A complete handbook for the sanitary troops of the U. S. army and navy

Front matter

Google to make the world's books discoverable online.

It has survived long enough for the copyright to expire and the book to enter the public domain. A public domain book is one that was never subject

to copyright or whose legal copyright term has expired. Whether a book is in the public domain may vary country to country. Public domain books

Preface To The Second Edition

In presenting the second edition of this handbook the author desires to say that every page has been carefully examined, corrected, and brought up to date. Many of the parts have been entirely rewritten and numerous new and improved illustrations inserted. The general size, plan, and scope of the work remain, however, unchanged.

Charles Field Mason.

Washington, January 31, 1909.

Preface To The Fourth Edition

In this edition it has been deemed advisable to omit the part on drill regulations for sanitary troops, and to considerably expand those on nursing, and those on pharmacy.

The appearance of a revision of Army Regulations and of the Manual Medical Department since the last edition of this book was brought out, has required a complete rewriting of those parts, while all the chapters have been carefully revised, corrected and brought up to date.

Charles Field Mason.

Washington, December i, 1916.

Chapter I Page

Organization . of the sanitary troops; instruction; promotion; duties ; uniform ; rules for hospital administration.

CHAPTER n

Administration zoiies. Objects of Medical Department Administration. Duties of the Medical Department. Personnel. Titles of Medical officers. Insignia.. Status of personnel. Organization in war. The service of the interior. Mobilization camps. Concentration camps. Camp hospitals. Hospital trains. Rest stations. Hospital ships. The theater of operations. The zone of the advance. Camp infirmaries. The ambulance company. The field hospital. The station for slightly wounded. The line of communications. Base hospital. Convalescent camp. Contagious disease hospital. Trains, boats and ships. Sanitary squads. Rest stations. Base supply depot. Advance supply depot. Evacuation hospital. Evacuation ambulance company. Administration. Resume.

Part II Anatomy And Physiology

Bone. Cartilage. Classification of bones. The vertebral column. The pelvis. Joints. Lower extremity. Thorax. Upper extremity. Skull. Teeth.

CHAPTER n

The Muscles, Cellular Tissue, and the Skin 48

Muscles, voluntary and involuntary. Action of muscles ; the sterno-mastoid, biceps, diaphragm. The connective or cellular tissue; fat The skin and its appendages. Functions of the skin.

vi CONTENTS

CHAPTER III PAGE The Nervous System and Special Senses 53

The cerebro-spinal system ; brain, spinal cord, and nerves. The sympathetic system ; ganglia and nerves. The special senses ; touch, taste, smell, hearing, and sight.

The Digestive Apparatus 61

The alimentary principles and their uses ; albuminates, fats, starches and sugars, minerals. The alimentaxy canal and digestion.

The lymphatic system and its functions. The blood ; its composition and uses. The heart, arteries, capillaries, and veins. The circulation of the blood. The special arteries and their compression points. Special veins.

The Respiratory Apparatus 8i

The larynx and vocal cords. The trachea, bronchi, and air cells. The lungs and pleura. Respiration. Air. Ventilation. Heat regulation.

CHAPTER VII

The Excretory Apparatus 85

The skin, lungs, and bowels. The urinary organs; the kidneys, ureters, bladder, urethra. The urine. The suprarenal glands.

Part III First Aid

How to act in emergencies; removal of clothing. Contusions; shock and its treatment; treatment of contusions. Wounds, incised, lacerated, contused, punctured, poisoned, gunshot. Wound infection; septicemia and pyemia. Treatment of wounds; first-aid packets. Wounds of the skull, of the chest, of the abdomen, of the bladder. Bites of insects, of tarantulas, scorpions, and centipedes; bites of snakes, of rabid animals. Tetanus; anthrax. Poisoned arrows, etc.

CONTENTS vii

CHAPTER II PAGE

Hemorshages 96

Capillary bleeding; nose-bleeding, bleeding from a tooth socket Venous bleeding. Arterial bleeding, primary, intermediate, and secondary. Treatment of arterial bleeding; compression with the fingers; with the tourniquet; the Spanish windlass. Bleeding from special arteries; in the upper extremity, the lower extremity, the neck, the tongue, the lips, the face, the scalp. Bleeding from the lungs, the stomach, the bowels.

