apply also to the similar medical department units on the line of
communications, except that the duties performed by the Surgeon
General with respect to the former will devolve in the latter case
upon the surgeon, base group.
For the purpose of giving attention to sanitary matters not within
the control of regimental or other military organizations, sanitary
squads will be organized on the line of communications at such
places as may be necessary.
The personnel of such squads will consist of enlisted men of the
Hospital Corps augmented by such number of other enlisted men
.to SANITARY TROOPS IN POST AND FIELD
and civilian laborers as the amount and character of the work may
justify. Each squad will be in immediate charge of a medical officer.
The function of sanitary squads is to supervise or execute, as
the case may be: (i) The necessary measures for the sanitation of
camp sites, towns or villages not occupied or garrisoned, or of such
parts of the same as may be otherwise unprovided for; (2) sanitary
work that may be necessary for the general welfare but that can not
be performed conveniently or profitably by individual organizations ;
(3) the operation of sanitary apparatus used by troops in common
and not under control of any one organization.
Sanitary squads will not be employed to relieve regimental and
other similar organizations of the duty of providing for the sanita-
tion of their own camps.
Rest stations are organized for the purpose of giving temporary
care and treatment to sick and wounded en route. When on railway
lines those established on the line of communications are similar in
every way to those pertaining to the service 'of the interior and their
personnel should, if practicable, be obtained in like manner.
THE BASE MEDICAL SUPPLY DEPOT
A medical supply depot will be established at the base. The
officer in charge of this depot will prepare in quadruplicate a list of
all supplies required, showing the maximum and minimum quanti-
ties of each article which should be kept on hand in the depot,
having due regard in formulating this estimate to the number of
troops to be supplied, the time required by the depot to replenish
supplies, the character of the military operations in prospect, etc.
In stating the minimum quantity of supplies the supply officer should
include at least one medical reserve unit for each division at
the front, in addition to the supplies likely to be required by the
sanitary formations on the line of communications. Three copies
of the above-mentioned list will be forwarded through military
channels to the commander of the military forces. When approved,
one copy will be retained at the headquarters of the commander of
the field forces, one copy will be sent to the Surgeon General, and
one copy will be returned to the officer in charge of the depot.
THE SANITARY SOLDIER IN WAR 31
THE ADVANCE MEDICAL SUPPLY DEPOT
The stock on hand at this depot will be considered a part of the
available supply of the base depot, as far as the table fixing the
maximum and minimum stock limits is concerned.
THE EVACUATION HOSPITAL
The evacuation hospitals are Medical Department units belonging
to the line of communications. Ordinarily two evacuation hosptals
will be assigned to a line of communications for each division which
it serves in the zone of the advance. They will be numbered and
designated like the base hospitals.
The primary function of the evacuation hospital is to replace field
hospitals so that the latter may move with their divisions, or to take
over their patients with the same object .in view, so far as it
may be practicable.
THE EVACUATION AMBULANCE COMPANY
Evacuation ambulance companies are organized only in time of
war or when war is imminent. They are allowed in the proportion
of one for each division at the front. They will be numbered con-
secutively from i upward for each field army to which they belong,
as " Evacuation Ambulance Company No. i, 3rd Field Army."
The primary function of the evacuation ambulance company is
the evacuation of field hospitals and the transportation and care of
patients en route therefrom to evacuation, base, or other hospitals
on the line of communications or to points with train or boat connec-
tions for rail or water transport to such hospitals.
For administration and control the line of communications is
organized as follows :
(1) A service of defense.
(2) A supply, sanitary, and telegraph service.
(3) A service of military railways.
All personnel pertaining to the sanitary service of the line of
communications report at the base for assignment to duty. Here
advance and intermediate sections are organized and sent forward
32 SANITARY TROOPS IN POST AND FIELD
RESUME OF THE OPERATIONS OF THE SANITARY
SERVICE IN WAR
When war is imminent, the Regular Army is mobilized at its
permanent posts or stations and the Organized Militia at mobiliza-
tion camps. Ltttle is required of the Medical Department at the
time of mobilization in connection with the preparation of organiza-
tions of the Regular Army for active service. Field equipment is
maintained at designated stations or depots in readiness for service
at all times; the men of the Hospital Corps available for service
with line organizations and with the sanitary train are designated
in time of peace and are in readiness to join their respective units.
