RAMC

Instructions to Regimental Surgeons
For Regulating the concerns of the sick
And of the hospital

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Instructions to Regimental Surgeons for
Regulating the concerns of the Sick and of the Hospital

Introduction

Horse Guards, September 1803.
His Majesty, having been pleased to approve the following regulations for the use of regimental hospitals, His Royal Highness the Commander in Chief, hereby enjoins commanding officers of regiments, of every description, and all regimental and assistant surgeons to govern themselves, in their respective duties, touching the care of sick soldiers, and the management of regimental hospitals, in strict conformity thereto.

By Order of 
His Royal Highness the Commander in Chief 
Harry  Calvert
Adjutant-General. 

Regulations

His Royal Highness the Commander in Chief having issued the most positive orders to all officers commanding Brigades and Regiments, to give very particular attention to the management of regimental hospitals, it becomes our duty to introduce such rules and regulations for the interior economy of the same, as may best provide for the health and comfort of the soldier, and generally secure to his majesty's service all the advantages to be expected from our care and superintendence.

We hope the following instructions, duly attended to, will be found conducive to those desirable and important objects. The reports of the visiting officer and of the surgeon will afford such information to the commanding officer, as will satisfy him, with the help of his own occasional visits, that the several duties of the hospital are duly performed.

The journals to be kept by the surgeon will be proof of his diligence, and the best evidence of his professional ability.

Control of the Hospitals

All regimental hospitals are under the immediate direction of their respective surgeons, subject nevertheless to the general superintendence and control of the Inspector General of Army Hospitals, and of any other officers of the medical staff, who may be ordered by his Royal Highness the Commander in Chief, to inspect the same from time to time. They are to see that every part of the hospital regulations has been observed, to assist with their advice the attending surgeon, and to propose to the officers commanding brigades or regiments, such further improvements as they may deem necessary to the benefit of the sick, and of the service.

When a regiment is divided and stationed in different quarters, the medical staff is to be equally distributed, that as few detachments as possible may be left to the care of country practitioners.

Each regiment of 500 men and upwards, should be provided with a surgeon and two assistant surgeons.

Station of the Medical Staff

The station of the surgeon is always to be at the headquarters of his regiment. If the regiment be divided into cantonments, the first assistant surgeon is to be placed with the strongest detachment, and the second with the next in succession in point of numbers, and in no case, where the regiment is thus divided and the surgeon present, should either of the assistants be allowed to remain at headquarters.

The quarters of one of the medical officers of the regiment should be always near the hospital, and, when encamped, one of them is to sleep in camp.

Leave of Absence

Leave of absence to the medical staff of regiments must be regulated by the Commander in Chief's order of the 3rd February 1803 (Appendix 1).

Barrack Hospitals

When a regiment is in barracks, a hospital is required to be provided and properly supplied with furniture, bedding and utensils, by the Barrack Department according to the regulation and the established schedule from that office, (Appendix 2). In other situations the surgeon will resort to his own regimental stores, which he is on no account to increase or replenish without previous permission, and, once a year at least, he will make a report of the state of them to the Inspector General.

Hired Hospitals

When in quarters the surgeon must look out for a house suitable to the strength of the regiment in a dry situation and with good water, but, before he engages it, he must state to the Inspector General of Army Hospitals, its rent and situation, with the number and size of the rooms, what wards have fire places, and how many beds each room will contain. Without this preliminary measure and the sanction of the Inspector General first obtained, no charge for a hired house will be allowed, unless very pressing emergency shall justify a departure from this regulation, and which must be stated in the first weekly return.

No hospital is to be engaged for a longer term than by the week. To obviate every unnecessary increase of hospital baggage, the landlord should be required to provide the necessary equipments of fire-irons, tables and forms, or they must be hired elsewhere at a weekly charge.

Hospital Servants

The establishment of hospital servants gives for a regiment of 500 men and upwards, one nurse at 1 shilling, one sergeant at 6 pence, and one orderly at 4 pence a day; this is understood to be the maximum of expense to be generally brought against the public, under that head. In battalions of inferior numbers the expense of hospital attendants must be regulated in due proportion to their strength. If from unusual sickness further assistance be necessary, application must be made to the Inspector General for his approval of it, unless the pressure of the moment will not wait for such sanction; but the necessity must be then stated in the next weekly return.

