
folding back upon itself, forms the valves of the heart. These valves allow 
the free passage of blood in the proper direction but effectually prevent its re- 
turn. The valves differ in the number and shape of the cusps or segments 
of which they are made and are named according to the number and shape of 
the cusps, or the openings which they guard. The right cmriculo-ventricxdar 
valve is also known as the tricuspid valve from the fact that it has three 
triangular-shaped cusps; the left auricula-ventricular valve is also known as 
the bicuspid or mitral valve from its two triangular-shaped cusps. Both the 
pulmonary valve and the aortic valve, opening respectively into the pulmonary 
artery and the aorta, have three half-moon-shaped cusps because of which they 
are known as semilunar valves. 
The heart is nourished by blood supplied to it through the right and left 
coronary arteries and its nerve supply is from the pneumogastric nerve and 
the sympathetic nervous system. The central nervous system can control and 
regulate the rhythmical, automatic contractions of the heart which are con- 
tinuous during life but it has nothing to do with the cause of those contractions, 
whose origin is not definitely known. 
The heart action consists of wave-like contractions, beginning in the auricles 
and passing to the ventricles, followed by dilatations. These contractions 
and dilatations are alternate and continuous and occur normally at the rate 
of about 72 per minute, although this rate varies according to age, sex, exercise, 
temperature, and in some pathological conditions. Contraction, or systole, as 
it is called, is a period of work; dilatation, or diastole, is a period of rest or 
relaxation. 
The time from the appearance of any feature of heart action to the appear- 
ance of that feature again is known as a complete cardiac cycle, during which 
blood is received into and ejected from the heart cavities. The events occur- 
ring in the heart during a single cardiac cycle and which show how the heart 
acts are here summarized. Ejection of blood from the ventricles having been 
completed, the ventricles quickly relax from the contraction which ejected the 
blood and the semilunar valves in the ventricles close. The’ auriculo-ven- 
tricular valves have been closed since the last filling of the ventricles with 38 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
blood and the auricles are now being steadily filled with blood from the large 
veins entering them while the ventricles are relaxed or resting. During this 
period of relaxation all the valves in the ventricles are closed and the ventri- 
cles are completely shut off on both sides for a short time. By the time the 
relaxation of the ventricles is complete the pressure of blood in the auricles 
has caused the auriculo-ver tricular valves to open and from then until the 
beginning of the brief auricular contraction blood from the large veins entering 
the auricles is flowing into and filling both the auricles and the ventricles. 
Soon the ventricles become more tense as the quantity of blood in them in- 
creases, the auriculo-ventricular valves float into position for closing, and the 
auricular contraction begins. At the end of the brief contraction of the 
auricles a sudden wave of blood is sent into the ventricles, completely filling 
them, the auriculo-ventricular valves close, and contraction of the ventricles 
begins, with the ventricles again being shut off momentarily due to all their 
valves being closed. The increasing pressure of the blood from the ventricular 
contraction causes the semilunar valves to open and blood is forced into 
the large arteries opening from the ventricles as long as the contraction lasts. 
The action of a normal heart produces two distinct sounds which may be 
heard by applying the ear to the chest. One is a long, booming sound caused 
when the auriculo-ventricular valves close and the ventricles contract; the 
other is a short, sharp sound, attributed to the closing of the semilunar valves. 
Arteries are hollow, elastic tubes that carry blood away from the heart. 
They have a certain amount of rigidity and consist of three layers, an inner 
lining of vascular endothelium, a middle muscular layer composed of involun- 
tary muscle tissue and elastic fibrous tissue, and an outer fibrous-tissue coat. 
Arteries have a nerve supply from the sympathetic nervous system by which 
the size of the passage-way in the arteries may be dilated or constricted. 
The smaller divisions of arteries are called arterioles. 
Capillaries are minute, hair-sized vessels through which the blood passes 
from the arteries to the veins. They have very thin walls of endothelium only, 
communicate with each other, and form a dense, interlacing network in all 
parts of the body. In passing through the capillaries the blood gives its 
nutritive materials to the tissues and takes from the tissues the various waste 
products that are to be carried away, the exchange taking place through the 
very thin walls of the capillaries. 
Veins are hollow collapsible tubes that carry blood to the heart. Their 
structure is similar to that of the arteries but their walls are much thinner, 
the middle layer containing less muscular tissue and elastic fibrous tissue. In 
many of the veins there are semilunar valves in pairs which act to prevent the 
backward flow of blood. They begin as minute venules formed from capillaries 
which have joined together. 
In tracing the circulation of the blood (Fig. 25) it is necessary to begin at 
and return to a given point. In this case the given point will be the right 
auricle where venous, or impure, blood is entering from the inferior and 
superior venae cavce. This venous blood passes from the right auricle through 
the right auriculo-ventricular opening past the tricuspid valve, into the right 
ventricle. When the right ventricle contracts the tricuspid valve closes and 
the blood is forced past the pulmonary semilunar valve into the pulmonary 
artery. This artery divides into two branches, one going to each lung where 
it subdivides into smaller arteries, arterioles, and capillaries which surround 
the alveoli, or air sacs, of the lungs. During its circulation in the lungs the 
blood becomes aerated and is returned through small vessels to the four 
pulmonary veins, two from each lung, which empty into the left auricle. From ANATOMY AND PHYSIOLOGY 
39 
the left auricle the blood passes through the left auriculo-ventrieular opening 
past the bicuspid or mitral valve into the left ventricle where, upon contrac- 
tion of this part, it is discharged past the aortic semilunar valves into the 
aorta. From the aorta the blood flows through its branches, the arteries, and 
the arterioles, to the 
capillaries in every 
part of the body. The 
blood is returned by the 
capillaries to the veins 
and finally reaches the 
right auricle through the 
veme cavse. 
The contraction of the 
left ventricle, forcing the 
blood into the arteries, 
causes a wavelike ex- 
pansions of the arteries 
which is synchronous 
with a heart beat. This 
is called the pulse, and 
may be felt at certain 
points where the arteries 
approach the body sur- 
face. The most common 
location is where the 
radial artery passes over 
the distal end of the 
radius, in each of the 
upper extremities. 
Blood pressure is the 
force of the blood ex- 
erted against the walls 
of the vessels in which 
it is contained. Although 
the term includes the 
pressure in the arteries, 
veins, and capillaries, 
the usual application of 
the term is to arterial pressure alone. The highest pressure—that is, that pro- 
duced by the forceful propulsion of the blood through the arteries at each con- 
traction of the ventricle—is known as the systolic blood pressure. Under normal 
conditions in the young adult this pressure is equivalent to about 120 millime- 
ters of mercury, but varies as to age, sex, and condition of arteries and heart. 
Roughly, systolic blood pressure equals 100 plus the age of the individual. A 
certain amount of blood pressure is maintained in the arteries during the 
period of cardiac relaxation. This is caused by the elasticity and tonicity of 
the arteries and by the peripheral resistance. This pressure is known as the 
diastolic blood pressure. In normal young adults it is equivalent to from 70 
to 90 millimeters of mercury. The difference between these pressures is called 
the pulse pressure. 
The blood vessels. 
The system of arteries and arterioles may be compared to a tree with the 
trunk giving off main branches which divide and subdivide again and again 
Figure 25.—Schema of circulation of the blood. 
(American Red Cross, modified.) 40 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
until they are but minute twigs. The arteries are constantly carrying a pulsat- 
ing stream of blood which leaves the arterial tree at the finest subdivision and 
passes into the network of capillaries. In many locations in the body arteries 
that arise from different sources join together to form a union called anas- 
tomosis, a good example of which can be found in the palm of the hand. In 
case some important artery is injured these anastomoses provide a collateral 
circulation that furnishes the necessary blood supply. The main trunk of the 
arterial tree is the aorta with which the discussion of the arteries will begin. 
The aorta arises from the left ventricle of the heart, ascends a short distance, 
arches backward above the root of the left lung, and descends along the spinal 
column through the diaphragm to terminate at the level of the fourth lumbar 
vertebra by dividing into the right and left common iliac arteries. During its 
entire course the aorta is a continuous single trunk which gradually dimin- 
ishes in size and gives off branches at various points. The portion of the aorta 
which is situated in the thorax is commonly called the thoracic aorta and con- 
sists of the ascending, the arch, and part of the descending aorta; the remain- 
ing portion is called the abdominal aorta. 
The ascending aorta, a short part 2 to 21/4 inches long and contained within 
the pericardium, gives off two branches, the right and the left coronary arteries 
which supply the heart itself with nourishment. 
The arch of the aorta extends from the ascending aorta, above the root of 
the left lung, to the border of the fourth thoracic vertebra. During its course 
it gives off three branches, the innominate, the left common carotid, and the 
left subclavian arteries. 
The innominate artery is a short arterial trunk 1% to 2 inches in length 
arising from the right upper surface of the arch of the aorta and ascending 
obliquely toward the right sterno-clavicular articulation where it divides into 
the right subclavian and the right common carotid arteries. 
The left common carotid artery arises at the middle of the upper surface of 
the aortic arch and the right common carotid artery is one of the termi- 
nal branches of the innominate artery. The common carotid arteries ascend 
obliquely on each side of the neck to the level of the laryngeal prominence 
where they divide into the external and the internal carotid arteries. The 
external carotid arteries supply the throat, tongue, face, ears, and the walls of 
the cranium; the internal carotid arteries supply the brain and the eyes. 
The subclavian arteries, the right a terminal branch of the innominate 
artery and the left springing directly from the aortic arch, form the first 
part of the arterial trunks supplying the upper extremities. They give off 
branches to the back, the chest, the neck, and the brain, the principal one being 
the vertebral which runs upward through the transverse processes of the cervical 
vertebrse to the brain. Both pass upward and outward under the clavicle and over 
the first rib, at the outer border of which they continue as the axillary arteries. 
These vessels give off branches to the chest, the shoulder, and the arm. The 
axillary artery on passing the armpit becomes the brachial artery, which gives 
off branches to the bone and muscles of the arm, and terminates just below 
the level of the elbow by dividing into the ulnar and the radial arteries. The 
ulnar artery, the larger of the two branches of the brachial artery, extends 
along the medial side of the forearm to the palm of the hand where it forms 
the superficial volar arch. The radial artery extends along the outer side of 
the forearm to the palm of the hand where it forms the deep volar arch. The 
deep volar arch anastomoses with the superficial volar arch and supplies the 
hand with blood. ANATOMY AND PHYSIOLOGY 
41 
The descending aorta is from 7 to 8 inches long and extends from the arch 
of the aorta to the diaphragm. It gives off the following branches: 
1. The intercostal arteries which are paired, 9 and 10 on each side, and 
supply the intercostal muscles and the adjacent structures. 
2. The superior phrenic arteries, which are small branches supplying the 
upper surface of the diaphragm. 
3. The bronchial arteries, two left and one right, which are the nutrient ves- 
sels of the lungs and the bronchi. 
4. The mediastinal arteries which are numerous small branches supplying 
the lymph nodes and the areolar tissue of the mediastinum. 
5. The oesophageal arteries, four or five in number, which anastomose around 
the oesophagus. 
6. The pericardial arteries, three or four small vessels distributed to the 
pericardium. 
The abdominal .aorta begins at the aortic opening of the diaphragm at the 
lower level of the last thoracic vertebra, and terminates at the level of the 
fourth lumbar vertebra by dividing into the common iliac arteries. The 
branches of the abdominal aorta are divided into two groups, those which 
supply the viscera, the visceral arteries, and those which are distributed to the 
walls of the abdomen, the parietal arteries. 
The visceral group consists of: 
1. The coeliac artery, a short wide vessel, one-half inch in length which 
arises from the front of the aorta just below the diaphragm and divides 
into three branches; the gastric, supplying the stomach; the hepatic, supplying 
the liver, the gall bladder, and the duodenum; and the splenic, supplying the 
spleen and a part of the stomach and the pancreas. 
2. The suprarenal arteries, right and left, which are distributed to the 
suprarenal glands. 
3. The renal arteries, right and left, two large trunks arising from the sides 
of the aorta which supply the kidneys. 
4. The superior mesenteric artery which arises from the front of the aorta just 
below the suprarenal arteries and supplies the small intestine, except the duode- 
num, and half of the large intestine. 
5. The spermatic arteries (ovarian in female), right and left, which are dis- 
tributed to the testes (ovaries in the female). 
6. The inferior mesenteric artery which arises from the front of the aorta 
about an inch above its division and is distributed over the lower half of 
the large intestine and the rectum. 
The parietal group includes: 
1. The inferior phrenic arteries, right and left, which supply the lower sur- 
face of the diaphragm. 
2. The lumbar arteries, usually four pairs, which supply the posterior and 
lateral abdominal wall and muscles. 
3. The middle sacral artery, a small vessel which is a direct continuation ol 
the abdominal aorta and supplies the sacrum and coccyx. 
The common iliac arteries (left and right) begin at the division of the 
aorta, extend downward and outward for 2 inches, when they divide into 
the hypogastric and the external iliac arteries. The hypogastric arteries 
supply branches to the pelvic walls, the pelvic viscera, the external genitals, 
and the biittocks. The external iliac artery forms the first part of a continuous 
arterial trunk which supplies the lower extremity and extends to the lower 
border of the inguinal ligament, where it passes from the abdomen through 
the femoral opening and becomes the femoral artery. The external iliac artery 
partially supplies the anterior abdominal wall and the external genitals. The 42 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
MAOOeM.39 
Figure 26.—Schema of principal arteries and veins. (U. S. Naval 
Medical School.) * ANATOMY AND PHYSIOLOGY 
43 
femoral artery runs an oblique course along the femur inward and back- 
ward in the upper three fourths of the thigh to the posterior surface of the 
knee joint, where it becomes the popliteal artery. The femoral artery supplies 
branches to the muscles, the bone, and the skin of the thigh. The popliteal 
artery, after giving off branches anastomosing around the knee joint, divides 
into the anterior and the posterior tibial arteries. The anterior tibial artery, 
the smaller of the two branches, passes forward between the tibia and fibula, 
and then down the front of the leg to the ankle, where it becomes the dorsalis 
pedis artery which supplies the dorsal surface of the foot. The posterior 
tibial artery passes down the back of the leg to the ankle, where it divides 
into two branches which supply the sole of the foot. It gives off various 
branches, the largest of which, the peroneal artery, also passes to the plantar 
surface of the foot and supplies some of the muscles and skin of the foot and 
the ankle joint. 
The veins begin as small branches called venules which unite to form larger 
vessels. Veins differ from arteries in that they have a larger capacity, thinner 
walls, and contain valves which assist in supporting the column of blood. 
This is necessary because most of the cardiac impulse is lost during the 
course of blood through the capillaries. 
The veins are divided into the pulmonary, the systemic, and the portal 
systems. 
It has been shown that the pulmonary arteries end in capillaries in the 
walls of the alveoli of the lungs. After oxygenation, blood is collected from 
these capillaries by the venules which unite to form a vein from each of the 
five lobes of the lungs. The right lung, however, sends but two veins to the 
heart as does the left lung, for the veins of the superior and the median 
lobes of the right lung unite. There are, then, four pulmonary veins carrying 
blood from the root of the lungs to the left auricle of the heart. These are 
the only veins in the body which carry arterial, or oxygenated blood. 
The veins of the systemic circulation are arranged in two sets, the deep 
and the superficial. The deep veins as a rule accompany their corresponding 
arteries and usually are called by like names. The larger arteries have only 
one accompanying vein but the medium sized or smaller arteries usually have 
two accompanying veins which anastamose freely with each other. The super- 
ficial veins lie just under the skin where in many localities they may be easily 
seen, and end by entering the deeper tissues to join the deep veins. 
The superficial veins of the head which drain the venous blood from the 
scalp and face and from the cancellous tissue of the skull empty into the 
right and left external jugular veins. The anterior jugular vein of the neck 
usually empties into the external jugular veins and with them drains the 
neck. The external jugular veins empty into the subclavian veins. 
Yenous blood from the brain and the interior of the skull drains into venous 
channels situated between two layers of the dura mater of the brain and having 
the same lining as the veins which empty into them. These channels are also 
known as venous sinuses and the most important ones are the superior saggital 
sinus running from front to back across the top of the brain, the two transverse 
or lateral sinuses, one on each side of the brain, and the two cavernous sinuses, 
one on each side of the sphenoid bone. The cavernous sinuses communicate 
with the veins of the face through the veins of the orbits and are therefore 
especially receptive to the backward spread of infective organisms from the 
nose and cheeks with resultant clotting of blood in the sinuses and almost cer- 
tain death. The saggital and cavernous sinuses empty into the transverse sinuses 
and they empty into the internal jugular veins, one on each side of the 
154294°—39 4 44 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
neck, which, with their tributaries, also drain the deep portions of the neck, 
the tongue, the jjharynx, and the thyroid gland. 
The superficial veins of the upper extremity start from the dorsal venous arch 
and the volar venous plexus of the hand and consist of the cephalic, basilic, 
median, and tributary veins. The cephalic vein passes up the outer side of the 
forearm and arm in front of the elbow and empties into the upper part of the 
axillary vein just below the clavicle. Below the elbow it gives off the median 
cubital or median basilic vein which passes across and joins the basilic vein. 
The basilic vein passes up the inner side and back of the forearm, receives the 
median cubital vein below the elbow, then passes upward in the arm and in the 
axilla joins the brachial veins to form the axillary vein. The median vein passes 
up the forearm to the level of the elbow where it joins the basilic vein. 
The deep veins of the upper extremity begin from smaller veins in the hand 
as the radial veins and the ulnar veins and as they pass upward receive tribu- 
tary veins. In front of the elbow they unite to form the brachial veins which 
continue upward through the arm and in the axilla unite with the basilic vein 
to form the axillary vein. The axillary vein passes on across the axilla and 
at the outer border of the first rib becomes the subclavian vein which continues 
on to the sternal end of the clavicle and there unites with the internal jugular 
vein to form the innominate vein. At this point the right subclavian vein 
receives the lymphatic duct and the left receives the thoracic duct. Before 
uniting with the internal jugular vein the subclavian vein receives the external 
jugular vein and sometimes the anterior jugular vein. 
The innominate veins, one on each side, receive numerous tributary veins 
draining various parts of the thorax and pass obliquely downward toward the 
sternum and unite to form the superior vena cava which receives the azygos 
vein draining most of the intercostal spaces and several small tributary veins. 
The superior vena cava, which returns to the heart all venous blood from the 
body above the diaphragm, descends on the right side of the center of the 
thorax, with a slight convexity to the right, and ends in the upper part of the 
right auricle of the heart. 
The blood which has supplied the heart itself with nourishment is returned 
as venous blood by a venous channel called the coronary sinus which lies in a 
groove on the back of the heart and enters the right auricle near the junction 
of the inferior vena cava with the right auricle. Tributary veins, most of 
which empty into the coronary sinus, collect the venous blood from the heart. 
The superficial veins of the lower extremity are the internal, great, or long 
saphenous vein which starts on top of the inner side of the foot and runs up 
the inner side of the leg and thigh to terminate just below the groin in the 
femoral vein, and the external, small, or short saphenous vein which starts in a 
similar manner on the outer side of the foot and terminates just behind the 
knee in the popliteal vein. Both saphenous veins are joined by numerous tribu- 
tary veins. The principal deep veins of the lower extremity are the anterior 
and posterior tibial veins, the peroneal veins, the popliteal vein, the femoral 
vein, and the deep femoral vein. The anterior and posterior tibial veins start 
from smaller veins in the foot, run upward and unite behind the knee to form 
the popliteal, the posterior tibial veins in the passage upward being joined by 
the peroneal veins which accompany the peroneal artery. The popliteal vein 
extends upward through the lower third of the thigh where it becomes the 
femoral vein, being joined shortly after its origin by the small saphenous vein. 
The femoral vein extends upward through the upper two-thirds of the thigh 
and then becomes the external iliac vein, being joined just before its termina- ANATOMY AND PHYSIOLOGY 
45 
tion by the great saphenous vein. The deep femoral vein communicates with the 
popliteal vein below and the inferior gluteal vein above. 
Only the principal veins of the abdomen and pelvis will be named, beginning 
with the external iliac vein which runs along the brim of the pelvis to the sacro- 
iliac joint where it unites with the hypogastric or internal iliac vein, which 
drains the pelvis, to form the common iliac vein. The common iliac veins, one 
from each side of the body, pass obliquely upward and unite on the right side 
of the fifth lumbar vertebra to form the inferior vena cava, into which the 
lumbar veins, the renal veins with the left suprarenal and left spermatic or 
ovarian veins, the right suprarenal and right spermatic or ovarian veins, and 
the hepatic veins empty. The inferior vena cava, which returns to the heart 
all venous blood from the body below the diaphragm, ascends along the spinal 
column on the right of the aorta, passes through the diaphragm into the 
thoracic cavity and ends in the lower part of the right auricle of the heart. 
The portal system of veins consists of the veins which drain blood from the 
stomach, the intestines (with the exception of the lower part of the rectum), 
the spleen, the pancreas, and the gall-bladder. Among the veins collecting 
blood from these viscera are the splenic and the superior mesenteric veins 
which unite behind the neck of the pancreas to form the portal vein, the prin- 
cipal one in the system as all the others ultimately empty into it. The veins 
communicating with the portal vein all have numerous tributary veins. The 
portal vein runs upward and slightly to the right to the transverse fissure of 
the liver where it divides into two branches which enter the right and left 
lobes of the liver respectively. After entering the liver the branches of the 
portal vein continue to branch until they end in small capillaries in blood 
spaces in the liver substance where the hepatic veins begin and, after leaving 
the liver, continue on to enter the inferior vena cava, as mentioned before. 
The purpose of the portal circulation is to subject the blood containing the end 
products of digestion to the special action of the liver prior to entering the 
general circulation. 
THE LYMPH AND THE LYMPH-VASCULAR SYSTEM 
Lymph is a colorless fluid, rich in white blood cells, of essentially the same 
composition as blood plasma, and largely the product of the filtration of blood 
plasma through the walls of the blood capillaries. It is found in the lymph 
vessels and in all of the tissue spaces of the body and serves as a medium for 
carrying nourishment and oxygen to the tissues and waste products from 
them. The tissues and organs of the body are bathed in lymph which then 
acts as a lubricant in aiding movement. After a meal, the lymph coming from 
the small intestine has a milky appearance because of the presence of fat in 
it and it is then called chyle. 
The lymph-vascular system. 
Lymph vessels and lymph glands constitute the lymph-vascular system 
which forms a network throughout the body and connects with serous and 
tissue spaces. There are also certain lymph trunks in the system the most 
important of which is known as the thoracic duct. The flow of lymph in the 
system is always from the tissues toward the terminal lymph vessels and is 
maintained in this direction mainly by the difference in pressure at the two 
ends of the system. The pressure is lowest at the terminal end and the termi- 
nal lymph vessels are the thoracic duct and the right lymphatic duct which 
empty into the left and right subclavian veins, respectively. 46 
HANDBOOK OF THE HOSPITAL CORPS, XJ. S. NAVY 
The lymph vessels. 
In many respects the lymph vessels resemble veins and have been found in 
every part of the body which possesses blood vessels except the brain, spinal 
cord, eyeball, and internal ear. Like the veins many of the lymph vessels 
contain valves which prevent the backward flow of the lymph, but, unlike the 
veins, they communicate directly or indirectly with the great serous cavities 
of the body and their continuity is interrupted by interposed lymph glands. 
Lymph vessels find their beginning in the tissues and organs of the body where 
they are known as lymphatic capillaries and which unite to form larger vessels. 
As the lymph vessels attain a larger size their walls become stronger due to 
the presence of elastic tissue and the larger vessels are composed of three layers 
as are blood vessels. Lymph vessels are known as superficial lymph vessels 
and deep lymph vessels, according to their position in the body. The super- 
ficial vessels collect lymph from the skin and subcutaneous tissue; the deep 
from all other parts of the body. 
The thoracic duct is about the size of a goose quill and is from 15 to 18 inches 
long. It extends from the level of the second lumbar vertebra to the root of 
the neck where it empties into the left subclavian vein at its junction with 
the left internal jugular vein. This lymph vessel lies just in front of the spinal 
column and receives the lymph from all lymphatic vessels of the body except 
those from the right side of the head, the right upper extremity, the right chest 
and its contents, the right side of the diaphragm, and the upper surface of the 
liver, all of which finally empty into the right lymphatic duct. 
The right lymphatic duct, which is not always present in the body as a dis- 
tinct lymph trunk, is about % to % inch long, lies at the right side of the root 
of the neck, and empties into the right subclavian vein at its junction with the 
right internal jugular vein. 
The lymph glands. 
These are small bean-shaped bodies that occur in groups of from 2 to 15 along 
the courses of the lymph vessels except for a few in the subcutaneous tissue 
that are single. These groups of lymph glands are known as lymph nodes. 
The glands vary considerably in size, are composed of lymphoid tissue, and act 
partly as filters for the removal of minute infective organisms and particles 
from the lymph stream. They also are the source of origin of most of the 
white blood cells known as lymphocytes. 
THE RESPIRATORY SYSTEM AND RESPIRATION 
Respiration, or breathing, in some form is a characteristic of all living 
organisms and without it life cannot continue. It may be defined as the 
process of gaseous exchange between a living organism and the medium in which 
it lives. The medium in which the animals and plants of Earth live is air, 
the mixture of gases which surrounds the earth. One of the gases in air is 
oxygen which both animals and plants require for their vital processes, those 
functions of the body on which life is directly dependent. These vital processes, 
for which the term metabolism is used, are the chemical changes proceeding 
continually in living cells by which the energy to maintain the processes and 
activities necessary for life is provided. In the production of this energy, 
destruction or waste occurs and one of the waste products is the gas called 
carbon dioxide which is exchanged for oxygen in the process of respiration. 
In the single-celled animals and plants the exchange takes place directly between 
the organism and its surrounding medium but in the more complex animals 
some form of respiratory apparatus is necessary. Man and the air-breathing ANATOMY AND PHYSIOLOGY' 
47 
vertebrates are provided with lungs or gills where the waste product carbon 
dioxide is exchanged for oxygen present in the surrounding medium of air. 
The respiratory apparatus. 
In man the respiratory apparatus consists essentially of the lungs and the 
air passages leading into them (fig. 27), the nasal chambers, the mouth, the 
pharynx, the larynx, the trachea, and the bronchi. The thorax, the ribs, and the 
diaphragm and other respira- 
tory muscles taking part in 
respiratory movements may be 
considered as accessory respir- 
atory apparatus. 
The nasal chambers are the 
normal entrance for air to the 
respiratory tract. They are 
irregular, wedge-shaped cavi- 
ties having a vestibule, a re- 
spiratory region and an olfac- 
tory region and are covered 
with a highly vascular mucous 
membrane which in the respir- 
atory region serves to warm 
and moisten the inspired air. 
In the respiratory region there 
are many fine hairs called 
cilia which act as filters and 
remove dust particles from the 
air being inhaled. The nasal 
septum separates the two 
chambers, both of which open 
posteriorly into the pharynx. 
The mouth, strictly speak- 
ing, is a part of the alimentary 
canal or digestive tube, but 
because the back of it connects with the pharynx and respiration can therefore 
be carried on through it when it is open, the mouth is sometimes considered as a 
part of the respiratory apparatus. 
The pharynx, like the mouth, is really a part of the alimentary canal, of 
which it is the expanded upper part. In the respiratory system it serves 
merely as a passageway for the air as it connects above with the nasal cham- 
bers and below with the larynx. 
The larynx, or organ of voice, lies in the upper and front part of the neck 
between the trachea and the hyoid bone and tongue. Above it opens into the 
pharynx, below it becomes continuous with the trachea. It is a triangular, 
box-like structure made up of several cartilages connected together at certain 
points by ligaments and membranes, and the upper part of the largest of these 
cartilages, the thyroid cartilage, forms a marked prominence in the midline of 
the neck which is the so-called “Adam’s apple.” In the upper part of the 
larynx there is a space commonly called the glottis. Along the sides of this 
space, extending from front to back and projecting into it are two pairs of 
elevated folds of mucous membrane. The folds in the upper pair are called 
the false vocal cords; those of the lower, more definite pair are the true vocal 
cords, the chief agents in the production of voice. Extending upward and 
Figure 27.—The larynx, trachea, right and left 
bronchi, and the lungs. The latter have been cut 
open to show the method of division and subdivi- 
sion of the bronchi. (Mason.) 48 
HANDBOOK OF THE HOSPITAL CORPS, IJ. S. NAVY 
backward over the upper opening of the larynx is a thin leaf-like flap of 
fibrous-cartilage called the epiglottis which in the act of swallowing directs 
the material being swallowed into the opening of the oesophagus. 
The trachea, or windpipe, is a wide fibro-muscular tube which extends down- 
ward from the larynx about 4 to 4% inches and there divides into the right 
and left bronchi. It lies in front of the oesophagus and its walls consist of 
fibro-elastic membrane and muscular tissue with a lining of mucous membrane. 
Because of the elasticity of its walls the trachea has considerable mobility but 
to prevent dragging on the roots of the lungs during movements of the head 
and neck the lower end is fixed in its position. Embedded in the fibro-elastic 
membrane of the trachea is a series of from 15 to 20 C-shaped cartilaginous 
bars which strengthen the tube and keep it always open. These bars are 
complete in front but incomplete behind and consequently the back wall of 
the trachea is flattened. In the mucous membrane lining of the trachea are 
many cilia which help to produce an upward movement of the mucus present 
on the surface of the mucous membrane. 
The bronchi begin as the two terminal branches of the trachea and are 
known individually as the right and the left bronchus. They are structures 
similar to the trachea but have cartilaginous plaques instead of bars and each 
bronchus enters into the corresponding lung. There they branch and rebranch 
like a tree, and the smallest branches, the bronchioles, end in tiny membranous 
sacs called air vesicles or alveoli, which are multitudinous in number and make 
up the greater part of the lung substance. The alveoli have very thin walls 
in and about which the blood capillaries are distributed in such numbers that 
they form the densest plexus, or network, of capillaries to be found anywhere 
in the body. The right bronchus is larger, shorter, and more vertical than 
the left and foreign bodies in the trachea are likely to be directed toward it. 
The lungs, two in number, occupy practically all of the cavity of the thorax, 
one being located in each of the two chambers called pleural cavities into 
which the thoracic cavity is divided by the mediastinal septum. They are 
light, soft spongy organs made up of the alveoli, bronchial tubes, blood vessels, 
lymphatics, and nerves, held together by connective tissue. The right lung 
has three lobes and is larger, broader, and shorter than the left which has only 
two lobes. The surfaces of the lungs next to the ribs are convex so as to 
fit the curvature of the thorax, and the other surfaces present concave hollows 
to fit the various organs wdiich are in contact with the lungs. One of these 
hollows is the pericardial concavity which is adapted to the shape of the 
heart. Above the back of this hollow there is a wedge-shaped depression on 
each lung known as the hilum, within which the bronchus, blood vessels, nerves, 
and lymph vessels enter and leave. These structures are bound together by 
a sheath of pleura to form a pedicle or stem by -which the lung is attached 
to the mediastinal wall of the pleural cavity. This pedicle or stem is called 
the root of the lung. There are two types of circulation in the lungs, the pul- 
monary, which brings the blood from the right heart to the lungs for the 
exchange of gases called oxygenation or aeration and returns it to the left 
heart, and that from the bronchial branches of the aorta which supply the 
lung tissue itself. The nerve supply of the lungs is from the vagus nerve and 
the sympathetic nervous system. 
The pleura is a serous membrane which envelopes the lungs and lines the 
walls of the thoracic cavity. It is without a break in its continuity and thereby 
forms a closed sac within which are all the organs located in the thorax. The 
inner surface of the pleura has a smooth, glossy appearance and is moistened 
with a small amount of serous fluid. The portion of the pleura which covers ANATOMY AND PHYSIOLOGY 
49 
tiie lungs is known as pulmonary or visceral pleura and is very firmly bound 
down to the surface of the lung. It is very thin and completely covers the 
entire surface of the lung. At the root of the lung the pulmonary pleura turns 
back on itself to line the walls of the thoracic cavity and it is then known 
as the parietal pleura or, according to the different parts of the thoracic cavity 
it lines, as the costal pleura, the diaphragmatic pleura, the mediastinal pleura, 
and the cervical pleura. Each lung is enveloped in its own pleural sac and 
these sacs do not communicate with each other. The serous fluid on the pleura 
permits respiratory movements of the lungs with little if any friction as 
it acts as a lubricant. The inner surface of the pleura sometimes becomes 
roughened by inflammation and this condition is known as pleurisy. Should 
the thoracic wall be perforated, thus allowing air to enter a pleural cavity, 
the lung of that side will collapse. 
The process of respiration. 
As has been explained at the beginning of this section, respiration is a 
necessity in the life of air-breathing vertebrates and it may be said that the 
purpose of respiration is to supply the body with oxygen and to remove carbon 
dioxide. This interchange of gases, which takes place in the lungs, is known 
as the oxygenation or aeration of the blood, and the actual exchange occurs in 
the alveoli of the lungs. Oxygen and carbon dioxide readily pass through the 
thin membranous walls of the aveoli and of the capillaries because both have 
the property of being able to pass through permeable and semi-permeable mem- 
branes in accordance with the natural laws of diffusion of gases. 
The gaseous exchange or absorption of oxygen and elimination of carbon 
dioxide that takes place in the lungs between the blood in the capillaries in 
the walls of the alveoli and the air in the alveoli may be called external res- 
piration; the similar exchange that occurs in the systemic capillaries between 
the blood and the tissues of the body may be called internal or tissue respira- 
tion. The latter is the respiration truly vital to life. 
In the section concerning blood it was stated that the blood carries oxygen 
from the lungs to the body tissues and carbon dioxide from the tissues to the 
lungs. The oxygen required by the tissues for their activities is carried to 
them principally in chemical combination with the haemoglobin in the red 
blood cells, only a very small amount being carried in physical solution as 
oxygen is not a very soluble gas. In the compound formed by the chemical 
combination of haemoglobin and oxygen, called oxyluemoglobin, the haemoglobin 
is almost completely saturated with oxygen. 
The carbon dioxide produced in the tissues during their metabolic activity 
is removed from them in chemical combination with haemoglobin and with 
constituents in the plasma, and in physical solution in the plasma. Carbon 
dioxide is a very soluble gas and upon reaching the plasma some of it dissolves 
to form carbonic acid which reacts with sodium chloride in the plasma and 
produces sodium bicarbonate, and a small amount is retained in the plasma in 
simple physical solution. The remaining carbon dioxide enters into chemical 
combination with haemoglobin to form carb-hsemoglobin. 
Oxygenated blood reaches the tissues through the blood capillaries at which 
point the oxygen content, and consequently its pressure, is higher than in the 
tissues. This difference in oxygen pressure causes the oxyhaemoglobin, which 
under those conditions has the property of dissociation, to give off free oxygen 
which diffuses through the thin walls of the capillaries and the lymph into 
the tissue cells. 
The blood, having given up its oxygen to the tissues, again contains uncom- 
bined or reduced hemoglobin, and therefore is ready to take up carbon dioxide. 50 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Being under higher pressure in the tissues than in the blood, the carbon 
dioxide diffuses from the tissue cells through the lymph and the capillary 
walls into the blood where it is taken up as previously explained. 
Deoxygenated or impure blood is carried to the lungs where the oxygen 
pressure in the alveoli is higher and the carbon-dioxide pressure lower than 
in the blood. In the lungs the carbon dioxide which was changed into sodium 
bicarbonate changes back to carbon dioxide. On reaching the capillaries in 
the alveoli the lower pressure of the carbon dioxide there causes that in the 
blood to diffuse through the thin walls of the capillaries and of the alveoli 
until an equilibrium in pressure between the carbon dioxide in the blood and 
in the alveoli is reached. At the same time the higher pressure of oxygen in 
the alveoli causes it to diffuse through the walls of the alveoli and the capil- 
laries and enter the blood where it combines with the reduced haemoglobin 
and oxyhaemoglobin is again present in the blood. In the lungs the blood 
does not ordinarily give up all its carbon dioxide as some is required for its 
action in the maintenance of respiration. 
The chemical change attendant upon the formation of sodium bicarbonate 
from carbon dioxide plays an important part in maintaining the slightly 
alkaline reaction of the blood. 
The ordinarily automatic, rhythmical movements of respiration are controlled 
by the respiratory center in the medulla oblongata which originates the impulses 
causing them. These impulses pass down the spinal cord to the nerves which 
supply the respiratory muscles. Probably the most important of these nerves is 
the phrenic which supplies the diaphragm, others being the vagus, supplying the 
larynx, and the intercostals, supplying the muscles of the thorax and abdomen. 
The respiratory center may be affected by. various conditions and it follows 
that the respiration is also affected. An increase in the amount of carbon 
dioxide (which has acid properties) in the blood increases the acidity of the 
blood and is immediately followed by increased respiratory movements. A 
decrease in the amount of carbon dioxide in the blood can cause all respira- 
tions to cease, which condition will remain until the normal amount of carbon 
dioxide is again present in the blood which stimulates the respiratory center 
and breathing is resumed. External sensations may affect the respiratory 
center; for example, the splashing of cold water on the face and chest often 
will stimulate resumption of breathing; a sudden plunge into cold water 
will cause a deep, gasping respiration. Emotional disturbances affecting the 
higher centers of the brain may alter respiration; for example, in excitement 
the respirations may increase while in shock they are usually shallow and 
sighing; laughing, crying, speaking, or singing, may to some extent modify 
respiratory movements. If for any reason the respiratory center loses its 
blood supply failure of respiration will ultimately occur. 
As has been stated in the section concerning muscles, the respiratory muscles 
ordinarily act automatically without conscious effort of the will. Activity of 
those muscles produces alternate inspirations and expirations of air in and out 
of the lungs which, with a period of rest between movements, constitutes what 
is called the cycle of respiration. This cycle is divided into three phases: 1. 
Inspiration, or the flow of air into the lungs; 2. Expiration, or the flow of air 
out of the lungs; and 3. A period of rest. 
The cycle is completed about 14 to 18 times per minute in the normal adult 
while at rest. In the act of inspiration the diaphragm contracts and the ribs 
are elevated by the accessory muscles of respiration, thus enlarging the thoracic 
cavity and creating a negative pressure in the cavity. This permits the lungs 
to expand and causes the outside air to rush in and equalize the pressure. In ANATOMY AND PHYSIOLOGY 
51 
expiration the diaphragm relaxes, and the elasticity of the lungs, together 
with the weight and the elasticity of the chest walls, causes the chest to return 
to its original size, expelling a certain amount of air from the lungs. 
The lungs, when filled to their utmost capacity, hold about 4,500 cc of air. 
Practically 500 cc of air is breathed out at a normal quiet expiration. This 
air which is changed at each respiration is called the tidal air. The amount 
of air breathed out or in may be increased by forceful expiration and inspira- 
tion. The amount of air left in the lungs after the most forceful expiration is 
about 1,000 cc and is known as the residual air. Under normal conditions the 
reserve supply of air in the lungs is about 2,600 cc. 
Certain sounds are produced by the entry and exit of air from the alveoli 
of the lungs and the bronchi. These sounds may be variously modified in 
lung diseases. 
Certain abnormal types of breathing may be noted. Dyspnoea is labored or 
difficult breathing. Apnoea is a condition in which there is a temporary cessa- 
tion of breathing. Asphyxia is the condition produced by oxygen starvation 
and is caused by prolonged interference with the aeration of the blood. 
THE DIGESTIVE SYSTEM AND DIGESTION 
In order to understand the processes concerned with digestion, it is necessary 
to know the meaning of the various terms used in describing this process. 
Digestion is the process or act by which various food substances are con- 
verted into simpler substances which can be absorbed and assimilated. 
Mastication is the division of food into small particles. This is accomplished 
by means of the teeth. 
Insalivation is the mixing of food with the saliva. 
This takes place within the mouth. 
Deglutition or swallowing is the act of transferring 
food from the mouth to the stomach. 
Enzymes are complex organic substances capable of 
effecting, by catalytic action, the transformation of some 
other compound or compounds. 
Absorption, as applied to digestion, means the taking 
up of digested food products, either in solution or sus- 
pension, by the blood and the lymph from the alimentary 
tract. 
Peristalsis is a wave-like contraction which passes 
along the intestinal tract. This movement moves or 
propels the contents of the intestine. 
Defsecation is the term applied to the act of expelling 
fgeces from the rectum. 
The digestive system consists of the alimentary canal 
and the accessory organs (fig. 28). The alimentary canal 
is a continuous tube extending from the mouth to the 
anus, 28 to 30 feet long and varying in size. It is com- 
posed of the mouth, the pharynx, the (esophagus, the stomach, and the small and 
large intestine. The accessory organs of digestion are the teeth, the tongue, the 
salivary glands, the liver, the gall bladder, and the pancreas. 
The mouth or buccal cavity is nearly oval in shape, and is formed in front 
by the lips; above, by the hard palate in front and the soft palate behind; at 
the sides, by the cheeks; and below or at the floor, by the tongue. This cavity 
opens posteriorly into the pharynx from which it is partially separated by the 
Figdeb 28.—Diagram 
of the alimentary 
tube and its append- 
ages. (Testut.) 52 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
uvula, a small flap of mucous membrane hanging from the soft palate, and the 
anterior pillars of the fauces, two curved folds of mucous membrane running 
from the uvula to the sides of the base of the tongue. In the small depression 
between the anterior and the posterior pillars of the fauces, on either side, is a 
small mass of lymphoid tissue called the tonsil. The semicircular borders of 
the upper and lower jaw bones, the alveolar processes, contain sockets for the 
reception of the teeth, of which there are two sets, the deciduous, or “milk” 
teeth, which erupt between the ages of 6 months and 3 years and are 20 in 
number, and the permanent teeth, which replace the first set between the ages 
of 6 and 21 years. In the adult there are 32 teeth, 16 in each jaw, 4 incisors, 2 
cuspids (canines), 4 bicuspids, and 6 molars. The structure of the teeth is 
described in the section on Emergency Dental Treatment (p. 160). 
The tongue is a muscular organ occupying the floor of the mouth. It is 
covered with mucous membrane, contains the special organs of taste, is an 
important organ of speech, and assists in the mixing and swallowing of food. 
The salivary glands, consisting of three pairs, are compound glands which dis- 
charge their secretion, saliva, into the mouth. The parotid glands situated in 
front of and below the ears, discharge their secretion by way of Stensoris ducts 
which enter the mouth opposite the second upper molar teeth. The submaxil- 
lary glands, lying under the lower jaw, and the sublingual glands, lying under 
the tongue, discharge their secretion by way of ducts opening into the floor of 
the mouth and known as Wharton’s ducts. 
The pharynx is the expanded upper part of the alimentary canal and lies be- 
hind and communicates directly with the mouth, the nasal chambers, and the 
larynx. By means of the Eustachian or auditory tubes it also communicates 
with the tympanic cavities, or the middle ears. That part of the pharynx 
which is above the level of the soft palate is used only for respiration, the 
other part is used for the passage of food. It is a fibro-muscular structure and 
extends from the base of the skull, above, to the level of the sixth cervical 
vertebra below, where it joins and is continuous with the oesophagus. It is 
somewhat funnel-shaped with the wide part at the top. The upper part is 
open in front but the lower part gradually becomes tube-like, the anterior and 
posterior walls finally join, and the opening reduces in size until it is only a 
slit except during the passage of food. 
The oesophagus, or gullet, is a muscular tube about 10 inches long extending 
from the pharynx, above, to the stomach, below. It is situated practically in 
the median line of the body and inclines slightly to the left. Its upper part 
lies directly behind the trachea and in front of the vertebral column, the re- 
mainder in front of the vertebral column. It passes downward through the 
thoracic cavity and pierces the diaphragm about one-half inch above its termi- 
nation at the cardiac orifice of the stomach. Its walls are composed of three 
layers, an inner lining of mucous membrane, a middle layer of connective 
tissue, and an outer coat of both voluntary and involuntary muscle tissue. In 
addition it is surrounded by a covering of connective tissue which permits its 
free movement and by which it is loosely connected to the various structures 
adjacent to it. 
The remaining parts of the digestive system are located in the abdomen 
which will be briefly described before continuing with the digestive system. 
The abdomen is that portion of the trunk lying below the diaphragm and 
consists of a wall made up in part of bones, muscles, tendons, etc., and of the 
largest cavity in the body in which are contained the stomach, liver, gall blad- 
der, intestine, pancreas, spleen, kidneys, bladder, some of the generative organs, 
blood vessels, nerves, etc. This cavity is termed the abdominal cavity but for ANATOMY AND PHYSIOLOGY 
53 
descriptive purposes is considered in two parts, an upper, larger part called 
the abdomen proper, and a lower, smaller part called the pelvis. The abdom- 
inal cavity in the adult male is shaped much like a barrel, with the upper 
end bounded by the diaphragm and somewhat wider than the lower. For 
convenience in describing or locating the or- 
gans contained in the abdominal cavity the 
abdomen is considered as divided into nine 
regions by imaginary lines drawn on its 
ventral surface and each region is named 
appropriately (tig. 29). A continuous, smooth 
membrane known as the peritoneum covers 
the wall of the abdominal cavity and the sur- 
faces of the organs in it. 
The peritoneum is a thin, glistening, serous 
membrane composed of a layer of fibrous tis- 
sue covered over on the cavity side with a 
layer of flattened endothelium which secretes 
a small quantity of serous fluid known as 
peritoneal fluid that lubricates the inner sur- 
face of the peritoneum and permits movement 
of the structures in the cavity with the least 
degree of friction. In the male the peritoneum 
is a completely closed sac but in the female 
it is indirectly open to the surface. The 
portion of the peritoneum lining the walls of 
the abdominal cavity is known as the parietal 
peritoneum; that which clothes the organs, or 
viscera, therein is known as the visceral peritoneum. Parts of the duodenum, 
the colon, the bladder, and the kidneys are not covered with peritoneum; the 
remaining principal abdominal organs are completely clothed with it. Numerous 
folds of the peritoneum extend between the various organs and serve to connect 
them with the posterior wall of the abdomen and with one another, such as 
the various ligaments of the liver, 
and the mesentery which holds the 
intestine in place and contains 
the vessels which supply it. The 
omentum, an apron-like structure 
composed of four layers of peri- 
toneum with enclosed fat, is pend- 
ant from the transverse colon and 
is freely movable. It is of service in 
walling off inflammations or infec- 
tions within the abdominal cavity. 
The stomach is a hollow, mus- 
cular organ situated in the ab- 
domen between the oesophagus, 
above, and the small intestine, be- 
low (fig. 30). In shape it is 
much like a gourd, its wide, upper 
end, which is called the fundus, lying in the hollow of the diaphragm and directed 
upward, backward, and to the left, and its narrow, tapering end passing down- 
ward, forward, and to the right. The fully distended stomach of an adult is 
about 10 to 11 inches long, its greatest diameter is about 4 to 4% inches, and its 
Figure 29.—Surface markings of 
thorax and abdomen. (Gray, 
modified.) 
Figure 30.—The stomach. (Cunningham 
modified. 54 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
average capacity is about 2 to 2y2 pints. The size and shape of the stomach 
depend considerably upon its contents. The stomach has two openings, one at 
the upper, oesophageal end called the cardiac orifice, and one at the lower, 
intestinal end called the pylorus or pyloric orifice. The portion of the stomach 
about the cardiac orifice is called the cardiac part, that about the pyloric orifice 
the pyloric part. The portion of the stomach which extends from the fundus to 
the pyloric part, called the body of the stomach, forms a rounded chamber, is 
capable of great distension, and contracts to a narrow, tube-like structure when 
the stomach is empty. Surrounding the pylorus is a circular ring of muscle called 
the sphincter pylori which closes and opens the stomach outlet. The upper sur- 
face of the stomach is concave and is known as the lesser curvature; the lower 
surface is convex and is known as the greater curvature. The walls of the 
stomach consist of four layers of tissue, a thick, inner lining of mucous mem- 
orane, a layer of strong connective tissue closely attached to the lining and 
loosely to the muscular layer, a layer of muscular tissue in which the fibers 
are arranged circularly, obliquely, and longitudinally in sets, and an outer coat 
of serous membrane which is formed of the peritoneum. When the stomach is 
empty the three outer coats contract and the inner coat is thrown into many 
folds which disappear when the stomach is distended. In the inner lining are 
numerous glands which secrete the gastric juice. 
The intestine is a musculo-membranous tube about 28 feet long beginning 
at the pyloric orifice of the stomach and ending at the anal orifice which opens 
on the surface. It consists of the small and the large intestine which together 
occupy a large portion of the abdominal and pelvic cavities. The small intestine 
is about 23 feet long and is divided into three parts, the first, the duodenum, 
immediately succeeds the stomach and is about 1 foot long; the second, the 
jejunum, is about 9 feet long; and the third, the ileum, is about 13 feet long. 
The duodenum lies in a horseshoe-shaped curve and is closely fixed to the pos- 
terior abdominal wall; the jejunum and the ileum lie in a series of irregular 
loops which hre quite freely movable. The small intestine is made up of 
four layers of tissue, an inner lining of mucous membrane, a layer of loose but 
strong connective tissue attached to the lining and the muscular layer, a layer 
of muscle tissue consisting of an inner stratum of involuntary muscle fibers 
arranged circularly and an outer stratum of involuntary muscle fibers arranged 
longitudinally, and an outer coat of serous membrane which is formed of the 
peritoneum. The mucous membrane lining of the small intestine lies in folds, 
some of which disappear when the intestine is distended while others are 
permanent, and when examined it presents a soft, velvety appearance because 
of the presence on it of an enormous number of minute, fingerlike projections 
called villi (fig. 31). The villi contain small blood capillaries and lymph ves- 
sels, called lacteats, and play an important part in the process of digestion by 
collecting digested food products. In the mucous lining are also many simple 
glands which secrete a digestive fluid, the intestinal juice. The small intestine 
opens into the large intestine through the ileoccecal orifice at the junction of the 
caecum with the ascending colon. This opening is guarded by a valve called 
the ileoccecal valve which prevents the regurgitation of contents of the large 
into the small intestine. The valve consists of two cresent-shaped segments 
or folds that project into the caecum and are continuations of the walls of 
the ileum. The muscle fibers in these segments keep the opening which lies 
between them closed except during the passage of digested food from the small 
into the large intestine. 
The large intestine begins on the right side about 2y2 inches below the 
ileocaecal junction and extends to the anus. It is about 5 feet long, is larger 
in diameter than the small intestine, and is divided into the following parts: ANATOMY AND PHYSIOLOGY 
55 
the ccecum; the ascending colon, which curves at the lower border of the liver to 
form the hepatic flexure; the transverse colon which crosses the abdomen from 
right to left to the splenic region where it curves downward, forming the splenic 
flexure; the descending colon, which descends to the brim of the pelvis over 
which it curves to form the sigmoid flexure; and the rectum, the terminal 
dilated portion of the intestine that communicates with the outside through 
the anal orifice. The walls of the large intestine are arranged in the same 
manner as those of the small intestine, and are of the same structure, except 
that the longitudinal muscle fibers of the large intestine are arranged in three 
Capillaries 
Lymph trunk 
Lymph trunk 
Figure 31.—Villi of small intestine. (Cadiat.) 
• Lymphatic plexus 
bands which extend the entire length of the colon and are a little shorter than 
the colon, thus causing the walls to pucker. The mucous lining of the large 
intestine is smooth and contains no villi, but secretes a mucus which lubricates 
the tube. At the blind end of the caecum is a small worm-like projection called 
the vermiform appendix which is the seat of the pathological condition known 
as appendicitis. 
This concludes the description of the structures and organs comprising the 
alimentary canal and the accessory organs of digestion which have not been 
discussed will now be considered. 
The liver is the largest gland in the body and weighs from 50 to 60 ounces 
in the normal adult (fig. 32). This organ measures 8 to 9 inches from side 
to side, 4 to 5 inches perpendicularly, and 6 to 7 inches from front to back, is 
located in the very upper part of the abdomen, directly beneath the diaphragm, 
more of it lying to the right side than to the left, and is held in position by 
ligaments which are formed by the peritoneum. Its general shape is that of 56 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
a wedge, much thicker at the right than at the left, and with the thin edge 
turned forward. The upper surface of the liver is convex, conforming to the 
dome shape of the diaphragm. The lower surface is irregular and contains 
many fissures and fossae. 
The liver is divided into five lobes by five fissures, the largest of which' 
is the transverse fissure, through which the vessels, ducts, and nerves enter 
and leave the organ. The liver has a double blood supply, one being from 
the hepatic artery of the systemic circulation, and the other from the portal 
vein carrying absorbed food mate- 
rial from the intestine. The drain- 
age for both sets of capillaries is 
the hepatic vein which empties into 
the inferior vena cava. The liver 
is made up of many minute lobules 
of liver cells arranged concentric- 
ally about a central vein, which is 
a small venule of the hepatic vein. 
The lobules are held together by 
connective tissue which contains 
the capillaries of the hepatic artery 
and the portal vein, as well as the 
bile ducts, and the blood from 
these vessels comes in close asso- 
ciation with the liver cells in order 
to reach the central venule. In the gall-bladder fissure on the lower surface of 
the liver is the gall-bladder, a small, muscular, pear-shaped sac about 3 to 4 
inches long which serves as a reservoir for the bile. 
Bile is partly an excretion which carries off certain waste products, and partly 
a secretion that plays an important part in the absorption of fats, and has been 
thought to limit putrefaction in the intestine to some extent. It is a thin, 
watery or a viscid, golden-yellow or dark olive colored liquid with a specific grav- 
ity varying from 1.050 to 1.10, a feebly alkaline reaction, and a complex composi- 
tion. It is secreted normally in amounts of from 500 to 800 cc per day and 
contains a pigment, bilirubin, which is derived almost entirely from the break- 
down of haemoglobin in the liver. Although formed more or less continually 
in the liver cells, bile enters the intestine only during periods of digestion, 
being prevented from entering at other times because the opening of the com- 
mon bile duct is closed, and it therefore backs up into the gall-bladder. Bile 
is collected from the liver cells by the biliary ducts which unite and gradually 
form larger and larger ducts that finally end in two main ducts which leave the 
liver and immediately join together to form the hepatic duct. The hepatic 
duct is soon joined by the cystic duct from the gall-bladder to form the common 
bile duct which enters into the duodenum with the pancreatic duct. 
The functions of the liver are important and numerous and are as follows: 
1. Bile secreting.—It manufactures and secretes bile. 
2. Glycogenic.—It manufactures glycogen from monosaccharides brought to 
the liver from the digestive tract by the portal vein. Glycogen is stored in the 
liver and is reconverted into dextrose by the action of a special enzyme at such 
times as body activities require it. Because it has the same chemical formula 
as the general one given to starch (CoBboOsK glycogen is sometimes called 
“animal starch.” 
3. Storing of fat.—A certain amount of fat may be stored within the liver 
cells. 
Figure 32.—The liver. (Cunningham modified) ANATOMY AND PHYSIOLOGY 
57 
4. Urea producing.—Takes up nitrogenous waste products from the blood and 
converts them into urea, which is discharged back into the blood stream for 
elimination by the kidneys. 
5. Removes by means of the bile certain other waste products, such as broken- 
down red corpuscles, disintegrated liver cells, and bile pigments. 
6. The liver is considered as the source of fibrinogen and prothrombin. This 
organ is the site of origin of blood cells in the embryo. 
The pancreas is a compound gland, long and irregularly prismatic in shape, 
and situated in the abdomen behind the stomach at about the level of the 
second lumbar vertebra (fig. 33). It has a head, which lies in the concavity 
Figure 33.—Pancreas. (Mason, modified.) 
of the duodenum, a neck, a body, and a tail, which touches the spleen. It is 
about 5 to 8 inches long, the three surfaces of the body are each about 1*4 
inches wide, and it secretes the pancreatic juice, a digestive fluid which is one 
of the chief agents in intestinal digestion, and is carried to the duodenum by 
the pancreatic duct. Beginning in the tail of the gland this duct runs from 
left to right through the body and neck into the head where it leaves and enters 
into the duodenum with the common bile duct. During its course through the 
gland the pancreatic duct receives tributary ducts from all portions of the 
gland and increases in size until, near the duodenum, it is about as large as a 
goose quill. In the connective tissue between the lobules of the gland are small 
areas of modified glandular tissue having no ducts which are known as the 
Islands of Langerhans and secrete a substance which is discharged directly 
into the blood stream. The function of this secretion will be described in the 
section on ductless glands. 
The process of digestion. 
Before describing the process of digestion the substances used as foods 
must be briefly considered. Foods are those substances necessary to maintain 
the normal composition of the body by building up tissue or, by oxidation, 
supplying heat and energy. Foods include: 1. Water; 2. Inorganic salts, 
principally of sodium, calcium, potassium, magnesium, and iron; 8. Vitamins, 
organic chemical compounds essential to normal life and growth; 4. Proteins, 
nitrogen-containing substances, chiefly lean meats and leguminous vegetables; 
5. Carbohydrates, starches and sugars; and 6. Fats, animal and vegetable oils 
and fats. 58 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Water, inorganic salts, and vitamins are substances essential to life but 
have no energy-producing properties. Water and inorganic salts are necessary 
to maintain the normal composition of the tissues and complete withdrawal 
of either would cause the death of the organism. Vitamins are essential, in 
some as yet unknown way, to normal metabolism. The body’s energy is derived 
from the proteins, carbohydrates, and fats, complex organic substances whose 
chemical structure is known in whole or in part. After being eaten these 
substances must undergo various chemical changes, generally spoken of as 
metabolism, before they can be utilized by the body. These chemical changes 
take place during the jirocess known as digestion, break up the complex mole- 
cules of the substances into forms that the tissue cells are adjusted to act 
upon, and are attended by the production of heat. Foods are more fully 
discussed in the chapter on Diets and Messing for the Sick. 
The process of digestion begins in the mouth and ends in the small intes- 
tine and is both mechanical and chemical. The mechanical features of the 
process include the chewing and grinding of the food, the passage of the food 
along the alimentary canal by muscular action, and the mixing of the food 
and its dilution and solution in aqueous secretions. The chemical changes that 
take place in food during digestion are brought about by the action of sub- 
stances in the digestive fluids called enzymes, or digestive ferments, the latter 
term being used because they act upon foods used by the body. 
In the definition for these substances given at the beginning of this section 
it is stated they effect the transformation of other compounds by catalytic 
action. By catalytic action, or catalysis, is meant a reaction or change pro- 
duced in a substance by contact with another sitbstance called the catalytic 
agent or catalyst which itself appears to remain unchanged as a result of 
the reaction it has produced. As the enzymes which bring about the changes 
in foods necessary for them to be used by the body are produced in living 
body cells they could well be termed organic catalysts. 
The chemical composition of enzymes is complex, uncertain, or unknown, 
and although they all apparently contain nitrogen, and most of them sulfur, 
aboxit all that can be said positively in regard to their chemical structure 
is that they are organic substances derived from living cells and are colloids 
or so closely associated with colloids that they have not been isolated in a 
noncolloidal state. 
The action of enzymes is specific to a high degree, a given enzyme attacking 
only a certain compound or group of compounds. Consequently the enzymps 
that act upon carbohydrates cannot affect proteins or fats, those acting on 
proteins cannot affect fats, etc. Even closely related substances such as malt- 
ose and lactose seem to require their own specific enzyme. 
The enzymes concerned in human digestion and nutrition are classified 
according to the nature of the substances upon which they act, the principal 
classes being shown in the following table: 
Classes of Enzymes 
Name 
Action 
Example 
Proteolytic 
Amylolytic . 
Protein splitting - 
Pepsin of gastric juice; trypsin of pancreatic juice; erepsin of 
pancreatic and intestinal juices. 
Ptyalin of saliva; amylase of pancreatic juice. 
Lipase of pancreatic juice, of liver, connective tissue, etc. 
Maltese of saliva and of intestinal juice; invertase of intestinal 
juice; lactase of intestinal juice. 
Rennin of gastric juice. 
Lipolytic- 
Pat splitting - 
Glycolytic-. 
Sugar splitting 
Coagulating 
Convert soluble to in- 
soluble proteins. ANATOMY AND PHYSIOLOGY 
59 
In the table which follows the enzymes that take part in the process of 
digestion are arranged in groups under the class title of the substances on which 
they act. 
Name 
Chiefly found in 
Action 
Acting on carbohydrates: 
Piyalin___ 
Converts starch to sugar (maltose). 
Do. 
Converts cane-sugar to dextrose and levulose. 
Converts maltose (malt sugar) to dextrose. 
Converts lactose (milk sugar) to dextrose 
and galactose. 
Splits fats into fatty acids and glycerin. 
(Some of fatty acid and alkali forms soap 
which emulsifies fat.) 
Converts proteins to peptones and proteoses. 
Splits proteins, peptones, and proteoses into 
amino-acid compounds. 
Splits amino-acid compounds into their 
constituent amino-acids. 
Precipitates casein from caseinogen and 
makes the curd of milk. 
Amylase - 
Invertase . 
Intestinal juice. 
Maltase 
Lactase- 
Saliva, intestinal juice, pan- 
creatic juice. 
Acting on fats: 
Lipase (steapsin) 
Pancreatic juice-. ... 
Acting on proteins; 
Pepsin - .. 
Trypsin 
Pancreatic juice .. 
Erepsin 
Pancreatic juice, intestinal 
juice. 
Gastric juice 
Rennin.__ 
In the process of digestion, food is first taken into the mouth where mastica- 
tion takes place. This is accomplished by the teeth and the lower jaw and after 
this mechanical dividing or grinding the food presents a larger surface for the 
action of the saliva. During mastication the saliva pours into the mouth from 
the salivary glands and is mixed with the food through the movements of the 
tongue and the muscles of the cheeks. This moistens and softens the food, and 
starch is converted into sugar through the action of the salivary enzymes, 
ptyalin and maltase. As found in the mouth, saliva is a colorless or opales- 
cent, turbid, and viscid liquid with a specific gravity of about 1.003 and a 
neutral or slightly acid reaction. The enzyme pytalin converts starch to mal- 
tose (malt sugar), and maltase breaks up the maltose into dextrose. The 
presence of food in the mouth and the sight and smell of appetizing foods act 
as nerve stimuli to increase the amount of saliva necessary for mouth digestion. 
The food taken into the mouth has there been reduced to a consistency suit- 
able for swallowing and has been formed into what is known as a bolus. By 
deglutition, or swallowing, the bolus passes from the mouth to the pharynx 
and thence into the oesophagus through which it is carried into the stomach. 
The act of swallowing is largely voluntary but the final stage and the pas- 
sage of the bolus through the pharynx and oesophagus is the result of involun- 
tary muscular action. The musculature of the oesophagus causes a contrac- 
tion of the tube to occur immediately after the passage of the bolus which 
follows the bolus from above downward like a wave, finally forcing it through 
the cardiac opening of the stomach. This wave-like contraction is called 
peristalsis. 
In the stomach the food which has been swallowed is thoroughly mixed 
with the gastric juice by muscular movements of the stomach walls. These 
movements, somewhat peristaltic in character, not only mix the food and the 
gastric juice but eject the liquefied portions of the food into the duodenum. 
As digestion proceeds in the stomach the food becomes a thin, liquid mass 
known as chyme, which periodically passes through the pylorus into the duo- 
denum. 
In the mucous membrane of the stomach are myriads of simple glands called 
gastric glands which secrete the gastric juice, a thin, colorless or nearly color- 
1542940—39 5 60 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
less liquid with a specific gravity of about 1.002 to 1.003, a strongly acid reaction 
because of the presence in it of hydrochloric acid, and a characteristic odor. 
Two enzymes, pepsin and rennin, and perhaps a third, lipase, are found in the 
gastric juice. The flow of gastric juice occurs partly in response to nerve 
impulses sent to the stomach as a result principally of the sensory impressions 
of taste and smell received in the brain, and partly by the presence of chemical 
substances in the stomach itself. Hard work should not be performed or 
strenuous exercise taken immediately after eating as this retards digestion in 
the stomach chiefly by checking the flow of gastric juice, with gastric distress 
and possibly vomiting as a result. Nor should a hearty meal be eaten when 
physically exhausted because the nervous, circulatory and digestive systems can- 
not properly perform their parts in the process of digestion. The food on mix- 
ing with the gastric juice becomes acid in reaction. The hydrochloric acid in the 
gastric juice stops the action of pytalin, aids in coagulating proteins, activates 
the enzyme pepsin which is secreted in an inactive form, pepsinogen, and seems 
to favor relaxation of the pyloric sphincter, which remains closed after each 
ejection of chyme until the acidity of the ejected chyme in the duodenum has 
been neutralized. The enzyme pepsin prepares the proteins of the food for 
complete digestion by breaking them down into simpler chemical compounds 
known as peptones and proteoses. Rennin, which is present in many persons 
only during early life, precipitates casein from the caseinogen in milk and causes 
the milk to clot, or curdle, and form a curd. Lipase, which when present is in 
small amounts, has very little activity in the stomach, its action probably 
being the splitting up of the finely emulsified fat found in milk. 
The chyme on passing into the duodenum from the stomach consists of water, 
inorganic salts, partially digested foods, and the indigestible portion of meats, 
cereals, and fruits. The acid character of the chyme causes the secretion and 
discharge of the intestinal fluids secreted by glands in the mucous membrane 
of the duodenum and of the small intestine, the pancreatic juice, and the bile. 
The intestinal fluids, which are alkaline in reaction, exert a neutralizing and 
precipitating influence on the various constituents of the chyme and as soon as 
this occurs gastric digestion ends and intestinal digestion starts. 
Beginning in the duodenum, intestinal digestion is largely completed by the 
time the food reaches the ileo-csecal valve and produces the important changes 
in the food necessary for its absorption. In intestinal digestion the partially 
digested food received from the stomach is subjected to the action of the pan- 
creatic juice, the intestinal juice, and the hide. These secretions mix with the 
food from the duodenum on and they act at the same time. 
The pancreatic juice in man is a thin, limpid liquid with a specific gravity of 
about 1.0075 and an alkaline reaction. It is undoubtedly the most important 
digestive fluid in the body and contains four enzymes, trypsin and erepsin, 
proteolytic enzymes, amylase (also known as amylopsin), a starch-splitting 
enzyme, and lipase (also known as steapsin), a fat-splitting enzyme. Trypsin, 
like pepsin, is secreted in an inactive form trypsinogen, which is activated by 
enterokinase, a constituent of the intestinal juice. The erepsin in the pan- 
creatic juice is similar to that in the intestinal juice. Lipase is aided and 
facilitated in its action by the presence of bile. The action of the pancreatic 
enzymes is shown in the table on page 59. 
Human bile plays an important part in the digestion and absorption of fats 
as it accelerates the action of lipase and perhaps of amylase, and helps in the 
neutralizing of the hydrochloric acid of the gastric juice. It is also considered 
to aid in lubricating the intestine to facilitate the passage of indigestible and 
waste matter. 61 
ANATOMY AND PHYSIOLOGY 
Peristaltic movement forces the contents of the small intestine along until 
finally they enter the large intestine through the ileo-csecal valve, at which 
time digestion is virtually complete. When the contents of the small intestine 
enter the large intestine they contain some unabsorbed food material, and, as 
they also contain digestive enzymes received in the small intestine, it is 
probable that digestion and absorption continue for a time in the large intestine. 
The indigestible waste material, combined with certain waste substances from 
the bile and intestinal secretions, passes slowly along the large intestine by 
peristaltic movement and rapidly loses its water content by absorption until, 
by the time it reaches the descending colon it has acquired the consistency of 
fceces. When the faeces reach the terminal portion of the large intestine they 
are ready to be expelled from the body by the act of defaecation. 
By digestion the carbohydrates, proteins, and fats contained in the various 
foods that have been eaten have been changed into substances of simpler 
chemical composition. Starches and compound sugars have been changed into 
simple sugars, proteins have been broken down into their constituent amino- 
acids, and fats have been finely emulsified and split into fatty acids and 
glycerin, all of which are forms suitable for absorption. 
In physiology absorption is a term to describe the passage of digested 
foods from the alimentary canal into the blood or lymph. The absorption of 
food takes place principally from the small intestine. There is some food 
absorption and a large absorption of water from the large intestine, and little 
or no absorption from the stomach. Absorption from the small intestine takes 
place by two paths: 1. By the capillaries of the villi to the blood stream; 
and 2. By the lymphatics to the thoracic duct and the superior vena cava. The 
products of fat digestion are taken up chiefly by the lymph capillaries, or 
lacteals, in the villi and carried by the lymph stream into the thoracic duct 
and finally into the blood stream at the junction of the left Internal jugular 
and the left subclavian veins. A small amount of fat is absorbed by the blood 
capillaries, part of which is appropriated by the liver for its own use and 
storage. The products of protein and carbohydrate digestion are taken up by 
the blood in the capillaries of the villi and carried through the portal circula- 
tion to the liver. In the liver the excess of dextrose (simple sugar) is with- 
drawn and changed to glycogen by the action of the liver cells, the amount of 
sugar in the blood remaining constant. Some of the amino-acids are also 
converted to glycogen by the action of the liver cells with the formation of 
urea, which is carried in the blood to be excreted by the kidneys. The glycogen 
is stored in the liver to be liberated again as dextrose when needed by the 
body. 
THE SPLEEN AND OTHER DUCTLESS GLANDS 
The term ductless glands is applied to those organs whose function is to 
produce special secretions containing hormones, which are discharged into the 
blood or the lymph. These organs are also called endocrine glands or glands of 
internal secretion and, as previously stated, are of glandular structure and have 
no ducts. A hormone is a chemical substance produced in a more or less 
distant organ which, carried by the blood or lymph to a functionally associ- 
ated organ, excites the latter to activity. The glands generally spoken of as 
ductless glands are the thyroid, the parathyroid, the thymus, the suprarenals, 
the pituitary iodyr or hypophysis, and the pineal body, or epiphysis. The 
spleen, though it has no ducts, has not been found to have an internal secre- 
tion, and therefore, while anatomically a ductless gland, physiologically it is 
not a gland of internal secretion. Some other glands in the body that have 62 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
ducts, as the pancreas and the gonads (testes in the male, ovaries in the 
female), also form internal secretions that are discharged directly into the 
blood and therefore act as ductless glands in addition to their more obvious 
functions. There are a few other ductless glands which will not be described 
in this section. 
The spleen is situated in the upper left part of the abdomen directly beneath 
the diaphragm in front of the upper part of the left kidney and behind and 
to the left of the stomach. Its border is roughly oval or circular in outline, 
its size varies greatly, and its average weight is from 5 to 8 ounces. It is a 
soft, highly-elastic, contractile organ, purplish in color, and composed of a 
fibrous capsule containing a soft substance called pulp in which nodules of 
lymph tissue are embedded. There are no capillaries in the spleen, the blood 
escaping from the arterioles into the pulp and being collected from the 
pulp by the small venules. The spleen is known to be active in the destruction 
of defective blood cells, both red and white, as well as being the source of 
some of the lymphocytes of the blood stream. It undoubtedly has othen 
functions not now definitely known. In some diseases, as chronic malaria, 
it becomes greatly enlarged. 
The thyroid gland is a highly vascular body situated anteriorly in the 
neck at the junction of the trachea with the larynx, and its tissue consists 
of spherical vesicles lined with epithelium and containing a fluid called colloidal 
material. It is composed of two conical lobes connected across the median 
line by a narrow strand of gland tissue called the isthmus, one lobe lying on 
each side of the larynx and extending upward. The gland secrets a sub- 
stance called thyroxin which contains a large percentage of iodine and has a 
marked influence on body growth and on nervous stability. Complete removal 
of this gland, leaving the parathyroids uninjured, does not cause death but 
does cause marked changes in metabolism and is usually followed by a state 
of chronic malnutrition or cachexia. Cretinism is the result of a congenital 
defect or atrophy of the thyroid gland, which causes the arrest of skeletal 
and mental development. On atrophy of this gland in the adult, a similar 
phenomenon called myxcedema results, the body becomes puffed and pasty, 
and the mentality blunted. In hyper-thyroidism, or goiter, there is an extreme 
nervousness, increased metabolism, quickened heart action, and in some cases 
protrusion of the eyeballs (exophthalmos). 
The parathyroids, usually four in number, are small grain-like bodies located 
on or near the posterior surface of the lobes of the thyroid, two on each side. 
The internal secretion which they furnish regulates calcium metabolism which 
is so essential in bones, blood, and other tissues, and is believed to aid in 
neutralizing certain toxic substances. Complete removal of the parathyroids 
is followed by acutely toxic results, muscular tetany, and death. 
The thymus is located in the thorax posterior to the sternum and varies 
greatly in size in different individuals and at different ages. It is considered 
to consist of two lobes, one on each side of the midline, and to reach its 
maximum size in childhood. While it undergoes atrophy after puberty it does 
not entirely disappear. Its function is obscure but it is believed it exerts 
an influence on body growth and the development of the reproductive organs. 
The suprarenals, or adrenal glands, are two flattened bodies situated in the 
back part of the abdomen which lie like caps over the upper pole of each kid- 
ney. These glands consist of two portions, an inner, highly vascular mass of 
tissue called the medulla enclosed within an outer portion, or capsule, of cor- 
tical substance called the cortex. The cortex in turn is surrounded by a capsule 
of fibrous tissue. Each portion has a separate secretion and function. The ANATOMY AND PHYSIOLOGY 
63 
secretion of the medulla, adrenalin, or epinephrine, is the better known and has 
a marked effect on the tone of the heart and the blood vessels. It increases 
blood pressure by constricting the blood vessels and slowing and increasing 
the force of the heart beat. Its constricting action on blood vessels causes it 
to be used in controlling haemorrhage. Cortin, the secretion of the cortex, 
regulates important phases of the mineral and water metabolism of the body, 
and appears to be of great value in the treatment of Addison’s disease. From 
the cortex was first isolated the substance known as ascorbic acid, which is 
the antiscorbutic vitamin 0. Removal of the cortex results in death. 
The pituitary body, or hypophysis, is a small, oval-shaped gland attached to 
the base of the brain and situated in a depression in the sphenoid bone. It 
consists of an anterior lobe of glandular structure and a posterior lobe com- 
posed chiefly of connective tissue, blood vessels, and nerve cells and to which 
a glandular portion, the pars intermedia, is attached. The anterior lobe is 
larger than the posterior, which it partly encircles, and has been called the 
“master gland” as it appears to influence the activity of most of the other 
glands of internal secretion. This gland, though its size is small and its gross 
structure simple, has the most complex function of the glands of internal 
secretion. In its secretion are a great number of hormones, some of which 
are far from being definitely identified. In the anterior lobe, hormones influenc- 
ing sex, growth, thyroid metabolism, and carbohydrate metabolism are known to 
be present, and in the posterior lobe hormones stimulating contractions of non- 
striated muscles, constricting arteries and raising blood1 pressure, and with 
anti-diuretic action have been found. Over or under production of the growth 
principle in the secretion of the anterior lobe results in pituitary giants or 
dwarfs. 
The pineal body, or epiphysis, is a small, fir-cone-shaped gland about the size 
of a cherry stone situated near the pituitary body but above and back of it. 
Little is known of the function of the pineal gland, but the general conclu- 
sion from evidence now at hand is that it has an internal secretion which counter- 
acts at least some of the functions of the pituitary, particularly the stimula- 
tion of the gonads. It is also necessary for the development of the eyeball, 
very small eyes occurring in its absence. 
The pancreas, mentioned elsewhere as producing digestive enzymes, also pro- 
duces, from areas of specialized tissue called the Islands of Langerhans, a 
hormone called imulin, which like other products of the glands of internal 
secretion, is poured directly into the blood. Insulin is essential in the regula- 
tion of carbohydrate metabolism. An insufficiency, relative or absolute, results 
in the condition called diabetes. 
The gonads, sex glands, male, testes, and female, ovaries, each produce, in 
addition to reproductive cells (spermatozoa and ova), an internal secretion 
which is responsible for the development of appropriate secondary sex charac- 
teristics in the individual. 
THE EXCRETIONS. 
The waste products resulting from the activities of the body are called 
excretions and are discharged to the exterior by organs known as excretory 
organs, some of which are arranged in systems. The discharge of the waste 
products of the body is called excretion and takes place by means of: 1. The 
urinary system, which eliminates water, and certain organic and inorganic 
waste products; 2. The skin, which eliminates water, organic and inorganic 
waste materials by means of perspiration; 3. The lungs, which eliminate cer- 
tain gaseous waste products, such as carbon dioxide, water vapor, and small 64 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
amounts of nitrogen; and 4. The alimentary canal, which eliminates the residue 
remaining after digestion and the waste products discharged into it. 
Normal urine of man varies in color from a pale yellow to a brownish hue, 
is acid in reaction, and has a specific gravity ranging from 1.015 to 1.025. The 
color varies according to the quantity excreted, being pale or light when the 
quantity is large, and dark when the quantity is small and the concentration 
of solids is greater. Various foods and medicinal substances also affect the 
pe. The pelvis of the kidney. 
cor. The cortex, the part between the 
cortex and the pelvis being the medul- 
lary portion. 
pyr. Pyramid. 
ca. The calices. 
m. r. The medullary rays. 
U. The ureters. 
B. The bladder. 
0. u. The ureteral openings. 
1. u. m. The internal urinary meatus. 
o. e. d. The openings of the ejaculatory 
ducts in the prostatic urethra. 
g. u. s. The genitourinary sinus. 
v. m’. The veru montanum. 
b. u. The bulbous urethra. 
d. c. Openings of the ducts of Cowper’s 
glands. 
c. c. Corpus cavernosum. 
c. s. Corpus spongiosum, 
u. Urethra. 
f. n. Fossa navieularis. 
e. u. m. External urinary meatus. 
Figure 34.—Anterior view of the opened genitourinary tract in the male. (Guiteras.) 
color of the urine. The degree of acidity varies at different periods of the 
day and is affected by the character of the individual’s food or by medicinal 
substances taken. The average daily output is from 40 to 50 fluidounces but 
may be more or less, depending upon many factors, among which may be 
mentioned atmospheric temperature, the intake of fluids, disease, medicinal 
substances taken, and other types of elimination of fluids, as in haemorrhage, 
perspiration, diarrhoea, and vomiting. Urine has a characteristic odor which 
is influenced by disease, vegetable foods, and other substances. The chemical 
composition of urine is very complex and is determined partly by tissue metab- 
olism and partly by the quantity and quality of foods consumed and metabo- ANATOMY AND PHYSIOLOGY 
65 
lized. Ordinarily it is composed of about 95 per cent of water and 5 per cent 
of solids comprised of nitrogenous waste products and organic and inorganic 
salts. The chief nitrogenous constituent of urine is urea which is present to 
the extent of about 2 per cent. Other nitrogen compounds are present in minor 
quantities. The inorganic salts are those of sodium, calcium, ammonium, 
potassium, and magnesium, the organic salts are lactates, acetates, and small 
amounts of formates. Certain abnormal constituents as albumin, sugar, indi- 
can, acetone, casts, and blood may be found under pathological conditions. 
The urinary system consists of the kidneys, the ureters, the bladder, and the 
urethra (fig. 34). 
The kidneys are two large, glandular organs situated in the posterior part 
of the abdominal cavity, behind the peritoneum, one on each side of the lower, 
SUBSTANCE- 
DEOULLARV SUBSTANCE 
-PAPILLA, 
RENAL VEINS 
RENAL ARTERIES 
• HILUn SINUS 
Figure 35.—Section of kidney. (U. S. Naval Medical School.) 
movable portion of the spinal column. They extend from about the level of 
the twelfth thoracic to that of the third lumbar vertabrse, the inferior end 
usually being from I1/) to 2 inches above the highest part of the crest of the 
ilium, and the right kidney slightly lower than the left. These organs (fig. 35) 
are bean-shaped and each is about inches long, 2 inches wide, and 1% inches 
thick. On the concave side of each is a deep, notch-like depression called the 
hilum, through which the blood vessels and nerves enter and leave the kidney. 
The hilum extends inward into the kidney to form the narrow space known as 
the sinus of the kidney. Each kidney is surrounded by a thin fibrous capsule 
and lies embedded in a mass of soft fatty tissue. The parenchyma, or special- 
ized glandular tissue, of the kidney is dense and friable, and consists of an 
inner portion called the medullary substance, or medulla, and an outer portion 
called the cortical substance, or cortex. The medullary substance surrounds 
the sinus of the kidney and appears largely in the form of conical masses known 
as renal pyramids, or pyramids, whose apices project into the sinus to form 66 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
small conical elevations called renal papillae, or papillae, whose rounded ends 
are pierced by minute openings called foramina papillaria that are the terminal 
apertures of the tubules of the kidney. Two or three and sometimes six or 
more pyramids end in one papiha, which number from 6 to 18 and cause the 
iloor of the sinus to be uneven. The bases of the pyramids are covered and 
also separated from the surface of the kidney by a layer of the cortical sub- 
stance of the kidney, which also extends inward towards the sinus, between 
the pyramids, in columns known as renal columns. In the cortical substance 
are an immense number of tubules called uriniferous tubules and thousands of 
small structures known as Malpighian bodies or renal corpuscles (fig. 36). 
These bodies are located in the 
cortical substance of the kidney 
and consist of an outer, spherical- 
shaped, membranous sac called 
Bowman's capsule, and an inner, 
minute, convoluted coil of blood 
capillaries called the glomerulus 
(fig. 36). Bowman’s capsule is an 
expansion of the uriniferous tubule 
and its membranous wall folds in 
so that its outer surface becomes 
an inner surface, as when one part 
of a hollow rubber ball is pushed 
inward. Through the opening made 
by the infolding of the wall a small 
artery enters and divides into a 
number of capillaries which coil 
and twist about to form the glomer- 
ulus and later unite in a single 
small vein that passes out through 
the same opening. The infolded 
wall of Bowman’s capsule adheres 
to the capillaries of the glomerulus, 
closely covering them and dipping 
into the spaces between the small 
coils of the glomerular capillaries. From Bowman’s capsule the uriniferous tubule 
immediately continues through the cortical and medullary substances until it 
terminates in the opening in the papilla with which it communicates. The 
uriniferous tubules, which may be roughly separated into a secreting part lined 
with several types of epithelial cells and a collecting part, are partly convoluted 
and partly straight and regular, and run a very complicated course before the 
collecting part begins in the pyramids. The collecting part of the tubule in 
the pyramids is straight and empties into the kidney pelvis, there discharging 
the urine collected. The blood supply of the kidneys is through the renal ar- 
teries which give off branches that, as they pass through the kidney substance, 
divide repeatedly into smaller branches each of which, with a few exceptions, 
ends in a glomerulus. The venous return is by the renal veins. 
The function of the kidneys is to remove certain waste materials from the 
blood and excrete them in the aqueous solution known as urine, thereby pre- 
venting the waste materials from accumulating in the blood and keeping its 
composition constant. They also play an important part in maintaining the 
normal, slightly alkaline reaction of the blood by excreting enough of sub- 
stances in the blood that might alter its reaction to reduce their quantity to 
Figure 36.—Schema of a renal pyramid show- 
ing enlarged nriniferous tubule, glomeruli, 
and blood supply, with further magnification 
of a glomerulus. (U. S. Naval Medical 
School.) ANATOMY AND PHYSIOLOGY 
67 
the normal level. For example, should the reaction of the blood tend to become 
too alkaline, the kidneys will excrete more alkali in the salts in the urine. 
Also, when the presence of more acid substances in the blood tends to make its 
reaction less alkaline, they excrete more acid. Likewise, although its removal 
is not concerned with the reaction of the blood, the kidneys will remove all 
excess sugar present in the blood. Through the kidneys the greatest part of 
nitrogenous waste products is excreted, that excreted elsewhere being almost 
negligible in quantity. 
The process by which substances are removed from the blood and excreted in 
the urine is not definitely known but the generally accepted theory is that it is 
a process of filtration, reabsorption, and secretion. All the substances present 
in the blood plasma except protein filter through the infolded wall of Bowman’s 
capsule into the sac-like cavity communicating with the uriniferous tubule The 
liquid that seeps through the capsule is known as the filtrate and consists of 
blood plasma without any protein. This filtrate as it passes along the course 
of the uriniferous tubule becomes altered in composition by the selective action 
of the epithelial cells lining the tubule. 
The selective action of the epithelium of the tubule consists very largely of a 
reabsorption of those substances that, at the time, are needed by the blood to 
maintain its normal composition, i. e., a composition having the proper aqueous 
dilution, the proper acid-base balance, the proper sugar concentration, etc. 
Also, by this mechanism those substances that are not needed in the operation 
of the body metabolism are thrown oft. Whether or not a certain substance is 
needed at a given time depends on conditions within the body at that time. 
Thus, when the body needs water, as may occur as a result of limited intake or 
from increased loss through sweating, diarrhoea, or copious vomiting, more 
water is reabsorbed from the filtrate and as a result the urine contains less 
water and its specific gravity rises. On the other hand, when the body has an 
excess of water, the urine contains more water and its specific gravity lowers. 
Similarly, if the body has need of sodium chloride that substance is selected 
out and reabsorbed from the filtrate in the tubule with the result that little is 
excreted in the urine. This occurs particularly when sodium chloride is absent 
from the diet. Also, ail sugar in the filtrate is normally reabsorbed in the 
tubule with the result that none is excreted in the urine. In blood plasma 
there is normally about 0.03 per cent of urea present while in urine there is 
nearly 67 times as much, or about 2.0 per cent. This great increase is largely 
due to concentrating the urea contained in a very large amount of filtrate in a 
relatively small amount of urine. 
In addition to the absorption taking place in the uriniferous tubule there is 
good experimental evidence showing that the epithelium which lines the tubule 
actually secretes some of the urinary constitutents, particularly the ammonium 
salts found in urine. 
Besides removing from the blood the waste products of normal body metahol- 
ism the kidneys also are able to remove surprisingly large amounts of foreign 
substances of a poisonous nature that may find their way into the blood stream. 
Outstanding examples of substances so removed are mercury, various barbituric- 
acid derivatives, and alcohol. Most medicinal substances given in treatment are 
ultimately eliminated from the body through the kidneys. 
These activities of the kidneys show them to be organs extremely vital to 
the well-being of the body. If they fail to perform their vital functions, the 
composition of the urine changes, substances that should be are not removed 
from the blood, and those substances rapidly build up to a concentration in 
the blood that results in toxic conditions. One of the most familiar conditions 68 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
manifesting a disturbance of kidney function is albuminuria which occurs 
when Bowman’s capsule fails to prevent protein from passing through it. 
When waste products are retained in the blood because of failure of the kid- 
neys to remove them, they quickly build up to a concentration in the blood 
that produces toxic effects. The acid-base balance is seriously disturbed and 
an excess of urea and other waste products accumulates. This condition is 
known as uraemia. 
The ureters (fig. 35) are two musculo-membranous tubes about 15 to 18 inches 
long, that begin above in a thin-walled, funnel-shaped expansion called the pelvis 
which lies partly within and partly without the sinus of the kidney. The part 
outside of the sinus gradually decreases in size until at about the level of 
the inferior end of the kidney its diameter is about that of a goose quill. The 
part within the sinus contains several cup-like divisions called renal calyces, 
or calyces, which enclose the papillae and receive the urine, which enters 
them through the openings in the papillae. The ureters connect the kidney 
and the bladder, leaving the kidney at the hilum and entering the bladder 
at the lower and back portion of the organ, where they deliver to the bladder 
the excretion of the kidneys. The course of the ureters through the muscular 
walls of the bladder is oblique so that when the bladder is distended the coats 
of the ureters are approximated in such a manner that regurgitation of urine 
from the bladder is prevented. 
The urinary bladder (fig. 34) is a musculo-membranous sac situated in the 
pelvis just behind the pubis, and does not, under normal conditions, extend above 
the upper border of the symphysis. It acts as a reservoir for urine until such 
time as micturition is convenient. When moderately distended the bladder 
holds about 1 pint. Upon the inner surface of the bladder in the upper part, 
or fundus, the mucous membrane is thrown into folds or rugae. The lower 
portion presents a comparatively smooth triangular surface, known as the 
vesical trigone, outlined by the openings of the two ureters and the urethra. 
Micturition, or the act of voiding urine, is an involuntary mechanism con- 
trolled partly by volition. 
The urethra (fig. 34) is a membranous tube passing from the bladder along the 
under surface of the penis to the distal end of that organ where it terminates 
in the meatus. It serves to convey the urine and, in the male, the secretions 
of the genital glands, to the exterior. In the male it is about 8 inches long, 
and is divided into three parts, the prostatic, the membranous, and the penile 
portions. The prostatic urethra, about 1 inch in length, is surrounded by the 
prostate gland and contains the orifices of the prostatic and the ejaculatory 
ducts. In this portion the diameter of the urethra is the largest. The mem- 
branous urethra is about one-half inch in length and consists of that portion 
which pierces the urogenital diaphragm. The penile urethra is the longest 
portion and lies along the base of the penis, extending to its external opening, 
the urinary meatus. (See section on Genito-urinary and Venereal Diseases.) 
The perspiration, or sweat, excreted by the sweat glands of the skin, is a 
clear, colorless, watery liquid with a specific gravity of about 1.004 and a 
slightly acid reaction. It has a salty taste and a distinctive, rancid odor or 
none at all. Perspiration is excreted continuously, taking place so gradually 
that it evaporates as fast as it is formed when it is known as insensible 
perspiration, or, under exposure to great heat and exercise, so rapidly that 
evaporation does not take care of it, and it is then known as sensible perspira- 
tion. Normally about 1 quart of this fluid is excreted daily, but the amount 
varies widely with atmospheric temperature and humidity, and the amount ANATOMY AND PHYSIOLOGY 
69 
of exercise taken. It consists chiefly of water with small quantities of salts, 
fatty acids, urea, and carbon dioxide. 
The skin is a tough elastic membrane forming the outer covering of the 
body, and contains certain appendages as the hair and nails. Certain glands, 
as the sweat and the sebaceous glands, discharge their secretions upon the 
surface of the skin. (Fig. 37). 
The skin is made up of two principal layers, the epidermis, or cuticle, and 
the derma, or true skin (cutis vera). The epidermis consists of stratified 
squamous epithelium and may be divided into two layers, the superficial layer 
being horny and hard, 
and the inner layer, 
known as the germina- 
tive layer, consisting of 
soft protoplasmic cells. 
The derma is a highly 
sensitive and vascular 
layer of connective tis- 
sue, containing blood ves- 
sels, hair follicles, sweat 
and sebaceous glands, 
and nerve endings. 
The sweat glands are 
coiled tubular glands, 
the coils of which lie 
embedded in the derma 
and surround a small 
tuft of capillaries. 
These glands are located 
in the subcutaneous tis- 
sue and open by a duct 
upon the surface of the 
skin. The sweat glands 
serve as excretory organs, excreting the sweat or perspiration. The sebaceous 
glands are compound sacular glands, the ducts of which open about the hair 
shaft. These glands secrete an oily substance, sebum, which keeps the skin soft 
and pliable. The true skin is well supplied with specialized nerve endings which 
carry impressions of touch, heat, cold, and pain. The true skin also contains 
motor nerves to blood vessels, and secretory nerve fibers to the glands. 
The skin serves as a protective covering to aid in the preservation of body 
temperature, and as an excretory organ. It contains the nerve endings pre- 
viously mentioned. 
Figure 37.—Perpendicular section of skin. (Mason, 
modified.) 
THE MALE REPRODUCTIVE ORGANS 
The male genital organs consist of the testes, the epididymis, the scrotum, 
ductus deferens, seminal vesicles, prostate, bulbo-urethral glands, urethra, and 
the penis, (fig. 38). 
The testes are two glandular organs suspended from the inguinal region by 
the spermatic cord and surrounded and supported by a musculo-membranous sac 
covered with skin, the scrotum. The testicle proper is somewhat oval in shape 
and is composed of tubular glands held together by connective tissue. These 
glands form the male generative cells, the spermatozoa. The interstitial cells 
of the testis produce an internal secretion which promotes the development of 70 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
masculine characteristics. The tubules of the testicles unite to form a single 
tube which lies as a tortuous mass called the epididymis on the posterior sur- 
face of the testicle and connects with the ductus deferens. 
The ductus deferens or vas deferens, is the excretory duct of the testicle and 
runs in the spermatic cord through the inguinal canal into the abdomen, thence 
extra-peritoneally on a convergent course to the seminal vesicles. The sper- 
matic cord forms the pedicle of each testicle and extends from the internal 
abdominal ring to the back of the testis, and is made up of the ductus deferens, 
spermatic arteries and veins, lymphatics, nerves, cremasteric muscle and con- 
nective tissue. 
Figure 38.—Section through male generative organs and bladder. 1, Rectum, 2, prostate; 
3, bulbo-urethral gland; 4, testicle; 5, glans penis; 6, urethra; 7, symphysis pubis; 
8, bladder. (Manual of Surgical Anatomy, U. S. Army, modified.) 
The seminal vesicles are two glandular pouches between the bladder and 
rectum and unite with the ductus deferens to form the ejaculatory duct. 
These vesicles serve as a reservoir for the semen and add a secretion of their 
own. The ejaculatory ducts pass from the seminal vesicles between the lobes 
of the prostate gland and open into the floor of the prostatic urethra. 
The prostate gland is a partly glandular and partly muscular organ that sur- 
rounds the first portion of the urethra and resembles a horse-chestnut in form. 
The glandular and muscular tissue of this gland is surrounded by a dense fibrous 
capsule. It secretes a fluid which is an essential element of the semen. The 
bulbo-urethral or Cowper’s glands are two small bodies about the size of a pea 
situated one on each side of the membranous urethra and opening into it. They 
secrete a fluid which forms part of the seminal fluid. 
The penis consists of three more or less cylindrical bodies composed largely 
of erectile tissue. The two corpora caveruosa lie above the corpus spongiosum 
which contains the urethra. The glans penis, forming the distal end of the ANATOMY AND PHYSIOLOGY 
71 
penis, is continuous with the corpus spongiosum and contains the external 
opening of the urethra, the meatus, or urinary meatus. The covering of the 
shaft of the penis is loose skin, but that portion reflected over the glans penis 
is a thin layer of skin lined with mucous membrane, and is called the prepuce. 
The semen is a fluid made up of the secretions of the bulbo-urethral glands, 
the prostate, the seminal vesicles, and the testes. 
THE NERVOUS SYSTEM 
lit order that the subject matter which is to follow may perhaps be better 
understood it is considered advisable to briefly describe the means by which 
the lower forms of animal life react to different conditions. 
The lowest form of animal life, the unicellular animal organism such as 
the Amoeba, possesses no distinctive nervous system but adapts itself to its 
surroundings by reason of the property of irritability which is inherent in 
the protoplasm of which it is composed. The single-cell animal moves about 
and carries out its processes of metabolism and reproduction entirely within 
and by itself and always reacts in the same way to any specific stimulus. 
A little higher form of animal life, the Metazoon, has a soft, semifluid body of 
protoplasm consisting of groups of cells which stick together. Most of these 
cells, originally derived from a single parent cell, have lost their character- 
istics as individual cells and become specialized for certain functions. Some 
are specialized so that they link the different parts of the body of this water- 
dwelling animal together with a primitive nervous system which deals with 
outside impressions, brings about necessary movements, and controls various 
living activities. Other cells are specialized to form a supporting substance 
(primitive skeleton) and others are specialized to provide for movement (prim- 
itive muscles). In all parts of the outer supporting substance are cells which 
are specialized to receive external stimuli and are known as sensory or receptor 
cells. From the receptor cells extend two elongated portions called processes. 
One, the peripheral process, passes toward the surface and may even pass be- 
yond it, the other, called the central process, passes inward into the body and 
connects with a network of cells of the nervous system called connector cells. 
The connector cells communicate with each other by processes and have other 
processes reaching still deeper into the body and connecting with motor or 
effector cells which have processes distributed to the primitive muscles of the 
animal. There is thus provided a means by which a sensation or impression 
of danger received by a receptor cell can he carried to a connector cell and 
thence, through the network of connector cells, to a number of motor cells. 
As a result of stimulation of the motor cells there occurs a general response 
of the primitive muscles and the animal moves away from the point of danger. 
Such a general muscular response to a local stimulus is always the same if 
conditions are the same. 
In producing the movement just described three basic nerve elements have 
been shown to exist; 1. The receptor or sensory cell; 2. The network of con- 
nector cells; and 3. The motor or effector cells. These basic elements are 
found in the nervous systems of all forms of animal life higher than the 
Metazoon, with such modifications as are necessary to permit a particular type 
of animal to carry out its purpose in life. 
When the higher stage in animal life represented by the earthworm, or 
Lumbricus, has been reached there has evolved from the primitive nervous 
system one in which there is a central, controlling part quite distinct from a 
peripheral portion of nerve fibers carrying impulses to or from the central 
part. In the earthworm this central part consists of a nerve-cord running 72 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
longitudinally through the entire length of the body, in each segment of 
which the nerve-cord is slightly swollen or enlarged on each side. These 
enlargements are collections of nerve cells called ganglia from each of which 
bundles of nerve fibers called nerves pass off to each side. Some of these 
nerves are motor and are connected with muscles; others are sensory and end 
in receptor or sensory cells in the covering of the body. Close to the front end 
of the worm is located a single pair of ganglia called the cerebral ganglia which 
are connected with each other by a bridge of nerve fibers. From the side of 
each cerebral ganglion a strand of nerve fibers curves around the side of the 
worm’s alimentary canal and connects with the first ganglion of the nerve-cord. 
In the more highly developed animals the cerebral ganglia in the worm may 
be said to be represented by the brain, the nerve-cord by the spinal cord, and 
the ganglia on the nerve-cord by the pairs of spinal nerves. 
In the higher animals modification and evolution of the primitive nervous 
system of the Metazoon has proceeded to the point where a central nervous 
system consisting of the brain and spinal cord and a peripheral nervous system 
consisting of the spinal nerves have been developed. The primitive connector 
cells and their processes and the primitive motor cells without their processes 
have collected to form the central nervous system and ganglia on sensory 
nerves. Nerves have evolved, the processes of the primitive receptor or sensory 
cells forming sensory or afferent nerves which pass into the central nervous 
system while the processes of the primitive motor or effector cells have formed 
motor or efferent nerves which pass out of the central nervous system. If, for 
convenience, both sensory and motor nerve fibers are carried in the same nerve 
trunk, that nerve trunk is known as a mixed nerve. The cranial nerves arising 
from the brain and the spinal nerves arising from the spinal cord are typical 
examples of mixed nerves. With this evolution of the nervous system there 
have been developed special receptors for the functions of sight, smell, hearing, 
etc., and in the highest forms of animal life certain parts of the brain have 
enlarged to enable it to properly control the many complex functions and 
movements of the body containing that brain. 
The ability of the human organism to adapt itself to its surroundings or 
environment, to coordinate and regulate the activities of its various parts so 
that they wrork harmoniously together, and to reason, is due solely to the 
presence in it of nerve tissue, which, as previously stated, is the most highly 
specialized tissue in the body. This tissue is present in every part of the 
body in the form of nerve cells, small masses containing nerve cells called 
nerve centers, or ganglia, and conducting or connecting elements called nerve 
fibers, bundles of which are termed nerves. These forms collectively consti- 
tute the complex apparatus known as the nervous system, frequently spoken of 
as the “ruler of the body.” 
For purposes of study and description in this book, the nervous system will 
be considered as divided into three parts, the cerebrospinal or central nervous 
system, the peripheral nervous system, and the sympathetic nervous system. 
Also, for ease in study and description, the impulses carried by the afferent or 
sensory nerves will be termed impressions while those carried by the efferent or 
motor nerves will be termed impulses. 
The central nervous system consists of the brain, or encephalon, contained 
within the cranial cavity, and the spinal cord, or medulla spinalis, which 
occupies the upper two-thirds of the spinal canal. Together the brain and 
the spinal cord dominate the entire nervous system. 
The peripheral nervous system consists of 12 pairs of cranial nerves attached 
to the brain and 31 pairs of spinal nerves attached to the spinal cord. ANATOMY AND PHYSIOLOGY 
73 
These nerves are associated with the functions of the special and general 
senses and with the voluntary movements of the body. 
The sympathetic nervous system is often considered as part of the peripheral 
nervous system with which it is intimately connected and closely intermingled. 
It is also known as the autonomic, vegetative, and ganglionic nervous system. 
Nerve tissue is made up of nerve cells, or neurones, and their processes, held 
together, in the brain and spinal cord, by a special supporting tissue called 
the neuroglia and by ingrowths of the membrane covering the brain and 
spinal cord, the pia mater. The nerve cell, or neurone, is the unit of struc- 
ture and of function in the nervous system, varies in size, shape, and structure, 
and consists of the cell-body, or cyton, and one or more processes extending out 
from the body. Nerve cells having but one process are called unipolar cells, 
those having more than one, multipolar cells. The cell body, made of nucle- 
ated protoplasm, is the seat of origin of the changes which give rise to nervous 
impulses, and presides over the nutrition of the cell. The processes of nerve 
cells are outgrowths of the cell-body and. provide the paths along which 
nervous impulses are carried. They are of two kinds, the axone, or axis- 
cylinder process, a single, unbranched process which lengthens out to become 
the axis cylinder, or conducting part, of a nerve, and the dendrone, dendrite, 
or protoplasmic process, a short process that divides into smaller and smaller 
branches which terminate in free ends that become lost in the nervous tissue 
(fig. 39). The axones vary in length, some extending only a very short dis- 
tance beyond the cell while others continue to 
distant parts of the body. The longer processes, 
which usually acquire protective sheaths, are 
known as nerve fibers, and these, arranged in 
bundles, form the nerves, or nerve trunks, that 
pass to every part of the body. 
Nerve fibers are the conducting elements of the 
nervous system and bring the nerve cells into rela- 
tion with each other and with the various tissues 
of the body. They constitute the greater part of 
the brain and the spinal cord, make up the nerves, 
and are known as medullated or white fibers and 
nonmedullated or gray fibers, the difference being 
due to the presence or absence of the white medul- 
lary sheath. The central and essential part of a 
nerve fiber is the axis cylinder which, in medul- 
lated fibers, is surrounded by the medullary sheath 
or white substance of Schwamm, and the whole 
enclosed in a delicate membrane called the prirni- n i . m 
tive sheath or neurolemma, and in nonmedullated fibers is surrounded by a 
delicate nucleated sheath corresponding with the neurolemma of the medullated 
fibers. Medullated nerve fibers form the white part of the brain and the spinal 
cord and the greater part of every cranial and spinal nerve; nonmedullated fibers 
compose most of the sympathetic nervous system and some of the central. The 
medullated fibers constitute the white matter of the nervous system; the non- 
medullated fibers the gray matter. 
Nerves usually are classed according to the impressions or impulses they 
conduct and the direction in which the impression or impulse is carried. 
Afferent nerves conduct impressions of pain, hunger, feeling, etc., from all 
parts of the body into the central nervous system, and as these impressions 
are spoken of as sensations, afferent nerves are also known as sensory nerves. 
Figure 39.—Motor nerve cell. 
(Howell.) *is the axone; 
the other branches are den- 
drites. 74 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Efferent nerves conduct impulses from the brain and spinal cord to the parts 
to which nerves are distributed. Most efferent nerves go to muscles and are 
commonly termed motor nerves; those that go to secreting glands are called 
secretory nerves; while those that restrain or check movement or secretion 
are called inhibitory nerves. Some nerves have both afferent and efferent 
fibers and are known as mixed, nerves. 
The cerebrospinal nervous system. 
The brain, the largest and most complex mass of nervous tissue in the body, 
weighs about 3 pounds and fills the cranial cavity of the skull (fig. 40). It is 
continuous with the spinal cord at the foramen magnum, is very vascular, and 
when observed in life is seen to pulsate. The outer layer of the brain, the 
cortex cerebri, is made up of gray matter and the deeper parts of white matter. 
The gray matter, composed largely of nerve cells, receives and stores affer- 
ent impressions and transforms them into efferent impulses; the white matter, 
consisting principally of nerve fibers, conducts the efferent impulses. The 
brain is covered by three membranous coats, the meninges, which, named from 
without inward, are the dura mater, the arachnoid, and the pia mater. 
The dura mater, a dense membrane of fibrous connective tissue, contains 
many blood vessels and is arranged in two layers, except in a few places. 
The outer layer of the dura mater is adherent to the inside surfaces of the 
bones of the skull where it forms their periosteum. The inner layer covers 
the brain and sends numerous prolongations inward for the support and pro- 
tection of the lobes of the brain. These projections form the venous sinuses 
through which the blood is returned from the brain to the large veins of 
the neck. They also form the sheath for the nerves leaving the cranial cavity. 
The inner layer continues through the foramen magnum into the spinal canal 
to there invest the spinal cord. 
The arachnoid, a delicate serous membrane, lies between the dura mater 
and the pia mater. Except in the longitudinal fissure of the brain this mem- 
brane does not dip down into the crevices and depressions of the brain. Between 
tjie arachnoid and the pia mater is a space called the subarachnoid space, in 
which is found a certain amount of cerebro-spinal fluid. It also continues into 
the spinal canal. 
The pia mater, a delicate membrane of connective tissue containing a net- 
work of blood and lymph vessels, lies under the arachnoid and extends to 
all crevices and depressions of the brain. It contains the blood vessels of 
the brain and supplies blood to all parts of the brain. It frequently is called 
the nutritive membrane, and continues into the spinal canal. 
The brain itself is divided into three main parts: The forebrain, containing 
the cerebral hemispheres and other bodies; the midbrain, a short constricted 
portion connecting the pons and cerebelhim with the forebrain; and the hind- 
brain, consisting of the medulla oblongata, pons, and cerebellum (fig. 40). 
The cerebrum, the largest part of the brain, fills the whole of the upper part 
of the cavity of the skull. It is composed of gray matter externally, which 
is the active part of the brain, and white matter internally, in which are em- 
bedded masses of gray matter. The outer portion of the cerebrum is made 
up of alternate elevations, called convolutions, and depressions, called fissures. 
The fissures divide the cerebrum into hemispheres and the hemispheres into 
lobes, the latter bearing names corresponding to the cranial bones near which 
they lie. The hemispheres are known as right and left. 
The great longitudinal fissure extends from the front to the hack of the 
cerebrum and completely divides it into two hemispheres except in the middle ANATOMY AND PHYSIOLOGY 
75 
portion where a broad transverse band of white fibers called the corpus cal- 
losum connects the hemispheres. The transverse fissure separates the cerebrum 
from the cerebellum. The fissures of the brain divide each hemisphere into 
sections called lobes, designated as the frontal, parietal, temporal, occipital, 
and central, or Island of Rcil. Among the important fissures are the fissure 
of Rolando, called the central sulcus, running from the top and near the 
middle of each hemisphere downward and forward for two-thirds of its ver- 
tical measurement and separating the frontal lobe from the parietal lobe; the 
lateral cerebral fissure (Fissure of Sylvius), separating the frontal and pari- 
etal lobes from the temporal lobe; and the parieto-occipital fissure separating 
the parietal from the occipital lobe. 
The function of the cerebrum is to govern all of the mental activities and 
coordinate body movements. This section of the brain contains the centers or 
seats of reason, intelligence, will, memory, and all of the higher emotions and 
feelings. Certain areas of 
the brain have a prepond- 
erance of control over cer- 
tain functions, although all 
areas are more or less 
closely connected by asso- 
ciation fibers; the frontal 
lobe is primarily the seat of 
reasoning or higher psychi- 
cal thought; that portion 
just anterior to the central 
fissure is the motor area; 
the temporal lobe is the 
seat of hearing; and the 
occipital lobe is the seat of 
vision. 
The white matter con- 
sists of fibers which run in 
three directions, from above 
downward, from the front 
backward, and from side to 
side. They form a connection between the different parts of the brain and con- 
nect the brain with the spinal cord. 
Within the brain there are four communicating cavities called ventricles. 
These are the two lateral ventricles, one situated within each cerebral hemi- 
sphere, the third- ventricle, lying in the lower middle portion of the brain and 
communicating on each side with a lateral ventricle, and the fourth ventricle, 
situated between the pons and the cerebellum, connecting above with the third 
ventricle and continuous through the medulla with the minute central canal of 
the spinal cord. The ventricles contain a clear lymph-like fluid, the cerebro- 
spinal fluid. There are openings between the fourth ventricle and the space 
between the inner and middle layers of the meninges of the brain, which space 
is continuous with a similar space between the meninges of the spinal cord 
that also contains cerebrospinal fluid. 
The cerebellum, sometimes called the “little brain,” lies in the lower posterior 
part of the skull, between the occipital lobes of the cerebrum above, and behind 
the pons and medulla oblongata, with all of which it is connected. It is some- 
what oval in form and consists of two lateral hemispheres and a central por- 
Figure 40.—Schema showing the connection of the 
several parts of the brain. (Gray.) 
154294°—39 6 76 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
tion called the vermis, or worm, and sometimes the middle lobe. A lai’ge, deep 
fissure called the horizontal fissure incompletely divides the cerebellum into an 
upper and a lower portion. Other deep fissures separate the hemispheres into 
lobes, and numerous, curved fissures, varying in depth and roughly parallel 
with each other, separate the lobes into layers, or leaves, the edges of which 
appear as fine ridges. The surface of the cerebellum therefore presents a 
slightly ridged and laminated, or 
leaf-like, appearance, instead of a 
convoluted one like that of the cere- 
brum. The substance of the cere- 
bellum is composed of a solid, com- 
pact mass of white matter in the 
interior over which is a layer of gray 
matter, and its principal function is 
believed to be the regulation and co- 
ordination of ordinary movements 
and the maintenance of equilibrium. 
The pons, or pons Varolii, is a 
roughly rounded, white mass situ- 
ated in the midline of the cranial 
cavity at the base of the brain, in 
front of the cerebellum, beneath the 
cerebrum, and continuous with the 
medulla oblongata below. It is com- 
posed of a ventral, or anterior por- 
tion and a dorsal portion, and con- 
sists chiefly of rope-like bundles of 
nerve fibers connecting with the mid- 
brain above and the medulla oblong- 
ata below, and areas of gray mat- 
ter. From its surfaces emerge the 
narrow white bands of nerve fibers 
that connect the medulla oblongata 
with the cerebrum and the cerebel- 
lum, the pons thus acting as the 
“bridge” which its name signifies. 
In the gray matter of the pons are 
located the nuclei from which arise 
some of the cranial nerves. 
The medulla ohlogata, or spinal 
bulb, extends in an almost vertical 
direction from the lower margin of 
the pons, above, through the fora- 
men magnum to the level of the 
upper border of the first cervical 
vertebra, or atlas, below, where it 
is continuous with the spinal cord. Shaped somewhat like a flattened pyramid 
or cone, it rests in and is supported by a shallow groove in the basilar portion 
of the occipital bone. It is divided into two lateral halves by two fissures 
continued ihto it from the spinal cord, the anterior one extending the entire 
length of the medulla and ending at the upper end, the posterior one ending 
in the lower half. The lateral halves are further divided longitudinally by 
grooves, and the surface of the medulla consequently appears convoluted. The 
Figure 41.—Spinal cord and nerves. (Mason.) ANATOMY AND PHYSIOLOGY 
77 
upper portion of the posterior surface forms the lower part of the floor of the 
fourtn ventricle of the brain, and the minute central canal of the spinal cord 
passes through the lower half of the medulla and there opens out into the 
lower, tapered end of the fourth ventricle. The medulla is made up largely 
of a continuation of bundles of nerve fibers from the spinal cord, some of which 
end in the medulla while others pass on into the cerebellum. Much gray matter 
also is present in which are located numerous nerve nuclei and the reflex 
centers for regulating respiration, accelerating heart action, and maintaining 
vascular tone. In the lower part of the medulla a large part of the nerve 
fibers decussate (cross to the opposite side) which is the reason why one side 
of the brain controls nervous activity in the opposite side of the body. The 
functions of the medulla are largely conduction, reflex action, and automatic 
action, its function of conduction being especially important as it conducts all 
impressions passing between the brain and the spinal cord. 
The spinal cord, or medulla spinalis, is that part of the central nervous 
system which occupies the upper two-thirds of the vertebral or spinal canal 
(fig. 41). It is nearly cylindrical in shape, being slightly flattened in front 
and behind, and extends from the level of the upper border of the atlas to the 
level of the lower border of the first lumbar vertebra, a distance of about 18 
inches in the male. Above it is continuous with the medulla oblongata and 
below it ends in a cone-shaped extremity, the conus medullaris, from the point 
of which a slender filament, consisting mainly of fibrous tissue and called the 
filum terminate, extends downward about 8 inches where it is attached to 
the periosteum of the coccyx and so anchors the spinal cord. The nerve roots 
which spring from the lumbar and sacral portions of the spinal cord descend 
for a considerable distance in the spinal canal as a bunch of long nerve fibers 
which, from its resemblance to a horse’s tail, is called the cauda equina. The 
three coats or membranes which cover the brain extend down and cover the 
spinal cord, and the subarachnoid space between the arachnoid and pia mater 
is likewise continued and also the cerebro-spinal fluid. Between the dura mater 
and the vertebral column is a protective covering of fatty tissue which also 
serves as a protection to the spinal cord. Two fissures, the ventro-median 
fissure anteriorly and the dorso-median groove posteriorly, almost completely 
divide the spinal cord, leaving only a 
narrow bridge of substance connect- 
ing the two halves. The bridge is 
called the isthmus of the spinal cord 
and in it is contained the minute 
cavity called the central canal which 
traverses the entire cord and com- 
municates with the fourth ventricle 
of the brain. The spinal cord is 
made up of white matter surround- 
ing an H-shaped section of gray mat- 
ter (fig. 42). The anterior parts or 
horns of this H-shaped substance 
are short and bulky while the poste- 
rior ones are long and slender. The 
white matter is composed of bundles 
of nerve fibers running lengthwise of the cord, the gray of cell bodies, dendrones, 
axones, and collateral branches held together by neuroglia. The function of the 
bundles of nerve fibers is to conduct sensory impressions to and motor impulses 
from the brain. 
Figure 42.—Cross section of spinal cord at 
seventh thoracic vertebra. (U. S. Naval 
Medical School.) 78 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The peripheral nervous system. 
The cerebral or cranial nerves, consisting of 12 pairs, originate in the brain 
and supply certain definite areas of the body. They are of three varieties, 
sensory, motor, and mixed nerves which contain both sensory and motor nerve 
fibers. These cranial nerves after leaving the cranium through definite ana- 
tomical exits split up into branches and are widely distributed. They are 
numbered from before backward in the order in which they arise from the 
brain, and are named in accordance with their nature, function, or distribution. 
Number, Name, Type, Distribution, and Function of the Cranial Nerves 
Nerve 
No. 
Nerve name 
Type 
Distribution 
Function 
1 
Olfactory 
Sensory. 
Upper third of the nasal cavity. 
Sense of smell. 
2 
Retina of eye. _ 
Sight. 
Movements of eye. 
3 
Oculomotor 
Motor.. 
All eye muscles except superior 
oblique and external rectus. 
4 
Trochlear 
do 
Superior oblique muscle of eye. 
Do. 
5 
Trigeminal 
Mixed.. 
Skin of face, eyeball, lacrimal 
glands, mucous lining of 
mouth and pharynx, teeth, 
and tongue, muscles of mas- 
tication. 
Taste, mastication, secretion, 
and touch. 
6 
Ahducens .. 
Motor 
External rectus muscle of eye 
Movements of eye. 
7 
Facial 
_ _do 
All muscles of expression ct 
face; also supplies ear and 
part of neck. 
Facial expression. 
8 
Internal ear. 
Hearing and equilibrium. 
Glossopharyngeal-.. 
Mixed.. 
Tongue and pharynx 
Taste, movement of pharyngeal 
muscles and sensation to 
mucous membrane of phar- 
ynx. 
10 
Vagus .. 
__.do 
Larynx, trachea, lungs, heart, 
pharynx, oesophagus, and 
stomach. 
Both motor and sensory to 
lungs and larynx. Cardio- 
inhibitory. Motor to oeso- 
phagus and stomach. 
11 
Certain neck muscles . _ 
Movements of head. 
12 
Hypoglossal.- __ 
__.do 
Tongue 
Movements of tongue. 
The spinal nerves, 31 pairs in number, are named in accordance with the loca- 
tion of their exit from the spinal canal, there being 8 cervical, 12 thoracic, 5 
lumbar, 5 sacral, and 1 coccygeal (fig. 41). Each nerve arises from the spinal 
cord by two roots, an anterior motor root and a posterior sensory root which 
contains a ganglion in which are the cell bodies of the sensory neurone. The 
two roots unite to form a single trunk which emerges from the spinal canal 
through an intervertebral foramen and immediately divides into an anterior 
and a posterior branch, each of which contains fibers from both the motor and 
sensory roots. Thus all of the spinal nerves are mixed nerves, for they carry 
sensory impressions and motor impulses. The posterior branches of these 
nerves are distributed to the skin and muscles of the back and trunk; the an- 
terior branches unite to form the three great plexuses known as the cervical, the 
brachial, and the lumbosacral, from which the nerve supply to the extremities 
and other parts of the body is derived. From the cervical plexus arise nerves 
whose branches supply the skin and muscles of the head, face, neck, upper back 
parts of the shoulders, and thorax, and certain organs within the thoracic 
cavity; from the brachial plexus arise nerves that supply the upper extremity 
among which are the median, ulnar, and radial nerves; and from the lumbo- 
sacral plexus arise nerves that supply the lower extremities, the chief ones 
being the sciatic (the largest nerve in the body), the femoral, and the obtura- 
tor nerves. ANATOMY AND PHYSIOLOGY 
79 
The sympathetic nervous system. 
This system, also called the autonomic and vegetative, innervates all the 
involuntary muscles and the various glands of the body, the striated muscles 
of the heart, and the skeletal muscles may receive some sympathetic fibers. 
It consists of two rows of central ganglia situated one on each side of the me- 
dian line, partly in front and partly at the sides, of the vertebral column and 
extending from the base of the skull to the coccyx, other ganglia situated in 
different parts of the body, and a network of small nerve trunks connecting the 
ganglia and ramifying to various organs. The central ganglia are joined with 
each other by cords of nerve fibers and each ganglion is connected with the 
spinal nerve of that region and with the spinal cord. A group or collection of 
ganglia and nerves supplying organs and structures in the body with nerve 
influence is called a plexus. Among the many of this system in the body are 
the cardiac plexus supplying the heart, the epigastric or solar plexus supplying 
the stomach, the pulmonary plexus, supplying the lungs, and the hypogastric 
plexus supplying the organs in that region of the body. Through the sympa- 
thetic system the movements of the viscera are regulated, the caliber of the 
blood vessels determined, the phenomena of secretion controlled, and the meta- 
bolic processes of life maintained. The activity of this system does not excite 
the consciousness and is almost entirely involuntary. 
Nerve action. 
The outstanding physiological property of nerve fiber is its conductivity, by 
which is meant the capacity of the nerve fiber to conduct impulses. For ease in 
description and study the impulses carried by the afferent nerves have been 
termed impressions throughout this section, while those carried by the efferent 
nerves have been termed impulses. A nerve impression may then be said to be 
the influence or effect on feeling, sense, or consciousness resulting from stimula- 
tion or excitation, and a nerve impulse the influence or effect on muscular or 
other tissue that incites it to action. Under normal conditions afferent nerve 
fibers are stimulated or excited only at their endings, called receptors, in the 
skin, mucous membranes, sense organs, etc., while efferent nerve fibers are 
stimulated only through the nerve cells from which they spring. Sensory im- 
pressions are converted into motor impulses in the nerve cells or nerve centers 
and the conversion may be totally unconscious as well as involuntary, as the 
emptying of the gall-bladder during digestion, or there may be consciousness 
of the act, as the winking of the eyelid when the eye is touched. On reaching the 
central nervous system sensory impressions may be carried to the brain, there 
to give rise to a specific sensation in the consciousness, or they may be con- 
ducted by a direct or a devious path within the central nervous system to a 
nerve cell or nerve center which converts them into motor impulses and con- 
ducts them away to incite response in some distant muscle or gland cell. When 
such a response occurs without intervening consciousness it is called reflex action, 
the nervous activity involved a reflex, and the path over which the impression 
and impulse travelled a reflex arc. The reflex is the basis of all functional ac- 
tivity of the nervous system, and the nervous function necessary for the con- 
trol of the most intricate movements and activities is probably only a com- 
pounding of reflexes. In reflex action it is essential that there be: 1. A receptor 
on which the stimulant or excitant is brought to bear; 2. A path to the central 
nervous system by which the sensory impression is carried; and 3. A path from 
the central nervous system by which the motor impulse is carried. Although 80 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
the sensory impressions may be sent to and the motor impulse received 
from the brain in reflex action, it is believed that in most cases the impressions 
are received in the spinal cord and the motor impulses originated therein. 
Thus, in response to impressions received over the afferent or sensory 
nerves, the nerve cells in the spinal cord send out orders without waiting for 
the impression to be carried to the brain or central nervous system and the 
orders sent out from there. As an example, the hand is pricked by a tack (fig. 
43). The receptor nerve ending receives the sensation and the afferent or 
sensory nerves carry it 
to the spinal cord and 
brain. Before the sensa- 
tion has reached the 
brain, however, an order 
to lift the hand has been 
originated by the nerve 
cells in the cord and sent 
out by the efferent or 
motor nerves. The hand 
is moved and the brain 
made conscious of the 
prick at about the same 
time. 
Reflexes are classed 
as simple reflexes, in 
which a single muscle 
or gland is involved, as 
in the corneal reflex; 
complex reflexes in 
which several muscles or 
glands are involved, the 
action remaining per- 
fectly coordinated, as in 
the patellar reflexes; 
spreading reflexes in 
which a large number of 
muscles are involved; 
tonic reflexes or continu- 
ous reflexes in which a 
reaction is repeated a number of times as in swallowing, coughing, hiccoughing, 
etc.; and association or perception reflexes in which a mental picture produces 
reaction, as in the flow of saliva or gastric juice when well-cooked food is seen 
or smelled, or when one person yawning causes others to do likewise. 
The special senses. 
Various kinds of external stimuli produce nerve impressions which give rise 
to the phenomenon in consciousness known as sensation. Stimuli within the 
body give rise to such sensations as thirst, hunger, fatigue, and many other 
less well-defined sensations. The body is equipped with various mechanisms 
especially adapted to receive specific forms of stimuli from external surround- 
ings. These mechanisms are called the organs of the special senses. The skin 
contains various forms of sensory nerve endings, which, when acted upon by 
specific stimuli, give rise through the nerve impulses generated to such sen- 
sations as heat, cold, pressure, and pain. Other more elaborate mechanisms 
similarly provide for the senses of sight, hearing, smell, and taste. 
Figure 43.—Diagram of reflex action: a. Tack pricking 
hand; 6, h', afferent nerves; c, c', c", nerve cells; d, d', 
efferent nerves; e, muscle moving hand; f, white matter; 
g, gray matter; h, spinal cord; i, medulla oblongata; 
k, brain. ANATOMY AYD PHYSIOLOGY 
81 
The visual apparatus consists of the eyeballs, the optic nerves, and the visual 
centers in the brain, together with certain associated organs, as the eyelids, 
eyebrows, muscles of the eyeball, and the lacrimal apparatus. 
The eyelids are two thin movable folds projecting from above and below, 
placed in front of the eye. They are covered externally by skin, and internally 
by a mucous membrane, the conjunctiva. This internal lining, the conjunctiva, 
is reflected over the front of the eyeball. The interior of the eyelid is com- 
posed chiefly of connective tissue, part of which is dense fibrous tissue which 
forms the tarsal cartilage. Several small glands, the Meibomian glands, are 
situated in this connective tissue. The upper eyelid contains a small muscle 
which acts to elevate or lower it. On the margin of each lid are double or 
triple rows of short hairs or cilia called the eyelashes. The function of the 
eyelids is to afford protection to the eyes. They are movable shades which 
may exclude light, dust, and other injurious substances. 
The lacrimal apparatus consists of the lacrimal glands, the canaliculi, the 
lacrimal sac, and the nasal duct. The lacrimal gland is situated at the up- 
per and outer angle of the orbit and secretes tears which flow to the surface 
of the conjunctiva via several small ducts. This secretion passes over the eye- 
ball and is collected by the canaliculi at the inner angle of the conjunctiva. 
These canaliculi communicate with the lacrimal sac from which the tears are 
discharged into the nose through the nasal ducts. 
The orbits are bony cavities in which the eyeball and its muscles are con- 
tained. They are shaped like a four-sided pyramid and are made up of seven 
bones, the zygomatic, maxilla, palate, ethmoid, frontal, sphenoid, and lacrimal. 
The orbit contains two openings posteriorly, the optic foramen for the passage 
of the optic nerve and the ophthalmic artery; and the sphenoidal fissure for 
passage of the ophthalmic veins and of nerves to the muscles of the eye. 
There are six extrinsic muscles of the eye the function of which is to 
move the eyeball. These are the internal, external, superior, and inferior recti 
muscles, and the inferior and superior oblique muscles (fig. 44). The innerva- 
tion of these muscles has been given under the cranial nerves. 
The general shape of the eye- 
ball is spherical, or, more exactly, 
it “is composed of the segments of 
two spheres of different sizes, the 
anterior being the segment of a 
small sphere forming about one- 
Figdee 44.—Muscles of the right 
orbit. (Gray.) 
Figure 45.—The right eye in horizontal 
section. (Toldt.) 
sixth of the eyeball and the posterior being the segment of a much larger sphere 
and forming about five-sixths of the globe” (fig. 45). The surface of the eyeball 
is made up of three distinct coats or layers. The outer layer consists of the sclera 
and the cornea. The sclera or “the white of the eye” is a dense, tough, fibrous 82 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
membrane covering the posterior five-sixths of the eyeball and pierced posteriorly 
by the optic nerve. In front where the light enters the eye the sclera changes to 
a transparent membrane having no blood vessels, which covers the remaining 
sixth of the eyeball and is known as the cornea. 
The middle layer is composed of the choroid and the iris. The choroid is 
a thin, vascular, chocolate-colored membrane lining the sclera and containing a 
network of blood vessels and pierced in the back by the optic nerve. It is 
folded inward and arranged in radiating folds about the lens of the eye. 
These folds form the ciliary processes and are well supplied with nerves and 
blood vessels and the ciliary muscle is contained therein. The iris is a thin, 
circular, contractile disc directly back of the cornea and suspended in front 
of the lens but not in contact with it, and perforated near its center by a circu- 
lar opening called the pupil. It divides the space between the cornea and the 
lens into anterior and posterior chambers which contain a watery substance 
called the aqueous humor. The iris is composed of connective tissue, pigment 
cells, blood vessels, and contains two sets of muscles. One set of muscle fibers 
contracts the pupil, the other dilates it. The function of the iris is to regu- 
late the amount of light entering the eye—by contracting, it decreases the 
amount of light entering, by dilating, it increases it. This is the part that 
gives the eye its characteristic color. 
The inner layer of the eye is the retina, which is essentially the expanded 
fibers of the optic nerve. It is the screen on which the images fall, is most 
essential to vision, and is a transparent, purplish-colored membrane situated 
between the inner surface of the choroid and the outer surface of the vitreous 
body, a transparent jelly-like substance nearly filling the cavity of the eyeball 
and separated from the retina by the hyaloid membrane. The retina consists 
of eight layers of cells, the most important of which is the first or external 
layer, called the “layer of rods and cones,” in which the cells act as end organs 
to the optic nerve. 
The crystalline lens is a solid transparent body enclosed in a transparent 
capsule or membrane and held in place by a ligament. It is situated between 
the iris in front and the vitreous body behind. The lens is an elastic body 
which hardens and loses its elasticity with age. It is kept normally tense 
by the pull of the suspensory ligament on the capsule. When the eye is 
adjusted for near vision, the ciliary muscle contracts, drawing the choroid 
forward, relaxing the suspensory ligament and allowing the lens to change 
its shape. This is called accommodation. 
Common defects of accommodation are: 
1. Hypermetropia, or farsightedness, a condition in which the focal point 
for near objects is behind the retina. 
2. Myopia, or nearsightedness, a condition in which the rays are brought 
to a focal point before the retina is reached. 
3. Presbyopia, a condition similar to hypermetropia, found in old age and due 
to loss of elasticity of the lens. 
4. Astigmatism, a condition in which the curvature of the cornea or lens 
is defective, causing a dispersion of rays and a blurring of the image. 
The ear or the organ of hearing is composed of three parts: The external, 
the middle, and the internal ear (Fig.46). The external ear consists of the 
auricle and the external auditory canal, which extends from the outside to the 
eardrum, or tympanic membrane. This membrane separates the external from 
the middle ear. The middle ear (tympanic cavity) is a small, irregular, air- 
filled cavity located in the temporal bone. It communicates with the pharynx, 
by the Eustachian or auditory tube, and also with the mastoid air cells, and ANATOMY AND PHYSIOLOGY 
83 
is separated from the internal ear by a thin bony plate containing two small 
openings, one of which is closed by a thin membrane. The other opening, the 
fenestra ovalis, is the connection between the middle and the internal ear, and 
is occupied by the base of the stapes, one of the ear ossicles or bones located 
within the middle ear. These bones form a chain 
extending from the tympanic membrane to the 
fenestra ovalis. The internal ear contains the 
perceptive organ of hearing and consists of a ~bony 
labyrinth hollowed out of the petrous portion of 
the temporal bone. This labyrinth is lined with 
a membrane, contains a fluid called endolymph, 
and is divided into the vestibule, the semicircular 
canals, and the cochlea. The semicircular canals 
and vestibule receive nerve endings from the ves- 
tibular branch of the auditory nerve and have to 
do with the sensation of equilibrium. 
The end organs of hearing are located in the 
cochlea. Hearing is accomplished by sound 
waves which strike against the eardrum and are transmitted by the ear ossicles 
to the endolymph of the internal ear, the movement of which stimulates the 
end organs of hearing. The center of hearing is in the temporal lobes of the 
brain. 
The sense of smell is accomplished by emanations from certain substances 
coming in contact with special nerve endings of the olfactory nerve which are 
distributed to the mucous membrane of the upper part of the nasal chambers. 
Taste is accomplished by certain end organs known as taste buds, which are 
groups of modified epithelium cells of the tongue around which terminate nerve 
fibers. The perceptive portions of the tongue are the tip, the borders and the 
posterior portion of the dorsum. The nerves concerned with the sense of taste are 
the chorda tympani branch of the facial, the lingual branch of the trigeminal, 
and the glossopharyngeal. There are four fundamental tastes: salt, sweet, 
acid, and bitter. The pleasing variations which commonly are called taste are 
usually combinations of taste and smell. It is necessary for a substance to be 
in solution to stimulate the nerve endings concerned with taste. 
Certain special functions and activities. 
Speech, or the expression of coherent thought is brought about by a com- 
bination of several acts under control of a certain brain center. The center 
of speech is considered to be located deep in the left temporal lobe df the brain. 
The larynx contains folds of mucous membrane called vocal chords, which are 
controlled by muscles which separate or bring these folds together according to 
the pitch of tone desired. When air is forced from the lungs past these folds 
certain sounds are produced, and in conjunction with the movements of the 
pharynx, tongue, lips, and cheeks articulate speech results. 
Sleep is a period of more or less unconsciousness, during which most of the 
higher psychical powers are quiescent, but during which the physiological 
activities continue. It usually is considered a period of rest, in which the 
constructive processes exceed the disassimilitory or katabolic changes. Certain 
changes take place during sleep; respiration is slowed, the pulse slowed, and 
less blood is sent to the brain and greater amounts to the extremities. The 
cause and necessity for definite periods of sleep is not thoroughly understood. 
Heat regulation, or maintenance of constant body temperature is a two- 
sided process, and consists of controlling the loss of heat as well as the pro- 
duction of heat. Heat is lost through the excreta, through expired air, by 
Figueb 46.—Section through 
right, external, middle, and 
internal ear. (Howell.) 84 
HANDBOOK OF THE HOSPITAL CORPS, V. S. NAVY 
evaporation of sweat, and by radiation and conduction from the skin. Heat is 
produced by physiological oxidations within the body. This is effected by 
muscular exercises and partly by the variety and quantity of food. 
The preservation or elimination of heat is controlled chiefly by the sympa- 
thetic nervous system, by nerves to sweat glands and vasomotor nerves. An 
increase of blood to the skin, increases the loss of heat by radiation. The 
opposite effect may be produced by vasoconstriction or decrease of blood to 
the skin. 
Pever is an abnormal condition of increased temperature, the exact cause 
of which is unknown. Generally it is considered to be a metabolic disturbance 
caused by certain toxic substances which act upon a possible heat center in 
the brain and influence the sympathetic nervous system. 
References 
Anatomy.—Gray. 
Text Book of Anatomy.—Cunningham. 
Human Anatomy.—Piersol. 
Elementary Anatomy and Physiology.—Whillis. 
Textbook of Physiology.—Howell. 
Zoology for Medical Students.—Kerr. 
A Textbook of Histology.—Bailey. 
Textbook of Biochemistry.—Harrow & Sherwin. 
Practical Bacteriology, Haematology and Animal Parisitology.—Stitt, Clough, and Clough 
Hospital Corps Handbook, U. S. Navy, 1923. 
Handbook of the Hospital Corps, U. S. Navy, 1930. CHAPTER III 
Page 
Section 1. Minor surgery and first aid 85 
Section 2. Bandages and bandaging 131 
Section 3. Splints and appliances 148 
Section 4. Emergency dental treatment 165 
Section 1.—MINOR SURGERY AND FIRST AID 
Minor surgery is that part of surgery which includes procedures not endan- 
gering life. The application of bandages, splints, dressings and sutures, coun- 
terirritation, cauterization, and similar simple surgical measures are all 
considered as being within the scope of minor surgery. 
First aid is the emergency treatment of the sick or injured before regular 
medical or surgical attention can be given. It should neither supersede nor 
take the place of proper medical or surgical attention and should consist of 
furnishing temporary assistance to a sufferer pending the arrival of medical 
aid. In rendering first aid there are certain things that are to be done in all 
cases of Injury or illness. After taking charge of the situation the hospital 
corpsman should: 
1. Send for a medical officer or somebody capable of giving the proper 
treatment. 
2. Have somebody keep bystanders far enough away to give room to work 
without hindrance. 
3. Lay the patient on a blanket, or clothing spread out flat, with the head 
level with the body; do not permit him to sit or stand up. 
4. Loosen the patient’s clothing about the neck, chest, and abdomen. 
5. Examine the patient to determine the nature of the injury or illness, 
paying particular attention to evidence of haemorrhage, stoppage of 
breathing, poisoning, wounds, fractures, dislocations, burns, etc. If 
necessary, cut or rip clothing to get it away from the injured part. 
In making the examination look at or feel of the chest to determine 
whether the patient is breathing, note the color of the face, especially 
the lips and cheeks, look for bleeding from the nose and ears, deter- 
mine if he is conscious by asking questions of him, examine the lips 
and mouth for burns, discoloration, or bloody froth and the tongue for 
cuts, smell the breath for evidence of alcohol or poisons, and feel for 
the pulse to determine the character of the circulation. 
6. Proceed with first-aid treatment at once, treating serious haemorrhage 
first, stoppage of breathing next, and other conditions in the order of 
their seriousness. Remember to keep the patient warm. 
7. Note the location of the accident or of the patient; inquire of the patient 
or bystanders as to what happened; get the time the accident or ill- 
ness occurred and the names of the patient and witnesses; be pre- 
pared to receive an ante-mortem statement and be sure to have at 
least two others hear such statement, it may be the patient’s non- 
cupative or oral will. 86 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
A hospital corpsman giving first aid should do so with evident display of self- 
assurance and authority born of knowledge, with decision, calmness, alacrity, 
and alertness of mind, thereby obtaining the confidence of the patient and of 
interested bystanders. 
INFLAMMATION 
Inflammation may be described as the changes which occur in living tissue 
when it is injured, providing that the injury is not of such a degree as tends 
to destroy the structure and vitality of the patient. When tissue is injured, 
the following changes take place: Engorgement of the blood capillaries in the 
injured tissue and a seepage through the dilated capillary walls of blood 
fluids and blood cells, particularly white blood cells (phagocytes). Nature 
brings about these changes with the object in view of bringing aid of a repara- 
tive and a nutritive nature to the cells which make up the tissue injured. 
Inflammation manifests itself by certain local signs and symptoms which are 
produced by changes in the injured tissue. These symptoms are heat, pain, 
discoloration, swelling, and disordered function of the part involved. Heat 
and discoloration are due to the enlargement of the blood capillaries, the 
swelling to the throwing out of blood fluids and cells into the injured tissues, 
and the pain to the pressure of pent-up fluids on the nerve ends in the 
area affected. There may also be constitutional symptoms, as increase of tem- 
perature and increase of white hlood cells (leucocytosis) which depend in a 
large measure upon the cause of the inflammation and the absorption into the 
general circulation of the broken-down products of this inflammation. 
The causes of inflammation are: Traumatic, such as blows and mechanical 
irritation; chemical, such as stings of insects, mustard, venom of serpents, 
ivy poisoning, etc.; thermal, heat and cold; microorganisms, such as staphy- 
lococcus, streptococcus, etc.; and agencies, such as electricity, X-rays, actinic 
rays of the sun, etc. 
The general principles involved In the treatment of inflammation are: 1. To 
remove the exciting cause; 2. To keep the inflamed part at rest; and 3. To 
reduce the local blood pressure by elevation of the part. 
Other agencies employed in the treatment of inflammation are heat and 
cold, wet dressings, and ointments. Heat acts by softening the tissues and 
hastening the carrying away of the products of inflammation, thus decreasing 
the pressure on the nerve ends in the inflamed area* Cold acts by contracting 
the dilated blood capillaries and thus decreasing tension. Wet dressings and 
ointments act by softening the tissues and frequently contain some agent lo 
rid the inflamed area of the specific cause of the inflammation—some micro- 
organism, for instance. 
The conditions in which inflammation plays a very important part are: 
Fractures, dislocations, sprains, strains, wounds, burns, frostbite, and many 
kinds of infection. 
Inflammation due to microorganisms or bacteria differs from inflammation 
due to other causes in that the cause of septic inflammation, or inflammation 
due to bacteria, is a living organism which multiplies and throws off poisons 
in increasing quantities until such time as the white blood cells and blood 
fluids thrown out from the dilated capillaries can overpower it. In the case 
of aseptic inflammation the cause is other than bacterial. 
The principal danger in a septic inflammation is that the white blood cells 
and blood fluids will not be able to overcome the microorganisms which may 
gain access to the circulation and set up areas of inflammation elsewhere in 
the body. The term applied in this condition is sepsis. MINOR SURGERY AND FIRST AID 
87 
Bacteria which cause infection or sepsis are present in myriads on the 
surface of the body and on every article touched, unless it has been ster- 
ilized. The skin and mucous membranes protect from infection and sepsis, 
and it is only when there is a break in these tissues that the bacteria of 
sepsis gain entrance and start septic inflammation. All bacteria of infection 
and sepsis do not cause the same degree of inflammation, some causing mild 
and others very severe inflammation. In the case of some it is easy for 
blood fluids and white blood cells to limit the inflammation locally, while with 
others it is difficult for them to do so. 
An abscess is a localized area of infective inflammation containing live and 
dead microorganisms, live and dead phagocytes (white blood cells which have 
been combating the microorganisms), fluids forced out from the blood capil- 
laries, and the broken-down products of dead tissue cells. The content of an 
abscess is called pus. 
The treatment of an abscess is in accordance with the rules for treating 
other inflammations, but with the added rule that the pus when formed must 
he evacuated. Abscesses should be incised and drainage instituted, in order 
to reduce pressure on the tissues, rid the tissues of the irritating products of in- 
fective inflammation, and lessen the chances of the infecting organism gaining 
access to the general circulation and causing further trouble. Strict care 
must be taken not to introduce further infective organisms when the incision 
is made; that is, an aseptic technique must be employed. The incision must 
be large enough to allow good drainage. Never squeeze an abscess as this 
tends to break down Nature’s barrier and to spread the infection. Depending 
on the severity of the inflammation, more or less of this tissue may die, and 
this dead tissue is spoken of as slough. When the slough includes the skin 
or mucous membrane, an ulcer results. 
A boil, or furuncle, is an abscess in the true skin in which the infecting 
microorganism generally gains access by way of a sebaceous or a sweat gland, 
and in which there is a small slough in or beneath the true skin. A boil at 
the end of the nose or within the nostrils is very dangerous because, as a result 
of handling, incision, or other trauma, the infection enters the blood and is 
very easily carried by veins to the large venous channels on each side of the 
sphenoid bone (the cavernous sinuses) and thence spreads to the brain to 
form abscesses, or to the meninges to cause meningitis, or into the general 
circulation to result in septicaemia and possibly death. 
A carbuncle is a boil or furuncle, in which there are multiple sloughs often 
coalescing in one beneath the true skin. When the pus from these sloughs 
finds its way to the surface an opening occurs, hence the numerous foci of 
pointing (called “coming to a head”). Carbuncles, wherever they are located, 
are very dangerous, those about the face being especially so on account of 
the ease with which the infection can be carried to the cavernous sinuses 
and thence to other parts of the body as explained in the preceding paragraph. 
A patient suffering from one should be brought immediately under the care 
of a medical officer. If a furuncle breaks, one opening results; i f a car- 
buncle breaks, numerous openings result. Diabetes, Bright’s disease, and 
conditions of lowered resistance brought about by living in impure air, on 
improper foods, etc., render an individual particularly susceptible to boils. 
Boils and carbuncles should be treated by first placing the site of the furuncle 
or carbuncle at rest, and putting the patient to bed is advisable. X-ray 
therapy is the ideal treatment when the boil or carbuncle is in the indurated 
state, that is, before it has “come to a head.” If X-ray therapy is not avail- 
able the treatment should be: 1. Rest and avoidance of trauma; 2. Applica- 88 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
tion of heat by hot wet-dressings; 3. Relief of pain (aspirin or codeine may 
be given); 4. Ample fluid intake and high-caloric diet; 5. When there is 
definite fluctuation make a small incision to evacuate the pus. When there 
is a medical officer present and in the absence of X-ray facilities, early, radical, 
and complete excision is curative. No attempt should ever be made to treat 
a boil at the end of the nose or within the nostrils as over or faulty treatment 
may result in death. The best treatment for boils in these areas, except 
that ordered by a medical officer, is to leave them strictly alone; they may 
be looked at but not touched or handled. 
SHOCK 
Shock is a sudden depression of the vital functions of the body. The ner- 
vous system, which controls these vital functions, may be likened to a system 
of electric wiring. If too heavy an electric current is made to traverse the 
wires in an electric system they are likely to be burned out, or fuses blown. 
Similarly, if too violent impulses traverse the nerve paths in the body, there 
may be death from complete nonfunctioning of the nervous system, or there 
may result a much milder condition in which there is only partial functioning 
of the same. As the nervous system controls all the vital functions, so in 
shock they are all more or less affected. Practically any impulse traversing 
the nerve paths, if severe enough, may cause shock. There is emotional shock, 
where the impulses originate in the brain; traumatic shock, which results from 
a severe blow in the solar plexus or testicle, or from crushing or cutting a 
large nerve trunk, or from some severe injury; and electrical shock resulting 
from a heavy electric current traversing the nerve paths. 
One of the main effects of too violent impulses on the nerve track is the loss 
of nerve control over the blood vessels, resulting in the circulating blood col- 
lecting in the veins, especially the large veins of the abdomen and depriving 
the brain and other parts of the body of their normal supply. More or less 
shock occurs from all injuries. Depending upon the stability of the nervous 
systems of individuals, what might cause a mild case of shock in one could 
cause a severe case in another. 
Symptoms. 
A person suffering from severe shock lies in a drowsy condition, with the 
limbs limp, but generally is not totally unconscious. The skin is pale and 
cold; the temperature is subnormal; the pulse is feeble, fluttering, and rapid, 
and may be irregular and barely perceptible; the respirations are shallow and 
sighing; the pupils are generally dilated. Great thirst is frequently an accom- 
paniment of shock. 
The sensibility of these patients often is lowered and they do not feel pain 
as acutely as in a normal condition. Shock may result in immediate death 
from heart failure, or a condition known as reaction may be established. This 
state frequently is ushered in by vomiting and is characterized by a gradual 
return of color to the skin and a rise of body temperature accompanied by an 
improvement in the heart’s action and fuller and deeper respirations. After 
reaction is established, it is not unusual for the patient to fall into a sound 
sleep. In a case of mild shock, there may be nothing more than momentary 
paleness, weakness, and perhaps some temporary confusion of the thought. 
Other names applied to conditions of shock are faintness and collapse. 
Concealed haemorrhage resembles shock very closely, and always must be 
kept in mind in all cases of severe shock. MINOR SURGERY AND FIRST AID 
89 
Treatment. 
The principle underlying the treatment of shock is to bring the blood which 
has accumulated in the large abdominal veins back into the general circu- 
lation, to bring the proper blood supply back to the brain where the vital 
centers are situated and to the surface of the body, and to administer proper 
stimulation. If the shock is at all severe, a medical officer should be sum- 
moned immediately, but treatment must be started at once without waiting 
for his arrival. This may be accomplished by placing the patient in the proper 
position, applying warmth and administering stimulants. The position in 
which the shocked person is to be placed is on the back with the head low in 
order that the blood will tend to run into the brain. A good way to do this 
is to raise the foot of the bed or bench on which lying. Never raise the head 
of a shocked person by placing it on a pillow. The application of warmth acts 
as a stimulant, and also tends to bring the blood to the surface of the body. 
Warmth should be applied both externally and internally. Externally, warmth 
is applied by friction and rubbing of legs and arms briskly toward the trunk, 
by putting the patient on a bed in a warm room, covering with blankets and 
surrounding with hot-water bags, hot bricks or stones. Care must be taken 
that the latter are properly covered and not so hot as to burn the patient. Loss 
of body heat always increases shock; therefore, never remove more clothing 
than necessary from a shocked person, and when possible spread blankets or 
coats over him. Be careful, while rubbing, that the patient is not uncovered. 
Warmth is applied internally by hot drinks such as coffee or hot beef tea in 
small amounts, given frequently, and hot enemas, such as 2 pints of hot saline 
solution. Care must be taken not to burn the patient Stimulants used hy 
mouth are one-half teaspoonful of aromatic spirit of ammonia in one-half 
glass of hot water, hot coffee, hot tea, hot beef tea, or plain hot water; hypo- 
dermically, one-thirtieth grain of strychnine, or caffeine and sodium benzoate, 
2 to 5 grains; and by inhalation, smelling salts or ordinary water of ammonia. 
Unconscious persons or those unable to swallow should never be given any 
thing by mouth. The inhalation method is particularly useful in such cases. 
The most important treatment in electrical shock is artificial respiration which 
should be continued at least 4 hours in all cases. Shocked patients who have 
resumed breathing often later stop breathing, and they should be watched 
closely for hours after treatment. 
It must be borne in mind in the treatment of all severe injuries that they 
are accompanied by more or less shock, and that the treatment of this shock 
is perhaps just as important as the treatment of the injury itself. 
HAEMORRHAGE 
Haemorrhage or bleeding is the escape of blood from the heart or< blood 
vessels due to a break in their walls. Haemorrhage is spoken of as arterial, 
venous, and capillary, depending upon whether the escape of blood is from 
arteries, veins, or capillaries. In arterial haemorrhage the blood is bright red 
in color, and escapes in jets; in venous haemorrhage there is a rapid flow of 
dark blood, a welling up, as it were, without any spurting; and in capillary 
haemorrhage there is a steady oozing of red blood from the entire wounded 
surface. 
Nature’s method of arresting haemorrhage is by the clotting of blood, thus 
forming a plug at the point of bleeding. In the average healthy person, it 
takes from 3 to 5 minutes for blood to clot. There are, however, some 
abnormal people whose blood-clotting time is very much lengthened and the 90 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
arrest of haemorrhage in them is very difficult. These people are spoken of as 
hwmophiliacs or bleeders. The clot of blood which arrests the haemorrhage 
eventually organizes and permanently plugs the break in the vessel wall if 
it remains undisturbed. Certain factors favor and hasten the formation of a 
clot at the point of bleeding, such as the stopping or slowing of the blood stream, 
at that point, and the obliteration or decrease in size of the opening in the blood 
vessel where the haemorrhage is occurring. When an artery is cut or torn, 
the muscular wall contracts, thus decreasing the size of the opening. With the 
increase in loss of blood, the pressure within the circulatory system becomes 
lower and lower. When the haemorrhage occurs in a confined space, the pres- 
sure of exuding blood in the surrounding tissue and on the blood-vessel wall 
tends to slow the current of blood and close the opening in the blood-vessel wall. 
Treatment. 
It is possible to assist Nature in arresting haemorrhage by elevation of the 
bleeding part, thus decreasing the pressure of blood at the point of haemorrhage 
with the help of gravity; by keeping the patient at complete rest so that the 
blood clot at the point of bleeding will not be disturbed and so that the blood 
pressure at that point will be as low as possible, due to the slow beating of the 
heart; by the application of heat or cold, which tends to cause the blood-vessel 
wall to contract; by the use, at the point of haemorrhage, of styptics, medicinal 
substances which act to hasten blood clotting or cause contraction of blood-ves- 
sel walls; by the use of pressure to close the bleeding vessel; and by the use of 
ligation or torsion, also to close the bleeding vessel. Do not give stimulants in 
treatment of haemorrhage, as they increase the blood pressure and tend to cause 
the dislodgment of the clot at the bleeding point. 
Capillary haemorrhage is treated by elevating the part and applying very 
hot or very cold water, followed by the application of uniform pressure by 
means of a gauze compress and bandage. In some cases it may be necessary 
to apply a styptic, such as epinephrine (adrenalin). Epistaxis, or nosebleed, and 
bleeding from a tooth socket after extraction of the tooth are examples of 
capillary haemorrhage. 
In epistaxis, or nosebleed, keep the patient quiet and in a sitting position; 
remove collar or any constriction about the neck; apply cold or ice to the 
back of the neck, and instruct the patient to breathe through his mouth and 
not to blow his nose. The cold application to the back of the neck causes 
a reflex contraction of the blood vessels of the nose. Styptics, such as a 
solution of alum or of epinephrine, may be snuffed up the nose. Put a roll of 
paper under the upper lip, between it and the gum. If bleeding still con- 
tinues, the nostril must be packed by taking some soft material—cotton, linen, 
or lint—and gently forcing it well back into the nose. If bleeding continues, 
the person is probably a haemophiliac, and a medical officer should be sum- 
moned. In severe bleeding from a tooth socket, pack the cavity tightly with 
cotton or linen saturated with some styptic, such as epinephrine or alum; then 
have the jaws closed tightly and apply a Barton or a four-tailed bandage. 
In venous haemorrhage, elevate the part (so little velocity is there in the 
venous current that often this procedure alone will stop the bleeding). If 
bleeding continues, make pressure directly over the wound with a sterile 
compress. If venous haemorrhage is from an extremity, the limb should be 
bandaged from toes or fingers up to the bleeding point in addition to pressure 
over the point. A common location for severe venous haemorrhage is from 
varicose veins of the legs. 
In the treatment of arterial haemorrhage prompt and decisive measures are 
required, particularly in the case of haemorrhage from the large arteries. MINOR SURGERY AND FIRST AID 
91 
Haemorrhage from the femoral artery may result fatally in a few minutes. 
The main reliance must be on the more strenuous methods, viz., pressure, liga- 
tion, and torsion. Ligation is the tying off of an artery with sutures, and 
torsion consists in twisting the end of the vessel with forceps or an artery 
clamp for five or six rotations; these two methods should be left to a medical 
officer ordinarily and should not be undertaken by the first-aid man unless 
absolutely necessary. This leaves the pressure methods available as the 
main reliance of the first-aid man. 
Pressure to control arterial haemorrhage always must be applied at some point 
between the bleeding point and the heart, preferably at a point where the bleed- 
ing artery can be compressed against bone. Pressure may be applied by means 
of the fingers, spoken of as digital pressure, or by means of compresses or by 
the application of a tourniquet. Digital pressure can serve only for a short 
time, as the fingers soon become tired. This pressure should be made with 
the thumbs and should be firm enough to arrest the bleeding; it should be made 
ever the clothes, as too much time may be lost in removing them. One will 
know that he is pressing on the right place by feeling the artery beating beneath 
the thumbs and by the arrest of the bleeding; if the artery cannot be found, 
make pressure directly over the bleeding point. As pressure with the thumb 
soon becomes tiresome, an assistant should relieve the first-aid man who 
should prepare to apply other pressure methods, either tourniquet or com- 
press. A tourniquet is a constricting band, and there are various kinds. 
The principle of all tourniquets is a pad over the artery to bring the pres- 
sure on the artery and take it off the veins, a band around the limb and 
over the pad, and some means of tightening the band. There are a num- 
ber of special tourniquets, but as they are not usually at hand, a suitable 
one must be improvised. An excellent one may be improvised with a rubber 
bandage, a number of turns being made about the limb and the rolled portion 
of the bandage then placed under the last turn in such a position as to press 
directly on the artery. The most common improvised tourniquet is the so-called 
Spanish windlass, in which arrangement any rounded, smooth, hard object, such 
as a stone, a cork, or a roller bandage, is used as a compress; for the band, a 
handkerchief, a suspender, a waistbelt, a bandage, or anything of the sort may 
oe used. To tighten the band, a stick, bayonet, or scabbard, or something of 
the kind, is passed under the band and twisted until the bleeding ceases, and 
the ends are then tied to the limb to prevent the band from becoming untwisted. 
Pressure t>y means of compresses may be effected as follows: A number of small 
pieces of gauze or linen, or a tampon, previously rendered sterile or antiseptic, 
are placed in the wound, one on top of the other, until there are a sufficient 
number to compress the bleeding vessel; a bandage then is applied firmly to hold 
them in place and exert the necessary pressure. Sometimes more effective pres- 
sure can be obtained by employing a compress of gradually increasing size (cone- 
shaped with apex nearest the vessel). Compresses may be applied in the same 
manner along the course of the vessel. 
The dangers in the use of tourniquets and constricting bands for the control 
of haemorrhage are that if applied tight enough to stop arterial haemorrhage they 
cause pain and swelling of the limb, and if left long enough may cause gan- 
grene or death of the part below the constriction. Therefore they should be 
watched and loosened from time to time, at about half-hour intervals. If on 
loosening the tourniquet the bleeding starts again, tighten it up; if there is 
no appearance of bleeding leave the loose tourniquet in place with an attend- 
ant instructed to tighten it should the bleeding recur. The tourniquet method 
is the most effective in the majority of cases, but due to the attendant after- 
154294°—39 7 92 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
dangers, in all but the most severe haemorrhages of the larger arteries arrest 
of the bleeding by elevation of the part and the compress method should be tried 
first. All possible care should be taken not to infect the tissue with dirty 
applications, but sometimes in tremendous haemorrhages all these precautions 
have to be laid aside to save the person’s life. In all cases of severe haemor- 
rhage the measures mentioned are only preliminary to arrival of a surgeon. 
With great loss of blood the patient 
suffers severe collapse and must be 
given treatment for shock, except that 
stimulants must not be given unless the 
blood vessel has been safely secured 
against recurrence of the haemorrhage. 
After severe haemorrhage tremendous 
thirst generally is complained of and 
should be relieved with frequent, small 
drinks. This may be termed the con- 
stitutional treatment of haemorrhage. 
The specific treatment for haemor- 
rhage from certain parts of the body is 
described immediately following: 
Bleeding from the scalp.—Apply pres- 
sure over wound with compress and 
bandage. 
Arterial bleeding from the lips.— 
Grasp lips between thumb and fingers 
on each side of wound, as the arteries 
to the lips come from both sides. 
Arterial haemorrhage in other parts 
of the face.—Apply digital pressure on 
the facial artery against the lower jaw 
midway between the ear and chin where 
its pulsation can be felt (fig. 47). 
Arterial haemorrhage from neck.— 
Apply digital pressure with the thumb 
on the carotid artery against the verte- 
brae. (A tourniquet cannot be used in 
this location.) (Fig. 47.) 
Arterial haemorrhage from the arm- 
pit.—Place a compress in the armpit 
and bind the arm tightly to the side. 
If this fails, compress the subclavian 
artery behind the clavicle (collar bone) 
between the thumb and first rib, or 
compress it with a key, the handle of 
which has been padded (fig. 47). 
Arterial haemorrhage of arm, forearm, 
or hand.—Apply digital pressure on the 
brachial artery on the inner side of the biceps, and then apply a tourniquet 
a little higher up. In case of arterial haemorrhage of the forearm, a pad may 
be placed in the bend of the elbow and the forearm forcibly flexed on the arm. 
In case the haemorrhage is from the palm, either of these two methods may 
be used, or a large firm compress may be placed in the hand with the fingers 
very tightly closed over it and bandaged in place (fig. 47). 
Figure 47.—Skeleton with black and 
dotted lines showing the course of the 
arteries and x indicating the pressure 
points. (Mason.) MINOR SURGERY AND EIRST AID 
93 
Arterial haemorrhage from the thigh, leg, or foot.—Compress the femoral 
artery against the head of the femur just below the middle of the groin with 
both thumbs, then apply a tourniquet to replace the thumbs. In case the 
haemorrhage is in the leg or foot, another method is to put a pad behind the 
knee, flex the leg forcibly, and tie it in that position. With arterial haemor- 
rhage in the foot, in place of these two methods, compression can be made, 
when the bleeding point is on the dorsal surface, on the anterior tibial artery 
at the instep; and, when the bleeding is on the plantar surface, on the posterior 
tibial artery behind the internal malleolus (fig. 47). 
Haemoptysis is haemorrhage from the lungs. It may result from wounds of 
the lung but more often is due to disease of these organs. The patient usually 
is seized by a fit of coughing and spits up bright red, frothy blood. Unfortu- 
nately, nothing can be done to arrest the haemorrhage quickly. The treatment 
consists of immediately summoning a medical officer, and in the meantime 
keeping the patient absolutely quiet, at rest, and giving ice by mouth. Listen 
over the chest, and where rattling is heard, apply an ice bag. Avoid all 
stimulants. 
Haemorrhage from the stomach.—The vomited blood is usually dark in color 
and may be mixed with food. It always should be remembered that vomited 
blood does not necessarily indicate haemorrhage from the stomach; blood 
coming from the back of the nose and throat may have been swallowed, and 
inquiry should be made to find out if there has been any nosebleed. The 
blood from pulmonary haemorrhage contains air and is frothy while blood from 
the stomach is not. The treatment is the same as for haemorrhage from the 
lungs, except that the ice bag is applied over the upper abdomen. 
Internal haemorrhage, also called concealed haemorrhage, may occur in any 
of the cavities and from any of the organs of the body as the result of injuries 
or disease. It is a condition which may be very difficult to diagnose, as the 
bleeding cannot be seen. Frequently the only symptoms are those of shock. 
In such cases summon a medical officer immediately; in the meantime, place 
the patient flat on his back and keep him absolutely quiet. Opiates are indi- 
cated in haemorrhage of this nature, their purpose being to produce quietness. 
Primary haemorrhage occurs immediately on receipt of a wound or injury. 
After the arrest of primary haemorrhage, a recurrence may occur, caused by 
dislodgement of the clot, the slipping of a ligature, or from the opening of a 
blood vessel by separation of a slough. Recurrence of haemorrhage within 24 
hours is spoken of as consecutive or intermediate, and recurrence after that 
time is spoken of as secondary haemorrhage. 
WOUNDS 
A wound is defined as the forcible solution of continuity of any of the tissues 
of the body. The principal kinds of wounds are: Clean or aseptic wounds; 
infected or septic wounds; and poisoned wounds. A clean or aseptic wound 
is one to which no germs have gained access; the best example of it being a 
wound made by the surgeon’s knife. An infected or septic wound is one in 
which there have been introduced pus-producing organisms (see inflammation), 
or such organisms as produce tetanus or lockjaw, gas gangrene, or hydro- 
phobia. A poisoned wound is one in which some nonliving poison, as distin- 
guished from bacteria or microorganisms, has been introduced by the agent 
causing the wound; e. g., bites of insects, scorpions, snakes, etc. 
An incised wound is one made by a sharp cutting instrument, the class 
of wounds commonly known as cuts. A lacerated wound is the result of the tear- 94 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
ing of the skin and underlying tissues by blunt instruments or machinery and 
presents ragged edges, which do not retract much, and which, as a rule, 
consist of masses of torn tissues, frequently with dirt ground into them. A 
contused wound is one in which the division of tissue is accompanied by 
more or less severe crushing. A punctured wound is deep and narrow; e. g., 
stabs are punctured wounds. Crushed wounds are more serious than they 
first appear, due to the fact that the dead tissues are an excellent culture 
medium for the growth of microorganisms of infective inflammation, resulting 
sometimes not only in loss of the part but also in general infection of the 
body, that is, septicaemia or blood poisoning. The term gunshot wound is applied 
to any wound inflicted by the missile of a weapon of warfare, such as by rifles, 
pistols, cannon, etc. 
When the skin and underlying tissues are divided, blood vessels, generally 
capillaries, also are divided, and there is more or less bleeding from 
the cut surfaces of the tissue, a clot forming between the cut surfaces. 
Young connective-tissue cells and capillary buds grow into this clot from 
the edges of the wound, replacing the blood elements. These young connective- 
tissue cells and the young capillaries form what is known as granulation 
tissue or “proud flesh.” Later the young connective-tissue cells and capillary 
buds develop into the mature connective tissue, and the epithelium of the 
skin grows over it from the edges of the wound. When the cut surfaces are 
so close together that there is very little granulation tissue required to 
heal the wound, healing is said to be by first intention; when the wound is 
gaping and considerable granulation tissue is required, healing is said to be 
by second intention. Pus Infection causes gaping of wounds, therefore in 
wounds infected with pus bacteria, healing is by second intention. Con- 
nective tissue filling in a gaping wound forms the so-called “scar.” 
Unless cut ends of tendons are brought together, the two ends will be 
so retracted, and there will be so much connective tissue formed between 
them in the healing of the wound, that the function of the tendon will be 
lost. Unless the cut ends of a nerve trunk are brought together, the function 
of that nerve will be lost forever. Nerve fibrils making up a nerve trunk re- 
generate centrifugally, and if the pathway for this regeneration is blocked 
by a wall of connective tissue, these fibrils can never reach the part they are 
supposed to innervate. 
The local factors preventing and delaying the healing of wounds are: 
Infection with pus bacteria; the presence in the wound of foreign bodies, such 
as dirt, bits of clothing, etc.; and a lowered vitality of the edges of the wound 
due to crushing and tearing of the tissues, etc. General and constitutional 
factors also prevent and delay healing, among these factors being poor circu- 
lation of blood, diabetes, Bright’s disease and syphilis. 
General principles underlying the treatment of wounds. 
Stop haemorrhage and treat shock; so handle the wound as not to introduce 
fresh bacteria of infection; remove foreign bodies, such as dirt, bits of cloth- 
ing, etc., from the wound; if infective bacteria already have been introduced 
into the wound, take measures to eliminate them or prevent their development. 
If the wound is an aseptic one, bring the edges together so that it can heal 
by first intention; if the wound is an infected one, keep the wound open and 
furnish drainage {see inflammation) ; if the wound is a poisoned one, neutralize 
the poison in it and prevent its entrance into the general circulation; treat 
any constitutional condition which may delay or prevent healing. 
There are two main types of bacteria commonly causing infection in wounds: 
Aerobic and anaerobic. The former are bacteria that live and multiply in the MINOR SURGERY AND EIRST AID 
95 
presence of air, while the latter are bacteria that live and multiply in the 
absence of air. The principal bacteria which cause infective inflammation and 
septiccemia or blood poisoning are Streptococci, some varieties of which are 
haemolytic (destroy red blood cells), Staphylococci, and Pseudomonas aeru- 
ginosa (Bacillus pyocyaneous), frequently called the bacillus of green or blue 
pus; these are aerobic. There are several anaerobic bacteria which are fre- 
quently present in wounds. They commonly inhabit the intestinal tracts of 
man and other animals and are often found in soils which have been fertil- 
ized with animal manure. Among those occurring in wounds, especially in 
war wounds, are the Clostridium welchii, commonly termed the “gas bacillus’’ and 
causing gas gangrene, the Clostridium sporogenes, the Clostridium cedematiens, 
and the Clostridium histolyticum. The Clostridium tetani, or tetanus bacillus, 
is common in the faeces of horses and cattle and consequently is found with 
great frequency in soils fertilized with manure from those animals. It is 
often associated with Clostridium welchii in wounds and it produces a toxin 
which is one of the most powerful poisons known, being said to be 20 times 
as poisonous as dried cobra venom. The filtrable virus causing rabies, often 
termed hydrophobia (fear of water, and a common symtom of the disease) 
is nonpathogenic and perhaps anaerobic in character. 
Inasmuch as the bacteria of pus infection are present everywhere, any wound 
is likely to be infected with them. However, contused and lacerated wounds 
are most likely to suffer from infective inflammation, owing to the lowered 
vitality of the tissues. The bacteria of tetanus or lockjaw and of gas gangrene 
are found in exceptional numbers in the intestinal contents of herbivorous 
animals, such as horses and cattle, and, for that reason, wounds inflicted by 
objects which have been contaminated by manure or by heavily fertilized soil 
are most liable to have introduced into them the bacteria of these diseases. 
In badly lacerated wounds and in punctured wounds there is great likelihood 
of absence of air due to the flapping1 back of the torn tissues after infliction of 
the wound, and for this reason these types of wounds afford a very favorable 
environment for the development of tetanus or gas gangrene. Tetanus, or 
lockjaw, frequently occurs after stepping on a nail near a bam or a stable, 
the nail previously having become infected with Clostridium tetani from the 
excretions of horses or cattle. The virus of rabies is found in the saliva of a 
rabid animal and is introduced by its bite. These bites generally are either 
lacerated or punctured wounds, with their associated anaerobic conditions. 
A wound dressing consists of everything used to cover or dress a wound. The 
pad which is put directly over the wound is called a compress. In ordinary 
emergency treatment a wound dressing consists of a compress with bandage 
to hold it on. A dressing may be either dry or wet, aseptic or antiseptic. An 
aseptic dressing is one which is sterile, that is, one with no bacteria on it. An 
antiseptic dressing is one which, in addition to being sterile, contains some sub- 
stance for killing bacteria. A wet dressing generally is an antiseptic dressing. 
A wet antiseptic dressing generally is used in wounds where infective inflam- 
mation is going on, whereas a dry sterile dressing is used to cover a fleeent 
wound which is considered to be free from infection. The purpose of a wound 
dressing is to stop haemorrhage, to prevent introduction of bacteria, and to 
prevent further injury to the wound. 
The Navy supplies a first-aid packet which is a hermetically sealed tin can 
containing a dry sterile dressing. This is excellent for a small wound. The 
directions for its use are contained in the packet. For large wounds, sick bays 
aboard ship are furnished with large and small shell-wound dressings. All 
these dressings consist of a sterile gauze compress with bandage attached Any 96 
HANDBOOK OF THE HOSPITAL CORPS, U, S. NAVY 
piece of cloth, such as gauze, cotton, linen, muslin, or a handkerchief, is suit- 
able for a compress in case of emergency, provided it is rendered sterile, and 
anything that can be used for bandaging is suitable as a bandage. The most 
vital point about material used as the compress of a wound dressing is that, 
before it is applied to a wound, it should be rendered sterile. 
The part of the dressing which is to come in contact with the wound must 
be kept absolutely sterile; i. e., it must not be touched with any part of the 
body or anything else except sterile Instruments before its application to the 
wound. In an emergency, material to be used in a wound dressing may be 
sterilized by boiling it for 10 minutes. 
When a patient can be brought under the care of a medical officer in the 
very near future, the procedure necessary in the first-aid treatment in the 
case of ordinary wounds is: Stop the haemorrhage, treat the shock, and apply 
a sterile dressing to the wound. If a surgeon is not available, the wound must 
be further treated as described hereafter. 
In treating a freshly made wound suspected of being contaminated (all wounds 
should be suspected of contamination by infective organisms unless made under 
strictly aseptic precautions) the following procedure is recommended; Cleanse 
one’s own hands as thoroughly as possible by a thorough scrubbing with soap 
and hot water, followed, if possible, by immersion of the hands in hot 1-2,000 
bichloride of mercury solution and then in 70 per cent alcohol. Sterilize all in- 
struments to be used in removing foreign bodies such as dirt, glass, splinters, etc., 
or for shaving the skin about the wound. If there is much bleeding, arrest the 
haemorrhage. If there is much hair about the part, remove it by cutting or 
shaving for a distance of several inches from the cut edges. If there is much 
grease in and about the wound, remove it with turpentine or gasoline. Remove 
all foreign particles with sterile forceps. Clean the skin about the wound with 
a sterile damp cloth, and, while doing this, protect the wound with a piece of 
sterile gauze. Dry the wound and skin about it with sterile dry cloth or cotton. 
Apply tincture of iodine to all parts of the wound and to the skin about the 
wound for a distance of about one-half inch beyond the wound edges. After 
the skin has been well dried, the wound edges are brought together and a dry 
wound dressing applied. 
There is no substance which should be used by the first-aid man to wash a 
wound. In the first place, he only washes in more dirt than he washes out, and, 
secondly, ordinary water is dangerous, as it contains many bacteria; this applies 
equally to soap and water. Strong antiseptics such as bichloride of mercury or 
phenol (carbolic acid) will destroy the cells of the body which dispose of the pus 
bacteria before they kill the latter, and should never be used except in certain 
wounds described later. Peroxide of hydrogen is not strong enough to kill all 
bacteria, and in a large or deep wound it washes some of these bacteria to un- 
infected parts which then become infected. Therefore, use none of these prepa- 
rations in a wound, which should be covered with a sterile cloth, while cleaning 
the skin around the wound as described before. If, however, there is much 
greasy dirt rubbed into the wound, the latter should be gently swabbed out with 
sterile gauze or a cotton applicator, saturated with benzine or gasoline, and for- 
eign bodies picked out with sterile forceps. Tincture of iodine is the only sub- 
stance to be used in an ordinary fresh wound by the first-aid man, aside from 
benzine and gasoline to cut grease, if present. The tincture of iodine should 
be used within two hours after the wound is inflicted, as after that time it is 
probably valueless. Tincture of iodine is best applied with a camel’s-hair 
brush, but a bit of cotton on a stick answers the purpose very well; the brush 
or cotton need not be sterilized, us the iodine accomplishes this. The tincture MINOR SURGERY AND FIRST AID 
97 
of iodine may be poured into a wound. Iodine can be used in wounds practi- 
cally anywhere in tbe body except in or near the eyes, where it must never he 
used. It must not he used in conjunction with bichloride of mercury. 
Attempts to bring the wound edges together should not be made when the 
patient can be brought under the care of a surgeon in the very near future, but 
if hours or days must elapse before the service of a medical officer can be 
obtained, coaptation shoidd be done in cases requiring it. The edges of a wound 
should not be brought together before foreign bodies and dirt have been re- 
moved and wound edges cleaned. Wounds in which infective inflammation is 
going on should be left open and allowed to drain. The two methods by which 
coaptation may be accomplished are by means of sutures and by means of adhe- 
sive strips. The former is preferable, as by the latter method bacteria of in- 
fective inflammation most probably will be introduced. As a rule, the edges of 
large deep wounds should not be too tightly apposed. Some chance of escape 
should be left for the serum and blood which are sure to be present, that is, 
means for drainage should be supplied. This may be done by the use of small 
pieces of sterile rubber tubing, strands of catgut or silkworm gut, or a narrow 
strip of gauze which has been sterilized by boiling. These drains should be 
placed in the lower angle of the wound. Wounds which are dirty and look 
badly should be left wide open. 
The materials ordinarily used for sutures are plain catgut, chromicized cat- 
gut, kangaroo tendon, silkworm gut, silk, or linen; sometimes horsehair also 
is used. Suture material, also called ligatures, is divided into absorbable and 
nonabsorbable ligatures. Ahsorhahle ligatures are those which can be left in 
a wound, inasmuch as the tissues absorb them, and included in this class are 
catgut and kangaroo tendon. Silkworm gut, silk, linen, and horsehair are non- 
ahsorhahle ligatures and must be removed after 6 or 7 days. Chromicized cat- 
gut is catgut which has been so treated that it is not as quickly absorbed 
as plain catgut. Catgut is the ligature to be preferred in the suturing of 
wounds. Needles used in the suturing of wounds are; Curved, straight, and 
round, or cutting. Where the skin must be pierced, the curved cutting needle 
is preferable. The main point about all suture material to be used in a wound 
is that it must be sterile. In case of emergency, an ordinary sewing needle 
with cotton or silk thread, well sterlized by boiling, may be used. This suture 
is nonabsorbable and must be removed after 6 or 7 days. With the operator’s 
hands, and also the wound, well cleansed, the needle, threaded with the suture, 
is passed through the skin about one-eighth of an inch from the cut edge and 
on out through the opposite side at a corresponding point The suture then 
is tied, and the ends cut leaving about one-quarter of an inch remaining; 
care should be taken in tying the suture to use but little tension, sufficient 
only to bring the cut edges in accurate approximation. The remaining stitches 
are inserted in the same manner at a distance of from one-quarter to one-half 
of an inch apart until the wound is closed. When a tendon or large nerve 
has been cut, the ends must be brought together and sutured with catgut be- 
fore the wound is closed. Suturing of tendons and nerves should be done by 
medical officers. 
The manner in which a wound showing evidence of infective inflammation 
is treated, is: Elevate the part; put it at rest; remove foreign bodies, if pres- 
ent; remove enough sutures, if present, to obtain good drainage; insert drain; 
apply a wet antiseptic dressing; and treat the constitutional symptoms. 
Wet antiseptic dressings generally are made up of a layer of sterile gauze, 
saturated with an antiseptic solution, to be applied directly on the wound. A 
layer of sterile cotton is then applied, some impervious material such as oiled 98 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
silk or waxed paper put over the dressing in order to retain the moisture, and 
a bandage over all. The dressing should he kept wet with the antiseptic solu- 
tion, either by frequent changing or by having perforated rubber tubes between 
the gauze and cotton through which the dressing can be periodically moistened 
with the antiseptic solution. The antiseptic solutions usually employed in 
wet dressings are: Bichloride of mercury solution 1-5,000; saturated solution 
of boric acid; and Dakin’s solution. Bichloride of mercury solution should not 
be applied on a wound freshly painted with tincture of iodine, as a corrosive 
iodide of mercury is formed which causes a very severe inflammation followed 
by ulceration. 
If the symptoms of an infected wound are severe, put the patient to bed, 
clear out the bowels with a brisk purgative, and apply an ice cap to the head to 
reduce the fever. 
The measures taken in fresh wounds suspected of being infected with tetanus 
or gas gangrene are: The wound is cleaned and treated as has been described, 
and kept freely open for a time in order that anaerobic conditions may not exist 
for the growth of these bacteria. As a further precautionary measure, tetanus 
antitoxin is given. A punctured wound suspected of being infected is frequently 
cauterized and a dry wound dressing applied. 
Symptoms and treatment of special types of wounds. 
Wounds inflicted by an animal suspected of being rahid or of having rabies 
are to be treated in the following manner: Thoroughly cauterize the wound 
with filming nitric acid and neutralize with sodium hydrate solution, 1 per 
cent, or sodium bicarbonate solution, 10 per cent. The Pasteur treatment may 
be given later. In the absence of fuming nitric acid, a red-hot needle may be 
used to cauterize the wound. Do not use silver nitrate or phenol for cauterizing 
these wounds as they coagulate the albumin in the tissues thereby producing the 
anaerobic conditions necessary for infective organisms and retarding their 
destruction. Apply a dry wound dressing. 
Poisoned wounds due to causes other than to bites of poisonous snakes 
include ordinary insect bites, such as those produced by mosquitoes, fleas, ants 
and bees. These bites require but little treatment. Sometimes the sting of 
a bee is broken off and remains in the skin. In treating these cases always 
search for the sting and remove it if it be present. As the poison of insects 
is composed chiefly of an acid, the local application of some alkali should 
be employed; either water of ammonia or a solution of washing soda affords 
great relief. Bites of the more poisonous spiders, centipedes, tarantulas, and 
scorpions require prompt treatment. Tie a ligature or tourniquet about the 
injured part between the wound and the heart to prevent the absorption into 
the general circulation; enlarge the bite by making an incision at its site, 
suck out the wound to produce bleeding, and apply crystals of potassium 
permanganate or tincture of iodine. If there be abrasions or open lesions 
in the mouth, it is not advisable to suck the wound. Release the tourniquet 
after a time to permit temporary restoration of circulation, replace it and 
repeat this process every half hour as long as may be necessary. Apply a 
wound dressing to the wound and treat shock which sometimes occurs in 
these cases. 
Poisonous snakes are classified into viperine snakes and colubrine snakes. 
To the viperine family belong the rattlesnake, the copperhead, the water moc- 
casin, and the viper; to the colubrines belong the cobra and the coral snake. In 
poisonous snakes the teeth are arranged in two rows, with a fang on each 
side, outside the teeth near the point of the jaw. Nonpoisonous snakes have 
four rows of teeth without fangs (fig. 48). The imprint of the wound often MINOR SURGERY AND FIRST AID 
99 
will tell whether a person has been bitten by a poisonous or a nonpoisonous 
snake. The venom of different poisonous snakes differs in its action. The 
poisonous constituents are neurotoxin, a nerve poison, and hcemorrhagin, which 
injures the lining of the blood vessels so that an escape of blood occurs into the 
surrounding tissues; a third constituent is hcemolysin, which destroys red blood 
cells. The venom of colubrine snakes is made up principally of neurotoxin 
and that of viperine snakes of haemorrhagin. In colubrine poisoning, the local 
symptoms are not marked, though there are at times severe pain and some 
Figure 48.—1, Single row of scales, posterior to vent (poisonous snake—water moccasin) ; 
2, double row of scales of harmless snake (Natrix) ; 3, side view of head of pit viper; 
4, side view of head of harmless snake; 5, dorsal view of pit viper; 6, dorsal view of 
harmless snake; 7 and 9, bite puncture and skull of Elaps; 8 and 10, the same of 
harmless snake; 11, poison apparatus of rattlesnake. (Stitt.) 
tenderness, swelling, and discoloration at the site of the bite; then in l1 to 2Vz 
hours the patient begins to feel tired and drowsy, there often being some nausea 
and vomiting; paralysis sets in, generally affecting the extremities first and 
then becoming more generalized, finally affecting respiration, so that the 
patient’s breathing becomes slow and shallow and finally ceases; convulsions 
also may be present. In viperine poisoning there is pain at the seat of the 
bite, which soon becomes excrutiating, with rapid swelling and discoloration; 
there is at the same time a feeling of nausea and faintness, while a sense of 
depression takes hold of the individual; the pulse becomes rapid and feeble. 100 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
and the breathing is labored; in fatal cases, death may occur in 24 to 48 hours. 
The severity of the symptoms and final outcome depend upon the amount of 
venom injected and absorbed into the general circulation, which in a large 
measure depends on the size of the snake. 
The treatment of wounds inflicted by a poisonous snake follows: If the wound 
is in an extremity, tie a bandage or handkerchief tightly about the single-bone 
part of the limb between the wound and the heart; incise the wound freely and 
suck out as much of the poison as possible. If there be abrasions or open lesions 
in the mouth it is not advisable to suck the wound. With a hypodermic syringe, 
inject a 2-per cent solution of potassium permanganate into and about the bite 
to destroy any poison which is left. Meanwhile, give stimulants in the shape 
of coffee and strychnine, one-thirtieth grain. The ligature should be loosened 
about every half hour to allow restoration of the circulation, but should be 
tightened up immediately if symptoms of general poisoning occur. There 
are antivenin serums available for the treatment of poisoning by snake bite, 
one which neutralizes neurotoxin and another which neutralizes hsemorrhagin. 
They are injected hypodermically or intravenously and are very effective if 
properly used; that is, serum to combat the venom of a colubrine snake must 
be used against that type of snake bite, and the specific serum for the viperine 
snake venom used to combat the toxin of that type of snake, in order to get 
results. 
Gunshot wounds inflicted by bullets.—Always look for the wounds of entrance 
and of exit and apply a sterile dressing to each. Concealed haemorrhage and 
injury to internal organs are the most dangerous results of these wounds and 
depend on the course taken by the bullet. The wounds of entrance and exit 
caused by high-velocity bullets may be so small as to be hardly visible, or 
the wound of entrance may be very small and the wound of exit large, due 
to the explosive effect of the bullet on the tissues. Never probe a bullet wound, 
as a bullet is very likely to be sterile, and by probing one is almost sure to 
introduce germs of infective inflammation. 
Symptoms and treatment of penetrating wounds of the chest.—The symptoms 
are the presence of air bubbles in the wound, difficult breathing, coughing, and 
spitting of blood. The first-aid treatment consists in laying the patient on the 
injured side, firmly bandaging the chest, summoning medical aid, and the gen- 
eral treatment for wounds. 
Symptoms and treatment of wounds of the abdomen with injury to the intes- 
tines and stomach.—The signs of Injury to the intestines are the escape of gas 
or faeces through the wound and the passage of blood in the stools. Injury 
of the stomach may result in the escape of its contents through the wound 
and the presence of bloody vomitus. Keep the patient absolutely quiet and 
place under the care of a surgeon as soon as possible, as every moment’s delay 
in surgical treatment lowers his chance of recovery. With a large abdominal 
wound from which more or less of the abdominal contents escape, place a 
sterile cloth over the wound and the extruded intestines; bandage in place and 
keep the dressing wet with sterile physiological salt solution until the patient 
can be placed under the care of a surgeon. 
Treatment for wounds of the eye.—Remove the foreign body, if present, as 
described under removal of foreign bodies. Never use tincture of iodine or other 
strong antiseptics in the eye. Boric acid solution or an organic silver prepa- 
ration (silvol or argyrol) are the only antiseptics to be used in the eye. All 
eye wounds should be brought under the care of a medical officer as soon as 
possible. In the meantime cover both eyes with absorbent cotton or soft cloths 
so as to keep the eyelids still, and hold the dressing in place with bandages MINOR SURGERY AND FIRST AID 
101 
around the head. Be careful not to put on these bandages so tightly that they 
will cause pressure on the eyeball. In case some time must elapse before the 
services of a medical official can be obtained, the dressing should be kept wet 
with cool saturated solution of boric acid, and if secretions are present, the 
eye should be irrigated at frequent intervals with warm saturated solution of 
boric acid. In lifting the eyelid do not press on the lid, but lift the upper lid 
by traction on the region above it; this prevents scratching of the cornea by 
pressure. 
CONTUSIONS, STRAINS, AND SPRAINS 
A contusion, or as it is commonly termed, a bruise, is a crushing and tear- 
ing of the tissues, usually without a break in the skin. It is characterized by 
swelling, tenderness, and discoloration, due to the rupture of blood vessels 
in the neighborhood of the injury. At first the discoloration is red, then blue 
or black, and finally turns yellow or green, commonly called black and blue 
spots. The change in color is due to the chemical change in the coloring 
matter of the blood haemoglobin. The rapidity in the formation of the swelling 
and its size depends on the number and size of the blood vessels ruptured. 
Contusions vary in extent from an ordinary black and blue spot to the almost 
complete purification of a limb with laceration of blood vessels and nerves 
such as sometimes occurs in railway or other accidents. A “black eye” is an 
example of a contusion. 
Slight contusions as a rule require no treatment. With severe contusions 
there is more or less shock which must be treated. For the contusion itself, 
the treatment is to stop the subcutaneous haemorrhage; this can be done by 
rest and elevation of the part; by very hot or cold applications; and if the 
injury is in a limb, firm, even pressure of a bandage may be effective. Later, 
when the bleeding has ceased, the absorption of the extravasated blood may 
be hastened by hot fomentations and massage. In the case of severe contu- 
sions and in contusions in elderly people, hot water is much better than cold, 
as the latter ends to lower the vitality of injured tissue. 
A strain is the overstretching of a muscle or tendon with an attendant 
rupture of the muscle or tendon fibers. In severe strains, small blood vessels 
often are ruptured, resulting in the escape of blood into the muscles in the 
same way that, in the case of a bruise, blood escapes beneath the skin. It is 
generally the result of violent exertion or sudden unexpected movement. The 
symptoms are pain in the affected muscle, stiffness, lameness, and more or 
less swelling. If complete rupture occurs, there will be loss of power of the 
affected muscle and on examination there will be found a distinct gap with 
considerable swelling above it, due to retraction of the muscle fibers. 
For slight strain, the treatment consists of strapping with adhesive plaster 
or bandaging, which, with rest, gives the most comfort. After 2 or 3 days, 
graduated massage may be given. If rupture occurs, in the absence of sur- 
gical assistance immobilize the part by splints or bandages and place the 
part in such a position that the muscles are relaxed, thus allowing the torn 
fibers to come together. 
A sprain is an injury to a joint due to wrenching or twisting its ligaments 
and adjacent soft parts. There usually is a momentary dislocation and auto- 
matic reduction of the joint affected. There also may be injury to cartilages, 
and even portions of bone to which the ligaments are attached may be torn 
away. Accompanying these injuries there is more or less escape of blood 
into the joint itself and surrounding tissues, resulting in severe pain and 
marked swelling of the injured part. Later, discoloration develops at the site 102 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
of injury. sprains of the ankle and wrist are the most common. Frequently 
it is difficult to determine whether or not a sprain is not complicated with 
fracture. An X-ray examination is always advisable to determine the presence 
of a fracture in these cases. 
In the treatment of sprains all severe cases should he brought under the 
care of a medical officer, particularly as the condition may be complicated witn 
fracture. Elevate the joint and apply very hot or very cold water for one-half 
an hour to an hour to stop the 
subcutaneous haemorrhage; then 
apply a tight bandage and keep 
the joint at rest in order to give 
the torn ligaments and tissues 
a chance to heal and the effused 
blood to be absorbed. Treat- 
ment of a sprain of the ankle 
by immediate strapping of the 
joint and allowing the patient 
to walk about may be practiced 
in the less severe uncomplicated 
cases. For this purpose strips 
of adhesive plaster 1 to iy2 
inches wide and about 18 inches 
long should be obtained. A strip 
is started well behind at the 
junction of the lower and middle 
third of the leg of the injured 
side, and is carried down under the heel with considerable tension, across the 
sole and up the other side of the joint. (Fig. 49.) The middle of another strip 
is applied to the point of the heel and the two ends are carried forward over 
the foot, but not far enough to meet. Leg strips and foot strips alternate, inter- 
lacing with each other and overlapping about one-third of the previous strip 
each time until the ankle joint is covered. (Fig. 50.) Strapping in this manner 
furnishes pressure and at the same time fixes the joint and gives support to the 
torn ligaments. If any individual is unable to walk immediately after injury to 
the ankle, the injury should be considered as a fracture until proved otherwise. 
DISLOCATIONS 
A dislocation is a slipping away from each other of the bones which form a 
joint, resulting usually in a, locking of the bones in a new position. Neces- 
sarily the dislocation is attended with tearing of the ligaments, and often with 
rupture of the muscular attachments as well, except in a joint which, on ac- 
count of frequent prior dislocations, has had its ligaments so stretched that not 
only is dislocation easy but no tearing of the ligaments results. As a result of 
the tearing of structure about the joint, there is also rupturing of the blood 
vessels, with consequent swelling and discoloration. 
Dislocations must be differentiated from fractures and sprains. In all three 
conditions there may be swelling and pain in the neighborhood of a joint. In 
fracture there is an unnatural movement of the bone between the joints 
instead of immobility at the joints as in dislocations, and the movement is 
attended with a grating sound and sensation; the deformity is in the bone be- 
tween the joints in fractures, whereas the deformity is at the joint in 
dislocations. In dislocations there is immobility at the joint and between 
Figure 49.—Strapping 
of ankle; first step. 
(Owen.) 
Figure 50.—Strapping of 
ankle; completed. 
(Owen.) MINOR SURGERY AND FIRST AID 
103 
the joints, and the head of the dislocated bone may be felt in an abnormal 
position. In sprains there is absence of any of the symptoms of dis- 
location except swelling and pain. As a rule sprains are momentary dis- 
locations in which the head of the bone has slipped back into place. All cases, if 
facilities are available, should be X-rayed before and after treatment. 
The treatment consists in restoring the bones to their normal positions, spoken 
of as “reducing the dislocation,” and then so confining the parts that a recur- 
rence of the trouble will be improbable. The joint should be immobilized until 
the rents in the ligaments have healed. While some dislocations slip easily 
back into place, to properly reduce the majority requires considerable 
knowledge, skill, and either local or general anaesthesia. Without careful 
manipulation blood vessels and nerves not only may be injured but a simple 
dislocation may become complicated with fracture. In view of this, if 
surgical aid can be obtained within a day or two, do not attempt to reduce 
a dislocation, except perhaps in case of the jaw and finger; loosen the 
clothing about the injured part and support it as comfortably as possible 
in the new position, or if the patient must be moved, support the limb in a sling 
or by splints and bandages, and summon surgical assistance. If, however, 
surgical assistance cannot be had for some time, 3 or 4 days, careful attempts 
should be made to reduce the dislocation, as the head of the bones concerned 
most probably will become bound by connective tissue formation and then 
reduction will become next to impossible without an operation. Shock is 
often present with major dislocations and should be treated. 
Treatment of certain dislocations. 
Dislocation of the jaw.—In this condition the patient cannot speak or 
close his jaws. The dislocation is due generally to a blow upon the mouth 
when open or by yawning or laughing. This dislocation usiially is reduced 
without much difficulty, but there is great danger of the thumbs of the 
operator being bitten. Wrap the thumbs well with a handkerchief or bandage, 
stand in front of the patient, and while pressing with the thumbs in the 
mouth just back of the last lower molars, at the same time lift up the chin 
with the fingers. The jaw usually will snap at 
once into place, and the thumbs must be quickly 
withdrawn to prevent them from being bitten. 
After reduction, no fur- 
ther treatment is indi- 
cated, but the patient 
should be advised to 
open the mouth no 
oftener than necessary. 
Dislocation of finger joints.—With a dislocated finger 
joint, pull on the dislocated end, at the same time bend- 
ing it backward if the dislocation is forward, or for- 
ward if the dislocation is backward, and pushing the 
joint into place; strap or splint the finger (fig. 51). 
Dislocation of the shoulder.—In this dislocation the 
arm is held rigid, the elbow stands off a distance of 3 or 
4 inches from the body, and the shoulder appears flat 
with a marked depression beneath the point of the shoul- 
der. In addition there is pain and swelling at the site of injury, and the head 
of the humerus can be felt in an abnormal position as compared with the other 
side. Do not try to reduce this dislocation if surgical assistance can be had in a 
few days; if not, try one of the three methods following. 
Figure 51.—Backward disloca- 
tion of finger ; reduction by 
extension. (Hamilton.) 
Figure 52.—Subglenoid 
dislocation of the 
shoulder. (Mason.) 104 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
(a) Stimson’s method.-—Place the patient on a canvas cot or stretcher lying 
on the injured side, arm hanging through a hole made in the cot or stretcher 
in the median line at a distance of about 18 inches from the head end. The 
cot or stretcher first should be elevated from the floor by means of chairs or 
blocks so that the arm does not touch the floor. Fasten a 10-pound weight on 
the dependent arm, and, in from 5 to 10 minutes, the muscles usually have 
become sufficiently relaxed to allow the head of the bone to slip into its proper 
place of its own accord. If it should not do so, the weights should be removed 
and the arm carefully brought to the patient’s side against the operator’s fist, 
held in the armpit. This should force the head of the bone back in place. Ap- 
ply a Velpeau or Desault bandage without the pad in the armpit and keep the 
arm bandaged for a week. 
(ft) Kocher’s method.—The patient should be in either the sitting or stand- 
ing posture, preferably the former. Grasping the affected arm at the elbow 
and wrist, flex the elbow to a right angle and press the arm against the chest 
(fig. 53). Turn the forearm as far as possible from the chest by external 
Figure 53.—Kocher’s method of reduction by manipulation: a. First movement, outward 
rotation; b, second movement, elevation of the elbow; c, third movement, inward rota- 
tion and lowering of the elbow. (Ceppi.) 
(outward) rotation of the humerus. Maintaining this external rotation, carry 
the elbow slowly inward across the front of the chest to the center line of 
the body. With the arm in this position quickly rotate the forearm inward 
until the hand touches the sound shoulder. Lower the elbow. Immobilize the 
entire arm by the application of a special bandage of the chest or a Velpeau 
bandage without the axillary pad. 
(c) Reduction by traction or extension.—Place the patient upon his back on 
the deck or table. The operator takes off one shoe, inserts his heel under the 
armpit of the dislocated side, and makes traction upon the arm downward 
and slightly toward the patient’s body. In doing this, care must be taken not 
to employ too great leverage action upon the arms, as a fracture might be 
produced. After reduction, immobilize the joint with a Velpeau or Desault 
bandage without the pad in the armpit, and keep the arm bandaged for a week. 
If a dislocation fails to be reduced by these methods, do not persist in attempt- 
ing reduction, as it is then a case for operative surgery. 
Dislocation of the elbow, hip, and knee.—These dislocations are not as com- 
mon as shoulder dislocations. The bones may be displaced in various directions 
and their reduction is difficult and often dangerous. First-aid treatment con- 
sists in obtaining surgical assistance, making the patient comfortable with 
pillows, etc., and treating for shock, if present. 
Compound dislocations are those in which the head of the bone has been 
forced through the skin and underlying tissues. Here not only the dislocation MINOR SURGERY AND FIRST AID 
105 
but also the wound must be treated. A complicated dislocation is one in 
which a large blood vessel or nerve has been injured. 
FRACTURES 
A fracture is the forcible solution of the continuity of a bone. Fractures 
are classified as simple or closed, and open or compounfi. A simple or closed 
fracture is one in which there is no opening to the outside air. An open or 
compound fracture is one in which, by a break in the overlying skin and other 
tissues, there is direct communication between the outside air and the broken 
bone. A compound fracture is always very serious, owing to the likelihood of 
infection. In an infected compound fracture not only is it difficult to obtain 
union of the bones but there is danger to life from the infection itself. This 
element of infection is absent in simple fractures. 
Careless handling of fractures may convert a simple into a compound frac- 
ture, and there is grave danger of injuring blood vessels, nerves, and other 
tissues in the neighborhood of the fracture (complicated fracture). 
Figure 54.—Green-stick 
fracture. 
Figure 55.—Comminuted 
fracture. 
Figure 56. — Impacted 
fracture of femur. 
(Wharton.) 
A complete fracture is one in which the bone is severed through its entire 
thickness. An incomplete or green-stick fracture is one in which the bone is 
broken or bent, but not broken entirely through (fig. 54). (It resembles the 
condition obtained from an effort to break a green stick.) A multiple fracture 
is one in which the bone is broken into more than two fragments, the lines of 
fracture not, however, communicating with each other. A comminuted 
fracture is one in which the bone is broken into several pieces, the lines of 
fracture communicating with one another (fig. 55). A complicated fracture is 
one accompanied by an injury to some surrounding part, as an injury to* a 
joint, muscle, nerve, or blood vessel. An impacted fracture is one in which one 
fragment of the bone is driven into the other, the two remaining tightly 
wedged (fig. 56). 
When a bone breaks, there is always an injury to the periosteum, or bone 
covering, and to the surrounding tissues. There is also haemorrhage about the 
ends of the fragments, and the space between the two fragments rapidly be- 
comes filled with a blood clot. This blood clot becomes organized as described 
in the healing of wounds, forming a callus which surrounds the ends of the 106 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
fragments, and, as it were, glues them together. At first the callus consists 
only of fibrous tissue, but later there is growth of bone cells, and a deposit of 
lime salts which changes the callus into dense bone. 
The following factors may prevent the union of fractures; Infection pre- 
venting the formation of a callus; the interposition between the fragments of 
muscle or other tissue; improper reduction of the fracture; general constitu- 
tional conditions such as syphilis, tuberculosis, diabetes, Bright’s disease, and 
an inability on the part of the patient’s body to deposit bone in the callus. This 
latter condition in which fibrous tissue, but not bone, is deposited in the callus 
is spoken of as ‘“fibrous union.” 
In the diagnosis of fracture the following conditions usually will be found: 
1. There is a loss of power in the part, for example, if the leg is broken, the 
man has fallen and cannot arise; 2. The part is in unnatural position, 
and comparison of a fractured limb with the uninjured one will show that 
there is a deformity between the joints and that the injured limb is probably 
shorter; 3. Movement can be obtained where normally there is no motion, 
with grating of the broken.ends of the bone (if an attempt to move the limb 
is made it will be found that there is movement in the bone between the joints 
where there should be none, and the broken ends of the bone grating together 
(crepitus) can be felt and heard) ; 4. There is history of violence and the 
patient will say that he heard the bone crack and, give way; and 5. The 
patient complains of great pain and tenderness at the seat of fracture and 
there is swelling present, due to bleeding from the broken ends. Whenever a 
fracture is suspected or doubtful, an X-ray picture of the part should be 
obtained, as this is the surest means of determining fracture. 
General principles for the treatment of simple fractures. 
The patient should be brought under the care of a medical officer as soon 
as possible. The object of treatment before a medical officer can take charge 
of the case, if his services cannot be had promptly, is to prevent further in- 
jury, especially to blood vessels and nerves, and, puncture of the skin by the 
sharp, knife-like edges of the broken bone, and to treat shock if it is present. 
The patient should be placed in a comfortable position while waiting for the 
medical officer or surgeon, and if it is necessary to move the fractured part in 
doing this or in treating shock, one hand should support the broken bone on 
each side of the break. The bone must not bend at the break while the patient 
changes his position to a more comfortable one. Support the broken bone in 
a natural position on a pillow or folded coat, great care being taken that it 
is not bent or does not drag on the point of fracture. If there is doubt as to 
whether or not a fracture is present, do not manipulate the part, but treat 
it as a fracture until the arrival of a surgeon. Do not move the patient more 
than is necessary before the fracture has been set and secured. If the injured 
person is wearing thin summer clothing, it will not always be necessary to re- 
move it; if thick clothing is worn, however, it is difficult to determine whether 
or not a fracture has occurred or the character of the injury. In the latter 
case, never try to take off the clothing, but cut it in the seams with a sharp 
knife or scissors. If the patient cannot be brought under the care of a surgeon 
for a day or more, the fracture must be set and immobilized as described 
hereafter. If a fracture is not set, it will unite in bad position and the bone 
will have to be refractured to secure proper 'alinernent. 
In the treatment of compound fractures the services of a medical officer 
should be obtained as soon as possible. In the meantime, treat the shock and 
the wound as described in the section on wounds. After treatment of the MINOR SURGERY AND FIRST AID 
107 
wound, treat the fracture as described before. In case no surgeon is available 
for a day or more, the fracture may be set as described hereafter, always 
keeping in mind the proper treatment of the wound while so doing, thus pre- 
ATenting, as far as possible, infection which is a serious complication in fractures. 
The setting of a fracture consists of bringing the two fragments in apposition 
and in holding them in that position. The force which keeps the fragments 
out of apposition and which must be overcome in order to bring them into appo- 
sition is muscular contraction. This muscular contraction is overcome by exten- 
sion and counterextension. Extension is pulling the far or distal end of the 
limb, and counterextension is merely holding the near or proximal end next 
the trunk. Extension and counterextension must be applied until the deformity 
and shortening disappear and the two limbs look alike. Where the muscular 
contraction is great, as in fractures of the thigh, the fragments frequently can- 
not be brought into apposition without relaxation of the muscles by a general 
anaesthetic or by gradual tiring out of the muscles by a steady pull with weights 
and pulley. In these cases extension and counterextension frequently have to 
be applied for some time after the fracture has been set in order to maintain 
the fragments in apposition. The fragments of a fractured bone are held in 
apposition by means of splints, plaster of Paris bandages, ordinary bandages, 
etc. 
Splints are agents for immobilizing a fractured part. There are two general 
classifications of splints, traction splints, and coaptation splints. Traction 
splints are those which, in addition to immobilizing a fracture, are constructed 
in such a manner that by their use extension and counterextension can be ap- 
plied without the use of other apparatus for this purpose. Coaptation splints are 
those which are used solely to immobilize the fracture. Traction splints are 
indicated in fractures where there is much muscle pull tending to displace the 
fragments. The most common traction splints are: The Thomas leg splint and 
modifications of the same, the Jones humerus traction splint, the Army hinged 
half-ring thigh and leg splint {Keller), the wire ladder splint, and the Cabot 
posterior vnre splint. To obtain extension by use of these splints, adhesive 
strips or tapes are fastened to the skin and attached to the distal end of the 
splint, while counterextension is obtained by the push of the other end of the 
splint against the body. 
In emergency any material which has sufficient firmness to give support to 
a limb will answer for coaptation splints. Examples are umbrellas, canes, 
swords, scabbards, guns, cigar boxes, wire, leather, laths, tent pins, pillows, or a 
folded coat. In fractures of the thigh and leg, the sound limb may be used as a 
splint. Plaster of Paris bandage may be used. Adhesive plaster generally is 
used to splint a fractured rib. The materials used for splints must be light but 
sufficiently rigid to prevent bending; long enough to fix into the joints above and 
below the fracture; broad enough to prevent pinching of the limb in bandaging; 
and sufficiently padded to protect the part from undue pressure. 
Coaptation splints may be applied temporarily over the clothing and should 
always be well padded, as a hard board against an injured limb soon becomes 
very painful. Oakum, cotton, grass, moss, portions of clothing, or any soft 
material will answer for the padding. If possible, two splints should be 
applied to a limb, while in fractures of the leg three generally are used, one 
on each side and one behind. In applying splints, have an assistant hold 
them in position and then firmly fasten them to the limb by several turns of 
a roller bandage, adhesive strips, handkerchiefs, pieces of rope, or portions 
of clothing. While splints should be applied snugly, care should be taken 
154294°—39 8 108 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
not to apply them too tightly for fear of cutting off the blood circulation; 
leave the tips of the fingers and toes exposed and watch the circulation. If 
the tips of the fingers are blue and cold, or if, upon pressing upon the 
nails, the normal pink color does not quickly return, the dressing is too tight. 
Remember that although a splint may be applied with the proper degree of 
snugness, later swelling of the fractured limb may cause it to be too tight. The 
use of plaster of Paris as splinting material should be left to the surgeon. 
Fractures of the skull are classified as fractures of the vault and fractures 
of the base of the skull. Fractures of the skull are dangerous on account of 
the probability of injury to the brain. In fractures of the vault, the danger 
lies in tearing of the brain tissue itself by the fragments of bone, and in 
tearing of the blood-vessel walls, resulting in haemorrhage, with the result- 
ing compression of the brain. Compression of the brain also may result 
from the displaced fragments of broken bone. In fractures of the base of 
the skull, the principal dangers are rupture of the meningeal arteries, result- 
ing in intracranial haemorrhage and compression of the brain. Both types of 
fracture may be compound, while there is the added danger of infection which, 
in fractures of the vault, occurs through injury to the overlying tissue at the 
site of fracture and, in fractures of the base, to infection from the nose and 
ears due to a tearing of the mucous membrane of the nose and middle ear. 
In fractures of the skull, unless compound or depressed, all the usual symp- 
toms of fracture are absent, or entirely overshadowed by the injury to the 
brain. The most prominent brain symptoms are loss of consciousness and 
paralysis; if the loss of consciousness is sudden, it is probably due to con- 
cussion or to the pressure of a piece of bone; if it comes on slowly, it is apt 
to be the result of haemorrhage from a torn blood vessel. In fracture of 
the base of the skull, there may be bleeding from the nose or ears, or into 
the orbits, or under the conjunctiva; the escape of cerebrospinal fluid—a clear, 
watery serum—from the ears is considered a sure sign of fracture of the base. 
In the treatment of a fracture of the skull obtain the services of a medical 
officer as soon as possible. In the meantime, keep the patient quiet, in a re- 
cumbent position, and apply an ice bag to the head; if the fracture is compound 
treat the wound. Avoid stimulants. 
In fractures of the spine the spinal cord is generally injured or cut across, 
with resulting paralysis to all parts below the fracture. On passing the 
fingers down the spine, irregularity of the spinous processes with deformity 
will usually be noted, as well as local pain over site of fracture. Keep the 
patient perfectly quiet, and lying flat on his face until surgical aid can be 
obtained. If it is necessary to move him, it should be done with extreme 
care to prevent any additional injury to the spinal cord, and keeping him in 
a prone position, face down. 
Symptoms and treatment for a fractured nose.—There is usually considerable 
deformity, the bridge of the nose being depressed and pushed to one side, 
crepitus generally can be felt, and there is considerable nosebleed. Return 
the bones to their normal position if possible, by gentle manipulation. To hold 
the bones in position, apply two very small rolls of narrow bandage on either 
side of the nose and hold the rolls in place with short strips of adhesive 
plaster. Check the bleeding by syringing the nostril with hot or cold water, 
or, if necessary, pack the nostrils with cotton. Warn the patient not to blow 
his nose. 
Symptoms and treatment of fracture of the lower jaw.—In fracture of the 
lower jaw the line of teeth is irregular and there may be bleeding from the 
mouth.; the patient cannot open his mouth, and by passing the fingers along MINOR SURGERY AND FIRST AID 
109 
the line of the lower jaw localized pain and deformity can be noted (fig. 57). 
Push the bones into place and apply a four-tailed or Barton bandage. The 
patient must be fed through a tube and the mouth kept clean, as these frac- 
tures are generally compound. Place 
the patient under the care of a surgeon 
as soon as possible. 
Symptoms and treatment of fracture 
of the rib.—The symptoms are pain or 
“stitch” in the side, and some difficulty 
in breathing. Pain may be especially 
severe if the patient coughs or sneezes, 
or breathes deeply. The danger in rib 
fracture is injury to the lung, and with 
this complication there may be spitting 
up of blood and escape of air beneath 
the tissues of the chest wall, a condition 
called emphysema. On examination, by 
passing the fingers along each rib in 
successipn, one will be able to find a 
local point of tenderness, and often a false point of motion or grating in one or 
more of them. By placing the ear against the injured side and asking the patient 
to take a deep breath, grating may be heard distinctly. As it is impossible to 
Figure 57.—Fracture of lower jaw, show- 
ing loss of alignment of teeth. (Scudder, 
modified.) 
Figure 58.—Application of the first adhesive strap in fracture of rib (note elevation of 
arm and shoulder and application of strap from below upward). 
splint only one or two ribs, in order to immobilize the fracture it is necessary to 
immobilize the whole side on which the fracture has occurred. This splinting 
can be temporarily accomplished with a broad binder of muslin, a triangular HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
bandage, or an ordinary roller bandage applied firmly around tbe cbest, but 
the best method is to strap the chest with adhesive plaster. Procure a 
strip of plaster wide enough to cover the injured side, about 8 or 9 inches 
wide, and long enough to extend from the spine behind to just beyond the 
median line in front, and apply as follows: With the patient standing with 
arms above the head, tell him to let all his breath out, and as he does this 
quickly apply the plaster to the injured side, starting just a little to the other 
Figure 59.—Strapping of chest for fracture of rib ; completed. 
side of the spine in the back and bring the strap to just beyond the middle 
line in front. The plaster is applied at the end of a forced expiration because 
at this time the broken fragments are more nearly in apposition. In place of a 
single strip of plaster several strips, each about 2% inches wide, may be applied, 
beginning well below the fracture and gradually working up (figs. 58 and 59). 
Apply each strip with firmness, at the end of a forced expiration, allowing it 
to overlap one-third of the one below. When there is injury to the lungs 
accompanied by spitting up of blood, keep the patient quiet in bed and give 
cracked ice by mouth. MINOR SURGERY AND FIRST AID 
111 
Symptoms and treatment of fracture of the clavicle or collar hone.—In fracture 
of the clavicle the attitude of the patient is characteristic; the shoulder drops 
downward, inward, and forward, and he attempts to support it by holding the 
elbow of the injured side in the hand of the sound side. The collar bone lying 
immediately under the skin, the fracture is easily made out from the deformity 
and localized pain and tenderness. As an emergency dressing until the patient 
comes under the care of a surgeon, all that is required is a large arm sling 
with a pad in the armpit and the arm bound to the side. Later treatment, in 
the absence of a surgeon, consists in the application of any dressing which 
will keep the shoulder up, back, and outward, thereby holding the fragments 
in their normal position. This may be done by means of the Velpeau or Desault 
bandages or the Sayre dressing (see section on Bandages and Bandaging) or 
by the T-splint (see section on Splints and Appliances). 
Symptoms and treatment of fracture of the humerus or arm bone.—Fracture 
of the humerus has all the general signs and symptoms of fracture. A fracture 
of the neck or upper third of the bone may be put up temporarily by placing 
a pad or folded towel in the armpit and securing the arm to the side with a 
bandage; then place a sling about the wrist. With this dressing the weight 
of the arm and forearm acts as an extension. Fracture in the middle of the 
shaft of the bone may be treated by the use of two broad splints or, better, 
four narrow ones, placed about the seat of injury and secured by a bandage 
or strips of adhesive plaster, the wrist being supported by a sling. Care must 
be taken that the splint does not extend too high in the armpit, as thus it 
might compress the blood vessels or at least be exceedingly painful. A fracture 
near the elbow joint may be dressed temporarily by simply applying a large 
arm sling and securing the arm to the body. Fractures in this locality are 
serious from the liability of the joint to become stiff, and the patient should 
be brought under the cax*e of a surgeon as soon as possible. 
Symptoms and treatment of fracture of the bones of the forearm.—When both 
bones of the forearm are fractured all the usual signs of fracture are present. 
When only one bone is broken, the other acts as a splint and but little deformity 
will be apparent, but there is inabilty to use the 
forearm, and on examination, tenderness and a false 
point of motion can be discovered at the seat of 
injury. With a fracture of the radius alone, low 
down and just above the wrist, there is a well- 
marked deformity, termed silver-fork deformity 
(fig. 60), which is a symptom of the fracture of the 
radius spoken of as Colics' fracture. In this frac- 
ture the tip (styloid process) of the lower end of 
the ulna Is often broken off, there may be rupture 
of the internal lateral ligament of the wrist, and as 
the bones are usually impacted, no grating or 
crepitus is present. In treating fractures of the 
forearm, the limb should be put up with the elbow 
bent at a right angle, the forearm across the chest, 
with the palm of the hand turned in and thumb pointing upward. First reduce 
the deformity by gentle traction upon the hand, and then apply two well-padded 
splints to the seat of fracture, having them long enough to extend from the elbow 
to below the wrist; bandage the splints, and support the forearm by means of a 
sling. It is very important that all cases of Colles’ fracture should be brought 
under the care of a surgeon as soon as possible, as, unless the fracture is prop- 
erly reduced and treated, the deformity is apt to be permanent. 
Figure 60.—Deformity at the 
wrist consequent upon dis- 
placement backward of the 
lower fragment of the 
radius after fracture at its 
lower extremity. (Levis.) 112 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Symptoms and treatment of fracture of the metacarpals, or wrist bones.—De- 
formity and pain are the most prominent symptoms. Apply splints on the back 
and front of the hand, reaching from the finger tips halfway up the forearm. 
Treatment of fractured fingers.—If only one finger is fractured, a narrow 
splint, such as a wooden tongue depressor (fig. 61), should be applied to the 
palmar surface of the finger and secured by strips of adhesive plaster. If sev- 
eral fingers are broken, it is better to place a pad in the palm of the hand and 
apply two well-padded splints, extending from below the tips of the fingers well 
up on the forearm. 
Figure 61.—Tongue depressor as a splint for fracture of finger. 
Symptoms and treatment of fractures of the pelvis.—The patient is unable to 
sit up or stand and complains of great pain and a sense of coming apart. Crep- 
itus may be felt on strong pressure. These fractures generally are accompanied 
with injury to internal organs and more or less shock. With injury to the 
bladder blood is passed in the urine. When fracture of the pelvis is suspected 
have the patient lie quietly on his back, apply a tight binder or bandage to 
the hips, and also fasten the knees together. He should be moved with great 
care and transported on a stretcher which will not sag. The patient’s bed 
should be fixed so that it will not sag under his pelvis and the thighs should 
be supported with pillows. In case of bleeding from the bladder, which indi- 
cates a rupture of that organ, a catheter should be introduced and left in, so 
that the urine will not accumulate and escape into the peritoneal cavity. A 
urinary antiseptic (methenamine (urotropin)) should be administered by mouth. 
Symptoms and treatment of fractures of the femur or thigh.—The patient 
usually lies with the toes of the injured limb pointing outward; any attempt 
to move the limb results in a spasm of the muscles and causes the patient ex- 
cruciating pain; there is loss of power in the limb, the patient being unable to 
lift it. Ou examination, if the fracture is on the shaft of the bone, a false point MINOR SURGERY AND FIRST AID 
113 
of motion is discovered. By measurements the fractured limb is found to be 
shorter than the other one, due to the pull of the powerful thigh muscles. 
Measurement should be made on each limb and compared by stretching a string 
from the anterior superior spine of the ilium to the internal malleolus with the 
patient on his back. Emergency treatment consists in applying two splints, 
one on the outside reaching from the armpit to beyond the foot and one on the 
inside from the crotch to the foot (fig. 62). The splints should be tied in five 
places—around the ankle, over the knee, just below the hip, around the pelvis, 
and just below the axilla. It is well also to tie the two limbs together. The 
Figure 62.—Service rifle as emergency splint for fracture of femur. 
patient must be brought under the care of a surgeon as soon as possible, as an 
amesthetic is frequently necessary to effect reduction, and a traction splint or 
other means of extension is generally required. Do not move these cases with- 
out splinting. \ 
Symptoms and treatment of fracture of the patella or knee cap.—In a frac- 
ture of the patella the patient cannot stand or walk, the upper fragment is 
drawn up to the thigh by the powerful muscle attached to it, and the gap can 
be felt readily; the joint swells up at once. Put the limb up straight with a 
well padded splint behind the thigh and leg. The two fragments can be brought 
together by strips of adhesive plaster, one strip passing above the upper frag- 
ment and the other below the lower one, or in place of the adhesive plaster a 
figure-of-eight bandage may be applied. The patient should be put to bed with 
the injured leg elevated on a pillow, and ice should be applied to the joint with 
the object of limiting and decreasing the swelling. Place the patient under the 
care of a surgeon as soon as possible. 
Symptoms and treatment of fracture of the leg.—When both bones of the 
leg are broken, the usual signs and symptoms of fracture are present. These 114 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
fractures often are compound. If only one bone is broken, the other acts as a 
splint and deformity will not be so marked, but there will be present a local point 
of tenderness, swelling, and probably discoloration of the skin. Fracture of 
the lower end of the fibula is spoken of as Pott’s fracture (fig. 63). Pott’s 
fracture generally is accompanied by tearing of 
the internal lateral ligaments of the ankle joint 
or by a fracture of the internal malleolus, in 
which case there is great deformity and turning 
out (eversion) of the foot. In case it is purely a 
fracture of the lower end of the fibula, there may 
be few of the usual signs of fracture and the in- 
jury may be mistaken for a sprain. For treatment 
of fractures of the leg, reduce any deformity by 
traction in the long axis of the limb, and then 
apply three well-padded splints, two side splints, 
and a posterior one (in case of Pott’s fracture, do 
not apply a posterior splint). The latter is to give 
support and prevent a backward sagging at the 
seat of fracture. A pillow and two side splints 
also make an excellent temporary dressing; a pil- 
low covered by a pillow case is placed upon the 
deck, and the injured leg is laid carefully upon 
it; the edges of the pillow then are brought un 
around the foot and limb and are pinned in place; 
finally the two side splints are applied outside of 
the pillow and are secured in place by straps of 
adhesive plaster or strips of bandage. 
Treatment for fracture of the foot.—Apply a 
light splint to the sole of the foot, and keep it 
immobilized by two side splints extending up each side of the leg from below 
the foot. Place the patient under a surgeon’s care, so that a plaster of Paris 
bandage may be applied. 
INJURIES DUE TO HEAT AND COLD 
Injuries due to heat are classified as general which embraces heat cramps, 
heat stroke (or sunstroke), and heat exhaustion, and local which includes 
burns and scalds. 
Heat cramps are painful, spasmodic contractions of the muscles, usually 
those of the abdomen or of the extremities, and are caused by exposure to heat 
and to conditions causing muscular fatigue and loss of body fluids and salts. 
They may be considered the mildest form of generalized body injury from heat 
and their treatment is essentially the same as that for heat exhaustion. 
Heat stroke (sunstroke or insolation) is due to prolonged exposure to exces- 
sive heat, usually to the heat of the sun. It may, however, occur in not rooms, 
particularly in firerooms aboard ship. Exhaustion and improper clothing pre- 
venting the proper elimination of heat from the body surface are powerful con- 
tributing factors; hence this condition is especially apt to occur to men on the 
march, particularly when marching in close formation. The warning symptoms 
are headache, dizziness, irritability, frequent desire to urinate, and seeing 
things red or purplish. With or without these symptoms, the patient sud- 
denly falls unconscious; the skin is dry and intensely hot; pupils contracted; 
pulse full and strong; respirations snoring; there may be convulsions; if the 
temperature of the body can be taken it usually will be found to be very high, 
Figure 63.—Pott’s fracture. MINOR SURGERY AND FIRST AID 
115 
105° to 109° F., or higher. The condition is very serious, and unless immedi- 
ately relieved terminates in death. The treatment has for its object the rapid 
reduction in temperature. The patient should be brought to the coolest acces- 
sible spot, in the shade, if out of doors; on deck if in the fireroom of a ship; 
the clothing removed; an ice bag applied to the head and cold water poured 
over the patient continually. At the same time the body may be rubbed with 
ice, and if a tub is available, immersed in cold water. The treatment should 
continue until the temperature is reduced. If the patient is able to swallow, 
cold, not iced, water should be given to drink, and this should be repeated as 
often as possible. Besides these measures for reducing the body temperature 
cool water to which table salt has been added, one-half teaspoonful to the 
glassful, should be given as freely as the patient will take it. In very severe 
cases, with the patient unconscious and unable to take fluid by mouth, give 
copious and frequent enemeta of 1,000 to cc of cool, salt water, 1 tea- 
spoonful of table salt per pint of water, every 30 minutes or hourly depending 
on the patient’s response in recovering consciousness and on the drop in his 
body temperature. Serious results are liable to follow a sunstroke, even when 
death does not occur; the most common of these after effects are permanent 
headache, paralysis, mental confusion, or even insanity. Moreover, one who 
has had a sunstroke is ever after very susceptible to the action of the sun. 
Heat exhaustion is due to the same causes that produce heat cramps and heat 
stroke. Under the same conditions, one man may get heat cramps, another 
heat stroke, and still another heat exhaustion. The warning symptoms are 
dizziness, often with nausea and vomiting associated in some instances, par- 
ticularly in flrerooms aboard ship, with cramps in the muscles. The patient 
suddenly falls; is not unconscious and may be easily aroused; temperature is 
subnormal; the face is pale, skin cool and moist; pupils dilated or normal; pulse 
very weak; respirations shallow, perhaps sighing; and perhaps one or several 
sets of muscles in painful contraction. In this condition of heat exhaustion 
certain muscles or groups of muscles frequently are thrown into violent con- 
tractions which cause excruciating pain. This condition is relieved by hot 
applications, immersion of the part of the person’s body in a hot bath, or by 
the administration of an opiate (hypodermic injection of morphine). The 
treatment for heat exhaustion consists in moving the patient into the shade or 
on deck, loosening the clothing, keeping the head low, and giving him salt and 
stimulants; hot salt water or coffee to which one-half teaspoonful of table 
salt to each cupful or glassful has been added should be given freely. After 
removal to the sick-bay or hospital, the patient should be kept perfectly quiet 
in bed, with hot-water bottles and blankets around him if necessary. 
The prophylaxis or prevention of heat cramps, heat stroke, and heat ex- 
haustion is most important. It is now known that most of these general 
reactions to the effects of heat are due in great measure to the loss of body 
salts, chiefly sodium chloride, in the perspiration or sweat. A person per- 
spiring freely for some time will not so readily taste salt in his drinking 
water which shows the loss of it in his body. Persons working in compart- 
ments in high temperatures, such as engine rooms and flrerooms, especially 
in the tropics, should replace lost salt by taking ordinary table salt by mouth. 
One Navy sodium chloride tablet per glassful of water may be used, but in 
the absence of these tablets ordinary table salt should be taken freely under 
conditions where heat cramps, heat stroke, and heat exhaustion are likely 
to occur. The number of cases of heat cramps, heat stroke, and heat ex- 
haustion can be reduced to a minimum by the adequate prophylactic use of 
sodium chloride in the drinking water. 116 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Burns and scalds.—Burns are produced by flame, hot solids, hot fluids, 
caustics such as strong acids and strong alkalies, wires charged with a heavy 
electric current, sun’s rays, and X-rays; scalds are produced by hot liquids. 
Burns and scalds differ only in that in the former the hairs are removed, 
whereas in the latter they are not; the treatment is the same for both. 
Burns usually are said to be of the first, second, and third degree; those 
which cause merely redness are of the first degree; if blisters are raised, 
they are of the second degree; if there is charring and destruction of tissue, 
the burn is of the third degree. The symptoms of burns are shock, which may 
be profound, chilly sensations, and pain; the pain may be agonizing or slight. 
The result of the burn depends more upon the extent of surface affected 
than upon its depth, a burn of the first degree being almost fatal if two thirds 
of the body surface be affected, and one of the second degree if one third of 
the body is burned. The chances of recovery are much less in children and 
elderly people. With extensive burns of the body surface, the danger in the 
first 24 hours is from shock, after that from internal congestion and inflam- 
mation, suppression of urine from nonfunctioning of the kidneys, ulcerations 
of the duodenum, intestinal haemorrhage, and finally exhaustion or infection. 
If the entire thickness of the skin is destroyed, terrible deformities are apt 
to follow the contraction of the skin which follows healing. As the result 
of inhalation of live steam from bursted steam pipes, the respiratory tract 
may suffer from burns, causing death in many instances from suffocation 
or shock. X-ray burns are particularly slow in healing. 
The treatment of burns is both constitutional and local. The constitutional 
treatment consists in the treatment of shock and pain, on the one hand, and, 
on the other hand, in measures to prevent suppression of urine, in combating 
the toxaemia and the effects of infection, etc. In addition to local measures for 
the treatment of pain, the administration of morphine, one-fourth grain, 
hypodermically, is frequently necessary. The bowels must be kept open, and 
plenty of water given by mouth, and also at times by rectum, so that the 
kidneys will continue to act. The smaller the area of body surface burned 
the less necessity there is for constitutional treatment. The object of the 
local treatment is to remove the cause, to allay pain, prevent infection, and 
promote healing. The deeper the burn, the more important do the methods 
for the prevention of infection become, and vice versa. The greatest factor 
in the causation of pain in burns is the movement of air over the inflamed 
area, and therefore local treatment in first-degree burns consists of covering 
the burned surface so that air is excluded. This may be done by means 
of tannic-acid jelly1 dressings or by use of any fresh, bland oil, such as cream, 
vaseline, liquid petrolatum, olive oil, etc. If the burn has been caused by 
a caustic such as an acid or an alkali, the acid should be neutralized with 
bicarbonate of soda or ordinary baking soda, and the alkali by a weak solu- 
tion of acetic acid or ordinary vinegar before the burned area is covered. 
In burns of the second and third degree the quickest temporary means of 
excluding air is to immerse the part or the entire body in warm water; 
then, having everything in readiness, carefully cut away the clothing, leaving 
such as may be sticking to the burned skin; blisters should be left undis- 
turbed unless they are very tense and painful, when they may be punctured 
by a sterilized needle, and the content allowed to escape. The application 
of tannic-acid jelly dressings should then follow and the patient be put to 
1 Tannic-acid jelly is carried as an item on the Supplementary Supply Table and a good 
supply should always be kept on hand and available for immediate use. 117 
MINOR SURGERY AND FIRST AID 
bed. Later, the raw areas where the outer tissues have been destroyed may 
be treated by a freshly prepared 5 per cent aqueous solution of tannic acid 
applied either by an atomizer or by sterile cotton applicators. Several coats 
of the tannic acid solution are applied to all raw areas while an assistant fans 
the areas to promote the “tanning” process. The solution of tannic acid is use- 
less for the treatment of first-degree burns in which the skin is intact for 
it will “tan” only raw areas. Following several repeated applications of the 
tannic acid solution the whole area is next treated with a 10 per cent silver 
nitrate solution applied with sterile cotton swabs. After the application of 
the silver nitrate solution, which is germicidal in its action and helps prevent 
infective organisms from growing beneath the “tanned” areas, a black pellicle 
of skin quickly forms beneath which new tissues grow and spread. 
Whenever possible burns should first be treated by the tannic-acid method. 
(See formulas under Tannic Acid in section on Materia Medica.) In this method 
the tannic acid unites with and “tans” the tissues in the raw areas. When 
“tanning” is complete the burned areas have become dark-brown in color, and 
when they have dried they are covered with a hard, leathery crust of a dark- 
brown or black color. This crust: 1. Keeps the burned areas aseptic except 
when infected material has been covered over by it; 2. Lessens the possibility 
of infection as ordinarily infective organisms cannot penetrate through it; 3. 
Protects sensory-nerve endings from external stimuli and thereby lessens pain 
and suffering; 4. Prevents loss of water from the injured tissues and loss of 
body heat; and 5. Serves as a protective covering for the new tissues forming 
and growing to replace those which have been destroyed. Unless infection 
occurs beneath it the crust should not be disturbed until it begins to curl up at 
the edges and to peel off of its own accord, when the loosened parts may be cut 
away with sterile scissors. 
The effectiveness of this method of treating burns is seriously interfered with 
if oils, ointments, or other greasy substances have previously been applied to 
the burned areas. Any oil, ointment, or grease that is present must be gently 
but thoroughly removed with sterile swabs and the area sponged with a weak 
solution of sodium bicarbonate before the tannic-acid treatment is begun, even 
though it may cause considerable suffering. 
In rendering first aid at a fire the points to be kept in mind are: Prevent 
drafts from fanning the fire. Shut and keep shut all doors and windows. If 
one’s own clothing catches afire, do not run, as this fans the flames; lie down on 
the deck or a bed and roll up as tightly as possible in a rug, shawl, overcoat, 
blanket, or other woolen cloth, leaving only the head out; if nothing can be 
obtained in which to wrap up in, lie down and roll over slowly, at the same 
time beating out the fire with the hands. If another person’s clothing is on fire, 
throw him to the ground and smother the fire with a coat, blanket, rug, or the 
like; in doing this care should be taken to stand at the head, and, holding down 
with one foot one edge of the blanket or whatever is used, to throw it toward 
the feet of the individual; the flames thus are swept away from the rescuer 
and from the face of the burning person. Remember that the air within 6 inches 
of the deck is free from smoke, so when unable to breathe a rescuer should 
crawl along the floor with the head low, dragging anyone who has been rescued 
behind him. The rescuer should tie a wet handkerchief or cloth over the 
mouth and nose to minimize the danger of suffocation. 
Cold or chilling.—Injuries due to cold are classified as general, or consti- 
tutional, not local. 
Prolonged exposure to extreme cold results in a general depression or lowering 
of the vitality, a gradual chilling of the body, and a congestion of the internal 118 
HANDBOOK OF THE HOSPITAL, CORPS, U. S. NAVY 
organs. The body and limbs first feel numb and heavy, and then become 
stiff; drowsiness and an irresistible desire to sleep take hold of the individual. 
If left alone, unconsciousness rapidly follows. When found in such a condi- 
tion, life not yet being extinct, a person should be taken into a cold room, 
all clothing removed, and the body rubbed briskly with sheets or towels wet 
with cold water. As soon as the stiffness is removed artificial respiration 
should be performed; and when the patient is able to swallow, warm drinks 
should be given. When there are signs of returning consciousness and cir- 
culation the body may be enveloped in a* blanket and the temperature of the 
room gradually raised. The reason why a frozen person must not be removed 
to a warm room is that the sudden restoration of the circulation gives rise 
to violent congestions and often to sudden death from the formation of clots 
in the blood vessels. 
, In intense cold, frostbite not infrequently occurs without one’s knowing it, 
but usually the ears, fingers, etc., become painfully cold, and then one sud- 
denly realizes that no longer is there any feeling in the parts. The color 
of the frozen part is white or grayish white. The object of treatment is 
to bring the frozen part gradually to its normal temperature. The danger 
of sudden thawing is congestion and bursting of the capillary walls which 
have been weakened by freezing, and resulting in gangrene or death of the 
part; therefore the patient should not go into a warm room or near a fire. 
Rub the part vigorously with wet snow or ice water; never with dry snow, 
as the temperature of the dry snow may be much below freezing and rubbing 
with it would aggravate the condition. When the pain and redness return 
use warm water gradually. Chilblain is a condition of acute or chronic con- 
gestion occurring especially in the feet and due to bringing cold feet near 
the fire too suddenly or merely following exposure to cold in persons with poor 
circulation. On the part affected are red spots, more or less swollen, which 
burn and itch intensely. The treatment consists in stimulating applications, 
such as liniments and tincture of iodine. Susceptible persons should wear 
woolen socks. 
REMOVAL OF FOREIGN BODIES 
Either inanimate objects such as splinters, cinders, marbles, peas, beans, 
etc., or animate objects such as insects, maggots, ticks, etc., may gain access 
to the tissues and cavities of the body. With regard to the removal of inani- 
mate foreign bodies, if their removal is difficult or liable to be attended with 
much damage to the tissues, the patient should be brought under the care 
of a surgeon as soon as possible for the removal of the foreign body. If 
the services of a medical officer are not to be had for some time, then the 
first-aid man must be guided by the probable relative benefit to the patient of 
having him wait the required time for expert treatment or of doing the 
operation himself. The main principle to be kept in mind in the removal 
of an inanimate foreign body is to avoid infecting the tissues, by using 
sterile appliances, and to do as little damage to the tissues as possible. The 
main principle underlying the treatment of conditions where insects, etc., have 
gained access to tissues and cavities of the body is to kill the object first 
and then remove it. Creatures such as Insects and ticks are best killed by 
putting some bland oil, such as olive oil or liquid petrolatum, into the cavity 
to which they have gained access, the oil covering over their breathing pores 
and thus suffocating them, after which they usually may be easily washed out. 
Foreign bodies in the eye.—Foreign bodies, such as particles of dust, cinders, 
etc., may lodge under the lids, upon the conjunctiva, or upon the cornea. In MINOR SURGERY AND FIRST AID 
119 
the latter situation they are seen and removed with the greatest difficulty, 
and the removal ordinarily should not be attempted by other than a medical 
officer. To remove a foreign body from the eye one end of a wooden appli- 
cator should be wrapped with cotton and dipped in boric acid solution, and 
then drawn lightly across the eyeball or eyelid with a wiping movement. 
Never attempt to lift off or dig out a foreign body from the eye. Probably 
the best improvised article for removing a foreign body from the eye, and 
one that nearly always is at hand, is a match, which may be used in the 
same way as a wooden applicator, the plain end being covered with cotton 
or with a clean handkerchief. Or, the match may be lighted, allowed to 
burn a moment, and the flame blown out; then, with a clean handkerchief 
and a rolling movement of the fingers twist off the charred end which leaves 
a soft, clean, splinterless surface with which to wipe away the foreign body. 
To examine the lower lid, draw it down with the fingers, at the same time 
having the patient look up; if the foreign body is not found there, evert the 
upper lid by standing behind the patient with the head upon your chest, and 
telling the patient to look down; at the same time press a match or the end 
of the finger firmly against the outside of the lid about a quarter of an inch 
behind its margin. Draw the lid down by the lashes, and turn it upward 
and outward over the match or finger tip. If the particle still is not visible, 
search thd ball of the eye carefully for it, and when it is found, lift it off 
gently by a quick movement with the point of the match. If the eye is 
very irritable, it may be necessary to put in a few drops of 2 per cent 
cocaine solution. It is important to remember that even after a foreign 
body is removed from the eye there is often for some time a sensation as 
if it were still there. After removing a foreign body the eye should be 
irrigated with boric acid solution and a few drops of 5 to 10 per cent silvol 
solution instilled. 
Foreign bodies in the ear.—The foreign body may be an insect, a pea, a grain 
of wheat, a pebble, a plug of hardened wax, etc. An insect in the ear by its 
movements and buzzing often causes the most intense annoyance. Hold the 
head over on one side with the ear containing the insect uppermost; drop in 
5 or 10 drops of bland oil, such as olive oil or liquid petrolatum, and then 
syringe the ear; or fill the canal with water which will cause the insect to 
float to the surface from where it can easily be removed. If the foreign body 
is vegetable, such as a pea, water should not be used, as it may cause the pea 
to swell and thereby render its extraction more difficult. If the pea is visible, 
bend the loop of a fine hairpin and try to get beyond it so as to hook it out. 
As there is always danger of injuring the eardrum when instruments are pressed 
into the ear, it should be a guiding rule that no instrument should be passed 
beyond the point where its tip can be seen. Hardened wax may be softened 
with a few drops of hydrogen peroxide, then removed by syringing with a warm 
5 per cent solution of soda. 
Foreign bodies in the nose.—Children and insane persons often push peas 
and other foreign bodies into the nose, and occasionally flies deposit their eggs 
there with the result that maggots develop in the nasal cavity. Foreign bodies 
are best removed by closing the free nostril with the finger and forcibly blowing 
through the obstructed side; snuffing a little powdered tobacco or pepper will 
cause sneezing and aid in the expulsion; if this does not succeed and the body 
can be seen, it may be hooked out with a bent hairpin in the same manner 
as described for the ear. Should these measures fail to remove the foreign 
body it should be left alone until the patient can be brought to a medical 
officer. The presence of maggots in the nose is a very serious condition, which 120 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
may result in death. Let the patient inhale through the nose a half teaspoon- 
ful of chloroform, and while the maggots are stupefied syringe them out with 
warm physiological salt solution. 
Foreign bodies in the throat.—Foreign bodies in the throat are usually bones 
or masses of food. If the bone dan be seen and reached, it may be 
removed by fingers or forceps; if not, it may be carried down by eating dry 
bread. If the obstruction is a mass of food, it may be dislodged by forcible 
blows on the back between the shoulders or the fingers may be passed into the 
throat to hook it out or to cause its ejection by vomiting. Foreign bodies in 
the air passages cause violent coughing and difficult breathing; the case is 
urgent, and in the case of a child, he may be held up by his heels and shaken; 
if an adult, inversion also may be attempted and the case treated as described 
for foreign body in the throat. 
Foreign bodies in the stomach.—Foreign bodies sometimes are swallowed and 
reach the stomach and intestine. Such cases are not usually serious. If the 
body is angular or pointed, such as a tack or pin, feed the patient on sub- 
stances which leave considerable residue to cover and protect the sharp points— 
potatoes, bananas, bread, etc. Do not give laxatives, as they will render the bowel 
movements liquid and thus leave sharp points exposed and because the in- 
creased peristalsis favors injury to the intestinal walls. The patient should, 
however, be brought under the care of a surgeon. 
Foreign bodies in the skin.—Here are found splinters, thorns, needles, pins, 
fishhooks, pieces of glass, gunpowder, etc. For splinters and thorns pass the 
point of the blade of a pocketknife under them; with the thumb-nail press the 
splinter against the blade and draw it out; or use a pointed dissecting or 
dressing forceps. If the splinter is buried, open up the skin a little with the 
point of a knife or a needle until it can be reached; if under a nail, cut a notch 
in the nail so as to expose it. If a needle or a pin is broken off in the skin 
and cannot be grasped with forceps, cut a small hole in the end of a cork and 
press it down over the point of entrance of the needle; this may cause the 
needle to emerge so far that it can be grasped. The needle may be so situated 
that it is best to push it through and extract it on the other side. If the 
needle or pin is in the foot or the hand and cannot be extracted, the patient 
should be directed not to use the part, as muscular action will cause it to 
work in deeper. A fishhook or an arrow cannot be drawn out on account of 
the barbs; they must be pushed through. Gunpowder is removed best by a 
thorough scrubbing with soft soap and a stiff brush, the remaining grains 
being picked out with a needle. 
ASPHYXIA 
Asphyxia is a condition where respiration, or breathing, has ceased. It may 
be the result of either abnormal physiological or physical causes. When due 
to the latter it may be spoken of as suffocation. Among the physiological 
causes of asphyxia are: Lack of stimulation of the respiratory center in the 
medulla oblongata, paralysis of the respiratory center, and inability of the 
blood to absorb oxygen from the lungs or to effect the normal exchange of 
gases in the body tissues. In asphyxia resulting from physical causes the 
lungs are deprived of air because of stoppage of the air passages mechanically, 
as by water in drowning, by a foreign body, by a diphtheritic membrane extend- 
ing into the larynx, by a tumor, by swelling of the mucous membranes follow- 
ing inhalation of live steam or an irritating gas, by a constricting band around 
the neck compressing the trachea; or because of the presence or irrespirable 
gases in the air. 121 
MINOR SURGERY AND FIRST AID 
The treatment is to first remove the cause or remove the patient from the 
cause, then give artificial respiration, and later treat for shock. 
Artificial respiration.—There are several accepted methods of applying arti- 
ficial respiration but the best and probably the least dangerous is the prone 
pressure or Schaefer's, method (fig. 64). No reliance should he placed upon 
Expiration ; pressure on. Inspiration ; pressure off. 
Figure 64.—Prone pressure or Schaefer’s method of artificial respiration. (Keen.) 
any special mechanical apparatus, as it is frequently out of order and often 
is not available when most needed. The prone pressure method of artificial 
respiration is as follows: Lay the patient face downward on a blanket or 
clothing spread out flat with the head turned to one side. The arm on the 
side toward which the face is turned is extended beyond the head, the other 
is bent at the elbow and the hand or forearm placed beneath the head. The 
operator kneels astride of both or of one of the patient’s thighs, facing toward 
the head and places the palms of his hands on the lower part of the thorax, 
the little fingers touching the lowest ribs and the ends of the fingers just out 
of sight. (If only one thigh is straddled it should be the one on the side toward 
which the patient’s face is turned so that his face can be easily observed.) 
Then, keeping the arms straight, the operator swings his body slowly forward, 
causing the hands to press upward and inward. This compresses the abdomen 
and the lower part of the thorax, forces out the air in the lungs' and produces 
an expiration. At the end of the forward swing the operator’s shoulders 
should be directly above the heels of his hands. Hold the pressure momen- 
tarily and then quickly remove it by swinging backward to the original position, 
which permits the thorax to expand and produces inspiration. After a wait 
of a couple of seconds swing forward again. The alternate compression and 
release movements together should take about 4 or 5 seconds and should be 
repeated rhythmically 12 to 15 times a minute. As an aid in timing the 
movements the operator may repeat the following words to himself: “Forward 
slow, hold it, swing back, wait a second.” 
In swinging backward the operator’s hands should not be removed from the 
patient, and he should adjust his position so that he can easily maintain his 
balance during the movements. The patient’s mouth should be cleared of any 
obstruction such as chewing gum or tobacco, false teeth, or mucus so that 
there is no interference with the entrance and escape of air. To keep the 
patient warm during artificial respiration is most important and it may be 
necessary to cover him with blankets and work through them, as well as to 
apply hot-water bottles, hot bricks, etc. 
Artificial respiration may be required in those persons apparently drowned; 
asphyxiated by gases, fumes, or noxious vapors, and anaesthetics; electric 
shock; shock or collapse; freezing or exposure to extremes of heat or cold; 
cases of poisoning, etc.; in other words, in all cases in which breathing is 
temporarily suspended. The symptoms by which the necessity for artificial 122 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
respiration may be recognized' are: Cyanosis (blueness of tbe skin and mem- 
branes) ; suspension of respiration; or shallow breathing in some cases of 
poisoning. Artificial respiration should be continued for at least 4 hours with- 
out interruption or until the patient is pronounced dead by a medical officer. 
Treatment for a person apparently drowned.—Every minute and second counts, 
so waste no time. Have bystanders move away to give the victim all the air 
possible. Loosen clothing about neck, chest, and abdomen. With handkerchief 
or towel in hand, gently swab out the mouth and throat to remove mud or 
mucus. Turn the patient over, face downward, place the hands under the 
abdomen, one on either side, and lift the patient, in an endeavor to drain the 
lungs and stomach, then with a large roll of clothing under the abdomen, and 
by making firm pressure upon the loins, continue the efforts to expel the water 
from the lungs and stomach. If the individual then does not breathe, proceed 
immediately with artificial respiration. It is well at the same time to try 
to stimulate respiration by having an assistant hold ammonia or smelling salts 
to the nostrils. Recovery from drowning has occurred where persons have 
been submerged for some minutes; the statements of observers as to length 
of time of immersion can never be accepted, as in emergencies of this sort 
minutes seem like hours. When breathing has been reestablished, remove wet 
clothing and treat the shock. 
Treatment for a person asphyxiated by hanging or by strangulation.—Promptly 
remove any constriction from the neck and also clothing from around the chest. 
Attempt to excite breathing by dashing cold water on the face and body; if 
this fails, proceed with artificial respiration. 
Treatment for a person asphyxiated by choking.—The choking may he due 
to a foreign body or to such a thing as a diphtheritic membrane. Make an 
attempt to remove the offending material as described in a previous paragraph. 
In many of these cases it will be necessary to do a tracheotomy, that is, 
cut a hole in the windpipe, or in diphtheritic cases, to do either an intubation 
or a tracheotomy. This, however, must be done by a surgeon and no time 
whatsoever must be lost in bringing the patient under his care. After removal 
of the obstructing material, perform artificial respiration in the manner 
described previously. 
Treatment for asphyxiation from poisonous gases.—Illuminating gas and the 
exhaust gases from gasoline engines are the most common causes of gas poison- 
ing. It is the carbon monoxide in these gases which is responsible for the dam- 
age. When carbon monoxide is in sufficient concentration in the air being breathed 
it forms a stable compound with the haemoglobin of the blood; this prevents the 
haemoglobin from taking up oxygen and carrying it to the tissues. The patient 
must be removed as soon as possible into the fresh air and artificial respiration 
instituted. In the meantime send for a medical officer, as it often becomes 
necessary to let out some of the patient’s blood and substitute therefor good 
blood from some one else (transfusion). A person poisoned with carbon 
monoxide presents a cherry-red appearance on cheeks and lips. 
Insensibility and unconsciousness are one and the same thing. There are 
varying degrees of unconsciousness, and the same agent causing partial un- 
consciousness, if further applied, may cause total unconsciousness. There are 
numerous causes for unconsciousness, and in order to properly treat it the 
cause must be discovered. To treat a case of unconsciousness is one of the 
most difficult things that may fall to the lot of the first-aid man. In all 
UNCONSCIOUSNESS 123 
MINOR SURGERY AND FIRST AID 
cases of unconsciousness strenuous efforts should be made to bring the patient 
under the care of a medical officer as soon as possible. To ascertain the 
cause of unconsciousness, the first-aid man should be very observant of the 
surroundings as well as of any evidence on the person of the patient which 
might give a clue to the cause. If there are any observers on the ground or 
any who are acquainted with the patient’s habits and past history, all informa- 
tion possible should be obtained from them. The patient’s body should be ex- 
amined for evidences of injury, bleeding, or paralysis. It should be noted 
whether the skin is moist and cold, or hot and dry. The character of the 
respirations should be noted, whether deep, strong, and fast, or whether 
weak, shallow, and slow. It should be noted whether the pulse is weak and 
shallow, or whether it is bounding and strong. The condition of the pupils 
should be noted; whether they are even or uneven, dilated or contracted. The 
breath should be smelled for evidence of alcohol, and a note made whether 
there is frothing at the mouth or injury to the tongue. The common causes 
for unconsciousness are asphyxiation, bleeding, shock, electric shock, heat 
exhaustion, freezing, sunstroke, epilepsy or fits, apoplexy and injury to the 
brain (concussion and compression), alcoholism and certain other poisons, 
hysteria, and uraemia. For the symptoms and treatment of suffocation, bleed- 
ing. shock, heat exhaustion, sunstroke, and freezing, see previous paragraphs. 
Electric shock is caused by coming in contact with a “live wire”; spasmodic 
contraction of the muscles occurs so that the person cannot let go. Depend- 
ing on the strength of the current in the wires in contact with the patient, sud- 
den death or insensibility, with or without severe burns, may be caused. The 
first thing to be done is to rescue the patient by setting him free from the wire, 
and this must be done with great care, as to touch him with bare hands will 
cause the rescuer to get the same shock. With a single quick motion, free the 
victim from the current. Use any dry nonconductor (clothing, rope, board) to 
move either the victim or the wire. Beware of using metal or any moist ma- 
terial. While freeing the victim from the live wire have every effort also made 
to shut off the current quickly. Immediately start artificial respiration, and 
when voluntary breathing returns, treat for shock. The burns must be treated 
as other burns. Lightning stroke causes similar symptoms to the foregoing and 
the treatment is the same. 
Epilepsy or fits.—In epilepsy there may be fits with insensibility, or a mere 
momentary unconsciousness with slight muscular twitching, but in which the 
patient does not fall. In the severe form, with or without warning signs, the 
person suddenly cries out in a peculiar manner and falls in a fit; at first the 
entire body is rigid, then there are general convulsions with jerking of the 
limbs, contortion of the face, and foaming at the mouth. After a few minutes 
the convulsions are followed by profound stupor, and this generally passes off 
into a deep sleep. During the attack the eyeballs may be touched without the 
patient flinching, the pupils are dilated, the patient often bites his tongue, and 
there may be involuntary evacuations of the bowels and bladder. Epileptic un- 
consciousness may be distinguished from other forms by the history of the fit, 
and of other previous fits, by the foam at the mouth and the bitten tongue and 
by the absence of any paralysis. As far as treatment goes, nothing can be done 
to stop the fit or to control it; all that can be done is to prevent the patient from 
hurting himself and to make him as comfortable as possible; do not attempt to 
hold him, but twist a handkerchief, passing it between his jaws, and tie it at 
the back of the neck until after the fit is over to keep him from biting his tongue. 
After the fit is over let the patient sleep as long as he will. One must be on the 
154294°—39 9 124 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
lookout in the service for men feigning epileptic fits in order to obtain a dis- 
charge. The feigned attacks usually occur at night when no one can see them; 
the man does not fall so as to hurt himself, does not bite his tongue, flinches when 
the eyeball is touched, the pupils are not dilated and the patient can be aroused. 
When there is foaming at the mouth a piece of soap often will be found inside 
the mouth. A pail of cold water suddenly thrown upon the man’s head and 
shoulders usually makes the diagnosis; it promptly revives the malingerer, but 
has little or no effect on the epileptic. 
Concussion of the brain.—Concussion of the brain is a condition present 
when a man has been ‘“knocked senseless” or “stunned.” It is a jarring 
and shaking of the brain due to blows or falls upon the head or falls upon 
the feet; the brain almost stops working for a time. The symptoms are un- 
consciousness, pallor of the face, breathing so quiet and shallow that it 
hardly can be detected, pulse fluttering, pupils equal and usually contracted. 
The degree of insensibility varies. Sometimes the patient can be aroused, 
but is irritable, and lapses again into unconsciousness which may last 
minutes or hours. Vomiting and turning on the side are favorable symptoms. 
The treatment consists in perfect rest in a dark, quiet room; warmth applied 
externally if the surface is cold; and aromatic spirits of ammonia by inhalation 
if there is much depression. 
Compression of the brain and apoplexy.—Compression of the brain is, as 
the term implies, a pressure on the brain. This pressure is due usually to 
either a piece of bone or to a haemorrhage from a torn vessel within the 
cranium, and as the blood cannot leave the cranial cavity it compresses the 
brain. This compression prevents certain parts of the brain from working. 
When the bleeding is the result of injury the condition is called compression 
of the brain; when it is the result of the bursting of a diseased blood vessel 
without any violence it is called apoplexy; the result and the symptoms are 
practically the same. The symptoms of compression are profound unconscious- 
ness ; loud, snoring breathing; slow pulse; pupils usually unequal and not 
reacting to light; and usually paralysis on one side of the body. If the 
compression is due to a piece of broken bone, the symptoms come immediately 
after the injury, while if it is due to bleeding they may come on later and 
gradually. The treatment of both compression and apoplexy consists of keep- 
ing the patient absolutely quiet, at rest in a comfortable position, and applying 
cold applications to the head during the acute stage. Do not administer 
stimulants. When convalescent, regulate diet, recommend a very moderate 
amount of exercise, and instruct the patient to avoid worry and excitement. 
Hysterical unconsciousness.—-Hysteria is a disease, of the nervous system 
accompanied by loss of control over the emotions. It usually is seen in 
women, but also may be present in nervous men. The disease is manifested 
in a great variety of ways, but the only form that will be mentioned here will 
be that accompanied by convulsions. In this form hysteria may closely 
resemble epilepsy. The patient usually has an attack of laughing and crying 
and gradually “works himself up” to such an extent that he falls in a con- 
vulsion. The attacks sometimes are prolonged for several hours, and upon 
recovery, it is not uncommon to find the patient laughing or sobbing for some 
time after. He appears to be unconscious, but in falling he always picks 
out some soft spot or chair to fall upon, and is careful not to injure himself. 
The tongue rarely is bitten in hysteria. Hysteria may be mistaken for 
epilepsy, but in the latter condition the fall is sudden, and the sufferer fre- 
quently receives painful scalp wounds or injuries to the tongue. While 
hysteria is a disease, the patient nevertheless should be treated with firm- 125 
MINOR SURGERY AND FIRST AID 
ness. The subjects usually crave sympathy. To sympathize with such a 
patient is the worst possible thing one can do and simply prolongs the 
attack or hastens another. The best thing to do is to leave the patient alone 
—of course seeing that no harm can come to him. When he recovers and 
finds himself alone and without sympathy it is not likely that he will repeat 
the attacks. In prolonged convulsions, throwing -water in the face usually will 
terminate the seizure. 
Uraemia or the insensibility of Bright’s disease.—The insensibility of Bright’s 
disease is really an acute poisoning from the retention of the waste products 
which the diseased kidneys are not able to eliminate. The unconsciousness often 
is attended with delirium and convulsions. The pupils are contracted, the pulse 
is slow, there is a peculiar odor of the breath, and the breathing is loud and 
snoring. The distinguishing characteristics are the history of Bright’s disease, 
the waxy color of the skin, sometimes dropsy, abnormal urine (albumin, casts, 
etc.), and ordinarily the absence of paralysis. Emergency treatment consists in 
applying cold cloths to the head and a hot mustard poultice to the back over 
the kidneys. If the services of a medical officer are not available within a brief 
period of time, catheterize, and give an enema and a hot pack. 
Unconsciousness caused by acute alcoholism.—The use of alcohol, if carried 
to excess, produces a condition of unconsciousness which is very likely to be 
confounded with other similar conditions. Too great care cannot be taken in 
examining these cases thoroughly, as mistakes are of frequent occurrence, and 
cases of fractured skull or apoplexy often are pronounced mere alcoholism. Do 
not be led astray by the fact that a person has an odor of liquor about him. 
He may have been drinking and had a stroke of apoplexy, or may in falling 
have fractured his skull. If there is the least doubt, it is better to give the 
patient the benefit than to run any risks. A person suffering from alcoholic 
coma lies in a stupor, but usually can be partially aroused and made to answer 
questions. The face is flushed, the pulse is first full and rapid then feeble and 
slow, and the respirations are deep. The pupils usually are dilated and the 
breath has the heavy odor of alcohol. Ordinary intoxication rarely requires 
any treatment besides rest and sleep. If the patient is in an exhausted state, 
it is well to wash out the stomach, then cover him warmly and apply heat to 
the extremities. If coma is present, try to arouse the patient by cold douching 
or striking with wet towels. If the pulse is weak, stimulants should be given; 
inhalations of ammonia and the internal use of strychnine or caffeine may be 
employed if the patient is conscious. The use of strong coffee by the rectum 
is often of great service. 
When unable to diagnose exactly the cause of unconsciousness determine, if 
possible, that it is due neither to a poison, to bleeding, nor to sunstroke, for 
each of these demands immediate special treatment, nor to suffocation, for 
which it would be necessary, of course, to give artificial respiration. Then, 
unless it is necessary to give the special treatment, if the patient is pale and 
weak, have him lie down with his head low, apply warmth and stimulate him 
in every way possible; on the contrary, if the face is red and pulse is very 
strong, while the position for the patient should also be lying down, the head 
should be raised. No stimulants should be given in the latter condition, and 
cold water should be sprinkled on the face and chest. 
After a patient has been taken to the sick bay or the hospital Bogan’s test 
to determine the amount of alcohol per cubic centimeter of circulating blood or 
in the urine may be used in doubtful cases of unconsciousness where alcoholism 
is suspected, but this test does not rule out poisoning, head injury, etc., which 
can and frequently do accompany alcoholism. 126 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
ACUTE ABDOMINAL CONDITIONS 
The most common, serious, acute abdominal conditions are acute appendi- 
citis, perforating ulcers of the stomach or duodenum, intestinal obstruction, 
gall-stone colic, kidney-stone colic, and poisoning by infected food or by other 
poisons. Pain and tenderness in the abdomen, general or localized or both, 
nausea and vomiting, and more or less shock are symptoms common to these 
conditions. Beginning pneumonia, lead poisoning (painters’ colic), and inflam- 
mation of the testicle are conditions outside of the abdomen which may 
produce similar symptoms. Acute indigestion and constipation are compara- 
tively mild conditions which may be confused with these conditions. 
Many cases of acute appendicitis, obstruction of the bowels, and acute 
pancreatitis that have been diagnosed as acute indigestion or constipation 
have resulted in the death of the patient. All cases presenting symptoms 
of abdominal pain or nausea and vomiting, particularly when associated with 
more or less shock, should be brought under the care of a medical officer as 
soon as possible, as time is a very important element in averting a fatal end 
in many of these conditions. 
One always should suspect something more than ordinary indigestion or 
constipation if there is much prostration, shock, or elevated temperature, or 
if the symptoms persist for any length of time. Many a person suffering 
from acute appendicitis or obstruction of the bowels will ascribe the condi- 
tion to something that has been eaten, but do not be deceived by such a 
statement. Get all the information possible as to how the attack started, 
history of previous attacks, and symptoms prior to the present attack, whether 
the patient has vomited blood or not, and when the bowels last moved; take 
the temperature and pulse rate; lay the patient flat with the abdomen bared 
and determine by gentle and careful palpation where the pain and tenderness 
are most marked. Make a white blood count if possible. 
Acute appendicitis.—Appendicitis is an inflammation of the appendix. A 
patient frequently complains for several days before the attack of indiges- 
tion, loss of appetite, constipation or diarrhoea, and uneasiness in the abdo- 
men, or the attack may come on suddenly. The pain may start in the pit 
of the stomach, then become generalized over the abdomen, and finally, after 
several hours, become localized in the right lower quadrant of the abdomen 
with marked tenderness on pressure and rigidity of muscles over that point. 
Vomiting generally comes on 3 or 4 hours after the beginning of the attack. 
The temperature may be subnormal from mild shock or be elevated to 100° 
or 101° F. There is generally an increase in white blood cells to above 
10,000 per cubic millimeter. In acute appendicitis the appendix becomes full 
of pus and the danger lies in its rupture with resulting peritonitis. Many 
cases never rupture, whereas others often rupture in 3 or 4 hours after 
the attack starts. The object is to remove the appendix before its rupture, 
as otherwise death may ensue from peritonitis, or the abdomen may have 
to be drained for months with or without final recovery and perhaps result- 
ing in the formation of adhesions, making the patient more or less a 
permanent invalid. The treatment consists in placing the patient under 
the care of a surgeon as soon as possible. In the meantime put to bed, 
giving nothing by mouth, not even hot water; give a soap and water enema 
very low and under very little pressure, and put a hot-water bag over the 
appendix. Do not use an ice bag. In case no medical officer is available 
for some time, liquids in small amounts may be given after 48 hours. Never 
give a cathartic to a person suspected of having acute appendicitis. MINOR SURGERY AND FIRST AID 
127 
Acute intestinal obstruction.—In this condition, a loop of bowel becomes 
constricted, resulting in the inability of the intestinal contents to move beyond 
the point of constriction and cutting oft the blood supply to the loop of the 
bowel with resulting gangrene or death to the bowel. This condition is 
followed by absorption of poisons from the intestine, peritonitis, and death if 
the condition is not relieved. Two very common ways for the bowel to 
become constricted are by means of adhesions within the abdomen and by 
a loop of bowel becoming strangulated in a hernia, or rupture, as it is commonly 
called. The symptoms are inability to pass gas or faeces by the rectum, pain in 
the abdomen, vomiting becoming more and more frequent, and intense shock. 
The abdomen may be distended above the point of constriction and be flat 
below that point. There is generally a leucocytosis as in appendicitis. The 
loop of bowel must be relieved of its constriction or death will ensue. Place 
the patient under the care of a surgeon at the earliest possible moment. In 
the meantime, take the following measures: 1. If the obstruction is due to a 
strangulated hernia, and the case has not gone too far, put the patient in a 
hot tub with the buttocks elevated in order to relax the inguinal ring, and 
exert gentle pressure over the tumor; 2. Put the patient to bed, give a soap 
and water enema, and nothing by mouth. Never give a person suspected of 
suffering from obstruction of the bowels a purgative. 
Perforated gastric or duodenal ulcer.—Generally, though not always, a person 
suffering from perforated ulcer of the stomach or duodenum gives a long his- 
tory of stomach trouble. Acute pain “in the pit of the stomach,” associated 
with more or less shock, is suddenly felt. The pain is sudden and intensely 
violent, which is greatly increased by swallowing fluids, by vomiting, by turn- 
ing the body, by coughing, by respiration, and by pressure. This pain may 
radiate throughout the abdomen, but the chief tenderness is in the region of 
the stomach. Vomiting occurs in about one-half the cases at the time of 
perforation. Shock may be severe following the perforation, but, as a rule, does 
not last long. A board-like rigidity of the muscles of the abdomen is present, 
and the temperature is usually normal or subnormal. The danger from per- 
forated ulcer of the stomach or duodenum is peritonitis, due to the escape of 
stomach or duodenal contents into the peritoneal cavity. The treatment con- 
sists in bringing the patient under the care of a surgeon as soon as possible 
before peritonitis sets in; in the meantime, put the patient to bed, give abso- 
lutely nothing by mouth, and put an ice bag over the stomach; and treat 
shock and haemorrhage if present. 
Gall-stone colic.—Gall-stone colic is due to the passage, or the attempt at 
passage, of a gall-stone from the gall bladder to the intestines. Depending on 
the location of the stones, a person with gall-stones may or may not be 
jaundiced. The patient frequently gives a history of stomach trouble with or 
without jaundice and may give a history of previous gall-stone colic. The 
colic consists of spasmodic, excruciating pain over the stomach and liver, 
radiating upward over the right half of the thorax, frequently up under the 
right shoulder blade. The patient is very nauseated, and usually vomits, and 
often the vomiting is violent. The abdomen is distended and a condition of 
collapse soon comes on. The respirations are shallow, the patient groans, 
cries out, or flings about the bed, often assuming strange contorted positions, 
trying to obtain relief, frequently holding one hand over the liver region. The 
pain is one of the most excruciating a human being can experience. The usual 
duration of an attack is from 4 to 20 hours, although it may last much longer. 
The temperature is usually normal or subnormal. The patient should be 
brought under the care of a medical officer as soon as possible. If one is not 128 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
at hand, give one-fourth grain of morphine hypodermically, followed in an 
hour by another one-fourth grain, and place a hot-water bag over the liver at 
the lower border of the ribs. 
Kidney-stone colic.—This condition is due to a small stone from the kidney 
entering into the ureter, which it blocks, tears, or distends. The pain is gradual 
or sudden in onset, is fearful in intensity, and runs from the lumbar region 
down the corresponding thigh and testicle and into the abdomen and back. 
There are nausea, vomiting, collapse, and sometimes unconsciousness or con- 
vulsions. Frequent attempts at urination result in j)ain but little urine. The 
urine is often smoky or red from injury to the ureter. After a time the pain 
vanishes, due to the stone falling back into the pelvis of the kidney or to its 
passing on into the bladder. Treatment consists of bringing the patient under 
the care of a medical officer, and, in the meantime, putting to bed, giving 
plenty of water by mouth to increase the flow of urine, putting a hot-water 
bag on the affected side of the abdomen, and, if necessary, giving morphine, 
one-fourth grain hypodermically. 
Poisoning causing acute abdominal symptoms.—If the condition is due to eat- 
ing infected foods containing toxins or harmful breakdown products formed by 
the action of bacteria on the food it is probable that more than one person will 
apply for treatment. The symptoms are vomiting, diarrhoea (at times bloody), 
fever, abdominal cramps, and sometimes considerable prostration. In the ab- 
sence of a medical officer, clear out the intestine with a good dose of castor oil. 
If a severe case occurs, put the patient to bed, give a purge, and allow nothing 
by mouth except plenty of water, until symptoms abate, then increase diet 
gradually. Should severe constipation be present an enema of soap and water 
may be given. 
In case the acute abdominal symptoms are due to inflammation of the testicles, 
there usually will be a history of urethral infection, or mumps, or injury to 
the testicle, and on examination the part wall be seen to be tender and swollen. 
Lead poisoning may resemble in its symptoms any acute abdominal condition 
mentioned, particularly acute intestinal obstruction and appendicitis; in this 
case, however, there is a history of working with lead, paint, or in compart- 
ments laden with lead paint chippings; the so-called “blue line” at the margin 
of the gums most likely will be present, and a blood smear stained with 
Wright’s stain will show stippled red cells and probably anaemia. In case the 
symptoms are due to a beginning pneumonia, there usually will be a histpry 
of chills a short time before, the respiration will be increased with a rising 
fever, and perhaps a beginning cough with sputum. There is generally a high 
leucocytosis, even up to 80,000. 
The main principles a first-aid man should remember when treating a ease 
with acute abdominal symptoms are: 1. No purgative should be given when 
appendicitis or intestinal obstruction is suspected; 2. The time elapsing before 
surgical aid can be obtained is of the greatest importance for the future welfare 
of the patient; 3. No morphine or opium should be given for pain except in 
frank eases of gall-stone and kidney-stone colic, as this will mask the symptoms 
for the surgeon when he arrives. 
SOME COMMON EMERGENCY SYMPTOMS 
Fever is a name given to a group of symptoms consisting of a rise of temper- 
ature above normal (98.6° F.), with attendant increase in the pulse rate and 
a rise in the number of respirations per minute; associated with which are 
generally headache and flushing of the face, a feeling of weakness, irritability, MINOR SURGERY AND FIRST AID 
129 
and loss of appetite. Fever is simply a group of symptoms and is not a disease 
in itself. Fever is one of the main symptoms of all infectious diseases and 
infections and for some time may be the only evidence of an infection or an 
infectious disease. It may, however, simply be due to the results of constipa- 
tion, with absorption of poisonous products from the intestine, but as a rule 
the temperature in these cases does not go above 101° F. In handling a fever 
case, if possible bring the patient under the care of a medical officer. The 
problem in a case of fever is to find the cause if possible. Get the history of 
the ease, how long there has been fever, what other symptoms have been or 
are present; if there has been exposure to an acute infectious disease, or con- 
stipation ; and examine the throat and skin for evidences of the cause. If no 
other symptoms are present but an acute fever, which is not very high, and if 
the patient is not particularly sick, a good purgative probably will give relief. 
Do not load up the patient with drugs. Constipation with fever is spoken of 
as autointoxication. If the patient has a high fever and is sick, give a brisk 
purgative, put to bed on a liquid diet, and put an ice bag on the head. In the 
meantime try to obtain the services of a medical officer and watch the patient 
carefully for symptoms which will point the way to ascertaining the cause 
of his fever. In case the beginning of an infectious disease is suspected the 
patient, of course, should be isolated. 
A cold.—The term “cold” is applied to a group of symptoms consisting of a 
running at the nose, lacrimation (overflow of tears), and fever, generally 
with headache and malaise (opposite of well-being). These symptoms may be 
due to a so-called common cold or they may be forerunners of such infectious 
diseases as influenza, measles, infantile paralysis, or cerebrospinal fever. If 
the patient is quite sick, fever high, and depression is marked, particularly 
if there has been exposure to the above-mentioned infectious diseases, suspect 
that it is something more than a common cold, and, if possible, place the 
patient under the care of a medical officer. Find out whether the patient has 
been recently exposed to such diseases, and by questions and examina- 
tion ascertain whether further symptoms are present which may lead to a 
diagnosis. Give the patient a brisk purgative; isolate, and keep on the lookout 
for further symptoms. If the case is one of common cold, a brisk purgative 
should be given early, the patient advised to drink plenty of water, and hot 
drinks given at night, possibly with 10 grains of aspirin, or Dover’s powder, 
to stimulate perspiration. 
Headache.—Headache may be due to a great variety of causes. It is a con- 
stant accompaniment of fever, of acute infectious diseases, of autointoxication, 
and of head injuries. It frequently is due to eye strain. In all eases of headache 
it is well always to take the temperature and to inquire into the condition 
of the patient’s bowels. There must be a cause, and the problem is to find 
it. Do not try to cure headaches with drugs without trying to find out the 
cause, except perhaps in emergency 10 grains of aspirin may be given after 
a good purgative. Patients with frequent headaches should always consult a 
medical officer when available- 
Diarrhoea.—Diarrhoea is a term applied to a condition characterized by the 
passage of frequent, watery stools. It may be due to diseases such as dysen- 
tery, meat or other poisoning, typhoid or other fever, or simply to the presence 
in the intestine of some irritating material from fermentation and putrefac- 
tion. Always take the temperature of a person suffering from diarrhoea; ques- 
tion and examine for any other symptoms present or for information able 
to be given. All cases of severe or continued diarrhoea should be brought 130 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
under the care of a medical officer. In case the diarrhoea is due to overeating, 
with consequent absorption of the products of intestinal putrefaction, adminis- 
ter a brisk cathartic to get rid of the offending material. 
Hiccough.—Hiccough usually is due to overeating and indigestion. It is 
caused by spasmodic contractions of the diaphragm, the great muscle which 
separates the chest from the abdomen. This is the reason that holding the 
breath as long as possible usually will cure this condition, as the air in the 
chest forces the diaphragm down so that it does not contract. Drinking a 
large glass of water in small sips while holding the breath has exactly the 
same effect. A sudden fright occasionally stops a hiccough, because it causes 
the patient to take a long breath. If none of these methods are successful, 
removal of the irritating material from the stomach by vomiting almost 
always will cure the hiccough. It may, however, be due to some constitutional 
disease, such as Bright’s disease, and persistent cases should be brought under 
the care of a medical officer. 
Convulsions.—Convulsions are most commonly due to epilepsy, hysteria, 
and various kinds of poisoning. The treatment consists in summoning a 
medical officer, keeping the patient from biting the tongue or inflicting other 
injury, and finding out all one can to ascertain the cause. 
Earache.—Earache may be due to a diseased molar tooth, to beginning 
mumps, to a stoppage of the Eustachian tube from an inflammation of the 
throat, and from inflammation or abscess of the external auditory canal, of 
the ear drum or of the middle ear. In treating examine the teeth and if 
there is a molar tooth diseased on the affected side, treat it as described in 
the section on Emergency Dental Treatment. Examine the throat, and if it 
is inflamed treat it as described under Sore Throat. Examine for begin- 
ning mumps by feeling back of the angle of the jaw for tenderness and swell- 
ing and put a very little diluted acetic acid on the back of the tongue to 
see whether it causes pain and aching in that locality. Pull the ear upward 
and backward and see if there is swelling and redness in the external audi- 
tory canal; if so, the earache is due to inflammation there or in the middle 
ear. Inflammation of the middle ear is dangerous, owing to the possibility 
of extension of the process into the mastoid cells and from there to the brain 
unless prompt surgical attention is given. If the earache is due to inflamma- 
tion of the middle ear, get the patient under the care of a surgeon as soon 
as possible, as the ear drum probably will have to be incised. In the mean- 
time, for inflammation of the external auditory canal or middle ear, put 
the patient to bed with hot applications or a hot-water bottle on the af- 
fected ear. 
Chills.—Chills may be simply the result of overexposure to cold and wet, 
or may be the forerunner of pneumonia, or part of an attack of malarial 
fever or other disease. Always watch the patient with a chill for other 
symptoms during and after the chills. The immediate treatment consists of 
putting the patient in bed between hot blankets, using hot-water bags, and 
giving hot drinks. 
Sore throat.—Sore throat may be one of the symptoms in quite a large 
number of diseases, particularly ordinary tonsillitis, diphtheria, scarlet fever, 
Vincent’s infection, and syphilis. Always have these diseases in mind in a 
case of sore throat, and never fail to examine the throat thoroughly in all 
cases. If a membrane is present in the throat, the case may be one of ordi- 
nary tonsillitis, of diphtheria, or of scarlet fever. If ulcers are present on 
the throat, syphilis may be the cause. A good treatment for an ordinary 
sore throat is to give a brisk cathartic, have the patient gargle his throat BANDAGES AND BANDAGING 
131 
every hour with Dobell’s solution or diluted vinegar. When possible, always 
make a smear and stain from the throat of a case of tonsillitis and examine 
for diphtheria organisms. When in doubt about a case, isolate it and bring 
it under the care of a medical officer as soon as possible. 
Modern Surgery.—Da Costa. 
Traumatic Surgery.—Moorhead. 
The Treatment of Injuries.—Owen. 
Accidents and Emergencies.—Dulles. 
Operative Surgery.—Binnie. 
References 
Section 2.—BANDAGES AND BANDAGING 
Bandages are employed to hold dressings applied to the surface of the body, 
to secure splints in the treatment of fractures and dislocations, to create pres- 
sure, to immobilize joints, and to correct deformity. 
Various materials are employed in making bandages, such as gauze, flannel, 
crinoline, muslin, linen, rubber, and elastic webbing. Gauze frequently is used 
because it is light, soft, thin, porous, readily adjusted and easily applied. Flan- 
nel, being soft and elastic, may be applied smoothly and evenly, and as it 
absorbs moisture and maintains body heat, is very useful for certain conditions. 
Crinoline, rather than gauze, is used in making plaster of Paris bandages, as 
the mesh of the crinoline holds the plaster more satisfactorily than gauze. 
Muslin is employed in making bandages because it is inexpensive and readily 
obtainable. It should be soaked in water to cause shrinkage, dried, and finally 
ironed to remove wrinkles. A large piece of this material easily may be torn 
into strips of the desired width. 
Rubber and elastic webbing are used to afford firm support to a part. The 
webbing is preferable to the pure rubber bandage, as it permits the evaporation 
of moisture. 
It is of the greatest importance that a hospital corpsman should become 
familiar with the general rules of bandaging and profiicient in the application 
of the various types of bandages. The comfort of a patient, the security of the 
dressing, and the professional reputation of hospital corpsmen depend upon 
the proper application of a bandage. A neatly and properly applied bandage 
is an indication that the dressing covered by the bandage has been properly 
performed. An untidy, uncomfortable, insecure, improperly applied bandage 
reasonably may lead one to suspect that the underlying dressing is of the same 
character and can result only in adverse criticism. 
Various types of bandages, commonly used, are the roller bandage, the trian- 
gular bandage, and the many-tailed bandage. 
The roller bandage is made from one of the afore-mentioned materials, the 
width and length depending upon the part to be bandaged. For convenience 
and ease of application, the strip of material is rolled into the form of a cylin- 
der. Each bandage of this type should consist of only one piece, free from 
wrinkles, seams, selvage, and any imperfections that may cause discomfort to 
the patient. Although there are various types of mechanical appliances used 
in winding bandages, it is essential that hospital corpsmen should be able to roll 
a bandage by hand. 
The strips of bandage material should be folded at one extremity several 
times to form a small, firm cylinder. This cylinder is held by its extremities 
with the index finger and thumb of the left hand. The free end of the band- 
age is held between the index finger and thumb of the right hand, close to the 132 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
cylinder. With this hand the bandage then is revolved around the cylinder, 
which is held in the left hand, the free fingers of which aid in turning the 
cylindrical roll. The amount of tension exerted upon the free end will deter- 
mine the firmness of the completed roller. A roller bandage consists of the 
free end or initial extremity, the body, and the terminal extremity in the center 
of the cylinder. 
The length and width of bandages vary according to the purposes for which 
they are employed. The sizes most frequently used are: 1 inch wide, 3 yards 
long, for the hand, fingers, and toes; 2 inches wide, 6 yards long, for head band- 
ages ; 2y2 inches wide, 7 yards long, for extremities; 3 inches wide, 9 yards long, 
for thigh, groin, and trunk. 
GENERAL RULES FOR BANDAGING 
In applying a roller bandage tbe roll should be held in the right hand so that 
the loose end is on the bottom; the outside surface of the loose or initial end 
is next applied to and held on the part by the left hand; and the roll 
is then passed around the part by the right hand, which controls the tension 
and application of the bandage. Two or three of the initial turns of a roller 
bandage should over-lie each other in order to secure the bandage and keep 
it in place. In applying the turns of the bandage it is often necessary to trans- 
fer the roll from one hand to the other. 
Bandages should be applied evenly, firmly, and not too tightly. Excessive 
pressure may cause interference with the circulation and may lead to disastrous 
consequences. In bandaging an extremity it is therefore advisable to leave 
the fingers or toes exposed in order that the circulation of these parts may be 
readily observed. It is likewise safer to apply a large number of turns of a 
bandage rather than to depend upon a few too-firmly-applied turns to secure a 
splint or dressing. 
In applying a wet bandage, or one that may become wet in holding a wet 
dressing in place, it is necessary to allow for shrinkage. The turns of a band- 
age should completely cover the skin, as any uncovered areas of skin may become 
pinched between the turns, with resulting discomfort. 
Bandages should be applied in such a manner that skin surfaces are not brought 
in contact, as perspiration will cause excoriation and maceration of the skin. 
In bandaging an extremity it is advisable to include the whole member (arm 
and hand, leg and foot), excepting the fingers and toes, in order that uniform 
pressure may be maintained throughout. It is also desirable in bandaging a 
limb that the part be placed in the position it will occupy when the dressing 
is finally completed, as variations in flexion or extension of the part will cause 
changes in the pressure of certain parts of the bandage. 
The initial turns of a bandage of an extremity (including spica bandages of 
the hip and shoulder) always should be applied securely, and, when possible, 
around the part of the limb that has the smallest circumference. Thus in 
bandaging the arm or hand the initial turns usually are applied aroiind the 
wrist, and in bandaging the leg or foot the initial turns hre applied immediately 
above the ankle. 
The final turns of a completed bandage usually are secured in the same 
manner as are the initial turns, by the employment of two or more overlying 
circular turns. As both edges of the final circular turn are necessarily ex- 
posed, they should be folded under to present a neat, cufflike appearance. The 
terminal end of the completed bandage is turned under and secured to the 
final turns by either a safety pin or adhesive tape. When these are not avail- BANDAGES AND BANDAGING 
133 
able, the end of the bandage may be split lengthwise for several inches, and the 
two resulting tails secured around the part by tying. 
When the turns of a bandage cross each other, as in the figure-of-eight, the 
spiral reverse, and the spica, the line of crossings should be straight, and if 
practicable, should be in the center line of the part bandaged, but the line of 
crossings should not be over a bony prominence. The exposed portions of 
the turns should be of approximately the same width. 
In removing a bandage, it may be cut, preferably with bandage scissors. 
In doing so the operator should be careful to avoid interference with the 
underlying dressing and the affected area. 
If the bandage is removed without cutting, its folds should be gathered up in 
first one hand and then the other as the bandage is unwound. This procedure 
will facilitate removal and the rewinding of the bandage, if that be desirable. 
APPLICATION OF BANDAGES AND THEIR USES 
Circular bandage.—After anchoring the initial turns of the bandage, as de- 
scribed in a previous paragraph, a series of circular turns is made around the 
part. Each turn should overlie accurately the turn beneath it, neither ascend- 
ing nor descending. Uses: Retention of dressings to a limited portion of an 
extremity, the neck, or the head; compression to control venous haemorrhage and 
to promote venous stasis. 
Spiral bandage.—After anchoring the initial turns, each turn is applied in a 
spiral direction in such a manner as to overlie one-third of the preceding turn. 
As usually applied to an extremity the upper edge of each turn of an ascending 
spiral is tighter than the lower edge with resulting Inequality of pressure. 
For this reason many surgeons object to its use on an 
extremity. However, this apparent fault may be overcome 
to a great extent by applying the bandage in the manner 
described in a preceding paragraph. 
Uses: Retention of dressings of the 
arm, chest, and abdomen (fig. 65). 
Oblique bandage.-—A series of ob- 
lique turns is applied around a part 
in such a manner as to have an uncov- 
ered area between turns. The width 
of the uncovered area should be uni- 
form throughout. Uses: Retention of 
thick dressings or of temporary dress- 
ings which require frequent removal. 
Recurrent bandage.—In applying 
this bandage, the roller, after securing 
the primary turns, is carried com- 
pletely over a part to a point opposite 
its origin, and then reflected and 
brought back to the starting point, 
where it is secured by one or more cir- 
cular turns (fig. 66). 
In the recurrent bandage of the hand, the bandage is secured at the wrist, 
carried over the back of the hand, around the tips of the fingers, across the 
palm to the wrist. Held at this point by the disengaged hand of the operator, 
the bandage is carried across the palm around the tips of the fingers, across 
the back of the hand to the wrist, where it is held by the thumb of the opera- 
tor’s disengaged hand. Each turn overlies one-third of the preceding turn. 
FlGDRE 66-~TRecur' 
rent bandage of 
stump. (Whar- 
ton.) 
Figure 65.—Spiral 
bandage. (Owen.) 134 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The original turn over the fingers may cover the middle and ring fingers, with 
each succeeding turn applied alternately over the other fingers first to one side 
and then to the other of the middle finger; or the original turn over the fingers 
may be applied over the first finger or over the little finger, each subsequent 
turn covering a portion of the remaining exposed fingers. The reflected portion 
of the bandage at the wrist is then secured by a number of circular turns. It 
is customary to complete such a bandage with a figure-of-eight bandage enclos- 
ing the entire hand. 
Figure-of-eight bandage.—This is undoubtedly the most useful bandage and 
with its various modifications, probably is employed more frequently than any 
other bandage. The hospital corpsman should perfect himself in the applica- 
tion of this bandage, as, with a few exceptions, the majority of bandages are 
applied on the principle of the figure-of-eight. Its name is derived from the 
fact that the turns are applied so as to form a figure 8. Although it is em- 
ployed commonly in bandages of the joints (elbow, knee, and ankle), it fre- 
quently is applied in bandaging the neck and axilla, the head and neck, and 
the head and jaw (Barton). If properly applied, it may be used very 
successfully in bandaging the extremities. 
Figure-of-eight of hand and wrist.—After anchoring the bandage with two 
circular turns about the wrist the bandage is carried across the back of the 
hand to the base of the fingers, then into the palm, across the palm to the 
back of the hand, and across the back of the hand to the starting point at 
the wrist, where one circular turn is made. This 
general course is followed with several similar 
turns, each one overlying about one-third of the 
preceding turn on the back of the hand. After a 
sufficient number of turns has been made, the 
bandage is terminated with a circular turn 
around the wrist. Uses: Retention of dressings 
on the back of the hand or in the palm (fig. 67). 
Figure-of-eight of forearm.—This bandage may 
be the continuation of the figure-of-eight of the 
wrist and hand, or may be started with primary 
circular turns of the wrist. The bandage is car- 
ried obliquely upward across the back of the 
forearm and around the arm in its natural 
course, where it forms the upper loop of the 
figure-of-eight. The bandage then is carried in 
an oblique direction downward, across the back 
of the arm, where it crosses the upward turn of 
the bandage. Then it is carried around the lower 
end of the forearm to complete the lower loop 
of the figure-of-eight. The same process is re- 
peated several times until the elbow is reached, each turn overlapping the upper 
one-half or three-quarters of the preceding turn. The bandage is terminated 
finally with two or more circular turns at the elbow. The final circular turn, 
with both upper and lower edges of the bandage folded under, should be applied 
firmly and should present a neat cufflike appearance at the upper end of the 
completed bandage (fig. 67). 
During the application of this bandage there is always considerable slack 
in one edge of the bandage where it is carried around the arm. As the 
bandaging proceeds, however, these loose edges are covered by the ascending 
turns of the bandage. Uses: Retention of dressings and covering of splints. 
Figure 67.—Figure-of-eight 
bandage. (Wharton, modified.) BANDAGES AND BANDAGING 
135 
Spiral reverse bandage of the arm.—This bandage is in reality a modification 
of the figure-of-eight, in that only the lower loop or one-half of the figure-of- 
eight is completed. After anchoring the primary turns, the bandage is carried 
obliquely upward on the back of the arm. When this turn reaches the center 
line of the arm, the thumb of the disen- 
gaged (usually the left) hand is placed 
upon the body of the bandage to hold it 
securely in place upon the arm. The 
operator then unrolls about 5 or 6 inches 
of bandage which is held slack and is 
folded upon itself by changing the posi- 
tion of the hand holding the roller 
from supination to pronation. The band- 
age then is carried obliquely downward 
across the arm to a point opposite that 
from which the ascending turn started. 
It then is tightened slightly to conform 
to the part accurately, then is carried 
around the limb and the procedure is 
repeated. It is necessary to retain the 
thumb upon the point of reverse until 
the succeeding turn reaches that point. As in the figure-of-eight, each turn 
should overlie at least one-third of the preceding turn, and the reverses should 
be in a straight line (fig. 68). 
Complete bandage of the hand.—After securing the initial turns around the 
wrist, a recurrent bandage of the hand is applied. The bandage then is carried 
obliquely across the back of the hand to the tip of the index finger. A circular 
turn is made around the ends of the fingers. The fingers and hand then are 
covered by a figure-of-eight or spiral reverse bandage, which finally is com- 
pleted by two or more circular turns around the wrist. This bandage may 
or may not be applied to 
include the thumb. Uses: 
Retention of dressings of 
the hand (fig. 69). 
Demigauntlet bandage.— 
Using a 1-inch bandage, 
secure the initial turns at 
the wrist and carry the 
bandage across the back 
of the hand to the base of 
the thumb, around the 
thumb, across the back of 
the hand to the wrist, 
where a circular turn is 
made. The same proce- 
dure is repeated succes- 
sively for each finger and the bandage finally terminated with a circular turn 
around the wrist. Uses: Retention of dressings on back of hand (fig. 70). 
Gauntlet bandage.—The demigauntlet bandage may be extended to include 
the entire thumb and fingers with either simple spiral turns or spiral reverse 
turns of each digit (fig. 71). 
Figure-of-eight bandage of the elbow.—With the elbow in the desired posi- 
tion, the initial end is secured by circular turns around the forearm just below 
the elbow. The bandage then is carried upward over the flexure of the elbow 
Figure 68.—Spiral reverse. (Eliason.) 
Figure 69.— 
Complete 
bandage of 
hand. 
(Wharton.) 
igure 71.— 
Gauntlet 
bandage of 
hand. (Whar- 
ton.) 
Figure 7 0.—Demi- 
gaunlet of hand. 
(Wharton.) 136 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
in an oblique direction and passed around the arm just above the elbow, where 
a circular turn is made, and then is carried obliquely downward across the 
flexure and passed around the forearm. This procedure is repeated, with each 
turn overlying the preceding turn, the turns on the forearm ascending and those 
on the arm descending until the entire joint is covered. The final turn is a 
circular one around the elbow joint itself. This bandage may be started with a 
circular turn around the joint followed by figure-of-eight turns covering the 
upper part of the forearm and the lower part of the arm. Uses; Retention of 
dressings around the elbow joint. 
Spica bandage of right shoulder (ascending).—After securing the initial end 
by two circular turns around the arm opposite the axillary fold, the bandage 
is carried diagonally across the arm and front of the chest to the axilla of the 
opposite side, then around the back of the chest, across the arm, and across the 
upward turn to the point of origin. After- 
carrying the bandage around the arm, 
this procedure is repeated, each turn over- 
lying about two-thirds of the preceding 
turn until the entire shoulder is covered. 
The turn should cross in a straight line 
extending up the center line of the arm 
over the point of the shoulder. Likewise 
the turns across the chest and back 
should overlap each other uniformly, and 
the turns in the opposite axilla should 
overlap each other exactly. The bandage 
may be secured by either a pin or adhesive tape. Uses: Retention of dressings 
of shoulder and axilla and of shoulder cap (fig. 72). 
Bandages of the lower extremity.—The bandages described in the preceding 
paragraphs may be applied to the corresponding parts of the lower extremity. 
However, a description of a few of the special bandages of the lower extremity 
is considered advisable. 
Spica bandage of the groin (ascending).—After securing the initial turns 
around the upper part of the thigh just below the groin, the bandage is 
carried obliquely upward across the lower 
abdomen to the iliac crest of the opposite 
side, transversely across the back and then 
downward obliquely across the front of 
the thigh, across the upward turn of the 
bandage and around the thigh to the point 
of origin, thus completing a figure-of-eight. 
This is repeated several times until the 
entire groin is covered, each turn overlying 
about two-thirds of the preceding turn. 
The same care in regard to the line of 
crossings of the turns and to the uniform 
overlapping of the bandage on the abdomen should be observed, as is noted in 
the description of the spica bandage of the shoulder. Uses: Retention of dress- 
ings in region of the groin (fig. 73). 
Spica bandage of the foot.—The initial end is secured by two circular turns 
around the leg just above the ankle. The bandage then is carried across the 
dorsum of the foot to the base of the toes where a circular turn is made 
around the foot. After two or three spiral reverse turns are made the 
bandage is carried across the dorsum of the foot, backward alongside of the 
Figure 72.—Spica of the shoulder. Spica 
loops of the shoulder. (Eliason.) 
Figcse 73.-—Ascending spica ; descend- 
ing spica. (Bliason.) BANDAGES AND BANDAGING 
137 
heel, around the heel, forward along the other side of the heel across the pre- 
ceding upward turn on the dorsum of the foot, and around the foot to the 
starting point of the turn. This process is repeated, the turns gradually 
ascending on both the foot and the heel, the crossings of bandage being in the 
midline of the dorsum of the foot. The bandage finally is carried upward 
around the ankle and secured by two or more circular turns at its original 
starting point. It is possible to apply this bandage without the use of the 
spiral reverse turns by employing the figure-of-eight throughout. Uses: Re- 
tention of dressings on the foot and support for sprained ankle (fig. 74). 
Bandage of foot, not covering the heel 
(French).—After securing the initial 
end by two circular turns around the 
leg just above the ankle the bandage 
is carried obliquely across the dorsum 
of the foot to the base of the toes, where 
a circular turn is made around the foot. 
The bandage is carried up the foot by 
a few spiral reverse turns crossings in 
the center line, and then applied as a 
figure-of-eight around the ankle and 
instep. The bandage may be terminated 
just above the ankle or be extended up 
the leg as far as may be necessary. It 
is frequently practicable to apply this 
bandage without employing the spiral reverse turns, the figures-of-eight being 
applied following the circular turns at the base of the toes. Uses: Retention 
of dressings of foot. This bandage usually is employed in application of bandages 
covering the entire leg. 
Figure 74.—Spica of the foot (first step) ; 
spica of the foot (completed). (Eliason.) 
Special bandages. 
Velpeau bandage.—The fingers of the affected side are placed upon the 
opposite shoulder, a pad placed in the axilla, and the skin surfaces separated 
by sheet wadding. Place the initial end of the bandage on the shoidder 
blade of the sound side, carry the bandage across the outer portion of the 
affected shoulder, downward over the 
outer and posterior surface of the 
flexed arm, behind the point of the el- 
bow, obliquely across the back of the 
forearm and chest to the opposite 
axilla, and around to the point of 
origin. After repeating this turn once 
the bandage is carried from the point 
of origin across the back and side of 
chest, in front of the flexed elbow and 
transversely across the front of the 
chest. Then it is carried around the 
other side of the chest, diagonally 
across the back to the affected shoul- 
der. The first turn then is repeated, followed by a second circular turn around 
the chest and flexed arm. Each vertical turn over the shoulder overlaps two- 
thirds of the preceding turn, ascending from the outer part of the shoulder to the 
neck and from the upper posterior surface of the arm inward toward the point of 
the elbow. Each transverse turn also overlies one-third of the preceding turn. 
These transverse turns are continued until the last turn covers the wrist. 
Figure 75.—Vel- 
peau (start). 
(Eliason.) 
Figure 76.—Velpeau 
(posterior view). 
(Eliason.) 138 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The bandage is finally secured with pins, both where it ends and at various 
points where the turns of the bandage cross each other. (The initial turns 
of this bandage may be secured by circular turns around the chest under the 
arm of the affected side.) Uses: Fixation of arm 
in treatment of fractured clavicle and fixation of 
humerus after reduction of dislocated shoulder 
joint (figs. 75, 76, 77). 
Barton bandage.—With the initial end of the 
bandage applied to the head just behind the right 
mastoid process the bandage is carried under the 
bony prominence at the back of the head, upward 
and forward back of the left ear, obliquely across 
the top of the head, downward in front of the 
right ear, under the chin, upward in front of left 
ear, obliquely across the top of the head, crossing 
the first turn in the midline of the head, thence 
backward and downward to the point of origin 
behind the right mastoid. Then it is carried 
around the back of the head under the left ear, 
around the front of the chin, under the right 
ear to the point of origin. This procedure is 
repeated several times, each turn exactly overlying the preceding turn. The 
bandage is secured with a pin or strip of adhesive tape, and either a pin 
or adhesive may be applied at the crossing on 
top of the head. Uses: Fracture of lower jaw; 
retention of dressings of chin (fig. 78). 
Recurrent bandage of head.—The initial turns 
are applied around the head, passing around the 
nape of the neck, above each ear and around the 
forehead. When the bandage has reached the 
center of the forehead on the third turn, its free 
margin is held by a finger of the left hand and 
the bandage is reversed and carried over the top 
of the head in the center line to the nape of the 
neck. With an assistant holding the bandage at 
the latter point, it is re- 
flected forward over the 
top of the head covering 
i he right half of i he pre- 
ceding turn. When it reaches the forehead in the midline 
it again is reflected over the top of the head, overlying 
the left half of the first turn. At the nape of the neck 
in the center line it is again reflected and carried forward 
overlying the outer half of the second turn. This process 
is repeated until the entire head is covered, the turns 
alternating to the right and left of the center line. The 
bandage finally is completed by several circular turns 
overlying the original turns and fixing the ends of antero- 
posterior turns at the nape of the neck and on the fore- 
head, where pins should be applied to provide additional security. Uses: Reten- 
tion of dressings of wounds of the scalp, of fractures and operative wounds of 
the skull (fig. 79). (This bandage may be applied with the turns over the head 
in a transverse direction extending from ear to ear. 
Figure 77.—Velpeau bandage. 
(Wharton.) 
Figure 78.—Barton bandage. 
(Wharton.) 
Figure 79.—Recurrent 
turns. (Eliason.) BANDAGES AND BANDAGING 
139 
Crossed bandage of one eye.—The initial extremity is secured by a circular 
turn around the head below the bony prominence at the back, above both ears 
and across the forehead. The bandage then is carried from the back of the 
head, below the ear, obliquely across the outer part of the cheek to the base 
of the nose at its junction with the forehead, over the opposite side of the 
head and downward behind the mastoid 
process. A circular turn then is carried 
around the head, overlying exactly the 
original turns. A second turn under the 
ear and across the face and head then is 
applied, overlapping the upper two-thirds 
of the preceding turn. These alternating 
turns are repeated until the eye (and if 
more comfortable, the ear on the same 
side) is completely covered. The bandage 
is completed with a final circular turn 
around the head. Uses: Retention of 
dressings of the eye (fig. 80). 
Crossed bandage of both eyes.—The initial turns are applied as for one eye, 
and the bandage carried forward below the right ear, diagonally upward across 
the cheek to the base of the nose and over the opposite side of the head 
above the left ear, and downward behind the left mastoid process. Then 
a circular turn is applied. When the roller reaches the back of the head 
below the bony prominence it is carried obliquely forward and slightly upward 
over the right ear across the forehead and downward over the left eye, the 
lower margin of the bandage crossing the previous turn at the junction of 
the nose with the forehead. The bandage then is carried across the left 
cheek below the left ear and backward to the nape of the neck. Then a 
circular turn is made, followed by a repetition of the previous turns across 
the eyes, each circular turn accurately covering its predecessor and each 
oblique turn overlying the upper one-half of the preceding turn, until both 
eyes are completely covered. The ears may or may not be included in the 
bandage, which is completed by two circular turns around the head. Pins 
are placed at the intersections of the bandage (fig. 80). 
Sayre’s dressing.—This consists of two 
strips of adhesive plaster 3 inches wide and 
2 yards long. Two circular turns of a 
flannel bandage 4 inches wide are applied to 
the arm of the affected side just below the 
axillary fold. The end of one adhesive strip 
is looped around the arm (overlying the 
flannel bandage) and pinned, with the loop 
sufficiently large not to constrict the arm. 
With the arm drawn upward and backward, 
the strip of plaster is carried across the 
back and around the opposite side of the 
chest. It may end here or be carried com- 
pletely around the chest. The hand of the 
injured side now is placed as near as pos- 
sible to the shoulder of the sound side, the 
skin surfaces being separated by sheet wadding. The end of the second 
strip is applied over the scapula of the affected side (some surgeons start 
this strip at the top of the posterior surface of the arm of the affected side; 
Figure 80.—Crossed bandage (figure-of- 
eight) of the eye; crossed bandage of 
both eyes. (Eliason.) 
Figure 81.—Sayre’s dressing for 
fracture of the clavicle, showing 
application of first and second 
strips. (Wharton.) 
154294°—39 10 140 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
others apply the initial end of this strip on the shoulder of the sound side) 
and is carried downward on the posterior surface of the arm of the affected 
side, under the point of the elbow, diagonally across the chest on the posterior 
surface of the forearm and hand over the sound shoulder down the back 
where it joins the first strip of plaster. A small hole is cut in this strip to 
receive the point of the elbow, which must be protected by a layer of cotton 
or sheet wadding. Then the entire dressing is covered with a Velpeau ban- 
dage. Uses; Treatment of fractures of the clavicle (fig. 81). 
“T” bandage.—This bandage consists of a horizontal bandage to which is 
attached, about its middle, a vertical bandage of approximately one-half the 
length of the horizontal bandage. The horizontal portion is employed to secure 
the bandage to the body, the vertical portion being used to retain dressings. 
This bandage is very useful in retaining dressings about the perineum and 
anal region. When used for this purpose, the horizontal band is applied around 
the abdomen above the iliac crests, in such a manner that the vertical portion 
is placed exactly in the midline of the back directly over the spine. The vertical 
portion then is brought forward between the thighs and secured to the hori- 
zontal portion in front of the abdomen. The vertical portion may be split 
longitudinally to form two strips of equal width. 
Double “T” bandage.-—This differs from the foregoing in having two vertical 
strips instead of only one. The horizontal portion may be of any desired width. 
It frequently is used for the retention of dressings of the chest, breast, and 
abdomen. When so employed the two vertical strips are carried over the 
shoulders from the back to the front and secured by pins to the horizontal 
portion. 
Many-tailed bandage.—The four-tailed bandage readily is made by splitting 
a strip of muslin or other material of the desired width, lengthwise, within a 
few inches of the center of the strip. This provides a bandage with a body 
and four tails. 
The many-tailed bandage is prepared in a similar manner, by splitting the 
muslin or other material into several strips, having a sufficiently large area 
in the center for the retention of dressings, etc. The number of tails on each 
side should be the same. 
Plaster of Paris bandage.—These bandages are prepared by impregnating the 
meshes of crinoline with plaster of Paris of the extra calcined, dental variety, 
A strip of crinoline about 3 or 4 inches wide, and usually 4 or 5 yards long, 
is placed on a table. Plaster of Paris then is dusted upon the strip, and evenly 
rubbed into the meshes of the fabric. A very satisfactory method of preparing 
this bandage is by constructing a wooden box, 12 inches long, 6 inches wide, 
and 3 inches deep, and at each end, just above the bottom of the box, cutting 
a slit 5 inches long and one-eighth to one-fourth inch wide. The end of the 
bandage is drawn into the box through one slit, across the bottom of the box, 
and out of the box through the other slit. A sufficient quantity of the plaster 
of Paris to cover the bandage with a layer of powder 1 inch deep is placed in 
the box. As the bandage is drawn through plaster of Paris is rubbed into the 
meshes with the hand or preferably with a smooth piece of wood approximately 
4 inches in length. The bandage may be loosely rolled into a cylinder as it 
emerges from the box. If the bandages are not to be used within a few 
hours they should be wrapped in paper to prevent absorption of moisture. 
Application of the plaster of Paris bandage.—The part to be encased in plaster 
of Paris should be covered with a suitable bandage of soft material, preferably 
flannel. The bony prominences should be well protected with cotton. Care 
should be taken to remove all creases in the dressing and bandage. BANDAGES AND BANDAGING 
141 
Two rolls of the plaster of Paris bandage are placed in warm water. When 
bubbles cease to arise from the bandage one roll is removed from the water, 
the excess water being expressed by grasping the roll at its two ends and 
exerting pressure with the hands. This method prevents the loss of a consid- 
erable amount of plaster through the ends of the roll. {Note.—As soon as a 
bandage is removed from the water replace it with another bandage.) 
The bandage should be applied rapidly and evenly to the limb. No special 
form of bandage is necessary as it is sufficient that the part be properly cov- 
ered. The second bandage is applied as soon as the first has been completed. 
During the application of the bandage it should be rubbed with the hands in 
order to provide a smooth even surface. It also is desirable to rub some loose 
plaster into the dressing. When the final roller has been applied the surface 
of the completed dressing should be rubbed evenly with liquid plaster prepared 
by addition of water to dry plaster until it has the consistency of thick cream. 
In many cases, such as compound fractures, it is frequently necessary to 
provide access to certain areas of the encased limb. After the bandage has 
partially set a “window” or trap may be cut in the bandage over the desired 
area. 
Removal of a plaster of Paris bandage may be accomplished with the aid of 
a plaster saw. If none is available the plaster may be softened with a small 
amount of peroxide of hydrogen, hydrochloric acid, or vinegar, and then may 
be cut with a knife. 
Uses: Fixation of fractures; ambulant treatment of fractures; fixation and 
treatment of injuries and diseases of joints. 
Starched bandage.—This bandage may be obtained already prepared or it 
may be prepared in the following manner: Starch is mixed with cold water 
until a thin, creamy mixture results. This is heated to form a clear muci- 
laginous liquid. The part should be covered with a flannel bandage over which 
a gauze bandage is applied. The starch then is rubbed evenly into the meshes 
of the material. A second gauze bandage is applied and again treated with 
the starch mixture. This may be repeated until the desired thickness of the 
bandage is obtained. 
Bandages impregnated with starch may be moistened and applied wet to a 
part. This type of bandage is occasionally useful in the treatment of sprains 
of the thumb or fingers. 
Triangular bandage.—This bandage, also known as the handkerchief bandage, 
is used for the temporary or permanent dressing of wounds, fractures, disloca- 
tions, etc., and for slings. It is very valuable in first-aid work as it is quickly 
and easily applied, stays on well, and can be improvised from any kind of 
cloth, as a piece of a shirt, an old sheet, a large handkerchief such as the 
Navy-uniform neckerchief, etc. Unbleached muslin is generally used in making 
triangular bandages although linen, woolen, silk, etc,, will answer the purpose. 
In making them a square of material about 3 by 3 feet or slightly more is 
folded diagonally to make one bandage or may be cut along the fold to make 
two bandages. The long side of the triangle is called the t>ase, the point 
opposite the base is called the apex, and the points at each end of the base are 
called the ends or extremities. These bandages may be used either as a triangle 
or as a cravat, the latter being made from the triangle by bringing the apex to 
the base and folding it upon itself a sufficient number of times to obtain the 
width desired (fig. 82). The names of these bandages indicate the part of the 
body to which the base is applied, the location'of the apex, and the shape. For 
example, in the fronto-occipital triangle the base of a triangular bandage is 142 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
applied to the forehead and the apex is carried to the occiput, and in the 
mento-vertico-occipital cravat the middle of the base is placed under the chin 
and the ends carried over the vertex of the skull to the occiput. A few of the 
more commonly used triangular bandages will now be described. 
Figure 82.—Folding cravat from triangle. 
Fronto-occipital triangle.—Place the middle of the base of the triangle on the 
forehead so that the edge is just above the eyebrows and bring the apex back- 
ward over the head, allowing it to drop over the occiput. Bring the ends of 
the triangle around to the back of the head, above the ears, cross them over 
the apex at the occiput, and carry them around to the forehead and there tie 
them in a square knot. Finally, turn up the apex toward the top of the head 
and pin with a safety pin, or turn up the apex and tuck it in behind the crossed 
part of the bandage. Uses: To retain dressings on the forehead or scalp 
(fig. 83). 
Triangle of chest or hack.—Drop the apex of the triangle over the shoulder on 
the injured side and bring the bandage down over the chest (or back) to the level 
desired and so that the middle of the base is directly below the shoulder. Carry 
the ends around the body and tie in a square knot on the back. Finally, bring 
the apex down on the back (or chest) and tie it in a square knot to one of 
the ends. Uses: To retain dressings on burns or wounds of the chest or back 
(fig. 84). BANDAGES AND BANDAGING 
143 
Brachio-cervical triangle, or arm sling.—The arm to be put in the sling should 
first be bent at the elbow so that the little finger is about a hand’s breadth above 
the level of the elbow. Drop one end of the triangle over the shoulder on the 
uninjured side and let the bandage hang down over the chest with the base 
Figure 83.—Fronto-occipital triangle. (First-aid Textbook, A. E. C., modified.) 
toward the hand and the apex toward the elbow. Slip the bandage between 
the body and the arm, carry the lower end up over the shoulder on the injured 
side and tie the two ends together at either side of the neck, using a square 
knot. Draw the apex of the bandage toward the elbow until it is snug, bring 
it around the elbow to the front, and after folding back a little fasten it to the 
front of the bandage with a safety pin. The lower end of the bandage may be 
passed between the arm and the body and under instead of over the injured 144 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
shoulder before tying to the other end. The ends of the fingers should extend 
slightly beyond the base of the triangle (fig. 85). 
Triangle of hand.—Place the middle of the base of the triangle well up on 
the palmar surface of the wrist, carry the apex around the ends of the fingers 
Figure 84.—Triangle of chest or back. (First-aid Textbook, A. R. C., modified.) 
and over the dorsum of the hand to the wrist or forearm, fold each half of the 
part at the sides of the hand back toward the opposite side of the wrist, cross 
the ends around the wrist and tie in a square knot. Uses: To retain dressings 
of considerable size on the hand (fig. 86). 
Triangle of foot.—Place the middle of the base of the triangle on the ankle 
well above the heel, carry the apex around the ends of the toes and over the BANDAGES AND BANDAGING 
145 
dorsum of the foot to the ankle, fold each half of the part at the sides of the 
foot back toward the opposite side of the ankle, cross the ends around the 
ankle and tie in a square knot. Uses: To retain dressings of considerable size 
on the foot (fig. 87). 
Gluteo-femoral triangle.—To apply this bandage requires two bandages, one 
a triangle, the other a cravat. First fasten the cravat around the waist. Place 
Figure 85.—Brachio-cervieal triangle or arm sling and showing lower end passing between 
arm and body. (First-aid Textbook, A. R. C., modified.) 
the base of the triangle in the gluteo-femoral fold, and carry the ends around 
the thigh to the front where they are tied with a square knot. The apex is 
then carried upward and passed under the cravat around the waist, turned HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Figure 86.—Triangle of hand. (First-aid Textbook, A. R. C., modified.) BANDAGES AND BANDAGING 
147 
down and fastened to the triangle with a safety pin. Uses: To retain dressings 
on the buttock or hip (fig. 88). 
Mento-vertico-occipital cravat.—After making a triangle into a cravat of the 
proper width, place the middle of the cravat under the chin, carry the ends 
Figure 87.—Triangle of foot. (First-aid Textbook, A. K. C., modified.) 
upward in front of each ear to the vertex of the skull crossing them there and 
continuing downward to the occiput where they are tied in a square knot. Uses; 
To retain dressings on the chin, cheeks, and scalp, and as a temporary dressing 
to secure fixation of the parts in fracture or dislocation of the jaw (fig. 89). 
Figure 88.—Gluteo-femoral triangle. 
(U. S. Naval Medical School.) 
Figure 89.—Mento-vertico-occiptal cra- 
vat. (U. S. Naval Medical School.) 
Bis-axillary cravat.:—After making a triangle into a cravat of the proper 
width, place the middle of the cravat in the axilla, carry the ends upward to 
the top of the shoulder crossing them there and continuing across the back and 
chest respectively to the opposite axilla where they are tied in a square knot. 
Uses: To retain dressings in the axilla or on the shoulder (fig. 90). 148 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Cravat of head or ear.—After making a triangle into a cravat of the proper 
width, place the middle of the cravat over the point desired, carry the ends to 
the opposite side of the head, cross them, and bring them back to the starting 
point and tie with a square knot. Use: To apply pressure to control serious 
haemorrhage from wounds (fig. 91). 
Figure 90.-—Bis-axillary cravat. (U. S. 
Naval Medical School.) 
Figure 91.—Cravat of head or ear. (U. S. 
Naval Medical School.) 
References 
Minor and Operative Surgery, Including Bandaging.—Wharton. 
Bandages and Bandaging for Nurses.—Cowan. 
American Red Cross First Aid Textbook. 
Section 3.—SPLINTS 
AND APPLIANCES 
The illustrations and most of the text in this section are taken from the Man- 
ual of Splints and Appliances of the U. S. Army, and the courtesy of the War 
Department, Office of the Surgeon General, in permitting the use of that manual 
is herewith acknowledged. 
In the foreword to the third edition of the Manual of Splints and Appliances 
of the U. S. Army it is stated that the number of splints and appliances is 
confined to as few as possible for adequate treatment and the designs meet the 
qualifications of efficiency and correct mechanical principles; simplicity of 
design and low cost of construction; and transportability, so that an efficient 
splint may be applied and remain in place until the patient reaches the hos- 
pital for definitive care. Many of the splints and appliances in the Manual 
have the outstanding advantages of quick manufacture and ease of distribution, 
the combination of traction and fixation in the same apparatus, and constancy 
of type and simplicity of mechanical principle, making it readily understood 
and easily applied. 
Splints should be applied so as to assure fixation and traction, thereby re- 
ducing the chances of infection and minimizing the pain and shock during 
transportation. SPLINTS AND APPLIANCES 
149 
THE SPLINTING OF FRACTURES FOR TRANSPORTATION 
The necessity of splinting of fractures before’ transportation is attempted 
cannot be over-estimated. It lessens pain, shock, and additional damage to 
bone and soft parts. 
Compound fractures are not further contaminated, shortening is prevented, 
and reduction is made less difficult. 
The primary mortality fate of 50 per cent in compound fractures of the femur 
in the British Army during the World War was reduced to 15 per cent by 
proper splinting alone. 
Every major fracture in the long bones should be splinted “where they lie” 
before transportation is attempted. 
The proper splinting of peace-time fractures is equally as essential as the care 
of war-time injuries. 
Army hinged half-ring thigh and leg splint.— (Keller leg splint). 
The side arms of the splint are made of %-inch cold rolled steel or Bessemer 
steel rod. The half-ring of same material % inch in diameter. 
Figure 92.—Army hinged half-ring thigh and leg splint (Keller). (U. S. Army.) 
The half-ring is covered with an inner layer of %-inch felt and an outer 
layer of %-inch felt. The felt is covered with first-cut horse hide, cream color, 
not oiled or dressed, and free from material that might irritate the skin. The 
leather is neatly and securely sewed with waxed linen thread, using a baseball 
stitch (about four to the inch). The covering is so stitched that the surface 
coming into contact with the patient is smooth. The finished padded portion 
is about 1% inches in diameter. The inner layer of felt stops at the joint, 
being tapered for a distance of about 1% inches just above the joint to allow 
for the thickness of the webbing strap over which it is sewed. The outer layer 
of felt stops 1% inches below the joint, the ends being tapered for a distance 
of approximately 2 inches and cut transversely to permit passage of the webbing 
strap. The stitching is continuous and is carried through the webbing (fig. 92). 150 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Uses.— 
Transportation and fixed traction of— 
1. Fractures of the femur. 
2. Fractures and injuries of the knee. 
3. Fractures of the tibia above the ankle 
Definitive care.—Suspension traction treatment of fractures of— 
1. The femur. 
2. The tibia and fibula. 
3. Other injuries and orthopedic conditions of the lower extremity. 
Splint strap, adjustable traction. 
This is accessory to the Army hinged half-ring splint for transportation. 
The adjustable traction splint strap is made of 1-inch nonelastic webbing. 
It consists of a main loop, a retention strap with buckle, and an extension 
strap with swivel. The loop is 14 inches in circumference and is designed 
to fit over the instep. A 12-inch strap without buckle and a 2%-inch strap 
Figure 93.—Splint strap, adjustable traction. (U. S. Army.) 
with a 1-inch chrome-plated nickel-steel release buckle are sewred to the loop 
in a manner which will retain the loop in proper position across the instep 
when the 12-inch strap is passed back of the ankle and buckled just posterior to 
the external malleolus. A 40-inch strap attached to the loop by means of a 
swivel is provided for the purpose of applying extension (fig. 93). 
The adjustable traction strap is applied over the shoe of the patient and 
attached to the lower end of the Army hinged half-ring splint to secure fixed 
traction. 
Traction is increased by the Spanish windlass principle. 
The illustrated ankle hitch or the Collins’ hitch, using a muslin bandage 
may be used as a substitute (fig. 94). 
The shoe should never be removed in the field. 
When clothing has been removed the extremity should be shaved and skin 
traction applied as shown in figure 108, the rope from the spreader being 
fixed to the end of the splint to obtain traction. 
Splint support and foot rest. 
This appliance (fig. 95) is made of cold rolled steel or Bessemer 
steel rod and its efficiency depends upon its spring—therefore the rod should 
be worked cold, as heat will remove the temper. 
For use two are required. One is attached to the lateral bars of the Army 
hinged half-ring splint, with the arms of the appliance toward the distal end SPLINTS AND APPLIANCES 
151 
of the splint after the leg has been fixed in the splint. It supports the distal 
end of the splint, allowing the leg to be suspended in the splint and not 
resting oh the ground, litter, or table. 
A second one is secured in a similar manner with the arms extending 
upward and to it the foot is secured by a triangular bandage. 
Figure 95.—Splint support and foot rest. (U. S. Army.) 
Allow the splint support to rest on the canvas of the litter and secure it 
to the stirrups of the litter by means of straps or bandages. 
See figures 96 and 97 for use of this appliance, supported by old-type 
stretcher bar. 
Application of immobilization by traction-fixation of major fractures of the 
lower extremity for transportation. 
For this purpose the following equipment is required: Army hinged half- 
ring splint; adjustable traction splint strap; two splint support and foot rests; 
and five triangular bandages. In the application of the traction-fixation splints 
for transportation, two men “A” and “B”, work together and carry out the 
following procedures: 
1. “A” grasps and makes traction on the foot of the patient while “B” 
applies the traction strap or ankle hitch over the shoe. 152 
HANDBOOK OF THE HOSPITAL CORPS, U. S. N’AYY 
2. While traction is continued by “A”, if the fracture be compound, 
“B” cuts away clothing about the wound, applies tincture of iodine and then 
an occlusive dressing (first-aid packet). 
Figure 96.—Immobilization of fractured femur for transportation. (U. S. Army.) 
Figure 97.—Immobilization of fractured femur for transportation. (U. S. Army.) SPLINTS AND APPLIANCES 
153 
3, While traction is continued by “A”, “B” adjusts the Army hinged half- 
ring splint (right or left), locking the half-ring at a right angle to the bars 
of the splint, slides the splint in under the leg and secures the ring against 
the tuberosity of the ischium, tightening the anterior strap to hold it there. 
4. “B” secures the traction strap to the end of the splint and increases trac- 
tion by the Spanish windlass method. “A” lets go his traction on the foot. 
5. “A” attaches the splint support to the splint which elevates splint from 
the ground and assists “B” in securing the extremity to the side bars of the 
splint, using four or more triangular muslin bandages. 
6, “A” attaches the foot support to the splint and ties the foot in position 
against it, using a triangular bandage. 
7. “A” and “B” place the patient on the litter and rest the splint support 
on the canvas of the litter, securing it to the stirrups of the litter by means 
of straps or bandages. (If a litter bar is attached to the litter the splint 
support is locked in the groove on the bar.) 
Pierson attachment for Army hinged half-ring leg splint. 
This attachment (fig. 98) is constructed of cold rolled steel or Bessemer 
steel rod and is U-shaped, 24 to 25 inches long, 6% inches wide at the open 
end and 4% inches at the other. To each open end is attached a metal hinge, 
Figure 98.—Pierson attachment for Army hinged half-ring leg splint. (U. S. Army.) 
freely moveable on the Pierson attachment and which will lock the attach- 
ment to a fixed place on the Army hinged half-ring splint. Its uses are in 
supracondylar fractures wThere knee flexion is necessary for the reduction 
of the fracture in conjunction with skeletal traction, and in suspension-traction 
treatment of all thigh and leg fractures to allow early knee motion, and in 
other conditions when traction and knee motion are desired. 
Splint, Liston long interrupted. 
This splint (fig. 99) is interchangeable, right and left, and consists essentially 
of a long member, a short member, a vertical foot piece, and a T-shaped cross 
member, constructed of ash or other suitable wood, and an offset metal U-shaped 
member. Dimensions and other details are illustrated in figure 100. 154 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Construction.—The long and short members are jointed together by the 
offset metal U-shaped member which is fastened thereto by a T-shaped attach- 
ment upon each side arm. The attachment of this metal member is effected 
by means of four %-inch head bolts with square nuts. On the inner side of 
Figure 99.—Liston long, interrupted splint. (U. S. Army.) 
the splint g’s-inch rectangular reinforcement plates, or suitable washers, are 
interposed between the wood and the bolt heads. It is important that the 
cross arm at the top of the splint be secured with four screws as well as 
glued. 
Figure 100.—Detailed drawing of Liston long, interrupted splint. (U. S. Army.) 
Uses.- 
1. Fractures of the femur, knee or tibia with injury about the ischial 
tuberosity so that the half-ring splint cannot be applied. 
2. Injury to the pelvis and hip where fixation is required. 
This splint is reinforced by additional bandages or slings for the support of 
the leg or thigh when indicated. Additional splinting, using the wire ladder 
splint or pieces of the basswood splint board, is added as indicated. 
Splint, wire ladder (fig. 101). 
Construction.—The frame is made in the form of three sides of a rectangle, 
3% by 31 inches, one short side missing, made of No. 9 B&S gauge malleable 
iron wire. 
2. The cross pieces are made of one continuous piece of No. 15 B&S gauge 
malleable iron wire shaped in the form of a gridiron with parallel bars about 
% inch apart. SPLINTS AND APPLIANCES 
155 
3. The gridiron section of wire is attached to the frame by tightly wrapping 
with a malleable iron wire of about 22 B&S gauge. Three turns to each lateral 
section and two in between. Ends are well wrapped and secured. 
4. Following assembly the splint is heavily galvanized. 
Figure 101.—Wire ladder splint. (U. S. Army.) 
Uses.— 
1. Splinting for transportation of Pott’s fractures, injuries and frac- 
tures about the ankle and foot. (Gauze-cotton pads in peace time 
and first-aid packet, large, in war are used as padding. The splints, 
when padded and applied, are held in position by a bias muslin 
bandage.) 
2. As coaptation splints in the field or in hospital. 
3. Where a malleable light splint is required for a temporary period, 
as for the shoulder, elbow, or wrist, to maintain a fixed position other 
than that of extension. 
Splint, Thomas, arm, hinged, traction. 
This splint (fig. 102) is made of ti-inch cold rolled or Bessemer steel rod, 
gray saddle felt, and NS—3 horse hide. 
The ring is protected with gray saddle felt covered with first-cut horse hide, 
cream color, not oiled or dressed and free from material that might irritate 
the skin. The leather is neatly and securely sewed with waxed linen thread, 
using a baseball stitch (about four to the inch). The covering is so stitched 
that the surface coming into contact with the patient shall be smooth. The 
finished padded portion is about 1% inches in diameter. 
Uses.— 
1. Injuries to the shoulder joint. 
2. Injuries to the shaft of the humerus. 
3. Injuries to the elbow joint. 
4. Injuries to the upper one-third of the forearm. 
154294°—39 11 156 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
A hitch about the wrist to obtain traction is forbidden. 
A method of application to the upper extremity, using two persons, “A” and 
“B” follows: 
1. “A” grasps the hand and makes traction. “B” determines site of fracture, 
removes all clothing to shoulder and if the fracture is compound, iodizes the 
wound and applies an occlusive dressing. 
2. “B” applies adhesive traction to the dorsal and volar surfaces of the 
arm from the fracture point or above down to the wrist. The adhesive is 
doubled back on itself over the hand, so that it will not- adhere—2or 3-inch 
Figure 102.—Thomas hinged, traction arm Splint for right or left arm. (U. S. Army.) 
adhesive is used and is covered with a gauze bandage to promote adherence. 
A short piece of light or %-inch braided cotton rope is tied to the end 
of each of the two adhesive straps. 
3. While “A” still makes traction, “B” threads the arm through the ring 
of the hinged ring traction splint until it rests against the chest wall and 
shoulder girdle. He then ties the ropes from the adhesive traction straps 
to the end of the splint. A small sliver of wood is passed between the 
adhesive straps at the finger tips to prevent tortion of the adhesive on the 
hand, while “B” increases traction with a second wooden sliver between the 
ropes by the Spanish windlass method. 
4. “A” and “B”’ secure the arm and forearm to the side bars of the splint, 
using three or more triangular bandages. SPLINTS AND APPLIANCES 
157 
Figure 103.—Thomas hinged, traction arm splint applied. (U. S. Army.) 
SPLINTS AND APPLIANCES FOR DEFINITIVE CARE OF BONE AND JOINT 
INJURIES 
Balkan Frame 
Bag, buckshot, 3-inch, holds 1 pound 10 
Bag, buckshot, 5-inch, holds 5 pounds 10 
Bag, buckshot, 8-inch, holds necessary number of 1- and 5-pound shot bags 5 
Buckshot, coarse pounds 50 
Clamp, large (Detail C) 10 
Clamp, small (Detail D) 10 
Hammock for suspension of pelvis, large 1 
Hammock, small 1 
Poles (Detail A) set— 1 
4 feet by 1% by 1 inch 3 
6 feet by 1% by 1 inch 5 
8 feet by 1% by 1 inch 4 
Pulley assemblage (Detail B) 8 
Rope, %6-inch, braided cotton, unglazed yards— 30 
Details of metal parts and timber are shown in figure 104. 
Uses.—The Balkan Frame is used for suspension of; Upper extremity; lower 
extremity; fractures of the pelvis; and the whole body when in plaster, 
The following material is required for erection and use of a Balkan Frame; 158 
HANDBOOK OF THE HOSPITAL, CORPS, U. S. NAVY 
Figure 104.—Balkan Frame ; details of metal parts and timber. (U. S. Army.) 
Figure 105.—Balkan Frame; side view. (U. S. Army.) 
When assembled (fig. 105), the middle over-head pole of the frame from 
which the leg is suspended is placed parallel with the long axis of the leg. 
Sufficient weight (1- and 5-pound shot bags) is placed in the open-mouthed 
bag to balance the weight of the splint and leg. The rope going over the 
pulley at the head of the bed carries sufficient weight (about 8 pounds) 
to hold the ring of the splint in position against the ischial tuberosity. SPLINTS AND APPLIANCES 
159 
Figure 106.—Balkan Frame in use lor fractured femur; thigh in abduction. (U. S. Army.) 
Figure 107.—Balkan Frame in use for fractured humerus. (U. S. Army.) 160 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Traction is obtained by the use of adhesive plaster through the rope over the 
pulley at the end of the frame (25 to 30 pounds). 
The extremity is suspended in the splint by the use of 5-inch canton-flannel 
bandages as slings, using large safety pins for fixation. 
Length is obtained by weight and pulley traction, alignment by abduction, 
adduction, flexion, or extension of the distal end of the splint (distal frag- 
ment). Alignment is also changed by adjusting the position and tightness of 
the supporting canton-flannel slings. 
Figure 106 shows the Balkan Frame in use for an intertrochanteric fracture 
of the femur treated in extreme abduction, using skin traction. 
The frame allows any position of abduction or adduction. All four ex- 
tremities may be suspended at one time or any combination, including a 
fractured pelvis. 
The foot of the bed is ordinarily elevated so that the body will better act 
as a counter weight against traction. 
If there is a wound in the region of the ischial tuberosity the half-ring of 
the splint may be reversed to the anterior surface of the thigh and dressings 
held in place behind by the strap and buckle. 
A “monkey bar” made of a broom handle and suspended from the frame 
by rope so that it hangs within reach of the patient is a welcome aid to 
him in changing his position in bed. 
Figure 107 shows the Balkan Frame in use for a fracture of the humerus 
treated by skin traction in abduction. 
The humerus is suspended in a canvas hammock 8 by 30 inches, with four 
eyelets above and a piece of board through both of which laces are passed. 
The forearm and hand are suspended from a wooden spreader, made locally, 
using four 1-inch steel buckles and sufficient 1-inch nonelastic webbing. 
A piece of broom stick makes an excellent hand hold. 
Position of the distal fragment is changed by abducting or adducting the 
arm and likewise by changing the supporting pole of the suspending frame 
and by increasing or decreasing the weight attached to the forearm or that 
attached to the hammock. 
Skin traction. 
Application.—The skin is prepared by shaving, cleansing with gasoline and 
alcohol, and drying. 
A strip of adhesive is rolled from a 3-inch spool and doubled on itself suffi- 
ciently so that this double thickness will extend from above the malleolus to the 
buckle of the spreader. The strip is then cut the length desired. A second 
strip is likewise prepared. A third strip is split in half to be used as the spiral. 
The lateral and mesial straps extend upward to the fracture site and are applied 
and bound by the spiral straps. It is applied evenly, wrinkling being avoided 
as it produces blisters (fig. 108). 
The spiral should avoid the peroneal nerve over the neck of the fibula, the 
suprapatellar bursa, and not be bandaged tightly about the ankle. The leg is 
then bandaged with a gauze bandage to promote adhesion. 
For below-knee traction, the adhesive extends only to the knee. 
The spreader and foot support (fig. 108) are made locally from: 
Sheet aluminum; 
Webbing, 1%-inch, gray, nonelastic; 
Buckle, 1%-inch, two-prong; 
Wood, 4% by 1% by % inch pine; and necessary 
Tacks, rivets or screws. 
The design of the spreader is from the Massachusetts General Hospital. SPLINTS AND APPLIANCES 
161 
Figure 108.—Skin traction using zinc oxide adhesive. (U. S. Army.) 
Splint, wire, Cabot posterior leg. 
A figure approximating but not exactly that of a parallelogram, is constructed 
of %-inch cold rolled or Bessemer steel rod, with the free ends welded. One 
end, the welded, will measure inches, the other end 4% inches. The small 
Figure 109.—Cabot posterior, wire leg splint. (U. S. Army.) 
end of the frame is bent at a right angle to the plane of the frame 12 inches 
back from this end. The two sides measure 30 inches. The large end which 
has been brazed or welded, shall present concavity 2% inches at its center. 
This splint (fig. 109) is used for immobilization of the knee, ankle, foot, and 
soft parts of the leg. 162 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Application.—A hammock is formed on which the extremity is supported in 
the steel frame by wrapping about it, not too tightly, a bias muslin bandage. 
Additional padding may he added, using gauze and cotton pads as desired. 
The extremity should at no place rest on the metal bars of the splint. The 
splint may be bent at the knee to give any amount of flexion desired. 
The extremity is bound to the splint, using additional muslin bandages. 
T-splint for fractured clavicle. 
This splint (fig. HO) is made locally of the following material: Wood, maple 
or hickory, 3 by 18 inches, 2 pieces; buckles for 1%-inch webbing, 6; felt, 
saddle, gray; stockinette, 3-inch; webbing, 1%-inch; and necessary carpet tacks, 
rivets or screws. 
Figure 110.—T-splint with straps; for fractured clavicle. (U. S. Army.) 
Construction.—The T is framed by mortising and fixing with rivets or 
screws the end of one piece of the wood with the middle of the other. 
Straps and buckles are secured to the wooden T-splint by carpet tacks, as 
indicated. 
Padding of saddle-felt covered with stockinette may be sewed to the straps 
which cause pressure under the axilla and to the abdominal strap, or, gauze 
cotton pads may be used, being pinned to the straps using safety pins. 
These dimensions of the T are used for the average patient: Larger, 20-inch, 
and smaller, 16-inch; splints should be made up and available. 
For infants and young children T-splints are made from basswood splint 
board, tacked together, padded, and fixed to the child with bandages and 
adhesive. 
Application.—In fractures of the clavicle the shoulder drops downward, for- 
ward, and inward. The proximal fragment is usually pulled slightly anterior 
and upward. The splint is padded with saddle felt, or gauze cotton pads, held 
in place by adhesive. SPLINTS AND APPLIANCES 
163 
Traction is made upward, outward, and backward on the shoulder to reduce 
the fracture. The splint is applied to maintain immobilization. 
The inner strap on each side is brought up under the splint and over the 
shoulder at the base of the neck of the patient, crossed over the chest and 
secured to the two upper buckles on the lower end of the vertical arm of the 
splint. The abdominal strap is applied. Both shoulders are now pulled up- 
ward, backward, and outward by the axillary strap and fixed in this position. 
Straps are adjusted daily and skin under splint cared for. 
Aeroplane or abduction splint. 
This splint (fig. Ill) is made locally of the following material: Buckles, 
1%-inch, two-prong, 3; rod, steel, Bessemer or cold rolled, 12 foot 
lengths; sheet aluminum, 16-gauge; and webbing, gray, nonelastic. 
Its measurements are— 
1. Width of lower end of splint, average 7 inches, convex curve. 
2. Distance from just below anterior superior spine of ilium to anterior 
axillary fold. 
3. Length of arm, measured from anterior axillary fold to flexed elbow, 
arm in abduction. 
4. Length of forearm, measured from flexed elbow to middle of palm of 
hand. 
5. Line across palm, average 3 inches. 
Figure 111.—Aeroplane or abduction splint. (XL S. Army.) 
Construction.—The steel rod is bent cold (easily accomplished by use 
of vise and hammer). The rod is joined and fixed under hand piece by fixing 
ends of the rod in an aluminum cylinder. The aluminum cylinder is formed 
from a piece of aluminum % by 2% inches, which is fashioned around a %-inch 
steel rod using a vise and hammer. 
Three nonelastic webbing straps and buckles are attached to the splint by sew- 
ing, as illustrated. 164 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Canvas is sewed over the metal bars of the splint forming a hammock which 
supports the splint against the pelvis and chest wall and the arm and forearm 
on the splint. Gauze-cotton pads are added, as indicated. A bias muslin band- 
age may be used in lieu of canvas. The arm and forearm may be secured to the 
splint by a bias muslin bandage. 
Uses.—The aeroplane or abduction splint is used for— 
1. Brachial-plexus injuries; 
2. Paralysis or weakness of abductor muscles of shoulder; 
3. Shoulder-joint injuries (other than dislocation) ; 
4. Fractures of the scapula, of the surgical and anatomical necks of the 
humerus, and convalescent fractures of the shaft of the humerus; 
5. Subacromial-bursitis; and 
6. Acromio-clavicular dislocations. 
Splint, basswood. 
This splint material is used in the splinting of forearm and carpal fractures, 
and for coaptation splints. 
When a splint is to be prepared for a Colics’ fracture it should extend from 
just below the flexed elbow to the metatarsal-phalangeal joints, so as to allow 
free motion in these joints, and should be cut away over the thenar eminence so 
as not to produce “flat hand”. 
Figure 112.—Splinting of lower forearm fractures. (U. S. Army. 
The good forearm and hand, with hand in ulnar deviation, is placed palm 
down on a piece of splint board and outlined with pencil as shown in figure 
112. The broken line is marked in after hand is removed from board. The 
posterior splint is marked out in a similar manner. 
The splints are now cut out from the splint board, using a plaster knife, a 
pocket knife, or scroll saw, and sufficient layers of sheet wadding are laid on 
each splint and cut with a pair of bandage scissors to fit the splint. The pad- 
ding is then secured to the splints with three or more narrow strips of adhesive. 
In splinting a Colles’ fracture after reduction, two additional pads are formed 
of sheet wadding. One, the longer of the two, is placed against the proximal EMERGENCY DENTAL TREATMENT 
165 
fragment and the palmar splint is placed in position. The second and smal- 
ler pad is placed over the distal fragment and the dorsal splint applied. While 
the splints are held in position an adhesive strap, 1 to 1% inches wide, is placed 
around the wrist, to be followed by a second one around the upper end of the 
splint, and a third around the lower end securing the hand in ulnar deviation. 
A gauze bandage is then applied. 
Splints should show a “spring” when compressed by the operator’s hand to 
insure that they do not bind too tightly. 
For other forearm fractures splints are applied as in Colies’ fractures, except 
that ulnar deviation may or may not be desired, and the position and size of 
the supplemental pads are changed as indicated to maintain reduction of frag- 
ments. 
Section 4.—EMERGENCY DENTAL TREATMENT 
Dental first-aid consists of skilled or semiskilled emergency treatment given 
to sufferers from disease and accidents involving the dental structures until 
regular dental care can be given. The treatment here suggested is intended 
only for the temporary relief of pain in the absence of a dental officer or when 
treatment facilities are inadequate. The effectiveness of dental first-aid depends 
upon an accurate diagnosis of the trouble to be treated and upon the correct 
application of the remedies indicated. 
All cases receiving dental first-aid should be referred to a dental officer as 
soon as possible for further treatment. Pain, apart from accidents such as 
bruises and fractures, is a symptom or expression of some deeper pathological 
change within the tissues and is evidence of the need for further treatment. 
The purpose of dental first-aid treatment is to relieve pain, to prevent its recur- 
rence, and to prevent the development of infection. 
Hospital corpsmen on independent duty should do all in their power to remedy 
conditions which later may result in dental emergencies. Quite frequently 
naval personnel are on types of duty which preclude the possibility of obtain- 
ing skilled dental treatment within a reasonable length of time. It is for this 
reason that intelligent forethought should be exercised and the following sug- 
gestion considered very seriously in the interests of the comfort and welfare of 
the crew. Personnel of craft of any description for whom it is anticipated 
dental service will not be available should, prior to departure from a yard or 
base, have dental examinations and treatment. Until very recently (1936) this 
advice would have been impracticable on account of the limited number of 
dental officers in the Navy, but the allowance of these officers has been in- 
creased and it is now practicable to carry this suggestion into effect to a greater 
extent than ever before. Health records should be examined to see if they 
contain up-to-date dental records, and if lacking, these should be supplied. This 
is most important because it not infrequently happens that dental records fur- 
nish the only means of identification. 
Whenever possible officers and men should be sent to a dental officer every 
6 months for examination and treatment. 
Advantage should be taken at isolated stations of the visits of naval or 
Coast Guard vessels carrying dentists. The services of Army, Public Health, 
Veterans’ Administration, and Indian Service dental officers may be obtained 
in cases of emergency. 
Dental treatment by dentists in civil life may be obtained in accordance with 
instructions contained in the Manual of the Medical Department. This manual 
authorizes emergency dental treatment for the relief of pain prior to authoriza- 166 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
tion by the Bureau of Medicine and Surgery, but ordinarily prior authorization 
must be obtained from the bureau. Read the manual, especially when in doubt. 
Dental first-aid to be effective must be rendered by one who is acquainted 
with the structural and functional characteristics of the dental tissues. It is 
therefore absolutely necessary for the hospital corpsman to know the funda- 
mental facts regarding the teeth and the related tissues. 
Dental tissues. 
The word dental is derived from the Latin word dens, meaning tooth. The 
dental tissues are those involved in the formation and structure of the teeth, 
and in their support in normal function. They consist of the enamel, dentin, 
cementum, pulp, peridental membrane, alveoli of the jaws, and gums or 
gingivae. 
Deciduous dentition. 
It is interesting to know that the baby or deciduous teeth begin their forma- 
tion during foetal life. The crowns of the two upper and two lower deciduous 
incisors are almost completely formed when the baby is born. There are 20 
teeth in a deciduous set, 10 upper and 10 lower. Each jaw has 4 incisors, 2 
canines, and 4 molars. While these teeth are being used for mastication the 
permanent teeth are forming in the jaw just below them. As the crowns of the 
permanent teeth grow the roots of the baby teeth are resorbed which accounts 
for the fact that, when shed normally, baby teeth do not have roots. 
Permanent dentition. 
There are 32 teeth in the normal permanent set, 16 in each jaw as follows: 
4 incisors, 2 canines, 4 premolars or bicuspids, and 6 molars. In the average 
mouth the third molars often fail to erupt and make their way through the 
gum and so do not take their normal working occlusion. This does not decrease 
the efficiency of the masticating organ. 
Figure 113.—United States Navy method of numbering teeth. 
In the Navy, for the purpose of uniformity of records, the teeth are num- 
bered from 1 to 32, beginning with the upper right third molar and continuing 
to the left side of the upper jaw, the third molar there being number 16, 
dropping to the lower right third molar for number 17 and continuing around 
the lower jaw to the left, the third molar there being number 32 (tig. 113). 
The teeth. 
Each tooth is usually considered to consist of two main parts, the crown 
and the root, which are connected by a third, the neck. The crown is that 
part of a tooth which projects above the gum and is the masticating part of EMERGENCY DENTAL TREATMENT 
167 
a tooth. The shape of the crown varies in the different teeth and on the 
masticating surface of the molars and premolars are from two to five rounded 
prominences called tubercles, or cusps, which are separated by grooves. The 
neck is the faintly constricted part of a tooth between the crown and the 
root and it is surrounded, collar-like, by the gum. The root is that part 
of a tooth which is embedded in the alveolus of the maxillae or mandible, 
supports the crown, and is designed to withstand the forces of mastication. 
The end of the root is called the apex and through an opening in it the 
nerve and blood supply enter the tooth. The number of roots on a tooth 
varies according to the amount of work done by it in mastication, the molars 
and premolars, or grinding teeth, therefore having two or three roots while 
the incisors, or cutting teeth, and the canines have but one. The alveolus 
is the cavity or socket in the maxillae and the mandible which receives the 
root or roots of a tooth. It varies in size and depth according to the tooth 
whose root or roots it contains, and is lined with the peridental membrane 
which also covers the root. 
When a tooth is cut in half vertically through the center (fig. 114) a cavity 
will be found in the crown and center of each root which connects with 
the opening in the apex. The larger part of this cavity in the crown and 
neck is called the pulp cavity, the long, slender part in the root is known as 
the root canal, and both are filled with a soft, loose connective tissue, the 
dental pulp, which contains the blood vessels and nerves of the tooth. In 
the molar and premolar teeth the pulp cavity is extended into the bases of 
the cusps and in the incisor teeth it extends out toward the angles of the 
crown. 
In structure, a tooth is composed of both hard and soft tissues, the hard 
tissues being the enamel, dentin, and cementum and the soft the dental pulp 
and peridental membrane. Surrounding the neck of the tooth and covering 
the alveolus is a firm tissue called the gingiva, or gum. 
Enamel is the white, glistening substance which covers the crown of the 
tooth and extends to the commencement of the root. It is thickest on the 
masticating surface of the crown and gradually thins as it approaches the 
neck where it is slightly overlapped by the cementum. Enamel is the hardest, 
most compact, and most resistant substance in the body and is composed of 
“slender, prismatic rods, irregularly five or six sided,” which lie parallel with 
one another and, generally speaking, at right angles to the junction of the 
enamel with the dentin, being vertical on the summit of the crown and hori- 
zontal on the sides. The enamel rods are held together by a cementing sub- 
stance which, like the rods, is composed of inorganic salts. According to 
Noyes the chemical composition of enamel is as follows: 
Calcium phosphate and fluoride 89. 82 
Calcium carbonate 1 4. 37 
Magnesium phosphate 1. 34 
Other salts * . 88 
Organic matter 3. 39 
Fat . 20 
Total 100.00 
Per cent 
Dentin is the hard, yellowish-white substance which composes the greater 
portion of the tooth and is a modification of osseous tissue but from which it 
differs in structure. It is highly elastic and very tough, gives strength to 
the tooth, and consists of the matrix, into which fine fibrils of the dental 168 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Figure 114.—Vertical section of an incisor tooth. 169 
EMERGENCY DENTAL TREATMENT 
pulp extend, and the dentinal tubules which traverse the matrix everywhere, whose 
walls are called the dentinal sheaths of Newman, and which contain the den- 
tinal fibers, prolongations of the outermost cells of the dental pulp. Accord- 
ing to Noyes the chemical composition of dentin is as follows; 
Per cent 
Calcium phosphate and fluoride 66. 72 
Calcium carbonate 3. 36 
Magnesium phosphate 1. 08 
Other salts . 83 
Organic matter 27. 61 
Fat . 40 
Total 100.00 
Cementum is the outer covering of the root of the tooth and begins as a very 
thin layer slightly overlapping the enamel at the neck and increasing in 
thickness as it nears the apex which is composed entirely of this substance. 
In structure and chemical composition it closely resembles bone and is formed 
around the root in layers which are deposited one on top of another. To it 
the fibers of the peridental membrane are attached thereby securing the root 
in the alveolus. 
The dental pulp which occupies the pulp cavity and the root canal is com- 
posed of branched connective tissue cells whose branches anastamose and form 
a fine network within which is a jelly-like material and the blood vessels and 
nerves of the tooth. The outermost cells of the dental pulp are known as 
odontoblasts, whose function is to form dentin and which have processes that 
are prolonged and extend into the dentinal tubules in the dentin. The func- 
tion of the nerves in the dental pxdp is largely sensory and they respond to 
thermal and chemical changes and traumatic irritation. A very rich blood 
supply is necessary for the normal functioning of the pulp and consequently 
there are numerous blood vessels in it which form a capillary plexus within 
the odontoblasts. 
The peridental membrane, also called the periodontal membrane and alveolar 
periosteum, is a 1'ayer of fibrous, nonelastic connective tissue which lines the alveo- 
lus and covers the root of the tooth. It is continuous with the fibrous structure 
of the gum and its fibers are attached on one side to the cementum of the root and 
on the other to the bone of the alveolus. The root is thus firmly fixed in the 
alveolus and may be said to rest in the peridental membrane as if in a ham- 
mock. It is obvious that the peridental membrane permits a very slight move- 
ment of the teeth in mastication. When this membrane is diseased the tooth 
movement becomes excessive and the tooth is loose or feels high. Pain will 
be experienced when the tooth feels high. 
The gingiva, or gum, is the soft but firm tissue surrounding the neck of the 
tooth. It is a dense fibrous tissue continuous with the peridental membrane 
lining the alveolus and is covered with a smooth and vascular mucous mem- 
brane. On each tooth there is a shallow trough or crevice which is formed by the 
free margin of the gum and is called the gingival trough or crevice. The gum is 
held snugly to the tooth by circular fibers which act as elastic bands, is firm 
to the touch, and normally is a pale pink in color. Damage done to the gum 
during a prophylaxis contributes to a breaking down of the tissues composing 
the gum, and wiien the tone (elastic effect) of the gum is lost, food has a ten- 
dency to fill the gingival trough. The pressure exerted by the packing of food 
in the trough, together with the activity of the bacteria incorporated in the 
food, leads to an inflammatory condition of the gums called gingivitis when 170 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
in the acute stage and pyorrhoea when in an advanced and chronic stage. 
Another factor of importance in the health of the gum is the hard incrustation 
of mineral and organic matter which forms on the teeth and sometimes on the 
gum called tartar or calculus. Tartar is of two kinds, salivary calculus, which 
forms above the gum, and serumal calculus, which forms below the gum line. 
If the teeth are not kept free from tartar formation, the gums become inflamed, 
recede, and are subject to attacks by dangerous organisms. 
The oral cavity. 
In considering the mouth from the standpoint of cleanliness, it must be re- 
membered that more types of bacteria are to be found there than in any other 
part of the body. In the vernacular it might be said that the mouth is a 
“club house” for bacteria, as the presence of food, and the air, moisture, and 
temperature in the mouth make conditions there most favorable for their growth. 
All bacteria found in the mouth are not harmful to man, and the body’s resist- 
ance to the invasion of bacteria is its natural protection against these lower 
forms of life. 
The harmful bacteria are the ones that are of most interest to the dentist 
and physician in their practice of the healing arts, and they, as well as the con- 
ditions they produce, can be recognized. Before any treatment is given the 
bacteria present should be identified so that measures to combat them may be 
taken. It is with this thought in mind that the following oral conditions are 
briefly described so that the semiskilled person may render first aid in the 
absence of a dental officer. 
It should be remembered that it is important to prevent the spread of in- 
fectious bacteria from one individual to another and when, through failure to 
properly cleanse the hands or to sterilize instruments such transference of bac- 
teria occurs it is known as cross infection. The spread of disease in this man- 
ner is the result of carelessness or ignorance and is inexcusable and culpable. 
Bacteria from the mouth of a patient may be transferred to the operator or to 
another patient unless the rules of asepsis and sterility are observed. Numerous 
cases are on record of syphilitic lesions appearing on the fingers of dentists 
and physicians and infections of this type wTere quite frequent before the advent 
and use of rubber gloves. 
Special attention should be paid to the fact that many diseases of the mouth 
are very contagious and an individual may carry very dangerous bacteria with- 
out exhibiting any of the symptoms of the disease. If, in some manner, such 
bacteria are transferred from the person carrying them to another, serious 
complications may arise through the appearance of the disease in the person 
to whom the bacteria have been transferred. It is therefore of paramount 
importance that the fingers and all instruments and materials used in a patient’s 
mouth should be absolutely clean. It is impracticable and unnecessary to have 
instruments sterile for dental operations except in those that are of a surgical 
nature, but they must be clean, that is, they must have been cleaned and steril- 
ized since they were used in the mouth of a previous patient. Briefly, all in- 
struments used in an operation must be washed and sterilized following their 
use. They should be thoroughly washed, then boiled for 15 minutes in an in- 
strument sterilizer, dried with a clean towel, and handled as little as possible 
while stowing awray in the instrument cabinet and before being used again in 
a mouth. Hospital corpsmen must realize how important it is to be clean in 
the handling of dental instruments and materials and should exercise care in 
disposing of waste materials. There is but little possibility of cross infection 
if this routine is followed. EMERGENCY DENTAL TREATMENT 
171 
Changes in the structure of the teeth may result from the action of putrefac- 
tive agents in particles of food lodged in the spaces between and around the 
teeth and also from the presence of various bacteria. In addition to causing 
decay of the teeth, these agents may cause irritation of the gums. The pre- 
vention of these changes is considered a part of dental first aid. 
Decay of the teeth and irritation of the gums to a large degree can be pre- 
vented by attention to and the execution of a few simple principles. “A clean 
tooth never decays” is a well-known slogan, which, while not true in its en- 
tirety, has so much in its favor that it is well worth keeping in mind. 
Decay occurs most frequently in places which are not kept clean. The sur- 
faces of the teeth which are seen when the mouth is opened are kept clean 
and polished, to a great extent, by the cheeks on one side and the food and 
tongue on the other. The spaces between the teeth, however, are not kept 
free from debris by the above means or by rough food, which well might serve 
that purpose. Attention is, therefore, to be directed to these spaces. In the 
usual procedure of brushing the teeth the surfaces which are kept clean by 
the tongue, food, and cheeks are the only ones which also are scrubbed with 
the toothbrush. The spaces which are vital in the prevention of decay of the 
teeth as a rule are not cleansed. To clean these spaces it is necessary to get 
in between the teeth and remove from these spaces food debris,. bacteria, and 
the products of decomposition. Several methods for the attainment of this 
result have been advocated, among which the use of dental floss has been the 
most satisfactory. By its use the individual may remove much of the offending 
material. A much simpler and more efficient method is that in which a small 
brush with the bristle tufts not set too closely together is laid against the neck 
of the teeth, bristle ends toward the teeth, and the bristles gently worked into 
the spaces between the teeth with a sort of oscillating motion. This is to be 
repeated several times in each vicinity. To help keep tone in the gums the 
brush should be passed briskly over all surfaces of mucous membrane in the 
mouth, including the tongue. Using salt on the brush or salt water is a good 
routine practice, though no objection exists to the use of the most popular denti- 
frices. Brushing the teeth and gums four times a day, upon arising and after 
each meal, is given as ideal, hut most persons must be content with a night and 
morning brushing. 
EMERGENCY DENTAL TREATMENT 
The most common dental conditions for which a dental technician or hospital 
corpsman may be called upon to render first-aid treatment when the services 
of a dental officer are not immediately available, will now be described. The 
descriptions of the symptoms and of the first-aid treatment are necessarily brief 
and are intended to serve only as a reference to assist the hospital corpsman 
in diagnosing and treating the dental conditions with which he has to deal. 
Hospital corpsmen should never attempt to administer dental treatment beyond 
the simplest measures which will relieve pain or render first aid in the event 
of an accident. 
Painful cavities. 
Decay or simple caries is a localized cavity containing decalcified tooth 
substance. Simple caries is usually painless except when subjected to thermal 
changes (usually cold), sweets, or pressure from some foreign material such 
as food within the cavity. The offending cavity may be seen by inspection 
of the mouth, it may be discovered through exploration with instruments, 
and often can he located only by transillumination especially when the enamel 
154294°—89 12 172 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
apparently is intact and the cavity is within the enamel. Such cavities are 
often disclosed by the enamel breaking off while eating. 
Food and soft debris in the cavity should be gently removed with suitable 
instruments, the cavity washed with warm water, dried with small pellets of 
cotton, and a small pellet of cotton moistened with dentalone or eugenol 
placed in the cavity. If temporary stopping is available it may be heated and 
used to fill the remainder of the cavity. If desired the cavity may be filled 
with a paste made by mixing zinc oxide and eugenol on a slab to a fairly thick 
consistency. This paste hardens when it comes into contact with saliva, and 
if mixed to a putty-like consistency will serve as a temporary filling material 
for several weeks, and in the meantime will exert a sedative action on the 
tooth substance. 
Occasionally a patient points to a perfectly sound tooth and complains 
that it aches. It is possible, of course, that nerve trouble does exist in that 
tooth, but it is always advisable to look at the other teeth on the same side 
of the jaw, both above and below, for a cavity, and if one is found, to cleanse 
it and apply a sedative, which will often relieve the pain in the tooth pointed 
out by the patient. Such pain in sound teeth is termed reflected pain. 
Dental pain resulting from inflamed pulp. 
The most common type of severe dental pain is toothache from an inflamed 
pulp which has become infected through a cavity in the tooth. This infection, 
with the attending inflammation and congestion, compresses the sensitive pulp 
tissue against the unyielding sides of the pulp cavity. The pain is apt to be 
sharp and lancinating, tends to increase on lying down, and is accentuated by 
temperature changes, particularly cold. The tooth is not noticeably tender to 
percussion (light blows struck with the handle of ail instrument), and does not 
strike opposing teeth first when bringing the teeth together. Food and soft 
debris should be gently removed from the cavity with suitable instruments, 
the cavity washed with warm water, dried with small pellets of cotton, and 
a small pellet of cotton moistened with dentalone or eugenol, first touched 
to another piece of cotton to remove excess fluid, inserted into the cavity. The 
pellet should be small enough to go into the tooth and leave a portion, of the 
cavity unfilled. Then take another piece of cotton large enough to fill the 
remainder of the cavity, dip this into compound tincture of benzoin or into 
sandarac varnish, remove the excess as above, and pack lightly over the 
sedative dressing. The benzoin or sandarac varnish on cotton will form a 
gummy, impervious mass when it comes into contact with saliva, thus tending 
to prevent dissipation of the medicament, will protect the pulp from tempera- 
ture and pressure changes and will keep out foreign material. This treatment 
should be renewed every day or two until dental attention is available. 
Alveolar abscess. 
If the treatment previously outlined fails to afford relief the pain probably 
is caused by a pulp which is partially or wholly putrescent, as a result of 
which gases have formed which are exerting pressure through the root canal 
into the area around the apex. This forces bacteria and their toxins into the 
tissues at the end of the root and sets up an inflammation in the structures 
surrounding the root apex. As this inflammation is outside of the tooth in 
the alveolus, any medicament applied to the tooth or in the cavity will 
likely fail to afford relief. The pain will continue until drainage is naturally 
or artificially established. This type of toothache (alveolar abscess) requires 
the services of a dental officer to establish drainage through the root canal EMERGENCY DENTAL TREATMENT 
173 
or through the soft tissues and alveolar wall to the site of the abscess. When 
swelling becomes apparent pain usually ceases, and the swelling indicates 
an opening through the tissues has been made by the pus working its way 
to the surface. Heat may be locally applied on the face. 
Digital examinations of the tissues of the mouth should be made at inter- 
vals to determine if a point of fluctuation has developed; when this is found 
an incision should be made through it directly toward the bone in the 
direction of the apex of the tooth for the evacuation of pus. Twenty-four 
to seventy-two hours may elapse between onset of pain and the appearance 
of swelling. Sedatives may be administered for the relief of pain pending 
the appearance of the swelling. 
Gum abscesses. 
These small abscesses are commonly called gum-boils, are frequently present 
and appear as small pimples or openings on the gums. This condition, as 
a rule, is painless, but by no means should it be neglected as in most cases 
it iftdicates the presence of a dead nerve in a nearby tooth. Gum-boils should 
receive professional attention at the flrst opportunity in order that the health 
of the individual may not be menaced. 
Inflammation of lower third molar regions. 
The lower third molar teeth (wisdom teeth) often are the cause of pain 
and swelling during their eruption. Upon looking into the mouth toward 
the angle of the jaw and just back of the last tooth, occasionally a part of 
a tooth may be seen coming through the gum with swelling and redness in 
the vicinity. To relieve this condition, wrap a small instrument or blunt 
probe firmly with a thin layer of cotton, dip this in half-strength tincture of 
iodine and gently force between the gum and tooth, working it carefully 
around the crown of the tooth. This simple treatment will sometimes result 
in an evacuation of a small amount of pus and relief will be afforded. The 
patient should be instructed to hold salt water, as hot as can be borne, in 
the mouth, forcing it back and forth over this area. This should be repeated 
frequently. Many times this area becomes infected with Vincent’s micro- 
organisms and treatment in these cases should be watched carefully for any 
spread of the infection. Using a 10-per cent solution of arsphenamine in 
glycerin, carry the solution gently around the tooth and under the gum on 
a probe wrapped with cotton. The mouth should be sprayed with a warm solu- 
tion of sodium perborate or a half-strength solution of hydrogen peroxide. 
As a pocket is usually formed distal to these teeth, it is advisable in many 
cases to drain the pocket, which is done by lightly placing a very small piece 
of iodoform gauze in the pocket, without pressure. This will maintain drain- 
age and act as an antiseptic and deodorant until the patient can be seen 
by a dental officer. 
Postoperative treatment for haemorrhage following extraction of teeth 
Haemorrhage may occur from a few hours to several days following the 
extraction of a tooth. It may originate from a socket or from the surrounding 
gum tissue. The origin of the bleeding must be determined and treatment 
applied in that area. The best means of controlling haemorrhage is pressure, 
and if bleeding occurs from a socket it should be packed with gauze. The 
socket is first syringed with warm water to dislodge the blood clot and a 
strip of gauze saturated with epinephrine or thromboplastin is firmly packed 
into the socket until it is filled. Several gauze napkins, 6 by 6 inches, may 174 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
be folded to produce a pack of appropriate size which, when placed over 
the socket and between the adjacent teeth, will exert a firm pressure when 
the jaws are closed. Pressure must be maintained and the compress should 
not be disturbed for at least 30 minutes. If bleeding persists the treatment 
should be repeated. The patient should be instructed to avoid all excitement 
and to remain throughout the day in a sitting or reclining position. The jaws 
may be held closed by means of a Barton bandage. Sedatives may be given 
but stimulants should be avoided. 
Postoperative treatment for pain following the extraction of teeth. 
It occasionally happens that a day or more after the extraction of teeth 
severe throbbing pain occurs in the socket from which the tooth has been 
removed. This condition, known as “dry socket,” indicates that a normal 
blood cot has failed to form and the socket is empty or is filled with debris. 
The socket should be gently cleansed by irrigation with warm saline or mild 
antiseptic solution and a small piece of plain or iodoform gauze moistened 
with dentalone, eugenol, or coated with dental-analgesic paste very gently 
inserted in the socket, taking great care not to exert pressure by packing 
in the gauze. Some relief should be experienced immediately but the pain 
and discomfort may persist for several days. The irrigation and gauze medi- 
cation should be renewed daily. If a rise in temperature is observed and 
the patient seems very ill, osteomyelitis may be suspected and the patient 
should be taken to a medical officer immediately. 
Vincent’s infection, oral, or trench month. 
The symptoms of this disease vary according to the degree of virulence of 
(he infection and the resistance of the patient. The patient usually complains 
of pain and discomfort and bleeding of the gums when eating or brushing the 
teeth. It is characterized by a very red, inflamed appearance of the gums 
about the teeth, and a film of deadened, white or grayish tissue over the gums 
and between the teeth which bleeds readily when touched. The condition may 
be acute with considerable pain and discomfort or it may be less acute with 
only a thin line of red, inflamed tissue about the teeth, and the grayish-white 
film noticeable principally between the teeth with very little or none on the 
gums. In general this disease exhibits a dirty, grayish membrane covering 
shallow ulcers, with a distinctive, foul breath and excessive bleeding. 