The men composing the line organizations have been given thorough
physical examinations which have been made of record, and they
have been vaccinated against smallpox and typhoid fever. Each
man is equipped with a first-aid packet and has been instructed in
its use. So far as the Medical Department is concerned, therefore,
these troops should be in readiness to proceed from their points of
mobilization to the camps of concentration on short notice.
Mobilization camps for the Organized Militia are provided in
each State. An officer of the Regular Army commands each camp
and has on his staff a camp surgeon, usually a medical officer of the
Regular Army. Mobilization camps are operated under the control
of department commanders, who are responsible for the complete
preparation and equipment of the troops which assemble there.
The work of the Medical Department at these camps is supervised
by the department surgeon and the sanitary inspector of the depart-
ment. The camp surgeon is provided with an adequate corps of
assistants. Physical examinations of troops mobilized are made and
recorded in accordance with specific instructions from the War
Department. Vaccinations against smallpox and typhoid fever are
administered and records made thereof. Individuals and organiza-
tions are furnished such portions of their equipment as pertain to
the Medical Department; and such training in sanitary matters is
given both the line troops and the sanitary troops as is possible, and
appropriate to each. When for any reason it is impracticable to
fully prepare individuals and organizations for service at the front,
so far as this preparation devolves upon the Medical Department,
THE SANITARY SOLDIER IN WAR 33
the camp surgeon will furnish a full report to the department
surgeon showing what remains to be done in order that the latter
may take the necessary steps to have the preparation of such indi-
viduals and organizations completed at the camp of concentration.
After mobilization, equipment, and preliminary training, the
troops are assembled at concentration camps for immediate use
against the enemy or for transport to an over-sea theater of opera-
tions. At camps of concentration the general instruction and train-
ing of line and sanitary troops in connection with the work of the
sanitary service is conducted under the direction of the camp
On leaving camps of concentration, troops pass from the service
of the interior to the theater of operations, where they came under
the control of the commander of the field forces. They may pass
directly into the zone of the advance or they may traverse the zone
of the line of communications before reaching the zone of the
advance, or they may be assigned to duty on the line of communica-
tions. In the latter case they may be assigned either to the service
of defense, to the supply, sanitary, and telegraph service, or to the
service of military railways. The relations and duties of the sani-
tary personnel in this zone are described in paragraphs 751 to 827
M. M. D.
The sanitary service of the zone of the advance is treated in
detail in paragraphs 630 to 750 M. M. D. The purpose of the service
in camp, on the march, and in combat is to render temporary aid to
the sick and wounded and to expedite their transportation to the
rear, always making such disposition as will secure the retention at
the front of all men fit for duty and relieve the fighting force of
the impediment incident to the presence of men incapacitated for
duty. To that end the service of the advance is assisted by the
service of the line of communications, if one has been organized;
otherwise directly by the service of the interior. In either event it
cooperates with the advance station of the service in its immediate
rear. When battle is imminent, the resources of the sanitary service
behind the zone of the advance are placed in readiness to meet the
demands for the care and transportation of the wounded which may
reasonably be expected, and personnel and supplies are advanced as
near the seat of operations as practicable, reaching forward into the
zone of the advance if conditions warrant it.
34 SANITARY TROOPS IN POST AND FIELD
The troops engaged in combat are accompanied by medical officers
and Hospital Corps attendants; ordinarily a medical officer with a
detachment of Hospital Corps men accompanies each battalion into
combat, and the surgeon of each regiment with the equipment carried
on a pack mule establishes an aid station. The wounded apply
their own first-aid dressings, if practicable, and the sanitary
personnel attached to organizations render first aid as soon as pos-
sible. The sanitary personnel with each battalion collect the
wounded in. groups and transport those who are unable to walk to
the regimental aid station. Men with trivial wounds are sent back
to their commands when their wounds are dressed, and those slightly
wounded but able to walk are directed to the station for slightly
wounded several miles in the rear, in order that dressing stations
and field hospitals may not be unnecessarilv congested by the
presence of this class of men.