This regulated allowance is intended for an entire regiment; when the regiment is separated, the surgeon is expected to exercise his discretion in dividing and apportioning the ordinary expense of the whole, in such a way as to meet the exigencies of all; thus, in the situation of a regiment detached in three parts, it is advisable to discontinue the nurse, and to employ three orderlies in her stead; and, by so doing, to give a due proportion of assistance to each detachment.

Duties of the Sergeant

The sergeant is to take charge of the bedding, utensils, and other hospital stores, and be himself answerable for any damage or loss. This non-commissioned officer should be selected by the surgeon, with the approbation of the commanding officer, and be exempted from other military duties; nor should he be removed, except in cases of misconduct or inefficiency. He is to go round, at periods fixed by the surgeon for administering medicines and nourishment, and to see that the nurse and orderly man punctually give to the patients what has been directed by the surgeon; he is likewise to observe that the wards are kept clean, and that every nuisance be removed as soon as possible.

He is to see that every patient has his face and hands washed, and his hair combed and tied, before the surgeon visits the hospital; and those men who are able to sit up are regularly to fold up their bedding, and to sweep under their beds every morning by six o'clock in summer, and eight in winter; they are likewise to separate their bedding, and to air it two hours every day in fine weather.

As quietness and rest are absolutely required in hospital, great care is to be taken that every duty be performed with the least possible noise, and that at night the house be perfectly quiet. Every man must be in his bed by eight o'clock in winter, and nine in summer; and no conversation should be permitted after that time.

The sergeant is to superintend the cleaning of the wards early every morning, and as frequently during the day as circumstances may render it necessary. The pernicious custom of washing floors and covering them with sand, particularly during the winter, is positively forbid; and as a far preferable mode of cleaning dry rubbing should be substituted, by means of the scrubbing brush mounted on the heavy block.

The sergeant should go every morning and evening round the wards, attended by the orderly man, to call a roll, and report to the attending medical officer, at the first visit, such men as were found absent; and whether the hospital was regular, and in good order.

Orderly Man

The duty of the orderly man is to assist the nurse, by attending the sick, administering the medicines and comforts, and keeping the wards clean.

Duties of the Sergeant

The commanding officer should be applied to for a guard, in order to furnish sentries to the regimental hospital, and to the hospital tent; which sentries are to be directed to admit no person but the staff, the officers of the regiment and those immediately employed in the hospital; they are to be particularly careful in preventing liquor or any other articles from being carried into the hospital, without the surgeon's permission; nor are they to allow any patient to go out (to the necessary excepted) without a ticket of leave from the attending surgeon.

Hospital Tent

During encampment a hospital tent is allowed in aid of a hospital; but, except in cases of absolute necessity, it is not to be the sole hospital; and great care should be taken to select a dry piece of ground for the tent in the neighbourhood of the regimental hospital. A trench is to be dug round it for carrying off the water; and, to make it dry within, straw worked into thick mats or interwoven in slight hurdles, should be laid under every palliasse, upon dry sand or gravel. Where such conveniences cannot be had, some fresh straw should be placed under each palliasse, confined by a board twelve or fourteen inches high, placed round the sides of the bed; the straw to be changed at least once a fortnight.

Bedsteads

Bedsteads seem to be too heavy an encumbrance for the ordinary equipment of a regimental hospital; but, in wet seasons or damp situations, during an encampment, a few cot frames may be supplied from the general store in the neighbourhood, if the prevalence of any particular disease should call for them.

The windows of the hospital tent to be opened, and the walls to be lowered every day to admit fresh air; and, during that period, the beds of the convalescents, and of others who are able to sit up during the day, are to be made, and the palliasses to be occasionally scoured with soap and water, under the special direction of the surgeon. Rugs and blankets, in fine weather, to be constantly hung out on bushes, or to be aired on the dry ground.

Fumigation

The wards are to be frequently fumigated with nitric acid and the plastered walls to be occasionally white-washed; but this last is not to be done in a hired hospital, without the knowledge and approbation of the commanding officer, and, in a barrack hospital, a due requisition for it must be made to the barrack master, who will have it executed. The sides of the wards (when of wood) may be occasionally scoured with soap and water; but the floors should be generally kept clean by constant dry rubbing as before directed.

Every patient on his admission into the hospital, should (if possible) be previously inspected by one of the medical staff of the regiment; and be made extremely clean with warm water and soap; he should put on a clean shirt, and the clothes he had worn should be purified.

