EEGULATIONS 
 
 MEDICAL DEPARTMENT 
 
 MILITARY FORCES 
 
 x\ORTH CAROLINA. 
 
 riBLisHEn nv 
 
 CHAS. E. JOHNSON, M. D., 
 
 SURGEON GENERAL OF N. C. 
 
 V 
 
 RALEIGH : 
 
 STUOTHi.K * ^I.VRCOM BOOK AND JOB PRINTERS. 
 
 1 8G1 
 
 (7>/A ^37 
 
DUKE 
 
 UNIVERSITY 
 
 LIBRARY 
 
 Treasure %oom 
 
KEGULATIONS 
 
 MEDICAL DEPARTMENT 
 
 1. The Surgeon General, under the authority of the Gorernor, 
 and the Military Laws of the State, is charged with the adminis- 
 trative details of the Jledical ])e{)artmcnt, the governiuent of hos- 
 pitals, the regulation of the duties of Surgeons and Assistant Sur- 
 geons, and the assignment of Surgeons or Assistant Surgeons, where 
 needed, for local or detached service. He will issue orders and 
 instructions relating to their professional duties, and all communi- 
 cations from them, which rcfiuire his action, will be made directly 
 ti) him. 
 
 2. The medical supplies ro(|uired by Surgeons and Assistant 
 Surgeons will be obtained by a requisition on the Surgeon General, 
 a duplicate of the requisition of the Surgeon or Assistant Surgeon 
 being furnished to be filed. 
 
 3. When a medical officer transfers medical supplies to another, 
 or to a different post, he will take a receipt for the Bame. 
 
 4. Medical officers will account for all medical supplies that come 
 into their possession. 
 
 5. The .senior medical officer of a hospital will distribute the 
 patients, according to convenience and the nature of their com- 
 plaints, into wards or divisions, under the particular charge of the 
 Assistant Surgeons, and will visit them himself each day, as fre- 
 quently as the sick or wounded may require, accompanied by the 
 Assistant, Hospital Steward and Nurse. 
 
 6. His prescriptions of medicine and diet arc daily to bo written 
 down in a register, with the name of the patient and number of the 
 bed; and the Assistant or Steward, in his absence, will see that the 
 directions are carried out. 
 
4 MEDICAL REOULATIOXS. 
 
 7. He will, if ill charge of a hospital or post, with the approval 
 of the ommandiiig fifBeer, appointa steward, cooks and nurses, who 
 will be uiulcr his orders. 
 
 8. lie will enforce the proper hospital regulations to promote 
 health and prevent contagion, hy ventilated and not crowded rooms, 
 scrupuliius cleanliness, changes of bed, linen, &c. 
 
 9. At the Surgeon's call the sick in each corapan\- will be con- 
 ducted to the hospital by the First Sergeant, who will hand to the 
 Surgeon in his company book a list of all the sick, on which list the 
 Surgeon shall state who are to remain or go into hospital ; who arc 
 to return to quarters as sick or convalescent; what duties the con- 
 valescents in quarters are capable of, or any other information in 
 regard to the sick of the company which he may have to communi- 
 cate to the commander, and report to him. (Form 1.) 
 
 10. Soldiers in hospital, patients or attendants, except stewards, 
 shall be mustered on the rolls of the hospital department. 
 
 11. When a patient is transferred from one hospital to another, 
 the medical officer shall send with him an account of his case and 
 the treatment. (Form 4.) 
 
 12. The regulations for the service of hospitals apply as far as 
 practicable to the service in the field. 
 
 13. The senior medical officer of each hospital, post, regiment or 
 detachment, will keep the following records: a register of patients 
 (Form 2;) a prescription and diet book (Form 3;) a case book; 
 copies of his reiiuisitions; monthly returns of sick and wounded; 
 an order and letter book, in which will be transcribed all orders and 
 letters relating to his duties. 
 
 14. Ordinarily, hospital attendants are allowed as follows: to a 
 general hospital, one steward, o'ne nurse to ten patients, and (me 
 cook to thirty; to a post or garri.son of one company, one steward, 
 one nurse, one cook and for every two companies more, one nurse. 
 
 lo. Medical officers, in giving certificates of disability, are to take 
 particular care in all cases which have been under their charge, 
 and especially in epilepsy, convulsions, chronic rheumatism, gout, 
 dcranaeineiil of ihc urinary orjians. (iplitlialiiiia. iiliers. or any ob- 
 scure disi'ascs. 
 
 16 As .soon as companies are organizeil and ofl'ered for service, 
 the Surgeon or Assistant Surgeon will examine the members and 
 vaccinate them, if necessary. 
 
MEDICAL UE(U'I,ATIOSS. 5 
 
 17. Every medical officer will report to the Surgeon General the 
 date when he arrives at a station, or when he leaves it. and his 
 orders in the ca.sc. 
 