At the aid stations the sanitary service with troops connects
with the service of the sanitary train. Each ambulance company
establishes a dressing station in a protected location usually some
distance in rear of the aid station. The dressing stations send for-
ward bearers to remove' the wounded who have been brought in to
the aid stations. At the dressing stations light nourishment is pro-
vided, dressings are examined and adjusted or reapplied, as condi-
tions may require, and the patients who require transportation are
made as comfortable as possible until it is practicable to transport
them to the rear, usually to the field hospitals. Whenever possible
the dressing stations are so located that they can be reached by
wheel transportation, and the wounded are sent to the field hospitals
The field hospitals do not perform the functions of civil hospitals
or of base or general hospitals, in that their equipment is limited
to those things necessary to provide shelter, nourishment, and
emergency treatment for patients until they can be transferred to
the immobile units at the rear. At the field hospitals no beds or
cots are provided. The patients are placed on straw over which
blankets are spread. The service of the zone of the advance con-
trolled by the division surgeon terminates with the field hospitals.
The units of the line of communications pushed forward into the
zone of the advance relieve the field hospitals of their sick and
wounded as rapidly as possible.
THE SANITARY SOLDIER IN WAR 35
One of the evacuation hospitals held in readiness at the head of
the line of communications will ordinarily receive the patients from
the field hospitals. In some cases an evacuation hospital is pushed
forward and takes charge of the patients at the location of the field
hospital ; in other cases transportation from the advance section of
the line of communications is sent forward to the field hospital to
receive the patients, and in many cases the wagons going to the rear
for supplies will transport the patients back to the refilling point
where they will be turned over to the wagons sent forward from the-
advance section. The evacuation hospital is the first sanitary unit
in which provision is made to retain patients for any length of time.
It is equipped with cots, blankets, and a liberal supply of comforts
for the sick, but ordinarily the evacuation hospitals will be cleared
of patients as early as practicable in order that they may be ready
to receive others from the front. The patients are usually sent back
by trains or boats to the base hospitals where all possible comforts
and facilities for their care are provided. All sick and wounded who
will be able to return to duty within a reasonable time will be retained
at their hospitals rather than turned over to the service of the inte-
rior. Patients who no longer need medical attention are placed in
convenient camps operated in connection with the base hospitals until
they regain sufficient strength to return to their commands. The
base is the great center of medical activity of an army. Personnel
and supplies intended for the Army are accumulated here and sent
forward as required. The sick and wounded are sent back to the
base and cared for. Records of both supplies and personnel are
kept at the base, and such abstracts and tabulations as the chief
surgeon of the field army may require from time to time are made
here and supplied to him.
The losses at the front are being constantly replaced by men sent
forward through the channels above described. New recruits are
sent to the mobilization camps where they are equipped and drilled
and pushed forward to meet the demands in the zone of the
Supplies furnished by the Medical Department for troops at the
front are ordinarily obtained through the supply depot at the head
of the line of communications on requisitions approved by the divi-
sion surgeon. Each sanitary formation may make its own requisi-
tion, and its supplies may be sent forward from the advance section
36 SANITARY TROOPS IN POST AND FIELD
to the refilling points where the transportation furnished by the line
of communications turns over the supplies to the transportation sent
back from the divisional organizations. The stream of supplies
coming forward, consisting of rations, clothing, and ammunition, is
constant, and ample opportunity is afforded to bring up the articles
required by the sanitary service with the other supplies. When
found to be more convenient the regimental sanitary supplies may
be replenished from camp infirmaries or from the supplies carried
by the ambulance companies, these latter making requisitions for the
supplies which they require. The supply depot at the advance sec-
tion draws its supph'es from the depot at the base, the stock of which
is automatically maintained by the service of the interior.