Vincent’s infection is a highly contagious disease and its spread throughout 
a group of men may be very rapid if strict precautions are not instituted. 
Mess gear and all items which might come in contact with the mouth secre- 
tions must be sterilized immediately after use and before being washed. The 
sterilization should be done by boiling, or by sterilizing with steam. It is 
advisable that mess gear be washed and handled by the patient and kept apart 
from other mess gear throughout the treatment. Measures should be instituted 
to insure that this is done, and the patient warned that the disease may be 
transmitted by anything which comes in contact with the mouth, as pipes, tags 
on tobacco bags, drinking cups, etc. Refer to appendix D, Manual of the 
Medical Department for further information concerning this condition. 
The treatment consists in the gentle application of medicaments which will 
destroy or reduce the causative organisms. No one method of treatment is 
effective for all cases. One level teaspoonful of sodium perborate dissolved in 
half a glassful of warm water as a mouth wash, prepared freshly for use 
every 4 hours, has been found effective in many cases. The solution of sodium 
perborate, however, in some instances causes additional irritation of oral tissues 
and this fact should be borne in mind. EMERGENCY DENTAL TREATMENT 
175 
Equal parts of peroxide of hydrogen and warm water also may be used as a 
mouth wash, and should be retained in the mouth for at least 2 minutes in 
order to get the benefit of the oxidizing action. 
Another treatment is the application several times daily of a 10 per cent 
solution of arsphenamine in glycerin to all inflamed surfaces, allowing it to 
remain in contact several minutes and then rinsing the mouth with warm 
water. When applying arsphenamine solution place cotton rolls or absorbent 
cotton in the mouth to protect the cheeks and tongue while the medicament is 
being applied and while it remains in the mouth. The patient should be 
referred to a dental officer upon the first available opportunity. 
Symptoms and treatment for fractures of the jaw. 
Fractures of the jaws exhibit the symptoms of fractures in other bones and 
in addition there may be an irregularity in the line of occlusion of the teeth. 
As in other fractures, reduction and immobilization are indicated. If teeth are 
present they will serve as the best guide for proper reduction and immobiliza- 
tion, the teeth of one jaw serving as a splint for the other. 
The bandage type of splint is useless as a permanent method of fixation and 
dental assistance should be secured as soou as practicable. As a first-aid meas- 
ure the Barton bandage is not suitable for fractures of the lower jaw though 
it may be useful in fractures of the upper jaw. The bandage turn in the front 
of the chin is the objectionable feature of the Barton bandage for fractured 
mandibles; this turn may be omitted by making a figure-of-eight modified 
Barton passing under the chin, over the head and down back of the occiput, 
and repeating six or eight times, which will serve as a temporary support for 
the mandible. As a rule if the bandage is tight enough to serve as a splint it is 
too tight for normal circulation. The mouth should be kept clean and liquid 
diet administered. 
Operative Dentistry.—Black. 
Anatomy of the Human Body.—Gray. 
Refeeences CHAPTER IV 
Section 1. Materia medica and therapeutics 177 
Section 2. Toxicology 257 
Page 
Section 1.—MATERIA MEDICA AND THERAPEUTICS 
Many of the substances used in the treatment of disease are obtained from 
the animal, vegetable, and mineral kingdoms. These substances generally are 
spoken of as medicines, commonly termed drugs, and in studying them it is 
necessary to consider their source, composition, physical characteristics, chemi- 
cal properties, preparation and administration,, and physiological and toxicolog- 
ical action. The science which treats of the substances used as medicines is 
materia medica. 
That particular science which relates to the properties of medicinal sub- 
stances and the application of remedial agents in the treatment of disease is 
known as therapeutics. In addition to the use of drugs as remedial agents, 
electricity, water, serums and vaccines, light rays, heat, physical, mechanical, 
and operative measures, and hygienic agents are employed for curative pur- 
poses. Therapeutics is divided into three classes known as rational, which is 
based upon known laws of the remedies and the diseases; empirical, based en- 
tirely on the results of clinical observation and experience, and general, when 
remedial agents other than drugs or medicines are used. 
Medicines may be divided into two general groups—stimulants, which increase 
the functional activity of the body or of any organ or tissue, and sedatives, which 
lessen or reduce the functional activity and, according to their composition, are 
inorganic or organic. 
The various preparations of drugs or the different forms in which they may 
be used and the names given to substances of vegetable origin are discussed in 
the chapter on Pharmacy. 
Medicinal substances usually are described according to their actions and 
effects on the body or its organs and tissues, and following is a list of the terms 
used, with definitions of the therapeutic action of each. 
Alteratives.—Medicines used to modify processes of nutrition so as to overcome 
morbid conditions. 
•Analgesics or anodynes.—Medicines used to allay pain. 
Anaesthetics.—Medicines used to produce local or general insensibility. 
Anaphrodisiacs.—Medicines which depress the sexual appetite and function. 
Anhydrotics.—Medicines which are used to diminish perspiration. 
Antacids.—Medicines used to neutralize acid in the stomach and intestine. 
Anthelmintics.—Medicines used to destroy or expel intestinal worms. 
Antidotes.—Medicines or agents which act upon poisons in such a manner as 
to alter their composition, rendering them less poisonous, and so preventing 
their toxic action from being exerted upon the organism.. 
Antiemetics.—Medicines used to arrest vomiting. 
Antiperiodics.—Medicines used for the relief of periodically recurring dis- 
eases, such as malaria. 178 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Antiphlogistics.—Medicines or agents which reduce or dissipate inflam- 
mation. 
Antipyretics.—Medicines used in the reduction of body tenqierature in 
fevers. 
Antiseptics.—Substances which have the power of preventing the growth 
and development of bacteria. 
Antisialics.—Medicines or agents which reduce the secretion of the saliva. 
Antispasmodics.—Medicines used for the relief of nervous irritability and 
minor spasms. 
Antisyphilitics.—Medicines used in the treatment of syphilis. 
Aperients.—Mild cathartics. 
Aphrodisiacs.—Medicines which stimulate sexual appetite and function. 
Aromatics.—Medicines characterized by a fragrant or spicy taste and odor 
and which stimulate the gastrointestinal mucous membrane. 
Aromatic hitters.—Medicines which unite the properties of the aromatics and 
the simple bitters. 
Astringents.—Medicines which produce shrinkage of mucous membranes or 
raw tissues, decreasing the amount of exudation from them. 
Bitters, simple.—Medicines which have a bitter taste and have the effect of 
stimulating the gastrointestinal mucous membrane without affecting the general 
system. 
Cardiac depressants.—Medicines used to lessen the force and frequency of 
the heart’s action. 
Cardiac stimulants.—Medicines used to increase the force and frequency of the 
heart’s action. 
Carminatives.—Medicines which aid in the expulsion of gas from the stomach 
and intestine by increasing peristalsis, stimulating circulation, etc. 
Cathartics.—Medicines which increase or hasten the evacuation of the intes- 
tine. They are classified according to their power, as follows: Laxatives or 
aperients, simple purgatives, drastic purgatives, saline purgatives, hydrogogues, 
cholagogues. 
Cerebral depressants.—Medicines which lower or suspend the functions of 
the higher brain after a preliminary stage of excitement. 
Cerebral excitants.—Medicines which, if given in proper doses, increase the 
functional activity of the cerebrum without causing any subsequent depression 
or suspension of the brain function. 
Correctives.—Medicines which are used to correct or render more pleasant 
the action of other remedies, especially purgatives. 
Deliriants.—Medicines which excite the functional activity of the higher brain 
to such a degree as to disorder the mental faculties and produce intellectual 
confusion, loss of will power, delirium, and even convulsions. 
Demulcents.—Substances usually of oleaginous or mucilaginous natures, 
which soothe and protect the parts to which they are applied. 
Deodorants.—Substances which destroy or hide foul odors. 
Diaphoretics.—Medicines which produce increased excretion of sweat. 
Digestants.—Ferments and acids which have the power of aiding in the 
solution of food. 
Disinfectants.—Substances which have the power of destroying disease germs. 
Diuretics.—Medicines which increase the secretion of the urine. 
Emetics.—Medicines which produce vomiting. 
Escharotics or caustics.—Substances which destroy the tissue to which they 
are applied and produce a slough. 
Expectorants.—Medicines which increase bronchial secretion. MATERIA MEDTCA AND THERAPEUTICS 
179 
Febrifuges.—Medicines which lessen fever. 
Haemostatics.—Medicines which arrest haemorrhages (usually applied to in- 
ternal bleeding). 
Hepatic stimulants.—Medicines which increase the functional activity of the 
liver cells and the amount of bile secreted. 
Hypnotics.—Medicines which, in the proper doses, produce sleep without nar- 
cotic or deliriant effects. 
Irritants.—Substances which, when applied to the skin, produce more or less 
vascular excitment. When employed to excite a reflex influence on a part 
remote from the place of application they are termed counterirritants. Rube- 
facients, the mildest of this group, cause redness (congestion) of the skin. 
Vesicants or blistering agents produce decided inflammation of the skin and 
the accumulation of serum between the epidermis and the derma. 
Motor depressants.—Medicines which lower the functional activity of the 
spinal cord and the motor apparatus, and in large doses paralyze them directly. 
Motor excitants.—Medicines which increase the functional activity of the 
spinal cord and motor apparatus, producing heightened reflex excitability, dis- 
turbances of motility, and when given in large doses, tetanic convulsions; their 
ultimate effect being motor paralysis from overstimulation. 
Mydriatics.—Medicines which cause dilation of the pupil. 
Myotics.—Medicines which cause contraction of the pupil. 
Narcotics.—Drugs which “lessen the relationship of the individual to the ex- 
ternal world.” At first excitant to the higher brain they soon cause profound 
sleep, characterized by increasing stupor, and if the dose is sufficient, coma, in- 
sensibility, and death by paralysis of the nerve centers which control organic 
life. 
Neurotics.—Medicines which act upon the nervous system. 
Nutriants.—Medicines which modify the nutritive processes. 
Nutrients.—Substances which give nourishment to the system. 
Parasiticides,—Medicines which destroy the various animal and vegetable 
parasites. 
Prophylactics.—Medicines which prevent the taking or the development of 
disease. 
Pulmonary sedatives.—Medicines which relieve cough and dyspnoea by lessen- 
ing the irritability of either the respiratory center or the nerves of respiration. 
Purgatives.—Medicines which produce free evacuation of the bowels. 
Refrigerants.—Medicines which impart a sensation of coldness and thereby 
allay thirst and restlessness. 
Renal depressants.—Medicines or agents which lessen the secretion of the 
urine. 
Respiratory depressants.—Medicines which lower the action of the respiratory 
center. 
Respiratory stimulants.—Medicines which exalt the function of the respiratory 
center in the medulla oblongata, quickening and deepening the breathing. 
Sialogogues.—-Medicines which increase the secretion of the salivary glands 
(the secretion of the mouth). 
Soporifics.—Hypnotics. 
Specifics.—Medicines which have a direct curative influence on certain indi- 
vidual diseases. 
Stomachics or gastric tonics.—Medicines which increase the appetite and pro- 
mote gastric digestion. 
Styptics.—Medicines or applications to control external haemorrhages. 
Tseniacides.—Medicines which kill tapeworms. 180 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Tonics.—Medicines which augment gradually and permanently the strength 
and vital activity of the body or its organs, increasing the vigor of the entire 
system. 
Vermicides.—Medicines which kill intestinal worms. 
Vermifuges.—Medicines which cause the expulsion of intestinal worms. 
Vesical sedatives.—Medicines which lessen the irritability of the bladder, 
decreasing the desire to urinate, and relieving vesical pain and tenesmus. 
Vesical tonics.—Medicines which increase the tone of the muscular fibers in 
the wall of the bladder, consequently the power for contracting and expelling 
the urine is increased. 
Administration of medicines. 
The normal or adult dose of medicine is based upon the condition that the 
individual must be 24 years of age and weigh about 150 pounds. Persons under 
24 and over 60 years of age require smaller doses in proportion. 
In computing the dose for persons under 24 years of age, the following rules 
are applicable. Young's rule directs that the age of the person be taken as 
the numerator of the fraction and the age plus 12 as the denominator. Thus 
for a child B years old 3 would be the numerator and 3 plus 12, or 15 the 
3 
denominator, =1/5 of adult dose. Cowling's rule directs that the age 
3+12 
at next birthday be taken as the numerator of the fraction, and 24 (the age 
of the adult) as the denominator of the fraction. 
In using either of these rules it should be remembered that children usu- 
ally require larger doses of purgatives, diaphoretics, and diuretics, and smaller 
doses of narcotics than is called for. 
When the dose of a drug is spoken of, the amount necessary to produce a 
medicinal effect in an adult, or the therapeutic dose, ordinarily is meant. The 
doses given in the Pharmacopoeia and the National Formulary are the average 
therapeutic doses. In addition, there are the minimum dose, the smallest 
quantity which can produce a medicinal effect, the maximum dose, the largest 
quantity which can be given without probable poisoning or harmful effects, the 
toxic dose, which is the amount producing poisoning, and the lethal dose, which 
is the smallest dose that will produce death. The average dose is the one 
usually learned. In the administration of medicines there are many factors 
which affect the dose, the method of administration, and the frequency of the 
doses. These conditions, briefly described, are: 
1. Age.—Children (see preceding rules) and aged adults as a rule require less 
than the normal adult dose. 
2. Sex.—Females require smaller doses than males. 
3. Race.—Negroes usually require larger and Asiatics smaller doses than 
white people. 
4. Physical condition.—Strong, burly patients require larger doses than 
weak patients. 
5. Temperament.—Sanguine (ardent, cheerful, full-blooded) temperaments 
require smaller doses of stimulants than phlegmatic (heavy, dull, stolid, 
apathetic) temperaments. 
6. Idiosyncrasy.—This is the peculiarity of constitution of individuals to react 
differently to drugs or other influences. 
7. Climate.—People in warm climates, as a rule, require smaller doses of 
purgatives. 
8. Occupation.—Men working out of doors at hard labor will require larger 
doses than those who sit at a desk all day. 181 
MATERIA MEDICA AND THERAPEUTICS 
9. Habitual use.—This modifies the dose by lessening the medicinal power 
of the drug, and the dose must be increased greatly to obtain a medicinal 
effect (opium, morphine, and cocaine users). 
10. Disease.—Disease conditions modify the dose, as in tetanus and peri- 
tonitis, when larger doses of narcotics are tolerated. 
11. Form of the drug.—This controls largely the rate of absorption, as all 
substances must be reduced to solution before entering the circulation. 
12. Time of administration.—Drugs given before a meal are more quickly 
absorbed than those administered upon a full stomach. 
13. Mode of administration.—-As a rule drugs administered hypodermically 
are used in much smaller quantities. 
14. The frequency of administration.—It is obvious that the dose of a drug 
is less if administered frequently than if administered at long intervals. 
Medicinal substances may be introduced into the circulation by any one of 
the following methods: 
By mouth.—This is the most common of all methods and is usually the most 
desirable except when very rapid action is required. 
Subcutaneously.—This method, in which medicines are injected under the 
skin, frequently is used when rapid action is desired or when the stomach 
will destroy the virtue of the drug if given by mouth. 
By rectum.—This method is used when it is impossible to administer drugs 
by mouth because of vomiting, semi or unconsciousness, delirium, or certain 
diseases of the gastrointestinal tract. 
By inunction.—This consists of applying ointments or oily combinations to the 
skin and rubbing them in. 
Intravascularly or intravenously.—By this means preparations of drugs are 
introduced directly into a vein. 
Inhalation.—By this method medicated vapors or drugs, such as ether or 
chloroform, are inhaled into the respiratory system. 
Fumigation.—In this manner easily volatilized drugs are applied directly to 
the skin, except the head, by means of a vapor bath. 
By hypodermoclysis.—This consists of introducing solutions of saline into 
the loose tissues about the breasts, abdomen, or below the scapulae. 
Intramuscularly.—This consists of injecting readily absorbable, sterile prep- 
arations of drugs into the muscle tissue. 
In order to obtain the greatest benefit of their action, as a general rule, 
hitters are administered before meals; alkalies, if to increase the flow of 
gastric juice, before meals; if to neutralize the acidity of the gastric juice, 
after meals; acids, one-half to one hour before meals; laxatives, before retiring; 
active cathartics, the first thing in the morning; hypnotics, from one-half to 
two hours before sleep is required; slowly acting drugs (digitalis), at long 
intervals; rapidly acting drugs (ammonia, nitroglycerin) at very short inter- 
vals ; such drugs as mercury, arsenic, iron, iodides, not on an empty stomach, 
but from one-half to one hour after meals. 
Following is a brief description of drugs in common use, and on the Naval 
Medical Supply Table, grouped in the various chemical classes to which they 
belong. 
INORGANIC MATERIA MEDICA 
The official Latin and English titles, the common names or synonyms, and 
the symbolic formulas, if any, appear in black face type in the following 
descriptions of medicinal substances. Those official in the Pharmacopoeia are 
indicated by the letters U. S. P. following the names, those recognized by the 
National Formulary by the letters N. F., and those in New and Nonoffieial Rem- 
edies by the letters N. N. R. 182 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Iodine and its preparations. 
lodum, Iodine, I, U. S. P.—Iodine contains not less than 99.5’ per cent of I. 
Preserve iodine in glass bottles closed with stoppers resistant to corrosion, 
and in a cool place, protected from light. 
Properties : Heavy, grayish-black, brittle plates, having a metallic luster 
and a characteristic odor. One gram is soluble in 2,950 cc of water, in 12.5 cc 
of alcohol, in 80 cc of glycerin, and in 4 cc of carbon disulfide. It is freely 
soluble in chloroform, in carbon tetrachloride, and in ether, and is dissolved 
by aqueous solutions of iodides. Iodine unites actively with iron and other 
metals. In weighing iodine use a hone or rubber spatula, and paraffined paper 
on the scale pans. With starch paste iodine gives a deep blue color. Iodine 
stains may be removed from linen by the application of a solution of sodium 
thiosulfate. 
Source: Iodine is now obtained principally from the mother liquors obtained 
in the purification of crude Chili saltpeter (sodium nitrate). Some iodine 
is obtained from the ashes obtained by burning seaweeds. A new source of 
iodine is the brine issuing from the oil in petroleum oil-wells. In Chili salt- 
peter iodine occurs as sodium iodate mixed with sodium nitrate. 
Action and Uses; See preparations of iodine. The antidote is starch paste. 
Average dose: 0.01 Gm, or % grain. 
Tinctura lodi, Tincture of Iodine', U. S. P.—An alcoholic solution of iodine 
and potassium iodide. One hundred cc contains not less than 6.5 Gm. nor 
more than 7.5 Gm. of I, and not less than 4.5 Gm. nor more than 5.5 Gm. of 
KI. Preserve it in glass bottles, closed with stoppers resistant to corrosion, 
and in a cool place, protected from light. 
Preparation : See U. S. P. 
Action and Uses: It is applied externally as a counter-irritant, disinfectant, 
and parasiticide. It may be applied to any part of the body externally except 
the eye. An alcoholic solution (half strength) containing equal parts of the 
tincture and alcohol is employed in the disinfection of the skin before opera- 
tions. It penetrates into the pores and acts as a powerful germicide. It should 
never be painted over a surface that previously has been washed with bi- 
chloride of mercury solution, because in the presence of the bichloride new 
compounds are formed which are intensely irritating, especially under a dress- 
ing, and blistering of the skin is liable to occur. To get the best germicidal 
results from tincture of iodine, it should not be applied to a surface wet 
with water. Internally tincture of iodine is used as an alterative. It acts 
as an irritating poison in large doses. The antidote is starch paste or starchy 
foods, such as bread and mashed potatoes. Iodine stains can be removed 
from linen with a solution of sodium thiosulfate. 
Average dose: 0.1 cc or iy2 minims (diluted with water). 
Tinctura lodi Mitis, Mild Tincture of Iodine, U. S. P.—Mild Tincture of 
Iodine contains, in each 100 cc, not less than 1.8 Gm. and not more than 2.2 
Gm. of I and not less than 2.1 Gm. nor more than 2.5 Gm. of Nal dissolved 
in 50 per cent alcohol. Preserve it in the same manner as Tincture of Iodine. 
Action and Uses; This weak tincture is actively antiseptic and when applied 
to the abraded surface is not so painful as the strong tincture. The presence 
of iodides in both the strong and the weak tinctures improves their stability 
and increases their penetrability. With acetone iodine forms an irritating 
compound. A solution containing 1 cc of Mild Tincture of Iodine to 100 cc 
of 70 per cent alcohol is used as a local application in the treatment of 
trichophytosis (athlete’s foot). MATERIA MEDIOA AND THERAPEUTICS 
183 
liquor lodi Compositus, Compound Solution of Iodine (LugoTs Solution), 
U. S. P.—Compound Solution of Iodine is a solution containing, in each 100 cc, 
not less than 4.5 Gm. and not more than 5.5 Gm. of I, and not less than 9.5 Gm. 
and not more than 10.5 Gm. of KI. Preserve it in glass bottles, closed with 
stoppers resistant to corrosion, and in a cool place, protected from light. 
Action and Uses: It is given internally for the preoperative treatment of 
toxic goiter. It should be highly diluted with water, when given by mouth, to 
prevent gastric irritation. 
Average dose: 0.2 cc or 3 minims. 
Oxygen and its compounds with hydrogen. 
Oxygenum, Oxygen, 0, U. S. P.—It contains not less than 99 per cent of O by 
volume. For convenience it is usually supplied in compressed form in metallic 
cylinders. 
Properties: A colorless, odorless, tasteless gas, which supports combustion 
more energetically than air. It is slightly soluble in water. 
Preparation : Oxygen is separated from the air by extreme cold and high 
pressure. When liquid air is allowed to vaporize the nitrogen escapes first be- 
cause of its greater volatility, and the gas that comes off last is nearly pure 
oxygen. 
Action and Uses : It is employed to relieve difficult respiration as in pneumo- 
nia. It is administered by inhalation in the treatment of poisoning by carbon 
monoxide. It is used with nitrous oxide in anaesthesia to prevent cyanosis. 
When the oxygen tent is being used great care must be exercised to prevent 
persons entering the room with a lighted cigarette. 
Aqua, Water, H20, U. S. P.—A clear, colorless, practically tasteless and odorless 
liquid. It has a pH of not less than 5.8 and not more than 8.3. Ordinary water 
contains in solution or suspension traces of salts, organic matter, and gases, vary- 
ing in amounts with different localities. These impurities in limited amounts 
do not render water unfit for drinking purposes or for making pharmaceutical 
preparations containing some drugs, but their presence is objectionable in cer- 
tain cases. 
Aqua Destillata, Distilled Water, H20, U. S. P.—Water purified by distillation. 
It is a clear, colorless liquid, without odor and taste. It has a pH between 
5.8 and 7. 
Aqua Destillata Sterilisata, Sterilized Distilled Water, U. S. P.—It is freshly 
distilled water recently sterilized. See U. S. P. page 66. It should be used with- 
in 24 hours after sterilization when stored in stoppered containers. 
Aqua Redestillata, Redistilled Water, Triple Distilled Water, U. S. P.—Redis- 
tilled water is free from nonvolatile matter and gases; also from microorganisms 
or other oxidizable matter. Redistilled water intended for intravenous use 
should be sterilized within 2 hours after its redistillation and should be pre- 
served in a suitable manner against contamination. It should be used for 
intravenous use only on the same day it is sterilized. Hard, insoluble glass 
flasks previously rinsed with triple distilled water should be used for sterilizing 
triple distilled water. See Pyrogen, page 1650 of Remington’s Practice of 
Pharmacy, eighth edition. 
Nitrogen, compounds. 
Nitrogenii Monoxidum, Nitrogen Monoxide (Nitrous Oxide), N20, U. S. P.— 
It contains not less than 95 per cent by volume of N20. It is supplied in com- 
pressed form in metallic cylinders. It is a colorless gas, having a slight, char- 
acteristic odor and in aqueous solution a somewhat sweetish taste. It supports 
the combustion of many substances. One volume of the gas dissolves in 1.5 184 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAYiT 
volumes of water under normal pressure and at 20° C. It is more freely 
soluble in alcohol than in water. 
Action and Uses: It is a quick-acting anaesthetic, requiring only a few in- 
halations to produce unconsciousness. It is usually given mixed with oxygen. 
Sulfur. 
Sulfur Suhlimatum, Sublimed Sulfur (Flowers of Sulfur), S, U. S. P.—It con 
tains 99.5 per cent S. 
Properties : A fine, yellow, crystalline powder having a faint odor and taste. 
It is insoluble in water and nearly insoluble in alcohol. It is soluble in carbon 
disulfide, ether, and in olive oil. It burns in air to form sulfur dioxide gas. 
Action and Uses : Sublimed sulfur is not given internally. It is used in the 
preparation of Washed Sulfur. 
Sulfur Lotum, Washed Sulfur, U. S. P.—It contains not less than 99.5 per 
cent of S. Washed sulfur is sublimed sulfur which has been treated with 
ammonia water. Ammonia water removes traces of arsenic and sulfuric acid 
which may be present in sublimed sulfur. After the removal of these impuri- 
ties sulfur is fit for internal use. 
Action and Uses: Used internally as a laxative in Compound Powder of 
Senna, U. S. P. 
Average dose: 4 Gm., or 1 dram. 
Sulfur Prsecipitatum, Precipitated Sulfur, U. S. P.—It contains not less than 
99.5 per cent of S. 
Properties : A very fine, pale yellow, amorphous or microcrystalline powder 
without odor or taste. 
Action and Uses: The particles are lighter and more easily suspended than 
washed or sublimed sulfur. Ointments made with precipitated sulfur are 
smoother than those made with sublimed sulfur. It is used in making Sulfur 
Ointment, U. S. P. It is suitable for internal administration. 
Average dose: 4 Gm., or 1 dram. 
ITnguentum Sulfuris, Sulfur Ointment, U. S. P.—It contains not less than 
13.5 per cent and not more than 16.5 per cent of S. 
Composition : Precipitated sulfur, 15 Gm., wool fat, 5 Gm., yellow wax, 5 Gm., 
white petrolatum, 75 Gm. 
Action and Uses: It is used externally as a parasiticide against scabies; 
and in seborrheal diseases. When applied to the face it should be diluted with 
5 parts of Unguentum, U. S. P. 
Carbon. 
Carbo Activatus, Activated Charcoal, U. S. P.—The residue from the de- 
structive distillation of various organic materials, treated to increase its 
adsorptive power. When Carbo Ligni is prescribed, Carbo Activatus may be 
dispensed. Preserve Activated Charcoal in well closed containers. 
Description : A fine, black, odorless, and tasteless powder, free from gritty 
matter. It is estimated that 1 cc of finely divided charcoal possesses a total 
surface of approximately 1,000 square meters. 
Action and Uses : It is given internally as an adsorbent of gases in intestinal 
fermentation. It is used in pharmaceutical manufacturing as a decolorizing 
agent. It is one of the substances found in most all gas masks used in chemi- 
cal warfare. (Chemical Warfare, Fries and West, p. 242.) 
Average dose: 2 Gm., or 30 grains. 
Carbonei Dioxidum, Carbon Dioxide, C02, U. S. P.—It contains not less than 99 
per cent by volume of COs. It is supplied in compressed form in metallic 
cylinders. MATERIA MEDICA AND THERAPEUTICS 
185 
Description : A heavy, odorless, colorless gas. The taste of an aqueous solu- 
tion of the gas is faintly acid. One volume of carbon dioxide dissolves in about 
one volume of water. Carbon dioxide extinguishes a flame. 
Action and Uses : It is a stimulant to respiration. It is added to oxygen in 
varying proportions, from 1 to 5 per cent carbon dioxide and from 95 to 99 per 
cent oxygen, for supplying artificial respiration and as a stimulant to the re- 
spiratory center. The proportion of carbon dioxide to oxygen must be carefully 
regulated because an excess of carbon dioxide causes death by asphyxia. 
Boron. 
Acidum Boricum, Boric Acid (Boracic Acid), HsBOs, U. S. P.—Boric acid con- 
tains not less than 99.5 per cent of HsBOs. Preserve it in well closed containers. 
Properties : Colorless scales of a pearly luster, or crystals, or a white powder, 
slightly unctuous to the touch. It is odorless and is stable in the air. One 
gram is soluble in 18 cc of water, and in 18 cc of alcohol, and in 4 cc of glycerin. 
An aqueous solution is slightly acid to litmus paper. 
Action and Uses : Boric acid is a mild antiseptic. Externally it is used as 
a dusting powder either alone or with diluents such as starch or talcum. An 
aqueous solution containing from 2 to 4 per cent is used as an eye lotion. Boric 
acid solution has caused death in infants when given internally by mistake. 
Unguentum Acidi Borici, Boric Acid Ointment, U. S. P.—It contains not less 
than 9 per cent and not more than 11 per cent of H3BO3. Each 100 grams of oint- 
ment contains 10 Gm. boric acid, 5 Gm. wool fat, 5 Gm. white wax, and 80 Gm. 
white petrolatum. 
Average dose: 0.5 Gm., or 8 grains. 
Action and Uses : It is used as an emollient and protective on superficial 
wounds and abrasions. Its antiseptic properties are very slight. 
Inorganic or mineral acids. 
These compounds all contain hydrogen which is replaceable by metals forming 
salts, having a characteristic sour taste and corrosive action, and change the 
color of blue litmus to red. When acted upon by a base (alkali) they are 
neutralized and in turn neutralize the base, forming a salt and water. This is 
why an acid is used as an antidote for poisoning by a base, and a base as the 
antidote for acid poisoning. An acid is defined as a compound of hydrogen with 
an electronegative element or radical. Sulfur (S) is an electronegative element 
and when it is combined with hydrogen produces ELS, hydrosulfuric acid; SO* 
is the electronegative sulfate radical, and when it is combined with hydrogen 
produces ELSCb, sulfuric acid. The strong inorganic acids should be handled 
with great care because they are very corrosive and poisonous. When given 
internally they should be highly diluted, and should be taken through a glass 
tube to prevent injury to the teeth, followed by rinsing the mouth with a 
solution of sodium bicarbonate. The chemical antidote for acid poisoning is 
any mild alkali; as lime water, milk of magnesia, chalk, bicarbonate of soda, etc. 
Acidum Hydrochlorieum, Hydrochloric Acid, HC1, U. S. P.—An aqueous solu- 
tion containing not less than 35 per cent nor more than 37 per cent of HCi. 
Preserve it in glass-stoppered bottles. It should be noted that about 64 per 
cent of the liquid is water and only 36 per cent (by weight) is hydrochloric 
acid (gas). Absolute HOI is a gas and this preparation is a solution of HCI 
gas in water. 
Preparation: It is made by acting on sodium chloride (common salt) with 
sulfuric acid. (1) 2NaCl+H2S04=HCl+NaCl+NaHS04; (2) NaCl+NaHS04= 
HCl-t-Na2S04. 186 
HANDBOOK OF TEE HOSPITAL CORPS, II. S. NAVY 
Properties : It is a colorless, fuming liquid having a pungent odor and an 
intensely acid taste. The fumes and odor disappear on adding the acid to 
twice its volume of water. It is strongly acid to litmus. Salts of hydrochloric 
acid are known as chlorides (sodium chloride). An aqueous solution containing 
not less than 9.5 Gm. nor more than 10.5 Gm. of HC1 in each 100 cc is known 
as diluted hydr®chloric acid. 
Action and Uses: Hydrochloric acid is a normal constituent of the gastric 
juice and sometimes is administered to make up any deficiency of this substance 
in the gastric juice. Its principal use is in the manufacture of chlorides (salts), 
many of which are used in medicines. It is used with nitric acid in making 
nitrohydrochloric acid. 
Average dose: 1 cc or 15 minims of the 10-per cent diluted acid. It should be 
diluted further with 1 fluidounce of water and taken through a glass tube, to 
avoid injury to the teeth. 
Acidum Sulfuricum, Sulfuric Acid, H2SO4, U. S, P.—A liquid containing not 
less than 94 per cent nor more than 98 per cent of H2SO4. Preserve it in 
glass-stoppered bottles. 
Properties : A colorless, odorless liquid, of oily consistence, very caustic and 
corrosive; strongly acid to litmus even when highly diluted. Specific gravity 
about 1.84 at 25° C. Miscible with water or alcohol with the evolution of 
much heat; the acid must he added ivith great caution to the diluent. In mix- 
ing water and sulfuric acid the acid always should he added sloioly with 
stirring to the water, and not the water to the acid. When mixed in a glass 
vessel the acid should be added slowly to avoid a sudden increase of tempera- 
ture with possibility of breaking the glass vessel. Because of its great affinity 
for water it is used as a desiccating (drying) agent. Being one of the strongest 
acids known, it is capable of decomposing salts of other acids, forming salts of 
sulfuric acid, and setting free the other acids. This principle is demonstrated 
in the making of hydrochloric and nitric acids. 
Preparation: There are several methods now employed in the manufacture 
of sulfuric acid, the principles involved being practically the same. Sulfur 
is burned with the oxygen of the air forming sulfur dioxide; the sulfur dioxide 
is oxidized by the action of either an oxidizing agent (nitric acid) or a catalytic 
agent (platinum sponge) to sulfur trioxide. The sulfur trioxide then is 
brought in contact with steam in a leaden chamber (sulfuric acid does not 
act on lead), forming sulfuric acid. The simplest expression of the reactions 
involved is as follows: 
(1) s+o2 =so2. 
(2) 3S02+2HN03 =3S0.+Ha0+N,01 
(3) SO3+H2O =H2S04. 
Diluted sulfuric acid is an aqueous solution containing not less than 9.5 Gm. 
nor more than 10.5 Gm. of H2S04 in each 100 cc. 
Action and Uses : Sulfuric acid rarely is given internally. Its principal 
use is in manufacturing other preparations. Not only is it used in the prepara- 
tion of salts (sulfates) of sulfuric acid, but also in the manufacture of other 
acids from their salts. 
Average dose of the diluted acid is 1 cc or 15 minims, 
Acidum Nitricum, Nitric Acid (Aqua Fortis), HN03, U. S. P.—An aqueous 
solution containing not less than 67 per cent nor more than 70 per cent of HNOs. 
Preserve it in glass-stoppered bottles protected from light, and in a cool place. 
Properties: Nitric acid is a fuming liquid, very caustic and corrosive, and 
has a peculiar, somewhat suffocating odor. It should be handled with extreme 
care. MATERIA MEDICA AND THERAPEUTICS 
187 
Preparation: Made by the action of sulfuric acid on sodium nitrate. 
NaN03+H2S0i=NaHS04+HN03. 
Action and Uses : Nitric acid rarely is given internally. It is used in the 
manufacture of salts of nitric acid (nitrates) and in the manufacture of ex- 
plosives (trinitro-phenol, glyceryl trinitrate, trinitro-toluol, etc.). It is an 
extensively used oxidizing agent, breaking down in the presence of oxidizable 
substances, as follows: 2HN03=H20+N202-|-3C). Applied to tissues it acts as an 
energetic caustic and is used for cauterization and to remove warts. It 
is used with hydrochloric acid in the preparation of nitrohydrochloric acid. 
When applied to the skin it produces a yellow stain due to the formation of 
xanthoproteic acid. 
The alkali elements and their compounds 
The alkali metals are potassium, sodium, lithium, and the radical am- 
monium. Chemically they are strongly electropositive, being directly opposite 
to the halogens. They are monovalent, soft, waxlike in consistence, having a 
low melting point, readily oxidize in the air and decompose water forming 
strong hydroxides (alkalies). These strong alkalies are very caustic and 
poisonous. Nearly all the salts of these alkalies (formed by their union with 
acids) are soluble in water. Potassium, sodium, and lithium as such have no 
special medicinal action of value. The medicinal properties of their chemical 
compounds are exerted by the acid radicals with which they are combined; 
therefore the medicinal properties of the alkali salts vary greatly. The chemical 
antidote for th& strong alkalies is any weak acid, as citric acid, vinegar, 
diluted acetic acid, etc. Neutralization of the acid should be followed by giving 
large doses of cottonseed oil. When acids and alkalies are brought together 
in solution they neutralize each other forming new compounds (salts). In this 
way they act as antidotes for each other. 
Potassii Hydroxidum, Potassium Hydroxide (Caustic Potash), KOH, U. S. P.— 
It contains not less than 85 per cent of KOH. Preserve it in well-closed con- 
tainers. If bottles are used they must be made of hard glass, and cork 
stoppers should be paraffined. 
Properties : Potassium hydroxide occurs in dry, white, or nearly white 
flakes, fused masses, or sticks; is hard, brittle and odorless. Great caution is 
necessary in handling it, as it rapidly destroys organic tissue. When exposed 
to the air it rapidly absorbs carbon dioxide and moisture and deliquesces. 
It is very soluble in water, alcohol and glycerin. (All the salts of potassium 
are soluble in water except potassium bitartrate). It is strongly alkaline to 
red litmus, turning it blue even in a very dilute solution. 
Preparation : It is made by electrolysis (passing an electric current through 
potassium chloride). 
Action and Uses: Pure potassium hydroxide is not given internally. If a 
large quantity should he swallowed accidentally, give vinegar or lemon juice 
as the antidote. Potassium hydroxide is used in making soap (soft soap). 
Lye may be composed of potassium hydroxide, although it usually contains 
sodium hydroxide, a cheaper substance. It sometimes is used as a caustic, 
but its principal use in medicine is in the manufacture of potassium salts. 
Potassii Acetas, Potassium Acetate, CHsCOOK, U. S. P.—It contains when 
dried to constant weight at 150° C. not less than 99 per cent of CH3COOK. 
Preserve it in airtight containers. 
Properties : It is very deliquescent on exposure to the air, and is very soluble 
in both water and alcohol. An aqueous solution is alkaline to litmus. 
154294°—39 13 188 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Preparation : It is made by tbe action of acetic acid on potassium 
bicarbonate. KHCOa+CHsCOOE^CHaCOOK+COz+EUO. 
Action and Uses: Used as a diuretic, diaphoretic, and to render tbe urine 
alkaline. In large doses it acts as a laxative. It is decomposed in tbe system, 
forming carbonates. 
Average dose: 1 Gm. or 15 grains. 
Potassii Bicarbonas, Potassium Bicarbonate, KHCOs, U. S. P.—It contains, 
when dried to constant weight in a desiccator over sulfuric acid, not less 
than 99 per cent of KHOOs. Preserve it in well closed containers. 
Properties : It is very soluble in water, but almost insoluble in alcohol. 
When a solution of potassium bicarbonate is heated it is converted into potas- 
sium carbonate. An aqueous solution is slightly alkaline to litmus. 
Preparation: It is made by passing carbon dioxide through a solution of 
potassium carbonate until it is fully saturated. K2C03-)-C02+H20—2KHC03. 
Action and Uses: Its action when given internally is very much like that 
of potassium acetate. It renders the blood and urine alkaline. In manufac- 
turing pharmacy it is used in the preparation of many of the other potas- 
sium salts. 
Average dose: 1 Gm. or 15 grains. 
Potassii Bitartras, Potassium Bitartrate (Cream of Tartar), EOOC.CHOH. 
CHOH.COOH, U. S. P.—It contains, when dried to constant weight at 100° C., 
no less than 99.5 per cent of KOOC.CHOH.CHOH.COOH. Preserve it in well- 
closed containers. 
Properties: Occurs as a colorless or slightly opaque, gritty powder, odor- 
less, and having a pleasant acidulous taste. It is very slightly soluble in 
water (the only sparingly soluble potassium salt in common use), and insolu- 
ble in alcohol. A saturated solution is acid to litmus. 
Preparation : It is made by purifying tartar, a substance deposited in wine 
casks during fermentation of grape juice in making grape wines. 
Action and Uses: Occasionally given as a hydragogue cathartic. It is 
one of the constituents of baking powders. In baking powder it acts slowly 
on bicarbonate of sodium, liberating carbon dioxide, which becomes entangled 
in the dough and causes it to rise. It sometimes is used as a diuretic and 
laxative. Tartrates are not oxidized in the system like citrates and acetates 
and do not act as alkalizers. 
Average dose: 2 Gm. or BO grains. 
Potassii Chloras, Potassium Chlorate, KClOs, U. S. P.—It contains not less 
than 99 per cent of KClOs. Preserve it in well-closed containers. Great 
caution should be observed in handling it, as dangerous explosions are liable 
to occur when it is heated or subjected to concussion or trituration with 
organic substances (cork, tannin, dust, sugar, etc.) or with sulfur, sulfides, 
hyposulfites, or other easily oxidizable substances. 
Properties: It occurs as colorless crystals or a white granular powder, 
odorless, and having a peculiar cooling taste. It is soluble in 16.5 parts of 
water, soluble in glycerin, and insoluble in alcohol. It is capable of yielding 
oxygen when heated. 
Preparation : It is made by boiling together a solution of potassium chlor- 
ide and calcium hypochlorite. 
Action and Uses: Applied locally in aqueous solution it acts as an anti- 
septic and stimulant to mucous membranes. It is decomposed easily by septic 
matter, yielding nascent oxygen, to which it owes its antiseptic properties. 
It is used in the following inflammatory conditions of mucous membranes: 
Catarrhal inflammations of the mouth and fauces, ulcerative and mercurial MATERIA MEDICA AND THERAPEUTICS 
189 
stomatitis, nursing sore mouth, and tonsillitis. When given internally in large 
doses it is likely to cause destruction of the red blood cells. 
Average dose: 0.25 Gm. or 4 grains (rarely used internally). 
Potassii et Sodii Tartras, Potassium and Sodium Tartrate (Rochelle Salt), 
U. S. P.—It contains, when rendered anhydrous by drying at 150° C., not less 
than 99 per cent of KOOC.CHOH.CHOH.COONa. It contains not less than 21 
per cent and not more than 26 per cent of water. Preserve it in well-closed 
containers. 
Properties: Occurs as colorless, transparent crystals or a white granular 
powder, odorless, and having a saline taste. Very soluble in water and almost 
insoluble in alcohol and slightly efflorescent in dry air. Its aqueous solution 
is slightly alkaline to litmus. 
Preparation : Made by adding potassium bitartrate to a solution of sodium 
carbonate. 2KHC4H406+NasCOs^KNaCJUOo+C02+H20. 
Action and Uses : Rochelle salt is an extensively used purgative in the form 
of Seidlitz powder, U. S. P. A Seidlitz powder consists of two powders, one 
wrapped in white paper, and the other wrapped in blue paper. The contents 
of the blue paper are: Rochelle salt, 115 grains, and sodium bicarbonate, 38 
grains. The white paper contains 33 grains of tartaric acid. When adminis- 
tered the contents of the two powders are dissolved separately, each in half 
a glass of water, and then poured together and taken while effervescing. The 
effervescence is caused by the action of the tartaric acid on the bicarbonate of 
sodium. In this reaction sodium bitartrate is formed. 
Average dose: 10 Gm. to 2% drams. 
Potassii lodidum, Potassium Iodide, KI, U. S. P.—-It contains, when dried to 
constant weight at 100° C., not less than 99 per cent of KI. Preserve it in 
well closed containers. 
Properties : It is very soluble in water and glycerin; slightly soluble in 
alcohol. Slightly deliquescent in moist air. Its aqueous solution is slightly 
alkaline to litmus. 
Preparation : It is made by the action of iodine on an aqueous solution of 
potassium hydroxide. (1.) 6K0H+3I2=5KI+KI03+BH20. (2.) KIOs+SC— 
KI+3CO. 
Action and Uses: A valuable and much used alterative. It is used in the 
treatment of syphilis, rheumatism, and arteriosclerosis. It also is used for 
chronic lead', mercury, and arsenic poisoning, forming with these metals double 
soluble salts which are eliminated easily. 
Average dose: 0.3 Gm. or 5 grains. Give small doses for chronic lead 
poisoning and large doses for syphilis. 
Potassii Permanganas, Potassium Permanganate, KMn04, U. S. P.—It contains, 
when dried to constant weight in a desiccator over sulfuric acid, not less than 
99 per cent of KMn04. Preserve it in glass-stoppered bottles. Potassium per- 
manganate when in solution or in the dry condition must not be brought into 
contact with organic or other readily oxidizable substances, as dangerous ex- 
plosions are liable to occur. 
Properties: It occurs as slender prisms, of a dark purple color, odorless 
and having a disagreeable astringent taste. It is stable in the air. It is 
soluble in 14.2 parts of water. An alcoholic solution cannot be made because 
it is decomposed by alcohol. It is a powerful oxidizing agent, two molecules 
in acid solution yielding five atoms of oxygen. When it comes in contact with 
organic matter it is decomposed with the liberation of oxygen. This property 
makes it a valuable antiseptic and disinfectant. 190 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Preparation: It may be made by fusing together a mixture of potassium 
hydroxide, manganese dioxide, and potassium chlorate, forming potassium 
manganate. When the potassium manganate is boiled with water potassium 
permanganate is formed. 
(1) 3Mn02+6K0H+KC103=3K2Mn04+KCI+3H20. 
(2) 3K2Mn04+3H20=2KMn04+Mn02+4K0H+H20. 
Action and Uses : It is used as an antiseptic astringent irrigating fluid, es- 
pecially for the urethra and bladder, in strengths of from 1—4,000 to 1-10,000. 
It seldom is used externally, largely on account of the objectionable stain which 
it leaves. A 5 per cent solution is used in the treatment of poisoning by ven- 
omous snakes by injection into the wound. It also is used in the treatment of 
morphine poisoning. It has been used with formaldehyde solution to volatilize 
formaldehyde gas in disinfection of rooms, but is has been displaced for this pur- 
pose by barium dioxide, a cheaper substance. 
Average dose: 0.06 Gm. or 1 grain. 
Sodii Hydroxidum, Sodium Hydroxide (Caustic Soda, Sodium Hydrate), NaOH, 
U. S. P.—It contains not less than 95 per cent of NaOH. Preserve it in well- 
closed containers. If bottles are used as containers they must be made of hard 
glass, and cork stoppers should be paraffined. 
Properties ; It occurs in dry, white or nearly white fused masses or sticks, 
hard and brittle, showing a crystalline fracture. Exposed to the air, it rapidly 
deliquesces, absorbs carbon dioxide, and becomes covered with a coating of 
sodium carbonate. Great caution is necessary in using it, as it rapidly destroys 
organic tissue. It is very soluble in water and alcohol. It closely resembles 
potassium hydroxide in its properties, being a very strong alkali. 
Preparation : It is made by electrolysis of sodium chloride; also by the action 
of slaked lime on a solution of sodium carbonate. (Na2C03+Ca(0H)2=2Na0H 
+CaC03.) 
Action and Uses: It is used in the preparation of compound cresol solution, 
solution of sodium hydroxide, and magma magnesia. It seldom is used in- 
ternally, because it is too caustic. As a caustic it may be used like potassium 
hydroxide. The antidote is vinegar, diluted acetic acid, citric acid, lemon juice, 
etc. Sodium hydroxide is used extensively in a crude, impure form, for house- 
hold cleaning under the name of lye. 
Sodii Bicarbonas, Sodium Bicarbonate (Bicarbonate of Soda, Baking Soda), 
NaHCOs, U. S. P.—It contains, when dried to constant weight in a desiccator over 
sulfuric acid, not less than 99 per cent of NaHCOs. Preserve it in well-closed 
containers in a cool place. 
Properties: It is a white, crystalline powder, odorless and having a cooling, 
mildly alkaline taste. It is stable in dry air, but slowly decomposes in moist 
air. When its aqueous solution is heated, even mildly, it loses carbon dioxide 
and is converted into sodium carbonate as follows: 2NaHC03=Na2C03+H20 
+C02. It is fairly soluble in water, and insoluble in alcohol. Its aqueous solu- 
tion is alkaline to litmus, and the alkalinity increases as the solution stands, is 
agitated or heated. When treated with acids it effervesces (the same thing oc- 
curs when any carbonate is treated with an acid). 
Preparation: It is made by the Solvay process (ammonia soda process). A 
concentrated solution of sodium chloride is mixed with ammonia water; carbon 
dioxide under pressure is forced into this mixture, resulting in the formation 
of sodium bicarbonate and ammonium chloride. Sodium bicarbonate is precipi- 
tated (being less soluble) and the ammonium chloride remains in solution. The 
reaction may be expressed: This MATERIA MEDICA AND THERAPEUTICS 
191 
process also may be used in making sodium carbonate. After making the bicar- 
bonate this may be heated, driving off carbon dioxide and water, leaving behind 
sodium carbonate. 
Action and Uses : A valuable and popular antacid. It is given frequently 
for hyperacidity of the stomach (heartburn), but it must be remembered that 
while it neutralizes the acid contained in the stomach it also causes increased 
secretion of more acid, and may defeat the purpose for which it is given if ad 
ministered over a long period. When used for heartburn it usually is com- 
bined with ammonium carbonate and oil of peppermint and given in tablet form 
(soda-mint tablets). It is used externally in saturated aqueous solution for the 
treatment of burns and poisoning by poison ivy. It may be used in the prepara- 
tion of other compounds of sodium. It is the principal ingredient in baking 
powder. In making bread this substance, when acted upon by either alum or 
cream of tartar, liberates carbon dioxide, which becomes entangled in the dough 
and causes it to rise. The term “soda” very often is applied to this compound, 
but “soda” is an indefinite term and might mean sodium carbonate or even caustic 
soda. For the preparation of sterile solution of sodium bicarbonate for in- 
travenous use see U. S. P. page 468. A solution for intravenous use should be 
colorless with phenolphthalein. 
Average dose: 1 Gm. or 15 grains. 
Sodii Biphosphas, Sodium Biphosphate (Sodium Dihydrogen Phosphate, Sodium 
Acid Phosphate), NaH2P04, U. S. P.—Sodium biphosphate, when dried to constant 
weight at 100° C., contains not less than 98 per cent of NaH2P04. It contains 
not less than 10 per cent and not more than 15 per cent of water. Preserve it 
in air-tight containers. 
Description : Colorless crystals or a white, crystalline powder. It is odorless 
and is slightly deliquescent. It is freely soluble in water but is practically in- 
soluble in alcohol. An aqueous solution of the salt is acid to litmus paper and 
effervesces with sodium carbonate. 
Action and Uses : It is given to increase the acidity of the urine. It is given 
in conjunction with methenamine, not at the same time but between the methe- 
namine doses, in order to render the urine acid when the methenamine is ex- 
creted by the kidneys. The acid urine decomposes the methenamine setting 
free formaldehyde which acts as an antiseptic in the urinary tract. If sodium 
biphosphate and methenamine are given at the same time decomposition be- 
tween the two will take place in the stomach which is not desired. If sodium 
biphosphate is not available use sodium phosphate and to each gram of sodium 
phosphate in solution add 1 cc of diluted hydrochloric acid or 4 cc of diluted 
phosphoric acid. 
Average dose; 0.6 Gm. or 10 grains. 
Sodii Boras, Sodium Borate (Borax, Sodium Tetraborate, Sodium Pyroborate), 
U. S. P.—It contains not less than 52.32 per cent nor more than 54.92 per cent 
of anhydrous sodium borate (sodium biborate or tetraborate), corresponding 
to not less than 99 per cent of the crystallized salt (Na2B407+10H2O). Pre- 
serve it in well-closed containers. 
Properties : It occurs as colorless, transparent prisms, or as a white powder, 
odorless, and having a sweetish alkaline taste. It is slightly efflorescent in 
warm, dry air. It is fairly soluble in water, very soluble in glycerin, and in- 
soluble in alcohol. Its aqueous solution is alkaline to litmus. It has the prop- 
erties of an alkali but is milder than sodium carbonate. When mixed with 
glycerin it decomposes alkali bicarbonates with effervescence (this accounts for 
the effervescence in the preparation of Dobell’s solution). An aqueous solution 
shows an alkaline reaction toward litmus, but when dissolved in glycerin it 192 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
gives an acid reaction, and when the glycerin solution is largely diluted with 
water the reaction is changed back to alkaline. 
Preparation: Sodium borate is found native (as sodium borate) as a crys- 
talline deposit in the blue mud at the bottom of Clear Lake and near Death 
Valley in California, and in lakes in other parts of the world. It can be made 
by treating crude boric acid with sodium carbonate. 
Action and Uses ; Sodium borate possesses mild antiseptic and cleansing 
properties, and because of them it is used very often in alkaline mouth washes 
and gargles. It is one of the ingredients in compound solution of sodium borate, 
N. F. (Dobell’s solution). It rarely is used internally. As a household clean- 
ing agent (borax) it is used extensively where a mild alkali is desired in the 
cleaning of delicate fabrics. It also is used as a food preservative. A 1 per 
cent solution in distilled water is used as an eye lotion in conjunctivitis. 
Sodii Bromidum, Sodium Bromide. NaBr, U. S. P.—It contains, when dried to 
constant weight at 100° 0., not less than 99 per cent of pure NaBr. Preserve 
it in well-closed containers. 
Properties : It occurs as colorless, or white, cubical crystals, or as a white 
powder, odorless, and having a saline taste. It is very soluble in water and 
fairly soluble in alcohol. Its aqueous solution is neutral or faintly alkaline to 
litmus. It absorbs moisture from the air without deliquescing. 
Preparation: It can be made by methods like those employed in making 
potassium bromide, using NaOH instead of KOH. 
Action and Uses : It is used as a cerebral depressant and nerve sedative. Its 
action is much like that of potassium bromide, but less irritating to the stom- 
ach and less depressing. It is useful for quieting nervous excitability in neu- 
rasthenia and hysteria. It is given as an adjunct to hypnotics such as chloral. 
When given for a long time it disturbs the digestion and produces irritation 
of the skin. 
Average dose: 1 Gm. or 15 grains. 
Sodii Carbonas Monohydratus, Monohydrated Sodium Carbonate, NaaCOs+ILO, 
U. S. P.—It contains, when rendered anhydrous by gentle ignition, not less than 
99.5 per cent Na2C03, and not less than 10 per cent and not more than 15 per 
cent of water. Preserve it in well-closed containers. 
Properties : It is a white, crystalline, granular powder, odorless and having 
a strong alkaline taste and reaction. When exposed to the air, under ordinary 
conditions, it absorbs only a slight percentage of moisture; exposed to warm, 
dry air at or above 50° 0., the salt effloresces, and at 100° C. it becomes 
anhydrous. It is very soluble in water and glycerin, and is insoluble in alcohol. 
An aqueous solution is strongly alkaline to litmus paper. 
Preparation ; There are three methods by which sodium carbonate may be 
made: LeBlanc’s process, the Cryolite process, and the Solvay process. The 
Solvay process has been explained under sodium bicarbonate. (The chemical 
reactions involved in the LeBlanc and the Cryolite processes are too compli- 
cated to treat in this book. The student is referred to standard textbooks on 
pharmacy for further information.) 
Action and Uses ; Because of its strong alkaline reaction and irritating effect 
on the stomach, sodium carbonate seldom is given internally; sodium bicar- 
bonate is preferred when the internal antacid effect of soda is desired. Added 
to water in which instruments are being boiled (1 teaspoonful to a gallon of 
water), it prevents their rusting (sodium bicarbonate and borax will do the 
same thing). It is used in washing clothes when a strong alkali is desired. 
(“Washing soda” is a term applied to sodium carbonate containing 10 molecules 
of water of crystallization.) MATERIA MEDICA AND THERAPEUTICS 
193 
Average dose: 0.25 Gm. or 4 grains. 
Sodii Chloridum, Sodium Chloride (Common Salt), NaCl, U. S. P.—It contains, 
when dried to constant weight at 110° C., not less than 99.5 per cent of pure 
NaCl. Preserve it in well-closed containers. 
Properties ; It occurs as colorless, cubical crystals, or white crystalline pow- 
der, odorless, and having a saline taste. Its aqueous solution is neutral to 
litmus. It is very soluble in water, fairly soluble in glycerin, and slightly 
soluble in alcohol. Its solubility in water is not increased by heating the 
water. 
Preparation: It occurs in the native state as rock salt in large deposits 
throughout the world. Sea water contains about 3 per cent of this salt mixed 
with other salts. The waters of Great Salt Lake in Utah contain about 20 
per cent of NaCl. It must be purified and freed from other salts before it is 
fit for medicinal or domestic use. 
Action and Uses : A tablespoonful to a glassful of tepid water is used as an 
emetic. As a condiment it is almost a daily necessity in the human economy. 
It is found in all fluids and tissues of the body. A weak aqueous solution is 
used as a gargle and nasal douche. It is used in the preparation of physi- 
ological solution of sodium chloride, U. S. P. This solution contains in every 
1,000 cc, 8.5 Gm. of sodium chloride, and is commonly known as normal salt 
solution. While usually used in this strength solutions up to 21 per cent may be 
given if necessary. Nearly all drugs that are injected into the system, either 
hypodermically or intravenously, are dissolved in physiological salt solution, or 
one slightly weaker, in order that they will be isotonic (same salt density as 
the blood) when injected into the circulation. 
Average dose: 15 Gm. or 240 grains dissolved in warm water as an emetic. 
Liquor Sodii Chloridi Physiologicus, Physiological Solution of Sodium Chloride 
(Physiological Salt Solution, Normal Salt Solution), U. S. P.— 
Sodium chloride 8. 5 Gm. 
Distilled water, a sufficient quantity 
To make 1000. 0 cc. 
Dissolve the sodium chloride in sufficient freshly distilled water, neutral to 
litmus paper, to measure 1,000 cc, and filter, returning the filtrate until free 
from foreign particles. Transfer the solution to a sterile flask of insoluble glass 
having a capacity of about 1,000 cc, and stopper with a plug of purified, non- 
absorbent cotton, wrapped in gauze. Fasten stout, nonabsorbent paper or tin- 
foil over the top of the cotton and the lip of the container, and sterilize in an 
autoclave under steam pressure, maintaining a temperature of not less than 
115° C. for 30 minutes. This solution must be protected from contamination 
and should be used intravenously within 24 hours after its preparation and 
sterilization. 
Sodii Citras, Sodium Citrate, U. S. P.—It contains not less than 99 per cent of 
C3H4.(OH) .(COONa)s and not less than 10 per cent nor more than 13 per cent 
of water. Preserve it in well-closed containers. 
Properties: Occurs as a white granular powder, odorless, and having a 
cooling saline taste. It is very soluble in water, and is insoluble in alcohol. 
An aqueous solution is slightly alkaline to litmus. It has the property of 
holding in solution certain insoluble substances, a property possessed by other 
alkaline citrates. 
Preparation ; It is made by the action of citric acid on sodium carbonate, 
2CsH4(OH) (C00H)3+3Na3C03=2C3H(0H) (C00Na)3+3C02+3H20. 194 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
Action and Uses : An aqueous solution has the property of preventing coag- 
ulation of the blood and delaying the curdling of milk. A solution containing 
2 grains of sodium citrate and 20 grains of sodium chloride to 1 fluidounce of 
water (Wright’s solution) is used for the irrigation of wounds and as a local 
application for furunculosis. For modifying cow’s milk in infant feeding to 
prevent the formation of large curds, 1 grain of sodium citrate to 1 fluid- 
ounce of milk may be used. Its action in preventing coagulation of the blood 
and delaying milk curdling is supposed to be due to the formation of calcium 
citrate, which does not ionize and is therefore inactive. It is used in Pharmacy 
as a buffer agent. 
Average dose: 1 Gm. or 15 grains. 
Sodii lodidum, Sodium Iodide, U. S. P.—It contains not less than 99 per cent 
of Nal. 
Properties : Colorless, odorless crystals, or a white, granular powder. In 
moist air it cakes and then deliquesces, and frequently undergoes decompo- 
sition, developing a brown tint. It is very soluble in water, alcohol, and 
glycerin. It should be preserved in airtight containers. 
Action and Uses: It has the same action as potassium iodide but is less 
irritating to the stomach. The “iodized table salt” sold in the United States 
contains 0.1 Gm. of sodium iodide in each 1,000 Gm. of sodium chloride. 
Average dose: 0.3 Gm. or 5 grains. 
Sodii Perboras, Sodium Perborate, U. S. P.—It contains not less than 9 per 
cent of available oxygen, corresponding to about 86.5 per cent of NaB03.4H20. 
Preserve it in well-closed containers. 
Properties: It occurs as white, crystalline granules or as a white powder. 
It is odorless and has a saline taste. It is stable in cool dry air, but is de- 
composed with the evolution of oxygen in warm or in moist air. One gram 
is soluble in 40 cc of water. In aqueous solution sodium perborate is decom- 
posed into sodium metaborate and hydrogen peroxide, the solution gradually 
evolving oxygen. Oxygen is evolved more rapidly if the solution is warm. 
A saturated aqueous solution is alkaline to litmus paper. 
Action and Uses: It is used as a cleansing mouth antiseptic. It is used 
in tooth pastes, tooth powders, and mouth washes. Solutions of sodium per- 
borate should be prepared fresh as they easily decompose on standing. 
Average dose: 0.06 Gm., or 1 grain. 
Sodii Phosphas, Sodium Phosphate, Na2HP04-f 7H20, U. S. P.—It contains, when 
dried to constant weight at 110° C., not less than 98 per cent of Na2HP04. It 
contains not less than 43 per cent and not more than 50 per cent of water. 
Preserve it in well-closed containers in a cool place. 
Properties : Occurs as a colorless or white, granular salt, efflorescent in warm, 
dry air. It is very soluble in water and slightly soluble in alcohol. An aqueous 
solution is alkaline to litmus. If sodium phosphate is stored in a warm store- 
room, much of the water of crystallization separates and the sodium phosphate 
settles in the bottom of the bottle, forming a hard mass that cannot be removed 
without breaking the bottle. This hard mass, having lost most of its water of 
crystallization, is much stronger than the granular salt. 
Preparation: Sodium phosphate is made from the inorganic part of animal 
bones. Bones contain a large amount of calcium phosphate (Ca3(P04)2), which 
by a series of reactions is converted into sodium phosphate. Sodium phosphate, 
if not properly prepared, may contain arsenic as an impurity through the use 
of impure sulfuric acid in its manufacture. MATERIA MEDICA AND THERAPEUTICS 
195 
Action and Uses: It is used as a saline cathartic, acting much like mag- 
nesium sulfate. It is administered dissolved in warm water and given before 
breakfast. It is considered an excellent remedy in catarrhal jaundice and 
chronic gastric catarrh. 
Average dose: 4 Gm. or 60 grains. 
Sodii Salicylas, Sodium Salicylate, NaCiHsOs, U. S. P.—It contains, when dried 
to constant weight at 100° C., not less than 99.5 per cent of pure 
CdL.OH.COONa. Preserve it in well-closed containers, protected from heat 
and light. 
Properties ; Occurs as a white powder, or scales, or an amorphous powder, 
colorless or with a faint pink tinge, odorless, and having a sweet saline taste. 
Soluble in 0.9 part of water, 9.2 parts of alcohol, and in 4 parts of glycerin. An 
aqueous solution is neutral or faintly acid to litmus. 
Preparation : It is prepared by mixing pure salicylic acid with sufficient 
distilled water to form a paste and then with pure, crystallized sodium car- 
bonate (uneffloresced), the reaction being: 2G;H4(OH)COOH-f-NaaCOs=2043-1 
(OH) COONa+H20+COa. 
Action and Uses: It is used as an antirheumatic, analgesic, and antipyretic. 
It is a valuable remedy in the treatment of rheumatism, tonsillitis, and influ- 
enza. It should be given with sodium bicarbonate to prevent precipitation 
of salicylic acid by the hydrochloric acid in the stomach. 
Average dose: 1 Gm. or 15 grains. 
Sodii Thiosulfas, Sodium Thiosulfate (Hypo, Sodium Hyposulfite) NaaSaOs+SHaO, 
U. S. P.—It contains, when rendered anhydrous by drying to constant weight 
at 100° C., not less than 99 per cent of Na2S203. It contains not less than 32 per 
cent and not more than 37 per cent of water. Preserve it in well-closed 
containers. 
Properties : Occurs as large, colorless crystals or a coarse crystalline powder. 
It is permanent in the air below 33° C., but effloresces in dry air above that 
temperature; deliquescent in moist air. Soluble in 0.5 part of water and 
insoluble in alcohol. When an aqueous solution is boiled the salt is decomposed 
rapidly. When brought in contact with a solution of iodine it immediately 
decolorizes the iodine, forming new compounds. It is capable of dissolving the 
halogen compounds of silver, as ; AgBr-fNa2S203=NaAgS203-l-NaBr. An aqueous 
solution is faintly alkaline to litmus paper. 
Preparation : It can be made by treating calcium thiosulfate with sodium car- 
bonate, CaS203+Na2C03—CaC03+Na2S203. 
Action and Uses: An aqueous solution of 1 in 10 may be used for various 
parasitic diseases of the skin. In the absence of starch it may be used for 
iodine poisoning. An aqueous solution is the best agent for removing iodine 
stains from linen. It is used extensively in photography as a fixing bath. 
Average dose: 1 Gm. or 15 grains. 
Sodii Sulfas, Sodium Sulfate (Glauber’s Salt), U. S. P.—When rendered anhy- 
drous by drying at 120° C. it contains not less than 99 per cent of Na2S04. 
It contains not less than 51 per cent and not more than 57 per cent of water. 
Preserve it in well-closed containers. 
Description : Large, colorless, odorless, transparent crystals or a granular 
powder. The salt effloresces rapidly in the air. One Gm. is soluble in 1.5 
cc of water. It is insoluble in alcohol but is soluble in glycerin. It liquefies 
in its water of hydration at about 33° C., and at 100° 0. it loses all of its 
water of hydration. An aqueous solution of the salt is neutral to litmus 
paper. 196 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Action and Uses : It is used as a saline cathartic. It is sometimes given 
with other salts. See Artificial Carlsbad Salt, N. F. 
Average dose: 15 Gm. 
Liquor Sodii Hypochloritis, Solution of Sodium Hypochlorite, U. S. P.— 
Caution : This solution is not suitable for application to wounds. 
Description : A clear, pale, greenish-yellow liquid, having a slight odor of 
chlorine. The solution first colors red litmus paper blue and then bleaches it. 
The addition of diluted hydrochloric acid to the solution causes evolution of 
chlorine. Preserve it in well-stoppered bottles in a cool place protected from 
light. 
Action and Uses: This solution is used in preparing the Diluted Solution 
of Sodium Hypochlorite, U. S. P. 
Liquor Sodii Hypochloritis Dilutus, Diluted Solution of Sodium Hypochlorite, 
U. S. P.—An aqueous solution of chlorine compounds of sodium containing 
in each 100 cc not less than 0.45 Gm. and not more than 0.50 Gm. of NaOCl, 
equivalent to not less than 0.43 Gm. and not more than 0.48 Gm. of available 
chlorine when prepared as directed in the U. S. P. 
Description: A colorless or faintly yellow liquid having a slight odor sug- 
gesting chlorine. Preserve it in well-stoppered bottles in a cool place pro- 
tected from light. 
Action and Uses : This is Modified Dakin’s Solution. It is used for continu- 
ous irrigation of infected founds. This solution can also be prepared by passing 
chlorine gas through a solution of sodium carbonate. 
Aqua Ammoniac Fortior, Stronger Ammonia Water, U. S. P.—An aqueous 
solution of ammonia (NH3) containing not less than 27 per cent nor more than 
29 per cent by weight of NH3. This solution deteriorates rapidly in open con- 
tainers. Preserve it in a cool place in glass-stoppered or rubber-stoppered 
bottles made of hard glass, free from lead. Great caution should be used in 
handling this liquid because of its caustic and irritating properties and it 
must never be tasted or smelled unless very greatly diluted. 
Properties : It has an excessively pungent, characteristic odor and a very 
caustic and alkaline taste. In its chemical properties it closely resembles the 
solutions of potassium or sodium hydroxide, being a strong, caustic alkali. 
If kept in a warm place, ammonia (NHS) is liberated and held in the upper 
part of the bottle; therefore great care should be exercised in opening the 
bottle to see if the stopper has been secure and has not allowed the gas to 
escape. There is danger of the sudden escape of a large amount of gas, which 
might cause injury to the eyes or mucous membranes of the nose and throat 
by inhalation. 
Preparation: Ammonia is a by-product in the manufacture of illuminating 
gas. When coal is subjected to destructive distillation ammonia is one of the 
products formed. The gases formed are passed through an acid solution (sul- 
furic or hydrochloric) and an ammonium salt is formed (ammonium sulfate 
or chloride, according to the acid used). This salt then is heated with lime, 
ammonia (NH3) is set free, and after passing it through quicklime it is passed 
into water until a saturated solution is formed. 
Action and Uses: Stronger ammonia water is never given internally. It is 
used in making the weaker solution of ammonia, known as ammonia water. 
Ammonia water is an aqueous solution of ammonia (NHS) containing not less 
than 9.0 grams nor more than 10.0 grams of NH3 in each 100 cc. This solution 
is used in making aromatic spirit of ammonia and ammonia liniment. The 
antidote for ammonia water is weak acids the same as for other alkaline hy- 
droxides. Inhalations of ammonia gas stimulate the heart and respiratory cen- 197 
MATEEIA MEDICA AND THERAPEUTICS 
ter. CEdema of the glottis, resulting in obstructed breathing, might result in 
giving inhalations of concentrated ammonia gas; therefore care should be 
exercised in giving inhalations to an unconscious patient. 
Ammonii Chloridum, Ammonium Chloride (Sal Ammoniac, Ammonium Mu- 
riate), NH4CI, U. S. P.—It contains, when dried for 24 hours over sulfuric acid, 
not less than 99.5 per cent of NH4C1. 
Properties: It is soluble in 2.6 parts of water, 100 parts of alcohol, and 8 
parts of glycerin. On heating it does not melt, but passes directly to the 
gaseous state. It occurs as colorless crystals or a white, crystalline powder, 
having a cool saline taste. It is somewhat hygroscopic. 
Preparation : It is chiefly made from gas liquor, the ammoniacal liquid ob- 
tained from gas works during the destructive distillation of coal in the manu- 
facture of illuminating gas, and neutralized with hydrochloric acid: NHs+ 
HC1=NH4C1. 
Action and Uses: It is a valuable stimulant expectorant and often is used 
in cough mixtures (Brown mixture with ammonium chloride). Large doses 
lower the alkali reserve of the blood and increase the acidity of the urine. 
Large doses irritate the stomach and must be given in capsules coated with 
stearic acid or other enteric coating. 
Average dose: 0.3 Gm. or 5 grains. 
Ammonii Carhonas, Ammonium Carbonate, U. S. P.—It consists of a mixture 
of acid ammonium carbonate (NH4HC03) and ammonium carbamate (NH4NH2 
CO2) in varying proportions, and yields not less than 30 per cent nor more 
than 32 per cent of NH3. Preserve it in airtight containers in a cool place pro- 
tected from light. For medicinal purposes use only the translucent portions. 
Properties : It occurs in white, hard, translucent masses, having an ammo- 
niacal odor. On exposure to the air the salt loses both ammonia and carbon 
dioxide, becoming opaque, and finally is converted into friable, porous lumps 
or a white powder. It is soluble in 4 parts of water and is decomposed by hot 
water with the elimination of carbon dioxide and ammonia. Alcohol dissolves 
the carbamate, but leaves the acid ammonium carbonate. An aqueous solution 
is alkaline to litmus. 
Preparation : At present it is made principally by the sublimation of a mix- 
ture of ammonium sulfate and calcium carbonate, 2(NH4)2S04+2CaC03=2CaS04 
+NH4HCa.NH4NH2C02-f-NH3+H20. 
Action and Uses: It is used in making aromatic spirit of ammonia and 
solution of ammonium acetate. It is a stimulant expectorant and heart stim- 
ulant, and is used in expectorant mixtures and smelling salts. It should 
never be given in powdered form because it is irritating. Mixed with an equal 
bulk of stronger ammonia water and scented with oil of lavender, it con- 
stitutes the common smelling salts. 
Average dose: 0.3 Gm. or 5 grains. 
Spiritus Ammoniac Aromaticus, Aromatic Spirit of Ammonia, U. S. P.—It con- 
tains in each 100 cc, not less than 1.7 Gm. and not more than 2.1 Gm. of total 
NH3; and ammonium carbonate, corresponding to not less than 3.5 Gm. and 
not more than 4.5 Gm. as (NH4)2C03. Preserve it in glass-stoppered bottles, 
in a cool place and protected from light. 
Description: A nearly colorless liquid when freshly prepared, but gradually 
acquiring a yellow color on standing. It has the taste of ammonia, and an 
aromatic and pungent odor. 
Action and Uses : It is used as a reflex stimulant to prevent fainting, and 
to relieve nausea or sick headache caused by hyperacidity of the gastric juice. 198 
HANDBOOK OF THE HOSPITAL CORPS, 17. S. NAVY 
It should be given well diluted with water. It contains from 62 to 68 per cent 
of alcohol. 
Average dose: 2 cc or 80 minims. 
The alkaline earth elements and their compounds, 
The alkaline earth elements are magnesium, calcium, strontium, and barium. 
They are called alkaline earth elements because their oxides have marked alka- 
line (basic) properties, and the compounds of these elements are found abund- 
antly in the earth. They are all divalent and are strongly electropositive. Their 
compounds are not nearly as soluble as the compounds of the alkali elements; 
in fact, many of their compounds are insoluble in water. The hydroxides, 
carbonates, and sulfates (except magnesium sulfate) are insoluble or only 
slightly soluble in water. Their alkaline properties are not as intense as in the 
case of the alkali elements (sodium, potassium, lithium), and their hydroxides 
are classed as mild alkalies (milk of magnesia and lime water). 
Magnesium compounds. 
Magnesii Carbonas, Magnesium Carbonate, U. S. P.—Basic hydrated magne- 
sium carbonate, equivalent to not less than 39.2 per cent and not more than 
41.5 per cent of MgO. 
Properties: It occurs as light, white, friable masses, or a white, bulky powder, 
odorless, and having a slight earthy taste. It is practically insoluble in water 
and alcohol. It is stable in the air. 
Preparation : It is made by mixing cold dilute solutions of magnesium sulfate 
and sodium carbonate: 5MgS04-l-5Na2C03H-H20=4MgC03.Mg(0H)2-f5Na2S04+ 
C02. 
Action anp Uses: It is used in making solution of magnesium citrate and 
magnesia magma. It is given internally as an antacid and as an antidote for 
acid poisoning. 
Average dose: 3 Gm. or 45 grains. 
Magnesii Sulfas, Magnesium Sulfate (Epsom Salt) MgS04.7H20, U, S. P.—It 
contains, when rendered anhydrous by ignition, not less than 99.5 per cent of 
MgSCh. It contains not less than 45 per cent and not more than 52 per cent of 
water. Preserve it in well-closed containers. 
Properties : It occurs as small, colorless needle-like prisms, without odor, and 
having a cooling, saline, and bitter taste. It is soluble in 0.8 part of water, 
almost insoluble in alcohol, and is slowly efflorescent in warm, dry air. 
Preparation: One of the methods of making magnesium sulfate is by the 
action of sulfuric acid on magnesium carbonate (mineral magnesite), MgCOs+ 
H2S04=MgS04+H20+C02. 
Action and Uses : It is an extensively used saline cathartic. It should be 
given before breakfast in a saturated aqueous solution. It acts both by pre- 
venting absorption of fluid from the bowel and by drawing more fluid from the 
blood into the intestine. Applied externally in saturated solution on lint to 
swollen joints in acute arthritis, to swollen testicles in orchitis, and to boils, it 
relieves pain and congestion by extracting fluid from these parts. It is the 
chemical antidote for poisoning by lead acetate, producing an insoluble lead 
sulfate, and is also used in phenol poisoning. Magnesium sulfate can be made 
more pleasant to take by mixing it with sodium bicarbonate, citric acid, and 
tartaric acid. This mixture is known as Effervescent Salt of Magnesium Sul- 
fate, N. F. 
Average dose: 15 Gm. or 4 drams. MATERIA MEDICA AND THERAPEUTICS 
199 
Magma Magnesias, Magnesia Magma (Milk of Magnesia), U. S. P.—It is an 
aqueous suspension of magnesium hydroxide containing not less than 7 per 
cent and not more than 8.5 per cent of Mg (OH) 2. For the purpose of mini- 
mizing the action of the glass container on Magnesia Magma, 0.1 per cent 
of citric acid may be added. One-half cc of a volatile oil or a blend of volatile 
oils suitable for flavoring purposes may be added to each 1,000 cc of Mag- 
nesia Magma. It should be stored in a cool place where the temperature is 
not above 35° C. It should not be permitted to freeze. 
Description: A white, opaque, more or less viscous suspension from which 
varying amounts of water usually separate on standing. It is alkaline to 
litmus and to phenolphthalein test solution. 
Action and Uses: It is used as an antacid and mild laxative and for other 
purposes for which magnesium oxide is used. 
Average dose: 4 cc or 1 fluidram as an antacid; 15 cc or 4 fluidrams as a 
laxative. 
Liquor Magnesii Citratis, Solution of Magnesium Citrate, U. S. P.—It contains 
in each 100 cc an amount of magnesium citrate corresponding to not less 
than 1.6 Gm. and not more than 1.9 Gm. of MgO. 
Description: A slightly yellow, clear, effervescent liquid, having a sweet, 
acidulous taste, and a lemon flavor. Keep the bottle on its side in a cool 
place, preferably in a refrigerator. 
Action and Uses: It is an agreeable saline purgative. 
Average dose: 200 cc or 7 fluidounces (1 glassful). 
Magnesii Oxidum Ponderosum, Heavy Magnesium Oxide (Heavy Magnesia), 
U. S. P.—Heavy Magnesium Oxide contains after ignition, not less than 96 
per cent of MgO. Its loss in weight, during ignition, does not exceed 10 per' 
cent. Preserve it in well-closed, moisture-proof containers. 
Description; In the form of a white powder. It absorbs moisture and car- 
bon dioxide when exposed to the air. 
Action and Uses : Used as an antacid to neutralize excessive acidity in 
the gastric juice, or acidity due to fermentation in the intestines. It is a good 
antidote for corrosive acid poisoning. 
Average dose: 0.25 Gm. or 4 grains as an antacid; 3.0 Gm. or 45 grains as 
a laxative. 
Talcum Purificatum, Purified Talc, U. S. P.—A purified, native, hydrous mag- 
nesium silicate, sometimes containing a small amount of aluminum silicate. 
Properties : It is a very fine white or grayish-white crystalline powder which 
adheres to the skin, free from grittiness and unctuous to the touch. When used 
as a filtering medium it should not be finer than No. 100 powder. 
Preparation; It is prepared by treating ordinary talcum with several wash- 
ings of diluted hydrochloric acid, which dissolves out aluminum, iron, and 
other salts of magnesium. 
Action and Uses: It forms the base of nearly all cosmetic powders. It is 
an excellent dusting powder, and is used in pharmaceutical operations as a 
filtering medium. When perfumed or medicated, or both, it is sold as talcum 
powder. 
Calcium compounds. 
Calx, Lime (Calcium Oxide, Quicklime), N. F.—When freshly ignited to con- 
stant weight with a blast lamp, it contains not less than 95 per cent of OaO. 
It loses not more than 10 per cent of its weight on ignition. Keep lime in air- 
tight containers, in a dry place. 200 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Description : Lime occurs in hard, white or grayish white masses or gran* 
ules or a white powder. It is odorless. One gram is soluble in 840 cc of 
water at 25° C. and in 1,740 cc of boiling water. It is soluble in glycerin 
and syrup, but is insoluble in alcohol. When moistened with water, lime 
becomes heated and is gradually converted into a white powder (calcium 
hydroxide or slaked lime). When this slaked lime is mixed with about three 
or four times its weight of water, it forms a smooth magma (milk of lime). 
Water when agitated with lime becomes alkaline to litmus paper. 
Action and Uses : Lime is used in making Solution of Sulfurated Lime, 
N. F. It may be used in making Lime Water, but the Pharmacopoeia now 
provides Calcium Hydroxide for this purpose. {See Calcium Hydroxide.) 
Quick-lime (lime) is used to disinfect excreta in outdoor toilets. 
Calcii Hydroxidum, Calcium Hydroxide (Slaked Lime), U. S. P.—Calcium 
hydroxide contains not less than 95 per cent of Ca(OH)2. Preserve it in 
airtight containers. 
Description : A soft, white crystalline powder, possessing an alkaline, 
slightly bitter taste. One gram of calcium hydroxide dissolves in 630 cc of 
water at 25° C., and 1 gram dissolves in 1,300 cc of water at the boiling 
temperature. It is soluble in glycerin and in syrup but is insoluble in alcohol. 
When mixed with about three or four times its weight of water, it forms a 
smooth paste (milk of lime). 
Action and Uses : It is used in making Solution of Calcium Hydroxide, 
U. S. P. 
Liquor Calcii Hydroxidi, Solution of Calcium Hydroxide (Lime Water), 
U. S. P.—Solution of Calcium Hydroxide is an aqueous solution containing 
in each 100 cc at 25° O., not less than 0.14 Gm. of Ca(OH)2. The content of 
calcium hydroxide varies with the temperature at which the solution is 
stored, being about 0.17 Gm. per 100 cc at 15° C., and less at a higher tem- 
perature. Preserve it in well-filled, tightly-stoppered bottles, in a cool place. 
Description ; A clear, colorless, odorless liquid with a sweetish, alkaline 
taste. The solution is strongly alkaline to litmus paper. It absorbs carbon 
dioxide from the air, a film of calcium carbonate forming on the surface of 
the liquid. When heated, it becomes turbid, due to the separation of calcium 
hydroxide. Calcium hydroxide is less soluble in hot water than in cold water. 
Action and Uses ; Lime Water is an antacid. It is added to milk to prevent 
formation of large curds in the stomach, 1 part of Lime Water to 4 parts of 
milk. It is an antidote for corrosive acid poisoning; however, because it is 
a very dilute solution, a very large amount would have to be given to neu- 
tralize a considerable amount of acid. 
Average dose: 15 cc or 4 fluidrams. 
Calcii Chloridum, Calcium Chloride, U. S. P.—Calcium Chloride is a hydrated 
salt, containing not less than 75 per cent and not more than 85 per cent of 
CaCl2. Preserve it in airtight containers. 
Description : White, slightly translucent, hard, odorless fragments or gran- 
ules. It is very deliquescent. One gram is soluble in 1.2 cc of water, and in 
about 10 cc of alcohol. An aqueous solution of the salt (1 in 20) is neutral 
or slightly alkaline to litmus paper. 
Action and Uses : In internal haemorrhage, certain bone diseases, and for lime 
deficiency anywhere in the body. Other salts of calcium are preferred for 
oral administration. It has been given intravenously in certain haemorrhagic 
conditions. 
Average dose: 1 Gm. or 15 grains. 
Greta Praeparata, Prepared Chalk, (Drop Chalk), U. S. P.—Prepared Chalk 
is a native form of calcium carbonate freed from most of its impurities by MATERIA MEDICA AND THERAPEUTICS 
201 
elutriation, and containing, when dried to constant weight at 200° C., not less 
than 97 per cent of CaCCh. 
Description : A white to grayish-white, micro-crystalline powder often 
formed into “conical drops”. It is odorless and tasteless, and is stable in the 
air. It is practically insoluble in water and is insoluble in alcohol. 
Action and Uses : It is used in the preparation of Mercury with Chalk, Chalk 
Mixture, and Compound Chalk Powder. Prepared Chalk possesses a stickiness 
causing it to adhere to irritated mucous surfaces of the intestinal tract. This 
property accounts for its preference for internal use over Precipitated Calcium 
Carbonate. It is a valuable antacid. It is used in tooth powders and pastes. 
It is a very good antidote for corrosive acid poisoning, particularly oxalic acid 
poisoning. 
Average dose: 1 Gm. or 15 grains. 
Calcii Carbonas Praecipitatus, Precipitated Calcium Carbonate (Precipitated 
Chalk), U. S. P.—Precipitated Calcium Carbonate, when dried to constant weight 
at 200° C., contains not less than 98 per cent of CaCo3. 
Description : A fine, white, micro-crystalline powder, without odor or taste. 
It is stable in the air. It is practically insoluble in water. Its solubility in 
water is increased by the presence of any ammonium salt and by the presence 
of carbon dioxide. It is insoluble in alcohol. 
Action and Uses: It is an antacid and detergent, but Prepared Chalk is pre- 
ferred for internal use. It is used in tooth powders. It is also used in dusting 
powders to neutralize acid secretions. It is the best Known antidote for poison- 
ing by oxalic acid. It is also a good antidote for poisoning by inorganic acids. 
Calcii Gluconas, Calcium Gluconate, U. S. P.—Calcium Gluconate is the normal 
calcium salt of gluconic acid. It yields not less than 12.4 per cent and not more 
than 12.8 per cent of CaO. Preserve in well-closed containers. 
Average dose : 1 Gm. or 15 grains. 
Description : A white, crystalline or granular powder. It is odorless, taste- 
less, and is stable in the air. One gram is slowly soluble in 30 cc of water. 
It is insoluble in alcohol. An aqueous solution (1 in 50) is neutral to litmus 
paper. 
Action and Uses: It increases the blood calcium. It is used in all calcium 
deficiencies. It is also used before surgical operations to lessen blood coagu- 
lation time. It may be given intravenously, and by mouth. Solutions of 
calcium gluconate are less irritating than the chloride and are preferred, for 
subcutaneous injection. 
Average dose: 5 Gm. or 75 grains, orally; 1 Gm. or 15 grains, intravenously. 
Calcii Lactas, Calcium Lactate, U. S. P.—Calcium Lactate is a hydrated salt 
containing not less than 25 per cent and not more than 30 per cent of water. 
When rendered anhydrous by drying to constant weight at 120° C., it contains 
not less than 98 per cent of (CH3.GH.OII.COO) 2Ca. Preserve it in well-closed 
containers. 
Description : A white, almost odorless powder. It is somewhat efflorescent 
and at 120° Co. becomes anhydrous. One gram is soluble in 20 cc of water. 
It is practically insoluble in alcohol. 
Action and Uses : It increases the blood calcium. It is used for the same 
purpose as the gluconate. 
Average dose: 1 Gm. or 15 grains. 
Barium compounds. 
Barii Sulfas, Barium Sulfate, U. S. P.—In directing the use of Barium Sulfate 
the title should always be written out in full to avoid confusion with the 
poisonous barium sulfide or sulfite. 202 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Description : A fine, white, odorless, tasteless, and bulky powder, free from 
grittiness. It is insoluble in water, in organic solvents and in aqueous solutions 
of acids and of alkalies. 
Action and Uses : It is used in making X-ray pictures of the stomach and 
intestine. It passes unchanged through the gastro-intestinal tract. It should 
be remembered that soluble salts of barium are poisonous. Barium Sulfate is 
nonpoisonous because it is insoluble in water or in the juices of the intestinal 
tract. The New and Nonofficial Remedies describes the method of admin- 
istration as follows: 
“For Roentgen Examination of the Stomach.—The evening before the exam- 
ination, the patient receives 1 fluidounce of castor oil. In the morning an 
ordinary portion of wheat-meal porridge, with which 2 ounces of barium 
sulfate has been well mixed, together with a little sugar and cream, is admin- 
istered by mouth. The patient is then directed to abstain from further food. 
The examination is made 6 hours later. 
“For Roentgen Examination of the Colon.—An enema consisting of 16 ounces 
of mucilage of acacia, 3 pounds of condensed milk, and 8 ounces of barium 
sulfate is warmed to body temperature and injected into the rectum from a 
height of from 3 to 6 feet (90 to 180 cm). The examination is made with a 
fluoroscope while the injection is passing into the rectum.” 
Zinc compounds. 
Zinci Oxidum, Zinc Oxide, ZnO, U. S. P.—It contains, when freshly ignited 
not less than 99 per cent of ZnO. 
Properties: It is a very fine, amorphous, white or yellowish-white powder, 
free from gritty particles, without odor or taste. It gradually absorbs carbon 
dioxide from the air; is insoluble in water or alcohol, but soluble in ammonia 
and ammonium carbonate test solutions, and in dilute acids. 
Preparation: It is made by calcination of pure zinc carbonate: 2ZnCOs. 
3Zn (OH) 2+heat=5Zn0+3H20+2C02. 
Action and Uses: Zinc oxide is a nontoxic protective and is mildly astringent 
and slightly antiseptic. It may be employed either in the form of a dusting 
powder, in a paste, in an ointment, or suspended in an aqueous mixture. The 
most popular of these is zinc-oxide ointment, which is composed of 20 per cent 
zinc oxide, 10 per cent liquid petrolatum, 5 per cent wool fat, 5 per cent white 
wax, and 60 per cent white petrolatum. 
Zinci Sulfas, Zinc Sulfate (White Vitriol), ZnS04+7H20, U. S. P.—It contains 
not less than 55.86 per cent nor more than 58.63 per cent of zinc sulfate, corre- 
sponding to not less than, 99.5 per cent of the hydrated salt (ZnSCb+'iTELO). 
Preserve it in well-closed containers. 
Properties: It occurs in colorless, transparent prisms, or small needles, or as 
a granular, crystalline powder, odorless, and having an astringent and metallic 
taste. It is efflorescent in dry air. Soluble in 0.6 parts of water, 2.5 parts of 
glycerin, and insoluble in alcohol. An aqueous solution is acid to litmus paper. 
Preparation: Made by treating metallic zinc with, diluted sulfuric acid; 
Zn+H2S0*=ZnS04+H2. 
Action and Uses : It is employed as an astringent and emetic. A weak 
aqueous solution 1-400 may be used as an eye wash, gargle, or urethral 
injection in gonnorhoea. It acts as a prompt emetic in 15-grain doses but as 
other drugs are preferred, it seldom is used. It is used in the Navy prin- 
cipally as an astringent eye wash, 1 grain dissolved in 1 fluidounce of dis- 
tilled water. 
Average dose; 1 Gm. or 15 grains. (As an emetic.) MATERIA MEDICA AND THERAPEUTICS 
203 
Calamina Prseparata, Prepared Calamine, N. F.—Prepared Calamine is zinc 
oxide with a small amount of ferric oxide, and contains, after ignition, not 
less than 98 per cent of ZnO. 
Description : Prepared Calamine is a pink powder which will pass through 
a number 100 sieve. It is odorless and almost tasteless. It Is insoluble in 
water but dissolves almost completely in mineral acids. 
Action and Uses : It is mildly astringent and soothing when applied to 
the inflamed skin. It is used in ointments, lotions, and powders. 
Zinci Chloridum, Zinc Chloride, U. S. P.—Zinc Chloride contains not less 
than 95 per cent of ZnCh. Preserve it in glass-stoppered bottles. 
Description : A white, or nearly white, odorless, crystalline powder, or in 
porcelain-like masses, or molded into pencils. It is very deliquescent. One 
gram is soluble in 0.25 cc of water, and in about 1.3 cc of alcohol. It is 
soluble in 2 parts of glycerin. An aqueous solution of the salt (1 in 10), is 
acid to litmus paper. Solutions of Zinc Chloride when diluted with much 
water become turbid, owing to hydrolysis. This turbidity disappears upon 
the addition of a small quantity of hydrochloric acid. 
Action and Uses: It is antiseptic, astringent, and escharotic. Solution of 
Zinc Chloride should be filtered through glass wool, because it dissolves paper 
filters. If an eye solution of zinc chloride becomes turbid it should not be 
cleared up with hydrochloric acid. The antidote for zinc chloride poisoning is 
sodium bicarbonate followed by milk or white of egg. A 1 to 2 per cent solution 
is used as a dental astringent and antiseptic. It is not given internally. 
Zinci Stearns, Zinc Stearate, U. S. P.—Zinc Stearate is a compound of zinc 
with variable proportions of stearic acid and palmitic acid, corresponding to not 
less than 13 per cent and not more than 15.5 per cent of ZnO. 
Description ; A fine, white, bulky powder, free from grittiness, and having 
a faint, characteristic odor. It is insoluble in water and in alcohol. 
Action and Uses: Used as an infant dusting powder but must be used with 
care to avoid inhalation of the fine dust,' which is toxic, causing inflammation 
of the baby’s lungs. It is also used in ointments. 
Aluminum compounds. 
Alumen, Alum, U. S. P.—It contains not less than 99.5 per cent of A1NH4 
(S04)2+12H20; or A1K(S04)2+12H20. The label of the container must indi- 
cate whether the salt is ammonium alum or potassium alum. 
Properties : It occurs as large, colorless crystals, crystalline fragments, or 
as a white powder, odorless, and having a sweetish, strongly astringent 
taste. Soluble in 5.2 to 7.2 parts of water, insoluble in alcohol, and fairly 
soluble in glycerin. Potassium alum is more soluble in water than ammonium 
alum. An aqueous solution of alum is acid to litmus. Ammonium alum can 
be distinguished from potassium alum by heating a small quantity of a sample 
with lime. If it is ammonium alum, ammonia will be set free from the mix- 
ture. When a hot concentrated solution of alum is poured into a hot concen- 
trated solution of an alkaline carbonate the carbonate is decomposed with the 
liberation of C02 (similar to the action of an acid on a carbonate). This 
reaction is taken advantage of in the manufacture of cheap baking powders; 
alum mixed with sodium bicarbonate is mixed with the dough used in making 
bread. When the dough begins to bake the reaction starts, liberating C02 
which, in rising, carries the dough with it for a certain distance. 
154294°—39 14 204 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Preparation: Made principally from aluminum clay (silicate) by treat- 
ment with sulfuric acid and then adding potassium or ammonium sulfate, 
forming the double salt. 
Action and Uses: It is used as an astringent both internally and externally. 
Used as a local styptic in epistaxis, external haemorrhages and bleeding from 
mucous membranes, to which the powder can be applied drectly. In nosebleed 
a saturated solution on pledgets of cotton sometimes is used in the nares. 
Barbers use it for bleeding caused by shaving. When powdered it is used as 
an emetic. Alum is used in making exsiccated alum U. S. P. (burnt alum), 
which is alum deprived of its water of crystallization. The properties of exsic- 
cated alum are the same as those of alum except that they are more intensified. 
Average dose: 0.5 Gm., or 8 grains. 
Alumen Exsiccatum, Exsiccated Alum (Burnt Alum), U. S. P.—Exsiccated 
Alum, when recently dried to constant weight at 200° C., contains not less 
than 96.5 per cent of Ammonium Alum (A1NH4(SO<)*) or of Potassium 
Alum (AIK(864)2). The label of the container must indicate whether the 
Exsiccated Alum was m'ade from Ammonium Alum or Potassium Alum. 
Preserve it in airtight containers. 
Description : A white, odorless power. It has a sweetish, astringent taste, 
and absorbs moisture on exposure to air. 
Action and Uses : It is almost twice as strong as Alum, U. 8. P., which 
contains water of crystallization. Its astringent and caustic action is due 
largely to its great affinity for water. It is used by barbers to stop bleeding 
caused by razor cuts. It is not given internally. 
Iron compounds. 
Iron forms two series of chemical compounds, in one of which it has a valence 
of three and the compounds are known as ferric; in the other it has a valence 
of two and the compounds are known as ferrous. The ferric compounds are 
distinguished by their brown color, the ferrous compounds are green. The 
ferric compounds are fairly stable; the tendency of the ferrous compounds 
is to change to the ferric condition, especially in the presence of oxidizing 
agents. The ferric compounds are oxidizing agents; the ferrous compounds 
are reducing agents. Ferrous compounds are made by the action of an acid on 
an electronegative element, such as iodine, on metallic iron, excluding the air 
(oxygen), which is an oxidizing agent, to prevent oxidation to the ferric state. 
Ferric compounds are made by oxidizing ferrous compounds. The principal 
effect of iron on the system is that it increases the amount of hsematin in the 
haemoglobin of the blood resulting in an improvement in the functions of the 
various organs of the body, to which its tonic effect is due. Both locally and 
internally iron acts as an astringent. The astringent properties of the different 
compounds vary, some being very active while others are very mild. Most of 
the compounds of iron are soluble in water. The oxide, hydroxide, and 
carbonate are insoluble. 
Tinctura Ferri Chloridi, Tincture of Ferric Chloride (Tincture of Iron), U. 8. 
P.—A hydroalcoholic solution containing in each 100 cc, about 13 per cent of ferric 
chloride (FeCU), corresponding to not less than 4.5 per cent of Fe. Protect tinc- 
ture of ferric chloride from light, in a cool place, in glass stoppered bottles. 
Properties: A bright, amber-colored liquid, having a slightly ethereal odor, 
a very astringent, styptic taste, and an acid reaction. 
Preparation ; It is made by diluting 850 cc of solution of ferric chloride with 
sufficient alcohol to make 1,000 cc. 
Action and Uses: It should be administered well diluted with water, and 
taken through a glass tube. The mouth should be thoroughly rinsed to avoid Materia medica a ad therapeutics 
205 
injury to the teeth. It is a valuable chalybeate (iron) tonic and styptic. It 
also has slight diuretic properties. It is used in making solution of iron and 
ammonium acetate (Basham’s mixture), N. F. 
Average dose: 0.5 to 2 cc or 8 to 30 minims. 
Tincture of Ferri Citrochloridi, Tincture of Ferric Citrochloride (Tasteless 
Tincture of Ferric Chloride, Tasteless Tincture of Iron), N. F.—It is a hydroal- 
coholic solution made by dissolving sodium citrate in solution of ferric chloride 
and adding a small amount of alcohol and much water. It resembles in proper- 
ties the scale salts of iron, except that it is a solution. It contains, in each 
100 cc, ferric citrochloride equivalent to not less than 4.48 Gm. of Fe. 
Action and Uses: It is used in making Elixir of Iron, Quinine, and Strych- 
nine, N. F. Its medicinal properties are practically the same as those of tincture 
of ferric chloride, U. S'. P., except that it is milder. 
Magma Ferri Hydroxidi, Magma of Ferric Hydroxide (Arsenic Antidote), 
U. S. P.—This preparation is used only as a chemical antidote for poisoning 
by arsenic. 
Average dose: 0.5 cc, or 8 minims. 
Preparation : Forty cc of Solution of Ferric Sulfate is mixed with 125 cc of 
distilled water and placed in a large, well-stoppered bottle. Ten Gm. of Mag- 
nesium Oxide is rubbed with cold water to a smooth, thin mixture, placed in a 
bottle capable of holding 1,000 cc, and 750 cc of distilled water then added. 
When needed, shake the mixture of magnesium oxide to a thin, creamy consist- 
ence, slowly add the diluted solution of ferric sulfate, and shake together until a 
uniformly smooth mixture results. 
A solution of Sodium Carbonate or Milk of Magnesia added to Tincture of 
Ferric Chloride, and the precipitate strained through cheesecloth, may be used 
if the official antidote is not available. 
Action and Uses : The antidotal action of this preparation is presumably due 
to the adsorption of arsenic. It is efficient only when freshly prepared, and, as 
it must be administered promptly, the two solutions should always be on hand 
ready for use. 
Piluae Ferri Carbonatis, Pills of Ferrous Carbonate (Bland’s Pills), U. S. P.— 
Each pill contains not less than 0.06 gram (1 grain) of FeCOa. 
Average dose: 120 cc or 4 fluidounces. 
Preparation : Made by the action of potassium carbonate on ferrous sulfate, 
FeS04+K2C0a=FeCO3+K2S04. The pills do not keep unless well coated to 
exclude oxygen. If kept on hand for a long time the ferrous carbonate is 
changed to the ferric state. When these pills are made in the dispensary they 
should be used as soon as possible after their preparation. They never should 
be prepared and kept in stock for issue, or dispensed if they are reddish-brown in 
color within. These pills are on the Supply Table, in tablet form, chocolate coated. 
Action and Uses: Valuable iron tonic. Used in the treatment of anaemias. 
Average dose: 3 pills. 
Ferri et Ammonii Citrates Virides, Green Iron and Ammonium Citrates, 
U. S. P.—Green iron and Ammonium Citrates contains ferric citrate equivalent 
to not less than 14.5 per cent and not more than 16 per cent of Fe. Preserve 
it in well-closed containers and protected from light. 
Description: Thin, transparent, green scales or granules. It is odorless and 
has a saline, mildly ferruginous taste. It is deliquescent in air, readily soluble 
in water, and insoluble in alcohol. An aqueous solution of the salt (1 in 20) 
is acid to litmus paper. 
Action and Uses: It is a suitable compound of iron for hypodermic adminis- 
tration. 
Average dose: 0.015 to 0.1 Gm. or 14 to 1% grains. (By parenteral injection.) 206 
HANDBOOK OF THE HOSPITAL CORPS, tf. S. NAVY 
Arsenic compounds. 
Arseni Trioxidum, Arsenic Trioxide (White Arsenic), U. S. P.—When dried to 
constant weight at 100° C., it contains not less than 99.8 per cent of AS2O3. Pow- 
dered Arsenic Trioxide when administered in solid form, as in powders, 
tablets, and pills must consist of particles not greater than 0.0125 mm. in 
diameter. 
Properties: A white powder, or irregular masses of two varieties, one 
amorphous, transparent and colorless, like glass; the other crystalline, opaque 
and white, resembling porcelain. Frequently the same piece has an opaque, 
white outer crust enclosing the glassy variety. Contact with moist air gradu- 
ally changes the glassy into the white, opaque variety. All varieties are 
odorless. It is slowly soluble in water, freely soluble in glycerin, and slightly 
soluble in alcohol. It is dissolved by hydrochloric acid and by solutions of 
alkali carbonates. Caution : Arsenic trioxide is extremely poisonous. 
Actions and Uses : It irritates the mucous membrane of the stomach and 
intestine. Toxic doses cause nausea, vomiting, colicky pains in abdomen, watery 
diarrhoea, fatty degeneration of the liver and other organs. Large doses pro- 
duce great depression and collapse. It is thought that arsenic stimulates the 
action of the blood-forming organs, especially the bone marrow, and for this 
reason is considered useful in the treatment of anaemia. Some skin conditions 
such as psoriasis and chronic eczema are apparently improved by proper doses 
of arsenic. The physiological effect of arsenic is due to the arsenic trioxide ion 
and not to the element arsenic. In cases of poisoning, wash out the stomach and 
give large doses of Magma of Ferric Hydroxide, U. S. P. 
Average dose: 0.002 Gm. or %o grain. 
liquor Potassii Arsenitis, Solution of Potassium Arsenite (Fowler's Solution), 
U. S. P.—An aqueous solution of potassium arsenite containing in each 100 cc the 
equivalent of not less than 0.950 Gm. nor more than 1.050 Gm. of AS2O3. Pre- 
serve the solution in amber-colored bottles. 
Properties: A clear, colorless liquid, alkaline to litmus. 
Preparation ; It is made by boiling together potassium bicarbonate and 
arsenic trioxide in the proportion to give a finished solution having the given 
strength. It is held that the following reaction takes place: AS2O3-fIKHCCb 
= 2K2HASO3+H2O+4CO2. 
Action and Uses: It is a useful remedy against protozoal affections. Used 
in the treatment of malaria and relapsing fever; in the treatment of certain 
chronic skin affections such as psoriasis, lichen planus, chronic eczema, chronic 
urticaria, etc. It stimulates the action of the blood-forming organs, especially 
the bone marrow, by its alterative and tonic properties. It is a poison and 
must he handled with great care. 
Average dose: 0.2 cc or 3 minims, diluted with water. 
Arsphenamina, Arsphenamine (Diaminodihydroxyarsenobenzol hydrochloride), 
U. S. P.—Also known as salvarsan, 606, arsenobenzol and arsaminol. Contains 
not less than 30 per cent of arsenic (As). Its manufacture is under the control 
of the U. S. Public Health Service. 
Properties: A light yellow, hygroscopic powder, very unstable in air, and 
put up in sealed ampules. 
Action and Uses: A specific remedy for syphilis in all stages, but it is more 
efficient the more recent the infection; also useful in various spirillum diseases, 
such as relapsing fever, Vincent’s angina, etc. 
Average dose: 0.3 to 0.6 Gm. or 5 to 9 grains, administered intravenously. 
Neoarsphenamina, Neoarsphenamine (Neosalvarsan), U. S. P.—The name ap- 
plied to a mixture, sodiumdiaminodihydroxyarsenobenzenemethanolsulfoxylate MATERIA MEDICA AND THERAPEUTICS 
207 
with inert, inorganic salts. It contains not less than 19 nor more than 22 
per cent of arsenic (As) and complies with the requirements of the National 
Institute of Health, U. S. Public Health Service. Preserve it in sealed tubes 
of colorless glass, from which the air has been excluded either by the production 
of a vacuum or by displacement with a nonoxidizing gas, in a cool place, prefer- 
ably not above 10° C. 
Action and Uses: Essentially the same as those of arsphenamine, although 
many observers claim better results. It differs from arsphenamine in that it 
dissolves readily in sterile water, making a neutral solution which can at once 
be injected. Water not warmer than from 20° to 22° C. (68° to 71.6° F) should 
be used in dissolving the drug and the injections should be made at once, as it 
oxidizes rapidly and becomes toxic. The solution should not be shaken and it 
must not be administered subcutaneously. 
Properties : A yellow powder, and is very unstable in air. 
Average dose: 0.6 to 0.9 Gm. or 9 to 14 grains. 
Tryparsamidum, Tryparsamide, U. S. P.—It contains not less than 25.1 and 
not more than 25.5 per cent of arsenic (As) when dried to constant weight 
at 110° G. 
Properties : A white, odorless, crystalline powder. One gram is soluble in 
2 cc of water. It is slightly soluble in alcohol. It should be preserved in well- 
closed containers protected from light. The arsenic in this compound is penta- 
valent (having a valence of five). 
Action and Uses : It is used in the treatment of syphilis of the central nerv- 
ous system where arsphenamine and neoarsphenamine have failed to produce 
favorable results. It is given intravenously, intramuscularly, or subcutane- 
ously dissolved in distilled water or salt solution. It was first used in the 
treatment of trypanosomiasis. 
Average dose: 2 Gm. or 30 grains (Caution: Never give by mouth). 
The directions on the package should be followed in its administration. 
Sulfarsphenamine, N. N. R.—It contains 19 to 24 per cent of arsenic in the 
trivalent form. 
Properties : It is an orange-yellow powder possessing an odor resembling 
that of sulfur dioxide and arsine. It is readily soluble in water yielding a yel- 
low solution which is acid to litmus. 
Action and Uses: It is used in the treatment of syphilis where it is desired 
to administer arsenicals intramuscularly. It may also be given by subcutaneous 
injection. 
Average dose: 0.4 Gm. or 6 grains (intramuscularly). 
Antimony compounds. 
Antimonii et Potassii Tartras, Antimony and Potassium Tartrate (Antimonyl 
Potassium Tartrate, Tartrated Antimony, Tartar Emetic), U. S. P.—It contains 
not less than 99 per cent of KOOC.CHOH.CHOH.COO(SbO)+V2H2O. Preserve 
it in well-closed containers. 
Properties: Occurs as a white, granular powder or colorless, transparent 
crystals. Disagreeable metallic taste, odorless. The crystals effloresce on ex- 
posure to air. Soluble in 12 parts of cold water, 3 parts of boiling water, 15 
parts of glycerin, and insoluble in alcohol. Its aqueous solution is slightly acid 
to litmus paper. 
Preparation ; It is made by boiling antimony oxide with potassium bitartrate. 
2KHC4IUO6+Sb=03=2K (SbO) C*H«0«+HaO. 
Action and Uses: It is used chiefly as an expectorant and a diaphoretic, 
rarely as an emetic, and is of value in African sleeping sickness. It is one 208 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
of the ingredients in Compound Mixture of Opium and Glycyrrhiza, U. S. P. 
(Brown Mixture). 
Average dose: 0.003 Gm. or %o grain. 
Bismuth compounds. 
Bismuthi Subnitras, Bismuth Subnitrate, U. S. P.—A basic bismuth nitrate of 
varying chemical composition, which, when dried for 24 hours in a desiccator 
over sulfuric acid, yields, upon ignition, not less than 79 per cent of bismuth 
oxide (Bi2Oa). Preserve it in well-closed containers protected from light. 
Properties: A heavy white powder, odorless, tasteless, and slightly hygro- 
scopic. Almost insoluble in water and insoluble in alcohol, readily soluble in 
hydrochloric or nitric acid. It is slightly acid in reaction. 
Preparation : It is made by dissolving metallic bismuth in nitric acid and 
treating the resulting solution with sodium carbonate which precipitates the 
bismuth as subcarbonate (here the bismuth is freed from arsenic) ; the sub- 
carbonate is redissolved with nitric acid, forming bismuth nitrate, which is 
converted to the subnitrate by treatment with ammonia water; the precipitate 
then is collected, washed, and dried. 
Action and Uses : It is used internally in the treatment of gastric and intes- 
tinal disorders as a sedative astringent, especially in diarrhoea and putre- 
factive conditions. In large doses it coats the mucous membranes of the 
intestine and acts as a protective. Very large doses are given in X-ray work 
for the purpose of outlining the stomach and intestine. However, bismuth sub- 
carbonate is better than the subnitrate for this purpose because it is less toxic. 
When applied to wounds or mucous membranes it acts as a protective, astrin- 
gent, and antiseptic. It is also given by parenteral Injection in the treatment 
of syphilis. 
Average dose: 1 Gm. or 15 grains; 0.125 Gm. or 2 grains as antisyphilitic. 
Bismuthi Suhcarhonas, Bismuth Subcarbonate (Basic Bismuth Carbonate), U. 
S. P.—It is a basic salt, which, when dried to constant weight at 100° C., yields 
upon ignition not less than 90 per-cent of Bi203. Protect it from the light in well- 
closed containers. 
Properties : A white or pale yellowish-white powder. It is odorless and taste- 
less, and is stable in the air. It is insoluble in water and in alcohol. 
Action and Uses : It is protective, slightly antiseptic, astringent, and ant- 
acid. It is used in the treatment of hyperacidity of the stomach and in the 
treatment of ulcers of the stomach and intestine. It is used in making X-ray 
pictures of the intestinal tract. It is less toxic than the subnitrate and may 
be given in larger doses with greater safety. It is used as an antiseptic and 
protective application in the treatment of skin diseases, old ulcers, and sup- 
purating wounds. Its external application to the broken skin must be watched 
for possible toxic symptoms due to absorption of the drug. 
Average dose: 1 Gm. or 15 grains. 
Bismuthi Subsalicylas, Bismuth Subsalicylate (Basic Bismuth Salicylate), 
U. S. P.—It is a basic salt containing not less than 62 per cent and not more 
than 66 per cent of BizOs when dried to constant weight at 100° C. Preserve it 
in well-closed containers protected from light. 
Properties ; A white, or nearly white, amorphous or crystalline powder. It is 
odorless and is stable in the air. It is practically insoluble in water. 
Action and Uses : It is given intramuscularly in the treatment of syphilis. 
It is administered suspended in oil. The preparation on the Supply Table 
known as Bismuth Subsalicylate in Oil contains 0.13 Gm. of Bismuth Sub- 
salicylate in each cubic centimeter of the mixture when thoroughly mixed by 
shaking. The oil is composed of 10 per cent camphor, 10 per cent creosote, and MATERIA MEDICA AND THERAPEUTICS 
209 
80 per cent olive oil. One cubic centimeter of this mixture is given each week 
until eight doses have been given. 
Average dose: 0.125 Gm. or 2 grains (intramuscularly). 
Bismuthi et Potassii Tartars, Bismuth and Potassium Tartrate, U. S. P.—It is 
a basic bismuth potassium bismuthotartrate containing the equivalent of not 
less than 71 per cent and not more than 75 per cent of BisOa. Preserve it in well- 
closed containers protected from light. 
Properties : A granular, white, odorless powder, having a sweetish taste. It 
darkens on exposure to light. One grain is soluble in 2 cubic centimeters of 
water. 
Action and Uses: It is given intramuscularly in the treatment of syphilis. 
A similar preparation is on the Supply Table by the name “Solution of Potas- 
sium and Sodium Bismuthotartrate (Bismosol)”. 
Average dose: 0.15 Gm. or 2grains (intramuscularly). 
Thio-Bismol, Sodium Bismuth Thioglycollate, N. N. R.—A salt formed by the 
interaction of sodium thioglycollate and bismuth hydroxide. It contains about 
38 per cent of bismuth. 
Properties; It is a canary yellow, hygroscopic, noncrystalline but granular 
substance possessing a garlic-like odor. It is freely soluble in water but the 
solutions are not stable. It is on the Supply Table in the form of a 0.2 Gm. 
ampule which is to be dissolved in 1 cubic centimeter of sterile distilled water 
before administration. 
Action and Uses : It is used in the treatment of syphilis. It is a water solu- 
ble compound, readily absorbable, and produces very little local injury when 
injected. 
Average dose; 0.2 Gm. or 8 grains, administered intramuscularly twice a week 
for a series of 12 doses. 
Lead compounds. 
Plumbi Acetas, Lead Acetate (Sugar of Lead), U. S. P.—It contains not less 
than 85.31 per cent nor more than 89.57 per cent of anhydrous lead acetate, 
corresponding to not less than 99.5 per cent of the hydrated salt (CHa.COOL 
Pb+3H20. Preserve it in well-closed containers. 
Properties: It occurs as colorless, shining, transparent prisms or plates, or 
heavy, white, crystalline masses, or granular crystals, faintly acetous odor, and 
is efflorescent and absorbs carbon dioxide from the air; therefore it must be 
kept in well-closed containers. It is soluble in 1.6 parts of water, about 30 
parts of alcohol, and is freely soluble in glycerin. An aqueous solution is 
slightly alkaline to litmus. 
Preparation: It is made by adding lead oxide to acetic acid and gently 
heating the mixture until combination takes place. PbO-f 2HC2H302= 
Pb (C2H3O2) 2+H2O. 
Action and Uses: It is used internally combined with opium (lead and 
opium pill containing 1 grain each), as a sedative astringent in diarrhoea. It 
is used in the preparation of Lotion of Lead and Opium, N. F., which is used 
externally as a sedative astringent application to sprains and bruises. A 1 
per cent solution in alcohol is used externally for ivy poisoning. It is a very 
poisonous drug. The best antidote is magnesium sulfate which forms with 
the lead acetate an insoluble lead sulfate. The lead sulfate so formed must 
he washed out of the stomach with a stomach tube. 
Average dose: 0.06 Gm. or 1 grain. 
Mercury compounds. 
Hydrargyrum, Mercury (Quicksilver), Hg, U. S. P.—It contains not less than 
99.5 per cent of Hg. Preserve it in strong, well-closed containers. 210 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Properties : A shining, silver-white, metal, liquid at ordinary temperatures. 
It solidifies at —38.8° O. and boils at 358° C. Its specific gravity is 13.596. 
Insoluble in ordinary solvents, but readily soluble in nitric acid. Mercury forms 
two series of compounds; Mercurows, in which mercury has a valence of one, 
and merur/c, in which it has a valence of two. 
Preparation: It is made by roasting sulfide of mercury (cinnabar), form- 
ing mercury and sulfur dioxide. 
Action and Uses : In its massive form mercury has very little action on 
the system, but when reduced to a fine state of subdivision it is capable of 
absorption either by the skin or mucous membranes and produces the physiolog- 
ical effects of its salts. It is contained in a fine state of subdivision, diluted with 
various vehicles in the following preparations: Mercury with Chalk, U. S. P.; 
Mass of Mercury, U. S. P.; Strong Mercurial Ointment, U. S. P.; Mild Mercurial 
Ointment, U. S. P. 
Hydrargyrum Ammoniatum, Ammoniated Mercury (White Precipitate), 
HgNHaCl, U. S. P.—'It contains mercurammonium chloride (HgNH2Cl) corre- 
sponding to not less than 78 per cent nor more than 80 per cent of Hg. Pre- 
serve it in well-closed containers, protected from light. 
Properties : A white, amorphous powder, odorless, and having an earthy, 
afterwards styptic metallic taste; permanent in the air; insoluble in water 
or alcohol. 
Preparation ; Made by precipitating a solution of mercuric chloride with 
ammonia water. HgCl2+2NH40H=HgNH2Cl+2H20+NH4Cl. 
Action and Uses: Taken internally it acts as an irritant poison. It is 
used externally in the form of an ointment (from 2 to 10 per cent) in the 
treatment of parasitic skin diseases. It acts as an antiseptic and local 
stimulant. 
Hydrargyri Bichloridum, Mercury Bichloride (Corrosive Sublimate, Corro- 
sive Mercuric Chloride, Bichloride of Mercury), HgCl2, U. S. P.—When dried for 
24 hours over sulfuric acid, it contains not less than 99.5 per cent of HgCl2. 
Preserve it in well-closed containers. 
Description ; Heavy, colorless, odorless crystals or crystalline masses, or 
a white powder. One gram is soluble in 13.5 cc of water, in 3.8 cc of alcohol, 
in about 12 cc of glycerin, and in 22 cc of ether. An aqueous solution of 
mercury bichloride (1 in 20) is acid to litmus paper, but becomes neutral 
upon the addition of sodium chloride. When heated it volatilizes. Caution : 
Mercury Bichloride is extremely poisonous. 
Action and Uses : As an antiseptic application to the skin it may be used 
in strengths varying from 1-1,000 to 1-5,000 dissolved in water. The injection 
of bichloride solution into body cavities or its application to raw surfaces 
should be done with great caution. When used for irrigation of the vagina 
it may be absorbed in sufficient quantity to produce poisoning. A solution 
of bichloride corrodes instruments. If an aqueous solution of bichloride is 
exposed to light it undergoes partial decomposition with precipitation of 
calomel. This may be prevented by the addition of a few drops of hydro- 
chloric acid or ammonium chloride. Bichloride in solution with potassium 
iodide is given by mouth and it is also injected intramuscularly in the treat- 
ment of syphilis. Poisoning by bichloride, taken by mouth, is treated by 
immediate administration of whites of eggs followed by emetic and washing 
out the stomach. See section on Toxicology. 
Average dose: 0.004 Gm. or Vis grain. 
Hydrargyri Chloridum Mite, Mild Mercurous Chloride, (Calomel, Mercurous 
Chloride, Protochloride of Mercury, Subchloride of Mercury), HgCl, U. S. P.— MATERIA MEDICA AND THERAPEUTICS 
211 
It contains, when dried to constant weight in a desiccator over sulphuric acid, 
not less than 99.6 per cent of HgCL Preserve it in well-closed containers, 
protected from light. 
Properties : It is a heavy, white, impalpable powder, turning yellowish white 
on being triturated with pressure; odorless, tasteless, and permanent in the air. 
Insoluble in water, alcohol, ether, or cold diluted acids. It should not contain 
the slightest trace of bichloride of mercury. It undergoes changes when 
exposed to light, or in contact with alkaline chlorides, bromides, or iodides, 
resulting in the production of mercuric salts which are toxic. 
Preparation : The process for making calomel is similar to that for making 
bichloride except that metallic mercury is added. Mercury, mercuric sulfate, 
and sodium chloride are heated together in a retort, resulting in the formation 
of calomel, which is sublimed and condensed in a separate container. Hg+ 
HgS04+2NaCl=2HgCl+Na2S0i. After sublimation the calomel is washed sev- 
eral times with distilled water to free it from bichloride of mercury. 
Action and Uses : Used externally as an antiseptic dusting powder and in 
ointments (33% per cent) as a venereal prophylactic. Internally it is used 
as an alterative, cathartic, and diuretic. When calomel is given for its pur- 
gative effect it should be followed from 4 to 6 hours after administration by 
a normal dose of Epsom salt. 
Average dose: Laxative 0.15 Gm. or 2.5 grains; alterative 0.015 Gm. or 
% grain. 
Hydrargyri Oxidum Flavum, Yellow Mercuric Oxide, U. S. P.—It contains, 
when dried to constant weight at 110° C., not less than 99.5 per cent of HgO. 
Preserve it in well-closed containers, protected from light. 
Properties : An orange-yellow, heavy, impalpable powder ; odorless and having 
a metallic taste; turns darker on exposure to light, and is almost insoluble in 
water; insoluble in alcohol. 
Preparation ; Made by precipitating a solution of mercuric chloride with 
sodium hydroxide: HgCl2+2Na0H=Hg0-j-H20+2NaCl. 
Action and Uses : It is not given internally. In the form of an ointment 
it is used in the treatment of inflammation of the eyelids. Yellow Mercuric 
Oxide Ointment, U. S. P., contains 1 per cent of mercuric oxide. 
Hydrargyri Salicylas, Mercuric Salicylate (Mercuric Subsalicylate), U. S. P.— 
A compound of mercury and salicylic acid containing not less than 54 per cent 
nor more than 59.5 per cent of Hg. Preserve it in well-closed containers 
protected from light. 
Properties : A wdiite or slightly yellow or slightly pink powder; odorless 
and tasteless; insoluble in water or alcohol. Soluble in warm solutions of 
alkali halides forming double salts. 
Preparation : It may be made by heating yellow mercuric oxide with salicylic 
acid and a little water until a white mixture results. 
Action and Uses : Used in the treatment of syphilis. It is given intramuscu- 
larly suspended in neutral oil (1 grain to 10 minims of oil). It possesses the 
advantage of being less irritant than the other salts of mercury, both to the 
intestinal tract and when given intramuscularly. It is absorbed slowly. 
Toxitabellae Hydrargyri Bichloridi Magnse, Large Poison Tablets of Mercury 
Bichloride, U. S. P.—Each tablet contains an average of not less than 0.45 Gm. 
and not more than 0.55 Gm. of HgCh, with a sufficient quantity of a suitable 
excipient or diluent. 
Average dose: 0.06 Gm. or 1 grain. 
These tablets must be of a distinctive color, not white; they must be of an 
angular or irregular shape, not discoid. When sold in small quantities suitable 212 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
for household use, they must be dispensed in glass containers of a distinctive, 
angular shape having irregular or roughened sides or edges. On the exterior 
of each container must be placed a red printed label bearing the word 
“POISON”, and a statement indicating the amount of mercury bichloride in 
each tablet. 
Uses : These tablets are used for convenient preparation of bicholoride solu- 
tion. One tablet dissolved in 500 cc of water makes a 1 in 1,000 solution. 
Toxitabellse Hydrargyri Bichloridi Parvae, Small Poison Tablets of Mercury 
Bichloride, U. S. P.—Each tablet contains an average of not less than, 0.1125 
Gm, and not more than 0.1375 Gm. of HgCh, with a sufficient quantity of a 
suitable excipient or diluent. 
These tablets must be of a distinctive color, not white; they must be of an 
angular or irregular shape, not discoid. When sold in small quantities suitable 
for household use, they must be dispensed in glass containers of a distinctive 
angular shape having irregular or roughened sides or edges. On the exterior 
of each container must be placed a red printed label bearing the word 
“POISON”, and a statement indicating the amount of mercury bichloride in 
each tablet. 
Uses : These tablets are used for convenient preparation of small quantities 
of bichloride solution. One tablet dissolved in 500 cc of water makes a 1 in 
4,000 solution. 
Unguentum Hydrargyri Forte, Strong Mercurial Ointment, U. S. P.—It con- 
tains not less than 49 per cent and not more than 51 per cent of Hg. The 
globules of mercury should be so fine that they are not visible under a lens 
magnifying 10 diameters. The base is composed of oleate of mercury, white 
wax, wool fat, and petrolatum. It is used in the preparation of Mild Mer- 
curial Ointment. 
Action and Uses: It is rubbed into the skin in the treatment of syphilis. 
Four grams of the ointment should be rubbed into a selected area of the skin 
at night and the part should be cleaned in the morning. A new area should 
be selected for inunction the following night to avoid irritation of the skin. 
If the ointment is irritating it should be diluted with wool fat. 
Unguentum Hydrargyri Mite, Mild Mercurial Ointment (Blue Ointment), 
U. S. P.—It contains not less than 29 per cent and not more than 31 per cent 
of Hg. In each 100 Gm. there are 60 Gm. of Strong Mercurial Ointment, 2 
Gm. of white wax, and 38 Gm. of white petrolatum. 
Action and Uses: It is a paraciticide and is rubbed on the skin to destroy 
lice. 
Hydrargyri Oxycyanidum, Mercuric Oxycyanide, Hg(CN)2 HgO, N. N. R.—It is a 
basic mercuric salt of hydrocyanic acid containing from 51.7 to 56 per cent of 
mercuric cyanide (Hg(CN)2) and from 44.3 to 48.0 per cent of mercuric oxide 
(HgO). Protect it from light in well-closed bottles. 
Properties : It is a white or nearly white, microcrystalline powder. One part 
is soluble in 80 parts of water yielding a solution which is alkaline to litmus 
paper. 
Action and Uses: It is an antiseptic which does not precipitate albumin, and 
in dilute solution does not attack surgical instruments. It is used in the dis- 
infection of surgical instruments that cannot be boiled. It is used in genito- 
urinary work for the disinfection of cystoscopes, 1 part of mercuric oxycyanide 
to 1,000 parts of water. 
Mercurochrome, Mercurochrome soluble, N. N. R.—It is the disodium salt of 
dibromohydroxymercurifluorescein containing 24 to 26 per cent of mercury. MATERIA MEDICA AND THERAPEUTICS 
213 
Properties : It occurs as iridescent, green scales or granules, odorless, and 
permanent in the air. It is freely soluble in water and practically insoluble in 
alcohol. The aqueous solution is stable in the air, does not precipitate pro- 
teins and does not respond to the usual tests for mercury ions. 
Action and uses : It is nonirritating, moderately active, antiseptic. It stains 
the skin red. The stains can be removed by washing with sodium hypochlorite 
solution or 3 per cent hydrochloric acid in alcohol. Mercurochrome Solution 
(Scott’s Solution) for disinfection of the skin before operation is composed of 
2 parts mercurochrome, 35 parts distilled water, 55 parts alcohol, and 10 parts 
acetone. 
Merthiolate, Merthiolate Sodium, Sodium Ethylmercuri Thiosalicylate, N. N. R.— 
Merthiolate contains about 49 per cent of mercury in organic combination. 
Properties : It is a light, cream colored, crystalline powder, having a slight 
odor. It is stable in air but unstable in sunlight. One part is soluble in 1 part 
of water, or in 8 parts of alcohol. 
Action and Uses : It has high germicidal potency against spore-bearing and 
non-spore-bearing bacteria and is also’ a fungicide. It does not precipitate with 
serum proteins and does not irritate. For disinfection of the skin use 1 in 
1,000 alcoholic solution; for wounds use 1 in 1,000 water solution; for instru- 
ments use 1 in 1,000 water solution. 
Silver compounds. 
Argenti Ultras, Silver Nitrate, AgNo3, U. S. P.—It contains, when powdered 
and dried to constant weight in a desiccator over sulfuric acid, in the dark, not 
less than 99.8 per cent of AgNOa. Preserve it in dark amber-colored, glass- 
stoppered vials, protected from light. 
Properties : Occurs in colorless, transparent, tabular, rhombic crystals, be- 
coming gray or grayish black on exposure to light or in the presence of organic 
matter; odorless, and having a bitter, caustic, and strongly metallic taste. 
Soluble in 0.4 part of water and in 30 parts of alcohol. An aqueous solution is 
clear, colorless, and neutral to litmus paper. 
Preparation : It is made by dissolving silver in nitric acid with the aid of 
heat, 3Ag+4HN03=3AgN03+2H20+N0. 
Action and Uses: Solutions of silver nitrate should be made with distilled 
water. Weak solutions are astringent and antiseptic to mucous membranes 
and strong solutions are caustic. The mucous membrane should always be 
cleaned before applying solutions of silver nitrate. A 1 per cent solution is 
instilled into the eyes of the newborn immediately after delivery to prevent 
gonorrhoeal conjunctivitis. The action of silver nitrate can be immediately 
stopped by the application of sodium chloride (salt) solution and this is often 
done when it is desired to limit the action of local application to the eye or 
throat. Silver nitrate forms on tissue a dense film of coagulated albumin. This 
film prevents deeper action of the silver nitrate. The film is at first white but 
soon becomes black due to the reduction of the silver. A 4 per cent solution 
is used for application to the mucous membrane of the throat, mouth or nose. 
Argenti Nitras Induratus, Toughened Silver Nitrate (lunar Caustic), U. S. P.— 
Toughened Silver Nitrate contains not less than 94.5 per cent of AgNOs. Pre- 
serve it in glass-stoppered bottles, in a cool place and protected from light. 
Average dose: 0.01 Gm. or % grain. 
Description : White, crystalline masses generally molded as pencils or cones. 
It breaks with a fibrous fracture. On exposure to light in the presence of 
organic matter Toughened Silver Nitrate becomes gray or grayish-black. It 
contains about 5 per cent silver chloride. 214 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Action and Uses : It is used as a caustic on excessive granulations, chanc- 
roids, and ulcers. The mode of application consists of dipping the stick into 
distilled water and applying to the part according to the degree of action 
desired. 
Argentum Proteinicum Forte, Strong Protein Silver (Strong Silver Protein), 
U. S. P.—A compound of silver and protein, containing not less than 7.5 
per cent and not more than 8.5 per cent of Ag. Preserve it in well-closed 
containers and protected from light. 
CAUTION: Solutions of Strong Protein Silver should he freshly prepared 
with distilled water and should he dispensed in amher-colored bottles. 
Description : A brown, odorless powder, usually somewhat hygroscopic. It 
is freely soluble in water, but almost insoluble in alcohol. Sodium chloride 
does not precipitate silver from a solution of silver protein. With mercuric 
chloride test solution a white precipitate is formed and the supernatant liquid 
becomes colorless or nearly so. 
Action and Uses: It is used in one-half of 1 per cent aqueous solution 
for injection into the urethra for the prevention and treatment of gonococcus 
infection of the urethra. The solution should be made in small quantities 
as needed. It is more irritating than Mild Silver Protein. Linen stains may 
be removed with 1-1,000 bichloride of mercury solution. 
Argentum Proteinicum Mite, Mild Protein Silver (Mild Silver Protein), 
U. S. P.—Silver rendered colloidal by the presence of, or combination with, 
protein. It contains not less than 19 per cent and not more than 25 per 
cent of Ag. 
CAUTION: Solutions of Mild Protein Silver should he freshly prepared with 
distilled water and should he dispensed in amher-colored hottles. 
Preserve it in well-closed containers and protected from light. 
Description : Dark brown or almost black shining scales or granules. It 
is odorless, and is frequently hygroscopic. It is freely soluble in water, but 
almost insoluble in alcohol. With sodium chloride solution, a solution of 
silver protein does not precipitate silver. With mercuric chloride test solution a 
white precipitate is formed and the supernatant liquid becomes colorless, or 
nearly so. Penis syringes should not be kept in a bichloride of mercury solution 
if they are to be used with either the strong or the mild silver protein. 
Action and Uses: In the preparation of solutions of silver protein they are 
likely to gum together if water is poured upon them; they then dissolve very 
slowly, but solutions can be made quickly if they are sprinkled upon the water 
and immediately shaken for a minute or two. Solution is also aided by wetting 
them first with glycerin. It is nonirritating and soothing, but less active as an 
antiseptic than Strong Protein Silver. It is used in the treatment of inflamed 
sensitive mucous membranes of the urethra, eye, and throat. It is usually used 
in strengths of from 5 to 20 per cent in distilled water. 
Copper compounds. 
Cupri Sulfas, Copper Sulfate, (Blue Vitriol, Bluestone, Cupric Sulfate), 
Cu'S04.5H20, U. S. P.—It contains not less than 63 per cent nor more than 66.8 
per cent of CuSCL, corresponding to not less than 98.5 per cent of the hydrated 
salt (CUSO4+5H20). Preserve it in well-closed containers. 
Properties: It occurs as deep blue triclinic crystals, or as blue crystalline 
granules or power, having a nauseous, metallic taste; slowly efflorescent in dry 
air; soluble in 3 parts of water, 500 parts of alcohol, and 2.8 parts of glycerin. 
Its aqueous solution is acid to litmus. 
Preparation: It is made by the action of sulfuric acid on copper. Cu+ 
2HaS04=CuS04+S02+2H20. MATERIA MEDICA AND THERAPEUTICS 
215 
Action and Uses: Internally it is used as an emetic, an astringent, or tonic, 
and an antidote for phosphorus poisoning. In small doses it acts as an as- 
tringent, while in large doses it is an irritant and is nauseating. It is astrin- 
gent and antiseptic even in a strength of 1 to 1,000. Its aqueous solution is 
very destructive to the lower forms of plant life (fungi). It is used in 
the preparation of Fehling’s solution, a reagent used in testing for the presence 
of sugar in urine. 
Average dose: 0.3 Gm. or 5 grains as an emetic; 0.01 to 0.03 Gm. or % to 
Y2 grain as an astringent or tonic. 
ORGANIC MATERIA MEDICA 
In the study of inorganic materia medica it was found that most of the 
substances were obtained or derived from the mineral kingdom. In the study 
of organic materia medica it will be found that most of the substances are 
obtained or derived from the vegetable and animal kingdoms or are made 
synthetically. Organic materia medica is the study of those compounds of 
carhon that are used in medicine. In this chapter only those used in the 
Medical Department of the Navy are discussed. The substances have been 
divided into groups, as far as practicable, according to chemical classification. 
Hydrocarbons. 
Hydrocarbons are chemical compounds formed by the union of the elements 
hydrogen and carbon. There are hundreds of these compounds, but only a few 
are on the Supply Table. For the general properties of the hydrocarbons refer 
to the chapter on Chemistry. 
Petrolatum, Petrolatum (Petroleum Jelly), U. S. P.—A purified mixture of 
semisolid hydrocarbons, obtained from petroleum. 
Properties : It is an unctuous mass; yellowish to light amber in color; trans- 
parent in thin layers; free from odor and taste. It is insoluble in water, almost 
insoluble in alcohol, soluble in ether, chloroform, oil of turpentine, benzine, or 
in most fixed or volatile oils. It melts between 38° and 54° C. Chemically it 
is very stable and does not turn rancid like vegetable oils and animal fats. It 
remains unchanged when brought in contact with strong acids or alkalies. 
Preparation ; It is an intermediate product in the distillation of crude 
petroleum. It comprises a part of the residue left after distillation of the 
lighter substances. 
Action and Uses ; It is used as a bland, neutral, protective dressing, and as 
a base for ointments. The absorption and rapidity of action of drugs is re- 
tarded when incorporated with petrolatum; therefore it should not be used 
alone as an ointment base when absorption of a drug is desired. Given in- 
ternally it is not absorbed from the intestinal tract; it acts as a lubricant and 
may be used in gastrointestinal irritation. White Petrolatum, U. S. P., is 
petrolatum that has been decolorized. 
Petrolatum Liquidum, Liquid Petrolatum (Mineral Oil, Liquid Paraffin), 
U. S. P.—A mixture of liquid hydrocarbons obtained from petroleum. Preserve 
it in well-closed containers, protected from light. The U. S. P. recognizes two 
kinds of liquid petrolatum—heavy liquid petrolatum having a viscosity of not 
more than 0.381, which is intended to be used as a laxative, and light liquid 
petrolatum having a viscosity of not more than 0.370 and intended to be used as 
a solvent in making sprays. 
Properties; Both varieties are colorless, transparent, oily liquids; free or 
nearly free from fluorescence, odorless and tasteless when cold; insoluble in 
water or alcohol, but soluble in ether, chloroform, benzine, and volatile oils. 216 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
It is miscible with most fixed oils and dissolves menthol, camphor, and similar 
substances. 
Preparation" : It is made from crude petroleum after removal of the lighter 
hydrocarbons (gasoline, kerosene,, etc.) by distilling the residue between 330° 
and 390° O. It should be noted that the definition does not state that it is a 
mixture of hydrocarbons of any particular chemical series. 
Action and Uses : Largely used in the treatment of constipation. Its action 
is mechanical, as it is not absorbed. It simply oils the entire intestinal tract 
and facilitates the passage of the fsecal mass. Used as a vehicle in the prepa- 
ration of the oil sprays for the nose and throat and in the preparation of 
petroxolins (N. F. preparations). 
Average dose: 15 cc or 4 fluidrams. 
Paraffinum, Paraffin, U. S. P.—A purified mixture of solid hydrocarbons 
obtained from petroleum. 
Properties : It is a colorless or white, more or less translucent mass, crystal- 
line when separating from solution, without odor or taste, and slightly greasy 
to the touch. It is insoluble in water or alcohol, but freely soluble in ether, 
benzene, volatile oils, and most fixed oils when warm. Like petrolatum, it is 
chemically inactive and resistant to the action of other chemicals. It melts 
between 50° and 57° G. 
Preparation : It is made by distilling the residuum obtained from the refining 
of crude petroleum and collecting and purifying the distillate. 
Action and Uses: It is used in ointments in hot climates to raise their melt- 
ing points; in making paraffin paper; for sealing bottles; in making candles; 
and in the preparation of paraffin-wax compounds. Paraffin Dressing, N. F., is 
used as a surgical dressing for burns. 
Ichthammol (Ammonium Ichthosulfonate), N. F.—It is obtained by the 
destructive distillation of certain bituminous schists, sulfonating the distillate, 
and neutralizing the product with ammonia. Ichthammol yields not less than 
2.5 per cent of ammonia, not more than 8 per cent of ammonium sulfate, 
and not less than 10 per cent of total sulfur. 
Properties: It is a reddish-brown to brownish-black, viscous fluid with a 
strong, characteristic, empyreumatic odor. It is soluble in water and in 
glycerin, and is miscible with fixed oils and fats. It is partly soluble in alcohol 
or ether, and entirely soluble in a mixture of equal volumes of alcohol and 
ether. 
Action and Uses : It is weakly antiseptic and emollient. It is used in oint- 
ments (Ointment of Ichthammol, N. F.) for the local treatment of furunculosis 
(boils). It is not given internally. 
Halogen derivatives of hydrocarbons. 
Halogen derivatives of hydrocarbons are compounds formed by substituting 
one or more halogen atoms (chlorine, bromine, fluorine, or iodine) for a cor- 
responding number of hydrogen atoms in hydrocarbon compounds. The sub- 
stitution may be done directly or indirectly. {See chapter on Chemistry.) 
The simplest hydrocarbon known is methane, CH4, which contains four hydrogen 
atoms united to one carbon atom. Substituting three chlorine atoms for three 
of the hydrogen atoms in methane produces a compound known as trichlor- 
methane, CHCL (chloroform) ; if the substitution is with three iodine atoms, 
a compound known as triiodomethane, CHL (iodoform) results; if one chlorine 
atom is substituted for one hydrogen atom in ethane (OsHs), a compound 
known as monochlorethane, C2H5CI (ethyl chloride), is formed, etc. 
Chloroformum, Chloroform, CHCL, U. S. P.—A liquid consisting of not less 
than 99 per cent nor more than 99.5 per cent by weight of OHCU and the 217 
MATERIA MEDICA AND THERAPEUTICS 
remainder consisting of alcohol. Preserve it in well-stoppered bottles in a cool 
place protected from light. Caution : Care should he used in vaporizing chloro- 
form in the presence of a naked flame, as noxious gases are produced. Chloro- 
form for anaesthesia must he preserved in glass bottles. 
Properties; A clear, colorless, mobile liquid, of a characteristic, ethereal odor 
and burning, sweet taste. Soluble in 210 parts of water; miscible with alcohol, 
ether, benzene, petroleum, benzine, or with fixed or volatile oils. Specific grav- 
ity, 1.474 to 1.478 at 25° C. It is volatile at a low temperature and boils at about 
81° C. It is not inflammable, but its heated vapor burns with a green flame. 
Chloroform is decomposed when exposed to light and air, liberating chlorine, 
hydrochloric acid, phosgene, and other compounds. The presence of a small 
amount of alcohol tends to prevent this decomposition. Chloroform that has 
been exposed to light and air should not be used for anaesthesia. 
Preparation : It is usually made by the action of chlorinated lime on acetone. 
Action and Uses: Used in surgery as a general anaesthetic by inhalation; 
internally as a carminative and sedative; externally as a rubefacient and 
vesicant. It is used in the preparation of Chloroform Water, U. S. P., Chloro- 
form Liniment, U. S. P., and Spirit of Chloroform, U. S. P. 
lodoformum, Iodoform, CHI3, U. S. P.—Triiodomethane. Preserve it in well- 
closed containers, in a cool place and protected from light. 
Average dose: 0.3 cc or 5 minims. 
Properties: It occurs as a fine, lemon-yellow powder or in lustrous crystals 
of the hexagonal system having a peculiar, very penetrating and persistent odor 
and an unpleasant, slightly sweetish taste suggestive of iodine. It is nearly 
insoluble in water, but soluble in 60 parts of alcohol, 80 parts of glycerin, 10 
parts of chloroform, 7.5 parts of ether, 2.8 parts of carbon disulfide and in 34 
parts of olive oil. The unpleasant odor may be partially disguised in ointments 
by adding 5 drops of oil of peppermint to the ounce. The odor of iodoform on 
utensils may be partially removed by wiping them off with oil of turpentine, 
followed by washing with soap and water. 
Preparation : Made by the action of iodine upon alcohol or acetone in the 
presence of an alkali or alkali carbonate. 
Action and Uses: It is used externally in the form of dusting powder, oint- 
ment, or iodoform gauze as an antiseptic and stimulating dressing to wounds 
and ulcers. Its antiseptic properties are due to iodine, of which it contains 
over 96 per cent by weight. Iodoform gauze may be made by saturating surgi- 
cal gauze with a 5 per cent solution of iodoform in ether and allowing to dry. 
Average dose: 0.25 Gm. or 4 grains. (Rarely given internally.) 
ASthylis Chloridum, Ethyl Chloride, CH3CH2CI, U. S. P.—Monochlorethane. 
Preserve it in hermetically sealed containers in a cool place, remote from fire 
and protected from light. 
Properties : At low temperatures or under pressure ethyl chloride is a color- 
less, mobile, very volatile liquid, having a characteristic ethereal odor and a burn- 
ing taste. It boils between 12° and 13° C. It burns with a smoky, greenish 
flame with the production of hydrochloric acid. When liberated at room tem- 
perature from its sealed container it vaporizes at once. Caution: The gas is 
very inflammable and must not be used in proximity to fire. 
Preparation : Ethyl chloride may be made by the action of hydrochloric acid 
upon alcohol: C2H50H+HC1=C-.H5C1+H20. 
Action and Uses: When inhaled it produces general anaesthesia promptly and 
may be used for operations that require only a few minutes. Sprayed on a part 
of the body it produces refrigeration and is used as a local anaesthetic in minor 
operations. 218 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Carbonei Tetrachloridum, Carbon Tetrachloride, (Tetrachlormethane), CC14, 
U. S. P. 
Properties : A clear, colorless, mobile liquid. It has a characteristic, ethereal 
odor, resembling that of chloroform. It is not inflammable. It is slowly de- 
composed by light, and by various metals if moisture is present. It is almost 
insoluble in water. It is miscible with alcohol, chloroform, ether, benzene, 
petroleum benzine, and dissolves most of the fixed and volatile oils. It has a 
high specific gravity and a low boiling point. It should be preserved in well- 
closed containers and protected from light. 
Preparation : It is made by the action of chlorine upon carbon disulfide under 
the influence of a catalytic agent. 
Action and Uses : It has narcotic and anaesthetic properties somewhat similar 
to those of chloroform. It is given internally as a vermifuge in the treatment 
of hookworm disease, and also removes some other intestinal 'worms. Its ad- 
ministration should be followed in 3. hours by a purgative dose of magnesium 
sulfate. It is used as a fire extinguisher (pyrene). When used as a fire extin- 
guisher, poisonous gases—phosgene and hydrochloric acid—are formed by the 
heat, and unless these gases are blown away from the man using the fire extin- 
guisher poisoning is likely to occur. It should not be used in unventilated spaces 
or closed compartments. 
Average dose: 2.5 cc or 40 minims. (This is a single dose for an adult as an 
anthelmintic and is not to be repeated under 3 weeks.) 
Chloramina-T, Chloramine-T, U. S. P.—Sodium paratoluenesulfonchloramide 
containing the equivalent of not less than 11.5 per cent and not more than 13 per 
cent of active chlorine (01). Preserve it in well-closed containers protected 
from light. 
Properties: A white or faintly yellow, crystalline powder, having a slight 
odor of chlorine. It slowly decomposes on exposure to air, losing chlorine. One 
gram is soluble in 7 cc of water. It is soluble in alcohol but the 
solution decomposes on standing. 
Action and Uses : It is used in 0.1 to 4 per cent aqueous solution as an anti- 
septic wound dressing. It was first used during the World War as a substitute 
for Dakin’s Solution (Solution of Sodium Hypochlorite). It has the advan- 
tage over Dakin’s Solution of greater stability, is easier to prepare, and pro- 
duces less irritation. It lacks the solvent action of the alkaline hypochlorites. 
Alcohols. 
Alcohols are compounds formed by the replacement of one of more hydrogen 
atoms of a paraffin hydrocarbon with an equal number of hydroxyl (OH) 
groups. If one hydroxyl group is substituted for one hydrogen atom in 
methane (CH4) an alcohol known as methanol (CHsOH) (methyl or wood alco- 
hol) results; if one hydroxyl group is substituted for one hydrogen atom in 
ethane (GHa) an alcohol known as ethanol (GH5OH) (ethyl or grain alcohol) is 
obtained; if three hydroxyl groups are substituted for three hydrogen atoms in 
propane (GHS) an alcohol known as glycerol (GH5(OH)s) (glyceric alcohol or 
glycerin) occurs. Alcohols are designated monatomic, diatomic, triatomic, etc., 
accordingly as they contain one, two, three, etc., hydroxyl (OH) groups. 
Alcohols are related closely to hydroxides or bases in inorganic chemistry, and 
sometimes they are referred to as organic hydroxides. When acted upon by an 
acid they form a salt (ester) and water which is analogous to the reaction 
that takes place when an acid acts on a base (hydroxide). They have a neutral 
reaction to litmus if pure. 
Alcohol, Alcohol (Ethanol, Ethyl Alcohol), C2H50H, U. S. P.—A mixture of 
alcohol and water containing not less than 92.3 per cent by weight or 94.9 per MATERIA MEDICA AND THERAPEUTICS 
219 
cent by volume at 15.56° C., of C2H5OH. Preserve it in well-closed containers 
in a cool place, remote from fire. 
Properties : It is a transparent, colorless, mobile, and volatile liquid, having 
a slight characteristic odor and a burning taste. Miscible in all proportions 
with water, ether, and chloroform. Specific gravity not above 0.816 at 15.56° G. 
(the United States Government standard temperature for alcohol). It is easily 
volatilized at low temperature and boils at 78° C. It is inflammable and burns 
with a pale blue, smokeless flame. 
Preparation: Alcohol is made by the fermentation of starch contained in 
grain. In making U. S. P. alcohol, rectified spirit is macerated with dehydrat- 
ing agents (quicklime) .to remove water, and then is.distilled. 
Action and Uses: Alcohol is used as a diffusible stimulant and hypnotic. 
Large doses cause intoxication by depression and, finally, paralysis of the cen- 
tral nervous system. Externally alcohol is used as a refrigerant in giving 
baths and alcohol rubs. It is a valuable bacteriostatic and is used extensively 
in surgery in 70 per cent strength. In pharmacy it is used as a solvent in 
making spirits, tinctures, elixirs, and fluid extracts. 
Average dose: 10 ce or 2.5 fluidrams. 
Alcohol Dilution, Diluted Alcohol, U. S. P.—A liquid containing from 41 to 
42 per cent by weight, or from 48.4 to 49.5 per cent by volume at 15.56° C. 
of C2H5OH. Preserve it in well-closed containers, in a cool place, remote from 
fire. 
Preparation ; It is made by mixing equal volumes of U. S. P. alcohol and 
distilled water. When 500 ce of alcohol and 500 cc of distilled water are mixed, 
instead of getting 1,000 cc of dilute alcohol only about 970 cc are obtained due 
to contraction in volume when these two liquids are mixed. 
Alcohol Dehydratum, Dehydrated Alcohol, U. S. P.—A liquid commonly known 
as absolute alcohol and containing not less than 99 per cent by weight of 
C2H5OH. Preserve it in well-closed containers, in a cool place, remote from 
fire. If the stopper is removed, it should be securely replaced as soon as 
possible to prevent the absorption of water from the air. 
Preparation ; It is made from ordinary alcohol by redistillation after per- 
colation through lime. There is still remaining 1 per cent of water, which 
is allowed. 
Alcohol Methylic, Methyl Alcohol (Wood Alcohol, Wood Naphtha, Wood Spirit, 
Carbinol, Methanol), CH30H.—Methyl alcohol is made by the destructive distil- 
lation of wood. 
Action and Uses : Absolute alcohol is used in microscopical work. 
Action and Uses : It is used in microscopical work. It is an excellent 
solvent, but is unfit for use in pharmacy because it is a dangerous poison, pro- 
ducing blindness and death. It is used in denaturing ethyl alcohol and in 
making formaldehyde. Caution : It should never he used internally. 
Spiritus Frumenti, Whisky, U. S. P.—An alcoholic liquid obtained by the 
distillation of the fermented mash of wholly or partly malted cereal grains, 
and containing, at 15.56° C., not less than 47 per cent and not more than 53 
per cent, by volume, of CJUOH. It must have been stored in charred wood 
containers for a period of not less than 4 years. 
Properties : A light to deep amber-colored liquid, having a characteristic 
odor and taste, and an acid reaction. 
Action and Uses : It is given Internally as a diffusible stimulant. Diluted 
Alcohol may be used internally in the place of Whisky. 
Glycerinum, Glycerin, (Glycerol), C3Hr,(0H)3, U. S. P.—A liquid obtained by 
the hydrolysis of vegetable or animal fats, or fixed oils; purified by distillation. 
154294°—89—15 220 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
and containing not less than 95 per cent of the trihydric alcohol C3Hs(OH)3 or 
CH2OH.CHOH.CH2OH. Preserve it in well-closed containers. 
Properties : It is a clear, colorless liquid, of a thick, syrupy consistency, 
having not more than a slight characteristic odor; sweet to the taste and 
producing a sense of warmth in the mouth; when it is exposed to the air it 
absorbs moisture. It is miscible with water or alcohol in all proportions; 
insoluble in chloroform, ether, benzene, petroleum benzine, and fixed or volatile 
oils. 
Preparation ; Glycerin is a by-product in the manufacture of soap. When- 
ever an alkali acts on a fixed oil or an animal fat a soap and glycerin are 
formed. The process is called saponification. 
Action and Uses: It is extensively used in pharmacy as a solvent. It pos- 
sesses the advantages of easily mixing with alcohol and water; is slightly 
antiseptic and preservative; has a sweet taste, and will dissolve many me- 
dicinal substances. It is used in making glycerin suppositories, glycerinated 
gelatin, and glycerites. It tends to keep substances from becoming hard. 
Aldehydes and aldehyde derivatives. 
The word “aldehyde” is derived from alcohol dehydrogenatum, meaning 
alcohol from which hydrogen has been extracted, and referring to the method 
of preparing aldehydes. If two atoms of hydrogen are extracted from methyl 
alcohol (CHs.OH—H2=H.CHO), formic aldehyde or formaldehyde is formed. 
The extraction of the hydrogen usually is accomplished by bringing some 
substance in contact with the alcohol that has a greater attraction for the 
hydrogen than has the carbon. Such a substance is oxygen, and the process 
of extracting the hydrogen is called oxidation; therefore it is said that for- 
maldehyde is made by the oxidation of methyl alcohol. When an aldehyde 
is oxidized (th,is time the oxygen is added to the carbon instead of taking 
something from it), it is converted into an acid: (2H.CHO+02=::2H.COOH) ; 
when acetic aldehyde is oxidized it is converted into acetic acid: (2CH3.CHO + 
02=2CH3C00H). The aldehyde group is CHO and is contained in all 
aldehydes. , 
Liquor Formaldehydi, Solution of Formaldehyde (Formalin), H.CHO, U. S. P.— 
An aqueous solution containing not less than 37 per cent by weight of H.CHO 
with varying amounts of methanol to prevent polymerization. Preserve it in a 
moderately warm place, protected from light. 
Properties: It is a clear, colorless, or nearly colorless liquid having a pungent 
odor and a caustic taste; its vapor acts as an irritant upon mucous mem- 
branes. It is miscible with water or alcohol. On long standing, especially 
in the cold, Solution of Formaldehyde sometimes loses its transparency, the 
cloudiness being due to the separation of paraformaldehyde (polymerization). 
Chemically it is a reducing agent. 
Preparation: It is made by the oxidation of methyl alcohol: 2CH3.0H+02= 
2H.CH0+2H20. 
Action and Uses : It is a powerful antiseptic and disinfectant. It acts as a 
disinfectant in aqueous solution in strengths of from 1 to 2 per cent (per cent 
here refers to the amount of absolute formaldehyde, H.CHO). This strength 
may be used in the disinfection of the hands, linen, or surgical instruments 
having cutting edges. A 1 to 10 solution in alcohol is used for the preser- 
vation of tissue. A solution composed of 13.5 cc of formalin, 5 Gm. of borax, 
and sufficient water to make 100 cc is used as an embalming fluid. It is used as 
a room disinfectant with barium dioxide. Five hundred cc of formalin mixed 
with 250 Gm. of barium dioxide in a suitable container will generate sufficient 221 
MATERIA MEDICA AND THERAPEUTICS 
formaldehyde gas to disinfect 1,000 cubic feet of air space. Formaldehyde is 
one of the few true deodorants. 
Methenamina, Methenamine (Hexamethylenetetramine). U. S. P.—A con- 
densation product of ammonia and formaldehyde containing not less than 99 per 
cent of (CH2)aN4. Preserve it in well-closed containers. 
Pkopektibs : It occurs as colorless, lustrous, odorless crystals, or a white, 
crystalline powder; soluble in 1.5 parts of water and in 12.5 parts of alcohol. 
Its aqueous solution is alkaline to litmus. 
Preparation : It is made by the action of ammonia on formaldehyde. 
Action and Uses: It is a urinary antiseptic, its antiseptic action being due 
to the liberation of formaldehyde in the normally acid urine in the bladder. 
Unless the urine in the bladder is acid there will not be enough formaldehyde 
set free to do any good and it is therefore often given in conjunction with acid 
sodium phosphate which renders the urine acid and permits more formaldehyde 
to be liberated. It has produced hsematuria and should be used cautiously. 
Average dose: 0.25 Gm. or 4 grains. 
Chloralis Hydras, Chloral Hydrate (Chloral), U. S. P.—A compound of 
trichloracetaldehyde or chloral, with the elements of one molecule of water. It 
contains not less than 99.5 per cent of C2H3O2CI3. Preserve it in tightly stoppered 
bottles, in a cool place, protected from light. 
Properties : It occurs in colorless, transparent crystals having an aromatic, 
penetrating, and slightly acrid odor, and a bitterish, caustic "taste. It is slowly 
volatilized when exposed to the air. It is soluble in 0.25 part of water, 1.3* 
parts of alcohol, 2 parts of chloroform, and 1.5 parts of ether; very soluble in 
olive oil, freely soluble in oil of turpentine. It is decomposed by alkalies, 
liberating chloroform. 
Preparation : It is made by passing chlorine gas through absolute alcohol, 
resulting first in the conversion of alcohol to acetaldehyde, and then the acetal- 
dehyde is converted into trichloracetaldehyde (chloral). 
(1) CH3CH2OH+Cl2=CH3CHO+2HCI 
(2) CH3CHO+SCI2 = CClaCHO -f BHC1 
Action and Uses : It is a powerful nerve sedative and hypnotic and is used 
in insomnia, hysteria, the various forms of insanity, and delirium tremens. 
It usually is given with bromides. It is used to cause muscular relaxation in 
tetanus and strychnine poisoning, when large doses are necessary. It is a 
habit-forming drug and should be used cautiously. It is one of the 11 drugs 
mentioned in the Federal Pure Food and Drugs Act and the amount contained in 
any preparation must appear on the label when it enters interstate commerce. 
Average dose: 0.5 Gm. or 8 grains. 
Ethers. 
Ethers may be defined as oxides of hydrocarbon radicals. There are simple 
ethers and mixed ethers. Simple ethers are formed by the union of two like 
hydrocarbon radicals with one oxgen atom; (C2H5)20 is diethyl ether (ether) ; 
compound ethers are formed by the union of two unlike hydrocarbon radicals 
with one oxygen atom, (CH3)(02H5)0 is methyl-ethyl ether. Ethers in 
organic chemistry are analogous to oxides in inorganic chemistry. The term 
very often is applied erroneously to esters. It should be understood clearly that 
ethers and esters are two different and distinct classes of organic compounds. 
Ethers are organic oxides, while esters are organic salts. (See chapter on 
Chemistry.) 
.ffither, Ether (Sulfuric Ether), (C2H5)20, U. S. P.—A liquid containing not less 
than 96 per cent nor more than 98 per cent of ethyl oxide ( the re- 222 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
mainder consisting of alcohol and water. Preserve it in partially filled, well- 
closed, light-proof containers, in a cool place, remote from fire. When ether is 
to be used for anaesthesia it is to be dispensed only in small, well-closed con- 
tainers and is not to be used for this purpose if the container has been opened 
longer than 24 hours. 
Properties : Ether is a transparent, colorless, mobile liquid, having a char- 
acteristic odor and a burning sweetish taste. It is soluble in 12 parts of water 
and is miscible with alcohol, chloroform, petroleum benzine, benzene, or fixed 
and volatile oils. It boils at about 35° C. It is highly volatile and inflam- 
mable. Its vapor when mixed with air and ignited may explode violently. It 
is slowly oxidized by the action of air, moisture, and daylight. 
Preparation :It is made by the action of sulfuric acid on alcohol. 
(1) C2H50H+H2S04=C2H5HS04+H20 
(2) GJ1-M S O.+C2H5OH= (C2H3)20+H2S04 
Action and Uses : It is administered by inhalation to produce general 
anaesthesia. In the administration of ether great care should be exercised to 
see that a flame is not brought near the vapor. In pharmacy it is used as a 
solvent in the preparation of oleoresins and in the assay of alkaloids. Given 
internally it acts as a cardiac stimulant, carminative, and antispasmodic. Sol- 
vent Ether was admitted to the Eleventh Revision of the U. S. P. under the 
name “Ethyl Oxide”, and may be purchased in larger containers at a lower 
cost than ‘‘Anaesthetic Ether.” The tests for aldehydes and peroxides in Ethyl 
Oxide are less rigid than for ASther, U. S. P. 
Phenols and phenol derivatives. 
Phenols may be defined as compounds formed by the substitution of one or 
more hydroxyl (OH) groups for a corresponding number of hydrogen atoms 
that are connected directly with carbon atoms in the benzene nucleus (C6H8). 
A phenol formed by substituting one hydroxyl (OH) group for one hydrogen 
atom in benzene (C8H8) is known as a monatomic phenol (CJELOH), ordinary 
phenol; the substitution of two hydroxyls for two hydrogens would give a 
diatomic phenol (C8H4(OH)2), resorcinol; the substitution of three hydroxyls 
for three hydrogens would give a triatomic phenol (C8H3(OH)3), pyrogallol. 
The substitution of three nitro groups for three of the hydrogen atoms in 
phenol (GiHsOH) gives a compound known as trinitro-phenol (G8H.0H(N02)3, 
or picric acid. It should be understood clearly that phenols are a distinct 
class of compounds. The term “phenol” is the name given to the most impor- 
tant member in this class, just as “alcohol” is the name applied to the most 
important member in the class of alcohols and the term “ether” to the most 
important member of the class of ethers. 
Some of the phenols are liquids and some are solids; they all have a 
characteristic odor; they act like weak acids, forming salts with strong 
alkalies, but they do not decompose carbonates, and their reaction to litmus 
is neutral or only faintly acid. They are nearly all very poisonous; most of 
them are disinfectants or antiseptics; are soluble in alcohol and sparingly 
soluble in water. Some are found in the vegetable kingdom (thymol) and 
some are formed when complex carbon compounds are subjected to destructive 
distillation; wood tar and coal tar, the residues resulting from the destructive 
distillation of wood and coal, contain phenols (phenol and cresol). A general 
measure against the caustic action of phenols (externally) is ethyl alcohol 
(grain alcohol), which dilutes the phenol, thereby weakening its action as 
well as making it easier to remove. Wash off - the phenol thoroughly wnth 
alcohol and. then apply cotton-seed oil dressings. Oils prevent penetration of 223 
MATERIA MEDICA AND THERAPEUTICS 
phenol into the tissues and absorb phenol from the tissues. For the treatment 
of poisoning by phenol when it has been swallowed see section on Toxicology. 
Phenol, Phenol (Carbolic Acid), CsHsOH, U. S. P.—It is obtained from coal 
tar or made synthetically. It contains not less than 98 per cent of C«H5OH. 
Preserve it in well-closed containers, protected from light. 
Properties : It occurs as colorless, interlaced or separate needle-shaped 
crystals, or as a white, crystalline mass, sometimes acquiring a red tint, hav- 
ing a characteristic, somewhat aromatic odor. When undiluted it cauterizes 
and whitens the skin and mucous membrane. It is soluble in 15 parts of 
water; very soluble in alcohol, glycerin, chloroform, ether, and in fixed or volatile 
oils. When heated it melts, forming a highly refractive liquid. It also is 
liquefied by the addition of about 8 per cent of water. 
Preparation ; It is obtained from coal tar by fractional distillation and 
subsequent purification. It also is made synthetically. 
Phenol Liquefaction, Liquefied Phenol (Liquefied Carbolic Acid), U. S. P.—A 
liquid containing not less than 88 per cent of CgILOH and about 10 per cent 
of water. Preserve it in well-closed containers, protected from the light. 
Action and Uses. See Liquefied Phenol. 
Properties : It is a colorless liquid, which may develop a red tint upon 
keeping, having a characteristic, somewhat aromatic odor. When undiluted 
it cauterizes the skin and mucous membrane. It is miscible with ether, alcohol, 
and glycerin. When it is diluted with an equal volume of glycerin the mixture 
is miscible with water. 
Preparation: It is made by melting crystallized phenol on a water bath. 
It then is poured into a tared vessel and weighed, and to every 9 Gm. of 
phenol is added 1 Gm. (1 cc) of distilled water, mixed thoroughly. 
Action and Uses: It is a valuable antiseptic and disinfectant. A 5 per cent 
solution may be used for the disinfection of the hands, soiled linen, stools, 
urine, bedpans, urinals, etc. In concentrated form it acts as a caustic and 
local anaesthetic. Applied in a tooth cavity on a small pellet of cotton that 
has first been touched to another piece of cotton to remove excess fluid, it 
relieves toothache. If pure phenol is spilled on the skin or in the mouth, it 
should be washed off immediately with alcohol. The concentrated phenol 
coagulates albumin, but its weaker aqueous solutions do not. Concentrated 
liquefied phenol is used for the disinfection of cutting-edged instruments which 
are damaged by boiling; after taking the instruments out of the phenol they 
are rinsed in alcohol to remove all the phenol. When phenol is to be mixed with 
a fixed oil, liquid petrolatum, or petrolatum, use melted crystalline phenol in- 
stead of liquefied phenol, because the water in liquefied phenol is insoluble in 
these solvents. 
Average dose: 0.05 cc or 1 minim. 
Cresol, Cresol (Tricresol), U. S. P.—A mixture of isomeric cresols, 
CeH4.CH3.OH, obtained from coal tar. Preserve it in well-closed containers, 
protected from light. 
Properties: It occurs as a colorless or yellowish to brownish-yellow, highly 
refractive liquid, becoming darker or assuming a reddish tint with age and 
on exposure to light, and having a phenol-like, sometimes empyreumatic odor. 
It is soluble in 50 parts of water; miscible with alcohol, ether, glycerin, ben- 
zene, or petroleum benzine. It also is dissolved by solutions of the fixed alkali 
hydroxides and soap solutions. 
Action and Uses: The action of cresol is similar to that of phenol except 
that it is stronger. It is a good disinfectant in the strength of 2 per cent 
solution for urinals, bedpans, stools, sputum cups, etc. It is used principally 
Preparation ; It is obtained from the phenol-distillates of coal tar. 224 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
in the form of Saponated Solution of Cresol, U. S. P. for disinfection of 
utensils, hands, and in obstetrical work, in strengths of from 1 to 3 per cent. 
The poisonous effects of cresol are similar to those of phenol and the treat- 
ment is the same as for phenol poisoning. 
Liquor Cresolis Saponatus, Saponated Solution of Cresol (Compound Solution 
of Cresol), U. S. P.—Preserve it in well-closed containers. It contains 50 per 
cent cresol in linseed-oil soap. 
Properties: It forms a clear solution with water. With water containing 
calcium or magnesium it forms a slightly cloudy solution due to the precipita- 
tion of insoluble soaps of these metals. 
Action and Uses: It is twice as strong as phenol as a germicide. It is less 
caustic but equally as poisonous as phenol. A weak aqueous (1 per cent) solu- 
tion is used as a vaginal douche. A 2 per cent aqueous solution may be used for 
disinfecting the hands. Instruments that cannot be boiled may be disinfected 
by using a 5 per cent aqueous solution. If accidentally swallowed, give an 
emetic followed by magnesium sulfate and demulcent drinks. 
Trinitrophenol, Trinitrophenol (Picric Acid), (C.iH20H(N02)3, U. S. P.—Pre- 
serve it in well-stoppered bottles, in a cool place, remote from fire. Caution: 
For safety in transportation it usually is mixed with about 20 per cent of 
water. 
Properties; It occurs in pale yellow, rhombic prisms or scales; odorless, and 
having an intensely bitter taste. Caution: It explodes when heated rapidly 
and when subjected to percussion. It is soluble in 78 parts of water, 12 parts 
of alcohol, 35 parts of chloroform, 65 parts of ether, and in 10 parts of benzene. 
Its aqueous solution is acid to litmus. 
Preparation : It is made by the action of nitric acid on phenol, resulting in 
the substitution of the nitro groups (N02) for three hydrogen atoms in 
phenol. 
Action and Uses: It is astringent and antiseptic. Its saturated aqueous 
solution is used mainly in the treatment of burns. Gauze saturated with the 
solution is applied to the burned area. A 5 per cent alcoholic solution is used 
(like tincture of iodine) in the first-aid treatment of wounds as a disinfectant. 
Picric acid solution should not be used in the treatment of burns covering a 
large area of the body as poisoning may occur. 
Resorcinol, Resorcinol (Resorcin), (C«H4(0H)2), U. S. P.—Meta-dihydroxyben- 
zene. It contains not less than 99.5 per cent of C«H4(OH)2. Preserve it in well- 
closed containers, protected from light. 
Properties: It occurs as colorless, or nearly colorless, needle-shaped crystals, 
or as a powder, having a faint peculiar odor and a sweetish, followed by bitter 
taste. It acquires a pink tint on exposure to air and light. It is soluble in 
0.9 parts of water, 0.9 parts of alcohol, freely soluble in glycerin or ether, 
slightly soluble in chloroform. 
Actions and Uses: It is antiseptic and antizymotic. It seldom is given 
internally. It is used in the form of an aqueous solution, and an ointment in 
the treatment of subacute and chronic skin diseases. The action after absorp- 
tion is similar to that of phenol. 
Average dose: 0.125 Gm, or 2 grains. (Rarely given internally.) 
Creosotum, Creosote (Creasote), U. S. P.—A mixture of phenols obtained from 
wood tar. Preserve it in tightly-stoppered bottles, in a cool place and pro- 
tected from light. 
Properties : It is an almost colorless or yellowish, highly refractive, oily 
liquid, having a penetrating smoky odor, and a burning caustic taste; it does 
not readily become brown on exposure to light. It is slightly soluble in water, 
but is miscible with alcohol, ether, and fixed or volatile oils. It is inflammable. MATERIA MEDICA AND THERAPEUTICS 
225 
Action and Uses : It is given internally as an antiemetic, an expectorant, and 
an intestinal antiseptic. The poisonous symptoms are like those of phenol and 
the treatment is the same. Locally it acts as an anaesthetic and antiseptic which 
makes it suitable for use in dental practice to stop toothache. 
Average dose: 0.25 cc or 4 minims. When given freely it should be adminis- 
tered in emulsion or dissolved in milk in order to overcome its irritating local 
effect. / 
Creosoti Carbonas, Creosote Carbonate (Creosotal), U. S. P.—A mixture of the 
carbonates of various constituents of creosote. 
Properties: It is a clear, colorless or yellowish, viscid liquid, odorless and 
tasteless, or having a slight odor of creosote. It is insoluble in water and freely 
soluble in alcohol and fixed oils. 
Action and Uses: Being less irritating it is a good substitute for creosote 
internally. It is an expectorant. 
Average dose: 1 Gm. or 15 grains. 
Guaiacol, Guaiacol, U. S. P.—A liquid consisting principally of the mono- 
methylether (C«H4(OH) (OCH3)) of ortho-dihydroxybenzene obtained from wood- 
tar creosote, or a solid, consisting almost entirely of CoH4(OH) (OCH3), usually 
prepared synthetically. 
Properties : It is a colorless or yellowish, strongly refractive liquid or a 
crystalline solid having an agreeable aromatic odor. It is soluble in 60 to 70 
parts of water, 1 part of glycerin, and is miscible with alcohol, chloroform, 
ether, and glacial acetic acid. Solid guaiacol melts at about 28° O. 
Preparation : It is made by the fractional distillation of wood-tar creosote. 
It also is made synthetically. 
Action and Uses : It is used externally as an antipyretic by applying locally 
on the skin; 1 to 3 cc painted on the chest, thigh, or abdomen of a fever patient 
will cause a fall of several degrees in the temperature of the body in an hour 
followed by excessive sweating and depression. It produces partial local 
anaesthesia when applied externally and sometimes is used for superficial neural- 
gias. It is used internally as an expectorant in bronchitis and tuberculosis. 
Acetophenetidinum, Acetophenetidin (Phenacetin), U. S. P.—The monoacetyl 
derivative (CsH4(OC2H5) .NH.CHsCO) of para-aminophenetol. 
Properties : It occurs as a white crystalline powder, odorless, and having a 
bitter taste. It is soluble in 1,310 parts of water and 15 parts of alcohol. 
Action and Uses: It is antipyretic, analgesic, and a cardiac depressant. It is 
used extensively as a headache remedy. 
Average dose: 0.5 cc or 8 minims. 
Average dose: 0.3 Gm. or 5 grains. 
Organic acids and their esters. 
Organic acids are compounds formed by the union of a hydrocarbon radical 
with a carboxyl group (COOH). They also are called carboxylic acids. They 
are not made by directly connecting the carboxyl group to a hydrocarbon 
radical but by the oxidation of an alcohol to an aldehyde, and further oxida- 
tion of the aldehyde to an organic acid. The reactions taking place in the 
formation of acetic acid from ethyl alcohol may be expressed as follows: 
2C2H5.0H+02=2CH3.C0H+2IL0 ; then, 2CH3.C0H+02=20ILC00H. If the acid 
contains only one carboxyl group (COOH) it is a monobasic acid; if it con- 
tains two, it is a dibasic acid; if it contains three, it is tribasic, etc. The 
only hydrogen that is replaceable by a metal or basic radical in an organic 
acid is the hydrogen in the carboxyl group. 
They possess the general properties of inorganic acids; they are sour to 
the taste, usually soluble in water, and have a strong acid reaction to litmus. 226 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Some are liquids and some are solids. They are not as corrosive as the 
inorganic acids, some being very mild in their acid properties. They decom- 
pose carbonates and combine with metals and basic radicals to form salts. 
Esters are compounds formed by the union of an organic and inorganic 
acid !with a basic hydrocarbon radical. Erroneously they sometimes are 
called ethers. Examples of esters are ethyl acetate, ethyl chloride, phenyl 
salicylate, methyl salicylate, ethyl sulfate, etc. They frequently are called 
organic salts. 
Acidum Aceticum Glaciale, Glacial Acetic Acid, CH3.COOH, U. S. P.—A liquid 
containing not less than 99 per cent of CH3.COOH. Preserve it in glass- 
stoppered bottles. 
Properties : It is a clear, colorless liquid with a strong, vinegar-like, pungent 
odor and an acid taste. It is miscible with water or alcohol. 
Preparation : It is one of the products resulting from the destructive dis- 
tillation of wood. It may be made by oxidation of methyl alcohol. 
Action and Uses: It is a very energetic acid and acts as a caustic. It is 
used principally in the preparations of the weaker acids (acetic acid, U. S. P., 
36 to 37 per cent, and diluted acetic acid, U. S. P., 5.7 to 6.3 per cent). It is 
used in the preparation of salts of acetic acid (acetates). When dropped upon 
the skin or mucous membranes it forms blisters and erodes the tissues beneath. 
It should be washed off the skin quickly with running water or soda solution. 
If swallowed accidentally give magnesium oxide mixed with water. 
Average dose: The 99 per cent acid is not given internally. The dose of 
the diluted acid is 2 cc or 30 minims. 
Acidum Benzoicum, Benzoic Acid, U.S.P.—It contains not less than 99.3 per 
cent of CgHs.COOH. It is found naturally in benzoin, balsam of tolu, balsam 
of Peru, storax, and other resinous substances from which it may be obtained 
by sublimation, but most of it is now produced synthetically. Preserve it in 
well-closed containers, in a cool place and protected from light. 
Properties : Colorless crystals, as scales or needles. It is odorless or may 
have a slight odor of benzaldehyde or benzoin. It is somewhat volatile when 
warmed. One gram is soluble in 275 cc of water, 2.3 cc of alcohol, and 3 cc 
of ether. It is soluble in fixed and in volatile oils. 
Action and Uses : In high dilutions it inhibits the growth of many organisms 
and in stronger solutions it is actively germicidal. It is sometimes used in 
mouth washes and is used in Whitfield’s Ointment with salycilic acid for ring- 
worm infections. It is stimulant, expectorant, and irritant to the mucous mem- 
branes. Benzoic acid and its salts, the benzoates, are used as food preservatives. 
Average dose: 1 Gm. or 15 grains administered in thick mucilage or syrup. 
Acidum Citricum, Citric Acid, U.S.P.—A tribasic organic acid usually obtained 
from the juice of limes or lemons. It contains not less than 99.5 per cent of 
C3H4(OH) (COOH)3 + H20. Preserve it in well-closed containers. 
Properties : It occurs as colorless, translucent crystals or as a white crystal- 
line powder, odorless and having an acid taste, and is efflorescent in dry air. 
It is soluble in 0.5 part of water and 1.8 parts of alcohol. 
Action and Uses: It is used in the preparation of citrates (solution of mag- 
nesium citrate, U. S. P.) and in the preparation of effervescent salts. It may 
be used as a substitute for lemon juice. 
Acidum Salicylicum, Salicylic Acid, U. S. P.—Orthohydroxybenzoic acid. It 
exists naturally in combination in various plants but generally is prepared 
synthetically. It contains, when dried at 100° C. for 2 hours, not less than 99.5 
per cent of GeEMOEOCOOH, Preserve it in well-closed containers, in a cool 
place, protected from light. MATERIA MEDICA AND THERAPEUTICS 
227 
Properties : It occurs as colorless crystals, usually in fine needles, or a fluffy, 
white crystalline powder having a sweetish, afterwards acrid, taste. Synthetic 
salicylic acid is white and odorless; when prepared from methyl salicylate it 
may have a slight yellow tint and a slight gaultheria-like odor. It is soluble in 
460 parts of water, 2.7 parts of alcohol, and 3 parts of ether. 
Action and Uses: Used as an antipyretic and antirheumatie. It is used 
principally in the preparation of the salicylates (phenyl salicylate, U. S. P., 
sodium salicylate, U. S. P., and acetylsalicylic acid) which are preferred for 
internal use. It is used externally for the treatment of skin diseases in the 
form of ointment, alcoholic solution, and dusting powder. It is used in skin 
diseases for its antiseptic effect and also its power of softening the horny, 
hard layer of the skin. It is contained in many corn collodions. 
Acidum Acetylsalicylicum, Acetylsalicylic Acid (Aspirin), U. S. P.—The acetyl 
derivative, of salicylic acid. Preserve it in well-closed 
containers. 
Average dose: 0.5 Gm. or 8 grains. 
Properties : It is a white crystalline powder or colorless crystals, odorless, and 
stable in dry air. It is sparingly soluble in water and freely soluble in alcohol. 
In moist air gradually hydrolizes into acetic and salicylic acids. It is decom- 
posed by alkalies. 
Action and Uses : It is used extensively as an antipyretic and antirheumatic. 
It is an excellent headache remedy. It must be used with caution because 
some individuals are easily poisoned by it, due probably to an idiosyncrasy. 
It should not be dispensed in solution because its aqueous solution slowly de- 
composes on standing. 
Average dose: 0.3 Gm. or 5 grains. 
Phenylis Salicylas, Phenyl Salicylate (Salol), U. S. P.—The phenyl ester 
(C.jHi (OH) COOCTIb) of salicylic acid. Preserve it in wrell-closed containers 
in a cool place, and protected from light. 
Properties: A white crystalline powder, having an aromatic odor and a 
characteristic taste. It is practically insoluble in water, soluble in 6 parts of 
alcohol, very soluble in chloroform, ether, and fixed or volatile oils. 
Preparation: It is made by the action of dehydrating agents on a heated 
mixture of phenol and salicylic acid. 
Action and Uses: It is used as an Intestinal antiseptic. In the intestine, 
when in contact with alkaline fluids, it is decomposed into its component parts 
of phenol and salicylic acid which there exert their antiseptic action. It is 
given with bismuth subnitrate for diarrhoea. It passes through the stomach 
unchanged, but breaks down in the intestine, and because of this property it is 
used for coating enteric pills, protecting them from the action of the stomach 
juices. 
Average dose: 0.3 Gm. or 5 grains. 
Acidum Tannicum, Tannic Acid (Tannin, Gallotannic Acid), U. S. P.—A 
tannin usually obtained from nutgall. Preserve it in well-closed containers 
in a cool place, protected from light. 
Properties : It is a yellowish-white to light brown, amorphous powder, 
glistening scales, or spongy masses, nearly odorless, and having a strong 
astringent taste. It is soluble in 1 part of glycerin and is very soluble 
in water or alcohol. 
Action and Uses: It is an astringent, and haemostatic. It is used in the 
form of an ointment for the treatment of haemorrhoids and in an aqueous 
solution as an astringent mouth wash and gargle. It is an alkaloidal precipi- 228 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
tant and may be used as a chemical antidote in certain cases of alkaloidal 
poisoning. It is used extensively in the treatment of burns in the form of an 
aqueous solution or a jelly. It acts as an astringent, hinders the growth of 
bacteria, and “tans” the tissues in the burned areas, forming a crust over them 
which prevents the escape of fluids from the body. Fantus and Dyniewicz in 
the Journal of the American Medical Association of July 17, 1937, favorably 
report the use of Compound Solution of Tannic Acid in the treatment of burns 
and state that the solution does not decompose and may be kept on hand for 
use in the emergencies occasioned by extensive burns, the salicylic acid pre- 
venting deterioration. Following is their formula: 
Potassium chloride 0. 42 Gm. 
Calcium chloride 0. 84 Gm. 
Acid salicylic 1. 00 Gm. 
Sodium chloride 10. 50 Gm. 
Acid tannic 100. 00 Gm. 
Distilled water to make 1, 000. 00 cc 
Mix and permit to stand with occasional agitation until 
dissolved; filter. 
Two formulas for the preparation of tannic-acid jelly are given in which 
phenol is used to prevent deterioration. Both may be prepared in quantity to 
be kept on hand for use in emergency. 
5 per cent Tannic-Acid Jelly with Tragacanth and % per cent Phenol 
Phenol 0. 500 
Tragacanth 3. 000 
Glycerin 42. 500 
Alcohol, 95 per cent 8. 000 
Tannic acid 5. 000 
Menthol , O'. 080 
Distilled water 79. 000 
Dissolve tannic acid in the water, add the glycerin and phenol, 
and heat until the solution is hot. Dissolve menthol in the alcohol. 
Mix the tragacanth with the alcoholic solution and while stirring 
add the aqueous solution. Continue stirring until a uniform jelly 
results. 
5 per cent Tannic-Acid Jelly with Starch and % per cent Phenol 
Tannic acid 5. 000 
Phenol 0. 500 
Starch 5. 500 
Glycerin 42. 000 
Distilled water 47. 000 
Mix the starch with 10 cc of cold water. Mix the glycerin and 
the remaining water, dissolve the tannic acid and the phenol in 
this solution and heat to boiling. Continue the boiling, hdd all the 
starch mixture at once, and stir until a homogeneous jelly results 
before removing from heat. Note: Failure to jell will usually be 
due to withdrawal of heat too soon after starch mixture is added. 
Acidum Tartaricum, Tartaric Acid, U. S. P.—A dibasic organic acid obtained 
from impure acid potassium tartrate (argol) in wine lees, by the action of MATERIA MEDICA AND THERAPEUTICS 
229 
calcium carbonate and sulfuric acid on acid potassium tartrate, or by synthesis. 
It contains not less than 99.5 per cent of G-H- (OH)2 (COOH)2. 
Pkopeeties : It occurs in colorless, translucent crystals, or as a white, fine to 
granular crystalline powder, odorless, and having an acid taste. It is soluble in 
0.75 parts of water, 3 parts of alcohol, and almost insoluble in chloroform and 
ether. It is stable in the air. 
Preparation : It is made from the deposit in wine casks, which is composed 
principally of acid potassium tartrate. This acid potassium tartrate is con- 
verted into normal calcium tartrate (insoluble) in order to remove other 
impurities, then the pure calcium tartrate is treated with sulfuric acid, forming 
calcium sulfate and tartaric acid. The calcium sulfate is precipitated and 
the tartaric acid remains in solution, from which it is obtained by filtration and 
evaporation. 
Action and Uses : It is used in the preparation of effervescent salts and 
drinks. It is contained in the white packet of a Seidlitz powder. Salts of 
tartaric acid are laxative (cream of tartar and Rochelle salt). 
Cinchophenum, Cinchophen, N. F.—Cinchophen contains, when dried to con- 
stant weight at 100° C., not less than 99.5 per cent of phenyl-quinoline-car- 
boxylic acid (OsHsN.CeHs.COOH). 
Average dose: 0.5 Gm. or 8 grains. (Rarely given internally.) 
Properties : It occurs in small, white or almost white, needle-like crystals or 
a fine powder, odorless, and has a bitter taste. It is stable in the air, is almost 
insoluble in cold water, but slightly soluble in hot water; slightly soluble in cold 
alcohol, but more readily soluble in hot alcohol. 
Action and Uses: This compound is sold under the trade name of Atophan. 
It stimulates the kidneys to excrete morel urine and has a selective action on 
the excretion of uric acid, which is increased in greater ratio than the increase 
in the amount of urine. Because of this selective action in increasing uric 
acid elimination it is used in the treatment of gout. Care must be taken in 
using it because it may cause damage to the kidney and sometimes has a 
dangerous effect on the liver. 
Amylis Nitris, Amyl Nitrite, U. S. P.—A liquid containing not less than 80 
per cent of CsHuONO. Preserve it in hermetically sealed glass bulbs or tightly 
stoppered vials, in a cool place, protected from light. 
Average dose: 0.05 Gm. or 8 grains. 
Properties : It is a clear, yellowish liquid, of a peculiar ethereal, fruity 
odor and a pungent, aromatic taste. It is almost insoluble in water, but is 
miscible with alcohol or ether. It is very volatile even at low temperatures 
and is inflammable. 
Action and Uses: Amyl nitrite, like other nitrites (glyceryl nitrite, etc.), is 
a vasodilator (dilates the blood vessels). Amyl nitrite is given by inhalation 
to relax spasms of blood vessels in angina pectoris, asthma, and other painful 
affections due to arterial spasms. It is supplied to the Navy in the form of glass 
pearls (ampules) containing 5 minims each. When it is to be administered the 
pearl is crushed in a handkerchief and the volatile amyl nitrite inhaled. Its 
action is almost instantaneous. 
Average dose: 0.2 cc or 3 minims by inhalation. 
Spiritus .ffithylis Nitritis, Spirit of Ethyl Nitrite (Sweet Spirit of Nitre), U. S. 
P.—An alcoholic solution of ethyl nitrite (C2HsONO) containing not less than 
3.5 per cent nor more than 4.5 per cent of C2H5ONO. Preserve it in well-filled, 
small, tightly-stoppered bottles, in a cool and dark place, remote from fire. 
Properties : It is a clear, mobile, volatile, and inflammable liquid of a pale 
yellow or faintly greenish-yellow tint, having a fragrant, ethereal, and pungent 230 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
odor, free from acridity, and a sharp, burning taste. When kept for a long 
time, or upon exposure to light and air, it acquires an acid reaction. 
Action and Uses : It is a diuretic and diaphoretic. It is one of the ingredi- 
ents contained in Brown Mixture. It frequently is given with solution of 
ammonium acetate. 
Average dose: 2 cc or 30 minims. 
Volatile oils, volatile-oil drugs, and preparations made from volatile-oil drugs 
Volatile oils are a class of substances having in common the properties 
of being volatile and almost insoluble in water; most of them are lighter than 
water, are soluble in ether and alcohol, have a highly characteristic odor, and 
possess antiseptic properties. They do not leave a permanent stain on 
paper like that left by a fixed oil. Most of them are obtained from plants 
where they exist naturally or are formed when the plant is brought in contact 
with water. They vary greatly in their chemical composition. The follow- 
ing classes of chemical compounds are found in volatile oils: Hydrocarbons, 
alcohols, aldehydes, esters, ketones, phenols and phenol derivatives, sulfur com- 
pounds, etc. All these classes of compounds are not found in any one oil but a 
volatile oil may contain one or more compounds belonging to one or more of the 
classes named. Oil of peppermint contains menthol which is an alcohol; oil of 
thyme contains thymol, which is a phenol; oil of gaultheria contains methyl sal- 
icylate, which is an ester, etc. The medicinal properties of the volatile oils 
vary greatly, due to the difference in their chemical composition. 
Oleum Menthae Piperitae, Oil of Peppermint (Peppermint Oil), U. S. P.—A 
volatile oil distilled from the flowering plant of Mentha piperita, rectified by 
steam distillation, and yielding not less than 5 per cent of esters, calculated 
as menthyl acetate and not less than 50 per cent of total men- 
thol (CioHri.OH), free and as esters. Preserve it in well-stoppered bottles, in a 
cool place, protected from light. 
Properties : It is a colorless liquid, having a strong odor of peppermint and 
a pungent taste, followed by a sensation of cold when air is drawn into the 
mouth. It is very slightly soluble in water, but is soluble in 4 parts of 70 per 
cent alcohol. 
Action and Uses : It is used as a flavoring, and as an aromatic stimulant 
and carminative. It is contained in Soda Mint Tablets. 
Average dose: 0.1 cc or iy2 minims. 
Menthol, Menthol, U. S. P.—An alcohol (CioHwOH), obtained from oil of pep- 
permint or other mint oils, or prepared synthetically. Preserve it in well-closed 
containers in a cool place, protected from light. 
Properties: It occurs in colorless, hexagonal crystals, usually needle-like, 
having a strong odor and taste like peppermint. When tasted it produces a sen- 
sation of warmth followed by cold when air is drawn into the mouth-. It is 
slightly soluble in water; very soluble in alcohol, chloroform, ether, or in petro- 
leum benzine; freely soluble in liquid petrolatum, fixed or volatile oils. When 
triturated with about an equal weight of camphor, thymol, or hydrated chloral 
the mixture becomes liquid. 
Preparation : It is made by placing oil of peppermint in a freezing mixture; 
when the temperature reaches —22° C. the menthol precipitates from the oil. 
Action and Uses : Externally it is applied to the skin as a local anaesthetic 
and cooling application for the relief of superficial neuralgias. It is exten- 
sively used in nose and throat sprays. It is applied in solution or ointment 
for the relief of itching skin diseases. 
Average dose: 0.06 Gm. or 1 grain. MATERIA MEDICA AND THERAPEUTICS 
231 
Spiritus Aurantii Compositus, Compound Spirit of Orange, U. S. P.—It con- 
tains oil of orange, oil of lemon, oil of coriander, oil of anise, and alcohol. 
It should be kept in completely filled, well-stoppered bottles in a cool, dark 
place. 
Action' and Uses: It is used as a flavoring and in the preparation of 
aromatic elixir. 
Oleum Caryophylli, Oil of Clove (Oil of Cloves, Clove Oil), U. S. P.—A vola- 
tile oil distilled from the dried flower buds of Caryophyllus aromaticus and 
yielding not less than 82 per cent, by volume, of eugenol (C10H12O2). Preserve 
it in well-stoppered bottles, in a cool place, protected from light. 
Properties : It is a colorless or pale yellow liquid, becoming darker and 
thicker by age and by exposure to air, having the odor and taste of clove. It 
is soluble in two parts of 70 per cent alcohol. 
Action and Uses : Internally it acts as a stimulant and carminative. Ex- 
ternally it is employed as a local anaesthetic, parasiticide, and counterirritant. 
In dental practice it is used to stop toothache by applying it, on a piece of 
cotton, to a previously cleaned tooth cavity. In microscopy it is used to clear 
tissues for mounting. 
Average dose: 0.1 cc or 1% minims. (When given internally it should be 
diluted with five times its volume of cottonseed oil.) 
Eugenol, Eugenol, U. S. P.—An unsaturated, aromatic phenol, C0H3.C3H5. 
OOHs.OH, obtained from oil of clove and from other sources. Preserve it in 
well-closed containers, in a cool place, protected from light. 
Properties : It is a colorless or pale yellow, thin liquid, having a strongly 
aromatic odor of clove and a pungent and spicy taste. It becomes darker 
and thicker on exposure to air. It is soluble in two parts of 70 per cent 
alcohol; miscible with alcohol, chloroform, ether, or fixed oils. 
Action and Uses: It is used in dental practice as a substitute for oil 
of clove. 
Average dose: 0.1 cc or 1% minims. 
Tinctura Cardamomi Composita, Compound Tincture of Cardamom, U. S. P.— 
It contains the aromatic, carminative principles from cardamon seed, cinnamon, 
and caraway. It is colored red with cochineal. The menstruum is diluted 
alcohol containing a little glycerin. 
Action and Uses: It is used as a carminative and flavoring agent. 
Average dose: 0.4 cc or 1 fluidram. 
Oleum Picis Rectificatum, Rectified Oil of Tar, U. S. P.—A rectified volatile 
oil distilled from pine tar. 
Properties : It is a liquid having a reddish brown color and a strong, empy- 
reumatic odor and taste. It is soluble in alcohol and insoluble in water. 
Preparation : It is made from wood tar by subjecting it to distillation and 
collecting that portion of the distillate which is lighter than water. It is a 
mixture of phenols, hydrocarbons, acetic acid, and oil of turpentine. 
Action and Uses : It is given internally in the treatment of chronic bron- 
chitis, administered in the form of an emulsion; externally it is used in the 
treatment of skin diseases, in the form of an ointment. 
Average dose: 0.2 cc or 3 minims. 
Eucalyptol, Eucalyptol (Cineol), U. S. P.—An organic compound (CwHisO) 
obtained from the volatile oil of Eucalyptus Globulus and from other sources. 
Preserve it in well-closed containers, in a cool place protected from light. 
Properties : It is a colorless, oily liquid, having a characteristic, aromatic, and 
distinctly camphoraceous odor, and a pungent, spicy taste, It is very slightly 232 
HANDBOOK OF THE HOSPITAL CORPS, XT. S. NAVY 
soluble in water, miscible with alcohol, chloroform, ether, glacial acetic acid, 
and fixed or volatile oils. 
Action and Uses : It is a stimulant expectorant, mild antiseptic, and anthel- 
mintic. It is given in the treatment of chronic bronchitis and pulmonary tuber- 
culosis. A mixture of 2 parts eucalyptol, 4 parts chloroform, and 45 parts of 
castor oil is used internally (given in two doses) in the treatment of uncinariasis 
(hookworm). Used locally in throat and nasal sprays and in the treatment of 
chronic skin diseases. 
Average dose: 0.3 cc or 5 minims. 
Fluidextractum Zingiberis, Fluidextract of Ginger, U. S. P.—Each 100 cc of 
the fluidextract contains not less than 4.5 Gm. of ether-soluble extractive, and 
each cc represents the medicinal activity of 1 gram of the drug (ginger). The 
active substances in ginger are a volatile oil and an aromatic resin. 
Action and Uses: It is used in the preparation of syrup of ginger. It acts 
as a warm, stimulating carminative when taken internally and is a valuable 
remedy in the treatment of abdominal cramps. 
Average dose: 0.5 cc or 8 minims (diluted with water). 
Camphora, Camphora, U. S. P.—A ketone (CaHieCO) obtained from Cinnamo- 
mum Camphora, or produced synthetically. Preserve it in well-closed contain- 
ers in a cool place, protected from light. 
Properties ; It occurs as white, translucent masses of granules of a tough 
consistence having a penetrating, characteristic odor and a pungent, aromatic 
taste. It is readily pulverizable in the presence of a little alcohol, ether, or 
chloroform. It is slightly soluble in water and freely soluble in alcohol, chloro- 
form, ether, or in fixed or volatile oils. 
Preparation: It is obtained by treating the branches and chipped wood of 
the camphor tree with steam. The camphor in the wood is volatilized by the 
hot steam and then condensed. 
Action and Uses: It is a circulatory stimulant, mild antiseptic, slight rube- 
facient, and carminative. As a circulatory stimulant it is given hypodermically 
in sterilized oil. It is used as a mild antiseptic in nose and throat sprays, as a 
rubefacient in liniments, and as a carminative in diarrhoea mixtures (Squibb’s 
Diarrhoea Mixture). 
Average doses: By mouth 0.2 Gm. or 3 grains; by hypodermic 0.1 Gm. or 1 % 
grains. 
Methylis Salicylas, Methyl Salicylate (Oil of Teaberry. Oil of Wintergreen, 
Oil of Sweet Birch), U. S. P.—It contains not less than 98 per cent of 
CelUtOIDCOO.CHs. It is produced synthetically or is obtained by distillation 
from Gaulthcria procumbens or from Betula lenta. The label must indicate 
whether the methyl salicylate has been made synthetically or distilled from 
either of the plants mentioned. Preserve it in well-stoppered bottles in a cool 
place, protected from light. 
Properties : It is a colorless, yellowish or reddish liquid having the charac- 
teristic odor and taste of gaultheria. It is sparingly soluble in water, miscible 
with alcohol and glacial acetic acid, and is soluble in 7 parts of 70 per cent 
alcohol. 
Action and Uses: It is antirheumatic and slightly antiseptic. Given inter- 
nally its antirheumatic action is like that of the other salicylates. It is rapidly 
absorbed when rubbed on the skin or applied to the skin on a cloth. It is 
applied locally for the relief of rheumatic pains in the joints. The synthetic 
oil is on the Supply Table. It is cheaper than the natural oil and is believed 
to be identical in its medicinal properties. 
Average dose: 0.75 cc or 12 minims. MATERIA MEDICA AND THERAPEUTICS 
233 
Thymol, Thymol, U. S. P.—A phenol (Cells(CH3) (OH) (C3H7) oecuring in the 
volatile oil of Thymus vulgaris and in some other volatile oils. Preserve it in 
well-closed containers. 
Properties : It occurs in large colorless crystals, having an aromatic, thyme- 
like odor and a pungent, aromatic taste, with a slight caustic effect upon the 
lips. It is soluble in 1,000 parts of water, 1 part of alcohol, 0.7 part of chloro- 
form, 1.5 parts of ether, 1.7 parts of olive oil, and in glacial acetic acid and in 
fixed or volatile oils. When triturated with about an equal weight of camphor 
or menthol, the mixture liquefies. 
Action and Uses: Thymol is used as an anthelmintic and antiseptic. As 
an antiseptic it is employed in mouth washes, gargles, and sprays. As an 
anthelmintic it is given for the cure of hookworm disease. Oils should not be 
given while thymol is in the intestinal tract because they cause it to be 
absorbed, with resulting symptoms of poisoning. Its administration should 
be preceded and followed by administrations of magnesium sulfate. 
Average dose: Antiseptic, 0.125 Gm. or 2 grains; anthelmintic, 1 Gm. or 
15 grains. 
Thymolis lodidum, Thymol Iodide (Aristol), U. S. P.—Chiefly dithymoldi- 
iodide (O0H2.CH3.C3H-.01). It contains, when dried to constant weight over 
sulfuric acid, not less than 43 per cent of iodine. Preserve it in well-closed 
containers, protected from light. 
Properties : It is a reddish-brown, or reddish-yellow bulky powder with a 
very slight, aromatic odor. It is insoluble in water or glycerin; slightly 
soluble in alcohol and very soluble in chloroform, ether, and in fixed or volatile 
oils. 
Preparation : It may be made by adding an aqueous solution of iodine and 
potassium iodide to an aqueous solution of sodium hydroxide and thymol with 
constant stirring. Thymol iodide is precipitated from this mixture. 
Action and Uses: It is a valuable antiseptic dusting powder. It is used in 
surgery as a substitute for iodoform, and as an external application to ulcers 
and skin diseases, either in the form of dry powder or ointment. It commonly 
is known as Aristol. 
Emplastrum Sinapis, Mustard Plaster (Mustard Paper), U. S. P.—A uniform 
mixture of powdered black mustard (deprived of its fixed oil) and a solution 
of rubber, spread on paper, cotton cloth, or other fabric. It should be one 
square decimeter (16 square inches) in size and contain not less than 2.5 grams 
of black mustard deprived of its fixed oil. 
Properties: When moistened thoroughly with tepid (not hot) water and applied 
to the skin, the plaster produces a decided warmth and reddening of the skin 
within 5 minutes. The irritating effect is produced by the volatile oil of 
mustard. This oil is liberated when mustard is mixed with water. 
Action and Uses : It is an extensively used counterirritant. It is used for 
the relief of congestion and pain in the chest, abdomen, joints, or muscles. 
Tinctura Capsici, Tincture of Capsicum, U. S. P.—It is a 10 per cent tincture, 
made by exhausting the active principles contained in Cayenne pepper with 
alcohol. It has a light reddish color and the fiery taste of Cayenne pepper. 
Action and Uses : Taken internally it stimulates the secretions of the salivary, 
gastric, and intestinal glands. It is especially valuable in gastritis due to 
alcoholism. 
Oleum Santali, Oil of Santal (Santalwood Oil, Oil of Sandalwood), U. S. P.— 
A volatile oil distilled from the dried heart-wood of Santalum album, yielding 
pot less than 90 per cent of alcohols, calculated as santalol (C10H2A)). Preserve 
Average dose: 0.5 cc or 8 minims. 234 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
it in well-stoppered, amber-colored bottles in a cool place, protected from light. 
Properties : It is a pale yellow, somewhat viscid, oily liquid; soluble in 5 parts 
of 70 per cent alcohol and having the characteristic odor and taste of sandal- 
wood. 
Action and Uses: It is given internally as a stimulant and disinfectant to 
the mucous membranes of the genito-urinary tract. In overdoses it is very 
irritating to the genito-urinary tract, and therefore should be given with care. 
Its principal use is in the treatment of chronic gonorrhoea. 
Average dose: 0.5 cc or 8 minims (in capsules, three times a day). 
Resins, oleoresins, gum-resins, balsams, and their preparations. 
Resins are natural, solid or semisolid plant exudations which usually are 
the oxidation products of the terpene group of volatile oils. They are complex 
in chemical composition, in which they show no uniformity, and apparently 
have as their chief constituents resin acids, resin esters, and resenes. Some 
are acid in character and form resin soap when combined with alkalies. They 
are hard, brittle, noncrystalline solids, fusible but not volatile, insoluble in 
water but soluble mostly in alcohol and ether, have little taste, burn with a 
smoky flame when ignited in the air, and soften or melt at moderate tempera- 
tures. They are transparent when pure but when they contain water are 
opaque and no longer hard and brittle. Resins are known as natural resins 
which occur as plant exudations, and prepared resins which are made in various 
ways. See under Resina1 in chapter on Pharmacy). 
Oleoresins are of two types, natural and prepared. Natural oleoresins are 
mixtures of volatile oil and resin and are obtained generally from natural 
fissures or from incisions made in the trunks of the trees in which they occur. 
(For prepared oleoresins see under Oleoresins in chapter on Pharmacy). 
Gum-resins are natural plant exudations composed of gum and resin. The 
gummy plant substances called gums are amorphous (shapeless), transparent 
or translucent, probably glucosidal in nature, and as the chemical composition 
of some of their constituents is similar to starch are classified with carbohy- 
drates (see under Sugars and substances containing sweet principles, p. 241). 
They are all insoluble in alcohol (differing in this respect from resins), some 
are completely soluble in water, others swell in water and form a paste or jelly, 
and a few are almost insoluble. When gum-resins are rubbed up with water they 
form an emulsion as the gum dissolves to form a mucilage which holds the resin 
in suspension. 
Balsams are natural oleoresins which contain benzoic or cinnamic acids or 
their esters, or other aromatic acids. When a natural resin contains benzoic 
or cinnamic acids and is therefore aromatic, it is known as a balsamic resin. 
Oleum Terebinthinse, Oil of Turpentine (Spirits of Turpentine), U. S. P.—The 
volatile oil distilled from the oleo-resin obtained from Pinus palustris and other 
species of Pinus. Preserve it in well-closed containers. 
Properties : It is a colorless liquid having a characteristic odor and taste, 
both of which become stronger and less pleasant on aging or exposure to the 
air. Almost insoluble in water but soluble in 5 parts of alcohol. 
Action and Uses; The rectified oil of turpentine, U. S. P., should be used 
internally and oil of turpentine externally. When given internally it acts as 
a diuretic, expectorant, and anthelmintic. Externally it is used as a counter- 
irritant and rubefacient. 
Average dose: 0.3 cc or 5 minims (of the rectified oil). 
Terpini Hydras, Terpin Hydrate, U. S. P.—The hydrate (GioHiS(OH)2-f H20) 
of the dihydric alcohol terpin. Preserve it in well-closed containers, in a cool 
place, and protected from light. MATERIA MEDICA AND THERAPEUTICS 
235 
Properties : It is a colorless, lustrous, white powder, almost odorless, having 
a slight aromatic and bitter taste. It is soluble in 200 parts of water and in 
13 parts of alcohol. It effloresces in dry air. 
Action and Uses: It has a stimulating action upon mucous membranes. Its 
action is expectorant, diuretic, and slightly antiseptic. Its principal use is as 
an expectorant in the treatment of chronic bronchitis. It is administered in 
the form of an elixir. 
Average dose: 0.25 Gm. or 4 grains. 
Tinctura Myrrhse, Tincture of Myrrh, U. S. P.—-It is made by extracting by 
maceration, the soluble principles from 200 Gm. of powdered myrrh with 
sufficient alcohol to obtain 1,000 ce of finished tincture. 
Properties: It is a dark reddish-brown liquid, having the balsamic odor of 
myrrh, and a bitter, aromatic taste. When mixed with water the resin con- 
tained in the alcoholic solution is precipitated. Myrrh is a gum resin and con- 
tains 3 to 8 per cent of an oxygenated volatile oil, a bitter principle, about 
50 to 60 per cent of gum, and 25 to 40 per cent of resin. 
Action and Uses : It is an astringent. It is rarely used internally. It is 
used locally as a mouth wash, diluted with water in the proportion of about 
1 to 20, in the treatment of stomatitis, spongy gums, sore throat, ptyalism, etc. 
Average dose: 1 cc or 15 minims. 
Balsamum Peruvianum, Peruvian Balsam (Balsam of Peru, Peru Balsam, In- 
dian Balsam, U. S. P.—A balsam obtained from Toluifera Pereirce. It contains 
about 60 per cent of a volatile oil and about 30 per cent of resin. 
Properties : It is a viscid liquid of a dark-brown color having an agreeable, 
vanilla-like odor, and a bitter, acrid taste. It is almost insoluble in water, 
soluble in alcohol or chloroform, and partly soluble in ether. 
Action and Uses : 95 per cent solution in castor oil is used as a stimulating 
dressing for sluggish granulations and chronic indolent ulcers. It is a valuable 
parasiticide in ringworm, pediculosis (crab lice), and scabies; for this purpose 
it is used in the form of an ointment consisting of 20 parts balsam of Peru, 
50 parts cottonseed oil, and 100 parts petrolatum. In the treatment of scabies 
it is used like sulfur ointment (hot bath before, etc.). There may be added 
to this ointment 10 per cent of sulfur to increase its efficiency in the treatment 
of scabies. 
Tinctura Benzoini Composita, Compound Tincture of Benzoin (Friars’ Balsam), 
U. S. P.—It is a dark-brown alcoholic liquid, made by extracting, by maceration, 
the alcohol-soluble principles from benzoin, 100 Gm.; aloes, 20 Gm.; storax, 80 
Gm.; and balsam of tolu, 40 Gm., with sufficient alcohol to make 1000 cc of 
finished tincture. 
Action and Uses ; It is used in steam atomizers as 'an inhalant in the treat- 
ment of croupous affections of the throat and bronchi. If a steam atomizer is 
not available, the inhalations may be given by adding a teaspoonful of tincture 
to h glassful of boiling water and inhaling the vapor. It also is used as a 
protective for ulcers, fissures of the lips and anus, bedsores, cracked nipples, etc. 
It rarely is used internally. 
Average dose: 2 cc or 30 minims. 
Oleoresina Aspidii, Oleoresin of Aspidium (Oleoresin of Male Fern), U. S. 
P.—Made by extracting the ether-soluble principles from Aspidium by percola- 
tion with a menstruum of ether. After percolation the ether is evaporated off, 
leaving the oleoresin of aspidium. It should be preserved in well-stoppered 
bottles. On standing, there is deposited in the bottom of the bottle a granular 
crystalline substance which should be thoroughly mixed with the liquid portion 
before use. 
154294°—39 16 236 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Action and Uses: Used as a taeniacide (kills tapeworms). Castor oil or 
other fixed oils should not be given while oleoresin of aspidium is in the 
intestinal tract, because they cause absorption of the oleoresin and thus may 
cause toxic symptoms. 
Average dose: 4 Gm. or 60 grains. Only one dose a day. 
Fixed oils, fats, and soaps. 
Fixed oils are so called because they leave a stain on paper or cloth that will 
not wash out, nor will it volatilize when subjected to mild heat. In this re- 
spect they differ from volatile oils. Solid substances that leave a similar stain 
are called fats. Fixed oils are found principally in the vegetable kingdom, 
and the fats are obtained from the animal kingdom. Fixed oils and fats are 
classed together because of the close chemical relationship that exists between 
them. They are composed principally of mixtures of glycerides of organic acids 
(esters). The principal acids that are combined with glyceryl radicals (C3H5) 
in these glycerides are: Oleic, palmitic, stearic, linoleic, and ricinoleic. The 
glycerides of these acids are liquids, except those of stearic and palmitic acids. 
Most fats and oils in common use are composed of glycerides of two or more 
of the above acids. The consistence of a fat or oil is governed by the propor- 
tion in which the solid and liquid glycerides are contained in it. Cottonseed oil 
is composed principally of glyceryl oleate (olein), while beef tallow, a solid, is 
composed principally of glyceryl stearate (stearin), etc. If the basic glyceryl 
radical (C3H5) in a glyceride is displaced by an alkali metal, like sodium, 
sodium stearate, sodium oleate, or sodium palmitate (soaps) are formed accord- 
ing to the acid in the glyceride; the glyceryl radical (C3H5) is set free to com- 
bine with hydroxyl (OH) groups that were attached to the sodium and form 
glycerin. This reaction is known as saponification. Rancidity is a condition in 
fixed oils and fats due to decomposition of the glycerides under the influence 
of air (oxygen), heat, and albuminous matter, resulting in the liberation of the 
fatty acids and generation of volatile acids that have a distinct odor. 
Oleum Gossypii Seminis, Cottonseed Oil, U. S. P.—A fixed oil obtained from 
seeds of cultivated varieties of Gossypium herbaceum, or other species of Gos- 
sypium. It is made by expression. Preserve it in well-closed containers, 
protected from light. 
Properties : It is a pale, yellow, oily liquid, odorless or nearly odorless, and 
having a bland taste. It is almost insoluble in water; slightly soluble in 
alcohol; and is miscible with ether, chloroform, and petroleum benzine. It is 
readily saponified by strong solutions of alkalies forming soap. 
Action and Uses: It is used in the preparation of liniments. Cottonseed oil 
and its derivatives are used extensively as food products. It also is used in 
large quantities in the manufacture of soap. 
Oleum Ricini, Castor Oil, U. S. P.—A fixed oil obtained from the seeds of 
Ricinus communis. Preserve it in well-closed containers. 
Average dose: 8 cc or 2 fluidrams. 
Properties : It is a pale-yellowish or almost colorless, transparent, viscid 
liquid, having a faint, mild odor and a bland, afterwards slightly acrid and 
generally nauseating taste. It is almost insoluble in water and is soluble in 
equal parts of alcohol and in one and one-half times its volume of liquid 
petrolatum. 
Action and Uses: It is used extensively as a simple purgative. It increases 
the intestinal secretions and stimulates the peristaltic movements of the intes- 
tine. Its disagreeable taste may be disguised partially by administering it 237 
MATERIA MEDICA AND THERAPEUTICS 
between a layer of peppermint water below and a layer of compound tincture 
of cardamon above the oil. 
Average dose: 15 cc or 4 fluidrams. 
Oleum Morrhuse, Cod Liver Oil (Oleum Jecoris Aselli), U. S. P.—The partially 
destearinated fixed oil obtained from the fresh livers of Oadus morrhua (cod- 
fish) and other species of the family Gadidw. Cod Liver Oil contains in each 
gram at least 600 U. S. P. Units of Vitamin A and at least 85 U. S. P. Units of 
Vitamin D. Preserve it in a cool place in well-closed containers which have been 
thoroughly dried before filling. 
Properties : It is a thin, oily liquid, having a peculiar, slightly fishy, but not 
rancid odor, and a fishy taste. It is almost insoluble in water but is slightly 
soluble in alcohol. 
Preparation ; The oil is obtained from the fresh fish livers by boiling them 
with water and skimming off the separated oil. 
Action and Uses : It is used as a tonic in the treatment of wasting diseases. 
The ease with which it is assimilated makes it an excellent food. Its bene- 
ficial effects are due principally to the presence of large amounts of Vitamin A 
and Vitamin D. Cod Liver Oil is also used as a local application to promote 
healing of burns on the body. 
Average dose: 10 cc or 2% fluidrams. 
Liquor Ergosterolis Irradiati, Solution of Irradiated Ergosterol (Viosterol in 
Oil), U. S. P.—A solution of ergosterol in corn oil, activated by irradiation with 
ultraviolet rays. It contains in each gram not less than 10,000 U. S. P. Units of 
Vitamin D. 
Properties : A clear, light yellowish, oily liquid. It is almost odorless and 
has a bland taste. It should be preserved in small, well-stoppered bottles, in 
a cool place. 
Action and Uses : It is used in prophylaxis and treatment of rickets and 
infantile tetany, and in other conditions due to faulty calcium and phosphorus 
assimilation. This preparation does not contain any Vitamin A, Care must 
be exercised in giving this preparation to avoid hypercalcsemia caused by large 
doses over a long period. 
Average dose: 0.3 cc or 5 minims. 
Note.—Through biochemical investigation into the physiological action of 
Vitamin D it was discovered that when food mixtures which caused the 
production of rickets in young animals were exposed to ultraviolet rays they 
became endowed with properties protecting the animals against the disease. 
Further research disclosed that the protective properties were concerned with 
a constituent of the fatty part of the ration and this constituent was finally 
found to be a substance known as ergosterol. Ergosterol was originally isolated 
as a constituent of ergot but is now obtained from other substances, mainly 
yeast. Either in crystalline form or in solution, when it is subjected to care- 
fully regulated ultraviolet radiation, ergosterol develops an antirachitic (Vita- 
min D) potency enormously greater than that of Cod Liver Oil. The Council 
of Pharmacy and Chemistry of the American Medical Association has adopted 
the term Viosterol to designate irradiated ergosterol, and Viosterol in Oil to 
designate a preparation containing this substance dissolved in a vegetable oil. 
Halibut Liver Oil with Viosterol, N. N. R.—Halibut Liver Oil to which has 
been added sufficient viosterol (irradiated ergosterol) to assure a potency of 
not less than 9,000 Vitamin D units (U. S. P. X-Revised, 1984) per gram; the 
halibut liver oil is adjusted (when necessary) to have a Vitamin A potency of 238 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
not less than 44,800 units (U. S. P. X-Revised, 1934) of Vitamin A per gram by 
the addition of fish liver oils. 
Action and Uses: The action and use are the same as for Cod Liver Oil. 
This preparation is much richer in both Vitamin A and Vitamin D than Cod 
Liver Oil and the dose is correspondingly smaller. 
Average dose: For infants 10 drops daily and for adults 20 drops daily. 
Oleum Theohromatis, Theobroma Oil (Cacao Butter, Cocoa Butter, Oil of 
Theobroma), U. S. P.—The fat obtained from the roasted seed of Theobroma 
Cacao. Preserve it in a cool place. 
Properties: It is a yellowish-white solid, having a faint, agreeable odor, 
and a bland, chocolate-like taste. It is insoluble in water, slightly soluble in 
alcohol, and freely soluble in ether or chloroform. It melts between 30° and 35° 
C. (86° and 95° F.). It is usually brittle at temperatures below 25° C. 
Action and Uses: It is used as a vehicle in the preparation of suppositories 
because it melts slightly below the temperature of the body, sets free any 
medicinal substance incorporated with it, and allows the medicine to come in 
contact with the mucous membranes. It also is used in the preparation of 
skin foods (ointment-like preparations) and as a lubricant in massage. It is 
not given internally. 
Adeps, lard, U. S. P.—The purified Internal fat of the abdomen of the hog. 
Preserve it in a cool place in well-closed containers which are impervious to 
fat. Adeps benzoinatus, (benzoinated lard), U. S. P., is a lard that has been 
treated with Siam benzoin to prevent it from turning rancid. In the prepa- 
ration of benzoinated lard for use in warm climates the Pharmacopoeia states 
that 50 Gm. of white wax (or more if necessary) may replace an equal amount 
of the lard in order to raise its melting point. Supply Table lard contains 
12 per cent of white wax. 
Properties : Lard is a soft, unctuous mass having a faint odor and a bland 
taste, and free from rancidity. It melts between 36° and 42° O., is insoluble in 
water, slightly soluble in alcohol, and readily soluble in ether, chloroform, and 
petroleum benzine. 
Action and Uses: Benzoinated lard is used principally as an ointment base. 
Adeps Lanse, Wool Fat (Anhydrous lanolin, Refined Wool Fat), U. S. P.— 
The purified, anhydrous, fat-like substance obtained from the wool of the sheep. 
Preserve it in a cool place in well-closed containers which are impervious to 
fat. 
Properties: It is a brownish-yellow, tenacious, unctuous mass having not 
more than a slight odor. It is insoluble in water, but mixes with its own 
weight of water without losing its ointment-like character. 
Action and Uses : It is used principally as an ointment base. It will permit 
100 per cent of its weight of water to be incorporated with it, which makes it 
an excellent base to use when a large volume of an aqueous liquid is to be 
incorporated in an ointment. Unlike lard and most other animal fats, it does 
not turn rancid. 
Cera Alba, White Wax, U. S. P.—It is yellow wax which has been bleached. 
Properties : It is a yellowish-white solid, somewhat translucent in thin 
layers, having a faint characteristic odor, practically tasteless, and free from 
rancidity. 
Action and Uses: It is used to stiffen ointments in warm climates, and it 
also is used in the preparation of cerates (stiff ointments). It is sometimes 
adulterated wth paraffin. 
Sapo Durus, Hard Soap, U. S. P.—Soap prepared from olive oil and sodium 
hydroxide. Preserve in well-closed containers. MATERIA MEDICA AND THERAPEUTICS 
239 
Properties : It occurs as a white or whitish solid in the form of bars, hard, 
yet easily cut when fresh, or as a fine, white or yellowish-white powder, having 
a faint peculiar odor, free from rancidity, and a disagreeable alkaline taste. 
It is soluble in water and in alcohol. 
Action and Uses: It is used as a pill excipient in the preparation of pills 
containing resinous drugs. It is used also in liniments and plasters. It is on 
the Supply Table under the name of Castile Soap. It originally came from 
Castile, Spain. 
Sapo Mollis, Soft Soap, U. S. P.—It is soap made by the action of sodium 
hydroxide and potassium hydroxide on linseed oil. 
Properties : It is a soft, unctuous, yellowish-white to brownish-yellow mass, 
having a slight characteristic odor and an alkaline taste. It is soluble in 
water and alcohol. 
Action and Uses: It is used in the preparation of liniment of soft soap 
(tincture of green soap). Tincture of green soap is used extensively for 
surgical cleansing. 
Linimentum Camphor® et Saponis, Camphor and Soap Liniment (Linimentum 
Saponis, IT. S. P. X., Soap Liniment), U. S. P.—Soap liniment is supplied to 
the Navy in powdered form consisting of soap, camphor, and oil of rosemary. 
The liniment is made from this powder by dissolving it in 70 per cent alcohol, 
allowing it to stand 24 hours and filtering. 
Action and Uses: It is applied externally with massage as a rubefacient 
and also is used as a vehicle in the preparation of other more active liniments 
(chloroform liniment). 
Amylaceous and mucilaginous substances. 
Amylaceous substances partake of the nature of starch which has the same 
chemical composition as cellulose (CeHioOs) and to which some of its prop- 
erties are closely allied. Starch is stored in plant cells in the form of granules 
of various shapes such as ovoid, spherical, polygonal, etc. Starches from dif- 
ferent plants can be recognized by the shape of their granules as seen through 
a microscope. 
Amylum, Starch (Cornstarch), U. S. P.—The starch separated from the grain 
of Zea Mays. 
Properties: It occurs in the form of a fine powder or irregular, angular, 
white masses, inodorous, and having a slight characteristic taste. It is insolu- 
ble in cold water and in alcohol. The individual grains are colored deep blue 
by iodine test solution. Cornstarch can be distinguished from other kinds 
of starch by the shape and size of the grain and the relative position of the 
hilum when viewed under a microscope. Boiled starch gives a dpeper blue 
reaction with iodine than raw starch. 
Action and Uses : It is used externally in dusting powders; internally as a 
demulcent; and in the form of starch paste in water as a vehicle for the 
administration of drugs by rectum. Starch paste is the best antidote for 
iodine poisoning. 
Mucilaginous substances are gums and other plant principles which in 
combination with water form viscid, sticky liquids. Gums have been briefly 
described under Gum-resins on page 234; other mucilaginous plant principles 
are dextrin, made from starch by oxidation with nitric acid, arabic acid, the 
active principle of acacia, bassorin, the chief constituent of tragacanth, cerasin, 
the exudation from peach and plum trees, and pectin, found in fruit juices. 
Dextrin is the substance which gives a loaf of bread its glossy outer surface 
and the high polish to- well-ironed linen. 240 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAY'S 
Acacia, Acacia (Gum Arabic), U. S. P.—The dried gummy exudation of 
Acacia Senegal and other African species of Acacia. 
Properties : It occurs in yellowish-white to light amber, translucent, brittle, 
spheroidal tears or angular fragments, inodorous, and having a mucilaginous 
taste. These tears or fragments are reduced to a white, granular powder and 
supplied under the name granular acacia. Acacia is completely soluble in water 
and insoluble in alcohol and very sensitive to certain reagents. It is precipitated 
from aqueous solutions by alcohol, tincture of ferric chloride, solution of lead 
subacetate, and saturated solution of borax, and should not be prescribed with 
these substances. 
Action and Uses: It is used as a demulcent and as an emulsifying agent; 
also as an excipient in pill making. Mucilages and syrups made with acacia 
do not keep well unless sterilized. 
Agar, Agar (Agar-agar, Chinese or Japanese Gelatin), U. S. P.—The dried 
mucilaginous substance extracted from Oelidium comeum and other species 
of Gelidium and closely related algae. It contains not more than 1 per cent 
of foreign organic matter, and yields not m,ore than 1 per cent of acid-insoluble 
ash, and not more than 18 per cent of moisture. 
Properties : Thin, translucent, membranous, agglutinated pieces or cut, flaked, 
or granulated; yellowish or brownish-white in color; brittle when dry and tough 
when damp; with a slight odor and a mucilaginous taste. Insoluble in cold 
water but slowly soluble in hot water. 
Action and Uses : In bacteriological work it is used in culture media. Is 
given internally to give moisture and bulk to the intestinal contents in chronic 
constipation. 
Average dose: 10 Gm. or 2% drams. 
Tragacantha, Tragacanth (Gum Tragacanth), U. S. P.—The dried gummy 
exudation from Astragalus gummifer or other Asiatic species of Astragalus. It 
is supplied in unground fragments, straight or spirally twisted ribbon-like 
pieces, and in ground white powder, and consists of bassorin and a soluble 
gum. 
Properties : With 50 parts of water it swells and forms a smooth, nearly 
uniform, stiff, opalescent mucilage. It does not dissolve in water. The best 
mucilage is obtained from the whole gum or flake tragacanth. Several days 
should be allowed for obtaining a uniform mucilage of maximum gel strength. 
To quickly make a mucilage from powdered tragacanth, according to “The Art 
of Compounding” by Scoville and Powers, it is best to first moisten the powder 
with a small amount of alcohol or glycerin, then add a large proportion of water, 
and shake and stir. In fragments tragacanth is whitish or yellowish-white in 
color, translucent and horny; in the powder it is white in color. It is odorless 
and has an insipid, mucilaginous taste. 
Action and Uses; It is used in the preparation of emulsions to increase 
consistence and retard creaming. It is used as a suspending medium in lotions, 
mixtures, and cosmetic preparations. It is used in the preparation of surgical 
lubricants. One formula for such a lubricant is: 
Tragacanth 12 Gm. 
Alcohol 10 cc. 
Salicylic acid 1 Gm. 
Boric acid 8 Gm. 
Sodium benzoate 2 Gm. 
Glycerin 45 cc. 
Water : 200 cc. MATERIA MEDICA AND THERAPEUTICS 
241 
Add the alcohol to the powdered tragacanth and stir. Dissolve 
the salicylic acid in the alcohol before adding it to the tragacanth. 
Add the glycerin. Add water containing boric acid and sodium 
benzoate and stir. Heat on water-bath for 1 hour. Pour into 
sterilized tubes while hot. 
Sugars and substances containing sweet principles. 
Included in the general classification of carbohydrates are sugars, starches, 
gums, and celluloses, all of which are of great importance in the life of plants 
and have similar chemical compositions in that they all contain C, H, and O, 
but in different proportions. (See p. 720.) In the chemical formulas of these 
substances the hydrogen and oxygen atoms attached to the carbon atoms in the 
molecule are present in exactly the same proportion as in water, i.e., there are 
always twice as many hydrogen atoms as oxygen atoms. Because of this pecu- 
liarity the term “carbohydrates” was given to the class of substances in which 
that characteristic was found. Of the substances mentioned as being classed as 
carbohydrates one class of sugars has the formula another the formula 
C0H22O11, and starches, celluloses, and constituents in gums have the formula 
CgHioOs. 
Sugars and saccharine substances having the nature of sugars are distin- 
guished by their sweetness of taste and their solubility in water. They are 
classified according to their chemical composition and their behavior toward 
agents such as mineral acids and enzymes which cause them to alter their 
composition by the addition of molecules of water and form new compounds. 
This forming of new compounds through the addition of molecules of water is 
termed hydrolysis and the agents which are instrumental in bringing about 
the alteration in composition are known as hydrolytic agents. Some sugars 
cannot be split up further by the action of hydrolytic agents and are known as 
monosaccharides and have the formula C.H12O0; others that split up into two 
molecules of monosaccharides are known as disaccharides and have the formula 
C12H22O11; and those that split up into three molecules of monosaccharides are 
known as trisaccharides and have the formula CisHaOie. Sugars which split 
up into more than three molecules of monosaccharides are called polysaccha- 
rides, in which group fall the sugars into which, because of their close chemical 
relationship to sugars, starches and celluloses can be converted. The polysac- 
charides obtained from starches and celluloses have the formula (CaHioCMn. 
Sugars have the ability td rotate the plane of polarized light to the right or to 
the left and therefore can be classified as dextrorotatory or levorotatory after 
the direction in which the polarized light is rotated has been determined by a 
polariscope or by a polarimeter. Dextrose is an example of a dextrorotatory 
sugar and levulose of a levorotatory sugar. 
Glucosum, Glucose (Syrupy Glucose, Liquid Glucose, Corn Syrup), U. S. P.—A 
product obtained by the incomplete hydrolysis of starch. The syrupy glucose 
obtained by one process of manufacture consists of 30 to 40 per cent of dextrose 
(d-Glucose, 30 to 40 per cent of dextrin, small amounts of other 
carbohydrates, notably maltose, and water. 
Propeeties : A colorless or yellowish, thick, syrupy liquid, odorless or nearly 
so, and having a sweet taste. It is very soluble in water but only sparingly 
soluble in alcohol. It is the principal source of Dextrose, U. S. P. The term 
glucose is frequently applied incorrectly to dextrose but should never be used 
when reference to dextrose is Intended. 
Action and Uses : Glucose is given per rectum as a food when feeding by 
stomach is impossible, and may be used to combat various types of shock. In 242 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Pharmacy it is used as a diluent in pilular extracts and has replaced glycerin 
in the commercial manufacture of many pharmaceutical preparations. If the 
U. S. P. preparation of glucose is not available ordinary commercial corn syrup 
is a satisfactory substitute. 
Glucose should not be given intravenously, intramuscularly, or intraabdom- 
inally as it contains substances not suitable for introduction into the body in 
those ways, and should not be used if dextrose is obtainable. 
Dextrosum, Dextrose, (d-Glucose), U. S. P.—A sugar (OelTzOu.HzO) usually 
obtained by the hydrolysis of starch, the conversion temperature being higher 
and the time of conversion longer than in the preparation of syrupy glucose. 
Preserve it in well-closed containers. 
Properties : Dextrose represents the complete hydrolysis of starch and occurs 
as colorless crystals, or a white, crystalline or granular powder, odorless, and 
having a sweet taste. It is soluble in 1 part of water and in about 59 parts 
of alcohol at 25° C., and is more soluble in boiling water and boiling alcohol. 
An aqueous solution (1 in 20) is neutral to litmus paper and is dextrorotatory. 
It loses not less than 8 per cent and not more than 10 per cent of its weight 
when dried to constant weight at 105° C. When dissolved in water and sub- 
jected to prolonged boiling it undergoes very little alteration. It is less sweet, 
less soluble in water, and more soluble in alcohol than cane sugar (sucrose). 
Strong mineral acids hardly act on dextrose but easily destroy cane sugar. It 
is sometimes called grape sugar because the principal sugar in grapes is 
dextrose, and has also been termed starch sugar and com sugar. 
Action and Uses : Dextrose is used in large quantities for its nutritive value 
and is usually given intravenously or injected into the subcutaneous tissues by 
hypodermoclysis. Dextrose is used whenever it is desired to raise the per- 
centage of blood sugar as in combating traumatic, postoperative, and insulin 
shock, in preparing feeble patients for operation, and in the treatment of 
threatened diabetic coma and of acidosis resulting from diabetes or starvation. 
When dextrose is given in diabetic conditions insulin, in the proportion of 1 
unit to 5 Gm. of dextrose, is usually given subcutaneously at the same time 
to promote sugar metabolism. It is used extensively as a source of water 
supply in eases of dehydration where it is impracticable to give water by the 
usual methods, and in tests to determine sugar tolerance. In hypertonic solu- 
tions (those whose osmotic tension exceeds that of blood serum) it promotes 
diuresis and aids certain types of oedema. 
Average dose; The N. F. preparations of Dextrose are usually used when it 
is to be administered. The general dose of Ampullae Dextrose, Ampuls of Dex- 
trose, N. F., is 50 cc, containing about 25 Gm. of Dextrose; of Ampulla Dextrosi 
et Sodii Chloridi, Ampuls of Dextrose and Sodium Chloride, N. F., is 10 cc, 
containing about 2.5 Gm. of Dextrose and 1.5 Gm. of Sodium Chloride; and of 
Liquor Dextrosi et Sodii Chloridi, Isotonici, Isotonic Solution of Dextrose and 
Sodium Chloride, N. F., which contains in each 100 cc not less than 2.3 Gm. and 
not more than 2.5 Gm. of Anhydrous Dextrose, and not less than 0.4 Gm. and not 
more than 0.425 Gm. of Sodium Chloride, is 1000 cc intravenously. 
Sucrosum, Sucrose (Saccharum, Sugar, Cane Sugar, Beet Sugar), U. S. P.—A 
sugar (C12H22O11) obtained from Saccharum officinarum, Beta maritima, and 
other sources. 
Properties : It occurs in colorless or white crystals, crystalline masses or 
blocks, or a white crystalline powder, odorless, with a sweet taste. It is stable 
in the air and is Soluble in V2 part of water and 170 parts of alcohol, at 25° C., 
and in slightly more than %o part of boiling water. It is insoluble in chloro- 
form and in ether. An aqueous solution (1 in 20) is neutral to litmus paper. MATERIA MEDICA AND THERAPEUTICS 
243 
Sucrose is dextrorotatory but by the action of an enzyme or by heating with 
diluted acids is converted into the fermentable mixture called invert-sugar which 
is levorotatory. If a dilute aqueous solution of sucrose is exposed to warm, 
dust-laden air it is converted into alcohol, carbon dioxide, and eventually 
acetic acid. 
Action and Uses : Sucrose is used principally in the making of pharmaceutical 
preparations such as syrups, troches, masses, confections, etc. The best sugar 
for general pharmaceutical uses is the kind known technically as “granulated”, 
one of very high purity is preferable for making pharmaceutical syrups, and 
a finely granulated type known as “confectioner’s” or “XXXIX” sugar is es- 
pecially suitable for the making of troches. Sucrose has a high food value but 
its use should be restricted or eliminated in diabetes mellitus, in obesity, and 
during the existence of fermentative changes in the stomach and intestine. 
Glycyrrhiza, Glycyrrhiza (Licorice, Licorice Root), U. S. P.—The dried rhizome 
and roots of varieties of Glycyrrhiza glahra known in commerce as Spanish 
Licorice and Russian Licorice, and of other varieties, yielding a yellow, sweet 
wood. 
Properties : It contains the sweet principle glycyrrhizin, a salt of glycyrrhizic 
acid, and an oleoresinous substance which gives Glycyrrhiza its slightly acrid 
taste. It has a distinctive odor, a yellowish-brown, dark brown, or pale yellow 
color externally and a yellow or pale yellow color internally, and yields not 
more than 2.5 per cent of acid-insoluble ash. 
Action and Uses : Its value in Pharmacy is due to the sweet principle it 
contains. The fluidextract is on the Supply Table and is used in making Brown 
Mixture. Both the extract and the fluidextract of Glycyrrhiza are excellent 
preparations for masking the taste of bitter drugs, like quinine, but acids should 
not be added as they precipitate the sweet principle. 
Average dose: 2 cc or 30 minims of the fluidextract. 
Glucosides, glucosidal drugs, and preparations made from glucosidal drugs. 
Olucosides are organic plant principles which, when treated with diluted acids 
or enzymes, decompose by hydrolysis into a sugar and one or more other sub- 
stances. The sugar into which glucosides split is usually any one of a number 
of bodies having the formula of glucose, ; the other substances are usually 
of a complex character and in most cases are compounds of benzene. A few 
glucosides contain nitrogen but most are nonnitrogenous. Saponins is the name 
given to a group of glucosides that are readily soluble in water and produce a 
froth, like soap-suds, when an aqueous solution is shaken. They are good 
emulsifying agents and aqueous solutions of some of them are used in place of 
soap for cleansing purposes. Many are markedly toxic in their physiological 
action and will dissolve or hsemolyze red blood cells. The toxic sapouins are 
termed sapotoxins. Medicinally, glucosides are very active bodies, the activity 
in some cases being due to the glucoside itself and in others to the decompo- 
sition products of the glucoside. Glucosidal drugs are drugs that contain glu- 
cosides and it is difficult to extract and isolate the glucosides in them without 
having the glucosides split up into something different. Owing to the difficulty 
in extracting and isolating the glucosides contained in glucosidal drugs they 
cannot be assayed by chemical means. Biological assays (determining the 
strength by testing the drug on an animal) have been provided for certain glu- 
cosidal drugs, as digitalis, strophanthus, and squill. Glucosidal drugs are some- 
times grouped according to their therapeutic action as drugs containing: Sweet 
glucosides, bitter glucosides, glucosides acting on the heart, purgative glucosides, 
astringent glucosides, and saponin. 244 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Digitalis, Digitalis (Foxglove), XL S. P—The dried leaf of Digitalis purpurea. 
The potency of Digitalis shall be such that 0.1 Gm. of it, when assayed as di- 
rected, shall possess an activity equivalent to not less than 1 U. S. P. digitalis 
unit. One United States Pharmacopoeial Digitalis Unit is identical in potency 
with the International Digitalis Unit, as adopted in 1928 by the Permanent Com- 
mission on Biological Standardization of the Health Organization of the League 
of Nations. One International Digitalis Unit represents the activity of 0.1 Gm. 
of the “International Standard Digitalis Powder.” Digitalis contains a number 
of glucosides, those of the greatest importance being digitalin, digitonin, digi- 
talein, and digitoxin. There are many proprietary preparations of Digitalis on 
the market but the U. S. P. recognizes only two, Powdered Digitalis and Tincture 
of Digitalis. Tincture of Digitalis is on the Supply Table. The potency of 
Powdered Digitalis is the same as Digitalis and when Digitalis is prescribed 
Powdered Digitalis should be dispensed. Digitalis should he stored in water- 
proof and airtight containers and protected from light. 
Action and Uses : It is used as a cardiac tonic and stimulant, slowing and 
strengthening the heart beat. Digitalis is cumulative in the system. Evidence 
of accumulation is shown by headache, giddiness, sickness, and a marked slow- 
ing of the pulse. The active principles of Digitalis are irritating to the gastric 
mucous mebranes and may cause nausea and vomiting. In case of mild poison- 
ing or overdosing administer atropine sulfate hypodermically. The diuretic ef- 
fect of Digitalis is due to improved circulation. 
Average dose: 0.1 Gm. or 1% grains. 
Tinctura Digitalis, Tincture of Digitalis, U. S. P.—The potency of Tincture of 
Digitalis shall be such that 1 cc of the tincture, when assayed as directed, shall 
possess an activity equivalent to not less than 1 and not more than 1.1 U. S. P. 
Digitalis Units. It is a 10 per cent tincture, which means that 100 ce of tincture 
possesses the medicinal activity of 10 Gm. of the powdered drug. The alcoholic 
content of the tincture is 67 to 72 per cent by volume. Preserve the tincture 
in small, well-closed bottles, protected from light, and in a cool place. 
Action and Uses ; See Digitalis. 
Average dose: 1 cc or 15 minims. 
Strophanthus, Strophanthus, N. F.—The dried ripe seed of Strophanthus 
Komhe, or of Strophanthus hispidus, deprived of the awns. When assayed 
biologically as prescribed it possesses a potency, per gram, equivalent to not 
less than 55 milligrams of standard ouabain, U. S. P. XI. (Ouabain is a glu- 
coside obtained from Acokanthera Ouahaio or from Strophanthus grains that 
is twice as toxic as Strophanthin, and is used for the international control of 
Strophanthin preparations.) Strophanthus contains the active glucoside Stro- 
phanthin which is on the Supply Table. 
Action and Uses: See Strophanthin. 
Strophanthinum, Strophanthin, U. S. P.—A glucoside or mixture of gluco- 
sides obtained from Strophanthus Komhe. Strophanthin, when assayed as 
directed, shall possess a potency equivalent to the activity of not less than 
40 per cent and not more than 60 per cent of ouabain when similarly assayed. 
Preserve it in well-closed containers and protected from light. 
Action and Uses: It is extremely poisonous. Its action is similar to the 
action of digitalis. It is absorbed more rapidly, its action is faster, and it is 
used in place of digitalis when immediate effect is required. In case of poison- 
ing give inhalations of chloroform to quiet the heart. If the poison is in the 
stomach it should be washed out. Death occurs quickly from poisoning. 
Average dose: 0.0006 Gm. or Mpo grain. MATERIA MEDICA AND THERAPEUTICS 
245 
Santoninum, Santonin, U. S. P.—The inner anhydride of santoninic acid, 
obtained from several species of Artemisia. Preserve it in well-closed containers, 
protected from light. 
Properties: It occurs in colorless crystals, usually tabular, or as a white, 
crystalline powder; odorless and nearly tasteless at first, but afterwards develop- 
ing a bitter taste; stable in the air, but becoming yellow on exposure to light. 
It is very slightly soluble in water and soluble in 43 parts of alcohol. 
Action and Uses : It is used principally as an anthelmintic for the removal 
from the intestine of Ascaris lumbricoides (round worms). It makes objects 
appear to the patient as if viewed through a yellow glass (xanthopsia). 
Average dose: 0.06 Gm, or 1 grain. (It is on the Supply Table in one- 
half grain tablets.) 
Tinctura Gentian* Composita, Compound Tincture of Gentian, U. S. P.—It 
contains in 1,000 cc the glycerin-hydro-alcoholic soluble principles from 100 
Gm. of gentian, the active principle of which is the glucoside gentiopicrin, 40 
Gm. of bitter orange peel, and 10 Gm. of cardamom seed. 
Action and Uses: It is used as a bitter tonic. 
Average dose: 4 cc or 1 fluidram. 
Drugs containing cathartic principles and their preparations. 
Fluidextractum Rhei, Fluidextract of Rhubarb, N. F.—Made by extracting 
the active principles of rhubarb with a menstruum consisting of 4 volumes of 
alcohol and 1 volume of water. 
Action and Uses: Acts principally on the large intestine by producing 
freouent fluid stools accompanied by griping. The stools frequently are col- 
ored yellow with bile. On account of the rheotannic acid which it contains, 
rhubarb constipates after its purgative action. As a laxative it is particularly 
efficient in treating summer diarrhoeas of children, because after its purgative 
effect has been produced it checks the diarrhoea. 
Average dose: 1 cc or 15 minims. 
Extractum Cascarse Sagradse, Extract of Cascara Sagrada, U. S. P.—It is an 
extract obtained from cascara sagrada. One grain of extract represents 3 Gm. 
of cascara sagrada. Cascara sagrada is the dried bark of the trunk and branches 
of Rhamnus Purshiana. Unlike most extracts, it is made by exhausting the drug 
with boiling water. 
Action and Uses: It is a valuable laxative, acting mainly on the lower 
bowel. It is used in the treatment of chronic constipation. It is supplied to 
the Navy in tablet form. 
Average dose: 0.25 Gm. or 4 grains. 
Fluidextractum Cascarae Sagradse Aromaticum, Aromatic Fluidextract of Cas- 
cara Sagrada, U. S. P.—Made by extracting the active principles of cascara 
sagrada with boiling water. The bitter taste is removed from the cascara by 
maceration and percolation while it is mixed with magnesium oxide. It is 
aromatized and sweetened with pure extract of glycyrrhiza, saccharin, oil of 
anise, oil of coriander, and methyl salicylate. It contains from 17 to 19 per cent 
alcohol. 
Action and Uses: It is preferred as a laxative over the other preparation of 
cascara because of its pleasant taste. 
Average dose; 2 cc or 30 minims. 
Products obtained from animal substances. 
Many products of great value in the prevention and treatment of disease 
are obtained from animals, whole animals, animal organs, animal excretions, 246 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
and animal serum being used in their production. Most of the animal products 
used in medicine are of such complex composition that they cannot be classed 
as definite chemicals; two, however, pepsin and pancreatin, are classed as ani- 
mal proteins, and lactic acid, obtained from milk, has a definite chemical formula. 
From whole animals are obtained Cantharides and Cochineal, U. S. P.; from 
animal organs are obtained Thyroid, Solution of Parathyroid, Thyroxin, Solu- 
tion of Posterior Pituitary, Epinephrine, Liver Extract, U. S. P., 'and others; 
from animal excretions are obtained Oxgall, U. S. P. and Milk, N. F.; and 
from animal serums are obtained Serums, Vaccines, Anti-toxins, Toxins, etc. 
Animal fats and oils have been described elsewhere but lack of space prevents 
the description here of all but a few of the remaining products obtained from 
animals and the student is referred to the U. S. Pharmacopoeia, textbooks on 
the Practice of Pharmacy, and other textbooks for information concerning them, 
Pepsimim, Pepsin, U. S. P.—A substance containing a proteolytic ferment or 
enzyme obtained from the glandular layer of the fresh stomach of the hog. 
When assayed as directed, it digests not less than 3,000 and not more than 3,500 
times its weight of egg albumin. Pepsin of higher digestive power may be 
reduced to the official standard by admixture with pepsin of lower digestive 
power or with lactose (sugar of milk). Preserve it in well-closed containers 
in a cool place. 
Properties : It occurs in lustrous, transparent or translucent scales, granular 
or spongy masses, ranging in color from light yellowT to light brown, or as a 
fine, white or cream-colored amorphous powder, free from any offensive odor, 
and having a slightly acid or saline taste. It is not more than slightly hygro- 
scopic, is freely soluble in water and nearly insoluble in alcohol, in chloroform, 
and in ether. When in solution it is incompatible with alkalies, alkali earths, 
and alkali carbonates. It is destroyed by salts of copper, lead, silver, mercury, 
bismuth, etc. The presence of more than 0.5 per cent of hydrochloric acid in 
pepsin solution retards its proteolytic activity. 
‘Action and Uses : Pepsin is a normal constituent of the gastric juice and 
its function is to digest albuminous matter. It is given when there is a defi- 
ciency of pepsin in the gastric juice. There are a large number of National 
Formulary elixirs and liquids containing pepsin. Pepsin and pancreatin never 
should he administered together; nor should pepsin he administered with sodium 
bicarbonate which renders it inert. 
Average dose: 0.5 Gm. or 8 grains. 
Liquor Pituitarii Posterioris, Solution of Posterior Pituitary (Solution of Pitui- 
tary), U. S. P.—It contains the water-soluble principles from the fresh posterior 
lobe of the pituitary body of healthy domesticated animals used for food by 
man. The pituitary body must have been removed from the animal imme- 
diately after slaughtering, and then extracted at once or kept frozen until 
extracted. One cc of Solution of Posterior Pituitary produces an activity upon 
the isolated uterus of the virgin guinea pig, corresponding to not less than 
80 per cent and not more than 120 per cent of that produced by 0.005 Gm. of 
the Standard Powdered Posterior Pituitary. The solution must be sterile. 
Preserve it in small, well-filled, amber-colored containers or in ampules. 
Properties: A transparent liquid, colorless, or nearly so, having a faint, 
characteristic odor. 
Action and Uses; It is administered hypodermically, or intramuscularly. It 
stimulates smooth muscle, especially that of the blood vessels and the uterus. 
It increases blood pressure find is given in certain conditions of surgical shock. 
It is used principally to stimulate uterine contractions in labor. It is not 
effective when given by mouth. 
Average dose: 1 cc or 15 minims. MATERIA MEDICA AND THERAPEUTICS 
247 
Liquor Epinephrinae Hydrochloridi, Solution of Epinephrine Hydrochloride, 
U. S. P.—It is a solution (1-1,000) of epinephrine in distilled water and 
hydrochloric acid, containing, in each 100 cc, not less than 0.095 Gm. and* 
not more than 0.105 Gm. of epinephrine (C0H13O3N). Epinephrine is sensitive to 
oxidizing agents and should be bottled excluding air. Once the bottle has been 
opened deterioration takes place rapidly. The solution should be slightly acid, 
should contain a preservative to prevent the growth of germs and fungi, and 
should contain a reducing agent to prevent oxidation. It is commonly called 
adrenalin. 
Properties: A nearly colorless, slightly acid liquid, gradually turning dark 
on exposure to air and light. When the solution has become brown in color, 
or contains a precipitate, it must be rejected. Preserve it in small, well-filled, 
amber-colored bottles or in ampules. 
Action and Uses: It is used locally for its vaso-constrictor action in 
haemorrhage. The vaso-constrictor action is used to prolong the anaesthetic 
effect of local anaesthetics by retarding the circulation in the Injected area, 
thus hindering removal of the anaesthetic agent by too rapid absorption into 
the blood stream. In this way it also lessens the general toxic effect of the 
anaesthetic. Intravenous injections are given in shock and anaesthetic acci- 
dents. By constricting the blood vessels it causes a rise in blood pressure. 
It stimulates the heart. 
Average dose: 0.5 cc or 8 minims by parenteral injection. 
Extractum Hepatis, Extract of Liver (Dry Liver Extract), U. S. P.—Contains 
that soluble fraction of mammalian livers which increases the number of red 
blood cells in the blood of persons suffering from pernicious anaemia. This 
fraction, which has been dried, conforms to the specifications for Standardiza- 
tion of Products for the Treatment of Pernicious Anaemia, U. S. P. XI, approved 
by the “U. S. P Anti-anaemia Preparations Advisory Board.” Preserve it in 
well-closed containers, preferably in a cool place. 
Preparation : No official method of preparation is prescribed by the U. S. P. 
In the method of Doctors Minot and Murphy of Boston, Mass., livers of food 
animals are ground with water, the mixture adjusted to the isoelectric point, 
heated to coagulate the protein and filtered; the filtrate is evaporated in vacuo 
and enough alcohol added to cause a concentration of 70 per cent of ethyl 
alcohol. The consequent precipitate is separated, dried, and powdered. 
Properties ; It is a yellow powder with a not unpleasant taste, and almost 
completely soluble in water, but insoluble in alcohol, acetone, and ether. 
Action and Uses : It is used in pernicious ansemia, in sprue when the bone 
marrow is not exhausted, and in certain cases of obscure ansemia. Although 
used experimentally in other conditions only those preparations of liver pri- 
marily intended for the treatment of pernicious ansemia have thus far been 
accepted by the Council on Pharmacy and Chemistry of the American Medical 
Association. Liquor Hepatis, Solution of Liver, and Liquor Hepatis Purificatus, 
Purified Solution of Liver are also official in the U. S. P. 
Average dose: As indicated on the label of the container. 
Insulin, N. N. R.—An aqueous solution of an active principle from the pan- 
creas which affects sugar metabolism. The strength of Insulin is expressed 
in “units.” The unit is equivalent to 0.125 milligrams of the International 
Standard Preparation of Dry Insulin Hydrochloride prepared by the Medical 
Council of Great Britain. One milligram of this standard preparation contains 
8 insulin units, as provisionally defined by the Insulin Commission of the 
University of Toronto, Canada. 
Action and Uses : It is used in the treatment of diabetes. If a suitable 
dose of Insulin is administered at suitable intervals to a person suffering from 248 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
diabetes mellitus, the blood sugar is maintained at or near a normal level and 
the urine remains free from sugar. In case of overdosing with Insulin the 
patient complains of weakness and fatigue and a feeling of nervousness and 
tremulousness followed by profuse sweating. This condition is relieved by 
giving orange juice by mouth, or dextrose intravenously if the patient is 
comatose. Insulin is administered by injection into the loose subcutaneous 
tissue of the body about 30 minutes before meals. There is no average dose 
for Insulin, each case must be studied individually. The dose of Insulin should 
always be expressed in units rather than by cubic centimeters. 
Alkaloids, alkaloidal salts, and alkaloidal drugs. 
Alkaloids are physiologically active principles found in the vegetable king- 
dom or produced synthetically having a complex composition. They are all 
nitrogenous and in addition contain carbon, hydrogen, and generally oxygen. 
Because they contain nitrogen, are built on the ammonia type of bases, and act 
as ammonias in their method of forming salts, they frequently are spoken of 
as nitrogenous plant bases. They are derivatives principally of pyridine, quino- 
line, or similar ringed bodies. The term alkaloid means “like an alkali,” 
with which substances, however, they must not be confused. Substances react- 
ing to many of the alkaloidal tests are obtained from the animal kingdom, 
those found in living animal tissues being generally known as leucomaines 
while those found in decayed animal tissues (probably produced in the process 
of decay) are known as ptomaines or “cadaveric alkaloids.” Alkaloids are re- 
garded as decomposition products of proteins, nucleins, etc., in the plant cells 
during the process of growth, which have condensed with the substances 
present in plants. 
In the vegetable kingdom their occurrence is confined to a few plant families 
as follows : Apocynacese, Leguminosse, Liliacese, Loganiacese, Papaveracese, Ranun- 
culaceae, Rubiacese, Rutacese, Solanacese, and Umbelliferse. They exist in all 
parts of plants, usually in the form of salts, as tannates, malates, quinates, 
meconates, etc. They can be extracted from drugs containing them, and are 
the active principles of the drugs in which they are present. 
Some alkaloids are solids (amides), and some are liquids (amines). Most 
of the nonvolatile alkaloids are solid, the volatile ones are mainly liquid and 
some of them contain no oxygen. They are generally colorless, are alkaline 
in their reaction, and resemble inorganic bases, especially ammonia, in their 
chemical behavior, in that they combine directly with acids to form salts. 
Their basic properties vary in intensity; some are strongly alkaline, and others 
are very weak. They are nearly all poisonous and have a bitter taste. With 
a few exceptions they are insoluble in water, but are soluble in alcohol, ether, 
chloroform, and petroleum benzine. The solubility of their salts is the reverse, 
being soluble in water but insoluble or slightly soluble in alcohol and insoluble 
in chloroform, ether, and petroleum benzine. Most of them are precipitated in 
aqueous solution from their salts upon the addition of alkalies or agents having 
an alkaline reaction. The alkaloids are decomposed by strong reducing or 
oxidizing agents (reason for the use of potassium permanganate in morphine 
poisoning). They are precipitated from their aqueous solution by mercuric 
potassium iodide, gold chloride, picric acid, tannic acid, sodium hydroxide, 
potassium hydroxide, alkali carbonates, alkali salicylates, benzoates, iodides, 
and bromides. 
They vary greatly in their action on the system; some are stimulants, while 
others are depressants, etc. Some of the most valuable remedies used in 
medicine, as well as most of the narcotic habit-forming drugs, belong to this 
class. It is important to differentiate between alkaloids, alkaloidal salts, and MATERIA MEDICA AND THERAPEUTICS 
249 
alkaloidal drugs. Alkaloids are the basic substances; morphine is an alkaloid. 
Alkaloidal salts are compounds (salts or esters) formed by the union of the 
basic alkaloid with an acid; morphine sulfate is an alkaloidal salt formed 
by the union of morphine with sulfuric acid. Alkaloidal drugs are drugs 
(parts of plants) containing alkaloids; opium is an alkaloidal drug because it 
contains, among others, the alkaloid morphine; cinchona is an alkaloidal drug 
because one of the alkaloids it contains is quinine. 
In order to distinguish alkaloids from glucosides a different terminology, 
which has been carried in the Pharmacopceial nomenclature, has been adopted 
for each class. The ending ine (Latin ina) is applied to alkaloids, and the 
ending in (Latin inum)) is given to glucosides. 
Opium, Opium, U. S. P.—The air-dried milky exudation obtained by incising 
the unripe capsules of Papaver somniferum or its variety album, and yielding in 
its normal condition not less than 9.5 per cent of anhydrous morphine. This 
form of opium is not used mjedicinally nor is it on the Supply Table, but 
it is used in making powdered opium and granulated opium, and these two 
preparations of opium are used in making the other opium preparations. 
Opium, its preparations, and its derivatives are restricted in their sale and 
use by the Harrison Narcotic Act, as they are habit-forming drugs. 
Opium Pulveratum, Powdered Opium, U. S. P.—Opium dried at a temperature 
not exceeding 70° C., reduced to a very fine powder, and yielding not less 
than 10 per cent nor more than 10.5 per cent of anhydrous morphine. Pow- 
dered opium of a higher morphine percentage may be brought within the 
required limits by admixture with powdered opium of a lower percentage, 
or with som,e inert diluent. Preserve it in well-closed containers. 
Properties: It is a yellowish-brown to brownish-red powder, having a heavy, 
characteristic odor and a very bitter, characteristic taste. 
Constituents : Opium contains more than 20 different alkaloids, the most 
important of which are morphine and codeine. 
Action and Uses : Opium and its preparations when given internally are 
depressant to the central nervous system, analgesic, and constipating. Opium 
has no local effect other than that produced after absorption. The effects 
produced by opium preparations are due principally to morphine. 
Average dose: 0.06 Gm. or 1 grain. 
Pulvis Ipecacuanhas et Opii, Powder of Ipecac and Opium (Dover’s Powder), 
U. S. P.—It is made by mixing 10 per cent opium powder, 10 per cent ipecac 
powder, and 80 per cent sugar of milk. Ten grains of this powder contains 1 
grain of powdered opium, 1 grain of powdered ipecac, and 8 grains of milk sugar. 
Action and Uses : It is used as an anodyne and diaphoretic. 
Average dose: 0.5 Gm. or 8 grains. 
Tinctura Opii, Tincture of Opium (Laudanum), U. S. P.—One hundred cc of 
tincture of opium yields not less than 0.95 Gm. nor more than 1.05 Gm. of 
anhydrous morphine. It is made by extracting the active principles from 
granulated opium with distilled water and alcohol. 
Action and Uses: It is a convenient form for the administration of opium. 
It is used in the preparation of Lead and Opium Wash, N. F. It is given in 
diarrhoea for its sedative and constipating effect on the intestinal tract. It 
produces the characteristic effects of opium when given internally, relieving 
pain and producing sleep. 
Average dose; 0.6 cc or 10 minims. 
Tinctura Opii Camphorata, Camphorated Tincture of Opium (Paregoric), U. S. 
P.—It is made of 40 cc of Tincture of Opium, 4 cc of Oil of Anise, 4 Gm. of 
Benzoic Acid, and 4 Gm. of Camphor dissolved in 900 cc of diluted alcohol to 250 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
which 40 cc of glycerin and sufficient diluted alcohol are added to make the 
finished product measure 1,000 ce. It is the weakest and one of the most used 
of the opium preparations and yields, from each 100 cc, not less than 0.035 Gm. 
and not more than 0.045 Gm. of anhydrous morphine. 
Action and Uses: It possesses analgesic and carminative properties. It is 
one of the ingredients in Brown Mixture (checks cough). It is used to relieve 
abdominal pain due to flatus (gas in the intestine), to check diarrhoea, etc. 
Average dose: 4 cc or 1 fluidram. 
Morphinae Sulfas, Morphine Sulfate, U. S. P.—The sulfate of the alkaloid mor- 
phine. Preserve it in well-closed containers, protected from light. 
Properties : It occurs in white, feathery, silky crystals, or cubical masses of 
crystals, or a white crystalline powder, odorless, and permanent in the air. It 
is soluble in 15.5 parts of water and in 565 parts of alcohol. 
Action and Uses : It is a powerful narcotic. It is depressant to the central 
nervous system, relieves pain, produces sleep, and tends to cause constipation. 
It is a dangerous habit-forming drug and should never he prescribed in 
repeated doses except by a doctor. In case of acute poisoning hy morphine, 
wash out the stomach with potassium permanganate solution and give 
stimulants. 
Average dose: 0.008 Gm. or % grain. 
Codeina, Codeine (Methylmorphine), U. S. P.—An alkaloid obtained from 
opium, or prepared from morphine by methylation. Preserve it in well-closed 
containers, protected from light. 
Properties : It occurs in colorless crystals or as a white, crystalline powder; 
odorless, and is slowly efflorescent in dry air. It is soluble in 120 parts of water 
and 2 parts of alcohol. Its aqueous solution is alkaline to litmus. 
Action and Uses; It is sedative, analgesic, and hypnotic. Its action is some- 
what like that of morphine but less intense. It is largely used as a sedative, 
in the treatment of coughs, to lessen the irritation of the respiratory tract. 
Average dose: 0.03 Gm. or % grain. 
Codeinse Sulfas, Codeine Sulfate, U. S. P.—The sulfate of the alkaloid codeine. 
Preserve it in well-closed containers, protected from light. 
Properties : It occurs in colorless crystals, usually needle-like, or as a wdiite 
crystalline powder, efflorescent in the air. It is soluble in 30 parts of water and 
very slightly soluble in alcohol. 
Actions and Uses : Same as codeine. 
Average dose: 0.03 Gm. or % grain. 
Apomorphinse Hydrochloridum, Apomorphine Hydrochloride, U. S. P.—The 
hydrochloride of an alkaloid prepared from morphine. Preserve it, protected from 
light, in small, well-stoppered vials which previously have been rinsed with 
diluted hydrochloric acid and dried. Apomorphine hydrochloride, if it imparts 
at once an emerald-green color to 100 parts of distilled water when shaken with 
it in a test tube, is unfit for use. 
Properties : It occurs in minute, white or grayish-white, glistening crystals; 
odorless, and acquiring a greenish tint upon exposure to light and air. It is 
soluble in 50 parts of water and in 50 parts of alcohol. 
Action and Uses: It is an emetic and expectorant, and is devoid of narcotic 
properties. Its principal use is as an emetic in cases where the stomach tube 
cannot he passed or emetics cannot be given by mouth. It is administered 
hypodermically. 
Average dose: Emetic, hypodermically, 0.005 to 0.0065 Gm. or %2 to Vio grain. 
Cinchona, Cinchona (Peruvian Bark), U. S. P.—The dried bark of the stem or 
root of Cinchona siicciruhm, or of its hybrids, yielding not less than 5 per cent 251 
MATERIA MEDICA AND THERAPEUTICS 
of the alkaloids of cinchona. The cinchona tree grows along the Andes 
Mountains in South America. Cinchona is not on the Supply Table, but it is 
the source of quinine, and is used in making compound tincture of cinchona. 
Tinctura Cinchonae Composita, Compound Tincture of Cinchona, U. S. P.— 
One hundred cc of compound tincture of cinchona yields not less than 0.4 Gm. 
nor more than 0.5 Gm. of the alkaloids of cinchona. 
Preparation : It is made by extracting 100 Gm. of Cinchona; 80 Gm. Bitter 
Orange Peel, and 20 Gm. of Serpentaria with a menstruum composed of alcohol, 
water, and glycerin and collecting 1,000 cc of percolate. See U. S. P. 
Action and Uses: It is a valuable bitter tonic and antimalarial. 
Average dose: 4 cc or 1 fluidram. 
Quininse Sulfas, Quinine Sulfate, U. S. P.—The sulfate of the alkaloid quinine. 
Preserve it in well-closed containers, protected from light. 
Properties : It occurs in white, tine, needle-like crystals, usually lusterless, 
making a very light and easily compressible mass; odorless and having a per- 
sistent, very bitter taste. It is soluble in 810 parts of water, and 120 parts of 
alcohol. It is freely soluble in water to which has been added a small amount 
of diluted hydrochloric or sulfuric acid. 
Action and Uses: It is antimalarial, antipyretic, and a bitter tonic. It is 
used principally in the treatment of malaria, for which it is specific. It should 
be noted that quinine sulfate is practically insoluble in water. If an aqueous 
solution is desired, it may be made by adding to the quinine sulfate mixed with 
the water in a graduate, diluted sulfuric or hydrochloric acid drop by drop 
until a solution is produced. An acid salt is formed in solution which is very 
soluble in water. 
Average dose: Tonic, 0.1 Gm. or 1% grains; antimalarial, at least 1 Gm. or 
15 grains daily. 
Quininae Hydrochloridum, Quinine Hydrochloride, N. F.—The hydrochloride of 
the alkaloid quinine. Preserve it in well-closed containers. 
Properties : It occurs in white, silky, glistening needles, odorless, and having 
a very bitter taste. It is soluble in 16 parts of water (more soluble than the 
sulfate), 0.8 part of alcohol, and in 7 parts of glycerin. 
Action and Uses: The action and use of quinine hydrochloride is the same 
as the sulfate. It was added to the Supply Table for use in making Elixir of 
Iron, Quinine, and Strychnine, N. F., because it is more soluble than the sulfate. 
Average dose: Tonic, 0.1 Gm. or iy2 grains; antimalarial, 1 Gm. or 15 
grains daily. 
Belladonnae Folium, Belladonna Leaf (Deadly Nightshade), U. S. P.—The dried 
leaves and tops of Atropa belladonna, yielding not less than 0.3 per cent of the 
total alkaloids of belladonna leaves. Belladonna leaves are not supplied to 
the Navy but they are used in making extract of belladonna and are the 
source of atropine. Belladonna leaves contain the mydriatic (pupil dilating) 
alkaloids of atropine, hyoscyamine, and belladonnine. 
Action and Uses ; See the Extract. 
Average dose; 0.06 Gm. or 1 grain. 
Extractum Belladonnae, Extract of Belladonna, U. S. P.—Extract of belladonna 
yields, from each 100 Gm., not less than 1.18 Gm. nor more than 1.32 Gm. of the 
alkaloids of belladonna leaf. It is dark green in color and of a pilular con- 
sistence. Extract of belladonna may be used in making tincture of belladonna. 
It is used in making belladonna plaster and belladonna ointment. 
Action and Uses: It is used internally as an anodyne and antispasmodic. 
In large doses it produces dryness of the throat, dilates the pupils, diminishes 
the secretion of urine, causes difficulty in swallowing, and checks perspiration. 
154294°—39 17 252 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
It prevents griping of the intestine and is used in the compound laxative pill 
for this purpose. It is used locally in plasters, ointments, and suppositories for 
its anodyne effect. 
Average dose: 0.015 Gm. or % grain. 
Atropinse Sulfas, Atropine Sulfate, U. S. P.—The sulfate of the alkaloid 
atropine. 
Properties : It occurs as a white, crystalline powder or colorless crystals 
efflorescent in dry air. Great caution should he used in tasting it, and then only 
in very dilute solution. It is soluble in 0.4 parts of water, and 5 parts of alcohol. 
Action and Uses : It is used in 0.5 per cent solution to dilate the pupil of the 
eye. Caution : It is an extremely poisonous drug. 
Average dose: 0.0005 Gm. or Yi2o grain. 
Homatropinse Hydrobromidum, Homatropine Hydrobromide, U. S. P.—The 
hydrobromide of homatropine, an alkaloid obtained by the condensation of 
tropine and mandelic acid. Preserve it in well-closed containers, protected from 
light. It is an artificial alkaloid (synthetic). 
Properties : It occurs as a white, crystalline powder or colorless crystals. 
Great caution must he observed in tasting it, using only very dilute solutions. 
Homatropine hydrobromide is extremely poisonous. It is soluble in 6 parts of 
water and 40 cc of alcohol. 
Action and Uses : The action of homatropine is nearly identical with that 
of atropine. A 1 per cent solution instilled into the eye produces dilatation of 
the pupil in less than an hour, and the effect wears off within 48 hours. This 
property gives it a decided advantage over atropine, which requires a longer 
time to dilate the pupil and a much longer time to recover from its effect. 
Average dose: 0.0005 Gm. or %20 grain (seldom used internally). 
Hyoscyamus, Hyoscaymus (Henbane), U. S. P.—The dried leaves, with or 
without tops, of Hyoscyamus niger, yielding not less than 0.040 per cent of the 
alkaloids of hyoscyamus. Hyoscyamus is not on the Supply Table hut it is used 
in making the fluidextract of hyoscyamus, and it is one of the sources of scopo- 
lamine (hyoscine). The alkaloids contained in hyoscyamus are hyoscyamine 
and hyoscine (scopolamine). 
Action and Uses : It is related closely to belladonna in its action, but is 
more sedative to the nervous system (due to the hyoscine which it contains). 
Hyoscyamus is supplied to the Navy in the form of a fluidextract, and its 
active principle hyosine is supplied in hypodermic tablets under the name 
scopolamine hydrobromide. 
Average dose: 0.2 Gm. or 3 grains. 
Fluidextractum Hyoscayamus, Fluidextract of Hyoscyamus (Fluidextract of 
Henbane), N. F.—One hundred cc of fluidextract of hyoscyamus yields not less 
than 0.035 nor more than 0.045 Gm. of the alkaloids of hyoscyamus. 
Action and Uses: It is used as a hypnotic, nervous sedative, and analgesic. 
Given with purgatives it prevents griping effect. 
Average dose: 0.2 cc or 3 minims. 
Scopolaminae Hydrobromidum, Scopolamine Hydrobromide (Hyoscine Hydro- 
bromide), U. S. P.—The hydrobromide of levorotatory scopolamine, also known 
as hyoscine, obtained from various plants of the Solanacew. Preserve it in 
well-closed containers protected from the light. 
Properties : It occurs in colorless crystals or a white, granular powder, odor- 
less, slightly efflorescent. Great caution must he observed in tasting it and then 
only in very dilute solutions, as it is extremely poisonous. It is soluble in 1.5 
parts of water and 20 parts of alcohol. 253 
MATERIA MEDICA AND THERAPEUTICS 
Action and Uses : It is a powerful cerebral and spinal sedative and hypnotic. 
It is given to produce sleep, in cases of mania. 
Average dose: 0.0003 Gm. or V200 grain. 
Nux Vomica, Nux Vomica, U. S. P.—The dried ripe seed of Strychnos Nux 
Vomica, an Asiatic plant. The alkaloids contained in nux vomica are strych- 
nine and brucine. It is not on the Supply Table but is used in the preparation 
of tincture of nux vomica. 
Action and Uses : The action of nux vomica is the same as that of strychnine, 
which is its most active principle. It is a direct stimulant to the spinal 
cord, and indirectly a stimulant to nearly all the organs of the body, thereby 
acting as a tonic. In large doses it is a poison, producing overstimulation and 
convulsions. Chloroform inhalations and chloral hydrate internally are given 
to relieve the convulsions. 
Average dose: 0.1 Gm. or 1% grains. 
Tinctura Nucis Vomicae, Tincture of Nux Vomica, U. S. P.—One hundred cc 
of tincture of nux vomica yields not less than 0.108 Gm. nor more than 0.120 Gm. 
of strychnine. It is approximately a 10 per cent tincture, but the exact strength 
is based on its proximate assay. 
Action and Uses; It possesses the stimulating and tonic properties of nux 
vomica. It is used as a gastro-intestinal tonic. 
Average dose: 0.5 ce or 8 minims, which is equivalent to about Yl20 grain 
of strychnine. 
Strychninae Sulfas, Strychnine Sulfate, U. S. P.—The sulfate of the alkaloid 
strychnine. Preserve it in well-closed containers, protected from light. 
Pkoperties : It occurs in colorless or white crystals, or as a white crystalline 
powder; odorless, efflorescent in dry air, and having an intensely bitter taste. 
It is soluble in 35 parts of water and 81 parts of alcohol. Great caution must 
he used in tasting it, and then only in very dilute solutions, as it' is extremely 
poisonous. 
Action and Uses : It is a powerful stimulant directly to the spinal cord and 
indirectly to nearly all the organs of the body. It is a powerf ul neurotic poison, 
and must he administered cautiously: It is used as a respiratory and circu- 
latory stimulant, is used also as a bitter tonic, and frequently is combined 
with iron and quinine in tonics, elixirs, and tablets. 
Average dose: 0.002 Gm. or %o grain. 
Physostigminae Sulfas, Physostigmine Sulfate (Eserine Sulfate), Unofficial.— 
The sulfate of an alkaloid obtained from Physostigma venonosum. Preserve it 
in small, sealed containers, protected from light. 
Properties : It occurs in minute white crystals, becoming yellow on exposure 
to light and air. It is very deliquescent and readily soluble in water. 
Action and Uses : It is a myotic and is used in the treatment of eye diseases 
for the purpose of contracting the pupil. It is used in glaucoma to lessen 
intra-ocular pressure. It may be used to hasten recovery from the effects of 
mydriatics. For use in the eye a 2 per cent boric-acid solution should be used 
as the solvent. Boric acid prevents physostigmine solution from turning red in 
color. A red-colored solution should not be used. 
Average dose: 0.001 Gm. or %o grain. 
Pilocarpus, Pilocarpus (Jaborandi), Unofficial.—The dried leaflets of Pilocarpus 
Jahorandi yielding not. less than 0.6 per cent of the alkaloids of Pilocarpus. 
It contains a number of alkaloids, the most important of which is pilocarpine. 
Pilocarpine hydrochloride is on the Supply Table in the form of 0.008 Gm. or 
Ys grain hypodermic tablets. 254 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
Pilocarpinse Hydrochloridum, Pilocarpine Hydrochloride, N. F.—The hydro- 
chloride of an alkaloid obtained from the dried leaflets of Pilocarpus Jaborandi. 
Preserve it in well-closed containers protected from light. 
Properties: It occurs in colorless, translucent crystals, odorless, and having 
a faintly bitter taste; hygroscopic on exposure to the air. It is soluble in 0.3 
parts of water. 
Action and Uses : It is used as a diaphoretic. In diseases of the eye such 
as glaucoma and corneal ulcer pilocarpine is used locally in weak solution to 
contract the pupil of the eye and thereby reduce intra-ocular pressure. 
Average dose: 0.005 Gm. or y12 grain (hypodermically). 
Aconitum, Aconite (Monkshood), U. S. P.—The dried tuberous root of Aconi- 
tum Napellus and its subspecies and varieties containing aconitine, a very active 
and poisonous alkaloid. Aconite is not on the Supply Table but is used in 
making tincture of aconite. 
Tincture Aconiti, Tincture of Aconite, U. S. P.—It is approximately a 10 per 
cent tincture. Tincture of Aconite possesses a potency, per cubic centimeter, 
equivalent to not less than 0.140 milligram and not more than 0.160 milligram 
of the alkaloid aconitine. 
Action and Uses : Aconite slows the pulse and lowers the blood pressure 
It is used internally as a circulatory depressant, diaphoretic, and antipyretic 
in fevers of short duration. It is a very poisonous tincture and must be 
administered cautiously. 
Average dose: 0.6 cc or 10 minims. 
Ipecacuanha, Ipecac, U. S. P.—The dried rhizome and roots of Cephaelis 
ipecacuanha or of Cephaelis acuminata, yielding not less than 2 per cent of 
the ether-soluble alkaloids of ipecac. Ipecac contains several alkaloids, the 
most important of which is emetine. 
Action and Uses : In large doses it acts as an emetic partly through its 
local irritant action. In small doses it stimulates the secretions of the respira- 
tory tract. It is specific against amoebic dysentery, given in the form of enteric 
pills. 
Average dose: Expectorant, 0.06 Gm. or 1 grain; emetic, 1 Gm. or 15 grains. 
Fluidextractum Ipecacuanhse, Fluidextract of Ipecac, U. S. P.—One hundred 
cc of fluidextract of ipecac yields not less than 1.8 Gm, nor more than 2.2 Gm. 
of the ether-soluble alkaloids of ipecac. 
Action and Use; The action and use of the fluidextract is the same as that 
of powdered ipecac. The principal use of the fluidextract is in making the 
syrup of ipecac. 
Average dose: Expectorant, 0.05 cc or 1 minim; emetic, 1 cc or 15 minims. 
Emetinse Hydrochloridum, Emetine Hydrochloride, U. S. P.—The hydrochloride 
of an alkaloid obtained from ipecac or prepared synthetically. It contains 
variable amounts of water of crystallization. Preserve it in well-closed con- 
tainers protected from light. 
Properties : It occurs as a white crystalline powder, without odor, and freely 
soluble in water. 
Action and Uses : It is used in the treatment of pyorrhoea and amoebic 
dysentery, administered hypodermically. 
Average dose: 0.02 Gm. or y3 grain. 
Coca, Coca, Unofficial.—The dried leaves of Erythroxylon Coca, known com- 
mercially as Huamico Coca, or as Truxillo Coca, yielding not less than 0.5 per 
cent of the ether-soluble alkaloids of coca. It is cultivated in South America, 
Mexico, and the West Indies. Most of the coca leaves come from Peru, Bolivia, 
and Ecuador. It contains a number of alkaloids, the most important of which 255 
MATERIA MEDICA AND THERAPEUTICS 
is cocaine. Coca leaves, its preparations, and derivatives, which includes 
cocaine, are restricted in their sale and use hy the Harrison Narcotic Act. 
Coca leaves are not on the Supply Table nor are they recognized by the Phar- 
macopoeia or National Formulary, and are of interest only as the source of 
cocaine. 
Cocainse Hydrochloridum, Cocaine Hydrochloride, U. S. P.—The hydrochloride 
of thfe alkaloid cocaine, obtained from Coca leaves. 
Properties : It occurs in colorless crystals or as a white, crystalline powder; 
soluble in 0.4 cc of water; soluble in glycerin and slightly so in alcohol. 
Cocaine solutions are decomposed by the heat of boiling water or in the presence 
of even slight traces of alkali. 
Action and Uses : When applied locally, cocaine paralyzes the peripheral 
nerves, causing loss of sensation. When injected around a nerve sheath or 
into a nerve it produces anaesthesia in the area supplied by the sensory fibers, 
of that nerve. When absorbed into the system it first produces stimulation, fol- 
lowed by depression of the central nervous system. The principal use of 
cocaine is as a local anaesthetic. It can be used for deadening sensation in 
the eye when foreign bodies are to be removed. It is employed in solutions 
ranging from 1 to 5 per cent, made with distilled wrater. The absorption of 
cocaine is largely prevented by mixing 1 part of solution of epinephrine hydro- 
chloride with 20 parts of cocaine solution. Cocaine is a dangerous habit-form- 
ing drug and must be used cautiously to avoid starting the habit. 
Average dose: 0.015 Gm. or grain. 
Ergota, Ergot (Ergot of Rye), U. S. P.—The dried sclerotium of Claviceps 
purpurea developed on rye plants. It contains not more than 8 per cent of 
moisture and not more than 4 per cent of seeds, fruits, and other foreign 
organic matter. Ergot is not on the Supply Table but is used in making the 
Fluidextract of Ergot. 
Fluidextractum Ergotae, Fluidextract of Ergot, U. S. P. 
Action and Uses: It is a powerful vascoconstrictor. It is used in the latter 
stages of labor as a stimulant to the uterus and a preventive of luemorrhage. 
Is also used to control other internal haemorrhages and for the relief of chronic 
congestions. Owing to its effect on the circulation it is also employed in many 
other diseases. 
Average dose: 2 ce or 30 minims. 
Caffeina Citrata, Citrated Caffeine, U. S. P.—A mixture of caffeine and citric 
acid containing, when dried to constant weight at 80° C., not less than 48 per 
cent and not more than 52 per cent of andydrous caffeine (CsHioChNU. 
Properties : It occurs as a white powder, odorless and having a slightly 
bitter, acid taste. It is soluble in about 4 cc of water. On diluting this solution 
with an equal volume of water caffeine slowly separates but redissolves on 
the further addition of water. 
Action and Uses ; It is used as a cerebral and cardiac stimulant and as a 
diuretic. 
Average dose: 0.3 Gm. or 5 grains. 
Caffeina cum Sodii Benzoate, Caffeine with Sodium Benzoate, U. S. P.—A mix- 
ture of caffeine and sodium benzo'ate, containing, when dried to constant weight 
at 80° C., not less than 47 per cent and not more than 50 per cent of anhydrous 
caffeine (CsHioChN*) ; and not less than 50 per cent and not more than 53 per 
cent of sodium benzoate (NaCTphCh). Preserve it in well-closed containers. 
Properties : It occurs as a white powder, is odorless, and has a slightly bitter 
taste. It is soluble in 1.1 parts of water. 256 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Action and Uses: It is used for the same purposes as citrated caffeine. It 
is preferred to caffeine citrate for hypodermic administration because it is more 
soluble in water. 
Average dose: 0.2 Gm. or 3 grains (hypodermically). 
Ephedrina, Ephedrine, U. S. P.—An alkaloid obtained from Ephedra 
cquisetina, Ephedra sinica and other species of Ephedra. It was first obtained 
from a Chinese herb. It is closely related to epinephrine structurally but is 
more stable. 
Properties : An unctuous, almost colorless solid, or white to colorless crystals 
or granules. It is soluble in water, in alcohol, in chloroform, in ether, and in 
liquid petrolatum, the latter being turbid if the ephedrine is not dry. Solu- 
tions of ephedrine are’strongly alkaline to moistened red litmus paper. 
Action and Uses : Ephedrine produces effects similar to those produced by 
epinephrine (adrenalin). It increases blood pressure and causes dilation of 
the bronchi and of the pupils of the eyes. It is used for shrinking congested 
nasal mucous membranes in rhinitis and sinusitis. It is also given in the 
treatment of asthma and hay fever. It may be given by mouth, hypodermically, 
or intramuscularly. The base (ephedrine) is used in ephedrine oil inhalant 
(usually 1 to 3 per cent in liquid petrolatum). The hydrochloride and sulfate 
are used in water solution. The sulfate is used in ephedrine jelly and in 
ephedrine syrup. The salts are not soluble in liquid petrolatum and cannot be 
used in the preparation of the oil inhalants. 
Average dose: 0.025 Gm. or % grain. 
Procainse Hydrochloridum, Procaine Hydrochloride (Procaine), U. S. P.— 
Para-aminobenzoyl-diethylaminoethanol hydrochloride (C13H20O2N2.HCI). 
Properties : It occurs as small, colorless crystals, or a white, crystalline 
powder, is odorless, stable in the air, and soluble in 0.6 parts of water and 30 
parts of alcohol at 25° C. It is precipitated from its aqueous solutions by alkali 
hydroxides and carbonates but not by sodium bicarbonate. An aqueous solution 
(1 in 20) is neutral to litmus paper. The aqueous solution may be heated 
to boiling without decomposition occurring which is a decided advantage over 
cocaine in that procaine may be thoroughly sterilized. 
Action and Uses : It is a local anaesthetic similar in action to cocaine but 
less toxic than cocaine and most other cocaine substitutes. When injected 
subcutaneously it exerts a prompt and powerful anaesthetic action, but the 
effect is not sustained. This condition is remedied by the simultaneous injection 
of epinephrine. It is nonirritant and has very little anaesthetic effect when 
applied externally to mucous membranes. 
Average dose; In place of the usual average dose the following information 
is given; For infiltration anaesthesia, 0.25 Gm. or 4 grains in 100 or 50 cc of 
physiological salt solution, making a or a % per cent solution, with 5 or 
10 minims of epinephrine solution (1 in 1,000) is used; for instillations and 
injections, 0.1 Gm. or 1% grains in 10 or 5 cc of physiological salt solution, 
making a 1 or a 2 per cent solution, with or without 10 minims of epinephrine 
solution (1 in 1,000) is used; in ophthalmology 1 to 5 or even up to 10 per 
cent solutions are used; and in rhinolaryngology 5 to 20 per cent solutions 
with 6 to 8 minims of epinephrine solution (1 in 1,000) to each 10 cc of solution 
are used. Internally, owing to its feeble toxicity, 0.5 Gm. or 8 grains may be 
given. 
Barbital and related compounds. 
Barbital, or diethylbarbituric acid, was introduced under the name “veronal” 
and is chemically related to urea, or carbamide (the diamide of carbonic acid), 
and the hypnotic compounds derived from urea. TOXICOLOGY 
257 
Barbitalum, Barbital (Diethylbarbituric Acid), U. S. P. 
Properties : Colorless or white crystals, or a white crystalline powder, odor- 
less, with a slightly bitter taste, and stable in the air. It is soluble in 130 parts 
of water, and in 14 parts of alcohol. A saturated solution in water is acid to 
litmus paper. 
Action and Uses ; It induces sleep and is a relatively safe hypnotic. A 
large number of deaths have resulted from its use, due to a single overdose or 
continuous administrations of small doses. 
Average dose: 0.3 Gm. or 5 grains. 
Phenobarbitalum, Phenobarbital (Luminal), U. S. P.—This compound is closely 
related chemically to barbital in that it represents barbital with an ethyl group 
replaced by a phenyl group. 
Properties : White, glistening, small crystals or a white crystalline powder, 
odorless, and stable in the air. It is soluble in 1,000 parts of water, and in 
8 parts of alcohol. A saturated aqueous solution is acid to litmus paper. 
Action and Uses: It is used as a sedative and hypnotic. The action is sim- 
ilar to that of barbital but more powerful. It is poisonous in large doses. 
Average dose: 0.03 Gm. or % grain. 
References 
United States Pharmacopoeia. 
National Formulary.—American Pharmaceutical Association. 
New and Non-Official Remedies.—American Medical Association. 
Useful Drugs.—American Medical Association. 
United States Dispensatory.—Wood-LaWall. 
Principles of Pharmacy.—Arny-Fischelis. 
Inorganic Pharmaceutical Chemistry.—Rogers. 
Pharmaceutical Recipe Book.—American Pharmaceutical Assoc. 
Remington’s Practice of Pharmacy.—Cook-LaWall. 
A Textbook of Practical Therapeutics.—Hare. 
Hospital Corps Handbook, U. S. Navy, 1923. 
Handbook of the Hospital Corps, U. S. Navy, 1930. 
Section 2.—TOXICOLOGY 
Toxicology is the science which treats of poisons. It is concerned with the 
detection, isolation, and quantitative estimation of poisons, their chemical and 
physiological effect on the ordinarily healthy organism, and the antidotes to 
their toxic effects. 
A poison is a substance which may produce death, serious illness, or harmful 
effects when introduced into the body. 
The effects of poisons may be local or remote and some poisons have both 
a local and a remote effect. By local effect is meant direct action on the part 
to which the poison is applied, such as corrosion and irritation, and by remote 
effect is meant the action of the poison on some organ remote from the seat of 
application or point of introduction. Sometimes a poison shows no effect, or 
only a slight one, until several doses have been taken, when suddenly an effect 
is produced nearly equal to that to be expected if the whole amount in the 
several doses had been taken at once. This is known as cumulative effect. The 
effect of a poison depends upon its solubility, the method of its introduction into 
the body, and the rapidity of its absorption into the system, and the method 
of introduction may determine its toxicity. For example, snake venom taken 
into the mouth and perhaps even into the stomach during first-aid treatment 
of a snake bite is not ordinarily harmful, but if snake venom were injected 
hypodermically it might be extremely poisonous. 258 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
There are various ways in which poisons may be introduced into the body, 
the most common being by mouth, by inhalation, and by injection. Poisons 
taken by mouth enter the circulation through absorption from the stomach and 
intestine and those inhaled enter the circulation through the air passages and 
lungs. When introduced by hypodermic injection or by injection into the ure- 
thral, rectal, or vaginal orifices poisons enter the circulation through absorp- 
tion from the body tissues and if the injection is intravenous they are in- 
troduced directly into the blood stream. Poisons may also be introduced 
through application to open wounds and to the unbroken skin. After entering 
the circulation a poison is carried by the blood to the tissues, and organs 
susceptible to its action and attacks them. 
Most of the excretion of poisons from the body takes place in the kidneys, 
lungs, liver, gastrointestinal tract, skin and salivary glands, and they may 
be excreted from the system unchanged or in the form of other compounds 
into which they have been transformed by the action of the various body 
organs and tissues. The most damaging effects of some poisons are found 
at the points of excretion, as in the kidneys and colon in poisoning by mercuric 
chloride (bichloride of mercury). 
Various conditions of the individual may modify the action and effect of 
poisons on the body. The age of the person makes a great deal of difference, 
young children being much more susceptible to poisons than adults and 
younger persons more so than older ones. Personal idiosyncrasy has a marked 
influence on the action of poisons, some persons by nature being unusually 
sensitive to certain poisons while others possess a natural tolerance for certain 
poisons that is not the result of habitual use. Most persons through habitual 
use of certain poisons, especially the narcotics, may become so accustomed 
to their effects that because of the habit they are not poisoned when they 
take doses of those poisons that ordinarily would produce death. It occasion- 
ally happens, however, that instead of becoming inured to their action the 
continuous use of chemical poisons externally results in a condition of hyper- 
sensitiveness. The action of poisons may be considerably modified by disease, 
some diseases increasing and others lessening the action of poisons, and in 
the latter case large doses are usually required to produce the desired effect. 
Poisoning may be either acute or chronic. Acute poisoning is the condition 
brought on by the individual taking one overdose of poison. Chronic poisoning 
is the condition brought on by the individual taking repeated doses of a 
poison or as the result of the absorption of the poison over a long period of 
time. Matchmakers, barometer and thermometer makers, painters, and wall 
paperers are some of the classes of people subject to chronic poisoning from 
phosphorus, mercury, lead, and arsenic, respectively. 
Poisons may be scientifically classified as follows; 
1. Gaseous poisons: Poisons present in the gaseous state which, if inhaled, 
destroy the capability of the blood as a carrier of oxygen and irritate or 
destroy the tissues of the air passages and the lungs, and when in contact 
with the skin and mucous membranes produce lacrimation, vesication, in- 
flammation, and congestion. Examples: Carbon monoxide, carbon dioxide, 
hydrogen sulfide (“sewer gas”), sulfur dioxide, nitrous oxide (“laughing gas”), 
nitric oxide and nitrogen dioxide, ammonia gas, chlorine, bromine vapors, 
“war” gases, etc. 
2. Inorganic poisons: (a) Corrosives. Substances which rapidly destroy or 
decompose the body tissues at point of contact. Examples: Hydrochloric, 
nitric, and sulfuric acids in concentrated form, oxalic acid, glacial acetic acid, 259 
TOXICOLOGY 
phenol, potassium hydroxide, sodium hydroxide, iodine, etc. (&) Metals and 
their salts. Substances which are corrosive and irritant locally but whose 
chief action occurs after absorption and damages internal organs, especially 
those of excretion. Examples: Arsenic, antimony, 'bismuth, copper, iron, 
lead, mercury, radio-active substances, tin, etc. 
3. Alkaloidal poisons: Nitrogenous plant principles which produce their 
chief effect on some part of the central nervous system. Examples: Aconitine, 
atropine, cocaine, morphine, physostigmine (eserine), strychnine, etc. 
4. Nonalkaloidal poisons: Various chemical compounds, some obtained from 
plants, having hypnotic, neurotic, irritant, and systemic effects. Examples : 
Barbital, salicylic acid, trinitrotoluene, acetophenetidin, digitalis, strophanthus, 
castor oil, croton oil, oleoresin of male fern, turpentine, santonin, canthar- 
ides, etc. 
5. Food poisons: These may be poisonous metallic or organic substances intro- 
duced by carelessness, accident, or intention into wholesome food; poisonous 
substances naturally present in the vegetable or animal tissues used as food; 
pathogenic bacteria in the food, or poisonous substances produced in food by the 
changes resulting from the action of bacteria. Examples of each of the above 
classes are: Arsenic, lead, tin, zinc, and copper introduced from containers, 
soldering, chemical action, and for purposes of adulteration; the poisons found 
in mushrooms, sometimes in rhubarb, and roots and tubers ordinarily edible, cer- 
tain species of fish and the flesh and roe of some fish during the spawning sea- 
son ; the causative agents of diphtheria, tuberculosis, scarlet fever, and typhoid 
fever in milk, of typhoid fever in or upon bread, sausage, oysters, and other 
foods, of botulism in or upon uncooked sausages, ripe olives, and other fruits 
and vegetables, and the ingestion of meat containing encysted worms or the 
larvae of worms; and the poisons, commonly known as ptomaines, which result 
from the decay or decomposition of food substances. 
For convenience of study the following general classification of poisons accord- 
ing to their chief effects on the body will be used: 
Coeeosives.—Substances which rapidly destroy or decompose the body tissues 
at point of contact. Examples: Hydrochloric, nitric, and sulfuric acids in 
concentrated form, oxalic acid, glacial acetic acid, phenol, potassium hydroxide, 
sodium hydroxide, iodine, etc. 
Iebitants.—Agents that do not directly destroy the body tissues but set up an 
Inflammatory process at the site of application or contact. Examples: Potas- 
sium nitrate, zinc chloride, zinc sulfate, ferrous sulfate, silver nitrate, arsenic, 
iodine, phosphorus, etc. 
Neueotics.—Poisons which act on the brain, spinal cord, and the general nerv- 
ous system. Examples: Opium, hydrocyanic acid (prussic acid), ether, chloro- 
form, aconite, nux vomica, belladonna, ethyl and methyl alcohol, etc. 
The general symptoms of poisoning by poisons of any of these classes are given 
next, and, in addition, the symptoms of individual poisons will appear in the 
table describing those poisons. 
Coeeosives.—Immediately there is an acid, caustic, burning pain in the mouth, 
with severe burning pain in the oesophagus and stomach. • This is followed by 
retching and vomiting of the stomach contents mixed with dark-colored liquid 
and shreds of mucous membrane from the mouth, oesophagus, and stomach; the 
inside of the mouth is corroded and the lips present the characteristic stain if 
an acid has been used. Swallowing is very difficult; respiration is impeded; 
the abdomen is tender and distended with gas; the temperature is high; and 
the countenance is expressive of anxiety and great suffering. 260 
HANDBOOK OE THE HOSPITAL CORPS, U. S. NAVY 
Irritants.—Nausea, vomiting, and purging (frequently the vomited matter 
and stools contain blood) ; pain and cramps in the abdomen. In some cases 
there is inflammation of the urinary tract. 
Neurotics.—-As it is a difficult matter to give general symptoms of this class 
of poisons, they are here classified under— 
(a) Depressants, which are characterized by a period of exhilaration fol- 
lowed by drowsiness and stupor; slow and stertorous breathing; cold, clammy 
skin; livid countenance, slow pulse, muscular relaxation; dilated or contracted 
pupils, insensibility to external impressions, and 
(&) Excitants, characterized by rapid and feeble pulse; delirium; hot and 
dry skin; a sense of suffocation and inability to breathe; shuddering, and 
jerking of muscles; dilated or contracted pupils; disordered vision; sometimes 
convulsions and tetanus (as in the case of strychnine poisoning). 
Gaseous poisons.—Irritation and corrosion of the respiratory tract, with 
resultant bronchitis (either mild or severe) ; irritation of the eyes, mouth, 
stomach, and kidneys. 
Food poisons.—Gastrointestinal distress, nausea, vomiting, diarrhoea, urticaria, 
circulatory and nervous disturbances are the general symptoms of food poison- 
ing and they may vary from mild discomfort to violent disturbance of the normal 
body functions. 
The treatment of poisoning consists of: 1. Removal of the poisonous sub- 
stance from the stomach; 2. Administration of antidotes; 3. Elimination of 
the poison from the circulation; and 4. Neutralization of the systemic effects 
of the poison. Only the first two parts of the treatment will be discussed 
here, the other two being particularly within the province of the medical officer. 
Removal of the poison from the stomach may be accomplished by the use of 
emetics (agents used to produce vomiting) and washing out of the stomach 
with a stomach tube. 
There are two kinds of emetics: (a) Local, which act by irritating the ends 
of the gastric, oesophageal, and pharyngeal nerves; and (b) Systemic, which act 
on the vomiting center in the medulla through the medium of the circulation. 
Commonly used emetics are powdered ipecac, 30 grains; ground mustard, 2% 
drams; tartar emetic, % to 1 grain; zinc sulfate, 10 to 20 grains; copper 
sulfate, 5 to 7% grains; fluidextract of ipecac, 15 to 30 minims; tepid water, 
large quantity; alum, 60 grains to 8 fluidounces of water; use of index finger; 
apomorphine hydrochloride (hypodermically), %5 to % grain. 
Antidotes are agents which counteract the effects of a poison, and are classi- 
fied as: (a) Chemical antidotes, which combine directly with the poisons and 
render them inert or harmless or produce a more insoluble compound and thus 
delay the absorption of poisons; and (b) Physiological antidotes, which coun- 
teract the effect of poisons on the system. Substances preventing absorption 
of poisons by holding them in suspension or by coating the stomach are con- 
sidered as a third class and are known as mechanical antidotes. 
The primary purpose of treatment in a case of poisoning is to prolong the 
life of the individual if possible. With that objective ever in mind the duties 
of a person attending a case of poisoning are: 
1. To quickly get the bulk of the poison out of the stomach; 
2. To antidote the remainder of the poison left in the stomach; 
3. To eliminate from the system that portion of the poison which has been 
absorbed; 
4. To treat the symptoms as they arise; and 
5. To take possession of all foods, medicines, vomited matter, faeces, urine, 
and anything that may be of value in determining whether the poison was TOXICOLOGY 
261 
taken accidentally or intentionally, or whether criminally administered. The 
nature or identity of the poison may have to be determined from such things 
and in cases of food poisoning it is most important to collect them. 
Cases of poisoning frequently are met with when it is almost impossible 
to obtain much or any information relative to the nature or type of poison 
taken. Any delay in treatment may result in serious consequences. Therefore 
every hospital corpsman should possess some practical knowledge of how to 
manage a poisoning case when the nature of the poison is unknown. 
For the purpose of general treatment in unknown poisons, the case may be 
considered as one of two kinds; it may be either a case where the local effects 
of the poison have injured the mucous lining of the mouth, oesophagus, and 
stomach to an extent contraindicating the use of instruments or emetics for 
evacuating the stomach; or, it may be a case where the poison has had but 
little or no local effect on the mucous lining of the alimentary tract, and there- 
fore one in which it would be safe to use a stomach tube or an emetic. 
Poisons coming under the classification of “Corrosives” generally produce 
conditions such as mentioned in the first Instance. They have a more or less 
injurious and even destructive effect on the lining of the mouth and stomach, 
and naturally in such cases the introduction of any sort of instrument, even a 
soft rubber stomach tube, may result in a perforation in the weakened wall; in 
such conditions, even rupture of the stomach may be caused by emesis. Poisons 
classified under “Irritants” and “Neurotics” have, generally, no special local 
or injurious action on the mucous membrane of the mouth and stomach, and 
therefore in such cases the stomach may be evacuated and washed by the aid 
of a stomach tube, or in the absence of a stomach tube the use of emetics could 
be resorted to without fear of injury. 
Even when the exact nature of the poison is unknown, one seldom finds it 
difficult to determine whether the offensive material belongs under the classi- 
fication of “Corrosives” or not; a corrosive leaves unmistakable signs about 
the lips and mouth. When the local condition points to a corrosive poison, the 
evidence usually Indicates also whether it is of the acid or alkali type. In the 
case of an acid, the general treatment is the same as that outlined under 
“Hydrochloric acid,” while the general treatment for almost any strong alkali 
is outlined under “Caustic alkali.” In neither case are the stomach tube or 
emetics employed. 
In cases where there are no signs of injury to the lining of the mouth, the 
probabilities are that the poison is one of the so-called “Irritants” or “Neu- 
rotics” ; that is, the poison may be a salt of one of the poisonous metals, as 
arsenic, mercury, copper, tin, zinc, silver; or it may be one of the alkaloidal 
drugs of opium, belladonna, nux vomica, or perhaps one of the many alkaloids, 
among the more common of which may be mentioned morphine, codeine, co- 
caine, heroin, atropine, and strychnine, although in an unknown case it would 
hardly be strychnine, for the symptoms in a case of strychnine poisoning are 
very characteristic. The patient may be suffering from poisoning by one of the 
drugs known as glucosides, of which the active principles of digitalis are ex- 
amples; or, the case may be one of poisoning by grain alcohol, wood alcohol, 
chloral, a cyanide, phosphorus, iodine (leaves stains on lips), or phenol (the 
undiluted form has corrosive action). 
Almost the entire range of possibilities for poisons coming under either the 
classification of “Irritants” or “Neurotics,” may be treated with a general 
antidote having properties of precipitating them, or of physically or chemically 
combining with those poisons in a manner to reduce their toxicity and, in some 
instances, to convert them into altogether harmless compounds. The following 262 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
is considered an excellent general antidote; Take one tablespoonful of mag- 
nesium oxide, 1 tablespoonful of tannin (tannic acid), 3 tablespoonfuls of 
powdered charcoal, and a small amount of water and mix together into a paste, 
thin the paste by further addition of water, about half filling an ordinary 
glass tumbler. This general antidote is administered in doses of from 1 to 2 
ounces each. Wash the stomach with lukewarm water or saline solution be- 
tween doses of the antidote, which should be repeated at intervals of 10 
minutes so long as may appear necessary. Occasionally, after washing out the 
stomach and between doses of antidote, give the patient a thin paste of starch, 
the white of two eggs or other albuminous substance. 
Always use the stomach tube when possible under the circumstances; the 
stomach tube facilitates the administration of antidotes as well as the washing 
out of the stomach at short and frequent intervals, and permits the handling 
of the case in a positive manner, in so far as it places under control the admin- 
istration of emergency treatment. When the stomach tube is not used, the 
patient is ’required to assist and work on himself; he must swallow large vol- 
umes of antidotal mixtures, saline solution, warm water, and besides he must 
take emetics to promote vomiting. All such efforts on the part of the patient 
have a tendency to weaken him and thereby lower his general resistance. 
However, when for any reason the stomach tube is not employed, antidotes 
must be taken by mouth and removed by emesis, which may in some cases 
be brought on by the tickling of the fauces but more often requires the use of 
emetics, the following being a very effective one and very easily prepared: 
About 2 teaspoonfuls of mustard in a glass of warm water. Soapy water is 
an excellent emetic, made by dissolving castile soap in water, this also has 
antidotal action on a number of metallic salts, principally mercuric chloride. 
Two teaspoonfuls of table salt dissolved in a glass full of warm water is some- 
times used as an emetic with good effect. 
After removing the residual poison from the stomach by the use of the 
stomach tube or emetics, magnesium sulfate should be given in small doses 
until a total of about 1% ounces has been taken. No oils should be given 
unless it is certain that the patient is not suffering from an oil-soluble poison 
such as phosphorus or phenol. 
This outline relative to the management of poison cases when the nature 
of the poison is not known covers only those steps that have to do with 
the removal of unabsorbed portions of poison, the residual poison, from 
the stomach, but the hospital corpsman should not lose sight of the fact that the 
treatment also calls for the application of proper measures to counteract that 
portion of the poison that may have been absorbed and carried in the system 
of circulation. No definite outline of treatment can be laid down for combat- 
ing the possibilities which may arise from absorbed poisons; this part of the 
treatment is based entirely on the symptoms the case presents. Effort to 
hasten the elimination of absorbed poison would include the giving of large 
quantities of water, the use of hot packs to stimulate skin action, and probably 
the use of enemas if deemed advisable under the circumstances. 
The hospital corpsman should endeavor to alleviate symptoms and distress 
of the patient by such means as come within his knowledge and experience in 
the general care of the sick, using hot water bags, ice bags, etc., as indicated. 
Physiological antagonists should not be administered in the absence of definite 
information as to the nature of the poison ingested. Medication should be 
limited to drugs whose physiological action is clearly understood by the hospi- 
tal corpsman. 263 
TOXICOLOGY 
Symptoms 
■ Suspect poisoning by— 
Poison suddenly fatal 
Hydrocyanic acid; potassium cyanide; phenol; oxalic acid; 
poisonous gases. 
Corrosive acids or alkalies; arsenic; antimony. 
Strychnine. 
Alcohol; opium (preparations); chloral hydrate; carbon monoxide 
or dioxide. 
Alcohol; atropine; belladonna; hyoscyamus; cannabis indica; 
camphor. 
Opiates (chronic); cocaine (chronic). 
Belladonna; gelsemium. 
Methyl (wood) alcohol. 
Quinine; salicylic acid, chenopodium. 
Mercurials; aconite; pilocarpine. 
Atropine; homatropine; gelsemium; hyoscyamus. 
Opium (preparations); phenol; pilocarpine; physostigmine 
Opiates; aconite; pilocarpine; salicylic acid and salicylates. 
Atropine; cocaine; scopolamine. 
Carbon dioxide; coal-tar products. 
Mercury; lead; arsenic. 
Phosphorus; potassium chlorate or nitrate. 
Bromides or iodides internally; croton oil, poison oak or ivy 
externally. 
Aconite; beginning lead palsy. 
Corrosive acids; alkalies; phenol; bichloride of mercury. 
Nitric acid (changing to brown). 
Iodine; bromine; potassium permanganate. 
Copper salts; Paris green. 
Arsenic; antimony; mercuric salts; ptomaines. 
Apomorphine; aconite. 
Lead; opiates. 
Opiates; digitalis (at first); physostigmine. 
Atropine; hyoscyamus; cocaine. 
Aconice; digitalis; physostigmine; salicylic acid; carbon dioxide. 
Lead; mercury; alcohol. 
Santonin; picric acid. 
Sulfonal; trional. 
Phenol; tar; creosote. 
Oxalic acid; atropine; potassium chlorate or nitrate. 
Mineral acids; oxalic acid. 
Turpentine; copaiba; cubeb. 
Collapse, with cold clammy skin and 
rapid pulse. 
Coma 
Active delirium 
M ental hebetude ... 
Double vision _ .. _ _ 
Blindness. .. 
Ringing in the ears 
Salivation (ptyalism) 
Pupils— 
Dilated _ . 
Contracted ... 
Skin— 
Moist, 
Hot and dry 
Dark but not cyanotic 
Yellow _ 
Eruptions 
Numbness and tingling 
Discoloration of tongue and mem- 
branes of mouth and throat— 
White 
Yellow 
Brown-. 
Greenish blue 
Vomiting and purging. __ _ 
Pulse— 
Muscular tremors 
Urine- 
Yellow - .. 
Symptoms of Poisoning by Certain Poisons 
Aconite. (Neurotic.) 
TABLE OE POISONS, SYMPTOMS AND TREATMENT. 
Symptoms : Palor; salivation; tingling and numbness in mouth and fingers; 
burning in throat and stomach; nausea and vomiting; slow, feeble and irregular 
pulse; rapid and shallow respiration; muscular weakness; cold, clammy skin; 
difficult swallowing; impaired voice; cramps in extremities and possible tetanic 
convulsions; death from paralysis of the heart and of respiration. 
Treatment: Place patient on back with head lower than feet; give animal 
charcoal (1 tablespoonful), tannic acid (10 to 30 grains), tea or strong coffee, 
as a chemical antidote. Apply heat externally; use stomach tube or siphon of 
rubber tubing to empty stomach (avoid emetics); administer stimulants, as 
aromatic spirit of ammonia, caffeine, atropine, ether, strychnine, and amyl 
nitrite. Physiological antagonist is digitalis. Artificial respiration if breath- 
ing stops. 264 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Alcohol, ethyl. (Neurotic.) 
Symptoms : Exhilaration, staggering gait, deep sleep with stertorous breath- 
ing, acute gastritis and profound depression. Delirium tremens frequently 
occurs after an alcoholic debauch. 
Treatment: Emetics or the use of the lavage tube, purgatives, proper diet, 
external heat. Ammonia inhalations, atropine, caffeine, digitalis, strychnine, 
oxygen, artificial respiration. 
The morbid conditions with which acute alcoholism may be confounded 
are: Apoplexy, opium narcosis, concussion of the brain, uraemia, epilepsy, and 
even acute pneumonia. The differential diagnosis is difficult to make in a 
state of deep coma. The pupils in alcoholism may be either dilated or contracted. 
Alcohol, methyl. (Neurotic.) 
Symptoms: Primary, dizziness, headache, nausea and vomiting, dimness of 
vision, with befogging of the brain; later, widely dilated pupils with ultimate 
blindness, weakened circulation, stupor, coma, delirium, convulsions, cold clammy 
skin, subnormal temperature, death from paralysis of respiratory center. 
Treatment ; Immediate evacuation of the stomach by means of a stomach 
tube followed by washing the stomach with a very dilute potassium perman- 
ganate solution, then warm water; administer two or three ounces of a solution 
of magnesium sulfate (Epsom salt) before removing the stomach tube; 
administer stimulants; apply external heat. It is beneficial at times to do a 
venesection; remove a quantity of blood and administer physiological saline 
solution intraveneously. (This should be done by medical officers only). 
Stupor from wood alcohol poisoning is treated by introducing into the system 
large doses of sodium, bicarbonate and sodium citrate solutions, either by mouth 
or by rectum. 
Arsenic. (Irritant.) 
Present in Fowler’s solution, Paris green, rat poisons. 
Symptoms : Faintness and depression come on in about one-half hour; intense 
pain in the region of the stomach; tenderness of abdomen on slight pressure, 
nausea and vomiting increase by every act of swallowing; purging, bloody 
stools; cold, clammy skin; feeble pulse. 
Treatment: Emetics (one of mustard, 1 part, salt, 6 parts, in large amount 
of water may be used) ; wash out stomach with warm water and milk. Then 
give a wineglassful of freshly prepared Magma of Ferric Hydroxide. Reliance 
must be placed on copious gastric lavage frequently repeated as the poison is 
not freely soluble. Warmth externally and demulcent drinks. Give opium, 
atropine, strychnine, and spirit of nitrous ether. 
Physiological antagonists to combat collapse are caffeine and digitalis. 
Atropine. (Neurotic.) 
Symptoms : Redness or rash of the skin; nose, mouth, throat and bronchi 
become dry; voice becomes hoarse; swallowing difficult; pulse full and bound- 
ing, later feeble and rapid; pupils dilated; vision disordered; predisposition to 
laugh and talk loudly. There may be wild and maniacal delirium; and mental 
depression; suppression of the urine; convulsions; death occurs usually from 
asphyxia. 
Treatment: Wash out stomach with a solution of potassium permanganate 
(20 grains to 1 pint of water) ; precipitate alkaloid in stomach by dilute solu- 
tion of iodine in water (6 drops of tincture to 4 ounces) or of tannic acid; if 
not available give strong tea and an emetic. Apply an ice cap to the head; 265 
TOXICOLOGY 
stimulate with strong coffee and eliminate the poison absorbed by the use of 
cathartics and diuretics. Treat symptoms as they arise. 
Physiological antagonists are morphine (cautiously administered), ether to 
control spasms, and caffeine for its effect on the heart and brain; pilocarpine. 
Belladonna. (Neurotic.) 
Symptoms and treatment same as atropine. 
Bichloride of Mercury. (Corrosive.) 
See Mercury. 
Caustic alkalies. (Corrosive.) 
Potassium and sodium hydroxides ; ammonia water ; quicklime ; lye. 
Symptoms; See general symptoms of corrosives. 
Treatment : Diluted acids, especially citric or tartaric; lemon or orange 
juice; vinegar; milk; oil. No emetics or stomach tube. Place patient on back. 
Warmth externally. Cold air. Give strychnine, opium, caffeine, aconite, and 
digitalis as indicated. Diluted hydrocyanic {prussic) acid must not be used. 
Cocaine. (Neurotic.) 
Symptoms: Dilated pupils; talkativeness, restlessness, excitement, delirium, 
hallucinations, mania, followed by depression; nausea, vomiting, numbness and 
tingling in hands, headache, dizziness; small, rapid pulse; irregular respira- 
tion ; later, convulsions, collapse, cyanosis, clammy skin, shock, possibly death. 
Treatment: Wash out the stomach with a solution of potassium permanga- 
nate (20 grains to 1 pint of water) or tannic acid or tea. Keep patient in 
recumbent position; apply external heat; fresh air; artificial respiration if 
necessary. 
Physiological antagonists are morphine, amyl nitrite, chloral, chloroform, and 
ether. 
Digitalis. (Neurotic.) 
Symptoms ; Pulse slow and full, then rapid and irregular; nausea, per- 
sistent vomiting, colic, and purging; thirst; vertigo and disturbances of vision 
and hearing; headache; muscular weakness; respiration rapid and feeble; 
cyanotic skin; coma and convulsions. Death occurs from sudden paralysis of 
the heart. 
Treatment: Wash out the stomach with tannic acid solution, or tea, or potas- 
sium permanganate solution (20 grains to 1 pint of water). Keep patient quiet 
and in a horizontal position. External heat, particularly over abdomen. Give 
magnesium sulfate, aromatic spirit of ammonia, alcohol, strychnine, oxygen, 
atropine. Artificial respiration if necessary. 
Physiological antagonists are aconite for the effects of a large dose and opium 
for the effects of its long-continued use. 
Food Poisoning. {See pages 377 and 379.) 
Symptoms: (Described on page 260.) 
Treatment : Must be adapted to the individual conditions found. If early 
treatment is possible, remove harmful contents from alimentary tract by use 
of stomach tube or emetics, high colon flushing, and active catharsis if there 
is no reason to suspect the presence of appendicitis or perforation of the in- 
testine. Saline infusion given hypodermically or intravenously should be used 
to aid in the elimination of the poisonous or noxious substance from the circu- 
lation. (This should be done by medical officers only.) 266 
HANDBOOK OF THE HOSPITAL CORPS, II. S. NAVY 
Heroin. (Neurotic.) 
See Morphine. 
Hydrocyanic (prussic) acid and cyanides. (Neurotic.) 
Symptoms : Sudden collapse; unconsciousness ; a convulsive seizure; cyanotic 
face; clenched teeth; open and staring eyes; perhaps bloody froth on lips; and 
death in a few seconds; or, collapse; slow, labored, and gasping respiration; 
slow pulse; disturbed mental activity; dilated pupils; unconsciousness; vomit- 
ing; general convulsions with involuntary defeecation and urination, then coma, 
and death from paralysis of respiratory center. Odor of peach kernels on 
breath. 
Treatment : Stomach tube if possible. Diluted ammonia; opium, to relieve 
pain; alternate cold and warm affusions; atropine and heart stimulants; 
artificial respiration; recumbent position; external heat. 
Hyoscyamus. (Neurotic.) 
Symptoms and treatment same as atropine and belladonna. 
Iodine. (Corrosive and irritant.) 
Symptoms : Acrid taste in mouth; pain and sense of great warmth in throat; 
severe pain in oesophagus, stomach, and abdomen with violent vomiting and 
purging (vomited matter may contain traces of iodine) ; upper digestive tract 
and stomach corroded and stained a dark brown; intense thirst; rapid, feeble 
pulse; face pale; suppression of urine; convulsive movements and collapse. 
Treatment: Free administration of starch in water or any starchy sub- 
stance ; induce vomiting; give demulcent drinks; digitalis, atropine, or strych- 
nine hypodermically; external heat; careful nursing. 
Irritant gases. 
Symptoms: Irritant gases produce irritation and qprrosion of the respiratory 
tract, causing bronchitis, which may be more or less severe. Irritation of the 
eyes, mouth, stomach, and kidneys also are produced. 
Treatment: Remove the patient from the source of the gas; give inhalations 
of ammonia and begin artificial respiration at once. When free respiration is 
established, give magnesium oxide or diluted alkalies. 
Lead. 
Symptoms : A sense of constriction about the throat; metallic taste in mouth; 
cramps; stiffness of abdominal muscles; blue line around the gums; paralysis 
of upper extremities; dropped wrist; vomiting of white flaky matter and 
constipation. 
Treatment; Free administration of soluble sulfates, particularly magnesium 
sulfate, followed by milk and raw eggs; give emetics and use stomach tube; 
opium to allay irritation. Chronic poisoning is best treated by iodides to satura- 
tion of the system, sodium iodide or calcium iodide being the best. (Painters 
are subject to chronic lead poisoning.) 
Mercury. (Corrosive.) 
The metal itself is not poisonous but may form toxic compounds if it remains 
in the body for any length of time. Inorganic compounds of the mercuric 
type, as mercuric chloride (commonly called bichloride of mercury and cor- 
rosive sublimate), red mercuric iodide, yellow mercuric oxide, etc., are usually 
soluble and actively toxic, while those of the mercuro«<s type, as mercurous 
chloride (commonly called calomel), yellow mercurous iodide, etc., are very 
insoluble and much less toxic, but may change in the body to the mercuric type 
and then cause poisoning. Most cases of mercury poisoning are caused by 267 
TOXICOLOGY 
mercuric chloride being swallowed, injected for therapeutic use, or used in the 
antiseptic dressing of wounds. 
Symptoms : Acrid, metallic taste in mouth; thirst; burning pain in mouth, 
throat and abdomen; nausea and vomiting of bloody material; straining to 
empty bowels or bladder; purging with mucous and blood in stools; suppression 
of urine; shock; and collapse. Face flushed; quick irregular pulse; cold 
extremities. Mucous membranes of lips, mouth, tongue, and throat may appear 
shriveled and white. 
Treatment: Give whites of eggs (white of 1 egg for each 4 grains of mer- 
cury taken) immediately. Follow this by an emetic (20 grains of zinc sulfate 
or 2 teaspoonfuls of mustard in tepid water) and wash out the stomach repeat- 
edly to prevent absorption and reabsorption of the poison. Copious draughts 
of albumin water will promote vomiting but too much albumin should not be 
given as albuminate of mercury is resolvable and consequently repeated washing 
out of the stomach is necessary. While it is stated that whites of eggs are of 
no value as an antidote in mercury poisoning the foregoing treatment should 
be given at once in order to quickly remove from the stomach as much of the 
poison as possible. 
In Remington’s Practice of Pharmacy it is stated that the only antidote for 
mercury poisoning known to be absolutely effective is Sodium Formaldehyde 
Sulfoxylate, which is administered as follows; Wash out the stomach with a 
5 per cent solution in distilled water, leaving about 200 cc remaining in the 
stomach. Immediately following this, 10 grams of the drug dissolved in 100 to 
200 cc of sterile distilled water is slowly injected intravenously, taking from 
20 to 30 minutes to give the injection. If the solution cannot be retained in the 
stomach, high colonic irrigations of the drug in 1 in 1000 solution should be 
given. 
After administering the antidote give demulcent drinks, milk, and ice 
water. External heat. Give opium, atropine, caffeine, strychnine, and cam- 
phor as indicated. 
Mineral and organic acids. (Corrosive.) 
Hydrochloric, nitric, and sulfuric acids, acetic and oxalic acids. 
Symptoms : Lips, mouth, tongue, and throat burned (dark-brown or black 
by hydrochloric and sulfuric acids, yellowish-green to orange-yelldw by nitric 
acid, brownish by acetic and oxalic acids) ; burning pain and destruction of 
tissues in mouth, throat, and stomach; vomiting; feeble pulse; difficult speak- 
ing and swallowing; cold clammy skin; shock; perhaps1 convulsions and 
coma in oxalic-acid poisoning; collapse. Possible yellow stains on clothing in 
hydrochloric acid and dark brown to red in oxalic acid poisoning. 
Treatment: Do not use stomach tube. Do not use emetics if acids are in 
concentrated form. Do not use alkalies of sodium or potassium to neutralize 
oxalic acid. Give milk of magnesia, chalk, limewater, if necessary taking 
plaster off walls, powdering it and mixing with water, to neutralize the acid. 
Baking soda and soapsuds may be given to neutralize hydrochloric acid. 
Follow with olive oil, barley water, linseed oil, mucilage of acacia, albumin, 
or milk to protect membranes. Place patient in recumbent position. External 
heat. Give aromatic spirit of ammonia, atropine, caffeine, strychnine, and 
opium as indicated. 
Morphine. (Neurotic.) 
See Opium. 
154294°—39 18 268 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Nux vomica. (Neurotic.) 
See Strychnine. 
Opium. (Neurotic.) 
Symptoms : Usually there is a period of mental exhiliration and physical 
ease with quickened pulse which is followed by dizziness, drowsiness, languor, 
and nausea; slow weakened pulse; slow stertorous breathing; cold clammy 
skin; extremities cold; muscular relaxation; cyanosis; livid countenance; 
pupils contracted (pin point) but may dilate just before death; insensibility 
to external impressions; deep sleep from which, if the patient be aroused, 
there will be an irresistible predisposition to go back to sleep. Death occurs 
by paralysis of the respiratory center. 
Treatment: First remove the poison from the stomach by the use of the 
stomach tube or emetics. The stomach wash, if used, should contain 20 grains 
of potassium permanganate to the pint of water. After the stomach has 
been washed out with this solution, a little (about 1 fluidounce) should be 
left in the stomach. In the absence of potassium permanganate an entetic 
should be administered hypodermically (emetics by mouth are generally use- 
less), and after evacuation of the stomach give tannic acid in some form. 
Cathartics and diuretics should be administered to prevent absorption. Caf- 
feine or strong coffee is very efficient. Efforts should be made to keep the 
patient awake, slap the face and neck with cold, wet cloths and force walking, 
but no violence should be used. External heat. Oxygen and artificial respira- 
tion if necessary. 
Physiological antagonists are caffeine, cocaine, ammonia, strychnine, amyl 
nitrite. Atropine (%o grain) may be used, but only one dose should be given. 
Phenol (carbolic acid). (Corrosive.) 
Symptoms : White burns about mouth, lips, tongue, and throat. Burning 
pain in the mouth, throat, and stomach; vomiting (vomitus and breath reek 
with characteristic odor) ; headache; cyanotic or pale face; contracted pupils; 
rapid pulse; irregular, stertorous breathing; muscular weakness; subnormal 
temperature; patient rapidly becomes comatose; collapse. 
Treatment: Immediately wash out the stomach with warm water or strong 
solution of magnesium or sodium sulfate. Give demulcent drinks, milk, egg 
albumin, etc. Then follow with stimulants, as atropine, hypodermically, or 
coffee; apply hot-water bags and warm blankets. Do not give alcohol, oils, 
or glycerin, as they will cause absorption of the drug. Alcohol may be used for 
local burns. 
Stramonium. (Neurotic.) 
Symptoms and treatment same as atropine. 
Strychnine. (Neurotic.) 
Symptoms : A sense of suffocation and inability to breathe; shuddering and 
jerking of the muscles; sense of stiffness about the neck; twitching and jerking 
of lower limbs and quivering of entire body; convulsions—the body becoming 
rigid and bent forward, emprosthotonos; backward, resting on the heels and 
head only, opisthotonos; or to one side, pleurosthotonos; the features assume 
a peculiar, stiff grin called risus sardonicus. During convulsions there is 
cyanosis, weak, rapid pulse, and dilated pupils, while between convulsions 
there is general relaxation, perspiration, weariness, and drowsiness. Convul- 
sions are induced by noise, drafts of air, jarring, or sudden bright light. 
Patient remains conscious until the end and is fully aware of what goes on 
about him. TOXICOLOGY 
269 
Treatment: Administer emetics until free vomiting is induced. Evacuate 
stomach by washing it out with a solution of potassium permanganate (20 
grains to 1 pint of water) or a diluted solution of iodine, tannic acid, and finely 
powdered charcoal. Chloroform inhalations to relieve pain and quiet spasms. 
Chloral hydrate and potassium bromide in large doses are useful. Patient 
must be kept in a recumbent position during treatment and must be kept in 
a dark room remote from all noises. Artificial respiration if necessary. 
Trinitrotoluene (T. N". T.) poisoning. 
Because of the extensive use of this substance on board ships and in naval 
magazines ashore, poisoning caused by it is not uncommon. 
Symptoms : The skin of the hands, arms, and exposed parts become seriously 
irritated and inflamed. When the fumes are inhaled the respiratory tract is 
irritated and there is sneezing, coryza, nose bleed, watering of eyes, dry cough, 
sore throat, and pain in chest; if swallowed there is spasmodic gastric pain, 
nausea, vomiting, griping diarrhoea or constipation, frequent urination, head- 
ache, dizziness, general weakness, drowsiness, pallor or cyanosis. Changes in 
blood corpuscles occur and there is loss of haemoglobin resulting in anaemia. 
Bile pigments are present in the urine and the skin and hair frequently turn 
yellow. Chronic poisoning results in a temporary enlargement of the liver, 
with subsequent atrophy, and in degeneration of the kidneys. Prophylactic 
measures consist of applying a solution of shellac, castor oil, and alcohol to 
the exposed parts of the skin, or, better, cover the arms with stockings and 
the hands with gloves impregnated with this solution. The entire face should 
be covered with a special mask, containing glass or other transparent noninflam- 
mable material, so that there may be no interference with vision. 
Treatment: The poison may be removed from the skin with a solution of 
sodium hyposulfite. Remove the patient from the vicinity of the substance, 
provide absolute rest, fresh air, and simple diet. Large amounts of water 
with large doses of sodium citrate and sodium bicarbonate should be given. 
Restrict the meat intake, give small doses of iron daily, and regulate the 
bowels. 
Gasoline, benzine, and naphtha poisoning. 
Gasoline poisoning frequently results from exposure to the fumes in motor 
launches and in places which are confined and shut off from free access to the 
outside air. Men attempting to siphon gasoline from a container by means of 
a hose frequently swallow an amount which is harmful. Inhalation of the 
vapors of these substances when used as paint solvents, in rubber manufacture, 
in dry cleaning, in work on automobiles, in cleaning tanks and tank cars, etc., 
may cause poisoning. 
Symptoms : When the fumes or vapors are inhaled there is first dizziness, 
nausea, vomiting, constriction of the throat, headache, staggering and trembling 
of the hands and arms (the so-called ‘“naphtha jag”) and later, partial or 
complete insensibility, slow respiration, weak and scarcely perceptible pulse, 
convulsions, and death. There is a tendency to mania during return to con- 
sciousness in cases recovering from the poisoning. If swallowed there is short- 
ness of breath, cyanosis, cold, clammy skin, coma, and death. External appli- 
cations of these substances may produce inflammation of the skin or pustular 
eruptions. 
Treatment: Remove the patient to the open air, remove all gasoline, benzine, 
or naphtha-soaked clothing, apply external heat if necessary. Administer stimu- 
lants (by enema if necessary) and treat symptomatically. {See under Treat 
ment for Carbon Monoxide Poisoning in note following.) 270 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Symptoms from the ingestion of gasoline resemble those caused by acute 
alcoholism, the patient is very apt to develop mania and later become uncon- 
scious. This condition should be treated by emptying the stomach by means 
of a stomach tube, followed by washing the stomach with very dilute potassium 
permanganate solution, then with warm water. It is advisable to administer 
two ounces of a solution of magnesium sulfate before withdrawing the stom- 
ach tube. Treat symptomatically by applying external heat, stimulants when 
indicated, etc. 
Note.—Carbon monoxide is contained in the fumes of gasoline, benzine, and 
naphtha and when inhaled results in the formation of carbon monoxide haemo- 
globin. The treatment indicated is: 1. Remove the patient from atmosphere 
containing monoxide; 2. Administer oxygen as quickly as possible and in as 
pure a form as is obtainable, preferably from a cylinder of oxygen through an 
inhaler mask; 3. If breathing is feeble, start artificial respiration at once by 
prone-pressure method; 4. Keep the patient flat, quiet, and warm; 5. After- 
wards give plenty of rest. 
References 
Legal Medicine and Toxicology.—Gonzales, Vance, Helpern, 
Hospital Corps Handbook, U. S. Navy, 1923. Page 
Section 1. Nursing 271 
Section 2. Ward management 344 
Section 3. Operating room and surgical technique 356 
CHAPTER Y 
Section 1.—NURSING 
In a brdad sense the word nursing means caring for the sick or injured. 
More specifically it means the skillful use of scientific methods in applying 
therapeutic measures to the sick or injured, thereby materially assisting in 
their recovery and promoting their physical and mental well-being. 
The individuals who carry out such measures may be of either sex and are 
spoken of as nurses. To qualify for nursing in civilian life nurses receive train- 
ing and instruction in the scientific principles of nursing in training schools for 
nurses which usually are connected with hospitals. In the Navy most actual 
nursing is done by hospital corpsmen who usually receive their training and 
instruction in the Hospital Corps Schools and in naval hospitals under the 
supervision, largely, of members of the U. S. Navy Nurse Corps. 
The qualifications necessary for those upon whom falls the nursing care of 
the sick or injured may be classified under three headings, physical, mental, 
and moral. In the discussion of these qualifications which immediately fol- 
lows, their application to naval hospital corpsmen, for whose instruction and 
guidance this section has been principally prepared, will be considered. 
Physical qualifications require health, strength, and endurance, and these 
can be maintained only by the faithful practice of habits of personal clean- 
liness, strict obedience to the laws of hygiene, avoidance of causes of indiges- 
tion, the securing of a sufficient amount of fresh air, sleep, exercise, and recrea- 
tion, and prompt attention to all minor ailments. Good health habits include 
daily bathing, frequent brushing of the teeth, keeping the hair properly cut 
and clean, regular habits of eating and sleeping, and plenty of exercise in the 
open air. It is most Important in nursing that the hands be kept clean and the 
following rules should be observed: 1. Always wash the hands before eating 
and after cleaning; 2. Always wash the hands before and after caring for a 
patient; 3. Keep the finger nails short, well-filed, and clean; 4. Keep the hands 
away from the face and do not pick at the face; 5. Do not allow abrasions on 
the hands to go unattended; 6. Keep the skin on the hands smooth, using a 
lotion if necessary. An infected wound on the body or any other infection 
should be reported at once in order that both the patient and the nurse may 
be protected. 
To be mentally qualified requires education, judgment, the faculty of observa- 
tion, a sense of order, and a good memory. Higher education, although desirable, 
is not absolutely essential for the success of a hospital corpsman, but he must 
have a high order of intelligence and a real desire to learn. With these assets 
it soon will be realized how important it is to know the underlying principles 
that govern the work in which he is engaged. Observation is the faculty of 
taking notice of things and requires constant practice for its development. A 272 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
hospital corpsman must be quick to observe minute details and equally quick to 
act intelligently in accordance with his observations. Loss of valuable time and 
many reproofs may be avoided by quick observation. A hospital corpsman pos- 
sessing this quality, when assisting at a treatment or an operation, will notice 
what is required and often anticipate the doctor’s needs. 
Judgment is the faculty of being able to reach a correct decision; that is, 
knowing what is best to do or say under known conditions. A hospital corps- 
man’s observation and judgment should be such that when two conditions are 
placed before him he can weigh them quickly in his mind and decide as to the 
relative value of each. 
The sense of order must be cultivated both in mind and habits, and literally 
means, “a place for everything and everything in its place.” A hospital corps- 
man should not tolerate disorder in the things about him nor should he allow 
confusion in his work. He must strive to make his work better than another’s 
work. Particular care in folding gauze for dressings, folding linen, and ar- 
ranging supplies helps to cultivate the habit of exactness. 
Memory is very important in nursing. It requires constant practice of con- 
centrating one’s attention on the thing at hand, and of forming mental associa- 
tions which will assist in recalling the things to be remembered. 
Moral qualifications required by hospital cotpsmen include truthfulness, 
obedience, dignity, tact, courtesy, sympathy, and economy. 
Truthfulness in the care of the sick takes on a broad meaning and embraces 
honesty of purpose, frank acknowledgment of an error, prompt confession of 
anything left undone, absolute accuracy of statements, and the conscientious 
performance of minute details. 
Obedience does not mean merely obeying rules and regulations, but includes 
prompt, unquestioning, and intelligent obedience to authority, regardless of 
whether the person in authority is an officer or other superior, or a fellow 
hospital corpsman. 
Dignity, if genuine, admits of no rudeness or familiarity from others, and 
at the same time is free of any display of personal importance or superiority. 
Tact is the ability to deal with others without giving offense; in other words, 
it is doing or saying the right thing at the right time. 
Courtesy is defined as a well-bred consideration for others founded upon 
kindness, and is a very necessary qualification when the sick are irritable, 
fault-finding, or unjust in criticism. It must be remembered always that a 
sick person is like a child and often is not responsible for his speech and actions. 
Sympathy is the feeling corresponding to that which the other person feels, 
and may be expressed by a smile or an encouraging word, but must not inter- 
fere with the carrying out of orders, treatments, or dressings. Patients are 
benefited by receiving proper care and treatment, although the reason for such 
may not be evident at the time to either the hospital corpsman or to the patient. 
Economy in all things is very essential. Extravagant habits are easily ac- 
quired where there are large quantities of supplies, and must be especially 
guarded against. 
Professional ethics may be defined as the moral obligation which a hospital 
corpsman owes to the service, its officers, the hospital, the ship, the station, or 
the training school, and to his fellow hospital corpsmen. He always should 
so conduct himself that he will do his part to be a credit to and add to the good 
reputation of the service, of the medical department, and of the unit to which 
he is attached. 
In nursing there exists a personal relationship between the patient and the 
nurse and between the doctor and the nurse that must be considered. The NURSING 
273 
satisfactory maintenance of such relationships depends largely upon the nurse 
and in doing so much of the foregoing must be remembered and practiced. 
A patient depends upon the nurse to give all possible aid in his illness, through 
nursing care to conserve and restore his strength and thereby assist his return 
to physical and mental health, to carry out the therapeutic measures ordered, 
and to help him to prevent incurring other illness. He also looks to the nurse 
to supply comfort through various nursing procedures and expects manual skill 
in carrying them out. It must never be forgotten that a patient is not well 
and the attitude of the nurse toward the patient should be such as will tend to 
encourage and benefit him. The nurse should show a sincere interest in the 
patient as an individual, should always be cheerful and willing in attending to 
his wants and needs, and should be tolerantly understanding of his whims and 
fancies. As a patient improves the nurse must endeavor to obtain his coopera- 
tion in personally doing many of the things that formerly were done for him 
and in gradually assuming more responsibility in recovering his health. 
A doctor depends upon the nurse for the faithful carrying out of his orders 
for treatment, and for observing, interpreting, reporting, and recording the 
symptoms and signs that indicate changes in the patient’s condition. And the 
doctor expects the nurse to do everything possible for the patient’s comfort 
and to assist in every way in bringing about his recovery. 
GENERAL NURSING CARE AND PROCEDURES 
General principles underlying nursing methods, 
To be effective and of value, nursing methods must be sound, and to be sound 
must be based on scientific principles. From many of the sciences have been 
obtained facts which form the scientific basis of nursing methods. A few ex- 
amples will show how the sciences affect nursing. Physics contributed the 
clinical thermometer used to determine body temperature and, having proved 
that water is a good conductor of heat, caused the water temperatures in warm 
baths to be kept constant in order to prevent chilling the patient’s body through 
loss of body heat to the water. From physiology it has been learned that all cell 
activity is work and consumes energy; consequently diets are varied according 
to the amount of work desired to be done in the process of digestion, and move- 
ment is reduced to a minimum in certain heart conditions and very sick pa- 
tients to avoid tiring the weakened body tissues. Chemistry has shown that 
chemical action increases with heat; therefore warm gargles, douches, etc., are 
more effective than cold, and specimens for gastric analysis must be kept cool 
to prevent acceleration of the action of enzymes or bacteria. Bacteriology has 
revealed that some bacteria are not killed by disinfecting solutions that promptly 
kill others, that the temperature of boiling is not high enough to kill some 
bacteria, and that some bacteria will live in the soil without air for 10 or more 
years. 
The application of scientific knowledge to the principles of nursing results 
in the better care of the patient, in providing for his greater safety and com- 
fort, in quickly recognizing symptoms and signs, and in the use of proper 
remedial measures and treatment. 
Observation of the patient’s symptoms. 
Symptoms are signs, evidences, or indications of conditions existing, imminent, 
or likely to follow, and noting them is an important part of the work of a 
trained nurse. Too much stress cannot be laid upon the development of keen 
observation on the part of the hospital corpsman who is doing actual nursing. 
Factors essential to its development and growth to a valuable and important 274 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
degree are: Alertness, intelligence, thoughtfulness, good eyesight and hearing, 
acute sense of smell, sensitiveness of touch, sympathetic understanding (re- 
sponsiveness), sense of responsibility to patient, quick perception, sense of 
order, eagerness to help, practical ability to recognize when knowledge 
gained iiv classroom or elsewhere is applicable in the daily routine, knowledge 
of normal conditions and the effects of disease and injury, and the power and 
desire to learn everything possible from contact with 'associates and from daily 
experience. Constant practice of watching, listening, and reasoning, that 
nothing may escape notice nor its significance be lost, is an asset of great 
value to the patient, the doctor, and the attendant. 
Symptoms are known as objective, those noted by an observer, and as sub- 
jective, those complained of by the patient, such as dizziness, faintness, weak- 
ness, and exhaustion; nausea (sensation of) ; pain, peculiar, indefinite, hard to 
describe or locate; itching, with no evidence of irritation; hunger and thirst, 
normal or abnormal; any peculiar feelings or sensations; fear, apprehension, 
chilliness, hot or cold flashes; exaggerated sensitiveness to noise, light, heat or 
cold; shortness of breath, and thirst for air with excessive thirst for water. 
Objective symptoms are readily observed by those trained to note them and 
consist largely of the general appearance of the patient as seen by the observer. 
In considering the general appearance of the patient the observer notes the gait 
in walking; the movements of the hands, as even or restless and jerky; the 
position of the body, as lying at ease, restless or tense; the "attitude toward 
others; and the type of conversation. The facial expression may be serene; 
placid of drawn, pale, pinched, anxious, worried, or apprehensive (evidence of 
pain, discomfort, or fear, or of some emotion or mental strain). The color may 
be pale, flushed, or bluish. The eyes may be bright or dull, normal in appear- 
ance, staring or bulging, bloodshot, the lids red or pale, the pupils of normal 
dilation, contracted to pin points, or extremely dilated. 
In observing a patient for symptoms there are many things to which the 
nurse should pay special attention. The appearance of the body should be 
noted, whether it is thin or well-nourished, normal or distended and swollen. 
The skin may be dry or moist, warm, cool or cold, firm, flabby, dry or damp 
and clammy, hot or feverish, without blemish or bruised and discolored. 
Swellings may be hard and tense, or soft and fluctuating. Distension of the 
abdomen may be from gas, abnormal collection of fluid, or from the accumula- 
tion of urine in the bladder or faeces in the intestine. Joints may be normal 
in appearance or deformed. The temperature of the body may be normal, 
slightly above or below normal, or extremely high or low. Respirations may 
be regular, even and normal in type and frequency, or irregular, labored and 
painful, abnormally fast or slow, full and deep or shallow. The pulse may 
be normal in frequency, force and rhythm, or abnormally fast or slow; firm, 
strong, and elastic, regular as to force and frequency, or soft, running, rapid, 
intermittent, difficult to find or to count. Observation of the general appear- 
ance should include insect bites, evidence or presence of vermin or body lice 
and nits, and eruptions and their type. The appearance of excreta (faeces, 
urine), vomitus, discharges, etc., should be observed. Pain is classified as to 
type: Dull or sharp; stationary or radiating; steady or intermittent; colicky; 
excruciating or merely irritating; superficial or deep; burning or stinging; 
relieved or aggravated by pressure; occurring before, during, or after eating; 
duration, severity, location, and extent of area involved; and whether nauseat- 
ing or not. Digestive symptoms include the appetite—normal desire for food, 
above or below normal, capricious or stable, craving for any special foods or NURSING 
275 
drink. Symptoms after eating include comfort or distress from gas, free 
expulsion of gas by rectum or by belching from mouth, pain or nausea. 
Symptoms of abnormal conditions associated with the eyes, ears, nose, mouth, 
and throat may be visible to the observer or may be complained of by thei 
patient and not visible to the observer. Any pain or tenderness in or, espe- 
cially, behind the ear may indicate a serious condition (mastoiditis) which 
requires prompt attention. Discharges from the eyes must be reported imme- 
diately as they may be of a virulent character and endanger the sight. Deposits 
or patches on the inside of the throat should be promptly reported and smears 
or cultures taken. The general condition of the mouth and teeth should be 
carefully noted, and any sores, ulcers, redness, or swellings reported. Any 
coating of the tongue should be described and peculiar spots noted, either on 
the tongue or on the sides of the cheeks. Report the presence of any discharges 
from the throat or nares (nose). 
A patient’s mental condition may be described as calm, placid or nervous, 
excitable, irritable or hysterical, quiet or talkative, sane or delirious. He may 
be cheerful or depressed and melancholy; irrational, mildly or extremely so; 
unconscious either from delirium, shock, stupor, or coma. 
A patient may assume a position in which the body is relaxed or rigid; 
the legs and arms relaxed or flexed loosely; stretched or drawn up taut and 
rigid; the legs may be flexed on the abdomen, or the head may be drawn back 
and the body bowed. The patient may be more comfortable on one side than on 
the other, or may be more comfortable in a sitting position. He may experi- 
ence ease or difficulty in turning; his head may be drawn to one side; there 
may be loss of motion in a limb, or twitching and jerking of limbs or muscles. 
Sleep may be described as quiet or restless, sound or light, normal or stupor- 
like, aroused from easily or with difficulty, and as to amount and time of 
sleep. 
Coughs are classified as dry or loose; persistent, slight, strangling as from 
tickling in throat; hard, deep, hacking; chronic or of occasional occurrence; 
racking and with pain, followed by exhaustion; of a type with or without 
expectoration. The expectoration may be thick and purulent, or thin, very fluid, 
or frothy; colored light or dark; streaked with blood (bright red or rusty 
brown, possibly tuberculous or pneumonic) ; may be easily raised and expec- 
torated, or raised and expectorated with difficulty. 
Vomiting is described as of the following types: Projectile or without force; 
difficult, after gagging and intense nausea, or as involuntary and with ease. 
The amount of vomitus is described as of large, small, or medium quantity 
(approximate amount stated in cc). The character of the vomitus is described 
as consisting of undigested, partly, or fully digested food; as containing little 
or no food; as clear and watery, or colored with bile; as streaked with blood, 
either bright red or dark in color; as containing mucus, pus, or faeces; and as 
with or without pain. The odor of vomitus is classified as of normal acid odor, 
excessively acid, bitter odor, or as having the odor of urine or of faeces (de- 
noting serious kidney condition or bowel obstruction.) The frequency of vomit- 
ing is described as periodic, as occurring at longer or shorter intervals, and 
as continuing for longer or shorter periods. The time of occurrence is described 
as before or after eating, or between meals, and as occurring during the night 
or in the day time. 
The voice is described as being clear or hoarse; firm and full, or thin and 
weak; and as loss of voice. Speech is classified as intelligible or thick and 
mumbling, as from shock or alcoholism, and as speech which halts with spaces 
between, as from weakness or loss of memory. 276 
HANDBOOK OF THE HOSPITAL CORPS, U. S, NAVY 
Perspiration is described as to amount, copious or scanty; as to odor, normal 
or rancid, having the odor of urine or of some drug or food; as to duration 
of period of perspiring; time of perspiring, continuous or periodic, occurring 
during the night or the day; and whether coming on suddenly or gradually. 
Perspiration may be induced by sudden shock or nervous reaction, by an acute 
septic condition, or by some chronic or long standing condition causing weak- 
ness and debility; it may be the result of tuberculosis (as an example, night 
sweats, a common symptom). Perspiration may be accompanied by a sudden 
drop or a gradual fall in temperature; or followed by a gradual or sudden 
rise in temperature. 
In describing hiccoughs the time of occurrence should be noted; the severity 
of the attack; whether it is checked easily or with difficulty; and the duration 
of the attack. 
Eruptions of the skin should be described as to the location of the first appear- 
ance, the time of the first appearance, the progress and extent of its spread, 
extent of area covered; as to the character of eruption and the symptoms 
associated with its appearance and spread, such as rise and fall in tempera- 
ture and general condition of the patient. 
Numerous symptoms are associated with heart action and heart conditions. 
Palpitation is the rapid, tumultuous beating of the heart which is felt by the 
patient, sometimes seen by the observer in the heart region of the chest, at the 
temporal arteries, and in the carotid arteries visible in the sides of the neck. 
It may be caused by organic disease of the heart; is often the result of shock, 
nervousness, or fright; and it may be caused by overexertion. It is some- 
times the result of hysteria, and may be the result of indigestion and pressure 
from gas in the stomach or intestine. A sudden, sharp, excruciating pain in 
the heart region is a cardinal symptom of angina pectoris. This is a serious 
condition and should be reported at once to the medical officer. In cases of 
this nature the attendant should remain with the patient and send someone 
as messenger for the doctor; while awaiting the arrival of the doctor, a hot- 
water bottle should be applied at once to the area of pain. An amyl nitrite 
pearl should be available so that if ordered it may be broken in gauze or a 
handkerchief, which should then be held under the patient’s nose. Difficult 
breathing, with distress of different types in the heart region, may be due to 
irritation of the muscles or membranes of the chest walls and area surround- 
ing the heart, to organic disease of the heart itself, to acute Indigestion, or 
some condition causing gas in the stomach or intestine with resulting pressure 
upon the diaphragm. 
The odor of the breath may be of diagnostic value. Certain odors are often 
characteristic of certain diseases or conditions. When the breath has any 
strong noticeable odor, as sweet, urinous, metallic, especially foul or fetid, a 
record of it should be made, and the medical officer promptly informed. Such 
a report may aid in establishing a diagnosis and prescribing treatment. 
Urine is one of the most important secretions of the body and when examined 
after excretion may present many important symptoms of pathological condi- 
tions. (See chapter on Anatomy and Physiology for description of urine). 
The presence of blood, pus, mucus, and sediment of various types should always 
be noted. Failure of the kidneys to secrete urine is termed suppression of urine 
and is a distinctly organic condition. It is sometimes caused by injury to the 
kidneys or adjacent parts, is a symptom of a very grave condition, and requires 
prompt attention. Retention of urine is the failure of the bladder to eliminate 
the urine stored there and is evidenced by the following symptoms: A feeling 
of fullness in the bladder, visible distention over the bladder, pain in the 277 
NURSING 
region of the bladder, headache, a keen desire to void with inability to do so, 
and sometimes dribbling of urine. The causes of retention of urine are restric- 
tion of the bladder muscles from nervousness, a kink in the neck of the 
bladder from tipping when overfull, mechanical obstruction of some kind, 
temporary loss of power of the sphincter muscles, temporary paralysis following 
injury, or from other cause, and sometimes because the quantity of urine in the 
bladder is insufficient to stimulate it to void. 
To overcome retention and induce urination give the patient a warm urinal 
or a urinal containing a small quantity of warm water; run water nearby 
where the patient can hear it; when permissible, give copious drinks of water; 
if permitted, place a hot-water bottle over the bladder; if patient is able, raise 
him somewhat on pillows and leave him alone with the urinal (consciousness 
of being observed, watched, or waited for, often causes a nervous reaction which 
in itself makes it difficult for a patient to void). Sometimes turning the patient 
well over on his side, or, when permitted by the medical officer, setting him up on 
the side of the bed with his legs hanging over will enable him to void. (The 
last-mentioned methods never must be used without permission of a medical 
officer. Should all these methods fail to induce urination, report to the medical 
officer who will, if necessary, order the patient to be catheterized. Never 
catheterize a patient without an order from the medical officer. 
Any unusual specimen of urine should be saved for observation of the 
medical officer who should be shown it as soon as possible after voiding, as 
decomposition is very rapid. The attendant should be so well informed con- 
cerning his patient that he will never fail to discover promptly any suppression 
or retention of urine. 
Many facts concerning a patient’s condition can be learned from observation 
of the faeces. The number of defsecations in the 24 hours should be noted. Fail- 
ure of the bowel to eliminate causes absorption of poisonous waste matter and in 
time results in sluggish peristalsis of the intestine. A patient is often uncom- 
fortable from a feeling of fullness in the bowel or from an accumulation of 
gas in the intestinal tract. 
Many times headache, and sometimes nausea, is caused by inactivity of the 
bowel. Alteration of the size or shape of faecal matter may indicate stric- 
ture of the bowel or an obstruction of the intestine. Hard stools indicate 
that the faeces have been impacted for some time and that the moisture from 
the intestinal content together with toxic matter has been absorbed by the 
system. Hard stools may also indicate that too small amounts of liquids 
have been taken by the patient or that some food or drug, which has a ten- 
dency to retard peristalsis or dry up secretions, has been taken. Liquid stools 
indicate the presence of an irritation causing increased peristalsis and increased 
secretions of intestinal fluid. Constipation frequently follows. The color of 
stools varies according to food and medicine taken and to the amount of bile 
poured into the intestine from the gall bladder; normally it is brown or 
greenish brown. Gray or gray-colored stools are an important symptom indi- 
cating a lessening of the secretion of the liver or of some obstruction to 
its discharge. (Morphine addicts often have pale gray stools.) If the stools 
are dark and tarry it is an indication that blood has remained in the intes- 
tine sufficiently long to be partly digested; it may be from a haemorrhage 
high up in the intestine or in the stomach which has become well mixed 
through the stool. Bright red blood in the stool indicates recent haemorrhage 
from the lower bowel where there is no digestion. Bright red blood on the 
surface of the stool indicates bleeding near the rectum, such as occurs from 
a rectal fistula, haemorrhoids, or possibly from a crack or fissure of the external 278 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
anus. The presence of pus in the stool is a grave symptom, denoting usually 
either inflammation of the intestine, liver, or pancreas, with suppuration, or 
the rupture of an abscess into the intestinal tract. The presence of mucus in 
a stool is the result of inflammation or irritation of the mucous membrane, 
causing an increase in the secretion of mucus. The following parasites are 
sometimes found in stools: Thread worm, round worm, and amoeba (found 
hy means of the microscope) ; tapeworm, hookworm (enters through sole of 
foot). When these intestinal parasites are found precautions as for infectious 
cases should be taken to prevent their transmission to other patients or to 
other persons in the ward, and also reinfection of the original patient. All 
articles used by the patient should be kept for his sole use and disinfected 
as necessary. 
Variations from normal in the temperature, pulse, and respiration indicate 
much concerning the condition of a patient. Temperature is the degree of 
intensity of heat of the body and as measured by the clinical thermometer 
represents the balance maintained between the heat produced by the activities 
and functions of the body and the various chemical changes within the body 
structure, and the heat dissipated or lost. Heat is produced by friction of 
the muscles, chemical action in various organs, also by hot drinks and applica- 
tion of heat to the exterior of the body in various ways. All points of natural 
friction in the body are provided by Nature with a lubricating fluid, and any 
interference with or shortage of this lubricating fluid causes abnormal body 
heat during friction, and a consequent rise in body temperature. Cool or cold 
drinks, applications of cold to surface of body, exposure to cold, and insufficient 
clothing are all means of lowering body temperature. 
Body temperature is measured by means of the clinical thermometer, a small 
glass cylinder, the center of which is a slender hollow tube dilated at its lower 
end into an oblong or round bulb, filled with quicksilver or mercury which 
expands on the application of heat. When heat is applied to this bulb the 
mercury, expanding, is forced as a slender silver thread to a height depending 
upon the heat applied at its base. This thread-like line is magnified by the 
outer glass, so that when the thermometer is held at the proper angle before 
the eyes it may be read easily. In the United States the clinical thermometer 
is usually marked in degrees and tenths of degrees Fahrenheit. Normal tem- 
perature, that is, the average body temperature, of a healthy person is 98.6° F., 
subject to slight daily variations. This temperature varies somewhat according 
to where taken, rectal temperature being slightly higher and axillary tempera- 
ture slightly lower than mouth temperature. 
Temperature trays vary somewhat in equipment but all carry out the principle 
of properly cleansing and disinfecting thermometers both before and after use. 
Whatever receptacles are used, the thermometers should be immersed in disin- 
fecting solution between periods of use; should he wiped free from solution 
before use, and wiped clean after use before return to the solution. There 
should be a sufficient number of thermometers on the tray to allow for disin- 
fection of a used thermometer while going from one patient to another, if 
possible using one thermometer no oftener than every fourth patient. The 
routine equipment always required on a temperature tray consists of small 
paper wipes, or absorbent cotton in sufficient quantity so that none need be 
used a second time; waste receptacle; time-piece with second hand; temperature 
book and pencil; rectal thermometer in special receptacle marked “For rectal 
use only,” and a jar of vaseline; two receptacles for holding thermometers, one 
marked “Clean,” to hold thermometers before use, the second marked “Used,” 
for immersion after use. NURSING 
279 
Temperature may be taken in various ways, the most frequently used methods 
being by mouth, by axilla, and by rectum. When taking temperature by mouth, 
remove the thermometer from the solution, wipe thoroughly free of solution, then 
grasping firmly but not stiffly between the thumb and the first and second fingers 
of the right hand and holding the wrist relaxed, not rigid, shake the thermom- 
eter with quick jerks, repeating as often as necessary until the mercury is down 
to 95° F. Then place the thermometer in a slanting position in the patient’s 
mouth, the bulb part under the tongue and the other end outside the patient’s 
mouth. The patient is then told to close his lips closely together on the ther- 
mometer, taking care not to bite or break the glass. Allow it to remain in 
patient’s mouth for from two to five minutes, then remove, read carefully, and 
record the temperature, together with the pulse and the respiration, in a record 
book. Cleanse the thermometer thoroughly on removal from patient’s mouth and 
place it in the receptacle for used thermometers. Take the pulse and respiration 
while waiting for the thermometer to register. 
In taking temperature by axilla first wipe the axilla with a dry towel to 
remove all moisture; wipe the thermometer and shake down the mercury to 
95° F., then insert the bulb well in the hollow of the axilla, close up to the 
junction of the adjacent surfaces. Hold the patient’s arm close to the body, 
flexing his elbow, and bringing the forearm and hand up on the chest. Keep 
the thermometer in place for from five to seven minutes. The thermometer is 
then cared for in the routine manner. Temperature by axilla is approximately 
1° lower than by mouth. 
When taking a temperature by rectum a thermometer larger in circumfer- 
ence and of thicker, heavier glass is used. This lessens the danger to the 
rectum by breaking and otherwise. First, free the rectum from faeces; lubri- 
cate the bulb well with vaseline; and then, with gentle pressure, insert the 
thermometer upward and backward in the rectum until well past the sphincter 
muscle. Temperature should register in from three to five minutes. On re- 
moval cleanse and disinfect the thermometer before replacing it in the recep- 
tacle marked “For rectal use only.” Rectal temperature is approximately one 
degree higher than that recorded by mouth. 
In taking temperatures certain precautions must always be remembered. 
Thermometers used for patients suffering with communicable diseases or with 
septic or infectious conditions of the mouth or throat should be properly 
labelled for their individual use and never used on other patients. Never 
take the temperature by mouth immediately following hot or cold drinks or 
after the patient has just been smoking. Never immerse a thermometer in 
hot water. When taking a temperature by rectum, never allow a patient to 
insert the thermometer himself. If a patient’s temperature suddenly goes 
very high or very low, without apparent cause, take it again with another 
thermometer to make sure there is no mistake. Closely observe the patient 
while taking his temperature to prevent accidents and deliberate errors. Never 
take by mouth the temperature of a patient who is coughing continuously, one 
unable to breathe through his nose, or one who for any reason cannot close 
his mouth. Never take the temperature by mouth of a delirious or unconscious 
patient. 
When the temperature of the body rises above normal the condition then 
existing is known as fever, and it is usually accompanied by quickened pulse 
and respiration, increased tissue waste, and disordered secretions. The onset 
of fevers may be abrupt or gradual, those of sudden onset being frequently 
characterized by chills, acute pain, headache, and sometimes accompanied by 
vomiting, while those of gradual onset are characterized by headaches, un- 280 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
easiness, weariness, loss of appetite, general malaise, etc., as well as by chilly 
sensations. Pneumonia is an example of a fever of sudden onset, and typhoid 
fever of one of gradual onset. 
Fevers 'are classified as continuous, remittent, and intermittent. A continuous 
fever is one in which the temperature remains continuously elevated, with 
only slight variations during the 24 hours. Never at any time does the tem- 
perature fall to normal or approach it. Pneumonia belongs to this type. In a 
remittent fever there is a moderate range between the highest and the lowest 
points, but the temperature until convalescence is always above normal. The 
highest point is reached in the evening, the lowest in the morning. Typhoid 
fever belongs to this type. In intermittent fevers there is a great range be- 
tween the highest and the lowest points in 24 hours, the temperature rising 
suddenly to 104° or 105° F., and as suddenly falling, sometimes to normal or 
below. Malaria is a typical example of this type. 
The termination of fevers occurs in either of two ways: By crisis, when the 
fever drops suddenly to norm'al or below, never again rising to any considerable 
degree, unless a relapse or some complication sets in, or by lysis when the fever 
gradually declines until it reaches normal. Most fevers terminate in this 
manner. During the crisis of a fever the patient per spires freely, the quantity 
of urine voided is sometimes increased, the pulse rate and respiration become 
normal, or nearly so, 'and following the crisis there is a marked improvement 
in the patient’s general condition, unless the drop is so sudden and extreme 
as to cause shock or collapse, in which case stimulants and application of ex- 
ternal and internal heat are indicated. Examples of diseases which usually ter- 
minate by crisis are pneumonia, influenza, measles, and typhus fever. A sudden 
drop of temperature in a fever does not always indicate “termination by 
crisis”, and when 'accompanied by a marked increase in pulse rate, rapid respira- 
tion, excessive restlessness and feeling of apprehension, and sometimes by 
shock, it is a grave symptom, and frequently indicates haemorrhage or intestinal 
perforation. 
The pulse is the intermittent change in shape of arteries due to the expan- 
sion of their walls following the contractions of the left ventricle of the heart. 
This expansion of the walls of arteries is synchronous with the heart beat 
and is wavelike in character. 
By the pulse rate is meant the number of beats to the minute counted at any 
point of an artery’s course where they may be seen or felt. It is sometimes 
spoken of as the frequency of the pulse. 
The pulse may be taken or counted at any point where an artery approaches 
the surface or passes over a bony prominence, firm muscle, or tissue. The loca- 
tions most frequently used are the radial artery at the wrist on the thumb side'; 
the temporal artery in front of the ears slightly above and at the outer angle 
of the eye; the carotid arteries in the sides of the neck (these may often be 
seen as well as plainly felt) ; the facial arteries where they pass over the lower 
jawbone just forward of the angle of the jaw; and the dorsalis pedis artery 
on the dorsal surface of the foot. 
The normal pulse of healthy individuals may vary somewhat in rate, force, 
and strength, but should maintain a certain regularity and be reasonably firm 
and elastic if the heart is in proper condition. The normal pulse rate for a 
man is 65 to 80, of a woman 70 to 80 beats per minute. Conditions which in- 
fluence the heart action and the pulse rate are age, sex, exercise, position, 
temperature, temperament, disease, injury, emotion, and excitement. 