 18. Surgeons will make to the Surgeon General a monthly return 
 (Form 7) of the medical officers of the Command, and a consoli- 
 dated monthly report of the sick and wounded from the several 
 reports made to them ; giving the disease, name, regiment and com- 
 pany, discharges and deaths. (Form 5.) ALso a return of medi- 
 cines, instruments, hospital stores, furniture, &c. (Form G.) 
 
 It). If it be at any time necessary to employ a private physician, 
 the commanding officer may do it liy written contract, reporting a 
 duplicate to the Surgeon General. 
 
 20. Assi.stant Surgeons will obey the orders of their Senior Sur- 
 geon; see that subordinate officers do their duty, and aid in en- 
 forcing the regulations of the hospital. 
 
 21. The Steward will take charge of all hospital stores, instru- 
 ments, furniture of every description, a.. d supplies for the sick; 
 keep a roster of nurses and attendants ; and make out returns Air 
 rations, according to the number in hospital; receive and distribute 
 rations, and submit his book to the Surgeon, monthly, for examina- 
 tion, or oftcner if required, lie will issue the stores to nurses and 
 cooks, and enter the amount delivered in his hook. He will fee re- 
 sponsible for furniture, bedding, cooking utensils, &c., and keep the 
 store-room neat and clean. (Form G.) 
 
 22. In the management of hospitals and posts, cleanliness, order, 
 regularity in meals, attention to cooking, and special care of the 
 sick and wounded, are particularly enjoined upon the medical officers. 
 
 23. In pa.ssing a recruit, the medical officer is to examine him 
 stripped; to see that he has free use of all his limbs ; that his chest 
 isam])le; that his hearing, vision, and s]iccch are perfect; and that 
 he is nut suHorlng from any disorder or infirmity that may unfit 
 him for militarv service. 
 
MEDICAL RElilL.VTIOXS. 
 
 giitctiouji to glnniJ ^urgcon.'j. 
 
 (FROM A PAMPHLET ON THE HOSPITAL BRIGADE.) 
 
 BY G. J. GUTnUIE, 
 
 Surjrcon General to the British forces in the Crimean War. 
 
 1. Water being of the utmost importance to wounded men. care 
 should be taken when before the enemy, not only that the barrels 
 attached to the conveyance-carts are properly filled with good water, 
 but that skins for holding water, or such other means as are com- 
 monly used in the country fur carrying it, should be procured and 
 duly filled. 
 
 2. Bandages or rollers, applied on the field of battle are. in gen- 
 eral, so many things wasted, as they become dirty and stiff, and are 
 usually cut away and destroyed, without having been really u.seful; 
 they are therefore not forthcoming when reijuired, and would be of 
 no use. 
 
 3. Simple gun-shot wounds require nothing more, for the first 
 two or three days, than the application of a piece of wet or oiled 
 linen, fastened on with a strip of sticking-plaster, or, if possible, 
 kept constantly wet and cold with water. When cold disagrees, 
 warm water should be substituted. 
 
 4. Wounds made by swords, sabres, or other sharp-cutting instru- 
 ments, are to be treated principally by position. Thus, a cut down 
 to the bone, across the thick part of the arm, immediately below the 
 shoulder is to be treated by raising the arm to or above a right angle 
 with the body, in which po.sition it is to be retained, however in- 
 convenient it may be. Ligatures may be inserted, but through the 
 skin only. If the throat he cut acmss in front, any great vessels 
 should bo tied, and the oozing stopped by a sponge. .Xfter a few 
 
MEDICAL KEUULATIOX:*. ( 
 
 hours, when the oozing is arrested, the spon-ic should be removed, 
 and the head brought down towards the chest, and retained in that 
 position without ligatures ; if this is done too soon the sufferer way 
 possibly be suffocated by the infiltration ot blood into the areolar 
 tissue of the parts adjacent. 
 
 5. If the cavity of the chest is opened into by a sword or lanee, 
 it is of the utmost importance that the wound in the skin should be 
 effectively closed, and this can only be done by sewing it up as a 
 tailor or a lady would sew up a seam, skin only being included; a 
 compress of lint .should be applied over the stitches, fastened on by 
 sticking plaster. The patient is then to be placed on the wounded 
 side, that the lung may fall down, if it can, upon, or apply itself to 
 the wounded part, and adhere to it, by which happy and hoped-for 
 accident life will, in all probability, be preserved. If the lung 
 should be seen protruding in the wound, it should not be returned 
 beyond the level of the ribs, but be covered over by the external 
 parts. 
 
 6. It is advisable to encourage previously the discharge of blood 
 from the cavity of the chest, if any have fallen into it; but if the 
 bleeding from within should continue, so as to place the life of the 
 sufferer in danger, the external wound should be closed, and events 
 awaited. 
 