Dislocations and Sprains 103

Dislocations, definition of; symptoms, diagnosis from fracture and sprain; treatment. Special dislocations; shoulder, lower jaw, fingers, knee-cap.

Sprains; definition; s3nnptoms, treatment. Sprained ankle.

Fractures, definition of; compound, simple, comminuted, complicated, impacted, green-stick; causes of; symptoms. Treatment; of simple fractures; setting, splinting; of compound fractures. Healing of fractures. Splints. Special fractures; of the skull, spinal column, ribs, pelvis, nasal bones, lower jaw, clavicle, arm, forearm, metacarpals, fingers, thigh, knee-cap, leg, foot.

Foreign Bodies 119

In the eye. In the ear. In the nose; maggots in the nose. In the throat. In the air passages. In the stomach and intestines. In the skin.

The Effects of Heat and the Effects of Cold 123

Heat-stroke. Heat exhaustion. Bums and scalds ; burns from corrosive acids and caustic alkalies. General freezing. Frost-bite. Chilblain.

CHAPTER VII

Insensibility and Fits 126

Fainting. Concussion and compression of the brain; apoplexy. Lightning stroke. Electric shock. Acute alcoholism. Epilepsy. Bright's disease of the kidneys. Opium poisoning.

viii CONTENTS

CHAPTER VIII PAGE

Asphyxia 130

Forms of asphyxia; causes, treatment. Artificial respiration; Schaefer's method, Marshall Hall's method. Drowning.

CHAPTER IX

Poisoning 136

Caustic acids. Caustic alkalies. General management of cases of poisoning. £lmetics, antidotes, combating the tendency to death.

Special poisons; phenol (carbolic acid), wood-alcohol, food-poisoning, ptomaine poisoning, "knock-out drops" (chloral), arsenic, corrosive sublimate, nitrate of silver, phosphorus, strychnine. Skin poisons ; poison-ivy, poison oak, poison sumach.

PART IV NURSING The Wakd 141

Wards in post hospitals; arrangements, heating, and ventilation. Field hospital wards. The wardmaster. Night nurse. Ward cleaning.

Ward Management 147

The new patient. Serving diets. Administering medicines. The use pf the hypodermic. Dying patients. Care of the dead. Autopsies.

Beds and Bed-making 152

The hospital bed; its preparation; changing bed linen. Changing the bed. Changing the mattress. Beds for operative cases. Fracture beds. The bed-rest. Air and water mattresses. Bed sores.

Baths and Bathing 157

Purposes for which baths are given. Classification of baths. Sponge baths. Sedative bath. Hot- water baths. Hot-air and steam baths. Cold baths. The Brandt System. The cold sponge. Bed tub-bath. Alcohol bath. Bakes. Electric light bath. The foot bath. Sitz bath.

CONTENTS ix

Temperature, Pulse, and Respiration 175

Normal and subnormal temperature. Fever; classifications of fevers. The clinical thermometer. Charting temperature. The pulse ; varieties of. Respiration ; varieties of. Pulse, respiration, and temperature ratio.

CHAPTER VIII Symptoms and Clinical Record 179

Symptoms; subjective, objective, feigned; the attitude and expression; mental conditions; the eyes; the hearing; the skin; the tongue, mouth, and teeth; cough; the appetite; vomiting; the stools; suppression, retention, and incontinence of urine; cough; hiccough; pain; hallucinations and delirium; sleep. Clinical records; history, treatment, charts.

CHAPTER IX Bandaging 185

The triangular bandage and its application to various parts of the body; the slings. The roller bandage; sizes; method of rolling; rules for applying; the figure of eight; the spica; the knotted turn; recurrent of the head; recurrent of a stump; application to various parts of the body. Flannel and rubber bandages. Fixed bandages; plaster-of- Paris bandages.

CHAPTER X Infection and Disinfection eoo

Definition. Disinfectants; dry heat, flowing steam; boilmg water, corrosive sublimate, phenal, cresol, quick-lime, chlorinated lime, formalin, sulphur. Prevention of spread of infectious diseases. Disinfection of sputum, feces, urine, vessels, infected clothing, beddmg, beds, rooms, tentage.

