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MEDICAL DEPARTMENT 
MILITARY FORCES 
NORTH CAROLINA 

1861 



I 



HEALTH SCIENCES LIBRARY 

OF THE 

UNIVERSITY OF NORTH CAROLINA 

AT CHAPEL HILL 



I 




ll 



Digitized by the internet Archive 

in 2011 with funding from 

North Caroiina History of Heaith Digitai Coiiection, an LSTA-funded NC ECHO digitization grant project 



http://www.archive.org/detaiis/reguiationsformenort 



REGULATIONS 



FOR THE 



MEDICAL DEPARTMENT 



OF THE 



MILITARY FORCES 



OF 



NORTH CAROLINA. 



rUBLISHED BY 

CHAS. E. JOHNSON,^M. D., 

SURGEON GENERAL OF N. C. 



RALEIGH : 

^rROTHER & MARCOJI BOOK AND JOB PRINTERS. 



1861. 




library of 
(Eljc UntDersity of HortI] Carolina 



COLLECTION OF 

NORTH C A R O L I N I A N A 



K N D O W E D T3 Y 

JOHN SPRUNT HILL 
of the class of 1889 



■'*. :!! 



IIEGULATIONS 



FOR THE 



MEDICAL DEPARTMENT 



OF THE 



MILITARY FORCES 



OF 



NORTH CAROLINA. 



P0ELTSHED BY 

CHAS. E. JOHNSON, M. D., 

SURGEON GENERAL OF N. 0. 



RALEIGH : 

STEOTHER & MAECOM BOOK AND JOB PRINTERS. 
1861. 



EEGULATIONS 

PQB THE 

MEDICAL DEPARTMENT 



1. The Surgeon General, under tlie authority of the Governor, 
and the Military Laws of the State, is charged with the adminis- 
trative details of the Medical Department, the government 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 require his action, will be made directly 
to him. 

2. The medical supplies required 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 same. 

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 are daily to be 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. 



26636 



4 MEDICAL REGULATIONS. 

7. He will, if in charge of a hospital or post, with the approval 
of the c jinmanding officer, appoint a steward, cooks and nurses, who 
will be under his orders. 

8. He will enforce the proper hospital regulations to promote 
health and prevent contagion, hy ventilated and not crowded rooms, 
scrupulous cleanliness, changes of bed, linen, &c. 

9. At the Surgeon's call the sick in each company will he 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 are 
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 requisitions; 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, ho.spital attendants are allowed as follows: to a 
general hospital, one steward, oViC nurse to ten patients, and one 
cook to thirty; to a post or garrison of one company, one steward, 
one nurse, one cook and for every two companies more, one nurse. 

15. 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, 
deranoemeut of the urinary organs, ophthalmia, ulcers, or any ob- 
scure diseases. 

16. As soon as companies are organized and offered for service, 
the Surn-eon or Assistant Surgeon will examine the members and 
vaccinate them, if necessary. 



MEDICAL REGULATIONS. 5 

17. Every medical oiRcer will report to the Surgeon General the 
date when he arrives at a station, or when he leaves it, and his 
orders in the case. 

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 6.) 

19. If it be at any time necessary to employ a private physician, 
the commanding oiRcer may do it by written contract, reporting a 
duplicate to the Surgeon General. 

20. Assistant 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, at.d supplies for the sick; 
keep a roster of nurses and attendants ; and make out returns for 
rations, according to the number in hospital; receive and distribute 
rations, and submit his book to the Surgeon, monthly, for examina- 
tion, or oftener if required. He will issue the stores to nurses and 
cooks, and enter the amount delivered in his book. He will be re- 
sponsible for furniture, bedding, cooking utensils, &c., and keep the 
store-room neat and clean/ (Form 6.) 

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 passing a recruit, the medical officer is to examine him 
stripped; to see that he has free use of all his limbs ; that his chest 
is ample; that his hearing, vision, and speech are perfect; and that 
he is not suffering from any disorder or iniirmity that may unfit 
him for military service. 






MEDICAL REGULATIONS. 



(FROM A PAMPHLET ON THE HOSPITAL BRIGADE.) 

BY G. J. GUTHRIE, 

Surgeon 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 for 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 useful; 
they are therefore not forthcoming when required, 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 position it is to be retained, however in- 
convenient it may be. Ligatures may be inserted, but through the 
skin only. If the throat be cut across in front, any great vessels 
should be tied, and the oozing stopped by a sponge. After a few 



MEDICAL REGULATIOXS. 7 

hours, when the oozing is arrested, the sponge should be removed, 
and the head brought down towards the chest, and retained in that 
position without hgatures; if this is done too soon the sufferer may 
possibly be suifocated by the infiltration oi blood into the areolar 
tissue of the parts adjacent. 