 7. When it is doubtful whether the bleeding proceeds from the 
 cavity of the chest, or from tl^ intercostal artery (a surgical bug- 
 bear,) an incision through the skin and the external intercostal 
 muscle will expose the artery close to the edge of the rib having 
 the internal intercostal muscle behind it. The vessel thus exposed 
 may be tied, or the end pinched by the forceps, until it cca.<<es to 
 bleed. Tying a string round the ribs is a destructive piece of 
 cruelty, and the plugs, &c., formerly recommended, may be consid- 
 ered as surgical incongruities. 
 
 8. A gun-shot wound in the chest cannot close by adhesion, and 
 must remain open. The position of the sufferer should therefore 
 be that which is most comfortable to him. A small hole penetrating 
 the cavity is more dangerous than a large one, and the wound is 
 less dangerous if the ball goes through the body. The wounds 
 should be examined, and enlarged if necessary, in order to remove 
 all extraneous substances, even if they should be seeh to stick on 
 
8 MEDICAL niXiULATIOXS. 
 
 the surface of tlic lungs; the opening should be covered with soft 
 oiled or wet lint — a bandage when agreeable. The car of the sur- 
 geon and the stethoscope are invaluable aids, and ought alwaj's to 
 be iu use; indeed, no injury of the chest can be scientifically treated 
 without them. 
 
 9. Incised and gun-shot wounds of the abdomen are to be treated 
 in ncnrli/ a similar manner; the position in both being that which 
 is most agreeable to the patient, the parts being relaxed. 
 
 11. In wounds of the bladder, an elastic catheter is generally 
 necessary. If it cannot be passed an opening should be made in the 
 perinseum for the evacuation of the urine, with as little delay as 
 possible. 
 
 12. In gun-shot fractures of the skull, the loose broken pieces 
 of bone, and all extraneous substances are to be removed as soon as 
 possible, and depressed fractures of bone are to be raised. A deep 
 cut made by a heavy sword through the bone into the brain, gener- 
 ally causes a considerable depression of the inner table of tlie bone, 
 whilst the outer may appear to be merely divided. 
 
 13. An arm is rarely to be amputated, except from the effects of 
 a cannon-shot. The head of the bone is to be sawn off, if necessary. 
 The elbow-joint is to be cut out, if destroyed, and the sufferer, in 
 either case, may have a very useful arm. 
 
 ll. In a ease of gun-shot fracture of the upper arm, in which the 
 bone is much splintered, incisions are to be made, for the removal 
 of all the broken pieces which it is feasible to take away. The 
 elbow is to be supported. The forearm is to be treated in a similar 
 manner; the splints used should be solid. 
 
 15. The hand is never to be amputated, unless all or nearly all 
 its parts are destroyed. Different bones of it and of the wrist are 
 to be removed when irrecoverably injured, with or without the 
 metacarpal bones and fingers or the thumb; but a thumb and one 
 finger should always be preserved when possible. 
 
 16. The head of the thigh bone should be sawn oft" ^vhen broken 
 by a musket-ball. Amputation at the hip-joint should only be done 
 when the fracture extends some distance into the shaft, or the limb 
 is destroyed by cannon-shot. 
 
 17. The knee-joint should be cut out when irrceovcrably injured; 
 but the limb is not to be amputated until it cannot be avoided. 
 
MliDKAL KKlJl LATIOXS. 9 
 
 18. A gun-shot fracture of the nruidle of the tliiirh. iittcnilud by 
 great splintering, is a case for amputation. In less difficult case.-", 
 the splinters should be removed by incisions, particularly when 
 they can be made on the upper and outer .side of the thigh. The 
 limb should be placed on a straight, firm splint. A broken thigh 
 does not admit of much, and sometimes of no extension, without an 
 unadvisablc increase of sufTering. An inch or two of shortening in 
 the thigh docs not so materially interfere with ]irogrcssion as to 
 make the sufferer regret having escaped amputation. 
 
 19. A leg injured below the knee .should rarely be amputated in 
 the first instance, unless from the effects of a cannon-shot. The 
 splinters of bone arc all t<i be immediately removed, bv saw or 
 forceps, after due incision.*. The limb should be placed in splints, 
 and hung on a permanent frame, as affording the greatest eomi'ort. 
 and probable chance of ultimate success. 
 
 20. An ankle-joint is to be cut out. unless the tendons around 
 are too much injured, and so are the tarsal and metatarsal bones and 
 toes. Incisions have hitherto been too little eni]iloyed in the early 
 treatment of these injuries of the foot for the removal of extraneous 
 substances. 
 
 21. A Wound of the principal artery of the thigh, in addition to 
 a gun-shot fracture, renders immediate aniput.ation necessary. In 
 no iithfr jKiit of the body is amputation to be done in the first in- 
 stance for such injury. Ligatures arc to be placed on the wounded 
 artery, one above, the other below the wound, and events awaited. 
 
