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Charles Field Mason.

A complete handbook for the sanitary troops of the U. S. army and navy and national guard and naval militia online

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dust.

Rubber catheters after drying are to be kept in talcum.

Rubber bandages in like manner are to be dusted with talcum
and rolled up, tapes, if any, inside; they must be protected from
the air by inclosure in a tin box with the top secured with a strip of
rubber plaster.

Rubber gloves should be thoroughly dried with a towel, dusted



OPERATING ROOM AND SURGICAL NURSING 251

with talcum inside and out, and protected from the air in tin boxes.
Punctures may be closed with rubber cement, or patched with a
piece of an old glove by the aid of the cement.

In the field many of the conveniences of the operating room in
the post hospital are absent, yet very excellent results may be ob-
tained. The work must be done in a tent, or even with no more
shelter than a fly ; under such circumstances dust is one of the great-
est dangers to be guarded against. If possible no movement of
troops or wagons should be allowed in the immediate vicinity ; the
floor of the tent and the grounds around it should be thoroughly
sprinkled to lay the dust, and wet sheets may be hung up so as to
afford further protection to the wounds. If no soda is available
to boil the instruments, wood ashes may be used tied up in a bag
to avoid clouding the water; when steam sterilizers cannot be had
the dressings may be boiled, or, in the absence of fire, saturated
with antiseptics. When the water is very hard, muddy, or full of
organic matter, bichloride of mercury is so rapidly decomposed
that it should not be relied upon as an antiseptic ; phenol should be
used instead. If there are no receptacles large enough to boil
the trays they should be scalded with boiling water, and strong
antiseptic solutions allowed to stand in them for a half-hour before
use.

In the absence of other suture material horsehair answers very
well; it may be rendered aseptic by washing with soft soap and
water, boiling ten minutes in 0.25 per cent solution of soda and then
ten minutes more in plain water, after which it is kept in a I :iooo
alcoholic solution of corrosive sublimate.



CHAPTER XIII

NURSING IN THE INFECTIOUS DISEASES

IT is important that nurses should know something of the most
common infectious diseases, especially how they are transmitted
from person to person, the particular symptoms and special dangers
of each, and how they affect the character of the nursing.

We have already defined infectious diseases as those which may
be transmitted to others; it is the business of the nurse to prevent
such transmission.

It should be remembered that contact is the great source of in-
fection in medical cases, just as it is in surgical cases, and therefore
medical asepsis should be observed.

All utensils and appliances used about the patient should be for
his exclusive use, and kept within the room or barrier; nothing
should be taken out of the roem unless it be immediately sterilized ;
the nurse should wear rubber gloves when handling the patient, or
wash and sterilize his hands immediately thereafter, and should put
on a special gown, to be kept in the room, whenever he comes in
contact with the patient or his bed.

Vaccines and antitoxins. Vaccines usually contain the dead or
weakened germs of the disease against which they are used, while
serums and antitoxins contain the natural antidotes for the poison
created by their germs. Both vaccines and antitoxins are used as
well to cure diseases as to prevent them.

The most common vaccines are those of smallpox, typhoid, cholera,
and plague, while the most common antitoxins are those of diph-
theria, tetanus, and plague.

Vaccination against typhoid. The site of the inoculation is the
arm at the insertion of the deltoid muscle. If for any reason this
site can not be used, the needle may be introduced in the back, over
the lower portion of the scapula, or in the chest below the clavicle.
The dose is to be given subcutaneously and not into the muscles nor
into the skin. The arm should be cleansed as for any other operation.

(252)



INFECTIOUS DISEASES 253

Tincture of iodine painted over the dry skin, before and after the
injection, has proven satisfactory.

The ampule should be washed off in an antiseptic solution and
opened after making one or more cuts near the top with a file.
The vaccine can be drawn out of the container with a syringe, or
it may be emptied into a shallow glass dish, such as a salt cellar,
which has been sterilized by boiling.

The syringe and needle should be sterilized by boiling in two-per-
cent soda solution. To insure perfect sterilization, draw the piston
out to its full length, or remove it entirely, so that the barrel is full
of water during the boiling. A fresh needle should be used for each
man, or, if one needle must be used on two or more men, it should
be resterilized before each injection.

Among the more common infectious diseases are gonorrhea, chan-
croid, syphilis, typhoid fever, malaria, yellow fever, cerebro-spinal
fever, dysentery, cholera, diphtheria, tuberculosis, influenza, ton-
sillitis, mumps, erysipelas, and wound infections.