The tension of the pulse is dependent upon the blood pressure, and this in 
turn is dependent upon the strength of the heart beat, the elasticity of the NURSING 
281 
artery wall, the degree of resistance offered to the flow of blood through the 
arteries, the amount of blood in the vessels, and in some degree upon the vis- 
cosity of the blood. When the tension of the pulse is high, the artery remains 
distended between beats and is compressed with difficulty; sometimes it can- 
not be compressed even following distention and may feel like a hard cord 
beneath the finger. When the tension of the pulse is low the artery does not 
remain distended for even the normal time of expansion, but quickly falls, is 
easily compressed, and the artery feels empty. Drugs and disease as well as 
other conditions, such as haemorrhage and changes in the elasticity of the ar- 
teries, may alter the tension of the pulse. To determine the tension of the pulse, 
the pressure required to obliterate the pulse beat is noted. Accurate measure- 
ments can be obtained only by use of the sphygmomanometer (blood-pressure 
apparatus), but an approximate idea of the tension may be obtained by increas- 
ing the pressure of the finger nearest the heart until the other finger fails to 
feel the pulse fyeat. The sphygmomanometer is an instrument made especially 
for the purpose of accurately estimating the blood pressure. In determining 
blood pressure the arm is encircled with a rubber bag which can be inflated with 
air and air is forced into this bag by means of a bulb which is connected with 
a dial or a graduated tube of mercury that registers the air pressure in the bag. 
When this pressure occludes the artery the pulse cannot be detected with a 
stethoscope distal to the bag. The pressure in the bag is then reduced grad- 
ually by opening an air cock connected with the bulb and as soon as the air 
pressure is sufficiently reduced to let the pulse be heard, the reading on the 
tube or dial will be the systolic pressure. If the air in the bag is further re- 
duced until the sound ceases to be heard, the reading at that point indicates the 
diastolic pressure. The pulse pressure is the difference between the diastolic 
and systolic pressures and normally is about 40 mm. 
The regularity in rate and rhythm of the pulse varies as a result of the 
action of drugs, disease, and in accordance with the physical and mental con- 
dition of the patient. Usually the pulse rate rises at the rate of about 10 
beats for every 1 degree of increase in temperature, though in some diseases 
the pulse beat may be high or low in proportion to the degree of temperature. 
A pulse is said to be regular when each successive beat is equal in volume, 
tension, and frequency. 
There are several variations occurring in the rhythm of the pulse and the 
most common of these irregularities is known as intermittent pulse. Although 
the heart may not miss a beat, because of failure of the arteries to distend 
properly the pulse skips a beat. This intermission may occur at regular or 
irregular intervals, and while it may be due to a weakened heart or some 
condition of the arteries it frequently occurs in apparently healthy persons 
who are addicted to the overuse of alcohol, coffee, tea, or tobacco. However, 
when a pulse is irregular in rate, in rhythm, or in both, this irregularity 
generally is a symptom of serious disease, commonly of the heart. Beats may 
follow each other with great rapidity and then change to slow with perhaps an 
intermission, and at the same time a variation in force and volume may be 
present. 
a. dicrotic pulse (from a Greek word meaning double beat) is one which 
frequently occurs in typhoid fever and other diseases causing a depleted condi- 
tion of the system. It is due to lack of tone of the walls of the aorta, whose 
natural rebound or recoil, normally not apparent, is so pronounced as to seem 
like an actual second beat of the heart. This recoil of the aortic walls is 
transmitted through the arterial system, and causes the pulse beats to seem 
divided, with the second part of the beat weaker than the first part. In 282 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
taking a dicrotic pulse the two beats must be counted as one in recording the 
pulse rate. 
The volume of the pulse refers to its size and depends upon the force of the 
systolic contraction of the heart and upon the general physical condition of 
the body. Some of the conditions affecting the volume of the pulse are dis- 
ease, exercise, excitement and emotion, the action of drugs, fatigue, and sleep. 
When the volume of blood flowing through the arteries is great the pulse is 
said to be full, and if at the same time the frequency of the beat is increased 
it is said to be full and bounding. Other descriptive terms used in connection 
with the volume of the pulse are thready, when the pulse feels like a little 
thread; hard, when the pulse is very small in volume but feels hard; and 
small, when the volume is lower than usual. 
When taking the pulse the condition of the artery should be noted by gentle 
and careful digital examination while apparently taking the pulse. A normal 
artery feels round and elastic, and usually is firm. But if it feels twisted, or 
hard and unyielding, and gives one an impression that it is brittle, this infor- 
mation should be reported to the medical officer and recorded, as such conditions 
often are important symptoms of disease. 
It is sometimes necessary to take the pulse in each wrist because of difficulty 
in obtaining an accurate count in one; and in certain conditions not often 
found, the pulse in one wrist is not the same as that in the other. The 
patient should be sitting or reclining so that, as a rule, the pulse may be taken 
at the radial artery, and his arm should be relaxed and supported. If the 
patient is excited, wait, if possible, until he is more quiet. Do not take the 
pulse with the thumb but use the middle or index finger, and hold it on the 
artery a sufficient time to determine the character as well as the frequency 
of the pulse beat. If unable to find or count the pulse in one location, try 
another; if not sure of the count, record it as approximate, and ask a more 
experienced person to verify it. In taking the pulse be accurate; never guess. 
The pulse should be counted for a full minute by inexperienced persons as 
should also always be done when the pulse is irregular or unusual in any 
way. When, from experience, one is thoroughly familiar with the method of 
taking a pulse and is accurate, a fairly good count may be made by taking 
the pulse for a quarter or half of a minute and multiplying the result by four 
or by two. 
Respiration is the usually automatic action of breathing and consists of the 
the alternate expansion and contraction of the chest walls which causes the 
lungs to expand and contract. The expansion movement, by means of which 
fresh air containing oxygen is taken into the lungs, is known as inspiration 
and the contraction movement, which forces the air laden with carbon dioxide 
out of the lungs, is known as expiration. Respiration consists of one inspiration 
and its accompanying expiration and a period of rest between them. The 
respiratory movements are more or less under the patient’s control and therefore 
should be counted without his knowledge. To do this, keep the fingers upon 
the pulse as though still counting it, at the same time watching the rise and 
fall of the patient’s chest, thus counting the respirations for a full minute. 
The rate of respiration is the number of expirations and inspirations counted 
as one which occur in one minute. The number per minute in the average 
healthy adult is usually from 18 to 24 per minute which is considered the 
normal rate, and any considerable deviation from this rate indicates some 
interference with the normal functions of the body. 
When the respirations of a normal, healthy adult are uniform in depth 
and frequency, smooth and quiet, with no sign of effort or strain, they are KURSING 
283 
spoken of as regular. They may be temporarily increased or decreased in 
rate by exercise, emotion, sudden application of heat or cold, or by any 
sudden fear or excitement, but they quickly adjust themselves and return 
to normal. Respirations are termed irregular when they vary from the normal 
as a result usually of pain in the muscles or tissues associated with breathing, 
of disease or injury to the lungs, of undue pressure from the diaphragm caused 
by gas or fluid in the abdominal cavity, of weakness, shock, heat or cold, lack 
of air, or of an insufficient blood supply resulting from anaemia or haemorrhage. 
In recording the respiratory movements, notation should be made as to 
whether or not they are shallow or deep, regular or irregular, and whether 
or not the chest walls expand normally. Any difficulty in breathing, or labored 
breathing which usually is accompanied by rapid respiration should be noted. 
This condition may be caused by heart disease or by conditions of the lungs. 
Dyspnoea is difficult breathing, accompanied usually by sound. In certain 
diseases the sound is of diagnostic value, being characteristic of them, as a 
grunting sound in pneumonia, accompanied by the moist, bubbly sound of bron- 
chitis and asthma; crowing sounds and sharp rasping breath sounds in croup; 
stridulent (squeaky) breathing as in diphtheria; and sighing respirations as in 
severe hsemorrhage, and in collapse and shock, showing that the body is not 
receiving sufficient oxygen. (In case of haemorrhage this is often accompanied by 
a definite gasping for air, called air hunger.) 
The type of breathing known as Cheyne-Stokes respiration indicates failure 
of the respiratory center. It is characterized by respirations which begin 
quietly, but at each succeeding respiration become deeper and louder until a 
climax is reached; then gradually decreasing until this type of respiration 
ceases with a deep sigh. This is followed by an appreciable pause, after 
which the cycle is repeated. In the second type of this class of respiration, 
the respiration begins and proceeds in the same manner as in the first until 
the climax is reached, when there is a sudden, complete pause, after which 
the respirations go on as before. 
CEdematous breathing is characterized by loud, moist, rattling rffles, caused 
by air passing through fluid in the air sacs of the lungs. This fluid is the result 
of an abnormal infiltration of serum into the air sacs. 
Singultus, or hiccough, consists of spasmodic inspirations suddenly arrested 
by an involuntary closure of the glottis. This is a serious symptom in a 
patient who is very ill. 
Clinical recording and charting is preparing written records of the observa- 
tions made by the attendant regarding the patient’s physical and mental condi- 
tion, of medications and treatments given to him, of nourishments taken by 
him, of his temperature, pulse, and respiration, of the number of defecations, 
of the quantity of urine voided, of specimens sent to the laboratory for exami- 
nation, etc. 
Such written records are termed clinical records and their purpose is to 
provide the medical officer with information as to the patient’s condition since 
last seen and afford him a means of comparing the patient’s condition from day 
to day. They also serve as a guide to the medical officer in making diagnoses 
and ordering treatment, and their importance can be realized when it is remem- 
bered that the patient is seen by the medical officer for but brief periods each 
day, while he usually is continually under the observation of an attendant. 
Clinical records can be kept indefinitely for reference, are often used in 
making statistical and similar compilations and are of value as evidence in 
legal actions. 
154294°—39 19 284 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
In preparing clinical records it is essential that they be correct in every 
detail, that the facts reported be true, that nothing of importance is omitted, 
and that the words used definitely describe what is observed. Therefore, the 
primary requisites of clinical records are accuracy and completeness. It is 
desirable that only objective information should be recorded although the 
subjective symptoms complained of by the patient are sometimes noted. In 
recording what is observed, care must be taken to see that the entries do not 
express any opinion of the observer as to the condition of the patient, as 
improved or not so well. The entries on clinical records should he legible so 
that there can be no question as to the meaning of the words or figures used, 
and they should be neatly arranged and spaced, without erasures. 
The statements entered on clinical records must be accurate, as brief as is 
consistent with furnishing complete information, and free from ambiguity. If 
things have not been weighed or measured the approximate amount, designated 
as such, should be given. » 
Each observation should be recorded in a separate paragraph, and record 
must be made of all objective symptoms noted and of subjective symptoms as 
necessary. Records of all medications and treatments with the time given 
must be made, but no medication should ever be entered on a record until 
after it actually has been given. If medication is given to relieve conditions 
which should be ameliorated in a short time, record the result and state the 
time elapsing before the drug or treatment was effectual. When recording 
baths that might have a bad effect, state something concerning the patient’s 
condition during the time. When recording the result of irrigations, douches 
and the like, state whether or not the flow was clear or contained foreign 
matter. When making records of the dressing of an open wound make a note 
of the presence or absence of discharge, and the nature of it, if present, also 
the general condition of the wound. If a medical officer or any one other than 
the attendant dresses the wound ask what record should be made. If a patient 
vomits, record the approximate amount, its color, and any noticeable charac- 
teristics. Observe and record with especial care the nature of all excreta, and 
any discharge from diseased parts (sputum, when trouble is in the lungs or 
bronchi; the faeces, when the trouble is in the stomach or intestine; the 
urine when the trouble is in some part of the urinary tract, or metabolism is 
at fault). When it is necessary to measure the urine voided it is also necessary 
to measure the fluids given and to record the amounts taken. 
Unusual symptoms should be promptly reported to a superior and recorded 
in sufficient detail; for instance, the time the first symptom was noticed and 
what it was, whether pulse rate, color, expression, appearance of blood; 
whether a visible external haemorrhage, or an internal haemorrhage recognized 
only by symptoms other than visible blood. Be absolutely sure of all signs 
and symbols used. 
The clinical or temperature chart (N. M. S. Form Q) should be started for 
every patient upon his admission to the ward, and should be kept complete 
and up to date until discontinued by the medical officer. Each page should be 
numbered and should contain the complete heading data of the first page— 
name in full, rating, diagnosis, race, religion, and age. The year and month, 
the day of month, and day of disease or days after operation (post opera- 
tive), should be recorded in the space allotted to them. Spaces marked “A. M,” 
and “P. M.” are provided for recording the time temperature, pulse, and 
respiration are taken; and at the bottom of the sheet are spaces to record the 
urine voided or catheterized; also movements of the bowel, whether natural 
or as a result of an enema. The main body of the sheet is divided into small NURSING 
285 
oblong blocks, separated vertically by dotted lines, horizontally by continuous 
lines. The top third is for recording temperature, the second section for the 
pulse rate, and the lower third for the record of respiration. A heavy black 
line drawn horizontally through each section at a certain place indicates 
normal for each. The temperature is indicated by a dot made in the block 
opposite the temperature index, marked in figures at the side of the chart. 
The sections of the divided vertical lines correspond to the divisions on the 
scale of the clinical thermometer, the space between each two representing 
0.2° F. The record dot should be made in the open space of the block, not on 
the lines. These dots showing the rise and fall of the patient’s temperature 
should be connected by lines drawn straight between them with the aid of a 
ruler; thus the whole course of the fever accompanying the ailment may be 
readily followed from its start to its finish. 
In the same manner in the lower sections provided for their recording, the 
increase and decrease of the respiration and pulse rate should be made. When 
the temperature is taken any other way than by mouth, the word “rectal,” 
“axilla,” or “groin,” depending upon where taken, should be noted in red ink 
above the record dot. The temperature, pulse, and respiration record should 
extend from 8 a. m. to 8 a. m. The record for 24 hours should be divided 
from the preceding 24-hour record by a red line drawn vertically before the 
beginning of each daily record. If customary or desired, the day may start 
at midnight, in which case the red dividing line should be drawn there. 
N. M. S. Hospital Form No. 17, entitled Clinical Notes, should be attached or 
placed directly beneath the clinical chart. In the use of this record the blank 
spaces at its top should be fully filled in with the data required, and in the 
columns headed date, hour, nourishment, and treatment should be recorded the 
appropriate information. In the column headed remarks, orders of the medical 
officer with their apparent results, necessary details of unusual variations in 
temperature, pulse, and respiration, information concerning the voiding of 
urine (with the amount) and of defecations, a record of the amount of fluid 
intake, and the symptoms observed by the attendant may be recorded. In cases 
where a 24-hour total of fluid intake and output is required, such totals are 
also entered in the column under remarks. Such a record is for the purpose 
of keeping the medical officer informed as to the fluid output in comparison 
with the fluid intake, and if proper elimination is taking place, the totals 
should approximate. In cases of diabetes, nephritis, or other conditions where 
special medications from which a regular increase or decrease in quantity of 
urine is expected, a similar 24-hour summary is made, giving the total amount 
of food with its caloric and other property values; and the total amount of 
medicines administered (as for instance, insulin), the highest and lowest tem- 
perature, pulse, and respiration, and a concise, general summing up of all 
important items of Information. Such summaries must be accurate, for upon 
them depends decision as to the patient’s condition and his future treatment. 
This special record is divided from the preceding and following daily records 
by double red lines so that this important information may stand out by itself, 
and thus be referred to easily and compared with other similar records. 
N. M. S. Hospital Form No. 59, the Clinical Record, is prepared by the medi- 
cal officer and is attached or placed next beneath the Clinical Notes. 
Reports of laboratory, X-ray, and other special examinations are also attached 
to the patient’s clinical records. These records combined are sometimes termed 
“case papers,” and upon discharge of a patient from a naval hospital become a 
part of the permanent flies of the hospital. 286 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
The collection of specimens from patients for examination is a very important 
detail. The collecting is usually done by a hospital corpsm'an and upon his 
conscientiousness and sense of responsibility the proper performance of this 
very important detail depends. The object of collecting specimens is to assist 
in diagnosis, to help determine the progress of the disease with which the 
patient is suffering, and to furnish information regarding the results of the 
treatment employed. Specimens are examined by general appearance and by 
chemical and microscopic methods. 
Certain general precautions should be followed in the collecting of specimens 
and it is essential that they be so marked that they cannot be confused with 
other similar specimens. Never use a cracked receptacle. Collect the speci- 
men in the right receptacle, use the right label, send the right amount; collect 
and send in proper manner at the right time, to the right place in the labora- 
tory. Have the receptacle thoroughly clean (sterile when so required), and 
well stoppered to avoid contamination from outside. When collecting speci- 
mens allow no opportunity for the patient to deceive, as one wishing to seem 
more or less ill than he really is might get another patient to void, expectorate, 
or produce some other specimen for use. When preservatives are used in speci- 
mens state the kind and amount used on the laboratory request blank. Make 
a notation on the clinical notes when a specimen has been sent to the 
laboratory, stating the date, hour and nature of specimen, and examination 
desired. With all specimens send the routine laboratory request blank properly 
filled out. Never leave unsightly specimens in the ward, nor uncovered in the 
lavatory; but when necessary, while further collection is being made, keep prop- 
erly covered in an isolated place in the heads or lavatory. Always take 
specimens to the laboratory at the earliest possible time. 
There are various designations for urine specimens, such as a routine speci- 
men, sterile specimen, catheterized specimen, 24-hour specimen, and a “staf’ or 
immediate specimen. A routine specimen of urine is collected at a single void- 
ing and is sent to the laboratory from each new patient the morning following 
his admission to the hospital. On the morning preceding, and the morning 
following the administering of a general anaesthetic a routine urine specimen 
(preoperative and postoperative) is sent to the laboratory, and for other cases 
when ordered by the medical officer or surgeon. The specimen must arrive 
at the laboratory at the time specified by the routine regulations of the hos- 
pital. 
Sterile specimens of urine are collected without catheterizing the patient in 
the following manner: Have sterile container with sterile stopper. Bathe the 
patient’s genitals and pubic region thoroughly with soap and water, remove 
all traces of soap, then bathe the parts with 3 per cent boric acid solution. In- 
struct the patient to void into the sterile container, rendering him all neces- 
sary assistance. Replace sterile stopper which has been kept uncontamiuated; 
mark specimen “sterile,” in addition to filling out request blank in routine man- 
ner, and send it to the laboratory. 
A catheterized specimen is obtained by following the preliminary procedure 
for a sterile specimen except that instead of being allowed to void the patient 
is catheterized. 
A 24-hour specimen contains the total amount of urine voided by a patient 
in 24 hours. The purpose of this particular specimen is to determine the total 
normal constituents and the total abnormal constituents. It is collected in a 
sterile wide-mouthed jar (if a preservative is to be used the designated amount 
is put in the jar), properly covered or stoppered with a sterile or absolutely 
clean cover. This container must be kept in a cool place. Unless otherwise NURSING 
287 
ordered, start the specimen in the early morning so that it may be completed 
the following morning and ready for delivery to the laboratory at the routine 
hour. On the evening before the specimen is to be started prepare and prop- 
erly label the jar and place it in a designated place, instruct the patient in 
regard to the required procedure. Tell the patient to void on first waking (if 
he does not wake early enough the night attendant, unless otherwise instructed, 
should awaken him) ; discard this first morning voiding, making a record of 
the time and date, and a statement that a 24-hour specimen was started. 
From that time until the following morning at the same time save all urine 
voided, including that -voided at the time of completing the specimen, in the 
receptacle prepared for it. If the patient is a bed patient the attend- 
ant must take care of the collection, but an “up patient,” with proper instruc- 
tions and supervision may collect his own. As an example: The patient voids 
at 6 a. m., which urine is thrown away, but all urine voided subsequently, up 
to and including 6 a. m. the following morning, is saved. Depending upon 
instructions and the routine regulations of the laboratory, the entire specimen 
is sent to the laboratory where it is measured and examined; or a specified 
amount is taken from the well-mixed 24-hour amount, which has been measured, 
is properly labelled and, accompanied by complete data concerning the entire 
specimen, sent to the laboratory in a routine receptacle. The remaining urine 
is thrown out, the jar cleansed, sterilized, and made ready for use at another 
time. 
When collecting urine for the phenolsulfonepthalein kidney-function test, the 
patient should be required to completely empty his bladder. One cc of phenol- 
sulfonepthalein is then injected into the lumbar muscles of the patient, one glass 
of water is given to him to drink, and he is instructed not to urinate for one 
hour and 10 minutes, at which time he should void as much urine as possible. 
This is placed in a bottle properly labeled and designated as first-hour specimen. 
One hour later the patient voids again, and this specimen is placed in a second 
bottle and marked second-hour specimen. Both specimens are then taken to 
the laboratory with the request clearly expressed on laboratory request blank. 
It is absolutely necessary that the bladder be completely emptied at the time 
the injection is given, so that the urine collected during the test may tell a true 
story. Full directions accompany the ampules of the drug, which should be 
given only under a medical officer’s order and supervision. 
Special precautions must be taken in collecting specimens from the throat 
for cultures and smears. The stopper and the edge of the test tube should be 
passed through flame before the swabs are removed from the sterile tube and 
again before they are replaced in the tubes or applied to the media. This will 
prevent contamination from outside bacteria. Sterile stoppers should be re- 
placed in test tubes while culture or smear is being taken. 
The following articles are required in making throat cultures and smears: 
Sterile test tubes with sterile swabs, sterile culture tubes containing media, 
matches, an alcohol lamp, a flash light, tongue depressors, gauze wipes, and a 
kidney basin in case the patient gags or vomits. Throat cultures and smears 
are taken as follows: Place the patient in a sitting position, if he is able; 
otherwise in the next best position for obtaining the specimen. Instruct him 
to relax his lower jaw and to draw his tongue flat by suction, breathing through 
his mouth in slightly panting fashion to lessen the tendency to gag. Flame 
the edge and stopper of the sterile tube to prevent contamination of the sterile 
swab while removing it from the container. While an assistant holds a flash 
light in a manner to well illuminate the patient’s throat depress the patient’s 
tongue with a tongue depressor held in the left hand and, holding the sterile 288 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
swab in the right hand, make a thorough swabbing of the affected areas of the 
throat, mouth, or gums, working quickly but gently. In the case of a culture 
use the swab, then apply it immediately to the culture media and return the 
swab at once to a plain sterile test tube. In placing the culture material 
great care must be taken to pass the swab gently over the culture media to 
avoid breaking its surface. At once break in two the tongue depressor used 
andi place it in a receptacle for burning. Flame the edge of the tube before 
replacing the sterile stoppers. Affix proper labels to the tubes and take the 
specimens to the laboratory without delay. 
The same care and precautions should be taken in procuring specimen cul- 
tures and smears from wounds as in obtaining other cultures and smears. 
Detailed instructions for procuring specimens for gonorrhoeal smears usually 
are given by the medical officer in charge of such cases or by some other com- 
petent person designated by him. The same general precautions, however, 
apply. Special precautions should be taken by the attendant when procuring 
such specimens to prevent infecting himself and to carefully protect his eyes 
from this virulent infection, which often causes blindness. 
Specimens of bone fragments, of diseased tissue, abnormal growths, fluids, 
etc., which are obtained during an operation or dressing should be placed in 
sterile containers and, with laboratory request blank properly filled out, sent 
to the laboratory. Such specimens always should be saved, even though no 
order for examination has been given, until the medical officer or surgeon has 
been questioned in regard to them. Valuable specimens are sometimes lost by 
disregarding this wise precaution and important investigations retarded. 
When specimens of stools which are to be examined for typhoid, cholera or 
tubercle bacilli, or other microorganisms of an actively infectious nature are 
collected they should be handled with extreme care in order to keep the cover 
and outside of the container free from particles of the specimen and to prevent 
infecting the ones who handle them. 
A specimen of sputum should be collected in this manner: Prepare and prop- 
erly label the specimen box or container the night before, giving the patient 
any necessary instructions. Be sure the container is clean; use no disinfectants. 
Have the container, usually a Petri dish, sterile when a sterile specimen is 
ordered. In the early morning before breakfast have patient rinse his mouth 
well with plain water, expectorating with this all excess of saliva; then instruct 
him to cough as deeply as possible in order to obtain a specimen from the 
bronchi or the lungs to expectorate directly into the sputum cup or dish, 
taking care that none is deposited on cover or sides of the container. 
General care and comfort of the patient. 
Although nursing usually is considered as consisting almost entirely of 
caring for the disease or condition with which a patient is suffering, it is a 
fact that but little time is so spent by the nurse. Actually, much more time is 
spent on measures which have for their object the promotion of the physical 
comfort of the patient and which help to maintain his strength and resistance. 
Those measures are chiefly concerned with his personal cleanliness, his nourish- 
ment, elimination, and rest. 
In promoting the physical comfort of a patient it should be remembered that 
his mental attitude has a marked influence on his physical condition. It is 
therefore important that every effort be exerted to keep a patient in a cheerful 
frame of mind, as contented as possible, free from worry or fear as to his 
condition, and from becoming depressed. Confidence in the medical officer and 
attendants and a generally hopeful attitude favorably affect the physical condition 289 
NURSING 
and their maintenance is most desirable. It is necessary that such efforts of the 
attendants be suited to the temperament of the individual patient and that they 
be made in the way that is most likely to obtain the proper response. To do this 
requires considerable understanding of the patient, his likes and dislikes, his 
strong points and his weak ones, and it must never be forgotten that a sick 
person reacts differently than a well one and is affected by things that ordinarily 
would hardly be noticed. 
The bed, when neatly and correctly made, is a most important factor in the 
comfort of a patient. It must be clean, comfortable, and fitted to the needs of 
the patient, and should have a good mattress and good pillows. Its appearance, 
furnishings, accessories, and agreement with other furniture are of secondary 
importance. 
A hospital bed usually is higher and narrower than the average one found 
in a home, and this fact contributes greatly to the efficacy of the care and 
treatment of a patient, as it makes it easier for the attendant to care for the 
patient. The mattress should always be protected with a linen or cotton mat- 
tress cover, made to fit the mattress as closely as possible in order to prevent 
surface soiling. This cover may be laundered easily and should be changed 
frequently. From time to time the mattress should be turned, always from 
end to end which changes the points of greatest pressure; when turned from 
side to side this is not accomplished. Two pillows should be allotted to each 
bed, one soft, and the other a hard, or hair pillow. The hard pillow is placed 
under the soft pillow to aid in support and elevation. In cases of high fever 
the soft pillow often is removed as the hair pillow is cooler, allows better cir- 
culation of air about the head and shoulders, is nonabsorbent, and is less easily 
impregnated with odors. Pillows of various shapes and sizes are used for 
special support in cases of serious illness, helplessness, and for obtaining im- 
mobility. They usually have an inner cover as well as an outer case, and when- 
ever necessary an inner rubber cover should be used inside the outer case for 
protection of the pillow. 
The mattress and lower sheet of all beds for strictly bed patients are pro- 
tected by a rubber draw sheet which should extend from several inches under 
the lower edges of the pillows to several inches below the patient’s knees, and 
should be long enough to tuck under the mattress about 8 inches on each side. 
As rubber should never be allowed to come in direct contact with the patient 
the rubber draw sheet is covered with a cotton draw sheet which should ex- 
tend about 2 inches above and below the rubber draw sheet. When necessary 
the entire mattress is covered with a full-length rubber sheet. 
Correct bed making is one of the first things that should he learned by those 
caring for the sick or injured. Loose and sagging beds should not be used 
and special care should be taken to prevent bed coverings from becoming too 
tight for the patient’s comfort. Whenever a patient is temporarily out of his bed 
it should be straightened and smoothed before his return. 
The fundamental principles of bed making are the safety and comfort of the 
patient, the warmth, cleanliness, and tightness of the under linen, and protection 
of the mattress. 
Bed linen should be changed as often as necessary hut economy in its use 
should be practiced, and badly stained linen should never be used. The under 
and draw sheets should be drawn tight to prevent the formation of wrinkles 
under the patient which makes possible the development of bedsores. There 
should be sufficient covering to keep the patient warm and, while it is necessary 
to have the bedclothes look neat and tight, care should be taken to avoid the 
causing of pressure sores on the toes, 290 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Beds and bedding should be kept free from vermin. If signs of bedbugs ap- 
pear the bed should be cleaned with a disinfectant solution, the bedding sterilized, 
and the mattress thoroughly brushed with kerosene and put in the sunlight 
for 48 hours. 
The proper method of making a bed is to obtain all the necessary bedding, 
put it in a place convenient to the bed, remove all clothing which may be on 
the bed and turn the mattress from top to bottom. The mattress cover should 
be placed over the mattress from head to foot, corners neatly fitted and the 
tapes tied at the foot of the mattress. The bottom sheet should be placed on 
the mattress right side uppermost with the wide hem at the head of the bed, 
the small hem even with the bottom, of the mattress, and so arranged that 
it hangs equally over the sides of the mattress. The wide hem should be 
folded under the head of the mattress and tucked in with envelope corners 
at each side. The sheet is then pulled down to the foot of the bed, made 
taut, and the sides tightly tucked in. The top sheet is placed on the bed 
wrong side uppermost with the wide hem toward the head of the bed and 
even with the upper edge of the mattress. It should be so placed that it 
hangs equally over the sides. The end is folded smoothly under the foot of 
the mattress, envelope corners made and the sheet freed from wrinkles. Next 
the blanket is placed on the bed in such a manner that it hangs equally at 
the sides and is 6 inches from the head of the bed. The blanket then is folded 
over the foot of the mattress, tucked in, envelope corners made, and the entire 
blanket freed from wrinkles. The upper part of the sheet extending beyond 
the blanket should be folded back over it and tucked in tightly at the sides. 
The spread next is placed in such a manner that it will be right side upper- 
most (anchor pointing to the lower left corner of the bed), hanging equally 
at the sides and should be tucked in at the foot just enough to make corners. 
All excess goes to the top. This protects the under sheet and keeps it free 
from dust. Pillow covers and cases are applied to the pillows, arranged in 
such a manner that the corners are well filled, and then placed at the head 
of the bed with the seam to the back and the closed end toward the entrance 
of the ward. 
A bed should be cleaned and aired weekly on specified days; after the death 
or discharge of a patient; in case vermin are found in the bed; and after use 
by a patient having a communicable disease. The approved method is as 
follows: Brush the mattress thoroughly with a whisk broom moistened in 
disinfecting solution, giving special attention to the tufts, seams, and bindings. 
Examine the mattress for rips, stains, and vermin; remove the stains, have 
it repaired if necessary, and if vermin are found proceed as previously directed. 
Remove the mattress from the bed and place it on the mattress-airing rack, 
if one is available. If such a rack is not available it should be placed on two 
ward chairs out of doors. A mattress should be sunned for 48 hours if 
possible, as it is when vermin have been found. Thoroughly wash and dry 
the frame of the bed. 
The purpose of making a bed with the patient in it is to obtain cleanliness 
with the least possible discomfort to the patient. Place all necessary clean 
linen in order on the bedside locker, arranging chairs at the foot of the bed 
to receive the soiled linen and to hold the pillows while airing. Loosen all 
bed linen, remove both pillows, unless by so doing the patient is made too 
uncomfortable, in which case remove one and place on the chair to air. 
Remove the spread by taking hold of it by the top and bottom hems. This 
will fold the spread in half. Fold again from side to side and place on a 
chair. If there are two blankets on the bed remove one in the same manner NURSING 
291 
as the spread. Next place a clean sheet, wrong side up, wide hem at top, over 
the remaining blanket, and on top of the clean sheet replace the blanket 
previously removed, turning down the sheet over its top edge 12 inches. If 
the patient is not too ill instruct him to hold the upper edge of the clean bed 
clothes while the soiled sheet and remaining blanket are removed; otherwise 
tuck them in about his shoulders and, while standing at the foot of the bed, 
reach under the clean sheet, grasp in turn the blanket, then the sheet, remove 
and fold them in the same manner as the spread, and place on a chair to air. 
Fold back the side of top sheet and blanket over the patient, leaving the fold 
wide enough to cover his back when he is turned or lifted to the far side of the 
bed, then turn or lift the patient to the opposite side of the bed. To change 
the under sheet and draw sheet, the under sheet is folded or rolled lengthwise 
close to the patient’s back and a clean sheet folded or rolled lengthwise to its 
middle and placed close up to the soiled sheet. The upper corner is then made 
and the sheet tucked in the entire length of the bed. The patient is turned on 
his opposite side, the soiled clothes removed, the clean sheet freed from 
wrinkles and tucked in at the head and side to make it taut. If a drawsheet 
is present it should be removed with the soiled sheet and a, clean draw sheet 
folded or rolled and placed in its correct position at the same time and in 
the same manner as the lower sheet. If it is impossible to turn the patient 
upon his side, assistance should be obtained. The head, shoulders, body, and 
hips are supported in that order while the soiled sheet is folded or rolled 
and gradually removed from head to foot, following it up with a clean sheet 
which has been rolled or folded and which is unrolled or unfolded as the soiled 
one is withdrawn. The sheet which has been airing, if sufficiently clean, may 
be used for the draw sheet or if a draw sheet is not on the bed use this 
former top sheet for the bottom. Replace the extra blanket if needed, and put 
on bedspread, being sure it is under the 12 inch fold of sheet at the head of 
the bed. All top bedding should be tucked in only enough to hold the covers 
In all ordinary bed making each piece of linen should be tucked in separately 
when the corners are made. 
In changing the lower sheet of a bed patient it is necessary to loosen all 
of the clothing from the head, foot, and sides of the mattress, and to remove 
the pillows and all upper clothing except the sheet. The patient then is turned 
on one side. The lower sheet is folded or rolled lengthwise close to the 
patient’s back and a clean sheet folded or rolled lengthwise to its middle and 
placed close up to the soiled sheet. The patient is turned on his opposite 
side, the soiled clothes removed, the clean sheet freed from wrinkles and tucked 
in at the head and sides to make it taut. If a drawsheet is present it should 
be removed with the soiled sheet and a clean drawsheet folded or rolled 
and placed in its correct position at the same time and in the same manner 
as the lower sheet. If it is impossible to turn the patient upon his side, 
assistance should be obtained. With an assistant on the opposite side of the 
bed, it is possible to loosen the clothing all around, and to remove the pillow. 
The head, shoulders, body, and hips are supported in that order while the 
soiled sheet is folded or rolled and gradually removed from head to foot, 
following it up with a clean sheet which has been rolled or folded and which 
is unrolled or unfolded as the soiled one is withdrawn. 
Changing the mattress with the patient in bed may be accomplished as fol- 
lows : The spread should be folded neatly and placed on a chair. The sides 
of the upper sheet and blanket should be folded over the patient, and the 
bottom part of it folded under the legs. The pillows should be removed, the 
lower sheets loosened and the sides of the sheets including the rubber sheet 292 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
rolled close to the patient One side of the rolled sheet then should be 
pulled, drawing the patient toward the attendant’s side of the mattress, an assist- 
ant should stand on the opposite side of the bed and draw the mattress toward 
his side until half of the springs are exposed. This exposed part is covered 
with a fresh mattress, the patient drawn upon it, the old mattress discarded 
and the fresh mattress pulled into position. The patient should be drawn 
toward the center of the bed, and the making tip of the bed continued. If 
the under sheets are to he changed, the vacant half of the mattress should 
be covered with fresh linen, and before the patient is drawn to the center of 
the bed, the patient lifted (with some assistance) onto the clean side, the soiled 
linen removed, the clean sheets drawn over the remainder of the mattress, and 
the making of the bed completed. 
Turning the mattress with the patient in hed may be accomplished in a 
manner similar to changing the mattress, except that after drawing the 
mattress to one side of the bed, the springs should be covered with three 
pillows and the patient lifted on to them. The mattress then is turned top 
to bottom, the patient lifted on the mattress, and the bed made up as before. 
Beds sometimes are prepared to take care of certain classes of patients and 
are then given names according to the purpose they serve. Two such types 
of beds are known as ether and fracture beds.' 
The fracture hed differs from the ordinary bed in that perforated boards, a 
frame of slats, or a number of slats running from side to side of the bed 
are placed between the springs and the mattress, or between the springs and 
the frame of the bed. The object of a fracture bed is to prevent any motion 
at the point of fracture by reason of sagging of the mattress. 
The ether bed, also known as an anaesthetic bed, is prepared especially for 
patients who are or have recently been anaesthetized. The object of an ether 
bed is to provide for easy accesibility, extra warmth, and the safety and 
comfort of the patient. In making an ether bed the following equipment is 
required: Two old blankets, 1 pajama coat, 1 hand towel, 1 paper bag and 
safety pin, 4 hot water bottles with covers, and necessary shock blocks. On the 
bedside locker should be placed a mouth gag, 2 pus basins, a quantity of gauze 
wipes, paper and pencil, and a small clock with second hand or a watch with 
a second hand. 
The procedure in making an ether bed is as follows: First make the bottom 
of the bed as for any bed patient, that is, with a draw sheet; over this place 
an old blanket crossways on the bed, the side even with the end of the 
mattress, and tuck in on both sides; next take a rubber and linen drawsheet and 
place them on the upper part of the bed being sure that they cover for about 
2 inches the bottom draw sheet; then take the second blanket and place it 
on the bed even with the top of the mattress; make the first part of the corners 
at the bottom but instead of finishing them fold the edges of the blanket toward 
the center of the bed. In one side of these folds place a pajama coat. Under the 
top blanket place three hot water bottles, one each at the foot, middle, and top 
of the bed. Next put on the top bed covers in the usual order, and fold fan- 
like to the foot of the bed. Place a hand towel across the head of the bed 
to protect the bedclothing after the patient returns from the operating room. 
Tie the pillow securely to the head of the bed with gauze bandage to protect 
the patient’s head from drafts. Place shock blocks at the foot of the bed and 
move the locker behind the bed after placing the proper articles on it. 
A screen should be placed around the bed after the patient has been placed 
in it, the room should be kept warm and well ventilated, the patient should 293 
NURSING 
never be left alone until after reaction from the anasaethetic is complete, and his 
pulse and respiration should be taken every 15 minutes and recorded. 
After being placed in bed an ether patient should be kept well covered and 
the hot water bottles used to warm the bed removed, unless otherwise ordered 
by the medical officer, in which case they should be placed not nearer than 8 
inches to the patient with a blanket in addition to the cover between them 
and the patient. Hot water bottles used in an ether bed should always be 
examined to make sure they do not leak. Chilling of the patient by exposure 
or by a damp bed may cause ether pneumonia. 
Shock blocks, or bed blocks as they are sometimes called, are solid cubes of 
wood about 6 inches square, the depth or height varying according to require- 
ment. In the middle of the top a hole is bored large enough to receive the 
end of the bed legs and deep enough to hold them without danger of slipping. 
The purpose of the bed blocks is to elevate the head or the foot of the bed in 
case of drainage, shock, or hemorrhage, and to facilitate giving certain kinds 
of baths, as a spray or shower bath, in bed. When using bed blocks care must 
be taken not to jar or jolt the patient while raising the bed; and both blocks 
must be of the same height so that the elevation will be uniform. If the bed is 
elevated at the foot the patient’s head must be protected from slipping against 
the bed bars by securing a stiff pillow on the inner side of them, and when 
permissible, raising the knee support of the Gatch spring. 
It is essential in caring for bed patients that the attendant understand 
the methods of changing their clothing and moving them. 
When changing the clothing of a helpless or unconscious patient, if the sleeves 
do not slip off readily, one hand should be slipped through the armhole, the 
patient’s arm grasped above the elbow, bent slightly, and gently drawn back- 
ward, while with the other hand the sleeve is removed by pulling the armhole 
or the wrist. If the arm is injured, the sleeve of the injured arm is removed 
last, but in putting on the pajama coat, the injured arm is put in first. The 
pajama coat should be pulled well down in the back in order to avoid wrinkles. 
In the case of helpless and unconscious patients it is better to have the pajama 
coat buttoned in the back. The most efficient way to remove a coat from 
a helpless patient is to draw it well up to the shoulders, then bring it over the 
head, taking out first one arm and then the other. The trousers are pulled down 
to the ankles, both legs are lifted with one arm, and the trousers removed with 
the free hand. If the leg or foot is injured or swollen the trouser leg should be 
cut at the seam to facilitate repair later. 
Before moving and lifting a patient he should be drawn to the edge of the 
bed, thus minimizing the degree of stooping required. When stooping is 
unavoidable, the lifter should bend his knees and hips, throw back his shoulders 
and retain them in that position. Before lifting, the patient should be in- 
structed to make himself rigid, and to remain so while being lifted. When 
two or more persons are lifting a patient, it should be done in unison, one 
directing and giving the word to start when ready, but when carrying a patient 
one carrier should step off with the right foot and the other with the left, 
to prevent swinging. 
In moving a helpless patient to the side of the bed, his head and shoulders 
should be supported with one arm and the other arm gently placed under the 
small of his back. The assistant standing on the same side of the bed should 
pass one arm under the upper part of the patient’s thighs, and the other 
under his knees. The patient thus can be lifted easily to one side of the bed. 
A heavy patient may be turned or moved more easilv bv loosening the draw- 294 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
sheet and pulling him with it to one side of the bed, or by grasping the loosened 
end of the sheet on a line with the shoulders and thighs and then gently pulling 
it upward and turning the patient on his side. 
A weak or helpless patient should be turned on his side by placing one arm 
under his far shoulder, obliquely across the back in such a manner that the 
hand comes under the patient’s near side; the other arm should be placed 
under his hips from the far side, the patient raised slightly and drawn some- 
what backward, and turned toward the attendant. It may be necessary to 
make some change in the position of the patient’s shoulders or hips. In moving 
the shoulders of a helpless patient the attendant’s arms should b.e placed on 
either side of the patient’s body, bringing the hands under the lower arm, then 
the patient should be raised slightly and moved as required. The hips should 
be moved in the same manner. 
As an aid in moving an extremely heavy or quite helpless patient the draw 
sheet may be loosened at the sides and the ends rolled or folded back close 
to the patient’s body. With an attendant at each side of the bed grasping 
the ends of the draw sheet the patient may then be easily raised and lifted 
toward the head of the bed. If the patient is too weak to support his head 
as he is lifted, a pillow may be left under his head and the draw sheet 
extended far enough under it to support the head, or, the lifters may support 
the head and shoulders with one arm while with the other hand they grasp 
the gathered end of the draw sheet and lift the buttocks. 
In turning bed patients they may be turned either from or toward the 
attendant. To turn a 'patient from him the attendant should place one arm 
under the patient’s shoulders, the other well under his hips, while firm pres- 
sure is made against the near shoulder and, with his hands at the axilla and 
hips on opposite side of patient, lift him slightly and roll him over gently, 
taking care not to roll him too far and out of the bed. The body should be in 
a position with a slightly forward cant, the under leg drawn back and the upper 
leg forward, with one pillow placed between the knees and one smig to the 
back for support, if necessary. The patient’s under shoulder should be brought 
back slightly, and the pillow arranged in the position required for support and 
comfort, drawing the under arm backward or forward to suit the comfort of 
the patient and to prevent pressure. To turn a patient toward him the attend- 
ant should put one arm over the patient with his hand well down under the 
patient’s shoulder on the opposite side, and place the other arm over the 
patient’s hip, the hand well down under the opposite hip. The patient should 
then be lifted slightly and rolled gently toward the attendant, after which he 
should be adjusted comfortably as described before. 
As a rule when transferring a patient from a stretcher to a bed three attend- 
ants are required, although two will suffice if the patient is not too heavy and 
has no serious injury. The upper bed covers should be fan-folded to the foot 
of the bed and the stretcher placed at right angles to the bed. One attendant 
or lifter should place his arms under the patient’s shoulders, one elbow sup- 
porting the head and the other arm extending well down on the back. The 
tallest and strongest should stand in the center, passing one arm under the hips, 
the other under the thighs, while the third keeps the lower legs from dangling 
or striking the foot of the bed. At a given signal all three should take firm 
hold of the patient’s body and lift, turn, and place him gently on the bed, 
lifting him well up in bed and arranging the covers. In a room too small to 
place the stretcher at right angles, it may be drawn close to the side of bed, 
and while the three lift the patient, another person may withdraw the stretcher 
before the patient is placed on the bed. Sometimes the stretcher is brought NURSING 
295 
only to the door of the room and the patient carried from there to the bed. 
Patients should be transferred from the bed to the stretcher in the same man- 
ner, except that, as the stretcher is lower than the bed, he must be lowered 
rather than lifted into place. In both procedures the patient should be well 
covered during the transfer, a blanket being wrapped about his feet and shoulders 
and tucked up and in at both sides for protection of the patient and to pre- 
vent dangling ends which might catch and drag, or trip the lifters. The fol- 
lowing precautions should be observed: Not to stumble, jar, or jolt the patient; 
not to squeeze or pinch a fold of flesh, or drop a patient on the bed, but to 
gently place him there; and not to allow the stretcher to roll or slip. 
When getting a patient np out of bed caution should be taken to avoid 
exhausting the patient by permitting him to stay up too long at a time; to 
watch his color, pulse, and general appearance for signs of weariness and 
weakness; to prevent chill or overheating by placing the patient in a shady 
spot during hot weather and in the sunshine during cool weather; to watch 
out for wrinkles in the chair fittings, and to observe for pressure spots; to have 
the bedside table with call bell, drinking water, reading matter, etc., conven- 
iently within reach of the patient, and to make certain that the chair is so 
placed that it will not tip or roll. The important points to remember are: 
When possible always roll the wheel chair to an outside porch in order that 
the patient may have the benefit of a complete change of environment and 
scenery, the direct rays of the sun, pure fresh air, and freedom from the sight 
and sound of acutely ill and suffering ward neighbors. When a porch is not 
available, a sunny window or sun parlor with the best possible view should be 
selected. One should not wait for the patient to complain of weariness before 
returning him to bed, but at the end of a reasonable period or at the first sign 
of weariness he should be put back to bed. As the patient gains in strength he 
may sit up longer. If the patient is unable to stand or walk, or is heavy, 
two assistants are required to lift him; one should raise and turn the patient 
so that his legs are over the side of the bed, then, standing one on each side 
of the patient, both lifters should place their arms in the position for raising 
a patient in bed, arms of patient resting across their shoulders, and lift 
together and place him carefully in a wheel chair. When the patient is able 
he may stand beside the bed, and, with the aid of an assistant, take the few 
necessary steps to the chair, which must be carefully steadied as he is assisted 
into it. Care should be taken that all rugs and furniture are out of the way, 
that the foot rest of the wheel chair is turned up until the patient is safely 
in the chair when it may be properly adjusted; that some one holds the wheel 
chair, or that it is placed firmly against something to prevent its rolling or 
tipping over while the patient is being placed in it. 
A most important duty of an attendant in a ward is in remedying the physical 
discomforts of which patients complain. A number of the things which can be 
done to attain this end are here briefly mentioned. Lights should be properly 
shaded and the position of the patient and his bed such that his eyes will 
always be protected from the glare. All duties in the ward should be per- 
formed systematically, with no unnecessary noise or confusion, and voices 
should be quiet and gentle. Heating and ventilation should be properly regu- 
lated so that there may be uniform temperature and no drafts. Damp linen 
should be changed and profuse perspiration and body odors removed by frequent 
bathing and alcohol rubs, powdering between contiguous parts or in between 
folds of flesh, and when necessary, placing small pads or pieces of soft linen 
compresses between two adjacent skin surfaces. Excessive body temperature is 
relieved by cool sponges, by ice cap to the head, and copious fluid intake. A 296 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
restless, weary, or apprehensive patient may be reassured and calmed by quiet, 
encouraging conversation, hot or cool drinks, baths or alcohol mbs, and attention 
to voiding and bowel movements. Frequent inspection should be made of all 
appliances, splints, bandages, etc., the position changed, and any point of 
pressure massaged and given an alcohol rub at frequent intervals to aid in 
giving general comfort to the patient and to prevent bedsores. Necessary 
articles for patient’s own use, call bell, drinking water, etc., should be placed 
within easy grasp that he may suffer no strain or danger of fall by having to 
reach for them. The patient may take some measure of exercise by change 
of position, flexing and extending arms and legs, actively or passively, and by at 
times lying without a pillow and with neck muscles relaxed, slowly rolling 
head about to relieve strain of cords of neck. The strength of a weak patient 
should be saved by guarding against exertion on his part, and by moving him 
no more than is necessary for his safety and comfort. Some one should feed 
the patient who is unable to feed himself, and should be on hand when the 
tray arrives. Slight gastro-intestinal disturbances may be relieved by drinks 
of hot water, application of hot-water bag to the gastric area, or by the insertion 
of a rectal tube. Copious drinks of hot water the first thing in the morning 
often render a cathartic unnecessary. Sleeplessness may often be guarded 
against by making sure that the patient is properly nourished, is neither too hot 
nor too cold, and by making certain that he is not annoyed or frightened. 
As many of the procedures taken in the general care and comfort of the 
patient not only improve his comfort and sense of well-being but actually tend 
to support his strength and resistance they may well be designated as physical 
supportive measures. 
The first, and perhaps the most important of the supportive measures to be 
now considered, is the cleanliness of the patient, which includes his bathing 
and the care of his mouth, teeth, hair, and nails. Cleanliness is essential to 
the health of anyone but it is especially so to one who is sick or injured. In 
many cases, particularly when the patient must remain in bed or cannot help 
himself, much of the work involved in maintaining his cleanliness must be 
done by the nurse. 
For convalescent patients and those who are not very ill the care of the 
mouth and teeth should consist of the same cleansing that is required two 
or three times daily by well persons. Those who are able should do this 
themselves, the necessary articles being brought to the bedside and later 
removed. Patients who are ill with high fevers, however, require special 
attention and faithful care as, with a high temperature, there is likely to 
be an insufficiency of the secretions of the mouth which in health tend to 
keep the mouth moist and clean. If such secretions are absent for any 
length of time the gums and mucous membranes of the mouth and throat 
become irritated, the lips and tongue become dry and may crack, and only 
the greatest care will prevent the appearance of either sordes or herpes, 
which in turn may develop into serious complications. Sordes is an accumu- 
lation of food residue, dried epithelium, mucus, and bacteria. If allowed to 
accumulate it quickly becomes adherent to the teeth and often the mucous 
membrane is torn in efforts to remove the sticky, tenacious substance. 
These abrasions frequently become infected and cause complications such 
as sinusitis and mastoiditis. Herpes is an inflammatory affection of the skin 
or mucous membrane that is characterized by groups of small vesicles on 
an inflamed base. When herpes appears on the lips it is often spoken of as 
“fevei blisters” or “cold sores” and the vesicles may become infected and 
form painful ulcers. 297 
NURSING 
A fever patient’s mouth should be washed after every feeding whether 
the food is fluid or solid, both at night and during the day. The following 
are often used as mouth washes: Dobell’s solution; Liquor antisepticus, N. F. 
and Petrolatum liquidum, U. S. P., equal parts; Glycerin and lemon juice, 
equal parts; Boric acid and water, equal parts. The night attendants must 
be very careful and faithful in the care of the mouth during the night 
or the work of the previous day may be undone. 
If the tongue and lips become dry and parched relief can be afforded by 
applying an oily, soothing lotion to them. In cleansing a patient’s mouth, 
care should be taken not to tickle the back of throat; if the patient gags, stop 
at once to prevent causing nausea and vomiting. After a short time try 
again, urging the patient to relax and breathe through his mouth in panting 
fashion, which prevents gagging. If the mouth is too sore and tender for 
a toothbrush, soft linen or gauze moistened with one of the previously-named 
mouth washes and wrapped about the finger should be substituted, or cotton 
applicators used. In all procedures the hands of the attendant should be 
scrupulously clean. A patient’s mouth should be cleansed fully 10 minutes 
before feeding time and not less than 10 minutes after taking food to lessen 
the danger of vomiting. In preparing the mouth swabs, cotton will adhere 
more readily to the applicators if the ends are dipped first in water. 
The care of the mouth of a patient having false teeth is the same as 
that of other patients. The teeth, however, are removed for cleansing. At 
night they should be placed in a 2 per cent solution of boric acid. 
While attending to the mouth and teeth it is well to see that the nostrils 
are kept clean. They may be cleaned by using a small applicator wrapped 
with cotton moistened with water or oil, after which a small amount of 
petrolatum should be applied on a fresh applicator. 
A patient’s face, neck, and ears should be kept clean by washing with 
warm water at least twice a day, his hair should be thoroughly combed, or 
combed and brushed, at least once a day and trimmed as often as necessary, 
and the nails of his fingers and toes kept clean and properly cut. 
The morning toilet is the routine care given a patient before he has his 
breakfast. The object is to refresh and cleanse him after the night and 
to make him comfortable and ready for his breakfast. Bedpans and urinals 
should be passed and removed, the patient’s face and hands washed, his 
teeth brushed, and his hair combed. The bed clothes should be straightened 
and changed if necessary, the draw sheets tightened, the pillows shaken up 
and rearranged, and the bedside table or locker made ready for the breakfast 
tray. 
The evening toilet is given to all bed patients before 9:00 p. m. and should 
follow the last evening nourishment. It consists of the morning toilet routine 
plus an alcohol rub. Lights should be adjusted, extra ventilation regulated, 
extra coverings placed within reach, and fresh drinking water provided on 
the bedside locker. 
Bathing a patient is most important in maintaining his cleanliness and 
baths given for that purpose are usually spoken of as cleansing baths. The 
cleansing bath may be a tub, shower, or sponge bath, and it is not advisable 
to give them immediately after eating as bathing has a tendency to bring 
the blood to the surface of the body and away from the digestive organs whore 
it is needed. A cleansing tub or shower bath is generally given to patients 
who require little or no assistance in bathing, but may be given to others 
if ordered. A sponge or, as it is sometimes called, a bed bath, is usually 
given to patients confined to bed, or who cannot help themselves. 298 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
A cleansing bath is given for the purpose of removing the accumulation of 
skin secretions, dust, dirt, and other foreign matter in order to observe the 
patient, to aid in elimination by keeping the pores of the skin open, to produce 
a sedative effect, to prevent bed-sores by stimulating the circulation, to keep 
the body free from excess moisture and irritating accumulations, and for the 
general refreshing effect on the patient. At least one such bath daily is neces- 
sary for a very ill patient, and the usual time for giving it is in the morning. 
Special cases often require baths twice a day or oftener. Convalescent bed 
patients should be bathed at least three times a week. The cleansing bath is 
an essential and most important aid in the treatment, comfort, and recovery 
of a patient. The skin being an important excretory organ, should have its 
sweat glands kept in working order and their outlets free from obstructions. 
A factor in serious illness is the lessening of strain on the kidneys by free 
elimination through the pores of the skin. Cleansing baths make bedsores less 
likely to occur, prevent body odors by removing excess perspiration, sebaceous 
matter, etc., and, by removing causes of irritation, prevent pimples, skin rashes, 
and sores. Bathing also prevents the propagation of body vermin in that it 
enables them to be brought to notice and treated. By allowing frequent obser- 
vation of the body, bathing brings to light any signs or abnormalities of disease 
or injury. By no means least among the benefits derived from the ordinary 
cleansing bath is the comforting, soothing effect produced upon the patient. 
When a sponge, or bed bath, is given, expose the patient’s body gradually 
and as little as possible during the procedure. Each part should be dried thor- 
oughly immediately after washing, and especial care should be taken in washing 
and wiping the umbilicus, between the fingers and toes, between folds of flesh, 
and about the pubic region. While giving the bath work briskly, but smoothly 
and methodically, using long strokes with firm pressure and avoiding jerky 
dabs. Water should not be allowed to drip from the wash cloth and an exces- 
sive amount of soap should not be used. The attendant as a rule should stand 
at one side of the bed when giving a bed bath and the patient’s hands and 
feet should, if possible, be immersed while bathing the arms and legs. To keep 
the bath water at an even temperature add hot water from time to time as 
necessary and for that purpose a pitcher of hot water should be on hand. All 
necessary clean linen and equipment should be at the bedside before starting 
the bath. Unnecessarily exposing a patient when giving a bed bath is inex- 
cusable and indicative of carelessness and faulty nursing technique. 
When giving a sponge or bed bath the temperature of the room should be 
not less than 72° F., the windows closed if the weather is cool, and the bed 
screened. In cold weather the clean bed linen and pajama suit shoxild be 
placed on a warm radiator or wrapped around a hot-water bottle. The pro- 
cedure then is to place a hot-water bottle at the patient's feet if necessary, 
loosen the bed clothes and replace the covers with a bath blanket over the 
upper edge of which a face towel is folded to protect the patient’s face and 
chin from irritation. Remove one pillow, both if the patient does not object, 
and move the patient to the far side of the bed while a bath blanket is placed 
on the near side, onto which the patient is moved and which is also used to 
cover the opposite side of the bed. If the patient is very ill or helpless, the 
under blanket may be omitted and a bath towel used to protect the bed. After 
removing the pajamas wash the face, neck, and ears, washing well behind 
the ears, and in all of their grooves and crevices, and dry thoroughly. Next, 
place the bath towel under the nearest arm, making sure that the patient is 
far enough over to leave room for placing the tub under the hand which is 
immersed while bathing the arm, Wash well up into the axilla. Remove the NURSING 
299 
tub and holding the patient’s wrist by a corner of the towel held in the left 
hand, with the opposite corner of the towel in the right hand, thoroughly 
dry the axilla, arm and hand. Move the patient to the near side of the bed 
and wash the other arm and hand in like manner. Next bathe the chest and 
abdomen, going well down on the sides and over the hips, protecting the 
exposed area with the bath towel and turning the bath blanket down to the 
hip line. Dry well, replace blanket, and turn the patient on his side, then, 
laying the bath towel over the bed close up to the patient’s back, bathe the 
back with long, smooth strokes, being careful to wash well down over the hips 
and buttocks, well up into the hair line and over the shoulders. Thoroughly 
dry the back, rub with 50 per cent alcohol, and powder. Place the bath towel 
and foot tub on the foot of the bed and immerse one or both feet in the water, 
gathering the blanket between the legs to prevent exposure while washing the 
thighs and legs. Next wash the feet thoroughly, going firmly between the toes 
and across the bottom of the feet, to avoid tickling. Remove the tub, place 
the feet on the bath towel and dry well between the toes. If one corner of 
towel is held in one hand, the patient may be comfortably dried by a circular 
motion with the opposite corner of the towel in the other hand. Remember to 
take special care when washing the pubic region. When the patient is able he 
shoidd do this himself, but never fail to attend to this portion of the bath when 
he is too ill or helpless to cleanse himself. The inner folds of the umbilicus may 
be thoroughly cleaned by using absorbent cotton swabs. Clean and cut the toe 
nails and finger nails as necessary, placing a towel under the hands and feet to 
receive the clippings and prevent their falling in the bed or on the deck. As 
bathing of each part of the body is completed it should be covered to prevent 
chilling. When the bath is finished remove the lower blanket and replace the 
under bed clothes in the routine manner. Put clean pajamas on the patient, and 
replace the upper bath blanket with fresh linen and the upper bed clothes. 
Cleanse the patient’s mouth and teeth, comb and brush his hair. Remove the 
soiled linen from the ward, and remove the bath tray and put it in order. Leave 
the bed and surroundings in order, and the call bell within reach. Encourage the 
patient to rest and sleep after his bath. 
The care of the back is important in safeguarding the patient in bed. At 
least twice a day, after the bath in the morning and as a part of the evening 
toilet, the backs of all strictly bed patients should be carefully examined for 
pressure spots, rubbed well with 50 per cent alcohol, and carefully powdered. 
All bony prominences require the same treatment. The object of this is to 
stimulate the circulation where, from pressure or inaction, the blood supply has 
been lessened; to toughen the skin and thus make it less sensitive to chafing 
and abrasions; to comfort the patient by soothing the nerves and stimulating 
the blood vessels, and thus lessen the danger of bedsores. For the comfort 
of the patient and for his own well-being, the attendant’s hands should be kept 
in the best possible condition. They should be clean always, the nails short, 
clean, and free from rough edges. Hangnails and abrasions render an attend- 
ant susceptible to infection from, a patient, and cause pain and smarting when 
alcohol is applied. Care should be taken not to pinch or pull the skin of a 
patient. 
Bedsores or pressure spots are local ulcerating conditions usually accom- 
panied by death of the tissues. These conditions frequently result from con- 
tinuous pressure on one spot caused by the patient staying too long in one 
position; by interference with circulation from a too tight bandage or other 
appliance; and by the heat and excessive moisture of two skin surfaces which 
are allowed to be too close together without proper padding and powder. The 
154294°—39 20 300 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
conditions are often caused by the chafing of improperly applied splints, casts, 
and extension or suspension apparatus. The predisposing causes of bedsores 
and pressure spots are faulty nutrition, lowered vitality, irritating chemical 
agents, and body discharges as in septic cases; involuntary urination and defe- 
cation ; pimples or breaks in the skin; wrinkles and crumbs in the bed; exces- 
sive moisture of skin; damp, or soiled linen; and infrequent baths and im- 
proper bodily care. 
The best treatment for bedsores is to prevent them. Their presence almost 
invariably denotes lack of care and watchfulness on the part of those responsi- 
ble for the patient’s welfare. To avoid and prevent bedsores, pressure must 
be relieved by the use of rubber or cotton rings, by frequent turning of the 
patient and changing his position when possible, by stimulating the circulation 
by frequent baths, and by massage and alcohol rubs especially about the points 
of pressure. The use of the air or water mattress keeps the body from becom- 
ing overheated and from suffering through undue pressure. In cases of severe 
fracture, as that of the pelvis or femur, it is necessary to watch continuously 
all points of pressure, to massage them often, and relieve pressure as much 
as possible even if for but a short period. The bed and body must be kept 
scrupulously clean and dry, and the bed free from crumbs and wrinkles. 
Pimples and abrasions must be attended to promptly and carefully. In cases 
of diarrhoea, or incontinence of urine, a pad should be kept constantly under 
the patient and it should be changed whenever soiled; parts should be 
cleansed, dried, and powdered after each evacuation of the bowel or bladder, 
and the pad, linen, and body kept dry and clean. A urinal, or rubber urinal, 
may be comfortably adjusted to receive the urine and protect the bed, which, 
to avoid accidents, should be watched closely and changed frequently. 
The appearance of bedsores usually reflects very badly on the nursing care 
but sometimes even the best of nursing care cannot prevent them. This is 
particularly true in cases where patients are very thin and emaciated, have 
been bed-ridden for long periods of time, or have fractures in which splints 
or casts have been applied. Should bedsores develop only the areas surround- 
ing them may be massaged with alcohol. The treatment of bedsores consists 
of keeping them clean, applying soothing and stimulating ointments, and cov- 
ering them with protective dressings, or such other treatment as may be 
ordered by a medical officer. 
In the prevention and treatment of bedsores hollow rubber rings of various 
shapes and sizes, commonly called air rings, when inflated to a sufficient degree, 
are often used to afford protection and support to various parts of the body, 
particularly to the pressure points. When filled too full with air they loose 
their resiliency, are hard and uncomfortable, and too greatly elevate the parts, 
while if inflated too little they lessen the protection from pressure, and are 
too flabby for support. 
If air rings of the proper size are not available, rings of any desired size 
may be made of absorbent cotton wound about with gauze bandage. Care 
must be taken that these rings are made firm enough for support, but not of 
such a degree as to cause pressure. The hole in the ring should be large 
enough to surround the point of pressure, but not large enough to allow the 
point (for instance, the heel) to slip completely through, and so fail to relieve 
the pressure. The purpose of rings is to eliminate pressure on bony promi- 
nences, such as hips, elbows, ankles, and the coccyx. They are also used be- 
tween the knees and under the heels of patients in bed for long periods, and 
of those who must remain in one position for a long time as in fracture cases. 
Rings must be inspected frequently and their position changed when necessary. NURSING 
301 
In the case of cotton rings a new one should replace the original one when it 
becomes flat, soiled, or hard. 
Among the various measures tending to physically support a patient none, 
perhaps, is of more importance than the food and water he receives, and 
special care must be taken to see that they receive the proper kinds and 
quantities. From the average patient’s point of view nothing probably makes 
more difference to him than his food and drink; what it is, how it is cooked, 
and how it is served, and to the convalescent patient with a returning appetite 
his three meals usually are the events of his day. 
Illness tends to make a patient very fastidious and notional in regard to 
food. He may like some things to-day and to-morrow dislike them, or vice versa. 
The feeding of a patient must not be taken lightly because food is an important 
item in his treatment and return to health. Patients who are ill must have 
nourishment in sufficient quantity, and of the type and quality best suited to 
his condition and ability to assimilate, in order to have strength to resist the 
inroads of disease. Liquid nourishment should be varied; the time of serving 
arranged with due regard to food value. Merely refreshing drinks should be 
given between servings of the more nourishing ones. Helpless and very ill 
patients must be served without effort on their part, drinking tubes, special 
feeding cups, etc., being used to avoid raising the head, or causing any unneces- 
sary strain. Foods which the patient dislikes but which have been ordered 
for him and are essential for his nourishment may often be disguised and 
given to him without his realizing it. For instance, an egg well beaten may be 
served in orange juice thoroughly iced, instead of in milk; milk in a cocoa or 
chocolate shake when the patient does not care for the milk alone; cream in 
ginger ale rather than as plain cream. 
Prompt serving, sufficient quantity of food, tempting variety, and attractive 
arrangement of his food are strong factors in making a patient contented and 
happy. Cheerfully serving second helpings if desired by the patient, unless he 
is on a restricted diet, is helpful. In cases of restricted diet arrangement of 
the food so that it is as attractive as possible is an asset. An attendant not 
thoroughly familiar with the patients should make sure, by asking a patient 
his name, that the tray he serves is meant for that particular patient. Unneces- 
sary waste may be eliminated and economy maintained by catering to the 
patient’s desires to as reasonable a degree as is permitted by the hospital 
regulations and routine. This is accomplished by serving an attractive tray 
having the food well cooked and properly seasoned; by serving at regular 
Intervals and on time; serving the food temptingly arranged on clean dishes 
on a clean tray and in moderate quantities, and serving hot foods hot, and 
cold foods cold. In serving food care should be taken that it is not “splashed” 
over the plate or left hanging over the edge to later drop in the tray cover. 
If the soup is slopped over onto the tray, or coffee or tea into a saucer, the 
tray should be returned to the diet kitchen and the tray cover changed. A 
sloppy, messy tray should never be served to any patient. When a patient is 
taking liquids only, care should be taken that they are served in a manner 
similar to other diets; the glass, cup, or bowl should be placed on a saucer or 
plate and served on a small tray, properly prepared with a clean cover and 
having the necessary silver, also sugar or salt as needed. All trays should be 
removed promptly after the patient has finished, but he should not be hurried 
in eating his food. The importance of thorough mastication should be empha- 
sized. A note should be made on the clinical notes whether the patient’s 
appetite is normal or not, and in cases so designated accurate record should 
be kept of all foods and liquids taken by the patient. 302 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Before food is served in a ward there are a number of things that should 
be attended to in preparation of patients to receive their food. Necessary 
urinals and bedpans should be passed one-half hour to an hour before tray 
time and promptly removed after use so that none may be present during the 
meal hour and the ward free of unpleasant odors. Bed clothes should be 
smoothed and tightened and pillows arranged for the patient’s comfort and 
support while eating. Unnecessary articles should be removed from the 
bedside locker or table to facilitate placing of the tray and if the sputum cup 
must remain it should be clean. A patient with persistent cough and frequent 
expectoration should be screened from the other patients, at least during meal 
time, and where possible should be in a room by himself or in one with similar 
cases. The patients’ diet list should be posted daily and be correct and up 
to date in order that an attendant unfamiliar with the ward and the patients 
may serve to the right patient the right food, in the right amount, on the right 
tray, in the right way, and at the right time. Some one should have been 
previously designated to feed a patient who is unable to do so himself, and 
should be ready and waiting when the tray arrives, so that there may be no 
delay in serving. Delay in serving, with food in sight, Irritates the patient, 
sometimes to the point of refusing to eat, and also results in cold food. 
When, for various reasons, the digestive tract is not able to perform its 
normal function in the process of digestion, or because of unconsciousness, re- 
fusal to eat, or conditions where swallowing is impossible, food cannot be ad- 
ministered by mouth, it is necessary to resort to other methods of feeding. 
These methods are discussed in the chapter on Dietetics and Messing for the 
Sick. 
The elimination of body discharges or waste products not only is a physical 
supportive measure but contributes greatly to the comfort of a patient. Body 
discharges are eliminated principally through the intestine, the urinary system, 
and the skin. Ip sickness as in health it is desirable that elimination through 
the intestine, known as defsecation, take place at regular times, especially as it 
tends to largely prevent the constipation which often results from the inac- 
tivity and disturbed routine accompanying illness. Some patients can be al- 
lowed toilet privileges but those who are not must be assisted by the attendant, 
and use of the bed-pan is required for many such cases. The bed-pan is a utensil 
devised to protect the patient from unnecessary exertion, exposure, and em- 
barrassment ; to prevent unnecessary discomfort to other patients in the ward; 
to prevent soiling of the bed linen and permeation of it with Decal odors; to 
avoid chilling of the patient, and to assure cleanliness of the patient’s body. The 
method of handling is to screen the patient during the use of the bedpan, 
warm the pan by running hot water over it, dry it and line with a couple of 
layers of toilet paper, then cover and carry it, together with a roll of toilet 
paper, to the bedside. If the patient is able, his head and shoulders may be 
raised slightly and supported, he should then flex his knees somewhat, while 
the attendant, supporting his back with his left hand, slips the pan under the 
buttocks with his right, and carefully adjusts it for the patient’s comfort, and 
the proper protection of the bed. If necessary for the comfort of the patient 
and protection of the back in cases of extreme emaciation or tender skin, a pad 
of absorbent cotton should be placed on the back shelf of the pan. After the 
patient has used the pan cleanse him thoroughly, washing the region, if neces- 
sary, and drying it. In removing the pan, place one hand under the sacrum 
for support, raise the buttocks gently, and slip the pan out, taking special care 
to see that the skin of the back is not rubbed or injured in the procedure. Im- 
mediately cover the pan and take it from the ward. Rearrange the patient’s NURSING 
303 
pajamas and the bed linen and air the room or ward. Before emptying the 
bedpan make an inspection of its contents for any abnormal appearance or 
unusual constituents. After emptying the pan clean it thoroughly with cold 
water, using a brush to remove all particles of faeces, then scald or boil it, dry 
and place in rack. Never take a soiled, improperly washed bedpan to the bed- 
side. Guard against injury to the patient’s back both in giving and in remov- 
ing the pan, also against soiling bed clothes and pajamas. 
Body discharges are eliminated through the urinary system by means of 
urination, or the voiding of urine, and ordinarily occurs when the patient 
responds to the desire to urinate, or void. For bed patients the urinal usually 
is used, even though a bed-pan is also being used. For patients who are very 
weak, ill, or unable to help themselves it is necessary to adjust the urinal. To 
avoid accident it should be removed promptly, care being taken not to tip 
it and spill its contents in the bed, thereby causing added discomfort to the 
patient and unnecessary labor and loss of time by the attendant. 
After a urinal has been used and the contents inspected it should be 
emptied at once and rinsed well first with cold water and then with hot water. 
Patients using a urinal should be screened to provide privacy and prevent 
embarrassment. 
Proper covers for both bed-pans and urinals are provided, and for obvious 
reasons always should be used. At least once a day bed-pans and urinals 
should be boiled for 10 or 15 minutes in the bed-pan sterilizer, and if usedj 
for more than one patient they should be sterilized after each use. Those 
used for patients with infectious diseases should be properly marked, sterilized 
after use, and kept apart from others. Absolute cleanliness from the use of 
soap, water, and a scrubbing brush, and occasional thorough soaking in strong 
soap suds, is a far surer and more hygienic method of caring for bed-pans and 
urinals than is the use of strong disinfectants. 
The elimination taking place through the skin, known as perspiration, usually 
“takes care of itself” provided the skin is properly cleansed and the pores kept 
open, and the temperature and humidity of a room properly regulated. 
Rest, sleep, and exercise are the last of the physical supportive measures 
to be considered. Plenty of rest and sleep are necessary for the majority 
of all patients and many things may be done by an attendant to help the patient 
in obtaining them. By rest is meant the complete relaxation of the patient 
in which his body is limp, without tension, and is supported entirely by the bed 
or chair without any physical effort of his own. Mental relaxation follows 
complete physical relaxation and the patient becomes calm and peaceful, at 
which time the greatest benefit from his treatment is derived and healing 
processes work best. To obtain such relaxation a bed must be comfortable, 
with pillows and linen arranged with a view to provide all possible comfort, 
and chairs, when used, should be of a design suitable for relaxation and large 
enough to permit arranging pillows and blankets to meet the patient’s wishes. 
To change a patient’s position relieves pressure on bony prominences and 
muscle strain, and improves circulation, all of which are conducive of comfort 
and relaxation is easier. It may be necessary to make such changes every 
2 or 3 hours and the use of pillows, sandbags, etc., may be required to support 
and maintain the patient in the position desired and avoid strain and fatigue. 
It is desirable that a patient’s shoulders should not sag forward, that his 
arms should not drag on the shoulder or lie heavily against the body, that 
the abdomen be flat, and that the chest allow plenty of room for expansion of 
the lungs. 304 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
To further the restful relaxation of a patient efforts should be made to relieve 
any physical cause of restlessness and to remove any cause for worry, as both 
restlessness and worry are conditions inimical to the well-being of anyone, sick 
or well. 
Sleep is considered to be a condition in which all the organs of the body 
generally relax, rest, and recuperate. During sleep all voluntary activity both of 
body and mind ceases and repair processes proceed unhindered. Sleep is an 
important factor in the recovery of the sick or injured and is especially beneficial 
when it is unbroken and dreamless. Great care must be exercised to avoid 
disturbing or awakening a patient, as it is often difficult for them to return to 
sleep. Turning on lights, bumping the bed or touching the patient, whispering, 
and all noise should be avoided as much as possible. Sleep often follows com- 
plete relaxation, even in the daytime, and the evening toilet generally induces 
sleep. 
Exercise, in judicious amounts and properly guided, plays a part in the 
recovery of patients that must be considered. It is particularly worth while 
for patients who are well on the way to recovery. Even with bed patients 
exercise is possible and desirable if it does not interfere with treatment. The 
arms, legs, and trunk can be moved in ways that will stimulate circulation, 
encourage elimination, and help to keep up a patient’s strength. As the patient’s 
condition Improves the kind of exercise he takes changes and the amount in- 
creases until it is no longer necessary to guide or observe him. 
Administration of medicines and of therapeutic treatments. 
As has been explained in Materia Medica the substances used in the treatment 
of disease generally are spoken of as medicines. In addition to the internal 
and local administration of medicines, agents other than medicines, or drugs 
as they are usually called, are employed in the treatment of disease for their 
therapeutic effects. 
The administration of medicines and therapeutic treatments is a most im- 
portant part of nursing and is a responsibility fraught with great dangers. 
Whoever is assigned to the task must thoroughly realize that responsibility and 
be absolutely honest and trustworthy. 
Those responsible for the administration of medicines should be familiar with 
the normal physiological action of drugs commonly used so that they may be 
able to quickly recognize any unusual effects following their administration, as 
some individuals have an idiosyncrasy for certain drugs. They should know: 
(a) The average dose and the minimum and maximum dose of ordinary drugs, 
especially of powerful or poisonous ones; (6) The antidotes of poisons and 
the first-aid treatment following their introduction, which makes possible the 
speedy assembling of required means of treatment and the prompt administra- 
tion of the remedy; (c) The ordinary cumulative drugs, the usual length of 
time they are taken continuously, and the symptoms indicating systemic accu- 
mulation; (d) The ordinary symptoms manifested by a drug addict; (e) The 
importance of having a definite place for each drug, so that no time will be 
lost in locating it; and if) The symbols and abbreviations used in writing 
prescriptions and orders. 
It is very helpful in preventing mistakes if those who give medicines learn 
an old adage called the “Five Rights” which is; “Give the right dose of the 
right medicine to the right patient in the right way at the right time.” 
The following are important points to be always remembered by those giving 
medicines: 
1. Be accurate. By this is meant that one should; (a) Think of nothing else 
while giving medications; (6) Read the label carefully three times before NURSING 
305 
giving any medicine—before taking tbe bottle from tbe sbelf, before and after 
pouring the medicine, and before returning the bottle to the shelf; (c) Be 
sure that the order is clearly understood; (d) Never pour medicines in an 
obscure light; (e) Give drops when drops are ordered, minims when minims 
are ordered; (f) Never give medicine from an unmarked bottle or an illegibly 
labeled container, or leave a dose standing unmarked; (g) Pour the medicines 
which are to be given and give the medicines which are poured; (h) Never 
allow one patient to carry medicine to another; and (i) Never record giving a 
medicine before it is given. 
2. Never combine medicines or give different medicines at the same time 
without an order from the medical officer. 
3. Never give a pill or powder to a delirious, unconscious, or very ill patient 
but dissolve them in a little water and drop far back on the tongue, or give as 
otherwise directed. 
4. Acids and medicines containing iron should first be well diluted to prevent 
irritation of the mucous membranes and then given through a glass tube or 
a straw to protect the teeth. 
5. Give syrupy cough medicines undiluted because dilution lessens their 
soothing effect. 
6. Make a disagreeable medicine as palatable as possible. Castor oil may 
be given in various combinations to disguise its taste; for example, rinse a 
glass with orange or lemon juice, leaving an ounce in the bottom of the glass, 
pour in the castor oil, then more orange juice; add a piece of ice to chill 
the mixture and instruct the patient to hold his nostrils together and take 
dose far back in the throat. A small amount of baking soda stirred into this 
mixture makes it more easy to take by some patients. 
7. Saline cathartics given to lessen oedema should be given in as small 
a quantity of water as is possible, but when given as a purgative should be 
given with plenty of water. 
8. Liquid medicines containing a precipitate or prepared by a combination 
of drugs should be shaken well before being poured. The medicine list should 
be compared daily with the doctor’s order book and all necessary changes 
made. This list should be absolutely accurate and always up to date. If a 
verbal order or order by telephone is received, repeat it before leaving the 
phone, record it as soon as possible, and have the medical officer sign it on 
his first visit to the ward. 
The proper care of the medicine locker, which includes the cleanliness and 
arrangement of the contents, is important. The locker must be cleaned at 
regular intervals and in cleaning it is best to start at the top and work down. 
Only a few bottles should be removed at a time so that they may be quickly 
replaced if the locker has to be locked before its cleaning is finished. Each 
bottle should be wiped off before returning it to the shelf, paying particular 
attention to the neck and rim, and being careful not to deface the label. Each 
bottle should be properly stoppered as many drugs are combined with or 
dissolved in volatile substances and will become weaker or stronger if allowed 
to remain uncorked. 
Poisons and drugs for external use should be kept on a separate shelf or in 
a separate compartment of the medicine locker. Opiates, habit-forming drugs, 
and alcoholic stimulants should not ordinarily be kept in the ward medicine 
locker, but in a special place reserved for them. A careful record of amounts 
received and amounts administered must be kept, and when narcotics are 
given they should be entered immediately on the patient’s chart, in the ward 
record book, and in the narcotic book. Drugs used for eye treatments should 306 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
be arranged separately from those used by mouth or externally. XVever put 
drugs used externally or for disinfecting purposes in a medicine glass. Medi- 
cines and preparations injured by heat, such as serums, vaccines, insulin, cod- 
liver oil, and suppositories, should be kept in the ice box or some compart- 
ment in the refrigerator reserved for their storage. Medicines injured by the 
light should be kept in dark bottles, enclosed in outer cover, or kept in a dark 
place. Emergency stimulants such as epinephrine (adrenalin chloride), cam- 
phorated oil, amyl nitrite, and aromatic spirits of ammonia should be in a prom- 
inent, easily accessible plaqe in the medicine locker. The location of these emer- 
gency stimulants should be the same always so that no time will be lost in 
obtaining them when needed. 
The person responsible for medications should make a note when supplies 
of drags need replenishing and should plan always to have on hand a quantity 
sufficient for 24 hours and for over a week-end. One should never wait until 
the supply is completely exhausted before ordering more. Drugs to be given 
in small doses should be ordered in small amounts, and when a patient having 
a special prescription is sent to duty or otherwise discharged the container 
should be returned to the pharmacy unless other patients are receiving the 
same medicine. 
Bottles of uniform shape and size should be provided for the medicine 
locker. Hough blue bottles with rough glass stoppers are required to be used in 
the Navy as poison containers. Dark brown bottles are provided for drugs in- 
jured by light. Glass stoppers should be used in all bottles containing drugs which 
disintegrate cork stoppers. Bottle labels should be kept clean and should 
only be changed and replaced in the dispensary. All bottles containing poisons 
should be marked with the regulation red “Poison label.” The size of the 
label may vary with the size of the bottle, but must always be large enough 
for easy reading. All medicines containing a precipitate and those formed 
by a combination of drugs should be in bottles labeled “Shake well before 
using.” Medicines should be poured from the side of the bottle opposite the 
label, and the neck and rim wiped off immediately after pouring. 
The “medicine tray” should contain a pitcher for cold or iced water, med- 
icine glasses, glass mixing rod, spoon, pieces of gauze, and medicine tickets 
in their proper receptacle. Each patient should have his own drinking glass 
and, where necessary, his own drinking tube. Medicine glasses, pipettes, 
measuring glasses, drinking tubes, etc., must be washed thoroughly after 
use and boiled or disinfected when necessary. A medicine list should be 
prepared and hung or posted in or close beside the medicine locker, with 
each name, medication, dose, time due, and location of patient written or 
printed plainly upon it. “Medicine Tickets” made of squares or oblongs 
of cardboard on which are inscribed the patient’s name, the medicine, dose, 
and time due are sometimes used as a means of insurance that the right 
patient gets the right dose of the right medicine at the right time. These 
tickets may cover the tops of medicine glasses or may be attached to them. 
When not in use they are kept in trays which are usually divided into 
compartments representing the different hours. When ready to prepare the 
medicines for administration, all tickets designating the same hour should be 
selected and all those specifying the same medicine grouped together. 
To prevent accidents and deliberate meddling it is necessary to keep the 
medicine locker locked at all times except when access to its contents is 
necessary. The keys to the medicine locker must be carried by the person 
in charge of a ward or in their absence by the next junior. The locker should 
be opened at weekly inspection only when a request is made by the command- NURSING 
307 
mg officer, and should be locked immediately following his inspection, in 
his presence. 
In giving medication by mouth, the following procedure should be strictly 
adhered to: Take the medicine glass in the left hand, read the label on 
the medicine bottle, and, taking the bottle from the shelf, shake its contents. 
Take the cork between the third and fourth fingers of the left hand and 
remove it. Read the label again. Raise the glass until the mark gauging 
the amount to be given is on a level with the eyes and pour into it the 
required amount. If more than one patient is to receive the same medicine, 
pour the required number of doses before wiping the bottle, recorking it and 
replacing it in cabinet. Read the label again as bottle is returned to shelf 
to make sure that correct medicine has been poured. Add iced water or 
small portions of ice to the medicine and place the medicine tickets on the 
glasses. Before giving the medicine to the patient read again the name on the 
medicine card so that there may be absolutely no chance for a mistake. 
Medication by inhalation is given in the form of moist inhalations when 
the local effect of the medicine in relieving inflammation is desired, as in 
laryngitis, bronchitis, etc., or in the form of dry or gaseous inhalations when 
the systemic effect of the medicine is desired, as amyl nitrite, oxygen, ether, 
chloroform, etc. In moist inhalations the medicine used is contained in the 
steam vapor arising from boiling water and may be given with an apparatus so 
arranged that the exit for the medicated vapors is in close proximity to the 
patient’s nos© and mouth. The steam atomizer is a special apparatus for this 
purpose. In the absence of the steam atomizer, drugs to be given by inhala- 
tion may be put in a pitcher of boiling water, covered with a heavy paper cone 
or bag with an opening at the top of sufficient size to permit free escape of the 
medicated vapors but small enough to keep steam concentrated in volume 
about the nose and mouth which are placed close to the opening. A heavy 
hath towel thrown over the pitcher and patient’s head make an excellent substi- 
tute for the atomizer. For continuous inhalations of steam a croup tent may be 
constructed. One of the most common medicines given by dry inhalation is 
oxygen, a colorless and odorless gas. It is confined under considerable pressure 
in large metal containers. The simplest method of giving oxygen is by means 
of an apparatus which provides for its passage through water before 
being inhaled. The force of its flow is regulated by a wrench or key 
attached to the tank and is measured by a gauge with dial'. In the absence 
of the gauge the activity of the bubbles in the water gives a very good idea of 
amount of pressure. The rate of flow should be regulated before holding funnel 
over patient’s nose and mouth. The stream should be slow and steady and 
the funnel not close enough to patient to prevent free escape of exhalations 
before the patient inhales the oxygen. There are special and more complicated 
methods of administering oxygen. As oxygen is expensive the valve on the 
tank must be securely closed after use to prevent waste and loss. Tanks 
emptied should be tagged at once so that they may be replaced with full ones 
and an adequate amount kept on hand for emergencies. 
Oxygen tents are of different types and the person responsible for the care 
of 'a patient in the tent must be sure to know how to use the apparatus. The 
medical officer’s orders as to temperature, humidity, and rate of oxygen flow 
must be strictly followed. Never run an oxygen tent until properly instructed 
by an authorized person. 
Subcutaneous medication is the hypodermic injection of drugs or their easily 
soluble preparations into the subcutaneous tissue of the body. This form of 
administering drugs is adopted when prompt action is required; when medicine 308 
HANDBOOK OF THE HOSPITAL CDRPS, U. S. NAVY 
cannot be taken by mouth; when a drug is undesirably acted upon by the 
gastric juices; and when the effect of the drug is desired in the area of injee 
tion, for instance, a local anaesthetic. When using this method it is important 
to remember the following: To avoid injury to nerves, not to make injection 
along the course of a blood vessel (the outer surfaces of the arms and legs 
are most commonly chosen as sites for subcutaneous injection), and to pre- 
vent infection by aseptic technique, by using a smooth, sharp needle, and by 
careful handling of the flesh to avoid bruising, i e., hold the flesh firmly; do 
not pinch. Guard against breaking off the needle in the body surface by 
explaining the procedure to the patient and reassuring him before starting, by 
using a perfect needle, and by having adequate assistance when giving to a 
delirious or highly nervous patient. A hypodermic injection should be given 
as quickly as safety will allow (a quick, sure stab is less likely to bend or 
break the needle than a slow push, and is easier for the patient, being less 
painful and more quickly over). Immediately report any mishap. The “hypo- 
dermic tray” should contain the following articles: Alcohol lamp filled with 
alcohol, 95 per cent; matches; a spoon with handle so bent that the bowl rests 
evenly when it is placed on the table; alcohol, 70 per cent; sterile cotton or 
gauze pledgets; sterile forceps in jar of 5 per cent lysol; a flask of sterile 
water; the drug or tablet necessary for the injection; a hypodermic syringe 
and needles; and a receptacle for waste. The procedure in preparation of the 
syringe and needle should be as follows: Scrub the hands thoroughly, inspect 
syringe and needles to be sure the syringe does not leak and that the needle is 
neither bent, blunt, rusty, nor plugged. Replace the wire in the Inspected 
needle, place the needle in the spoon, cover it with water, and boil over the 
flame of the lamp for one minute. Take a sterile pledget from the jar with 
forceps and put it on glass. Disinfect the inside of the syringe by drawing it 
full of alcohol and expelling same five or six times. Moisten sterile pledget 
with alcohol; remove needle from spoon and wire from needle and place the 
needle on the sterile pledget. Rinse the syringe by drawing up sterile water 
from spoon and expelling it; then draw into the syringe sufficient sterile water 
to dissolve the tablet, discarding the remainder left in spoon. Dissolve the 
tablet in the spoon with the water from syringe, making sure that every 
particle is dissolved. A tablet not readily dissolved, as caffeine sodium ben- 
zoate, makes it necessary to hold the spoon over flame, until the tablet is dis- 
solved. In such a case a larger quantity of water is needed, 20 to 30 minims 
instead of 15 to 20 minims. When the tablet is thoroughly dissolved, draw 
all solution into the syringe; fit the needle securely onto the syringe; expel air 
from syringe and needle by holding it upright and exerting slight pressure on 
the piston until a few drops of solution flow through the needle; hold syringe 
on a level so that the piston will not fall back, and keep the needle covered 
with alcohol pledget. 
The site chosen for a hypodermic injection should be thoroughly cleansed 
with alcohol just before giving the injection. Then, holding the syringe firmly 
between the thumb and first two fingers of the right hand take up a fold of 
flesh with the other hand, holding it so that a firm, smooth surface is exposed. 
Into this insert the needle with a quick, firm pressure. Do not touch the piston 
while inserting the needle. Withdraw the needle slightly, readjust the fingers, 
and inject the solution. Do not move the needle while doing this. Withdraw 
the needle quickly after the solution has been injected, hold an alcohol sponge 
closely over the point of injection for an instant, then gently massage the 
distended tissue until absorption is well established. Rinse out the needle and 
syringe first with water and then with alcohol. Inserting, drawing out, and NURSING 
309 
wiping the “hypo” wire, repeating as often as necessary, is a sure way to dry 
out the needle; and this is very essential to prevent a small rust spot clogging 
the bore or blunting the end of the needle. Waste ether is excellent for drying 
out the bore of a needle. 
When giving serums or insulin, which come in special rubber-stoppered 
bottles, the head and neck of the bottle should first be wnped off with iodine 
and alcohol. Having a sterile hypodermic syringe and needle ready, with the 
piston partly withdrawn, insert the needle through the rubber covering, force 
a small amount of air into the container by pushing in the piston, and then 
withdraw the required amount of solution. 
Intramuscular medication is the injection of drugs or their easily soluble 
preparations into the skeletal muscles. As absorption takes place more 
readily in the deeper tissues, intramuscular injections are given when the 
drugs to be used are not easily absorbed, when a drug is especially irritating 
to the tissues just below the skin, or when a lai’ge quantity of solution is to be 
introduced. The gluteal, lumbar, and deltoid muscles are sites frequently 
chosen for these injections. The equipment for this method is the same as 
for the hypodermic tray plus iodine, 5 per cent, and a larger syringe and 
needle. In preparing for an intramuscular injection, paint the site with 
iodine, 5 per cent. Boil the needles, and boil the syringe, or immerse it in 70 
per cent alcohol for half an hour. (An all-glass syringe may be boiled, but 
one which has metal attachments cemented to the glass cylinder is ruined 
by boiling.) The skin where medication is to be given must be held tense by 
pressing in opposite directions with the thumb and fingers of left hand. Insert 
the needle almost perpendicularly, quickly, and steadily into the muscle. Sub- 
sequent procedure- is the same as for subcutaneous injection, except that the 
somewhat larger point of injection is sealed with collodion. 
Medication by intravenous injection (sometimes called intravascular injec- 
tion), is the introduction of a solution of a drug or an easily soluble preparation 
of a drug directly into a vein. A vein at or near the bend of the elbow is 
usually selected for intravenous injection, the median basilic or median cephalic 
being most commonly used. Occasionally the vein chosen will be found deeply 
embedded in the surrounding tissues and it is then necessary to cut through 
the skin and dissect out the vein. If such dissection is required the site 
should be thoroughly cleansed and sterilized and only sterile instruments used. 
Intravenous injections are always given by or under the direct supervision 
of a medical officer aided by trained assistants. Two of the drugs with the 
intravenous injection of which a hospital corpsman will most frequently come 
in contact are arsphenamine and neo-arsphenamine, the solutions of which are 
usually prepared Dy trained technicians under the supervision of a medical 
officer. On the day when a patient is to receive intravenous medication no 
food should be given to him in the morning. 
It should be remembered the transfusion of blood is by intravenous injection. 
Hypodermoclysis (sometimes called hypodermatoclysis) is the introduction 
of large quantities of fluids into the subcutaneous tissues when rapid absorp- 
tion is desired. An increased flow from the kidneys usually can be noted 
within 15 minutes. It is used to replace body fluids that have been lost 
through excessive purging, as in cholera, or through haemorrhage, and to supply 
fluid to tissues which are suffering from a lack of fluid and the body with 
liquid when liquid cannot be taken into the stomach because of vomiting, 
gastric ulcer, or surgical operation. Its use in the treatment of burns, intes- 
tinal obstruction, and surgical shock is frequently of great value. 310 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The solution most frequently given by hypodermoclysis is physiological salt 
solution, and occasionally dextrose, with or without saline solution, is given 
in this way. The temperature of the solution when given should be about 
100° F. and the amount given at one time usually varies from 500 cc to 
1,000 cc. 
The site chosen for hypodermoclysis in most cases is the loose flesh under 
the breasts, the shoulder blades, or in the abdomen, and should be prepared 
with the same aseptic care and precaution as if for a surgical operation. 
Excessive accumulation of fluid in the tissues should be avoided by regula- 
tion of the rate of flow and by gentle massage in the region of the introduc- 
tion. Absorption may be facilitated and swelling and pain largely prevented 
by the use of hot fomentations over the area. 
When a large amount of solution is to be given, when absorption is slow, 
or it is desired not to have too much solution introduced in one place, 2 needles 
and 2 lengths of tubing connected by a glass Y-tube to the single length of 
tubing attached to the irrigator jar may be used, each needle being inserted 
in a separate site. 
Proctoclysis, also known as Murphy drip and rectal seepage, is the slow, 
continuous, drop-by-drop instillation of a liquid into the rectum for the pur- 
pose of being absorbed. The liquid so instilled may be physiological salt 
solution, 5 per cent dextrose solution, 2 per cent sodium bicarbonate solution, 
or plain sterile or distilled water. When saline solution is used in procto- 
clysis it provides fluid to replace body fluids lost through haemorrhage, pro- 
fuse perspiration, diarrhoea, excessive vomiting, or lack of fluid intake and 
acts as a stimulant in cases of shock. Solution of dextrose provides a small 
amount of nourishment; solution of sodium bicarbonate helps to prevent and 
aids in the treatment of acidosis. The use of water dilutes toxins, aids in the 
elimination of infectious material, helps flush the kidneys, and supplies the 
body with fluids, being especially valuable in relieving the excessive thirst 
accompanying many cases of peritonitis. 
In giving proctoclysis a special apparatus so arranged that the inflow of 
fluid may be regulated to any required number of drops per minute should be 
used. Regulation of the flow may be accomplished by use of the Murphy bulb 
and a screw clamp or guage or a practical substitute therefor, or by elevating 
the irrigating jar to the height where the proper flow is obtained by gravity. 
The latter method is especially useful when the special apparatus is not 
obtainable. 
The proper temperature for the fluid in proctoclysis is 110° F., and in order 
to maintain that temperature it is necessary to have some means of heating 
the fluid just before it enters the rectum. A metal hot-water bottle with a 
hollow channel for the tubing running diagonally through its center has been 
devised for this purpose, but it is expensive and not ordinarily available. A 
satisfactory substitute is an ordinary rubber hot-water bottle which is filled 
only to the point that will allow it to be folded over on itself with the tubing 
passing between the folds. As either hot-water bottle must be placed in the 
bed near the patient it must be completely and adequately covered to avoid 
burning the patient and there must be a frequent inspection made for the 
same reason. 
For proctoclysis it is necessary that the following equipment should always 
be in readiness: Irrigating jar or can with rubber tubing, gauge, Murphy-drip 
bulb (if available) for observation of drops, glass Y-tube connected with 2 
lengths of rubber tubing (one for inflow of solution, the other for the escape 
of gas and back flow of solution), a single length of tubing connected with a NURSING 
311 
catheter by a glass connecting tube; a standard for the irrigating can, or jar; 
a solution thermometer; a large cotton pad to be placed under the buttocks of 
the patient for protection of the bed; a towel to cover the irrigating can; a 
lubricant; a pitcher of solution, properly prepared and of the proper tempera- 
ture ; a kidney basin; and some appliance for maintaining the proper tempera- 
ture of the solution. (See under Enemata for the preparation of the patient 
and the bed and remember that a cleansing enema should first be given). 
When giving proctoclysis be sure that the tubing is of the proper length, as 
too long tubing allows sagging and accumulation of fluid while too short causes 
tension of the tubing and danger of its slipping out of the rectum. Regulate 
the drops to the required rate per minute, place the heating appliance in the 
bed in such a position and so protected that it cannot burn the patient and the 
solution will not cool too quickly. Have sufficient tubing extending beyond the 
heating appliance to allow for insertion in the rectum without tension. The 
attendant should remain with the patient long enough to be certain that the 
catheter is securely placed and that no pressure from gas, faeces, or constriction 
is forcing it out; also to make sure that there are no leaking connections and 
no back flow from the rectum into the bed. The amount of solution in the can 
when the flow is started should be noted and recorded, and the time. Cover 
the irrigating can with a towel, and inspect the contents of the can from time 
to time and replenish as necessary, making a record each time of the amount 
absorbed and of any loss. Inspection of all apparatus must be frequently made 
to avoid wetting the patient and bed, or burning the patient. If fluid leaks 
out around the tube at the rectum, inspect for obstruction in tube or rectum 
or to see if the tube has partially slipped out; when absorption is not taking care 
of the fluid fast enough, reduce the number of drops per minute or discontinue 
the proctoclysis for a time, notifying the medical officer of the fact. Sometimes 
proctoclysis is given at intervals instead of continuously. Special watchfulness 
must be maintained to prevent the bed becoming wet and the patient chilled 
and to prevent the binder and dressings becoming contaminated. 
The administration of therapeutic treatments is concerned with the use of 
agents other than medicines to produce therapeutic effects. The use of such 
agents is largely external and in their application there is required considerable 
skill, manual dexterity, and physical ability on the part of those giving such 
treatments. 
When therapeutic treatments are applied externally their action naturally 
takes place through the skin and the effects produced may be local or remote. 
The application of heat and cold to the body in the treatment of disease consti- 
tutes one of the most important procedures in general nursing practice, and 
has for its principal objectives: 1. A change in blood distribution and the 
amount of blood present in any area or areas; and 2. A local or general change 
in body temperature. When heat is applied to the body the circulation is 
quickened, the skin becomes flushed and warm as its blood vessels are dilated, 
perspiration is increased, the temperature is raised, and the blood supply to 
the head and internal tissues is decreased. When cold is applied to the body 
the circulation is slowed, the skin becomes pale and cool as its blood vessels 
are constricted, perspiration is decreased, the temperature is lowered, and the 
blood supply to the head and internal tissues is increased; later, when reaction 
occurs from the effects of cold, the blood supply to the head and internal tissues 
becomes normal and the other conditions mentioned change to the opposite. 
Hot packs and hot baths are given principally to induce perspiration and to 
relieve muscular tension. 312 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The articles necessary for giving hot packs are: An ice cap, four blankets, 
one towel, a foot tub lined with a rubber sheet in which to carry blankets 
wrung out of very hot water, five hot-water bags, pitchers of hot and cool 
water, a glass and drinking tube, and a large rubber sheet. 
Soak two blankets in water at 150° F., leaving one corner of the upper and 
lower edge of each blanket out of the water (these corners should be diago- 
nally opposite each other, as the blanket will then, when stretched, be somewhat 
on the bias) ; wring each blanket separately (two attendants are required, 
each taking a dry corner and twisting in opposite directions until the blanket 
has been wrung dry.) It then should be placed in the foot tub lined with 
a rubber sheet, covering hot-water bags, and the process repeated with the 
second blanket; carry the blankets to the bedside while the rubber sheet 
is still folded over them; pass two dry blankets with rubber sheet between 
under the patient; remove the pajama suit; wrap the patient in the dry 
blanket upon which he is lying; and turn the upper bedclothes over the 
foot of the bed. Place one hot blanket under the patient and one over him; 
fold the rubber sheet over the wet blankets; pull up the bedclothes, placing 
a towel around the patient’s neck; apply an ice cap to the head and hot-water 
bags to the hips, arms, and feet. Watch the patient’s pulse and encourage 
him to drink freely, unless directed to the contrary. The usual duration of 
this pack is 20 minutes. 
During and after removing a hot pack take the pulse at the temporal artery 
frequently; give plenty of fluids while the patient is in the pack; watch for 
collapse, in which case discontinue the pack and apply external heat; remove 
the wet blankets under cover of a dry one, thus avoiding exposure; wrap the 
patient in a dry blanket and leave an ice cap applied to the head and a 
hot-water bag to feet. Draw up the bedclothes and let the patient remain 
between blankets for one hour, at the expiration of which time dry the 
patient and give him an alcohol rub. 
Two commonly-used methods for applying heat are the foot and sitz baths. 
Foot baths are used for the relief of congestion either in the feet or in 
some other part of the body, as the throat, abdomen, or chest. Sometimes 
mustard is added in the proportion of two tablespoonfuls to the gallon of 
water. 
To give a foot bath in bed the articles required are a foot tub full of 
water at 108° to 112° F., a large blanket, a small towel, and a pitcher con- 
taining water at 130° F. 
Loosen the upper bedcovers at the foot of the bed and double them back 
to expose the feet and legs to the knees; gently lift the legs and arrange 
a rubber sheet, covered with a bath towel, on the bed under the feet; place 
the foot tub on the bed alongside of the feet and place a folded hand towel over 
the edge of the foot tub upon which the legs will rest when in the tub. Next 
put the arm nearest the foot of the bed across the tub and place the other 
arm, the hand of which supports the heels, under the patient’s legs; raise 
the feet from the bed and at the same time draw the tub into position; 
place the patient’s feet gradually into the tub, lowering and lifting them 
into and out of the water several times until he becomes accustomed to 
the temperature, keeping the free arm across the tub during this procedure, 
A folded blanket then may be wrapped around the tub and the bedclothes 
drawn down. The feet usually are left in the water for 20 or 30 minutes, 
and the water maintained at the required temperature by adding water from 
the pitcher. During this process place the hand between the stream of water 
and the patient’s feet to guard against injury. In removing the feet put NURSING 
313 
one arm and hand under the patient’s legs and heels; lift the feet from the 
tub; hold them above it for a few seconds in order that the excess water 
may drain off; place them on a bath towel; remove the tub from the bed; 
and dry the feet and legs thoroughly. Gently remove the rubber sheet and 
towel and replace the bedcovers. 
In the sitz bath the thighs and trunk up to the waistline only are immersed; 
the temperature of the water is 110° to 112° F.; and the duration is from 
5 to 10 minutes. It is used principally for the relief of local inflammation in 
the pelvic region. 
Cold is applied principally for the purpose of: 1. Stimulation of the vital 
processes, circulation, respiration, etc.; 2. Relief of congestion; 3. Stimulation 
or quieting of the nervous system; and 4. Reduction of temperature. 
The primary effect of cold is the contraction of the superficial blood vessels 
and drives the blood from the surface to the interior of the body. 
The following rules should be observed in the administration of cold baths: 
A cold compress or ice cap should be applied to the head to prevent an increased 
flow of blood to that part of the body; a hot-water bag should be placed at the 
feet, as this tends to prevent chill or rigor, conditions which are evidence of 
muscular contraction and a too decided difference between the temperature of 
the central and the peripheral portions of the body. Continuous light friction 
is given for the same reason. Stimulants should be administered 15 or 20 
minutes before the bath to prevent chilling and to help counteract any undesira- 
ble effect from immersion; hot drinks should be given after the bath, and 
blankets should be left on until reaction takes place. 
Baths to reduce high temperature usually are given every three or four hours 
while the temperature is 103° F. or over. The temperatures of cold baths vary 
from 65° to 95° F., and the duration also varies (10 to 20 minutes being the aver- 
age). The temperature, pulse, and respiration always should be taken one hour 
after the bath and charted with dotted line to indicate the drop or rise. 
When giving a cold pack protect the bed with a rubber sheet; wrap a wet 
sheet around the patient in such manner that no two surfaces of skin come 
together; apply a binder to the loins; keep the sheet wet by squeezing water 
of the required temperature over it; rub the surface of the sheet briskly; apply 
an ice cap to the patient’s head and a hot-water bag to his feet. The dura- 
tion of the pack should be 15 minutes. 
In giving a cold pack when the patient is not to he turned, the following 
apparatus and materials are essential; A large basin or foot tub containing 
water at the temperature prescribed (usually 60° to 70° F.) ; three bath towels; 
several cotton or linen towels, the number depending upon their size (usually 
seven or eight) ; a bath thermometer; a basin containing a few small pieces of 
ice; an ice cap or compress; a hot-water bag; and a binder for the loins. 
Remove all top covers except the sheet; pass the binder around the pelvis; 
protect the bed by placing a bath towel on either side of the patient and one 
over the legs; wring the towels fairly dry and place them around the arms 
and legs and over the chest and abdomen; remove the top sheet; have an 
extra towel in the water with which to start changing those on the body, and 
change them in turn at the rate of one every minute, rubbing the towels cover- 
ing the body between changes. Dry the body by rubbing with a dry towel; 
cover with a blanket; apply a hot-water bag to the feet; draw up the bed- 
clothes and administer a hot drink of either broth or beef tea. 
In giving either a hot or cold pack be careful that no two skin surfaces are 
permitted to come together; watch for collapse during the process; protect 
the bed; avoid pressure upon the abdomen; avoid too much turning of a very 314 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
ill patient; heat should be applied after a bath; screen the bed; prevent drafts; 
have the room warm before giving the bath. 
When the giving of a cold pack, a cold bath, or a cold sponge is inadvisable, 
an alcohol sponge is often employed to obtain the desired results. Less solution 
is used in giving an alcohol sponge, for alcohol evaporates more rapidly than 
water, thus giving greater stimulation to the nerve endings, and causing 
more rapid cooling of the skin. An alcohol sponge is given when it is unwise 
or impossible to move the patient too much; when quick results with less 
danger of violent reaction are desired; when the shock of the ordinary cold- 
water sponge would be too great; and when for any other reason other baths 
are contraindicated. One quart of 50 per cent alcohol is necessary. 
Before starting to sponge take and record the patient’s temperature, pulse, 
and respiration, noting particularly the character of the pulse and respiration. 
Then bring equipment to the bedside; replace the top covers with a bath 
blanket and fold the covers to the foot of the bed. Remove the patient’s 
pajamas, place an ice-cap on his head and a hot-water bottle at his feet. Place 
a rubber sheet covered with a bath towel under each arm, slipping them well 
under the shoulder and axilla, down along the side of the trunk and well 
under the hips. Similar protection should be placed under the legs and thighs. 
Spread the patient’s legs well apart, place his arms away from his sides and 
arrange a loin cloth or towel over the pubic region. Give the patient a 
quick, light friction rub over the body. The alcohol solution should be kept 
at the desired temperature by adding small lumps of ice as necessary and in 
it should be placed 6 compresses. Compresses, well wrung out, should be 
placed over the abdomen and, rolled or folded, in each axilla, and should be 
changed every 3 minutes. Fold the bath blanket to the foot of the bed using 
a bath towel for any necessary protection of the body; exposure of the body 
to the air assists in the radiation of heat, the evaporation of moisture, and 
the consequent cooling of the body surface. With long, light strokes sponge 
the nearest arm and leg, allowing three minutes for each; next sponge the 
chest, then the opposite arm and leg. If permissible to turn the patient sponge 
his back, buttocks, and along the back of his legs, using long, smooth strokes, 
otherwise raise one side and then the other enough to allow sponging under- 
neath as far as possible to reach. In the same manner raise each leg and 
sponge the under surface as freely as possible. Apply friction if patient 
shivers, and watch constantly for unfavorable reaction, frequently feeling the 
pulse. Dry, if necessary, with light strokes of the towel. Draw up bath 
blanket (or sheet) and remove compresses and loin cloth. Finish procedure 
and make patient comfortable according to routine for other baths. Take 
temperature one-half hour to one hour following the sponge, and keep con- 
stant watch of pulse and respiration during and for some time following the 
sponging. 
For some conditions medicated baths may be ordered, the temperature of 
the bath, the quantity of the medicament and the length of time the bath is to 
be taken also being specified. 
For medicated baths the trunk and extremities should be covered by the 
bath water which requires the tub to be between half and three-quarters full; 
an ordinary-sized bathtub when half full contains about 25 gallons of water. 
In medicated baths the patient lies quietly in the bath for 10 to 20 minutes 
and then is removed and enveloped in a warm sheet and dried gently by patting 
over the sheet. These baths are given largely for their soothing effect upon 
the irritated skin; rubbing will counteract the benefit of the bath and should 
not be practiced. NURSING 
315 
Of the medicated baths the bran, starch, bicarbonate of soda, and sulfur baths 
are used in the treatment of skin diseases, and mustard, Nauheim, and salt 
baths are used to produce counterirritation, improve the cutaneous circulation, 
and thereby relieve congestion of the viscera and for other abnormal conditions. 
For the bran bath 1% pounds of bran contained in a thin cloth bag is boiled 
in a basin for 20 minutes, the fluid drained off and added to the bath water, 
which should be at a temperature of about 95° F. 
The bicarbonate of soda or alkaline bath is generally used to allay itching 
of the skin. It is prepared by dissolving in the bath 8 ounces of bicarbonate of 
soda to each gallon of water used. When tested with red litmus paper it 
should give a strongly alkaline reaction. If the water has *a slippery feeling 
it is sufficiently alkaline. 
In the starch bath' one-half pound of starch is first mixed with sufficient cold 
water to cover it and enough boiling water is slowly added so as to make a 
paste of about the consistency of thick cream, which is then poured into the 
bath water and thoroughly mixed with the hands. 
For the sulfur bath y2 to 2 ounces of sulfurated potash to each 15 gallons 
of water is dissolved in a small quantity of hot water and added to the bath 
water, which should be at a temperature between 85° and 95° F. 
Substances which produce more or less local vascular excitement when applied 
to the skin are termed irritants and when these or other substances are em- 
ployed to excite a reflex influence on a part remote from the place of appli- 
cation they are termed counterirritants. In the application of counterirritants 
the sensory nerve endings lying beneath the surface are irritated and this pro- 
motes relief of congestion and inflammation in either an adjoining or a distant 
part. 
Drugs, heat, and cold are used as counterirritants and their principal purposes 
are to relieve congestion and inflammation as in tonsillitis, pneumonia, and 
headache; to promote absorption of serous effusions, as in pleurisy, and exudates 
around joints; to stimulate nerve centers in collapse; and to increase peri- 
stalsis and thus overcome tympanites. Substances used as counterirritants 
produce different stages of irritation according to their strength and the length 
of time applied and are known as rubefacients or reddeners, which cause the 
superficial vessels to dilate and redden the skin; vesicants which produce a 
blister; and caustics or escharotics, which cause a burn or sloughing. {See 
section on Materia Medica.) Rubefacients are sometimes spoken of as first 
degree irritants, vesicants as second degree irritants, and escharotics as third 
degree irritants. 
The rubefacients in general use are heat (both dry and moist), mustard pastes, 
flaxseed poultices, stupes, cupping, and certain liniments. Unless special care 
is exercised in the use of rubefacients, blisters may be caused which, unlike 
those resulting from vesicants, may be very slow in healing, and may become 
infected. Substances employed as rubefacients may be classed as physical (heat 
and cold), mechanical (cupping, friction, pressure, etc.), and chemical (mustard, 
iodine, turpentine, ichthyol, etc.). Rubefacient counterirritation by heat usually 
is produced by the use of hot-water bags, hot-air baths, compresses, poultices, 
stupes, and by electric-pads. Such hot applications are applied for the stimulat- 
ing effect (heat expands the tissues and thus increases hypersemia to a greater 
degree than any of the other counterirritants). Moist heat induces softening 
of the tissues and at the temperature attained by the use of poultices, if applied 
directly over an inflamed area, will favor suppuration. For this reason the 
use of poultices sometimes may produce harmful results. Moist heat is more 
penetrating than dry heat. 
154294°—39 21 316 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Hot-water hags.—The water must not be hot enough to scald; the bag should 
be half full; superfluous air should be forced out of the bag and water appear 
in the neck before the cap is screwed on; an uncovered hot-water bag should 
never be given to a patient, and care should be taken that a blanket Intervenes 
between the covered bag and the body of an unconscious patient. Post-operative 
patients require special care when hot-water bags are applied and should not 
be left alone while the hot-water bags are in the bed. An attendant never 
should take a patient’s word concerning the temperature of a bag, but should 
judge for himself and carefully watch the skin for reaction. Be sure the hot* 
water bag does not leak. 
The use of electric pads requires important precautions. When these ap- 
pliances are used make sure that the insulating material around the wires is 
intact; otherwise the bedclothes may be set on fire. It should be remembered 
that if the pad is used continuously for any length of time its temperature 
will Increase and it may burn the patient, the heat causing the perspiration to 
scald him. 
Hot wet dressings should be applied in the form of fluffed gauze or rolled 
gauze compresses wrung out of a hot antiseptic or sterile solution. They should 
be applied and covered with thin oiled silk or rubber sheeting to protect the 
bedclothes and mattress, and a hot-water bag should be placed outside of the 
rubber sheeting to maintain the heat. Precautions should be taken against per- 
mitting a wet dressing to become cold, especially at night; carelessness may 
result in the development of serious complications. 
Poultices are hot, soft, moist pastes prepared for local, external application. 
Flaxseed meal is the substance generally used for poultices because when 
cooked or par-boiled it retains heat and moisture for a considerable time. 
The following articles should be at hand: Flaxseed meal, saucepan with boiling 
water, oiled muslin of sufficient size to cover the poultice when finished, old 
muslin cut 2 inches larger than the required size of the poultice, hot-water 
bottle, 2 dressing towels, tablespoon, spatula, soda bicarbonate, a binder, and 
a light wrap of flannel for shoulder or chest covering. When the water (one- 
half pint for medium-sized poultice) is boiling, gradually add the flaxseed, 
stirring constantly with the tablespoon to keep the mixture smooth and without 
lumps. When of the right consistency the paste may be easily scraped from 
the sides of the pan. At this time add a small amount of soda bicarbonate 
and with the tablespoon beat the poultice until it becomes fluffy; then pour it 
on the muslin and with the spatula spread it quickly to within 2 inches of the 
edges. Turn the edges back over the paste and cover with one layer of muslin, 
the edges of which are folded under the foundation of the poultice. Fold the 
poultice in a warm towel or a folded newspaper, carry it on a hot-water bag 
to the bedside, and after testing its temperature against the cheek apply it 
to the patient who has been previously prepared. The patient’s skin should 
be oiled and the poultice applied in the same manner as a stupe, except that 
after making sure that the poultice is not too hot the binder is adjusted and 
left in place for 30 to 45 minutes, or as ordered, when another poultice is 
applied. On removing a poultice put it in a waste receptacle; never use it 
a second time. After removal of a poultice the skin surface should be dried, 
observed as to the degree of redness, and covered with a layer of warmed 
cotton which should remain until the next poultice is applied or its removal 
is directed. After use the equipment should be cleaned and placed in order. 
Always put water in a cooking pan as soon as the paste has been taken out. 
Stupes, or hot fomentations, are prepared by placing two layers of flannel 
in boiling water, wringing as dry as possible by means of a canvas or towel NURSING 
317 
and applying directly to the skin, which has been greased with petrolatum to 
prevent blistering. The flannels are covered with a light rubber sheeting or 
heavier flannel and kept in place with a bandage or binder, and are changed 
frequently. They usually are allowed to remain over a period of from 20 
minutes to 1 hour, or as directed. If the stupes are ordered over a broken 
surface, sterile gauze should be used and wrung dry by means of a sterile 
towel, observing the strictest asepsis in regard to water, hands, material, etc. 
In preparing stupes for application to the abdomen the following equipment 
should be at the bedside: Electric stove and basin of boiling water, piece of 
oiled muslin and three pieces of flannel or old blanket; binder, chest protector, 
and three towels; vaseline or oil, stupe wringer, and waste receptacle; safety 
pins; and, if turpentine stupe is to be given, a medicine glass, mixing rod, 
turpentine, and olive oil. Have basin and electric plate near, but at a safe 
distance from the patient. Fold one piece of flannel double and, placing it in 
stupe wringer, immerse it in the boiling water, leaving the ends of wringer 
out of the water. Protect the patient with a chest protector or lightweight 
blanket over his chest, turn the bed-covers down, and cover the abdomen with 
a warm, dry flannel and oiled muslin. Protect the bedclothes with towels at 
upper edge and beyond the area of application. Remove the flannel from the 
boiling water, wring it as dry as possible, and give the folds a quick shake 
to somewhat cool the stupe. Before applying, test the temperature of the 
flannel by laying against the cheek, then raising the abdominal cover slightly, 
slip the folded stupe under it, and over the abdomen. After applying the stupe 
raise it slightly and lower it a few times if the patient complains or if thfe 
skin becomes too red. Prepare another stupe in like manner and replace the 
first when it cools. Repeat applications for the length of time prescribed or 
until the purpose is accomplished. On completion of the treatment cover the 
abdomen with a warm, dry flannel and secure the binder, which has been 
previously placed in position. Remove equipment and make it ready for further 
treatment. 
When turpentine stupes are to be given it is desirable to mix the turpentine 
with olive, cotton-seed, or mineral oil in the proportion of 1 part of turpentine 
to 2 of oil for an adult and stir well so that there is no danger of globules of 
turpentine remaining free. After heating apply the mixture to the abdomen 
with the tips of the fingers which prevents leaving a stray drop remaining to 
burn the patient when the heat is applied. Then apply the heated flannel as 
previously described, making 2 or 3 applications of the turpentine and oil 
during the procedure, if desired, ascertaining each time that they are warm 
and well mixed. 
Mustard sinapisms, or plasters, are used in the form of a mustard paste or 
mustard leaf. The paste is made from flour and warm water, into which 
mustard is stirred in the proportion desired, usually varying from one-eighth 
to one-half, the latter proportion for applications to the chest. If the skin is 
sensitive the white of an egg should be mixed with the mustard. Spread the 
paste on thick muslin, turn in the edges, and cover the surface next to the 
skin with gauze. This application generally is allowed to remain not longer 
than 15 minutes, and should be watched carefully. Certain individuals blister 
more rapidly than others. After removing, if the skin is very red, a bland 
ointment should be applied. If the official mustard leaf is used, it should be 
dipped in tepid water, allowed to drip, applied directly to the skin or on a 
layer of thin muslin, allowed to remain for 5 or 10 minutes, and watched care- 
fully to avoid blistering. After removal the surface should be dried and kept 
covered until all redness has disappeared. 318 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
If the plaster is made some distance away from the patient it should be 
placed on a hot-water bottle to be carried to the patient’s bedside. The action 
of a mustard plaster is due to the presence of an irritant volatile oil which 
is released when mustard is combined with water. 
Iodine is applied as a counterirritant by “painting” the area to be treated 
with a solution of the desired strength and allowing it to dry. Blistering is 
to be avoided by making certain: That the solution used is of the proper 
strength; that the patient is not idiosyncratic to iodine (some skins cannot 
bear a single application of iodine without being burned) ; that dressings are 
not applied over surfaces to which iodine has been applied; and that iodine 
is not applied in conjunction with bichloride of mercury. A second applica- 
tion of iodine should not be made too soon nor continued applications made 
on consecutive days over too long a period. 
Cupping is the application of glass cups in which a vacuum can be created 
to parts of the body surface to obtain hypersemia and to relieve congestion in 
underlying parts. The vacuum is created by heat or by suction. In creating 
vacuum by heat great care must be taken to avoid heating the rim. A cupping 
glass should never be forcibly removed, but by gentle insertion of the finger 
tip under the edge of the glass the vacuum can be destroyed and the cup 
then removed easily. 
Cold usually is applied as a counterirritant in the form of ice, iced water, 
and iced solutions by the use of ice caps, ice coils, compresses, local baths or 
irrigations. 
In using ice caps the ice should be broken into pieces about the size of a 
walnut, using a canvas bag and mallet. After half filling the bag the air 
should be expelled by squeezing and the cap securely screwed down. The bag 
should not be more than three-quarters full and always should be covered 
with gauze. After use the surface of the bag should be washed with a dis- 
infectant and hung up to dry before putting away. 
Cold compresses consist of several layers of gauze or absorbent cotton im- 
mersed in cold water or iced water, wrung out to remove the excess water, 
and applied to the desired part. These compresses must be changed very 
frequently in order to keep the part cold. Eye and throat compresses are the 
most commonly used cold compresses. Absorbent cotton should be used for the 
eye compresses, the pad consisting of several layers of cotton a little larger 
than the eye in size but not large enough to extend over the bridge of the 
nose. If both eyes are to be treated, separate pads and separate basins of 
iced water should be used for each eye. When there is discharge from the 
eye the same compress must never be used more than once. A receptacle 
should be provided, in which to throw the soiled compresses. A compress 
should not be allowed to remain on a part until it becomes warm. 
Vesicants, or epispastics, are agents that produce blisters and usually are 
applied to cause absorption or removal of inflammatory waste after true 
inflammation. A common vesicant is cantharides (cantharidal collodion or 
plaster). The skin should be aseptically prepared before the application of 
cantharides; as this drug is absorbed through the skin and it is eliminated 
through the kidneys, the urine should be watched for 24 hours following for 
symptoms of nephritis. A definite statement should be obtained from the 
medical officer regarding the size of the area to be treated, usually not more 
than one-half inch to 2 inches square, and this area should be outlined in oil. 
A thin coating of cantharidal collodion is applied, using a sterile swab, and 
allowed to dry. After the blister has formed, usually in from four to eight 
hours, the collodion should be removed by patting it gently with a sterile NURSING 
319 
gauze sponge wet with ether, taking care not to break the blister in removing 
the plaster, and any adherent particles of collodion wiped away with oil and 
a sterile dressing applied. The blister should not be opened unless it is so 
ordered, in which case a slit should be made in its lower edge with a sterile 
scissors and the escaping fluid caught in sterile gauze. Slight pressure should 
be made above the blister with a sterile gauze sponge to promote complete 
discharge of fluid. 
The type of counterirritation produced by escharotics is very prolonged in 
its action and is not greatly used. The therapeutic uses are: To produce 
death and sloughing of tissues, to stimulate healing, to neutralize and prevent 
absorption of poisons from snake bite, dog bite, etc., and to remove surface 
growths such as w-arts, etc. Chemical agents commonly used as escharotics 
are acids such as sulfuric, nitric, salicylic, and glacial acetic; alkalies such as 
potassium and sodium hydroxide; metallic salts such as silver nitrate, copper 
sulfate, zinc chloride, burnt alum, and arsenic; carbon dioxide (liquid or solid), 
and the cautery. Escharotics must be applied with great care so as to reach 
the local area only. When the desired result has been obtained the action of 
the caustic is checked by neutralizing it. 
Among the therapeutic treatments that rank high in importance and which 
require more than ordinary skill in their administration are the enemata. 
An enema, or clyster, is the injection of fluid into the lower bowel by way of 
the rectum for therapeutic or nutritive purposes, and is usually classed as 
evacuant or retention. 
The general object of this form of treatment is to relieve constipation by 
cleansing the lower bowel; to soothe, nourish, or stimulate; to destroy micro- 
organisms or worms; to act as an astringent; to relieve distension from gas; 
to supply tissues with needed fluid; to supply medication locally, or to the 
general system; and to increase or decrease body temperature. 
The following routine equipment is required for giving an evacuant enema: 
A bath blanket or sheet, an extra rubber sheet and covering; irrigator stand- 
ard ; irrigating can, fully equipped with tubing, connecting tubes, tip and rectal 
tube, stopcock or regulator, all connected ready for use; pitcher of solution, 
properly prepared and of required temperature; bedpan and cover, lubricant 
and wooden tongue depressor; kidney basin; bath thermometer; gauze com- 
presses ; mixing spoon; basin with warm water for cleansing patient following 
enema; towel; bed screen. The following points should be remembered: Have 
all necessary articles assembled at the bedside; have patient properly screened; 
never expose patient; have mattress well protected with extra rubber sheet and a 
sheet. 
The simple soap-suds enema is the one most frequently given, and for 
this there should be kept on hand a jar of liquid soap, prepared by boiling 
or dissolving some pure soap in sufficient water to form a soft jelly. To 
prepare the enema dissolve two or three ounces of this jelly in a pitcher of 
water at temperature of 108° F., mix well, and remove froth. If pieces of 
soap are used, after water becomes sufficiently soapy remove pieces to pre- 
vent clogging of the tubing. Carry solution, covered, to the bedside, where 
proper assembly of articles and preparation of bed and patient have been 
previously made. 
When giving an enema replace the upper bedclothes with a blanket or sheet; 
draw the patient to the right side of the bed, turn him on his left side, draw- 
ing up and flexing somewhat the right leg, and drawing the left leg down 
and back somewhat; have the right amount of solution at right temperature; 
lubricate the tube well to make insertion easy, and to prevent injury; expel 320 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
all air from tube by allowing the solution to flow through until of the right 
temperature; pinch the tube and insert it in the rectum. Use no force when 
introducing the tube or tip. If the sphincter muscles are tense, encourage 
and assist the patient to relax by reassuring him and explaining the necessity 
of so doing; remove pressure on the tube and allow the solution to enter 
slowly; if the patient complains of pain, and gas is heard rolling, shut the 
clamp on the tube for a moment and move it slightly back and forth, at all 
times urging patient to relax and prevent premature expulsion of the enema. 
Frequently where gas has accumulated behind the faeces some will escape 
about the tube or, forcing back the fluid in the tube, escape through it in 
bubbles in the top of the can; following this relief from escape of gas, more 
fluid may be injected until a pint or more has been given. Urge the patient 
to retain this for 15 or 20 minutes, or as long as he can without distress, 
when it should be freely and voluntarily expelled. Occasionally a patient, 
because of weakness, constriction of muscles, or from temporary paralysis 
of peristalsis, is unable to expel the enema. When this occurs hot stupes 
are sometimes used to stimulate muscles and relax rigidity, and if these 
are not effective the fluid is siphoned off by inserting the rectal tube and 
draining the fluid into the bedpan. When this is necessary the object of the 
enema has been accomplished only partially, for peristalsis has not been 
stimulated and the abdominal muscles have not been relaxed as they should 
have been. The resulting relief is nmch less; in fact, this is sometimes a dan- 
gerous symptom as, when following an operation, it may indicate peritonitis; 
or in typhoid it may indicate a perforation of the intestine. Sometimes when 
too small a quantity has been taken or when the system, needing fluids, has 
absorbed much of the enema, a second enema will have to be given. When 
this is necessary use the routine procedure, but watch carefully for any 
untoward symptoms. Stop immediately and siphon off fluid, if excessive dis- 
comfort, distension, or other unpleasant symptoms occur. When the enema has 
been expelled remove the bedpan, cover it and take it from the ward imme- 
diately. Thoroughly cleanse the patient, remove the extra rubber and draw 
sheets, replace pajamas, straighten and tidy the draw sheet, and replace 
the bath blanket or sheet with the bed covers, leaving the patient comfortable 
and clean. Remove all utensils and return them to their accustomed places 
in readiness for the next time needed. Air the room thoroughly, and make 
a complete and correct record of results of the enema on the bedside notes. 
The rectal tube or tip should never be placed in the enema can, but removed 
from tubing and placed in a receptacle for that purpose. 
Retention enemata are given for the purposes of: 1. Supplying a patient 
with food or fluid when he is unconscious, unable to swallow, cannot retain 
food or fluids taken by mouth, or his body is dehydrated; 2. Administering 
medicines; 3. Administering local applications to the mucosa of the rectum 
and lower bowel; and 4. Administering anaesthetics. Barium sulfate is some- 
times introduced into the lower bowel in this way so that X-ray photographs 
of this part of the intestine may be taken. 
The amount of fluid given in retention enemata varies, 6 to 8 ounces being 
the usual maximum amount when given within a short period, but may be 
considerably more if given drop by drop over an extended period of time. 
The temperature of the fluid should ordinarily be 100° F. Retention enemata 
should be given strictly according to specific directions as to quantity, rate of 
speed, and length of time to be retained. Before giving ascertain that the 
lower bowel has been emptied sufficiently long to allow peristalsis to have 
subsided. For small amounts of fluids a rubber catheter with funnel attach- NURSING 
321 
ment may be used. Following the introduction of the fluid a hot compress 
applied with pressure to the anus for a few minutes will often assist greatly 
in preventing expulsion of the enema. Remove the catheter slowly, pinching 
the tube or applying the shut off before and during the removal of the tube. 
Nutritive enemata consist of specially prepared foods in liquid form. They 
are prepared according to various formulae, depending upon the conditions 
for which given, and the preference of the medical officer prescribing. Seda- 
tive enemata usually contain some drug or special preparation for quieting 
or soothing and are given according to specific directions. The patient should 
be made as comfortable as possible before the sedative enema is given so that 
he m,ay be ready for sleep following it. Astringent enemata consist of hot 
water (120° F.) or of some astringent preparation for drying up or lessening 
intestinal secretions or for stopping haemorrhage. They are given under definite 
instructions from the medical officer. Carminative enemata are occasionally 
used. These are of many types but two are of sufficient importance to be 
mentioned here. These are the turpentine enema and the milk and molasses 
enema. These cause an increased expulsion of flatus. Turpentine enemata 
are made by mixing 1 dram (1 teaspoonful) of turpentine with 1 ounce of 
cotton seed or mineral oil. This mixture is then added to 1 pint of soap suds 
and is stirred constantly while it is being given. Milk and molasses enemata 
are made up of equal parts of milk and molasses (usually 7 ounces of each). 
This mixture should be retained by the patient as long as possible and then 
followed by a soap suds enema. 
Enteroclysis, also termed colonic flushing or rectal irrigation, is the intro- 
duction of a large amount of fluid into the colon by way of the rectum, pro- 
vision being made at the same time for a return flow of all fluid not absorbed. 
The object of enteroclysis is to cleanse the colon and rectum of toxic, irritat- 
ing, or putrefying material, and to remove mucus. The equipment required 
consists of a two-way rectal tube of rubber or a satisfactory substitute; a 
rubber operating pad (commonly called a Kelly pad) ; a rubber sheet or 
newspaper to protect the deck; a bucket to receive the outflow; sufficient 
solution with convenient means of adding it as needed to the contents of the 
irrigating can; and the remainder of the equipment the same as listed under 
routine equipment for enemata. A cleansing enema is given before starting 
enteroclysis to free the colon and rectum of faeces; following this the inflow 
and outflow go on simultaneously; the introduction of two tubes, instead of 
a two-way tube, is accomplished by inserting the inflow tube for 8 inches, then 
inserting the outflow tube just inside the rectum, then gently pushing both 
tubes 3 inches farther in. All tubes inserted in the rectum should be well 
lubricated. 
All routine precautions for enemata are essential in giving enteroclysis and 
in addition care should be taken to provide adequate means for the disposal 
of the unusual quantity of solution; the return-flow tube should remain in 
until the outflow ceases; the contents of the can should be replenished as often 
as necessary until the required amount has been given or the purpose accom- 
plished, and at no time should the can become empty and air enter the tube. 
The result should be noted and recorded accurately so that the medical officer 
may be fully informed as to the effectiveness of the treatment. 
Instead of the soap-suds enema for cleansing, some medical officers prefer 
to use either physiological salt solution or a 2 per cent sodium bicarbonate 
solution for this purpose as it is less irritating. 
Two important therapeutic treatments frequently given are gastric lavage and 
gavage, 322 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Gastric lavage is the washing out of the stomach. Its object is to remove 
poisons, to remove irritating substances or those causing nausea, vomiting, 
or distension, and to relieve congestion. It should be remembered that except 
in cases of poisoning, a lavage must never be given without an order. When 
giving a lavage reassure the patient, instruct him to remove any false teeth, 
to breathe naturally through the mouth and nose, to hold the head slightly 
forward and lowered, and, as the tube is introduced, to contract the throat 
as in swallowing. Never force the tube, but take sufficient time, working 
quietly and encouraging the patient, and if the patient complains of severe 
pain when fluid is introduced, or blood appears, stop treatment immediately 
and report to the medical officer. Never allow the funnel to become empty 
during the introduction of the fluid; do not tickle the back of the patient’s 
throat when introducing the tube. Insert the tube only to the mark (16 to 18 
inches), as this indicates the limit the tube should be inserted. See that 
clothing is loose about the neck. 
The necessary equipment consists of a lavage tube coiled in ice, a pitcher 
of the prescribed solution at a temperature of 105° F., a kidney basin; gauze 
handkerchief; 2 rubber aprons; white enamel bucket; towel; mouth gag or 
tongue depressor; rubber sheet, or a newspaper to protect the deck; and a 
lubricant, such as glycerin or liquid petrolatum. The solution used is usually 
3 to 5 per cent soda bicarbonate, 2 per cent boric acid, or plain water. When 
ready to introduce the tube place the patient, if he is conscious and able, in a 
sitting position, explain the procedure and reassure him. Thoroughly wash 
the hands and take a position to the right of the patient, give him a gauze 
handkerchief and a kidney basin, and protect him with a rubber apron or 
sheet covered at the neck with a towel. 
A bucket should be convenient for the return flow. Take the tube from the 
ice and expel all air from it by stretching it, and pinching it at the funnel 
end, 2 or 8 inches from the end to be inserted. Hold the tube so curved that 
it will not strike the back of throat as it is inserted. Insert just above the 
tongue and instruct the patient to swallow just as he would swallow food. 
Glycerin applied to the tube makes swallowing easier. Pass the tube steadily 
but without force until the mark on the tube reaches the lips. Try to make the 
patient fully understand that if he relaxes and breathes easily the tube will 
be passed without discomfort while if he is rigid or struggles, it will be passed 
with much more difficulty, and with far more discomfort to him. Hold the 
funnel about 6 inches above the patient and pour in the solution, always re- 
filling when the funnel becomes half empty. When about a pint of fluid has 
been given invert the funnel quickly, while still half full, to below the level of 
the stomach, for siphonage, instructing the patient to lean forward at the same 
time. Repeat the procedure until the required amount has been given, or 
until the return flow is clear. Then pinch the tube and withdraw it quickly. 
Place the tube and funnel in the basin before releasing pressure on it to prevent 
release of the contents on the patient or the deck. Give the patient a mouth 
wash and bathe his face with cool water. Remove equipment and set it in 
order. Rinse the tube and funnel with clear cold water to thoroughly 
cleanse it from all deposits, then boil them before replacing on tray. If 
lavage is given in the absence of the medical officer, save the return flow for 
his inspection. Record the time of treatment, the amount of solution given, and 
the amount and appearance of return flow. 
Gavage signifies the introduction of liquid food into the stomach through a 
tube. It may be oral (through the mouth) or nasal (through the nose). 
Gavage is indicated following operations upon the mouth; in cases of insanity NURSING 
323 
or excessive weakness; in tetanus; in cases of spasm or stricture of the 
oesophagus when the patient is unable to swallow; during continuous uncon- 
sciousness ; and to administer an antidote or other medication. 
The procedure for oral gavage is the same as for lavage, except that the 
fluid introduced is in smaller quantity and is allowed to remain in the stomach 
instead of being siphoned off. After introducing the tube, wait until all 
muscular contractions have ceased and the sensation of gagging has been over- 
come ; then slowly pour in the food, pinching the tube before all food has left 
it, to prevent air entering the stomach, or food being drawn into the trachea. 
Withdraw the tube quickly. Have patient lie down and remain quiet until all 
danger of vomiting is past. Clean and replace equipment as following lavage. 
SURGICAL NURSING 
Surgical nursing is primarily concerned with the operating room and surgical 
operations, the preparation of surgical dressings and the dressing of surgical 
wounds, the preoperative preparation and postoperative care of surgical patients, 
and minor surgical procedures involved in the special nursing care of certain 
more or less surgical conditions. Reference should be had to the section on 
Operating Room and Surgical Technique for the discussion of certain parts of 
surgical nursing. 
Preoperative preparation. 
The details of the preparation of a patient for an operation vary somewhat 
in different hospitals, but the general principles are the same. Always bear in 
mind that overtiring or exciting a patient previously will cause unfavorable 
reaction both while he is going under the anaesthetic and while recovering from 
it. A patient should never be teased or alarmed while waiting for this ordeal. 
Usually patients for operation are sent to the hospital 24 hours before the 
operation is to be performed so that the necessary preparations may be made 
without haste and without exhausting the patient. The attendant, while pre- 
paring the patient, should encourage him, keep him in good spirits, and in 
various casual ways inspire him with confidence in the surgeon, the nursing 
staff, and the hospital in general. 
Much of the preoperative preparation of a patient for operation takes place 
on the day before the operation is scheduled. The patient should, if he is 
able, take his own bath and shampoo, but he should be inspected afterward 
to make certain he is thoroughly clean. Patients having an elevation of tem- 
perature should be given a cleansing bath in bed. 
In the local preparation for most operations, except in definite emergency, 
the site of operation is shaved and thoroughly cleansed after the bath. The 
area prepared should extend beyond the specified point of incision far enough 
to prevent danger of contamination from adjacent skin surfaces during the 
operation, and to allow sufficient sterile space for a second incision or change 
of site of incision. For most areas the general preparation varies but little. 
Most surgeons, however, have their own special routine for preoperative prepa- 
ration and for postoperative care, and this is posted in their wards or given 
and signed by them for each individual case. In the preparation of abdominal 
cases special attention should be given the cleansing of the umbilicus. Using a 
small applicator well padded with absorbent cotton, the attendant should cleanse 
well within the folds with green soap and water, clear warm water to remove 
all traces of soap, and then dry with alcohol or ether. The stomach, intestine, 
and bladder should be empty to prevent embarrassment and the contamination 
of the patient and operators by the involuntary discharge of the contents of 324 
HANDBOOK OF THE HOSPITAL CORPS, IT. 
S. NAVY 
those organs when the patient becomes relaxed under the anaesthetic; to 
prevent accidental incision of bladder or intestine because of their distention; 
to prevent choking from aspirating fluid or food during vomiting, which fre- 
quently occurs during the administration of an anaesthetic when the stomach 
is full; also to prevent unnecessary discomfort following an operation, from 
the accumulation of gas due to putrefaction of partially digested food in the 
intestine. Usually a cathartic is ordered the night before operation. Fre- 
quently this is castor oil because it accomplishes thorough evacuation and does 
not overstimulate peristalsis. 
Early on the morning of operation a soap-suds enema is given, and repeated, 
if necessary, to secure a clear return flow. The enema is given slowly, and 
should be retained for a few minutes to assure a thorough washing out of the 
lower intestine. It should not be repeated more than once (except for some 
definitely specified reason), as distention might follow, or excessive peristalsis 
be stimulated which might be difficult to reduce or control before the time 
scheduled for the operation. Following the enema the patient should be made 
clean and comfortable and allowed to rest until time to go to the operating 
room. Frequently a surgeon will order an enema at 8 p. m. the evening before 
an operation, in addition to the enema on the morning of operation. This 
aids greatly in the thorough cleansing of the intestinal tract and in the con- 
sequent comfort of the patient following the operation. Except in special 
emergency an enema should not be given to a patient just before going to the 
operating room. 
On the morning before and the morning following an operation under a gen- 
eral anaesthetic a specimen of urine is sent to the laboratory for examination. 
On the day preceding the day of operation the diet should consist of light 
nutritious food that can be quickly digested and readily assimilated, leaving 
little residue in the intestinal tract. No solid food should be given within 12 
hours of the operation. If the patient is weak and requires nourishment, 
strained soups and broths may be given up to six hours before the operation, 
after which nothing should be given by mouth. Water should be given freely 
up to within six hours of an operation, as it flushes the kidneys and clears 
the pores of the skin. When an operation is to be performed under local 
anaesthesia a light breakfast is often given on the day of operation. 
Before a patient is taken to the operating room any money or jewelry he 
has should be listed and turned over to the proper authority for safekeeping. 
Artificial teeth should be removed and placed in boric-acid solution in a labelled 
receptacle. His pajama coat should be reversed and he should urinate, the 
amount of urine and the time voided being recorded on the information sheet 
accompanying him to the operating room as well as on the Clinical Notes. An 
opiate by hypodermic injection is usually given from 10 minutes to half an 
hour before the patient leaves for the operating room, depending entirely 
upon the surgeon’s order. The time and amount given are recorded on the 
Clinical Notes, and on the information sheet for the operating room. When 
the patient leaves for the operating room on the wheel stretcher he is well 
wrapped with blankets, the head being usually covered with a special oper- 
ating-room cap or with a towel to protect his head from drafts and to absorb 
excess of moisture during anaesthesia. Care should be taken that the patient 
is neither teased nor alarmed as he leaves for the operating room but is 
cheered and reassured. Record on his Clinical Notes the time of departure 
for the operating room. In placing the patient on the operating table care 
should be taken to see that his position on it is as comfortable and unstrained 
as possible. A small pillow or pad under the hollow of the back will aid NURSING 
325 
greatly in preventing undue strain which results in the severe backache so 
frequently complained of by postoperative patients, sometimes far exceeding 
the pain and discomfort of the operation itself. Patients with large, heavy 
shoulders require greater elevation under the head than do others. 
The postoperative care of a patient begins with his return from the operating 
room. When a patient arrives in the ward recovering from a general anaesthetic, 
place him at once in a well-warmed ether bed in a warm room with sufficient 
ventilation but without drafts; do not leave him alone until he fully regains 
consciousness, because of the danger of swallowing his tongue, choking on 
aspirated mucus, becoming chilled, and other accidents which might happen 
to an unconscious patient. Take pulse and respiration every 10 to 15 minutes 
during the first two hours, and longer if there is any reason for so doing; 
if no reason for alarm exists, take every half hour for the next hour or two 
and then every 2 to 3 or 4 hours. Record them as taken, stating the time. 
Until the patient has reacted, hold his jaw upward and forward firmly, but 
without rigid pressure 'as too great pressure might cause facial paralysis, to 
prevent his tongue from falling back in the throat. Turn the head somewhat 
to one side to make it easier to care for the vomitus and to remove mucus from 
the mouth and throat. When vomiting occurs raise the head slightly and 
tip it forward to the side, placing the kidney basin under the angle of the jaw, 
and, supporting the patient’s head with one arm and hand, with the other 
hand wipe his mouth and face and remove all mucus possible from his 
mouth, using squares of gauze. If violent retching occurs in an abdominal 
case, apply firm pressure over the region of the wound to prevent undue strain 
on the sutures and the surgically-injured muscles. Dry the face frequently 
during the period of excessive perspiration following the anaesthesia; and dry 
the body and replace the damp linen as soon as it is wise to disturb the patient, 
taking great care to avoid exposing any part of the body surface. Give nothing 
by mouth until ordered by the surgeon in ch'arge of case, and allow no water 
within reach of patient until he is permitted to have it freely. If the mouth 
is very dry swab the mouth occasionally with iced water. Persistent vomiting, 
if not relieved by simple measures such as a hot-water bottle, small amounts of 
cracked ice, or hot water, may necessitate gastric I'avage. This is given only by 
the ward medical officer or under his direct supervision. When liquids are first 
given they must be dispensed either hot or cold, never lukewarm. Many surgeons, 
as a routine procedure, order 500 cc of fluid by proctoclysis, to be administered 
as soon after the patient’s return from the operating room as is practicable, for 
all abdominal cases that have had a general anaesthetic. The kidneys are thus 
furnished with fluid to assist in flushing and in elimination of waste, and the 
bladder is stimulated to action and discomfort from thirst is lessened. Reten- 
tion of urine is very common after an operation. When a patient does not 
void within 8 or 10 hours following an operation, especially if he complains 
of any discomfort, the surgeon should be notified after all simple means to 
induce patient to void have been tried. Catheterization may then be ordered, 
and is performed by or under the supervision of the surgeon. 
Special complications to watch for, guard against, and report promptly when 
discovered in postoperative cases are: Haemorrhage, indicated by weak, rapid 
pulse, pallor, subnormal temperature; excessive restlessness; drawn, anxious 
expression; thirst and air hunger (gasping for air); blood-stained dressings 
or blood in stools, urine, or vomitus; collapse, indicated by excessive weakness; 
cold, clammy skin; weak, thready, almost imperceptible pulse; unconsciousness; 
temporary paralysis of peristalsis, indicated by excessive distension, failure 
to expel flatus by rectum, respiratory and heart symptoms from pressure of 326 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
gas against the diaphragm, and by symptoms of shock; and peritonitis, a com- 
plication which frequently develops following an operation for an abdominal 
septic condition and sometimes following a clean operation which has become 
infected. The symptoms of peritonitis include many of the foregoing, and in 
severe cases the restlessness, rapid respirations, and feeling and appearance of 
apprehension are extreme. This condition is the most trying, as even in fatal 
cases consciousness continues almost to the last. 
In the care of haemorrhage inform the medical officer immediately after the 
first symptoms are noted. Do not leave the patient alone; stand by and 
reassure him. If evidenced by external bleeding, reenforce outer dressings 
and, where practicable, apply tight bandage while waiting for the surgeon. 
Following tonsillectomies elevate the head and shoulders and apply an ice- 
collar to the throat. The care of collapse requires the immediate reporting 
of the condition to the medical officer, the prompt application of heat, and 
stimulation as ordered. To care for paralysis of peristalsis report the first 
symptoms noted to the medical officer. Relief measures such as insertion of 
a rectal tube, turpentine enemata, hot stupes, external heat, etc., must be taken 
at once, otherwise the paralysis may continue and serious results follow. 
Prompt recognition and reporting of symptoms are essential in the care of 
peritonitis and prompt and efficient carrying out of all orders are necessary for 
the relief of the patient. Fowler’s position is almost always ordered as a 
routine measure in abdominal pus cases in order to promote free drainage from 
the abdominal cavity, and in empyaema cases to keep the fluid in the chest at the 
lowest level. The degree of elevation is 40° to 50° and should not be more, as 
the greater elevation would be too trying; it should not be less, for then drain- 
age would be less free. 
In all post operative cases the patient should be warned of the danger of 
infection incurred by putting his fingers under his dressings to adjust them 
or to scratch himself. In drainage cases the patient should be placed in 
Fowler’s position as soon as practicable. Fluids should be forced as soon as the 
patient is able to take them by mouth, and when unable to take fluids by mouth 
they should be given by proctoclysis, either continuously or at intervals. When 
there is free discharge of pus the dressings should be changed as frequently 
as required to keep the wound clean and the skin surface free from irritation. 
Care of the genito-urinary tract is very important in the nursing of post- 
operative cases and may involve catheterization and bladder irrigation. Cath- 
eterization is a word generally used in connection with the withdrawal of fluid 
from a body cavity, particularly with reference to the removal of urine from 
the bladder or ureters. The purposes of the latter type of catheterization are: 
To relieve the discomfort of a patient when, because of retention he is unable 
to void; to obtain a sterile specimen of urine; and to empty the bladder when 
urination is involuntary. For catheterization the following articles are re- 
quired: Sterile boric-acid solution; sterile dressing bowl, sterile rubber cathe- 
ters (sizes 10 and 12), sterile lubricant (oil), sterile sponges, two sterile dress- 
ing towels, sterile gloves and gown, urinal or basin to receive urine (sterile 
when so required), and a waste receptacle. Remember, always, to use strict 
aseptic measures in preparing for and carrying out this procedure; never to 
catheterize until all routine means of inducing patient to void have been ex- 
hausted and then only when ordered by a medical officer; to have hands surgi- 
cally clean and not to touch the catheter on or near the end to be inserted nor 
to let it come in contact with anything unsterile; to have good light. 
After properly cleansing the glans and protecting with a sterile sponge, 
placing sterile towels, the attendant disinfects his hands, puts on sterile gloves, NURSING 
327 
lubricates the catheter, and introduces it without force until it enters the 
bladder and the urine starts to flow. When the bladder is empty remove the 
catheter carefully, and apply a sterile compress to urethral exit. When cathe- 
terizing observe the following precautions: Never use force; have all articles 
used sterile, and hands surgically clean as improper care and the introduction 
of bacteria into the bladder or injuring the mucous lining of bladder or 
urethra may give rise to an inflammatory condition which is very hard to 
cure. If the bladder is distended greatly, not more than 600 cc of urine should 
be removed at once, as the bladder walls would collapse; enough urine should 
remain in the bladder to keep its walls separated until they have gradually 
contracted to normal size. Measure the urine obtained and record the amount on 
Clinical Notes, together with the time of catheterization. 
Expedients that should be tried to cause voluntary micturition before cathe- 
terization is resorted to are: Placing the patient on a bedpan and pouring 
warm water over the pubis; applying hot compresses or a hot-water bag to 
the pubis; if the patient is near a bathroom, allow water to run from a faucet, 
in order that he may hear the sound of running water; give plenty of liquids 
to drink, if allowed, especially mineral waters, and lemonade; and with the medi- 
cal officer’s permission only, allow the patient to sit up, with support. This latter 
procedure must not be permitted without the medical officer’s consent. 
Bladder irrigation is the washing out of the bladder. The equipment 
consists of the catheterization tray, a silver return catheter, or a Y-connecting 
tube with stopcocks; sterile irrigating can with sterile solution (usually 
boric-acid solution) at required temperature, sterile tubing with clamp for 
regulating inflow attached to can which is covered with a sterile towel, 
and a piece of sterile tubing to attach to the Y-tube for the outflow; a rubber 
operating pad or other protection for bed, and bucket to receive return flow; 
a sterile solution thermometer. Prepare the patient as for catheterization 
and hang the irrigating can about 12 inches above the patient’s hips. Place 
the patient on the pad, the free end of which extends into the bucket at 
side of bed. Attach a piece of sterile tubing to lower projection of the 2-way 
catheter, with stopcock shut; allow solution to run through tubing on can 
until of the required temperature and until all air is expelled from tubing, 
which is then attached to the Y-tube, the stopcock of which is closed. Open 
the cock on outflow and catheterize patient, again closing cock before any 
air has entered the tubing; open the cock on inflow and allow half a pint 
of solution to flow into the bladder, after which open the stopcock on the 
outflow and allow solution to flow in and out until the desired amount has 
been given. Because of the restriction of the outflow at the beginning there 
is at all times in the bladder sufficient solution to thoroughly bathe the 
bladder walls. Before all solution has left the can, apply the shut-off. Allow 
all the solution to flow from the bladder, and finish treatment as following 
catheterization. 
Surgical dressings and dressing surgical wounds. 
The purposes of surgical dressings are to prevent contamination of the area 
surrounding a wound and its consequent infection, to keep the wound clean 
and protect it from mechanical irritation, to absorb discharges and thereby 
protect the patient, his clothes, and his bedding from becoming soiled. 
Surgical gauze and absorbent cotton are the materials used most frequently 
in the preparation of surgical dressings. The particular method for folding 
the gauze and the shape and size of the sponges and packing used depend upon 
the preference of the surgeon and the size and type of the wound dressed. 328 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Whatever method is used, one fundamental principle remains the same—that 
is, ail raw edges are well folded in so that no ra veilings are free to get into 
the wound during an operation or dressing. This precaution is especially 
necessary when dressing abdominal or other deep wounds. Absorbent cotton 
may be made into small balls, or fluffs, for eye work, etc., or made into 
pads of various sizes and covered with gauze for use over the dressings 
of discharging wounds. These pads, unsterile, are used in various ways for 
padding and protection at pressure points. 
There are various kinds of surgical dressings which are designated by 
names indicative of the kind. The simplest dressing used is the dry dressing 
which consists of dry, sterile gauze, applied to a wound, and held in place 
by bandage or adhesive plaster. Wet dressings consist of gauze moistened 
with solution and covered with some protective material, as oiled muslin, to 
help the dressings retain the moisture and to protect the patient and his bed 
from dampness. Such dressings are kept moist by solution poured in through 
an aperture left for that purpose or injected in required amounts through 
tubing inserted in the wound with the outer end extending outside the dress- 
ings. Hot wet dressings should be applied in the form of sterile fluffed cotton 
or folded gauze compresses wrung out of a hot sterile solution. After appli- 
cation they should be covered with oiled silk or other similar protective 
material to keep the moisture from the pajamas and bed clothes, and to guard 
the wound from the absorption of infectious matter. Over the oiled silk should 
be placed a binder, bandage, or dressing towel, fastened not too tightly, to 
hold the dressings in place. Over all a hot-water bag should be placed to 
keep the dressings warm. Never allow hot dressings to become cold. 
Before discussing the dressing of surgical wounds it is necessary that one 
should know the important facts relative to the natural healing of wounds 
and the conditions which interfere with their healing. For that information 
see under Wounds in the section on Minor Surgery and First Aid. 
In the dressing of surgical wounds, whether in the dressing room or at the 
bedside, there are many important things to be remembered. All necessary 
equipment for a dressing should be ready on a dressing tray or dressing car- 
riage, there should be ample light, and the patient should be in proper position 
for his comfort and the convenient dressing of the wound. Always dress aseptic, 
or clean, wounds before septic, or suppurating, ones, maintain absolute aseptic 
technique in the dressing of all wounds, and avoid unnecessary conversation dur- 
ing a dressing. When removing adhesive plaster moisten it with ether or ben- 
zine, and before attempting to remove adherent gauze moisten it with a sterile 
solution. When removing adhesive strips pull them quickly toward the wound 
to prevent pulling or spreading it. Remove the dressings where possible with 
sterile forceps, seizing the sponge in the center and turning the hand so that 
the discharge on underside of dressing may be examined. Open packages of 
sterile supplies quickly and correctly without contaminating the contents with 
the fingers. The sterile sponges may be tipped from the cover onto the sterile 
towel or tray without contamination and the attendant’s hands thus left free. 
With clean, sterile forceps (not the ones used to remove the soiled dressings) 
seize the sterile sponge, moisten it with alcohol, and carefully wash the skin 
about the wound, always wiping away from the wound, never toward it. In 
dressing and cleansing a wound never touch with the fingers anything that may 
be handled with forceps. If necessary to remove a cover from a jar or stopper 
from a bottle, the contents of which are sterile, be very careful not to contami- 
nate the inner surface of either; if necessary to lay them down, place them with 
outer surface down and make sure that nothing falls on the inner surface; re- NURSING 
329 
move sterile contents from the container with sterile forceps, spatula, or other 
suitable sterile implement and replace the cover as soon as possible. When pour- 
ing a sterile or disinfecting solution from a bottle into a wound or onto a sterile 
sponge, unless the entire neck of the bottle is sterile, wipe off the top and the 
lip with alcohol or other disinfectant before pouring the solution, and pour a 
little into a basin before pouring any into the wound or onto the gauze. When 
lifting or holding a sterile basin of solution never take hold of the edge or 
allow fingers to dip in the solution. Slip hands well under the basin and hold 
it steady, being careful to not cough or sneeze, or while talking to allow droplets 
to fall into the basin. 
The preparation for and assisting with a dressing calls for conscientiousness 
in regard to technique and exactness in attention to detail. The equipment of 
a dressing tray or carriage varies according to the methods of the surgeon and 
the general routine of the hospital; but one thing is the same concerning all 
such equipment—each article has it own place, so that there will be no delay 
in finding each thing as needed. The tray or carriage is covered always with 
a sterile field cloth, on which the sterile articles are placed and covered with 
another sterile cloth, which is turned back or taken off as necessary. Accord- 
ing to the number of dressings to be done, the tray should contain: Instru- 
ments.—Sterile forceps, hsemostats, probes, grooved directors, scissors, sterile 
syringes, needles, and a sterile flask of solution; Materials.—Sterile dressing 
towels, gauze sponges, pads, and packing, sterile applicators, safety pins, and 
gloves; Nonsterile articles.—On the unsterile shelf of the carriage should be 
arranged bandage scissors, bandages, adhesive plaster, oiled silk or paper, binders 
(as necessary), safety pins, rubber operating pad or rubber sheet, and attached to 
carriage should he a bag or bucket for discarded dressings; Drugs.—Iodine, alco- 
hol, sterile vaseline, ether (or benzine) ; also any special drugs, preparations, or 
solutions required by the surgeon should be on the unsterile portion of the car- 
riage as should extra packages of sterile gauze, unopened. Instruments required 
for a simple routine dressing are: One pair of tissue forceps, one pair of 
hsemostats, one probe, one grooved director, and one pair of scissors. 
In a simple routine dressing proceed as follows: After the proper arrange- 
ment of the bed linen, pajamas, and shoulder or chest coverings, unpin the 
binder and turn it back, then loosen the adhesive straps at one side or cut 
through the middle. Place the dressing carriage conveniently by the bedside. 
Remove soiled dressings with sterile forceps, which are then discarded or placed 
in disinfecting solution. With a dry, sterile sponge or sponge dipped in alcohol 
or other prescribed solution, cleanse the area about the wound, wiping away 
from the wound, never toward it, and never going over the same area twice 
with the same sponge. Handle the sponge with sterile forceps, using a fresh 
sponge each time any area about the edge of wound is wiped. Dress the wound 
itself as directed, apply fresh sterile dressings, and secure them with bandage 
or adhesive tape, or with adhesive tape and binder as the case may be. Clean 
wounds are disturbed as little as possible, and after the first few dressings 
and the removal of the sutures the dressings are changed only as they become 
soiled or loose and disarranged. Infected wounds are dressed at least once a 
day and more often as necessary. The surgical technique of the ward surgeon 
must be followed in detail by whoever does the dressing. 
When a wound is being irrigated, the tubing from the irrigator should be 
handled carefully to prevent the tip and adjacent tubing from being con- 
taminated. Grasp 6 or 8 inches from the free end. Never squeeze a sup- 
purating wound nor any localized collection of pus, there being danger of bruis- 
ing the adjacent tissues and causing the infection to spread. Remove sloughs 330 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
and stringy fibers of dead tissues from a wound with forceps or by irrigation; 
never rub out with gauze, because irritation of the tender underlying tissues 
and spread of the infection may result. When gauze packing is used in a 
wound do not pack it tightly; it should be loose and fluffy, otherwise it will 
not absorb the secretions, and drainage will be interfered with. If the skin 
around a wound is irritated by the drainage, cover the area with sterile vase- 
line. When there is profuse discharge from a wound the dressings should be 
changed frequently to prevent spread of infection, unpleasant odors, uncleanli- 
ness, and discomfort. Before applying a caustic, such as nitrate of silver, 
thoroughly dry the area chosen for the application. Before and after doing 
dressings the attendant should thoroughly scrub and disinfect his hands. 
Abdominal paracentesis is a surgical procedure used to draw fluid from the 
abdominal cavity and for which sterile technique is required. The usual equip- 
ment is iodine and alcohol for the skin, a few sterile sponges, 2 or more trocars 
and canuhe with rubber tubing attached, rubber operating pad or rubber sheet 
to protect bed, a scalpel, a 2 cc syringe and small needle with 2 per cent procaine 
solution for skin anaesthesia, and a bucket to catch the fluid withdrawn. The 
patient must be supported in a sitting position if possible. Sterile rubber gloves 
and sterile field sheets should always be used. This treatment is frequently neces- 
sary in heart and kidney cases in order to relieve the distress caused by the 
distention following the accumulation of fluid in the abdominal cavity. 
Nursing in eye, ear, nose, and throat conditions. 
Because of the delicate structures of the eye, ear, nose, and throat, there is 
required in the treatment of conditions affecting those organs an unusual de- 
gree of gentleness on the part of those giving such treatment. Carelessness 
or roughness may result in blindness, deafness, serious injury to the nose or 
throat, infection of the sinuses or other adjacent parts, and not infrequently 
in the loss of the senses of taste or smell. 
All treatments of eye conditions must be done with the utmost care, both 
to avoid injury and to prevent infection. Absolute cleanliness of the atten- 
dant’s hands and of the apparatus is essential and must be scrupulously 
maintained. 
When giving an eye douche or irrigation always have adequate light. Never 
use force or pressure in opening the lids or in directing the flow of the solu- 
tion. Never direct the stream of fluid against the eyeball, but gently, at an 
oblique angle, so that the flow is from the inner angle of the eye to the outer. 
Tilt the head toward the side on which is the eye to be irrigated. Cleanse 
the lids from all accumulation of discharge before starting an irrigation. Pro- 
tect and cover one eye while the other is being treated. When both eyes are 
being treated, protect each during the treatment of the other, sterilize the 
hands, and use fresh tips and other equipment for the treatment of the second 
eye. Never use a swab or eye wipe a second time, but, once used, discard it at 
once. Never allow an irrigation point or tip to come in contact with the eye- 
ball or lids. Dry gently with absorbent cotton, wiping from the inner to the 
outer angle of the lids. Thoroughly cleanse and sterilize all points, tips, 
pipettes, or syringes used, both before and after the irrigation. All such 
articles used in eye treatments should be reserved for that purpose only. The 
attendant should properly protect himself from infection, especially where there 
is profuse discharge, by using goggles, gown, and gloves when necessary. 
All possible precaution should be taken to prevent discharges collecting at 
the entrance to the lacrimal sac, and thus infecting it. Irrigation should be 
continued until all discharge is removed; in case of inflammation without dis- NURSING 
331 
charge, it should be continued until the prescribed 'amount of fluid has 
thoroughly flushed the eye. 
In the instillation of drops remember to keep the pipettes or medicine 
droppers used in this form of eye treatment absolutely clean and use them 
for nothing else. There should be a pipette for each of the various drugs 
used and they should not be interchanged. Where available, use special bottles, 
properly labeled and containing their own pipettes which serve also as stoppers. 
Drugs used for eye treatments should not be kept with other drugs but kept 
in a place reserved especially for them. When instilling drops instruct the 
patient to tilt his head backward and slightly to the side on which treatment 
is to be given; give him a soft compress or piece of absorbent cotton to catch 
the overflow of secretion sometimes caused by the instillation. Gently draw 
down the lower lid until a pocket-like space is formed by the folds of the 
conjunctiva. Into this space drop the medication, then instruct the patient 
to roll the eyeball outward, that there may be less chance of the drop striking 
directly over the pupil of the eye. Release the lid and, as the patient auto- 
matically closes the eye and rolls the eyeball, the drop wull be distributed 
over the surface of the eye and over that of the conjunctiva lining the lids. 
If more than twm drops are ordered, remember that the free space about the 
eye will not accommodate more than two drops, and sufficient time must be 
allowed after the instillation of that amount to allow the contents of this 
space to become normal again before the additional drops are put in. 
Before the application of an ointment to the eyelids the eye and the lids 
should be cleansed if it is possible and is permissible. The ointment then 
should be applied with an absorbent-cotton fluff made especially for use in eye 
cases, or with an eye spatula. If ordered to place the ointment within the 
eye space, put it on and under the lower lid and draw the upper lid down 
over the lower. 
The removal of foreign bodies from the eye may be accomplished in several 
ways. They may sometimes be washed out by using boric acid solution in an 
eyecup. When the foreign body can be plainly seen and is not embedded in 
the cornea or conjunctiva it is often easily removed with an eye fluff, or the 
corner of a handkerchief or other soft cloth brushed gently over the spot. The 
naturally increased secretions of the eye when irritated frequently wash 
out the foreign body without other assistance. Forcible blowing of the nose, 
with the upper lid drawn down over the lower one, sometimes accomplishes 
the same end. When a foreign body is embedded in the cornea, conjunctiva, 
or any part of the eye make no attempt to remove it but send for a medical officer, 
preferably an eye specialist. In the meantime bandage the eye to keep from 
increasing the irritation by motion. Emergency treatment before the arrival 
of a medical officer in case of burns, either from heat, acid, lye, or other definitely 
known cause, may consist of the applications within and without of sterile oil. 
Hot applications or fomentations are used to relieve pain and to reduce 
inflammation. Special points to remember are: Never use hot fomentations on 
the eye without an order from the medical officer. When applying fomenta- 
tions to both eyes, be sure to use the same compress on the same eye; and 
when there is discharge from the eyes never use the same compress twice, take 
a fresh one each time. Wash away discharges before starting treatment. 
Assemble all necessary articles at the bedside. Assist the patient to assume a 
comfortable position, with head slightly thrown back and the eye to be treated 
somewhat lower than the other eye to lessen the danger of infecting the well 
eye, and cover the good eye with an eye patch or other protective covering. 
Protect the patient and bed with rubber sheet and towel and have a paper bag 
154291°—30 22 332 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
or other waste receptacle fastened to the bed or placed conveniently near for 
receiving all debris. Keep the basin containing the solution on an electric hot- 
plate with the heat regulated to maintain the solution at the proper tempera- 
ture. Place a soft compress in a small stupe wringer and put the two in the 
basin of solution. After cleansing the eyelids of any discharge and applying 
boric acid ointment to them, take the compress from the solution, wring it out 
well to prevent dripping and gently place it over the closed eye. A little shake 
will cool the compress sufficiently, but be certain that, though hot enough to 
accomplish the desired result, it is not hot enough to injure the tissue or skin. 
Compresses so small cool very quickly, and during the time of treatment 
changing them is practically a continuous performance, one compress being 
always on the eye and another heating in the solution. Following the treat- 
ment, dry the eye, make the patient comfortable, remove equipment, cleaning 
and boiling basins, etc., and leave the tray in readiness for the next treatment. 
Time and frequency of treatments depend upon the medical officer’s orders, 
which many times designate continuous applications for 10 to 15 minutes every 
hour or two. 
Gonorrhoeal ophthalmia is a severe and purulent inflammation of the con- 
junctivas of the eye resulting from their infection with the mircroorganism 
causing gonorrhoea. The infection is especially virulent, its destructive work is 
very rapid, and unless prompt and persistent treatment is given serious impair- 
ment of vision and, not infrequently, blindness follows. This dangerous infec- 
tion is contracted through improper care of hands by one suffering from 
gonorrhoea who is ignorant of its dangers; through carelessness of those dressing 
such cases, by rubbing the eyes with the hands during or following the dressing 
before the hands have been thoroughly scrubbed and disinfected; by using a 
towel or other article previously used by an infected person; through the 
splattering of discharge into the eye of patient or attendant during the dress- 
ing. In the care of such cases it is important to remember to isolate the 
patient and all utensils, dishes, linen, and other articles used by him; to have 
a special attendant have charge of such a case that the treatment may be 
uniform and consistent ; to have the attendant wear gown and gloves and 
protect his eyes by large glasses, which are cleansed and sterilized after each 
treatment; to keep hands away from face and eyes during treatment and to 
thoroughly cleanse and disinfect them following each treatment; to promptly 
and conscientiously give treatments and irrigations ordered, remembering that 
any pus left in the eye rapidly increases the infection which may involve the 
cornea and permanently impair the vision. Remember if only one eye is 
infected to keep the other properly covered and protected at all times so that 
no infectious material may gain entrance to it. The general procedure in the 
care and treatment of such cases is the same as for all infected eyes; the 
above points are emphasized because of the virulence of this infection, the 
rapidity of its increase when neglected, and the destructive results which 
follow. 
Operations on the eye are usually performed under a local ansesthesia. For 
this reason the patient should be reassured and instructed as to the importance 
of remaining quiet and not moving until permission is given by the surgeon. 
Especial care should be taken to place the patient in a comfortable, unstrained 
position before the operation starts, and on his return to the ward to see that 
his position is as comfortable and relaxed as the position required allows. 
Surgeons’ orders in regard to preoperative preparation must be explicitly fol- 
lowed. As in all cases, unless otherwise ordered, the patient should shave and 
take a full bath the evening previous to the operation. Following an operation NURSING 
333 
on the eye the surgeon will give definite directions as to postoperative care, 
especially in cases where the patient must not turn his head or be jarred or 
in any way help himself, as following an operation for cataract, iridectomy, 
or similar conditions. Bandages must not be loosened or tightened except by 
the surgeon’s orders, and any misplacement of the bandage or dressings must 
be reported at once to him. Following an operation on the eye all dressings 
done and treatment given must be carried out with the most painstaking 
surgical technique. Impairment or loss of vision is a most grievous affliction. 
Most nursing treatment of ear conditions consists of irrigations of the 
external auditory canal. They are termed aural irrigations and should never 
be given, nor should fluid of any kind be ever introduced into the canal, 
without a medical officer’s authorization. It is necessary to exercise great 
care in giving aural irrigations and certain precautions should always be 
taken. Never use a cold solution but have it at the proper temperature and 
of the required strength. Never use a sharp instrument in the ear, as it might 
puncture the drum or cause injuries and abrasions through which serious 
infection might be introduced. When applicators are used for cleaning the 
auditory canal, or applying ointment or medication, the ends should be ade- 
quately padded with absorbent cotton, carefully rolled on and tested before 
the applicator is introduced within the canal, that there may be no danger of 
the cotton falling off before the withdrawal of the applicator. Never use force 
with an instrument or fluid. The irrigator tip should be of rubber, or if a 
glass tip is used it should be covered with a soft rubber catheter, this only 
being inserted in the ear. A special aural tip goes into the ear only the 
required distance; if a rubber catheter is used it should be inserted only 
just beyond the external orifice, that there may be no injury to the inner 
surface or to the drum of the ear. 
To give an aural irrigation it is necessary, as in all procedures, to assemble 
all equipment at the bedside or in the dressing room. Where possible, and 
when permitted, have the patient in a sitting position; otherwise have him 
lying down with his head turned somewhat to one side and slightly forward. 
Protect the patient and, where necessary, the bed, with a rubber sheet and 
towel. Have a kidney basin held under the ear, close to the head and cheek, 
which are protected from pressure by a pad of absorbent cotton. Cleanse the 
outer ear and the auditory canal from any accumulation of discharge with 
an absorbent swab, discarding the swab at once into the waste receptacle. 
Hang the irrigating can containing the solution about 12 inches above the 
patient’s head. Make certain that the temperature of the solution is correct; 
if a solution thermometer is not available, run fluid through tubing over 
the back of the hand until comfortably warm, which at the same time expels 
all air from the tubing. Grasp the lobe of the ear and draw it gently but 
firmly upward and backward to straighten out the canal for the inflow of fluid. 
Direct the stream of the irrigation against the upper surface of the canal, 
that the fluid may flow gently, without force, against the drum of the ear. 
The outflow should be continuous during the irrigation and all foreign matter 
removed by the flow should be noted and its amount and character, together 
with the time of treatment, recorded on the patient’s Clinical Notes. When 
the irrigation is given to ease pain or to reduce swelling or inflammation the 
patient should be questioned as to the relief given and his answer recorded; 
any change in appearance should be noted. Following the irrigation, dry out 
the canal with a swab and dry off the external ear. Sometimes a soft bit of 
cotton is placed in the outer opening to catch any remaining solution or dis- 
charge, but frequently the ear specialist forbids any closing of the outer 334 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
aperture when an ear is discharging, for fear of obstructing free outflow, and 
thus encouraging an extension of the infection to the inner ear and adjacent 
parts. Always protect the pillow of a patient having a discharging ear with 
a rubber sheet or pillowcase and a towel, and provide the patient with plenty 
of absorbent cotton to hold or place under the ear and to keep the outer surface 
of the ear clean. See that soiled pieces of gauze, etc., do not accumulate, but 
that they are at once placed in the waste receptacle provided for them. Fol- 
lowing treatment, cleanse and sterilize the equipment and leave in readiness 
for the next treatment. 
Many of the nose and throat conditions requiring nursing treatment are those 
that follow operations for abscesses, adenoids, deviated nasal septum, nasal 
polypui, removal of tonsils, etc. The nursing treatment to be given in these 
and other nose and throat conditions is usually in accordance with specific 
orders given by the medical officer for each case. 
Nasal irritations and pharyngeal douches are frequently ordered in the 
treatment of nose and throat conditions and instructions concerning each 
immediately follow. 
In administering nasal irrigations the stream should be of small caliber and 
under slight pressure. The patient should lean forward with his chin depressed 
and mouth open, and should breathe through the mouth. The great danger 
attending a nasal irrigation isi infection of the middle ear, caused by forcing 
some of the discharge into the Eustachian tube. The following is a list of 
the articles required for this treatment: 1. A small irrigator with 12 inches 
or more of rubber tubing attached; 2. Nasal tips attached to the distal end of 
the rubber tube; 3. A basin in which the used solution may be collected; 4. A 
towel; 5. A piece of gauze to be used as a handkerchief; and 6. The desired 
solution (usually physiological salt solution at a temperature of 108° F.). 
Place the solution in the irrigator, properly connected with the tube and 
nasal attachment; hang the irrigator in such a position that it will be 2 or 
3 inches higher than the patient’s nose; allow the solution to flow through 
the tube until the air contained therein has been expelled, at which time the 
flow is checked by pressure of the thumb and index finger. Insert the nasal 
tip in one nostril and permit the solution to flow into that nostril and escape 
through the one on the opposite side, thus washing out the nasal cavity. If 
either one or the other side of the nasal cavity is obstructed, the solution 
should be allowed to flow into that side until the obstruction has been removed, 
care being taken not to cause too great a pressure. Irrigation should be dis- 
continued immediately if the patient begins to cough or choke. 
The chief purposes of a pharyngeal douche are to prepare for an operation on 
the interior of the throat and to act as a cleansing agent in suppurative conditions 
of the throat. The following appliances are necessary; 1. An irrigator; 2. A 
piece of rubber tubing 2 to 4 feet long with a clamp attached; 3. A tip (a 
curved drinking tube often is used) ; 4. A tongue depressor; 5. A rubber dressing 
sheet; 6. A dressing towel; 7. A basin; and 8. One quart of physiological salt 
solution, temperature 100° F., or a specially ordered solution. In administering 
this treatment it is advisable to cover the rubber sheet with a dressing towel 
and place it about the patient’s neck for the protection of the bed and the 
patient’s clothing. The irrigator should be filled with the required solution and 
placed in such a position that it is 3 feet above the patient’s head, which 
should be bent forward to prevent the discharge, if present, from being washed 
down the patient’s throat. The basin should be so placed that it collects the 
used solution which flows from the mouth. The patient’s tongue should be 335 
NURSING 
depressed with a tongue depressor and the tip moved gently from side to side 
in such a manner that the irrigating fluid will reach all parts of the pharynx. 
Should it be inadvisable to have the patient in a sitting posture, the irrigation 
may be performed with the patient lying in bed with his head turned to one 
side. 
NURSING CARE OF COMMUNICABLE DISEASES 
Communicable diseases are those which may be transmitted from one person 
to another and are caused by the invasion of the body by living microorganisms. 
Their entrance into the body is by way of the mouth and nose (respiratory 
and alimentary tracts), from contaminated food and drink, droplets from breath, 
infected dishes, linen, and contaminated articles, by bites of infected insects 
(mosquitoes, body lice, fleas, flies), and by entrance of infective agents through 
abrasions of the skin and mucous membranes. Tetanus, food infection acquired 
from the flesh of diseased animals, botulism and diseases such as tularaemia 
in which an animal serves as a reservoir of infection, are all classified as 
communicable but are not, under ordinary conditions, transmitted from one 
person to another. 
Often communicable diseases appear in wards other than those assigned 
to such diseases and it is essential that one should be able to recognize 
their symptoms and promptly take the necessary steps to provide for the 
patient’s removal to the appropriate ward, and thereby materially lessen 
the danger of other patients becoming infected. 
Communicable diseases are fully described in the section on Hygiene and 
Sanitation and the general precautionary measures that must be observed 
in the care of all such diseases, with an outline of the nursing care required 
in some of those most frequently met with, will now be given. 
Those caring for patients with communicable diseases should: 1. Wear 
a cap and gown, and rubber gloves if necessary, while in the ward or room; 
2. Thoroughly scrub their hands and wash their faces, if possible in running 
water, before leaving the ward or room and before meals, and mpke a prac- 
tice of keeping their hands away from their faces; 3. Scrub their hands 
with soap and water and then immerse them in an antiseptic solution after 
doing anything for the patient or handling contaminated articles; 4. Wear 
glasses and a gauze mask over the nose and mouth when caring for patients 
suffering with diseases in which the causative agent is found in the secretions 
of the nose and mouth as in diphtheria, meningitis, measles, etc., and be 
especially careful to avoid the spray from the nose and mouth when the 
patient is coughing or sneezing. 
They should guard their own health by taking sufficient and proper nourish- 
ment, avoiding excessive fatigue, taking sufficient exercise in the open air 
and sunshine, personal cleanliness, and protection by appropriate innocu- 
lations. Whenever possible those assigned to the Immediate care of patients 
suffering with a communicable disease should be immune by reason of having 
had the disease or by having been artificially immunized. 
When removed, gowns should be folded so that the inside is kept clean; 
if hung in the room of the patient the contaminated side should be out and 
if hung in an adjacent room the contaminated side should be folded in. 
Gowns should never be worn away from the immediate vicinity of the ward 
or room. 
For medical officers and others not in regular attendance on patients with 
communicable diseases provision should be made for the cleansing and dis- 
infecting of their hands before leaving the room after completion of their 336 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
visit. A basin of hot water, Tincture of Green Soap, a disinfectant, and 
clean towels should be in readiness for that purpose. 
A patient with a comjmunicable disease should be isolated, that is, com- 
pletely separated from others and direct or indirect contact between the 
patient and others prevented, and both concurrent and terminal disinfection 
must be conscientiously practiced in his care. 
Patients having communicable diseases are generally isolated in special 
wards or rooms distant from others and with which communication with 
other departments can be controlled in order to prevent as much as possible 
any spread of the diseases. Usually such wards or rooms are large, sunny, 
well ventilated, and completely screened to keep out mosquitoes and flies. 
There should be no unnecessary furniture, and what furniture there is should 
be cleaned daily by wiping with a cloth dampened with a disinfectant such 
as a 1 in 40 solution of phenol. 
Concurrent disinfection is the prompt disinfection and disposal of infective 
material throughout the course of a disease. It must ever be kept in mind, 
its importance never minimized, and its practice never omitted. All articles 
used in the examination of a patient and those used by or for him should 
ordinarily be left in his room and disinfected after use. His bed and other 
linen should be disinfected or sterilized before being sent to the laundry. 
Discharges, droplets, and excreta, any and all of which may contain bacteria, 
must be properly disposed of and disinfected. Gauze handkerchiefs and paper 
sputum cups should be burned. Excreta should be kept covered until such 
time as they may be disposed of readily by disinfection or burning. 
Terminal disinfection is the definite measures taken to prevent the spread of 
a communicable disease by infectious material after the termination of the dis- 
ease. It depends upon the degree of communicability of the disease and the 
avenues through which infection enters, is discharged, and is carried. Before 
a patient who has had a communicable disease is discharged or transferred from 
isolation he should be given a thorough cleansing, including the hair, before he 
is discharged or transferred from the ward or room. A disinfecting bath, bi- 
chloride of mercury 1-10,000, is sometimes ordered. Especial attention should 
be given to the throat and mouth, and the eyes carefully cleaned. A clean sheet 
should be arranged for the patient to step on as he leaves the tub or shower, and 
fresh, clean clothing provided for him to wear when he leaves isolation im- 
mediately following his bath. All his baggage and belongings should have been 
previously sterilized or disinfected and placed in proper storage and safe-keep- 
ing. Following the patient’s departure the windows of the room should be 
opened wide to admit plenty of fresh air and sunshine. The walls, furniture, 
and paintwork should be washed thoroughly with soap and water, followed, 
when ordered, with a disinfecting solution such as phenol 5 per cent. Mattresses 
and pillows should be thoroughly aired and sunned for at least 48 hours or steri- 
lized if necessary, and all bed and other linen sterilized immediately. All dishes 
and utensils should be sterilized by boiling for 20 minutes before returning them 
to their proper places. The clinical thermometer should be immersed (entirely 
covered) in a disinfecting solution, e. g., formaldehyde 2 per cent, for at least 30 
minutes. In certain instances where deemed advisable, fumigation is used. All 
attendants should take precautions and practice methods of cleansing and disin- 
fecting their persons and garments to prevent conveyance of infected material 
from the patient to themselves and to others. 
In addition to the discussion of the nursing care of the communicable dis- 
eases which follows, the diseases mentioned are arranged in special groups and 
a brief discription of each disease given. NURSING 
337 
Diseases characterized by a skin eruption. 
Measles.—Cause: A filtrable virus transmitted by discharges from the mouth 
and nose; incubation period about 8 to 14 days; symptoms are coryza, sneezing, 
cough, nausea, vomiting, chilliness, and fever on the first day from 102° to 104° 
F. which on the third day gradually drops and then rises with the appearance 
of the eruption, the temperature dropping by lysis as the rash fades. The erup- 
tion is seen first on the mucous membranes of the cheeks, prior to its appear- 
ance on the skin. On the third or fourth day it appears on the chin or forehead, 
sides of the neck, face, and the body. It consists of red, elevated spots which 
run together, forming crescent-shaped blotches. Common complications of 
measles are: Broncho-pneumonia, laryngitis, otitis media. The nursing care 
consists of darkening the room or shading the eyes, forbidding the patient to 
read and washing the eyes frequently with boric-acid solution. The nose, 
mouth, and throat should be kept clean and the room warm and free from 
drafts. Itching of the skin may be troublesome and may be relieved by cocoa 
butter rubs. 
German measles.—The cause is unknown but it is transmitted by discharges 
from the mouth and nose; incubation period 14 to 21 days usually about 16 
days; symptoms are headache, conjunctivitis, pharyngitis, swelling of the 
glands of the neck, especially those behind and just below the ears, under the 
occiput, and in the back of the neck, and slight febrile rise. The temperature 
for a short time may be quite high. In some cases the constitutional symptoms 
are so slight that the patient hardly seems to be sick. It frequently happens 
that the first knowledge a patient has of the disease is the appearance of the 
eruption. The rash and the swollen glands are the two principal diagnostic 
symptoms. The eruption appears within 24 to 48 hours, first on the face, then 
spreading over the entire body, and usually beginning to fade on the second day. 
It consists of large, isolated, pinkish macules, resembling the rash of scarlet fever 
but without the characteristic stippling of the latter disease. The eruption, 
which usually is altogether out of proportion to the constitutional symptoms, 
sometimes presents a papular appearance and occasionally consists of small 
vesicles, which may appear in crops. Pneumonia, nephritis, intestinal dis- 
orders, and suppuration of the enlarged glands are complications which may 
occur. The nursing care consists of quietness and rest in bed for at least 1 
week, hot or cold applications to the neck, washing the eyes frequently with 
boric-acid solution, relieving itching of the skin (if present) with cocoa-butter 
rubs and keeping the nose, mouth, and throat clean. 
Scarlet fever.—Cause: A haemolytic streptococcus transmitted by discharges 
from the mouth and nose; incubation period is from 2 to 7 days, usually 3 or 
4; symptoms are sudden onset with nausea, vomiting, chill, sore throat, head- 
ache, fever, and rash on second or third day. The temperature is 104° to 105° 
F. for the first 4 or 5 days, dropping by lysis. The eruption or rash appears 
within 18 to 36 hours, first on the chest and neck, then on the back, face, arms, 
legs, hands, and feet. It is pin point in appearance, usually scarlet red, very 
diffuse, and disappears upon pressure. Desquamation takes place in long strips 
at the expiration of a week or 10 days, and continues from 1 to 7 weeks. Some 
possible complications are: Otitis media, acute endocarditis, nephritis, and 
arthritis. Chronic endocarditis and myocarditis, chronic nephritis, blindness, 
deafness, and paralysis may be sequelae to this disease. The nursing care 
consists of keeping the room warm and free from drafts, and carefully observ- 
ing the urine, which should be measured, and the appearance and amount 
charted. 338 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
Smallpox,—Cause: A filtrable virus transmitted by contact with persons sick 
with the disease and by articles or persons contaminated by discharges of the 
sick, including fseces and urine; incubation period usually is from 8 to 16 days; 
symptoms appear suddenly and consist of chill, vomiting, and severe headache 
and intense backache. The temperature is from 103° to 105° F., until the rash 
appears, at which times it falls. Pustules are formed, usually at the end of the 
ninth day, associated with a rise of temperature which after several days 
drops by lysis. The eruption appears on the third day on the palms, soles, and 
the hair line of the forehead, the first stage being characterized by a hard 
lump under the skin, the second stage by vesicles above the skin, and the third 
stage by the appearance of pus in the vesicles. Only one stage is present at a 
time. Some possible complications are septicaemia, pyaemia, myocarditis, nephri- 
tis, pharyngitis, abscesses, and cellulitis. The nursing care consists of wash- 
ing the pus from the lesions with a disinfectant, applying oil or vaseline to 
relieve itching, encasing the hands in cotton gloves, and irrigating the eyes every 
two hours. Anyone caring for a smallpox case should have been vaccinated 
recently. 
Chicken pox.—Cause: A filtrable virus transmitted directly from person to 
person and indirectly through articles freshly soiled by discharges from an in- 
fected person; incubation period is from 2 to 3 weeks; symptoms are chilliness, 
mild headache, and a temperature of 100° to 102° F., for the first two or three 
days, at the end of which time it returns to normal. The eruption appears with- 
in 24 hours in crops on the trunk, back, and chest, all stages being present at 
the same time, new crops coming out before the old ones have disappeared. The 
skin lesions are very itchy. The nursing care consists of sponging and oiling 
the skin daily, and using cotton gloves, if necessary. 
Diseases transmitted by discharges from the intestinal tract. 
Typhoid fever.—Cause: The Eberthella typhosa (Bacillus typhosus) trans- 
mitted by direct or indirect contact with a source of infection; incubation 
period is from 3 to 38 days, usually 7 to 14; symptoms are, at the onset, head- 
ache, nausea, pain in back, legs, and abdomen, loss of appetite, coated tongue, 
epistaxis, diarrhoea, and frequently bronchitis ; later the spleen becomes enlarged, 
the Widal reaction becomes positive, stools become liquid yellow (pea-soup ap- 
pearance), or the patient may be constipated. The temperature during the 
first week rises a degree or degree and a half higher each evening and drops 
slightly each morning. During the second week it remains continuously high 
(103° to 104° F.), with a very slight morning remission, and during the third 
week the remissions are more marked; in favorable cases the decline is gradual 
and in mild cases the temperature reaches normal at the end of the third week. 
The majority of normal cases end in the fourth week of the disease. The pulse 
varies from 80 to 100, is dicrotic and slow in proportion to fever. Haemorrhage 
and perforation of the intestine are indicated by a sudden, rapid, and weak 
pulse, associated with marked rapid fall of temperature. The tongue is coated 
white at first, and later becomes very dry and brown or black in the center. 
The approach of convalescence is indicated when the tongue begins to moisten 
and become clear around the edges. The mental condition is usually dull and 
stupid and frequently is accompanied by delirium. A continued low, muttering 
delirium, with picking at the bedclothes, is an unfavorable symptom. A typhoid- 
fever patient never should be left unattended. After 7 to 10 days small, rose- 
colored spots, which disappear upon pressure, appear on the abdomen, the lower 
part of the chest, and the back, remain for 2 to 3 days and fade, leaving a 
brownish stain for a time. Successive crops of “rose spots” form until the NURSING 
339 
middle of the third week. Some common complications are tympanites, haemor- 
rhage from the intestine, perforation of the intestine, and dilation of the heart. 
Endocarditis, empysema, periostitis, meningitis, pneumonia, phlebitis, and throm- 
bosis may be the sequelae. The nursing care consists of carefully watching the 
patient’s position, which should be recumbent and changed frequently, and sup- 
port being afforded with pillows. All exertion on the part of the patient must 
be avoided, and he should have absolute rest. The mouth should be kept clean, 
guarding against reinfection; the prescribed diet should be strictly adhered to 
and plenty of water should be given. Daily enemata usually are prescribed if 
necessary. No cathartics should be given, and the buttocks should be washed 
after each stool. Special care should be observed to prevent bedsores. 
Bacillary dysentery.—Cause: The Shigella dysentence and Shigella para- 
dysenterke (Bacillus flexneri), transmitted by infected foods, contaminated 
water, hand-to-mouth transfer of infected material, by flies, and by objects 
soiled with discharges from infected persons or carriers; incubation period is 
2 to 7 days. This disease is highly infectious, is characterzed by a sudden 
onset and its symptoms are frequent small stools, containing blood, mucus, pus, 
and very little faeces, and accompanied by tenesmus, with pain and tenderness 
over the colon. In severe cases the temperature is high, there is great prostra- 
tion, and excessive toxaemia. Death frequently results within a few days. 
Some of the common complications are emaciation and anaemia. The nursing 
care consists of maintaining plenty of fresh air, quiet, and cleanliness. Stools 
should be carefully observed and charted. Rectal irrigations frequently are 
prescribed, and in administering them great care and caution are necessary. 
Cholera.—Cause: The Vibrio comma (Spirillum cholera), transmitted by food 
and water polluted by infectious organisms, by contact with infected persons, 
carriers, or articles freshly soiled by their discharges, and by flies; incubation 
period is from 1 to 5 days, usually 3; symptoms headache, malaise, diarrhoea, 
and colic. During the later stage or stage of collapse, excessive vomiting, 
purging, high temperature, cold and clammy, shrunken and livid skin, rapid 
emaciation, intense thirst, severe muscular cramps, diminished secretion of 
urine, and rice-water stools (water and salts from the blood, and epithelium 
from the intestinal walls) are present. An increased temperature with a warm 
feeling of the body indicates the turning point, and recovery usually results. 
Failure of the heart action is the most common complication. The nursing 
care consists of isolation, absolute quiet, the application of external heat, and 
the administration of physiological salt solution by hypodermoclysis. 
Diseases transmitted by insects and other arthropods. 
Malaria—This disease results from invasion of the red-blood cells of man by 
one of at least three types of the genus Plasmodium, class Sporozoa, division 
Protozoa, of the animal kingdom. The three types are the Plasmodium vivax, 
i the cause of benign tertian malaria, the Plasmodium falciparum, the cause of 
malignant tertian or sestivo-autumnal malaria, and the Plasmodium malaria, 
i the cause of quartan malaria. The only known means by which malarial 
parasites are transmitted is by the bite of an infected female Anopheles mos- 
quito which usually bites at dusk or at night. Symptoms are chills and fever. 
During and after the chill the patient usually has a headache, is nauseated, 
the pulse is frequent and full, the temperature is very high (occasionally 
107° F.), and is accompanied by profuse sweating. Severe cases of malaria 
may show typhoidal symptoms, while mild cases usually feel comparatively well 
between chills, the temperature, pulse, and respiration being normal. Some of 
the common complications are ansemia, congestion of the liver and kidneys, and 340 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
bloody urine. The nursing care consists of noting and recording all chills, 
their duration, time of starting and ending, and their severity, varying from a 
slight chilly sensation to shaking of the entire bed. Temperature, pulse, and 
respiration should be taken every hour after a chill until they return to the 
previous temperature, pulse, and respiration. During a chill external heat 
should be applied and the patient surrounded with hot-water bottles and kept 
in bed. Plenty of easily digested, nutritious food should be given and the 
bowel and kidneys kept active. The prevention of malaria is taken up in the 
section on Hygiene and Sanitation. 
Yellow fever.—Cause: A filtrable virus transmitted by the bite of infected 
iEdes segypti and allied species of mosquitoes; incubation period is 3 to 6 days, 
rarely longer; symptoms characterized by sudden onset, a chill, muscular pain, 
especially in the legs and back, jaundice of the skin and conjunctives, and 
vomiting (sometimes black vomitus or digested blood). The eyes become 
watery, glazed, and sunken; the temperature reaches 102° to 103° F. for 2, 3, or 
4 days, when it drops to normal. At the end of 24 hours it rises to 102° F., 
then falls by crisis or lysis. The pulse rate is first 90 to 115 and later com- 
paratively slow. Some of the common complications are suppression of urine 
and haemorrhage from any part of the body. The nursing care consists of keep- 
ing the patient absolutely quiet. Hot applications, counterirritants, and light 
massage should be applied for muscular pain. All urine should be measured, 
its appearance noted and charted. The patient’s bed should be covered with 
cotton netting. 
Typhus fever.—This disease, the cause of which is Rickettsia prowaseki, 
Rickettsia quintana, and, provisionally, Rickettsia mooseri, occurs in a clas- 
sical, severe, epidemic form transmitted from man to man by the bite of the 
body louse, and in a mild, sporadic form transmitted from rat to rat or to 
man by scratching or rubbing the faeces of fleas into the tiny wounds made in 
the skin by the biting of the fleas, the infection not being introduced directly 
by bite; the incubation period is 5 to 20 days, most often 12 days; and the 
symptoms are variable onset, often being sudden, chills, headache, fever, gen- 
eral pains, toxaemia, and delirium. The temperature is high during the first 
week, with a marked remission in the morning during the second week, and. 
at the end of 13 to 14 days returns by rapid lysis to normal. A macular erup- 
tion appears on the fourth to sixth day as elevated rose spots or patches which 
later assume a dusky hue, lose elevation, and appear as ecchymotic areas 
under the epidermis. The nursing care consists of maintaining an abundant 
supply of pure, fresh air and the usual general fever nursing. 
Diseases which may result from an abrasion of the skin or mucous membrane. 
Tetanus.—The cause of this disease is the Clostridium tetani (Bacillus 
tetani), transmitted by direct infection of a wound; incubation period is com- 
monly 4 days to 3 weeks; symptoms are rigidity of muscles, beginning with 
the jaws and neck, and progressing until all except the arms are involved. 
Convulsions are caused by the slightest stimuli and vary in severity, some- 
times reaching the extent that the body becomes arched so that the head and 
heels only touch the bed. The temperature varies from 103° to 105° F., and 
the pulse rate is about 110. The nursing care consists of maintaining absolute 
quiet, keeping the room dark, and general nursing care and prophylactic 
measures. It is frequently necessary to resort to nasal or rectal feedings. 
Septicaemia.—Caused by pus-forming organisms transmitted directly to the 
blood stream; incubation period is from 2 hours to 2 or 3 days; symptoms are 
chills, temperature of 102° to 105° F., nausea, headache, anorexia, and all the NURSING 
341 
febrile symptoms. Cases of this disease often become typhoidal in type with 
or without delirium, the skin becoming cold, the body freely perspiring, marked 
cyanosis being present, and the face being pinched and drawn. Pyaemia is a 
common complication. The nursing care consists of maintaining plenty of 
fresh air, an abundance of nutritious food, and careful general nursing. 
Erysipelas.—Caused by the Streptococcus erysipelatis, a type of the Strepto- 
coccus pyogenes (Streptococcus haemolyticus); incubation period is from 24 
to 72 hours; symptoms are sudden onset with chill, nausea and vomiting, high 
temperature, and appearance of localized inflammation of the skin. The area 
of skin involved is red, swollen, and sharply limited, and sometimes is accom- 
panied by severe pain. The nursing care consists of isolation, the administra- 
tion of plenty of fluids, and rigid precautions against transmitting the infec- 
tion to surgical cases. It is imperative to use all prophylactic measures. 
Diseases of the respiratory tract. 
Influenza.—The primary cause is a filtrable virus, often associated with 
various types of other bacteria, transmitted by discharges from the mouth 
and nose; incubation period is from 2 to 4 days; symptoms are sudden onset 
with slight chill, intense aching of muscles (legs and back), coryza, frequently 
sore throat, and increase in temperature in mild cases to 100° to 102° F., in 
severe cases to 103° to 104° F., dropping by lysis to normal. Otitis media, 
sinusitis, bronchitis, pneumonia, and myocarditis are common complications. 
The nursing care consists of keeping the room warm and free from drafts and 
general nursing. 
Pneumonia, acute lobar.—Caused by infection of the lungs with various 
pathogenic bacteria such as the Diplococcus pneumoniae (Pneumococcus of 
Fraenkel), Klebsiella pneumoniae (Friedlander’s bacillus) and occasionally the 
Streptococcus haemolyticus and the Haemophilus influenzae (Bacillus influenzae), 
transmitted by direct contact with infected persons or carriers, or with articles 
freshly soiled with the discharges of the nose and throat of such persons, and 
possibly from infected dust of rooms occupied by infected persons; incubation 
period usually is from 1 to 3 days but is not well determined; symptoms are 
sudden onset with chill, severe pain in chest, fever, and usually cough and 
dyspnoea. The temperature rises to 104° or 105° F., and remains high for 
from 3 to 9 days, at which time it falls to normal or below in a few hours 
(crisis) or more slowly (lysis) ; the respirations are shallow, rapid (up to 60), 
and labored, and the pulse is full and bounding (96 to 120 or 140). During 
the first stage of the disease the sputum is a frothy, serous fluid mixed with 
mucus, and streaked with blood; during the second stage it becomes prune 
juice or brownish red in color, due to the presence of blood; and during the 
third stage it is abundant, shows evidence of less blood, which gradually 
disappears, the sputum gradually becoming less in quantity, until it returns to 
normal. Cyanosis, oedema of lungs, tympanites, circulatory failure, and pleu- 
risy are common complications. Empysema, abscess of the lung, and gangrene 
of the lung may be sequelae. The nursing care consists of limiting all move- 
ments of the patient which require exertion, etc. Tenacious or sticky sputum 
should be carefully wiped from the lips with small pieces of gauze and placed 
in a paper bag to be burned later. The patient must be encouraged not to talk 
too much. Visitors should not be permitted except by the medical officer’s per- 
mission. Unfavorable symptoms, especially delirium, should be watched for. 
Maintain plenty of fresh air, keep the patient warm, and avoid drafts. A rectal 
tube having its free end in a pus basin may be inserted and hot fomentations 
applied to the abdomen to relieve discomfort in tympanites. The patient should 342 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
not be permitted to sit up during convalenseence until orders to that effect are 
issued by the medical officer in charge of the case. 
Tuberculosis, pulmonary.—Cause: The Mycobacterium tuberculosis (hominis) 
(Bacillus tuberculosis), usually transmitted through discharges of the respira- 
tory tract and occasionally through those of the digestive tract, by direct or 
indirect contact with infected persons, by means of coughing, sneezing, or other 
droplet infection, by kissing, by the use of contaminated eating and drinking 
utensils, and possibly by contaminated flies and dust; incubation period is 
variable; symptoms are loss of appetite, loss of weight, a short hacking cough 
with the production of more or less sputum, a moderate increase of temperature 
in the afternoon, a hectic flush, especially in the afternoon, and a soft and 
rapid pulse. Later in the disease there are usually emaciation, progressive 
weakness, and night sweats. The nursing care consists of keeping the patient 
out of doors and dressed warmly, giving an abundance of nutritious foods, 
and general nursing care. Sputum cups should be kept covered and later 
disinfected and burned. Separate eating and drinking utensils should be pro- 
vided for a tuberculous patient and sterilized after use. Bed and other linen 
should be sterilized before being sent to the laundry, and all handkerchiefs, 
cloths or other articles soiled with sputum should be disposed of by burning. 
Tubercle bacilli of the type found in cattle and, rarely, of the type found in 
birds, have been found in pulmonary lesions in man. 
Diphtheria.—This disease occurs in the upper air passages and is caused 
by the Gorynebacterium diphtheritic (Bacillus diphtherioe) ; is transmitted 
directly by personal contact, indirectly by articles freshly soiled with dis- 
charges, or through infected milk or milk products; the incubation period is 
usually 2 to 5 days, occasionally longer; and the symptoms are general malaise, 
swelling of the glands of the neck, and soreness of the throat. At first the 
throat is red and slightly swollen but by the end of the first day a pale, gray 
membrane appears on the tonsils and may extend to the pillars, the uvula, 
pharynx, and soft palate. This membrane is removed with difficulty and 
leaves a bleeding surface. The temperature is comparatively low, seldom rising 
above 103° F., lasts from 7 to 10 days, and falls by lysis. The pulse is rapid 
and in severe cases, weak, and irregular. Cardiac weakness is indicated when 
the piilse rate falls below 60, or increases above 120. The common complica- 
tions are heart failure, acute nephritis, broncho-pneumonia, paralysis, especially 
of the muscles of the eyes, the pharynx, and the vagus nerve. The nursing care 
consists of spraying and irrigating the throat, giving plenty of nourishment 
and water, watching for regurgitation of food and water, and preventing all 
exertion and excitement. The patient should not be allowed to sit up too 
soon during convalescence, because of the danger of overtaxing the heart. 
Preventive measures are taken up in the section on Hygiene and Sanitation. 
Before concluding the nursing of communicable diseases it is necessary to 
give the general care required for patients suffering with inflammation of the 
meninges of the brain or spinal cord. 
Meningitis.—Cause: The Neisseria* intracellularis (Diplococcus intracellularis 
meningitidis, or Meningococcus), transmitted by direct contact with infected 
persons and carriers and indirectly by contact with articles freshly soiled 
with discharges from the mouth and nose of such persons; incubation period 
is 2 to 10 days, commonly 7; symptoms are sudden onset, chill, or convulsion, 
intense headache, projectile vomiting, photophobia, and strabismus. The tem- 
perature runs an irregular course; the muscles of the neck become rigid, the 
head is retracted, attempts to extend the thigh and leg meet with resistance, 343 
NURSING 
and the skin and muscles become very sensitive. Pneumonia, pleurisy, 
endocarditis, pericarditis, and otitis media are the common complications. 
Deafness, blindness, local or general paralysis, and mental derangement may 
be the sequela?. The nursing care consists of maintaining absolute quiet; 
keeping the room cool and dark and at a temperature of 65° F., the practice 
of general prophylactic measures, and nasal feedings, if necessary. 
In the condition known as delirium there is mental excitement and con- 
fusion which is usually accompanied by false sense-perception (hallucination) 
of objects or phenomena having no actual existence, as hearing voices or seeing 
imaginary persons, or a false interpretation by the mind (illusion) of actual 
objects, as mistaking a piece of furniture for an animal. Delirium usually 
occurs in a low muttering form or a vnld or violent and noisy form and among 
its causes may be mentioned toxaemia, anaemia, uraemia, the use of drugs, 
exhaustion from illness and shock, and acute or chronic alcoholism. 
NURSING CARE OF THE DELIRIOUS PATIENT. 
The characteristics of the low muttering type are constant or occasional 
disconnected and irrational speech, restless impulses, disturbing dreams, attacks 
of weeping or excitement, impaired mental and muscular power, involuntary 
urination and defaecation, and, frequently, plucking at the bed-clothes. When 
restlessness is present the patient continually tries to get out of bed and not 
infrequently attempts to escape. This type of delirium may be present in all 
the acute infectious fevers and in typhoid fever is almost invariably present. 
In the violent and noisy type, usually associated with toxic conditions due to 
uraemia, alcoholism, and poisoning by drugs, wild, maniacal excitement occurs. 
When caused by alcohol it is termed delirium tremens. The patient is noisy 
or quiet, violent or calm, at different times, but always is difficult to control, 
is usually insensible to his surroundings, his speech is rapid and incoherent or 
irrelevant, eyes open and staring with pupils usually dilated, and face flushed. 
In this type of delirium homicidal mania may suddenly develop. 
In the nursing care of a delirious patient remember never to leave him 
alone; even when the symptoms, appear mild he requires constant watching. 
Medicines should never be given in pill or powder form and his food or nourish- 
ment should be given regularly and slowly. If urination is not involuntary be 
sure that it takes place regularly, and if it does not occur at least once in 
every 8 hours promptly report the fact to the proper authority. An accurate 
record of the patient’s condition should be kept and other patients prevented 
from coming near him. Nothing with which the patient might injure himself 
or others should be where he might get it. Always have the means for quickly 
restraining a delirious patient near at hand. 
Restraint appliances consist of strait-jackets of various types, leather or canvas 
wristlets or anklets (commonly called cuffs) and other mechanical devices 
which are easily adjusted, are usually available for patients whose condition 
requires their use. For mild cases bed-boards, sheets and bandages may be 
used. Restraint appliances should be used only when absolutely necessary as 
they tend to antagonize and irritate a patient. In using restraint appliances 
care should be taken to insure that there is no interference with the patient’s 
circulation or respiration, and therefore a patient should never be restrained 
across the chest. Knots should never be within reach of the patient’s fingers 
or teeth and never where they might cause pressure or discomfort to him. 
When cuff restraint is used the cuffs should be applied on opposite sides for if 
applied to the same side the patient may easily fall out of bed and severely 344 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
injure himself. All restraints should be applied in such a way that they 
are neither too tight nor too loose. 
References 
Practical Nursing.—Maxwell and Pope. 
Modern Methods in Nursing.—Sanders. 
Principles of Nursing Care.—Smith, Broadhurst, et al. 
Hospital Corps Handbook, U. S. Navy, 1923. 
Handbook of the Hospital Corps, tl. S. Navy, 1930. 
Section 2.—WARD MANAGEMENT 
Responsibility for the successful management of a ward rests primarily 
upon the person in charge of the ward who, to properly discharge the duties 
comprising that responsibility, must possess the essential quality of executive 
ability. 
In addition to supervising the nursing care of patients, as described in the 
preceding section, it is the duty of the person in charge of a ward to see that 
work in the ward is carried on without friction, to direct the cleaning or 
housekeeping of the ward and adjacent rooms, to make sure that orders for 
the care and treatment of patients are fulfilled, to preserve in good condition 
all instruments, equipment, or other property charged to the ward, to keep an 
adequate stock of supplies on hand and prevent waste in their use, and to give 
instruction in nursing procedures to those requiring it. 
In naval hospitals the executive officer usually has general supervision of 
all patients and he therefore has general supervision of all wards and, as a 
rule, inspects them daily as to cleanliness, good order, and care of patients. 
Each ward is under the direct supervision of a medical officer, termed the 
ward medical officer, who is responsible to the executive officer and his chief 
of service. The chief nurse in a hospital has general charge of the nursing 
in all wards, of their maintenance, and of the members of the Nurse Corps, 
U. S. Navy, who usually are in direct charge of all medical and surgical 
wards. Wards in which patients with venereal or genito-urinary diseases are 
domiciled and treated are in direct charge of senior petty officers of the Hos- 
pital Corps. Nurses and hospital corpsmen in charge of wards are responsible 
for the care and nursing of the patients and the management of the ward as 
outlined in the preceding paragraph. In their absence the senior hospital corps- 
man assumes charge of the ward. The executive officer details hospital corps- 
men to duty in all wards and when so assigned they are under the supervision 
of the nurse or hospital corpsman in charge, and under their direction they 
administer medicines, give treatments, do dressings, give patients the necessary 
nursing care, and attend to the cleaning of the ward. 
MANAGEMENT AND GENERAL SUPERVISION OF WARDS 
The management of a ward in a hospital or a hospital ship and of the sick 
bay on board ships requires a well-arranged schedule of work, a regular and 
systematic routine for cleaning, and the proper assignment of the personnel 
to definite nursing and other duties. 
A schedule of work in either a ward or a sick bay must first take into con- 
sideration the necessity of allowing sufficient time for those on duty in a ward 
or sick bay to dress, make up their beds, and attend to their personal toilets 
before reporting for duty. It is essential that a schedule provide for a dis- WARD MANAGEMENT 
345 
tribution of work according to the amount of work, the kind of patients cared 
for, the arrangement of the ward and adjacent rooms, and the number of per- 
sons assigned to the ward for duty. The nursing care (bed-making, bathing, 
medication, etc.) of the patients in a Ward should be divided so that, as far as 
practicable, one attendant continually looks after certain patients who, to 
save time and for greater convenience, should be grouped together as closely 
as possible. 
In arranging 'a schedule of work the more responsible duties should be as- 
signed to those having the most experience and the simplest duties to those of 
least experience. For the training, instruction, and development of nursing 
proficiency of the latter it is advisable to rotate their assignments every week 
or 10 days so that the performance of duties does not become monotonous and 
experience in all may be gained. When a new hospital corpsman reports to a 
ward the nurse or hospital corpsman in charge should acquaint themselves 
with the amount of previous experience he has had and arrange his assign- 
ments to duty accordingly. If just reporting from one of the Hospital Corps 
Schools they should teach him the actual bed-side care of the sick, how to give 
treatments and medications, and all phases of ward duty. They should con- 
tinue to instruct, supervise, and observe the work of the new man until certain 
that he understands exactly what is expected of him and can be depended upon 
to do it correctly. To help a new man attain that degree of proficiency he 
should be detailed as often as possible to assist experienced men in the care 
of the sick. Actual contact with illness deepens the sense of responsibility, 
quickens the powers of observation, resource, and helpfulness, and ends a 
careless, frivolous, or flippant attitude more quickly than any other means. 
In the management of wards it is essential that those in charge endeavor at all 
times to assign personnel to the various ward duties and to so arrange the ward 
work that there is the least possible amount of friction. This greatly helps in 
maintaining the spirit of cooperation so necessary between medical officers, 
nurses, hospital corpsmen, and patients, if a ward is to function efficiently, and 
results in the cheerful atmosphere in the ward that aids in the recovery of the 
sick. 
Daily ward duties. 
In the morning, before breakfast is served, the hospital corpsman on night 
duty in a ward should see that all bed patients have their faces and hands 
washed, their mouths cleansed, and teeth brushed, and that all other patients do 
the same for themselves. The temperature, pulse, and respiration of all 
patients should be taken and recorded in a book kept for that purpose; all 
medications and treatments ordered to be given before breakfast should be 
given; all specimens for examination should be collected and taken or sent to 
the laboratory; and all preoperative routine carried out before the night man 
goes off duty. 
Breakfast is served by the hospital corpsmen on day duty and they are re- 
sponsible for patients receiving the right diets. Patients too ill to feed them- 
selves must be fed by hospital corpsmen or by patients who can assist in this 
way. In hospitals where the food is not served from regular food carts under 
the supervision of a dietician, the men on duty in the ward diet kitchen should 
report in ample time to have steam turned on the steam tables and trays pre- 
pared so the serving of breakfast will not be delayed. It is most important that 
the breakfast be served and all trays and dishes collected and returned to their 
proper places as promptly as possible for if breakfast is late the whole day’s 
work is delayed. 346 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
If food on any tray remains untouched it is necessary to determine the 
reason; it may be that the patient needed assistance in order to eat, or that he 
had lost his appetite, or for some other reason did not desire food. Whatever 
the cause, a report should be made to the medical officer. 
After breakfast beds should be made up, bed baths given, and the ward aired, 
swept, and dusted, and then put in readiness for morning sick call at 9: 00 a. m. 
Beds, chairs, and bedside lockers should be aligned; the latter should be washed 
and all trash disposed of. Only toilet articles and clothing actually needed 
should be allowed in bedside lockers and they should be kept neatly and in good 
order. Under no circumstances should food stuffs or medicines be kept in bed- 
side lockers. 
As soon as nurses or hospital corpsmen report in the morning they should 
visit all the seriously and critically ill patients so that they may acquaint the 
medical officer of their condition when he arrives for sick call. All charts 
should be up-to-date and, with all clinical notes and all X-ray, laboratory, and 
special reports attached, should be placed on the foot of the patient’s bed or in 
a convenient place for the medical officer to see. 
During sick call everyone should be as quiet as possible and all convalescent 
patients who are able should stand by their beds unless excused by the ward 
medical officer. 
When making sick call with the ward medical officer the nurse or hospital 
corpsman in charge of the ward carries the ward order book and enters in it 
in ink all orders of the medical officer, which he afterward reads and signs. 
All orders for narcotics should be signed when the order is given. Another 
hospital corpsman carries towels, tongue depressors, flash-light, stethoscope, 
etc., for the medical officer’s use in making sick call. Hospital corpsmen who 
are not making sick call should continue with their work, being careful not to 
cause undue noise or commotion. 
The following routine forms should be ready at sick call for the signature 
of the ward medical officer: Liberty list, duty cards, transfer slips, requests 
for leave or special liberty, etc., drug book, and diet sheet. The drugs needed 
should be entered in the drug book and after being signed taken to the 
pharmacy where the drugs will be issued. After the diet sheet has been 
signed it should be sent to the chief nurse. Before 9:30 a.m., daily, the ward 
report, which is a special printed form giving the census of the previous day 
and the census to date, the number of admissions, discharges, deaths, and 
absentees, should be made out in diiplicate, one copy being sent to the personnel 
office, the other to the office of the chief nurse. It is very important that the 
nurse or hospital corpsman in charge of the ward have all forms ready for 
the ward medical officer’s signature immediately after sick call. As early as 
convenient other forms, such as laundry slip in duplicate for exchange of linen, 
daily blanket count, request for repairs, etc., should be prepared. Expendable 
and nonexpendable supplies are ordered in separate books once each week. 
These forms must be signed by the ward medical officer, and then sent to the 
chief nurse, who forwards them to the executive officer. 
After sick call is over the order “carry on” is given, charts are collected and 
returned to their proper place, uncompleted work in the ward finished, treat- 
ments and medicines administered, dressings done, slips taken to their respective 
offices, and the ward made ready for the executive officer’s inspection. All 
supplies for the day should be obtained between the hours of 10 and 12 and 
drug baskets gotten from the pharmacy before noon. Attention should be 
given to medicines, temperatures, and diets between 11 o’clock and noon. After 
dinner the patients should be allowed to rest and the hospital corpsmen should WARD MANAGEMENT 
347 
police the wards and carry on the necessary work of the ward. A hospital 
corpsman under no circumstances should leave the ward without permission or 
proper relief. On visiting days he should see that visitors do not sit or recline 
on the beds, provide chairs for visitors, and when visiting hour is over, see 
that they leave the ward. If visitors have not heard the word passed that 
visiting hours have ended, the hospital corpsman should politely inform them 
that it is time for them to go. The evening meal then is served, and not sooner 
than one hour afterwards evening toilets should be given. Evening sick call 
is held some time after 7 o’clock, and should be followed by the evening treat- 
ments, medicines, and dressings. All patients are mustered, any absentees 
reported to the officer of the day, and all ward lights, except night lights, put 
out at taps. The wards, heads, bathrooms, diet kitchen, and offices should be 
left in a clean condition by the day force. In refrigerators that are not electric 
there should be sufficient ice for the night as well as enough supplies, such 
as milk, fruit, eggs, and broth, for the fluid diets, and, when necessary, eggs for 
the morning breakfasts. 
Ward cleaning. 
The cleanliness of a ward is of great importance, for dust and dirt favor the 
growth of bacteria. The procedures necessary in keeping a ward clean are 
largely of a housekeeping character and ward cleaning might well be termed 
ward housekeeping. Such procedures should disturb the comfort of the patients 
as little as possible and must not interfere with their care and treatment if it 
can be avoided. The work required in ward cleaning, or housekeeping, should 
be divided as equitably as possible among the duty personnel, that to be done 
by the nurse or hospital corpsman in charge naturally being considerable less 
because they must supervise all such work and on account of their other 
responsibilities. Each hospital corpsman assigned a detail must know exactly 
what is expected of him and that he is responsible for that detail. Patients 
who are able may be assigned to help on such details. 
It is advisable that each day of the week be set aside for some special 
cleaning, such as walls, windows, and wood work on one day, beds, bed-side 
lockers, and metal furniture on another, cleaning and polishing decks on 
another, etc. When certain special cleaning is done on a certain day of the 
week there is not so much left for “general field day” and it will be found that 
wards will almost always be in good order. 
Each day’s special cleaning should be started as soon as possible on the day 
assigned it, the routine cleaning going on as usual in the meantime so that by 
10:00 a.m. the ward and its service rooms are ready for inspection by the 
chief nurse and by the executive officer who may inspect at any time. 
Everything in a ward, beds, lockers, chairs, desks, windows, radiators, elec- 
tric light fixtures, doors, woodwork and paintwork should be dusted daily. On 
the death of a patient the springs of a bed should be whisked with a disin- 
fectant solution and the bed washed with hot water and soap. 
In dusting, a damp (not wet) duster should be used, a basin of clean water 
should be at hand in which to rinse the duster frequently. It is impossible to 
clean anything with dirty water or a dirty duster. The habit of removing dust 
with a firm stroke should be formed, as it is a waste of time and energy to 
move the duster back and forth on a surface. Dust should be removed from 
cracks and crevices (those too small for the duster to enter may be cleaned 
with the point of a wooden toothpick), and when dusting beds, the bars which 
are not exposed should not be forgotten. When cleaning the medicine cabinet, 
remove only a few bottles at a time (if called away they will not have to be 
154294°—39 23 348 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
left out of place). If dusting is done daily and systematically, everything will 
be ready for the commanding officer’s inspection without any extra effort. 
Dusters always should be washed after use and not put away unclean. Polished 
furniture should be dusted with a dry duster or one that has been slightly 
oiled. 
The walls of a ward should be swept down once a week with a long-handled 
broom and, if possible, washed once a month. 
The cleaning of floors depends upon the material of which they are made. 
They should be swept as often as necessary, at least three times a day, and 
care taken that no more dust is raised during the sweeping than is necessary. 
Stone and unpolished wooden floors should be scrubbed occasionally with a 
scrubbing brush, hot water, and soap powder. The water should be changed 
frequently. Dirty water will not clean anything. After washing, floors should 
be thoroughly dried and hardwood floors should be waxed and polished once 
each week. 
Copper, brass, and nickel should be cleaned frequently with metal polish. 
Sand soap should not be used for glass or metal, as it may scratch the surface. 
Porcelain tubs and sinks are cleaned best with hot water and the special 
cleansing materials provided for that purpose. 
The refrigerator and water cooler should be cleaned as early in the morning 
as possible so that they may be ready for the daily supply of ice, fruit, etc. 
The water cooler should be taken apart and washed thoroughly inside and out 
with hot soap and water, scalded well, and rinsed with cold water. 
When cleaning the refrigerator, all foods, drinks, bottles, etc., should be 
removed, its shelves should be taken out, thoroughly washed and scalded, 
placed in the open air and sunshine while the ice compartment and the inside 
and outside casings are being cleaned. The drain pipe and drain pan (when 
one is used) should receive special attention, be washed with hot soapy water 
and scalded; the pipe should be taken apart and each section freed from all 
residue and slimy deposit. Scalding water should be run through this, and the 
drip pan well rinsed with the same. Drain pans should be emptied three times 
a day. Doors of the refrigerator should be kept closed, except when cleaning 
or putting in or taking out supplies. The shelves and all containers should be 
well dried before being returned to their places, and any left-over supplies used 
at once or returned to the commissary department. Accumulation of supplies 
should be guarded against and only those ordered which are actually required. 
Tables and dish cabinets and all of their drawers and shelves should be 
scrubbed and aired daily. No paper covers or linings should be used for 
these as they form hiding places for roaches and food crumbs. Grease or 
hardened food particles on trays, silver dishes, or any kitchen utensils are 
evidences of neglect and carelessness, and should not be tolerated. Coffee or 
tea grounds should never be thrown in the sink nor should oil or grease in 
any quantity be poured there. A clogged drain pipe causes much unnecessary 
labor and waste of valuable time. 
All dishes and silver should be thoroughly washed and sterilized after use. 
In most hospitals electric dish washers are provided, and readily accomplish 
this. When a mechanical dish washer is not provided, dishes used by a 
patient isolated in a general ward should be given special attention, reserved 
for his special use, and kept on a marked tray. They should be sterilized 
by boiling in a large pan, or other vessel, and the hospital corpsman handling 
them before they are sterilized should carefully wash and disinfect his hands 
before handling other things. WARD MANAGEMENT 
349 
Utensils such as bedpans, urinals,, irrigating cans, etc., should be scrubbed 
daily with hot water, soap, and a brush, and kept clean at all times. 
Rubber sheets and other rubber articles such as air cushions, hot-water 
bottles, ice-bags, etc., are cleaned best wuth warm (not hot) water and soap; 
after washing they should be rinsed well as soap tends to destroy rubber. 
They should then be wiped with a disinfectant solution and hung up in a cool 
place to dry. Rubber sheets and operating pads should be rolled instead of 
folded before being stowed away, and under no circumstances should they 
be put away until thoroughly dried. Remember that heat, acids, and fats 
destroy rubber. 
The brooms, deck-swabs, dustpans, dust cloths, and materials used in cleaning 
should always be stowed in the spaces provided for them when not in use. 
Before stowing deck-swabs they should be thoroughly cleaned by washing in 
warm water and soap. Where fresh water is available ordinary soap or soap 
powder may be used but salt-water soap must be used with salt water. Re- 
member to use hot water to remove dirt and the addition of a small amount 
of sodium carbonate (washing soda) or ammonia will soften the water and 
help to remove grease. Lye never should be used without a definite order and 
special reason as it is dangerous to handle and is destructive to materials. 
When lye is used great care must be taken to dissolve it first in water, and 
to open the can over a hopper or on a cement or stone deck to prevent the 
powder from destroying and staining woodwork, paint, varnish, etc. Be sure 
to clean all corners and crevices, moving furniture when necessary in order to 
clean behind it. In sweeping use long smooth strokes so that no unnecessary 
dust is raised to scatter through the ward. All metal work should be kept 
clean, bright, and shining by the use of the agents best adapted to each metal 
accompanied by vigorous rubbing. Porcelain tubs and sinks should be cleaned 
with kerosene, soap and water, scouring powder, or other effective cleaning 
material in routine use. Never use a strong acid or alkali on porcelain, tile, 
or marble, as it destroys the finish and roughens the surface, causing it to 
readily accumulate grime and microorganisms. Never allow any refuse to be 
thrown down the toilets, hoppers, etc. Toilet paper is the only material of 
this type that is soluble, and made purposely for use in these places. Waste 
receptacles are provided for all other debris and should be used. Sputum cups 
and other similar containers of infectious material should be carefully covered 
and carried directly to the incinerator, never thrown loosely into trash 
receptacles. 
Linen used for patients suffering with communicable diseases should be placed 
in a bag kept for this purpose and sterilized or disinfected before being taken 
to the laundry. Most hospitals are equipped with a large steam sterilizer for 
this purpose, but when this means is not available the linen is placed in some 
disinfecting solution or exposed to the direct sunshine and fresh air for an 
hour or more, turning at least once so that the sun’s rays may reach its entire 
surface. 
“General field day” is a term used to designate the general, final cleaning of 
wards, service rooms, furniture, etc. in preparation for inspection by the com- 
manding officer on the day following. On the morning of general field day the 
ward need not be in the usual order for sick call, but patients must have their 
usual care, and their records must be in readiness. On general inspection by 
the commanding officer the entire ward should be in readiness by 10: 00 a. m. A 
preliminary inspection should be made by the ward medical officer and the ward 
nurse to assure the personal cleanliness and comfort of the patients and the 
! order and cleanliness of the ward and its service rooms. 350 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVA 
For general inspection by the commanding officer all charts and accompanying 
records, order books, narcotic books, and admission book should be up-to-date 
and in a convenient place for examination. All lockers should be clean and all 
doors opened except medicine, narcotic, and linen lockers, which doors are 
opened in the presence of the commanding officer and closed immediately after- 
ward. Bed-side lockers and table and desk drawers should be open. All 
ambulatory patients should be in the uniform of the day and by their beds at 
this inspection, during which there should be absolute quiet and no smoking, 
card playing, or reading allowed. The ward medical officer, nurse or hospital 
corpsman in charge of the ward, and another hospital corpsman with a flash- 
light and a towel dampened at one end should meet the inspecting party at the 
ward entrance, take places beside the commanding officer and remain there 
throughout the inspection in order that they can answer his questions and 
record any suggestions he may offer. A hospital corpsman should precede the 
inspecting party to open doors and turn on lights. All orders and suggestions 
given during the inspection must receive prompt and careful attention. 
Ward property and linen. 
The utmost attention must be given to preserving in good condition all instru- 
ments, equipment, linen, or other property in a ward. All nurses and hospital 
corpsmen should take a personal interest in the upkeep of Government property, 
should see that it is not abused, and those in charge of wards should be espe- 
cially careful to see that necessary repairs are given prompt attention. A 
record of the property with which a ward is charged should be kept and the 
property inventoried once a month to determine if there has been any loss. 
After making the inventory the nurse or hospital corpsman in charge of a ward 
prepares and signs a statement concerning the ward property which is sub- 
mitted to the executive officer for approval or such other action as may be 
necessary. If, on taking inventory, property is found to be missing, efforts to 
locate it should be made and if it cannot be found then responsibility for its 
loss should be determined if possible, and the loss and the responsibility there- 
for reported to the executive officer. Property may not be transferred without 
prior approval of the executive officer. 
Linen should receive special attention and a general inventory should be 
taken weekly. Soiled linen should be counted before going to the laundry for 
exchange for clean linen and the clean linen counted before leaving the linen 
room, the exchange being made piece by piece. Linen lockers and hampers for 
soiled linen should be kept locked at all times and the nurse or hospital corps- 
man in charge of the ward should carry the keys which are turned over to 
their relief on going off duty. Damage to linen should be avoided by the use 
of protective pads and by care in giving and removing bed pans and urinals. 
Torn linen should never be used but sent to the linen room for mending, folded 
with the torn side out or with the damaged part indicated by marks made with 
a soft-lead pencil. There should be a designated time to issue clean linen in 
wards, and each patient up and about should bring his soiled linen to be 
exchanged for clean. Nurses or hospital corpsmen are responsible for the 
exchange of bed patients’ linen which is changed as often as necessary for their 
comfort and cleanliness. Ambulatory patients should have their bed linen and 
pajamas changed not oftener than twice a week although towels may be ex- 
changed every morning. The nurse or hospital corpsman in charge of a ward 
should take property and linen inventories personally, counting linen weekly 
and blankets daily. For cases requiring treatment which will stain linen, 351 
WARD MANAGEMENT 
such as genito-urinary cases, burns, scabies, etc., old, repaired linen may be 
used. 
It is inevitable that linen should become stained and the removal of stains is 
a part of the care of linen. Before being sent to the laundry all possible stains 
must be removed. 
Stains from blood, defecation, vomitus, medications, or dressings should be 
removed immediately where at all possible, and always before sending linen to the 
laundry in order that they may not become fixed and render the linen unfit for 
use. Blood stains, when fresh, are removed by soaking in cold water, then 
washing in warm (not hot) water and soap. Stains on a mattress are removed 
by applying a starch paste to spot, allowing it to dry, then brushing well. Re- 
peat the process until the spot disappears. Vomitus and fwces are removed by 
holding under cold running water and brushing, then washing with soap and 
water. Fruit stains are removed by pouring boiling water through the stain 
until it disappears. Meat and egg stains are treated in the same manner as 
blood stains. Iodine stains may be removed by soaking the stain in sodium 
thiosulfate solution. Stains of silver preparations are removed by soaking the 
stain in salt solution and rinsing in clear water, or by covering the spot with 
tincture of iodine and after a few minutes washing with alcohol, ammonia 
water and clear hot water. Ink stains may be removed from linen by the ap- 
plication of lemon juice and salt, afterwards putting the material in the sun- 
light to dry and then washing with warm water and soap. If the stain does 
not disappear at once, repeat the process. Potassium permanganate stains may 
be removed by washing it in a solution of oxalic acid, followed by ammonia 
water, and then rinsing in clear water. Vaseline stains may be removed with 
kerosene and hot water and soap. Rust stains on fabrics may be removed by 
washing in warm oxalic acid or citric acid solution (if the colors will bear it) 
and rinsing in water. Mercurochrome stains on colorless cotton or linen cloth 
are removed by soaking the material in a 20 per cent chlorinated soda solution 
(Labarraque’s solution) for 2 minutes, then adding 5 per cent solution of acetic 
acid in an amount equal to about one-fifth the volume of the soda solution. The 
cloth should be agitated to hasten the results. These stains are very difficult 
to remove from cloth fabrics. Repeated washing and rinsing is all that can 
be recommended. Bichloride of mercury makes an ugly, gray-colored stain in 
linen which is exposed to the heat of washing and ironing. Linen which has 
been wet with bichloride of mercury should be soaked for several hours in 
Labarraque’s solution and then thoroughly rinsed and washed as the solution 
is injurious to fabrics when used in full strength. Oil or grease stains may be 
removed by washing the stains with ether, benzine, or gasoline. This must not 
be done near an open flame as these substances are highly inflammable. 
Be sure and wash with clear water following the removal of any stains, and 
always be sure that linen is dried before it is put in the linen hamper. Do not 
apply hydrogen peroxide to any fabric for the removal of stains, as it tends to 
destroy the fibers of the fabric. 
While discussing the removal of stains from linen it is well to mention some 
of the ways in which stains may be removed from sinks, utensils, etc. Rust 
stains on iron and steel may be removed with kerosene, but care must be taken 
to apply kerosene to a stove at such time that it will have evaporated before 
the stove is used. This precaution is necessary because of the inflammable 
nature of kerosene. Rust or other stains may be removed from granite and 
enamel ware by washing with kerosene, hot water, and soap. All utensils 
should be dried thoroughly before they are put away, in order that rusting may 352 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
be prevented. If alcohol is spilled on a white enamel surface, oil should be 
applied to the spot before attempting to remove the alcohol. This is necessary 
because the enamel is soluble and may be removed by the alcohol. Acid 
destroys the polish on marble, therefore an alkali should be used to neutralize 
and remove the acid. If orange or lemon juice is spilled, ammonia and soda 
applied immediately will prevent a stain. 
Mercurochrome stains on the skin are easily removed, when fresh, by acid- 
ulated alcohol; when fixed, by the application of Labarraque’s solution or any 
other “hypochlorite.” If, in the latter case, a dilute acid is used following the 
hypochlorite, the action will be more prompt. 
General care of the ward. 
It is essential that certain conditions in wards be maintained by the nurses 
or hospital corpsmen in charge. These conditions are: Proper ventilation, 
freedom from unpleasant odors, uniform temperature (the degree required de- 
pending upon the diseases in the ward), proper lighting, cleanliness, definite 
places for furniture and utensils, and furniture and furnishings kept free from 
stains and defacement. 
To have proper ventilation in a ward the incoming air must be pure, and 
the air in the ward kept in circulation without causing a draft. When windows 
are opened they should all be raised or lowered a uniform distance, and 
window shades should be kept at a uniform height. Exposure of patients 
should be avoided by having them sufficiently covered when the windows are 
opened to air the ward. To prevent unpleasant odors in wards bedpans should 
be covered when carrying them through the ward, and should be clean when 
not in use; bed linen may be kept free from faecal odor when giving an 
enema by using a blanket which can be aired; patients and bedding should 
be absolutely clean; dressing and garbage pails should be kept covered, emptied 
frequently, and kept clean; hoppers and toilets should be properly flushed and 
a deodorant or kerosene used frequently; and waste pipes, sinks, and hoppers 
should be free from obstruction. 
A low temperature, providing the patient’s body is kept warm, often will 
act as a respiratory and circulatory stimulant Patients who are restless and 
excited frequently become quiet and go to sleep out of doors or in a cold room, 
while, on the contrary, patients become restless and do not sleep well in a hot 
ward. Patients with chronic diseases, associated with poor circulation and 
anaemia, usually require warmer surroundings than fever patients, while those 
in shock and under the influence of an anaesthetic temporarily require a still 
warmer environment. The average ward temperature should be 68° F. during 
the day and 65° F. at night. The temperature of the operating room should 
be 78° F., that of the recovery and treatment rooms 72° F., and that of the 
bathrooms 72° F. 
Direct rays of the sun are the very best air purifiers and germ destroyers, 
and a ward or room should have as much sunlight as possible, preferably 
unflltered, direct rays. Artificial light should be by tbe indirect lighting 
method, but where other methods of lighting are used, shades, screens, and the 
position of the bed should be so arranged that the patient’s eyes are adequately 
protected from glaring or direct lights of any kind. Strict economy should be 
practiced in the use of artificial lights, by turning them off when not needed. 
Exposed or defective wires should be reported at once, thus preventing danger 
of fire and accident. 
Furniture in a ward should be arranged uniformly, and in straight lines if 
practicable. No accumulation of articles on beds, chairs, or lockers should be WARD MANAGEMENT 
353 
permitted, and clothing and other articles must not be stowed under the pillows 
or the mattress. Service clothing should be rolled or folded neatly and placed 
inside the locker, the shoes on under-shelf of locker. Window sills and radia- 
tors should never be used for holding debris nor for hanging clothes. All 
articles broken, missing, or in need of repair should be surveyed or repaired 
promptly. 
Admission and discharge of patients. 
The actual care of a patient begins on his admission to the ward. On his 
arrival in the ward he should be given immediate attention, should be received 
with courtesy and kindness, made to feel that he is expected, and that every- 
thing possible will be done for his comfort and quick restoration to health. 
A general air of friendliness and quiet order in a ward helps greatly in gaining 
a patient’s confidence and cooperation. 
If the patient is an ambulatory case, and not too ill, he should not be 
assigned a bed at once, but given, if available, a seat near the ward desk while 
routine records, slips, temperature, pulse and respiration are taken and recorded. 
Then, supplied with pajama suit, towels, and soap, he should be shown the 
bath and toilet rooms, and instructed to take a tub or shower bath before going 
to bed. If not put to bed, he should be instructed to “stand by” near his bed 
until seen by a medical officer or given permission to leave the ward. Patients 
up and about should be informed of the hours of sick call, the times their medi- 
cines and treatments come due and the time meals are served, and instructed to 
be always on hand for each unless excused. 
If the patient is brought to the ward in a stretcher, has a temperature of 
100° F. or over, or shows evidence of acute illness, pain, weakness, or injury, 
he should be put to bed immediately and all data and information taken at his 
bedside, after which he should be given a bed bath. All symptoms and 
evidences of disease or injury should be noted and reported to the nurse or 
hospital corpsman in charge of the ward who reports them to the medical officer 
who examines the patient. At the time of bathing the patient’s body should be 
carefully examined for eruptions or vermin. If an eruption is present the 
patient may have a contagious disease and should be kept away from others 
until seen by a medical officer; if vermin are found the steps necessary to rid 
him and his clothing of them and prevent their spread must be taken as soon 
as possible. 
An admission card should be filled out for the record office, being sure to 
give the full first and middle names of the patient as initials are not enough. 
If a duplicate is sent to the officer of the day the patient’s temperature, pulse, 
and respiration at the time of admission should be recorded on it. Do not fail 
to ascertain the patient’s religion, and the name and address of his nearest 
relative, friend, or guardian. This is most important, as any patient at any 
time may suddenly take an ill turn or meet with an accident, when it would be 
necessary to at once call a priest or minister, and notify relatives or friends. 
Each ward has an admission book or card index of patients in which is 
recorded a duplicate of the record on the red admission card. This must be 
complete, and available day or night to the nurse or hospital corpsman on duty. 
When a patient is admitted from another ward he brings a “transfer slip” with 
him from that ward, but an admission card is not made out as that was done 
by the first ward. The complete data, however, are obtained from the patient 
or his records, and entered in the ward admission book the same as if he were 
a new admission. 354 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Each ward has a “bed list” or “bed roster”, a ruled sheet of foolscap on 
which the beds are numbered in the order in which they are placed in the wrard. 
The patient’s name, rating, diagnosis, and date of admission to the ward are 
placed opposite the number of the bed assigned to him. If, later, for any reason 
the patient’s bed is changed, his name on the bed roster is changed correspond- 
ingly. This is very important, as a morning and evening checkup of patients is 
made, and a list of absentees sent to the officer of the day. As changes are fre- 
quently made necessary on this roster, because of transfers, discharges, etc., it is 
wise to make it out in pencil. Then, as changes occur, erasures are easily made 
and the changes can be recorded immediately. This is very essential as this 
list must be complete and correct at all times, and available as a reference for 
medical officers, nurses, and hospital corpsmen on duty in the ward, and for 
executive heads of departments who may make inquiry at any time. At a 
glance the number of patients in the ward may be ascertained, also the number 
of empty beds available for new patients. All patients on leave are carried on 
the ward census and listed at the bottom of the roster, but no beds are assigned 
them. Patients absent without leave (A. W. O. L.) or over leave (A. O. L.) 
are dropped from the roster at the end of 10 days. 
On each bed should be a tag or card on which the patient’s name, rating, 
religion, diagnosis, and date of admission are recorded. This should be made 
out at the time of admission with the other admission forms. 
As soon as possible the patient’s temperature, pulse and respiration should 
be recorded on his clinical chart, together with his name, rating, diagnosis, 
color and religion. On the clinical notes are recorded the time of admission, 
name and rating of patient, whether he is a stretcher or an ambulatory case, 
his admission diagnosis, any orders received from the officer of the day with 
the patient, any immediate treatment given, and any symptoms noted, especially 
those complained of by the patient. 
Next to the clinical notes and chart is placed the clinical record, for the 
medical officer’s use when he makes the physical examination and starts the 
history of the case. 
A laboratory request for routine urinalysis is made out for all new patients 
on admission, and sent, with the specimen, on the following morning to the 
laboratory. Requests for laboratory examinations of other kinds are sent as 
ordered by the medical officer. When an unconscious, delirious, or demented 
patient is admitted, get all possible data and information from the friend 
coming with him, including a list of any valuables or clothing. 
The clothing of patients should be removed as much under cover as possible, 
and with a minimum of discomfort to the patient and injury to the clothes. 
In case of Injury the procedure must be modified to suit conditions, garments 
being removed from the injured part last. When necessary for the comfort 
and safety of the patient, or when, because of his serious condition, time is of 
the utmost importance, rip, tear, or cut the clothes at the seams and remove 
them as speedily as possible. 
All infectious cases must be isolated upon admission. List the clothing, place 
in a bag or other cover, tag properly and send to the sterilizer. Furs, skins, 
leather goods, etc., will not stand sterilization by steam. 
All property is valuable to its owner and precautions must be taken to safe- 
guard the belongings of a patient. In the bedside locker may be placed toilet 
articles, clothing actually needed during illness or while convalescing, inti- 
mate personal effects, writing materials, papers, books, magazines, playing 
cards, or work from the vocational therapy department. These articles should WARD MANAGEMENT 
355 
be arranged neatly and in order, with the idea of tidy appearance and easy 
access. 
All money and valuables of a helpless patient, and other patients when 
desired, are listed, preferably by two people, in the presence of the patient or 
his representative, and then placed in an envelope marked with the patient’s 
name, rating, ward, date, list of contents, and signed by the person making the 
list. The above property is then turned over for safe-keeping to the executive 
officer who issues a receipt which the patient holds until his convalescence or 
discharge, when he returns it to the executive officer and receives his property. 
The bag and hammock, and any baggage or articles of clothing not required 
for use of the patient during his illness are properly tagged, locked, and sent 
to the bag room where they are listed and kept under responsible supervision. 
If money, valuables, or clothing are turned over to relatives of a patient, a 
receipt should be obtained from them. 
As soon as possible the medical officer makes a physical examination of the 
patient for the purpose of obtaining a complete history and making a diagnosis, 
and to determine the treatment. All articles required by medical officers should 
be available at the time of examination. A conscious patient should be told 
something of the examination which is to be made, and what will be required 
of him during the procedure. A nervous patient should be reassured, made as 
comfortable as possible, and encouraged to relax and lie at ease. The examining 
room should be warm, as chilling prevents relaxation. The patient should be 
protected from unnecessary discomfort and exposure, placed in the required 
position, and the assistant should anticipate by close observation and intuition 
the wishes and requirements of the medical officer. The ward or room should 
be quiet and have the best possible light. Positions of the patient depend upon 
the purpose of the examination, the part to be examined, and the condition of 
the patient. 
Patients are discharged from treatment for various causes such as recovery 
from the condition for which admitted, death, physical disability, transfer to 
other hospitals, etc. 
In order that the patient’s records may be ready at a designated time, a list 
of the names of all patients ready for discharge is signed by the senior medical 
or surgical officer and sent to the record office at least 24 hours before date of 
discharge. Charts and records are closed out and sent to the designated office. 
On the morning of discharge a card with the patient’s name, rating, number of 
ward, and date is sent from the personnel office to the ward from which 
patient is to be discharged. This card is signed by the ward medical officer 
and by the nurse or the hospital corpsman in charge of the ward and delivered 
to the patient, who presents it at the bag room as identification before receiving 
his baggage; to the librarian, in order to make certain before his departure 
that all books charged to him have been returned; and at the post office to 
inform the mail clerk of his change of address. The card is then returned to 
the personnel office, and the patient is ready to depart. A record is also made 
on the ward census report of the following morning. The date of discharge is also 
checked (in red ink) opposite the date of admission in the ward admission book. 
When death of a patient is expected the hospital corpsman and others in 
attendance must be careful to assume the right attitude. Their manner should 
be sympathetic and attentive, both to the patient and to his relatives. A dying 
patient should be separated from other patients in a ward, either by transfer 
to a quiet room or by being screened in the ward; he should never be left 
alone. It should always be borne in mind that a dying patient, although 
apparently unconscious, may hear and understand much that is said near and 356 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
concerning him, and for that reason no unnecessary conversation should be 
carried on in his vicinity. 
If a medical officer is not at the bedside when death occurs one must be 
notified when respirations have ceased, so that he may officially pronounce him 
“dead.” As soon as the patient is pronounced “dead” and the relatives have 
left the procedure with regard to the body and the disposition of the effects 
should be as described in the section on “Deaths and Medico-legal Matters. 
Section 3.—OPERATING ROOM AND SURGICAL TECHNIQUE 
When one speaks of an operating room it is usually with a broad meaning 
that includes not only the room or rooms where operations are actually per- 
formed but all the other rooms connected and associated with them, all of 
which constitute the operating suite. This section of a hospital or a hospital 
ship or of the sick bay aboard ship is a most important place, and upon its 
equipment and care depend to a considerable extent the success or failure of 
an operation. Of course surgeons often are required by necessity to perform 
operations under conditions far from satisfactory; for instance, under war 
conditions or in isolated farmhouses. However, whenever possible, operations 
of a major character should be performed in hospitals where the patient can 
be safeguarded by all possible aseptic conditions. 
The operating room. 
The administration of the operating room or operating suite is one of the 
duties of the chief of the surgical service, the Manual of the Medical Depart- 
ment directing that he shall be in charge of all operating rooms and their 
accessory treatment rooms, and that he shall issue necessary instructions to 
nurses and hospital corpsmen regarding procedures and technique. 
The operating suite of a modern hospital should be in a location as free from 
miscellaneous hospital traffic and noises as possible. It consists of the operat- 
ing room or rooms and various accessory compartments arranged in a conven- 
ient order. There are usually at least two operating rooms so that one is 
always ready for use while the other is being cleaned or repaired, the main 
room being used for clean surgery and the alternate one for the dirty or pus 
cases. In an emergency both may be used simultaneously. 
The actual size of an operating room should be determined by the number 
and character of operations to be performed and the space available; it should 
be sufficiently large to preclude the necessity of crowding yet not so spacious 
that it is difficult either to clean, ventilate or heat. 
Lighting.—When natural light is used, a northern exposure is preferable 
because there is less variation in the intensity of the light from that direction. 
However, if large north windows are used in a cold climate, one must consider 
the danger of placing the operating table too close to the window. Little 
dependence is now placed on natural light, since artificial light is much more 
dependable and easily controlled. Overhead adjustable top lights are now 
made with the rays focused from a number of reflectors to reduce shadows on 
the field of operation to a minimum. These are even more effective when the 
new spot-beam portable light is used in conjunction with them. Side lights 
are also in use, and are arranged to work with batteries should the electric 
current fail. 
Heating and ventilation.—The temperature of the operating room is kept at 
about 80° F. during operations and the ventilating system should be capable 
of maintaining this temperature during the coldest weather likely to occur in SURGICAL TECHNIQUE 
357 
the locality. Many of the modern hospitals are equipped with an air-condition- 
ing unit. There are two main types of air-conditioning equipment, the unit 
installation and the central-plant system. Unit installations are used to cool, 
heat, humidify, clean, and circulate the air in the particular rooms in which 
they are located. The central-plant system differs in that the air is conditioned 
in a central plant and then distributed through ducts to the various rooms. 
Direct or natural ventilation is used chiefly in small hospitals, and must be 
as nearly perfect as possible. Fresh, clean, warm moist air should be con- 
stantly provided and drafts avoided. 
Figure 115.—View of an operating room at time of operation showing arrangement of 
furniture, positions of personnel, conventional operating dress, and type of lighting. 
Equipment.—An operating table with all accessories, adjustable as to height 
and the various standard positions, is desirable, but this type of table is expensive, 
and quite as good work may be performed on one of a simple design, provided 
proper forethought is given the type of operation and the required position of 
the patient. On the table there should be a soft pad about IV2 inches thick 
covered with rubber sheeting and over all a linen sheet. In addition to the 
operating table but few pieces of apparatus are necessary. There should be 
two or three tables with glass or polished metal tops—preferably metal—for 
surgical dressings and instruments to be used during the operation, one single 
and one double hand basin stand, an irrigating stand, two enamel buckets with 
covers, and a set of glass shelves for solutions, ligatures, drains, pins, etc. All 
the operating-room accessories should be of simple, sturdy, easily cleaned design, 
and should be painted with a durable white enamel. 
Each table in the operating room holds certain specified articles placed in a 
definite way so that no time is lost in hunting for the desired article. 
On the large table (Fig. 115) are kept special Instruments, reserve instru- 
ments, reserve sutures, and linen. At the far end is laid out the preparation 
equipment for sterilization of the operative field. 358 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
There is a double basin stand placed near the foot of the operating table 
within easy reach of the instrument nurse; one basin contains sterile water 
for dipping the suture materials or for soaking tape sponges, the other basin 
contains the dry tape sponges. On this same stand between the basins, the 
dry sutures are neatly arranged in a dry towel for immediate use. 
The instrument tray or table which extends over the operating table holds 
instruments arranged in regular order (Fig. 116). This table routinely holds 
knives, various scissors, plain and toothed thumb forceps, curved and straight 
haemostats, Allis’ forceps, Babcock’s forceps, gauze sponges, stick sponges, vari- 
ous retractors, probes, and grooved directors. 
Figure 116.—View of instrument table showing orderly arrangement of instruments. 
A stand with a hand basin for sterile water is behind the surgeon for rinsing 
his gloves during the operation if necessary. 
Conveniently located, either in the scrub room or in the operating room near 
the entrance from the scrub room, are placed basins for solutions to sterilize 
the previously scrubbed hands of the surgeon and assistants. 
A table is provided near the entrance from the scrub room to hold sterile 
gloves and gowns. 
The anaethetist’s table for general anaesthesia, in addition to the articles 
necessary for the administration of the anaesthetic and an extra supply of the 
anaesthetic, always should have the following equipment on it and immediately 
available for use in an emergency: 
(«•) Wooden mouth gag. 
(&) Tongue forceps. 
(c) A curved needle threaded with silk, sterilized, and in a sterile package. 
(d) Sterile hypodermic syringes with the following drugs in sterile solution 
in appropriate containers: 
Caffeine sodium-benzoate. 
Atropine sulfate. 
Epinephrine hydrochloride (adrenalin). 359 
SURGICAL TECHNIQUE 
(e) Tracheotomy set. 
(f) Gauze strips. 
(g) Forceps (to hold gauze sponge) 
(ft) Watch or small clock. 
(i) Pus basin. 
(j) Blood-pressure apparatus. 
This equipment should be within easy reach and it never should be necessary 
to ask for any of these important articles during anaesthesia, as delay in meeting 
an emergency may result in disaster. It is also desirable to have an anaes- 
thetist’s chart for the recording of data on the table. 
Some cases require gastric lavage (washing out of stomach) during or upon 
completion of operation. It is essential, therefore, that a stomach tube be 
available in the operating room. 
Cleanliness.—The walls and floor of the operating room are usually built of 
waterproof material with a smooth surface and so constructed that sharp, dirt- 
collecting angles are avoided. Glazed porcelain tile for the walls and unglazed 
porcelain tile for the floor are admirably suited for the purpose in hospitals 
on shore, but on battleships, while it may be possible to have a tiled floor, the 
walls are usually steel, painted white, because the great vibration caused by 
gunfire might loosen or crack a tile wall. The floor should be washed daily 
with soap and warm water and all surfaces that might collect dust wiped with 
a damp cloth, the glass-topped tables, that are usually draped sterile, being 
wiped with a cloth dampened with alcohol. Once a week, usually on field day, 
furniture, walls, floors, etc., are thoroughly scrubbed with soap and water, spe- 
cial care being taken to scrub and clean all corners and crevices. Blood or 
other stains that may get on the floor during an operation should be removed 
as quickly as possible, and, if a second operation is to be performed immediately, 
the floor, if necessary, should be cleaned by hand. 
Adjoining rooms. 
The rooms, other than those used for operating, that comprise the operating 
suite are usually the anaesthetizing room, the wash or scrub-up room, the 
sterilizing room, the instrument room, the surgical-dressings room, the store- 
room, and the cleaning-gear room. 
The anesthetizing room is suitably equipped for the administration of 
anaesthetics. 
In the wash or scrub-up room there should be at least two lavatories, with 
foot or knee control for the hot and cold water, a shower bath and toilet, and 
clothes lockers for the use of the surgeon and his assistants when they change 
into the operating suits. It is well also to have in this room a basin stand for 
the solutions used to disinfect the hands after the preliminary scrubbing, in 
order that the surgeon and his assistants can receive their operating gowns 
and proceed without delay. 
The sterilizing room is provided with all equipment necessary to properly 
sterilize instruments, utensils, dressings, water, etc. Despite the fact that this 
equipment is sturdily constructed, constant care must be taken that it is always 
in working condition and the printed directions furnished by the manufacturers 
exactly observed. Operation of this equipment should never be entrusted to an 
inexperienced or careless person, for in inexperienced or careless hands it is 
dangerous, and may fail to kill infectious organisms, thereby endangering the 
lives of patients. 
An instrument room, while not a necessity, is advantageous. However, as a 
rule, unless the clinic is unusually large and of great variety, suitably designed 
glass cabinets placed in the surgical-dressings room will suffice. 360 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The surgical-dressings room should be constructed similarly to the operating 
room, with tiled walls and floor. In this room are made, prepared, and stored, 
after sterilization, the various surgical dressings and packages of linen, such 
as gowns, sheets, towels, etc., used in operations. Here cleanliness is of para- 
mount importance. Ample locker and shelf space should be provided, and also 
a large smooth-top worktable. 
There should be a storeroom solely for the storage of operating-room sup- 
plies. Much valuable time may be lost unless such a room is provided and kept 
fully stocked in anticipation of emergencies. 
The cleaning-gear roam, in which all cleaning gear used in the operating 
suite should be stowed, should have in it a large deep sink with running hot and 
cold water, in which the linen used during operations may be soaked and the 
greater part of blood stains removed before sending to the laundry. The clean- 
ing-gear room, it should be remembered, is an integral part of the operating-room 
equipment, and as such must be scrupulously cared for. 
Modern surgical technique is founded on the work of Lord Lister, who, in 
March 1867, published the first of a series of articles on the antiseptic principles 
of the practice of surgery. From this work has been evolved the modern aseptic 
methods which aim to prevent the entrance of microorganisms into the tissues. 
These aseptic precautions account for nearly all the details of present-day 
operating room technique. 
SURGICAL TECHNIQUE 
Before an operation it is necessary to make sterile and to keep sterile: 
1. The patient’s skin; 2. The hands and clothing of the surgeon and his assist- 
ants; and 3. All instruments and materials that come in contact with the 
wound or 'are handled by the surgeon and his assistants. 
During the operation the surgeon and his assistants must not touch anything 
that is not sterile. A great responsibility rests upon the operating room 
hospital corpsmen, because the most perfect surgery may be a complete fail- 
ure if there is the smallest break in the aseptic technique for which they are 
responsible. It follows, then, that a great deal of credit for the success of 
surgery in the Navy is due to the nurses and hospital corpsmen of the operat- 
ing room detail. It is their efficiency that makes aseptic surgery possible. 
By aseptic surgery is meant that mode of surgical practice in which every- 
thing used at the time of operation and at subsequent dressings, as well as 
the wound, is free from pathogenic bacteria and is sterile, or surgically clean. 
To maintain that condition requires constant vigilance before, during, and 
after an operation, and no failure of technique however trivial, must be 
allowed to pass uncorrected. 
Infection is the word used to describe the condition which exists when 
pathogenic bacteria, commonly spoken of as infectious organisms, gain access 
to the tissues of the body in such numbers that their presence is manifested 
by characteristic symptoms, such as inflammation, suppuration, putrefaction, etc. 
Inflammation is the first objective or outward symptom of infection and is 
characterized by local pain, heat, redness, swelling, and disordered function. 
The general or subjective symptoms of inflammation vary greatly, depending 
upon the amount and anatomical location of the tissue involved, the physical con- 
dition of the patient, and the virulence (disease-producing power) of the infecting 
organism. Fever is the most constant subjective symptom of inflammation, 
but it may be so slight that it escapes notice or it may be so severe that 
recovery of the patient seems doubtful. Aseptic treatment and careful observa- SURGICAL TECHNIQUE 
361 
tion of wounds, traumatic or operative, is imperative, in order that in the first 
place infection with its subsequent possibilities may be prevented and, secondly, 
if infection does occur it may be recognized promptly and appropriately treated. 
Suppuration is the result of inflammation and is due to the liquefying action 
of pyogenic (pus producing) organisms on the exudates of tissues damaged by 
inflammation and also upon the tissues themselves, forming pus. 
When a wound has become so infected that the inflammation does not subside 
and pus forms, it is termed a “septic” wound. Frequently, as a result of the 
passage of bacteria from a septic wound into the blood stream or of the 
absorption of the toxins (poisons) elaborated by the bacteria, grave general 
symptoms are caused and sepsis or septicwmia (blood poisoning) is said to 
be present. 
The word putrefaction refers to that condition when inflammation has so 
far progressed that the tissues have been devitalized and a foul or putrid 
odor arises from the wound. The putrid odor is due to the action of putre- 
factive bacteria. 
The microorganisms producing pus are known as pyogenic bacteria. The 
various strains (varieties) of the staphylococcus and streptococcus are the 
causative agents in the majority of surgical infections. Other organisms such 
as the Mycobacterium tuberculosis (hominis), Bacillus anthracis (Bacillus of 
anthrax), Actinobacillus mallei (Bacillus of glanders), Diplococcus pneumonke, 
Escherichia communior, Clostridium tetani (Bacillus of tetanus), and Clos- 
tridium welchii (gas bacillus), are, however, occasionally demonstrable. The 
staphylococcus is the most common cause of infection. It rarely causes alarm- 
ing constitutional symptoms, and as a rule such an Infectious process remains 
quite localized. The streptococcus is more virulent and tends to invade the 
whole system. Infection of wounds by one type of organism is quite rare; 
two or more varieties usually are present and the coincident symptoms are 
dependent upon the predominating bacterium, either because of its virulence or 
numbers. It is well to note that the encapsulated spores or buds of the bacillus 
anthracis are the most difficult of all germs to kill, and any process which will 
render them harmless (and they must be dead to be harmless) may be relied 
upon to accomplish the same result as regards the other bacteria. 
The prevention of infection is the best treatment known for this condition. 
Infection is prevented through the employment of measures that destroy infec- 
tious bacteria and their spores or inhibits or stops their growth. These meas- 
ures make up that process in surgical technique known as sterilization. 
Sterilization is the process of rendering anything sterile by destroying infec- 
tious organisms and their spores, and is accomplished by mechanical, thermal, 
and chemical methods. Sterilizing agents are substances which destroy or 
remove or prevent the growth of infectious organisms. 
The methods used in mechanical sterilization, while not dependable, are 
important preliminary steps to more complete methods of sterilization. The 
most important of the mechanical methods of sterilization are scrubbing ana 
irrigation. 
A thorough scrubbing with hot water, soap, and brush is frequently of great 
importance as it removes dirt which may harbor harmful bacteria from the 
walls and floors of operating and treatment rooms, from instruments and uten- 
sils, the hands of the surgeon and those assisting at operations and dressings, 
and the skin of the patient. Instruments and utensils should always be cleaned 
and scrubbed immediately after use as that removes most of any bacteria 
present and makes subsequent sterilization more easily effective. 362 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The irrigation of wounds with sterile water or other aqueous solutions to 
float off or dislodge by force dirt and bacteria, or to bring solutions in con- 
tact with parts of a wound which are not otherwise accessible, has a distinct 
place in surgical practice. Irrigation is a splendid mechanical cleanser and, in 
many cases, will remove infectious organisms when other methods fail. 
Thermal sterilisation, or sterilization by heat is the most efficient agent of 
sterilization, and, when properly used, is almost certain in its germicidal action. 
Moist heat is used as a sterilizing agent in two forms, boiling water and live 
steam under normal or increased pressure. 
Boiling water is the simplest method of sterilization, killing anthrax spores 
in 3 minutes, and is used chiefly for sterilizing instruments (except those with 
lenses), glass and metal utensils, enamel ware, and other objects which are not 
injured by heat and moisture. The articles should be boiled for 20 minutes in 
water containing about 1 per cent (3 teaspoonfuls to the quart) of sodium car- 
bonate, which is added to prevent rusting, to raise the boiling point of the 
water, and to dissolve any organic matter that may be present. In emergencies 
surgical dressings may be boiled, but it is far more satisfactory to have them 
dry at the time of operation. 
Live steam is air-free steam and for sterilization purposes is used under normal 
or increased pressure. Steam under increased pressure is termed superheated 
steam and is the best method of sterilization. Steam at normal pressure is 
but little used at the present time. 
An autoclave is a sterilizer in which steam under pressure (superheated 
steam) is used. A vacuum first is created to insure penetration of the steam, 
and when the proper reading of negative pressure (vacuum) is registered in the 
gauge superheated steam is admitted to the chamber and the articles therein 
subjected to a steam pressure of 15 pounds for one-half to three-quarters of an 
hour. At the end of this time all organisms will have been killed and the dress- 
ings or other articles rendered safe to use, but they are wet. A second vacuum 
then is induced and maintained until they are dry. One such sterilization 
ordinarily is sufficient to preclude the possibility of infection, but that there 
may not exist the slightest doubt as to the asepsis of the sterilized material 
the process is repeated two or three times, despite the fact that anthrax spores 
are killed by live steam in 12 minutes. This method of repeated sterilization, 
either by steam or boiling, is termed fractional sterilisation. 
The method of sterilization in which dry heat is used includes the use of the 
actual cautery, a flame, or hot air. Hot air is fairly satisfactory and it will 
kill anthrax spores in about threee hours at 140° C. The cautery is a positive 
germicide, but causes extensive destruction of the tissues. Sterilization by a 
flame is rarely, if ever, used in surgery, but may be used for rapid sterilization 
of platinum loops, needles, and other small instruments. Dry heat was once 
extensively used in the sterilization of dressings and clothing but has been 
largely superseded by steam under pressure which is quicker and more effective. 
In chemical sterilisation chemicals that will kill bacteria and spores are used, 
but in order to do this promptly they must be used in such a strong solution 
or concentration that the tissues to which they are applied may likewise be 
destroyed. As such a result is usually undesirable the use of chemicals as 
sterilizing agents is confined chiefly to the sterilization of instruments which 
boiling or steam would ruin, or in weak solution as an adjunct to the mechani- 
cal method of sterilization. Chemical solutions of appropriate strength are used 
in the sterilization of instruments, materials and utensils, the skin of the 
patient, the operator’s hands, and the walls and floors of rooms. When used SURGICAL TECHNIQUE 
363 
in contact with the tissues the aim is to secure complete sterilization without 
causing damage to the tissues, but no such ideal antiseptic has yet been found. 
The terms antiseptic, disinfectant, and deodorizer are often applied to chemi- 
cals according to the purpose for which they are used. When used in con- 
nection with chemicals, an antiseptic is an agent which inhibits or stops the 
growth of or kills bacteria but not the spores; a disinfectant is an agent which 
kills both the bacteria and the spores; and a deodorizer is an agent which 
destroys offensive odors. While the terms antiseptic and disinfectant have 
distinctly different meanings, they have been used synonymously so often 
that, from a practical standpoint, it is considered correct to use them inter- 
changeably. Many chemicals may be used either as an antiseptic or a disin- 
fectant. 
Some of the chemicals used in chemical sterilization are named and briefly 
described immediately hereafter. 
Alcohol, in strengths varying from 50 to 95 per cent, is commonly used to dis- 
infect the hands of operators, for disinfecting cutting and sharp instruments, for 
cleansing and drying the skin of the operating field preparatory to the application 
of iodine, and as a solvent or diluent for various antiseptics. 
Iodine, in strengths varying from 21 to 7 per cent, is a reliable germicide and 
is used for sterilizing wounds and in preparation of the skin. The 2 per cent 
solution is sometimes used in preparation of the operator’s hands. In the 
presence of water the iodine is precipitated and it will not penetrate if the skin 
or tissues be wet. When used for skin sterilization it is usually preceded by an 
application of benzine or ether to remove the sebaceous matter and dry the 
skin. After the iodine has dried it is customary to remove the excess with 
alcohol to prevent burning or blistering the skin. 
Bichloride of mercury is now seldom used in contact with the body although 
some operators use it in preparation of their hands. In weak solutions it has 
a powerful germicidal action on superficial bacteria, but is of little value as a 
germicide in deep wounds because it combines with the proteins in the tissues 
to form an insoluble albuminate of mercury which markedly hinders its action 
and penetrative power. A 1 in 500 solution in alcohol is useful in sterilizing 
rubber goods. As mercury has a corrosive action on metals it should never be 
used to sterilize instruments. 
Phenol (carbolic acid) in saturated solution, is used for sterilization of 
cutting instruments which would be injured by boiling. They are submerged 
in the solution for 15 minutes, washed in sterile water and placed in alcohol 
until needed. It is also used for sterilization of tissues, such as the stump of the 
appendix, where deep penetration is not required, and as a local cauterizing 
agent. Phenol dressings should not be used because of the danger of subsequent 
gangrene. 
Dakin's solution is a solution of sodium hypochlorite of strength between 
0.45 and 0.5 per cent and practically neutral in reaction. In contact with the 
tissues it gives off nascent chlorine which destroys bacteria and dissolves the 
necrotic tissue in which they grow. It is rapidly decomposed by light and 
heat and should be titrated daily to insure the proper strength. When used 
according to the Carrel technique in a properly prepared wound, it is of great 
value. 
The chloramine group of disinfectants also act by liberation of chlorine. 
They are more stable than Dakin’s solution and give off their chlorine more 
slowly but they lack the important solvent action qn the necrotic tissue, 
154294°—39 24 364 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
Potassium permanganate is an excellent deodorizer and, in addition, is a 
good disinfectant for the hands in saturated solution. 
Boric acid is a very mild antiseptic and generally is used in saturated solu- 
tion (4 per cent) for the irrigation of infected wounds or the sterilization of 
instruments which heat in any form would destroy. 
Formaldehyde is an excellent germicide and is used either as a gas or in 
solution. It is very irritating to the tissues and seldom is applied in a dress- 
ing; in weak solutions (1 to 2 per cent) it will prove a satisfactory sterilizing 
solution for instruments. Formaldehyde gas in a glass jar is perhaps the most 
satisfactory method of sterilizing instruments which heat or moisture would 
injure, as catheters, cystoseopes, and similar articles. As a gas it is sometimes 
used in the disinfection of wounds, but this is no longer done as a routine in 
the operating suite. 
Various substances that color or dye the skin, such as picric acid, mercuro- 
chrome, gentian violet, and acriflavine are also used as disinfectants. 
The sterilizing methods used in the operating suite at the Norfolk Naval 
Hospital, Portsmouth, Va., are here given as an example of a satisfactory 
routine. 
Large packs are sterilized for 60 minutes under 20 pounds pressure with 20 
to 30 minutes vacuum allowed for drying. Small packs are sterilized for 30 
minutes under 20 pounds pressure with 15 to 20 minutes vacuum allowed for 
drying. Enamel ware, glassware, and rubber goods are sterilized for 15 min- 
utes under 15 pounds pressure with no vacuum. Solutions in flasks are steri- 
lized separately for 15 minutes at 15 pounds pressure. Pressure, at conclusion 
of sterilization period, is allowed to decrease gradually. No vacuum is used on 
solutions. Sharp instruments are sterilized in oil in a hot-oil sterilizer at a 
temperature of 250° F. and above for 15 minutes. Sharp instruments can be 
sterilized by placing in an 87% per cent solution of phenol for 15 minutes, rinsed 
in plain sterile water and placed in 95 per cent alcohol for 20 minutes. Other 
instruments are placed in trays and boiled for 20 minutes. A 1 per cent solution 
of sodium carbonate (3 teaspoonfuls to the quart) raises the boiling point about 
5 degrees, prevents rust, and removes grease and other organic matter. Gloves 
are cleaned, inspected for holes, dried, then powdered well and evenly on both 
sides with talc. The cuffs are turned back for 2 inches. Each pair is placed 
in a muslin envelope of 4 thicknesses with a small powder bag. This is wrapped 
in a muslin cover and sterilized for 15 minutes under 15 pounds pressure. 
Both chemical and bacteriological controls are used to insure proper steriliza- 
tion, and laboratory cultures of all packages are frequently taken. 
Basins are boiled in a special sterilizer for 1 hour. 
The suture materials which are dispensed in tubes have been rendered sterile 
by the manufacturer. The tubes themselvs are sterilized in 2 ways. If the 
tubes are marked “boilable” they are sterilized by boiling with the instru- 
ments for 15 minutes. If they are not marked boilable, they are stored in 
5 per cent phenol solution and then placed in 95 per cent alcohol for 20 minutes 
just prior to operation. 
Suture materials such as silk and linen not dispensed in tubes are sterilized 
in the autoclave under 15 pounds pressure for 15 minutes. Horse hair, silk- 
worm gut, silver wire, etc., are sterilized by boiling for 15 minutes prior 
to operation. 
Surgical dressings. 
Surgical dressings commonly are made from gauze, cotton, flannel, rubber, 
linen, etc., by the operating-room force. The gauze and cotton should be 
of good quality and capable of rapidly absorbing fluids. SURGICAL TECHNIQUE 
365 
It sometimes happens that the gauze, as received from the manufacturers, 
is sized—that is, coated with a starch preparation which makes it unfit for 
surgical use—and such gauze must be boiled in a 1 per cent solution of 
sodium carbonate in order to remiove this sizing. 
Sponges are used for many purposes and are made of gauze, either rolled 
in a ball or flat. The flat sponges are of various sizes from 4 by 4 to 4 by 8 
inches and are usually of from 6 to 8 thicknesses of gauze. All raw edges are 
turned in. Sponges are wrapped in muslin wrappers for sterilization. 
Packs, or taped sponges, are used for surrounding the field within the 
abdomen. They are made of 6 or 8 layers of gauze, with all the raw edges 
turned in and sewed. To avoid leaving them in the abdomen, a tape is 
sewed to one corner, and to this a metal ring is secured, or a hsemostat may 
be clamped to the end of the tape. The common sizes of packs are 12 by 12 
inches, 12 by 6 inches, 12 by 3 inches, and 2 by 10 inches. For sterilization 
they are placed in muslin covers or bags, each package containing a definite 
number and so labeled. During the operation the nurse or hospital corps- 
man in charge of them must know the exact location at all times of every 
pack that has been issued. 
Pads consist of various thicknesses and sizes of absorbent cotton wrapped 
in an outer covering of gauze. They are used in wound dressings for absorb- 
ing fluids and to protect the tissues from pressure. 
Sheets and towels are folded in a certain manner and wrapped, a definite 
number in each package, in a small muslin cover for sterilization. 
Caps and masks are worn to prevent infection by dandruff or secretions 
from the mouth and nose. They are enclosed in muslin wrappers, sterilized 
and placed in the surgeon’s dressing room. 
Pajamas are worn in place of their outer clothing by surgeons and hos- 
pital corpsmen during operations. (Fig. 117). They may be used as they 
come from the laundry or if preferred they may be sterilized. 
Operating gotcns are of a standard type in the Navy and are worn by all 
persons present at an operation. The hospital corpsman who is first to scrub up 
usually holds the gown for the others. When putting on a sterile gown one 
should avoid touching the ungloved hand to its outside. 
In preparation for emergencies a hospital or a ship should have on hand 
a considerable quantity of sterile goods. They may be placed in metal drums 
or in packages, each containing a standard outfit for an operation. These 
should be sterilized once a week if not used. Such an emergency outfit 
may consist of the following articles which are sufficient for the ordinary 
operations: 6 sheets; 1 laparotomy sheet; 12 surgical towels; 12 field cloths; 
6 hand towels; 1 tray cover; 1 sacral sheet; 2 plain covers; 3 operating 
gowns; 1 can of glove talc; and a small bag containing the following articles: 
24 “prep” sponges; 4 large, 4 medium and 4 small packs; 24 flat sponges; 1 skin 
towel; 1 test tube containing 2 safety pins; 1 roll of binding tape; applicators; 
1 appendix apron and Diak controls. 
To pack such an outfit a double muslin cover is laid out smooth, a sheet 
folded in the middle is placed on it, and the articles listed, stacked neatly, are 
placed on the sheet. The ends of the sheet are brought together, then the outer 
cover is pinned together and the whole package is sterilized. When needed, the 
outer cover is unpinned and serves as a cover for the sterile goods table. 
Sutures and ligatures. 
There are two principal kinds of sutures and ligatures, absorbable and non- 
absorbable. The principal varieties of absorbable sutures are plain gut, chromic 366 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
gut, and kangaroo tendon. Gut sutures are made from the submucous coat of 
the intestine of the sheep; they are used in the deep tissues such as peri- 
toneum, muscle and fascia. The plain gut is supposed to last from eight to 
ten days in the tissue. Chromic gut sutures are prepared in four types, to last 
10, 20, 30, and 40 days in the tissue, but the rate of absorption is very variable. 
Gut sutures come in various sizes from 0000 to 4. They are usually issued in 
plain glass tubes which may be sterilized by boiling or submerging in a special 
suture sterilizing solution such as potassium-mercuric-iodide solution 1—8000 in 
95 per cent alcohol. Kangaroo tendon is much stronger and heavier than the 
gut and lasts about 30 days in the tissue. 
Figuee 117.—Operating-room dress. 
The introduction of the atraumatic intestinal suture has been a great step 
in minimizing suture trauma, as the suture is attached to the needle in such a 
manner that the perforation made by the needle is not enlarged or traumatized 
by the entrance of the suture itself. These sutures are made in both plain 
and chromic from size 0000 to 2 and may be used for all membranes 
where minimized suture trauma is desirable. 
Nonabsorbable sutures are made of silk, linen, silkworm gut, horse hair, 
silver wire and other materials. SURGICAL TECHNIQUE 
367 
Instruments. 
Most surgical instruments are made of special steel, and are nickel plated 
to prevent rusting. The newer instruments are made of stainless steel which 
is not plated and prove highly desirable in that they do not chip and show no 
wear from sterilization and scrubbing. They are kept in a special cabinet 
when not in use. 
After an operation all metal instruments should be washed carefully to 
remove all blood and other foreign matter. They should then be dried and 
carefully examined for dirt in the crevices, breaks in the plating and sharpened 
if they need it. They are then wiped with liquid petrolatum or typewriter oil 
to prevent rusting and placed in the instrument cabinet. 
The instruments required for an operation vary greatly according to the 
nature of the operation and the ideas of the surgeon. The following is sug- 
gested as a basic outfit for ordinary operations (others may be added as de- 
sired) ; 2 scalpels; 3 scissors (1 curved Mayo, 1 straight Mayo and 1 blunt 
for suture scissors) ; 2 plain thumb forceps; 2 rat-toothed thumb forceps; 10 
small straight hsemostats; 10 curved Kelly hsemostats; 8 Allis intestinal 
forceps; 6 Babcock intestinal forceps; 6 large Oschner straight forceps; 12 
towel clips; 2 large retractors; 2 small retractors; 1 grooved director and tongue 
tie; 1 silver probe; 1 blunt dissector; 3 needle holders; needle kit containing all 
types of needles (straight intestinal, straight skin, curved cutting, curved in- 
testinal, fascia and muscle needles) ; plain and chromic gut; assorted glass 
syringes and hypodermic needles; 3 medicine glasses; and skin clips and forceps 
or silkworm gut for the skin. 
Operating personnel. 
In the Navy this consists of the operating surgeon and the medical officers 
who assist him, the operating-room nurse, the anaesthetist, and two or more 
hospital corpsmen. 
The operating surgeon is in general charge. He is responsible for the patient’s 
life and for the successful outcome of the operation. He is held accountable 
for all mistakes and accidents, no matter whose the fault may be, that may 
cause unfavorable outcome. 
To the operating-room nurse is delegated the authority necessary for the 
routine administration of the operating suite. This involves numerous details 
such as the care and accounting for all property, cleanliness, sterilization, prep- 
aration for operations, and supervision and instruction of hospital corpsmen. 
The anaesthetist is usually a nurse who has had special training in this 
branch. She is responsible to the operating surgeon for the general condition of 
the patient during the administration of a general anaesthetic. 
Since local and spinal anaesthesia have become so popular, many surgeons 
prefer to be their own anaesthetists. The operating-room nurse, in case no 
regular anaesthetist is assigned, sits at the patient’s head during the opera- 
tion and keeps a record at frequent intervals of the blood pressure, pulse 
and respirations. 
The hospital corpsmen "are detailed to the operating room for the purpose 
of instruction and training so that they will be capable of running an operat- 
ing room aboard ship. The principal characteristics of a good operating-room 
hospital corpsman are dependability, faithfulness in the most minute details 
of his work, and an even temper which will enable him to work quickly and 
accurately in emergencies, intelligence to understand the reason for everything 
he does, and a devotion to the welfare of the patient. 368 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
PREPARATION FOR OPERATION, 
Each one of the operating room personnel removes his outer clothes, puts on 
his operating clothes, and then proceeds to the scrub-up room. Here the hands 
and forearms are scrubbed for 15 minutes with hot water and green soap and 
rinsed and soaked in 70 per cent alcohol. This washing should be done in a 
Figure 118.—Holding rubber glove for another with palm and thumb of glove turned 
toward the one who is to wTear it. 
Figure 119.—Putting on second rubber glove, with gloved fingers inside the cuff so that 
they do not touch the ungloved hand. SURGICAL TECHNIQUE 
369 
methodical way so that each side of the fingers and every part of the hands 
and forearms is scrubbed thoroughly. It is essential that persons engaged in 
surgical work keep their nails short and clean. No special cleaning of the 
nails is necessary or desirable while scrubbing for an operation, because this 
is likely to bring to the surface microorganisms which would otherwise remain 
harmlessly buried in the tissue beneath the nails. After scrubbing and rinsing 
in alcohol, the surgeon enters the operating room where he is handed a hand 
towel with which he dries only his hands, leaving his forearms untouched by the 
towel. He then puts on a sterile gown and sterile rubber gloves. (Figs. 118 
and 119). When fully prepared as above, and while waiting for the start of 
the operation, the surgeon and his assistants must hold their hands above 
their waist. If the wait is long, the hands should be covered with a sterile 
towel. 
Figure 120.—Spinal anaesthesia table. 
The field of operation is shaved before the patient enters the operating room, 
though sometimes this is done in the operating room. If a general anaesthetic is 
used the skin preparation is done after the patient is unconscious. With spinal 
anaesthesia the field is prepared after the anaesthesia is given. With local or 
block anaesthesia the field is prepared before the injection of the anaesthetic is 
given. 
If a spinal anaesthetic is used special material and apparatus are 
necessary which should be laid out on a table as shown in figure 120. The 
spinal kit consists of the following articles: 2 5-cc hypodermic syringes; 1 2-cc 
hypodermic syringe; 3 spinal needles; 2 hypodermic needles; 1 mixing needle; 
1 ampule saw; 1 sacral sheet; sponges, etc.; 150, 200, or 300 milligrams of 
novocaine crystals may be used, the desired amount being designated by the 
operating surgeon. After the spinal injection the table is tilted with the 
patient’s head lowered at about a 10° angle. 
There are many ways of preparing the skin. A simple and very satisfactory 
one is to scrub the skin with a gauze “prep” sponge wet with ether to remove 
grease and moisture, and then paint the skin thoroughly with tincture of 370 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
merthiolate, and allow to dry. After the merthiolate is completely dry paint 
the skin with a second coat, beginning in the middle of the field and progressing 
outward to the edges of the previous coat. The field should then be draped 
with sterile towels and sheets, so that only the prepared skin is exposed. 
Other common disinfectants used in the Navy for skin preparation are iodine 
and alcohol, mercurial preparations such as mercurochrome, Scott’s solution, etc. 
Following is a summary of the routine preparations for an operation: 
1. The operating-room nurse, the anaesthetist, and the surgeon are notified as to 
the time and the nature of the operation. 
2. The hospital corpsman in charge of the instruments selects those needed 
and puts them in the sterilizer along with the necessary utensils. 
3. The cutting instruments are placed in the hot-oil sterilizer or in a sterilizing 
solution. 
4. All hands assist in placing the furniture and equipment in proper order, 
and all glass-topped tables, Mayo tables, overhead lights, and portable lights, 
are wiped with a towel wet with alcohol. 
5. The hospital corpsman in charge of sterile supplies selects the packages of 
sterile goods and places them on the proper tables. 
6. The hospital corpsmen proceed to scrub up and put on sterile gowns and 
gloves. 
7. Both hospital corpsmen drape, with sterile sheets, the table for gowns and 
gloves, the instrument table, the surgical dressing table, the basin stands, and 
the spinal anaesthetic table. 
8. The trays of sterile instruments are brought in from the sterilizer. A hos- 
pital corpsman arranges them in the proper order on the instrument table and 
drapes them with a sterile towel until they are needed. 
9. The basin and utensil set is opened and the contents placed in their proper 
places. 
10. The sterile packages are opened and a hospital corpsman places their con- 
tents in the proper place on the surgical dressing table. 
11. A hospital corpsman sorts and arranges the extra instruments on the cir- 
cular table and prepares the sutures and ligatures. (Sutures are no longer 
placed in a damp towel, but in a dry one, as it has been discovered that con- 
tinued soaking causes them to lose their tensile strength and greatly increases 
the danger of contamination. They are dipped in warm water for a few seconds 
immediately before handing them to the operator). 
12. If spinal anaesthesia is to be used, the spinal kit is opened and then pre- 
pared by the hospital corpsmen. 
13. All tables and stands containing sterile articles are draped with sterile 
towels or sheets until they are needed. 
14. The patient is wheeled into the operating room and the anaesthetic is 
given. 
15. By this time the surgeons and assistants are dressed and scrubbed and 
ready to be dressed in sterile gowns and gloves by the junior hospital corpsman. 
16. The patient’s skin is then prepared by the assistant in the manner previ- 
ously described. 
17. The patient is then draped with towels and laparotomy sheets by the 
assistant and the senior hospital corpsman. 
18. The instrument table is rolled into place as well as the double-basin stand. 
19. The surgeon and his assistants assume their proper places. 
20. The senior hospital corpsman hands the surgeon the scalpel, the incision 
is made after which the skin knife is discarded and the operation proceeds. CHAPTER VI 
Page 
Section 1. Hygiene and sanitation 371 
Section 2. Allergy 469 
Section 3. Genito-urinary and venereal diseases 490 
Section 4. Prevention of venereal diseases 511 
Section 5. Industrial medicine 514 
Section 6. Field sanitation 521 
Section 7. Duty with Marine Corps expeditionary forces 564 
Section 8. Landing force 570 
Section 9. Shore patrol 574 
Section 1.—HYGIENE AND SANITATION 
Preventive medicine may be defined as the branch of medical science which 
deals with the prevention and control of disease, and includes all hygienic, sani- 
tary, or other measures and practices contributing to that end. Hygiene and 
sanitation, often confused with preventive medicine, are really specific fields 
of prevention of disease. Hygiene is the science of health and deals with the 
proper care of the human body to permit the proper functioning of its various 
organs. In the broadest sense its object is to “render growth more perfect, 
decay less rapid, life more vigorous, and death more remote.” Sanitation deals 
with the proper care of man’s surroundings. Personal hygiene pertains to the 
individual’s care of his own body in order that it will function properly. 
COMMUNICABLE DISEASES AND PRACTICAL PREVENTIVE MEDICINE 
The practice of preventive medicine is not confined alone to the prevention 
and control of the diseases which are communicable from man to man, or 
from animals or insects to man, by means of microorganisms, bacteria, fungi, 
or minute animal parasites, but to all diseases with which man is affected. 
The subject thus includes all other fields of medical, surgical, physical, or 
sociological activity which aid, first, to prevent disease and second, to control 
its spread. 
In the practice of preventive medicine it is necessary to know the cause, 
the nature, and in what manner man contracts a disease before such diseases 
may be controlled. The science which deals with determining, describing, 
and explaining the distribution of disease and variations of type is known as 
epidemiology. 
While Hippocrates, who lived in the fifth century B. C., stressed the value of 
a hygienic mode of life, preventive medicine as a science made slow progress 
until Tenner’s discovery in 1790 of vaccination as a preventive against 
smallpox. Another lull ensued until Pasteur’s discoveries between 1857 and 
1882 regarding bacteria as a cause of disease and the value of vaccines and 
“viruses.” Then followed a veritable “germ hunt” by many investigators, 
with the result that in a remarkably short time not only the cause, but 
usually the mode of transmission, and hence the means of prevention, of many 
diseases were discovered. 372 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Communicable diseases are constantly decreasing, and today there are means 
for the control of many that formerly were prone to occur in epidemic form 
during mobilization. By environmental sanitation and immunization intestinal 
diseases can be satisfactorily controlled. Insect-borne diseases can be prac- 
tically eliminated from a station by attacking the insect, or parasite in the 
host or both. Smallpox can be controlled by vaccination with cowpox. The 
incidence of venereal diseases can be greatly reduced by use of immediate 
and thorough prophylaxis. Adequate control measures for the prevention 
of certain of the upper respiratory diseases, however, remain to be discovered. 
The control of communicable diseases is a problem with which medical officers 
and hospital corpsmen have to deal constantly. Therefore, the communicable 
diseases which are most likely to attack the personnel of the Navy will be 
dealt with in detail. Before considering such diseases separately, the definitions 
of terms used in connection therewith as recommended by the American Public 
Health Association, will be given. 
Source of infection.—Most of the communicable diseases to which man is 
susceptible are peculiar to and spread by him. Lower animals are the source 
of some infections, such as plague, trichinosis, tape worms, etc. 
Modes of transmission.—These may be classified in the following general 
groups; 
(a) Contact: 1. Month spray or droplet infection.—In talking, coughing, or 
sneezing, persons emit from the mouth and nose a fine spray which contains the 
microorganisms harbored in the mouth, nasopharynx, and respiratory passages. 
The droplets will remain suspended in the air for varying lengths of time and 
air currents may distribute them short distances. The radius of droplet infec- 
tion without air current is 6 or 8 feet; 2. Hands and fingers contaminated with 
infected secretions are unquestionably the most important agencies in contact 
infection. They may infect directly or indirectly; and 3. Direct approximation 
of body surfaces of two individuals, such as that occurring during kissing or 
sexual intercourse. 
(6) Foods, including water and ice, milk and dairy products, meat and 
shellfish, and vegetables. 
(c) Insects, by mechanical and biological transmission. 
(d) Soil. 
(e) Fomites. Linens, dishes, etc., used by the infected person and contami- 
nated with infected discharges. 
Carrier.—A person who, without symptoms of a communicable disease, harbors 
and disseminates the specific infectious agent of the disease. 
Cleaning.—This term signifies the removal by scrubbing and washing, as 
with hot water, soap, and washing soda, of organic matter on which and in 
which bacteria may find favorable conditions for prolonging life and virulence; 
also the removal by the same means of bacteria adherent to surfaces. 
Contact.—A “contact” is any person or animal known to have been suffi- 
ciently near to an infected person or animal to have been presumably exposed 
to the transfer of infectious material directly or by articles freshly soiled by 
such material. 
Delonsing.—By delousing is meant the process by which a person and his 
personal apparel are treated so that neither the adults nor the eggs of the 
varieties of lice that infest man survive. 
Disinfection.—By this is meant the destroying of the vitality of pathogenic 
microorganisms by chemical or physical means. When the word concurrent 
is used as qualifying disinfection, it indicates the application of disinfection HYGIENE AND SANITATION 
373 
immediately after the discharge from the body of an infected person of infec- 
tious material or the soiling of articles with such infectious discharges. When 
the word terminal is used as qualifying disinfection, it indicates the process 
of rendering the personal clothing and immediate physical environment of the 
patient free from the possibility of conveying the infection to others at the time 
when the patient is no longer a source of infection. 
Disinfesting.—By disinfesting is meant any process, such as the use of dry or 
moist heat, gaseous agents, poisoned food, trapping, etc., by which insects and 
animals known to be capable of conveying or transmitting infection may be 
destroyed. 
Filtrable virus.—The term “filtrable virus” as defining the etiological agent 
of certain diseases is used in the sense of a causal agent differentiated from 
other kinds of infectious agents such as bacteria, protozoa, etc. Many of these 
filtrable viruses can be grown in vitro in the presence of living susceptible 
cells, and such cultures will produce regularly typical diseases in animals and 
in man. The term “filtrable virus” has a significance comparable to that of 
bacterium, spirochsete, or protozoon and is as definite a description of an 
etiological agent as is the statement that the typhoid bacillus causes typhoid 
fever. The idea conveyed by the statement that a filtrable virus is the etiolog- 
ical agent is that the cause of this disease is known, even though present 
knowledge does not permit further precision in distinguishing among filtrable 
viruses except by reference to the name of the disease produced by each. 
Fumigation.—By fumigation is meant a process by which the destruction of 
insects, as mosquitoes and body lice, and of animals, as rats, is accomplished 
by the employment of gaseous agents. 
Incubation period.—The period between the time a person Is first infected 
with a communicable disease until the first clinical symptoms appear is known 
as the incubation period. 
Isolation.—By isolation is meant the separating of persons suffering from 
a communicable disease, or carriers of the infectious organism, from other 
persons, in such places and under such conditions as will prevent the direct or 
indirect conveyance of the infectious agents to susceptible persons. 
Quarantine.—By quarantine is meant the limitation of freedom of movement 
of persons or animals who have been exposed to communicable diseases for 
a period of time equal to the longest usual incubation period of the disease to 
which they have been exposed. 
Renovation.—By renovation is meant, in addition to cleansing, such treat- 
ment of the walls, floors, and ceilings of rooms or houses as may be necessary 
to place the premises in a satisfactory sanitary condition. 
Report of a disease.—By “report of a disease” is meant the notification sent 
to the health authorities, and, in the case of communicable diseases in animals, 
also to the respective departments of agriculture, who have immediate juris- 
diction, that a case of communicable disease exists in a specified person or 
animal at a given address. 
Susceptibles.—A susceptible is a person or animal who is not known to be 
immune to the particular communicable disease in question by natural or 
artificial means. 
Immunity. 
Because of the part it plays in the control of communicable diseases it is 
necessary to briefly discuss the defense mechanism against disease that is pos- 
sessed by the body and is known as immunity. 374 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Although the living body of man may serve as a source of food and as a host 
for the reproduction and growth of disease-producing microorganisms, or bac- 
teria, it does not willingly or passively do so. Instead, the body resists the 
entrance of such bacteria and if, in spite of that resistance, entrance is gained, 
then the body attempts to prevent their reproduction and growth or to de- 
stroy them. 
Before microorganisms can produce disease they must invade or break 
through the physiological exterior of the body, or enter through breaks therein. 
The physiological exterior of the body consists of the skin and the mucous 
membranes of all passages or tracts leading into and away from the body, 
e. g., the gastro-intestinal, genito-urinary, and respiratory tracts, etc. 
Certain microorganisms, known as parasitic microorganisms or parasites, live 
on the physiological exterior of the body and under ordinary conditions do not 
produce disease, while others, known as pathogenic bacteria, possess the power 
to produce disease. Those which cause the communicable diseases are said to 
be specific because they can cause only their own disease. Thus the typhoid 
bacillus can only cause typhoid fever; the diphtheria bacillus alone can cause 
diphtheria, etc. 
The power of bacteria to produce disease is known as virulence. This viru- 
lence or disease-producing power is increased by suitable food, moisture, and 
temperature, such as are found in the human body, also by the absence of light 
and the presence or absence of light and the presence or absence of oxygen for 
aerobic and anaerobic bacteria respectively. The virulence is decreased by the 
absence or diminution of the above favorable conditions. 
The virulence of a bacterium tends to increase under conditions of direct 
transmission until the maximum virulence is reached, after which it tends to 
become lessened. Thus many outbreaks have their origin in cases of diseases so 
mild or atypical as to remain unrecognized. The infected persons go about 
their work or diversions in contact with many people, handle milk, food, etc., 
disseminating the infective microorganisms which increase in virulence as a 
result of the direct transmission. 
The body is protected against the invasion of disease-producing bacteria 
through; 1. The physical barrier or wall afforded by the coverings of the body, 
its physiological exterior; and 2. Through the action of the secretions of various 
glands connected with the physiological exterior of the body such as the saliva, 
gastric juices, perspiration, etc., which wash away the microorganisms, and in 
many cases kill them. 
After the body has been invaded by pathogenic bacteria it protects itself 
against infection through: 1. The action of antibodies; and 2. Phagocytosis. 
In the blood, as explained in the chapter on Anatomy and Physiology, the 
lymph, and other secretions of the body, and in the tissue cells are substances 
that together constitute the defense mechanism that acts to prevent the growth 
of or to destroy invading bacteria. 
When microorganisms or their products (toxins) invade, or are injected into 
the body, the cells of the body are stimulated to produce antibodies (p. 32) 
which fight the invading microorganisms. To have antibodies on hand, so that 
one will not “catch” certain diseases when exposed to them, the body is inocu- 
lated with the vaccines, viruses and toxins, examples of which are typhoid vac- 
cine, cowpox virus, diphtheria toxin-antitoxin mixture. The antibodies formed 
against a microorganism or its product act only against that particular type of 
microorganism and prevent only the disease it causes. When a person is in- 
fected or exposed to certain communicable diseases, diphtheria for example, a 
serum containing the specific antibodies which have been produced usually in HYGIENE AND SANITATION 
375 
the body of a horse is injected into the body to assist in fighting the invading 
microorganisms, or give an immediate supply of antibodies to prevent those 
exposed from “catching” the disease. This is necessary because it takes a longer 
period for the body to form sufficient antibodies to protect itself, either when 
the person is infected or exposed to the disease. 
Phagocytosis is the ability of the white blood cells of the body, particularly 
the polymorphonuclears, to engulf and destroy the invading microorganisms. 
In phagocytosis, which is usually associated with inflammation as in a boil or 
acute appendicitis, there is an increase in the number of white blood cells. The 
phagocytes and antibodies work in conjunction with each other, especially 
where inflammation also is present, as in epidemic meningitis (cerebrospinal 
fever). 
From the foregoing it will be seen that, in short, immunity is the ability of 
the body to ward off disease. It is that power which prevents the gaining 
of a foothold by disease-producing organisms in the animal body, or which 
neutralizes their harmful products or destroys the parasites. Its effectiveness 
depends upon two main factors—the power of resistance of the human body 
and the aggressiveness or virulence of the invading organisms. Immunity may 
be inherent or acquired. Inherent immunity is present from birth and is repre- 
sented best by the immunity of certain animals to specific infections. It is of 
theoretical interest but of little practical value in diseases of human beings. 
Acquired immunity is that which results from, an attack of a disease, called 
naturally acquired immunity; or from inoculation of the individual with killed 
specific organisms or their products and known as artificially acquired im- 
munity. Not all diseases confer immunity by their attack, nor is it possible 
to produce artificial immunity to all diseases. 
Artificially acquired immunity may be active or passive. When the body is 
infected by disease, or when the causative organisms of a disease are injected 
into the body, substances are produced that combat that disease, leading to 
cure and in some cases to the production of prolonged immunity to that disease. 
The agents that combat the disease are the previously mentioned antibodies, 
and if antibodies against a specific disease are produced in the body the 
immunity is known as active immunity. When antibodies are produced in 
one animal and the serum of that animal is injected into another to produce 
immunity it is known as passive immunity because the cells of the second 
individual played no part in the formation of the antibodies. 
The serums used to produce passive immunity are made by giving repeated 
injections of the specific causative bacteria or their soluble toxins into animals, 
horses commonly being employed. The animal becomes immune, and its serum 
contains specific antibodies, which are collected by bleeding the animal and 
separating the serum. This serum when injected into man or another ariimal 
will afford protection against that disease, but no other. 
The use of these serums, especially those from the horse, is frequently fol- 
lowed by annoying symptoms and occasionally by severe or even fatal reactions. 
The syndrome spoken of as serum, sickness may appear within a day or two 
of the injection but more often after about 8 or 10 days. The patient usually 
complains of headaches, fever, joint and muscle pains, oedema, and particularly 
of various skin eruptions usually urticarial or erythematous in character. Seram 
sickness is due to foreign proteins in the serum and has nothing to do with 
the antitoxin. Most of these mild attacks of serum sickness clear up with rest, 
mild skin lotions and catharsis. Epinephrine will very often relieve the 
urticaria. 
Anaphylactic shock, under certain circumstances, occurs a few minutes after 
the injection and may be fatal. This complication is characterized by rest- 376 
HANDBOOK OF THE HOSPITAL CORPS, H. S. NAVY 
lessness, anxiety, dyspnoea, cyanosis, unconsciousness, and oedema. Anaphylaxis 
means that the patient is hyper susceptible to that serum and does not indicate 
any inherent poisonous property in the antitoxin. How an individual becomes 
hypersensitive in these cases is not always clear. A previous injection of horse 
serum or a hereditary transmission may account for it. 
Before administering serum it is necessary to inquire of the patient whether 
he has had previous injections or has suffered from asthma. In order to prevent 
anaphylactic shock, all patients should be given an injection of 1/50 cc of serum 
subcutaneously as a test for hypersensitivity. When this test is positive the 
procedure for desensitization described on p. 485 should be followed. 
Immunity to certain diseases seems to increase with age, and under ordinary 
conditions adults possess a marked immunity to the so-called “children’s dis- 
ease,” such as diphtheria, scarlet fever, etc. 
Susceptibility to disease is just the opposite of immunity and means a special 
liability to contract certain diseases. It may be natural and is greatly increased 
by overwork, overstrain or worry, inadequate rest or sleep, improper environ- 
ment, lack of fresh air and sunlight, exposure to wet and cold, insufficient and 
improper food, excesses in eating and the use of alcohol, disease, injury or 
operations, and excesses of any kind. 
This is well illustrated by the seasonal incidence of “colds,” pneumonia, and 
other respiratory diseases. These diseases are rare during the summer and 
early autumn when people are much in the open (with little close contact) and 
get plenty of sunshine (ultraviolet rays), and also eat an abundance of fresh 
vegetables and fruits which furnish vitamins, mineral salts, and roughage. 
Likewise, they take more exercise than in winter and are not exposed to wet 
and cold conditions. With the coming of winter as these favorable conditions 
decrease the respiratory diseases increase progressively until favorable condi- 
tions arrive again in the spring. 
Different organs and tissues of the body appear to possess varying immunity 
against or susceptibility to different microorganisms. In other words, certain 
microorganisms always select some organ or tissue in the body where they set 
up their infection. At this site toxins, or poisons, are produced which, when 
circulated throughout the body, cause general symptoms or effects. For ex- 
ample the meningococcus is thought to enter the body through breaks in the 
mucous membrane of the nose and throat, and is carried by the blood to the 
membranes of the brain and spinal cord where it causes cerebrospinal fever. 
These facts are applicable to the occurrence of epidemics or outbreaks of dis- 
ease. To have an epidemic there first must be present a highly virulent micro- 
organism ; then a sufficient number of persons who are susceptible to that particu- 
lar microorganism. The spread of the disease is influenced by whether or not sus- 
ceptibles come in contact with the infective microorganism. The best means to 
prevent this and hence control the spread of epidemics is to detect new cases 
as early as possible, isolate them immediately, and practice rigid concurrent 
disinfection to prevent dissemination of the infective microorganisms. Early 
treatment also results in a fewer number of deaths. In some diseases the per- 
sons who have been in contact with the infected one are quarantined for the 
normal incubation period of the disease. 
For these reasons it is necessary to be constantly on the alert to detect sick 
persons at the earliest possible moment, as they may be “coming down” with 
highly communicable diseases. 
It has been proposed that the term “mass immunity” be used to account for 
the decreasing number of communicable diseases transmitted by the nose and HYGIENE AND SANITATION 
377 
mouth discharges. In explanation it is suggested that under conditions of close 
association where the hygienic and sanitary conditions are good and the general 
population is healthy, an immunity of varying degree to such diseases is built 
up as a result of exposure to pathogenic microorganisms of low virulence or 
disease-producing power. In other words, healthy people living under good 
sanitary conditions are benefited by the exchange of microorganisms in the 
droplet spray incident to close association such as is met with in the military 
and naval services and in city life. On the other hand, epidemics are bound to 
occur among overcrowded populations living under insanitary conditions. 
Food and its relation to health and disease. 
While food usually is considered in its relation to the maintenance of bodily 
health and efficiency it is sometimes injurious to health. Animal foods convey 
infections or have properties injurious to health more frequently than those 
obtained from plants, and meat and milk are the principal offenders. 
Food may affect health as a result of: 1. Natural poisons contained in it, 
as some mushrooms, some fish, etc.; 2. Animal parasites or then eggs or 
larvae contained in or conveyed by foods; 3. Bacteria conveyed by both animal 
and vegetable foods, as tubercle bacilli, typhoid bacilli, streptococci, etc.; 4. 
Toxins developing in foods as a result of bacterial growth, as botulism; 5. 
Special poisons contained in foods, as solanin in sprouted potatoes; 6. Poisons 
accidentally or purposely added, as arsenic, lead, acids, insect powders, etc.; 
7. Amount, too little or too much; 8. Composition, an unbalanced diet; 9. Faulty 
digestion or disturbances of metabolism; and 10. Idiosyncrasy to certain foods. 
Food poisoning can cause acute attacks of illness in more men in a short 
time than any other condition. The term “food poisoning” is conventionally 
divided into two groups, food infection and food intoxication. Food infection 
is usually caused by a specific group of organisms, namely the Salmonella 
group but occasionally the Dysentery group. Food intoxication is due to a 
specific toxin produced outside the body, for example the Clostridium botulinum. 
Other organisms cause food intoxication by producing toxins, the exact nature 
of which is imperfectly understood. These toxins are formed under suitable 
conditions by staphylococci, streptococci, coliform, proteus, and possibly sal- 
monella organisms. 
The consumption of unwholesome food may also give rise to diverse condi- 
tions due to inherently poisonous substances, e. g., toad stools, hemlock, certain 
fruits, and fish which are poisonous; food containing poisonous substances such 
as arsenic, lead, or other heavy metals; and foods for which the individual 
has an idiosyncrasy. 
Food infection is characterized by a sudden onset with headache, followed 
by nausea, vomiting, diarrhoea, abdominal pain or distress, prostration and 
sometimes fever, and commencing from 1 to 24 hours after ingestion of food. 
The causative organism may be revealed by examination of the vomitus and 
faeces. 
The great majority of outbreaks are caused by meat or meat mixtures. The 
meat may come from an animal infected during life with a specific organism; 
or it may come from a healthy animal and be infected during the process of 
slaughtering and handling. Such sources of infections are best controlled by 
meat inspectors at slaughter houses. Food handlers with hands not thoroughly 
washed after leaving the toilet, hands and arms infected with boils and other 
sores are frequent means of conveying contamination to food. Food may also 
be infected by flies, cockroaches, rats, mice, and polluted water when used in 
cooking and preparation of food. 378 
HANDBOOK OF THE HOSPITAL CORPS, XT. S. NAVY 
Foods which most often cause food poisoning are mixtures with meat as a 
basis, such as hash, meat or fowl loaf, and pie; meat, crab, lobster, and chicken 
salads; hamburger steak; and cold sliced meat. Veal mixtures are a frequent 
cause. Milk and milk products also have been reported as causes of outbreaks. 
Meat mixtures that have caused trouble have the following in common: 
They are cooked, then handled in preparation, and often allowed to stand in 
a warm place several hours; in some instances over night. If they have been 
infected with one of the causative organisms, it may be readily seen that with 
moisture, a good protein food supply, and warmth, there is every desirable 
condition present for a large growth of bacteria and the production of much 
toxin. 
The filling of cream puffs, cream pies, and custards and various sauces made 
from milk and cream have been the cause of outbreaks. 
It is important to remember that the organisms which cause food infection 
do not necessarily cause any alteration from the normal appearance, odor, or 
taste of the food. A classic example of this occurred in connection with an 
outbreak in Ghent, Belgium. A meat inspector was so certain that the suspected 
meat had no connection with the trouble that he ate three slices to demonstrate 
their harmlessness. He suffered a severe attack of gastro-enteritis and died 
five clays later. Bacterium enteritidis was isolated from his viscera at autopsy. 
The treatment is mainly eliminative, symptomatic, and supportive. Elimina- 
tion is largely effected by the infection through vomiting and diarrhoea. If 
the number of cases is not too large gastric lavage can be performed, followed 
by a saline purge. Best and Nature usually effect a cure. While the symptoms 
are sometimes alarming, the fact should be kept in mind that the mortality is 
only between 1 and 2 per cent. 
The preventive measures are plainly indicated by the sources of the infection. 
The ante-mortem sources can be eliminated only by a rigid inspection of animals 
before slaughtering. Post-mortem sources can be prevented by careful inspec- 
tion of the slaughtered carcasses for localized infection and the elimination 
of any suspected meat until it is proved safe by bacteriological examination; 
also, by disinfecting the hands, tools, and other objects and surfaces which have 
been contaminated by infected carcasses in the slaughter house. 
On board ship, no food, especially meat mixtures, should be prepared and 
then set aside to be served at a subsequent meal. The time between the prep- 
aration and serving of the food should be reduced to the minimum. If it be- 
comes necessary to hold over 'any food, it should be put in a cold refrigerator 
as soon as possible and kept cold until it is to be served or prepared for 
serving. 
A high standard of sanitation in the galley and butcher’s shop is very im- 
portant. The personal hygiene of the cooks and handlers of food should be 
looked into; particularly, their attention to the important detail of thoroughly 
washing their hands after visiting the toilet. They should be watched con- 
stantly for symptoms of intestinal disturbances and no men allowed to handle 
or prepare food who are suffering from any degree of diarrhoea. 
Immediately after an outbreak occurs effort should be made to get samples 
of the last meal served so that they can be examined in a laboratory. After 
the rush of cases has slackened, an epidemiological study of the outbreak 
should be undertaken. The patients should be questioned regarding the foods 
eaten 'and the messes to which they were assigned. Unaffected members of 
the same mess should be interrogated as to whether they ate the same foods. 
Men frequently eat the same foods, but because of immunity, eating very small HYGIENE AND SANITATION 
379 
portions, or an unequal distribution of the infection throughout the food mass, 
are not affected. 
By careful study one can 'arrive at a fairly accurate idea of the food re- 
sponsible for the outbreak. If some men were affected yet did not eat the sus- 
pected food, that food should be ruled out. Specimens of the urine and faeces 
from the more severe cases should be collected and sent as soon as possible to 
the nearest hospital or other clinical laboratory for examination. 
Food handlers should be brought under observation for medical and bacte- 
riological examination to determine possible origin, whether from infections of 
the skin or bowel discharges. 
Food intoxication follows the ingestion of food containing toxic substances 
which have been formed by proliferation of bacteria. The general symptoms 
of food intoxication, caused by other than the Clostridium botulinum, are 
similar to those due to food infection, but the time interval of onset is 
shorter—half an hour to 4 hours—vomiting is more violent, and prostration 
more severe, there is usualy less fever and recovery is more rapid. 
The type of food associated with such outbreaks varies considerably. It 
usually includes canned or potted meat or fish, pressed tongue, beef, or ham, 
cheese or milk products. 
In outbreaks where demonstrable evidence of Salmonella or dysentery in- 
fection is absent the laboratory should endeavor to find the presence of toxins 
of bacterial origin in the food or organisms capable of forming toxic substances. 
Botulism is an acute food intoxication due to the toxin produced by the 
Clostridium botulinum and is characterized chiefly by oculomotor paralysis, 
weakness, prostration, incoordination, a variety of central nervous system 
paralyses, and a high case-fatality rate. 
The botulism toxin has a strong afiinity for the nervous system in animals 
as well as man. It causes “limber neck” in chickens and turkeys and various 
types of paralysis in domestic animals. 
There are at least four strains of the organism—Types A, B, O, and D. Anti- 
toxins have been prepared from strains A and B by injecting increasing 
amounts of the toxin into susceptible animals. The antitoxin prepared from 
the toxin of one strain of the organism will not protect against the toxin 
produced by the other strain. Types C and D have not been found in the 
United States and have not been known to cause botulism in man. 
The transmission is only by eating food containing the botulinus toxin. In 
the United States it has been associated with such foods as string beans, 
cottage cheese, corn, asparagus, peas, and spinach, particularly when the 
vegetables named were canned at home and the processing temperatures were 
not high enough to kill the spores. Ripe olives, which have been improperly 
processed, have been a frequent source of the infection. Fresh foods are 
seldom, if ever, dangerous in so far as botulism is concerned. Smoked, pickled, 
and canned, particularly home-canned, foods are the dangerous ones. 
There may be some evidence of spoilage about the infected food, but many 
foods which have produced botulism have been normal in taste, odor, and 
appearance. It is said that the peculiar butyric acid or rancid butter odor 
associated with cultures of botulinus is present; this is not always the case, 
and because of the extreme lethal character of the toxin no suspected food 
should be tasted. It is not safe to taste “home-canned” foods before they 
have been thoroughly cooked. Canned goods which show gas formation, 
either by the presence of gas bubbles or bulged ends of cans, should be 
destroyed. 
154294 °~39 25 380 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The symptoms usually appear in 24 hours after the particular food has 
been eaten. This interval may be shortened or lengthened in proportion to 
the amount of toxin ingested. 
The disease is ushered in with a general feeling of indisposition, fatigue, 
and muscular weakness. There may be headache and dizziness. Gastro-intes- 
tinal symptoms are not frequent except in the severe cases, when there may 
be gastric distress, nausea, vomiting and diarrhoea; these symptoms are tran- 
sient. Constipation, due to paralysis of peristalsis, is constant. 
Disturbances of vision occur early, associated with or followed by difficulty 
in swallowing and talking. The mouth and throat are dry and the breath 
offensive. There is a dry ineffectual cough and a bitter taste in the mouth. 
The pulse is usually rapid and the temperature subnormal. Respiration at 
first is not impaired, but later the embarrassment becomes great and death 
results from paralysis of the respiratory center. 
Death may occur in 48 hours after ingesting the poison; usually it occurs 
within 4 to 8 days; few die after 10 days. 
The mortality of botulism is very high and depends upon the amount and 
virulence of the toxin ingested. The mortality runs from about 60 per cent 
in some outbreaks to 100 per cent in highly virulent outbreaks. 
The table next hereafter, in which Burke and May have tabulated the differ- 
ences in botulism and food infection, is copied from Practical Bacteriology, 
Haematology, and Animal Parasitology (Stitt, Clough and Clough). 
Botulism 
Food infections 
Botulinus toxin ... 
Bacilli of the Salmonella group. 
Characteristic; acute. 
Mainly in summer. 
Fresh foods or freshly contaminated 
foods, usually meat or milk. 
Diarrhoea; offensive. 
Absent. 
Present. 
Sudden. 
Short, usually from 6 to 12 hours. 
Normal. 
Systemic. 
From 1 to 2 per cent. 
Fever 
Not characteristic; temperature 
usually subnormal. 
Mainly in winter. .. ... . 
Associated with 
Condition of bowels 
Visual disturbances 
Preserved foods 
Constipation; rarely diarrhoea 
Double vision; ptosis of lids 
Absent. 
Usually gradual. . _ . _. _. 
Incubation period 
Variable, usually from 12 hours to 
several days. 
Mortality 
From 60 to 70 per cent 
The treatment consists of administration of the appropriate antitoxin as 
soon as botulism is suspected, but do not wait for the diagnosis to be con- 
firmed. Antitoxin should be given to others who ate the same food, even 
though they have shown no symptoms of botulism. The botulinus toxin is 
a nerve poison; therefore the antitoxin is of little use after the disease is 
well advanced. 
Until antitoxin can be administered, full physiological doses of morphine 
should be given. Death results from paralysis of the respiratory center; 
therefore artificial respiration is often indicated. 
The prevention of botulism is in the main a matter of using great care 
and cleanliness in the preservation of nitrogenous foodstuffs. Fruits and vege- 
tables should be heated to at least a temperature of 120° C, for a period 
of not less than 10 minutes when they are being preserved in order to 
kill the botulinus spores. It is not safe to use “home-canned” vegetables 
for salads, etc., unless they have been cooked after removal from the container. 
Neither should they be tasted before cooking to detect spoilage. HYGIENE AND SANITATION 
381 
The average amount of cooking will destroy the toxin, but it will not kill 
the spores. These may remain alive and, in case the food is set aside for 
a while, form more toxin. Such foods should be reheated before eaten. Thor- 
ough and recent cooking of all food is preventive against botulism. 
In commercial canning the food is heated to appropriate temperatures which 
render the food sterile. 
Following an outbreak, effort should be made to obtain specimens of the 
responsible food and have them examined at the nearest naval hospital or 
other clinical laboratory. Specimens in sterile containers can be sent to 
the U. S. Naval Medical School, Washington, D. C., for examination. 
While botulism does not occur with great frequency, nevertheless, because 
of its virulence and high mortality, it is advisable to have a centralized and 
readily available supply of antitoxin. 
The following questionnaire indicates the epidemiological data desired by 
the Bureau of Medicine and Surgery in cases or outbreaks of food poisoning. 
A careful study of this questionnaire will not only serve as a basis of an 
epidemiological study but will also serve as a quiz on the foregoing discussion. 
The student should ask himself why each question is asked and to what 
type of food poisoning a positive and negative finding in each instance should 
point: 
“ I. What was the character of duty being performed at the time the supposed poisoning occurred? 
II. What was the supected food; where and under what circumstances was it eaten? 
III. What other foods were eaten during the period when poisoning could have occurred—(within 48 
hours for practical purposes) ? Discuss menus of meals served. 
IV. How long after eating was it before the first indications of illness appeared? 
V. Were others made ill at the same time? If so, how many and what was the relationship to this 
case? 
VI. Did any person or persons eat the same food without becoming ill? 
VII. Give clinical description of the case not overlooking the following points: 
a. What was the first indication of illness? 
b. Was the onset sudden? 
c. Had there been any previous disease or symptoms? 
d. Could this attack have been a relapse or recurrence of any disorder? 
e. How long had the patient been ill when first seen by the medical officer? 
/. What was the general appearance of the patient? 
g. Was there any pain? If so, was it continuous or spasmodic? 
h. Was there vomiting? For a short period or continued for a day or more? 
i. Was there intestinal colic or abdominal distention? 
j. Was there diarrhoea? If so, describe. 
k. Was there a chill? 
l. Was there any fever? If so, describe. 
m. Was there headache? Frontal or occipital? 
n. Was there general aching or soreness? 
o. Was there prostration? Sudden? Marked? 
p. Was the mouth dry? Was there excessive salivary secretion? Was there a continued bitter 
taste? 
q. Were there any ocular symptoms—ptosis, blurring, diplopia, disturbances of accommodation? 
What was the condition of the pupils and pupillary reflexes? 
r. Was there alternate flushing and pallor? 
s. What was the pulse rate? Was the pulse persistently rapid or slow? Was it regular or inter- 
mittent? What was the blood pressure? 
t. What was the rate of respiration per minute? What was the character of the breathing? 
u. Was there any skin eruption? If so, describe. 
VIII. Was a blood count made? If so, give findings. 
IX. Was the urine examined? What were the findings? Was a culture made from the urine? 
X. Was any toxicological or bacteriological examination made of the vomitus or stools? 
XI. What are the ascertainable facts regarding the purchase, condition, storage, handling, preparation, 
cooking, and serving of the suspected food? 
XII. If canned goods, did the can appear to be in good condition before opening? How long had the can 
been opened before the contents were used? Were the contents kept cold? Was the food heated 
or boiled before it was eaten? Was the food served hot or cold? Was there any evidence of spoil- 
age? Give name of brand or manufacturer and necessary data for tracing this shipment. 382 
HANDBOOK OF THE HOSPITAL CORPS, XL S. NAVY 
XIII. Was any of the suspected food obtainable for examination? Was any of it fed to experimental animals 
and if so, did it make them sick? What laboratory examination was made of the food? 
XIV. If suspected food was purchased or eaten at a civilian establishment, and there was reason to supect 
their methods of handling food, were the local health authorities notified in order to prevent the 
poisoning of others? 
It is requested that any pertinent facts which are not brought out in replies to above questions be added.” 
Milk is man’s most important food and one for which there is no effective 
substitute. For the suckling of the same species it contains all the elements 
and vitamins necessary for life. But at the same time it (together with its 
products, particularly cream) is one of the most frequent means of trans- 
mission of such diseases as bovine tuberculosis, typhoid and paratyphoid 
fevers, diphtheria, scarlet fever, septic sore throat, Malta fever, dysenteries, 
and diarrhoea. 
Milk is a natural culture medium for bacteria; it decomposes readily and 
is probably the most difficult of all foods to obtain, handle, transport, store 
and deliver in a clean, fresh, and satisfactory condition. The number of 
bacteria per cc is the most reliable test to determine its age, purity, and 
cleanly methods of handling. Milk is graded chiefly on its bacterial content. 
Today milk is largely consumed in a pasteurized state. All milk for use by 
naval personnel should be Grade “A” pasteurized milk and delivered in bottles. 
Pasteurization is a process by which milk is heated to a degree sufficient to 
kill harmful microorganisms but with the least possible effect upon the value 
of milk as-a food. There are two recognized methods of commercial pasteuri- 
zation, the holding method and the flash method. 
In the holding method of pasteurization every particle of milk is heated to 
a temperature of not less than 148%° F. and held at such temperature for not 
less than 30 minutes in apparatus of approved design and properly operated. 
The milk is then rapidly cooled to a temperature of 50° F. 
In the flash method of pasteurization every particle of milk is heated to a 
temperature of not less than 160° F. and held for not less than 15 seconds In 
an apparatus of approved design and then rapidly cooled to a temperature of 
50° F. 
Pasteurization may cause a slight reduction in the vitamin content of milk 
but milk need not be used as a principal source of vitamins. 
Contamination of milk with disease-producing bacteria is almost always 
from human sources. The preventive measures are scrupulous cleanliness in 
production methods, immediate chilling of milk, and keeping it clean and cold 
until consumed. 
The following paragraphs regarding foods and messing are taken from U. S. 
Navy Regulations and are of particular interest to the hospital corpsman. 
“Art. 1320 (2).—A medical officer shall inspect, as to quality, all fresh food 
purchased for the general mess, and frequently inspect the fruit and other 
articles of food and drink offered for sale alongside. In localities where night 
soil is commonly used for fertilizing purposes none of the vegetables ordinarily 
eaten uncooked shall be permitted on board; and in infected ports no fresh’ 
milk, bottled water or fruits shall be allowed. 
“(3).—When possible a junior medical officer and one or more petty officers 
shall be present when meals are served out at the galley; they shall report if 
there is any cause for complaint as to the quantity and quality of the food. 
“(4).—The commanding officer shall establish hours for messing, having due 
regard for the duties of the ship and the health of the crew. The crew shall 
not be disturbed during meal hours when it can be avoided. The practice of 
conducting visitors through the messing space during meal hours shall be 
discouraged. HYGIENE AND SANITATION 
383 
■‘(5).—The commanding officer shall see that all cooking and mess utensils 
are kept clean; that the food is wholesome and well cooked. Only pure water, 
distilled when practicable, shall bo allowed for drinking and culinary purposes, 
and no water shall be issued for drinking until it has been examined and 
approved by the medical officer.” 
Likewise all cooks, mess cooks, and other food handlers should be frequently 
examined for the presence of disease. 
The discussion of communicable diseases that follows was published by the 
United States Public Health Service in pamphlet form entitled “The Control 
of Communicable Diseases.” A few of the diseases in that publication have 
been omitted, but in no instance has the sense of the contents been modified. 
GROUP I. DISEASES TRANSMITTED BY DISCHARGES FROM THE MOUTH 
AND NOSE 
Cerebrospinal fever. 
Diphtheria. 
German measles. 
Influenza. 
Measles. 
Mumps. 
Pneumonia. 
Scarlet fever. 
Septic sore throat. 
Tuberculosis. 
Whooping cough. 
Others, not here discussed : 
Leprosy. 
Poliomyelitis. 
Tonsillitis, acute follicular. 
Vincent’s angina. 
Cerebrospinal fever. 
1. Recognition of the disease.—An acute infectious disease with sudden onset, 
fever, headache, nausea, rigidity of neck, and in epidemics not infrequently 
petechial spots on the skin. The specific microorganism in one of its 
several types may in some cases be found in the early stages by blood 
culture, and usually during the course of the disease in the spinal fluid, and 
in the discharges of the retronasal surfaces. The disease occurs in epi- 
demic and sporadic manner. 
2. Etiological agent.—Neisseria intracellularis (Diplococcus intracellularis men- 
ingitidis; meningococcus). 
3. Source of infection.—Discharges from the nose and mouth of Infected per- 
sons. Clinically recovered cases, and healthy persons not known to have 
had the disease but recently in contact with cases or other carriers may act 
as carriers and are commonly found, especially during epidemics. Such 
healthy carriers are found independent of epidemic prevalence of the dis- 
ease, even up to 5 to 10 per cent of a general population. 
4. Mode of transmission.—By direct contact with infected persons and carriers 
and indirectly by contact with articles freshly soiled with the nasal and 
mouth discharges of such persons. 
5. Incubation period.—Two to ten days, commonly seven; tends to be short in 
epidemics; in rare instances the period may be longer when a carrier de- 
velops the disease. 
6. Period of communicability.—During the clinical course of the disease and 
until the specific microorganism is no longer present in the nasal and 
mouth discharges of the patient, about 2 weeks. The same applies to 
healthy carriers so far as affects persistence of infectious discharges. 
Readily communicable in crowded living conditions among persons of low- 
ered resistance. 
7. Susceptibility and immunity.—Susceptibility is limited. Acquired Immunity 
from having had the disease, apart from immediate clinical relapses, may 
be of long duration but is uncertain. There is no artificial immunity. Re- 384 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
sistance to infection appears to be low when those exposed to crowded 
conditions of living are also fatigued and ill fed 
8. Prevalence.—Usually low incidence of sporadic cases. Within a community 
in epidemics at long but irregular intervals. The cases are mostly in 
children under 10 years of age and in young adults, but occur at all ages. 
Local epidemics commonly related to chronic or emergency overcrowding 
of living quarters, as in ships, barracks, and lodging houses or slums, and 
usually in the winter or spring. No limitations in geographical distribution. 
9. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting: Clinical symptoms con- 
firmed by the microscopic and bacteriological examination of the 
spinal fluid, and by bacteriological examination of nasal and 
pharyngeal secretions. 
2. Isolation of infected persons until 14 days after onset of the disease 
or until negative swabs are obtained from the naso-pharynx. 
3. Concurrent disinfection: Of discharges from the nose and mouth 
or articles soiled therewith. 
4. Terminal disinfection: Cleaning. 
5. Quarantine: None. 
6. Immunization: None. 
7. Investigation of source of infection; Impracticable. 
B. General measures: 
1. Education as to personal cleanliness and necessity of avoiding con- 
tact and droplet infection. 
2. Prevention of overcrowding such as is common in living quarters. 
transportation conveyances, working places, and especially in 
barracks, camps, and ships. 
C. Epidemic measures: 
1. Increase the separation of individuals and the ventilation in living 
and sleeping quarters for such groups of people as are especially 
exposed to infection because of their occupation or some neces- 
sity of living conditions. Chilling, bodily fatigue, and strain 
should be minimized for those especially exposed to infection. 
Diphtheria. 
1. Recognition of the disease.—An acute febrile infection, generally of the air 
passages, especially of tonsils, throat, and nose, marked by a patch or 
patches of dirty white and grayish membrane, from which cultures of the 
diphtheria bacillus may be obtained. Cases of diphtheritic infection in 
infants are often missed because of the lack of definite local symptoms. 
2. Etiological agent.—Corynebacterium diphtherias (Bacillus diphtherias; the 
Klebs-Loeffler bacillus). 
8. Source of infection.—Discharges from diphtheritic lesions of nose, throat, con- 
junctiva, vagina, and wound surfaces. Secretions from the nose and throat 
of carriers of the bacillus. 
4. Mode of transmission.—Directly by personal contact, indirectly by articles 
freshly soiled with discharges, or through infected milk or milk products. 
5. Incubation period.—Usually 2 to 5 days, occasionally longer if the carrier 
state precedes the development of clinical symptoms. 
6. Period, of communicability.—Variable, until virulent baccilli have disappeared 
from the secretions and the lesions. Usually 2 weeks or less, seldom over 
4 weeks. In exceptional cases virulent bacilli remain in the throat and dis- 
charges from 2 to 6 months. HYGIENE AND SANITATION 
7. Susceptibility and immunity.—Infants born of mothers with an established 
immunity are relatively immune for the first 6 months of life. By the 
ninth month of life this passive congenital immunity has been lost in a high 
percentage of infants. Subsequently children 'and adults develop immunity 
apparently in approximate proportion to their contact with associates who 
carry the diphtheria bacillus with or without exposure to persons with 
recognized attacks of the disease. It is usual to find about half of the 
children of school 'age and three-quarters of adults in large cities immune. 
Such accidental immunity is less frequent among rural and small-town 
populations. Passive temporary immunity (10 days to 3 weeks) and active 
immunity of commonly permanent duration can be developed artificially. 
Recovery from attack of the disease, especially if with the aid of therapeu- 
tic diphtheria antitoxin, is not necessarily followed by active immunity. 
8. Prevalence.—Endemic and epidemic. Two-thirds or more of the cases are in 
children under 10 years of age and two-thirds or more of the deaths occur 
in children under 5 years of age. More common in temperate zone than 
elsewhere, and in fall and winter months. Local increased prevalence may 
occur in irregular cycles of 4- to 8-year Intervals. Reduction in incidence, 
death rate, and case fatality rate has been progressive and marked in the 
past 30 years. 
9. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting: By clinical symptoms 
with confirmation by bacteriological examination of discharges. 
2. Isolation: Until 2 cultures from the throat and 2 from the nose, 
taken not less than 24 hours apart, fail to show the presence of 
diphtheria bacilli. Isolation may be terminated if the micro- 
organism reported as morphologically “positive” although per- 
sistently present, proves to be an avirulent form. Where ter- 
mination by culture is impracticable, cases may be terminated 
with fair safety as a rule 16 days after onset of the disease. A 
virulence test should be made in any case where positive throat 
cultures are reported 3 weeks or longer after onset of the 
disease. 
3. Concurrent disinfection of al| articles which have been in con- 
tact with the patient, and all articles soiled by discharges of 
the patient. 
4. Terminal disinfection: At the end of the illness, thorough airing 
and sunning of the sick room, with cleaning or renovation. 
5. Quarantine: All intimate contacts until shown by bacteriological 
examination not to be carriers. 
6. Immunization: Passive immunization with antitoxin is rarely 
necessary for exposed persons over 5 years of age, for whose pro- 
tection daily examination by a physician or nurse sutfices. 
Infants and young children exposed to diphtheria in the family 
should receive a prophylactic dose of antitoxin without prior 
Schick testing, unless they are already known to the physician 
to be immune. 
7. Investigation of source of infection: In unreported cases, in car- 
riers, and milk. 
B. General measures: 
1. Active immunization of all children, without prior Schick testing, 
at the age of 6 months, with a diphtheria toxoid. This same 386 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
procedure should be applied to all children at or below 6 years 
of age if immunization has been neglected in infancy. 
2. Older children, and adults especially exposed, including teachers, 
nurses, and physicians found to be Schick-positive should be 
actively immunized. In order to minimize local and constitu- 
tional reactions in members of these groups, it is desirable to 
carry out a preliminary “toxoid reaction test”, nonreactors to 
receive toxoid, and reactors toxin-antitoxin (goat) in 2 or 3 
inoculations or suitably diluted toxoid. 
3. Pasteurization of milk supply. 
4. Educational measures to inform the public, and particularly the 
parents of little children, of the advantages of toxoid immuniza- 
tion in infancy. 
German measles (Rubella). 
1. Recognition of the disease.—A febrile infection in epidemics, characterized 
by a polymorphous rash, sometimes resembling that of measles, sometimes 
that of scarlet fever, and sometimes of both at the same time; few or no 
constitutional symptoms but almost always enlargement of post-auricular, 
sub-occipital and cervical, and occasionally of other, lymph nodes. Usually 
absence of leueocytosis. 
2. Etiological agent.—Unknown. 
3. Source of infection.—Secretions of the mouth and possibly of the nose. 
4. Mode of transmission.—By direct contact with the patient or with articles 
freshly soiled with the discharges from the nose or throat of the patient. 
5. Incubation period.—From 14 to 21 days; usually about 16 days. 
6. Period of communicability.—From onset of catarrhal symptoms for at least 
4 days, but not more than 7; the exact period is undetermined. Highly 
communicable. 
7. Susceptibility and immunity.—Susceptibility is general among young children. 
An attack usually confers permanent immunity. 
8. Prevalence.—Epidemic in expression, occurring mostly in childhood, but 
more in adults than is the case with measles. Commoner in urban than 
in rural communities, and oftener in winter and spring than at other 
seasons. 
9. Methods of control: 
A. The infected individual, contacts and environment: 
1. Recognition of the disease and reporting: Clinical symptoms. 
2. Isolation; Separation of the patient from nonimmune children, 
and exclusion of the patient from school and public places for 
the period of presumed infectivity. Isolation rarely practicable. 
3. Concurrent disinfection: Discharges from the nose and throat of 
the patient and articles soiled by discharges. 
4. Terminal disinfection: Airing and cleaning. 
5. Quarantine: None. 
6. Immunization: None. 
7. Investigation of source of infection; Of no importance except to 
clarify doubts created by clinical difficulty in distinguishing this 
disease from] scarlet fever in its early stages. 
B. General measures : None. 
Note.—The reason for attempting to control this disease is that it may be confused with 
scarlet fever during its early stages; each person having symptoms of the disease should 
therefore be placed under the care of a physician and the case should be reported to the 
local department of health. HYGIENE AND SANITATION 
387 
Influenza. 
1. Recognition of the disease.—Whether occurring in a pandemic, in endemic- 
epidemic incidence, or as sporadic cases this disease is characterized in its 
typical form by sudden onset, fever of 1 to 7 days’ duration, accompanied 
by excessive prostration, aches and pains in back and limbs, coryza and 
bronchitis, and not uncommonly by pneumonia as a complication. During 
epidemic when such cases occur in large numbers and over a wide area, 
other cases of less distinctive type are found to be epidemiologically related 
to typical cases, and in these the diagnosis would not be made without such 
obvious association. The clinical criteria of influenza are quite indefinite, 
particularly in absence of widespread prevalence of the disease. Micro- 
scopic or other laboratory procedures are of no practical value in determin- 
ing or excluding the diagnosis of influenza. 
2. Etiological agent.—A filtrable virus; associated often with various types of 
bacteria as secondary invaders. 
3. Source of infection.—Probably discharges from the mouth and nose of in- 
fected persons and articles freshly soiled by such discharges. 
4. Mode of transmission.—Believed to be by direct contact, by droplet infec 
tion, or by articles freshly soiled with discharges of the nose and throat 
of infected persons. 
5. Incubation period.—Short, usually 24 to 72 hours. 
6. Period of communicability.—Undetermined; possibly in prodromal as well as 
In the febrile stage and convalescent stages. 
7. Susceptibility and immunity.—Susceptibility is not general, for natural re- 
sistance or relative immunity appears to protect from one-quarter to 
three-quarters of persons intimately exposed to the disease even during 
widespread epidemics. Acquired immunity if it is actually developed by 
an attack of and recovery from the disease is of short duration (a few 
months) and of low grade, or perhaps only effective against a certain 
strain or strains of the virus. 
8. Prevalence.—Uncertain in pandemic, local epidemic, and sporadic occurrence, 
by reason of indefinite clinical symptoms. In epidemics may affect up to 
50 per cent of the population, especially at age groups between infancy and 
maturity. Commonly between December and May in North America. 
Occurs pandemically in cycles with intervals of several decades. 
9. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting: By clinical symptoms 
only. Uncertain in interepidemic periods. 
2. Isolation: During acute stage of the disease, especially in severe 
cases and those complicated by pneumonia. 
3. Concurrent disinfection: Discharges from the nose and throat of 
the patient. 
4. Terminal disinfection: None. 
5. Quarantine: None, but visiting should be discouraged. 
6. Immunization: None. 
7. Investigation of source of infection: Of no practical value. 
B. General measures: 
1. During epidemics efforts should be made to reduce opportunities 
for direct contact infection, as in crowded halls, stores, and street 
cars. Kissing, the use of common towels, glasses, eating utensils 
or toilet articles should be avoided. In isolated towns and insti- 
tutions infection has been delayed and sometimes avoided by 388 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
strict exclusion of visitors from already infected communities. 
The closing of the public, parochial, and private schools has not 
been effective in checking the spread of infection. The judicious 
use of masks by nurses and other attendants may prove of value 
in preventing infection in hospitals. Scrupulous cleanliness of 
dishes and utensils used in preparing and serving food in public 
eating places should be required, including the subjection of such 
articles to disinfection in hot soap suds. In groups which can be 
brought under daily professional inspection, the isolation of early 
and suspicious cases of respiratory tract inflammation, particu- 
larly when accompanied by a rise in temperature, may delay the 
spread of the disease. To minimize the severity of the disease, 
and to protect the patient from secondary infections and thus 
reduce mortality, patients should go to bed at the beginning 
of an attack, and not return to work without the approval of 
their physician. 
2. Crowding of beds in hospitals and institutions to accommodate 
increased numbers of patients and other inmates is to be espe- 
cially avoided. Increased spacing between beds in wards and 
dormitories should be carried out to reduce the risk of attack, 
and of the occurrence of pneumonia. 
1. Recognition of the disease.—Clinical characteristics are fever, catarrhal symp- 
toms in eye£ and nose and throat in the prodromal stage, as well as at the 
height of the disease, an early eruption in the mouth, Koplik spots, later an 
exanthem and enanthem, and a branny desquamation during convalescence. 
When the disease is prevalent, or a susceptible child has been exposed to a 
case of measles, the diagnosis should be suspected on appearance of the 
fever and catarrhal symptoms, without waiting for confirmatory eruptions, 
and isolation precautions should be instituted at once. 
2. Etiological agent.—A specific flltrable virus. 
3. Source of infection.—Buccal and nasal secretions of an infected individual. 
4. Mode of transmission.—Directly from person to person; indirectly through 
articles freshly soiled with the buccal and nasal discharges of an infected 
individual. The most easily transmitted of the communicable diseases. 
5. Incubation period.—About 8 to 10 days from date of exposure to onset of fever : 
12 to 14 days to appearance of rash; rarely as long as 18 days. When con- 
valescent serum has been used, but too late to prevent infection, the incu- 
bation period may be as long as 21 days. 
9>. Period of communicability.—During the period of catarrhal symptoms and 
until the cessation of abnormal mucous membrane secretions—minimum 
period of 9 days; from 4 days before to 5 days after the appearance of the 
rash. 
7. Susceptibility and immunity.—All persons must be considered susceptible until 
they have had the disease, except that most babies born of mothers who 
have had the disease are immune for the first six months of life. Natural 
immunity may last into adult life in rare instances. Acquired immunity 
is usual after recovery from an attack. Passive immunity may be estab- 
lished for a few weeks, but not more than 4, by the use of 4 to 10 cc of 
convalescent measles serum or 20 to 50 cc of whole blood of immunes, or if 
citrated blood is used, 25 to 60 cc. 
Measles. HYGIENE AND SANITATION 
389 
8. Prevalence.—Universal. Probably 80 to 90 per cent of all persons surviving 
to the twentieth year of life have had an attack, and rarely does a person 
go through life without having had measles. Occurs most commonly in 
children between 5 to 14 years of age, but many cases are in children 
under 5. Endemic in large population units. In remote or insular groups 
epidemics occur on contact with a case in a visitor. Highest incidence 
from March to June in North America. Frequency of epidemics depends 
on size of community, or proximity to a large center, amount of communi- 
cation between large and small population groups, accretion of population 
by births and other less exactly determined factors. Much more likely to 
result in death from complicating pneumonia in children under 2 than at 
higher ages. 
9. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting: Clinical symptoms. Spe- 
cial attention to rise of temperature, Koplik spots and catarrhal 
symptoms in exposed individuals. 
2. Isolation: During period of communicability for the sake of the 
patient as well as others. 
3. Concurrent disinfection: All articles soiled with the secretions of 
the nose and throat. 
4. Terminal disinfection: Thorough cleaning. 
5. Quarantine: When the disease is very prevalent and in large com- 
munities, quarantine of exposed susceptible children may be 
impracticable and of no value. Exclusion of exposed susceptible 
school children and teachers from school until 14 days from last 
exposure may be justifiable under other conditions. This applies 
to exposure in the household. Exclusion of exposed susceptible 
children from all public gatherings for the same period. If the 
date of only exposure is reasonably certain, an exposed suscep- 
tible child of school age may be allowed to attend school for the 
first 7 days of the incubation period. Quarantining of institu- 
tions of young children and of wards or dormitories where 
exposure is suspected is of some value. Strict quarantine of 
wards of infants if a case occurs in an institution is important. 
6. Immunization: By the use of the semm or whole blood of con- 
valescent patients, or of any healthy adults who have had 
measles, given within 5 days after exposure to a known case 
of measles, the attack in the exposed person may be averted in 
a high percentage of instances; if not averted, the disease is 
modified. Given later, but at a time prior to the clinical onset 
of the disease, convalescent serum usually modifies the severity 
of the attack and the patient probably acquires the usual last- 
ing immunity to the disease. 
7. Investigation of source of infection; Search for exposed suscep- 
tible children under 3 years of age is profitable. Carriers are 
not known to occur. Every effort should be made to have all 
cases reported early in the disease by the physician, or, if there 
is none in attendance, by parent or guardian. The chief object 
of discovering cases is to assure suitable care for little children 
and immunization if practicable of those exposed under 5 years 
of age. 390 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
B. General measures : 
1. Daily examination of exposed children and of other possibly 
exposed persons. This examination should include record of the 
body temperature. A nonimmune exposed individual exhibiting 
a rise of temperature of 0.5° C. or more should be promptly 
isolated pending diagnosis. 
2. Schools should not be closed or classes discontinued where daily 
observation of the children by physician and nurse is pro- 
vided for. 
3. Education as to special danger of exposing young children to those 
exhibiting fever and acute catarrhal symptoms of any kind, 
particularly during years and seasons of epidemic prevalence 
of measles. 
4. In institutional outbreaks, immunization with convalescent serum 
of all minor inmates who have not had measles, is of value in 
checking the spread of infection and in reducing mortality. No 
new admissions and no visitors imder 16 years of age should be 
permitted in an institution for children, during a measles out- 
break in the community or in the institution. 
5. The immunization of infants and children under 3 years of age 
with convalescent serum or whole adult blood in families where 
cases of measles occur in older children or adults should be 
encouraged by the department of health and by private 
physicians. 
Mumps. 
1. Recognition of the disease.—Acute specific infection characterized by fever, 
swelling, and tenderness of the salivary glands, usually of the parotid, 
sometimes of the sublingual or submaxillary glands. Metastases occur 
sometimes in the ovaries and testicles. Epidemic occurrence is usual, es- 
pecially in schools, colleges, and barracks, of new recruits. Inflammation 
of Stenson’s duct may assist in early diagnosis. There are no laboratory 
aids of value. 
2. Etiological agent.—A specific flltrahle virus. 
3. Source of infection.—Secretions of the mouth and possibly of the nose. 
4. Mode of transmission.—By direct contact with an infected person or with 
articles freshly soiled with the discharges from the nose and throat of such 
infected persons. 
5. Incubation period.—From 12 to 26 days. The most common period 18 days, 
accepted as usual. A period of 21 days is not uncommon. 
6. Period of communicability.—Unknown, but assumed to persist until the paro- 
tid gland has returned to its normal size. 
7. Susceptibility and immunity.—Susceptibility believed to be general. Im- 
munity follows an attack but second attacks of the disease are not rare. 
Brief passive immunity may follow inoculation with convalescent serum or 
whole blood. 
8. Prevalence.—This disease is decidedly less prevalent than the other common 
communicable diseases of childhood such as measles, whooping cough, and 
chicken pox. Winter and spring are the seasons of greatest prevalence. 
Its occurrence is sporadic and epidemic except in large cities, where it is 
endemic. HYGIENE AND SANITATION 
391 
t>. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting: The diagnosis is usually 
made on swelling of the parotid gland. 
2. Isolation: Separation of the patient from nonimmnne children and 
young children and young people and exclusion of the patient 
from school and public places for the period of presumed infec- 
tivity, particularly when the disease appears in children’s insti- 
tutions or among young recruits. 
3. Concurrent disinfection: All articles soiled with the discharges of 
nose and throat of the patient. 
4. Terminal disinfection: None. 
5. Quarantine: None. Exposed susceptible persons should be regu- 
larly inspected for the onset, the presence of initial symptoms 
of the disease, such as fever, or swelling or pain of the parotid, 
or submaxillary glands, for 3 weeks from the date of last ex- 
posure. Exposed children medically certified as having had the 
disease should not be excluded from school as susceptibles. 
6. Immunization: None. Passive temporary immunity by convales- 
cent serum or blood still in experimental stage. 
7. Investigation of source of infection: Search for unreported or re- 
cent cases among associates of the patient in school or family or 
other group of young people. Carriers are not known to occur. 
B. General measures: None. 
Pneumonia, acute lobar. 
1. Recognition of the disease.—An acute infection characterized by sudden onset 
with chill followed by fever, often pain in the chest, usually cough and 
dyspnoea. In many cases in children, vomiting and convulsions occur at the 
onset. Determination of the infecting microorganism by microscopic and 
cultural examination of the sputum is useful as an aid in therapy and for 
epidemiological studies. The X-ray may disclose pulmonary lesions before 
the stethoscope. 
2. Etiological agent.—Various pathogenic bacteria commonly found in the nose, 
throat and mouth, such as the pneumococcus in about 95 per cent of the 
cases, and of these, 50 per cent types I and II; the bacillus of Friedlander; 
in occasional cases, the haemolytic streptococcus; the influenza bacillus, etc. 
3. Source of infection.—Probably discharges from the mouth and nose of in- 
fected person or carrier and articles freshly soiled with such discharges. 
Except when already attacked by some respiratory infection, exposed indi- 
viduals rarely develop pneumonia as a result of transmission of infection 
by direct or indirect means from the patient. 
4. Mode of transmission.—By direct contact with infected person or carrier, or 
with articles freshly soiled with the discharges of the nose and throat of 
such persons, and possibly from infected dust of rooms occupied by infected 
persons. 
5. Incubation period.—Believed to be short, usually 1 to 3 days—not well deter- 
mined. 
6. Period of communicability.—Unknown; presumably until the discharges of 
the mouth and nose no longer carry the infectious agent in an abundant 
amount or in a virulent form. 392 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
7. Susceptibility and immunity.—Susceptibility is general, accentuated by wet 
and cold and exposure, and apparently under certain conditions by bodily 
and mental fatigue, and by alcoholism. Natural immunity may occur, but 
is doubtful. Acquired immunity to the particular microorganism may fol- 
low an attack of pneumonia; such immunity is of short duration. Artificial 
active or passive immunity cannot be relied upon. 
8. Prevalence.—Common, and affecting at one time or other, between adoles- 
cence and old age, a large proportion of the population. No race or color 
or either sex is exempt from likelihood of having this disease. Occurs in 
all climates and seasons, but most often in winter and spring and in 
regions where cold, windy, changeable, and inclement weather prevails. 
9. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting; Clinical symptoms. 
Specific infecting organisms may be determined by serological 
and bacteriological tests early in the course of the disease, 
which may give basis for epidemiological studies and for specific 
serum therapy. 
2. Isolation: Medical aseptic technique preferably at home. 
3. Concurrent disinfection: Discharges from the nose and throat of 
the patient. 
4. Terminal disinfection: Thorough cleaning and airing. 
5. Quarantine: None 
B. General measures: 
6. Immunization: None, 
1. Whenever practicable and particularly in institutions, barracks, 
and on shipboard, crowding in living and sleeping places should 
be avoided. The general resistance should be conserved by 
good food, fresh air, sufficient sleep, temperance in the use of 
alcoholic beverages, and other hygienic measures. 
Scarlet fever 
1. Recognition of the disease.—Sudden onset with nausea, vomiting, fever, and 
sore throat; rash (bright red spots on subcuticular flush) on second or 
third day. Cases occur without eruption, when provisional diagnosis may 
be made on sore throat, fever, vomiting, and history of exposure. The 
Schultz-Charlton blanching phenomenon may be used when rash has recently 
appeared: one-tenth to one-half cc convalescent serum or scarlet fever anti- 
toxin is injected into skin where rash exists, which causes local blanching 
in 6 to 36 hours if rash is scarlatinal; absence of blanching, however, does 
not rule out scarlet fever. 
2. Etiological agent.—A haemolytic streptococcus. 
3. Source of infection.—Discharges from the nose, throat, ears, abscesses, or 
wound surfaces of sick or convalescent patients, and articles freshly soiled 
therewith. The nose and throat discharges of carriers may also spread 
the disease. 
4. Mode of transmission.—Directly by contact with an infected person, indirectly 
by articles freshly soiled with discharges of an infected person, or through 
contaminated milk or milk products, not by skin desquamation. 
5. Incubation pei'iod.—Two to seven days, usually three to four days. 
6. Period of communicability.—'Usually until 3 weeks from the onset of the dis- 
ease, without regard to the stage or extent of desquamation, but until all 
abnormal discharges have ceased and all open sores or wounds have healed. HYGIENE AND SANITATION 
393 
Adults convalescent from scarlet fever appear to be less likely to transmit 
infection than are children. The infectious agent is more likely to be 
transmitted in colder seasons of the year. 
7. Susceptibility and immunity.—Susceptibility is not general, particularly 
among adults. Unnoticed infections occur and produce immunity. Lasting 
immunity is usual after an attack, but not Invariable, as second attacks 
occur. Artificial passive immunity of a few weeks may be developed by 
human convalescent serum. Artificial active immunity of uncertain dura- 
tion can be developed in a considerable proportion of susceptible persons 
by the use of a suitable streptococcus antigen. 
8. Prevalence.—Found in all parts of the world but unimportant in tropics and 
of low incidence in subtropical areas of North America. Commoner in 
urban than in rural areas. About 5 per cent of total deaths from scarlet 
fever occur in children under 1 year of age. Most common in winter and 
spring. 
9. Methods of control: 
A. The infected individual, contacts and environment: 
1. Recognition of the disease and reporting: By clinical symptoms. 
2. Isolation; In home or hospital, maintained in each case until the 
end of the period of communicability. If medical inspection is 
not available, isolation for 21 days from onset for uncomplicated 
cases. 
3. Concurrent disinfection: Of all articles which have been in contact 
with a patient and all articles soiled with discharges of the 
patient. 
4. Terminal disinfection: Thorough cleaning. 
5. Quarantine: Exclusion of exposed children and teachers from 
association with children, and food handlers from their work, 
until 7 days have elapsed since last exposure to a recognized case. 
6. Immunization: Exposed susceptibles, as determined by the Dick 
test, may be passively immunized by convalescent scarlet fever 
serum or scarlet fever antitoxin, under special circumstances. 
7 Investigation of source of infection: Search for individual source 
in contact cases or carrier, and in unpasteurized milk and milk 
products. It is important to discover undetected cases and 
convalescent and contact carriers. 
B. General measures: 
1. Daily examination of exposed children and of other possibly 
exposed persons for a week after last exposure. Encourage 
removal of young susceptible contacts in the family to homes of 
adult friends for duration of communicable stage in the patient. 
Septic sore throat. 
1. Recognition of the disease.—Acute sore throat appearing in epidemic out- 
breaks, often of a highly virulent character, and accompanied by various 
general septicsemic manifestations. The onset is likely to be abrupt with 
chill, high temperature, and vomiting. 
2. Etiological agent.—Streptococcus (haemolytic type).1 
3. Source of infection.•—The human naso-pharynx, usually the tonsils, any case 
of acute streptococcus inflammation of these structures being a potential 
source of infection, including the period of convalescence of such cases. 
1 Bovine mastitis of staphylococcus origin may lead to epidemic outbreaks of gastro- 
intestinal disturbance in those who drink unpasteurized milk from a cow so infected. 394 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The udder of a cow infected by the milker is a common source of infection. 
In such udders the physical signs of mastitis may he absent.3 
4. Mode of transmission.—Direct or indirect human contact; consumption of 
raw milk contaminated by case or carrier or from an infected udder. 
5. Incubation period.—One to three days. 
6. Period of communicability.—In man, presumably during the continuance of 
clinical symptoms; in the cow, during the continuance of discharge of the 
streptococci in the milk, the condition in the udder tending to a spontane- 
ous subsidence. The carrier stage may follow convalescence and persist 
for some time. 
7. Susceptibility and immunity.—Susceptibility general, but somewhat less, in 
young children. Immunity, either natural or acquired, is rare and uncer- 
tain, if it occurs at all. 
8. Prevalence.—Usually in epidemics, in any geographic area except where milk 
supply is pasteurized. Most cases in adolescents and adult milk drinkers. 
Most often in spring and early summer, but may occur at any season. 
9. Methods of control: 
A. The infected individual, contacts, and environment 
1. Recognition of the disease and reporting: Clinical symptoms. 
Bacteriological examination of the lesions or discharges from the 
tonsils and naso-pharynx may be useful. 
2. Isolation; During the clinical course of the disease and convales- 
cence, and particularly exclusion of the patient from participa- 
tion in the production or handling of milk or milk products. 
3. Concurrent disinfection: Articles soiled with discharges from the 
nose and throat of the patient. 
4. Terminal disinfection: Cleaning. 
5. Quarantine: None. 
6. Immunization: None. 
7. Investigation of sources of infection: Search for cases and carriers 
among milkers and other handlers of unpasteurized milk, and 
for mastitis in milk cows. 
B. General measures: 
1. Exclusion of suspected milk supply from public sale or use until 
pasteurized. The exclusion of the milk of an infected cow or 
cows in small herds is possible when based on bacteriological 
examination of the milk of each cow, and preferably the milk 
from each quarter of the udder at frequent intervals. Exclusion 
of human cases or carriers from handling milk or milk products. 
2. Pasteurization of all milk. 
3. Education in the principles of personal hygiene and avoidance of 
the use of common towel, drinking and eating utensils. 
4. In the absence of an epidemic, the milk of any cow with evidence of 
mastitis should be excluded from sale or use as a protection in 
addition to pasteurization. 
Tuberculosis, pulmonary. 
1. Recognition of the disease.—Evidence of present or past infections in the 
absence of clinical symptoms can be determined by a variety of specific 
tuberculin reactions, among which the Mantoux intradermal test is the 
2 Mastitis in the cow, due to bovine streptococci, is not a cause of septic sore throat 
in human beings unless a secondary infection of the udder by a human type of strepto- 
coccus takes place. HYGIENE AND SANITATION 
395 
most reliable. In the presence of early constitutional symptoms with or 
without pulmonary signs, the existence or location of pulmonary or other 
thoracic lesions can best be revealed by the X-ray. When fever, cough, loss 
of appetite and weight, and physical signs on auscultation and percussion 
are found, the pulmonary lesion is already well developed. Discovery of 
tubercle bacilli in the sputum confirms the diagnosis not infrequently in 
early cases but is an evidence usually of a well-advanced lesion. 
2. Etiological agent.—Mycobacterium tuberculosis (hominis) (Bacillus tuber- 
culosis (human)). Tubercle bacilli of bovine type have been isolated from 
pulmonary lesions in man; avian type rarely. 
3. Source of infection.—The specific microorganism present in the discharges, 
or articles freshly soiled from the discharges, from any open tuberculosis 
lesions, the most important discharge being sputum. Of less importance 
are discharges from the intestinal and genitourinary tracts, or from lesions 
of the lymph nodes, bone, and skin. 
4. Mode of transmission.—Usually through the discharges of the respiratory 
tract, occasionally through those of the digestive tract, by direct or indirect 
contact with infected persons, by means of coughing, sneezing, or other 
droplet infection, by kissing, by the use of contaminated eating and drink- 
ing utensils, and possibly by contaminated flies and dust. Infection rarely 
occurs from casual contact, but usually results from the continued type of 
exposure characteristic of family relationships. 
5. Incubation period.—Variable and dependent upon the type of the disease. 
6. Period of communicability.—As long as the specific microorganism is elimi- 
nated by the host. Commences when a lesion becomes an open one, i. e., 
discharging tubercle bacilli, and contihues until it heals or death occurs. 
The degree of communicability varies with the number and virulence of 
the bacilli discharged, the frequency of exposure, and the susceptibility of 
the persons exposed. 
7. Susceptibility and immunity.—Susceptibility is general; in children greater 
than in adults; in aboriginal races more than among races long exposed to 
the disease; in the undernourished, fatigued, and neglected more than in 
the well fed and well cared for; in those exposed to dusty trades, and in 
particular to silica dust, more than in persons with outdoor occupations in 
clean air. Resistance of some degree is developed by age and by the main- 
tenance of good nutrition. 
8. Prevalence.—Among the most common communicable diseases of man, with 
but slight variations of occurrence of infection, although considerable var- 
iation in mortality rate according to race. At present in some modern 
occidental nations its incidence as a disease has fallen markedly, and both 
incidence and deaths continue to fall from year to year. Infection occurs 
more commonly in childhood (from infancy to adolescence) than at later 
ages. Mortality highest among males between 25 and 40 and among 
females about 5 years earlier. Aboriginal races when first exposed develop 
the disease in a rapidly fatal form. 
9. Methods of control: 
A. The infected individual, contacts, and environment 
1. Recognition of the disease and reporting; By thorough physical 
examination supplemented by use of the X-ray and tuberculin 
testing when necessary and confirmed by bacteriological exami- 
nation of sputum and other materials. Early discovery in con- 
tacts, particularly in family groups exposed to an open case of 
tuberculosis (“positive” sputum), is of great importance. 
154294 °—-39 26 396 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
2. Isolation of such “open” cases as do not observe the precautions 
necessary to prevent the spread of the disease may prove advis- 
able. A period of hospital or sanatorium treatment is very 
desirable in all cases to remove the patient as a focus of infec- 
tion in his home, and to teach him the hygienic essentials of 
tuberculosis control as well as to increase his chances of recovery. 
3. Concurrent disinfection: Of sputum and articles soiled with it. 
Particular attention should be paid to prompt disposal or disin- 
fection of sputum itself, of handkerchiefs, cloths, or paper soiled 
therewith, and of eating utensils used by the patient. 
4. Terminal disinfection: Cleaning and renovation. 
5. Quarantine: None. 
6. Immunization : None. 
7. Investigation of source of infection: In spite of the length and 
uncertainty of the incubation period and the numerous possible 
sources of infection, a systematic effort should be made to dis- 
cover the probable source in each case and to identify other cases 
of the same origin, by thorough examination by X-ray, physical 
examination, and where appropriate by tuberculin test of family 
and household contacts. 
B. General measures: 
1. Education of the public in regard to the danger of tuberculosis, 
the mode of spread and the methods of control, with especial 
stress upon the danger of exposure and infection in early 
childhood. 
2. Provision of dispensaries and visiting-nurse service for discovery 
of early cases and supervision of home cases. 
3. Provision of adequate sanatorium facilities for isolation and 
treatment of active cases. Two beds per annual tuberculosis 
death in the community is an adequate ratio. 
4. Provision of open-air schools and preventoria for infected chil- 
dren not yet showing clinical signs of the disease. 
5. Improvement of housing conditions and nutrition of the poor. 
(5. Elimination of silica dust in certain industrial establishments. 
7. Improvement of habits of personal hygiene and betterment of 
living conditions among the underprivileged. 
8. Separation of babies from tuberculous mothers at birth. 
9. Pasteurization of all milk supplies. 
10. Eradication of tuberculosis in cattle. 
11. AVhere the disease is endemic and the incidence high particularly 
among little children, the routine use of B. C. G. (bile Calmette 
Guerin) vaccine in infancy for active immunization has been 
suggested. 
Tuberculosis, other than pulmonary. 
1. Recognition of the disease.—By local manifestations, by constitutional reac- 
tions, by specific reactions, and by microscopic identification of the tubercle 
bacillus in the lesions or their discharges. 
2. Etiological agent.—Mycobacterium tuberculosis (hominis et bovis) (Bacillus 
tuberculosis (human and bovine)). 
3. Source of infection.—Discharges from mouth, nose, bowel, and genito- 
urinary tract of infected human beings; the discharging lesion of bones, 
joints, and lymph glands; articles freshly soiled with such discharges; 
milk from tuberculous cattle. HYGIENE AND SANITATION 
397 
4. Mode of transmission.—By direct contact with infected persons, by contami- 
nated food, and possibly by contact with articles freshly soiled with the 
discharges of infected persons. 
5. Incubation period.—Unknown. 
6. Period of communicability.—Until discharging lesions are healed. 
7. Susceptibility and immunity.— (See statement under this heading in Pul- 
monary tuberculosis.) 
8. Prevalence.—Much less common than the pulmonary form and more rapidly 
falling in incidence, representing about 10 per cent of total cases and deaths 
from the disease. Especially common in infants and young children where 
intimately exposed to parent infection and to bovine infection through 
unpasteurized milk from tuberculous cattle. 
9. Methods of control: 
A. The infected individual, contacts and environment: 
1. Recognition of the disease and reporting: Clinical signs and symp- 
toms confirmed by bacteriological and serological examinations. 
2. Isolation: None. 
3. Concurrent disinfection: Discharges and articles freshly soiled 
with them. 
4. Terminal disinfection: Cleaning. 
5. Quarantine: None. 
6. Immunization: None. 
7. Investigation of source of Infection; Search should be made for 
possible original source in family, household, or other intimate 
contacts, and to discover previously unrecognized cases of similar 
origin, such a search to be aimed at discovery of infected but 
latent or arrested cases as well as those showing an active proc- 
ess. Special inquiry and investigation should be made to dis- 
cover possible source of bovine tubercle infection where unpas- 
teurized milk has been used in the family or particularly used 
uncooked, by the patient. 
B. General measures: 
1. Pasteurization of milk and milk products and inspection of meats. 
2. Eradication of tuberculosis in dairy cattle. 
3. Patients with open lesions should be prohibited from handling 
foods. 
4. Adequate hospital, sanatorium, preventorium, and out-patient facil- 
ities for discovery, control, and clinical management. 
Whooping cough (Pertussis). 
1. Recognition of the disease.—An acute infection involving trachea and bron- 
chi and characterized by an initial catarrhal stage with slight fever, and 
a paroxysmal stage in which the paroxysmal cough ends in a sonorous or 
whooping inspiration often accompanied by vomiting. Identification of 
the Bordet-Gengou bacillus in the tenacious tracheo-bronchial mucus can 
be made in a high percentage of cases during the early and paroxysmal 
stages of the disease before the whoop develops, and less readily from the 
fourth to the sixth week after the onset of the disease by the use of special 
cough culture plates held before the mouth during a spontaneous or 
induced paroxysm of coughing. A definite lymphocytosis in the pre-parox- 
ysmal stage may assist the clinical diagnosis. 