ANATOMY AND PHYSIOLOGY
IN order that the hospital corps man may intelligently perform
his numerous duties in connection with the sick and wounded, it is
necessary that he should understand something of the structure of
the human body and the functions of its various organs. It is not
intended to give him that little incomplete knowledge that is a " dan-
gerous thing," but rather a knowledge which, while not like that of a
physician, is complete as far as it goes.
THE SKELETON AND JOINTS
THE skeleton is the bony framework of the
body, gives it stability and form, and protects the
organs, while the joints permit of motion.
Bone, is composed of about one-third animal
matter, mostly gelatin, and two-thirds mineral
matter, chiefly lime salts. The animal matter
gives bone its toughness and elasticity ; this may
be demonstrated by leaving a bone for some time
in dilute acid by which the mineral matter is re-
moved and the gelatin alone is left; the bone
may then be tied in a knot. The mineral matter
gives the bone its hardness ; the animal matter is
all removed by burning the bone which then be-
comes brittle as chalk. Young bones contain
more animal matter and are hence tougher and
harder to break ; when they do break, the fracture ,
is apt to be incomplete like a broken green stick.
Elderly persons' bones break easily because they FIG. 3 . Section of Fe-
J ' 'mur. A, A, Cancellous
contain more mineral matter.
tissue; B, compact tissues.
ANATOMY AND PHYSIOLOGY
If you saw a long bone across, the end will be found spongy or
cancellous, while the shaft is compact and dense. The shaft is also
hollow and contains marrow (Fig. 3).
Bone is covered by a vascular membrane, the periosteum, which
nourishes the bone ; where the periosteum is stripped off, the bone is
apt to die from insufficient
nourishment, the death of
the bone being known as
caries or necrosis.
The bones of the human
body number about two
hundred, without counting
the thirty-two teeth and
some accessory small
bones; taken together with
the cartilages they compose
the skeleton. Cartilage, or
gristle, is an elastic sub-
stance, like bone without
mineral matter; it is seen
extending from the lower
ribs to the breast bone and
covering the ends of the
The bones are classified
as long, short, flat, and
The long bones, of which
the thigh bone is an exam-
ple, form a system of levers
which support the weight
of the body and provide the
means of locomotion. The
short bones, such as those
of the wrist, are found
where strength and limited
motion are the requisites;
the flat bones, of which the
FIG. 4.- Skeleton
bones of the
a re an
THE SKELETON AND JOINTS
example, serve principally for protection; the irregular bones are
illustrated by those of the pelvis.
In considering the skeleton (Fig. 4) let us start from the vertebral
column, also called the spinal column, spine, or backbone. The
name vertebra is given to each separate
bone composing the column. The sep-
arate bones are not allowed to rub
against each other, but are separated
by pads or buffers of elastic cartilage,
and at the same time tied together with
Strong fibrous ligaments.
These buffers of intcrvertcbrcl sub-
stance break up and distribute the
shock which would otherwise result
from falls or in jumping.
On looking at the spine (Fig. 5) it
will be observed that it increases in
size from above downward, which is
but natural when one considers the
increase in weight to be borne by the
lower part as compared with the upper.
The highest vertebrae, those of -the
neck, seven in number, and called
cervical, support the head only. Next
in order come the twelve dorsal, which
in addition support the ribs, chest, and
upper extremities. In the next region,
the small of the back, are found the
five massive lumbar vertebrae, which
have the entire trunk to support. The
vertebral column ends in two large masses of bone known as the
sacrum and the coccyx or tailpiece. In the growing youth the
sacrum is composed of five separate bones and the coccyx of four,
but in the adult these separate bones are welded into one mass.
Each vertebra consist of a solid body in front and an arch en-
closing a central cavity behind. When the vertebrae are in their
natural position one resting upon another, the arches together form
a canal, the spinal canal, 'which in the living body contains and pro-
tects the spinal cord.