Typhoid fever: This disease is due to infection with the typhoid
bacillus, which always gains entrance to the body through the mouth,
and escapes from the body of the typhoid patient in the stools and
urine and occasionally in the sputum. The germs are usually
swallowed in infected water or food, but may get into the mouth
indirectly as when one has been handling infected clothes, bedding,
or other articles, and then handles food without washing the hands.
The urine of the typhoid patient often contains typhoid germs for
weeks after the patient is convalescent, hence the danger of urinating
on the ground, where the germs grow readily and, getting on the
shoes of the soldier, are carried into barracks.

The initial lesion of typhoid fever is usually ulceration of the
lower end of the small intestine, and this ulceration causes diarrhea
and may go deep enough to cause hemorrhage or even perforation
of the bowel. Sudden collapse in the course of typhoid fever is
usually caused by either perforation or hemorrhage.

The fever ordinarily lasts about four weeks.

For his own protection the nurse should submit himself to pro-
phylactic vaccination against typhoid and in addition must be care-
ful to thoroughly wash and disinfect his hands every time after
handling his patient, and again before eating. For the protection of
others he must disinfect immediately all urine and stools, and every-



254 NURSING

thing which may have been soiled by them, such as bedding, towels,
nightclothes, etc. Even the water which has been used in bathing
the patient must be regarded as infected ; it should never be emptied
on the ground, but into a sink which is afterward flushed with a
disinfectant solution.

Separate thermometers, feeding cups, etc., must always be used,
but if this is not practicable they must be disinfected before use
with other patients.

As flies carry the disease germs on their feet they must not be
allowed to reach the patient or his discharges. Clothing and bedding
must be disinfected.

Dysentery: This occurs in two principal forms, amebic or tropical
dysentery, and bacillary or epidemic dysentery. In both forms the
germs are swallowed with water or food, chiefly the former, and in
both they are thrown off in the stools.

The disease is therefore spread much like typhoid fever, and the
precautions to be taken are practically the same, except that the
urine in dysentery is not infectious.

Cholera: This disease is spread in the same way as dysentery,
but is of short duration and very fatal. The only safety lies in
eating and drinking nothing which has not been recently cooked.

Clothing and bedding must be disinfected, and also of course the
stools and vomited matter.

Malaria: In this disease the infection is in the blood and cannot
be carried from one person to another except by mosquitoes (the
anophelina), which, after biting the malarial patient, then bite a
person hitherto well. Therefore, the sick must be protected against
mosquitoes, so that the mosquitoes can not get the 'disease, and the
well must be also protected, so that if there are any infected mos-
quitoes about they may not do any harm.

Yellow fever: This disease resembles malaria in that the infection
is in the blood, and can only be carried by the mosquito (Aedes
calopus) ; the precautions to be taken are the same. It is, however,
a much more serious malady than malaria, and usually of much
shorter duration. A curious feature of the disease is that it is not
infectious, that is, cannot infect the mosquito, after the end of the
third day; but the mosquito once infected is capable of carrying
the disease to man probably as long as she (the mosquito) lives.

Cerebro-spinal meningitis: In this disease it is believed that the



INFECTIOUS DISEASES 255

infective germ usually gains access to the body through the throat and
nose and is frequently received from meningococcus carriers, or
persons who have been in contact with other cases or themselves
recently had the disease and still carry the coccus in their throats.
This being the case, it is necessary to carefully disinfect all discharges
from the throat and nose of the patient and also that nurses and
physicians who come m contact with cases of this disease should
frequently spray their own throats and noses with an antiseptic
solution. Inasmuch as we do not know just how contagious the
disease is, nor in what excretions the meningococcus leave the bodies
of the sick, all cases and their attendants must be carefully isolated,
arid all discharges from the patient and everything which has come
in contact with him, including the room in which treated and its
contents, must be thoroughly disinfected.

Gonorrhea or clap: There is no danger of contracting this disease
in its ordinary form except through sexual intercourse, but there
is danger of getting some of the pus into the eyes and thereby induc-
ing a very serious inflammation which ofter completely destroys
vision. This may happen to the patient himself by bringing the
unwashed hands, after handling the penis, in contact with the eyes,
or more commonly to the nurse or other innocent person, from use
of a towel on which the gonorrhea patient has managed to get some
of the pus from his penis. Such a patient should be cautioned
about the danger to his own eyes, and should not be allowed to use
any toilet article except his own.