Place half an ounce of Vitriolic Acid into a crucible, or into a glass, or china cup, or deep saucer; warm this over a lamp, or in heated sand; adding to it from time to time, some nitre, or common salt; these vessels should be placed at twenty or thirty feet distance from each other, according to the height of the ceiling, or virulence of the contagion. In hospitals or prisons, the lamps or vessels containing heated sand, may be placed on the floor, the fumigating lamps of moser may be employed for this purpose, although they would answer much better, if the saucer was deeper, and if, instead of a place for a lamp, there was a box proper for containing hot sand, in which the saucer might be placed; as fumigating with nitrous acid is attended with no inconvenience, and as the process is so simple, and the materials so cheap, it should, as a means of prevention, be employed for some hours every day, in transports having troops on board, or in crowded hospitals, and if there is any appearance of contagion, the fumigation should be executed with more care and attention, and the vapour confined for several hours at a time. Fumigating vessels or lamps should also be placed contiguous to the hammocks or beds of persons affected with any contagious or putrid distemper, whether fever or dysentery.

As the quantity of vapour depends in some measure on the surface it is better to have the vitriolic acid put in a number of small vessels, than in one or two large ones, besides in this way, it has the advantage of being diffused more readily in any given space [ see Dr Carmichael Smith, on nitrous vapour].

Venereal Patients

All men with venereal disease are to be confined to the hospital.

Itch Patients

Men with the itch should be cured in a separate tent in summer, or in a separate room of the hospital; such men should each bring a clean shirt for a change after they are cured; four frictions or smearing the body all over four times, at six hours distance, with the sulphur ointment (keeping in bed the whole time) will, in most instances eradicate the complaint, they must then be well washed with warm water, and put on clean linen and clothes. Whenever this complaint prevails in a regiment, there is to be a weekly inspection of all the men, by the surgeon or assistant surgeon.

Punished Men

Punished men should, if possible, be placed in a separate ward, and their linen be frequently changed. Their bedding should be protected by a guard of oil cloth under the sheet.

Every patient to be provided with a clean shirt and a clean pair of stockings (if he can sit up) twice a week or oftener if necessary, and with clean palliasse cases and clean sheets once a fortnight, or oftener, as particular circumstances may require.

The patients should be shaved at least twice a week, and other personal cleanliness be observed as before directed.

Infectious Diseases

All men with infectious diseases, putrid fevers, fluxes, small pox, or measles, whose situation will admit of removal, should be immediately sent from camp or barracks, to a separate house; or, in certain cases of exigency, to an hospital tent. Upon the death of a patient, the whole of the bedding, after being steeped in running water, or in a tub, should be dried by the heat of an oven, and afterwards washed with soap and boiling water, before it is either used again, or put into the regimental store. The like should be done with the bedding of the whole ward. The straw about the bed of a man who dies, to be taken out and burnt, and the place or bed where he lay, to be well scoured with soap and hot water.

In all cases of this sort, and particularly after the removal of a corpse, the ward is to be well fumigated.

Charge of the Necessaries

No packs to be permitted to hang up, or lay in the wards. The non-commissioned officer attending the hospital is required, on the admission of a patient, to take charge of his necessaries, and is to be responsible for them. The hospital is never to be crowded, every man to have at least the space of five feet allotted to bis bed, and each man a bed to himself.

Convalescents

Men, when become convalescent, should not be reported too soon for duty.

Instruments

The surgeon is to be always in possession of a complete set of Instruments, provided at his own expense, agreeable to the list in Appendix 3.

Hospital Utensils

Regiments will be provided with hospital necessaries and utensils, in proportion to their strength, on a due requisition to this office. Schedule No 4 gives a list of the established articles; and, for the more ready conveyance, as well as better preservation of them, they have been formed into one or more canteens, suitable to the strength of the regiment, and the exigencies of detachments.

Hospital Books

The regimental surgeon, or assistant surgeon, should regularly visit the hospital, at least twice every day, and keep a book of the admissions, discharges and the cases of the patients in which the name, age, disease, diet, and treatment, are to be fully inserted, subject to the call of the Inspector General of Army hospitals, or commanding officer of the regiment.