1 i

X CONTENTS

Chapter XI Page

Description of the ordinary instruments and appliances. Special appliances and apparatus of the medical department of the army; compressed air apparatus; electric batteries; restraint apparatus; steam sterilizing apparatus; aspirating case, emergency case. Diagnosis tags. Field equipment; desk; food box; commode chest; acetylene chest; regimental combat equipment; mess chest.

CHAPTER XII The Operating-room and Surgical Nursing 242

The bacteria of surgical infection. Toxemia, septicemia, and pyemia. Preparation of the patient for operation ; after-care ; dressing.

Preparation in the operating-room. The sterilizer. Sterilization of instruments, trays, dressings, sutures, and ligatures; metal and glass syringes ; rubber goods, web catheters ; water. Normal saline solution. Drains. Disinfection of the hands and field of operation. Care of instruments, etc., after the operation. Operations in the field.

Chapter XIII

Nursing in the Infectious Diseases. How Infections Spread. Vaccines and Antitoxins. Typhoid Vaccinations 252

Typhoid fever. Dysentery. Cholera. Malaria. Yellow fever. Cerebro-spinal meningitis. Gonorrhea. Chancroid. S>'philis. Pulmonary tuberculosis. Pneumonia. Influenza. Follicular tonsillitis. Diphtheria. The eruptive fevers. Mumps. Erysipelas. Wound infections. Plague. Typhus.

Part V

The mess ; sources of supply in post and field. The rations. The diet.

Cooking 266

The kitchen. Effect of cooking on foods. Boiling, stewing, soupmaking, roasting, baking, broiling, frying. Bread-making.

CONTENTS xi

CHAPTER III PACE

RsaPES 270

Liquid diets. Semisolid or light diets. The hospital stores. The rations. Approximate measures.

Part VI Materia Medica And Therapeutics And Pharmacy

Drugs; active principles; classification. Administration of medicines ; dosage. Army and Navy supply tables.

Definitions. Pharmaceutical operations. Official and non-official preparations. Directions for making emulsions, pills, ointments, powders, and suppositories. Weights and measures. Filling prescriptions. Incompatibility.

Part VII Hygiene. Post And Camp Sanitation

Daily allowance. Surface and ground waters. Purification of water; the Lyster sterilizing bag; the Damall siphon-filter; other processes. Water-borne diseases. Collection of samples.

Air and Ventilation 343

Composition of air; impurities. Floor space and cubic air space. Ventilation; natural and mechanical. Heating by stoves, furnace, Hot water, steam.

The Disposal of Wastes 349

Disposal in posts; by pits, pans, water carriage. House drainage. Bacterial methods for purification of sewage. Disposal in the field; with moving commands; construction of sinks; in fixed camps; garbage; crematories. Sanitation of camps.

xii CONTENTS

CHAPTER IV PAGE

Typhoid, malarial, and yellow fevers, and their transmission by insects. Diarrhea. Dysenteries. Eruptive fevers; vaccination and vaccinia. Cholera.

Sanitation in the Field 564

Camp sites. Tents. Water supply. Care of the feet Chafing. Lice.

CHAPER VI

Personal Hygiene 367

Cleanliness. Dhobie itch. Teeth; hair. Clothing. Veneral disease. Alcoholism. Food and drink. Exposure to the sun. Chilling at night. <

Part VIII Riding, Packing, And Driving

The equipment of the horse. Riding without and with the saddle. Stable duty.

CHAPTER n

Pack Saddle and Packing 389

The Medical Department pack outfit; to use.

CHAPTER HI

The escort wagon. The army wagon. The ambulance. Harness. Care of animals, wagons, and harness in the field.

Part IX

Medical Department. Hospital Corps. Garrison Service. Field Service. General Hospitals. Service of Hospitals. Hospital Buildings. Sick Call. Medical Supplies. Artificial Limbs. Manual for the Medical Department. Field Hospitals and Ambulance Companies. Hospital Corps Detachments. Analyses of Water. Reports, Returns, and Records. Hospitals and Medical Attendance. Service of Hospitals, general. General Hospitals. Supplies and Materials. The Sanitary Service in War.

CONTENTS xiii

PART X CLERICAL WORK page

List of reports rendered daily, trimonthly, monthly bimonthly, quarterly, semiannually, annually, occasionally; on breaking up of hospital; on being relieved of medical property. List of Records.