Chancroid: While this disease is nearly always venereal, a nurse
with a hang-nail or other abrasion may inoculate himself while
dressing the sore or the resulting bubo.

Syphilis: Syphilis, though very contagious at certain times and
under certain conditions, is not always so. The chancre, mucous
patches, condylomata, and the blood during the first few years of
the disease, are all contagious. The mucous patches, being often
located in the mouth and throat where they are not visible, are espe-
cially dangerous. All the table ware, toilet articles, instruments and
appliances, and bed linen used by syphilitics should be kept entirely
separate from those used by others, and should be frequently disin-
fected. Should the nurse have any cut or abrasion on his hands
he must be exceedingly careful in handling the syphilitic lesions,
or the dressings which have been used on them.



256 NURSING

Pulmonary tuberculosis: In this disease the infection is contained
in the sputum. As long as the sputum is moist the germs can not
escape into the air, but they may be carried by flies which alight upon
it or in the fine spray which is thrown out when the patient coughs.
The danger is in the dry sputum which becomes pulverized and
mixed with dust ; hence it must be kept moist and always received
in a disinfectant solution. If paper spit cups are used, these with
their contents are burned. Clothing and bedding must be dis-
infected.

Pneumonia, like tuberculosis, is infectious through sputum which
must be treated in the same way as that of the latter disease. Cloth-
ing and bedding must be disinfected.

Influenza; or " the Grip " : In this disease the sputum is infectious
and also the nasal discharge when there is any. The sputum is to
be treated like that of pneumonia and tuberculosis, the nasal dis-
charges are to be received on small pieces of gauze or toilet paper
and immediately burned. Clothing and bedding must be disinfected.

In follicular tonsillitis the discharges from the nose and throat
are infectious and should be "handled in the same way as those of
influenza.

The same remark applies to diphtheria, but this disease is very
contagious through particles of the membrane which is present in
the throat and often in the nose, and may be coughed into the face
of the attendant; minute portions of the membrane lodged in the
eye, nose, or mouth of the attendant may reproduce the disease in
him. Patients with diphtheria should always be isolated. Clothing
and bedding must be disinfected.

Measles belongs to the class of eruptive fevers, which includes
also scarlet fever, smallpox, and chicken pox, all of which are con-
tagious, the infectious agent being inhaled or swallowed. Though
there is reason to believe that they are all germ diseases, that sup-
position has not been proven for any of them. The discharges from
the throat and nose are highly infections, as are also the skin lesions
in smallpox. The modern belief is that this class of diseases, like
erysipelas and other wound infections, is spread chiefly if not en-
tirely by persons or things which have been in contact with other
cases. The general rules for nursing infectious diseases are to be
followed and all discharges disinfected. Before the convalescent



INFECTIOUS DISEASES 257

is allowed to mix with well people he should be given an antiseptic
bath, i :2000 bichloride, and the hair and scalp thoroughly shampooed.

Mumps: In mumps the contagious agent is. probably in the secre-
tions of the mouth and throat. The disease is to be handled like
eruptive fevers.

Erysipelas may be carried from one wound to another on the
hands of the nurse, on instruments, dressings, etc., and possibly
also through the air. So very contagious is it that an erysipelas
patient should be isolated and his nurse should not go near any
one with a wound.

Wound infections are readily carried from one patient to another
in the same way as erysipelas is transmitted. A nurse who dresses
infected wounds should not attend those whose wounds are aseptic.

As hospital corps men serving in the tropics occasionally have
to nurse cases of plague, it is necessary that they should know some-
thing of that disease.

The most prominent symptoms of plague are great prostration,
high fever, and the development of buboes, most commonly in the
groin; but buboes are not always present. The disease is due to a
bacillus which is found in the blood and all the discharges, including
the pus from the buboes, the urine, feces, sputum, etc. It is con-
tagious and everything about the patient becomes infected, especially
the locality. It may be conveyed by dust, food, water and clothing,
by rats, mice and flies, and probably by ants and mosquitoes. Often
the infection occurs through some slight wound of the skin. Plague
patients should be isolated and everything which comes in contact
with them disinfected. Rats and vermin of every sort must be
systematically destroyed, and the utmost cleanliness insisted upon.
No one with a wound, sore, or even a scratch, should nurse plague
patients or visit an infected locality. Nurses should wear leggins
and should frequently disinfect their hands, mouths, and nostrils.