Examination of Recruits

The regimental surgeon is to pay particular attention to the examination of recruits, and be careful not to certify for any man's fitness to serve, into whose state of health he has not regularly enquired; and who has not, at his examination, been stripped of all his clothes to ascertain that he has no rupture, that he has the perfect use of his eyes and ears, and the free motion of every joint and limb; that he has no sore leg, or diseased enlargement of bones or joints ; that his appearance is generally healthy, and that he is neither consumptive, nor subject to fits. With any of these defects, the man is to be reported as unfit for service.

Cow Pox Inoculation

The inoculation of the cow pock is to be constantly practiced. Let every man who does not bear the mark of the small pox, either, by inoculation or otherwise, be subject to the trial of the cow pock if it has not been already done, after the manner described in Appendix 5. The cow pock occasions no disturbance to the frame, or confinement from duty, and therefore may be performed either in barracks or quarters. When cow pock matter is wanted application may be made for it to this office; but the respective surgeons are expected to use every precaution to keep up a supply of fluid matter.

Hospital Stoppage

By a General Order of His Royal Highness the Commander in Chief (Appendix 6) the stoppage to be drawn from men in hospital, is fixed at 10 pence per day.

In pursuance of the King's warrant, dated 25th May 1797*, the extra price of meat and bread is allowed to be charged by the paymaster; no more than 6d per lb. for the former and 1 1/2d for the latter, can therefore be included in the surgeon's weekly returns; in cases where white bread is necessary, the contract bread must either not be drawn at all, or the difference alone must be inserted as an extra charge in the stoppage account, against the respective man's name for whom it shall have been ordered.
(*From the 25th May 1797, the soldier is to defray the whole expense of his bread and meat; with this exception, that if meat, of the quality proper to be provided for him, should exceed the price of six-pence a pound, or if bread, of the household quality should exceed the price of three half-pence a pound, such excess of price shall be allowed to him upon a quantity not exceeding three quarters of a pound of meat, and one pound of bread a day, for each man.)

Weekly Return

The above stoppage and the general expenditure of the hospital are under the immediate direction of the surgeon, who will check and control the sergeant's accounts, being himself responsible for the due appropriation of the money; as well as for the general conduct of the hospital, and of the servants under his authority. Blank forms of returns will be regularly furnished by this office, to be filled up and certified weekly, according to the instructions given, and to be transmitted by Sunday's post, to the Inspector General.

Sick Returns

The sick return forming part of the table, is to be filled up every fourth week, or that week in which the 20th of the month occurs: for example, if Wednesday be the 20th, let the next Sunday's return give the account of sick, but if the 20th fall on the Monday or Tuesday, it will be better to make it upon the preceding 18th or 19th, that it may reach this office in due time for the general report to the Commander in Chief. This return is to give the total number of the sick of the regiment whether at head quarters, in General Hospital, on detachment, or on furlough, and it is to be regularly sent on or about the 20th of the month, whether a hospital be established or not.

Diets

For the sake of uniformity, the diet in ordinary of the sick is (in the weekly return) divided into four classes, viz. full, half, low, and spoon.

Diet Tables

In the composition of these diets, the surgeon must conform to the table in the Appendix no 7, except under circumstances that can be satisfactorily explained in the next weekly return.

The diet roll is to be daily filled up, and weekly signed by the surgeon of the regiment and to be regularly filed for future inspection. As this serves (with the hospital book) for a voucher of the charges in the weekly return, it behoves the surgeon to be very circumspect in its detail; for if, on inspection, any charges appear in the one that are not supported by the other the expense will inevitably fall on himself.

Administration of Wine and Porter

When wine is indispensably necessary, it should be given as long as the urgency exists, but no longer; and porter or good beer should, whenever the case will admit of it, be substituted for wine.

Washing

The washing of bedding in regimental hospitals (out of barracks) is part of the duty of the nurse, unless her time be otherwise occupied by a heavy sick list. The personal washing of the sick is to be committed to the charge of some woman out of the hospital; and to be paid for at a regular price, but the ordinary washing must in no case exceed 4d per man per week, in the infantry, and 6d in the cavalry. All extra washing must be specifically stated in the extra. table.

Medicines

When a regiment has been furnished with one or more medicine chests (according to its strength) the subsequent supplies are to be drawn from the public elaboratory, by a requisition made to the Inspector General, half yearly, viz. on the 24th June, and 24th December.