FIG. 5. Spinal Column. A,
Cervical; B, dorsal; C, lumbar;
V, sacrum; E, coccyx.
This spinal cord is everywhere in contact with the bony canal in
which it lies, so that when a fracture or dislocation of the spinal
column occurs a laceration of the cord is almost certain to occur,
and it is this coincident injury to -the cord which gives to these
injuries their special importance.
If the fingers are drawn along the center of one's back they come
in contact with a number of projecting bony points; these are the
spinous processes of each
vertebra and are situated
on the back of the arch.
Both the sacrum and
coccyx take part in the
formation of the large
girdle of bone met with at
the lower part of the trunk
under the name of the
pelvis, or basin (Fig. 6),
and which receives the
weight of the body and
hands it over to the lower
extremities at the hip
joints. The sacrum forms
the keystone of the arch,
the sides of which are composed of the two innominate bones or
nameless bones, separated in front by a pad of cartilage, and all
locked together by powerful ligaments.
Within the pelvis are situated the urinary bladder in front and the
rectum behind, and, in the female, between the two is placed the
uterus. Each innominate bone consisted originally of the three
bones, the ilium, ischium, and pubis, but these become fused to-
gether so as to form one bone in the adult. On each side of the
pelvis is seen a cup-shaped cavity in the innominate bone, known as
the acetabulum, the purpose of which is to receive the spherical head
of the femur, so as to make the hip joint.
A joint is the place where two bones meet and move upon each
other; the ends of the bones are covered with smooth cartilage and
to still further prevent friction the cartilages and the whole joint are
enclosed in a smooth, glistening membrane, the synovial membrane,
which secretes the synovia or joint oil.
FIG. 6. Pelvis.
A, Innominate bone; B, sacrum; E, coccyx.
THE SKELETON AND JOINTS
Outside the synovial membrane the bones are firmly bound to-'
gether by fibrous ligaments, while the joint is still further strength-
ened by the surrounding muscles. A joint, therefore, consists of
bones, cartilages, synovial membrane, and ligaments.
Joints differ very much in their character and the kind of motion
they permit. Thus we have the almost perfect freedom of motion
permitted by the ball-and-socket joints, like the shoulder and hip, the
more limited motion of hinged joints, like the knee, and the almost
motionless, imperfect joints, such as the sutures of the skull.
A dislocation is a slipping away of the joint surfaces from each
other to such an extent that they remain " out of place " and the
joint is locked; in such a deep, strong joint as the
hip, violence is more apt to give rise to fracture
than to dislocation.
Entering into the formation of the hip joint is
the thigh bone or femur (Fig. 7), the largest and
longest bone in the body.. Like other long bones
it has a shaft and two extremities. The upper ex-
tremity consists of a head, neck and two trochanters.
The head is globular and attached to the shaft by a
narrow neck set at an angle; it is in this narrow
neck that fracture so frequently occurs.
The trochanters are merely bony knobs to which
muscles are attached to move the joints; the great
trochanter is the bone which you may feel just
under the skin on the outer side of the hip. The
lower extremity of the femur is expanded into two
broad condyles which with the upper end of the
tibia or shin-bone, and the patella or
knee-cap (Fig. 8) form the knee-joint.
The patella is the small round bone lying
just in front of the knee and in the ex-
8. tended position of the leg is freely mov-
able with the tendon in which it lies.
The knee joint is the largest in the body and from its exposed
position one of those most liable to injury; once injured it is apt to
be sensitive ever afterward.
Beyond the knee we come to the leg composed of the tibia on the
inside and the fibula or splint bone on the outside (Fig. 9). The
FIG. 7. Femur.
ANATOMY AND PHYSIOLOGY
tibia is a strong prism-shaped bone, the inner surface and front
edge just beneath the skin and constituting the shin;
on account of its being just beneath the skin, frac-
tures of this bone are apt to be compound. The
fibula is a long slender bone deeply buried under
the muscles; it is frequently broken just above the
ankle where it can be felt; such a break is known