In typhus fever the infection is conveyed by the bite of the body
louse; probably also by the head louse and " crab " louse.

The body and clothing of the patient must be thoroughly disin-
fected in such a way as to kill all lice and their eggs ; then there will
be no danger of coatching the disease provided the surroundings of
the patient are also clean and free from vermin.
17



PART V

MESS MANAGEMENT AND COOKING



CHAPTER I

MESS MANAGEMENT

THE management of the hospital mess is one of the most impor-
tant duties pertaining to the hospital corps, as upon its success de-
pends not only the welfare of the patients, but much of the content-
ment and happiness of the men themselves. The noncommissioned
officer selected for this assignment must be not only a man of in-
telligence and business capacity, but also one who has had actual
experience in the kitchen.

The sources from which the mess is supplied are the rations issued
for the hospital corps ; a variable money allowance per day for each
enlisted man sick in hospital ; the hospital fund ; the products of the
hospital garden, chickens, and cows, and, in the field, hospital stores.

A ration is the allowance for the subsistence of one person for one
day. The garrison ration is intended for troops in garrison, and, in
time of peace, for troops in maneuver camps ; the ration to be issued
to troops on the march in time of peace will be prescribed by the
commander, and will not exceed the allowances prescribed for the
garrison ration : the travel ration is for troops traveling otherwise
than by marching and separated from cooking facilities ; the reserve
ration is carried on the person of the men and in the trains, and con-
stitutes the reserve for field service; the field ration is the ration
prescribed in orders by the commander of the field forces; the
Filipino ration is for use of the Philippine Scouts; and the emer-
gency ration for troops in active compangn for use on occasions of
emergency or in the field for purposes of instruction.

In time of war when Philippine Scouts are serving in the field
they will be subsisted the same as are regular troops. When im-
practicable for Philippine Scouts to use the Filipino ration while
traveling otherwise than by marching, on account of the lack of
cooking facilities or for other reasons, the travel ration may be
prescribed.

The kinds and quantities of the component articles of the Army

(259)



260



MESS MANAGEMENT AND COOKING



ration and the substitutive equivalent articles which may be
issued in place of such components are as follows :



i. GARRISON RATION.



Component article* and
quantities.


Substitutive articles and quantities.


Beef, fresh

Flour

Baking powder ...
Beans

Potatoes?
Prunes


20 ounces ....

8 ounces ....

0.08 ounces.
2.4 ounces . . .

20 ounces ....

i .28 ounces . .
i . 12 ounces . .


Mutton, fresh


20 ounces.
12 ounces.
16 ounces.

1 6 ounces.

14 ounces.
18 ounces.
16 ounces.
1 6 ounces.

18 ounces.
16 ounces.

20 ounces.

1.6 ounces.
i .6 ounces.
15 ounces.

1.28 ounces,
i .28 ounces.

i . 12 ounces.
i .4 ounces.
0.32 ounce.

0.014 ounce.
0.014 ounce.
0.014 ounce.

0.5 ounce.
0.014 ounce.


Canned meat, when impracticable to fur-
nish fresh meat.
Hash, corned beef, when impracticable to
furnish fresh meat.






Turkey, dressed, drawn, on Thanksgiving
Day and Christmas, when practicable.


Hard bread, to be ordered issued only
when the interests of the Government
so require.


(Rice




Onions, in lieu of an equal quantity of
potatoes, but not exceeding twenty per
cent of total issue.
Tomatoes, canned, in lieu of an equal
quantity of potatoes, but not exceeding
twenty per cent of total issue.
Other fresh vegetables (not canned) when
they can be obtained in the vicinity or
transported in a wholesome conditior
from a distance, in lieu of an equal
quantity of potatoes, but not exceeding
thirty per cent of total issue.
Apples, dried or evaporated
Peaches, dried or evaporated
Jam, in lieu of an equal quantity oi
prunes, but not exceeding fifty per cent
of total issue.


Coffee, roasted anc
ground.
Sugar








Pickles, cucumber, in lieu of an equal quan
tity of vinegar, but not exceeding fifty
per cent of total issue.


Milk, evaporated
unsweetened.
Vinegar

Salt


0.5 ounce,
o. 1 6 gill

0.64 ounce.
0.04 ounce.