An invoice of the medicine chest now in use, is given in the Appendix no 8, and the surgeon is expected to confine his practice to it. When a medical officer of a regiment desires to use a medicine not in his chest, he must procure it at his own expense, unless in his weekly return, he can explain the peculiar necessity of the case that called for it.

At the before-mentioned periods, viz. 24th June, and 24th December, the surgeon will send returns, stating the quantities last received, the present stock in hand, and a detail of the articles to be renewed; with the quantities that may in his judgment be equal to the probable wants of the ensuing six months, not exceeding the original supply. It is very desirable that all intermediate requisitions be avoided, but if real and unexpected consumption should make it necessary, the extra supply must be drawn as before from the public elaboratory. No druggist's charge will be admitted, unless the surgeon has previous permission to purchase occasional articles; or unless the pressure of the moment will not allow of that delay; the circumstances with the charge must be then stated in the next weekly return.

Allowance of medicines to Soldier's Wives and Children

The wives and children of soldiers are allowed medicines from the chest, but this indulgence is not to extend to any charge on the hospital fund.

Regulated allowance to Country Practitioners

When a detachment is without a regimental assistant, and is not within reach of any military surgeon, the country practitioners may be employed. The regulated allowance has been at 1d per man, per week, for medicines and attendance; but, where the number is under thirty, and the contract cannot be made for that sum, it is allowable to give 6d per month. Every officer commanding a detachment, should be apprised by the regimental surgeon of this regulation, and of the necessity of certifying in the bill the precise number of men and the period of attendance; as, without this form, the charge will be rejected. When from the pressure of the moment (on a march or on furlough) such agreements cannot be made, the country practitioner will be allowed to charge his medicines at a price suited to such class of patients.

When smaller numbers are under the command of a sergeant, it should be his duty to have the bills certified by the proper officer of his company as soon as he joins the regiment.

Bills of Country Practitioners

The bills of practitioners and other bills must be early sent for approval to the Inspector General; and when paid must be inserted in the next weekly return. A half yearly account is to be made up on the 24th June, and 24th December, according to the form in Appendix no 9, and be transmitted to the Inspector General; which account must include all expenses of the period that have not been charged in the weekly return. It is to be certified by the commanding officer of the regiment and accompanied with regular vouchers. All charges or bills in arrears beyond the half year will be positively rejected.

Every surgeon, before he quits his situation or leaves the kingdom, must make up his accounts from the last half yearly settlement, and transmit the same to the Inspector General, or he will be charged by the pay-master to the whole amount of the uncertified expenditure.

The surgeon is to deposit in the hands of the pay-master, monthly, any growing surplus of the hospital fund, taking his receipt for the same; and when deficiencies shall call for an advance of money to the surgeon for hospital uses, the paymaster, by a late order from the war office, is allowed to issue it on account, under the authority of the commanding officer.

Every regimental surgeon and assistant surgeon, on receiving the commanding officer's authority for so doing, are expected to take care of the sick of any other regiment, detachment or recruiting party, men on furlough, and whose regiments are at a distance, provided there is no general hospital in the neighbourhood.

Removal of Hospital Stores

The removal of hospital stores is not a charge on the hospital fund; they are considered as part of the regimental baggage, and must be conveyed according to the War Office regulations.

Mode of correspondence with the Army Medical Board

All letters and returns to the Inspector General, or any other member of the Army Medical Board must be sent under cover to the Right Honourable the Secretary at War, War Office.

The foregoing Instructions are to be strictly observed by the regimental surgeon; all former rules and regulations being revoked.
Lucas Pepys , Thomas Keate, Francis Knight

Appendix No I. General Orders Horse Guards dated 3 February 1803

The Commander in Chief, has observed, that the benefit to be expected to the service from the increased establishment of the regimental medical staff officers, has been in many instances entirely lost by these officers having been permitted to go on leave of absence in common with other officers of the regiment, without a due attention to the particular nature of their employment, and to the importance and necessity of their constant attendance; nor has the expense to the public, for the extra attendance of country practitioners been diminished in the proportion, which might have been expected, from the increased medical aid, which has been afforded to regiments.

His Royal Highness recommends these observations to the serious consideration of officers, in the command of regiments, and enjoins them to be very circumspect, in the leaves of absence, which they hereafter recommend for their regimental surgeon and assistant surgeon; the applications can be proper only in one of the following instances, either that from the regiment being assembled in one or two quarters, and remarkably healthy, the attendance of one of the medical staff officers can for a time be dispensed with; or else, that from particular circumstances the indulgence of leave of absence to an officer of this description, becomes an object of most material importance to his private concerns.