PART XI MINOR SURGERY Anesthesia, General and Local 467

General anesthesia; preparation for; ether; chloroform. Anesthesia in the tropics. Local anesthesia; ethyl chloride; cocaine; eucaine; Schleich's method. Spinal anesthesia.

CHAPTER n

Assisting at Operations. Minor Operations 472

Preparation for operation. Handling instruments. Sponging. Incised wounds ; suturing. Contused and lacerated wounds. Boils. Carbuncles. Felons. Abscesses. Gum-boils. Ulcers. Piles.

Subcutaneous saline infusions. Rectal continuous saline infusion. Intra-venous infusions; salvarsan. Antitoxin injections. Acupuncture. Aspiration. Lumbar puncture. Mercury injections for syphilis. Taking blood specimens. Use of the stomach tube. Forced feeding. Introduction of metallic catheters and sounds into the bladder. Hernia and trusses. Toothache and tooth extraction. Electric batteries.

CHAPTER IV.

Adhesive Plaster, Straps and Strapping 485

To retain splints. Extension in fracture of the thigh. Strapping for fracture of the ribs. Sayre's strapping for fractured clavicle. Strapping a swollen testicle. To draw wound edges together. Removal of adhesive plaster.

A COMPLETE HANDBOOK

FOR THE

SANITARY TROOPS

OF THE

U. S. ARMY AND NAVY

AND

NATIONAL GUARD AND NAVAL MIUTIA

Part I Sanitaby Tboofs In Post And Field

The Medical Department consists of one Surgeon General, chief of said department, a Medical Corps, a Medical Reserve Corps temporarily, a Dental Corps, a Veterinary Corps, an enlisted force (Sanitary Troops), the Nurse Corps and contract surgeons.

The enlisted force of the Medical Department consists of the following personnel : Master hospital sergeants, hospital sergeants, sergeants (first-class), sergeants, ocrporals, cooks, horseshoers, saddlers, farriers, mechanics, privates (first-class), and privates. Master hospital sergeants are appointed by the Secretary of War, but no person can be appointed master hospital sergeant until he shall have passed a satisfactory examination under such regulations as the Secretary of War may prescribe before a board of one or more medical officers as to his qualifications for the position, including knowledge of pharmacy, and demonstrated his fitness therefor by service of not less than twelve months as hospital sergeant or sergeant, first class, Medical Department, or as sergeant, first class, in the Hospital Corps; and no person may be designated for such examination except by written authority of the Surgeon General. Original enlistments for the Medical Department are made in the grade of private, and reenlistments and promotions of enlisted men therein, except as hereinbefore prescribed, and transfers thereto from the enlisted force of the line or other staff departments and corps of the Army are governed by such regulations as the Secretary of Wir may prescribe. The total number of enlisted men in the Medical Department should be approximately equal to, but not exceed, except as hereinafter provided, the equivalent of five per centum

4 SANITARY TROOPS IN POST AND FJELD

of the total enlisted strength of the Army authorized from time to time b> law but in time of actual or threatened hostilities, the Secretary of War is authorized to enlist or cause to be enlisted in the Medical Department such additional number of men as the service may require. The number of enlisted men in each of the several grades designated below may not exceed, except as hereinafter provided, the following percentages of the total authorized enlisted strength of the Medical Department, to wit: Master hospital sergeants, one-half of one per centum ; hospital sergeants, one-half of one per centum ; sergeants, first class, seven per centum ; sergeants, eleven per centum ; corporals five per centum ; cooks, six per centum ; privates, first class, forty-five per centum, and privates nine per centum. The number of horseshoers, saddlers, farriers, and mechanics may not exceed one to each authorized ambulance company or like organization.