 22. The occurrence of mortification in any of these cisos will be 
 known by the change of color in the skin. It will rarely occur in 
 the upper extremity, but will fieiiuently do so in the lower. When 
 about to take place, the C(dor of the skin of the foot changes, from 
 the natural flesh color to a tallowy or mottled white, .imputation 
 should be performed immediately above the fractured part. The 
 mortification is yet local. 
 
 23. When this discoloration lia.s not been observed, and the jiart 
 shrinks, or gangrene ha.s set in with more marked appearances, but 
 yet seems to have sfnjyinl at the ankle, delay is, perhaps, admissible, 
 but il' it should again spread, or its cessation be doubti'ul, amputa- 
 tion shoulil take place forthwith, although under less favorable 
 circumstances. The mortification is becoming, or ha.< 1 ecome con- 
 slitulional. 
 
10 -MKUICAi, KKOiLLATIOXS. 
 
 24. IJlccJiiiL'. to the loss of life, is not a cominoi) occurreiK-e in 
 uuii-sliot wounds, althouu'li many do lileed considerablj-, seldom, 
 however, reijuirinc: the application of a tourni(|UCt a.s a matter of 
 necessity, although frequently a.s one of jjreeaution. 
 
 25. AVhen the great artery of the thigh is wounded (not torn 
 across), the bone being nninjiirfil. the suflVrer will probably bleed 
 to death, unless aid be afforded, by making coin])ression above, and 
 on the bleeding part. A long, but not broad stone, tied sharply on 
 *vith a handkerchief, will often suffice until a.«sistanee can be ob- 
 tained, when both ends of the divicbil ur wonnded artery are to be 
 secured by ligatures. 
 
 26. The upper end of the great artery of the tliigh bleeds scarlet 
 blood, the lower end dark venous-colored blood; and this is not 
 departed from in a case of accidental injury, unless there have been 
 previous diseases in the limb. A knowledge of this fact or cir- 
 cumstance, which continues for several days, will jjrcvent a mistake 
 at the moment of injury, and at a subsequent period, if secondary 
 hajuinrrbage should occur. In the tipper extremity both ends of 
 the principal artery bleed scarlet blood, from the Iree collateral 
 circulation, and from the anastomoses in the hand. 
 
 27. From this cause, mortification rarely takes place after a wound 
 of the principal artery of the arm, or even of the arm-pit. It 
 freqnmtlji follows a wound of the principal artery in the upper, 
 middle, or even lower pai-ts of the thigh, rendering amputation ne- 
 cessary. 
 
 28. It is a great question when the bone is iininjiircil, where, and 
 at what part, the amputation should be performed. Mortiticatiou 
 of the foot and leg, from such a wound, is disposed to stop a little 
 below the knee, if it should not destroy the sufferer; and the ope- 
 ration, if done in the first instance, as soon ns the tallowy or mot- 
 tled appearance of the foot is observed, should be doneat that part; 
 the wound of the artery, and the operation for securing the vessel 
 above and below the wound, being left unheeded. By this proceed- 
 ing when successful, the knee-joint is saved, whilst an amputation 
 above the middle of the thigh is always very doubtful in its result. 
 
 29. When mortification has taken place from any cause, and has 
 been arrested below the knee, and the dead parts show some sign 
 of separation, it is usual to amputate above the knee. By not doing 
 
MEmCAL UECirLATIOXS. 11 
 
 it, but by gradually separating and removing the dead parts under 
 the use of disinfecting nicdieaments and fresh air, a good stump 
 may bo ultimately made, the knee-joint and life being preserved, 
 which latter is frequently lost after amputation under such circum- 
 stances. 
 
 30. Hospital gangrene, when it unfortunately occurs, should be 
 considered to be contagious and infectious, and is to be treated 
 locally by destructive remedies, such as nitric acid, and (he bivou- 
 acking or encamping of the remainder of the wounded, if it can be 
 cflcctcd or their removal to the open air. 
 
 31. Poultices have been very often ap|)licd in gun-shot wounds, 
 from laziness, or to cover neglect, and should be used as seldom a.s 
 possible. 
 
 32. ('hlori)forin may be administered in all ca.ses of amputation 
 of the upper extremity and below the knee, and in all minor opera- 
 tions; which cases may also be deferred, without disadvantage, until 
 the more .serious operations are performed. 
 
 33 Amputation of the upper and middle parts of the thigh are 
 to be done as soon as possii)lo after the receipt of the injur_y. The 
 adminislration of chloroform in them, when there is much prostra- 
 tion, is doubtful, and must be attended to. and observed with great 
 care. The ((Uestion whether it should or should not be administered 
 in such cases being undecided. 
 
 i 
 
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MEDICAL REGULATIONS. 
 
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