2. Etiological agent.—Haemophilus pertussis (Bacillus of Bordet-Gengou). 
3. Source of infection.—Discharges from the laryngeal and bronchial mucous 
membranes of infected persons. 398 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
4. Mode of transmission.—Contact with an infected person, or with articles 
freshly soiled with the discharges of such person. 
5. Incubation period.—Commonly 7 days, almost uniformly within 10 days, 
and not exceeding 16 days. 
6. Period of communicability.—Particularly communicable in the early catarrhal 
stage before the characteristic whoop makes a clinical diagnosis possible. 
The catarrhal stage occupies from 7 to 14 days. After the characteristic 
whoop has appeared, the communicable period continues certainly for 3 
weeks. Even if the spasmodic cough with whoop persists longer than this 
it is most unlikely that the infecting organism can be isolated from the dis- 
charges. The communicable stage must be considered to extend from 7 
days after exposure to an infected individual to 3 weeks after the develop- 
ment of the characteristic whoop. 
7. Susceptibility and immunity.—Susceptibility is general. There is no natural 
immunity. The greatest susceptibility is in children between 6 months 
and 5 years of age, after which there is some decrease. One attack confers 
a definite and prolonged immunity, although second attacks do occur. A 
brief passive immunity may be conveyed to young children by convalescent 
serum or adult whole blood. Artificial immunity is still of doubtful value 
and as yet of no definite reliance. Susceptibility is apparently higher in 
females at all ages than in males. 
8. Prevalence.—Very prevalent, and a common disease among children every- 
where regardless of race, climate, or geographical location. About half 
the reported cases in cities are in children under 5 years of age, and 90 
per cent in children under 10. Incidence and fatality rates are higher among 
females. Somewhat less prevalent in tropical than in temperate climates. 
Seasonal incidence variable, but mortality higher usually in spring months 
in North America. Cyclical occurrence irregular. 
9. Methods of control. 
A. The infected individual, contacts and environment 
1. Recognition of the disease and reporting: Clinical symptoms, 
supported by a differential leucocyte count, and confirmed where 
possible by bacteriological examination of bronchial secretions. 
A positive diagnosis may be made by bacteriological examination 
of laryngeal discharges as early as 1 week before the develop- 
ment of the characteristic cough. 
2. Isolation: Separation of the patient from susceptible children, 
and exclusion of the patient from school and public places for 
the period of assumed infectivity. It is of particular impor- 
tance to protect children under 3 years of age against contact 
with any other children with cough and fever, of whatever 
origin, and especially if whooping cough is suspected or is known 
to be prevalent. Isolation of children over 2 years of age is 
impracticable, and even those under 2 shoiild not be insisted upon 
at the expense of fresh air in the open if weather permits. 
3. Concurrent disinfection: Discharges from the nose and throat 
of the patient and articles soiled with such discharges. 
4. Terminal disinfection: Cleaning of the premises used by the 
patient. 
5. Quarantine: Limited to the exclusion of nonimmune children from 
school and public gatherings for 10 days after their last ex- 
posure to a recognized case. This precaution may be omitted HYGIENE AND SANITATION 
399 
if exposed nonimmune children are observed with care by a 
physician or nurse on their arrival at school each day for 10 
days after their last exposure to a recognized case. 
6. Immunization: Use of prophylactic vaccination is recommended 
by some observers, but is still considered to be of doubtful 
reliability. 
7. Investigation of source of infection: An effort should be made 
to discover undiagnosed and unreported cases, with the main 
object in view of protecting young children from exposure, 
and thus reducing the mortality. Postponement of the age of 
infection at least until school age and great care in the man- 
agement of the disease in young children offer some hope of 
reducing deaths from whooping cough although reduction of 
incidence by any means appears unlikely. Carriers in the exact 
sense of this term are not known to occur. 
B. General measures; Education in habits of personal cleanliness and in 
the dangers of association or contact with those showing catarrhal 
symptoms with cough. 
GROUP II. DISEASES TRANSMITTED BY DISCHARGES FROM THE 
INTESTINAL TRACT 
Cholera. 
Dysentery, amoebic. 
Dysentery, bacillary. 
Hookworm disease. 
Paratyphoid fever. 
Typhoid fever. 
Cholera. 
1. Recognition of the disease.—In a few mild cases, diarrhoea may be the chief 
or only symptom. In the typical case, rice-water stools, vomiting, and 
general symptoms of dehydration occur with thirst, pain, and coma. The 
cholera vibrios are found in the stools. 
2. Etiological agent.—Vibrio comma, (Spirillum cholerce.) 
3. Source of infection.—Bowel discharges and vomitus of infected persons, and 
faeces of convalescent or healthy carriers. Ten per cent of contacts may he 
found to be carriers. 
4. Mode of transmission.—By food and water polluted by infectious agent; by 
contact with infected persons, carriers, or articles freshly soiled by their 
discharges; by flies. 
5. Incubation period.—One to five, usually three days, occasionally longer if 
the healthy carrier stage, before development of symptoms, is included. 
6. Period of communicability.—Usually 7 to 14 days or longer and until the 
infectious organism is absent from the bowel discharges. A high degree 
of communicability is usual. 
7. Susceptibility and immunity.—Susceptibility is general, although natural im- 
munity appears to exist to a limited degree. Acquired immunity is 
uncertain. Active artificial immunity for about 1 year may be obtained by 
vaccines. 
8. Prevalence.—Rare in North America. Appears in epidemic form frequently 
in the Philippines. Does not occur sporadically, except as an isolated case 
is discovered in the course of maritime quarantine enforcement. 
9. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting: Clinical symptoms con- 
firmed by bacteriological examination of stools. 400 
HANDBOOK OF THE HOSPITAL CORPS, U. S, NAVY 
2. Isolation of patient in hospital or screened room during com- 
municable period. 
3. Concurrent disinfection: Prompt and thorough disinfection of the 
stools and vomited matter. Articles used by and in connection 
with the patient must be disinfected. Food left by the patient 
should be burned. 
4. Terminal disinfection: The room in which a sick patient was 
isolated should be thoroughly cleaned. 
5. Quarantine: Contacts for 5 days from last exposure, or longer if 
stools are found to contain the cholera vibrio. 
6. Immunization: Prophylactic immunization of contacts is useful 
and advisable. 
7. Investigation of source of infection: Search for contaminated 
food and water as common origin of groups of cases, and for 
unreported cases and for carriers. 
B. General measures: 
1. Rigid personal prophylaxis of attendants by scrupulous cleanli- 
ness, disinfection of hands each time after handling patient 
or touching articles contaminated by dejecta, the avoidance 
of eating or drinking anything in the room of the patient, and 
the prohibition of those attendant on the sick from entering the 
kitchen. 
2. The bacteriological examination of the stools of all contacts to 
determine carriers. Isolation of carriers. 
3. Water should be boiled, if used for drinking or toilet purposes, or 
if used in washing dishes or food containers, unless the water 
supply is adequately protected against contamination or is so 
treated, as by chlorination, that the cholera vibrio cannot sur- 
vive in it. 
4. Careful supervision of food and drink: Where cholera is preva- 
lent, only cooked foods should be used. Food and drink after 
cooking or boiling should be protected against contamination, as 
by flies and human handling. 
C. Epidemic measures: Inspection service for early detection and isolation 
of cases; examination of persons exposed in infected centers for de- 
tection of carriers, with isolation or control of carriers; cleaning of 
rooms occupied by the sick, and the detention, in suitable camps for 
5 days, of those desirous of leaving for another locality. Those so 
detained should be examined for detection of carriers. 
Dysentery, amoebic (Amoebiasis). 
1. Recognition of the disease.—Insidious and undetermined onset characterizes 
mild acute cases, with digestive disturbance, anorexia, diarrhoea or consti- 
pation, and usually little abdominal discomfort. Severe acute cases fol- 
lowing massive infection may simulate acute appendicitis, or other acute 
surgical abdominal condition with high temperature and severe prostration. 
The subacute and chronic forms of the disease vary widely in the extent of 
local and constitutional symptoms. There may or may not be diarrhoea or 
constipation; or these may alternate in the same patient. 
2. Etiological agent.—Endamoeba histolytica. 
3. Source of infection.—The bowel discharges of infected persons and of carriers. 
4. Mode of transmission.—By drinking contaminated water and by eating in- 
fected foods, especially those that are commonly served cold and moist, and HYGIENE AND SANITATION 
401 
hand-to-mouth transfer of infected material; from moist objects soiled with 
discharges of an Infected individual; by flies. 
5. Incubation period.—From 2 days in severe infections to several months in 
subacute and chronic cases; commonly 3 to 4 weeks. 
6. Period of communicability.—During course of infection and until repeated 
microscopic examination of stools shows absence of the Endamoeba his- 
tolytica (either trophozoites or cysts). Direct transmission unusual. 
7. Susceptibility and immunity.—Susceptibility to infestation is general; im- 
munity uncertain; no artificial immunity. 
8. Prevalence.—Not a common disease clinically in continental North America. 
Epidemic outbreaks are rare. It is estimated that almost 5 per cent of the 
population are carriers of cysts. 
9. Methods of control: 
A. The infected individual, contacts and environment: 
1. Recognition of the disease and reporting; Clinical symptoms 
confirmed by microscopic examination of stools. 
2. Isolation: None. 
3. Concurrent disinfection: Sanitary disposal of the bowel discharges. 
Hand washing after use of toilet. 
4. Terminal disinfection; Cleaning. 
5. Quarantine: None. 
6. Immunization: None. 
7. Investigation of source of infection; Microscopic examination of 
stools of inmates of the household, or of work associates of the 
infected person, and of other suspected contacts, should be 
supplemented by search for direct contamination of water and 
foods by human fseces. 
B. General measures: 
1. Sanitary disposal of human faeces. 
2. Protection of potable water supplies against faecal contamination, 
and boiling drinking water where necessary. Chlorination of 
water supplies as generally used has been found inadequate for 
the destruction of cysts. 
3. Supervision of the general cleanliness, of the personal health and 
sanitary practices of persons preparing and serving food in pule 
lie eating places, especially moist foods eaten raw. 
4. Education in personal cleanliness, particularly washing hands with 
soap and water after evacuation of the bowel. 
5. Control of fly breeding and protection of foods against fly con- 
tamination by screening. 
6. It is of importance that all cross connections between potable and 
polluted water supplies be forbidden. Systematic inspection 
should be made to discover them, and the supply should be dis- 
connected until such cross connections have been eliminated. 
7. Instruction of convalescent and chronic carriers in personal hy- 
giene, particularly as to sanitary disposal of faecal waste, and 
hand washing after use of toilet. 
C. Epidemic measures: In case of epidemics due to relatively massive doses 
of infectious material, active measures should be employed to dis- 
cover the source of infection, and to warn the public and the medi- 
cal profession of the early and characteristic symptoms, and of the 
serious immediate and remote results of such infection. 402 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Dysentery, bacillary. 
1. Recognition of the disease.—The typical case exhibits an acute onset, fever, 
tenesmus, with frequent stools containing blood and mucus. One or more 
of a large number of possible types of the dysentery bacillus can usually 
be found in the stools in the first 2 days of the disease. 
2. Etiological agent.-— Shigella dysenterise and Shigella paradysenterise. 
3. Source of infection.—The bowel discharges of infected persons. 
4. Mode of transmission.—By eating infected foods, and by hand-to-mouth trans- 
fer of infected material; by flies, from objects soiled with discharges of an 
infected individual or of a carrier; by drinking contaminated water. Pol- 
luted milk and water are less common vehicles of this disease than is the 
case with typhoid fever. 
5. Incubation period.—2 to 7 days. 
6. Period of communicability.—During the febrile period of the disease and 
until the microorganism is absent from the bowel discharges, sometimes 
as long as 4 weeks. 
7. Susceptibility and immunity.—Susceptibility is general among children, but 
less so, and the disease less severe, in adults. A relative and not perma- 
nent immunity follows recovery from the disease. 
8. Prevalence.—Endemic, epidemic, and sporadic, but shares with other enteric 
infections in striking and progressive reduction wherever water supplies 
are rendered safe, sewage is disposed of in a sanitary manner, milk is 
pasteurized, and infant hygiene is of a good order. Most common in the 
summer months and in subtropical and tropical areas. 
9. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting; Clinical symptoms con- 
firmed by serological and bacteriological tests; groups of cases 
of acute diarrhoeal disorder should always be reported at once. 
2. Isolation: Infected individuals during the communicable period 
of the disease, particularly rigid personal precautions by at- 
tendants. 
3. Concurrent disinfection: Bowel discharges. 
4. Terminal disinfection; Cleaning. 
5. Quarantine: None. 
6. Immunization: Vaccines may give some immunity. Owing to 
severe reactions their use is not recommended, nor should vacci- 
nation be made compulsory except under extreme emergency. 
7. Investigation of source of infection: Search for a common source 
in contaminated food and water, and for carriers particularly 
among food handlers, should be undertaken as in the case of 
typhoid fever. 
B. General measures: 
1. Protection and purification of public water supplies, together 
with prevention of subsequent contamination. 
2. Pasteurization of public milk supplies; use of boiled milk for 
infant feeding. 
3. Supervision of preparation and handling of other foods, particularly 
those which are moist and eaten raw. 
4. Hand washing, by food handlers in particular, following use of 
toilet. 
5. Prevention of fly-breeding; screening. 
6. Sanitary disposal of human excreta. HYGIENE AND SANITATION 
403 
7. Persons known to be infected, and their attendants, should he 
excluded from handling food for public consumption, and from 
handling the family food supply if possible. 
8. The exercise of rigid precautions in known cases of bacillary dysen- 
tery is requisite but is inadequate as a safeguard against the 
ever-present risk of infection from concealed sources. Reduction 
of high infant mortality rates is dependent upon prevention of 
diarrhoea and enteritis. Infant hygiene, including breast feeding, 
scrupulous cleanliness at all times in the preparation and han- 
dling of food for children, and continuous attention to diet in 
order to avoid minor digestive disturbances that may lower 
resistance to the infection will do much toward accomplishing 
this aim. As a precautionary measure, all cases of infantile 
diarrhoea should be regarded as bacillary dysentery. Prevention 
of epidemics of bacillary dysentery by guarding against massive 
dissemination of infection should be a major concern, particularly 
in prisons, camps, and institutions. 
Ancylostomiasis (Hookworm disease). 
1. Recognition of the disease.-—Light degrees of infestation may produce no 
striking clinical symptoms, although some degree of secondary anaemia and 
slight interference with bodily and mental development may be noted. A 
medium degree of infestation shows marked anaemia and, if before puberty, 
definite physical and mental retardation, and a dry dirty-yellow skin. 
Severe infestations may show petechiae and atrophy of the skin, oedema, 
general or of dependent parts, extreme anaemia, anxious, stupid expression, 
prominent abdomen. The diagnosis is definitely established by finding 
ancylostoma ova in the stools, by smear or flotation methods. 
2. Etiological agent.—In the United States, Necator americanus, rarely Ancy- 
lostoma duodenale. 
3. Source of infestation.—Faeces of infested persons. Infestation generally takes 
place through the skin, occasionally by the mouth. 
4. Mode of transmission.—The larval forms pierce the skin, usually of the foot, 
and, passing through the lymphatics to the vena cava and the right heart, 
thence in the blood stream to the lungs, they pierce the capillary walls and 
pass into the alveoli. They then pass up the bronchi and trachea to the 
throat, whence they are swallowed and finally lodge in the small intestine. 
Also by drinking water containing larvae, by eating soiled food, by hand-to- 
mouth transmission of the eggs or larvae from objects soiled with infested 
discharges. The chief reservoir of infectious material is contaminated soil. 
5. Incubation period.—No incubation period occurs comparable to that observed 
in bacterial and virus infections. Onset of symptoms varies widely in 
time, according to the intensity of the infestation, from 2 to 3 weeks in 
massive infestations (commonly 7 to 10 weeks), to many months or even 
years where infestation or reinfestation is by small numbers of worms. 
The free living form may exist in the soil under favorable conditions for 
several weeks. Eggs are found in the stools in about 4 to 6 weeks after 
the larvse penetrate the skin, and develop the next generation of larvae 5 
to 8 days after being deposited on soil, under favorable conditions. 
6. Period of communicability.—As long as the parasite or its ova are found 
in the bowel discharges of an infested individual. Contaminated soil may 
remain infective for 5 months in the absence of freezing. An individual 
can communicate the disease to others only by the indirect method of 
pollution of the soil with his faeces. As long as mature female worms are 404 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
in the Intestine, eggs, if deposited in the faeces in warm moist soil, become 
sources of infestation, especially where the soil is sandy. 
7. Susceptibility and immunity.—Susceptibility to infestation is universal, 
although among adults, especially Negroes, infestations are likely to be less 
heavy than among children and in the white races. Immunity does not 
develop after infestation. 
8. Prevalence.—Endemic widely throughout those climatic belts where frost 
does not last more than 6 weeks in the year, and particularly where the 
soil is sandy. In rural areas of the Southern States of the United States, 
particularly among white children of school age; less commonly and less 
severely among Negro children. Damp summer weather increases the prev- 
alence of infestation. During the past two decades there has been some 
decrease in prevalence and severity of the disease in continental United 
States. Prevalence is high in Puerto Rico. 
9. Methods of control: 
A. The infested individual, contacts, and environment: 
1. Recognition of the disease and reporting: Microscopic examination 
of bowel discharges. 
2. Isolation: None. 
3. Concurrent disinfestation: Sanitary disposal of bowel discharges to 
prevent contamination of soil and water. 
4. Terminal disinfestation: None. 
5. Quarantine: None. 
6. Immunization: None. 
7. Investigation of source of infestation: Each case and carrier is a 
potential or actual spreader of the disease and should be brought 
under treatment and his family contacts examined. 
8. Treatment; Appropriate treatment of infested persons with carbon 
tetrachloride, oil of chenopodium, or tetra-chlor-ethylene, to rid 
the intestinal canal of the parasite and its ova. 
B. General measures: 
1. Education as to dangers of soil pollution and methods of pre- 
vention. 
2. Prevention of soil pollution by installation of sanitary disposal 
system for human discharges, especially sanitary privies in rural 
areas. 
3. Personal prophylaxis by cleanliness and the wearing of shoes. 
Paratyphoid fever. 
1. Recognition of the disease.—A general infection with the paratyphoid bacil- 
lus characterized especially by continued fever and involvement of the 
lymphoid tissues in the intestine, enlargement of the spleen, and a variety 
of constitutional symptoms, sometimes rose spots on the trunk, usually 
diarrhoeal disturbance. The infecting microorganism may be found in the 
faeces, blood, and urine. This disease should not be confused with food 
poisoning or with infection due to enteritidis bacilli of animal origin. 
2. Etiological agent.—Salmonella paratyphi (Paratyphoid bacillus A) ; Salmon- 
ella shottmiilleri (Paratyphoid bacillus B). 
3. Source of infection.—Bowel discharges and urine of infected persons, and 
water or foods contaminated with such discharges of infected persons or 
of healthy carriers. Healthy carriers may be numerous in an outbreak. 
4. Mode of transmission.—Directly by personal contact: indirectly by contact 
with articles freshly soiled with the discharges of infected persons or through 
milk, water, or food contaminated by such discharges, probably by flies. HYGIENE AND SANITATION 
405 
5. Incubation period.—Four to ten days; average, seven days. 
6. Period of communicability.—From the appearance of prodromal symptoms, 
throughout the illness and relapses, during convalescence, and until re- 
peated bacteriological examination of discharges shows absence of the 
infecting organism. 
7. Susceptibility and immunity.—Susceptibility is general. Natural immunity 
probably exists in some adults. Acquired immunity is usually permanent 
after recovery from the disease. Artificial active immunity of probably 2 
years’ duration can be developed by the use of vaccines. 
8. Prevalence.—Frequency has fallen with that of typhoid fever until in most 
parts of North America it is relatively rare, occurring sporadically or in 
small local carrier or contact epidemics. Probably nowhere endemic in 
North America. 
9. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting: Clinical symptoms 
confirmed by specific agglutination test, or by bacteriological 
examination of blood, bowel discharges, or urine. 
2. Isolation: In fly-proof room, preferably under hospital conditions, 
of such cases as cannot command adequate sanitary environ- 
ment and nursing care in their homes. 
3. Concurrent disinfection; Disinfection of all bowel and urinary 
discharges and articles soiled with them. 
4. Terminal disinfection; Cleaning. 
5. Quarantine: None. 
6. Immunization: Of exposed susceptibles. 
7. Investigation of source of Infection: Search for common source in 
polluted water, milk, shellfish or other food, and individual 
sources as unreported cases and carriers. 
B. General measures: 
1. Protection and purification of public water supplies. 
2. Pasteurization of public milk supplies. 
3. Limitation of collection and marketing of shellfish to those from 
approved sources. 
4. Supervision of other food supplies, and of food handlers. 
5. Prevention of fly breeding. 
6. Sanitary disposal of human excreta. 
7. Extension of immunization by vaccination to persons especially 
subject to exposure by reason of occupation and travel,, to 
those living in areas of high endemic incidence of typhoid fever 
and to those for whom the procedure can be systematically and 
economically applied, as military forces and institutional popu- 
lations, depending on prevalence of the disease. 
8. Discovery and supervision of partyphoid carriers and their ex- 
clusion from the handling of foods. 
9. Exclusion of suspected milk supplies on epidemiological evidence 
pending discovery and elimination of the personal or other cause 
of contamination of the milk. 
10. Exclusion of suspected water supplies until adequate protection 
or purification is provided unless all water used for toilet, cook- 
ing, and drinking purposes is boiled before use. 406 
HANDBOOK OF THE HOSPITAL CORPS, XJ. S. NAVY 
Typhoid fever. 
1. Recognition of the disease.—A general infection with the typhoid bacillus, 
characterized by a continued fever, and by involvement of the lymphoid 
tissues especially with enlargement and often ulceration of Peyer’s patches, 
enlargement of the spleen,, usually rose spots on the trunk, diarrhoeal dis- 
turbance, and a variety of severe constitutional disturbances accompanying 
parenchymatous involvement of various viscera. The infecting micro- 
organism can be found in the blood, the faeces, and the urine. 
2. Etiological agent.—Eberthella typhosa (Bacillus typhosus). 
3. Source of infection.—Bowel discharges and urine of infected individuals. 
Healthy carriers are common. 
4. Mode of transmission.—Conveyance of the specific microorganism by direct 
or indirect contact with a source of infection. Among indirect means of 
transmission are contaminated water, milk, and shellfish, and probably flies. 
5. Incubation period.—From 3 to 38 days, usually 7 to 14 days. 
6. Period of communicability.—From the appearance of prodromal symptoms, 
throughout the illness and relapses during convalescence, and until repeated 
bacteriological examinations of the discharges show continuous absence of 
the infecting organism. 
7. Susceptibility and immunity.—Susceptibility is general. Natural immunity 
exists to some extent in adults. Acquired immunity of permanent duration 
usually follows recovery from the disease. Artificial active immunity of 
probably 2 years’ duration can be developed by the use of typhoid vaccine. 
8. Prevalence.—Widespread throughout the world regardless of race, age, sex, 
climate, or geography. Formerly in most large cities of North America 
and in many extensive rural areas in endemic and epidemic form, and still 
endemic in some rural areas of the southern United States but commonly 
now occurring in sporadic cases and as small contact and carrier epidemics. 
Steadily falling in incidence, particularly in all urban areas supplied with 
water of a sanitary quality and pasteurized milk, and where human faecal 
waste is disposed of without polluting water supplies, food, or surface of 
the soil. 
9. Methods of control: 
A. The infected individual, contacts, and environment 
1. Recognition of the disease and reporting: Clinical symptoms con- 
firmed by specific agglutination test and bacteriological exam- 
ination of blood, bowel discharges, or urine. 
2. Isolation: In fly-proof room, preferably under hospital conditions, 
of such cases as cannot command adequate sanitary environment 
and nursing care in their homes. Release from isolation should 
be determined by two successive negative cultures of stool and 
urine specimens collected not less than 24 hours apart. 
3. Concurrent disinfection: Disinfection of all bowel and urinary 
discharges and articles soiled with them. 
4. Terminal disinfection: Cleaning. 
5. Quarantine: None. 
6. Immunization: Of susceptibles in the family or household of the 
patient who have been exposed or may be exposed during the 
course of the disease. 
7. Investigation of source of infection: The actual or probable source 
of infection of every case should be determined by searching for 
common and individual sources: 1. Polluted water, milk, shell- 
fish, and other food supplies; 2. Unreported cases and carriers. HYGIENE AND SANITATION 
407 
B. General measures: 
1. Protection and purification of public water supplies. 
2. Pasteurization of public milk supplies. 
3. Limitation of collection and marketing of shellfish to those from 
approved sources. 
4. Sanitary disposal of human excreta. 
5. Supervision of other food supplies, and of food handlers. 
6. Prevention of fly breeding. 
7. Extension of immunization by vaccination to persons subject to 
unusual exposure by reason of occupation or travel, to those 
living in areas of high endemic incidence of typhoid fever and to 
those for whom the procedure can be systematically and eco- 
nomically applied, as in the military forces and institutional 
populations. 
8. Discovery and supervision of such typhoid carriers, and their ex- 
clusion from the handling of foods, as epidemiological and bac- 
teriological evidence indicate are of importance. 
9. Exclusion of suspected milk supplies on epidemiological evidence 
pending discovery and elimination of the cause of contamination 
of the milk. 
10. Exclusion of suspected water supply, until adequate protection or 
purification is provided unless all water used for toilet, cooking, 
and drinking purposes is boiled before use. 
11. Education of the general public and particularly of food handlers, 
concerning the sources of infection, and modes of transmission of 
the disease. 
12. Instruction of convalescents and chronic carriers in personal hy- 
giene, particularly as to sanitary disposal of faecal waste, and 
handwashing after use of toilet, and restraint from acting as 
food handlers. 
GROUP III. DISEASES TRANSMITTED BY INSECTS. AND OTHER 
ARTHROPODS 
Dengue. 
Malaria. 
Plague. 
Typhus fever. 
Yellow fever. 
Others, not here discussed : 
Filariasis. 
Others, not here discussed—Continued. 
Leishmaniasis. 
Relapsing fever. 
Rocky Mountain fever. 
Trench fever. 
Tsutugamuchi fever. 
Tularaemia. 
Dengue. 
1. Recognition of the disease.—An acute febrile infection of sharp onset with 
two paroxysms, of short duration. Intense headache, joint and muscle 
pains, and irregular eruption are usual. 
2. Etiological agent.—A specific filtrable virus. 
3. Source of infection.—The blood of infected persons, during first 3 days of the 
disease. 
4. Mode of transmission.—By the bite of infected mosquitoes, Aedes cegypti, from 
11 days after biting a patient during the first 5 days of the disease, until the 
death of the mosquito. 
5. Incubation period.—Three to 10 days. 
6. Period of communicability.—From the day before onset to the fifth day of the 
disease. Degree of communicability depends on prevalence of infected 
humans and abundance of Aedes cegypti mosquitoes. 408 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVA 
7. Susceptibility and immunity.—'Susceptibility apparently universal. Acquired 
immunity may last a few months to a year. After several attacks an 
almost complete immunity is developed. 
8. Prevalence.—Occurs only where the Aedes a’.gypti mosquito exists, mainly in 
tropics and subtropics. When occurring in epidemic form in the United 
States, begins usually in southernmost States, moving north until the range 
of the vector mosquito is stopped by climate or the season of the year. 
Common, and in frequent epidemics, in the Philippines. Occurs equally 
among males and females; less among indigenous than among visiting or 
transient whites where the disease commonly occurs. 
9. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting. 
2. Isolation; The patient must be kept in a screened room. 
3. Concurrent disinfection: None. 
4. Terminal disinfection: None. 
5. Quarantine: None. 
6. Immunization: None. 
7. Investigation of source of infection: Search for unreported or un- 
diagnosed cases and for the Aedes cegypti mosquito and its 
breeding places. 
H. General measures: Measures directed toward elimination of mosquitoes 
(Aedes cegypti). Screening of rooms. 
Malaria. 
1. Recognition of the disease.—A group of specific infectious fevers due to in- 
vasion of the red blood cells by 1 of at least 3 types of Sporozoa of the 
genus Plasmodium. These fevers occur endemically or epidemically and 
are associated with a symptom complex fairly characteristic of each variety, 
marked particularly by periodicity of fever and symptoms due to the 
growth and development of the organism. Enlargement of the spleen, 
secondary anaemia, and the characteristic recurrence of chills and fever as 
clinical findings are confirmed by observing presence of the malaria para- 
sites in blood film on microscopic examination. Mosquitoes of anopheline 
family are the only known vectors. 
2. Etiological agent.—The several species of microorganisms: Plasmodium vivax, 
causing benign tertian malaria, Plasmodium falciparum, causing malignant 
tertian (wstivo-autumnal) malaria, and Plasmodium malariae (causing 
quartan malaria). 
3. Source of infection.—The blood of an infected individual. 
4. Mode of transmission.—By the bite of infected Anopheles mosquitoes. The 
mosquito is infected by biting an individual suffering from acute or chronic 
malaria. The parasite develops in the body of the mosquito for from 10 to 
14 days (21 days for quartan), after which time the sporozoites appear in 
its salivary glands. 
5. Incubation period.—Varies with the type of species of infecting microorganism 
and the amount of infection, usually 14 days in the tertian variety. 
6. Period of communicability.—As long as the sexual form of the malaria micro- 
organism exists in the circulating blood in sufficient quantities to infect 
mosquitoes. In untreated cases this may last for months. 
7. Susceptibility and immunity.—Susceptibility is universal. Negroes appear 
to suffer less severely from the disease. Some relative immunity appears 
to follow repeated attacks of the disease. A state of good nutrition is be- HYGIENE AND SANITATION 
409 
lieved to be a factor in maintaining resistance to the disease and in 
spontaneous recovery. 
8. Prevalence.—Endemic and sporadic, occurring more frequently among chil- 
dren than adults, and more among Negroes than among whites. Particular- 
ly prevalent in the southeast coastal plain, Mississippi Valley, south of St. 
Louis, in eastern Texas, New Mexico, Louisiana, Arkansas, southern Mis- 
souri, and slightly in California and Oregon. Serious in Puerto Rico and 
the Philippines. Seasonal occurrence of tertian type in early summer, 
sestivo-autumnal in early fall. 
9. Methods of control: 
A. The infected individual, contacts and environment: 
1. Recognition of the disease and reporting: Clinical symptoms, al- 
ways to be confirmed by microscopical examinatipn of the 
blood. Repeated examination of blood films may be necessary. 
2. Isolation: The individual with malarial parasites in his blood 
should be protected from the bites of ‘mosquitoes. With the 
exception of this simple precaution, isolation and quarantine are 
of no avail. 
3. Concurrent disinfection; None. Destruction of Anopheles mos- 
quitoes in the sick room. 
4. Terminal disinfection: Destruction of Anopheles mosquitoes in the 
sick room 
5. Quarantine: None. 
6. Immunization: None. The administration of prophylactic doses 
of quinine should be insisted on for those constantly exposed to 
infection and unable to protect themselves against Anopheles 
mosquitoes. This is not in an exact sense prophylaxis but early 
therapeusis. 
7. Specific therapy: Quinine bisulfate is preferred for routine 
treatment and “atebrin” is found by some to be equally reliable. 
Plasmochin seems to be specific for destruction of the adult 
sexual form of the parasite in sestivo-autumnal malaria and in 
conjunction with quinine for tertian and quartan infections. 
8. Investigation of source of infection: Breeding places and house 
infestation by Anopheles mosquitoes should be sought for and 
larvse and mosquitoes destroyed when and where possible. Car- 
riers of the malarial microorganism, untreated, or inadequately 
treated, should be sought and brought under systematic therapy 
until the microorganism can no longdr be found in their blood. 
B. General measures. 
1. Employment of known measures for destroying larvse of anophe- 
lines and the eradication of breeding places of such mosquitoes. 
2. Blood examination of persons living in infected centers to deter- 
mine the incidence of infection. 
3. Screening sleeping and living quarters: use of mosquito nets. 
4. Killing mosquitoes in living quarters. 
5. Education of the public as to the mode of spread and methods of 
prevention of malaria. ' 
Plague (bubonic, septicasmic, pneumonic). 
1. Recognition of the disease.—An acute infection running a rapid, severe 
course, often terminating fatally, and characterized by extreme weakness, 
high fever, buboes, severe general symptoms, and often accompanied by 410 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
subcutaneous haemorrhage and pustules. The infecting microorganism is 
regularly found in the buboes and skin lesions, and in the pneumonic type 
of the disease in the sputum. Pneumonic plague gives the picture of a 
virulent septic pneumonia. 
2. Etiological agent.—Pasturella pestis (Bacillus pestis). 
3. Source of infection.—Blood of infected rodents and, in the pneumonic form, 
the sputum of human cases. The primary or indigenous source of the 
disease is the so-called “wild-plague”, the animal reservoir among such 
rodents as the tarbigan of Manchuria, and the ground squirrel of Califor- 
nia. Infection may reach man from these sources, or more often through 
the medium of the rat. 
4. Mode of transmission.—Direct, in the penumonic form. In other forms the 
disease is generally transmitted by the bites of fleas (Xenopsylla cheopis 
and Ceratophyllus fasciatus), by which the disease is carried from rats 
to man, also by fleas from other rodents. Accidental, by inoculation. 
5. Incubation period.—Commonly from 3 to 7 days, although occasionally pro- 
longed to 8 or even 14 days. 
6. Period of communicability.—Pneumonic type intensely communicable during 
acute symptoms. Bubonic type not communicable from person to person. 
7. Susceptibility and immunity.—Susceptibility is general, particuarly to the 
pneumonic form. Natural immunity may exist but is rare. Lasting im- 
munity almost always results from recovery from an attack of the disease. 
Artificial passive immunity of about 3 to 4 weeks’ duration by antiplague 
serum, and active immunity of about 6 months’ duration by vaccines may 
be relied upon. 
8. Prevalence.—Very rare in North America and insular possessions, and only 
sporadic cases, from exposure to infection to ground squirrels in California. 
Endemic in ground squirrels in large areas on Pacific Coast. Occasionally 
found in rats trapped at seaports. 
9. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting: Clinical symptoms, con- 
firmed by bacteriological examination of blood, pus from glan- 
dular lesions, or sputum. Animal inoculation of material from 
suspected cases. 
2. Isolation: Patient in hospital if practicable; if not, in a screened 
room which is free from vermin.3 
3. Concurrent disinfection: Sputum and articles soiled therewith, 
in pneumonic type of the disease. 
4. Terminal disinfection: Thorough cleaning followed by fumigation 
to destroy rats and fleas. 
5. Quarantine: Contacts of pneumonic cases for 7 days. 
6. Immunization: Ordinarily not practicable. 
7. Investigation of source of infection: Search for human (in pneu- 
monic) and rodent (in bubonic) sources to which patient is 
known to have been exposed, among wild rodents, and particu- 
larly the rat. 
3 In plague pneumonia, personal prophylaxis to avoid droplet infection must be carried 
out by persons who come in contact with the sick. Masks of closely woven cloth with 
mica windows should be worn over the head and to the- shoulders. A long gown and 
rubber gloves drawn over the sleeves of the gown should be provided. These articles 
should not be removed from the sick room until disinfected. 411 
HYGIENE AND SANITATION 411 
B. General measures: 
1. Extermination of rats and vermin by use of known methods for 
their destruction; destruction of rats on ships arriving from 
infected ports; examination of rats, ground squirrels, etc., in 
areas where the infection persists, for evidence of endemic or 
epidemic prevalence of the disease among them. 
2. Rat-proofing of buildings and elimination of breeding places and 
opportunities for the harboring and feeding of rats as a funda- 
mental sanitary measure. 
3. Investigation of all deaths during epidemics with autopsy and 
laboratory examination when indicated. 
4. Handling of corpse under antiseptic precautions. 
Typhus fever. 
1. Recognition of the disease.—Whether in the classical and severe epidemic 
form of the louse-transmitted disease or in the mild flea-borne and sporadic 
type, the onset is variable, often being sudden and marked by headache, 
chills, fever, and general pains, and a macular eruption on the fifth or 
sixth day, toxaemia, and a quite definite course terminating in rapid lysis 
after 12 to 21 days. A positive Weil-Felix reaction is valuable as con- 
firmation of the diagnosis. 
2. Etiological agent.—Rickettsia prowazeki, Rickettsia quintana, and provision- 
ally, Rickettsia mooseri. 
3. Source of infection.—The only known source is the blood of infected persons 
or infected rats. 
4. Mode of transmission.—The infectious agent is transmitted from man to 
man by lice (Pediculus humanus var. corporis) and from rat to rat or 
man by fleas (Xenopsylla cheopis). 
5. Incubation period.—From 5 to 20 days, most often 12 days. 
6. Period of communicability.—In the presence of lice, highly communicable 
until 36 hours have elapsed after the temperature reaches normal. 
7. Susceptibility and immunity.—Susceptibility is general. One attack confers 
immunity, which is not always permanent. 
8. Prevalence.—Widespread. Flea-borne typhus predominantly in late sum- 
mer and fall; louse-borne predominantly in winter and spring. The case 
fatality of flea-borne typhus is 2 per cent, and of louse-borne typhus 20 
to 40 per cent. 
9. Methods of control: 
A. The infected individual, contacts and environment: 
1. Recognition of the disease and reporting: Cases should be promptly 
reported to the health authorities. 
2. Isolation: In a vermin-free room. 
3. Concurrent disinfection: Destroy all lice and louse eggs on the 
clothing or in the hair of the patient. 
4. Terminal disinfection: None. 
5. Quarantine: In the presence of lice, exposed susceptibles should 
be quarantined for 14 days after last exposure. 
6. Immunization: Methods not yet available for general application. 
7. Investigation of source of infection: Particular attention should 
be paid to patient’s contact with rats, and with louse-infected 
persons or clothing. 
R. General measures: The elimination of rats. 
C. Epidemic measures: Delousing of persons, clothing, and premises. 
154294°—39 27 412 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Yellow fever. 
1. Recognition of the disease.—Clinical diagnosis usually rests upon sudden 
onset, fever, prostration, slow pulse in relation to body temperature, severe 
headache and backache, congestion of mucous membranes, black vomit, 
bleeding gums, and late jaundice, with brief duration of illness. Pro- 
nounced albuminuria and leucopenia are characteristic. A history of possi- 
ble bites of infected mosquitoes is corroborative but absence of such or 
even failure to find Aedes cegypti mosquitoes in the vicinity does not 
necessarily exclude the diagnosis. Almost symptomless and certainly un- 
recognizable cases of this infection occur among Negro races in Africa. 
2. Etiological agent.—A specific filtrable virus. 
3. Source of infection.—The blood of infected persons. 
4. Mode of transmission.—By the bite of infected Aedes cegypti mosquitoes, 
and of a few allied species. (It is not yet certain that some other suctorial 
insect may not be capable of acting as the transmitter.) 
5. Incubation period.—Three to six days, rarely longer. 
6. Period of communicability.—First 3 days of the fever, possibly 4. High 
degree of communicability where infected mosquitoes abound and there 
are many susceptible persons. 
7. Susceptibility and immunity—Recovery from an attack of the disease is 
regularly followed by immunity, apparently for life. There is no natural 
immunity. Artificial immunity may be developed by the use of con- 
valescent serum. The duration of this is brief. Artificial active immunity 
may be developed by the use of modified living virus and human immune 
serum. The duration of this is uncertain but it apparently lasts for sev- 
eral years. 
8. Prevalence.—Very rare in North America and insular possessions. Not 
known in the Pacific Basin.- No case in North America or Puerto Rico for 
many years. 
9. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting: Clinical symptoms. 
2. Isolation: Isolate from mosquitoes in a special hospital ward 
or thoroughly screened room. It is necessary that the room 
or ward should be freed from mosquitoes by fumigation, trap- 
ping, or highly responsible collection and destruction of the 
insects. Isolation necessary only for the first 4 days of the 
fever. 
3. Concurrent disinfection: None. 
4. Terminal disinfection: None, except for the purpose of destroying 
mosquitoes in the house occupied by the patient and in the 
nearest neighboring dwellings, usually best by gaseous 
fumigation. 
5. Quarantine: None. 
6. Immunization: None. 
7. Investigation of source of infection: Human carriers are not 
known to exist. Search for undiscovered mild and unreported 
cases of illness resembling yellow fever, and systematic testing 
of immunity in groups related in time and proximity to the 
case in question are of epidemiological importance. Search for 
the Aedes cegypti mosquito and other species believed to be 
capable of transmitting the infection should be particularly 413 
HYGIENE AND SANITATION 
thorough in the vicinity of places of residence, work, or travel 
of known cases of the disease. 
B. General measures: 
1. Eliminate breeding of Aedes cegypti mosquito throughout the 
community by organized service of inspection and sanitary 
control. 
2. An inspection service for discovery of those ill with the disease 
is desirable whether the disease occurs in the classical, mild, 
or atypical form. 
GROUP IV. DISEASES TRANSMITTED BY DIRECT CONTACT 
Scabies. 
Venereal diseases. 
Ring worm. 
Others, not discussed here : 
Impetigo contagiosa. 
Yaws. 
Scabies (itch). 
1. Recognition of the disease.—Observation of the characteristic interdigital 
burrows of the itch mite, its identification under a hand lens, or of the 
eggs scraped from the burrows. 
2. Etiological agent.—Sarcoptes scabiei, the itch mite. 
3. Source of infestation.—Persons harboring the itch mite on their skin in 
burrows, particularly between the fingers. 
4. Mode of transmission.—Direct contact with infested persons and indirectly 
by use of underclothing, gloves, bedding, etc., of such persons. 
5. Incubation period.—Merely the length of time for the itch mite to burrow 
under the skin and lay eggs and start the itching and scratching, all of 
which may occur within 24 to 48 hours of original infestation. 
6. Period of communicability.—Until the itch mites and the eggs are destroyed. 
7. Susceptibility and immunity.—These terms are not appropriate to this con- 
dition. Anyone may become infested and immediately reinfested. 
8. Prevalence.—Wide-spread and occurring sporadically and in epidemics, es- 
pecially where there is a low level of bodily cleanliness and neglect of 
personal and clothing hygiene. 
9. Methods of control: 
A. The infested individual, contacts, and environment: 
1. Recognition of the disease and reporting; The condition should 
be reported to the school authorities if discovered in school 
children. 
2. Isolation: Children should be excluded from school until disin- 
fested. Persons should be denied common recreation and bath- 
ing facilities while infested. 
3. Concurrent disinfestation: Care of body clothing and bedding 
until free from the infestation. 
4. Terminal disinfestation: Underclothing and bed covering to be 
so treated by dry heat or washing as to destroy the mite and 
the eggs. 
5. Quarantine: None. 
6. Investigation of source of infestation: Search for unreported or 
unrecognized cases in companions or house or family mates of the 
infested individual. 
B. General measures: Cleanliness of body and underclothing and bed cover- 
ing especially. 414 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Chancroid. 
1. Infectious agent: Haemophilus ducreyii (Bacillus of chancroid). 
2. Source of infection: Pus and secretion from the chancroid itself. 
3. Mode of transmission■: By direct contact with infected persons. Almost 
invariably through sexual intercourse. Possibly in other ways. Indirectly 
as mentioned under syphilis. 
4. Incubation period: Usually within 5 days; always within 10 days. 
5. Period of communicability: During continuance of specific organism and 
lesion. 
6. Method of control: 
(A) The infected individual and his environment—Same as for syphilis. 
(B) General measures—Same as for syphilis. 
Gonorrhoea. 
1. Recognition of the disease.—Occurring initially as an infection of one of the 
mucous membranes, most frequently of the genital tract, urethra in the 
male, the vaginal or uterine mucosa in the female, the disease develops as 
an acute or chronic process in adjacent or remote tissues, among the latter 
especially as arthritis and endocarditis. Relapsing and chronic inflamma- 
tory discharging condition at the site of original attack are common. 
Demonstration of the etiological agent in the lesions or discharges is the 
best and only certain diagnostic procedure. Specific antibodies may he 
demonstrated, and specific constitutional and local reactions can be 
provoked. 
2. Etiological agent.—Neisseria gonorrhoea (Gonococcus). 
3. Source of infection.—Discharges from lesions of inflamed mucous membranes 
and glands of infected persons, viz., urethral, vaginal, cervical, conjunctival 
mucous membranes, and Bartholin’s or Skene’s glands in the female and 
Cowper’s and the prostate glands in the male. 
4. Mode of transmission.—By direct personal contact with infected persons and 
indirectly by contact with articles freshly soiled with the discharges of 
such persons. In adults by sexual intercourse; in children by other per- 
sonal and indirect contact with discharges. 
5. Incubation period.—One to 8 days, usually 3 to 5 days. 
6. Period of communicability.—As long as the gonococcus persists in any of the 
discharges, whether the infection be an old or a recent one. Readily com- 
municated in sexual intercourse. 
7. Susceptibility and immunity.—Susceptibility appears to he general, particu- 
larly of vaginal tract in young girls, and of conjunctiva in newborn. Ac- 
quired immunity does not occur generally, but some degree of transient 
local immunity may appear during infection. One attack and recovery does 
not protect against subsequent infection. 
8. Prevalence.—Wide-spread in both sexes and at all ages, but most common 
among men from 18 to 40 years of age and among women at a little earlier 
age. Endemic, sporadic, and epidemic. 
9. Method of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting; Clinical symptoms, con- 
firmed by bacteriological examination or serum reaction. 
2. Isolation: When the lesions are in the genito-urinary tract, exclu- 
sion from sexual contact, and when the lesions are conjunctival 
exclusion from school or contact with children, as long as the 
discharges contain the gonococcus. HYGIENE AND SANITATION 
415 
3. Concurrent disinfection; Discharges from lesions and articles 
soiled therewith. 
4. Terminal disinfection: None. 
5. Quarantine: None. 
6. Immunization: None. 
7. Investigation of source of infection: Each acute case should be 
traced to probable source of infection and appropriate control 
and treatment of this spreader of disease instituted. Males 
may continue to be carriers for a year or more; females for 2 to 
3 years. 
B. General measures; 
1. Provision of accurate and early diagnosis, and careful treatment 
of infected persons, with due consideration for privacy of record, 
consistent with effective control of the patient, search for source 
of infection, and provision for following cases until cured. 
2. Education in matters of sexual hygiene, particularly as to the 
fact that continence in both sexes at all ages is compatible with 
health and normal development. 
3. Repression of commercialized prostitution, and associated use of 
alcoholic beverages, by police or other competent authority. 
4. Restriction of advertising of services or medicines for the self 
treatment of sex diseases, etc. 
5. Elimination of common towels and toilet articles from public 
places. 
6. Use of prophylactic silver solution in the eyes of the newborn. 
7. Personal prophylaxis should be advised to those who expose them- 
selves to opportunity for infection, and made available for use 
immediately after sexual intercourse. 
8. Exclusion of persons in the communicable stage of the disease 
from occupations involving contact with children. 
Lymphogranuloma venereum (inguinale) and Climatic bubo. 
1. Recognition of the disease.—Adenopathy, inguinal in male, pelvic in female, 
and history of exposure to venereal infection in tropics (climatic bubo) or 
in temperate climates. Natural infection limited to human beings, but 
experimentally transmissible to monkeys and mice, less readily to other 
species. Characterized by small herpetiform lesion of inoculation on exter- 
nal genitalia or uterine mouth (rarely in it), often transitory, followed by 
subacute or chronic adenitis and periadenitis, usually with multiple foci of 
suppuration; associated with constitutional symptoms, fever, prostration, 
loss of weight, rheumatic affections, and skin reactions. Clinical diagnosis 
may be confirmed by Frei antigen intradermal test. 
2. Etiological agent.—A specific filtrable virus. 
3. Source of infection.—Discharges from lesions. 
4. Mode of transmission.—Direct contact by skin and mucous membranes, 
almost exclusively in sexual relations with infected persons, or indirectly 
by articles soiled with discharges from the lesions of such persons. 
5. Incubation period.—One to four weeks. Glandular enlargement follows the 
initial lesion in 1 or 2 weeks. 
6. Period of communicability.—As long as there are open lesions upon skin or 
mucous membranes. 
7. Susceptibility and immunity.—Susceptibility appears to be general. Immu- 
nity apparently does not follow an attack of the disease. There is no 
artificial immunity. 416 
HANDBOOK OF THE HOSPITAL COUPS, H. S. NAVY 
8. Prevalence.—Has been known for many years as an occasional venereal 
infection in the Negro quarters of cities in the United States and more 
commonly in tropical possessions. Is still a rare disease in northern cities 
and among whites. Widely prevalent in the tropics and common among 
inmates and clients of brothels in tropical seaports. 
2. Methods of control: 
A. The infected individual, contacts, and environment; 
1. Recognition of the disease and reporting: Clinical symptoms. 
2. Isolation: Exclusion of infected person from sexual contacts and 
from preparation and serving of food during period of com- 
municability. 
3. Concurrent disinfection: Discharges and articles soiled therewith. 
4. Terminal disinfection: None. 
5. Quarantine: None. 
6. Immunization: None. 
7. Investigation of source of infection: Search should be made for 
case of origin, particularly among prostitutes and among persons 
of Negro race, and of former residence in tropical and subtropical 
areas. 
B. General measures: 
1. Education in matters of sexual hygiene, particularly as to the fact 
that continence in both sexes and at all ages is compatible with 
health and normal development. 
2. Repression of commercial prostitution and associated use of alco- 
holic beverages by use of police and other competent authority 
and control of living premises. 
3. Elimination of the use of common towels, cups, toilet articles, and 
eating utensils. 
4. Exclusion of persons in the communicable state of the disease from 
participation in the preparing and serving of food. 
5. Personal prophylaxis should be advised and made available for 
use immediately after sexual intercourse to those who expose 
themselves to opportunity to infection. 
Syphilis. 
1. Recognition of the disease.—A disease acquired by contact or transmission in 
utero, running a chronic course with local and constitutional manifesta- 
tions, usually in a definite sequence although of infinite variety. The lesion 
is an infectious granuloma, similar to that seen in tuberculosis and leprosy, 
in the acquired disease usually on mucous or muco-cutaneous area of sexual 
contact. Confirmation of diagnosis is practicable and should be established 
in every instance by finding the spirochsete in the lesions or discharges or by 
positive serological findings. 
2. Etiological agent.—Treponema pallidum (Spirochceta pallida). 
3. Source of infection.—Discharges from the lesions of the skin and mucous 
membranes, the blood of infected persons, and articles freshly soiled with 
such discharges or blood in which the Treponema pallidum is present. 
4. Mode of transmission.—By direct personal contact with infected persons and 
indirectly by contact with discharges from lesions or with the blood of such 
persons, by sexual intercourse chiefly, by kissing, by dental and other sur- 
gical or technical accidents, congenitally from syphilitic mother through 
the placenta. 
5. Incubation period.—About 3 weeks, minimum 10 days, occasionally 6 weeks 
or longer. HYGIENE AND SANITATION 
417 
6. Period of communicability.—As long as the lesions are open upon the mucous 
membranes or skin, but practically limited to the first 2 years of the 
disease. 
7. Susceptibility and immunity.—Susceptibility is universal, especially when 
moist surfaces of infected and exposed persons are brought into direct 
contact. Natural or acquired immunity is not known to exist. One attack 
and recovery does not protect against subsequent infection. 
8. Prevalence.—Widespread in all regions of the world, regardless of race, cli- 
mate, or geography, or of sex or age. Prevalence varies from less than 
one-half of 1 per cent to 80 per cent and over of local population groups, 
averaging probably about 5 per cent of all the people of North America. 
Occurs in sporadic, local, or group epidemic, and commonly endemic form. 
Most commonly acquired by unmarried males between 20 and 40 years of 
age. Occurs in about 10 per cent of all pregnant women. Most frequent 
among Negroes. 
9. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting: Clinical symptoms, con- 
firmed by microscopical examination of discharges and by serum 
reactions. Diagnosis is essentially a laboratory problem and 
treatment should never be instituted without laboratory con- 
firmation. 
2. Isolation: Essential for noncooperative patients at least until sur- 
face lesions have healed. No person in the communicable stage 
of syphilis should be permitted to engage in occupations of 
personal service in which he or she may infect others with syph- 
ilis, such as those of nurse or nursemaid, domestic servant, bar- 
ber, hairdresser, chiropodist, manicurist, bath attendant, mas- 
seur, wet nurse. Sexual intercourse should be specifially warned 
against and so far as possible prevented for persons with syphilis 
until declared to be free from infection by the physician respon- 
sible for treatment of the patient. 
3. Concurrent disinfection of discharges and of articles soiled there- 
with. 
4. Terminal disinfection: None. 
5. Quarantine: None. 
6. Immunization: None. 
7. Investigation of source of infection: Bach case, particularly those 
cases of presumably recent origin, as the congenital form of the 
disease in infants, and first and second-stage cases of the ac- 
quired disease, should be traced to the probable source of infec- 
tion, appropriate control and treatment of this spreader of 
disease instituted, and further exposed contacts examined for 
unsuspected or unreported cases. 
B. General measures: 
1. Provisions for accurate and early diagnosis and careful treat- 
ment of infected persons, with due consideration for privacy of 
record, consistent with effective control of the patient, search 
for source of infection, and provision for following cases until 
cured. 
2. Education in matters of sexual hygiene, particularly as to the fact 
that continence in both sexes and at all ages is compatible with 
health and normal development. 418 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
3. Repression of commercial prostitution and associated use of alco- 
holic beverages, by means of the police or other competent 
authority. 
4. Restriction of advertising of services or medicines for self- 
treatment of sex diseases, etc. 
5. Elimination of the use of common towels, cups, and toilet articles 
from public places. 
6. Serological as well as clinical examination for syphilis should be 
part of the routine prenatal supervision of the expectant mother 
and if she is found to be infected, antisyphilitic treatment should 
he begun if possible before the end of the fifth month of preg- 
nancy. 
7. Personal prophylaxis should be advised and be made available for 
use immediately after sexual intercourse to those who expose 
themselves to infection. 
Ringworm. (Of scalp, body, feet, and groin.) 
1. Recognition of the disease.—Inspection of the scalp and other parts of Ihe 
body for the characteristics of the local lesion. Identification of the fungus 
in the scrapings from the edges of the skin areas involved. 
2. Etiological agent.—Trichophyton, or epidermophyton. 
3. Source of infection.—Lesions on bodies of infected persons or articles of 
clothing carrying the fungus or its spores. 
4. Mode of transmission.—Direct skin-to-skin contact with lesions of infected 
persons and indirectly by articles of wearing apparel or by surfaces con- 
taminated by scurf or scalings or hair from lesions. 
5. Incubation period.—Undetermined. 
6. Period of communicability.—As long as the fungus or its spores can be found 
at the site of the lesions. Transmission is easy in ordinary conduct of home 
or recreational pursuits, particularly those carried out indoors. 
7. Susceptibility and immunity.—Susceptibility general. There is relative 
immunity to scalp ringworm after 15 years of age. 
8. Prevalence.—Wide spread, varying with aggregation of people under condi- 
tions appropriate for spread, as at swimming pools. Foot ringworm 
more common in adults, and the body, face, and head form more so among 
children, more especially in warm weather. 
9. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of disease and reporting: All cases recognized on 
inspection of school children should be reported to school 
authorities. 
2. Isolation: Children and adults with marked cases of the disease 
should be excluded from privileges in gymnasium and at swim- 
ming pools. Exclusion from school may be desirable in cases of 
ringworm of the scalp. There are too many carriers of foot 
ringworm to make control of them at all practicable. 
3. Concurrent disinfection: Cleanliness of body and underclothing, 
especially socks 
4. Terminal disinfection: None. 
5. Quarantine: None. 
6. Immunization: None. 
7. Investigation of source of infection: Among school children medi- 
cal inspection should be used to detect unreported cases. In gym- 
nasia and buildings devoted to athletics, particularly swimming, 419 
HYGIENE AND SANITATION 
search should be made as a routine, to exclude cases from 
common facilities. 
B. General measures: 
1. Cleanliness of body and underclothing. 
2. Prompt and persistent treatment of the lesions should be urged. 
3. Protection of feet against contamination in showers and dressing 
rooms and areas used by people with bare feet. 
4. The use of disinfecting solutions may prove useful in connection 
with common bathing and dressing rooms. 
GROUP V. DISEASES OF LOWER ANIMALS WHICH MAY BE TRANS- 
MITTED TO MAN 
Rabies. 
Trichinosis. 
Others, not here discussed ; 
Actinomycosis. 
Anthrax. 
Others, not here discussed—Continued. 
Foot and mouth disease. 
Glanders. 
Malta fever. 
Tularsemia. 
Rabies. 
1. Recognition of the disease.—In the human being this acute, specific, rapidly 
fatal infection may not be recognized until a spasm of deglutition appears, 
unless the earlier and mild constitutional symptoms such as an expression 
of anxiety, paresthesias especially in or near the wound, and some paralysis 
have been looked for after the bite of a rabid animal. In the dog or other 
animal, recognizable symptoms are any unexplained change in behavior 
followed by excitability or paralysis, and death within 10 days of onset of 
symptoms. Verification of cause of death may be established by discovery 
of Negri bodies in nerve cells of brain or cord, or by animal inoculation. 
2. Etiological agent.—A specific flltrable virus. 
8. Source of infection.—Saliva of infected animals, chiefly dogs. 
4. Mode of transmission.—Inoculation of denuded tissue with saliva of infected 
animals, almost always by bites. 
5. Incubation period.—Usually 2 to 6 weeks. May be prolonged to 6 months 
or even longer. Duration depends on virulence of saliva and on site of 
wound in relation to richness of nerve supply and directness of nerve path 
to brain. 
6. Period of communicability.—For 15 days in the dog before the onset of 
clinical symptoms and throughout the clinical course of the disease. Only 
slightly communicable in man. 
7. Susceptibility and immunity.—Susceptibility general. Natural immunity is 
not known to exist in man or among the animals subject to the disease. 
Prophylactic antirabic treatment of infected humans will prevent develop- 
ment of the disease, with rare exceptions, if the treatment is begun soon 
after the injury and the site of the wound is not extensive in the distri- 
bution of the facial nerve. 
8. Prevalence.—Rare in man; more likely to occur in males than females and 
most often in persons under 20 years of age. World-wide distribution. 
Universally fatal in developed human cases. More prevalent among dogs 
and sometimes in wild carnivorous animals. 
9. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting; Clinical symptoms, con- 
firmed by the presence of Negri bodies in the brain of the 420 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
animal which has caused the injury, and by animal inoculations 
with material from the brain of such animal. 
2. Isolation: None if the patient is under adequate medical super- 
vision, and the immediate attendants are warned of possibility 
of inoculation by human virus. 
3. Concurrent disinfection: Saliva of patient and articles soiled there- 
with. 
4. Terminal disinfection: Thorough cleaning. 
5. Quarantine: None. 
6. Immunization: Preventive vaccination of the patient after ex- 
posure to infection by inoculation. 
7. Investigation of source of infection: Search for the rabid animal 
and for any animals bitten by it. Carriers in animals are not 
known to occur. 
B. General measures: 
1. Detention and examination of dogs suspected of having rabies. 
2. Immediate antirabic treatment of people bitten by dogs or by 
other animals suspected or known to have rabies, unless the 
animal is proved not to be rabid by subsequent observation or 
by microscopic examination of the brain and cord. The wound 
caused by any bite of a rabid animal should be treated at once 
to the depths with fuming nitric acid, with complete protection 
of the eye in the case of face bites. 
3. Education in the care of dogs, especially directed to dog owners 
and the police, including advice against shooting of rabid or 
suspected animals in the head lest the laboratory examination 
of the brain be rendered difficult or impossible. Dog owners 
should be impressed wuth the serious implications of keeping 
dogs in densely built up cities. 
4. Control of dog population by requiring animal license, provision 
for the impounding and the humane destruction of all unli- 
censed dogs, quarantine of all dogs in areas wffiere rabid ani- 
mals have run at large. 
Trichinosis. 
1. Recognition of the disease.—In human beings confined to persons who have 
eaten raw7 or insufficiently cooked fresh pork products, occasionally bear 
meat, and characterized by onset of variable intensity according to the 
amount of infested meat eaten and the abundance of the trichinae in the 
meat. The symptoms of invasion may be mild or of severe gastro-intestinal 
disturbance. Muscle soreness or pain, oedema of face and eyelids, weak- 
ness and distress are accompanied by a marked eosinophilia. Microscopic 
examination of the stools for adult werrns, and of teased specimen of 
deltoid muscle for suspected embryos is helpful. Occasionally examination 
of the uncooked pork will reveal the parasites, 
2. Etiological agent.—Trichinella spiralis {Trichina spiralis). 
3. Source of infection.—Uncooked or insufficiently cooked pork, rarely meat of 
other animals. 
4. Mode of transmission.—Direct from meat to man through consumption of 
undercooked infected pork products. 
5. Incubation period.—Variable; usually about 1 week. 
<i. Period of communicability.—Disease is not transmitted by human host to 
man. 421 
HYGIENE AND SANITATION 
7. Susceptibility and immunity.—Susceptibility is general. Neither natural 
nor acquired immunity is known to occur. 
8. Prevalence.—World-wide, but uncommon. No selection by age, sex, race, 
region, season, or climate except as these affect the custom of eating the 
insufficiently cooked flesh of infested hogs or other animals. 
9. Methods of control. 
A. The infested individual, contacts, and environment: 
1. Recognition of the disease and reporting: Clinical symptoms, 
confirmed by microscopical examination of blood for eosinophilia, 
and about the third week for encysted larvae in muscle tissue. 
2. Isolation: None. 
3. Concurrent disinfection: Sanitary disposal of the faeces of the 
patient. 
4. Terminal disinfection: None. 
5. Quarantine: None. 
6. Immunization; None. 
7. Investigation of source of infection: Every effort should be made 
to trace each case to a definite or probable source of raw or 
undercooked pork. Where hogs are fed on, or have access to, 
human offal, and human beings eat insufficiently cooked fresh 
pork products, there is an endless sequence of infestation and 
reinfestation of hog and human. 
B. General measures: 
1. Inspection of slaughtered hogs for the detection of trichinosis 
(rarely found unless muscles are heavily infested). 
2. Thorough cooking of all pork products at a temperature of 160° F. 
or over. 
3. Refrigeration of pork at 5° F. for 20 days. 
4. Extermination of rats, especially around meat shops and slaugh- 
ter houses and hog pens. 
5. Cooking swill and offal which is to be fed to hogs. 
GROUP VI. MISCELLANEOUS DISEASES. 
Chicken pox. 
Small pox. 
Tetanus. 
Trachoma. 
Chicken pox. 
1. Recognition of the disease.—Clinical picture is of an acute disease with a 
slight fever, mild constitutional symptoms, and an eruption, maculopapular 
for a few hours, often not observed, vesicular lasting 8 to 4 days leaving 
a granular scab. Vesicles tend to be as abundant on the covered as on 
the exposed parts of the body, and frequently appear in different stages on 
the same region of the body. 
2. Etiological agent.—A specific filtrable virus. 
3. Source of infection.—The infectious agent is presumably present in the lesions 
of the skin and of the mucous membranes; the latter, appearing early and 
rupturing as soon as they appear, render the disease communicable early, 
that is, before the exanthem is in evidence. 
4. Mode of transmission.—Directly from person to person; indirectly through 
articles freshly soiled by discharges from an infected person. 
5. Incubation period.—Two to three weeks. . 
6. Period of communicability.—Probably not more than 6 days after the appear- 
ance of the first crop of vesicles, and certainly not more than 10 days. 422 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Especially communicable in the early stages of the eruption. One of the 
most readily communicable of diseases. 
7. Susceptibility and immunity.—Susceptibility is practically universal among 
those who have not previously had the disease. An attack confers perma- 
nent immunity, with rare exceptions. Passive temporary immunity may be 
conferred by the use of convalescent serum from those recently recovered. 
8. Prevalence.—Universal. Probably 90 per cent of persons have had the dis- 
ease by the time they are 15 years of age. Not uncommon in early infancy. 
Winter and spring are seasons of greatest prevalence in North America. 
9. Methods of control: 
A. The infected individual, contacts and environment: 
1. Recognition of the disease and reporting; The chief public health 
importance of this disease is that cases thought to be chicken 
pox in persons over 15 years of age, or at any age during an 
epidemic of smallpox, are to be investigated to eliminate the pos- 
sibility of their being smallpox. 
2. Isolation: Exclusion from school, and avoidance of contact with 
nonimmune persons should be made effective. 
3. Concurrent disinfection; Articles soiled by discharges from lesions. 
4. Terminal disinfection: Thorough cleaning. 
5. Quarantine: None. 
6. Immunization; Passive immunization of susceptible children may 
be of value in institutions when exposure is feared, or under 
exceptional conditions in individual cases. 
7. Investigation of source of infection: Of no importance unless in 
persons over 15 years of age or when smallpox is suspected or 
is locally prevalent. 
B. General measures: None. 
Smallpox. 
1. Recognition of the disease.—One to five days of febrile symptoms before the 
eruption, which is papular for 1 to 4 days, vesicular for 1 to 4 days, and 
pustular for 2 to 6 days, forming crusts which fall off 10 to 40 days after 
the first sign of the lesions, and leave pink scars which fade gradually. 
Unless scanty, the eruption is symmetrical and general, more profuse on 
prominences, extensor surfaces, and surfaces exposed to irritation, than on 
protected surfaces, flexures, and depressions. Most abundant and earliest 
on the face, next on forearms, wrists, and hands, favoring the limbs, 
especially distally, more than the trunk. More abundant on shoulders and 
chest than on loins or abdomen, but the lesions may be so few as to be 
overlooked. The individual lesions are deep-seated and have an infiltrated 
base, except when modified naturally or by previous vaccination. Any case 
of purpura or haemorrhage into the skin with fever should be treated with 
smallpox precautions until another diagnosis is clear. 
2. Etiological agent.-—A specific filtrable virus. 
3. Source of infection.—Lesions of the mucous membranes and skin of infected 
persons. 
4. Mode of transmission.—By contact with persons sick with the disease. This 
contact need not be intimate, but aerial transmission through more than a 
few feet is unlikely; by articles or persons contaminated by discharges of 
the sick, including faeces and urine, but for a brief time. 
5. Incubation period.—Eight to sixteen days. (Cases with incubation period of 
21 days are reported.) HYGIENE AND SANITATION 
423 
6. Period of communicability.—From first symptoms to disappearance of all 
scabs and crusts. 
7. Susceptibility and immunity.—Susceptibility universal. Acquired permanent 
immunity usually follows recovery from an attack of the disease. Second 
attacks are rare. Artificial imnmnity by vaccination is usually complete 
for 5 to 20 years, but relative susceptibility often occurs after 5 years. 
8. Prevalence.—Distribution in sporadic or epidemic form; varies widely accord- 
ing to the immunity status of the population of an area and its exposure 
to infection from without. Cases occur most often in young adult males. 
Occurrence is most frequent in the winter and least in summer months. 
There is no regional or climatic limitation to its prevalence except as popu- 
lation groups are more or less well protected by vaccination. 
9. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting: Clinical symptoms. The 
rapidly fatal or fulminating type and the very mild type may 
escape diagnosis until secondary eases appear. 
2. Isolation: Hospital isolation in screened wards, free from vermin, 
until the period of infectivity is past. 
3. Concurrent disinfection of all discharges: No article to leave the 
surroundings of the patient without boiling or equally effective 
disinfection. 
4. Terminal disinfection: Thorough cleaning and disinfection of 
premises. 
5. Quarantine: Isolation of all contacts until vaccinated with virus 
of full potency, and daily medical observation of these contacts 
until height of reaction is passed, if vaccination was performed 
within 24 hours of first exposure; otherwise for 16 days from 
last exposure. 
6. Immunization: Vaccination. 
7. Investigation of source of infection: The immediate prior case 
should be sought industriously, and cases of reported chicken pox 
associated in time or place carefully reviewed for error of diag- 
nosis. Active cases of the disease without remaining constitu- 
tional symptoms must be sought, also passive carriers recently 
in contact with cases, and exposed vaccinated persons who may 
have developed unrecognized forms of the disease, and thus be 
serving as sources of infection. 
B. General measures: 
1. General vaccination in early infancy, revaccination of children 
on entering a school, and of entire population when the disease 
appears in a severe form. 
2. In order to avoid possible complications or secondary and subse- 
quent infections at the site of vaccination, it is important that 
the vaccination insertion be as small and superficial as practi- 
cable, not over one-eighth inch in any direction, and that the 
site be kept dry and cool. The use of shields or other dressings 
is to be condemned. The multiple pressure method is recom- 
mended. Primary vaccination as soon after 1 week of age as 
possible is desirable. The time of vaccination should be adjusted 
to avoid skin lesions elsewhere on the body, and in older children 
to avoid the warmer months. Particular care should be used in 
primary vaccinations beyond the age of infancy. 424 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
10. Method of vaccination.—The best method of vaccination is probably the 
“multiple pressure” method as recommended by the United States Public 
Health Service. This method consists of pressures against the cleansed 
but not irritated skin with the side of a needle point, through a drop of 
smallpox vaccine, covering an area not more than one-eighth of an inch 
(3 millimeters) in its greatest diameter. This gives very superficial 
implantation and the eruption is typical. The skin of the left upper arm, 
over the insertion of the deltoid muscle, is the standard site for vac- 
cinating, and has some advantages over any other. Acetone has been 
Figure 121.—The “multiple pressure” method of vaccination, showing the rapid up-and- 
down motion of the side of the needle, held by the hand at the right, against the drop 
of vaccine on the arm at the left. It is not necessary to hold the skin taut with the 
operator’s left hand as is done in other methods of vaccination. (U. S. Public Health 
Reports.) 
found satisfactory for cleansing the skin. It is somewhat more efficacious 
than alcohol and evaporates more rapidly. The needle, which should 
be new, sharp, and sterile, is not thrust into the skin, but is held 
quite parallel or tangential to it, with the forefinger and middle finger 
of the right hand above the needle and the thumb below, the needle 
pointing to the operator’s left. {See fig. 121.) The needle should be 
crosswise of the arm, so that the thumb of the operator is not impeded 
by hitting the skin. The side of the needle point is then pressed 
firmly and rapidly into the drop about 30 times within five seconds 
(or not more than 10 times for primary vaccinations with highly 
potent vaccine) the needle being lifted clear of the skin each time. 
This rapid up-and-down motion of lifting the needle and pressing it against 
the skin should be quite perpendicular to the skin and needle and not in 
the direction of the long axis of the needle. The point is not driven into HYGIENE AND SANITATION 
425 
the skin, but at each pressure the elasticity of the skin will pull a fraction 
of a millimeter of the epidermis over the point of the needle so that the 
vaccine is carried into the deeper layers of the epidermis, where multi- 
plication takes place most easily. 
If the skin has not been unduly rubbed in cleansing, and if the pressure 
is entirely perpendicular to the needle, no signs of bleeding should occur 
and all evidence of the trauma will be gone in a few hours. Immediately 
after the pressures have been made, the remaining vaccine is gently wiped 
off the skin with sterile gauze and the sleeve pulled down. 
11. Interpretation of results of vaccination.—Primary Reaction ; With the 
typical primary vaccination, indicating absence of immunity to smallpox 
prior to this vaccination, the zone of redness, rather narrow from the third 
to the seventh day, begins a sudden spread about seven days after vaccina- 
tion, and reaches its broadest diameter in 8 to 14 days after vaccination, 
rapidly disintegrating and disappearing thereafter. 
Accelerated Reaction : With the accelerated or modified vaccination 
reaction indicating a partial immunity, the broadest redness is reached 
and passed in three to seven days after vaccination. 
Immune Reaction : In this reaction which indicates full protection 
against smallpox, the broadest redness is reached and passed in 8 to 72 
hours after vaccination. This redness is accompanied by a, slight eleva- 
tion of the skin, which can be felt by passing the fingers lightly over the 
vaccinated area. 
The sharp division of the postvaccinal reaction into these three types 
(immune reaction, vaccinoid, and primary vaccinia) is somewhat arbi- 
trary, all gradations being found in practice; strictly speaking, all three 
reactions are forms of vaccinia ; differentiation into the three types is based 
on the time of broadest redness. Therefore, a single observation is not 
sufficient to tell, for example, whether a vaccination has resulted in a re- 
action of immunity or in a vaccinoid. It is not the time of appearance 
of the reaction but the time when the areola is at its maximum that forms 
the basis of differentiation. The more prompt the maximum the greater 
was the previous immunity. The size and intensity of the reaction, and 
to some extent its time relations, are dependent also on individual (or 
familial) predisposition as well as on the vaccine and method of inser- 
tion. Such variations in the reaction are subsidiary to the three types 
classified by immune status. 
12. Storage of smallpox vacei/ne.—Icebox refrigeration is not cold enough for 
this purpose. Smallpox vaccine, formerly called vaccine virus, cannot be 
injured by freezing, as can serums and other vaccines. Even a single 
day out of cold storage, in addition to the necessary transportation from 
the manufacturing laboratory, may produce detectable deterioration in 
potency. Smallpox vaccine which has been out of cold storage so that 
It gives only about 80 per cent or 90 per cent of successful vaccinations on 
previously unvaccinated Individuals is not satisfactory and may be 
dangerously weak in the presence of severe smallpox. When reactions 
of immunity are to be observed, the vaccine should be obtained direct 
from the manufacturer and kept below freezing. For all vaccinations, 
vaccine of full potency should be used, so- that the insertions may be as 
small and superficial as possible, yet success be assured in every vaccina- 
tion. Weakness of vaccine has in the past been the reason for danger- 
ously large insertions. Vaccine should be of uniformly high potency, but 
not too strong. Though other factors than temperature are concerned 426 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
in potency, it is possible that improvement in refrigeration practice in 
America has been one of the chief agents in recent reductions in the 
incidence of smallpox and of vaccination mishaps. 
In an electric refrigerator the smallpox vaccine should be kept in 
an ice-making compartment. Next best to storage below freezing is 
placing the vaccine in a metal or glass container in constant contact with 
ice or with the freezing chamber. If a vacuum bottle is used for trans- 
porting smallpox vaccine, the inside of the bottle should be packed with 
ice around the vaccine. The packages in a pharmacy are best stored in 
a wide-mouth rubber-stoppered bottle fitting loosely inside the cooling unit 
of a mechanical refrigerator, which should be defrosted just before the 
packages are received, rather than after. Other biologic products are less 
sensitive to heat but are sensitive to freezing and should not be stored in 
this way. The stoppered bottle prevents maceration of the labels and 
rusting of the needles caused by moisture condensing when the door is 
opened. If this protection is impossible, a memorandum should be made 
of the lot number and the expiration date, lest the stamping of the package 
become illegible, and the needles should be removed unless they are in 
glass-sealed tubes. 
Tetanus. 
1. Recognition of the disease—An acute infectious disease caused by the toxin 
of the tetanus bacillus; characterized by painful muscular contractions, 
first and principally of the masseter and neck muscles, and secondly those 
of the trunk; rarely the rigidity is confined to the region of the injury. A 
history and usually physical evidence of a wound of entry for infection is 
found. Bacteriological examination and mouse inoculation may he useful 
in confirmation of diagnosis. 
2. Etiological agent.—Clostridium tetani. (Bacillus tetani). 
3. Source of infection.—Animal manure, human faeces, soil, and street dust. 
4. Mode of transmission.—Wound infection. 
5. Incubation period.—Commonly 4 days to 3 weeks, dependent somewhat upon 
the character, extent, and location of the wound. Longer periods of incu- 
bation have been noted. Subsequent operative interference or local tissue 
changes may initiate the activity of quiescent bacilli at even lengthy inter- 
vals after the original wound infection. 
6. Period of communicability.—Patient not infectious except in rare instances 
where wound discharges are infectious. 
7. Susceptibility and immunity.—Susceptibility general, but inoculated bacilli 
often fail to produce toxin. Artificial passive immunity for about 10 days’ 
duration can be relied upon from the use of tetanus antitoxin. An active 
immunity may be produced by the use of tetanus toxoid. 
8. Prevalence.—World-wide distribution, following wound infection. Most fre- 
quent in North America among young males and in summer. Prevalent 
especially following wounds contaminated with manured soil. 
9. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting: Clinical symptoms may 
be confirmed bacteriologically. 
2. Isolation: None. 
3. Quarantine: None. 
4. Immunization: Ordinarily a subcutaneous injection of tetanus 
antitoxin (1,500 units) given on the day of the wound. A second 
injection within 10 days may be desirable in certain instances. HYGIENE AND SANITATION 
427 
5. Investigation of source of infection: Of only academic interest, as 
the infecting organism is widely spread, especially through 
animal fceces, in all inhabited places. 
6. Concurrent disinfection: None. 
7. Terminal disinfection: None. 
B. General measures: 
1. Educational propaganda such as “safety first” campaign, and 
“safe and sane Fourth of July” campaign. 
2. Prophylactic use of tetanus antitoxin where wounds have been 
acquired in regions where tetanus is prevalent, and in all cases 
where contaminated material may be embedded in the wound. 
3. Removal of all foreign matter as early as possible from all 
wounds. 
Trachoma. 
1. Recognition of the disease.—A specific destructive chronic inflammation of the 
conjunctiva, characterized by formation of granulations, either papillary or 
follicular, leading ultimately to formation of scar tissue and deformity of 
the eyelids. Microscopic examination of the conjunctival discharges and 
scrapings cannot be relied upon1 as an aid to diagnosis, but may exclude 
other infections. 
2. Etiological agent.—Undetermined. 
3. Source of infection — Secretions and purulent discharges from the conjunctive 
and adnexed mucous membranes of the infected persons. 
4. Mode of transmission.—By direct contact with infected persons and indirectly 
by contact with articles freshly soiled with the infective discharges of 
such persons. 
5. Incubation period.—Undetermined. 
6. Period of communicability.-—During the persistence of lesions of the conjunc- 
tive and of the adnexed mucous membranes or of discharges from such 
lesions. 
7. Susceptibility and mtmwwti/.—Susceptibility is general, greater in children 
than in adults and increased by malnutrition, chronic irritation by dust, 
wind, exposure to the sun, and by carelessness of personal cleanliness. 
Natural or acquired immunity is not known to occur. 
8. Prevalence.—Not uncommon in immigrants from southern and eastern Europe. 
Incidence high among mountain population of southern Appalachians, and 
to an extent of 5 to 25 per cent among plains and Pueblo Indians of the 
United States. In Canada the main focus is in southern Manitoba; rare 
in white, native born Canadians; in Indians, cases are distributed from 
Ontario westward through the prairie provinces and into British Columbia. 
Cases most common among children but may occur and persist at any age. 
9. Methods of control: 
A. The infected individual, contacts, and environment: 
1. Recognition of the disease and reporting; Clinical symptoms. 
2. Isolation: Exclusion of the patient from general school classes. 
Isolation of the patient is not necessary if he is properly 
treated and instructed in precautions against spread of secretions 
of the eye to others by common use of articles. 
3. Concurrent disinfection of discharge and articles soiled therewith. 
4. Terminal disinfection: None. 
5. Quarantine: None. 
6. Immunization: None. 
154294°— 39 28 HANDBOOK OF THE HOSPITAL CORPS. U. S. NAVY 
7. Investigation of source of infection: Careful search should be 
made of persons in any way intimately related or exposed to the 
patient, particularly members of the household, and playmates 
and schoolmates. Carriers are not known to occur, but apparently 
healed scars of old lesions may be the site of reactivity and 
becomes sources of infection. 
B. General measures: 
1. Search for cases by examination of school children, or immi- 
grants, and among the families and associates of recognized 
cases; in addition, search for acute secreting disease of con- 
junctive and adnexed mucous membranes, both among school 
children and in their families, and treatment of such cases 
until cured. 
2. Elimination of common towels and toilet articles from public 
places. 
3. Education in the principles of personal cleanliness and the neces- 
sity of avoiding direct or indirect transference of body dis- 
charges. 
4. Control of public dispensaries where communicable eye diseases 
are treated, and creation of special treatment classes where 
the disease prevails. 
5. Exclusion of infected immigrants at national boundaries, or pref- 
erably at foreign ports of embarkation. 
6. Routine examination of eyes of children admitted to institutions, 
or in industrial camps where the disease is prevalent. 
7. Under certain conditions in areas of widespread prevalence of the 
disease, the prophylactic use of solutions of zinc sulfate (1 per 
cent) or copper sulfate (0.5 per cent) may prove a valuable 
protective measure for children. 
PRACTICAL HYGIENE AND SANITATION 
Air, ventilation, heating, lighting, and housing. 
Air is one of the absolute necessities of life and it has been aptly said that 
man lives at the bottom of a vast ocean of air. It is not a fixed chemical 
compound but a mixture of gases, and its chemical composition is practically 
uniform the world over. In normal atmospheric air the percentages of the 
different gases are approximately as follows: Oxygen, 21; nitrogen, 78; carhon 
dioxide, 0.03; argon, 0.94; and traces of helium, krypton, neon, xenon, hydro- 
gen, hydrogen peroxide, ammonia, and ozone. In addition to the gases named 
there is present in the air varying amounts of water vapor, and there are 
suspended in the air such particles as dust, bacteria, yeasts, etc. 
In relation to health, air affects the physiological functioning of the body 
in two ways, the interchange of gases in respiration and the regulation of 
body temperature. 
Of the gases present in air only a few are considered to be of physiological 
importance. While nitrogen is of the most vital importance in the compo- 
sition and functioning of the body, the nitrogen found in the air serves only 
as a diluent of the oxygen present. The body gets its nitrogen from the proteins 
in the food eaten. 
Oxygen is the vital gas in the atmosphere. It is necessary for all forms 
of animal life. It passes through the very thin walls of the air sacs of the 
lungs into the blood, where it iai taken up by the haemoglobin, is carried back HYGIENE AND SANITATION 
429 
to the heart and pumped to all parts of the body where it oxidizes or burns 
up the food with the production of the heat and energy necessary to carry 
on the normal body processes. The excess of oxygen unites with waste carbon 
dioxide and water. These are carried back to the lungs by the venous blood 
and are taken from the body by the breathed-out air. If the oxygen in the 
air falls below 16 per cent, distress follows; if it falls below 12 per cent, 
slow death occurs. 
The small amount (0.03 part) of carbon dioxide found in atmospheric air 
is of no sanitary importance. It is not poisonous outside of the body, but 
being a waste product constantly being breathed out by all forms of animal 
life, its presence in increased amounts indicates pollution of the air and poor 
ventilation. A certain amount of carbon dioxide is necessary for the body as, 
by its presence in the blood, the action of the heart is regulated and the 
respiratory center stimulated. 
Carbon monoxide is a colorless, odorless, and tasteless gas not normally 
present in the atmosphere. It is a by-product of incomplete combustion and 
is present following explosions of gunpowder, in illuminating gas, in coal 
gas, and in the exhaust from gasoline engines. With the increasing use of 
the automobile with its gasoline engine, carbon monoxide is increasing in 
sanitary importance. Wherever gasoline engines are used there should be 
abundant ventilation. Carbon monoxide acts as a poison by uniting and 
forming a fixed compound with the haemoglobin of the blood. Death results 
when there is insufficient free haemoglobin remaining to carry an adequate 
supply of oxygen to the body cells. 
The chief physical properties of air are temperature, humidity, movement 
of the air, and atmospheric pressure. Formerly the discomfort and ill effects 
suffered in crowded, ill-ventilated rooms were thought to be due to the pres- 
ence of increased amounts of carbon dioxide breathed out by the occupants. 
It is now believed to result from increased temperature and humidity, and a 
lack of air movement consequent upon inadequate ventilation. Bodily comfort 
is largely dependent upon the constant elimination of the excess heat formed 
during metabolism, and the maintenance of the “normal” body temperature 
of about 98.6° F. This is accomplished in a condition of health through the 
functioning of the heat-regulating center in the medulla oblongata. Heat is dissi- 
pated from the body chiefly through radiation, conduction, convection, evapora- 
tion, and respiration. By radiation is meant the emanation of heat directly from 
a heated object, as in the case of a steam radiator. By conduction is meant 
the transmission of heat to a contiguous substance, as when a red-hot poker 
is put into water the poker is cooled and the water heated. By convection is 
meant the carrying away of the heat radiated by the body. Heat is lost by 
evaporation of perspiration, the process of evaporation abstracting heat from 
the body with consequent cooling. When one becomes overheated the heat 
regulating center goes into action, sending the hot blood to the surface of 
the body where some of the excess heat is radiated and conveyed away; and 
perspiration, and respiration are accelerated. The relation of these physiolog- 
ical functions to the physical properties of the air, temperature, humidity, 
and movement will now be discussed. 
The human body possesses wide powers of adaptability to varying degrees 
of temperature. Man lives in all climates and labors under diverse conditions 
of temperature. These conditions are modified largely by clothing, food, 
housing, artificial heating, cooling, and by the heat-regulating center of the 
body. When many persons are closely associated and the ventilation is poor 
the heat radiated by their bodies causes a rise of temperature. Discomfort 430 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
increases as the room temperature approximates that of the body, preventing 
as it does loss of heat by radiation. 
Humidity influences the output of heat from the body in two ways. It in- 
creases the conductivity of the atmosphere for heat, a cooling influence, and 
hence cold moist air is chilling, and it interferes with the evaporation of 
perspiration, a heating influence, and hence warm moist air is enervating. 
At a temperature of about 68° F. humidity has comparatively little effect. 
Relative humidity is a term generally used to express the amount of moisture 
in the air and means the amount of moisture present at the time the ob- 
servation is made, relative to the amount of moisture required at that same 
temperature to completely saturate the air. 
The amount of moisture present (relative humidity) in the air affects the 
body by controlling the rate of evaporation of perspiration from the skin. 
The greater the relative humidity the less moisture the air can absorb, and 
hence the slower will be the evaporation of perspiration. For example, on the 
hot, “humid” days in summer there is high relative humidity, though not 
always necessarily a high temperature. If the air is dry (low relative hu- 
midity) as found in desert and mountainous regions, one can stand high tem- 
peratures without great distress. Conversely the same thing applies in cold 
weather, the greater the relative humidity the more one will mind the cold, 
the moisture in this case acting as a rapid conductor of heat away from the 
body. The relative humidity is often referred to as the drying power of the 
air; when the humidity is high the drying power is poor, there already being 
a high percentage of moisture in the air. When the relative humidity is low, 
the drying power is high—the air being able to take up a great deal of moisture. 
The movement of air is one of the factors which determine the degree of 
comfort under various atmospheric conditions, even when the temperature and 
relative humidity are high. A layer or blanket of hot, moist air collects in 
the meshes of the clothing about the body. The moving air blows this way and 
mixes it with the air in the room, thus cooling and relieving the body. The 
movement of air associated with minute changes in temperature has a distinct 
stimulatory effect on the heat regulating center of the body and explains the 
comfort produced by an oscillating fan. Men placed in carefully controlled 
chambers where the conditions of overcrowded, badly ventilated rooms were 
produced (increased relative humidity and heat; oxygen reduced to 16 or 17 per 
cent and the carbon dioxide increased to between 3 and 4 per cent), suffered 
even when breathing pure fresh air through tubes from without the chamber; 
while men who were outside the chamber under conditions where the excess 
heat and moisture produced by their bodies were quickly dissipated, experienced 
no discomfort when breathing the polluted air from within the chamber through 
tubes. These experiments proved that under ordinary conditions discomfort 
does not result from decreased oxygen or increased carbon dioxide, but be- 
cause the body cannot eliminate the excess waste heat. Discomfort, symptoms 
of heat exhaustion or heat stroke, and what is called “crowd poisoning,” result 
under the following conditions, which constitute a summary of the foregoing 
discussion of the effects of the physical properties of air: 
1. When the temperature is so high that the body cannot eliminate its excess 
heat; 
2. When the relative humidity is so high that perspiration cannot be evaporated 
from the surface of the body with a consequent cooling effect; and 
3. When there is no movement of air to remove the hot, moist blanket of air 
which accumulates about the body, and stimulates the heat-regulating center 
in the medulla. HYGIENE AND SANITATION 
431 
The normal atmospheric pressure at sea level is 15 pounds to the square 
inch which is really the weight of a column of air 1 inch square at its base 
and as high as the air extends. An average man at sea level is subjected to 
an air pressure of more than 15 tons. Regardless of the elevation at which 
one lives the pressure of the gases in the body tissues is in equilibrium with 
the gases surrounding the body. With sudden changes in atmospheric pres- 
sure certain changes and symptoms are produced in the body by the effort of 
the gases inside the body, principally nitrogen, to come into equilibrium with 
the atmospheric pressure outside, and also because the atmospheric content of 
oxygen per cubic foot decreases with the pressure and vice versa. 
The effects of inci'eased atmospheric pressure on health.—Men in the Navy 
are subjected to increased pressure in deep-sea diving. The normal air pres- 
sure at sea level of 15 pounds per square inch is spoken of as 1 atmosphere. 
Every depth of 10 meters increases the pressure 1 atmosphere and at a 
depth of 30 meters (about 100 feet) a diver is exposed to a pressure of 4 atmos- 
pheres, or about 60 pounds to the square inch. The symptoms attendant upon 
increasing pressure and consequent absorption of increased amounts of gases 
in the tissues are not marked. It is when the pressure is suddenly decreased 
as wThen a diver is brought to the surface too quickly, that the dangerous 
symptoms known as caisson disease occur. These are due to the release of 
the accumulated gases in the tissues and body fluids when the pressure is 
suddenly decreased. The gases tend to form bubbles, and it is the escape of 
these bubbles through the tissues and capillary walls that causes the distress. 
The symptoms of caisson disease are excruciating pain in the muscles and joints, 
called “bends”; haemorrhages from the nose and ears; paralysis, unconscious- 
ness, and even death from the plugging of blood capillaries by air bubbles, and 
haemorrhages into the brain and spinal cord. The disease is prevented by 
gradual decompression of persons under increased pressures, i. e., bringing 
them to the surface slowly. If suffering when brought to the surface, the vic- 
tim should be placed in a compression chamber such as is available in diving 
operations, and decompressed slowly. 
The effects of decreased atmospheric pressure upon health.—The symptoms of 
decreased pressure (known as mountain or aviator’s sickness) are due to the 
rarefied air, as well as to the decreased pressure, and come on when ascend- 
ing high mountains or ascending in aircraft. The noticeable symptoms are: 
Increase in the respiration; noises in the head and dizziness; impairment of 
the senses of sight, hearing, and touch; dullness of the intellectual faculties, 
and a strong desire to sleep. Consciousness is lost at the altitude of about 
26,000 feet. The prevention of mountain sickness consists of keeping warm, 
avoidance of muscular exertion, inhalations from an oxygen tank, and gradual 
ascent into rarefied atmosphere. 
While often very offensive to one’s sense of smell and at times even nauseating, 
odors produce no other harmful effects, unless they are poisonous gases. 
In the open air there is very little danger from the microorganisms that cause 
disease in man. They require a suitable temperature (that of the body), 
moisture, and a food supply of body fluids or tissues to retain their virulence 
or power to cause disease. All of these are lacking under outside conditions 
where microorganisms also are affected adversely by sunlight. In close prox- 
imity to others and within buildings under crowded, poorly-ventilated 
conditions the danger from microorganisms in the air is very great. Persons 
are constantly spreading bacteria by coughing and sneezing as well as by 
spitting on the decks and floors. The communicable diseases transmitted by 
the nose and mouth discharges are largely spread by these means. Great care 432 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
should be taken to never cough or sneeze In the presence of other persons 
without first covering the mouth and nose. 
Dust in wide open spaces is of relatively little importance as a cause 
of disease. As previously pointed out, pathogenic microorganisms do not find 
the conditions necessary for life in the outside air and quickly die. Within 
rooms and compartments (particularly hospital wards and sick bays) dust 
may be dangerous because of expectoration and microorganisms coughed or 
sneezed into the air. Care should be exercised in sweeping and dusting, to 
raise as little dust as possible. Industrial dust, or that arising in connection 
with manufacturing or repair work is a serious problem. Such dust is classed 
as hard and soft, according to its composition and abrasive qualities. Bits of 
steel and other sharp, hard fragments injure the eyes and exposed parts of 
the body. Goggles, masks, and gloves are preventives. When inhaled, dust 
lodges and accumulates in the lungs, causing disease conditions, as well as 
predisposing to pulmonary tuberculosis and other respiratory diseases. Use of 
respirators is the chief preventive measure. 
Ventilation is the process by which the air of compartments which has 
become vitiated by human and animal occupancy or manufacturing processes 
and machinery is diluted and replaced by fresh air of proper chemical and 
physical composition. 
Satisfactory ventilation should: 
1. Dilute and replace polluted and vitiated air in compartments with pure 
air from without, 
2. Maintain a temperature within the compartment of from 60° to 72° F., 
according to the activity of the occupants; and a relative humidity of about 50. 
3. Keep the air in a gentle continuous motion. 
Any system of ventilation should supply each occupant with between 2,500 
and 3,000 cubic feet of pure air per hour. A properly designed system will 
allow six complete changes of air each hour. Ventilation methods are classified 
as natural and artificial. Inasmuch as ventilation in the Navy has to be 
carried out ashore and also on board ship, the methods applicable in each case 
will be considered separately. 
Natural ventilation ashore is carried out by the proper manipulation of 
windows, doors, transoms, and other openings admitting fresh air from with- 
out. Such openings are best situated on opposite sides of the rooms and may 
be assisted by window ventilators, ridge ventilators, etc. 
Artificial ventilation ashore is carried out much the same as on board ship 
(discussed later). 
As in buildings natural ventilation of ships takes place through all openings 
in the sides of ships and those leading from the “top side” to the decks below. 
It may be assisted by using scoops in air ports, windsails, and screens. 
Artificial ventilation of ships and buildings is accomplished by the use of 
blower fans of which there are two types: 1. Supply blowers which suck in 
fresh air and force (supply) it to compartments; and 2. Exhaust blower fans, 
which suck out or exhaust highly polluted air from compartments. 
There are three systems of artificial ventilation: 1. The supply or plenum; 
2. The exhaust; and 3. A combination of the supply and exhaust systems. 
The plenum or supply system is that by which fresh air is sucked in from 
without and propelled by fans through ducts to the places it is needed. The 
intake should be located at a point where the least smoke, dirt, or odors will 
be taken in. Frequently the air is washed, humidified, and heated in connec- 
tion with the supply system. This is the most generally used system of ventila- 
tion and operates on the theory that the fresh air supplied will force out and HYGIENE AND SANITATION 
433 
replace the polluted air, which escapes through the natural openings of the 
ship or building. 
The exhaust system of ventilation is the reverse of the supply system, and is 
used only where there is great pollution of the air, as in the “heads,” certain 
storerooms, the engine and fire rooms, culinary department, and the magazines. 
It is used extensively in connection with manufacturing to draw off dust, odors, 
and poisonous gases and discharge them into the outside air. 
The combined supply and exhaust system is used where fresh air is needed 
and foul air must be gotten rid of. This system is generally iised in sick bays 
afloat. 
In testing the efficiency of ventilating systems the air of various parts of the 
compartments should be examined as to its carbon dioxide content, its humidity 
and drying power determined by the psychrometer, movement determined by 
the anemometer, and its odor noted. Polluted air generally has a bad odor. A 
very simple and practical method to determine the movement of air is by means 
of lighted caudles or the smoke from burning cigarettes. Pockets of stagnant 
air can be relieved readily by an electric fan. 
There are three methods in common use for heating compartments or rooms: 
1. Direct heating, effected by radiators, stoves, open fires, etc., in which the 
heat rays progress directly from their source; 2. Indirect heating, effected by 
supplying to the compartment air previously heated elsewhere, as by hot-air 
furnaces or by a thermo-ventilation system; and 3. Direct-indirect heating, ef- 
fected by a combination of the two foregoing methods, in which part of the 
heat is supplied by warm air entering the room and part by radiators or stoves 
in the room. 
Most barrack buildings on shore, and the older ships of the Navy as well as 
the modern smaller ships are heated by the direct system. In the modern 
capital ships the indirect system, or the direct-indirect system, is used; the air 
also is humidified. 
Regardless of what heating system is used, living rooms and compartments 
should be kept at a temperature of about 65° to 72° F., and a relative humidity 
of about 50. When the indirect system of heating is used precautions must be 
taken to supply sufficient humidity or moisture to the air. This can be accom- 
plished by passing the air through a steam chamber or in the case of hot-air 
furnaces by evaporation from a pan of water within the furnace. 
The artificial cooling of air is used more extensively each year. It is effected 
by passing air through a cold-spray chamber or by substituting cold coils for 
the hot coils used in conditioning the air in a combined heating and ventilating 
plant. It is used particularly where there are overcrowded conditions in hot 
weather, as in theaters, and where conditions would be otherwise unbearable. 
It is logical to suppose that with the perfection of “air cooling,” it will be used 
on naval vessels designed for tropical service; and also the parts of ships 
where the heat becomes so excessive as to endanger health and life. Artificial 
cooling is already used aboard submarines. Fans are great aids to artificial 
cooling. 
Light may be natural, that emanating from the sun, or artificial, that pro- 
duced by various kinds of illuminants, such as gas, oils, electricity, etc. 
Natural light provides illumination, and also has certain marked stimulatory 
effects on all forms of life processes. Artificial light is generally used for 
illuminating purposes, but some forms, such as ultra-violet and X-rays have 
marked chemical and therapeutic effects and are used in medicine and science. 
Colored lights influence the emotions, green being neutral and soothing, while 
red and violet are stimulating. 434 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Natural light is made up of energy given off from the sun and is conceived of 
as being made up of units called photons having electro-magnetic waves of 
various lengths, each wave producing a different sensation of color when 
striking the retina of the eye; the combined effect being that of white light. 
When a ray of sunlight is passed through a quartz prism, it is broken up into 
the “visible colors of the spectrum”—violet, indigo, blue, green, yellow, orange, 
and red; arranged according to their wave lengths. Violet is the shortest, 
and red the longest. Among the invisible rays, both natural and artificial, 
are those shorter than the violet, such as ultra-violet and X-rays, and those 
longer than the red, such as infra-red and electric waves (wireless, radio, etc.). 
The ultra-violet rays in sunlight are of the greatest interest to the sani- 
tarian and hygienist. They effect many chemical compounds (the reason colored 
bottles are used for certain chemicals) and photographic plates; kill bacteria; 
energize food with the production of certain types of vitamins; form vitamin 
D from chemicals in the skin; cause sunburn and freckles; and act as a 
stimulant to growth and health in most forms of animal and vegetable life. 
In conditions of lowered metabolic and physiological processes such as rickets 
in children and in tuberculosis of the bones and joints, sunlight is usually 
quite beneficial. It may have harmful effects, however, such as severe sun- 
burn, leading even to death in some cases; causes the horny layers of the 
skin to multiply (sailors’ and farmers’ skin) and may lead to skin cancers 
in certain individuals if exposed for long periods over a number of years 
(particularly true of those having little natural pigment in the skin such 
as blonde and red haired persons); causes conjunctivitis; may be the cause 
of certain types of cataract, of sunstroke, of snow-blindness and its equivalent 
by light reflected from snow, large bodies of water, or white sand. 
There is very little ultra-violet light present in the sunlight striking the 
earth during the winter months. Smoke and dust in the atmosphere filter 
it out also, so that even in the summer very little will reach the ground of 
a smoky city. 
The ultra-violet and other short invisible rays from the sun (called “vital 
rays” until more is known about them) will not pass through ordinary 
window glass or clothing. Hence while there may be plenty of what seems 
to be sunlight, the vital, stimulating rays do not reach one through ordinary 
window glass or through one’s clothing. They will, however, pass through 
quartz glass which unfortunately is very expensive. The eyes may be pro- 
tected from too much visible, infra-red and ultra-violet light by tinted glasses. 
For this purpose sage green and smoky glasses are usually preferred except 
in certain industries. There is still much to be learned concerning light and 
the effects of light and other rays so that this study is still in its infancy. 
There are two general methods of artificial lighting or illumination: 1. Direct; 
and 2. Indirect. 
In the direct method of lighting the light rays progress directly from their 
visible source. The disadvantages are glare, shadows and unequal diffusion 
of light. 
In the indirect method of lighting the lights are concealed behind a screen. 
The light is thrown by a reflector against a light surface (usually the ceiling) 
which reflects and diffuses the light more evenly throughout the room, pro- 
ducing a soft, pleasing illumination without glare. This form of lighting is 
more expensive, however, and a combination of direct and indirect lighting 
is usually used although the totally indirect method is less tiring to the eyes. 
In living spaces, wards and sick rooms there should be plenty of light where 
it is needed. The light should come from the back or sides, and be so located HYGIENE AND SANITATION 
435 
as to prevent shadows or bright lights in the field of vision. The amount of 
light falling on a surface is usually measured in foot-candles, one foot-candle 
being the amount of light falling on a surface one foot away from a standard 
candle. Instruments for measuring the lights are called light meters, photome- 
ters, foot-candle meters, or photo-electric light meters, depending upon the 
principle by which they are operated. For ordinary reading 10 to 20 foot- 
candles should fall on the surface of the book or paper, depending upon the 
color of the paper and other factors. For very fine or exacting work such 
as watch making, reading verniers, operating, etc., from 100 to 200 foot-candles 
should be available. 
The standard for natural light in buildings is one square foot of window 
space to 5 square feet of floor space. Roughly there should be one moderate- 
sized window for each bed in barracks and hospitals. There should be plenty 
of sunshine in the sick spaces, even if the patients have to wear tinted glasses 
to eliminate the effects of glare on the eyes. The most suitable colors for ceil- 
ings and upper walls are white or light buff, for lower walls the lighter combi- 
nations of green and yellow. Dark colors should not be used for this purpose. 
Eyestrain, provided the vision is otherwise normal, results from overwork 
and consequent fatigue of the muscles of accommodation of the eye, which 
regulate the amount of light striking the retina. It is produced by excessive 
light and brilliant points of light in the field of vision, flickering or irregular 
light, and insufficient light, especially when reading, writing or performing 
work requiring continuous or exacting use of the eyes. Continued use of 
strained eyes may lead to permanent damage to the eye as well as reflex troubles, 
such as headaches, indigestion, lassitude, styes, etc. Preventive measures 
against eyestrain are indicated by the causes. 
The housing of naval personnel constitutes one of the most serious problems 
with which military and naval sanitarians have to deal, because the nature of 
the “service” brings large numbers of men into close association, with a constant 
tendency, especially in war time, to “crowd” as many men as possible into 
barracks and on board ship. Overcrowding always is conducive to the spread 
of the diseases transmitted by the discharges of the mouth and nose and also 
is conducive to the dissemination of vermin. Under the close associations of 
barrack life, or life aboard ship, the types of bacteria found in the nose and 
throat tend to become uniform among the personnel, through the agency of 
the “droplet spray” issxung from the mouths and noses of persons when talking, 
laughing, coughing, and sneezing. 
Thus the percentage of those who will become carriers of such pathogenic 
microorganisms as pneumococci, streptococci, meningococci, diphtheria bacilli, 
etc., if those bacteria are introduced, will be greater than among the same 
number of persons housed under ordinary conditions. The general principle, 
therefore, is that small barracks, preferably small individual buildings or units, 
are safer than large barracks. Large barracks should at least be divided into 
compartments to house the occupants more or less separately in groups as 
small as consistent with military and administrative requirements. No bar- 
rack room should house more than 50 men. 
For housing in barracks the sanitary standards given in the Manual of the 
Medical Department, U. S. Navy, require that in all dormitories or sleeping 
rooms there shall be per man a minimum of 50 square feet of floor space, 450 
cubic feet of room space, and 5 feet of distance between the heads of sleeping- 
men. Hammock fastenings usually provide a 12-foot swing to avoid exceeding 
the first and second of those requirements and hammocks are placed 2y2 to 3 
feet on centers and alternate men are required to sleep with their heads in 436 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
opposite directions. Toilet and bathing facilities are based on 1 toilet for every 
20 men; 1 foot of trough urinal for every 20 men, or 25 men to each individual 
urinal fixture; 1 lavatory, or 2 linear feet of trough lavatory or wash sink, for 
every 5 men; and 1 shower for every 25 men. 
At stations or on ships having laundries, provisions should be made to 
launder as much of the men’s clothing as conditions will permit. Special 
effort should be made to wash underwear, handkerchiefs, and socks as the 
process of thorough laundering will kill any pathogenic bacteria and fungi 
they might contain. 
At first it might seem that with a large number of men living together in 
such a small space as the various decks of a ship afford, the dangers of over- 
crowding and density of population would produce their maximum effect. 
The experience has been that the effects produced are not nearly so serious 
as occur ashore in recruit barracks under similar conditions. The chief reason 
for this is that the men aboard ship tend to divide into groups according to 
occupation or duties; they are “seasoned” men thoroughly accustomed to their 
environment, whereas ashore the reverse is usually the case (the admission 
rate among recruits being about three times greater than that for seasoned 
men) ; there is less opportunity for the introduction of new and virulent 
strains of pathogenic microorganisms; the mode of living is very regular and 
moderate; the men are under constant and close surveillance for the detection 
of sickness; and finally the sanitary and ventilation conditions are good. 
Possibly the greatest health handicap for men at sea is the frequent inability 
to procure fresh milk, fruits, and vegetables. (See “Mass immunity,” p. 376.) 
Navy regulations require that sports and exercises be encouraged. Special 
effort should be made to get the men whose duties confine them to the lower 
decks into the open air and sunshine. This benefits morale as well as increases 
the resistance to disease. Swimming is an important exercise and sport in 
naval life. Every one should be qualified in swimming. Drowning (much 
of which is preventable) is one of the leading causes of death from year to 
year in the Navy. 
Careful regulations should be framed for the ship’s barber shop and enforced 
to prevent the spread of any disease through insanitary barbering methods. 
Soil and its relation to health and disease. 
Were it not for the self-purifying power of the soil, the human race would 
have disappeared long ago. All water, except rain water caught and stored 
in cisterns, passes over or through the soil layer of the earth; therefore a 
brief consideration of the relation of soil to health and disease naturally precedes 
the study of water. Aside from this, certain pathogenic microorganisms remain 
alive for long periods in the soil by means of highly resistant spores and cause 
what are known as the “soil” diseases—tetanus, gas gangrene, botulism, anthrax, 
and malignant oedema. The most frequent and dangerous form of soil pollu- 
tion, however, is that by the human intestinal and urinary wastes, causing 
typhoid and paratyphoid fever, bacillary and amoebic dysentery, hookworm 
disease and infestation by round worms. 
Purification of the soil is largely effected by the “soil” bacteria or saprophytes, 
i.e., bacteria which live upon decaying organic matter. Saprophytic bacteria are 
found almost wholly in the superficial layers of the soil, often occur in millions 
to the cubic centimeter and are largely responsible for all decay. When dead 
organic matter reaches the soil it is attacked by these bacteria, and after passing- 
through many chemical changes, is finally reduced to simple chemical compounds, HYGIENE AND SANITATION 
437 
thereby making available for plants the carbon, nitrogen, and other compounds 
locked up in the dead bodies of animals and plants. The various species of these 
bacteria, both aerobic and anaerobic, develop mutually. The so-called “nitrogen 
cycle” which occurs in the soil is an illustrative example of this action. Sapro- 
phytic bacteria break down the dead nitrogeneous or protein matter into ammonia 
and carbon dioxide. The ammonia is further changed by “nitrifying sapro- 
phytes” into nitrites, then into nitrates, which dissolve in the soil water. In this 
way plants get their supply of nitrogen, without which they will not grow. 
Microorganisms pathogenic to man require a food supply and the conditions 
found in the human body to reproduce. These conditions are not found in the 
soil, where also the millions of saprophytes accustomed to soil conditions act 
upon the pathogenic bacteria and rapidly kill them unless they can form 
spores or the soil is very highly polluted. Unfortunately the typhoid bacillus, 
one of the most dangerous pathogenic bacteria found in soil polluted by 
human excrement, withstands adverse influences, even freezing, for long periods. 
In the tropics, where soil pollution with faecal matter is common, and the 
soil is moist, together with a favorable temperature for bacterial growth, the 
constant presence of diseases transmitted by the intestinal discharges is readily 
explained. 
The prevention of all such intestinal diseases rests solely in the sanitary 
disposal of faeces and urine. 
Water and its relation to health and disease. 
Water is a prime necessity of life, not only as an article of diet, but also for 
the proper cleanliness of person, clothing, and other objects used by man, and 
for other purposes. 
While water is not strictly a food it forms an important part of the diet. A 
man can go without food a long time but he cannot live over 4 or 5 days 
without water. 
The tissues are constantly being bathed in a fluid, and water forms the 
chief ingredient of all the fluids of the body. It distributes body heat and 
helps to regulate the temperature of the body by the physical process of absorption 
and evaporation. And it should be remembered that man must depend upon 
water for elimination. 
Large quantities of water are required for flushing purposes in modern 
sewage systems, as well as for manufacturing. It not only “washes” the 
surface of the earth carrying with it pollution, but bodies of water, especially 
rivers, are utilized for the disposal of sewage. Hence there are the “water 
borne” diseases—typhoid and paratyphoid fever, cholera, and the dysenteries— 
from water polluted with human intestinal and urinary wastes. 
On shore, provisions should be made to provide not less than 15 gallons of 
water per diem per person, and the Bureau of Yards and Docks figures on 
125 gallons per day per man in designing water systems. The allowance of 
fresh water for all purposes aboard ship should never be less than 5 gallons per 
capita per diem. The members of a crew or the personnel of a command 
should be allowed sufficient water to meet the requirements of good personal 
hygiene. 
The sources of water supply are conveniently considered as (a) rain water, 
(ft) surface water, and (c) ground water. In addition, the Navy procures much 
of its water supply aboard ship by the process of distillation. 
Rain water (snow or crystallized moisture), when collected and stored under 
sanitary conditions, is the purest of all natural waters. The rain should be 438 
HANDBOOK OF THE HOSPITAL CORPS, V. S. NAVY 
allowed to fall for a short period to wash the atmosphere and also the surfaces 
from which the water is collected. Cisterns should be of the same sanitary 
water-tight wall construction as wells and carefully protected against pollution. 
Cisterns and rain barrels, like all similar collections of water, should be screened 
to prevent mosquito breeding. 
Surface water includes bodies of water which collect upon the surface of 
the earth, such as streams, lakes, ponds, and impounding reservoirs. Streams 
form natural sewers for the sur- 
rounding terrain, therefore sur- 
face water always must be puri- 
fied before it is used for human 
consumption. Swimming should 
not be permitted in polluted 
water. 
Ground water is that which 
permeates into the “ground” 
and is obtained from springs, 
shallow wells, and artesian wells, 
according to the water-bearing 
strata from which obtained. 
These water-bearing strata lie 
above impervious strata of clay 
and flow toward large bodies of 
water, which explains why wells 
can be sunk and fresh water 
obtained next to bodies of salt 
water. 
Springs are formed when 
ground water—that above the 
first impervious stratum—over- 
flows upon the surface as a re- 
sult of the geological formation. 
Spring water is safe provided it 
does not “spring” from lime- 
stone formation, and the drain- 
age area around the spring is 
protected against contamination. 
Shallow wells tap the first 
water-bearing stratum, and the 
water is usually of excellent quality and safe for drinking purposes, provided it 
is not from limestone formation and the well is properly constructed. The walls 
should be solid masonry and extend 12 to 18 inches above the surrounding ground 
level to prevent surface drainage into the well. (Fig. 122.) The top covering 
should be tight—pollution of shallow wells usually occurs through or around 
the top. Near the surface of the soil microorganisms tend to die and are 
filtered out together with other pollution as the water percolates down through 
the sand and gravel. 
Artesian wells penetrate an impervious stratum of the earth’s surface and 
provide a safe and satisfactory supply of water. (Fig. 123.) 
Water obtained from limestone formation always should be regarded with 
suspicion, because the water may flow through the large cracks and crevices 
found therein, unacted upon by the purifying processes of the soil. Pollution 
may enter from privies, etc. 
Figure 122.—A model well, cased with brick laid 
in cement mortar and properly graded, curbed, 
and protected. (Virginia Health Bulletin.) HYGIENE AND SANITATION 
439 
Figure 123.—Geological formation favorable to the obtaining of water by means of artesian 
wells. (Harrington.) 
Figure 124.—A diagram showing the general plan of the apparatus used for distilling salt 
water on board ship. The salt water is evaporated by means of steam coils which pass 
through it. The vapor is then distilled, being cooled by passing around pipes in which 
salt water is circulating. (Gatewood.) 440 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Ships, when away from sources of pure water, procure fresh water by the 
evaporation of salt water taken from over the side and condensing the resulting 
vapor, thus removing not only the salt, but all other impurities and bacteria. 
(Fig. 124.) Due to the vigorous boiling, the evaporators sometimes “prime,” and 
droplets of salt water are carried over into the distilled water; also there may 
he leaks in the condenser coils, when impure salt water would contaminate the 
distilled water. For these reasons the distilled water is constantly tested for 
sodium chloride (salt), and if found in appreciable amounts the plant is 
stopped until the trouble is located and corrected. 
Fresh water on hoard ship is stored in tanks which frequently need cleaning. 
The tanks should be entered if possible from manholes at the side to reduce the 
danger of contamination from without. Only men free from disease should be 
permitted to enter the tanks to scrub and clean them. They should wear clean 
rubber boots and clean clothing. After cleaning, a steam hose should be inserted 
and the tanks thoroughly steamed before freshly distilled water is run into them 
again. 
Before any water supply is accepted for human consumption and fre- 
quently during its operation, a water supply should be subjected to a proper 
sanitary analysis, including: 
1. A physical examination to determine odor, color, turbidity, taste, etc. 
2. A microscopic examination to determine the number and character of the 
particles in suspension, especially algae. 
3. A chemical examination to determine the amount and nature of chemical 
impurities, principally free oxygen and the oxygen-consuming power; chlorides; 
ammonia (free or albuminoid) ; nitrites and nitrates. The latter (nitrates) 
are the terminal stages of the decomposition of nitrogenous matter brought about 
by the saprophytic bacteria. 
4. A bacteriological examination to estimate the number and kind of bacteria 
present. The bacillus coli is the most important, because it is constantly 
present in the intestinal discharges of man and animals and, if found in 
water, it indicates pollution with intestinal wastes. When present it is logical 
to assume that the pathogenic microorganisms contained in the intestinal wastes 
of carriers or persons infected with cholera, typhoid and paratyphoid fevers, 
and the dysenteries might be present also. This is the most important single 
test to determine the purity of water. 
5. A sanitary survey of the watershed, including methods of collecting, 
handling, storing, and distributing water, to discover possible sources of 
contamination, and the degree and kinds of pollution. 
6. A clinical survey of the persons who have been drinking the water for 
cases of the diseases transmitted by the Intestinal discharges. 
While not of so much sanitary importance, the hardness of water is of great 
economic importance. 
Hardness of water is due to the amount of chemical salts dissolved therein. 
Water, being practically a universal solvent, dissolves chemical salts as it 
passes through the soil. Hardness may be temporary or permanent. 
Temporary hardness is due to the soluble bicarbonates of calcium and 
magnesium. Boiling removes these by driving off carbon dioxide and pre- 
cipitating the insoluble carbonates of calcium and magnesium. 
Permanent hardness is due to the permanently soluble chlorides and sul- 
fates of calcium and magnesium. 
When persons begin to drink hard water they usually suffer from varying 
degrees of diarrhoea. This is the chief virtue of the so-called “medical” and 
“mineral” waters. In regions where there are deposits of sulfur are found HYGIENE AND SANITATION 
441 
sulfur springs and wells; in the vicinity of iron deposits chalybeate or iron 
springs and waters are found. 
In regions where there is no iodine in the water, goiter is often present. 
In recent years it has become a practice in such regions to add small amounts 
of iodine to the water to prevent goiter. The iodine also may be supplied by 
using “iodized” salt, or by administering chocolate wafers containing iodine. 
Water purification is practiced principally to remove all traces of contamina- 
tion with intestinal discharges. By the purification of water and the sanitary 
disposal of intestinal and urinary wastes the pestilential outbreaks of cholera, 
typhoid fever, and dysentery can be and are being prevented. 
The following are the principal methods used in water purification; 
1. Clarification by sedimentation. 
2. Filtration by (a) slow sand filters; (ft) rapid, mechanical, gravity filters; 
and (c) pressure filters. 
3. Sterilization with (a) chlorine; (b) ultra-violet rays; (c) ozone; and 
(d) copper sulfate. 
Sedimentation is used to clear muddy or colored water. It may be natural 
by simply slowing the current or allowing the water to stand; or chemical 
when coagulants, such as aluminum sulfate alone, or a combination of iron 
and lime, are added. These form a “floe” which settles to the bottom, leaving 
a clear water. Coagulants are used chiefly in connection with mechanical 
filters. 
Slow sand filters are an imitation of Nature’s purification process. Each 
filter is about an acre in size, either open or closed, and consists of tile drains (to 
carry oft the filtered water) overlaid with a filter bed consisting of to 2 
feet of coarse and fine gravel and 2 to 3% feet of coarse and fine sand in con- 
crete basins. The water to be filtered, usually about 3% feet in depth, need not 
be previously treated by precipitants or coagulants, but may he subjected to plain 
sedimentation. A film of protozoa, saprophytic bacteria, and microscopic 
plants, which is analagous to the upper layers of soil, removes organic impuri- 
ties in the water and kills pathogenic bacteria by biological action. These are 
filtered out as the water passes by gravity through the sand and gravel. This 
is a very efficient method and was preferred until the development of liquid 
chlorine as a sterllizant. 
Rapid, mechanical, gravity sand filters are characterized by the use of chem- 
icals to coagulate and precipitate suspended organic matter in the water and 
by sedimentation of the water to remove turbidity and the coagulated material 
before passing into the filters. The chemical coagulants or precipitants most 
commonly used are aluminum sulfate and iron and lime combined. Sedimen- 
tation may be accomplished by slowing the velocity of a stream or by allowing 
the water to stand in large surface ponds or in sedimentation or settling tanks. 
Purification of water by this method of filtration is being used more and more 
especially since apparatus for treating water with liquid chlorine has been 
developed, thereby insuring complete sterilization of water. The filtering ma- 
terial consists of about 12 inches of graded gravel upon which rests about 30 
inches of graded sand. This type of filter clogs easily and requires frequent 
cleansing. 
Pressure filters are closed tanks with a filter bed similar to the foregoing, 
the water passing through under pressure rather than by gravity. They are 
useful only for small supplies. 
Sterilization may be applied to raw water after sedimentation or after filtra- 
tion. It is a final and safe means of purification, provided of course it is prop- 
erly done. 442 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Chlorine is the most important of all disinfectants used for water purification. 
It is used as a gas compressed into a liquid and stored in steel cylinders for large 
water supplies; or as chlorinated lime for small water supplies, in the field, and 
for tanks on board ship. Chlorine, by its chemical reaction with water, liberates 
nascent oxygen upon which its bactericidal action largely depends. The process 
is, therefore, one of oxidation. Organic matter also has a great affinity for 
nascent oxygen and absorbs or fixes it before it can react with bacteria. Con- 
sequently the amount of chlorine required for a given water depends upon the 
quantity of organic matter contained. Ordinarily, liquid chlorine is used in 
from 0.1 to 0.5 parts per million for relatively pure waters. Chlorinated lime 
(30 per cent available chlorine) should be used in the proportion of 1 gram per 
36 gallons of water. This will give about 1.5 parts available chlorine per million. 
Ozone and ultra-violet rays can be used only in very clear and colorless 
waters. They are very expensive. Ultra-violet rays are frequently used for 
sterilizing the water used in swimming pools. 
Copper sulfate is used chiefly to kill algae. 
Sewage and refuse. 
The term sewage includes not only human excreta, but the other solid and 
liquid wastes from human habitations and factories usually discharged into 
sewers. It varies greatly according to time of day, season, and character of 
the community, but ordinarily contains about 99.9 per cent of water. The re- 
maining constituents include objectionable substances such as floating solids, 
fats and oily products, settleahle solids, putrescible matters, and bacteria. 
By refuse is meant all other solid waste matter resulting from the natural 
activities of a community, such as garbage, ashes, rubbish, street cleanings, 
manure, etc. 
Typhoid fever and paratyphoid fever, cholera, dysentery, and hookworm dis- 
ease are spread by intestinal discharges and are frequently termed “sewage 
diseases.” The disposal of sewage in such a manner that the bacteria and par- 
asites which cause these and other such diseases are destroyed before they can 
reenter the body in any manner constitutes a real problem in preventive medicine. 
Underlying all methods of sewage disposal are certain basic principles that 
have as their object the getting rid of sewage as speedily as possible, with the 
least nuisance to the fewest people, with the least danger to health and prop- 
erty, and at the lowest cost. 
Sewage-disposal methods fall under two general systems; The water-carriage 
system, and the dry system. 
The water-carriage system is based upon the principle of transferring the 
sewage from the immediate community to some other place where it can be 
disposed of in accordance with the existing conditions. A plentiful supply of 
water is required for flushing purposes. Final disposition is carried out in two 
general ways: 1. By discharging the sewage into bodies of water, the dilution 
method; or 2. By various treatment and purification processes. 
Dilution is the oldest, simplest, and cheapest method of disposal of sewage 
and is suitable when, by dispersion in water, the impurities are disposed of 
without nuisance or menace to health. The process of purification depends 
upon certain chemical and biological changes for which a sufficient supply of 
free or “dissolved” oxygen in the water is essential. Under suitable conditions 
the complex organic matter is broken up and oxidized by saprophytic bacteria 
into simpler forms, such as nitrates, carbon dioxide, and water, as noted under 
the section on Soil. Bacteria are food for protozoa, the dissolved matter for 
algae; protozoa and algae are food for crustaceae, and these in turn for aquatic HYGIENE AND SANITATION 
443 
animals and fishes. Animal life requires oxygen and produces carbon dioxide, 
while plants consume the latter and produce oxygen. If the chemical balance 
(oxygen) is disturbed, the biological cycle just described is broken and a 
nuisance follows. There are many places where the dilution method is not 
always suitable unless the sewage is given some form of treatment, varying 
with local conditions as to degree and cost. 
The determining factors as to the suitability of the dilution method are: (a) 
The amount and character of water in the receiving body, with reference to 
degree of sewage dilution and available dissolved oxygen; (6) The temperature 
of the water in the receiving body and of the atmosphere; (c) The current in 
the receiving body, with reference to diffusion and transfer and as to constancy 
of flow, whether constant in direction and force or tidal; (d) The proximity of 
sewer outlets to intakes for water supplies; and (e) The possibility of infecting 
waters at bathing beaches and other recreational areas, waters used by grazing 
cattle, or waters from which edible fish and shellfish are taken for human con- 
sumption. In other words, waters from which living pathogenic bacteria might 
directly or indirectly gain entrance to human bodies and cause disease are not 
suitable for use in the dilution method of sewage disposal. 
The sewage of practically all ships and naval stations is disposed of in 
this manner. 
Sewage treatment, by which it is purified, is necessary when sewage cannot 
be discharged into bodies of water without endangering the health of others. 
The following procedures are employed separately or in combination in the 
treatment of sewage: 
1. Separation and removal of suspended matter by: 
a. Screens, coarse and fine, to remove matter such as wood, cans, etc. 
b. Skimming tanks provide by flotation for the collection and removal 
of oil, grease, wood and other floating matter. 
c. Grit chambers usually precede a treatment process for the separa- 
tion and retention of sand, cinders, and other mineral matters. 
d. Plain sedimentation where sewage is retained one to four hours 
to permit the process of clarification whereby solids are deposited 
by sedimentation unaided by chemicals. 
e. Sedimentation with chemical precipitation. 
f. Filtration and activation. 
2. Destruction or liquefaction of organic solid matter in liquid sewage 
by anaerobic decomposition in: 
a. Single-story septic tanks. 
b. Two-story septic tanks of Imhoff or Emscher type. 
3. Transformation of the organic matter to a condition of stability with 
oxidation processes such as: 
a. Irrigation. 
b. Sand filtration. 
c. Contact beds. 
d. Trickling filters. 
e. Activated sludge. 
4. Destruction of pathogenic bacteria by: 
a. Disinfection with chlorine. 
5. Disposal of sludge by: 
a. Dilution. 
Single-story septic tanks are ordinary flat-bottomed sedimentation tanks 
fitted with baffles to retard the flow and retain the sewage from 8 to 24 hours. 
The sludge remains for longer periods. They have a double function, one 
154294°—39 29 444 
HANDBOOK OF THE HOSPITAL CORPS, II. S. NAVY 
relating to sewage clarification by sedimentation and the other to the decompo- 
sition of organic solids by anaerobic saprophytes. 
Small septic tanks are frequently unsatisfactory because they give trouble 
from very foul odors from the released gases. Digestion also is often incomplete, 
due to the necessity for frequent removal of the sludge in order to insure 
adequate sedimentation space. 
Two-story septic tanks consist of an upper sedimentation compartment and 
a lower compartment for storage and digestion of the sludge. The two com- 
partments are separated by sloping walls having narrow slots at the bottom 
which permit settleable solids in the upper compartment to continuously pass 
into the lower. The gases generated in the sludge are diverted into gas vents 
and do not pass upward into the sedimentation compartment. Such tanks are 
called Emscher or Imhoff tanks. 
Two-story tanks have proved to be more satisfactory than the single-story 
septic tanks. Under trained and intelligent operation many have produced 
thoroughly digested sludge without the occurrence of extensive odors. 
Both types of septic tanks when first put in operation must be “seeded” 
with sludge from other tanks in use containing the anaerobic saprophytic 
bacteria. 
If the effluent from septic tanks cannot be discharged into bodies of water 
without danger of contaminating water supplies, bathing beaches, or shellfish 
areas, it must be further purified. It has been seen that in the septic tanks 
the solid organic matters were broken down and some degree of purification 
was effected by the action of the anaerobic saprophytic bacteria. In the follow- 
ing process the purification is brought about mainly by aerobic bacteria, oxida- 
tion, and filtration. The chief purification methods are as follows: 
Contact beds are constructed of crushed stone, cinders, etc., in series of two 
or three, the sewage flowing from one bed onto another. Purification is effected 
by physical oxidation with atmospheric oxygen, sunlight, biological action of 
aerobic bacteria, animal and vegetable life, and finally filtration. 
Sprinkling filters are beds constructed of crushed stone, cinders, etc., and 
the sewage is applied to them by means of a fine spray from sprinkler nozzles, 
whereby the sewage is saturated with atmospheric oxygen. Otherwise the 
purification is substantially the same as occurs in contact beds. 
Intermittent sand filtration l>eds are filled with coarse sand over a layer of 
gravel. The sewage, without any preliminary treatment other than being passed 
through screening and grit chambers, is flowed onto the beds. The purifying 
action is due to oxidation, both aerobic and anaerobic bacteria, animal and vege- 
table life, and filtration. The beds must be allowed to rest intermittently to 
permit the breaking down and oxidation of the material which otherwise would 
clog them. 
The activated sludge process consists of aeration of sewage in tanks in 
contact with sludge from previously aerated sewage. The air is introduced 
from the bottom, produces greater oxidation, and also permits increased aerobic 
bacterial action. 
In the sterilization of sewage liquid chlorine is used as in water purification. 
It is most effective when mixed with the effluent from the purification processes 
and is applied to insure the death of practically all the microorganisms. 
In the dry system of sewage disposal faecal and urinary matters are re- 
ceived in pails or water-tight receptacles, which are regularly replaced by empty 
sterilized containers. This system, also known as the bucket system, is 
suitable for isolated houses or small groups of houses and for temporary camps 
where the natural drainage is into the public water supply or where there is HYGIENE AND SANITATION 
445 
insufficient water available for the water-carriage system. It is frequently 
used in military operations and has the advantage of immediate availability. 
The safety of the system depends upon proper care by the user and the 
collector—cleanliness in handling, prompt and frequent collection, disinfection 
of receptacles, protection of faecal material from flies, and final incineration 
or burial in a suitable locality or discharge into sewers. 
Aboard ships at sea the dry refuse, such as paper, boxes, etc., is burned in 
the fire boxes of the boilers on coal-burning ships or in incinerators on modern 
ships. Tin cans are punctured and thrown overboard. Wet garbage is dis- 
charged over the side through slop chutes. 
In port, trash, garbage, and ashes have to be disposed of in lighters provided 
for those purposes. In navy yards, bins and containers are provided by the 
yard authorities and the refuse removed by them. Scrupulous cleanliness 
should be observed with garbage and trash containers to avoid unpleasant 
odors and attracting flies and rodents. Garbage cans always should be covered 
tightly. 
Refuse ashore is generally estimated at one ton per person per year. It 
varies according to season and community. Methods of collection and disposal 
are as follows: 
Collection Methods. 
1. Separate method, in which wet garbage 
is placed in one container, trash in 
another, and sometimes ashes in an- 
other. 
2. Mixed collection, in which all wastes are 
placed in one container, the dry mat- 
ters absorbing the excess liquid. 
Disposal Methods. 
Garbage is fed to hogs or subjected to 
reduction. In the latter case, the garbage 
is boiled in cookers, the fat skimmed off 
and sold for making soaps, candles, etc.; 
the tankage remaining in the cookers is 
dried and sold for making fertilizers. 
Ashes and noncombustible materials are 
used for filling. 
Incinerated or used for filling purposes. 
Clothing. 
The chief purposes of clothing are to maintain the temperature of the body, 
to hinder as little as possible the body’s heat regulating mechanism by per- 
mitting evaporation from the skin, to afford free movement of the body, and 
to protect the body from injury by heat, cold, wind, rain, snow, etc. 
Clothing is derived chiefly from the animal kingdom, which jirovides wool, 
leather, fur, and silk, and the vegetable kingdom which provides cotton, linen, 
rubber, paper, and other fibers. 
The structure of the principal clothing fibers is as follows: Wool fiber is 
large and is made up of scales of hairs overlapping like shingles on a roof, 
which take up and hold moisture and large quantities of air. When spun into 
yarn from which cloth is woven it enmeshes greater quantities of air. Cotton 
fiber is flat and twisted spirally. Cotton thread is compact and contains prac- 
tically no air. Silk fiber is a small, smooth tube. Linen fiber is cylindrical 
with cross lines indicating division of cells. 
The value of material used for clothing depends upon its action in relation 
to the amount of air enmeshed in its fibers, its action in relation to moisture, 
and its special adaptability to varying needs and conditions. Air is a poor 
conductor of heat and if much of it is contained in the meshes of clothing 
it makes the clothing warm. Added layers of clothing give additional layers 
of air and thereby decrease heat loss. Water is a good conductor of heat 
and if clothing material takes up moisture rapidly and also permits its rapid 
evaporation heat is extracted from the body too quickly and chilling results. 446 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The color of clothing has a bearing on its warmth, dark colors absorbing 
heat while light colors reflect away heat waves. Consequently white and 
light-colored garments are worn when the sun is hot, and dark-colored ones in 
cold weather. 
Wool, being the natural covering of animals, and its structure as noted before, 
makes the warmest garments. It is woven in such a manner as to entangle 
great quantities of air, which being a poor conductor of heat, prevents sudden 
lowering or raising of the body temperature. It takes up moisture readily, but 
gives it oft slowly; thus reducing the “cooling by evaporation.” When saturated 
with moisture, its fibers still contain much air, which also checks rapid loss of 
heat. A good example of the effect of these qualities is the use of woolen gar- 
ments by athletes and others who are exposed to cooling temperatures when wet 
with perspiration. Wool is very irritating to the skin, costly, wears poorly, and 
shrinks greatly. 
Leather is used for hard wear and as a wind breaker. 
Fur protects against the wind and cold because of the impermeability of the 
basic skin, and the large amount of air about the hairs. 
Cotton fiber and thread contain very little air, and therefore do not make 
warm garments. However, it can be woven so as to entangle air, as in fleece- 
lined underwear, flannelette, etc., which are warm and soft. It gives off 
moisture rapidly and contains practically no air when saturated, hence wet 
cotton garments are chilling. Cotton is cheap, very durable, and is used gen- 
erally for light, cool, summer garments and for making underwear. 
Linen has much the same properties as cotton, but like silk is not used in 
the Navy. It makes excellent tropical clothing. 
Paper at present has no wide adaptability for clothing purposes. It is used 
chiefly as a wind breaker. Its sanitary uses are increasing, however, as for 
towels, napkins, handkerchiefs, dishes, etc. It is cheap and when contaminated 
with human body discharges can readily be burned. 
Rubber and rubberized garments are used to protect against wet conditions. 
Garments can be treated with nonhygroscopic chemicals such as aluminum 
acetate, which causes them to shed water. This is called cravenettlng. 
From the foregoing it can be seen that in so far as materials and colors are 
concerned the Navy uniform is based on sound scientific principles. This is 
further enhanced by adapting the “uniform of the day” to the weather 
conditions as advised by the medical officer. 
In the tropics, the head and back of the neck should be protected from the 
direct rays of the sun. 
The relation of insects, vermin, and rodents to disease and methods for their 
extermination. 
The primary considerations in the control of insects and pests and the 
prevention of the diseases transmitted by them are; To prevent them from 
breeding, to prevent them from coming in contact with infected cases, to 
remove all possible sources of food supply, and to use all possible control 
measures constantly. 
Not only are mosquitoes bothersome pests, but they are responsible for the 
transmission of malaria, yellow fever, filariasis, and dengue fever. Patients 
with such diseases always should be thoroughly screened to prevent access of 
mosquitoes. Anopheles mosquitoes breed in semiwild conditions in swamps and 
bogs; the disease-transmitting Culex and Aedes varieties breed about human 
habitations. Neither species flies ordinarily more than half a mile; therefore 
control measures against the disease-transmitting mosquitoes need not extend 
beyond that distance from the community or camp. HYGIENE AND SANITATION 
447 
The development of mosquitoes may be conveniently studied in two general 
stages, the aquatic and the aerial stages, and control measures correlated 
therewith. 
The eggs of mosquitoes are always deposited in water and hatch in 1 to 2 
days into larvae or wrigglers, which change into shrimplike bodies called pupae 
in about 7 days. As mosquitoes require stagnant water for breeding, the 
most important of control measures is to get rid of the standing water by 
filling up depressions or draining off the water through subsoil or open drains. 
Drains should be as few as possible, clean cut, with sloping edges, narrow 
bottoms, and straight courses; lateral drains should connect at acute angles 
(“fishbone”) to lessen deposits of silt. Frequent inspection and thorough 
upkeep of drains is necessary. If the water cannot be drained off, crude oil 
or kerosene or mixtures of these can be spread over the surface to suffocate 
the larvae and pupae which must have air to live. If the water is not to be 
used for humans or animals, larvacide (containing phenol) can be added 
to the water to kill the larvae and pupae; Paris green diluted with an inert 
dust also is spread over the water for this purpose. Water in cisterns, rain 
barrels, etc., should be screened to prevent access of mosquitoes to breed. 
Larvae-eating fish can be added to ponds, cisterns, etc., where oiling, larvacides, 
or screening are not applicable. Vegetation which slows water and forms 
breeding sites for mosquitoes should be cleared from the banks of streams 
and ditches. Tin cans should be flattened or punctured and jugs and bottles 
broken, etc., in order to eliminate all standing water. 
The aerial stage of development begins when the adult winged mosquito 
emerges from the pupa in 2 to 12 days, the entire metamorphosis from egg 
to adult requiring 9 to 12 days, according to weather conditions. Principal of 
control measures for adult mosquitoes is thorough and complete screening con- 
taining not less than 16 meshes to the square inch, preferably 20 meshes. In- 
secticides, such as sulfur-dioxide gas, burning pyrethrum or camphophenique, or 
one of the many insecticide sprays on the market are useful. Volatile or pungent 
liquids such as oil of citronella may be applied to the skin or clothing to repel 
them; the mosquitoes return, however, after the oil has evaporated. In malarial 
regions a valuable preventive measure is to destroy engorged Anopheles mos- 
quitoes attempting to escape from sleeping quarters in the morning. Thick 
shrubbery harbors adult mosquitoes and should be cut or burned away. 
Differentiation of mosquitoes and their morphological characteristics will be 
found under Parasitology in the section on Laboratory Procedures and 
Technique. 
Flies may transmit many diseases under the following conditions: By having 
access to human body discharges (fseces, urine, sputum) containing infectious 
microorganisms (Fig. 125) ; by having access to contagious or infectious mate- 
rials on the external surface of the body; and by biting and carrying infection 
from one person or animal to another, as in African sleeping sickness and 
tularaemia. 
The common house fly or, as it is frequently and appropriately called, the 
“typhoid fly,” passes through the following developmental stages: The egg 
hatches into the larva or “maggot” in 8 hours to 1 day; the larva changes 
into the pupa in 4 to' 8 days; and 3 to 5 days later the adult fly emerges 
from the pupa. The entire metamorphosis requires 7 to 14 days or longer, 
according to weather and other conditions. Flies are prolific breeders, it 
having been estimated that a single female fly can produce 810 pounds of flies 
in a single season. {See p, 543.) 448 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
The presence of flies is an indication of nearby filth, as they breed in decay- 
ing garbage, animal manure, and human faeces. The feet of flies have adhesive 
pads enabling them to adhere to very smooth surfaces, and hairs and claws by 
means of which they hold on to rough surfaces. Filth and microorganisms are 
carried about on these pads and hairs. They also possess a retractile proboscis 
which transmits filth. 
Control measures consist of preventing fly breeding by sanitary disposal of 
all body and other wastes, particularly manure; destruction of larvae by kero- 
sene, borax, incineration, etc.; and destruction of adult flies by poisons placed 
in sweetened water, fly paper, live steam, insecticides, and swatting, early in 
the season. No fly should be permitted to live in a sick room, a hospital ward, 
or a sick bay. Food and all body wastes should be thoroughly protected from 
them. 
FINGERS 
Excreta 
FROM 
Patients 
OR 
Germ 
Carriers 
Foods 
(milk) 
Vegetables 
Oysters 
MOUTHS 
or 
Persons 
FLIES 
WATER 
Figure 125.—Illustrating the participation of several routes of dissemination in the propa- 
gation of the typhoid bacillus. (U. S. Public Health Reports.) 
Plague is a disease of rodents transmitted from one to another and from 
rodents to man by the bite of the flea. Rats also are considered the reservoir 
of trichinosis. They are particularly bothersome in trench warfare. Rats eat 
every known kind of food and are prolific breeders, and therefore easily exist 
and multiply everywhere. The estimated annual economic loss in the United 
States due to rats is 1 billion dollars. The Norway or brown rat, to which 
many names are applied, is the most common type. It is very ferocious and 
drives other types away from buildings. 
Numerous control measures are used to prevent the spread of disease by 
rodents. They should be kept from human contact by rat proofing buildings, 
plugging up all rat holes with cement, and screening basements. Their food 
supply should be eliminated by protecting all food, garbage, fodder, etc. Traps 
of all kinds should be employed continually and baited with out-of-season 
foods, taking care to eliminate human odor from about the traps and to place 
them in rat runways, near rat holes, and out of sight. Shops and buildings 
should be fumigated with sulfur-dioxide, carboxide, or hydrocyanic-acid gas. 
Rat guards should be used on all ship’s mooring lines. Poisons may be used 
but are not recommended in view of other available methods and the danger 
of poisoning other animals and persons, especially children. To control rats 
it is necessary to use all possible methods all the time. HYGIENE AND SANITATION 
449 
While there are about 200 species of fleas, only 2 are of medical interest: 
Pulex irritans (the human flea) and Xenopsylla cheopis (the rat flea). As 
noted under rodents, the flea is responsible for the spread of plague, 
which transmission is purely mechanical. The eggs are laid in the cracks of 
floors or in loose earth. If deposited on the animal they drop oft into its 
flea-infested bed. The eggs develop after 2 to 14 days into the larval form, 
which spin silken cocoons housing the larvse, from which the adult fleas emerge 
in 10 to 14 days. The complete metamorphosis requires about 30 days, and if 
deprived of an opportunity to feed, adults die in 6 days or less. If the larvae 
are killed, fleas will soon disappear. Control measures consist of fumigation 
with sulfur-dioxide gas or hydrocyanic-acid gas which destroys them, and 
crude fuel oil, kerosene, or gasoline sprinkled in the nests of animals, the 
cracks or crevices of floors or beneath houses is effective. Posts supporting 
houses can be smeared with crude fuel oil. In using inflammable oils special 
care must be taken to avoid fire. Use the same measures for infested clothing 
as are used for lice. 
Lice transmit typhus fever, relapsing fever, and trench fever and their bites 
may lead directly or indirectly to secondary pathologic conditions of various 
kinds. There are five stages in the development of the louse requiring ordi- 
narily about 16 days; the nit or egg, three molting larval stages, and the adult 
stage. They are insatiable feeders and live on human blood, needing at least 
one feeding a day. They cannot live over 10 days away from the body. There 
are three types of human lice: Pediculus humanus var. corporis, the clothing 
or body louse, Pediculus humanus var. humanus, the head louse, and Phthirius 
pubis, the crab louse. Lice are more common in winter than in summer because 
of the favorable temperature for the laying of their eggs and partly because 
the clothing is likely to remain unchanged and bathing is less frequent. The 
effect of temperature on the occurrence of lice is shown by the fact that lice 
are prevalent in certain places in high altitudes where the climate is cool, 
while in certain places which are low and hot there are very few vermin- 
infested individuals. 
As lousiness results chiefly from overcrowding and insanitary conditions, 
the principal control measures and the best preventives of louse infestation 
are the maintenance of personal hygiene and of a sanitary environment. Cloth- 
ing infested with Pediculus humanus var. corporis can be disinfested with 
live steam under pressure followed by a vacuum to dry the clothes, boiling 
for five minutes, or immersed in 5 per cent saponated solution of cresol for 30 
minutes. Kerosene also is very effective. If males are infested with Pediculus 
humanus var. humanus the hair should be clipped short. In the case of 
females, the hair should be treated with a mixture of equal parts of vinegar 
and kerosene; and covered with a towel for one-half hour; then washed with 
warm water and soap. The kerosene kills the lice and vinegar loosens the 
nits. For infestation with Phthirius pubis the pubic hair should be closely 
clipped and mild mercurial ointment or camphophenique applied. Kerosene 
may be used but care must be taken to prevent burning or blistering the skin. 
General delousing of troops or large numbers of people is carried out by 
having each person disrobe and their clothing bagged and turned over to 
attendants for steam disinfection. An inspection of the body is then made 
for nits, head, or crab lice. If found, the infested parts are clipped or shaved. 
A thorough warm shower is then taken, using liquid soap. Attendants in 
delousing plants should be protected from infestation by wearing vermin- 
proof suits. 450 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The bedbug, Cimex lectularius, is a blood-sucking insect and seeks human 
skin at night in order to obtain nourishment. It has been suspected of being 
a transmitter of many different infections but there is no convincing evidence 
that it is. In biting preparatory to feeding it forces an irritating substance 
into the skin that may cause an urticarial, petechial, or macular eruption, 
and its bites, if numerous, are sometimes quite painful. The bedbug lives 
in cracks and crevices, particularly about beds, is most numerous where there 
are transients, as in boarding houses, hotels, etc., and is known to migrate 
from house to house. The eggs are deposited in cracks and in about 10 days 
hatch into larva1, which pass through five moultings to adults in 2 or 3 months. 
Control measures in bedbug infestation require sterilization of bedding and 
mattresses, which is best done by steam under pressure. Ships or buildings 
badly infested can be fumigated with sulfur-dioxide gas or carboxide gas. 
For metal beds and springs the flame torch or live steam is effective. A 
pyrethrum spray is very efficient. A solution of 5 per cent cresol in kerosene 
may also be used. All liquid or powder insecticides must penetrate into the 
cracks where the bedbug hides and breeds to be effective. Bedding, ashore 
or afloat, should be aired and sunned at least twice weekly, at which time it 
should be examined carefully for vermin. Each piece should be shaken sepa- 
rately. Soothing lotions containing menthol, phenol, and camphor should be 
used on the skin to relieve pain. 
Roaches are among the commonest and most offensive of insects which infest 
human habitations and are under suspicion of carrying several infections, 
including typhoid fever and “meat” poisoning. Cockroaches are nocturnal in- 
sects, hiding in cracks and crevices in the presence of light. They are voracious, 
eating everything or rendering it useless because of peculiar odor emitted. 
The eggs are laid in a hard capsule which almost fills the body of the female 
before it is laid. The eggs hatch and pass through several molts requiring at 
least a year under favorable conditions before full growth is reached. The 
most important control measures are scrupulous cleanliness about all places 
(galleys, bakeries, butcher shops, storerooms, etc.) where food is handled, and 
preventing their access to food. All unnecessary cracks and crevices where 
they breed and hide should be eliminated. Repeated fumigation with carboxide 
gas will destroy them. The usual insecticidal sprays are effective but must be 
sprayed into cracks repeatedly. A concentration of 15 per cent 20-1 pyrethrum 
concentrate with 5 per cent Lethane 384 in deodorized kerosene is an extremely 
efficient spray. Sodium fluoride powder sprinkled in their runways, about 
shelves, closets, drawers, etc., and allowed to remain helps to control them. 
Disinfection and fumigation. 
The distinction between disinfection and fumigation must be kept clearly in 
mind. Disinfection properly applied is of great value in the prevention of com- 
municable diseases. With the destruction of infective discharges and the exer- 
cise of great care and cleanliness throughout the course of a communicable 
disease there is less need for terminal disinfection. The boiling of sheets, pa- 
jamas, towels and similar articles and a thorough scrubbing of the sufaces with 
hot water and soap, and disinfecting of bedding with steam is a more effective 
method of disinfection than by the use of one of the gaseous agents. Gaseous 
fumigation for the bacterial viruses has been discontinued as a sanitary meas- 
ure. Gases, such as formaldehyde, are uncertain in practice and have the 
merest surface action but they cannot be depended on against tuberculosis or 
diphtheria. Fumigation has its place in preventive medicine and is used prin- 
cipally for the destruction of rodents in the control of plague, the extermination HYGIENE AND SANITATION 
451 
of insects, especially bedbugs, and, in exceptional instances, for the extermination 
of mosquitoes as a disease prevention measure. 
The agents used in disinfection are of two types, physical and chemical. 
Physical agents of disinfection include sunlight, burning, boiling, and steam. 
Sunlight is an active germicide, due to the ultra-violet rays contained therein. 
Burning is of unquestioned efficiency and should be used whenever conditions 
permit. Incineration of wastes is practiced more extensively each year. 
Boiling is very effective and of wide usefulness. The articles should be com- 
pletely immersed for not less than 10 minutes in water actually boiling. The 
addition of 1 per cent of carbonate of soda renders the process applicable to 
polished steel and cutting instruments. 
Steam is one of the most satisfactory disinfecting agents. It is reliable, 
quick and may be depended on to penetrate deeply. It may be used as flowing 
steam, or steam under pressure. 
Flowing steam has the same disinfecting power as boiling water when the 
exposure is continued for 30 minutes. Steam under pressure is more power- 
ful as a germicide than flowing steam. After the pressure has reached 15 pounds 
per square inch above atmospheric pressure, the temperature is approximately 
120° 0. (248° F.) and can be depended on to sterilize in 20 minutes. The air, 
being a poor conductor of heat, must be expelled from the apparatus at the 
beginning of the process. 
The best method of applying steam under pressure is in a special apparatus 
with a vacuum attachment, the object of the vacuum apparatus being to expel 
the air and to promote the penetration of the steam. 
Clothing, fabrics, textiles, curtains, hangings, etc., may be treated by either 
of the above methods as circumstances may demand. 
Cooking and eating utensils, after washing, should always be disinfected by 
immersion in boiling water or steam. Where dishwashing machines are used 
the dishes are washed for 1 minute maintaining the temperature of the wash 
water at not less than 160° F, throughout the washing period and rinsed for 
10 seconds with the rinse-water temperature maintained at not less than 180 °F. 
Commonly used chemical agents of disinfection are bichloride of mercury, 
phenol (carbolic acid), formalin, and chlorinated lime. 
Bichloride of mercury is used very extensively, but as it attacks metals it can- 
not be used on them, and must be placed in containers of glass, china, wood, or 
earthenware. It coagulates albumin and therefore cannot be used to disinfect 
albuminous matters. It is incompatible with alkalies and their carbonates, 
lime water, soaps, and most metallic salts. 
Bischloride of mercury is used commonly in a strength of 1:1,000, adding to 
the water used for solution 2 parts per 1,000 of sodium or ammonium chloride. 
Materials to be disinfected should be immersed in that solution for at least 
an hour. It is used for soiled fabrics and to wash down floors and walls. 
Phenol (carbolic acid) is generally used in a 5 per cent solution. It is very 
efficient and is used to standardize disinfectants. Because of its expense many 
cheaper but effective derivatives are employed, chief among which is cresol, 
as in Liquor Cresolis Saponatus, U. S. P. (used in 1; 20 solution). Phenol or its 
derivatives are used to disinfect fteces, urine, sputum, spit kits, contaminated 
clothing or fabrics, walls and decks of compartments. Exposure should be 
for 1 hour. 
“Formalin” is a commercial solution containing not less than 37 per cent of 
formaldehyde gas and is used in a 5 per cent solution (commercial formalin 5 cc, 
water 95 cc). Exposure should be for 1 hour, and when used to disinfect liquids 452 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
or semisolids formalin should be added in sufficient amount to make a 5 per cent 
solution. It has a wide variety of uses and is also an excellent deodorant. 
Chlorinated lime, containing not less than 30 per cent available chlorine, is 
used as a disinfectant by adding 1 pound to 4 gallons of water. This solution 
is satisfactory for mopping floors and walls. For disinfecting faeces, urine, and 
sputum, an equal amount of the solution should be added and allowed to stand 
for 1 hour. 
The principal gaseous agents of fumigation used are hydrocyanic-acid gas, 
sulfur dioxide, carboxide gas, and formaldehyde. 
Hydrocyanic-acid gas is extremely poisonous to all forms of animal life and 
is the most effective and the cheapest fumigant for the destruction of rats. 
It does not harm textiles, foodstuffs, metals or painted surfaces. 
As small quantities of hydrocyanic-acid gas are rapidly fatal to man its use 
as an insecticide is necessarily limited. Its use requires the abandonment of the 
vessels for a more or less protracted time and is reasonably safe only when super- 
vised by experienced personnel. 
Fumigation by hydrocyanic-acid gas on naval vessels is authorized where in 
the opinion of the commanders of forces afloat, the conditions aboard ship are 
considered such as to make fumigation by this process necessary, and where 
rules of the U. S. Public Health Service require cyanide fumigation by that 
service before docking at a United States port. 
It is not a practical method to be used by hospital corpsmen. For a more 
detailed, discussion of cyanide fumigation refer to the Manual of the Medical 
Department, U. S. Navy. 
Sulfur dioxide is a weak germicide hut is exceedingly poisonous to mam- 
malian and insect life. It has feeble penetrating power resulting in an action 
merely upon the surface. It bleaches fabrics and materials dyed with vegetable 
or aniline dyes. It destroys linen and cotton goods by rotting the fibers. It 
attacks almost all metals and therefore machinery and metal parts should be 
first coated with vaseline. As compared to hydrocyanic-acid gas, sulfur dioxide 
is much less dangerous to man but it cannot be depended on to kill more than 
65 per cent of the rats in holds and buildings laden with cargo under which 
rats can hide. 
To generate sulfur dioxide sulfur may be burned in shallow iron pots standing 
in pans of water, each pot containing not more than 30 pounds of sulfur. 
More equal distribution and better results can be obtained by distributing the 
sulfur in a number of small pots. 
The following amounts of sulfur for each 1,000 cubic feet of space are neces- 
sary: To kill mosquitoes and flies, 2 pounds and exposure for 1 hour; to kill 
lice, 4 pounds and exposure for 6 hours; to destroy rats, mice and fleas, 3 
pounds and exposure for 6 hours. The time of exposure should be doubled 
for cargo-laden holds and well-filled storerooms and compartments. 
Carhoxide gas is a very effective insecticidal fumigant of low toxicity to ani- 
mals. Following exhaustive tests on board certain naval vessels it has been con- 
clusively shown that it can be applied aboard ship by naval personnel without 
undue hazard, and with a minimum of interference of ship’s routine or of move- 
ments of the vessels. 
When required carboxide gas should be obtained by requisition on the nearest 
navy yard or station, but should not be carried on board vessels as part of the 
regular allowance. 
Six pounds per 1,000 cubic feet is the required concentration for an exposure 
period of 3 hours for insects. HYGIENE AND SANITATION 
453 
The following instructions on fumigation with carboxide gas should be 
adhered to: 
1. Open wide all locker doors, furniture drawers, file cases, etc., and remove 
covers from mattresses and pillows. 
2. Disconnect ventilating ducts at the point of entrance to compartment, 
wherever practicable, and apply watertight covers. Otherwise the dampers 
of all terminals must be closed and the louvers plugged with damp rags or 
waste. 
3. Seal all openings which might permit gas to escape. Utilize masking tape 
or a combination of greased paper and masking tape for magazine vents, voice 
tubes, radio leads, enunciator chain leads, non-watertight doors, natural venti- 
lators, etc. Close all drains in heads and bathrooms. Dog down all water- 
tight doors and ports. 
4. Maintain circulation of air by running all fans in space or spaces to be 
fumigated. 
5. Open-flame heaters or exposed-element-electric heaters should not be used 
in areas being fumigated. 
6. All cylinders should be securely lashed in the upright position and grounded 
before discharging gas to avoid static sparks. If cylinder is standing on 
linoleum or other insulating deck covering, grounding may be effected through 
wire lashing to a bulkhead or to metal furniture which in turn is grounded to 
some metal structure of the ship. 
7. Make sure that all personnel in the area are accounted for. When all 
preparation is complete and all openings to the space closed except the exit, 
open wide the valves of the cylinders successively, beginning with the unit 
farthest from the point of exit and with the nozzle directed away from the 
operator. 
8. The area of fumigation may be opened at the end of 3 hours. Personnel 
wearing oxygen-rescue-breathing apparatus should be detailed to open all 
airports and re-establish supply and exhaust ventilation. Two hours after 
full ventilation has been in progress it will ordinarily be safe for personnel 
to enter for their normal activities. Storerooms and other poorly-ventilated 
spaces should not be entered until the following day. 
Experiments indicate that concentrations of carboxide lethal for bedbugs 
and cockroaches are also lethal for rodents in equivalent periods of exposure. 
Formaldehyde gas can be depended on to accomplish surface disinfection but it 
is valueless as an insecticide. It apparently does not damage fabrics, metals 
or most colors. The use of this gas is decreasing in public-health work and 
is limited chiefly to disinfection of rooms, clothing and fabrics, where deep 
penetration is not required. 
The most convenient and efficient method of producing formaldehyde gas is 
by pouring solution of formaldehyde on potassium permanganate or barium 
dioxide, allowing 500 cc of formaldehyde solution and 250 Gms. of potassium 
permanganate, or 250 Gms. of barium dioxide, for each 1,000 cubic feet of space. 
Place a glass or metal receptacle (10 times the size of the amount of formalde- 
hyde to be poured into it to allow for foaming) containing the permanganate or 
barium dioxide in a large pan containing water. Then pour the proper amount 
of formaldehyde from a pitcher or other wide-mouthed receptacle on the per- 
manganate or barium dioxide. Gas is generated in great amounts in a few 
seconds. Better distribution is secured by having a number of units, but care 
must be taken to “set off” those nearest the exit last. Exposure should be from 
6 to 12 hours. 454 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Maritime quarantine. 
Medical officers of ships are required to comply with the quarantine laws of 
this and other countries. Persons exposed to any of the following diseases 
should be quarantined for the full period of incubation, viz., cholera, 5 days; 
yellow fever, 6 days; pneumonic plague, 7 days; typhus fever, 12 days; and 
smallpox, 14 days. Ships arriving in the United States with any of these 
diseases on board are quarantinable. Alien lepers are not permitted to land. 
Lepers, if citizens of the United States, must be handled in accordance with 
the local laws in force at the port of landing and are usually sent to the 
National Leprosarium at Carville, Louisiana. 
Vessels arriving at any port in the United States from a foreign port are 
considered to be in quarantine until they are given free pratique. Pratique is 
a certificate, signed by the quarantine officer, to the effect that the vessel has, 
in all respects, complied with the quarantine laws, and all on board are free 
from quarantinable diseases, or the danger of conveying the same. Radio 
pratique is issued United States naval vessels when a medical officer is on 
board provided there are no contagious diseases aboard and the vessel has 
come from a clean port. Naval vessels coming from infected ports must stop 
at quarantine. One case of plague, cholera, or yellow fever makes a port an 
infected one. 
United States Bills of Health are issued by the American consular officers 
at the ports of departure. They give a description of the vessel, the sanitary 
history of vessel, the sanitary conduct of vessel while at port, and the sanitary 
conditions existing in the port. A vessel coming from a foreign port to the 
United States should obtain a bill of health from the port official and also a 
United States consular bill of health in duplicate. 
Each country has its own particular bill of health. The United States bill 
of health is the only one that is of service to the vessel upon arrival in a 
port in the United States although several may have been obtained at the 
port of departure. For instance a British ship clearing from the port of 
Rio de Janeiro, Brazil, for the United States is required to secure three 
bills of health, one from the British consul, another from the Brazilian 
authorities, which is a clearance paper, and the third from the American 
consul. 
In case of a vessel sailing for the United States, the port of departure 
is the first port at which intention to sail to the United States is decided 
in making clearance from the port, or at which passengers or cargo destined 
to the United States are taken aboard. Not only must bills of health be 
secured from this port, but also from all intermediate ports of call until 
arrival at a United States port. 
Naval vessels departing from a port in the continental United States for 
a port in the Canal Zone or United States possessions are not required to 
procure a bill of health or port sanitary statement at such port of departure 
except when plague, cholera, or yellow fever exists, or typhus fever or small- 
pox prevails in epidemic form in the port of departure. 
A naval vessel departing from a port in the possessions or dependencies of 
the United States for a port in the Canal Zone or other United States posses- 
sions is required to procure a bill of health in duplicate at each port of 
departure. 
A naval vessel departing from a port in the United States for a foreign 
port should procure a bill of health and have it visaed by the consular or 
other representative of the country or countries of port of call, if such ports 
can be determined upon prior to sailing. A naval vessel sailing from a for- HYGIENE AND SANITATION 
455 
eign port to another foreign port should likewise procure and have visaed a 
bill of health. 
Guantanamo Bay, Cuba, is construed to be a foreign port and bills of 
health are required for a naval vessel entering or departing therefrom. 
Bills of health or port sanitary statements are issued in the United States 
ports by medical officers of the U. S. Public Health Service where available, 
otherwise by the collector of customs. 
Personal hygiene. 
By personal hygiene is meant any measure taken by the individual by which 
he can avoid disease, promote his health and strength, and enjoy their bless- 
ings. Such measures include the eating of the proper amount and kind of 
food, drinking the proper kind and amount of water, the wearing of proper 
clothing to suit the temperature, the breathing of wholesome air, all of which 
tend to heighten resistance; the avoidance of habits and practices which are 
liable to contract or transmit infectious diseases such as those borne by the 
mouth, nose, intestinal, and venereal discharges, etc.; the proper use of the 
eyes; etc. Cleanliness of the person and the clothing is one of the first 
requisites for good health. The entire body, if practicable, but at least the 
feet, armpits, and genitals should be bathed daily, and the exposed parts of 
the body, face, and neck ais often as necessary. The hair should be kept cut 
short, and the finger and toe nails kept trimmed and clean. Dirty bodies and 
dirty infected clothing are very often the cause of skin and other diseases. A 
moderate amount of exercise in the open air should be taken regularly. With 
proper exercise the elimination of waste products from the body is increased 
through deeper breathing, and more perspiration; the muscles and heart 
become better nourished by more rapid metabolism, and a better circulation 
improves all the other functions of the body; the digestion is improved; and 
resistance to certain diseases is increased. The bowel should move daily, 
otherwise poisonous substances are absorbed into the system. If proper food 
is eaten and proper exercise taken, the bowel generally will look after itself. 
The mental state may affect the health and a cheerful state of mind promotes 
and benefits all the functions of the body and vice versa. 
Not only is the practice of personal hygiene one of the greatest factors in 
the prevention of physiological diseases, but it is one of the chief aids to the 
sanitarian in destroying or preventing the transmission of the agents which 
cause the communicable diseases. Infective discharges from the respiratory 
tract can be readily transferred to others by promiscuous coughing, sneezing, 
and expectorating, or by the use in common of towels, drinking cups, and eat- 
ing utensils. Good personal hygiene will prevent many of the air-borne and 
hand-to-mouth infections. 
Following is a summary of the principles of personal hygiene which are 
adaptable to naval life. 
1. Keep the body clean. Bathe the entire body, or as much of it as possible, 
daily. 
2. Keep the hands clean. Always wash them before eating and after leaving 
the toilet. Keep the fingers away from the nose and mouth, and the finger 
nails clean and cut short. 
3. Keep the feet clean and the toe nails cut short and straight across. 
4. Change the underwear and socks frequently. Wear socks that are IVo 
or 2 sizes larger than the shoe size and shoes that have been fitted carefully. 
5. Brush the teeth every morning and evening or after each meal if possible. 
Have the teeth examined by a dentist at least every 6 months. 456 
HANDBOOK OF THE HOSPITAL CORPS, XJ. S. NAVY 
6. Eat slowly a moderate amount of nutritious food regularly and drink 
plenty of pure water. 
7. Be regular in going to the toilet for bowel actions. 
8. Take a moderate amount of exercise in the open air regularly. Breathe 
deeply at all times. 
9. Sleep in a well-ventilated place with plenty of fresh air. 
10. Avoid excesses of any kind, but especially alcoholic drinks and promiscuous 
sexual intercourse. If exposed to venereal infection immediately use prophylaxis. 
11. Avoid persons with colds or coughs and keep away from others when 
suffering with one. Cough and sneeze in a handkerchief. 
12. Avoid unnecessary exposure to extremes of weather. Change into dry 
clothes as soon as possible after getting wet, and dry the wet clothing before 
stowing it away. Clothing wet with perspiration should be dried and, if 
possible, washed before being stowed away. 
13. Avoid using the toilet or other personal articles of others and do not 
allow others to use one’s own. 
14. Be cheerful. 
The precautions regarding the care of the hands and fingers are of particular 
importance for the majority of infections are taken into the body through 
the mouth and the hands are responsible for a large number. Likewise the 
principle pertaining to “colds” should be closely observed. Finally, if there 
is one basic law, it is to avoid excesses of any kind. 
VITAL STATISTICS 
The importance of vital statistics to the practice of preventive medicine 
cannot be overstated. Without the statistical method comparatively little 
progress would have been made in epidemiology and less toward the prevention 
and control of disease. 
Vital statistics may be defined as the branch of medical science that deals 
with the quantitative aspects of vital phenomena; in other words it is the book- 
keeping of human beings. It comprises a numerical presentation of facts 
relating to sickness, deaths, births, and marriages for the population (or 
strength) as a whole, or for specified groups or classes. Vital statistics 
commonly are prepared specifically for the following groups or classes: Sex, 
age, race and color, occupation. They may be prepared for subgroups of 
these; for instance, whites of the male sex, belonging to the age group, 20 to 29. 
Furthermore, it may be that only males of a particular occupational class are 
under consideration. 
Graphic methods for presenting statistics. 
Although statistics present facts for study in the form of numerals, their 
significance cannot be grasped always until the statistical facts have been 
further presented in graphic form—curves, lines, bar charts, spot-pin maps, 
pin charts, etc. (Figs. 126, 127, 128.) 
Graphic records are constantly necessary in statistical work for the fol- 
lowing reasons: 
1. They make it possible to perceive instantly facts which otherwise might 
be concealed or discovered only after careful study. 
2. They make it possible to place before the eye at one time, in under- 
standable form, information which otherwise could not be presented without 
long tables of figures accompanied by long and involved explanation. 
3. They facilitate comparison of facts with other facts, closely correlated, 
remotely related, or, perhaps, as determined by study, bearing no relation 
whatever. HYGIENE AND SANITATION 
457 
INCIDENCE OF VENEREAL DISEASE, 
U. S. Navy, 1937. 
AGE IM YEARS 
Figure 126.—Type of arithmetical chart, 
VENEREAL DISEASES, RATE PER 1,000 
U, 5. Navy, 192$ - 1957. 
GONOCOCCUS INFECTIONS 
PRIMARY CHANCROID 
SYPHILIS 
N MS D/V of PREVENTIVE MEDICINE 
CHART No. 4 - LOGARITHMIC SCALE. 
Figure 127.—Type of logarithmic chart. 458 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
4. By their means it is possible at times to make a person untrained in the 
statistical method perceive certain facts and appreciate their significance when 
by other means he could not be made to understand. 
5. The relation or the possible relation of one set of facts to another set of 
facts, and still other facts may be recorded pictorially on a single chart or map. 
6. In conjunction with the records for previous corresponding periods of 
time, graphic records show the trend of current events and sometimes enable 
one to look into the future for a short distance. 
NON-EFFECTIVE RATIO PER 1,000 BY 
OCCUPATIONAL GROUPS, U.S.NAVY, 19 57. 
NAVY 
OFFICERS 
MARINE 
MIDSH IP POEM 
ELECTRICIANS 
engine ROOM 
ARTIFICERS 
FIRE ROOM) 
ALL OTHERS 
CLERICAL 
COLINARY 
MISCELLANEOUS 
FORCE 
HOSPITAL 
MARINES 
MARINE MUSICIAN 
NAVY MUSICIAN 
PgISONEQS 
NURSES 
AVIATION 
APPRENTICES 
SEAMAN bRANCH 
ORDMAMCE 
ALL OTHERS 
Figuee 128.—Type of bar chart. 
In administrative work the routine use of graphic records insures that 
important information which otherwise might be buried in the files and for- 
gotten will be kept in view. Frequently such records can be used to advan- 
tage in attempting to convince other persons of the necessity for certain pre- 
ventive measures. 
Subject matter of the vital statistics of the Navy. 
In the Navy vital statistics are limited almost exclusively to morbidity sta- 
tistics and mortality statistics. In a few instances—Guam and Samoa—birth 
and marriage statistics are collected for the civilian population. 
The subject matter of vital statistics of the Navy is composed of— 
1. Basic data.— (a) Individual morbidity reports, i. e., the Form F Card, 
which shows the diagnosis and certain attending circumstances for each admis- 
sion to the sick list; (b) Individual mortality reports, i. e., the Death Cer- 
tificate, Form N. 
2. Summarized written or telegraphic reports of new eases and deaths. 
3. Compilations, i. e., tables or tabulations showing cases, deaths, or rates. 
4. Graphic charts, spot maps, or charts posted by means of colored spot pins. 
Correct vital statistics depend upon the accuracy and completeness of the 
basic data. Morbidity returns are incomplete when mild cases of a disease 
are not reported, and incorrect when erroneous diagnoses are recorded. A HYGIENE AND SANITATION 
459 
morbidity report is incomplete when any of the data required on the form 
are omitted. Mortality reports are incomplete when any of the required data 
are omitted, and incorrect when sufficient collateral evidence to insure correct 
classification of the death with regard to cause is missing. The death cer- 
tificate also must contain the necessary information to permit charging the 
death to the station or ship where the disease or injury resulting in death 
was acquired, and not to the place where death occurred—in a naval hospital 
perhaps. 
Purpose of vital statistics. 
The immediate and most important purpose, from the standpoint of preven- 
tive medicine, is to furnish information as to when, where, and under what 
circumstances, loss of manpower is occurring. It follows, therefore, that mor- 
bidity and mortality reports invariably should be made as promptly as possible. 
Reports should be forwarded promptly as a matter of routine even when, from 
the local viewpoint, no apparent reason for haste exists. 
The historical value of vital statistics is also very great. Complete statis- 
tics must be prepared for each calendar year. 
Use of vital statistics. 
Alone, vital statistics do not necessarily prove anything. The facts thus 
presented in arithmetical form may or may not comprise all the facts pertain- 
ing to the question under consideration—almost invariably they do not. All 
epidemiological factors which possibly may have a bearing on the question 
must be taken into consideration. 
It is because of positive but unwarranted assertions based on statistics, 
by persons who fail to observe proper limitations, owing to lack of thorough 
training in the statistical method, that uninformed or misinformed persons 
not infrequently question the value of the statistical method in general, and 
of any statistics in particular that may be invoked in perfectly logical sup- 
port of a given contention. 
The answer to the old saying, “There are two kinds of lies, ordinary lies 
and statistics,” is, “Figures do not lie, but unfortunately liars do make use 
of figures.” 
The idea of comparison always is involved in statistics. The user may 
not be conscious of this, but everything in the universe is relative to some- 
thing else, and if any given statistical statement appears to be absolute it is 
merely because it unconsciously is interpreted and weighed in association with 
similar information previously acquired. More frequently in practice the at- 
tempt frankly is made to compare the statistical information under considera- 
tion with other statistical data, and often with information of a different 
character as well. 
Standards of comparison. 
In order that any fact or set of statistical facts may be compared honestly 
with other facts in the realm of vital statistics they all must be expressed in 
the same ratio to population or group in the population. 
The ratio itself does not matter; that is, the rate may be per 100, per 1,000, 
per 100,000, or per 1,000,000 of population as best suits the purpose. To change 
a rate per 100 to the equivalent rate per 1,000 is a simple matter of moving 
the decimal point over one place to the right. Rates per 1,000 are used for 
most purposes by the Bureau of Medicine and Surgery. 
To make satisfactory comparisons it is necessary to have available standard 
rates, “norms,” so called. The rate for a whole previous year, or preferably 
154294°—39 30 460 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
the mean rate for a series of previous years, is used for this purpose. 
Ordinarily figures should not be used for more than the five-year period 
immediately preceding. Conditions tend to change, and circumstances may not 
permit true comparison with figures relating to a more remote period. There 
are certain exceptions to this rule. For example, it may be desired to show 
a death rate, by years, for a long period of time. 
In studying the rate from a given condition for a season of the year, a cer- 
tain month for instance, the similar rates for the corresponding month of 
previous years should be available, although very likely it will be compared 
also with the average whole-year rate. 
As a rule, morbidity and mortality rates are computed for current study 
by weeks, by months, and by years; occasionally by 5-year or 10-year periods. 
Exceptionally, as for an epidemic of influenza, morbidity and mortality rates 
are computed by days in order that a more complete statistical analysis of 
the outbreak may be made. 
Rates for weeks or for months or other short periods of time fluctuate 
widely. The weekly rate is almost sure to vary a great deal from week to 
week. Because of this the fairest available whole-year rate always should be 
borne in mind. 
Naturally it follows that the rate for the week or other short-time period 
must be expressed in terms of an annual rate in order to facilitate comparison. 
This is done as follows: The number of cases (or deaths) for the week is 
multiplied by 52 and the rate then computed. This rate is called the annual 
rate for the week and one merely assumes that if conditions were exactly the 
same for the other 51 weeks the whole-year rate would be that figure. 
It is the practice to express all rates as annual rates, whether for a week, 
month, whole year, or longer period. In this way any rate may be compared 
directly with standard rates or with rates for any period of time, shorter or 
longer, corresponding or different. 
Population statistics. 
It is evident that there must be accurate or nearly accurate population (or 
strength) figures in order to compute approximately correct rates. In civil 
practice the estimated mid-year population as of July 1 is taken. 
In the Navy the daily average strength for the period under considera- 
tion is used. This is determined by taking the total number of daily rations 
issued and commuted during the period (the figures being obtained from the 
Supply Department) dividing this figure by the number of days in the period 
and then adding the number of officers and others not entitled to rations. 
The larger the average strength the smaller the error caused in a rate by 
incorrect figures. In any event the omission or addition of one case (or death) 
will have more effect on the rate than a considerable variation in the strength. 
Annual rates. 
The rate for an .entire year is computed by multiplying the number of cases 
(or deaths) which have occurred during the year by 1,000 and dividing the 
result by the average strength for the year. 
An annual rate per thousand for any definite period of time—a week, month, 
or quarter—may be obtained by multiplying the number of deaths or admis- 
sions for that period by 365 and dividing the result by the number of days 
in the period; the figure obtained by division then is multiplied by 1,000 and 
the result divided by the average strength for the period. If desired, the number 
of cases (or deaths) for a week may be multiplied by 52 instead of by 365. HYGIENE AND SANITATION 
461 
Provisional rates and final rates. 
Morbidity and mortality rates computed from week to week or from month 
to month must, of necessity, be provisional rates based upon reports for the 
period in question as received. Final rates ordinarily are not prepared until 
after the end of the year when final returns have been received. Then the 
figures may be reviewed and corrections made in weekly or monthly rates by 
excluding cases (or deaths) which actually did not occur in a given period, and 
by charging them to the week or month in which they did occur. (In civil 
practice, in revising death rates, corrections sometimes are made for deaths 
occurring in the community but chargeable elsewhere.) 
Current morbidity and mortality rates are prepared as a matter of routine 
in order that the incidence, distribution, and severity of disease may be 
determined for comparison with similar figures for past periods and other 
communities. 
It must be borne in mind that rates for short periods of time—weekly and 
monthly rates—fluctuate widely because of epidemic conditions, seasonal and 
other periodic or cyclic influences, and fortuitous circumstances. Such rates 
always should be compared with similar rates for corresponding periods of past 
years, although rates for past whole years furnish a guide as to what may be 
regarded as a normal average, seasonal and other influences, of course, being 
taken into consideration. 
Comparison between one naval station and another, or between ships, and 
especially between ships and stations, should not be made without taking into 
consideration a number of conditions which may vary widely—number of per- 
sonnel, density of population, overcrowding, housing conditions, permanency 
and character of the personnel, nature of activities carried on, environment, 
geographical location, climate, and season. 
Rates other than those expressed in terms of annual rates. 
Epidemic rate.—Epidemic morbidity and epidemic mortality rates are com- 
puted simply as the rate per thousand of strength attacked or died as a re- 
sult of the epidemic, regardless of its length. 
Attack rate.—Sometimes used to indicate the incidence of a disease among 
those presumed or known to have been exposed. Generally expressed as the 
percentage of cases occurring among contacts. With regard to influenza, it is 
permissible to conclude that practically everybody in the community has been 
exposed if the disease is epidemic. 
Case fatality rate.—Percentage of fatal cases among persons attacked by a 
given disease. Computed by multiplying the number of deaths by 100 and divid- 
ing by the total number of cases, fatal cases included. 
To express this,, other terms, such as “mortality,” “mortality rate,” or “death 
rate,” are frequently used. The objection to use of the expression “mortality” 
is that it is not always clear that the case-fatality rate is meant. The other 
terms have an entirely different meaning, viz., the ratio of deaths to the popula- 
tion or some group in the population. 
Noneffective ratio.—This indicates the loss of time due to sickness. Along 
with deaths and invalidings from the service, the noneffective ratio is the final 
expression of the effect of sickness in terms of loss of manpower. It is the 
average number of noneffectives per given number of persons during the year, 
or other period of study. The noneffective ratio per 1,000 average strength 
would represent the average number out of each 1,000 constantly on the sick 
list during the period, or the number of sick days per 1,000 man days. 462 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
It is obtained as follows: 
Number of sick days during period 
• X i 
Number of man days during period 
For a period of a year this would be: 
Number of sick days per year 
*—-—————————————1 jtX/U 
Average strengthX365 (or 366) 
For per cent of noneffectives multiply by 100 instead of 1,000; for noneffective 
ratio per 100,000 multiply by 100,000, etc. 
Minimum rate.—The lowest rate in a series of rates. 
Maximum rate.—The highest rate in a series of rates. 
Median rate.—The rate which stands in a series halfway between the minimum 
and maximum rates. 
The mode (modal rate).—The rate which occurs in the series with the greatest 
frequency. In some series the mode is not apparent. 
The items of a series arranged in order from the minimum to the maximum 
figure are said to have been placed in array. 
Mean rate.—The average rate independently computed from the combined 
basic data included in the series—not the average of the rates. 
Example: Communicable diseases, Class VIII, at the Naval Training Station, 
Norfolk, Va., first quarter of 1937; 
Month 
Average 
strength 
Cases 
Annual rate 
per 1,000 
3,089 
2,899 
3,122 
412 
1, 570. 40 
February - 
234 
1,052. 21 
467.64 
120 
The mean annual rate for the quarter is 1,022.90 (obtained as follows; 766 
cases multiplied by 365 and divided by 90; this figure then is multiplied by 
1,000 and divided by the average strength for the quarter, 3,037). 
Average of the rates.—In the example given the average of the rates is 
1,030.08 and the discrepancy between this figure and 1,022.90 is obvious. In 
rough calculations it is often sufficient to take the average of a series of rates, 
but the figure thus obtained must not be regarded as the mean rate. (See 
Weighted and unweighted averages.) 
Combined rate.—The average rate for two or more communities combined— 
not the average of the rates. 
Example: Death rate from disease, entire Navy, April 1937: 
Navy 
Marine 
Corps 
Entire 
Navy 
Average strength . ... 
114, 489 
16 
18,366 
3 
132, 855 
19 
Deaths from disease- _ - - - 
Annual death rate per 1,000 . _ ___ 
1.70 
1.99 
1.74 
The combined rate is, therefore 1.74. Clearly, it would not be proper to take 
the average of the rates, 1.84, as the death rate of the entire Navy. If that 
were done, undue weight would be given to the comparatively small strength 
of the Marine Corps and not enough to the relatively large strength of the 
rest of the Navy. If the strengths were equal the combined rate and the 
average of the rates would agree. This also would hold for a series embracing 
more than two items if the strengths were all equal. HYGIENE AND SANITATION 
463 
Other terms used in statistical work. 
Series of data.—The items of a series may be either rates or basic statistical 
data (cases or deaths). 
Geographical series.—The items in the series represent ships, stations, or 
other places. 
Historical series.—The items in the series refer to time periods, each series 
representing a single place. 
Weighted and unweighted averages.—If the arithmetical averages of two 
or more series are added together and divided by the number of series the 
average thus obtained is an unweighted average. It is an average of averages 
and does not give due weight to differences in strength; an average of the rates 
instead of a properly computed mean or combined rate as described in the 
preceding example. 
Likewise, in dealing with cases or deaths directly, care must be exercised 
not to take an average of averages or the result will not be a properly weighted 
average; especially should comparison be avoided between unweighted aver- 
ages for a series of places, or time periods, and a weighted average for another 
series. 
Moving average.—This is calculated as a series of averages moving along, 
so to speak, through a series of rates. The moving average is most useful 
where the rates are to be plotted as a curve representing a great many time 
periods in unbroken sequence, especially when there is reason to believe that 
the fluctuations observed in the individual rates are largely due to periodic 
or cyclic influences. Suppose the death rate by years for a given place is 
plotted on a chart as a curve extending over a long period. There will be 
fluctuations from year to year, of course. If a curve for successive 5-year 
averages instead of by single years is plotted, the fluctuations will be smoothed 
out to a considerable extent, but the effect of unusually high or low rates will 
be merged in each separate 5-year average and the tendency will be to conceal 
any periodic effect on the rate that is due to cyclic phenomena which periodi- 
cally recur, such as epidemics of influenza, measles, unusually bad winters, etc. 
A curve can be plotted from moving averages that will smooth out fluctuating 
rates and yet preserve in the comparatively smooth curve the influence of regu- 
larly recurring fluctuations. This is best explained by an example. Suppose 
the following series of rates; 3.5, 4.2, 4.0, 6.1, 5.2, 4.2, 4.0, 3.2, 4.6, 4.2, and per- 
haps a longer series, be taken. To plot a moving average curve on a 3-year pivot 
(3-year moving average) proceed as follows: The average for the first three 
rates, 3.5, 4.2, 4.0, is taken and plotted under the 4.0 rate as the first moving 
average plot point. The next moving average point is obtained from the rates, 
4.2, 4.0, 6.1; the next from 4.0, 6.1, 5.2, and so on, dropping a rate and taking 
up the next in the series for each new moving average point. The following 
diagram illustrates this, the figures in parentheses referring to the position on the 
chart of the first, second, third moving average plot point, etc.: 464 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The moving average period may be taken as 5 year, 7 year, 10 year, or 
other pivot number. The closer the period chosen approximates the periodicity 
of recurring phenomena the better their influence will be brought out. It some- 
times is desirable to try two or three moving average periods to see which 
works out best. 
The question sometimes arises as to whether the first moving average plot 
point should be set back. For instance, in a long series of monthly rates the 
moving average is to be calculated on moving average periods of 12 months; 
strictly speaking, the first moving average plot point falls on the date of the 
twelfth month, but it is usually permissible to antedate it to the sixth month, 
in which case half of the data from which it is calculated lies before and half 
behind it. 
Progressive average.—This is a simple matter of plotting under each new 
rate in the series the average of all preceding rates from the beginning of the 
series. 
Suppose the death rate of the Navy by weeks from the first of the year is to 
be charted. The rates fluctuate from week to week. The progressive average 
curve shows, each week, the average annual rate from the first of the year to 
date. Inasmuch as all rates are expressed as annual rates, the progressive 
average for the last week of the year actually is the annual rate for the year, 
subject of course to revision upon receipt of final returns. 
Of course, the correct procedure is to compute the mean rate for each new 
progressive average point, but for ordinary purposes the average of the pre- 
ceding rates is sufficiently accurate to show the trend of the curve, which is 
frequently so obscured by fluctuations that it cannot be perceived without a 
progressive average curve, plotted along with the fluctuating curve. The follow- 
ing diagram shows the scheme, the figures in parentheses indicating the posi- 
tions on the chart of the progressive average plot points. 
Compilation of statistical data. 
On board ship, or at a naval station, compilation is ordinarily a simple 
matter of counting up the total number of admissions to the sick list, or the 
number of admissions on account of certain diseases, deaths, and number of sick 
days. The daily average strength must be determined in order that rates 
may be computed. 
Where thousands of reports must be handled, as in the bureau, card-punching 
machines, sorting machines, adding machines, and machines for calculating 
rates are used. 
Where a great many reports must be handled without machines, recourse to 
hand tally sheets must be had. The cross 5 method usually is employed; HYGIENE AND SANITATION 
465 
Sheets of paper are ruled in accordance with the different combinations of 
data to be tallied from individual reports. 
From the figures thus obtained rates may be computed, and these may be 
presented for study on graphic charts in the form of curves plotted to scale, or 
as bars plotted or drawn to scale. 
Before statistical data can be compiled they must be definitely classified, both 
with regard to the average strength and the type of disease or injury. Average 
strength is classified in accordance with the established ranks and ratings of the 
Navy, and composite groups such as recruits, fireroom force, deck force, officers, 
enlisted men, age groups, force ashore, force afloat, etc. 
To make accurate classification of diseases possible, medical officers are re- 
quired strictly to follow the Diagnostic Nomenclature for the Medical Depart- 
ment of the United States Navy which has been compiled to meet the Navy’s 
needs. The diagnostic titles in it are acceptable names of: (a) Diseases 
and conditions grouped in various anatomical, epidemiological, and miscel- 
laneous classes; (ft) Injuries; and (c) Poisonings. The epidemiological clas- 
sification of the important communicable diseases is based upon the modes of 
their transmission which has a more or less direct bearing on measures for 
their prevention and control. Therefore when a medical officer is in doubt 
as to which diagnostic titles he should use reference should be made to the 
classification table in order that the title selected will place the case in its 
proper class. Care must be used to select the title which actually fits the 
case. For example, the title, “cerebrospinal fever, meningococcic” is to be 
used when, in the judgment of the medical officer, the disease is probably 
meningococcic meningitis, even though meningococci have not been recovered 
by lumbar puncture or by nasopharyngeal swab. The title “meningitis cere- 
brospinal” means some other form of acute cerebrospinal meningitis, as pneu- 
mococcic, streptococcic, etc., other than tuberculous meningitis or cerebrospinal 
syphilis. 
Deaths are classified in the bureau in accordance with the International 
List of Causes of Death, as prepared by the International Commission of 1929 
in Paris, France. 
In order that the health of the Navy may be properly studied data con- 
cerning disabilities and deaths are compiled in the bureau to show the 
statistics of: 
1. General morbidity and mortality. 
2. Each of the more important communicable diseases separately: Cere- 
brospinal fever, meningococcic; chicken pox; diphtheria; encephalitis, lethar- 
gic ; influenza ; malaria ; measles ; German measles; mumps; pneumonia, lobar; 
pneumonia, primary broncho-; poliomyelitis, acute anterior; scarlet fever; 
tuberculosis (all forms) ; typhoid fever. 
3. Communicable diseases exclusive of common infections of the respiratory 
tract and the venereal diseases. 
4. Venereal diseases as a class and separately. 
5. Diseases by anatomical systems. 
6. Injuries and poisonings: Accidental; homicides and homicidal 'injuries; 
suicides and attempted suicides; war casualties; food poisonings; and drown- 
ing, all causes. 
7. Diseases only. 
8. Injuries only. 
9. Poisonings only. 
10. Primary disabilities, complications, and squelsea. 466 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
11. Occupational distribution of diseases, injuries, poisonings, deaths, suicides, 
homicides, and invalidings from the service. 
12. Deaths, all causes. 
13. Invalidings from the service, all causes. 
14. Causative agents of accidental injuries and poisonings. 
15. Character of accidental injuries and poisonings. 
It must be remembered in statistical work that two series of data which vary 
closely with a third may not' hear a causal relation, or, indeed, any relation 
whatever to each other. 
Example involving secondary correlation.—In an epidemic of cerebrospinal 
fever, meningococcic, the epidemiological factors to be considered are: 
Number, frequency, and distribution of the cases. 
Number and distribution of carriers. 
Length of service of those attacked. 
Housing conditions. 
Month of the year and weather conditions. 
Personal hygiene of those attacked. 
Fatigue, worry, and exposure to other predisposing influences. 
Prevalence of other diseases. 
It is only by establishing direct and indirect correlation between the inci- 
dence of the disease and these factors (and any other factors which seem to 
have a bearing) that the whole truth about the outbreak can be determined. 
Experience during the World War showed that there was low correlation 
between cases and carriers but that a high degree of correlation existed between 
the incidence of the disease and certain combinations of the other factors which 
in turn were closely correlated with each other. 
Methods of demonstrating correlation are: (a) By graphic charts, comparison 
of curves or bars and (6) by mathematical formulae involving the use of co- 
efficients. 
Demonstration of cause or causal relationship.—1. The synthetic method of 
proof, by which known particular facts are pieced together in order to reach 
a more general conclusion. This is the inductive method of reasoning. 
There must be agreement between the facts which are to be accumulated. 
It is, therefore, sometimes called the method of agreement. The following rules 
are applicable to the synthetic method of proof: 
(a) Rule of agreement: If certain instances of the phenomenon in question 
have only one circumstance in common, that circumstance is the cause of the 
phenomenon (or the effect, depending upon the proposition). 
(h) Rule of difference: When the phenomenon in question occurs in one 
instance and is absent in another, and one circumstance only is missing in the 
latter instance, all other circumstances being in agreement, then that one cir- 
cumstance is the cause or an inseparable part of the cause of the phenomenon 
(or effect, depending upon the nature of the proposition). 
(c) Rule of combined agreement and difference: When the phenomenon in 
question occurs in two or more instances and is absent in other instances, if 
there is one circumstance common to all instances in which the phenomenon 
does occur, and all instances in which the phenomenon is absent have nothing 
in common but the absence of that circumstance, then that circumstance is the 
cause or an inseparable part of the cause of the phenomenon (or effect, de- 
pending upon the nature of the proposition). 
In the synthetic method a few instances are not sufficient to establish proof. 
The larger the series the stronger the proof. 
2. The analytic method of proof.—Deductive reasoning by which a proposi- 
tion is asserted to be true after which the proof is sought in correct premises, 467 
HYGIENE AND SANITATION 
and so on from one proposition to another until a known truth is reached and 
the main proposition proved. In other words, the mind looks ahead to the 
conclusion and then seeks to justify that conclusion by establishing correct 
premises for its logical proof. This method must be resorted to when it is 
not clear how to start the ordinary inductive method. 
The figures for any special grouping of diseases can be obtained quickly in 
the bureau by means of sorting machines. The groups mentioned are used as 
a matter of routine, and rates also are computed for each of the 27 classes of 
the Navy nomenclature classification. 
Following is a summary of rates used in presenting morbidity and mortality 
statistics: 
Morbidity rates: 
General morbidity rates (rates expressed in terms of 
the average strength without regard to sex, age,< 
race, or occupational group). 
For all causes. 
For a given disease. 
For a class of diseases. 
Specific morbidity rates (rates for specified groups i 
or classes in the average strength, as by ageJ 
group, race, or occupational group). 
For all causes. 
For a given disease. 
For a class of diseases. 
Mortality rates: 
General death rates (rates expressed in terms of the 
average strength without regard to sex, age, racej 
or occupational group). 
For all causes (this is the 
crude death rate). 
For a given disease. 
For a class of diseases. 
Specific death rates (rates for specified groups or 
classes in the average strength, as age group, race,< 
or occupational group). 
For all causes. 
For a given disease. 
For a class of diseases. 
Interpretation of vital statistics. 
It is the main purpose of vital statistics to establish relationship between 
different facts relating to sickness and death. Such relationship is termed 
correlation. The underlying purpose, of course, is to determine cause and effect. 
This brings one at once into the domain of logic. 
Cause of an event.—The circumstances which must have preceded in order 
that the event should happen (Jevons; Lessons in Logic). An event seldom 
has a single cause. Statistics do not in themselves establish cause. However, 
the first step is to prove the existence of correlation, and this may be ac- 
complished by the statistical method. 
Correlation may be simple or complex. 
Primary or simple correlation (direct comparison).—Two series of data only 
are compared. Example: Death rates from pneumonia set forth by months, 
to determine correlation between pneumonia mortality and season of the year. 
From the statistical standpoint epidemiological data are known as variables. 
In any given problem one of the variables always is used to interpret or 
measure the other data and is termed the independent variable. In the example 
given the death rates are measured by months; months, therefore, constitute 
the independent variable. 
Almost without exception, when time periods constitute one of the variables, 
it is the independent variable. The same is true of classifications such as 
sex, age groups, races, occupational groups, etc. 
The data to be measured are termed dependent variables. Numbers of cases, 
deaths, morbidity and mortality rates, percentage of all sorts of things, 
bacterial counts, gallons, cubic feet of water, and similar data expressed in 
varying or fluctuating numbers naturally constitute dependent variables. 
On a chart the horizontal scale always should be used to show the inde- 
pendent variable and the fluctuating dependent variable should be plotted 
to the vertical scale (the numerical scale). 468 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
When correlation is established definitely between two series of data a casual 
relationship is demonstrated thereby provided connection between the vari- 
ables also can be established. Connection is not shown by statistics alone. 
Causal relationship does not necessarily mean the only cause. 
Secondary or indirect correlation.—Three or more series of data are com- 
pared, as data not obtainable in suitable form for direct comparison. The 
processes of logic are more complicated in such instances, and the liability 
to arrive at an erroneous conclusion is greater. 
3. The indirect method of proof.—Logical process of reductio ad absurdum. 
Fallacies and pitfalls.—There is always danger of unfair comparison of mor- 
bidity and mortality statistics for different places when consideration is not 
given to— 
1. Comparative reliability of the basic data. 
2. The accuracy with which the data for each place were compiled and the 
methods of computing rates. 
3. Epidemiological influences—comparative effect of potent factors. 
4. The danger of concealed classification. 
There is always danger that statistical data which purport to convey certain 
definite information may be concealing classes such as sex, age, race, color, or 
particular occupation, which, if revealed, might cause a very different inter- 
pretation to be placed on the figures. For example, if the incidence rates of 
pulmonary tuberculosis among employees in two different industries are com- 
pared a conclusion that one may be more conducive to the development of the 
disease than the other may be fallacious, because the figures may conceal the 
fact that the majority of employees in one are very young, while in the other 
they are mostly persons beyond middle age. In the same way nationality or 
race may be concealed. Negroes in the United States have a high death rate 
from tuberculosis irrespective of occupation. 
The following example illustrates the necessity for constant guard against 
the introduction of concealed facts: A very extensive experiment to determine 
the possible prophylactic value of pneumococcus vaccine was conducted in a 
series of large institutions, by vaccinating every other newcomer, leaving each 
alternate one as a control. Now, some of these upon arrival were in good 
physical condition; others not. In cases of choice it practically worked out 
that an undue proportion of those who were not well to start with fell into the 
group of controls. For the first few months the death rate from pneumonia 
was much lower among those vaccinated. The figures concealed the fact that 
a higher proportion of those unvaccinated probably would have contracted and 
succumbed to pneumonia under any circumstances. 
Preventive Medicine and Hygiene.-—Rosenau. 
Public Health and Hygiene.—Park. 
Military Hygiene.—Harvard. 
Military Preventive Medicine.—Dunham. 
Naval Hygiene.—Pryor. 
Sanitation in War.-—LeLean. 
The Medical Department of the United States in the World War, Vol. VI, Sanitation— 
United States War Department. 
Sedgwick’s Principles of Sanitary Science and Public Health.—Prescott and Horwood. 
Solving Sewage Problems.—Fuller and McClintock. 
Practical Bacteriology, Haematology, and Animal Parasitology.—Stitt, Clough, and Clough. 
Pathogenic Microorganisms.—Park and Williams. 
Current publications in the particular subjects, especially of the Bureau of Medicine and 
Surgery, United States Navy, and the United States Public Health Service. 
Manual of the Medical Department, United States Navy. 
References ALLERGY 
469 
Section 2.—ALLERGY 
In the United States the word allergy is in general medical use as compris- 
ing all of the human conditions of specific sensitiveness and excluding the 
phenomena of experimental hypersensitiveness in the lower animal known as 
anaphylaxis. 
An individual may be said to be hypersensitive when he reacts specifically, 
with characteristic symptoms, to a substance which in the normal individual 
of the same species produces little or no reaction. 
For convenience the term anaphylaxis is commonly used in describing certain 
reactions occurring in the human, but, while it is not possible to assert that 
anaphylaxis does not occur in man, it is a fact that the existence of the condi- 
tion of anaphylaxis in human individuals has not been demonstrated and use of 
this term is now restricted to conditions of sensitization in laboratory animals. 
Experimental anaphylaxis may be produced in the guinea pig by injecting 
subcutaneously or intravenously minute amounts of horse serum or egg white 
and after an interval of at least 10 days the injection of the same quantity 
intravenously will produce symptoms of shock known as anaphylactic shock, 
and in some instances death may occur. 
The term allergy, or hypersensitiveness in the human, includes the conditions 
known as allergic diseases and for convenience will be considered in the 
following categories: 
1. Atopy or the Inherited Group. 
A. Hay fever. 
B. Asthma. 
C. Food allergies or idiosyncrasies. 
(а) Gastro-intestinal allergy. 
(б) Urticaria. 
(c) Angio-neurotic oedema. 
(d) Eczema. 
(e) Migraine. 
2. Contact dermatitis. 
3. Serum allergy. 
4. Drug allergy. 
5. Bacterial allergy or hypersensitiveness of infection. 
6. Allergy due to parasites. 
7. Physical allergy. 
ATOPY 
The clinical forms of human hypersensitiveness that are classified under the 
heading of atopy are so grouped because of their hereditary tendency. This 
tendency has long been known to play a part in the cause of pollen allergy, 
some families suffering more than others. Of 500 cases of hay fever, asthma, 
and food idiosyncrasies, investigators have been able to demonstrate conclu- 
sively the hereditary transmission of the tendency to become hypersensitive to 
various proteins. Research investigators have concluded that, when both 
parents are affected, 75 per cent of the offspring should be affected and that, 
when only one parent is affected, 50 per cent of the offspring should be affected. 
The influence of heredity on the age of onset of symptoms of hay fever was 
shown in the fact that, in those cases in which there was a bilateral inheritance, 
36 per cent showed symptoms before the fifth year and in cases where only 
one parent had a history 14 per cent developed symptoms before the fifth year 
and where no history could be elicited from either parent the incidence was 
only 5 per cent. These figures are maintained until the tenth year of life. 470 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The conclusion must be drawn then that “inheritance” does exert a distinct 
effect upon the age of onset of hypersensitiveness, the more complete the 
inheritance the earlier the symptoms are manifested. 
Hay fever. 
Hay fever is a relatively common condition in the United States and the 
term originated among the laity from the belief that the symptoms were caused 
by something given off by hay. It is known under various names as June 
cold, summer cold, summer catarrh, pollen catarrh, rose fever, ragweed fever, 
pollinosis and several others. 
The term hay fever is used to designate those nasal, pharyngeal, and eye 
symptoms which are the result in the greatest number of cases of specific 
hypersensitiveness to plant pollen and occur only in the human and bear a 
hereditary influence. It must be borne in mind that pollens not only produce 
mild or severe nasal, pharyngeal, ophthalmic and bronchial symptoms, but 
according to Rowe (1), may produce gastrointestinal symptoms, toxaemia, and 
migraine as well. 
Air-borne pollens belonging to the class of inhalants are the important 
causative factors of hay fever. The pollen from ragweed is the greatest single 
cause of hay fever in the United States. Certain air-borne mold spores have 
been recently added to the inhalants causing hay fever and asthma among 
which the genus Alternaria is the most important. It is estimated that between 
1 and 2 per cent of the total population suffers from hay fever. 
Predisposing causes.—Among the predisposing causes of this disease heredity 
plays an important role. Coca (2) and Cooke (3) considered the hereditary 
feature in hay fever or asthma of sufficient importance to designate this type 
of hypersensitiveness by the word atopy, a word derived from the Greek, 
meaning “a strange disease.” 
Age— Hay fever before the third year of age is rare, although symptoms 
may occur as early as the first year of life. It has been estimated that 25 
per cent of all cases occur in the first decade of life, 85 per cent in the second, 
25 per cent in the third and 10 per cent thereafter. 
Race.—It is more prevalent in the white race, occurring less frequently in 
the black and yellow races. 
Climate.—Any climate that favors pollination, such as the temperate climates, 
increases the prevalence of this disease. It has been stated that the air-borne 
pollens are the important causative factors although almost any pollen may 
be a cause when in sufficient concentration. In most instances the pollens 
that cause hay fever symptoms emanate from flowers that are inconspicuous 
as to fragrance and color while those that are conspicuous as to scent and 
color and whose pollens are heavy and sticky are insect-borne and not easily 
carried by the wind, are unimportant as a cause of hay fever or asthma. The 
pollens of golden rod, dandelion, sun flower, daisy, and rose are examples of 
insect-borne pollens. 
There is considerable misunderstanding by the public as to the type of 
plants causing hay fever. Thommen (4) postulated five requirements for 
a pollen in order that it produce symptoms: 1. The pollen must contain an 
excitant of hay fever; 2. It must be wind-borne; 3. It mwst be produced in 
large quantities; 4. It must be sufficiently buoyant to be carried a consider- 
able distance by the wind; and 5. It must be produced by a plant which is widely 
and abundantly distributed. 
Trees, grasses, and weeds pollinate more or less at different seasons. The 
most prevalent type of hay fever in the United States is that caused by weeds ALLERGY 
471 
which pollinate in August, September, and October. This is known as the 
late summer or fall type of hay fever and the greatest offender amongst 
the weeds are the ragweeds. 
The grasses rank next to the weeds and they pollinate in May, June, and 
July, the hay feyer caused by them being known as the summer type. The 
pollinating season of the grasses is longer in the Southern States than in the 
northern. Timothy and June grass are the most important members amongst 
the grasses. Other grasses are red top, orchard grass, Johnson grass, and 
Bermuda grass. 
Tree pollens are the least important of the three groups which cause 
hay fever. The hay fever caused by them is known as the spring type, 
the pollinating season usually being short, from April to June. Certain trees 
in the south are exceptional in pollinating during the summer and winter 
months. The spring type is caused by the pollens of the poplar, oak, ash, 
walnut, maple, hickory, birch, beech, and cedar. 
Pollen concentration of the air is influenced by weather conditions. Rain- 
fall during the night does not inhibit the crop whereas rain during the day 
hinders it. Sunshine during the early hours of the day causes the pollen to 
ripen in large amounts and be discharged. Land breezes are usually laden 
with pollen while sea breezes are usually free. The direction of the wind also 
plays some part in producing symptoms such as blowing over areas containing 
large amounts of pollen. 
Within the past few years it has become apparent that not all patients 
suffering from seasonal symptoms of hay fever and asthma fall into any 
one or all of the pollen groups. According to Pratt (J), many persons suf- 
fering from hay fever from spring until long after frost are worse during 
the middle of the summer, between the grass and ragweed seasons. He states 
that many of these patients are sensitive to air-borne mold spores. Molds 
may behave like bacteria and produce infection of the lungs, body cavities, 
and the skin. Typical examples of infection of the skin are the epidermophy- 
toses of the feet commonly known as Dhobie itch. Molds may also be non- 
infectious and act as sensitizers similar to pollen and other air-borne excitants 
or allergens. Skin tests with rapids of the infectious variety produce delayed 
reactions similar to the tuberculin type of reaction, coming on in 24 hours 
or more. Noninfectious molds causing hay fever and asthma will produce 
an immediate reaction consisting of a hive and an area of erythema similar 
to the pollen reaction. 
The molds that act as excitants in hay fever and asthma are, in order of their 
importance, the Alternaria, Aspergillus, Hormodendrum, and Penicillium. 
The symptoms of hay fever start about the same time every year if the 
environment has not changed and the patient is not under treatment. The 
onset is gradual and mild, depending on the concentration of the pollen. 
Usually the early morning hours are the worst, decreasing during the day 
and increasing again at night. Local symptoms involve the nose, eyes, and 
pharynx, the nasal and eye symptoms being the most annoying. The nasal 
symptoms are sneezing, continuing sometimes until the patient is exhausted, 
and a profuse serous discharge from the nose which follows or accompanies 
the sneezing. The eye symptoms are itching, burning, lacrimation (flow of 
tears) and sensitiveness to light. The lids may be swollen and congested. 
Itching of the pharynx and a troublesome cough may cause considerable 
annoyance. Fever does not occur in uncomplicated cases of hay fever. 
The diagnosis of hay fever is made by a positive history of atopy in the 
patient or members of his family; the seasonal occurrence; the eye and nasal 472 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
symptoms, and specific sensitivity tests with the suspected excitants as described 
under asthma. 
All pollen therapy must be individualized. Specific .treatment by means of 
pollen extract is well established. The results vary, perfect or almost perfect 
results are obtained in as high as 35 per cent of cases and satisfactory results 
are claimed in at least 80 per cent of cases. The purpose of specific treat- 
ment in hay fever or asthma which is due to an inhalant such as pollen or 
spores from molds is to increase the patient’s tolerance to the excitant by 
administering it in gradually increasing doses. 
In all known cases of hay fever the pre-seasonal method of treatment 
should be begun 4 to 10 weeks in advance of the expected attack or before 
the hay-fever season begins, the maximum dose being reached, if possible, 
before the onset of symptoms. Treatment with the maximum dose is then 
continued at weekly intervals throughout the hay-fever season. The injec- 
tions of pollen extract usually number about 15, given at intervals from 2 to 7 
days. The site of inoculation is usually the arm or the outer side of the thigh. 
Pre-seasonal or prophylactic treatment.—The selection of the suspected 
pollen or other excitant is made from the skin test showing the largest reaction. 
Where sensitivity is marked, a study of local conditions and a knowledge of 
plant distribution is necessary to enable one to select the offending agent. 
Desensitization with the most irritating allergen or excitant will probably 
afford sufficient relief to the patient. 
Usually it is not necessary to test the patient with every pollen which the 
patient may be sensitive to. Pollens of the closely related plants may have 
a common excitant, such as the active principle of timothy being present in 
red top, June grass, orchard grass and Bermuda grass. The entire family of 
the oats may be represented by a single oat. This also applies to the weeds. 
Many pharmaceutical houses throughout the United States manufacturing 
the diagnostic pollen allergens for skin testing also furnish information as to 
the geographical distribution of the various plants. It is usually a good plan 
to use test and treatment sets made by the same manufacturer to obtain best 
results. 
Co-seasonal treatment.—When patients apply for treatment during or just 
before an attack begins the same method of making a diagnosis by skin tests 
is necessary. The ophthalmic or eye test cannot be used after the attack has 
begun. Effective relief from hay-fever symptoms may be obtained by giving 
small, gradually increasing doses of the pollen extract at frequent intervals. 
The maximum dosage, which it is wise to give, should be reached at approxi- 
mately the fifth injection and continued at approximately this level throughout 
the season. 
Perennial treatment.—A common method now in use that offers the maximum 
degree and the greatest percentage of relief obtainable in hay fever is the 
perennial method of treatment. Patients treated by the pre-seasonal or 
prophylactic method may carry out their treatment until the season is over. 
Following this the maximum dose may be reduced to % or % and given semi- 
monthly throughout the year. As the next season approaches the dose is 
gradually increased again until the maximum dose is reached before the season 
starts. 
Precautions for avoiding reactions.—A few persons may be unusually sensi- 
tive so that in the course of the treatment some doses may produce a severe 
constitutional reaction. In such cases the patient should receive at the next 
visit one-half the dose which caused the reaction. ALLERGY 
473 
Care should be taken so that no solution is injected into a vessel. After 
inserting the needle into the tissue pull back the piston of the syringe. In 
case blood enters the barrel the needle should be withdrawn and reinserted. 
The patient should remain in the doctor’s office for at least one-half hour 
for observation. In the case of severe symptoms such as sneezing, itching of 
the eyes or skin, or difficulty in respiration, 0.5 to 1 cc of epinephrine hydro- 
chloride, 1-1,000, should be given and repeated if necessary. The interval between 
doses varies according to circumstances. 
The next dose should not be given until any marked local reaction from the 
previous dose has practically disappeared. 
A blood-pressure cuff or tourniquet may be placed above the site of injec- 
tion in severe cases of reaction to lessen the rate of absorption and epinephrine 
solution injected into the other arm or above the constricting band. The band 
may be loosened after the reaction subsides. 
Local treatment.—For immediate relief a nasal spray of an aqueous or oily 
solution of epinephrine 1-4,000 or 1-10,000 is helpful. These solutions may be 
used as eye drops for relief from the eye symptoms if necessary. 
Medicinal treatment.—Ephedrine sulfate or chloride in doses of % to % 
grain by mouth may aid in controlling the symptoms. Atropine sulfate in 
doses of Viso to Y200 grain lessens the discharge but is of little value in relieving 
the symptoms. 
Hay fever resorts.—The selection of districts known to be free from the 
offending agent offers relief for many. An ocean voyage is beneficial to those 
who are able to avail themselves of the opportunity. Air filters installed in 
the patient’s bedroom or office afford relief just so long as the patient remains 
in the environment. 
Asthma. 
One of the common forms of allergy affecting the organs of respiration is 
asthma, commonly known as bronchial asthma, and may be defined as a condi- 
tion in which the outstanding feature is wheezy breathing with a prolonged 
expiratory phase. 
The causes of this condition are numerous. Bearing in mind the hereditary 
influence previously mentioned, the causes may be classified as extrinsic, those 
due to causes or conditions outside the body, and intrinsic, those due to causes 
or conditions inside the body. Under the extrinsic causes may be enumerated 
foreign substances inhaled or inspired such as pollens from ragweed and the 
grasses which are also the cause of many cases of hay fever, dander, and 
emanations from domestic animals or the feathers of birds, vegetable dusts 
such as flowers and face powders containing orris root, and other dusts such 
as house-dust or dust occurring in factories, as leather and wool dust, are 
offending agents. 
The intrinsic causes are also very numerous. Among some of the important 
ones are foods. The ingestion of egg white is one of the most important. 
Cereal proteins, especially those of wheat, cow’s milk, various kinds of fish and 
meats and a host of others are also offenders. Bacteria may cause asthma 
and an attack may follow a cold. 
Other causes under the intrinsic group are reflex from the nose or throat 
produced by irritation of the nerves, and foci of infection such as the teeth 
or appendix. Nervousness associated with faulty hygiene or stress and strain 
may be a factor, the asthma completely disappearing when the source of anxiety 
is removed. 474 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAYY 
Climate influences the frequency of the attacks, and to some extent the 
severity, by its effect upon vegetation such as pollens. 
Season has some effect upon the nature or quantity of existing agents, such 
as pollens, diet and clothing varying with seasons. High temperatures and 
humidity aggravate the disease while high altitudes have a beneficial action. 
Age.—About one-third of all cases of bronchial asthma show symptoms during 
the first decade of life and about one-half start during the next three decades. 
The symptoms of asthma are as follows: The onset is usually sudden but is 
more often preceded by symptoms of tightness in the chest, sneezing or a 
cough accompanied by wheezing. 
Gradually or suddenly the illness may enter the paroxysmal stage. Attacks 
of dyspnoea or difficult breathing may recur frequently or at great intervals, 
the patient may be normal or the symptoms may be those that precede the 
paroxysm. The patient is frequently awakened from his sleep by an attack 
He assumes the sitting position, the inspirations are short, slow and deliberate, 
and the expirations long and wheezy and may be loud enough to be heard 
at a distance. The patient is pale or dusky, has an anxious expression and 
may perspire profusely, the so-called “cold sweat.” The attack may last 
from minutes to several days. There may be only a slight cough at first but this 
later increases in frequency and is productive of a viscid or sticky type of 
sputum. The pulse is rapid and usually diminished in volume. 
There is a characteristic position assumed during a severe paroxysm. The 
patient bends forward and grips objects tightly or he sits down with the 
elbows on the knees with the head down so that every accessory muscle 
of respiration can be brought into play. 
The diagnosis is usually made with little difficulty and is facilitated by 
certain characteristic features in the patient’s history, and the symptoms. The 
most common are as follows: A previous history or family history of allergic 
diseases classified under atopy; early age of onset; frequently recurring 
paroxysms of dyspnoea or difficult breathing with normal intervals between 
attacks; the tendency towards night attacks; examination of the sputum for 
Curschmann’s spirals, Charcot-Leyden crystals and eosinophiles, and skin tests 
for hypersensitivity to important inhalants and foods. Skin testing reveals 
positive results in a large number of cases estimated to be approximately 
one-half to two-thirds of all cases of bronchial asthma. 
In obscure cases it is advisable to change sleeping quarters or spend a 
short time in a dust-free room ventilated by filtered air. When positive skin 
tests are not obtained by food extracts, trial diets or elimination diets may 
be tried. 
Tests for hypersensitiveness may be performed in several ways and have 
proved to be successful in the diagnosis of asthma, hay fever, and other 
allergic conditions. Cutaneous or skin tests are made as follows: (a) The 
scratch technique is the one commonly employed. Any surface of the body 
which is free from hair such as the flexor surface of the forearm or the back 
may be used. The area is cleansed with alcohol and allowed to dry, or 
followed with physiological salt solution, prior to making the scratch. A scratch 
approximately Vs inch in length in the skin is made with a sharp instrument, 
needle, or scalpel, being cautious not to cause bleeding. If the powdered 
extract is used a drop of tenth-normal sodium hydroxide is placed over the 
scratch and a small amount of powder is nxbbed into it. If pastes instead 
of powder are used no alkali is necessary, the paste being rubbed into the 
scratch similar to the powder. A sterile tooth pick serves as an excellent ALLERGY 
475 
spatula for rubbing the extract into the scratch. After 20 to 30 minutes 
the solution or paste is wiped off and the reactions are read by comparing 
them with a control test made "with the sodium hydroxide solution or a 
paste containing no extract. A large number of tests may be done at one 
time by this method (fig. 129). (6) The intracutaneous method is also known 
as the intradermal method and consists of the injection of a very small 
amount of the sterile extract into the superficial layers of the skin. Amounts 
Figure 129.—Skin reactions to various extracts; scratch method. (Courtesy Dr. Albert 
H. Rowe.) 
not to exceed 0.01 cc are injected using a small gauge needle, care being 
taken not to inject too many tests at one sitting. Absorption is more rapid 
than by scratch method and reactions such as an acute attack may be pre- 
cipitated. The reactions are read from 15 to 20 minutes later comparing them 
with a control test made with the extracting fluid containing no extract. 
In suspected cases of pollen sensitivity the conjunctival test may be used by 
dropping a small amount of the dry powdered extract in the eye. The lower 
lid is retracted and the powder dropped into the conjunctival sac. Redness 
with congestion, itching and lacrimation develops in a few minutes if the in 
154294°—39—31 476 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
dividual reacts in a positive manner. The powder may be washed from the eye 
with a boric acid solution and a few drops of epinephrine solution 1-4,000 instilled 
if the reaction is severe. 
In the reading of reactions the results of the tests are recorded as negative, 
doubtful, slightly positive, moderately positive, and strongly positive. A reac- 
tion is positive when there is a central wheal or light area of erythema or red- 
ness. The wheal may be absent or very small in some instances while in others 
it may reach an inch or more in diameter (fig. 130). As a rule the wheal is 
irregular in outline and may send out pseudopodia into the erythematous area. 
A test is said to be positive when it exceeds the control in size, either in the 
amount of erythema or the size of the wheal or both. 
Figure 130.—Skin reaction to pollen extracts. Positive reaction easily distinguished by a 
typical hive, irregular in outline, surrounded by a zone of erythema. 
Cases have been recorded as showing a delayed reaction, the cause of which 
is not understood, that may appear at the site several hours or days after the 
test. 
The treatment of asthma consists of the prophylaxis or prevention of the 
disease and the treatment after symptoms have developed. Persons suffering 
from allergic diseases with an hereditary influence should be careful to select 
an occupation free from exciting factors such as dust, cereal flours, animal 
danders, and chemical irritants. Areas known to be free from pollens should 
be selected if possible, or every case of hay fever should be given specific treat- 
ment. The early recognition of allergic conditions so that precautionary methods 
may be instituted is a factor not to be overlooked. 
Treatment of the paroxysm.—Epinephrine hydrochloride solution 1-1,000 is the 
drug of choice. It is administered subcutaneously in doses of 0.5 cc to 1 cc and 
repeated as often as necessary until the paroxysm is under control. It is not 
effective when given orally. 
Epinephrine hydrochloride solution 1-100 is administered solely by inhalation 
and is an effective agent for prophylaxis and relief of allergic asthma. Relief 
usually occurs more rapidly than with the hypodermic injection. The spray is 
inhaled through the mouth with the aid of an all-glass atomizer which should 
deliver an even vapor-like spray, free from droplets. Ten drops of the solution 
are placed in the atomizer and the patient instructed to place the nozzle of the 
vaporizer just inside the mouth. Five or six inhalations, by squeezing the bulb 
once or twice, with 2-minute intervals, are usually sufficient. 
Ephedrine in % to % grain doses may be given orally and has practically 
the same action as epinephrine. It is slower in its action and is not so effective 
as epinephrine for controlling a severe attack. It is particularly beneficial in 
preventing a mild attack from becoming worse. It produces some unpleasant ALLERGY 
477 
symptoms in some cases such as headache, tremors, nausea, increased pulse, 
and insomnia. The symptoms are less noticeable or absent in epinephrine. 
Morphine and atropine have been used but their use should be discouraged. 
Iodides in the form of the potassium or sodium salts, acting as expectorants, 
may be given in doses of 5 to 10 grains several times daily. 
Specific treatment.—The most simple yet effective method of specific treat- 
ment is prevention of contact with the exciting agents that cause asthmatic 
symptoms. When this procedure cannot be carried out satisfactorily then 
relief must be obtained by the methods given next. 
Relief, and in many cases complete cessation of symptoms, occurs by raising 
the patient’s tolerance to the exciting agent by its administration in gradually 
increasing doses. 
Food hypersensitiveness can be overcome by avoiding the offending food in 
the diet. Milk as an exciting agent may be combated by the use of evaporated 
or powdered milks or by substitutes. Oral desensitization or as termed by 
some, hyposensitization, to important foods such as eggs, wheat, etc., may be 
attempted by the daily ingestion of small amounts and gradually increasing 
the amounts until the point of tolerance is obtained. 
Inhalant sensitivity may be successfully dealt with by preventing contact 
with the exciting agents such as pollens and dust. Persons sensitive to dust 
may change their environment to a dust-free atmosphere. This can be accom- 
plished by removing everything from the room except a bed which is made 
from substances harmless to the patient. If the contact cannot be avoided the 
desensitization method described under hay-fever may be resorted to. This 
is usually not necessary for exciting agents other than pollens, molds, and 
house dust. Inhalation of smoke of stramonium leaves, the chief constituent 
of most commercial asthma powders and of special cigarettes for the relief of 
asthma, often relieves the symptoms if the attack is not too severe. Non- 
specific protein therapy such as the injection of peptone, milk, venom protein, 
and vegetable proteins has been tried. Vaccine prepared from the sputum 
or nasal secretions of asthmatics is a popular form of nonspecific protein 
therapy. The injection of one’s own blood or serum, called auto-haemotherapy 
and auto-serotherapy, has produced some favorable results. 
Under the physical agents for treatment the Roentgen ray is more successful 
than diathermy, actinotherapy, or hydrotherapy. The artificial means of induc- 
ing fever by high-frequency current is one of the more recent methods of 
treatment. All these methods produce temporary results and are unreliable, 
being comparable in that respect to nonspecific protein therapy. 
Surgical procedures for the relief of obstruction to the breathing passages 
such as removal of nasal polyps, straightening of septa, turbinectomy and 
tonsillectomy produce little benefit. 
Endocrine substances such as thyroid, parathyroid, corpus luteum and ovarian 
extracts have proved effective to some extent. 
Breathing exercises and change of climate have been resorted to. Patients 
suffering from chronic bronchitis and sinusitis will find a warm, dry climate 
beneficial. 
Food allergy. 
According to Rowe (6), food is the outstanding cause of ingestant allergy. 
Most physicians realize its frequency as a cause of mild to severe disturbances 
in most tissues of the body. Many people at some time in life, and especially 
in childhood, and as late as 50 or 60 years, may have mild or marked food 
allergy. 478 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Foods which are eaten continuously in excess or at intervals are especially 
prone to produce allergy, such as milk, wheat, eggs, and various fruits. 
The tendency to group reactions in some people to foods that are closely 
related biologically explains sensitization to all cereals such as wheat, rice, 
corn, barley, and oats. The same is true for citrus fruits, the cabbage group, 
or to all fish or shell fish. 
Gastro-intestinal allergy. 
Rowe states that gastro-intestinal allergy is probably the most common cause 
of alimentary symptoms. As with asthma, atopic eczemas, urticaria (hives), 
angio-neurotic oedema, or migraine, the predisposition to develop gastro-intestinal 
symptoms often exists as a familial tendency. 
Coated tongue, canker sores, gastric distress, belching, burning, loss of 
appetite, pain simulating various diseases, and mucous colitis are some of 
the conditions due to food disturbances. There may be allergic symptoms 
referable to the liver, biliary system and appendix, due to food disturbances, 
as well as oedema and smooth-muscle spasm in the genitourinary tract. 
The gastric tissues are often the site of food allergy. Allergy to foods 
affects the cells of the gastric glands and accounts for large amounts of 
mucous. Congestion of the mucosa and of the glands, with muscle spasm, can 
explain the stomach unrest and injured digestion which leads to belching, disten- 
sion, sour stomach, nausea, vomiting, tenderness, and even poisoning. 
In the small intestine there may he idiopathic haemorrhages or bleeding and 
an excessive amount of mucous due to allergic origin. Localized allergy in 
different parts of the large bowel often produces sudden attacks of severe 
cramping pain or persistent soreness which is difficult to explain. The so- 
called unstable or irritable bowel is a frequent manifestation of allergy. 
Pruritis ani or itching near the anal outlet frequently results from a local- 
ized eczema due to food allergy. 
Urticaria (Hives, Nettlerash). 
This condition may be defined as an acute or chronic skin disease char- 
acterized by the sudden appearance of smooth, slightly elevated patches, 
whitish, pinkish, or reddish in color known as wheals, and attended by 
severe itching. The urticarial wheal may he allergic or nonallergic in nature. 
The nonallergic wheal is due to the direct effect of irritant substances such 
as the toxins or stings and bites of insects and nettles. The allergic wheal 
is often due to idiosyncrasy to foods. This condition is frequently associated 
with angioneurotic oedema and when hereditary influence plays a part it may be 
transmitted through several generations. 
Causes.—Certain food stuffs appear to be especially liable to cause hives, 
such as fish, particularly shell fish, eggs, pork, strawberries, and other fruits. 
Certain drugs mentioned under drug allergy may cause an acute urticaria. 
Symptoms.—The lesions in urticaria vary greatly in size and shape, ranging 
from a pin head to a fingernail or larger. As a rule they appear suddenly, 
although they may be preceded by gastro-intestinal symptoms if due to ingested 
material. The individual wheals are whitish or pinkish in color, often with 
a reddish border, and cause intense stinging, burning, and itching. All parts of 
the body may be affected but the usual sites are the lower trunk and outer 
surface of the thighs and buttocks. They may appear suddenly and disappear 
in a few minutes or last hours and even days, leaving no trace. 
Diagnosis.—In the acute cases the exciting cause may be determined by a 
history of ingesting food or drugs. In the allergic type a history of symptoms 
appearing after the ingestion of food should suggest food allergy. A previous ALLERGY 
479 
personal or family history of allergy in any form may be helpful in locating 
the cause and eliminating the exciting factor, bearing in mind that allergic 
manifestations may develop in patients without previous personal or family 
histories of hypersensitiveness. A history of anorexia or food disagreement is 
important. 
Rowe (7) lists his trial diets next in importance as a diagnostic guide when 
food allergy is suspected. He states skin testing must take a position subordi- 
nate to history and trial diets in the diagnosis of food allergy. Routine testing 
of food allergies by the scratch method is important and positive reactions are 
helpful; however, it is generally recognized that skin tests are negative to 50 
per cent or less of those foods which produce clinical allergies. 
Treatment.—The treatment for the allergic type of urticaria may be divided 
into specific and nonspecific measures. 
The specific treatment Includes the avoidance of offending substances and 
the use of prophylactic injections to raise the tolerance of the patient to these 
materials. In the case of food allergy the diet is restricted. {See elimination 
diets at end of this section). Desensitization to foods is not attempted except 
perhaps in infants and children when they are sensitive to milk and eggs. In 
the case of serums and drugs causing acute urticaria, avoidance or substitution, 
if practicable, may be resorted to. 
The immediate treatment, if due to something ingested which has not left 
the stomach, is to induce vomiting. A brisk saline purge is indicated as soon 
thereafter as possible. In a severe attack 1 cc of 1-1,000 solution of epinephrine 
hydrochloride, subcutaneously, repeated as often as necessary, may relieve the 
acute attack. Ephedrine sulfate % grain is also helpful. 
The local application of calamine lotion containing 1 or 2 per cent phenol 
or menthol is beneficial to allay itching and a saturated solution of sodium 
bicarbonate, boric acid, or magnesium sulfate will also give relief. 
Angioneurotic oedema (Quincke’s disease, giant hives). 
It has been suggested that urticaria and angioneurotic oedema are dependent 
on the same mechanism, urticaria involving the superficial layers of the skin 
and the latter involving the skin or mucous membrane and occasionally the 
viscera, and characterized by transient, circumscribed swellings. The lesions 
do not essentially differ from those of urticaria, the variation being in size only. 
The swellings are usually preceded by itching, prickly or burning sensation, 
and vary in size from a few millimeters up to large areas, in some instances 
covering nearly the entire back. The swellings may be tense and elastic and 
nonpitting or soft and pitting. The skin may not change in color over the 
area or it may be pink or dusky red. 
Areas commonly involved are the lips, the loose tissue about the eyes and 
mouth, the tongue, hands and feet, in fact any surface of the body may be 
affected. The swellings may persist for several days but usually disappear 
in 24 to 36 hours. The attacks may occur daily or there may be years between 
attacks. The diagnosis and treatment of urticaria applies equally to this 
condition. 
Eczema (tetter, salt rheum). 
The frequent association of allergic eczema with a personal or family history 
of asthma or hay fever points toward an hereditary abnormality of the skin. 
The transmission of eczema through four generations has been reported and it 
is considered that heredity can act as an important predisposing factor. 
The excitants of atopic eczema are protein substances in foods which reach 
the affected parts through the blood after their ingestion. Eczema as an 480 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
expression of hypersensitivity to foreign proteins is most common in the infant, 
although persons of all ages may be afflicted. In general however, as life 
advances, the skin gradually develops an immunity to foods and becomes 
relatively more sensitive to contact reactions. Where eczema is of food origin, 
particularly in adults, it is usually accompanied by other manifestations of the 
allergic state. 
Symptoms.—The disease is characterized by the presence of numerous types 
of lesions or manifestations such as erythematous, papular, vesicular, or 
pustular. Several of these may be combined, the most frequent being the 
papulo-vesicular. The vesicular variety is probably the most typical form of 
eruption. The majority of the vesicles rupture as a result of scratching or 
spontaneously and the patch becomes covered with thin yellowish crusts of 
dried serum and may ooze profusely, producing the so-called weeping type of 
eczema. Symptoms referable to the gastro-intestinal tract are similar to those 
of urticaria, namely, loss of appetite, and in the case of some children, gagging 
and regurgitation occurs when forced to eat food to which they are allergic. 
Treatment.—The specific measures covering the allergic type of cutaneous 
conditions under urticaria may be applied to the allergic type of eczema in 
contrast to the nonallergic type of dermatitis. In recent years contact eczema 
from the oils of pollens and leaves has been recognized and its treatment with 
intramuscular injections of such sterile oils has been of some value. Pro- 
longed pollen desensitization must be instituted when pollen is the cause of 
allergic eczema. 
Food being the most common cause of allergic eczema, procedures similar to 
those under asthma and urticaria are necessary to eliminate the offending 
food. Asthma and eczema frequently occur together in the same patient or at 
different times. 
The constitutional treatment is similar to that for asthma inasmuch as 
foods aggravate both conditions. Overeating should be prevented. Rowe’s 
(8) trial diets contain foods which infrequently produce allergic manifesta- 
tions and are successful in a high percentage of cases that are hypersensitive 
to certain foods. The general principle in the foundation of these diets has 
been to include one or two starches and meats, and two to four vegetables and 
fruits, together with sugar, oil and salt. A milk diet for several days prior to 
beginning the trial diets is beneficial provided that the individual is not sensi- 
tive to milk. Other foods may be added gradually. 
For the acute conditions requiring additional treatment lotions containing 
soothing drugs, as well as preparations to allay itching as noted under urti- 
caria, are beneficial. 
Migraine. 
Migraine may be defined as a condition characterized by periodic attacks of 
headache usually accompanied by nausea and often preceded by disturbances in 
vision. 
Cause.—An hereditary influence can be shown to exist in many individuals 
who suffer from migraine. Certain kinds of food that have been known to 
cause an attack of migraine may cause asthma. In each the attacks are 
periodic and nervous influences may precipitate an attack of either. This 
similarity suggests an allergic state may exist in these individuals. 
There is increasing evidence that a food allergy is the cause in a high per- 
centage of cases. 
Diagnosis.—The diagnosis is made on the personal and family history, skin 
tests for the offending allergen, and elimination diets. ALLERGY 
481 
Symptoms.—Preceding the attack eye symptoms may develop, later to be fol- 
lowed by intense pain across the forehead, between the eyes, in the occipital 
or temporal region and limited to one side. The pain is usually in the same 
place in every attack. Dizziness and nausea which may lead to vomiting is 
frequent. 
The attack usually lasts from a few hours to several days and recurs at 
varying intervals. They are rarely accompanied by fever. 
Treatment.—In the cases that have been proved to be due to hypersensitive- 
ness in the patient, relief was obtained by allergic treatment where all other 
forms of treatment failed. Rowe reports many successful cases which received 
complete or nearly complete relief by elimination diets. 
Stress and strain must be avoided as well as worry. Regularity of meals 
and regular sleeping hours are essential. 
Foci of infection from tonsils, teeth, and sinuses must be removed. 
Symptomatic treatment for the relief of pain consists of aspirin and similar 
products. 
CONTACT DERMATITIS 
The term contact dermatitis is now applied to a condition of specific sensi- 
tiveness which is limited to the epidermis and appears after surface contact with 
the exciting cause. 
This category of allergic diseases was formerly known only through the skin 
disease known as dermatitis venenata, an acute inflammation of the skin caused 
by contact with various substances of a chemical, animal, or vegetable nature, 
and a term which still serves well as the type of a condition that is now 
increasing in number and importance. There is hardly an occupation which 
may not yield a special cause for contact allergy. 
Some of the most important excitants causing this form of dermatitis are 
derived from the leaf, stalk, and root of various plants such as poison oak, 
poison ivy {see p. 560), poison sumac, primrose, daffodil, geranium, lily, satinwood, 
eucalyptus, and many others; chemicals such as formaldehyde, photogravure 
ink; trinitrotoluol or T. N. T.; paraphenylendiamine, a hair dye; other materials 
such as coal tar, furniture polish, soap, copra, oil of citronella, adhesive plaster, 
feathers and many others. 
Symptoms.—The eruptions of contact dermatitis caused by plants are as 
a rule vesicular and accompanied by marked cedema or swelling, although 
purely erythematous eruptions or discrete blisters are observed. The onset is 
usually sudden, a few hours or days after exposure with involvement of the 
face, neck, wrists, hands, or ankles (fig. 132). There is a tendency for the 
dermatitis to spread by the fingers to other parts, especially the forearms or 
the genitals. 
Diagnosis.—The diagnosis is made on the history of the case and by specific 
cutaneous tests using the patch test. This test may be applied in various ways 
depending upon the material to be tested. The test can be made with the 
natural material such as a leaf, powder, or fluid. An undiluted oily substance 
should be applied to a small area of the unbroken skin and the area covered 
for protection with a square of waxed paper and then with adhesive plaster. 
Alcoholic or other solutions may be applied to the skin by moistened blotting 
paper and covered with waxed paper and adhesive plaster. 
The patient should be instructed to take off the patch as soon as itching is 
noticed and to remove the oil with alcohol or ether. A positive reaction ap- 
pears in from 1 to 5 days as a more or less typical contact dermatitis varying 
from redness to vesiculation or blistering. 482 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Treatment.—The ideal treatment is avoidance of the excitant; however, in 
many instances the excitant cannot be avoided without great inconvenience or 
expense. Contact dermatitis which develops in the home regions requires suspi- 
cion of cosmetics, soaps, foods, fabrics, furniture polish, waxes, cleaning ma- 
terials, etc. If the history indicates an occupational source a change in occu- 
pation is desirable if practicable. 
Figure 131.—Poison ivy branches showing the leaves, fruit, and aerial rootlets. 
Contact dermatitis caused from the oils of pollens and leaves is treated by 
intramuscular injections of a solution of the respective oils. Three or four 
injections have hee,n beneficial in many cases. 
If the dermatitis is seasonal begin the injections about 3 weeks previous to 
the expected symptoms, following directions as recommended by the manu- 
facturer furnishing the treatment material. Testing material as well as the 
treatment may be purchased from pharmaceutical houses handling biological 
supplies. ALLERGY 
483 
Local treatment.—Upon exposure the poison is on the surface of the skin and 
may be removed by thorough washing and rinsing, using ordinary laundry soap. 
In the early stages the disease may be controlled by scrubbing the parts with 
benzine followed by rinsing with alcohol. After the disease has been present 
for several days these measures are useless and astringents should be used, 
i. e., calamine lotion, liquor aluminum acetate 1-20 in water, 5 per cent aqueous 
Figure 132.—Dermatitis venenata (poison ivy). 
solution of ferric chloride, 5 per cent solution of potassium permanganate, or 
fluidextract of grindelia diluted with 5 to 10 parts of water. During the exuda- 
tive stages ointments or oily preparations should not be used as they tend to 
dissolve and spread the poison. 
SERUM ALLERGY (SERUM DISEASE) 
Serum disease (or serum sickness) is an allergic reaction resulting from the 
administration either into the soft tissues, the blood stream, or spinal canal of 484 
HANDBOOK OF THE HOSPITAL CORPS, II. S. NAVY 
preparations containing a foreign serum. The reaction may be mild or severe. 
The frequency with which serum disease or sickness occurs makes it impera- 
tive, if possible, to ascertain whether there is a previous history of having had 
asthma, hay fever, or any of the allergic diseases. It is also important to know 
whether serum has been given at any time during life following an injury or 
in the process of immunization for the prevention of disease. The well-known 
antitoxins used in the prevention and treatment of tetanus, diphtheria, scarlet 
fever, and many others are typical examples of those that are frequently admin- 
istered and in which serum sickness is often seen. (See p. 375.) 
Symptoms.—When serum is administered to an individual for the first time 
there is usually a period of 6 to 12 days before the onset of serum disease. 
In some cases where large amounts of serum have been administered the disease 
comes on as early as 3 hours after administration and the severity of the symptoms 
depends upon the susceptibility of the individual. In rare cases illness does 
not appear for 2 or 3 weeks. 
Some individuals may show nothing more than a few hives and some swelling 
of the superficial glands following the administration of large amounts of serum 
and lasting for only a few days, while others after receiving a few cubic 
centimeters will show a large number of hives, fever, oedema, painful joints, 
and swollen and tender glands for several weeks. 
The common symptom is fever, occurring in about one-third of the cases, the 
degree of which is often considerable, reading as high as 106° F., although an 
elevation of only 1° may occur. Associated with fever in a large number of 
cases is an eruption. The eruption may be urticarial (hives), macular (spotted), 
papular (pimple), vesicular (blister), haemorrhagic, or in the form of erythema 
(redness). The serum eruption may be local, occurring only about the site of 
injection, or general, involving all parts of the skin. 
The fever and eruption may occur together although not necessarily so. The 
highest point of the fever is usually accompanied by the appearance of the rash 
or on the day previous to it. Relapses occur occasionally after being free from 
4 to 14 days. 
Individuals who have had a previous injection of serum in any form, upon 
receiving a subsequent injection may develop alarming symptoms or even fatal 
reactions. Persons susceptible to asthma and certain allergic nasal conditions 
are particularly susceptible. These reactions are termed serum accidents and 
usually occur immediately. In some cases almost before the needle is with- 
drawn local itching and swelling occur. If the attack is severe, sneezing, 
tickling of the throat, choking sensation, cough, or swelling of the face, hands 
or the whole body may occur. An acute attack of asthma may develop and 
may be followed by convulsions and death. 
Those who suffer from asthma due to coming in contact with horses are 
highly susceptible to horse-serum proteins. Such patients should not be treated 
with preparations containing horse serum if it can be avoided. If necessary 
to do so great care must be used in the administration. 
Treatment.—It has not been demonstrated that serum disease or serum 
accidents can be entirely prevented. In ordinary serum sickness, which is 
the common type and follows the injection of serum for the first time, cold 
applications to the site of injection for the local swelling, and applications 
of calamine lotion containing 1 per cent phenol, or sodium bicarbonate baths, 
may be helpful to control the itching. Hypodermic injections of epinephrine 
hydrochloride solution 1-1,000 in 0.5 cc to 1 cc doses subcutaneously may give 
relief from the itching, swelling, and rash. In addition to the above measures 
free elimination, with sufficient intake of fluids, should be encouraged. ALLERGY 
485 
To prevent grave symptoms, as in serum accidents, an attempt should be 
made to elicit a history of previous administration of serum or a history 
of asthma or hay fever. Tests for sensitivity as mentioned later should be carried 
out and if positive the patient should be considered an unsafe subject for serum 
treatment by routine methods. 
Desensitization offers a method of administering serum to many patients 
who would react violently to serum if given in the usual way. Patients who 
have asthma which is aggravated by coming in contact with horses may be 
so sensitive that they cannot be desensitized, but most of those whose hyper- 
sensitiveness dates back to a previous injection of serum can be treated 
with the usual amount without danger. Patients who have a history of 
Figure 133.—Positive reaction to horse serum 10 minutes after intradermal injection of 
0.1 cc of 1-10 dilution of horse serum. This reaction would be classed as moderate. 
asthma or have a strongly positive skin test, should be given the first desensi- 
tizing dose subcutaneously. Beginning with 0.005 cc to 0.025 cc the dose may be 
doubled every half hour until a dose of 1.28 cc is given (ninth dose). Then 0.1 cc 
is injected intravenously and the dose should be doubled every 20 to 30 minutes 
until the required amount is given. Dilution with physiological salt solution 1-10 
is advisable when unrefined serum is used. 
With patients showing mild skin reactions, which is often the case when 
persons have had previous serum treatment, desensitization may be shortened 
by starting with a larger dose and increasing the size of subsequent doses. 
One should always keep on hand, when administering serum, a syringe con- 
taining epinephrine hydrochloride solution 1-1,000. 
The symptoms of serum sickness must be treated promptly should they 
arise. Administration of serum must be stopped immediately and a tourniquet 
applied about the site of injection if possible to do so. Epinephrine hydrochlo- 486 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
ride solution 1-1,000 in 0.5 cc to 1 ec amounts should be injected subcutaneously 
and repeated at short intervals, if necessary, until relief is obtained. 
Site of injection.—Many physicians prefer the muscular region on the outer 
area of the thigh for injection of serum because a tourniquet may be easily 
applied above the site, if necessary, to retard the process of absorption in 
case serum reactions occur. Serum that is given intramuscularly is less liable 
to be followed by serum reactions, due to slower absorption and thus serving to 
desensitize, than when given by the intravenous or intraspinal routes. 
Sensitivity tests may be either conjunctival or dermal (skin). 
In the conjunctival test several drops of a 1-10 dilution of normal horse 
serum are instilled into the conjunctival sac by retracting the lower lid gently 
and instilling the serum into the outer canthus or angle of the eye. A positive 
reaction will appear within 20 minutes, manifesting itself by congestion and 
dilatation of the vessels, increased lacrimation or flowing of tears, and itching. 
A severe conjunctival reaction may be neutralized by washing out the serum 
with a solution of boric acid containing a few drops of a 1-4,000 solution of 
epinephrine hydrochloride. 
In the skin test a small amount of normal horse serum or the antiserum to 
be used in the treatment should be diluted 1-10 with physiological saline 
solution and 0.1 cc. of this dilution injected intradermally in the forearm. The 
reading should be made in 15 to 20 minutes. In hypersensitive patients there 
will be a wheal or hive approximately 1 cm. in diameter and a zone of erythema 
considerably larger (fig. 133). The size of the wheal and erythema depends 
upon the sensitivity of the patient. A positive reaction indicates that a patient 
is sensitive and should be desensitized before the administration of serum. 
Rabbit serum may be substituted for horse serum in certain types of pneu- 
monia treated by serum in the event hypersensitivity tests with horse serum are 
positive. Prior to giving rabbit serum the patient should be tested for sensitivity 
using the same procedure as for horse serum. 
DRUG ALLERGY 
Drug allergy may be defined as a condition of hypersensitiveness to certain 
drugs among which are some of the well-known drugs now in common use, such 
as arsenic, mercury, bromides, iodides, quinine, morphine, strychnine, antipyrine, 
aspirin, sandalwood oil, balsam of copaiba, and many others. 
In most cases the symptoms of drug allergy appear within a few hours 
after the administration of the drug although the appearance of allergic mani- 
festations may not appear until after prolonged administration. In some indi- 
viduals prolonged administration of drugs causes no allergic symptoms but 
upon resuming treatment at a later date an immediate attack of hypersensitive- 
ness is brought about. This may persist for some time or disappear completely. 
One of the most common symptoms of drug allergy is fever, which in some 
cases is preceded by a chill. Temperatures as high as 104° to 108° F. have been 
recorded. Various forms of eruptions may occur, the most common are the 
erythematous or redness, the urticarial or hives, the vesicular or blister, the 
macular, spotted or blotchy, the papular or pimple, and the hgemorrhagic. 
Fever may not be present during the eruption nor may the eruption be present 
during the fever. Other symptoms less frequently noted are oedema, a painless 
swelling, especially of the face or at the site of injection; swelling of the 
joints, and in some cases swelling of the lymph glands. 
The clinical characteristics of drug allergy are readily recognized as the 
same as those of serum disease. But for the chemical difference between serum ALLERGY 
487 
and drugs, serum allergy or serum disease and drug allergy would have been 
identified as the same disease. 
It is important to remember that sensitivity to drugs may be detected by 
skin tests. Such tests are carried out by the scratch or patch method using 
the same technique in preparing the skin as described elsewhere in this section. 
A small amount of the drug, either in powder or solution, is rubbed into the 
scratch or applied to the skin, if using the patch test. The reaction to the 
scratch test may occur at any time from 10 minutes to 24 hours, usually less 
than 24 hours. The reaction to the patch test occurs somewhat later than 
the scratch test, usually between 2 and 24 hours. 
BACTERIAL ALLERGY OR HYPERSENSITIVENESS OF INFECTION 
A state of allergy may develop in any bacterial infection which ha« become 
chronic or which, with antigenically identical bacteria, is frequently repeated. 
The infectious exanthematous rashes such as scarlet fever, the syphilides and 
tuberculides are examples of allergic reactions. The tuberculides are typical 
examples of bacterial allergy and are associated with a high grade of resist- 
ance to the infection. Erythematous reactions of various types are found 
associated with a number of infections and should be regarded as allergic 
cutaneous reactions. 
Erythema nodosum, a skin disease characterized by red, smooth, and shiny 
nodules on the shins, is found occasionally in tuberculosis, syphilis, acute strep- 
tococcal tonsillitis and acute rheumatism. Erythema multiforme, another skin 
disease characterized by a rash of various types is also considered to be an 
allergic reaction. 
Obvious foci of infection, especially in the teeth, tonsils, and sinuses, should 
be eradicated. Urticaria, angioneurotic oedema and asthma have responded 
to the eradication of foci of infection. Occasionally bacterial allergy compli- 
cates a case of hay fever or asthma due to other allergens. 
A group of generalized cutaneous allergic reactions occurs in fungus infec- 
tions, The prevalent ring-worm infections of the feet and hands, particularly 
between the toes and fingers, frequently provokes an allergic response in the 
tissues and they often resist all forms of local treatment applied to the site 
of the infection. 
The common fungi responsible for this condition are the trichophyton, epider- 
mophyton, and monilia. Skin testing with extracts of the various types followed 
by desensitization with the specific type of fungus has given favorable results 
in many cases. 
Tuberculin tests.—Evidence of bacterial allergy is best shown in tuberculosis. 
Cutaneous tests with tuberculin do not show the immediate wheal seen in 
pollen allergy but show a delayed reaction, the maximum reaction coming on 
some hours after the innoculation. 
The most satisfactory tuberculin test is the intra-cutaneous one known as the 
Mantoux test. The antigen used in this test may be the purified protein deriva- 
tive known as Tuberculin P. P. D. or the more familiar Old Tuberculin known 
as O. T. Purified protein derivative is furnished in tablet form in two strengths. 
Individuals who do not react to the first strength are reinjected 48 hours later 
with the second, stronger tablet. 
The flexor surface of the arm is cleansed in the usual manner and 0.1 cc 
from the vial labelled first strength is injected just beneath the first layer of 
skin using a tuberculin syringe and number 26 gauge needle, approximately 
one-half inch long. The reactions should be read 48 hours after the injection. 488 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The test is read as follows: A negative reaction shows no swelling and little 
redness or tenderness; a positive reaction (Fig. 134) may be classified according 
to size, a 1-plus consisting of an area of swelling measuring 5 mm. to 10 mm. 
in diameter, a 2-plus from 10 to 20 mm., a 3-plus over 20 mm. in diameter, and 
a 4-plus an area of swelling and necrosis; a doubtful reaction is one character- 
ized by a trace of swelling measuring 5 mm. or less in diameter. In inter- 
preting reactions swelling is more important than redness. 
The first test dose of P. P. D. corresponds to 0.1 cc of a 1-25,000 dilution 
of Koch’s Old Tuberculin. The latter may be used if desired, but owing to the 
uniform potency of P. P. D. a large number of extensive reactions previously 
seen with old tuberculin are eliminated and the purified form is now preferred. 
Figure 134.—Positive tuberculin test 72 hours after intradermal injection of 0.1 cc of First 
Test Strength of Tuberculin, P. P. D. (purified protein derivative). 
Iii Yon Pirquet’s test a drop of Koch’s Old Tuberculin is placed on the 
forearm and a slight scratch made through the drop. A control consisting of 
a drop of 50 per cent glycerin is placed several inches from the first drop 
containing the tuberculin, the skin being scratched in a similar manner. If 
the test is negative both areas will be the same size. If positive the drop 
containing the tuberculin will cause redness and swelling while the other will 
show no such reaction. 
Moro’s percutaneous test consists of rubbing into the skin over the chest 
or abdomen an ointment consisting of 50 per cent old tuberculin in lanolin. 
An area of approximately 4 inches may be used. If positive a reaction is 
shown by an eruption of papules over the area in 2 to 7 days. A rubber 
finger cot should be used in applying the ointment. 
Recently Wolff devised a test similar to the Moro test using a small drop 
of the ointment and a drop of ointment containing no tuberculin. The drop 
is not rubbed in but covered, as in the patch test mentioned under contact 
dermatitis. The test is read in 48 hours producing papules similar to those of 
the Moro test when positive. 
Other tests which may lead to unpleasant reactions and have no advantages 
over the previously described cutaneous tests are the subcutaneous test and 
Calmette’s conjunctival test. ALLERGY 
489 
ALLERGY TO PARASITES AND INSECTS 
Parasites in the intestinal tract or the body tissues may produce various 
allergic disturbances. 
Ascarides (round worms), tape worms and ecchinoccocci in particular have 
been known to cause allergic disturbances. 
The bitesr of fleas and lice produce manifestations. 
Inhalants such as the emanations from flies, moths, and butterflies may 
also produce symptoms referable to the upper respiratory tract. 
PHYSICAL ALLERGY 
Duke states that many nasal, bronchial, cutaneous and other allergy-like 
manifestations may arise from the effects of light, heat, cold, and effort on the 
body cells. 
Localized or generalized urticaria is the most common single symptom of 
physical allergy and is not often lacking. 
The cause for this condition is not definitely known; however, experiments 
lend weight to the conception that urticarial wheals and probably some of the 
other manifestations of physical allergy are but normal responses to the pres- 
ence of histamine or, as Rowe states, the physical agent may act as a trigger 
mechanism which releases an underlying potential ingestant, inhalant, or 
possibly a bacterial sensitization. 
Elimination Diets (Rowe) 
Diet 1 
Diet 2 
Diet 3 
Diet 4 
Rice. 
Com. 
Tapioca. 
Milk.i 
Tapioca. 
Rye. 
White and sweetpotato. 
Rice biscuit. 
Corn pone. 
Lima bean potato bread. 
Rice bread. 
Corn rye muffin. 
Rye bread. 
Rye crisp. 
Soya bean lima bean bread. 
Lettuce. 
Tomato. 
Beets. 
Spinach. 
Squash. 
Carrots. 
Carrot. 
Asparagus. 
Lima beans. 
Beet. 
Peas. 
String beans. 
Artichoke. 
String beans. 
Tomato. 
Lamb. 
Chicken. 
Bacon. 
Beef. 
Bacon. 
Lemon. 
Pineapple. 
Lemon. 
Grapefruit. 
Peaches. 
Grapefruit. 
Pears. 
Apricots. 
Prunes. 
Peaches. 
Apricots. 
Cane sugar. 
Cane sugar. 
Cane sugar. 
Wesson oil. 
Mazola oil. 
Olive oil. 
Olive oil. 
Wesson oil. 
Wesson oil. 
Salt. 
Salt. 
Gelatin. 
Gelatin. 
Karo Corn sirup. 
Salt. 
Syrup made of maple sugar or 
cane sugar flavored with 
mapeline or maple sugar. 
Olives. 
Pear butter. 
Gelatin. 
Olives. 
Maple syrup or syrup made with 
cane sugar flavored with 
maple. 
i Milk should be taken up to 2 or 3 quarts a day. Tapioca cooked with milk and milk sugar also may be 
taken. 
Note.—Wesson (Cottonseed) Oil is included in all diets. 
With allergy to cottonseed as shown bv skin 
test or history this must be excluded and a cottonseed-oil shortening must not be used. If allergy to cane 
sugar is suspected, beet sugar or corn glucose may be used. 
(1) Gastrointestinal Allergy.—Albert H. Rowe, Nov. 22, 1935. 
(2) (3) A. F. Coca and R. A. Cooke.—Journal of Immunology 8: 136; 1923. 
(4) Etiology and Hayfever.—A. A. Thommen; New York State Journal of Medicine, 30; 
437-442, 1930. 
(5) Seasonal Aspects of Asthma and Hayfever in New England.—Henry N. Pratt; New 
England Journal of Medicine, Vol. 219, No. 20, P-782, Nov. 11, 1938. 
References 490 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
(6) Allergy. Its Recognized Causes.—Albert H. Rowe; North West Medicine, Vol. 34, 
Nos. 10 and 11, Oct. and Nov. 1935. 
(7) Elimination Diets for Diagnosis and Treatment of Food Allergy.—Albert H. Rowe; 
American Journal of Digestive Diseases and Nutrition, L : 387-392, August 1934. 
(8) Clinical Allergy—Manifestations, Diagnosis and Treatment, 1937.—Albert H. Rowe. 
Serum Sickness and Serum Accidents.—G. M. MacKenzie, in Textbook of Medicine, Cecil. 
Hypersensitiveness.—A. F. Coca, in Practice of Medicine, Tice. 
M. Walzer, in Practice of Medicine, Tice. 
Diseases of the Skin.—C. G. Andrews. 
Cutter Laboratories, Berkeley, Calif. 
Eli Lilly and Co., Indianapolis, Ind. 
Parke, Davis and Co., Detroit, Mich. 
Lederle Laboratories, Inc., New York, N. Y. 
B. R. Squibb and Sons, New York, N. Y. 
Illustrations (figs. 130 to 134 inch) by Glen Leith, Vallejo, Calif. 
Section 3.—GENITOURINARY AND VENEREAL DISEASES 
The male genitourinary system. 
In the male the genital and urinary systems are so closely associated, both 
anatomically and functionally, that they are often referred to as one system, 
the genitourinary. 
The anatomy of the different structures comprising these systems has been 
described in the chapter on Anatomy and Physiology. 
DISEASES, INJURIES, AND ABNORMALITIES OF THE MALE GENITALIA 
The most common diseases of the penis are chancre, chancroid, gonorrhoea, 
cancer, tuberculosis, and elephantiasis of the foreskin. Injuries include crush- 
ing, laceration, fracture, and complete loss by cutting or crushing. A urinary 
fistula is a false passage from the natural urinary passage in the penis to the 
external surface and usually follows abscesses of the urethra or injuries. 
The scrotum has few diseases. The more common are elephantiasis, in the 
tropics, cancer, and sometimes chancre and chancroid. Injuries of the scrotum 
are usually lacerations or bruises. 
The testes ordinarily have the following diseases: Syphilis (gumma), mumps, 
and tumors. The testes are rarely attacked by the gonococcus and tuberculosis, 
and are rarely injured except intentionally, in mutilation, which may be self- 
inflicted. 
The epididymis is most commonly infected with gonococcus and next with 
tuberculosis and finally with ordinary pus germs. In some instances it is at- 
tacked by syphilis. It is rarely injured, excepting in grave injuries which 
involve the testicle. It may have tumors in rare cases. 
The vas, the prostate, and the seminal vesicles are most frequently attacked 
by the gonococcus, tuberculosis, ordinary pus germs, and sometimes by 
syphilis. The prostate has, in addition, cancer and an enlargement which ob- 
structs urination in old men is called hypertrophy. 
Varicocele is an enlargement of the veins of the spermatic cord. 
Hydrocele is a condition in which the sac surrounding the testicle is filled with 
a watery, serous fluid. It may reach an enormous size. 
Hcematocele is the same as hydrocele, except that the fluid is blood. 
Undescended testicle may mean that the testicle is within the abdomen (it 
descends normally in the seventh month of foetal life), or it may have stopped 
in the groin, or it may hang on the corner of the pubis. 
Epispadias is a malformation of the penis in which the urethra opens on 
the top. GENITOURINARY AND VENEREAL DISEASES 
491 
Hypospadias is a malformation in which the urethra opens underneath the 
penis. 
Hermaphrodites are unfortunate individuals who have faulty development 
of the genitalia and partake of the characteristics of each sex, so that in 
extreme cases it is difficult to determine to which sex they belong. There is 
doubt if there is ever a true hermaphrodite, as this would depend on careful 
study and proving the presence of both true ovary and true testicle in the 
same individual. 
Pyelonephritis and pyonephrosis are infections which involve the pelvis of 
the kidney. When the pelvis alone is involved it is termed pyelitis. 
Ureteritis, cystitis and urethritis are conditions which indicate inflamma- 
tion of these organs, the result of infection, chemical injury, or traumatic 
Injury. 
Stones or calculus formations may be found anywhere in the urinary tract. 
In general the treatment of the foregoing lies beyond the scope of the hospital 
corpsman. However, there are a few conditions and treatments of which mention 
must be made. 
Phimosis is a deformity of the foreskin which renders its retraction behind 
the glans, or head of the penis, impossible because of the small opening in 
the foreskin. The condition often induces an attack of balanitis or balano- 
posthitis. The remedy is circumcision, but if no medical officer is available 
for several days it should be cut on top; using injections of 1 per cent pro- 
caine or novocaine for anaesthesia. The cut can be made with a sturdy, sharp 
pair of scissors or with a knife on a grooved director which has been passed 
between the foreskin and the glans, being sure that the director is above the 
glans and not in the urethra. Care must be exercised to avoid cutting the 
glans and the cut should be extended far enough back so that the foreskin 
can be pulled back and everything seen. Bleeding can easily be stopped by 
tying off the bleeding points with catgut or silk ligatures. 
Paraphimosis is a condition in which a tight foreskin has been retracted 
behind the head of the penis and cannot be brought forward readily. The 
small opening in the foreskin forms a band of constriction on the dorsal 
surface of the penis, which, interfering with the circulation of the blood, causes 
more or less deformity of the organ from oedema. The condition causes great 
discomfort and if neglected may go on even to ulceration and gangrene of the 
foreskin and head of the penis, with possible loss of the glans. 
The first requirement of treatment is the immediate reduction of the dis- 
placed foreskin. This often can he accomplished in the following manner: 
With the two thumbs pressing on the head of the penis at either side of the 
meatus, and the index and middle fingers behind the constriction, the blood is 
pressed out of the head, which being thus reduced in size and softened, is pushed 
back through the constricting ring and the foreskin drawn forward. 
Should this procedure fail, owing to the tightness of the constriction, and the 
head of the penis shows great swelling and purpling, the tight constricting 
baud must be found and a small longitudinal incision made completely through 
it on the dorsal surface, under local anaesthesia, so that the foreskin may 
be brought forward. The wound should be dressed with sterile gauze. 
In injuries to the penis, scrotum, and testicle, bleeding m$ay be dangerous, 
and if no medical officer is available an effort must be made to stop it. The 
first thing is to give morphine by hypodermic, at least one-quarter grain, re- 
peated in a couple of hours if necessary, to quiet excitement. As a rule 
154204°—30——32 492 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
do not put on a tourniquet, but try to find the bleeding points and then clamp 
and ligate them with catgut. Tourniquets may destroy the only chance of 
saving the part, because they shut off all the blood supply. 
In cases where rings, wire, rubber bands, etc., have been placed around the 
penis, they must be cut or filed off at once; otherwise the swelling may produce 
gangrene and complete loss of the part. 
If too strong solutions are introduced into the urethra by accident, give mor- 
phine, at least one-quarter grain, by hypodermic at once. In general pass no 
instruments, but inject gently plenty of sterile water. If the solution was lye 
or other alkali and the condition is seen early, inject vinegar or acetic acid, 
one-half of 1 per cent. Again, if the solution was nitric or sulfuric or some 
other acid, inject a solution of sodium bicarbonate, a teaspoonful to a pint. 
If phenol, inject magnesium sulfate, a tablespoonful to a pint. Bichloride of 
mercury is neutralized with the white of an egg. Iodine is neutralized with 
starch water. An ice bag will help keep down swelling. The services of a 
medical officer should be obtained as soon as possible. 
THE VENEREAL DISEASES 
The venereal diseases are those contracted almost always through sexual inter- 
course and include syphilis, gonorrhea, chancroid, and lymphogranuloma, vene- 
reum. These diseases are very prevalent in every community and do a great deal 
of damage not only to the individuals affected but to the community by reason of 
invalidism and premature death. In a military service the venereal diseases cause 
much loss of efficiency. In the year 1917 the British Army lost the services of 
98,000 men as a result of venereal disease. During the same year the total 
number of admissions from venereal disease in the United States Army was 
71,955, resulting in 875,553 sick days. In the United States Navy during the 9 
years 1909 to 1917, inclusive, an average of 158 men out of every 1,000 were 
admitted to the sick list for venereal disease. 
It is highly probable that every person who indulges in promiscuous sexual 
intercourse sooner or later acquires one or several of the venereal diseases. 
It has been estimated that 60 per cent of the adult male population of the 
United States have had gonorrhea. Now that routine Wassermann tests are 
made in many large civil hospitals, it is found that from 20 to 30 per cent 
of all admissions give a positive reaction indicating syphilis. 
In 1917, in a large Pacific coast city, 97 per cent of the prostitutes were 
found to be infected with venereal disease. In a city on the Atlantic coast, 
96 per cent of the prostitutes had venereal disease. These statistics may serve 
as an index of the prevalence of venereal disease among persons who practice 
promiscuous sexual indulgence. 
The effects of venereal disease are far-reaching. In the case of syphilis 
the effects are in the beginning slight and local, but as the organism which 
causes the disease spreads throughout the body they become grave. One 
great danger is that early in the progress of the disease the symptoms are 
often so trivial that no anxiety is aroused in the patient’s mind. The symp- 
toms may be so slight as not to be observed. The patient may not seek treat- 
ment and he may succeed in unknowingly infecting other people. 
When the infection becomes generalized every organ and every system in the 
body may be attacked. Syphilis is especially liable to attack the walls of the 
arteries. When this occurs the muscular portion of the artery often is replaced 
by nonelastic fibrous tissue. The artery becomes thickened and hardened. 
Hardening of arteries is a natural process which accompanies advancing age, but 
the hardening process resulting from syphilis is much more rapid and dangerous GENITOURINARY AND VENEREAL DISEASES 
493 
as far as life is concerned. If the arteries of the brain become thickened and 
hardened the blood supply is diminished and the portion of the brain supplied 
with blood by the artery affected ceases to exercise its function. What the 
symptoms will be depends upon what part of the brain is involved, but the 
condition may cause mental debility, insanity, loss of speech or memory, or 
paralysis. Syphilis frequently attacks the aorta, the great artery leading from 
the heart. A part of the wTall of the aorta becomes thickened and loses its 
elasticity by the formation of fibrous tissue which is weaker than the muscle 
in the wall of the vessel. The force of the blood stream causes a bulging of 
this weakened part and in time the wall becomes thinner and the bulging 
greater until eventually a distinct pouch is formed. The bulging of an artery 
in this manner is known as an aneurysm. The thinning of the wall makes the 
aneurysm very liable to burst. This often happens and the patient dies sud- 
denly. Syphilis frequently causes disease of the heart or other important 
Internal organs. 
Perhaps the most important part of the body attacked by syphilis is the 
nervous system. Either the brain or the spinal cord, or both, may be affected. 
Once the organism of syphilis has lodged in the nervous system it is extremely 
difficult to evict it. A man with syphilis, if he marries, may infect his wife, 
and a child bom after the infection is apt to show grave manifestations of the 
disease. Syphilis is a most frequent cause of miscarriage in pregnant women. 
The local inflammation of the urethra, which is all that most patients see 
in gonorrhoea, is actually the least of its dangers. Apart from the danger of 
infection of the eyes and the general infection of the body resulting in heart 
disease and gonorrhoeal rheumatism, the complications due to direct extension 
of the disease are different in the two sexes. In man all of the organs con- 
nected with the genito-urinary tract may become infected. In women grave 
complications are common. Invasion of the uterus, the Fallopian tubes, and the 
peritoneum by the organism is frequent. This invasion takes place either shortly 
after infection or after the birth of the first child. The gonorrhoea may subside 
and become quiet in the glands of the mucous membrane of the vagina until 
pregnancy excites a congestion that increases the virulence of the bacteria 
causing the disease. By these virulent organisms the child’s eyes are endangered 
at birth; its mother’s uterus and Fallopian tubes immediately thereafter. It is 
estimated that in 10 per cent of blind children the blindness is due to gonor- 
rhoeal infection of the eyes during birth. Over 60 per cent of the inmates of 
asylums for the blind are made blind by gonorrhoea. Gonorrhoea of the uterus 
and Fallopian tubes usually makes a woman sterile—that is, unable to conceive 
children. Besides depriving a woman of her children, gonorrhoea may render her 
a permanent invalid—may even cost her her life. It is a curious fact that gonor- 
rhoea in women is either much milder or much more severe than the disease in 
man. Some women while heavily infected have few or no symptoms of the 
disease and are not inconvenienced by it. Others are overwhelmed hy gonor- 
rhoeal abscesses in the Fallopian tubes, in the pelvis, or by peritonitis. They must 
undergo severe surgical operations or die; should they recover they often are 
invalids the rest of their lives. 
Syphilis. 
This is a generalized, chronic, infectious disease that attacks any and every 
part of the human body. It occurs in two forms, acquired and hereditary. 
Acquired syphilis is communicated by a syphilitic person to one free from the 
disease, the point of inoculation always being marked by a sore called the 
initial lesion or chancre. Hereditary syphilis is transmitted to the unborn 
child from one or both of its parents; in this form there is no initial lesion, 494 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
the onset of the disease being marked by general manifestations which may be 
noticed at the time or shortly after the syphilitic child is born. 
The cause of syphilis is the Treponema pallidum, a microorganism belonging 
to one of the lowest families of the animal kingdom, the Spirochcetacew, or 
spirochsetes. This organism is shaped like a corkscrew sharpened at both ends, 
is very active, and is very easily killed by heat, drying, sunlight, and anti- 
septics ; its transmission is easy by sexual intercourse, and it is not infrequently 
transferred by the kissing, biting, and scratching of infected persons, or the 
use of the toilet articles, eating, drinking, or smoking utensils, pencils and pens, 
etc., of infected persons with open lesions. It may also be transferred through 
the handling of open lesions. While it is believed that there must be at least a 
slight break in the skin for its entrance, there is no certainty that such a break 
is necessary. 
Acquired syphilis, to which this discussion will be confined, is usually divided 
into three stages, the primary, the secondary, and the tertiary. The primary 
stage consists of two periods of incubation, the first of which exists from the 
time of exposure to the appearance of the initial lesion and, as a rule, lasts 
from 14 to 21 days but has been noted within as short a time as 3 or 4 days 
and as late as 4 months. This is followed immediately by the second period 
of incubation which dates from the formation of the initial lesion to the de- 
velopment of certain constitutional manifestations and usually occupies from 
40 to 45 days but may be prolonged much longer. The initial lesion, primary 
sore, or; chancre appears on the penis, scrotum, or elsewhere. Usually there is 
but one sore which is a hard and cupped-out ulcer showing a tendency to heal 
slowly and giving little if any pain. These sores vary greatly in their character 
and some are so small and insignificant that they escape the notice even of 
cleanly persons. The near-by lymph glands are swollen, but not painful ex- 
tender, and do not tend to form pus. Blood tests in this stage are seldom posi- 
tive. The secondary stage, or secondaries, is characterized by the appearance 
of the constitutional manifestations consisting of any or all of the following: 
Rashes on the skin, superficial lesions on the mucous membranes, general en- 
largement of the lymph glands, headaches, fever, pain in the bones, muscles, 
and joints, and falling hair. The duration of this stage is variable, usually be- 
ing from 1 to 2 years, and in it the blood tests for syphilis are generally posi- 
tive. Should the result of the first blood test be negative repeat tests should 
be made at intervals for at least 1 year after the appearance of any suspicious 
lesion, particularly one located on the genitalia. 
The tertiary stage usually begins at about the end of the second year but may 
not appear for years after symptoms of the secondary have disappeared. It 
is not seen so frequently today as formerly because of modern methods of treat- 
ment. It manifests itself by tumor-like swellings called gumma, destructive 
lesions in the nose and other parts of the body, affections of the heart and blood 
vessels, liver, kidneys, bones, and sometimes of the nervous system, the latter 
producing paralysis, insanity, etc. Tertiary manifestations may simulate every 
symptom known to medicine. 
The treatment of syphilis should be begun just as soon as a positive diagnosis 
is made, even if the disease is still in the chancre stage. The prognosis is much 
better if efficient medication is given before the organisms have had an oppor- 
tunity to produce tissue changes throughout the body. 
Although the details of treatment cannot be fully gone into here it may be 
stated that it consists principally of the administration of salvarsan, mapharsen, 
neosalvarsan, silver-arsphenamine, tryparsamide, and sulfarsphenamine, all be- 
longing to the arsenical group, the first five being injected into the veins, and GENITOURINARY AND VENEREAL DISEASES 
495 
the latter being injected deep into the buttocks. Mercury is given by mouth, 
by inunction,, and by injection deep into the buttocks, bismuth subsaliscylate is 
injected deep into the buttocks; iodide of either potassium or sodium usually 
is given by mouth, and the latter sometimes into the veins. 
The disadvantages and dangers of these substances will be mentioned under 
a paragraph devoted to that subject. 
Local treatment amounts to very little, and no antiseptic should be put on a 
primary sore until the sore is definitely diagnosed. Dress it with warm physio- 
logical salt solution only and do not even use soap, because this and antiseptics 
interfere with finding the microorganism. 
Every case with open sores should strictly adhere to the use of their own 
clothing, towels, bedding, pipes, toilet articles, etc., and separate toilet seats 
and separate mess gear should be provided. If possible they should be kept 
in separate wards and should not be allowed to go on liberty. All dressings 
should be burned and hospital corpsmen dressing such cases should wear gloves, 
especially if they have any cuts or scratches on their hands. If gloves are 
not available, the hands should be washed thoroughly with soap and water 
immediately after dressing the case. They should not skylark or wrestle with 
such patients. If a medical officer or hospital corpsman should cut or prick 
his finger while working with these cases the wound should be cauterized at 
once which will practically always prevent infection. An entry of such an acci- 
dent should always be made in the health record of the individual concerned. 
The diagnosis of syphilis in the primary stage is made by demonstrating 
the Infecting organism in smears from the chancre by means of dark-field 
illumination. This method is described in the section on Laboratory Procedures 
and Technique. 
The blood tests used in the diagnosis of syphilis are possible because of the 
characteristic changes in the blood serum as a result of the invasion of the 
spirochgetes, and are known as serological reactions. In them the serum of an 
infected person reacts specifically with certain substances from normal tissues. 
Principal among these tests are the Kalfn flocculation test and the Wassermann 
complement fixation test, the details of which are too technical to be given 
here. There are many other tests, such as the Noguchi, Emery, Kline, Hin- 
ton, etc. 
Changes may occur in the cerebrospinal fluid of persons infected with syphilis 
and positive Kahn and Wassermann reactions with it can also be obtained. 
There are other tests of the cerebrospinal fluid that may be used in the diag- 
nosis of syphilis. 
In some instances there may be repeated positive serological reactions with- 
out history, symptoms, or other signs. In such cases the diagnosis of Syphilis, 
sero-positive only, should be used in reporting the condition. 
With treatment the reaction in these tests usually grows weaker and finally 
becomes negative, but many cases responding well to treatment never become 
negative. 
It should be remembered that there are some other diseases that will give 
positive Kahn and Wassermann reactions, of which one is yaws. 
Chancroid. 
This is an ulcerative type of disease whose action is local in character, not 
generalized like syphilis, being limited to the parts where it occurs and related 
lymph glands. The word means “like a chancre,” and nearly always occurs 
in those who are most uncleanly in their habits, being preeminently “a disease 
of dirt and filth ” 496 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The cause of chancroid is undoubtedly the Haemophilus ducreyii (Bacillus of 
Ducrey) which is often called the streptobacillus of Ducrey because it occurs 
in the form of short rods end to end like a chain until ulceration sets in. Its 
transmission is commonly by sexual intercourse and it may be transferred by 
inoculation in an abrasion of the skin of another person or of the person 
already infected, as the secretion of a chancroid is highly infectious. Chan- 
croid nearly always occurs on the genitals, occasionally in the anus or mouth 
in cases of perversion, and rarely on the hands, etc., by accidental infection. 
On the male genitals it is most common in the groove behind the penis, 
especially in the little pocket on each side of the frsenum, but it may occur on 
the head of the penis, the inner surface and free border of the foreskin, and 
the skin covering the penis. 
Chancroid is characterized by an ulcer that is usually painful, tender, soft, 
prone to bleed easily, and has a tendency to spread and form secondary ulcers. 
These ulcers are likely to be phagedenic and destroy tissue, and may finally 
destroy the whole penis. The first ulcer usually begins as a small pustule 
surrounded by a highly inflamed area. The pustule soon breaks down and 
leaves a round or irregular ulcer with sharply defined edges and undermined 
walls. The floor of the ulcer is rough and generally is bathed by a purulent 
secretion which is very infectious. There is a varying amount of inflammatory 
thickening of the tissues around and beneath the sore, which shades off gradu- 
ally into the surrounding parts, thus differing from the ring-like induration 
of the syphilitic chancre which is hard and sharply outlined. The chancroid 
is prone to form buboes which are painful and tender, and usually form pus. 
The chancroid has no fixed period of incubation, its development is rapid, and 
it usually appears in 2 to 5 days after infection. 
In addition to forming bilboes chancroid may be complicated by mixed infec- 
tion with syphilis and with pyogenic organisms, by destruction of the frsenum. 
by phimosis, balanoposthitis, etc. 
The treatment of chancroid should never be started until after the sore has 
been studied to make sure that it is not a chancre, because it is always possible 
that any sore on the penis is syphilitic. It should be dressed at first with warm 
physiological salt solution only, and repeated examinations of the secretions for 
the presence of Treponema pallidum should be made. When it is decided that 
the sore is a chancroid local treatment should be immediately started. There are 
many remedies but probably the best in order, would be copper sulfate, nitric 
acid, phenol, alum, chlorinated lime water, calomel ointment, etc. On account 
of pain it is usually necessary to apply a 4 or 5 per cent novocaine or procaine 
solution to the sore before carrying out the more drastic treatment. Although 
there may appear to be no syphilitic element present some very bad phagedenic 
chancroids may be healed by an intravenous dose or two of salvarsan which is 
probably due to the tonic effects of the arsenic in the salvarsan. 
Gonorrhoea. 
Acute anterior urethritis, or clap, as gonorrhoea is commonly called, is a 
local inflammatory disease usually affecting the raucous membranes of the 
urethra in the male and the urethra and cervix uteri in the female; by accident 
or perversion, the mucous membrane of the anus or mouth; and, by accident, 
the conjunctivse of the eyes. It does not occur in any of the lower animals. 
The causative organism may extend and infect any part of the genito-urinary 
tract, and may attack joints, the valves of the heart, and even the meninges by 
entering and circulating in the blood stream. The word gonorrhea is a mongrel 
one from the Hebrew and Greek languages meaning “flow of semen,” which is, 
of course, incorrect. GENITOURINARY AND VENEREAL DISEASES 
497 
The cause is the Neisseria gonorrhcew (gonococcus) which belongs to the 
family of bacteria known as the Coccacese, or cocci. When stained and viewed 
through the microscope they usually are seen in pairs, either within or outside 
of pus cells, and have the appearance of two coffee beans with their flat sides 
together. In the earliest stage of the disease, when the discharge is glairy, 
a considerable number may be seen lying free or adhering to the surface of 
cells thrown off from the inflamed mucous membrane, but when the discharge 
becomes purulent the large proportion within pus cells is very striking. The 
transmission of gonorrhoea of the male urethra may be said to be by sexual 
intercourse only, through the deposition of the gonococcus on the mucous mem- 
brane of the urethra during intercourse with a woman having the disease. Its 
transmission to other parts of the body is by the hands, towels, etc., or by 
perverted practices. 
The usual manifestation of gonorrhoea of the urethra is a local inflam- 
mation of the infected surface which is characterized by redness, swelling, 
and exudation of pus at the outlet of the urethra as a creamy drop. During 
intercourse the gonococci enter the anterior part of the urethra and proceed 
to grow into the delicate lining membrane and set up an inflammation which 
becomes noticeable usually about the fourth day after exposure but may be as 
early as 24 hours or as late as 10 days. The first sign is usually a. slight 
sensation of burning, itching, or pain about the urinary meatus, and some- 
times a slight desire to urinate frequently. The pain or burning is most 
marked during urination owing to the irritation caused by the urine passing 
over the inflamed area. After a day or two a small quantity of glairy mucus 
can be squeezed out from the meatus, the lips of which now appear slightly 
reddened and have a tendency to stick together. The mucous stage lasts for 
about 24 hours after which the discharge becomes decidedly purulent in 
character, the pain is sharper and during urination there is a marked burning 
sensation in the urethra. The discharge becomes profuse, yellowish-green in 
color, creamy in consistence and sometimes tinged with blood, the lips of the 
meatus and often the entire head of the penis are bright red in color, hot, 
and swollen. In severe cases the lymphatics on the dorsum of the penis 
become swollen and painful, and as they communicate with the inguinal glands 
these latter may become enlarged and tender. 
The infection spreads and the entire anterior urethra becomes inflamed. 
Every act of urination is now painful as the urine is forced through the 
urethra, whose caliber has been greatly lessened by the swelling of its mucous 
membrane. The pain may be so severe as to inhibit the passage of urine. 
Painful erections (chordee) occur, especially at night, which rob the patient of 
his rest, and in this way cause debility, general malaise, and nervousness. 
The symptoms increase in severity up to about the third week of the dis- 
ease, and then in favorable cases gradually decline until at the end of about 
6 weeks the patient is practically normal. The discharge almost disappears and 
the only reminder of the disease may be a little moistness at the meatus in 
the morning. The patient perhaps considers himself cured, but may find that 
any dietetic indiscretion, such as the drinking of alcoholic beverages or sexual 
intercourse, causes a reappearance of the symptoms. 
The foregoing description refers to an uncomplicated and untreated case. 
Although the patient is free of symptoms, he is not cured. The disease 
merely has become chronic. The urethra has become tolerant to the gonococci 
which are still present, as generally can be shown by microscopic examination. 
Chronic gonorrhoea, or gleet as it is sometimes called, is a serious matter. 
It is the man with chronic gonorrhoea who mainly is responsible for the spread 498 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
of the disease. The patient is quite unaware that he is in an infective state 
and he may marry without any misgiving. The gonococcus to which his urethra 
is practically immune is then implanted in the vaginal mucous membrane of 
his wife, and in this fresh soil takes on renewed activity. It not infrequently 
happens that such a man after a few weeks of married life finds symptoms of 
acute gonorrhoea developing in himself. He usually suspects his wife and 
serious domestic trouble may result. In reality all that has happened is that 
he has been reinfected by his own organisms which have become rejuvenated by 
their residence in the genital passages of his wife. 
The gonorrhoeal process rarely is limited to the anterior urethra. In about 
90 per cent of all cases of acute gonorrhoea the infection passes quite quickly 
up the urethra to and beyond the region of the compressor or cut-off muscle of 
the urethra. When this locality is passed inflammation is set up in the 
posterior urethra. 
This invasion of the deeper parts of the urethra may take place gradually 
and with such mild symptoms as to escape detection; but in the majority of 
cases it is indicated by a sudden and very marked decrease in the amount of 
discharge at the meatus, accompanied by frequent desire to urinate, with inability 
to hold the urine when the desire comes on. 
In the mild cases involvement of the posterior urethra may be detected by 
means of the two-glass test, which is performed in the following manner: 
The patient passes the greater part of his urine into one glass and the re- 
mainder into another. If the disease is confined to the anterior urethra, the 
urine in the first glass will be cloudy from the pus washed out of the anterior 
urethra, while in the second glass it will be clear, as it consists of normal 
urine from the bladder passed through a urethra which has been washed clean 
of pus. Should the posterior urethra be involved, however, the pus from it, es- 
caping backward into the bladder, renders all the urine in it cloudy; the urine 
in both glasses therefore will be cloudy, the first a trifle more so than the 
second, as it consists of turbid urine from the bladder in addition to the an- 
terior urethral discharge which it washes out. 
Gonococci not infrequently enter the duct of the prostate gland, giving rise 
to an inflammation known as prostatitis, indicated by severe pain in the rec- 
tum which is generally intensified by defalcation. This inflammation may go 
on to the formation of an abscess which may burrow in various directions and 
burst into important near-by structures with serious results. The prostatic 
inflammation when chronic may give rise to an increase in the size of the gland. 
As the prostate surrounds the urethra just where it leaves the bladder, this 
increase in the size of the gland may interfere with the complete emptying of 
the bladder. The urine thus retained may decompose, become infected, and 
cause inflammation of the bladder. This inflammation may extend up the 
ureter and involve the kidneys, with serious results. 
When gonorrhoeal infection of the posterior urethra spreads along the vas 
deferens to the epididymis inflammation of that organ is set up. Such inflam- 
mation is known as epididymitis. About 5 per cent of all cases of gonorrhoea 
under treatment develop this condition. The patient first notices a slight ten- 
derness along the course of the epididymis. Later on the pain becomes very 
severe, and the scrotum or bag in which the testicles hang, becomes swollen and 
puffy. Constitutional symptoms may be severe and the patient’s temperature 
may rise to 104° F. With proper treatment after about a week of acute symp- 
toms the condition begins to subside. Although the patient may not complain 
of either pain or discomfort, the epididymis has not returned to its normal GENITOURINARY AND VENEREAL DISEASES 
499 
healthy condition, and the condition tends to become active again on the slightest 
indiscretion, such as getting out of bed too soon. 
The important effect of an epididymitis is that the inflammation often causes 
the caliber of the epididymis to become narrowed or obliterated, with the result 
that spermatozoa no longer are able to pass from the testicle to the urethra. 
In other words, the patient has become sterile on that side. If there has been 
epididymitis on both sides the patient becomes completely sterile. He still re- 
tains his potency but the ejaculated fluid, mainly prostatic secretion, is scanty 
in quantity and is- devoid of spermatozoa. Impregnation of the female is thus 
impossible, hence the unfortunate patient no longer can reproduce his species. 
An important sequel of gonorrhoea is stricture of the urethra. By this is 
meant a narrowing of the urethra by scar tissue at the site of an ulceration 
set up by the gonococcus. The narrowing of the urethra interferes with the 
free flow of urine and in time may cause complete retention or inability on the 
part of the patient to pass his urine. 
The treatment of typical gonorrhoea has been one of the open questions of 
medicine for a century. The ideal treatment would be to put a man to bed on 
a milk diet but this rarely is successful because few healthy men will keep it up 
for more than 5 or 6 days. 
In the acute stage a patient must be kept quiet and all sexual stimulation 
avoided. For the first week or 10 days, or even longer if the symptoms 
of inflammation are very marked, the diet should be light and easily digested. 
The following articles should be excluded: Ham, bacon, red meats, green veg- 
etables, fresh fruits of all kinds, condiments and spices, coffee, chocolate, 
cocoa, all alcoholic drinks, ginger ale, and similar effervescent waters. 
By mouth, sulfanilamide is of value, but methenamine, salol, and other 
urinary antiseptics are of questionable value. 
The testicles must be supported by a well-fitting suspensory bandage, which 
does not press upward on the urethra at the junction of the penis with the 
scrotum and thus interfere with the free drainage of the urethra. The head 
of the penis and the cavity of the foreskin must he kept clean by the frequent 
washing of these parts with hot water. 
The penis should be so dressed as to allow free drainage of the pus from the 
urethra, which at the same time must be kept from the cavity of the foreskin, 
the patient’s fingers, and clothing. These requirements are filled by a piece 
of gauze cut about 4 inches square, with a slit in the center through which 
the head of the penis is passed until the gauze rests in the groove behind the 
head. The foreskin then is drawn down over the gauze which protrudes from 
the orifice of the foreskin and catches the pus as it is discharged from the 
urethra. This dressing should be changed several times daily according to the 
amount of the discharge. If the foreskin is too short to hold such dress- 
ing in place, the end of the penis can be covered by a tobacco bag into 
which some gauze is placed. Never plug up the cavity of the foreskin with 
cotton or use cotton in a tobacco bag, as this interferes with the free dis- 
charge of pus and will favor the spread of the infection to the posterior 
urethra. To allay local pain and inflammation the penis should be immersed 
several times a day in hot water. 
A hot sitz-bath relieves to a great extent the feeling of soreness in the 
perineum. This bath is indicated if the patient has difficulty in passing urine. 
The heat has a tendency to relax the inflamed parts and the urine may be 
passed directly into the bath water. 500 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVT 
In all manipulations of the penis it is important to remember that the gono- 
coccus when transferred to the eyes will set up a severe inflammation which 
may result in permanent impairment of vision. 
As soon as a case of gonorrhoea comes under treatment the patient should 
be warned of the danger of infecting the eyes, the necessity of thoroughly wash- 
ing the hands after handling the penis, and the danger of contaminating 
towels, etc., and in this way causing the infection of others. 
The bowel should be kept freely open, preferably by vegetable cathartics, 
as saline purgatives are apt to produce more or less urethral irritation. 
To render the urine bland and nonirritating the patient should drink water 
freely, a glassful every hour during the day and whenever he wakes at night. 
For the prevention of painful erections the patient should be instructed to 
empty his bladder just before retiring, to sleep on his side on a hard mattress, 
with as little covering as possible. 
If awakened by an erection, he usually can obtain relief by emptying the 
bladder and by cold applications to the penis. 
When in a few days, as a result of the above constitutional treatment, the 
very acute inflammatory symptoms begin to subside, as is indicated by a dimi- 
nution and thinning of the urethral discharge, less pain on urination, and a 
decrease in the redness and swelling of the meatus, local treatment by injection, 
usually administered by the patient himself, may be instituted. 
If the urethra was a straight, smooth tube, gonorrhoea would be easy to 
treat, but there are along the urethra numerous little pockets in which the 
gonococci are buried and consequently are difficult to reach with any solution 
injected. 
Any injection should be gently done and the solution used should not be 
strong enough to produce more than a mere tingling; never a burning, painful 
sensation. Some men are very sensitive and the solutions must be diluted below 
the usual strengths. 
The solutions commonly used are mild or strong protein silver (argyrol, 
silvol, and protargol), mercurochrome, potassium permanganate, etc., the 
strengths of which are given later. 
Hand injections are given as follows: The patient urinates, wipes the 
meatus with a bit of gauze, gently inserts the nozzle of the syringe completely 
filled with the solution used into the meatus, the lips of which are lightly 
pressed together from side to side against the syringe; the solution then is 
forced in very slowly until there is a feeling of distention in the urethra. 
The solution should be held in the urethra 4 or 5 minutes, if not too uncom- 
fortable, before being allowed to escape. Injections should be made three or 
four or even five times daily, and while the fluid is being injected the patient 
should contract the compressor muscle of the urethra, much as if he were 
trying to hold back the contents of the bladder, in order to prevent the passage 
backward of any of the medication into the posterior urethra. While the 
solution is in the urethra the penis should not be massaged or rolled. 
If the foregoing treatment has been successful, in about 3 weeks the patient 
will have only a trifling urethral discharge, sometimes seen only in the morn- 
ing, with flakes or shreds in the urine. At this stage the injection should 
be changed to a solution of zinc sulfate one-half of 1 per cent in strength, 
administered daily. 
The patient should be warned against “stripping” or “milking” the penis 
in an endeavor to find a “morning drop.” Such manipulation irritates the 
inflamed mucous membrane of the urethra and retards healing. GENITOURINARY AND VENEREAL DISEASES 
501 
The patient’s urine should be watched daily by the two-glass method de 
scribed before and as soon as evidence of acute posterior urethritis develops 
all injections must be suspended. 
The patient should be kept very quiet and, if possible, put to bed for a few 
days, on a light, nutritious diet with the testicles properly supported. The 
bowel must be kept freely open as any accumulation of faeces in the rectum is 
liable to irritate the inflamed deep urethra and the prostate gland. 
Water should be taken freely. Hot water bags over the bladder or against 
the perineum relieve the pain in the deep urethra, as does the hot sitz-bath. 
If retention of urine occurs, it should be relieved promptly by the hot sitz- 
bath, or if that measure fails, by catheterization with a soft-rubber catheter. 
When the frequency in urination, bladder irritation, and other acute inflam- 
matory symptoms begin to subside, the local urethral treatment may be care- 
fully resumed and the patient allowed to be up and about. 
There are several complications of acute gonorrhoea which require special 
treatment. 
Balanitis is an inflammatory process attacking the mucous membrane of 
the head of the penis, and if accompanied by inflammation of the mucous 
membrane lining the foreskin, as it generally is, it is called halanoposthitis. 
It is caused by uncleanliness or by allowing smegma or gonorrhoeal pus to 
collect beneath the foreskin, where more or less inflammation is set up. The 
condition usually occurs in persons with a long tight foreskin, a condition 
which prevents retraction and proper cleaning of the parts. In treating this 
condition the parts must be kept clean by washing with hot water and separated 
by means of gauze wet in boric acid solution. When the acute process has 
subsided the parts may be treated by careful cleansing, drying, and the appli- 
cation night and morning of a dusting powder, such as thymol iodide. If the 
foreskin cannot be retracted, the space about the head of the penis may be 
washed out with hot water or physiological salt solution injected by means of 
a syringe. If there is considerable swelling of the parts the patient should be 
kept in bed with the penis enveloped by a wet dressing of physiological salt or 
boric acid solution. Soaking the entire penis in hot solution of boric acid, salt, 
or magnesium sulfate is useful. 
Phimosis and paraphimosis have been previously discussed. 
Epididymitis is one of the most frequent complications of acute posterior 
urethritis. The patient should be put to bed and given a brisk cathartic. The 
enlarged scrotum with its painful contents should be supported by a band of 
zinc oxide adhesive plaster 3 or 4 inches wide, which passes beneath the 
scrotum to each thigh, care being taken to have the thighs, legs, and inner 
borders of the feet close together before applying the plaster. If there is much 
hair on the thighs it should be shaved off to prevent pain when the plaster is 
removed. 
The scrotum, supported as described, is surrounded with gauze which is kept 
wet day and night with boric-acid solution or a saturated solution of magnesium 
sulfate. When the acute inflammatory symptoms have subsided, as a result 
of treatment, 20 per cent ointment of iehthyol is spread over the scrotum, 
which then is surrounded by a layer of lint or nonabsorbent cotton, over 
which is placed a piece of oiled silk or impermeable paper, the whole dressing 
being kept in position by a snug suspensory bandage. The patient is allowed 
to get up 4 or 5 days after all pain, tenderness, and temperature have dis- 
appeared. If he is allowed out of bed too soon a recurrence of the symptoms is 
likely. 502 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Prostatitis is an acute inflammation of the prostate gland and is a very com- 
mon complication of acute posterior urethritis. When infected the gland be- 
comes engorged with blood and swollen. This gives rise to a sense of fullness 
in the perineum and rectum, accompanied by irritation of the bladder. There 
is more or less pain in the prostate, as the faecal masses press upon it as they 
pass through the rectum during defsecation. The finger, covered with a rubber 
finger cot, if introduced into the rectum finds the gland to be enlarged, hot, 
and painful. 
A patient suffering from acute prostatitis should be put to bed immediately. 
All injections should be stopped and the urine rendered bland by copious 
drafts of water. The bowel should be moved freely every day, using vege- 
table cathartics for the purpose. Hot-water bottles over the bladder and against 
the perineum are useful. Much relief is obtained from the use of hot rectal 
irrigations of physiological salt solution given twice a day in the following 
manner: 
The patient lies on his side with the buttocks near the edge of the bed or 
table. An irrigating can filled with saline solution at a temperature not over 
113° F. is so suspended that its lower end is about 1 foot above the patient’s 
hips. Two rectal tubes thoroughly lubricated with petrolatum are inserted 
very gently for a distance of about 3 inches in such a way that the outlet of 
one tube is near the gland. The fluid in the can is allowed to flow slowly into 
the rectum through this tube and out through the other which may have to be 
adjusted by withdrawing it a little to obtain a ready return flow. The posterior 
surface of the prostate thus is bathed with hot saline solution. Each treatment 
should last from 20 to 30 minutes. 
Gonorrhoeal ophthalmia is an infection of the eye caused by the accidential 
transference of gonorrhoeal pus from the genitals to the eyes by means of the 
fingers, dressings, or towels. It is one of the most serious complications of 
gonorrhoea as it may result in either partial or complete blindness. 
The symptoms usually appear within a few hours after infection and consist 
of redness and swelling of the conjunctiva, increased lacrimation, accom- 
panied by intense itching and a feeling as if a foreign body were under the lids. 
The conjunctivitis is associated with a profuse purulent secretion in which 
gonococci may be found on microscopical examination. 
The eyelids rapidly become red and swollen and the patient is soon unable 
to open the eye. 
The treatment may be divided into prophylactic and curative. 
Prophylaxis consists in thoroughly cleansing the hands after administering 
treatment or after handling the penis, the sterilization of all instruments and 
the immediate burning of all dressings which have been soiled by gonorrhoeal 
discharge. 
When a gonorrhoeal infection of an eye is suspected, the patient should be 
put to bed at once. If only one eye is affected, the sound one is covered with 
a glass shield to prevent its infection; this shield consists of a watch glass 
placed against a hole slightly smaller than the glass, in the center of a piece 
of adhesive plaster 4% inches square; the adhesive plaster is fastened to 
the skin about the eye and nose. It is advisable to leave a small area of the 
plaster nonadherent at the outer edge of the eye to permit the evaporation of 
moisture from the skin, which otherwise would collect within the shield. 
If a glass shield is not available the noninfected eye may be protected by 
covering it with a clean dressing and bandage. 
The infected eye must be washed out day and night with cold boric acid 
solution as often as any secretion accumulates. This flushing of the eye 503 
GENITOURINARY AND VENEREAL DISEASES 
should be followed by the instillation of a drop of 10 per cent mild protein 
silver solution (argyrol, silvol) into the eye. In the intervals between the 
washings the eye should be kept covered with cold compresses—squares of 
gauze taken from a block of ice if possible, and changed every 2 or 3 minutes. 
These gauze squares should be used only once and then burned. Rubber gloves 
should be worn when giving these treatments. The eye is flushed out by 
means of an irrigator held high enough to allow the cold boric acid solution 
to flow out in a gentle stream. 
The patient should be gotten to a medical officer as quickly as possible. 
By the foregoing methods of treatment the hospital corpsman cannot expect 
to cure a gonorrhoeal infection, but by adhering to the treatment advocated 
he can relieve his patient of many distressing symptoms and shorten the time 
required by the medical officer to effect a cure. 
lymphogranuloma, venereum. 
This so-called “fourth venereal disease” is a subacute infectious condition 
involving chiefly the inguinal region, and also the prepuce, perineum, or vulva. 
It affects both men and women and is more common in tropical than in 
temperate climates. 
The cause of this disease is very probably a filtrable virus although the 
specific etiological agent has not as yet been demonstrated. Its transmission 
is by direct contact and almost exclusively by sexual intercourse. The dis- 
charges or secretions from lesions are infective. 
The disease is characterized by a small primary herpetiform lesion on the 
genitalia followed by inguinal lymphadenitis, usually with a multiple source of 
suppuration, and not infrequently associated with constitutional symptoms such 
as fever, anorexia, loss of weight, and prostration. It first manifests itself, 
from 1 to 4 weeks after exposure, by the appearance of a small, superficial 
ulceration on the external genitalia. The primary lesion is usually painless, 
and transient, disappearing in a few days, and may be so small as not to be 
detected. About 1 or 2 weeks later glandular enlargement occurs, the inguinals 
in male and the deep pelvic perirectal glands in the female. The enlarged 
glands vary in size from that of a small lime to that of an orange and may 
be involved singly or in chains, frequently bilaterally. Later central softening 
and suppuration occurs with the formation of indolent, discharging sinuses. 
Constitutional symptoms are variable. Fever, prostration, loss of weight, 
rheumatic affections and skin reactions have been observed. Elephantiasis of 
the penis and scrotum may occur due to blocking of the lymph spaces by in- 
guinal adenitis. 
The clinical syndrome of lymphogranuloma, venereum in women has been 
classified into three types: 1. Anorectal elephantiasis; 2. Rectal stenosis and 
stricture; and 3. Pelvimetritis with secondary rectal stricture. 
Various therapeutic measures have been recommended; physical, chemical, and 
surgical. A specific has not been found. Sulfanilamide has proved a valuable 
adjunct to therapy. It aids in the healing of ulcerations and helps draining 
buboes to cease. Good results have been obtained by the administration of 
iodine or antimony preparations. 
Roentgen irradiations and ultra-violet light have been used with variable, and 
in most instances inconclusive, therapeutic response. 
Frei antigen, diluted four times, and administered intradermally, at intervals 
of 5 days, has demonstrated encouraging results. 
In the diagnosis of lymphogranuloma, venereum the Frei antigen intracutaneous 
test is widely used. The antigen consists of pus from a bubo heated to 60° O. 504 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
for 2 hours on one day and for 1 hour on the following day. Intracutaneous 
injections of 0.1 cc in the forearm give rise in an infected person to an in- 
flammatory, dome-shaped area at least 0.5 cm. across with a small central in- 
filtrated papule. The reaction reaches its height after 48 hours. 
This disease must be differentiated from granuloma inguinale which is pri- 
marily a disease of the skin and not caused by a filtrable virus. Donovan in- 
clusion bodies found in the smear from the ulcer are characteristic of this 
condition. 
Because of the frequency with which they occur on the genitalia the two 
conditions next named are included here. 
Verruca accuminata, venereal. 
Venereal warts usually appear as small growths springing from the mucous 
membrane of the head of the penis or the inner surface of the foreskin, the 
region of the frsenum or the margin of the meatus. They are not necessarily 
venereal. Their cause usually can be traced to irritation incident to prolonged 
contact with inflammatory discharges. Thus, in the uncleanly with long fore- 
skins, in those suffering from gonorrhoea or chancroid, these growths are not 
uncommon. The redundant or phimotic foreskin which prevents proper cleans- 
ing is an important predisposing cause. 
The treatment consists of complete removal of the growth with possibly cir- 
cumcision, and this is the only reliable treatment. 
Herpes. 
This is a condition which is not venereal but which is mentioned in this 
connection because of its frequency and the liability of its confusion with 
venereal sores. This affection is characterized by the rather sudden appear- 
ance of small blisters upon a reddened base. Commonly they appear in or 
about the groove behind the head of the penis, involving both the head and 
the foreskin. The blisters quickly break leaving rounded or irregular erosions 
or ulcers which may run together forming a ring of ulceration around the penis. 
Sometimes these blisters are accompanied by intense pain, and the pain may 
precede the development of the blister. 
Herpes having once appeared is prone to develop again; at times the recur- 
rence quickly follows the first attack, new crops of blistersi forming as fast as 
the earlier lesions are healed. More frequently there is a distinct interval 
between the attacks. 
The lesions should be kept clean and protected with dressings of physiological 
salt solution which allows repeated examinations to be made for possible 
chancroidal or syphilitic infection. 
INSTRUMENTATION 
In genitourinary and venereal diseases. 
It is not expected that hospital corpsmen will give intravenous treatments or 
pass sounds, but they should be familiar with the instruments and their care, 
the preparation of the patient and his after care, and be able to do ordinary 
catheterization. 
The equipment for the administration of mercury, bismuth, and sulfars- 
phenamine by hypodermic injection and salvarsan, neosalvarsan, mapharsen, 
silver-arsphenamine and tryparsamide by intravenous injection, consists of 
measured glass syringes, measured glass irrigating cylinders, glass funnels, 
irrigating stands, rubber tubing, and needles of various sizes. The glassware 
should be boiled in distilled water or put through the autoclave, and it must GENITOURINARY AND VENEREAL DISEASES 
505 
be remembered that all this glassware breaks easily by rough handling and 
too quick changes of temperature. Needles should be cleaned immediately 
after use by washing and passing the stylet or wire through them several 
times. They should be dried by blowing ether through them, the stylet then 
inserted, and the needles put away in liquid petrolatum. They should be 
sharpened each time and should be sterilized by boiling for not over 10 minutes. 
In sharpening on the oilstone, the slope should be fiat and rather short and 
the edges hot rounded. 
The rubber tubing should be of the best quality red rubber, and when new 
tubing is used it should be soaked for 24 hours in a 4.5 per cent sodium- 
hydroxide solution, washed and boiled in distilled water for 4 hours, and then 
washed and boiled again for 2 hours, and finally washed again. This is neces- 
sary because rubber contains compounds which cause dangerous reactions. 
All of the arsenicals (salvarsan, neosalvarsan, mapharsen, silver-arsphena- 
mine, sulfarsphenamine and tryparsamide), should always be kept with all the 
wrapping around them, and they should never be kept together. This is espe- 
cially important with salvarsan and neosalvarsan, because to do so gives the 
danger of Injecting into the veins an unneutralized salvarsan, which means 
death in nearly all cases. Each should be kept away from light and heat. 
Just before mixing, the tube should be taken out of the package, Inspected, 
and put into 95 per cent alcohol to be sure it is not cracked. Never use a tube 
which is cracked or in which the powder is lumpy or discolored or which has 
an unusual odor when opened. The color of the different arsenicals is as 
follows: 
Arsphenamine.—Pale yellow to a lemon yellow; 
Neoarsphenamine.—Lemon yellow to canary yellow; 
Mapharsen.—White; 
Silver-arsphenamine.—Dark-brown; 
Tryparsamide.—White; 
Sulfarsphenamine.—Light yellow cast. 
Always note and record the name of product, maker, lot number, and dosage 
used, and the name of the patient to whom it is given. 
The water for intravenous use should be distilled always and never more 
than 24 hours before use. It should be sterilized not more than 24 hours 
before use. The same thing applies to physiological salt solution, of course. 
Salvarsan must be alkalinized before used. For this purpose 0.85 cc of 4 per 
cent freshly prepared sodium-hydroxide solution is used for each 0.1 Gm. of 
arsephenamine. This is the correct amount necessary to form the disodium 
salt of arsphenamine," the form which is best tolerated by the patient. The 
preparation of these drugs for administration is so important that it should be 
made by, or under, the direct supervision of a medical officer. The following 
principles should be kept in mind: Salvarsan is permitted to stand for 30 
minutes after preparation prior to administration. The solution may stand as 
long as 3 hours, without undergoing any increase in toxicity, provided it is 
protected from the air, not shaken, and the temperature does not exceed 30° C. 
Mapharsen is relatively stable and may be given as long as 1 hour after prepa- 
ration. All of the other arsenicals should be administered as soon as prepared 
and never longer than 20 minutes after preparation. All of these drugs should 
be given slowly except mapharsen which, in contradistinction to the others, 
should be given rapidly. All of these arsenicals are given intravenously 
except sulfarsphenamine which is injected intramuscularly. No salvarsan or 
neosalvarsan should be given without resting and fasting before and after for 
several hours. 506 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Always have convenient and ready, syringes and needles, with ephedrine hydro- 
chloride and ampules of sodium thiosulfate, in case of bad reactions. 
Mercury is occasionally given by mouth in the form of mixed treatment: 
(Bichloride of Mercury, 1 grain; Potassium Iodide, 2 drams; water or other 
vehicle, 3 fluidounces;) 1 teaspoonful three times a day; or mercury with chalk, 
1 grain, three times a day. The best method is probably by inunction of 
about 4 Gm. of strong mercurial ointment once daily on a different part 
of the nonhairy portion of the body, using the inner side of the thighs, inner 
side of arms, and between hip and arm pits, never using one place the second 
time until all the other places have been used. The salicylate of mercury, 
1 grain in 1 cc of liquid petrolatum, or the succinimide, one-sixth grain in 1 cc 
of water, are on rare occasions given intramuscularly. Bismuth should be 
administered only by intramuscular injection and the subsalicylate is probably 
the best form. The dose is 0.2 Gm. of subsalicylate (not 0.2 Gm. of metal- 
lic bismuth), at 5 to 7 day intervals. A course is 6 to not more than 12 
injections. The solutions of mercury and bismuth for intramuscular injection, 
should be shaken up to the last second, as they tend to settle out quickly. In 
injections into the buttock always draw back the plunger of the syringe to see 
if any blood shows, which indicates the needle is in a vein, before injecting. If 
blood shows, pull the needle out and reinsert. Inject slowly. 
Of the urinary system. 
For the most part this is done through the urethra and through the ureters 
with instruments called catheters, sounds, bougies,, filiforms, cystoscopes, ure- 
throscopes, urethral dilators, and urethrotomes. 
The first consideration is the care of these instruments. Some of them are 
rubber, some woven silk with wax covering, some silver, some steel or brass 
with silver or nickel plating, some whalebone, and some with glass lenses or 
prisms cemented in them. All should be handled carefully and not scratched, 
bent, or dented. Metal instruments should be kept clean and dry and polished 
with nonscratching material, and well greased with vaseline when in moist 
climates, as on shipboard. All metal instruments except cystoscopes may be 
boiled for not more than 10 minutes in distilled water. Rubber and whalebone 
catheters may be boiled for not more than 10 minutes. 
The woven, wax-covered instruments as well as the cystoscopes should never 
be boiled, but should be sterilized by thorough washing in soap and water and 
soaking for at least 20 minutes in formaldehyde or oxcyanide of mercury 
solution. 
The metal instruments must never be soaked in bichloride of mercury solu- 
tion. Alcohol and phenol solutions tend to injure rubber or wax. 
The sizes of instruments to be passed into the urethra or on into the bladder 
or by the ureters up to the kidneys are indicated by three different systems 
of numbering—French, English, and American. For practical purposes the 
French only should be considered. These have a scientific basis and the number 
indicates the number of millimeters (a millimeter is one twenty-fifth of an 
inch) around the instrument. Thus, a No. 25 sound would be exactly 1 inch 
in circumference. The instruments are usually made only in even sizes from 10 
to 32, inclusive, and in both odd and even sizes from 4 to 10. The latter are 
used almost exclusively in ureteral work. 
For urethral or ureteral catheterization the patient should lie on his back 
in an easy position and breathe with the mouth open and the belly muscles 
relaxed. In cystoscopic and urethroscopic work the patient lies on the back 
with the knees and thighs Hexed and supported, and the operator stands GENITOURINARY AND VENEREAL DISEASES 
507 
between the legs. The whole penis should be cleansed with soap and water 
and bichloride of mercury solution, or, better, with full-strength alcohol; 
although the latter may sting a little, it is perfectly safe. 
No instruments should be passed into the urethra without a lubricant. A 
tragacanth or similar jelly should be used for cystoscopes and routine work 
where the treatment is with watery solutions. (See formula on p. 240.) Glycerin 
is also a fairly good lubricant. However, sterile liquid petrolatum should always 
be used for difficult catheterizations and the passing of sounds. The oil is 
warmed and slowly injected with a syringe held tightly against the meatus. 
In cystoscopic work and where difficulty is expected it is a great advantage 
to give a hypodermic injection of morphine % and atropine %50 grain about 
three-quarters of an hour before and to inject vigorously a syringeful of 4 
per cent procaine or novocaine solution 5 minutes before and repeated just 
before starting. 
Gentleness is of the greatest importance in passing instruments in the male 
urethra. Rough handling or overdilation will often give fever and chills, 
which reaction is known as a urethral chill. Men have been killed by rough 
instrumentation. 
For the inexperienced the best catheter to try in a difficult case is a woven, 
waxed one. Start with a No. 20, and then a No. 16, and then a No. 12, and 
finally a No. 10. It will follow the curve of the urethra better if it is warmed 
to a little above body temperature. In ordinary cases a No. 20 rubber catheter 
passes easily. The penis should always be put on a stretch. In cystoscopic 
work in America an irrigating outfit with sterile water or boric acid solution is 
used at room temperature. 
After use all instruments should be thoroughly rinsed off and sterilized in 
the appropriate way. After cystoscopic study and difficult instrumentation a 
patient should always lie down for a few hours and drink plenty of water, as 
pains, chills, and fever often follow in these cases. 
If a man cannot urinate and has a great deal of urine in the bladder and 
a catheter is successfully passed, do not draw off more than 600 cc at first. 
Leave the catheter in place and fix it with adhesive strips and then clamp 
the catheter with a hsemostat and let out about 150 cc per hour until the 
bladder is empty. This will lessen the shock that accompanies emptying an 
overstretched bladder. 
Sometimes a man can be made to urinate naturally by some of the following 
means: Applying a hot towel to the pubis; immersing the penis in warm 
water; letting water run in his hearing; leaving him alone for a while; letting 
him sit in a tub of hot water; giving a good warm enema; and giving plenty 
of water to drink. 
DOSES, DANGERS, AND STRENGTHS 0E SOLUTIONS USED IN 
GENITOURINARY AND VENEREAL TREATMENT 
1. Argyrol (mild protein silver).—Used in solutions of 5 to 10 per cent as an 
injection. 
2. Alum.—Sometimes used in the treatment of chancroids. It is dried, pulver- 
ized, and sprinkled on the ulcer. There is no danger, but it may sting very 
sharply. 
3. Bismuth subsalicylate.—'This is given in doses of 1 or 2 cc of the sub- 
salicylate, each cc representing 0.18 Gm. of metallic bismuth suspended in 
sterile olive or peanut oil. Care must be taken in the administration to be 
sure the needle is not in a vein or artery. This substance injected into a vein 
154294°—39 33 508 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
is apt to be fatal. If injected into an artery it may produce necrosis of the 
structures supplied by the vessel. 
4. Camphor.—Given in doses of 0.065 Gm. (1 grain) in cases of irritation of 
the neck of the bladder. There is no danger in this dosage. 
5. Copper sulfate.—Used in the form of crystals or in solutions of 10 to 25 
per cent strength for application to ulcers. It is painful and should be pre- 
ceded by procaine locally. There is no danger, but if it should be swallowed, 
milk should be given and the stomach lavaged. 
6. Formaldehyde.—Used in full strength to touch up ulcers. To sterilize 
instruments soak them in 5 to 10 per cent solution for 20 minutes and always 
rinse off with sterile water before using. If accidentally swallowed, give milk 
and wash out stomach. 
7. Iodides.—These are given in the form of sodium or potassium iodide in 
saturated solutions when 1 drop equals approximately 1 grain. The dose is 
from 5 drops to 100 drops by mouth. The danger is very little and the signs 
of toxicity are headache, watering of eyes and nose, and breaking out in small 
boils. Sodium iodide is also given intravenously in a 10 per cent solution; 
dosage from 20 to 100 cc. A slight burning of the throat sometimes occurs 
when given in this way. 
8. Mapharsen.'—Always given intravenously in sterile water so that each 
0.01 Gm. of the drug is represented by about 2 cc of water. The dose is not 
more than 0.06 gram. 
9. Mercurochrome.—One per cent for urethral and bladder injections and 
also for intravenous use, 10 cc and even 25 cc being given in desperate cases. 
Should be freshly made. Ten per cent strength is used for touching ulcers. 
10. Mercurial ointment, strong.—Used as an inunction in treating syphilis; 
should be diluted with equal parts of vaseline or lanolin. Rub a piece weighing 
4 Gm. into the skin on a nonhairy portion of the body at night and wipe off with 
kerosene in the morning. Change the spot rubbed every night. 
11. Mercurous chloride mild, ointment of (calomel ointment).—One-third 
strength made up in lanolin for venereal prophylaxis. 
12. Mercury bichloride (bichloride of mercury).—Used in a strength of 
1-1,000 for sterilizing the skin, nonmetallic instruments, etc. Used by mouth 
in the treatment of syphilis, in solution so that a dram dose equals one-thirty 
second to one-twelfth grain. Rarely given by intramuscular injections. 
13. Mercury oxycyanide.—One to 1,000 solution for soaking instruments. 
Noncorrosive and metal instruments are not harmed. 
14. Mercury protoiodide.—One-sixth to one-third grain tablet three times a 
day in the treatment of syphilis. 
15. Mercury salicylate.—One grain in 1 cc of liquid petrolatum injected deep 
into the buttock once a week in treating syphilis. 
16. Mercury succinimide.—Two-fifths to three-fifths grain in 1 to 3 cc of 
water injected about once a week deep into the buttock in treating syphilis. 
The dangers of mercury when absorbing too much in medication are 
ptyalism or salivation (sore teeth and excessive secretion of saliva) and irri- 
tation of the kidneys. Stop at once and give a mild purge of magnesium sul- 
fate. The emergency treatment in cases of accidental swallowing- of mercury 
should be borne in mind always. 
17. Methenamine.—Given by mouth in dosages of 0.3 to 1 Gm. about four 
times a day for neutralizing irritating urine. Should be combined with sodium 
acid phosphate, as the urine must be acid for it to be of value. The sign of 509 
GENITOURINARY AND VENEREAL DISEASES 
excessive dosage is irritation and a slight smokiness of the urine. It should 
be stopped at once. 
18. Neosalvarsan.—Always give intravenously in sterile water so that 
each 0.1 Gm. of the drug is represented by about 2 cc of water. The dose 
is from 0.3 to 0.6 Gm. and it requires no neutralization. 
19. Phenol.—Used in full strength to touch ulcers. Sometimes in weak 
solutions of 1-100 to 1-200 as a dressing; also to sterilize instruments. When 
used in too large a dressing enough may be absorbed by the skin to produce 
irritation of the kidneys, the sign of which is smoky urine. In accidents where 
strong phenol is spilled on the skin use alcohol locally. Where it has been 
swallowed use magnesium sulfate solution and wash out the stomach. 
20. Potassium acetate.—Used by mouth in dosages of 2 to 4 Gm., in irritation 
of the bladder. 
21. Potassium citrate.—Used by mouth in dosages of 1 to 1.5 Gm., in irrita- 
tion of the bladder. 
22. Potassium permanganate.—Used for injections and bladder irrigations. 
Start with a solution strength of between 1-10,000 and 1-8,000 and increase 
the strength cautiously. 
23. Procaine and novocaine.—Used in y2 to 1 per cent solutions for local 
anaesthesia. To inject in the urethra, a 4 per cent solution is used. There is 
practically no danger in these strengths. 
24. Protargol (strong protein silver).—Used in strengths of % to 1 per cent 
as an injection. The silver solutions should be fresh and they should be kept 
away from light. There is little danger in the strengths noted. To neutralize 
where irritation results or where swallowed accidentally give saturated solution 
of table salt and wash out the stomach. 
25. Salvarsan.—Always give intravenously in solution so that each 30 cc equals 
0.1 Gm. Always neutralize with sodium hydroxide because it is acid. The doses 
are from 0.2 to 0.4 Gm, 
26. Silver nitrate.—Used in the form of sticks to touch ulcers or in 25 to 
50 per cent solution for the same purpose. It may be used in solution for 
urethral injection or into the bladder but should not be used stronger than 
1-10,000 to 1-5,000 solution at first. Its action is neutralized by salt solution. 
27. Silver-arsphenamine.—Always given intravenously in sterile water or 
physiological salt solution so that each 0.1 Gm. of the drug is represented by 
about 7 cc of water. The dose is 0.3 Gm. or less. 
28. Sulfarsphenamine.—Always given deep into the muscles of the buttock, 
in the smallest amount of water in which it will dissolve. The dose is from 
0.2 to 0.4 Gm. and this will dissolve in about 1 cc of water. 
29. Silvol.—Same as argyrol. 
30. Sodium acid phosphate.—In dosages of 0.5 Gm., to acidify the urine. 
Usually combined with methenamine in the dosage of 0.5 Gm. each. 
31. Sodium thiosulfate.—One gram in 10 cc of water intravenously for mer- 
cury, bismuth, arsenic (salvarsan and neosalvarsan), silver, and lead poison- 
ing. One gram in 10 cc of cold (never boil the solution) sterile water. 
32. Sulfanilamide.—Of value in many infections. It is given by mouth in 
doses of 20 to 120 grains a day. Due to idiosyncracies to the drug shown 
by many patients, it should never be given unless the patient is under medical 
supervision. 
33. Tincture of hyoscyamus.—Given in irritation of the urinary tract in 
dosages of 10 to 15 drops. 
34. Tryparsamide.—Given in 3 Gm. doses in 10 cc of water intravenously. 510 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
NOMENCLATURE OF TERMS RELATING TO THE ANATOMY, DISEASES, IN- 
JURIES, CONDITIONS, AND INSTRUMENTATION OF THE MALE GENITOURI- 
NARY SYSTEM 
Adenopathy.—Enlargement of lymphatic glands. 
Alopecia.—Natural or abnormal deficiency of hair. 
Balanitis.—Inflammation of the glans penis (head of the penis). 
Balanoposthitis.—Inflammation of the glans penis and the prepuce (foreskin). 
Bougie.—A slender sound with a bulb-shaped tip. 
Bubo.—Inflammatory swelling of a lymphatic gland, particularly in the axilla or groin. 
Castration.—Complete removal of the testes. 
Catheter.—A tubular instrument used to draw urine from the bladder or kidney. 
Chancre.—The primary lesion of syphilis no matter where it appears. The word is 
from the Greek and literally means “a crab,” but its general meaning now is an ulcer. 
The word “cancer” is also from the same Greek word. 
Chancroid.—A soft, nonsyphilitic sore. Also called “soft chancre.” 
Chordee.—Inflammation of the corpus spongiosum of the penis resulting in a painful 
semierection and bending downward of the penis. 
Clap.—Same as gonorrhoea. 
Condyloma.—A wart-like excrescence near the anus or Vulva, especially the flat, moist 
papule of secondary syphilis. 
Corona.—The crown-like rim surrounding the base of the glans penis. 
Cystitis.—Inflammation of the urinary bladder. 
Cystoscope.—An electrically-lighted instrument for examining the interior of the bladder. 
Dermatitis exfoliativa.—A severe, obstinate, scaly rash sometimes resulting from poison- 
ing by used in treating syphilis and usually associated with loss of the hair and 
nails. 
Ejaculation.—The sudden expulsion of the seminal fluid. 
Epididymis.—Oblong, convoluted body attached to each testicle. 
Epididymitis.—Inflammation of the epididymis. 
Epispadias.—A congential malformation in which the urethra opens on top of the 
penis. 
Erection.—The condition of being made rigid and elevated. 
Eroding.—Eating away; destroying. 
Filiform.—Thread shaped; an extremely slender bougie. 
Frcenum.—The fold on the lower surface of the glans penis by which it is attached to 
the prepuce. 
Clans.—The head, or terminal end, of the penis. 
Gleet.—An old, chronic form of gonorrhoeal discharge. 
Gonococcus.—The same as Neisseria gonorrhoeas. 
Gumma.—A soft, tumor-like swelling occurring in the third stage of syphilis. 
Hwmatocele.—Effusion of blood into a cavity, especially into the ones containing the 
testes. 
Hermaphrodite.—An individual who partakes or appears to partake of both male and 
female characteristics. 
Hydrocele.—A collection of excess serous fluid in the sacs containing the testes. 
Hypospadias.—A congential malformation in which the urethra opens on the under side 
of the penis. 
Inguinal rings.—Openings in the wall of the abdomen through which the spermatic cord 
passes; known as internal and external. 
lodism.—A condition resulting from prolonged administration of iodides characterized 
by headaches, running nose, watering eyes, and skin eruptions. 
Kohlman dilator.—An instrument passed into the urethra and then made to expand, 
thereby stretching strictures. 
Locomotor ataxia (tabes dorsalis).—A degenerative condition of the spinal cord resulting 
from syphilis that produces difficulty in walking, etc. 
Meatus or meatus urinarius.—The external opening of the urethra. 
Mucous patches.—Syphilitic lesions or sores in the mouth and about the genitalia and 
anus, usually occurring in the secondary stage. 
Orchitis.—Inflammation of the testicle. 
Paraphimosis.—The retraction of a narrow or inflamed foreskin behind the glans penis 
which cannot be replaced. 
Paresis, or general paresis.—A chronic, degenerative disease of the brain resulting from 
syphilitic infection and causing insanity. 
Penis.—The male organ of copulation or sexual intercourse. 511 
GENITOURINARY AND VENEREAL DISEASES 
Perineum.—The space between the anus and genital organs forming the floor of the 
outlet of the pelvis and occupied hy the terminations of the rectum, the urethra, and the 
root of the penis, the vagina in the female, and various muscles, fasciae, vessels, and 
nerves. 
Phagedenic.—Same as eroding. 
Phimosis.—Tightness of the foreskin so that it cannot he drawn hack over the glans 
penis. 
Posthitis.—Inflammation of the foreskin. 
Prepuce.—The foreskin. 
Prerenal.—In front of the kidney. 
Prostate or prostate gland.—A gland surrounding the neck of the bladder and the urethra 
and in which the secretion of the testes is diluted. 
Prostatitis.—Inflammation! of the prostate. 
Ptyalism.—Excessive secretion and discharge of saliva, especially from the administra- 
tion of too much mercury. 
Pubis.—The bony arch above the root of the penis. 
Pyelitis.—Inflammation of the pelvis of the kidney. 
Pyelonephritis.-—Inflammation of the pelvis of the kidney with kidney involvement. 
Pyonephrosis.—A condition in which pus is present in the pelvis of the kidney. 
Raphe or raphe scroti.—The seam or ridge in the middle of the scrotum. 
Resectoscope.—An instrument for resecting a portion of the prostate through the 
urethra. 
Rupee.—The folds or wrinkles of the scrotum. 
Salivation.—Same as ptyalism. 
Scrotum.—The sac or pouch which contains the testes. 
Secondaries.—The symptoms of the secondary stage of syphilis. 
Semen.—'The secretion containing the spermatozoa produced by the male generative or- 
gans ejaculated during coition. 
Seminal vesicles.—Two small sacs situated at the base of the bladder serving as reser- 
voirs for the storage of semen. 
Seminal vesiculitis.—Inflammation of the seminal vesicles. 
Sound.—An instrument used to measure the size of or to dilate the urethra or ureters. 
Spermatic cord.—The ,cord-like structure containing arteries, veins, lymphatics, and the 
vas deferens or ductus deferens, that suspends the testicle. 
Stricture.—An abnormal narrowing of a canal, duct, or passage. 
Sulcus.—A groove, trench, or furrow; the sulcus behind the glans penis. 
Tertiaries.—The symptoms of the third stage of syphilis. 
Testicle.—The male organ producing the spermatozoa. 
Treponema pallidum.—The microorganism causing syphilis. 
Ureter.—The tube which conveys urine from the kidney to the bladder. 
Ureteritis.—Inflammation of the ureter. 
Urethra.—The membranous canal or tube through which urine passes from the bladder 
to the external air. In the male it also conveys the seminal ejaculations. 
Urethritis.—Inflammation of the urethra. 
Urethroscope.—An instrument used for examining the interior of the urethra. 
Urethrotome.—An instrument used to cut strictures of the urethra. 
Varicocele.—Enlargement of the veins in the spermatic cord. 
Vas deferens or ductus deferens.—The excretory duct of the testicle and carrying the 
spermatozoa from the testes to the seminal vesicles. 
Section 4.—THE PREVENTION OF VENEREAL DISEASES 
Because of their prevalence, ready transmissibility, and far-reaching effects, 
the venereal diseases are a menace to home and to family life. In one way, 
and one only, can infection with venereal disease be prevented, and that is by 
completely avoiding promiscuous sexual intercourse. Clean living, the in- 
dulgence in athletic sports which promote health and occupy the mind, and 
the avoidance of alcohol during hours of relaxation are important factors in 
the prevention of venereal disease. 
The principles underlying the control of veneral diseases differ in no way 
from those concerning the prevention of other communicable diseases. The 512 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
immediate, practical problem is to prevent the further spread of venereal 
infection. 
The preventive measures for venereal diseases may he summed up as follows: 
A. Control through the community. 
1. Segregation and regulation of prostitution. 
2. Suppression of clandestine and occasional prostitution. 
3. Isolation and/or treatment to shorten the period of infectivity. 
4. Suppression of questionable resorts. 
B. Control through the individual. 
1. Social approach—disuasive measures. 
a. Ethical and moral instruction. 
h. Instruction in effects of disease on individual and on his social 
relationship. 
2. Recreational approach—substitutional measures. 
a. Occupation to engage interest, fill leisure, absorb energies, and 
proper social contacts. 
3. Disciplinary approach. 
а. Preventing exposure by restriction of liberty. 
б. Placing localities out of bounds. 
c. Denial of liberty to disease carriers. 
d. Segregation and treatment of infected persons. 
e. Penalties for disabilities of venereal origin. 
/. Punishment for failure to use prophylaxis. 
4. Personal prophylaxis. 
a. Mechanical appliances. 
&. Medicinal agents 
—at disinfecting stations. 
—in portable form. 
The use of both chemical and mechanical prophylactics against venereal 
infection has been advocated in the Navy for many years. The effectiveness 
is high when these measures have been used early and properly. Those who 
expose themselves to the danger of contracting a venereal disease should be 
urged to use immediate prophylaxis. 
On January 9, 1909, the Secretary of the Navy issued an order to the service 
which required promulgation of information regarding venereal disease to the 
men of the service, and directed that facilities for prophylaxis be made avail- 
able. Since 1914 personnel of the Marine Corps, and since 1916, personnel of 
the Navy and Marine Corps, have been penalized by losing their pay and time 
wThile absent from duty because of a venereal disease, which was contracted as 
a result of their own misconduct. 
The oldest and best prophylactic measure is the mechanical appliance known 
as the sheath or condom. This is usually made of rubber and is for sale in 
most Ship’s Service Stores. Government regulations specify high requirements 
of rubber prophylactics and shoddy materials are not sold by reliable firms. 
Two simple tests that can be applied to rubber goods sold by Ship’s Service 
Stores are quoted from the Bureau of Standards specifications: 
“E-3. Inflation test.—The prophylactics shall withstand inflation to a length 
of 24 inches for a period of 1 minute, and when inflated shall show no porosity 
or thin spots. 
“E-4. Oil test.—One hour after application of mineral oil of medicinal grade 
the prophylactics shall withstand inflation to a diameter of 6 inches for a period 
of 1 minute. It is not essential that the shape of inflation be uniform.” GENITOURINARY AND VENEREA! 
DISEASES 
513 
In the use of a condom it is essential that some space remain at the end to 
prevent any chance of undue stress or strain on the rubber. Upon removal 
care must be exercised so as not to increase the chance of contamination from 
the sheath. Then immediate washing of the penis and surrounding parts and 
the proper application of the contents of a prophylactic tube or 33 per cent 
calomel ointment will prevent many a case of venereal infection. Prophylactic 
tubes, often called Sani tubes, are given to anyone on request at the sick bay, 
dispensary, or prophylaxis station. 
Medicinal or chemical prophylactic treatment used immediately or within 
the first hour after exposure is very efficacious in preventing the development 
of venereal infection. Although its value rapidly diminishes from then on and 
is greatly reduced after 8 hours have elapsed, men returning to the ship or 
station within 8 hours following exposure should be urged to avail themselves 
of chemical prophylaxis under supervision of a hospital corpsman, 
A careful record should be kept showing the name and rating of the person 
treated, the hour of treatment, the hour and place of exposure, and the name 
and address of consort. 
The method of prophylaxis used in most Navy prophylaxis stations is to have 
the man urinate and then thoroughly wash the penis, scrotum, and pubic region 
with liquid soap and warm water. One-half a syringeful of 1 per cent solution 
of strong protein silver (protargol) or 10 per cent solution of mild protein 
silver (argyrol, silvol) is injected gently into the anterior urethra and allowed 
to flow out; the remainder is then injected and held in the urethra for 5 
minutes. When the parts that were washed have thoroughly dried, the penis, 
scrotum, thighs, and pubic region are liberally annointed with 33 per cent 
calomel ointment in lanolin. The ointment should be well rubbed in for at 
least 10 minutes, paying especial attention to the corona and region of the 
frsenum. The clothing should be protected with a temporary dressing and the 
ointment allowed to remain for 12 hours. 
The Navy prophylactic tube consists of a pliable, metal tube with a tip 
which can be inserted into the urethra. One half of the contents is injected 
into the urethra and the other half is used externally. Use of the contents 
immediately before cohabitation is a valuable preventive measure. The for- 
mula of the contents of the Navy prophylactic tube is as follows: 
Mild mercurous chloride (calomel) 33 
Camphor 2 
Phenol 3 
Anhydrous lanolin 39 
Benzoinated lard 20 
Beeswax 3 
Bach tube contains 7.5 grams of this ointment. 
As a result of a 4-year investigation undertaken at the U. S. Naval Medical 
School, Washington, D. C., to compare the efficacy and suitability of the many 
substances considered of possible value in the immediate chemical prophylaxis 
of venereal infection there has been reported a formula that will probably 
prove to be superior to and more effective than any previously used. 
The value of the various prophylactic measures in preventing venereal in- 
fection is well shown by the reduction in the total admission rate for syphilis, 
gonococcal, and chancroidal infections from 193.52 per 1,000 in 1909 to 63.90 
per 1,000 in 1937. During this same period the admission rate per 1,000 for 
gonococcal infections was reduced from 102.51 to 43.85, for chancroidal infec- 
tions from 27,51 to 7.82, and for syphlitic infections from 25.81 to 11.08. 514 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
It should always be remembered that diseases that have attacked more 
than half the men of the country during youth, diseases that bring misery 
to thousands of children and suffering to hundreds of thousands of women 
innocently infected, and that are incurred almost exclusively through promis- 
cuous sexual intercourse, are diseases to be avoided. It should also be 
remembered that the man who practices promiscuous cohabitation almost 
invariably contracts one of the venereal diseases, sooner or later, in spite 
of every precaution. And if sufficient moral stamina to resist sexual tempta- 
tion is not possessed, then it must be remembered to take prophylactic treatment 
as soon as possible after exposure. 
References 
Syphilology.—Stokes. 
Practice of Urology.—-Young. 
Hospital Corps Handbook, U. S. Navy, 1923 
Section 5.—INDUSTRIAL MEDICINE AND INDUSTRIAL 
HAZARDS 
Industrial Medicine is that branch of medicine which deals with the pre- 
vention of diseases and injuries among industrial workers. Strictly speaking, 
industrial medicine has become of such importance in late years, that it is 
not now limited to workers, but endeavors to promote good health and in- 
crease the life span of the entire people. 
Its purposes or aims are to insure good health, the prevention of avoidable 
accidents, to alleviate unnecessary suffering and thereby provide contentment 
and promote more efficient work. It further deals with the rehabilitation 
of diseased and injured persons and reclassifies them to work in such posi- 
tions as their disabilities will permit, thereby obviating the necessity for their 
becoming public charges and insuring them a livelihood. 
Industrial Medicine is akin to Hygiene and Sanitation and Preventive Medi- 
cine, but spreads out to embrace accident prevention as well. Its aims are 
accomplished by endeavoring to reduce the health and accident hazards to a 
minimum by education, safety devices and precautions, periodic physical exam- 
inations, cooperation of employees, and by the passage of laws for the protection 
of the workers. 
The need for the development of this branch of Medicine is apparent to all, 
when it is known that in the sixteenth century the average life expectancy 
of the working man was 22 years, as compared to 44 years for those of the 
upper classes. The working men were really slaves. They worked from 12 to 
20 hours daily, 7 days a week. They were subjected to forms of health 
hazards about which little or nothing was known. The death of the men was 
considered a natural course of events. 
The value of Industrial Medicine to the workers has been clearly manifest. 
Today, the average working man in industry may well expect to live to the 
age of 50 with still a better outlook for the future when the hazards to health 
and accident are better understood and safety measures are developed and 
perfected to protect against such hazards. 
In this country today, every employee is protected by laws which require 
that certain standards of protection be maintained against health and accident 
hazards. Compensation laws are in force to require the payment of disability 
benefits to those incapacitated by accident or disease which were connected 
with their employment. INDUSTRIAL, MEDICINE 
515 
A National Safety Council was established in 1912 and its slogan of “Safety 
First” has become a by-word in all homes. In 1914 a health section composed 
largely of Industrial Surgeons, was incorporated as part of the association. 
Thus the need of medical advice in industry was established. It is a well- 
recognized fact that the “human machine” constitutes a very definite hazard 
to health and accident. The medical man therefore must form a definite part 
of any industrial organization. Today, the National Safety Council in America 
is one of the greatest organizations of its kind and by its help has put the 
working conditions in this country on a very high plane and the industrial 
worker has reaped the benefits. 
Today, every industry in this country, no matter how large or how small, 
has its medical staff, or its equivalent. Many large industries have their own 
hospitals and medical staffs; others have contract surgeons but all are required 
in one form or other to give medical attention to the employees under them. 
The Government having passed such laws must therefore lead the way in 
protecting its own employees. The United States Navy is one of the largest 
of the industries maintained by this Government. An organization has been 
set up in the Navy to protect its personnel, both civilian and naval. A safety 
engineer is provided, who acts directly under the Assistant Secretary of the 
Navy. He has supervision of the safety precautions taken to protect the 
civilian employees in the navy yards, ammunition depots, torpedo stations 
and the like. He is also a consultant in all matters pertaining to safety aboard 
ships, at training stations and other Navy Department activities. A naval medical 
officer is assigned to his office for the purpose of consultation in all matters 
pertaining to health and safety and to cooperate in devising means by which 
health may be protected and accidents prevented. Aside from this particular 
medical officer, all medical officers, dental officers, members of the Hospital 
Corps and nurses form the balance of the medical staff of this organization. 
It is essential that each one of these members know and understand the 
hazards to be encountered in the Navy, the steps to be taken to protect against 
injury and disease, the treatment of diseases and injuries arising therefrom 
and the organization of the medical personnel for such purposes. Naval 
medical personnel are required to perform duties ashore, at sea, in foreign 
countries, in the air and under the sea. In each of these places a variety of 
health hazards exist. It is therefore necessary that this personnel have a 
thorough knowledge of the industry to which they are attached, the hazards 
presented, the methods of prevention and the treatment of all injuries occurring. 
An occupational hazard is any condition, existing in the trades, which will 
lead directly or indirectly to disease or injury. No method can be devised for 
classifying hazards for they are too numerous. However, they may be grouped 
under the following headings: 
1. Those hazards present in the working force by reason of physical defect. 
2. Those hazards found in the working places, including hygienic and sani- 
tary defects, mechanical defects of machinery, lack of safety education and the 
like. 
3. Those hazards presented by carelessness of employees. A large majority 
of accidents are due to this cause alone. 
4. Those hazards due to unforeseen influences such as lightning, earthquake, 
tornado, and the like. 
Industrial accidents may be prevented by an understanding of the hazards pre- 
sented in the foregoing groups, by: 
1. Thorough physical examination of all new employees, prior to their actual 
employment, to discover potential physical defects which would render the em- 516 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
ployee a hazard to himself or others. An example of this would be a person with 
manifestly defective vision being employed as a machinist. Physical examina- 
tion of all regular employees periodically, to determine their ability to continue 
working at their trade and to reclassify them to less hazardous work or to re- 
tire them, as found necessary in individual cases. Repeated examination of 
all employees engaged in hazardous trades such as sandblasting, painting, chrome 
plating, T. N. T. handling, and others, to determine any possible systemic effects 
present as a result of their trade. 
2. A constant and thorough inspection of all shops and working places by the 
safety engineer, the medical officer, and their assistants to determine the causes 
of accidents, the hazards to health and the immediate correction of these faults. 
Education of the employees by means of lectures, motion pictures, posters, and 
such, will further accomplish much in the line of prevention. 
3. The prevention of carelessness by indoctrination of all employees with the 
spirit of prevention and building up a spirit of cooperation and high morale 
among them. If necessary, disciplinary measures should be taken when workers 
are habitually careless. 
4. Providing, in so far as is possible, means of protection and escape in cases 
of disaster. 
An exact classification of occupational diseases is difficult, in view of the 
great number and types of diseases presented by the industry. There is such a 
great variety and number of skin diseases in the trades that they are generally 
grouped under the heading of Occupational or Trade Dermatoses. It is suf- 
ficient to state here that practically all diseases and injuries may be associated 
with industry. 
To successfully carry out the objects of Industrial Medicine the medical per- 
sonnel of the Navy must know: 
1. The organization of a safety unit of an industry and the duties of each 
of the personnel. 
2. The hazards to health and accident presented by the particular industry 
to which they are attached. 
3. The methods and means of protection to be established against the en- 
countered hazards. 
4. The treatment of industrial diseases and injuries. 
5. The laws relating to compensation and treatment of sick and injured per- 
sonnel, including a knowledge of the necessary reports and returns to be sub- 
mitted in such cases. 
For the purpose for which this book is intended, it seems sufficient to give 
the hospital corpsmen a general idea of the organization, hazards, protection, 
treatment and laws as related to the Navy, rather than to try to discuss In- 
dustrial Medicine as a whole. This may well be done by discussing the safety 
organization and its associated duties at a navy yard, for those in force at 
navy yards are applicable to a greater or lesser degree throughout the Navy. 
These will be considered in the order given. 
Organization. 
At all navy yards, the Commandant is the head of the organization. He is 
responsible to the Navy Department for the protection of the employees, as 
well as the naval personnel, under his command. He is familiar with the 
nature of the work being performed by the employees at his station and the 
health and accident hazards presented. Accordingly, he appoints, as the work- 
ing head of the organization, a safety officer or a safety engineer, as he is bet- 
ter known. The safety engineer must be of sufficient rank and service to have INDUSTRIAL MEDICINE 
517 
become familiar with the various trades in a navy yard, a knowledge of 
machinery, a man of cooperative ability and well liked, and having sufficient 
knowledge of safety devices and appliances to intelligently make inspections 
and recommend proper protective measures. His duties are primarily, to pre- 
vent accidents and promote healthy working conditions. It is his duty to 
inspect all working places, make a general survey of all mechanical conditions 
and to recommend the addition of all necessary safety appliances for the pro- 
tection of the workers. He must make daily inspections of the shops to see 
that these safeguards are in working order and are being used. He must inves- 
tigate all major accidents in order to determine the cause and recommend 
methods to prevent a similar accident. There should be full cooperation between 
him and the medical officer. All improvements come under his supervision. 
The Commandant further assigns a medical officer to act as advisor to the 
safety engineer. The medical officer must be of the same qualifications as the 
safety engineer, with the addition that he must be thoroughly versed in the 
diseases connected with Industry. He need not have a thorough knowledge of 
machinery but must understand sufficient of the operation of the various 
machines to intelligently advise the safety engineer in matters relating to the 
development of safety devices. The duties of the medical officer are as follows, 
and in this connection it is well for members of the Hospital Corps to under- 
stand the nature of these duties in order that they may be of assistance to him 
in the performance of these duties: 
The medical officer is the safety engineer of the human body. He acts as 
consultant to the safety engineer in all matters pertaining to the general wel- 
fare and health of the employees. Hygiene and sanitation are his important 
duties. He must interest himself in the employees and instruct them in the 
every day principles of personal hygiene and self preservation. He must 
instruct the employees in safety measures and encourage them to cooperate in 
protective measures. They must be made “safety conscious” or “safety minded”. 
The morale must be kept up. A high morale leads to fewer accidents and 
better workmanship. The medical officer must Inspect all working places in 
order to have a better understanding as to the actual conditions under which 
the men work. He must make appropriate recommendations to improve 
deficiencies noted and must then see that these recommendations ai*e carried 
out. He must personally make all physical examinations of prospective em- 
ployees or see that the physical standards for employment are adhered to. He 
must make physical examinations of all employees believed to be physically 
unfit for further work to prevent them from injuring themselves or others. He 
must further treat and view the scene of all accidents to be able to determine 
their cause and to assist the safety engineer in formulating plans to prevent 
recurrences. He must so organize the personnel under him that prevention will 
be effectively handled. 
The safety engineer is assisted in his work by the foremen of the shops and 
in some instances by safety committees in each shop elected by the employees. 
These men or committees are generally chosen from among the older employees 
and from men who have considerable experience in their trade. It has been 
repeatedly recommended, but not as yet accomplished, that the safety organiza- 
tion be enlarged by the creation of two new civil service ratings. These are, a 
civilian safety engineer and a civilian assistant safety engineer. These men 
would be appointed by competitive examination and should be men who have 
had considerable experience in the trades with a liberal understanding of all. 
They would act as assistants to the naval safety officer and would be of great 
value to the organization, inasmuch as their duties would be permanent. A 518 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
naval officer is subject to change of duty and cannot act as permanent safety 
officer. In changing the safety officers at intervals a weakness is left in the 
organization which the civilian assistants could well fill, until such time as the 
new officer became familiar enough with his new duties to take hold. 
The organization of the medical advisor is composed of junior medical 
officers, dental officers, to some extent, members of the Hospital Corps, and of 
nurses. The duties of the hospital corpsmen are to assist the medical officer 
in his inspections, assist in the treatment of the injured and to prepare the 
necessary reports and returns in cases of accident, occupational disease, and 
the physical examination of employees. This, then, is briefly the organization 
of a safety unit in a navy yard. This unit will function as well aboard a 
battleship or in other places. The commanding officer of a ship is the head 
of the organization. He is assisted by the First Lieutenant acting as safety 
engineer. Division Officers act as assistants to the First Lieutenant and safety 
committees are elected in each division from among the crew. The medical 
officer is the advisor to the safety engineer and he in turn, is assisted by the 
dental officer and hospital corpsmen. All then that is necessary for the unit 
to function is that a study be made of the hazards presented aboard ship and 
to proceed as explained later. 
Hazards to health and accidents. 
The organization completed, a study must be made to determine the hazards 
existing in the particular organization to which the unit is attached. There 
are major hazards and minor hazards. A major hazard is represented by 
unguarded machinery or improperly or faulty ixasulated electrical wiring. A 
minor hazard is a greasy shop floor, loose articles lying around on the deck 
or an open, unguarded hatchway aboard ship. It must be remembered that 
no two industries present the same hazards. There are hazards peculiar to 
each trade or profession. Efforts must therefore be made by the safety 
organization to locate these hazards and afford protection accordingly. To 
indicate just what types of hazards may be encountered while working with a 
safety unit of a navy yard and in an effort to make the subject of hazards a 
little clearer to the readers the following questionnaire, prepared by the 
inspector of the Medical Department Activities of the West Coast is quoted 
in part. This questionnaire represents a very thorough picture of the major 
hazards with which a safety unit of a navy yard must cope, aside from the 
many minor ones always present in any organization. Answers to these 
must be made not only to the inspecting officer but they must in 
some form or other be answered daily if the organization is to be successful. 
By this is meant that problems of this nature are a daily occurrence and the 
safety unit must be prepared to meet them at once and not wait to formulate 
answers at inspection intervals. 
“Q. 1. What industrial processes employ lead at some stage of the work? 
This includes tetraethyl lead. How many workers are exposed to lead? What 
precautions are taken to prevent damage to workers using lead? How fre- 
quently are workers using lead checked to determine possible absorption of 
this element? 
“Q. 2. What industrial processes employ chromium at some stage of the 
work? What precautions are employed to safeguard workers from chromium 
poisoning? 
“Q. 3. What processes create a possible dust hazard? What precautions are 
observed to prevent damage to workers exposed to dust? Are routine examina- 
tions made of the chests of workers exposed to dust? Are X-rays made to de- INDUSTRIAL MEDICINE 
519 
termine the presence of silicosis in workers exposed to dust? Have cases of 
silicosis developed? 
“Q. 4. What industrial processes produce fumes which may be a health 
hazard? How are these fumes controlled? 
“Q. 5. What Industrial processes produce carbon monoxide in possible danger- 
ous concentrations? What industrial processes produce carbon dioxide in 
possible dangerous concentrations? Have any cases of poisoning from these 
sources occurred? 
“Q. 6. What processes employ volatile solvents during some stage of the 
work? Are aniline compounds used? Has damage occurred from their use? 
“Q. 7. Are organic wax compounds used? Has damage occurred? 
“Q. 8. What precautions are exercised to prevent damage from pipe covering 
compounds? What asbestos hazards exist? 
“Q. 9. What precautions are taken to prevent damage from glass wool? 
“Q. 10. What radio-active compounds are used on the station and what 
precautions are used to prevent damage from this and luminous paints?” 
These are but a few of the questions asked but they serve the purpose for 
which they were intended, i. e., to indicate just what is meant by a health 
hazard and ones which must be studied in Industrial Medicine. 
Protection. 
Having made a survey to determine the hazards presented in the organization 
to which one is attached, means of protection must be sought. This is done 
first by protecting against physical hazards by employing physically tit men. 
In the Government, the physical standards are set according to the employment 
and the hazards to be met with in each type of work. The U. S. Civil Service 
standards are as follows: 
3. For employment in arduous duties. Must be physically sound and in 
good health, active and able bodied. Bating “A”. For some positions e. g. 
divers, requirements are specially rigid. Rating “A plus”. 
2. For less arduous employment. Requiring sound general health but less 
physical strength, though for some employment special requirements exist, 
i. e. perfect color preception for brakemen and chauffeiirs. Rating “B”. 
3. For lighter and usually sedentary employments. General good health 
but minor anatomical defects not interfering with efficient performance of 
work may be passed, i. e. a typist may be lame. 
Next, having employed a healthy working force it is necessary to protect 
their health. Proper working places must be provided and maintained. 
Hygienic and sanitary conditions must be kept on a high plane. All moving 
parts of machinery must be guarded; goggles provided for workers required 
to use them; helmets and masks for sand blasters; proper ventilation for 
the chrome workers; masks for asbestos workers; protection for workers in 
X-ray and radium; protective gloves, shoes, and other garments for foundry 
workers, and other means of protection too numerous to mention here must 
be available and used. 
Special physical examinations must be made of all sand blasters, asbestos 
handlers, those exposed to radium and its compounds, lead workers, those 
engaged in dusty or smoky trades, handlers of T. N. T. and other explosives, 
etc., to prevent the occurrence of the diseases associated with those trades from 
injuring the men. 
As mentioned before, all workers who are sick for any length of time and 
whose efficiency has fallen off because of physical reasons must be examined 
and either retired or reclassified. 520 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Treatment. 
The treatment of industrial diseases and injuries is essentially that for 
any others. All accidents are treated according to the severity and locality. 
Men are not allowed to treat themselves for even minor accidents by reason 
of the dangers of infection and later incapacity. The treatment of diseases 
of occupation is a specialty in itself and need not be considered here. 
Laws governing workers and accidents occurring during work. 
The laws governing occupational diseases and injuries are quite numerous. 
It is therefore essential that a hospital corpsman be familiar with only those 
pertaining to Government employees. These, in general, are as follows: 
All men injured or taken sick during the course of their employment are 
required to report to the dispensary for treatment. It makes no difference 
how trivial the accident or how minor the illness, he must still report. No 
first-aid boxes are allowed in any of the shops or offices. When a man reports, 
his injury or illness is investigated, treated, or otherwise disposed of. At 
the U. S. Navy Yard, Puget Sound, Wash., a form report of the case is 
prepared in quintuplicate, two copies of which are forwarded to the safety 
engineer, one copy is sent to the foreman of the shop or the supervisor of the 
office, one is given to the employee, and one placed in his file jacket. A separate 
file jacket is maintained for each employee who reports to the dispensary for 
treatment or for any other reason and is a permanent record which is kept 
during the entire time of employment. The information furnished on this 
report is as follows: Date; whether report is of injury or return to work; 
name; rating; pay number; shop; diagnosis; date and hour of injury; date 
and hour reported to dispensary; whether or not injury is due to employment; 
disposition (treated and returned to work, given time off, or transferred to 
naval hospital) ; name of medical officer treating case; and patient’s state- 
ment regarding injury. 
In addition to this form, a card-index form, U. S. Employees’ Compensation 
Commission Form CA-19, is made out in each case. This form is started 
when the man reports and when final disposition of the case is made it is 
likewise filed in the man’s jacket. 
When an injured employee returns to his shop or office, or when the fore- 
man or supervisor receives his copy of the form report, the foreman or super- 
visor immediately fills out U. S. E. C. C. Form CA-2, and forwards it to the 
injury officer, who, in turn, submits it to the dispensary for completion by 
the medical officer treating the case. The medical officer gets the data for 
this report from the forms previously described. 
U. S. E. C. G. Form CA-3 is forwarded at the termination of total or partial 
disability of an employee, or upon his death. 
U. S. E. C. C. Form CA-4 is a claim for disability allowance or compensation 
for injuries received which must be submitted by the employee within 60 days 
after the injury. This form must also be completed by the medical officer at- 
tending the case and once again the form report and U. S. E. C. C. Form 
CA-19 are of value. 
U. S. E. O. C. Form CA-8 is similar to Form CA-4 but must be submitted on 
the first and sixteenth of each month by the employee, during the period of his 
disability. 
When it becomes necessary for an injured employee to have hospital or other 
treatment not provided by a dispensary or local physician, U. S. E. C. C. Form 
CA-16 is made out and forwarded with the patient to the hospital or place 
where he is to receive such additional care. FIELD SANITATION 
521 
Times arise when there is doubt as to the origin of the disability, i. e., 
whether or not the disability is occupational. In such cases U. S. E. C. O. Form 
CA-17 is substituted for Form CA-16. Whenever U. S. E. C. C. Forms CA-16 
and CA-17 are made out they must be accompanied by U. S. E. G, C. Form 
CA-20. 
U. S. E. C. C. Form CA-21, Discharge Report of Injury Case, is forwarded 
when an employee is discharged from treatment after having been incapacitated 
by reason of occupational injury or disease. 
U. S. E. C. C. Form CA-32 is a report of hernia and must be submitted in 
all cases in which claim is made that a hernia was caused by employment. 
Numerous other forms, such as public bills for payment for treatment, are 
used in handling these eases, but as they are accomplished by the injury officer 
they are not listed here. 
Forms showing reports of all physical examinations of employees, including 
the special examinations previously mentioned, are also kept. These are 
routine however, and are easily learned when actually engaged in this work. 
Special forms for W. P. A., E. R. N., and P. W. A. workers are also provided. 
In conclusion, it is well to state the qualifications expected of a hospital corps- 
man engaged in Industrial Medicine. 
1. He should realize that his first duty is to the workman who is injured. 
2. His personality should inspire confidence. 
3. He should have a knowledge of first aid. 
4. He should have a knowledge of an efficient medical record system and 
of statistical methods. 
5. He should have a knowledge of sanitation, of working conditions, of 
occupational hazards and preventive measures. 
6. He should possess a general knowledge of industrial relations, including 
employment, its methods and problems. 
7. He should have a working knowledge of the workmen’s compensation laws. 
8. It would be well for all hospital corpsmen to obtain and read the publication 
Medical Service in Industry and Workmen’s Compensation Laws, 1938, published 
by the American College of Surgeons as prepared by M. N. Newquist, A. B.. 
B. Sc., M. D., to enhance their knowledge of this subject and thereby be of 
more value to the medical organization of the Navy for industrial medicine. 
This publication contains concise, complete statements of the problems of the 
industrial organization and is of value to all industries. 
References 
Industrial Medicine and Surgery.—Mock, 1931. 
Industrial Health.—Kober and Hayhurst. 
U. S. Naval Medical Bulletin, January and April, 1935. 
Medical Service in, Industry and Workmen’s Compensation Laws, 1938. 
Inspection Questionnaire, West Coast Medical Activities, U. S. Navy. 
Section 6.—FIELD SANITATION 
Health is necessary in war, and cannot he replaced hy anything else.—Napoleon 
Introduction. 
The activities of a medicomilitary organization tend to concentrate toward 
one primary objective, “The conservation of physical efficiency for combat.” 
The hospital corpsmen of the Navy serve ashore, as well as afloat, and in 522 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
addition to their duties pertaining to naval warfare must be prepared to serve 
as members of the medical department of a naval landing party or a Marine 
Corps expeditionary force; and, as such, require a knowledge of field conditions. 
One of the prime requisites for victory is health, consequently field hygiene 
and sanitation is one of the most important subjects for military personnel. 
The functions of a military medical organization may be roughly divided 
into (a) prevention of disease and (6) treatment of disease and Injury. 
Prevention of disease is of such vast importance to military personnel that 
this function will be considered in this section. 
Preventive medicine is not an exact science nor is it possible to obtain 100 
per cent efficiency. However, if by careful attention to the minor details the 
sanitation officer is able to increase military efficiency from 96 per cent to 98 
per cent, he has not gained a mere increase of 2 per cent as it may seem, but 
has effected a gain of 50 per cent—that is, the noneffective rate has been 
reduced from 4 per cent to 2 per cent. It is this little difference which some- 
times may be the deciding factor between victory and defeat. 
Tact and a certain amount of technical ability are necessary qualifications 
for a successful sanitarian. Sanitation is so closely interrelated with cleanli- 
ness that the major portion of the duty of a sanitation officer consists in the 
supervision of cleanliness. 
The differences between field sanitation and sanitation of garrisons aro 
marked. 
1. Field sanitation is easier to institute. For example, the devices used for 
the disposal of waste are of simple construction, whereas the installation of a 
water-carriage sewerage system requires more expert engineering knowledge, 
takes longer to construct, and by reason of its permanent nature is more 
expensive. 
2. Constant vigilance is required to maintain field sanitary devices in proper 
sanitary condition. 
3. Field sanitary appliances are a potential menace, if not properly main- 
tained. 
In established garrison life, with water-carriage waste disposal, an adequate 
and potable water supply, permanent housing facilities, protective screening for 
insect control, and similar modern developments, the duties of the sanitation 
officer are comparatively simple and more or less routine. In the field, the 
conditions are such that the field sanitary devices require constant and pains- 
taking personal supervision from both the line and the medical officers in order 
that there may not be a weak link in the chain of sanitary measures. 
Barracks life may give comparatively little concern, but when taking the 
field, vigorous sanitary measures must be instituted and maintained and, if 
possible, improved from day to day. 
The commanding officer of an organization is responsible for the health of 
his command and the enforcement of sanitary measures. The medical depart- 
ment acts in an advisory capacity. The medical officer is charged with the 
initiative in making necessary recommendations to the commanding officer 
tending to the promotion of health and prevention of disease. For instance, 
the medical officer should recommend the type, number, and regulation of sani 
tary devices, but the responsibility for the actual construction and the main- 
tenance of the same in a sanitary condition rests with the respective unit 
commanders. Likewise the collecting company of the medical battalion exer- 
cises supervision over sanitation, tmt the latrines, urinals, incinerators, etc., 
should be constructed by a detail from other units. FIELD SANITATION 
523 
Victory, success in a military endeavor, is intimately interrelated and 
dependent upon personnel losses; in fact, the wastage from diseases frequently 
assumes such magnitude as to cause military campaigns to terminate in 
disaster. 
When a million men are placed in the field and decimation from disease is 
prevented, it is defying one of the biological principles that tends to prevent 
over-crowding of a species. The methods available to combat these fundamental 
biological principles are not complicated and may be classified and will be dis- 
cussed as follows: 
1. Proper food. 
2. Potable water supply. 
3. Hygiene of the march. 
4. Conservancy—waste disposal. 
5. Insect control—fly, mosquito, louse, etc. 
In war the supply of food is most important. The men attached to an organ- 
ization on field duty are likely to be entirely dependent upon the military 
ration. Hence, it is important that the field ration be well balanced in fats, 
proteins, and carbohydrates and it must have the required vitamin content. 
An extended discussion of the component parts of a well-balanced ration 
would be a departure from the subject of this section and, as such data may 
be found in chapter VIII of this hook, only certain aspects of a military ration 
which are related to field conditions will be considered. 
Caloric value of the military ration.—It has been found that a ration con- 
sisting of 3,700 calories is insufficient for troops in the front line. It has been 
experimentally proved that troops on a test march can maintain weight on a 
ration of 4,100 calories. 
If troops must entrench after a day’s hike, a total of 5,000 to 6,000 calories 
per day is required. It is often impractical for a soldier to assimilate such 
a large number of calories per day, and consequently, in time of war soldiers 
are allowed a greater amount of food (often at the expense of the civilian 
population) so that they may have a reserve supply of fat in the body to enable 
them to temporarily withstand the unusual expenditure of foot-pounds of 
energy. It is stated that 20 pounds of reserve fat in a man’s body will supply 
3,000 additional calories per day for a period of 30 days. 
The following is the caloric value of the United States Army ration; 
FOOD 
Calories 
1. Reserve (haversack ration) 2,825 
2. Mobile - 3,500 
3. Normal 4,125 
4. Special 4,850 
The heat of hot drinks and hot food supply additional calories, 1 pint of hot 
tea adding 50 calories of direct heat to the body. Hence the stimulating effect 
of hot tea, coffee, soup, and broth after a long march. 
A soldier at hard work requires 24 ounces of food, daily, exclusive of water, 
made up as follows: 
Ounces 
Proteins 4 
Carbohydrates 17 
Fats : 3 
154294°— 39 34 524 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
In terms of articles of food, the above is represented by the following field 
ration : 
Beef ounces 11 Sugar ounces— 2 
Cheese do 3 Jam do 2 
Bread do 16 Sago do 4 
Potatoes do 10 Milk pint % 
The nitrogenous foods (proteins) serve for the building and repairing of 
tissues, and also serve for the maintenance of heat and energy. 
The carbohydrates and fats yield heat and energy. The mineral salts are essen- 
tial to life and health, and for the formation of the skeleton and tissues. Water 
is as essential a food as the foregoing, and serves for the solution and convey- 
ance of food to the various parts of the body, and also for the removal of the 
waste products formed in the body, viz., the solid and liquid excreta. Water 
alone, by its evaporation from the skin, assists in stabilizing the temperature 
of the body. 