Enlisted men may be transferred from the line to the medical department as privates Married men are not accepted as recruits, nor transferred from the line for service in the department Candidates for enlistment should apply to a post medical officer or to a recruiting officer. Applicants who have graduated in pharmacy, or who have had training as nurses in civil hospitals, should present certificates of their special qualifications. Slight physical defects which, under existing orders, would disqualify for the line, do not disqualify for enlistment in the department, provided they are not of such a character as would interfere with the full performance of the duties of a sanitary soldier in garrison or in the field. If a candidate is accepted he is forwarded to a company or detachment for instruction in: i. Discipline and the duties of a soldier; 2. Care of animals and equitation; 3, Bearer drill and field work; 4, Anatomy and physiology; 5. First aid and personal and camp hygiene, including the sterilization of water and disinfection; 6. Nursing, 7. Army Regulations; 8. Cooking; 9. Materia medica and pharmacy; 10. Elementary hygiene; 11. Clerical work. All privates are instructed in the first six subjects, and those who show special aptitude take the complete course.

Instruction in the first three subjects is continuous throughout the year : the other subjects are included in the regular winter course of instruction covering a period of thirty-four weeks.

Field hospitals and ambulance companies maintained in time of peace are also utilized so far as practicable in teaching recruits the work of the sanitary field organizations. The course of study taught recruits while with these organizations is supplemented by practical instruction at posts and in the field after their assignment to other commands.

The course for noncommissioned officers comprises the following subjects: Sanitary administration, pharmacy, clerical work, minor surgery, mess management and Army Regulations. Privates first class and privates who are candidates for appointment as noncommissioned officers are required to take this course; and in addition the regular course prescribed for their grades, or any part of it, if deemed necessary by the officer in charge of instruction.

Privates first class or privates who have shown special proficiency may be recommended for promotion by the surgeon. To test their capacity for performing the duties of a noncommissioned officer, they may be first detailed as lance corporals. Before being appointed sergeants they must pass an examination as to (r) Physical condition; (2) character and habits, especially as to the use of stimulants and narcotics; (3) discipline and control of men; (4) knowledge of regulations; (5) nursing; (6) dispensary work; (7) clerical work; (8) principles of cooking, and mess management; (9) Hospital Corps drill; (10) minor surgery and first aid, including extraction of teeth. The board will require the candidate to prepare a full set of papers pertaining to the medical department, and to drill a detachment sufficiently to demonstrate his thorough knowledge of the drill regulations.

The written examination will embrace the following subjects: (i) Arithmetic; (2) materia medica; (3) pharmacy; (4) care of sick and ward management; (5) minor surgery and first aid; (6) elementary hygiene. Ten questions will be asked in each subject. Proficiency in penmanship and orthography will be estimated from the papers submitted.

Sergeants who have served a year as such, or enlisted men of the hos])ital corps who served as hospital stewards of volunteers or acted in that capacity for more than six months during and since the .Spanish-American war, may be appointed sergeants first class upon the recommendation of the Surgeon General, provided they have successfully passed a more extensive and detailed examination in the above subjects than is required for promotion to the grade of

6 SANITARY TROOPS IN POST AND PJELD

sergeant. A reexamination before his first reenlistment may not be required if his commanding officer and the department surgeon concur in the statement that the candidate has performed his duties efficiently; but a reexamination is called for before a second reenlistment, after which no further examination :s ordinarily required.

Army Regulations provide for at least one noncommissioned officer and four privates at each permanent military post, with an additional noncommissioned officer for every additional four privates; six privates when the garrison is two hundred, and 'two privates additional for every additional one hundred of strength.

The uniform for ordinary wear is the same as that of the line except that the facings are of maroon-colored cloth and that the caduceus is the emblem of the corps. Privates first class are distinguished from privates by wearing a caduceus upon the sleeves of the blouse above the elbow. For duty in the wards, kitchen, dispensary, and operating-room a uniform of white cotton duck is worn.

The dutieS' of the sanitary troops in time of peace are chiefly concerned with the care of the sick, sanitation and preparation for war ; that they are many, varied, and important may oe gathered from the scope of the scheme of instruction detailed in the following pages.

The peace hospitals of the army are of three classes, post hospitals, department hospitals, and general hospitals; post and general hospitals are distinguished from each other by the fact that the former usually receive only the sick of the post to which they belong, while the generaf hospitals receive the sick from widely separated commands. Some of the general hospitals are of a special nature, su^'h as that of Fort Bayard for the treatment of tuberculosis, and the general hospital at Hot Springs, Arkansas, for the treatment of cases requiring a course of bathing'

Department hospitals correspond in all respects to general hospitals except that they are under the control of the Department Commander.