5. If the cavity of the chest is opened into by a sword or lance, 
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^titchea, 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 the 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 ceases to 
bleed. Tying a string round the ribs is a destructive piece of 
cruelty, and the plugs, &c., formerly recommended, maybe 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 REGULATIONS. 

the surface of tlie lungs; the opening should be covered with soft 
oiled or wet lint — a bandage when agreeable. The ear of the sur- 
geon and the stethoscope ai-e invaluable aids, and ought always to 
be in 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 nearly 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 cannoy)e passed an opening should be made iu the 
perinaeum for the evacffiition 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 the 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. 

14. In a case 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 off when 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 irreeoverably injured; 
but the limb is not to be amputated until it cannot be avoided. 



MEDICAL REUULATIOXS. it 

18. A gun-shot fracture of tlie middle of the thigh, attended by 
;reat splintering, is a case for amputation. In less difficult cases, 
,he 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 
unadvisable increase of sufiering. An inch or two of shortening in 
the thigh does not so materially interfere with progression as to 
make the suiferer regret having escaped amputation. 

19. A leg injured below the knee should rarely be amputated in 
the first instance, unless from the efi"ects of a cannon-shot. The 
splinters of bone are all to be immediately removed, by saw or 
forceps, after due incisions. The limb should be placed in splints, 
and hung on a permanent frame, as aifording the greatest comfort, 
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 employed 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 amputation necessary. In 
no other part of the body is amputation to be done in the first in- 
stance for such injury. Ligatures are to be placed on the wounded 
artery, one abo^''c, the other below the wound, and events awaited. 

22. The occurrence of mortification in any of these cases will be 
known by the change of color in the skin. It will rarely occur in 
the upper extremity, but will frequently do .so in the lower. When 
about to take place, the color of the skin of the foot changes, from 
the natural flesh color to a tallowy or mottled white. Amputation 
should be performed immediately above the fractured part. The 
mortification is yet local. 

23. When this discoloration has not been observed, and the part 
shrinks, or gangrene has set in with more marked appearances, but 
yet seems to have stopjyed at the ankle, delay is, perhaps, admissible, 
but if it should again spread, or its cessation be doubtful, amputa- 
tion should take place forthwith, although under less favorable 
circumstances. The mortification is becoming, or has heoome con- 
stitutional. 

9. 



10 MEDICAL REGULATIONS. 

24. Bleeding, to the loss of life, is not a common occurrence in 
gun-shot wounds, although many do bleed considerablj', seldom, 
however, requiring the application of a tourniquet as a matter of 
necessity, although frequen.tly as one of precaution. 

25. When the gyeat artery of the thigh is wounded (n«t torn 
across), the bone beiag uninjured, the sufferer will probably bleed 
to death, unless aid be- afforded, by making compression above, and 
on the bleeding part. A long, but not broad stone, tied sharply on 
with a handkerchief, will often suffice until assistance can be ob- 
tained, when both ends of the divided or wownded artery are to be 
secured by ligatures. 

26. The upper end of the great artery of tlie thigh 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 prevent a mistake 
at the moment of injury, and at a subsequent period, if secondary 
haemorrhage should occur. In the iqjjyer 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 eveu of the arm-pit. It 
frequently follows a wound of the principal artery in the upper, 
middle, or even lower parts of the thigh, rendering amputation ne- 
cessary. ■ * 

28. It is a great question when the bone is uninjured, where, and 
at what part, the amputation should be performed. Mortification 
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 as 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 



MEDICAL RESULATIONS. 11 

it, but by gradually separating and removing the dead parts under 
the use of disinfecting medicaments and fresh air, a good stump 
may be 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, aud is to be treated 
locally by destructive remedies, such as nitric acid, and the bivou- 
acking or encamping of the remainder of the wounded, if it can be 
effected or their removal to the open air. 

31. Poultices have been very often applied in gun-shot wounds, 
from laziness, or to cover neglect, aud should be used as seldom as 
possible. 

32. Chloroform may be administered in all cases 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 possible after the receipt of the injury. The 
administration of chloroform in th«m, when there is much prostra- 
tion, is doubtful, and must be attended to, and observed with great 
care. The question whether it should or should not be administered 
in such cases being undecided. 



12 



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