A part of the water required by everyone is contained in the solid food 
taken, of which it forms a very large proportion; meat, for instance, contains 
about 75 per cent water, some vegetables as much as 90 per cent, and bread 
about 38 per cent. 
The amount and the particular kind of foodstuffs required by an individual 
will vary with his age, his build, his work, and the climate in which he works. 
In cold climates a man will require more of the heat-producing foods, espe- 
cially fats, and in a hot climate he needs less of the nitrogen-containing foods 
and fats, and more of the vegetable foodstuffs. 
The greater amount of muscular energy required, the greater will be the 
amount of food necessary to supply this energy. 
The energy value of food is generally expressed in large or kilo-calories, a 
large calorie being the energy, in the form of heat, required to raise the 
temperature of 1 kilogram of distilled water from zero to 1° C. 
It has been found by experiment that 1 Gm. of protein or carbohydrate is 
capable of yielding, by its oxidation in the body, 4.1 calories, and 1 Gm. of 
fat, 9.3 calories. 
Daily menu.—It is advisable to prepare the daily menu at least 24 hours in 
advance. It should provide food of satisfactory quantity, quality, and variety. 
There is often a tendency for cooks to prepare an excess of stews, which 
may cause dissatisfaction among the men. When on the march or otherwise 
heavily worked, the men will have a craving for sweets; a liberal amount 
of jam should be provided to satisfy this craving. 
The presence of much refuse food in the garbage can is a good indication 
that the men are not receiving the proper kind of food, that it is not palatably 
cooked or served, or the qiiantity is excessive. 
The field ration should contain tomatoes and lemon or orange juice whenever 
practical. Potatoes should be cooked and eaten unpeeled, thus supplying 
additional vitamins. Fruit and vegetables which are to be eaten raw and 
unpeeled, should have the exterior surface sterilized by temporary immersion 
in boiling water whenever there is suspicion of soil contamination being 
present. 
Every effort must be made to vary the field diet to the greatest possible 
extent, changing the food substances as well as the manner of cooking. 
The guard at night should have coffee and bread before going on duty, and 
this should apply to relief parties. FIELD SANITATION 
525 
Field kitchens.—The use of rolling kitchens on the march has superseded 
the old method by which each man cooked his own food. One rolling kitchen 
supplies food for 200 to 250 men. The field kitchen should be located on the 
opposite side of the camp from the latrines and urinals. Somie means should 
be used to protect the food from dust and sand. If circumstances permit, 
the kitchen should be screened; if not, other precautions should be taken 
to protect food from flies and other insects. Burlap sacking may be used 
for screening when more suitable material is not available. 
There should be on hand at all times a sufficient supply of pure water 
and material for cleaning purposes, such as soap, soda, and soap powder. 
Scouring material, boiling water, and dishcloths should be available. 
If the kitchen has a dirt floor it may be oiled wflth used motor oil to control 
dust. 
The cooks and other attendants working in the kitchen and handling food 
should be instructed and trained in personal hygiene. Food handlers should be 
required to wash their hands thoroughly after each trip to the latrine. Rigid 
supervision is necessary to prevent the cooks from becoming lax in personal 
cleanliness, especially in keeping the hands and finger nails clean. 
Physical examination of all food handlers should be made at regular inter- 
vals, and, if the laboratory facilities permit, an effort should be made to detect 
and eliminate any disease carriers among them. Frequent venereal inspections 
also should be made. 
Liquid and solid refuse should be disposed of as soon as possible. The outside 
of all garbage cans should be kept clean, and covered at all times. 
The object of cooking processes is: 
(а) To make food more digestible and appetizing; and 
(б) To destroy germs and parasites. 
Mess halls.—The mess halls should be located near the kitchen and all possible 
provisions to protect the food in the mess halls from flies, dust, and sand, using 
wire screening if available, must be taken. 
Clothes and toilet articles must not be stored in kitchens or mess halls. 
The mess tables should be cleaned and sunned at regular intervals and care 
must be taken to see that food particles do not collect in the cracks of the tables. 
One of the best methods to prevent the collection of food particles in the 
cracks of the tables is to construct the tables with a removable center board 
which may be lifted off, and thus permit the cleaning of the cracks between the 
boards. Another method is to construct the tables with a 2-inch space between 
the boards. 
Washing mess gear in the field.—After meals all mess gear should be sterilized 
in boiling water. In a semipermanent camp the mess gear may be placed in 
wire racks and washed by immersion for 5 minutes in water that is kept boiling. 
On the march and under conditions where the mess kits from the haversack 
are in use, the following method of washing the individual mess gear is em- 
ployed : 
Immediately after the men have finished eating they should form a line and 
pass a garbage can or pit where the refuse liquid and solid foods are disposed 
of. After disposing of this refuse food each man inserts his mess gear succes- 
sively in three cans. These cans are placed over a trench in which a fire is 
burning. The first and second cans contain boiling soapy water, while the third 
can contains boiling clear water. A few moments insertion in each of these 
cans is usually sufficient to cleanse and partially sterilize the utensils. After 526 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
insertion in the third can, the mess gear dries by its own heat almost im- 
mediately and no wiping is necessary. Care should be taken to see that the 
water in each can is kept at a boiling point, as lukewarm dishwater is a potent 
factor in the dissemination of saliva-borne diseases. 
Protection, storage, and inspection of food supplies.—Surplus and reserve food 
supplies should be protected from insects such as flies and roaches, from dust 
and dirt, and from rats and mice. Perishable foods should be stored at a tem- 
perature that will inhibit the growth of molds and bacteria. For camps of less 
than 1 week’s duration, storage devices for preservation of food are not 
necessary. 
1. In temporary camps food may be stored in watertight containers and im- 
mersed in springs or streams, care being taken to prevent water contamination. 
Food may be buried below the surface of the ground where the temperature is 
lower, lining a pit with burlap, and placing boards on the bottom. In addition, 
food containers suspended from trees or tripods and underground ice boxes 
provide satisfactory means of protecting and storing food. 
A suspended food container consists of a screened box that permits free cir- 
culation of air but prevents contamination by insects. The cooling effect is 
increased by wrapping the box in burlap which is kept damp. Fresh meat, bot- 
tled milk, and vegetables may be temporarily stored in such a container. It 
should not be used where the air contains any considerable amount of dust. 
2. In semipermanent camps fresh or cured meats, milk, and vegetables 
should be kept in an underground storage room constructed similar to an old- 
fashioned root cellar. The floor consists of well-tamped earth, or boards may 
be used. The walls should be boarded. Ventilation is secured by windows at 
the ends or an outlet through the roof. Vegetables should be kept in vege- 
table bins, constructed of spaced slats to permit the circulation of air. The 
bottom should slope sufficiently to permit the older vegetables to be used first. 
Canned goods should be kept in the storeroom adjacent to the kitchens. 
Bread boxes which permit aeration of the contents should be used. 
The quality of meat can be recognized by the appearance, odor, and texture. 
Good meat is firm to touch, moist but not wet, and is red in color for beef, 
pinkish brown for veal, dark pink for mutton, and light pink for lamb and 
pork. Good meat has a fresh, agreeable odor. 
The fat should contain no watery juices or jelly, and should be firm and 
white. The fat interposed between the muscle fibers gives the meat a mottled 
appearance. 
In the field, inspection of the freshly-killed carcass may be necessary. The 
most likely place to look for signs of disease is the chest cavity, and to a 
lesser extent the abdominal cavity; adhesions of the lining membrane indicate 
inflammation, probably tuberculous. 
When decomposition of meat is suspected trim off the tainted parts of the 
quarter of beef and sink a probe into the shoulder or hip joint. The odor of 
the probe will determine whether decomposition has set in. A whole quarter 
of beef should not be condemned because part of it has begun to decompose, as 
it is often possible to trim off the tainted portion and serve the remaining 
wholesome portion. 
The Eber test (ammonia test) is used to detect decomposition. Place 2 cc 
of reagent (1 part ether, 1 part concentrated hydrochloric acid, and 3 parts 
absolute alcohol) into a test tube and shake. A small piece of meat to be 
tested is lowered to within one-fourth inch of the surface of the reagent. If 
ammonia is present white ammonia chloride fumes will appear around the 
specimen. FIELD SANITATION 
527 
Meat may be hung in cold storage but it should not be stacked in the refrig- 
erator until it has been thoroughly chilled, preferably frozen thoroughly. 
When warm meat is stacked in the refrigerator decomposition develops in the 
center part of the stack before it can be frozen. The hind quarters and fore 
quarters should be stacked to permit issue alternately. 
In the held a percentage of the rations is issued in tin containers, which, 
due to improper preparation, exposure to excessive heat, and lack of care in 
handling, frequently undergo decomposition and are especially dangerous to 
health if their use is permitted. Therefore a careful inspection of all canned 
goods should be required. 
The terms “springers” and “swells” are applied to bulged, blown, or swelled 
cans. These cans, when pressure is applied at the ends give a crackling sound. 
“Springers” are caused by overloading the can, and though not desirable, the 
contents are fit for use. “Swells” are caused by the formation of gas, due to 
decomposition and may be differentiated from “springers” by a splashing 
sound when the can is shaken, and a hollow note when the can is gently tapped. 
These should always be condemned. 
Occasionally the inside of a can may present a blackened appearance—so- 
called “can burn.” This condition is not due to putrefaction, but is caused 
by the precipitation of stannous (tin) sulfide in an acid medium. 
Formerly a can with two solder holes was indicative of a “swell” which had 
been punctured to let out the gas and then resoldered, but now many manu- 
facturing firms use two solder holes in sealing their cans. It is well to reject 
cans with three solder holes. 
Vitamins.—Vitamins are accessory food factors that occur in minute amounts 
in natural foods and are in varying degree essential for normal body growth 
and maintenance. They are discussed in the chapter on Diets and Messing 
for the Sick. 
Conservation of food vitamins.—Several simple but important facts must be 
remembered in providing troops with an adequate intake of vitamins. Personnel 
charged with preparing food for consumption should be familiar with these 
facts and conserve food vitamins. The vitamin content of foodstuffs decreases 
with age and exposure to heat, light, oxygen, and alkali. Since vitamins are 
water or fat soluble, the water, or fatty liquids in which foods are preserved 
or cooked contain vitamins and other beneficial extractives which should be 
incorporated in the ration, if possible, rather than discarded as waste products. 
Prolonged cooking, such as is apt to occur with field kitchens, tends to destroy 
the vitamin content of the ration. The vegetables for stew should be cooked 
separately and not longer than 30 minutes; then they should be added to the 
meat, which requires about 2 hours of cooking. Avoid the use of alkali, e. g., 
sodium bicarbonate, when cooking green vegetables as it tends to destroy 
the vitamins. 
The vitamin-containing foods of an exclusive military ration should weigh 
at least 30 per cent of the total. 
WATER 
Responsibility for water supply.—The quartermaster is responsible for the 
procurement of water rights and for the delivery of water to the camp site. 
The medical officer is responsible, in an advisory capacity, for the quantity 
and the quality of the water at the source as well as at the ultimate point of 
consumption. The unit commander is responsible for the proper distribution 
of the water within the organization. 
Water consumption.—Water constitutes 60 per cent of the body weight, or the 
equivalent of 10 gallons, which equals 100 pounds approximately in the average 528 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
man’s body. The loss of 1 gallon of this water has serious consequences; if 
IV2 gallons are lost, the result is fatal. (The volumetric measures used here 
are Imperial). 
The quality and quantity of the water supply is a vital factor during field 
operations. In a war of movement the supply of water is very apt to he 
inadequate, which may mean that the consumption of water will have to be 
restricted to a minimum. 
The minimum allowance of water for the needs of men and animals varies 
according to the amount of daily labor performed and also the conditions of 
the weather. The following may be taken as an absolute minimum: Each 
man, 1 gallon per day, to be used as follows—IV2 quarts for drinking, 2y2 
quarts for cooking and drinking with meals. In combat, a soldier can maintain 
physical efficiency for 2 days only on one-half gallon of drinking water each 
day. 
This is the minimum for soldiers on the march and in bivouac, and provides 
no allowance for the washing of person or clothing. 
In camps of more than 1-night duration the following minimum allowance 
should be furnished: 
Gallons 
In barracks 20 
In camps 5-10 
Drinking and cooking only 2 
The daily requirements for animals are: 
Horse 10 
Mule or donkey 6 
Source of water.—The sources of water are divided into (a) surface waters, 
such as lakes, ponds, rivers, streams, etc.; (&) ground (underground) waters, 
which include wells, springs, etc,; all these vary in degree as to purity and pot- 
ability. Rain water is usually the most satisfactory of all natural waters. Large 
bodies of water are more likely to contain pure water than small ones, because of 
the greater dilution of the contaminating material. Water which is obtained from 
the center of a large lake is very apt to be pure, especially where the sun 
shines upon it. 
One should always be suspicious of all surface waters as the appearance 
of water is no index as to its purity. Water should be considered contaminated 
until tests prove it potable. Also, water found potable may become contam- 
inated subsequent to test. Consequently, water used for drinking and cooking 
purposes should be guarded and tested frequently for contamination. 
Wells are of two Varieties, “deep” and “shallow.” Water taken from shallow 
wells is always suspicious, while water taken from deep wells and deep springs 
is usually fit for human consumption. 
1. If water from a running stream is used, it should be taken from a point 
where there is considerable depth, and where the current is strong, always 
upstream, or in other words, above the campsite. Upon arrival in camp, 
a guard should be posted over the water supply and the stream should be in- 
spected and marked for use. Beginning upstream the water should be assigned 
for use as follows: (a) Drinking and cooking water; (ft) Water for animals; 
(c) Water for bathing; and (d) Water for laundry purposes. 
To compute the volume of water of a flowing stream the following may be 
used as a guide: Sectional area in square feet, multiplied hy 0.8 velocity in feet 
per minute, multiplied by 748, equals the flow in gallon# per minute. 
2. Rain water, though not very palatable, is the safest 'and purest of waters. 
In warm countries it may be necessary to use it for drinking purposes but it FIELD SANITATION 
529 
must be properly collected and stored. Rain water is easily collected from the 
roofs of houses or other prepared surfaces. These surfaces must be kept free 
from pollution, such as excrement of birds, dust, decayed leaves, etc. The first 
washing of the rain should never be used as it will probably contain some pol- 
lution from the roof. In storing the rain water, the containers should be well- 
screened and ventilated, and frequently cleaned to prevent pollution. One inch 
of rainfall produces 22,500 gallons of water per acre. The number of gallons 
of rain water expected to be recovered from a roof may be determined by the 
following formula; Area of roof in square feet, multiplied by one-half the 
rainfall in inches, equals the number of gallons. 
3. Well water usually comes from two sources. The greater portion filters 
in from the deeper strata of the soil and may be considered as free from con- 
tamination, However, wells are rarely properly encased near the surface 
and properly covered as protection against surface water drainage and other 
pollution. Therefore all wells should be regarded as contaminated and should 
be cleaned and disinfected prior to use by employing the following measures: 
(а) Remove all refuse from well. 
(б) Pour into well about one-half barrel of a solution of freshly burned 
lime (or a 1 per cent solution of chlorinated lime can be used). 
(c) Scrub sides of well with this solution. 
id) Wait 2 hours, pump well dry, and repeat above procedure. 
(e) Wait 24 hours, pump out well, allow to refill. 
if) Continue to pump out until all taste of lime has disappeared. 
ig) Sterilize water in well by adding a solution of chlorinated lime— 
80 grains to every 100 gallons of water in well. To compute the 
number of gallons in well use formula: The square of diameter 
of well in feet multiplied by 0.7854, multiplied by depth of well 
in feet multiplied by 635 equals gallons in well. 
Transportation and storage.—Water carts employed in the transportation 
of water should be subjected to the following sanitary measures: 
(a) The tank of water cart should be scrubbed out every 4 days with 
a 1 per cent solution of chlorinated lime. 
(5) Water carts should never be devoted to other purposes than to 
provide drinking water for men. 
(c) A half teaspoonful of chlorinated lime—30 grains—well dissolved 
as a paste, added to 100 gallons of water will produce approxi- 
mately 1 part per million of free chlorine, and is sufficient to 
sterilize this quantity of water. 
The best storage containers are those made of concrete, slate, or galvanized 
iron. Wooden containers will, after a time, give the water a very disagree- 
able taste. Water receptacles should be well covered. As the ground in close 
proximity to a water faucet is likely to be wetted, it is best to build a sand 
or gravel pit, 2 feet square and 1 foot deep, to absorb the waste water. 
The receptacles should be cleaned daily with boiling water, or rinsed with 
a solution of potassium permanganate (one-third teaspoonful to 1 gallon of 
water). A solution of chloride of lime is also very good for this purpose, in 
proportion of 1 to 1,000. These solutions are harmless and more certain in 
their action than boiling water used alone. 
Canteens, when not in use, should be emptied, dried, and cleaned with one 
of the above solutions. Weak tea has been highly recommended for drinking 
purposes in canteens; it should be boiling hot when poured in, thus insuring 
the sterility of the canteen as well as of the contents. 530 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
Common drinking cups should not be used; however, if individual drinking 
cups cannot be supplied, lip drinking should be practiced. Should conditions 
arise which make it absolutely necessary to use common drinking cups, a 
certain degree of safety can be insured by keeping the cup immersed in a 
1 per cent solution of formaldehyde. 
Purification of temporary water supplies. General.—The water supply for mov- 
ing troops, for temporary camps and installations, or for troops in the theater of 
operations frequently must be purified under conditions which do not permit 
the installation of permanent or semipermanent water purification works. 
The agencies employed generally for this purpose are: 1. Chemical; 2. Heat; 
8. Filtration. 
Chemical purification.—Chlorination is extensively practiced today. Hypo- 
chlorite of calcium, commonly called bleaching powder, is the substance used, 
and is issued by the quartermaster in small glass tubes. 
The ordinary calcium hypochlorite (Calx chlorinata) or bleaching powder, 
contains 33% per cent of available chlorine when freshly prepared, but is an 
unstable substance, so that the supply received xhay contain but little chlorine. 
There are hypochlorites available however, and now recommended for use, 
which contain well above 60 per cent available chlorine, are very stable and 
easily miscible. Bleaching powder tends to form small, hard lumps when 
placed in water. In preparing a hypochlorite solution just sufficient water should 
be added to the powder to permit the easy formation of a smooth, thin paste, 
which is then diluted as required and placed in the chlorinator. Twenty-five 
pounds of ordinary bleaching powder added to 1,000,000 gallons of water give 
one part per million of chlorine. If 4,000 gallons of water are to be chlorinated 
one-tenth pound of hypochlorite is sufficient. A drip chlorinator may be used 
in a small stream, the size of the containers and the strength of the solution 
being determined by the rate of flow of the stream, however, the drip chlorin- 
ator is not recommended. In case water is so turbid as to make it unsatis- 
factory for use, it may be clarified by allowing it to stand for some time in 
a reservoir and clarification may be hastened by the addition of chemicals. 
Alum, lime, and soda ash are used for this purpose. 
Chlorinating water for small detachments.—Small detachments separated from 
the main body of troops and its pure water supply may be provided with safe 
water by chlorination of canteen water. The contents of one tube of calcium 
hypochlorite are dissolved in 1 quart of water and preserved in a glass bottle. 
A metal container is not used as the concentrated calcium hypochlorite has a 
chemical action on the metal. One teaspoonful of this solution added to 1 
canteen of water and allowed to stand for 30 minutes renders the water safe 
for drinking. If the tubes are not available, then dissolve 1 teaspoonfifi of 
chlorinated lime taken from a freshly opened container, in 1 quart of water 
and label this “stock solution.” This solution deteriorates very rapidly and fresh 
solution should be prepared every fourth day. One teaspoonful of this stock 
solution added to each gallon of water and allowed to settle for 30 minutes 
will insure the destruction of most bacteria. 
Sterilising water hy iodinisation.—Two and one-half teaspoonfuls (10 cc) 
of 7 per cent tincture of iodine added to a sterilizing bag of water will purify 
it in 30 minutes. Two drops of the tincture added to one canteen of water 
and allowed to stand for 30 minutes will render it pure. 
There are two objections to this method of sterilization: 
1. There is no reliable method for titrating the iodine in a test for 
sufficiency of the amount added; and 531 
FIELD SANITATION 
2. This method is more expensive than the hypochlorite method. (The 
excess of iodine may be neutralized by adding 1 gram of sodium 
thiosulfate.) 
Water sterilizing lag.—The water sterilizing bag, often called the Lyster 
bag, is made of specially woven, waterproof canvas, weighs about 7 pounds, 
and can be folded into a compact package. It measures 20 inches in diameter 
and 28 inches in length, and holds about 36 gallons. (Fig. 185.) Its sole use is as 
a stationary receptacle for water while being sterilized and distribution of same 
after sterilization, without dipping. 
This is accomplished by faucets which 
are arranged around the bottom of the 
bag. The Lyster bag is part of the 
Marine Corps field equipment and is 
issued on the basis of 1 bag for each 
100 men or fraction thereof. 
In use, this bag is suspended from a 
tripod and filled with water. To each 
bag of water (36 gallons) there is 
added the contents of 1 ampule of cal- 
cium hypochlorite. The calcium hypo- 
chlorite is issued in sealed glass tubes, 
one tube sufficing for one bag of water. 
The water is then allowed to stand for 
at least 30 minutes before using, as the 
sterilizing process is one of oxidation, 
and is not complete in less time. In 
water that contains much suspended 
matter, or is very cloudy, the sterilizing 
action is not very satisfactory so that 
it is necessary to clarify the water be- 
fore chlorination which may be accom- 
plished by means of a small filter cloth 
provided with the bag. 
1. Arrange bag on tripod. Strain 
water and fill bag to within about 4 
inches of the top. 
2. Procure a clean stick, or cut a limb from a tree for use in stirring of 
water. Place this in water and leave there during sterilization. 
3. Break one of the glass ampules of calcium hypochlorite and shake the 
powder into a cup. Mix with water until a fine paste results, and then- stir 
with a spoon, adding more water until the paste is entirely dissolved. 
4. Add the hypochlorite solution to the contents of the bag and mix thor- 
oughly with the stick provided for that purpose. Draw 3 cupfuls through 
each of the faucets (to clean and sterilize) and pour back into the bag. 
5. Draw off 1 cup of water and add to it the contents of 1 ampule of ortho- 
tolidine, stirring with a clean, dry spoon. As the water is stirred it turns 
yellow, the degree depending on the amount of hypochlorite present. An orange 
or orange red color indicates a sufficient amount for sterilization. A canary 
yellow color indicates an insufficient amount and hypochlorite should be added 
to the bag 1 tube at a time until the right color is obtained. The water is 
then allowed to stand for 30 minutes and guarded to prevent use during this 
period. 
Figure 135.—Water ba 532 
HANDBOOK OF THE HOSPITAL CORPS, XL S. NAVY 
6. Excess chlorine gives the water an unpleasant taste. This can be dis- 
pelled by neutralization with sodium thiosulfate. Sodium thiosulfate is provided 
in glass ampules. The contents of 1 ampule should be added to a cup of water, 
stirred until dissolved, and after sterilization of the contents of the bag is 
complete, should be poured into it. 
7. The faucets should then be rewashed for the last time, running at least 
5 cups of water through each faucet and returning the water to the bag. This 
treatment renders the water perfectly safe, even though it was previously 
heavily contaminated. 
8. Unless precautions are taken men will drink directly from the faucets. 
They should be required to use their individual mess-kit cups. 
9. The bag cover may be supported in the center by means of a wire to 
the apex of the tripod support. This gives a pitched-roof effect, allows rain 
water to run off the top and prevents sagging of the top and contamination 
of the contents. 
Mobile water purification unit.—The United States Marine Corps has pro- 
cured two highly efficient mobile purification units, and has placed one on 
each coast. Essentially the unit consists of the following: 
1. Gasoline engine-driven centrifugal pump. 
2. Pressure filter. 
3. Chlorinator. 
4. Soda-ash feeding device. 
5. Suction hose and discharge hose. 
These are mounted on a circle-steer highway trailer. 
The pump has the following capacities: 
1. Twenty-five gallons per minute against a 10-foot delivery head 
through filter. 
2. When filtration equipment is bypassed—in case the raw water is suf- 
ficiently clear—the pumping equipment and solution feed chlorinator 
will deliver 50 gallons per minute of sterilized water against a 50 
foot head. 
3. When filtration and purification equipment is bypassed, and the 
unit used as a pumping device, then 100 gallons of water per 
minute can be delivered against a 75-foot head. 
Thus the mobile unit may be operated as: 1. A simple pumping unit; 2. A 
pumping and chlorinating unit; or 3. A pumping and filter unit, with or with- 
out chlorinator. 
It is rather spectacular to watch the operation of one of these units with 
the suction hose placed in a muddy contaminated pond of water deliver a 
clear purified stream of potable water, at the rate of a barrelful each minute, 
at the discharge hose. 
Boiling.—Boiling is a simple and effective method of water sterilization 
and may be used in the presence of an epidemic of intestinal disease, such 
as dysentery or cholera, and when materials are lacking for sterilization by 
other methods. 
However, boiling all drinking water entails a considerable amount of fuel 
and time. For 250 men nearly three barrels of drinking water are required 
each day and it would be a heavy task upon the rolling kitchen if the boiling 
is to be done there. 
Boiled water has a flat taste unless it is aerated after cooling. Its taste 
may be improved by the addition of tea or coffee. FIELD SANITATION 
533 
Each man can boil water in his canteen, by placing the canteen full of water 
in a fire, or upon hot coals until the water boils, after which it is removed and 
allowed to cool. Troops can, after a day’s march, prepare their canteens full 
of boiled water for use on the next day. 
Field filters.—The barrel filter consists of a small barrel inserted into one 
of larger dimensions and separated from the bottom of the larger barrel by 
about 3 inches of fine sand. The smaller barrel having a perforated bottom, 
is placed upon the sand in the larger barrel; then more sand is placed around 
the small barrel to the height of about 6 inches. A layer of charcoal and a 
layer of gravel may be placed above the sand. 
The barrel filter may be sunk into a lake or spring; water may also be 
filtered by pouring it into the larger barrel. 
In connection with drinking water, special attention should be given the 
following: 
1. Regard all water in the field as contaminated unless proved otherwise. 
2. Do not let the men fill their canteens from any unauthorized source. 
3. Place a guard at the source of the water supply to prevent its pollution. 
4. Water discipline on the march should |?e rigidly enforced. 
5. Remember that not only the quality of the water supply but also its 
quantity should be supervised by the medical officer. 
6. The amount of water lost by evaporation, and otherwise, by a man 
marching for 1 hour, or 3 miles, is nearly 1 pint. 
7. The results obtained by modern military organizations demonstrate 
that water-borne diseases are preventable. 
8. The prevalence of a water-borne disease in a camp indicates a weak 
link in the chain of sanitary measures. 
“Field Conservancy” is a technical term employed to designate the disposal 
of waste products in the field. 
The disposal of waste products is one of the most important field sanitary 
measures, and the importance of proper waste disposal was known to the 
ancients. 
Burial was the earliest means of disposal and is instinctive in many of the 
lower animals. 
Field sanitary measures of modern military preventive medicine have reached 
a stage in development in which it is now possible to assemble a million men 
in the field and prevent decimation by epidemics. 
Waste products may be divided as follows: 
1. Refuse: 
(a) Garbage. 
(ft) Rubbish (boxes, paper, etc.) 
2. Excreta: 
(а) Night soil (urine and faeces). 
(б) Manure (stable litter). 
Or they may be classified as follows: 
1. Solids: 
(a) Human faeces. 
(&) Kitchen garbage. 
(c) General camp rubbish. 
id) Stable refuse. 
FIELD CONSERVANCY 534 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
2. Liquids: 
(a) Urine. 
(ft) Kitchen sullage. 
(c) Ablution water. 
The proper disposal of waste constitutes one of the most important functions 
of the field sanitarian. 
In the disposal of waste the following objectives are involved: 
1. Prevention of insect breeding.—To change the nature or location of waste 
matter so that fly breeding will be prevented, and also the breeding of other 
disease-carrying insects. 
2. Destruction of microorganisms.—To destroy or otherwise eliminate the 
presence of organisms which may cause disease. 
3. Removal of a nuisance.—Waste matter and filth are almost synonymous 
terms; and, as such, the accumulation of waste creates a condition which is 
offensive to the senses of sight and smell. 
The methods for ultimate disposal of waste products can be grouped into 
two main procedures, namely : 
1. Burying: 
(а) Shallow—Temporary camps. 
(б) Deep—Semipermanent camps. 
2. Burning—Permanent camps. 
In camps not of a permanent nature and with moving troops, burial is a 
more convenient and rapid means of waste disposal and is universally practiced 
in modern armies. Incineration has the advantage of complete destruction 
of all waste and is the better method, from a sanitary standpoint, for permanent 
camps. 
Collection and disposal of refuse.—Metal garbage cans, if available, should 
be placed at intervals in the company streets for the disposal of waste paper, 
burnt matches, cigarette stumps, fruit peelings, etc. The use of receptacles of 
this sort accomplishes primary cleanliness of the camp and inculcates the habit 
of cleanliness in the men. If metal receptacles are not available, wooden or 
cardboard boxes may be employed. 
Garbage cans should be well covered and placed on raised platforms at least 
2 feet from the ground. The soil beneath these platforms is easily contaminated 
by the overflow of drippings, and requires careful supervision to prevent pollu- 
tion and fly breeding. The surface beneath garbage cans should be scraped 
daily and shoveled into the garbage cans. Fresh dry earth should be spread 
over the scraped area. The promiscuous use of lime to cover filth is not 
recommended. 
Shallow burial.—The surface of the earth usually consists of bacterial soil 
varying from a few inches to a few feet in depth. The top layer of the earth’s 
surface is inhabited by millions of friendly germs—the germs of decomposi- 
tion—which break up organic matter into various gases and water, and so rid 
the earth of the debris which would accumulate on the surface. (See p. 436.) It 
is part of the scheme of Nature that it must be so, for if constant breaking up of 
organic matters were not going on, the surface of the earth would become choked 
and one would find himself up to the middle in leaves, which fall and accumulate. 
The surface of the earth is always assisting in this destruction of organic 
matter. This layer of germ-charged earth is known as the live humus or living 
filter, because the germs not only destroy organic matter, but they prevent the 
passage of filth into the soil. The live humus varies in depth according to the 
nature of the soil, and is deepest where the soil is very light and where air can FIELD SANITATION 
535 
percolate through the surface, in which case it may reach to a depth of 2 or 3 
feet. Usually, the depth of this humus-bearing soil is 1 to iy2 feet. Below 
the level of the live humus the earth is sterile or free from germs, and, if 
buried deep, organic matter such as excreta receives no assistance from the 
earth in the matter of decomposition. The live humus varies in its intensity 
from time to time, for if the germs are well fed they increase and multiply, 
whereas if they are starved they perish. 
Germs require food, moisture, and warmth for their growth, and if well sup- 
plied with these they will multiply in proportion to the amount of food they 
obtain. Thus the live humus varies in intensity according to the time of year, 
for in a very dry summer, when the surface of the earth becomes bone-dry, 
decomposition may be absolutely arrested, and a body may become mummified 
or sun dried if it is covered with sand to keep off flies. (Moss-Blundell.) 
The Allahabad system.—Nitrification of excrement in the soil is the sole aim 
of sanitary science, and the more intimately the excrement is mixed with the 
dry earth the quicker will nitrification occur. (See p. 437.) 
The germs which cause nitrification are in the upper few inches of the soil 
and this fact is taken advantage of in the disposal of excreta by the so-called 
Allahabad system, as used in India. 
An area 16 feet long and 5 feet wide is excavated to the depth of 3 inches. 
The excavated soil is placed at one end. The denuded area is then loosened to 
a depth of nine inches. The area is sufficient to dispose of 60 gallons of night 
soil, when dumped in the center. The liquid waste is absorbed by the loosened 
soil. The solid matter is spread over the area, and then covered with the 3 
inches of soil previously removed. This is tamped down. 
In a few weeks, depending on the temperature, the solid matter is completely 
decomposed and all pathogenic germs are destroyed. 
The Allahabad method is useful in permanent campsites—using the bucket 
system—where fuel is limited for incineration, but under the usual field 
conditions this method is of more academic interest than practical value. 
Shallow latrines.—On the march: A marching column is supposed to rest for 
10 minutes every hour on the march, and during the rest period the medical 
officer should see that some place is provided for the men to relieve themselves. 
As soon as the column halts, a sanitary detail from the company should im- 
mediately proceed to improvise latrines. A few narrow trenches about 8 inches 
deep and 1 foot wide will suffice, and can be hastily constructed with a sharp 
stick, spade, or bayonet. The sanitary detail should remain behind to fill in the 
latrines with earth when the march is again resumed. 
In temporary camps: Camps which are to be occupied for 15 days or less 
should be provided with “straddle trench” latrines with dimensions as follows: 
1 foot wide, 2 feet or less deep, 3 feet long. The straddle trenches are also 
called the “One-two-three” latrines because of their dimensions. 
These shallow trenches are more effective in disintegrating solid waste than 
the deep trenches, as the germs of nitrification are found only in the upper 
few inches of the soil. All excretions and disease-producing organisms, even 
the toilet paper, disappear in these shallow trenches in 4 to 5 weeks, as one 
investigator reports. 
Straddle-trench latrines should be constructed parallel to each other and 
should be 3 feet apart; the loose earth should be heaped close to one end of 
the trench. A shovel, spade, tin, or other similar article should be on hand, 
and each man should he required to cover his dejecta with loose earth after 
deflation. In addition straddle-trench latrines may he sprayed with crude 
011 or covered with quicklime, and then covered with a layer of earth daily. 536 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Often it is necessary to establish a guard in the sanitary area to prevent this 
weak link in the chain of sanitation. The straddle trench latrine may be 
designated the open shallow latrine. Sixteen feet of trench should be provided 
for each 100 men. 
Deep latrines.—The open, deep latrines, similar to those used during the 
Spanish-American War, and which created such insanitary conditions and 
contributed to the spread of typhoid fever, will be omitted from discussion, 
for quite obvious reasons. 
In semipermanent and permanent camps deep, covered latrines are recom- 
mended. 
These latrines require more time and labor to construct than the shallow- 
trench latrines, but have the advantage that they are easier to make fly 
proof. 
Figure 136.—Modification of standard U. S. Army latrine box. 
The dimensions for deep latrines vary considerably, but the following may 
be taken as a standard: 2 feet wide, 6 feet deep, 7% feet long. 
In loose soil it may be necessary to revet or face the latrine pit. 
The Army latrine box is an excellent type of cover for deep latrines. The 
exact specifications for building this box will be found in figure 136. The box 
consists essentially of an inverted open box built to a convenient height above 
the ground, containing pear shaped holes in the top, with lids covering these 
holes. The lids are made to open not over 85°, which will cause them to close 
automatically. A space of one-fourth inch should he left at the seat hinge to 
allow for the swelling of the wood. 
These deep latrines are usually intended for use over a long period of time. 
Most of the odors of latrines are due to ammoniacal and other decomposition 
of urine and the separator system is sometimes used to separate the urine from 
the fseces. A urinal soakage pit is built close by, and by means of a tin 
gutter, built in front of and under the seat, the urine accompanying defsecation 
is drained into the soakage pit. A urinal trough connected to a soakage pit 
should be constructed within the latrine enclosure. 
The latrine is improved by erecting it on a mound a foot high composed of 
earth removed from pit. This mounding of earth prevents surface drainage 
into the pit causing the contents to overflow. Latrines should be abandoned FIELD SANITATION 
537 
when filled to within 1 foot of normal surface level, and when abandoned they 
should be liberally sprayed with crude oil or covered with quicklime and. 
mounded with earth. When dug in wet soil a foot or two of water often appears 
in the bottom of the pit. Such water aids in absorption of the contents into the 
surrounding soil and many such latrines exhibit septic action. Two boxes should 
be provided for each 10 men. 
Site and number of latrines.—Latrines should: (a) Be constructed at least 
100 feet from the camp, although deep closed latrines may be constructed at a 
distance of 50 feet; (ft) Be constructed on the side of the camp opposite to 
the galley and kitchen; (c) If practicable, be located so as to drain away 
from the water supply; (d) Be placed at a safe distance from ditches and 
gulleys to avoid the overflow which might be caused by a heavy rainfall; and 
(e) Be located to leeward of the camp, if practicable. Separate latrines should 
be constructed for officers and men. 
The seating capacity of the latrine area, as given by various authorities, 
ranges from 5 to 15 per cent of the command, depending upon the conditions. 
For commands on the march, stopping for only 1 night in camp and breaking 
camp shortly after breakfast, a latrine frontage of 1 yard for every 10 men 
is not an excessive allowance. It is not always practicable to construct this 
number, and under such circumstances the medical officer should be satisfied 
with a 6- to 8-per cent frontage, using the latter figure for commands under 
500. In a semipermanent camp estimate 1 seat for every 15 men. 
The advantage of straddle-trenches is that the sides are not subject to 
contamination by urine. A trench lasts 1 to 2 days. 
For straddle-trenches the frontages required in yards is 6 times the comple- 
ment in hundreds—that is, 200 men will need 12 yards of latrine frontage. 
The depth in yards is two-thirds the number of days stay in that camp. 
Care of latrines.—When' deep latrines are filled to within 1 foot of the 
surface with excreta, they should be filled in with earth and abandoned. The 
tilled-in latrines should be covered with a mound of earth and labeled with 
an “L” if practicable. This marking of the abandoned latrines serves to 
inform future occupants of their site. 
The inside of deep-trench latrines should be darkened by the use of tar 
paper, lampblack, or other suitable material. The use of a dark substance tends to 
prevent the entrance of ova-depositing flies. This depends upon the principle 
that flies usually avoid dark places. 
The box cover may be removed occasionally and the inside burned out with 
kerosene or crude oil. 
In order to prevent the egress of any fly larvae which may develop in the 
depth of the latrine and burrow through the ground around the mouth of 
the pit, an area of about 4 feet around the pit should be covered wdth crude 
oil, or a 5-per cent solution of cresol. A better method is to cover the area 
with burlap sacking soaked with crude oil. 
It is very desirable that some provision be made for the men, especially 
cooks and other food handlers, to wash their hands after using the latrines. 
Sufficient toilet paper should always be available. 
In order to prevent the possible flooding of latrines by storm water, a 
shallow trench should be dug around the area occupied by the latrine. 
Latrines should be surrounded by a canvas screen or a screen made of 
shrubbery. Each abandoned latrine should be distinctly marked. 
Soakage pits.—Soakage pits are one of the greatest developments in impro- 
vised sanitary appliances. 538 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
These pits are designed for the ultimate disposal of liquid wastes, urine, 
sullage water and ablution water. These sanitary expedients should be con- 
sidered in the establishment of semipermanent and permanent camps. 
Ant heaps, or nests of other termites, have been used as ready-made soakage 
pits, and have been found capable of absorbing 300 gallons of waste liquids 
in 24 hours. 
Figure 137.—Urine soakage pit 
(Modified from “Lcleon") 
Urine soakage pits.— (a) Dig a pit 4 feet square and 4 feet deep, fill to 
within 6 inches from surface with large stones, or empty perforated cans. 
(&) Insert 4 pieces of iron piping, 1 to 2 inches in diameter, and 4% feet 
long at each corner of the pit, so that the upper end is at a convenient height 
above the ground to serve as a urinal. If iron piping is not available, long 
tin or tar-paper funnels may be improvised for this purpose. 
(c) Cover stones with oil-soaked burlap sacking, tar paper, or other material. 
(d) Fill over burlap with earth. 
(e) Insert replaceable tin funnels in iron piping—preferably with screening 
over apex of funnel to catch cigarette butts and other debris. 
if) Surround urinal pit with white-washed stones to render it more visible 
at night. 
(g) A vent leading into the pit may be constructed to give exit to the gases 
of fermentation and putrefaction. 
(h) In porous soil, one urinal soakage pit will dispose of the urine of 100 
to 200 men for an indefinite period. (Fig. 137.) FIELD SANITATION 
539 
Night urinals.—If the urinals are located some distance from the camp, it 
is a temptation to a man desiring to evacuate his bladder, particularly on a 
cold night, to urinate upon the adjoining tent, and so on down the company 
street. To overcome this tendency, urinal cans should be placed in the com- 
pany streets at night, with a lighted lantern to mark the location. The cans 
used for urinals should be cleaned and sunned during the day. A more simple 
type of night urinal can be improvised by making a hole in the center of the 
tops or garbage containers and placing the inverted tops over the garbage cans. 
Sullage pits.—The sullage pit is for the disposal of water from kitchen 
garbage. These pits are 4 by 4 by 4 feet. They should be fitted with grease 
traps to remove the grease which tends to clog the interstices of the soakage 
pit. Figure 138 shows a combined soap and grease trap. Provide a sullage pit 
for each 200 men. 
Figure 138.—Waste water and grease trap. 
In very temporary camps, sand and gravel placed in a can or bucket with 
perforated holes at bottom will serve to remove the major portion of the grease. 
The improvised bucket grease trap may be placed over the open soakage pit 
filled with stones. 
Ablution pits.—If the ablution water is run through a box of fine sand, before 
entering the soakage pit, the major portion of the soap is removed. 
Ash barrel grease trap.—An ash barrel grease trap is prepared by using a 
barrel of about 50 gallons capacity with 1 head removed, and boring 30 one-inch 
holes in the remaining head. Place about 8 inches of gravel or stone in the 
bottom, the size of the stones decreasing from 1 inch at the bottom to % inch 
at the top, and over this place 16 inches of wood ashes. Fasten a piece of 
burlap over the open top of the barrel by means of a hoop. The trap may be 
placed directly on the soakage pit or on an impervious platform which drains 
into the pit. 
The sullage water is poured into the barrel through the burlap, food particles 
thus being strained out. As the greasy, soapy water filters through the ashes 
the greater part of the grease and soap will be removed. The burlap should be 
154294°—39 35 540 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
removed daily and burned, and it will be necessary to replace tbe ashes every 
3 or 4 days. 
When more than 200 gallons of water per day are to be disposed of, additional 
soakage pits and grease traps may be necessary. One barrel grease trap 
should be provided for each 200 men. 
Disposal of garbage to farmers.—It is sometimes possible to dispose of the 
kitchen refuse by contract with the farmers in the vicinity to haul it away to 
use as food for hogs, poultry, etc. This method of removal is satisfactory at 
times, but at other times it will be found difficult to induce the farmers to 
remove the garbage at regular intervals, which allows the waste to accumulate 
and become a nuisance. Under these circumstances it is frequently advisable 
to resort to other means of disposal and to burn or bury the kitchen garbage 
together with the other waste products. 
Small sewage disposal plant.—In the field, occasions may arise that require 
the construction of small sewage disposal plants. The “filter type” is recom- 
mended as simple and easily constructed. This type embodies the essential charac- 
teristics of the method of sewage treatment known as intermittent sand filtration.” 
1. Excavate a circular pit not less than 5 feet deep and 8 feet in diameter. 
2. Line the pit with a wall of stones, old bricks or other suitable material 
laid up without mortar in joints, leaving a space between this wall and the wall 
of the pit. 
3. Fill in the space between this wall and the natural soil with coarse sand 
and gravel. 
4. Fill in pit with fine gravel to provide a filter bed of at least 30 inches 
depth and allow 6 inches between bottom of soil pipe and top of filter bed. 
5. Construct a suitable roof and sod over it. It is essential for successful 
operation that the water level be kept well below the surface of the filter, and 
in rare cases where the soil is nonporous, often joint subsurface drains should 
be installed. 
Incineration of waste products.—Incinerators used for the disposal of waste 
products may be divided into two types, open and closed. Characteristics of 
the open type are that they are easily constructed, require less material for 
construction, and are practical for use in semipermanent camps; character- 
istics of the closed type are that they are more quickly started, are not so 
liable to be put out by rain, are not so productive of bad odors, produce more 
heat, and are practical for use in permanent camps. 
An example of the open type is the rock pile incinerator which is constructed 
as follows: Dig a circular pit 15 feet in diameter and 8 feet deep; line the pit 
with boulders or mashed tin cans. In the center of the pit raise a pyramid 
of stones about 5 feet high which will serve to create a draft. A fire is built 
around the pyramid of stones and the garbage is later thrown on the pyramid 
where the solid matter is consumed and the liquid is evaporated by the hot 
stones. 
One cord of wood will consume about 4,000 pounds of ordinary camp refuse, 
after the stones have been heated. 
A closed-type incinerator to dispose of all types of kitchen garbage in per- 
manent and semipermanent camps may be constructed as indicated in the 
accompanying diagram (fig. 139). This incinerator should be constructed about 
200 feet away from the kitchen, and in a location where prevailing winds are 
least liable to blow smoke toward the camp. It is advantageous to build the 
incinerator in a small grove of trees, if available. Trees serve as a wind- 
break, preventing scattering of papers, ashes, etc., and aid in carrying the 
smoke upward. 541 
FIELD SANITATION 
The incinerator is fueled by logs, the fire hottest at the middle and lower 
end, to prevent “burning out” and warping of the iron plate. Wet garbage 
is deposited on the plate near the stack where it steams and dries slowly; 
agitation wuth a rake hastens drying. Portions which have become sufficiently 
dry, and large chunks of material, are raked over on the iron rods where 
they are burned and fall into the fire box. All but objects such as tin 
Low stack to prevent 
too much draft. 
CROSS SECTION OF FLUE 
Figure 139.—Incinerator for permanent and, semi permanent camps. 
cans, etc., are reduced to ashes, which may be cleaned cut occasionally and dis- 
posed of, preferably by burying. An incinerator of these dimensions should 
be large enough to dispose of all the waste in a camp of about 100 or 200 men. 
Disposal of carcasses of animals.—The labor involved in burying a dead animal 
is considerable, consequently a combination of burial and burning is 
recommended. 
A hole is dug beside the body, which is then disemboweled and the internal 
organs are buried. 
The disemboweled carcass is then covered inside and outside with 30 to 40 
lbs. of dry hay, or other litter, saturated with kerosene, and set fire to. This 542 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
method aims at sterilization of the carcass and not incineration. If sufficient 
fuel, time, and labor are available, complete incineration of the carcass may 
be accomplished. 
Manure disposal.—There are several methods for the disposal of manure, a 
few of which will be discussed. 
Distribution method.—This method is applicable only in warm weather. 
The manure is spread in a thin layer on hard level ground, care being taken 
not to have the layer more than 1 inch in thickness. It is raked over a few 
hours later and all small lumps are broken up. This rapid drying method 
prevents fly breeding. The manure of 500 horses will require an area of 25 
by 25 yards, and three such areas used, one every third day in rotation. 
Close packing.—This method is also known as the “bio-thermic” method of 
manure disposal. In it the mahure is moistened with water and closely packed 
by gradually adding new manure and beating the pile with shovels. The 
center of the pile undergoes fermentation and heat of more than 150° F. is 
generated, which heat is sufficient to destroy the eggs and larvae (maggots) of 
flies. Flies lay eggs only in fresh manure which is damp, and do not lay eggs 
in fermenting manure or dry manure. Eggs which are laid in fresh manure 
hatch within about 24 hours and the maggots migrate away from the hot 
center of the pile to the cooler outer layers, because contact with heat of fer- 
mentation kills them. When the larvae of the domestic fly are exposed to a 
heat of 122° F. they die in about 3 minutes. The gases of fermentation kill 
them in about 1 minute at 124° F., in about 4 to 8 seconds at 139° F., and in 
from 4 to 6 seconds at 140° F. The daily amount of manure produced by 
one horse is from 1 to 2y2 bushels. 
Because of the fact that flies lay their eggs in manure, maggot or larvae traps 
are often used in connection with the disposal of manure. 
Concrete basin 
to catch 
maggots 
Figure 140.—Fly larvae trap. 
Maggot trap.—The manure is stored on an elevated platform composed of 
parallel slats, underneath which is placed a receptacle containing water or 
some insecticide solution. 
The pile is exposed, thus encouraging flies to lay their eggs. The eggs 
hatch into maggots, and the maggots burrow through the pile in search of 
earth, with the result that they fall between the slats into the solution below, 
where they are destroyed. (Fig. 140.) FIELD SANITATION 
543 
Larvse traps have been designed for use in manure heaps. Empty tin 
cans with slits of a sufficient size to admit maggot forms are filled with dry 
hay and sunk into the manure pile so that the slits are flush with the surface. 
The larvae seeking a dry spot for pupation crawl into the tins and are later 
destroyed by burning. Several thousand larvae have been caught in this 
type of trap in 1 day. 
Incineration of manure.—When the manure is not used as fertilizer, a wire 
hammock may be improvised and slung between two trees. The requisites are 
an amount of heavy wire, a pair of wire clippers, and some ingenuity. The 
manure is thrown on the hammock and burned. The hammock may be 
swung with a pendulum motion in order to increase the draft, which will 
facilitate the destruction of the litter. The hammock incinerator was devised 
at Quantico, Va., and proved a very satisfactory method for the destruction of 
manure of several hundred horses and mules. If the number of horses is 
small, an old wire bed-spring may be used as a hammock incinerator. 
Another useful method of manure incineration is to place the manure in piles 
about 2 feet high—known as windrows—sprinkle with oil and burn. 
Rails from railroads may be used to construct an incinerator for the cremation 
of stable refuse. 
Persistently wet weather may delay or prevent the burning of manure for 
some days, and during the rainy season in some countries incineration becomes 
impracticable. 
Manure enclosure with maggot trap.—For cases where the manure is to be 
stored for some time and later used as fertilizer, there has been devised a 
manure storage receptacle with a trap to catch larvae. This is somewhat similar 
in principle to the maggot trap. 
A screened enclosure, 4 by 4 by 4 feet, is erected over a concrete base, 
surrounded by a trench with overhang to catch and retain fly larvae. The fly 
larvae are fed to chickens, or destroyed by hot water, or chemicals. The trench 
is connected with a small sump, in order to keep the trench dry. The wetted 
manure is packed tightly in the wire enclosure, and the fermentation of the 
organic matter generates heat, so that the fly larvae, not being able to with- 
stand the interior heat, come tumbling out through the meshes of the en- 
closure and fall into the maggot-retaining trench below. 
FIELD MEASURES FOR INSECT CONTROL 
The human race is at constant warfare with hordes of visible enemies— 
insects, which frequently act as carriers of myriads of invisible foes, pathogenic 
organisms, and ova of parasites. This is especially true of conditions in the 
field, and for an expeditionary force to withstand successfully the attacks 
of insects requires detailed consideration of field measures for insect control. 
Flies. 
The question of fly control is of tremendous importance in the prevention of 
disease in the field, so extended remarks on the life history are appropriate. 
The development of the fly by metamorphosis has been described on page 447 
in the section on Hygiene and Sanitation. 
The egg must be kept warm if it is td develop, and it is therefore usually 
laid in vegetable or faecal matter which is about to ferment, the rapidity of 
chemical changes therein supplying the needed heat. 
The larva of the fly has no digestive glands, and is therefore dependent 
upon predigested food or other readily assimilable food—another reason for 
the fly depositing its egg in faeces. Its most interesting habit is that of bur- 544 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
rowing. It does so first to reach moister areas of its habitat; if disturbed, it 
hides with great speed; finally, in the prepupal stage, it comes to rest an inch 
or two beneath the surface of the ground in the vicinity of its feeding place. 
Having reached this haven its skin contracts, hardens, and darkens, thus form- 
ing the pupa-case within which the change to the perfect insect takes place. 
The pupa remains without food for 4 days while developing into the adult 
fly. To enable it to escape from the pupa-case and force its way to the surface 
of the ground, the young adult is provided with a temporary structure, in the 
shape of a dilatable frontal sac, the so-called ptilinum, the first use of which 
is to pry open the anterior end of the pupa-case. The young adult then 
emerges, and will escape through a depth of 6 inches of loose soil, and even 
through 6 feet of dry sand—the latter being a truly heroic effort. 
Anatomy of the fly.—The adult fly has the following anatomical points of 
interest: 
It is provided with a nonpiercing, retractile proboscis through which food 
is sucked by the powerful pharyngeal muscles. 
The salivary, glands are large, and saliva is freely expectorated onto dry 
foods, which are thus dissolved prior to ingestion. 
The alimentary tract is provided with no other digestive glands. In addi- 
tion to the stomach, the insect has a large crop capable of holding a 4 days’ 
reserve of food. The hairiness of body and legs is remarkable. The feet 
are provided with minute hairs, bristles, terminal claws, and adhesive pads. 
The latter consists of surfaces covered with multitudes of fine hairs, and 
moistened by a glairy, sticky substance, by means of which the fly maintains 
its foothold when inverted. For the conveyance of organisms in vast numbers, 
it would be difficult to imagine a more suitable apparatus than the fly’s foot. 
Habits of the fly.—Having had no food for 4 days, the emerging adult fly is 
so hungry that it seeks the nearest feeding ground, and gorges up to 70 per 
cent of its weight at a single meal. 
Its preference for certain foods is dictated by anatomical considerations. 
It must either get soluble carbohydrates or predigested protein; the former 
from kitchens and swill tubs and the latter preferably from faeces. When 
both sources are available, the latrine and kitchens are frequented alternately, 
hence the danger in the field from flies transmitting intestinal diseases. 
When resting, the fly can often be observed to regurgitate crop contents, 
until there is suspended from the end of its proboscis a drop nearly as big as 
its head. This fluid is drawn in and out with gusto so long as the fly is 
undisturbed, but is dropped if alarm leads to hasty flight. A cropful of fsecal 
fluid may thus be deposited on the surface of food ready for human consump- 
tion. Well-fed house flies evacuate their bowel about once every 5 minutes. 
A fly will go upward through a hole, but seldom downwards, and this fact 
is utilized as a principle in the construction of some flytraps. 
Flies endeavor to avoid strong sunlight and tend to congregate in shady 
places in room light. They likewise avoid a dark place, hence lampblack is 
used, as a fly deterrent, to cover the interior of latrines. 
These insects have a tendency to rest upon vertical rather than horizontal 
objects; they also prefer curved surfaces rather than plane surfaces. The lat- 
ter two facts are utilized to catch the adults by suspending curved strips of 
fly-paper from the ceiling. 
Flies tend to select certain colors and shades of color. They prefer a lighter 
shade to a dark one of the same color and have a tendency to avoid blue 
colors. 
Flies can travel long distances—100 miles or more. FIELD SANITATION 
545 
A temperature of 120° F. is usually fatal to flies; they are most active at 
a temperature between 80° and 90° F. and are torpid at 50° F. 
Prevention of fly breeding.—Flies breed in horse manure, excreta, decaying 
organic matter, and even in dirty rags and paper. One neglected stable may 
supply a horde of flies for an entire district, as a cart load of manure may 
harbor as many as 200,000 maggots. 
Chickens feed freely on fly larvae growing in manure, and it has been 
claimed that six chickens per horse will keep down flies around a stable. 
Garbage should be1 kept in covered containers to prevent fly breeding and 
should be removed frequently, especially in warm weather. 
The suppression of flies resolves itself into a matter of cleanliness—organic 
cleanliness of the environment. 
Grease traps must be covered and the surroundings kept clean and dry, or 
larvae will develop there. 
The proper care of a picket line is a difficult problem. Daily removal of 
the manure with cleaning of the picket line and burning over of the area are 
only partially effective measures in the prevention of fly breeding. The heat of 
burning over the surface penetrates only from 1 to 2 inches of the ground and 
fails to kill the developmental forms which may be several inches under the 
surface. Digging up the picket line and saturating it with crude oil and 
tamping it down is fairly satisfactory. 
Protection of food and personnel.—It may be accepted as a maxim that 
the presence of an undue number of flies is indicative that food or filth is 
exposed somewhere in the vicinity. 
A marked reduction in the number of flies around the kitchen follows the 
simple measure of cleaning the outside of garbage cans. 
In a permanent camp the kitchens, mess halls, and garbage cans should be 
screened. In a semipermanent camp screening may be impractical, consequently 
dependence must be placed upon cleanliness and insect proof containers. Un- 
less the screening of a building is maintained in an efficient state, the use of 
screens is apt to do more damage than good. Leaking screens (especially cracks 
around the screen door) frequently convert the building into a large “fly- 
trap”—flies are able to gain entrance into the building through leaking screens 
but are unable to get out. Screen doors should be made to open outward and 
should be in direct sunlight, when practicable. One of the places most apt to be 
overlooked is the space between the bottom of the screen door and the floor, 
a defect which may be remedied by using extra battens. Some of the other 
faults to be looked for include torn screens, warped doors, improper closing of 
doors, broken door stops, etc. 
Destruction of flies may be accomplished by the use of muscicides, fly paper, 
fly traps, by swatting, etc. 
Of the muscicides the following is very effective and is easily prepared: 
Formalin (solution of formaldehyde), 50-60 cc, or about 3 tablespoonfuls. 
Sugar, 20-25 Gms. 
Filtered limewater, 250 cc. 
Water, add enough to make 500 cc. 
The effect of this solution will not be very satisfactory in a humid atmos- 
phere. The flies should not be given access to water when this solution is used. 
A 1-percent solution of sodium salicylate will also kill flies. 
Fill a dish with the solution and place pieces of absorbent paper in it so 
that the paper will absorb the solution. As the solution is evaporated more 
must be added. 546 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
A small glass jar about half full of the solution is inverted on a flat-bottomed 
dish which is covered with about three layers of absorbent paper. This is a 
very efficient method, as the paper is always kept moist by capillary attraction. 
A thick rubber band placed around the jar and plate will hold the jar in 
position. 
Fly sprays are effective. The basis of these insecticides consists of pyrethrum 
in kerosene, or similar hydrocarbons. Use of the standard Navy issue insecticide 
is recommended. 
Fly paper is very efficient for catching flies and is prepared as follows: Heat 
powdered rosin 8 parts and castor oil 5 parts (by weight) ; stir well while heat- 
ing ; the mixture should not be brought to a boil. In hot weather the proportion 
of rosin should be increased. Sugar or honey may be added, but it is not 
essential. The fluid is spread while hot over glazed paper. The mixture may 
he painted upon iron hoops or wire strands. Wires so painted will last for 2 
or 3 days, when they should be cleaned and recoated. 
Fly traps consist of wire-cone, glass-bell, and many other varieties, and are 
constructed on the principle that flies are attracted by the sense of smell through 
a dark opening in the bottom or side of the trap; after feeding they attempt to 
leave by flying upwards toward the light and thus into the trap. 
Traps should be lifted a certain distance from the ground to allow free 
access to the flies and should always be baited with some attractively odorous 
substance. Molasses in water (molasses 1 part to 3 parts of water) or brown 
sugar (1 part of brown sugar to 4 parts of water) may be used as bait for 
flies. Both of these solutions increase in attractiveness when fermented. 
The habits of flies should be considered in locating fly traps; 
1. Flies will go from sunlight into room light, and will go from a dark 
room to a lighter one. 
2. They congregate on the lee side of a shelter. 
3. They tend to avoid certain colors, such as blue. 
Judging from the experiments conducted by one observer it would appear 
that the efficacy of fly traps is largely dependent upon the bait used in them. 
In these experiments 15 different kinds of bait were used and a total of 45,000 
flies was caught. 
The following are the results of 7 of the 15 types of bait used; the results 
of the other 8 kinds of bait are omitted for sake of brevity. 
Kind of fly bait; 
Percent of total 
flies caught 
Pish head 
- - - 31.34 
Overripe bananas- 
21.30 
Bran mixture 
20.72 
Canned salmon 
14.00' 
Molasses, water, and vinegar 
. _ 1.00 
Sweet corn 
- ___ _ .13 
Mashes, cheese, and molasses 
_ - * .10 
Putrefying fish, kept moist with one part molasses to three parts of water, 
is said to make an excellent bait for fly traps. 
The conical hoop trap (Fig. 141) consists essentially of a screen cylinder 
with a frame made of barrel hoops, in the bottom of which is inserted a screen 
cone. The height of the cylinder is 24 inches, the diameter 18 inches, and the 
cone is 22 inches high and 18 inches in diameter at the base. The apex of the 
cone is then cut off to give an aperture 1 inch in diameter. FIELD SANITATION 
547 
On the basis of extensive tests, Dr. F. C. Bishopp, principal entomologist in 
charge, division of insects affecting man and animals, Bureau of Entomology, 
U. S. Department of Agriculture, reports that this trap is best for effective 
trapping, durability, ease of construction and repair, and cheapness of 
construction. 
Flies gaining access to kitchens and mess halls should be killed by swatting 
with fly swatters. Fly swatters consist of a piece of wire mesh, leather or 
rubber tacked to a long handle. 
When rubber or leather is used 
it should be well perforated. The 
free edges of the wire mesh may be 
covered with leather if so desired. 
Care should be exercised not to 
swat and crush flies on mess tables, 
serving tables, butcher’s blocks, or 
on any surface on which food is 
likely to be placed. 
Flies and other insects are some- 
times destroyed by electrocution. 
To do this copper wires are inter- 
woven alternately across an insu- 
lated framework and spaced one- 
fourth of an inch apart on screen 
doors. 
The screens are supplied with a 
high tension static charge of elec- 
tricity from a small transformer, 
which produces a charge of ap- 
proximately 3,500 volts and less 
than 0.05 millampere. 
These doors are said to have killed as many as 15,000 flies on a summer day. 
Mosquitoes. 
Different measures are undertaken in the field to combat the activities of 
the mosquito in the transmission of disease. 
Medicinal prophylaxis.—It appears to be the generally accepted opinion that 
the routine internal administration of quinine as a prophylaxis against malaria 
is of questionable value, but the treatment of malarial carriers with quinine, 
plasmochin or atabrine (atebrin) is an important factor in the prevention of the 
dissemination of this disease. 
Personal protection.—Screening of living quarters in permanent camps may 
be utilized by using mesh screen having 16 meshes to the inch for anopheles—18 
meshes to the inch must be used when screening against Aedes mosquitoes. 
The female mosquito, which is nocturnal in its feeding, transmits the malarial 
germ, consequently sleeping nets are the chief means of reducing the possibility 
of the transmission of this disease to troops on field duty. This article of 
equipment is supplied by the United States Marine Corps to every individual 
of an expeditionary force. If the circumstances warrant, all sentinels should 
wear head nets and gloves after sunset. 
Culifuges.—Kerosene is extensively used in some of the tropical countries 
as a repellent to mosquitoes, and some of the essentia] oils, such as oil of 
citronella, have been used. (One part, of citronella to 4 parts of vaseline.) 
These oils have little practical value in the field as their effect will not last 
through one night. 
Figure 141.—Conical hoop fly trap. (Bishopp.) 548 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
A very good insect repellent consists of: 
Oleum anisi 2 drops. 
Oleum eucalypti Do. 
Oleum terebinthinse Do. 
Lanolin 1 ounce. 
Light shades of color, especially yellow, are repellent to Anopheles mosquitoes 
which select dark shades, especially navy blue. The Aedes mosquito prefers 
a dotted white surface. 
Mosquito destruction.—The adult mosquitoes may be killed by fumigation— 
burning 2 pounds of sulfur for each 1,000 cubic feet of space. 
Mosquitoes are infinitely more susceptible to the action of insecticide sprays 
than flies. The standard Navy issue insecticide is the best spray for this 
purpose and should be carried in stock by the supply officer or quartermaster. 
Mim’s culicide consists of equal parts (by weight) of phenol (carbolic acid) 
crystals and gum camphor. The phenol is slowly melted and then poured over 
the camphor, thus forming a clear volatile liquid. Volatilize 3 ounces of this 
mixture for every 1,000 cubic feet of space. 
The following formula has been reported as an excellent insecticide spray: 
Parts 
Carbon tetrachloride 1 
Oil of wintergreen (synthetic) ' 2 
Kerosene 97 
Naphthalene—Vi pound added to each gallon of mixture. 
Mosquito traps and swatters are sometimes used for the destruction of adult 
mosquitoes. Destruction of wintering adults is said to be very effective in 
reducing malaria. 
Destruction of mosquitoes in developmental stage.—Mosquito-breeding areas 
may be controlled by oiling, and crude petroleum is the oil usually selected. 
When the mosquito larvae, commonly called wiggle-tails, come to the surface 
for air the oil clogs their breathing apparatus and kills them by asphyxiation. 
About one-half ounce of oil suffices for every square yard of water surface 
under normal conditions, i. e., small areas where the wind does not blow the 
oil aside. The application of this amount of oil once a week is sufficiently 
frequent to destroy each crop of larvae. It requires 10 or more days for the 
cycle—from the egg to the adult mosquito. For ornamental fish and lily ponds 
use gasoline, one-half gallon to each 100 square feet. 
There are several different methods for oil distribution upon water surfaces. 
The “knapsack sprayer” is a well known means of oil distribution, and is 
often utilized. 
The “Panama dripper” consists of an oilcan with a faucet near the bottom 
which allows the oil to fall on the water, drop by drop (usually at the rate 
of about 30 drops per minute), and furnishes a means of continuous oiling of 
a running stream. 
The “submersible oil bubbler” devised at Quantico, acts similarly to the 
“dripper” except that the device is completely submerged and the oil comes from 
below upward. The advantage of this method is that the device is less apt to 
be interfered with by unauthorized persons and the flow of oil tends to be 
more uniform and less affected by a change in temperature. These cans are 
removed and refilled once a week. The container is filled with oil and sunk 
in the stream of water. The oil, at the rate of 40 to 60 drops per minute, is 
released and comes to surface, forming a uniform film of oil to destroy the 
“wiggle-tails” of mosquitoes. (Fig. 142.) FIELD SANITATION 
549 
The “oilsoaked sawdust” method of petrolization (also originated at 
Quantico), affords a simple means of distributing oil over mosquito breeding 
areas. This method was worked out contemporaneously and independently by 
the United States Public Health Service. The oil-soaked sawdust is placed in 
a wire cage or in perforated boxes which are partially embedded in running 
streams. The cages were found to be effective without renewal of the oil for a 
period of from 2 to 3 weeks. 
Oil-soaked sawdust can be placed in paper bags, which are thrown into 
marshy vegetation. The bags rupture and liberate the sawdust, the particles 
of which give a widely 
distributed film of oil, 
scattered throughout the 
aquatic vegetation. 
Where there is dense 
surface vegetation, such 
as water lilies, the oil-im- 
pregnated sawdust may be 
thrown at random among 
the vegetation and float- 
age ; each individual par- 
ticle becomes a means of 
slowly liberating oil. 
The Panama larvicide 
consists of phenol (car- 
bolic acid), rosin, and 
caustic soda combined in 
such a manner that the 
product has approximately 
the same specific gravity 
as water. This larvicide 
has the advantage over 
oiling inasmuch as it kills 
the larvae of one species, 
Mansonia titilans, which 
does not come to the sur- 
face of the water but gets 
its air from the roots of water plants. One part of this preparation to 5,000 
parts of water will kill larvae. 
Other chemicals, some of which are byproducts in the manufacture of gun- 
powder, have been employed as larvicides. Arsenic dusting by hand, or air- 
plane, is a more recent development. 
Drainage and filling.—Where the mosquito-breeding area is below sea level 
and cannot be drained, it may be flooded with salt water to prevent breeding. 
In other undrainable areas deep canalization may be used to reduce the water 
surface to a minimum, which may then be easily controlled by oiling. 
Small swamps and marshes may be filled with dirt, ashes and debris. 
A comparatively small amount of stagnant water will furnish sufficient breed- 
ing area to infest a small camp with mosquitoes. 
A camp located about a mile from mosquito-breeding areas is considered fairly 
safe from Anopheles. In the selection of a camp site one should endeavor to 
avoid the proximity of habitations, as these dwellings are apt to harbor mosqui- 
toes and human malaria carriers. 
Figure 142.—Quantico type of submersible oil bubbler. 550 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
All tin cans, broken bottles, and other receptacles which will retain water 
should be immediately disposed of to prevent their use as breeding places, and 
rain barrels and fire barrels should be checked constantly for wiggle-tails. Even 
the foot prints of horses and men have been found to contain wiggle-tails in 
regions where water does not evaporate quickly after a rain. 
Biological barriers.—It has been demonstrated that Anopheles mosquitoes do 
not travel far from breeding places if a food supply is close by, which fact may be 
taken advantage of in the use of “biological barriers.” By establishing the 
corral and stables between the camp site and mosquito-breeding areas the animals 
provide a source of food for the mosquitoes whose flight in search of food is 
thereby stopped and the animals act as biological barriers. 
Mosquito control by airplane dusting.—This method is advisable when mos- 
quito breeding in large areas of swamps and low, marshy ground must be pre- 
vented. The larvicidal mixture commonly used in this way consists of 1 part 
of Paris green and 4 parts of powdered soap-stone, the mixture being dusted 
in the proportion of 5 pounds to the acre. 
Lice. 
Various methods are employed for delousing purposes. “N. C. I.” powder, 
which is considered very efficient in the destruction of lice, consists of the 
following: Naphthalene, 96 parts; cresosote, 2 parts; iodoform, 2 parts. 
This powder is dusted inside of wearing apparel, care being taken to avoid 
the forks of trousers, as this preparation, if used too freely, is an irritant to 
the perineal region and may cause a dermatitis. After the use of this mixture 
the soldier should wrap himself up in a blanket in order to retain the fumes 
which are generated. 
“Vermijelli” is less irritating than N. C. I. powder, and is composed of the 
following ingredients: Crude mineral oil, 9 parts; soft soap, 5 parts; water, 
1 part. This preparation will kill adult lice but has no effect on the eggs. 
Clothing may be deloused by immersion in kerosene or gasoline. 
Ironing of clothes will kill both the adults and the eggs; steam heat will ac- 
complish the same purpose. The “Serbian barrel” and the “sack disinfestor” are 
two simple methods of using steam heat in the field. 
The Serbian-barrel disinfestor consists of a barrel with a perforated bottom 
and a tightly fitting removable cover which is weighted down with stones. 
The barrel is placed over a tank of boiling water; the steam generated from 
the boiling water flows under pressure into the barrel. The water must be kept 
boiling at all times while this barrel is in use. 
Clothes and other articles may be disinfested by these means. The sack 
disinfestor depends on the principle that steam entering the upper portion 
of the inverted bag displaces the air in its course downward and produces 
an extra atmospheric pressure (about 15 pounds per square inch) which pres- 
sure in turn raises the temperature of the interior of the sack to 107° C. 
The sack disinfestor is useful for disinfection and disinfestation. 
For the destruction of the head louse, acetic acid in 10-per cent solution is 
applied. Equal parts of kerosene and olive oil are sometimes employed in place 
of the acetic acid solution. The hair should be combed with a fine-tooth comb. 
The methods for the destruction of pubic lice are well known and will not be 
considered here. 
Bedbugs. 
There are two species of bedbugs, namely, the Cimex lectularius (Acanthia 
lectulai'ius) and the Cimex rotundata, the former being the common bedbug FIELD SANITATION 
551 
found in the northern climates while the latter is found in the tropical regions. 
The eradication of this parasite, especially in the tropical regions, is a very 
difficult problem. 
Fumigation provides very effective extermination. It is a method to be 
employed primarily in sealed spaces. Carboxide gas is highly recommended. 
Hydrocyanic-acid gas is equally efficient but should he employed only by 
personnel skilled in its use. 
The blow-torch is effective when applied to the cracks of metal beds. 
Kerosene, gasoline, and other chemical insecticides may be poured into 
crevices to exterminate this pest. 
Heating rooms and even entire buildings to a temperature of 120° to 125° F. 
for several hours will completely eliminate bedbug infestations. Superheating 
has been resorted to repeatedly with success during hot summer weather when 
advantage can be taken of the normally prevailing high temperatures. In sum- 
mer, most home heating equipment is sufficient to raise the temperature of in- 
fested rooms to 120° to 125° F., if not higher, without harm to the furnishings. 
It is well to place thermometers in various parts of the room or rooms in order 
to note the temperature obtained. The temperature in the cracks where the 
bugs are secreted must be held as high as 120° F. for several hours. In loosely 
constructed frame buildings it may not be possible to secure a killing 
temperature at points close to wall spaces. 
Cockroaches. 
There are four domesticated species of this family, namely, the Oriental, 
German, American, and Australian. 
Sodium fluoride blown in corners and crevices is a standard poison for this 
pest. The roaches walk through the powder, some of which adheres to their 
legs, and are killed by the sodium fluoride when it gets into their mouths, as 
they clean their legs with their mouths. The use of sodium fluoride is not 
without danger around a mess hall as it may be mistaken for sodium bicar- 
bonate, baking soda or powdered sugar. Roaches may carry it to food. It is 
highly toxic to humans. 
Another cockroach poison consists of dry plaster of Paris, 1 part, flour, 3 
parts. When using the above mixture a dish containing water should be close 
by. The insect, after feeding upon this preparation, becomes thirsty and seeks 
water which sets the plaster of Paris and kills by clogging the intestine. 
Pyrethrum is extensively used as an insecticide for the extermination of cock- 
roaches and other insects. It is incorporated in the Navy issue liquid insecti- 
cide. 
Fleas. 
Pyrethrum powder is effective for removing fleas from the body. 
Iodoform and oil of pennyroyal act as repellents. 
An emulsion of 5 per cent cresol, with or without soft soap solution (20 per 
cent), gives excellent results. 
Sprinkling a flea-infested floor with flaked naphthalene and closing the room 
for 24 hours is very effective. A solution of naphthalene in gasoline should be 
poured into all holes—such as mouse holes—in the treatment of plague-infested 
houses. 552 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVA 
Military value of marching. 
The ability to march has always been—and the results of the World War 
tend to show that this is still true—one of the determining factors of victory. 
The superiority in marching ability of troops enables the responsible comman- 
der to secure the preponderance of men at the critical time and place. Infan- 
try, in spite of the rapid development of other branches of the military service, 
is still the dominant arm. To be able to endure long marching requires careful 
training and attention to a host of trivial details. 
According to the Field Service Regulations, United States Army, “Good 
marching is secured by careful preparation, strict discipline, and observance 
of march sanitation.” 
Physics and physiology of the march. 
Physics of the march—A soldier weighing 160 pounds, carrying 40 pounds, 
and walking 15 miles at the rate of 3 miles per hour on a level surface will 
perform an amount of work equivalent to 353.57 foot-tons. 
According to Haughton, as quoted by Harrington, this labor, in walking over 
a level surface, is determined by the following formula: 
HYGIENE AND SANITATION OF THE MARCH 
(160a+406) X 79,200c 
2j240dX20e =353'57 foot-tons- 
Key: a=weight of person; 6=weight carried; c=distance walked in feet; 
d=pounds in long ton ; e=coefficient of traction. 
The coefficient of traction varies for different rates of speed, with the char- 
acter of the terrain, and wind effect. For 2, 3, 4, and 5 miles per hour, on a 
level surface, it is approximately 1/26, 1/20, 1/16, and 1/14, respectively. 
Physiology of the march.—Compared to the steam engine the human mecha- 
nism is a bit more efficient, as the engine is capable of utilizing only 13 per 
cent of the energy from its fuel for useful work while the human body is 
able to utilize 20 per cent of the energy value of its diet; the 80 per cent balance 
goes in the production of heat which must be dissipated in order to keep the 
body temperature constant. 
The unit of energy is the calorie which has been previously explained. 
A soldier at rest requires 3,000 calories per day, of which one-fifth (600 
calories) actually goes into work, and four-fifths (2,400 calories) is dissipated 
as heat. 
The evaporation of perspiration acts in dissipating heat of the body similar 
to the radiator of the automobile in maintaining the motor near a constant 
temperature. 
The evaporation of 1 cc of water reqinres 0.5 calorie, consequently the 
evaporation of a quart of water—(Imperial measure, 1 quart = 1,182.52 cc) — 
from the body’s surface will dissipate 600 calories of heat. 
To produce 350 foot-tons of work, such as in the example of the marching 
soldier, would require the expenditure of 254 calories as muscular energy. 
Since the body is only 20 per cent efficient the total expenditure of energy to 
produce this work would be 1,270 calories, of which 1,016 calories are dissipated 
as heat. The soldier normally expends 1,000 calories in 8 hours. Therefore, 
the total caloric need of the soldier during the 8-hour march is 2,270 calories, 
of which 1,816 calories must be dissipated as heat. 
Of the 1,816 calories, 30 per cent is disposed of by radiation, conduction, and 
convection, while the remaining 70 per cent of the 1,816 calories (equal to nearly 
1,300 calories) must be disposed of by evaporation of fluids. As the evapo- 553 
FIELD SANITATION 
ration of 1 quart of water takes 600 calories, then the total water which must 
be lost in this 8-hour march is approximately 2 quarts, provided the entire 
amount evaporates on the body surface. 
Effects of water loss: 
Miles 
marched 
Quarts 
perspired 
Soldier’s condition if 
water is not replaced 
Miles 
marched 
Quarts 
perspired 
Soldier’s condition if 
water is not replaced 
7 VS 
1 
30 ... . 
4 
Danger. 
Death. 
15 
2 
Thirst of necessity. 
Marked inefficiency. 
45 
6 
22 
3 
The physiology of perspiration is vitally connected with heat stroke and 
heat exhaustion with result from failure to dissipate the excess body 
heat. As body heat increases due to increasing labor or to increasing ac- 
cumulation from the environment, a fireroom for example, the function of 
perspiration becomes of greater importance in keeping body temperature 
normal. Men should be thoroughly indoctrinated in a few simple facts: 
1. Perspiration lowers body temperature only when it evaporates from the 
surface of the body. Evaporation is retarded when the air is still and has 
a high degree of humidity. Light, loosely worn clothing promotes evapora- 
tion by retaining perspiration on the body surface. Water of perspiration 
that runs off the body or is wiped off represents a loss and the amount of 
this loss should be added to the second column of the accompanying table. 
2. The body has a comparatively small reserve supply of water and when 
this reserve is exhausted the body ceases to perspire. As this is the major 
factor that keeps the body heat normal, heat stroke or heat exhaustion follows. 
Therefore, water loss should be promptly replaced. 
3. Furthermore, ordinary table salt is an essential factor in control of 
body temperature. The body can neither absorb nor perspire salt-free water. 
The reserve stock of this salt is limited. When this reserve is exhausted 
the body will cease to perspire even if the supply of water in the body 
is ample and it will not absorb water from the intestinal tract even though 
large quantities are drunk and there is great need for water. This con- 
dition of insatiable thirst and diarrhoea can be corrected by adding salt 
to the water. Prophylactic treatment consists of supplying salt to men 
perspiring excessively. 
Preparation for the march. 
It is remarkable to note what improvement in marching ability can be 
effected in a few weeks of graduated exercise and muscular training. One 
investigator conducted a series of experiments on an untrained man marching 
a certain distance in a given time with the following results: 
Untrained 
After 3 weeks’ 
soldier 
training 
Increase in pulse beats-- 
72 
28 
Increase in temperature, °F . - . 
2.2 
0.6 
Loss of weight --. pounds.- 
2H 
2 H 
Men should be trained in marching by increasing the length of the hike 
and the weight of the pack. They should be so trained for several months. 
This training means the development of all muscles in the body—an increase 554 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
of capacity of the lungs and heart, also strengthening of the foot arches, and 
the like. It is at this time that the medical officer should keep close super- 
vision over the men. Overtraining defeats the purpose and leads to cardiac 
dilatation and eventually to exhaustion. 
Men under training should be given periods of mental and physical relax- 
ation and recuperation. It is remarkable how quickly the human mechanism 
develops with progressive and systematic exercises. The raw recruit under 
proper supervision shows rapid development within a few weeks of training. 
The men should be trained to breathe through the nostrils, as in this way 
dust and other foreign bodies are removed from the air before it reaches 
the lungs, and the air is warmed. Mouth breathing tends to dry the mouth 
and thus increase the sensation of thirst. 
A person marching at the rate of 4 miles per hour inhales five times as much 
air as when reclining. 
Conduct of the march. 
The most suitable time to start a day’s march is 1 hour after the break 
of day. Night marching should be practiced only when military necessity 
demands, and then should begin soon after sunset. 
The canteens should be filled preferably the night before the march. The 
sick and the physically unfit should be eliminated at the morning sick call. 
By all means avoid premature assembly of the men—get them “under way” as 
soon as practicable after “falling in.” A light breakfast should be served. 
The sanitary officer, with a police detail, remains for a few minutes after 
the camp is cleared to see that all waste and litter are disposed of, latrines 
filled in and labeled, and that the camp site is otherwise left in a clean and 
sanitary condition. 
Rate of march.—The human mechanism—similar to the automobile motor— 
must be warmed up before it can function at its best in marching. 
The physiologically best temperature for the body in marching is 100.5° F. 
and 102° F. is the maximum temperature before serious symptoms become 
noticeable, such as swaying, tremor, nervousness, etc. Thus there is only 1.5 
degrees range between the optimum body temperature and danger body tem- 
perature “and this narrow safety margin indicates alike the delicacy of the 
adjustment mechanism and the importance of every means of aiding that 
adjustment.” 
A horseman always starts his horse off slowly, and the end of the ride 
is made at a slow pace. Likewise the infantry leader should start his men off 
slowly so as to warm up, and the last few minutes should be at a slow pace for 
the men to cool off. Always avoid the tendency to the final spurt in nearing 
evening camp. 
The ordinary Marine Corps shirt holds a pint of perspiration, when satur- 
ated, this is equivalent to 300 calories, which energy can be conserved by the 
simple expedient of slow marching at the end of the day. This permits the 
moisture to be evaporated on the body during the marching period when the 
cooling effect serves a useful purpose. The march should be completed with 
a nearly dry shirt to prevent a harmful chilling effect during the following 
rest and recovery period. 
The rate for infantry is 100 yards per minute. To maintain this speed, one 
hundred and twenty 30-inch steps are required, which gives an actual rate of 
3.46 miles per hour (exclusive of rest periods). This may be regarded as the 555 
FIELD SANITATION 
most economical speed for experienced troops. For unseasoned troops and for 
longer hikes, the economical speed is a slower cadence. 
With a speed of 3.46 miles per hour for the day’s march, if the rest periods 
are included, from start to end of the march an average of 2y2 miles per hour 
is considered the maximum expected of foot troops. 
Double time is a 36-inch step at the rate of 180 steps per minute, and should 
never be used in routine marching. 
In route step, there is no standard stride or cadence, and the men are out of 
step, which is often a restful variation. 
The marching column varies with route step, marching in time, and marching 
to music or singing. 
Mechanics of marching.—Mathematical calculations show that in marching 
the best mechanical advantage is obtained by a stride the length of which is 
six-sevenths the length of the leg. The stride is a pendulum motion. 
The correct position for head and limbs in marching corresponds to the 
attitude one assumes when about to ascend a flight of stairs. 
The proper load for an infantryman should not exceed one-third of the body 
weight, or 50 pounds for a 150-pound man. The maximum is 45 per cent of 
body weight or 67 pounds for the average man, and any increase above this 
67 pounds causes expenditure of energy to be increased three times as rapidly 
as the weight of the load. 
The load should be adjusted near the center of gravity of the body, i. e., in 
the erect position 0.6 cm in front of the line connecting the femoral heads and 
opposite the center of the third lumbar vertebra. 
The chest or abdomen should not be constricted by the load and the load 
should be borne by the shoulders and back. 
March formation.—If there is much traffic on the road the marching column 
should keep to the right and proceed in squad formation. If circumstances 
permit, it is much better to march in open ranks, half on each side of the 
road, which order tends to decrease the heavy oppressive cloud of dust, foul 
odor, and water vapor from perspiration which tend to hang over close-order 
formation. 
The taller men at the head of the column are apt to set a pace uncomfortable 
to the shorter men marching in the rear of the column, and it is also easier 
marching at the head than in the rear, consequently the column should be 
reversed from time to time. The rear files as a rule expend about 6 per cent 
more energy than those at the head. 
Halts.—The first halt should be after 30 minutes of hiking, and should be 
for a period of 12 minutes. The object of the first halt is to permit the men 
to get their “second wind,” adjust shoe laces, rearrange packs, and to attend 
to the calls of nature. The succeeding halts are made every 50 minutes and 
are for a period of 10 minutes rest, except for the halt for the noon meal, 
which is for 1 hour. 
During the rest periods the men should remove their packs and lie upon 
their backs. Their coats should be replaced and unbuttoned to avoid undue 
exposure to drafts and winds. An endeavor should be made to halt in cool, 
shady places, protected from strong winds. A place should be provided for 
the men to attend to the calls of nature during the rest periods—shallow 
trenches dug with a bayonet or sharp stick will suffice for this purpose. 
Endeavor to select locations for halts that have the following character- 
istics : Clean and dry; sheltered from the sun; and privacy. 
154294°—39—36 556 
HANDBOOK OF THE HOSPITAL CORPS, XI. S. NAVY 
If practicable avoid baiting the column in towns, villages, or near habitations. 
Massage and kneading of the muscles of the legs during halts helps free them of 
accumulated waste products and prevent stiffness. 
In difficult and mountainous country the halt periods should be more frequent. 
The order should be given to “remove packs” within 30 seconds after a halt— 
any unnecessary delay irks and irritates the marching organization. 
Length of march.—The length of the day’s march is not measured by miles, 
but according to the condition of the roads, the weather, the pace, the weight 
of the loads, experience and physical condition of the troops, etc. 
Miles 
per day 
Average for large body of infantry 12 
Average for small body of infantry 15 
Any distance beyond the above is regarded as a forced march. 
Wagon trains march about as rapidly as foot troops. 
Artillery covers 15 to 20 miles per day. 
Morale.—A fatigued body causes a hypersensitive state of mind, which is more 
susceptible to real or imaginary adverse stimuli. To inhibit the action of these 
stimuli calls for resourcefulness and leadership in company officers. One com- 
pany under proper leadership will arrive in the evening camp, tired, but happy, 
whereas another company, not so fortunate in the selection of company officers, 
is apt to come into camp tired and dissatisfied. 
Singing and whistling of popular tunes should be encouraged, as this distracts 
the minds of the men from their fatigued state, and is one of the surest means 
of preventing them from succumbing to exhaustion. 
Straggling, either from poor discipline or fatigue, is always to be avoided, 
as it is depressing to the morale of the entire body of troops. 
Night marching.—Marching at night should be permitted only for strong tac- 
tical reasons, as marching at this time interferes with the sleep routine; in 
the darkness men cannot be sure of their footing and accidents may occur. 
Marching in the tropics.—In warm countries the march should be started 
earlier, shortly after daybreak, if practicable. Marching in the middle of the 
day should be avoided by a midday rest period of 2 to 3 hours. 
Green leaves or a wet handkerchief in the hat serve to protect the head and 
neck from the sun’s rays. 
It is particularly necessary to open up shirt fronts and roll up the sleeves. 
Tests with a dry and wet bulb reading 79° F. and 67° F. were conducted on an 
organization hiking 7 miles and the men were found to lose an average of 3 
pints of water. But with shirts opened and sleeves rolled up the loss of fluid 
was reduced from 3 pints to 2 pints in marching the same distance under the 
same climatic conditions. 
In warm countries the loss of heat by radiation is generally very rapid after 
sunset, consequently a fall in body temperature and a chill results if the men 
are wet with perspiration and not given time to cool off gradually before halt- 
ing for the night. 
An endeavor should be made to detect early appearance of symptoms of heat 
stroke which frequently occurs during hot weather marches. 
The treatment is: 
1. Loosen all clothing. 
2. Remove patient to shade. 
3. Strip to waist. FIELD SANITATION 
557 
4. Fan patient. 
5. Apply ice bag or cold water freely to head, neck, and spine, and con- 
tinue until symptoms subside. 
6. Eestore body chlorides by administering salt. 
Water discipline on the march. 
In marching 1 mile a fully equipped soldier generates 90 calories which will 
require the evaporation of 180 cc of water to dissipate the heat. For 3 miles, 
or 1 hour of hiking, he will require 540 cc of water, which is a little over one 
pint (473 cc) and for 2 hours of hiking the soldier will lose 2 pints or the 
equivalent of one canteen of water. 
In interpretation of the above, it must be remembered that the water require- 
ments are based upon the climate of middle and western Europe. In a hotter 
and drier climate, a larger amount of water should be used. 
There are so many factors entering into the water requirements that any 
attempt to be dogmatic or standardize the fluid intake for the marching 
soldier is apt to result in more damage than good, if a standard is too rigidly 
adhered to. It is safe, however, to use the following as a guide, since the 
soldier starts the march with about 1 pint of extra fluid in his stomach: 
Drink 1 pint, half the contents of the canteen, for each hour of marching, 
including rest periods, the marcher to take the first drink at the end of the 
second hour after leaving camp. 
The following table shows how the water requirements of a man on a day’s 
march may be met: 
Start of 
march 
First 
hour 
Second 
hour 
Third hour 
Fourth and 
fifth hours 
Sixth 
hour 
Seventh 
hour 
Eighth 
hour 
Ninth hour 
Leave 
with 1 
pint in 
stomach. 
Drink Vi 
canteen- 
ful. 
Drink re- 
maining 
Vi canteen- 
ful. 
Noon rest. 
Refill can- 
teen. Leave 
with 1 pint 
in stomach. 
Drink H 
canteen- 
ful. 
Drink re- 
maining 
yi canteen- 
ful. 
Camp. Re- 
fill can- 
teen. 
As the hot climate of the tropics considerably increases the water demands 
of the infantryman, the above must be increased; hilly, muddy, and rough 
roads also increase water demands. 
The canteen should be used only during the rest period and then upon 
command. Water should be slowly sipped as thirst is quenched better. In 
addition to water consumed from] canteens, a pint or more is consumed with 
each meal. 
The experienced soldier has instinctively determined the proper amount 
of water which his system will require; it is the raw recruit who is apt 
to “water log” his tissues, sweat profusely, and tire easily. 
One type of thirst is due to dryness of the mouth, and to overcome this 
factor the men are advised to chew gum, or keep pebbles in their mouths, 
which promote the flow of saliva and tend to allay this form of thirst. 
Smoking on the march tends to increase thirst and should be limited to 
rest periods, or, as some authorities recommend, should be prohibited during the 
march. 
As a rule marching troops are accompanied by water carts containing 
potable water. It is most important that only pure water be used in the 
canteens, as the stomach of a marching soldier is apt to contain insufficient 
hydrochloric acid to destroy infective organisms. 558 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The water needs of officers are slightly less than those of men, because 
their equipment is lighter, and marching to one side requires less work 
than marching in ranks. 
Immediately after arriving in camp guards are posted over the water 
supply which is marked to show the use to be made of different portions 
of the running stream. A white flag indicates the portion farthest upstream to 
be used for drinking water; a blue flag, next downstream, the portion for water- 
ing animals; and a red flag, farthest downstream, the portion for bathing and 
washing clothes. 
Food on the march. 
A light breakfast consisting of oatmeal, tea or coffee, bread and jam, and 
perhaps some bacon to “stick to the ribs”, should be served before beginning 
a march. The food should be easily digestible. A heavy breakfast is inad- 
visable as digestion is interfered with by the vascular demands of muscles 
used in marching. 
Exhaustion retards digestion so that it is well to have a brief interval 
of rest just before the noon and evening meals. The noonday meal should also 
be light and digestible, and should be served during the noon rest period. 
Upon arrival in camp for the evening, serving soup ahead of the meal 
increases the digestive capacity 20 per cent, owing to the stimulation of the 
flow of gastric juices. The main meal should be the evening meal. 
Slowly-cooked stew increases the digestibility of proteins. 
Foods with high-vitamin content such as fruits, vegetables, or even canned 
tomatoes should be served, because the individual soldier in the field does 
not have the opportunity of supplementing his ration by outside purchases 
of food. 
In view of its rapidity of digestion and oxidation, sugar is the quickest re- 
storative of muscular energy. A marching man craves sweets, candies, jams, 
preserves, and sweetened coffee or tea. Chocolate or cocoa are excellent for 
restoring muscular tone. 
The following table furnishes data for use as a basis for calculating the 
food requirement of the marching man: 
Calories 
Foot tons 
of energy 
4.1 
6.3 
9.3 
14. 2 
4.1 
6.3 
When marching at the rate of 3 miles per hour the soldier does work the 
equivalent to raising one-twentieth part of the weight of the body through 
the distance he walked. 
Work in tons 
lifted 1 foot 
Marching 1 mile __ . _ . 
18. 86 
Marching 2 miles __ .. _ . ... ... 
37.72 
Marching 10 miles . 
188. 60 
Marching 20 miles 
377. 20 
If the soldier carries 60 pounds of equipment, the foot-tons are increased 
30 per cent. Carrying 60 pounds and marching 20 miles the soldier expends 
the equivalent to 518.60 foot-tons. FIELD SANITATION 
559 
Manifestly the caloric requirement of a soldier when marching is higher 
than when at rest. A diet of 4,000 to 6,000 calories should be planned, depend- 
ing on the length of the marches, rate, condition of road, terrain, weight of 
load carried, and other influencing factors. 
The use of tobacco and alcohol by marching troops has proponents and 
opponents. Smoking should be limited to rest periods. Alcoholic beverages 
should be restricted to the evening after arrival in camp and temperance must 
be enforced. 
March sanitation. 
Sanitary measures to be carried out while on a march are as follows : 
At the start.—1. Fill and chlorinate water carts; canteens should be filled 
the night before; 2. Police camp, extinguish camp fires; 3. Fill in, close, and 
mark latrines; 4. Sanitary officer and police detail remain and clear up waste 
and litter; and 5. Final inspection of camp site. 
At a halt.—1. Designate sanitary area; 2. Dig shallow pits for calls of 
nature, using bayonet or stick for digging implement; and 3. Refill canteens. 
Selection of camp site.—Toward the end of the day’s march a staff officer, 
a medical officer, and an engineer officer or a quartermaster should ride 
forward and select a camp site, unless this has been previously arranged. The 
functions of the medical officer are advisory in the final selection of the 
camp site. In time of war tactical consideration is of primary importance 
in the selection of a camp site. It is impracticable to locate an ideal camp 
site which will be entirely satisfactory from a medical viewpoint, hence the 
medical officer must consider the pros and cons of the available locations. 
Favorable consideration should be given the following characteristics: 
(a) Accessibility to a supply of good water, fuel, and forage. 
(b) Sandy loam or gravel soil. 
(c) Elevated site well drained, such as sloping plateau. 
(d) Shade trees as a protection from the sun’s rays in warm weather. 
(e) Hills and forests acting as windbreaks in cold weather. 
(f) Location large enough to accommodate the troops without crowding. 
(g) Grass-covered location. 
Unfavorable consideration should be given to: 
(a) Sites recently occupied by other troops, allowing 2 months’ vacancy 
before reuse as an arbitrary standard. 
(b) Dry bed of river, ravines, and base of hills if there is likelihood of 
rain. 
(c) Clay, alluvial, or dusty soil. 
(d) Proximity to marshes, swamps, and other mosquito-breeding areas. 
(e) Steep slopes. 
(r) Sites where the ground water is near the surface. 
(g) Proximity to native habitations especially in malarial regions. 
In camp.—1. Proper waste disposal; 2. Insect control; 3. Water inspection; 
4. Food inspection; 5. Care of the feet; 6. Do not keep troops waiting in ranks 
after arrival at destination; and 7. Water responsibility: Its purity—medical 
officer; quantity and delivery—engineer officer; procurement—quartermaster; 
and water guards and distribution—Unit commander. 
Always remember that today’s camp site may be tomorrow’s line of com- 
munication. 560 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
MEDICAL DEPARTMENT ON THE MARCH 
Before starting, the responsible surgeon should see that all sick and unfit are 
eliminated, that the camp site is left in a sanitary condition, that the quality 
of water in the canteens is satisfactory, and that foot disorders have been 
given the requisite attention. 
The brigade surgeon proceeds forward on the staff of the brigade commander. 
The regimental surgeon occupies a corresponding place in the regiment to that 
of the brigade surgeon, and the assistant regimental surgeon marches in the 
rear of the headquarters company. 
The battalion surgeon proceeds with the staff of the battalion commander, 
and the assistant battalion surgeon marches in the rear of the battalion. If 
there is only one surgeon assigned to a battalion, he should march in the rear 
of the unit. 
The junior medical officers marching in the rear should occasionally proceed 
up and down the marching column of their respective organizations to observe 
the condition of the troops. 
Soldiers suffering from the effects of fatigue may be dropped at the march 
collecting stations, ride in ambulances, or they may be allowed to proceed 
without their equipment—their equipment may be thrown upon one of the 
wagons of the train. All sick and injured patients should be properly tagged 
with the diagnosis tag and recorded. A compilation of these records is made 
at the end of the day’s march. 
The medical battalion proceeds in two groups—one, consisting of the mounted 
and foot group, marching in advance of the animal-drawn train, and the 
other, consisting of the motor-drawn group, proceeding at the head of the 
motorized train of the brigade. 
If the marching command is composed of a brigade or larger organization, it 
is advisable to establish march collecting stations every 3 miles. The personnel 
for these stations consists of two or more hospital corpsmen, who are equipped 
to give first-aid treatment to the sick, injured, and exhausted, and to retain 
the patients until they are picked up by the ambulances in the rear of the 
column. 
The hospital corpsmen detailed for the purpose of establishing march collect- 
ing stations should proceed with the head of the column or advance party and 
drop off every 3 miles to form collecting stations. They remain until the tail 
of the column has cleared their station, then fall in with the rear units. 
Toward the end of the day’s march the necessary sanitary personnel should 
join the advance guard to supervise water purification and make arrangements 
for sanitation before the main body arrives. 
Combatant units of advance guards, rear guards, and other security detach- 
ments are normally accompanied by their attached medical troops. 
In view of the fact that poison ivy is a source of danger to a marching 
command, detailed consideration is advisable. (See Contact Dermatitis, p. 481.) 
Ivy poisoning is a form of dermatitis venenata due to exposure to poison 
ivy (Rhus toxicodendron), and the excitant is an oily compound called toxico- 
dendrbl, belonging to the phenol group. As little of 0.001 mgm. of toxicodendrol 
may produce dermatitis. All parts of poison ivy contain the irritating principle, 
the leaf especially. 
Poison ivy grows as a woody vine, trailing shrub, or erect bush, growing in 
the woods or in the open, in moist or dry soil. It climbs trees and posts. 
The plant is recognized by its leaves which are divided into three leaflets, 
and by its white mistletoe berries, known as drupes; the latter remain on the FIELD SANITATION 
561 
plants into winter after the leaves have fallen. All of these plants do not 
bear the drupes and it must be recognized by the leaves. 
The leaves are from 1 to 4 inches long. The end leaflet of the triad has 
a longer stem than the two opposite leaflets, which, as the leaves are broad, 
though pointed, preserves the symmetry of the arrangement. 
The mature leaves are dark green on the upper surface and lighter under- 
neath. The crinkly young leaves are red when they first unfold, becoming 
green later. In autumn they turn to beautiful shades of scarlet and orange. 
The innocent sometimes pluck these leaves and to their sorrow bear them off. 
The old adage: “Leaflets three, let it be,” is a safe rule for those who are not 
familiar with poison ivy to follow. 
The period of incubation, after contact by the susceptible, is usually a few 
hours but may be delayed for days. Redness and erythema appear, usually 
first on the face and hands. Shortly, fine vesicles, clear and closely grouped, 
are observed in the thinner areas, such as the inner surface of the fingers. 
Other areas of the skin become affected, even those where there has been 
no direct contact. The eyelids and surrounding tissues are frequently greatly 
swollen. Probably by indirect contact the genitals become oedematous and 
the rash has a predilection for the looser and thinner skin. 
As the active agent is fat and alcohol soluble, the irritant may be largely 
removed if immediately after exposure the areas are washed with soap and 
water. Alcohol or ether, used on swabs, being careful to clean the irritated 
areas from the periphery towards the center, is a more effective measure. 
Two readily available agents are recommended for the treatment of the 
lesions. 
1. Potassium permanganate in a 5 per cent solution in water, applied locally 
by cotton swabs or cloths; frequent applications should be made, or if a dress- 
ing is used, frequent changes of the dressing. 
2. Chloride of iron, a 5 per cent solution in equal parts of alcohol and water 
can be used in the same way. 
THE FOOT 
Anatomy and physiology. 
The human foot is a specialized organ designed to promote terrestial locomo- 
tion of the individual by leverage action of the foot in lifting the body’s 
weight and it plays such a dominant role in marching that a brief descrip- 
tion is appropriate. 
Considered in its entirety, the human foot is indeed a very wonderful 
anatomic part of the individual. In the smallness of its size and weight, 
out of all proportion to the burden borne and carried, it constitutes a mobile, 
strong, flexible, and efficient member of the organism designed to bear weight 
forwards, backwards, and sideways without mishap. Encased in a cloth 
covering, the sock, and in a protective leather covering, the shoe, both con- 
comitants of an advancing and exacting civilization, this member, the most 
unintentionally neglected part of the body, is expected to do its full duty. 
The foot is composed of a nicely adjusted aggregation of 26 bones of 
various sizes and shapes, each, however, designed to perform a certain definite 
function. Seven of these are of a very irregular shape and are located in 
the hind part of the structure forming the heel and a portion of the so-called 
instep. The remaining 19, situated in the forepart of the foot, form a portion 
of and radiate fan-like from the instep. These extend forward and to the 
outer and inner sides, finally ending in the toes. These different bones are held 
together in a correct position by ligaments, tendons, and muscles; the ligamen- 562 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
tous support predominating in the posterior 7 bones which form the static 
portion of the foot, while muscular action predominates in the anterior 19 
bones which form the dynamic portion. (Fig. 143.) 
The posterior seven bones, forming a compact mass held by ligamentous 
attachments, move very slightly when a step is taken and serve to minimize 
the shock of impact and act as a recoil mechanism. On this mass—the static 
portion of the foot—in 
the shod man, all the 
weight of locomotion is 
first borne; first affect- 
ing the heel and center 
of the instep. 
As mentioned under 
the Mechanics of March- 
ing, the center of grav- 
ity of the body must be 
considered in the carry- 
ing of extra equipment. 
When the soldier is 
standing, stance, stable, 
or static equilibrium is 
involved as the center of 
gravity is directly above 
the feet which act as a 
support. 
When locomotion is 
started as in marching, 
dynamic equilibrium is 
brought into force by an 
active interplay between 
the organic energy of the soldier and the force of gravity. The feet function as 
a series of levers that act against the body’s center. In marching the body’s 
center is constantly being displaced forward and gravity thus assists the for- 
ward translational motion through its influence upon the imbalanced body 
weight. The walking man, so to speak, tends to fall forward at each step, 
until this action is interrupted temporarily and the body is balanced momentarily 
by one foot as a support. The marching soldier always has one foot on the 
ground. 
Man, more often than any other animal, in upright bipedism, makes better 
use of gravity as an auxiliary force in locomotion. 
Care of the feet. 
It is difficult to overemphasize the value of the proper care of the feet. 
It is said that during the first days of a campaign 10 to 25 per cent of the 
men are physically disabled from foot troubles. Of course the prevention of 
the foot injury while marching depends upon properly fitting shoes and socks. 
Shoes.—According to the Duke of Wellington, the three most important 
parts of a soldier’s equipment are a pair of good shoes, a second pair of 
good shoes, and a pair of half soles. 
A common mistake of the recruit is to call for the same size shoe worn in 
civil life. With the noticeable difference in the last of the military shoe, es- 
pecially its width, the man will receive a shoe perhaps three or four sizes too 
short, and in a few weeks will develop some form of sore feet. To obviate 
these common mistakes the feet must be measured by an officer, the man must 
Figdee 143.—Bones of the foot. FIELD SANITATION 
wear his full equipment to cause full expansion of the feet, and the inner 
surface of the shoe must he a quarter of an inch longer and wider than the 
foot. 
New shoes should not be worn on the march unless they have been broken 
in. An excellent method of adapting new shoes to the foot consists in the 
soldier standing in his shoes in 2 inches of water for 5 minutes. This makes 
the leather soft and pliable. The man then walks on level surface about 
an hour, and the pressure of the body weight causes the drying leather to 
conform to the shape of the feet. This scheme accomplishes in an hour 
what a week of ordinary “breaking in” can produce. 
Socks.—It is equally imperative to wear properly fitting socks, and the proper 
sizes to be worn with the required length of shoe are given in the sub-joined 
table. 
Light woolen socks in summer time, and heavy woolen ones in winter, are 
preferable over cotton fabric. 
Socks too large will form folds and thus cause pressure foot injuries and if 
too small tend to produce ingrowing toenails, hallux valgus, and clubbed toes. 
Turning socks wrong side outwards, and changing socks from one foot to 
another equalizes wear, and is conducive to comfort. Holes in socks are apt 
to cause blisters as the edges of the hole tend to curl and cause pressure 
damage upon the subjacent skin area. Avoid using darned socks. 
The life of a good light-wool sock is about 100 road miles, but if feet are wet 
the sock will wear through much sooner. 
Socks colored with aniline or other irritating dyes which wash out with 
perspiration should not be worn; gray or white being preferable. 
Ribbed socks are better than plain ones, as they are more elastic and fit the 
foot better. 
Shoe Size: 
Corresponding 
sock size 
5~5i/2 _ _ _ . 
10 
6-61/2-7 _ _ . 
IO1/2 
71/2-8-81/2 _ _ . 
11 
9-»%-10 _ _ 
11% 
101/2-11-111/2 _ . 
__ . 12 
12-121/2-13 _ . __ _ . _ 
12i/2 
_ 13 
15 _ _ _ _ __ . __ 
131/2 
Some soldiers grease their socks or rub the feet with candle, vaseline, or 
nnsalted pork, and thus lessen the friction between foot and sock. 
New socks should be washed and shrunk before use for marching purposes. 
Feet.—It is also essential to keep the feet clean, to prevent abrasions and 
infections. The feet must be washed daily at the end of the march, clean socks 
should replace the dirty ones, which should be washed and dried overnight. 
If water is not abundant the feet can be cleaned by wiping them, particularly 
the toes, with a wet cloth. The following routine upon arrival in camp is 
recommended: 
1. Remove shoes, clean, dry, and dub them. 
2. Wash feet in cold water to tone foot muscles. Foot inspection by company 
commanders. 
3. If feet are tender bathe in alcohol or 1 per cent formaldehyde solution, or 
2 per cent alcoholic solution of salicylic acid, or 1 per cent picric acid solution. 
4. Put on clean socks and shoes. 
5. Wash and knead soiled socks for use next day. 564 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
6. Trim toenails square, so as to prevent ingrowing toenails. Another 
method of prevention of ingrowing toenails consists of scraping the upper 
surface of the toenail in center. This causes the nail to be thinner in center 
and leads to eversion of the outer sides of the growing nail. This method 
is claimed to be an effective prophylaxis. 
Treatment of foot disorders.—Puncture blisters at dependent portions of 
base, using sterile needle, remove serum, and paint with tincture of iodine. 
Cover blister with adhesive tape with small hole in center to allow discharge 
to escape. 
For smelly feet (bromidrosis) use 2 per cent solution of formaldehyde or apply 
2 per cent salicylic acid ointment. 
An old custom of the soldier to lessen friction between socks and foot is 
to soap the inside of the sock; with the perspiration of the foot the soap 
becomes a lather which serves as a lubricant. Another means of minimizing 
the rubbing of the foot by the shoe is to wear 2 socks on each foot. 
In cold weather, when the feet perspire less, friction may be minimized by 
dusting foot powder inside the sock. This foot powder consists of: 
Parts 
Talcum (Magnesium silicate) 87 
Boric acid 10 
Salicylic acid 3 
Chafing between the toes is cured easily by cleanliness, a small wedge of 
cotton separating the toes, and the application of the foot powder. Corns 
are treated by salicylic acid collodion or ointment applied nightly after a hot 
foot bath; usually after four or six applications the corn easily can be removed 
with curved scissors. Corn collodion consists of: 
Salicylic acid grains— 60 
Extract of Cannabis indica do 8 
Flexible collodion ounce— 1 
To preserve this mixture a small amount of alcohol may be added. 
Corn salve consists of: 
Parts 
Salicylic acid 40 
Vaseline 30 
Lanolin 30 
In some experienced organizations, sore feet are reckoned as a military 
offense both for the individual and for his company commander. Careful 
attention to the feet of marching men is as important as the attention bestowed 
on the rifle, and many foot troubles can be eliminated by the rules described. 
Field Sanitation.—Mann, in U. S. Naval Medical Bulletin, vol. XXXVI, no. 3, July, 1938. 
Hospital Corps Handbook, U. S. Navy, 1923. 
References 
Section 7.—DUTY WITH MARINE CORPS EXPEDITIONARY 
FORCES 
The hospital corpsman serving with Marines has many and varied duties. 
He becomes primarily a soldier and may be detailed with the medical detach- 
ment of the combat units; as a nurse in the hospital section of the medical 
eompany; a clerk in the headquarters section; or as a litter bearer in the MARINE CORPS EXPEDITIONARY FORCES 
565 
collecting section. He must be physically robust and capable of quickly 
adapting himself to all the conditions of a soldier’s life. 
The act of August 29, 1916, provides, in part, as follows: “Officers and 
enlisted men of the Medical Department of the Navy, serving with a body of 
Marines detached for service with the Army in accordance with the provisions 
of section sixteen hundred and twenty-one of the Revised Statutes, shall, while 
so serving, be subject to the rules and articles of war prescribed for the gov- 
ernment of the Army in the same manner as the officers and men of the 
Marine Corps while so serving.” 
The responsibility and functions of the medical department with Marines 
may be summarized as: The conservation of the fighting strength of the force. 
This is accomplished by: 
(а) Supervision of sanitation and hygiene. 
(б) Prevention of epidemics. 
(c) Management of epidemics when they occur. 
(d) Collection, evacuation, and hospitalization of the sick, injured, and 
wounded. 
(e) Prompt return of sick and wounded to their organization, and elim- 
ination of the permanently unfit. 
(f) Procurement, storage, and distribution of medical supplies. 
The medical department of a Marine Corps post is organized as follows: 
1. An administrative headquarters, or post surgeon’s office with the follow- 
ing duties: 
(a) Coordination of all the medical activities. 
(&) Preparation and forwarding of all medical department reports and 
returns. 
(c) Preservation of medical department files. 
(d) Procurement, stowage, and issue of medical supplies. 
The post surgeon is the advisor to the commanding general on all matters 
pertaining to sanitation and the health of the post. 
2. The sanitary inspector has the following duties: 
(A) Supervision of the sanitation of the post. 
(B) Preparation of data and charts relative to— 
(а) Sick rate. 
(б) Incidence of venereal disease. 
(c) Epidemics. 
(d) Sanitary work contemplated or undertaken. 
(e) Disease carriers. 
if) Food. 
(g) Water. 
(h) Epidemiology. 
(0) Maintenance of contact with local civil health authorities. 
3. Dispensaries maintained in each brigade area with a medical officer in 
charge who keeps health records of brigade personnel; provides temporary 
care of the sick and Injured; instructs his subordinates in first aid; advises 
the brigade commander on matters affecting the health of the organization and 
instructs the brigade personnel in personal hygiene and first aid. 
4. A sick quarters maintained to furnish hospital treatment for the sick and 
injured and similar to a naval hospital in organization. 566 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
THE FLEET MARINE FORCE 
The Fleet Marine Force is a highly mobile body of troops composed of infan- 
try, artillery, engineers, and aviation groups, created for employment as a 
component unit of the United States Fleet and kept in the same state of readi- 
ness as the other units of the fleet. This force is divided into two brigades. 
The first is stationed at Quantico, Ya., and the second at San Diego, Calif. 
For purposes of training it operates directly under the Commander-in-Chief, 
U. S. Fleet and accompanies the fleet on the annual fleet problems. It consti- 
tutes the force which is ready at all times to go on expeditionary duty. The 
organization and functions of the medical department of the force on expedi- 
tionary duty are outlined briefly in the following paragraphs. 
ORGANIZATION OF MEDICAL DEPARTMENT WITH A MARINE EXPEDI- 
TIONARY FORCE OF ABOUT THE STRENGTH OF ONE INFANTRY 
BRIGADE WITH ATTACHED ARTILLERY, ENGINEER, AIR SERVICE, 
AND OTHER SPECIAL TROOPS 
The whole medical department is under the control of the force surgeon who 
is responsible for the sanitation of the occupied area; the collection, evacuation, 
and hospitalization of all sick and wounded; preparation of reports, records, 
and returns; procurement, storage, and distribution of medical and surgical 
stores; training and coordination of all the medical units of the force. 
For convenience the organization may be shown by briefly considering the 
various medical units from the front to the rear beginning with that of the 
infantry regiment (fig. 144). 
The medical section of an infantry regiment is composed of a regimental 
surgeon, assistant regimental surgeon, dental officer, and 9 hospital corpsmen. 
For each of the 3 battalions of the infantry regiment there is a medical section 
composed of 2 medical officers and 16 hospital corpsmen. The hospital corps- 
men of each battalion may be assigned duties as company-aid men, litter bearers, 
or aid-station men. 
In combat the regimental medical section is concerned with furnishing medical 
supplies to the battalions, reports and returns, sanitation of the area and 
coordination of the evacuation of wounded and sick from the regimental area. 
Regimental aid stations are not established unless the regiment is acting inde- 
pendently or the military situation requires their participation. 
The battalion medical section furnishes first aid to and transportation to aid 
stations for the wounded, and provides for their temporary care until they 
can be evacuated. With this object in view, aid stations usually are estab- 
lished behind each battalion. The hospital corpsmen serving as company-aid 
men go forward with their companies and apply first-aid dressings to the 
wounded. If the whole force is advancing rapidly, the aid stations are not 
established until the situation becomes somewhat more stationary, and the 
wounded who have been given first aid are left in groups to be evacuated by 
other medical units following. 
After the company-aid man has completed his initial task of applying first 
aid, he directs the slightly wounded to the aid stations and the litter bearers 
transport the nonambulant cases. 
At the aid stations they are given supplementary first aid, haemorrhage is 
controlled, shock is combated, pain is relieved, tetanus antitoxin administered, 
fractures are immobilized with field splints, slightly wounded are treated and 
returned to their units at the front while those requiring evacuation are sorted, 567 
MARINE CORPS EXPEDITIONARY FORCES 
tagged, and recorded. Wounded able to walk are directed to the collecting 
station, others are carried thereto by litter bearers from the rear. 
The aid stations are established as close to the front as the situation permits, 
taking advantage of any available shelter from rifle and artillery fire, such as 
dugouts, ravines, and deserted cellars. These places of course should be avoided 
in the presence of enemy gas. 
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Figure 144.—Organization of medical department for one brigade, Fleet Marine Force. 
As the functions of the battalion-aid station require it to keep close contact 
with its battalion it must keep as clear of wounded as possible at all times. 
During combat the battalion-medical section covers the whole area occupied 
by its organization, from the aid station forward to the battle line. It is 
essential that all its activities be confined to this area and that its efforts be 
coordinated by the regimental surgeon, who is informed from time to time by 
runners or other means of communication from the battalion-aid station, of 
any change in their location. The battalion surgeon keeps contact with the 
medical units in his rear by means of a contact agent from the collecting station, 
who directs the litter bearers forward to the aid station. Routes to aid stations 
may be shown by some means such as hanging pieces of bandage at intervals 568 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
along the route. Their location should be shown to those in the rear by indi- 
cating their map position. 
Dispensary service is established in the regiment when not in combat. 
The regimental and battalion medical sections are called attached medical 
troops because each section is part of the headquarters company of its respective 
organization. 
jL/A/£T 
Figure 145.—Schematic distribution of medical department units with a Marine brigade. 
Fleet Marine Force, in a landing operation. 
Behind the attached medical troops is the medical company. 
There are four medical companies attached to each brigade (fig. 145). A 
medical company consists of a headquarters section, a collecting section, a hos- 
pital section, and a service section. It is a highly mobile unit whose chief 
functions are the collection of the wounded and sick from the battalion-aid sta- 
tions and the further evacuation of these casualties to a hospital ship or evac- 
uation hospital. Temporary hospitalization is provided as required by the in- 
dividual case and by the military situation. Secondary functions are the keep- 569 
MARINE CORPS EXPEDITIONARY FORCES 
iug of records and the requisitioning of medical and quartermaster supplies and 
the distribution of the same. 
The headquarters section is divided into staff (administration, personnel, and 
records) and medical supply (materiel and storeroom). The service section 
consists of mechanics, electricians, cooks, supply and commissary personnel, and 
drivers for the ambulances and trucks of the company. Storage, lighting, and 
water trailers complete the rolling equipment of the company. 
The medical company forms the relay for evacuation of all wounded and 
sick from front to rear by establishing collecting stations, ambulance stations, 
hospital stations, and beach-evacuation stations. 
In combat the collecting-section group establishes a collecting station at a 
point giving protection from enemy fire, which should be as near to the bat- 
talion-aid stations as possible. This station should be equipped with surgical 
dressings in abundance, medicines, hot food, and water for the wounded. Its 
functions are to sort the wounded, reapply dressings if necessary, and prevent 
shock. 
When the collecting station is established the litter bearers of the collection 
section bring in the wounded from the battalion-aid stations; ambulances are 
used when possible. 
The collecting section also establishes the ambulance station ordinarily about 
midway between the collecting station and the hospital station. It is merely 
a control point, which, when established, sends forward one or two ambulances 
to carry the nonwalking wounded from the collecting station to the hospital 
station, and then returns to the ambulance station. When loaded ambulances 
pass the ambulance station on their way to the rear, others from this control 
center are sent forward by the regulating officer to replace them. Treatment 
of the wounded ordinarily is not attempted between the collecting station and 
the hospital station. 
The service section establishes and maintains the medical company mess; req- 
uisitions, cares for, and issues quartermaster supplies; and provides chauffeurs, 
cooks, and mechanics. 
On the march, when not in the presence of an enemy, collecting stations are 
established along the route to provide temporary shelter for men falling out 
from illness or injury. These stations are evacuated by the ambulances follow- 
ing the troops and the casualties are carried to the camp-hospital station. 
The hospital section is a relatively lightly equipped hospital, capable of free 
movement in the field, and establishes a hospital station to the rear of the am- 
bulance station, thus forming a relay in the evacuation system from front to 
rear. In combat, this section establishes a hospital station where all sick, injured, 
or wounded cases are received and properly cared for. Surgical operations are 
performed when necessary, but the hospital section must at all times, to be fully 
effective, be capable of evacuating all wounded, so that the organization can 
advance as an active part of the field force. This would be done, when the 
distance is not prreat, by evacuating to a hospital ship or a base hospital. When 
a unit of a medical company which has established a hospital station fills up, 
another company establishes a new station and the first takes no more cases, 
but clears itself and then stands by to form a new hospital station. Thus dur- 
ing an advance the hospital sections would “leapfrog” each other. 
This completes a brief outline of the mobile portion of the medical department 
of an expeditionary force. Under certain circumstances, however, if the dis- 
tance between the hospital station and the base becomes too great, as in an 
advance, another medical unit must provide hospital treatment in order that 
the hospital section may remain mobile. This service is performed by the 570 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
evacuation hospital, which is organized with headquarters and various sub- 
divisions similar to those of a naval hospital. As its equipment is relatively 
elaborate, it moves only with the aid of a large number of trucks or by rail. 
It is intended to give the complete or definitive treatment ordinarily given by 
the hospital ship or base hospital, and is used only under the condition men- 
tioned. 
The field medical supply depot on the hospital ship or with the expedition 
quartermaster carries sufficient medical and surgical stores for resupply for a 
given period. This relatively frequent resupply is necessary in order that the 
supply section of the medical company may remain mobile. This depot also 
carries more elaborate dispensary equipment for attached medical troops and 
hospital equipment for the medical company, which they may be able to use to 
advantage under certain conditions, as during the occupation of an enemy city, 
in a semipermanent camp, or in a defensive position from which no advance 
is intended. 
Section 8.—LANDING FORCE 
Hospital corpsmen serving on board combatant ships must also be prepared 
to serve ashore as members of the medical department of the ship’s landing 
force. 
Organization and equipment. 
A permanently organized landing force consisting of infantry, artillery, 
machine guns, and other auxiliary units, is maintained on each ship and is 
known as the ship’s battalion. It varies in size and composition according to 
the type of ship. For a ship of the first rate it normally consists of one com- 
pany of Marines, two companies of Navy infantry, and one company of Navy 
artillery, a machine-gun unit, the battalion commander and staff, and special 
details consisting of pioneers, signalmen, cooks, messmen, and the ambulance 
party. This organization is flexible, so that all or any part may be landed at 
the discretion of the senior officer present. 
The ambulance party which is commanded by the battalion surgeon, usually 
the junior medical officer of the ship, is ordinarily composed of two litter bearers 
from the line of each company, or preferably, an equal number from the ship’s 
engineering divisions, with a chief pharmacist’s mate and as many hospital 
corpsmen of the lower ratings as the circumstances may demand. The total 
number of litter bearers should not be less than 2 per cent of the number of 
combatants landed. During an actual engagement, in order to reduce the 
number of ineffectives to a minimum, messmen, orderlies, and others not 
actually engaged in their own legitimate duties, should he pressed into service 
to augment and reinforce the litter bearers. This additional personnel should 
recover the arms and ammunition of disabled men, assist in the transportation 
of the wounded, and perform such other duties as the battalion surgeon may 
direct. Litter bearers should invariably be drawn from line personnel. 
In an actual engagement, hospital corpsmen will be so busily engaged in the 
dressing of wounds and in other professional work, that it will not only be 
impractical but will also be disastrous to even attempt to employ them in any 
other capacity. The assignment of hospital corpsmen as litter bearers will 
weaken the entire medical organization, destroy its morale and ruin its effi- 
ciency. The equipment of the ambulance party depends largely upon the nature 
of the battalion’s duty ashore. Ordinarily the litter bearers and hospital corps- LANDING FORCE 
571 
men carry no weapons, but wear the Geneva Cross on the left arm; however 
against a savage or uncivilized enemy, the personnel of the ambulance company 
carry pistols and omit the brassard. The battalion may be assembled for 
landing either fully or lightly equipped. 
When fully equipped each member of the ambulance party wears the uniform 
prescribed and carries a pack carrier (packed), haversack, rubber blanket 
(poncho), cartridge belt, filled canteen and wears leggings. There is no pro- 
vision for carrying the overcoat on the pack. When weather conditions make 
it necessary to carry the overcoat it has to be worn. The haversack contains 
rations, knife, fork, spoon, meat can, bacon can, and condiment can; also a 
towel, soap, comb, toothbrush, tooth powder or paste, sewing kit, matches and 
tobacco and pipe, if desired. The poncho is folded to suitable size and carried 
in the haversack on top of the rations. The pack carrier when completely 
assembled should contain one-half of a shelter tent with the accompanying tent 
pins and pole, a blanket, one pair of trousers and one jumper, one pair of 
drawers and one undershirt, two pairs of socks, a white hat, and a comfortable 
pair of high shoes. When pack carriers are not provided, the most necessary 
of the above mentioned articles are carried in the blanket neatly rolled length- 
wise, covered with the poncho and stopped with clothes stops, and the roll 
placed over the left shoulder with both ends of the roll secured together under 
the right arm. 
When the battalion is lightly equipped the men carry filled canteens and 
cartridge belt and wear leggings. The blanket and poncho or the pack carrier 
with haversack may be prescribed if circumstances require it. The special 
equipment of the ambulance party is as follows: 
(a) One litter for each two bearers. 
(5) A Geneva-cross brassard for each man. 
(c) A Hospital Corps pouch for each hospital corpsman. (Large for 
chief pharmacist’s mate; small for others). 
(d) A Geneva-cross flag on a staff. 
The expeditionary medical and surgical units and the medical emergency 
boat boxes are available for use with the landing force. 
Preparations are made by the battalion surgeon for an additional supply 
of instruments, dressings, and other equipment for an expedition in accord- 
ance with the length and character of the service and he will invariably 
make an inspection of all equipment prior to embarkation to see that medicines, 
instruments, dressings, and the men’s clothing are ample and in proper condi- 
tion. Each member of the ambulance party should wear his identification tag 
attached to the neck. 
The mission of medical-department personnel in a landing force. 
The mission of the ambulance party is to keep as many men physically 
fit as possible; to give prompt and efficient treatment to wounded or inca- 
pacitated personnel; to provide for rapid evacuation of casualties and to 
maintain and promote the morale of fighting units. Before leaving the ship, 
all personnel participating in the landing, should be subjected to a careful 
examination for the purpose of eliminating the physically unfit. If this is not 
done, there will be many men engaging in the landing who will not be able 
to keep up with their respective units, they will easily become fatigued and 
rapidly exhausted and therefore will be a distinct detriment to the efficiency 
and morale of the fighting force. Mobility is of vital importance to a landing 
force and the successful accomplishment of the mission assigned cannot be 
154294°—39 37 572 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVF 
gained without it. When the order is given to man the boats, 1)61800061 
should leave the ship via cargo nets that have previously been secured along 
the hull of the vessel and not via gangways. The cargo net method of 
loading men into small boats is a much safer method and a much mtore 
rapid and effective procedure than the use of the gangway; this is especially 
true in rough weather. Medical-department personnel of the landing force 
should be divided into sections and accompany their respective line units; 
their medical equipment goes along with them. This division of personnel 
and equipment prevents total loss, in case an individual boat in which all 
personnel and supplies is being carried, is sunk. The medical equipment for 
a landing force is arranged in packs and is easily carried on the backs of 
hospital corpsmen. These packs when filled to capacity have a maximum 
weight of only 35 pounds and are waterproof for 10 minutes submergence. 
This method of carrying medical material greatly facilitates the embarkation 
from small boats and renders it a far less dangerous procedure than with 
the employment of the old and cumbersome medical and surgical chests. Re- 
ducing the weight and the bulk of medical materiel that personnel must carry 
is of vital importance, for hospital corpsmen must keep up with their respec- 
tive units in the field, therefore anything that unduly reduces mobility de- 
tracts from efficiency. 
On landing, the ship’s battalion may join battalions from other ships to 
form a regiment, which in turn may be associated with other regiments to 
form a brigade. Both the regiment and brigade have a medical organization 
which is outlined in the Manual of the Medical Department, United States 
Navy. Ordinarily the ambulance party of each battalion will operate with 
that battalion. In an actual engagement, the important duties that medical- 
department personnel will be called upon to perform will fall under the 
following captions: 
1. Relief of pain (morphine). 
2. Arrest of haemorrhage (tourniquets and compression). 
3. Control of shock (artificial heat; morphine; absolute rest). 
4. Immobilization of fractures (splints, often improvised. “Splint ’em where 
they lie”). 
5. Treatment of wounds: 
(a) Haemostasis. 
(b) Asepsis. 
(c) Suturing. 
(d) Sterile dressings. 
(e) Bandages and adhesive plaster. 
(f) Tetanus antitoxin or combined with gas-gangrene antitoxin. 
6. Evacuation (stretchers and motor transportation). 
The medical-department personnel of the landing force, including company- 
aid men, battalion-aid station tmits, and collecting and ambulance sections, 
treat, collect, and transport wounded or incapacitated personnel from the 
front line to the beach. Here the responsibility of the landing force medical- 
department personnel ceases. The problem of transporting the wounded from 
the beach to the ships of the fleet rests upon the medical units afloat. 
In the event that the tactical situation demands the holding of ground 
gained, it may be necessary for a landing force to establish a temporary camp. 
In the event of such a contingency it becomes the duty of medical-department 
personnel to plan and advise in regard to necessary sanitary measures. It is a 
well-established fact that failure to observe essential and fundamental princi- LANDING FORCE 
573 
pies in hygiene and sanitation brings upon the personnel engaged in field opera- 
tions against an enemy greater misery and more deaths than all the bullets 
and machinations of the enemy. In any landing expedition the tactical situation 
will undoubtedly determine the location of the camp. In any camp, wherever 
it may be, three important sanitary problems concerning water, food, and the 
disposal of wastes must be settled. 
Water from questionable sources or of doubtful purity must not under any 
circumstances be employed for drinking purposes. In the event that it becomes 
necessary to use water, the source of which is questionable, it must in all cases 
be subjected to chemical or physical methods of purification before being em- 
ployed for drinking purposes. Boiling is the best method of rendering question- 
able water safe for drinking. In the event that this method is impracticable, 
chemical methods of purification must be used. The chemical compound that is 
usually employed for this purpose is calcium hypochlorite. (See p. 530.) 
The food supply in a camp of this type is likely to be inadequate in quanti- 
ty and of doubtful quality. As a precautionary measure against food infections 
an order should be promulgated and enforced to the effect that no food will 
be served unless it has been thoroughly and recently cooked. 
The disposal of wastes and camp sanitation is fully discussed in the section 
on Field Sanitation. 
Latrines should be placed to the leeward, 100 yards from the galley and mess 
halls and at least 75 feet from the nearest tent. In the event that the encamp- 
ment is to be for a period greater than 1 week, the disposal of human excreta 
will be via the pit type of latrine and all latrines will be thoroughly and effi- 
ciently flyproofed. The fly menace should be combated by eliminating breeding 
places and destroying adult flies; by protecting all food intended for human 
consumption from flies; and by the disposal of human excreta in such a manner 
that flies cannot gain access to it. 
In an encampment of this type, a sickbay will be established where all in- 
juries and diseases will be treated as efficiently as the facilities available will 
permit. A record of all patients treated must be made. All cases of sufficient 
importance to warrant admission to the sick list will be written up on loose 
leaves from health records and a Form F card prepared when the case is 
discharged to duty or otherwise disposed of. A journal also is kept in which 
daily entries of all important, interesting, and pertinent data pertaining to 
personnel, hygiene, and sanitation are recorded. Upon return to the ship the 
medical entries are to be inserted in the proper health records. 
Drills, inspections, and parades. 
Frequently at sea or in port, the ship’s battalion is formed for Inspection or 
drill. The ambulance party assembles at a place on deck designated in the 
ship’s organization scheme. Members of the party should report promptly in 
clean uniform and with the equipment specified. The party is mustered by the 
chief pharmacist’s mate, who reports the result of the muster to the battalion 
surgeon, who in turn makes a report to the battalion adjutant. When the 
battalion surgeon is away from the ambulance party’s place of assembly, the 
party is in charge of the chief pharmacist’s mate, who should see that the men 
keep in formation, and refrain from loud talking or other disorder. 
If the battalion is formed for inspection of the equipment, the pack carriers 
are unstrapped, the packs removed, unrolled and arranged as explained in the 
Hospital Corps Drill Book. 
The ship’s battalion sometimes is landed for parades or reviews. On these 
occasions the ambulance party follows the battalion, each litter being carried 574 
HANDBOOK OF THE HOSPITAL CORPS, U, S. NAVY 
by four bearers, the litters being horizontal and carried abreast of each other. 
It is landed not simply for parade, but to administer first-aid treatment in 
cases of sunstroke, accident, or sickness. 
References 
Hospital Corps Handbook, U. S. Navy, 1923. 
Handbook of the Hospital Corps, U. S. Navy, 1930. 
Section 9.—SHORE PATROL 
Whenever a fleet or vessels of the United States Navy visit a United States 
or foreign port it is! customary to land a body of men known as the shore 
patrol. The purpose of this patrol is to preserve order among the men who 
are ashore on liberty and to enforce whatever regulations concerning the port 
the senior officer present may issue. A medical officer and some hospital 
corpsmen usually are detailed for duty with the shore patrol and become an 
integral part of it. The duty of the medical detachment of a shore patrol is 
to render emergency medical and surgical treatment to men ashore on liberty 
from the vessels present and to members of the shore patrol who may be 
injured or become ill. 
The ease with which this duty may be performed depends greatly upon 
the nature of the port in which liberty is granted. In a well-organized com- 
munity possessing an efficient police force, public hospitals, and ample facilities 
for handling large liberty parties, such as are found in any well-organized 
municipality, the problem is easy to solve. But in cities having few attrac- 
tions for the men, no welfare activities, numerous liquor stores, houses of 
prostitution, and an inefficient police force the problem presents a different 
aspect. It is a port of this type which will be considered in this section. 
The personnel of the medical detachment of the shore patrol should consist 
of one medical officer and four well-trained, reliable pharmacist’s mates. Each 
man should carry ashore with him his field equipment, viz., a poncho, belt and 
canteen, extra shoes and leggings, a change of underwear and socks, an extra 
suit of whites or blues, hammock, mattress, cot, two blankets, mosquito net, 
necessary toilet articles, two towels, shoeblacking, a notebook, and pencil or 
fountain pen. The detachment should have a bucket for water, a washbasin, 
and a supply of toilet paper. 
In many ports the members of the shore patrol will be quartered in a hotel, 
or in a comfortable military barracks or in a police station, but one never 
knows what is ahead ofs him when liberty is given in a strange port, so each 
pharmacist’s mate detailed with the shore patrol should go ashore prepared to 
camp out in whatever quarters are available. He may find himself lodged in 
an empty warehouse or in the baggage room of a x’ailway station. 
Before leaving the, ship it is necessary to assemble certain material for use 
in connection with the treatment of sick or Injured among the liberty party. 
As conditions ashore are more or less unknown a fairly complete field equip- 
ment will be necessary, in which must be the following: 
1. A Geneva-cross flag and staff to mark the main dressing station. 
2. The medical and surgical expeditionary cases. 
3. A mess table upon which to place the expeditionary cases and other appli- 
ances at the main dressing station. 
4. Three folding cots. 
5. Three pillows with pillow cases. SHORE PATROL 
575 
6. Three blankets. 
7. Two Stokes’ splint stretchers, each having a pillow and two blankets. It 
is advisable to place a tag bearing the name of the ship on each of these 
stretchers and on each blanket as they may be used for the transportation of 
men to the hospital ship and easily become lost unless tagged. 
8. Two buckets for water. 
9. Four washbasins (two for main dressing station and two for venereal 
prophylactic station). 
10. Five hundred cc of Tincture of Iodine, or Tincture of Merthiolate. 
11. An ample supply of sterile dressings and bandages. Materials to make 
tincture of iodine and compressed dressing material are to be found in the 
expeditionary cases, but it is better to use a freshly sterilized supply of dress- 
ings' and to disturb the cases as little as possible as it might be impossible to 
renew supplies from them for some time. 
12. A blank book to be used for a journal in which is to be entered an 
account of all the detachment’s activities, especially notes of all cases treated 
and examinations made. 
18. A package of shipping tags. 
14. Material for venereal prophylaxis and report blanks which when tilled 
out are sent to the medical officer of the applicant’s ship. 
The quarters for the shore patrol generally are selected by an officer of the 
Train, Base Force, which usually arrives in advance of the fleet. Therefore when 
the patrol party lands, it is marched at once with its equipment to the quarters 
selected. It is a good rule in Navy life never to become separated from one’s bag- 
gage, so on this march from the dock to the quarters see that all the medical- 
department equipment is brought along and none left on the dock. Most of the 
material brought ashore can be packed in the two splint stretchers and carried 
safely with the aid of meu from the patrol, who will be detailed by the senior 
patrol officer on request. 
Having arrived at the patrol quarters, the sleeping accommodations for the 
pharmacist’s mates are arranged for. These probably will be with the rest 
of the patrol, and the comfort each man gets depends upon his adaptability 
for service in the field. Next comes the question of food. In some ports the 
shore patrol will be subsisted from some vessel and the cooked food sent 
ashore. Usually, however, each man’s ration is commuted and he is allowed 
not more than 75 cents for each meal. A survey of the neighborhood will 
reveal the best eating places. Remember that no member of a shore patrol 
is permitted to drink any alcoholic beverage while on duty. 
The next step is to establish the main dressing station, where seriously 
injured men may be brought for first-aid treatment. This station should be 
as near the landing place as possible and should be marked by the Geneva- 
cross flag. Having secured a suitable location, set up the three cots and the 
mess table, upon which place the expeditionary cases and two of the wash- 
basins, together with other dressing material. This table will be found very 
useful as a dressing stand. Secure a supply of fresh water and make up 
whatever antiseptic hand solution the medical officer uses, covering it with a 
clean towel. The splint stretchers should be prepared for use and placed out 
of the way. One pharmacist’s mate is detailed to care for the main dressing 
station. 
The venereal prophylactic station likewise should be established near the 
landing place and if possible adjacent to the main dressing station. Experi- 
ence has shown that these two stations should not be combined, because if 
there is opportunity for much exposure to venereal disease in the port it is 576 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
likely that a large crowd of noisy men will visit the prophylactic station and 
if the dressing station be in the same place its proper functioning will be 
interfered with. This station must be in charge of one pharmacist’s mate, 
who will prepare and supervise the treatment and fill out the treatment report 
blanks. He should be assisted by at least two members of the shore patrol, 
whose duty is to preserve order. The prevention of venereal disease is most 
important and must be faithfully and conscientiously carried out. It is not 
agreeable duty, as the patients often are under the influence of liquor, foul- 
mouthed, and disorderly, but if venereal disease is prevented by the treatment 
it is worth all the effort expended. 
A dressing station equipped with a Hospital Corps pouch and a supply of 
sterile dressings, iodine, and bandages, and in charge of one pharmacist’s 
mate, should he established at the landing place, as it is to be expected that 
many men will present themselves with minor wounds which require steriliz- 
ing and dressing before embarking for their ships. All cases of serious Injury, 
such as fractures, severe haemorrhage, large lacerated wounds, etc., appearing 
at this station should be sent to the main dressing station for treatment be- 
cause at the landing there will be more or less confusion caused by embarking 
men, some of whom may be intoxicated. 
At the landing place a space should be reserved for the reception of severely 
intoxicated men. This space should be so located as to safeguard the men 
placed in it. Many of these men will be unconscious or semiconscious, others 
will be noisy or talkative, while others will be fighting drunk. If these men 
be permitted to wander about at will there is danger of their falling off the 
dock into the water or onto the landing float. The space selected for tihe 
retention of drunken men should be in charge of a competent chief petty 
officer of the shore patrol. He should have sufficient assistants to preserve 
order. 
The fourth pharmacist’s mate should act as a relief for meals and as assistant 
to the medical officer. Experience has shown that none of the stations men- 
tioned should be left unmanned while the liberty party is ashore. One never 
knows when a serious accident will happen. A man may be run over by a 
trolley ear or shot or stabbed at any time. Liberty in a port such as is being 
discussed generally begins at noon and expires at 8 p. m., but it will probably 
be midnight before the dock is cleared of the last stragglers; and until all the 
liberty party has embarked the medical detachment must keep their dressing 
stations open because the patrol in their final search of the streets for the 
night may find some men injured or unconscious. 
As soon as possible after the landing the medical officer of the shore patrol 
should make a sanitary survey of the port. This survey should include an 
investigation of the food and water supply of the port, the diseases prevalent, 
and the neighborhoods harboring contagious diseases or houses of prostitution. 
With the information so gained, and through the cooperation of the senior patrol 
officer he should prevent, as much as possible, the exposure of the liberty party 
to disease by suitable recommendation for the restriction of infected localities. 
There are several special points relating to the activities of the medical 
department which are well to bear in mind. Frequently men are brought down 
to the landing place profoundly intoxicated and often unconscious. Each 
of them should be examined carefully by the medical officer, as the uncon- 
sciousness may be due to a head injury which necessitates immediate trans- 
portation to the hospital ship. An attempt should he made to identify every 
unconscious man. Examination often will show that he has no identification 
tag and his clothing may bear several names; therefore it becomes necessary 577 
SHORE PATROL 
to learn, his name and the name of his ship from his shipmates who may be 
around. Write this information on a shipping tag and tie it securely to his 
clothing, then have him placed in the space reserved for intoxicated men. This 
will facilitate his return to his ship. Men will be brought to the medical officer 
for examination to determine whether they are under the influence of liquor. 
If the man is found under the influence of liquor, careful notes should be made 
in a notebook kept for this purpose of all the details of the case—the man’s 
name, his rating, his ship, his peculiarities, or marks by which he may be 
identified, and the signs or symptoms upon which the decision that he is 
intoxicated is made. Then get some officer or chief petty officer from his ship 
to identify him and record that officer’s name for future reference. All this 
is necessary, because men often give wrong names and have no identification 
tag or proper marks upon their clothing, and the medical officer in all proba- 
bility will be called as a witness by a court-martial in the case weeks after, 
and unless he has kept a very clear record of each case and has the identity of 
each man pronounced under the influence of liquor clearly in mind he will not 
be able to give clear testimony in court. 
Men seriously injured may be expected at the main dressing station at any 
time, and provisions for their care always must be in readiness. Great care 
must be taken to identify each badly injured man and to place upon him a tag 
bearing his name, rating, and the name of his ship. All severely injured men 
after having been given the necessary first-aid treatment should be sent im- 
mediately to the hospital ship, where there are medical officers always on duty. 
If an injured man should be sent to his own ship, it is possible that the medical 
officers of that vessel might be ashore and the professional attention required 
would be lacking. Severely injured men are best transported in the splint 
stretcher, and may be sent to the hospital ship in either a patrol boat or a 
liberty boat, which may be diverted from its regular duty by order of the senior 
patrol officer. When an injured man is sent to the hospital ship a member of 
the medical detachment should accompany him to care for him enroute and to 
insure the prompt return of the stretcher to the dressing station. 
In every case involving an injury ashore of sufficient importance to require 
treatment and the return of the individual to his ship, or of sufficient severity 
to demand direct transfer to the hospital ship or hospital ashore, an immediate 
report will be submitted to the senior medical officer of the ship to which the 
man is attached, giving answers to the following questions: 
1. Was the man on authorized liberty? 
2. Was the man intoxicated? 
3. Was the injury due to his own misconduct? 
4. Concise and pertinent facts concerning the circumstances attending 
the injury. 
The information given under No. 4 should be so explicit that anyone with no 
previous knowledge of the case may read it and visualize the accident. 
This report must invariably be sent to the senior medical officer of the ship 
to which the individual is attached whether or not the man is returned there. 
In the event that the injured patient is transferred direct to the hospital ship 
or a hospital ashore a duplicate of the report should be submitted to the activity 
concerned. In addition, a file copy for future reference should be retained. 
This procedure is of the utmost importance but unfortunately is often 
neglected. The importance of this report is undoubtedly realized and apprec- 
iated by everyone in the medical department of the U. S. Navy. Injured per- 
sonnel are constantly being sent to the hospital ship with no information as 578 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
to the circumstances attending the injury, or if information is submitted it is 
often insufficient, inaccurate, misleading, and therefore of no value. Upon re- 
ceipt of such a case the senior medical officer of the hospital ship immediately 
sends a radio to the medical officer of the ship to which the man is officially 
attached requesting information at once; however this unfortunate medical 
officer has no more and probably less information than the hospital-ship author- 
ities. So in the end a medical officer must go ashore and spend the major part 
of a day obtaining information that the patrol officer could have easily secured 
at the time the accident occurred, thus saving much inconvenience, time, labor, 
and expense. 
References 
Hospital Corps Handbook, U. S. Navy, 1923. 
Handbook of the Hospital Corps, U. S. Navy, 1930. CHAPTER VII 
DIETS AND MESSING FOR THE SICK 
Feeding the sick has become so important a factor in their treatment and 
cure that it may well be termed Diet Therapy and placed among the other reme- 
dial agents employed in therapeutics. While not actually a remedy in itself, 
diet therapy supplements and makes other treatment more effective. Where 
formerly the feeding of the sick was based largely on experience and observa- 
tion and the patient’s whims and fancies as well as his physical disability, today, 
because of the marked increase in the scientific knowledge of the composition 
of foodstuffs, of their metabolism in the body, and of their relation to normal 
and pathological conditions in the body, it is a science. Due to variable factors 
such as age, temperament, idiosyncrasy, etc., influencing metabolism, it cannot 
be classed as an exact science and consequently diets for the sick require more 
or less individual prescription. In common with all sciences, dietetics requires 
a knowledge of the other sciences with which it is allied. 
Nutrition is the process of providing the body with the necessary material 
for maintenance, growth, and renewal of all the body tissues. 
Dietetics is the science which treats of food and its effect on the body in 
health and disease. 
Foods are those substances obtained from the animal, vegetable, and mineral 
kingdoms which, when taken into the body, yield heat and energy, build and 
renew tissues, and regulate the body processes and internal conditions. They 
usually are classified as proteins, carbohydrates, and fats, and equally essential 
for life are water, inorganic mineral salts, and vitamins. Foods contain other 
substances which, while not absolutely necessary, are useful in nutrition through 
increasing or improving the palatability of food and stimulating the flow of 
digestive juices. These substances are known as accessory articles of diet and 
consist of: Flavors, various substances that give odor and taste to foods; 
condiments, as pepper, salt, mustard, etc., and stimulants, as alcohol, tea, coffee, 
cocoa, etc. 
Proteins, the only class of foods containing nitrogen, sulfur, and phosphorus 
as well as carbon, hydrogen, and oxygen, are found in both the animal and 
vegetable kingdoms. All proteins are built up of amino acids, the proportions 
of which differ widely in proteins obtained from different sources. Some of 
these amino acids are absolutely essential for the maintenance of life while 
others are necessary for the growth and development of the body. The 
difference in proportions of amino acids determines the biological (or nutritive) 
value of proteins and according to their amino-acid content proteins are knowui 
as “complete,” as those found in lean meat, milk, and eggs, “partially complete,” 
of which type those in cereals and legumes are examples, and “incomplete,” as 
gelatin. 
Proteins are essential in food to promote growth and renew tissue. They 
also yield energy but are an expensive source of it. Deficiency of protein in 
the diet will stunt growth, promote a secondary anaemia or induce nutritional 
cedema. The amount of protein necessary in the daily diet is a disputed 
point. Experiments have shown a minimum of 0.6 Gm. per kilogram of body 580 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
weight to be necessary. An optimal amount is from 1.0 to 1.5 Gm. per kilogram 
of body weight, or 70 to 100 Gm. a day for a man weighing 70 kilograms. 
Part of this protein should be of good biological value, as protein from animal 
sources. 
Carbohydrates, containing carbon, hydrogen, and oxygen, are found largely 
in the vegetable kingdom, are easily procured and inexpensive, and usually rep- 
resent from 50 to 75 per cent of the normal diet Examples are sugars, syrups, 
grains, vegetables, and fruits. They are also found in milk, and are the most 
valuable source of energy. They are protein sparers in the body if for any 
reason proteins must be curtailed. They may be stored in the liver as glycogen 
to be used by the body when needed, and when taken in excess are stored 
as adipose tissue. When taken too sparingly, weight is lost and acidosis may 
result. Carbohydrates are essential for the metabolism of fats. In the form 
of glucose, carbohydrates are the most valuable emergency fuel for the body. 
Pats, like carbohydrates, contain carbon, hydrogen, and oxygen, but in dif- 
ferent proportions and are found in both animals and vegetables. Examples are 
butter, cream, cheese, fat meats, egg yolks, nuts, and vegetable oils. They are the 
most concentrated source of energy, are protein sparers, and are essential for 
all cells. Fat acts as a padding both for organs and subcutaneous tissue and 
is stored up as adipose tissue to form a reserve supply in time of need. The 
fat requirement varies with the individual, and also depends on his protein 
and carbohydrate intake. In the normal diet fats usually make up from 35 
to 50 per cent of its calories. An excess of fat in the diet is apt to promote 
indigestion. It is bound to produce obesity, the forerunner amongst the 
middle-aged of arteriosclerosis, hypertension, diseased gall bladder and diabetes. 
Water, composed of hydrogen and oxygen, makes up two thirds of the body 
weight and is found in every cell in the body. It is the most important single 
item in the diet, and is found in all beverages and in all foods not artificially 
dehydrated. Six to eight glasses of water a day is a normal intake. Taken 
in excess water may overtax a diseased heart and kidneys, while an insufficient 
intake causes constipation, loss of weight, disturbs the maintenance of normal 
body temperature, and causes dehydration inducive to ketosis. 
The inorganic mineral salts found in the body are calcium, phosphorus, 
magnesium, potassium, iron, sodium, chlorine, iodine, copper, and others in 
small amounts. The more important ones will be discussed briefly. 
Calcium. Good sources of calcium are milk, cheese, egg yolk, dried beans, 
almonds, peanuts, walnuts, turnips, oranges, and dried prunes. Most of the 
calcium in the body is found in the bones and teeth, but is by no means 
limited to this use. It is essential for the coagulation of blood, for normal 
heart action, and for contractility of the muscles. Deficiency of calcium 
in the diet, and this is the most common deficiency in the American diet, 
causes faulty structural development, rickets, dental caries, heart atony, tetany, 
and excessive bleeding. The amount of calcium needed in the daily diet is 
0.68 Gm. for an adult. This is increased to 1.0 Gm. a day for a child. One 
pint of milk a day will keep an adult in positive calcium balance while 1 quart 
of milk is necessary for a child. 
Phosphorus is found in cheese, eggs, whole grain cereals, meat, dried beans 
and dried prunes in good amounts. Two-thirds of the phosphorus In the 
body is found in the bones and teeth. It is also found in every cell in the 
body and thus is essential for growth. If the phosphorus intake is not suf- 
ficient, the results are poorly developed bones and teeth, retarded growth, 
and rickets. An adult needs 1.32 to 1.5 Gm. of phosphorus a day, and the 
growing child needs more. DIETS AND MESSING 
581 
Iron. Good sources of iron are liver, kidney, heart, beef, egg yolk, oatmeal, 
dandelions, almonds, apricots, peaches, green vegetables, and dried fruits. 
It is essential for the formation of haemoglobin and lack of it in the diet 
causes anaemia. Fifteen milligrams of iron daily is necessary in the diet 
of an adult. This amount is increased in the diet of a child and in nutritional 
anaemias. 
Copper has been found in recent years to be absolutely essential for the utiliza- 
tion of iron in the body. Although the daily requirement is very small, 0.0002 
Gm., anaemia will develop without it. Copper is found in liver, bran, sea- 
foods, nuts, leafy foods, and legumes. 
Iodine is found in fish and vegetables of nougoiterous regions. It is essential 
for the normal functioning of the thyroid gland and lack of a sufficient amount 
will cause goiter. The amount needed daily is not known but different 
goiter belts prescribe from 15 micrograms for an adult to 150 micrograms for 
a child. As the iodine content of the foods and drinking water in these 
regions is so variable, or lacking entirely, iodine is introduced in the drinking 
water or table salt and is sometimes given in weekly doses in the schools. A 
microgram is one millionth of a gram. 
Vitamins are substances which are absolutely necessary for the maintenance 
of health and were once called “food factors of unknown natures.” Later they 
were thought to be amines necessary for life and were given the name of 
“vitamines.” Many years of scientific investigation has proved their existence 
and that they are essential to health beyond the possibility of doubt. They 
now are known as “vitamins” (the letter “e” having been dropped from the 
spelling of the word) which is considered to signify only that they are essential 
to life. It is an unsatisfactory name but a better one has not yet been chosen. 
Their chemical composition is gradually becoming known, pure preparations 
of most of them have been made from natural sources, some have been prepared 
artificially in the laboratory, and much has been learned about the part they 
piay in life and health. The existence of 6 vitamins has been established, more 
are recognized, the existence of others is suspected, and some now considered 
to be single vitamins may be found to consist of 2 or more. An antihsemorrhagic 
dietary factor, to be known as vitamin K, has been discovered and appears to be 
concerned with the regulating of the time required for blood to clot. Vitamins 
are designated by letters of the alphabet in the order of their discovery, except 
vitamin B which was discovered shortly before vitamin A. 
Vitamin A is called “fat soluble” because it is soluble in fats. Very little 
of it is destroyed by ordinary cooking as it is only slightly soluble in water and 
is very little affected by heat. It is destroyed by drying. Taken in excess it 
can be stored in the liver. Sources of vitamin A are fish-liver oils, liver, fish 
roe, egg yolk, milk, butter, cheese, escarole, lettuce, carrots, sweet potatoes, 
apricots, and peaches. 
Vitamin A stimulates growth and development, and is necessary for well- 
being at all ages. It has a definite part in the maintenance of the normal 
protective function of the mucous membranes lining the nasal passages, the 
mouth, the throat, the intestinal tract and various other body cavities. A 
long-continued deficiency results in arrested growth, defective tooth and bone 
formation, nutritional night blindness, and loss of reproductive power. Defi- 
ciency also causes xerophthalmia, a condition of the eyes and lacrimal glands 
which may result in total blindness. 
Vitamin A itself occurs only in animal and sea foods but plant foods having 
a deep yellow or green color contain certain pigments which are changed into 
vitamin A in the body, and are known as provitamin A. 582 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The daily requirement of vitamin A for an adult is 5,000 to 6,000 Interna- 
tional units. One quart of milk will furnish about 1,000 International units 
of vitamin A and 1 Gm. of calcium. 
Vitamin B is now known as “vitamin B complex” for the reason that scientific 
investigation has shown it to be a complex dietary factor instead of a simple 
one as was at first believed. The existence of 5, and possibly 6, factors having 
distinct and separate biological properties has been determined, which, for 
convenience, have been designated as vitamins Bi, B2, B3, B4, B0, and B8. In 
the United States vitamin B2 is also known as vitamin G. 
Vitamin Bi, or thiamin, and sometimes called aneurin, is known as the 
amtineuritic vitamin, is soluble in water, and destroyed by heat. Some of it 
is lost in improper cooking, by refining, and by the addition of alkalis. Being 
water soluble much of the vitamin Bi contained in fruits and vegetables may 
be in the water in which they are cooked, and it is therefore advisable to 
use as little water as possible in cooking them and to serve the cooking liquor 
with the foods. The liquor with canned fruits and vegetables should also 
be used. It is found in small amounts in many foods, good sources being whole- 
grain cereals and breads, yeast, dried beans, broccoli, and other green veg- 
etables, chicken, brains, liver, kidney, and lean pork. It is also manufactured 
commercially. 
Vitamin Bi is necessary for the normal functioning of the nervous system 
and for normal muscle tone of the alimentary tract, and it is believed general 
health and well being could be much improved if more of it was contained 
in the daily diet. It is also necessary for the normal oxidation of sugars in 
the body. A deficiency stops growth and causes loss of appetite, a sluggish 
digestive system, and nervous irritability. Absolute lack of vitamin Bt pro- 
duces the disorder of the nervous system known as beriberi. Vitamin Bi does 
not stimulate normal appetite as is sometimes claimed. 
The daily requirement for this vitamin is believed to be about 400 to 500 
International units. 
Vitamin C, or ascorbic acid, and also known as cevitamic acid, is the anti- 
scorbutic vitamin, is water soluble, and is destroyed in cooking (when air 
is present) as well as in the presence of alkalis. It can be stored in the 
body in a limited degree and is found largely in the vegetable kingdom. 
It is present also in the suprarenal glands. Excellent sources are green 
vegetables, peppers, turnips, horseradish, most fruits, sprouted seeds, liver, 
and brain. Citrus fruits and tomatoes are especially rich in this vitamin. 
Raw fruits and vegetables are preferable for supplying this vitamin although 
canned fruits and vegetables are good sources as, in most cases, air is ex- 
cluded during the cooking process. 
Vitamin G is essential for growth and good health. It is particularly im- 
portant for normal capillary blood vessels, good teeth, and healthy gums. 
Bleeding gums, loose teeth, sore joints, loss of appetite with loss of weight 
and fatigue, are symptoms of a lack of vitamin C and of the disease known as 
scurvy. 
An adequate allowance of vitamin C for the adult is 1,200 to 1,500 Inter- 
national units which can be supplied by one large orange or one-half a 
grapefruit. 
Vitamin D, the antirachitic vitamin, is fat soluble and is not destroyed by 
ordinary cooking. It is not widely distributed in foods being found naturally 
in only a few in important quantities. Foods containing certain substances 
known as provitamin D when exposed to ultra-violet rays become sourced of 
vitamin D into which the provitamin D is changed. Ergosterol, a complex 583 
DIETS AND MESSING 
substance resembling fat or oil but not saponifiable, and widely distributed 
in plant and animal tissues, of which the skin is one, is changed into vitamin 
D on exposure to ultra-violet rays. 
This vitamin is necessary for the utilization of calcium and phosphorus 
in the body and is therefore essential for the formation of bones and teeth. 
A lack of it retards growth, especially of bones and teeth, and an excessive 
deficiency results in rickets, a disease that until recently afflicted in some 
degree nearly 80 per cent of the children in large cities in America and western 
Europe. 
The daily requirement of vitamin D for adults is not known but 400 to 
600 International units provide for good growth and maximum calcification in 
infants. Overdoses of this vitamin are toxic. Egg yolk, fish-liver oils, salmon, 
sardines, and dairy products are good sources of this vitamin, as are foods 
enriched by irradiation. The concentrates, as fish-liver oils, are advised for 
use in the winter months, especially for children. 
Vitamin E, the antisterility vitamin, is fat soluble and heat stable, and is 
essential for reproduction. It is found in small quantities in many foods, the 
germ of the wheat grain being an especially rich source. It is not deficient in 
the human diet as it is present in green lettuce, vegetable oils, and a number 
of other vegetables in considerable quantities. 
Vitamin G, or riboflavin, is also known as vitamin B2. It is a yellow pigment 
widely distributed in both animal and plant foods, is water soluble, and is not 
easily destroyed in cooking except in the presence of alkalis. The best sources 
of this vitamin are lean meat and glandular organs, eggs, milk, and green vege- 
tables, and it is also found in the germ portion of wheat, in peanuts, soybeans, 
and rice polishings. 
The use of vitamin G in the body is not yet clear but it is believed to play a 
part in the chemical processes of all living cells and it has been stated that it 
increases nutritional well-being. Experiments on animals have shown that a 
deficiency results in retarded growth, loss of hair, and nutritional cataract. No 
figures are yet available for the amount needed daily but protection is sup- 
posed to be afforded by 1 pint of milk, 1 serving of turnip greens, 1 serving of 
grapefruit, 5 slices of whole-wheat bread, or 1 egg. 
The P-P (pellagra-preventing) factor, or nicotinic acid, was identified in 
1937. An insufficient amount of this factor in the diet appears to be the chief 
cause of pellagra, a disease common in the southern part of the United States 
and to alcoholics. It is found in liver, lean meat, salmon, egg yolk, butter- 
milk, collards, green peas, turnip and other greens, and tomato juice. 
Deficiency of this factor first is followed by loss of appetite, loss of weight, 
and general weakness. If the deficiency is prolonged sore mouth, digestive 
and nervous disturbances, and eruptions on the skin of the hands, arms, feet, 
and legs result. This factor is still in process of study and no figures are yet 
available as to the daily requirement. It is known that 1 to 2 milligrams daily 
will cure pellagra. 
ENERGY VALUE OF FOOD AND PLANNING THE DIET 
An extremely important function of food is to supply energy. The energy 
value of food is variously referred to as its fuel or caloric value. In food 
chemistry the unit used to measure the caloric value of food substances is the 
large calorie which is the amount of heat necessary to raise the temperature 
of 1 kilogram of distilled water from zero to 1° 0. 
The energy or heat value of foods is determined by the use of calorimeters, 
experiments with which have shown that foods furnish the same amount of 584 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
energy when used in the body as when burned in calorimeters, providing the 
end products in each case are the same. Experiments also have shown the 
fuel values for the different classes of foods to be approximately as follows: 
1 Gm. of protein yields 4 calories. 
1 Gm. of fat yields 9 calories. 
1 Gm. of carbohydrate yields 4 calories. 
The food requirements of individuals are affected by several factors, muscu- 
lar activity, age, size, shape and weight, body composition, influence of ductless 
glands, pathological conditions, pregnancy and lactation, effect of food, climate, 
etc. It should be remembered that a certain amount of food is required to 
maintain the body at all times. 
The first step in determining the energy needs of the individual is to find 
the ideal weight according to the age and height. The weight-height-age tables 
put out by insurance companies and other authorities may be used for this 
purpose. From the standpoint of good health, it is considered undesirable to 
be underweight before 30 or overweight after that age. This makes the weight 
at 30 years of age in the tables ideal for most adults. Tables of average 
heights and weights are given immediately hereafter. 
Table of Average Heights and Weights—Men 
[From Nutrition and Diet Therapy—Proudfit] 
OiOCnOptOOtOC* 
Age 
COCCCOCOtOtOtOH- O 
Cn^O0i-*00O5fcO-gi-<i 
5 feet, 0 inches 
COCOOOCOCOtOtOH-O 
5 feet, 1 inch 
WWOiWWWtOtOK 
C000-<IOTb0O05fc0t0 
6 feet, 2 inches 
Ji^^COWWtOtOM 
to M o 00 CO o Oi Oi 
5 feet, 3 inches 
Oi^COh-OOCSCOOOOO 
S feet, 4 inches 
COOO-^OitOO^JfcOtO 
5 feet, 6 inches 
CnCnCn^^^^COtO 
COtO^OOS^t—‘0505 
5 feet, 6 inches 
OiCnCnOtCn^^^CO 
OOOsOiWOOOCnOO 
5 feet, 7 inches 
O5O5O5C3CnCn^4^C0 
COH-OOOOifcOCD^^ 
5 feet, 8 inches 
GO 05 Oi CO O C5 W OO GO 
5 feet, 9 inches 
05 05 
COH-OOOCWh-MtObO 
5 feet, 10 inches 
00 H 05 rfi>. O 05 lO 05 M 
6 feet, 11 inches 
iMM M O 05 tO M H* td 
6 feet, 0 inches 
Ot 
H-O00 05t0C»C005^J 
6 feet, 1 inch 
C0c0t00 00 
OOMCTfCCCO^CDH-tO 
6 feet, 2 inches 
M WtOtOMMMMM 
CCOOcO®00*^05 
Cnrf*-tOOCnOrf*-05^l 
6 feet, 3 inches 
tOtOfcObOfcO^^^r-* 
hmOOOOOOOO^ 
fc0t-‘COO5t-‘O5?Ot-‘b0 
6 feet, 4 inches 
tototobototo^j-*!--4 
HHHHOOtCOOM 
eD-4Cnt0-vJH-^05-^ 
6 feet, 5 inches 
Table of Average Heights and Weights—Women 
[From Nutrition and Diet TherapyProudfit] 
CnC^rf^^WCOtOhO'-* 
0«ODtOC«OOiOCn 
►> 
CD 
KJMMmmmOOO 
Ot Oi M CO cn to CD 05 H 
4 feet, 8 inches 
totototo*-“-‘H*oo 
4 feet, 9 inches 
tOWtOtOMMMMO 
C0005M003W001 
4 feet, 10 inches 
WWlOtOtOHHMO 
l-*t-‘00OtH-‘00CntOO5 
4feiet, 11 inches 
OOGOCOtOtOtOH-H-O 
WWOMCOO*^^^ 
5 feet, 0 inch 
00C000t0t0fcCl-‘H-O 
CnCnfcOcOCnfcOCOCscO 
5 feet, 1 inch 
COWWWbOtOtCMM 
OOOOOifcO^J^t—COtO 
5 feet, 2 inches 
H*1 H-'H M m m m m m 
1 
MH00 0iO^rf*-t0Cn 
5 feet, 3 inches 
OOCnOO 
5 feet, 4 inches 
OOOOOOtOOO^h-OObO 
5 feet, 5 inches 
WU)0 05tOGOCnt0 05 
5 feet, 6 inches 
00 01W005M0050 
5 feet, 7 inches 
05 CO o 
5 feet, 8 inches 
Oj t—4 QO O C*3 00 
5 feet, 9 inches 
H I© rf*. H Vj K M 
5 feet, 10 inches 
5 feet, 11 inches 
hhhmmmmmh 
•^■sIMOOiOJOiCnCn 
6 feet, 0 inch 
After the ideal weight for age and height has been determined, the influence 
which activity has on food requirements must be considered and calorimeter DIETS AND MESSING 
585 
studies of individuals in different states of activity have shown the require- 
ments to be as follows: 
require- 
Activity 
Calories per 
kilo 
Total calories 
Basal ... 
20 
1, 200-2,000 
1,300-2, 200 
1, 600-2,500 
1, 800-3.000 
2, 200-4,000 
Bedrest _ 
25 
Light work ..... __ 
30 
Moderate work .. ... 
35 
Heavy work ... 
50 
After determining the total amount of food required it is necessary to 
determine how much protein, fat, and carbohydrate should be used to supply 
the desired number of calories. There is some difference of opinion as to 
this, although it is known, to a fair degree of accuracy, the amount of each 
which can be utilized to the best advantage. The total amount of food required 
depends largely upon the amount of exercise taken. The protein metabolism, 
however, does not depend so much upon the amount of exercise as it does 
upon the amount of food taken. It is known that carbohydrates and fats 
protect the body protein, and if a diet is used which is low in protein, nitrogen 
equilibrium may be obtained by adding fats and carbohydrates to the diet, 
providing, of course, the protein intake does not fall below the minimum require- 
ment. Ordinarily the protein intake, to supply the average body requirements, 
need not exceed 120 Gm. nor be under 60 Gm. daily, and the optimum probably 
lies between these figures, varying with the individual conditions. 
As regards the amount of fat and carbohydrates in the average diet, there 
is also some difference of opinion, although the figures do not vary as much 
as for the protein. 
It is an easy matter to determine the quantities of carbohydrates, proteins, 
and fats necessary to produce any number of calories in a diet by using the 
percentages of distribution of each class of food and the caloric value of each. 
If, in a diet having a distribution of 50 per cent carbohydrates, 15 per cent 
proteins, and 35 per cent fats, it is desired to provide a total of 2,400 calories, 
it is first found that— 
Carbohydrates should furnish 50 per cent of 2,400 calories or 1,200 
calories; 
Proteins should furnish 15 per cent of 2,400 calories or 360 calories; and 
Fats should furnish 35 per cent of 2,400 calories or 840 calories. 
Having found the number of calories to be furnished by each class of food, 
by using the caloric values of each class as given before in this section, it 
is next found that there will be required to furnish a total of 2,400 calories: 
or 300 Gm. of carbohydrates; 
360-M, or 90 Gm. of proteins; and 
840-5-9, or 93.3 Gm. of fats. 
In planning a diet in an individual ease it should be remembered that 
undernutrition lessens the natural power of resistance to diseases, while 
overeating puts unnecessary strain on the organs of digestion and elim- 
ination, favors obesity, and increases the amount of waste products. Prob- 
ably the best way to work out a diet is first to determine the number of 
calories required, of which amount, from 10 to 15 per cent should be fur- 
nished by protein. The nature of the protein should be considered, and those 
containing the necessary amounts of amino-acids should be included. The 586 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
proteins found in milk and meat are, as a rule, more valuable than those 
in vegetables. The remainder of the calories is made up from fats and 
carbohydrates. These are interchangeable within certain limits. Ordinarily the 
amount of fat taken does not exceed 60 to 100 Gm. per day and the balance 
is made up of carbohydrates. 
The diet also should contain the various salts needed in metabolism and 
in a general mixed diet they are almost always present, although in restricted 
diets the quantity may be too low. In ordinary diets the requirements are 
easily met if milk products, salads, and other green vegetables are included 
and the importance of so including them must be emphasized. 
Foods ordinarily should furnish more bases than acids, and meats, cereals, 
and other acid-forming foods should be offset by those containing alkalies, 
as potatoes, bananas, vegetables, and fruits. 
The inclusion of vitamins is important and necessary. 
There always should he an antiscorbutic in the diet such as some fresh 
fruit or vegetable. The food also should contain sufficient bulk. 
Flavors and condiments have no nutritive value, but are used to increase 
the appetite by rendering food more palatable and adding savor to the 
diet. Spices are represented by such substances as ginger, cinnamon, nut- 
meg, and cloves; flavoring extracts by vanilla, lemon, and strawberry; and 
condiments by mustard, horseradish, pepper, salt, and vinegar. 
Beverages, as tea and coffee, may be regarded as stimulants due to the 
effect of caffeine; cocoa contains carbohydrates, fats, and proteins. The various 
meat extracts contain little in the way of food value, but have a stimulating 
effect on the digestive secretions. 
An adequate diet for a normal individual should consist of foods producing 
sufficient calories to maintain ideal body weight, of which carbohydrates fur- 
nish 50 to 75 per cent, proteins 10 to 15 per cent, and fats 35 to 50 per cent 
of the total caloric requirements, and the protein requirement may be con- 
sidered for estimating purposes as 0.66 to 1.5 Gm. per kilogram of standard 
weight. In such an adequate diet there should be the amounts of inorganic 
mineral salts and vitamins shown in the following table: 
Minerals 
Vitamins 
A—5,000 to 6,000 International units. 
B—400 to 500 International units. 
Iron (0.015 Gm) 
C—1,200 to 1,500 International units. 
D—Amount for adults not definitely known but it is essential 
that foods containing it be provided in the diet. 
Foods known to contain the other vitamins should be used gen- 
erously in the diet. 
The composition of an adequate diet is shown in the following table: DIETS AND MESSING 
587 
Vitamins 
Cal. in 
Phos. in 
Iron in 
Food 
Portions in household measures 
in Gms. 
in Gms. 
Gms. 
Gms. 
Gms. 
Gms. 
A 
B 
C 
Q 
480 
24.0 
16.0 
19.0 
0. 576 
0.446 
0. 0012 
1, 200.0 
96.0 
9.6 
288.0 
960 
1 qt. (child). - 
48.0 
32.0 
38.0 
1.152 
0.892 
0.0024 
2. 400.0 
192.0 
19.2 
576.0 
150 
77.5 
12. 5 
2.5 
0.075 
0.375 
0. 0030 
220.0 
50 
6.7 
5.2 
0.033 
0.090 
0.0015 
550.0 
25.0 
65.0 
45 
0. 45 
36.0 
0.0072 
0.0076 
0.00009 
1, 287.0 
120 
30.0 
22.0 
0.016 
0. 320 
0. 0044 
80.0 
60.0 
163.2 
60 
20.0 
5.0 
2.0 
0.019 
0.126 
0.0011 
60.0 
22.0 
4.0 
0.106 
0.043 
0.0004 
100 to 150 
12.0 
1.0 
0.045 
0.021 
0. 0005 
67.0 
60.0 
65.0 
35.0 
100 
15.0 
0.5 
0.5 
0.007 
0.012 
0.0004 
80.0 
25.0 
25.0 
20.0 
50 
11.5 
0.6 
0.1 
0.004 
0.014 
0.0003 
137.5 
15.0 
9.0 
17.5 
Vegetables: 
10% string beans - 
100 
% cup (if young estimate as 6%) - . _ _ 
7.7 
2.4 
0.2 
0.050 
0.051 
0.0010 
1,000.0 
40.0 
25.0 
25.0 
100 
4.0 
1.0 
0.5 
0.010 
0.026 
0.0004 
1, 500.0 
17.5 
15.0 
6.5 
100 
19.0 
2.0 
0.050 
0.051 
0.0010 
40.0 
40.0 
15.0 
25.0 
120 
5. 5 
3.0 
22.0 
0.112 
0.096 
0.0002 
750.0 
15 
15.0 
1 scant tbsp. * 
13 
0.5 
11.0 
? 
? 
? 
45 
45.0 
Pifdding (cornstarch) 
(?) 
3 rounded tbsp _ . __ 
26.0 
3.0 
3.5 
0.018 
0.084 
0.0002 
? 
? 
7 
? 
304.7 
88. 15 
124.5 
2.1282 
1, 7626 
0.01569 
6, 691. 5 
758.5 
1636 
633.2 
Total calories, nutrients, 
to 
to 
to 
to 
to 
to 
to 
to 
to 
to 
and vitamins 
2678 to 2987.9 
328.7 
104.15 
143.5 
2. 7042 
2. 2086 
0. 01689 
7,891.5 
854.5 
173.2 
921.2 
Analysis of Adequate Diet 
(From Nutrition and Diet Therapy—Proudfit) 
154294°—39 88 588 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The foods contained in the adequate diet analysed in the preceding table 
may be used in a menu arranged as follows: 
Breakfast: 
Fruit—1 orange with 2 teaspoonfuls sugar; 
Cereal—1 serving, with 
Cream (medium)—% cup and 2 teaspoonfuls sugar if desired; 
Egg—1 whole, prepared as desired; 
Bread—1 to 2 slices with 2 teaspoonfuls butter; 
Beverage—1 glass milk for children; 
Jam, or equivalent—1 tablespoonful. 
Luncheon or Supper: 
Cereal (macaroni)—1 serving cooked with 1 ounce grated cheese; 
Fruit— 
Vegetable— 
Salad dressing—J 
1 small banana; 
lettuce, 3 to 5 small leaves; 
2 teaspoonfuls mayonnaise or salad dressing; 
ll serving 
Bread—2 slices, whole-grain preferred ; 
Milk—1 glass ; 
Butter—1 tablespoonful. 
Fruit—1 serving applesauce (1 medium cooked with 1 tablespoonful sugar) ; 
Cream (medium)—2 tablespoonfuls. 
Dinner: 
Meat—1 serving roast beef; 
Potato—1 medium ; 
v , J10%—1 serving string beans (if very young, will come under 5% group) , 
ege a es|g% tomato, raw (medium) ; 
Salad dressing—1 tablespoonful; 
Bread—1 slice ; 
Butter—i teaspoonfuls ; 
Dessert—1 serving rice, tapioca, or cornstarch pudding. 
As a knowledge of the composition, use, and digestibility of foods is essential 
in the planning of diets, the principal food substances are next discussed briefly. 
Animal foods. 
The flesh of animals, poultry, and fish is classed as meat and is one of the 
most important articles of food. Meat is man’s chief source of protein and 
contains muscle tissue, connective tissue, blood vessels, nerves, and lymphatics, 
together with a varying amount of fat. 
Cooking has the effect of rendering connective tissue soluble and allowing 
the digestive secretions to mingle more freely with the muscle fibers. It also 
improves the flavor and appearance of the meat and destroys bacteria which 
may be present in the meat. 
Beef.—An ox from 3 to 5 years old supplies the best beef. The meat of a 
very lean animal will contain about 75 per cent of water and 2 per cent of 
fat. The muscles least exercised are the most tender and make the best 
roasts and steaks. Beef juice is nutritious when properly prepared and con- 
tains from 5 to 10 per cent of protein. 
Veal.—Veal is more difficult to digest than beef and is obtained from calves 
6 to 10 weeks old. In some persons it tends to produce digestive disturbances 
and is to be avoided in cases of digestive disability. 
Mutton.—Mutton is obtained from the 3- to 5-year-old sheep and is consid- 
ered by some writers more digestible than beef. 
Lamb.—Is obtained from sheep less than a year old and is as digestible as 
beef or mutton but contains relatively too much fat. 
Pork.—Pork is the most indigestible of all meats on account of the large 
percentage of fat it contains. 
Ham and bacon.—Ham and bacon are both more digestible than pork. When 
cooked crisp, thin slices of bacon are digested easily. 589 
DIETS AND MESSING 
Animal viscera.—Animal viscera are not quite so nutritious as most meats. 
Tripe, liver, kidney, and brains are used extensively. The heart is tough and 
indigestible. Sweetbreads, either the pancreas or the thymus gland of the calf, 
are digested easily. In recent years liver and kidney have been used exten- 
sively in the diet because of their vitamin and iron content. Liver and the 
extract therefrom are specific in the treatment of pernicious anaemia. 
Poultry.—Chicken is one of the most digestible and agreeable varieties of 
meat. Squab is also a desirable and easily digested food. Game birds are 
digested easily and are richer in extractives. 
Fish.—Fish is used very widely as a food and is always best used in season. 
Fish are in best condition just before spawning. After this process they be- 
come thin and unfit for food. Fish undergo decomposition rapidly and as a 
rule should be eaten in as fresh condition as possible. Shell fish (oysters, 
clams, and mussels) may be eaten raw or cooked. Oysters, when eaten raw and 
fresh, are very digestible but when cooked are less easily digested. 
Eggs.—Hens’ eggs are consumed in large quantities and those of the duck, 
turkey, guinea hen, and wild fowl also are eaten. Eggs contain mainly protein 
and fat in addition to water and are extremely valuable in the diet because 
of their vitamin and mineral content. Eggs are highly nutritious and when 
served with milk or broth form an important article of diet for convalescent 
patients. 
Milk.—Milk is probably the most important of animal foods, containing all 
the elements necessary for the maintenance of life. It forms the exclusive 
diet for young growing mammals but is unsuited as an exclusive diet for adults. 
It contains about 4 per cent of fat, 3.3 per cent of protein, 5 per cent of carbo- 
hydrate, 0.7 per cent of mineral matter, and 87 per cent of water. Milk is a 
valuable source of vitamins A, D, and G. Heat is employed in keeping milk, 
usually by two methods—either sterilization or pasteurization. Sterilisation is 
accomplished by boiling for 10 minutes or longer. There are certain objections 
to sterilized milk as boiling kills the ferments and places milk in the class of 
so-called “dead foods.” It may be used to advantage, however, in very hot 
weather when ice is not available. Pasteurisation means heating milk to a de- 
gree sufficient to kill harmful bacteria but with the least possible effect upon its 
value as a food. See page 382 for pasteurizing methods. While pasteurization 
kills most of the bacteria, particularly the pathogenic bacteria, it does not render 
the milk sterile; however, it does not materially change the composition of the 
milk as does sterilization. Pasteurized milk must be kept cool to prevent 
deterioration. 
Vegetable foods. 
Vegetable foods differ from animal foods in that they contain more starch 
and sugar and a relatively small amount of protein. 
Cereals.—These are the most important of the vegetable foods and to this 
class belong wheat, corn, rye, oats, barley, rice, and buckwheat. The cereals 
are supplied chiefly in the form of flour or meal. 
Legumes.—Peas and beans are the most important legumes and contain a 
liberal proportion of protein. Lentils are used comparatively little in the United 
States, but are used extensively in other countries. Peanuts belong to this 
class and differ from other legumes in that they contain a large amount of 
fat. The principal legumes, peas and beans, should be well cooked so that the 
cellulose enclosing the vegetable cells is broken down. 
Roots and tubers.—This includes potatoes, sweetpotatoes, yams, artichokes, 
beets, carrots, parsnips, turnips, and radishes. They contain both starch and 
sugar but are relatively lower in nutritive value than either legumes or cereals. 590 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Green vegetables.—Green vegetables are valuable not only on account of 
their nutriment but for variety and relish and for their content of salts and 
vitamins. They also give bulk to the food which is important on account of 
its mechanical action in maintaining a healthy alimentary tract. The princi- 
pal articles of food in this class are cabbage, cauliflower, spinach, lettuce, 
sorrel, tomatoes, eggplant, cucumbers, asparagus, rhubarb, pumpkin, squash, 
onions, and garlic. 
Fruits and nuts.—Fruits are used extensively as flavoring agents. Their 
chief nutrient constituent is sugar, the principal sugar being levulose and some- 
times cane sugar. The mineral elements of fruit contain potash with tartaric, 
stearic, and malic acids. The antiscorbutic properties of fruits are due to 
their salts and vitamins. Fruits also act as diuretics and laxatives. The 
most easily digested fruits are oranges, lemons, grapes, and peaches. Apples, 
pears, and bananas are slightly less digestible. 
Nuts contain a large quantity of fat and somewhat more protein than 
fruits. They are taken mainly as a dessert and as a rule do not constitute a 
large source of nutriment. They are not digested easily as a rule, owing to the 
large amount of cellulose and high proportion of fat. 
DIET THERAPY OR DIET IN DISEASE 
In feeding the sick it is advisable to carry out the patient’s wishes whenever 
practicable, and to a certain extent make allowance for likes and dislikes and 
certain idiosyncrasies. A tactful, observing, and sympathetic nurse who ac- 
quaints himself or herself with these facts will be of the greatest help to the 
medical officer in carrying on his dietary regime. The nurse should have a 
knowledge of practical dietetics and of the amount of food required by different 
types of patients. 
Food should be given at regular intervals. This is particularly important 
in semiconscious or comatose patients, and in the conscious patient regularity 
in meals Is also of distinct advantage. 
The appetite of the convalescent patient requires catering to, as patients in 
this condition are apt to be more fastidious than when they are well. 
The sick room should be neat, and no dishes, utensils, or food allowed to 
stand about the room either before or after using. Food and drink should be 
served from scrupulously clean utensils. These utensils should be as attrac- 
tive as possible, and the food must be dainty and appetizing in appearance. 
If the patient approaches his food with the flow of his digestive secretions 
stimulated by the psychic reaction to the odors and appearance of the food, he 
is in a position to get the greatest amount of good from his meal. An attrac- 
tive dish, garnished with sprigs of green, accompanied by clean linen and 
bright silverware, will go a long way toward accomplishing this result. 
Food that is stale or has acquired an unpleasant odor or taste from standing 
in a refrigerator should never be given. A strong egg in an eggnog or an 
odorous piece of meat may be the means of turning the patient away from 
much needed nourishment. 
The patient should be made to feel that the utmost cleanliness and care 
have been observed, and the face and hands of the patient should be cleansed 
before food is given, and the lips and teeth cleansed after the meal is com- 
pleted. If the mouth is dry, it should be moistened from time to time with a 
mixture of water, glycerin, and lemon juice. 
When special diets are ordered, the contents of the tray should be checked 
with the written orders. An error in serving a special diet may cause dis- 
comfort, serious illness, or even death. DIETS AND MESSING 
591 
If an order is given to record the intake of food or drink for a patient, it 
should be kept accurately and be available for the medical officer at all times; 
it is essential for his treatment of the patient. 
To recapitulate, the tray should be served with the proper diet and arranged 
in an attractive manner. Hot foods should be served on hot dishes and cold 
food on chilled dishes. A restful atmosphere is conducive to a good appetite 
and good digestion. 
Diets used in the treatment of disease are often spoken of by names that 
show a special composition and often indicate the purpose for which the diet 
is intended. Some of these names are: High-caloric, low-caloric, high-roughage, 
low-residue, salt-free, salt-poor, high-fat, low-fat, fat-free, fat-poor, high-calcium, 
high-carbohydrate, low-protein, diabetic, ketogenic, obesity, etc. 
A brief description of the diets suitable for certain diseases is given next. 
Allergies.—Food allergy diets are high-caloric diets made up from a more or 
less restricted dietary list. They may he made up from “elimination” diets or 
from the patient’s skin sensitization list. In the latter case, all foods to which 
he reacts positively are excluded from his diet. 
Anaemia.—The diet in anaemia should consist of easily digested foods rich in 
iron and copper, such as eggs, liver, kidney, beef and other meats, green 
vegetables, whole grain cereals, fresh and dried fruits, and dried legumes. 
Cardiac diseases.—In acute heart failure with oedema, the patient usually 
is placed on a restricted diet consisting of 800 to 900 cc of milk in 24 hours 
until the oedema tends to disappear. The transition from milk to a more solid 
diet is begun slowly by adding gradually soft cooked eggs, dry toast, baked 
potato, fish, or the white meat of chicken. Later, as the cardiac condition 
improves, more solid food is given, but never a large amount of food at any 
one meal, in order to avoid embarrassing the heart by a well-filled stomach. 
Constipation.—In the ordinary type of constipation, due to sluggish action 
of the bowel, and not due to mechanical obstruction, it is advisable to give 
food which tends somewhat to irritate and stimulate peristalsis, such as oat- 
meal, whole wheat, vegetables, fruit, and a liberal amount of water. 
In spastic constipation the diet is just the reverse of that employed in the 
atonic type. A bland, low-residue diet is given, beginning with one of the semi- 
liquid or soft character. Later, the diet is increased to a soft, smooth-residue 
one. 
Diarrhoea.—In the ordinary type of diarrhoea, due to an acute gastroin- 
testinal disorder, give bland nonirritating liquids for a diet, well-cooked and 
strained gruels, such as arrowroot, farina, and rice, and boiled milk. Later, 
as the condition improves, lean meat and fish, potatoes, simple extracts, and 
milk puddings may be added. 
Diabetes.—The diet in diabetes is one in which carbohydrates and fats are 
regulated by the medical officer. It is given exactly as prescribed by the med- 
ical officer and it is essential that the patient should eat it entirely.* Nor 
should he take any other food. 
Gastric ulcer.—Lenhartz or Sippy diet or some similar diet is probably the 
most generally used. This consists of hourly feedings during the first 10 days 
of small amounts of milk and cream, between which feedings alkalies are given 
by mouth. Later the feedings are given at 2-hour intervals, and at the end 
of 4 or 5 weeks five or six feedings a day are given, with gradual addition 
of semisolids and later solid foods. 
Long Island College Hospital ulcer diet is another diet successfully used in 
the treatment of gastric ulcers. It includes milk, toast, butter, cream, cooked 592 
HANDBOOK OF THE HOSPITAL CORPS, V. S. NAVY 
cereals, soft cooked eggs, cream cheese, simple desserts, stewed fruits, and 
lactose. It is served in meals three times a day with interfeedings. 
Gout.—Prohibit food of glandular organs, such as sweetbreads, liver, kid- 
neys, and all food rich in extractives, as well as acid and highly seasoned 
foods. The diet should consist principally of milk, cream, eggs, butter, farina, 
tapioca, cornstarch, extracts, ice cream, water ices, potatoes, and possibly a 
little boiled meat. 
Nephritis— In an acute attack with oedema, avoid condiments and salt in the 
diet and give bland, easily digested food with not more protein than is necessary 
to maintain the basal requirements, the balance of the diet being made up 
from carbohydrates and fats in sufficient amounts to maintain the caloric 
requirements of the individual. In some cases the Karell diet is recommended, 
consisting of 800 cc of milk a day, although it is not considered advisable to 
maintain the patient on this diet for any length of time. 
In, the chronic forms of nephritis this principle still holds, it being ad- 
visable to throw the minimum amount of work on the kidneys and to elimi- 
nate all irritating and highly seasoned dishes from the menu. The restriction 
of protein intake below that required for the actual body needs is inadvisable, 
as if insufficient protein is derived from the food the patient will make up the 
deficiency from his own tissues. 
As regards the amount of water a patient with nephritis should take, it is 
not advisable to lay down any specific rule, as the amount which should be 
taken in each case depends upon the ability to excrete water, and this can be 
ascertained readily if the amount ingested and the amount excreted is meas- 
ured daily. 
Obesity.—In obesity, determine the number of calories the patient is to have 
each day, giving less, of course, than the amount required to maintain the 
weight of the patient. Ordinarily, if a patient is up and about and can com- 
bine a restricted diet with a certain amount of exercise, the efforts at reduc- 
tion of weight will be much more effective. A diet containing 1,200 to 1,500 
calories per day, together with exercise, such as walking 3 to 5 miles a day, 
usually will accomplish the desired result. If the patient is given foods of low 
caloric value such as the green vegetables, and items such as butter, cream, 
bread, and potatoes eliminated from the diet, he usually can get along with- 
out suffering inconvenience or severe hunger. 
Fevers.—In fever the metabolic processes are increased and the power of 
assimilation is lowered. In order to maintain a fever patient properly the food 
should be easy to take, easy to digest, and readily assimilated. Milk is the 
almost universally used food in this condition, but must be supplemented by 
additional items. Cream is of great value owing to its high caloric content, 
and eggs also constitute a valuable addition to the diet. Meats ordinarily are 
not used in fevers, although the meat juices may be used occasionally. The 
balance of the diet may be made up from sugars and starches, and sufficient 
fluid should be supplied to keep the patient comfortable. 
Tuberculosis.—The diet of the tuberculous patient should be ample, slightly 
more than the patient’s calculated requirement. It should be well balanced 
and not lacking in vitamins, minerals, or roughage. Protein should be liberal 
but not excessive. Fats should be generous, and carbohydrates in normal 
proportions. 
The food should be simple, easily digested, and well prepared. Some authori- 
ties believe food between meals is inadvisable because, as a rule, more will be 
eaten at meal times and with better enjoyment if there has been no interfeed- 
ing. Rest before and after meals is beneficial to the digestion. DIETS AND MESSING 
593 
CLASSIFICATION OF DIETS IN NAVAL HOSPITALS 
The diets served in naval hospitals usually are liquid, soft, light, regular, 
and special diets. 
Liquid diets are usually ordered as “clear liquid” or “full liquid.” A clear 
liquid diet includes clear broths, rice and barley water, black tea or coffee, 
jello, and strained fruit juices. A full liquid diet includes all liquids served 
in a clear liquid diet with the addition of strained soups, strained gruels, milk 
and milk drinks, ice cream, and junket. 
Soft diet includes all liquids in addition to well-cooked cereals, Italian 
pastes, white bread and crackers, soft-cooked eggs, cottage cheese, soft cream 
cheese, tender fish, chicken, minced tender lamb and beef, sweetbreads, and 
brains. Baked, mashed, escalloped, and creamed potatoes, and pureed vege- 
tables are also given on a soft diet. The desserts used are custards, gelatin 
puddings, simple cakes and cookies, cooked fruits without seeds or heavy fiber, 
and ripe bananas. 
Light diet includes all articles given in the soft diet as well as prepared 
cereals, whole-wheat bread, creamed or grated cheese, steaks, chops, bacon, tender 
roast lamb or beef, fish, and liver. The vegetables allowed, not purded, are 
asparagus, peas, string beans, spinach, carrots, beets, squash, tomatoes, and 
lettuce. All cooked fruits, citrus fruits, olives, and mayonnaise are allowed. 
Regular diet is the diet served to the general mess. 
Special diets include the Lenhartz, Sippy, Karell, and other special dietaries 
which are indicated in some particular diseases and which are prescribed by 
the medical officer for some particular case. 
SPECIAL METHODS OF FEEDING 
Special methods of feeding include rectal feeding, duodenal alimentation, 
nutrient inunctions, intravascular injection, saline irrigations and saline in- 
fusions. 
Nutrient enemata.—This is the term applied to the administration of food by 
rectum. With careful technique, a patient may be fed by rectum for a period of 
several weeks, although it is doubtful if more than one-sixth to one-fourth of 
the total caloric requirements can be supplied in this manner. The rectum 
first should be cleansed thoroughly by high injection of physiological salt solu- 
tion an hour before the enema is to be given. This cleansing enema should be 
given at least once a day. 
Nutrient enemata may be indicated in extremely weakened conditions when 
the quantity of food taken through the mouth is insufficient to maintain life; 
in obstruction of the pharynx or oesophagus, and in paralytic conditions of 
the pharynx when the patient is unable to swallow food; in diseases of the 
stomach, as in cancer with stricture and in delirious, comatose, or insane per- 
sons who cannot be fed by mouth. 
In feeding by rectum it must be remembered that the large intestine has 
no power of digestion, apparently absorbs little besides water and salts, and 
there is but little possibility that food administered in this way will reach 
the small intestine where most of digestion takes place. Consequently in feed- 
ing by rectum only predigested foods or foods in an immediately absorbable 
form, such as dextrose solution, should be given. 
The usual nutrient enema consists of milk, which has been pancreatized for 
24 hotirs and boiled, about 8 ounces, to which may be added either 2 to 3 drams 
of dextrose, 2 to 3 drams of alcohol, 1 or 2 yolks of eggs, or a combination 
of all three. 594 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The nutrient enema usually is given by the drop method and it is sometimes 
advisable to add 10 or 15 drops of tincture of opium as a sedative. 
Duodenal alimentation.—This consists of feeding through a duodenal tube 
which has been introduced through the stomach and is a desirable way of 
feeding a patient in conditions in which the stomach needs a rest. 
Nutrient inunctions.—Particularly if oils such as olive oil, cod liver oil, 
coconut oil, or cocoa butter are used, nutrient inunctions are sometimes of 
value, especially in infants suffering from marasmus or malnutrition. 
Intravascular injection.—This consists in introducing fluid into a vein, usually 
in the form of salt, alkaline, and dextrose solutions. It usually is practiced as 
an emergency measure and not as a routine procedure. 
Subcutaneous feeding.—This method of administration is somewhat unsatis- 
factory, but solutions of dextrose in physiological salt solution and also olive oil 
have been given in this manner. 
Saline irrigation and infusion.—Saline Irrigations by rectum are especially 
useful in such conditions as luemorrhage and in various acute fevers when it 
is inadvisable to give fluids by mouth. They serve to allay thirst and are 
a very useful means of increasing the amount of fluid in the system. Saline 
infusion given subcutaneously is useful in cases where the patient cannot 
retain a rectal solution and usually is given in the chest, lumbar region, abdo- 
men, or buttock. 
RECIPES 
Peptonized Milk (Warm process) 
Put one-half cup (gill) of cold water and the powder contained in one 
peptonizing tube into a clean quart bottle and shake thoroughly; add a pint 
of cold fresh milk and shake again; then place the bottle in a pail or kettle 
of warm water at about 115° F., or not too hot to immerse the whole hand in 
it without discomfort. Keep the bottle in the water bath for 5 or 10 minutes, 
or longer if it is desired to peptonize the milk quite completely, then put it 
immediately on ice in order to check the process of digestion and keep the milk 
from spoiling. The container should be placed directly in contact with the ice. 
The degree of peptonization is regulated very simply in this process by the 
length of time during which the milk is kept in the water bath. It is seldom 
necessary to peptonize milk until it becomes bitter. 
In the following formulas for preparation of food for the sick, those marked 
with an asterisk (*) are quoted from “Dietetics for Nurses,” by F. T. Proudfit: 
* Okangeade 
Juice of 1 orange. 
1 tablespoonful sugar. 
Juice of % lemon. 
Enough water to fill the glass. 
* Albuminized Okangeade 
Make orangeade as directed in preceding recipe without the addition of water. 
Break the whites of two eggs into a saucer and with scissors cut the albumin 
until free from membrane and strain, stir this into the orange juice and add 
several pieces of cracked ice. This is both nourishing and palatable, and the 
taste of the egg cannot be detected. 
1 egg. 
% tablespoonful sugar. 
Speck of salt. 
Egg Nog 
% cup milk. 
Flavor with nutmeg. 
Beat the egg, add the sugar and salt; blend thoroughly, add the milk and 
nutmeg. Serve immediately. DIETS AND MESSING 
595 
2 teaspoonfuls cocoa. 
V2 teaspoonful sugar. 
* Cocoa 
y2 cup boiling water. 
% cup milk 
Mix cocoa and sugar together and add boiling water slowly. Boil 3 to 5 
minutes; heat milk in double boiler and add cocoa mixture. Beat with egg 
beater to distribute cocoa and prevent scum forming. Serve with or without 
whipped cream. Cocoa may be reinforced with albumin or the whole or yolk 
of one egg well beaten. If the white alone is used, care must be observed that 
the liquid is not hot enough to coagulate the albumin. Proprietary foods and 
casein preparations are used in like manner. 
* Malted Milk Chocolate or Cocoa 
1 tablespoonful malted milk. 
1 tablespoonful cocoa or grated choco- 
late. 
6 ounces milk. 
2 ounces water. 
y2 teaspoonful sugar. 
4r-5 drops vanilla extract. 
Mix cocoa or chocolate with water and boil 2 to 3 minutes. Pour milk into 
a double boiler and heat, mix malted milk with a little water and stir into 
the hot milk, add the cocoa paste, sugar, and vanilla, beat the mixture briskly 
to mix ingredients thoroughly, and serve with or without cream. 
1 ounce (3 tablespoonfuls) chocolate. 
1 cup boiling water. 
Chocolate Syrup 
1 y2 cups sugar. 
1 tablespoonful of vanilla. 
Put chocolate in a saucepan and add the water gradually, stirring all the 
time. Add sugar and stir until it begins to boil; boil 3 minutes, strain, cool, 
and add 1 tablespoonful vanilla. Bottle and keep in a cold place. 
Chocolate Shake (Individual rule) 
2 tablespoonfuls chopped ice. 
2 tablespoonfuls chocolate syrup 
3 tablespoonfuls whipped cream. 
y2 cup milk. 
% cup soda water or carbonated watei. 
Shake or stir well before drinking. A tablespoonful of vanilla ice cream is 
a desirable addition. It is a delicious drink, even if the soda or carbonated 
water is omitted. 
A plainer drink is made by combining the syrup, three-fourths cup milk, and 
the ice, and shaking well. 
* Coffee 
2 tablespoonfuls ground coffee. 
2 teaspoonfuls white of egg. 
1 cup boiling water. 
M cup cold (boiled) water. 
Mix coffee with 1 tablespoonful of cold water and egg white in small pot 
(after scalding pot), add boiling water; allow to boil 3 minutes; stir down and 
add cold water; set pot where coffee will stay hot, but not boil, for 10 to 15 
minutes, serve with cream and sugar or to flavor. 
* Coddled Egg 
1 egg 
1 pint water. 
Allow water to boil; wash egg; drop into boiling water and place saucepan 
where water will keep hot, but not boil; allow to stand 7 or 8 minutes. Serve 
with salt. 596 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
* Soft Cooked Egg 
Proceed as for coddled eggs, but allow egg to remain from 10 to 15 minutes 
or even longer, if very soft eggs are not desired. 
Have small, shallow saucepan half filled with boiling water or milk, if an egg 
poacher is at hand, use that; otherwise, lower a flat perforated spoon into 
water and place where the water cannot boil. Break the egg carefully into 
the spoon, taking care not to break the yolk; allow to stand in hot water until 
the white is of the consistency of jelly; lift out, slide egg on to hot toast, 
taking care not to break. (A broken poached egg is very unappetizing, as well 
as untidy in appearance). 
* Poached Egg 
Scrambled Egg 
Wash an egg, break it into a small frying pan, add a teaspoonful of butter, 2 
tablespoonfuls of milk, and pinch of salt and shake of pepper. Put over heat, 
and stir just enough to keep from sticking to pan. Allow mixture to become 
jellylike, remove, and serve on hot buttered toast. 
Toast a slice of bread to golden brown, have about a pint of boiling water, 
put in a teaspoonful of salt. Dip the toast in boiling water and take it out again 
very quickly, then butter lightly, and serve at once. This form of toast can 
be used in case of sore mouth. 
Water Toast 
Toast a couple of pieces of bread to golden brown. Put on 1% cups of milk 
and bring to a scalding point. Add one-fourth teaspoonful salt. Butter the 
toast, cut in strips, and place in bowl. Pour on the scalding milk and serve. 
Milk Toast 
* Baked Custard 
1 egg. 
1 tablespoonful sugar. 
% cup milk. 
A few drops of vanilla. 
Beat eggs and sugar together, stir into milk, grease custard cup with butter, 
pour in the mixture. Set cup on several layers of paper in a deep pan, surround 
with hot water (to about half its depth). Set pan in moderate oven and allow 
to cook slowly until custard is firm in the center. It may be served hot or 
chilled, and turned out, with a tablespoonful of whipped cream on top. 
Care must be taken not to allow the oven to get hot or the egg will coagulate, 
making a watery, unpalatable, and indigestible mixture. 
* Soft Custard 
1 egg (or 2 yolks). 
1 tablespoonful sugar. 
1 cup milk. 
A few drops of vanilla. 
Heat milk in double boiler. Beat egg and sugar together. When milk has 
reached the scalding point (small bubbles form around the edge of the sauce- 
pan), stir in the egg. Care must be taken not to allow the water under the 
saucepan to become too hot, as the custard will curdle if the egg is cooked at 
too high a degree of temperature. The custard must be stirred constantly in 
the beginning until it begins to thicken, then several times a minute until it 
is of the desired consistency and the raw taste is cooked out of the egg. This 
mixture is done when it will form a coating upon the spoon. Serve with 
whipped cream on top. DIETS AND MESSING 
597 
Beef Tea with Hydrochloric Acid 
Select one-half pound of good beef; remove everything that is not clear 
meat. Chop it fine. Put in pint fruit jar and add 1 cup cold water and 
5 drops diluted hydrochloric acid. Stir and set in refrigerator or any cold 
place for 2 hours to digest. Then strain, season with salt, and serve in 
dainty china cup on account of color. If one should object to color, heat the 
tea in a double boiler just till color changes. Do not strain. Beef tea made 
in this way is recommended by physicians for feeble children and patients 
much weakened by sickness. 
Select a piece of meat from the rump or top of the round. Remove all fat 
and broil or warm slightly 1 or 2 minutes, to set free the juices; lay on 
plate and cut meat in various directions that more juice may be extracted; 
then squeeze out the juice by means of a press, lemon squeezer, or potato ricer 
into a slightly warmed cup. Salt if necessary, and serve at once. Prepare 
only enough to serve, as it does not keep well. Serve in dainty china cup to 
disguise color. One pound of meat yields 4 ounces of juice. 
Beef Juice 
1 teaspoonful granulated gelatin. 
1 tablespoonful cold water. 
3 tablespoonfuls boiling water. 
Orange Jelly, (Individual rule) 
2 tablespoonfuls sugar. 
3 tablespoonfuls orange juice. 
2 teaspoonfuls lemon juice. 
Soak the gelatin in the cold water one-half hotir; add the boiling water 
and dissolve. Add sugar and fruit juice, strain through a cloth and strainer 
into cold, wet mold. 
Cocoa Junket (Individual rule) 
1 tablespoonful cocoa. 
2 teaspoonfuls sugar. 
2 tablespoonfuls boiling water. 
1 cup milk. 
% Junket tablet. 
1 teaspoonful cold water. 
3 drops vanilla. 
Mix the cocoa, sugar, boiling water, and cook over heat and rub to a smooth 
paste; add gradually the fresh cool milk. Heat until lukewarm (not more), 
add vanilla and then tablet dissolved in the cold water. Pour mixture im- 
mediately into sherbet cups, partly full. Stand in warm room undisturbed 
until firm, like jelly, then put on ice to cool. 
Dietetics for Nurses.—Proudfit. 
Nutrition and Diet Therapy.—Proudfit. 
Diet Manual, St. Mary’s Hospital, Rochester, Minn.—Sister Mary Victoria. 
Nutrition.—Chaney and Ahlborn. 
Nutritional Charts.—H. J. Heinz Co. Research Department. 
Foods Rich in Vitamins A, B, C, D, E, G, and the P-—P Factor.—Munsell and Daniel.— 
U. S. Department of Agriculture Bulletin. 
Hospital Corps Handbook, U. S. Navy, 1923. 
Handbook of the Hospital Corps, U. S. Navy, 1930. 
References CHAPTER VIII 
PHARMACY 
From the vegetable, mineral, and animal kingdoms of Nature are obtained 
the medicinal substances used for the alleviation of disease and for the restoring 
or the preserving of health. 
Pharmacy is the science which treats of medicinal substances. 
The study of pharmacy embraces not only a knowledge of medicinal sub- 
stances and of the art of preparing, compounding, and dispensing them, but 
also of their identification, selection, preservation, combination, analysis, and 
standardization. The discovery of new medicinal drugs and the making of 
organic compounds are Important functions of scientific pharmacy. 
The word pharmacy is also used as the name of a place where medicines 
are sold, and it is derived from the Greek word pharmacon, meaning “a drug, 
a medicine.” 
For convenience in studying pharmacy, this science is divided into two 
major classes: Theoretical Pharmacy and Practical Pharmacy. 
As all Nature is called upon to provide the remedies used in the healing 
art, it follows that the sciences which contribute to a thorough understanding 
of the vegetable, mineral, and animal substances used as medicines, and the 
sciences which treat of the laws governing them, furnish many of the important 
facts forming the basis of scientific pharmacy, and that a knowledge of those 
sciences is essential to theoretical pharmacy. 
Theoretical pharmacy is that branch of pharmacy which treats of the sub- 
stances used as medicines and of the laws governing them. 
The following sciences comprise theoretical pharmacy: 
Botany, the science of plants. 
Mineralogy, the science of inorganic substances found in and on the earth. 
Zoology, the science which treats of animals. 
Physics, the science which describes and explains the changes produced in 
substances by which their original identity is not destroyed. 
Chemistry, the science which treats of those changes produced in substances 
affecting or altering their original identity. 
Materia medica, the science which treats of the medicinal materials used 
for cure or the prevention of disease. 
Pharmacognosy, the science which treats of crude drugs. 
Toxicology, the science which treats of poisons, their sources, effects, and 
antidotes. 
Microscopy, the science of examining the minute structure of substances by 
the aid of the microscope. 
Bacteriology, the science which treats of microorganisms. 
Serology, the science which treats of serums. 
Biology, the science which treats of life. 
Pharmacodynamics, the science which treats of the action of drugs and their 
effects upon the various organs and functions of the body. 
Pharmacology, the science which treats of the nature and properties of 
drugs. 600 
HANDBOOK OF THE HOSPITAL CORPS, XL S. NAVY 
Upon the sciences of physics and chemistry pharmacy is most dependent 
for its greatest development and for its highest degree of usefulness. 
Practical pharmacy is that branch of pharmacy which treats of the opera- 
tions, processes, and methods used in applying the principles of theoretical 
pharmacy. Practical pharmacy is sometimes known as operative pharmacy. 
In the Navy the practice of pharmacy is concerned primarily with the com- 
pounding and dispensing of remedial agents according to the prescription 
of the medical officer or to the instructions given in authoritative texts. Com- 
pounding is the skillful blending of two or more ingredients. Dispensing is the 
transferring of a substance from one container to another for any one of 
several reasons. In civil life compounding and dispensing are the acts which 
legally distinguish the practice of pharmacy from the mere selling of drugs 
and remedies. 
The principal books used in the study and practice of pharmacy are the 
United States Pharmacopoeia, the National Formulary, dispensatories, and 
textbooks on the principles and practice of pharmacy. 
The United States Pharmacopoeia is an authoritative book containing a list 
of standardized medicinal substances, with descriptions, tests, and formulas for 
preparing them. The medicinal substances listed in it are recognized as official, 
and the word “official” as applied to a drug or preparation means that it is 
listed only in the Pharmacopoeia. It was first published in the year 1820, 
by the doctors of the United States who before that time had no national 
standard for the medicines and preparations they were using. It has been 
revised every 10 years since 1820 and the present revision is known as the 
eleventh, abbreviated U. S. P. XI. The Pharmacopoeia is owned, edited and 
revised by the United States Pharmacopoeial Convention which is incorporated 
under the laws of the District of Columbia. This convention is made up of 
delegates appointed from the professions of medicine, dentistry, pharmacy, and 
chemistry. 
The U. S. Pharmacopoeia recognizes nearly all the drugs and preparations 
that are considered by the medical profession as essential in the treatment of 
the sick or in the prevention of disease. Exceptions are some of the valuable 
medicines of recent discovery and medicines whose composition or method of 
preparation is kept secret or that are controlled by patent rights. It establishes 
the official titles, abbreviation, dose, and synonym of each substance, and defines, 
describes, establishes the purity, gives tests for the identity, assay processes or 
methods for determining the strength, chemical formula, source in the case of 
animal and vegetable drugs, and instructions for the preservation of nearly all 
the medicines which it contains. 
The Pharmacopoeia is recognized by the Federal and State Governments in 
the enforcement of food and drugs acts as the standard for the articles listed 
therein when they are used for medicinal purposes only. 
Medicinal substances of sufficient importance to be given a place in the 
Pharmacopoeia are indicated by— 
1. The official Latin title. Example: Dnguentum Phenolis. 
2. The official English title. Example; Ointment of Phenol. 
3. The abbreviated title. Example: Ung. Phenol. 
4. The synonym. Example: Ointment of Carbolic Acid. 
5. The botanical name (in the case of plants). Example: Capsicum 
frutescens. 
6. The symbolic formula (in the case of chemicals). Example; NasSO^lOILO. 
Latin, being universally used and understood as the language of science 
because it is a dead language and not liable to change, is selected for the official PHARMACY 
601 
title of the substances named in the Pharmacopoeia. The official Latin titles 
of those substances are therefore distinctive and precise, and there is almost no 
possibility for error. The official English titles are used in ordinary conversa- 
tion and in commercial transactions. The abbreviated titles provide uniformity 
in use and help to prevent mistakes in reading and compounding prescriptions. 
Synonyms are usually from old and unscientific sources but through common 
custom and long usage they have become so well established that they cannot be 
entirely ignored or abandoned. The botanical name is the name for plants that 
is recognized by botanists; it serves as the basis of the official name in the 
Pharmacopoeia and its use is absolutely necessary in establishing the identity 
of any vegetable drug, for the Pharmacopoeia names the particular variety of 
a plant that is recognized as official. The symbolic formula is a combination of 
certain arbitrary symbols used to briefly and exactly state the composition of a 
chemical. 
The Purity Rubric was first introduced into the U. S. P. VIII to limit the 
quantity of permissible harmless impurities in chemicals, by stating in terms 
of percentage the amount of pure substance that must he present. Its use 
has been continued and extended to drugs and many other articles in the 
Pharmacopoeia. 
Doses are given in the Pharmacopoeia in both the metric and apothecaries 
systems, but the figures are not interchangeable, nor are they to be considered 
as exact equivalents. Under the term average dose are stated the doses which 
may be expected ordinarily to produce the therapeutic effect for which the 
preparation is most commonly employed. The doses when administered orally 
are those for human adults, unless otherwise indicated. The method of 
administration is named whenever necessary. 
The National Formulary is a book containing a list of extensively used drugs 
and preparations that are not included in the Pharmacopoeia. The medicines 
which it contains are recognized because of their extensive medicinal use and 
pharmaceutical soundness, rather than their therapeutic value. A drug to 
be recognized by the Pharmacopoeia must not only be extensively used, but it 
must also have well-recognized therapeutic properties, or be used in the prep- 
aration of some other medicine in the Pharmacopoeia. A drug to be recog- 
nized by the National Formulary, however, need only be extensively used and 
pharmaceutically sound. This difference makes the National Formulary a book 
of secondary importance to the Pharmacopoeia. 
Many of the drugs and preparations listed in the National Formulary were 
at some time contained in the Pharmacopoeia, and, as they were dropped from 
time to time, the National Formulary took them up, because they were still 
used by many members of the medical profession in different parts of the 
country, and because they were extensively used, it was necessary there should 
be some standard by which they could be prepared. 
The National Formulary is owned, edited, and revised by the American 
Pharmaceutical Association. It is revised every 10 years, usually following 
the revision of the Pharmacopoeia. In the last revision the policy of adopting 
only those preparations and drugs cast aside by the Pharmacopoeia was 
discontinued. 
It is recognized by the Federal and State Governments in the enforcement 
of the food and drugs acts as the standard for the articles listed therein when 
they are used for medicinal purposes only. 
A Dispensatory is a commentary on the United States Pharmacopoeia, the 
National Formulary, the pharmacopoeias of other countries, and, in addition, 
contains information about most of the substances that have been or are now 602 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
used in the cure or prevention of disease. It is an excellent reference book for 
one studying pharmacy or medicine, as it gives a complete description of the 
physical, medical, and pharmaceutical history of medicinal substances, their 
preparation and properties, constituents and compounds, uses, action and doses, 
tests and assays, etc. 
METROLOGY 
Metrology is the science of weights and measures, and treats of the measures 
of length, surface, volume, and weight. The word is derived from Greek words 
meaning measure and discourse. 
Weight is defined as the difference between the attraction of the earth and 
that of surrounding bodies for bodies on the surface of the earth. The weight 
of a body depends upon its bulk and density, density being the amount of 
matter in a given bulk of the body. 
Weighing is the balancing of a body of known gravitating force with one 
whose gravity is not known in order to estimate and determine the gravitating 
forces of the latter, which is called its weight 
Weights are bodies of known gravitating force used for weighing. The 
apparatus used for weighing are scales or balances and weights. Weights are 
based upon standards known as the grain and the meter. 
The weights and measures in general use in the United States are avoir- 
dupois, used in commercial buying and selling; troy, used by jewelers; 
apothecaries, used by pharmacists in compounding; and metric, used almost 
entirely in scientific work and research. 
The grain weight was established by King Henry III of Great Britain in 
1266 in an act in which he decreed in part that “An English silver penny 
called the sterling, round and without clipping, shall weigh 32 grains of wheat, 
well dried and gathered out of the middle of the ear.” This statute was 
reiterated by Edward I in 1304. 
The metric system of weights and measures has for its fundamental unit 
the meter, which is the distance equal to one ten-millionth part of a quadrant 
of longitude running through Paris, France. The length of the meter is usually 
defined as the one forty-millionth part of the circumference of the earth around 
the poles. 
The metric system of weights and measures, also known as the French and 
the decimal system, originated in France as a result of suggestions that there 
be a standard for scientific measurements. The French Assembly in 1790 
appointed commissions to study and report on such a standard and these com- 
missions decided upon the meter as the unit of length, drew up a system of 
weights and measures based on the length of the meter, and fixed the nomen- 
clature. The system of weights and measures and the nomenclature were 
established by law in 1795 but it was not until 1799 that the report on the 
length of the meter was made. On December 10, 1799, a law definitely fixed 
the value of the meter and of the kilogram, or weight of a liter of water. 
Use of this system has been adopted by nearly all countries but has never 
been made compulsory in the United States where, however, its use was 
legallized by an Act of Congress passed in 1866 which also directed its use in 
the medical department of the Army and Navy and the Marine hospital service. 
The Secretary of the Navy in 1878 directed that this system be used in the 
Medical Department of the Navy and its use has also been adopted by many 
scientific bodies in this country. 
In Paris, France, there are preserved the models of the meter and kilogram 
from which all prototypes are made. Since 1875 there has been in Paris, 
France, an International Bureau of Weights and Measures managed by an PHARMACY 
603 
International Committee composed of representatives of all civilized nations. 
This committee makes and provides prototypes of the model meter and kilo- 
gram for the subscribing nations. 
The United States prototypes, made of a platinum-iridium alloy, are kept in 
the Bureau of Standards at Washington, D. G. and are used for standardizing 
all the weights and measures used in the United States. 
The denominations of this system are multiplied by the Greek words deka, 
meaning ten; hecto, meaning hundred; and kilo, meaning thousand, and are 
divided by the Latin words deci, meaning one-tenth; centi, meaning one- 
hundredth ; and milli, meaning one-thousandth. 
The metric system is divided into four branches but only three of these are 
ordinarily used in pharmacy. They are the measures of length, of volume or 
capacity, and of weight. 
The unit of length is the meter, which is the one forty-millionth part of the 
circumference of the earth around the poles1 and is equivalent to 39.37 inches. 
The unit of volume or capacity is the liter, which is the volume of one cubic 
decimeter. It is also defined as the volume occupied by the mass of 1 kilogram 
of distilled water at its maximum density (4°C.). It is equivalent to 2.1134 
pints. The unit of weight is the gram, which is the weight of one milliliter of 
distilled water at its maximum density (4° C.). It is equivalent to 15.432 
grains. 
The unit of microscopic measurement is the micromillimeter, or micron, 
which is a thousandth part of a millimeter. 
The denominations most commonly used in pharmacy are the kilogram, the 
gra'm, the milligram, the liter, and the milliliter. Metric prescription weights 
are usually supplied in two denominations, the gram and the milligram. Nearly 
all small graduates are graduated in mils or milliliters (another name for the 
milliliter is cubic centimeter, abbreviated ce) and measures of more than 1,000 
mils capacity are usually graduated in liters. The volume of one cubic- 
centimeter was officially adopted for general use as the capacity unit in the 
U. S. P. XI, which states that 1 liter equals 1000.027 cc, and that 1 Gm. of 
water at 4° C. measures 1.000027 cc. Use of “cc” instead of “mil” is therefore 
correct. 
The conversion of ordinary weights or measures into metric weights or 
measures and vice versa is not difficult and involves only simple mathematical 
procedures and the use of the figures given in the next paragraphs. 
To convert metric weights or measures into those in ordinary use multiply 
the metric quantities by the corresponding equivalent. Therefore, to convert: 
Meters into inches, multiply by 39.370. 
Liters into fluidounces, multiply by 33.815. 
Grams into grains, multiply by 15.432. 
To convert the weights or measures in ordinary use into metric weights or 
measures multiply the quantities by the corresponding equivalent. Therefore, 
to convert: 
Inches into meters, multiply by 0.0254. 
Fluidounces into milliliters, multiply by 29.572. 
Grains into grams, multiply by 0.0648. 
The avoirdupois ounce contains 437.5 grains, the apothecaries 480, and the 
weight of 1 fluidounce of distilled water is 454.6 grains. In the avoirdupois 
pound there are 7,000 grains and in the apothecaries 5,760. 
A gallon contains 231 cubic inches. 
154294°—39 39 604 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The table of equivalents of weights and measures immediately following is 
given in order that the student may become familiar with the relations existing 
between the different systems. 
Equivalents of Weights and Measures 
English System 
Metric Equivalent 
Avoirdupois weight: 
1 grain 
gram. 
0.0648 
437.5 grains make 1 ounce (oz.) ... _ _ 
grams. 
. 28.35 
16 ounces make 1 pound Gb.) .. 
do.__ 
. 453.60 
100 pounds make 1 hundredweight (cwt.). 
20 hundredweight make 1 ton. 
Apothecaries weight: 
1 grain ... 
gram 
0.0648 
20 grains make 1 scruple O) _ _ ... . _ 
grams. 
1.30 
3 scruples make 1 dram (3) 
do... 
3.90 
8 drams make 1 ounce (5) 
do... 
. 31.103 
12 ounces make 1 pound 
do... 
. 373.236 
Troy weight: 
1 grain 
gram. 
0.0648 
24 grains make 1 pennyweight (dwt.) 
grams. 
1.555 
20 pennyweights make 1 ounce 
do... 
. 31.103 
12 ounces make 1 pound-.. .. 
do... 
. 373.236 
Apothecaries measure: 
... .cubic centimeter 
1 minim (0.95 grain) (Til) 
0.06 
60 minims make 1 fluidram (f3) 
do... 
3.70 
8 fluidrams make 1 fluidounce G5) 
do__. 
. 29.57 
16 fluidounces make 1 pint (O) 
do... 
_ 473.18 
8 pints make 1 gallon (Cong.) 
do... 
. 3,785.40 
Linear measure: 
1 inch — 
millimeters 
25.4 
12 inches make 1 foot 
centimeters. 
. 30.48 
3 feet make 1 yard - _ . -- 
.. ... ..meter. 
0.914 
5.5 yards make 1 rod (or perch). 
40 rods make 1 furlong. 
8 furlongs make 1 mile 
do... 
. 1,609.35 
Metric System 
English Equivalent 
Length: 
Kilometer, 1,000meters - ... 
mile 
% 
Hectometer, 100 meters. 
Decameter, 10 meters. 
Meter (unit) 
.inches. 
39. 37 
Decimeter, one-tenth meter .. 
do... 
3.937 
Centimeter, one-hundredth meter 
do... 
% 
Millimeter, one-thousandth meter 
do__ 
V* 
Capacity: 
Kiloliter, 1,000 liters. 
Hectoliter, 100 liters 
Decaliter, 10 liters. 
Liter (unit), cube of one-tenth meter 
fluidounces 
33.814 
Deciliter, one-tenth liter. _ 
do... 
3.3814 
Centiliter, one-hundredth liter __ 
do___ 
Vi 
Milliliter, one-thousandth liter (ml) ... 
minims. 
16.23 
Weight: 
Kilogram, 1,000 grams 
fapothecaries ounces. 
■ ■ 1 avoidupois ounces. 
32.15 
. 35.27 
Hectogram, 100 grams. 
Decagram, 10 grams. 
Dram (unit) 
. 15.432 
Decigram, one-tenth gram 
1.5 
Centigram, one-hundredth gram 
do... 
v> 
Milligram, one-thousandth gram 
Hi 
Apothecaries 
Metric 
A tumblerful... 
240 cc 
AteacupfuL. 
—fSiv... 
120 cc 
A wineglassful 
fBii 
60 cc 
A tablespoonful. 
fjiv— 
16 cc 
A dessertspoonful 
f3ii—- 
8 cc 
A teaspoonful. 
- f3i 
4cc 
Approximate measures 
Balances and measures. 
A balance is an instrument for determining the relative weights of sub- 
stances, or, for weighing. If accurate results are to be obtained in the use 
of a balance it must be correctly constructed, skillfully used, and carefully 
protected from injury. A balance is frequently called a scales, a term who«« 
use is not desirable. PHARMACY 
605 
Pharmaceutical balances may be classified according to the type of their 
construction as: 1. Single beam, equal arm; 2. Single beam, unequal arm; 
3. Double beam, unequal arm; 4. Compound lever balance; and 5. Torsion 
balance. Of these, the types most commonly used in pharmacy are the single 
beam, equal arm, and the torsion balance. In analytical work the balance used 
has to be much more sensitive than the average pharmaceutical or prescrip- 
tion balance and great care and accuracy is required in its construction. One 
type of analytical balance is called the Chainomatic balance. 
In the construction of the single beam, equal arm balance, a beam is sus- 
pended on a knife-edge, which divides it into equal arms, and knife-edges are 
placed at each end of the beam on the same plane and at exactly equal distances 
from the point of suspension to support the pans which carry the substances to 
be weighed. The construction of the single beam, unequal arm balance can be 
seen by inspecting the well-known Fairbanks scales. This type of balance de- 
pends on the principal in physics: “The power is to the weight or resistance in 
the inverse ratio of the arms of the lever.” The longer arm of the beam is 
graduated for a movable weight, the use of which dispenses with small weights 
and is a decided advantage. 
In the double beam, unequal arm balance the construction is the same as given 
before, but with two parallel beams, and is employed for weighing liquids, etc., 
the outside beam being used to tare the bottle or jar. 
A compound lever balance is well shown in Fairbanks platform scales. It 
is used on druggists’ counters and sometimes for prescription scales. 
A torsion balance is one in which a compound beam is balanced and sup- 
ported upon an immovable frame. The beam is prevented from slipping out 
of place, and the torsion is secured by a flattened steel wire or spring stretched 
upon the center frame and firmly fastened to the underside of the beam. 
Upon the ends of the beam are fastened the movable frames which support 
the pans. Motion of the beam may be arrested easily by moving the lever, and 
the delicacy of the balance is increased by placing a weight upon the index, 
whereby the center of gravity is elevated. In this type of balance knife-edges 
are done away with entirely. 
Care of a balance.—A balance should be kept in a closed case in a dry place 
protected from corroding vapors. The balance and scale pans should not be 
polished with gritty substances but should be cleaned with chamois. Steel 
knife edges should be coated with a very thin coating of vaseline. The beam 
should not be left in an oscillating position when the balance is not being used. 
Weights should be put on and taken off with pincers. The substance to he 
weighed should be placed in the left-hand pan (the pan to the left of the 
operator as he faces the balance) and the weights in the right-hand pan. The 
first step in weighing is to see that the balance is balanced, and that the 
knife edges are in position; then place a piece of pan-paper in each pan, and 
see that the balance is balanced after the paper has been placed in the pans. 
Put the weights in the right-hand pan, and carefully place enough of the drug 
in the left-hand pan to exactly balance the weights. After removing the drug, 
check the weights to see that the amount is right, put the weights away, and 
clean up the balance. In weighing substances that injure the scale pans, by their 
chemical action, always use glass pans or waxed paper. 
The weights used in pharmaceutical weighing are constructed of brass or 
aluminum. In the construction of metric weights, the gram weights are made 
of brass, lacquered to prevent oxidation, and the milligram weights are made 
of aluminum because it is a light metal and gives bulk to the small weights. 606 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
In the construction of apothecaries weights, all weights including and above 
the scruple are made of brass, and the grain weights are made of aluminum. 
Measures.—Liquids are measured by the use of graduated vessels of tinned 
copper or iron, agateware, and glass. For use in the practice of pharmacy 
glass measures are preferable, vessels of the other materials usually being 
used in measuring quantities larger than 1 pint. To measure small quantities 
of liquids, such as minims, glass vessels known as pipettes often are used because 
of the assurance of accuracy. 
Pipettes are glass tubes with a constricted point and graduated on the side. 
They are used by applying suction to the upper end and holding the liquid in 
the tube by placing the finger on the upper end while reading off the contents. 
Owing to capillary attraction, the top of the liquid in a graduated pipette pre- 
sents a cup shape. This is called a meniscus. A line drawn through the bot- 
tom of the meniscus of transparent and the top of opaque liquids usually is 
selected as the reading point. 
A drop, through error, is supposed to be a minim; but though this may be 
approximately true when applied to water, a drop and a minim are rarely the 
same. This fact must be kept in mind when administering medicines or when 
compounding from formulas and prescriptions that call for minims or for drops. 
Thick viscous liquids produce large drops; heavy mobile liquids small ones. A 
drop of syrup of acacia is five times as large as a drop of chloroform. The size 
of a drop depends also upon the shape of the vessel from which dropped, upon 
the form of the lip, upon adhesion, cohesion, rapidity of flow, and viscosity. A 
drop of liquid from a curved medicine dropper is larger than one from a straight 
dropper having the same sized opening, because the straight one generally is held 
at an angle so that the drop falls from one side of the orifice, but with a curved 
dropper the drop falls from the whole circle of the orifice. The table following 
shows the variation in the number of drops for several liquids when a standard 
dropper having an exit with an external diameter of 3 millimeters which will 
discharge 20 drops of water of such size that they will weigh 1 Gm. is used. 
Number of Drops Obtained From a Standard Dropper 
Liquid 
Drops per 
gram 
Drops per 
cc 
Drops per 
fluidram 
Drops per 
minim 
20.0 
22.2 
81. 5 
1. 36 
19.5 
23.8 
88.0 
1. 46 
22.9 
40.0 
148.0 
2. 46 
65.5 
50.0 
185. 0 
3.10 
Chloroform - _ _ . ... . 
58.8 
100.0 
370.0 
6.16 
37. 4 
45. 5 
160.0 
2 70 
90.0 
66.5 
246.0 
4.10 
52.6 
50.0 
185.0 
3 10 
23. 1 
33. 3 
123.0 
2.05 
41. 5 
50.0 
185. 0 
3.10 
35. 5 
40.0 
148.0 
2. 46 
21.1 
22. 2 
81.5 
1. 36 
18. 7 
28. 6 
106.0 
1. 76 
65. 5 
59.0 
218.0 
3. 63 
56.3 
50.0 
185.0 
3.10 
48.1 
50.0 
185.0 
3.10 
53.3 
65.5 
205.0 
3. 41 
50. 8 
50.0 
185.0 
3.16 
50.9 
50.0 
185.0 
3.10 
57.3 
50.0 
185.0 
3.10 
63.3 
66.5 
246.0 
4.10 
As recommended by the Brussels Conference, temperature 15° C. or 59° F. 
Specific Gravity (abbreviated sp. gr.) is the weight of one body compared with 
the weight of an equal bulk or volume of another body selected as the standard, 
both bodies having the same temperature, or the temperature of each being PHARMACY 
607 
definitely known. The substance taken as a standard is distilled water for 
solids or liquids, and air for hydrogen or gases. Example: If at a certain 
temperature 1 cc of distilled water (the standard) weighs 1 Gm., and 1 cc of 
mercury at the same temperature weighs 13.5 Gms., the specific gravity of the 
distilled water is 3.000 and the specific gravity of the mercury is 13.500. 
Methods by which specific gravity may be taken are: 
1. By the specific-gravity bottle (pycnometer). 
2. By the use of Lovi’s beads. 
3. By the use of the Westphal specific-gravity balance. 
4. By the use of hydrometers (urinometer, lactometer, alcoholometer, sac- 
charometer, etc.). 
Because of certain physical characteristics solids are grouped under the 
following heads when their specific gravity is taken: 
1. Solids insoluble in, and heavier than water. 
2. Solids soluble in, and heavier than water. 
3. Solids insoluble in, and lighter than water. 
4. Solids soluble in, and lighter than water. 
A different procedure is necessary wdien taking the specific gravity of a 
solid belonging to one of these groiips. 
As the weights of bodies are proportionate to their masses, and as the 
amount of matter in, or the mass of, a given bulk of a body is termed its 
density, it is evident that the specific gravity of a substance is equivalent to 
its density. Consequently the term density is frequently used in place of spe- 
cific gravity. 
The specific gravity, or density, of a substance has a direct bearing on its 
purity, and therefore specific gravity is made use of in determining the strength 
or purity of drugs and preparations. In the Pharmacopoeia and in the National 
Formulary, under the description of a drug the specific gravity is frequently 
stated, especially when it would be of value in determining the strength or 
purity of the substance. The strength of alcohol, ammonia water* nitric acid, 
sulfuric acid, or hydrochloric acid can readily be determined by taking their 
specific gravity. Specific gravity tables for some substances have been worked 
out and are printed in the Pharmacopoeia. 
Specific Volume (abbreviated sp. vol.) is the volume of one body compared 
with the volume of an equal weight of another body selected as the standard, 
both bodies having the same temperature. Example: If, at a certain tempera- 
ture, 100 cc of alcohol weighs 82 Gms., and the same weight of distilled wTater 
at the same temperature measures 82 cc, the specific volume of the alcohol will 
be as the volume of the alcohol (100 cc) is to the vojume of the distilled water 
(82 cc). Dividing 100 by 82 gives 1.22, which is the specific volume of the 
alcohol. 
Specific volume is directly the opposite of specific gravity for, while specific 
gravity deals with what weight of a certain substance will go into a certain 
sized bottle, specific volume asks what sized bottle will hold a certain weight 
or amount of that substance. 
PHARMACEUTICAL ARITHMETIC 
The rules of arithmetic apply to problems in pharmacy in exactly the same 
way as they apply to any other practical use of arithmetic. In pharmaceutical 
arithmetic accuracy is absolutely necessary, for an incorrect calculation or the. 
misplacing of a decimal point can mean the difference between life and death, 608 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Addition, subtraction, multiplication, division, fractions, decimals, percentage, 
ratio, and proportion all find their uses in the arithmetic of pharmacy. 
A brief explanation of how to prepare solutions and mixtures of different 
strengths will now be given. 
The strength of a solution or mixture is the proportion of active substance 
or drug to the solvent, vehicle or base, and is usually expressed in one of 
two ways: 1. By the percentage method; or 2. By the ratio method. The 
percentage method will first be considered. 
Percentage means parts per 100 parts. In pharmaceutical and chemical 
problems percentage refers to parts by weight unless parts by volume is 
specifically stated. In the Pharmacopoeia and in the National Formulary the 
term “per cent” is frequently used in stating the purity standard of the 
drug or preparation, preceded by a number. There also it refers to parts by 
weight unless parts by volume is specifically stated. 
Percentage solutions, for convenience in preparation and administration, are 
divided in the Pharmacopoeia into three classes: Weight in weight (w/w) solu- 
tions; Weight in volume (w/v) solutions; and Volume in volume (v/v) 
solutions. 
A weight in weight percentage solution is one containing in every 100 
Gms. of finished solution, the number of grams of the drug corresponding to 
the percentage strength. Thus a 5 per cent (w/w) solution of cocaine hydro- 
chloride in water contains in every 100 Gms. of solution 5 Gms. of cocaine 
hydrochloride and 95 Gms. of water. It must be clearly understood that 100 
Gms. of a weight in weight solution does not always measure 100 cc; in some 
cases it may measure more than 100 cc, but usually it will measure slightly less 
than 100 cc. 
The only absolutely accurate type of percentage solution is the weight in 
weight but because of certain disadvantages it is not prepared as often as the 
weight in volume type. It is difficult to prepare a weight in weight solution 
because it is necessary to weigh the liquids used in its preparation which 
makes it impracticable in dispensing, especially when liquids other than 
water are used as solvents. Because of the contraction in volume that takes 
place in making solutions it is necessary to make more than the volume called 
for and results in a waste of the drug. In administering such solutions it is 
not a simple matter to calculate the amount of drug contained in a tea- 
spoonful or in a certain number of cc. Because of these disadvantages the 
weight in volume and the volume in volume types of percentage solutions are 
much more popular. 
A rule for determining the amount of drug and the amount of solvent 
to be used in making a stated number of grams of a weight in weight (w/w) 
solution is: Rule.—Multiply the number of grams of solution desired by the 
per cent expressed as a whole number; divide the product by 100; and the 
quotient will be the number of grams of drug required; subtract this from 
the number of grams of finished solution, and the remainder will be the number 
of grams of solvent to use. Instead of expressing the per cent as a whole 
number and dividing by 100, a common practice is to express the per cent 
decimally (0.05 for 5 per cent), multiply, and use the product as shown 
before. Problem.—Make 100 Gms. of 5 per cent (w/w) solution of silver 
nitrate in water. One hundred multiplied by 5 equals 500; 500 divided by 
100 equals 5; and 100 minus 5 equals 95; or, 100 multiplied by .05 equals 
5, and 100 minus 5 equals 95. Answer.—Dissolve 5 Gms. of silver nitrate 
in 95 Gms. of water. The finished solution will weigh 100 Gms. but will 
measure slightly less than 100 cc. PHARMACY 
609 
A weight in volume (w/v) percentage solution is one containing in every 
100 cc of finished solution the number of grams of drug corresponding to 
the percentage strength. Thus a 5 per cent weight in volume (w/v) solution 
of silver nitrate contains in every 100 cc of finished solution 5 Gms. of silver 
nitrate and enough solvent to make 100 cc of solution. 
As liquids are administered by volume instead of by weight it is easier 
to calculate doses, or the amount of drug contained in a given volume of a 
solution, if the strength of the solution is expressed in grams of solid or cc 
of liquid drug in every 100 cc of solution. The uniform relation between the 
milliliter (cc) and the gram in the metric system makes calculations very 
simple in preparing such solutions. This is the type of solution that is 
usually desired when a percentage solution is called for. 
A rule for determining the amount of drug and the amount of solvent to 
be used in making a stated number of cc of a weight in volume percentage 
solution is: Rule.—Multiply the number of cc of solution desired by the per 
cent expressed as a whole number; divide the product by 100 and the quotient 
will be the number of grams of drug required. To this is added enough solvent 
to make the desired number of cc of finished solution. Problem.—Make 75 
cc of a 5 per cent (w/v) solution of silver nitrate in water. Seventy-five mul- 
tiplied by 5 equals 375; 375 divided by 100 equals 3.75. Answer.—Dissolve 
3.75 Gms. of silver nitrate in enough water to make 75 cc of finished solution. 
A volume in volume (v/v) percentage solution is one containing in every 
100 cc of finished solution the number of cc of liquid drug corresponding to 
the percentage strength. Thus a 5 per cent (v/v) solution of glycerin in 
water contains in every 100 cc of finished solution 5 cc of glycerin and 
enough water to make up the volume to 100 cc. 
A rule for determining the amount of drug and the amount of solvent to 
be used in making a (v/v) percentage solution is; Rule.—Multiply the number 
of cc of solution desired by the per cent expressed as a whole number; divide 
the product by 100; the quotient will be the number of cc of drug required. 
To this is added enough solvent to make the desired number of cc of finished 
solution. Problem.—Make 500 cc of a 3 per cent (v/v) solution of glycerin 
in water. Multiplying 500 by 3 equals 1,500; dividing 1,500 by 100 gives 15. 
Answer.—Measure out 15 cc of glycerin and to it add enough water to make 
500 cc of finished solution. 
In making percentage mixtures of solid or semisolid substances the weight 
in weight (w/w) percentage method is used. Problem.—Make 2,000 Gms. 
of an ointment containing 10 per cent of sulfur, using benzoinated lard as a 
base. How much sulfur and how much benzoinated lard is required? Multi- 
plying 2,000 by 10 equals 20,000; dividing 20,000 by 100 gives 200; and 2,000 
minus 200 equals 1,800. Answer.—Use 200 Gms. of sulfur and 1,800 Gms. of 
benzoinated lard to make the ointment. 
It is often desired to know the percentage strength of a solution or a mixture 
made according to a formula or prescription. A simple rule for determining the 
percentage strength of a solution or a mixture is: Rule.—Multiply the number 
of grams (or cc in the case of a volume in volume solution) of active drug 
used by 100 and divide the product by the number of grams (cc in the case 
of weight in volume solution or a volume in volume solution) of solution or 
of mixture. Problem.—What is the percentage strength of a solution that 
contains 2 Gms. of cocaine in 50 Gms. of solution? Two multiplied by 100 
equals 200 ; 200 divided by 50 equals 4. Answer.—Four per cent. Problem.— 
What is the percentage strength of an ointment that contains 1 Gm. of yellow 
oxide of mercury in 30 Gms. of the ointment? One multiplied by 100 equals 610 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
100, which, divided by 30 equals 3.33. Answer.—Three and thirty-three hun- 
dredths or 3% per cent. 
In arithmetic ratio is the expression of the relation or of the comparison 
of two quantities. The two quantities compared are called the terms of the 
ratio. In the ratio 8 to 16, 8 is called the first term or antecedent and 16 
the second term or consequent. Ratio is that number by which the second 
term must be multiplied to produce the first. As in any comparison, the two 
terms of a ratio must be of the same denomination before the relation between 
them can be found. 
A ratio may be expressed in three ways: By the sign of division (8-K16) ; 
by a fraction (%e) ; or by a colon (8:16). The value of a ratio is found by 
dividing the first term by the second term, and if the answer is a fraction it 
is reduced to its lowest terms. Problem.—What is the ratio of 2 yards to 
4 feet. Two yards equals 6 feet; 6 feet: 4 feet equals 6: 4 equals % equals % 
equals iy2. Answer.—The ratio of 2 yards to 4 feet or 6 feet to 4 feet is 1%. 
In the ratio method of expressing the strength of a solution the strength is 
expressed by stating the number of grams of solution (w/w) that contain 1 
gram of the drug; the number of cc of solution (w/v) that contain 1 gram of 
the drug; or the number of cc of solution (v/v) that contain 1 cc of the drug. 
A 1 in 10 (sometimes written 1-10) weight in weight solution contains 1 
gram of drug in every 10 grams of finished solution. A 1 in 10 weight in 
volume solution contains 1 Gm. of the drug in every 10 cc of finished solution. 
A 1 in 10 volume in volume solution contains 1 cc of the drug in every 10 cc 
of finished solution. 
Ratio solutions are usually prepared in strengths as follows: 1-10, 1-20, 1-50, 
1-100, 1-200, 1-500, 1-1,000, etc., using round numbers to simplify calculations. 
A rule for determining the amount of drug and the amount of solvent to be 
used in making a stated number of grams of a weight in weight solution by 
the ratio method is: Rule.—Divide the number of grams of solution desired by 
the larger number of the ratio and the quotient will be the number of grams 
of the drug to be used; subtract the number of grams of the drug from the 
number of grams of finished solution and the remainder will be the number of 
grams of solvent to use. 
A rule for determining the amount of drug and the amount of solvent to he 
used in making a stated number of cc of a weight in volume solution is; 
Rule.—Divide the number of cc of solution desired by the larger number of 
the ratio; the quotient will be the number of grams of the drug to be msed, 
and to this is added enough solvent to make the desired number of cc of 
finished solution. 
A rule for determining the amount of drug and the amount of solvent to be 
used in making a stated number of cc of a volume in volume solution by the 
ratio method is: Rule.—Divide the number of cc of solution desired by the 
larger number of the ratio; the quotient will be the number of cc of the drug 
to be used and to this is added enough solvent to make the desired number of 
cc of finished solution. Problem.—Make 500 cc of a 1-20 (v/v) solution of 
glycerin in water. Five hundred divided by 20 equals 25; take 25 cc of 
glycerin and to it add enough water to make 500 cc of finished solution. 
Alligation, or “the rule of mixtures,” is an arithmetical rule relating to the 
solution of problems concerning the compounding or mixing of different in- 
gredients, or ingredients of different qualities or values, and is so named from 
the method of connecting together the terms in a problem by lines. 
It is made use of in pharmacy to determine the amounts of two or more 
strengths of a given substance needed to blend into a new, intermediate PHARMACY 
611 
strength of that substance. It is also applied in making adjustments of per- 
centage or ratio strengths, and of specific gravities. 
When the different strengths of a substance to be blended and the new 
strength of that substance are expressed in terms of percentage, the following 
is the procedure undertaken in determining the quantities of the different 
strengths at hand required to produce the new strength desired: Draw a 
horizontal line and above the center of it write the new or desired percentage; 
below the same line write the different percentage strengths of the substances 
to be mixed and draw a short vertical line downward from each; with a 
horizontal line link together the line below each percentage figure that is 
greater than that desired with one that is less; draw another horizontal line 
below the lines linking the percentage figures together and below this last 
line write the differences between the desired percentage and the percentages 
given, placing the difference for a lesser percentage under the greater percentage 
with which it is linked and the difference for a greater percentage under the 
lesser percentage with which it is linked. The numbers placed below the 
lowest line will be the numbers of parts by weight of each strength to be used 
in making a mixture having the new or desired strength. It must be remem- 
bered to always link together a quantity which is less with one wMcth is 
greater than the desired percentage. 
A simple problem in which it is desired to know how many parts of a 9 per 
cent mixture and of a 14 per cent mixture would be required to make a 12 
per cent mixture would be expressed thus: 
Nine is subtracted from 12, leaving 3, which figure is placed under the 14, and 
12 is subtracted from 14, leaving 2, which figure is placed under the 9 ; there- 
fore it takes 2 parts of a 9 per cent mixture and 3 parts of a 14 per cent 
mixture to make 5 parts of a 12 per cent mixture. 
It is desired to know in what proportions four solutions of silvol containing 
5, 10, 25, and 40 per cent (w/w) respectively wnuld have to be mixed to obtain 
a solution containing 20 per cent of silvol. Express the problem thus: 
By subtracting 5 from 20, 20 from 40, 10 from 20. and 20 from 25, it is 
found that it will take 20 parts of 5 per cent, 5 parts of 10 per cent, 10 parts 
of 25 per cent, and 15 parts of 40 per cent solutions of silvol to produce a 
20 per cent solution, and as these are w/w solutions the parts represent 
grams of the solutions. By adding the lowest row of figures it is found 
that there would be 50 Gms. of the 20 per cent solution of silvol. The problem 612 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
may be proved as follows: Multiply the numbers of parts used by the per- 
centages, add the columns of parts and answers, and divide the larger by 
the smaller. The result of this division should be the percentage desired if 
the operations are correct. 
20X 5= 100 
5X10= 50 
10X25- 250 
15X40- 600 
50 )1000(20 
155_ 
0 
0 
It is desired to make 500 Gms. of a 20 per cent (w/w) solution from the 
solutions of different strengths previously named; what quantities of each 
solution will be required? As it has been found by alligation that a total 
of 50 parts of the solutions of different strengths are required to make a 
20 per cent solution, to make 500 Gms. of the 20 per cent solution will require 
the use of 99 of 500 Gms. or 200 Gms. of the 5 per cent solution, A of 500 Gms. 
50 50 
or 50 Gms. of the 10 per cent solution, 99 of 500 Gms. or 100 Gms. of the 25 
50 
15 
per cent solution, and — of 500 Gms. or 150 Gms. of the 40 per cent solution. 
50 
Following is the proof that these quantities are correct; 
55 of 500 = = 200 
50 50 
— of 500= 5g>5 = 50 
50 50 
15 of 500- 
50 50 
— of 500- 5|55=150 
50 50 
55 of 500-55555=500 
50 50 
Reducing the fractions in the left hand column to decimals and then mul- 
tiplying the amount of the 20 per cent solution to be made by them will also 
give the quantities of the different strength solutions to be used. 
The problem can also be solved by the use of proportion, that process in 
arithmetic known as the equality of ratios or the relation between quantities. 
A ratio consists of two terms; a proportion of four. In a proportion the two 
outside terms are called the extremes and the two inner terms are called the 
means. In the proportion 8 : 4:: 160 : 80, 8 and 80 are the extremes, and 
4 and 160 are the means. This proportion is read: 8 is to 4 as 160 is to 80. 
In a proportion the product of the extremes is equal to the product of the 
means, and for the proportion given 8X80 equals 4X160 or 640 equals 640. 
If one of the extremes in a proportion is missing, it can be found by dividing 
the product of the means by the extreme given, and likewise, if one of the 
means is missing, it can be found by dividing the product of the extremes by 
the given mean. The missing term is expressed by the letter x. In the proportion 
8:4:; 160 : x, find the missing term. = X; cancelling, = 80; 
O $ 
the missing term is 80. PHARMACY 
613 
In working with proportion certain rules must be remembered. Those rules 
are: 1. Let “x” always be the fourth term: 2. Let the third term be that num- 
ber in the question which expresses the same kind of value as is expected in 
the answer; 3. Decide whether the answer sought will be greater or less than 
the third term, and if greater, the larger of the two remaining terms belongs 
in the second place, but if smaller, the lesser of the two remaining terms 
belongs in the second place; and 4. The remaining term goes in the first place. 
To solve the problem of the solutions of different strengths by proportion, 
state the proportions as follows; 
(а) 50 : 20 :: 500 : x;20X500=x; cancelling, = 200; x = 200 
(б) 50 : 5 :: 500 : x; = x; cancelling, — X^0 10 = 50; x= 50. 
(c) 50 : 10 :: 500 : x; *QXf00 = x; cancelling, >0X500 100; x= i00, 
50 50 
{d) 50 ; 15 : : 500 ; x; .15X^00 = x; cancelling, 15X^0 --=150; x=150 
50 50 
Therefore, to make 500 Gms. of a 20 per cent solution of silvol 200 Gms. of a 
5 per cent solution, 50 Gms. of a 10 per cent solution, 100 Gms. of a 25 per 
cent solution, and 150 Gms. of a 40 per cent solution of silvol will be required. 
PHARMACEUTICAL OPERATIONS AND PROCESSES 
Heat.—From the time of the ancient Greeks different theories have been 
advanced to explain the nature of heat. The one now almost universally 
accepted is known as the dynamical theory of heat which assumes that heat is 
produced by the constant motion of the particles composing the body, and that 
heat varies in quantity dependent upon whether the body is solid, liquid, or 
gaseous. The kinetic theory of matter states that the molecules of all matter 
are in perpetual motion, striking against and rebounding from each other, and 
by that motion producing heat. It may therefore be said: Heat is that form 
of molecular motion, or molecular kinetic energy, which produces the sensation 
called warmth. More simply: Heat is a form of molecular motion. 
The sun is the most important source of heat. Friction, electricity, light, and 
chemical action all produce heat and may be said to be sources of heat. Rub- 
bing two pieces of wood together to kindle fires, and igniting substances from 
sparks obtained by striking a flint and steel together are examples of heat 
produced by friction; electricity passing through wires having high resistance 
to the passage of electricity, as in an electric toaster, is an example of produc- 
ing heat by electricity; igniting a substance by concentrating the rays of the 
sun on it through a “burning glass” is an example of heat produced by light; 
the mixing of alcohol and water with the formation of hydrates of alcohol, and 
the burning of fuels are examples of the production of heat by chemical action. 
Chemical action is an important source of heat and by chemical action is 
meant the breaking up of the molecules of a substance with the formation of 
new molecules. In chemical action, sometimes called decomposition, there is 
considerable movement of the molecules and their constituent atoms, which 
movement is a form of friction and therefore produces heat. The combining of 
iron with iodine in a test-tube in the presence of water, forming ferrous iodide, 
produces so much heat that the test-tube becomes so hot it can hardly be held 
in the hand. This is an example of heat produced by chemical action. The 
burning of wood is another example of heat produced by chemical action, but 614 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
the chemical action here is much different from that in the other example, 
because not only is the heat produced of greater intensity, but flame, or light, 
is also produced. This is due to the heat being so great and the reaction so 
rapid that some of the carbon in the wood fails to combine with oxygen and, 
becoming heated, glows as does the carbon filament in an incandescent light. 
Chemical action accompanied by heat and light is called combustion. 
Any substance with which a combustion can be had is called a fuel. Fuels 
may be solid, as wood, charcoal, coal, coke, etc., liquid, as alcohol, kerosene, 
gasoline, petroleum, benzine, etc., or gaseous, as natural and artificial gas. In the 
burning of fuels it is necessary to have apparatus suitable for the fuel used. 
Heat performs work according to the quantity of heat present. To measure 
the quantity of heat the unit used is the calorie. The calorie is the amount of 
heat required to raise the temperature of 1 Gm. of distilled water from zero 
to 1° C. This is known as the small calorie and there is also the large calorie 
which equals 1,000 small calories. The large calorie is generally used in 
expressing the energy or heat value of food substances. 
There is a difference between heat and temperature which must be remem- 
bered. Heat is quantity or amount while temperature is quality, degree, or 
intensity. A gallon of water at 100° C. is just as hot as a barrel of water at 
100° C. because the temperature is the same, but the quantity or amount of heat 
in the barrel of water is very much greater than that in the gallon of water. 
The intensity of heat is known as its temperature, the degree of intensity is 
determined by instruments called thermometers and is expressed relatively in 
degrees. 
A thermometer is a glass tube with a capillary bore, sealed at one end and 
the other end terminating in a cylindrical or globular bulb which is usually 
filled with mercury. When subjected to the influence of heat the mercury ex- 
pands and rises in the tube, the degree of heat being read 
either on a graduated scale marked on the tube or on a 
graduated scale placed at the side or back of the tube 
(fig. 146). 
The lower limit of accuracy of a mercury-filled ther- 
mometer is —30° C. because mercury freezes at —40° C.; 
the upper limit of accuracy of a mercury-filled thermometer 
is about 300° C. because mercury boils at 350° C. If that 
part of the capillary tube above the mercury column be 
filled with an inert gas, such as nitrogen, the mercury will 
be prevented from boiling by the pressure of the gas above 
it, and such a thermometer may be used for temperatures 
as high as 550° O. 
The three scales used in marking thermometric degrees 
are Fahrenheit, Centigrade, and Reaumur. In the Fahren- 
heit scale the freezing point of water is 32, the boiling point 
is 212, and the intervening space is divided into ISO degrees. 
In the Centigrade scale the freezing point of water is zero, 
the boiling point is 100, and the intervening space is divided into 100 degrees. In 
the Reaumur scale the freezing point of water is zero, the boiling point is 80, and 
the intervening space is divided into 80 degrees. The Reaumur scale is rarely 
used in English-speaking countries. Most thermometers in use in the United 
States are graduated either in the Centigrade or the Fahrenheit scale, and 
some thermometers have both scales. 
Statements of temperature are given in the U. S.' Pharmacopoeia in Centigrade 
degrees. The standard temperature for making specific gravity determinations. 
Figure 146.—Ther- 
mometers ; from 
left to right, Fahr- 
enheit, Centigrade, 
Reaumur, (Rem- 
ington.) PHARMACY 
615 
solubility tests, polarimetric determinations, and for the preparation of volu- 
metric solutions is 25° C. (U. S. P. XL) 
It is often necessary to convert the degrees of one scale into those of another, 
and in converting Centigrade degrees into Fahrenheit degrees or vice versa, 
it should be kept in mind that 100 degrees Centigrade are equal to 180 degrees 
Fahrenheit, or that 1° C. is equal to 1.8° F. It should also be kept in mind 
that on the Fahrenheit scale the freezing point of water is 32 degrees above 
zero or 32 degrees higher than on the Centigrade scale, and this difference of 
32 degrees must be considered. 
With temperatures above the freezing point of water, to convert Fahrenheit 
degrees to Centigrade degrees the rule is: Subtract 32 from the number of 
Fahrenheit degrees and divide the remainder by 1.8. Problem.—Convert 122° 
Fahrenheit to Centigrade; 122 minus 32 equals 90; 90 divided by 1.8 equals 
50; the answer is 50° C. 
With temperatures above the freezing point of water, to convert Centigrade 
degrees to Fahrenheit degrees the rule is: Multiply the number of Centigrade 
degrees by 1.8 and to the product add 32. Problem.—Convert 50° C. to Fahren- 
heit ; 50 multiplied by 1.8 equals 90; 90 plus 32 equals 122; the answer is 122° F. 
With temperatures below the freezing point of water, to convert Fahrenheit 
degrees to Centigrade degrees the rule is: Add 32 to the number of degrees 
below the freezing point and divide the sum by 1.8. Problem.—Convert —31° F. 
to Centigrade; 31 plus 32 equals 63; 63 divided by 1.8 equals 35; the answer is 
—35° O. 
With temperatures below the freezing point of wTater, to convert Centigrade 
degrees to Fahrenheit degrees the rule is : Multiply the number of degrees below 
the freezing point by 1.8 and from the product subtract 32. Problem.—Convert 
—35° O. to Fahrenheit; 35 multiplied by 1.8 equals 63; 63 minus 32 equals 31; 
the answer is —31° F. 
Heat is applied and temperature is controlled in pharmaceutical operations 
by the use of heat baths. Some of the commonly used heat baths are the 
water bath, salt-water bath, glycerin bath, oil bath, sand bath, etc. If it is 
desired to heat a substance at a temperature of 100° C., for some time, a water 
bath is used. It does not matter how much heat is applied to the water bath, 
the temperature will not go any higher than 100 degrees because this is the 
boiling point of water. The temperature of a liquid does not increase after 
it reaches the boiling point (unless confined), but the boiling points of different 
liquids vary greatly; the boiling point of water is 100° C., glycerin about 
260° C., saturated solution of salt water about 108° C.; therefore, if it is desired 
to heat a substance no higher than 100° C., use a water bath; if a temperature 
of 106° O. is desired, use the salt water bath, etc. The sand bath is used for 
very high temperatures and must be cautiously used if a constant temperature 
is desired. Wire gauze is used under glass vessels when they are subjected to 
the direct heat of a flame to prevent them from breaking. 
Pharmaceutical operations requiring the application of heat. 
Not all pharmaceutical operations which require the application of heat are 
made use of in the retail drug store or the dispensary, most of them being 
employed only in manufacturing establishments and in laboratories when drugs 
are tested and analyzed. 
In these operations the degree of heat used varies from what is called gentle 
heat to strong heat. In the definitions of these operations or processes which 
follow, the degree of heat used is named whenever it is essential to the process: 616 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Ignition consists of strongly heating inorganic substances, with access of air, 
to obtain a definite residue. 
Incineration is the process of strongly heating, or burning, organic substances 
in a crucible until nothing but ashes remain. This process is made use of in 
making analyses of certain organic substances. 
Fusion is the process of liquefying solid substances by the application of heat 
without the use of a solvent. An example of this process is the melting of wax. 
Calcination is the process of separating volatile substances, such as carbon 
dioxide, from fixed inorganic matter by the application of strong heat, without 
producing fusion. Magnesium oxide and calcium oxide (quick lime) are made 
by heating (calcining) the carbonates of magnesium or calcium wiiich drives 
off tlie carbon dioxide and leaves behind the oxide. (MgCOs+heat—>MgO+C02), 
Deflagration is the process of strongly heating one inorganic substance with 
another capable of yielding oxygen (usually a nitrate or a chlorate). Decom- 
position ensues, accompanied by a violent, noisy, or sudden combustion. Salts 
of antimony and arsenic may be made by this process. 
Carbonization is the process of strongly heating organic substances without 
the access of air until they are charred. The volatile prodiicts are driven 
off and the non-volatile products, principally carbon, remain behind. Charcoal 
is made in this way. 
Torrefaction is the process of moderately heating, or roasting, organic 
substances. The roasting of coffee is an example of the application of this 
process. 
Vaporization is the process of separating volatile substances from fixed 
bodies or from less volatile bodies, usually with the aid of heat at varying 
temperatures. The use of this process has four principal applications as 
follows: 
1. To separate a volatile liquid from a less volatile liquid, when it is 
called evaporation. 
2. To separate a volatile liquid from a solid, when it is called desiccation, 
exsiccation, or granulation. 
3. To obtain a volatile liquid, when it is called distillation, 
4. To separate a volatile solid from a nonvolatile solid, when it is called 
sublimation. 
Evaporation, as used in pharmacy, is the process of driving off the more 
volatile or less valuable portions of a liquid by the application of heat with 
the object either of purifying or concentrating the liquid for the purpose of 
obtaining the less volatile portion. An example of evaporation is the con- 
centrating of liquids intended for crystallization. Ebullition, or boiling, is an 
important form of evaporation. 
Desiccation is the process of depriving solid substances of moisture at as 
low a temperature as possible. The moisture driven out is known as hygro- 
scopic moisture to distinguish it from the moisture 'combined in chemical 
salts as water of crystallization. This process is used to aid in the preserva- 
tion, to reduce the bulk and weight, and to facilitate the comminution of 
medicinal substances. 
Exsiccation is the process of depriving a solid crystalline substance of its 
water of crystallization or moisture by heating it strongly. The object of 
this process is to reduce the bulk and volume of substances. Exsiccated alum 
(burnt alum) is made by heating crystalline alum. 
Granulation is the process of heating the solution of a chemical substance 
with constant stirring until nearly all of the liquid is evaporated and a 
coarse-grained powder is produced which usually is composed of very small PHARMACY 
617 
crystals. In granulation the solution is first evaporated rapidly, the heat 
then is moderated, and toward the end of the process the heat is very moderate. 
Distillation is the process of heating liquids or solids until gas or vapor 
is driven off and condensing all or some of the gas or vapor back into the 
liquid which is sought. The first part of the process is identical with evap- 
oration ; the second part, called condensation, is the conversion of the vapor 
into a liquid by the application of cold. Distillation is extensively used in 
retail and in manufacturing pharmacy and there are three modifications 
known as fractional, destructive, and vacuum distillation. Fractional dis- 
tillation is the process of separating mixed liquids having different boiling 
points. The liquids having low boiling points distill over first and in that 
way can be separated from those having high boiling points. Destructive 
distillation is the process of heating dry organic matter in a distillatory ap- 
paratus until the substance is decomposed and new products are formed, 
volatilized, and condensed. Oak wood subjected to this treatment breaks 
down into wood alcohol, acetic acid, acetone, creosote, and other products; 
coal, when subjected to this treatment yields illuminating gas, ammonia 
products, phenol bodies, cresols, benzene, toluol, dye color bases, and other 
products, while coke is left behind. Vacuum distillation is the process of facil- 
itating evaporation by the removal of air pressure from the distilling 
chamber which permits the operation to be conducted at a lower temperature. 
The special advantages of vacuum distillation are made use of on a large 
scale by gasoline refineries, liquor distilleries, and factories manufacturing 
solvents. 
Sublimation is the process of distilling solid volatile substances. The product 
is termed a sublimate. Many solid substances are purified from their impuri- 
ties by this process, which is also made use of to obtain a solid substance in the 
form of a very fine powder. In sublimation the temperature at which the 
condensation of the vapor takes place largely determines the physical character 
of the sublimate. There are three kinds of sublimates: Cake, as camphor, 
corrosive sublimate, etc.; Powder, as calomel, sublimed sulfur, etc.; and crystal, 
as iodine, naphthalene, etc. 
Pharmaceutical processes not requiring the use of heat. 
Comminution is the process of reducing a substance to fine particles. Under 
this head are grouped various mechanical processes for accomplishing the neces- 
sary reduction, some of which are: Cutting, slicing, bruising, rasping, grating, 
chopping, rolling, stamping, grinding, trituration, levigation, elutriation, pul- 
verizing, etc. The object of all these processes is to facilitate the solution of a 
substance or of its active principle and to permit of its administration in the 
form of a fine powder. Those most employed in retail dispensing are tritura- 
tion, grinding, and pulverization. A few of them will now be described. 
Trituration is the process of reducing substances to fine particles in a mortar 
with a pestle. Mortars are usually made of glass, porcelain, or wedgewood and 
the pestles are made of the same material as the mortar. The substance to be 
triturated is placed in the mortar and rubbed with the pestle. The motion of 
the pestle should follow the curve of a spiral, beginning in the center and 
gradually working outward. This process is employed more than any other in 
a retail dispensary when it is desired to reduce a substance to fine particles. 
Levigation is the process of reducing substances to a state of minute division 
by triturating them after they have been made into a paste with water or other 
liquid. A shallow mortar with a properly fitting pestle, or a ground-glass slab 
with a flat-surfaced glass muller is required. When the slab and the muller 618 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
are made of porphyry the process is called porphyrization. The motion given 
to the muller should closely follow the lines of the figure 8 or of oval loops 
intersecting each other, the object being to so vary the motion that all particles 
of the powder are reached. 
Elutriation is the process of separating coarser from finer particles of insolu- 
ble substances by suspension in water, and is sometimes called water-sifting. 
The substance is powdered, mixed into a thin paste with water, and thrown 
into a vessel containing water. After allowing the heavier particles to subside, 
the liquid containing the lighter particles is decanted into another vessel, and 
the fine particles allowed to settle. Later the clear liquid is drawn off. Pre- 
pared chalk is an example of a substance obtained by elutriation. 
Pulverization by intervention is the process of reducing substances to powder 
through the use of a foreign substance from which the powder is subsequently 
freed by some simple method, such as evaporation. Camphor can be reduced 
to a fine powder by triturating it in the presence of a few drops of alcohol 
or chloroform. 
After a drug has been reduced to a fine state of subdivision it is often 
necessary to separate the fine from the coarse particles which is accomplished 
by sifting with a sieve. Sieves are numbered 20, 40, 60, 80, and 100, according 
to the number of meshes per linear inch of the screen. The degree of fineness 
of a powder is designated by the number of the finest sieve through which it 
will pass. A number 80 powder is one that will pass through a number 80 
sieve but will not pass through a number 100 sieve. The degree of fineness is 
also designated by the terms coarse powder (20), moderately coarse powder 
(40), moderately fine powder (50), fine powder (60), very fine powder (80), etc. 
The reduction of vegetable drugs to fine particles is necessary to allow the 
extraction of their soluble principles in making tinctures and fluidextraets. A 
glance at the IT. S. Pharmacopceial formulas for making tinctures and fluid- 
extracts will show that the fineness of the powder to be used is always specified. 
In some cases a coarse powder, sometimes a moderately fine, and again a very 
fine powder is specified. A vegetable drug having fine cells must be reduced 
to fine particles in order to break up as many of the cells as possible because 
the active principles of the drug might be confined within a tough cell wall, 
and if this wall remained unbroken the active principle might escape extraction. 
Solution. 
A solid, liquid, or gaseous substance can be so completely absorbed into, and 
so homogeneously mixed with, another liquid substance, that it can be said to 
have disappeared in that liquid substance. This is because the particles of 
the first substance are so uniformly diffused through the liquid that they do 
not separate upon standing, cannot be detected even under a high power 
microscope, and cannot be removed by filtration. 
When substances are thus combined the result is what is called a true or 
simple solution, which may be defined as a permanent and complete molecular 
incorporation of a solid, liquid, or gaseous substance in a liquid substance. 
The substance incorporated in the liquid is called the solute, and the liquid in 
which the substance is incorporated is called the solvent. 
Solutions may be divided into several different classes according to the 
different ways in which solution is effected or according to the physical states 
of the components, but in pharmacy the principle concern is with solutions of 
solids, liquids, and gases in liquids. Two of these classes are simple, in which 
no change occurs in the chemical structure or identity of the dissolved sub- 
stance, as when sugar is dissolved in water, and chemical, in which there is a PHARMACY 
619 
change in the chemical structure or identity of the dissolved substance, as in 
the making of solution of nitrate of mercury, when red mercuric oxide is dis« 
solved in a mixture of nitric acid and distilled water and the mercuric oxide 
changes to mercuric nitrate. In simple solutions the process of evaporation 
will recover the dissolved substance with its identity unchanged, but evapora- 
tion of chemical solutions will not yield the original dissolved substance for 
its identity has been changed. 
A saturated solution is a solution in which, at a given temperature, the sol- 
vent has taken up the maximum amount of the solute. In other words, the 
solvent can dissolve no more of the solute. A saturated solution is usually 
understood to be made at 25° C., the standard temperature for solubilities 
prescribed by the U. S. Pharmacopoeia. Practically, saturated solutions are 
made up at ordinary room temperature. A solution might be saturated with 
one substance and still be capable of dissolving a large amount of another 
substance. When a saturated solution is cooled below the temperature at 
which it is made, precipitation usually occurs; therefore, a saturated solution 
made during the summer would undergo a certain amount of precipitation if 
kept until winter, 
A supersaturated solution is one that contains more of a given substance 
than it will retain at ordinary temperatitre. A supersaturated solution is 
made by heating the solvent and dissolving the substance in it while hot. 
When such a solution cools precipitation of the excess takes place. 
Solution is aided by agitation, heat, comminution, and by slightly changing 
the chemical character of the substance to be dissolved. Heat aids solution by 
keeping the liquid in motion, and by increasing the size of the intennolecular 
spaces of both the solvent and the solute, allowing an intermingling of the 
molecules. (See under molecular physics in chapter on Chemistry). The in- 
crease in the size of the intermolecular spaces accounts for expansion of a 
substance when it is heated, and for the fact that a hot solvent will dissolve 
more of a given substance than a cold solvent. 
Chemical action aids solution by changing the chemical composition of the 
substance to be dissolved. Quinine sulfate which is normally soluable in 720 
parts of water can be made to dissolve in 9 parts of water by addition of a 
few drops of hydrochloric acid. Iodine which is practically insoluble in water 
can be made to dissolve freely by the addition of potassium iodide. In these 
cases the chemical character of the substances is very slightly changed. In 
other cases chemical action aids solution by producing a complete and permanent 
change in the character of the substance dissolved. 
The solubility of a substance is indicated in the U. S. Pharmacopoeia by stating 
the minimum number of cc of solvent that 1 Gm. of the substance will dissolve 
in at 25° C. It is also expressed in some cases by the use of such terms as 
freely soluble, sparingly soluble, soluble, very soluble, etc. 
Some of the more common solvents used in pharmacy are water, alcohol, 
diluted alcohol, glycerin, petroleum benzine, liquid petrolatum, benzene, ether, 
chloroform, diluted acetic acid, fixed oils, volatile oils, and diluted ammonia 
water. 
Water dissolves many compounds both organic and inorganic, inorganic 
salts, alkaloidal salts, gums, etc. It is chemically and therapeutically inactive, 
and in general has no effect on the substances dissolved in it. One of the 
objections to its use is the tendency for microscopic plants of the fungus type 
to grow in it; this is overcome largely by the use of recently boiled distilled 
water. It is very often mixed with other solvents in the manufacture of 
154294°—39 40 620 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
official preparations. It is the solvent used in the preparation of the official 
waters and liquors. Water has no preservative properties, which is one of 
its principal disadvantages. 
Alcohol is, next to water, the most important solvent used in pharmacy. 
It is frequently used as a solvent mixed with different proportions of water 
in the preparation of tinctures and fluidextracts. It dissolves many sub- 
stances that water will not and it possesses preservative properties that give 
it a decided advantage over water. The principal objection to its use is 
that even in small quantities it produces its characteristic effect on the system. 
It dissolves resinous drugs, oils, many organic and inorganic compounds, alka- 
loids, and many other substances. It is used in making tinctures and fluid- 
extracts. 
Glycerin will dissolve many substances that water will, and will precipitate 
hut few substances from aqueous solution. It mixes well with alcohol or 
water and is often used with one or both of these solvents. It is an excellent 
solvent for tannin and phenol. It is used as the solvent in the preparation 
of the U. S. P. glycerites. 
Separation of fluids from solids. 
Some of the processes for separating fluids from solids are lotion, decanta- 
tion, eolation, filtration, clarification, expression, percolation, etc. 
Lotion (meaning to wash) is the process of separating soluble matter from 
a solid by pouring upon the solid a liquid which will dissolve and wash out 
the soluble portion. This process is usually preceded by filtration or straining, 
and the substance to be washed is usually what remains on the filter after 
the excess liquid has drained off. Lotion is made tise of extensively in making 
chemical analyses of substances. 
Figure 147.—' 
■Decantation from beaker (left) and from precipitating jar (right). (Arny.) 
Decantation is the process of separating a liquid from a solid by pouring 
off the liquid after the solid has settled. This is sometimes better effected 
by use of a syphon. Decantation is a very effective method of washing soluble 
substances from solids. (Fig. 147.) 
Colation (straining) is the process of separating a solid from a liquid by 
pouring the liquid mixture upon a cloth strainer stretched on a frame. The PHARMACY 
621 
cloth usually is a piece of gauze, muslin, or flannel, depending on the character 
of the liquid that has to pass through it. This process is employed in strain- 
ing those liquids that will not pass readily through a filter paper. 
Filtration is the process of separating liquids from solids with the view of 
obtaining the liquid in a transparent condition and free from the very finest 
particles of insoluble matter. Of all the processes made use of in separating 
solids from liquids filtration is the most important. Filters are made of paper, 
paper pulp, sand, asbestos, ground glass, charcoal, porous stone, glass wool, etc. 
Clarification is the process of separating from liquids, without the use of 
strainers or filters, solid substances which interfere with their transparency. 
This process is seldom used in pharmacy. It is sometimes substituted for 
filtration or straining in the case of liquids that will not pass through a 
strainer, or where straining is slow or difficult. Clarification may be effected 
by the application of heat, by the addition of water, by the use of albumin, 
gelatin, or milk, by fermentation, by the use of paper pulp, and by long stand- 
ing, when the solid substance settles to the bottom of the container and 
is known as a sediment. This method of clarification is sometimes called 
sedimentation. 
Precipitation is the process of separating a solid from its solution by the 
action of heat, light, or chemical substances. The separated solid is termed 
a precipitate; the cause of the precipitation the precipitant; and the liquid 
which remains in the container the supernatant liquid. A precipitate may 
either rise to the top or sink to the bottom of the liquid from which it is 
precipitated, according to whether it is heavier or lighter than the liquid. 
Whereas a sediment is solid matter separated from solution by gravity, being 
merely suspended instead of dissolved in the solution, a precipitate is solid 
matter that has been separated from solution. 
The objects of precipitation are to obtain solid substances in the form of 
fine powder, to purify substances, and to identify a substance in chemical 
testing. The physical characteristics of precipitates are described by the words 
curdy, granular, bulky, flocculent, gelatinous, crystalline, etc. A magma is a 
thick tenacious precipitate left after the liquid is decanted. The character of 
precipitates, whether heavy or light, may be controlled by regulating the con- 
centration and temperature of the two solutions which are poured together 
to produce the precipitate. Light precipitates are made by mixing cold diluted 
solutions, and heavy precipitates are made by mixing hot concentrated solutions. 
Crystallization is the process by which substances are caused to assume cer- 
tain definite geometric forms called crystals having plane surfaces called faces, 
edges and angles. The scientific classification of crystals is based on the length, 
number, and relative position of their axes (plural of the word axis) and in 
this classification six systems are commonly recognized. In describing crystals 
the Pharmacopoeia does not always use scientific terms but general terms such 
as prismatic, laminar, acicular, cubical, etc. 
Substances that crystallize are known as crystalline and those that do not 
as amorphous substances. When a substance crystallizes in two or more forms 
belonging to different systems it is said to be dimorphous, trimorphous, poly- 
morphous, etc. When different substances crystallize in the same form they 
are said to be isomorphous. Crystallizable substances always assume their 
own characteristic form, or some form directly derived from it or related to it. 
The principal object of crystallization is to obtain a substance in a highly 
purified form. Crystals are obtained by the following different methods; 
Fusion and partial cooling; sublimation; deposition from supersaturated solu- 
tions as they cool; deposition from solutions during evaporation; deposition 622 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
from solutions while a galvanic current is passing through them; precipitation: 
adding a substance having a strong affinity for water. In pharmacy the use 
of granular crystals is usually preferred for the reason that they are more 
readily soluble than are large, perfect crystals. 
Many substances in the act of crystallizing combine chemically with water, 
and this water is known as water of crystallization. The amount of water of 
crystallization that a substance contains is expressed relatively by stating the 
number of molecules of water (H20) that are loosely combined with one mole- 
cule of the substance. The formula for monohydrated sodium carbonate is 
Na2C03.H20, which means that each molecule of contains one molecule 
of H20; the formula for magnesium sulfate is MgSCh.TELO, which means that 
each molecule of MgSCX contains seven molecules of H20. 
When crystalline substances are heated the water of crystallization is driven 
off and they are then known as exsiccated or anhydrous substances. If an 
exsiccated salt is dissolved in water and the solution evaporated gently the 
exsiccated salt will recrystallize with the same amount of water of crystalliza- 
tion that it originally contained. 
In determining the molecular weight of a substance, the molecular weight of 
the water of crystallization is added to the molecular weight of the substance 
without water. 
When crystals lose their water of crystallization and form a powder on the 
mttside they effloresce; crystals that absorb water are said to be hygroscopic, 
and when they absorb sufficient water to liquefy they are said to deliquesce. 
The liquid remaining after crystals have formed is known as the mother liquor. 
Some substances in crystallizing form masses of crystals and in the process 
mechanically imprison water in the interstices between the crystals. Such 
imprisoned water is called interstitial water to differentiate it from water of 
crystallization, and crystals may be freed of it by crushing the mass or gently 
heating it. 
It is sometimes necessary to separate crystallizable from noncrystallizable 
substances and the process of separating them is known as dialysis. The vessel 
used for this operation is called a dialyzer and has a drum-like head or dia- 
phragm made of parchment-like membrane at one end. Into this the substances 
to be separated are placed in the form of a solution and whole is floated on 
water where the crystallizable substance passes through the drum head into 
the water below, leaving the noncrystallizable substance behind. In this opera- 
tion the crystallizable substances are called crystalloids and those which are 
not crystallizable are called colloids. The object of dialysis is to obtain either 
the crystallizable or noncrystallizable substance free from the other. 
Extraction is the process of separating soluble principles from drugs by 
treating them with a liquid in which the principles are soluble. There are 
five principal methods of extraction: Maceration and expression, digestion, per- 
colation, infusion, and decoction. The solvent used in all cases of extraction 
is called the menstruum. 
Maceration is the soaking of a drug in the appropriate menstruum at room 
temperature until the soluble portion of the drug is dissolved. After the drug 
has soaked for some time, with frequent shaking, the insoluble matter is 
separated by straining and expression. Expression is the forcible separation of 
liquids from solids and is accomplished usually by the use of presses which in 
pharmacy are known as spiral twist, screw, roller, wedge, lever, and hydraulic, 
according to the mechanical principles involved in their action. This process 
is preferred to percolation in making strong extracts of vegetable drugs where 
a long time is required for the liquid to permeate the dried particles, and in PHARMACY 
623 
the case of those drugs which clog a percolator. Maceration is sometimes aided 
by suspending the ground drug, tied in a bag, in the upper part of the men- 
struum. This is known as circulatory maceration. When gentle heat is applied 
during the process of maceration or when warm water is used the process is 
then called digestion. Infusion is the process of extracting the water soluble 
principles from vegetable drugs by pouring hot water on the drug or by 
treating the drug with cold water for a definite length of time. Cold water 
should be used when the drug contains a valuable volatile principle, when the 
active principle is injured by heat, and when the desired principles are readily 
soluble in water of ordinary temperature. If the mixture of drug and water 
is boiled to secure the active principles of the drug the process is then called 
decoction. The last of the methods of extraction is that now to be discussed. 
Percolation is the process whereby a powder contained in a suitable vessel 
is deprived of its soluble constituents by the descent of a solvent through it. 
This process is also known as displacement. The U. S. Pharmacopoeia directs 
that a substance, in powder, contained in a vessel called a percolator, be sub- 
jected to the solvent action of successive portions of menstruum in such man- 
ner that the liquid, as it traverses the powder in its descent to the receiver, 
shall be charged with the soluble portions and pass from the percolator free 
from insoluble matter. 
A percolator is a cylindrical or conical vessel with a porous diaphragm at 
the bottom, into which the drug in the form of a powder is introduced, and its 
soluble portions extracted by the descent of the solvent through it. (Fig. 148). 
The solvent, or menstruum, which is poured on 
the top of the powder, in passing downward exer- 
cises its solvent power on the successive layers of 
the powder until saturated, and is impelled down- 
ward by the combined force of its own gravity 
and that of the column of liquid above, minus the 
capillary force with which the powder tends to 
retain it. When the menstruum, saturated with 
the soluble principles of the drug, escapes from 
the bottom of the percolator it is known as the 
percolate. 
It has been stated before that vegetable drugs 
must be reduced to fine particles in order to break 
up the walls of the cells within which much of 
the active principles of the drug is contained. 
After grinding or otherwise breaking up the 
vegetable drug the soluble principles are to be found in the fine dust scattered 
through the powdered drug and in the thoroughly disintegrated particles. In 
this form but little resistance is offered to the passage of the solvent through 
the powder and the first portion of the solvent passing through the powder will 
come in contact with more of the soluble principles than will the later portions. 
The solvent first takes up the soluble principles released through grinding and 
powdering and afterward permeates the cells and cell walls to take up any 
soluble principles remaining in them. Consequently, the percolate first escaping 
from the percolator is more highly colored and contains more of the soluble 
principles than the later portions. 
The process of percolation may be divided into six steps as follows: 1. 
Comminution or reduction of the drug to the required degree of fineness; 2. 
Moistening of the drug; 3. Maceration or soaking of the drug either within or 
without the percolator before pouring on the menstruum; 4. Packing the 
Figure 148.—Official percola- 
tor (left) and process of 
percolation (right). (Rem- 
ington. ) 624 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
drug in the percolator; 5. Pouring on the menstruum; 6. Regulating the flow 
of and collecting the percolate. 
The process of percolation is used in pharmacy in the preparation of tinc- 
tures, fluidextracts, etc., and it has a great advantage over maceration in ex- 
tracting the soluble principles of drugs as by percolation every trace of soluble 
matter can be removed. 
PHARMACEUTICAL PREPARATIONS OFFICIAL IN THE U. S. 
PHARMACOPCEIA XI 
In this section only those pharmaceutical preparations named in the IT. S. 
Pharmacopoeia XI will be discussed as they are those commonly known as 
“official”, or “pharmacopoeial”, preparations, the U. S. P. XI directing that 
the word “official” shall “be considered as synonymous with ‘pharmacopoeial’ 
In addition to the “official” pharmaceutical preparations herein discussed there 
are others recognized by the National Formulary and miscellaneous ones not 
recognized by the U. S. Pharmacopoeia or the National Formulary which are 
frequently used in the practice of pharmacy. 
Pharmaceutical preparations manufactured by the processes which have been 
described in the preceding section are divided into two main classes known 
as galenical preparations and chemical preparations. Galenical preparations are 
those in the manufacture of which no chemical action is involved; they are 
simple solutions or mechanical mixtures. Chemical preparations are those in 
which chemical changes occur during the process of their manufacture. 
They are also grouped further in two general classes of liquids and solids 
according to the nature of the preparation. Liquid preparations are those 
in which the medicinal substance is contained in various liquid vehicles, and 
solid preparations are those in which the medicinal substance is incorporated 
in a solid or semisolid vehicle. Liquid and solid preparations may also he 
grouped in classes according to the nature of the principal vehicle used in their 
manufacture, as aqueous, oleaginous, etc., and according to the nature of the 
preparation, as extracts, pills, etc. Both liquid and solid preparations may 
be made with maceration and percolation or without maceration and percolation. 
In addition to these pharmaceutical prepartions there are natural prepara- 
tions used in pharmacy, some of which are alkaloids, glucosides, and other 
neutral principles, acids, alkalies, etc. 
Liquid preparations. 
Aceta (vinegars) are solutions of the active principles of vegetable drugs in 
diluted acetic acid. Diluted acetic acid is used as a menstruum because it is 
a good solvent and also possesses antiseptic properties. Vinegars are a very 
old class of pharmaceutical preparations but are gradually passing into disuse. 
There is but one official vinegar in the U. S. P. XI, Acetum scillce; vinegar of 
squill. 
Aquae (waters) are aqueous solutions of volatile substances, and are also 
known as medicated, aromatic, or distilled waters. In the U. S. P. XI are 
listed Aqua destillata, distilled water, and Aqua destillata sterilisata, sterilized 
distilled water, neither of which contain anything in solution. 
The substances used in the preparation of waters may be either solid, liquid, 
or gaseous, but they are all volatile. Many of the waters are made from volatile 
oils which are only slightly soluble in water and such waters are spoken of as 
aromatic waters. They have very little medicinal effect and are used princi- 
pally as flavored vehicles in which active drugs are administered. Ammonia PHARMACY 
625 
water differs from the other waters in that it is a powerful caustic and must 
be handled with care. 
Four methods are employed in the preparation of waters as they are made 
from substances that are not readily soluble in water. The methods are: 1. 
Simple solution in cold water; 2. Filtration with the aid of an absorbent powder; 
3. Filtration with the aid of pulped or shredded filter paper; 4. Distillation. 
For making waters by the process of filtration through an absorbent powder the 
Pharmacopoeia recommends the use of purified talc. 
In the preparation of most of the waters official in the Pharmacopoeia it is 
directed that distilled water be used, and the use of distilled water that has 
been recently boiled is preferable as it is then free from the microorganisms 
that produce unsightly growths in waters after they have stood for some time. 
The term “aromatic waters” refers to those waters made from odorous prin- 
ciples and which are used chiefly as perfumes and flavorings. After aromatic 
waters stand for a long time they deteriorate and are unfit for use; therefore 
they should be made up only in small quantities as required. 
Fifteen waters are recognized in the U. S. P. XI. 
Collodia (collodions) are liquid preparations intended for external use having 
as their base a solution of pyroxylin, or gun-cotton, in a mixture of ether and 
alcohol. When applied to the skin the ether and alcohol evaporate and leave a 
thin film of gun-cotton (“new skin”) which acts as a protective. The layer of 
gun-cotton left after evaporation of the ether and alcohol is brittle and liable 
to crack when applied to a movable joint. In flexible collodion a small amount 
of castor oil is added with the result that the film left after evaporation is 
pliable. Two collodions are official. 
Decocta (decoctions) are liquid preparations made by boiling vegetable drugs 
with water for 15 minutes. There are no official decoctions but a general 
formula for their preparation is provided in the Pharmacopoeia. This formula 
directs that 50 Gms. of drug, coarsely comminuted, be boiled with sufficient 
water to make 1,000 cc of decoction. Decoctions spoil quickly and should 
never be dispensed unless freshly made. 
Elixiria (elixirs) are aromatic, sweetened, hydro-alcoholic solutions some- 
times containing active medicinal substances. Aromatic elixir, composed of 
water, alcohol, and syrup, flavored with compound spirit of orange, is used as 
the vehicle in preparing most medicated elixirs. Two elixirs are official. 
Emulsa (emulsions) are liquid preparations in which oily or resinous sub- 
stances are suspended in water by means of adhesive, mucilaginous, or other 
viscid matter. They are sometimes classified as natural and prepared emul- 
sions. A natural emulsion is one which exists ready formed in Nature, of 
which typical examples are milk, egg yolk, and rubber latex; a prepared emul- 
sion is one which is made artificially, of which all pharmaceutical emulsions 
are examples. 
Oil and water are two liquids of which emulsions may be formed, and 
according to whether the oil is mixed in the water or the water in the oil, 
emulsions are known as the oil-in-water type (cod-liver oil emulsion) or the 
water-in-oil type (Carron oil). 
Violently shaking oil and water together produces an emulsion for the 
moment but on standing the oil and water quickly separate because there is 
nothing present to keep the fine globules of oil from running together and 
separating from the water. In order to make an emulsion that is stable and 
will not separate it is therefore necessary to use a third substance known as an 
emulsifier or emulsifying agent which is a substance that makes it possible 626 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
for one liquid to hold another liquid in suspension without “breaking” or 
“cracking”, terms used when the particles in an emulsion separate and run 
together. Most substances which produce foam in water are good emulsifying 
agents. They may be saponaceous (soapy), mucilaginous (gummy), or albu- 
minous (white of egg) in character. The most commonly used emulsifying 
agents are acacia, tragacanth, egg yoke, Irish moss, casein, etc. Casein is 
obtained from milk, a natural emulsion. 
Prepared emulsions usually are made by either the Continental or the Eng- 
lish method. The Continental method, sometimes called the 4-2-1 method 
because 4 parts of oil, 2 parts of water, and 1 part of emulsifying agent are 
first mixed to make the nucleus or primary emulsion, produces an emulsion 
quicker than the English method and is more generally used, as a good emulsion 
always results if the method is correctly followed. 
In making an emulsion by the Continental method the first step is to place 
the oily or resinous substance in a dry mortar, add the emulsifying agent, and 
rapidly triturate them until intimately mixed. The next step is to add the 
water all at once and continue to triturate rapidly and vigorously until a thick, 
creamy emulsion results, which is the nucleus or primary emulsion. The final 
step is to bring the emulsion up to its final volume and the proper strength by 
adding water to the nucleus in small portions with constant trituration. 
Triturating the oily or resinous substance reduces it to a state of very fine 
subdivision, or in other words breaks it up into very fine particles which are 
intimately mixed with the emulsifying agent. When the first water is added a 
mucilage is formed with the emulsifying agent and each fine particle is sur- 
rounded or enveloped by a thin film of the mucilage which holds them in sus- 
pension and prevents them from running together again. Four emulsions are 
official. 
Fluidextracta (fluidextracts) are liquid preparations of vegetable drugs con- 
taining alcohol as a solvent or as a preservative, or both, and so made that 
each 1 cc contains the therapeutic constituents of 1 Gm. of the standard drug 
which it represents. 
Fluidextracts resemble tinctures but they are stronger. The solvents used 
and the methods employed in their preparation are much like those for the 
preparation of tinctures. Some of the advantages possessed by fluidextracts are 
permanence, concentration, and uniform relation between the drug and the fluid- 
extract. They keep well because they are made with a menstruum containing 
alcohol, and sometimes glycerin, both of which are preservatives. The concen- 
tration of the active principles of a vegetable drug in a small volume of liquid 
reduces the volume of the dose and thereby largely avoids the physiological 
effect of the alcoholic menstruum which is one of the objections to the use of 
tinctures, especially weak tinctures that are given in large doses. The uniform 
relation (1 Gm. of the standard drug equaling 1 cc of the fluidextract) existing 
between the vegetable drug and finished fluidextract simplifies calculations in 
the preparation of doses. 
The official fluidextracts are standardized whenever made from a drug that 
is capable of being assayed either chemically or biologically. They are made 
by the process of percolation and the menstruum to be used is specified in each 
case, the rate of flow of the percolate is directed, and the time of maceration 
is prescribed, so that the medicinally active or important constituents may be 
completely extracted from the specified quantities of the drug. The Pharma- 
copoeia provides four general formulas or processes for making fluidextracts 
which are known as Processes A, B, C, and D. Process A is used for preparing PHARMACY 
627 
fluidextraets with menstrua of alcohol or with mixtures of alcohol and water 
by ordinary percolation; Process B is used in preparing fluidextraets, the 
menstrua for which contain, in addition to alcohol, or a mixture of alcohol and 
distilled water, definite quantities of other components such as an acid or 
glycerin, the two menstrua being successively employed; Process C, known as 
fractional or divided percolation, is used for preparing fluidextraets of drugs 
whose constituents are injured by heat; and Process D is used for preparing 
fluidextraets with boiling distilled water as the menstruum, alcohol being added 
to the concentrated percolate as a preservative. Eleven fluidextraets are official. 
Glycerita (glycerites) are mixtures or solutions of medicinal substances with 
glycerin. They can easily be diluted with water without causing precipitation 
of the substance dissolved in the glycerin. Many substances can be dissolved 
in greater concentration in water if they are first dissolved in glycerin and 
the glycerin solution then mixed with water. For example, if it is desired to 
make a solution of phenol in water of a greater strength than 5 per cent it 
can be done by making a 50 per cent solution of phenol in glycerin and then 
diluting that solution to the desired percentage strength. Three glycerites are 
official, one of which, glycerite of starch, is a semisolid. 
Infusa (infusions) are liquid preparations made by treating vegetable sub- 
stances with either hot or cold water. They are seldom used in America and 
as they spoil quickly should be used the same day they are made or as soon 
as possible. There are no official infusions but the Pharmacopoeia provides a 
general formula for their preparation. In making infusions boiling water may 
be poured over the drug but it should not be subjected to the boiling process. 
They usually are made by maceration, digestion, percolation, or by diluting 
concentrated preparations. 
Linimenta (liniments) are solutions or mixtures of various substances in 
oily or alcoholic liquids intended for external use by friction and rubbing of the 
skin. In dispensing liniments the container should always bear a label indi- 
cating that they are for external use only. Four liniments are official. 
Liquores (solutions) are aqueous solutions of nonvolatile substances. This 
group of pharmaceutical preparations usually contains very active medicinal 
substances and some solutions contain powerful poisons. Generally they are 
classed as simple or chemical solutions, according to the methods by which 
they are prepared. Those classed as simple solutions are made by the ordinary 
process of dissolving the drug in water and without any change in the chemical 
structure of the dissolved substance; chemical solutions are those in the making 
of which the chemical structure or identity of the dissolved substance is changed 
because of chemical reaction at the time solution is effected and the original 
identity is lost. Twenty-one solutions are official. 
Magmse (magmas) are aqueous suspensions of the finely subdivided insoluble 
constituents of inorganic substances. They are closely related to mixtures and 
consist of soft, thick, tenacious precipitates suspended in water. Two magmas 
are official, one of which, Magma ferri hydroxidi, is used only as an antidote 
for arsenic poisoning. It is sometimes known as “the official antidote” for 
arsenic poisoning and should never be used unless freshly prepared. 
Mistura (mixtures) are aqueous liquid preparations intended for internal 
use containing insoluble nonfatty substances. Frequently the insoluble matter 
is suspended by the aid of viscid or sweet liquids but generally it is in the 
form of a sediment in the bottom of the container. 
The insoluble matter usually constitutes the principal part of a mixture 
and it is therefore important that mixtures be dispensed with a “Shake Well” 628 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
label. Mixtures do not keep well because they usually contain substances that 
are prone to,fermentation. They differ from emulsions in containing no fat 
and from liniments in being used internally. There are two official mixtures. 
Mucilagines (mucilages) are thick aqueous preparations containing viscid 
substances in solution or suspension. They are made by dissolving gum in 
water, or by extracting with water the mucilaginous principles of vegetable 
substances. Mucilages readily undergo fermentation on standing and therefore 
should always be made fresh when needed; they are used as emollients, as 
emulsifying agents in making emulsions of oily substances, as pill excipients, 
and as suspending agents in mixtures. Two mucilages are official and one is 
made with heat, the other without heat. 
Oleata (oleates) are solutions of metallic oxides or alkaloids in oleic acid. 
They are used externally by rubbing them on the skin, through which the 
active medicinal agent they contain is absorbed and produces its constitutional 
or local effect. Oleic acid is more readily absorbed than most of the fatty 
substances used in making ointments. One oleate is official. 
Oleoresinae (oleoresins) are liquid preparations consisting principally of nat- 
ural oils and resins extracted from vegetable substances by percolation with 
acetone, ether, or alcohol. Subsequent distillation and evaporation of the 
solvent leaves behind the oleoresin. They are the strongest liquid preparations 
of vegetable drugs produced and can be prepared only from drugs containing 
volatile oil and resin. Besides the pharmaceutical oleoresins there are natural 
oleoresins, which are mixtures of volatile oil and resin exuding from plants. 
Examples of natural oleoresins are turpentine and copaiba. There is but one 
oleoresin official in the U. S. P. XI. 
Spiritus (spirits) are alcoholic solutions of volatile substances. They differ 
from waters only in the solvent used (alcohol instead of water) and a number 
of volatile substances used in making medicated waters are also used in making 
spirits. Volatile oils are more soluble in alcohol than in water and the amount 
of volatile oil in a spirit is therefore much greater than in a water. The 
average strength of spirits is from 5 to 10 per cent although some are less 
than 5 per cent and some more than 10 per cent in strength. 
They are made by: 1. Simple solution; 2. Solution with maceration; 
3. Chemical reaction; and 4. Distillation. The spirits made by dissolving 
volatile oils in alcohol are popularly called “essences”, as Essence of Pepper- 
mint. There are thirteen official spirits. 
Syrupus (syrup) is a concentrated solution of sucrose in water or aqueous 
liquids. When distilled water alone is used in making the solution of sucrose 
the result is known as simple syrup; when the solution contains soluble 
medicinal principles the syrup is known as a medicated syrup; and if the solu- 
tion contains aromatic or pleasantly flavored substances not medicinal in nature 
the syrup is called a flavored syrup. 
In the preparation of syrups a high grade of sucrose (sugar) should be 
used, preferably a grade that meets the requirements of the Pharmacopoeia. 
Syrup made from inferior grades of sucrose (sugar) is usually colored, does 
not keep well, and contains impurities. In preserving syrups they should be 
kept in a cool place in well-filled bottles. A fresh supply of syrup should never 
be placed in a bottle containing even a trace of old syrup. The bottle should 
be washed with hot water before refilling. In preparing simple syrup it should 
be made concentrated because a saturated syrup keeps better than a diluted 
one. Fourteen syrups are official. 
Tinotura (tinctures) are alcoholic or hydro-alcoholic solutions of the active 
principles of animal or vegetable drugs according to the definition given in PHARMACY 
629 
the U. S. P. XI. They are also defined as alcoholic solutions of nonvolatile 
substances. Tinctures are different from spirits as they are made from, non- 
volatile substances, but the tinctures which contain volatile substances ex- 
tracted from drugs and those which contain iodine are exceptions to the general 
definitions. Iodine is a volatile, uonmetallic substance or element. 
Tinctures constitute one of the most important classes of pharmaceutical 
preparations. Their strength varies, that of the potent, or strong, tinctures 
being commonly spoken of as 10 per cent, which means that they contain in 100 
cc of finished tincture the active principles of 10 Gms. of the standard drug, 
while others are stronger or weaker than 10 per cent. The IT. S. P. requires 
that a number of tinctures be assayed in order that the strength may conform 
to the standard adopted. 
Two general processes for the making of tinctures are prescribed in the 
U. S. P. XI. They are Process P, or percolation, and Process M, or macera- 
tion. The menstrua used are alcohol, diluted alcohol of various strengths, aro- 
matic spirit of ammonia, ether, ammonia water, or mixtures of alcohol, water, 
and glycerin. Tincture of iodine is made by the process of solution, the iodine 
being dissolved in a solution of potassium iodide and alcohol added; tincture 
of ferric chloride is made by diluting the solution of ferric chloride with 
alcohol. 
Tinctures should be kept in a cool place, in tightly stoppered containers, and 
protected from light. Thirty are official. 
Solid preparations. 
Cerata (cerates) are combinations of medicinal substances with fats and 
waxes intended for external application. They are stiff, ointment-like prep- 
arations of such consistence that at ordinary temperatures they may be easily 
spread on cloth or paper, but not soft enough to liquefy and run when applied 
to the skin. 
They are called cerates because they contain wax (cera) and are generally 
made with oil, lard, or petrolatum for a basis, with sufficient wax, paraffin, or 
spermaceti sometimes being added to raise the melting points of oils and fats. 
They are made either by fusion or by incorporation and three are official. 
Emplastra (plasters) are solid preparations intended for external application 
and containing medicinal substances. Plasters should be of such consistence 
that they are pliable and will adhere to the skin. Some require the aid of 
heat in their application. 
The plaster base or mass which contains the medicinal substance generally 
is made of lead plaster (a compound of litharge and oil), gum-resins, resin 
plaster (a compound of resin, lead plaster, and wax), Burgundy pitch, isinglass, 
and India rubber, or combinations of these substances. The plaster mass is 
spread upon a backing of muslin, paper, cotton cloth, etc., of suitable size 
and shape. 
Common adhesive plaster contains no medicinal substance and is a mixture 
of rubber, resins, and waxes with one or more fillers of an absorbent powder 
as zinc oxide, orris root, starch, etc. 
Most plasters today are machine made and their manufacture is seldom called 
for in the practice of pharmacy. Four are official. 
Extracta (extracts) are solid or semisolid preparations containing the soluble 
and active principles of vegetable and animal drugs. They are obtained by 
extracting the soluble and active principles of those drugs with appropriate 
menstrua and evaporating the percolates to the proper consistency. According 
to their consistency extracts are divided into two classes: Soft, plastic masses, 630 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
known as pilular extracts, and dry powders, known as powdered extracts. The 
menstrua employed in making extracts vary, alcohol, distilled water, alcohol 
with distilled water, alcohol with ammonia, alcohol with an acid, and alcohol 
with glycerin all being used. 
Extracts contain the active constituents of drugs in a concentrated, uniform, 
and permanent condition. Those made from alkaloidal drugs are required by 
the Pharmacopoeia to be standardized as to strength and assay processes are 
prescribed for this purpose. After the menstruum has been evaporated off a 
portion of the extract is assayed and the remainder, as determined from the 
strength shown by the assay, is adjusted to standard strength. In the cases 
of those extracts not required to be assayed the finished extract is adjusted 
so that its weight bears a uniform relation to the amount of the drug that 
was percolated in making the extract. In the finished extract of cascara 
sagrada 1 gram must be equal to 3 grams of the powdered cascara bark used 
in the manufacture, because the U. S. P. directs that 900 Gms. of cascara 
sagrada bark, in fine powder, be exhausted by percolation, the percolate evapo- 
rated to dryness, reduced to fine powder, weighed, and enough diluent added 
to make 300 Gms. of finished extract. The diluent is the substance used to 
adjust the finished extract as necessary to meet the requirements of the Phar- 
macopoeia. Glucose is directed as the diluent for pilular extracts and starch 
for powdered extracts but the use of others is permitted. 
Pillular extracts are soft solids intended for use in making ointments, pills, 
suppositories, etc. In their preparation the U. S. P. directs that they be diluted, 
when necessary, with glucose in order to reduce them to the standard strength. 
Soft extracts should be kept in a cool place, away from light, and in well 
closed containers to prevent evaporation. If the containers are left open 
they become hard and dry. Extracts vary slightly in their strength from time 
to time due to loss of moisture. 
Powdered extracts are dry fine powders. They are made like pillular ex- 
tracts except the drying process is carried farther in order to reduce them 
to a powdered condition. The drying must be carefully done at a low tempera- 
ture to avoid injury by heat. After they have been dried and powdered they 
are weighed (assayed in the case of alkaloidal drugs) and diluted as required 
to bring them to standard strength. Powdered extracts are easier to dispense 
than pillular extracts because they do not stick to the containers, they can 
be more accurately weighed, and they are more constant in their strength than 
pillular extracts. They should be preserved in well closed containers in a dry 
place. In contact with moist air they absorb mioisture and become sticky. 
Twelve extracts are official. 
Massae (masses) are soft, solid preparations composed of an active medicinal 
substance mixed with excipients to form a mass resembling a pill mass. They 
are used in making pills and two are official. 
Pilulae (pills) are small, solid bodies of a round, ovoid, or lenticular shape, 
usually weighing from 1 to 5 grains. They contain medicinal matter and are 
intended to be swallowed whole. A holtis is a very large pill and a granule 
is a very small pill. There are certain advantages in administering medicines 
in pill form as they can be swallowed without mastication, they are adapted 
for the administration of heavy metallic substances which cannot readily be 
suspended in liquids, the action of the medicine is slow and is even retarded 
in some cases until the pill reaches the lower bowel, being in compact form 
they are easily swallowed, and when coated they are tasteless. 
Occasionally pills have to be made by hand and the process of pillmaking 
consists roughly of three stages, first, making the pill mass, second, dividing PHARMACY 
631 
the pill mass, and third, rolling the pill. A pill mass should be sufficiently ad- 
hesive to permit rolling of it without falling in pieces; it should be firm enough 
to retain its shape when rolled and yet not so soft that the finished pills will 
flatten during the process of drying; it should be plastic enough to be easily 
rolled; and most important of all, it should be sufficiently soluble in the 
juices of the intestinal tract to disintegrate and allow1 the active ingredients 
to escape and exert their medicinal effect. 
Excipients are agents added to the contents of a pill to facilitate its being 
made into a suitable mass. There are four classes of excipients: Those which 
are intended to develop adhesiveness and hence act as solvents, as water, alco- 
hol, diluted alcohol, glycerin, and mixtures of water and glycerin; those which 
are intended to impart adhesiveness, as glucose, syrup, honey, mucilage of 
acacia, syrup of acacia, mucilage of tragacanth, glycerite of starch, acacia 
with glucose or honey, tragacanth with glycerin, soap with water, soap with 
diluted alcohol, extract of malt, confection of rose, etc.; those which are in- 
tended to act simply as absorbents of excessive moisture, and, in a few cases 
to impart adhesiveness to the mass at the same time, as licorice, powdered 
orris root, powdered tragacanth, powdered elm bark, powdered marshmallow, 
starch, etc. 
After the pill mass is finished it is rolled out and cut into small pieces. 
Each one of these pieces represents one pill, and it is finished by rolling it 
between the thumb and fingers, or in the palm of the hand. To prevent them 
from adhering together, or from sticking to the fingers while rolling them, they 
may be dusted lightly with any one of the following powders: Rice flour, pow- 
dered licorice root, powdered althaea, talcum, lycopodium, or magnesium 
carbonate. Two pills are official in the U. S. Pharmacopoeia. 
Pulveres (powders) are combinations of solid drugs in a finely divided state. 
They may be for internal use or for external application. There are four 
official powders, all of which are known as compound powders and are for 
internal use. Powders intended for external application are known as dusting 
powders, healing powders, etc. 
Besides the Pharmacopceial and the National Formulary powders, physicians 
frequently prescribe other drugs in powder form; these may be composed of 
one or more active ingredients, or they may be composed of active ingredients 
mixed with an inert diluent (sugar of milk) to give bulk to the powder. The 
official powders are usually made by rubbing the ingredients together in a 
mortar until a thorough mixture is obtained, the ingredients being previously 
reduced to a fine state of subdivision. Some substances have a tendency to 
cake when rubbed in a mortar, and these should be mixed on a pill tile. This 
caking is due to the presence of moisture, and to the fine state of subdivision 
of the powder. Dusting powders and granular effervescent powders should 
not be triturated in a mortar because of this caking. Dusting powders should 
always be sifted after they are mixed. 
Powders which contain strong drugs must of necessity be very intimately 
mixed in order to insure that an overdose is not contained in any one of the 
powders. In order to mix one or more strong drugs intimately with other 
parts of the powder the following rule should be followed: Mix the strongest 
drug with an equal weight of the next most active drug, and after they are 
intimately mixed incorporate the remainder of the weaker drug, and then 
gradually add to this mixture the next weaker drug, etc., until all the 
ingredients are incorporated. 
Resinae (resins) are solid preparations consisting principally of the resinous 
principles from vegetable drugs. They are soluble in alcohol but are insoluble 632 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
in water and are known as natural resins, natural plant exudations, and 
prepared resins, those obtained by pharmaceutical processes. Prepared resins 
usually are made by taking the alcoholic extracts of vegetable drugs obtained 
by percolation and concentrated by evaporation and pouring them into water 
or acidulated water when the resinous principles are precipitated. These are 
then collected, washed, and dried. Resins may also be obtained by distilling 
natural oleoresins, the volatile oils passing over and leaving behind the 
resin. Although prepared by the process of extraction as are extracts, resins 
differ from extracts by containing only those plant principles that are soluble 
in alcohol and insoluble in water. Two resins are official. 
Suppositoria (suppositories) are solid bodies intended for introduction into 
different orifices of the human body to produce medicinal action. They are 
of various weights and shapes and melt or soften at body temperature. The 
vehicles usually employed to carry the medicinal substances are oil of 
theobroma, glycerinated gelatin, or sodium stearate. 
In the preparation of suppositories it is important that the medicinal sub- 
stance be equally distributed throughout the vehicle. This distribution may 
be made by rubbing the medicinal substance with the vehicle, or by fusion 
of the vehicle and incorporation of the medicine with the melted vehicle 
followed by chilling of the fused mixture in molds. Suppositories are usually 
prepared by methods known as “hand made or rolled”, “molded”, and 
“machine made or pressed”. 
Suppositories should be of such consistency as to retain their shape until 
inserted and then quickly melt. Oil of theobroma (cocoa butter) is the ideal 
vehicle or base for suppositories because it melts at a temperature slightly 
below that of the body but remains solid at ordinary temperatures. It is also 
a bland, nonirritating oil. After suppositories have been made they should 
be kept in a cool place. Rectal suppositories should be cone shaped, and if 
oil of theobroma is used as the vehicle they should weigh about 2 Gms. 
Urethral suppositories should be pencil shaped and with a rounded point at 
one end. When 7 centimeters (2y2 inches) long they should weigh 2 Gms., 
and when 14 centimeters (5 inches) long they should weigh about 4 Gms., if 
made with glycerinated gelatin as the vehicle. If made with oil of theobroma 
as the vehicle they should weigh one-half the above amounts. Vaginal sup- 
positories should be ovoid or globular in shape and weigh about 4 Gms. if 
made with oil of theobroma and 10 Gms. if made with glycerinated gelatin. 
Only one suppository is official. 
Tabellae (tablets) are solid, small, flattened masses of medicinal powders. 
They are divided into several classes according to the method of manufacture 
or the use for which they are intended. Among these classes are the tablet 
triturate, the compressed tablet, and the hypodermic tablet. The general pro- 
cedure in making tablets is to first grind, thoroughly mix, and sift the 
ingredients, next granulate the mixed materials by moistening with a suitable 
liquid containing a “binder” and passing through a very coarse screen, and 
then dry the coarse granules. After drying the coarse granules they are 
reduced to the proper size and the material pressed into the proper size and 
shape. (For full information concerning tablet making refer to a standard 
textbook on the Practice of Pharmacy.) Three tablets are official, two of them 
being the “poison” tablets of mercuric chloride which have a distinctive color, 
not white, and an angular or irregular shape. 
Triturationes (triturations) are a class of powders having a definite relation 
between the active medicinal ingredient and the diluent. This relation is one PHARMACY 
633 
part of the medicinal substance and nine parts of diluent. They are made 
by adding to the substance, previously reduced to a moderately fine powder if 
necessary, an equal amount of the diluent, mixing well by means of a spatula, 
and triturating the powders together in a mortar. The remainder of the dilu- 
ent is added in portions until the whole is added, triturating after each portion 
is added, and continuing the trituration until a fine powder is obtained. 
Sugar of milk (lactose) is prescribed as the diluent, largely because its hardness 
helps to insure a fine comminution of the medicinal substance. Triturations are 
excellent forms for the administration of powerful alkaloids. Only the general 
formula for triturations is official in the Pharmacopoeia. 
Unguenta (ointments) are semisolid preparations containing medicinal sub- 
stances blended with fatty matter of sufficient softness to permit their being 
applied to the skin by inunction. All official ointments are made either by 
fusion or incorporation; one ointment recognized in the National Formulary, 
ointment of mercuric nitrate (citrine ointment), is made by chemical reaction. 
When made by fusion the fatty substances are liquefied by the aid of heat and 
the medicinal substance incorporated while the fats are liquid or after solidifica- 
tion ; when made by incorporation the medicinal substance is rubbed up with 
the solid fatty matter, either in a mortar or on an ointment slab. In making 
ointments by fusion ingredients having high melting points should be melted 
before those having a lower melting point as the high heat necessary to melt 
the former may be injurious to the latter. Ointments made by fusion should 
be stirred while cooling, because the ingredients having high melting points 
usually will solidify first, resulting in a granular ointment. If the medicinal 
substance used is a powder it should be brought to ths finest possible state 
of subdivision before incorporating it with the ointment base. 
According to their therapeutic use, ointments may be classified as non- 
absorbable, those which act as protectives and produce their medicinal effects 
on the epidermis or outer skin; emollient, those which soften the epidermis 
and carry their medicinal effects into the derma or true skin; and absorbable, 
those which penetrate the skin and enter the general circulation producing 
systemic or constitutional medicinal effects. In order that these therapeutic 
effects of ointments may be obtained the bases used in the different classes 
of ointments vary and must be suitable for the purpose intended. 
An ointment base should not be rancid, not only because of the peculiarly 
disagreeable odor but because the volatile fatty acids released when rancidity 
develops are frequently irritating and may cause chemical reaction. Petro- 
latum is a good ointment base for almost any purpose except when absorption 
is desired. Being practically nonabsorbable it is an excellent base for oint- 
ments used in treating skin diseases. Hydrous wool fat is a good ointment 
base, is quite absorbable, perhaps because of the water it contains, and is 
used especially in making ointments containing liquids which are not miscible 
with the prescribed base. The U. S. Pharmacopoeia allows as much as 30 per 
cent of water in the official hydrous wool fat, and the presence of that amount 
of water gives it the proper consistency for use as an ointment base. Anhy- 
drous wool fat is very tough and sticky and for making ointments con- 
taining a large amount of water or other liquid its use is preferable to 
the hydrous wool fat. Yellow wax is better for an ointment base than 
white, or bleached, wax, because in the process of bleaching the yellow wax 
a change takes place which makes the white wax more likely to become ran- 
cid. The official glycerite of starch is sometimes directed to be used as the 
vehicle for ointments under the name of plasma or plasma (jlycerini because 634 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
it is not greasy, can be washed off without difficulty, and never becomes rancid. 
In making ointment of boric acid it is stirred until congealed, as boric acid 
is not soluble in petrolatum and is held mechanically. 
Glycerin is used in tannic-acid ointment to dissolve the acid and make it 
more effective. Metal spatulas should not be used in making tannic-acid oint- 
ment, as it attacks the iron, forming tannate of iron, resulting in a darkened 
ointment. If the spatula first is smeared with the fatty substance, there is 
little danger. 
In making cold cream (ointment of rose water) rose water is used instead 
of oil of roses to perfume it, as the water makes it softer and more creamy. 
Borax is used in cold cream to give a whiter and more creamy preparation. 
Water is warmed in making cold cream, because if not warmed it will chill 
the melted base and make it lumpy or granular. Many cold creams are made 
with paraffin and liquid petrolatum, as it is a cheaper base and one that does 
not become rancid. 
In making belladonna ointment the extract is rubbed with diluted alcohol to 
thoroughly soften the extract so as to make a homogeneous mixture. Wool 
fat then is used to take up the liquid. 
Oleate of mercury is used in making mercurial ointment because it will hold 
mercury in a microscopic state of subdivision. Mercurial ointment should 
be kept in a cool place, as the mercury separates out when warmed. Metal 
spatulas should not be used in its making. 
Lanolin is better for making yellow oxide of mercury ointment than the 
simple ointment, as the mercury oxide is not reduced readily. 
Potassium iodide is used in iodine ointment, as iodine cannot be reduced to 
an impalpable powder, but is very soluble in a glycerin solution of potassium 
iodide, and this solution can be mixed intimately with the base. Glycerin is 
used in iodine ointment to dissolve the potassium iodide. Water is objectionable 
because it evaporates and the iodide is left in gritty crystals. 
PRESCRIPTIONS 
The preparation and dispensing of medicines intended to be compounded ex- 
temporaneously or as the occasion or the physician’s needs may require is 
termed magistral pharmacy. Under this head is placed the filling of 
prescriptions. 
A prescription is a formula which a physician writes, specifying the sub- 
stances he intends to have administered to a patient. It is written in the 
Latin language because that is the official language of science, is understood 
throughout the world, and, being a “dead” language, is not subject to change. 
It is sometimes necessary and always advisable that a patient should not know 
the names and properties of the medicinal agents administered and this is 
usually possible when Latin is used. 
The parts of a prescription are: 1. The name of the patient and the date; 
2. The superscription, or heading, indicated by the symbol “It”, standing for 
the Latin word “Recipe” (take thou) ; 3. The inscription, or the names and 
quantities of the ingredients (the base, the adjuvant, the corrective, and the 
vehicle) to be compounded; 4. The subscription, or the directions to the pharma- 
cist or compounder; 5. The signa (mark) or transcription, or the directions to 
the patient; 6. The name or initial of the physician. PHARMACY 
635 
B For: John Jones 3/15/23 
Sodii bromidi 16 Gm. ( 5iv) 
Antipyrinae 8 Gm. ( 3 ii) 
Liquor acidi arsenosi 4 cc (f3 i) 
Aquae menthae piperitae—q. s. ad 120 ec (f 5iv) 
Misce et signa: One teaspoonful in water three times daily after meals. 
Richard Doe, M. D. 
Model Prescription 
Before filling a prescription the compounder should read it carefully to judge 
the safety of the doses of the different ingredients and their compatibility. In 
law, the pharmacist as well as the physician, is held responsible in case of an 
overdose, and suit for damages is much more likely to be brought against the 
pharmacist than the physician. 
The words “use as directed’’ should be avoided by the preseriber as the patient 
is generally in a more or less nervous condition and likely to forget the details; 
then, too, having the directions on the prescription makes another safeguard 
in that pharmacists can detect an error more readily if one is present. Upon 
the dose depends the safety. 
In filling prescriptions requiring the mixture of an insoluble substance with 
a liquid, it is preferable to rub it in a mortar with a small amount of liquid, 
because if the solid is put simply into a bottle and shaken the substance may 
“lump” and require time and agitation in order to get it mixed. This 
is particularly true with calomel, magnesia, sulfur, or a vegetable drug. 
The employment of abbreviations in prescription writing is universal but 
great care must be taken to avoid abbreviations that might lead to the use of 
unintended substances and the death of the patient. Some titles of medicinal 
substances should never be abbreviated. Following is a table of abbreviations 
of the principal Latin words used in pharmacy with their contraction and 
meaning; 
Term or phrase 
Contraction 
Meaning 
Ad 
Ad 
To, up to. 
Adde, addantur, addentum, addendo-- 
Add 
Add, let them be added, to be added, by 
adding. 
At pleasure. 
White. 
Ad lib 
Alb 
Every other hour. 
Of each. 
a a, A 
Before eating, before meals. 
Boiling water. 
Common water. 
Aq. comm 
Hot water. 
Well. 
Twice. 
Bis in d., B. i. d-_ 
Twice a day. 
Let him (or her) take. 
Paper. 
Chart - 
Food. 
Cochlear or cochleare, Cochleatim 
Coch., CochleaC __ 
Coch. amp . 
A spoonful, by spoonfuls. 
A tablespoonful. 
A large spoonful (about half an ounce). 
Coch. mag- - 
A dessertspoonful (about 2 fiuidrams). 
A teaspoonful (about 1 fluidram). 
Strain. 
CoL.-. 
A nose wash. 
Collut 
A mouth wash. 
Collyr., Col 
An eye wash. 
Cong... - 
A gallon. 
Against. 
Cort 
The bark. 
Cum 
C 
With. 
154294°—39 41 636 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Term or phrase 
Contraction 
Meaning 
Dividatur in partes aequales 
D. in p. seq... ... 
Let it be divided into equal parts. 
The same. 
Of the same. 
And. 
Make, let it he made, let them he made. 
Let 12 papers be made. 
Let 12 pills be made. 
Let 12 powders be made. 
Let it be made according to the rules of art. 
Let a solution be made. 
Filter (thou). 
Yellow. 
A gargle. 
A drop. 
By drops. 
The same. 
Mix. 
Not. 
Do not repeat. 
A pint. 
Equal parts. 
After eating. 
Occasionally. 
A powder. 
As much as is sufficient. 
According to art, according to nature. 
A half. 
Mark thou. 
Dissolve. 
Above. 
Three times a day. 
The last ordered. 
An ounce. 
As directed. 
Ejusd.. . 
Et - - 
Fac., Fiat., Fiant.. .. 
Fiant chartulse xii 
Fiantpilulsexii ... 
Fiant pulveres xii 
Fiat secundum artis regulas 
F„ Ft 
Ft. chart, xii 
Ft. pil.xii .. 
Ft. pulv. xii 
F. S. A. R 
Ft. solut .. 
Filtra 
Flav .... 
Gtt . 
M 
Nonrepetatur . 
Non rep.. . ... 
O 
P.r.n... 
Quantum sufflciat, Quantum satis .. . 
Secundum artem, Secundum naturam. 
Q. S 
S. A.,S.N 
Ss 
Sig., S 
T. i. d 
Ultimo (or ultima) praescriptus 
Ult. praesc ... 
Ut Diet 
INCOMPATIBILITY 
Incompatibility is a term used in Pharmacy to describe conditions in which 
drugs used in pharmaceutical mixtures will not combine, produce new com- 
pounds, or are therapeutically opposed. These conditions are known as pharma- 
ceutical, chemical, and therapeutic incompatibility. 
Chemical incompatibility is chemical action resulting in the decomposition 
of one or more of the ingredients entering into the prescription. It may result 
in precipitation, production of a gas, in a change in color, or in explosive or 
poisonous compounds, and is sometimes intentional. Examples: Alkaloids will 
be precipitated from their solution by tannic acid, alkalies, carbonates, iodine 
or iodides, phosphates, boric acid, and borates. Explosive compounds will result 
from mixing powerful oxidizing agents with others which are readily oxidiza- 
ble, such as nitric or nitrohydrochloric acids, potassium chlorate, or potassium 
permanganate with glycerin, sugar, alcohol, oils, ethers, tannin, sulfur, sulfides, 
phosphorus, and hypophosphites. Glucosides are decomposed with substances 
containing emulsin. Iron salts with tannic acid or drugs containing tannin 
produce inky mixtures. 
Pharmaceutical incompatibility (also known as physical incompatibility) is 
the condition arising from attempting the mixture of pharmaceutical prepara- 
tions or ingredients which are physically repellent to each other and results 
in the physical dissociation of one or more constituents, but without chemical 
action. Examples: Tincture of chloride of iron added to syrup of acacia will 
gelatinize; fluidextracts diluted with liquids differing from those used in the 
fluidextracts cause the gum, albumin, resin, or mucilage to separate. Water 
is the solvent for albuminous, gelatinous, gummy, and saccharine bodies and for 
a large number of inorganic salts, while alcohol is the solvent for volatile oils 
and resins, gum resins, resinoids, balsams, and all drugs containing these sub- PHARMACY 
637 
stances as their active principles. The solvent power of either alcohol or water 
for the particular substance decreases in proportion to the amount of one added 
to the other. 
Therapeutic incompatibility occurs when two agents antagonistic to each other 
in their action in the human system are given together. Examples: Bella- 
donna in any form with physostigmine; a solution of bromide of potash with 
strychnine; opium with caffeine. 
In many cases physiological antagonists intentionally are given together so 
that one will act as a guard against the excessive action of the other, as the 
use of morphine with atropine. 
THE HARRISON NARCOTIC LAW 
The Harrison narcotic law, enacted by the United States Congress December 
17, 1914, provides that on or after March 1, 1915, every person who imports, 
manufactures, produces, compounds, sells, deals in, dispenses, or gives away 
opium and coca leaves or any compound, manufacture, salt, derivative, or 
preparation thereof, shall register with the collector of internal revenue of his 
district his name or style, place of business, and place or places where such busi- 
ness is carried on. The provisions of this act are not construed to apply to the 
sale, distribution, giving away, dispensing, or possession of preparations and 
remedies which do not contain more than 2 grains of opium, or more than 
one-fourth of a grain of morphine, one-eighth of a grain of heroin, or more 
than 1 grain of codeine, or any salt or derivative of any of them in 1 fluid- 
ounce, or, if a solid or semisolid preparation, in 1 avoirdupois ounce, or 
to liniments, ointments, or other preparations which are prepared for external 
use only, except liniments, ointments, and other preparations which contain 
cocaine, * * * etc., provided that such preparations are manufactured, sold, 
distributed, given away, dispensed, or possessed as medicines and not for the 
purpose of evading the intentions and provisions of this act. A Federal law 
was later passed which prohibits the importation of heroin and of opium for the 
manufacture of heroin. 
Paragraph 736, Manual of the Medical Department, U. S. Navy, concerns the 
prescription of narcotic drugs. 
GENERAL PRECAUTIONS IN REGARD TO DISPENSING 
In filling prescriptions for eye solutions the greatest care should be taken 
not only in accurately weighing and measuring the amounts called for, but 
also in maintaining scrupulous cleanliness. See that all containers and utensils 
are absolutely clean. All eye solutions and eye washes should be filtered through 
a high grade of filter paper, and distilled water only should be used in making 
them. These precautions also apply in making solutions for hypodermic injec- 
tion, such as procaine and cocaine solutions. 
Be careful when’giving out medicine that the correct drug in correct dosage 
is being given. Before putting any medicine in the eye or injecting any solu- 
tion into the uretha, recti ,n, or other body opening one should be sure that the 
solution is of the proper strength and temperature. Care should also be exer- 
cised as to ointments and medicaments for application to the skin that they 
are of the right strength. Nothing so reflects on the Medical Department, 
and on the individual hospital corpsman who has made the mistake, as an 
error in which a patient seeking assistance has been made worse or seriously 
or fatally injured by a poisonous dose of a drug. The greatest care therefore 
should be exercised in the preparation and giving out of all medication. 638 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
It is also desirable to display an appropriate warning sign in red over the 
prescription counter to further draw attention to the danger of preparing and 
dispensing poisonous doses of any drug. 
HINTS IN PRACTICAL PHARMACY 
PRESCRIPTIONS 
1. Read the prescription carefully, noting the quantity of each ingredient. 
2. Do not hesitate to ask if in doubt about the name of a certain drug, proper 
weight, or dose. 
3. Check the weight of each ingredient. 
4. Make certain that the balance is in balance. 
5. Check off with pencil the name of each ingredient on the prescription in 
the process of compounding. 
6. Do not weigh the ingredients on the bare scale pan. Always place a piece 
of pan-paper on each pan and again balance the balance. 
7. After the prescription has been compounded make such notes on it as 
may be necessary so there will be no likelihood of the renewed prescription 
differing from the original. 
8. Request the medical officer to initial any change in the prescription he 
may have ordered. 
9. Reduce to a fine powder all crystalline salts before admixture. 
10. Do not strain out any insoluble medicinal substance unless directed by 
the medical officer. 
11. If the prescription contains any insoluble matter, dispense it with a 
“shake” label. 
12. All hypodermic solutions and eye lotions should be filtered. 
13. Clear solutions containing “specks” or accidental impurities should be 
strained through absorbent cotton. 
14. In making dusting powTders pass the material through a No. 80 sieve to 
insure greater uniformity and fineness. 
15. In folding powders avoid having any medicinal substance in the folds 
of the powder paper. 
PILLS 
16. Use a white excipient in making light pills with corn starch or rice 
powder as a dusting powder. 
17. When making dark pills use a dark excipient such as extract of gentian, 
with lycopodium as a dusting powder. 
Note.—When making pills containing oxidizable substances such as potas- 
sium permanganate, silver nitrate, etc., use cocoa butter as an excipient. 
18. The maximum weight of the average pill should not exceed 5 grains. 
19. Always use the proper utensils in making pills—shallow mortar, flat 
pestle, stiff broad spatula, glass tile, pill machine and finisher (if available.) 
20. A whiter emulsion is obtained when acacia is used as an emulsifying 
agent. 
21. Tragacanth is preferred as an emulsifying agent in emulsions containing 
alcoholic mixtures. 
22. Do not use tincture of soap bark as an emulsifying agent as it exerts 
some physiological action. 
23. Solution of potash or soda must not be used. The finished product will be 
a soap and not an emulsion. 
EMULSIONS 639 
PHARMACY 
24. The mortar must be perfectly dry when making an emulsion. 
25. Add water very slowly to the “primary emulsion,” or nucleus, to prevent 
cracking. 
26. Wedgwood mortars are preferred in making emulsions. 
27. Use the “Bottle” method in making emulsions containing volatile oils. 
28. Remember the proportions in making an emulsion of a fixed oil by the Con- 
tinental method: Oil, 4 parts; water, 2 parts; gum, 1 part. 
29. In making the nucleus of an emulsion of a volatile oil the proportions 
are: Oil, 4 parts; water, 2 parts; gum, 1 part. 
OINTMENTS 
30. Do not use a rancid ointment base. 
31. Use anhydrous wool fat in making ointment containing a large amount 
of water or other fluid. 
32. Use benzoinated lard in making ointments to retard rancidity. 
33. The medicinal agents must first be mixed with a small portion of the 
base to insure a smooth finished product. 
34. Ointments intended for application to the eyes should be mixed in a glass 
mortar. 
35. Never use the fusion method in making sulfur ointment—the sulfur is 
precipitated. Avoid using too much heat in making any ointment. 
36. In making boric-acid ointment stir until congealed, because the boric 
acid is held in the petrolatum mechanically. 
37. Do not use an iron spatula in making iodine or tannic-acid ointments. 
38. Use warm water in making cold cream to prevent a lumpy or granular 
product. 
39. Diluted alcohol should be used in making belladonna ointment to soften 
the extract. 
40. Reduce the iodine to an impalpable powder with the aid of a glycerin 
solution of potassium iodide in making iodine ointment. 
41. Use water to dissolve the potassium iodide in making the ointment of 
this salt. 
CAPSULES 
42. It is desirable to seal hard capsules containing liquid medicine. 
43. Sealing hard capsules is accomplished by pressing the cap upon a small 
piece of absorbent cotton saturated in hot water or diluted alcohol. 
44. Before dispensing always rub the filled capsule between the folds of a 
towel or piece of gauze to remove any powder clinging to the outside. 
45. In filling capsules, fill the body of the capsule and not the cap. 
GENERAL HINTS 
46. Waxed or parchment paper should be used when dispensing medicine 
that is hygroscopic or is likely to change in the air. 
47. Do not triturate potassium chlorate with organic matter. There is 
danger of an explosion. 
48. The only way camphor can be powdered is by addition of a small quantity 
of alcohol. 
49. Always put the tartaric acid of the Seidlitz powder in the white paper to 
prevent the acid from becoming colored. 
50. Keep tincture of iron in a colored bottle and protected from light, as light 
reduces the iron. 640 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
51. Use blue-colored bottles for poisonous liquids or liquids intended for 
external use. 
52. Every medicinal substance sent out from the dispensary must have a 
neat and distinct label upon it. 
53. It is good pharmaceutical practice always to attach a poison label when 
dispensing medicines containing poisons. 
54. Attach “local use” labels to eye lotions and mouth washes and “external 
use” labels to liniments. 
55. Never dispense an emulsion or mixture containing insoluble material 
without a “shake” label. 
56. Always remember the five cardinal points in labeling a prescription— 
1. Patient’s name and rating; 2. Date; 3. Number; 4. Directions; and 5. Medical 
officer’s signature. 
57. In refilling prescriptions thoroughly clean the soiled containers. Affix a 
new1 label and in case of a bottle use a new cork. 
58. Two hospital corpsmen should check prescriptions when possible. 
59. If the man who compounds a prescription is required to check his own 
work, he should keep on the counter all the containers from which he takes 
the ingredients until the prescription is compounded. Then proceed to check 
off each item and its quantity. 
60. If in doubt as to just what was used or the quantity used, throw away 
the entire prescription and start again. It is better to lose some material than 
to dispense the wrong medicine. 
61. Paste the label evenly on the front of the bottle, a little above the 
center. All bottles, even round ones, have a front. Avoid an excess of paste. 
To smooth the label on the bottle place a piece of clean paper over it and rub. 
To make labels stick on tin, coat the tin first with a thin layer of tincture of 
benzoin (or any resinous substance) and let dry. Then apply paste and, lastly, 
the label. 
62. Be neat in dispensing. Be sure that utensils and bottles are clean, 
corks are whole, and that packages are wrapped neatly. 
63. Do not forget the proper cleaning of a mortar or graduate which has been 
used with oil or ointment; the excess may be easily removed by wiping out with 
sawdust or newspaper. 
64. A handy twine holder is a small funnel suspended in a convenient place. 
Place the ball of twine inside and run the end of the string through the 
funnel end. PHARMACY 
641 
Solution Table Showing the Quantity of Drug in Grains to Use in Preparing Aqueous Solutions op Various Strengths 
Apothecaries measure. (1 FLUIDOUNCE WATER WEIGHS 456 GRAINS) 
Fluidounces of solution 
1 
1 
1 
1 
1 
1 
500 
A per 
cent 
1 per 
cent 
2 per 
cent 
3 per 
cent 
4 per 
cent 
5 per 
cent 
10 per 
cent 
20 per 
cent 
25 per 
cent 
50 per 
cent 
5,000 
4,000 
3,000 
2,000 
1,000 
'A 
0.0456 
0.057 
0.0760 
0.114 
0.228 
0.456 
1.14 
2. 28 
4.56 
6.84 
9.12 
11.4 
22.8 
45.6 
57 
114 
1 
.0912 
.114 
.1520 
.228 
.456 
.912 
2.28 
4.56 
9.12 
13.68 
18.24 
22.8 
45.6 
91.2 
114 
228 
2 
.1824 
.228 
.304 
.456 
.912 
1.824 
4. 56 
9.12 
18.24 
27. 36 
36. 48 
45.6 
91.2 
182.4 
228 
456 
3 
.2736 
.342 
.456 
.684 
1.368 
2.736 
6, 84 
13.68 
27. 36 
41.04 
54. 72 
68.4 
136.8 
273.6 
342 
684 
4 
.3648 
.456 
.608 
.912 
1.824 
3. 648 
9.12 
18. 24 
36.48 
54. 73 
72. 96 
91.2 
182.4 
364.8 
456 
912 
6 
.5472 
.684 
.912 
1.368 
2.736 
5. 472 
13.68 
27. 36 
54. 72 
82.08 
109. 44 
136. 8 
• 273.6 
547.2 
684 
1,368 
8 
.7296 
.912 
1.216 
1.824 
3.648 
7.296 
18.24 
36.48 
72.96 
109. 44 
145. 92 
182.4 
364.8 
729.6 
912 
1,824 
12 
1.0944 
1.368 
1.824 
2.736 
5.472 
10. 944 
27. 36 
54. 72 
109. 44 
164.16 
218. 88 
273.6 
547,2 
1,094. 4 
1,368 
2,736 
16 
1.4592 
1.824 
2.432 
3.648 
7.296 
14. 592 
36.48 
72.96 
145.92 
218.88 
291.84 
364.8 
729.6 
1,459. 2 
1,824 
3,648 
Solution Table Showing the Quantity op Drug in Grams to Use in Preparing Aqueous Solutions of Various Strengths 
Metric measure 
Cubic centimeters of 
solution 
1 
1 
1 
1 
1 
1 
500 
H per 
cent 
1 per 
cent 
2 per 
cent 
3 per 
cent 
4 per 
cent 
5 per 
cent 
10 per 
cent 
20 per 
cent 
25 per 
cent 
50 per 
cent 
5,000 
4,000 
3,000 
2,000 
1,000 
10 
0.002 
0.0025 
0.0033 
0.005 
0.01 
0. 02 
0 05 
0 1 
0 2 
0 3 
0 4 
0 5 
1 
2 
2 5 
5 
25 
.005 
. 00625 
.0083 
.0125 
.025 
.05 
. 125 
. 25 
. 5 
75 
1 
1 25 
2. 5 
5 
6. 25 
12. 5 
50 
.01 
.0125 
.0167 
.025 
.05 
. 1 
.25 
.6 
i 
1.5 
2 
2.5 
5 
10 
12.5 
25 
75 
.015 
.01875 
.025 
.0375 
.075 
. 150 
.375 
.75 
1.5 
2.25 
3 
3. 75 
7.5 
15 
18.75 
37.5 
100 
.02 
.025 
.033 
.05 
. 1 
.2 
.5 
1 
2 
3 
4 
5 
10 
20 
25 
50 
200 
.04 
.05 
.067 
.1 
.2 
.4 
1 
2 
4 
6 
8 
10 
20 
40 
50 
100 
300 
.06 
.075 
.10 
.15 
.3 
.6 
1.5 
3 
6 
9 
12 
15 
30 
60 
75 
150 
400 
.08 
. 1 
.133 
.2 
.4 
.8 
2 
4 
8 
12 
16 
20 
40 
80 
100 
200 
500 
.1 
.125 
.167 
.25 
.5 
1 
2.5 
5 
10 
15 
20 
25 
50 
100 
125 
250 CHAPTER IX 
CHEMISTRY 
GENERAL INTRODUCTION 
Man lives in a world of material, and his body is of a material nature. This 
material occurs in an infinite variety of forms and is generally spoken of 
as matter. On the basis of the natural physical form of its occurrence matter 
is classed as solid, liquid, or gaseous, and on the basis of its structure it is 
classed as organic and inorganic. 
Animal and plant forms of matter are vitalized by a force called life and 
are endowed with the power to grow, to assimilate other matter, to reproduce 
their kind, and to react to environmental stimuli. Such matter is classed as 
organic or living and a clear understanding of the differentiation between 
organic and inorganic forms of matter is essential to a proper appreciation 
of the science of chemistry. Plant life, through the action of sunlight on 
chlorophyll, has the exclusive power to extract carbon from the air and to 
change and combine it in the complex forms needed by the plant structure. 
This is the origin of organic matter. Plant organic matter may decompose 
with liberation of the carbon contained in it, may be preserved as inanimate 
organic matter, of which coal is an example, or it may be assimilated by some 
form of animal life and become animal tissue. This animal-tissue carbon is 
subject in turn to the same fate, and eventually becomes available for the 
support of plant life. 
An aquarium is a familiar exairiple of the fundamental part carbon plays 
in organic life. When the plant life and fish in the aquarium are properly 
balanced in quantity of each, the aquarium can be sealed off from the outside 
air without suffocating either form of life. The fish produce carbon dioxide 
as a waste product; the plant life takes up this gas, separates the carbon 
and oxygen, utilizes the carbon for plant growth and discards the oxygen 
which the fish need. Then the fish eat plant forms to get carbon in organic 
forms. 
Plant life and animal life, therefore, supplement each other. The general 
processes of utilizing the carbon and oxygen are known as plant and animal 
physiology. The means employed to effect this utilization are chemical. Na- 
ture still remains the master chemist and man has devoted much time, effort, 
and study to discover the secrets of Nature’s chemical processes and to attempt 
to duplicate them. The study of the chemical processes of living matter is 
termed organic chemistry. 
In contrast, inorganic chemistry is concerned with mineral matter which 
does not contain carbon and does not originate from a vital process. Actually 
this differentiation needs qualification because organic compounds have been 
synthesized in the laboratory and there are rare inorganic compounds that 
contain carbon. 
Through the many centuries of man’s existence he has manifested an atti- 
tude of curiosity towards the unknown which has provided him with a fertile 
field for exploration. He developed special senses which allowed him a fairly 644 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
safe and comfortable existence with his environmental material. These senses 
helped him detect and utilize beneficial material and warned him of dangerous 
matter. This classification of matter was sufficient for his purpose but the 
nature or composition of matter has become a major source of interest. At 
any given period some facts about matter were known to man and he re- 
sorted to mystic and philosophical speculation to account for the other char- 
acteristics of matter. The rewards to the successful have brought immortality 
to the names of the adventurers and their discoveries have been stepping stones 
in the progress of the human race. 
The ancient Greeks were familiar with gold, silver, iron, and copper, and 
developed alloys of these elements. Although they had no idea that these 
metals represented elemental material their ignorance did not prevent them 
from employing these metals and other matter in a very practical form. The 
Romans added mercury, tin, and lead to this list of elements. 
The ancient Egyptians, Chaldeans, Hindus, and Chinese, were also familiar 
with many processes involving the transformation of materials as is evidenced 
by the mechanical separation of gold, the smelting of iron, the preparation of 
metallic alloys, and the manufacture of glass, pottery, and enamel ware, 
and animal and vegetable dyes. 
Until Greek philosophers, about the fifth century B. O., began to speculate 
upon the origin of the universe and the constitution of matter, these ancient 
peoples had shown no desire to investigate the nature of the chemical processes 
by which they made new materials from other materials; they were concerned 
only with the practical application of these processes. Aristotle (384-322 B. C.) 
believed that all matter was composed of various proportions of four simple 
bodies or elements, earth, air, fire, and water, to which he added a fifth, the 
quintessence, that acted as a carrier for the four fundamental properties of 
matter, hotness, coldness, dryness, and moistness. He also believed in the 
possibility that one form of matter could be changed into another by altering 
the amounts of the elemental qualities. 
The ancient Egyptians were highly skilled in the application of many chem- 
ical processes and their practical knowledge became mingled with the specula- 
tive theories of the Greeks following the conquest of both peoples by the 
Romans. From this mingling of knowledge at about the beginning of the 
Christian era, is believed to have originated the idea of the transmutation of 
metals, such as the conversion of base metals into gold. 
The Arabs, about the seventh century A. D., translated many Greek works on 
chemistry, effectively united Greek theory and Egyptian practice, and produced 
a definite system of chemistry in which experiment and theory were correlated. 
Although the Arabs added but little to existing chemical knowledge they 
systematically studied the properties of substances and classed all bodies as 
animal, vegetable, or mineral. Several chemical words, such as alchemy, alco- 
hol, alembic, alkali, and borax, are Arabic in origin. It appears that the Arabs 
also studied the chemistry of organic substances. One of the foremost chem- 
ists of the Arabian period appears to have been Geber (721-813 A. D.), who 
was familiar with the processes of crystallization, calcination, distillation, 
filtration, and reduction. He was also familiar with sulfuric acid, ammonium 
chloride, arsenous acid (arsenic trioxide), and mercurous chloride (calomel), 
and was acquainted with acetic and citric acids. 
Following the decline of Arab learning about 1200 A. D. the study of alchemy, 
as chemistry was then termed, spread to Europe where, during the Middle 
Ages, it was strongly influenced by religion, mysticism, and the doctrines of 
Aristotle and transmutation. During the next four centuries the chief interest CHEMISTRY 
645 
of the alchemists centered in the attempt to discover the philosopher’s stone 
or the stone of wisdom by which they could make gold out of base metals. 
They also sought the elixir vitae, supposed to be the sovereign remedy which 
would cure all disease and prolong life. Although no gold was produced and 
the sovereign remedy was not found, much valuable knowledge of chemical 
processes was gained, many new and important substances were discovered, 
and apparatus and methods were perfected as incidental by-products. Today 
thousands of tons of some of the substances discovered by the alchemists are 
made and used every year. The efforts which produced these results cannot 
be classed as scientific for they represented random explorations conducted 
without compass or guide. 
The influence of Paracelsus (1493-1541 A. D.) caused chemistry to become 
closely allied with medicine, and during the sixteenth and seventeenth cen- 
turies it was known as iatro-chemistry, iatros being a Greek word meaning 
physician. 
During this period chemistry appears to have been applied principally to 
the production and purification of drugs for medicinal use and to the investi- 
gation of their composition and action. Many chemical facts were accumulated 
by the iatro-chemists and standards of chemical purity and chemical individu- 
ality were developed. 
Living during this period were many men whose names will ever be asso- 
ciated with chemistry. A few of them were Libavius (1540-1616), Van Helmont 
(1577-1644), Francis de la Boe (1614-1672) (better known as Sylvius), Agricola 
(1494-1555), Palissy (1510-1589), and Glauber (1604-1668). 
Robert Boyle (1627-1691) was probably the first to study chemistry as a 
science, and as a science chemistry dates back only to him. His studies were 
with a view “to find out Nature, to see into what principles things might be 
resolved, and of what they were compounded.” Until the advent of Boyle 
there was no sound system of scientific theory based on experiment. He it was 
who brought into use analytical methods of determining the composition of 
substances, and by his work, in which he strictly observed scientific method, he 
cleared chemistry of the false doctrines of the alchemists and iatro-chemists. 
The use of Indicators in detecting acids and alkalis is due to him; he differ- 
entiated between mixtures, elements, and compounds; and stated that elements 
are substances that cannot be split up into other substances. Boyle is best 
known perhaps for his development of the physical laws governing the conduct 
of gases. 
As a result of Boyle’s scientific work chemistry as a science gained a firm 
foundation and began to progress along rational lines. Following him came 
Lavoisier (1743-1794) who is credited with the modern oxygen theory of com- 
bustion and with whom begins modern chemistry; Cavendish (1731-1810), who 
demonstrated the composition of air, water, and nitric acid; Scheele (1742- 
1786) who discovered oxygen and chlorine, and, with Priestly (1733-1804), 
many new gases; and Black (1728-1799) who originated the theory of latent 
heat and demonstrated the precise difference between carbon dioxide and air. 
Lavoisier’s scientific work largely established the foundations of modern 
science and he completely overthrew the phlogiston theory of combustion. 
According to this theory a suppositional substance called phlogiston escaped 
into the air during combustion, and this implied that the substance remaining 
after burning weighed less than before burning. Boyle had recognized that 
the opposite was true, and in 1784 Lavoisier proved conclusively that combus- 
tion is a rapid chemical combination of a substance with oxygen, and that but 
one of the two principal gases composing air was consumed in combustion. To 646 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
the gas consumed in combustion he gave the name oxygen; the other he called 
azote which was later to become nitrogen. 
By these discoveries chemistry was definitely established as a science sep- 
arate from physics, although both deal with the nature of matter, are closely 
related, supplement each other, and overlap considerably in their fields of 
investigation. In general, physics is concerned primarily in comparing various 
material forms with the object of discovering characteristics common to both, 
and Boyle’s discovery concerning gases actually was in the realm of physics. 
Chemistry deals with the characteristics peculiar to any given form of mat- 
ter. It therefore endeavors to break down material into its basic elements, 
identify them, and determine what peculiarity differentiates a particular form 
of material from all other forms. The discovery of the atom, the identification 
of the atoms characteristic of the different elements, and their reactions be- 
came the task of the chemist. The idea that all matter is composed of some 
fundamental unit dates back to at least the fifth century, B. C., when Demo- 
critus not only proposed this theory but even christened this unit the “atom’' 
which means indivisible. 
John Dalton (1766-1844), an English chemist and physicist, developed an 
atomic theory very different from that of the ancients. He propounded that all 
matter consisted of atoms; that atoms are indestructible, indivisible, and differ 
in their nature and properties; that atoms of the same element have the same 
weight and properties; and that atoms of elements combine with atoms of 
other elements to form compounds. His table of atomic weights was first 
published in 1807 and his theory of the atom in 1808. This theory of Dalton’s 
produced a great influence on the advancement of chemical knowledge, and, 
with the work of Lavoisier, may be said to form the basis of modern chemistry. 
The theory, no longer used entirely as propounded, still serves some practical 
purposes. 
About 1900 the atom was accepted as the basic unit of structure for matter. 
Seventy-five elemental atoms had then been identified and on the basis of the 
Periodic Table, 92 were regarded as theoretically possible. The atom of each 
element was regarded as a complete, indivisible unit peculiar to that element, 
and it was found that, as Dalton had postulated, these atoms differed from other 
atoms in weight and valence (combining power, or affinity ; see p. 664). Combina- 
tions of atoms are known as molecules and an almost infinite variety of mole- 
cules is possible. It was discovered that the atoms of any element always 
combined with a definite number of atoms of another element. Helium lacks 
affinity for any other atom and it therefore remains uncombined chemically 
and has a valence of zero. The hydrogen atom which is the lightest atom by 
weight and was formerly used as the standard for comparison in determining 
the weight of other atoms, is the standard for the determination of valence. 
Hydrogen, with a valence of one, will unite atom for atom with atoms of like 
valence; for example, one atom of hydrogen unites with one atom of chlorine 
to form a molecule of hydrochloric acid. Any atom of oxygen, which has a 
valence of two, will combine with two atoms of hydrogen to form a molecule 
of water; any atom of nitrogen with a valence of three, will combine with three 
atoms of hydrogen to form a molecule of ammonia gas. 
As atoms are the substance of which matter is composed, they must have 
weight and occupy space. Dalton investigated these properties of the atom and 
summed up the results of his investigations in two laws which bear his name 
and will be discussed later. 
Atoms do not occur in Nature as such but in the form of molecules, and to 
designate them letters taken from the names of the elements are used. These CHEMISTRY 
647 
letters are termed symbols (see p. 661) and when used alone refer to the atom of 
the element, but by placing figures before or after the letters the number of the 
atoms or of the molecules of an element present in a substance may be shown. 
Thus, “O” indicates one atom of oxygen, “20” two atoms of oxygen, “02” a 
molecule of oxygen, and “202” two molecules of oxygen. 
For all practical purposes elements are considered to be substances which 
cannot be resolved (split up) into or built up from anything simpler. This 
means that an element is a substance from which no other substance can be 
extracted and which cannot be made from other substances. Water can be 
separated into hydrogen and oxygen, air can be separated into oxygen, nitro- 
gen, and other gases, and salt can be separated into sodium and chlorine; 
therefore they are not elements. But the substances into which water, air, 
and salt can be resolved are elements because it has never been possible to 
obtain any other substance from them or to make them from other substances. 
It has happened in the past that following improvement in analytical methods, 
substances considered to be elements have been found to be compounds, and the 
same may happen again. 
In studying the elements it is customary to classify them as metals and non- 
metals and to group them according to the similarity of chemical properties 
they exhibit. These groups are known as the halogen family, the nitrogen 
family, the alkali family, the inert gases, etc. Properties in which the elements 
may show similarity are natural physical form (solid, liquid, or gaseous), tend- 
ency to form acid or basic compounds, valence, tendency to combine with other 
atoms or remain inert, etc. 
Following the grouping of elements in families suggestions to classify the 
elements on the basis of their atomic weights had been made by various 
investigators who had traced numerical sequences among the atomic weights 
of some of the elements and noted connections between them and the prop- 
erties of the different substances. In 1863 Newlands (1838-1898), an English 
chemist, published his conception of the periodicity of the elements which 
showed that if the elements be arranged in the order of their atomic weights 
those having consecutive numbers frequently either belonged to the same group 
or occupied similar positions in different groups. He also pointed out that 
each eighth element starting from a given one was a kind of repetition of 
the first. His idea was ignored or treated with ridicule as fantastic and not 
worthy of serious consideration. 
Newland’s idea led to further investigations by a Russian chemist, Mendeldef 
(1834-1907), who is perhaps best known for his work on the Periodic Law. 
By 1850 about 60 elements had been identified and their atomic weights 
determined. Mendeleef noted the similar characteristics of these elements 
and when he placed them in series according to their atomic weights he 
found that these characteristics tended to repeat themselves in an orderly 
fashion in these series. He recognized that these properties of the elements 
were a periodic function of their atomic weights and on this basis he evolved 
his periodic classification of the elements which he published in 1869 and 
which, in revised form, is still in use. He did not consider this merely as a 
system of classifying the elements according to certain observed facts but 
as a law of Nature which could be relied upon to predict new facts and to 
disclose errors in what were believed to be true facts. This classification of 
Mendeleef indicated the probable existence of about 92 elements and permitted 
predicting the characteristics of missing and hypothetical elements with sur- 
prising accuracy. The existence of many of these then unknown elements has 
also been confirmed. 648 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
SKAlfeS 
1 
Group 0 
Group I 
— r2o 
Group II 
RO 
Group HI 
—•— R2O3 
Group IV 
RH4 ROj 
Group V 
RHj R2O6 
Group VI 
RH2 RO3 
Group VII 
RH R2O7 
Group Vffl 
H 1 
1.0078 
o 
He 2 
Li 3 
Be 4 
B 6 
C 6 
N 7 
O 8 
F 9 
4.002 
6.940 
9.02 
10.82 
12.01 
14.008 
16.0000 
19.00 
Q 
Ne 10 
Na 11 
Mg 12 
A1 13 
Si 14 
P 15 
S 16 
Cl 17 
6 
20.183 
22.997 
24.32 
26.97 
28.06 
31.02 
32.06 
35.457 
A 18 
K 19 
Ca 20 
Sc 21 
Ti 22 
V 23 
Cr 24 
Mn 25 
Fe 26 
Co 27 
Ni 28 
4 
39.944 
39.096 
40.08 
45.10 
47.90 
50.95 
52.01 
54.93 
55.84 
58.94 
58.69 
Cu 29 
Zn 30 
Ga 31 
Ge 32 
As 33 
Se 34 
Br 35 
63.57 
65.38 
69.72 
72.60 
74.91 
78.96 
79.916 
Kr 36 
Rb 37 
Sr 38 
Y 39 
Zr 40 
Cb 41 
Mo 42 
Ma 43 
Ru 44 
Rh 45 
Pd 46 
R 
83.7 
85.48 
87.63 
88.92 
91.22 
92.91 
96.00 
99 
101.7 
102.91 
106.7 
Ag 47 
Cd 48 
In 49 
Sn 50 
Sb 51 
Te 62 
I 53 
107.880 
112.41 
114.76 
118.70 
121.76 
127.61 
126.92 
Xe 54 
Cs 55 
Ba 56 
Rare Earths * 
Hf 72 
Ta 73 
W 74 
Re 75 
Os 76 
Ir 77 
Pt 78 
131.3 
132.91 
137.36 
Nos. 57-71 
178.6 
180.88 
184.0 
186.31 
191.5 
193.1 
195. 23 
R 
Au 79 
Hg 80 
T1 81 
Pb 82 
Bi 83 
Po 84 
Ab 86 
197.2 
200.61 
204.39 
207.21 
209.00 
210 
219 
Rn 86 
Vi 87 
Ra 88 
Ac 89 
Th 90 
Pa 91 
U 92 
i 
222 
225 
226.05 
227 
232.12 
231 
238.07 
* Rare Earths: La 57 Ce 68 
Pr 59 Nd 60 11 61 Sm 
62 Eu 63 Gd 64 Tb 66 
Dy 66 Ho 67 
Er 68 Tm 69 Yb 70 
Lu 71 
138.92 140.13 
140.92 144.27 
146 150.43 152.0 156.9 159.2 
162.46 163.5 
167.64 169.4 
173.04 
175.0 
Figure 149.—Periodic Arrangement of the Elements. (U. S. Naval Medical School.) 
[Note.—Atomic numbers are shown in black-faced type at right of symbols and 1937 International Atomic Weights are shown beneath symbols] CHEMISTRY 
649 
In this periodic classification, usually called the Periodic Table (fig. 149), 
the elements were formerly arranged in groups and families according to 
their atomic weights. It later became apparent that in that arrangement 
certain irregularities existed and recent studies have shown that if the 
elements are arranged according to their increasing atomic numbers most of 
these irregularities disappear and certain properties appear at regular intervals 
systematically throughout the table. As a result of this it has been con- 
cluded that most of the properties of an element are dependent upon its 
atomic number. (See p. 663.) Most of the metals appear on the left side 
of the table and their activity increases as their names go down in any column. 
The nonmetals are located on the right side of the table and their activity 
increases as their names go toward the top of any column. The most general 
utilization of this table is in showing the valence relation of the various 
families. 
By referring to figure 149 it will be seen that the symbols of the names 
of the elements appear in numbered vertical columns and horizontal rows, 
each column being called a group and each row a series. The elements 
in each series are arranged in sequence according to their atomic numbers. 
The elements in series 2 beginning with element No. 2, helium, all differ 
markedly from each other, and element No. 10, neon, which is very similar to 
helium, is therefore placed in series 3, beneath helium, and followed by new 
elements until element No. 18, argon, is reached, which, because it is an 
element similar to both helium and neon, begins series 4. 
The elements in each vertical column have a more or less pronounced 
resemblance to each other which is called group resemblance and is especially 
noticeable in the valence of the elements in any group. Because of the re- 
semblance in valence the elements in a group form oxides, hydroxides, acids, 
and salts of the same general formula, and the hydrides and oxides of 
maximum valence are shown in formulas at the top of certain columns, the 
R in the formula representing any element in the column. It will be noted 
that in most of the columns the elements are placed on either the right 
or the left side of the column which is because those elements on the right 
side of the column resemble each other much more closely in both chemical 
characteristics and physical properties than they do those on the left side. 
Thus the elements in a group are separated into such groups, or families, as 
they are called, which usually are named after the first element of the family 
appearing in a column, as the nitrogen family, the sulfur family, etc. Elements 
in series 2 and 3 which do not fall distinctly into either family of their 
group but combine properties of both, are known as type elements because they 
represent the general characteristics of their group. 
In series 4, 5, and 6 appear 18 elements which are divided into 2 rows, one 
row consisting of 11 elements appearing on the left side of the columns and 
the other of 7 elements appearing on the right side of the columns. Of the 
11 elements in the upper rows of these series 3 are placed in Group VIII because 
they resemble each other very closely, being metals with almost identical 
characteristics, and, if arranged as the first three elements in new rows, they 
would interrupt the regularity of periodic recurrence of properties of the 
elements already appearing in series 2 and 3. The series containing 18 elements 
are often spoken of as long series and those containing 8 as short series. 
It is an interesting fact that in the Periodic Table there is no place for 
the element hydrogen which, while one of the most important of all the elements, 
seems to have no close relation to any other element and to stand quite alone. 
Because of its great chemical activity it cannot be placed with the inert gases 650 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
in Group O and although it has some characteristics similar to those of the 
metallic elements in Group I, it is a gas and not a metal and therefore cannot 
be placed with the elements in Group I. 
There are some other irregularities in the Periodic Table which will not be 
discussed here. 
Of even more importance is the fact that Mendeldef’s classification presented 
a fundamental picture of atomic structure. No longer could the elemental 
atom be accepted as the ultimate form of matter. The table indicated that 
the atom consisted of variable but definite combinations of some simpler unit 
of matter, a situation that was distressing to the chemist who had accepted the 
various elemental atoms as the ultimate form of matter. 
This confused state did not begin to clarify until radiology appeared on the 
scene at the turn of the century. The X-rays were discovered by Roentgen in 
1895 and the physicist studied them and discovered that the emanations from 
the negative or cathode pole of the X-ray arc consisted of a stream of very 
minute particles much smaller than atoms. In the United States Dr. R. A. 
Millikan determined the velocity and weight of these particles and discovered 
that they carried a negative charge of electricity. These were known as 
cathode rays and it was also known that another form of matter was thrown 
off from the positive pole. Discovery that different elements produced the 
same emanations of these particles proved that their basic composition was 
similar. Next it was demonstrated that the quantity of positive emanations 
was proportional to the atomic weight of the element under investigation. 
These discoveries changed the entire chemical picture. 
The atom is now postulated as a structure similar to the solar system of 
which the Earth is a part. At its center is a core or nucleus consisting of 
particles charged with positive electricity called protons and other particles 
bearing charges of negative electricity called electrons, both occurring in pairs. 
The characteristics of an atom are due to the number and arrangement of 
these pairs of protons and electrons, which, in a normal atom, are equal in 
number, and the total charge of positive electricity therefore neutralizes the 
total charge of negative electricity. All protons and usually about 50 per cent 
of the electrons are located in the nucleus. The other electrons are relatively 
at a great distance from the nucleus and rotate around it in definite orbits, 
as the planets rotate in orbits around the sun, and are called “planetary” or 
rotating electrons. Consequently the space occupied by an atom is relatively 
as free from substance as is the solar system. This explains the phenomenon 
of the penetrating power of the X-rays in the body and even in iron. That is, 
they penetrate because they fail to collide with either protons or electrons in 
their transit through space. 
The proton has about 1,850 times the mass of the electron and determines 
the mass or weight of the atom. So large is the mass of a proton as compared 
with the mass of an electron that the mass of the atom of any element is 
approximately proportional to the number of protons in the atom. The simplest 
atom, that of the element hydrogen, consists of only one proton with one 
“planetary” electron. In contrast the atom of the element uranium has 238 
protons in its nucleus and its specific gravity is approximately that of gold. 
It is possible to estimate the number of protons in any atom by comparing the 
known value of its atomic mass with that of hydrogen with its one proton. 