The duties of noncommissioned officers of sanitary troops arc to maintain discipline m hospitals and watch over their general police; to supervise the duties and assist in the instruction of the subordinate personnel in hospital and fn the field ; to look after and distribute hospital stores and supplies ; to care for hospital pro])- erty ; to compound medicines ; to prepare reports and returns ; and to perform such other duties as may, by proper authority, be required of them.

The senior noncommissioned officer must be an efficient disciplinarian, expert clerk, accurate arithmetician, and a trustworthy pharmacist, with as much knowledge of materia medica, therapeutics, and minor surgery as will enable him to give sound advice and suitable treatment in the minor ailments and accidents which in civil life are dependent on the resources of domestic medicine or the knowledge of the nearest pharmacist; in addition, he must have that higher knowledge, for use in the wards, which enables the experienced nurse to appreciate the condition of those who are seriously ill, that their improvement may be fostered and all harmful influences excluded. At small posts, during the temporary absence of the medical officer, the unforeseen casualties and even many of the exigencies of military life impose duties upon him the satisfactory performance of which may be of the first importance to the individuals concerned.

The following are official rules for the interior administration of hospitals :

(a) GENERAL RULES

(i) In the smaller hospitals the senior noncommissioned officer, under the direction of the surgeon, is in immediate charge of the hospdtal and the Hospital Corps detachment. He will see that all men of the detachment and all patients in the hospital are always present or accounted for. He will require all members of the detachment to perform their duties quietly and treat the sick with gentleness and consideration ^

(2) The noncommiissioned officer in charge of public property will keep an accurate account of the same and its place of distribution.

(3) Each man in charge of a department of the hospital, as wardmaster, noncommissioned officer in charge of mess, etc., is responsible for the property used in his department. He will keep a list of the same and will by frequent inventories assure himself of its presence.

(4) All public property in the possession of the n^n must be kept in good order and all missing or damaged articles accounted for.

(5) A noncommissioned officer or other man, upon his assignment to a department of the hospital, will make himself familiar with the special orders governing it, and all must familiarize 'themselves with the standing orders of the hospital.

* In the larger hospitals it may be necessary to distribute these duties among several noncommissioned officers as determined by the commanding officer of the hospital.

(6) All noncommissioned officers and privates of the detachment will be present at all formations unless specially excused.

(7) All men on duty in the kitchen and mess room will arise at least one hour before reveille ; all other members of the detachment, unless specifically excused, will arise at or before first call for reveille.

(8) Immediately after reveille each man will arrange his bed and personal belongings in a neat and orderly manner. All clean underclothing will be neatly folded and placed in the lockers, which will be uniformly packed ; other clothing will be brushed and hung in the lockers or in a specially designated place. Soiled clothing will be kept in the barrack bags. Shoes will be polished and neatly arranged in the lockers or under the sides of the beds.

(9) All beds will be overhauled and cleaned each week and, weather permitting, the bedding and mattresses, together with the other clothing, will be well shaken and hung out to air for at least two hours. Mattress covers will be changed immediately before each monthly inspection or oftener if necessary. Sheets and pillowcases will be changed at least once each week.

(10) A card bearing the name of the soldier will be attached to the foot of his bed, and his accouterments will be hung, neatly and uniformly arranged, on the foot end iron of his bunk.

(11) The squad room will always be kept clean, neat, and orderly.

(12) The men will pay the utmost attention to personal cleanliness; each will bathe at least once weekly, his hair must be kept short, and his face shaved, or beard neatly trimmed, and his underclothing frequently changed. (See Army Regulations.)

(13) Members of the detachment will wear the prescribed uniform at all times when present at the post. While on fatigue they may wear the fatigue dress. While on duty in wards, dispensary, operating room, mess room, or kitchen, they will wear the white uniform.

(14) No member of the detachment will leave the hospital bounds except by permission of proper authority or, in case of emergency, in the execution of duty.

(15) Immediately after "breakfast the hospital will be thoroughly policed in every department. It must be ready for mspection at the hour designated by the surgeon and always be kept absolutely clean.

(16) No member of the hospital personnel will borrow from or have financial dealings with any patient.