0.014 ounce . .

0.64 ounce,
o. 5 ounce . . .
0.32 gill.
0.014 ounce .


Pepper, black . . .
Cinnamon
Lard


-< Ginger


Oleomargarine
Vanilla


Butter


Flavoring extract
lemon.





1 In Alaska, 16 ounces bacon, or, when desired, 16 ounces salt pork, or 22 ounces salt
beef.

1 In Alaska the allowance of fresh vegetables will be 24 ounces instead of 20 ounces, or
canned potatoes 18 ounces instead of 15 ounces.

NOTE. Food for troops traveling on United States Army transports will be prepared
from the articles of subsistence stores which compose the ration for troops in garrison,
varied by the substitution of other articles of authorized subsistence stores, the total daily
cost per man of the food consumed not to exceed 20 per cent more than the current cost
of the garrison ration, except on Thanksgiving Day and Christmas, when 60 per cent
increase over the same current cost is authorized.



MESS MANAGEMENT



261



One day in each alternate month of the season of practical instruc-
tion, not exceeding three days in each year, the use of the reserve
ration with individual cooking will be required by all troops in the
field for purposes of instruction.



2. TRAVEL RATION.



Component articles and
quantities.


Substitutive articles and quantities.


Beef, corned
Beans, baked ....
Tomatoes, canned.
Jam


18 ounces ....
12 ounces
4 ounces.
8 ounces.
i .4 ounces.
1.12 ounces.

2.4 ounces.
0.5 ounce.


Hard bread
Hash, corned beef


1 6 ounces.
12 ounces.


Coffee, roasted and
ground.
Sugar


Milk, evaporated,
unsweetened.



3. RESERVE RATION.



Component articles and
quantities.



Substitutive articles and quantities.



Bacon








or meat canned.
Hard bread
Coffee, roasted and
ground.
Sugar


1 6 ounces.
16 ounces.
1. 12 ounces.

2.4 ounces.






Salt


o. 1 6 ounce.















4. FIELD RATION.

The field ration is the ration prescribed in orders by the commander of the field forces.
It consists of the reserve ration in whole or in part, supplemented by articles of food
requisitioned or purchased locally, or shipped from the rear, provided such supplements
or substitutes correspond generally with the component articles or Substitutive equivalents
of the garrison ration.

5. FILIPINO RATION.



Component articles and
quantities.



Substitutive articles and quantities.











Beef, fresh


12 ounces ....


I Canned meat


8 ounces.
12 ounces.










Flour


8 ounces


f Hard bread


8 ounces.


Baking powder,
when in field
and ovens are
not available.
Rice, unpolished. .
Potatoes
Coffee, roasted and
ground.
Sugar


0.32 ounce.

20 ounces.
8 ounces
i ounce.


Onions


8 ounces.




0.08 gill.






Salt


0.64 ounce.






Pepper, black


0.02 ounce.







262 MESS MANAGEMENT AND COOKING

Scout organizations will be required to use the entire allowance
of the meat component, and not more than 16 ounces of rice per day
to be used for each ration. The purchase of 1.6 ounces of beans
per ration in substitution of the portion of the rice ration not drawn
will be made, and use of as large an extent as possible of native
products, such as camotes, mongos, and squash, will be required.

6. EMERGENCY RATION

The emergency ration is furnished, in addition to the regular
ration, as required for troops on active campaign or in the field for
purposes of instruction, and will not be opened except by order of an
officer or in extremity, nor used when regular rations are obtainable.

Ration returns upon which emergency rations are drawn will bear
the certificate of the organization commander that such rations are
required for the enlisted men of his organization and that the money
value of any rations previously drawn by him, and improperly
opened or lost, has been charged against the person responsible.

All articles of the garrison, travel, or Filipino ration due a com-
pany, or other military organization, will be retained by the com-
missary and credit given to the organization for the money value of
these articles at the current price of the articles ; and the commissary
will pay as savings to the organization commanders any excess in
value of the stores so retained over those purchased by the organiza-
tion.

The revenue from this source as well as that from the post bakery
(savings on flour), the post exchange, and the care of patients other
than soldiers in hospital constitutes the hospital fund, which may be
expended as far as desirable in giving greater variety and abundance
to the mess of the hospital corps.



Online LibraryCharles Field MasonA complete handbook for the sanitary troops of the U. S. army and navy and national guard and naval militia → online text (page 18 of 38)