The total “planetary” or rotating electrons located in the orbits of an atom 
determine its atomic number, or position, in the Periodic Table, while those 
located in the outermost orbit usually determine its valence. The outermost CHEMISTRY 
651 
orbit is termed the valence orbit, and the electrons in this orbit are called 
valence electrons. 
The chemical properties of an atom are very largely due to the “planetary” 
electrons. As the atomic weight of an atom increases the number of “planetary” 
electrons also increases. The hypothetical position of the “planetary” electrons 
is in a series of orbits around the nucleus, the greatest number of orbits being 
seven. The helium atom has only 2 “planetary” electrons which rotate in a 
single orbit. Helium and hydrogen are the only 2 elements whose atom has 
but 1 orbit. Additional electrons assume positions in orbits outside of the 
original or innermost orbit. The number of rotating electrons in an orbit varies 
according to the atom of the element, and the maximum number of electrons 
which may be in any 1 orbit also varies. This arrangement of nucleus and 
orbits is known as the octet theory and has the virtue, at least, of proposing 
an atomic structure that harmonizes with the Periodic Table. In the first or 
innermost orbit there may be no more than 2 rotating electrons, in the second 
no more than 8, in the third no more than 18, in the fourth no more than 32, 
in the fifth and sixth, with two exceptions (mercury and lead), no more than 18, 
and in the seventh or outermost no more than 8. 
The atom of an element may, therefore, be regarded as being composed of a 
definite number of pairs of protons and electrons arranged in a definite fashion 
and reacting in a characteristic manner. The atom has functioned so effectively 
as a unit of matter that only comparatively recently has its complex structure 
been demonstrated or even suspected. 
The atoms of some elements, as lithium, boron, and lead, differ in their 
atomic mass although their chemical properties are the same. The difference 
in mass is due to there being different numbers of protons in the atoms. Atoms 
having the same chemical properties but different atomic masses are termed 
isotopes, and evidence now shows that many elements are mixtures of isotopes. 
Radium B, radium D, thorium B, and actinium B are all isotopes of lead and 
of one another. 
From facts brought out in the introduction it is possible to define chemistry 
as the science which treats of the composition of matter when considered as 
composed of either electrons, atoms, or molecules; and of the changes which 
modify or alter the composition of matter. When two or more substances 
combine to form a new substance, or substances are divided into their ele- 
mentary components, the resulting products exhibit entirely new characteristics 
and are incapable of identification with the original. 
As previously stated the science of chemistry is separated into two main 
divisions on the basis of the structure of matter. These divisions are inorganic 
chemistry, which is the study of the elements, their properties, applications, 
and chemical combinations, and organic chemistry, which is the study of carbon 
compounds as found in, or as by-products of, living organisms. 
Applied chemistry has many special branches depending upon the industry 
or profession in which it is employed, i. e., physiological, pharmaceutical, 
industrial, etc. 
By observing the infinite variety of forms in which matter occurs in Nature, 
and the constant changes taking place, the unlimited applications of chemistry 
are obvious. The changes which occur in matter may be physical or chemical, 
and the earliest knowledge of chemistry was obtained by observing the changes 
continuously occurring in Nature but it was not until man began to experi- 
ment on the substances of Nature that his chemical knowledge made progress. 
In the performance of his experiments man found certain conditions were 
154294°—89 42 652 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
invariable, and from these constants the fundamental laws of matter have been 
derived. 
Suppose a stick of sulfur held in the hand is rapidly twirled or thrown 
through the air. It may be shattered or broken but it still is sulfur; any 
change occurring is superficial and has to do only with shape or position. 
Suppose the sulfur is placed in a mortar and finely ground, then fine iron 
filings added, and the two intimately mixed until a gray colored powder is 
obtained. If the powder is fine enough, it is possible that the naked eye 
may not detect the different particles and that the mass will present a uniform 
and homogeneous appearance, but the mixture is not homogeneous. Should a 
portion of this mixture be placed beneath the lens of a microscope the particles 
of sulfur and iron readily can be distinguished from each other. The mixture is 
therefore heterogeneous; that is, composed of unlike or dissimilar particles 
and is simply a physical mixture resulting, as is said in chemistry, from 
a physical change. The proportion of either ingredient may be changed at 
will, either by adding more of one of the ingredients or by the removal of 
one of those present. By adding carbon disulfide the sulfur can be dissolved 
from the mixture and poured off, leaving the iron, or by applying a magnet 
the iron may be withdrawn. Suppose that a part of this mixture of powdered 
iron and sulfur is placed within a test tube and heated over a Bunsen burner; 
the mass will fuse, will reach a red heat, and finally will glow brilliantly, 
and when cooled will present the appearance of a black, hard, fused mass. If 
a fragment be broken off, powdered, and placed beneath the microscope it 
will be seen that it presents a homogeneous appearance, all particles being 
similar. An attempt to remove a portion of the particles with a magnet will 
fail, and any solvent used will act on all particles alike. Clearly the mass 
is different from the original powder because the heating of the sulfur and 
iron together has produced a chemical change in which a new substance or 
compound has been formed. This new compound is called ferrous sulfide and 
is composed of approximately 35 per cent of sulfur and 65 per cent of iron 
by weight. These weights are constant and never vary, as is the case in physi- 
cal mixtures. From this fact the following law has been adduced: “A chemical 
compound is always composed of the same ingredients in the same proportions 
by weightThis is known as Dalton’s law of Constant Proportions. Another 
example of this law is shown in the heating of 1 part of alcohol with 2.09 parts 
of oxygen (a total of 3.09 parts) which gives 1.91 parts of carbon dioxide and 
1.18 parts of water (again a total of 3.09 parts). Dalton also discovered the 
law of Multiple Proportions which is: If two or more elements form more 
than one compound, and one is considered as a constant, the different weights 
of the elements that combine with the constant are simple multiples of each 
other. In water the weights of hydrogen and oxygen are in a ratio of 1 to 8 
but in hydrogen dioxide the ratio is 1 to 16. Likewise carbon monoxide is 
composed of 3 parts of carbon and 4 parts of oxygen while carbon dioxide 
consists of 3 parts of carbon and 8 parts of oxygen. The law of Reciprocal 
Proportions states that: The proportions in which any two elements unite 
with a third are the same when they unite tenth each other, or simple multiples 
thereof. For example: Carbon dioxide contains 12 parts of carbon combined 
with 32 parts of oxygen; in methane 12 parts of carbon are combined with 
4 parts of hydrogen; if hydrogen and oxygen form a compound, in accordance 
with this law, they should combine in proportions of 4 to 32 or in simple 
multiples thereof as 1 to 8, as is found in water. CHEMISTRY 
653 
A law, as the word is used in science, is a statement summing up facts 
which actually have been found to be true after a large number of experiments 
have been performed carefully, accurately observed, and verified. 
It has been shown by the foregoing that a chemical change differs from a 
physical one in that, while physical changes are superficial, the changes 
occurring during a chemical reaction are internal. The whole nature of the 
reacting substances undergoes a profound change, resulting in the formation 
of new substances markedly differing in characteristics and properties from 
those of the original substance or substances. 
To discover what elements are in any substance and to learn what are the 
laws governing the actions of elements upon each other is the principal object 
of chemistry. The process by which the composition of substances is deter- 
mined is known as analysis, and that by which substances are produced by 
combining elements, is known as synthesis. 
SOME PHYSICAL PHENOMENA OF MATTER 
In the introduction it was stated that the sciences of chemistry and physics 
are both concerned with the investigation of the properties of matter and are 
closely related. It is therefore evident that the study of chemistry must be 
supplemented by and include a knowledge of the physical properties of matter 
from the viewpoint of the science of physics. Accordingly there will next be 
given a brief discussion of some of the physical phenomena of matter which are 
essential to the study of chemistry. 
Physics is the science which treats of the phenomena associated with matter 
in general and of the laws governing those phenomena. It is also known as 
Natural Philosophy and formerly included the sciences of chemistry, biology, 
astronomy, and geology which are now classed as individual sciences. 
Characteristics and properties of matter. 
Anything that has weight and occupies space (takes tip room) is known as 
matter. In the science of physics the unit of matter is the molecule; in 
chemistry the unit is the atom. Matter exists in three states: Solid, when 
it has a definite volume and shape and does not require confinement; liquid, 
when it has a definite volume, requires confinement on sides and bottom, and 
takes the shape of the containing vessel; and gaseous, when it has neither 
definite volume nor shape and must be confined on all sides. Science has 
demonstrated that all matter is composed of about 92 elemental substances 
which cannot themselves be resolved or split up into two or more substances 
and cannot be produced from other substances. It follows, then, that matter 
which can be resolved into two or more elemental substances is compound 
matter; therefore matter composed of molecules made up of two or more ele- 
mental substances is termed a compound. 
One of the first fundamental laws of both chemistry and physics that man 
discovered in his experiments with substances in Nature was the indestructi- 
bility of matter, which means that, regardless of what chemical or physical 
change may take place, matter can neither be destroyed nor called into exist- 
ence. After a chemical or physical change has occurred there remains as 
much matter as there was previous to the change and if a substance is changed 
physically or chemically it still exists in another form, as has been shown in 
the examples of mixing sulfur and iron and of heating sulfur and iron. An- 
other example is the burning of a piece of wood weighing 10 Gms. in a closed 654 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVA 
vessel containing a definite weight of oxygen. After combustion has taken 
place it will be found that the weight of the resulting materials, including 
gases formed, will be 10 Gins, plus the amount of oxygen used from the vessel. 
This law concerning the indestructibility of matter is also known as the law 
of Conservation of Matter. 
All matter has the property of volume which is designated by the terms 
length, breadth, and thickness. 
Matter possesses mass and weight. The mass of a substance, which does 
not vary, is the measure of the quantity of matter the substance contains. 
Weight is the measure of the difference between the attraction of the earth 
and that of surrounding bodies for bodies on the surface of the earth. The 
weight of a body may vary according to the quantity of matter it contains 
and its distance from the earth’s center. 
Porosity is a property of matter that signifies that a certain amount of 
space exists between the molecules of a substance. This property is quite evi- 
dent in the common sponge and exists in varying degrees in all matter. 
Compressibility allows the volume of a body to be diminished by pressure. 
It is a proof of porosity and exists to a great degree in gases. 
Elasticity is the property which allows a body to resist deformation and 
resume its original form or volume when the altering force ceases to act. 
Solidity is the property wherein the relative position of the molecules of a 
substance is fixed and cannot be altered without the application of force. 
Fluidity is the property wherein the relative position of the molecules of a 
substance is not fixed and they are capable of gliding over each other with 
comparative ease, the body assuming the form of the vessel in which it is 
placed. 
Tenacity is the property of a substance by which it resists the total separa- 
tion of its molecules. 
Ductility is the property of a substance whereby its form may be changed 
by the action of traction or pressure. 
Malleability is the property of a substance which permits it to be hammered 
or rolled into sheets. 
Hardness is the resistance which substances offer to being scratched by other 
substances. This is only a relative property for an object which is hard in 
reference to one substance may be soft in reference to others. 
Brittleness is the relative property of a substance which allows it to be 
broken when struck a sharp blow. 
Transparency is that property of a substance which allows the passage of 
rays of light. 
In studying chemistry the word “force” is often used in connection with the 
natural phenomena affecting the many chemical and physical changes taking 
place and described. For this reason the definition of the word and its attend- 
ant word, energy, is given here. 
Force is the action of one body upon another, or is that which produces, 
changes, or stops motion. It is a manifestation of energy which may be caused 
in different ways, as by electricity, heat, and light. 
Energy is a property possessed by all matter which may be defined as the 
capacity to do work and exists in one of two states, kinetic or potential. 
Kinetic energy is that state recognizable as heat, light, or motion. Potential 
energy is the latent power of all matter to produce a change, and is defined 
as the energy of position. A supported object has potential energy due to its 
position. When the support is withdrawn its potential energy is transformed 
into kinetic energy by the motion of the falling object. Kinetic energy is rep- CHEMISTRY 
655 
resentative of motion, visible in the movement of a mass, or evident in light 
and heat due to the invisible motion of molecules. 
Just as matter can neither be created nor destroyed, neither can energy be 
created nor destroyed, and the total amount of energy in the universe remains 
constant and unchangeable. Energy that apparently is lost actually goes off 
in some other form of energy, most of it in heat. From a given amount of 
heat a relative amount of mechanical motion can be obtained, and vice versa. 
A similar relation exists between heat and electrical energy, and between 
these and chemical energy. By burning a definite amount of material a rela- 
tive amount of heat is obtained; and by the application of this heat a corre- 
sponding amount of chemical action is produced. Although there is no direct 
way of proving that energy is never destroyed, all experimental evidence points 
to the principle that: Enei'gy is never created and never destroyed and all 
forms of energy are convertible, one into another, without loss, the total amount 
of energy in the universe remaining constant. This principle is termed the law 
of the Conservation of Energy and is applied to atomic and molecular changes, 
to electrical phenomena, to biological phenomena, in fact, to all the processes 
of Nature. 
Pressure. 
Pressure is that force which tends to decrease the volume or alter the shape 
of a substance in direct proportion to the density or weight of the substance 
exerting the pressure. The density of a substance is measured by its specific 
weight which is represented by an abstract number showing the density of a 
given volume of substance as compared with that of water, hydrogen, or some 
other standard substance, both substances having the same temperature or the 
temperature of each being known. This is more commonly known as specific 
gravity. For example: 1 cc of sulfuric acid weighs 1.84 Gms; the weight 
of 1 cc of distilled water is 1 Gm; therefore, sulfuric acid is 1.84 times heavier 
than water. The equation used in determining specific weight (or gravity) is: 
w 
Sp. wt= "r- 
W being the weight of a given substance and Y being the weight of an equal 
volume of the substance used as the standard. 
That gases are easily compressed is evident from the inflation of an automo- 
bile tire or a balloon. Even the atmosphere of the earth is under pressure, the 
air pressure at sea-level being 14.7 pounds per square inch (one atmosphere). 
This is due to the layers of the atmosphere exerting their weight upon the 
earth’s surface, the pressure gradually decreasing with altitude. By doubling 
the pressure on a given quantity of gas in a tube its volume is decreased to 
y2; by trebling this pressure its volume is decreased to %, etc. This principle 
is the basis of Boyle’s law of the Compressibility of Gases; The volume of 
any dry gas, the temperature remaining constant, varies inversely to the pressure 
applied. The equation used in determining the volume of a gas is: 
YP=Y'P'; 
V being the original volume, P the original pressure, V' the new volume and 
P' the new pressure. Problem.—What will be the volume of 10 liters of gas, 
calculated at 14.7 pounds pressure, if it is subjected to a pressure of 29.4 
pounds, the temperature remaining constant? 
10 X 14.7= V' X 29.4; 
29.4V'= 147; 
V'= 5 liters (new volume) 656 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Heat. 
All matter is composed of very small particles called molecules, which are 
in constant motion. As the velocity of these molecules increases, the tempera- 
ture of a body rises. A decrease in molecular velocity causes a corresponding 
decrease in temperature. Consequently heat may be defined as kinetic energy 
due to molecular motion. Heat is derived from many sources, the sun being 
the most important. Evidence that the interior of the earth is highly heated 
is furnished by molten rock issuing from volcanoes, and boiling water spouting 
from geysers. Chemical reactions are important sources of heat, especially 
those of oxidation. Mechanical action can be transformed into heat, friction 
being a common example. 
The heat of an object and its temperature are different entities. It is possible 
for a body to have a high temperature and little heat; it may have a low 
temperature and little heat; it may have a high temperature and much heat; 
or it is possible for it to have a low temperature and a large quantity of 
heat. A burning match has a high temperature but gives off little heat, whereas 
a steam radiator has a comparatively low temperature but gives off much 
heat. Temperature is measured by degrees, heat by calories. The terms “hot”, 
“cold” and “warm” are used to indicate temperature, but their use is only 
relative. Inasmuch as man’s temperature sense is unreliable thermometers 
necessarily are used to measure temperature. Several scales are used on 
thermometers, the Centigrade and Fahrenheit being the most common; the 
former is employed in scientific measurements, the latter in weather observations 
and household applications. For the conversion of degrees of Centigrade tem- 
perature to Fahrenheit degrees and vice versa, see chapter on Pharmacy. 
All substances expand to some degree when heated and contract when 
cooled. This phenomenon is most apparent in gases. Unlike liquids and solids, 
all gases have approximately the same coefficient of expansion. That all gases 
conduct themselves in practically the same manner under the influence of 
changes in temperature and pressure is explained by the assumption or 
hypothesis that equal volumes of gases at the same temperature and pressure 
contain the same number of molecules. This is known as Avogadro’s Hypothe- 
sis. The coefficient of cubical expansion for gases is 1/273 of the volume at 
0° C., or 0.00367 for each degree Centigrade. If a given volume of gas at 0° C. 
is cooled to a minus 100° C., it will be found that its volume has decreased 
100/273, or, it has only 173/273 of its former volume. Theoretically, a gas 
cooled to a minus 273° C. would lose 273/273, or all of its volume. Actually 
it would be liquefied, then solidified. At zero volume, molecular motion having 
ceased, the body would be without heat, or absolutely cold. Consequently 
minus 273° C. is considered absolute zero, and from this factor the absolute 
temperature scale is calculated. 
The uniform expansion of gases is defined by Charles’ law; If the pressure 
be constant, the volume of a given mass of dry gas is directly proportional to 
the absolute temperature. This law may be expressed by the equation: 
V:V'::T:T'; 
V being the original volume, V' the new volume, T the original temperature, 
and T' the new temperature. The Centigrade temperature first must be con- 
verted into absolute temperature by adding 273 to the given Centigrade 
temperature. Problem.—What will be the volume of 117 cc of gas, calculated 
at 52.26° C., if the temperature is decreased to 5° O., the pressure remaining 
constant? CHEMISTRY 
657 
117: V':: (52.26+273) : (5 +273) ; 
117: V':: 325.26: 278; 
325.26V'=32526; 
Y'=100; new volume is 100 cc. 
To determine the volume of a gas subjected to changes in temperature and 
pressure the following formula is used: 
T T' 
Problem.—What will be the volume of 500 cc of gas, calculated at 2° 0. and 
a pressure of 10 pounds, if it is subjected to a pressure of 100 pounds at 35° O.? 
500X10 _Y'X 100 
2 +273 35+273 
5000 100V' . 
27500Y'=1540000 
275 308 
V'=56; new volume is 56 cc. 
Molecular physics. 
It has been explained that all matter is made up of exceedingly small par- 
ticles called molecules. In gases the distance between these molecules is 
relatively great, whereas in liquids the particles are closer together; but in all 
cases there is sufficient space between adjacent molecules to permit them to 
move freely. In solids this space is greatly diminished, proportional to the 
density of the substance. 
The conception that molecules of all matter are in constant motion is known 
as the kinetic theory. (See chapter on Pharmacy). The velocity of this 
motion depends upon the nature of the substance, its state, and its tempera- 
ture. Under a powerful microscope small particles suspended in a liquid can 
be seen moving backward and forward erratically or jumping up and down 
in ceaseless motion. These movements are caused by the motion of the liquid’s 
molecules, which, by their impact on the particles drive them hither and 
thither. This motion, known as the Brownian movement, is a manifestation 
of molecular motion and was first noticed in 1827 by a Scottish botanist 
named Brown while examining suspensions of pollen grains in water under a 
microscope. 
Evidence of this molecular motion is demonstrated by the diffusion and 
evaporation of matter. If a jar containing carbon dioxide is placed directly 
under one containing hydrogen, with their openings together, it will be found 
that the carbon dioxide will diffuse upward and mix with the hydrogen. As 
carbon dioxide is 22 times heavier than hydrogen, had it been placed above, 
its movement downward into the jar of hydrogen could be explained by its 
greater weight. The movement upward of the carbon dioxide, diffusing through 
the hydrogen, is therefore possible only because of the movement of the mole- 
cules. The diffusion of liquids through a semipermeable membrane, which is 
continuously occurring in living cells, is known as osmosis and is explained by 
this molecular motion. In the evaporation of water the molecules are con- 
stantly bounding upward; some mix with air currents and are carried away 
while others rebound off the air molecules back into the water. If the resist- 
ance of the air molecules is removed by vacuum, evaporation proceeds more 
rapidly. Some evaporation occurs from solids and is readily noted with 
substances like camphor, musk, and iodine crystals. 658 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAYY 
Because there is ceaseless molecular motion it is remarkable that all sub- 
stances do not evaporate rapidly and expand indefinitely. Yet many solids 
have great tensile strength and enormous forces are required to pull them apart. 
Opposing molecular motion there is a strong force binding together the mole- 
cules. This force of attraction between like molecules is called cohesion. 
Unlike molecules may also adhere to one another strongly. The force of attrac- 
tion between unlike molecules is called adhesion. 
An examination of the surface of water in a container shows that it is not 
exactly level or plane, but slightly concave. The edge of the column in contact 
with the glass is raised above the general level, forming a crescent-shaped sur- 
face called the meniscus. The lifting of the water at the edge is caused by the 
adhesion of the water molecules to the glass, this attraction being greater than 
the cohesion between the water molecules. A line drawn through the bottom 
of the meniscus of transparent and the top of opaque liquids usually is selected 
as the reading point. 
When a column of mercury is examined the edges are found to he depressed 
and the surface slightly convex, because in this condition cohesion between 
the molecules is greater than their adhesion to the glass. 
If a finger is placed in thick molasses and withdrawn one is conscious that 
a certain amount of force is required to separate the molecules of the molasses. 
This demonstrates the cohesion of molecules. 
Surface tension.—The surface of all liquids has a tendency to contract, which 
tendency is known as surface tension and is the result of action of the mole- 
cules of the liquid. In contracting the surface of the liquid tends to assume a 
spherical shape because a sphere is the geometrical figure in which a given 
volume has the least surface; in other words, surface tension tends to reduce 
the surface area of a liquid, or to make the surface area smaller. 
A molecule in the interior of a liquid is attracted equally from all directions 
by the cohesion of the surrounding molecules, while those on the surface have 
only molecules of air above to attract them. As a result the attraction on the 
surface molecules is unbalanced and they are attracted only by the force tend- 
ing to pull them out of the surface toward the interior of the liquid. This 
unbalanced attraction causes the surface to contract to as small an area as 
possible and it then acts like an elastic membrane. 
Such a condition may be demonstrated by floating a clean needle on the 
surface of water. A careful examination shows that the‘needle floats in a 
hollow, the water behaving as though a thin elastic film or membrane had 
been stretched across its surface; the weight of the needle is not great enough 
to break through. A wet needle cannot be floated in this manner due to the 
cohesion of the water molecules; hence, the experiment is more easily performed 
if the needle is covered with oil. 
Like water, all liquids have this property. On alcohol the film lacks the 
strength of that on water. Many oils possess a weaker film but have greater 
viscosity; that is, the resistance offered by a liquid to the relative motion of 
its particles causes more friction within the liquid itself and gives it a sup- 
portive surface. 
Capillarity.—This property of liquids is due to the combined forces of 
adhesion and surface tension. The adhesion of water to the surrounding me- 
dium causes the surface of the water to become concave. Surface tension 
tends to decrease the surface area, or flatten it, by contraction. The two forces 
working together raise the liquid above the surrounding level. The height to 
which a liquid will be lifted depends upon its density and the strength of the 
liquid film. CHEMISTRY 
659 
The phenomenon of capillarity is governed by the following rules: 1. Liquids 
rise in capillary tubes if the liquids wet the tubes and are depressed if they 
do not; 2. The elevation or depression is inversely proportional to the diameter 
of the tube; and 3. The amount of elevation or depression decreases as the 
temperature increases. 
Solution.—It is common knowledge that a piece of salt dissolves when it is 
placed in water. Water in this case is called the solvent and salt the solute, 
and the molecules of the solute occupy space between the molecules of the 
solvent. All solutions possess the following characteristic properties: 1. A 
solution is of the same nature throughout and each unit volume of the solvent 
contains the same amount of the solute; 2. The solute does not separate from 
the solvent upon standing unless the temperature changes or some of the solvent 
is lost by evaporation; 3. Only a definite weight of solute can be dissolved in 
a given volume of solvent at any given temperature, and when the solvent holds 
all it can of the solute at that temperature it is said to be saturated; 4. The 
solubility of a solid generally increases with a rise of temperature; and 5. The 
solubility of a solid varies with the nature of the substance and the solvent 
used, water being the greatest general solvent and alcohol perhaps second. 
Crystallization.—When the saturated solution of a solid is cooled or evap- 
orated, some of the solute separates from the solvent in the form of crystals. 
Crystallization may occur when a liquid changes from the liquid to the solid 
state. During crystallization the molecules of the solid arrange themselves in 
definite geometric figures. The types of the crystals depend upon the nature 
of the substance and the conditions under which crystallization occurs. 
Solubility of Liquids.—It is possible to dissolve one liquid in another, and 
in such a case either liquid may be considered the solvent. Two liquids which 
are mutually soluble are said to be miscible; if they are insoluble they are 
said to be immiscible. If an oily liquid is shaken with water so that finely 
divided particles of oil remain suspended in the water the resulting product 
is called an emulsion. 
Solubility of gases.—All gases are soluble to some extent in water. When 
water is heated, bubbles, consisting of air which was dissolved, rise through 
the liquid and are liberated; hence, an increase in temperature decreases a 
liquid’s ability to dissolve gases. This ability is increased by pressure and is 
employed in the manufacture of carbonated beverages. The increase in a 
liquid’s ability to dissolve gases under pressure is governed by Henry’s law; 
The volume of a gas that can be absorbed by a liquid is directly proportional 
to the pressure applied. 
The elements. 
INORGANIC CHEMISTRY 
The earth, the atmosphere, plants, animals, and everything with which man 
is surrounded are composed of certain elementary substances in more or less 
complex forms. These substances are termed elements and each has definite 
characteristics and properties, chemical and physical, which are governed by a 
set of constants or laws. Regardless of the way in which the elements com- 
bine or separate, they do so according to the same definite principles or laws, a 
number of which have been discussed. 
The elements at present known to science are shown in the table on page 660 
and the atomic weights given are the 1937 International Atomic Weights. 
As explained in the introduction elements are substances which cannot be 
resolved into or built up from anything simpler. This definition takes into 
consideration only the ordinary types of chemical change and takes no cogni- 
zance of those changes in elements that occur when they are subjected to bom- 660 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
bardment by a-rays emitted by radioactive substances, an example of which is 
the breaking down of nitrogen into hydrogen and helium by such bombardment. 
Notation.—The names of many elements are derived from Greek or Latin 
words that signify some distinguishing feature or peculiarity of the element; 
others are named after mythological personages or deities, minerals containing 
them, places where they were discovered; and some are named after planets 
in the solar system. The names of the more recently discovered elements usually 
end in “um” or “on”. 
Table of the Elements 
Element 
Symbol 
Atomic 
Weights 
(0=16) 
Atomic 
Number 
Valence 
Specific Gravity 
Water 
Air 
Actinium 
Ac 
227.0 
89 
Alabamium. .. ... 
219. 0± 
85 
1 
Aluminum . ... ... 
A1 
26. 97 
13 
3 
2. 7 
Antimony (Stibium) . .. .. . ... 
Sb 
121. 76 
51 
3,5 
6. 7 
Argon . .. _ 
A 
39. 944 
18 
o 
1.38 
Arsenic _ - .. . 
74.91 
33 
3, 5 
5 7 
Barium ... 
Ba 
137. 36 
56 
2 
3 5 
Beryllium .. _. _ 
Be 
9. 02 
4 
2 
1 84 
Bismuth .. ... 
Bi 
209. 00 
83 
3, 5 
9 8 
Boron ... __ .. . 
B 
10. 82 
5 
3 
2 0 
Bromine .... 
Br 
79.916 
35 
1 
3 12 
Cadmium __ _ 
Cd 
112. 41 
48 
2 
8 6 
Calcium. 
Ca 
40. 08 
20 
2 
1 65 
Carbon. _ ....... _ 
C 
12. 01 
6 
2 4 
2. 26 
Cerium 
Ce 
140.13 
58 
3 4 
6. 92 
Caesium. _ _ ... _ ... 
Cs 
132. 91 
55 
' 1 
Chlorine ..... . _ . .... 
Cl 
35. 457 
17 
1 
2 49 
Chromium. ... .. . 
Cr 
52. 01 
24 
2, 3 6 
7 1 
Cobalt . . ... 
Co 
58.94 
27 
2, 3 
8 9 
Columbium 
Cb 
92. 91 
41 
3, 5 
12 7 
Copper (Cuprum) 
Cu 
63.57 
29 
1, 2 
8.9 
Dysprosium 
Dy 
162.46 
66 
3 
Erbium.. . . . .... 
Er 
167. 64 
68 
3 
4. 77 
Europium .. ... ... 
Eu 
152.0 
63 
3 
Fluorine. .. 
F 
19.0 
9 
1 
1.31 
Gadolinium 
Gd 
159. 6 
64 
3 
1 31 
Gallium.. 
Ga 
69. 72 
31 
3 
5 94 
Germanium. ... 
Qe 
72. 60 
32 
2, 4 
5 47 
Au 
197.2 
79 
1, 3 
19.32 
Hafnium . . ... 
Hf 
178.6 
72 
4 
Helium _ „. _ 
He 
4.002 
2 
o 
0.137 
Holmium ... ._ ... 
Ho 
163.5 
67 
3 
Hydrogen ... . .... 
II 
1.0078 
1 
1 
0.069 
Illinium ... 
11 
146.0 
61 
3 
Indium. _ ... 
In 
114. 76 
49 
3 
7.12 
Iodine . ... __ 
I 
126.92 
53 
1 
4 94 
Iridium .... . 
Ir 
193.1 
77 
3,4 
22 42 
Iron (Ferrum) ..... 
Fe 
55.84 
26 
2, 3 
7.86 
Krypton ._ __ __ . 
Kr 
83.7 
36 
0 
2.18 
Lanthanum . 
La 
138.92 
57 
6 155 
Lead (Plumbum) 
Pb 
207. 21 
82 
2,4 
11 34 
Lithium . ... 
Li 
6.94 
3 
i 
0.534 
Lutecium .... . 
Lu 
175.0 
71 
3 
Masurium ......... 
Ma 
98.8 
43 
Magnesium 
Mg 
24. 32 
12 
2 
1. 74 
Manganese. . 
Mn 
54.93 
25 
2,4,6,7 
7 42 
Mercury (Hydrargyrum) . 
Hg 
200.61 
80 
L 2 
13 59 
Molybdenum... ... _ . . 
Mo 
96.0 
42 
9.01 
Neodymium 
Nd 
144. 27 
60 
3 
6 95 
Neon ... . . ..... 
Ne 
20.183 
10 
o 
0. 674 
Nickel.._ .. 
Ni 
58.69 
28 
2,3 
8 75 
Nitrogen. ... ........ 
N 
14.008 
7 
3, 5 
0.967 
Osmium . ._ 
Os 
191. 50 
76 
2,3,4, 8 
22. 48 
Oxygen _ ... ... ...... 
0 
16.00 
8 
2 
1.105 
Palladium ... . ... ...... 
Pd 
106. 70 
46 
2,4 
12 16 
Phosphorus _ 
P 
31.02 
16 
3,6 
1 83 
Platinum 
Pt 
195.23 
78 
2,4 
21 37 
Pollonium. 
Po 
210,0 
84 
3,5 
Potassium (Kalium) _ ... . 
K 
39.096 
19 
1 
0 870 
Praseodymium 
Pr 
140. 92 
59 
3 
6.48 
Protoactinium ... 
Pa 
231.0 
91 
3,5 
Radium 
Ra 
226.05 
88 
' 2 
Radon 
Rn 
222.0 
86 
0 
Rhenium ... 
Re 
186. 31 
75 
2, 4, 6, 7 
Rhodium _ 
Rh 
102.91 
45 
3 
12. 44 
Rubidium. 
Rb 
85.48 
37 
1 
1.52 CHEMISTRY 
661 
Element 
Symbol 
Atomic 
Weights 
(0 = 16) 
Atomic 
Number 
Valence 
Specific 
Gravity 
Water 
Air 
Ruthenium _ 
101.7 
44 
3,4,6, 8 
12. 06 
Samarium .. 
150.43 
62 
3 
7.76 
Scandium ___ 
Sc 
45.10 
21 
3 
Selenium __ _ 
Se 
78.96 
34 
2, 4, 6 
4. 65 
Silicon . . ... 
Si 
28. 06 
14 
4 
2.42 
Silver (Argentum) _ _ _ _ _ 
Ag 
107. 88 
47 
1 
10.50 
Sodium (Natrium) . . 
Na 
22.997 
11 
1 
0.971 
Strontium.. ... 
Sr 
87.63 
38 
2 
2.54 
Sulfur 
S 
32.06 
16 
2,4,6 
2.046 
Tantalum . ... . ._ 
Ta 
180. 88 
73 
5 
16.6 
Tellurium 
Te 
127. 61 
52 
4,6 
6.25 
Terbium ... 
Tb 
159. 20 
65 
3 
Thallium ... _ . 
T1 
204. 39 
81 
1,3 
11.85 
Thorium . 
Th 
232.12 
90 
' 4 
11.2 
Thullium.. __ 
Tm 
169. 40 
69 
3 
Tin (Stannum) 
118. 70 
50 
2, 4 
6.85 
Titanium. _ _ _ 
Ti 
47. 90 
22 
2,4 
4. 5 
Tungsten _ _ . 
W 
184.00 
74 
6 
18.7 
Uranium ... .. ...... ... 
U 
238. 07 
92 
4,6 
18. 68 
Vanadium.. . 
V 
50. 95 
23 
3,5 
5.69 
Virginium ...... 
Vi 
225. 0± 
87 
Xenon . 
Xe 
131. 30 
54 
0 
4. 42 
Ytterbium.. 
Yb 
173.04 
70 
3 
Yttrium ... ... ... ... 
Y 
88.92 
39 
3 
3.80 
Zinc ... 
Zn 
65. 38 
30 
2 
7.00 
Zr 
91.22 
40 
4 
4.15 
Table of the Elements—Continued 
For convenience and simplicity in expressing the composition of substances 
made up of various elements, in representing the results of chemical action, 
and in working out chemical equations, there is used an abbreviated form of 
chemical language or a system of symbols. These symbols are abbreviations 
of the names of the elements and have become fixed by long usage. They 
usually consist of the first letter of the names of the most important, most 
abundant or earliest-discovered elements, as O for oxygen, H for hydrogen, N 
for nitrogen, etc., and in cases where several elements have the same initial 
letter some other letter of the name is added, Ni for nickel, Ba for barium, Bi 
for bismuth, etc. In a few instances the symbol is derived from the old Latin 
name of an element, as Au for gold, Cu for copper, Fe for iron, Na for sodium, 
etc. As has been stated before, symbols refer to the atom of an element, 
and the number of atoms or molecules of an element in a substance is 
shown by placing numbers before or after the symbol. A symbol therefore 
represents not only the name of an element but a definite quantity of that 
element, an atom or a molecule, and as atoms and molecules have weight it 
also represents a definite weight of the element. A collection of symbols, with 
any attached numbers, shows how the atoms or molecules of an element are 
united in a substance, and such a collection is known as a chemical formula. 
A chemical formula is a collection of symbols and numbers showing the 
kinds and amounts of elements contained in a substance, or compound. A 
formula standing alone represents one molecule of the substance. A symbol 
of an element contained in a molecule represents one atom of that element. 
If more than one atom is present in a molecule the proper small numeral is 
placed after and slightly below the symbol, and if more than one molecule is 
present a large numeral is placed before the symbol. Placing a large num- 
eral before a symbol or before a collection of symbols multiplies everything 
following the numeral including the subscripted small numerals. For example: 
H20 is the formula for water, and as so written represents one molecule of that 
compound, while 2ILO represents two molecules consisting of four atoms of 662 
HANDBOOK OP THE HOSPITAL CORPS, U. S. NAVY 
hydrogen and two atoms of oxygen. To be correct the valences (see p. 664) in a 
chemical formula must balance. It has been stated that oxygen has a valence 
of II and that the valence of hydrogen is I. Manifestly one atom of hydrogen 
is not the equivalent of one atom of oxygen in combining power, and if 
the two are combined it will require two atoms of hydrogen to balance or 
equalize one atom of oxygen, because in any given compound all valences 
of each atom must be employed; that is to say, no element may have a free 
valence in any saturated compound. (See p. 665.) The valence of barium is II, 
and therefore one atom of barium can unite with one atom of oxygen to form a 
molecule of barium oxide. If the valence of one element of a compound is a 
multiple of the valence of the other element in the compound, take the symbol of 
the element with the lower valence as many times as it is contained in the valence 
of the other element and write the quotient as the exponent of the element 
with the lower valence as directed before. To write the formula of silicon 
oxide and have it balance, silicon having a valence of IV and oxygen II, the 
symbol of oxygen must be multiplied by 2. The formula of silicon oxide, there- 
fore is SiO-2. If the valences of the two elements concerned are not eqiiiva- 
lent and are not multiples of each other, write the symbols side by side and 
take each symbol as many times as the other has valences. The valence of 
aluminum is III, and one atom of that element is not balanced by one atom 
of oxygen with a valence of II, so to write the correct formula of aluminum 
oxide it is necessary to take the symbol of aluminum twice and the symbol of 
oxygen thrice, which gives the formula A12G3. This is the simpliest arrangement 
in which the two can be combined to form a compound. 
Chemical formulas are of four kinds, which are named and described as 
follows: Empirical formulas show the quality but not the quantity (other than 
relative) of compounds, as in (CJHioOb)*, the formula of starch, but when some 
special arrangement of the atoms of the substance is made to show not only the 
quality and quantity of the elements in the compound but the relationship 
between the different elements or groups of elements they are known as rational 
formulas, an example of such an arrangement being (0H)2S02 the formula of 
sulfuric acid. Graphic or structural formulas are those in which the relative 
position of the atoms is shown as a picture, the exact linking of the atoms 
being given with the symbols of the elements entering into the compound. 
Graphic formulas are shown on pages 714 and 715. Stereochemic formulas are 
used in the study of such advanced chemistry that they will not be discussed here. 
In order to understand the use of chemical formulas, especially graphic for- 
mulas, a knowledge of the combining power of elements, which is based on that 
of the atoms of the element, is necessary. 
Atomic weight.—The symbols of the elements represent a quantitative por- 
tion of the substance they designate, and each symbol signifies the smallest 
division of that element present in a molecule, and denotes a definite and 
fixed quantity, as, for example, in the formula NaCl the symbol Na repre- 
sents 22.997 parts of sodium and the symbol Cl represents 35.457 parts of 
chlorine as combined in a molecule of sodium chloride. 
Atoms of the same element always possess the same weight in relation to 
any definite standard selected with which to compare them, but the weight 
of an atom of one element is never the same as that of an atom of any 
other element. Atomic weight is purely relative and, as it is impossible 
to weigh single atoms, it is determined by comparison with the weight of some 
element selected as a standard. For many years hydrogen, the lightest of all 
known elements, was used as the standard for atomic weights and its atomic 
weight arbitrarily was placed as 1, but hydrogen is very difficult to obtain CHEMISTRY 
663 
in a pure state and mistakes as to its actual weight frequently occurred. 
Each time an apparatus or process was developed which came a little nearer 
to obtaining pure hydrogen, and consequently nearer the determination of its 
true weight, a revision, entailing recalculations of the atomic weights of all 
other elements, became necessary. This caused much work and finally the 
use of hydrogen as a standard was discontinued and oxygen substituted. 
Under the old system the atomic weight of oxygen was 15.88 but in the new 
system was fixed at 16. Thus when it is stated that the atomic weight of 
sulfur is approximately 32, it is meant that the weight of an atom of sulfur 
bears the same relationship to the weight of an atom of oxygen as 32 bears 
to 16, and similarly, as the atomic weight of iron is approximately 56, the 
relationship between the atomic weights of iron and of oxygen is as 56 is to 16. 
The absolute weight of the atom of any element is unknown but definite 
relative weights have been determined, and upon them all quantitative chemical 
analysis depends. 
Molecular weight.—The weight of a molecule is the sum of the weights of 
all atoms which compose it. A molecule of hydrochloric acid is composed of an 
atom of hydrogen and an atom of chlorine. The atomic weight of hydrogen 
being 1.008 and the atomic weight of chlorine 35.457, the molecular weight of 
hydrochloric acid is the sum of 1.008 and 35.457, or 36.465, and the rela- 
tionship of the molecular weight of hydrochloric acid is to the atomic weight 
of oxygen as 36.465 is to 16. 
The molecular weight of any substance expressed in grams is called the 
gram-molecular weight, or mole; thus, 18.016 Gm. is a mole of water and 32 
Gm. a mole of oxygen. At a given temperature and pressure the gram- 
molecular, or molar, weight of a gas will, in accordance with Avogadro’s hypo- 
thesis, occupy a constant volume which is called the gram-molecular volume or 
the molar volume. When the given temperature is 0° O. and the given pressure 
is 760 mm. the molar volume of a gas is 22.415 liters. 
Atomic number.—This is a number that indicates the position of an element 
in the Periodic Table and represents the net positive electrical charge on the 
nucleus of an atom. It also represents and is equal to the number of planetary 
electrons outside the nucleus upon which depend the chief physical and chemical 
properties of the elements; therefore a knowledge of the atomic numbers of 
the elements is important. 
The net, or excess, positive electrical charge on the nucleus of an atom is 
equal to the number of natural units of positive electrical charge (protons) in 
the nucleus of an atom minus the number of natural units of negative elec- 
trical charge (electrons) in the nucleus. As the helium atom has an atomic 
mass of 4 and as the atomic mass of an atom is approximately proportional to 
the number of protons in the atom, the nucleus of the helium atom is consid- 
ered as containing 4 protons. There being twice as many protons as electrons 
in the nucleus of an atom it follows that there are but 2 electrons in the nucleus 
of the helium atom and therefore the net or excess positive electrical charge 
is 4 minus 2 or 2, which is the atomic number of the element helium, and also 
represents and is equal to the number of planetary electrons outside the nucleus. 
For the helium atom to be electrically neutral it must have an equal number 
of positive and negative electrical charges, and as but 2 of the 4 electrons 
necessary to neutralize or balance the 4 protons are in the nucleus, the other 
2 electrons must be outside of the nucleus. 
In most cases atomic numbers follow the order of the atomic mass of the 
elements. Each element has its own atomic number which determines its 664 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
place in the Periodic Table and all its properties except those depending on 
atomic weight. 
Atomic numbers are determined by X-ray spectra according to the method 
devised by H. G. J. Moseley (1887-1915), a brilliant British physicist killed in 
the World War. He found that the X-rays emitted by different elements when 
bombarded by cathode rays in a vacuum tube give different X-ray spectra and 
hence the X-rays were of different wavelengths. By studying these charac- 
teristics he was able to calculate the number of the element giving off the 
X-rays, and his discovery made it possible to determine the number of elements, 
how many were missing, and to correct discrepancies in the position of certain 
elements in the Periodic Table as based on their atomic weights. 
Valence. 
This is the term used to describe the power of the atoms of elements to com- 
bine with the atoms of other elements. It sometimes is spoken of as the 
saturating or replacing power of elements and as chemical affinity. As stated 
in the introduction hydrogen is taken as the standard in fixing the valuation 
of valences, and its valence arbitrarily is designated as one. In some elements 
valence is comparative only, because they will not combine with hydrogen, as 
mercury, for instance. The valence of such elements is determined by compari- 
son of the noncombining element with one which will combine with hydrogen. 
Therefore, as one atom of mercury will combine with one of oxygen, and it is 
known that one oxygen will combine with two hydrogen, the valence of mercury 
is said to be two. If an element has such combining power, or valence, that 
it can unite with two atoms of hydrogen, it is said to have a valence of two; if 
it can unite with four atoms of hydrogen its valence is four, etc. Elements 
which do not form compounds, such as the inert gases, are said to have no 
valence. Elements often are designated as univalent, divalent, trivalent, or 
tetravalent respectively when their atoms are possessed of one, two, three, or 
four valences. Similarly, they may be designated as monads, diads, triads, 
tetrads, etc. The valence of an element may be indicated also by Roman 
numerals placed slightly above and to the right of the symbol. 
The table following, which is illustrative only, shows the difference in the 
number of hydrogen atoms which combine with one atom of several elements 
in the hydrogen compounds given, and indicates the valence of the element 
in the compound with which the hydrogen has combined. 
Valence of I 
Valence of II 
Valence of III 
Valence of IV 
HC1 
H20 
HsN 
H4C 
HBr 
H2S 
HsP 
H4Si 
HF 
EtaSe 
HaAs 
HI 
HsTe 
H3Sb 
Chlorine and bromine which combine with hydrogen, atom for atom, are 
monads. Oxygen and sulfur require two atoms of hydrogen for saturation and 
are therefore diads. Sodium does not combine with hydrogen, but as in its 
reaction with hydrogen chloride (HC1) it replaces hydrogen, atom for atom, 
its valence as a monad is established. Similarly, as an atom of zino in its 
reaction with hydrogen chloride displaces two atoms of hydrogen, it is a diad. 
The valence of all the elements toward hydrogen is constant and unchangeable. 
A hexad atom can unite with and completely neutralize six atoms of a monad, 
three atoms of a diad, two atoms of a triad, or one atom of a hexad. An atom 
of a tetrad could unite with four atoms of a monad, two atoms of a diad, or CHEMISTRY 
665 
one atom of another tetrad. Furthermore, any triad, tetrad, etc., atom may 
neutralize several different kinds of atoms of lower valence at one and the 
same time. For example, a hexad may unite with one triad, one diad, and one 
monad, or with any other combination of atoms the sum of whose valences 
does not exceed six. 
Valence may be likened to men having as many hands as elements have 
valences and each hand ready to grasp the hand of another person and form 
a bond. Sometimes, as has been shown, one hand may be so strong that it 
takes more than one of the other’s hands to hold the grip which forms the bond. 
Certain elements may possess more than one valence and this condition is 
known as polyvalence. An atom of mercury, for example, under some circum- 
stances will combine with one atom of chlorine, forming mercurous chloride, 
commonly known as calomel, and under other conditions it will combine with 
two atoms of that element to form mercuric chloride, popularly called bichloride 
of mercury. Just why an element may possess this quality of polyvalence 
is not known; it only is known that they do possess it. 
When an element changes its valence, either higher or lower, the change 
usually is in degrees of two, changing from monad to triad, diad to tetrad, 
etc., or the reverse. Exceptions to this rule are known, however, as iron, 
which changes its valence 1 degree at a time, from a valence of 2 to a valence 
of 3, and mercury, which changes from 1 to 2. 
That these varying valences may be indicated, the terminations ous and ic 
are used, denoting the lower and higher valence, respectively, as cuprous oxide, 
Cu20, in which copper has the valence of 1, and cupric oxide, CuO, in which 
copper has the valence of 2. 
When chlorine, bromine, and iodine combine with hydrogen they are always 
monads, as they also are when combined with metals, as copper chloride 
(CuCh) or bismuth chloride (Bids). But when the various elements combine 
with the diad oxygen, or such elements as chlorine and bromine, variations 
in the valence of these elements develop. This valence toward oxygen or 
the halogens, is termed halogen valence, usually increases in increments of 2, 
and is an example of polyvalence. The variation of the oxygen, or halogen, 
valence of sulfur and osmium is shown in the table following. 
Valence of III 
Valence of IV 
Valence of VI 
Valence of VII 
SjOj 
SOa 
S03 
S2O7 
Valence of II 
Valence of IV 
Valence of VIII 
OsO 
OsOj 
OSO4 
When all the valences, or bonds, of one element have been satisfied or 
replaced by a like number of another element, the resulting compound is said 
to be saturated, but where one of the elements of a group has a valence less 
than its maximum valence the group is said to be unsaturated. In some com- 
pounds it is believed that the valences for which there is no satisfying valence 
may hook up with each other, although this is not known positively. Groups 
of elements having unsatisfied valences are known as radicals (SO*, N03 OH, 
etc.). During chemical change a radical behaves as a unit similar to an indi- 
vidual atom and has a definite valence and retains its structure throughout 
the reaction. 666 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
In ammonium chloride, NHUCl, it is known that nitrogen acts as a pentad and 
has all valences satisfied, while in ammonia gas, NHS, it is known that nitrogen 
acts as a triad having 3 valences satisfied. The fact that when hydrochloric 
acid is added to ammonia gas, ammonium chloride is produced, with the con- 
sequent increase in valence from 3 to 5, and the knowledge of similar occur- 
rences in other compounds, has led to the belief that possibly the unsatisfied 
valences unite with each other in compounds which otherwise would not be 
saturated. 
Valence also is indicated by using the symbol of the element with bonds, or 
arms as they might be called, equal to the degrees of valence, extending from 
it. It is not necessary that these bonds be attached to the symbol in any 
definite position, but only that the proper number of bonds corresponding to 
the degree of valence be used. To illustrate this the following examples are 
given showing the placing of the required number of bonds about the symbol 
of the element and the name of the degree of valence: 
Monad Diad Triad Tetrad Pentad 
H— —O— —B— —C— =P= 
Different positions of bonds 
II I / // X? 
_P= =p= -p< =?<; -p< 
Practical use of graphic formulas to show the composition of compounds is 
obtained by linking the bonds of the symbol of one element with those of 
others, so that all bonds are joined, always remembering that one bond of an 
element can be linked with only one bond of another element. Some examples 
of common compounds written graphically are: 
Water Nitric Acid Ammonia (gas) 
//° /H 
H—O—H H—O—N/ Nr-H 
N) \H 
To show how the formula of a compound may be written, acetic acid can be 
represented in any of the following ways: 
H O 
CII3COOH; C2H402; H—C—ft—0—H 
A 
In writing the usual chemical equations none of the various ways of indicat- 
ing valence is ordinarily used, and it must be remembered that under no circum- 
stances do the bonds used in graphic or structural formulas actually exist; 
they are used only to indicate theoretically the relationship or linking together 
of the different atoms in compounds. 
As stated in the introduction and in the discussion of atomic structure the 
valence of atoms is determined by the number of electrons contained in the 
outer shell or orbit. This is due to the gain or loss of electrons in this shell or 
orbit in order to complete its symmetry. Metallic elements lose electrons read- 
ily while nonmetallic elements readily gain them. Amphoteric or intermediate 
elements, which partake of the characteristics of both metals and nonmetals, 
have the ability to gain or lose electrons according to the influences by which 
they are surrounded. 667 
CHEMISTRY 
Beryllium with an atomic weight of 9, has in its nucleus 9 protons and 5 
electrons (fig. 150(a)). Surrounding the nucleus is one complete orbit or shell 
of two electrons and there are two valence electrons in the outer orbit. It 
becomes symmetrical by the loss of its two valence electrons, leaving it with an 
excess of two positive charges, forming a bivalent ion, Be++. Therefore, it 
requires one atom of a diad or two atoms of a monad for saturation. Hence, 
beryllium readily combines with one atom of oxygen, which requires two elec- 
trons to complete its outer shell; or it might combine with two atoms of hydro- 
gen, each hydrogen atom requiring one electron to complete its respective outer 
shell. Boron can lose three electrons, hence, it is trivalent (fig. 150(&)). 
The carbon atom contains 4 valence electrons and will become symmetrical 
either by the addition or loss of 4 electrons (fig. 150 (c)). While the ion of 
carbon is unknown, the compounds formed by the carbon atom indicate its 
intermediate nature and demonstrate that its chemical behavior is governed 
by the same principles that control both the metals and nonmetals. 
In the oxygen atom there are 6 electrons in the outer shell (fig. 150 id)). If 
it were to resort to the symmetry of the helium 'atom it would be compelled 
to lose 6 electrons from its outer shell, but by gaining 2 electrons it assumes 
the symmetry of the neon atom (fig. 150 (e)). After gaining 2 electrons it has 
an excess of 2 negative charges, so it is said to have a valence of minus II. 
The outer shell of the fluorine atom assumes symmetry upon the addition of 1 
electron, therefore its valence is minus I (fig. 150 if)). 
The electronic theory. 
Electricity is spoken of as being static when it remains stationary, or at rest, 
and as dynamic, when it is in action, or in motion, and produces power, heat, 
and light. Static electricity may become active by friction. 
It has long been known that when certain solids, as amber, rubber, glass, 
etc., which do not conduct electricity, are rubbed with a piece of wool, or silk, 
or fur, they acquire the ability to attract light objects such as small pieces of 
paper, cork, pith, feathers, etc. The solids are then said to have become 
electrified, or charged with electricity and practically every solid, when rubbed 
with a different substance, will acquire this property. They may also become 
electrified by liquids, as when liquids pass through pipes. The electrification 
in all cases is the result of friction activating the static form of electricity in 
the substances themselves. 
If a rubber rod is electrified by rubbing with wool and then suspended by 
a thread and another electrified rubber rod is brought near to it, the two 
rods will repel each other, but if a glass rod that has been electrified by 
rubbing with silk is brought near to the suspended rubber rod, the two rods 
will attract each other. This is evidence that there is more than one state 
of electrification and is the basis for the law that like electrifications repel and 
unlike attract. To the electrification found on the glass rod the name positive 
has been given, and to that on the rubber rod the name negative. 
When a body has become electrified it is said to be charged with electricity, 
or to have a charge of electricity, and the flowing of this charge from one 
body to another is termed a current of electricity. For a current of electricity 
to flow from one body to another it is necessary for the bodies to be connected 
by substances which will conduct, or carry, the current, and such substances 
are known as conductors, a familiar example being copper wire. Substances 
which will not conduct electricity are known as nonconductors or insulators 
and are used to support conducting substances and prevent them from losing 
their electrical charge, common examples being rubber and glass. Due to 
154294°—39 43 668 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
If) FLUORINE (i) NITROGEN fit) HYDROGEN ATOM (•) HELIUM //) LITHIUM (*) HYDROSEN MOLECULE 
(=) BERYLLIUM (*) BORON M CARBON (*) OXYGEN <e> NEON 
(1) SODIUM (m) LITHIUM FLUORIDE M ARGON 
Figure 150.—Shells and orbits of elements. CHEMISTRY 
669 
the fact that in different substances the degree of conductivity varies it is not 
possible to classify them strictly as either conductors or nonconductors, and 
they are therefore spoken of as being good or poor conductors, metals being 
the best and glass, rubber, sealing wax, and like substances the poorest. 
Many important facts concerning the relations between elements have been 
determined through knowledge gained by the practical application of the law 
that like electricities repel and unlike attract, and that bodies charged with 
positive or negative electricity act in the same manner. 
It has been explained that all matter is considered as composed of electrons 
charged with negative electricity and of protons charged with positive elec- 
tricity. This has been shown by experiments carried out on solutions of sub- 
stances made up of known elements in water, contained in vessels called 
decomposing cells. In these cells are placed the positive and negative termi- 
nals, or electrodes, of an apparatus producing electricity, to which metallic 
plates are usually attached. If perfectly pure water, which is an extremely 
rare product, is then poured into the cell it will be found that no electricity 
will pass through it. If, however, a small amount of an acid, a base, or a 
salt be added to the water the solution will readily conduct the electric cur- 
rent. Substances which, when added to water, make it possible for the 
solution to conduct electricity are known as electrolytes, and substances which 
do not, as organic bodies like sugar, starch, and albumin, are known as 
nonelectrolytes. The substances used as electrolytes are electrically neutral 
or balanced, or, in other words, the protons and electrons in their atoms are 
equal in number. 
An electric current in passing through a solution of an electrolyte brings 
about a chemical decomposition called electrolysis in which the electrolyte is 
separated or split up into two groups of particles, each of which flows either 
to the positive or negative electrodes and on contact becomes electrically neu- 
tral. If the water in a decomposing cell is made slightly acid it splits 
up into hydrogen gas and oxygen gas when the current passes through the 
solution, the hydrogen gas being liberated at the negative, or cathode electrode, 
and the oxygen gas at the positive, or anode, electrode. The liberation of 
hydrogen at the negative electrode shows that it was charged with positive 
electricity, and the liberation of oxygen at the positive electrode shows it 
was charged with negative electricity. Passage of an electric current through 
water in which copper sulfate has been dissolved causes copper to be de- 
posited on the negative electrode and oxygen to be finally liberated at the 
positive electrode. Electrically charged particles of matter are called ions, 
from a Greek word meaning “to go”, and ions charged with positive electricity 
are known as cations, because they go to the cathode, or negative, electrode, 
while those charged with negative electricity are known as anions, because 
they go to the anode, or positive, electrode. Cations and anions carry the 
matter with which they are associated, and on touching the electrodes the 
electric charges leave them and pass into the electrodes while the matter is 
deposited or liberated. In the electrolysis of hydrochloric acid in water (fig. 
151) the acid ionizes into positive hydrogen cations and negative chlorine 
anions, with molecules of hydrogen gas and of chlorine gas being liberated 
later. 
These examples have also shown that during electrolysis there is movement 
of the electrified particles of matter or ions in the solution toward the positive 
and negative electrodes in accordance with the law that unlike electricities at- 
tract. It is believed this movement is the result of the loss or gain by a neu- 
tral atom of an electrolyte of one or more electrons in the formation of the 670 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
particles of matter called ions. If electrons are lost the particle or ion 
becomes positively electrified, and if they are gained, the particle is negatively 
charged. 
In the theory of electrolytic dissociation, or ionization, any one molecule of an 
electrolyte breaks down into one or more cations and one or more anions, the 
total number of the positive and negative charges being equal. Each cation 
and anion forms a nucleus to which may be attached a variable number of mole- 
cules of the solvent, and as a result, the moving particle or ion is complex. 
Fig. 151.—Electrolysis of hydrochloric acid. 
The valence of the ion corresponds with the valence of the element or group 
of elements from which it is derived and is equal to the number of electric 
charges borne by it. 
The process of electrolytic dissociation or ionization, or the formation of ions, 
may be represented as follows: 
Hydrochloric acid Hydrogen ion Chlorine ion 
— -~>H+ + Cl- 
ztH+ 
+ ci- 
Sulfuric acid 2 Hydrogen ions Sulfate ion 
2 Hydrogen ions 
Sulfate ion 
H2S(y + SO r “ 
In the ionization of sulfuric acid positively charged hydrogen ions and nega- 
tively charged sulfate ions are formed by the dissociation of sulfuric acid 
molecules. CHEMISTRY 
671 
The arrows as used in the examples show that the reactions are reversible; 
that is, the products under suitable conditions will produce the original 
substances. 
By electrolysis the positive hydrogen ions are attracted to the negative elec- 
trode where they lose their charges of positive electricity and are liberated 
as molecules of hydrogen gas. When the sulfate ions reach the positive electrode 
the process, while similar, is more complicated, but the liberation of oxygen is 
the final, or end, result. 
Through the observation of these and similar phenomena the electronic 
theory has been developed, by which many chemical reactions have been made 
clear. 
Numerous experiments have shown that the atoms of elements are composed 
of positive and negative electrically charged particles which are present in 
sufficient numbers to exactly balance or neutralize each other. The unit of 
positive electricity, the proton, is designated by placing a single plus sign 
above and to the right of the symbol of the element, while that of negative 
electricity, the electron, is designated by placing a single minus sign in the 
same position. As a result of experiments concerning the electrical properties 
of the atom certain postulates or assumptions have been laid down: 
1. All atoms are composed of positive and negative electrical charges in 
equal quantities. 
2. Each atom is composed of two main parts. The central part is called 
the nucleus; surrounding it at some distance are particles of negative electricity 
called electrons, considered to be arranged and rotating in concentric circles 
or orbits about the nucleus. 
3. The nucleus consists of both positive and negative electricity, with positive 
charges always present in larger numbers than the negative. 
4. The atomic number of an element signifies the number of extra protons 
present in its nucleus. 
5. The external rotating or planetary electrons always exist in a sufficient 
number to balance the excess protons in the nucleus of the element (fig. 150 
(ff) )• 
The external electrons are associated in groups of shells, or orbits, the first 
shell or orbit being nearest the nucleus and complete, or symmetrical, when it is 
occupied by two electrons. The external electron of hydrogen is located in this 
shell (fig. 150 (h)), as are the two external electrons of helium (fig. 150 (i)). 
The lithium atom has 3 external electrons, so the third is contained in a second 
shell (fig. 150 (j)) outside of the first. The second shell is complete when it 
contains 8 electrons. Sodium which has 11 external electrons is demonstrated 
with its eleventh electron in a third shell (fig. 150 (0) outside of the first two. 
The third shell, like the second, may be completed with 8 electrons; in heavier 
elements it contains 18. The fourth shell may contain 32 electrons. The evi- 
dence of the nature of these shells and the number of electrons they contain 
was obtained largely through a study of valence. 
When an atom has in its outermost shell less than the number of electrons 
required for completeness, or symmetry, it always shows a tendency to combine 
with other atoms. For example: Lithium with an atomic number of three has 
only one electron in its outermost shell; fluorine with an atomic number of 
nine has seven. These two elements readily combine, the single electron of the 
lithium shell supplying the necessary electron to complete the outer shell of 
the fluorine atom, and producing the compound, lithium fluoride, which power- 
fully resists any effort to separate the two atoms (fig. 150 (j, f, & m)). When 672 
HANDBOOK OF THE HOSPITAL CORPS, XT. S. NAVY 
an element is extremely active its atoms combine with each other forming 
molecules (fig. 150 (fc)). 
Atomic structure.—The hydrogen atom is the simplest of any of the elements 
and like all other atoms is electrically neutral, containing an equal number of 
electrons and protons. It readily loses one electron forming an ion which 
contains an excess of one proton and is represented by H+. This electron, 
situated outside the nucleus and intimately connected with the chemical be- 
havior of the atom, is termed the valence electron. All atoms possess valence 
electrons with the exception of the inert gases, helium, neon, argon, etc. (fig. 
150 (i, e, S n)) and the basis of chemical activity is the interchange of the 
valence electrons among the elements to produce various compounds. The 
activity of these electrons is demonstrated when a substance is dissolved in 
water and the various atoms receive and contribute their outer electrons, 
according to their nature, to form ions. An atom that contributes, or loses, 
its electrons is left with an excess of protons, and hence is a positive ion or 
cation. A negative ion is formed when an atom receives, or gains, electrons, 
and as an excess of electrons is then present in its structure it is a negative ion 
or anion. In this form the individual atoms are electrically unbalanced. 
Upon removal of the solvent the ions revert to their original molecular structure. 
In the study of the structure of atoms, the atomic numbers assigned to the 
various atoms are indicative of the number of excess protons contained in the 
nucleus, which excess in every case corresponds to the number of planetary 
electrons in the various shells surrounding the nucleus. To clarify the study 
of atomic structure it is necessary to consider the relative weights of the atoms 
(atomic weights) as whole numbers, and in most cases the atomic weights are 
so nearly whole numbers that the fraction of error is negligible. Also, it will 
be found that the approximate atomic weights represent the total number of 
protons or the total positive electrically charged units contained in the nucleus 
of the element considered. Therefore: Atomic numbers designate both the 
number of protons, or positive factors, in excess and the number of electrons 
contained in the electronic shells of a given atom; and the approximate atomic 
weights correspond to the total number of protons in a given atomic nucleus. 
The atomic number of helium is 2 which denotes an excess of 2 protons which 
are balanced by 2 planetary electrons. The nucleus with its surrounding elec- 
trons forms a stable configuration in that the external shell is complete, there 
being no valence electrons present to combine it with other atoms. This is 
true, in fact, for helium, being an inert gas, is incapable of combining with 
other elements. This condition is indicative of a valence of zero. 
Lithium, with an atomic weight of approximately 7 and an atomic number of 
3 must contain 7 protons and 4 electrons in its nucleus and 3 rotating or plane- 
tary electrons in its electronic shells. Two of the planetary electrons are firmly 
held in the first shell, as are the two outer electrons in the helium atom. The 
remaining electron in the second shell produces an asymmetrical arrangement, 
in that the second shell requires 8 electrons for completion. This disturbs the 
forces within the atom. Theoretically, to overcome this asymmetry the valence 
electron is removed, forming a lithium ion (Li+). This is true because the 
lithium atom is very active chemically, having a valence of one. 
It is convenient to represent atoms containing more than one shell or orbit as 
cubes, as shown in figure 150, or as a series of concentric circles around the 
nucleus, but it must be remembered that such figures merely represent the 
postulated relationship of the various parts of the atom, do not imply that atoms 
are necessarily cubical or spherical in form, and that the electrons are not 
stationary but revolve about the nucleus. CHEMISTRY 
673 
Reactions and equations. 
In chemistry these terms are synonymous in so far as their use is concerned. 
It has been shown how chemical symbols are used to indicate the composition 
of a substance, and chemical symbols are used further to show exactly the 
nature of the chemical changes which occur when different substances come in 
contact with each other. The grouping of the symbols in this manner is called 
a reaction, but, strictly speaking, the statement is an “equation of the re- 
action,” as it is written in the form of an equation and both sides of the equa- 
tion must balance. It is customary to speak of these expressions either as 
reactions or equations. The signs of addition, +, and equality, = or —are 
used in expressing the reaction, but as the reaction may be reversible the use 
of the words “results in,” “produces”, or “gives” is preferred to “equals”, and 
use of the arrow to the sign of equality. When an arrow is pointed upward 
(t) it indicates that a gas is liberated and when pointed downward (I) 
that a substance has been precipitated or thrown out of solution. 
The use of chemical symbols to express a chemical equation may be described 
as a shorthand method of recording what has happened in a chemical reaction 
and obviously must be a statement of facts that actually occurred. In other 
words, the equation is written to fit the reaction, and consequently equations 
cannot be written until it is known through testing and experimenting ex- 
actly what has happened in any given instance. The general laws of chemistry 
and physics and observations of large numbers of reactions have been studied 
until it is known just what will happen in the majority of cases where specific 
reagents (compounds used for producing reactions) are brought in contact. 
In writing reactions or equations, three difficulties usually are encountered. 
These difficulties are to know if a given change will occur, to know the amount 
of the substance to be used, and to know the character of the substance formed 
in the reaction. The first difficulty is experienced because the varying electri- 
cal natures of the elements affect their affinities, and because of the disturbing of 
ordinary affinities by the formation of insoluble bodies wrhen liquid substances 
capable of producing them are brought together, the facility with which bodies 
that can be volatilized or converted into a gas diminish in their chemical power 
when this occurs, and in the proportion or concentration of the substances 
brought in contact with each other. The second difficulty is caxised by the 
necessity of knowing the ratio in which the substances can react upon each 
other, which is determined by their valences. The third difficulty encountered 
is due to the electrical relations of the ions of the substances coming in contact 
with each other, in which it is necessary to remember that electro-positive ions 
can unite only with electro-negative ions. 
Reactions are chemical changes in substances and changes in matter of this 
character affect the molecules of the substances involved therein. Molecules 
are the smallest portions of a chemical compound that retain the properties 
of that compound and are composed of two or more atoms which are, in 
turn, the smallest possible divisions of the elementary substances. The atoms 
composing the original molecules dissociate, or combine with like and unlike 
atoms of other molecules, to form new substances possessing entirely different 
properties from the original. For example; If an electric current is allowed 
to act upon water the water loses its identity as such and is resolved into 
two gases, hydrogen and oxygen. These products no longer possess the 
characteristics of water. In the rusting of iron, due to its combination with 
the oxygen of moist air, a reddish-brown powder is formed, iron oxide, which 
no longer has the characteristics of either iron or oxygen. 674 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
The attraction of one atom for another permits the formation of a com- 
pound. This attractive force is known as chemical affinity and varies greatly, 
not only among the various elements, but also with each element itself by the 
action of varying physical forces. The first condition necessary to produce 
a chemical change is intimate contact and freedom of motion between molecules, 
so that they may exchange their atoms. With solids this condition is obtained 
by dissolving them in a liquid medium. Some chemical reactions take place 
upon molecular contact while others need the application of physical forces 
such as heat, light, or electricity, along with molecular contact, to produce the 
desired change. 
The most common types of reactions or chemical changes are: 
1. Synthetic reactions, or direct combination, in which simple compounds or 
elements unite to form complex substances, as: SOa+ELO—^EhSCh; 
2. Analytical reactions, or decomposition, which embrace a large variety of 
reactions whereby the elements are separated from their compounds for the 
purpose of forming insoluble bodies or stable substances capable of being iden- 
tified and weighed, as: BaCl2-f Na2S04—>BaS04-l-2NaCl, in which reaction the 
barium sulfate is precipitated and therefore, the amount of it or of the sodium 
chloride may be determined ; 
3. Substitution, or displacement, wherein one element of a compound is dis- 
placed by another element, as: Fe+2HC1—^FeCh+EB; 
4. Double decomposition, or metathesis, is the most common type and is the 
mutual reaction of substances in solution to form new compounds by the inter- 
change of atoms or atomic groups (radicals), as: H2S044-2NaCl—>NaS04 + 2HCl; 
and 
5. Dissociation, or reversible reactions which are those produced by physical 
forces such as heat, light and solution. The molecules of certain compounds 
separate into simpler forms which exist as long as the favoring conditions con- 
tinue. When these conditions cease to act, the products of dissociation recom- 
bine to form the original substance: 
HCl+water±^H++Cl- 
NH4C1+heat NH3+HC1 
It has been previously stated that under suitable conditions the products of 
reactions will produce the original substances and that such reactions are known 
as reversible reactions. This means that, to a certain extent, a reaction and 
its degree of completion may be controlled partially and in some cases made to 
proceed in either direction. Such reactions are also known as incomplete. 
The reaction between calcium oxide and carbon dioxide is of this nature, for, 
if a stream of carbon dioxide is allowed to pass over calcium oxide, calcium 
carbonate is produced; while if calcium carbonate is heated, that compound is 
decomposed into calcium oxide and carbon dioxide. Such a reaction is written 
as follows: 
This equation simply means that the reaction may proceed from left to right, 
or vice versa, according to the conditions obtaining at the time. 
Equations.—A chemical equation expresses several important laws, among 
which are those of the Conservation of Matter and of Definite Proportions, 
indicates the weights of the reacting substances and their resulting products, 
and must balance and conform to the laws which govern it. In writing the 
chemical formula for potassium chlorate and its reaction due to the applica- 
tion of heat, experimental facts show that oxygen is liberated and the potas- 
sium chlorate converted into potassium chloride. It might be thought that 
CaO+COa CHEMISTRY 
675 
the equation KClOs+heat *02+KCl would express the reaction but exam- 
ination shows that it is incorrect, in that while there are 3 atoms of oxygen 
on one side of the equation there are only 2 on the other, and the equation 
therefore fails to conform to the law of Conservation of Matter. To correct 
this the equation must be balanced by placing numbers, as necessary, before 
each of the chemical formulas, so that finally there will be the same number 
of atoms of each element on each side of the equation. These numbers show 
the smallest amount of the elements that can enter into the reaction, and 
must be whole numbers as it is obvious that half an atom cannot be used. 
In the foregoing equation the oxygen molecule contains 2 atoms of O, but 
the formula for KClOa contains 3, and the 03 and 02 do not balance. Therefore, 
some multiple of 3 and 2 must be represented in the equation. As the smallest 
multiple of 3 and 2 is 6; enough KClCh must be used to furnish 6 atoms of O, 
and as 6-H5=2, that number of parts of KCIO.i is required. The correct equa- 
tion then will read: 2KCl(>+heat—>302-f2KC1. 
In stating equations it is necessary to remember that the molecular formulas 
of elements entering into combinations to form new compounds must always be 
used. Especially is this true of the gaseous elements such as hydrogen, oxygen, 
chlorine, nitrogen, etc,, which can exist only in the free or molecular state. All 
but 11 of the elements have one atom to the molecule, the exceptions being ar- 
senic, phosphorus, sulfur, selenium, bromine, iodine, fluorine, chlorine, hydrogen, 
oxygen, and nitrogen. Therefore when these elements are used in equations 
they must appear as As*; P4; Ss, So, S2, or S; Ses; Br2; I2; F2; Cl2; H2; 02; 
and N2. 
When dealing with reactions generally between acids and metals, or metallic 
oxides or hydroxides, it is safe to assume that a salt of known content will be 
formed; for example, when zinc is placed in a solution of hydrochloric acid it 
is known that zinc chloride will be among the products formed and that hydro- 
gen will be another product. 
In connection with the writing of equations showing reactions, the following 
rules, with examples, are given to assist the student. 
1. Any metal plus any acid gives a salt of the metal plus hydrogen. 
Example: 
2Ag + 2HC1—»2AgCl + II. 
2. Any hydroxide plus any acid gives a salt of the acid used plus water. 
Example: 
Metal Acid Salt Hydrogen 
NaOH + + H=0 
Hydroxide Acid Salt Water 
3. Any carbonate plus any acid gives a salt of the acid used plus carbon 
dioxide plus water. Example: 
Na2C03 + 2HNOs—> 2NaN03 + C02 + H20 
Carbonate Acid Salt Carbon Water 
Dioxide 
4. Any metal plus water which produces a reaction gives a hydroxide of the 
metal plus hydrogen. Example: 
2Na + 2H20 -> 2NaOH + H2 
Metal Water Hydroxide Hydrogen 
By the use of equations in conjunction with certain mathematical procedures 
it is possible to ascertain the percentage of each element entering into the 
composition of chemical compounds, the quantities of substances involved in 676 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
chemical reactions, the combining weights of elements, etc. The procedures 
necessary to obtain such information are spoken of as chemical arithmetic or 
stoichiometry. 
Stoichiometry is that branch of chemistry which treats of the relations between 
the properties of substances and their composition, and of the methods of cal- 
culating the quantities of substances, by weight or volume, involved in chem- 
ical reactions. It is based on the fundamental laws of chemistry. 
Chemical formulas and equations are made up of chemical symbols which 
represent atoms of elements and, as previously explained, definite weights of 
matter. The figures representing these weights are used in the mathematical 
calculations of stoichiometry, as shown in the examples appearing hereafter, 
in which also are explained the methods used in such calculations. 
If 1 atom of zinc and 2 molecules of hydrochloric acid will produce 1 molecule 
of zinc chloride and 1 of hydrogen it follows, then, that a definite weight of 
each of the former must produce a definite weight of each of the latter, be- 
cause, through the law of Conservation of Matter, no matter, or weight, can 
be lost or gained in any chemical reaction. The actual weight of no atom 
is known but the relative weights are and it is those which are used in 
chemical equations. After writing the symbols of the elements involved in 
this reaction in the form of an equation, figures representing the atomic and 
molecular weights of the elements and compounds are placed in the proper 
position just above the symbols in the equation and the result observed. Zinc 
has an atomic weight of approximately 65.4, and as only one atom of that 
element is involved in this equation that figure is placed above the symbol 
of zinc. The atomic weight of hydrogen is, roughly, 1, and of chlorine 35.5. 
The molecular weight of hydrochloric acid therefore is 36.5, but as that figure 
represents the weight of only one molecule and in this equation two molecules 
are necessary, the number is doubled and the number 73 placed above the 
formula of hydrochloric acid. The molecular weight of zinc chloride must be 
the atomic weight of zinc (65.4) plus twice the atomic weight of chlorine 
(35.5X2=71) or 136.4, which is written, above the formula of that compound, 
and 2, of course, is the molecular weight of hydrogen. The equation then 
appears as follows: 
65.4 73 136.4 2 
Zn+2HCl-> ZnCl2+H2. 
As no weight may be lost or gained in a chemical reaction, the combined 
weights of zinc and hydrochloric acid should just equal the combined weights 
of zinc chloride and two atoms of hydrogen, and it is found that they do, the 
sum of the weights of the elements and compounds on either side of the equality 
sign being 138.4. Now, irrespective of what the actual weight of the atoms 
or molecules may be, this equation shows that 65.4 parts by weight of zinc 
and 73 parts by weight of hydrochloric acid will produce 136.4 parts by weight 
of zinc chloride and 2 parts by weight of hydrogen. One may substitute any 
unit of weight desired—grains, ounces, tons, kilograms, or grams—for the 
word “part” and the actual weights involved read off as such. If a chemical 
equation is written correctly, the combined weights of the reacting substances 
will exactly equal the combined weights of all the products. It naturally 
follows that if a compound is formed which contains more atoms of an element, 
or requires two or more radicals to balance it, and those amounts are not 
contained in one molecule of the substance from which it is to be supplied, 
more molecules of that substance must be used, as previously explained. In 
other words, enough of the substance must be used to supply the amounts CHEMISTRY 
677 
needed. Suppose metallic calcium is dropped into some hydrochloric acid. It 
is known that calcium chloride (CaCh) will be formed, the equation being: 
40 73 111 2 
Ca+2HCl->CaCl2+H2 
As a molecule of calcium chloride contains two atoms of chlorine and one 
molecule of hydrochloric acid contains only one atom of chlorine, it is necessary 
to use two molecules of that acid. Determining the weights involved in the 
equation, shows that 111 parts of calcium chloride and 2 parts of hydrogen 
are formed by the action of 73 parts of hydrochloric acid on 40 parts of 
calcium, all parts being by weight. 
By applying these principles the weights of any substances required to 
produce a definite weight of a specific compound may be calculated. First the 
equation must be stated and balanced, next the reacting weights must be 
written in their respective places above the equation, and then, by making a 
simple statement in proportion, the required weights easily are ascertained. 
Suppose the problem is to ascertain the quantity of hydrochloric acid neces- 
sary to produce 75 grams of calcium chloride. By reference to the preceding 
equation it is noted that 73 grams of hydrochloric acid will produce 111 grams 
of calcium chloride. It follows, then, that: 
wherein it is found that x equals 49.32+ grams of hydrochloric acid. Simi- 
larly, had the problem been to determine how much calcium chloride could be 
made from 1,850 grams of hydrochloric acid the statement would have been: 
73: 111:: x: 75 
73: 111:: 1850: x 
and x would equal 2,813+ grams of calcium chloride. 
The next examples given show a different method of working the problems 
occurring in chemical equations although based on the same principles as the 
others. 
Suppose it is desired to make 20 Gms. of oxygen (O) without wasting 
material. Set down the formula and write the amount, in grams, above the 
substance to be obtained. Place an “x” to represent the unknown quantity 
above the substance to be weighed. Below the formulas write the formula 
weights, which are calculated from the atomic weights. The number before 
the formula is used as a multiplier to obtain the equation weight. The numbers 
for KC1 are omitted as they do not enter into the problem. 
x 20 
2KC10i -> 302 +2KC1 
Atomic weights: K, (39) ; Cl, (35~5) ; O, (16 X 3)~ O, (l(Tx 2)' 
Formula weights; 122.5 32. 
Equation weights: 2 X 122.5 = 245. 3 X 32 = 96. 
if 245 grams of KClCb produce 96 grams of O, then: 
245:96:: x: 20 
96x = 4900 
required to produce 20 grams of O. 
x = 51, the number of grams of KC103 
The “x” can be on either side of the arrow. In other words the weight of 
any product can be. calculated, if the weight of any one of the substances is 
known. 678 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The “x” and the known weight can also be used on the same side of the 
equation. What weight of hydrogen is required to react with 100 Gms. of 
iron oxide? 
100 x 
Atomic weights: Fe, (56X2) ;0, (16x3) H,(1 X 2) 
Formula weights: 112 48 3 X2 
Equation weights: 160 6 
FG203 -f- 3H2 
If 6 grams of hydrogen are required to react with 160 grams of iron 
oxide, then: 
160: 6 :: 100: x 
160x = 600 
x = 3.75, the number of grams of hydrogen 
required to react with 100 grams of iron oxide. 
The weights expressed in the foregoing equations are for 100 per cent, or 
absolute compounds, which are compounds with absolutely no diluent or im- 
purities present. Unfortunately such compounds rarely are met with in prac- 
tice, so that when dealing with actual cases it generally is necessary, after 
determining the required weights of the absolute substance, to calculate how 
much of the impure or diluted product at hand will be necessary to furnish 
the required amount of absolute substance. In dealing with liquids the specific 
gravity, in addition, must be taken into consideration. Suppose the problem 
is to determine how many cc of a solution of sulfuric acid, specific gravity 
1.90, 90 per cent by weight, will be required to liberate 1,125 Gms. of hydro- 
chloric acid from the appropriate quantity of sodium chloride. The equation 
is written and the reacting weights calculated. Using approximate atomic 
weights, this would be as follows: 
117 98 142 73 
2NaCl+H2S04-*Na2S04+2HCl 
which shows that 98 grams of absolute sulfuric acid will produce 73 grams of 
absolute hydrochloric acid. Then, 
98: 73:: x: 1125 
and x is found to equal 1,510+ Gms. 
Now, the specific gravity of the solution of sulfuric acid to be used is 1.90, 
therefore 1 cc will weigh 1.9 Gms. (volume X sp. gr.=weight), of which 90 per 
cent, or 1.71 Gms., is absolute sulfuric acid. Then, if 1 cc contains 1.71 Gms. 
of absolute acid and 1,510 Gms. of the absolute acid are needed, by dividing 
1,510 by 1.71 the required number of ec is ascertained, which is, in this case, 
883+. 
It also will be observed that many compounds are crystalline in character, 
and in these crystals the compounds are combined loosely with one or more 
molecules of water (water of crystallization), and the weight of this water, 
though it may be driven off by heating the crystal, must be taken into con- 
sideration when the crystals themselves are used. The molecular weight 
of sodium carbonate, for instance, is, in round numbers, 106, but crystals of 
this compound cannot be indicated always as Na2C03. In one official salt 
the compound exists as Na-COs.lOELO; therefore to obtain 106 Gms. of the 
absolute salt in this case it will be necessary to weigh out 286 Gms. of the 
crystals of that compound. 679 
CHEMISTRY 
Nomenclature and classification of chemical compounds. 
To be a compound a substance must be composed of atoms of two or more 
elements which have combined to form molecules or the smallest particles of 
the substance. Simple molecules (H2, P*) consist of like atoms while compound 
molecules (H20, KI) are made up of unlike atoms. 
The naming of chemical compounds depends on a system in which certain 
accepted terminations are added to the name of one of the elements in the 
compound. These terminations are considered as meaning that nothing but 
the elements specifically named is present in the compound. For compounds 
containing only two elements or one element and a radical the termination ide 
is used; compounds formed in the union of oxygen, sulfur, chlorine, etc., with 
another element or radical are known as oxides, sulfides, chlorides, etc., 
respectively. 
In addition to this termination there are other ways of distinguishing com- 
pounds, each of which indicates a compound formed by the combination of ele- 
ments in different proportions. Copper oxide is the proper designation of both 
the cuprous and cupric salts of copper, for they contain only two elements, but 
they are different bodies. Therefore the cuprous salt is designated as copper 
SM&oxide and the cupric salt as copper monoxide. Sub is used to Indicate a 
difference in the normal combination of the elements in a salt and in this case 
there is less oxygen in combination with copper than there is in copper mon- 
oxide. Mon is but one of the several syllables used to designate the relative 
quantities of elements which combine in more than one proportion, the others, 
with examples, being: Carbon dioxide, C02; sulfur trioxide, SOs; carbon tetra- 
chloride, CCh; and phosphorus pentachloride, PC15, etc. Occasionally a com- 
pound has one-half more of an element than another compound containing the 
same elements, or the proportion is as 1 to 1%. But as fractions are not al- 
lowed in formulas the whole expression is multiplied by two and the proportion 
becomes as 2 to 3, and such compounds are known as sesqai-compounds, the 
word sesqui meaning one and a half. The formula of iron-sesquioxide, there- 
fore, instead of being is FeaOa. 
Other syllables and terminations used in the naming of compounds will be 
explained during consideration of acids, bases, and salts (these being the prin- 
cipal representatives of ternary compounds), those which have been given here 
being used almost entirely in binary compounds. 
Binary compounds are compounds containing atoms of two elements, as 
water, ELO, potassium iodide, KI, or calcium oxide, CaO. Compounds con- 
taining atoms of three or more different elements are known as ternary com- 
pounds, as potassium chlorate, KClOa, magnesium sulfate, MgSCb, or sulfuric 
acid, H2SO4. 
Ternary compounds are considered as being first derived from binary com- 
pounds and the negative part of the formula of ternary compounds usually 
consists of a group of atoms which act in the same manner as the negative 
element in a binary compound. Thus, in the compounds sulfuric acid, H2SO4, 
and magnesium sulfate, MgSCh, the hydrogen and magnesium are the metallic 
or positive parts, and the group SCh acts as the nonmetallic or negative part 
of the formula. Such groups of elements arc termed radicals and will next 
be discussed. 
Radicals are groups or combinations of the atoms of elements that play the 
part of a single atom in certain types of compounds. They appear in many 
compounds and although the groups remain intact and act as single atoms in 
chemical reactions they cannot exist in a free state but are alwaysi found in 680 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
combination with other atoms. One radical, NH4, or ammonium, acts as a 
positive metal. As explained under valence they are groups of atoms having 
unsatisfied valence. The valence of radicals is determined by the number of 
valencies unsatisfied, and is known as saturated, (CH4), monad, (OIL), diad, 
(CO), etc. With but few exceptions the names of radicals terminate in yl, 
as carbon yl, methyl, etc., and they are identified in chemical formulas 
by enclosing them in brackets or parentheses, as (Fe(OH)3, instead of FeOiIL. 
In addition to being known as a radical such a group of atoms may be known 
as a residue; that is, what remains after the removal of an atom from a 
saturated molecule. 
The formulas, valences, and names of some of the more important radicals 
are given in the table following. 
Formula 
Name 
Valence 
Formula 
Name 
Valence 
NH4 
Monad. 
Monad. 
Monad. 
CHj 
Methyl . 
Monad. 
Monad. 
Diad. 
NOj.. 
ON 
OH 
Hydroxy] 
CO 
Although sometimes referred to as radicals, the groups S03 and SO- are really 
anhydrides, which are compounds derived from acids by the abstraction of a 
molecule of water. Literally, anhydride means “without water.” 
The positive radical ammonium, —NH4, cannot exist by itself. When 
ammonia gas, NH3, is dissolved in water a molecule of it and a molecule of 
water unite to form ammonium hydroxide, NELOH. Chemically, ammonia 
is nitrogen trihydride, and as such the nitrogen must have a valence of III. 
When brought in contact with water the nitrogen is theoretically considered to 
be oxidized to its maximum valence, Y, with which it can hold the four hydrogen 
atoms and one hydroxyl group. This hydroxyl group can be exchanged for other 
radicals similarly, as though it were attached to a single positive element. The 
formation of ammonium hydroxide is shown graphically as follows; 
(Nitrogm/trihydride)} Water Ammonium hydroxide 
The univalent hydroxyl radical, —OH, consisting of one atom of hydrogen 
and oxygen, cannot exist by itself, and is a characteristic part of bases, alcohols, 
oxyacids, etc. 
Radicals play a most important part in the various reactions of analytic 
and synthetic chemistry, readily interchanging with atoms in chemical reactions. 
Radicals are so closely interwoven in the theories and laws concerning the 
formation of acids, bases, and salts that consideration of them will be continued 
in the discussion of the latter. 
Acids, bases, and salts are the three main types of inorganic chemical com- 
pounds and any one of the three may be either a binary or ternary compound. 
Acids are compounds of hydrogen with a negative element or radical, and 
are sometimes considered as salts of hydrogen. They possess a sour taste when 
diluted, saturate bases (neutralization), destroy or change the color of litmus CHEMISTRY 
681 
or other indicators, have a corrosive action on animal and vegetable tissues, and 
in aqueous solution dissociate into hydrogen ions, producing the characteristic 
reaction of the substance, and electronegative elements. All acids contain hydro- 
gen which is readily replaceable by a metal, the product being a salt. 
Acids are divided into two classes, binary (hydrogen, hydro, or halogen) 
acids which are compounds of the halogens and hydrogen, and ternary (oxy or 
oxygen) acids in which hydrogen is linked by means of oxygen to negative 
radicals containing oxygen, as HO—NO2. Examples of each are shown in the 
table following. 
Hydrogen acids 
Oxygen acids 
Hydrochloric acid .. HC1 
Hydrobromicacid ..... HBr 
Hydriodic acid HI 
Hydrofluoric acid.. HF 
Sulfuric acid _ ... .. H2SO1 
Nitric acid HNO3 
Phosphoric acid.. .. HsPO* 
Carbonic acid IHCOj 
Chloric acid HCIO3 
The strength of an acid is said to depend upon the degree to which it can 
dissociate or ionize. When an oxide of a negative element is dissolved in 
water an acid is produced. Theoretically, then, in order to manufacture an 
acid the first step is to produce an oxide of the element. Such an oxide is 
known as an acid anhydride, which may be described as an acid from which 
all hydrogen with sufficient oxygen to form water has been removed. For 
purposes of nomenclature all ternary acids are considered to be derived from 
acid anhydrides. 
A molecule of an acid may be said to be composed of two parts—its replace- 
able hydrogen and the remainder of the molecule. This remainder is known 
as an acid radical or residue. If an acid contains one atom of hydrogen to 
a molecule, as does hydrochloric acid, one atom of any univalent or monovalent 
element may replace that hydrogen to form a normal salt, but as an atom of a 
divalent element is equivalent in strength, or valence, to two hydrogen atoms 
one divalent atom can replace the hydrogen contained in two molecules 
of such an acid. Conversely, if the acid contains two atoms of replaceable 
hydrogen to a molecule, as sulfuric acid, it is evident that it must require two 
atoms of a univalent or monovalent element, or one atom of a divalent element 
to replace it. For that reason radicals are regarded as groups not broken up 
easily, which act as a unit in most reactions, and which possess valence (or 
basicity) the same as do elements, this basicity being determined by the num- 
ber of replaceable hydrogen atoms in a molecule of the acid of which they 
are the residue; for example: 
depend 
upon the degree to which it can 
Acid 
Radical 
Basicity 
HN03. . 
-N03 ... 
1 
HCIO3 
— ClOa 
1 
H2CO3 
= C03 
2 
=so4 
2 
H3PO4 
=P04. 
3 
=bo3 
3 
The formula for a radical may be written correctly and no attention paid to 
the valence of any particular element in it, since these elements are acting as 
a group, or whole, and, as stated before, the valence or basicity of the radical 
or group is governed solely by the number of replaceable hydrogen atoms orig- 682 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
inally combined with them in the acid of which they are the residue. Observ- 
ing the matter in this light, it is clear that by knowing the valence of the base 
to be used and the formula of the acid from which the radical is derived, the 
two then may be combined exactly in the same manner as would be two ele- 
ments to form any binary compound. For example, it is desired to write the 
formula for zinc carbonate. Zinc has a valence of two. Its symbol, Zn, is 
written down. A carbonate must come from carbonic acid, since carbon is the 
characteristic element in that radical and “ate” salts come from “ic” acids. 
The formula for carbonic acid is H2CO3. The carbonate radical therefore must 
be COs and is written down alongside and next after the symbol for zinc. Car- 
bonic acid, containing two atoms of replaceable hydrogen to a molecule, shows 
that the carbonate radical must be dibasic and accordingly will exactly match 
in valence strength with one atom of zinc. The formula for zinc carbonate 
therefore is ZnCOs. In other words, zinc being divalent, is equal in combining 
power to two hydrogen atoms and can replace them in any acid. Sodium is 
univalent, and it would require two atoms of that element to replace all the 
hydrogen in a molecule of carbonic acid, so that the formula for sodium car- 
bonate would be Na2C03. Whenever a whole radical must be used in a formula 
more than one time (unless it is a binary radical) it is necessary to enclose it 
within parentheses and multiply it by using a small numeral suffixed somewhat 
below the parentheses, as is done in the case of multiplying a single atom. 
For example— 
Calcium chlorate Ca(C103)2 
Ferric sulfate Fe2(S04)3 
Ferrous phosphate Fe3(P04)2 
Carbonate radicals generally are broken up when brought in contact with an 
acid or when heated, and therefore when a carbonate reacts with an acid 
another carbonate is not formed, but carbon dioxide and water are among the 
products. This is shown by the equation marked (a) following. When heated, 
all carbonates except those of the alkalies will produce carbon dioxide and an 
oxide of the element with which it is combined as a carbonate, as shown by the 
equation marked (&). 
(а) CaC03+H2S04->CaS04+C02+H20 
(б) CaCOs+Heat—>Ca0+C02 
Very few salts are actually formed by treating a metal or its base with an 
acid, although practically all of them can be so produced. Many of the acids 
do not exist as such, and others, though formation is possible, are of such a 
weak or unstable nature that their use outside of a laboratory would be most 
impracticable, and in most instances formation of salts by such a method would 
prove too costly. In practice, therefore, compounds are produced usually by 
other methods, an outline of which will be given later. 
Most of the acid-forming elements are polyvalent, and therefore they can 
unite with oxygen to produce more than one oxide. In the cases of those 
elements which form only two oxides, as nitrogen or arsenic, the nomenclature 
is easy and is carried out exactly as described for all binary compounds; that 
is, there would be nitrous and nitric oxides and arsenic and arsenious oxides. 
In examining chlorine it will be seen that this element possesses four distinct 
sets of valences, and therefore can unite with oxygen in four ways. It 
develops that chlorine, as well as others of these polyvalent elements, has two 
sets of valences with which it unites with oxygen much more often than it 
does with its other two sets. Also that these more common compounds with 
oxygen are much more stable. To the compounds formed by these two sets of CHEMISTRY 
683 
valences the endings ic and ous are given. Thus there are chloric oxide (CI2O5) 
and chlorous oxide (CI2O3), in which the valence of chlorine is V and III, 
respectively. For the oxides next above the ic form the prefix per is used, and 
for the oxide next below the ous form the prefix hypo. Accordingly the oxides 
of chlorine are named as follows: Perchloric oxide, chloric oxide, chlorous 
oxide, and hypochlorous oxide. Such oxides also may be named in other ways; 
for example, chloric oxide correctly may be called chloric oxide, chlorine 
pentoxide, or chloric anhydride. 
As has been said, an acid is produced by dissolving a negative oxide (acid 
anhydride) in water, and the acid so produced inherits the name of the oxide, 
the word “acid” simply being substituted for the word “oxide”; therefore 
sulfuric oxide produces sulfuric acid, nitric oxide produces nitric acid, and 
hypophosphorous oxide produces hypophosphorous acid, and chloric, iodic, and 
bromic acids are derived, respectively, from chloric, iodic, and bromic an- 
hydrides. The negative element which unites with oxygen to form an acid 
anhydride is known as the “characteristic” element of that oxide and of the 
acid produced from it. It is the element that gives the acid its name; e. g., 
sulfur is the characteristic element in sulfuric acid, etc. The reaction that 
actually occurs when an anhydride is dissolved in water is that the molecule of 
the anhydride unites with the molecule of the water to form one or more 
hydroxyl groups, so that, if lines are used to designate valence or bonds, the 
transformation that takes place is as shown in the following graphic formula 
of sulfuric acid: 
Sulfuric anhydride 
Sulfuric trioxide 
+ Water 
yields Sulfuric acid 
S03 + H20 H2S04 
It should be noted that it is only the hydrogen contained in the hydroxyl 
group of a ternary acid that can be replaced by a metal or a base. Usually in 
all inorganic acids all of the hydrogen is so combined but not always. The 
formula for phosphorous acid is H3PO3, but only two of the hydrogen atoms can 
be replaced for the reason that only two are contained in hydroxyl groups, as 
is shown by the graphic formula of that acid: 
Phosphorous acid 
Experiments have proven that hydrogen not so contained is not replaceable by 
a positive element, and as phosphorous acid contains hydrogen that is not part 
of a hydroxyl group it is therefore one in which all of the hydrogen cannot be 
replaced. (Some authorities question the graphic formula of phosphorous acid 
as shown.) 
Acids are also classed according to their basicity, which is determined by 
the number of hydrogen atoms they contain that are replaceable by monovalent 
positive atoms. Acids having one replaceable hydrogen atom, as hydrochloric 
(HC1), are known as monobasic, those with two, as sulfuric (H2SO4), as dibasic, 
h3po3 
154294°-—89 44 684 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
those with three, as phosphoric (HsPCb), as tribasic, etc. Any acid containing 
more than one replaceable hydrogen atom may be termed a polybasic acid. 
Tables showing examples of the two classes of inorganic acids are given 
next. 
Binary or Hydracids 
Name 
Formula 
Name 
Formula 
Name 
Formula 
Hydrobromic- 
HBr 
Hydrocyanic 
HCN 
Hydriodic- 
HI 
Hydrochloric _ _ 
HC1 
Hydrofluoric 
HF 
Hydrosulfuric. 
II2S 
These acids form salts whose names terminate in the ending ide and the 
prefix hydro is not used in naming the salt. Thus hydrochloric acid produces 
chlorides and hydrosulfuric acid produces sulfides. 
Ternary or Oxyacids 
Name 
Formula 
Name 
Formula 
Name 
Formula 
HCIO4 
H2S2O7 
HC1O3 
Sulfuric . 
H2SO4 
HBrO 
HCIO2 
H2S2O3 
HCIO 
Sulfurous . . ... 
H2SO3 
HIOs 
H2S2O4 
HNOs 
Pyrophosphoric 
H4P2O7 
HNO2 
HsPOi 
IIB02 
H4S104 
HPOs 
H3PO2 
Cyanic . 
HCNO 
Salts formed by these acids are named as follows: Acids whose names end 
in ic produce salts whose names end in ate; acids whose names end in ons pro- 
duce salts whose names end in ite and any prefix occurring in the name of the 
acid before the part referring to the “characteristic” element also is used in 
the name of the salt. Thus sulfuric acid produces sulfates, sulfurous acid 
produces sulfites, and persulfuric acid produces persulfates. 
Some of these acids may not actually exist and some are' so unstable that 
their actual use, outside a laboratory, would be impracticable, but salts of all 
of them are existent. 
The formulas given in these tables are molecular formulas in that they 
express the content, qualitatively and quantitatively, of a molecule. 
Bases are compounds in which a positive element or radical is united with 
a hydroxyl (—OH) group. They are capable of reacting with acids to form 
salts, and when dissolved in water they dissociate, yielding hydroxyl ions, 
which produce their characteristic alkaline reaction, and electropositive ele- 
ments. Because they contain the hydroxyl group they are also known as 
hydroxides. Hydroxides of the alkali-metals are called alkalis, while those of 
calcium, strontium, barium, and magnesium are called alkaline earths. Alkalis 
are known as mild and caustic, according to the strength of their action. 
Bases have several characteristic properties such as: Interaction with acids 
to form salts; alkaline reaction, if soluble; restoration of the blue color of 
substances reddened by acids, as litmus; soapy, slippery feeling, if soluble; 
power to saturate or neutralize acids, taking away their characteristic proper- 
ties; and the effervescence of most mild varieties with acids, giving off carbon 
dioxide (C02). CHEMISTRY 
685 
In theory, for purposes of nomenclature, bases are regarded as being formed 
either by the direct union of some basic element and oxygen, as calcium 
oxide, CaO, or by the action of a positive element or its oxide on water, where- 
by a hydroxide is formed, as potassium hydroxide, KOH. A hydroxide is a 
compound in which an atom of an element is combined with one or more groups 
of hydroxyl (—OH). Being a radical, hydroxyl cannot exist by itself, and 
when combined as a hydroxide it may he regarded as water in which one of 
the hydrogen atoms has been replaced by another element. Hydroxides are 
regarded as binary compounds, as the group (—OH) acts much the same as a 
univalent element. Hydroxides must not be confused with hydrates. The 
latter are additive compounds of one or more whole molecules of water with 
a molecule of some other compound, such as, for instance, terpin hydrate 
(C10H20O2.H2O). 
When acids are mixed with bases mutual rearrangements of the composi- 
tions of these substances take place, and the products of this interaction 
between acids and bases are known as salts. This term should not be confused 
with the common name of sodium chloride, “salt.” 
The saturating or neutralizing power of bases is determined by the number 
of hydroxyl groups present. When one hydroxyl group is present a base is 
known as mon&hydric (sodium hydroxide, NaOH) ; when two are present a 
base is known as dihydric (barium hydroxide, Ba(OH)2) ; etc. 
Salts are the products or compounds formed when all or part of the replace- 
able hydrogen in an acid has been replaced by a positive element or a base. 
They are classified according to the amounts of the acids and bases entering 
into the interaction, being known as normal or neutral, acid or mixed, double, 
and basic or oxy or sub. 
Normal or neutral salts are those in which all replaceable hydrogen of an acid 
has been replaced by a metal or base, as in calcium sulfate (CaSCh). 
Acid salts are those in which the amount of the base is not sufficient to allow 
complete interaction and only a part of the replaceable hydrogen of the acid 
can be replaced by a metal or base, as sodium acid sulfate (NaHSCh). Be- 
cause of the presence of this unreplaceable hydrogen, the names of acid salts 
usually contain the word acid and their formulas always contain an H. They 
also are designated as hydrogen salts or, instead of using the word acid or 
hydrogen in their names, the prefix “bi” may be used, and when so used always 
denotes an acid salt. Its use in any other kind of compound is incorrect, and 
therefore should never be used in place of “di” to indicate a double quantity. 
Bichloride of mercury is an example of the incorrect use of this word. Sodium 
acid sulfate, then, correctly may be called by that name or sodium hydrogen 
sulfate or sodium bisulfate. 
Double salts are those in which the hydrogen of an acid has been replaced 
by two or more elements, as in sodium and potassium sulfate, NaKSCh, or by 
an element and a radical, as in sodium ammonium sulfate, NaNIBSCh. 
Basic salts are those which contain more base than is required to form a 
normal salt and are regarded generally as being formed when there is not 
enough acid present to neutralize the base. An example of a basic salt is bis- 
muth subnitrate or, as it is sometimes called, bismuth oxynitrate. This basic 
salt is prepared by the decomposition of bismuth nitrate in a large quantity 
-of water according to the following interaction: 
Bi(N03)3 +2H20 BiO(NOs) .H20 + 2HNO-, 
Bismuth nitrate-f Water gives Bismuth subnitrate-{-Nitric acid 686 
HANDBOOK OF THE HOSPITAL CORPS, XT. S. NAVY 
In the interaction shown it might seem that there was sufficient nitric acid 
present to neutralize the base (a metal in this case) but immediately water 
is added to the normal salt (bismuth nitrate), two of the acid anhydrides 
(NOs) in it combine with two of the hydrogen atoms in the water to form 
nitric acid, so it can be seen that there is not enough acid (NOs) present in 
bismuth subnitrate to neutralize the base, the base bismuth having a valence of 
3 while the valence of the acid anhydride is but 1. 
Just as the acids are named from the anhydrides from which they are 
derived, so, too, are salts named from the acid which produces them, by naming 
the first or basic part of the salt just as described for the basic part of binary 
salts and dropping the ending of the names of the acid and substituting other 
endings. As the salt of a binary acid is itself a binary compound its name 
must end in “ide” so that from a reaction of zinc and hydrochloric acid would 
be obtained zinc chloride. The names of all ternary acids, as has been learned, 
end either in “ous” or “ic” and the names of the salts from these acids end 
in “ite” or “ate” respectively. In all salts, except binaries, any prefix the acid 
may have had is carried over and incorporated in the name of the salt. Thus 
it may be said that “ous” acids produce “ite” salts, “ic” acids produce “ate” 
salts, “per-ic” acids produce “per-ate” salts, “hypo-ous” acids produce “hypo- 
ite” salts, and “meta-ic” acids produce “meta-ate” salts. Similarly, any other 
prefix the name of a specific acid may have is inherited by any salt it may 
produce, as, for instance, pyrophosphoric acid produces pyrophosphates. 
All rules are tested by the exceptions thereto, and it must not be inferred 
from anything that has been said that in all instances the facts will adhere 
rigidly to the theory laid down. The scheme of nomenclature for acids and 
salts herein described is conceived as the one most nearly fitting all cases. 
It is purely theoretical and conceives that all acids are formed from their 
respective anhydrides, as described, and further, that all salts are derived 
directly through the action of an acid on a positive element, or upon an oxide 
or hydroxide of a positive element (bases). 
For the reason that ternary acids are produced from binary compounds and 
all other ternary compounds in turn are derived from the acids, in order to 
determine the formula of any salt, it is necessary that the formula of every 
acid listed in the tables of inorganic acids on page 684 be committed to memory. 
Just as it is necessary to know the valences of the different elements before 
it is possible to accurately write the correct formula for any acids, so is it 
necessary to know these formulas before it will be possible to write the formula 
of any compound (salt) derived from them. 
The nonmetals. 
Hydrogen.—Symbol: H ; Atomic number : 1; Atomic weight; 1.0078 ; Valence : 
I; Molecular formula : H2. 
Occurrence: Hydrogen is one of the most widely distributed elements. It 
forms one-ninth of the water of the earth, one one-hundredth per cent of the air, 
and is a constituent of nearly all organic material. 
Properties: Pure hydrogen is an odorless, colorless, tasteless gas. It is the 
lightest substance known, one liter weighing 0.089783 Gm. at 0° C. and 760 mm. 
pressure. Because of this property “lighter-than-air” aircraft are inflated with 
it to give them buoyancy, but due to its inflammable nature its use for that 
purpose is extremely hazardous. Inasmuch as its molecules have great diffusi- 
bility nonporous containers are necessary to retain it. 
Because of its activity in the nascent state, i. e., when being liberated from 
its compounds in the form of atoms, two atoms of hydrogen combine to form CHEMISTRY 
687 
a stable molecule. In this form it has little affinity for other substances, but 
in the nascent state or when its temperature is elevated, its behavior is quite 
the opposite. It bums with a nonluminous but intensely hot flame, combining 
with the oxygen of air to form water. This intense heat is put to practical 
use in the oxy-hydrogen torch employed to weld metals having a high melting 
point. 
When a current of hydrogen is directed upon a mass of finely divided plat- 
Figure 152.—Generation of hydrogen gas: (a) Generator; (6) wash bottle; (c) thistle 
tube ; (d) outlet. 
inum, the latter becomes incandescent. This results from the heat produced 
by the union of hydrogen with the oxygen occluded (absorbed) in the finely 
divided metal. The platinum undergoes no chemical change. Other metals 
and substances act in a similar manner, facilitating a chemical reaction with- 
out undergoing any chemical change themselves. These substances which 
accelerate such chemical reaction through their presence are known as 
catalysts and the action is termed catalysis. 
Hydrogen combines with chlorine even more readily than with oxygen, but 
with most other nonmetals it does not unite unless in a nascent state. The 688 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
nascent state represents the element in its atomic condition at the moment of 
generation. While in the nascent state hydrogen is capable of reducing ic 
compounds to lower ous compounds, or metallic oxides and chlorides to their 
metals: 
2FeCl3 + H2—>2FeCl2 + 2HC1 
Fe203 3H2—>3H20 -f- 2Fe 
Isolation.—Hydrogen may be prepared by the electrolysis of acidified water, 
2H20-^2H2+Ou> 
or by the action of dilute acids upon a metal, the gas being collected over water 
(fig. 152) : 
Zn+H2S04-*ZnS04+H21 
When the zinc is brought into contact with the acid solution an equivalent 
weight of the metal passes into solution in the ionic condition. The hydrogen 
ions recover their missing electron from the zinc atoms and are liberated as 
molecular (gaseous) hydrogen. This giving up of an electron by the metallic 
atoms shows that they have a smaller affinity for their electrons than does 
hydrogen. The reaction of the metal and the acid is attended by the evolution of 
considerable heat and experiments have shown that the heat evolved when various 
metals are used is quite different, which shows that the “chemical activity” 
of the metals is different. 
Some metals, like sodium, react vigorously with water at ordinary temper- 
atures displacing hydrogen, while others, like iron, must be heated before 
the hydrogen is displaced. This is because sodium is more active than iron, 
and the same difference exists when they are brought in contact with an 
acid. 
As a result of this difference in chemical activity it has been found that 
certain metals will displace others in acid solutions and it is possible to 
arrange all the metals in the order in which they will displace each other 
in this way. Such an arrangement is known as the electrochemical series of 
the metals, and also as the electromotive series. 
Following is a list of the common metals showing their position in the 
electrochemical series according to their decreasing chemical activity. 
Lithium Aluminum Nickel Copper 
Potassium, Manganese Tin Mercury 
Sodium Zinc Lead Silver 
Strontium Chromium HYDROGEN Platinum 
Barium Iron Antimony Gold 
Calcium Cadmium Bismuth 
Magnesium Cobalt Arsenic 
All the metals above a given one in this list will displace it from solutions 
of its compounds, while it, in turn, will displace all those of lower position. 
Sodium and potassium react violently with water at room temperature; mag- 
nesium burns in steam while iron must be heated before it reacts with steam; 
and the metals below iron do not react with steam unless excessive tempera- 
tures are employed. 
The place of hydrogen in the electrochemical series is most interesting. All 
those metals which precede it will, under ordinary conditions, evolve hydrogen 
from dilute acids, while those which follow it will not. CHEMISTRY 
689 
All the metals down to and including mercury combine directly with oxygen, 
while the oxides of gold and platinum are formed indirectly. If the oxides of 
the first ten metals are heated in hydrogen no reduction takes place, but those 
oxides from iron to copper inclusive are reduced by heating with hydrogen. 
The oxides of the last four metals are reduced by heat alone. 
The Chlorine Family ok “Halogens”.—Chlorine, bromine, iodine and 
fluorine exhibit such a close resemblance as elements, and in their compounds, 
that they are grouped into a family known as halogens or “salt formers.” 
They all unite with metals to form salts such as sodium chloride. 
chlorine.-—Symbol: Cl; Atomic number: 17; Atomic weight: 35.457; 
Valence: I; Molecular formula : Cl2. 
Occurrence.—In Nature chlorine does not occur free but is found abundantly 
in combination with sodium in sea-water and salt mines. It is not very 
abundant in the vegetable kingdom, but in the animal kingdom, combined with 
sodium, it is a constituent of the body fluids. 
Proper'ties.—Chlorine is a yellowish-green gas with a suffocating odor and 
when inhaled has a corrosive effect on the mucous membrane of the respira- 
tory tract. Next to fluorine, chlorine is the most active element of the non- 
metal group, readily combining with all the elements except oxygen, the inert 
gases and some of the rarer metals. A mixture of chlorine and hydrogen com- 
bines with explosive violence when a flame or spark is applied, upon contact 
with a platinum sponge, or upon exposure to the sun’s rays. Because of its 
intense affinity for hydrogen, chlorine indirectly becomes a powerful oxidizing 
agent by liberating nascent oxygen from the water in moistened materials. 
Isolation.—Chlorine may be isolated by the electrolysis of HOI or chlorides, 
or through the oxidation of HC1 by higher metallic oxides with the application 
of moderate heat: 
2HC1-»IL+C12 
It is extensively used as a bleaching agent in the form of chlorinated lime 
and is employed in water purification and sewage disposal as a powerful 
germicide and deodorizer. Chlorine was the first gas used in modern chemical 
warfare, and has a demoralizing effect upon troops because of its irritant, suf- 
focating action. Prior to the development of efficient masks it caused heavy 
casualties. 
Hydrochloric acid, HC1, is one of the gaseous products ejected from volcanoes 
and is a normal constituent of the gastric juices of mammals, being present in 
quantities from 0.1 to 0.4 per cent. It is a colorless gas with a sharp, suffocat- 
ing odor and acid taste. The dry gas neither acts on metals nor reddens 
litmus. It fumes in moist air and is very soluble in water. In contact with 
most metallic oxides it decomposes them to form water and a chloride: 
Mn02+4HC1—»MnCU+2HjO+Cla 
Fe203+6HCl->2FeCl3+3H20 
The concentrated aqueous solution, commonly called muriatic acid and con- 
taining 35 to 37 per cent HC1, is a colorless, corrosive fluid with a strong acid 
taste and pungent odor. Most metals dissolve in it, liberating hydrogen. 
Certain typical reactions are produced by strong acids acting upon various 
substances, and examples of them are shown in the following equations in 
which HC1 is the strong acid used: 690 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
1. Metals are acted upon by acids, hydrogen being displaced and a salt 
formed: 
2HC1+Fe—> FeCh+Ha T 
2. Acids react with oxides of the metallic elements, a salt and water being 
formed: 
Fe0+2HC1—»FeCl2+H20 
3. Acids react with metallic hydroxides to form a salt and water: 
Fe(0H)2+2HCl-»FeCl2+2H20 
4. An acid reacts with a carbonate to form a new salt and water, with the 
liberation of carbon dioxide: 
FeC03+2HC1 —> FeCl2+H20+C02 T (H,CO.) 
5. In general there is a tendency for the active acids to react with metallic 
salts, liberating the acid of the salt and forming a new salt: 
bromine.—Symbol; Br; Atomic number: 35; Atomic weight: 79.916; Valence: 
I; Molecular formula : Br2. 
Occurrence.—The chief sources of bromine are from magnesium bromide in 
brine wells and in sea-water. The magnesium, calcium, and sodium salts of 
bromine are found in many rock salt deposits. 
Properties.—Bromine is a reddish-brown, intensely caustic liquid which lib- 
erates orange-red vapors of a suffocating odor resembling that of chlorine. It 
is similar to chlorine in chemical action, although less active, chlorine displac- 
ing bromine from salts. In the presence of water it is an active oxidizing 
agent: 
FeS04+2HC]->H2S04+FeCl2 
H2 S+4Br2+4H20-+ H2SO*+8HBr 
Isolation.—The various methods employed for the isolation of bromine depend 
upon its displacement from bromine salts by chlorine: 
Cl2+2NaBr—»2NaCl+Br2 
Hydrolromic acid, HBr, is a colorless, heavy gas, with a sharp, irritating 
odor and acid taste; it is very soluble in water, the concentrated solution 
fuming in air. Solutions of the acid decompose upon standing, bromine being 
liberated. It combines with most metals to form salts, called bromides, which 
are used extensively in medicine and photography: 
NaOH+HBr —>NaBr+H20 
Hydrobromic acid is prepared by the action of an acid upon a bromide; 
Sulfuric acid cannot be used due to the liberation of sulfur dioxide and molecular 
bromine. 
iodine.—Symbol: I; Atomic number: 53; Atomic weight: 126.92; Valence: I; 
Molecular formula: I2. 
Occurrence.-—In small quantities, iodine is distributed throughout Nature 
combined with sodium, potassium, calcium, and magnesium. In sea-water, 
iodides are absorbed by sea-weeds, known as kelp, and certain species of 
sponges, which formerly comprised the chief source. Most of the present world 
supply is obtained from the iodate impurities of salpeter found in Chile and 
3KBr+H3P04-> K3P04+3HBr CHEMISTRY 
691 
Peru. Traces of iodine are found in the blood and certain portions of the 
animal body, as the thyroid and the liver. 
Properties.—The bluish-black rhombic plaques of pure iodine have a metallic 
luster, distinctive odor, acrid taste and neutral reaction. Iodine is slightly 
soluble in water, but in the presence of alkali iodides or hydriodic acid its 
solubility is greatly increased. One Gm. is soluble in 12.5 parts of alcohol. 
It resembles chlorine and bromine in its chemical reactions, although it is less 
active. Its affinity for hydrogen is comparatively weak, but the reverse is 
true in its relation to oxygen, for chlorine and bromine are replaced in their 
oxygen compounds by iodine: 
2KC10,-!+I,-* 2KI03+Cl2 
Iodine unites with the positive element in a solution of alkali hydroxides to 
form iodides and iodates: 
3l2+6NaOH-^5NaI+NaI03+3H20 
Upon treatment with ammonia water, it forms a very explosive compound, 
nitrogen tri-iodide (NL). 
Isolation.—Iodine is extracted from Chilean saltpeter by precipitation from 
the mother liquor (after the removal of the sodium nitrate) with a mixture 
of acid and neutral sodium sulfite: 
2NaI03+3Na2S03+2NaHS03-^5Na2S04+H20+I2 
The precipitate is collected on muslin, strained, dried, and purified by 
sublimation. 
Iodine and its salts are used extensively in medicine and photography. 
Hydriodic acid, HI, is a colorless, heavy gas with a sharp penetrating odor, 
fuming in air and very soluble in water. This is a very unstable compound, 
decomposing upon exposure to air. As a reducing agent it is very active 
due to the readiness with which it resolves into iodine and nascent hydrogen; 
hence, it is employed extensively in organic synthesis. It may be prepared 
by the action of phosphoric acid upon potassium iodide with the application 
of heat: 
Most of the compounds known as iodides are very soluble in water and may 
be prepared by the direct union of the elements in water: 
3KI+H3P04—^PCX+SHI 
or by the addition of iodine to the hydroxide of an alkali metal: 
Fe+Ia— 
3l2+6KOH-> 5KI+KI03+3H20 
The mass is then burned with charcoal to reduce the iodate: 
KIOs+SC—>KI+3C0 
Fluorine.—Symbol: F ; Atomic number : 9; Atomic weight: 19.00; Valence I; 
Molecular formula: F2. 
Occurrence.—Fluorine occurs mainly as calcium fluoride (fluorspar), CaF2, 
widely distributed throughout the world, and as sodium and aluminum fluoride 
(cryolite), BNaF.AlFs, found in Greenland. 
Properties.—Fluorine is the most active element known, combining with 
hydrogen even in the dark with explosive violence, and decomposing water 
with the formation of hydrogen fluoride and ozone. Many organic substances 
are ignited upon contact with it. 692 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Isolation.—It is prepared by the electrolysis of anhydrous hydrofluoric acid. 
Hydrofluoric acid, anhydrous, HF, is a colorless liquid which vaporizes as 
an intense, irritating, corrosive gas. In the presence of water it corrodes glass, 
porcelain, earthenware and most of the metals, but has slight effect upon the 
nonmetals. Its action upon silica makes it very useful in etching glassware. 
The gaseous envelope which surrounds the earth is called the atmosphere. It 
is composed of: 
Percent 
Nitrogen (N) 78 
Oxygen (O) 21 
Argon (A) 00.94 
Carbon dioxide (CO2) 00.03 
Hydrogen (H) 00.01 
Neon (Ne) 
Helium (He) 
Krypton (Kr) 
Xenon (Xe) 
Niton (Nt) 
00. 02 
Except for carbon dioxide, these elements as found in the atmosphere are in 
a free and uncombined state, so that air is a mixture. 
Helium, neon, argon, krypton, xenon, and niton are completely inactive, uniting 
with no known substance or element to form compounds and having only one 
atom in their molecules. They are the so-called inert gases, existing only in 
the atomic state. 
Oxygen.—Symbol: O ; Atomic number: 8; Atomic weight: 16.00; Valence II; 
Molecular formula: Ch. 
The discoverer of this element is regarded as Joseph Priestley of England 
who in 1774 obtained an “air”, as he called it, from the heating of mercuric 
oxide over mercury in which he found “that a candle burned * * * with 
a remarkably brilliant flame.” Although it is certain that Scheele of Sweden 
had isolated this gas in 1772 and there is little doubt that other experimenters 
had obtained oxygen long before either Scheele or Priestley, credit for its 
discovery is given to Priestley because he was the first to publish the results of 
his experiments and make them known to the world. Lavoisier of France, 
with whom begins modern chemistry, developed experiments showing its source 
and properties and in 1784, because he thought the properties of acids were 
due to the presence in them of this substance, he gave it the name of oxygen, 
which is derived from Greek words meaning “sour” and “I produce,” or roughly, 
“acid former,” sourness being a characteristic of acids. 
Oxygen is the most useful element known to man and is essential to animal 
life in the repair of tissues and the furnishing of heat and energy. It is vital 
in developing heat, light, and power from burning fuel. It is used in the 
acetylene torch, in special high-temperature furnaces and in treating respiratory 
distress from pneumonia, heart disease, and severe asthma. Submarine opera- 
tions, diving, caisson work, high-altitude flying and rescue-breathing apparatus 
all require oxygen. It is mixed with anaesthetic gases in the production of 
general anaesthesia. 
Occurrence.—Oxygen makes up one-half of all matter known to man, eight- 
ninths of the water of the ocean, and, more than one-fifth of the atmosphere. 
Two-thirds of the human body is combined oxygen. Ordinary soil and rocks 
contain about 50 per cent oxygen. It occurs free only in the air, its most 
natural and cheapest source. CHEMISTRY 
693 
Properties.—Oxygen is a colorless, odorless, tasteless gas which is 1.105 
times as heavy as air. One liter weighs 1.429 Gm. measured at 0° C. and a 
barometric pressure of 760 mm. It may be liquefied at and below minus 118° C., 
but no pressure is great enough to compress it to a liquid above minus 118° 0. 
which may then be called its critical temperature. At this critical temperature 
a pressure of 50 atmospheres is required to liquefy oxygen, and hence is called 
the critical pressure. 
Liquid oxygen is light blue in color and boils at minus 182.5° 0. under atmos- 
pheric pressure. Frozen oxygen is a pale blue, snowlike solid, melting at minus 
227° O. It is only slightly soluble in water, 30 ec per liter. 
While oxygen is only moderately active at ordinary temperatures, it is very 
active at elevated temperatures and unites with all the elements except fluorine 
and the inert gases. 
Iron will rust in the air at ordinary temperatures but when heated red hot 
and placed in oxygen, will actually burn: 
3Fe+20a—> FeO.Fe2Os 
A compound of oxygen with an element or radical is termed an oxide. Accord- 
ing to their observed composition they are known as monoxides (R-O), and 
(RO), sesquioxides (R/h), dioxides (R02), trioxides (RO..) tetmoxides (ROi), 
pent oxides (JB205), and heptoxides (K207), R in these formulas representing 
any element. 
Oxides are divided into two general classes according to the nature of the 
compounds resulting from their union with water. Oxides yielding acids with 
water are called acidic oxides, and those yielding bases with water are called 
basic oxides. Acidic oxides, also called acid anhydrides, combine with basic 
oxides to form salts, as sulfur trioxide (SOs) which combines with barium 
oxide (BaO) to form barium sulfate (BaSO*). Basic oxides unite with acids 
and acidic oxides to form salts, as copper oxide (CuO) unites with diluted 
sulfuric acid (H2SO4) to form copper sulfate (CuSOO, and sodium oxide (Na20) 
unites with sulfur trioxide (SOs) to form sodium sulfate (Na2SO.i). 
Oxides consisting of a metallic element and oxygen are known as metallic 
oxides, and those that do not form acids with water, that cannot be obtained 
by removing water from acids, and that do not form salts by uniting with 
either basic or acidic oxides or with acids are known as neutral oxides. 
Oxides that combine with acids to form salts corresponding with oxides con- 
taining less oxygen than they do themselves are termed peroxides, as hydrogen 
dioxide (H2O2) and barium dioxide (Ba02). 
Elements whose oxides react with water to form bases are called metals 
and elements whose oxides react with water to form acids are called nonmetals. 
When substances react, heat is usually liberated and if this reaction becomes 
vigorous enough to produce light it is called combustion. As a rule this term 
is applied to a union of oxygen with other substances. The temperature at 
which a substance in contact with air bursts into flame is called its Mndling 
temperature. Reactions accompanied by heat are exothermic and those requir- 
ing the application of external heat to keep them going are endothermic. 
The unit of measure for heat is the calorie which is the amount of heat 
required to raise the temperature of 1 Gm. of water from zero to 1° C. The 
British thermal unit (B. T. U.) is the amount of heat required to raise the 
temperature of 1 pound of water 1° F. Since 1 pound contains 453 Gm. and 
1° F. is five-ninths of 1° C., the B. T. U.=% of 453 or 252 calories. The 
number of calories liberated when the formula weight (molecular weight in 694 
HANDBOOK OF THE HOSPITAL CORPS, XT. S. NAVY 
grams) of any pure substance burns completely is the heat of combustion. 
When a gram of substance oxidizes slowly it liberates the same amount of 
heat as when it burns violently. If the heat from a slow oxidation is not 
conducted away fast enough it accumulates, finally bringing the temperature 
of the substance to the ignition point. This is called spontaneous combustion. 
Oil-soaked rags are most likely to ignite spontaneously and should be disposed 
of or placed in closed tin cans. 
Isolation.—To obtain oxygen air is liquefied by pressure under reduced 
temperature and then allowed to evaporate. The more volatile nitrogen 
evaporates first and leaves the oxygen which is pumped into strong cylinders. 
Electrolysis of water releases oxygen and hydrogen at the anode and cathode 
electrodes respectively but this method is expensive. 
The heating of oxygen compounds is the most convenient laboratory 
method: 
2HgO + Heat -» 2Hg -f O2 T 
Mercuric oxide Mercury Oxygen 
2KN03 + Heat -» 2KN02 + O2 t 
Potassium nitrate Potassium nitrite Oxygen 
3MnOa + Heat —> Mn30* + 02 T 
Manganese dioxide Manganese oxide Oxygen 
2Ba02 + Heat -> 2BaO + 02 T 
Barium dioxide Barium monoxide Oxygen 
2KC103 + Heat -► 2KC1 + 302 T 
Potassium chlorate Potassium chloride Oxygen 
The last reaction shown is much more complete and rapid, even at a rela- 
tively low temperature, when a small amount of manganese dioxide is present. 
The manganese dioxide aids the reaction without entering into the chemical 
changes and is therefore a catalyst. The oxygen is collected by displacement 
of water in inverted containers. 
When an element exists in more than one form in the same physical state 
these forms are said to be allotropic modifications of the element, and the 
condition is known as allotropism. This condition is found in several of the 
elements, one of them being oxygen, the allotropic form of which is ozone, 
(Os), with distinct physical properties. 
Ozone is 1.5 times as heavy as oxygen and more active chemically. It is 
formed in the upper atmosphere by ultra-violet radiation. Static electrical 
discharges, lightning, static machines, and electric motors produce it from the 
oxygen of the air. The change from oxygen to ozone is represented thus: 
It has a characteristic pungent odor and is rather unstable, tend- 
ing to turn to oxygen. Its oxidation is done with the third atom releas- 
ing O2. Thus: H2S+O3—HI20+S+02. Formerly its chief use was as a bleaching 
agent and water purifier but now it has been largely replaced by chlorine. 
Produced electrically it is very effective as a deodorizing agent in homes, restau- 
rants and theatres. Ozone is claimed to be healthful and stimulating. 
Water, H20, is the most important of all chemical compounds. It occupies 
about five-sevenths of the earth’s surface as lakes, rivers, and oceans; as ice 
and snow it covers the vast arctic and antarctic regions. In addition to its 
abundant natural occurrence, water is present in green plants to the extent 
of 75 per cent to 80 per cent and in the soil from 5 per cent to 20 per cent. CHEMISTRY 
695 
It exists in considerable quantities in the atmosphere from which it is pre- 
cipitated in various forms. 
Pure water is an odorless and tasteless liquid. In small quantities it is 
colorless, but with an increase in depth it assumes a bluish-green color. When 
cooled, water contracts, reaching its maximum density at 4° C. at which temper- 
ature 1 cc has a weight of 1 Gm. At 0° C. it solidifies, forming ice. The 
freezing point may vary slightly under certain circumstances, but the melting 
point remains constant at 0° C. At 100° C. water boils, forming steam. These 
figures are determined at a pressure of 760 mm. of mercury. Water evaporates 
constantly and the higher the temperature, the faster the rate. Increased 
pressure and vapor tension reduce the rate of evaporation. 
If a little water or any other liquid is introduced into the vacuum of a 
mercury barometer, its molecules immediately begin to saturate the space with 
vapor, depressing the mercury column according to the temperature of the 
tube. If the height of the mercury column is subtracted from the true baro- 
metric reading, taken at the same temperature, the vapor tension of the liquid 
is obtained. At 0° C. water has a vapor tension of 4.6 mm. of mercury; at 
100° C. it has a vapor tension of 760 mm. of mercury; that is, the vapor tension 
equals the atmospheric pressure. When this condition prevails, the water 
boils because the molecules can escape freely from the liquid. The boiling 
point of a liquid is attained when its vapor tension just exceeds the pressure 
of the surrounding atmosphere. 
The importance of water is due largely to its capability of dissolving many 
substances, chemical reactions taking place readily in solutions of water. Many 
substances upon crystallizing from a solution, form molecular compounds 
containing water known as water of crystallization. The quantity of water 
taken up at a given temperature is always the same. In many instances the 
color of the salt is determined by the presence of this water of crystallization, 
as in copper sulfate, CuSCb.SIhO, which exhibits a blue color in the crystal- 
line form but becomes white upon the loss of its water of crystallization. 
Water of crystallization may usually be removed at from 100° O. to 105° C.; 
the substance then assumes its amorphous form. 
Water is composed of 2 parts of hydrogen and 1 part of oxygen. A mixture 
of these two gases, when ignited, explodes with violence to form water. By 
electrolysis water is resolved into these gases. The alkali metals and the 
alkaline-earth metals decompose water at ordinary temperatures while some 
of the other metals decompose it with the aid of heat. It combines with the 
oxides of some nonmetals to form acids. 
Water, as found in Nature, contains many inorganic and organic substances 
in solution. To obtain pure water these substances are removed by distillation. 
oxidation and eeduction.—When an element combines, with oxygen to form 
a compound it is said to be oxidized and the process or change which occurs 
is called oxidation. Compounds also may undergo oxidation when oxygen 
unites with one or more of the elements making up the compound. Oxidation 
usually is explained as being the addition of oxygen to an element or compound, 
the substance which furnishes the oxygen being termed the oxidizing agent, and 
the compound resulting from the combination with oxygen being called the 
product, an oxide of the element with which oxygen has combined. Examples 
of ordinary oxidation are: 
Substance Oxidizing agent Product 
2Mg + O 2 —♦ 2MgO 
Cr203 + KCIO3 -* 2Cr03+KCl 696 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
In a broad sense oxidation includes all chemical reactions, in many of which 
oxygen takes no part, which result in the addition of electro-negative elements 
or radicals to an element or compound, examples being: 
2FeCl2+Cl2-+2FeCl3; and 
4FeS04+2H2SOi-f 02 —>2Fe2 (SOi) s+2H20 
When oxygen is partially or entirely removed from a compound it is said to 
be reduced and the process or change which occurs is called reduction, being 
usually explained as the removal of oxygen from a compound. The substance 
which unites with oxygen to remove it from the compound is termed the 
reducing agent and the substance resulting from the removal is called the 
product. Examples of ordinary reduction are; 
Substance Reducing agent Product 
KN03 + Pb -» KN02 + Pb0 
Fe203 + H2 —> 2Fe0 + H20 
Reduction also may he explained as the partial or entire removal of electro 
negative elements or radicals from a compound, examples being: 
2FeCl3 + H2 -► 2FeCl2 + 2HCI 
Fe2(S04)3 + H2 2FeS04 + H2S04 
Hydrogen and the metals form the electro-positive part of compounds; and 
oxygen, the nonmetals and most radicals the negative part. To facilitate the 
understanding of oxidation and reduction equations it is necessary to consider 
the valences of the substances involved from the viewpoint of the electronic 
theory. To determine the valence of each individual element in a ternary 
compound it is necessary to consider the hypothesis that the total sum of their 
respective valences is zero, i. e., the total positive electrical charges are exactly 
equal to the total negative electrical charges and the compound is neutral or 
has a valence of zero. In the compound H2SO4, hydrogen, each atom of which 
has a valence of plus 1 (H+), has a total valence of plus 2 (H+ +), and oxygen, 
each atom of which has a valence of minus 2 (0~ ~), has a total valence of 
minus 8(0 ). As but 2 of the 8 negative valences of oxygen have 
been satisfied or neutralized by the 2 positive valences of hydrogen, and as the 
compound H2SO4 is considered neutral or to have a valence of zero, the sulfur 
in this compound must therefore have valence of plus 6 (S+ + + + + +). It is 
also considered that an element in an uncombined state has a valence of zero 
and it should be remembered that this consideration is not to be confused with 
the true valence of elements as regards their chemical affinity. 
By applying this theory to the oxidation of sulfur, S+02 —> SO2, it is found 
that the valence of the sulfur changes from zero to plus 4, while at the same 
time each oxygen atom changes from zero to minus 2. When the positive 
valence of an element is increased, that element is said to be oxidized. 
As an example of this principle the oxidation of hydrochloric acid by 
manganese dioxide may be taken: 
Mn02+4HCl-*Cl2+MnCl2+2H20 
Chlorine, when combined with hydrogen, has a valence of minus 1. Assuming 
the valence of chlorine is zero in an uncombined state, upon liberation it has 
become oxidized. In a similar fashion the valence of manganese in manganese 
dioxide, Mn02, which is the oxidizing agent, is plus 4, while in manganous chloride, 
MnCb, it is plus 2; during the reaction its valence has been reduced. Whenever 
an element loses positive valence it is said to be reduced. CHEMISTRY 
697 
This gives a broader conception of the terms “oxidation” and “reduction” 
and it will be found that this idea is a very convenient one to use. For 
example, in the oxidation of sulfur the valence of sulfur changes from zero to 
plus 4; therefore, it is oxidized; the valence of oxygen changes from zero to 
minus 2 so it is reduced. In the oxidation of hydrochloric acid the valence of 
chlorine changes from minus 1 to zero; hence, it is oxidized; the valence of 
manganese changes from plus 4 to plus 2, the element undergoing reduction. 
In the equations for these reactions both oxidation and reduction occur and 
in every case where one element undergoes oxidation some other element is 
reduced. In observing these two equations it will be noted that the gain and 
loss of valence are equal; one atom of sulfur gains 4 while each atom of 
oxygen loses 2. One atom of manganese loses 2 while each atom of chlorine 
gains 1. In every case of oxidation and reduction the total gain in valence is 
equal to the total loss. 
Balancing oxidation and reduction equations.—If the products of a reaction 
involving a change in valence are known, the coefficients required to balance an 
equation can be determined by the following rules: 
1. Write the reactants and their products, as determined by the simple rules 
discussed under hydrogen, in the form of an unbalanced equation. 
2. Select the elements which show a change of valence and indicate the 
valence of each atom above its symbol. 
3. Determine the gain and loss, and what coefficients are required to make 
the gain and loss equal. 
4. Use these coefficients in their proper places and complete the balancing. 
Usually it is best to leave hydrogen and oxygen until the last and if the quanti- 
ties of these elements check the equation is completely balanced. 
Hydrogen sulfide reacts with ferric chloride, reducing the iron to the fer- 
rous state with the liberation of sulfur and hydrochloric acid, the unbalanced 
equation being: FeCl3+H2S—>FeCl2+S+HCl. In changing valence each 
atom of iron loses 1 valence while each atom of sulfur gains 2; therefore, 
to balance the equation, there must be twice as many molecules of FeCU as there 
are of H>S. This leaves two atoms of hydrogen and two atoms of chlorine 
which unite to form 2 molecules of hydrochloric acid, and the balanced 
equation becomes: 
2FeCl3+H,S-»2FeCl*+S+2HCI 
Another example is the reaction between potassium permanganate and hydro- 
chloric acid, in which free chlorine is liberated. Potassium permanganate being 
the oxidizing agent it appears probable that the resulting products will be free 
chlorine, water, and a chloride of each of the two metals, potassium and 
manganese. The unbalanced equation in this reaction will then be: 
KMn04+HCl-»KCI+MnCl2+H20+Cl 
The elements in this equation which show a change of valence are manganese 
and chlorine. In the compound KMnO-i manganese has a valence of positive 7 
which, added to the valence of positive 1 of potassium, gives 8 positive valences 
to exactly balance the 8 negative valences of the 4 atoms of oxygen and make 
the compound neutral. As, in the compound MnCk manganese must have a 
valence of positive 2 to balance the valence of negative 2 of chlorine, it is evi- 
dent that manganese has lost 5 valences. In this reaction free chlorine is 
liberated as a gas. In this form chlorine can neutralize 2 positive valences 
and, although it is in an uncombined state, in order to work out the equation it is 698 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
considered as having a negative valence of 2, and therefore the chlorine liberated 
as a gas may be said to have gained 1 valence over what it had in the com- 
pound HC1. The valence of the chlorine in the chlorides of the metals remains 
unchanged and need not be considered. To balance this loss and gain of val- 
ences there must be 5 atoms of chlorine liberated for every molecule of KMnCh 
used, but as the free chlorine is expressed in its molecular form CL, to liberate 
5CL (10 atoms of chlorine) it will therefore be necessary to use 2 molecules of 
KMn04. Using 2 molecules of KMnCh increases the number of atoms of oxygen 
in the oxidizing agent from 4 to 8 which have 16 negative valences that will 
require 16 positive hydrogen valences for balancing. Consequently 16 molecules 
of the compound HC1 are needed to react with 2 molecules of the compound 
KMnOi and the left side of the equation becomes 2KMnC>4+16HCl. By work- 
ing out this part of the equation so that the products previously mentioned 
are represented in the other part it will be found that the complete equation 
for the reaction is: 
2KMn04+16HC1 —>.2KC1+2MnCl2+8H20+5C12 
and examination shows that each side of the equation balances the other. 
It might be thought that in this reaction free oxygen would escape but it 
does not for as fast as it is liberated it is used in oxidizing hydrochloric acid 
to form water and chlorine. 
Oxidation and reduction may take place simultaneously in a reaction, an 
example being in the preparation of sulfuric acid from sulfur and nitric acid, 
when sulfur is oxidized by the oxygen in nitric acid and the nitrogen in nitric 
acid is reduced to nitric oxide. The unbalanced equation of this reaction is: 
S+HN03->H2S04+N0 
In this equation sulfur, as an uneombined element, has a valence of zero 
while in the compound H2S04 it must have a positive valence of 6 as that 
is the number obtained by substracting the positive valence of 2 for hydrogen 
from the negative valence of 8 possessed by the 4 atoms of oxygen, and sulfur 
therefore has gained 6 valences. In the compound HN03 nitrogen must 
have a positive valence of 5 as that is the number obtained by subtracting 
the positive valence of 1 hydrogen from the negative valence of 6 possessed 
by the 3 atoms of oxygen, while in the compound NO it must have a positive 
valence of 2 to balance the negative valence of 2 of oxygen, and nitrogen 
therefore has lost 3 valences. Consequently, to balance the gain and loss of 
valences, there is required twice as much nitrogen as sulfur, and the balanced 
equation therefore is: 
S+2HNOs H.S04+2N0 
It must always be remembered that oxidation and reduction bring about 
changes of valence and that oxidation leads to an increase and reduction to 
a decrease of positive valence. 
The Sulfur Family.—The elements usually considered as members of this 
family are sulfur, selenium and tellurium, between which there is such close 
family resemblance that only sulfur will be discussed with any detail. Ref- 
erence to the Periodic Table will show that with these elements in Group VI 
is the element oxygen from which it naturally would be expected that they 
all exhibit certain similarities in properties and might be considered as the 
oxygen family of elements. Certain properties of all are similar but others 
are in reverse order, and it is therefore customary to study oxygen singly 
and the others as the sulfur family. CHEMISTRY 
699 
sulfur.—Symbol: S; Atomic number: 16; Atomic weight: 32.06; Valence: 
II, IV, VI; Molecular formula: Ss, Sa, Sa, or S, depending upon temperature, 
Ss or S being used most commonly. 
Occurrence.—Sulfur is the “brimstone” of the Bible and is found uncombined 
in nearly all volcanic regions. Sicily and Louisiana are the chief commercial 
sources. In the combined state, sulfur is found in many mineral ores, especially 
as glcmce (mineral sulfides), and traces of it are found in the cells of animal 
and plant life. During the process of decay or disintegration this organically 
combined sulfur is liberated in the form of volatile compounds, especially 
hydrogen sulfide, which account for their permeating, offensive odor. 
Properties.—Sulfur is a pale yellow, tasteless and nearly odorless substance, 
insoluble in water. It may exist in several allotropic modifications depend- 
ing upon the temperature and physical forces to which it is subjected. These 
forms are crystalline, amorphous, and liquid. At ordinary temperatures sulfur 
is relatively inactive, but upon the application of heat it combines with nearly 
all the metals to form sulfides. Many nonmentals combine with sulfur, as 
chlorine, bromine, hydrogen, etc. Sulfur burns with a pale bluish flame and 
when heated with oxidizing reagents, it is converted into sulfuric acid. Caustic 
alkalies dissolve it to form a mixture of alkali sulfides and thiosulfate. 
Sulfur is used in large quantities for the preparation of sulfuric acid, sulfur 
dioxide for bleaching purposes, and vulcanized rubber. In medicine it is used 
externally and to some extent internally. Sulfur is obtained from its ores 
by melting, and from subterranean deposits by the application of hot water 
and air under pressure. Purification of the impure sulfur is carried out by 
sublimation. 
Hydrogen sulfide, H2S, is a heavy, colorless gas with a nauseating odor re- 
sembling that of rotten eggs. It is poisonous, and prolonged inhalation of 
its fumes will cause distressing symptoms and even death in dilutions as 
weak as 1 to 200. It is a powerful reducing agent and is extensively employed 
in chemical analysis to precipitate many metals from their salts as sulfides: 
PbO + H2S—>PbS J, +H20 
This gas is extremely inflammable and burns with a pale blue flame. The 
products of its combustion are water and sulfur dioxide, or sulfur, if combus- 
tion is rapid. In aqueous solution it undergoes slow oxidation from contact 
with air, sulfur being precipitated. Boiled (air free) water should be used 
in preparing its solution, which is to be kept in well-closed containers away 
from light. It is decomposed by many oxidizing agents. Chlorine, bromine, 
and iodine combine readily with its hydrogen, precipitating sulfur: 
H2S+CI2—>2HC1+S I 
When solutions of metallic salts are treated with hydrogen sulfide various 
metallic sulfides of characteristic color and solubility are formed. These 
sulfides are divided into two large groups: 
1. Sulfides insoluble in dilute acid (CuS, HgS, As2S3, etc.); 
2. Sulfides insoluble in neutral or alkaline solutions, but soluble in dilute 
acids (NiS, MnS, ZnS, etc.). 
By application of these factors (solution or precipitation with an acid or 
base) and separation by filtration, the sulfides of most metals can be isolated, 
then identified, and their percentage estimated. This method is useful in 
detecting lead in the urine, and arsenic or mercury in the stomach, liver, and 
kidneys. 
154294 °—39 45 700 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
Hydrogen sulfide is formed when a stream of hydrogen is passed over boiling 
sulfur. In the laboratory it is prepared by the action of hydrochloric acid 
upon a metallic sulfide in the presence of water: 
FeS+2HCl-»FeCl2+H2S f 
A generator similar to the one illustrated in figure 152 may be satisfactorily 
used. In the generator (A) is placed some ferrous sulfide covered with water 
and to it from time to time is added hydrochloric acid, sufficient to keep up 
evolution of the gas. The gas is readily evolved without the application of 
heat, and may be used directly or passed through a wash-bottle. 
Sulfur dioxide, SCh, is a colorless gas with a peculiar suffocating odor; it is 
easily liquefied at ordinary temperatures. It is a strong reducing agent, 
weakly acid in aqueous solution, and reacts with water to form sulfurous acid: 
SO2 H2O H2SO3 
It also reacts with hydrogen sulfide, oxygen, and chlorine. Sulfur dioxide is 
the gas used in many mechanical refrigerators; sulfuric acid is manufactured 
from it, and it is employed as a bleaching and fumigating agent. It may be 
prepared by burning sulfur or metallic sulfides. 
Sulfuric acid, ELSCh, is an oily, colorless liquid with a density of 1.838 at 
15° C. It mixes in all proportions with water, evolving much heat, and 
therefore should always be poured slowly into water to avoid spattering. 
Sulfuric acid is a powerful oxidizing and dehydrating agent, charring dry wood, 
sugar, and other organic substances. It combines with nearly all the metals 
to form sulfates; 
It is prepared on a commercial scale by two processes: 
1. The Lead Chamber Process in which sulfur dioxide mixed with air is 
oxidized to sulfur trioxide (S03) by nitric acid vapors in a lead lined chamber, 
enough water being present to form sulfuric acid: 
Cu+ILSO.—»CuS04+H2 T 
2S0a+2HN0s+H20-*2H2S(X+N0+N0: 
2. The Contact Process in which sulfur dioxide mixed with air is passed 
over a catalyst, such as finely divided platinum or ferric oxide, at 400° C. and 
oxidized to sulfur trioxide. The sulfur trioxide is allowed to bubble through 
a mixture of sulfuric acid and water where it combines with the water to 
form more sulfuric acid: 
SOs+HaO—>H2SC)4 
Sulfuric acid is used in the manufacture of nitro-glycerin, smokeless powder, 
hydrochloric acid from sodium chloride and nitric acid from sodium nitrate. 
selenium and tellurium, as well as their compounds, are very similar to 
sulfur and its compounds. Selenium is valuable chiefly because its electrical 
conductivity is greatly increased while exposed to light, making it useful in 
many automatic devices which are controlled by light; its molecular formula 
is Ses. 
Tub Niteogen Family.—This family consists of nitrogen, phosphorus, arsenic, 
antimony, and bismuth. These elements show a graded difference in their 
physical and chemical properties. The difference is more pronounced between 
these elements than those of the halogen group. In their chemical properties 
the nonmetallic properties gradually give way to the metallic with increase in 
atomic weight. CHEMISTRY 
701 
nitrogen.—Symbol: N; Atomic number: 7; Atomic weight: 14.008; Valence: 
III, V; Molecular formula: N*. 
Occurrence.—In the free state nitrogen constitutes about % of the atmosphere. 
It is found in large quantities combined with sodium and oxygen in Chili 
saltpetre. Combined with hydrogen in the form of ammonia, it is a by-product 
of the destructive distillation of coal. Animal and vegetable substances contain 
nitrogen which is given off as ammonia during the process of decomposition. 
Properties.—Nitrogen is a colorless, odorless, and tasteless gas. It is neither 
combustible nor capable of supporting combustion. In the free state it is 
inactive, but nearly all nitrogen compounds are very active, the alkaloids and 
cyanides being quite toxic to animal tissues. The preparation of its compounds 
is almost always performed by indirect means. 
Isolation.—Nitrogen may be prepared by removing the oxygen from the 
air, or by chemical means through the reaction of potassium dichromate on 
ammonium chloride: 
K2Cr20r+2NH4CI-*Cr203+2KCl+4H20+N2 
Ammonia, NIL, is a colorless gas with a pungent suffocating odor and caustic 
taste, quite soluble in water. It is alkaline to litmus and combines with acids 
to form ammonium salts. The formula NIL (ammonium) represents a hypo- 
thetical compound that has many properties in common with potassium and 
sodium. Ammonia gas, NIL, combines with water to form a weak hydroxide, 
NELOH, the equation being: NEL-f-ELO—>NELOH. Ammonia is used chiefly 
in mechanical refrigeration and in the production of nitric acid. In dilute 
aqueous solutions it is an effective cleaning fluid. 
Nitrous oxide, N20, is a colorless gas with a faint peculiar odor and sweetish 
taste. It supports the combustion of many substances almost as actively as 
oxygen. A mixture of nitrous oxide and hydrogen explodes with violence when 
ignited. This gas is used extensively in minor surgery and dentistry when a 
short anaesthesia is desired. The anaesthetic effect is controlled by inhalation 
of the gas mixed with oxygen. Aside from its anaesthetic effect, it is physio- 
logically inert. The usual method of preparation is by heating ammonium 
nitrate at a temperature of below 250° C., decomposing it into nitrous oxide 
and water: 
NH4N0s+Heat-»N20+2H20 
Nitric oxide, NO, is a colorless gas which produces reddish colored fumes 
upon contact with the oxygen in the air, forming nitrogen dioxide; 
2NO+02—>2NOa 
Nitric oxide will not burn, but supports combustion at high temperatures. It 
is used in the manufacture of nitric acid, and sulfuric acid by the Lead 
Chamber Process. 
Nitric acid (aqua fortis), HNOa, is not found in Nature in the free state, 
but the nitrate radical (NOs) in nitric acid, is found combined with potas- 
sium, sodium, calcium, and magnesium in the nitrates of those elements, the 
largest known deposits of nitrates being the sodium nitrate beds of the rain- 
less districts on the coast of Chile. Nitric acid is a colorless, fum/ing, very 
corrosive liquid. When exposed to light it assumes a yellow to orange color 
due to slight decomposition, with the formation of nitrogen dioxide (NCh). 
Due to its unstable character nitric acid acts as a powerful oxidizing agent. 
Through action that occurs within itself nitric acid frequently is reduced, 
forming the lower nitrogen oxides NO, N2O3, and N02. As a result of such 
energetic properties, it dissolves nearly all the metals, with the exception of 702 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
gold and platinum, forming nitrates, or converting them into acids and in- 
soluble oxides according to their nature: 
Due to the oxidizing action of nitric acid upon hydrochloric acid, chlorine is 
liberated in its most active (nascent) form. This atomic chlorine reacts 
vigorously with metals and is useful in combining with those metals which 
are below hydrogen in the Electrochemical Series, especially gold and plat- 
inum. Such a mixture, containing 1 part of nitric acid to 3 parts of hydrochloric 
acid, is known as nitrohydrochloric acid (aqua regia). 
Many organic substances, such as turpentine, burst into flame upon contact 
with nitric acid, while others merely turn yellow. Substances like cotton, 
benzene and glycerin undergo a process of nitration when treated with the 
concentrated acid (nitro-cellulose, nitro-benzene, nitro-glycerin). 
In dealing with nitric acid it must be clearly remembered that it has two 
actions, that of an acid and that of an oxidizing agent. 
Nitric acid containing nitrogen tetroxide, which imparts an orange color 
to the liquid, is known as fuming nitric acid. This substance is prepared 
by the addition of paraformaldehyde or a little starch to the colorless acid 
and heating the solution. This form of nitric acid is more energetic in its 
oxidizing power than the colorless variety. 
Nitric acid has extensive commercial applications, being employed in the 
manufacture of sulfuric acid, explosives, artificial silks, and many other 
important commodities. It is used as a solvent in the refining of precious 
metals. 
Nitric acid is produced from sodium and potassium nitrate by heating them 
in a retort with sulfuric acid; 
3Hg+8HNOs-»3Hg (N03) 2+4H20+2N0 
The nitric acid distills over, is concentrated, and then purified. 
Nitrates are monobasic salts prepared by dissolving a metal or its oxide in 
nitric acid. Nearly all the nitrates are soluble in water with the exception 
of a few basic salts. The alkali nitrates are employed in dry oxidation. 
phosphorus.—Symbol: P ; Atomic number: 15; Atomic weight; 31.02; Valence: 
III, V; Molecular formula : P4. 
Occurrence.—Phosphorus is never found in the free state, but chiefly as 
tri-calcium phosphate, which is the principal constituent of bones as well as 
of the minerals, apatite, CaFs.SCasCPChh and phosphorite, CastPChh. Both 
of these minerals are used extensively in commercial fertilizers. Phosphorus is 
also found distributed in comparatively small quantities in plant and animal 
tissues, in the soil and in sea-water. 
Properties.—Phosphorus exists in several allotropic forms, yellow and red 
phosphorus being the most important. The yellow variety is a translucent, 
wax-like solid which is soft enough to be cut with a knife at ordinary tem- 
peratures. It is insoluble in water but extremely soluble in carbon disulfide, 
1 Gm. dissolving in 0.9 cc. In handling, phosphorus must be kept under water 
because it is a very inflammable substance, igniting spontaneously in the air 
at 40° C. The phosphorescence visible in the dark upon exposure to air, 
appears to be due to slow oxidation. 
Yellow phosphorus possesses a great affinity toward many elements, uniting 
directly with nearly all except nitrogen, the inert gases, carbon and the noble 
metals. With bromine and sulfur it reacts violently. Due to its great affinity 
for oxygen it is a powerful reducing agent. It decomposes nitric acid with 
H2S04+2NaN0s->Na3S04+2HN0s. CHEMISTRY 
703 
explosive violence, and reduces salts of some metals, as mercury, gold and 
copper, to metals and phosphides. 
Red, or amorphous phosphorus, an allotropic form, possesses essentially 
different properties from the yellow variety, being a dark red to yellowish 
brown, inodorous powder which is insoluble in carbon disulfide and all other 
solvents. It does not phosphoresce and is stable in air. Red phosphorus is 
prepared by heating the yellow variety to 300° C. in airtight chambers. After 
the conversion, the resulting product is treated with carbon disulfide to remove 
any remnants of yellow phosphorus. The chief use of this variety is in the 
manufacture of safety matches. It is also extensively employed in organic 
synthesis. 
The red variety is not poisonous, whereas the yellow variety produces burn- 
ing in the stomach, vomiting and convulsions. The inhalation of the vapors, 
for any length of time, causes necrosis of the bones and liver. 
Isolation.—Phosphorus is obtained from bone ash by treatment with silica 
and coke in the “continuous acting” electric furnace process: 
2Ca3(PO4)2+6SiO2+10C-»P4+6CaSiO3+10CO T 
Phosphorus combines readily with the halogens to form compounds of the 
types Pi?3 and PR-,, R representing any of these elements. 
Four oxides and eight acids of phosphorus are known: 
are known : 
Oxides 
Acids 
Phosphorus protoxide 
P20 
Hypophosphorous acid _ 
Phosphorus trioxide 
PiOfl 
Orthophosphorus acid __ .. 
Phosphorus tetroxide 
P2O4 
Metaphosphorous acid... 
HPO2 
Phosphorus pentoxide 
P2O5 
Orthophosphoric acid 
Metaphosphoric acid 
Pyrophosphorous acid 
Pyrophosphoric acid 
Hypophosphoric acid 
HPO? 
—H4P2O5 
H4P2O8 
The meta- and pyro-phosphoric acids are anhydrides of orthophosphoric acid 
and may be considered derivatives of phosphoric oxide plus varying amounts 
of water: 
P2O5+H2O—>2HP03 
P2O5+2H2O—>H4P207 
P205+3H20->2HsP04 
Phosphorus Pentoxide, Pa0B, is a bulky, white, amorphous, or crystalline 
powder, prepared by burning phosphorus in iron cylinders supplied with a cur- 
rent of dry air and purified by subsequent sublimation in a current of oxygen 
to free it from ous oxides. Phosphorus pentoxide has a powerful affinity for 
water, producing a hissing sound when thrown into it. Because of this property 
it is used as a desiccating agent, especially for drying gases. 
Orthophosphoric acid (anhydrous), H3PO4, occurs in rhombic prisms which, 
on exposure to moist air or upon addition to water, deliquesce to a thick syrupy 
liquid. The Acid Phosphoricum, U. S. P., contains not less than 85 per cent, nor 
more than 88 per cent of HsPCh. 
When heated from 200° C. to 215° 0., orthophosphoric acid is gradually con- 
verted into pyrophosphoric acid H4P2O7. When heated above 400° C. it is com- 
pletely converted into metaphosphoric acid, HPOa. 704 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
This acid forms 3 classes of salts depending upon the number of hydrogen 
atoms replaced by a metal: 
Primary phosphate NaHaPCh 
Secondary phosphate Na2HPOi 
Tertiary phosphate NasPCh 
Arsenic.—Symbol: As; Atomic number : 33; Atomic weight: 74.91; Valence: 
III, V; Molecular formula : As4. 
Occurrence.—Arsenic is widely distributed in nature. In the free state it is 
usually found in crystals, while in the combined state it is abundantly distrib- 
uted as sulfides or metallic arsenides. Small quantities of arsenic are found 
in many mineral waters and in sea-water. 
Properties.—Arsenic usually occurs in the form of a steel-gray, brittle, crystal- 
line mass. It exhibits two allotropic modifications, crystalline and amorphous. 
The latter form is black and when heated to 360° C. reverts to the crystalline 
form. 
Isolation.—Arsenic is obtained by heating arsenical pyrites out of contact 
with air. The arsenic sublimes, leaving the iron as a sulfide. 
Arsenic forms compounds analogous to those of nitrogen and phosphorus, 
arsenic trioxide being one of the most important. 
Arsenic trioxide, or arsenious oxide, AS2O3, is a white amorphous or crystalline 
powder having three allotropic forms, each variety depending upon its crystal 
formation. It is readily oxidized to arsenic oxide, hence, it is employed as a 
reducing agent. With the alkali hydroxides it readily forms salts. 
Arsenic trioxide is a powerful irritant poison, the antidote being the Magma 
Ferri Hydroxidi of the U. S. P. which acts as a colloid, absorbing the arsenic 
and rendering it innocuous. 
In small doses arsenic trioxide and other arsenical compounds are widely 
employed in medicine. It is also used in the preparation of dyes. 
Antimony.—Symbol: Sb; Atomic number: 51; Atomic weight: 121.76; 
Valence: III, V. 
Occurrence.—The chief source of antimony is the antimony glance or stibnite, 
Sb2S3. Native antimony is usually accompanied by arsenic. 
Properties.—Antimony is a silver-white, lustrous metal, more basic than 
arsenic, but less so than bismuth. It possesses both metallic and nonmetallic 
properties, combining with oxygen and the halogens. Strong nitric acid and 
sulfuric acid react with it to form the nitrate and sulfate, but with dilute acids 
no reaction occurs. In combination with other metals it composes some of the 
more common alloys. Aside from the fact that some of its compounds, which 
are similar to those of arsenic, are used in medicine, they have very little 
practical value. 
bismuth.—Symbol: Bi; Atomic number; 83; Atomic weight: 209.00; Valence: 
III, V. 
Occurrence.—The commercial sources of bismuth are not numerous. Both 
the metal and its ores are generally disseminated through rock. Bolivia is now 
the chief source of supply. 
Properties.—Bismuth is a hard, brittle, lustrous, white metal of crystalline 
structure, being isomorphous with arsenic and antimony. It is chemically 
inactive at ordinary temperatures, but at elevated temperatures it is converted 
into the oxide: 
4FeAsS+Heat—>As4+4FeS 
4Bi+302—>2BiaOa CHEMISTRY 
705 
It is acted upon by hot nitric and sulfuric acids. Combination with the halogens 
takes place slowly. 
The insoluble salts are employed in medicine, while metallic bismuth is a 
valuable constituent of various alloys. Both bismuth and arsenic are extensively 
used as spirochseticidal agents in the treatment of syphilis. 
Carbon and Silicon.'—These are the first two elements in Group IV of the 
Periodic Table and are the only ones of the two families in this group that 
will be here discussed. 
Carbon is the essential element in the organic world and it has far more 
compounds than any other element due to the fact that its atoms possess the 
power of combining with each other and thus forming compounds that are 
very complex in character. The organic compounds of carbon possess certain 
well-defined characteristics, thousands of them are known, and many can be 
prepared by synthesis from the elements. So numerous are the compounds of 
carbon that most of them are considered and studied as a special branch of 
the science of chemistry known as organic chemistry, which later will be 
briefly discussed. 
Silicon occupies in the mineral or inorganic world the same position that 
carbon does in the organic, and is considered as the most important element 
in that world. 
carbon.—Symbol: C: Atomic number: G; Atomic weight: 12.01; Valence: IV. 
Occurrence.—Carbon occurs in Nature in three allotropic forms, two of which 
are crystalline and the third amorphous. The two crystalline forms are the 
diamond and graphite. Amorphous carbon occurs naturally in the various 
forms of coal and many amorphous forms may be prepared, as coke, charcoal, 
boneblack, lampblack, and soot. Combined with hydrogen and other elements 
it comprises all organic material and their by-products. Carbon and its com- 
pounds are found widely distributed in the Earth as coal and oil. 
Properties.—Carbon is an odorless, tasteless, black solid except in the diamond 
where it is colorless. Different forms vary in hardness and electrical con- 
ductivity, intense heat converting them all to the graphite modification. It 
has great absorbing powers which are employed in the refining of sugar and 
the construction of gas masks. 
Carbon when heated unites readily with oxygen, hydrogen and some of the 
metals. As coke it is a reducing agent used in blast furnaces. It is an 
amphoteric element exhibiting both metallic and nonmetallic properties. Car- 
bon stands alone among the elements in that it is capable of combining with 
itself to form long chains of carbon atoms. Silicon possesses this property to 
some degree but the length of the chain is limited. 
Carlon dioxide, CO2 is a colorless, odorless, heavy gas, soluble in an equal 
volume of water at 15° C. but much more so under pressure. It is a product 
of the oxidation of all organic matter, being formed in both combustion and 
decay, and of many fermentation processes, and is exhaled from the lungs 
of all animals in respiration. It will not support combustion nor is it com- 
bustible. Metallic oxides unite with it to form carbonates: 
Carbon dioxide reacts with water to form the hypothetical carbonic acid 
(H2O+CC; which has never been isolated because upon liberation 
it immediately reverts to carbon dioxide and water. In solution, it reacts 
with bases to produce carbonates, or bicarbonates if an excess of acid is 
present. Carbon dioxide is used in fire extinguishers, leavening agents, and 
in the manufacture of carbonated beverages. 
CaO-j-CO*—>CaC03 706 
HANDBOOK OP THE HOSPITAL CORPS, U. S. NAVY 
Carbon monoxide, CO, is a colorless, poisonous, almost odorless gas formed 
from the incomplete combustion of carbon, 2C+02—>2CO. It escapes from 
stoves too closely damped, kerosene heaters, automobile exhausts, and is 
a constituent of illuminating gas. Dilutions of 1 in 800 are fatal if breathed 
for one-half hour. It is a good reducing agent, extracting oxygen from hot 
metallic oxides. 
Phosgene, COCh, is a gas used in chemical warfare. 
Carbon tetrachloride, CC14, is valuable as a solvent and fire extinguisher. 
Carbon disulfide, CS2, is a highly inflammable liquid and is of value as a 
solvent of rubber, sulfur and other substances. It is also an efficient exterm- 
inator of vermin. 
Cyanogen, C2N2, is a very poisonous gas from which is derived hydrocyanic 
acid, HCN (“prussic acid”), a colorless, extremely poisonous, volatile liquid 
characterized by its almond-like odor. Hydrocyanic acid reacts with most of 
the metals to form cyanides and cyanates. It is used in the fumigation of 
ships. 
silicon.—Symbol: Si; Atomic number : 14 ; Atomic weight: 28.06; Valence: 
IV. 
Occurrence.—Silicon does not occur in the free state, is not found in the 
air either as an element or a compound, and is not present to any consider- 
able extent in water. Except for oxygen, it is the commonest element, com- 
posing one-fourth of the Earth’s crust. It is found in quartz, sand, and 
sandstone. Clay and all common rocks, except limestone and dolomite, are 
silicates. 
Properties.—Silicon occurs in two allotropic forms, amorphous silicon which 
is a brown powder, and crystalline silicon which is obtained as hard, black, 
hexagonal crystals. It burns in oxygen and combines with the halogens at 
suitable temperatures to form gases. It is insoluble in acids, but dissolves 
readily in sodium hydroxide, displacing hydrogen from the solution: 
Silicon is capable of uniting with itself in a manner similar to that of the 
carbon atoms, but whereas the carbon atom is capable of building an almost 
limitless number of complex molecules, the limit of stability for the silicon 
chain is SioHu. It is of importance in the manufacture of glass. The element 
is isolated by reducing the oxide with powdered magnesium or aluminum: 
4NaOH+Si—>Na4SiO*+2H2 
Si02+2Mg—»2MgO+Si, or 
3Si02+4AI-»3Si+2Al203 
The metals. 
The Alkali Metals.—The elements of the alkali group constitute a family 
in Group I of the Periodic Table and have a valence of I. They are called 
alkali metals because the most familiar members of the family, sodium and 
potassium, are found in compounds that have long been known as alkalis. 
The members of this family possess certain properties in common in that 
they are light, soft metals with a low melting point, silvery-white in appear- 
ance, and of a bright metallic luster when pure. They oxidize in air and 
energetically decompose water, with the evolution of hydrogen, to form hydrox- 
ides of a strong alkaline reaction. They occupy places near the top of the 
electrochemical series which shows they are very active metals, do not occur 
free in Nature, and their compounds with very few exceptions, are white solids 
soluble in water. Sodium and potassium are the most important members 
of the family. CHEMISTRY 
707 
sodium.—Symbol: Na ; Atomic number: 11; Atomic weight: 22.997; Valence: I. 
Occurrence.—Sodium, like all other alkali metals, is not found in Nature in 
the free state but in combination with other elements in which form it is 
widely distributed throughout the world. Combined with chlorine it forms 
the salt of sea-water and rock-salt mines. 
Properties.—Sodium is a silvery-white metal of waxy consistency at ordinary 
temperatures prepared in various ways. It decomposes water, reacts with 
acids forming the corresponding salts and liberating hydrogen, and combines 
directly with the halogens: 
and has a great affinity for oxygen : 
2Na+Cl2—>2NaCl 
2Na+0_. —♦ N a20. 
It is a good reducing agent, displacing hydrogen from water and alcohol: 
2Na+2H20—»2NaOH+H2 
When heated in the Bunsen flame it, as well as most of its compounds, volatil- 
izes and colors the flame yellow. 
Sodium and its compounds are of great importance. 
Isolation.—Sodium is isolated by the electrolysis of fused sodium hydroxide 
in Castner cells. 
Sodium chloride, NaCl, is found in rock-salt deposits, salt lakes, and sea- 
water. It occurs as transparent cubical crystals and as a white crystalline 
powder. When calcium or magnesium is present it is more or less hygroscopic, 
but in the pure state it does not possess this property. It is used in the prepa- 
ration of other sodium compounds and reacts with nonvolatile acids to form 
hydrochloric acid: 
NaCl+H2S04 NaHS04+HC1 
It is the principal condiment used for seasoning food and also acts as a food 
preservative. Mined in the comparatively pure state it is sent into commerce 
without further purification. Large quantities are obtained from the evapora- 
tion of sea-water. 
Sodium hydroxide, NaOH, is a white, solid, hard mass that is deliquescent 
in the presence of moist air. It is extremely basic to indicators and is a 
strong caustic. It has many uses, being employed in large quantities in the 
manufacture of soap and in the neutralization of acids to form their sodium 
salts. It may be prepared by the electrolysis of sodium chloride. 
Sodium bicarbonate, NaHCOs, is a white opaque powder, permanent in air 
under ordinary circumstances but decomposing slowly in moist air. It has a 
mild alkaline reaction which increases upon long standing due to the loss of 
carbon dioxide and subsequent formation of sodium carbonate. It is the main 
constituent of most baking powders and has considerable use in the textile 
industry. In medicine it is used as an antacid. Nearly all the sodium bicar- 
bonate of commerce is prepared by the Solvay Process which is known as the 
ammonia-soda process, the reaction being: 
Sodium carbonate, Na2COs, closely resembles sodium bicarbonate except that 
its alkaline reaction is stronger due to its greater hydrolysis in water. 
It is prepared by heating sodium bicarbonate: 
NaCl+NH3+C02+H20^NaHC03+NH4Cl 
2NaHCa+Heat-»Na!!C03+C02+Ha0 708 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
potassium, lithium, eubidium, and cusiuM are similar to sodium in their 
properties. 
The Alkaline Earth Metals.—The metals of this group are grayish-white 
in color, of a bright metallic luster, malleable and ductile. They belong to 
Group II of the Periodic Table, have a valence of II, are very active, tarnish 
quickly in air, and react with water to form hydroxides, with hydrogen 
being liberated. The halogens and nitrogen combine with them directly. The 
hydroxides of these metals increase in solubility with the increase in atomic 
weight of the metals; the sulfates decrease in solubility with the increase in 
atomic weight. 
magnesium.—Symbol; Mg; Atomic number: 12; Atomic weight: 24.32; 
Valence: II. 
Occurrence.—This element is not found in the uncombined state in Nature, 
however, its compounds are widely distributed. 
Properties.—'Magnesium is a silvery-white, highly lustrous metal. It is stable 
in dry air but in the presence of moisture gradually becomes covered with a 
film of magnesium oxide. Heated in air it ignites and burns with a blinding 
white light which is especially rich in actinic rays. It is employed in photog- 
raphy as a flashlight powder, and in the manufacture of fireworks and light- 
weight alloys. It decomposes slightly at 100° C. or over in air with the 
formation of magnesium oxide (MgO) and some magnesium nitride (Mg3N2). 
Isolation.—Magnesium is isolated by the electrolysis of the fused double 
chloride, MgCl2.KCl.6H2O (carnallite). 
Magnesium chloride, MgCl2, is found in sea water and certain salt deposits. 
It is very deliquescent in air. 
Magnesium sulfate, MgSCb, is found along with the chloride in salt deposits; 
the hydrate, MgS04.7H20, is known as Epsom Salts. 
calcium.—Symbol: Ca; Atomic number: 20; Atomic weight: 40.08; Va- 
lence: II. 
Occurrence.—The compounds of calcium are widely distributed in Nature, 
the carbonate being the most abundant. 
Properties.—Calcium is a tough and malleable silvery-white metal with a 
bright luster. It resists oxidation in dry air, but in the presence of moisture 
it quickly becomes covered with the hydroxide which gradually extends 
throughout the whole mass. It is very active chemically and at high tempera- 
tures burns with a brilliant white light. 
Isolation.—Calcium is isolated by the electrolysis of the fused chloride. 
Calcium carbonate, CaC03, is found as limestone, marble, and chalk. It is 
a white transparent solid insoluble in water, but dissolved by most acids with 
the liberation of CO2. It is used in the building industries as stone, mortar, 
plaster, etc. 
Calcium oxide, CaO, (lime) is prepared by heating calcium carbonate: 
CaCOs+Heat—>Ca0+C02 
It is a white solid which reacts with water, forming calcium, hydroxide and 
producing considerable heat: 
CaO+H.O—>Ca (OH) 2 
beryllium, strontium, and barium are elements somewhat similar in their 
properties to magnesium and calcium. 
Boron and Aluminum.—Boron and aluminum are the first two elements of 
Group III in the Periodic Table. None of the other elements in this group are 
abundant or well known. Boron is a nonmetal; aluminum is a metal. A 
valence of III is shown by both elements in all their compounds. CHEMISTRY 
709 
Boron more closely resembles silicon than aluminum in its properties. 
boron.—Symbol: B; Atomic number; 5; Atomic weight: 10.82; Valence: III. 
Occurrence.—Boron does not occur in the free state but is found combined 
with oxygen and hydrogen as boric acid and sodium borate, or borax, deposits 
of the latter being located in California and Nevada in the United States and 
in Peru and Chile, South America. 
Properties.—Boron is an amorphous powder which can be fused to a very 
hard and brittle mass. It combines slowly with oxygen at 100° C. and at 
high temperatures bums with a green flame: 
The halogens combine with it at high temperatures; nitric acid oxidizes it to 
boric acid, and the metals combine with it to form borides. There are no 
important uses of boron. 
Isolationj—Boron is Isolated by heating boric trioxide with magnesium to 
redness. The resultant mass is treated with hydrochloric acid and alkalies. 
Boric acid, H3BO3, occurs in certain volcanic districts, especially in Tuscany 
where it is obtained by condensing the vapors of hot springs. It may be pre- 
pared by treating borax (Na2B4Or.l0H2O) with an acid. It is sparingly soluble 
in water and has weak acidic properties. Its main use is as a mild antiseptic. 
aluminum.—Symbol: A1; Atomic number : 13; Atomic weight: 26.97; Valence; 
III. 
Occurrence.—Aluminum composes 7 per cent of the Earth’s crust, being the 
most abundant metal. Due to its chemical activity it is never found in the 
free state. 
Properties.—It is a bluish-white metal of high luster, somewhat malleable 
and ductile. Water does not act upon it at any temperature. It combines 
with many of the nonmetals, especially the halogens, and with members of the 
sulfur family. It reacts with acids: 
•lB+302—»2B20s 
and soluble bases 
2A1+6HC1—> 2 A1C13+3H3, 
2Al-j-6NaOH—^NasAlOs+SHa 
In oxygen it burns with a brilliant light and is used in the manufacture of 
flashlight bulbs. Most cooking utensils are now made of aluminum. Light- 
weight alloys are also largely aluminum. 
Isolation.—Aluminum is isolated by the electrolysis of bauxite, molten cryolite 
being used as the solvent. 
Aluminum oxide, AhOs, is found in Nature as corundum, and in the finer 
crystals as ruby and sapphire, colored red or blue, due to traces of metallic 
oxides. 
Rare Earths.—These elements are trivalent and when oxidized are of the 
general formula Rf)s. The hydroxides are white amorphous precipitates which 
do not dissolve in alkali hydroxides. With alkali sulfates they form double 
salts. 
Copper.—Symbol: Cu; Atomic number: 29; Atomic weight, 63.57; Valence: 
I, II. 
Occurrence.—Metallic copper is found in the free state and in combination 
with other elements. It is obtained from its ores by smelting. 
Properties.—Copper is a lustrous, malleable, and ductile metal with a peculiar 
reddish color. Next to silver it is the best conductor of electric current and 
its most important use is as “electric wire”. It forms two series of com- 
pounds, those in which the valence is I (cuprows), and those in which the 
valence is II (cupric). 710 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Copper sulfate, CuSCh, is prepared by the action of sulfuric acid on copper. 
The crystalline form has a bluish color. When the crystals are heated they 
lose their color and become a white, amorphous powder which reverts to the 
blue crystalline form upon the readdition of water. It is used in copper refining, 
electroplating and calico printing. It is occasionally used in lakes and reservoirs 
to kill organisms such as algae. 
Zinc.—Symbol: Zn; Atomic number: 30; Atomic weight: 65.38; Valence: II. 
Occurrence.—Zinc occurs chiefly as a sulfide or zinc blende, and as a car- 
bonate. The pure metal is obtained by roasting and refining. 
Properties.—Zinc is a bluish-white metal, malleable and ductile between 
100° C. and 150° C. and is used in the manufacture of galvanized iron, bronze, 
brass,' German silver, and other alloys. Zinc tarnishes readily but the forma- 
tion of a basic carbonate prevents its oxidation. In a flame it burns with 
a blue color. Acids act upon it to form salts. Soluble bases combine with it 
to form zincates: 
Zn+2HCl->ZnCl2+H2; 
Zn+2Na0H-^Na2Zn02+H2 
Zinc oxide, ZnO, is made by burning zinc vapors in oxygen. It is a white 
powder used in paints. 
Zinc sulfate, ZnSQt, is used in printing, dyeing cloth, and in medicine as an 
astringent. All zinc compounds are poisonous. 
Mercury.—Symbol: Hg; Atomic number; 80; Atomic weight: 200.61; Valence; 
I, II. 
Occurrence.—Mercury is found in the native state as minute globules dis- 
seminated throughout its ores. The most abundant mercury ore is cinnabar, 
(mercuric sulfide, HgS). 
Properties.—At ordinary temperatures mercury is a liquid, silvery-white, 
lustrous metal. When cooled to minus 38.8° C. it forms a malleable, ductile, 
and crystalline solid. It is insoluble in water or other solvents. At ordinary 
temperatures hydrochloric and sulfuric acids have no effect upon it, but when 
boiled with the latter it slowly dissolves with the evolution of sulfur dioxide. 
Nitric acid dissolves it rapidly, forming mercurous nitrate if the mercury is in 
excess, and mercuric nitrate if the nitric acid is in excess: 
6Hg+8HN03-»6HgN08+2N0+4H20; 
3Hg+8HN03->3Hg(N0a)2+2N0+4H20 
With oxygen it combines to form an oxide; this action is reversible: 
2Hg+G2^2HgO 
The halogens combine with mercury at ordinary temperatures. Many metals, 
such as gold and silver, form an amalgam with mercury. 
Mercuric chloride, HgCh, is a white crystalline salt, soluble in water, made 
by heating a mixture of mercuric sulfate and sodium chloride. It is a power- 
ful antiseptic and a dangerous irritant poison. 
Mercurous chloride, HgCl, is a white powder prepared by heating mercuric 
chloride with mercury. It has extensive use in medicine. 
The Tin Group.—Germanium, tin, and lead, along with carbon and silicon 
form a group in which the elements exhibit a valence of II and IY. A sub- 
group related to these are titanium, zirconium, and thorium. 
tin.—Symbol: Sn; Atomic number: 50; Atomic weight: 118.70; Valence: II, 
IV. CHEMISTRY 
711 
Occurrence.—The most important tin ore is cassiterite, or tin stone, Sn02, 
found most abundantly in the Malay States, Bolivia, the East Indies, and 
China. 
Propertiesf.—Tin is a white, lustrous metal existing in two allotropic forms, 
the gray form being brittle and easily crumbled into powder, while the white 
variety is soft and malleable. It is not affected by air or water at ordinary 
temperatures, but when strongly heated in a flame it burns with an intense 
white light to its oxide, SnCh. Tin reacts with the strong acids and hot con- 
centrated solutions of the strong alkalies, but is not affected by organic acids 
and weak alkalies. Due to its resistance to many chemical solutions it is used 
to plate copper and iron vessels. Most of it is used for tin plating cans, and 
it is a constituent of alloys such as bronze. 
Isolation.—Tin is obtained by reducing the oxide, Sn02, with carbon in a 
reverberatory furnace. Many of the compounds of tin are used in the dyeing 
industry. 
lead—Symbol: Pb ; Atomic number: 82; Atomic weight: 207.21; Valence: II, 
IV. 
Occurrence.—The most important and abundant source of lead is the sulfide 
(galena), PbS, which is widely distributed. 
Properties.—Lead is a silvery-grayish metal, soft and malleable, easily cut 
with a knife, and when drawn across paper it leaves a gray streak. In the 
presence of air a coating of lead oxide is formed which protects the metal 
from further oxidation. Cold concentrated hydrochloric and sulfuric acids 
have but little action on it. When boiled with these acids the chloride and 
sulfate are formed. With nitric acid it acts readily to form lead nitrate and 
oxides of nitrogen: 
3Pb+SHNOs -*3Pb (NOa) 2+4H20+2NO 
Large quantities of lead are used in the plumbing industry and in the manu- 
facture of storage batteries, alloys and paints. 
Isolation.—Lead is obtained from its ores by roasting in a current of air to 
oxidize the sulfide: 
2Pb S+30a —>2Pb0+2 S02 
The air supply is removed after % of the ore has been oxidized and then the 
temperature is raised. This produces metallic lead: 
PbS+2PbO-»SPb+SOa 
Oxides of lead.—Litharge (PbO), red lead (PbsCh), and lead dioxide (PbCb) 
are the important oxides of lead. The first is used in glass manufacture, the 
second as a paint pigment, and the third in making storage batteries. 
Basic lead carbonate, 2PbC03.Pb(0H)2 (white lead) is prepared by the action 
of air, carbon dioxide, and acetic acid upon perforated lead plates. It is used 
as a paint pigment. 
The Iron Group.—This group, No. VIII in the Periodic Table, contains iron, 
nickel, and cobalt. It is distinguished because of the magnetic properties of its 
members. 
Iron.—Symbol: Fe; Atomic number: 26; Atomic weight: 55.84; Valence: II, 
III. 
Occurrence.—Iron occurs free in meteorites, and combined as oxides, car- 
bonates, silicates and sulfides. 
Properties.—Pure iron is of a silvery-white appearance. In this state it is 
too soft for commercial purposes, therefore, small quantities of other elements, 
such as carbon, silicon and manganese are added to give it hardness. When 712 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
iron is combined with small quantities of carbon it is known as steel. Dry air, 
or water free from carbon dioxide, does not affect iron, while the presence of 
moisture and carbon dioxide causes the formation of hydrated ferric oxide 
(rust). Concentrated nitric acid and sulfuric acid have no action hpon iron at 
ordinary temperatures, although when diluted they attack it readily. 
Isolation.—Iron, as used in commerce, is obtained by reducing its ores in 
blast furnaces. Pure iron is isolated by electrolysis or reduction of the pure 
oxide in a current of hydrogen. 
Ferric chloride, FeCL is prepared by burning iron wire in chlorine. It is 
extremely soluble in water and alcohol. Its alcoholic solution is known as 
Tincture of Ferric Chloride. 
Ferrous chloride, FeGU, is prepared by treating iron with hydrochloric acid, 
in the absence of air: 
Silver and Gold.—Silver and gold are known as the noble metals and appear 
in Group I In the Periodic Table. This group also includes copper to make a 
family of three members, although there is not much resemblance in the 
chemistry of any two of these elements. Copper and gold usually have a 
higher valence than I which is characteristic of this group. 
silver.—Symbol: Ag; Atomic number: 47; Atomic weight: 107.88; Valence: I. 
Occurrence.—Silver is found free embedded in rock, or in combination as 
argentite (Ag2S) and as silver chloride (horn silver). 
Properties.—Silver is a soft, white, lustrous metal capable of taking a high 
polish. It is very malleable and ductile, and the best conductor of electrical 
current. Air and water have no action upon it. Nitric acid attacks it readily 
with the formation of silver nitrate: 
Fe+2HCl-*FeCl2+H2 
GAg+8HNO3 —>6AgN03+4H20+2NO 
Hydrochloric and dilute sulfuric acids have but slight action upon silver even 
at boiling temperatures, while hot concentrated sulfuric acid dissolves it form- 
ing silver sulfate and liberating sulfur dioxide. It reacts readily with the 
halogens. The alkalies have little or no action upon it. 
Isolation.—In the combined state silver is obtained from its ores by smelt- 
ing. It is removed from rock, where it occurs in the free state by crushing 
the rock and amalgamating the silver with mercury, after which the mercury 
is removed by distillation. Some of the silver salts are used in photography 
and medicine. 
Silver nitrate, AgNOa, is prepared by the action of nitric acid upon pure 
silver. This compound is used in the manufacture of other silver compounds 
and indelible inks. In medicine it Is used as a caustic. In ancient times 
silver and gold were among the few metals known. Gold was symbolical of 
the sun and silver of the moon (luna), hence the term “lunar caustic” applied 
to this compound. 
gold.—Symbol: Au ; Atomic number : 79; Atomic weight; 197.2; Valence; 
I, III. 
Occurrence.—Gold is ordinarily found in the free state, widely distributed 
but in small quantities. 
Properties.—Gold is a soft, heavy, bright yellow metal, extremely malleable 
and ductile. It is very inactive and will not react wuth any of the common 
acids; it dissolves in nitrohydrochloric acid (aqua regia) however, and in sodi- 
um cyanide with the presence of oxygen. The fused alkalies corrode it. This 
metal has been basis of currency throughout the world for centuries. Large 
quantities are used for making jewelry, and in dentistry. CHEMISTRY 
713 
ORGANIC CHEMISTRY 
Introduction. 
By the middle of the seventeenth century the study of the substances occur- 
ring in Nature had so far developed that they were grouped in the three 
natural kingdoms of animal, vegetable, and mineral matter. At this time the 
study of chemistry was divided into three branches, each dealing with the 
substances in one of these kingdoms, and chemists devoted themselves mainly 
to the study of mineral or nonliving substances. 
Following the discovery that certain substances are formed in the growth 
of both animals and plants the distinction between animal and vegetable chem- 
istry was discarded and substances produced by organized life-processes became 
known as organic. It was then believed that such substances were formed 
as the result of the so-called “vital force” in living things and could not be 
artificially produced by chemists. Although Lavoisier showed that organic 
substances are composed largely of carbon, hydrogen, oxygen, and nitrogen, 
and it was known that inorganic substances could be artificially prepared in 
chemical laboratories, the belief that organic substances could be produced 
only within living organisms persisted for many years. 
In 1828 Friedrich Wohler, a German chemist, in the course of some experi- 
ments, discovered, much to his surprise, that by warming ammonium cyanate 
it was transformed into urea, a waste product of the body that is secreted 
into the urine by the kidneys. Urea is a typical organic compound and pre- 
viously had been known only as a product of living organisms, while am- 
monium cyanate was essentially a laboratory-prepared compound. With Woh- 
ler’s production of a typical compound normally produced by the living organism 
from inert or nonliving matter the belief that “vital force” was necessary for 
the formation of organic compounds began to disappear, and by the middle of 
the nineteenth century had been abandoned, but the term organic chemistry 
survived and is used today to define this branch of chemistry, principally to 
distinguish it from inorganic chemistry. 
Since the first synthesis of an organic compound investigations have shown 
that organic substances obey the same laws of composition as inorganic sub- 
stances and enough syntheses of substances occurring in the living organism 
have been made to show that the chemical changes that take place in the 
living organism obey the same laws as those that occur in the laboratory. 
It has been further shown that carbon is present in all so-called organic 
compounds and organic chemistry may therefore be defined as the chemistry 
of the compounds of carbon, as they are found in Nature or have been syn- 
thesized in the laboratory. At the present time approximately 300,000 com- 
pounds of carbon are known while the compounds of all the other elements 
combined number only about 26,000. Organic chemistry is also defined as the 
chemistry of the hydrocarbons and their derivatives. 
In the last few decades organic chemistry has made rapid progress, even 
to the point of producing substances which have no counterpart in Nature, as 
plastics, for example. Today it plays an important part in industry for the 
organic chemist produces antiseptics, drugs, explosives, and perfumes from 
coal-tar, converts cotton and wood into paper, artificial silk, explosives, photo- 
graphic films, and celluloid, and prepares leather, soap, sugar, paints and 
varnishes, synthetic plastics and resins, rubber, and linoleum. Organic chem- 
istry makes it possible to understand the changes that take place in the 
making of jam, the baking of bread, the brewing of beer, etc., and to correctly 
understand physiology and the chemical processes that occur in the healthy, 714 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
as well as the diseased body, a knowledge of that branch of organic chemistry 
known as physiological chemistry is necessary. 
As a source of organic compounds Nature is unequalled for not only are 
they formed in the growth of animals and plants but they exist in and are 
obtained from substances that once were living animals and plants. Starch, 
sugar, cellulose, vegetable acids, fats, proteins, alkaloids, etc. are examples of 
organic compounds formed in the growth of plants and animals. By natural 
processes of decomposition or by laboratory methods many of these substances 
are broken down into simpler forms resulting in additional compounds. Many 
important compounds are obtained through the process of fermentation, exam- 
ples being alcohol and vinegar. The destructive distillation of coal, wood, and 
bones produces a large number of organic compounds. From the destructive 
distillation of coal are obtained illuminating gas, ammonia products, coke, and 
coal tar. The latter is especially rich in organic compounds, there being about 
200 present in it, among which are numerous phenol bodies, cresols, benzene, 
toluol, dye bases, etc. In the destructive distillation of wood acetone, acetic 
acid, methanol (wood alcohol), creosote, charcoal, and tar are some of the 
products. The destructive distillation of bones produces ammonia and of- 
fensively smelling substances used to denature other substances. Petroleum 
contains many compounds of carbon and hydrogen. 
The methods used in the study, analysis, and synthesis of organic compounds 
are too complex for discussion here. 
Two distinct divisions or types of carbon compounds, or hydrocarbons, exist: 
1. The aliphatic or open-chain series; and 2. The aromatic, carbocyclic, or closed- 
chain series. 
The word aliphatic is derived from a Greek word meaning fat, oil, and the 
aliphatic series consists of an open chain of carbon atoms, represented 
structurally as follows: 
Ethane 
The aromatic series is characterized by a closed chain of carbon atoms known 
as the benzene nucleus or benzene ring, represented structurally as follows: 
Benzene 
The aromatic series can be further divided into two groups, one of which, 
called the polymethylenes, exhibits properties closely resembling those of the 
aliphatic series, while the other exhibits properties differing in many respects 
from the aliphatic and polymethylene compounds, and is the true aromatic 
series. 
Structure and structural formulas of carbon compounds.—In the discussion of 
rhe element carbon on page 705 its valence is given as IV, shown structurally as: CHEMISTRY 
715 
and which means that it requires four monovalent atoms for saturation. It 
was also explained that carbon atoms possess the property of self affinity, 
being capable of combining with each other to form long chains. This property 
is shown structurally as: 
and is always true unless the saturation bonds are united with some other 
element. In the writing of these structural formulas it should be remembered 
that when two carbon atoms are shown as C — C—, the single bond uniting 
1 1 
the two C’s actually represents one bond from each carbon atom joined together. 
Also, as in the formula of benzene shown before, where no bond uniting a 
hydrogen atom with a carbon atom appears, it is considered that a single bond 
representing one bond from the hydrogen atom and one from the carbon 
actually exists but has been omitted for convenience in writing the formula. 
The formula of benzene showing all bonds appears on page 722. 
When a carbon atom or group of carbon atoms is found in such a state 
that all bonds are not occupied, it is said to be unsaturated. Consequently 
compounds containing such groups are also unsaturated, and are capable of 
taking on additional atoms and radicals. In these groups the carbon atoms 
may be likened to the nucleus of an atom, and the various atoms saturating 
the bonds represent the electrons. The number of unsaturated bonds is equal 
to and identical with the group’s valence: 
Valence I 
Valence II 
When all the bonds of the group are satisfied, its valence being zero, a 
saturated compound results. 
In organic chemistry the carbon atoms, as a rule, unite with hydrogen to 
form hydrocarbons. The hydrogen atoms are readily replaced by monovalent 
atoms or groups to form substitution or addition compounds: 
Methane 
Methyl iodide 
Methyl alcohol 
Ethyl alcohol 
Isomerism.—When analyzing organic compounds their molecular weight and 
the ratio of the atoms composing them is expressed by empirical formulas, as 
CzELiO for example. As there are two substances which have the composition 
and molecular weight represented by this formula, it is evident that the 
formula must be written in two different ways if each compound is to be dis- 
tinctly represented. To do this the formula for one substance, which has many 
of the properties of a hydroxide, is written O2H5.OH, while that for the other, 
which is an oxide, is written (CH3)20. Formulas of this type are known as 
rational formulas. (For a general discussion of formulas see p. 661.) 
In the study of organic substances the chemist endeavors, by means of 
graphic or structural formulas, to show the chemical properties possessed by a 
154294°—39 16 716 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
substance, in order to definitely distinguish between compounds having the 
same percentage composition and molecular weight. That there are many such 
compounds is evidenced by the fact that more than 100 compounds with the 
formula CaHnNCh have been described. 
Such compounds are known as isomers and the phenomenon of the existence 
of such substances is termed isomerism. In seeking an explanation of this 
phenomenon chemists concluded that, if the molecules of two substances con- 
tain the same number and kind of atoms in the same relative proportions, 
the difference in properties exhibited by the two substances must be due to a 
difference in the arrangement of the atoms within the molecules. Thus, the 
two compounds having the formula C2H0O are isomers, and to distinguish 
between them, the chemist, in a structural formula, shows the different 
arrangement of the atoms within each molecule as follows: 
Ethyl alcohol 
Di-methyl ether 
Compounds having the same percentage composition but different molecular 
weights are known as polymers and this condition of compounds is termed 
polymerism. Thus, benzene, CeHs, is a polymer of acetylene, C2H2. 
Homologous series.—By observing the structural formulas of methane and 
H 
ethane it will be seen that in the formula for ethane there is one more C group 
H 
than in the one for methane. By the addition of similar groups other com- 
pounds are formed as: 
Propane 
Butane 
and by continuing the procedure a considerable number of hydrocarbons can 
be obtained. It will be noticed that each compound differs from the ones next 
H 
to it by one i group, and the molecular formulas of these substances, methane, 
H 
CIL, ethane, C2Ho, propane, C3Hs, and butane, CJLo, show a like difference of 
one CH2 group. A group of such compounds is known as a series and each 
compound as a member of the series. A series of compounds in which the 
members have similar chemical properties and each successive member differs 
in composition by a constant increment of CH2 is termed a homologous series, 
the relationship is homology, and any member in the series is a homologue of 
any other member in it. CHEMISTRY 
717 
This principle not only applies to the hydrocarbons but to their derivatives 
as well: 
Methyl chloride 
Ethvl chloride 
Propyl chloride 
That such a series can be built up is due to the fact that, in the methane 
series for example, one hydrogen atom, El, can be replaced by a CEL radical, 
H 
—C—H; by taking one hydrogen atom from the formula for methane, CEL 
A 
there is left OH* and replacing this hydrogen atom with the radical CEL gives 
CaHe, the formula for ethane. (See p. 714.) 
The fact that it is possible to classify the hydrocarbons into a small num- 
ber of homologous series greatly simplifies their study. This classification is 
based on the chemical properties of the different hydrocarbons, which is de- 
termined largely by the relation between the carbon and hydrogen atoms in 
the molecules. 
When brought into contact with other substances a great many hydrocar- 
bons are very inactive, being little affected by concentrated sulfuric acid and 
nitric acid and resisting the action of strong alkalies and most oxidizing agents. 
Under certain conditions these hydrocarbons will react with chlorine and 
bromine and their hydrogen is replaced by the halogen. Certain hydrocarbons 
having these properties are classified in the series known as the paraffins (de- 
rived from Latin words meaning little affinity). This series is also known as 
the methane series, because methane is the simplest member of the series, 
and as the marsh gas series, because methane, a gas, is formed when 
dead leaves, grass, etc., disintegrate in stagnant pools of water in marshes 
or swamps, the gas rising in bubbles in the water when the decaying mass 
is stirred. 
The methane series is one of the principal homologous series of hydro- 
carbons, and the first eight members in it are: 
Name 
Formula 
Name 
Formula 
Methane 
cn4 
C2H6 
C3H& 
C4H10 
C5H12 
CoH,4 
C?H,6 
CgHis 
Ethane . 
Propane __ __ 
As each member of the series differs from its preceding member by a definite 
and constant increment of CEL, a general formula can be used to represent that 
increment as: CaH2n+2, n equalling the number of carbon atoms combined. 
Ethane, the second member of the methane series, contains 2 combined carbon 
atoms, and therefore: C2H(2xj)+3=C2H8. An easier method is to “add 12” to 
the subscribed numbers in the formula of the preceding member, using the 1 
for the carbon atoms and the 2 for the hydrogen, thereby increasing the number 
of carbon atoms by 1 and the number of hydrogen atoms by 2. 718 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The chief source of the methane series of hydrocarbons is petroleum, from 
which they are obtained by fractional distillation. The lower members of this 
series consist of gases which are dissolved in the middle or liquid members 
of the series. The higher members are solid forms and also are dissolved in the 
liquid portion. These hydrocarbons also may be obtained by dry distillation of 
many other organic substances, such as bituminous coal, shales, and wood. 
Methane, CH4, is the only hydrocarbon containing but one carbon atom. It 
is found in petroleum and also occurs as a by-product from decomposing vege- 
table material, especially at the bottom of marshes and pools. Methane is a 
colorless, odorless gas, burning with a pale, faintly luminous flame, and forming 
an explosive mixture with air. It may be prepared in the laboratory by 
heating a mixture of anhydrous sodium acetate and soda-lime. Illuminating 
gas, manufactured from coal, contains 30 to 40 per cent of methane. 
Ethane, CaHn, is found in crude petroleum and natural gas. It is a colorless, 
odorless gas, burning with a pale flame. It may be prepared by the action 
of zinc or sodium upon methyl iodide: 
CH3I + Nal 2N t , 19Hs 
CH3I + Na/^2Nai + |(lH3 
This building up of complex molecules from simpler ones is synthesis. 
Propane, normal butane, pentane, and hexane occur as liquids in crude 
petroleum, the latter two especially being present in gasoline. 
The hydrocarbons from Oi«Hm on are solid at ordinary temperatures and 
comprise the bulk of petrolatum products. A mixture of still higher 
hydrocarbons constitutes the commercial paraffin. 
Hydrocarbon derivatives. 
Halogen substitution products are derived from the hydrocarbons by replacing 
one or more of the hydrogen atoms with halogen atoms. {See p. 215.) 
Chloroform, CHCh, (trichlormethane), is a comparatively heavy liquid with 
an ethereal odor and sweetish taste. It is noninflammable, very slightly 
soluble in water, and boils at about 61° C. Chloroform is prepared by treating 
acetone or ethyl alcohol with chlorinated lime. It is good solvent and a 
general anaesthetic. 
CHS 
Ethyl chloride, | is a colorless, extremely volatile, inflammable liquid 
CH2CI 
having a pleasant ethereal odor and boiling between 12° and 13° 0. It is 
prepared by treating ethyl alcohol with hydrochloric acid. In minor surgery 
ethyl chloride spray is used to anaesthetize local areas by freezing. It is also a 
general anaesthetic. 
Alcohols.—An alcohol is derived from a hydrocarbon by substituting a hy- 
droxyl group (OH) for one or more of the hydrogen atoms. Alcohols con- 
taining one OH group are monohydroxy alcohols. Those containing two OH 
groups are dihydroxy alcohols, etc. {See p. 218.) 
OH 
Methyl alcohol, J is a colorless liquid with a peculiar odor, burning with 
CH3 
a nonluminous flame. It boils at 66.7° C. It is poisonous and blindness and 
death may result from its internal use. Methyl alcohol or “wood spirit” is 
obtained from the dry distillation of wood (wood alcohol) and is also prepared 
synthetically in large quantities under the name of methanol. It is an excellent 
solvent for fats, oils, and resins. CHEMISTRY 
719 
CH3 
Ethyl alcohol, | ., is a colorless, inflammable liquid with a pleasant 
CH2OH 
odor, and at 95.57 per cent strength it has a boiling point of 78.3°C. It burns 
with a nonluminous flame and its vapors, when mixed with air, explode when 
ignited. Ethyl alcohol is obtained by the fermentation of grain or fruit with 
subsequent distillation. It is one of the best solvents and is the starting point 
in the manufacture of many such useful compounds as ether, chloroform, 
and iodoform; large quantities are used in the preparation of varnishes, per- 
fumes, and tinctures of drugs. It is not poisonous although when taken to 
excess in strong beverages the effect on the system is distinctly injurious. 
The general group CH2n+i, is termed the “alkyl radical group”. Individual 
radicals take their names from the corresponding hydrocarbons, as CH3, the 
methyl radical, and C2H5, the ethyl radical. 
Aldehydes.—An aldehyde is derived from a hydrocarbon by substituting an 
oxygen atom for two hydrogen atoms on a terminal carbon atom. {See p. 220.) 
0 
Formaldehyde, J| , is a gas of extremely pungent odor, which reduces cold 
CH2 
ammoniacal silver solution. It is prepared by passing a mixture of gaseous 
methyl alcohol and air over gently heated copper oxide. It is valuable as an 
antiseptic, fumigating agent, and preservative. Undertakers use a solution of 
formaldehyde of about 40 per cent in water for embalming. 
Acetaldehyde, 
is a colorless, mobile liquid, having a marked 
characteristic odor and boiling at 21° C. It is prepared by the oxidation of 
ethyl alcohol with a mixture of dilute sulfuric acid and potassium dichromate. 
Ketones.—A ketone is derived from a hydrocarbon by substituting an oxygen 
atom on a carbon atom other than a terminal one in place of two hydrogen 
atoms. 
Acetone, 
is a colorless liquid with a somewhat pleasant 
ethereal odor. It is very soluble in water and boils at 56.6° 0. The chief use 
of acetone is as a solvent and it is prepared by the distillation of calcium 
acetate: 
Ethers.—An ether is an alkyl oxide, that is, two alkyl radicals such as CH3 or 
C2H5 are attached to an oxygen atom. {See p. 221.) 
Ethyl ether, 
(commonly called sulfuric ether be- 
cause sulfuric acid is used in its preparation), is a transparent, mobile 
liquid with a characteristic odor and a burning sweetish taste. It is some- 
what soluble in water (1 —10) and boils at about 35° C. The vapor is very in- 720 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
flammable and forms an explosive mixture with air. Ethyl ether is the most 
important general anaesthetic. In commerce its chief use is as a solvent. 
The ethers are prepared by treating alcohols with sulfuric acid and con- 
densing the vapors. 
Organic acids.—An organic acid is derived from a hydrocarbon by sub- 
stituting an oxygen atom and a hydroxyl group for the three hydrogen atoms 
of a methyl radical, CHS, thus forming a carboxyl group, COOH, which is 
common to all organic acids. {See p. 225.) 
Acetic acid, 
is a clear, colorless liquid with a very penetrat- 
ing, acid odor and sharp burning taste. It boils at 118° C. and mixes with 
water in all proportions. It is produced by the oxidation of alcohol in 
fermented liquors due to the presence of a microscopic organism, the 
My coderma aceti. It may also be obtained from the dry distillation of wood. 
Vinegar contains 4 per cent of acetic acid. 
Fats or animal and vegetable oils, are esters of organic acids. 
Soaps are the metallic salts of organic acids 
Esters.—An ester is derived from an organic or inorganic acid by replacing 
the carboxyl hydrogen in organic acids, or the ionizable hydrogen in inorganic 
acids, with an alkyl radical. {See p. 226.) 
Ethyl acetate, 
is a transparent, colorless liquid with a 
fragrant and refreshing odor and a peculiar acetous, burning taste, moderately 
soluble in water and easily soluble in alcohol and ether. It is inflammable and 
burns with a yellowish flame and acetous odor. Its most important use is as 
a solvent. 
Ethyl nitrite, 
is a mobile liquid having a penetrating 
ethereal odor and peculiar stinging taste, boiling at 18° C. and burning with a 
bright white flame. Its alcoholic solution is Spiritus ASthylis Nitritis, XL S. P., 
commonly known as sweet spirit of niter. Ethyl nitrite is prepared by the 
action of sulfuric acid upon a mixture of sodium nitrite and alcohol. 
If the alkyl radicals in a compound are designated by the letter R the various 
hydrocarbon derivatives may be represented by the following formulas: 
Derivative 
General 
formula 
Derivative 
General 
formula 
ROH 
RCHO 
RCOR 
Acid 
RCOOH 
RCOOR 
ROR 
Ether__. .. ... 
Carbohydrates.—Among the important derivatives of the open-chain series of 
hydrocarbons are the saturated compounds known as carbohydrates. These 
compounds are produced in the growth of all green plants by the process of CHEMISTRY 
721 
photosynthesis and constitute a major class of foods for animals. The name 
originated in the fact that they contain the elements carbon, hydrogen, and 
oxygen and their elementary composition may be expressed by the general 
formula CH>0, the latter two elements being in the same proportion as they 
are in water. There are, however, true carbohydrates in which this ratio of 
hydrogen to oxygen does not exist and other compounds that are not carbo- 
hydrates in which it does exist and to such compounds the term carbohydrate 
is therefore not strictly applicable. Notwithstanding these facts it continues 
to be used as the name of this class of compounds for it is too well fixed in 
chemical nomenclature to be displaced. {See p. 241.) 
Typical carbohydrates are sugars, starches, and cellulose. Their molecules 
are very complex and study of this class of compounds has shown that they 
are in general aldehyde or ketone alcohols, or compounds which are converted 
by hydrolysis into those types of alcohols. 
The carbohydrates are also known as saccharides and may be divided into 
two classes, the monosaccharides, which do not hydrolyze, and the polysac- 
charides, which can be converted into monosaccharides by hydrolysis. When a 
monosaccharide contains the aldehyde group it is known as an aldose and 
when it contains the ketone group it is known as a ketose. Monosaccharides 
are also classified according to the number of carbon atoms in the chain as 
dioses, trioses, tetroses, pentoses, hexoses, etc. 
The simpler carbohydrates are also called simple sugars, which are named 
as are the monosaccharides and are polyhydroxy derivatives of saturated 
aldehydes and ketones. The complex sugars, the starches, and cellulose, all 
of which are polysaccharides, consist of 2, 3, or many such simple sugars united 
into a single molecule. 
The structural formula of glucose, a hexose sugar, is as follows: 
Tlnsaturated hydrocarbons. 
Associated with the saturated hydrocarbons in petroleum is a series of hydro- 
carbons each member of which contains two hydrogen atoms less than the 
corresponding member of the saturated series. They possess the general 
formula CnH2n and are known as the olefin series. Hydrocarbons of this 
series are also known as the ethylenes, from the first member of the 
H H 
series, ethylene, H— —H. They contain one unsaturated linkage which is 
indicated structurally by a double bond placed between two of the carbon atoms 
as shown in the formula of ethylene just given. 
Their most characteristic reaction is the direct combination with two atoms 
of halogens to form “addition compounds”. An example is the combination 
H H 
I I 
of two atoms of bromine to form ethylene bromide, H—C—C—H, They 
Br ir 
have been named by adding the termination “ene” to the monad radicals 
derived from the corresponding saturated hydrocarbons. In their physical 
properties they resemble the methane homologues closely. 722 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Hydrocarbons containing two hydrogen atoms less than the corresponding 
member of the olefin series and four less than the same member of the paraffin 
series are known. They may belong either to the allenes containing two double 
H H 
linkings, such as allene, H— Ui —H, or to the acetylenes containing one 
triple linking, such as acetylene, H—C=C—H. The names of some of the 
members of these series are given in the following table: 
Ethylene series 
CnHjn 
Acetylene series 
CuH2a-2 
Name 
Formula 
Name 
Formula 
Ethylene 
Propylene 
Butylene 
Pentylene 
Hexylene.-. 
Heptalene 
Octalene 
C2H4 
c3h8 
C4H8 
C5H10 
CeHia 
C7H,4 
CsHis 
Acetylene. ... 
Propine. 
Butine.. 
Pentine 
Hexine 
Heptine 
Octlne 
C2H2 
C8H4 
c4h6 
c6h8 
CgHio 
C7H12 
C8H14 
Aromatic hydrocarbons. 
The derivatives of methane and similar hydrocarbons have one common 
feature in that they are open-chain hydrocarbons, or aggregates of carbon 
atoms linked together in such a way that the end carbon atoms are distin- 
guished from those occupying a middle position in the molecular grouping. In 
the aromatic series of hydrocarbons it is considered that the molecule contains 
six carbon atoms linked together in a closed chain so that no one of the six 
is an end carbon atom. The fundamental hydrocarbon of this series is 
benzene, the structural formula of which is shown on page 714. 
Before continuing with the discussion of the aromatic hydrocarbons a brief 
explanation of the benzene ring is essential. If the structural formula of 
benzene is so written as to show all bonds linking the carbon and hydrogen 
atoms together it will appear as: 
This is a cumbersome method and for convenience a simple oblong hexagon 
is ordinarily used. At each angle of the hexagon it is assumed a CH 
group is situated and the hexagon so written is always understood to mean CcHe. 
The hydrogen atoms in benzene are replaceable by the substitution of other 
elements or groups, and when only a single hydrogen atom is replaced, as in 
the formation of phenol from benzene, the replacing OH group may be shown 
OH 
at any angle of the hexagon but usually is placed at the top, as which 
V CHEMISTRY 
723 
it is understood to be CoHsOH, or phenol. (See p. 222.) If, however, two hydro- 
gen atoms are replaced it is necessary to know at which angles to place the 
replacing element or group. To facilitate this the angles of the hexagon are 
given imaginary numbers starting with 1 at the top and proceeding clock- 
wise, thus: 
Replacement or substitution of two hydrogen atoms can take place in three 
different ways, to form three isomeric compounds, as shown in the following 
structural formulas where the OH group is again used as the substituent: 
Each of the compounds shown, in which 2 hydroxyl groups are substituted for 
2 hydrogen atoms, is dihydroxybenzene, but to designate the structure the 
figures of the substitution places or the prefixes ortho, meta, or para are added. 
Thus the first compound shown is known either as 1-2 or ortho, the second 
as 1-3 or meta, and the third as 1-4 or paradihydroxybenzene. 
Substitution of three hydrogen atoms in the benzene ring also gives three 
isomeric compounds as follows, with OH as the substituent: 
The substituent groups in the compounds shown are said to be vicinal (adjoin- 
ing or consecutive), in the one at the left, asymmetrical in the one in the 
center, and symmetrical in the one at the right. These isomeric compounds, all 
of which are trihydroxybenzene, are designated by numbers or by the first 
letters of the words indicating the positions, as 1-2-3 or v-, 1-2-4 or a-, and 
1-3-5 or s-trihydroxybenzene. 
For further information concerning the benzene ring reference should be 
had to any standard text book on Organic Chemistry. 
Resuming discussion of the aromatic series, homologues of this series are 
formed by the replacement of one or more of the hydrogen atoms by methyl 
and ethyl groups; 
The limit of this replacement is reached when other atoms or groups have 
been substituted for the six hydrogen atoms. Both the hydrocarbons of this 
series and the substitution derivatives are quite stable. 724 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The benzene derivatives are not convertible into methane derivatives by 
the addition of halogens or other atomic groups; benzene, CbHo, cannot be 
converted into hexane, CsHw, by any means, direct or indirect. In fact, it is 
strikingly evident that OsHe is a peculiarly constituted molecule, which resists 
change and remains substantially intact through all the substitutions that 
may be effected. It cannot be transformed into a simple molecule containing 
5, 4, or 3 carbon atoms; when oxidized, it reverts into carbon dioxide and 
water. More than half of all the carbon compounds are benzene derivatives. 
Among the important derivatives is nitrobenzene which is prepared by treating 
benzene with nitric acid. 
Nitrobenzene is reduced by nascent hydrogen to aniline, from which the “aniline 
dyes” are derived. The general formula for the benzene series is represented 
aS CnH2n—6« 
The scope of Organic Chemistry is practically unlimited and in this chapter 
it has not been possible to give more than a very brief outline of this most 
interesting subject. As has been previously stated many hundred times more 
compounds than Inorganic Chemistry contains are already known, and what 
future research in this realm may produce is purely a matter of speculation. 
ANALYTICAL PROCEDURES 
The division of chemistry which deals with the composition of substances 
is called Analytical Chemistry and its procedures are known as chemical an- 
alyses. It is divided into two parts: 1. Qualitative analysis, in which the 
constituents in a given compound are identified; and 2. Quantitative analysis, 
in which the percentage of various elements or compounds is determined. 
The methods used to make these determinations are based upon the simple 
laws of chemistry and the similarity of properties and reactions existing among 
certain groups of elements and their compounds. 
Because the molecules of a substance necessarily must have intimate con- 
tact to facilitate a complete reaction, the substance to be analyzed is first 
dissolved in a liquid, usually water. This induces the substance to dissociate 
into its various ions. The determinations in chemical analysis are based upon 
the conduct of these ions and their reactions with various reagents, and 
therefore a knowledge of the theories and laws of ionization as related to 
the various elements and reagents employed is necessary. A brief discussion 
of ionization as regards its use in chemical analysis will follow. 
The first step in proceeding with a chemical analysis is either to isolate 
the various components to be determined by precipitation of their ions and 
subsequent filtration, or to treat their solution in such a manner that their 
reaction with the indicated reagents is not modified or obscured. 
Pure water freezes at 0°C., but when a substance is dissolved in water the 
freezing temperature ordinarily is depressed in proportion to the amount added. 
It is evident, therefore, that the depression of the freezing point of water is 
proportional to the number of molecules of the substance dissolved in a given CHEMISTRY 
725 
quantity of water. For example, if a mole {see page 663) of alcohol (46 Gms.) 
is dissolved in sufficient water to make 1,000 cc, the freezing point is lowered 
1.86° C. Similarly, one mole of many other substances, such as sugar or glycerin, 
when dissolved in sufficient water to make 1,000 cc, depresses the freezing 
point of the water 1.86° C. 
Acids, bases, and salts, in the same equivalent proportion, cause the freezing 
point of water to be depressed even more than 1.86° C., in many cases as much 
as 2, 3, or 4 times. In dissolving one mole of Nad in sufficient water to make 
1,000 cc of water, the freezing point is lowered nearly 2 times 1.86° O. From 
this fact it might seem that there are twice as many particles present in the 
solution from a mole of NaCl as there are from a mole of alcohol, but as a mole 
of one substance contains the same number of molecules as that of any other 
substance, there therefore cannot be twice as many molecules of NaCl as there 
are of alcohol. Consequently, it becomes evident that the molecules of NaCl 
split into two particles. 
One molecule of BaCb dissolved in sufficient water to make 1,000 cc depresses 
the freezing point of the water nearly 3 times 1.86° C., and hence it is obvious 
that its molecules have split into 3 distinct particles. 
Further evidence of this splitting process is the precipitation of AgCl when 
AgNOs is added to a solution of NaCl or BaCb. This precipitation will occur 
with any chloride regardless of what active metal is combined with the Cl. 
Therefore, it is apparent that the characteristics of a solution are to some 
extent due to the functions of the constituent parts of the salts, rather than 
the molecules of the salts as a whole. 
In like manner all acids exhibit the same properties which classify them as 
acids (turn litmus red, have a sour taste, decompose carbonates) regardless of 
what elements or groups of elements are combined with the hydrogen which is 
common to all acids. This shows that the properties of an acid are dependent 
upon its hydrogen, for that is the only element common to all acids; the other 
elements combined with hydrogen in acids have extremely different properties. 
The characteristic properties of all the bases in solution are derived from the 
hydroxyl radical, (OH), which is the only unit common to all bases. 
These facts demonstrate that acids, bases and salts, when dissolved in water, 
split up into their constituents in the following manner: 
hci +cr 
+OH~ 
HaCl <=?Na+ + C1- 
H2S04 + H+ + SOr - 
BaCl2 + Cl- + Cl- 
The hydrogen formed when an acid splits up in solution behaves quite differently 
from that found in the gaseous state or in compounds such as the hydrocarbons. 
Likewise, the sodium formed is quite different from metallic sodium which reacts 
violently with water. This is because these particles, called cations or anions 
according to their nature, carry electric charges, and when they come in con- 
tact with the cathode or anode electrode, as the case may be during the proc- 
ess of electrolysis, they give up their electrical charge and assume their 
natural state. (See previous discussion of electrolysis.) Substances which per- 
mit the passage of an electrical current through their solutions, and which, 
from the consideration of their depression of the freezing point, do split into 
their constituent parts, are known as electrolytes. Substances which do not 
permit the passage of electrical current through their solutions and give normal 726 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
freezing point depressions (1.86° C. per one mole in sufficient water to make 
1,000 cc) are known as non-electrolytes. From these observations the theory 
of electrolytic dissociation, or ionization, has been developed, in which it is 
considered that: 
1. When an acid, base, or salt is dissolved in water it instantly separates or 
dissociates into particles called ions; 
2. These ions are electrically charged, hydrogen and the metals carrying posi- 
tive charges and the non-metallic elements and radical groups except NH*, carry- 
ing negative charges. The total of the positive and negative charges is equal, 
that is, they balance each other; and 
3. When oppositely charged ions in a solution collide they reform, for an 
instant, molecules of the original substance. The process of ionization is there- 
fore reversible, and is indicated by double arrows <=*. The solution will con- 
tain, at a given instant, a definite number of whole molecules along with the 
ions. Ionization is not complete until the solution is so greatly diluted that 
collision of the ions rarely occurs. The number representing the percentage 
of molecules ionized at a given instant is called the degree of ionization. Thus, 
if at a given instant, 90 out of every 100 molecules of a substance are ionized 
and 10 still exist as whole molecules, the degree of ionization is 0.90 or 90 
per cent. 
Acids, such as HC1, HNOs and H2SO4, which have a high degree of ioniza- 
tion (0.50 to 0.90) in normal solutions are called strong acids. Other acids, 
such as H.C2H302, H2S and H2C03, which are ionized very slightly (less than 
0.1) in normal solution are known as weak acids. There is, however, no very 
distinct demarcation between weak and strong acids, all acids being completely 
ionized in very dilute solutions. 
Bases, such as NaOH and KOH, which have a high degree of ionization in 
normal solutions are called strong bases. Those having a low degree of 
ionization, such as NHtOH, are called weak bases. 
Nearly all the soluble salts are highly ionized, even those derived from 
weak acids. 
When ions are removed from a solution by the addition of another sub- 
stance, the relative velocity at which the molecules break up to form new 
ions will be increased, although the number of ions present at a given instant 
will remain the same. For example, HC1 is normally ionized 80' per cent, in 
a normal solution, into positive hydrogen (H+) and negative chlorine (Cl-) ions. 
If a mole of NaOH is added to the solution, the H+ ions unite with the OH~ 
ions derived from the NaOH to form H20 which is very slightly ionized. 
Therefore, the H+ ions are removed from the solution. HC1 is constantly 
ionizing, but the OH~ ions continuously remove the H+ ions from the solution, 
preventing the reforming of HC1 molecules. As a result, the HOI molecules 
are progressively broken down until no more molecules of HC1 remain. In 
the same way the ions of NaOH undergo a like process. When there are no 
longer molecules of HCl or of NaOH left to ionize, the solution exhibits 
neither the properties of an acid nor a base; hence it is termed neutral. The 
reactions which take place are indicated by the following equation: 
HClfc? ir +C1- 
_l_ -j- 
OH-+Na+ 
it it 
H20 NaCl 
Standard solutions are those which contain a known and definite amount 
of a given substance. They are divided into two classes, molar and normal. CHEMISTRY 
727 
Molar solutions.—The concentration, or quantity of solute a solution con- 
tains, is often an important factor in chemical reactions. The ratio of solute 
to a definite volume of solvent is usually expressed in grams per 1000 cc, 
ounces per quart, or pounds per gallon. These are convenient arbitrary units 
selected by man. On the other hand there are certain units which are constant 
in Nature and must be considered in chemical reactions, for, in truth, chemistry 
is a duplication, by man, of natural processes. 
The natural unit of an element is the atom and is the unit which is exchanged 
in chemical reactions. In the case of compounds the natural unit is the 
molecule. Therefore, the natural unit of weight in a chemical reaction is the 
actual weight of each individual atom concerned. 
It is readily apparent that the actual weights of the atoms and molecules 
are too small for convenient use. The actual weight of a hydrogen atom 
has been determined as 0.000,000,000,000,000,000,000,001,662 Gm., and that of 
oxygen as 0.000,000,000,000,000,000,000,026,4 Gm., the latter being nearly 16 
times the former. Due to the impracticability of working with such volu- 
minous figures, relative weights rather than absolute weights are used. The 
relative weights are the same regardless of the number of atoms compared. 
Thus, one atom of oxygen is nearly 16 times as heavy as one hydrogen atom; 
2 oxygen atoms are nearly 16 times as heavy as 2 hydrogen atoms, etc. 
One gram of hydrogen contains a definite number of hydrogen atoms. To 
acquire the same number of oxygen atoms it would be necessary to have 
nearly 16 Gm. of oxygen. Therefore, the relative atomic weight of an element 
in grams contains the same number of atoms regardless of what element is 
considered. The calculation of the relative atomic weights is based on oxygen 
(0=16) as the arbitrary standard; then 16 Gm. of oxygen contain the same 
number of molecules as 1.0078 Gm. of H; 22.99 Gm. of Na; 32.06 Gm. of S; 
35.457 Gm. of Cl; etc. 
One molecular weight in grams is called a mole. A solution containing one 
mole of solute in 1,000 cc of the solution (not the solvent) is termed a molar 
solution. Such molar solutions are designated by the abbreviations M/l or H- 
and solutions containing one-half mole, one-tenth mole, etc., in 1,000 cc, as M/2 
orM, M/10orM, etc. One mole of any substance contains the same number 
of molecules as a mole of any other substance. Hence, a mole of a given 
substance has the exact number of molecules necessary to react completely 
with one mole of another substance, or with a definite multiple or fraction 
thereof. Thus: 
H2S0 + H+ +S04- - 
+ + + 
+ Na+ + Na+ 
it it 
2H20 Na2S04 
In this reaction one molecule of H2S04 combines with two molecules of NaOH 
to form a salt and a neutral solution; or one mole of H2S04 reacts with two 
moles of NaOH. With a molar solution of NaOH and a molar solution of HC1, 
it will take the entire liter of NaOH solution to neutralize the liter of HC1 
solution, or 1 cc of NaOH solution to neutralize 1 cc of HOI solution. Molar 
solutions are convenient because 1 cc of a molar solution of one substance will 
neutralize 1 cc or 2 cc or 3 cc or % cc or % cc or % cc of a molar solution of 
some other substance. The reaction between NaOH and H2S04 demonstrates 
why the numbers are not always 1:1. 728 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
It is obvious that it would be more convenient to have all standard solu- 
tions neutralize each other cc for cc rather than in multiples of 2, 3, 4, etc. 
This can be accomplished by the use of normal solutions. 
Normal solutions.—Solutions which contain 1.0078 Gm. of replaceable hydrogen 
or its equivalent weight of solute in 1,000 cc of solution are termed normal 
solutions. 
It has been noted that all acids derive their characteristics from the ionizable 
hydrogen which they contain, this hydrogen being readily replaceable by 
active metals. In preparing a normal solution of an acid, it is necessary to 
consider the number of hydrogen atoms contained in the molecule. As the 
molecular weight is derived from the sum of the atomic weights, it is con- 
venient in preparing standard solutions to use the molecular weight in grams. 
To prepare a normal solution of HC1 first note that the molecular formula 
shows 1 replaceable atom of hydrogen and that the molecular weight is 36.465 
Gm. in which 1.008 Gm. is the weight of 1 atom of replaceable hydrogen; 
therefore, 36.465 Gm. of HC1 is to be dissolved in sufficient water to make 1,000 
cc. In preparing normal solutions of acids containing more than 1.008 Gm. of 
replaceable hydrogen, it is necessary to use that portion of the molecular 
weight in grams which will represent 1.008 Gm. of replaceable hydrogen. For 
example: H2SO4 contains 2 replaceable hydrogen atoms and its molecular 
qo 
weight is 98.07; therefore, - — -—>49.03 Gm. of H2SO4, or the equivalent of 
/u 
1.008 Gm. of H% must be used. HsPO* contains 3 replaceable hydrogen atoms 
qo ni 
and its molecular weight is 98.04 Gm.; therefore, Gm. of II1PO4, 
O 
or the equivalent of 1.008 Gm. of H+, must be used. 
For convenience in designating a normal solution the abbreviation N/l or 
N 
— is used. In normal solutions or fractions of normal, appropriate numbers 
are placed below or after a line next to the letter N. Thus, a half normal solution 
N N 
Is designated as N/2 or-g-, a fifth normal solution as N/5 ory, a tenth normal 
N 
solution as N/10 etc. Solutions which are stronger and therefore are 
multiples of normal solutions are represented by numbers placed before the letter 
N. Thus, a double normal solution is designated as 2N, a solution 5 times 
normal as 5N, etc. In preparing solutions which are fractions of normal, the 
designated fraction of the molecular weight (or of its proportionate part 
representing 1.008 Gm. of H+ in 1,000 cc) is used, as, for a N/10 solution of HC1, 
l/10th of 36.47 Gm. or 3.647 Gm. (the figure in the third decimal place of the 
molecular weight being dropped and that in the second increased by 1). For 
solutions which are multiples of normal, the designated multiple is used, as, for a 
5/N solution of HC1, 5X46.465 Gm., or 182.325 Gm. 
Bases do not contain H+ ions but ionize into R++OH" (R being any element 
forming part of a base), each OH- ion being capable of combination with one 
H+ ion. In preparing a normal solution of a base the molecular weight (or its 
fractional part containing OH-, which is the equivalent of one H+) is used. 
The molecular weight of NaOH, 40.00 Gm., is used in 1,000 cc to prepare the 
normal (N/l) solution of NaOH. 
In order to make the H+ equivalent more comprehensive and concise the 
following formula may be used: 
__. . . , . molecular weight 
H+ equivalent weight — , rr- : • 
total positive valence 
Then, to prepare a normal solution of an acid containing 1, 2, or 3 replaceable 
hydrogens the equations would be: CHEMISTRY 
729 
HC1 ; —36.465 Gm. in 1,000 cc. 
oft 07 
H2S04: -—~ = 49-03 Gm-in i*000 cc.' 
OS 04 
H3P04: ——— — 32.68 Gm. in 1,000 cc. 
The amount of soluble salts to use in preparing normal solutions may be deter- 
mined in the same manner, as: 
ono 07 
Ba++Cl,~ : — 104.13 Gm. in 1,000 cc 
Hydrogen ion concentration and Indicators. 
It is often desirable to determine the acidity or alkalinity of a solution, or 
the point of neutrality when the positive hydrogen (H+) ions and the negative 
hydroxyl (OH") ions are equal. By the use of litmus paper the relative differ- 
ence between acidity, alkalinity, and neutrality may be demonstrated, but often 
this procedure is unsatisfactory, in that it does not denote the degree in which 
these properties are present. 
Solutions containing a preponderance of H+ ions, as previously stated, are 
considered acid and solutions containing a preponderance of OH- ions are 
alkaline, the degree of acidity or alkalinity being dependent upon the number 
of these ions present. In order to define a definite degree of ionization, either 
of H+ or OH~, a convenient scale is necessary. In order to have a comparable 
scale there must be a constant, so, in order to determine the degree of ionization, 
a scale has been devised using distilled water as a constant, because distilled 
water has a relatively unappreciabie dissociation into H+ and OH- ions. 
By electrical-conductivity measurements the degree of ionization of distilled 
water has been determined as 0.000,000,1, or, to use a negative exponent, 10-7. 
This means that in 1,000 cc of distilled water there is present only 0.000,000,1 
gram of hydrogen ion (H+), the balance of the hydrogen being in the molecular 
form as H20. Likewise the ionization constant of distilled water has been 
determined to be 0.000,000,000,000,01 or, to use a negative exponent, 10~14. This 
ionization constant is the product of the multiplication of the hydrogen (H+) 
concentration and the hydroxyl ion (OH-) concentration as shown by the 
following dissociation or ionization equation for distilled water: 
H+ OH- _Constant 
(10-7)x(10-7)~ (10-14) 
Using this factor as a constant, a scale of measure is formulated in terms of 
potential hydrogen, pH, (ionized hydrogen) to cover the complete range of 
acidity and alkalinity. The equivalent pH value for any given H+ is the 
logarithm of that concentrate’s reciprocal. For example: 10,000,000 is the 
reciprocal of 0.000,000,1 and the log of this is 7 which is the pH value for the 
H+ concentration of 0.000,000,1. 
In order to eliminate the unwieldy ciphers the H+ concentrations are ex- 
pressed by negative exponents. The mathematical calculations by which the 
pH values are obtained are too complicated, especially in determining the frac- 
tional parts, to be discussed in this chapter. Inasmuch as H+ concentrations 
are universally expressed in pH values, which are readily determined, a knowl- 
edge of logarithms is not necessary to determine the degree of acidity or 
alkalinity. However, it is to be remembered that the pH values are repre- 
sented by logarithms, hence, the numerical order in the pH scale is inversely 
proportional to the H+ concentration it represents. With an increase in pH 730 
HANDBOOK OF THE HOSPITAL CORPS, II. S. NAVY 
values from 0 to!4 there is a decrease in H+ concentration with a correspond- 
ing increase in OH' concentration to maintain the equilibrium of 10"14, the 
ionization constant of H20. At pH 7.0 there is an equal number of H+ and 
OH" ions, the concentration in each group being 10"7 hence, pH 7.0 is the neutral 
point. A decrease in pH from 7 to 0 is accompanied by a progressive increase 
in H+ ions, and in acidity, with a decrease in OH- ions. An increase in pH 
from 7 to 14 is accompanied by a progressive decrease in H+ ions with an 
increase in OH" ions, and in alkalinity. Because logarithms are used, in the 
pH scale it is to be noted that pH 6 represents 10 times as many H+ ions as 
pH 7, and that pH 5 represents 100 times as many H+ ions as pH 7, etc. 
pH Scale 
Hydrogen ion concentration 
pH value 
Hydroxyl ion concentration 
1.0 
or 10-° 
pH 
0.0 
IO-14 or 0.00000000000001 
0.1 
or 10-1 
pH 
1.0 
10-13 or 0.0000000000001 
0.01 
or 10-2 
pH 
2.0 
IO-12 or 0.000000000001 
0.001 
or lO"3 
pH 
3.0 
IO-11 or 0.00000000001 
0.0001 
or IO-4 
pH 
4.0 
IO-10 or 0.0000000001 
0.00001 
or 10-5 
pH 
5.0 
10-9 or 0.000000001 
0.000001 
or 10-6 
pH 
6.0 
10-8 or 0.00000001 
0.0000001 
or 10“7 
pH 
7.0 
10-7 or 0.0000001 
0.00000001 
or 10-* 
pH 
8.0 
10-6 or 0.000001 
0.000000001 
or 10-9 
pH 
9.0 
10-5 or 0.00001 
0.0000000001 
or IO-10 
pH 
10.0 
lO"4 or 0.0001 
0.00000000001 
or 10-ii 
pH 
11.0 
10-3 or 0.001 
0.000000000001 
or 10-12 
pH 
12.0 
10-2 or o.Ol 
0.0000000000001 
cr IO-13 
pH 
13.0 
10-1 or 0.1 
0.00000000000001 
or lO-'4 
pH 
14.0 
10-6 or 1.0 
Hydrogen ion determinations are made either electrochemically or col- 
orimetrically. Electrical-conductivity tests for the quantitative determination 
of H+ ions require elaborate apparatus and special training, whereas colori- 
metric determinations may be made comparatively accurately and conven- 
iently with inexpensive apparatus, buffer solutions, and indicators. 
A buffer solution is one that has a definite concentration of hydrogen ions 
(H+) which is not altered by dilution, and is prepared by dissolving definite 
weights of the salts of weak acids and of weak bases or of both in sufficient 
water to make 1000 cc. As a rule, two buffer solutions are used in con- 
junction, one containing a preponderance of H+ ions and the other a preponder- 
ance of OH- ions. By mixing prescribed volumes of these solutions together 
it is possible to produce a solution of any desired pH value. Due to the low 
ionization value of the substances used, the H++OH~ equilibrium is maintained 
under ordinary circumstances and the pH value of their combination remains 
constant. For detailed preparation of buffer solutions refer to “Clinical 
Diagnosis by Laboratory Methods”, Todd and Sanford, p. 668. 
Indicators are natural or synthetic organic substances used in chemistry to 
show by a color change whether a substance is acid or alkaline in reaction. A 
familiar example is blue litmus which turns red with acids and is unchanged 
with alkalies. 
To determine the pH value of a given solution, a range of known pH values 
is prepared with buffer solutions contained in a series of test tubes, to which 
is added an indicator that will cover the pH range desired. An equal amount 
of indicator being added to each tube, a distinct and progressive range of 
colors develops. An equivalent amount of indicator is added to a proportionate 
part of the unknown solution and the resulting color compared with the known CHEMISTRY 
731 
range, the pH value of the unknown solution being identical with that of the 
tube whose color it matches. 
Following are some of the more common indicators used and the pH range 
they cover: 
Indicator 
pH range 
Color change 
Acid 
Alkaline 
Brom-phenol blue 
3. 0- 4. 6 
4.4- 6. 0 
6. 2- 6. 8 
6. 0- 7. 6 
6.8- 8.4 
7. 2- 8. 8 
8.3-10.0 
Yellow 
Red 
Blue. 
Y ellow. 
Purple. 
Blue. 
Red. 
Red. 
Red. 
Brom-cresol purple . 
Brom-thymol blue_ 
Yellow 
Yellow 
Yellow 
Yellow 
Phenolphthalein 
Colorless 
Phenolphthalein is one of the most common indicators used, especially in 
titrating acids and alkali hydroxides. However, care must be employed in the 
choice of an indicator, as some are affected in the chemical reactions used 
for analysis, e. g., when titrating carbonates and ammonium compounds 
phenolphthalein cannot be used. In titrating carbonates methyl orange is 
used. In ammonia titration cochineal is used. It is also Important to note 
if the indicator to be used covers the pH range in which the end-point is 
to be obtained. 
are affected in the chemical reactions used 
Qualitative anaylsis 
Qualitative analysis is concerned only with the identification of the con- 
stituents of a compound. As previously stated the elements are divided into 
the metals and nonmetals. Upon solution, a substance dissociates into ions, 
the metals forming the positive ions and the nonmetals the negative ions. 
In determining the character of the positive ions it is found that a number 
of elements, often elements in the same family, are similar in that one type 
of their salts is insoluble in water which makes it possible to classify them 
in groups by precipitation and filtration. After the element has been isolated 
it is usually identified by its reaction with known reagents or by the color 
of its precipitate. The negative ions are also identified in a similar manner. 
Quantitative analysis. 
Quantitative analysis is concerned with the determination of the percentage 
of various elements and compounds contained in a substance. Quantitative 
analysis may be of two types: 1. Ultimate analysis in which the various ele- 
ments present in a substance are determined, as the determination of sodium, 
sulfur and oxygen in sodium sulfate; and 2. Proximate analysis in which is 
determined the groups of elements which act in a similar manner when treated 
with a reagent or series of reagents, as in determining the amount of insoluble 
matter in limestone. 
Quantitative methods of analysis may be performed by gravimetric or 
volumetric procedures. In gravimetric methods the substance to be deter- 
mined is isolated, dried, and weighed. In visual volumetric analysis the sub- 
stance to be determined is titrated against a volumetric solution containing 
a known quantity of material that will produce a definite reaction with the 
unknown. The completion of the reaction is signified by an appearance, the 
disappearance, or a change of color either natural or from an indicator that 
has been added, or by the end or beginning of precipitation. 
154294°—39 47 732 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Visual volumetric analysis is performed by one of the following methods: 
Acidimetry, in which the percentage of an acid is determined by neutraliza- 
tion with a standard alkali solution. An indicator is used. 
Alkalimetry, in which the percentage of an alkali is determined by neutral- 
ization with a standard acid solution. An indicator is used. 
lodimetry, in which the percentage of a substance is determined by indirect 
oxidation through the use of iodine. Iodine is also used in connection with the 
estimation of other halogens. 
Oxidimetry, in which the percentage of a substance is determined by direct 
oxidation through the use of potassium permanganate or some other sub- 
stance capable of yielding oxygen. 
In volumetric determinations there are three general types of reactions em- 
ployed, direct, indirect and residual. 
In the direct type a known solution is added directly to the unknown until 
the reaction is complete, as in alkalimetry and acidimetry. 
The indirect type is used where the quantity of the unknown cannot be con- 
veniently determined unless it is acted upon by a second substance to form an- 
other compound which is in proportion to the quantity of the unknown. This 
second compound is then titrated to find the percentage of the unknown, as in 
the determination of chlorine. The substance containing chlorine is acted upon 
by potassium iodide, iodine being liberated in proportion to the amount of 
chlorine; the iodine is then titrated against a known solution of sodium thiosul- 
fate, starch paste being used as the indicator. 
The residual type is used where it is impossible or extremely difficult to ob- 
tain a reaction between the unknown and the reagents when equivalent quanti- 
ties are added to each other. Therefore, an excess of the standard solution is 
added to the unknown to obtain a complete reaction and then a second standard 
solution is used to titrate the amount of the first solution that remains. The 
percentage of the unknown is determined from the quantity of the first solution 
used in the reaction, as in the determination of sodium chloride. A definite 
quantity of silver nitrate is added in excess to the unknown solution. After 
the reaction is complete the amount of silver nitrate left from the reaction is 
titrated against a standard solution of sodium sulfocyanate, ferric ammonium 
alum being used as an indicator. The amount of silver reacting with the sulfo- 
cyanate solution is then subtracted from the original quantity added. From 
this the equivalent amount of sodium chloride is determined. This is known as 
“back titration”. 
If it is desired to determine the percentage of sodium hydroxide in a given 
solution proceed in the following manner: 
1. Measure the solution to obtain its volume. 
2. Into a 25 cc burette place an N/l solution of hydrochloric acid and 
bring the meniscus exactly to the 0 mark. 
3. Place 10 cc of the sodium hydroxide solution in a 250 cc white porcelain 
evaporating dish and add 3 drops of phenolphthalein indicator. 
4. Allow the HC1 solution to run slowly into the evaporating dish con- 
taining the NaOH solution, stirring constantly. 
5. When the solution becomes visibly paler, add the HCl, a drop at a time, 
noting the reading on the burette after each addition. When the NaOH 
solution shows just the faintest tint of pink and the addition of one more 
drop will make it colorless, the end-point of the reaction has been reached. 
From the reading on the burette calculate the percentage of NaOH. 
If the NaOH solution measured 350 cc and neutralization was obtained with 
8 cc of HCl, the percentage is calculated in the following manner: 733 
CHEMISTRY 
N/l solution of NaOH contains 40.0 Gm. of NaOH per 1000 ce. 
1 ce of N/l HC1 is the equivalent of 0.040 grams of NaOH. Therefore: 
q^o 
8 X 0.040=0.320 Gm. of NaOH in 10 cc, and in 350 cc there areX 0.320= 
11.21 Gm. of NaOH. 
The percentage of an acid is determined in the same manner. 
Other analytical procedures involve more complicated reactions and for 
these reference should be made to a standard text on chemical analysis. 
References 
General Chemistry.—B. S. Hopkins. 
General Chemistry.—H. N. Holmes. 
General Chemistry.—H. G. Deming. 
A Course in General Chemistry.—McPherson and Henderson. 
Textbook of Inorganic Chemistry.—J. R. Partington. 
Organic Chemistry.—J. F. Norris. 
Modern Chemistry.—F. Prescott. 
Modern Physics.—C. E. Dull. 
Physics.—O. M. Stewart. 
Hospital Corps Handbook, U. S. Navy, 1923. 
Handbook of the Hospital Corps, U. S. Navy, 1930. CHAPTEK X 
ANAESTHESIA 
Anaesthesia is the state in which total or partial loss or absence of feeling 
or sensation exists and may be the result of disease or injury, or of the 
administration of an anaesthetic agent. It is known as general or regional 
{local), according to the extent of insensibility to pain. 
The combination of gas-ether anaesthesia is still used extensively, although 
it is being replaced to a great extent by the cyclopropane-ether-oxygen mixture. 
Ethylene-oxygen is being used less because it has only a 25 per cent potency, 
while cyclopropane, with 100 per cent potency, gives the same rapid type of 
induction and recovery, with deeper anaesthesia. As more surgeons become 
familiar with spinal anaesthesia, recognizing its safety, they adopt it for most 
operations below the diaphragm. Patients have less postoperative complica- 
tions from spinal and regional anaesthesia than from the other types. 
REGIONAL ANAESTHESIA 
Regional or local anaesthesia produces loss of sensibility to pain in the area 
or region involved, which may be small or extensive, depending upon the 
method used and site of injection. There is no loss of consciousness. There 
are four different types of regional anaesthesia: 1. Surface or topical anaesthe- 
sia ; 2. Infiltration anaesthesia; 3. Block anaesthesia; and 4. Spinal anaesthesia. 
Surface or topical anaesthesia. 
This type of regional anaesthesia is produced by the instillation or applica- 
tion of an anaesthetic agent directly on the tissue to be anaesthetized, usually 
the mucous membranes of the eye, nose, mouth, urethra, and anus. It is also 
applicable to painful skin ulcers and itching dermatitis. The four most com- 
monly used drugs are: Cocaine hydrochloride, (C17H21NO.HCI) ; metycaine 
hydrochloride, (CcHi.COOCCHsh.NCeHu.HOl) ; nupercaine hydrochloride, 
(aHr,N.OC4HD(2).CONH(CH2),N(C2H3)2HCl(4) ; and pontocaine hydrochloride, 
(C4H0NH.CcH4COO.aH4N (CHS) >. HC1). 
Cocaine Hydrochloride.—For instillation in the eye a 4 per cent solution 
is used. Two to four drops instilled in the eye at intervals of 3 to 5 minutes 
for a period of one-half hour will produce sufficient anaesthesia to permit 
operations on the eye. For internasal operations the nose is packed with 
pledgets of cotton soaked with a 20 per cent solution. 
Cocaine should never be used for local infiltration, block or spinal anaethesia 
as it is a very potent protoplasmic poison. Certain individuals are very 
susceptible to its action and grave systemic reaction may result even with 
topical applications. This reaction is manifested by rapid pulse, dilatation 
of the pupils, facial pallor, shortness of breath, anxiety and restlessness. The 
more serious cases may have convulsions and loss of consciousness, with the 
skin becoming cold and livid. Treatment for restlessness and anxiety consists 
in giving a barbiturate, such as pentobarbital sodium, 3 grains intravenously, 
and in addition institute artificial respiration. Do not give epinephrine, as 
the cocaine has already caused vasoconstriction. 
735 736 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Metycaine Hydrochloride.—This drug can be used for topical application, 
local infiltration or spinal anaesthesia. It is somewhat more toxic than pro- 
caine, but its potency permits the use of a smaller dose, especially for spinal 
anaesthesia, thus making the therapeutic doses of each equal as to toxicity. 
For surface or topical anaesthesia a 1 per cent solution is used, and for 
infiltration anaesthesia 0.5 to 2 per cent. 
Nupercaine Hydrochloride.—In a 1 per cent solution it will anaesthetize 
mucous membranes, but due to its extreme potency and toxicity it should not 
be used repeatedly over a period of several days. 
Pontocaine Hydrochloride.—This drug is 10 times more toxic and 10 times 
more potent than procaine of which it is a derivative. For mucous membrane 
anaesthesia it can be used in a 1 per cent solution. It may also be used in 
a 1 per cent ointment, but like nupercaine, should not be used over a long 
period of time. Its most common use is for spinal anaesthesia. 
Infiltration and Block anaesthesia. 
Local infiltration consists of injecting the tissues at the site of the incision. 
All tissues to be cut must be injected. This method is applicable for minor 
surgical procedures but should not be used where tissues with infection are to be 
incised, as the injection will be painful and there is chance of spreading the 
infection to the lymphatics or blood stream. 
Block amesthesia is produced by injecting the solution around the area to be 
operated on. This procedure is considered superior to local infiltration and is 
applicable to nearly every part of the body. After local infiltration the incision 
can be made immediately, but with field block 5 to 15 minutes must intervene. 
In nerve block the injection is made around or into the nerves which supply 
the field of operation. 
Procaine hydrochloride (C13H20O2N2.HCI), different brands of which are known 
as Novocaine and Neocaine, is the anaesthetic of choice for infiltration and block 
anaesthesia. A 0.5 per cent solution is sufficiently strong for all infiltration and 
field block anaesthesia. For nerve block a 1 or 2 per cent solution should be 
used. The anaesthesia may be prolonged by the addition of epinephrine which is 
due to the fact that epinephrine causes a constriction of the blood vessels at the 
site of the injection and thus delays absorption of the anaesthetic agent. There 
is also less bleeding as a result of this vasoconstriction. For each 200 cc of 0.5 
per cent procaine solution 16 drops or 1 cc of a 1 to 2,600 solution of epinephrine 
is added. 
With patients considered a good risk it is safe to use the following maximal 
amounts of procaine; 300 cc of 0.5 per cent solution; 100 cc of 1 per cent 
solution ; 40 cc of 2 per cent solution. 
Spinal anaesthesia. 
This is a regional nerve block accomplished by injecting the solution into the 
spinal canal. Another special type of anaesthesia is caudal block in which the 
sacral nerves are anseesthetized by an injection of an anaesthetic solution into 
the sacral canal. Spinal anaesthesia will permit any operation from the level 
of the diaphragm downward, while caudal anaesthesia limits the field of opera- 
tion to the structures supplied by the sacral nerves, the pelvic viscera, perineum, 
etc. 
The drugs used for spinal anaesthesia are, in the order of choice: Procaine hy- 
drochloride, metycaine hydrochloride, pontocaine hydrochloride, and nupercaine 
hydrochloride. 
Procaine Hyrochloride.—The dosage of procaine hydrochloride for spinal 
anaesthesia varies from 50 milligrams to 200 milligrams, the maximal dose. For ANAESTHESIA 
737 
high abdominal operations 200 milligrams are dissolved in 3 cc to 6 cc of spinal 
fluid and injected into the spinal canal at the third or fourth lumbar interverte- 
bral space. This will give an anaesthesia lasting about 1 hour. For operations 
on the lower abdomen 150 milligrams will suffice and 50 milligrams for short 
operations on the lower extremities. 
Metycaine Hydrochloride.—For spinal anaesthesia 75 milligrams of metycaiue 
hydrochloride is equivalent to 100 milligrams of procaine hydrochloride. It is 
given interspinally the same as procaine with approximately 30 to 40 per cent 
longer duration of anaesthesia. 
Pontocaine Hydrochloride.—This agent is obtainable in ampules containing 
10 milligrams in crystal form for use in spinal anaesthesia. It is also available 
in ampules containing 2 cc of a 1 per cent solution representing 20 milli- 
grams. The adult dose ranges from 5 milligrams to 20 milligrams. The usual 
site of injection is between the twelfth thoracic and first lumbar vertebrae. 
Anaesthesia lasts from 2 to 3 hours. 
Nupercaine Hydrochloride.—For spinal anaesthesia a 1 to 1,500 solution is 
used. It produces long anaesthesia and is extremely potent and toxic. 
General anaesthesia produces a state of unconsciousness associated with 
general loss of sensation, including, of course the loss of sensibility to pain. 
Usually the induction is by inhalation, but may be by intravenous or rectal 
administration of the anaesthetic agent. The principles governing the admin- 
istration of general anaesthetic agents have advanced remarkably during recent 
years. 
The trained anaesthetist is not satisfied with merely keeping his patient 
under the influence of the anaesthetic, as was formerly the practice, but 
endeavors to induce and maintain a light, even, surgical stage of anaesthesia 
during the entire operation. The various factors which influence the proper 
administration of the anaesthetic are discussed in more detail at the end of this 
section. 
The anaesthetist is required in many instances to assume great responsibili- 
ties, and should acquire a thorough knowledge of the methods of anaesthesia 
and how to handle patients. In this connection it should be emphasized that 
patients awaiting operation frequently and needlessly are alarmed by a care- 
less or thoughtless remark made by the attending hospital corpsman. This 
is especially true in the operating room during spinal anaesthesia and the early 
stages of general anaesthesia while the patient is still conscious. At such 
times his hearing is often very acute, and he is likely to hear conversation 
concerning his condition which might cause him needless anxiety and add to 
the risks of the operation. 
The responsibility of the anaesthetist does not terminate upon completion 
of the operation. He is directly responsible for the patient during his trans- 
portation from the operating table to his bed and until properly relieved by 
a competent attendant. 
GENERAL ANESTHESIA 
Inhalation anaesthesia. 
Inhalation anaesthesia is based upon the laws of diffusion of gases and 
vapors. During induction of anaesthesia the diffusion is from the lung alveolar 
air spaces to the blood and tissue cells, the direction of lessening partial 
pressure. Upon discontinuing anaesthesia the flow is reversed. 
The main factors governing the efficiency and rapidity of anaesthesia are 
the potency of the agent, and the method of administration. These two 738 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
factors are responsible for anaesthetic concentration in the alveolar air and 
rapidity of diffusion through the alveolar membrane to the blood, which in 
turn carries the anaesthetic agent to the tissue cells, especially those of the 
brain. It is the saturation of the brain tissues with the anaesthetic agent 
which causes general anaesthesia. The rapidity with which an agent is absorbed 
by the brain tissues decides the rapidity of anaesthesia, and likewise the rapidity 
Figueb 153.—Schema of inhalation anaesthesia (after Guedel). 
of elimination by the brain tissues determines the speed of recovery from anaes- 
thesia. It must be remembered that once the brain tissues become saturated 
sufficiently to produce anaesthesia it will take much less of the anaesthetic 
agent to keep the patient in this state. 
Stages of Inhalation Anesthesia.—The four stages of inhalation anaes- 
thesia are represented in Fig. 153. It also shows the relative duration of these 
stages which, according to Guedel, is constant with all inhalation anaesthetic 
agents. ANAESTHESIA 
739 
The time required to carry anaesthesia through all stages by various agents, 
is as follows: 
minutes 
Ether 10 to 30 
Chloroform 4 to 12 
Nitrous oxide 1 to 4 
Ethylene 1 to 4 
Ethyl chloride 1 to 4 
Cyclopropane ya to 3 
This time is average and is flexible, depending on such conditions as age, risk 
group, etc. 
First stage.—This lasts from the beginning of anaesthesia to the loss of con- 
sciousness. No attempt should be made to perform any operation in this stage. 
During this stage the respiration is normal until the approach of the second 
stage when it is increased. If during this stage respiration ceases it is due 
to the anaesthesia being forced. The patient is holding his breath, the result 
of laryngeal irritation. The pupils, with no preanaesthetic medication, will be 
dilated or normal depending upon the emotional reaction. If morphine has been 
given the pupils will be contracted. The eye-lid reflex is present. This reflex 
is elicited by raising the upper lid and upon being released it will close. 
Second stage,—While this stage is short in duration it is the danger stage. 
Death may occur from physical injury or ventricular fibrillation and cardiac 
failure. Avoid all unnecessary external stimulation, such as handling the 
patient, loud talking, clatter of instruments and utensils, and surgical prepara- 
tion of the field of the operation, etc. The patient should be well strapped to 
the table and not touched unless he attempts to fight the anaesthesia. It must 
also be remembered that the patient can become delirious emerging from the 
third stage to the second. The greatest eye-ball activity is in this stage, the 
extraocular muscles moving them back and forth. 
Third stage.—This stage is divided into four planes and is the stage of 
surgical anaesthesia. In the first plane of the third stage the respiration is 
rhythmic and full with an increase of volume. The eye-ball activity in this 
plane gradually diminishes and when it ceases the second plane is reached. 
Eccentric fixation of the eye-ball is sometimes present instead of the eye-ball 
activity, but as the second plane is approached the eye-ball returns to its 
normal position. When no preansesthetic medication has been given the pupil 
returns to normal. The size of the pupil varies with preansesthetic medication. 
The eye-lid reflex is absent. When the anaesthesia goes from the third stage 
to the second (patient coming out of anaesthesia), the swallowing reflex may 
become evident and precedes vomiting. 
In the second plane respiration remains the same and the pupil usually 
begins to dilate. 
In the third plane there is intercostal muscular paralysis and respiration 
becomes diaphragmatic. This can be detected by watching the thoracic move- 
ment or by placing a hand on the anterior thoracic wall. With complete 
intercostal paralysis there is no motion of the thorax, (lower part of third 
plane). Pupillary dilatation increases. 
In the fourth plane respiration becomes shallow and the pupils completely 
dilated. Cyclopropane produces very little pupillary dilatation up to the fourth 
stage. 
Fourth stage.—This is the stage of respiratory paralysis and failure and is 
followed by cardiac failure. 740 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Open Drop Ether Technique.—Ether is dropped upon a wire mask covered 
with gauze which is held a few inches over the patient’s face for a short period 
so as to accustom him to the odor. It is then placed over the nose and mouth 
and no attempt is made to further confine the vapor by wrapping the mask. 
Guedel has worked out a very good system governing the amount of anaes- 
thetic agent to be used which is as follows: “A fair guide to the dropping rate, 
which of course is only approximate, depends upon the size of the drops and 
the thickness of the gauze mask, is 12 drops the first minute 24 drops the sec- 
ond minute, 48 the third minute and 96 the fourth minute, doubling, each 
minute, the rate of the minute before. A rough guess of the percentage of 
ether vapor under the mask from this rate of dropping would be about one per 
cent the first minute; three per cent or four per cent the second minute; six 
per cent or seven per cent the third minute; and ten per cent or twelve per 
cent the fourth minute, which last figures represent approximately total satura- 
tion of the ordinary mask. 
“It has been estimated that six per cent or seven per cent ether vapor under 
the mask is necessary for the maintenance of anaesthesia once it is estab- 
lished * * *. 
“With the above rate of dropping of the ether the patient should pass into 
the second, or delirium stage of anaesthesia in about 4 minutes. The ether con- 
centration inspired at that time is 10 per cent or 12 per cent, which is much 
higher than is necessary for maintenance. However, we must hold to this high 
concentration until we have driven the anaesthesia down to the desired 
stage * * *. It is impossible to figure the course of an anaesthesia mathemat- 
ically, but we may estimate that complete saturation of the mask must be main- 
tained from the fifth to the tenth minute after anaesthesia is started in an ordi- 
nary adult, and probably longer than this * * *. To summarizie the rate of 
ether administration, we may state that during the first 15 minutes it is carried 
as rapidly as possible to full saturation of the mask; about 100 drops per minute. 
During the second 15 minutes the rate is lowered to approximately 50 drops; 
during the third 15 minutes 20 or 30 drops and from this time on it is carried 
somewhere near the last figure. Again it is necessary to state that any esti- 
mate of the number of drops required or the percentages that exist under the 
gauze mask, cannot even approach accuracy. They are stated in this manner, 
only as a guide.” 
Sbmicloseid Method.—Is the same as the open drop method except that the 
mask is wrapped with towels, wet or dry, to prevent loss of anaesthetic vapor 
and retention of some of the expired carbon dioxide. By cutting down carbon 
dioxide depletion of the body the acid-base equilibrium of the blood is better 
maintained. Also the increase of carbon dioxide causes an increase in the 
amount of tidal air which with the higher concentration of anaesthetic agent 
will produce a faster induction of anaesthesia. The standard gas-oxygen ether 
machines used in the Navy give a semiclosed method of anaesthesia induction. 
Closed Method.—This method necessitates the mask being tightly secured 
around the nose and mouth, thereby preventing any loss of anaesthetic agent. 
The accumulation of carbon dioxide is absorbed by soda-lime placed in a by- 
pass between the breathing bag and anaesthetic mask. This can be cut in or 
out so as to regulate the carbon dioxide concentration. This feature was per- 
fected by Waters and it allows the use of a minimal amount of agent and 
conserves the body heat and moisture. Special machines must be used for this 
method. 
Drugs Used for Inhalation Anesthesia.—Nitrous oxide (N20).—A color 
less gas with a specific gravity of 1.527. It is not inflammable, but forms an ANAESTHESIA 
741 
explosive mixture when combined with ether, ethylene, or oxygen. To be a 
good anaesthetic gas it should be not less than 95 per cent pure. To produce 
anaesthesia there must be a concentration of at least 80 per cent by volume. It 
produces no irritation to the respiratory tracts, and has about a 15 per cent 
potency. (See fig. 153.) Unless there is sufficient preanaesthetic sedation it 
will be difficult to carry the anaesthesia beyond the middle of the first plane, 
third stage. In attempting to obtain a deeper anaesthesia where there has been 
insufficient preanaesthetic medication given the oxygen content of the anaesthetic 
mixture is reduced. This reduction of oxygen, if continued, will produce 
anoxaemia and anoxia with a resulting acidosis. The closed method is em- 
ployed and it can be used in the presence of a flame or cautery. It is applicable 
to operations of short duration and where deep anaesthesia with complete 
muscle relaxation is not essential. Nitrous oxide should be used with caution 
in the presence of high blood pressure, toxic goiter, and cardio-vascular disease. 
A trained anaesthetist only should administer it. 
Ethylene (GtH*).—A colorless gas with a specific gravity of 0.8. It is inflam- 
mable and has a pungent odor and sweetish taste. Mixed with nitrous oxide it 
is highly explosive. Its potency is about 25 per cent, anaesthesia being carried 
to the lower border of the first plane in the third stage which is slightly more 
than nitrous oxide. It will permit the use of a higher percentage of oxygen 
to produce the same anaesthesia, hence there will be less chance of acidosis. 
It is administered by the semiclosed or closed carbon-dioxide-absorption method. 
As it is highly inflammable it should not be used in the presence of a cautery. 
Ethylene can be used for much the same conditions as nitrous oxide, and like 
the latter it does not give good muscular relaxation, although the relaxation 
is better than with nitrous oxide. 
Cyclopropane (CsHs).—A colorless, inflammable gas, having a specific gravity 
of 1.46. It is supplied in cylinders and like nitrous oxide and ethylene is admin- 
istered by the closed method. Its absorption and elimination by the body 
tissues is rapid, thus producing a rapid induction and recovery from anaes- 
thesia. It is nonirritating to the respiratory tract and unlike the other 
inhalation anaesthetic agents it does not stimulate respiratory function. Cyclo- 
propane has a 100 per cent potency and when administered produces similar 
physical signs to those of ether in the various stages of anaesthesia. There 
are not, however, the irritating effects that are present with ether in the first 
and second stages. It must be remembered that with cyclopropane there is 
but little pupillary dilatation. The depth of anaesthesia is governed by the 
depth of respiration. 
Ether (C2H5.O.C2H5).—A transparent, colorless, inflammable liquid which vola- 
tilizes at room temperature. Ether vapor is 2.6 times heavier than air and 
when mixed with oxygen, nitrous oxide or air it is explosive and inflammable. 
When ether contacts the skin and is covered with a towel, thus preventing 
evaporation, it will cause a burn. If dropped in the eye, it will produce 
conjunctivitis. It has a 100 per cent potency and can be given by the open, 
semiclosed, or closed method. 
Chloroform (CHC13).—A colorless liquid with a pleasant odor, the vapor 
being 4.1 times heavier than air. It is not explosive, and has an anaesthetic 
potency of 100 per cent. As it is highly toxic to the liver and the cardio- 
vascular and nervous systems, and produces deep anaesthesia rapidly, it is con- 
sidered an unsatisfactory anaesthetic agent. It is not inflammable but its heated 
vapor burns with a green flame, and care must be taken not to vaporize it in 
the presence of a naked flame because of the production of noxious gases. 742 
HANDBOOK OF THE HOSPITAL CORPS, XI. S. NAVY 
Ethyl chloride (CH3.CH2CI).—A colorless, inflammable liquid, the vapor 
being 2.2 times heavier than air. When sprayed on the skin it will freeze the 
superficial tissues, giving local anaesthesia. It can also be used for inhalation 
anaesthesia, but because of its being so volatile it is hard to maintain the 
anaesthetic levels. It is not recommended for inhalation anaesthesia. 
Divinyl oxide (CEL : CHOCH : CH2).—Known also as divinyl ether, vinyl ether, 
and vinethene. A colorless and inflammable liquid; it is given by the drop 
method. Induction and recovery are rapid, the absorption and elimination 
rate being twice that for ether. Physical signs of anaesthesia are practically 
the same as for ether. It is not recommended for long operative procedures. 
Further investigation must be made with respect to the value of divinyl oxide 
as an anaesthetic agent. 
With the exception of nitrous oxide and chloroform these drugs are all inflam- 
mable and, with the exception of chloroform and ethyl chloride, all are explosive. 
Therefore great care must be taken to avoid using those that are inflammable 
or explosive, or are both, near an open flame such as is found in a lighted gas 
jet, lamp, burning candle, or stove, or in the vicinity of a hot cautery or elec- 
tric spark. Carelessness in this respect has been the cause of many explosions 
and burning with fatal results. Electric sparks are the most common cause of 
explosions in anaesthesia, static sparks occurring within the anaesthetic appara- 
tus or between the patient’s face and the mask most frequently causing fatal 
explosions. 
Administration of the Anaesthetic in Inhalation Anaesthesia.—The choice 
of the anaesthetic to be used is left entirely to the medical officer in charge of 
the case, and is governed by the condition of the patient, the type of operation, 
the climatic conditions, and the type of agent available. 
The hospital corpsman is particularly interested in the last two conditions. 
In very hot climates, as in the tropics, it is frequently next to impossible 
to induct general anaesthesia with ether, as it is so volatile that evaporation 
occurs almost immediately upon release from its container. Under such con- 
ditions it may be necessary to use chloroform. As nitrous oxide and ethyl 
chloride usually are not available in sufficient quantities outside of hospi- 
tals, dependence must be placed upon ether and chloroform. It is therefore 
essential that the hospital corpsman become thoroughly familiar with the 
administration of these two ansesthetic agents, especially the former. 
Insufficient oxygenation of the blood is the cause of most of the difficulties in 
securing a quiet, peaceful, satisfactory anaesthesia, and of a large percentage 
of fatalities in connection with the use of anaesthetics. 
The first important object, therefore, is to maintain a clear air passage 
in the patient. The anaesthetist should familiarize himself with the signs of 
obstructed breathing and should be able to recognize and overcome these 
obstructions as they occur. The most common causes of obstruction of the air 
passages are partial obstruction of the nasal passages, frequently found in 
otherwise normal individuals; the presence of mucus or vomitus in the mouth, 
pharynx, and naso-pharynx; firm closure of the jaws in the early stage of 
anaesthesia (patients with no teeth are prone to press their upper and lower gums 
together so firmly that very little or no air can enter) ; dropping of the lower 
jaw and “swallowing” of the tongue; position of patient with reference to 
mechanical pressure; spasm of the laryngeal muscles. 
The only sure practice to follow in observing the patient’s breathing is to 
hear or feel every respiration. As the patient’s respiratory efforts continue for 
some time even though the air passages are obstructed, it is not enough that the ANESTHESIA 
743 
anaesthetist should only see the chest and abdominal movements; he must be 
certain that respiration actually is taking place. 
Mucus or vomitus should be removed with a gauze sponge held in forceps. 
Dropping of the jaw and “swallowing” of the tongue should be overcome by 
light, even pressure under the jaw. In this connection it may be stated that 
long continued pressure over a small area of the jawbone may cause considerable 
soreness and tenderness for several days. It is occasionally necessary to hold the 
tongue forward by means of tongue forceps, although this procedure should 
be avoided if possible. Turning the patient’s head to one side allows the 
drainage of mucus and other secretions and frequently prevents the backward 
drop of the tongue and jaw. 
Laryngeal spasm usually is due to reflex action; a most frequent cause is too 
strong anaesthetic vapor. Withholding of the anaesthetic frequently will over- 
come the spasm. Impending vomiting with its resulting laryngeal spasm may be 
prevented by deepening the anaesthesia. 
The question which naturally arises in each and every case is “How far is 
the patient under the influence of the anaesthetic?” It is essential that the 
anaesthetist know the exact degree of narcosis present at any and every given 
moment of anaesthesia. The requirements of the operation decide the depth of 
anaesthesia desired in each case. Constant practice in administering anaes- 
thetics is necessary to obtain a knowledge of the finer details concerning general 
anaesthesia. 
Induction of Ether Anesthesia.—The open-drop technique of administering 
ether for general anaesthesia is considered the best as the amount of mucus 
secreted is generally much less, the tendency to coughing and labored breath- 
ing is decreased, the patient’s color is better, and the pulse rate and blood pres- 
sure are well maintained. Most of the effects of deficient oxygenation of the 
blood do not occur, as this method permits the admixture of an adequate supply 
of oxygen from the air. 
When the patient is in as comfortable a position as possible the face should 
be anointed with a bland ointment and the eyes covered with a layer of gauze. 
The mouth and nose then are covered either with one of several types of gauze 
mask or with three or four strips of gauze. It is best to allow the patient to 
breathe several times with the gauze in position in order that the patient may 
become accustomed to its presence and also to determine whether or not the 
thickness of the gauze is too great to permit free and easy respiration. 
Before beginning the administration of the anaesthetic, which to some patients 
may be very disagreeable, it is frequently desirable to drop a few drops of oil 
of bitter orange peel on the gauze. This is then followed by the ether, which 
should be administered drop by drop, very slowly at first, then gradually in- 
creasing the amount until the patient can take the strongest vapor. The ether 
should be dropped over an area involving the mouth and nares. The patient 
should never be hurried and should never be advised to breathe deeply, as a 
feeling of suffocation will ensue and the patient is also likely to struggle. 
During the administration of the anaesthetic the anaesthetist should talk con- 
stantly to his patient in order to maintain the latter’s confidence. In other 
words, the anaesthetist should talk his patient to sleep. By this method under 
ordinary conditions the patient can be brought under the influence of ether in 
from four to six minutes. 
The four stages of inhalation anaesthesia with ether will next be described, 
omitting reference to the four planes of the third stage. 1. In the stage of 
analgesia, or light anaesthesia, occurs the primary decrease of consciousness 744 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
accompanied by a feeling of asphyxia and ringing in the ears. Respiration is 
accelerated; the blood pressure is increased slightly; the pulse becomes full 
and bounding; and the color of the skin becomes heightened. Concentrated 
vapor in this stage will cause coughing, holding of the breath, swallowing, 
spasm of the glottis, muscular rigidity, turning of head from side to side and 
slight dilatation of the pupils. 2. In the stage of delirium, or excitement, the 
controlling centers in the cerebrum are depressed and there is incoordination 
of movements and speech, which may amount to violent struggling and shout- 
ing. Memory, volition, and intelligence are interfered with; consciousness is 
partially or wholly lost; marked rigidity of muscles supervenes; the pupils are 
dilated and mobile; secretions of the respiratory tract are increased markedly; 
the face is very flushed; perspiration is evident and the breathing may be irregu- 
lar. As the patient passes from this stage to the third stage, vomiting is not 
infrequent. Patients addicted to the use of alcoholic liquors frequently require 
a rather forced administration of the anaesthetic during this stage. In the 
stage of surgical anaesthesia the cerebrum and spinal cord are paralyzed, sensa- 
tion to pain is lost, and there is complete unconsciousness and relaxation. 
The respirations are deep, regular, and generally audible. A soft stertor may be 
considered normal. A strong stertor indicates obstruction of the air passage 
which requires immediate attention. The color of the face, ears, and lips is 
normal; the pupil is usually normal or contracted, but reacts to light; and 
the eyeball is eccentric or oscillatory. If the eyeball is stationary on center 
with pupil dilated, the patient is receiving too much ether, the administration 
of which should be discontinued at once. The lid reflex is weakly active; 
coughing and phonation are absent; and the heart action is accelerated. As 
anaesthesia progresses the face may become more flushed than normal. From 
the third stage the patient may change in the direction of consciousness or of 
deepening narcosis, the fourth stage. Returning consciousness is indicated by 
the following signs: Respiration regular, not full, but quiet; pallor of face; 
moderate dilatation of the pupils with light reflex ; increased activity of lid reflex ; 
swallowing movements ; return of phonation. 4. The stage of respiratory paraly- 
sis, or dangerous stage, is the stage of overdose of the anaesthetic. The 
medulla oblongata becomes paralyzed and asphyxia and weakened circulation 
follow. Death occurs in this stage from paralysis of the respiratory center 
in the medulla. The signs of the fourth stage are weak, shallow respiration, 
cyanosis, soft feeble irregular pulse, dilatation of pupils with no reaction to 
light, absence of lid reflex, central fixation of eyeballs, separation of eyelids, and 
fall of blood pressure. 
Treatment of Emergencies.—While every effort should be made to prevent 
the occurrence of emergencies, it is nevertheless true that, even in the hand of 
the most expert anaesthetists, various crises may occur which require immediate 
treatment. These emergencies or crises may be grouped under two headings, 
those due to respiratory failure and those due to circulatory failure. Reference 
already has been made to certain causes of respiratory obstruction and the 
indicated remedial measures have been discussed. The main effort in cases of 
respiratory failure should be directed toward clearance of the air passage and 
maintenance of the act of respiration. If the latter be not voluntary, artificial 
respiration is indicated. Regular pressure on the chest, drawing the tongue for- 
ward and lowering the head usually will restore normal breathing. If this pro- 
cedure fails, it may be necessary to perform artificial respiration in accordance 
with the Sylvester method. Large amounts of fluid in the abdominal and pleural 
cavities may be the cause of respiratory embarrassment, and measures directed 
toward at least partial removal of these causes should be instituted. ANESTHESIA 
745 
The loss of the pupillary and corneal lid reflexes, associated with feeble 
respiration and, increasing cyanosis, indicates paralysis of the respiratory 
center in the medulla. A hypodermic injection of atropine sulfate should be 
given immediately and artificial respiration instituted and continued until 
normal breathing is resumed. Anaemia of the brain, due to extensive haem- 
orrhage or to chloroform, is counteracted by lowering the head and raising 
the lower limbs if necessary. 
Circulatory failure recognized by a running, feeble, or irregular pulse, in- 
creasing pallor, and feeble respirations must be overcome by stimulation of 
respiration as indicated above and by the administration hypodermically of 
cardiac stimulants (caffeine, epinephrine, etc.). 
Any change in the general condition of the patient should be communicated 
immediately to the operating surgeon. The latter depends upon the anaes- 
thetist to inform him concerning the progress of the anaesthesia, and the 
anaesthetist should not hesitate to institute whatever measures are indicated 
to promote a successful anaesthesia. 
Intravenous anaesthesia. 
The two anaesthetic agents commonly used in intravenous anaesthesia are: 
Evipal soluble, or sodium cyclural, (Sodium N-Methyl-cyclohexenyl-methylma- 
lonylurea) ; and Pentothal sodium (Sodium ethyl (1-methyl butyl) thiobarbitu- 
rate). Both are derivatives of barbituric acid and are obtainable in ampules 
containing 15 grains (1 Gm.) each. The method of administration and the 
effects of both are the same, so the technique described herewith will apply 
to either. Pentothal sodium is the more potent of the two, requiring less 
dosage and giving more relaxation. 
Technique of Administration.—The contents of one ampule (1 Gm.) is 
dissolved, in 20 cc of triple-distilled sterile water making a 5 per cent solution. 
Each cubic centimeter of this solution contains % grain of the agent. This 
is drawn up into a 20 cc syringe to which is attached a 20 gauge needle. 
A vein is selected, preferably in the arm, the skin is prepared and the arm 
draped. The vein is punctured with the needle and the solution injected 
slowly. At the time the injection is started the patient is told to count 
slowly and usually can only count to seven or ten before becoming anaes- 
thetized. By this time (5 to 15 seconds) from 2 to 4 cc’s have been injected. 
This will give from 15 to 30 minutes anaesthesia. To give further anaesthesia 
an additional 1 or 2 cc’s of the solution is injected after the patient shows 
signs of recovering from first injection. Recovery is indicated by movements, 
deepening respiration, and increased muscle tone. The two things that must 
be maintained are unobstructed air passage and sufficient depth of respira- 
tion. Four cc’s of the 5 per cent solution given rapidly can stop respiration, 
and 2 cc in the aged will produce the same bad effect. 
Preliminary medication is the same for this type of anaesthesia as for 
others except that where the surgical procedure will last but a few minutes, 
the preanaesthetic medication can be omitted. 
Rectal anaesthesia. 
This type of anaesthesia, also known as colonic, is produced by the instillation 
of a drug into the rectum. The two commonly used drugs are avertin (tribrom- 
ethanol (CBrs.CHaOH) dissolved in amylene hydrate) and ether and oil. 
Avebttn gives sedation simulating sleep but is not analgesic; therefore pain 
stimuli will arouse the patient. It depresses respiration and circulation but 
less postoperative medication is needed, and is safe for use in conjunction 
with other anaesthetic agents. Avertin is a white crystalline substance and 746 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
must not be exposed to sunlight or alcohol. Elimination is by the liver and 
to some extent by the kidneys. Anaesthesia with this agent will last from 1 
to 4 hours, averaging iy2 hours. Following the period of anaesthesia the 
patient usually has a period of peaceful sleep lasting from 3 to 6 hours. It 
should be used with caution where there is evidence of disease of the kidney, 
liver or rectum. 
The dosage is governed by the patient’s weight and age and the solution 
prepared in accordance with a special table. It should be given only under 
the supervision of a medical officer. 
Preparation of patient.—Give a cleansing enema, not soap-suds, the day 
before operation and a sedative the night before. Repeat the enema on the 
morning of operation. Preanaesthetic medication should be given 1 hour before 
operation. Following the operation any anaesthetic remaining in the rectum 
should be siphoned off and the rectum cleansed with 1 quart of warm water. 
The anaesthetic tray should contain the following articles; 
1. Large catheter. 
2. Rubber tubing with connection for catheter. 
3. Funnel to fit into tubing. 
4. Special mixing flask and cork. 
5. Large pan to hold hot water and flask. 
6. Distilled water. 
7. Thermometer (centigrade). 
8. Graduate (cc). 
9. Bottle of Congo red with dropper. 
10. Lubricant. 
11. Draw sheet (1) ; Tow'els (4). 
In Oil-ether Anesthesia a combination of ether and olive oil is given rec- 
tally by means of rectal tube or large catheter and funnel. The systemic effect 
is the same as when ether is administered by inhalation. The mixture used 
consists of 6 fluidounces of ether and 2 fluidounces of olive oil which makes a 
75 per cent mixture. The dose of this mixture is on the basis of 1 fluidounce 
to each 20 pounds of body weight, and a man weighing 140 pounds would there- 
fore require 7 fluidounces. The patient is prepared the same as for avertin 
anaesthesia, except that the skin over the sacrum and perianal region must be 
protected with petrolatum for the oil-ether mixture is very irritating to the skin. 
The genitalia and inner aspect of the thighs must he well draped. At the finish 
of the operation any anaesthetic remaining in the rectum should be siphoned off 
and measured. Cleanse the rectum with 1 quart of warm water, and then instill 
about 100 cc of olive oil and allow it to remain. 
The patient should have close supervision following both avertin and oil-ether 
anaesthesia, using the same precautions as are taken for ether inhalation 
anaesthesia. 
The anaesthetic tray should contain the following articles: 
1. Large catheter or rectal tube. 
2. Funnel to fit catheter or rectal tube. 
3. Bottle or container with tight-fitting top for mixing oil and ether. 
4. Graduate. 
5. Petrolatum. 
6. Draw sheet. 
7. Towels. 
8. Clamp for rectal tube. ANESTHESIA 
747 
PREAIOESTHETIC MEDICATION 
Preansesthetic medication is important, as it allays the patient’s fear and 
anxiety, thus giving him more nearly normal pulse, respiration and blood 
pressure, with a quiet induction, and thereby requiring less anaesthetic agent. 
The night before operation a mild sedative, such as codeine or a barbiturate 
should be given to induce sleep. 
On the day of operation further preansesthetic medication with opium de- 
rivatives, solanaceous alkaloids, barbituric acid derivatives, etc. should be given. 
Opium derivatives. 
Morphine, the most commonly used of these derivatives, is an analgesic in 
small doses and a respiratory depressant in large doses. It should be given 
1 to 1% hours prior to operation, as there may be a mild stimulation during 
the first half-hour, and the greatest respiratory depression during the second 
half hour. The dosage used is Vs to M grain. 
Solanaceous alkaloids. 
Atropine lessens the secretions of the respiratory tract and stimulates metabo- 
lism. Because of the metabolic stimulation it should not be given to toxic 
goiter cases. It is usually given combined with morphine in which form the 
usual dose is morphine M grain and atropine Mso grain. 
Scopolamine is given for its sedative action thereby inhibiting the emotional 
activity. It is often given in combination with morphine when there is obtained 
both sedative and analgesic action, the ordinary dosage in this form being 
morphine M grain and scopolamine Moo grain. 
Barbituric acid derivatives. 
Of the many barbiturates available the most commonly used are barbital, 
amytal, phenobarbital and pentobarbital in the form of their more soluble 
sodium salts. They all act similarly as soporifics, affecting the intellectual cen- 
ters with practically no analgesic action. They are synergetic in action with 
morphine, hence when used in combination with morphine there will be obtained 
cerebral sedation and analgesia. Barbital and phenobarbital are eliminated 
mostly by the kidneys, while amytal and pentobarbital are detoxified by the 
liver. Hence, with pathology in the kidneys, amytal and pentobarbital should 
be chosen. Likewise, with liver damage, barbital and phenobarbital are 
preferable. 
Tribromethanol, or Avertin, is sometimes used as a preansesthetic medica- 
tion being given per rectum in doses of 60 mgm. per kilogram of body weight. 
References 
The Operating Room—Instruction for nurses and assistants.—St. Mary’s Hospital, 
Rochester, Minn. 
Inhalation Anaesthesia—A fundamental guide.—A. E. Guedel, M. D. 
Hospital Corps Handbook, U. S. Navy, 1923. 
Handbook of the Hospital Corps, U. S. Navy, 1930. 
154294°—39 48 CHAPTER XI 
Page 
Section 1. Administration and General Clerical Procedures 749 
Section 2. Hospital Supplies and Property Accountability 774 
Section 3. Commissary Supervision 804 
Section 4. Deaths and Medico-Legal Matters 833 
Section 1.—ADMINISTRATION AND GENERAL CLERICAL 
PROCEDURES 
Upon the officers and enlisted men of the Hospital Corps the Medical Depart- 
ment of the Navy depends largely for the supervision and the performance of 
the clerical work required wherever there is a representative of the Medical 
Department on duty. 
In the lower ratings the primary duty of hospital corpsmen concerns the 
care of the sick and the injured. As they advance in rating they necessarily 
become more familiar with the administrative and clerical duties in the Medi- 
cal Department, and when assigned to such duties must assume responsibility 
not only for the accuracy of the work performed but also for so organizing 
and supervising the clerical force that a maximum of efficiency will be obtained. 
To satisfactorily perform these duties, hospital corpsmen must: 
1. Be conversant with the Navy as regards its organization and personnel, 
its history, and the laws and regulations governing the Naval Establishment; 
2. Be thoroughly familiar with the history and organization of the Medical 
Department, the laws and regulations governing its duties, the sources and 
application of monies under its control, and the relationship of the Medical 
Department to the Naval Establishment; 
3. Have a full knowledge of the duties of the Medical Department ashore 
in naval hospitals and at other shore stations, and afloat on the various types 
of vessels composing the fleets; and 
4. Understand office management and the Navy Regulations and bureau 
manuals governing the performance of clerical and administrative duties. 
In this section much information that could well be included is omitted 
on account of lack of space and because it can be found in official publica- 
tions that are easily accessible. For these reasons the information given here 
is more or less general in scope and must be supplemented by reference to 
other publications for detailed and specific information not found here. 
THE NAVY DEPARTMENT, ITS BUREAUS AND OFFICES 
Section 415 of the Revised Statutes of the United States provides that there 
shall be at the seat of government an executive department, to be known as 
the Department of the Navy, and a Secretary of the Navy, who shall be the 
head thereof. 
The Navy Department is charged with the general control and administration 
of the Navy of the United States. 
In section 2 of Article II of the Constitution of the United States ,of America 
it is provided that the President of the United States shall be the Commander 
in Chief of the Navy of the United States. 
749 750 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The Secretary of the Navy, a civil officer, is appointed by the President, 
by and with the advice and consent of the Senate of the United States, and 
because he is the head of an executive department is a member of the Presi- 
dent’s Cabinet. He performs such duties as the President may assign to him 
or are required by law and has the general superintendence of construction, 
manning, armament, equipment, and employment of vessels of war. 
The Secretary’s deputy is the Assistant Secretary of the Navy, a civil officer, 
whose appointment is authorized by law and who performs such duties as 
may be prescribed by the Secretary of the Navy or are required by law. In 
the absence of the Secretary of the Navy his duties are performed by the 
Assistant Secretary of the Navy. 
In the temporary absence of the Secretary and the Assistant Secretary of 
the Navy, the Chief of Naval Operations is, by law, next in succession to act 
as Secretary of the Navy. In the absence of all three of those just named 
the duties of the Secretary of the Navy temporarily devolve upon line officers 
of the Navy in the following order of succession: Chief of the Bureau of 
Navigation, Chief of the Bureau of Ordnance, Chief of the Bureau of Engi- 
neering, Chief of the Bureau of Aeronautics, and the Judge Advocate General 
of the Navy. 
For administrative purposes the Navy Department is divided into the Office 
of Naval Operations and eight bureaus, each charged with certain specific 
duties and in charge of an officer of the Navy appointed by the President, by 
and with the advice and consent of the Senate. These officers are appointed 
for 4 years and during their term of office have the rank of rear admiral except 
in the case of the Chief of Naval Operations who has the rank of admiral. In 
addition to the foregoing there are the Judge Advocate General of the Navy 
and the Major General Commandant of the Marine Corps. The Judge Advocate 
General is an officer of the Navy or the Marine Corps, appointed by the President 
for 4 years, by and with the advice and consent of the Senate, and while so 
serving has the rank of rear admiral in the Navy or of major general in the 
Marine Corps, as the case may be. The Major General Commandant of the 
Marine Corps is an officer of the Marine Corps appointed by the President for 
4 years, by and with the advice and consent of the Senate, and while so serving 
has the rank of major general in the Marine Corps. 
Following is a list of the eight bureaus of the Navy Department and the 
titles of the officers in charge of them: 
Yards and Docks Chief of the Bureau. 
Navigation Chief of the Bureau. 
Ordnance Chief of the Bureau. 
Construction and Repair Chief Constructor and 
Chief of the Bureau. 
Engineering Engineer in Chief and 
Chief of the Bureau. 
Supplies and Accounts Paymaster General and 
Chief of the Bureau. 
Medicine and Surgery Surgeon General and 
Chief of the Bureau. 
Aeronautics Chief of the Bureau. 
The business of the Department of the Navy not specifically assigned by 
law is distributed among the bureaus and offices by the Secretary in such 
manner as he judges to be expedient and proper. The various duties per- 
formed under this distribution are, briefly, as follows: ADMINISTRATION AND GENERAL CLERICAL PROCEDURES 
751 
Office of the Chief of Naval Operations. 
Operations of the fleet and the preparation and readiness of plans for its use 
in war; direction of the Office of Naval Intelligence and the Division of Fleet 
Training; operation of the Communication Service, of naval districts, of 
Naval Reserve vessels, and of mines and mining; the operations of the Marine 
Corps, except when operating with the Army or on other detached duty by 
order of the President; the operations of Coast Guard vessels when operating 
with the Navy; the direction of all strategic and tactical matters, organization 
of the fleet, maneuvers, gunnery exercises, drills and exercises, and the train- 
ing of the fleet for war; and the preparation, revision, and record of regula- 
tions for the government of the Navy, general orders, tactical Instructions, 
drill books (except those issued for the individual instruction of officers and 
enlisted men), signal codes, and cipher codes. 
Bureau of Yards and Docks. 
The design, construction, alteration, and inspection of the public works and 
public utilities of the shore establishments of the Navy and (with certain 
exceptions) their repair and upkeep and administrative supervision of opera- 
tion ; the acquisition and disposition of real-estate and the custody of real 
property no longer needed for the use assigned, as provided in articles 426 
and 427, U. S. Navy Regulations. 
Bureau of Navigation. 
The procurement, education, training, discipline, and distribution of officers 
and enlisted men of the Navy, Naval Reserve, and the Reserve Officers’ Train- 
ing Corps, except the professional education of officers, nurses, and enlisted 
men of the Medical Department; the supply, maintenance, and repair of ships’ 
navigational outfits, including instruments; ocean and lake surveys and the 
collection of foreign surveys; the publication and supply of charts, sailing 
directions, and nautical works, and the collection and dissemination of all 
nautical, hydrographic, and meteorological information to ships and aircraft; 
the upkeep, operation, and repair (with certain exceptions) of the Naval 
Academy, Postgraduate School, Naval War College, training schools for en- 
listed men, training stations, Naval Home, Naval Observatory, and Hydro- 
graphic Office; the direction of receiving ships and stations; the issue, 
recording, and enforcement of orders of the Secretary of the Navy to officers 
of the Navy and of the Naval Reserve; the keeping of the records of service 
of officers and enlisted men; the preparation, revision, and enforcement of 
regulations governing uniforms; and naval discipline, rewards, and 
punishments. 
Bureau of Ordnance. 
The design, manufacture, procurement, maintenance, issue, and efficiency 
of all offensive and defensive arms and armament, and, unless otherwise 
excepted, optical and other devices and material for the control of guns, 
torpedoes, and bombs; the upkeep, operation, and repair (with certain ex- 
ceptions) of naval gun factories, ordnance plants, torpedo stations, proving 
grounds, powder factories, ammunition depots, magazines on shore, and mine 
depots. 
Bureau of Construction and Repair. 
The general design, structural strength, stability, and seaworthiness of all 
ships of the Navy, except airships; the designing, building, fitting out, and 
repairing of hulls of vessels; preparation of plans and data showing designs 752 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
of new vessels; provision of facilities and arrangements for salvage of ves- 
sels; the drydocking of vessels and the operating and cleaning of drydocks 
and marine railways; the design, development and procurement of materials 
and appliances for gas defense; diving gear and experimental diving units, and 
respiratory protective devices; paravanes and mine-sweeping gear. 
Bureau of Engineering. 
The design, construction, installation, and maintenance of all propelling 
machinery, together with its auxiliaries, and, unless otherwise excepted, 
exterior and interior communication systems, electric wiring and cable, and 
auxiliary machinery; the design, manufacture, installation, and maintenance of 
all radio and sound equipage; the upkeep, operation, and repair (with certain 
exceptions) of the Engineering Experiment Station, Naval Research Labora- 
tory, Naval Boiler Laboratory, and Material Laboratory (jointly with the 
Bureau of Construction and Repair) ; preparation of specifications for fuel. 
Bureau of Supplies and Accounts. 
The procurement, purchase, custody, shipment, warehousing, and sale of all 
supplies, fuel, and other property of the Navy (unless otherwise provided for 
and excepting supplies for the Marine Corps) ; the supply and disbursement 
of funds and the payment for articles and services procured for the Navy; 
the upkeep and operation of the Naval Clothing Factory and coffee-roasting 
plants; administrative supervision over fuel plants and commissary activities; 
authorization of transportation of Navy property and household effects of 
Navy personnel. 
Bureau of Medicine and Surgery. 
“The Bureau of Medicine and Surgery, under the direction of the Secretary 
of the Navy, is charged with and responsible for the maintenance of the health 
of the Navy, for the care of the sick and injured, for the custody and preserva- 
tion of the records, accounts, and properties under its cognizance and pertain- 
ing to its duties, and for the professional education and training of officers, 
nurses, and enlisted men of the Medical Department of the Navy.” (Art. 457 
(1), N. R.) 
“It is charged with the upkeep and operation of all naval hospitals, medical 
supply depots, medical laboratories, the Naval Medical School and of all tech- 
nical schools established for the education or training of members of the Med- 
ical Corps, Dental Corps, Nurse Corps, and Hospital Corps, and with their 
repairs, except as excluded in article 484.” (Art. 457 (2), N. R.) 
“The Bureau of Medicine and Surgery shall provide for inspection of the 
sanitary condition of the Navy, shall recommend with respect to all questions 
connected with hygiene and sanitation affecting the service, and, to this end, 
shall have opportunity for necessary inspection; it shall advise with other 
bureaus and offices in reference to the sanitary features of ships under con- 
struction and in commission, regarding berthing, ventilation, and location of 
quarters for the care and treatment of the sick and injured; of the provisions 
for the care of wounded in battle; and, in the case of shore stations, with 
regard to health conditions depending on location, the hygienic construction 
and care of public buildings, especially of barracks and other habitations, such 
as camps. It shall also advise concerning matters pertaining to clothing and 
food, to water supplies used for drinking, cooking, and bathing purposes, and 
to drainage and disposal of wastes, so far as these affect the health of the 
Navy. It shall safeguard the personnel by the employment of the best methods 
of hygiene and sanitation, both afloat and ashore, with a view to maintaining ADMINISTRATION AND GENERAL CLERICAL PROCEDURES 
753 
the highest possible percentage of the personnel ready for service at all times, 
and shall adopt for use all such devices or procedures as may be developed in 
the sciences of medicine and surgery as will in any way tend to an increase in 
military efficiency.” (Art. 458 (1), N. R.) 
“It shall be the duty of the Bureau of Medicine and Surgery to provide 
for the physical examination of officers, nurses, and enlisted men, with a 
view to the selection or retention of those only whose physical condition 
is such as to maintain or improve the military efficiency of the service if 
admitted or retained therein; and it shall pass upon the competency, from 
a professional standpoint, of all men of the Hospital Corps for enlistment, 
enrollment, and promotion by means of examinations conducted under its 
supervision or by such forms as it may prescribe.” (Art. 458 (2), N. R.) 
“The Bureau of Medicine and Surgery shall recommend to the Bureau of 
Navigation the complement of Medical Department personnel for hospitals 
and hospital ships, and shall recommend and have information as to the 
assignment and duties of medical officers, dental officers, and hospital corps- 
men. It shall be charged with the administration of the Nurse Corps, and 
shall have power to appoint and remove all nurses, subject to the approval 
of the Secretary of the Navy.” (Art. 458 (3), N. R.) 
“It shall require for and have control of the preparation, inspection, recep- 
tion, storage, care, custody, transfer, and issue of all supplies of every kind 
used in the Medical Department for its own purposes; and shall have charge 
of the civilian force employed at naval hospitals, medical supply depots, medical 
laboratories, the Naval Medical School, and at all technical schools for the 
education or training of Medical Department personnel.” (Art. 458 (4), N. R.) 
“It shall approve the design of hospital ships insofar as relates to their 
efficiency for the care of the sick and wounded, and shall provide for the 
organization and administration of the Medical Department of such vessels.” 
(Art. 458 (5), N. R.) 
“The arrangements for care, transportation, and burial of the dead shall 
be under the jurisdiction and control of the Bureau of Medicine and Surgery, 
except as otherwise provided in article 1841.” (Art. 458 ( 6), N. R.) 
Bureau of Aeronautics. 
The design, construction, fitting out, testing, repair, and alteration of naval 
and Marine Corps aircraft and (with certain exceptions) instruments, equip- 
ment, and accessories pertaining thereto; the upkeep, operation, and repair 
(with certain exceptions) of all aeronautics shore establishments of the Navy 
and Marine Corps, exclusive of aircraft operations. 
The Judge Advocate General of the Navy. 
Shall have cognizance of all matters of law arising in the Navy Department; 
revise and report upon the legal features of and have recorded the proceedings 
of all courts-martial, courts of inquiry, boards* of investigation and inquest, 
and boards for the examination of officers for retirement and promotion in the 
naval service; prepare charges and specifications for courts-martial, and the 
necessary orders convening courts-martial, courts of inquiry, and various exam- 
ining boards when ordered by the Secretary of the Navy; prepare courts-martial 
orders promulgating final actions and other legal information; conduct all 
official correspondence relating to such courts and boards; examine and report 
upon all questions relating to rank and precedence, promotions and retirements, 
and the validity of the proceedings in court-martial cases, all matters relating 
to the supervision and control of naval prisons and prisoners, including prisoners 
of war; removal of the mark of desertion, correction of records of service of 754 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
naval personnel; certification of discharge in true name; pardons; interpretation 
of statutes; references to the General Accounting Office; proceedings in civil 
courts by or against the Government or its officers; preparation of advertise- 
ments, proposals, and contracts; insurance; patents; the sufficiency of official 
contracts, and other bonds and guarantees; claims by or against the Govern- 
ment; conduct correspondence respecting the foregoing, including preparation 
for submission to the Attorney General of all questions directed by the Secretary 
of the Navy to be so submitted; examine and report upon all Congressional 
bills and resolutions referred to the Navy Department; draft all proposed 
legislation arising in the Navy Department; examine and report on questions 
of international law; search titles, purchase, sale, transfer, and other questions 
affecting lands and buildings pertaining to the Navy; and care for and preserve 
all muniments of title to land acquired for naval uses. 
The Major General Commandant of the Marine Corps. 
The procurement, discharge, education, training, discipline, and distribution 
of officers and enlisted personnel of the Marine Corps, including the Marine 
Corps Reserve, and the administration and general efficiency of the Marine 
Corps and of the Marine Corps Reserve; the upkeep, operation, and repair 
(with certain exceptions) of marine barracks and marine posts. 
THE NAVAL FORCES AND N£VAL STATIONS 
Primarily, the Navy is the naval forces of the United States composed of 
the combatant forces of vessels, aircraft, and troops operating under naval 
authority together with such additional vessels, district craft, aircraft, or 
other units as may be assigned thereto for training, utilitarian, or other 
purposes. 
The combatant forces are organized into fleets, forces, type organizations, 
flotillas, aircraft wings, aircraft groups, squadrons, and divisions. The vessels 
of the Navy are classified as battleships, cruisers, aircraft carriers, destroyers, 
mine layers, submarines, patrol vessels, and auxiliaries consisting of destroyer, 
submarine, aircraft, and seaplane tenders; repair, store, ammunition, and 
cargo ships; oilers; transports; mine sweepers; submarine rescue vessels; 
hospital ships; and tugs. 
Although afloat, the vessels of the naval forces must place great dependence 
on shore stations for many repairs, for supplies and equipment, and for 
personnel so that the maximum of efficiency may be maintained. As a direct 
result of this dependence the Navy Department has under its control a 
number of naval stations both within and without the continental limits of 
the United States. 
The United States and its possessions, with the exception of Guam, Amer- 
ican Samoa, Puerto Rico, and the naval station at Guantanamo, are divided 
into naval districts within which are located naval bases, navy yards, and 
naval stations. 
The following definitions from Navy Regulations clearly state the composi- 
tion and object of naval bases and shore stations: 
“A naval base is, generically, a center from which men-of-war can operate 
and be maintained, and may be of a permanent or temporary character, de- 
pending upon whether its constructed naval accommodations are of a fixed 
or transient nature.” (Art. 2050 (a), N. R.) 
“Naval bases are divided geographically into two classes, home bases and 
outlying bases, and these are themselves divided by their facilities into 
main bases, subsidiary bases, and bases for particular types of naval craft. ADMINISTRATION AND GENERAL CLERICAL PROCEDURES 
755 
(Destroyer bases, submarine bases, aviation bases, etc.).” (Art. 2050 (b), N. R.) 
“A main home base is one within the continental territory of the country, 
from which the fleet can operate at all times and which is designated to 
maintain the fleet in all respects, both in peace and war.” (Art. 2050 (c) N. R.) 
“A main outlying base is one without the continental limits of the country, 
having as many of the attributes of a main home base as practicable, and 
designed to be a strong point of support for the fleet and from which it can 
be maintained for limited periods in war.” (Art 2050 (d), N. R.) 
“A subsidiary base (home or outlying) is one that contains some of the fixed 
elements of the main base and which, while not capable of supporting and 
maintaining the whole fleet, may so care for portions of it.” (Art. 2050 (e), 
N. R.) 
“A destroyer, submarine, aviation, or other base for particular types of 
naval craft is one from which the type in question can operate and be main- 
tained. It may or may not form part of a main or subsidiary base.” (Art. 
2050 (f), N. R.) 
“An outlying base of a temporary character used in war for the fleet or 
portions of it is termed an advanced base.” (Art. 2050 (g), N. R.) 
“The characters, composition, and strength of naval bases will depend upon 
the necessities of service, at all times.” (Art. 2050 (h), N. R.) 
“A naval station is the location of a particular form of naval activity, and 
may or may not form part of a naval base.” (Art. 2050 (i), N. R.) 
“A naval depot is the location where naval personnel or material is stored 
and delivered, and may or may not form a part of a naval base.” (Art 2050 
(j), N. R.) 
Navy yards are shore establishments, largely industrial in character, that 
are principally concerned with the repair, alteration, dry docking, and overhaul 
of naval vessels. Some are equipped for the construction of naval vessels 
and others for special kinds of work. 
The following definitions of certain naval terms often used are from U. S. 
Navy Regulations: 
“Strategy applies to the distribution of naval forces, their armament and 
supplies in preparation for war or in the prosecution of war. It includes 
logistics. It refers to naval movements and dispositions made before contact 
with the enemy’s forces.” (Art. 2051, N. R.) 
“Tactics applies to all naval movements and operations made after contact 
with the enemy’s forces. The term ‘contact’ is here employed in a broad sense, 
meaning such proximity to the enemy as affects fleet formation and renders 
a battle imminent.” (Art. 2052, N. R.) 
“Naval policy.—Everything that includes the fixed condition of preparation 
for war; that is, the strength, character, and composition of the Navy, forti- 
fication of ports and bases, etc. (This wrill be based upon our political rela- 
tions and the probability of war with different powers. It will also be influ- 
enced by the conclusions of a comprehensive study of the political relations 
between other powers throughout the world and their influence upon coali- 
tions and alliances.)” (Art. 2053, N. R.) 
From before the inception of the Government to August 31, 1842, the history 
of the medical department of the Navy is interwoven with that of other branches 
of the service. 
In 1775 the Continental Congress organized the Navy. Thus it will be seen 
that the Navy has existed longer than the Government and was established 
THE BUREAU OF MEDICINE AND SURGERY 756 
HANDBOOK OF THE HOSPITAL COEPS, TJ. S. NAVY 
prior to the Declaration of Independence. Military control of the earliest 
vessels of the Navy was directly under the Continental Congress and was 
conducted through its naval committee. 
Under the present form of government the executive department known as 
the Department of War was created by act of Congress in 1789. This depart- 
ment controlled the Navy as well as the Army. By the act of Congress of 
April 30, 1798, another executive department, denominated the Department 
of the Navy, was established. But the Navy Department was not divided 
into bureaus and consisted only of one office, whose head then, as now, was 
the Secretary of the Navy. 
Each vessel of the Navy in those historical days carried at least one sur- 
geon, and some of the larger ships a surgeon and surgeon’s mate. Surgeons 
usually held commissions, and the surgeon’s mates received warrants. These 
members of the medical profession serving in the Navy seem to have had 
little, if any, relationship to one another (which is not surprising when one 
realizes that at that time there was no medical corps and no organization 
in the Navy Department directly responsible for the supervision of them or 
their work), and their rank and status was not well defined. 
The first attempt to regulate the medical establishment and provide a sys- 
tematic organization occurred in 1799, when Congress authorized the following 
officers in the medical establishment of the United States: “A physician general 
who shall be charged with the superintendence and direction of all military 
hospitals, and generally of all medical and chirurgical practice or service con- 
cerning the Army or Navy of the United States, and of all persons who shall be 
employed in and about the same, in camps, garrisons, and hospitals; an apothe- 
cary general, and one or more deputies, who shall be charged with the safe- 
keeping and delivery of all medicines,- stores, and whatsoever else may be 
necessary in relation to said practice or service.” 
In 1815 Congress authorized the President to appoint three naval officers as 
a board of commissioners for the Navy, to be attached to the Secretary’s office 
and, under his direction, to discharge the ministerial duties of his office. Here 
may be seen the first step toward the creation of the present day chiefs of 
bureaus. In 1832 two post captains were added to the board of commissioners 
for the Navy, making five members on the committee. 
Then came the reorganization of the Navy Department, when by the act of 
August 31, 1842, the board of commissioners for the Navy was abolished and five 
bureaus were created to conduct the business of the Navy Department. 
The Secretary of the Navy by this act was directed to assign the duties of 
the newly created bureaus in the following words: “Sec. 5. And be it further 
enacted, That the Secretary of the Navy shall assign and distribute among the 
said bureaus such of the duties of the Navy Department as he shall judge to 
be expedient and proper; and all the duties of the said bureaus shall be per- 
formed under the authority of the Secretary of the Navy, and their orders shall 
be considered as emanating from him and shall have full force and effect as 
such.” 
One of the bureaus created by this act, and by it responsible for conducting 
a part of the business of the Navy Department, was the Bureau of Medicine and 
Surgery, and its existence as a separate and distinct bureau in the Navy 
Department dates from August 31, 1842. 
At that time there were 60 surgeons in the Navy and the first chief of the 
Bureau of Medicine and Surgery was selected from them. Upon the man so 
selected rested the burden of planning the organization of the newly created 
bureau, of developing a medical corps, of coordinating the activities of the sur- ADMINISTRATION AND GENERAL CLERICAL PROCEDURES 
757 
geons and surgeon’s mates, and other personnel, and formulating the necessary 
regulations to govern and control this branch of the Navy Department. 
Viewed from the standpoint of later years it must be conceded that a wise 
selection was made in choosing as the first Chief of the Bureau of Medicine 
and Surgery, Surgeon William Paul Crillon Barton. By education, training, and 
naval experience he was peculiarly fitted to organize and administer the new 
bureau, and to him must be accorded full credit for the work which he performed 
under adverse and trying conditions in establishing the bureau upon a firm 
foundation. 
Following is a list of the names of the chiefs of the Bureau of Medicine 
and Surgery and the Surgeons General, United States Navy, from 1842 to date: 
Chief of Bureau. (Act of August 31, 18^2.) 
William Paul Crillon Barton Sept. 2, 1842, to Apr. 1, 1844. 
Thomas Harris Apr. 1, 1844, to Sept. 30, 1853. 
William Whelan Oct. 1, 1853, to June 11, 1865. 
Phineas J. Horwitz July 1, 1865, to June 30, 1869. 
Chief of Bureau, with relative rank and pay of commodore and title 
of Surgeon General. (Act of March 3, 1871.) 
William Maxwell Wood July 1, 1869, to Oct. 31, 1871. 
Jonathan M. Foltz Nov. 1, 1871, to June 8, 1872. 
James C. Palmer June 10, 1872, to July 8, 1873. 
Joseph Beale July 9, 1873, to Feb. 2,1877. 
William Grier Feb. 3, 1877, to Oct. 5, 1878. 
J. Winthrop Taylor Oct. 28, 1878, to Aug. 19, 1879. 
Philip S. Wales Aug. 20, 1879, to Jan. 27, 1884. 
Francis M. Gunnell Apr. 1, 1884, to Apr. 1, 1888. 
John Mills Browne Apr. 2, 1888, to May 10, 1893. 
James Rufus Tryon May 11, 1893, to Sept. 7,1897. 
Newton L. Bates Oct. 1, 1897, to Oct. 18, 1897. 
Chief of Bureau, ivith the rank of rear admiral, title of Surgeon General, and 
pay and allowances of brigadier general in the Army. (Act of March 3, 1899.) 
William Knickerbocker Van Reypen Oct. 23, 1897, to Jan. 25, 1902. 
Presley Marion Rixey Feb. 5, 1902, to Feb. 4, 1910. 
Charles Francis Stokes Feb. 7, 1910, to Feb. 6, 1914. 
Chief of Bureau, vnth the rank of rear admiral, title of Surgeon General, and 
pay and allowances of major general in the Army. (Act of July 1, 1918.) 
William Clarence Braisted Feb. 7, 1914, to Nov. 29, 1920. 
Edward Rhodes Stitt Nov. 30, 1920, to Nov. 29, 1928. 
Charles Edward Riggs Jan. 19, 1929, to Jan. 18, 1933. 
Perceval Shearer Rossiter Mar. 16, 1933, to Nov. 30, 1938. 
Ross “T” Mclntire Dec. 1, 1938, (present incumbent). 
The duties of the Bureau of Medicine and Surgery, as defined by the United 
States Navy Regulations, articles 457 and 458, are given on pages 752 and 753. 
To carry out these duties, officers and enlisted men of the Medical Depart- 
ment of the Navy necessarily will be found wherever the activities of the Navy 
lead. 758 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAYY 
The primary duty of the medical department of the Navy is to preserve the 
Navy’s personnel from impairment by reason of sickness or injury, and to 
return men so incapacitated to active duty in the shortest period consistent 
with circumstances. To accomplish this object more readily, naval hospitals 
have been established at the geographical points where concentration of naval 
activities occurs and the Bureau of Medicine and Surgery is charged with their 
upkeep and operation under the general charge and superintendence of the 
Secretary of the Navy. Officers and enlisted men of the Navy and Marine 
Corps, afloat and ashore, in need of hospital treatment are transferred to the 
naval hospital most convenient to the ship or station on which they are 
serving at the time. To provide hospital care for the personnel of the fleets 
when transfer to a naval hospital is not possible, modern hospital ships are 
available. 
It is in naval hospitals that the medical department’s utility as a conserving 
force of the personnel of the Navy becomes most apparent, where its sphere of 
usefulness is best demonstrated, and where all that pertains to the sick and 
injured finds its fullest development. 
The naval hospitals controlled by the Bureau of Medicine and Surgery and 
at present in commission are located at: Portsmouth, N. H.; Chelsea, Mass.; 
Newport, R. I.; New York, N. Y.; Philadelphia, Pa.; Annapolis, Md.; Wash- 
ington, D. C.; Norfolk, Va.; Parris Island, S. O.; Charleston, S. O.; Pensacola, 
Fla.; Great Lakes, 111.; San Diego, Calif.; Mare Island, Calif.; Puget Sound, 
Wash.; Pearl Harbor, Hawaii; Guam; and Canacao, P. I. In addition to the 
above naval hospitals, at the submarine bases at New London, Conn., and Coco 
Solo, O. Z., at the Marine Barracks, Quantico, Va., and at the naval stations, 
Guantanamo Bay, Cuba, and Tutuila, Samoa, establishments commonly known 
as sick quartersi provide for the care of the sick and injured at these places 
in a manner similar to naval hospitals. 
The naval hospitals at Brooklyn, N. Y., and San Diego, Calif., are designated 
for the treatment of cases of malignant diseases. 
In addition to the hospitals directly under the cognizance of the Bureau of 
Medicine and Surgery there are special hospitals at which Navy and Marine 
Corps patients may receive treatment. One is the Army and Navy General 
Hospital at Hot Springs, Ark., where relief reasonably may be expected for 
the various forms of rheumatism, including muscular and articular conditions, 
after the acute inflammatory stage has passed; neuralgia and neuritis and 
metallic poisoning of a chronic nature; paralysis not of central origin; the 
earliest stages of locomotor ataxia and any other chronic degenerative change 
of nervous origin (insanity excepted) ; chronic nephritis and cardiorenal diseases 
(the early stages only) ; chronic skin diseases, especially the squamous varieties; 
arteriosclerosis; neurasthenic conditions, due to overwork, and other conditions 
accompanied by high blood pressure; certain metabolic diseases, such as gout, 
diabetes, obesity, etc.; chronic gastro-intestinal diseases which have not re- 
sponded to continued hospitalization at other places (gastric neuroses, post 
dysenteric colitis, chronic intestinal stasis, etc.). In Fitzsimons General Hos- 
pital, United States Army, at Denver, Colorado, cases of pulmonary tuberculosis 
may receive treatment. Insane cases are cared for at St. Elizabeths Hospital, 
Washington, D. C. (formerly known as the Government Hospital for the Insane). 
At Philadelphia, Pa., “a permanent asylum for disabled and decrepit Navy 
officers, seamen, and marines” has been established and is known as the United 
States Naval Home. Officers of the Navy or Marine Corps may be admitted 
to the benefits of the Naval Home by permission of the Secretary of the Navy. 
Enlisted men of the Navy or Marine Corps may be admitted to the benefits of ADMINISTRATION AND GENERAL CLERICAL PROCEDURES 
759 
the Naval Home by authority of the Bureau of Navigation under the following 
classification: 
(A) Discharged enlisted men of the Navy or Marine Corps who have served 
in the Mexican War, the Civil War, the War with Spain, the Philippine Insur- 
rection, the World War, or any other service where the armed forces of the 
United States have been employed, and their lives hazarded in military opera- 
tions, and who are, by reason of wounds, sickness, old age, or other disability, 
xmable to support themselves by manual labor. 
(B) Discharged enlisted men of the Navy or Marine Corps who have become 
disqualified for further service by wounds, or injuries received, or by disease 
contracted in the service in the line of duty and who are unable to support 
themselves by manual labor. 
(C) Retired enlisted men of the Navy and Marine Corps unable to support 
themselves by manual labor. 
Applicants for admission to the Naval Home must be certified by a naval 
medical officer or a reputable physician as unable to support themselves by 
manual labor. Beneficiaries in the Naval Plome are quartered in separate 
rooms, are outfitted with the necessary uniform and such other clothing as 
may be deemed necessary upon admission, are issued such items of clothing 
quarterly as may be required for health and comfort, are given 1% pounds of 
tobacco per month, and when not in receipt of a pension are given an allow- 
ance of $3 per month for pocket money. 
When naval hospitals are not convenient, United States Army Hospitals, the 
hospitals of the United States Public Health Service, and the facilities of the 
Veterans’ Administration are available for the treatment of the Navy’s sick, 
and in emergency patients may be transferred to a civil hospital, as provided 
for by article 1143, United States Navy Regulations. 
The Surgeon General of the Navy is the Chief of the Bureau of Medicine 
and Surgery and its administrative head. Upon him devolves the formation 
of general policies and the maintenance of contact with: 
(а) The medical divisions of the fleets through the fleet surgeons; 
(б) The medical departments of naval stations through the senior medical 
officers; and 
(c) Naval hospitals, naval medical supply depots, naval medical and Hospi- 
tal Corps schools, and separate naval dispensaries or sick quarters through 
their commanding or senior medical officers. 
The assistant to the chief of the bureau, a naval medical officer, acts as the 
executive, has general supervision of the entire organization and work of the 
bureau, assists in the development of general policies, and in the absence of 
the Surgeon General becomes the acting chief of the bureau and signs all mail 
or official correspondence. 
The chief clerk has general supervision of the operation of the various bureau 
offices and becomes the acting chief of the bureau in the absence of both the 
chief of the bureau and the assistant to the chief of the bureau. 
For ease of administration and to facilitate the transaction of business, the 
bureau is divided into the following divisions: Administration, Personnel, Den- 
tistry, Physical Qualifications, Preventive Medicine, Aviation Medicine, Materiel 
and Finance, Inspections, Planning, Publications, and Red Cross and Veterans’ 
Administration. The duties assigned to each are indicated by the titles. 
MEDICAL DEPARTMENT PERSONNEL 
Comprising the personnel of the medical department are the members of 
four corps, the Medical, Dental, Hospital, and Nurse Corps. The Medical Corps 760 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
is composed of medical officers, the Dental Corps of dental officers, the Hos- 
pital Corps of commissioned warrant officers, warrant officers, and enlisted 
men, and the Nurse Corps of trained nurses. 
Medical and dental officers and nurses are appointed from civil life, the 
former by the President, by and with the advice and consent of the Senate, the 
latter by the Surgeon General with the approval of the Secretary of the Navy. 
Hospital corpsmen are enlisted or change their rating from other branches of 
the service to Hospital Corps ratings. Pharmacists (warrant officers) are 
appointed from chief pharmacist’s mates (enlisted men) by the Secretary of 
the Navy and chief pharrpacists (commissioned warrant officers) are appointed 
to that grade from pharmacists, being appointed by the President, by and with 
the advice and consent of the Senate. 
For full Information concerning the grades and ratings, appointments, pro- 
motions, and advancements, and the duties of the members of these corps, 
reference should be made to chapters 2 to 10, inclusive, and sections 2 to 4, 
inclusive, of chapter 12, Manual of the Medical Department. 
NAVAL HOSPITALS 
Legally, the title “naval hospital” can be applied only to those naval medical 
activities established as naval hospitals by order of the Secretary of the Navy 
prior to March 4, 1913, or authorized by act of Congress since that date. 
However, field hospitals and Navy base hospitals for foreign duty may, by 
competent authority, be classified as naval hospitals. All other medical facili- 
ties can be designated as dispensaries. 
The advancement made in hospital construction reflects itself in the many 
types of architecture found in naval hospitals. 
In addition to the main or hospital building, each hospital is equipped with 
other buildings necessary for the proper maintenance of the hospital, such 
as quarters for staff, power plant, laundry, garage, etc. 
To carry out the principal “mission” of naval hospitals the duties performed 
by Medical Department personnel will be found to be of two kinds, profes- 
sional or clinical and administrative. Professional duties are those primarily 
connected with the medical, surgical, dental, and nursing services. Each of 
these services is in charge of medical-department personnel designated by the 
commanding officer as Chief of Medical, Surgical, or Dental Service, and Chief 
Nurse. Under supervision of the Chief of Medical Service are the services of 
general medicine, psychiatry, laboratories, physical therapy, and out-patient; 
under supervision of the Chief of Surgical Service are the services of general 
surgery, eye, ear, nose, and throat, X-ray, urology, and orthopedics. The Chief 
of Dental Service has supervision of all dental work, and the Chief Nurse of all 
nursing. Administrative duties are those which concern organization, discipline, 
and training, maintenance and repair, preparation and preservation of records, 
preparation and serving of foods, procurement, custody, and disposition of prop- 
erty, etc. The commanding and executive officers are directly in charge of 
organization, discipline, and training, and the other administrative duties named, 
under their supervision, are directly in charge of naval pharmacists. 
Naval hospitals are commanded by an officer of the Medical Corps of the 
United States Navy, usually of the rank of captain, who is responsible to the 
Bureau of Medicine and Surgery for the care and treatment of the patients and 
for the discipline, cleanliness, and economic management of the Institution, and 
in turn exacts from subordinates, employees, and patients a proper obedience 
to his orders and to the laws and regulations of the Navy. All persons be- ADMINISTRATION AND GENERAL CLERICAL PROCEDURES 
761 
longing to the Navy or Marine Corps who may be attached to the hospital or 
civilian employees in the hospital perform such duties as may be assigned them 
by the commanding officer. The general policies regarding the administration 
of naval hospitals are formulated in the Navy Department, but the commanding 
officer is responsible to the Bureau of Medicine and Surgery for the accom- 
plishment of those policies in such manner as he may deem most suitable to 
local conditions. The general orders regarding the operation of a naval hos- 
pital are in the main very similar at all institutions, as they are governed by 
the policies of the Navy Department; but the working details of these policies 
differ at the various hospitals, due to location, capacity, arrangement, etc. The 
policies of the Bureau of Medicine and Surgery and the Navy Department are 
sufficiently flexible to allow for these varying conditions, over which the 
commanding officer is given complete control. 
The medical officer next in rank to the commanding officer, unless otherwise 
ordered by the Navy Department, performs the duties of executive officer of the 
hospital. He is responsible to the commanding officer for the general functioning 
of the institution. The orders issued by the executive officer are the orders of 
the commanding officer, and therefore he always is well informed concerning the 
orders and policies of the commanding officer. Subject to the approval of the 
commanding officer, the executive officer directs all matters as regards duty 
assigned to personnel, discipline, leave, liberty, cleanliness, good order, etc. of 
the hospital. As he is the direct representative of the commanding officer, all 
requests or communications of any nature intended for the commanding officer 
must be taken up with him before being submitted to the commanding officer. 
Military etiquette demands that permission be obtained from the executive 
officer to communicate directly with the commanding officer. This is done in 
order that the executive officer may be informed regarding all matters pertinent 
to his office and at times relieve the commanding officer of minor details which 
can be adjusted by him. In the absence of the commanding officer, the execu- 
tive officer is recognized as the commanding officer and performs such duty 
during his absence. 
All medical officers attached to a naval hospital, other than those just men- 
tioned, are commonly designated as junior medical officers. They are assigned to 
the various activities of the hospital by the executive officer with the approval of 
the commanding officer. The assignment of these officers to duty in the wards, 
operating room, X-ray department, laboratory, etc., places them in charge of work 
performed within the activity concerned, and they are directly responsible for the 
proper performance of their duties, and in turn exact of the hospital corps- 
men and nurses under them strict attention to duty and proper performance 
of all orders issued by the commanding officer. The junior medical officers 
alternate in duty as officer of the day. An officer so acting is the representa- 
tive of the commanding officer and is responsible to him for compliance with 
orders and the maintenance of good order and discipline in the hospital. If 
the commanding officer and executive officer be absent from the hospital, he 
is responsible for the efficient management of the hospital and during their 
absence has the authority necessary for the enforcement of the orders and 
regulations governing the hospital. In the absence of an officer assigned as ward 
officer, the officer of the day is charged with the proper care of the sick in the 
ward concerned, and all information regarding patients which under ordinary 
conditions would be taken up with the ward officer, is communicated to the officer 
of the day, who issues orders accordingly. Hospital corpsmen take up all 
matters pertaining to the treatment of patients directly with the medical 
officer of the ward, or in his absence the officer of the day, and all details 762 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
regarding patients, liberty, leave, work, etc., must be approved by the ward 
officer before being submitted to the executive officer. All patients admitted 
to a naval hospital are received by the officer of the day or his representative; 
he also is informed of all discharges involving patients; and all attachments, 
transfers, or discharges of staff must pass through his hands. 
The replenishment of supplies, the upkeep, expenditure, accountability, and 
survey of property, management of the commissary department, and the cor- 
respondence and clerical work of the administrative offices of a naval hospital 
are duties performed by chief pharmacists and pharmacists. However, the 
commanding officer may direct that these officers perform other duties than 
those mentioned here. In order to accomplish this work, hospital corpsmen and 
civilian clerks are detailed in the offices concerned, under the direct charge of 
the chief pharmacist or pharmacist. In connection with the accountability of 
property great care has to be exercised at all times by hospital corpsmen, as it 
must be remembered that all equipment and supplies of the medical department 
are Government property and the laws governing their care and preservation 
are stringent and binding. 
Hospital corpsmen may be detailed for duty in any activity of the hospital as 
the commanding officer may direct. As it is the policy of the Bureau of Medicine 
and Surgery that hospital corpsmen’s duty shall be such as pertains directly 
with the care of the sick, all hospital corpsmen on duty in a naval hospital 
should thoroughly acquaint themselves with the orders and regulations govern- 
ing the hospital, in order that they can carry out faithfully such duties as may 
be assigned them and all instructions concerning the treatment of patients 
consigned to their care be conscientiously accomplished. A chief pharmacist’s 
mate customarily is detailed for duty as police petty officer of the hospital. He 
is responsible to the executive officer, and in his absence to the officer of the 
day, for such duties as may have been assigned him by the executive officer as 
regards the maintenance of discipline and order in the hospital and the various 
utility buildings of the hospital. Though the duties of a hospital corpsman at 
naval hospitals may, at times, seem disagreeable, such duties are often most im- 
portant from a nursing standpoint, and the accomplishment of such duties in 
the manner directed by the medical officer concerned will make much for the 
efficiency of the hospital and will be recognized only as part of that Intricate 
machinery called management. 
Under direction of the commanding and executive officers the nursing service 
of a naval hospital is under the direct supervision of the chief nurse. She 
instructs nurses in their duties, particularly as they pertain to the naval serv- 
ice, and sees that the orders of the executive officer and ward officers are 
carried out by the nurses under her. Nurses in charge of wards, operating 
rooms, diet kitchens, or linen rooms are given the necessary authority over 
patients and hospital corpsmen for the purpose of direct care of the sick and 
of ward or other work. They are held responsible for their conduct, attention 
to duty, and practical instruction in the details assigned to them. The work 
assigned hospital corpsmen in naval hospitals is considered as a training for 
the work to follow when they are assigned to duty on board men-of-war and on 
independent duty, when the instructions obtained in the hospital will be fully 
appreciated. 
The hospital has various special departments, such as dispensary, linen room, 
diet kitchen, etc., which are indirectly concerned in the treatment of the sick, 
but are necessary adjuncts to the hospital. These departments are in direct 
charge of a nurse or hospital corpsman, who is responsible to the executive officer 
for the proper performance of duty as directed by the commanding officer. ADMINISTRATION AND GENERAL CLERICAL PROCEDURES 
763 
IT. S. NAVAL MEDICAL CENTER 
The Naval Medical Center, established by General Order No. 70, dated June 
20, 1935, at Washington, D. C., consists of the Naval Medical School and the 
Naval Hospital, Washington, D. C. It is under the control of the Bureau of 
Medicine and Surgery, and functions as a medical, diagnostic, and educational 
center. Each unit of the Naval Medical Center has its own commanding officer. 
At the Naval Medical School postgraduate education is given medical officers 
and dental officers, and nurses and hospital corpsmen receive technical training 
in various subjects. 
XT. S. NAVAL DISPENSARY, WASHINGTON, D. C. 
The Naval Dispensary provides treatment for naval personnel attached to the 
Navy Department and their families, renders first-aid treatment and care to 
the civil employees of the Navy Department, and conducts special physical and 
other examinations. 
IT. S. NAVAL MEDICAL SUPPLY DEPOTS 
Three naval medical supply depots are maintained. The central depot is lo- 
cated at Brooklyn, N. Y., one at the Navy Yard, Mare Island, Calif., and one 
at Canacao, P. I. The central depot contracts for and purchases all supplies 
listed on the supply table and such other special equipment as may be required. 
It supplies the other depots with stock, also all shore stations on the Atlantic 
seaboard, and all ships operating in European, Atlantic, and South Atlantic 
waters. Mare Island supplies the shore stations on the west coast and ships 
in Pacific waters. Canacao supplies all ships and shore establishments in 
Asiatic waters. 
The medical supply depots are separate commands for officers of the Medical 
Corps. The staff usually consists of one or more chief pharmacists or pharma- 
cists, hospital corpsmen, and civil employees. 
HOSPITAL CORPS SCHOOLS 
Two schools are maintained for the instruction of hospital corpsmen, one at 
the Norfolk Naval Hospital, Portsmouth, Ya., and one at the Naval Hospital, 
San Diego, Calif. 
The commanding officers of these hospitals are also the commanding officers 
of the respective schools. The teaching staff consists of medical officers, chief 
pharmacists, pharmacists, and members of the Hospital Corps and Nurse 
Corps. 
CLERICAL WORK IN THE MEDICAL DEPARTMENT OF THE NAVY 
The clerical work in the medical department of the Navy required of hos- 
pital corpsmen may be explained most advantageously if separated into three 
divisions, as 1. General correspondence, i. e., letters, endorsements, etc.; 2. 
Requisition and voucher forms for the procurement of supplies and services; 
and 3. Reports and returns other than requisition and voucher forms. 
Correspondence. 
Correspondence or written communication in the Navy is divided into three 
general classes, which are official, semiofficial, and unofficial. 
(a) Official correspondence is communication between officers of the Navy 
and the offices and bureaus of the Navy Department, commanders in chief, 
154294°—39 49 764 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
commandants, vessels of the Navy, naval stations, ships and stations, and 
with other executive departments by the office of the Secretary of the Navy. 
The subject matter usually embraces information concerning the activities, 
duties, and policies of the Navy, recommendations, reports, and knowledge of 
conditions in foreign countries which are of value to the transaction of public 
business. 
(6) Semiofficial correspondence usually is the communication of informa- 
tion in a partly official manner to a bureau or office in the Navy Department 
by officers under the direct cognizance of that bureau or office. 
(c) Unofficial correspondence is all communication not considered official or 
semiofficial. 
Official correspondence and information relating to any matter of such 
nature that special precautions should be taken to insure that information 
concerning it shall be permanently or temporarily limited in circulation is 
classified as secret, confidential, or restricted, and is defined as follows; 
Secret matter is matter of such a nature that its disclosure might endanger 
the national security, or cause serious injury to the interests or prestige of 
the Nation or any Government activity thereof. 
Confidential matter is matter of such a nature that its disclosure, while 
not endangering the national security, would be prejudicial to the interests 
or prestige of the Nation or any Government activity thereof. 
Restricted matter is matter of such a nature that its disclosure should be 
limited for reasons of administrative privacy; or, is matter not classified as 
confidential because the benefits to be gained by a lower classification out- 
weigh the value of the additional security obtainable from the higher classi- 
fication. 
Correspondence or information relating to methods of procedure regularly 
followed and to other subjects, a full knowledge of which could by no possi- 
bility be of use to an enemy is not considered as classified matter, constitutes 
a large part of correspondence, and is sometimes termed nonconfidential. 
Official correspondence within the naval service is carried on in the manner 
prescribed in detail by the Navy Regulations. While the substance of official 
correspondence concerning the medical department of the Navy is determined 
by the officers charged with such duty, its transcription into official form for 
signature and forwarding usually is entrusted to hospital corpsmen. For one 
preparing correspondence, it is most important to remember to keep a copy 
of every letter or endorsement prepared and to have a systematic method 
of numbering and filing all such papers, so that they can be referred to readily. 
A hospital corpsman detailed to perform clerical work should have access 
to a copy of the Navy Regulations, and the instructions in Chapter 52 thereof 
should be referred to whenever there is any doubt as to the proper form to 
be used or the method of procedure to be followed. In this section will be 
described only so much of the official instructions as will make clear the essential 
features of service correspondence by letter or endorsement. 
Correspondence must be courteous in tone and free from expressions of a 
personal nature, but courtesy shall be indicated by the substance and feeling 
rather than by artificially polite phrases and formulas. 
So far as is possible, and with due consideration of the public interests, 
the number of letters written and their length should be minimized. Accuracy, 
simplicity, and conciseness, especially in official correspondence, and confining 
letters to the one subject at hand without omitting necessary details and 
arranging the paragraphs of letters in logical sequence is most essential. If ADMINISTRATION AND GENERAL CLERICAL PROCEDURES 
765 
adding to the clearness of a letter, the use of accompanying diagrams, tables, 
and sketches is permissible, but they should never be embodied in the letter. 
Communications from subordinates are sent to their superior officers for 
transmittal. If in proper form and language, the superior officer forwards 
them as soon after receipt as practicable, stating thereon in writing, by endorse- 
ment or otherwise, his opinion in relation to every part of the subject con- 
tained in the communication. 
To such papers as are complete in themselves and do not require an expres- 
sion of opinion from the office through which they are transmitted, the term 
“forwarded” may be affixed and such papers transmitted under the endorse- 
ment of an officer of the staff, by direction of the commander in chief, the 
commandant, or the senior officer present. 
As a general rule, letters shall be answered by letters and not by endorse- 
ment. This does not prevent the use of stamped or written endorsements on 
papers or reports copies of which are not retained, or the use of endorsements 
on papers necessarily referred to several bureaus or offices. This is intended 
to prevent unnecessary clerical work. When the original is answered by a 
separate letter each office has a complete record of the correspondence without 
extra work. Separate letters shall be written on separate subjects unless 
the subjects are of a like nature. The subject matter in a letter should be 
divided into paragraphs in logical sequence, each containing statements com- 
plete in themselves but all relative and pertinent to the subject at hand, and 
the paragraphs numbered. 
All communications, except such as require neither action nor reply, shall be 
acknowledged. 
Letters and endorsements shall be numbered and shall be typewritten if 
practicable, using noncopying ribbons and making a sufficient number of car- 
bon copies for filing or other purposes. If correspondence cannot be type- 
written, it should be written legibly and contain no erasures or interlineations. 
Carbon copies shall show the office of origin and the name of the signing 
officer shall be typewritten or stamped on all copies. In preparing letters, 
endorsements, and reports which go through another office or other offices, the 
office preparing the original will make on thin white paper a copy for each 
office through which the correspondence is to pass before it reaches its final 
destination. These copies will be marked for the appropriate office. 
Letter paper habitually is used for official correspondence in the Navy, 
whether letters or endorsements. For the original or first copy, it is white 
linen typewriter paper, 8 by 10% inches in size, weighing approximately 4% 
pounds per ream of 500 sheets of that size. For file copies, a green tinted paper 
of the same size and weighing about 3 pounds per ream is used. Thin paper 
other than green is used for additional carbon copies. 
Typewriter cap, used only in special cases, shall be 8 by 13 inches in size, 
but otherwise similar to letter paper. 
The paper used for letters and endorsements has two holes punched in it, 
the center of the holes one-half inch from the top of the sheet and 2% inches 
apart and equidistant from the center of the sheet. These holes permit the 
sheets to be fastened together uniformly. 
The following instructions relative to correspondence are quoted in full from 
article 2015, of U. S. Navy Regulations in order that they may be available 
for those who may not have ready access to a copy of that publication. 
“(1) The forms prescribed in this article shall apply to all correspondence 
within the naval service, with the State naval militia organizations, and with 766 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
such departments as may adopt a similar form of correspondence, but not with 
departments, officials, and persons that have not adopted these or similar 
forms. 
“(2) Letters shall begin with the ship or station, place and date, grouped 
and spaced as indicated in the examples in paragraph 27. The upper line of 
the heading shall be at least iy2 inches from the top of the page. In the case 
of endorsements which start on a new page, or any letter or endorsement con- 
tinued on a new page, there shall also be left clear at least 1% inches at the 
top for binding purposes. 
“(3) The official designation of all vessels of the Navy shall be the name 
of the vessel preceded by the letters U. S. S. The word flagship shall follow 
the name of the vessel in the heading of a communication emanating from the 
office of a flag officer. 
“(4) Special subletterheads may be used at shore stations to designate the 
different offices of the station, and by officers on detached duty ashore, but 
shall not be used to designate the different heads of departments on board ship. 
(See Example B and the last two examples under C.) 
“(5) In communications dated on board a vessel at sea, the latitude and 
longitude shall be stated if exactness be necessary, otherwise the expression 
‘Passage, to ’ shall be used. 
“(6) Following the heading and date in letters and endorsements either the 
official designation, or the name and rank of the writer preceded by the word 
‘From’, shall be written at the left side of the page as indicated in examples 
in paragraph 27. 
“(7) On the line below ‘From’, and preceded by ‘To’ at the left of the 
page, shall appear the official designation of the office or official addressed; 
following this the channel through which the communication is to pass; these 
offices to be designated by numerals indicating the sequence of routing. 
“(8) Following the address, the subject of the correspondence, briefed, shall 
be written across the page, preceded by ‘Subject’. 
“(9) The brief of the subject should be written in about the same form and 
terms as would be used in indexing the communication in filing; for example, 
‘Delaware; feed pumps; recommends change in type’, ‘Navy Yard, New 
York; Dry-dock No. 1; reports damage to caisson struck by tug’. 
“(10) The subject shall not be repeated at the beginning of an endorsement, 
except when required by the filing system of the writer’s office to identify the 
file copy, or when the endorsement begins on a new sheet, in which case it 
shall always be repeated. 
“(11) After the subject the references to previous correspondence on the 
same subject, if any, shall be briefly indicated, preceded by ‘Reference’. 
Usually the references have been addressed either to the writer or to the 
addressee of correspondence, and it is necessary to indicate only the office of 
origin in references. Occasionally for clearness it is desirable to indicate the 
addressee of a referenced letter as shown in the form in paragraph 27. 
“(12) In acknowledging, answering, or referring to official communications, 
the file number (letters as well as figures), and date shall be included in the 
‘Reference.’ References shall be lettered in small letters, and may be referred 
to in the communication as ‘Reference (a)’, etc. 
“(13) When a plan that has been given a file number is referred to in the 
correspondence, this number should be stated in connection with such reference. 
“(14) Following ‘Reference’, if any, the number of enclosures shall be 
stated preceded by ‘Enclosure’ at the left of the page, as indicated in the 
example in paragraph 27. ADMINISTRATION AND GENERAL CLERICAL PROCEDURES 
767 
“(15) The use of numbered enclosure slips attached to the enclosures is 
authorized, and in case they are used the serial number of the slip or slips 
should be given after the word ‘Enclosures’. (See example B.) 
“(16) Where necessary the method of forwarding enclosures, whether enclosed 
under separate cover or by express, shall be indicated. The absence of ‘Refer- 
ence’ or ‘Enclosure’ will indicate that no reference or enclosure accompanies 
the communication. 
“(17) The file number of the letter or endorsement shall be placed in the 
upper left corner, about 1 inch from top and 1 inch from the left edge of 
the page; the abbreviation or initials of the section or division preparing the 
correspondence to follow on the same line as the file number. 
“(18) The body of letters and endorsements shall be written single spaced, 
with one double space between paragraphs. Each endorsement shall, where 
possible, be written on the same sheet as the preceding letter or endorsement, 
with a space of about one-half inch intervening. 
“(19) Paragraphs in letters and endorsements, or other official papers, shall 
be numbered. Subparagraphs shall be lettered thus: (a), (&), etc. 
“(20) The body of the letter shall begin and end without any ceremonial 
form or expression, such as ‘Sir,’ T have the honor to report’, ‘Very respect- 
fully’, etc., and shall be followed by the signature of the writer without desig- 
nation of rank, title, or office. Information will be imparted, reports made, 
and questions asked directly, dispensing with such introductory phrases as ‘The 
bureau informs you that’, ‘Information is requested as to’, ‘It is directed’, etc. 
“(21) In the body of the letter IT. S. Navy shall be abbreviated to U. S. N., 
U. S. Naval Reserve to U. S. N. R., U. S. Marine Corps to U. S. M. O., and U. S. 
Marine Corps Reserve to U. S. M. C. R. In the case of names of officers of the 
Staff Corps the designations as given in article 148 shall be abbreviated as 
follows: Medical Corps to M. C., Supply Corps to S. O., Dental Corps to D. C., 
Construction Corps to C. C., Civil Engineer Corps to C. E. C., Chaplain Corps 
to Ch. C., Professors of Mathematics to Math. 
“(22) When any article referred to in a communication is forwarded under 
separate cover, it shall be tagged and plainly marked in the following manner: 
‘From Commanding Officer, U. S. S. , accompanying letter (or 
endorsement) No. , date ’ If possible this shall appear 
also on the box or package carrying the enclosure. 
“(23) Stamps showing the date of receipt of papers shall be so placed as 
not to occupy any writing space. If stamps constituting pro forma endorse- 
ments, such as ‘Received and forwarded’, ‘Referred for action’, etc., are used, 
they will be placed on the face of pages as though written in a more formal 
manner, and will be numbered as indicated in example. 
“(24) Endorsements, whether written or stamped, except those referred to 
in the next paragraph, shall be placed in regular order, beginning on the 
last page of the letter, immediately below the signature, if there be room 
there; if not, additional full sized sheets shall be appended to the letter 
to accommodate them. Endorsement slips shall not be used, except on corre- 
spondence with other departments using such slips. 
“(25) All endorsements affecting pay, mileage, transportation, and traveling 
expenses shall be placed on the face of the original order involving travel, 
if practicable, otherwise on the back of the order. Such endorsements shall 
never be placed on sheets which might be detached from the original order. 
“(26) Only one page of the sheet shall be written upon, and a margin of 
% inch shall be left on each side and at the bottom of the sheet. 768 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
“(27) The following are examples of the forms of correspondence prescribed 
in this article: 
Example A 
No. 122-3. 
U. S. Navy Yard, Philadelphia, 
From: Commandant, Navy Yard, Philadelphia. 
To: Commanding Officer, U. S. S. Southwark. 
Via: (1) Construction Officer. 
(2) Engineer Officer. 
Subject: U. S. S. Southwark—Repairs to boat crane. 
References: 
(a) Comdg. Off. let #576-D, of 27 April, 20. 
(b) Dept. let. 2345-432, of 30 April, 20, to Bu. of C. & R. 
Enclosures: 
(A) (separate cover) Blueprint #1234 showing proposed arrangement of 
boat crane. 
(B) (herewith) Copy of previous correspondence on this subject. 
1. The repairs to the boat crane of the U. S. S. Southwark are to be under- 
taken by the ship’s force. The yard force will give such assistance as may be 
necessary in this connection, and you will please be governed accordingly. 
SO June, 1920. 
A. B. __ 
1st endorsement 
No. 324-S-OD. 
U. S. Navy Yard, Philadelphia 
Construction Department, 
1 July, 1920. 
From: Construction Officer. 
To: Commanding Officer, U. S. S. Southwark. 
Via: Engineer Officer. 
Subject: U. S. S. Southwark—Repairs to boat crane. 
1. The commanding officer has been consulted concerning the desired repairs, 
and the necessary material therefor under the construction department will be 
furnished. 
Estimated cost: 
Labor $10 
Material 80 
Indirect 40 
Total 130 
C. D. 
2d endorsement 
No. 411-237-PW. 
U. S. Navy Yard, Philadelphia 
Engineering Department, 
5 July, 1920. 
From: Engineer Officer. 
To: Commanding Officer, U. S. S. Southwark. 
Subject: U. S. S. Southwark—Repairs to boat crane. 
The construction officer and commanding officer have been consulted, and the 
necessary material under the engineering department for the proposed repairs 
will be furnished. ADMINISTRATION AND GENERAL CLERICAL PROCEDURES 
769 
Estimated cogt: 
Labor $8 
Material 60 
Indirect 30 
Total 98 
E. F. 
1382-67-C. O. 
Example B. 
Navy Yakd, Puget Sound, Wash., 
Hull Division, 
6 May, 1920. 
From: Construction Officer. 
To; Commandant. 
Subject: Quick-drying paint. 
References: (a) Bureau C. & R. letter 4048-A-306 of 14 March, 20. 
(6) Bureau C. & R. letter 4048-A-139 of 27 July, 19. 
(c) Bureau C. & R. letter 1808-B-912 of 12 Feb., 20. 
Enclosures : #13821 & #13822. 
1. I request that the Bureau of Construction and Repair furnish formula 
for manufacturing slate-color, quick-drying paint mentioned in the first para- 
graph of reference (c). 
2. Also request information as to the proper formula for boot topping on 
battleships. The second paragraph of reference (c) states that black quick- 
drying paint is used for boot topping on vessels painted slate color. Reference 
(?>) gives black boot topping formula for use on torpedo boats, destroyers 
and colliers, but states nothing about modifying previous instructions regard- 
ing boot topping for battleships, the last instructions received on that point 
being in reference (c). Attention invited to enclosure #13822 showing sam- 
ples of boot topping used on ships at the yard, and that mixed according to 
reference (c). 
A B 
12879-136-c 
1st endorsement. 
Navy Yabd, Puget Sound, Wash., 
7 May, 1920. 
From: Commandant. 
To: Bureau of Construction and Repair. 
Subject: Quick-drying paint. 
Enclosure: #13822. 
1. Approved and forwarded. 
E F G 
Example C. 
(Form of letterheads and subletterheads.) 
Navy Department 
Bureau of Construction and Repair 
Washington, D. C., 1 July, 1912. 770 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
U. S. S. Connecticut 
Hampton Roads, Va., 1 July, 1912. 
United States Atlantic Fleet 
U. S. S. Connecticut, Flagship 
Navy Yard, New York, 1 July, 1912. 
U. S. S. Connecticut 
(Passage, New York to Hampton Roads) 
1 July, 1912. 
Navy Yard, New York 
Captain of the Yard’s Office 
1 July, 1912. 
Navy Yard, Boston 
Hull Division 
1 July, 1912. 
Navy Yard, Norfolk 
Machinery Division 
1 January, 1913.,> 
The sheets of a letter or report shall be arranged in regular order from 
bottom to top; i. e., the first sheet on the bottom, the last sheet on top. 
Enclosures, if any, shall be attached in regular order on bottom of the letter, 
all securely fastened together, the head of the fastener underneath and the 
ends turned over the face of the correspondence in order that the last sheet 
may be readily removed to place endorsements thereon. Additional sheets 
bearing endorsements shall be attached, each on top of the preceding one, on 
the face of the correspondence, so that the last endorsement shall be uppermost. 
Whenever an endorsement begins on a new sheet the subject shall be repeated. 
Each page of letters and endorsements shall be numbered in the middle of 
the page about one-half inch from the bottom. These numbers shall run 
consecutively throughout the correspondence. 
When folding is necessary, letter paper shall be folded in three and type- 
writer cap in four equal folds parallel to the writing. 
All papers of whatever nature which by law or regulation must be signed, 
approved, or forwarded by an officer commanding a fleet, squadron, division, 
or station, the commandant of a naval station, the senior officer present, or the 
commanding officer of a ship, actually must be signed by such officer in his own 
handwriting. In his absence they shall be signed by the line officer next in 
rank and actually in command at the time, and the word “Acting” shall be 
written or stamped after his signature, but the title of the official from whom 
the communication emanated, as indicated after the word “From” at the 
beginning of the paper, shall not be modified. The name of the officer signing 
also shall be typewritten or stamped. Thus, in the absence of the Chief of the 
Bureau of Navigation, the words “Bureau of Navigation” still would appear 
in the letterhead, and the acting chief of bureau would write “Acting” after 
his signature. “Acting” shall not be used by officers left in command of ships 
or divisions. 
When the officers in charge of sections of a bureau or office are authorized to 
sign mail of their section, they write or stamp the words “By direction” after 771 
ADMINISTRATION AND GENERAL CLERICAL PROCEDURES 
their signature, and the title of the bureau or office shall appear in the pre- 
scribed place at the head of the communication. 
Communications generally are addressed to those who by regulation or 
law have cognizance of the subject presented or are authorized to take action 
thereon. 
Official communications intended for officers holding positions with recognized 
titles are addressed to them by title and not by name, as “The Secretary of 
the Navy,” “Bureau of Navigation,” “The Commandant,” “The Commander in 
Chief, Fleet (or Squadron),” ‘The Commander, 
Squadron (or Division),” “The Commanding Officer.” 
Officers left in temporary command of a station, fleet, squadron, or division, 
or in general, of any command, are addressed as if they were the regular com- 
manding officer, on the principle that it is the office and not the person that is 
addressed. The temporary incumbent transacts the business so that the 
necessary copies and records shall be preserved in the files of the absent 
superior officer’s office, using stationery of that office when practicable. 
For the purpose of expediting public business between offices of the department 
or within any command, mail shall be regarded as consisting of three classes-— 
urgent, important, and ordinary. “Urgent” mail shall be given precedence over 
all other, and in order that it may be readily distinguished, it shall have 
affixed to it a red slip, 2 by 3 inches in size, with “Urgent” printed thereon. 
“Important” mail shall be given precedence after urgent mail and shall bear a 
blue slip with the word “Important” thereon. In general, “ordinary” mail shall 
be handled in the order in which received. 
Official mail received on board ship, or at any station, shall be opened at 
once by the officer actually in command for the time being, or his designated 
representative, and all papers requiring prompt action given immediate 
attention. 
Official communications for the Navy Department or any of its bureaus or 
offices are addressed directly to the bureau or office which has cognizance 
over the subject matter. 
It is prohibited to address communications to “The Navy Department” or to 
“The Navy Department ( ).” 
The following are examples of authorized addresses: 
The Secretary of the Navy. 
The Assistant Secretary of the Navy. 
The Chief of Naval Operations. 
The President of the General Board. 
The Chief of the Bureau of 
The Major General Commandant, Marine Corps. 
The Judge Advocate General. 
The Chief Clerk of the Department. 
When papers are addressed erroneously and reach any bureau or office under 
the jurisdiction of the Navy Department they are turned over to the bureau or 
office to which they should have been properly addressed without action thereon. 
No written communication is official which has not been forwarded through 
the prescribed channels and with the endorsements of the officers through whom 
it should have been forwarded. 
All officers are required to file and preserve all official documents received 
and copies of all official letters and endorsements sent. 
Suitable files containing copies of all orders given and official letters written 
and the original of all letters received on public service in all offices on board 772 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
naval vessels and at shore stations shall be kept and preserved. Commanding 
officers may take copies of orders or letters sent and received. The system of 
filing shall be such as to safeguard all official papers and to render them 
readily accessible to reference. A flat filing system shall be used when 
practicable. 
United States Navy filing system. 
A uniform system of filing all correspondence by subjects with key letters 
and numbers was adopted by the Navy in 1923. This system, the rules for 
which are contained in the United States Navy Filing Manual, must be strictly 
adhered to. 
The subject titles are so arranged as to be as nearly as possible self-indexing. 
To this end the activities of the Navy have been divided into seven main parts 
and each part designated by a letter. These are: 
(1) A Administration. 
(2) F Aircraft material. 
(3) H Hydrography, meteorology, navigation, and astronomy, 
(4) L Logistics. 
(5) N Shore establishment material. 
(6) P Personnel. 
(7) S Material of ships. 
The activities under each of these main parts have been so arranged that 
those of correlative nature or having the same general purpose are grouped 
together and each group assigned a descriptive file arrangement title with its 
corresponding file number. For example, the personnel groups run thus: 
PI Genealogy and identification. 
P2 Preventive medicine. 
P3 Medicine. 
P4 Surgery. 
P5 Dentistry. 
P6 Death and casualties. 
P7 Domestic relations. 
P8 Social relations. 
P9 Political relations. 
P10 Amusement and recreation. 
Pll Education. 
Pi 2 Religion. 
PI 3 Misconduct and discipline. 
P14 Appointment. 
P15 Commendations, citations, and medals. 
P16 Assignment and detail. 
P17 Rank, precedence, and promotion. 
PI8 Attendance and absence. 
P19 Separation (personnel). 
P20 Performance. 
P21 Morale. 
In selecting a file number from the index, it should represent a specific 
title. Example: An endorsement is to be placed on an officer’s request for 
leave from the Naval Hospital, Washington, D. C. By referring to the index 
it is found that the file number for that hospital is NH6, the subject of the 
endorsement is leave of absence. Again referring to the index it is found ADMINISTRATION AND GENERAL CLERICAL PROCEDURES 
773 
that P18-1 covers that subject. If correspondence for personnel is filed in 
individual jackets for those concerned, then the letter J is also added. All 
letters and figures are now joined, but each block is separated by a slant (/). 
Thus the complete file number is NH6/P18-1/J and twTo carbon copies should 
be prepared, one for file under P18-1 and one for the jacket J. 
A copy of the filing manual is to be found in each office. 
Organization of clerical force. 
The clerical work required of the medical department of a ship or hospital 
is carried on largely by members of the Hospital Corps. When hospital 
corpsmen are on independent duty the preparation and forwarding of the 
various reports and returns required is entirely in their care, and unless 
they have prepared themselves for this work it is very confusing to the bureau 
and entails unnecessary work in the attempt to gather accurate data from 
incorrect and carelessly made reports. 
The duties in a naval hospital comprise all that relates to the replenish- 
ment of supplies, the upkeep, expenditure, and survey of property, the com- 
missary department and the correspondence and clerical work of the record 
section incident to the above, as well as the filing of all permanent records. 
Clerical activities at a naval hospital are usually divided into four sections, 
i. e., personnel or record office, accounting office, property office, and commis- 
sary department. 
Aboard ship the clerical work comprises all the work required at naval hos- 
pitals, except commissary, and is not divided. A chief pharmacist’s mate is 
usually in charge, the whole being under the supervision of the medical officer. 
BLANK FORMS AND RETURNS OF THE MEDICAL DEPARTMENT OF THE 
NAVY OTHER THAN REQUISITION AND VOUCHER FORMS 
To secure uniformity and accuracy of the reports and returns connected 
with the duties of the medical department of the Navy certain blank forms for 
specific purposes have been provided. To designate these forms they are lettered 
or numbered, and they usually bear other letters indicating that they belong 
to the Bureau of Medicine and Surgery. 
The data contained in these reports are the basis for all of the bureau’s 
statistical compilations, and become permanent and highly important records 
of the Navy Department. The Bureau of Medicine and Surgery is compelled to 
rely upon them for the medical histories of the officers and enlisted men of the 
Navy when requested to furnish specific information of importance demanded 
by other departmental bureaus and of vital concern to the individual. It is 
therefore obvious that these reports must be without error. In combining and 
tabulating these reports an error in any one makes the whole faulty and im- 
pairs any deductions made from such statistics. 
To assure the uniformity and accuracy desired and to aid those wrho prepare 
these forms, detailed instructions for preparing each particular form are printed 
on the form itself, or the information desired is fully indicated in the printing 
and wording of the form. A great difficulty with printed instructions of this 
character is that those for wThose guidance they are intended do not read them 
and consequently do not comply strictly with the directions given. Only by 
strict compliance with instructions can mistakes and needless correspondence 
be avoided. Before attempting to prepare any bureau form or report it is 
therefore essential to read carefully the instructions pertaining to the form 
and to understand their meaning. 774 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
These forms, as well as the instructions for preparing them, are subject 
to change, and therefore the form itself should always be resorted to for the 
necessary directions as to its preparation. 
In transacting the business of the Medical Department of the Navy many 
reports and returns other than those pertaining to that department must be 
prepared as occasion requires. General and detailed instructions concerning 
their preparation are contained in bureau manuals and circular letters, or on 
the forms, and in all cases should be strictly followed. 
Hospital corpsmen whose examinations for advancement in rating include 
the subject of Administration and General Clerical Procedures must famil- 
iarize themselves not only with the contents of all sections in this section hut 
with those parts of bureau manuals, Navy Regulations, Naval Courts and 
Boards that pertain to the subject. 
References 
Handy Book for the Hospital Corps, 1917. 
U. S. Navy Regulations. 
Manual of the Medical Department. 
Bureau of Navigation Manual. 
Hospital Corps Handbook, U. S. Navy, 1923. 
Handbook of the Hospital Corps, U. S. Navy, 1930. 
Section 2.—HOSPITAL SUPPLIES AND PROPERTY 
ACCOUNTABILITY 
The title of this secton, usually spoken of by the term Property and 
Accounting, as employed by the Medical Department of the Navy, comprehends 
the procurement, custody, and final disposition of property under its cognizance, 
and the accounting procedures concerned therewith. It is essential, therefore, 
that all personnel of the Medical Department, particularly hospital corpsmen, 
understand the subject and be familiar with the terms in common usage and 
the routine procedures. In this section the terms and procedures will be 
covered generally by definitions, explanations, and illustrations. A study of the 
Manual of the Medical Department, U. S. Navy, and other official publications, 
for details and directives, is recommended to all personnel, especially to those 
whose duties are in any way concerned therewith. 
In general, medical-department property is of two classes—equipment and 
supplies. At naval hospitals “land and buildings” constitutes a third class. 
Equipment is property that is not consumable, i. e., not easily breakable (as 
hospital furniture) or not readily rendered unfit for. service by continued use 
(as surgical instruments). Consumable materials and personal services are 
classified as supplies. In order to determine if an item is equipment or 
supplies reference should be made to the Supply Table and Supplementary 
Supply Table. Items not specifically listed therein should be classified accord- 
ing to the classification of similar or identical items in the supply tables, and 
should be grouped by classes in the equipment or supplies ledger according to 
the listing of similar or identical items in the Federal Standard Stock Catalog. 
Property accountability and accounting procedures. 
Article 1194, U. S. Navy Regulations, holds the medical officer in command 
of each hospital, and the medical officer of each station and ship responsible 
and accountable for all public property under his control belonging to the 
Medical Department of the Navy. HOSPITAL AND PROPERTY ACCOUNTABILITY 
775 
In order to avoid unnecessary expenditures of public money or stores and 
to attend to the care and preservation of Government property, an accurate 
account of property under the cognizance of the Medical Department must be 
kept. This is accomplished by the utilization of certain accounting records, 
bookkeeping procedures, reports, and returns. 
The following paragraph, quoted from the Code of Laws of the United 
States, Title 5, section 430, fixes the responsibility of the Bureau of Medicine 
and Surgery for its books of records and accounts: 
“The several bureaus shall retain the charge and custody of the books 
of records and accounts pertaining to their respective duties, and all of 
the duties of the bureaus shall be performed under the authority of the 
Secretary of the Navy, and their orders shall be considered as emanating 
from him, andt shall have full force and effect as such.” 
It is impracticable for the Bureau of Medicine and Surgery to attend to 
all the details of accounting for monies and materials for each Individual 
station and ship. Therefore there have been established accounting systems 
for use by naval hospitals and by ships and stations. Reports and returns 
forwarded by medical-department activities at regular intervals provide the 
bureau with the information necessary to carry out its financial responsibilities 
and control its financial obligations. 
At each naval hospital there is established a Property and Accounting Office 
in which correspondence, records, reports, returns and documents required in 
the handling of the financial affairs of the hospital are prepared and maintained. 
This department is usually under the charge of a chief pharmacist or pharma- 
cist designated as the Accounting Officer with an assistant designated as the 
Property Officer, although the duties of both these officers may be combined. 
In addition to such other duties as may be assigned them the duties of 
officers assigned to the Property and Accounting department of a naval hospital 
are as listed immediately hereafter. 
The accounting officer— 
1. Is the assistant to the commanding and executive officers in financial 
and property matters; 
2. Is responsible for the accounting records and keeps the commanding 
officer informed relative to the status of allotments, expenditures, 
etc. Keeps the Land and Buildings, Equipment, and Supplies 
Ledgers and is responsible for their accuracy; 
3. Supervises the preparation of requisitions, public vouchers, payrolls, 
invoices, requests for allotments, surveys, annual estimates and 
advanced years’ estimates of expenditures, and all other forms and 
reports pertaining to financial matters; 
4. Submits to the commanding officer, via the executive officer at the 
end of each month, a report on the condition of allotments, and 
a statement of the balances available, or prospective over-obliga- 
tions, if any, with reasons therefor; and 
5. Keeps himself informed of the laws, regulations, and instructions 
governing the preparation and submission of accounting records 
and reports and keeps the books of account and financial records 
of the hospital. 
The property officer— 
1. Is custodian of all stores and equipment belonging to the hospital, 
exercising personal and careful supervision over them and the 776 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
economical use and expenditure thereof, reporting any deficiencies 
to the accounting officer; 
2. Receipts for, issues, and accounts for all stores (except commissary 
stores) and equipment; 
3. Maintains the proper records of equipment issued to the several serv- 
ices and facilities of the hospital, obtains and retains in file custody 
receipts therefor, and reports any deficiency in property charged to 
these activities to the accounting officer; 
4. Takes an actual inventory of stores (except commissary stores) on 
hand at the end of each quarter and reports to the accounting 
officer any differences in the amounts as shown on the books and 
as determined by actual inventory; 
5. Correlates the inventories from the various activities as of 30 June, 
each year, and prepares the annual inventory for submission to 
the bureau; 
6. Is responsible for the management and accounting of the pharmacy 
unless the commanding officer shall specifically except this responsi- 
bility from his assigned duties; and 
7. When detached or relieved, makes a complete inventory of all equip- 
ment and supplies (except commissary stores) and transfers them 
to his successor. 
The accounting system prescribed for naval hospitals is based upon double- 
entry bookkeeping principles modified to provide data essential to central con- 
trol and internal management. Such elements of appropriational, cost, and 
fiduciary accounting as will provide the necessary data are utilized in this 
system which is designed to suit the needs of all naval hospitals regardless of 
size or of the number of administrative units into which each hospital may be 
divided. A knowledge of the fundamental principles of double-entry bookkeep- 
ing procedure is necessary to the proper understanding of the accounting system 
in use at naval hospitals. As a detailed discussion of the fundamentals of 
bookkeeping is beyond the scope of this section, and in view of the fact that ac- 
counting instructions are contained in Chapter 20 and Circular Letter F, 
Appendix D, Manual of the Medical Department, U. S. Navy, only brief mention 
of medical department accounting records and reports will be made here. 
Naval hospitals.—The accounting records required to be kept at each naval 
hospital are: 
1. Journal.—The Journal is a book of original entry in which is recorded, 
either in detail or in summary form, the debit and credit effects of financial 
transactions. 
2. Charge Register.—The charge register is a columnar subsidiary journal 
record in which is recorded the debit and credit effects of financial transactions 
involving the receipt of property, except property received by transfer voucher 
or taken up from inventory adjustment vouchers. 
3. General Ledger.—The general ledger is the control or master ledger in 
which is recorded the debit and credit effect of every receipt and expenditure 
of property. Postings to this ledger are made only from the Journal. 
4. Land and Buildings Ledger.—The land and buildings ledger is an itemized 
record of the receipt and expenditure of land and buildings items. 
5. Equipment Ledger.—The equipment ledger is an itemized record of the 
receipt and expenditure of all equipment items. 
6. Supplies Ledger.—The supplies ledger is an itemized record of the receipt 
and expenditure of all consumable supplies except provisions. HOSPITAL AND PROPERTY ACCOUNTABILITY 
777 
7. Commissary Ledger.—The commissary ledger is an itemized record of the 
accounts of the commissary department, both as to quantity and cash value 
of provisions. 
8. Expense Analysis Register.—The expense analysis register is a cost analysis 
of the hospital operating expense subdivided to show: (a) The operating cost 
by departments; (ft) the expenditures on account of pay of the military staff; 
and (c) the expenditures made for the Navy as a whole. 
9. Recapitulation of Ledger Accounts. (Register No. 3).—The recapitulation 
of ledger accounts is prepared quarterly and when decommissioned, in dupli- 
cate, and is forwarded to the bureau not later than 15 days after the close 
of each quarter. In addition to the recapitulation of general ledger accounts 
this form furnishes a recapitulation of each Expense Analysis Register account 
and information related to both recapitulations. When forwarded it is accom- 
panied by other required financial reports and supporting data. The duplicate 
copy is retained in the files of the accounting office of the activity submitting 
the report. 