(17) When necessary a noncommissioned officer in charge of quarters will be detailed daily by roster from noncommissioned officers on duty with the detachment, and an emergency squad will always be designated.

(18) The noncommissioned officer in charge of quarters will make an inspection of all wards and quarters at such times as the suigeon may direct, will report all unauthorized absentees to the noncommissioned officer in charge of the detachment, and will see that no unauthorized lights are burning. In case of fire he will give the alarm and proceed as ordered in fire regulations. He will be responsible for the efficient performance of the watchman's duties.

(19) The night watchman, when one is necessary, will be under the immediate orders of the noncommissioned officer in charge of quarters. He will patrol the hospital grounds at least once every three hours and will be constantly on the alert for fires, lights, and unauthorized persons in or about the hospital. He will at once report to the noncommissioned officer indicated all unusual occurrences and violations of existing orders which come under his observation.

(b) WARD RULES

(i) The wardmaster oi each ward is directly responsible to the ward surgeon. He is in charge of his ward and the enlisted assistants and patients in it, and will be obeyed and respected accordingly.

(2) The wardmaster is responsible for the cleanliness and order of his ward, for the public property therein, and for the effects of his patients until they have been turned over to the proper custodian. He is responsible for the prompt delivery of prescriptions to the dispensary, of medicines to his ward, and of the diet orders to the hospital office.

(3) In wards to which members of the Nurse Corps are not assigned the wardmaster is responsible for the administration of medicines and other treatment prescribed, the keeping of records, and all other duties that may be assigned to him by the ward officer.

(4) Phenol, bichloride of mercury, other active poisons, alcohol, and alcoholic liquors, when necessarily on hand in the ward, will be kept under lock and key and every precaution taken to prevent their improper use.

(5) On the death of a patient the wardmaster will notify the ward surgeon, or in his absence the medical officer of the day. He will not remove the body from the ward until' after it has been examined by a medical officer.

(6) The wardmaster will see that patients are acquainted with the ward rules.

(7) Before leaving the ward at the end of his daily tour of duty, the wardmaster will turn over to his relief all orders of the ward surgeon, accompanied by such explanation and instruction as may be necessary.

(8) Upon reaching the ward, patients will be promptly bathed, clothed in clean hospital clothing, and put to bed, unless their condition indicates otherwise or a specific order forbids.

(9) Money and valuables found on patients will be disposed of as prescribed in Manual Medical Department. The commanding officer will not be responsible for money or valuables of patients not turned over for deposit in the hospital safe.

(10) A clinical record will be carefully kept for each patient Upon final disposition of the case this record will be completed and signed by the ward surgeon and turned in to the record office.

(11) No information regarding the diseases or condition of patients under treatment will be given to anyone except those authorized under the regulations to receive it.

( 12) Visitors will be allowed to see friends in the ward at a specified time, when their presence will in no way disturb other patients ; but female visitors will not be permitted in the wards except when cases are serious, and then only by special permission of the ward surgeon.

(13) Bed linen will be changed on occupied beds at least twice weekly, and oftener if necessary to insure cleanliness. Whenever a bed is to be occupied by a new patient clean linen will be furnished. All bedding and clothing used by infectious cases will be promptly disinfected when removed from the beds. Patients will not occupy their beds when dressed in other than hospital clothing.

(14) Loud noises, boisterous actions, the use of profane language, and gambling are forbiddeh in the wards, and no food, intoxicants, or other articles of food or drink, except as prescribed or authorized, will be brought into the wards.

(15) Patients are forbidden to use towels, basins, toilet articles, eating utensils, or articles of clothing pertaining to another patient.

ADMISSION AND DISTRIBUTION OF PATIENTS

Upon his admission to hospital a patient will first be taken to the receiving ward, if there is one, or to the office, where his register card will be filled in so far as the data are available at the time, the treatment ward to which he is assigned being noted on the back thereof. There will also be entered on a clinical record brief (Form 55a) the patient's name, rank, organization, etc., the diagnosis on the transfer card, if one has been received, and the designation of the ward to which he is assigned. This form will accompany the patient to the ward and will be the wardmaster's authority for his admission thereto.

Upon reaching the treatment ward the patient will be promptly stripped, bathed, clothed in clean hospital clothing and put to bed, unless his condition indicates otherwise or a specific order forbids.