10. Quarterly Ration Return. {N. M. S. II. Form 36).—The quarterly ration re- 
turn is prepared in duplicate, quarterly and when decommissioned, and the 
original is forwarded to the bureau with the Recapitulation of Ledger Ac- 
counts (Register No. 3). This report supplies the bureau with information as 
to subsistence furnished personnel, the amount of reimbursement received or to 
be obtained by the bureau therefor, the value of provisions received and 
expended, and the average daily cost of ration. 
Ships and stations.—The accounting system for shore stations other than 
naval hospitals and for ships consists principally of records of the receipts and 
expenditures of materials and services and of records of appropriational ex- 
penditures and obligations. The following financial records are required to be 
kept in the operation of this system; 
1. Journal of Receipts and Expenditures of Medical Department Property.— 
This journal is the book of original entry for stations and ships and is used 
to record data relative to each financial transaction involving the receipt and 
disposition of medical-department property. It should be posted daily, or as 
frequently as may be necessary to keep the record up to date. Each entry 
should be substantiated by a duly authenticated voucher (N. M. S. Form 4 
invoices, stub requisition summaries and stub requisitions, public vouchers, 
transfer vouchers, surveys, issue vouchers, etc.) and the vouchers should be 
preserved in such manner as to be readily accessible for reference or audit 
purposes. At the close of each quarter and upon decommissioning, each amount 
column in the Journal should be totaled and the sums entered on the Statement 
of Receipts and Expenditures of Medical Department Property (N. M. S. 
Form E). 
2. Equipment Ledger.—In this ledger a sheet (N. M. S. Form W) is kept for 
each item or group of identical items of equipment arranged by Supply-Table 
classes, Supplementary Supply-Table classes, and Federal Standard Stock Cata- 
log classes. A control sheet for each class and a master' control sheet for all 
classes should be kept. Receipts of equipment are posted in this ledger from the 
data contained in the substantiating voucher following posting of the total 
amount of the voucher in the Journal of Receipts and Expenditures of Medical 
Department Property. Expenditures of equipment are posted to this ledger 
from approved surveys and transfer vouchers, following posting in the Journal. 
3. Supplies Ledger.—In this ledger a sheet (N. M. S. Form W) is kept for 
each item or group of identical items of supplies arranged by Supply-Table 778 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
classes, Supplementary Supply-Table classes, and Federal Standard Stock 
Catalog classes. A control sheet for each class and a master control sheet for 
all classes should be kept. Receipts of supplies are posted in the same manner 
as are receipts of equipment. Expenditures are posted from issue vouchers 
(N. M. S. Form R.), transfer vouchers issued, and inventory adjustment vouch- 
ers, in the same manner as expenditures of equipment are recorded. New unit 
costs of items are determined and recorded on the ledger sheets upon receipt 
of additional items having a unit cost greater or less than the unit cost then 
appearing on the ledger sheets. 
Accounting records and reports used hy the Medical Department provide sta- 
tistics of two kinds: Appropriational, and cost. By appropriatlonal accounting 
is meant the procedures involved in recording and analyzing the value of receipts 
of materials and services obtained by reason of the expenditure or transfer of 
funds from appropriations under the cognizance of the Bureau of Medicine and 
Surgery or from the Naval Hospital Fund. Cost accounting concerns the pro- 
cedures involved in recording and analyzing the value of materials and services 
consumed in the operation of an activity regardless of the source from which 
such materials and services may have been received. 
N. M. S. Form B is the report of allotment expenditures and obligations 
used in appropriational accounting and is forwarded to the bureau quarterly 
by all medical-department activities required to submit financial returns. This 
form is designed to report expenditures as follows: By appropriation, and by 
objects of expenditure and subheads under objects, including totals expended for 
supplies, for equipment, and, at naval hospitals, naval medical supply depots, and 
the naval medical school, on land and buildings. It furnishes information 
concerning the allotment status as to amount available at the beginning of the 
period covered by the report, amount expended during the period covered by 
report, and obligations outstanding and unexpended balance at end of the 
period. It also analyzes the expenditures reported to show the source (stub 
requisition, purchase requisition, bureau work request, etc.) of materials, sub- 
divided according to the appropriations chargeable. 
On the face of the form are reported the expenditures under the supply 
depot credit allotment, the status of that allotment, the data concerning each 
medical supply depot requisition received during the accounting period covered 
by the report, and the data with respect to each such requisition outstanding 
at the close of the accounting period. On the reverse of this form is reported 
an analysis of the receipts from medical supply depots by supply table classes 
and subheads, subdivided into supplies, equipment, and mortuary supplies and 
equipment. This analysis is prepared by consolidating the cost data shown on 
the reverse of all naval medical supply depot requisitions and invoices (N. M. 
S. Form 4) actually receipted by the activity during the accounting period 
covered by the report. {See sample forms on pages 798 to 893, inclusive). 
It is essential that accurate information be furnished on Form B as it is 
used in the bureau for many purposes, chiefly to fiirnish the information 
required for allotment control and analyses of expenditures by subheads. 
N. M. S. Form E is the statement of receipts and expenditures of medical- 
department property and is forwarded to the bureau by such ships and stations 
as are required to submit medical-department financial returns. It is designed 
to furnish a perpetual inventory control and cost analysis, and reports the 
receipt and expenditure of all materials and services, regardless of source, 
divided into equipment and supplies, and analyzes certain receipts and expendi- 
tures. Incidental information as to operating expense, complement, and medical HOSPITAL AND PROPERTY ACCOUNTABILITY 
779 
services rendered civilians is supplied on lines 46 to 55 inclusive. (See sample 
form on pages 796 and 797). The information contained on all N. M. S. Forms E 
submitted is consolidated in the bureau. In order to coordinate the various 
expenditures and consider the entire problem of financing the Medical Depart- 
ment, it is essential that this report correctly reflect the financial affairs of the 
reporting activity. 
The initial financial record is the allotment card covering the allocation of 
funds to medical-department activities. Allotment cards, on each of which is 
shown the name of the appropriation, the allotment number, and the amount 
of money allotted, are forwarded by the bureau to shore stations with the 
returned annual estimate of expenditures, as approved. Allotment cards for 
ships are prepared and forwarded by the bureau. Except for supply-depot 
credit allotments, the total amount allotted is divided into quarterly appor- 
tionments, the amount apportioned for each quarter depending upon the 
estimated requirements of the activity during each quarter. 
Allotments are classified by the Bureau of Medicine and Surgery as appro- 
priational (money credits) and medical supply depot (material credits). 
Appropriational allotments are money credits made to medical-department 
activities from the Congressional appropriations Medical Department, Navy, 
and Care of the Dead, Navy, and from the Naval Hospital Fund, and represent 
the amounts reserved or set aside by the bureau exclusively for the activities 
to cover the anticipated expenditures and transfers of funds in the procurement 
of the materials and services necessary to carry out the mission of the Medical 
Department. 
Medical supply depot allotments are material credits authorizing withdrawals 
of equipment and supplies from stock at naval medical supply depots and are 
measured in terms of money for convenience. In such withdrawals no dis- 
bursement or transfer of funds is involved because the materials were paid 
for from funds allotted to the medical supply depots for that purpose. The 
stock available for issue at medical supply depots is procured from funds 
allotted by the bureau to the depots annually, prior to 1 July, to cover regu- 
larly stocked Supply-Table and Supplementary Supply-Table items estimated to 
be required by all medical-department activities for one year. 
Upon receipt of the allotment cards, the medical department of an activity 
is prepared to initiate the procedures necessary to obtain the needed materials 
and services for its proper function. 
Procurement. 
The financial duties of the Bureau of Medicine and Surgery are set forth 
in Sections I and II, Chapter 20, Manual of the Medical Department, U. S. 
Navy. 
Not all monies under the cognizance of the Navy Department are appropri- 
ated funds; there are also Working Funds and Trust Funds. A notable 
example of a trust fund, and one of interest to hospital corpsmen, is the 
Naval Hospital Fund which derives its revenue from within the naval service 
and is administered by the Secretary of the Navy, the Trustee. The sources 
of revenue of this trust fund are; 
1. By the deduction of 20 cents per month from the pay of each officer, 
seaman, and marine (Sec. 4808, R. S.). 
2. By fines imposed on officers, seamen and marines (Sec. 4808, R. S.). 
3. By the value of one ration per day allowed for each officer, seaman, 
and marine, during his continuance in hospital (Sec. 4812, R. S.). 
154294°—39 50 780 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
4. By the relinquishment of disability pensions due officers, seamen, and 
marines (other than Veterans’ Administration beneficiaries) while inmates 
of naval hospitals (Sec. 4813, R. S.). 
5. By forfeitures on account of desertion (Act of June 7, 1900, 31 Stat. 
697). 
Monies required for the maintenance and operation of medical-department 
activities are made available from two sources: Annual appropriations and 
a trust fund. Services and materials are procured for the medical depart- 
ment of ships and stations and at hospitals both from the money appropriated 
and from the Naval Hospital Fund, the trust fund just mentioned. 
Annual appropriations are made by the Congress for expenditure during 
a specified fiscal year. The annual appropriations included in the Appropriation 
Act for the Naval Establishment which pertain to the Bureau of Medicine 
and Surgery are titled as follows; 
(a) Medical Department, Navy; 
(&) Care of the Dead, Navy; and 
(c) Salaries, Bureau of Medicine and Surgery 
The detailed purpose of expenditure under the fixed title of appropriations 
is contained in each annual appropriation act. The language of the appropri- 
ation controls expenditures to be under that appropriation. For example, 
the annual appropriation, Care of the Dead, Navy, by its title presupposes, 
and correctly so, that expenditures for the care of the remains of the dead are 
payable from this appropriation. The language of this appropriation reveals 
the specific objects such as funeral expenses, recovery of bodies, cremation, 
preparation for burial, transportation, burial expenses of pensioners and desti- 
tute patients, and so forth. The language of an appropriation or fund must be 
studied carefully to determine the one to which an expenditure is chargeable. 
It should be remembered therefore that the appropriations and funds are 
not interchangeable and do not constitute a lump sum to be expended as 
desired. Rather, the language of the act, naming a specific purpose or object, 
prevents the use of funds from a less specific appropriation for that particular 
purpose or object. 
The Naval Appropriation Act for each fiscal year contains the wording of 
the annual appropriations; Chapter 20, Manual of the Medical Department, 
U. S. Navy, defines expenditures to be made from the Naval Hospital Fund. 
Funds to operate a naval hospital or the medical department of a naval 
station are obtained by the medium of an annual estimate of expenditures. 
As ships have approximately the same expenses from year to year the bureau 
does not require individual ships to submit an annual estimate, but allots 
funds, by classes of ships, on an average expenditure basis. 
Under ordinary circumstances, a medical-department activity should not 
incur any appropriational obligations unless, and until, an allotment for the 
purpose has been granted by the bureau. Certain contingencies indicated in 
Article 1396, U. S. Navy Regulations, permit the commanding officer to authorize 
appropriational expenditures without an allotment. In each such case, however, 
a full report of the emergency must be made to the bureau in order that 
provisions may be made to meet the expenditure. 
The annual estimate of expenditures may be defined as a detailed analysis 
and itemization of the appropriational expenditures which, it is expected, will 
be required to provide the submitting activity with the materials and services 
necessary for its maintenance and operation for a stated period. As the manner HOSPITAL AND PROPERTY ACCOUNTABILITY 
781 
of submitting estimates and the data required to be submitted to the bureau with 
each estimate is subject to change, the current circular letter on the subject 
should be consulted before preparation. 
An annual estimate is submitted to the bureau by shore stations to cover 
the period of one fiscal year from 1 July of one to 30 June of the next calendar 
year. Another estimate, known as “Tentative Estimate, Advance Fiscal Years” 
is also submitted annually. For example, an annual estimate would be sub- 
mitted for the period: 1 July, 1942, to 30 June, 1943. The tentative estimate 
for advance fiscal years is submitted for the two fiscal periods immediately 
following the period covered by the annual estimate, in this case for the period 
1 July, 1943 to 30 June, 1944, and for the period 1 July, 1944 to 30 June, 1945. 
Annual estimates are reviewed in the bureau and when approved constitute 
a fiscal guide for1 the activity. 
The preparation of an annual estimate is not a one-man job. The full 
cooperation of all persons having to do with materials and services is essential 
to a complete and intelligent estimate covering requirements for all departments. 
The data required for the preparation of estimates should be collected from 
official weekly inspections, notes, experience data, and so forth, classified and 
filed for reference. 
Materials and services may be obtained on the following official request 
forms, duly prepared and accomplished: 
1. Purchase Requisitions (S. & A. Form 76 and 76a ashore, and S. & A. 
Form 44 and 44a afloat) ; 
2. Stub Requisition (Local memorandum invoices) ; 
3. Requisition for Labor (N. Y. O. Form 6) ; 
4. Bureau Work Request (Special M. & S. Form) ; 
5. Medical Supply Depot Requisition and Invoice (N. M. S. Form 4) ; 
and 
6. Transfer Vouchers (Usually S. & A. Form 71). 
In order that a supply officer may make a payment legally, he must have 
definite authority therefor. The approval of a purchase requisition by the 
cognizant bureau, or bureaus, constitutes the necessary authority to make 
payments. A purchase requisition, therefore, may be defined as an authorization 
to the supply officer designated thereon to make a contract in accordance with 
the terms of the requisition. 
Regarding the expenditure of funds of the Medical Department of the Navy 
it should always be borne in mind that officers of the Supply Corps and Marine 
Corps Quartermasters are the only persons in the naval service who may make 
appropriational expenditures, an exception sometimes icing made when the 
Chief of the Bureau of Supplies and Accounts specifically designates an officer 
as Special Disbursing Agent. 
It naturally follows, therefore, that the appropriational expenditures reported 
by medical department activities must agree with the appropriational expendi- 
tures reported by the supply officer. 
Procurement by requisition, in contrast to procurement by transfer, pre- 
supposes prior approval of a requisition and an allotment of sufficient funds 
to cover the cost. An allotment of funds may be defined as evidence of a 
credit which has been established for the maintenance, operation, Improvement, 
or extension of a specified medical-department activity. The sum allotted is 
based upon general and specific projects of an approved fiscal plan. Contrary 
to general opinion, if sums allotted are in excess of needs for approved projects, 
due to over-estimates, deferred projects, or otherwise, the excess is not available 782 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
for accomplishment of unapproved projects, without specific approval for such 
use. It should be borne in mind that a project is approved prior to the allotment 
of funds. 
Certain minor procurements of materials and services are required fre- 
quently by medical-department activities. It would be impracticable for an 
activity to submit a purchase requisition to the bureau for approval in each 
such case, prior to obtaining the necessary materials or services. This situation 
is met by the submission and subsequent approval of annual purchase requisitions 
covering such recurring needs throughout the fiscal year. The language of such 
requisitions is approximately as follows: 
For hospitals and large stations 
For sundry items of supplies, equipment and services, including services 
of Mood donors, in such quantities and at such times as may be required 
during the fiscal year 19—. 
(The services of blood donors are omitted from requisitions drawn under 
the Naval Hospital Fund because such services are provided for in and 
are chargeable to the appropriation Medical Department). 
For ships and small stations 
For sundry items of medical and dental supplies; special diets for 
the sick; laundry supplies and services; services of blood donors; repair 
of and parts for medical-department equipment; repair of and parts 
for motor vehicles; in such quantities and at such times as may be 
required during the fiscal year 19—. 
(Requests for dental supplies and repair of and parts for motor vehicles 
are omitted from requisitions submitted by ships and stations having no 
dental officer and at which there are no medical-department motor 
vehicles). 
As may be seen, the approval of an annual purchase requisition authorizes a 
supply officer to make contracts for the purchase of a variety of items, accord- 
ing to the language appearing on the requisition. 
The proposed method of procurement of each item on the approved annual 
estimate of expenditures must be given, that is, whether by Special Purchase 
Requisition (SR), Annual Purchase Requisition (AR), Stub Requisition (S), 
or Bureau Work Request (BWR). The method by which an item will be procured 
is determined by the source from which it is to be obtained as follows: 
(o) Obtain on N. M. S. Form 4 requisition, if the item is listed on the 
Medical Department Supply Table or Supplementary Supply Table. 
(6) Obtain on stub requisition, if the item is listed in the Federal 
Standard Stock Catalog as Navy material. 
(c) Obtain on Bureau Work Request, if work involved in connection 
with the item is beyond the capacity of the hospital force employed. 
(d) Obtain on purchase requisition, if the item must be procured in 
the open market where a cash payment is involved. 
In determining the method of procurement of an item the sources of supply 
are to be considered in the following order of priority: 
1. Naval Medical Supply Depot; 
2. Supply Officers’ stores; 
3. Bureau Work Request, to be performed by yard labor or Public Works 
contract; and 
4. Purchase requisition. HOSPITAL AND PROPERTY ACCOUNTABILITY 
783 
The three naval medical supply depots are located in Brooklyn, N. Y.; 
Navy Yard, Mare Island, Calif.; and Canacao, P. I. Supply-Table and Supple- 
mentary Supply-Table stores are purchased in large quantities by the procuring 
depot at Brooklyn, and stored locally, or in the naval medical supply depots 
at Mare Island and Canacao. Issues from these depots are usually made 
under the authority of an N. M. S. Form 4 requisition, approved by the bureau. 
The items listed on the requisition are boxed by the depot and shipped to 
the medical officer requesting them through the facilities of the Supply 
Department. 
The bureau provides tables listing items stocked, for issue, at naval medical 
supply depots. The tables are known as the Supply Table of the Medical 
Department, U. S. Navy, and the Supplementary Supply Table of the Medical 
Department, U. S. Navy. Instructions as to ordering, and limitations on 
particular items, are contained in each table. 
Items carried in stock by the local supply officer may be withdrawn on 
stub requisition for use provided funds are available in the appropriate allot- 
ment of the medical-department activity. The form of stub requisition to be 
used may differ at various activities. 
When labor (including incidental materials) is required for maintenance 
of buildings, ambulances, or other items of equipment, and such labor is 
beyond the capacity of the force employed, an M. & S. “Bureau Work Request” 
form is submitted covering the project. 
Custody. 
From the date of procurement (receipt) of medical-department property 
until the date of its disposition an individual member of the medical department 
is responsible, in a fiduciary capacity, for its custody. 
The custody of medical-department property includes the accountability, 
inspection, and storage of such property and Article 1132, U. S. Navy Regula- 
tions delegates to the medical officer of each ship the charge of all material 
and stores on board which are under the cognizance of the Bureau of Medicine 
and Surgery. Medical officers in command of naval hospitals and the medical 
officers at shore stations are likewise held responsible for medical-department 
property in their charge by Article 1194, U. S. Navy Regulations. Persons 
charged with the custody of medical-department property are not relieved of 
responsibility therefor until custodianship is regularly transferred to a suc- 
cessor in accordance with existing instructions, or is disposed of by survey. 
Also, by U. S. Navy Regulations, officers are required to avoid any unneces- 
sary expenditure of public money or stores, and so far as may be in their 
power prevent the same in others, and to attend to the care and preser- 
vation of all Government property in their charge. 
Hospital corpsmen who are custodians of or whose duties are concerned 
with the care of medical-department property are expected to do everything 
in their power to preserve such property and prevent its loss, waste, or 
unauthorized use. They also are expected to be thoroughly familiar with the 
instructions governing the custody of and accountability for medical-department 
property as contained in the U. S. Navy Regulations and the Manual of 
the Medical Department, U. S. Navy. 
As the details of the inspection and storage of medical-department property 
vary with the location of activities they will not be discussed in this section. 
Disposition. 
Equipment and supplies consumed in any given period result in a depletion 
of material inventories and a change in the total value of stock on hand; 784 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
therefore, records are needed to reflect the physical and financial changes 
and to provide an administrative control. The primary form used to record 
storeroom issues at medical-department activities is N. M. S. Form R. Some 
materials and services are issued without passing through the storeroom, such 
as payment of salaries and wages to civil employees; bulky stores such as coal 
or fuel oil; special medicines in small amounts procured locally and consumed 
immediately upon receipt; etc. Nevertheless an issue voucher, or other docu- 
ment, covering such supplies is essential: 1. To record the issue authorization; 
2. To relieve the storekeeper of responsibility; and 3. To substantiate the 
necessary entries in the accounting records. 
After materials are issued from the storeroom of a medical-department 
activity the issue vouchers are cbmpleted by entering the unit and extension 
prices on them and the total quantity and cost of each item is then recorded 
as an expenditure on the respective ledger sheets of the appropriate ledger. 
Records of quantity and cost of materials withdrawn are tabulated from these 
vouchers and entered on ledger sheets. A recapitulation of such issues is 
recorded in the Journal of Receipts and Expenditures of Medical-Department 
Property at stations and on ships, and in the Expense Analysis Register at 
hospitals. These recapitulations form the basis for the expenditure entries 
made on N. M. S. Form E and in the Statement of Expense Analysis Register 
Accounts on the reverse of N. M. S. Register No. 3, respectively. 
Equipment and supplies under medical-department cognizance may be trans- 
ferred to another naval activity or to another Federal activity in emergencies 
or as a matter of expediency. Such a transfer constitutes an expenditure 
“by transfer.” The first step in the accounting procedure is the invoicing of 
the material on Bureau of Supplies and Accounts Form No. 71. When receipted, 
this form constitutes the duly authenticated voucher required to substantiate 
the entries in the accounting records and reports with regard to the disposition 
of the material transferred. 
Equipment in excess of requirements, missing, worn out, or otherwise unfit 
for use, is required to be made the subject of a property survey. Surveys 
are requested and the reports are recorded on Bureau of Supplies and Ac- 
counts Form No. 154. U. S. Navy Regulations and Chapter 20, Manual of 
the Medical Department, U. S. Navy, contain complete instructions governing 
survey procedures. Surveys of property are of two types—formal and informal. 
The fiduciary (custodial) accountability for property may be terminated by 
means of a properly executed property survey. The term, property, embraces 
both medical-department supplies and equipment. A property survey is the act 
of inspecting Navy materials (property) by a duly appointed officer or board 
of officers with a view to determining and reporting facts regarding the desig- 
nated property items and making appropriate recommendation concerning the 
disposition of such items. 
The recommended disposition of medical-department property which has 
been so inspected (surveyed) is subject to the approval of the Bureau of 
Medicine and Surgery. To this end, the surveying officer or survey board 
performing the acts of inspection submits a report on the prescribed form 
(S. & A. Form No. 154), listing in the space provided the condition, cause, re- 
sponsibility, recommendation, and appraised value of each item. 
A formal survey is a property survey performed by a surveying officer or 
survey board appointed by the senior officer present. A survey board con- 
sists of one or more naval officers, at least one of whom must be commissioned. 
An informal survey is a property survey performed by the head of depart- HOSPITAL AND PROPERTY ACCOUNTABILITY 
785 
raent having charge of the property. No survey board or surveying officer 
is appointed in cases of informal survey. 
To determine whether a property survey shall be formal or informal, 
with respect to medical-department property, the instructions published in 
Chapter 20, Manual of the Medical Department, U. S. Navy, should be followed. 
A formal survey is required: 
(а) When an item of equipment has a book value in excess of $25, or 
a group of identical items has a book value in excess of $100; 
(б) When the head of department is not a commissioned officer; and 
(c) When specifically directed by the commanding officer of a ship, or 
the commandant or commanding officer of a shore station. 
An informal survey may be held when none of the foregoing restrictions apply. 
The form used for reporting a property survey is S. & A. Form No. 154. An 
effort should be made to conserve forms and to this end, where all items can- 
not be listed on the form itself, the additional items may be listed on standard 
typewriter paper. The form is designed so that all information with respect 
to a particular item will be on one page. The upper half only of each sh(eet 
is to be used for listing the items to be surveyed, the lower half being reserved 
for use of the surveying officer in reporting the condition, cause, responsi- 
bility, recommendation, and appraised value of the items appearing in the 
upper part of the same sheet. When additional sheets are required and are 
prepared on standard typewriter paper, each sheet shall be divided into two 
parts in the same manner as S. & A. Form No. 154 is divided. The upper 
part of the additional sheets shall be used for listing the items to be surveyed 
and the lower part for the report on the items appearing in the upper part. 
The condition, cause, responsibility, recommendation, and appraised value, 
required to be indicated for each item are explained as follows: 
Condition refers to the actual physical condition with relation to the original 
purpose, that is, broken ; hinges sprung; leaky; chipped; etc. 
Cause refers to the reason the item is in its present condition, if such can 
be determined. The usual causes are: Worn out in use; excess; lost; acci- 
dentally dropped; damaged by fire; or some other happening or event which 
brought about the present defects. 
Responsibility refers to the person or persons who caused the item to be 
defective. Usually no responsibility attaches to articles worn out in use or 
rendered defective by some unavoidable act, the usual report as to responsi- 
bility being: None; Responsibility cannot be fixed; etc. 
Recommendation refers to the opinion of the board regarding the most appro- 
priate disposition of the item. The usual recommendations are; Destroy; To 
naval medical supply depot (naming the depot) ; To supply department for sale; 
To yard scrap heap; or, Retain and repair on ship or station. The Manual of the 
Medical Department, U. S. Navy, paragraph 3076, contains detailed instructions 
with respect to the recommendations mentioned. The surveying officer, or survey 
board, is required by Article 1911, U. S. Navy Regulations to state in the recom- 
mendation for disposition whether or not replacement is required. 
Appraised value is the estimated monetary value of the item in its present 
condition. Items recommended for transfer to a naval medical supply depot 
for repair or for further disposition, or to a supply officer for sale or exchange 
shall, in each case, be assigned a conservative appraised value. 
The original and two copies of property survey reports on medical-depart- 
ment property are submitted to the Bureau of Medicine and Surgery for items 786 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
of equipment or supplies all of which are recommended to be destroyed. Para- 
graph 3076, Manual of the Medical Department, U. S. Navy, should be consulted 
for the correct number of copies required to be submitted in cases where the 
disposition recommended is other than destruction. 
When the survey report is returned to the ship or station by the bureau as 
“approved” or “approved as modified”, the recommendations appearing thereon 
should be carried out. The commanding officer appoints an officer to supervise 
the destruction of all items approved to be destroyed, and after destruction is 
completed the officer so appointed places an endorsement to this effect on the 
survey report. Items to be transferred or retained are handled by the property 
and accounting officer or the medical officer in accordance with the recommenda- 
tion for each item as it appears in the approved survey. 
The individual items surveyed are written off in the Equipment Ledger, the 
Supplies Ledger, or the Land and Buildings Ledger, depending on the nature 
of the items. At naval hospitals, the value of the material disposed of by 
authority of approved survey is accounted for in the hospital’s financial 
records and is ultimately reported on N. M. S. Register No. 3. On ships and 
af; stations the value of the material so disposed of is recorded in the Journal 
of Receipts and Expenditures of Medical-Department Property and is ultimately 
reported on the appropriate line, and in the appropriate analysis, on N. M. S. 
Form E. 
In order to emphasize the importance of maintaining, in the proper manner, 
the Journal of Receipts and Expenditures of Medical Department Property on 
board all ships and at all stations required to submit N. M. S. Forms B and E, 
samples of these forms have been prepared and are reproduced at the end of 
this section. These sample forms are intended to demonstrate by example the 
manner in which the Journal should be prepared and maintained, the method 
of preparing financial reports, and the relation of each form to each of the 
others. 
A detailed discussion of the entries in the sample N. M. S. Forms B and E 
will not be undertaken here. Instructions for the preparation and submission 
of these forms are covered fully in Circular Letter F, Appendix D, Manual of 
the Medical Department, U. S. Navy. An understanding of the purpose of each 
form and its relation to each of the others can be most readily obtained by 
tracing each entry in the sample Journal to the various lines, tables, and 
analyses on the sample N. M. S. Forms B and E. 
The comments on medical-department accounting procedures appearing next 
are made in order that the reader may observe the procedures in concrete 
form and thus obtain a working knowledge of the proper method of recording 
and reporting transactions involved in the procurement and disposition of 
medical department property on board ships and at stations. 
Allotment expenditures to liquidate obligations against allotments for a 
previous year are reported monthly on supplementary N. M. S. Form B until 
all obligations outstanding at the close of the previous fiscal year are liquidated. 
However, on board ships and at stations, the materials or services received by 
reason of the incurrence of such obligations are considered to be current 
receipts and are properly taken up in the Journal as at the date of liquida- 
tion and are reported as receipts on the N. M. S. Form E for the quarter in 
which the obligations are liquidated. In the sample forms this procedure 
applies to S. D. Requisitions Nos. 14-40, 16-40, and to Public Voucher No. 
1-12 (40). 
By reference to the sample forms it will be noted that bills of lading covering 
the transportation of remains are recorded and reported as though they were HOSPITAL AND PROPERTY ACCOUNTABILITY 
787 
public vouchers. This procedure is followed because charges for transportation 
of remains, authorized by Government bill of lading or transportation request, 
are ultimately liquidated by public voucher. Expenditures for transportation 
of remains are made by disbursing officers in the same manner as other expend- 
itures on public vouchers. In view of the long period of time which ordinarily 
elapses between the incurrence of the obligation and the payment for the trans- 
portation of remains, and since a very accurate estimate may be obtained from 
the initial carrier, the estimated cost of transportation of remains as obtained 
from the initial carrier is taken up by the medical-department activity shipping 
the remains from a memorandum voucher prepared for that purpose. The 
estimated cost of transportation is recorded as a receipt by public voucher in 
the Journal and in the Supplies Ledger. An issue voucher (N. M. S. Form 
R) is prepared immediately following the preceding entry and is recorded as an 
expenditure in the Journal and in the Supplies Ledger. It is reported as an 
appropriational expenditure on N. M. S. Form B, and as both a receipt and an 
expenditure on N. M. S. Form E, for the accounting period in which shipment 
is made. Adjustment of the expenditures reported by the medical-department 
activity is made in the Bureau of Medicine and Surgery when the changes are 
finally paid. Obligations for transportation of remains in foreign countries, 
when liquidated locally by authority of public vouchers, are taken up in the 
Journal and the Supplies Ledger and are reported on N. M. S. Form B for the 
accounting period in which the public voucher is dated. 
When materials are procured under a contract which does not include free 
delivery to the medical-department activity, the cost of transportation is added 
to the purchase price as an allotment charge and as a part of the book value 
of the material. Transportation charges on such items are always paid for 
from the Naval Supply Account Fund, a revolving (working) fund under the 
cognizance of the Bureau of Supplies and Accounts, but the appropriation 
paying for the material obtained on the contract is ultimately chargeable with 
the cost of transportation. 
The transportation charges, when paid, are taken up in the Naval Supply 
Account, by a supply officer, as though they were actually material and the 
cost is charged to the Naval Supply Account Fund. In order to charge the 
cost of transportation to the appropriation paying for the material obtained 
on the contract, and in order that the medical-department activity for which 
the material was purchased may be furnished the necessary information for 
entry in the accounting records and financial reports, the transportation charges 
are transferred as “material” to the Appropriation Purchases Account and the 
Naval Supply Account is credited. At the time the transportation charges are 
transferred from the Naval Supply Account to the Appropriation Purchases 
Account the cost of transportation is charged to the appropriation paying for 
the material obtained on the contract and the Naval Supply Account Fund is 
credited. Up to this point all transactions and accounting procedures in con- 
nection with the transportation charges are handled by officers of the Supply 
Corps. The medical-department activity concerned clears the transportation 
charges through the Appropriation Purchases Account by furnishing the supply 
officer, in whose account they are lodged, with an accomplished stub requisition. 
As the appropriation paying for the material obtained on the contract has 
also been charged with the transportation cost the stub requisition invoicing 
such cost is taken up by the medical-department activity concerned as a charge 
to its allotment under that appropriation and is recorded in the Journal in the 
column headed N. S. A. material. Transportation charges being a part of the 
gross cost of placing the material in a “ready to use” status at the activity 788 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
are therefore an integral part of the “book value” of the material and are 
taken up on the ledger sheet recording the description and purchase price of 
the material. In the sample forms this procedure applies to the transportation 
charges on the ambulance. 
In connection with the preceding discussion of transportation charges on 
material purchased on contract, attention is invited to the fact that the cost 
is charged to the appropriation for the fiscal year in which the supply officer 
actually takes up the charges in his Appropriation Purchases Account and 
not to the appropriation current at the time the material was purchased. For 
example, an ambulance may be paid for from the appropriation Medical Depart- 
ment, Navy, 1941 while the transportation charges incurred in its delivery may 
be paid for from the appropriation Medical Department, Navy, 1942. 
In connection with the property surveys recorded in the sample Journal it 
will be noted that Survey No. 1-41 is recorded as having been approved by 
the Bureau of Medicine and Surgery during the fiscal year 1940 and that the 
typewriter value to be expended in accordance therewith is recorded as having 
been expended on the first day of the fiscal year 1941. The fact that Survey 
No. is so recorded is explained by the assumption that the survey was 
submitted during the month of June, 1940, accompanied by Special Purchase 
Requisition No. 4-41, in order to comply with instructions which require that 
purchase requisitions for replacement typewriters be accompanied by the survey 
request and report on the typewriters to be replaced and that they be forwarded 
to reach the Bureau of Medicine and Surgery not later than 15 July of each 
year. Annual contracts for1 the procurement of typewriters expire on 31 July 
of each year. Obviously, if the field activity is located at a considerable distance 
from the bureau the survey and requisition will, of necessity, have to be 
forwarded prior to the beginning of the fiscal year in which they are to become 
effective in order to insure compliance with instructions. Even though the 
approved survey had been received by the activity prior to 1 July, 1940 the 
typewriter value to be expended in accordance therewith will not have been 
expended until, or after, that date. 
The fact that Survey No. 6-40 was not expended during the fiscal year 1940, 
although the date of approval by the Bureau of Medicine and Surgery is 
recorded as 3 June, 1940, may be explained by assuming that the approved 
survey was not received by the activity until 1 July, 1940 after the Journal 
for the fourth quarter of the fiscal year 1940 had been closed. The fact that 
it apparently was received on the same date as Survey No. 1-41, approved by 
the bureau 17 days later, is explained by the fact that surveys on ambulances 
and motor vehicles must be returned to the activity via the Bureau of Yards 
and Docks in each case and also via the Bureau of Supplies and Accounts when 
transfer to a supply officer for sale or other disposition has been recommended. 
The reader should note that the value to be expended by survey is expended 
upon receipt of the original of the survey bearing the approval of the Bureau 
of Medicine and Surgery, or on the first day of the fiscal year in which series 
it is numbered, and that the expenditure is not held in abeyance until any 
items having an appraised value have been disposed of in accordance with the 
approved recommendation of the surveying officer or survey board. 
A transfer of material is not complete until the receipted transfer voucher 
issued, signed hy the officer to whom the material is invoiced, has been received 
by the activity issuing the transfer voucher. The accountability for the material 
remains vested in the activity transferring it until such time as the signed 
receipted transfer voucher is received from the activity which is to take up 
the material in its accounting records. The value of the material transferred HOSPITAL AND PROPERTY ACCOUNTABILITY 
789 
should be expended from the accounting records only after receipt of the transfer 
voucher, accomplished as stated before, regardless of the period of time inter- 
vening between the transfer of the material and receipt of the accomplished 
transfer voucher. Therefore the expenditure of such material should appear 
in the Journal and on the N. M. S. Form E for the quarter in which the properly 
accomplished Transfer Voucher Issued is received. The expenditure will 
appear in the Journal and the financial reports for the quarter in which the 
material is transferred only when the signed receipted transfer voucher is 
received in the same quarter as that in which the material was transferred. A 
signed receipted copy of all Transfer Vouchers Issued must accompany financial 
reports for the quarter in which the material so transferred is expended from 
the accounting records of the activity. The preceding comment is applicable to 
T. V. I. No. 12-40 as recorded in the sample Journal and the sample N. M. S. 
Form E. 
It should be noted that the value of Naval Supply Account (N. S. A.) 
material received on stub requisitions has been taken up in the sample Journal 
from the monthly Summary of Stub Requisitions (S. & A. Form 178) and not 
from the individual stubs received at the time each issue was made by the 
supply-department activity from which the material was obtained. The indi- 
vidual stubs for each month should be filed in numerical sequence until the 
stub summary is received at the end of the month. The charges shown on 
each individual stub should be checked against the charges reported on the 
stub summary. In the event discrepancies are found the supply department 
should be contacted and the necessary adjustments made to bring the total 
money value of the individual stubs into agreement with the total money 
value reported on the stub summary. The stub summary should not be signed 
by the medical officer until appropriational charges have been verified. This 
procedure should be followed for the reason that individual stubs furnished 
at the time the material is issued are subject to adjustment for final appro- 
priational charge by the accounting officer of the supply-department activity 
furnishing the material. After verification of the stub summary the charges 
shown thereon should be entered in the Journal and in the appropriate ledgers. 
The charges for equipment and the charges for supplies should be segregated 
and entered in their respective sections of the Journal and in their respective 
ledgers. The total money value of the summary, as verified, is reported on 
N. M. S. Form B as an allotment charge. 
The transactions incident to the procurement and disposition of typewriters 
and other office machines and devices being rather involved, and requiring 
strict compliance with instructions, the subject of replacement of typewriters 
will be discussed in detail. During the progress of this discussion reference 
should be made to the entries recording Survey No. 1-41, T. V. I. No. 1-41, 
Public Voucher No. 4-1 and A. P. A. Stub No. 54 in the sample forms. 
Typewriters for use of the medical department afloat are purchased from 
funds under the cognizance of the Bureau of Supplies and Accounts while 
those for use of the medical department ashore are purchased from funds 
under the cognizance of the Bureau of Medicine and Surgery. Typewriters for 
use of the medical department afloat are obtained from the supply officer on 
custody receipt and no medical-department accounting procedures are involved. 
The annual estimate from shore stations should contain provision for type- 
writer replacements and additions because they may not ordinarily be obtained 
otherwise. Annual contracts are made by the Procurement Division of the 
Treasury Department with all leading manufacturers of typewriters and 
the General Schedule of Supplies lists each company’s machine and the 790 
HANE BOOK OF THE HOSPITAL CORPS, U. S. NAVY 
contract price for each model by item number. The particular make and model 
to be purchased is left to the discretion of the activity requiring the machine. 
When the replacement of typewriters is authorized in the annual estimate 
the procedure to accomplish replacement is as follows: 
1. Submit a property survey on S. & A. Form No. 154, to the Bureau of 
Medicine and Surgery, listing only the machines to be replaced. The make, 
model number, length of carriage in inches, and serial number must be given 
for each typewriter listed in the request section of the form. No other items 
should be listed in the survey. In addition to the routine data applicable to 
all property surveys, a survey of typewriters must contain a statement by the 
surveying officer or survey board as to whether or not the carriages and main 
frames are broken. The recommendation should be “To Supply Department for 
sale or exchange”. The appraised value of each typewriter for which replace- 
ment is recommended must be stated as the trade-in allowance listed in Class 
No. 104 of the General Schedule of Supplies for the current year. 
2. A specific purchase requisition, original and seven copies of S. & A. 
Forms Nos. 76 and 76a, shall be prepared and submitted to the Bureau of 
Medicine and Surgery with the property survey. If the new typewriters are 
authorized in the annual estimate no letter of transmittal is required. The 
item number, detailed description, and the contract price as given in the 
General Schedule of Supplies, as well as the kind of type and size of carriage 
desired, must be stated for each typewriter requisitioned. The total contract 
price of all the typewriters requisitioned shall also be stated. Following the 
entries concerning the last machine requisitioned must be listed: (a) The name; 
(6) Model number; (c) Serial number; (d) General Schedule of Supplies item 
number and exchange value as shown in Class No.-104; and (e) The condition 
of the carriage and main frame, for each machine to be exchanged on the 
purchase of the new machines. The total exchange allowance shall be deducted 
from the total contract price of the new machines to determine the net cost 
of the requisition. The item number, object and subhead number, and project 
number, as given in the approved annual estimate, shall be shown following 
the aforementioned data. 
3. Upon receipt of the approved property survey from the bureau the dif- 
ference between the original book value and the appraised value stated in 
the survey is expended in the equipment section of the Journal and on the 
Equipment Ledger sheet. The machine is then transferred, on a Transfer 
Voucher Issued (S. & A. Form 71), to the nearest supply officer and his 
signature covering receipt is obtained on the voucher. Upon receipt of the 
accomplished Transfer Voucher Issued the typewriter value transferred to the 
supply officer is also expended in the equipment section of the Journal and 
on the Equipment Ledger sheet. Whether or not the typewriter is retained 
by the medical department for use pending receipt of the new machine is a local 
administrative matter. If retained, the typewriter value shall be invoiced 
to the supply officer as stated before and the supply officer furnished with a 
custody receipt. The custody-receipt transaction has no effect on the books 
of account. 
4. Upon receipt of the new machine and the invoice, a public voucher is 
prepared under the Naval Hospital Fund, at naval hospitals, and under the 
appropriation Medical Department, Navy, at shore stations. The description 
of the new machine is listed in detail and the contract price is extended 
to the money value column. Immediately below, in the item column, are 
inserted the words “Less exchange allowance on (name of) typewriter num- 
ber surveyed on property survey number and the amount of the allow- HOSPITAL AND PROPERTY ACCOUNTABILITY 
791 
ance is extended in the money value column. The net amount to be paid on 
the voucher is determined by deducting the exchange allowance from the con- 
tract price and is inserted. By reference to the sample forms it will be seen 
that the contract price is stated on public voucher No. 4r-1 as $70.00, the 
exchange allowance as $15.00, and the net amount of the voucher as $55.00. 
In the section of the public voucher (Standard Form No. 1034) headed “Account- 
ing Classification” the following information must be recorded: In the first 
of the four columns from left to right, insert the Navy symbol number and 
the General Accounting Office symbol and subhead numbers of the appropria- 
tion or fund chargeable; in the second column insert the name of the appro- 
priation or fund chargeable; in the third column insert the title and account 
chargeable (13-X-2 in this case) ; and in the fourth column insert the net 
amount chargeable to the appropriation or fund. In the two columns under 
the heading “Cost Account” is inserted the account number and name of the 
nearest stores activity to which is attached a supply officer who renders stores 
returns to the Bureau of Supplies and Accounts. The symbol numbers, sub- 
head numbers, and the name of each appropriation and fund under the cog- 
nizance of the Navy Department are stated in the annual Appropriation 
Bulletin prepared and distributed by the Bureau of Supplies and Accounts. 
The account number of each naval activity may be found in the List of 
Accounting Numbers of Ships and Stations published annually by the Bureau 
of Supplies and Accounts. 
5. When the public voucher is “abstracted” to the stores activity by the 
Bureau of Supplies and Accounts, the supply officer will take up in his Appro- 
priation Purchases Account the net amount paid, in this case $55.00. The 
supply officer will then have in his Appropriation Purchases Account a total of 
$70.00, representing the $15\00 taken up from the Transfer Voucher Issued and 
the amount of $55.00 taken up from the public voucher. It will then be neces- 
sary for the medical-department activity to furnish the supply officer with an 
Appropriation Purchases Account (A. P. A.) stub requisition in the amount of 
$70.00. 
6. At stations, other than naval hospitals, the amount of the A. P. A. stub 
requisition representing the trade-in allowance on the surveyed typewriter (in 
this case $15.00) is taken up in the Journal as h Transfer Voucher Received and 
is so reported on line 7 and under the analysis of transfer vouchers received 
on N. M. S. Form E for the quarter in which received. At naval hospitals the 
amount of $15.00 is taken up by Journal entry debiting equipment account and 
crediting transfer vouchers received account, and is so reported on N. M. S. 
Register No. 3 for the quarter in which received. In either case the amount of 
$15.00 is entered on the equipment ledger sheet as a receipt from the Supply 
Department. 
7. If a copy of the 13-X-2 public voucher is furnished the medical-department 
activity, the amount of $55.00 charged to the appropriation is taken up by stations 
in the Journal, under public vouchers, and is so reported on line 4, and under the 
summary of public vouchers paid, on N. M. S. Form E and in tables 1, 2, and 4 
on N. M. S. Form B for the quarter in which taken up. At naval hospitals the 
hmount of $5&.00 charged to the Naval Hospital Fund is taken up in the Charge 
Register, debiting the amount in the equipment column and crediting the 
amount in the vouchers payable column, and is so reflected on N. M. S. Register 
No. 3 and in tables 1, 2, and 4 of N. M. S. Form B for the quarter in which 
taken up. At either stations or hospitals the amount of $55.00 is entered on the 
equipment ledger sheet as a receipt by public voucher and this is the only 
amount of the transaction to be reported as an appropriational expenditure on 792 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
N. M. S. Form B under object 32 and subhead 65. The exchange allowance on 
the surveyed typewriter is taken up as A. P. A. material, at no allotment charge, 
as the surveyed typewriter was paid for from funds under the cognizance of 
the Bureau of Medicine and Surgery at the time it was purchased. The A. P. A. 
stub invoicing the exchange allowance represents typewriter value in the form 
of the appraised value of the surveyed typewriter previously transferred to the 
supply officer and taken up by him in his Appropriation Purchases Account. 
The value is returned on the A. P. A. stub in the form of an allowance on the 
new typewriter and no charge against an appropriation is incurred by the 
transaction. To determine the book value of the new typewriter the value of 
the exchange allowance is added to the amount paid by public voucher. 
8. In the event a copy of the 13-X-2 public voucher is not furnished to 
the medical-department activity the amount charged to the appropriation or 
fund ($55 in this case) is taken up from the A. P. A. stub requisition following 
exactly the same procedure as if a copy of the voucher had been furnished. 
In conclusion the reader must remember that the scope of this section is 
limited, and all hospital corpsmen, especially those whose rating subjects them 
to assignment to duty independent of medical officers or who are assigned 
to duty in connection with property and accounting, are again reminded 
that the information contained herein must be supplemented by constant refer- 
ence to and study of the U. S. Navy Regulations, the Manual of the Medical 
Department, U. S. Navy, the Bureau of Supplies and Accounts Manual and 
Memoranda, other bureau manuals, and such instructions relative to this subject 
as are issued from time to time. 793 
HOSPITAL AND PROPERTY ACCOUNTABILITY 
RECEIPTS 
U) .(!).. 
(1) 
(1) 
(1) 
EQUIPMENT SECTION 
Date 
Medical 
Supply 
Depot 
Supply 
Dept. 
N.S.A. 
Material 
Public 
Vouchers 
T.V.R. 
Other 
M. D. 
Activitfcs 
T.V.R. 
as 
A.P.A. 
Material 
Remarks 
7-2-40 
18.16 
S.D. Requisition No. 14-40.Class 7.Reported on supplementary Form B.F.Y.1940 
7-15-40 
87.15 
S.D. Requisition No. 1-41. Class 15 
7-18-40 
100.00 
T.V.R. No,1-41. 10 beds from Naval Hospital, Great Lakes, Illinois. 
8-2i-40 
6.00 
Special Issue Requisition No. 15-41. Class 16. 
3-15-40 
15.00 
A.P.A. Stub No.28. Deck Clock. (No allotment chapgei 
8-30-40 
55.00 
Public Voucher No. 4-1. Typewriter. 
8-31-40 
35.00 
Stub Summary, August. Fire Extinguishers. 
9-30-40 
1.250.00 
P.V.#876.(Abstracted by Bu.S&A) Buiok ambulance, U.S.N. No. 4095. 
9-30-40 
15.00 
A.P.A. Stub No.54. Exchange allowance on typewriter.(No allotment charge) 
9-30-40 
62.30 
A.P.A. Stub No.61. Transportation on Buick ambulance. (Allotment charge) 
Totals 
111.31 
97.30 
1.305.00 
100.00 
30.00 
FIRST QUARTER TOTALS. F.Y. 1941 
3 
3 
4 
6 
7 
Lines on rtiioh reported on NMS Form "E" 
NOTE: (1) Always taken up In the equipment ledger by Individual items, except that transportation charges on equipment are 
added to the cost of the equipment and the exchange value of typewriters Is added to the cost of the typewriters. 
JOURNAL OF RECEIPTS AND EXPENDITURES OF MEDICAL DEPARTMENT PROPERTY 
EXPH1DITDRES 
(U (2) 
(2) 
FISCAL YEAR, 1941 
EQUIPMENT SECTION 
Date 
Surveys 
T.V.I.to 
Supply 
Office: 
for Sale 
T.V.I. to 
other 
Med.Dept. 
Activities 
Remarks 
7-1-40 
50.00 
Survey No. 1-41. approved by Bu.M&S 6-20-40. (Typewriter) 
7-1-40 
1,340.00 
Survey No. 6-40. approved by Bu.M&S 6-3-40.(Ambulence) Book value $1,390.00 
7-9-40 
15.00 
T.V.I. No. 1-41, Appraised value of survey No, 1-41 (Typewriter) 
7-20-40 
10.00 
T.V.I. No. 2-41. Appraised value of beds on survey No.8-40,approved by BuM&S 6-13-40. 
8-30-40 
60.00 
T.V.I. No.12-40. Lockers to N.A.S.,San California on 5-12-40. 
9-15-40 
50.00 
T.V.I. No. 3-41. Appraised value of ambulance on survey No, 6-40. 
Totals 
1,390.00 
75.00 
60.00 
FIRST QUARTER TOTALS, F.Y, 1941 
11 
12 
13 
Lines on which reported on NMS Form "E" 
NOTE: (2) Always charge off individual Items In equipment ledger. 
JOURNAL OF RECEIPTS AMD EXPENDITURES OF MEDICAL DEPARTMENT PROPERTY 
FISCAL YEAR. 1941 794 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
REG 
(3) 
EIPTS SUPPLIES SECTION 
(*) (5) (3) (3) 
Date 
Medical 
Supply 
Depot 
Supply 
Dept. 
N.S.A. 
Material 
Public 
"touchers 
Pay 
Roll, 
Civil 
Employees 
T.V.R. 
other 
M.D. 
ActivitlBs 
T.V.R. 
as 
A.P.A. 
Material 
Remarks 
7-5-40 
10.00 
PV#1-12{40).Special diets.June.Reported on supplementary Form B.FY-1940 
7-12-40 
76.50 
B/L #1087.Memo.voucher,Transportation of remains (T.L.Schmidt). 
7-15-40 
726.13 
S.D. Requisition No.1-41. Classes 6 & 8. 
7-15-40 
90.00 
Pay Roll, 7-1 to 7-15, inclusive 
7-15-40 
35.00 
PV#2-1. Embalming and encasement of T.L. Schmidt 
7-31-40 
$12.00 
Stub Summary.July,Stationery.15.70. Gasoline,$6.30 
7-31-40 
20,00 
Public Voucher No.1-1. Special diets, July. 
7-31-40 
22.00 
Public Voucher No.1-2. Laundry services, July. 
7-31-40 
90.00 
Pay Roll. 7-15 to 7-31, inclusive 
8-3-40 
6.00 
Transfer Voucher Received No.2-41.Sugar from Naval Hospital .Wash. .D.C. 
8-5-40 
296.18 
S.D. Requisition No.2-41. Classes 1. 2 and 11. 
8-10-40 
35.00 
PV#3-1 (NHF) .Hospitalization of D.E.Fox in Memorial Hospital. 
8-15-40 
90.00 
Pay Roll, 8-1 to 8-15, inclusive 
8-20-40 
18.30 
S.D.Reqn.#16-40.Class IS.Reported on supplementary Form B, F.Y.1940, 
8-31-40 
11.50 
Stub Summary. August.'Cleaning gear,#1,50.Gas.,Oil k Grease ,$10.00. 
8-31-40 
1.75 
A.P.A.Stub Summary ,Aug. Pyrex ,1ar for Laboratory .No allotment charge. 
8-31-40 
10.00 
T.V.R.No.3-41.Laundry services from NH,Washington,D.C. (August) 
8-31-40 
90.00 
Pay Roll, 8-16 to 8-31, inclusive 
9-2-40 
$18.60 
Drugs and Dental supplies purchased during July and August. 
9-15-40 
90.00 
Pay Roll, 9-1 to 9-15, inclusive 
9-20-40 
178.60 
S.D. Requisition No, 3-41. Classes 10,13,17 and 23. 
9-30-40 
19.25 
Public Voucher No.1-4. Special Diets, September. 
9-30-40 
90.00 
Pay Roll, 9-16 to 9-30, inclusive. 
9-30-40 
22.30 
S&A Form 280,September.Work Request #37-41.Painting of ambulance. 
9-30-40 
12.80 
Stub Summary,September.Gas..Oil & local minor repairs to ambulance. 
9-30-40 
10.00 
T.V.R.#4-41.Laundry services from NH.Washington, D.C. (September) 
Totals 
1,219.21 
58.60 
236.35 
540.00 
26.00 
1.75 
FIRST QUARTER TOTALS. F.T. 1941. 
1 
18 
19 
20 
21 
23 
24 
Lines on which reported on NMS Form "E". 
"NOTES: 
3) Always taken up In supplies ledger by individual items. 
5) Maintain one ledger sheet for salaries end one for wages. 
*) Maintain at least one ledger sheet for each expenditure classification as shown in the expenditure section, end 
in addition, one sheet for civilian medical, dental, nursing and hospital services. Additional sheets should be 
maintained under each expenditure class!fleation as may be necessary for adequate analysis. 
$) Stationery and Drugs taken up In supplies ledger by individual items. 
JOURNAL OF RECEIPTS AND EXPENDITURES OF MEDICAL DEPARTMENT PROPERTY 
FISCAL YEAR, 1941 HOSPITAL AND PROPERTY ACCOUNTABILITY 
795 
EXPENDITURES 
Tii—rri 
(•) 
(•) 
(*) 
(4) 
(4) 
(*) 
(*) 
(*)(4) 
(4) 
(4) 
(4) 
SUPPLIES SECTION 
Date 
Supply- 
Table , 
Medical 
Supply 
Table, 
Dental 
Special 
Diets 
leundiy 
Trans- 
port- 
ation 
Wise. 
Dental 
Supplies 
Mi sc. 
M.D.‘ 
Supplies 
Salaries 
Wages 
Care 
of 
the 
Dead 
Survey 
of 
Supplies 
T.V.I. 
to 
Supply 
Officer 
TVl.to 
other 
U.D. 
Aclivltfes 
Remarks 
7-5-40 
10.00 
Special Diets. June. 1940 
7-8-40 
71.50 
6.75 
09.00 
issue Voucher 
7-18-40 
“76.50 
Issue Voucher(Trans.remains-T.L.Schmidt) 
7-15-40 
76.00 
13.50 
Issue Voucher 
7-15-40 
60.00 
30.00 
Pay Roll,7-1 to 7-15, inclusive 
7-15-40 
*35.00 
Embalming 4 encasement (T.L.Schmidt) 
7-82-40 
63.00 
11.15 
02.15 
01.50 
Issue Vouchers 
7-29-40 
75.00 
12.20 
01.13 
01.17 
Issue Vouchers 
7-31-40 
20.00 
22. 0C 
6.30 
Spec.Diets.Laundry.Gasoline lJuly) 
7-31-40 
60.00 
30.00 
Pay Roll, 7-16 to 7-31, inclusive 
8-5-40 
74.13 
5.76 
011.00 
Issue Vouchers 
3-10-40 
*35.00 
Uospitalization,D.E.Fox(Hemorial Hospital) 
3-12-40 
62.15 
12.70 
Issue Vouchers 
B-15-40 
60.00 
30.00 
Pay Roll, 8-1 to 8-15, inclusive 
3-19-40 
72.32 
13.02 
02.15 
Issue Vouchers 
3-26-40 
70.15 
12.34 
02.16 
Issue Vouchers 
3-31-40 
10.00 
Gas..Oil,Grease (August) 
3-31-40 
10.0C 
Laundry Services, August. T.V.R.#3-41 
3-31-40 
60.00 
30.00 
Pay Roll, 8-16 to 8-31, inclusive 
9-2-40 
56.70 
13.15 
#11.52 
Issue Vouchers 
9-9-40 
72.18 
11.12 
.27 
2.18 
Issue Vouchers 
9-15-40 
60.00 
30.00 
Pay Roll, 9-1 to 9-15, inclusive 
9-16-40 
62.76] 
2.01 
.32 
Issue Vouchers 
9-23-40 
51.11 
10.57 
Issue Vouchers 
9-30-40 
19.25 
Special Diets, September 
9-30-4C 
82.76 
13.07 
2.16 
3.65 
Issue Voucher 
9-30-4C 
12.80 
Gas.,Oil 4 minor repairs to ambulance 
9-30-40 
60.00 
30.OC 
Pay Roll, 9-16 to 9-30, inclusive 
9-30-40 
125.00 
Casket,N.S. (H.B.Smith) Local Burial 
9-30-40 
1.00 
Drugs to U.S.S. KANE. T.V.I. #4-41 
9-30-40 
22.3C 
Painting of ambulance. Work Request #37-41 
9-30-40 
10.00 
Laundry Services, September. T.V.R. #4-41 
Totals 
889.76 
137.34 
49.25 
42.0C 
51.4C 
8.19 
77.17 
360,00 
180.OC 
236.50 
1.00 
FIRST QUARTER TOTALS. F.Y. 1941 
28 
29 
30 
31 
32 
33 
34 
35 
36 
38 
40 
41 
42 
Lines on which reported on NMS Form "E" 
NOTES:(4) Charge off 
individual items in supplies lodger. (*) Maintain one ledger sheet in supplies ledger for each classification so marked. 
I®; Miscellaneous supollea expended 
which were purchased during 
previous quarters. 
Iff) Issue Voucher for $11,52 includes $1.50 for cleaning gear and #10,02 for 
drugs consumed (issued) upon receipt. 
JOURNAL OF RECEIPTS AMD EXPENDITURES OF MEDICAL DEPARTMENT PROPERTY 
FISCAL YEAR. 1941 
154294°—39 51 796 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
STATEMENT OF RECEIPTS AND EXPENDITURES OF MEDICAL DEPARTMENT PROPERTY 
U. S. ...(Name., of Station) For Quarter Ended .. , 1940 
EQUIPMENT (NONEXPENDABLE) ~~ ===== 
1. Balance from previous quarter (line 16, last report) $ 12,934*89 
RECEIPTS DURING QUARTER 
2. From Medical Supply Depots (charged to S. D. allotment) $ 
3. From Supply Officer, stub requisition and expendi- 
ture invoices $ 9.7.?50 
4. Public Vouchers (M. & S. Reqn. only) 50 5.00 
5. Total (lines 3 and 4) (charged to local pro- 
curement allotments) 
TRANSFER VOUCHERS RECEIVED DURING QUARTER 
6. From other Medical Department activities (S. & A. 
Form 71) *9.9 
7. From Supply Officer, A. P. A. material, no allot- 
ment charge 99*99 
8. Total (lines 6 and 7) 130 *99 
9. Total receipts during quarter (lines 2, 5, and 8) 1 ».§4*5.61 
10. Total (line 1 plus line 9) .ou 
EXPENDITURES 
11. By approved survey (Equipment only) 4j.5j?P*QQ 
12. By transfer to Supply Officer for sale 7.?..*.P9 
13. By transfer to other Medical Department activities 
.(S. & A. Form 71) .. 60.00 
14. Total (line 12 plus 13). 155*00 
15. Total expenditures (line 11 plus line 14) J i 
16. Balance to next quarter (line 10 less line 15) $ 
SUPPLIES (EXPENDABLE) 
17. Balance from previous quarter (line 45, last report) $.....?.».§.§?.i38.«« 
RECEIPTS DURING QUARTER 
18. From Medical Supply Depots (charged to S. D. allotment), $ 
19. From Supply Officer stub requisitions and expendi- 
ture invoices $ 58 *60 
20. Public Vouchers (M. & S. Reqn. only) 236,55 
21. From pay rolls, civil employees 540 ,00 
22. Total (lines 19, 20, and 21) (charged to local 
procurement allotments) * 
TRANSFER VOUCHERS RECEIVED DURING QUARTER 
23. From other Medical Department activities (S. & 
A. Form 71) — — 2§«00 
24. From Supply Officer, A. P. A. material, no allot- 
ment charge - X*?5 
25. Total (lines 23 and 24) 27.75. 
26. Total receipts during quarter (lines 18, 22, and 25) .. 2»081.91 
27. Total (line 17 plus line 26) 
EXPENDITURES 
28. Supply table supplies, medical, expended from storeroom 
29. Supply table supplies, dental, expended from storeroom -X?.7.*34. 
30. Special diets .49.*25 
31. Laundry .. „ 4£*00 
32. Transportation service .51*40 
33. Miscellaneous supplies; dental (other than supply 
table) 
34. Miscellaneous supplies; other (other than supply 
table) — .... 
35. Salaries $ .. 360 *00. 
36. Wages .180*00. 
37. Total (lines 35 and 36) 540*00'.. 
38. Care of the dead 236,50 
39. Total (lines 30, 31, 32, 33, 34, 37, and 38 - .1.PP4.53,— 
40. By approved survey (supplies only) ..P..*.PP 
41. By transfer to Supply Officer (when authorized) Q.*.Q0. 
42. By transfer to other Medical Department activities 
(S. & A. Form 71) IsQQ 
43. Total (line 41 plus line 42) -*-99 
44. Total expenditures (lines 28, 29, 39, 40, and 43) - ... . 
45. Balance to next quarter (line 27 less line 44)^I11..I..:^.i:::.::i::li:::i^^ 
OPERATING EXPENSE 
46. Gross expenditures (line 15 plus line 44) $...5.1.557 • 61 
47. Less nonoperating expenditures (lines 14, 38, and 43) 572*50 
48. Net operating expense - $ . 5,185,11 
COMPLEMENT (INCLUDES ALL UNITS) 
49. Average active-duty service personnel during quarter - ~ .1*7X3 
50. Average number of civil employees at station during quarter - &7P 
61. Average service and civil personnel during quarter 
MEDICAL SERVICES RENDERED CIVILIANS 
Number of individuals Number of treatments 
52. Civil employees - X»Q.?.£...*. 
53. Dependents .. — 1 ,.9.6.1 
64. Civilians, other (humanitarian) 3 SLa 
55. Totals ....5S4. 3.f.Q58 
The respective values stated herein as on hand (lines 16 and 45) at the close of the quarter have veri- 
fied by actual inventory. The balances of the equipment and supplies ledgers agree with the respective values 
6tated' A. B. CAST, Commander (MC) , U. S. N. 
Forwarded ; liiiSiSter) 
tr. s. N. 
Commanding. a/WBSfl*J HOSPITAL AND PROPERTY ACCOUNTABILITY 
797 
(1) Analysis of Supply Depot Requisitions Received During Quarter: 
Requisition Mo. Date Received Equltment Supplies Total 
S.D.14-40 7-2-40 $ 18.16 $ 0.00 $ 18.16 
S.D. 16-40 8-20-40 0.00 18.30 18.30 
S.D. 1-41 7-15-40 87.15 726.13 813.28 
S.D. 2-41 8-5-40 0.00 296.18 296.18 
S.D. 3-41 9-20-40 0.00 178.60 178.60 
S. 15-41 8-2-40 5.00 0.00 6.00 
Totals. $ 111.31 $ 1.219.21 $ 1.350.52 
(2) Analysis of Stub Requisitions and Expenditure Invoices (Priced) Received During Quarter; 
Month Equipment Supplies Total 
July $ 0.00 $ 12.00 $ 12.00 
August 35.00 11.50 45.50 
September 62.30 35.10 %7.40 
Totals. $ 97.30 $ 58.60 $ 155.90 
(8) Summary of Public Vouchers Paid, Drawn Against M. & S. Requisitions; 
Annual Requisition .Vo. Equipment Supplies Total 
1-40 {P.V.#1-12) $ 0.00 $ 10.00 $ 10.00 
1- (P.V.#1-1 to 1-4,ine.) 0.00 79.85 79.85 
2- (P.V.#2-1) 0.00 35.00 35.00 
3- (P.V,#3-1) 0.00 35.00 35.00 
Other than annual requisitions, 8t88 1,218:88 
B/L #1087 (C/Pi 0.00 76.50 76.50 
Totals. $ 1.305.00 $ 236.35 $ 1.541.35 
(4) Analysis of Transfer Vouchers Received from Other Medical Department Activities During Quarter; 
T. V. R. No. Received from Equipment Supplies Total 
1- USNH,Great Lakes,111. $ 100,00 $ 0,00 $ 100.00 
2- USNH,Washington, D.C. 0.00 6.00 6.00 
3- USNH,Washington, D.C. 0.00 10.00 10.00 
4- USNH,Washington, D.C. 0.00 10.00 10.00 
Totals. $ 100.00 $ 26.00 $ 126.00 
(5) Analysis of A. P, A. Material Received from Supply Officer During Quarter: 
Month Equipment Supplies Total 
July 0.00 $ 0.00 $ 0.00 
August 15.00 1.75 16.75 
September 15.00 0.00 15.00 
Totals, t 30.00 $ 1.75 $ $1.75 
(6) Analysis of Approved Surry* During Quarter: 
Dote approved Value expended Value to B. O. Total value 
Survey No. Vy Bureau hy survey for sale Value to M. 8. D. of survey 
6-40 6-3-40 « 1,340.00 $ 50.00 $ 0.00 $ 1,390.00 
1-41 6-20-40 50.00 15.00 0.00 65.00 
Totals, $ 1.390.00 $ 65.00 » 0.00 $ 1.455.00 
(T) Analysis of Transfer Vouchers Issued During Quarter; 
T. T.t.So. IsineS ta Authority for Issue Equipment Supplies Total 
12-40 NAS,San Diego, BuMtcS ltr.(Ll-$ * $ 
California PA) of 5-9-40. 60.00 0.00 60.00 
1- Supply Officer App.Survey #1-41 15.00 0.00 15.00 
2- Supply Officer App.Survey #8-40 10.00 0.00 10.00 
3- Supply Officer App.Survey #6-40 50.00 0.00 50.00 
4- U.3.S. BANS Bul&S Itr.(U-PA) 0.00 1.00 1.00 
Totals. ef 9-g5-40 j 1SS'.M $ 1.00 $ 
(8) Analysis of Pay Rolls: 
Accrued and unpaid Accrued current Paid during Accrued and unpaid 
Month from previous month month month at end of month 
July $ 0.00 $ 180.00 $ 180.00 I 0.00 
August 0.00 180.00 180.00 0.00 
September 0.00 180.00 180.00 0.00 
Totals. ~ 0.00 * 540.00 $ 540.00 0.00 
Remarks: 
Eatimted cost of Supply Table supplies consumed in the treatment of dependents 
of Naval Personnel 1216.00. 798 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
SUPPLEMENTARY 
REPORT OF ALLOTMENT EXPENDITURES AND OBLIGATIONS 
HUH 
From: U. S. 
EK ENDED Sl.JCuly> 
0S»e..pf.;fi5.tiYltyi Date.X. 
Augus.t..l9.40._ 
Table 1. STATUS OF ALLOTMENTS 
Medical Depart- 
(1) 
Naval Hospital 
Fund 
(2) 
Care or the Dead 
(3) 
Supply Depot 
(4) 
2719 
None. 
3362 
1961 
2. Annual allotment—plus increases, less decreases 
3. Expenditures previously reported 
X X X X X X X 
X X X X X X X 
$ Q*00 
X X X X X X X 
X X X X X X X 
$....LTQne 
X X XX XXX 
X X X X X X X 
$ None 
$-....40.*7.5.. 
-Qa.0.0.. 
X X X X X X X 
X X X X X X X 
$....ACU7.5...... 
5. Obligations brought forwar 
6. Total Amount A\j 
d 
11.00 
None 
None 
ILABLE 
S 11.0Q 
$....None 
$ None 
$...1Q»QQ 
.Final 
S.—Hone 
S 1R.16 
?.n,7R 
l.QQ 
Hone .... 
None 
1.84 
10. Total (to agree with line 6) 
$ 11.00 
$... Ilona 
$ Hone 
$ .40.75 
Table 2. 
ANALYSIS OP COMPLETED TRANSACTIONS 
Medical 
Department 
Naval Hospital Fund 
Care or 
the Dead 
Provisions 
Maintenance 
1. NS A material (summary 
2. Work requests (supply offi 
3. Annual req. No.lr4D(PV 
$ 
$ 
$ 
ft 
cer’s S&A 280 only 
1 
) 
—.10...0.0. 
to PV# 
inclusive).. 
8. Provision contracts... (PV 
9. Other charges (list separat 
(I) 
ely): 
(2) 
(S) 
(4) 
(5) 
(6) 
(7) 
(8) 
(9) 
— 
(W) 
an 
$ 10.00 
Table 3. ANALYSIS OP SUPPLY DEPOT REQUISITIONS 
(A) Supply Depot Requisitions Received During Current Quarter 
(B) Requisitions Submitted (Material Not Received) 
Number 
Date received 
Amount 
Number 
Dated 
Estimated cost 
5.,E*..14-4Q. 
.7-JS.-4.0. 
$....18*16 
5?Tn,. 16-40 
.4-28-40..... 
Total... 
$....12*16 
Total... 
$ 20,75 
4—8008 HOSPITAL AND PROPERTY ACCOUNTABILITY 
799 
ANALYSIS OF ALLOTMENT EXPENDITURES 
Table 4. 
BY OBJECTS AND SUBHEADS 
Table 5. by classes and subheads 
MD Allotment 
no. ...37.12 
Fiscal year 19.4.0 
(2) 
NHF Allotment 
C/D Allotment 
(A) SUPPLIES 
SD Allotment No 
Object and 
Subhead 
(1) 
No 
Fiscal year 19.... 
(3) 
No 
Fiscal year 19 
(4) 
S. T. class 
Amount 
Subhead totals 
1413. 
IQ.,.0.0. 
Q.QQ 
Q.QQ 
ilml 
...Q.QQ 
s ,c.Q0 
Q.QQ 
8 
Q.Q0 
Q.QQ 
0.00 
Q.QQ 
Q.QQ 
Q.QQ,... 
0.00 
Q.QQ 
Q.QQ 
Q.QQ 
27 
.Q.QQ 
0.00 
17 
.Q.QQ 
30 
.Q.QQ 
c 
C 
C 
.Q.QQ 
O.QQ 
(B) EQUIPMENT 
s IB.16 
0,00 
0.00 
0.00 
OtOO 
O.JDlQ 
Totals... 
10.00 
0,00 
0.0,0 
24 
0.00 
0.00 
Hii ,.m 
$ 10.00 
$ 0.00 
$ 0.00 
16 
J0..Q0. 
Fimhfintrnt' 
0.00 
0.00 
0.00 
Subhead 72.... 
0.00 
0.00 
0.00 
28 
a.oa 
Totals... 
$ 10.00 
$ 0.00 
$ O.oo 
Subhead 74.... 
Q.QQ 
Remarks: 
Total Equipment 
$. ,13.16 
(C) mortuary supplies and equipment 
S 
$ .0,,0.0... 
0.00 
Total 
PLIES 
Mortuary Sup- 
and Equipment... 
$ 0.00 
(D) RECAPITULATION 
$ 0,00 
18,16 
A..J3...CAST* 
0,00 
Commander, Medical Corps 
, U. S. Navy. 
Total Receipts 
s.. .18,16 
«. t. GOVERNMENT MINTING CMC 
4—8002 HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
soo 
FINAL supplementary 
REPORT OF ALLOTMENT EXPENDITURES AND OBLIGATIONS 
MONTH 
(raxmSK ENDED 
.31. August. 1940. 
FROM: U. S. 
LKama of nctivltv 1 
Date 20 August 1940 
Table 1. status of allotments 
Medical Depart- 
ment 
(1) 
Naval Hospital 
Fond 
(2) 
Care or the Dead 
(3) 
Supply Depot 
(4) 
2719 
None 
3362 
1961 
$ 20.75 
0.00 
s 
s 
$ 
6. Total Amount Available 
$ Mods 
$ None 
s ..None 
S 20.75 
v - 
$ 
$ 
$...ia»2Q... 
.Final 
2.45 
10. Total (to agree with line 6) 
$ None 
s Nona 
None. 
$ 20.75 
Table 2. 
ANALYSIS OF COMPL 
Medical 
Naval Hospital Fund 
Care or 
ETED TRANSACTIONS 
Department 
Provisions 
Maintenance 
the Dead 
$ 
$ 
$ 
4. Annual req. No (PV# to PV# 
ft Annual rnq No. (PV# .. fo PV# 
- 
9. Other charges (list separately): 
(2) 
(S) 
(^) 
(^) 
(7) - . .. 
/p) 
[10) . 
(.11) 
10. Totals 
$ None 
S....Hone 
$ Hone 
$....Hone. 
Table 3. 
ANALYSIS OF SUPPLY DEPOT REQUISITIONS 
Number 
Date received 
Amount 
Number 
Dated 
Estimated coat 
a.D....i6.-40. 
.....8-8Q-4Q 
$ aa.59 
None 
Total... 
$ 1.8. *.50. 
Total... 
$ Hone HOSPITAL AND PROPERTY ACCOUNTABILITY 
801 
Table 4. 
BV OBJECTS AND SUBHEADS 
Table 5. BY CLASSES and subheads 
MD Allotment 
NHF Allotment 
C/D Allotment 
(A) SUPPLIES 
SD Allotment No 
Object and 
No 
Subhead 
Fiscal year 19.... 
Fiscal year 19 
Fiscal year 19.... 
S. T. class 
Amount 
Subhead totals 
(1) 
(2) 
(3) 
(4) 
1 
$ P.OQ 
2 
Q.QQ 
Q.OQ 
4 
QxQQ 
$ 0.00.. . 
6 
0*00 
8 
0*00 
13 
13.30 
18.30 
Q.QQ 
Q.QQ 
Q.QQ 
0.00 
23 
Q.QQ 
Q.QQ 
Q.QQ 
Q.QQ 
0.00 
Q.QQ 
Q.QQ 
Q.QQ. . 
Q.QQ 
Q.QQ. 
.Q.QQ 
Q.QQ 
$ 18.2Q 
0.00 
0.00 
0.00 
0.00 
0.00 
s 0.00 
0.00 
Totals... 
Kone 
None 
Eone 
Q.,.0.0. 
RECAPITULATION 
26 
Q-.-0-0. 
0.00 
16 
.0.0.0. 
Subhead 72.... 
.o.oo 
28 
.0.0.0. 
Totals... 
S.Ji'sne 
*..:;pne 
$ i.’oce 
Subhead 74.... 
0.00 
Total Equipment 
$ -0..Q0- 
(C) MORTUARY SUPPLIES AND EQUIPMENT 
$ 0.00 
$ 0,00.... 
21 
0,00 
Q.QQ 
Total 
Mortuary Sup- 
plies 
and Equipment... 
$ 0.00 
(D) RECAPITULATION 
$ 18.30 
... .0..QQ 
. A. B—.CAST- .. 
0*00 
Commander, 
medical Corps, u- s- Na<m- 
Total Receipts 
S 18.30 
W. ». MVIIKIIM MINTING ®»fl 
I 4—8062 
ANALYSIS OF ALLOTMENT EXPENDITURES 802 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
SJSTJmI) report op allotment expenditures and obligations 
QUARTER ENDED ....JS0..September<..X9.4Q.. 
From: U. S. (Ilame of activity) 
Date.. 3.DotoieX.... 19.40 
Table 1. STATUS OF ALLOTMENTS 
Medical Depart* 
(1) 
Naval Hospital 
Fund 
(2) 
Care op the Dead 
(3) 
Supply Depot 
(4) 
8376 
None 
3896 
1250 
$...5.,.0.QD...QD— 
O..O.Q-. 
$ £4 
,175.00- 
$ 0.00- 
$ 250-00.. 
0-00 
0.00 
0.00 
6. Total Amount Available 
$-.8,175.00- 
$ 0.00 
$ :850.DD 
$.-5,-00.0.00 
$ 8.080.75 
$ 111.50- 
$-1,294.05- 
115.9.7... 
.....O-OQ 
Q.QQ„. 
....... Q.QD- 
94.25 
0.00 
138.50 
3.588.97 
10. Total (to agree with line 6) 
$—2 
,175.00 
$ 35.00 
$ 250.00 
S 5,000.00 
Table2. 
ANALYSIS OF COMPL 
Medical 
Naval Hospital Fund 
Care or 
ETED TRANSACTIONS 
Department 
Provisions 
Maintenance 
the Dead 
.71.30 
$ 
$ 
$ 
22.30 
.79.85.. 
25^00 
35.00- 
9. Other charges (list separately): 
ID ms. Specific..Ee.a...n.o..—4..(Ir7.-4-l) 
(2) ByM&S.JReg... n2-41.-Cont..NO .UL0jal557 
55.00 
5....J..250-.QQ- 
(s) Transportation, oa Equipment. . . 
*62-30 
(4) 8/lNo.,1097 (Trans....of. remains) 
26.50... 
(A) Civil Payrolls 
.540..J0Q.- 
(8) 
(.9) 
(10) 
(ii) 
10. Totals 
S 2,030.75 
$ 0.00 
$ 35.00- 
$ 111.50 
Table 3. 
ANALYSIS OF SUPPLY DEPOT REQUISITIONS 
(A) Supply Depot Requisitions Received During Current Quarter 
(B) Requisitions Submitted (Material Not Received) 
Number 
Date received 
Amount 
Number 
Dated 
Estimated cost 
... S.E. 1-41 
7-15-4Q 
$. 813.28 
4-41. 
a-15-40 
$ 97^62 
2.2.—2-41 
3-5-4P 
8.9.6..1S— 
,*S.I.,.I29-41 
9-26-40 
19.35 . 
S.D. 3-41 
9-8Qr4D... 
178.60 
E .1 ..-15-41 
8-8-40 
6. 
00 
Total... 
$1,894.06 
Total... 
* 116.97- 
4—8008 803 
HOSPITAL AND PROPERTY ACCOUNTABILITY 
Table 4. 
BY OBJECTS AND SUBHEADS 
Table 5. BY CLASSES AND SUBHEADS 
MD Allotment 
NHF Allotment 
C/D Allotment 
(A) SUPPLIES 
SD Allotment No. ..1mS0. 
Object and 
V. 2376 
Subhead 
Fiscal year 
Fiscal year 19.41 
Fiscal year 19...41 
S. T. class 
Amount 
Subhead totals 
(1) 
(2) 
(3) 
(4) 
1401 
.360*00. 
1 
s 113.92 
1402 
..130*00, 
2 
26.47 
1406 
15*85 
0.00 
1410 
2*75 
0.00 
......1411 
5*70. 
* 140.39 
1412 
1.50 
286.48 
......1413 
39*25. 
8 
43.9.65 
1416 
22*00. 
5,9.88 
1413 
26*30. 
.786*01. 
......1440 
25.10 
18.21 
... 155.79 
1605 
.. 35*00.. 
,0.00. 
174.00 
2250 
12*50 
84.15 
2251.. 
.76*50... 
O.0D- 
2252 
.22*50... 
25a 
0.00 
27 
0*00.. 
3265 
55*00 
84.15 
3268 
1*312*30. 
16*36 
3269 
..35*00. 
0-00 
.... 16.36 
5 
0*00. 
0.00- 
0-00. 
0.00 
Total Supplies 
$ 1,200,91 
0-00 
87.15 
JS 87-15 
0.00 
Totals... 
2,080.75 
35.00 
111.50. 
24 
0.00 
0*00 
* 678.45 
« 35.00 
$ 1H.50 
16 
6*00... 
...1,402,30 
0.00 
0*00 
Subhead 72.... 
6*00. 
0.00 
0.00 
0.00 
28 
Q.QQ— 
Totals... 
$ 2,080.75 
$ 35.00. 
$ 111.50 
Subhead 74.... 
0.00 
Remarks: 
Total Equipment 
$ 93.15 
not 
(C) MORTUARY SUPPLIES AND EQUIPMENT 
received. 
20 
* 0.00 
$ 0.00 
21 
0.00 
Subhead 73.... 
0.00 
Total 
Mortuary Sup- 
PLIES 
and Equipment... 
$ 0.00 
(D) RECAPITULATION 
Supplies 
$..1,200*91. 
93*15.. 
A*_E 
...CAST.— 
Mnrtnuy snppliMi anH Mpppm* 
Commander, 
Medical Corps, V. S. Navy. 
Total Receipts 
$ 1,294*05.. 
«• 
. u«umiiT miitins o»nc 
4--80M 
ANALYSIS OF ALLOTMENT EXPENDITURES 804 
HANDBOOK OF THE HOSPITAL CORPS, XT. S. NAVY 
Section 3.—COMMISSARY SUPERVISION 
In naval hospitals the department charged with the feeding of patients and of 
certain staff personnel is termed the commissary department. The organization 
of this department and its personnel, and other matters connected therewith will 
be discussed in this section. 
The commissary department of a naval hospital is directly in charge of the com- 
missary officer who is assigned to that duty by the commanding officer. Under 
the supervision of the commanding and executive officer he directs the work of 
the department, and is responsible for its proper administration. 
Section 1635, Chapter 12, Manual of the Medical Department, U. S. Navy, 
states that the commissary officer shall be a chief pharmacist or pharmacist 
who shall: 
1. Be responsible for all commissary stores and provisions, and for all equip- 
ment pertaining to the commissary, 
2. Be in charge of all personnel assigned to commissary activities. 
3. Upon receipt of stores and provisions verify their weights, condition, com- 
pliance with specifications and contract requirements; be punctilious in com- 
plying with hospital regulations concerning inspection of commissary stores 
and in event of any items being unsatisfactory notify the executive officer or 
officer-of-the-day. 
4. Exercise strict supervision over upkeep, cleanliness and food handling in 
galleys, mess halls, store room, diet kitchen and all other commissary activities. 
5. Be responsible for all meals, giving unremitting attention to the prepara- 
tion and service of food and exacting constant attention to economy and clean- 
liness. 
6. Supervise the issue of all commissary stores used at the hospital. The 
daily issue of stores shall be made in accordance with menus prepared in 
advance and approved by the executive officer, based on personnel to be sub- 
sisted and requirements of approved special-diet lists. Individual rations will 
be inspected to determine that they are adequate but not excessive. 
7. Directly supervise messing facilities and issue special articles of diets, 
rations, or subsistence in kind upon presentation of accomplished diet sheets 
or other requisition as may be authorized by the commanding officer. 
8. Permit no special mess to be set up without specific authority of the 
commanding officer. 
9. Comply with all regulations and instructions concerning special messes 
listed in paragraph 1636 so far as they apply to the commissary. 
10. Prepare or supervise the preparation of daily Receipt and Expenditure 
Vouchers for the preceding day, submit them to the commanding officer, via 
the executive officer, and post them, or cause them to be posted in the com- 
missary ledger. 
11. Take an actual inventory of stores and provisions on hand at the end 
of each month and report in detail to the commanding officer, via the execu- 
tive officer, any discrepancies between amounts as shown on the books and 
those found by actual inventory; certify a copy of the inventory to the prop- 
erty and accounting officers as a permanent record. 
12. Keep himself informed of regulations and instructions governing the 
procurement, inspection, storage, and issue of provisions and the proper method 
of obtaining provisions on contract. Keep a complete file of Navy Department 
provisions specifications for reference in inspections. COMMISSARY SUPERVISION 
805 
13. When detached or otherwise relieved from duty, make a complete inven- 
tory of all commissary stores, provisions, and equipment under his charge 
and transfer custody thereof to his successor. 
ORGANIZATION OF THE COMMISSARY DEPARTMENT 
Comprising the commissary department are kitchens, mess halls, storerooms, 
etc., and the personnel necessary to carry out the work of the department. 
Personnel organization. 
The personnel of the commissary department assists the commissary officer 
in the performance of the duties assigned to him and ordinarily consists of 
hospital corpsmen assigned to this department for duty and of such civil 
employees as may be allowed as a complement by the Bureau of Medicine and 
Surgery. 
The positions occupied by hospital corpsmen in the organization and their 
general duties are outlined next. 
The commissary steward, usually a chief pharmacist’s mate, is the chief 
petty officer assistant of the commissary officer. He is entitled to respect and 
obedience from all persons of inferior rating and from civil employees in 
the department. He is responsible for the proper execution of the commissary 
officer’s orders. He may be called upon to prepare the weekly menu for 
approval of the commissary officer and subsequent approval of the command- 
ing officer. He has general supervision over storerooms, main kitchen, and 
mess halls. He pays particular attention to garbage collections and food waste, 
reporting any excessive waste to the commissary officer. He supervises the 
issue of all provisions and the serving of food in the general mess halls. When 
provisions are received, he should be present to assist in the inspection thereof, 
take charge of those accepted, and see that proper disposition is made of 
them. He should keep the stock records of provisions in the dry provisions 
storeroom and make estimates of provisions required so that orders or requisi- 
tions may be prepared by the clerk for the signature of the commissary and 
executive officers. He prepares the Receipt and Expenditure Voucher daily, or 
furnishes the data from which the clerk may prepare it. In the absence of the 
commissary officer, the commissary steward temporarily assumes the duties 
of the former. 
The commissary clerk, usually a pharmacist’s mate, is responsible to the 
commissary officer for all entries made in the commissary ledger; the prepara- 
tion of orders and requisitions for provisions; the checking of dealer’s invoices 
and the preparation of public vouchers (when prepared by the commissary 
department) in payment thereof; accomplishing invoices covering provisions 
received from the supply department; filing and typewriting incident to the 
commissary department. He may be required to prepare the smooth Receipt 
and Expenditure Voucher and perform such other special or routine duty as may 
be assigned to him. 
The duties of storeroom keepers, usually pharmacist’s mates, are as follows: 
Make all issues of provisions from the issuing storerooms on requisitions ap- 
proved by the commissary officer or his representative; keep the storeroom clean, 
orderly and ready for inspection at all times; prepare lists of provisions required 
to replenish the issuing storeroom from the dry provisions storeroom; and, 
by daily inventory, keep the commissary steward informed concerning the 
quantities of nonstock items on hand. 806 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The mess hall police petty officer, usually a pharmacist’s mate, is responsible 
for the maintenance of discipline in the mess halls during meal hours; he 
directs patients, hospital corpsmen, civil employees, and others to their 
proper mess hall; he receives complaints and reports them to the commissary 
officer; he assists the storeroom keepers in handling, storing, and issuing provi- 
sions; and performs such other special or routine work as may be assigned 
to him. 
If other hospital corpsmen are assigned to the commissary department they 
usually serve as assistants in the positions that have been listed. 
By Executive Order No. 791G of June 24, 1938, civil employees of the com- 
missary department are included within the classified Civil Service effective 
February 1, 1939. The ratings of commissary employees are classified as 
follows; 
Group IV (a) 
Group III 
Group II 
Steward. 
Chief Cook. 
Chief Mess Attendant. 
Baker. 
Cook. 
First Cook. 
Second Cook. 
Meat Cutter. 
Mess Attendants. 
For detailed instructions pertaining to civil employees consult circular letter 
C, Appendix D, Manual of the Medical Department, U. S. Navy. 
The positions and general duties of the civil employees of the commissary de- 
partment are as follows; 
When one is employed, the steward is the senior civil employee of the com- 
missary department. Under supervision of the commissary officer and/or com- 
missary steward, he has charge of and is responsible for the sanitary condition of 
the kitchen, bakery, butcher shop, and mess halls, together with the equipment 
thereof. He may assist in the requisitioning, inspection and issuing of food, and 
the preparation of menus. 
Under the supervision of the commissary officer, commissary steward, or stew- 
ard, the chief cook directs and works with the cooks and assistants engaged in the 
preparation of food in a large hospital, or is responsible for the entire kitchen, and 
bakery service of a smaller hospital; he supervises the work incident to cleaning 
the kitchen, utensils, refrigerators, and other kitchen equipment; he requisitions, 
issues, and keeps accounts of food and kitchen supplies; and performs all 
related work as may be required. 
First cooks, under supervision of the chief cook, prepare and cook the food. 
In the smaller hospitals, the senior first cook may be charged with the duties of 
the chief cook. He supervises the other employees assisting in the preparation 
of food, and is responsible for the cleanliness of the kitchen, accessory rooms, 
and the equipment thereof. He may be required to perform related work as 
deemed necessary. 
Second cooks, under immediate supervision, assist in the preparation and 
cooking of foods; direct and work with other employees engaged in the care 
and preparation of food for cooking; assist in all kitchen work; serve the cooked 
food and perform all related work as may be required. 
Bakers, under general supervision, bake bread, cakes, and pastry; work with 
and direct other employees engaged in baking; clean and care for the bakery 
and its equipment; requisition and account for bakery supplies; and perform 
gpch related work as may be required. COMMISSARY SUPERVISION 
807 
The meat cutter, under supervision, cuts and prepares meats, fish, and 
poultry for cooking; works with and directs other employees engaged in meat 
cutting; requisitions, inspects, stores, and issues such supplies as may be re- 
quired; cleans, keeps in a sanitary condition, and is responsible for the meat 
room, tools, refrigerators, and other equipment; and performs all related work 
as may be required. 
It is the duty of the pantryman, usually a mess attendant, under supervision, 
to receive, store, and issue foods used by the hospital kitchens and messes; 
to keep the storeroom, its equipment and stores in a clean, orderly, and sanitary 
condition; to keep necessary records; and to perform all related work as may 
be required. 
Chief mess attendants, under supervision, direct and supervise employees or 
patients engaged in serving food in mess halls, dormitories, and wards, or in 
ordinary culinary work in connection with serving of food. They are responsible 
for the appearance and cleanliness of mess halls and the equipment thereof. 
They perform such additional related work as may be required. 
Mess attendants, under immediate supervision, perform ordinary culinary 
work in the kitchen, pantry, or mess hall, such as: Washing dishes, cleaning and 
polishing metal utensils, cutlery, and silverware; scrubbing floors, washing 
walls, windows and woodwork; and assist in the preparation of vegetables and 
other food for the cook. They serve the prepared food in mess halls, dormitories, 
and wards; clean the mess halls and equipment; act as yardmen by keeping the 
garbage cans and the outside area around the kitchen and commissary in a tidy 
and sanitary condition, and one usually is assigned duty as pantryman. 
Physical arrangement. 
The commissary office should be located in the subsistence building, if such a 
building exists, or in the immediate vicinity of the commissary department. It 
should be furnished with sufficient desks, typewriters, and other equipment 
necessary for the performance of the clerical work of the department, and 
should have a telephone with city connection. Here are kept the provisions stock 
ledger, the commissary ledger, the dealers’ jacket files, commissary department 
correspondence file, and other commissary records. All orders and requisitions 
for provisions are prepared in the commissary office and all matters pertaining 
to the commissary department are routed through it for appropriate action. 
In the dry provisions storeroom is kept the reserve stock of dry provisions. 
It holds from 1 to 3 months’ supply of provisions of a character that neither 
deteriorate rapidly nor require refrigeration. All provisions in this storeroom 
are considered as unexpended supplies, and are in the same status as are supplies 
in the medical storerooms. It is the value of this stock, and this stock only, that 
is determined monthly by physical inventory and is considered as an asset for 
accounting purposes. The stock of this storeroom is replenished by requisition 
monthly, or when necessary, on the nearest provision depot of the supply depart- 
ment of the Navy, and by orders placed with contractors under current contracts 
for special dry provisions not carried in stock in provision depots. 
The Issuing storeroom is usually located in the subsistence building in close 
proximity to the main kitchen. It is equipped with shelves, bins, and racks for 
the storage of foods in small quantities for current use. The main hospital refrig- 
erator is considered to be a unit of the issuing storeroom for administrative pur- 
poses and is under the charge of a hospital corpsman. All provisions issued to 
kitchens, butcher shop, messes, wards, etc., pass directly or indirectly through 
the issuing room. It is restocked by issue from the dry provision storeroom and 
by deliveries of fresh provisions from the contractors, and issues from it are 808 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
made only on the authority of requisitions approved for issue by the commissary 
officer. The stock carried in the issuing storeroom, having been expended by 
appropriate entry in the commissary ledger, is not considered as an asset for 
inventory purposes. 
The main kitchen is the one in which regular and other diets are prepared. If 
is a separate section from the mess halls for administrative purposes and is 
under the immediate supervision of the steward or the chief cook. It includes 
the kitchen proper, the bakery, the vegetable room, the butcher shop and such 
other accessory units as may exist and all of the equipment therein. The regu- 
lar and other diets are distributed from this point. 
In the diet kitchen food is prepared for the very sick, or others, as may be 
prescribed by a medical officer. It is usually located in the subsistence building 
and in the vicinity of the main kitchen. A nurse, especially trained in dietetics, 
a cook, and mess attendants perform such work as may be required. Hospital 
corpsmen are often detailed to the diet kitchen for instruction in dietetics. In 
this kitchen are prepared liquid diets, soft diets, convalescent diets, and, in addi- 
tion, such diabetic, salt-free, meat-free, or other special diets as may be ordered 
by the ward medical officers for individual patients. These special diets are dis- 
tributed from this point to the wards. 
The mess halls for the general mess are equipped with facilities for serving 
meals to convalescent ambulatory patients, hospital corpsmen, civil employees, 
and the Marine guard, if one is attached to the hospital. A chief mess attendant 
is in charge of the dining-room service and has as many mess attendant assistants 
as may be required to wait on the tables and to keep the mess halls shipshape. 
The scullery is considered to be a part of the mess hall and is usually in charge 
of a chief mess attendant. Chief mess attendants work under the supervision of 
the commissary steward and have no control over the patients or others who eat 
in the mess halls. A police petty officer is on duty in the main mess hall during 
meal time to maintain order and enforce observance of the rules and regulations 
of the hospital. 
The sick officers' mess is maintained in the sick officers’ quarters which are 
usually provided with a mess room, a kitchen, and a separate force of cooks and 
mess attendants. Or, lacking these facilities, the food is prepared in the main 
kitchen or diet kitchen, carried in containers to the sick officers’ quarters, and 
served either in the dining-room or on trays in the patients’ rooms. 
The nurses' mess is conducted in much the same manner as the sick officers’ 
mess, a dining-room and kitchen usually being provided in their quarters for that 
purpose. Cooks and mess attendants are detailed from the commissary force to 
the nurses’ mess. The housekeeper, under the general supervision of the chief 
nurse, is in charge. The nurses’ mess was given quasi-recognition by the 
so-called pay bill of 1922 which recites, in part, “From and after July 1, 1922, 
female nurses are entitled to one subsistence allowance per day, except when 
on duty and furnished quarters at hospitals and on board ship, when they shall 
be subsisted in kind, except that when, in the opinion of the commanding officer 
of a ship, it is considered more desirable,” etc. (See Appendix A, Sec. C, Par. 
C-2, S. and A. Manual). 
Procurement. 
The Naval Hospital Fund, (see page 779) from which every expense involved 
in the maintenance of a naval hospital may be paid, provides for the procurement 
of provisions and articles of special diets consumed at naval hospitals and on 
hospital ships of the Navy. 
PROCUREMENT, ACCOUNTABILITY, AND EXPENDITURE OF PROVISIONS COMMISSARY SUPERVISION 
809 
Prior to July 1 of each year the Bureau of Medicine and Surgery makes 
an allotment from the Naval Hospital Fund for the ensuing fiscal year to each 
naval hospital and hospital ship. These allotments represent limited credits 
against which public vouchers, stub requisitions, and other intra-Navy transfers 
may be charged and they constitute the authority for the individual activities 
to obligate the Naval Hospital Fund to cover such charges. 
The allotment of funds being granted, requisitions approved, and contracts 
awarded, orders may be placed and requests made for deliveries of provisions. 
The Bureau of Supplies and Accounts, or its representative, forms a very 
important link in the procurement of provisions by: Replenishing naval provi- 
sion depots, preparing joint requisitions for provisions which may be required by 
local activities, preparing schedules for bidders to furnish provisions (monthly or 
annually) on a “more or less” basis, awarding contracts to successful bidders and 
circulating abstracts of contracts showing the various items to be furnished by 
contractors, preparing and publishing applicable specifications, etc. 
Provisions are divided into two classes: Dry provisions and Fresh provisions. 
Dry provisions are further divided into the subclasses of: Dry provisions, Navy 
standard and Dry provisions, special. Dry provisions, Navy standard, are 
those items of groceries that have been standardized by the Navy Department, 
defined by printed specifications {see “Index of Specifications issued by the 
Navy Department” issued quarterly by the Bureau of Supplies and Accounts) and 
carried in stock by all naval provision depots. Dry provisions, special, are those 
items of groceries which are not ordinarily furnished to the “General Service,” 
i. e., ships and stations, but may be obtained for the use of “Hospitals Only.” 
Fresh provisions are fruits, vegetables, milk, meats, and similar articles which 
are obtained for early consumption. 
In order to obtain fresh provisions and dry provisions, special, it is necessary 
to furnish the local supply officer a list showing the estimated amounts of these 
two classes of provisions that will be needed to meet the requirements of the 
hospital. This list should show the amounts required by months. If the list is 
prepared properly and carefully and the seasonal rotation of fruits and vegetables 
taken into consideration, very little difficulty will be experienced in obtaining the 
various kinds of fresh provisions as they appear in the local markets. 
The supply officer makes an annual requisition on the Bureau of Supplies and 
Accounts for the requirements of the hospital and other naval activities within 
the district, and upon the approval of that bureau, he makes monthly contracts 
to furnish these items. After the contracts are made, each activity concerned is 
supplied with a “Schedule of Provisions Contracts” for the following month. 
This schedule shows the names, addresses, and telephone numbers of all firms 
holding contracts during the month, together with the contract numbers and 
unit prices. In addition to the list of provisions contracted for delivery to the 
general service, there will be given a list of items for the use of “Hospitals 
Only.” Naval hospitals may order from both lists. The latter list shows such 
items of dry provisions, special, for hospitals only, as have been included in 
the original estimate furnished the supply officer and previously referred to. 
Orders against these monthly contracts may be made direct to the contractor, 
iising N. M. S. Hospital Form No. 23. The contractor is allowed at least 24 
hours’ notice before delivery can be required. To obtain either class of dry 
provisions or other supplies from the local supply officer or commissary store, 
S&A Form No. 71, a stub requisition, or a letter is used. Local customs vary 
somewhat in this detail. 
Food Inspection.—All fresh provisions procured for use in the commissary 
department are required to be inspected by the commissary officer to determine 810 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
whether or not the articles delivered conform to the following requirements: 
Agreement with the amounts ordered; delivery at the time stated in the order; 
in good condition at. the time of delivery and fit for human consumption; and 
in conformity in all respects with the specifications as written into the formal 
contract or order issued by the supply officer authorizing the transaction. If 
they conform to requirements they are accepted. 
No detailed discussion of requirements and specifications will be made, but 
a few general rules are given, so that the fundamentals of food inspection may 
be available. 
meats.—All items of meats and meat food products are required by naval 
regulations to be inspected by an inspector of the Bureau of Animal Industry, 
U. S. Department of Agriculture. The meats are required to be stamped by the 
inspector and a certificate issued by him stating that the meats or products 
described on the invoice have been passed by the Department of Agriculture 
and that they are also in accordance with naval specifications. This certificate 
is signed by the inspector. 
Sex recognition.—The Navy contract specifications for fresh and various other 
meats exclude from acceptance meats from bulls, boars, stags, and, in most 
cases, cows. For this reason reference to the recognition of sex in the dressed 
carcasses has a practical value in this discussion. 
“The bull is characterized by the massive development of his muscles, espe- 
cially the neck and shoulder musculature, also by the dark color of the muscu- 
lature and the scarcity of fat tissue. Finally the inguinal canal is open. 
“The ox (steer) is distinguished from the bull by the weaker development of 
the shoulder and neck musculature, by its thick panniculus adiposus, and by the 
possession of a mass of scrotal fat tissue (cod fat) which completely conceals 
the inguinal ring (a positive and recognizable anatomical point in the hind 
quarter of all adult males is the ischio-penal ligament, which appears as a cir- 
cular white fibrous patch in the posterior region of the ischio-pubic symphysis). 
“The carcasses of cows are more angular in their various outlines than are 
those of steer carcasses. There is a marked curvature to the ribs. The cut 
termed ‘round’ is flatter; the shanks are thinner, and the mass of ‘cod fat’ 
which is seen in the steer is absent in cow carcasses. Very often the udder is 
carefully removed from fat cow carcasses and fat skewered over the cut surface 
in order to give them the appearance of steers. This attempted deception, how- 
ever, is easily recognized by the mammary tissue which remains and by the 
supramammary lymph glands covering this tissue. 
“Close examination will disclose the true character of the small udder on 
young heifers, which, on account of heavy fat infiltration, resembles the mass 
of scrotal fat of steers. 
“In sheep, the slaughtered buck is distinguished from the ewe and wether 
by the strongly developed musculature of the neck, withers, and shoulder. The 
meat of bucks may also possess a disagreeable odor, but, as a rule, this is rare. 
“The distinction of importance as regards hogs is between boars and stags 
on the one hand and sows and barrows on the other. The meat of the boar is 
coarse and possesses a darker color and the shoulder (or shield) is extremely 
hard. The meat of the service boar usually has a specific odor best described 
as a urinous or strong sexual odor. Under the Federal meat inspection regula- 
tions, meat or carcasses having this odor are condemned as unfit for food. 
“Meat which is suspected of being from a boar or from a recently castrated 
service boar should be tested for odor. This test is made by placing a sample 
of meat or raw fat in water in a covered vessel and bringing it to a boil and 
testing for odor from time to time while heating, or the sample may be heated 
in a frying pan. In some cases the urinous or boar-sex odor will be found very COMMISSARY SUPERVISION 
811 
pronounced and disagreeable; in others it may be faint, but whenever the odor 
exists to such degree that its presence can be declared the meat should be 
rejected as unfit for human food. 
“Characteristics of good meat.—In all cases the carcass should be that of a 
well-nourished animal without signs of attenuation or wasting; good meat is 
firm and elastic to the touch, without oedema or emphysema; that is, does not 
pit or crackle on pressure. It should be juicy, but not wet nor flabby; the color 
should be uniform, without brown or discolored patches. 
“Good beef is of bright-red color, marbled with fat; veal is always paler and 
less firm to the touch. Mutton is dullish red and firm, the fat hard and white. 
In both beef and mutton a uniform yellowness of the carcass may be associated 
with health conditions. The carcass of the pig should be plump; the flesh is 
naturally pale and the fat somewhat soft; the skin should not set in folds 
or wrinkles and should be without stains or blotches. However, slight bruises 
and scratches are not infrequently present in good carcasses. 
“In all cases when sufficient time has elapsed for the carcass to cool and set, 
the fat of cattle and sheep should be firm and the suet hard, containing no 
watery jelly or juice, free from blood stains, and creamy white or yellowish 
in color. The odor should be sweet and agreeable. A skewer thrust deeply 
into the flesh should have no unpleasant odor when withdrawn. 
“The pleura and the peritoneum (the white, shiny membrane lining the chest 
and thoracic and abdominal cavities) should be free from adhesions and staining 
and free from evidence that anything has been stripped away; also particular 
attention should be paid tot the connective tissues about the flanks, shoulders, 
diaphragm, and region of the kidneys ; signs of wetness, oedema, imperfect setting, 
and evidence of disease in the lymph glands should be absent. 
“Bull beef, it should be remembered, is usually and normally dark in color, but 
in other cases marked darkness of the flesh is to be regarded with suspicion.” 
(From Osterhag.) 
Fresh meats defined.—The word “fresh,” whenever occurring in Navy specifica- 
tions for meat and meat-food products, is interpreted to include chilled fresh prod- 
ucts which are not and have not been frozen. Conversely, products which are, or 
have been, frozen cannot be accepted as fresh . Meats that have been frozen and 
subsequently thawed out are dull in color and the blood from it is thin and pale in 
color (due to separation of the fibrin and serum upon freezing). If a specimen of 
the blood is mounted on a glass slide and examined under a microscope using a 
low-power lens the red corpuscles will present a crinkled appearance or the edges 
will appear scalloped if the meat is or has been frozen. 
thawed-out POULTRY.—Frozen poultry that has been thawed out may be de- 
tected by the appearance of the lung tissue. If the fowl has been frozen the lung 
tissue will be dark in color and congested in appearance, but if it has never been 
frozen the lung will be pink in color and without the congested appearance. The 
lung from a fresh fowl, if slightly compressed between the fingers, will crackle 
(due to the air cells bursting under pressure). A thawed-out lung will not give 
this crackling sensation because the air cells already have been ruptured in the 
process of freezing. 
eggs.—Every hospital should have “strictly fresh” eggs included on the local 
monthly provisions contract. The specifications may be very definite or the 
description “strictly fresh” only may be used. The following discussion will be 
helpful to those who are not familiar with the distinguishing characteristics of 
a fresh egg. 
Several methods of determining the freshness of eggs have been suggested in 
various books and pamphlets on the subject, such as placing them in water and 
154294°— 39 32 812 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
noting the angle which they assume and whether or not they float. This method 
depends on the fact that in newly laid eggs the contents fill the egg, and since the 
specific gravity of the egg is greater than water, the egg therefore assumes a hori- 
zontal position at the bottom of the vessel when immersed. Depending on the 
length of time since an egg has been laid, evaporation of water from the con- 
tents through the porous shell will cause it to assume various angles from a 
horizontal position up to a vertical one. An egg that has lost sufficient moisture 
so that the specific gravity is less than water will float. Also an egg that has 
undergone decomposition to such an extent that gases have been liberated within 
the egg will always float. 
This method has the disadvantage of being slow and inaccurate and is not 
always a true indication of the age of an egg. Eggs that have been placed in 
cold storage very soon after being laid, provided the storage rooms are kept 
sufficiently humid, may remain in good condition for several months without 
sufficient evaporation of contents to make any noticeable difference in the float- 
ing angle. On the other hand, they cannot be classed as “strictly fresh” eggs 
and may have a slightly disagreeable flavor. 
It is desirable for every hospital to have an egg-candling device. They may 
be made in the hospital carpenter shop, or a very satisfactory one may be pur- 
chased at little cost. One that can be used in daylight, thereby eliminating the 
necessity of a dark room, is the most desirable. A suitable type consists of a 
small sheet-steel box enclosing a 60-watt electric light. There is an opening about 
IVs inqhes in diameter in one side of the box, with a shield extension on the top 
and sides about the opening to exclude rays of daylight. The inside of the shield 
is painted black to prevent reflected rays from striking the opening. Through the 
top of the shield is an opening surrounded by another shield similar in shape to 
the light shield on an ordinary parlor stereoscope. By holding an egg against the 
small opening and looking down through the upper opening a very clear view of 
the contents of the egg may be had. 
Any shrinkage of the egg is evidenced by an air bubble at one end. The yolk 
in a fresh egg will show up as a light shadow. A heavy shadow usually 
indicates that the egg is stale. The various degrees of staleness may be judged 
by the heaviness of the shadow. A rotten egg always will show black. Hatched 
eggs are fertile eggs that have been kept in a warm place sufficiently long after 
laying to start the development of the embryo. This shows up under the candle 
as a small dark spot. 
Broken-yolk eggs are eggs that have been kept in a warm place long enough 
for the capsule of the yolk to disintegrate through to such an extent that the 
yolk mixes with the white of the egg. This condition under the capsule appears 
as a floating shadow throughout the entire contents of the egg rather than 
being localized, as is the case in a normal egg. 
A “strictly fresh” egg should appear under the candle as almost entirely trans- 
lucent. The only opacity should be the slight shadow cast by a normal fresh yolk. 
The air bubble should not be over 5 per cent of the egg contents. Eggs that do 
not meet these requirements should be regarded with suspicion and opened on a 
saucer. If, after opening, the yolk has a decidedly mottled appearance, does not 
stand up to almost the shape of a hemisphere, or breaks upon careful opening of 
the shell, the egg may be considered to be stale. The appearance of the white of 
the egg is also very helpful in egg inspection. In a fresh egg the white consists of 
two parts, a viscid, jellylike part and a thin, watery part. In storage eggs that 
have been held for several months and in stale eggs that never have been in storage 
but have been held for several days in a warm place the jellylike part of the 
white disintegrates into a thin, watery fluid. COMMISSARY SUPERVISION 
813 
In the inspection of eggs at a naval hospital one rarely is called upon to 
differentiate between fresh eggs and eggs that are distinctly rotten, but almost 
daily one must be able to tell the difference between “strictly fresh” eggs and 
eggs that are slightly stale. Those that are slightly stale certainly are not 
“strictly fresh” and therefore should be rejected. 
For the purpose of inspecting eggs under a candle the air-cell gauge is very 
useful. These gauges may be obtained from the United States Department of 
Agriculture, Washington, D. C. 
milk and cream.—Samples of milk and cream, both thin cream (20 per cent 
milk fat) and double cream (40 per cent milk fat), should be collected fre- 
quently, at least weekly, and sent to the hospital laboratory for analysis. 
Usually a Babcock test to determine the milk-fat content will be the only 
test necessary. In collecting samples of milk and cream care should be taken 
to collect average samples. If the milk is in cans, the milk should be poured 
from one can to another at least six times, so that the cream will be thoroughly 
mixed and evenly distributed throughout the milk, and then about a pint col- 
lected in a clean bottle as a sample. If the milk is in quart bottles, send a 
whole bottle to the laboratory. The same precautions should be taken in col- 
lecting samples of cream. 
fish.—The inspection of fish is difficult unless the person inspecting it is 
familiar with the various kinds. A study of a dictionary or a natural history 
that describes and gives illustrations of the different species of the fish family 
will prove very helpful. Cheap varieties frequently are delivered for the more 
expensive kinds; pollock for bluefish, flounder for baby halibut, croakers for 
Virginia spots, Boston mackerel for Spanish mackerel, etc. Frozen fish that 
have been thawed out are frequently delivered for fresh-caught fish. Fish 
that have been frozen lose their delicate flavor. Fresh-caught fish present the 
following characteristics: The gills are red; the eyes are bright; the blood is 
bright red, and the flesh is firm. In fish that have been frozen, held in storage 
and subsequently thawed out, the gills are pale, the eyes dull, the blood dark in 
color, and the flesh is usually soft with a slightly disagreeable odor, even if it is 
still edible. To show the points of differentiation between fresh, stale, and putre- 
fied fish, the following table from Meat Hygiene, by Edelmann, Mohler, and 
Eichhorn, is given. 
Condition 
Scales 
Eyes 
Gills 
Body in general and 
meat 
Specific grav- 
ity 
Fresh 
Glittering, free 
from slime, 
firmly adher- 
ent. 
Standing out - 
Gills, lids, and 
mouth closed. 
Solid; placing fish 
horizontally on the 
hand it does not 
bend. Meat firm, 
elastic, tight on 
bones. 
Sink in water. 
Not fresh, 
More or less 
Red bordered, 
Lids open or 
Bony, bends easily, es- 
Float on the 
stale for 
some time. 
easily remov- 
able, slightly 
slimy or 
smeary. 
sunken; cor- 
nea cloudy. 
can be easily 
opened; gills 
pale, yellow 
dirty, or gray- 
ish red, cov- 
ered with the 
same kind of 
fluid; odor 
disagreeable. 
peeially at tail end; 
occasionally bloat- 
ing of the abdomen, 
which may be bluish 
discolored. Finger 
impressions are eas- 
ily made, and re- 
main; meat is soft, 
can be easily re- 
moved from the 
bone. 
water. 
Putrefied 
Very loose, cov- 
ered with a 
smeary, slime- 
like mass of 
disagreeable 
odor. 
Breakingdown; 
are frequent- 
ly removed. 
Very off-colored; 
extremely of- 
fensive odor. 
Withered, flabby, soft, 
pale, bloated. The 
meat is sloppy. 
Do. 814 
HANDBOOK OF THE HOSPITAL CORPS, U, S. NAVY 
shellfish.—In the inspection of crabs and lobsters there is but one rule to 
follow and that is do not accept them unless they are alive. Ptomaines (so- 
called toxic animal alkaloids) develop very quickly in crabs and lobsters. It 
should be remembered that the shells of dead oysters and clams are open. 
The juice of opened oysters and clams should be almost clear and not stringy; 
any stringy or milky appearance of the juice is a cause for rejection, as 
it indicates bacterial growth. The oysters and clams should be slightly salty 
to the taste; a decided fresh taste indicates adulteration by “floating” or by 
being in direct contact with ice. “Floated oysters” are oysters that have 
been taken up from their natural beds and either laid down in fresh or brack- 
ish water or placed in floats at the mouth of a fresh-water stream for a few 
weeks. When salt-water oysters are placed in fresh or brackish water the salt 
in the oyster tissue is dissolved out by the fresh water and the oyster becomes 
inflated with fresh water (due to osmosis) and increases in size so that when the 
bivalves are opened the oysterman is enabled to obtain from 10 to 20 per cent 
more oyster meat from the same quantity of oysters in the shell, thereby increas- 
ing his profits at the expense of the innocent purchaser. “Floating” destroys the 
delicate flavor of the oyster and renders it more liable to contamination by 
sewage from the stream. Ice in direct contact with the oysters destroys the 
flavor in the same manner, but does not contaminate the oyster unless the ice 
itself is contaminated. Clams are not generally “floated.” 
The inspection of fruit and vegetables will not be discussed, as the standard 
specifications are very clear and variations from the standards are quite apparent, 
as almost everyone can distinguish between the good, the indifferent, and the bad. 
food adulteration.—The following abstract from the Federal pure food laws 
will serve as a guide in the inspection of all items of foods, but more particularly 
in the inspection of dry provisions, special, purchased direct from the contractor, 
All items of Navy standard dry provisions obtained on requisition from provision 
depots of the Navy have been inspected at the time of their original purchase by 
the Navy, and therefore inspection for quantity received is the only inspection 
necessary when they are received at a hospital. 
Adulteration of food consists in practices, some fraudulent, and others technical 
in nature. Some are injurious to health, but most of them have an economic 
rather than a sanitary significance. 
Methods of adulteration: 
1. The removal of nutritive substances. 
2. The addition of injurious substances. 
3. The fraudulent substitution of cheaper articles. 
4. Misbranding. 
5. The sale of food that is filthy, decomposed, or putrid. 
The more common adulterations are: Cottonseed oil for olive oil; starch or 
sugar in cocoa and chocolate; caramel, pea meal, or chickory in coffee; cheap fats 
or cottonseed oil in lard; saccharin for cane sugar; cereals in sausages; bran in 
flour; oleomargarine as butter; distilled and colored vinegar as pure cider 
vinegar, etc. 
A food is considered adulterated, according to the Pure Food and Drugs Act 
of 1906— 
1. If any substance has been mixed and packed with it so as to reduce or lower 
or injuriously affect its quality or strength. 
2. If any substance has been substituted wholly or in part for the article. 
3. If any valuable constituent of the article has been wholly or in part 
abstracted. COMMISSARY SUPERVISION 
815 
4. If it is mixed, colored, powdered, coated, or stained in any manner whereby 
damage or inferiority is concealed. 
5. If it contains any poisonous or other added deleterious ingredient which may 
render such article injurious to health. 
6. If it contains in whole or in part a filthy, decomposed, or putrid animal or 
vegetable substance or any portion of an animal unfit for food, whether manu- 
factured or not, or if it is the product of a diseased animal or one that has died 
otherwise than by slaughter. 
7. Misbranding is regarded as a form of adulteration under the Pure Food 
and Drugs Act. 
Accountability. 
Immediately upon the receipt, inspection, and acceptance of dry and fresh 
provisions delivery is completed, title to them passes, and they become the prop 
erty of the hospital, and the commissary department is held accountable for them. 
The accountability of the commissary department for provisions Includes: The 
keeping of the necessary accounting records, the storage and preservation of 
provisions, and such measures as are necessary to insure the economical use 
of provisions. Accounting procedures will first be briefly discussed. 
Deliveries of provisions are accompanied with dealer’s bill, S&A Form No. 76, 
or other invoice. One copy (or more as may be required) is receipted and 
returned to the vendor or transferor and one copy is retained for internal 
purposes. It is from these retained copies that the “receipt” portion of the 
daily Receipt and Expenditure Voucher (N. M. S. Form No. 37) is prepared. 
The “expenditure” portion of this form is prepared from the records which 
record issues from the issuing storeroom, through which (for bookkeeping pur- 
poses) all provisions are considered to pass. This form is so arranged as to 
present a daily itemization of all provisions received and/or expended, the 
quantities involved, the unit cost and extensions. After the preparation of this 
form, invoices are filed in the appropriate dealer’s jacket for future reference. 
The receipt of all provisions, regardless of source, is recorded in the com- 
missary ledger. Similarly, all expenditures (issues from the issuing storeroom, 
including those provisions made available to the messes immediately upon 
receipt) are also recorded in this ledger. It should be posted daily from the 
invoices representing receipts and from the expenditure records, i. e.; the 
daily journal or N. M. S. Form R, whichever may be the local practice, and 
it is the responsibility of the commissary steward to keep this record posted 
to date and verified weekly by physical inventory. The receipts and expendi- 
tures of provisions are recorded as debits and credits in the Stores Account 
of the General Ledger of the hospital. 
Upon approval by the commanding officer, N. M. S. Form No. 37 becomes 
an accomplished voucher and a permanent record. It may be likened to a 
journal entry in a bookkeeping system, inasmuch as it is the supporting voucher 
for entries of quantities and values in the commissary ledger. 
The commissary ledger is a loose-leaf book provided with pages in sets of two 
and arranged to present quantities and cash values. The page provided for 
quantity accountability is arranged to present receipts and/or expenditures of 
accepted units in distinctive columns headed “R” and “E” respectively. In order 
to distinguish more clearly between the columns, receipts are entered with black 
ink and expenditures with red ink—positive and negative entries. The page pro- 
vided for cash values is arranged to present the value of the inventory brought 
forward, summary values of daily receipts and expenditures, and running totals. 
The running totals provide a convenient expedient for the control of appropria- 816 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
tional expenditures against the provision allotment and a ready means of comput- 
ing the average per diem cost of the current ration. At the beginning of a month 
the name, unit, unit cost, number of units on hand, and total value of all items 
on the inventory are brought forward from the preceding month and entered 
on new pages of the commissary ledger. Transactions for the current month 
are then posted chronologically from the approved N. M. S. Form No. 37. 
After the final transactions of the month have been entered, all columns are 
summarized, the expenditures deducted from receipts (including the inventory 
brought forward), and a closing book inventory determined. Quantities and 
summary values of this inventory must be verified by i jference to the provisions 
stock ledger and by an actual inventory of unexpended stock on hand as of the 
corresponding date. Adjustments are often indicated due to picking up or drop- 
ping fractions. Errors are also discovered at this time and must be corrected 
or adjusted as may be deemed proper before a final closing inventory is deter- 
mined and carried forward to the next succeeding month. 
The value of inventories is calculated on the average cost basis of items and 
when new lots of provisions differ in unit cost from those already in stock, a 
new unit cost price of the combined lots must be made. This price is deter- 
mined in the following manner: If on a certain date there are in store 6 bags of 
corn meal valued at $1.00' per bag, and 10 more bags valued at $2.00 per bag are 
received, the sum of the units and the total value of the combined stock are 
determined. The latter is divided by the former and a new value per bag is 
established, which in this instance is $1,625. 
When dry provisions are received they should be promptly placed in the dry 
provisions storeroom, and perishable fresh provisions should be stored imme- 
diately in refrigerating rooms in order to prevent deterioration and spoiling. 
For the information of the reader there will now be given a brief account of 
methods used in preserving foods in order to keep them fit for human con- 
sumption. 
Food preservation.—The methods used in the preservation of foods are: Cold, 
drying, pickling, smoking, canning, preserving, and chemical treatment. 
cold is an antiseptic rather than a germicide. Low temperatures kill few 
bacteria, but prevent the growth and multiplication of most of them. No 
microorganisms pathogenic to man will grow or multiply at the temperature 
of the refrigerator, but many saprophytic bacteria and molds will, even as low 
as zero Centigrade. Most pathogenic bacteria withstand freezing, but suffer a 
quantitative reduction. Most animal parasites die in cold storage. At a tem- 
perature of 9° F. trichinae will die in 20 days. The longer an article remains 
in cold storage the relatively safer it is. The proper preservation temperature 
varies for different foods. Meat and poultry for long keeping should be kept 
frozen at a temperature of 25° F. To keep them for short periods in a chilled 
condition the temperature should be 33° F. Milk and eggs in the shell are 
injured by freezing. Fish for long keeping usually are frozen, then dipped in 
water and refrozen, then stored at 20° F. This coating of ice prevents the loss 
of water due to surface evaporation. 
Articles may be kept in cold storage for a long time; fish for as long as 
2 years. Meat, poultry, eggs, and vegetables may be kept for months. Undrawn 
poultry keeps better in cold storage than drawn, and drawn poultry decomposes 
more rapidly after removal from the refrigerator. 
Cold imparts no new taste nor does it seriously alter the natural flavor; It 
does not diminish the digestibility nor cause any loss of nutritive value. 
drying is a primitive method of preserving meats, fruits, vegetables, and other 
food substances. It furnishes an ideal antiseptic condition, for bacteria require 817 
COMMISSARY SUPERVISION 
moisture for their growth, and drying removes this. Furthermore, dried foods 
usually are cooked before being eaten. It is not adapted as well to meats as to 
fruits and vegetables. Dried meats lose their natural flavor. Dried eggs and 
milk keep their nutritive value. 
pickling is a method of preserving food by submersion in brine, vinegar, or 
weak acids. When brine is used for pickling it should contain 18 to 25 per cent 
of salt. Pickling should be considered antiseptic rather than germicidal. 
Trichinae die after prolonged pickling. 
smoking consists in drying food and exposing it to smoke in which certain 
substances such as acetic acid, creosote, formaldehyde, etc., have been incorpo- 
rated. These are considered germicidal, but it must be remembered that the 
penetration is only partial; for example, in smoking sausages, if they are large 
in diameter, the smoke does not penetrate to the whole of the contents, and 
they may become dangerous in regard to the various parasites and the products 
of decomposition contained therein, as smoked meats often are eaten raw. 
canning is the practical application of the process of fractional sterilization 
to the preservation of food. Two or more sterilizations are usually made, with 
a lapse between the sterilizations to permit the germination of spores, which are 
killed by the subsequent sterilizations. Canned foods are sterile and safer than 
the fresh article. Fortunately, improperly sterilized canned foods are easily 
detected by the odors that are produced. Properly canned goods are safe and 
quite as nutritious as the fresh article. 
preserving is a method of preserving food by the addition of sugar and 
cooking. For this reason the food article must be considered as free from 
infection. Various acids and salts, such as salicylic acid, benzoic acid, and 
sodium benzoate, are sometimes employed as chemical preservatives. 
chemical preservatives may be considered as antiseptic substances, and not all 
of them are injurious to the health, the least harmful being benzoic acid and 
sodium benzoate. Most people object to any chemical or drug substance being 
used as a preservative. 
The chemicals used most commonly are: Benzoic acid and sodium benzoate, 
borax and boric acid, formaldehyde, salicylic acid, sodium and potassium nitrate, 
potassium permanganate, sodium fluoride, hydrofluoric acid, sulfites, sodium 
bicarbonate, hydrogen peroxide, and arsenic. 
Expenditure. 
Provisions may be expended by issue from the issuing storeroom, by transfer to 
other activities, or by survey should they become unfit for human consumption. 
In order for provisions to be issued from the issuing storeroom the chief cook 
in the main kitchen, the dietitian in the diet kitchen, the housekeeper in the 
nurses’ quarters, and the person in charge of any other special mess, prepares a 
food requisition and submits it to the commissary officer every morning. The 
requisitions are based on the menus prepared in advance, except in the case of 
the diet kitchen. The requisitions should call for sufflcent food for three meals— 
supper, and breakfast and dinner for the following day. After the requisitions 
are approved by the commissary officer they are sent to the issuing storeroom 
for issue at stated hours. The hours of issue should be arranged so that they 
operate to the best advantage, both to the section drawing the provisions and 
to the commissary department. All eggs, oranges, milk, cream, etc., issued to 
the wards on request should be issued by the issuing storeroom and through 
the diet kitchen. No uncooked food should be issued to any section or hospital 
department, except by the method outlined. In other words, all food is issued 
through the issuing storeroom, and no food is issued from there except upon the 818 
HANDBOOK OF THE HOSPITAL CORPS. U. S. NAVY 
authority of a requisition signed by the commissary officer. This permits the 
commissary officer to have absolute control over all issues of food. 
When provisions are expended by survey the survey in most cases is an informal 
one. {See page 784). The value of the provisions surveyed is charged to the 
cost of the ration. 
Should provisions be transferred to other activities the procedures are as 
described in the section on Hospital Supplies and Property Accountability. 
Issues of provisions to the chief cook are principally made to meet the require- 
ments of the menu for the general mess and of regular diets. In the issue and 
economical use of provisions the menu is an important factor and will now be 
discussed. 
Menus and their, preparation.—Menus are prepared for as many classes of 
diets as may be necessary and in preparing them S&A Form No. 333 usually is 
used. They should be prepared not later than Tuesday of each week for 7 days, 
Monday to the following Sunday, and be submitted to the commanding officer for 
approval, via the executive officer. 
After being approved, menus should not be changed except for some very good 
reason, such as inability to obtain certain articles of provisions, etc. 
Regular-diet menus only will be discussed in this section. For a discussion of 
soft diets, convalescent diets, and special diets, see chapter on Diets and Messing 
for the Sick. The points to be kept in mind in preparing regular diet menus are: 
First, to serve sufficient food to satisfy body requirements; second, to prepare 
food that is pleasing to the senses, thus stimulating the appetite; and third, to 
do these economically. 
A proper regular-diet menu should be changed every week to give it variety. 
No matter how carefully a menu is planned or how well the food is cooked and 
served, if it is repeated too often indifference or aversion may result. Most per- 
sons wall tire of chicken and ice cream in the same manner as they do of stew 
and prunes if repeated at short intervals. In the interest of digestive functions 
and proper metabolism, different kinds of foods should be served in such propor- 
tion that the various food-stuffs, i. e., protein, fats, and carbohydrates, are 
ingested in approximately the proportion of one part of fat, two parts of protein, 
and eight parts of carbohydrates. A lack of the proper food elements in a diet 
may cause “food deficiency diseases” such as scurvy, pellagra, and beriberi. 
It has been found that man does his best when he ingests animal and vegetable 
food in the proportion of about 20 per cent animal and 80 per cent vegetable. 
A man requires from 3,000 to 5,000 calories of foodstuffs per day in the propor- 
tion given above, and knowing that 1 Gm. of protein yields approximately 4 
calories, 1 Gm. of fat approximately 9 calories, and 1 Gm. of carbohydrates ap- 
proximately 4 calories, the caloric value of menus should be computed from time 
to time in order to check the caloric sufficiency of the diet. 
When uncooked rations are being served on the basis of a well-balanced ration, 
quantities should be issued in excess to allow for waste. Experience has shown 
that waste, such as loss in peeling potatoes, food left on plates, etc., can be kept 
down to about 20 per cent. If the principles of a well-balanced ration are 
observed food will not be wasted to any great extent by being left on plates. 
It may be advantageous to work up a menu by first arranging the dinners for 
each day, starting in with the meats and building around that main dish. 
By first deciding what meat to have for each day’s dinner, it is easier to obtain 
a rotation in meats, and it also enables one to work in left-over portions for 
suppers and breakfasts. COMMISSARY SUPERVISION 
819 
In addition to the required amounts of ordinary meats, starchy vegetables, 
cereals, beverages, etc., some article of fresh fruit, preferably raw, and also 
some variety of green leafy vegetable should appear each day on the menu. 
In summer the selection of these articles is comparatively easy, but in winter 
most of them are too expensive for routine use. The following list is suggested, 
from a combined food value and economic point of view, for use in the late 
fall, winter, and early spring. Fresh fruits, such as oranges, lemons, grape- 
fruit, apples, bananas, and fresh vegetables, such as tomatoes, spinach, lettuce, 
cabbage, string beans, carrots, and cauliflower. 
A good rule to follow in preparing menus is never to open a can when the 
same article of food is procurable in the market in its fresh condition, pro- 
vided the fresh article can be purchased at a reasonable price and the per- 
sonnel of the commissary department has the time to prepare it. It takes more 
time and labor to prepare fresh articles for serving than it does to open cans, 
and it is very much easier for the cooks to open cans than it is to get the 
mess attendants to prepare the fresh articles. Consequently, the kitchen 
requires constant supervision by the commissary officer to prevent the substi- 
tution of canned goods from the dry-provision storeroom for fresh provisions 
when the latter has been procured for the menu. Then, if it is intended to 
have fresh string beans for a certain meal the words “fresh string beans” 
should be written on the menu and not the words “string beans.” 
The color combinations of foods presented when the finished meal is on the 
plate should be considered in preparing menus. Avoid a similarity of color 
so far as practicable, as a variety of colors stimulates the appetite. A dinner 
consisting of cream of potato soup, roast pork, mashed potatoes, stewed dried 
lima beans, vanilla ice cream, and bread would all be white in color. If the 
soup were changed to vegetable soup, the lima beans to tomato salad, apple 
sauce served with the roast pork, and the vanilla ice cream changed to choco- 
late, the color monotony would be broken. 
In order to have a standard as a basis for the caloric or fuel value in 
preparing menus at hospitals the caloric value of a “fresh provision,” U. S. 
Navy ration, given in Gatewood’s Hygiene as 3,563 calories per day per man, 
may be taken. It must be understood that the average caloric value for all 
food consumed in a hospital will be greater than this figure because of the 
special diets, special messes, and for other reasons. Accepting this standard 
for the regular diets, the U. S. Navy ration table, as given in the Bureau of 
Supplies and Accounts Manual, article 1320, may be used as a basis for com- 
parative purposes. For instance, 1% pounds of fresh meat per day per man 
is allowed; also 1% pounds of fresh vegetables, 2 ounces of butter, 4 ounces 
of sugar, etc. By computing the amounts of the various items of provisions 
used in a hospital a very accurate idea may be had of whether or not excessive 
amounts of the various items of foods are being used in the menus. 
The table given herewith is based on information contained in bulletin No. 
28 of the United States Department of Agriculture, The Chemical Composi- 
tion of American Food Material; Diet in Health and Disease, by Friedenwald 
and Ruhrah; and Feeding the Family, by Rose. 
No claim is made for mathematical accuracy in presenting this table, as the 
matter of standardization of weights and measures is exceedingly difficult, 
especially when an attempt is made to make them agree with average portions. 
It is believed, however, that this table will be found useful in balancing menus, 
so that they may be kept somewhere near the standard selected—that of 3,563 820 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
calories per day per man. Where no figures appear in the tables, data are not 
available on which to base computations. 
“Average portions” as referred to in the table are considered to be the 
average amounts required or expected by the average man of good health at 
one meal in the general mess at naval hospitals. 
The abbreviations used in the table are explained as follows: 
tsp teaspoonful. 
tbsp tablespoonful. 
Ige large. 
med medium. 
sml small. 
dia diameter. 
lb pounu. 
qt quart. 
si slice. 
pc piece. 
av average. 
Table of Foods Usually Found on Naval Hospital Menus, Showing Size of 
Average Portions Expressed in Common Household Measure, Weights of 
Portions, Caloric Values, and Percentage of Proteins, Fat. and Carbo- 
hydrate Calories 
Beverages 
Ounces 
Calo- 
ries 
Pro- 
tein 
Fat 
Car- 
bohy- 
drate 
Cocoa (1 cup milk, 2 tsp. co- 
1 cup 
9.5 
250 
16 
44 
40 
coa, 2 tsp. sugar). 
7.4 
200 
21 
48 
31 
7.0 
70 
100 
1 cup 
8.0 
0 
1 cup 
8.0 
0 
Breads, Biscuits, Muffins 
Note.—Add 160 calories to calorie values of breads, etc., listed, if butter (0.8 oz.) is served with th 
breads. 
1.3 
100 
11 
27 
62 
1 si. %" x 3" dia. 
1.8 
100 
10 
10 
80 
1.4 
100 
14 
6 
80 
Bread, corn, old New England. 
1 pc.’ iyj' x 2" x 1" 
2.0 
200 
8 
30 
62 
1.6 
100 
14 
6 
80 
2 si. x 2M’"'x Y." 
2.8 
200 
16 
3 
81 
Breadi corn cake 
2 si. 2" x 2" x 1" . 
2.4 
200 
10 
24 
66 
.8 
100 
10 
22 
68 
6 crackers . 
.8 
100 
10 
26 
64 
.9 
100 
10 
20 
70 
Croutons (toasted) 
15 croutons, Yi' cubes 
.8 
100 
7 
49 
44 
3 cakes, 4M” dia ... . ... 
5.4 
300 
14 
25 
61 
3.2 
266 
13 
25 
62 
9.0 
600 
15 
69 
16 
1 si. with Y cup sauce. 
3.6 
165 
13 
43 
44 
Toast, French. 
2 si. 3" x 3" x Y" 
2.8 
200 
10 
48 
42 
Cakes, Etc. 
Angel cake _ - 
1 pc. 1 \i" x 2" x 2Yi" 
1.3 
100 
12 
1 
87 
1 pc. 1/4" x 3%" x 1" 
1.6 
200 
5 
11 
84 
1.8 
200 
5 
41 
54 
Doughnuts _ 
1 doughnut .. .. 
1.6 
200 
6 
45 
49 
1.8 
200 
6 
26 
68 
Gingerbreads __ 
1 pc. 2" cube _ - 
2.4 
200 
8 
22 
70 
1 pc. l%" x 1%" x 3J#' 
2.0 
200 
8 
32 
60 
2.7 
150 
6 
33 
61 
.9 
100 
11 
19 
70 
■Icing, “White Mountain” 
.5 
60 
1 
99 
Sugars and Syrups 
Maple syrup __ 
1 Yi tbsp 
1.2 
100 
100 
1.2 
100 
3 
97 
Sugar, white, granulated 
2 tbsp. (scant) 
.9 
100 
100 
.9 
100 
100 
Sugar j brown.. 
2 tbsp 
.9 
100 
100 COMMISSARY SUPERVISION 
821 
Table of Foods Usually Found on Naval Hospital Menus, Etc.—Continued 
Cereals 
Note.—Add 100 calories to caloric value of any cereal given to allow for milk (4 oz.) and sugar 
(2 tsp.) it served. 
Ounces 
Calo- 
ries 
Pro- 
tein 
Fat 
Car- 
bohy- 
drate 
Cornflakes.. . ... 
1 cup _ _. _ 
0.8 
80 
6 
4 
90 
Cornmeal, cooked. ... 
6.0 
100 
10 
5 
85 
Farina. 
6.0 
100 
12 
4 
84 
Qrapenuts 
3 tbsp 
1.0 
100 
12 
2 
86 
Hominy grits, cooked . . 
6.8 
100 
9 
1 
90 
Macaronf, cooked 
5 2 
100 
15 
2 
83 
Macaroni croquette.. . 
1.2 
100 
10 
45 
45 
Macaroni, tomato sauce. 
3.6 
100 
10 
36 
54 
Oatmeal, cooked.. 
1 cup .. 
7.9 
100 
17 
16 
67 
Puffed Bice _ 
1.0 
100 
9 
1 
90 
Puffed Wheat 
1.0 
100 
15 
3 
82 
Rice, steamed. . __ ... 
4.0 
100 
9 
1 
90 
Shredded Wheat 
.9 
100 
13 
5 
82 
Puddings, Ice Creams, Etc. 
Apple tapioca 
7.2 
200 
1 
1 
98 
Boiled custard 
6.6 
300 
13 
44 
43 
Brown Betty 
5.0 
250 
3 
35 
62 
Bread pudding, raisin __ 
'Yi cup 
5.0 
250 
Cornstarch, blanc mange- 
6.4 
200 
8 
33 
' 59 
Cottage pudding - ~ 
1.1 
100 
7 
26 
67 
Custard pudding 
6.6 
200 
17 
39 
44 
Lemon ice_ 
3.1 
100 
100 
Lemon jelly 
3.8 
100 
9 
91 
Lemon milk sherbet _ 
3.8 
200 
4 
12 
84 
3.0 
180 
4 
51 
45 
Prune souffle-. - 
Y cup . 
2.2 
125 
10 
90 
Raspberry sherbet 
4.2 
200 
1 
99 
2.0 
120 
12 
27 
61 
2.2 
100 
10 
90 
Vanilla ice cream (1 qt. 20 per 
K qt" 
3.2 
200 
4 
63 
33 
cent cream; % cup sugar; V/t 
tbsp. vanilla extract). 
Butter. ... 
Ho lb 
0.8 
160 
1 
99 
Cheese, American, full cream. 
i pc. 2" x 1" x Yi" 
.9 
100 
25 
72 
3 
1.2 
40 
76 
9 
15 
.25 
25 
5 
86 
9 
Cream, 40 per cent.. 
1 tbsp. . 
.7 
75 
2 
95 
3 
.45 
50 
2 
95 
3 
.7 
65 
11 
23 
66 
.5 
25 
23 
51 
28 
Milk, fresh 
1 cup 
8.1 
160 
19 
52 
29 
Dairy Products 
Eggs and Cheese Dishes 
4.0 
150 
36 
64 
4.2 
200 
20 
76 
4 
2.1 
100 
17 
39 
44 
Welsh rarebit 
3 tbsp. rarebit and 1 si. toast-. 
2.6 
200 
22 
57 
21 
Apple, baked, with 2 tbsp. 
1 med. sized apple 
3.5 
150 
1 
3 
96 
suear. 
Apple, baked, with cream 
1 med. sized apple 
5.0 
200 
1 
31 
68 
5.0 
65 
3 
6 
92 
3.5 
100 
1 
3 
96 
3 Ige. halves with 2 tbsp. 
juice. 
4.8 
100 
5 
95 
2.7 
100 
4 
2 
94 
4.5 
80 
5 
6 
89 
12.2 
200 
9 
16 
76 
Blackberries, stewed 
Vi cup 
4.4 
200 
2 
4 
94 
9.0 
50 
6 
94 
1.5 
100 
1 
99 
Cranberry sauce 
Vt. cup 
1.5 
100 
1 
99 
Fruits 822 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Table of Foods Usually Found on Naval Hospital Menus, Em—Continued 
Fruits—Continued 
Ounces 
Calo- 
ries 
Pro- 
tein 
Fat 
Car- 
bohy- 
drate 
6. 0 
80 
yi cup 
3.5 
100 
100 
4.9 
100 
6 
15 
80 
3. 7 
100 
5 
15 
80 
4. 7 
100 
3 
7 
90 
3.8 
35 
9 
15 
76 
.8 
50 
1 
83 
16 
9. 5 
100 
7 
2 
91 
10. 5 
100 
6 
3 
91 
Peaches, canned ... ... 
2 Ige. halves and 3 tbsp. juice.. 
7.5 
100 
6 
2 
92 
3. 5 
100 
2 
98 
6.3 
100 
4 
6 
93 
Pears, canned . _. 
2 halves and 2 tbsp. juice - 
3.0 
65 
2 
4 
94 
2. 3 
100 
1 
4 
95 
4. 1 
50 
4 
6 
90 
2.2 
50 
6 
95 
4 prunes and 4 tbsp. juice 
5.6 
200 
2 
98 
1.1 
100 
3 
9 
88 
5.0 
90 
10 
14 
76 
1.7 
100 
1 
2 
97 
6.6 
75 
10 
14 
76 
Watermelon, edible portion... 
Large portion 
11.7 
100 
5 
6 
89 
3.0 
100 
53 
47 
tent). 
2.3 
100 
20 
62 
18 
Beef, hamburger steak, broiled- 
2 "cakes, 2W dia. x %" thick. 
4.0 
200 
55 
45 
2.0 
200 
21 
68 
11 
3.0 
200 
40 
60 
6.8 
400 
10 
43 
47 
1 si. 5" x 5" x W' --- 
3.2 
200 
46 
54 
3.3 
150 
90 
10 
3.3 
200 
62 
38 
4.0 
200 
48 
52 
4.0 
300 
31 
69 
7.5 
250 
16 
45 
39 
2.2 
200 
31 
67 
2 
Lamb chops, broiled .. 
2 chops, meat portion, 2" x 2" 
3.8 
200 
40 
60 
x y2". 
Lamb, leg, roast 
3.6 
200 
41 
59 
1 si. 3" x 3H"'x Vi" 
3.6 
300 
33 
67 
Pork (bacon) ... 
.5 
100 
13 
87 
2.6 
200 
29 
71 
Pork, loin, roast 
4.0 
300 
33 
67 
4.0 
250 
33 
67 
Pork sausage, broiled 
3 sausages, 3" long, %" dia 
2.2 
200 
20 
78 
2 
Poultry: 
l/i of av. lb. broiler. 
3.2 
100 
80 
20 
4.0 
250 
51 
49 
4.0 
340 
40 
60 
1.6 
200 
9 
48 
43 
Veal cutlets, breaded 
5.0 
250 
30 
52 
18 
5.0 
250 
71 
29 
4.2 
200 
47 
53 
450 
12.0 
350 
60 per cent potatoes. 
Meats, Cooked 
Blueflsh 
3.8 
150 
72 
28 
3. 4 
200 
14 
65 
21 
Codfish, creamed- - 
cup -- _ 
2.5 
100 
32 
46 
22 
Halibut steak, broiled--- - _ 
1 pc. 3" x 2W' x 1" 
3.0 
100 
61 
39 
Mackerel, Spanish, broiled 
1 serving 
3.9 
150 
56 
44 
Salmon, canned . 
cup __ _ _ 
2.0 
125 
45 
55 
Salmon, creamed, on toast, 
cup salmon and 1 si. toast-. 
4.8 
200 
22 
42 
36 
Salmon, loaf . 
4, 2 
200 
37 
52 
11 
Sardines, canned 
1. 7 
100 
46 
54 
Clams, _ 
7.6 
100 
56 
8 
36 
Lobster, canned - 
Yt cup . . - 
2.8 
65 
86 
12 
2 
Oystersl 
7.2 
100 
49 
24 
27 
Shrimp 
3. 2 
100 
91 
8 
1 
Fish and Shellfish COMMISSARY SUPERVISION 
823 
Table of Foods Usually Found on Naval Hospital Menus, Etc.—Continued 
Pies 
Apple- 
4. 8 
300 
3 
41 
56 
Cranberry 
4. 8 
340 
2 
18 
80 
4. 3 
225 
9 
32 
59 
4. 5 
450 
5 
27 
68 
Mince 
K of a 9" pie_ 
5. 4 
450 
8 
39 
53 
4. 5 
450 
3 
27 
70 
5.0 
300 
5 
18 
77 
Squash- 
4. 0 
225 
10 
25 
65 
4. 0 
200 
10 
25 
65 
Banana salad 
1 serving 
4.0 
150 
12 
36 
52 
1.4 
50 
6 
78 
16 
33 
2 
Cheese and pineapple salad... 
Chicken salad .. 
1 serving 
3. 4 
200 
9 
58 
1 serving 
3.2 
200 
12 
86 
Egg salad. 
1 serving 
3.5 
250 
14 
85 
I 
French dressing 
1 Yi tbsp . ... 
.6 
100 
100 
Fruit salad - _ I 
Yi cup and 1 tbsp. dressing 
1 serving 
3.0 
200 
3 
75 
22 
Lettuce salad with French 
2.4 
200 
1 
95 
4 
dressing. 
1 tbsp... 
.5 
100 
1 
97 
2 
3.4 
200 
3 
68 
29 
15 
1 serving 
3.0 
150 
4 
81 
6.4 
200 
3 
86 
11 
1 serving 
3.0 
250 
4 
76 
20 
Salads and Dressings 
Soups 
8.0 
100 
17 
56 
27 
1 cup 
8.0 
25 
84 
8 
g 
7. 2 
200 
11 
61 
28 
1 cup 
7.8 
200 
12 
38 
60 
1 cup . 
7.8 
150 
16 
46 
38 
1 cup .. 
9. 0 
200 
16 
63 
21 
1 cup 
8. 5 
200 
15 
38 
47 
1 cup 
10.0 
250 
26 
2 
72 
1 cup 
9. 0 
135 
12 
12 
76 
Tomato, cream of. 
1 cup 
8.5 
260 
11 
63 
26 
4.0 
25 
32 
8 
60 
8.0 
300 
21 
18 
61 
4.9 
100 
26 
18 
56 
1.0 
100 
26 
5 
69 
1 cup'.. . 
3.6 
45 
22 
7 
71 
2.0 
25 
14 
2 
84 
1 cup ... _ _ 
2.0 
20 
20 
9 
71 
2.0 
20 
10 
5 
85 
2.0 
20 
23 
15 
62 
1.0 
6 
24 
5 
71 
3.4 
100 
16 
41 
43 
3.6 
100 
11 
11 
78 
9.0 
100 
12 
9' 
79 
Yi cucumber, 7" long 
2.4 
10 
19 
12 
69 
1.0 
6 
25 
14 
61 
2.0 
25 
13 
6 
81 
3.0 
60 
2.5 
100 
8 
59 
33 
3.0 
65 
26 
3 
71 
Peas, creamed _ 
2.7 
100 
18 
37 
45 
Peppers, stuffed, meat and 
1 pepper. 
6.0 
250 
11 
21 
68 
bread crumbs. 
Potatoes, sweet, baked-.. 
1 medium 
6.0 
200 
6 
5 
89 
sweet, candied 
4.0 
200 
4 
7 
89 
Potatoes, white, baked 
1 large 
5.0 
166 
11 
1 
88 
Potatoes, white, boiled. 
5.4 
150 
11 
1 
88 
white, creamed 
5.4 
200 
9 
60 
41 
Potatoes, white, mashed. 
6.0 
200 
7 
48 
45 
Potatoes, white, escalloped 
Ya cup 
3.5 
100 
9 
30 
61 
Potatoes, white, fried ... .. 
5.0 
200 
Radishes, red, turnip.. . 
6 medium 
2.0 
16 
18 
3 
79 
8.0 
40 
12 
8 
80 
7.6 
100 
10 
70 
20 
5.3 
150 
15 
9 
76 
Tomatoes, canned 
4.4 
30 
21 
8 
71 
Tomatoes, fresh .. 
5.0 
35 
16 
16 
68 
Tomatoes, stuffed 
4.0 
100 
13 
45 
42 
Turnips, creamed 
Kcup 
1.4 
100 
13 
5 
82 
Vegetables 824 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Table of Foods Usually Found on Naval Hospital Menus, Etc.—Continued 
Miscellaneous 
Ounces 
Calo- 
ries 
Pro- 
tein 
Fat 
Car- 
bohy- 
drate 
1 serving (estimated)--, - 
1.0 
200 
10 
82 
8 
Coconut, prepared-.. 
Hcup I 
.6 
100 
4 
77 
19 
Peanut butter 
2XA tsp 
.6 
100 
19 
69 
12 
Sample Winter Menu fob the General Mess, Showing Approximate Caloric 
Values of the Items 
Breakfast 
Dinner 
Supper 
Corn flakes and milk 
180 
Roast loin of pork 
303 
Boston baked beans 
300 
fcH 
Hamburger steak- _ 
200 
Boiled sweetpotatoes.. 
203 
French-fried potatoes 
150 
<1 
Baked potatoes - - 
165 
Fresh apple sauce 
100 
Fruit salad— 
200 
55 
Corn bread and butter, _ 
360 
String bean and lettuce 
Brown bread and butter 
260 
O 
Coffee 
salad 
100 
Tea and milk, 
160 
”905 
Pumpkin pie ------ 
200 
1,070 
Bread, butter, coffee 
260 
1,160 
Baked apples and cream 
200 
Porterhouse steak, gravy,. 
300 
Oyster stew, ... 
200 
Pork sausage. 
200 
Fried onions,., 
60 
Crackers 
100 
◄ 
Griddlo cakes 
100 
Mashed potatoes, 
200 
Cold sliced meats ,,, 
200 
00 
Maple syrup,, 
100 
Celery 
Potato salad 
200 
W 
Bread, butter, coffee 
260 
Custard pudding ... 
200 
Spiced pears , , , 
100 
~860 
Bread, butter, coffee.-. 
260 
1,020 
Bread and butter 
Cocoa _ 
260 
250 
1,310 
{H 
Shredded wheat and 
Cream of tomato soup,., - 
260 
Meat croquettes 
250 
Q 
milk _ .. __ 
200 
Roast lamb, mint sauce, _ 
200 
Creole rice 
100 
oo 
Fried eggs, .. 
150 
Roast brown potatoes 
165 
Cabbage salad 
50 
55 
Fried bacon, _ _ , , 
100 
Stewed canned peas,. 
65 
Brown Betty pudding,. 
250 
Q 
Hot rolls and butter, _ 
260 
Lemon sherbet .. 
100 
Bread, butter, tea 
260 
6s 
Coffee , , 
Bread, butter, coffee _ , 
260 
910 
710 
1,050 
Oranges , 
100 
Chicken potpie__ 
300 
Pork chops 
300 
tH 
Creamed chipped beef on 
Baked sweetpotatoes, 
200 
Cottage fried potatoes,,_ 
150 
d 
toast 
300 
Baked squash 
100 
Combination salad 
200 
« 
Fried potatoes 
120 
Fruited rice pudding,, , 
120 
Stewed apricots with 
& 
n 
Coffee , , ,, ,, 
Bread, butter, coffee 
260 
raisins 
Bread and butter 
100 
260 
520 
980 
Tea and milk 
160 
1,170 
Rolled oats and milk 
200 
Bean soup 
250 
Clam chowder 
225 
Fresh meat hash 
200 
Boiled fresh salmon 
150 
Baked macaroni and 
5* 
Soft boiled eggs 
75 
Hollandaise sauce 
50 
cheese ,,. 
200 
Hot rolls and butter 
260 
Mashed potatoes.,, 
200 
Asparagus salad... 
200 
s 
Coffee.. 
Esoalloped tomatoes 
Fresh apple pie, cheese 
100 
300 
Dill pickles. 
Ginger bread 
200 
735 
Bread, butter, coffee 
260 
1,310 
Bread and butter 
Cocoa ... 
260 
250 
1,335 
5h 
Puffed wheat and milk,. 
200 
Pot roast of beef 
200 
Codfish cakes 
200 
< 
Eroded pork sausage 
200 
Brown gravy 
50 
Tomato sauce 
50 
s 
Creamed potatoes,.. 
200 
Boiled potatoes 
150 
Spinach with egg 
100 
I-) 
H 
Bread, butter, coffee 
260 
Creamed turnips 
Bread custard with raisins 
100 
260 
Bananas 
Bread, butter, tea 
100 
860 
260 
Bread, butter, coffee 
260 
1,020 
710 
Grapefruit 
80 
Asparagus soup.. 
125 
Shrimp salad 
150 
Broiled ham 
200 
Roast chicken 
250 
Creamed potatoes 
200 
>< 
Scrambled eggs 
203 
Mashed potatoes 
200 
American cheese 
100 
■*< 
Hot rolls and butter 
260 
Sage dressing 
200 
Sliced pineapple 
100 
g 
Coffee 
Cranberry sauce, 
Celery and olives ,,. 
100 
50 
Raisin loaf cake ... 
Bread and butter, ... 
150 
260 
£ 
740 
Vanilla ice cream 
200 
Cocoa 
250 
Bread, butter, coffee 
260 
1,210 
1,385 825 
COMMISSARY SUPERVISION 
When the caloric values are totaled by days, allowing 600 calories each day 
for incidental articles of food used in cooking and flavoring, such as sugar and 
milk in the coffee and tea, flour and cornstarch used by the cooks as “thickening,” 
etc., it will be found that the menu given will total as follows: 
Monday 1 3, 735 
Tuesday 3, 790 
Wednesday 3, 270 
Thursday 3, 270 
Friday 3, 980 
Saturday 3, 190 
Sunday ' 3, 953 
Average for 1 day 3, 598 
In order to show the approximate amounts of the various nonstock items to 
order for a menu, the following list is suggested, based on a complement of 400 
rations: 
Amount: Delivery day 
600 pounds beef in sides (2 sides) Monday. 
300 pounds loins of beef Monday. 
300 pounds loins of pork Saturday before. 
250 pounds of fowl, dressed and drawn Wednesday. 
300 pounds of chicken, dressed and drawn Saturday. 
400 pounds of lamb, carcasses Tuesday. 
150 pounds salmon Thursday. 
10 gallons clams Friday, a. m. 
10 gallons oysters Tuesday, a. m. 
40 pounds codfish, shredded Friday. 
150 pounds pumpkins Saturday before. 
5 pounds mint Tuesday. 
200 pounds squash Wednesday. 
150 pounds turnips Friday. 
60 pounds cake Saturday. 
No estimates will be given for the remaining items of food on the menu, as they 
all are items which should be carried as stock items, and sufficient amounts of 
them should be in store at all times to meet ordinary demands. 
The two sides of beef should be cut up and used as follows; 
2 rounds .1 
2 sirloin butts 
2 chucks 
2 shoulder clods j 
Use as pot roast for Saturday dinner. 
2 loins . Use as beefsteaks for Tuesday dinner. 
2 eight-rib cuts Use as cold sliced meats for Tuesday 
supper. 
The briskets, cross ribs, plates, navels, rumps, and flanks remaining can be 
used as hamburger steak on Monday. The two loins of beef trimmed out of the 
two sides may be added to the 300 pounds of loins ordered for Monday and cut 
up into steaks for the Tuesday dinner. The lamb carcasses should be cut up 
into legs, shoulders, racks, and loins. The legs and shoulders to be used as 
roast lamb for Wednesday and the loins and racks saved for issue to the special 
diets as lamb chops. There will be sufficient meats left over during the week to 
provide left-over meats from which to make the croquettes Wednesday and 
fresh-meat hash on Friday. 
An important measure in the economical use of provisions is the proper cut- 
ting of meats. The description of meat cutting which follows is based on the 
instructions contained in the Navy training course for preparation for the rating 
of chief commissary steward. 
Meat Cutting.—The fore quarter of beef consists of six major parts, namely : 
Prime ribs, chuck, plate, brisket, foreshank, and neck. Before dividing a fore 
quarter of beef the meat cutter removes the skirt steak by cutting at either end, 
pulling the steak toward him and keeping the knife close to the ribs as he cuts. 826 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Dividing fore quarter.—First separate the fore quarter into two parts, one 
consisting of the prime ribs and chuck and the other consisting of the plate, 
brisl&t, shoulder clod, and shank. This cut is a long one, extending from the 
BEEF CHART 
WHOLESALE AND RETAIL CUTS 
(T) HIND SHANK 
I TO 3 SOUP BONES 
4-HOCK 
Z ROUND 
ITO 14 ROUND STEAKS 
15 HEEL OF ROUND 
3 RUMP 
STEAKS on ROASTS 
4 LOIN END 
I TO 6 SIRLOIN STEAKS 
6 FLANK 
1- STEAK 
2- OR HAMBURGER 
5 SHORT LOIN 
Ito3 CLUB or OELMONICO 
STEAKS 
4 to M PORTERHOUSE 
STEAKS 
12 PLATE 
I -STEWS OR BONED AND 
ROLLED ROASTS 
2-SHORT RIBS 
7 RIB 
I TO 4 RIB ROASTS 
5 SHORT RIBS 
II BRISKET 
I-STEW'S OR BONED AND 
ROLLED ROASTS 
8 TRIMMED CHUCK 
I * 2 BOTTOM CHUCK ROASTS 
3 & 4 TOP CHUCK ROASTS 
5to7 CHUCK RI8 ROASTS 
10 FORE SHANK 
I TO3 SOUP BONES 
4-SHOULDER CLOD 
(9) NECK 
(-BONELESS ROASTS 
STEWS on HAMBURGER 
Numerals m circles Q refer to wholesale cuts and major subdivisions of 
such cuts. Other numero/s refer to retail cuts 
WHOLESALE CUTS AND SUBDIVISIONS 
ALL PERCENTAGES BASED ON CARCASS WEIGHT 
<T)to© H I N UQUARTER 48.0% 
©to©ROUND AND HUMP 24.0 
® HIND SHANK 4.0% 
S BUTTOCK 15,0 
RUMP . ,5.0 
@S/§) TULL LOIN INC. SUET 20.5 
@ LOIN END . 7.0 
©SHORT LOIN 10.5 
KIDNEY KNOB 3.0 
©FLANK 3.5 
(7) TO @ FOREQUARTER . 52.0V. 
@RIB 9.5 
(§)&(§) CHUCK .22.0 
©TRIMMED CHUCK .. 17.OV. 
(g) NECK 5.0 
§ TORE SHANK S.S 
(ip BRISKET 6.5 
@ PLATE.. 8.5 
Piguke 154.—Cuts of beef. (U. S. Department of Agriculture Department Circular 300, 
March 1924, plate I.) 
first rib of the fore quarter through to the socket joint of the shoulder. First 
point off the proper distance on this rib about 10 inches from close under the 
chine or backbone. This gives the point where the cut must begin, and also 
insures sufficient length to the rib to make rolled prime rib roast. Before mak- 827 
COMMISSARY SUPERVISION 
ing this long cut be sure to locate the top of the shoulder knuckle joint, which 
is easily done in chilled beef by using the shank for leverage. After this cut 
is completed the socket bone on the chuck side should not protrude beyond the 
cut surface, as more meat would be left on the brisket than is desired. Begin 
cutting at the point which has been marked off on the first rib and cut straight 
to a point where the meat of the ribs is thicker, and then angle from this point 
through the top of the shoulder knuckle joint, which completes the cut. 
Separating shoulder clod and shank from brisket and plate.—In making this 
separation care should be exercised that this cut is so made as to leave on the 
clod all meat that properly belongs to it. Begin cutting where meat of the clod 
is flattened at the short-rib end of the brisket and cut to the depth of about 1 
inch, where a guide is located. Then raise the shank, which affords a leverage 
that assists in striking the other guide under the shoulder. Next pull upward 
and cut directly under the bone, following the second guide closely to the first 
guide, and finally cut forward, separating the clod from the brisket. 
Separating shank from shoulder clod, boning shank.—Place the shoulder clod 
on end upon the block with shank pointing upward. A piece of meat weighing 
about 1 pound which contains no sinews and lies on the front part of shank 
must be removed from the shank by following the natural separations between 
muscles, leaving it attached to the clod. Begin cutting at the top of the shin, 
following the separation between tissues and hard bone to the completion of this 
cut where the knife will touch the ends of bones which are peculiarly shaped 
at the joint and difficult to unjoint on account of heavy tendons. 
Boning shoulder clod.—Begin cutting at the knuckle joint on the inside of 
the shoulder on “top of bone,” following the line of the center of the bone 
downward to the other end. Remove from the bone, by a sort of skinning process, 
the soft tissue to which the muscles are attached. This entirely separates the 
bone from the meat. 
Dividing plate from brisket.—Raise the plate and brisket on end with a full 
view of the ends of the ribs. Count off six ribs by tapping the ends with the 
back of the knife, then cut directly between sixth and seventh ribs from above 
downward, which will make it possible to cut through the bones of this part 
with the knife. 
Boning plate and brisket.—First remove, by pulling, all the skinny tissues 
from the thoracic surface just over the breast bones. Then cut through tissue 
on the inside at the center of the ribs. Next insert the knife between the 
tissues and bone at the top of ribs, the meat cutter pulling the bones toward him 
and cutting at the same time, thus separating them from the meat. This oper- 
ation removes the ribs. A small piece of meat which lies in the thoracic 
cavity near the lower end of ribs must be removed before boning the plate and 
brisket. The small bones of the plate and brisket can best be removed by 
inserting the knife close to the bones and by closely following their outline 
while cutting. When all hard fat and cartilaginous tissue has been removed 
from the muscles the boning of plate and brisket is complete. 
Dividing ribs, chuck, and neck piece.—Set the major cut rib and major cut 
chuck upright on chine bone with ribs toward the meat cutter. Count off six 
ribs by tapping the ends with the back of the knife. Cut directly between the 
sixth and seventh ribs as counted, leaving an equal amount of meat on both 
ribs. Remove the neck piece from the chuck, cutting close to the socket bone 
of the shoulder. Do not cut so close as to leave bone exposed. There should 
be about an inch of muscle tissue covering the joint bone on the cut side. In 
removing the neck piece, be careful that chuck is squared. Then hone the 
neck piece. 
154294°—39 53 828 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Boning prime ribs.—First remove the fat that lies exposed on or between 
ribs before this part is boned. Next saw off the chine bone along the line of 
the spinal canal. Raise the sawed end of the spine bones and cut all tissue 
attachments and remove the six spines together. Then remove the piece of 
“flax” or neck ligament just above the tip of each spine. Finally remove the 
ribs, being careful that no meat is left on the bones. 
Dividing chuck into upper chuck and lower chuck.—Set up the chuck on the 
chine bone and divide it part way by forcing the hand downward in the guide, 
which is the natural separation between the heavy muscles of the chuck. Then 
cut directly under the shoulder blade from the prime rib end. Next cut through 
the remaining attached muscles, leaving an equal amount of meat on the upper 
and lower chuck. 
Boning upper chuck.—Cut directly from the knuckle joint through the center 
of the meat on the shoulder blade on the inside of the exposed meat surface. Fol- 
low the shoulder bone closely, ascertaining that the meat which lies next to the 
bone is pulled from the knuckle joint downward along the shoulder blade. No 
meat will be left on the bone if this instruction is followed. When boning the 
other side, be careful at the point where the shoulder blade runs close to the skin 
muscles, as a soft tissue or cartilage is present at the top of this bone, where 
the knife is apt to cut through and render this part useless for roasting. 
Boning lower chuck.—First remove the muscles which lie just beneath the 
vertebrae inside the thoracic cavity, for if cut through when boning this meat 
will be partially wasted. Then remove separately the three neck or cervical ver- 
tebrae of the chuck. The vertebrae bones must be closely followed while cutting 
so there will be few ragged edges. Next start from the other end of the chuck, 
removing the ribs and backbone. 
The hind quarter of beef consists of four major parts, namely: Round, loin, 
flank, and shank. Before dividing it a hind quarter of beef is suspended from a 
beef hook and the first operation in cutting is the removal of the flank. 
Dividing and honing hind quarter.—Start cutting just above the cod fat and 
cut downward to a point within a few inches of the hip bone. From this point 
cut straight downward for the entire distance, squaring off the short loin and 
leaving just enough meat on this end of the loin so that it can be rolled with the 
tenderloin included. 
Preparing the flank.—The muscles which lie on the inside of the flank below 
the cod fat must be removed and used for steak or Hamburg. These form what 
is known as the inside flank, and all other meaty or muscular portions are 
known as the outside flank. All connective or skinny tissue and hard fat 
should be removed. 
Removing the loin and top sirloin from the round.—Start at the top of knuckle 
joint on the round and cut through the hard piece of fat into the joint so that a 
finger can be put through for leverage. Follow the same on outside of the round 
directly downward to the socket joint at the lower end of the round. On the 
inside of the round, cut from the knuckle joint to the center of the round bone, 
which can best be detected by sounding with the point of the knife. Then cut 
downward along this bone to the socket joint. Next cut between the tissue and 
bone at the bottom of the knuckle joint, pulling the top sirloin downward and 
separating it from the round, and leaving it attached to the loin. Finally, cut 
from the socket joint through to a few inches below the point where the tail was 
removed, squaring off the loin. Use a saw to cut through the end of che socket 
bone and sacral vertebrae, which are called tail bones. 
Removing top sirloin from loin.—Place the loin on the block and cut the top 
sirloin from the loin at point where the socket bone was removed, cutting at au 829 
COMMISSARY SUPERVISION 
angle, so that when the top sirloin is placed base downward on block It will be 
set up straight. Remove the knuckle bone at end of the top sirloin. 
Dividing short loin from sirloin, and honing these parts.—The first operation 
is to remove all the suet from the entire loin. Next remove the tenderloin; then 
cut the loin into two parts, separating the short loin from the sirloin by cutting 
just in front of the hip bone. To bone the short loin, first saw off chine bone, 
following the line of the spinal canal. Next insert the knife beneath the sawed 
end of T-bones and the tissues, and remove each bone separately by pulling while 
cutting. To bone the hip or sirloin, first remove the one T-bone on the short loin 
end; then insert the knife between the hip bone and tissues, cutting along the 
bone very carefully, as it is peculiarly shaped and difficult to follow. 
Removing round from shank and large hone of the round.—Cut through tendon 
above the “horseshoe,” which is a part of the round lying next to the shank, in 
which sinews or heavy tendons are found, and follow the guide downward. Cut 
a small hole in the horseshoe in which to insert the finger for leverage. This 
will make it possible, with the aid of a knife, to pull muscles, termed “horse- 
shoe” from the shank. Next remove the meat from the long bone of the round 
by cutting downward, exercising care to cut beneath the tissues which are firmly 
attached to this bone and place the round on the block. 
Subdividing and honing round.—The amount of meat termed “horseshoe” 
to be removed depends upon the quality of the carcass being cut. If it is of a 
good corn-fed steer very little “horseshoe” should be removed, but if it is a 
western or Texas carcass, sufficient “horseshoe” should be removed so that no 
tendinous and sinewy portions are left on the round. Place the meat on the block 
and remove more of the upper part of the round than of the lower part when 
removing “horseshoe” but cutting from the posterior side of the round forward 
at an angle to where the knuckle joint was removed. Next, remove fat and the 
piece of meat exposed on the aitchbone; then insert knife between the aitchbone 
and the muscle tissues and follow the outline of the bone closely, removing this 
bone and the tail of the rump in this operation. Always sew the rump in with 
the round. 
Boning shank on block.—Begin cutting at the top of the bone on either side, 
cutting beneath tendon and tissue, and follow the seams downward. This will 
enable the cutter to remove all the meat from the bone in one piece. 
The foregoing operations result in a division of beef as follows: Boned meat; 
suet; and bones. 
Boned meat should be used as follows: 
Roasts 
Steaks 
Boiled 
Corned 
Stew 
Prime rib. 
Loin. 
Shoulder. 
Brisket. 
Brisket. 
Loin. 
Round. 
Brisket. 
Plate. 
Plate. 
Round. 
Prime rib. 
Plate. 
Flank. 
Flank. 
Rump. 
Rump. 
Plank. 
Rump. 
Neck. 
Chuck. 
Clod. 
Shank. 
Shoulder. 
Shank. 
Shoulder. 
Chuck. 
Neck. 
Clod. 
Shoulder. 
Brisket. 
' 
Boned meat for roasts should be rolled and tied. 
For hash, croquettes, salads, hamburger, steak, etc., use the same cuts that 
would be used for stews or boiled beef. Of course, any parts of the carcass 
may be used for these purposes, if necessary, but the foregoing table should 
be followed, as it provides for the most economical use of the entire carcass. 
All lean meat trimmings should be utilized for chopped beef and none wasted. 
Do not use an excessive amount of fat in chopped beef or Hamburg steak. 830 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Tainted meat must not be used for any purpose. In cutting steaks always use 
the hind quarters if available; never the fore quarters. 
Suet will be considered as including that fat which was removed during 
the dividing and boning, previously indicated. It includes the loin, pelvic, and 
cod fat. Kidney fats will be handled with other fats. All fats should be 
saved for grease and soap making. Be careful of this material; it is a money 
saver. 
VEAL CHART 
WHOLESALE CUTS 
RETAIL CUTS 
(I) LEO 
I TO 12 CUTLETS 
IS-ROAST 
I A - SHANK (STEW) 
vj) and (2HIND SADDLE 
8 LEG 
LOIN 
(2) LOIN 
I to IS LOIN AND 
KIDNEY CHOPS 
(f) HOTEL RACK 
(TOIL- rib chops 
@ anu @ FORE SADDLE 
(g) HOTEL RACK 
(g) CHUCK 
@ CHUCK Inc/uding 
shoafc/er, neck and breast 
1-STEW 
a "ROASTS 
Numerals m circles Qrefer to wholesale cuts Other numerals 
refer to retail cuts 
®AND CD HIND SADDLE 
® LEGS - AO% 
@ LOIN - 9% 
YIELDS OF WHOLESALE CUTS AND SUBDIVISIONS 
S3) AND @ fore; SADDLE-51 % 
(g) HOTEL RACK- 6.5% 
® CHUCK - 4A.5% 
Figure 155.—Cuts of veal. (U. S. Department of Agriculture Department Circular 300, 
March 1924, plate II.) 
Bones make material for the stock pot. Proper attention to the directions 
for cutting and boning will result in clean bones. There will, however, be 
particles of meat remaining on some bones, the quantity depending on the 
thoroughness with which directions for boning are carried out. All this ma- 
terial should go into the stock pot, keeping it in the chill room until needed 
if necessary. 
Veal.—In general, the directions given for dividing the major cuts of beef can 
be applied to veal. The amount of veal allowed is limited to 5 per cent of COMMISSARY SUPERVISION 
831 
the total fresh meat used plus any part of the 5 per cent formerly allotted to 
mutton which is not used in other fresh meats. This limits the use of veal 
to once or twice a week. 
If cutlets or steaks are used, the hind quarters should be boned and sliced 
in pieces of about 6 ounces. When necessary, in order to obtain enough meat 
LAMB CHART 
WHOLESALE CUTS 
RETAIL CUTS 
® (2)and(§)HIND SADDLE 
§LEG 
LOIN 
PLANK 
©LEG 
ITO A CHOPS 
7-ROAST 
©LOIN 
I to 13 LOIN AND KIDNEY 
CHOPS OR ROAST 
CD® and(5) FORESADDLE 
@HOTELRACK 
©CHUCK 
©BREAST 
©hotel rack 
IT0I3 RIBORFBENCH CHOPS 
©CHUCK 
I -BOASTS AND STEWS 
(|)BREAST 
l-STEWS OR BONED AND 
) ROLLED ROASTS 
©FLAN K 
l-STEWS 
CHUCKS & BREASTS HOTEL RACK 
LOINS 
LEGS 
Numera/s In circles Q) refer to wholesale cuts. Other numerals 
refer to reta/V cuts 
PER CENT OP CARCASS 
®@a.© HIND SADDLE 50.0% 
@ @ & © FORE SADDLE 50.0% 
Yl ELDS OF WHOLESALE CUTS 
SUBDIVISIONS - PER CENT OF CARCASS 
® LEGS 33.0% 
@ & ® LOIN AND PLANK 17.0 
@ HOTEL RACK 12.0 
@ CHUCK INC. NECK.. .23.5 
(§) BREAST INC. SHANK IA.5 
Figure 156.—Cuts of lamb. (U. S. Department of Agriculture Department Circular 300, 
March 1924, plate III.) 
for a meal, ribs and chuck may be used from the fore quarter, but the menu 
is generally arranged so that the less desirable cuts can be put aside and run 
as a stew or fricassee. Boning is not resorted to in veal roasts as in cutlets 
and steaks. The beef cuts that are rolled for roasts are heavier than the cor- 832 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
responding cuts in the veal, which are not of sufficient thickness for rolling. 
Veal, being younger and more delicate than beef, requires less time in de- 
frosting and more care in handling. 
FRESH PORK CHART 
WHOLESALE AND RETAIL CUTS 
WHOLESALE CUTS - PERCENTAGE OF CARCASS 
I - HIND FEET .00% 
2- 19.00 
3- BELLIES 16.50 
4- PORK LOINS 12.75 
5- RIBS** 2.50 
6- RIBS<«sJ 1.50 
. 7-BRISKET 2.25*/. 
8-PICNIC " .50 
9 N.Y. STYLE SHOULDER 16.00 
10-NECK BONES .95 
I 1-PICNIC BUTT 3.02 
12 -JOWL BUTTS (uurmuueo) 3.75 
12 -JOWLBUTTS:W*“' 2.25 */. 
13•• BONELESS BUTT 3.05 
13-BOSTON BUTT 5.20 
14 LOIN BUTT 4.00 
!5 FORE FEET .92 
16 LEAF FAT 3.52 
Figure 157.—Cuts of pork. (U. S. Department of Agriculture Department Circular 300, 
March 1924, plate IV.) 
Pobk cuts.—Hog cuts for regular diets are confined to loins, smoked hams, 
and smoked bacon. The percentage of pork (10 to 15 per cent) allowed under 
fresh meat percentages (loins) will permit running this item about twice a 
week. Ham and bacon are usually high in price and their use will be governed 
both by variety desired and cost at time used. DEATHS AND MEDICOLEGAL MATTERS 
833 
Chicken, fowl, and txjkkey.—An understanding of the fundamental prin- 
ciples underlying the preparation of fowl for cooking and of cutting after 
roasting is necessary in order to serve it attractively and economically. 
When these items of the ration are bought frozen, they are required to be 
dressed—that is, the feathers only are to be removed. When they are delivered 
fresh chilled, they are either dressed or dressed and drawn. “Dressed and 
drawn” requires removal of feathers, heads, and feet, as commercially trimmed 
in the locality where bought and with all entrails, except giblets, removed. 
Gizzard shall be clean and the gall bladder removed from the liver. 
In handling fowl, singeing is necessary to remove down and hairs. Excessive 
pin feathers should be removed with a sharp-pointed knife. While the removal 
of tendons is desirable, it is not considered practicable for larger messes. To 
remove the entrails, make an Incision through the skin below the breastbone 
just large enough to admit the hand. The gizzard, heart, and liver make up 
the giblets. Be careful in removing liver that the gall bladder, lying on the 
right under surface of the liver, is not broken. A little of the bile contained 
in the gall bladder will give a bitter taste to any of the flesh it touches. Be 
sure that the lungs and kidneys are removed. Remove the windpipe, crop, and 
oil bag. Wash by running water through the bird; do not soak it in water. 
Wipe inside and outside, being careful to see that everything has been removed. 
In cutting a bird after cooking, place a fork firmly across breastbone, one 
prong on each side, and cut through the top of the shoulder, close to the 
neck down through the wing joint. A slight sweep of the knife removes the 
wing. Next, remove the leg and thigh by placing the knife between the breast 
and thigh, cutting downward to the joint next the body, bending the leg over 
and cutting oft at the joint. Then divide the leg at the second joint, making 
two pieces, one the leg and the other the thigh. Next, remove the breast by 
cutting in a straight line with a heavy chopping knife from the point where the 
neck and back of bird come together to the end of the breastbone which is half 
way between the point of the breastbone and the tail. Split this cut into two 
rations. Divide the remainder of carcass by removing the first third of the 
back. Serve the remainder and retain the first third for seconds or stock. 
When birds are large, it will be possible to slice breast meat from each side 
of the breast after removing wings and legs instead of serving each side of 
breast as a single ration as is done when birds are small. 
Section 4.—DEATHS AND MEDICOLEGAL MATTERS 
Silence. 
The first rule of conduct for the hospital corpsman is to maintain a close 
guard upon his words and his actions. If he thinks-twice before he speaks and 
then speaks not at all, he often will have cause to congratulate himself upon 
his good judgment. 
Sad experience teaches this lesson in due course of time, or else the indi- 
vidual will find himself no longer connected with medical activities. The young 
man just entering upon a career in the Hospital Corps should try to acquire the 
habit as soon as possible. Moreover, the old saying that actions speak louder 
than words must not be forgotten. Information can be imparted intentionally 
or unintentionally by an appearance of excitement or a shrug of the shoulders 
as clearly as by voice. 
This does not mean that matters are not to be discussed with persons who 
should know them, but it does mean that idle gossip is to he avoided. The 834 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
senior hospital corpsman and the medical officer are entitled to a knowledge 
of everything pertaining to the medical department that comes to the attention 
of the junior hospital corpsman, and all problems should be taken to them. 
Whether the information should go farther is a matter to be left to the judg- 
ment of the medical officer. The hospital corpsman acting alone is responsible 
to the person in charge. 
The very foundation of a successful medical department is based upon con- 
fidence. Those who care for the sick and Injured often have glimpses into the 
innermost thoughts and habits of patients that are denied to others, and it is 
only under such conditions that they can be properly ministered unto. A 
patient should know that he can confide in those caring for him, feeling that 
what he says or does will reach only those who are to help him. The minute 
that he thinks that anyone has abused his confidence the opportunity to aid 
him has been lost and the medical department has been placed under a cloud. 
Hospital corpsmen also must be close-mouthed about other things than pa- 
tients. Extend the habit to cover all the activities of the medical department. 
This is not for the reason that they are so secret, but because the person to whom 
one talks probably will not understand fully. He has not been trained medically 
and is not qualified to pass judgment, and has merely been provided with some- 
thing upon which the imagination can work, and there is no telling where the 
incident will end. This applies not only to sanitary measures or ordinary occur- 
rences, but particularly to accidents occurring in the sick-bay or operating room, 
to deaths from other than natural causes, etc. The medical officer bears the 
responsibility and it is for him to handle the situation. 
The prohibition against talkativeness is to be emphasized especially in con- 
nection with this section. The hospital corpsman, by reason of his duties, comes 
intimately in contact with situations that afford rich material for gossip. Oper- 
ations, deaths, autopsies—all, in time, may become largely matters of routine 
to him, but to others, however, they are unusual, and their details serve to 
gratify a morbid curiosity. The talkative hospital corpsman is always certain 
of a large and attentive audience, but not necessarily one of the highest order 
of intelligence. His story soon becomes entirely distorted as it is passed along. 
But the matter does not end there. He has betrayed a confidence and loses in 
large measure the respect of his fellows. Certainly they will not entrust him 
with their own troubles. The distortion of his tale may bring his department 
into disrepute. His value as a witness is lessened, for he may have said some- 
thing in his enthusiasm as a story-teller that he would not feel justified in 
repeating under oath. He may have handicapped the investigation of some 
criminal act and thereby caused much inconvenience to the course of justice. 
And, last but not least, he may have made public something that, for the good 
of the service, should have been kept quiet. 
So, both by words and bearing, a hospital corpsman must always strive to 
create confidence in the efficiency of the medical department. He should make 
others feel that there they will find competent treatment for their ills and 
solution of their sanitary problems; he should make them feel that he is incom- 
municative, not because he is unsociable, but for the reason that he minds his 
own business. No matter whether things are going right or wrong, a hospital 
corpsman should be calm, close-lipped, cheerful, and efficient. In other words, 
he should live up to the best traditions of the Hospital Corps. 
Property. 
The duties of the hospital corpsman often make him responsible for the prop- 
erty of others, and he will save himself and others much trouble by being very DEATHS AND MEDICOLEGAL MATTERS 
835 
careful. Few things cause as much worry and ill-feeling as an accusation by 
a patient or next of kin that some possession has been lost or stolen. 
The original inventory on the hospital ticket (N. M. S. Form G) is very 
important, as it is the very basis of the transaction, and also because the patient 
may not see all of his property again for days or months or, perhaps, never. 
And, when he does take charge of them again, there must be no question as to 
whether the list is correct. So prepare it carefully, and actually see every item 
that is entered. Do not simply ask the patient what he has and put down what 
he says. 
The patient usually is able to assist with the inventory, but occasionally he 
cannot do so because he is too ill or is insane. Precautions then must be 
doubled and there should be a witness to the inventory. 
In the ward the patient often keeps certain valuables with him, such as a 
watch, jewelry, small change, etc. He should be advised to place them in safe- 
keeping, but usually does not do so. The habit of having a good idea of what 
is in a patient’s possession is an excellent one to develop, for he may claim that 
something is missing, or he may become unconscious, or he may die. Then one 
is in a position to speak authoritatively as to whether everything is on hand 
that should be. (See par. 1762 (c)(7), Manual of the Medical Department, 
U. S. Navy, 1939.) 
Often there is occasion to take charge of personal property, Including valua- 
bles. This occurs upon death, or when a corpse is found, or when a patient for 
some reason can no longer guard his property. Ordinarily it should be done 
immediately, for valuables have a curious habit of soon disappearing. Do not 
wait an hour or so, but see that the property is placed as soon as possible under 
the care of the proper person. {See Manual of the Medical Department, U. S. 
Navy, 1939.) 
Dispensing. 
Matters of life and death are always under the hand of the hospital corpsman. 
This will be novel at first, but soon becomes familiar and tends to be mere 
routine, and the hospital corpsman must closely guard himself against the 
development of such an attitude. He is surrounded by death-dealing agents 
and uses them constantly, and the mistake that results in death or serious 
illness is not merely a sad occurrence, it makes him criminally responsible. 
Every endeavor is made to supply all reasonable means of avoiding mistakes 
in the dispensing of drugs and the use of poisons. The regulations specify 
that the dangerous ones shall be placed in special bottles or kept under lock 
and key so that there may be no mistake. The poison bottle can be recognized 
easily in the light or in the dark. Failure to detect the poison bottle can be due 
only to gross carelessness. 
Hold drugs and chemicals in deep respect, and cultivate at the outset the 
habits of care and precision. Be sure to be wide-awake when using them. In- 
spect the container, read the label, and be certain that it is the one specified by 
the prescription or by instructions. Settle any doubt by inquiry of the proper 
person. Label the containers promptly, and never think that the nature of the 
contents can be guessed when there is no label. Never do any guessing. 
One of the greatest sources of trouble is the care of alcohol and narcotics. 
It is in their care and use that hospital corpsmen are particularly liable to the 
penalties of the law. The Manual of the Medical Department, U. S. Navy, 1939, 
in paragraphs 241, 736, 738, 1621, 1640, and 1672, discusses this subject, and the 
hospital corpsman must be thoroughly familiar with it. The very number of 
references indicates its importance. Article 1145, U. S. Navy Regulations also 
refers to it. 836 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The insane. 
Another situation, in which the hospital corpsman shoulders great responsi- 
bility and is very liable to come in contact with the law, is in the care of the 
insane. The very nature of his calling, naturally, will insure the best of care 
for the patient. But the problem goes deeper. It must be realized that an insane 
person is not responsible for his acts. He is a sick man, and does not think 
in all things in the same manner as those who are well. It is the duty of those 
caring for the insane to protect others who may come in contact with him, and 
also to guard him against himself. 
Usually there is some person who has the responsibility for the welfare of 
the patient, and the instructions for his care will be definite and complete. But 
it is the duty of hospital corpsmen to use their common sense to the utmost. The 
person who is mentally unbalanced is extremely likely to injure himself seriously. 
Keep him under constant observation. Remove articles that are dangerous. 
Do not take any chances. 
A hospital corpsman may have to guard an insane patient while traveling, or 
while he takes exercise on the deck of a ship, or in the grounds of an institution. 
Then one must be trebly careful for he may attack others, or try to escape, or 
attempt to commit suicide. It wall happen unexpectedly and most suddenly, and 
he may avail himself successfully of some opportunity that failed to be consid- 
ered or did not appear to be of importance. Remember that his condition may 
lead him to think or reason in a different manner than a normal person. 
The best procedure is to cultivate the friendship and respect of the patient. 
How to do so is a problem in each case, but usually it can be done, and success 
in handling him will depend upon the ability with which this is done. And 
never forget that he is a sick man; he may make a nuisance of himself or attack 
his attendant, but he is not really responsible. It is a hospital corpsman’s duty to 
control him, but it must be done by as gentle means as possible and without 
losing one’s temper. 
Dying declarations. 
A hospital corpsman may happen sometime to be the one to whom a person 
at death’s door makes a statement of importance; that is, a dying declaration, or 
ante-mortem statement. It may have to do with matters of money, property, 
or some criminal incident. Under any circumstances it is an expression of the 
thoughts and desires of a dying person. In it may lie the clue to the solution 
of some problem of crime. Therefore exercise every care to understand it 
correctly and fully. 
To have full weight in law, however, and to be admissible as evidence before 
a court, the dying declaration must be made and recorded under certain definite 
conditions. Real responsibilities are assumed when circumstances compel one 
to receive such statements. And it is a duty to know how to insure that they 
be of legal value, and to make them so. 
The person making the statement must be convinced that his death is soon 
to occur—he must have no expectation or hope of recovery. The person receiving 
the statement must assure himself that this is his attitude, and also, to the best 
of his ability, as to whether his mind is clear and rational. Then explain to 
him the importance of the statement he is about to make. 
The statement must be voluntary; that is, not forced. Write it in his own 
words as he makes it, and be very careful not to include anything he does not 
say. Never put down what it may seem he should have said. If it can be 
done, have the person swear to his words before proper authority. DEATHS AND MEDICOLEGAL MATTERS 
837 
A declaration made thus will be of value in the eyes of the law, but do not 
hesitate to take any such declaration under any circumstances. Take it in 
writing, and remember which of these conditions has or has not been fulfilled. 
Signs of death. 
All are familiar with the tales of persons being buried alive. Such occurrences 
are rare, and the responsibility probably would never fall upon a hospital corps- 
man. The occasion may arise, however, when timely measures would save life 
that wrongly was supposed to be extinct. The proper equipment of the hospital 
corpsman should, then, include a working knowledge of how to recognize death. 
He then will be in a position to apply first-aid treatment and possibly save a 
life that would have been lost had he erroneously considered the person to be 
dead, and done nothing until the arrival of others. 
The decision as to whether the person is dead ordinarily is made by a medical 
officer. It is only when a hospital corpsman is acting alone that he will be 
obliged to make it. 
Death is considered to be present when the heart no longer beats and when 
respiration has ceased for more than 20 minutes. Both conditions must be pres- 
ent, and their proof is not always as simple as one might think. Do not rely 
upon any single test, but consider the results of all. No one test is conclusive. 
Test for the heart’s action by feeling for the pulse, and by feeling and listening 
over the heart. A stethoscope should be used for listening. If no pulse or heart 
beat is heard or felt, further evidence may be afforded by holding the hand, 
with the fingers extended and close together, against a bright light, and com- 
paring the result with one’s own hand. After death the redness that can be 
seen in a living hand is usually absent, the hand in question looking dull or 
opaque. Tie a cord or wrap a rubber band tightly about a finger near where it 
joins the hand; if the blood is circulating the finger will become swollen and 
bluish within a few minutes; no change is found when death is present. But 
remember that, if the cord is too tight, the blood going into the finger through 
the arteries may be stopped as well as that flowing out through the veins. 
Swelling and bluish color is secured when the pressure is just enough to stop 
the return venous flow but not sufficient to prevent the arterial. 
Test the respiration by watching the chest for movement and by listening over 
the windpipe (trachea) in the neck, preferably using a stethoscope. Examine 
for at least 20 minutes. Have a good illumination, and it will be found that 
a cross light (one that throws some shadows) is best. A further test is made 
by holding a very cold mirror before the mouth and nose; moisture will collect 
if there is breathing. 
The preceding examination is usually sufficient, and covers the early signs of 
death. The more important of the later signs are: 
1. Changes in the cornea of the eye. 
2. Cooling of the body. 
3. Pallor of the body. 
4. Rigor mortis. 
5. Cadaveric lividity (suggillation). 
6. Putrefaction, saponification, or mummification. 
The corneal changes consist of loss of sensation, loss of transparency, and 
wrinkling. To be of real use, one must know the condition of the cornea 
before death. 
The temperature of the body must be judged by the use of a thermometer 
placed in the rectum. Do not rely upon the touch of the hand. Occasionally, 838 
HANDBOOK OF THE HOSPITAL CORPS, II. S. NAVY 
the temperature rises for a time after death, but cooling soon begins, and its 
rate and extent will depend upon many things. It usually will be about 4° F. 
per hour for the first 3 hours, 3° per hour for the next 6 hours, and then rather 
more than 1° per hour. 
A corpse usually has a peculiar ashy color that is suggestive but not con- 
clusive as regards death. 
Rigor mortis is a stiffening of the muscles and results in rigidity of the 
body. It usually appears within 2 to 8 hours after death and lasts from 16 
to 24 hours, but both onset and duration are subject to wide variations. It 
extends commonly from the eyes gradually down over the body, and disappears 
in the same order. The muscular spasm and rigidity that occurs in some cases 
of poisoning may resemble it. 
By cadaveric lividity is meant the purplish or reddish-violet colored spots 
that appear in about 12 hours after death, and are due to the settling of the 
blood into the parts of the body that are lowest as it lies. These spots often 
are mistaken for bruises. Upon cutting, however, bruises will show consider- 
able blood or even a clot, while the spots under consideration will not do 
so. They are positive proof of death. 
Putrefaction, saponification, and mummification are, of course, absolute proof 
of death. Putrefaction (rotting) does not appear until rigor mortis has gone, 
and its onset usually occurs within a few hours to many days, depending upon 
the circumstances. Saponification and mummification are late incidents, and 
unusual. They preserve the body for long periods of time. Saponification 
means the conversion of the corpse into a fatty or waxy substance called 
adipocere. Mummification consists of the complete drying of the body. 
Care of the dead. 
The hospital corpsman should familiarize himself with the general procedure 
in cases of death, studying particularly chapter 19 of the Manual of the 
Medical Department, U. S. Navy, 1939. 
Frequently one will be obliged to take charge of the body of a person who 
has just died. The first duty in such a case is to consider the living. Remove 
all traces of death as soon as possible. A death is very depressing to other 
patients, and one should try to avoid having it occur in their presence, as in 
a ward. The medical officer usually will order a patient on the eve of death 
transferred to a private room, if possible. When this cannot be done, the bed 
should be well screened. 
The imaginative or morbid patient who realizes that a death has occurred 
in his vicinity will imagine himself as possibly dying and his body being treated 
as he sees this one treated. Hospital corpsmen should bear themselves well in 
hand, and be quiet, calm, orderly, and, above all, respectful. Make others do 
the same. There is no place at such a scene for noise or tomfoolery. Let the 
dead be respected. And this should apply not only for the moment but at all 
times until and after the remains have been removed from the institution. 
When the patient has been pronounced dead, take charge of the remains and, 
possibly, the personal property, if no person in authority is available im- 
mediately. Gather the property together, store it safely for the moment, and 
make a list of it and transfer it as soon as possible to the proper person. (See 
par. 1672 (c) (7), Manual of the Medical Department, U. S. Navy, 1939.) 
Certain things (given later in detail) must be done for the corpse, but, unless 
it lies in a private room, these are accomplished best in the morgue. Before 
the body is removed from the bed, fasten securely upon it a tag that bears the 
full name and rating of the person, the ward where death occurred, and the 
date and exact time of same. Removable teeth must be sent with the body. DEATHS AND MEDICOLEGAL MATTERS 
839 
If death has been due to a contagious or infectious disease, the body must be 
wrapped in a sheet wet with 5 per cent phenol (the official embalming fluid is 
preferable, if it is available) before being transferred. When the body has 
been removed, disposition is to be made of the bedding, and the bed, bedsprings, 
bedside table, etc., need attention. This varies with the customs of the institu- 
tion and with instructions, but the use of soap and hot water and a disinfectant 
is essential. It is a good general routine, however, to remove all bedding, in- 
cluding the mattress, if the death occurred in a ward. No patient likes to 
believe that he may be obliged to use such a mattress. Disinfect the bedding, 
to still wagging tongues if for no more important reason, and wipe the furni- 
ture with some suitable disinfectant. 
The body must be “laid out” as soon as possible. Rigor mortis may begin 
quickly, and its presence renders proper care difficult. But early attention 
is desirable for other reasons as well-prevention of discharges and soiling 
from the anus, the penis, the vagina, the mouth, and the nose, or other openings. 
Pack these openings tightly with cotton. A little salt in the cotton may be of 
help. Discharge from the penis is best prevented by tying a length of bandage 
tightly about it. The packing for the mouth should go well back into the throat. 
Insert any artificial teeth. Place the body on its back, and straighten the 
limbs, holding the knees together with a loose, broad bandage. Place the hands 
across the chest or abdomen, and secure the wrists together loosely with a 
broad bandage. The head should be slightly elevated by means of a pad or 
block. The mouth must be closed. It is better to hold the jaw in position by 
means of a support, such as a folded towel, beneath the chin, rather than use 
a bandage. The eyes must be closed. If they,do not remain so, place wet 
pledgets of cotton upon the lids, or, if necessary, insert a very small piece of 
dampened cotton beneath the upper lid. Finally, cover the body with a clean 
sheet, or, if necessary, rewrap it in the sheet that has been wet with phenol. 
Deaths from unnatural causes. 
The first rule of conduct, when one finds the remains of a person who ap- 
parently has met his death from violence or other unnatural causes, is to avoid 
any disturbance of the body or of objects in the vicinity. Make certain that 
the person really is dead, and then see to it that nothing is disturbed until 
those in authority so direct. This applies to others as well as to the hospital 
corpsman, but, as he probably will be in charge, his will be the responsibility. 
Avoid unnecessary handling of objects about the corpse, especially such as 
may bear finger-prints. 
The only reasonable excuse for disturbing anything will be to ascertain 
whether or not the person is dead. And, before doing so, a clear mental picture 
of the condition and position of the body before disturbance must be formed. 
Meanwhile, be sure to notify the medical officer or other person in authority. 
If no messenger is available and the remains must be left alone, endeavor to 
prevent possible tampering by others, as by locking the room. Return and re- 
assume charge as soon as possible. 
A hospital corpsman probably will arrive at the scene early, and he must 
try to make himself a useful witness. Imprint clearly upon the memory the 
position and condition of the body and of objects in its vicinity. This requires 
that one’s common sense be used to the utmost. Prepare a private record of 
the results of the inspection at the earliest possible moment. Memory is 
treacherous, and later one may be very thankful for such notes. 
Previous remarks relative to valuables apply here also. Make an inventory 
of those that are visible so that it can be referred to if the question arises later 
as to whether something has been lost or stolen. 840 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Habits of silence will be of particular importance in connection with unnat- 
ural deaths. Beyond its value in general, as already discussed, here one must 
anticipate a probable call to the witness stand. One’s knowledge should be 
clear in the memory, as well as clearly stated in the notes. If the matter 
is discussed with unauthorized persons, all sorts of suggestions and comments 
will be heard, and, before long, one’s own knowledge may become so con- 
taminated that one doubts whether he really saw what he thought he did. And 
unconsciously the opinions of others may be permitted to replace one’s own. 
The court is not interested in this hearsay evidence—the thoughts of other 
persons. It desires what one knows of his own knowledge, and therefore strive 
to preserve that intact and clear-cut. 
Identification of the dead. 
This problem usually will fall to the lot of persons other than the hospital 
corpsman. Still, he may find himself so situated that he must give an opinion, 
and he should be familiar with the means that may be employed. 
The records kept in the naval service are usually very complete as to the 
physical characteristics of each individual. There are the health record, the 
service record, and the finger-prints. The portion of the health record that is 
devoted to the teeth is of great importance. 
There is also the identification tag. But even the finding of such a tag with 
the body must not be considered conclusive evidence of identity. The character- 
istics listed in the before-mentioned records of the individual specified by the 
tag must check with those of the corpse before identification can be considered 
as established. A finger-print also must be made, and compared with that on 
the tag. 
The procedure to be followed, then, involves a careful examination of the body 
for the points recorded concerning some missing person. Not only must marks, 
moles, and scars be considered but also external measurements, color of hair and 
of eyes, deformities, etc. It is especially important to compare the teeth closely 
with the description in the dental abstract. 
It is surprising how obscure scars, moles, freckles, and birthmarks can become 
after death, even when decomposition has not occurred. The latter, of course, 
adds to the difficulty. So, the search must be very carefully made, and it is 
all-important to have a good light. It is for this reason that the dental 
record is of such able assistance. The peculiarities of the teeth are very 
reliable and permanent. 
It is the finger-prints, however, which will settle any doubt. The epidermis is 
very resistant to decomposition. As long as it is present, it will be rare that 
serviceable prints cannot be secured if proper care is exercised. Even when 
the skin is shriveled, good results usually can be obtained by carefully following 
the directions given in chapter 11, Manual of the Medical Department, U. S. 
Navy, 1939 or subsequent circular letters that may come from the Bureau of 
Medicine and Surgery. 
Occasionally, the remains consist only of a number of bones. The teeth will 
help in such a case. Otherwise, the identification will be beyond the ability of 
the hospital corpsman. If other aid cannot be secured, his problem will be to 
determine how many bodies are represented by the bones. This is not so difficult 
if many bones are present. Look for duplicate bones, but remember that there 
are two sides to the body. 
Post-mortem examinations. 
After death, a body often is opened for examination, the proceeding being 
known as a post-mortem examination (also called necrospy, necroscopy, or 
autopsy). 841 
DEATHS AND MEDICOLEGAL MATTERS 
The duties of the hospital corpsman at such an examination are those of an 
assistant. It lies, however, within his power to make the task run smoothly, or 
to have it unsatisfactory. Great care of instruments in the operating room is 
exercised, but the same cannot be said of those in the morgue. The first duty is 
to have them in proper condition—cutting edges sharp, forceps that grasp, joints 
that are snug, etc. 
A commendable attitude on the part of a hospital corpsman is to strive to fit 
himself to perform the autopsy with his own hands. This, of course, means 
close observation of others at work, and intensive application. Study anatomy, 
and also the sections on autopsies to be found in textbooks. In time one may 
attain the necessary proficiency, and will have benefited himself in knowledge 
and also in efficiency as a hospital corpsman. Moreover, the instruments in his 
care will receive proper attention because he will have had to use them. 
It will be the hospital corpsman’s duty to prepare the room, instruments, 
utensils, etc., and to care for them when the examination is finished. It prob- 
ably will be his duty also to close the openings (incisions) that have been made 
in the corpse, and he may be directed to embalm and dress the body, under super- 
vision. Just as in the operating room, no two medical officers will pursue pre- 
cisely the same method, and one should ask beforehand for instructions as to 
doubtful details. 
As regards the room where the examination is made, it should be neat, clean, 
and comfortable. Be sure that the lights are in good working order. A porta- 
ble light will be found useful at times, as well as a flashlight. Regulate the 
heat, and also the ventilation. There is a great tendency to neglect these last- 
mentioned details, and the result is that often some of those present “catch cold.” 
So, provide for the escape of odors, but do not do so at the expense of a proper 
warmth and freedom from drafts. 
Have the water supply working properly. If there is piping for hot water, 
see to it that hot water is available. The plumbing needs care, and remember 
that the traps may retain fluids which will decompose and cause foul odors. It 
is well to flush them with saponated solution of cresol after each use of the 
room. 
Check the scales occasionally to be certain that they weigh accurately. 
Due economy should also be exercised in this work. Good hand towels, absor- 
bent gauze, and absorbent cotton are expensive. They may be needed for cer- 
tain purposes, but certainly never for cleaning or mopping about the room or 
about the corpse, for which old, surveyed linen is available. Sections of crash 
toweling also can be used to advantage for less filthy tasks. 
Certain equipment, in addition to the furniture of the room, must be provided, 
and, if possible, it is preferable to have a locker for storage of the same rather 
than to attempt to secure it in a hurry just prior to the examination. At that 
time, one may not have much notice. The medical officer will indicate his special 
desires as regards equipment, and will advise if any unusual procedures are 
contemplated. The list following includes articles that should be available as 
a matter of routine for the examination itself. Cleaning gear for general use 
will be in addition. 
Three rubber aprons. 
Four gowns. 
Rubber gloves for three persons. (Provide an extra pair for each person, and 
have them of the size and weight desired by those who will use them.) 
Six hand towels. (For use at the sink by persons who may desire to cleanse 
their skin.) 
Soap. (For the hands.) 
Two sheets. (For the corpse.) 
Cotton, absorbent. (To be used sparingly.) 842 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Gauze, absorbent. (To be used sparingly.) 
Bandages, gauze, assorted sizes. 
Necroscopic case of the Supply Table of the Medical Department, U. S. Navy 
(Be certain that each article is in good working order.) 
Head block. (Used beneath the neck of the corpse to hold the head forward 
while removing the brain.) 
Three sponges, about the size of a man’s head. (These are very useful for 
mopping about the corpse. Great care, however, is necessary in order to keep 
them in sanitary condition. Cleanse them thoroughly with water after use, and 
store them in a large jar of 2 per cent formaldyhyde.) 
Twine. (A ball of same for use in tying during the post-mortem examination.) 
Board, 1 inch thick by 18 inches square, and smooth. (For use in sectioning 
organs.) 
Needles and thread. (For use in closing cuts in the corpse. These are selected 
according to the desires of the person doing the work.) 
Trays, enameled. (For holding and local transportation of organs, etc.) 
Three buckets, agate. (One for use at the drain of the table, one for rinsing 
sponges, and one for general utility.) 
Memorandum pad and pencil. (For taking notes during the examination.) 
Outfit for tissues or fluids that are to be saved for histological or bacterio- 
logical examination. 
Outfit for material saved for chemical examination. 
Outfit for disinfection of cuts, punctures, or abrasions occuring during the 
examination. 
The corpse having been placed upon the table prior to the necropsy and 
covered with a sheet, clear the vicinity of idly curious spectators, and then 
make the necessary preparations. Have the equipment at hand, and regulate 
the details of heat, ventilation, water, etc. 
Arrange the contents of the necroscopic case and the sponges upon a cloth- 
covered table where they will be convenient to the hand of the pathologist (the 
person who is performing the necropsy). The linen, trays, and other materials 
are placed upon another table where they can be easily reached. Place a 
bucket where it will catch the drainage from the table. When the time for 
the examination arrives, remove the sheet from the corpse, put on a rubber 
apron, gown, and gloves, and be prepared to assist as directed. 
The skin of those working at a necropsy may be broken accidentally by 
needles, instruments, and otherwise. Such wounds may become infected and 
be very serious. The medical officer will prescribe the proper treatment, but 
one should have at hand some things for immediate disinfection, including a 
200 cc bottle of tincture of iodine, wooden applicators, absorbent cotton, small 
pads of sterile gauze in muslin packages, and gauze bandages. 
When the necropsy is finished, the openings that have been made must be 
closed and the corpse cleansed and dried. The closing is to be done neatly 
by means of needle and thread and a simple running stitch. The aim is to 
leave the body presentable, not only as a matter of pride, but also because it 
probably will be viewed later by friends and relatives. It would be a waste 
of time to try to give directions for this, as no two bodies will require the same 
treatment. It is a matter of common sense and experience, and the medical 
officer will advise in each case. 
Sponge all cavities until dry. The viscera, such as the brain, lungs, heart, 
and those of the abdomen and pelvis usually have been removed and, unless 
local laws make it mandatory to do so, it is best not to return them to the 
body before closing. Instead fill the cavities with absorbent cotton soaked in 
embalming fluid or with a hardening compound as described in the section on 
Embalming. If important bones have been removed, pieces of wood can be 
wired in their place. When the skull has been opened to examine the brain, 
special care must be exercised to prevent the skullcap from slipping after the 
scalp has been sewed. This can be done by means of sutures (stitches) through 843 
DEATHS AND MEDICOLEGAL MATTERS 
soft parts or drill-holes before closing the skin. Double-ended tacks are also 
useful for the purpose. If the body is not embalmed or dressed immediately, 
cover with a clean sheet as at the start of the examination. 
Embalming usually is done at about this stage, probably most satisfactorily be- 
fore the openings have been closed. The remains then are prepared for burial by 
dressing and placing in the casket or coffin. Full directions for these procedures 
are given in the section on Embalming and in the Manual of the Medical Depart- 
ment, IT. S. Navy, 1939, section 4, chapter 19. Circular letters concerning them 
also appear from time to time from the Bureau of Medicine and Surgery. Study 
the directions given in order to be able to follow them implicitly. 
It cannot be emphasized too strongly that every care must be exercised to 
make the body presentable. Probably no other single thing, when not perfectly 
done, can occasion more distress to friends and relatives, and cause more 
trouble for those responsible. Friends and relatives are extremely critical, and 
one must spare no precautions that may prevent criticism. Use the razor 
upon those who have been accustomed to shaving as carefully as if shaving 
oneself. Wash the body with soap and water until clean. It is well to give 
the hair a shampoo. Clean and trim the nails. And a few toilet articles, such 
as a little talcum and something to make the hair lie smoothly, are of real 
help. Arrange the hair so as to hide any cuts that have been made in the 
scalp. Clothing and linen must be clean and neat, and should be arranged 
so as to hide features that may be distressing. 
After the work in connection with the body is completed, the room and 
equipment must be cleaned and put in order. This is largely an ordinary 
cleaning procedure. The care of certain articles of equipment already has been 
specified. Instruments should be in perfect condition before storage, and covered 
with a thin coat of vaseline. If they are so left it avoids trouble in case they 
are needed in a hurry. If the post-mortem examination has been of a person 
dead from a contagious or infectious disease, the usual precautions listed else- 
where in this book must be observed—the room, contents, and oneself being 
treated or disinfected to prevent spread of the disease. An occasional fumiga- 
tion of the morgue is a useful routine measure. 
Mention has been made of an outfit for tissues or fluids that are to be saved 
for microscopical examination or for preservation of large specimens. For the 
latter purpose instructions will be given by the medical officer. Usually they 
are carried to the laboratory in trays, closely covered. Certain things should 
be kept on hand for specimens for microscopical examination, and by so doing 
much trouble will be saved because a decision to save something usually will 
be made on the spot and the incidentals will be wanted in a hurry. 
It may be desired to secure some sample, usually fluid, under aseptic pre- 
cautions, and therefore certain articles of the equipment must be stored in 
sterile condition. A free flame, such as that of a Bunsen burner, is of use 
under such circumstances. Between it and the tincture of iodine, that is on 
hand for wounds, there should be no difficulty in securing a suitable specimen. 
The list of articles following usually will handle the situation. It is well, 
however, to consult the medical officer in charge of the laboratory on the subject, 
as he may have some other preference. 
One test-tube rack. 
Ten test tubes, sterile, and plugged with cotton. 
Twenty slides, glass (clean, flamed, and protected from dirt). 
One platinum loop, in a handle. 
Twelve sterile swabs, two packages of six each. (Wooden applicators with a small 
amount of cotton wrapped around one end. Make a muslin-covered package and 
sterilize). 
154294°—39 54 844 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Syringes, all glass, 10 cc capacity, in sterile package. (One syringe with two 
large-bore needles in each package. The needles should contain their wires.) 
Ten bottles, wide-mouthed of about 50 cc capacity, with corks. 
One bottle, containing 1,000 cc of 10 per cent solution of formaldehyde. (Liquor 
formaldehydi). (For use in the bottles above for the preservation of small pieces 
of tissue.) 
Pencil, wax. (For writing on glass.) 
There are occasions also when it is necessary to preserve portions of the corpse 
for chemical examination, usually for poisons. This is practically always a legal 
matter and the procedure must be surrounded with every precaution. Either 
accidentally or intentionally, there may be tampering with the specimens; there- 
fore every care must be exercised to have them reach the chemist in proper condi- 
tion—nothing having been added to them or removed from them. Not only must 
the medical officer and the hospital corpsman be satisfied as to this, but they 
must be able to convince a jury, which can be accomplished only when all con- 
cerned can, upon their oath, testify that the necessary precautions have been 
observed. 
It follows that the work must be protected by seals, and the seal should be one 
that cannot be imitated readily or that can be used only by those in authority. 
Unauthorized tampering with the specimens then would be known. One also 
must try to permit no opportunity for the same by means of the strictest safe- 
guarding under lock and key. 
A medical officer ordinarily will supervise the work in this connection. It is 
well, however, always to be prepared for an emergency. It often comes unex- 
pectedly and the containers cannot be prepared at a moment’s notice. Many 
precautions are necessary for this. So prepare the containers in advance and 
seal them effectively. Seal them in a package and keep them under lock and key. 
The viscera that practically always are saved for chemical examination are 
the stomach and duodenum with their contents, the intestine, the liver, the kid- 
neys, and the brain. Often, also, other organs, as well as the urine, are saved— 
in fact, any portion of the body may be saved for chemical examination. So one 
must have containers large enough to hold such material. There should be a 
bottle or jar for each organ to be saved, and the different organs should be 
placed in separate containers—not all together. The containers must be thor- 
oughly washed with soap and water, treated with strong sulfuric acid, and 
finally, thoroughly rinsed with distilled water. When prepared, wrap each one 
separately in firm, stout paper and secure the paper with tape or stout twine 
passed over and around the jar several times and in all directions. Seal each 
package with wax at many points. 
A reasonable outfit then will consist of the following: 
Ten jars, wide-mouthed, preferably glass-stoppered, assorted sizes. (There 
should be no rubber or metal at the joints or elsewhere that could come in contact 
with the contents. Joints are closed with paraffin, after the specimens are in 
the jars.) 
Five bottles, glass-stoppered, assorted sizes from 1,000 cc capacity down. 
Five catheters, new, of assorted sizes. (These are to be thoroughly cleaned and 
stored in perfectly clean bottles. They are used for securing the urine or other 
fluids.) 
Distilled water. (Secure a large bottle for the purpose from the laboratory the 
same day as the examination.) 
Paraffin. (Several cakes.) 
Rinse the containers with distilled water just before the material is placed in 
them. Then they are covered, the joints closed with a very liberal amount of 
paraffin, labeled, and immediately sealed as before. If they are to be kept for a 
time or shipped some distance the best practice is to keep them constantly at 845 
DEATHS AND MEDICOLEGAL MATTERS 
as low a temperature as possible. If this cannot be done a liberal quantity of 
95 per cent alcohol should be added to the contents and 500 cc of the same alcohol 
placed in a perfectly clean bottle and sent with them. 
Make an inventory of the number and contents of each container. A copy of 
the inventory is sent along when a duly authorized person makes the shipment 
and a copy of the imprint of the seal should be included. 
The matter of shipping specimens of medical interest is not as simple as one 
might think. The express companies and the postal authorities place many 
restrictions upon such packages, and one may get into trouble if he violates the 
regulations. Therefore before making such a shipment be sure that it is being 
done properly. Consult the local express company or postal authorities. Cir- 
cular Letter X, Appendix D, Manual of the Medical Department, U. S. Navy, 
1939, discusses the matter, and one should familiarize himself with its contents. 
References. 
Medical Jurisprudence.—Edwin W. Dwight. 
A Textbook of Legal Medicine and Toxicology.—Peterson and Haines. 
Hospital Corps Handbook, XL S. Navy, 1923. CHAPTER XII 
HOSPITAL CORPS TECHNICAL SPECIALTIES 
Page 
Section 1. Aviation Medicine 847 
Section 2. Basal Metabolism 849 
Section 3. Blood Grouping and Matching 856 
Section 4. Chemical Warfare 862 
Section 5. Diving and Submarine Duty 872 
Section 6. Electrocardiography 879 
Section 7. Embalming 882 
Section 8. Independent Duty 887 
Section 9. Laboratory Procedures and Technique 889 
Section 10. Physical Therapy 917 
Section 11. Recruiting 936 
Section 12. X-ray 940 
Section 1.—AVIATION MEDICINE 
Aviation first assumed military importance during the World War. Since the 
armistice the race for aeronautical supremacy on the part of almost every country 
has been continuous and unremitting. Considered in the light of present day 
military value, aviation is regarded as one of the most important military arms. 
The effort to constantly surpass in performance all preceding types of planes, 
led to great advancement in the modern types of aircraft. So great have been 
these advancements, that performance of the modern plane now tends in many 
ways to surpass the ability of the pilot at control. Planes now fly long hours in 
continuous sustained flights. Speeds have been tremendously advanced. Ma- 
neuverability has been whipped up until the pilot is seriously taxed in his effort 
to operate the advanced types of aircraft at their maximum capacity. 
In the face of these facts it is being realized daily that the weakest link in 
the chain of aeronautical forces is the human element, the pilot. However 
efficient the plane may be, in the final analysis its safety in flight depends upon 
the physical and mental fitness of the pilot. Therefore, good pilots must be 
developed as well as good planes, and it is as necessary to safe-guard and care 
for the pilots as it is to service and repair the planes. 
The selection of and the daily care of pilots has become a specialty of military 
medicine which is called “Aviation Medicine”. It requires specially trained 
medical officers or fight surgeons, and the assistance of specially trained hospital 
corpsmen or aviation technicians. Assignments of hospital corpsmen for this 
special training are made after approval of requests for such training by the 
Bureau of Medicine and Surgery. 
Although the primary goal of aviation medicine is the prevention of accidents, 
to increase the safety and efficiency of flying its field of activities has been 
roughly divided into two parts, namely: 1. The selection of flying personnel; and 
2. The care of flying personnel. While the aviation technician may be of very 848 
HANDBOOK OF THE HOSPITAL CORPS, H. S. NAVY 
great assistance to the flight surgeon in both these fields of endeavor, he is par- 
ticularly helpful in regard to the examination and selection of flying personnel. 
Physical examinations. 
Every applicant for flight training must first pass the flight physical examina- 
tion and all pilots and aviators shall likewise take the annual physical examina- 
tion for flying, not later than January of each year. {See paragraphs 1538 to 
1544 inc., Section 23, Chapter 11, Manual of the Medical Department, U. S. 
Navy, 1939.) 
The physical examination for flying is a rather long and considerably involved 
examination, which requires the use of special appliances, such as the phorom- 
eter, an instrument for measuring the strength of the external nmscles of the 
eye, the Barany chair, for study of the reactions of the semicircular canals, and 
other apparatus not commonly used in the ordinary type of examination. The 
report of the examination is submitted on a special form, N. M. S.-Aviation No. 
I, which contains the necessary printed instructions for guidance of those pre- 
paring the reports. It is in the use of this special apparatus and familiarity in 
the preparation of the various aviation forms that aviation technicians may be 
of very great assistance. 
Generally speaking, the aviation technician should have a ready knowledge of 
the physical requirements for flying and a thorough familiarity with the contents 
of Section 23, Chapter 11, Manual of the Medical Department, U. S. Navy. He 
should have a working knowledge concerning the use of all the special appliances 
used in connection with the examination. He should be able to conduct a great 
portion of the measurable part of the physical examination, such as determination 
of visual acuity, angle of convergence, the Barany chair test, height, weight, chest 
measurement, and the taking of the Schneider Index. Ordinarily the flight sur- 
geon is present, or conducts all phases of the physical examination, but a familiar- 
ity on the part of the technician concerning the details of the examination is of 
great assistance to the examiner. The technician is also expected to be familiar 
with the preparation of the special report of the examination, Form N. M. S.- 
Aviation No. 1, and also the preparation of Form N. M. S.-Aviation No. 3, Report 
of Crash. 
Ordinarily upon reporting, each pilot or aviator is given a special filing jacket, 
in which all current reports of physical examination and other important data are 
filed. It is the duty of the aviation technician to look after the records and 
properly maintain the files pertaining to the physical and medical records of flying 
personnel. 
Schneider Index. 
The Schneider Index is the name of a special test to determine the circulatory 
efficiency of an individual. It is based upon the recording and assignment of 
numerical factors to the reclining and standing pulse rate and blood pressure, and 
the changes produced after a given exercise. {See Paragraph 1565 (f), Chapter 
II, Manual of the Medical Department, U. S. Navy.) The test is easily and quickly 
given and indicates to a very practical degree the nature of an individual’s 
vasomotor tone and control. 
Normally, flying personnel whose Schneider Index falls below 7, should be tem- 
porarily disqualified for flying. Inasmuch as the test is so constantly used in 
examining and checking the physical efficiency of aviation personnel, all aviation 
technicians should be thoroughly familiar with this test and should develop a 
careful technique in its conduction. They should always avoid hurrying the 
examination or exciting the candidate. Such errors of technique lead to low 
scores, which do not represent the true physical picture. BASAL METABOLISM 
849 
Care of flying personnel. 
In this sphere of aviation medicine a great deal could be stated. When one real- 
izes that flying establishes a new environment, to which the pilot must become 
adjusted, one can begin to appreciate the many problems to be solved. 
Generally speaking, flying personnel require a higher degree of physical perfec- 
tion than is normally required of other Navy personnel. This is referred to as 
physical reserve. Especially is this required for the eyes and the circulatory 
system. Due to the effects of diminished oxygen at high altitudes, pilots who lack 
physical reserve or efficiency are readily affected at such altitudes. Their efficiency 
is lowered and frequently their flight may end disastrously. 
It is because of these additional demands, that pilots should lead orderly lives 
and maintain a high state of physical efficiency at all times. The loss of sleep and 
rest, the excessive use of alcohol, and other forms of intemperance, tend to lower 
physical efficiency and should be avoided. Flying personnel operating in big-boat 
squadrons are often subjected to long fatiguing hours with poor tender facilities, 
and therefore inadequate provision for rest at night. They soon reach a virtual 
stage of weariness and near-exhaustion. Domestic troubles, loss of confidence in 
flying, recent crashes, all may serve to affect individuals. Frequently the worries 
may be mild at first, but as time progresses the pilots gradually develop a nervous 
anxiety state, which comes to seriously affect their flying. The terms staleness, 
or effort syndrome, or neurasthenia, are commonly used to describe such cases. 
In caring for the flyer, all these conditions should be kept in mind. The pilot 
should be assisted past all such difficulties, and it is to such a task that the field 
of aviation medicine is in great part directed. 
First aid. 
In the pressure of aviation activities, both ashore and afloat, active measures 
should be taken to render first aid promptly in case of an accident. Crashes fre- 
quently occur over the water, or at some distance from the base or ship. It is 
necessary that assistance be prompt and efficient. Hospital corpsmen serving as 
aviation technicians should be experts in the resuscitation of the apparently 
drowned. The ambulances and crash boats should be provided with crash gear 
as a ready means of extracting the injured from the wreckage. Especially is this 
important where the wreckage is submerged, or where fire may be an added hazard. 
{See Paragraph 1261, Section 3, Chapter 10, Manual of the Medical Department, 
U. S. Navy.) 
Section 2.—BASAL METABOLISM 
In discussing this subject certain general and basic considerations will be given 
first in order that the reader may form an accurate conception of what is meant 
by basal metabolism. Nor is it considered necessary to illustrate this chapter with 
pictures, tables, and charts, for the apparatus can be seen in operation in any naval 
hospital and at the U. S. Naval Medical School. Technique will be dealt with only 
as necessary for clarity. Specific technique is furnished in detail by the manufac- 
turers of each type of apparatus and should be followed to the letter. 
By metabolism is meant all those chemical reactions (oxidation, reduction, 
hydrolysis, synthesis, etc.) occurring within the tissues of the living body. These 
reactions are constantly going on as long as there is life and are both constructive 
(anabolic) and destructive (katabolic) in nature. Such chemical changes form 
the basis of the various physiological processes and functions. 
GENERAL CONSIDERATIONS 850 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Oxidation is the chemical reaction with which one is concerned in basal metab- 
olism. Oxidation gives rise to energy. When anything burns (oxidizes) inside 
or outside the body, slowly or rapidly, heat is produced, and heat can be measured. 
It is common knowledge that the body is always warm, and by use of the clinical 
thermometer one may see that the temperature of the body remains remarkably 
constant regardless of most influences, a? climatic conditions, which would mark- 
edly affect the temperature of inanimate objects. This is due to the delicate mech- 
anism which adjusts the relationship of heat loss and heat production, somewhat 
analogous to the thermostat of an incubator, but much more complicated. (See any 
text book on physiology.) But the clinical thermometer is a qualitative measure 
of heat only and in fevers it indicates that oxidation has speeded up, but it gives 
no accurate idea as to the amount of heat actually being produced. In basal 
metabolism a quantitative measure of heat is determined, and, with this fact 
known, an idea of the intensity of oxidation going on may be had, and certain 
deductions can be drawn therefrom. For this purpose the large calorie (C.) is 
used as the unit measure of heat, this calorie being that amount of heat necessary 
to raise the temperature of 1000 grams of water from zero to 1° C. 
Oxidation of what?—Many substances undergo oxidation in the body, but the 
oxidation of carbohydrates (glucose), fats, and proteins (amino acids) consti- 
tutes such a large percentage of the whole that for practical purposes no others 
need be considered so far as basal metabolic work is concerned. These basic 
food materials when burned within the body or in a bomb calorimeter produce 
practically the same amount of heat, the caloric value being given in round 
numbers as follows; 1 Gm. of carbohydrate, 4 C.; 1 Gm. of protein, 4 C.; and 
1 Gm. of fat, 9 C. 
During oxidation glucose and fats are completely broken down into C02 and 
H20, the CO2 being eliminated by the lungs in exchange for oxygen from the air, 
and the H2G being eliminated through the lungs, skin, kidneys, and other excre- 
tions. Amino acids, on the other hand, are not completely oxidized. Amino acids 
are used to synthesize proteins to replace those lost by wear and tear, to promote 
growth, and for fuel, if needed. The by-products of oxidation are H20, C02, urea, 
etc., while 58 per cent may be used to synthesize glucose which may be further 
oxidized if needed. Approximately 15 per cent of the total calories is derived 
from proteins, the rest from carbohydrates and fats. The chemical reactions 
may be expressed as follows: 
C6H12O0 (glucose)+602=6H20+6C02=4 calories per gram of glucose or 5.05 
calories per liter of oxygen consumed; and 
2C67Huo06 (tristearin) + 16302=110H20+114C02=9 calories per gram of fat 
or 4.69 calories per liter of oxygen consumed. Proteins, however, are not com- 
pletely oxidized in the body as in the laboratory (bomb calorimeter) and the 
caloric value is 4.0 calories per gram or 4.485 calories per liter of oxygen 
consumed. 
The respiratory quotient (R. ft.).—From the foregoing it may be observed that 
the amount of oxygen required to oxidize a given amount of carbohydrate, 
protein, or fat will differ in each case and that the caloric value of one liter of 
oxygen will vary according to which substance is being burned. This will become 
clearer by study of the respiratory quotient (R. Q.). 
The R. Q. is the volumetric relation of the oxygen consumed to the carbon 
dioxide eliminated, i. e., the amount of C02 divided by the amount of 02. Under 
similar conditions of atmospheric pressure and temperature equal volumes of 
different gases will contain an equal number of molecules, or, in other words, 
a given number of molecules of different gases will occupy equal volumes. (See 
Avogadro’s Hypothesis, p. 656.) Consider the following equations; BASAL METABOLISM 
851 
1. Oxidation of glucose: 
C6H1208+602-6H20 + 6C02. Then R. Q-^Vvol.^*”1-0 
It will be observed that when glucose is oxidized all the oxygen used (or 
added) is consumed in the formation of C02 and that for each volume of oxygen 
used one volume of C02 is given off. Hence an R. Q. of unity. 
2. Oxidation of fat (palmitin, for example) : 
C5iH9806+72.502 = 51C02 + 49H20. Then R. 0,703 
It will here be observed that fat contains a relatively smaller amount of 
oxygen than does glucose; hence more oxygen is required to burn this sub- 
stance. This results in a low R. Q. 
In a more or less similar manner it may be shown that the R. Q. for proteins 
will be between these extremes at about 0.80. The R. Q. will again vary accord- 
ing to what particular fat or protein is being oxidized. 
Now the human body probably never burns only one food stuff at a time, but 
it is constantly oxidizing a mixture of all three. By the determination of the 
R. Q. and by reference to the appropriate table one can estimate the proportion 
of protein, fat, and carbohydrate being oxidized at one time. For accurate 
metabolic work the R. Q. must be determined because the caloric value of a given 
amount (1 liter) of oxygen will depend upon it, this fact entering into the calcu- 
lation of the Basal Metabolic Rate (B. M. R.). For practical purposes, however, 
it has been found that after 14 hours of fasting the R. Q. is rather constant 
at 0.82, and this figure has been chosen for routine use in clinical basal 
metabolism, the determination of the R. Q. being dispensed with. 
At this point one might consider basal metabolism as the amount of heat, ex- 
pressed in calories, produced by the body in a definite length of time under basal 
conditions. But this is only a partial definition which is not yet sufficiently 
clear, for as yet the conditions termed basal and the factors influencing the rate 
of oxidation have not been discussed. 
Factors influencing the rate of oxidation and hence the B. M. R.—1. The thyroid 
gland is a gland of internal secretion producing a complex chemical substance 
containing iodine {see page 62). This substance is thyroxin, the thyroid 
hormone. It has a powerful influence on the rate of metabolic activity through 
its catalytic action. Overactivity of the thyroid (hyperthyroidism, toxic ade- 
noma, exophthalmic goiter) produces more than the normal amount of thyroxin 
and stimulates oxidation, whereas a decrease in thyroid activity (hypothy- 
roidism, cretinism, myxoedema, surgical removal, X-ray) causes a reduction in 
the normal amount of thyroxin and a decrease in the rate of oxidation. It has 
been estimated that about 15 mg. of thyroxin is normally present outside the 
gland, and that the thyroid must manufacture % to 1 mg. of thyroxin daily to 
maintain this concentration. Other glands (pituitary, adrenal, ovary, testis) 
influence metabolism but to a less marked and less understood degree. 
2. In general any condition associated with increased cellular activity is 
likewise associated with an increased B. M. R. (leucaemia, fever, etc.). For 
each degree of fever (Fahrenheit) the B. M. R. is increased about 6.2 per cent. 
3. Exercise stimulates oxidation to a marked degree, so that a person at rest 
will have a very different B. M. R. from what the same person will have 
shortly after exercise. Muscular tremor will do the same. 
4. Digestion of food also increases metabolism to a great degree. After 14 
hours of fasting this factor is eliminated. 852 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
5. The mental state of the patient, (worry, apprehension, excitement, pain) 
increases metabolic activity. 
6. Anaemia and heart disease may cause an increased B. M. R., due to in- 
creased activity of the heart and muscles of respiration. 
7. Age.—Metabolism increases slightly to the age of 6 years when there is a 
rapid decrease to the age of 20. After that there is a very gradual decline with 
age. At 75 years of age, the B. M. R. is about 30 per cent less than at the age 
of 15. 
8. Sex.—On the whole basal metabolism is about 7 per cent less in the female 
sex. The reason is not evident. Before the age of puberty there is still a 
definite but less marked difference. During pregnancy the metabolism is 
increased due to the metabolic activity of the foetus. There is also about a 
10 per cent rise shortly before and during menstruation. 
9. Race has a slight influence. The B. M. R. is said to be somewhat lower 
in occidental races who are noted for their repose and low protein diets. On 
the other hand the Esquimo, who is exposed to cold and who is a heavy meat 
eater, has a higher rate. 
10. Proteins have a definite stimulating action on metabolism in addition to 
the energy released by their mere combustion. This has been called by Rubner 
the specific dynamic actions of foods and is observed mostly with proteins. 
This dynamic action of proteins lasts for many hours and, after a heavy protein 
meal, may be observed the next day. 
11. Metabolism is reduced during sleep to 10 or more per cent below that 
under basal conditions. This is probably due to lessened heart and respiratory 
activity. 
12. Drugs.—Sedatives and narcotics will reduce the rate. Thyroid extract, 
dinitrophenol, certain pituitary preparations, caffeine, and epinephrine will in- 
crease the rate. 
What is meant by basal conditions. 
Various factors have just been discussed as influencing the basal metabolic 
rate. With few exceptions these factors revise the rate upward. But not all 
of these factors render abnormal figures. In preparing a patient for a 
metabolic test as many of these factors as possible must be eliminated or 
reduced to a minimum. The more important factors are food, exercise, the 
mental state, drugs, and adequate rest prior to the test. Hence, if a patient 
has not eaten for 14 hours, is mentally calm and not suffering from pain or 
other discomfort (as a full bladder), has not had certain drugs within a 
reasonable period, has had a good night’s rest, and has been at complete rest 
for one-half hour immediately before the test, he is said to be under basal 
conditions. Under basal conditions the B. M. R., is as low as it is possible to 
get it while the patient is awake and not under the influence of drugs. As 
all patients are similarly prepared, comparison can be made in the B. M. R. 
of different patients or in the case of the same person at different times. 
Relation of B. M. R. to height, weight, surface area, age, sex. 
For comparative purposes it is not enough merely to do the test under basal 
conditions. There must be other criteria for comparison. In arithmetic a 
common denominator is found when one wishes to compare the values of com- 
mon fractions, for example, to compare % and % a much better conception is 
had by finding a common denominator and studying the fractions as %5 and 
%5. In basal metabolism a common denominator must be found. One cannot 
compare the total metabolism of a large man with a small one even though 
they be the same height and age. Nor would one expect the B. M. R. to be 853 
BASAL METABOLISM 
the same in an old man and a young woman of the same height and weight. 
Various methods have been tried and it has been found that the metabolism is 
not directly proportional to age, sex, height, weight, or any other convenient 
standard. It is believed to be proportional to muscle mass, but there is no 
way of determining muscle mass. It has, however, been found that the 
metabolism is directly proportional to surface area. But while one person 
may have 1 square meter of surface area, another 2 square meters ,and so on, 
metabolism is proportional to a given unit of that area, namely, 1 square meter. 
Regardless of the total area, the metabolism of 1 square meter of surface area 
of one person can be compared to that of 1 square meter of surface area of 
another person, both being under basal conditions. The surface area may be 
calculated with considerable accurateness by the following formula of DuBois: 
A = W0.425XH0.725X71 84 A==Are& . 
W=Weight in kilograms; and 
H= Height in centimeters 
The mathematical calculations required by this formula ordinarily need not 
be performed for it generally is necessary only to determine the height in 
inches or centimeters, the weight in pounds or kilograms, and then refer to a 
chart based on the above formula and read at a glance the surface area in 
square meters. Ordinarily a healthy adult under basal conditions produces 
about 40 calories per square meter of body surface per hour. It is customary 
to express the results in percentage above or below a base line called zero. The 
normal range lies within plus 15 per cent to minus 10 per cent (above or below 
the base line). /■ 
Definition. 
From the foregoing it is possible to define basal metabolism as the minimum 
oxidative or heat-producing metabolism of which a person is capable while awake 
and not under the influence of drugs, the results being expressed in calories per 
square meter of body surface per hour. The basic metabolism rate (B. M. R.) 
is the same except that it is expressed in percentage above or below a normal 
base line of zero. 
APPARATUS 
In the determination of basal metabolism two types of apparatus are used 
which operate on the principles of direct calorimetry and indirect calorimetry. 
Direct calorimetry requires a large apparatus, built somewhat on the order 
of a bed room, in which a person may live for specified periods of time, and the 
actual amount of heat given off in calories determined. It is a most accurate 
method suitable for research work, but it is too expensive and complicated for 
routine clinical use. Apparatus for determining basal metabolism by this prin- 
ciple have been devised by Atwater, Benedict, Rich and Lusk, Murlin, DuBois, 
and others. 
Indirect calorimetry is the method of choice for clinical use and is sufficiently 
accurate for such use. One make of this type of apparatus, the Benedict-Roth, 
not only determines the amount of oxygen consumed but also the amount of 
C02 eliminated, so that the respiratory quotient can be determined and used 
in the calculation for each patient. This type of apparatus, too, because of its 
more exacting technique and greater expense, has been largely supplanted 
by simple ones as the Sanborn, the Jones motor basal, etc. These simple 
apparatus measure the amount of oxygen consumed only. As pointed out 
before, under basal conditions the R. Q. is rather constant at 0.82 and thus 
may be used for practical purposes. As a matter of fact either the oxygen 854 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
alone or the C02 alone could be used in the calculation, but it has been found 
more practical and accurate to use oxygen consumption alone, and most ap- 
paratus for clinical use have been devised accordingly. 
Preparation of the patient. 
This has .been mentioned before, but it is of the greatest importance, and each 
patient must be given specific instructions in writing prior to the test. It is 
also important prior to the test to ascertain if these instructions have been car- 
ried out. Nor is it essential for the patient to remain in a hospital overnight 
for this test. A nervous patient would probably obtain a better night’s rest at 
home and could then report to the metabolic laboratory by the least exertion 
possible and rest in bed one-half hour in the laboratory. 
“Before giving patient his instructions, assure yourself of the following: 
“1. Assure yourself the day before the test that the patient: 
“(a) Has not received thyroid preparations within a month and is not re- 
ceiving dinitro-o-cresol, dinitrophenol, caffeine or adrenalin. 
“(6) Is not suffering from toothache, earache, headache, or any other cause 
of continued pain. 
“(c) Is not having fever or chills at any time of day. 
“(d) Is not menstruating, or due to menstruate within the next 48 hours. 
“2. Explain to the patient the harmless nature of the test and the importance 
of following instructions explicitly.” (Osgood.) 
The following is an example of printed instructions for the patient: 
“(a) Eat a light evening meal about 6 p. m., containing very little protein 
(meat). 
“(6) Take nothing of any kind whatsoever after this meal until after the 
test is completed the next morning. If very thirsty, a little water at 
body temperature an hour or more before the test will do no harm, 
but milk or coffee or any other food or beverage must not be touched 
unless specifically permitted. A glass of orange juice several hours 
before the test will not introduce any material error. 
“(c) Spend the evening quietly at home, or preferably in the hospital, and 
go to bed by nine o’clock. It is probably better not to smoke within 
2 hours of the time set for the test. 
“(d) Choose the method of transportation to the place where the test is to 
be done that will involve the least exertion. It is still better if the 
patient can spend the night in the room where the test is to be done. 
“(e) Arrive at the hour specified, preferably 8 a. m.” (Osgood). 
The test. 
The simple, less expensive, portable, and easily operated apparatus consist 
essentially of a closed circuit containing a sealed container of oxygen at one 
end and the patient at the other, connected by means of tubes and a mouth piece. 
There is a motor blower to facilitate the circulation of the gases and to make 
breathing easier. In the circuit there is also a soda-lime container to absorb 
CO2 from the patient and thus keep the oxygen pure. The oxygen con- 
tainer is equipped with a thermometer because correction for temperature 
must be made. The barometric pressure is read from a barometer. By means 
of a kymograph attached to the machine the amount of oxygen consumed in a 
specified time (say 6 minutes) may be read and then calculated for one hour. 
Now, having obtained certain specific data (age, sex, height, weight, surface area, 
TECHNIQUE 855 
BASAL METABOLISM 
amount of oxygen consumed corrected to a barometric pressure of 760 mm. 
mercury and a temperature of 0° C.) the calculation of the basal metabolism 
and the B. M. R. may proceed. This is readily done by arithmetic and reference 
to certain tables and charts. Use the formula: 
Loss of 02X (factor corrected to 760 mm. and 0° C.) X . X4.825—B.M.R. 
time of test 
Sq. M. of body surface 
Example: “Patient: Male 29 yrs., 5 ft. 8% in., 147% lb. 
Body surface : 1.8 sq. M. 
Time of test: 5 min,, 7 sec. 
Bar. 30.11 in. 
Temp, of 02 at start, 23.5 C. Factor 0.926 
Vol. 02, 7200 cc. 
Temp, of 02 at end, 24.0 C. Factor 0.925 
Vol. 02, 4900 cc. 
7200X0.926 = 6667.2 cc. 
4900X0.925 = 4532.5 cc. 
2134.7 cc., or 2.1347 liters of 02 at 760 mm and 0° C. 
2.1347X^X4.825 
—p——-67.1 Cal. 
1,8 39.5 Cal. (Normal) 
27.6 Cal. per hour per sq. M. body surface above normal, 
x : 100 = 27.6 : 39.5 
x=69.87% or B. M. R. is approximately 70% above normal, 
or +%.” (Stitt). 
As a matter of fact the calculation has been greatly simplified in recent years 
by use of a slide rule. In the case of the Jones motor basal apparatus the cor- 
rection for pressure and temperature is automatic. It is then only necessary to 
apply certain factors as to height, weight, age, sex, etc., to the slide rule and read 
off the B. M. R. direct. 
The technique supplied by the manufacturers with each type of apparatus 
goes into detail and should be followed. This literature also must be followed 
in regard to the care of the apparatus and how to test it at regular intervals 
for efficiency. Efficiency in doing basal metabolic work comes only with an 
understanding of the principles involved and with practice. 
For clinical purposes basal metabolism has boiled itself down almost entirely 
to a study of the thyroid gland. It is important in the diagnosis of thyroid 
disturbances. In hyperthyroidism the B. M. R. will range anywhere from plus 
20 per cent to plus 100 per cent or more depending on the severity of the case. 
In hypothyroidism rates of minus 15 per cent or lower are common. In 
myxcedema minus 40 per cent is not uncommon. As a rule a series of two or 
more readings should be made to get an average and to get the patient accus- 
tomed to the test. This is especially important if the first reading is abnormal. 
The test is of great importance in following cases on thyroid therapy but this 
of course does not represent the patient’s true metabolism. The B. M. R. at 
intervals is also necessary while a patient is on Lugol’s solution prior to oper- 
ation in order to determine the best time to operate—when the B. M. R. is plus 
30 per cent or less and before it has started to rise again. 
The total metabolism (number of calories in 24 hours) is of some impor- 
tance in calculating basic diets for diabetics and obese persons. 
Basal metabolism has been of great value in research work and has thrown 
much light on the problems of nutrition. 
CLINICAL SIGNIFICANCE 856 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The Diagnosis and Treatment of Disorders of Metabolism.—McLester. 
Labratory Diagnosis, 2d edition.—Osgood. 
Text Book of Physiology.—Howell. , 
Practical Bacteriology, Blood Work, and Animal Parasitology, 8th. edition.—Stitt. 
Practical Bacteriology, Haematology, and Animal Parasitology, 9th edition—Stitt, Clough, 
and Clough. 
Treatment of Diabetes.—Joslin. 
Physiology in Health and Disease, 2d edition.—Wiggers. 
Practice of Medicine.—Tice. Vol. 2. 
References 
Section 3.—BLOOD GROUPING AND MATCHING 
HISTORY 
Blood transfusion, the term used for the process of transferring blood from 
one person to the circulation of another, is often a life-saving remedy, especially 
in cases of severe haemorrhage, anaemia, and infections. 
The use of blood as a therapeutic agent is as old as medicine itself. The 
ancients drank fresh blood and even bathed in it for the purposes of resuscita- 
tion, recuperation, and rejuvenation. There are vague references that trans- 
fusion was practiced, but it is not until the early part of the seventeenth cen- 
tury that authentic references to transfusion are to be found. 
William Harvey, in 1616, when he propounded the theory of the circulation 
of the blood, made the first important contribution which made possible blood 
transfusion as it is known today. Immediately following Harvey’s theory as 
to the circulation numerous human beings were transfused with the blood of 
various animals, mostly with dire results. A few successful transfusions of 
blood from one human being to another were done, but usually there were 
severe reactions and numerous deaths, so that blood transfusion soon fell into 
ill repute. It was considered extremely hazardous and only to he used as a 
last resort. 
The modern period in the development of blood transfusion began in 1900 
when Landsteiner discovered iso-agglutinating and iso-agglutinable substances 
in human blood. The following year he divided blood into three groups with 
regard to their agglutinable reactions. In 1902 Decastello and Sturli added a 
fourth group. In 1907 Jansky worked out the reciprocal agglutinating reac- 
tions of the four groups, and in 1910 Moss, working Independently, confirmed 
Jansky’s work. It was also found if the blood of the donor was of the same 
group as that of the recipient transfusion could be safely done. It was Land- 
steiner, then, who provided the basis for the present methods of determining 
the compatibility or incompatibility of blood for transfusion. 
Classification. 
Three separate classifications of the four blood groups are in common use, 
the Jansky, the Moss, and the Landsteiner or International. The International 
classification is recommended by the American Association of Immunologists 
and by the Health Committee of the League of Nations, and was adopted by 
tlie Medical Department of the United States Navy in 1928. The International 
classification designates the four blood groups by the Roman capitals O, A, B, 
and AB, and to avoid confusion no further mention will be made of the other 
classifications, except for a correlation of the groups shown in the table on 
page 858. BLOOD GROUPING AND MATCHING 
857 
Agglutination. 
The work showing that all bloods can be classified into four groups was done 
by random cross matching of the bloods of a large number of people. Two 
specific antigens, the iso-agglutinogens or the agglutinable substances, desig- 
nated by the capital letters A and B, were found to be distributed in the red 
cells. Two anti-bodies, the iso-agglutinins or the agglutinating substances, 
identified by the small letters a and b were found in the sera. Hsemolysins are 
also present in sera, but since haemolysis does not occur without being preceded 
GROUP O 
Containing 
3 and b 
GROUP A 
Containing 
ft, b 
GROUP 0 
Containing 
0 , a 
GROUP AB 
Contai ning 
ft and 6 
Figure 158.—Diagram showing the interrelationship among the blood groups. 
by agglutination they can usually be ignored in grouping bloods. The iso-agglu- 
tinogens and iso-agglutinins are so distributed that an iso-agglutinogen and its 
corresponding iso-agglutinin are never present simultaneously in the same 
blood. The table following shows the distribution of the iso-agglutinogens and 
the iso-agglutinins in the various blood groups. 
Distribution of the iso-agglutinogens and iso-agglutinins in the four blood groups 
International group 
Agglutino- 
gens in red 
cells 
Agglutinins 
in serum 
Percentage 
of individ- 
uals in group 
0 
43 
A 
A 
b.. 
40 
B ... 
B .. 
7 
AB 
10 
A blood serum containing a given agglutinin will agglutinate red cells con- 
taining the corresponding agglutinogen and will not effect other red corpuscles, 
so from the table it is seen that the various groups are classified according 
to the agglutinogen content of the red cells. The interrelationship among the 
blood groups is more plainly shown in figure 158. 858 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
The serum of any group will agglutinate the red cells of any group toward 
which the arrows point. No arrows point toward Group O for its red cells con- 
tain no iso-agglutinogens and its cells are not agglutinated by the serum of any 
of the other groups; therefore individuals of this group, are sometimes called 
“universal donors.” Conversely, no arrows point away from Group AB for it 
contains no agglutinins and its serum will not agglutinate the cells of any other 
group, and individuals of this group are often spoken of as “universal recipients.” 
However, such bloods must be studied, when cross matched, before being de- 
clared suitable. The question of universal donors will be further discussed under 
the heading of precautions. 
To determine the group to which a blood belongs it is necessary to mix sep- 
arately a suspension of its red cells with serum of a known group A and group 
B which contain agglutinin b and agglutinin a, respectively. The resulting 
agglutination, or absence of agglutination, determines the group to which it 
belongs and is a necessary procedure with the blood of both the donor and 
recipient. One of four possible combinations of reactions, as shown in the 
following table, will result: 
Agglutinating Reactions of the Red Cells of the Four Blood Groups 
International blood group 
Serum A 
(b) 
Serum B 
(a) 
Jansky 
blood 
group 
Moss 
blood 
group 
0 
I 
IV 
A 
— 
+ 
11 
II 
B 
+ 
III 
III 
AB 
+ 
+ 
IV 
I 
— Denotes absence of agglutination. 
+ Denotes presence of agglutination. 
TECHNIQUE OF BLOOD GROUPING 
Preparation of grouping sera. 
Grouping sera A and B can readily be prepared, but are usually obtained from 
some large or central laboratory. Under absolutely sterile precautions collect 
blood by venipuncture from healthy young adult males of blood group A and of 
blood group B. Allow the bloods to clot, then loosen and separate the clots from 
the sera by centrifuging. Pipette oft the sera and determine their agglutinating 
power by titration of varying dilutions of the sera against proper red cell 
suspensions. 
For the purposes of preservation and distinctive coloration, to each cubic centi- 
meter of serum A add 0.01 cc of a 1 per cent aqueous solution of neutral acri- 
flavine and 0.01 cc of a 0.5 per cent aqueous solution of basic fuchsin, and to 
each cubic centimeter of serum B add 0.02 cc of an aqueous solution of brilliant 
green. Store in ampules or vials of suitable size. 
Preparation of the suspension of red cells to be grouped. 
As fresh cells are necessary this procedure should be done immediately, at 
least not more than 2 hours, before the test is to be done. From a needle prick of 
the finger, or of the ear lohe, collect two drops of blood (four drops if anaemic) 
in a small test tube containing 4 cubic centimeters of 1 per cent solution of 
sodium citrate made up in 0.85 per cent sodium chloride solution. Mix thor- 
oughly by sucking the mixture up and down with a clean medicine dropper 
which is left in the tube for future mixture and transference. BLOOD GROUPING AND MATCHING 
859 
Procedure for grouping. 
Slide Method.—When only a few bloods are to be grouped this method will be 
found convenient and satisfactory. With a blue wax pencil mark a capital letter 
A on the left end of a 
clean, double, hollow- 
ground slide, and on the 
right end a capital letter 
B; then rim the concavi- 
ties with petrolatum. In 
the left concavity place 
one drop of grouping se- 
rum A and in the right, 
one drop of grouping se- 
rum B. Then to each add 
one drop of physiological 
salt solution and one drop 
of the red-cell suspension. 
The sera, salt solution, 
and cell suspension are 
mixed thoroughly by stir- 
ring with individual clean 
toothpicks or by rotating 
and tilting. Drop a cover 
glass on the petrolatum 
ring to prevent evapora- 
tion. The preparation is 
then examined at inter- 
vals under the low power 
lens of a microscope for 
the presence or absence 
of agglutination. Aggluti- 
nation usually takes place 
in from 5 to 10 minutes, 
but if it does not the 
preparation should be in- 
spected at intervals for 1 
hour because the aggluti- 
nogens may be weak and 
the red cells may not 
clump for 45 minutes or 
more. If agglutination 
takes place the red cells 
gather in dense, irregular 
groups which appear to 
the naked eye as “brickdust” granules which will not be broken up by stirring or 
shaking. If there is no agglutination, the red cells will be fairly evenly distri- 
buted over the field and will remain so for hours. 
Caution: Droppers must only be used in their respective sera and cell suspen- 
sions. Toothpicks used for mixing serum A and the cell suspension must not 
be used for mixing serum B and cell suspension, and vice versa. 
For interpretation of results see table on page 858 and figure 159. 
GROUP O 
SERUro A 
SERon 0 
NO AGGLUTINATION 
GROUP A 
NO AQQLUTI NATION 
SERun A 
SERun 9 
NO AGGLUTINATION 
AGGLUTINATION 
GROUP 6 
5£RUn A 
SERUAl B 
AGGLUTINATION 
(VO AGGLUTINATION 
GROUP A0 
5ERUn A 
SERun 6 
AGGLUTINATION 
AGGLUTINATION 
Figuee 159.—Agglutinating reactions of the red cells of 
the four blood groups with grouping sera A and B. 
Slide method. (Magnification about 100 x.) 
154294°—39 55 860 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Test Tube Method.—When a large number of bloods are to be grouped this 
method is recommended. Set up a double row of test tubes, measuring 1.0 cm. 
inside diameter by about 7.5 cm. long, in Kahn or other suitable test tube racks. 
Each pair of tubes is numbered consecutively, i. e. both tubes of the left hand 
pair are labeled #1, the next pair #2, etc. Deliver to the bottom of each tube 
in the front row one drop of serum A, to the bottom of each tube in the back 
row one drop of serum B, and to the bottoms of all tubes one drop of physiological 
salt solution. Then to each tube of pair #1 add one drop of the cell suspension 
of the first blood to be grouped, 
and to each tube of pair #2 one 
drop of the cell suspension of 
the second blood to be grouped, 
etc., being careful that the cell 
suspension reaches the bottoms 
of the tubes, not the side walls. 
Give each rack a few short quick 
shakes to mix the contents of 
each tube. Observe and shake 
several times over a period of 
1 hour, giving the tubes a final 
shaking at the end of the hour, 
at which time the final reading 
is made. If there is agglutina- 
tion red clumps of cells may be 
seen by the naked eye, but if 
agglutination is doubtful or is 
apparently negative, transfer 
the contents of the tubes in 
question to a glass slide and 
observe under the low power lens of the microscope. The same cautions con- 
cerning droppers, etc., applies as in the slide method. There will be very little 
evaporation from the tubes during the time taken to perform the tests. Greater 
quantities of grouping sera, saline and cell suspension may be used, but the 
given amounts are satisfactory and grouping sera are not wasted. 
For interpretation of results see table on page 858 and figure 160. 
Cross matching. 
When the recipient’s or patient’s blood group is ascertained, a donor of the 
same group is obtained. From a vein of the patient draw 3 or 4 cc of blood 
into a syringe. Using two drops, of the blood prepare a cell suspension, as pre- 
viously described. Place the remaining blood into another tube and allow to 
clot in order to obtain the serum as described under preparation of grouping 
sera. Blood from the donor is similarly collected and treated. Mark a double 
hollow-ground glass slide as shown in figure 161. On the left side place one drop 
of the patient’s serum and one drop of the donor’s cell suspension. On the right 
side place one drop of the donor’s serum and one drop of the patient’s cell 
suspension. Mix and proceed as in the slide method of grouping. If no agglu- 
tination or haemolysis on either side takes place in 60 minutes the bloods are 
compatible. If agglutination or haemolysis takes place on either side, or both 
sides, they are not compatible and another donor must be cross matched. How- 
ever, in extreme emergency a blood may be used for transfusion which shows 
agglutination or haemolysis of the patient’s cells by the donor’s serum, as the 
donor’s serum is greatly diluted in the patient’s blood. If the serum of the 
Figure 160.—Agglutinating reactions of red cells ; 
test-tube method. 1. No agglutination. 2. 
Agglutination in numerous small clumps. 3. 
Agglutination in one large clump. (All after 
shaking.) 861 
BLOOD GROUPING AND MATCHING 
patient agglutinates or hsemolyzes the donor’s cells the blood of the donor must 
not under any circumstances be used in transfusing the particular patient. 
Precautions. 
1. Grouping sera of high 
agglutinating titre must be 
used to avoid false negative 
reactions, but the titre 
should not be high enough 
to cause rapid haemolysis as 
it will mask the results. 
Freshly prepared grouping 
sera are more likely to 
cause haemolysis. 
2. Stock grouping sera 
should be checked frequent- 
ly for deterioration. 
3. Avoid low tempera- 
tures in doing the test as 
it will occasionally bring 
out a so-called “cold agglu- 
tinin”, besides slowing up 
the reactions. Room tem- 
perature or 37° C. is best. 
4. Do not let prepara- 
tions dry out—the reason 
for the petrolatum ring. 
5. All suspension must 
be fresh or the cells may be 
agglutinated by all sera. 
6. Avoid too heavy cell 
suspensions and keep them 
mixed to cut down rouleau 
formation which might be 
mistaken for agglutination. 
7. Weak agglutinogens or 
agglutinins may lead to 
false group determinations 
or cross matchings, so allow 
the full hour’s observation 
in doubtful or apparently 
negative reactions and observe under the microscope before the final conclusion 
is made. 
8. In cases of repeated transfusions cross match before each transfusion, even 
though the same donor is to be used and was previously compatible. Iso- 
antibodies may have developed in the blood of the patient and cause a severe 
reaction. 
9. The so-called “universal donors”, i. e. those of group O, are frequently used 
as it is assumed that their cells are not agglutinated by any human sera. Severe 
and even fatal reactions have occurred because certain group O sera contain 
strong agglutinins for A cells or B cells, or for both. It is better that the 
recipient and donor be of the same group. 
DS=Donors Serum 
pC=PoVienl'S Cells 
Figure 161.—Slide marked for cross matching. 
PS = Pahenfs Serum 
DC = Donors Cells 862 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
10. Be certain all slides and tubes are labeled correctly and that the results 
are recorded correctly and properly. 
11. Cross match before every transfusion as it may save much embarrassment. 
SELECTION OF A DONOR 
The donor must be a healthy individual, preferably a young male, free from 
infectious diseases. Syphilis and malaria must be excluded. A Kahn or Wasser- 
mann test should be done on every donor just prior to giving blood for a trans- 
fusion, but a history and careful physical examination are also necessary. 
Syphilis has been conveyed by blood from donors with primary syphilis but 
whose Wassermann reactions were negative. Malaria has been transmitted, even 
from old latent cases. It is much safer to reject all donors with a history of 
syphilis or malaria even though their bloods are negative. 
A donor should not be used a second time until his blood volume, haemoglobin 
and red cell count have returned to normal; which is usually from 4 to 6 weeks. 
Practical Bacteriology, Haematology, and Animal Parasitology.—Stitt, Clough, & Clough. 
Diseases of the Blood and Atlas of Haematology.—Kracke and Garver. 
Laboratory Manual of Haematological Technique.—Beck. 
Surgical Pathology.—Boyd. 
Practice of Medicine.—Tice. Vol. I. 
Blood Groups and Blood Transfusions.—Wiener. 
References 
Section 4.—CHEMICAL WARFARE 
The subject of chemical warfare is a matter of considerable importance to 
the Hospital Corps of the Navy for several reasons. While an authentic in- 
stance of the use of poison gas at sea is lacking, it is possible that it may be 
used in naval battles of the future. Hospital corpsmen are subject to detail 
with the Marine Corps in operations ashore, in which case their problems are 
identical in most respects with those of the medical department personnel of 
the Army. Furthermore, it may develop upon the Hospital Corps to assist 
ashore in the care of casualties among the civilian population and in the care 
in naval hospitals of patients suffering after-effects of war poisoning who for- 
merly were attached to and received their injuries during service in the Army 
or the Marine Corps. 
The hospital corpsman should have a thorough knowledge of the following 
aspects of chemical warfare: History of chemical warfare; general information 
about the chemical warfare agents; methods of use of agents in weapons and 
munitions; protection, individual and collective; and decontamination of mate- 
rial. The book “Service Chemicals, United States Navy, 1936”, should be used 
for this instruction. The paragraphs following will describe the physiological 
action of these agents and the first aid to chemical casualties. 
MEDICAL ASPECTS OF CHEMICAL WARFARE 
The important chemical warfare agents are few in number, but during a war 
new agents or new combinations may be expected at any time. To better 
understand the actions of these agents they will be divided or classified accord- 
ing to their physiological action on man. It is impossible to draw hard and 
fast lines of distinction as the groups overlap somewhat in their physiological CHEMICAL WARFARE 
863 
effects. The agents used in chemical warfare are physiologically classed as: 
1. Lacrimators (tear gases) ; Example: Chloracetophenone (CN) ; 
2. Irritant smokes (sternutators, sneeze gases) ; Examples: Diphenylchlorar- 
sine (DA) ; Diphcnylaminechlorarsine (DM) ; 
3. Burns seccmdary to incendiaries; Examples: Thermit; White Phosphorus; 
4. Lung irritants; Examples: Chlorine (Cl); Phosgene (GG) ; Chlorpicrin 
(PS); (Secondary to explosions: Nitrous fumes; Irritant effects of ammonia 
fumes); 
5. Vesicants; Examples: Mustard gas (HS) ; Lewisite (M-l) ; 
6. Paralysants (direct poison of nervous system); Example; Hydrocyanic 
Acid (HCN) ; and 
7. Asphyxiants (secondary to explosions) ; Example: Carbon monoxide (CO). 
Generally speaking, all of the gases in a given group will manifest similar 
actions and produce similar effects; therefore, with slight modifications, a single 
description for a particular group will suffice for all the members of that divi- 
sion. However, it must be understood that high concentrations of lacrimatory, 
vesicant, and sternutatory gases may cause severe lung injury and eye irritation. 
The summary of symptoms and first-aid treatment of casualties caused by 
exposure to chemical agents (Fig. 162) is included for quick reference in study 
and during an emergency. 
Lacrimatory gases. 
Physiological Action.—Lacrimatory gases, such as chloracetophenone and 
brombenzylcyanide, are used for the purpose of putting men out of action by 
interfering with their vision, and not with the idea of producing serious casual- 
ties. Small traces of these substances cause profuse lacrimation, smarting of 
the eyes, and spasm of the eyelids, making it impossible for the individual 
affected to keep his eyes open. These gases produce their intended results with 
much lower concentrations than is required in the case of the other types of 
gases. Some of these lacrimatory or tear gases are effective when present in 
a concentration of one part of gas in 25,000,000 parts of air. Strong concentra- 
tions cause irritation of the respiratory passages, nausea, and vomiting. On 
leaving the poisonous atmosphere the symptoms subside in the matter of half 
an hour or less, depending upon the gas encountered, and no subsequent toxic 
effects are noted other than a slight redness of the eyelids and a moderate 
inflammation of the conjunctiva. 
First-aid Treatment.—Affected men should leave the contaminated atmos- 
phere and face the wind, allowing it to blow into their eyes. They should be 
directed not to rub their eyes; their clothing and equipment should be loosened 
so as to get rid of entrapped gas. Bathing the eyes in cold water or with a 
weak boric acid or sodium bicarbonate solution (2 per cent) will aid. For skin 
irritation, wash with soap and water and apply weak sodium bicarbonate 
solution. 
Irritant smokes. 
Physiological Action.—Gases of this class, typified by diphenylchlorarsine, 
are very effective in low concentrations, producing congestion of the upper air 
passages with consequent severe pain in the sinuses, irritation of eyes with 
lacrimation, and irritation of the lungs with a feeling of suffocation. There is 
excessive nasal secretion, ropy saliva, and severe headache. If exposure is pro- 
longed, aching pains in the stomach and numbness of the limbs results. A 
delayed effect is severe mental depression; men seriously affected often show 
loss of mental control and considerable weakness of legs. Practically all cas- 
ualties recover in 12 to 24 hours. 864 
HANDBOOK OF THE HOSPITAL CORPS, XI. S. NAVY 
CHEMICAL WARFARE 
865 
Symptoms in order of 
severity 
Type of agents 
Agent 
Special peculiarities 
Time of appearance of 
symptoms 
First-aid treatment 
Irritation of eyes. 
Copious flow of tears. 
Blindness (temporary). 
LACRIMATORS 
C hloracetophenone. 
Brombenzylcyanide. 
Chlorpicrin (ordinary 
field concentration). 
Burning sensation on 
skin. 
May cause vomiting. 
Immediate. 
Immediate. 
Immediate. 
Remove temporarily from gas atmosphere; have 
man face wind. He should not rub his eyes. 
Bathing eyes with boric acid solution or bicar- 
bonate of soda solution or even plain cold water 
helpful. Symptoms shortly disappear. Do not 
evacuate. 
Irritation nose and throat. 
Watery discharge from 
nose. 
Coughing. 
Pain at base of nose. 
Severe headache. 
Nausea. 
Mental and physical de- 
pression. 
IRRITANT 
gases 
(STERNUTA- 
TORS). 
Diphenylchlorarsine. 
Diphenylamine-chlor- 
arsine. 
Irritation immediate; 
other effects may be 
delayed 30 minutes or 
longer. 
Put man at rest, loosen clothing, bathe nose and 
throat with salt water or bicarbonate of soda 
solution. Breathing chlorine as given off from 
bottle of chloride of lime beneficial. Keep away 
from heat. 
Mild cases need not be evacuated; more serious 
cases should be. 
Bums on body. 
INCENDIAR- 
IES 
White Phosphorus. 
Thermits and solid oils. 
Burning particles adhere 
to flesh. 
Cause heat burns—set 
fire to clothing. 
Immediate. 
Immediate. 
Immerse affected part in water to stop burning 
of phosphorus and pick out phosphorus particles 
from flesh. Apply mud or damp earth as tempo- 
rary expedient if water not available. If copper 
sulfate solution available, apply immediately. 
It forms coating over phosphorus particles; 
stops their burning and makes them readily 
visible so that they may be picked out. Evacuate 
severe cases. 
Other incendiaries: Treat as any ordinary bum— 
bandage. 
Irritation nose and throat. 
Coughing. 
Difficult breathing. 
Pains in chest. 
Retching—vomiting. 
Strangulation. 
Blue pallor—lips, ear lobes. 
Grayish pallor face. 
LUNG IRRI- 
TANTS 
Chlorine. 
Chlorpicrin (high con- 
centration) . 
Phosgene. 
Intense irritation of 
throat; violent cough- 
ing. 
Lacrimation and vomit- 
ing. 
Nonirritating except in 
high concentration. 
Immediate. 
Usually immediate. 
Often delayed. 
Remove man from gas atmosphere; loosen clothing; 
keep at absolute rest lying down; do not allow to 
walk; keep warm with blankets, hot water bottle, 
etc.; give nonalcoholic stimulants—hot coffee or 
tea; administration of oxygen frequently re- 
quired in severe cases; evacuate to aid station as 
soon as possible. 
VESICANTS i 
If face has been exposed to either mustard or 
Lewisite vapor, bathe the eyes, nose, and throat 
with solution of boric acid, bicarbonate of soda, 
or common salt; and if vapor has been breathed- 
treat and handle as for lung irritant casualty. 
Eye effects: 
Irritation. 
Inflammation of lids. 
Inflammation of cornea. 
Blindness (usually tem- 
porary; rarely per- 
manent). 
Skin effects: 
Redness or rash. 
Intense itching. 
Blisters. 
Ulcers. 
Granulation and slough- 
ing of tissue. 
Mustard gas. 
Lewisite. 
Skin burns not painful; 
no effect noticed when 
exposed to gas, hence 
its insidious character. 
Vapor causes sneezing, 
often at once. 
Liquid-burns first ap- 
pear as grayish 
splotches. Burns not 
painful. 
Secondary effects—ar- 
senic poisoning. 
Delayed: 
Vapor—2 to 6 hrs. 
Liquid—15 min. to 
1 hr. 
Delayed: 
15 min. to 1 hour. 
Skin burns: . x ... 
Mustard vapor.—Immediate soap and water bath 
may prevent or lessen casualties; but no treat- 
ment is of much value after long exposure to 
vapor. . ,, 
Mustard liquid— Swab affected area repeatedly 
with oily solvent, such as kerosene, gasoline, 
lubricating oil, or carbon tetrachloride (pyrene), 
using fresh cloth or cotton for each swabbing. 
Then follow with thorough scrubbing with soap 
and water. ... 
(Weak solution of chloride of lime, or “bleach”, 
may be used instead of oily solvent; but this 
solution is irritating, and must be removed in 
subsequent washing.) 
Lewisite vapor— Scrub thoroughly with soap and 
water; and apply dressing of ferric hydrate paste. 
Lewisite liquid— Apply hydrolyzing agent, such as 
5 per cent solution of sodium hydroxide (caustic 
soda); scrub thoroughly with soap and water; 
and apply dressing of ferric hydrate paste. 
Supply fresh uncontarainated clothing; and evacu- 
ate all but the most minor casualties from any 
vesicant as soon as possible. 
Faintness, dizziness, dry- 
ness of throat, rush of 
blood to head, uncon- 
sciousness, death. 
Hydrocyanic acid gas. 
HON even in low con- 
centration usually fa- 
tal in few minutes. 
Respiration is one vital requirement. Remove 
patient to pure atmosphere, and begin artificial 
respiration immediately. Dashing cold water on 
face and chest may help to restore breathing. 
If available, and during artificial respiration, have 
patient breathe fumes of ammonia or of amyl 
nitrite. (Additional oxygen not necessary). 
Blurring of sight, weakness 
of knees, roaring in ears, 
pain in stomach, sweetish 
taste, muscular weak- 
ness, unconsciousness, 
failure of respiration, 
death. 
Cyanosis; and usually blu- 
ish or red splotches on 
skin. 
PARALYS- 
ANTS 
Carbon monoxide. 
\ 
C 0 being odorless is fre- 
quently not detected 
in time to avoid it. 
Generally fatal. 
Remove patient to pure atmosphere, and, if breath- 
ing has ceased, begin artificial respiration imme- 
diately. Dashing cold water on face and chest 
may help to restore breathing. 
Additional oxygen vitally necessary; and, if avail- 
able, administer oxygen-carbon dioxide mixture. 
Watch out for relapse. 
i All the vesicant agents are extremely toxic. If breathed, they cause severe inflammation of the lungs likely to result in bacterial infection and pneumonia. For effects of breath- 
ing, first aid as prescribed for lung irritants should be rendered. 
Figure 162.—Summary of Symptoms and First-Aid Treatment of Casualties Caused by Exposure to Chemical Agents 866 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
First-aid Treatment.—The slightly affected patient will recover in a short 
time after rest in fresh air. In the severe cases, however, the following meas- 
ures are recommended. Use a 5 per cent sodium bicarbonate solution! for nasal 
irrigation and as a gargle. Have patient inhale a low concentration of chlorine 
until symptoms are relieved. The concentration of chlorine evolved from a 
bottle of bleach will be satisfactory for this purpose. Wash the exposed surfaces 
of the body with soap and water. 
Burns secondary to screening smokes and white phosphorus. 
Physiological Action.—Burns resulting from screening smokes and incen- 
diaries, except phosphorus, can be treated like a heat burn. White phosphorus 
is used for smoke screens and flying particles of burning phosphorus which hit 
the skin will continue to burn, unless smothered. 
First-aid Treatment.—Immerse the affected part in water or use a wet pad 
to stop the burning of the phosphorus. The solid particles should be picked out 
of the flesh. As phosphorus melts at 44° C. (112° F.) it is advantageous to 
apply hot water at this temperature or above and remove the melted phosphorus 
from the wounds by a gauze sponge. All particles of phosphorus must be 
removed as there is danger of phosphorus poisoning by absorption. 
An excellent first-aid procedure, if available, is the prompt application of an 
approximately 2 per cent solution of copper sulfate in water; this solution forms 
a thin coating of copper phosphide on the phosphorus particles, and stops the 
burning at once, after which the coated particles can be picked out of the flesh. 
Apply the copper sulfate solution by pouring on or with a pledget of cotton. 
Dress the burned areas as for heat burns. 
Lung irritants. 
The common agents of this group are chlorine, phosgene, and chlorpicrin. 
While chlorine was used repeatedly during the World War, it probably will not 
be used alone to any extent in the future. Chlorpicrin may be used in future 
chemical warfare. Phosgene will be considered as the typical agent of this 
group. 
Physiological Action of Phosgene.—Phosgene is a liquid which boils at 
46.8° F. with the formation of a colorless cloud. Vapor density as compared 
to air is 3.4 so that the vapor fills trenches and low areas. It has a charac- 
teristic odor of musty hay and is detectable in low concentrations. Phosgene 
is 10 times more toxic than chlorpicrin. Phosgene has a persistency of about 
5 minutes in the open in summer and 10 minutes in the open in winter. 
Lung irritants act upon the respiratory tract causing inflammation of these 
structures. Chlorine and chlorpicrin act upon the upper respiratory passages 
as well as the lungs. Phosgene acts primarily upon the lung tissues. The 
resulting inflammation of the lung alveoli hinders the oxygen exchange with the 
blood. The lung capillaries are injured by the gas so that the circulation of 
blood through the lung is impeded. The patient becomes cyanotic, a condition 
of blueness of the face, hands, and feet. The degree of injury to the lungs 
depends upon the concentration of the gas and the length of time it is breathed. 
High concentrations of phosgene can cause severe injury to the lungs so that 
oedema, a condition of fluid in the alveoli of the lungs, may appear in a short 
time. Usually, however, moderate concentrations of phosgene will cause a 
slower development of severe symptoms so that oedema appears only after 
several hours and after some exertion. 
High concentrations of chlorine or chlorpicrin will produce immediate irrita- 
tion of the throat and lungs with holding of the breath, followed by a strangling 
type of cough and constriction and pain in the chest. When the patient is CHEMICAL WARFARE 
867 
removed to fresh air the symptoms will be somewhat ameliorated but he will 
evidence a great discomfort in the chest. Vomiting, headache, and prostration 
are evident. A paroxysmal cough, often followed by vomiting, may remain for 
some time afterwards. In contrast there is a marked latent period after breath- 
ing a moderate concentration of phosgene. This interval may extend for several 
hours. Soldiers gassed with phosgene during the World War often walked 
several miles before severe symptoms appeared. This delayed action char- 
acterizes many of the lung irritant gases including nitrous fumes from burning 
powder. 
The cases in which pulmonary oedema develops to a serious extent tend to 
fall into two groups. The first group—blue type of asphyxia—comprises cases 
which show definite venous engorgement; the face is congested and deeply 
cyanosed, the lips and tongue are a full blue color, and there may be visible 
distention of the superficial veins of the face, neck, and chest. The breathing 
is increased not only in frequency, but the actual amount of air reaching the 
lungs per minute is markedly above normal. Cough may be present, and expec- 
toration of large quantities of thin frothy fluid is more likely to occur in this 
group than in the other. The pulse rate is usually little over 100 per minute 
and is full and of good tension. Cases in the second group—the gray type of 
asphyxia—show an ashen pallor rather than deep cyanosis, the lips being pale 
and leaden colored, and they are in a general state of circulatory collapse. 
Respiration is rapid and shallow in character. Though the lungs are intensely 
oedematous, there is often little expectoration and cough is infrequent. The 
pulse is very rapid (130-140 per minute), weak, and running. The prognosis 
is less favorable than in the first group. Sometimes a case which at an earlier 
stage has shown congestive cyanosis with a full pulse will develop cardio- 
circulatory failure and will gradually assume a gray pallor while the pulse 
accelerates and weakens. 
Fibst-aid Treatment.—Certain features of treatment can be carried out only 
by a medical officer. However, the proper handling of these cases by the 
stretcher and first-aid parties is very important; it is therefore necessary that 
hospital corpsmen be thoroughly acquainted with the therapeutic measures. 
Such procedures as blood letting should be understood by him so that he will 
be better able to assist the medical officer. In general, therapeutic measures 
are carried out as described hereafter. 
If there is doubt that a man has been gassed by a lung irritant gas, he should 
be closely watched for 24 hours at the first-aid station for signs of lung irritation 
and be kept both warm and quiet. 
Casualties should be handled as follows: 
1. Remove from gassed areas or compartments. 
2. Force patient to lie down so as to conserve oxygen. 
3. Keep warm with blankets and hot water bottles. Give hot drinks. 
4. Evacuate only by stretcher or ambulance. 
5. Give oxygen by inhalation to severely affected cases. 
blood letting.—Even at the first-line dressing station the patient who pre- 
sents pulmonary oedema, signs of suffocation and of cyanosis, with frothing at 
the lips, should be bled as soon as possible. Bleeding is contra-indicated in 
the gray cases. Remove 300 to 600 cc of blood from a vein, using a large bore 
needle. 
oxygen inhalation.—Administer oxygen by a multi-perforated nasal catheter; 
tip of catheter should be visible in posterior pharynx. Oxygen should be ad- 
ministered carefully at low pressure, and whenever possible the gas should 868 
HANDBOOK OF THE HOSPITAL, CORPS, U. S. NAVY 
be passed through water. Determine a rate of flow which is both comfortable 
and will relieve the cyanosis, and continue the administration at this rate for 
about 5 out of every 15 minutes in order to conserve the oxygen supply. 
postural drainage.—Elevate the foot of the stretcher or bed about 18 inches, 
at intervals, to aid in drainage of fluid from the upper air passages. Remove 
secretions from mouth and throat to aid in keeping the air passages clear. 
Nitrous fumes. 
Physiological Action.—When powder is burned, especially in a compartment, 
nitrous fumes are formed consisting largely of nitric oxide and nitrogen per- 
oxide. Carbon monoxide is also present. The Navy gas mask does not protect 
against these gases; the oxygen breathing apparatus should be worn by those 
entering such a compartment. 
Nitrous fumes produce a slight irritation of the eyes and upper respiratory 
passages, with slight cough. As in phosgene poisoning, there is a latent period, 
often terminated by undue exertion; symptoms of lung irritation such as cough, 
pain and constriction in the chest, and breathlessness ensue. If there has been 
severe poisoning, pulmonary oedema results as in phosgene poisoning, often 
terminating fatally. 
First-aid Treatment.—First-aid measures are the same as those recommended 
for phosgene poisoning. 
Vesicant gases (blistering gases). (Mustard gas and Lewisite.) 
Physiological Action.—Mustard gas possesses two properties which differenti- 
ate it from other warfare gases and render it a particularly difficult weapon to 
protect oneself against. These properties are persistence and insidiousness. 
A single inhalation of most war gases, as for example, chlorine and chlorpic- 
rin, causes immediate irritation and institutes a defensive reflex at once. Not 
so with mustard gas. The action of this poison is not accompanied at first 
with any painful sensation. The only warning is a faint garlic or mustard 
odor. Nevertheless the gas is causing changes in the skin, eyes, and respiratory 
tract that later will be attended with severe symptoms. Experiments have 
shown that a saturated vapor of mustard gas in contact with the skin for 1 
minute will later produce an erythema. Those who are unfamiliar with the 
insidiousness of mustard gas frequently fall into the error of thinking that the 
absence of early irritation indicates a concentration which is too low to be 
harmful. 
The explosion of a mustard-gas shell sprinkles the surrounding area with a 
heavy liquid that tends to evaporate very slowly in cold weather and quite 
slowly even in warm weather. Consequently, contaminated objects remain so, 
and are dangerous, for a long period afterwards. The heavy liquid soaks into 
any porous material and continues to give off toxic and blistering vapors. 
Hence, long after an actual bombardment has ceased there is always the possi- 
bility that there will be casualties among troops that occupy shelled areas. 
This has been known to happen as long as 2 weeks after a bombardment. 
When dealing with lung-irritant gases one is apt to gauge the effectiveness 
of the gas by its killing power. It is necessary to regard mustard gas in a 
different light. Its value lies in its incapacitating power. 
On the average the first symptoms appear 2 or 3 hours after exposure; with 
higher concentrations symptoms occur earlier, possibly in less than 2 hours; 
while with very low concentrations the appearance of symptoms may be delayed 
for as long as 24 to 48 hours. 
The clinical picture of mustard gas poisoning, in general outline, is about 
as follows: Several hours after exposure there occurs a smarting of the eyes CHEMICAL WARFARE 
869 
with watery discharge, and a swelling of the eyelids. Erythema of the skin 
appears about the same time as the eye symptoms, usually about the face, 
chest, buttocks, and between the thighs. 
Inflammatory manifestations of the respiratory passages begin to appear 
about the second day after exposure, and are characterized by pharyngitis, 
laryngitis, tracheitis, and bronchitis. The earliest symptoms referable to the 
lesions in the air passages are hoarseness and cough. Often the cough is pain- 
ful and incessant. The outstanding fact in connection with these lesions is the 
formation of a false membrane lining the trachea and bronchi. This is the 
result of the direct action of the gas. The patient brings up thick purulent or 
bloody sputum, fragments of the false membrane, or even a cast of the portion 
of the trachea or bronchi. 
In the World War the British, French, and American masks protected against 
any concentration of mustard gas attained in the field, therefore most of the 
cases admitted for treatment in the allied forces showed only skin lesions and 
conjunctivitis. Although these lesions were distressing in the symptoms they 
produced and kept the patient on the sick list for several weeks, rarely if 
ever, did they, in the absence of involvement of the respiratory organs, cause 
death. A fatal outcome usually is the result of the direct action of the gas 
on the respiratory passages or to a secondary infection in the lungs. 
In the American Army there were 70,552 admissions as the result of poison 
gas; of these 27,711 were caused by mustard gas; 1,843 by chlorine; 6,834 
by phosgene; and 577 by arsine. Mustard gas caused the loss of 1,286,784 days 
to the American Expeditionary Forces, as compared with 12,545,442 days lost 
as the result of all battle injuries. From this it would appear that mustard 
gas must be placed in the foremost rank as a producer of casualties. The 
Germans originally placed mustard gas in the smaller artillery shells, but later 
they employed shells of all calibers as gas carriers. Mustard gas will probably 
be dispersed in the future in shells, bombs, and by spray from airplanes. 
Fibst-aid Treatment.—(a) preventive measures. The following prophylactic 
measures are recommended for use after exposure to a contaminated atmos- 
phere or when bare skin or outer clothing has been sprayed with liquid mustard. 
If prophylactic treatment is started immediately after contamination it will 
prevent, or markedly reduce, the degree of burn. Supplies should be made 
available so that alternative methods may be used if part of the prophylactic 
material is lost during action. 
1. Alcohol-carbon tetrachloride mixture.—Make a mixture of equal parts of 
95 per cent alcohol (ethyl) and carbon tetrachloride. The mixture is non- 
inflammable in storage. When exposed to the air for about 1 minute it becomes 
inflammable, due to the evaporation of the carbon tetrachloride. Adjust masks 
before applying this solution as the fumes of carbon tetrachloride are toxic. 
While alcohol and carbon tetrachloride each are good solvents, the former is 
inflammable and the latter is dangerous in high concentration. Kerosene is 
a good solvent, but is inflammable and irritates the skin. Immediately after 
being contaminated with spray or splash of mustard gas, swab all exposed 
surfaces, using the method of swabbing described in the following paragraph. 
Follow the swabbing with soap-and-water wash when time is available. 
Hospital corpsmen should be trained, in applying alcohol-carbon tetrachloride 
mixture, to use all surfaces of the gauze sponge. Do not go over the same 
area of the skin several times with the same sponge surface or the mustard 
will be spread over uncontaminated skin surfaces. Cotton sponges are not 
efficient for the use of solvents for swabbing. The alcohol-carbon tetrachloride 
mixture is a good solvent for mustard but the resulting solution must be re- 870 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
moved from the skin by the gauze. Sopping or poulticing the alcohol carbon 
tetrachloride mixture on the skin will cause the mustard to penetrate widely and 
deeply. The gauze sponge should be used as would a rag to remove a splash 
of cylinder oil from the skin, at least three sponges being required for each 
arm or an equivalent area of skin. Each area should be gone over 3 times with 
the alcohol-carbon tetrachloride mixture. The flat surgical gauze sponge, 2 
by 2 inches in size, is recommended. It is estimated that 12 sponges will be 
required for each man. At least 100 cc of alcohol-carbon tetrachloride mixture 
should be available for each man for one decontamination. Hospital corpsmen 
should wear rubber gloves, gas mask, and protective clothing. If gloves are 
not available for personnel using the solvents, they should sponge the hands 
with the alcohol-carbon tetrachloride mixture, following with soap and water, 
after completing prophylactic treatment. The hands may also be treated with 
a thin bleach paste as described in a later paragraph. 
2. Soap and water method.—Scrub with Navy salt water soap or a strong 
alkaline laundry soap (yellow laundry soap) and water (preferably hot). 
Tincture of green soap may also be used. Sea-water may be used with the salt- 
water soap if fresh water is not available. The amount of mustard removed 
depends upon the thoroughness of the brushing of the contaminated skin. 
Soap and water is the medium for removal of mustard gas by emulsification. 
Use a flesh brush or piece of gauze with enough pressure to cause reddening of 
the skin surface. This brisk brushing removes some of the outer surface cells 
of the skin with grease, dirt, and absorbed mustard. The tender areas of the 
skin should be swabbed with gauze sponges. If soap is not available, or 
supplies for the other methods, follow the same procedure using large quantities 
of water. In an emergency this method will be of some benefit, if other 
methods! cannot be used. 
3. Bleach method.—Wet the areas of the body to be treated with water (fresh 
or salt) and apply a handful of bleach powder (high-test bleach) to the wetted 
skin and rub thoroughly, making a thin paste. Add more water or bleach 
powder as necessary to keep the paste thin. Allow" to remain on the skin 5 
minutes,; remove by washing with plain w-ater or soap and water. It may be 
necessary to remove the bleach paste from the tender areas of the skin in a 
shorter period, if the treatment causes discomfort and irritation. Keep bleach 
powder away from the eyes and nose; the gas mask wrill ensure protection to 
the eyes and nose. As bleach paste deteriorates on standing, the above pro- 
cedure assures an active preparation which can be quickly applied. 
//. Prophylactic measures for contaminated eyes.—These measures are to be 
carried out under the supervision of a medical officer. Use a 0.2 per cent 
chloramine solution or a 1-5000 solution of potassium permanganate, as soon 
as possible; apply solutions by means of eye cups, renewing solution several 
times. Follow this treatment by everting lids and swabbing the conjunctival 
surfaces, especially the fornix, with a cotton swab. (&) treatment of skin 
lesions.—The erythema requires only protection from friction and pressure, and 
the application of a dusting powder, or calamine lotion. Treatment of the 
deeper burns will be directed by the medical officer. 
Lewisite as used in the field is a heavy, dark, oily liquid, and has a char- 
acteristic odor of geraniums. It will persist for 24 hours in the open in summer, 
and about 1 week in winter. Lewisite, unlike mustard gas, will still be effective 
in very cold weather. Clothing contaminated with Lewisite becomes dangerous 
to wear and must be removed. 
Physiological Action.—Lewisite is very irritant to the respiratory system, 
and when the vapor is breathed there are immediate symptoms of nasal irri- CHEMICAL WARFARE 
871 
tation, coughing, and a subsequent bronchitis, which may lead to broncho- 
pneumonia. The Navy gas mask will protect against liquid and vapor Lewisite. 
This agent penetrates the skin on contact and causes a stinging sensation. 
The latent period is short, erythema and vesication resulting more rapidly 
than with mustard gas; erythema appears in about 15 minutes, vesication 
within 12 hours. If liquid Lewisite contaminates the eyes, as from airplane 
spray, there is immediate severe pain, lacrimation and spasm of the eyelids. The 
man becomes a casualty due to the ensuing inflammation of the conjunctiva 
and cornea. 
First-aid Treatment.— (a) prophylactic treatment. Immediately remove 
contaminated clothing and carry out prophylactic measures prescribed for 
mustard gas decontamination. Lewisite penetrates the skin very rapidly, hence 
measures, to be effective, must be used without delay. Lewisite can be neu- 
tralized by immediate application of a 5 per cent aqueous solution of sodium 
hydroxide (caustic soda) ; this should be followed by a thorough scrubbing 
with soap and water. (ft) treatment of burns. Cleanse the skin surrounding 
the blisters, as recommended in minor surgery. Open blisters, removing the 
epithelial covering, and irrigate the raw surface with antiseptic solution. This 
treatment will reduce the absorption of arsenic. The burned areas should be 
dressed with ferric hydrate paste, spread on gauze. 
Paralysants. (Hydrocyanic or prussic acid and carbon monoxide.) 
Physiological Action of Hydrocyanic Acid.—It is a rapidly acting poison and 
produces death under asphyxial symptoms, by hindering the oxidative processes 
of the tissues. It is also a general protoplasmic poison. Inhalation of hydro- 
cyanic acid in dilute concentration causes an unpleasant metallic taste in the 
mouth, faintness and dizziness, constriction and dryness of the throat, gasping 
for breath, headache, convulsions, unconsciousness, and even death. With 
higher concentrations the patient may fall unconscious, often with a loud cry, 
and die within a few minutes with or without convulsions. 
First-aid Treatment.—Remove patient to fresh air and give artificial respira- 
tion immediately. The rescue breathing apparatus should be used if available. 
Physiological Action of Carbon Monoxide.—This gas is not employed as a 
war gas but is of considerable importance through its occurrence in the combus- 
tion of gunpowder. It is found with the nitrous oxides in the fumes of burning 
powder. The explosion of a large bomb or shell in a compartment may result 
in a high concentration of this gas. Serious casualties may occur among those 
entering the compartment. The Navy gas mask does not protect against this 
gas, unless a special caunister is used. The oxygen-breathing rescue apparatus 
should be worn by those entering such a compartment. 
This gas is colorless, odorless, and tasteless, lighter than air, and diffuses 
rapidly in the open air, so that there is no warning of its presence. 
Probably the first symptoms noted in a case of moderate severity are dizziness, 
languor, headache, and weakness. Where the intoxication is more severe there 
is loss of consciousness, vomiting, convulsions, and cessation of respiration. This 
gas forms a firm compound with haemoglobin thereby preventing it from carry- 
ing oxygen, with resulting asphyxia. The skin and lips are often bright red 
due to the color of carbhsemoglobin. Death sometimes occurs abruptly through 
aspiration of vomited matter during unconsciousness. 
First-aid Treatment.—Remove patient from contaminated atmosphere. Clear 
respiratory passages, if necessary, of vomited material and secretions. If avail- 
able the rescue breathing apparatus for oxygen and carbon dioxide administra- 
tion should be used. Give artificial respiration by the Schaefer method. Do 872 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
not attempt to give liquids by mouth until patient is fully conscious. Watch 
for possible relapse. 
References 
The Medical Department of the United States Army in the World War. XIV, 1926. 
The Medical Aspects of Chemical Warfare.—E. B. Vedder. 
Service Chemicals, U. S. Navy. 1936. 
A Manual of Pharmacology.—T. Sollmann. 
Section 5.—DIVING AND SUBMARINE DUTY 
The submarine service consists of submarine tenders, submarine salvage 
vessels, submarines, and submarine bases. Hospital corpsmen are assigned to 
duty independent of medical officers aboard salvage vessels and the larger 
submarines. They should therefore be familiar with the section of this vol- 
ume dealing with independent duty. 
A great deal of diving is done from aboard salvage vessels, and hospital 
corpsmen assigned to duty aboard these vessels are usually qualified as divers, 
first class, after having completed the prescribed course at the Diving School, 
Navy Yard, Washington, D. C. They should therefore be thoroughly familiar 
with the physics and physiology of deep diving, and with the treatment of com- 
pressed-air illness. Detailed information on diving is given in the Diving Manual 
issued by the Bureau of Construction and Repair. 
Hospital corpsmen assigned to duty aboard submarines should read carefully 
the Bureau of Construction and Repair pamphlet “Submarine Safety—Respira- 
tion and Rescue Devices,” and they should become familiar with the methods of 
submarine escape with the submarine “lung.” This is essential in view of the 
fact that all personnel assigned to duty aboard submarines are required to 
qualify annually in the use of the “lung” by simulating escape from a depth 
of at least 18 feet. 
“Lung” training tanks are located at the submarine bases at New London, 
Conn., and Pearl Harbor, T. H. 
Contrary to popular belief, the crew of a submarine is subjected to no in- 
creased atmospheric pressure when the submarine dives. The true hull receives 
the pressure. Occasionally, due to compressed air leaks, there is a slightly 
greater barometric pressure present, but this is noted only by observing the 
barometer or by a crackling sound in the ears as the pressure becomes equalized 
on the two sides of the ear drums. 
While running on the surface in a calm sea, the ventilation scheme of a sub- 
marine is, in general, comparable to that of any surface ship. Natural ventila- 
tion through hatches, which may be left open, is of tremendous assistance in 
improving the habitability of the ship. This method is employed in conjunction 
with the use of compartment electric fans to impart motion to the air, and 
is aided by the hull ventilation system. The hull ventilation system consists 
of an exhaust blower in the motor room, the farthest compartment aft, which 
takes the air from that compartment and forces it through a large-diameter air 
line forward over the pressure hull and beneath the superstructure deck above 
to the torpedo room, the most forward compartment. It is drawn in by a 
supply blower and distributed by ducts and louvers to the various compartments. 
The hull ventilation system is of most value during submerged runs. In that 
SUBMARINE VENTILATION DIVING AND SUBMARINE DUTY 
873 
condition the ventilation line running beneath the superstructure decking and 
over the pressure hull is surrounded by sea water, and the contained air is not 
only cooled but moisture is taken out of the air. 
For obvious reasons it is not always possible to keep all hatches open on 
surface runs. It is usually necessary to close the torpedo room hatch and the 
access hatch just forward of the conning tower, to prevent seas being shipped. 
It may also be necessary to close the engine-room and motor-room hatches. 
Air for the Diesel engines is then taken through the conning-tower hatch and 
through the main induction system, primarily designed to take in air at a point 
high up near the periscopes and deliver it to the engines. 
Under the latter condition there is a considerable throbbing, to-and-fro move- 
ment of the air noticeable in the ears. It is of prime importance that the 
water-tight door leading from the control room (beneath the conning tower) to 
the engine room be kept open while the engines are running. If it should, by 
accident or carelessness, become closed a partial vacuum will be produced in 
the engine room in a short period of time, with serious effects on the engine-room 
personnel if the engines are not stopped immediately. 
During submerged runs all hatches and the main air-induction system are, 
of course, closed. Ventilation is then by the hull ventilation system and by 
electric fans in the various compartments. The air contained is simply agitated 
and moved about in the ship, as there is no communication with the outside. 
Under these conditions the temperature rises and the humidity is quite likely 
to become excessive. Indeed, most of the discomfort experienced by the crew 
is due to these changed physical properties of the air. The later types of sub- 
marines are equipped with air conditioning plants which are designed to 
reduce the dry bulb temperature and to decrease the humidity by mechanical 
refrigeration. The excess moisture removed from the air in the cooler is 
drained into the vessel’s sanitary tanks. 
Hospital corpsmen are often called upon to make observations of air con- 
ditions aboayd submarines. Therefore, they should be familiar with the 
essential states of atmosphere and the means of control employed. 
\ 
Katathermometer. 
This is an alcohol thermometer with a cylindrical bulb about 4 cm. long and 
2 cm. in diameter. It has a stem 20 cm. in length on which are two gradua- 
tions, one corresponding to a temperature of 100° F. and the other to 95° F. 
When using the instrument, the bulb is warmed to a temperature well above 
100° F. by means of a flask of hot water, and the bulb is then dried. The time 
required for the thermometer to cool from 100° F. to 95° F. is determined by 
a stop watch. Unavoidable differences in their size and conformation are 
corrected by a factor which is inscribed on each instrument. If the number 
of seconds required for the instrument to cool from 100° F. to 95° F, is divided 
into the factor, the so-called cooling power of the air is ascertained. It has 
been found that for persons engaged in light occupations, the cooling power 
of the air should attain a value of 6 or more, but may not unreasonably fall as 
low as 5. 
The calculation of the air velocity from the observed cooling power can be 
made by means of a chart furnished with each instrument. Thus, if the factor 
is 460 and the instrument cools in 160 seconds, the cooling power is 2.9 (nearly), 
and if the air temperature is 84° F., a line B taken from 2.9 on H through 
84° F., on the air temperature scale will indicate an air velocity of 45 feet per 
minute. 874 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
If the temperature of the atmosphere exceeds 90° F., the kata cooling rate 
will be too slow to record. The high temperature kata should then be used to 
obtain the air velocity, though its cooling power is not a measure of comfort. 
It can also be advantageously used for temperatures which approach 90° F. 
The high temperature kata cools from 130° to 125° F. Thus, if the factor of a 
high temperature kata is 410 and the instrument cools in 45 seconds, the cool- 
ing power is 9.2 and if the air 
temperature is 84° F., a line 
C taken from 9.2 on H through 
84° on the high temperature 
kata scale will indicate an air 
velocity of 45 feet per minute. 
Effective temperature. 
The numerical value of the 
effective temperature for any 
given air condition is fixed by 
the temperature of saturated 
air which at a velocity of 15 
to 25 feet per minute induces 
a sensation of warmth or cold 
like that of the given condition. 
Given the dry bulb tempera- 
ture and the velocity of air 
motion, the effective tempera- 
ture may be determined from 
the thermometric chart. 
Say the dry bulb tempera- 
ture is 76, the wet bulb temper- 
ature is 62, and the velocity of 
air is 100 feet per minute, the 
point where the line drawn 
through the wet and dry bulb 
temperature intersects the 100 
feet per minute curve gives 69° 
for the effective temperature. 
For optimum comfort, the ef- 
fective temperature should be 
between 66° and 71°, and the 
relative humidity should be 
between 30 and 70 per cent. 
It is important that when the sling psychrometer is used for determining the 
wet bulb temperature, the revolutions be as rapid as possible. It is usual 
to take temperature at 5 feet above the floor level, or what is termed the breath- 
ing line. 
Hydrogen. 
Separate and distinct from previously mentioned arrangements is the battery 
ventilation system. As nearly everyone has observed, an electric storage bat- 
tery gives off bubbles of gas constantly, mainly during the taking of a charge 
and particularly toward the end of a charge. This gas is hydrogen, a highly 
inflammable gas. When hydrogen is burned, two parts of this gas unite with 
one part of oxygen to form water. Considerable heat is produced. This 
gas is the most diffusible of all gases and passes through the meshes of the 
Figure 163.—Chart for determining kata cooling 
power and air velocity. DIVING AND SUBMARINE DUTY 
875 
Davy safety mining lamp, which prevents the production of explosions in mines. 
An air mixture containing 4.1 per cent of hydrogen is considered inflammable 
and 8 per cent is explosive. Instructions for the care and ventilation of bat 
teries are aimed to keep the hydrogen in the battery cells and ventilation 
ducts below 2 per cent, and it is usually well within these limits. Each 
battery compartment contains a Hydrogen Detector for determining the per- 
centage of hydrogen in the air of the system. Full details regarding the 
operation of this instrument are given in the Bureau of Construction and 
Repair Manual. Dangerous amounts are occasionally discovered in making 
an air analysis or they may be announced emphatically by a battery explosion. 
Figure 164.—Thermometric chart showing scale of effective temperature. 
The battery ventilation system of ducts and blowers can be made to dis- 
charge the battery gas overboard during surface runs or inboard during sub- 
merged runs. While hydrogen itself is odorless, a more or less strong acid 
odor is noted coming from the battery ducts during a submerged run. This is 
due to a minute envelope of sulfuric acid surrounding the hydrogen bubbles 
which come off from the battery cells. The blowers suck up some of the 
minute droplets and distribute them into the air of the battery compartment. 
This produces at times an unpleasant odor, often mistaken for chlorine. 
Chlorine. 
This gas is two and one half times heavier than air and remains close to 
the deck unless distributed by air currents. It is highly toxic, causing cough- 
ing when present in a concentration of 1 part in a million, dangerous if 
breathed in concentration of 10 parts per million for half an hour, and 
very dangerous in concentrations of 100 parts per million if breathed for a 
few minutes. This gas is produced in a submarine when sea water gets into 
a battery cell. The gas masks issued to submarine personnel protect against 
chlorine in the concentrations which may occur as a result of sea water 
accidentally getting into the battery cells. The canister of the submarine 
154294°—39 56 876 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
mask for protection against chlorine contains in addition to soda lime, Whet- 
lerite (activated charcoal impregnated with copper sulfate). The submarine 
“lungs” are now so designed that by the insertion of an appropriate canister 
they serve the purpose of a gas mask. 
Carbon monoxide. 
This gas results from the incomplete combustion of any kind of fuel and is 
a constituent of the exhaust gases of engines. It is also found after fires in 
closed compartments where there is an insufficient supply of oxygen. The 
gas, even if present in concentrations of 1 part in 10,000, combines with the 
blood to form a stable compound which will no longer carry oxygen to the 
tissues. Carbon monoxide is particularly dangerous because it is odorless, 
and those exposed to it are often unaware of any ill effects until they collapse. 
The canister of the submarine gas mask for protection against carbon mon- 
oxide contains Hopcolite, which converts carbon monoxide to carbon dioxide. 
It is necessary to keep these respirators free from moisture in tightly sealed 
containers. 
Carbon dioxide. 
There is only 0.03 per cent of carbon dioxide in pure atmospheric air. When 
the proportion of carbon dioxide rises to 3 per cent the rate of breathing begins 
to be noticeably increased; with 6 per cent carbon dioxide there is quite severe 
panting, and when more than 10 per cent carbon dioxide is breathed, the effect 
is to produce stupefaction. This effect is very marked with higher percentages, 
and it is interesting to note that carbon dioxide was one of the gases tried as 
an anaesthetic by Sir James Simpson before he adopted chloroform. 
Under conditions of bodily activity comparable to that aboard submarines, 
each man produces about 0.75 cubic foot of carbon dioxide an hour. The 
instructions for air purification aboard submarines are designed to limit the 
concentration of carbon dioxide so that it will not exceed 3 per cent. As 
the contained air in a submarine at the outset of a dive is pure, it will not 
reach the limiting value of 3 per cent carbon dioxide in any compartment 
until the expiration of x hours, which may be calculated from the formula 
3 X capacity in cubic feet 
0.75 X100 X No. of men 
When C is substituted for capacity in cubic feet and N for number of men, 
Q 
balancing this formula gives 0.04 hours when carbon dioxide will rise 
to 3 per cent. The capacity in cubic feet of different types of submarines is 
given in the Bureau of Construction and Repair Manual. 
Higgins-Marriott Carbon Dioxide Testing Outfits are supplied for determining 
the percentage of carbon dioxide. This consists of a rack of four standard 
tubes indicating 1 per cent, 2 per cent, 3 per cent, and 4 per cent carbon 
dioxide. A sample of air bubbled through a solution of sodium bicarbonate 
containing an indicator is matched with the standard tubes, and the percentage 
of carbon dioxide is thus read off. Complete instructions for operating the 
Higgins-Marriott instrument are given in the Bureau of Construction and 
Repair Manual. 
Air at normal atmospheric pressure containing as high as 3 per cent carbon 
dioxide can be breathed for short periods without danger. When the atmos- 
pheric pressure is abnormal, however, the physiological effects of carbon dioxide 
and other gases in the air breathed depend on their partial pressure. It is 877 
DIVING AND SUBMARINE DUTY 
only when the barometric pressure is constant that their actions depend on 
their percentage proportion. The method of calculating the partial pressure of 
carbon dioxide may be illustrated by an example. Let it be supposed that the 
barometric pressure is 760 mm (one atmosphere) and that 3 per cent carbon 
dioxide is found in the air. Of this pressure, then, 3 per cent is due to carbon 
760 
dioxide. Hence, the pressure of carbon dioxide is 3 =22.8 mm. or 3 per 
J-UU 
cent of an atmosphere, as 22.8 is 3 per cent of 760. Every 33 feet of sea water 
represents an atmosphere of excess pressure. Therefore, if a submarine escape 
compartment containing 3 per cent carbon dioxide is flooded to equalize the 
pressure of the outside sea water at a depth of 66 feet or 3 absolute atmospheres, 
the partial pressure of carbon dioxide will be increased threefold, and the 
physiological effect will be equivalent to that of air containing 9 per cent carbon 
dioxide. Prior to a flooding process, therefore, it is advisable to rapidly remove 
any excess carbon dioxide that may be present in an escape compartment. 
The Navy Standard carbon dioxide absorbent has been developed especially 
for air purification aboard submarines. One tenth of a pound will absorb 0.75 
cubic feet of carbon dioxide, the amount given off per man per hour. It is 
thus about 5 times more efficient than soda lime. It absorbs carbon dioxide by 
contact. Full instructions regarding the application of this chemical aboard 
submarines are found in the Bureau of Construction and Repair Manual. 
Oxygen. 
Pure atmospheric air contains 20.93 per cent oxygen. Just as in the case of 
carbon dioxide, the physiological action of oxygen in the air breathed depends 
on its partial pressure. The effects of a low percentage or decreased partial 
pressure of oxygen are well known. They are encountered among aviators, 
mountain climbers, and men who have been poisoned by carbon monoxide from 
illuminating gas or from the products of incomplete combustion in fires in 
closed spaces. If a person be exposed to an atmosphere in which the amount 
of oxygen is diminishing slowly, he gradually becomes acclimated by means 
of a physiological adaption of his blood circulation and respiration to the new 
conditions. On the other hand, men exposed to a rather sudden diminution in 
oxygen will show symptoms of mountain sickness, such as weakness, dizziness, 
blue color, rapid respiration, nausea, and finally collapse. Such symptoms are 
rarely ever encountered in a submarine—certainly not under normal operating 
conditions, because air purification is carried out long before the onset of these 
signs. These symptoms can be relieved by a return to air richer in oxygen or 
by the administration of oxygen from a cylinder. 
At present there is no oxygen test applicable for use in submarines simpler 
than the Orsatt. This apparatus is too fragile for routine issue to submarines. 
For practical purposes a lighted candle usually indicates air which contains 
sufficient oxygen for a man to breathe safely. But man and candle are pro- 
foundly different. The candle becomes extinguished when the oxygen falls to 
15 or 16 per cent, or about 114 mm. partial pressure, equivalent to the oxygen 
pressure at an altitude of 5,500 feet above sea level, approximately that of 
Denver, Colo, where people live healthy lives and candles burn normally 
because the atmospheric air contains 20.93 per cent oxygen. On the other hand, 
an atmosphere containing 5 per cent oxygen and compressed to 4 atmospheres 
pressure (the partial pressure of oxygen will then be nearly normal), will 
maintain a man perfectly in respect to oxygen, but a candle cannot be lighted. 
It is found that with the production of 0.75 cubic foot of carbon dioxide 
per man per hour each man consumes about 0.9 cubic foot of oxygen per hour. 878 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
It is not desirable for the oxygen to fall below about 17 per cent. Therefore, 
the formula for calculating x hours for limiting the value of 3 per cent carbon 
dioxide gives the approximate expiration of x hours for the contained air in 
the submerged vessel to reach 17 per cent oxygen. Hence, the instructions for 
air purification call for bleeding into the vessel 0.9 cubic foot of oxygen per man 
per hour when the carbon dioxide absorbent is required to be used. As 
normal atmospheric pressure corresponds to 14.7 pounds per square inch, the 
approximate quantity of oxygen desired is obtained by allowing the gauge 
pressure in the cylinder to drop in pounds per man equal to 0.9X14.7 divided 
by the net capacity of the cylinder in cubic feet. Thus, if the volume of the 
oxygen cylinder is 1.53 cubic feet and there is a crew of 43 men, oxygen is 
13 23 
released until the gauge pressure drops X 43=372 pounds. A new type of 
1.53 
outlet valve is now being installed, so that if the hand on the metering gauge 
is set for the number of men for whom oxygen is being supplied, about 0.9 cubic 
foot of oxygen per man is released. 
Oxygen at high partial pressure is well known to be toxic. It is desirable, 
therefore, to avoid any great increase in the percentage of oxygen above normal 
prior to a flooding process in an escape compartment, since the partial pressure 
of oxygen will increase in the same manner as considered in the discussion of 
carbon dioxide. 
On the other hand, if the oxygen percentage of the atmosphere is much 
below normal at the time of the flooding process, the percentage proportion of 
nitrogen will be increased, and the partial pressure of nitrogen will be corre- 
spondingly increased, and susceptibility to compressed air illness may be 
increased. 
Nitrogen. 
Normal atmospheric air contains about 79 per cent nitrogen. During the 
flooding of a compartment for “lung” escape, the air is compressed to a pressure 
corresponding to that of the depth of the water in which the submarine is 
submerged. This becomes necessary in order to open the escape hatch. In 
compressed air the blood reaching the lung capillaries becomes instantly satu- 
rated with nitrogen at the partial pressure existing in the air. The amount of 
nitrogen which thus goes into solution in the blood is directly proportional to 
the pressure. Thus at three atmospheres (corresponding to a pressure of 66 
feet of sea water) thrice as much nitrogen will be taken up by the blood as is 
taken up at normal atmospheric pressure. During exposure to compressed air, 
the blood carried to the tissues will, by diffusion, share with them its excess of 
nitrogen, and the tissues will gradually become more and more saturated with 
nitrogen at the partial pressure of nitrogen in the inspired air. 
The symptoms of compressed air illness are due to the fact that gas, chiefly 
nitrogen, which goes into solution in the blood and tissues during exposure to 
compressed air, is liberated as bubbles on too rapid air decompression. It 
is well known, however, that the blood and tissues of the body can hold gas 
for long periods in a state of supersaturation, provided the supersaturation 
does not exceed a certain limit. No symptoms occur with less than 1.25 atmos- 
pheres of excess pressure (42 feet of sea water), no matter how long the 
period of exposure may be. The frequency and gravity of symptoms increase 
rapidly with higher pressures unless the time of exposure is limited or slow 
decompression is resorted to. Therefore, after the pressure has been raised 
in the escape compartment, if the period of exposure is prolonged, the ascent 
with the “lung” may require a certain amount of decompression in order to ELECTROCARDIOGRAPHY 
879 
avoid symptoms of compressed air illness. If possible, decompression in the 
recompression chamber of a salvage vessel would expedite escape. The de- 
compression tables for various depths and periods of exposure are given in 
the Diving Manual. 
Air embolism. 
As the volume of air is directly proportional to the pressure, the volume 
of air in a man’s lungs will undoubtedly expand during ascent with the sub- 
marine “lung”, unless breathing is continued at the normal rate. To hold the 
breath during ascent with the “lung” is very dangerous, because the increased 
pressure built up in the lungs by the expansion of air may rupture the lung 
capillaries and thus cause air embolism. For this reason, men are enjoined 
to ascend the line at a rate no faster than 50 feet per minute, and to continue 
breathing at the normal rate. 
Section 6.—ELECTROCARDIOGRAPHY 
Electrocardiography is one of the most important methods of cardiovascu- 
lar examination, ranking in value third after history taking and physical 
examination. 
Kolliker and Muller in 1856 demonstrated that when a frog’s heart contracted 
it produced an electric current. Then in 1887 Waller showed that the human 
heart current could be demonstrated by connecting the outside of the body by 
electrodes with the capillary electrometer. However, this mercury capillary 
electrometer was not sufficiently accurate for practical clinical use, although 
it was being used in the laboratories by physiologists. Finally in 1903 came 
the announcement of the discovery of the accurate and practical string galva- 
nometer by Einthoven, a Dutch physiologist. 
Electrocardiographs have been installed in hospitals and examining rooms 
throughout the world, and of late years, through the invention of portable in- 
struments, it has become practical to take an electrocardiographic tracing (elec- 
trocardiogram) in the sick room whether ashore in a hospital or in a hospital 
ship afloat. It may well be said now that a cardiovascular examination is not 
complete without an electrocardiogram, which often affords much help in 
diagnosis. On the other hand, it must be realized that the electrocardiogram 
may be perfectly normal even in the presence of serious heart disease. 
The instruments. 
An electrocardiograph (string galvanometer type) is complex and must be 
personally inspected to be satisfactorily understood. The essential feature is 
a very fine fiber or string of quartz or glass made opaque by a coating of 
silver and capable of conducting electric currents. Some strings are made of 
finely drawn platinum. This fiber is but 2 to 5 microns in diameter, so fine in 
fact that it cannot be readily seen except by the use of reflected light. The 
fiber is suspended in the magnetic field between two poles of an electromagnet 
and its ends are in circuit with certain attachments or electrodes placed upon 
the patient. When the patient is connected with the electrocardiograph a 
minute electrical current passes through the string and causes it to oscillate 
laterally as the circular waves of electromotive force induced by the passing 
current coincide with or are opposed by those streaming between the poles of 
the electromagnet. The magnetic field remains constant but the current may 
pass through the string in one direction at one moment and in the reverse at 
another. On each side of the magnetic field is a set of lenses arranged as in 880 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
a microscope and commonly called microscopes. Through one set of lenses 
light from an electric lamp is directed on the opaque string, which causes it 
to make a shadow. This shadow is magnified about 900 times by the opposite 
set of lenses, which projects and focuses it on the lens of a motion camera, where 
it is subsequently photographed. A suitable marker is included in the instru- 
ment. An electrocardiograph is, in brief, an instrument in which a very fine 
fiber is suspended in a magnetic field and its oscillations induced by the electrical 
forces set up by the passage of the current derived from the heart beats of a 
patient are recorded photographically. 
Oscillographic galvanometer.—This type of instrument, introduced about 12 
years ago for electrocardiography, is a modification of a well known type of 
galvanometer much used by the engineering profession under the name of 
oscillograph. The modification consists of passing the heart current through 
a set of three electro-vacuum tubes (audion bulbs) which greatly amplifies the 
current. This current oscillates a mirror from which a beam of light is reflected 
onto a photographic surface. This instrument is sturdier, more portable, less 
delicate, and the technique is simpler. 
Electrodes.—A common type of electrode is a sheet of German silver covered 
with cloth pads and wet with warm 20 per cent salt solution, or a special acid 
paste may be used at the point of contact with the body. Suitable wires are 
attached to the electrodes and thence run to the switchboard of the electrocar- 
diograph. 
The leads.—Although two electrodes may be attached to any parts of the 
body (if they are not too far from the heart and too close together) to lead 
the heart current to the galvanometer, it has been found by experience that 
the most suitable lead points for routine clinical use are the forearms, the 
left leg, and the prsecordium (the area of the chest overlying the heart) at the 
cardiac apex. Hence there are four standard leads: Lead 1 consists of the con- 
nection of the right lower arm to one end of the galvonometer string and of the 
left lower arm to the other end; Lead 2 consists of the connection of the right 
lower arm to one end of the galvanometer string and of the left leg to the 
other end; Lead 3 consists of the connection of the lower left arm to one end 
of the galvanometer string and of the left leg to the other end; and Lead 4, also 
called the chest lead, consists of the connection of the prsecordium at the cardiac 
apex to the galvanometer string by an electrode to which the left leg lead wire 
is attached while the left arm lead wire is attached to the electrode on the 
left leg and is taken on lead 3. 
Technique. 
While the details of the taking of an electrocardiogram are to be learned in 
the laboratory or heart station, a few statements, however, may properly be 
included in this presentation of the subject. 
The patient may be lying or sitting but should be relaxed and immobile. The 
skin is rubbed briskly with a cloth wet with warm saline solution to reduce 
the resistance of the skin to the passage of the minute electrical current. The 
electrodes are then applied and connected with the wires to the instrument. 
The lead desired is selected by turning the proper key on the switchboard 
and the patient is put in circuit with the string while the protective resistance 
(supplied by the instrument) is in operation. This resistance is to protect the 
delicate string from the possibility of fracture by receiving too great a current 
from the patient’s skin. If, when the key is turned (first step) the string 
shadow is deflected from the starting point, it is brought back by letting in 
sufficient compensating current (obtained by turning a certain knob on the ELECTROCARDIOGRAPHY 
881 
switchboard). This procedure is repeated to remove the protective resistance 
by steps and introduce enough compensating current to neutralize the skin 
current, until the patient is in free circuit with the string. 
The next step is known as standardization. The usual standardization is 
that advocated by Einthoven, and is an excursion of the string shadow 1 cm. 
in distance on the camera in response to the throwing in of one millivolt of 
electric current (obtained by turning a certain knob on the switchboard). If 
the string shadow jumps too much or too little, the correct excursion is obtained 
by turning a milled screw which tightens or loosens the string as desired. 
The purpose of standardization is to allow comparative observations to be 
made upon electrocardiograms taken at different times and in different labora- 
tories. Also, the determination of whether the excursion of individual waves 
is within normal limits is permissible only if the tracing has been taken under 
the standard method. 
Having been standardized, the string shadow is then focused as sharply as 
possible on the front of the camera, by focusing the objective of the microscope 
or set of lenses nearest the camera. A photograph of suitable length is then 
made, and the above process repeated for the other three leads. The film or 
paper is then developed according to the rules of photography in general. After 
being dried the tracing is ready for examination. 
The normal electrocardiogram. 
An electrocardiogram is a photograph of the oscillations of the string of the 
galvanometer caused by changes in the electrical potential of the heart muscle 
as the contraction wave passes over the organ. At first sight the tracing looks 
Figure 165.—Diagram of a normal electrocardiogram drawn to scale. Two cardiac cycles 
are represented. The complexes are designated by the letters P, Q, R, S, T. Vertical 
lines in background of diagram represent time. Heavy lines =one-fifth second; fine 
lines=one twenty-fifth second. Horizontal lines designate height of waves in millimeters. 
like a zigzag line, but on closer inspection it can be seen that the departures 
from the base line are of several types which are repeated in regular order. 
These deflections are called waves. They were originally labelled in an 
arbitrary manner (before their significance was known) as the P, Q, R, S, T, and 882 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
U waves. The use of these letters to designate the individual waves has become 
an established practice. 
The waves are termed upright or inverted according as they are above or 
below the base line. It is also a common practice to refer to upright waves 
as positive and inverted ones as negative. 
The P wave is the record of auricular systole. 
The QRS complex is associated with the initial spread of the contraction 
through the specialized tissue in the ventricle. 
The T wave is known as the end deflection of the ventricular complex. It is 
associated with the retreat of the contraction after its spread in the ventricle. 
The U wave is a small upright wave sometimes found immediately subsequent 
to the T deflection. It is more often present in slow beating hearts, is of 
uncertain origin, and is considered unimportant. 
Figure 165 shows a diagrammatic normal electrocardiogram. 
Section 7.—EMBALMING 
Embalming is the art of preserving bodies after death and is an art which 
has been practiced for many centuries. Preservation of the dead was regarded 
as a religious duty by the ancient Egyptians who carried the art of embalming 
to a high degree of perfection. That Egyptian embalming was effective has 
been proved by the discovery of mummies in excellent states of preservation 
after the passage of centuries, in one instance about 25. 
The Egyptians used three methods of embalming, and from the description 
of those methods, as reported by the Greek historians Herodotus and Diodorus, 
it is apparent that the principles of modern embalming are much the same as 
those of ancient times. 
All members of the Hospital Corps should be familiar with the procedures 
employed in embalming the bodies of the dead and with preparing the remains 
for interment and for shipment. Embalming only will be discussed in this 
section and reference should be made to Articles 908, 1513, and 1841, U. S. 
Navy Regulations, and to Chapter 19, Manual of the Medical Department, 
U. S. Navy, for full information regarding deaths and the care of the dead. 
Reference also should be made to the section on Deaths and Medicolegal Matters 
in chapter XI of this book. 
All bodies prepared for interment or shipment under the supervision of naval 
medical officers are thoroughly and completely embalmed in the manner de- 
scribed hereafter, using the embalming fluid as prescribed. If the embalming 
is done in the United States by a licensed embalmer he may be permitted to 
use the standard embalming fluid with which he is familiar. 
It is incumbent on all Navy embalmers to exercise great care in the preserva- 
tion of bodies and their preparation for the casket, so that they may reach 
relatives showing evidence of respectful and careful handling, without signs 
of decomposition, and with the so-called natural appearance preserved. 
Shaving and modeling of the features should be completed before beginning 
the injection. The face and hands should be liberally anointed and carefully 
massaged with an ointment made of vaseline in which 10 per cent each of 
eugenol and thymol are thoroughly incorporated. This ointment prevents dry- 
ing and tends to prevent the growth of molds on exposed skin, an important 
matter in regard to preserving the natural appearance of the face and hands. 
Any excess ointment should be removed and care should be exercised in its 
use, as it is very irritating to living skin and may be escharotic. EMBALMING 
883 
Although recommended as tending to produce a more pleasing appearance of 
the body and as lessening the liability to development of discolored spots and 
localized collections of gas, it is not necessary to drain the veins of contained 
blood. It is well, however, to emphasize the fact that draining the maximum 
amount of fluid from a body facilitates penetration of the embalmijng fluid, 
and the more the veins are drained the better the penetration obtained. 
Embalming, to be satisfactory, requires both arterial and cavity injection. 
Arterial injection. 
(a) The arterial system shall be injected with an amount of the prescribed 
embalming fluid equal to 15 per cent of the body weight, estimating 450 cc of 
fluid as 1 pound. (Fig. 166.) 
Inject each femoral artery toward toes with 2 per cent body weight. 
Inject each brachial artery toward fingers with 1 per cent body weight. 
Inject one common carotid artery toward head with 2 per cent body weight. 
Inject same common carotid artery toward heart with 7 per cent body weight. 
Total amount of fluid, including both femorals and both brachials, 15 per 
cent body weight. 
(&) The technique of injection is important, because prolonged preservation 
depends upon saturation of every tissue of the body with embalming fluid. To 
insure uniform distribution it is usually necessary to make all six injections. 
The return of fluid through the veins while the extremities are being injected 
will indicate saturation of the extremities, and the return of fluid during the 
carotid injection upward will indicate sutflcient fluid has been injected into 
the head and upper extremities. When beginning the injection it is often 
advisable to first use about 200 cc of warm physiological salt solution, a 12 per 
cent aqueous solution of sodium sulfate or enough of a solution of 180 Gm. of 
magnesium sulfate dissolved in sufficient water at 85° F. to make 4,000 cc to 
dissolve clots and thickened blood and thereby aid in removing the blood from 
the veins and facilitate the flow of the embalming fluid. It is claimed that a 
25 per cent aqueous solution of magnesium sulfate will completely prevent clot- 
ting of blood. Care should always be exercised to make certain that the 
injection is1 made into an artery, for if a vein, tendon, or nerve is mistaken 
for an artery and an attempt made to inject them, the embalming fluid escapes 
into the surrounding tissues, which harden and make it very difficult to proceed 
with the injection. 
Penetration is promoted by repeated flexion and extension of limbs and by 
gentle but thorough massage of soft parts with vaseline or phenol ointment. 
Massage is the only satisfactory method of removing discoloration from soft 
parts. An advancing line of firmness of the tissues may be taken as an indi- 
cation of the progress of the fluid. Raising the head and neck about 6 inches 
at the start of the injection will tend to prevent flooding of the face and to give 
more equal penetration. 
It is an easy matter to overinject so that the face and hands are puffy and 
unnatural. To avoid this two signs may be accepted as indicating that sufficient 
fluid has been used regardless of the actual amount injected, namely: First, 
if the eyes, lips, or one side of the face become overdistended, or in the case of 
an extremity when it is apparent that the fluid has circulated from the smaller 
arteries through capillaries into veins; and, second, when the tissues of a region 
are uniformly firm, with no “soft” areas remaining. 
Overinjection, however, is not objectionable if a long time is to elapse before 
the remains are to be viewed, because a slow shrinkage of the body usually 
takes place. 884 
HANDBOOK OF THE HOSPITAL COUPS, U. S. NAVY 
THE NAVY STANDARD 
EMBALMING OUTFIT 
PI LIQUID FORMALDEHYDE 13.5 C.C. 
BORAX (SODIUM BORATE) 5.0 QMS. 
I V GLYCERIN (OPTIONAL) 5.0 C.C. 
I A WATER, SUFFICIENT TO MAKE 100.0 C.C. 
0 PREPARE EMBALMING FLUID 
@ ASSEMBLE OUTFIT FOR USE 
@ INJECT FEMORAL ARTERIES TOWARD TOES. 
(g) INJECT BRACHIAL ARTERIES TOWARD FINGERS. 
® INJECT ONE CAROTID ARTERY TOWARD HEAD 
AND TOWARD HEART. 
(g) DRAIN AND INJECT THORAX. 
©DRAIN AND INJECT ABDOMEN. 
(§> TIE UP ARTERIES AND SEW UP INCISIONS IN 
SKIN. 
AMOUNT OF FLUJD TO USE 15 V. OF BODY WEIGHT. 
2 V. IN EACH FEMORAL ARTERY. 
1 % IN EACH BRACHIAL ARTERY. 
2 7o IN ONE CAROTID ARTERY TOWARD HEAD. 
7V. IN SAME CAROTID ARTERY TOWARD HEART. 
INJECT THORAX UNTIL SLIGHT EPIGASTRIC FULLNESS 
IS APPARENT. 
INJECT ABDOMEN UNTIL SLIGHT DISTENTION IS 
apparent, * 
Figure 166. EMBALMING 
885 
(c) When the carotids are being injected, massage of the face and adjacent 
parts is important, it being especially necessary to make sure that the fluid 
reaches less vascular parts, such as the tip of the nose and margins of the ears. 
Here, as elsewhere, palpable firmness of the tissues is the indication of success- 
ful injection. If any of these parts remain soft after completion of the arterial 
injection and show signs of “skin slipping,” fluid should be introduced by means 
of a hypodermic syringe, the point of the needle being inserted through the ear, 
hair line, nostril, or mouth, so that the puncture will not be noticeable. 
When, as sometimes happens, it is impossible to attain uniform firmness at 
the first injection, a second injection undertaken the next day often reaches the 
soft areas. 
Cavity injection. 
Besides injection of the arterial system, cavity injection should be performed, 
as much additional fluid being used for this purpose as may be required. 
When circumstances permit delay, it is well to postpone cavity injection until 
several hours have elapsed after the arterial injection has been completed. By 
that time, if a second arterial injection is to be required, the necessity for it will 
be apparent, and it can be undertaken before the breaks in the arterial system 
resulting from cavity injection are made. 
(a) Thorax.—By means of aspiration at several points remove all body fluids 
and inject each pleural cavity with embalming fluid under moderate pressure 
until a slight epigastric fullness becomes apparent. 
(ft) Abdomen.—By means of aspiration, the point of the needle being ex- 
tensively moved about, remove as far as possible all gas, liquid intestinal 
contents, and pathological fluids. Then inject embalming fluid, again moving 
the needle point about extensively, until slight distention is apparent. Kneading 
of the abdomen favors diffusion of the fluid. 
General instructions. 
(a) After autopsy bodies are to be embalmed in the same way; but in such 
cases the cavities of the abdomen, chest, and skull, after complete removal of 
all viscera, shall be packed with absorbent cotton saturated with embalming 
fluid, or a hardening compound composed of equal parts by weight of flake 
camphor or naphthalene, plaster of Paris, and dry sawdust may be used. 
Especial care must be exercised that the evidences of autopsy shall not cause 
unnecessary distress to relatives. To that end all wounds that have been made 
shall be neatly closed, if the brain has been examined the skullcap shall be 
secured to prevent its slipping, and packings and dressings used shall be clean 
and of suitable material. 
(ft) If fluid cannot be forced into an artery because of clots or other reasons, 
such as mutilation or advanced decomposition, multiple injections may be made 
into the tissues, which then should be wrapped in cotton saturated in embalm- 
ing fluid. In such case, further, the anus, mouth, and nostrils should be plugged 
with cotton soaked in embalming fluid, and the entire body, including the face, 
ears, and hair, washed with the fluid. 
(c) In the case of a body dead of smallpox, plague, Asiatic cholera, typhus 
fever, diphtheria, or scarlet fever, the remains, after being washed and after 
completion of the embalming, shall be bandaged completely, excepting the head, 
with muslin soaked in embalming fluid. The hands and face shall be enveloped 
in a suitable cloth saturated with embalming fluid. The laws of some States 
require that in such cases all body orifices be plugged with cotton soaked in 
1-500 solution of mercury bichloride and the body wrapped in cloths saturated 
with 1-1,000 solution of mercury bichloride. 886 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Embalming fluid. 
(a) The formula for the embalming fluid to be used is given herewith. 
Liquid formaldehyde (U. S. P. solution of formaldehyde) cc— 13.5 
Sodium borate (borax) grams— 5.0 
Glycerin (optional) cc__ 5.0 
Water, sufficient to make cc— 100. 0 
Should the solution of formaldehyde contain less than 37 per cent of formal- 
dehyde gas, the amount used should be increased proportionately. 
The addition of ethyl alcohol in the proportion of 10 per cent of the amount 
of the liquids in this formula aids in the solution of the sodium borate and to 
some extent in preventing “graying” of the skin. 
(ft) As this solution is irritating to many skins, some form of protection is 
advisable. Gloves may be worn in special cases, but in general it will be found 
more convenient and equally safe to anoint the hands prior to beginning work 
with a heavy protective ointment. 
(c) The exact composition of an embalming fluid is of less importance than 
the method of injecting it, but service embalmers, who may be acquainted with 
civilian practice and inclined to follow it, should remember that methods which 
have proved equal to preserving remains for a few days in temperate regions 
may be entirely inadequate to preserve bodies for months in the tropics. The 
fluid represented by the formula quoted (Francis) will retain its stability for 
more than 2% years; it has proved effective in preserving human subjects ex- 
posed for 2 months to a temperature of 98° F.; and the property of formal- 
dehyde in acid solution of bleaching muscular tissue to an ashy gray is over- 
come by the addition of borax, which furnishes the desired alkalinity without 
causing deterioration of the solution. This formula is to be used, therefore, in 
all cases. 
(d) The fluid hardens tissues so rapidly that thorough penetration to more 
remote parts often is hindered. For this reason the whole procedure should be 
carried out expeditiously, and it is recommended that at each site specified the 
injection be started with half-strength solution; when the return flow is estab- 
lished the full-strength solution then should be used as directed in this section. 
(e) The pressure essential to successful injection may be obtained either by 
elevating the container to a height of 6 feet or, in emergency, by means of a 
continuous flow rubber bulb syringe or a hard rubber pump syringe. The details 
requiring attention in employing either method will suggest themselves. It is 
necessary to state that if a pump is used, in order to avoid rupturing blood 
vessels, the pumping must he slow and no attempt made to force or hurry the 
flow of the embalming fluid. A slow penetration by gravity with a minimum of 
pressure gives better results and preserves the natural appearance much better. 
When an embalmed body is to be returned from foreign countries to the 
United States or must be retained on board ship for some time, especial care 
must be exercised to insure that it will be in good condition at the time of 
shipment and interment. To accomplish this an injection of one-fourth 
strength embalming fluid may first be made, followed 12 hours later by one-half 
strength and 36 hours after the first injection by one of full strength. In such 
cases the body should not be encased until sufficient time has elapsed after 
embalming for thorough evaporation of moisture to take place. After time for 
evaporation has been allowed, the entire body should be coated with vaseline 
or phenol ointment and wrapped, first with gauze, muslin, or surveyed linen and 
then with impervious waxed paper, the wrappings being secured in place by 
bandages. Before encasing the wrapped but unclothed body the casket should INDEPENDENT DUTY 
887 
be opened and exposed to the sun or artificial heat in order that the lining and 
padding may be free from moisture. Clothing for the body should be dried, 
wrapped in impervious waxed paper, and placed on top of the casket in the 
shipping box. 
References 
Manual of the Medical Department, U. S. Navy. 
Bureau of Medicine and Surgery circular letters. 
Section 8.—INDEPENDENT DUTY 
To carry out the duties with which it is charged in articles 457 and 458, Navy 
Regulations, the Bureau of Medicine and Surgery assigns chief pharmacist’s 
mates and pharmacist’s mates, first class, to duty as the representatives of the 
medical department on board small vessels and at small shore stations where 
the nature of the duty does not justify the assignment of medical officers. They 
are not offered as substitutes for qualified medical officers, but rather as first- 
aid men who are capable of relieving the commanding officer of most, if not all, 
of the detailed management of the sick and injured. Because of the training, 
instruction, and experience of men in the Hospital Corps, especially in the upper 
ratings, the Bureau of Medicine and Surgery believes that many times life or 
limb may be saved that might, without their intelligent first-aid, be jeopardized. 
The responsibilities of pharmacist’s mates on independent duty are similar 
to those of a medical officer, and the mission is the same. Pharmacist’s mates 
assigned to independent duty have demonstrated their qualifications for their 
rating by written and practical examinations and the Bureau of Medicine and 
Surgery feels that the commanding officers of vessels and shore stations to 
which no medical officer is attached, whose experience, general education, judg- 
ment, and mental training especially fit them for the assumption of responsi- 
bility in emergencies, ordinarily may rely on these men for valuable and trained 
assistance in first-aid work when more skilled medical services cannot be 
secured. 
Pharmacist’s mates assigned to duty independent of a medical officer and 
where medical officers are not available are cautioned to bear in mind the fact 
that the commanding officer of the ship or station is directly responsible for the 
proper care and disposition of the sick and injured. But it is a paramount 
duty of a hospital corpsman so situated to make recommendations to the com- 
manding officer regarding matters affecting the health of the crew, the disposi- 
tion of the injured, or any unusual condition requiring the services of a medical 
officer or qualified medical practitioner, temporary assistance for members of the 
crew, etc. 
There should be a definite time, approved by the commanding officer for sick 
call. Minor ailments and injuries are attended to at this time; arrangements 
for vaccination, visiting a medical officer, and excusing men from duty, but at 
any time the pharmacist’s mate should be ready to examine men who could 
not attend regular sick call or who have become ill or have been injured 
subsequently. 
Second only to the care of those actually sick or injured is the responsibility 
of independent-duty pharmacist’s mates with regard to the application of 
hygienic and sanitary measures. A daily inspection of the ship or station is 
necessary to accomplish this, and should not be made until after all cleaning 
stations have been policed. 888 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
In making this daily inspection particular attention should be given to places 
where dirt can accumulate, such as corners, angle-irons, mess gear, mess and 
clothes lockers, fans, ventilators, blowers, ice boxes, vegetable lockers, wash 
bowls, urinals, drains, scuppers, and gratings—in fact, any place where an 
effort must be made to attain cleanliness. The condition of the cooking utensils, 
pots and pans, the galley range and the deck beneath it should be observed; 
the bottoms of mess tables and bunks, especially the bunk frames, should be 
inspected; in storerooms the stowage of unauthorized articles, such as wash 
buckets, swabs, dirty or wet clothes, should not be permitted, and one should 
be sure that the bilges of storerooms aboard ship are dry and clean. Ashore, 
in addition to the above, care must be exercised in the disposal of waste and 
garbage, the accumulation of stagnant water, drainage, protection of water 
containers, removal of undergrowth, manure, leaves, etc., cutting weeds and 
long grass, and the methods used in the disposal of human excreta. ' 
In short, it is most important that the pharmacist’s mate on independent 
duty constantly be on the alert to observe anything and everything that in any 
way might be detrimental to the health and welfare of those with whom he 
is serving and who depend upon him for protection against disease. Dirt, 
filth, grease, and decayed or decaying matter are dangerous to health; all can 
be removed by the use of water, soap, kerosene, and “elbow grease”; and all 
can be prevented by careful observation and frequent inspection. 
In the absence of medical officers it devolves upon the pharmacist’s mate 
representing the medical department to inspect the food prepared for the crew, 
as to wholesomeness and cleanliness, the fruit and other articles of food and 
drink offered for sale by boats alongside, and all fresh provisions purchased for 
the general mess. After such inspections a report should be made to the 
proper officer as to the conditions found, with such recommendations as are con- 
sidered necessary. There should be no hesitancy in recommending rejection or 
refusal of permission to boats alongside to sell if the inspection shows them to 
be unsatisfactory. Instructions governing such inspections are contained in 
articles 1156, 1157, 1158, 1159, 1320(2), and 1324, Navy Regulations. 
On duty independent of a medical officer pharmacist’s mates primarily are 
expected to: 
(a) Care for the ordinary ailments of the crew of the vessel or station to 
which they are attached. 
(&) Administer first-aid to any serious case that may occur. 
(c) Maintain a sanitary supervision of the vessel or station, and make suit- 
able recommendations to the commanding officer. 
(d) Maintain a proper amount of medical supplies to meet ordinary condi- 
tions. 
(e) Prepare for forwarding the necessary forms of the Bureau of Medicine 
and Surgery and keep the required medical records. 
(/) Investigate the health conditions in ports visited or in adjacent cities and 
make a report to the commanding officer with such recommendations as may 
be indicated. Learn and comply with local quarantine regulations. 
Whenever contact with medical officers is possible, independent-duty phar- 
macist’s mates should visit them for council and advice. Frequent consultation 
with the commanding officer is desirable. They should inform him promptly 
of any suspected contagious or infectious disease that may appear, and when 
a patient is in need of the services of a doctor. They are expected at all times 
to be ready to exert themselves to the utmost to assist any person on board in 
need of assistance by reason of illness or injury, and, so far as may be prac- 
ticable, to segregate in the sick bay or other designated place any member of the 889 
LABORATORY PROCEDURES AND TECHNIQUE 
crew who is on the sick list, and to calmly, quietly, and efficiently aid the 
commanding officer in the maintenance of the morale of the crew in the presence 
of disease or injury on board. 
Upon reporting for duty independent of a medical officer, pharmacist’s mates 
should, if practicable, communicate immediately with the medical officer having- 
supervision of the medical department of the vessel or station and inform 
themselves regarding the local organization and the arrangements for obtain- 
ing medical assistance when needed. They should accurately check the inven- 
tory of medical-department property (if possible with the man being relieved) 
and report any discrepancies to the commanding officer and medical officer. 
Do not accomplish a transfer of property unless prepared to assume responsi- 
bility for the property reported on the inventory. A pharmacist’s mate on inde- 
pendent duty has the same responsibility regarding care of property and 
submission of reports as a medical officer, and when selected for that duty it is 
assumed that his training and experience have been such that he can perform 
such duties and can be trusted with the care of medical-department property 
without immediate supervision. All health records should be examined and 
carefully checked for errors and omissions and to see that all members of the 
crew have been properly immunized against small pox and typhoid fever in 
accordance with current instructions. Any who have not should be immunized 
immediately for a single case of small pox or typhoid fever is evidence of gross 
negligence, particular on the part of the one having custody of the health record 
at that time. Attempt to locate any missing records and open new ones if 
necessary. 
The space and equipment for use by the representative of the medical de- 
partment in the care of the sick or injured should be clean and ready for use 
when the occasion demands. 
The question of “how far should I go in treating this case” will present itself 
time and again to the pharmacist’s mate on independent duty. It would be 
unwise to establish a rule or rules governing this, but it should never be for- 
gotten that the primary duty is to prevent disease, to prevent injuries, and 
to preserve life and limb of the person afflicted. The capable pharmacist’s mate 
will, considering all things and knowing his own ability, decide what is best 
for his patient, and the life of the patient often will depend upon this decision. 
Section 9.—LABORATORY PROCEDURES AND TECHNIQUE 
URINALYSIS AND BLOOD CHEMISTRY 
Urinalysis. 
Urine is an important and complex excretion formed in the kidneys. It 
carries in aqueous solution waste products arising from metabolism and prod- 
ucts which come directly from substances eaten. The normal constituents of 
the urine are divided into organic and inorganic groups. The important or- 
ganic constituents are urea, uric acid, and creatinine; those of the inorganic 
group are the chlorides, phosphates, sulfates, and ammonia. The normal urine 
may contain various cellular elements, such as epithelial cells and leucocytes, 
also a number of crystals which usually form on standing, and are recognized 
microscopically. 
Normal ubine as voided is light straw to dark amber in color, acid in 
reaction, and transparent. Usually the composition of the urine of a given 
individual, voided in a 24-hour period, does not vary much from day to day; 
specimens voided at different times in the day may, however, differ markedly. 890 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
In qualitative work random specimens may be examined, but a 24-hour speci- 
men is more desirable, and quantitative tests are valueless unless done on the 
mixed specimen for the 24-hour period. A 24-hour specimen of urine should 
be collected in a clean container and kept cold, preferably on ice, or protected 
by a suitable preservative, until examined. Toluene is the best preservative, 
as it interferes least with the tests which may be performed. One or two 
cubic centimeters placed in the container to be used for collection of specimen, 
suffice for this purpose. Thymol also may be used as a urinary preservative. 
Numerous other preservatives have been used but are less desirable as they 
may cause false positives or interfere with reactions. The use of preservatives 
should not be substituted for refrigeration, cleanliness, and care. 
Routine examination.—Urine for examination should be clear, and may be 
made so by simple filtration or by filtration after the urine has been mixed 
and shaken with a small amount of purified talc. 
When making a routine urine examination one should: 
1. measure the amount.—The 24-hour specimen, normally, should be from 
1,000 to 1,500 cc. This amount depends upon the balance between the quantity 
of fluids ingested and the fluids lost by other avenues—perspiration, respiration, 
faeces (as in diarrhoea), and vomitus. 
2. note the color.—This varies in health and depends upon the concentra- 
tion. The presence of blood, bile, urobilin, and some drugs will affect the color. 
A pale urine of high specific gravity suggests the presence of sugar (diabetes). 
3. note the transparency.-—Freshly passed urine is usually clear, but upon 
standing becomes cloudy. Large quantities of amorphous phosphates, amor- 
phous urates, pus, blood, and bacteria produce sediments or cloudy appearances. 
4. note the odor.—An aromatic odor is due to volatile acids; ammoniacal 
to decomposition; fruity to acetone; and characteristic odors are produced by 
certain substances, as asparagus, etc. 
5. test for reaction.—Acid urine turns blue litmus paper red; alkaline urine 
turns red litmus paper blue. If the urine is neutral in reaction, no apparent 
change is produced in the litmus papers. Normally urine is acid in reaction, 
but soon becomes alkaline upon standing when not refrigerated or preserved. 
6. test to determine specifio gravity.—Normally this is 1.010 to 1.020. A 
urinometer is the most convenient means of determining the specific gravity of 
urine. A special container is filled with urine and a urinometer placed in the 
container. The urinometer should not touch the sides or bottom of the con- 
tainer and should be read at the bottom of the meniscus. The specific gravity 
of normal urine varies with the concentration. The sugar content of urine in 
diabetes causes a high specific gravity. 
7. test for albumin using the heat and acetic acid test. Fill a clean test 
tube two-thirds full of clear urine. Filter, if necessary, to clear. Boil the upper 
portion. Add 3 to 10 drops of 10 per cent acetic acid to acidify and reboil. 
Compare boiled and unboiled portion and report the degree of turbidity of the 
coagulated albumin on the basis of 4 plus as a maximum. A turbidity in the 
boiled portion that clears with the acid is ordinarily due to carbonates or 
phosphates. Albuminuria is an abnormal condition indicating a leakage of blood- 
serum albumin into the urinary tract and requires further careful investigation. 
8. test for glucose (sugar) by placing 5 cc of Benedict’s qualitative solu- 
tion in a test tube. Boil. Add 0.5 cc of urine. Boil 2 minutes and let cool. If 
glucose is present, the blue cupric salt will be reduced to a cuprous salt and 
the solution will be filled with a green, yellow, or red precipitate. Report on 
the basis of 4 plus as the maximum red precipitate. Benedict’s qualitative solu- 
tion for urine sugar test is prepared by dissolving 173 6m, of sodium citrate and 891 
LABORATORY PROCEDURES AND TECHNIQUE 
100 Gm. of anhydrous (or 200 Gm. of crystalline) sodium carbonate in 700 cc of 
hot water and filter. Add slowly, and with constant stirring, 17.3 Gm. of copper 
sulfate dissolved in about 100 cc water. Cool, and dilute to 1 liter. 
Benedict’s quantitative solution is used when required to calculate the amount 
of glucose present. (See any standard laboratory textbook for preparation of 
this solution and procedure). 
An occasional trace of sugar in the urine may be an unimportant finding 
and may occur following general anaesthesia, the administration of certain 
drugs, in pregnancy, in head injuries, or a meal heavy in carbohydrates. The 
finding of sugar, however, always warrants carefully repeated examination and, 
if persistent, carbohydrate tolerance should be tested, the basal metabolic rate 
ascertained, and the blood sugar content determined in an effort to establish 
the cause of this abnormal finding. 
9. examine microscopically.—The uncentrifuged urine may be examined 
microscopically, especially if allowed to stand and some of the sediment taken 
up in a pipette, but it is usually preferable to centrifuge the urine and examine 
the sediment. The casts, pus cells, red blood cells, crystals, and other formed 
bodies, which may be present in a quantity of urine are, by centrifuging, concen- 
trated and more easily found. The sediment may be examined microscopically 
either uncovered or covered with a cover glass. In acid urine may be found 
uric-acid crystals, amorphous-urate deposits, calcium-oxalate 'crystals, and, 
rarely, leucin, tyrosin, and cystin crystals, and fat globules; in alkaline urine, 
amorphous phosphates, calcium-carbonate deposits, and ammonium-urate crystals. 
The following organized structures may be found in urinary sediments: 
Tube casts, epithelial cells, bacteria, red and white blood cells, spermatozoa, 
and animal parasites. Pus cells and red blood cells, when present, are reported 
as the number per high-power field in uncentrifuged urine, using a cover glass 
preparation. As the urine ages the casts and red blood cells decrease in 
number, also in alkaline urine. 
Special tests.—In addition to a routine urinalysis the abnormal constituents 
named hereafter may be present in the urine and require special tests to de- 
termine their presence. 
ketone bodies.—Acetone and diacetic acid are abnormal acid bodies formed 
in the acidosis of diabetes, in fevers, and in starvation. The importance of 
examining urines for ketone bodies, which have been found positive for sugar, 
should be emphasized. Diabetic patients are frequently first discovered in the 
coma of diabetic acidosis. This type of acidosis (ketonic) may also be a 
serious complication in the febrile diseases of childhood. 
bile.—Found in the urine in cases of jaundice. 
urobilin.—May be found in abnormal amount in conditions in which red 
blood cells are being destroyed rapidly, in cases of liver insufficiency, or liver 
infection. 
indioan.—Caused by the absorption of the products of protein decomposition. 
occult blood.—When the presence of blood is suspected but cannot be found 
by microscopic examination a chemical test may be used. 
Blood chemistry. 
The blood comes into intimate contact with all the tissues and carries nour- 
ishment to and waste materials away from them. It carries those products 
of the glands of Internal secretion which act as chemic excitants, stimulants, 
or regulators and are known as hormones. Insulin from the pancreas, thy- 
roxin from the thyroid, and epinephrine from the adrenals are examples of 
hormones. The blood carries oxygen to and carbon dioxide away from the 
154204'’—39 57 892 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
tissues and is the vehicle through which the acid-base balance of the blood is 
so accurately regulated. The body is continually taking in acid and alkali sub- 
stances. Much acid is also formed in the body by normal oxidative processes. 
The sulfur and phosphorus of the proteins are oxidized to sulfuric and phos- 
phoric acids, and the carbon of the carbohydrates forms carbonic acid. The 
amount of acid formed, neutralized, and excreted in this way in 24 hours 
equals the acid contained in several hundred cubic centimeters of normal 
hydrochloric acid. How, then, is the reaction (hydrogen ion concentration 
or pH) of the blood maintained and regulated within the narrow limits neces- 
sary? This is accomplished by the so-called buffer substances of the body. A 
buffer in this connection, may be defined as a substance which has the prop- 
erty of stabilizing the reaction of a solution in which it is present; that is, it 
takes up the acid without appreciable change in its own reaction. When ex- 
cessive amounts of acid are formed the blood buffers—that is, the alkali re- 
serve—of the blood becomes dangerously lowered. Valuable and accurate clini- 
cal methods of measuring the alkali reserve and thus determining the degree of 
acidosis are the measurement of the carbon dioxide combining power of blood 
plasma and the carbon dioxide content of the alveolar air. 
The blood being in such constant and intimate contact with all the organs 
and tissues, changes in them or alterations of their function are often accu- 
rately mirrored by it. Changes in the chemistry of the blood occur as the 
result of conditions altering formation, utilization, or elimination of substances 
in the body. Examples of these are changes in the kidneys by which products 
normally excreted tend to be retained (urea, uric acid, creatinine), or metabolic 
diseases, such as diabetes, in which the formation of the internal secretion of 
the pancreas is diminished, and, as a result, the organism loses its power to 
properly utilize carbohydrates. 
Collection of blood.—For analysis blood is collected in the usual manner 
from a vein in the arm. Chemically clean and dry glassware must be used 
throughout. It is necessary in chemical work to prevent clotting of the blood. 
In order that this may be accomplished neutral potassium oxalate in the pro- 
portion of 2 milligrams for each cubic centimeter of blood is placed in the 
flask in which the blood Sample is to be collected. For a complete chemical 
analysis collect about 15 cc. An excess of the oxalate should be avoided, as 
large amounts may interfere seriously with analysis. A good plan is, where 
practicable, to obtain the small flasks for collection of the blood specimen 
directly from the laboratory where sufficient oxalate has already been added to 
prevent the coagulation of 10-15 cc of blood. Blood for tests is usually drawn 
before breakfast after an over-night fast. 
Certain procedures, such as calcium and phosphorus determinations, agglu- 
tination reactions, complement fixation tests, Kahn tests for syphilis, and serum 
colorimetric determinations require clear, nonhsemolized serum. The blood is 
therefore taken without the use of the oxalate anticoagulant, allowed to 
coagulate, and the serum separated. 
Special training is required to master the methods used in quantitative 
analysis of blood and urine. The technique will be found in detail in texts 
on laboratory procedures. 
Normal blood chemical standards per 100 cc are as follows: 
Cholesterol milligrams 140-200 
Chlorides (as NaCl in whole blood) milligrams 450-500 
Creatinine milligrams 1-2 
Glucose — milligrams 80-120 
Nonprotein Nitrogen————— milligrams— 25-35 LABORATORY PROCEDURES AND TECHNIQUE 
893 
Urea Nitrogen ; milligrams 12-18 
Uric Acid milligrams 2-4 
Total Protein grams 6-8.5 
Albumin , grams 4.5-S.5 
Globulin grams 1.5-3 
Calcium milligrams— 9-11 
Phosphorus milligrams 3-4.5 
FUNCTIONAL TESTS 
Kidney function. 
The ability of the kidney to excrete substances from the blood stream is fre- 
quently affected by disease, especially such disease as disturbs the kidney, and 
is usually diminished after the age of 50 years. Disease of the kidney, how- 
ever, does not necessarily imply an inability to eliminate substances; that is to 
say, the functional lesion need not parallel the anatomical. Function, even 
when serious disease exists, may be normal, especially when the changes are 
of focal type. Moreover, impairment of renal function does not affect the 
excretion of different compounds to the same extent. It is well established 
that functions for chlorides and for urea are independent of each other. In 
any urine examination, then, one should restrict conclusions regarding im- 
pairment of excretory power to the substances under consideration. By com- 
bining the findings derived from blood chemistry and other tests of renal func- 
tion, one is in a position intelligently to adjust the diet, etc., to the excretory 
X>owers of the kidney, always bearing in mind, however, that the nutritive 
need of the body cannot be neglected. Many methods are employed for the 
determination of kidney function, and their relative values are still debatable. 
Their multiplicity indicates that no single test is entirely satisfactory, and 
one should always apply two or more to the case before forming a conclusion. 
Several kidney-function tests will next be described. 
Bloou Nitrogen Retention.—Of the nitrogenous constituents in the blood, the 
kidney excretes creatinine most readily, urea next, and uric acid with the most 
difficulty. As a consequence, an impairment of function usually results first 
in the retention of uric acid, then urea, and, finally, creatinine. Owing to the 
relatively small amount of uric acid and creatinine present, the nonprotein 
nitrogen, which includes the nitrogen in them as well as in other compounds, 
is affected very little by alterations in their amounts. The nonprotein nitrogen 
value is dependent chiefly upon the urea content. This fact is the basis of an 
intelligent interpretation of the findings. It is said that urea excretion is 
normal until three-fourths to six-sevenths of the total functional capacity of 
the kidneys is lost. Nonprotein nitrogen increases only when about 60 per cent 
has been lost, and retention is rare unless the phthalein excretion is less than 
40 per cent for 2 hours. Hence, an increase in urea nitrogen or nonprotein 
nitrogen means bilaterally impaired function. It has been found that uric 
acid determination is of much assistance in judging the significance of occa- 
sional casts and traces of albumin in the urine, an increase speaking for an 
organic kidney lesion. 
On the usual hospital diet over 20 for urea nitrogen should be considered 
suggestive of impaired kidney function; over 70 speaks decisively for renal 
involvement and probable uraemia. Values for creatinine of over 4 do not 
occur without great impairment of renal function and probability of uraemia. 
Dilution Test.—1. Preparation of patient: The day before the test instruct 
the patient to consume at least 1,000 cc of liquids during the 24 hours and to 
follow his usual routine in regard to meals. This procedure precludes the test 894 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
being performed on an individual whose tissues have been deprived of fluid. 
2. Day of test: At 8 a. m. instruct patient to empty his bladder (this urine 
to be discarded). 3. Patient to drink 1,500 cc of water within 15 minutes. 
4. Omit breakfast. 5. Collect specimens of urine in separate containers at 8: 30, 
9. 9:30, 10, 10:30, 11, 11:30 a. m., and 12 noon. Each specimen should be 
labeled with exact time of collection. 
The patient may receive his usual diet for luncheon and dinner. Test; 
1. Measure the Quantity of urine obtained in each specimen. 2. Obtain the 
specific gravity of each specimen. Record as a curve. 
normal findings.—The total quantity voided up to 12 noon should be not 
less than 1,200 cc nor more than 1,800 cc. The specific gravity of at least one 
sample should be 1.003 or below. 
clinical significance.—This test determines the ability of the kidney to 
dilute urine and excrete water. Deviation from normal indicates impaired 
renal function. 
Concentration Test.—Preparation of patient: 1. Instruct patient to take no 
fluids after the evening meal the day before the test and no fluids at any time 
during the test and to strictly adhere to the dry diet. 2. At 8 a. m. on the 
day of the test instruct the patient to empty the bladder and discard urine. 
Sample diet for three meals on day of test: At 8 a. in., dry cereal with sugar, 
syrup, or honey; one egg; toast or bread with butter; no fluid. At 12 noon, 
roast beef, steak or chops; potatoes (boiled, baked, or riced) ; bread and butter; 
jam; no fluid. At 5 p. m., two eggs; bread and butter; jam; no fluid. 
collection of urine.—Collect urine in separate containers every three hours 
until 8 p. m. (11 a. m., 2 p. m., 5 p. m., and 8 p. m.). Samples should be labeled 
with the hour of collection. Collect night urine at 12 midnight and at 8 a. m. 
in separate containers. 
test.—Note the quantity and specific gravity of each sample. 
normal findings.—The specific gravity of one day sample should reach 1.025 
or above. The specific gravity of one night specimen should reach 1.030 or 
above. 
clinical significance.—The finding of the specific gravity below 1.025 in all 
day specimens and below 1.030 in all night specimens indicates decreased renal 
efficiency. These two tests have repeatedly shown impaired kidney function 
before it could be demonstrated with other kidney function tests. Twenty-four 
hours should elapse between tests and both tests should be performed before 
reaching a conclusion as to renal efficiency. 
Mosenthal Test.—This test is generally spoken of as the two-hour test. 
Preparation of patient: 1. To receive the usual diet on the day of the test; 
also the day before the test. No food or drink is to be taken except at meals. 
2. Patient to empty bladder immediately before breakfast (8 a. m.) on day 
of test (this to be discarded). 3. Collect specimens at 10 a. m,, 12 noon, 
2 p. m., 4 p. m., 7 p. m., and 10 p. m. Each specimen to be collected in a 
separate container, properly labeled with the hour of collection. Note: The 10 
p. m. specimen must not be collected less than 3 hours after the evening meal 
has begun. 4. Collect all urihe from 10 p. m. to 8 a. m. the following morning. 
This specimen to be in a separate container and labeled “8 a. m. specimen.” 
test.—1. Determine volume and specific gravity of each specimen passed 
during the day. 2. Measure the night urine (10 p. m. to 8 a. m.) and deter- 
mine the specific gravity. 
sources of error.—All samples not at the same temperature when specific 
gravity is taken. Erroneous figures will be obtained unless the samples are at 
the same temperature when specific gravity is obtained. LABORATORY PROCEDURES AND TECHNIQUE 
895 
normal findings.—1. Night urine will be less than one-half the quantity of 
total day urine (usually less than 500 ce). The normal ratio of day to night 
urine is not disturbed, the normal being 4-1 or 3-1. Night specimen should 
have a specific gravity of 1.018 or above. 2. One day specimen will usually 
have a specific gravity of 1.018 or above and 1 day sample will have a specific 
gravity 8 points lower than the highest specific gravity for the day specimen. 
Example: Highest specific gravity recorded for any single day sample 1.020; 
the most dilute will be 1.012 or less in normal findings. 
clinical significance.—1. Usually the first and most definite evidence of 
impaired kidney function is Indicated by an increase in the night urine, over 
500 cc, and the normal ratio of day urine to night urine is disturbed. 2. The 
highest specific gravity of a day specimen falling below 1.018 is an indi- 
cation of impairment of renal function. 3. Fixation of specific gravity and 
an increase in the quantity of urine voided at night .(more than 500-700 ce) 
is definite indication of impaired renal function. 
By fixation of specific gravity is meant a variation between extremes of less 
than 0.008. 
Pool all specimens in one container and determine the 24-hour excretion of 
sodium chloride and nitrogen, Mosenthal states that the results obtained by 
dividing the urea value obtained by the hypobromite test by 2.14 (the nitrogen 
factor) is a sufficiently accurate expression of the total nitrogen value for the 
purposes of the test. 
A normal maximal specific gravity indicates that the kidney can concentrate 
the urine satisfactorily, providing the 24-hour amount of urine is adequate. 
A high specific gravity with oliguria (urine excretion deficiency) occurs only 
in passive congestion of the kidney, and in acute, subacute, or chronic diffuse 
nephritis, conditions that also show a markedly diminished sodium chloride 
excretion, together with considerable albuminuria and oedema. Long life is 
often possible, providing a low specific gravity is compensated by polyuria, 
(excessive urine secretion) as in diabetes insipidus, chronic nephritis, marked 
anaemia, during the elimination of oedema, cystitis, pyelitis, polycystic kidney, 
prostatic hypertrophy, urethral stricture, and paralysis of the bladder, such as 
occurs in tabes dorsalis, tumor of the cord, etc. Such cases may do well as 
long as there is a compensatory polyuria. 
A nocturnal polyuria indicates an overworked kidney and the strain may 
result in functional damage. Over 500 cc should be considered somewhat 
suspicious of renal insufficiency. In nephritis it may be improved by cur- 
tailing the food intake. 
Nycturia (nocturnal urinary incontinence), the result of prostatic or vesical 
irritation, should not be confused with nocturnal polyuria. 
Sodium chloride is being ingested in unnecessary amount if the 24-hour ex- 
cretion exceeds 5 Gm. A very low excretion, together with oedema, indicates 
an inadequate elimination, and is then not a criterion of the diet. 
If 5 or 6 Gm. of nitrogen are eliminated in the urine every 24 hours, there 
is sufficient protein in the food to maintain the individual’s health and 
strength, provided the diet contains a considerable amount of starch. Restric- 
tion of proteins should be guided by the nature of the disease. 
Thus the test supplies information useful in diagnosis, is an early index of 
renal function, and serves as a guide to diet. 
Phenolsulfonephthalein (phtiialein or red) Tbst.—This was developed by 
Rowntree and Geraghty, and its simplicity makes it very useful. It estimates 
only excretory ability at the moment for a foreign substance, is not considered 
quite as reliable as chemical analysis of the blood, and, of course, does not give HANDBOOK OE THE HOSPITAL, CORPS, U. S. NAVY 
the additional information that the latter sxipplies; also, in certain cases com- 
plete collection of urine sample may be difficult. It is, however, of much value, 
gives positive results before urea retention appears, has no contraindications, 
and does compare the kidneys and evaluate each when combined with ureteral 
catheterization or use of a separator. Diminished excretion of the dye occurs 
only when about 50 per cent of kidney function is lost. Positive results are of 
more significance than negative. Values of more than 75 per cent for 2 hours 
may be accompanied by diuresis, and Frank considers such a finding suggestive 
of renal disturbance with irritation if there is any corroborative evidence. 
The technique comprises administration of the dye, determination of the 
interval before it appears in the urine, and the amount then excreted during 
definite periods. The dye is employed in solution, and is conveniently pur- 
chased already sterilized in ampules, each containing slightly more than 1 
cc of a solution of its monosodium salt of the strength of 6 mg. per cubic 
centimeter. The patient drinks 200-400 cc of water, and 20 minutes later 0 
mg. of the dye is injected intramuscularly into the lumbar muscles or intra- 
venously. The bladder is immediately emptied and the urine discarded. The 
succeeding portions of urine may be collected by voiding, but it is more accu- 
rate to catheterize the bladder or ureters, and catheterization is practically a 
necessity for determination of the “appearance time.” 
The “appearance time” is the interval of time elapsing between injection 
of dye and its appearance in the urine. It is determined by allowing the urine 
to drip from the catheter into a receiver containing a drop of 10 per cent 
sodium hydroxide solution. The first traces of the dye will cause a pink color. 
The time interval chosen for calculating excretion is then computed from the 
instant of this appearance. There is considerable diversity in practice as re- 
gards this time interval, and it would seem that shorter intervals and quicker 
results are gaining in preference, as well as being considered equal in value to 
longer periods. 
The percentage excretion of the dye is now measured in each sample of the 
collected urine. One may employ the simple and inexpensive colorimeter of 
Dunning, but it is better to prepare a fresh standard, as the colors of such 
permanent ones tend to fade. It is also preferable to follow the suggestion 
of Cabot and use standards in test tubes rather than in the ordinary colorim- 
eter, because off colors frequently occxxr, and a satisfactory match of unknown 
and standard is then impossible in the latter instrument. 
Prepare a 100 per cent standard by diluting 1 cc of the phenolsulfoneph- 
thalein solution to 1,000 cc with water. Using test tubes and rack such 
as those for pH determinations, measure into the test tubes portions of this 
standard, each tube receiving 0.5 cc less than the preceeding one. A series 
from 6 to 1.5 cc is satisfactory and gives standards representing 60 per cent to 
15 per cent with 5 per cent intervals. Add one drop of 10 per cent sodium 
hydroxide solution to each tube, fill to the 10 cc mark with water, and mix. 
Dilute the specimen of urine to some convenient volume that will permit a 
color match in the standard series and estimate its percentage strength, inter- 
polating if necessary. To calculate the per cent of dye excreted in the sample, 
multiply the determined percentage by the total volume to which it was diluted 
and divide by 1,000. 
After intravenous injection the appearance time is 4-6 minutes normally, and 
the normal elimination is 35-40 per cent in 15 minutes, 50-65 percent in 30 min- 
utes, and 65-80 per cent for 60 minutes, or for the first 30 minutes it may be 
stated as about 1 per cent per minute from each kidney. 897 
LABORATORY PROCEDURES AND TECHNIQUE 
After intramuscular injection, the normal appearance time is nearer 10 
minutes, and the normal elimination is 30-40 per cent in 30 minutes, about 
50 per cent (40-60) for 60 minutes, and about 80 per cent (50-85) for 2 hours, 
or 20-25 per cent during the second hour. If the appearance time is not 
determined it is customary to allow for it, collecting the first hour’s specimen at 
70 minutes after injection of dye and the second hour’s 60 minutes later. 
Impairment of kidney function, of course, increases appearance time and 
lessens excretion, serious cases not unusually excreting less than 1 per cent 
during two hours. 
When the question of the kidney involved arises, the urine must be taken by 
ureteral catheterization or by a separator. 
Urea Clearance Test.—Preparation of patient; Eats usual breakfast at 
8 a. m. without tea or coffee, but water as desired. At 9 a. m. patient voids 
completely and urine is discarded. Give 100 cc water. At 10 a. m. patient voids 
completely. Save urine and label with time. Give 100 cc water. Take speci- 
men of blood for urea-nitrogen determination. At 11 a. m. patient voids com- 
pletely. Save urine and label with time. If urine specimens are not obtained 
exactly 1 hour apart, the number of minutes must be precisely known by the 
laboratory. Send all specimens to laboratory. By urea clearance is meant the 
volume of blood which is entirely cleared of urea by the kidneys in 1 minute. 
Sugar Tolerance.—This study of sugar tolerance has clinical value in a 
variety of conditions. The test is carried out as follows: After an overnight 
fast, ingest 100 Gm. dextrose dissolved in 300 cc black coffee. Collect blood 
samples just before feeding and at 45 and 120 minutes after same and determine 
the blood sugar in each sample. If the blood sugar has not by then returned 
to normal or about normal one may test further samples taken at hourly inter- 
vals. Venous blood, not finger blood which is practically arterial, should be 
used. The urine may also be collected and tested for sugar. 
A normal person should show no glycosuria (excretion of glucose in urine) 
and his blood sugar will be at its maximum (about 150) within 45 minutes and 
normal again after 120 minutes. The usual abnormal variation consists in 
increased height or, especially, prolonged duration of curve before reaching 
normal, as much as 6 hours being not unusual. The research work reported 
on the problem of sugar tolerance indicates that it is best to interpret an 
abnormal curve simply as indicating an impaired sugar tolerance and its degree. 
High blood sugar and alimentary glycosuria may readily be produced in cases 
of hyperthyroidism. Hyperglycsemia (excessive glucose in the blood) may 
occur in nephritis due apparently to raising of the threshold point of the kidney 
for glucose. Hyperglycsemia and flattened sugar tolerance curves are often 
found in hypoendocrine (low endocrine secretion) conditions. Low blood 
sugars (60-90 Mg. per 100 cc) are reported in myxoedema, cretinism, Addison’s 
disease, and pituitary disease. 
Gastric analysis. 
The stomach mucosa normally secretes 1,000 to 1,500 cc of liquid in each 
24 hours. This is called the gastric juice. It mixes with the food so that even 
if no liquid is swallowed at meal time the stomach contents soon become liquid. 
The gastric juice contains hydrochloric acid in a concentration of 0.4 to 0.5 per 
cent, pepsin, rennin, and lipase. These aid in digesting the food. In certain 
diseases the hydrochloric acid may be increased in amount and in other dis- 
eases diminished or absent. Also when the stomach retains the liquid contents 
too long fermentation takes place and lactic acid develops. Therefore tests 
are made to determine the amount of liquid present 12 hours after eating, the 898 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
percentage of acid, both free and combined, with the food, and the presence of 
lactic acid. Sometimes easily recognized foods, as prunes, are given the night 
before and looked for in the residual stomach contents. This fluid is removed 
by a small rubber duodenal tube passed into the stomach. After the residual 
stomach contents are removed the tube is left in place while an Ewald test 
meal is eaten. This test meal consists of 2 pieces of toast (about 35 6m.) and 
400 cc of water. After the test meal small quantities may be removed every 
15 minutes until the stomach is empty or the entire stomach contents removed 
at the end of 1 hour, care being taken to have the patient lie successively on 
his back, abdomen, right and left sides to facilitate getting all the fluid. The 
stomach contents thus obtained are examined to determine the quantity of acid, 
both free and combined, with the food. Also tests are made for pepsin and 
occult (invisible) blood and a microscopic examination to discover any pus 
cells, blood cells, yeasts, cancer cells or large fermenting bacteria (Boas-Oppler 
bacilli). 
The acid content is expressed in degrees, indicated The number of degrees 
reported shows the number of cubic centimeters of N/10 alkali needed to 
neutralize 100 cc of gastric contents. 
Duodenal drainage. 
A tube is passed into the duodenum and specimens obtained before and after 
introduction of magnesium sulfate solution. Magnesium sulfate stimu- 
lates emptying of the gall bladder into the duodenum. Gall-bladder bile is 
concentrated and brown in color. The specimens are examined as to amount, 
color, turbidity, and presence in the sediment of crystals of cholesterin, calcium 
bilirubin, bile-stained epithelium or leucocytes, and flagellates (Giardia lamblia). 
If both cholesterin and bilirubin crystals are found in the gall-bladder bile 
specimen the presence of gall stones is strongly indicated. 
liver function tests. 
Icterus Index.—The color of the blood serum is matched against an arbitrary 
standard of 1-10,000 solution of potassium dichromate in a colorimeter. The 
normal index is 2-6, latent jaundice 7-15, and clinical jaundice from 16 up. 
A good test for the degree of jaundice. Harmless pigments such as carotin 
from foods may color the serum if a fasting blood specimen is not obtained. 
Beomsulfalein Dye Test.—The dye is injected intravenously in a dosage of 
5 mg. per kilogram of body weight. Samples of blood are withdrawn 5 minutes 
and 30 minutes after the injection. The blood serum is matched against a 
standard. Any retention of dye above 50 per cent after 5 minutes, or the 
presence of any dye after 30 minutes, is indication of hepatic diseases. 
Galactose Liver Function Test.—Forty grams of galactose are given on a 
fasting stomach. The bladder is emptied. Five subsequent hourly specimens of 
urine are collected and Benedict’s quantitative test for sugar is performed on 
each. Excretion of over 3 grams of sugar is assumed to indicate hepatic 
functional impairment. 
Van Den Beegh Test.—Ehrlich’s diazo reagent is added to blood serum and 
the time of appearance of the maximum color is noted. If a reddish violet color 
appears within 30 seconds the reaction is immediate direct and indicates obstruc- 
tive jaundice. If the color appears after 30 seconds the reaction is delayed 
direct and indicates haemolytic jaundice. An indirect reaction is a quantitative 
test for bilirubin in the serum by adding diazo reagent followed by alcohol 
and ammonium sulfate. Normal serum contains from 1-3 mg. of bilirubin 
per liter. Any amount above this is abnormal. LABORATORY PROCEDURES AND TECHNIQUE 
899 
Urobilinogen Test.—Ehrlich’s reagent is added to urine. A pinkish color 
appears in the presence of urobilin. A positive test in a dilution up to 1-10 is 
normal. Diffuse liver damage is indicated by positive tests in higher dilutions 
of the urine. A negative test in undiluted urine is found in complete obstruction 
of the common bile duct. Urobilin is formed in the intestine by the action of 
bacteria on bilirubin. It is reabsorbed and reconverted into bilirubin by the 
liver and reexcreted in the bile, except for a small amount which is normally 
passed in the urine. If the liver is damaged it is unable to convert the urobilin 
to bilirubin and it passes out in the urine. If the common bile duct is completely 
obstructed no bile enters the intestine and no urobilin is formed. 
BACTERIOLOGY 
This discussion of bacteriology and haematology is not intended to serve as 
a working manual for laboratory use, but rather to outline the principles 
involved, the general methods, and something of the application of the more 
common procedures. Details of technique that are absolutely essential for 
the proper performance of any test are available in the manuals of laboratory 
work that are supplied to the medical department of all ships and stations. 
The microscope. 
The most important single piece of apparatus in a laboratory is the micro- 
scope, and it must be used and cared for accordingly. It is used to magnify 
and so make visible to the eye very small bodies, such, as bacteria, the eggs of 
intestinal parasites, and the material found in urine sediments. A simple 
microscope is nothing more than a single magnifying lens. A compound micro- 
scope, which is the type used in medical laboratories, consists of a number of 
such lenses arranged in line so as to give a very great magnification, even 
up to 1,000 times the actual size. Complete and detailed descriptions of micro- 
scopes are to be found in all books on laboratory work. 
Before attempting to use a microscope for the first time one should read 
over a description of its parts and their functions so that it will be possible 
to adjust the light and the lenses properly. There are a few important things 
to keep in mind regarding its use, and they are: Never leave the microscope 
exposed to direct sunlight, excessive heat, or splashing water; never use ether, 
alcohol, or xylol to clean it, as they all destroy the finish; never pick it up by 
any of the movable parts; never leave immersion oil on the lens or objective, 
as it is called, but wipe it off immediately after use with a fine, soft cloth or 
with special lens paper; when not in use see that it is well covered to protect 
it from dust. 
Mxcromettey is the measurement of microscopic bodies. The unit is called 
the micron and is one one-thousandth part of a millimeter, or one twenty-five 
thousandth of an inch. A glass disk, with a scale etched on it, is inserted 
in the eyepiece of the microscope and there it is at the level at which the image 
of the object on the stage is brought to a focus. The lines of the scale seem 
to cut the object and the number of divisions of the scale covered by the object 
is noted. The scale must be standardized for each objective of each micro- 
scope it is used with. Since the value in microns of one division is thus 
known and, knowing how many divisions are covered by the object, its size 
is determined by multiplying these values. 
Culture media are the materials used for the growth of bacteria in the labora- 
tory. Simple media are so made that they simulate to a greater or lesser degree 
the conditions present in the human body, where the bacteria have been grow- 900 
HANDBOOK OF THE HOSPITAL CORPS, TJ. S. NAVY 
ing. The basis of most media is bouillon or broth which is a solution of 
meat juice, salt, and peptone in water and having a definite degree of acidity. 
The acidity may be determined by titration. The more modern and satisfac- 
tory method is to determine the hydrogen ion concentration or its pH value. 
The usual pH value is about 7.5, approximating that of blood. A few bacteria 
require media of other values for their cultivation. Simple nutrient broth 
may be modified by the addition of agar, making it solid, and is then known 
as nutrient agar. To the latter blood may be added, producing blood agar. 
In the same way other body fluids, such as hydrocele fluid, may be added, 
making the enriched media required by some of the more delicate organisms. 
Figure 167.—1, Filling tubes ; 2, plugging tubes; 3, inoculating tubes; 4, culture flask 
plate; 5, Durham fermentation tube ; 6, Smith fermentation tube; 7, pharyngeal loop for 
meningococcus pharynx cultures; 8, West tube for same. (Stitt.) 
Other substances are used as media, such as milk, broth with sugars added, 
coagulated blood serum (Ldfflers, particularly useful for Corynebacterium 
diphtherife), and many others used for special purposes. Milk is used to 
determine whether the organism produces acid by fermenting the lactose of 
the milk (shown by a change in the litmus indicator) and whether it produces 
enzymes that will coagulate the milk. Sugar broth is used In fermentation 
tubes and always contains an indicator such as litmus. If an organism 
produces acid, the indicator changes color. If it produces gas as well, some 
of the gas is collected in the closed branch of the tube. The various activities 
of organisms on culture media, such as the appearance of the colony, produc- 
tion of acid and gas in one sugar and not in another, have been classified and 
serve to identify the specific organism. Media, after preparation, are put up in 
tubes—fermentation tubes, flat glass dishes with covers known as Petri dishes, 
or in flasks, and are then sterilized. 
Sterilization of culture media is accomplished by means of heat, either 
from streaming steam in an Arnold sterilizer or by steam under pressure in LABORATORY PROCEDURES AND TECHNIQUE 
901 
an autoclave. Glassware often is sterilized by dry beat. Fractional steriliza- 
tion is repeated sterilization at 1 to 24 hour intervals and is employed to kill 
bacteria developing from spores. As the dust of the air is loaded with bacteria 
all media must be kept covered or, if in tubes, plugged with cotton from the 
time first made. 
Bacteria are very small single-celled bodies, visible only through a micro- 
scope. They are distributed almost universally in soil, air, water, and in the 
human body. The mouth and throat contain enormous numbers; milk and 
butter contain millions. The large intestine contains countless numbers, and 
a large part of the solid matter of the faeces is made up of bacteria. It is 
evident, therefore, that not all of these bacteria produce disease, and some 
of them are harmless or even distinctly beneficial to the body and are called 
nonpathogenic. Many bacteria are known to produce disease, and these are 
called pathogenic. In order to study bacteria they are grown on culture media, 
the different organisms separated out and then grown in pure culture for 
identification. As the majority of bacteria of medical interest grow in the 
human body the media employed for laboratory growth must be kept at body 
temperature; hence cultures are kept at a constant temperature of 37.5° O. 
This is known as incubation and usually is continued for 24-hour periods. 
Bacteria are classified according to the appearance of colonies, the shape and 
arrangement of the individual cells, their color when stained by appropriate 
methods, whether or not they are motile (have the ability to move from place 
to place in fluid), by their action on milk and sugar bouillon and by their 
action on experimental animals. The three usual types are the round organ- 
isms, or cocci, rod shaped, or bacilli, and spiral forms, or spirilla;. All of them 
are killed by boiling, many of them by a lower temperature if prolonged suf- 
ficiently. Some grow only in the presesnce of oxygen and are called aerobes, 
while others require an atmosphere free of oxygen and are called anaerobes. 
They reproduce by fission or simple splitting into parts. Some of them produce 
bodies called spores that are much more resistant to high temperatures, drying, 
and cold than the bacteria and serve to produce new organisms when material 
containing them again is placed in surroundings favorable to bacterial growths. 
Filtrable viruses are organisms so minute that they will pass through the 
pores of a porcelain filter. They cause the following diseases: Small pox, 
varicella, lymphogranuloma inguinale, foot and mouth disease, herpes febrilis, 
epidemic encephalitis, poliomyelitis, rabies, benign lymphocytic chorio-meningitis, 
influenza, common cold, measles, mumps, dengue, yellow fever, and sandfly 
fever. 
Smears are thin spreads of pus, blood, bacteria, or similar material on a 
glass slide. They may be made from material from the throat, from sputum, 
from an abscess, or of blood. The first essential for a proper bacteriological 
examination is a good smear, and the chief difficulty is to get it thin enough. 
If a culture is to be examined, place a loopful and a drop of distilled water 
on a perfectly clean glass slide and with a sterile platinum wire rub up some 
of the bacteria in the water, spreading it over as large an area as possible. 
If the bacteria are in fluid media, the water is not needed. For examination 
of piis use a cotton swab or a loop and spread out just enough of the material 
to make a visible film on the slide. Smears of sputum should be made from 
fresh material—that is, material recently coughed up from the lungs and as 
free of mouth secretions or saliva as possible and collected in a clean container. 
For the smear select a thick lump of mucus and avoid the frothy, watery saliva. 
Smears are allowed to dry in the air and then are fixed to the slide by passing 
through a flame two or three times. Blood smears should not be fixed by such 902 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
heating. The smear then is ready for staining with whatever dye is indicated, 
Gram’s method being the best routine process for most bacteria, except tbe 
tubercle bacillus which requires the acid fast staining method. 
Stains are substances used to color bacteria and tissue cells so that their 
morphology may be studied microscopically. They are usually solutions of 
anilin dyes in water or alcohol, but a few are derived from vegetable sub- 
stances. The more common stains are hsematoxylin and eosin, used for tissue 
staining, and methylene blue, carbol fuchsin, gentian violet, and safranin for 
bacteria. Each of these is made up for use in definite strength, alone or in 
combination with another dye. For some purposes several stains are applied 
successively, as part of the material will take up and retain one stain while 
other parts will react with another dye. This is the principle of Gram’s method 
and of acid-fast staining for tubercle bacilli. 
Gram’s stain.—1. Stirling’s gentian violet solution; Five grams of gentian 
violet are ground in a mortar with 10 cc of 95 per cent alcohol. After prac- 
tical solution, 2 cc of anilin oil are added and then 88 cc of distilled water. 
The grinding is continued a short time and then the mixture is let stand 
a day or two when it is filtered through paper. It has the merit of staining 
quickly and intensely and of keeping many months. 
2. Gram’s iodine solution : The formula for this solution is: 
Iodine I 1 gram. 
Potassium iodide 2 grams. 
Distilled water 300 cc. 
3. Decolorizing agents: Alcohol and acetone, equal parts; or alcohol, 95 
per cent. 
4. Counterstains: (a) Dilute carbol fuchsin: One part carbol fuchsin in 
.10 parts water; (&) Safranin: 10 cc of saturated alcoholic solution of water 
soluble safranin with 90 cc of distilled water. 
5. Technique: The film should be thin, dried in tbe air, and fixed by passing 
through the flame or with methyl alcohol. The gentian violet is applied for 
one-half minute and washed off. The Gram’s iodine solution is applied for 
one minute or longer and washed off. Alcohol 95 per cent or alcohol and 
acetone equal parts are now dropped on the film until no more violet 
color streams out. 
Wash with water and apply one of the counter stains for 1 or 2 minutes. 
Gram-positive bacteria are stained a deep violet, whereas the Gram-negative 
organisms take the color of the counter stain. 
Method of staining acid-fast bacilli.—Carbol fuchsin (Ziehl-Neelsen), satu- 
rated alcoholic solution of basic fuchsin, 10 cc, and 5 per cent aqueous solution 
of phenol, 100 cc. 
(a) Dry smear in air and fix by passing through flame or with methyl 
alcohol. 
(&) Flood smear with stain and gently steam for 3 to 5 minutes. Wash 
in water. Decolorize with 95 per cent alcohol containing 3 per cent hydro- 
chloric acid, until only a suggestion of pink color remains. 
(c) Wash in water. 
(d) Counterstain with saturated aqueous solution of methylene blue. 
(e) Wash, dry, and mount. 
(f) Acid-fast organisms are stained red, other organisms and cells blue. 
Important acid-fast organisms are the tubercle and leprosy bacilli. 
Blood cultures are made to determine whether bacteria are present in the 
blood stream, thus serving as an index of the nature of the disease in some 903 
LABORATORY PROCEDURES AND TECHNIQUE 
cases. Ordinarily about 10 to 20 cc of blood are required. It is taken from 
a vein by means of a needle and syringe or a needle connected by sterile 
tubing with a flask, observing strict asepsis throughout. The skin over the 
vein is sterilized with Tr. iodine and alcohol prior to the taking of the blood. 
The blood is received in sterile containers and transferred to appropriate 
media. Usually it is added to bouillon and in varying proportions to melted 
agar that has been cooled below 45° C. and then is poured into Petri dishes and 
incubated. 
Blood for the Wassermann reaction and Kahn test are taken in the same 
manner, preparing the patient’s arm, constricting above with a tourniquet, 
and puncturing a vein with a needle. Here, as absolute asepsis of the blood is 
not required, the blood may be permitted to run from the end of the needle into 
a tube, but it is better to collect it in a closed system of apparatus. 
Dark-field examinations usually are made on serum from sores on the geni- 
talia to detect the Treponema pallidum, the organism causing syphilis. For 
this purpose a special substage condenser replaces the ordinary Abbe con- 
denser of the microscope. It is so constructed that light rays are prevented 
from passing directly from the mirror to the objective by a light-proof black 
surface. Light is reflected by means of mirrors around the sides of this 
dark field and so illuminates the organisms or cells that may be present in 
the fluid on the slide. Ordinary daylight is not sufficient, and special lamps 
are required. 
To make the preparation the suspected sore is cleaned of all accumulated 
secretions with sterile gauze and physiological salt solution. Then it is rubbed 
sufficiently to promote a flow of serum but not to draw blood. A drop of this 
material is placed on a slide and immediately covered by a water glass and 
examined while still moist. The Treponema pallidum is examined in a dark-field 
preparation because it does not take the ordinary dyes, and when stained by one 
of the more complicated methods loses many of its characteristics. Other organ- 
isms may be seen in the dark-field preparation, but as they are stained easily, 
this method Is not employed. There are a number of spiral-shaped organisms 
that occur in ulcerative lesions, so great care must be exercised in making a 
positive report of Treponema pallidum. 
Bacteriophage is a filtrable, particulate substance which causes lysis or 
dissolution of susceptible bacteria. It can be obtained from faeces or sewage 
and can be transmitted indefinitely from one culture to another with increase 
in quantity. 
Agglutination tests.—If the serum of a typhoid fever patient is added to a 
culture of typhoid bacilli clumping or agglutination of the bacteria takes 
place. This is called the Widal reaction. Several other diseases can be diag- 
nosed by agglutination tests, among them meningitis, tularaemia, undulant 
fever, cholera, paratyphoid fever, using the patient’s serum and the causative 
organism. 
Pneumococcus typing.—Thirty-two strains of pneumococci have been identi- 
fied. If rabbits are injected with these strains 32 specific serums can be 
obtained which when added to pneumococci in pneumonia sputum cause swell- 
ing of the capsule of the organism enabling the specific strain to be identified. 
This is the Neufeld reaction. 
Sensitization tests.—Many people are hypersensitive (allergic) to certain 
proteins (foods, epidermals, pollens) and suffer from asthma, hay fever, urti- 
caria, etc. Extracts of the proteins when applied as a scratch test or intrader- 
mally produce a local urticarial wheal in a person sensitive to the particular 
substance. {See section on Allergy.) 904 
HANDBOOK OF THE HOSPITAL COUPS, U. S. NAVY 
Friedman test for pregnancy.—If the urine of a pregnant woman is injected 
intravenously into a virgin female rabbit, hsemorrhagic follicles can be seen in 
the ovaries of the rabbit within 24 hours. This test is of great value in the 
early diagnosis of human pregnancy. 
Schick test.—Inject intradermally 0.1 cc of diphtheria toxin. If a reddened 
area appears within 24 hours and reaches a maximum after 2-3 days the test 
is positive and indicates that the individual is lacking in antitoxin and is sus- 
ceptible to diphtheria. 
Dick test.—Scarlet-fever toxin is injected intradermally. If the person is sus- 
ceptible to scarlet fever a red infiltrated area appears within 24 hours. 
Mantoux test.—Tuberculin is injected intradermally. A local reaction indi- 
cates past or present tuberculous infection. If a scratch test is used it is called 
a Yon Pibquet test. 
Frei test.—An antigen made from an emulsion of a mouse’s brain infected 
with the virus of lymphogranuloma inguinale is injected intracutaneously. A 
local reaction which persists for 3 days or longer is diagnostic of lymphogranu- 
loma inguinale. 
Paul, and Bunnel test.—When the human serum is added to sheep corpuscles 
agglutination occurs at dilutions of 1 to 8, or 1 to l(i. Serum from patients 
with infectious mononucleosis agglutinates sheep cells in high dilutions. Serum 
from leucsemic patients agglutinates in dilutions of 1 to 4 or less. 
Following is a list of important pathogenic bacteria and the diseases in which 
they are the primary causative agent: 
Organism 
Disease 
Gram Positive 
Bacillus anthracis_ 
Clostridium tetani {B. tetani) 
Corynebacterium diphtheria; (B. diphtherias) 
Diplococcus pneumoniae (Pneumonoccus) _ 
Mycobacterium leprae (B. leprae) 
Mycobacterium tuberculosis (hominis) (B. tuber- 
culosis) . 
Staphylococcus. 
Streptococcus. _ _ _. 
Anthrax. 
Tetanus (lockjaw). 
Diphtheria. 
Pneumonia. 
Leprosy. 
Tuberculosis. 
Boils, abscesses. 
Cellulitis, scarlet fever. 
Gram Negative 
Eberthella typhosa (B. typhosus) _ „ _ 
Haemophilus ducreyii {B. of chancroid) . 
Haemophilus influenzae (B. influenzae) 
Klebsiella pneumoniae {B. pneumoniae) (Fried- 
lander). 
Neisseria gonorrhoeae {Gonococcus) _ 
Neisseria intracellularis (Meningococcus)._ 
Pasteurella pestis (B. pestis) _ 
Pasteurella tularensis {Bacterium tularense) 
Salmonella enter!tidis {B. enteritidis) 
Salmonella paratyphi {B. paratyphosus (H)) 
Salmonella schotmiilleri {B. paratyphosus {B))__ 
Shigella dysenteriae {B. dysenteriae) 
Vibrio comma {Spirillum cholerx) _ 
Typhoid fever. 
Chancroid. 
Bronchopneumonia. 
Pneumonia. 
Gonorrhoea. 
Epidemic meningitis. 
Plague. 
Tularaemia. 
Food poisoning. 
Paratyphoid fever A. 
Paratyphoid fever B. 
Dysentery. 
Cholera. LABORATORY PROCEDURES AND TECHNIQUE 
905 
Counting blood cells. 
Complete blood count—This includes the determination of the number of 
red and white cells in 1 cubic millimeter of blood, the percentage of hfemo- 
globin, and a differential count which determines the percentage of each type 
of white cells present. Cells are so numerous in the blood that it must be 
diluted to separate them and permit the counting of individual cells. The 
dilution is accomplished in special pipettes (marked 101 for red count and 
11 for white count), first taking up blood and then the proper diluting fluid. 
The pipettes are so graduated that known dilutions may be made. One part 
of blood to 200 parts of fluid gives a dilution of 1-200 for the red pipette and 
1-20 for the white. The pipettes must be clean and dry before use, and this 
is accomplished by washing out with water, sucking alcohol through to wash 
out the water, then ether to take out alcohol, and then air to evaporate the 
ether. The bulb of the pipette or mixing chamber contains a glass bead to 
aid in thoroughly mixing the diluted blood; and if cleaned properly, the bead 
will not stick to the sides of the bulb. 
Red blood count.—Cleanse finger tip with alcohol, let dry. Puncture with 
sterile needle. Draw blood to exactly 0.5 mark, wipe off tip. See that the 
blood column reaches from the tip to mark. Draw up diluting fluid (Hayem’s) 
to 101 mark. Cover ends of pipette with thumb and finger and shake vigor- 
ously to thoroughly mix. Blow out 2 or 3 drops and discard, then apply a 
drop to the top of the ruled platform of the counting chamber of the hema- 
cytometer at the edge of the cover slip and allow enough of the diluted blood 
to run in by capillary attraction to fill the space beneath the cover. This 
space is 0.1 mm. deep. Allow erythrocytes to settle and using the high dry 
objective find the large center square which is divided into 400 small squares. 
Count the number of red cells in 80 of these squares and add four ciphers 
for the correct red blood count. A normal red blood count is 4.5 to 5 million 
per cubic millimeter. Hayem’s solution consists of bichloride of mercury 
0.5, sodium sulfate 5, sodium chloride 1, distilled water 200. 
White blood count.—Draw blood to 0.5 mark and diluting fluid (3 per cent 
acetic acid, or tenth normal hydrochloric acid to the 11 mark. Mix and blow 
out two drops. Fill the counting chamber. Allow to settle and count the 
leucocytes under low power in those square millimeters at each of the 4 
corners of the Neubauer ruled areas and multiply the total by 50. A normal 
white blood count is 5 to 10 thousand per c. mm. of blood. A count below 
5,000 is called a leucopcenia and above 10,000 a leucocytosis. 
Differential count.—This is made on a stained smear of undiluted blood. 
Smears are made on slides or cover slips that are clean and free of all grease. 
Smears on slides are made by drawing out a drop of blood on one slide by 
means of the end of another slide. With cover slips, a drop of blood is taken 
up on the center of one and a second dropped on it. The blood spreads out 
rapidly in a thin film and then the slips are separated by a sliding motion. 
Both methods are illustrated. The smears are dried in the air and then stained 
with Wright’s stain. This stain is made by adding 0.3 Gm. of the dye to 
100 cc of pure methyl alcohol and put aside for a few days to ripen. To 
stain cover blood smear with the stain for one minute then dilute with equal 
amount of freshly distilled water and allow to stain for 3 to 6 minutes. 
Wash off, let dry and examine with the oil immersion objective, counting 
100 cells. The number of each type of white cells then gives the percentage 
of each. The identification of the various types of leucocytes is best learned 
by examining many slides with the aid of an experienced technician. 
HEMATOLOGY 906 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The Schilling classification of leucocytes for differential count and their 
normal percentage follows: Basophiles 0-1, eosinophiles 2-4, myelocytes 0, 
juveniles 0-1, band forms 3-5, segmented neutrophiles 51-67, lymphocytes 21- 
35, monocytes 4-8. In severe infectious diseases the number of band and 
juvenile forms increases at the expense of the segmented neutrophiles and 
is known as the “shift to the left.” In certain diseases abnormal or patho- 
logical cells appear. Among the latter are the myeloblasts and myelocytes of 
myelogenous leucaemia and the lymphoblasts of lymphatic leucaemia. 
Figure 168.—1, 2, 3, 4, Making blood smears on slide; 5, smear ready for staining— 
grease marks prevent Wright’s stain from running over slide; 6, U-shaped glass tubing 
to hold title in staining; 7, right hand holding two cover glasses—one cover glass is 
being touched to drop of blood from ear; 8, cover glasses transferred to left hand in 
preparing to place one cover glass on another and spread film; 9, separating cover 
glasses by sliding one from the other. (Stitt.) 
The stained smear also is used to demonsti’ate the presence of malarial 
parasites, the staining qualities of the red cells, and their shape, size, and 
whether or not any of them show nuclei. 
Hemoglobin is the coloring matter of the erythrocytes and is estimated by 
adding tenth normal hydrochloric acid to blood (which converts haemoglobin to 
haematin) and comparing the color with the color scales of a Sahli or Haden- 
Hausser haemoglobinometer. It is reported either in per cent of normal or as 
grams per 100 cc of blood. 
Coagulation time of the blood is determined by filling a piece of capillary 
glass tubing with blood. At half minute intervals break off a portion. When 
coagulation has taken place a wormlike coagulum can be pulled out. Normal 
coagulation time is 3 to 6 minutes. A long coagulation time is seen in 
Inemophilia and some jaundiced patients. 
Sedimentation test.—Five cc of blood are placed in a Cutler graduated 
tube containing 0.5 cc of 3 per cent sodium citrate solution to prevent clotting. LABORATORY PROCEDURES AND TECHNIQUE 
907 
As the blood settles a reading is made every 5 minutes for 1 hour and 
recorded on a graph. The normal sedimentation index for men is 2-8 mm. 
It is slightly higher for women. Sedimentation increases with increasing 
destructive processes of disease, hence is a good prognostic indicator. 
ANIMAL PARASITOLOGY 
General considerations. 
While there are many lower forms of animal life that are parasitic for man, 
only the most common ones will be considered in this section. Before discuss- 
ing the systematic relationships, structure, and life history of these parasites, 
there are certain terms employed in animal parasitology which it is necessary 
to understand. Among these are: 
1. Hosts.—The animal in which a parasite undergoes its sexual life is called 
the definitive or final host, that in which it passes its nonsexual or larval 
existence the intermediate host. For example: Man is the intermediate host 
of the malarial parasite, the mosquito the definitive host. 
2. True parasitism.—By this is understood the condition where the parasite 
does harm to the host, deriving all the benefit of the association. A good 
example of this is the hookworm infecting man. 
3. Mutualism.—In such an association there is mutual benefit to each party 
of the association. An instance of this would be the oyster crab found inside 
the oyster shell. 
4. Commensalism.—Where there is benefit to the parasites but no injury to 
the host. An example of this would be the Endamceha coli in the intestine of 
man. 
5. Ectoparasites.—Those living upon the body of the host. Example: In- 
festation with lice. 
6. Endoparasites.—Those living within the body of the host. Example: 
Infection with hookworms, 
7. Male parasites are designated by the sign of Mars ( $ ) ; the female by the 
sign of Venus ( ? ). 
8. The name of a parasite consists of its generic and specific names. The 
first or the generic name always commences with a capital. Example: 
Cimex lectularius, the name of the bedbug. 
Classification. 
Practically all animal parasites of man belong to the following zoological 
phyla, or branches: 1. Protozoa (one-celled animals); 2. Vermes (low*er 
worms) ; and 3. Arthropoda (mites, ticks, and insects). 
Protozoa are one-celled animals and are made up of protoplasm, which is 
divided into cytoplasm and a nucleus. There are four groups of protozoa as 
follows: 1. Sarcodina ; 2. Flagellata ; 3. Infusoria ; and 4. Sporozoa. (Fig. 169.) 
saroodina.—This class of protozoa moves and secures food by throwing out 
protoplasmic projections called pseudopodia, or false feet. Evdamwha histolyt- 
ica, one of the parasitic intestinal amoeba of man, is the important member of 
this class. It exists in two stages, motile and encysted. Man acts as the 
definitive host. An intermediate host is not required. It is transmitted by 
cysts in food or water. Flies may act as carriers. It causes the disease known 
as amoebic dysentery. Diagnosis is made by finding the motile or encysted 
amoeba in the stools. 
flagellata.—This class sometimes is called the Mastigophora and includes 
those protozoa that move and obtain food by means of whiplike appendages, or 
flagella. Trypanosoma yamhiense is an important member of this group. This 
154291°—39 58 908 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
parasite is fish-shaped, has two nuclei and a long flagellum. It lives in the 
blood and tissues of man. For its development two hosts are required: A fly 
(Olossina palpalis), the definitive host, and man, the intermediate host. It is 
transmitted by the fly biting man. It causes the disease known as trypano- 
somiasis, or sleeping sickness, a disease found chiefly in Africa. Diagnosis is 
made by finding the trypanosome in the blood or tissues of man. Intestinal 
flagellates such as Trichomonas, Chilomastix, and Giardia, are frequently 
found in an examination of the stools. Trichomonas vaginalis is an important 
flagellate often found in vaginal discharges. 
Figure 169.—Parasitic protozoa of man : 1, adult Endarnoeha histolytica; la, encylsted 
/<;. histolytica; 2, Plasmodium malariae, A, B, C, D, various stages ; Trypanosoma 
yambiense; 4, a, Treponema pallidum; b, Borrelia refringens; 5, Ballantidiurn coli; 6, 
Trichomonas hominis; 7, a, adult Oiardia lambliaj b, encysted O. lamblia. (Stitt.) 
infusoria.—This group frequently is called the Ciliata on account of the fine, 
hairlike fringe or cilia that surrounds them. These cilia aid in movement and 
securing food. Balantidium coli, a rather large intestinal protozoan, is the only 
member of this group of importance to man. It is transmitted similarly to 
Endamocba, and causes dysentery. Diagnosis is made by finding the parasite 
in the stool. 
sporozoa.—The protozoa have neither cilia, flagella, nor other organs for 
movement. They live parasitically in the tissue cells of the host, and repro- 
duce by forming spores. The ones that live in the red blood cells, Hoemosporidia, 
are of the most interest medically because they include the parasites that cause 
malaria. There are three types of malarial parasites of man: 1. Plasmodium 
malaria;, the cause of quartan malaria; 2. Plasmodium vivax, the cause of 
benign tertian malaria; and 3. Plasmodium falciparum, the cause of malig- 
nant tertian (aestivo-autumnal) malaria. These parasites require two hosts for 
their development, the definitive host, a mosquito (Anopheles), and man, the 
intermediate host. The development in the mosquito requires 10 to 21 days; LABORATORY PROCEDURES AND TECHNIQUE 
909 
thus, an anopheles mosquito biting a man suffering from malaria cannot infect 
another man until after this time has elapsed. 
In the body of a mosquito which has been infected by biting a person having 
some form of malaria the malarial parasite develops for from 10 to 21 days 
and then appears in the salivary glands of the mosquito in the form known as 
sporozoites and is ready for transmission to another host. By the bite of the 
infected mosquito the sporozoites are introduced into the blood stream of the 
new host where they enter the red-blood cells and are known as trophozoites. 
In the red cells the trophozoites rapidly mature, the benign tertian type in 
48 hours, the quartan in 72 hours, and the malignant tertian in about 48 hours, 
and when full-grown they are termed schizonts. The nucleus of a schizont 
divides into minute particles which scatter through the cytoplasm of the 
parasite, later to become the nuclei of new parasites, and the cytoplasm splits 
into segments which each contain a nuclear particle and are called merozoites. 
The red cell then ruptures and the merozoites are released into the plasma 
whence they seek and enter fresh red cells where the cycle is repeated. Repro 
duction of the parasites continues for about 2 weeks (the incubation period) 
at the end of which time a sufficient number have been produced to cause the 
symptoms characteristic of malaria, the chill followed by fever. The chill in 
malaria is coincident with the rupturing of the red cells and is attributed to 
the sudden liberation into the blood of toxic substances, possibly excretory 
material of the parasites, from the disintegrated red cells. 
Diagnosis is made by examining a blood smear for the presence of these 
parasites. 
Vebmes are divided into two classes, the platyhelminthes, or flat worms, and 
the nemathelminthes, or round worms. 
platyhelminthes.—Of these parasites, known only as the flat worms, there 
are two classes: 1. The trematodes or flukes; and 2. The cestodes or tapeworms. 
Trematodes or flukes are generally leaflike in shape and vary considerably 
in size. Characteristic of them is the possession of suckers, by which they 
hold on to the skin or alimentary tract of their host. They develop from eggs, 
and the larval stage usually is passed in a snail. Some flukes require, in addi- 
tion to the snail, a second intermediate host, usually a fish. Man, the definitive 
host, contracts the parasites by eating insufficiently cooked fish or by bathing 
in or drinking infected water. The flukes of importance to man are: 1. 
Fasciolopsis buski, which parasite lives in the intentine, the diagnosis being- 
made by finding the fluke or its eggs in the stools; 2. Clonorchis sinensis, an 
important liver fluke, the eggs of which likewise are found in the stools; 
3. Paragonimus ringeri, the fluke that lives in the lungs, the diagnosis being 
made by finding eggs in the fresh sputum; and 4. Schistosomes, which are the 
blood flukes, of which there are three kinds, Schistosoma hwmatobium, S. 
japonicum, and S. mansoni. Unlike the other flukes, the blood flukes are, 
not hermaphroditic, but have separate sex. Diagnosis is made by finding the 
eggs in the faeces or, in the case of S. haematobium, in both urine and faeces. 
Cestodes or tapeworms.—These consist of a head and a series of segments. 
The head, which is a little larger than a pinhead, is provided with suckers, 
or hooks, or sometimes both, to enable them to hold on to the intestine. The 
segments may number several hundred or more. Some tapeworms attain the 
length of 25 or 30 feet. In treating cases of tapeworm infection, it is imt- 
portant that the head be expelled, otherwise, in about two months, a full- 
grown worm again will develop. Among the important tapeworms of man 
are: Taenia saginata, Taenia solium, Hymenolepis nana, and Diphyllobothrium 
latum. 1. Twnia saginata is the common and widely distributed beef tape- 910 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
worm. Its head has four large suckers but no booklets and it often is called 
the unarmed tapeworm. The segments have a uterus showing 15 to 30 
branches. The genital pores are lateral and alternate. Several hundred seg- 
ments may be present, and the worm varies from 10 to 25 feet in length. 
Man is the definitive host and cattle the intermediate host, infection being 
brought about by eating insufficiently cooked beef. 2. Taenia solium is the so- 
called pork tapeworm and is not as common as the beef tapeworm. Its head 
shows, in addition to suckers, a rostellum crowned by booklets, for this reason 
often being called the armed tapeworm. The segments have a uterus showing 
only 5 to 10 branches. Man is the definitive host and the hog the intermediate 
Figure 170.—Adult and larval stages of cestoda of man. (Stitt.) 
host. Infection is contracted by eating insufficiently cooked pork. 3. Hyme- 
nolepis nano, is one of the most common tapeworms and is called the dwarf 
tapeworm on account of its small size, it being only a quarter to a half 
inch in length. Its head has four suckers and a rostellum with a single 
row of booklets encircling it. There are about 150 to 200 segments. The gen- 
ital pores are lateral and all are on the same side. Man acts as both the 
definitive and intermediate host. As many as 1,000 worms may be present 
at one time. Infection is caused by swallowing the eggs. 4. Diphyllobothrium 
latum, the broad Russian tapeworm, has an olive-shaped head, with two slitlike 
suckers, broad segments with a rosette-shaped uterus, and may reach more 
than 30 feet in length. Segments sometimes number 3,000 or more. Man, 
the definitive host, contracts the infection by eating insufficiently cooked fish. 
Two intermediate hosts are recognized—first a cyclops (a minute, one-eyed 
shellfish) and second a fish. The eggs are operculated (have a lid) and the 
worms do not have the booklets characteristic of the other tapeworms previously 
discussed. 
The diagnosis of these worms is made by finding their segments or their 
eggs in the stools. (Fig. 170). LABORATORY PROCEDURES AND TECHNIQUE 
911 
nemathelminthes.—These woriiKS are known as roundworms on account of 
being tubular or filiform in shape. They are not segmented and are covered 
by a cuticle or skin, which is frequently ringed. An alimentary canal is usually 
present and complete. The sexes as a rule are separate. The male usually 
can be recognized by its smaller size, its curved posterior end, and at times 
exhibiting an umbrellalike expansion called the copulatory bursa. The most 
common roundworms are: Ascaris lumbricoides, hookworms, Trichuris tri- 
chiura, Enterobius vermicularis, Trichinella spiralis, and Wuchereria bancrofti. 
1. Ascaris lumbricoides, the round or eel worm, probably is the most common 
parasite of man, especially children. They average about fi inches in length 
Figure 171.—la, copulatory bursa of Necator americanus, showing the deep cleft dividing 
the branches of the dorsal ray and the bipartite tips of the branches; also showing the 
fusion of the spicules to terminate in a single barb. Scale 1/10 mm. lb, Branches of 
dorsal ray magnified. 2a, the Buccal capsule of N. americanus. 2b, The same magnified 
3a, Cop. bursa of Ancylostoma duodenale, showing shallow clefts between branches of 
the dorsal ray and the tridigitate terminations. Spicules hairlike. 3b, The dorsal ray 
magnified. 4a, The buccal capsule of A. duodenale, showing the much larger mouth 
opening and the prominent hooklike ventral teeth. 4b, The same magnified. 5a, Egg 
of N. americanus. 5b, Egg of A. duodenale. 6a, Rhabditiform larva of Strongyloides 
as seen in fresh faeces. 6b, Rhabditiform larva of hookworm in fasces 8 to 12 hours 
after passage of stool. (Stitt.) 
and are grayish to reddish in color. An intermediate host is not required. 
Infection takes place through food or drink or by fingers of children who 
have been playing where soil pollution exists. The adults live in the intestine. 
2. Hookworms (fig. 171). These roundworms are of considerable importance 
from a medical standpoint. Human infection comes almost entirely from two 
types of hookworms, Ancylostoma duodenale, the Old World species, and Neca- 
tor americanus, which generally is called the New World species. They average 
about one-half inch in length. The males are distinguished from the females 
by their expanded posterior end. The large open mouth of the Old World 
hookworm has four claw-like teeth on the ventral side and two knob-like teeth 912 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
on the dorsal aspect; the New World hookworm has a smaller round mouth 
and the ventral teeth are replaced by plates, and it also has a prominent dorsal 
tooth projecting into the mouth cavity. Man is the definitive host and an inter- 
mediate host is not required. Infection takes place by larva in polluted soil 
penetrating the skin from where the larvae make their way to the intestine, 
and there develop into adults. 3. Trichuris trichiura, usually called the whip- 
worm on account of the thickened body resembling the handle and the narrow 
neck the lash, is one of the most common parasites in both temperate and 
tropical climates, and averages about 2 inches in length. It does not require 
an intermediate host. The diagnosis of the three roundworms described is 
Figure 172.—Nematode ova. (Stitt.) 
made by finding the adults or their ova (fig. 172) in the stools. 4. Enterobius 
vermicularis, a parasite commonly known as the pin or seat worm and found 
more frequently in children than in adults. The male is about one-sixteenth of 
an inch and the female about one-half inch in length. The male has an in- 
curved tail with a single spicule and the female a long tapering tail. The 
female, loaded with eggs, wanders out of the rectum, and, as the result of 
scratching, the fingers become contaminated with the eggs, which may be 
carried to the mouth and cause a fresh infection, an intermediate host thus not 
being required. Diagnosis usually is made by examining the stools for the 
white, threadlike females, which usually are expelled after a purgative. 
5. Trichinella spiralis is the cause of trichinosis. The adults live in the in- 
testine and are about one-sixteenth of an inch in length. The female does not 
lay eggs, but gives off larvae directly which wander to the muscles of the body. 
Man acts as the definitive host and hogs as the intermediate host, infection 
being contracted by eating insufficiently cooked pork. Diagnosis is made in the 
first 5 days of the disease by finding the adults in the stools, after that time 
by finding the larvae in the blood or muscles. 6. Wuchereria hancrofti is the 
most important of filarial worms and causes an infection common in tropical LABORATORY PROCEDURES AND TECHNIQUE 
913 
countries. The adult worms live in the lymphatics and are about 2 inches in 
length. The female normally does not lay eggs but gives off larvae, which enter 
the blood stream. Characteristic of this parasite is the appearance of the 
larvae in the blood stream only when the patient sleeps. Man is the definitive 
host, and the mosquito, especially the Culex quinquefaciatus, the intermediate 
host. It takes about 3 weeks for the larvae to develop properly in the mosquito 
before they can infect another man. Diagnosis is made by the presence of 
the larvae in the blood stream. 
The Arthropoda is the other branch of animals which will be particularly 
discussed in this section. Of these, from a medical standpoint, interest cen- 
ters in two classes only, the arachnids and the insects. 
arachnida.—This class includes the mites and ticks, which differ from the 
insects in having a head and thorax fused together and possessing four pairs 
of legs instead of three, and the spiders. A common parasite belonging to this class 
is the Sarcoptes scahei, the human itch mite. This minute, whitish mite causes a 
skin disease known as scabies. The disease is brought about by the female 
mite burrowing into the skin, where eggs are laid, from which come young 
mites that are to spread the infection. Diagnosis is made by examining the skin 
scrapings under the microscope for the presence of the mites or their eggs. 
The tick family of arachnids is of great and increasing importance medi- 
cally. It was through proving the tick transmitted a disease of cattle 
in Texas that the zoological principle of transmission of diseases by 
means of arthropod hosts was estab- 
lished. Ticks are much larger than 
mites, readily being seen by the unaided 
eye. They are wholly parasitic in their 
habits. Some of them live on their 
host practically all their lives, dropping 
to the ground to deposit their eggs. 
Among the ticks of importance are: 
Ornithodoros mouhata and Dermaccntor 
andersoni (fig. 173). 1. Ornithodoros 
mouhata has a hard, rough skin, and 
on looking down on its back the head 
cannot be seen. It lives in the huts of 
the natives of Africa and has habits 
very similar to the bedbug, feeding at night and hiding during the day. It 
transmits a protozoan, Borrelia duttoni, which causes South African tick fever. 
2. Dermaccntor andersoni. A tick found in the western part of the United 
States which can be roughly distinguished from the O. mouhata on account of 
its smooth skin and the head parts projecting beyond its body outline. It 
transmits the spotted fever of the Rocky Mountains. The dog tick, D. vari- 
ahilis, also transmits Rocky Mountain spotted fever which is due to the virus 
often called Dermacentroxenus rickettsi. 
Of the spiders, Lactrodectus mactans, the “black widow” or hour glass spider, 
is important because of her dangerous bite. She lives in outbuildings and is 
recognized by the black color and deep orange hour-glass shaped spot on the 
ventral abdomen. About 30 minutes after the bite excruciating pains are 
felt in various parts of the body particularly of the abdomen with marked 
rigidity of the muscles. 
insecta.—In this class are the mosquitoes, the fleas, flies, lice, and bedbugs. 
These parasites have three well-marked divisions of body: Head, thorax, and, 
abdomen; three pairs of legs and one pair of antenna;. 
Figure 173.—Ticks : 1, Ornithodoro* 
moubata; 2, Dermacentor andersoni. 
(Stitt.) 914 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The Culicidw or mosquitoes are of the greatest importance medically, not 
only from their influence upon health in general by reason of interference 
with sleep and possibly from direct transmission of disease but, more specifi- 
cally, because they are the only means by which it at present appears possible 
to bring about infection with such diseases as malaria, yellow fever, filariasis, 
and dengue. In the life history of mosquitoes (fig. 174) the female lays eggs 
in water or in places where water is apt to collect; otherwise they will not 
hatch. In from 1 to 4 days a larva or wriggler emerges and comes to the 
surface to breathe. These larvae are of two types—the siphonate and the 
asiphonate. The siphonate are so called on account of having a breathing 
Figure 174.—Life cycle of the Anopheles, Culex, and Aedes mosquitoes. (Stitt.) 
tube projecting from the tail end of the abdomen. When seen at rest this 
tube projects above the surface of the water and the head end of the larva 
hangs down at an angle. The larva of the mosquito (Culex) that transmits 
filariasis has a long, narrow siphon, and the larva of the yellow-fever mosquito 
{Aedes) has a short, barrel-shaped siphon. The asiphonate do not have this 
tube, but possess breathing slits and at rest float parallel to the surface of the 
water. This is the larva of the mosquito (Anopheles) that transmits malaria. 
This larva has another characteristic feature, namely, fan-shaped hairs on each 
side of its abdominal segments, called palmate hairs. After a period of about a 
week the larva enters a nongrowing, nonfeeding stage, called the pupa or 
nymph, from which in about 3 days the adult mosquito releases itself and 
flies away. 
It is desirable that the anatomical characteristics of mosquitoes be known 
to those who may have to examine them (Fig. 175). In examining an adult 
mosquito it will be noted that there are three divisions of the body: Head, 
thorax, and abdomen. The head shows a stout projection, called the pro- 
boscis, which contains the biting parts. In mosquitoes of medical interest 915 
LABORATORY PROCEDURES AND TECHNIQUE 
this proboscis is long and straight. In males the biting parts are not strong 
enough to pierce the human skin; thus it is known that only the female bites. 
On each side of the proboscis are the palps, or sensory organs, and to the 
Figure 175.—Anatomy of mosquito: 1, Cross section of proboscis; 2, anatomy of mosquito, 
longitudinal section ; 3, tip of proboscis ; a, labium epipharynx; b, hypopbarynx; o, 
mandible; d, maxilla. (Stitt.) 
outer side of these are the antennae, or feelers. The male mosquitoes can be 
distinguished hy the heavily feathered antennae. The thorax supports the three 
pairs of legs and one pair of wings. The wings have a characteristic arrange- 
ment of the veins and show scales. Mosquito-like 
insects do not have scales on their wings. The 
abdomen has nine segments, and on the last seg- 
ment of the male are claspers. 
While there are about a dozen varieties or genera 
of mosquitoes, from a medical standpoint interest 
centers in but three of these genera, the Anopheles, 
the malaria mosquito; the Aedes, the yellow-fever 
mosquito; and the Culex, the filaria mosquito. To 
definitely differentiate these mosquitoes it is neces- 
sary to use elaborate keys and tables. But to tell 
whether a mosquito is a probable malaria or yellow- 
fever transmitter is a comparatively easy matter. 
The first step is to obtain a female, remembering 
that the antennae of the female are sparsely and 
not heavily feathered, as in the case of the male. 
The males also show claspers on tail end of ab- 
domen. Having secured a female, note the length 
of the palps (Fig. 176). If they are as long as the 
proboscis and clubbed and the wings of the mosquito 
are spotted, it is an Anopheles. If the palps are 
not as long as the proboscis and it is a small, black 
mosquito with silver or white markings on the back of its thorax it is an Aedes. 
A mosquito with short palps, without these markings, is probably a Culex. 
Pigdke 176.—M osquito 
heads showing heavily 
feathered male antenna 
and the long palps of the 
Anopheles female and the 
short palps of the Culex 
female. (Stitt.) 916 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The Siphonaptera or fleas (tig. 177) have come into prominence on account 
of their importance in connection with the spread of plagaie. In this case the 
transmission of the disease is mechanical; that is, by biting and depositing 
faecal matter containing the bacillus in the wound. The bacillus causing the 
disease is merely carried without change in the flea host. This is in contrast 
to what is known as a biological transmission, such as in the case of malaria 
and yellow fever, where the protozoan that causes these diseases undergoes a 
change in the mosquito host. 
Figdre 177.—Types of fleas and jigger : 
1 and 2, male and female Xenopsylla 
chcopsis ; 3, head of Geratophyllus; 4 
and 5, male and egg-distended female 
of Tunga penetrans. (Stitt.) 
Figure 178.—1. Pediculus humanus var. 
humanus. 2. Pediculus humanus var. 
corporis. 2a. Protruded rostrum of 
Pediculus. 3. Phthirius pubis. 4. Ci- 
mex lectularius. 5. Cimex rotundatus. 
6. Triatoma megista. (Stitt.) 
The Pediculidce or lice (fig. 178) are of three varieties. The one living on 
the head is called the Pediculus humanus var. humanus, the one on the body the 
Pediculus humanus var. corporis, and the one living in the hairy region about 
the pubis, popularly known as crab louse, the Phthirius pubis. The body louse 
lays its eggs in the seams of the under-clothing and is important on account of 
transmitting European relapsing fever, trench fever, and typhus. The relapsing 
fever is due to a spiral shaped organism called Borrelia recurrentis. Trench 
fever and typhus are caused by miniate, chromatin staining, lanceolate organisms 
called Rickettsia. 
Flies.—The fly best known is the ordinary house fly Musca domestica. Its 
mouth parts are fitted for sucking and not biting. Its food must be in a liquid 
or semisolid state before it can be sucked up into its stomach. If it wishes to 
feed on any solid substance, such as sugar, it first pours out saliva to liquefy it. 
Many people think that the house fly can bite, but careful examination of such 
a biting fly will usually show it to be the stable fly, Stomoxys calcitrans. 
Perhaps the most dangerous parts of a fly are the pads or pulvillse on its 
feet. By means of these it can carry much filth frequently containing bacteria 
which cause typhoid fever and other diseases. 
Another important fly belonging to the same family as the house fly is the 
tsetse fly (Glossina palpalis), which transmits the Trypanosoma gamhiense, the 
cause of African sleeping sickness. Some flies, like the flesh fly (Sarcophaga 
carnaria), can cause considerable discomfort by laying their eggs in wounds or 
cavities like the nose, ear, etc., their eggs developing into larvae or maggots. 
Following is a list of important diseases due to animal parasites: PHYSICAL THERAPY 
917 
Parasite 
Disease 
Entamoeba histolytica _ 
Amoebic dysentery. 
Trypanosoma gambiense _ 
African sleeping sickness. 
Plasmodia malariae 
Malaria. 
Schistosoma japonicum. _ 
Japanese schistosomiasis. 
Tsenia saginata._ .. .. 
Beef tapeworm. 
Taenia solium. _ _ 
Pork tapeworm. 
Wuchereria bancrofti 
Filariasis. 
Diphyllobothrium latum 
Fish tapeworm. 
Hymenolepis nana. _ 
Dwarf tapeworm. 
Necator americanus. _ 
Hookworm. 
Sarcoptes scabiei 
Itch or scabies. 
Tunga penetrans 
Sand flea or chigger itch. 
Ascaris lumbricoides 
Ascariasis. 
Trichinella spiralis _ _ 
Trichinosis. 
References 
Practical Bacteriology, Haematology, and Animal Parasitology.—Stitt, Clough, and Clough. 
Clinical Diagnosis by Laboratory Methods.—Todd and Sanford. 
Laboratory Manual of Biological Chemistry.—Poiin. 
Clinical Laboratory Methods and Diagnosis.—Gradwohl. 
Textbook of Laboratory Diagnosis.—Osgood. 
Section 10.—PHYSICAL THERAPY 
Physical therapy is the application of physical energy in the treatment of 
diseases, injuries, and new growths. Physical therapy has become such an 
important part of many medical and surgical treatments that it should always 
be under the direction of a medical officer who has the training necessary for 
diagnosis, proper selection of modalities, and correlation of treatment with the 
other forms of medical and surgical prescriptions that may be necessary. For 
convenience physical methods may be classified as mechanotherapy, hydro- 
therapy, light therapy, and electrotherapy. 
MECHANOTHERAPY 
This method of applying physical energy in the treatment of disease Involves 
especially the use of movement and is sometimes called the therapy of move- 
ment. Massage and exercise are two ways of obtaining movement in treating 
disease. 
Massage. 
This is one of the oldest and most useful methods of physical treatment. It 
is a therapeutic manipulation of the soft tissues and is best mastered by 
manual demonstration and long practice. In massage there are three main 
varieties of movement which are used singly or in combination. 
To prevent causing unnecessary discomfort or pain to the patient the use 
of a lubricant such as cocoa butter, a bland oil, or an appropriate liniment is 
advisable. 
Stroking, or eflleurage, is fundamental and consists of even and uniform 
pressure exerted along a certain * path. The palm of the radial side of the 
hand is used on large surfaces, the thumbs in areas close to bone, and the 918 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
finger tips around small joints. The hands must be relaxed to follow the body 
contours, and should be warm, dry and clean, always kept in contact with the 
parts and always returned lightly to the starting point before changing 
direction. Stroking is always in direction of the venous flow and should be 
slow and rhythmic, about 15 strokes per minute. The patient’s muscles must 
be relaxed. In deep stroking, the pressure is deep but not heavy, and 4 or 5 
strokes a minute are used to promote fluid flow. Fifteen to thirty light strokes 
per minute are used for sedative effect. 
Compression may be effected by kneading or friction. In kneading, the 
skin and subcutaneous tissue is picked up between the thumb and fingers, with 
pressure short of causing pain. It is best accomplished by the two hands 
opposed, as picking up small muscles between the finger tips, or with the 
finger tips against the palm rolling the muscles under them against the bone, 
as in the large muscle masses of the thigh and leg. The movement is always 
gradual, from the periphery inward. While pressure is being given, the skin 
is moved with the hand, and the part squeezed in the direction of the venous 
flow. The hand is never entirely removed from the part. Treatment is from 
the proximal end, distally in a muscle group but each individual motion is 
in the direction of venous flow. Kneading stretches retracted muscles and 
tendons, adhesions, and removes waste products from the muscle, friction 
is a circular form of kneading with pressure against underlying tissues that 
cannot be grasped. The tips of the thumbs, working in opposite directions, 
are used in small areas; the tips of the fingers around joints and the entire 
hand over large areas, as the back and thigh. It should always be preceded 
or followed by stroking, and carried out in the same general direction. 
Friction is used to free adherent skin, and to loosen scars and adhesions of 
deeper parts. (Mechanical vibration is also used.) 
Percussion, or tapotement, is the most stimulating form of massage and 
(he most apt to be overzealously employed, slapping is accomplished with the 
palmar surfaces of the fingers as quick alternating strokes, with the wrist 
relaxed and the fingers immediately rebounding. It is a powerful stimulation 
to the skin capillaries and nerve endings as well as to the entire nervous 
system. For hacking, the ulnar side of the hand and little finger is used to 
make rapid chopping motions, from the wrist, either light or heavy. Hacking 
is used for its effect on the deep structures, relaxing muscle spasm, breaking 
up organized exudates, and stimulating deep muscles. In tapping the tips of 
the fingers are used. 
In general, massage is used to aid lymphatic and venous flow, to loosen 
adherent scar tissue and stretch contractures, for its sedative effect, and to 
increase metabolism generally, to Improve muscle tone, strength, and relieve' 
spasm, and to improve skin function and tone. Massage should be given in a 
warm (70° F. to 75° F.) light room, with the patient comfortable, preferably 
reclining. In addition to those previously mentioned, talc is also a satisfactory 
lubricant, and oil should always be used over scar tissue. Warm the area by 
radiant heat or hot baths before massage. When used alone 10 to 15 minutes 
is the usual time, but 5 to 10' minutes is enough when other treatment is used 
in connection. Use massage daily in acute or painful conditions. 
Clinical uses of massage.—Recent injuries, fractures, Sprains, dislocations, 
stiff (not ankylosed) joints, arthritis, rheumatic conditions, gastro-intestinal 
atony, chronic constipation, flaccid and spastic paralysis are conditions which 
may be benefltted by massage. In central nervous conditions massage is used 
for its soothing effect. In chronic cardiac decompensation oedema may be 
decreased and the heart load lessened by cautious general stroking and gentle 919 
PHYSICAL THERAPY 
kneading. Massage may be used in convalescence for its general stimulative 
effect. 
The type of massage and the time the procedures are to be used is deter- 
mined by the medical officer. 
Contraindications to massage.—Massage is not to be used in the following 
conditions: Acute skin diseases, skin and subcutaneous infections, over pig- 
mented moles, wounds, tumorous swellings, acute phlebitis and thrombosis, in- 
fectious arthritis, undrained osteomyelitis, inflammatory processes in the ab- 
domen, gastric or duodenal ulcers, acute neuritis, heart diseases, unless ordered 
by the medical officer, or varicose veins. Massage may be used around varicose 
veins. 
Exercise. 
In general the value of exercise in maintaining health is well recognized. 
Schools make provision for systematized exercise under the direction of teachers 
specially trained in physical education. A large part of the adult population 
has become acquainted with various “setting up exercises.” The Navy and 
military organizations employ calisthenics in their drill schedule. They also 
use competitive games and sports for their physical training as well as for 
the beneficial effect on morale. It is obviously better to force deep inspiration 
by activity, than by artifieal deep breathing. 
There are four general types of exercises used in therapeutics. 
Passive exercises are those done wholly by the operator, the weight of the 
patient’s body, or by utilizing some other external force. 
Assistive exercises are performed as far as possible by the patient, assisted 
by the operator. 
Active exercises are movements executed exclusively by the patient. 
Resistive exercises are done by the patient, opposed by friction, gravity, 
weights, the operator’s or the patient’s own physiologically opposing set of 
muscles. 
In nearly all faulty postures, not due to defects in the skeleton, the following 
factors are present: 1. Lack of balance in power of opposing sets of muscles; 
2. Gradual shortening of the stronger set of muscles, and lengthening of the 
weaker set; 3. Gradual lessening in the flexibility and range of motion in the 
joints moved by affected muscles; and 4. A dulling of “muscle and joint sense” 
which causes the awareness of malposition. 
Every exercise regime must be aimed at correction of each of these factors, by 
strengthening weak sets of muscles, stretching those contracted, maintaining 
and increasing full flexibility, and developing the muscle sense. And lastly, 
development of the general physique is essential. 
Before starting treatment, all causes that can should be corrected or removed, 
as defective hearing and eyesight, improper sitting posture, pain, habitual uni- 
lateral carrying methods, improperly applied clothing and supports, nutritional 
defects, and deficient exercise. 
Therapeutic exercise is often preceded by the use of radiant light, short 
wave diathermy, mild sinusoidal current, and massage to warm and prepare 
the part for exercise. 
Clinical uses of exercise.—Many morbid conditions are benefitted by ex- 
ercise, a few of such conditions being: Hsemiplegia, cerebral degeneration, 
encephalitis lethargica (sleeping sickness), lesions of the spinal cord, injuries 
of the peripheral nerves, fractures, sprains, valvular heart disease, functional 
cardiac disturbrances. falling of abdominal organs (visceroptosis), constipation, 
tuberculosis, emphysema, and curvatures of the spine. The use of exercise 920 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
in any of these or in other conditions must always be as ordered by a medical 
officer. 
For information as to the programs of exercises to be used in the treatment 
of various disease conditions reference may be bad to any standard text on 
Physical Therapy. 
HYDROTHERAPY 
Hydrotherapy is a term used to designate the therapeutic procedures related 
to the external application of water to the body. Many of these measures are 
very simple and in common practice, and can be applied without special ap- 
paratus. with positive benefits to the patient. 
The outer layer of the human skin is essentially a waterproof covering under 
which is the true skin containing blood vessels and nerve endings, and still 
deeper the sebaceous and sweat glands. The effect of hydriatric measures 
consists of the reaction in the skin, and in the organs reflexly connected with it. 
Mechanical force adds to the effect of any hydriatric application. 
Water is applied in the treatment of disease at different temperatures with 
different reactions for each. The application of tepid water, 85° F. to 95° F., 
causes relaxation. The short application of cold water, 40° F. to 65° F., 
causes the skin to pale, the small blood vessels to constrict, and the muscular 
tissues to contract. This is followed immediately by relaxation and increased 
blood flow. There is deep inhalation at the time of application. With reaction 
the pulse rate slows and the heart is more efficient. A sense of well-being 
follows. This must not be used in persons of low vitality. The long applica- 
tion of cold water causes continued contraction of blood vessels, followed by 
total or partial relaxation and paralysis (a severe example is frostbite). A 
short, intense application of hot water, 100° F. to 110° F., causes the same 
immediate reaction as cold, but the primary effect subsides quicker. The result- 
ing hyperaemia is more widespread and is atonic in character. The local and 
general effect of continued local application of hot water corresponds to radiant 
heat. 
Fompresses are folded linen cloths placed over the part to be treated. They 
are slightly wrung out of water at the temperature desired, and held in posi- 
tion by dry flannel bandages. The size depends on the area to be treated and 
the temperature on the effect desired. 
gold compresses cause contraction of the peripheral vessels and are used 
for immediate relief of recent injuries, in the early stages of inflammation, 
and for combating swelling, redness, and pain. They may be renewed every 
half hour. 
In cerebral congestion (headache) apjily cold compresses to the forehead; 
in heart disorders they may be applied prsecordially. 
A stimulating compress is a cold compress under several layers of flannel. 
It causes first a vasoconstriction, then, with reaction, vasodilatation; the bandage 
dries in 1 to 4 hours. It is used over the throat in sore throat, laryngitis, and 
tonsillitis, over the chest in all pulmonary conditions, and over the abdomen in 
gall-bladder disease. 
hot compresses are applied in the same manner as cold ones but. at 105° F. 
to 115° F. In 1 to 2 hours they will produce intense hyperaemia, soften inflam- 
matory congestion, and relieve pain and spasm. 
Fule Coed Wet Packs are used for their sedative effect and as antipyretics. 
The temperature of the water should be between 60° F. and 70° F. 
Fuel Hot Wet Packs are used to increase elimination, The temperature of 
the water should be between 110° F. and 115° F, PHYSICAL THERAPY 
921 
Technique for applying either pack.—Spread rubber sheet over the bed and 
a blanket over the rubber sheet. Immerse a cotton sheet in the water at the 
temperature that has been ordered and wring out. Open sheet and spread over 
the blanket. Patient now lies fiat on his back on this sheet. 
Have the patient raise his arms above his head. Fold one-half of the sheet 
closely over patient’s body and high under his arms. Work fast. Have 
patient lower his arms to his sides. Wrap the remaining half of the wet sheet 
around the patient with the upper edge surrounding the neck. Press a fold 
down between the legs and feet and fold the lower end under the heels. Be 
sure the sheet clings snugly to the body everywhere. 
Fold the blanket smoothly around the patient and cover with an extra 
blanket on top. If feet will not warm up apply a hot water bottle to them. 
Patient may stay in the pack 45 minutes to 1 hour. 
Ablutions, full.—Pouring water over the entire body or part of it is a mild 
procedure to apply thermal stimuli. The patient sits in a tub and water at 
60° F. to 70° F. is poured over the back and chest. The procedure should be 
short and not used in patients with high blood pressure. 
Partial or Towel Bath.—The patient is in bed, covered with sheet and blan- 
ket. Towels at 65° F. are applied in succession over arms and legs, chest and 
back. Each towel is rubbed until It feels warm. Each area is dried, covered, 
and the next area then treated. Do not use over 5 minutes. This bath is 
used on febrile and elderly patients and gives a mild stimulating effect. 
Sheet Bath.—The patient, on a rubber sheet, is wrapped in a sheet wrung 
out of 50° F. to 80° F. water. He is then rubbed until the sheet feels warm 
(2-3 minutes), quickly dried and put to bed, well covered. This bath stimu- 
lates vasomotor and nervous tone. 
Drip Sheet.—The patient stands with a wet towel on his head, and a sheet 
wrapped around him. As the sheet becomes warm attendants pour water over 
it at a temperature of 5° F. lower than the first used. It is a vigorous gen- 
eral nervous stimulant and antipyretic after 15 minutes. It may overtax a 
patient’s reactive powers, so caution must be used. 
Baths.—A short cold bath is given a few seconds to 2 minutes in a tub of 
water at 60° F. to 65° F. The skin is rubbed and as soon as dried the patient 
exercises or is given a massage. Cold baths must not be used in hypertension, 
weak heart, or haemorrhagic states. A cold bath is a tonic procedure. 
continuous tepid baths.—Patient’s body is greased with lanolin or vaseline. 
He is then placed in a tub of water at 94° F. to 98° F., suspended in a hammock- 
like arrangement. Rubber pillows support the head and buttocks. The water is 
kept at the desired temperature, preferably by thermostatic valves. It is 
used from a few hours to days or weeks to quiet nervous conditions, treat sup- 
purating wounds, burns, and extensive skin lesions. 
hot baths are full tub baths given at temperatures from 100° F. to 108°F. 
Start at body temperature and quickly raise the temperature after the patient is 
immersed to the chin. Continue for from 10 to 20 minutes, dry the patient 
and give an alcohol rub. Hot baths increase elimination, metabolism, and 
give some relief to muscle spasms. They were often used in arthritis and 
rheumatoid conditions until the electric light cabinet superseded it in most 
institutions. 
hyperpyrexia baths.—Patients are immersed in a tub of water at 110° F. 
(starting at body temperature). Ice is applied to the head and neck. The 
body temperature may reach 104° F. in 20 minutes. The water is then lowered 
to 105° F. and the body temperature is kept at this degree for 45 minutes to 
1 hour. Patient may require considerable nursing. Reduce temperature to 922 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
normal by cooling the bath and follow with rest in bed. Baths are to be 
administered 1 to 3 times a week for 10 to 20 times. 
hip and sitz baths.—A local bath that may be given in any tub not over a 
foot high. In most institutions, specially built tubs support the back and arms. 
The water should cover the umbilicus. 
Short cold sitz haths with water at 65° F., given for a few mimites with 
vigorous friction of the abdomen, result in a strong stimulation of the abdominal 
muscles and tissues. 
The hot sitz hath with water at from 110° F. to 115° F., is given for 15 
minutes. They cause relaxation of abdominal pain and spasms and are also 
used for prostatitis and haemorrhoids. 
contrast baths cause an intense vasomotor stimulation of the hands or feet. 
The part to be treated is placed in hot water at from 105° F. to 115° F. for 1 
minute; then in cold water for 1 minute, and repeated 7 to 15 times, followed 
with massage and motion. The part should he immersed in hot water last. 
These baths are used in circulatory disturbances of the extremities; chilblains, 
trench feet, wounds, scars, amputation stumps, and foot disabilities. 
For shoulders, knees, and other parts of the body contrast baths may be given 
by using a hot spray for 5 minutes and then a cold spray for 1 minute; then a 
hot spray for 1 minute and cold spray for 1 minute. Continue changing at 1 
minute intervals for 15 to 20 minutes, and always end with hot spray. 
pakaffin baths are used to apply intense local heating to the skin. The 
skin is covered with hot molten paraffin and soon becomes encased in a solid 
nonconducting cast, which keeps up the temperature of underlying parts for a 
long time. 
Method of use.—Obtain about 3 or 4 pounds of paraffin, or “jelly wax” as it is 
commonly called, and melt it in the top of a double boiler until it is liquid. 
Then let it cool until a thin, white coating appears on the top when it is ready 
for use. 
When applied to the hands, the hands are dipped in and out, without moving 
the fingers, until several coatings are applied. Then let the hands remain in 
the wax for 20 minutes, take them out and peel off the wax. 
To apply to other parts of the body (knees, shoulders, elbows, back, etc.) 
obtain a wooden paddle or a wooden cooking spoon. Wrap several thicknesses of 
cloth around it, tying them on. Dip this in the wax and paint a coat over the 
entire area to be treated, until the part is completely covered. Then paint 10 
to 12 coatings on top of this. Cover with a towel or blanket and leave on for 20 
minutes. Then peel off the paraffin and the part is ready for further treatment. 
Paraffin baths are useful in after treatment of fractures of the bones of the 
wrist and hands, stiffness of joints following lacerations or infections, scar tissue 
restricting motions of joints and tendons, weakness or stiffness of hands secon- 
dary to nerve lesions associated with fractures, or other lesions of nerve trunks. 
Hydrokinetic Measures consist of douches and showers, showers are in 
common use by many people and have a strongly invigorating effect, but must 
be used cautiously in the weak and ill. douches are administered from a con- 
trol table (fig. 179), usually with two nozzles and appropriate mixing valves for 
temperature control. Valves for pressure control and thermometers and pres- 
sure gauges are on each nozzle. 
Rain showers (from overhead) affect the shoulders and head. The circular 
or needle douche is arranged with outlets around the shower cabinet so that by 
turning, the entire body is in contact with many fine jets of water. This shower 
can be used at constant temperatures, or by alternating hot and cold several PHYSICAL THERAPY 
923 
times. Is mildly stimulant to circulation and metabolism and is of value in 
nervous and functional heart conditions. 
Jet douches are applied from the control table, with a solid stream of water. 
In fan douches the tip of the finger is held over the nozzle tip to fan the stream, 
thus creating mechanical stimulation. A constant hot or cold douche or an 
alternating hot and cold douche (Scotch douche) is used with the patient facing 
the table, 10 to 12 feet away. The jet is applied slowly from the feet up to the 
shoulders and down again, with the same application over the back, for 2 to 4 
minutes; the patient should then quickly dry and dress. Allow reaction to occur 
and repeat several times. Do not overtax patient’s reactive power. 
Figure 179.—Hydrotherapy apparatus showing: a, control table; h, arm whirlpool; c, leg 
whirlpool; d, sitz bath; e, needle spray; f, shower. 
Whirlpool Baths are batlis in which water at 110° F. to 115° F. is kept in 
agitation in a vessel which will hold an arm or leg. This has the advantages 
of heat and the gentle mechanical effect of whirling water. In 15 to 45 minutes 
the skin becomes pink, inflammatory induration is softened, pain and spasm 
relieved, repair of wounds stimulated, and the removal of necrosed tissue and 
pus speeded up. 
They are used for the stiffness, pain, and sluggish skin circulation following 
fractures as soon as immobilization can be removed. Painful scars, adhesions, 
peripheral nerve injuries, some forms of arthritis, indolent chronic suppurating 
wounds, painful stumps, weak and painful feet respond very well to this treat- 
ment. They are used as a preparation for massage and electrical therapy. 
Thkkapkutic Pools and Tanks.—Under-water medical gymnastic exercises 
lake advantage of the buoyancy of water for the reeducation of feeble and flabby 
muscles. The temperature of the water is also beneficial, and in outdoor pools 
the sun and fresh air are of aid. Salt will increase the buoyancy. Their 
greatest use is in treating victims of poliomyelitis, but it is also used in spastic 
paralysis, multiple sclerosis, chronic arthritis, post-operative bone cases (espe- 
cially back and hip cases), scoliosis and postural spine deformities. The usual 
154294°—39 59 924 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
temperatures are 97° F. to 100° F. for spastic states and sensitive muscles, and 
86° F. to 92° F. for other chronic conditions. 
A large bath tub may be used for children and special tanks are often con- 
structed. The usual hospital pool is 10 x 15 feet with a depth of 2 to 4% feet. 
The floor is of non-skid material; easy steps are necessary and often hoisting 
devices are provided. Hand holds, choirs, and various floating supports are 
necessary. 
LIGHT THERAPY AND ELECTROTHERAPY 
The methods used in light therapy and electrotherapy may be considered sim- 
ply as the application of energy which is obtained from a number of sources and 
has various wave lengths, with corresponding frequencies of wave oscillation. 
The various wave lengths vary markedly in their effects on the human body and 
are measured usually in Angstrom units (abbreviated A", or A. U.) the length of 
one unit being )4o,ooo,ooomillimeter. The electromagnetic spectrum extends from 
the cosmic rays which have a wave length of 0.001 to 0.01 A. U., are generated 
in intrastellar space and are of no known therapeutic use, through the gamma 
rays of radium (0.01 to 1.4 A. U.) X-rays, ultraviolet, visible light, infrared or 
heat rays, to the long and short Hertzian waves. The latter waves include the 
length used in diathermy (300 meters), short wave diathermy (30 to 3 meters), 
and the extremely long waves used in radio transmission. 
Light therapy consists of the therapeutic application of radiant energy. 
Radiation is the process by which energy is propagated through space. A light 
ray consists of an enormously large number of exceedingly small entities trav- 
eling through space at a speed of 186,000 miles per second. 
The clinician tests the length of the waves he uses by their skin effect, and 
for other methods he relies on the manufacturer or physicist. 
Luminous sources.—Infrared and luminous radiations are long wave, or far 
infrared rays, such as are radiated from hot-water bottles and electric pads and 
do not penetrate deeper than 3 mm. in the skin, and short wave, or near infrared 
lays, which are supplied by the sun, carbon arc lamps, incandescent lamps, and 
specially built infrared generators, and penetrate 10 to 30 mm. to the subcutane- 
ous tissue. The most common luminous sources are incandescent filament radi- 
ators, electric light bulbs with tungsten or carbon arc filaments, with reflectors. 
A wattage of from 150 to 1,500 may be used but the penetration is the same. 
These lamps produce 95 per cent infrared rays, 4.8 per cent visible radiation, and 
0.1 per cent ultraviolet rays, the latter being absorbed by the glass. 
“Bakers” are provided with several small (60 watt electric) light bulbs in 
cradles, and if necessary can be built by any tinsmith. 
Nonluminous sources.—A heating element mounted in the center of a portable 
reflector is heated by an electric current to a dull red, and the reflector distributes 
heat on the body evenly. They are similar to bathroom heaters and are only 
skin warmers. 
The local effect of light therapy is nearly immediate, and shows as a reddening 
of the skin which lasts from 10 minutes to an hour. The active hypenemia re- 
sults in better circulation, better nutrition, increased removal of wastes and 
increased resistance to infection. Overdoses cause deep burns. Small amounts 
are sedative, large amounts are counterirritant. The effects of general irradia- 
tion are profuse perspiration, rise in pulse rate, lowering of blood pressure, in- 
creased respiration, increased elimination from kidneys, and sedation. 
Clinical useis.—Light therapy is beneficial in contusions, muscular sprains, 
traumatic synovitis, sprains and dislocations, fractures in accessible locations 
(not in the first few hours), arthritis, rheumatoid conditions, neuritis, neuralgia, PHYSICAL THERAPY 
925 
acute, subacute, and chronic catarrhal conditions in accessible areas, as con- 
junctivitis, sinusitis, nonsuppurative otitis media, and bronchitis. If used early 
in head colds it will often abort them. It is also of value in folliculitis and 
furunculosis, and to warm antiseptic dressings in cellulitis, etc. For this purpose 
it has the advantage of even heat, no pressure, and does not disturb the patient. 
Light therapy is used to warm the skin before diathermy, galvanism, massage, etc. 
Technique.-—The patient is made comfortable and the generator directed over 
the part to be treated, at a comfortable distance, usually 2 to 3 feet. A 10-minute 
treatment is given to warm the skin, one-half to 1 hour is used for other treat- 
ments. Repeat daily or oftener, depending upon acuteness of cases and the 
progress. 
Precautions.—Never make the patient uncomfortable. Use 1V2 times the nor- 
mal distance for anaesthetic areas. 
General heat radiation is used for selected cases of arthritis, nephritis, early 
active sclerosis, obesity and toxaemias, and often in combination with hydro- 
therapy. 
Electric light baths.—A wooden cabinet, large enough for a patient to sit in 
with the head protruding, containing a number of light bulbs is used. The 
patient is undressed, seated, the box closed, and the lights turned on. An ice bag 
is applied to the head. The patient is never left alone, and the treatment is 
stopped if he becomes faint. For tonic treatments use 5 to 8 minutes; for elimi- 
native, use 8 to 15 minutes and give water with salt to replace that lost by per- 
spiration. Follow with a tepid shower. For bed patients, a large heat cradle 
may be used. 
Ultraviolet radiation.—The chief natural source of ultraviolet radiation is 
the sun. Of artificial sources the electric arcs between electrodes of metal, of 
carbon, and of mercury in quartz are used. The range of radiant energy desig- 
nated ultraviolet is from 3,900 to 1,800 A. U. and is divided into “long ultra- 
violet” rays extending to 2,IKK) A. U., and short ultraviolet rays of 2,900 to 1,800 
A. U. Sunlight contains less of the shorter rays. Quartz permits the passage of 
ultraviolet rays to 1,800 A. U., air up to 1,850 A. U., but dirt, smoke and dust 
filter out more. Ordinary window glass only permits passage of waves over 3,200 
A. U. Human skin stops all ultraviolet rays, and even paper-thin clothing arrests 
most of the radiation. 
The biological effects of sunlight are to increase the regeneration of red blood 
cells, to stimulate the formation of white blood cells, to increase resistance to 
some infections, to increase the calcium and phosphorus content of the blood 
serum, and to stimulate all metabolic processes. 
clinical uses of general ikradiation.—The range of about 3,000 A. U. is 
curative in rickets. It is useful in bone and joint, lymph node, and genito- 
urinary tuberculosis, and as an adjunct to the treatment of general debility, 
secondary anaemia, convalescence, chronic bronchitis, asthma, and selected cases 
of neurasthenia. 
Local irradiation is most nearly specific in lupus vulgaris and erysipelas. 
It is of value in many dermatoses, sluggish healing wounds, indolent ulcers 
and chronic osteomyelitis. Also in the treatment of chronic catarrhal condi- 
tions of the upper respiratory tract. 
Sterilization of infected areas in carriers of cerebrospinal fever and diph- 
theria is often obtained after treatment with quartz rod applicators. 
contraindications.—Ultraviolet irradiation is dangerous in active pulmo- 
nary tuberculosis, advanced cachexia, heart diseases with failure in compen- 
sation, advanced arterio-sclerosis, and gross renal or hepatic insufficiency. 
Annoying skin and general reactions may occur in diabetic and hyperthyroid 926 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
patients, and a generalized dermatitis as a rule is a contraindication. Photo- 
sensitization is a condition in which certain drugs, endocrine products, and 
heavy metals in the blood increase the effects of radiation. Check such cases 
with a subminimal application first. 
Heliotherapy.—Usually sunlight contains 60 per cent infrared and 40 per 
cent invisible and ultraviolet radiation (never below 2,900 A. U.). At higher 
altitudes the ultraviolet increases at the expense of the infrared. The season, 
climatic conditions, and hour of the day influence the amount of ultraviolet radi- 
ations reaching the earth. The greatest antirachitic effect is produced in the 
summer at noon. The effects of heliotherapy are produced by the blending of 
infrared, luminous, and ultraviolet radiations, as well as the usual nursing care 
used. The sun rays produce a pigmentation of the skin, an increase in gen- 
eral tone of muscle and skin, and a general euphoria with a lessening of pain 
and fatigue. 
technique.—Heliotherapy can be practiced anywhere, except that sufficient 
sunshine and clearness of atmosphere are prerequisites. The best hours in the 
summer are from 7 to 11 and in winter from 10 to 2. On the first day expose 
the feet 5 minutes; on the second day expose legs 5 minutes and the feet 10 
minutes, and by similar exposures include the whole front of the body in 5 
days. Then on the sixth day expose the entire back for 5 minutes. Gradually 
increase the amount of exposure each day, but stay under dermatitis doses. 
Young adults, for tonic purposes, use 8 minutes to 4 surfaces (two divisions 
of the front and back) the first day, and increase the time 5 minutes daily. 
Babies 6 to 8 months old may start with y2 minute on the back and y2 minute 
on the front, and may increase the time of exposure 1 minute daily until 6 min- 
utes are reached, front and back. 
Heliotherapy should not be given if headaches, restlessness, elevation of the 
body temperature or of the pulse rate are present. 
Ultraviolet transmitting windows are not at present practical except in special 
hospital solaria. 
Artificial ultraviolet therapy.—Carbon arc lamps consist of two carbon 
electrodes held in the lamp so that their free ends touch and are connected 
with a source of current. The current is started and the ends separate; the 
current continues to flow, striking an arc and producing an intense illumina- 
tion. The radiation varies, depending on the carbon used, and the strength of 
(lie current. Radiation is emitted from the hot tips of the carbons and the 
arc itself. In general, mercury vapor lamps are more satisfactory. 
quartz mercury-vapor lamps are often designated as hot and cold. 
Hot quartz lamps.—The principal part is the burner, a fused quartz tube, 
air-exhausted and containing mercury. The air-cooled lamps are mounted on 
a stand with a reflector and are used principally for general irradiation. In 
the water-cooled lamps the burner is surrounded by a water jacket with inflow 
and outflow pipes for cold water, and a window at one side for radiation after 
the heat has been absorbed. This type can be used in contact with the skin, 
and with suitable quartz rods, for an orificial application. 
To operate, the water is started, the current is turned on, and the burner 
tilted slightly until the mercury runs across the vacuum and completes the 
circuit. The heat generated vaporizes enough mercury to fill the tube and 
the vapor conducts the current. Ten minutes should be used to build the tube 
up to maximum capacity of radiation. 
All quartz burners deteriorate with age so erythema checks should be made 
frequently to determine the correct dosage. PHYSICAL THERAPY 
927 
Cold quartz lamps.—The radiating source is a fused quartz tube, highly 
evacuated, but containing rare gases (argon, xenon, and krypton) and a few 
drops of mercury. The tube is shaped in the form of a hexagonal grid for 
general irradiation and mounted on a large aluminum reflector. Alternating 
current is stepped up to 2,500 volts with low amperage (15-25) and a high 
voltage flow is provided in the tube. Emission takes place as a glow discharge. 
Full strength is obtained in about a minute, with 95 per cent radiation at 2,537 
A. U. These lamps are proving very efficient. 
Electrodeless high frequency induction lamps.—The radiating surface is a 
round bulb of quartz or corex—a glass which is evacuated and contains a tiny 
drop of mercury. The bulb is surrounded by a high frequency coil attached to 
a transformer of a diathermy machine. A current of 5,000 volts from the 
secondary brings the vapor of the mercury in the bulb to full luminescence in 
30 seconds. The bulb remains cool, and does not deteriorate. Special appli- 
cators are made for all cavities of the body. 
Tungsten filament bulls of sun-lamp type.—A pyrex glass bulb filters ultra- 
violet rays shorter than 2,800 A. U. The bulb has a U-shaped tungsten fila- 
ment and a small pool of mercury. Fifteen minutes application (average) 
gives a mild sunburn at 24 inches. A transformer is needed to operate these 
lamps in the usual house circuit. 
technique of genebal ibradiation.—The entire body is exposed and recum- 
bent. Protect the eyes with dark goggles. Cover the genitals and face with 
a thin towel at first. In adults divide the front and back into 2 halves, giving 
4 fields for treatment. 
Dosage.—Each lamp must be calibrated for itself. A standard distance, as 
30 inches, is best used. Cover forearm with paper with 3 dime-sized holes. 
Expose each for a different time, as 1, 3, and 5 minutes. In a few hours one 
should show a first erythema reaction which is the erythema reaction time of 
the lamp. Begin treatments at the standard distance, with tested erythema 
exposure time. Slowly change the time to 15 minutes, 2 minutes at a time 
(hot quartz lamp) then lower the lamp 2 inches at each successive treatment 
to 18 inches, 48 hours apart, but irritative doses are never applied except to 
small areas. No treatment should be repeated until reaction from the previous 
treatment has disappeared. 
People of fair complexion, blondes, young children, and old people are more 
susceptible to the erythema-producing radiation than adults of the dark type. A 
safe routine is to give, for an initial dose, the aged one-half, women three-fourths, 
blondes and redheadheads one-third to one-fourth the average dose. The most 
sensitive areas in order are the face, chest, abdomen, back, sacral regions, arms, 
legs, hands, and feet. 
local irradiation.—The area to be treated must be cleaned of all grease, oils, 
etc., preferably by ether. For burns and clean granulating tissue give a mild 
erythema daily. For suppurating areas and old skin lesions use intensive dosage, 
as 4 minutes at 15 inches. From a new air-cooled mercury lamp this should pro- 
duce a marked dermatitis (third-degree dermatitis). This treatment can be re- 
peated every fourth or fifth day. 
In erysipelas very intensive dosage, 20 times erythema has been given. For 
counterirritation in neuralgia, myositis, etc., give second and third degree 
erythema doses. 
In applying ultraviolet therapy to mucous surfaces with quartz-rod applicators, 
about double the usual skin dosage may be used. 
Clinical estimation of dosage.—Sub-erythemal—no visible reaction ; first degree 
erythema (tonic dose), administered over entire body or large area, skin redden- 928 
HANDBOOK OF THE HOSPITAL COUPS, U. S. NAVV 
ing very slight, and disappears in 1 or 2 days with no trace; second degree 
erythema (stimulating dose) mild reaction, followed by slight desquamation that 
subsides in 3 days and may leave pigmentation; and third degree erythema 
(bactericidal dose or destructive dose) intense reddening after 2 hours, and blis- 
tering, persists for many days and leaves deep pigmentation. 
TYPE OF 
CUEHENT 
MODE OF FLOW 
APPROXIMATE 
FREQUENCY 
VOLTAGE 
AMPERAGE 
PHYSICAL EFFECTS 
AND USES 
COMMON 
30UBGE 
Galvanic. 
Uhidirection- 
al; constant 
Low 
Medium 
Mild thermal. Chemic- 
al :(+) acid, hardens 
tissues; (-) alkaline, 
softens tissues. Both 
poles; Vasomotor 
stimulation, promotes 
nutrition and relief 
of Inflammatory condi- 
tions, and contusions, 
Ionic medication; 
surgical-. 
Motor 
gener- 
ator as 
Morse. 
Interrupted 
galvanic. 
Unld 
al 
ire 
urg 
ct 
. 
lc 
n- 
Up to 100 
per second. 
Low 
Medium 
Mild thermal. Chemic- 
al: Alternating acid 
or alkaline. Dynamic: 
Motor and sensory 
stimulation. Muscle 
testing. 
As above 
and break 
key. 
Slow (Gal- 
vanic) 
sinusoidal. 
Slow alter- 
nating waves. 
A A 
3 to 9 
per minute. 
Low 
Medium 
Stimulates smooth and 
skeletal muscle In 
flaccid paralysis. 
Motor 
gener- 
ators. 
Interrupted 
or modulated 
alternating 
galvanic. 
V/ V/ 
Rapid alter- 
nating waves. 
A dill 
Up to 180 
per second. 
Low 
Medium 
Graduated contractions 
in non-paralyzed 
muscles. 
Motor 
gener- 
ators. 
w 
1 
W 
Farad1c. 
Hapid alter- 
nating asy- 
metric. 
JVJU 
00 to 100 
per second. 
Medium 
Low 
Ele ctro-dlagnos1s. 
Faradlc 
coil, as 
Bristow 
coil. 
Faradlc 
surged. 
Above surged 
ill i\ VI A A 
100 per 
second. 
Medium 
Low 
Graduated exercise 
without tetany. 
Motor 
driven 
device 
in 
' 
a 
1 
) 
High fre- 
quency, 
(damped)• 
Extremely rap- 
id alternating 
oscillations. 
1,000,000 
High 
High ' 
Thermal: Increased 
circulation, sensory 
and motor sedation. 
Bactericidal. Relief 
of spasm and pain. 
Conven- 
tional 
Diather- 
my. 
Promotion of nitri- 
tion and absorption. 
High fre- 
quency, (un- 
damped ) 
Short and 
wave dia- 
thermy. 
Extreme 
rapid a 
nat ing 
oscilla 
urn 
iy 
Iter- 
tions 
mi 
1 
Over 
2,000,000 
oscilla- 
tions per 
second. 
High 
High 
Profound thermal. 
Keating tissues. 
Hyperpyrexia. 
Cutting current. 
High fre- 
quency , 
undamped 
apparatus. 
Figuue 180.—-Currents used in electrotherapy. 
Electrotherapy is the treatment of disease by means of electricity in the form 
of different kinds of electrical currents derived from various sources. Figure 180 
shows the currents used in electrotherapy. 929 
PHYSICAL THERAPY 
The galvanic current is a unidirectional and constant current of low voltage 
(2-100) and low amperage (1-50). It is obtained from wet or dry cells, from 
direct current mains with rheostat control, or from an alternating current supply 
changed to direct current by a motor generator or valve tubes. It is used: 1. To 
treat acute and chronic traumatic and inflammatory conditions, as contusions, 
spasms, or myositis; 2. For ionic medication in selected cases of arthritis, neu- 
ritis, neuralgia, and rheumatoid conditions; 3. As part of the follow-up treatment 
of selected cases of cerebral haemorrhage; and 4. Surgically, in the treatment of 
benign new growths, superfluous hair, and dilated blood vessels. 
Technique.—The polarity of the galvanic current can be determined by dipping 
two metal electrodes from the apparatus in a bowl of salt solution. Bubbles arise 
from the negative pole. 
The electrodes, metal plates covered with a well moistened pad (16 thicknesses 
of gauze) of the size and shape of the area to be treated, are applied firmly. If 
the electrodes are of equal size the polarity effect may be ignored, if unequal, the 
polarity effect will be more marked at the smaller electrode. Warm the skin first. 
Turn the apparatus on gradually, opening the rheostat until the desired cur- 
rent is obtained. If patient complains of burning, reduce the current, or turn 
the current off and remoisten and rearrange electrodes. Current within com- 
fortable tolerance of patient, % to 1 milliampere of current per square inch of 
electrode surface. Treatments are usually given for 15 to 20 minutes, on alternate 
days, or started at 7 minutes and gradually increased to 40 minutes. 
In cerebral applications the patient is recumbent, and two electrodes, 2 inches 
wide and 4 inches long, well secured at the forehead and nape of the neck, are 
used. The negative pole is at the forehead. The current must be constant, 
with no sudden changes, and started slowly at 1 milliampere and increased to 
2 to 5 milliamperes daily or on alternate days. This treatment is used in 
post-hemiplegic conditions. 
Galvanic baths are given in wooden or porcelain tubs, with two electrodes in 
wooden frames to prevent direct contact with patient. The current is turned on 
gradually to comfortable toleration, 500 to 200 milliamperes for 10 to 15 min- 
utes. These baths cause general muscular stimulation, acceleration of metabo- 
lism, and are of value in generalized arthritic conditions, extensive paralysis, 
and neurasthenia. 
Ionic medication.—A large dispersive electrode is applied to a convenient part 
of the body and the active electrode over a pad well moistened in the therapeutic 
solution is placed over the area to be treated. Current to comfortable tolerance is 
used for one-half hour. The following table gives information concerning sub- 
stances used in ionic medication: 
Drug 
Active 
electrode 
Use 
Time 
Sodium chloride, 1% solution— 
Iodine, 1% solution 
Salicylic acid, 1% solution 
Quinine, 1% solution . 
Negative 
pole. 
do 
- ___do 
Positive 
Soften scars 
Goiter; chronic synovitis.- 
Resistant arthralgia 
Trigeminal neuralgia... 
Circular anaesthesia 
Vi hour daily or alter 
nate days. 
Do. 
Do. 
Do. 
Do. 
Pew minutes. 
Do. 
20-30 minutes. 
Comfortable (10) totol 
eration (30). 
Lithium ions, 1% solution 
Histamine (acid neoplate), 1 to 
1,000 solutions. 
Cholin, H to 1% solution 
Zinc chloride or zinc sulfate, 
Vi% solution. 
do 
---._do 
do 
do 
Gout 
Myositis; rheumatical condition, 
chronic. 
Periphera vascular processes 
Indolent ulcers; chronic otitis 
media. 930 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVA 
Interrupted galvanic current is produced by a mechanical device placed in a 
galvanic circuit that interrupts the current flow at regular intervals. This cur- 
rent causes muscular contraction beginning at the cathode on “make” and con- 
traction beginning at the anode on “break” due to the chemical stimulation 
produced by the current. It is used for muscle testing and occasionally in cases 
of paralyzed muscles that will not respond to other currents. It also causes a 
sensation of pain at the sensory nerve endings in the skin. 
Faradic current is produced by an induction or faradic coil. The intensity 
is regulated by varying the relation of the secondary and primary coils. This 
current produces a tetanic contraction of all muscles supplied by the motor 
nerve stimulated. It is seldom used except for electrodiagnosis because it is 
quite painful. 
Surging Faradic Current. A motor-driven device “surges” the faradic cur- 
rent by interposing varying resistances in its path and allows the use of this 
current for stimulating weak nonparalyzed muscles without painful tetanic 
contractions. 
In the Faradic Vacuum-tube Current 120 short unidirectional impulses per 
second are produced by vacuum tubes; this current is nonpalnful. 
The Slow (Galvanic) Sinusoidal Current is a galvanic current passed through 
a rythmically varying resistance which at the same time periodically reverses 
the direction of flow of the current at the rate of 5 to 30 alternations per min- 
ute; it stimulates smooth and skeletal muscles in flaccid paralysis without pain- 
ful contractions. 
The Surging and Interrupted Sinusoidal or Modulated Alternating Current 
is a current with a more rapid alternation and surging, or rise and fall, than 
the slow sinusoidal, and which is well tolerated. It effects graduated contrac- 
tions in nonparalyzed muscles. For simple muscle stimulation the patient should 
be comfortable and the muscles warmed and relaxed. Place a large dispersive 
electrode (3 by 4 inches) over the sternum or spine and a small active electrode 
3 inch in diameter over the belly of the muscle. Moistened pads are used under 
the electrodes. 
Clinical uses : In cases of weak muscles with no organic nerve involvement 
use the surged forms of faradic and interrupted modulated forms of alternat- 
ing current with 50 to 100 alternations per second. The first stimulation should 
be weak, the second stronger, and the third still stronger. Rest, and repeat sev- 
eral times but avoid fatigue after treatment. Tremor in the muscle indicates 
too much current, or too long stimulation. Use voluntary exercise as soon as 
practicable. For group stimulation use the surged currents 5 to 10 minutes daily. 
Place the electrodes at the ends of the extremities, as at the sole of the foot, and 
under the buttock. Such currents are of especial value in disuse atrophy and 
are used for sprains, strains, contusions, hsematoma, adhesions, myositis, tor- 
ticollis, lumbago, atony of abdominal muscles after childbirth, and various joint 
adhesions. In the electrotherapy of flaccid paralysis the purpose is to retain 
some of the contractile power of the muscle until nerve function returns. The 
choice of currents is the slow (galvanic) sinusoidal. Place the dispersive elec- 
trode over the cervical or lumbar spine and the active electrode directly over the 
muscle. Great care must be used to avoid overfatigue of these very weak mus- 
cles. Start with 3 to 10 contractions, and only a flicker of motion at the ten 
don is necessary. Treat for 2 to 3 minutes, and gradually increase to 30 to 40 
contractions for 15 minutes. Sometimes the interrupted galvanic current must 
be used to get a response. The treatment must be combined with muscle train- 
ing, as is necessary after hemiplegia. For spastic paralysis use the surged or PHYSICAL THERAPY 
931 
interrupted alternating current only as an adjunct to muscle training and re- 
education. 
Electrodiagnosis deals with the reaction of muscles and motor nerves to elec- 
tric stimuli and is a valuable aid in the diagnosis, prognosis and therapy of 
pathological conditions of the motor tract, Including the brain, spinal cord, and 
peripheral nerves and, also, of the muscles. 
In faradic testing, a faradic coil, activated by a galvanic (direct) current is 
used. The patient is placed comfortably in a well-lighted room. The muscles to 
be tested are warmed and relaxed. In unipolar testing place the large dispersive 
electrode any place where there is little muscle tissue, as over the sternum or 
sacrum. Using the faradic current set the active electrode over the motor point 
of the muscle or nerve to be tested, turn on the current with about 2 to 3 cm. on 
the secondary coil scale. Press the key of the interrupting handle and start the 
current flow. Change the coil until the lowest setting is obtained that gives a 
response. With the galvanic, use the negative pole for the active electrode and 
advance the rheostat slowly, pressing the key down from time to time to get the 
minimal response. 
In testing with condensers use a technique similar to that used in galvanic 
testing. Various strength condensers are used consecutively for the test, and it 
gives an accurate measurement of the current needed. It is mainly used to 
indicate progress in infantile paralysis. 
Reaction of Degeneration (abbreviated R. D.) indicates damage to the nerves, 
muscles, or both, and is shown when the response elicited is of a different type, 
and is elicited by a different current strength than under normal conditions. 
Standard texts must be consulted for full details of electrodiagnosis. 
High frequency.—The essential source of high frequency currents is a supply 
of alternating current raised to a high voltage by electromagnetic induction 
(transformer). This high voltage current charges a set of condensers which 
discharge across a multiple spark gap. The spark discharge sets up oscillations 
of fairly well sustained damped (impeded) character at a rate of several hun- 
dred thousand to over a million a second. The high frequency current thus pro- 
duced is conducted to the patient from the terminals of the apparatus by suitable 
electrodes and conductors. 
Most high-frequency machines also contain an Oudin coil, which produces a 
very high-voltage current (Oudin current) which is led off a single terminal. 
To operate a high-frequency apparatus turn on the main switch with the 
rheostat closed, allowing no current to flow to the transformer. Have spark 
gaps closed or slightly opened. Then open rheostat until the desired current 
is obtained. A pleasant treatment results when the rheostat is slowly opened 
and the spark gaps adjusted in balance. The milliammeter usually reads from 
100 to 2,500 milliamperes, or if two are used, a high (1,000 to 4,000) and a low 
(100 to 1,000) is usual. 
Diathermy apparatus of vacuum (thermionic) tube type is a more modern 
development of high-frequency apparatus and produces undamped oscillations 
of stable and efficient character through use of the three element or amplifier 
tube of DeForest. 
Effects.—The rapid alternations do not produce sensory or motor effects 
as obtained with low frequencies. Heat is produced depending on the strength 
of the current, the resistance of the tissue, and the length of the treatment. 
Secondarily, an active arterial hypersemia is produced, and metabolism is 
increased. Little permanent change in blood pressure results. A definite 
sedative effect is produced. 932 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Clinical Uses.—High frequency currents are used for traumatic or inflam- 
matory changes in joints, bursae, and bones, chronic inflammation of intes- 
tinal organs, all chronic gonorrhoeal infections, congestive lung conditions, 
neuritis, neuralgia and circulatory disorders. 
Contraindications.—In general, any condition in which simpler heat is as 
effective. Specifically in acute inflammatory conditions with fever and sup- 
puration, and also in conditions with tendency to haemorrhage (as 
haemoptysis). 
Technique.—Block tin, gauge 22, is cut and molded to fit the part. If it is 
smooth and gives perfect contact, no soaping, etc., is necessary. Warm the 
skin slightly before applying. Bandage or sandbag to hold firm. 
The transverse or through and through method is the common method. 
Two electrodes are placed on opposite sides of the part to be treated. If the 
electrodes are of equal size and the part thickness is not over 1% times 
their greatest diameter there will he equal heating through the part. If 
the part is thicker, larger electrodes must be used. When unequal size 
electrodes are used, the smaller gets the most current and heat, and so can 
be used to heat a small superficial spot. In the longitudinal or cuff method 
two bent or cuff electrodes, placed fully or partly around an extremity, heat 
superficially. They must be 10-15 inches apart and the limb must be straight 
if the cuff goes completely around. 
Dosage.—A comfortable sensation of heat only should be felt by the patient. 
This should occur when a current of 70 to 100 milliamperes per square inch 
of active electrode, if it is not a cuff or over 4 inches square, is used. About 
1,200 to 1,500 milliamperes may be used for 4 by 6 inch electrodes. 
Twenty minutes is the average time used for a treatment, on daily or 
alternate days, depending on the progress, although in some conditions a 
longer treatment may be advisable. 
Safety Rules.—Electrodes must be in absolute skin contact to avoid burns. 
See that skin is unbroken and sensation normal. Instruct patient to report 
any uncomfortable sensation, as prickling or burning. Open main switch, 
open rheostat gradually, and then the spark gaps. Raise current slowly. Mod- 
erate heat Is better over a longer period, than high heat over a short period. 
Check all uncomfortable complaints of the patient. 
Never leave a patient. Watch the milliammeter for an even flow of cur- 
rent. Stop treatment by turning switches in reverse order. Inspect electrode 
site. Cool patient before leaving department. 
Monoterminal High Frequency.—The Oudin current is applied through glass 
vacuum or non vacuum (condenser) electrodes. 
In close contact for a long time it produces a mild heating. When the 
electrodes are moved with slight contact to give sparking, a mild counter 
irritation is produced. It is used in neuralgia of skin nerves; and in post- 
operative scar neuralgias (10 minutes, mild sparking). When applied for 
35 minutes with fairly vigorous sparking, it acts as a counter irritant in deep 
seated pain. A mild sparking is used for sluggish ulcers, anal fissures, etc., 
and close contact for functional neuroses. 
High-frequency Saturation is a modification of the monoterminal treat- 
ment. The patient holds in his hands a vacuum tube which is connected 
with the Oudin terminal. Diathermic massage can be performed while the 
patient is in contact with this current. A mild sedative effect is produced. 
For General Diathermy large trunk electrodes are applied for 1 hour with 
a current of from 1,500 to 3,000 milliamperes. A temperature of about 100.6° F. 
and sweating is produced. It can be used on alternate days for a week in 933 
PHYSICAL THERAPY 
general circulation disturbances, as mild arteriosclerosis, and general 
neuresthenic conditions. 
In Autocondensation a current of 500 to 1,200 milliamperes is applied 
through a large body electrode, (a special chair or a large trunk electrode 
under a hair mattress) and a second electrode in direct body contact. Usually 
a metal bar is held in the hands. A mild heating effect and a general sedative 
effect is produced. It is most often used in hypertension. 
Short-Wave Diathermy is the newest development of high-frequency cur- 
rents in therapy. It is divided into two fields, short-wave diathermy, using 
12 to 30 meter (M.) waves, (10,000,000 to 25,000,000 oscillations per second) and 
Figure 181.—Diathermy apparatus. A, foot switch plug, for use with surgical attach- 
ments ; B, plug for electric current main ; C, dial, power control; D, dial, milliammeter 
in power “input” circuit; E, plate switch, to be turned on after filament switch ; F, 
filament switch; G, dial, resonance control; H, dial, milliammeter, in patient’s circuit; 
I, jacks for electrode or surgical electrodes; J, electrode; K, sponge rubber to separate 
the electrode from the skin. Note that electrode cables do not touch the patient or each 
other. 
ultra short-wave diathermy with waves below 12 M. (over 25,000,000 oscillations 
per second). It may be produced by vacuum tube oscillators, or by spark gap 
apparatus, but for practical reasons the tube apparatus is commonly used. An 
alternating current is passed through a stepup transformer to usually two 
rectifier tubes, and two oscillator tubes, combined with suitable inductance and 
capacity. Oscillations are transferred to the treatment circuit, and treatment 
plates attached to the ends of the circuit form condensers. A variable con- 
denser or variable self induction is placed in the treatment circuit to bring 
the capacity of the patient into resonance with the main oscillating circuit. This 
is varied by the resonance control on the apparatus and when in resonance 
the highest output of the machine is obtained, and the highest reading is shown 
on the milliammeter. The oscillations are undamped. One type of apparatus 
is shown in figure 181. 934 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
The Mode of Heating differs from diathermy in that heating depends not on 
tissue resistance but on dielectric hysteresis, i. e. the heat) generated by the 
friction of the rapid motion of the tiny particles comprising the body dielec- 
trics in a very rapid oscillating condenser field. In the short wave field 
the therapy effect is the same, regardless of the wave length, and it can be 
applied to all conditions in which diathermy has been used, or in which heat 
is indicated. Selective effects have been claimed for ultra-short diathermy. 
Technique.—Condenser electrodes consist of flexible metal, covered with 
thick pliable rubber, with a suitable cable to connect with the jacks on the 
machine. They are made in various sizes, and special applicators are made for 
localized uses, as for sinuses and various body orifices. It is necessary that an 
air space be provided between the electrodes and the skin. Glass electrodes 
are made that incorporate definite skin (air) spacing in their construction, but 
for usual techniques rubber pads, felts, or folded towels are used. Four 
thicknesses of bath toweling gives a satisfactory spacing, and absorbs all perspi- 
ration from the skin. This is important in avoiding skin burns. The depth 
of heat effect is greatest with the greatest skin distance, and the heat effect 
is greatest on the skin when the electrodes are closest. The usual distance is 
0.5 to 1.5 inches but for ultra short waves 2.0 inches is necessary. The elec- 
trodes or applicators should be of equal size, unless a heat point is desired, and 
spaced equidistant from the skin. If not, the closer pad concentrates the heat. 
Bach applicator must be equidistant at all points from the skin to avoid “hot 
areas.” This is very important over bony prominences, as the shoulder. With 
the electro-magnetic type of apparatus a coil is provided that is wrapped around 
a part, looped over it or coiled “pancake” over the area to be treated. The 
coils should be close together, and as near the skin as is comfortable. 
In general, the size of the applicator depends on the area to be treated, 
for thick parts large electrodes well separated from the skin are used, to reduce 
the skin heat sensation and supply more energy. One may be used (unipolar) 
especially in treating conditions in which through and through heat is not 
wanted, as boils, the nasal sinuses, the middle ear, etc. (the other electrode 
must be connected to the machine). In general an electrode is placed on each 
side of the part to be treated, avoiding bony prominences as much as possible. 
They may both be placed on the same surface, but not too close together. The 
distance depends on the current used, and the size of the part, but not less than 
6 inches. For pelvis heating, long narrow electrodes that encircle the body 
(36 by 6 inch “cuff electrodes”) are used above and below the parts, or one in 
combination with a smaller “point heating” electrode. This may also be applied 
over the length of a limb. With large electrodes body temperature will be 
raised, so care to avoid chilling is necessary. The electrodes must be held in 
position with bandages or sandbags, but never put weight directly over a bony 
prominence. Place the electrodes, patient’s skin exposed, turn on the filament 
current, the plate current, and adjust the resonance control to maximum reading, 
with power control (if one is provided) low. Wait for the sensation of heat by the 
patient; if too warm, turn back power and then resonance if necessary. If not 
warm enough increase power. The one reliable guide to intensity of treatment 
is the patient's sense of heat. Do not disregard complaints of too much heat, 
and instruct the patient carefully to report uncomfortable heat before begin- 
ning the treatment, for severe burns can occur. The milliammeter reading indi- 
cates a flow of current, but does not show the heat being applied, or generated 
in the tissues. This reading will change with any change in position of the 
electrodes, of the patient, or even because a person comes into the vicinity of 
the field. Care must be used in treating anaesthetic areas. A sense of com- PHYSICAL THERAPY 
935 
fortable heat is obtained and maintained. Pain in an extremity usually means 
too much heat, probably due to periosteal irritation. 
In pneumonia short-wave diathermy is given by through and through electrode 
application over the affected side of the chest, or the electrodes may be placed 
parallel over the chest to avoid disturbing the patient. Forty-five to sixty 
minutes, otjce or twice daily. 
Advantages.—Short-wave diathermy facilitates the treatment of regions to 
which it is hard or dangerous to apply diathermy, and permits use of simpler 
and more stable apparatus; plates are not applied directly to the skin; permits 
a simpler and more flexible technique; provides a more effective method of 
applying heat; and is safer than diathermy with comparable precautions. 
Dangers.—Severe burns can be produced by overheating and improper elec- 
trode spacing. 
Inductotherm.—A vacuum tube oscillator generating approximately 26 M. 
waves, is used to charge a cable which is applied around, about, or over a part 
to be treated. Heat is produced by electro-magnetic induction in the tissue, 
from the rapid oscillating cable current. Is an efficient source of diathermic 
heat, and is capable of producing hyperpyrexia. 
Ultra Short-wave diathermy uses any wave length belowT 12 M., and 6 M. 
apparatus is in common use. Technique and indications are similar to short 
wave but greater spacing, 2 inches, must be used. It probably has no ad- 
vantages over the longer waves in the short-wave field, and is more dangerous 
because the sensation of skin heat is not marked. 
Hyperpyrexia (fever) can be easily induced in human subjects with high- 
frequency currents. This procedure however has definite dangers unless prop- 
erly supervised, and should only be used in hospitals under direction of a 
medical officer familiar with this form of treatment. 
A short-wave or inductothermy apparatus of suitable power, and insulating 
material are necessary. With short-wave diathermy, several insulating systems 
are used. 
The Kettering Hypertherm, an air conditioned cabinet, heated with an electric 
unit and controlled by easily accessible humidistat and thermostat, is an 
efficient apparatus. 
The patient (with weight bearing points greased) wrapped in toweling to 
absorb perspiration may be placed in a heavily insulated sleeping bag arrange- 
ment. Large electrodes are then placed over the body and the current applied. 
They should be moved frequently to avoid uncomfortable heat under them. The 
cable of the electro-magnetic machines, fixed in a disk and supported by a stand 
makes for easy application. This is also incorporated into a cabinet, and makes 
an efficient unit. The patient may also be effectively insulated by wrapping in 
toweling, a rubber sheet, and blankets. A temperature rise of 4 to 5 degrees F. is 
usually obtained the first hour, depending on the insulation, and the current is 
stopped about 1 degree F. short of the desired maximum. The current can be re- 
applied from time to time to maintain the desired temperature. In the treatment 
of resistant gonorrhoeal conditions a temperature of 106 to 107 degrees F. is 
necessary for several hours. A frequently used treatment is a 10-hour period, 
and one such treatment is often sufficient for cure. The patient may need 
sedatives as sodium amytal or codeine, cramps or tetany may occur and require 
10 cc of sodium gluconate intramuscularly. Tongue forceps, oxygen, and car- 
bon-dioxide mixtures should be available for use if respiration becomes em- 
barrassed. Intravenous dextrose, morphine sulfate, epinephrine chloride, and 
caffeine benzoate should also be prepared. Sodium chloride, 0.3 per cent, is 
given in water steadily. After the desired temperature is reached cool cloths 936 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
are used on the head. The temperature and pulse is taken every 15 minutes. 
Oral temperature is unreliable. After the treatment is completed, the patient 
is carried to bed, heavily wrapped in blankets, and the temperature is taken 
every % hour until normal. Fluids are continued. 
Hyperpyrexia is most commonly used in gonorrhoea resistant to other treat 
merit, nervous-system syphilis, cholera, and other neurological conditions. 
Precautions with short-wave diathermy.—No metal parts in thfe treatment 
field (as hairpins). No metal or rubberoid materials on the treatment table. 
Cable must not touch the patient or chair, or the other cable. Do not treat 
through clothing, and inspect treatment area after each treatment. Do not use 
damp towels or felt for spacers. No not use pressure over bony points. Close 
points must be avoided in spacing. Treat anaesthetic areas with at least 2 
inches skin distance. Do not give treatments “by the meter.” Never disregard 
complaints of too much heat, and check applicators if unwanted point heating 
is complained of. Do not treat deep closed abscess cavities. Check spacing 
over protruding areas, as ears, etc. Do not touch electrodes with current on. 
Do not place electrodes on concrete, marble, or linoleum floors. Keep electrodes 
within 3 feet of each other. Avoid transcranial application when possible. 
Electro-surgery denotes the application of electricity for the destruction of 
new growths and diseased tissue; and for cutting through normal tissue with 
minimal bleeding. 
Electro-desiccation.—A needle point electrode connected to a single high 
voltage (Oudin) terminal is held in contact with or at a slight sparking distance 
from the area to be treated. It is a high voltage and low amperage current, the 
oscillations are damped, and result in drying and shrinking of the tissue due 
to water evaporation. A dry mass results which may be curretted or will 
slough oft if left alone. Fulguration is the biterminal use of current from a 
high frequency coil. It is painful and has no advantage over desiccation. 
Electro-coagulation.—This requires higher amperage and damped oscilla- 
tions. A large dispersive electrode and a small active coagulative electrode is 
used. Although it is effective it is hard to regulate the size of the area coagulated. 
Two small active electrodes as needles may be used and this limits the reaction 
to a small area between the needles. 
Electro-section.—A needle point or thin blade is attached to one terminal of 
a high frequency apparatus current of undamped oscillations. This point cuts 
tissue readily with a minimum of coagulation, simply sealing the capillaries. 
References 
Electrotherapy and Light Therapy.—Kovacs. 
Physiotherapy.—Stewart. 
Instruction forms for physiotherapy patients, The Mayo Clinic.—Krusen. 
Handbook of Physical Therapy.—Council on Physical Therapy, The American Medical 
Association. 
Section 11.—RECRUITING 
The strength of the Navy greatly depends on manpower and manpower is 
measured by the physical fitness of its personnel. This being so, it may be stated 
(hat the selection of the recruit is one of the most important functions of the 
Navy. 
In order that enlistment may be possible to all, without the necessity of travel- 
ing long distances from their homes for the purpose of examination, recruiting 
stations are located in various large cities throughout the United States. RECRUITING 
937 
Generally the complement of a recruiting station consists of: The officer in 
charge of the station, usually a line officer who has been in the Navy a number 
of years; the medical officer, whose duty it is to examine carefully every applicant 
as to his physical and mental fitness and adaptability for the Navy; one or two 
yeomen for the regular office work; and a hospital corpsman to assist the 
medical officer. 
The hospital corpsman is an integral part of the recruiting activity, and as a 
member of the medical department his duties are important. Especially is this 
the case where a pharmacist’s mate is on duty at a substation or outlying station 
away from a medical officer. Here he must perform in a measure some of the 
functions of the medical officer in the preliminary examination of applicants 
and in eliminating those unfit for further examination. That means he must 
be capable and efficient, courteous and tactful, and well versed in the affairs 
incident to recruiting. It is well, therefore, to give an idea of the Organization 
of the Recruiting Service and its workings. 
The Recruiting Section is a regular part of the Bureau of Navigation, consti- 
tuted and operated like any other section of that bureau. From it come the 
orders and instructions governing all recruiting activities. 
For convenience and efficiency, recruiting in the United States is separated 
into five divisions as follows: Northeastern; Southeastern; Southern; Central; 
and Western. 
Under the above divisions there are about 35 Recruiting Districts and approxi- 
mately 200 substations. 
There are two Recruiting Training Schools, one at San Diego, Calif., and the 
other at Hampton Roads, Ya., where special instruction and training are given 
to men prior to their assignment to duty at recruiting stations. It has been the 
policy whenever practicable to send pharmacist’s mates to these schools for the 
course of instruction when assigned to recruiting duty. Members of the Hospital 
Corps to be eligible for such duty must be in good health, free of venereal diseases, 
and dentally sound. 
The principle duties of the recruiting personnel are to secure suitable applicants 
and to enlist them in the Navy. A definite selective system is employed in 
securing applicants. This system aims to procure recruits of the highest quality. 
Such a method of recruiting raises the Navy standard; it also results in a 
smaller turnover in the personnel of the ships, in higher efficiency in ship 
operation, in reduction in desertions and discharges, and reduction in the cost 
of recruiting. Mistakes in recruiting resulting in rejection at the training station 
are expensive. It costs the Government about $650.00 to replace one man lost 
through avoidable means during the first year of enlistment. 
The advantages which the Navy has to offer the applicant are: 
1. A career; 
2. Education (opportunity to learn a trade) and travel; 
3. Physical improvement; and 
4. A steady job with regular pay. 
In return for these the Navy demands a full enlistment and a standard physical 
make-up. Here is where the medical department is chiefly concerned, which 
concern is the selection of applicants who measure up to the Navy standards 
for enlistment. 
The chief duties of the medical officer are to review all applicants and give 
each a thorough and efficient physical examination to determine his physical 
qualifications. If the applicant cannot meet these requirements he is rejected. 938 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
The hospital corpsman is an assistant to the medical officer, and his 
duties are; 
1. To assist in making contacts; 
2. To assist the medical officer in physical examinations; 
3. To help detect underlying defects in applicants; 
4. To take care of recording and clerical work; and 
5. To assist the medical officer in caring for station personnel. 
The pharmacist’s mate is an important cog in the recruiting machine and 
must fit in with the organization for its efficient operation. He should be 
selected with an eye to personality, education, and professional ability. Like 
the other members of the station he represents the Navy; he must look the 
part, be properly and neatly uniformed, and in all respects be prepared to 
uphold the high standards of the Navy in the community in which he is 
stationed. He must make the right impression upon the civilian population 
both in and out of the examining room. 
Responsibility for accepting only those qualified physically for the service 
rests primarily with the medical personnel. This means a thorough investi- 
gation of the applicant’s past history and his present status from standpoints 
of family and environment, together with a thorough physical examination. 
There are two forms used at recruiting stations that are very useful in 
evaluating the physical requirements of the applicant. One is N. R. B. Form 
10, which is the Recruiting Physical Examination Check-off List for use of 
nonmedical recruiters solely as a preliminary to the medical officer’s exam- 
ination. Use of this form enables recruiters to eliminate individuals who 
would not pass an examination before a medical officer. It does not take 
the place of the physical examination by the medical officer, and any applicant 
who is rejected by it may make a final appeal to the medical examiner at 
the recruiting station. No applicant is accepted or rejected solely on the 
findings of this check-off list. The other form referred to is N. R. B. Form 24. 
The first two pages of this form cover the application for enlistment; the 
third page is a record of the physical examination; and the final page is 
the applicant’s physical questionnaire. This form gives a complete picture 
of the applicant as to his origin, home life and education, and physical make- 
up ; and also a record of disabilities and abnormal conditions he may now have. 
This physical questionnaire prepared by the recruiting station is forwarded 
to the training station in cases of all accepted applicants, for further reference. 
Every care should be used in making out this questionnaire, and it is the 
hospital corpsman’s duty to see that the questions and answers by the appli- 
cant are thoroughly understood and the applicant is warned as to the serious- 
ness of any false statement. Conditions such as bedwetting, fits, painful feet, 
and many others cannot be discovered unless the applicant is questioned 
definitely and pointedly on each defect named in the questionnaire. The easy 
way of just handing the applicant this blank form and allowing him to 
struggle over it himself defeats the purpose of the form. 
Proper conduction of the physical investigation and examination will elim- 
inate the unfit in most cases. It has been found that a large number of 
defectives were aware of their condition before enlistment. Painstaking and 
thorough examination of these at the time of interview would have elimi- 
nated most of them. The hospital corpsman, due to his close contact with the 
applicants, is in a position to materially aid the medical officer in discovering 
these underlying conditions. Failure to eliminate the unfit results annually 939 
RECRUITING 
iii discharges by medical survey, and by inaptitude and undesirable discharges. 
This means unnecessary expense to the Government. 
During the examination refrain from an over-bearing attitude toward the 
applicant; a hospital corpsman must remember that the people he comes in 
contact with on recruiting duty are neither in the naval service nor are they 
his subordinates. Courtesy will reward his efforts, for the public will be 
impressed and formulate their opinion of not only the recruiting personnel 
but of the Navy as a whole by his general appearance and conduct. 
Especially on recruiting duty one’s private life must be strictly above 
reproach. Drunkenness, financial irresponsibility, marital troubles, or any 
scandalous conduct will not only reflect upon the individual but also upon 
(he Navy as a whole. Many recruiting stations are in inland cities where 
few people know much about the general activities of the Navy and many 
questions will be asked, so it becomes an additional duty of a hospital corps- 
man to be able to intelligently give definite answers to many questions on 
Navy matters, such as advancement in ratings and pay, and the opportunities 
available for learning a trade. 
Some of the more common physical causes of separation from the service are: 
1. Bed wetting; 2. Epilepsy; 3. Flat feet; 4. Defective teeth; 5. Defective 
ears and hearing; 6. Defective vision; 7. Defective physical development; 8. 
Hernia; 9. Constitutional inferiority; and 10. Deformities. 
Bed-wetting and epilepsy as well as constitutional inferiority are frequently 
covered up by the applicants. They are determined by careful investigation of 
the home and environment, school and social conduct. 
Final acceptance is made at the main station after physical examination by 
the medical officer. The pharmacist’s mate should be thoroughly familiar with 
the sections of the Manual of the Medical Department covering the physical 
examination of applicants for enlistment and should have at hand a list of 
causes for rejection. Physical defects should not be overlooked for they will 
be detected later at the training station and will result in the recruit’s discharge 
from the service. Such errors reflect on the medical staff making the examina- 
tion and lower the rating of the station, and incur useless expense to the 
Government. 
It is necessary that careful consideration be given to the dental condition of 
all applicants for enlistment. The hospital corpsman is expected to be able not 
only to note the loss of a sufficient number of teeth to constitute a disqualifying 
defect, but also to detect gross pathological conditions of the teeth and theii 
surrounding structures which would make the applicant for enlistment a poor 
physical risk. He should endeavor to acquaint the substation personnel with 
the dental requirements for enlistment and the causes for rejection. 
Explanation of some of the dental standards or requirements which are often 
misconstrued follows. 
1. An opposed tooth is one that comes into functional contact (hits or strikes) 
with one or more teeth of the opposite arch (jaw). 
2. A vital tooth is a tooth containing a vital (not dead) dental pulp. 
3. A serviceable tooth is one free from advanced disease, and that does not 
have a faulty restoration, crown or bridge attachment. 
4. A permanent tooth is a natural tooth of the second dentition. Deciduous 
(temporary or baby) teeth are not counted as serviceable teeth. 
5. An edentulous space is a space (gap) without natural teeth. 
6. Malocclusion is a condition of malposition of the teeth resulting in abnor- 
mal occlusion (teeth do not mesh properly), or in a protrusion or retrusion (over 
or underbite) of either arch. 
154294°—39 60 940 
HANDBOOK OF THE HOSPITAL CORPS, XL S. NAVY 
Hospital corpsmen assigned to duty at recruiting stations should have ade- 
quate clerical ability in order to take care of recording and clerical work. A 
hospital corpsman often has to do this work in the main office with the yeomen, 
and his personality should be trained to fit in with that force. It may be de- 
sirable or necessary at times for each to assist the other in carrying out the 
clerical work. To illustrate the clerical work to he performed by a hospital 
corpsman, the following procedure is necessary for every recruit taken into the 
Navy: 
1. Complete Form N. Nav. 2. 
2. Complete pages 3 and 4 of service record. 
3. Complete shipping articles, Form N. Nav. 351. 
4. Complete application, Form N. R. B. 24 (previously mentioned). 
5. Complete health record, N. M. S. Form H. 
6. Complete N. M. S. Form “X” (Card). 
Besides these the routine medical-department reports and returns have to he 
submitted as indicated. 
Page 4 of the service record contains fingerprints. Especial care should be 
exercised in making fingerprints as they are a permanent record and at some 
future time may be a sole determining factor of identity. Smeared prints are 
useless and always must be remade. 
There is another feature in connection with recruiting that comes back to 
rest with the Hospital Corps. Quite a number of hospital corpsmen are 
obtained from the ranks of the regular recruits. Recruits at the training sta- 
tions are made familiar with the Hospital Corps and medical-department activi- 
ties, and are given an opportunity to transfer to that organization whenever 
they so desire and are found to have the necessary educational qualifications. 
Many good men are taken from the ranks of apprentice seamen, sent through 
the Hospital Corps Schools and become hospital apprentices, second class. 
Watchfulness to this end will help much to secure recruits of the superior type 
which the Hospital Corps demands. 
Section 12.—X-RAY 
To become a competent X-ray technician requires special training. However, 
there are many small X-ray units that may be safely operated by carefully 
following the manufacturer’s instructions provided the operator uses the proper 
safety precautions. Before attempting to operate even small units, it is a 
great advantage to know the principles of X-ray production and control. X-ray 
equipment is expensive and easily damaged, and when it is placed in ignorant 
hands, the danger to patients and operator can become very great. The in- 
formation in the following pages will help operators to learn the reasons for 
the various controls and procedures. Further detailed instructions should be 
obtained, preferably by demonstrations, before attempting to use equipment. 
HISTORICAL 
X-rays were discovered by Whilhelm Konrad Roentgen at the University of 
Wurzburg, Bavaria, in 1895. Many previous investigators had paved the way 
for his discovery. The colors produced in a vacuum tube by high voltage 
electric current had been observed by Geissler. Crookes had studied the effect 
of gradually increasing the vacuum until no current would pass through the 
tube. Other experimenters had discovered, during 35 years of research, that X-RAY 
941 
eertain crystals would give off light (fluoresce) when they were near such 
tubes in operation. 
Roentgen, however, made this important change in the usual experimental 
conditions—he covered the tube with black paper so that no light was visible. 
A neighboring cardboard, coated with barium platinocyanide crystals, gave off 
light as usual. But there was no visible light to activate the crystals. Fur- 
thermore Roentgen was astounded when his hand accidentally came between the 
tub© and, screen and he saw the dim outlines of the bones. He reasoned that 
there must be some invisible rays coming through the black paper covering 
the tube. Roentgen called these unknown rays “X-rays” and they have been 
known by this name ever since. They are also known as Rcentgen rays. 
THE NATURE OF X-RAYS 
X-rays are now considered as wave motions in the ether. The ether is the 
theoretical substance that fills all space. X-rays are similar in some respects 
to the rays of light emanating from the sun. There are several important 
differences: Visible sunlight can be broken up into its different colors (dif- 
ferent wave lengths) or spectrum by a glass prism. Invisible X-rays, whose 
wave lengths are about 5,000 times shorter, can be broken up only, as far as is 
known, by certain crystals. They can neither be reflected from a mirror nor 
focused through a lens. 
The most useful property of X-rays is their ability to penetrate solid objects. 
This they do in nearly direct proportion to the density of the object. Such 
materials as paper, cardboard, cotton, gauze, and wool are easily penetrated. 
Metals produce more obstruction. While a Via inch thickness of a light metal 
such as aluminum can be readily penetrated, the same thickness of lead 
obstructs all but the short wave lengths. 
There is a great difference in penetrating power of the short and long wave 
lengths. The shortest will penetrate over an inch of lead (million volt tube) 
while the longest will barely penetrate cardboard (Grenz rays). 
For “seeing through” the human body, best results are obtained when the 
predominant wave length is just able to penetrate the denser parts. A beam 
of X-rays coming from a tube is composed of various wave lengths. By means 
of metal filters such as thin sheets of copper and aluminum the longer wave 
lengths are stopped (absorbed). The shorter ones go on through but still 
differ among themselves as to length and penetrating power. 
The production of the shadow of an object by Roentgen rays (X-rays) 
depends on: 1. The difference in density of the object and its surroundings; and 
2. The penetrating power of the X-ray beam selected. 
When the difference in density is great and a beam of proper penetrating 
power is used the contrast of the shadows on the film or screen is good. For 
example, the shadow of the dense heart will stand out very well because it is 
surrounded by the air filled lungs. The long bones are easy to demonstrate 
because they are surrounded by soft tissue of much less density. The organs 
of the abdomen are seen with difficulty because they and their surrounding 
structures are all of about the same density. Various methods have been 
devised to increase the density of certain organs. The stomach and colon are 
filled with barium mixtures. The kidneys and gall bladder are visualized by 
injecting certain dyes into the vein of the arm or taking them by mouth. The 
dyes are concentrated in the organ and increase its density so that it stands 
out from its surroundings. 
It is highly important to remember that the object itself is never seen. What 
is seen is the shadow of the object. Just as hands and fingers may be ar- 942 
HANDBOOK OF THE HOSPITAL COUPS, IT. S. NAVY 
ranged between a light and a white sheet to throw shadows resembling snakes, 
dogs, ducks, etc., so may the shadows on X-ray films and screens resemble things 
they are not. 
PRODUCTION OF X-RAYS 
To generate X-rays it is necessary that: 1. Electrons be separated from their 
atoms; and 2. Separated electrons be hurled with terrific velocity (% to Vz 
the speed of light) against a suitable material. 
The following is a simple explanation of X-ray production: “If a handful of 
marbles is thrown against a drum head, the marbles set up vibrations in the 
drum. These vibrations set up vibrations in the air that are recognized by 
the ear as sound. The marbles represent the electrons; the force that sets 
the marbles in motion represents the high voltage electric current that sets 
the electrons in motion; the drum head corresponds to the target of the X-ray 
tube; the sound waves produced in the drum correspond to the X-rays pro- 
duced in the X-ray tube.” The sound waves are long and travel through the 
air about 362 yards per second, while the X-ray waves are short and travel 
through the ether with the speed of light or 186,000 miles per second. 
Electrons and atoms.—In the past atoms were thought of as the smallest parti- 
cles of matter that could exist, which were joined together to form molecules. 
Today is it believed that atoms are composed of positive and negative charges 
of electricity which usually are exactly equal in number. The positive charges 
(protons) are considered as being contained in a central nucleus with part of 
the negative charges (electrons), the remaining negative charges revolving 
around the central nucleus in orbits like the earth revolves around the sun. 
(See chapter on Chemistry for a fuller discussion.) 
When an atom has an equal number of protons and electrons it is a balanced 
atom, but this balance may be disturbed by several methods, a common one being 
the use of heat. When this occurs one or more electrons revolving in an orbit 
are lost and the atom is unbalanced. An atom may also become unbalanced by 
taking up electrons. When an atom loses electrons it has more positive than 
negative charges and is electrically positive as a whole. If an atom gains elec- 
trons it has more negative than positive charges and is electrically negative as 
a whole. If two such unbalanced atoms approach near enough to each other 
the excess electrons in one leave and take up the vacant places in the other and 
both atoms are again balanced. 
When atoms are unbalanced there is a stress or tension between them due 
to the positive and negative charges seeking each other. This tension is 
spoken of as difference of potential or voltage. When the negative charges 
finally move toward the positive the resulting flow of electrons is called an 
electric current. This flow is always from negative to positive. 
X-ray tubes.—A common type of X-ray tube, which is rapidly disappearing, 
is the Coolidge Universal Tube shown in figure 182. The tungsten anode (A) 
has a high melting point. This is important because about 99 per cent of the 
energy striking the anode is turned into heat. About 1 per cent is used 
to produce X-rays. The anode is the positive side of all X-ray tubes. 
The cathode (C) or negative side of the tube contains a filament of tungsten 
wire similar to that of a small electric lamp. This is heated to white heat 
by the current in a small 12-volt circuit. The atoms of the filament are 
unbalanced by the heat which drives numerous electrons of negative charge 
to the surface. These negative electrons stay on the surface of the hot filament 
until high voltage current is applied to the positive and negative terminals 
of the tube. They are then attracted to the target which is positive. During 943 
X-RAY 
their travel of less than iy2 inches from filament to anode, these electrons 
attain enormous speed. They strike the target when their velocity is about 
one-half to one-third the speed of light. This tremendous speed sets the target 
into vibration causing it to give off wave motions in the ether known as X-rays. 
Figdre 182.—Coolidge universal tube. A, anode and target; C, cathode containing filament 
All X-ray tubes are vacuum tubes. Producing a high vacuum is difficult and 
methods of attaining it are prized by manufacturers. Theoretically a per- 
fect vacuum without electrons will not pass an electric current no matter how 
high the voltage. If the number of electrons released by the hot filament can 
be controlled, the amount of current that will pass through the tube can also 
be controlled. This, in turn, will control the quantity of X-rays produced. 
This is actually done by controlling the heat of the filament and is the big 
advantage of a hot filament X-ray tube. Prior to the perfection of this tube 
by Coolidge, electrons were badly controlled by adding and removing gas 
from a tube with a low vacuum. The gas tube is now rarely seen. 
The radiator type Coolidge tube (figure 183) followed the universal type. 
The radiator (R), combined with a heavy copper anode (A), carried the heat 
away from the target much faster. This did away with “inverse” current when 
Figure 183.—Radiator type tube. A, anode and target; C, cathode containing filament; 
R. radiator for cooling anode. 
the tube was used without a rectifier (see figure 192). Then the glass bulb 
was made smaller and the radiator tube became a favorite for bedside machines 
and fluoroscopes on account of its small size and simple operation. However, 
its capacity of 10 to .‘10 milliamperes is too limited for high speed radiography. 
To overcome these shortcomings, the heavy copper anode has been made 
heavier and the glass bulb larger. This allows even more rapid loss of heat. 
By adding a reservoir and circulating water around the anode, very rapid 
loss of heat has been attained. Tubes with 100 milliampere capacity and 
higher are now commonplace. 944 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
To obtain fine detail it is necessary to project X-rays from a small area on 
the target to film or screen. This is done by a focusing shield around the fila- 
ment (figure 184). When electrons leave the filament, most of them are 
Figure 184.—Method of focusing electrons on the target. T, target; F, focal spot; S, 
focusing shield; HP, hot filament; X, X-ray beam. 
focused on a small spot on the target. Tubes with focal spots less than 3 
millimeters in diameter are called fine focus tubes. If the usual 45-degree 
slope of the target face is made smaller, it becomes possible to focus the cathode 
stream (or electrons) on a long, narrow line, instead of a small round spot, 
and the useful part of the X-ray beam is projected as a small square (figure 
185). The great advantage of these "line focus” tubes is that the heat is dis- 
tributed over a larger area on the target. 
tungsten target 
filament 
ACTUAL FOCAL 
SPOT AREA 
AREA OF 
EFFECTIVE FOCUS 
Figure 185.—Line focus, showing electrons focused on a much larger area than in Figure 
184. Hence the metal is not raised to the melting point as quickly. 
Figure 186 shows a line focus tube that is covered by a metal envelope (M). 
This is reinforced with lead near the anode. The latter prevents X-rays 
leaving the tube except through the opening directly under the line focus. The 
anode end takes either a radiator or a water reservoir. By using two filaments 
with a selective switch, one tube may serve for both flue and broad focus uses 
These are called double focus tubes. X-RAY 
945 
Figure 186.—Protected line focus tube. A, anode terminal; C, cathode terminal; F, fila- 
ment ; L, lead lining above and below target with X-ray window ; M, metal envelope. 
Figure 187 shows a rotating anode tube. The disc-shaped anode is rotated 
by a small motor. Heat is distributed over the whole circumference of the 
disc. This tube will do the heavy work of a broad focus tube with the tine 
radiographic detail of a fine focus tube. 
15’ ANODE FACE 
ROTOR BEARING 
STATOR WINDINGS 
CATHODE CONNECTIONS 
ROTOR 
ANODE CONNECTION 
TUNGSTEN 
DISK ANODE 
X-RAY 
WINDOW 
PYREX 
GLASS 
Figure 187.—Rotating anode tube. (General Electric X-ray Corporation.) 
STATOR PUNCHINGS 
Various types of tubes are used for treatment. Some of these are very 
large, require upwards of one million volts to operate, and must be installed 
in specially constructed buildings. 
The separation of electrons from their atoms and how they are stopped 
abruptly by the target of the X-ray tube has been explained. The force that 
hurls these electrons with terrific velocity against the target is the high voltage 
electric current coming from the secondary coil of the X-ray step-up transformer 
(figure 188). 
A modern X-ray transformer consists of a square or ring of iron (closed 
core) with two separate coils of wire. One coil is called the primary, the 
other the secondary. They are insulated from each other by the surrounding 
coil. The secondary coil has many more turns and is made of smaller wire than 
the primary. Low voltages are sent through the primary coil. This causes 
the whole iron ring to become a magnet. The magnet induces a high voltage 
current in the secondary coil. This induced current will have a voltage in 
direct proportion (ignoring losses) as the number of turns in the primary coil is 
SECONDARY HIGH VOLTAGE CURRENT 946 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
to the number of turns in the secondary coil. For example, suppose there are 
22 turns of wire in the primary coil with a voltage of 220. If there are 8,80b 
turns of wire in the secondary coil then there are 400 times as many turns 
as there are in the primary, hence, the voltage in the secondary coil is 
400 X 220 — 88,000 volts. 
Figure 188.—Diagram of X-ray transformer wiring. 
Induction. 
The 88,000-volt current just mentioned is an induced current. Electric cur- 
rent can be created or induced in a coil of wire by pushing a magnet within 
the coil (figure 189). Also, a magnet can be treated or induced by placing a 
bar of soft iron in a coil of wire carrying an electric current. 
Figure 189.—Induction. When a magnet, NS, is pushed into a coil of wire, lines of mag- 
netic force, LF, are cut, causing an electric current to flow in the wire and register on 
the galvanometer, G. (After Sante.) 
In the X-ray transformer the ring of iron is turned into a magnet when 
electric current is passed through the primary coil. This magnet has a field 
of magnetic influence surrounding it, which is similar to the field shown in 
figure 18!). It is convenient to picture this field as “lines of magnetic force.” 
When lines of magnetic force are being cut by a wire passing through them, 
an electric current flows in the wire. When the motion stops the current stops. 
Increasing the number of turns of wire around the magnet increases the num- 
ber of lines of force that are cut which increases the amount of current pro- 
duced. If the lines of force can he moved across the wire it amounts to the 
same thing as moving the wire across the lines of force. These lines are rap- 
idly nn)ved by the alternating current flowing in the primary coil. If direct 
current is used, it must be changed to alternating current before it reaches the 
transformer. This is accomplished by a rotary converter. 
When speaking of volts the pressure of an electric current is meant: when 
speaking of amperes the rate of flow is meant, A high pressure can be pro- X-RAY 
947 
duced in a small water pipe by a pump while the volume of water flowing will 
be small. A high voltage can be produced in a small sized wire by a step-up 
transformer, yet the amount of electrical current flowing (amperage) will be 
small. This is a suitable type of electrical current for the production of 
X-rays. 
The voltages used for production of X-rays usually vary from 30,000 to 
200,000. These are awkward figures and the custom has developed of measur- 
ing in “kilovolts”. One kilovolt equals 1,000 volts; 80 kilovolts equals 80,000 
volts, etc. These high voltages are measured by observing the distance they 
will cause a spark to jump through air. The point gaps or sphere gaps are 
gradually closed by moving the points or spheres toward each other until a 
spark jumps across. The scale of point gaps reads in inches. Six inches 
equals about 100 kilovolts. The scale of sphere gaps reads directly in kilovolts. 
The amperages used for production of X-rays vary from 0.004 to 0.500 of an 
ampere. These figures are awkward, so amperage is measured in “mili- 
amperes”. One milliampere equals 0.001 of an ampere; 50 milliamperes equals 
0.050 of an ampere, etc. Milliamperes are measured by a special type of 
ampere meter called a milliammeter, which is connected in the high voltage 
secondary circuit. On small units a low voltage meter is mounted on the con- 
trol stand. This meter is calibrated in milliamperes at the factory by compar- 
ing it with a standard milliammeter. 
Rectification. 
When the high voltage current leaves the secondary coil of the transformer 
it is alternating current. Like the current introduced into the primary coil, it 
rises from zero to its peak and falls back to zero again (figure 190). Then the 
VOLTAGE 
Figure 190.—Wave forms of low voltage primary alternating current and high voltage 
secondary full wave rectified current. The form of the latter, which is direct pulsating 
current, has been modified by condensers. 
current reverses its direction and falls below zero an equal amount to return 
again to zero. These events are called a cycle. Most electric power supplied to- 
day is 60 cycle alternating current. That means that 60 such cycles occur every 
second or 8,600 cycles occur every minute. Each cycle has two impulses which 
flow in opposite directions. 
To produce X-rays it is necessary that current flow through the X-ray tube 
in one direction only. It must flow to the cathode where it is picked up by 
“small boats” (electrons) and carried to the anode. The current must always 
leave the anode and return to the transformer in order to complete the circuit. 
One way of doing this is to select only that part of the alternating current 
that is flowing in the right direction. In other words, only half of each cycle 
is used. This is called half-wave rectification. If the target of an X-ray tube 948 
HANDBOOK OF THE HOSPITAL CORPS, IT. S. NAVY 
can he kept cool enough so that electrons will not be released from it, the tube 
itself will make this selection (self-rectification). 
With electrons available only at the hot filament (cathode) the current 
must approach from the cathode side to find transportation. When the current 
tries to cross from anode to cathode, no electrons are available. 
This is satisfactory for a small number of watts (volts X amperes = watts), 
hut when more watts are used the target heats, electrons are released and “in- 
verse” current passes from anode to cathode. Hence, when more X-rays or 
more penetrating X,-rays are wanted, it becomes necessary to rectify the cur- 
rent before it reaches the X-ray tube. 
Many ingenious methods of rectification have been devised. Figure 191 
shows a mechanical rectifying switch in the shape of a disc. The disc is made 
of insulating material that carries copper contacts. It is turned by a syn- 
chronous motor that makes one-half of a complete revolution on each cycle 
Figukb 191.—Diagram of rectifying disc in two positions, 
of the alternating current. As there are 30 revolutions of the disc per sec- 
ond and 60 cycles of alternating current per second, the disc can he adjusted 
on the shaft so that the contacts reach the terminals connected to the trans- 
former at just the right moment. Thus, the current entering the switch is chang- 
ing its direction 120 times per second while the current leaving the switch has 
120 impulses per second but all in the same direction. 
Figure 192 is a valve-tube rectifier. Modern valve tubes have a cylindrical 
metal plate (A. A.) surrounding a spiral filament. The filament is heated by 
a current of 12 to 14 amperes passing through the terminals (F. F.). The 
hot filament releases electrons which carry the current across the vacuum to 
the plate. This tube will pass current only in the direction of the large ai’row. 
Figure 192.—Valve tube. A. A., cylindrical metal plate surrounding a spiral filament; 
F. F., filament terminals. (Sante.) 
Figure 193 is a two-valve, half-wave rectifier. When the current from the 
X-ray transformer is flowing to the left it meets the heated filament of valve 
tube (A) where plenty of electrons are waiting to carry it across the vacuum 
to the plate. The current crosses the X-ray tube and valve tube (B) in similar 
fashion and completes the circuit by arriving at the opposite end of the trans- X-RAY 
former secondary. When the current is Rowing to the right, it meets the 
plate of valve tube (B). No electrons are waiting to carry it across and hence 
no current passes. Notice that only half of each alternating cycle is used and 
that the X-ray tube receives 60 impulses per second. 
Figure 193.—Circuit diagram of two-valve half-wave rectifier. 
Figure 194 is a four-valve full-wave rectifier. When the current from the 
X-ray transformer is flowing upward it passes through valve tube (A), to X-ray 
tube, to valve tube (B) and completes the circuit by arriving at the lower end 
of the transformer secondary. When the current is flowing downward it 
passes through valve tube (C) to X-ray tube to valve tube (D) and completes 
Figure 194.—Circuit diagram of four-valve full-wave rectifier 
the circuit by arriving at the upper end of the transformer. With 60-cyclr 
alternating current the X-ray tube passes 120 impulses per second. Each valve 
tube passes 60 impulses and stops 60 impulses per second. Notice that the 
whole alternating cycle is used. The direct pulsating curve shown in figure 
190 is similar to full-wave rectified current combined with condensers. Full- 
wave rectification wears out the X-ray tube faster than other types because 
there are no cooling intervals. However, it is very efficient for fast exposures. HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
Figure 195 shows the essential parts of the secondary circuit connected to- 
gether. The rectifier is a revolving disc type. Other types of rectifiers can be 
substituted. 
Figure 195.—Diagram of the principal parts of the high voltage secondary circuit and 
lilament circuit connected to X-ray tube. Sec., secondary coil of X-ray transformer; 
R, rectifier; MA, milliampere meter; C, step-down transformer of filament circuit. 
Before the current enters the primary coil of the step-up transformer, it must 
pass through several devices. Some of these serve to control the input. Others 
serve to automatically shut off the current in case of grounding or short circuit. 
PRIMARY LOW VOLTAGE CURRENT 
Fuses. 
If one starts at the power panel switch or lamp socket to which the X-ray 
machine is connected, the first devices usually met are the fuses. These are 
similar to the fuses of a lighting circuit in a private home. A small bedside 
machine will be equipped with 10- or 15-ampere fuses. A large X-ray machine 
may carry 200-ampere fuses or larger. 
Such fuses consist of a short piece of flat wire inside a cartridge with contacts 
on each end, or they may be the type that screw into a socket. A fuse wire de- 
signed to pass 200 amperes of current at 220 volts should melt if more than 200 
amperes is “drawn” by the X-ray machine. Most X-ray machines never \ise this 
amount of current unless something goes wrong. This something is usually a 
“grounded” circuit and may be on either the primary or secondary side. Because 
the secondary circuit is high tension, which is constantly seeking escape, most 
“grounds” occur there. This makes it easy for current to flow because the re- 
sistance of the X-ray tube has been avoided. The situation is similar to a 
bursted water main. Great quantities of current are demanded from the trans- 
former. The voltage (pressure) drops and the rate of flow (amperes) increases. 
Unless something is done immediately, the heat generated by the heavy current 
will “burn out” the transformer, or, worse still, if a patient’s or operator’s body 
is responsible for the ground, this heavy current is passing through him and may 
result in death. 
While fuses can usually be depended upon to protect the transformer from 
“grounds”, they are not always dependable for protection of personnel. A per- 
son may “ground” the high-tension current sufficiently to kill himself and yet 
not make good enough ground contact to pass a heavy current that will melt the 
fuses. The best method is to use fuses whose capacity is just above the routine 
operating requirements of the X-ray machine. X-RAY 
951 
On leaving the fuses, the current usually meets another safety device called 
a circuit breaker. A simple type (figure 196) is composed of a coil of wire 
surrounding a bar of iron (I). The coil is connected in the primary circuit. 
OPEN 
CLOSED 
Figure 196.—Diagram of circuit breaker. When the primary current increases beyond the 
limit set, the iron bar, I, is drawn farther into the coil of wire and strikes the liber 
plunger, F, which trips the spring device, S; (’, contact; SC, incoming special circuit; 
MS, outgoing circuit to magnetic switch ; P, handle for setting breaker ; SS, set screw. 
Whenever an unusual amount of current starts to flow, the iron bar is drawn, 
by magnetic force, farther into the coil. Here the bar meets a plunger (F) 
which trips a spring device (S). This opens the contact (0) and the primary 
circuit is broken by a magnetic switch. The circuit breaker may be made more 
sensitive by pushing the iron bar farther into the coil by means of the set 
screw (SS). 
After the primary current has passed through the fuses, circuit breaker, and 
a line switch, it meets the autotransformer (AT in figure 197). This is a de- 
vice which steps down the voltage by induction. It consists of a single coil of 
heavy wire wound around an iron bar (B). The same coil of wire serves as both 
primary and secondary. 
It is a proven fact that two electrical currents may travel over the same wire 
without interfering with each other. Telephone wires often carry several dif- 
ferent circuits at the same time. When alternating current flows through the 
coil of the autotransformer it produces lines of force about the iron bar. These 952 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
lines of force are cut by the same coil of wire that produced them. If the taps 
from the coil are removed a current of the same voltage as the primary will he 
induced in the same coil. This induced current always works against the pri 
mary current. As the voltage of the primary alternating current is falling the 
voltage of the induced current is rising. The net result is zero as far as flow 
(amperage) of current is concerned. Such a device is known as a choke coil. 
The Induced voltage is called counter electromotive force. 
Figure 197.—Diagram of the principal control devices in the primary circuit. A, incoming 
alternating current; AT, autotransformer with iron bar, B, and contact arm, C; RH, 
rheostat with resistance coils, D, and contact arm, E; F, X-ray switch; T, outgoing 
alternating current to X-ray transformer. 
Adding the taps or leads to several coils, and connecting any two of them to 
a current consuming circuit, makes an autotransformer out of a choke coil. The 
induced voltage now has an outlet. Not all of it is expended in “bucking” the 
primary voltage. This also allows primary current (amperage) to flow because 
there is less force against it. In practice, both the primary and induced low 
voltages are referred to as the primary circuit of the X-ray transformer. 
When the contract arm (C) is on the button as shown in figure 197, there are 
15 turns of wire in the outgoing circuit. 
As there are 85 turns in the whole coil the incoming voltage is to the outgoing 
voltage as 35 is to 15. In other words, the outgoing voltage is three-sevenths of 
the incoming. Thus, if the incoming voltage is 110, the outgoing voltage, ignoring 
losses, will be % of 110 or 47 volts. Modern autotransformers have many more 
turns of wire and many more taps so that steps of 2 volts may be obtained. It 
is bad practice to change the setting of an autotransformer when it is passing 
current because of arcing between contact points. 
The reading of the voltmeter is controlled by the autotransformer. Thus the 
proper incoming voltage for the work in hand may he selected. The voltmeter 
is sometimes calibrated in kilovolts at the factory where spark gap readings are 
taken simultaneously with voltmeter readings. The line voltage must agree 
with the factory voltage for the scale to read correctly. This is adjusted by a 
compensator which is a small autotransformer and voltmeter connected ahead of 
the autotransformer. When a compensator is used, the main autotransformer 
steps may be calibrated in kilovolts and the second voltmeter omitted. 
On leaving the voltmeter, the primary current usually meets a resistance. 
In some controls this resistance is permanent and the operator frequently is un- 
aware of its presence. In controls for larger machines, this resistance is variable 
and is known as a rheostat (RH in figure 197). A resistance is a coil of wire or X-RAY 
953 
series of grids that checks the flow of electricity because the arrangement of their 
atoms is unfavorable. The metal used in rheostats has a high resistance and is a 
poor conductor. 
The unit of resistance is called the ohm. A resistance of one ohm will pass 
one ampere of current at a pressure of one volt. A resistance of 5 ohms will pass 
1 ampere of current at a pressure of 5 volts, 2 amperes at 10 ,volts, and 20 
amperes at 100 volts. The current used up by the resistance is converted into 
heat. This is accompanied by a drop in voltage. 
The rheostat in figure 197 has five coils and a contact button for each coil. 
Suppose that each coil has a resistance of one ohm. If the contact arm is placed 
on the button to the extreme left, all five coils are in the circuit. AVith the auto- 
transformer set to feed 47 volts to the rheostat, the largest amount of current 
that will pass is a little over 9 amperes. If the voltage should drop to 40 the 
largest amount of current that will pass is 8 amperes. If the resistance of the 
X-ray tube is avoided by the current taking an easier path (short circuit or 
ground), these examples do not hold because the total resistance of the combined 
primary and secondary circuits has been reduced. 
Compare the autotransformer to the rheostat. When the supply line voltage 
entering the autotransformer drops from 110 to 100, the voltage leaving the auto- 
transformer drops from 47 (when set for this voltage) to about 43 volts. How- 
ever, the amperage does not drop. Thus, the important difference between auto- 
transformer and rheostat control is the loss of voltage and current with the latter. 
When the two methods of control are combined as in figure 197, the rheostat is 
“cut out” for film exposures (radiography). When giving treatments (therapy) 
some variable resistance is usually left in so that settings may be changed to 
compensate for line fluctuations. 
Figure 198.—Operating devices on control stand. 1, line switch ; 2, X-ray switch ; 3, 
voltage compensator; 4, voltmeter; 5, autotransformer control; (1, resistance; 7, fila- 
ment regulator. (General Electric X-ray Corporation design.) 
X-ray switch,—When the current leaves the resistance it has passed through the 
various controls and safety devices of the primary circuit and is ready for the 
primary coil of the X-ray transformer. It is convenient to have a switch at this 
point that may be opened and closed for short or long intervals (F in figure 
197). The time of the X-ray exposure on a film or fluoroscopic screen and the 954 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
treatment of a patient is controlled by closing this switch for the proper inter- 
val. The X-ray switch is placed on the control stand (figure 198). Frequently 
there is a timing device and a foot switch connected with it. The latter are 
merely convenient forms of X-ray switches, all of which send the current to 
the primary coil of the X-ray step-up transformer. 
ARRANGEMENT OF X-RAY EQUIPMENT 
The foregoing discussion started with the production of X-rays and worked 
backward in the high voltage secondary circuit to the secondary coil of the 
step-up transformer. Then it started again at the supply line of the ship or build- 
ing and worked forward in the low voltage primary circuit tc the primary coil 
of the step-up transformer (figure 188). These two divisions, high voltage and 
low voltage are arranged in a very different manner. 
Practically all of the low voltage control and safety devices of the primary 
circuit are found in the control stand (figure 198). This includes fuses, circuit 
breaker, line switch, autotransformer, voltmeter, rheostat, and the X-ray 
switch with its accessory-timer and foot switch connections. The control stand 
also carries an ammeter and a choke coil or resistance control to regulate the 
amount of current flowing to the step-down transformer of the filament circuit. 
The meter may be connected in the overhead system. These regulate the heat of 
the filament in the X-ray tube. It will be recalled that the heat of the filament 
regulates the amount of current (milliamperes) that pass across the X-ray 
tube. This, in turn, regulates the amount of current drawn from the step-up 
transformer and power line. 
The low voltage current leaves the control stand at a pressure of 40 to 210 
volts and enters the step-up transformer. It leaves the step-up transformer at 
a pressure of 30 to 200 kilovolts or higher. A pressure of 100 kilovolts will cause 
a spark to jump across a 6-inch air gap. If this current is not kept confined to 
its proper channels it becomes very dangerous. This is accompanied by locating 
the high voltage lines high enough to be out of reach. The connecting wires 
brought down from the overhead system to the X-ray tube are wound on reels 
containing a spring. The reels exert a constant pidl and keep the wires away 
from the table and patient. These precautions have never been “fool proof” and 
many fatal contacts with high-tension wires are on record. 
SHOCK PROOF EQUIPMENT 
Two recent designs of X-ray apparatus have practically eliminated the danger 
of electric shock. The safest design is that shown in figure 199. All of the high- 
tension secondary circuit, including the step-up transformer and X-ray tube is 
mounted on insulators and enclosed in a grounded metal casting. This hollow 
metal casting or “head” is filled with oil having a high resistance. Starting 
with small self-rectifying dental X-ray tubes, this design has been developed at 
present writing to enclose valve tubes, filament transformer, therapy tube, and 
step-up transformer of 400 kilovolt capacity. 
Another design encloses only the X-ray tube in oil. This is combined with 
heavily insulated cables connecting the tube to the overhead system (figure 200). 
Thus, the most dangerous high tension parts are protected. 
X-RAY EXAMINATIONS 
There are two methods of examining with X-ray equipment, the screen and 
the film. Screen examinations should always be made by persons having exten- 
sive knowledge of anatomy, physiology, and pathology, Otherwise, they lose X-RAY 
955 
most of their value and may lead to wrong conclusions. The film method 
requires similar knowledge for interpretation of the shadows. It will be recalled 
that these shadows often resemble things they are not. However, the exposure 
of the film and its processing in the dark room do not require medical training 
for satisfactory results. This technical part of Roentgenology, as the science 
of X-ray is called, is rightfully placed in the hands of X-ray technicians under 
medical direction. 
Figure 199.—Shock proof tube head. A, step-up transformer ; B, filament transformer ; C, 
X-ray tube ; D, bakelite X-ray window. (General Electric X-ray Corporation design.) 
LEAD IMPBECilSATeo 
COLLARS 
Figure 200.—Shock proof Coolldge tube unit—oil immersed. (General Electric X-ray 
Corporation.) 
Film exposures. 
Space prohibits a detailed description of the technique of film exposures. 
Many fine books have been written on this subject, at least one of which should 
be carefully studied. There are certain fundamental principles that must be 
followed if satisfactory films are to result: 
1. The part should be as near the film as possible, otherwise, the shadow of 
the part will be much larger than the part itself. 
154294°—39 61 956 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
2. The X-rays passing through the center of the part should usually strike 
the film at a right angle, otherwise the shadow will be distorted and difficult 
to interpret. 
3. Standard positions as illustrated in technique should he strictly observed. 
4. Standard target film distances should he used unless the X-ray equipment 
is too small for the necessary exposure. Chest films, for example, are usually 
made at a six or seven foot target film distance. A small bedside unit does 
not have the milliampere capacity to make such a chest film with a short 
exposure time. Hence, the distance is reduced to three feet. The amount of 
exposure necessary varies inversely as the square of the distance (inverse 
square law). The square of 6 feet is 36. The square of 3 feet is 9. By reduc- 
ing the distance to 3 feet the amount of exposure necessary is as 36 is to 9. In 
other words, only one-fourth the number of milliampere seconds used at 6 feet 
is necessary at 3 feet. Variations in distance and voltage affect the film accord- 
ing to their squares. Variations in milliamperes and time have far less effect. 
5. Motion must be eliminated by using compression bands, sand bags, head 
holders, etc., and by making sure that the patient holds his breath during the 
exposure. These important points are illustrated in technique books but usually 
are not emphasized. Motion frequently ruins a film completely for diagnostic 
purposes. 
Scattering. 
Scattering should be reduced by using cones, Bucky diaphragms and Lysholm 
grids. Figure 201 shows the principle of the Bucky diaphragm. When X-rays 
strike a patient’s body many of them 
are broken up into stray X-rays (S) of 
longer wave lengths. The effect is 
similar to light passing through 
muddy water. These stray or scattered 
rays take different directions. Many 
of them strike the film and fog the 
image. Only the rays coming from the 
focal spot of the tube and passing 
straight through the body are wanted. 
Scattering increases with increased volt- 
age, thickness of part, and size of area 
exposed. If the X-rays after leaving 
the body must pass through small slits 
between lead strips (L) and these strips 
are placed close together, very few rays 
outside of those coming from the direc- 
tion of the target will get through. 
The scattered rays strike lead and are 
absorbed. The lead strips are kept 
moving during the exposure and thus 
do not show on the film. 
A Lysholm grid is made of very thin 
stationary lead strips placed closely 
together on a flat base. The shadows 
of the thin lead strips are not apparent 
on the film without close inspection. This grid is frequently placed behind 
fluoroscopic screens to overcome the blurring effect of scattered rays. 
The simplest and cheapest way to overcome scattering is to use the metal 
cones that are supplied with most tube stands. The smallest cone is used that 
Figure 201.—Diagram of Bucky dia- 
phragm. C, cassette; L, lead strips ar- 
ranged radially to form a curved grid; 
S, scattered rays. X-RAY 
957 
will include the desired area of the body. Scattering is reduced because the 
X-rays are confined to a narrow field. This method is not efficient for large 
films but serves very well for the 8 by 10 size. 
Potter-Bucky diaphragm. 
In radiography of the thicker parts of the body, such as the spine, pelvis, 
kidney, gall-bladder, head, etc., increased penetration and time are necessary. 
The passage of the X-rays through these heavier parts materially increases sec- 
ondary radiation. This secondary radiation, emanating in all directions from 
the point of origin, causes fogging, which renders the finer details unrecognizable 
in the film. Hence, in order to obtain radiographs of proper diagnostic quality, 
the elimination of as much of the unwanted radiation as possible must be 
accomplished. This is done by absorption of all except those rays that pass 
vertically or nearly vertically through the area examined. To accomplish 
this absorption the Potter-Bucky diaphragm is used. 
The diaphragm consists of a metal frame holding a “grid” composed of thin, 
narrow strips of lead, separated by strips of wood. This grid is incorporated 
in a mechanism so arranged that it can be made to move at a steady, even 
pace across the plane between the film and the part examined. The speed with 
which the diaphragm moves can be controlled by the operator and should be 
regulated to correspond to the exposure time. The distance between the grid 
and part, as well as the distance between the grid and film, should be as slight 
as possible. 
The absorption of secondary radiation necessitates a considerable increase in 
exposure time. This increase in time depends upon several factors in the con- 
struction of the grid, chief of which are the ratio between the widths of the 
lead and the wooden strips, and the depth of the grid. The increase in exposure 
time with the use of diaphragms ranges from 3 to 5 times that of exposure 
time without a diaphragm. 
Bucky diaphragms are usually rated as “High-Speed,” “Semi-Speed” or 
“Standard.” “High-Speed” diaphragms are for use when very rapid work is 
desirable; they operate effectively with exposure times ranging from 1/20 of a 
second to 10 seconds. “Semi-Speed” diaphragms operate with an exposure 
time ranging from 1/10 of a second to 12 seconds. “Standard” diaphragms 
operate efficiently with exposure times ranging from % to 20 or more seconds. 
Fluoroscopy. 
The fact that certain crystals glow when excited by X-rays was what led to 
the discovery of the Roentgen ray. When these crystals are finely divided and 
spread upon a suitable base, a fluoroscopic screen results. The original screen 
was composed of barium platino-cyanide crystals. After experimentation with 
thousands of crystals, in 1896 Thomas A. Edison discovered that calcium tung- 
state made ideal crystals for this purpose. Since then, cadmium tungstate and 
zinc sulfide have been found to serve best for fluoroscopic screens. The latter,, 
however, are very sensitive to the actinic rays of sunlight and lose some of their 
fluorescing ability if exposed to direct light. Consequently, it is necessary to 
keep such screens covered with dark cloth when they are not actually in use. 
Roentgenoscopy is the study of bodies by use of X-rays and a fluoroscopic 
screen. When a patient or object is placed between the screen and the X-ray 
tube and the tube is activated, shadows, corresponding to the different densities 
of the part examined, can be outlined on the screen. As the difference in gradu- 
ation of the shadows is very slight, absolute darkness is essential for careful 
examinations. For this same reason the eyes of the examining Roentgenologist 
must be accommodated to the darkness. This accommodation requires a period 958 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
of several minutes in total darkness or may be accomplished by wearing dark or 
colored glasses. Glasses for this purpose have been manufactured and are in 
common use, having dark green or red lenses. 
Fluoroscopy may be done in the operating room or at the bedside with hand 
or head fluoroscopes in conjunction with a portable or bedside X-ray unit. This 
tluoroscope consists of a small screen fitted into a light-proof cone. The latter 
is held before the eyes, either by means of a handle, or strapped to the head, 
according to the type used. 
During fluoroscopy great care should be exercised that the patient or operator 
does not come in contact with the high-tension conductors. It should be borne 
in mind that great damage can be done by too long exposure to X-rays and that 
for this reason the examination should be as brief as practicable. The screen 
should contain a lead glass protective sheet between it and the operator, who 
should also wear heavy leaded rubber gloves and apron. 
Radiography. 
In fluoroscopy the shadows of the image examined are seen upon a screen. 
In radiography, the shadows are made a permanent record by means of photo- 
graphic films. 
Modern X-ray films consist of a special emulsion, containing a silver halide 
compound, coated in layers about %ooo of an inch in thickness on both sides 
of a cellulose acetate support or base. This transparent base is about %ooo 
of an inch in thickness, is slow burning, and presents somewhat less of a fire haz- 
ard than common newsprint paper. The base is usually slightly tinted with a 
blue pigment which aids in determining contrast in interpretation of the radio- 
graph. Such a film is known as “dupli-tized, safety film with a tinted base.” 
When a film is exposed to X-rays a change takes place in the silver halide 
salts. The salts that have been affected by exposure are converted into another 
silver compound through the action of a chemical solution called developer. 
The unaffected salts are then removed by another chemical solution called the 
fixing solution. 
The emulsion of the X-ray film is affected by X-rays, radium, light, heat, 
moisture, chemical fumes, gases, static electrical discharges, scratching, abrasion, 
and contact with the fingers. Since any one of these things may cause defects 
to appear in the radiograph, it is evident that the greatest possible care must be 
exercised in their handling and storage. 
Processing procedure.—As X-ray films are extremely sensitive to white light, 
the processing to bring out and make permanent the radiographic image must be 
done in a “darkroom.” Such a room may be illuminated by subdued green or 
ruby light, for it has been found that these lights do not affect the photo- 
graphic emulsion of the film unless the latter is exposed to them for a consider- 
able period. Naturally, as in all chemical procedures, processing should be car- 
ried out with scrupulous care as to cleanliness and ventilation. 
After the film has been exposed it is quickly immersed in the developing solu- 
tion. This solution contains the correct proportions of oxidizing agents which 
convert the affected silver salts into a form of metallic silver. As oxidization 
takes place only in a neutral or alkaline solution, the developer is strongly 
alkaline. 
Development commences in the instant of submersion and continues until all 
the affected salts have been changed. The time of completion of this chemical 
reaction depends upon the temperature of the solution. It has been found that 
immersion of a film in a developing solution with a temperature of 65° F. for 
a period of 5 minutes will fully develop the recorded image. By decreasing X-RAY 
959 
or increasing the developing time approximately 20 seconds for each degree of 
change in temperature, normal development may be accomplished in tempera- 
tures ranging between 60° F. and 70° F. Belowr the former or above the latter 
temperature, development should never be attempted unless in specially pre- 
pared solutions. 
Powders compounded in the proper proportions are issued to all naval activi- 
ties having X-ray facilities. The developing solution should be prepared as 
outlined in the instructions appearing on each container. Distilled water should 
be used if practicable. 
There are several cautions that must be observed in mixing processing solu- 
tions. The vessels or pails should be made of glass or enamelware, for metals, 
such as galvanized iron, tin, copper, zinc, etc., will cause contamination, and re- 
sult in fog in the radiograph. 
After development, the film should be rinsed for about 30 seconds in clean, 
running water to remove as much of the developing solution as possible. If 
the film is transferred directly to the fixing bath from the developer, the alkali 
from the former solution retained on the film will neutralize some of the acid 
in the fixing solution. After a certain quantity of acid has been neutralized, 
the bath has lost its chemical balance; the hardening action is destroyed and 
stains are apt to appear on the radiograph. 
The purpose of fixation is to remove all unexposed silver salts from the 
emulsion and to fix permanently the image that has been brought out by the 
developer. The fixing bath contains not only the fixing chemicals but also 
those chemicals that harden the gelatin of the emulsion, and it permits ordinary 
handling and filing of the film without damage. 
The fixing solution ordinarily used in the naval service is prepared as 
follows; 
Acid Fixing Bath 
Sodium hyposulfite (“hypo”) 2 lb. 8 oz. 
Acetic acid (28% pure) 5.2 oz. 
Sodium sulfite 1.6 oz. 
Potassium alum 1.6 oz. 
Water to make 1 gal. 
{To make 28% acetic acid from glacial acetic acid, take 3 parts of glacial 
acetic acid and add 8 parts of water.) 
To prepare the bath, dissolve the “hypo” in 48 ounces of water. The water 
used in dissolving the different ingredients should be at approximately 125° F. 
Dissolve the sodium sulfite in 32 ounces of water and when it is thoroughly 
dissolved, add the acid. Dissolve the alum in 32 ounces of water and mix with 
the sulfite-acid solution. Never add the alum before the acid, or a milky pre- 
cipitate will result. Now mix the two solutions and add sufficient cold water 
to make 1 gallon, and stir. The solution must be free from debris and clear. 
If a milky precipitate results, known as sulfurization, an error has been made 
in the preparation and the solution should be discarded. 
Proper fixation has occurred when the film is left submerged in the fixing 
solution twice as long as is required to remove all trace of the opalescent silver 
salts. This usually requires from 15 to 30 minutes, depending upon the strength 
and condition of the solution. 
After fixation, the film should be washed in running water which is so circu- 
lating that all parts of the film and hanger receive frequent changes. If the 
hourly flow in the tank is 4 times the tank capacity, 30 minutes’ wash will be 960 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
sufficient • if the hourly flow is 8 times the tank capacity, 15 minutes will usually 
be enough. If the flow of water is very slow, 45 or more minutes’ washing will 
be required. 
To process films properly, it is important that the temperature of the solu- 
tions and wash water be the same. The temperature of 65° F. has been selected 
as ideal. 
The processing solutions after preparation should be allowed to stand for 
at least 24 hours to blend before they are put into routine use. They should 
be kept covered, when not in use, to prevent oxidation. When the level of 
the solutions has been lowered so that the film is not completely covered, fresh 
solution should be added. When preparing the solutions, it is a good plan to 
prepare an extra amount of each, putting the excess in tightly stoppered, amber- 
colored bottles, to use as the level of the solutions in the tanks is lowered. 
The practice of adding chemicals to weakened or worn-out solutions should 
be discouraged. When the solutions become weak they should be thrown out 
and new ones prepared, for the use of worn-out solutions destroys the quality 
of the radiograph. New solutions should in any case be prepared at least 
every 4 to 6 weeks even if the number of films processed is not sufficient to 
cause exhaustion. Each gallon of developer should properly reduce approxi- 
mately 5,200 square inches of dupli-tized film surface. Each gallon of fixing 
solution should fix and harden approximately 2,600 square inches of film sur- 
face, if films are properly rinsed before immersion. 
After the film has been thoroughly washed, it should be dried. Most activi- 
ties are equipped with “dryers”, consisting of a cabinet with electric heating 
units and an electric fan. The air from the outside is drawn or forced in at 
one end of the cabinet, passes across the films and out through a duct at the 
other end. The efficiency of a dryer is about 24 films per hour. 
Where no dryers are available, radiographs may be dried by hanging in the 
open air or before an electric fan. It must be remembered, however, that the 
wet film will pick up particles of dust, so it is important that they be dried in 
a dust-free room. 
Darkroom.—The darkroom should be large enough to care for the expectant 
work. It should be well ventilated, yet as nearly lightproof as possible. It 
must be kept scrupulously clean at all times and should be so arranged as to 
facilitate the handling of films, solutions, etc. 
Such a room should contain the following items: Safe-lights for illumination; 
a master processing tank with at least two solution tanks and a wash compart- 
ment, connected to hot and cold running water regulated by a thermostatic 
mixing valve; a sink for mixing solutions; a film-loading bench into which is 
built a lightproof film-bin for storage of a small quantity of unexposed films; 
shelves and compartments for cassettes, film holders, chemicals, etc.; a film- 
drying cabinet; a lead-lined transfer cabinet; racks for storage of film hangers; 
towel rack; interval timer, and photographic thermometer. 
Stkrfjoradiogkaphs.—The principle of binocular vision is that, when objects 
are viewed with a normal pair of eyes, they appear in their true perspective; 
that is, they give a sense of depth. This results from the fact that each eye 
receives a slightly different view of the object and the two images are com- 
bined by the brain to give the plastic or stereoscopic impression. 
A single radiograph does not possess perspective and is accordingly called 
“flat”. It cannot indicate the position of the various parts of the object along 
the direction of vision. Hence, to overcome this deficiency in the ordinary 
radiograph, stereoscopic films are made. These are obtained by successively 
exposing two films, with the object, or part radiographed, and also the film. X-RAY 
961 
in exactly the same position each time, but with a different position of the 
tube for each exposure. When these two films are viewed in a stereoscope, each 
eye sees one film only; but then, as in ordinary vision, the brain fuses the two 
images into one, showing the various parts standing out clearly in their true 
perspective. 
The stereoscope consists of two viewung boxes with two mirrors exactly half 
way between them at a distance of 25 to 28 inches. The mirrors are so placed 
that the viewing box on the right can be seen only by the right mirror and 
the one on the left only by the left mirror. 
As the average distance between the pupils of the eyes is 2.5 inches, it ap- 
proximates i,lo of the distance between each viewing box and its mirror. Con- 
sequently, when the tube is shifted Vio of the distance between the tube target 
and film, correct fusion of the images will be seen in the stereoscope. Stereo- 
scopic radiographs should never be made at a distance of less than 25 inches. 
In viewing stereoscopic films, the examiner should be in the same relative 
position as that of the target of the X-ray tube when the radiographs were 
made. Hence, the film taken with a right hand shift of the tube should be 
placed in the right-hand box and that taken with the left-hand shift in the left- 
hand box. Then, if viewed from this position, the object will appear to have 
solidity and relief. 
Intensifying screens.—Certain chemicals become luminous when exposed to 
X-rays or other forms of radiation. This property is called fluorescence. Under 
the influence of X-rays, intensifying screens radiate the light thus produced 
to the X-ray film, held in close contact between them. The resultant density of 
the processed film is, therefore, due on the one hand to the quality and in- 
tensity of the X-rays, and on the other to the type of screen used. 
The chemicals used in the manufacture of intensifying screens are crystals 
of calcium tungstate or of zinc sulfide. These finely divided crystals are spread 
over the surface of a thin sheet of cardboard and held together by means of 
a suitable binding material. The size of each crystal and the thickness of 
the coating determine the intensifying factor or speed of the screen. The 
active surface is glazed as a protective measure. 
The intensifying action or speed of the screens lessens the time of radio- 
graphic exposure. The requirements in these screens should include the 
following points: 
1. Screens of the same type should have uniform speeds. 
2. They should produce no grainy effect in the radiograph due to large 
crystals. 
3. They should be comparatively free from afterglow. 
4. They should have a hard protective surface. 
5. They should cause practically no loss in radiographic detail. 
Screens produced by different manufacturers have varied intensifying fac- 
tors. Classified according to speed, there are three general types of calcium 
tungstate screens: 1. Detail or definition (slow); 2. Mid-speed or par-speed 
(medium) ; and 3. Extra-speed or ultra-speed (fast). These types, obtained 
from three different manufacturers, were tested at the U. S. Naval Medical 
Supply Depot, Brooklyn, N. Y. All reached their maximum intensity at a 
potential of 65 kv. peak with comparatively no loss at higher potentials. The 
intensifying action of the “fast” type was only slightly greater than that of 
the “medium” type, but there was a greater loss in radiographic detail in the 
former. This would appear to indicate that there is no justification for the 
use of calcium tungstate screens of the “fast” type. 962 
HANDBOOK OF THE HOSPITAL, CORPS, U. S. NAVY 
The zinc sulfide screen gives its maximum intensity at potentials below 
70 kv. peak and is not recommended for use above that potential. It is of much 
higher speed than the calcium tungstate screen at low potentials and so is of 
great value for the radiographic unit of lower capacity. However, the zinc 
sulfide screen is extremely sensitive to secondary radiation emanating from 
heavy portions of the body which require greater kilovoltages for the pene- 
tration. Hence, if 70 kv. peak is exceeded, a Potter-Bucky disphragm should be 
used to absorb much of this secondary radiation. Because zinc sulfide screens 
are very susceptible to the actinic rays of the sun, they should never be exposed 
to direct sunlight. 
The use of double intensifying screens decreases the necessary exposure time 
to about %o of that used without screens. For example: Radiographs requir- 
ing a technique of 70 kv. peak, 10 ma., 25 inch film-target distance and 5 seconds’ 
exposure time, without screens, will be duplicated, with the use of double in- 
tensifying screens, in approximately % of a second. 
cake of screens.—Intensifying screens, being very delicate and sensitive, 
should be handled with extreme care. Any particle of dirt or dust, any stain or 
scratch, will destroy their efficiency. Naturally, they gradually lose their 
fluorescing ability, but, with careful and conscientious use, screens should last 
for a period of approximately 18 months. 
Rules for care of screens.—1. Active screen surfaces should not be touched 
by the fingers; 2. Chemicals, especially developer, will cause staining of the 
screen and impair its efficiency; 3. Cassettes should be brushed with a camel’s 
hair brush at regular intervals to remove dust or small pieces of lint and paper 
due to insertion and removal of films; 4. Screens may be washed, when neces- 
sary, with a tuft of cotton, using warm water and a small amount of a pure 
soap. They should be rinsed immediately and dried before using. Since fre- 
quent washing impairs screen efficiency, it should be done only when absolutely 
necessary; and 5. Screens should be properly mounted in cassettes and good 
contact between screen and film maintained at all times to insure sharp detail 
in the radiograph. 
X-RAY TREATMENT 
The application of Roentgen rays to the human body for treatment (thera- 
peutic) purposes should not be attempted without the supervision of a medical 
graduate with special training and experience. Dangerous injuries to patients 
and technicians in recent years have usually occurred only when this rule has 
been broken. 
Roentgen therapy is divided into deep high voltage therapy and superficial low 
voltage therapy. The dosage is measured in Roentgen units by special instruments. 
Modern deep therapy uses voltages of 200 kilovolts and higher. The longer 
wave lengths are absorbed by placing copper, tin, and aluminum filters between 
the tube and the patient. The resulting X-ray beam is composed of the shorter 
wave lengths which penetrate to the deeper tissues and have less effect on the 
skin. Superficial therapy uses voltages between 75 and 100 kilovolts with little 
if any filtration. Certain skin diseases respond well to the longer wave lengths 
produced by voltages around 10 kilovolts (Grenz rays). In superficial therapy 
most of the radiation is absorbed before it passes through the various layers 
of the skin. 
PROTECTION 
The safe operation of X-ray tubes demands that precautions be taken to 
avoid excessive radiation striking the patient or technician and to avoid contact 
with the high-tension electrical current. X-RAY 
963 
Radiation precautions. 
Serious changes in the skin occur when certain limits of radiation are 
exceeded. Patients have become permanently bald from too much X-ray 
exposure to the scalp. A safe working rule for radiography is to always use 
at least 25 inches target film distance and to always use an aluminum filter, 
one millimeter thick, in the tube holder. This filter absorbs long wave lengths 
that affect the skin but fail to penetrate through to the film. Under these 
conditions 1,200 milliampere seconds to any one part of the body should not be 
exceeded. When the limit is reached it takes about 30 days for the skin or 
scalp to recover so that it will take additional radiation without injury. This 
is true for voltages up to 85 kilovolts which is seldom exceeded in radiography. 
A bedside machine is frequently used at a 15 milliampere setting. When the 
exposures to the head (regardless of sides) total 1 minute and 20 seconds there 
have been 15 milliamperes for 80 seconds or 1,200 milliampere seconds. It is 
well to remember that 25 inches target film distance is about 15 inches target- 
scalp distance in the above example. 
Dental radiography uses short target film distances and the danger of skin 
damage would be considerable were it not for the small cone that confines the 
X-rays to a small area. Always inquire about previous X-ray exposure. If 
several films have been taken of the same region during the previous 30 days, 
it is advisable to wait until 30 days have elapsed since the last exposure. A 
point frequently overlooked is the risk of making skull and sinus exposures 
directly after a full set of dental exposures and vice versa. 
Radiation protection for the technician consists of keeping lead-lined walls 
or screens between the active tube and himself. Even with px-otected tubes 
such as shown in figxxres 187 and 201, this is the safest practice and the only 
protection against scattered or stray radiation. When assisting in the fluoro- 
scopic room or operating bedside units, technicians should wear long aprons 
impregnated with lead. This protects xxxost of the blood forming centers in the 
hones which are sensitive even to scattered radiation. Protective gloves should 
be worn if the duties require placing the hands nearer than 6 inches to the 
X-ray beam. 
While the amount of radiation absorbed by a technician in one day is usually 
small, a small dose repeated daily over a period of months amounts to an 
alarming total. Technicians may determine whether or not they ai'e absorbing 
dangerous amounts of radiation by the dental film method. Fasten two lead 
numbers, used for numbering films, to the exposure side of a dental film pack. 
This may be wrapped in one layer of black paper, for additional protection. 
Place the pack in a pocket with the exposure side out. After carrying for a 
full working day, develop and let someone not familiar with the numbers used 
inspect the film. If he can read the different numbers correctly on 3 of 5 films 
carried on 5 consecutive days, the technician is receiving too much radiation. 
There are several other methods of testing for radiation hut they require 
equipment that is not always available. 
The inside walls of radiographic and fluoroscopic rooms are xxsually lined 
with lead or coated with barium plaster to protect persons working habitually 
in adjacent rooms. The inside walls of rooms containing deep therapy equip- 
ment are usually lined with sheet lead of % inch thickness or more depending 
upon the kilovoltage used. If there are occupied rooms directly above and below, 
the ceilings and floors must also be protected. 
Electrical precautions. 
Only alert, mature individuals with good judgment should be allowed to 
operate equipment that involves risk of contact with high voltage. The habit 964 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
should be developed of looking and thinking before switches or push buttons are 
closed. Caution the patient not to move and do not allow spectators or attendants 
to approach any high-tension part. If the equipment has not been used for several 
days, or, in the case of bedside units, has been moved, it should be tested before 
the patient is placed in position. X-ray apparatus should not be accessible to 
anyone not responsible for its care and use. Accidents, breakdowns, and faulty 
performance frequently result from the curious tampering with controls and 
connections. 
A good working rule is to never allow the tube terminals or any other high- 
tension part to come closer to the patient than twice the distance of the point 
spark gap. To allow for line surges, this distance should never be less than 
1 foot. When the secondary coil of the transformer is grounded in the middle, 
the voltage at each end of the tube is one-half the total voltage. Nevertheless, it 
is safer to observe the working rule and not develop habits that might be carried 
to other apparatus. Remember that the autotransformer control with the 
resistance “cut out” allows dangerously high amperage to be drawn from a 
transformer when the high-tension is grounded. 
Before approaching an X-ray tube or posturing a patient, see that the line 
switch and X-ray switch are in the “off” position. It will be recalled that timing 
devices and foot switches are merely convenient forms of X-ray switches. Any 
push button type of switch may stick and remain in the “on” position. For this 
reason it is safer to have the X-ray switch on a control stand connected in series 
with the timer and foot switch. The latter are then “dead” until the X-ray 
switch is thrown to the “on” position. Control stands with these devices con- 
nected in parallel are dangerous because a defective push button may close 
the circuit unbeknown to the operator. This is especially true of valve tube 
rectification whose operation is silent. To overcome this it is good practice 
to connect a warning light and buzzer in the primary circuit. 
When high-tension jumps from its proper path it does so because it has found 
an easier path to follow. This simple fact is not so simple in practice. The 
easier path may be ionized air, defective or damp insulation, a patient’s body, 
or a combination of these and several other factors. High-tension is always 
seeking a path to the ground. As a working principle, the path to ground 
through a patient’s or operator’s body should be made more difficult (contain 
more resistance) than some other paths that are not dangerous. 
It is generally agreed that tube stands should carry a ground wire con- 
nected to a water pipe if possible and that they should not be in contact with 
radiographic tables. The latter should have a poor conductor in contact with 
the patient (such as a wooden table top) and should not have a connecting ground 
wire unless they collect static. A heavy charge of static electricity collects on 
some X-ray tables. 
Fluoroscopic tables should be grounded because the patient is not between 
the tube and the table. Bedside units usually have a connection for a ground 
wire. This may be incorporated in the lamp socket connection of the unit for 
the low-tension wires will carry off a high-tension ground very efficiently. 
Otherwise, the ground wire should have a spring contact terminal that may be 
clamped to a radiator or waiter pipe. Never allow any part of the unit to touch 
the bed. See that the bed is not grounded by extension lights, radio ear 
phones, etc. 
Floor coverings of X-ray rooms should be nonconducting material such as 
linoleum or rubber composition. To prevent the accumulation of ionized air, 
such rooms should be well ventilated. X-RAY 
965 
X-ray protection. 
An Advisory Committee on X-ray and Radium Protection was formed in tlie 
United States for the purpose of preparing unified safety recommendations. The 
complete recommendations of that committee are published by the U. S. Depart- 
ment of Commerce in the Bureau of Standards’ Handbook, HB-20. The follow- 
ing excerpts from that publication are quoted: 
“2. Special requirements for apparatus of class a. 
(X-ray installations for diagnostic purposes at voltages up to 130 kv peak.) 
“b. peotection of patient 
“2.03. The equivalent of 1 mm. of aluminum shall be permanently mounted 
between the tube target and patient in all fluoroscopic tube inclosures and 0.5 mm. 
of aluminum in all radiographic tube Inclosures. Part or all of this may be 
contained in the glass of the tube walls. 
“2.04. The diaphragm of the tube container shall have a permanent covering 
of asbestos board at least 0.5 mm. thick placed between the tube and filter, next 
to the filter. 
“c. PEOTECTION OF PHYSICIAN AND PEESONNEL 
“Protection From Direct Radiation. 
“2.05. The fluorescent screen shall be covered with plate lead-glass having 
an equivalent lead thickness of at least 1.5 mm. 
“2.06. Protective gloves shall have an equivalent lead thickness of at least 
0.5 mm., and shall insure protection to the whole hand—outer surface, palm, 
fingers, and wrist. 
“2.07. Protective aprons worn by the physician or technician shall have an 
equivalent lead thickness of at least 0.5 mm. 
“Protection From Scattered Radiation. 
“2.13. To protect the operator and personnel, control apparatus for radio- 
graphic work should be in an adjacent room which provides protection 
equivalent to at least 0.5 mm. of lead. Control operators should be behind 
such protection during all radiographic exposures, and during all radioscopic 
work when practicable. 
“2.14. When it is impracticable to place the control apparatus in an adjacent 
room, as in paragraph 2.13, it may be inclosed in a lead-lined booth within the 
radiographic room. 
“2.15. Either control room or booth shall be provided with a suitably large 
lead-glass window of 2.0-mm. lead equivalent. 
“2.16. The use of movable upright protective screens is dangerous and shall 
be discontinued. 
“2.17. When thermionic rectifiers are used they shall be either placed in a 
separate room or surrounded by material of 0.1-mm. lead equivalent. 
“10. high-tension leads to tubes 
“10.07. When using an X-ray tube having any exposed high-tension parts, 
the table shall be insulated from ground by suitable material capable of with- 
standing 3/2 the maximum working voltage to ground. 
“10.08. Metal parts of X-ray apparatus, such as tube stands, transformer 
tanks, motors, controls, etc., shall be permanently grounded to a water pipe 
through at least a no. 6 AWG wire or the equivalent. This wire must he 
suitably protected against accidental breakage. 966 
HANDBOOK OF THE HOSPITAL CORPS, U. S. NAVY 
“IV. STORAGE OF X-RAY FILM 
“15. General 
“15.05. Smoking shall be prohibited in rooms where film is handled or stored. 
Conspicuous “No Smoking” signs shall be posted in prominent places. 
“15.06. No films shall be stored within 2 feet of steam pipes, radiators, 
chimneys, or other sources of heat. 
V. OPERATING RULES 
‘16. Rules for technicians, nurses, etc. 
“16.01. A copy of these rules shall be given to every X-ray worker, whether 
temporary or otherwise, upon entering service. A signed receipt stating that 
the rules are understood shall be given to the physician in charge of the 
department. 
“16.02. A copy of these rules, together with a copy of first-aid instructions 
for electrical shock, shall be posted conspicuously in all principal X-ray rooms. 
“16.03. Protective gloves and aprons, even though in compliance with these 
recommendations, do not afford adequate protection. Consequently, care shall 
be taken at all times not to expose the body unnecessarily to radiation. 
“16.04. Lead rubber becomes hard and brittle with age, and all such pro- 
tection should be tested at regular intervals for possible cracks and imperfec- 
tions. This test should be made radiographically or radioscopically. 
“16.05. Radioscopic work should be performed in the minimum time pos- 
sible, using the lowest X-ray intensity and smallest aperture consistent with 
demands. It is important, however, that the fluoroscopist use sufficient X-ray 
intensity so that he can see without eyestrain. 
“16.06. The omission of any protective devices for the sake of expediency 
of operation shall be strictly forbidden. 
“16.07. Before touching any X-ray generator or high-tension part, particular 
care shall be taken to make sure that the main-line switch is open and the 
whole apparatus is disconnected from the power line. 
“16.08. In the case of equipment having high-tension condensers, care shall be 
taken that both sides of the high tension are actually and securely grounded 
before touching any part thereof. 
“16.09. If the transformer and controls are located in a remote room, a plaque 
reading “Do Not Touch” shall be hung over the main-line switch when it is 
necessary to touch high-tension parts in another room. 
“16.10. Where several appliances for treatment or examination may be con- 
nected to a common high-tension system, care shall be taken that conductors to 
all idle equipment are disconnected. 
“16.11. Where the machine operation depends upon two persons, a distinctly 
audible or visible signal shall be given by the operator before throwing on the 
high tension, and a return signal received from the person using the equipment. 
“16.12. Any acoustical or optical signal system for protective purposes should 
he checked daily before commencing work. 
“16.13. The main switch should be opened immediately upon completion of the 
X-ray work, or when the machine is not in actual use. 
“16.14. The high-tension overhead system should be examined frequently for 
possible faulty insulators or loose parts. 
“16.15. A daily check shall be made, to be certain that no idle flexible high- 
tension leads extend below the minimum prescribed height above the floor. 
“16.16. All grounding connections shall be examined weekly. X-RAY 
967 
“16.17. All high-tension barriers shall be examined frequently. When possible, 
this should be done when cleaning the apparatus. 
“16.18. In case of fire in the X-ray or control rooms, or in any part of the 
building, all X-ray apparatus should be immediately disconnected from the mains 
by opening the main power line switch. 
“16.19. All workers should be thoroughly familiar with the Schaefer prone 
pressure method of resuscitation in case of electric shock, and a set of such 
instructions should be posted conspicuously in each main room. Above the de- 
scription of the method should be placed the instructions: 
“ ‘This hospital may be provided with pulmotor or other resuscitation appara- 
tus. Do not wait to send for it, but proceed immediately with the Schaefer prone 
pressure method.’ 
“17. RULES FOE PHYSICIANS IN CHARGE 
“17.03. At least every 4 months each worker shall be supplied with a dental 
X-ray film half covered with lead foil, which shall be worn on the breast con- 
tinuously, with the film side out, for 15 working days. If, upon development, 
appreciable darkening of the exposed part of the film is indicated, the cause 
therefor shall be investigated and eliminated. 
“17.04. Circuit-breakers should be examined monthly to be certain that the 
overload adjustment is correct. 
“18. PERSONNEL WORKING CONDITIONS 
“18.03. Every assistant, technician, and operator should be given at least 4 
weeks’ vacation a year with at least 2 weeks of this consecutively and during the 
summer months. 
“18.04. All persons occupied in radiological work should be examined for 
general radiation injuries yearly. Complete blood counts should be made fre- 
quently. The results of all tests and examinations should be permanently re- 
corded. It is advisable that all persons be carefully examined before entering 
radiological work.” 
References 
Manual of Roentgenological Technique.—Sante. 
U. S. Army X-ray Manual.—Pillsbury. 
Physics of Radiology.—Weatherwax. 
Roentgenographic Technique.—Rhinehart. 
Science of Radiology.—American College of Radiology. 
Wilhelm Konrad Roentgen.—Glasser. 
X-ray Protection.—Handbook. Bureau of Standards. No. 20. INDEX 
Abbreviations: Page 
In prescription writing 635 
Of Latin words in pharmacy 635 
Abdomen.. 52 
Acute conditions of. 126 
Abdominal: 
Cavity 52 
Conditions, acute 1 126 
Paracentesis 330 
Abduction ..■ 24 
Ablution, full. 921 
Abscess-es. 87 
Alveolar 172 
Gum.. 173 
Absorption.. 51,61 
Acacia (gum arabie) 240 
Accelerated reaction in vaccination 425 
Accomodation, 82 
Defects of. 82 
Accountability, property 774 
Hospital Supplies and m, vi, 774 
Accounting 778 
Officer , 774 
Procedures 774 
Records and reports 778 
Acetabulum 21 
Acetaldehyde 719 
Acetic acid, poisoning by 266 
Acetone 719 
Acetophenetidin 225 
Acetylene-s 722 
Acidic oxides. 693 
Acidimetry... 732 
Aeid-s. 680 
Acetic 720 
Glacial 226 
Acetylsalicylic 227 
Amino 59,61,579,585 
Anhydrides- 681 
Ascorbic -... 63,582 
Barbituric, derivatives of... 747 
Base equilibrium 30,892 
Bases, and salts.. 680 
Benzoic 226,817 
Binary 681 
Boric. 709,817 
Carbolic. (See phenol.) 
Carbonic 49 
Cevitamic.. 582 
Citric 226 
Deflni tion of 680 
Diethylbarbituric 257 
Dibasic 683 
Fixing bath 959 
Aeid-s—Continued. Page 
Halogen . (581 
Hydriodic... 691 
Hydro 681 
Hydrobromic 681,690 
Hydrochloric 60,185,690 
Hydrocyanic 684,871 
Hydrofluoric 692,817 
Hydrogen 681 
Inorganic or mineral .... 683 
M onobasic 683 
Nicotinic 533 
Nitric 186 
Of phosphorus 703 
Organic 225,720 
And their esters 225,720 
Poisoning by 267 
Orthophosphorie ...... 703 
Oxalic 266 
Oxy 681 
Oxygen.. 681 
Picric. 224,364 
Polybasic. 684 
Prussic 871 
Reaction 680 
Salicylic.. 226,817 
Salts 684 
Sulfuric 186,700 
Tannic ! 227 
Tartaric. ...... 228 
Ternary 684 
Tribasie 684 
• Uric (crystals) 891 
Acidosis. 32 
A conite 254 
Poisoning by 263 
Tincture 254 
Acriflavine 364 
Acromion process 20 
Activated sludge process (sewage purification). 444 
A dam ’sapple 47 
Adduction r 24 
Adeps. 238 
Benzoinatus. 238 
Lanse- - 238 
Adhesion. 658 
Adipose tissue n 
Administration: 
And general clerical procedures... ra, vi 749 
Of— 
Medicines _• 180,304 
Care of medicine locker 305 
Conditions affecting 180,181 
“Five Rights” in 304 
Methods of 304 
960 970 
INDEX 
Administration—Continued. Page 
Of—Continued. 
Therapeutic treatments... 304,311 
Application of heat and cold 311 
Counterirritants.. 315 
Enemata. 319 
.Enteroclysis 321 
Gastric lavage... 322 
Gavage 322 
Medicated baths 314 
Adrenal (suprarenal) glands 62 
Adrenalin. (See Epinephrine.) 
Agdes aegypti mosquito 340, 407, 412 
Aeration of blood... 48 
Agrobes 94,901 
Aerobic bacteria 94 
Aeronautics, Bureau of T 753 
Aeroplane splint 163 
Afferent nerves 72, 73 
Agar 240 
Agglutination 857 
Tests.. 903 
Agglutinins 32 
Iso... I 857 
Agglutinogens, iso- 857 
Aid stations: 
Battalion, Marine Corps expeditionary 
force * 566 
Regimental, Marine Corps expeditionary 
force - 566 
Air; 
Atmospheric pressure 429 
Carbon dioxide in 429 
Composition of — 428,692 
Embolism.. 879 
Microorganisms in 431 
Physical properties of 429 
Relation to health 428 
Residual _1 ... 5i 
Tidal— 51 
Albuminuria 68 
Alchemy 644 
Alcohol-s.. 218,718 
Dehydrated 219 
Dilute — 219 
Ethyl 218,719 
Glycerin.. 218,219 
Methyl .... 219,718 
Poisoning by 264,718 
Sponge bath 314 
Alcoholism, acute: 
Bogan’s test in.. 125 
Unconsciousness caused by .. 125 
Aldehydes... — 220,719 
And aldehyde derivatives 220 
Alimentary canal (or tract) 51,64 
Alimentation, duodenal 594 
Aliphatic carbon compounds 714 
Alkali-s ... 187,684,706 
Caustic.. 187 
Poisoning by 265 
Elements and their compounds 187 
Metals 706 
Antidote for poisoning by 187 
Hydroxides of 187 
Alkali-s—Continued. Page 
Mild ,.. 198 
Reserve. . 31 
Alkalimetry. 730 
Alkaline: 
Earth elements and their compounds. 198 
Earth metals 708 
Earths 934 
Reaction 684 
Alkaloid-s 248 
Alkaloidal salts, and alkaloidal drugs 248 
“Cadaveric” 248 
Alkalosis 32 
Allahabad system of excreta disposal 535 
Allenes ■_ 722 
Allergy.. m, v, 469 
Atopy 469 
Bacterial. _ 437 
Categories of.' 459 
Drug 486 
Food ■ 477,591 
Gastrointestinal 473 
Physical 439 
Serum. 433 
To parasites and insects.... 439 
Alligation 610 
Allotment-s ... 779 
Appropriational 779,730 
Medical Supply Depot 779 
Allotropicmodifications.: _ 694 
Allotropism 694 
Alteratives 177 
Alternating current, modulated 930 
Alum.. 203 
Exsiccated 204 
Aluminum 709 
Compounds 203 
Oxide 709 
Alveolar process-es _ is, 52 
Alveolus-i 167 
Of lungs..---— 38,48 
Ambulance party, ship’s landing force, mis- 
sion of 571 
Aminoacids. 59,61,579,585 
Amitosis (amitotic division; fission) 9 
Ammonia 201 
Aromatic spirit of 197 
Water 196 
Stronger 196 
Ammoniated mercury . 210 
Ammonium: 
Carbonate 197 
Chloride 197 
Ichthosulfonate 216 
Radical 680 
Amoeba 71 
Amoebic dysentery 400 
Amyl nitrite. .1 229 
Amylaceous: 
And mucilaginous substances 238 
Substances 239 
Amylase - 60 
Anabolism 9 
Anaerobes - 94,901 INDEX 
971 
Page 
Anaerobic bacteria 94 
Anaesthesia m, vi, 735 
General 737 
Inhalation 737 
Intravenous 745 
Rectal 745 
Preanaesthetic medication 746,747 
Regional 735 
Infiltration and block 735,736 
Spinal. 735,736 
Surface. 735 
Anaesthetics 177 
Avertin 745, 747 
Chloroform ...... 216,739,740 
'Cocaine hydrochloride 735 
Cyclopropane '. 739,740 
Divinyl oxide 742 
Ether 739,740 
Ethyl chloride 217, 739, 742 
Ethylene ... 739,740 
Evipal soluble 745 
Metycaine hydrochloride 736, 737 
Nitrous oxide 739, 740 
Nupercaine hydrochloride 736, 737 
Pentothal sodium 745 
Pontocaine hydrochloride 736,737 
Procaine hydrochloride : 736 
Anaesthetist: 
Table for ... 358 
Anaesthetizing room 359 
Anal orifice.. 55 
Analgesics 177 
Analysis 653 
Chemical 724 
Gastric 897 
Gravimetric 731 
Of— 
Adequate diet T. 587 
Water, sanitary 440 
Proximate 731 
Qualitative 724, 731 
Quantitative. 724,731 
Ultimate 731 
Volumetric.. 731 
Analytical: 
Procedures 724 
Reactions 732 
Direct type. . 732 
Indirect type. 732 
Residual type 732 
Anaphrodisiacs 177 
Anaphylactic shock... 375 
Anaphylaxis 376 
Anastomosis 40 
Anatomical positional terms 14 
Anatomy: 
And physiology in, v, 5 
Definition of - - — 6 
Descriptive 6 
Human 6 
Microscopical (histology) 7 
Surgical... 6 
Topographical.. :.. 6 
Page 
Ancylostoma duodenale (hookworm) 403,911 
Aneurin (vitamin Bj; thiamin) 582 
Angio-neurotic oedema 479 
Angiology 7 
Angstrom units 924 
Anhydroties... .... . 177 
Animal-s: 
Carcasses, disposal of 541 
Foods * 588 
Parasites . 907 
Parasitology 907 
Substances, products obtained from 245 
Anions 669 
Annual: 
Estimates 781 
Purchase requisitions 782 
Anode . 669 
Anodynes 177 
Anopheles mosquito. _ 408,446 
Antacids 177 
Ante-mortem statement ■_ 85 
Anthelmintics 177 
Antibody-ies 32,374 
Antidote-s.. 177,260 
For poisoning by alkali metals 187 
Antiemetics 177 
Antigen 32 
Antimony 704 
And potassium tartrate 207 
Compounds _. 207 
Antiperiodics 177 
Antiphlogistics _... 178 
Antipyretics .. • 178 
Antiseptic-s. 178 
Antisialiacs ...... . 178 
Antispasmodics 178 
Antisyphilitics 178 
Antitoxins :... 32 
Antrum... ... 16 
Of Highmore 18 
Aorta 40 
Abdominal .= 41 
Arch of 40 
Ascending 40 
Descending 41 
Thoracic... 40 
Aortic valve 37 
Aperient J ... 178 
Apertures, posterior nasal 16 
Aphrodisiacs 178 
Apncea .. - 51 
Apomorphine 250 
Aponeuroses 24 
Apoplexy. 124 
Apparatus: 
Lacrimal 81 
Visual 81 
Appearance: 
General, of patient 274 
Of body of patient 274 
Appendicitis, acute 126 
Appendix,vermiform 55 
Appropriations, annual 779,780 
154294°—39 62 972 
INDEX 
Page 
Aqueous humor. ■ 82 
Arachnida (arachnids).... 913 
Mites: 
Sarcoptes scabei.. 913 
Spiders: 
Lactrodectus mactans (“black widow”).. 913 
Ticks: 
Dermacentor andersoni 913 
Dermaeentor variabilis 913 
Ornithodoros moubta 913 
Arachnoid membrane : 74 
Areh-es: 
Deep volar 40 
Dorsal venous. 44 
Of aorta 40 
Superficial volar... 40 
Vertebral 19 
Zygomatic -.. 16 
Arithmetic, pharmaceutical 607 
Army and Navy General Hospital 758 
Aromatic-s 178 
Bitters 178 
Carbon compounds. 714 
Fluidextract of cascara sagradse 245 
Hydrocarbons __ 722 
Spirit of ammonia 197 
Arsenic. 704,817 
Antidote for poisoning by 205,704 
Compounds of 206,704 
Poisoning by 264,704 
Trioxide 206,704 
Arsphenamine 206,505 
Arterial injection (embalming) 883 
Arterioles 38 
Artery-ies 38 
Aorta 40 
Abdominal 41 
Arch of.. 40 
Ascending 40 
Descending 41 
Thoracic. 40 
Axillary... 40 
Brachial 40 
Bronchial 41 
Coeliae .-. 41 
Common carotid. 40 
Common iliac 41 
Coronary 37 
D orsalis pedis 43 
External iliac 41 
Femoral 43 
Gastric 41 
Hepatic 41 
Hypogastric. 41 
Innominate. , 40 
Intercostal 41 
Lumbar... 41 
Mediastinal. 41 
Meningeal 108 
Mesenteric 41 
GSsophogeal 41 
Ophthalmic 81 
Ovarian 41 
Parietal 41 
Pericardial. 41 
Artery-ies—Continued. Page 
Peroneal 43 
Phrenic 41 
Popliteal. 43 
Pulmonary.. . 33 
Radial 39,40 
Sacral, middle 41 
Spermatic 41 
Splenic 44 
Subclavian 40 
Tibial 43 
Ulnar. 40 
Vertebral 40 
Visceral 44 
V olar arches. 40 
Arthrology 7, 44 
Arthropoda 943 
Arachnida. 943 
Insects 943 
Articular cartilage .. 45 
Articulations, description of 22 
Artificial: 
Cooling of air 433 
Lighting 434 
Respiration 424 
Schaefer’s method of 424 
Ultraviolet therapy 920 
Ventilation 432 
Ascarls lumbricoides (round or eel worm) 944 
Ascorbic acid (vitamin C) 532 
Aseptic surgery.. 300 
Asphyxia 54,420 
Artificial respiration in 424 
Choking, treatment for 422 
Hanging or strangling, treatment for 122 
Poisonous gases.. 422 
Resuscitation of apparently drowned 422 
Treatment for 424 
Asphyxiants (chemical warfare) 863 
Aspirin 227 
Assimilation.......... 9 
Assistant Secretary of the Navy 750 
Aster-s. 9 
Rays 9 
Asthma 473 
Astigmatism '.. 82 
Astringent-s. ... 473 
Enemata 320 
Atmosphere, gaseous content of :... 428,692 
Atmospheric pressure 429,434 
Atom-s. 646,942 
Atomic: 
Number. 663 
Structure.. 672 
Weight 662 
Atropine...: 252,747 
Poisoning by. 264 
Sulfate 262 
Aural irrigations 333 
Auricle; 
Of ear 82 
Ofheart. .'. 37 
Aurieulo-ventricular valve 37 
Autoclave 362 INDEX 
973 
Page 
Autoeondensation 933 
Autonomic nervous system 73 
Autopsy. (See Postmortem examinations.) 
Autotransformer 951 
Avertin (tribromethanol) .. 745,747 
Aviation medicine m,vi,847 
Avogadro’s hypothesis 656 
Axone (axis cylinder process) 73 
Bacillary dysentery 339,402 
Bacilli... 901 
Acid-fast, method of staining 902 
Bacteria 374,901 
Aerobic.. 94,901 
Anaerobic 94,901 
Dysentery group in food poisoning 377 
Pyogenic 361 
Reproductionof... 901 
Salmonella group of 377 
Saprophytic 436 
Staining of 901 
Bacterial allergy 487 
Bacteriology 699,899 
Bacteriolysins 32 
Bacteriophage- 903 
Balance-s: 
Acid base (equilibrium) 892 
Care of 605 
Chainomatic 605 
Compound lever 605 
Double beam, unequal arm 605 
Single beam, equal arm 605 
Single beam, unequal arm 605 
Torsion 605 
Balanitis 501 
Balanoposthitis 501 
Balantidium cob.... - 908 
Balkan frame 157 
Balsam of Peru.. 235 
Bandage-s 131 
And bandaging in, v, 131 
Application of 132 
Barton 138 
Circular 133 
Complete of hand 135 
Cravat 141 
Demigauntlet 135 
Desault 104, 111 
Figure-of-eight 134 
Gauntlet 135 
Handerchief 141 
Many-tailed 140 
Neckerchief. 141 
Oblique ,.. 133 
Of— 
Back 142 
Extremities 134 
Eye 139 
Fingers 135 
Groin 136 
Head... 138 
Heel.. 136 
Hip.... 146 
Jaw 138 
Shoulder 136 
Stump 133 
Bandage-s—Continued. Page 
Plaster of Paris.. . 140 
Recurrent 133 
Of head ,. . 433 
Removal of 133 
Roller 43j 
Sayre dressing . _. 439 
Spica 138 
Ascending .... i36 
Descending.. 435 
Spiral 133 
Reverse 435 
“T” 140 
Triangular 444 
Velpeau 437 
Bandaging 131 
General rules for... 432 
Barbital ... 256,257 
And related compounds 256 
B arbiturie acid derivatives 747 
Amytal 747 
Pentobarbital. 747 
Pentothal sodium 745 
Phenobarbital 257 
Sodium cyclural (evipal soluble) 745 
Barium. 703 
Compounds.. 201 
Dioxide 201 
Sulfate. 201 
Barton bandage 433 
Basal; 
Conditions 352 
Metabolic rate (B. M. R.) 354 
Factors influencing 354 
Relation of to height, weight, surface area, 
age, sex 352 
Metabolism in, vi, 849,853 
Apparatus for determining 853 
Clinical significance of 855 
Technique 854 
Bases..... 680,684 
Dihydric . 685 
Hydroxides of 684 
Monohydric 685 
Basic: 
Lead carbonate ....... 711 
Salts 685 
Basophiles 36 
Basswood splint 164 
Bath-s: 
Acid fixing 959 
Alcohol sponge 314 
Bed. 298 
Cleansing 298 
Cold 313,921 
Rules in administering 313 
Continuous tepid 921 
Contrast. 922 
Electric light 925 
Foot 312 
Hip 922 
Hot 311,921 
Hyperpyrexia 921 
Medicated.... 314 
Paraffin 922 974 
INDEX 
Bath-s—Continued. Page 
Sheet 921 
Sitz 313,922 
Sponge 298 
Towel 921 
Whirlpool 923 
Bed-s and making of ... 290 
Changing- 
Lower sheet of a bed patient 291 
Mattress 291 
Cleaning and airing..... 290 
Ether 292 
Fracture 292 
Turning mattress with patient in bed 292 
With patient in bed 290 
Bedbug-s (Cimex lectularius) 450 
Control measures for 450 
Bedpan 303 
Bedsores (pressure spots) . 299 
Beef, as food 588 
Cuts of 829 
Belladonna: 
Extract of.. 251 
Leaf ..... 251 
Poisoning by 265 
Benedict’s qualitative solution 890 
Benzene... 714,722,724 
Ring 714,722 
Benzine, poisoning by, 269 
Benzoic acid 226 
Benzoin, compound tincture of. . .. . 235 
Benzoinated lard ... ..238 
Beryllium ..... 708 
Bicarbonate of soda _ 190 
Bichloride of mercury 210, 264 
Disinfectant 451 
Poisoning by. 265 
Sterilization by 363 
Bicuspid: 
Teeth 52 
Valve (mitral) 37 
Bile 56,60 
Duet, common 56 
Biliary ducts 56 
Bilirubin v 56,899 
Bill of Health. _ ... 454 
Binary compounds 679 
Biology .. 7,599 
Bismuth _ ... 704 
And potassium tartrate 209 
Compounds 208 
Subcarbonate ... 208 
Subnitrate 208 
Subsalicylate 208 
Bitters 178 
Aromatic 178 
Simple . 178 
Bladder: 
Gall 56 
Irrigation 327 
Urinary 68 
Blank forms, medical department 773 
Blanket count.... 346,350 
Blaud’s pills 205 
Page 
Blood. 29 
Acid-base equilibrium (balance) 30,892 
ASration of 38,40 
Agglutination 857 
Alkali reserve 31 
And blood vascular system 29 
Cells ........ 29 
Corpuscles.. 29 
Counting of 36,905 
Crenated.. 35 
Polymorphonuclear 36 
Red 29,33 
Schilling classification of 906 
White... 35 
Chemistry 891 
Circulation of. 38 
Clot (coagulum) 33 
Coagulation and time of 33,906 
Composition of 29 
Count: 
Complete. 905 
Differential.. 36,905 
Red cell ... 905 
White cell. 905 
Cultures 902 
Deoxygenated 50 
Donor, selection of.. 862 
Formed elements of. .... 33 
Functions of 29 
General description of 29 
Grouping and matching . __ 111, vi, 856 
Classification in .' _ 859 
Cross matching 860 
Precautions in j.. 861 
Technique of 858 
Occult 891 
Oxygenated 49 
Plasma. 29,30 
Platelets (thrombocytes) 29,36 
Poisoning. (See Septicaemia.) 
Pressure. 39,281 
Apparatus (sphygmomanometer) 281 
Sedimentation test ... 906 
Serum 33 
Transfusion.. _ 856 
Vascular system... .. 29,36 
Vessels .( 36,39 
Blue ointment ... . 212 
Bodies, foreign, removal of 118 
Body wastes: 
Alimentary canal (faeces) . 64 
Elimination of . 63,302 
Lungs (expiration) 63 
Skin (perspiration) _ 63,68 
Urinary system (urine) 63,303 
Boil, or furuncle .... 87 
Boiling 616 
Point of substances 695 
Bone-s 12,14 
Anatomical description 14 
And joints ... 14 
Atlas 16 
Calcaneus 22 
Capitate. 21 INDEX 
975 
Bone-s—Continued. Page | 
Carpal 21 
Clavicle 20 
Coccyx. 19 
Composition of 14 
Cuboid... 22 
Cuneiform 22 
Ethmoid 17 
Femur 21 
Fibula.. .: 22 
Frontal ... 17 
Greater multangular 21 
Hamate 21 
Humerus 20 
Hyoid 18 
Incus 17 
Inferior turbinated 18 
Innominate , 21 
Lacrimal 18 
Lesser multangular 21 
Lunate ..... 21 
Malar 18 
Malleus ...... 17 
Mandible 18 
Marrow.. 15 
Giant cells of 36 
Maxillae .-. 18 
Metacarpal 21 
Metatarsal 22 
Nasal 18 
Navicular; 
Of foot . 22 
Ofhand , 21 
Number and distribution 15 
Occipital 17 
Of— 
Cranium 17 
Ear 17,83 
Face 17 
Lower extremity.... 21 
Neck and trunk 18 
Pelvis 21 
Skeleton ........ 15 
Spinal column... 18 
Thorax 19 
Upper extremity 19 
Palate. 18 
Parietal 17 
Patella 21 
Phalanges 21,22 
Pisiform 21 
Radius... 20 
Ribs (false, floating, true). 19 
Sacrum ... 19 
Scapula -.. 20 
Sesamoid.. 15 
Shapes of._ 15 
Sphenoid. 17 
Stapes. — 17 
Sternum 17 
Sutures of 16 
Talus v 22 
Tarsal 22 
Temporal. 17 
Bone-s— Continued. Page 
Tibia 22 
Triangular.. 21 
Ulna. 20 
Vertebrae (true) ... 18 
Vomer 18 
Words used in describing 16 
Zygoma 16 
Bony labyrinth of ear 83 
Boric acid 185, 709,817 
Boron 185,708 
Borrelia: 
Duttoni 913 
Recurrentis 916 
Botany ...7,599 
Botulism 379 
Bowman’s capsule... 66 
Boyle’s law 655 
Brachial: ■ 
Artery 40 
Plexus 78 
Vein. 44 
Brain 72,74 
Arachnoid membrane 74 
Cerebellum 75 
Cerebrum 74 
Compression of 124 
Concussion of 124 
Corpus callosum '... 75 
Cortex cerebri 74 
Dura mater 74 
Forebrain ' 74 
Gray matter ... 74 
Hindbrain 74 
Meninges - 74 
Midbrain 74 
Piamater.... .. 74 
Subarachnoid space 74 
Ventricles 75 
Lateral (two) 75 
Fourth 75 
Third 75 
White matter. 74 
Breath, odor of 276 
Bright’s disease 125 
British thermal unit (B. T. U.) 693 
Brittleness, definition of 654 
Brombenzylcyanide 863 
Bromine 689 
Bronchi and Bronchus 48 
Bronchioles 48 
Bubonic plague 409 
Buffer solutions 730 
Buffers 30 
Bulbo-urethral glands (Cowper’s) 70 
Bureau-s, Navy Department: 
Aeronautics 753 
Construction and Repair 751 
Engineering 752 
Medicine and Surgery 752 
Appropriations annual 780 
Assistant chief of 759 
Chief clerk of 759 
Chief of 759 976 
INDEX 
Bureau-s—Continued. Page 
Divisions of 759 
Duties of 752 
Finances of... 774 
History of 755 
Organization of 755 
Navigation 751 
Ordnance 751 
Supplies and Accounts 752 
Titles of head of 750 
Yards and Docks 1 751 
Burns: 
And scalds 116 
Treatment of 116 
Secondary to screening smokes and white 
phosphorus 866 
Cadaveric: 
Alkaloids 248 
Lividity.. 837,838 
Caecum 55 
Caesium 708 
Caffeine: 
Citrate 255 
Withsodiumbenzoate 255 
Caisson disease (bends) 431 
Calamine, prepared 203 
Calcination 616 
Calcium 580, 708 
Amount required in diet 680 
Carbonate 201,708 
Chloride. 200 
Compounds 199 
Conditions caused by lack of 580 
Gluconate. 201 
Hydroxide.. 200 
Lactate 201 
Oxide 708 
Calculus, dental. 170 
Calomel.. 210 
Calorie-s: 
Definition of 583,614,693 
Large (kilo-) 524, 583, 614,693, 850 
Small 614,693 
Yielded by foods 624,583,818 
Calorimetry: Direct and Indirect 853 
Calx (lime) 199 
Chlorinata (chlorinated lime) ? 442.462, 530 
Camphora 232 
Camphorated tincture of opium 249 
Canal-s: 
Alimentary 51,64 
Central 77 
External auditory 16 
Haversian..... 15 
Medullary 14 
Semicircular, of internal ear 83 
Canaliculi 81 
Canning, in food preservation 817 
Oantharidal: 
Collodion 318 
Plaster.. 318 
Capillaries 38 
Lymphatic 46 
Capillarity 658 
Capsule-s: Page 
Bowman’s. 66 
Joint 22 
Carbhsemoglobin 35,49 
Carbo activatus 184 
Carbocyclic series , 714 
Carbohydrates .. 580,720 
In foods. 58O 
Or sacccharides 721 
Sources of 58O 
Carbolic acid. (See Phenol.) 
Carbon 184,705 
Activated charcoal 184 
Compounds: 
Aliphatic or open-chain series of 714 
Aromatic, carbocyclic, or closed-chain 
series of.i.. 714 
Chemistry of. 713 
Structure and structural formulas of 714 
Dioxide 49, 429, 705, 876 
Disulfide.. 705 
Monoxide 429,706,871,876 
Tetrachloride.. 217 
Carbonic acid 49 
Carbonization 616 
Carboxidegas 452 
Carbuncle. 87 
Cardiac; 
Cycle 37 
Depressants 173 
Orifice of stomach __ 54 
Plexus 79 
Stimulants ..... 173 
Care and comfort of patient 288 
Care of the dead 838 
Appropriation... 78O 
Care of the feet.. 562 
On the march 502 
Caries, dental 171 
Carminative-s 178,320 
Carrier 372 
Cartilage: 
Articular is 
Tarsal... .. 81 
Cascara sagrada: 
Aromatic fluidextraet of 246 
Fluidextract of 245 
Casein 60 
Caseinogen. 2 60 
Castor oil 236 
Catalyst (catalytic agent) ..... 58, 687 
Catalytic action 53 
Cathartic-s i7g 
Aperients. 178 
Cholagogues 178 
Hydrogogues 178 
Laxatives 173 
Purgatives 178 
Drastic 178 
Saline 178 
Simple 178 
Catheterization 326 
Articles required for urinary 326 INDEX 
977 
Catheterization—Continued. Page 
Procedures in urinary 326 
Cathode. 669,942 
Cations.. 669 
Cauda equina 77 
Caustics 264 
Cavity-ies: 
Abdominal 52 
Buccal - 51 
Cranial 16 
Glenoid.. 20 
Injection (embalming) 885 
Nasal 16 
Oral... 16 
Orbital 16 
Pulp .' 167 
Tympanic 52,82 
Cell-s. .* — 7 
Aster rays 9 
Asters..... 9 
Blood 29 
Counting of 905 
Body 7 
Centrosome 8 
Chromatin 8 
Connector ; 71 
Cytoplasm 7 
Differentiation 9 
Fertilization 9 
Growth 8 
Irritability (excitability) 8 
Motor (effector) ... 71 
Nucleus 8 
Reproduction. 9 
Segmentation 1... 9 
Sensory (receptor) 71 
Simple 7 
Specialized 8 
Spindle 9 
Undifferentiated 7 
Wall 8 
Cementum 169 
Census report of patients 346 
Centigrade thermometer 614 
Central: 
Canal 77 
Lobe (Island of Reil) 75 
Nervous system 72, 74 
Sulcus, brain 75 
Centrosome 8 
Cephalin (thrombokinase) 33 
Cerates (cerata) 629 
Cerebellum 75 
Fissure, horizontal 76 
Hemispheres of 75 
Vermis (middle lobe) 76 
Cerebral: 
Depressants 178 
Excitants 178 
Nerves. (See Cranial nerves.) 
Cerebrospinal: 
Fever r 383 
Fluid 75,77 
Nervous system 72,74 
Page 
Cerebrum 74 
Convolutions 74 
Fissure-s of 74 
Central sulcus 75 
Great longitudinal 74 
Lateral cerebral . 75 
Of— 
Rolando (central sulcus) 75 
Sylvius (lateral cerebral) 75 
Parieto-occipital 75 
Transverse 75 
Function oL ... . 75 
Lobes of . 75 
Cervical; 
Pleura - - 49 
Plexus 78 
Vertebrae 18 
Cestodes (tapeworms) 909 
Diphyllobothrium latum '.... 910 
Hymenolepis nana r 910 
Taenia saginata; and solium 909; 910 
Chancre 493 
Chancroid 414; 495 
Channel-s, venous 43,44 
Characteristics and properties of matter 653 
Charcoal, activated 184 
Charge register 776 
Charles’ law . 656 
Charting, clinical 293 
Chemical: 
Affinity, definition of 664 
Change —- 652 
Compound 679 
Compounds, nomenclature and classification 
of 679 
Disinfection 451 
Bichloride of mercury 451 
Chlorinated lime 452 
Formalin .. 451 
Phenol (carbolic acid) 451 
Equations 673 
Formulas 661 
Incompatability 636 
Notation .. 660 
Preparations 624 
Preservatives of food 817 
Solutions 659 
Sterilization 362 
Symbols.. 661 
Venereal prophylaxis 513 
Warfare in, vi, 862 
First-aid treatment 863, 866,867,868,869,871 
Medical aspects of 862 
' Physiological action of agents . _ 863,866,868,871 
Summary of symptoms and first-aid treat- 
ment of casualties caused by exposure to 
agents 864 
Chemistry . in, vi, 599,643 
Acids 680 
Analysis 724 
Atomic weight 662 
Atoms. 646 
Structure of .. 646 
Bases 680 978 
INDEX 
Chemistry—Continued. Page 
Blood. —. 891 
Compounds 653 
Binary 679 
Naming of 681 
Ternary. 679 
Definition of 651 
Elements 660 
Acid forming 681 
Table of 660 
Inorganic 651 
Definition of 661,659 
Laws and theories 653 
Molecular weight ... 663 
Molecules. 646 
Nomenclature 679 
Organic, definition of 651,713 
Physical change 652 
Polyvalence 665 
Salts 680 
Synthesis. 6,653 
Valence 661 
Weights, atomic, table of 660 
Cheyne-Stokes respiration 283 
Chicken pox 338,421 
Chief of Bureau of Medicine and Surgery, 
duties of... 759 
Chief pharmacists (commissioned warrant 
officers) appointment of . 760,762 
Chilblain. 118 
Chilling 117 
Chills. 130 
Chloracetophenone ... 863 
Chloral hydrate 221 
Chloramine-T ' 218,364 
Chlorine . 442,689,866,875 
Family of elements, .. 689 
Chloroform (trichloromethane) 216, 718, 739,740 
Chlorophyll 5 
Chldrpicrin 866 
Cholagogues — 178 
Cholera 339,399 
Choroid 82 
Chromatin 8 
Chromosomes 9 
Chyle 45 
Chyme 60 
Cilia 47 
Ciliary: 
Muscle. 82 
Process 82 
Cimex lectularius (bedbug) 450,550 
Cinchona 250 
Compound tincture of 251 
Cinchophen 229 
Circulation: 
Collateral- 40 
Of blood 38 
Portal. A. 45 
Systemic, veins of. 43 
Citric acid— 226 
Clarification 621 
Clavicle 20 
Fracture of Ill 
T-splint for fractured 162 
Page 
Cleaning .. 372 
Gear 349 
Of operating room .' 359 
Of wards 347 
Clerical: 
Force, organization of in naval hospitals 773 
Procedures, administration and general-m, vi, 749 
Work, medical department 763 
Clinical: 
Chart (NMS Form Q) 284 
Notes (NMS Form No. 17) 285 
Record (NMS Form No. 59) 285 
Recording and charting 283 
Thermometer 278 
Clonorchis sinensis (liver fluke) 909 
Clostridium: 
Botulinum (Bacillus botulinus) .. 379 
Histolyticum (Bacillus histolyticus) .... 95 
CEdematiens (Bacillus oedematiens) 95 
Sporogenes (Bacillus sporogenes) 95 
Tetani (Bacillus tetani) 95, 340,361, 426 
Welchii (Bacillus welchii; “gas bacillus”) . 95,361 
Clothing: 
Color of 446 
Disinfection of 451 
Of patients . 354 
Purpose of 445 
Where obtained 445 
Coagulation (clotting) .. 33 
Chemical factors in .' 33 
Physical factors in 33 
Time . 33,906 
Coagulum (clot) 33 
Coaptation splints 107,164 
Coca (Erythroxylin) . 254,637 
Cocaine. 255,637 
Hydrochloride 255,735 
Poisoning by r 265 
Cocci. 901 
Cochlea ■ - 83 
Cockroaches 1... 651 
Control measures 651 
Cod liver oil 237 
Codeine 250 
Sulfate — 2.50 
Cohesion.. 658 
Colation (straining) 6 
Cold: 
Applications 311 
Bath 921 
Common, symptoms and treatment of 129 
Compresses 318,920 
Injuries due to. 114,117 
Packs. 313,920 
Purposes for which applied 311 
Quartz lamps 926 
Use of, in food preservation 816 
Colic: 
Gall-stone 127 
Kidney-stone.. 128 
Collapse. 325 
Collecting stations, Marine Corps expedi- 
tionary force , 567,569 INDEX 
979 
Page 
Conservation of matter, law of 654 
Constant proportions, law of 652 
Construction and Repair, Bureau of 751 
Contact — 3.72 
Beds (sewage purification) 444 
Dermatitis ... 481 
Contusion. 101 
Conus medullaris 77 
Convection.. 429 
Convulsions.. 130 
Copper 581,709 
Amount required in diet 581 
Anaemia caused by lack of 581 
Compounds 214 
Sulfate, sterilization of water by.. .. 214,442,710 
Coracoid process 20 
Cerium 28 
Cornea 82 
Cornstarch 239 
Corpora cavernosa 70 
C orpus spongiosum 70 
Corpuscles: 
Blood...... 29 
Renal 66 
Correctives.. 178 
Correspondence , 763 
Classes of 763 
Confidential .. 764 
Examples of 768 
Filing and files 772 
Methods of handling '764 
Official 763 
Restricted... 764 
Secret... 764 
Corrosive-s: 
Mercuric chloride 211 
Poisoning by 266 
Poisons 258 
Cortex: 
Cerebri 74 
Of— 
Kidney 65 
Suprarenal (adrenal) glands 62 
Cortin 63 
Corynebacterium diphtheriee (Bacillus diph- 
therias; Klebs-Loefller bacillus) 342,384 
Costal pleura. 49 
Cotton, used for clothing 446 
Cottonseed oil 236 
Coughs 275 
Counter irritant-s 315 
Cold as.. 315 
Escharotics 315 
Rubefacients 315 
Vesicants 315 
Cowling’s rule 180 
Cramps, heat 114 
Cranial nerves; 
Distribution of 78 
Function of 78 
Table of — - 78 
Varieties of 78 
Cranium: 
Bones of 17 
Description of... 16 
Collection: Page 
And disposal of refuse, ashore 445, 534 
Of specimens. (See Specimens.) 
Colies’fracture 111 
Collodion-s (collodia) 625 
Cantharidal 318 
Corn 564 
Colloids 622 
Colon: 
Ascending , 54 
Descending 54 
Transverse 54 
Combustion. 693 
Commensalism 907 
Comminution 617 
Commissary: 
Clerk, naval hospitals, duties of 805 
Department, naval hospitals 804 
Accounting and accountability 815 
Civil employees, Civil Service status of.. 806 
Organization of. 805 
Personnel, duties of. 805 
Physical arrangement of 807 
Ledger 777 
Officer, naval hospitals, duties of 804 
Steward, naval hospitals, duties of 805 
Supervision m, vi, 804 
Common: 
Bile duct... •- 56 
Carotid artery 40 
Cold, symptoms of and treatment of.. 129 
Iliac artery — 41 
C ommunicable diseases 383 
And practical preventive medicine 371 
Definition of 335 
Modes of transmission. 372 
Nursing care of. 335 
Source of infection 372 
Compound-s: 
Binary 679 
Chemical 679 
Dislocation 104 
Fracture 105,106 
Ternary, — 679 
Compresses 920 
Cold ... 318,920 
Hot 920 
Compressibility, definition of 654 
Compression 918 
Of the brain 124 
Concurrent disinfection. 336,372 
Concussion of the brain. 124 
Condiments 579,686 
Condition-s: 
Abnormal, of eyes, ears, nose, mouth and 
throat 275 
Acute abdominal 126 
Heart 276 
Mental, of patient 275 
Conduction 429 
Condyle-s 16,21,22 
Conjunctiva.. -r 81 
Connective tissue 11 
Forms of 11 
Conservancy, field 533 
Conservation of energy, law of 655 980 
INDEX 
Page 
Creosote 224 
Carbonate .- 225 
Crepitus 106 
Cresol 223 
Saponated solution of 224 
Crisis.. 280 
Crystallization 621,659 
Definition of 621 
Interstitial water 622 
Mather liquor... 622 
Water of 622,695 
Crystalloids 622 
Crystals... 621 
Cubic centimeter 603 
Culex mosquito 446 
Culicid8D_ 914 
Culifuges 547 
Culture media 899 
Sterilization of 900 
Cupping 318 
Current: 
Alternating, modulated 930 
Faradic 930 
Surging 930 
Galvanic 929 
Interrupted 930 
High-frequency 931 
General diathermy 932 
Monoterminal 932 
High-voltage, secondary 945 
Induced 946 
Low-voltage, primary 950 
Sinusoidal, slow 930 
Surging and interrupted 930 
Cusps: 
Of- 
Teeth 167 
Valves of heart 37 
Cutaneous membrane 29 
Cuticle , 69 
Cutis vera 69 
Cutting of meats 825 
Cyanides, poisoning by... 265 
Cyanogen. 706 
Radical...... 680 
Cyclopropane 739,740 
Cystic duct 56 
Cytology. 7 
Cytoplasm.... 7 
Daily ward duties 345 
Blanket count 346 
Cleaning schedules 347 
Dakin’s solution 363 
Dalton’s law 652 
Darkfleld examinations ... 903 
Dead: 
Care of the 838 
Identification of the 840 
Property of the 834 
Death-s: 
And medico-legal matters. in, vi, 833 
Conduct of hospital corpsmen in presence of. 833 
D y ing declarations 836 
E arly signs of 836 
Death-s—Continued. Pag6 
Later signs of 837 
Signs of ..... 837 
Unnatural causes, conduct in 839 
Decantation... 620 
Decoctions (decocta) 625 
Decomposition 6 
Double (metathesis) 674 
Defsecation -. 51 
Deflagration 616 
Deglutition (swallowing) 51 
Degree-s: 
Centigrade j 614 
Fahrenheit 614 
Of burns 116 
Reaumur. 614 
Thermometric; 
Conversion of, rules for 615 
Seales used in marking 614 
Deliquescence 622 
Deliriants 178 
Delirious patient, nursing care of 343 
Delirium 343 
Causes 343 
Tremens 343 
Types of 343 
Delousing .... 372 
Demulcents 178 
Dendrone ..: 73 
Dengue 407 
Density. 607 
Dental: 
Calculus 170 
Caries 171 
Corps 752 
First-aid 171 
Haemorrhage 173 
Pain 172 
Pulp 167 
Records. 166 
In identification of dead 840 
Tissues 166 
Treatment, emergency m, v, 165,171 
Dentin 167 
Deodorants 178 
Department of the Navy 749 
Assistant Secretary of the Navy 750 
Bureaus of 750 
Judge Advocate General of the Navy 763 
Office of Naval Operations 761 
Major General Commandant, U. S. Marine 
Corps 754 
Secretary of the Navy 750 
Depressant-s; 
Cardiac. 178 
Cerebral.. 178 
Derma 69 
Dermacentor andersoni; and variabilis (ticks) _ 913 
Dermacentroxenus riekettsi 913 
Dermatitis, contact 481 
Dermatoses, trade or occupational 516 
Desault bandage. 104, 111 
Desensitization. 376,485 
Desiccation 616 981 
INDEX 
Page 
Dextrose 242 
Diabetes 63 
Diet in 591 
Dialysis 622 
Dialyzer. 622 
Diaphoretics 178 
Diaphragm 26,28 
Potter-Bucky 957 
Diarrhoea .... 129 
Diastole 37 
Diathermy: 
General 932 
Short-wave 933 
Ultra short-wave 935 
Dibasic acids 683 
Dicrotic pulse 281 
Diet-s: 
Adequate— 
Analysis (composition) of 587 
Menu arrangement of foods in 588 
Allergies. 591 
Anaemia... 591 
And messing for the sick... in, vi, 579 
Balanced, determination of. 585 
Cardiac * 591 
Classification of in naval hospitals 593 
Constipation 591 
Diabetes 591 
Diarrhoea 591 
Elimination. 489 
Fevers 592 
Gastric ulcer 591 
Gout 592 
Karell. — 592 
Lenhartz 591 
Light - 593 
Liquid 593 
Long Island College Hospital ... 591 
Names of 591 
Nephritis 592 
Obesity 592 
Planning of 590 
Regular 593 
Serving of 590 
Sippy 591 
Soft 593 
Special 593 
Therapy 579,590 
Tuberculosis 592 
Dietetics, definition of 579 
Diethylbarbituric acid 257 
Differential blood count 905 
Digestants.— -.. 178 
Digestion... 51 
Absorption 51,61 
Defsecation 51 
Deglutition r 51 
Insalivation 1 51 
Mastication 51 
Peristalsis 51 
Pharmaceutical 623 
Process of 57 
Digestive: Page 
Ferments . 58 
System. 51 
Digitalis 244 
Poisoning by 265 
Tincture of 244 
D ihydric bases 685 
Dihydroxybenzene: meta, ortho, and para 723 
Diphenylaminechlorarsine 863 
Diphenylchlorarasine 863 
Diphtheria- 384 
Diphyllobothrium latum (Russian tapeworm) 910 
Diplococcus: 
Intracellularis meningitidis 342,383 
Pneumoniae (pneumococcus of Fraenkel) _ 341.361 
Disaccharides 721 
Disease-s: 
Apoplexy 124 
Appendicitis, acute 126 
Autointoxication. 129 
Balanitis 501 
Balanoposthitis. 501 
Beriberi 582 
Bright’s 125 
Caisson 431 
Cerebrospinal fever 383 
Chancroid 414,495 
Characterized by a skin eruption 337 
Chicken pox 338,421 
Cholera 339,399 
Communicable, and practical preventive 
medicine 371 
Dengue 407 
Diptheria 342, 384 
Due to animal parasites, list of Important.. 917 
Dysentry: 
Amoebic. 400 
Bacillary 339,402 
Empyaema 341 
Epididymitis. 498,501 
Epilepsy 123 
Erysipelas.....' 341 
Food deficiency 818 
Gall-stone colic. 127 
Genitourinary and venereal m, v, 490 
German measles 337, 386 
Gonorrhoea 414,496 
Gonorrhoeal ophthalmia 332, 502 
Herpes 296, 504 
Hookworn (Ancylostomiasis) . _. 403 
Influenza 341,387 
Injuries, and abnormalities of the male geni- 
talia 490 
Kidney-stone colic 128 
Lymphogranuloma venereum (inguin- 
ale) 415,503 
Malaria 339,408 
Measles 337,388 
Meningitis (cerebrospinal fever) 342,383 
Mumps 390 
Of— 
Lower animals transmissible to man 419 
Respiratory tract 341 982 
INDEX 
Disease-s—Continued, Page 
Paraphimosis 491 
Paratyphoid fever 404 
Pellagra... J 583 
Phimosis 491 
Plague (bubonic, pneumonic, septicaemia),. 409 
Pneumonia, acute lobar 341,391 
Prostatitis 498,502 
Rabies 419 
Resulting from an abrasion of skin or mucous 
membrane 340 
Rickets 583 
Ringworm 418 
Scabies 413,913 
Scarlet fever 337,392 
Scurvy.. .: 682 
Septic sore throat 393 
Smallpox 338,422 
Stricture of urethra 499 
Symptoms of 273 
Objective 274 
Subjective 274 
Syphilis 416,493 
Tetanus 340,426 
Trachoma 427 
Transmitted by— 
Direct contact 413 
Discharges from intestinal tract . _ 338,399 
Discharges from mouth and nose 383 
Insects and other arthropods 339,407 
Trichinosis 420 
Tuberculosis: 
Other than pulmonary 396 
Pulmonary. 342,394 
Typhoid fever. 338,406 
Typhus fever 340,411 
Uraemia 68,125 
Venereal 492 
Prevention of m,v, 511 
Verruca acuminata, venereal 604 
Vincent’s infection, oral 174 
Water-borne... : 437 
Whooping cough 397 
Xerophthalmia 581 
Yellow fever 340,412 
Diseased tissue specimen-s, collection of 288 
Disinfectant-s 178 
Disinfection 372,450 
Bichloride of mercury 451 
Boiling 451 
Burning. 461 
Chemical 451 
Chlorinated lime 452 
Concurrent— 336 
Distinction from fumigation 450 
Formalin •... 451 
Phenol (“carbolic acid”) 451 
Physical 451 
Steam... 451 
Sunlight 451 
Terminal.. 336 
Disinfesting 373 
Dislocation-s , .... 102 
Complicated 105 
Compound. 104,105 
Dislocation-s—Continued. Page 
Elbow.. 104 
Finger joints 103 
Hip 104 
Jaw. 103 
Knee 104 
Reducing of 103 
Shoulder 103 
Kocher’s method of reduction.. . 104 
Reduction by traction or extension 104 
Stimson’s method of reduction 104 
Symptoms of. 102 
Treatment of 103 
X-ray examination in 103 
Dispensaries. 760 
At Marine Corps posts 565 
Dispensary, IT. S. Naval, Washington, D. C _ 763 
Dispensing 637,835 
D ispensatory 601 
Disposal: 
Of— 
Refuse ashore 445 
Sewage ... 442 
Wastes 542,673 
Dissociation 674 
Distillation 617 
Destructive 617 
Fractional. 617 
Vacuum ... 617 
Distilled water 183 
Diuretic-s 178 
Diving and submarine duty.. m, vi, 872 
Divinyl oxide. 742 
Donor, blood, selection of 862 
Dorsal vetebrse. (See Thoracic vertebra.) 
Dose-s: 
Adult (normal).. 180 
Average 180 
Cowling’s rule for computing 180 
Factors affecting 180 
Lethal 180 
Maximum 180 
Minimum. 180 
Therapeutic 180 
Toxic. 180 
Young’s rule for computing 180 
Double: 
Decomposition (metathesis) 674 
Salts. 685 
Douche-s: 
Eye 330 
Fan. 923 
Jet 923 
Pharyngeal 334 
Scotch 923 
Drainage, duodenal 898 
Dressing-s 95 
Antiseptic- 95 
Aseptic. 95 
Dry 95 
Sterile i.. 95 
First-aid packet . 95 
Kinds of 95 
Occlusive.. 95 
Station, shore patrol... 575 INDEX 
983 
Dressing-s— Continued Page 
Surgical 327,364 
Emergency outfit of. 365 
Sterilization of 364 
Tray or carriage..I 329 
Wet 95 
Antiseptic 95,97 
Hot 95 
Drowning. (See Asphyxia.) 
Drug-s.. 177 
Administration of. ... 180 
Conditions influencing 180 
Allergy 486 
Book, ward 346 
Containing cathartic principles and their 
preparations.... 245 
Inorganic. 181 
Organic 215 
Therapeutic classification of 177 
Toxicology of 263 
Drum, ear 82 
Drying, in food preservation 816 
Ductility, definition of 654 
Ductus deferens (vas deferens) 70 
Duodenal: 
Alimentation 594 
Drainage 898 
Duodenum 54 
Dura mater 74 
Duty-ies: 
Diving and submarine in, vi, 872 
Independent m, vi, 887 
Of— 
Bureau of Medicine and Surgery 757 
Hospital corpsmen; 
Administrative and clerical. 763 
At sick call ----- 347 
In— 
Care of patients 273 
Care of property and stores 350,783 
Preparation of reports 763 
Property accountability 775 
Sanitary investigations 887 
On recruiting , 936 
Personnel, naval hospitals 805 
With— 
Marine Corps expeditionary forces... in, vi, 564 
Ship’s landing force 571 
Shore patrol 574 
Dying declarations 836 
Dysentery: 
Amoebic 400 
Bacillary.. 402 
Group in food poisoning 379 
Dyspnoea —. 51,283 
Ear. 82 
Ache 130 
Drum. 82 
External 82 
Internal. 83 
Middle.. 82 
Ossicles (bones) 17,83 
Removal of foreign bodies from 119 
Treatment of conditions of 333 
Page 
Eberthella typhosa (Bacillus typhosus) 338 
Ebullition eig 
Ectoparasites.. 907 
Eczema 479 
Effective temperature in submarines 874 
Effects, patients’ 354,834,835 
Efferent nerves. 72,73 
EfHeurage (stroking) 917 
Efflorescence 622 
Eggs, as food 589,811 
Recipes for preparation of., 594 
Ejaculatory duct 70 
Elasticity, definition of 654 
Elbow, dislocation of 104 
Electric: 
Current 667 
Light baths 925 
Pads.... 316 
Shock. 123 
Electrocardiogram. 881 
Electrocardiography m, vi, 879 
Instruments 879 
Technique... 880 
Electrochemical (electromotive) series 687 
Electrocoagulation 935 
Electrodeless high frequency induction lamps. 927 
Electrodes 880,929 
Electrodesiccation i 936 
Eleetrodiagnosis- 931 
Electrolysis— 669 
Electrolytes 669 
Electrolytic dissociation 670 
Electronic theory.. 667 
Electrons 650,669,942 
Electrosection 936 
Electrosurgery. 936 
Electrotherapy „ 928 
Element-s 659 
Electrochemical series of 687 
Periodic- 
Arrangement of (fig. 149) 648 
Classification of 649 
Table of 650 
Table of 660 
Elimination diets in food allergy 489 
Elixirs (elixiria) . . 625 
Elutriation 618 
Emblaming in, vi, 882 
Arterial injection 883 
C a vity injection 885 
Fluid - 886 
General instructions 885 
Embolism, air 879 
Embryology 7 
Emergency: 
Dental treatment m, v, 165 
Splints 164 
Sterile operating outfit 365 
Emetic-s 178,260 
Emetine hydrochloride. 254 
Emprosthotonos 268 
E mulsions (emulsa) 625 
Enamel - 167 984 
INDEX 
Page 
Endamoeba histolytica 400,907 
Endocardium 37 
Endocrine (ductless) glands 29,61 
Endolymph.. 83 
Endoparasites.. 907 
Endothelium 28 
Enema-ta (clyster): 
Evacuant 319 
Equipment for giving 319 
Soap-suds... 319 
Method of giving. 319 
Object of giving 319 
Retention 320 
Astringent... 320 
Carminative 320 
Nutritive 320 
Purposes for which given. 320 
Sedative 320 
Energy 654 
Kinetic 654 
Law of conservation of.. 655 
Potential 655 
Radiant 924 
Engineering, Bureau of 752 
Enterobius vermicularis (pin or seat worm).. 912 
Enteroclysis .• 321 
Enterokinase 60 
Enzymes 51,58 
Action of. 58 
Amylase 60 
Classes of 58 
Composition of 58 
Erepsin 60 
Invertase 58,59 
Lactase 58,59 
Lipase 59,60 
Maltase 59 
Pepsin 60 
Ptyalin 59 
Rennin.. 60 
Trypsin 60 
Table of 59 
Eosinophiles 36 
Ephedrine 256 
Epicondyles, lateral and medial 20 
Epidemiology 371 
Epidermis 69 
Epidermophyton.. 418 
Epididymis 70,490 
Epididymitis 498,501 
Epigastric (solar) plexus 79 
Epiglottis.. 48 
Epilepsy 123 
Epimysium 24 
Epinephrine (adrenalin). 63 
Epinephrine (adrenalin) hydrochloride 247 
Epiphysis. (See Pineal body.) 
Epispastics... 318 
Epistaxis (nosebleed) — 90 
Epithelial tissue (epithelium) 11 
Classes of 11 
Epso m salt. 198 
Equations 673 
Balancing of. '.... 674 
Chemical. 673,674 
Oxidation and reduction, balancing of...... 697 
Equipment; Page 
For— 
Postmortem examinations 841 
Postmortem specimens 843 
Shore patrol 574 
Ledger. 776,777 
Of operating room. 357 
X-ray: 
Arrangement of 954 
Shock-proof 954 
Erepsin. 60 
Ergosterol, solution of irradiated 237, 582 
Ergot, fluidextract of 255 
Eruption-s 276 
Erysipelas 341 
Erythroblasts 15 
Erythrocytes 33 
Escharotics (caustics) 178,319 
Eserine sulfate (physostigmine sulfate) 253 
Esters: 
Definition of 720 
Of organic acids 720 
Ethane 717 
Ether-s 221,719,739,740 
Anaesthesia, induction of 737 
Bed.. 292 
Definition of 719 
Solvent (ethyl oxide) 222 
“Sulfuric” 7I9 
Ethyl: 
Acetate 720 
Alcohol 218,718 
Chloride 217,718,739,740 
Ether l 222,739,740 
Nitrite, spirit of 229,720 
Ethylene-s 721,739,740 
EucalyptoL. 231 
Eugenol. 231 
Eustachian (auditory) tubes 52,82 
Evaporation 616 
Of body heat.. 445 
Eversion. * 23,114 
Of eyelid 119 
Evipal soluble (sodium cyclural) 745 
Examination-s: 
Darkfield. 903 
Of— 
Patients 355 
Urine 890 
Sediment in 891 
Water. 440 
Physical 848 
Postmortem 840 
X-ray. _ 103,954 
Excitants, cerebral 178 
Excretions 63 
Excretory organs 63 
Alimentary canal. 64 
Ldngs 63 
Skin. 63 
Urinary system 63 
Exercise. 304,919 
Of patients 304 
Types of... 919 
Expectorants 178 
Expense analysis register 777 INDEX 
985 
Page 
Expression 622 
Exsiccation 616 
Extension 24 
In treatment of— 
Dislocation of shoulder 104 
Fracture 107 
External: 
Auditory canal 16,82 
Ear 22 
Inguinal ring 27 
Oblique muscle 26 
Extract-s (extracta) 629 
Of— 
Belladonna 251 
Cascara sagrada 245 
Liver 247 
Extraction 622 
Eye: 
Application of ointment to 331 
Balls 81 
Brows 81 
Chambers of 82 
Douche 330 
Installation of drops 331 
Lashes 81 
Lids. 81 
Nursing in conditions of 330 
Operations on 332 
Removal of foreign bodies from (jl8, 331 
Strain, cause of 435 
Treatment of wounds of 100 
Face, bones of 17 
Faeces 61,277 
Observation of 277 
Significance of color of 277 
Fahrenheit scale 614 
Faradic current 930 
Surging 930 
Fasciae 24 
Fasciculus 24 
Fasciolopsis buski (intestinal fluke) 909 
Fats 580,720 
Sources of 580 
Fauces, anterior pillars of 62 
Febrifuges 179 
Feeding, special methods of 593 
Feet, care of 562 
Femoral: 
Artery —— 43 
Nerve - 78 
Ring 27 
Vein 44 
Femur 21 
Fracture of - 112 
Splinting of fractured 113 
Fenestra ovalis.. 83 
Ferments, digestive. (See Enzymes.) 
Ferric: 
Chloride, tincture of 204,712 
Citrochloride, tincture of 205 
Hydroxide, magma of.. 205,263 
Ferrous: 
Carbonate, pills of (Blaud’s pills). 205 
Chloride 712 
Fertilization 9 
Pago 
Fever-s._ 83,128, 280 
Continuous 280 
Diet in 592 
Intermittent 280 
Remittent 280 
Termination of (crisis; lysis) 280 
Treatment of 128 
Fiber-s: 
Muscle 13,24 
Nerve 72,73 
Fibrin 33 
Fibrinogen 30,33 
Field: 
Conservancy 533 
Sanitation. in, vx, 521 
Filing: 
Manual, U. S. Navy 772 
System, U. S. Navy 772 
Film-s: 
Exposures 955 
X-ray. 958 
Filters 441 
Field... 533 
Pressure 441 
Rapid, mechanical, gravity, sand 441 
Slow sand 441 
Sprinkling 441 
Filtrable virus 373,901 
Filtration 621 
Beds, intermittent sand 441 
Water . 441 
Filum terminate 77 
Finger-s: 
Bones of 19 
Fracture of 112 
Joints, dislocation of.. 103 
Prints, in identifying dead 840 
First aid 85,849 
At a fire 117 
Dental 171 
Dressing of wounds 95 
General measures in 85 
Minor surgery and ni, v, 85 
Packet 95 
First-aid treatment of; 
Abdomen, acute conditions of - 126 
Abscess 87 
Apoplexy 124 
Appendicitis, acute 126 
Asphyxia 120 
Aviation... 849 
Boil or furuncle 87 
Bright’s disease - 125 
Bruise— 101 
Bums and scalds 116 
Carbuncle 87 
Chills 1 - 130 
Cold 114,117,129 
Compression of brain 124 
Concussion of brain 124 
Contusion 101 
Convulsions 130 
Diarrhoea 129 
Dislocation. 102 
Earache.,.,, - 13° 986 
INDEX 
First-aid treatment of—Continued. Page 
Epilepsy or fits 123 
Fractures 105 
Gall-stone colic. 127 
Gastric or duodenal ulcer, perforated... 127 
Haemorrhage 89 
Headache ... 129 
Heat exhaustion... 114 
Heat stroke 114 
Hiccough 130 
Hysterical unconsciousness 124 
Inflammation 86,128 
Intestinal obstruction, acute 127 
Kidney-stone colic 128 
Poisoning causing acute abdominal symp- 
toms 128 
Poisonous insect bites 98 
Removal of foreign bodies 118 
Scalds... — 116 
Shock. '88 
Electric 88,123 
Snake bites. 100 
Sore throat 130 
Sprain. 101 
Strain 101 
Unconsciousness 122 
Caused by alcoholism 125 
Uraemia 125 
Wounds... 93 
Fish, as food 689,813 
Fission... 9,901 
Fissure-s 16 
Of— 
Cerebrum 74 
Liver 56 
Sphenoidal 81 
Fitzsimons General Hospital 758 
“Five Rights” in administration of medi- 
cines 304 
Fixed oils, fats, and soaps 236 
Flagellata (mastigophora) 907 
Trypansoma gambiense 907 
Flavors in foods. 579 
Fleas (siphonaptera)... 449, 551 
Control measures for. 449,551 
Fleet Marine Force 566 
Flexion 24 
Flexure: 
Hepatic 55 
Sigmoid 55 
Splenic 55 
Ventro-median 77 
Flies .... 447,916 
Control measures for. 448,543 
Development (metamorphosis) of. 447 
Glossina palpalis (tsetse) 916 
Musca domestica (house or “typhoid”)... 447,916 
Sarcophaga carnaria (flesh) 916 
Stomoxys calcitrans (stable) 916 
Fluid: 
Cerebrospinal 75,77 
Embalming, formula for 886 
Pericardial ... 36 
Peritoneal 53 
Seminal 70 
Serous 28 
Fluid—Continued. Page 
Specimens, collection of. 288 
Synovial . 28 
Tissue 8 
Fluidextract-s (fluidextracta) 245,626 
Of— 
Caseara sagrada, aromatic 245 
Ergot 255 
Ginger 232 
Hyoscyamus 252 
Ipecac ... 254 
Licorice 243 
Rhubarb.. 245 
IJ. 8. P. processes for making 626 
Fluidity, definition of 654 
Flukes. (See Trematodes.) 
Fluorine 689,691 
Fomentations, hot 316,331 
Fomites 372 
Food-s —. 57,523,579 
Acid forming 586 
Adulteration 814 
Allergy. 477 
And its relation to health and disease 377 
Animal.. 588 
Bacon 589 
' Beef. 588,825 
Beverages. 586 
Bolus 59 
O alcium in 680 
Canning of. ' 817 
Carbohydrates .... 57,579 
Cereals.. 589 
Chemical preservatives 817 
C lassification of 579 
Cold, preservation by 816 
Colors of 819 
C ondiments 679,586 
Containing alkalies 586 
Copper in 581 
Deficiency diseases 818 
Drying 816 
Eggs 589,811 
Energy value of 583 
Fats.. * ..i... 57,579 
Fish.—.1. . 589,813 
Flavors 579,586 
Fruits. 590 
Green vegetables :... 590 
Ham 589 
Importance of in care of patient 301 
Infection 377 
Inorganic mineral salts in 57,580 
Inspection 382,810 
Intoxication 379 
Iodine in 581 
Iron in 581 
Lamb ... 588 
Legumes 689 
Meat 588,810 
Military ration 523 
Milk 382,813 
Mutton 588 
Nuts 690 
On the march. — 558 
Phosphorus in 580 INDEX 
987 
Food-s—Continued. , Page 
Pickling 817 
Poisoning: 
Acute symptoms of.. 265,377 
Pork.... 588,832 
Poultry 589,811,833 
Preservation... 626,816 
Proteins 57,579 
Requirements of individuals 523,585,818 
Roots and tubers 589 
Serving of 301 
Shellfish 814 
Smoking 817 
Toxins.. 377 
Values in calories, tables of.. 586 
Veal... — 588 
Vegetables 589 
Viscera, animal 689 
Vitamins 57,579 
Water 57,579 
Foot: 
Anatomy and physiology of 561 
Baths... 312 
Care of 562 
Fracture of 114 
Powder, formula for 564 
Foramen-ina 16 
Intervertebral. 78 
Magnum 16,74 
Obturator 21 
Optic 81 
Ovale 37 
Papillaria. 66 
Vertebral... 19 
Foraminae, nutrient — 15 
Force, definition of. 654 
Force surgeon, Marine Corps expeditionary 
force 566 
Forearm: 
Bones of 20 
Fracture of Ill 
Foreign bodies, removal of 118,119,120,331 
Foreword in, v 
Formaldehyde 364,817 
Gas.. 453 
Solution of 220 
Formalin 220 
Disinfectant.. 451 
Form-s; 
Blank 773 
NMS B; report of allotment expenditures 
and obligations.. 778,798 
E; statement of receipts and expendi- 
tures of medical department prop- 
erty 778,796 
F card; individual statistical report of 
patient. 458 
N; death certificate 458 
Q; clinical chart 284 
R; issue voucher 777,784 
W; supplies and equipment ledger 
sheet.. 777 
4; medical supplies and equipment 
requisition and invoice 777 
Forms—Continued. Page 
NMS B; report—Continued. 
37; receipt and expenditure voucher 
(for commissary ledger) . 815 
Aviation No. 1; physical examination 
for flying 848 
Aviation No. 3; report of crash _ 848 
NMSH 17; clinical notes 285 
23; order and inspection blank 809 
36; quarterly ration return 777 
59; clinical record... 285 
Bill of fare for general mess, etc. (S&A Form 
333) 818 
Property survey (S&A Form 154) 784 
Summary of stub requisitions (S&A Form 
178). 789 
Formula-s; 
Chemical. 662 
Empirical. 662 
Graphic or structural 662 
Of radicals 680 
Rational 662 
Stereochemic., 662 
For— 
Compound solution of tannic acid-. 228 
Corn collodion.. 564 
Corn salve 564 
Embalming fluid ., 886 
Foot powder 564 
Navy prophylactic tube... 513 
Surgical lubricant 240 
Tannic-acid jelly 228 
Formulary, National, description of 601 
Fossa-se 16 
Anterior cranial 16 
Middle cranial. 16 
Posterior cranial 16 
Temporal "... 16 
Fowler’s: 
Position 326 
Solution.. 206 
Fracture-s - 105 
Bed. - 292 
Callus in 105,106 
Crepitus in 106 
Definition of 105 
Diagnosis of... , 106 
X-ray 108 
Of certain bones, symptoms and treatment of 108 
Reduction or setting of. — 107 
Simple, general principles for treatment of.. 106 
Splints for 107 
Symptoms of. , 105 
Types of 105 
Friction.. 613,656 
Frontal: 
Bone,. I7 
Lobe of cerebrum. 75 
Sinuses 17 
Frostbite H8 
Fruits as food 590 
Fumigation 373,450 
Carboxide gas... — 452 
Distinction from disinfection 450 
154294°—39 63 988 
INDEX 
Fumigation—Continued. Page 
Formaldehyde gas 453 
Gaseous agents used in 462 
Hydrocyanic acid gas... 462 
Sulfur dioxide 452 
Fund, Naval Hospital... 779 
Fur, used for clothing 446 
Furuncle 87 
Fuses.. 950 
Fusion 616 
Galenical preparations 624 
Gall bladder 56 
Gall-stone colic 127 
Galvanic current 929 
Interrupted 930 
Ganglia 72 
Garbage. (See Refuse.) 
Gas-es: 
Lacrimatory — 863 
Law of compressibility of. 655 
La w of expansion of 656 
Law of solubility of. 659 
Mustard 868 
Vesicant (chemical warfare) 868 
Gas gangrene.. 95 
Gaseous: 
Agents used in fumigation— 
Carboxide gas 452 
Formaldehyde gas 463 
Hydrocyanic-acid gas.. 452 
Sulfur dioxide 452 
Content of atmosphere 428,692 
Poisons 258,260 
State of matter 653 
Gasoline, poisoning by 269 
Gastric: 
Analysis — 897 
Gavage.. 321 
Glands 59 
Juice 59 
Lavage 321 
Ulcer, diet in.. 591 
Gastro-pulmonary mucous membrane ‘ 8 
Gavage, definition of 322 
General; 
Anaesthesia. (See Anaesthesia.) 
Heat radiation 429 
Ledger 776 
Genital organs, male 69 
Genitourinary: 
And venereal diseases. in, v, 490 
Doses, dangers and strengths of solutions 
used in 607 
Mucous membrane 28 
System 490 
Gentian violet: 
As disinfectant 364 
Solution, Stirling’s 902 
German measles 337,386 
Oingiva-ae (gum-s) 169 
Glacial acetic acid 226 
Gland-s 29 
Compound 29 
Ductless (endocrine) 29,61 
Salivary 52 
Simple 29 
Qians penis 70 
Page 
Qlomerulus-i . 66 
Glottis 47 
Glucose. 241 
Qlueoside-s 243 
Olucosidal drags, and preparations made 
from 243 
Glycerin 219 
Use of in iodine and tannic-acid ointments.. 634 
Qlycerites (glycerita) 627 
Glycogen 61 
Olyeyrrhiza 243 
Goiter . 62 
Gold 712 
Gonads 63 
Ovaries. 63 
Testes 63,69 
Gonorrhoea, symptoms and treatment of... 414,496 
Gonorrhoeal; 
Ophthalmia... 332,502 
Smears, collection of and precautions in 
taking 288 
Grain weight 602 
Gram weight 603 
Gram-molecular volume... 663 
Gram-molecular weight 663 
Gram’s stain.. 902 
Granulation 616 
Granulocytes 36 
Gray matter 74 
Green iron and ammonium citrates. 205 
Groove 16 
Dorso-median... 77 
Grouping, blood, and matching m, vi, 856 
Quaiacol 225 
Gum: 
Arabic 240 
Resins 234 
Gumboils 173 
Gunshot wound-s 100 
Haematology.. 905 
Haemoglobin. 35,49,906 
Reduced 49 
Haemolysin-s. 35,99 
Haemolysis 35 
Haemophilia : 33 
Haemophiliac. 33,90 
Haemophilus: 
Ducreyii (Bacillus of chancroid) 414,496 
Influenzae (Bacillus influenzae) 341 
Pertussis (Bacillus of Bordet-Gengou) 397 
Haemoptysis. 93 
Haemorrhage 89 
Arterial - 89 
Prom- 
Arm, forearm, or hand 92 
Armpit 92 
Face 92 
Lips 92 
Lungs 93 
Neck 92 
Stomach 93 
Thigh, leg, or toot 93 
Capillary 89 
Consecutive or intermediate. 93 
Constitutional treatment of 92 
From scalp 92 INDEX 
989 
Haemorrhage—Continued. Page I 
Internal 93 
Ligation 90 
Primary. 93 
Secondary 93 
Tourniquet, use of in 91 
Treatment of.. 90 ; 
Venous 89 
Haemorrhagin 99 
Haemosporidia.. 908 
Plasmodium falciparum; malariae, and 
vivas... 339,908 
Haemostatics 179 
Halibut liver oil and viosterol 237 
Halogen-s (chlorine family of elements) 689 
Substitution products 718 
Ham and bacon 588 
Hard soap 238 
Hardness; 
Definition of 654 
Of water 440 
Harrison Narcotic Law 637 
Haversian canals 15 
Hay fever 470 
Hazards: 
Industrial 514 
Occupational.. 515 
Headache 129 : 
Healing of wounds— 94 : 
First intention 94 : 
Second intention 94 ; 
Health records, care of— 889 ; 
Hearing: 
Center of 83 ; 
End organ of 83 
Organ of... 82 . 
Sense of - 80 
Heart: 
Action of 37 
Blood supply of 37 
Description of 36 
Nerve supply of 37 
Sounds 38 
Valves of 37 
Heat 613,656 
And cold, application of 311 
Conduction of. 429 
Convection of — 429 
Cramps 114 
Dry 315 
Sterilization by 362 
Evaporation of body 445 
Exhaustion. 114 
Methods of measuring 656 
Moist 315 
Of combustion 694 
Pharmaceutical processes requiring use of... 615 
Radiation of—. 429 
Regulating center. 429 
Regulation 83 
Sterilization by (thermal) 362 
Stroke. 114,556 
Heating: 
Direct 433 
Direct-indirect 433 
Indirect. 433 
I Heating—Continued. Page 
Of— 
Compartments and rooms 433 
Operating room 353 
Heliotherapy 923 
Henry’s law 659 
Heparin ... 33 
Hepatic: 
Duct 56 
Stimulants- . 179 
Vein 45 
Heroin (prohibitions against) 636 
Poisoning by 266 
Herpes 296,504 
Hexamethylenetetramine- 220 
Hiccough-s (singultus) 130,283 
How described 276 
High frequency (electric current) 931 
Diathermy apparatus 931 
MonoterminaL. 932 
Saturation 932 
High tension leads to X-ray tubes 965 
Hilum of— 
Kidney 65 
Lung 48 
Hints in practical pharmacy 638 
Histology. 7 
History of the Hospital Corps m, 1 
Homatropine hydrohromide 252 
Homologous series 716 
Homologue.- 716 
Homology 716 
Hookworm disease (ancylostomiasis) 403 
Hookworms. (See Ancylostoma duodenale and 
Necator americanus.) 
Hormone-s 61,891 
Transmission of 32 
Hospital-s: 
Corps- 
History of the. ..... nr, 1 
Schools 763 
Fund, Naval — 779 
Naval. - ..I.. 757 
Other than navy 758 
Supplies and property accountability.— in, vi, 774 
Hosts (animal parasitology) 907 
Hot: 
Applications 331 
Baths 311 
Fomentations (stupes) 331 
Packs 311,920 
Quartz lamps- 926 
Water bags.. 316 
Housing of personnel 435 
Humerus. — 20 
Fracture of. — 111 
Humidity 430 
Relative - 430 
Hyaloid membrane 82 
Hydriodic acid - 691 
Hydrobromic acid 690 
Hydrocarbon-s —- 215 
And their derivatives, chemistry of. 713 
Aromatic,. ' 722 
Derivatives - 718 990 
INDEX 
Hydrocarbon-s— Continued. Page 
Hydrogen derivatives of 216 
Unsaturated— 721 
Hydrochloric acid 60,185,690 
In gastric juice 60 
Poisoning by 266 
Hydrocyanic-acid 265 
Gas. 265,452 
Poisoning by 266 
Hydrofluoric acid 692,817 
Hydrogen 649,686,874 
Acids 681 
Derivatives of hydrocarbons 216 
Dioxide (peroxide) 96,173, 351 
Ion concentration and Indicators 729 
Ion scale 730 
Sulfide 699 
Hydrogogues 178 
Hydrokinetic measures...... 922 
Hydrolysis- 241 
Hydrolytic agents 241 
Hydrophobia (rabies) 95 
Hydrotherapy 920 
Hydroxide-s 685 
H ydroxyl radical 680 
Hygiene: 
And sanitation. in, v, 371 
Of the march.. 552 
Personal.. 455 
Hygroscopic 622 
Hymenolepis nana (dwarf tapeworm) ._ 910 
Hyoscyamus. 252,265 
Fluidextract of. 252 
Poisoning by. 266 
Hypermetropia.. 82 
Hyperpyrexia 935 
Hypersensitiveness 376,486 
Tests for.. 474 
Hypertherm (Kettering) 935 
Hypnotics 179 
Hypodermic: 
Injection, method of giving 308 
Tray. 308 
Hypodermoclysis 309 
Hypogastric plexus 79 
Hypophysis. (See Pituitary body.) 
Hysterical unconsciousness 124 
latro-chemistry. 645 
Ice caps (bags) 349 
Ichthammol— 216 
Identification: 
Of dead 840 
Records. 840 
Tags 840 
Idiosyncrasy 258,180 
Food (allergy) ......... 377,477 
Ignition 616 
Heocseeal: 
Orifice. 54 
Valve. 54 
Ileum.. ...1 54 
Ilium.. .... — 21 
Immune reaction in vaccination 425 
Page 
Immunity 32,373 
Acquired .. 375 
Active.. 375 
Passive . 375 
Inherent 375 
Mass.. 376 
Serums, use of in 375,434 
Incineration 540,616 
Ineinerator-s: 
Closed type 540 
In field. 540 
Open type. 540 
Incompatibility.. 636 
Chemical 1 636 
Pharmaceutical. 636 
Therapeutic 636 
Incubation period, definition of 373 
Independent duty ni, vi, 887 
Indestructibility of matter, law of 653 
Indicators: 
Definition of 730 
Table of 731 
Induction 946 
Inductotherm 935 
Industrial medicine and industrial hazards., in, 
Vi, 514 
Inert gases 692 
Infection 95,360 
Bacteria causing 94 
Food 377 
In wounds.. 94,36! 
Prevention of. 36I 
Infectious organisms 95 
Infiltration and block anaesthesia 735,736 
Inflammation ge, 128,360 
Causes of 86 
Treatment of... 86 
Influenza 341,337 
Infrared rays 924 
Infusion, saline 594 
Infusions (infusa)„ 623 
Infusoria 627,908 
Balantidium eoli 908 
Inguinal: 
Ligament (Poupart’s) 27 
Ring- 
External 27 
Internal...... 27 
Inhalation: 
Administration of drugs by 307 
Anaesthesia 737 
Initial lesion, syphilis 493 
Injuries 114 
Innominate: 
Artery 40 
Bone 21 
Vein.. — 44 
Inorganic: 
Acids (mineral) 185 
Chemistry 659 
Materia medica 181 
Matter : 5,643 
Salts (mineral) 580 INDEX 
991 
Page 
Page 
Insalivation 51 
Insane, care of 836 
Insecta.. 913 
Bedbugs. 650 
Cockroaches 551 
Fleas (siphonaptera)— 551,916 
Flies 447,543,916 
Lice (pediculidae) 550,916 
Mosquitoes (culieidae)... 446,547,914 
Insect-s: 
Bites 98 
Control of, in camps 446,643 
Diseases transmitted by. 407 
Repellent, formula for 648 
Insecticide spray, formula for 548 
Insensibility. (See Unconsciousness.) 
Insolation. (See Heatstroke.) 
Inspection: 
Food 382,810 
General, of wards 350 
Of— 
Equipment for landing forces 573 
Food handlers.. 378,525 
Personnel on march 560 
Sanitary. 559, 565, 576,887 
Instruments, surgical: 
Basic outfit for ordinary operations 367 
Care of 367 
Instrumentation: 
In genitourinary and venereal diseases 504 
Of urinary system. 504 
Insulin 63,247 
Intensifying screens 961 
Intercellular substance 11 
Intermittent sand filtration beds.... 444 
Internal: 
Ear.. 82 
Haemorrhage. 93 
Inguinal ring 27 
Oblique muscle. 26 
Secretion, glands of 61 
International: 
Classification of blood groups 856 
Digitalis unit 244 
List of causes of death 465 
Interpretation of vital statistics. 467 
Interstitial water 622 
Intervertebral foramen 78 
Intestinal: 
Juice 54,60 
Obstruction, acute 127 
Suture, atraumatic 366 
Intestine 54 
Large 54 
Small 54 
Glands of. 54 
Intoxication, food 379 
Intramuscular administration of drugs 181,309 
Intravascular medication 1 309,594 
Blood transfusion 856 
Intravenous: 
Administration of drugs 181,309 
Anaesthesia 745 
Inunction-*.. 181 
Nutrient 594 
Inversion,. 24 
Invertase.. 58,69 
lodimetry 732 
Iodine J 182, 265,318, 363,581,689 
Amount required in diet 581 
And its preparations 182 
As rubefacient 318 
Compound solution of (Lugol’s) 183 
Goiter caused by lack of 183 
Mild tincture of 182 
Poisoning by... 182,266 
Solution, Gram’s 902 
Tincture of. 96,182 
Iodoform (triiodomethane) 217 
Ionic medication 929 
Ionization 670,726 
Ions 670 
Ipecac 254 
And opium, powdered 249 
Fluidextract of 254 
Iris 82 
Iron 581,711 
Amount required in diet 681 
Anaemia caused by lack of 681 
Compounds 204 
Group of elements 711 
Tasteless tincture of 205 
Tincture of 204 
Irradiation: 
General: 
Clinical uses of. 925 
Technique of 927 
Local. 925,927 
Irrigation-s: 
Aural 333 
Bladder. 327 
Nasal. .... 334 
Of wounds 330,362 
Saline 594 
Irritant-s - 179 
Counter 315 
Gases, poisoning by 266 
Lung (chemicalwarfare) 866 
Smokes (chemical warfare) 863 
Ischium 21 
Island-s: 
Of— 
Langerhans. 57 
Reil 75 
Isolation 694 
Isomers 716 
Isomerism 716 
Isotonic 193 
Isotopes 651 
Jansky classification of blood groups 856 
Jaw-s; 
Bones of (mandible; maxillae) 18 
Fracture of lower 108,175 
Jejunum 64 
Jelly, tannic-acid, formulas for 228 
Joint-s, description of 22 
Ball and socket ... 22 
Condyloid. 24 
Gliding 22 992 
INDEX 
Joints—Continued. 
Hinge.. 22 
Immovable 22 
Movable 22 
Movements 24 
Rotary 22 
I Journal 776 
Of receipts and expenditures. 777,793 
Judge Advocate General of the Navy 750 
Earelldiet 591 
Katabolism.. 9 
Katathermometer 873 
Ketone-s 719 
Kidney-s. 65 
Functions of 66 
Functional tests 893 
Stone colic 128 
Kilogram, weight 603 
Kindling temperature 693 
Kinetic: 
Energy 654 
Theory 657 
Klebsiella pneumonise (Friedlander’s ba- 
cillus)... 341 
Knee (hinge joint)... 22 
Cap, fracture of.. 113 
Dislocation of 104 
Kocher’s method for reduction of shoulder 
dislocation 104 
Laboratory procedures and technique in, Vi, 889 
Labyrinth, bony, of internal ear 83 
Lacrimal: 
Apparatus. 81 
Bones.. 18 
Glands 81 
Sac — 81 
Lacrimatory gases (chemical warfare) 863 
Lactase 58,59 
Lacteals. - 54 
Lactrodeetus mactans (“black widow” 
spider) — 913 
Lamb, as food 588 
Cuts of 830 
Lamps: 
Electrodeless high frequency induction 927 
Quartz mercury-vapor 926 
Land and buildings ledger 776 
Landing force in, vi, 570 
Organization and equipment 570 
Sanitary problems in ... 573 
Landsteiner classification of blood groups 856 
Lanolin 238 
Lard — — 238 
Benzoinated 238 
Larva-se 548,914 
Asiphonate 914 
Siphonate 914 
Larvacide-s 649 
Larynx (organ of voice) 47 
Latin words used in pharmacy, table of 635 
Latrine-s; 
Care of ' 637 
Frontage 637 
Location 537 
Types of 535 
Page 
Lavage, gastric.. 322 
Laws and theories 652 
Avogadro’s. 656 
Boyle’s . 655 
Charles’.. 656 
Compressibility of gases 655 
Conservation of energy 655 
Conservation of matter 654 
Constant proportions 652 
Dalton’s 652 
Expansion of gases 656 
Henry’s. 659 
Indestructibility of matter 653 
Multiple proportions ...... 652 
Reciprocal proportions .... 652 
Solubility of gases 659 
Laxatives 178 
Lead 265,711 
Acetate.. 209 
Carbonate, basic. 711 
Compounds of.. 209 
Oxides 711 
Poisoning by.. 266 
Leather, used for clothing 446 
Ledger; 
Commissary 777,815 
Equipment.. 777 
General 776 
Land and buildings 776 
Supplies 776 
Leg, fracture of 113 
Legumes, as food 589 
Lenhartz diet 591 
Lens, crystalline 82 
Lepers, quarantine of 454 
Letters, official, forms of 765 
Leucocytes 35 
Migration of 35 
Schilling classification of 906 
Leucocy tosis 35,86,905 
Leucomaines 248 
Leueopenia 35,905 
Levigation (porphyization) 617 
Levulose 241 
Lewisite . 870 
Lice (pediculidse) 449,550 
Control measures for 449 
Licorice 243 
Ligament=s 22 
Inguinal (Poupart’s) 27 
Joint 22 
Ligation, in haemorrhage 97 
Ligatures 97,365 
Light-ing: 
Artificial 433 
Direct 434 
Indirect- 434 
Chemical effects of.. 434 
Eyestrain caused by improper 435 
Illuminants. 433 
Illumination 434 
Measuring, and instruments for 435 
Natural 434 
Source of 434 
Standard for 435 
Page INDEX 
993 
Page 
Page 
Light-ing—C ontinued. 
Of— 
Operating room 356 
Wards, and rooms. 352 
Therapeutic effects of 434 
Therapy.. 924 
Clinical uses. 924 
Precautions in 924 
Sources 924 
Technique of 925 
Lime; chlorinated 199 
Disinfectant 451 
Linen: 
Care of 350 
Exchange of 350 
Removal of stains from. 351 
Used for clothing 446 
Ward 350 
Liniment-s (linimenta) 627 
Soap 239 
Lipase 60 
Liquefied phenol 223 
Liquid-s: 
Diet 593 
Immiscible 659 
Measure.. 606 
Miscible 659 
Petrolatum 215 
Preparations.... 624 
Solubility of 659 
State of matter 653 
Supernatant 621 
Liquor, mother 622 
Liter, measure... 603 
Lithium 55,708 
Liver ... 55 
Functionsof 56 
Lobes of 56 
Lividity, cadaveric (suggillation) 837,838 
Long Island College Hospital diet.. 591 
Lotion 620 
Lower: 
Extremity, bones of.. . 21 
Jaw, fracture of 108,175 
Lubricant, surgical, formula for 240 
Lumbosacral plexus. 78 
Lumbricus 71 
Lung-s.. 48 
Aircapacityof. 51 
Haemorrhage from (haemoptysis) 93 
Irritants (chemical warfare) 866 
Lobes of 48 
Lymph 30,45 
Glands 46 
Nodes 46 
Vascular system... 45 
Vessels 46 
Lymphatic duct 46 
Lymphocytes 36 
Lymphogranuloma venereum (inguinale) 415 
Lysis 280 
Maceration 622 
And expression. 622 
Circulatory — 623 
Maggot traps.. 542 
Magma-s (magmse 621,627 
Of— 
Ferric hydroxide (arsenic antidote) 205,263 
Magnesia.. 199 
Magnesium 708 
Carbonate 198 
Chloride 708 
Citrate, solution of 198 
Compounds 198 
Oxide (in glacial acetic acid poisoning) 226 
Heavy 199 
Antidote for corrosive-acid poisoning. _. 226 
Sulfate 198,708 
Major General Commandant, U. S. Marine 
Corps . 750, 754 
Malaria 339,408 
Benign tertian 408 
Malignant tertain 408 
Quartan 408 
Malleability, definition of 654 
Malleolus, internal and lateral 22 
Malpighian bodies (renal corpuscles) 66 
Maltese 59 
Mammalia 6 
Management, ward in, v, 344 
Manubrium 1 „ 19 
Mapharsen . 505 
March sanitation.. 559 
Marine Corps Expeditionary Forces, duty 
with. m, vi, 564 
Maritime quarantine 454 
Marrow, bone 15 
Giant cells of (megakaryocytes) 36 
March-gas series 717 
Mass 654 
Immunity. 376 
Massage.. 917 
Masses (mass®) 630 
Mastication 51,59 
Mastoid process 16,17 
Materia medica: 
And therapeutics... in, v, 177 
Definition of 177, 599 
Inorganic 181 
Organic — 215 
Matter ... 653 
Characteristics of 653 
Law of conservation of 654 
Law of indestructibility of 653 
Inorganic 5,643 
Organic 5,643 
Physical phenomena of 653 
Propertiesof. 653 
Mattress-es: 
Care of.. 289 
Changing of... 291 
Covers 289 
Turning of 292 
Maxillary sinus 18 
Measles 337,388 994 
INDEX 
Measure-s 606 
Liquid 606 
Pharmaceutical 606 
Tables of.. 604 
Meat cutting 825 
Meatus, urinary. 71 
Mechanotherapy 917 
Media, culture 899 
Mediastinal: 
Arteries 41 
Pleura. 49 
Septum 48 
Medical: 
Company, Marine Corps expeditionary 
force... 565 
C ollect ingsection.. 565 
Headquarters section 564 
Hospital section 564 
Service section 565 
Corps. 752 
Department—.. 752 
Allotments 780 
Appropriations.. 780 
Clerical work 763 
Of— 
Marine Corps expeditionary force 565 
Marine Corps post 565 
Ship’s landing force... 571 
On the march 560 
Personnel- 671,759 
Supplies, procurement of 779 
Detachment of shore patrol. 574 
Section, Marine Corps expeditionary force.. 666 
Battalion 566 
Regimental ,... 566 
Supply depots 763 
Troops, Marine Corps expeditionary force.. 566 
Medicated baths 314 
Medication, ionic. 929 
Medicine-s: 
Administration of 181,304 
Methods of.. . 181.304 
And Surgery, bureau of 752 
Aviation in, vi, 847 
Bottles. 306 
Labels 306 
Industrial, and industrial hazards m, vi, 514 
Locker, care of 305 
Tickets 306 
Trays.... 306 
Medicolegal matters, deaths and m, vi, 833 
Medulla: 
Oblongata (spinal bulb) 76 
Of— 
Kidney 65 
Suprarenal glands 62 
Spinalis (spinal cord) 72,77 
Medullary: 
Canal. 14 
Sheath 73 
Substance of kidney 65 
Meibomian glands 81 
Membrane-s 28 
Cutaneous 29 
Hyaloid. 82 
Mucous. 28 
Peridental- 169 
Page 
Membrane-s—Continued. 
Plasma... 8 
Serous 28 
Special, and glands in general. 28 
Synovial 22,28 
Tympanic (ear drum) 82 
Meninges 74 
Arachnoid coat of... 28,74 
Meningitis (cerebrospinal fever) 342 
Meningococcus 342,383 
Meniscus.. 606,658 
Menstruum 622 
Menthol 230 
Menu-s: 
Adequate diet 817 
And their preparation 818 
Forms used for. 818 
Regular diet 818 
Sample, naval hospital 820 
Table of foods found on 824 
Mercurial ointment; 
Mild (blueointment) 212 
Strong 212 
Mercuric 211 
Chloride 211,710 
Oxide, yellow.. 211 
Oxycyanide 212 
Salicylate. 211 
Mercurochrome soluble 212,364 
Mercurous chloride, mild. 210,710 
Mercury (quicksilver) 209,710 
Ammoniated 210 
Bichloride. 210, 264, 266, 363,451 
Large poison tablets of 211 
Small poison tablets of 211 
Citrine ointment 633 
Compounds 209 
Poisoning by 266 
Vapor lamps, quartz 926 
Yellow oxide of 211 
Merozoites 909 
Merthiolate 213 
Mesentery 53 
Mess-es: 
Attendants, naval hospitals 806 
General, naval hospitals 806 
Hall-s 525,806 
Police petty officer, duties of 806 
Nurses’ 806 
Sick officers’ 806 
Metabolism... 6, 46 
Basal in, vi, 849 
Destructive (katabolism) 9 
Metacarpal bones 21 
Fracture of i 112 
M etallic oxides 693 
Metals 706 
Alkali. 706 
Alkaline earth 708 
Iron group of 711 
Tin group of 710 
Metamorphosis (development): 
Of— 
Flies 447 
M alarial parasites 909 
Mosquitoes 447 
Metathesis (double decomposition) 674 
Metazoon 71 
Page INDEX 
995 
Page 
Meter, measure 602,603 
Methane 718 
Series. 717 
Methenamine (urotropin) 221 
Methyl: 
Alcohol 219 
Poisoning by 264 
Radical. 680 
Salicylate 232 
Metric system of weights and measures 602 
Metrology, definition of 602 
Metycaine hydrochloride _. . 736,737 
Micrometry.. .. 899 
Micron (micromillimeter) 603,899 
Microscope, care of .. 899 
Microscopy .. 599 
Micturition 68 
Expedients to cause voluntary 327 
Middle ear 82 
Migraine ... 480 
Mild mercurial ointment. ... ... 212 
Milk, as food 382, 589,813 
Pasteurization of 382 
Peptonized 594 
Sterilization of 589 
Milligram, weight 603 
Milliliter, measure . 603 
Mineral acids 683 
Poisoning by 267 
Mineral oil 215 
Mineralogy I 599 
Minim, measure .. 606 
Minor surgery _. 85 
And first aid _ in, v, 85 
Mites . 913 
Mitosis (mitotic division) ... . 9 
Mitral valve 37 
Mixtures (mistura) _.. 627 
Modes of transmission of infectious diseases... 372 
Molar: 
Solutions ;. 727 
Teeth 52 
Volume 663 
Mole (gram-molecular weight) 663, 727 
Molecular: 
Physics .. .. 657 
Weight 663 
Molecules, definition of . . 646 
Monobasic acids 683 
Monocytes 36 
Monohydric bases. 685 
Monosaccharides. 721 
Monoterminal high-frequency (electric cur- 
rent) 932 
Morgue, care of 841 
Morphine; 
Poisoning by 267 
Sulfate 250,747 
Mosquito-es , 446,547 
Aedes aegypti... 340,407,412,446,914,915 
Anopheles 446,914,915 
Control in camp 447 
Oulex 446,914,915 
Development (metamorphosis) of 447 
Page 
Moss classification of blood groups 856 
Motor: 
Cells (effector) 71 
Depressants. 179 
Excitants 179 
Nerves 72 
Mountain sickness 431 
Mouth _. 47,51,296 
And teeth, care of... 296 
Mueilagines (mucilages)... 628 
Mucous membrane 28 
Multiple proportions, law of 652 
Mummification ■ 837 
Mumps 390 
Murphy drip (proctoclysis). 310 
Muscle-s 13,24 
Action of. .. 24 
Adductor , .... 24 
As anatomical landmarks 27 
Biceps 28 
Deltoid.. 28 
Diaphragm.. 26,28 
Epimysium of 24 
Extensor 24 
Fasciae of 24 
Fasciculus of ,.. 24 
Fibers 13,24 
Inguinal (Poupart's) ligament . 27 
Insertion of 24 
Internal oblique 26 
Oblique of eye 81 
Of— 
Abdomen 26 
Back 26 
Chest and thorax 26 
Head and face 26 
Lower extremity 27 
Neck... 26 
Perineum...... 27 
Upper extremity 27 
Origin of 24 
Perimysium of ... 24 
Recti, of eye 81 
Rectus abdominis 26 
Sarcolemma of ... 24 
Skeletal 24 
Sternocleidomastoid 27 
Temporal 27 
Transversus abdominis 26 
Triceps 28 
Muscular tissue 11,13 
Cells of. 13 
Changes in substance of 26 
Properties of 13 
Rigor mortis 26 
Types of— 
Cardiac - 13 
Nonstriated. .. 13 
Striated * 13 
Mustard: 
Gas ... 868 
Sinapisms (plasters) 233 
Mutton. 588 
Mutualism 907 996 
INDEX 
Page 
Mycobacterium tuberculosis (Bacillus tuber- 
culosis) : 
Hominis (human) 342,361,395 
Hominis et bovis (human and bovine)...... 396 
Mydriatics 179 
Myocardium . 37 
Myology 7,24 
Myopia 82 
Myotics. 179 
Naphtha, poisoning by 269 
Narcotic-s 179 
Law, Harrison 637 
Nasal; 
Apertures, posterior 16 
Bones 18 
Chambers 47 
Duct.. 81 
Irrigations 334 
Septum. 47 
National Formulary, description of 601 
Natural: 
Oleoresins 234 
Ventilation.. 432 
Naval: 
Bases. 754 
Dispensary 763 
F orces and stations. 754 
Hospital Fund 779 
Hospitals.. 757,760 
Medical: 
Center.. 763 
School 752 
Supply depots. 763 
Operating bases 755 
Operations, office of 751 
Policy 755 
Stations ... 754 
Strategy 755 
Tactics 755 
Navigation, Bureau of.. 751 
Navy: 
Department... 749 
Uniform 446 
Yards.. 755 
Necator americanus (hookworm) 403,911 
Neck: 
Bones of — 18 
Muscles of 25 
Of bones ..... 16 
Needles.. 97 
Neisseria: 
Gonorrhoea? (Gonococcus) 414,497 
Intracellularis (Diplocoecus intracellularis 
meningitidis; meningococcus) 342,383 
Nemathelminthes (round worms) 911 
Ascaris lumbricoides , 911 
Enterobius vermicularis 912 
Hookworms 911 
Trichinella spiralis. 912 
Trichuris trichiura 912 
W ucheria bancrofti 912 
Neoarsphenamine 206,505 
Nerve-s.. 72 
Action... 79 
Afferent (sensory) 72,73 
Nerve-s—Continued. Page 
Cells (neurones) _ 72,73 
Connector . 71 
Cyton (body) of 73 
Effector (motor) _ 71 
Motor,.. 71 
Multipolar 73 
Processes. 71 
Axone (or axis cylinder). . 73 
Central. 71 
Dendrone (dendrite or protoplasmic)... 73 
Peripheral 71 
Unipolar 73 
Centers (ganglia) : 72 
Chorda tympani . 83 
Cord 71 
Cranial (cerebral). 72,78 
Efferent (motor) 72,73 
Endings (receptors) 79 
Femoral. 78 
Fibers 72,73 
Conductivity 79 
Gray 73 
Medullated (white) 73 
Medullary sheath (white substance of 
Sehwamm) 73 
N eurolemm a 73 
Nonmedullated (gray) 73 
Primitive sheath (neurolemma) 73 
White 73 
Ganglia. 72 
Cerebral ’ 72 
Glossopharyngeal 83 
Impressions. 72, 79 
Impulses 72,79 
Inhibitory. I 74 
Intercostal 50 
Lingual 83 
Median. 78 
Mixed 72 
Motor (efferent) 72 
Obturator... 78 
Phrenic 50 
Pneumogastric 37 
Radial 78 
Sciatic 78 
Secretory..., 74 
Sensory (afferent) : 72 
Spinal 72-78 
Roots of 78 
Tissue 72 
Trunks 72,73 
Ulnar 78 
Vagus 50 
Nervous: 
System-s 71 
Cerebrospinal (or central) 72,74 
Peripheral 72,78 
Sympathetic (autonomic, ganglionic, or 
vegetative) 37,73 
Tissue... 13,73 
Neufeld reaction 903 
Neuroglia. 73 
Neurolemma... 73 
Neurology 7 
Neurone-s 73 INDEX 
997 
Page 
Neurotic-s 179,259 
Poisoning by.. 260 
Poisons.- 259 
Neurotoxin 99 
Neutral oxides 693 
Neutrophiles 36 
Nieotinic acid 583 
Nitrates 702 
Nitric: 
Acid 186,701 
Poisoning by 266 
Oxide 701 
Nitrobenzene 724 
Nitrogen 701,878 
Compounds 183 
Cycle 437 
Family of elements 700 
Monoxide (nitrous oxide) 183 
Nitrous: 
Fumes (chemical warfare) 868 
Oxide.. 183,701,739,740 
Use as anaesthetic 701 
Nomenclature: 
And classification of chemical compounds.. 679 
Of terms relating to male genitourinary sys- 
tem 510 
Non-electrolytes... 669 
Nonmetals 686 
Normal: 
Blood chemical standards 892 
Electrocardiogram 881 
Pulse 280 
Salt solution. 193 
Salts 685 
Solutions 728 
Norway or brown rat, control methods 448 
Nose: 
Fracture of 108 
Removal of foreign bod y from 119 
Nosebleed (epistaxis) 90 
Notation 660 
Nucleus... 8 
Nupercaine hydro'chloride... 736,737 
Nurse-s: 
Appointment of. 760 
Corps 752 
Operating-room 367 
Nursing m, v, 271 
Care and procedures, general. 273 
Care of communicable diseases 335 
Care of delirious 343 
Definition of 271 
In eye, ear, nose, and throat conditions 330 
Methods, principles underlying 273 
Qualifications for. 271 
Surgical 323 
Dressings and dressing surgical wounds... 327 
Nutriants.. 179 
Nutrient-S— 179 
Agar (culture media) 900 
Broth (culture media) 900 
Enemata 593 
Foraminae 15 
Inunctions 594 
Page 
Nutrition, definition of 579 
Nuts as food 590 
Nux vomica 253 
Poisoning by... 268 
Tincture of 253 
Obesity, diet in 592 
Obstruction, acute intestinal 127 
Obturator foramen 21 
Occipital: 
Bone... 17 
Lobe of cerebrum 75 
Octet theory 651 
(Edematous breathing 283 
(Esophagus (gullet)... 52 
Officer-s: 
Chief pharmacists 3, 769,762 
Commissioned warrant... 760,762 
Dental 760 
Medical 760 
Of— 
Hospital Corps. 3,760 
Naval hospitals: 
Accounting 762,775 
C hiefs of service 760 
Commanding 760 
Commissary 762,804 
Executive. 761 
Of the Day 761 
Property 762,775 
Ward medical 761 
Pharmacists 3,760,762 
W arrant 760, 762 
Official (pharmacopoeial) preparations 624 
Oil-s: 
Castor 236 
Clove 231 
Cod liver 237 
Cottonseed 236 
Fixed . 236 
Halibut liver with viosterol 237 
Peppermint 230 
Santalwood 233 
Tar, rectified 231 
Theobroma 238 
Turpentine 234 
Viosterol in 237 
Volatile — 230 
Wintergreen 232 
Ointment-s (unguenta) 633 
Blue 212 
Boric acid 185 
Citrine .. 633 
Mild mercurial-.- 212 
Strong mercurial 212 
Sulfur. 184 
Yellow mercuric oxide 211 
Oleates (oleata) 628 
Olecranon process . 20 
Olefin series 721 
Oleoresin-s (oleoresinae) 234,628 
Natural 234 
Of aspidium (male fern) 235 
Prepared.. 234 
Omentum 53 998 
INDEX 
Operating: Page 
Gowns 365 
Instruments, surgical.. 367 
Pad, rubber (Kelly) 321 
Personnel- 367 
Room (or suite) 356 
Adjoining rooms; . 
Anaesthetizing 359 
Cleaning gear.... 360 
Instrument 359 
Sterilizing. 359 
Storeroom. 360 
Surgical-dressings 360 
Wash or scrub-up 359 
And surgical technique m, v, 356 
Cleanliness 359 
Equipment 357 
Heating and ventilation 356 
Lighting 356 
Nurse 367 
Rules, X-ray 966 
Operation: 
Preparation for 368 
Preparation of — 
Operating personnel for. 368 
Patient for 323 
Local , 323 
On morning of operation 323 
Preoperative 323 
Opisthotonos 268 
Opium 249 
Camphorated tincture of 249 
Poisoning by 268 
Powder of ipecac and. 249 
Powdered 249 
Tincture of.. 249 
Opsonins.. 32 
Optic foramen... 81 
Orbital cavities 16 
Orbits (of eyes) 81 
Ordnance, Bureau of 752 
Organ-s 8,13 
Accessory, of digestion 51 
Male reproductive . 69 
Organic: 
Acids 225, 720 
And their esters . 225,720 
Poisoning by 267 
Chemistry.. 713 
Definition of 713 
Materia medica 215 
Matter 5,643 
Organism-s.. 6 
Animal 6 
Living 5 
Vegetable 6 
Organization of: 
Bureau of Medicine and Surgery 752 
Medical Department, expeditionary force.. 565 
Medical Department, shore patrol 574 
Naval hospitals 757 
Clerical force at 773 
Commissary department at 805 
Ornithodoros moubata (tick) 913 
Orthophosphoric acid (anhydrous) 703 
Osmosis 657 
Page 
Osteology 7,14 
Ovum 9 
Oxalic acid, poisoning by 266 
Oxidation 695,850 
And reduction 695 
Oxide-s.. 693 
Acidic 693 
Basic 693 
Metallic. 693 
Neutral 693 
N omenclature of 693 
Per 693 
Oxidimetry 732 
Oxidizing agents 695 
Oxyacids.. 681 
Oxygen 183,428, 692,877 
Acids. 681 
Action and uses 681 
And its compounds with hydrogen 183 
Oxygenation of blood 48 
Oxyheemoglohin 35,49 
Ozone 442,694 
Sterilization of water by 694 
Packs: 
Cold 313,920 
Hot. 311,920 
Operating, sterilization of 364 
Pad-s: 
Electric 316 
Operating, rubber (Kelly) 321 
Palate; 
Bone 18 
Hard. 16,51 
Soft. 51 
Pancreas 57,63 
Pancreatic; 
Duct.. 57 
Juice 57,60 
Paper, uses of 446 
Paracentesis, abdominal 330 
Paraffin 216 
Baths 922 
Series.. 717 
Paragonimus ringed (lung fluke) 909 
Paralysants (chemical warfare) 871 
Paraphimosis 491 
Parasites 374,907 
Animal 907 
Classification 907 
Important diseases due to 917 
Malarial, development of 909 
Names of.. 907 
Parasiticides 179 
Parasitism, true 907 
Parasitology, animal ; , 907 
Terms employedin 907 
Parathyroid glands 62 
Paratyphoid fever. ...: 404 
Parenchyma of kidney 65 
Parietal; 
Bones ' 17 
Lobe of cerebrum 75 
Pleura.. 49 
Parotid glands 62 999 
INDEX 
Page 
Pasteurization 382,589 
Flash method 382 
Holding method. 382 
Pasturella pestis (Bacillus pestis) 410 
Patella 21 
Fracture of.. 113 
Pathology... 7 
Patient-s: 
Admission to ward, procedures on 353 
Bag, baggage, and, hammock 354,355 
Bed, turning of 294 
Census report of.... 346 
Changing clothing of helpless or unconscious. 293 
Clothing of 354 
Death of, procedures on 355 
Discharge from ward, procedures on 355 
Effects... 354,834 
Inventory of . 354,835 
Examination of 355 
General care and comfort of 288 
Money and valuables of 324,355 
Moving and lifting 293 
Physical supportive measures 296 
Cleanliness of patient 296 
Bathing 297 
Care of— 
Back 299 
Mouth and teeth 296 
Cleansing bath 298 
Evening toilet 297 
Morning toilet 297 
Elimination 302 
Food and water 301 
Rest, sleep, and exercise 303 
Postoperative care of 325 
Preoperative preparation of 323 
Property of ; 354 
Remedying physical discomforts of. 296 
Symptoms, observation of... 273 
Transferor 353 
Transferring from stretcher to bed 294 
With infectious diseases. _ 354 
Patrol, shore. in, v, 574 
Pediculidae. 916 
Pediculus: 
Humanus var. corporis (body louse) 449,916 
Humanus var. humanus (head louse)... 449,916 
Phthirius pubis (crab louse) 449,916 
Pellagra-preventing (P-P) factor 583 
Pelvis — 53 
Bones of 21 
Fracture of... ... 112 
Of ureter 68 
Penis 70 
Pentothal sodium. 745 
Pepsin 60,246 
Pepsinogen 60 
Peptones 60 
Percolate.. 623 
Percolation :.. 623 
Percolator. 623 
Percussion 918 
Perforating ulcers of: 
Duodenum 127 
Stomach 127 
Page 
Pericardium 28,36 
Perichondrium .. 15 
Peridental membrane- 169 
Perimysium 24 
Perineum, muscles of 27 
Periodic: 
Arrangement of elements (fig. 149) 648 
Classification of elements. 647 
Table. ....... 649 
Periosteum. 16 
Peripheral nervous system 72,78 
Peristalsis 51, 59 
Temporary paralysis of 325,326 
Peritoneum 28, 53 
Parietal 53 
Visceral 53 
Peritonitis.. .... 326 
Personal hygiene.. 371,455 
Personnel; 
Commissary department, naval hospitals... 805 
Flying, care of ... 849 
Medical department _ 571,759 
Operating-room 367 
Perspiration. 68,276,553 
Characteristics and composition of 68 
How described 276 
Insensible 68 
Physiology of 553 
Sensible 68 
Petrolatum 215 
Phagocyte-s 86 
Phagocytosis 35,375 
Pharmaceutical: 
Arithmetic 607 
Incompatibility 636 
Operations and processes 613 
Preparations; 
Cerates.. 629 
Chemical 624 
Collodions 625 
Decoctions 625 
Elixirs. 625 
Emulsions 625 
Extracts 629 
Fluidextracts 626 
Galenical 624 
Glycerites 627 
Infusions 627 
Liniments 627 
Liquid 624 
Magmas 627 
Masses 630 
Mixtures 627 
Mucilages 628 
Natural 624 
Official 624 
Ointments 633 
Oleates 628 
Oleoresins ■ 628 
Pharmacopoeial 624 
Pills. 630 
Plasters 629 
Powders 631 
Resins 631 
Solid 629 1000 
INDEX 
Pharmaceutical—Continued. Page 
Preparations: 
Solutions 618 
Spirits 628 
Suppositories 632 
Syrups 628 
Tablets 632 
Tinctures 628 
Triturations 632 
Vinegars 624 
Waters 624 
Pharmacists (warrant officers) appointment 
of.. 760 
Pharmacodynamics 599 
Pharmacognosy 599 
Pharmacology 599 
Pharmacopoeia, U. 8.: 
Description of 600 
Purity rubic in. 601 
Pharmacy — m, v, 599 
Definition of 699 
Practical 600,638 
Theoretical 699 
Pharyngeal douche 334 
Pharynx 47,52 
Phenacetin 225 
Phenobarbital 257 
Phenol-s (carbolic acid) 222,223 
Acetophenetidin (phenacetin) 225 
And phenol derivatives 222 
Antidote for poisoning by 267 
“Carbolic acid” 222 
Creosote 224 
Creosote carbonate 225 
Cresol 223 
Disinfectant- 451 
Guaiacol. 225 
Liquefied 223 
Poisoning by.. 268 
Resorcinol.. 224 
Saponated solution of cresol 223 
Trinitrophenol (picric acid) 224 
Phenosulfonephthalein 895 
Phenyl salicylate (salol) 227 
Phimosis 491 
Phosgene 706,866 
Phosphorus. 580,702 
Acids of 703 
Amount required in diet 580 
Conditions caused by lack of 580 
Oxides of 703 
Pentoxide 703 
White... 866 
Photosynthesis 6 
Physical: 
Allergy 489 
Change... 652 
Disinfection 451 
Examination 848 
Phenomena of matter, some 653 
Therapy in, vi, 917 
Physics: 
Definitionof. 599, 653 
Of the march 552 
Physiological: Page 
Chemistry 714 
Classification of chemical warfare agents .. 863 
Exterior of body 374 
Salt solution 198 
Physiology: 
Anatomy and m, v, 5 
Definition of 7 
Of the march 552 
Physostigmine sulfate (eserinc sulfate) 253 
Pia mater 73,74 
Pickling, in food preservation 817 
Picric acid (trinitrophenol) 224, 364 
Pillow-s, hospital 289 
Pills (pilulae) 630,638 
Of ferrous carbonate (B laud’s) 205 
Pilocarpine hydrochloride 253 
Pilocarpus 253 
Pineal body (epiphysis) 63 
Pipettes 606 
Pits: 
Ablution 539 
Soakage 537 
Sullage 639 
Urinal soakage 538 
Pituitary body (hypophysis) 63 
Plague (bubonic, pneumonic, septicaemic) 409 
Plasma: 
Blood 29,30 
Composition of . 30 
Glycerini 633 
Membrane 8 
Plasmodium falciparum; malarias; and vivax. 839, 
448,908 
Plaster-s (emplastra) 629 
Mustard (sinapism) 317 
Of Paris bandage: 
Application of 140 
Removal of 141 
Platelets, blood.. 29 
Platyheminthe-s 909 
Cestodes (tapeworms) 909 
Trematodes (flukes) 909 
Pleura 48 
Pleurosthotonos 268 
Plexus 79 
Pneumococcus typing 903 
Pneumonia, acute lobar. 341,391 
Poison-s: 
Accidentally or purposely added to food 259 
Alkaloidal 259 
Classification of 258 
Corrosive 259 
Definition of 257,259 
Efleetsof 257 
Food 259, 260, 265, 377 
Gaseous 258,260 
Handling of 835 
Inorganic ' 258 
Irritant 259, 260 
Ivy.. 481,560 
Neurotic. 259, 260 
Nonalkaloidal 259 INDEX 
1001 
Poison-s—Continued. Page 
Special, food 379 
Table of symptoms and treatment . 263 
Poisoning; 
Aconite.. 263 
Acute 258 
Alcohol; 
Ethyl 264 
Methyl 264 
Antidotes 260 
Arsenic 264 
Atropine 264 
Belladonna 265 
Bichloride of mercury 265 
Causing acute abdominal symptoms 128 
Caustic alk alies 265 
Chronic 258 
Cocaine 265 
C olubrine snake. 98 
Corrosive 258 
Depressants. 260 
Digitalis.. 265 
Emetics 260 
Excitants 260 
Food — 260,265,377 
Dysentery group 379 
Salmonella group 379 
Gaseous 258 
Gasoline and benzine 269 
Heroin 266 
Hydrochloric acid.. 266 
Hydrocyanic acid gas 266 
Hyoscyamus 266 
Iodine 266 
Irritant 259 
Gases 266 
Lead 128,266 
Mercury 266 
Mineral and organic acids 267 
Morphine 267 
Neurotic 259 
Nitric acid.. 266 
Nux vomica 268 
Opium 268 
Oxalic acid 267 
Phenol (“carbolic acid”) 268 
Stomach tube, use in.. 261 
Stramonium 268 
Strychnine 268 
Sulfuric acid.. 266 
S ymptons of 260 
By certain poisons, table of 263 
Treatment of 260 
When nature of poison is unknown 261 
Viperine snake 98 
oisonous gases, treatment of asphyxiation 
Pfrom 122 
Pollution of soil.. ...... 437 
Polybasic acids 684 
Polymerism 716 
Polymers 716 
Polysaccharides 721 
Polyvalence 665 
Pons (pons Varolil) 76 
Pontocaine hydrochloride 737,738 
Pork, as food . 588,832 
Cuts of 832 
Page 
Porosity, definition of 654 
Portal: 
Circulation 45 
System of veins 43,45 
Position-s: 
A ssumed by patient 275 
In strychnine poisoning . 268 
Fowler's—— — 326 
Postmortem examinations __ 840 
E quipment for 841 
Specimens 843 
Postoperative care of patient 325 
Post surgeon, duties of 565 
Potassium 187,708 
Acetate 187 
And sodium tartrate (Rochelle salt) 187 
Arsenite, solution of 206 
Bicarbonate 188 
Bitartrate 188 
Chlorate. 188 
Compounds of 187 
Hydroxide. 187 
Iodide 186 
U se of in Iodine ointment 634 
Use of in tincture of iodine 629 
Permanganate 189,351,364,509,817 
Potential energy. 654 
Potter-Bucky diaphragm 957 
Pott’s fracture 114 
Poultices 316 
Poultry, as food 589, 811,833 
Cutting of 833 
Powder-s (pulveres) 631 
Fineness of.. 631 
Of ipecac and opium 249 
Practical: 
Hygiene and sanitation 428 
Pharmacy; 
Definition of 699 
Hints in 638 
Pratique. 454 
Preansesthetic medication 746 
Precautions, X-ray: 
Electrical 963 
Radiation. 963 
Precipitant 621 
Precipitate 621 
Precipitated: 
Calcium carbonate (chalk) 201 
Sulfur. 184 
Precipitation . 621 
Precipitins 32 
Preparation-s: 
For— 
Marches 553 
Operation, routine 370 
Liquid. 624 
Of— 
Bodies of the dead 843,885,886 
Patients for— 
Anaesthesia 746 
Operation 323 
Skin for operation 369 
Pharmaceutical 624 
Preoperative of patient 323 1002 
INDEX 
Prepared:—Continued. Page 
Calamine.. 203 
Chalk 200 
Oleoresins 234 
Prepuce.. 71 
Presbyopia-. 82 
Prescriptions: 
Abbreviations used in writing, table of 635 
Definition of 634 
Filling of 635,638 
Model. 635 
Preservation, food 816 
Preservatives: 
Chemical— 817 
Used in collection of specimens. 286,890 
Preserving, in food preservation... 817 
Pressure 655 
Blood - 281 
Apparatus (sphygmanometer) 281 
Diastolic 281 
Pulse.. 280 
Systolic 281 
Filters.. 441 
Spots (bedsores). 299 
Prevention: 
Of— 
Heat stroke.. 115 
Infection 96,327,361 
Venereal diseases in, v, 511 
Preventive medicine, definition of 871 
Primary: 
Haemorrhage.-. 93 
Low voltage current 950 
Reaction in vaccination 425 
Stage, syphilis 493 
Procaine hydrochloride 256,736 
Procedures; 
For replacement of typewriters. 789 
General clerical, administration and in, vi, 749 
Laboratory, and technique in, vi,889 
Process-es. 16,71 
Acromion. 20 
Activated sludge 444 
Alveolar. 18,52 
Bone, definition of 16 
Central 71 
Ciliary 82 
Condyloid 18 
Coracoid 20 
Coronoid— 18 
Mastoid 16,17 
Of— 
Digestion. 57 
Respiration... ...- 49 
Olecranon.... 20 
Peripheral.. 71 
Pharmaceutical 613 
Spinous 19 
Styloid 20 
Transverse.... 19 
Trochanter, greater and lesser 21 
U. S. P., for making: 
Fluidextracts 626 
Tinctures 628 
Xiphoid 19 
Page 
Proctoclysis (Murphy drip) 310 
Production of X-rays 942 
Products obtained from animal substances... 246 
Pronation 24 
Prone-pressure method of artificial respiration. 121 
Property: 
Accountability 774 
And accounting procedures 774 
Care of.. 350,774,783 
Hospital supplies and. m, vi, 774 
Medical department; 
Custody of and responsibility for 774,783 
Disposition of 783 
Procurement of 779,782 
Of the dead 834 
Office, naval hospitals 775 
Officer, naval hospitals, duties of. 775 
Patient’s, care of. 354 
Surveys, formal and informal. 784 
Ward, care of.. 350 
Prophylactic-s, venereal disease 179,512 
Chemical (medicinal) agents 512 
Mechanical 512 
Station, shore patrol 575 
Tube, U. S. Navy, formula of contents of... 513 
Prophylaxis, venereal. 512 
Prostate gland 70,490 
Prostatitis- 498,502 
Protection, X-ray. 962 
Protein-s 579 
Amount required in diet 579 
Conditions caused by lack of. 579 
Metabolism of 579 
Silver, mild and strong 214 
Sources of. 579 
Proteoses.. 60 
Prothrombin (thrombogen) 33 
Protons 650 
Protoplasm. 7 
Protozoa 907 
Provision-s: 
Accountability for 815 
Contracts. 809 
Expenditure of 817 
Inspection of 809 
Issue of_. 809 
Procurement of. 808 
Storerooms 805,807 
Provitamin: 
A 581 
D 582 
Prussic acid. (See Hydrocyanic acid.) 
Pseudomonas aeruginosa (Bacillus pyoeyan- 
eus) 95 
Psychology 7 
Ptomaines 248 
Ptyalin 59 
Pubis. 21 
Pulex irri tans (flea) 449 
Pulmonary; 
Artery 38 
Pleura (visceral) 49 
Plexus 79 
Sedatives 179 1003 
INDEX 
Pulmonary—Continued. Page 
System of veins... 43 
Tuberculosis 394 
Valve 37 
Vein 43 
Pulp cavity 167 
Pulse. 39,280 
Dicrotic. 281 
Intermittent 281 
Normal 280 
Pressure 39,281 
Rate (frequency) 280 
Regular 281 
Tension of... ... 280 
Volume of. 282 
Full. 282 
Full and bounding... 282 
Hard 282 
Small 282 
Thready 282 
Pulverization by intervention 618 
Pupa-ae 447 
Pupil of eye 82 
Purchase of typewriter, procedures in 789 
Purgatives 179 
Drastic 178 
Saline. 178 
Simple 178 
Purification of: 
Sewage 444 
Soil 436 
Water 441 
Purified talc 199,530 
Purity rubric 601 
Pus 32, 87 
Producing organisms. — 361 
Pylorus (pyloric orifice) 54 
Pyogenic bacteria 361 
Qualifications for nursing 271 
Qualitative analysis 724,731 
Quantitative analysis 724,731 
Quarantine: 
Definition of... 373 
Maritime 454 
Quartan malaria 408 
Quarterly ration return (Form NMSH 36) 777 
Quartz mercury vapor lamps. 926 
Questionnaire involving food poisoning 381 
Quicksilver (mercury) 209,710 
Quinine: 
Hydrochloride 251 
Sulfate —. 251 
Rabies 95,419 
Treatment of 98 
Radiation of beat 429 
Radical-s. 665,679,681,682 
Ammonium 680 
Hydroxyl 680,685 
Table of important 680 
Radiography 958 
Rat-s. 448 
Brown or Norway 448 
Control measures 448 
Ration, military, caloric value of. 523 
Page 
Reaction-s_. 88 
Accelerated, in vaccination .... 425 
Analytical. 674 
Endothermic 1 693 
Exothermic 693 
Immune, in vaccination 425 
Neufeld 903 
Of degeneration (R. D.) 931 
Primary, in vaccination 425 
Serological 496 
Serum 375,483 
Synthetic 674 
RSaumur scale 614 
Recapitulation of ledger accounts (Register 
No. 3) 777 
Receptors (nerveendings) 79 
Recipes 594 
Reciprocal proportions, law of 652 
Recruiting in, vi, 936 
Rectal anaesthesia 745 
Rectification 947 
Rectum 55 
Red blood cells 29,33 
Redistilled water 183 
Reducing agent-s 696 
Reduction. 6,695 
Of— 
Dislocation.. 103,104 
Fracture 105 
Oxidation and. 695 
Refiex-es - 79 
Action... 79 
Arc 79 
Association (perception) 80 
Complex 80 
Simple... - 80 
Spreading — 80 
Tonic 80 
Refrigerants- — 179 
Refuse 442 
Disposal of 445,634 
Sewage and.. 442 
Shallow burial of. 534 
Regional (or local) anaesthesia 735 
Register: 
Charge - 776 
Expense analysis... 777 
No. 3... - - —- 777 
Regular diet 593 
Relation of insects, vermin, and rodents to 
disease and methods for their extermina- 
tion. - 446 
Removal of: 
Bandages. 133 
Dressings 328 
Foreign bodies 118,331 
Plaster of Paris bandage. 140 
Renal: 
Calyces. 68 
Columns 66 
Corpuscles (Malpighian bodies) 66 
Depressants 179 
Papillae 66 
Pyramids 65 
154294°—39 64 1004 
INDEX 
Page 
Rennin........ 60 
Renovation 373 
Report of— 
A disease 373 
Allotment expenditures and obligations 
(NMS Form B) 778,798 
Reproductive organs, male 69 
Requisition-s 781 
And Invoice, medical supplies and equip- 
ment (NMS Form 4) 781 
Bxireau work request (special M&S form)... 781 
For labor (NY O Form 6) 781 
Purchase (S&A Forms 76 & 76a and 44 & 
44a) 781 
Stub — 781,789 
Resins (resinse) 234,631 
Natural 234 
Oleoresins, gum-resins, balsams, and their 
preparations , 234 
Prepared 234 
Resistance 952 
Resorcinol 224 
Respiration 46,282 
Apncea.. 51 
Asphyxia 51 
Cheyne-Stokes 283 
Cycle of 50 
Expiration 50,282 
Inspiration 50,282 
Period of rest 50,282 
Dyspnoea 51, 283 
External 49 
How taken 282 
Internal 49 
Normal rate 282 
(Edematous 283 
Process of 49 
Recording of.. - 283 
Regular 283 
Singultus 283 
Tissue 49 
Respiratory: 
Apparatus - 47 
Center 50 
Depressants 179 
Quotient (R. Q.) 850 
Stimulants 179 
System, and respiration 46 
Tract, diseases of 341 
Rest, definition of 303 
Restraint appliances 343 
Retention: 
Enemata— 
Astringent 321 
Carminative 321 
Method of administration 320 
Nutritive 321 
Purpose of 320 
Sedative 321 
Turpentine 321 
Of urine. 276,325,501 
Retina 82 
Reversible reactions. 674 
Page 
Rhei (rhubarb), fluidextract of . 245 
Riboflavin 533 
Ribs (false, floating, true) 19 
Fracture of .. 109 
Rickettsia . 916 
Mooseri .340,411 
Prowazeki 340,411 
Quintana .. 340,411 
Rigor mortis : , 838 
Ringworm 418 
Risus sardonicus 268 
Roaches 450 
Control measures for 450 
Rochelle salt 189 
Rodents. 448 
Control methods for 448 
Roentgenoscopy 957 
Roller bandages . . 131 
Root-s: 
And tubers as food 590 
Of lung 48 
Rotation .. 24 
Roundworms. (See Nemathelminthes.) 
Rubber-ized: 
Garments 446 
Gloves, sterilization of 364 
Goods, care of 349 
Operating (Kelly) pad 321,349 
Rings . 300 
Sheets 349 
Rubefacients 315 
Classes of 315 
Substances used as 315 
Rules for computing doses of medicines 180 
Sac, lacrimal . . 81 
Saccharides 721 
Classes of_. 721 
Or carbohydrates . 721 
Saccharine substances, sugars and 721 
Safety engineer. 516 
St. Elizabeths Hospital 758 
Salicylic acid 226,817 
Saline: 
Infusion. 594 
Irrigation.. 594 
Saliva. 62,59 
Salivary glands. 52 
Salmonella: 
Group in food poisoning 377 
Paratyphi (paratyphoid bacillus A) 404 
Shottmiilleri (paratyphoid bacillus B) 404 
Salt-s__ 193,680,685 
Acid.. 685 
Acids, bases, and... 680 
Alkaloidal 249 
Basic.. 685 
Double.. 685 
Normal or neutral 685 
Solution, physiological (normal) 193 
Sanitary: 
Analysis of water 440 
Inspection, on independent duty 887 
Inspector, Marine Corps post, duties of 565 INDEX 
1005 
Sanitary—Continued Page 
Measures— 
In the field — 522 
With ship’s landing force 572 
Supervision, on independent duty 887 
Survey— 
Of water shed 440 
On shore patrol 576 
Sanitation: 
Field m, vi, 521 
Hygiene and nx, v, 371 
Santal, oil of 233 
Santonin 245 
Saponated solution of cresol 224 
Saponification 236,837 
Saponins 243 
Sapotoxins - 243 
Saprophytes 436 
Sarcodina 907 
Endamoeba histolytica 400,907 
Sarcolemma.. 24 
Sarcoptes scabei (itch mite) 413,913 
Saturated: 
H y drocarbons 715 
Solutions 619,659 
Sayre dressing- 139 
Scabies 413,913 
Scalds... 116 
Scales, thermometric 614 
Scarlet fever 337,392 
Scattering (X-rays) 956 
Schaefer’s method of artificial respiration 121 
Schilling classification of leucocytes 906 
Schistosoma (blood flukes) 909 
Hsematobium. 909 
Japonicum 909 
Mansoni 909 
Schizonts- 909 
Schneider index 848 
School-s; 
Hospital Corps 763 
Naval medical.. - 763 
Sclera — - 81 
Scopolamine hydrobromide 252, 747 
Screens, intensifying 961 
Scrotum 69,490 
Scrubbing 361 
Scrub-up room 359 
Sebaceous glands 69 
Secondary: 
Haemorrhage 93 
High voltage current 945 
Secretary of the Navy. 749 
Sediment: 
Definition of 621 
In urine, examination of 891 
Sedimentation: 
In- 
Process of clarification 441 
Purification of water 441 
Treatment of sewage 443 
Test. 906 
Segmentation 9 
Selenium 700 
Semen. 71 
Semicircular canals, ear 83 
Semilunar valves. 37,38 
Seminal: Page 
Fluid.. 70 
Vesicles _ 70,490 
Senses, special . _. 80 
Sensitivity, tests for ,, 486,903 
Separation, fluids from solids _. 620 
Sepsis 86 
Septic: 
Sore throat 393 
Tanks 444 
Septicaemia 95,340,361 
Series: 
Acetylene 722 
Aliphatic ..... 714 
Aromatic 714,722 
Oarbocyclic 714 
Closed-chain 714 
Ethylene 722 
Homologous 716 
Marsh-gas 747 
Methane 747 
Olefin 721 
Open-chain 714 
Paraffin- 717 
Serology-- 599 
Serous membrane 28 
Serum-s: 
Allergy (serum disease) 483 
Animal, used in producing passive im- 
munity 375 
Blood 33 
Diagnosis of syphilis 495 
Sickness 375 
Sewage 442 
And refuse „• 442 
Disposal methods 442 
Dry system 442 
Water-carriage system 442 
Purification methods .... 444 
Treatment methods 443 
Sheet-s: 
Changing of lower 291 
Draw 291 
Changing of 291 
Rubber... 289 
Drip 921 
Rubber 289 
Cleaning of... 349 
Shigella: 
Dysenteriae 339,402 
Paradysenteriae (Bacillus flexneri) 339,402 
Shock 88 
Anaphylactic 375 
Blocks.... 293 
Electrical 88,123 
Emotional 88 
Symptoms of 88 
Traumatic 88 
Treatment of 89 
Shore patrol m, vi, 574 
Dressing stations 575 
Equipment for 574 
Medical detachment with- 574 
Prophylactic station _ _ 575 
Sanitary survey 576 
Short wave diathermy 933 1006 
INDEX 
Page 
Shoulder 103,104 
Dislocation of 103,104 
Methods of reducing dislocation: 
By traction or extension 104 
Kocher’s 104 
Stimson’s 104 
Showers, rain. 922 
Sialogogues.. 179 
Sick: 
Call; 
On independent duty. 887 
Ward, duties at 346 
Diets and messing for the.. m, vi, 579 
Quarters, Marine Corps posts 565 
Siedlitz powder 189 
Sigmoid flexure 55 
S igns of death 837 
Silicon 705,706 
Silver. — ... 712 
Arsphenamine 505 
Compounds of 213 
Mild protein 214 
Nitrate.. — 213,712 
Strong protein 214 
Toughened nitrate 213 
Simple: 
Solution 618,627 
Syrup 628 
Sinus-es_ — 16 
Cavernous , 43,87 
Coronary 44 
Frontal 17 
Maxillary. 18 
Of kidney 65 
Superior saggital. 43 
Transverse, or lateral 43 
Venous ■ 43,74 
Sinusoidal current: 
Slow.. 930 
Surging interrupted 930 
Siphonaptera (fleas) 916 
Sippy diet. — - 591 
Sitzbath 313,922 
Skeleton... 14 
Bones of 16 
Function of. 14 
Skin.. 69 
Eruptions of, how described 276 
Function of 69 
Preparation of for operation 323,369 
Removal of foreign bodies from. 120 
Traction . 160 
True 69 
Skull: 
Bones of. 17 
Description of.. 16 
Fracture of.. 108 
Slaked lime 200 
Sleep — — 83,275,304 
Slow galvanic sinusoidal current 930 
Slow sand filter-s 441 
Sludge process, activated —.. 444 
Smallpox.. 338,422 
Vaccine. 425 
Storage of.. 426 
Smears 901 
Page 
Smell, sense of .. 83 
Smokes, irritant (chemical warfare).. 863 
Smoking, in food preservation 817 
Snake-s: 
Bites 98 
Differentiation, non-poisonous and poison- 
ous.. 98 
Treatment of 100 
Colubrine family of. 98 
Poisonous, classification of 99 
Venom, constituents of— 
Hsemolysin 99 
Haemorrhagin ■ 99 
Neurotoxin 98 
Viperine family of 98 
Soap-s 720 
Hard. 238 
Liniment. 239 
Soft 239 
Sodium. 187,707 
Benzoate 817 
Withcaffeine 255 
Bicarbonate. 49,190,707,817 
Biphosphate— 191 
Bismuth thioglycollate (Thio-Bismol) 209 
Borate 191 
Bromide.. 192 
Carbonate, monohydrated— 192,707 
Chloride. 193,707 
Physiological solution of 193 
Citrate 193 
Cyelural (evipal soluble) 745 
Fluoride 817 
Formaldehyde sulfoxylate— 267 
Hydroxide 190,707 
Hypochlorite, solution of 196 
Diluted solution of 196 
Iodide 194 
Perborate 194 
Phosphate. 194 
Salicylate 195 
Sulfate 195 
Thiosulfate 195 
Soft; 
Diet 593 
Soap :.. 239 
Soil: 
And its relation to health and disease....... 436 
Bacteria... 436 
Pollution 437 
Solid state of matter 653 
Solidity, definition of 654 
Solubility — 659 
Of— 
Gases, law of *. 659 
Liquids. 659 
Solute. - 618,659 
Solution-s (liquores) 618,659 
Chemical 618,659 
Definition of 659 
Hayem’s diluting 905 
Of— 
Calcium hydroxide (lime water).. 200 
Cresol, saponated 223 
Epinephrine (adrenalin) hydrochloride... 247 
Formaldehyde (formalin) 220 INDEX 
1007 
Solution-s—Continued, Page 
Of—Continued. 
Iodine, compound (Lugol’s) 183 
Irradiated ergosterol 237 
Magnesium citrate 199 
Posterior pituitary 246 
Potassium arsenite 206 
Salt, physiological. 193 
Sodium hypochlorite- 196 
Dilute 196 
Physiological salt 193 
Saturated 619,659 
Simple — 618 
Standard 726 
Supersaturated.. 619 
Tables of .’ 641 
Solvent 618,659 
Soporifics 179 
Sordes 296 
Sore throat 130 
Septic 393 
Source of infection, definition of 372 
Spanish windlass 150 
Special: 
Diet.. 590 
Membranes and glands in general 28 
Purchase requisitions.. — 782 
Senses - 80 
Specific: 
Gravity, definition of— 606 
Methods of determining 607 
Volume, deflnitionof 607 
Methods of determining 607 
Weight - 655 
Specifics. — 179 
Specimens, collection of: 
Cultures and smears from wounds 288 
F or gonorrhoeal smears 288 
From the throat 287 
General precautions in 286 
Of— 
Abnormal growths 288 
Bone fragments - 288 
Diseased tissue.. — 288 
Fluids. 288 
Sputum 288 
Stools.... 288 
Urine 286 
For kidney-function test 287 
Use of preservatives in.. 286 
Speech — 83 
Classification of in delirium. 343 
Spermatic cord 70,490 
Spermatozoon-oa... 9,63,69 
Sphincter pylori. 54 
Sphygmomanometer. 281 
Spider (“black widow”) 913 
Spinal; 
Anaesthesia 735,736 
Column 18 
Cord (medulla spinalis) 72,77 
Isthmus 77 
Nerves 72 
Plexuses of — - 79 
Page. 
Spine, fracture of .. 108 
Spirilae 901 
Spirit (spiritus) 628 
Of— 
Ethyl nitrite . 229 
Orange, compound- 230 
Splanchnology 7 
Spleen 62 
And other ductless glands 61 
Splenic: 
Artery—. 41 
Flexure— 55 
Vein 45 
Splint-s 107,148 
Aeroplane (abduction)— 163 
And appliances 148 
Application of 107,148,151 
Army hinged half-ring thigh and leg 
(Keller) 107,149 
Pierson attachment for 153 
Balkan frame 157 
Basswood 164 
Cabot posterior leg, wire 107,161 
Coaptation 107 
Liston long interrupted 153 
Materials used for, in emergency. 107 
Purposes of 148 
Strap, adjustable traction 150 
Support and foot rest 150 
‘ • T ”, for fractured clavicle ... 162 
Thomas, arm, hinged, traction 107,155 
Traction 107,160 
Wire, ladder 107,154 
Sponge-s 365 
Baths. 298 
Spontaneous combustion 694 
Spores. 901 
Sporozoa 908 
Hsemosporidia 908 
Plasmodium falciparum; malarise; and 
vivax— 339,448,908 
Sporozoites. 909 
Sprain-s 101,102 
Treatment of 102 
Sprinkling filters (sewage purification) ......... 444 
Sputum specimen-s: 
Collection of 288 
Stages of general anaesthesia 738 
Planes of third stage 739 
Stain-s 902 
Bacteriological 902 
Oram’s 902 
Removal of, from— 
Linens - 351 
Sinks, utensils, etc 361 
Tissue 902 
Staining: 
Acid-fast bacilli, method of 902 
Staphylocci-us 95,361 
Starch (cornstarch) , — 239 
Statement of receipts and expenditures of 
medical department property (NMS Form 
E) 778,796 1008 
INDEX 
Station-s; Page 
Aid, battalion and regimental 566 
Collecting 566 
Main dressing, shore patrol 575 
Prophylactic, shore patrol 575 
Statistics, vital. (See vital statistics.) 
Steam: 
Atomizer, uses of 307 
Live, sterilization by r. 362 
Stenson’s duct 52 
Stereoradiographs.. 960 
Sterile; 
Caps.. 365 
Gowns, operating 365 
Masks 365 
Packs 365 
Sheets 365 
Specimens. 286 
Collection of 286 
Towels 365 
Sterilization 301 
Chemical 362 
Fractional 362 
Mechanical 361 
Of— 
Culture media 900 
Milk 589 
Rubber gloves.. 364 
Sewage 444 
Surgical dressings 365 
Surgical instruments 364 
Sutures and ligatures 365 
Water. 441 
Thermal 362 
Sterilized distilled water 183 
Sterilizing: 
Methods 362 
Room. , 359 
Stimson’s method for reduction of shoulder 
dislocation 104 
Stimulus-i 8 
Stoichiometry 676 
Stomach 53 
Removal of foreign bodies from 120 
Stomachics, (gastric tonics) 179 
Storerooms, commissary department 805,807 
Strain 101 
Treatment of.... 101 
Stramonium, poisoning by 268 
Strangulation. (See Asphyxia.) 
Streptococci-us. 95,361 
Erysipelatis 341 
Haemolytic type 337, 392,393 
Hsemolyticus 341 
Stroking (eflfieurage) 917 
Strong mercurial ointment 212 
Stronger ammonia water 196 
Strontium.... 708 
Strophanthin 244 
Strophanthus 244 
Strychnine: 
Poisoning by.. 268 
Sulfate 253 
Stupes (fomentations) 316 
Turpentine 317 
Styloid process. 20 
Fracture of 111 
Page 
Styptics 179 
Subcutaneous: 
Administration of drugs 181 
Feeding 594 
Medication. 307 
Subjective symptoms.. 274 
Sublimate-s 617 
Sublimation.. 617 
Sublingual glands 52 
Submarine: 
Duty, diving and in, vi, 872 
Ventilation 872 
Submaxillary glands 52 
Substance, intercellular 11 
Substitution.. 674 
Sucrose. 242 
Suffocation (See Asphyxia.) 
Sugar-s 241 
And saccharine substances 241 
Tolerance test 897 
Suggillation (cadaveric lividity) 837,838 
Sulfarsphenamine 207,505 
Sulfur... 184,699 
Dioxide. 452,700 
Family of elements. 698 
Flowers of. 184 
Hydrogen sulfide 699 
Ointment. 184 
Precipitated 184 
Washed. 184 
Sulfuric: 
Acid „ 186,700 
Dilute 186 
Poisoning by .. 266 
Preparation of 186 
Ether 719 
Summary of symptoms and first-aid treatment 
of casualties caused by exposure to chemical 
agents 864 
Sun stroke. (See Heat stroke.) 
Supervision, commissary m, vi, 804 
Supination 24 
Supplies and Accounts, Bureau of 752 
Supplies and equipment, medical department: 
Custody of 775 
Disposition of- . 783 
Procurement of. 779 
Supplies ledger 776,777 
Suppositories (suppositoria) 632 
Suppression of urine 276 
Suppuration ..... 361 
Suprarenal (adrenal) glands 62 
Surface: 
Anaesthesia- 735 
Tension 658 
Water. 438,528 
Surgeon-s general, U. S. Navy.. 750,757 
Surgery, aseptic 360 
Surgical; 
Dressings 327,364 
Dry 328 
Hot wet. 328 
Packs 365 
Pads 365 
Sponges 365 
Wet 328 INDEX 
1009 
Surgical—Continued. Page 
Lubricant 240 
Formula for 240 
Nursing, definition of 323 
Technique 360 
Aseptic. 360 
In operating rooms 360 
Wounds 327 
Aseptic 371 
Dressing tray.. 329 
Contents of 329 
Septic. 360 
Susceptibility 376 
Causes of 376 
Susceptibles. 373 
Sutures 97,365 
Sweat. (See Perspiration.) 
Sweat Glands 69 
Switch, X-ray 953 
Symbols, chemical 661 
Sympathetic nervous system 37,73 
Symphysis pubis.. 21 
Symptoms 274 
Objective 274 
Observation of 273 
Of poisoning by certain poisons, table of 263 
Subjective 274 
Syndesmology 14 
Synovial: 
Fluid.. 22 
Membrane 22,28 
Synthesis 6,653 
Synthetic reactions. 674 
Syphilis 416,493 
Diagnosis of 495 
Infection, sources of 494 
Initial lesion of 493 
Stages of 494 
Symptoms of.. 494 
Treatment of 494 
Syrup (syrupus) (flavored, medicated, and 
simple) 628 
System-s 13 
Blood-vascular 29 
Digestive 51 
Lymph-vascular 45 
Nervous 71 
Of veins 43 
Respiratory 46 
Urinary 63,65 
Systole 37 
Table-s; 
For calculating food requirements, marching 
men 558 
Of— 
Abbreviations of Latin words 635 
Average heights and weights 584 
Binary or hydracids 684 
Bones of— 
Cranium... 17 
Face.. 17 
Lower extremity 21 
Neck and trunk.. 18 
Skeleton 15 
U pper extremity 19 
Tables—Continued. Page 
Of—Continued. 
Botulism and food infection, differences 
between 380 
Common indicators. 731 
Contents m 
Cranial nerves 72,78 
Elements (atomic weights and numbers, 
symbols, etc.) 660 
Elimination diets 489 
Enzymes 59 
Poods on naval hospital menus 820 
Formulas, valences and names of im- 
portant radicals 680 
Hydrogen and oxygen acids 681 
Pathogenic organisms and diseases caused 
by .. 904 
Poisons, symptoms and treatment 263 
Symptoms of poisoning by certain poisons. 263 
T ernary or oxyacids 684 
Water requirements on the march... 557 
Weights and measures, equivalents of 604 
Showing- 
Amounts of mineral salts and vitamins in 
adequate diet 586 
Analysis (composition) of adequate diet.. 587 
Number of drops obtained from standard 
dropper 606 
Periodic arrangement of the elements (fig. 
149) 648 
Valence of certain elements combined with 
hydrogen 664 
Variation of oxygen valence of sulfur and 
osmium 665 
Solution 641 
Tablets (tabellae) 632 
Of— 
Mercury bichloride, large 211 
Mercury bichloride, small 212 
Taenia saginata; and solium (beef and pork 
tapeworms) 909,910 
Taeniacides 179 
Talc, purified. 199 
Tanks: 
Fresh water: 
Care of ... 440 
Cleaning of.. 440 
Sewage disposal: 
Emscher.. 443 
Imhoff 443 
Single-story septic... 443 
Two-story septic.... 444 
Tannic acid 227 
Formulas for: 
Compound solution of 228 
Jelly. 116,228 
Tapeworms, (See Cestodes.) 
Tapotement 918 
Tar, rectified oil of 231 
Tarsal; 
Bones 22 
Cartilage. 22 
Tartaric acid 228 
Taste: 
Buds 83 
Sense of. 83 1010 
INDEX 
Technique: 
Laboratory procedures and.. _i. in, vi, 889 
Of— 
Basal metabolism 854 
Blood grouping 858 
Electrocardiography. 880 
Surgical 360 
Operating room and 356 
Teeth 52,166 
Apex 167 
Bicuspid 52,166 
Canine ■ 52,166 
Crown.. 166 
Cusps ... 167 
Deciduous (milk) , 52,166 
Incisor 52,166 
Molar 52,166 
Neck 166 
Peridental membrane 169 
Permanent 52,166 
Root and root canal . . 166,167 
Structure of.. .. 166 
Temperature 278,614 
Absolute. ... 614 
Body 278 
How measured 278,614 
Methods of taking 279 
Normal 278 
Recording of 283 
Effective 874 
Rules for converting 615 
Trays 278 
Temporal: 
Bones. 17 
Lobe of cerebrum 75 
Muscle 27 
Tenacity, definition of 654 
Tendons .... 24 
Tenon, capsule of 28 
Terminal disinfection 336,373 
Ternary: 
Acids.. 684 
Compounds 679 
Terpin hydrate.— 234 
Testes (testicles; male gonads) . 69,490 
Inflammation of. 128 
Test-s: 
Agglutination 903 
Blood sedimentation 906 
Dick 904 
Duodenal drainage 898 
For— 
Albumin in urine 1 890 
Glucose (sugar) in urine 890 
Hypersensitiveness 474 
Frei. 904 
Friedman 904 
Functional 893 
Gastric analysis 897 
Kahn flocculation 495 
Kidney function 893 
Blood nitrogen retention 893 
Concentration 894 
Dilution 893 
Test-s—Continued. Page 
Kidney function—Continued. 
Mosenthal. 894 
Phenolsulfonephthalein (phthalein or 
red). 287,895 
Sugar tolerance 897 
Urea clearance 897 
Liver function.. 898 
Bromosulfalein dye 898 
Galactose 898 
Icterus index 898 
Urobilinogen 899 
Van Den Bergh 898 
Mantoux 487,904 
Moro’s 488 
Paul and Bunnell .. 904 
Schick 904 
Sensitization 903 
Tuberculin 487 
Von Pirquet 488 
Wassermann complement fixation 495 
Tetanus. 95,340,426 
Antitoxin 426 
Bacillus of (Clostridium tetani) 426 
Toxoid 426 
Theobroma, oil of 238 
Theoretical pharmacy __ 599 
Therapeutic-s: 
Definition of . . . 599 
Dose 180 
Empirical 177 
General. 177 
Incompatibility ... 637 
Materia medica and m, v, 177 
Pools and tanks (physical therapy) 923 
Rational.. 177 
Treatment.... 311 
Therapy: 
Artificial ultraviolet ....... 926 
Diet 590 
Electro 924,928 
Helio. 926 
Hydro 920 
Light... 924 
Mechano 917 
Physical ni,VT,917 
Thermal sterilization 362 
Thermometer-s: 
Centigrade : 614 
Clinical 278 
Care of 278 
Disinfection of 278 
Fahrenheit.. .... 614 
RSaumur 614 
Scales used in marking 614 
Thiamin (vitamin Bi; aneurin). 582 
Thio-Bismol 209 
Thoracic: 
Duct 46 
Vertebrae (dorsal) 18 
Thorax 19 
Throat, removal of foreign bodies from 119 
Thrombin. 33 
Thrombocytes 29 INDEX 
1011 
Page 
Thymol 233 
Iodide 233 
Thymusgland 62 
Thyroid: 
Cartilage 47 
Gland. 62 
Thyroxin 851 
Ticks 913 
Tin 710 
Group of elements 710 
Tincture-s (tinetura) 628 
Of— 
Aconite 254 
Benzoin, compound 235 
Capsicum 233 
Cardamon, compound 231 
Cinchona, compound 250 
Digitalis 244 
Ferric chloride 204 
Ferric citro-chloride, tasteless 205 
Gentian, compound 245 
Green soap 239 
Iodine 182 
Mild 182 
Myrrh 235 
Nux vomica 253 
Opium.. 249 
Camphorated 249 
U. S. P. processes fof making 628 
Tissue-s 8,9 
Blood and lymph 11,13 
Connective 11 
Adipose 11 
Areolar 11 
Cartilaginous 11 
Elastic 11 
Fibrous. 12 
Lymphoid.. 12 
Osseous (bone) 12,14 
Cancellous 14 
Compact. 14 
Epithelial (epithelium).. 11 
Ciliated 11 
Columnar 11 
Cuboidal =.. 11 
Flat — 11 
Glandular (secreting) 11 
Protective 11 
Simple 11 
Squamous... 11 
Stratified. 11 
Fluid. 8 
Muscular. 11,13 
Cardiac, (striated (striped); involuntary). 13 
Nonstriated ((unstriped); involuntary)... 13 
Properties of— 
Contractility 13 
Extensibility. 13 
Irritability 13 
Tonicity 13 
Striated ((striped); voluntary) 13 
Nervous (nerve) 11,13,72,73 
Toluene (urine preservative) .. 890 
Page 
Tongue . . 52 
Tonics jso 
Tonsil... 52 
Toothache- 172 
Torrefaction 616 
Torsion: 
Balance. 606 
In heemorrhage 90,91 
Tourniquet, use of 91 
Toxic dose. igo 
Toxicology m, v, 257,599 
Toxins ..... 32 
Trachea (wind pipe) 43 
Trachoma 427 
Traction: 
Or extension in dislocation of shoulder 104 
Skin. 160 
Splints 160 
Tragaeanth 240 
Transfer: 
Of medical department property. 788 
Voucher: 
Issued (T. V. I.) 788 
Received (T. V. R.) 733 
Transparency: 
Definition of : 654 
Of urine 890 
Transportation: 
Charges 788 
Of remains 780 
Treatment: 
Of boils 87 
X-ray 962 
Trematodes (flukes) 909 
Clonorchis sinensis 909 
Fasciolopsis buski .. 909 
Paragonimus ringeri 909 
Schistosomes. 909 
Trenchmouth 174 
Treponema pallidum (Spirochaeta pallida) _ _ 416,494 
Tribasic acids 684 
Trichinella spiralis (Trichina spiralis) 420,912 
Trichinosis 420 
Trichophyton : 418 
Trichuris trichiura (whipworm) 912 
Tricresol 223 
Tricuspid valve 37 
Trihydroxy benzene; a, s, and v 723 
Trinltrophenol 224 
Trinitrotoluene, poisoning by 269 
Trisaecharides ; 721 
Triturations (triturationes) 617,632 
Trochanter, greater and lesser . 21 
Trophozoites 909 
Troy weight 602 
Trunk and neck, bones of 18 
Trypanosoma gambiense ... 907 
Trypanosomiasis 908 
Tryparsamide 207,505 
Trypsin 60 
Trypsinogen 60 
Tubercle (bony process) 16 
Tubercle bacillus, staining of, 902 1012 
INDEX 
Tuberculosis: Page 
Diet in. 592 
Other than pulmonary. 396 
Pulmonary. 394 
Tuberosity, (bony process) 16 
Tubes: 
X-ray - - 942 
Eustachian or auditory— 62 
Turpentine: 
Oil of 234 
Retention enemata.. 320 
Stupes 317 
Tympanic membrane 82 
Typewriters, procedures for replacement of... 789 
Typhoid fever 338,406 
Typhus fever 340,411 
Ulcer: 
Perforated gastric or duodenal 127 
Ultra short-wave diathermy 935 
Ultraviolet: 
Radiation - 925 
Rays - 442 
Therapy (artificial).. 926 
U nconsciousness — 122 
Caused by acute alcoholism. 125 
Hysterical 124 
Symptoms, differentiating '. 123 
Treatment of - - 123 
Unit, British thermal (B. T. U.) 693 
Unsaturated hydrocarbons 721 
Upper extremity, bones of. 19 
- 65 
Clearance test 897 
Ureters 68 
Urethra 68 
Urinal 303 
U analysis 889 
And blood chem istry 889 
Urinary; 
Bladder - 68 
Meatus 71 
System.. - 63,65 
Instrumentation of 506 
Urine --- - - 64,276 
Abnormal constituents in... 65 
Characteristics of normal 64 
C omposition of normal 65 
Examination of.... - — 890 
Microscopical — 891 
Preoperative and postoperative 324 
Routine 890 
Special tests 891 
N ormal — 64,889 
Rentention of 276, 325, 601 
Specimens, collection of 501 
Suppression of — 276 
Uriniferous tubules 66 
Urotropin (methenamine) 220 
Urticaria , 478 
Uvula.. 52 
Vaccination 424 
Method of 424 
Results of 425 
Vaccines 246,374 
Page 
Valence . 664 
Of certain elements combined with hydrogen. 664 
Oxygen, of sulfur and osmium, variation of. 665 
Valuables, patient’s 355,834 
Valves of heart.. 37 
Vaporization 616 
Vascular system: 
Blood 29,36 
Lymph. 45 
Vas deferens (ductus deferens) 70 
Veal, as food .’ 588,830 
Cuts of 830 
V egetables as food 589 
Vein-s 38 
Axillary 44 
Azygos 44 
Basillic 44 
Median (median cubital) 44 
Brachial 44 
Cephalic „„ 44 
Deep 43 
Femoral 44 
Deep.. 45 
Hepatic 45 
Hypogastric (internal iliac) 45 
Iliac, common, external, and internal (hypo- 
gastric) 45 
Inferior vena cava 38,45 
Innominate-—, 44 
Jugular, anterior, external, and internal 43 
Lumbar ... 45 
Median 44 
Of systemic circulation. ... 43 
Ophthalmic - 81 
Ovarian... 45 
Peroneal 44 
Popliteal- 44 
Portal 45 
System of. 43,45 
Pulmonary. 43 
System of 43,45 
Radial - 44 
Renal .... 45 
Saphenous: 
External, small, or short 44 
Internal, great, or long.... 44 
Spermatic 45 
Splenic 45 
Subclavian... 44 
Superficial 43 
Superior mesenteric 45 
Superior vena cava 38,44 
Suprarenal. 45 
Systemic system of 43 
Tibial, anterior and posterior 44 
Ulnar 44 
Velpeau bandage 137 
Venereal: 
Diseases 414,490 
Chancroid 414,495 
Genitourinary and in, v, 490 
Instrumentation in . 504 INDEX 
1013 
Venereal—Continued. Page 
Diseases—Continued. 
Gonorrhoea 414,496 
Acute (clap)... 496 
Complications of 497 
Balanitis. 501 
Balanoposthitis 501 
Epididymitis 498 
Gonorrhoeal ophthalmia. 332,502 
Paraphimosis 501 
Phimosis 501 
Prostatitis 497,502 
Stricture of urethra. 498 
Chronic (gleet) 497 
Lymphogranuloma venereum (inguinale) 
415,503 
Prevention of in, v, 511 
Syphilis 416,493 
Verruca acuminata, venereal 504 
Prophylaxsis — 612 
Venous: 
Arch, dorsal. - 44 
Blood 38,43 
Channels (sinuses) 43,87 
Plexus, volar... 44 
Sinuses.. ..' 43,74 
Ventilation 432 
Aboard ship. 432 
Artificial 432 
Ashore 432 
Natural 432 
Of— 
Operating rooms 356 
Submarines 872 
Wards 352 
Ventricle-s; 
Of— 
Brain 75 
Heart — - 37 
Venules 38,43 
Vermes (worms) 909 
Vermicides 180 
Vermifuges. - 180 
Verruca acuminata, venereal 504 
Vertebrae: 
Cervical 18 
False - 18 
Lumbar 18 
Thoracic (dorsal) — 18 
True - 18 
Vertebral: 
Arch IS 
Column, bones of 18 
Foramen 19 
Vertebrates - 6 
Vesical: 
Sedatives 180 
Tonics 180 
Vesicant-s 318 
Gases (chemical warfare) 868 
Vessels: 
Blood — — 36,39 
Lymph 46 
Of blood-vascular system 36,39 
Vestibule (internal ear) — 83 
Page 
Veterans’ Administration hospitals 758 
Vibrio comma (Spirillum cholera) 339,399 
Villi. 54 
Vincent’s infection, oral.. 174 
Vinegars (acetae) 624 
Vlosterol: 
Halibut liver oil with 237 
In oil. 237 
Virulence 374 
Virus: 
Filtrable 901 
Vaccine.. 246,374 
Viscera, animal, as food 689 
Visceral pleura. (See Pulmonary pleura.) 
Viscosity 658 
Visual; 
Apparatus 81 
Centers 81 
Vital statistics 456 
Compilation of statistical data 464 
Graphic methods for presenting 456 
Interpretation of 467 
Of the Navy, subject matter of. 458 
Other terms used in statistical work 459 
Population.... 459 
Purpose of 459 
Rates used in 459,460 
Standards of comparison of statistical facts.. 459 
Use of 459 
Vitamin-s 527,581 
Amounts required in adequate diet 581 
Antihsemorrhagic (K) 581 
Antineuritic (thiamin; aneurin; Bi) 582 
Antirachitic (D)_. ... ... 582 
Antiscorbutic (ascorbic acid, cevitamic acid; 
C) 582 
Antisterility (E) 583 
Conservation of 527 
Daily requirements of 582,583 
Designation of 581 
Effects of in life and health 581 
Pellagra-preventing (P-P) factor (nicotinic 
acid) 583 
Riboflavin (Q, and Bj) 583 
Sources of .. 581 
Vitreous body 82 
Vocal cords (false and true) 47 
Voice: 
How described 275 
Organ of — 47 
Volar venous plexus 44 
Volatile: 
Oil drugs, and preparations made from 230 
Oils 230 
Voltmeter , 952 
Volume 554 
Gram-molecular (molar) 663 
Specific 507 
Volumetric procedures 731 
Vomiting 275 
Voucher-s: 
Issue (NMS Form R) ... 777 
Public 787,791 1014 
INDEX 
Voucher-s—Continued. Page 
Receipt and expenditure (for commissary 
ledger, NMS Form 37) 815 
Transfer (usually S&A Form 71) 781 
Issued 788 
Received. 788 
Ward-s: 
Cleaning t 347 
Care of cleaning gear and materials 349 
Care of equipment and utensils 349 
Daily. 347 
Dusting.. 347 
General field day 347,349 
Of— 
Floors and walls 348 
Rubber sheets and other rubber articles. 349 
Special daily ,. 347 
Drug book 346 
Duties: 
Daily. 345 
Of persons in charge of.. 344 
General care of 352 
Arrangement of furniture and utensils 352 
Care of furniture and furnishings 352 
Cleanliness 347 
Freedom from unpleasant odors 352 
Lighting : 352 
Temperature 352 
Ventilation 352 
General inspection of 350 
Linen 350 
Changing of 350 
Damaged 350 
Exchange of soiled for clean 350 
Inventory of, weekly..., 350 
Issue of clean 360 
Of patients with communicable diseases . 349 
Removal of stains from 351 
Management . ra, v, 344 
And general supervision of 344 
Assignment of personnel ... 345 
Cleaning routine 347 
Responsibility for successful 344 
Schedule of work in. 344 
Property 350 
And linen 350 
Care of 350 
Inventory of, monthly 350 
Missing 350 
Record of__ 350 
Transfer of 350 
Warfare, chemical in, vi,862 
Water-s (aquae) 57,183,527, 573,624,694 
Analysis of, sanitary 440 
Boiling, sterilizing by , 532 
Discipline on the march 557 
Distilled 183, 624 
Examination of.. .... 440 
Interstitial 622 
Of crystallization.... 622,695 
■ Redistilled 183 
Relation of to health and disease 437 
Shed, sanitary survey of 440 
Sources of _T 437,528 
Sterilized distilled. 183,624 
Water-s—Continued. Page 
Stronger ammonia „ 196 
Surface. 438,528 
Weighing-. 602 
Weight-s .. 602,605,654 
And measures, table of equivalents of 604 
Definition of 602 
Grain .' 602 
Gram. 603 
Gram-molecular (mole) 663,727 
Specific 655 
Well-s. 438,528 
Artesian 438 
Deep.. 528 
Shallow 438,528 
Water 529 
Wet dressings 95 
Wharton’s duct 62 
Whiskey 219 
White: 
Blood cells 35 
Matter 74 
Phosphorus 866 
Wax.. 238 
Whooping cough 397 
Wool.. • 446 
Fat 238 
Work request, bureau 782 
Wound-s 93 
Bacteria causing infection in 93,94,95 
Bites of— 
Poisonous insects 93,98 
Poisonous snakes 93,98 
Rabid animals 98 
Clean or aseptic 93 
Contused 94 
Crushed 94 
Dressings 95 
First-aid treatment of 93 
Gunshot... 94,100 
Healing. .1 ... 94 
Factors preventing 94 
First and second intention 94 
Incised 93 
Infected or septic 93 
Irrigation of 330,362 
Lacerated. 93 
Of— 
Abdomen 100 
Chest 100 
Eye. 100 
Poisoned 93,98 
Punctured 94 
Sutures.. 97 
Treatment of: 
General principles underlying 94 
Wucheria bancrofti (thread worm) 912 
Xenopsylla cheopis (flea) 410,449 
X-ray-s in, vi, 940 
Darkroom 960 
Equipment: 
Arrangement of 954 
Shockproof 954 INDEX 
1015 
X-ray-s—Continued. Page 
Examinations .. 103,954 
Fluoroscopy ... 957 
Potter-Bucky diaphragm 957 
Radiography. ... 958 
Scattering of ,•... 956 
Film-s.... 958 
Exposures 955 
Nature of 941 
Production of 942 
Primary low voltage current 950 
Secondary high voltage current 945 
X-ray tubes 942 
Protection 962,965 
Electrical precautions. 963 
Radiation precautions.. 963 
X-ray-s—Continued. Page 
Switch 953 
Treatment 962 
Yards and Docks, Bureau of 751 
Yellow: 
Fever 340,412 
Mercuric oxide 211 
Young’s rule . . 180 
Zinc i 710 
Chloride 203 
Compounds 202 
Oxide 202,710 
Stearate 203 
Sulfate 202,710 
Zoology 7,599 
Zygomatic arch . . 16