Officers commanding detachments not having any medical staff officer attached to them, are immediately on arrival at their stations to enquire whether there are any means of obtaining medical assistance from a military staff officer in the vicinity, and it is only in cases when such aid cannot be obtained, that they are justified in having recourse to the practitioners of the country, of which a special report is immediately to be made to the officer commanding the regiment, who will state the same to the Inspector General of Regimental Hospitals; hereafter, no charge will be admitted for extra expenses incurred for medical assistance, the necessity of which has not at the time, been reported in the manner above directed.

By Order of His Royal Highness 
The Commander in Chief,    
Harry Calvert,  
Adjt. Gen. of the Forces.

List of articles furnished by the Barrack Department for Regimental Hospitals in barracks.

List of articles for the use of Regimental Hospitals in barracks
Kitchen Surgery Wards
A set of Fire Irons Fire Irons Bedsteads
Fender Fender Palliasses
Trivet 2 chairs Pillows
Table Forms Bolsters
Dresser Coal Box Blankets
2 Small Forms Candlestick Sheets
Shelves Round Towel Rugs
An Iron pot, pot-lid, and hooks Cupboard or Shelves Chamber Pots
WoodenLadle A Tin Slipper Bath Table
Flesh Fork   Small Forms
Bowls or platters   Coal Box, Small
Small bowls or platters, or porringers   Fire Irons eg poker, shovel, fender
Trenchers   Candlesticks or lamp
Spoons   Round towel
Coal box   1 Close-stool for each ward
Candlestick   2 Bed-pans for the hospital
Tin can   2 urinals for the hospital
Earthen pan    
Box, or basket for carrying coals in the wards    
Buckets, mops, and scrubbing brushes - sufficient for the use of the hospital in general    
Birch and hair brooms sufficient for the Use of the hospital in general    
Round Towel    
1 Lantern    
2 Saucepans    
2 Large tea-kettles    
Quart and pint pots    
Appendix No II. List of articles to be furnished by the Barrack Department for the use of Regimental Hospitals in barracks.

Appendix No III. A complete set of Instruments, with the modern Improvements for Regimental Hospitals

  • An amputating saw, with spare blade
  • 1 Metacarpal saw, with spare blade
  • 24 Curved needles
  • 2 Amputating Knives
  • 1 Catlin
  • 2 Tenaculums
  • 1 Bullet forceps
  • 1 Pair of bone nippers
  • 2 Screw tourniquets
  • 4 Field tourniquets with handle
  • 2 Callico compresses
  • 2 Trephines with sliding Keys
  • 1 Trephine forceps
  • 1 Elevator
  • 1 Lenticular
  • A brush
  • Key Instruments for teeth, to fit trephine handle
  • 8 Scalpels
  • 3 Silver catheters
  • 2 Elastic catheters
  • 1 Trocar with spring and introductory cannula
  • 1 Trocar with spring and cannula for hydrocele
  • 1 Probang
  • 1 Long silver probe

Appendix No IV. Canteens of Hospital Utensils for 250 men.

  • 1 Flesh fork
  • 2 Iron block tin soup ladles
  • 12 Trenchers
  • 12 Iron spoons
  • 2 Tin saucepans, 1 of 4 qts. and 1 of 3 qts. to shut in each other
  • 12 Tin cups of 1 pint each
  • 1 Horn lantern
  • 1 Iron tea Kettle, 7 Quarts
  • 1 Tea pot, 5 pints
  • 2 Tin candle sticks, with snuffers chained
  • 1 Pewter bed pan
  • 1 Pewter Urinal
  • 6 Knives and forks
  • 1 Pair of steelyards
  • 2 Pint tin pots, with handles
  • 12 Cotton night caps
  • 3 Yards of osnaburgh
  • 3 Round towels
  • 2 Rollers and 2 pair of brackets
  • 3 Yards of flannel
  • 1 Hand scrubbing brush
  • 1 Whitewashing brush
  • 2 Sponges
  • 2 Large wooden platters
  • 2 Pewter wash-hand basons
  • 1 Tinder box and steel
  • 2 Packing needles
  • 1 Trivet
  • 1 Pair of wooden scales and weights, 2oz. to 21b.

Separate:

  • 1 Water bucket
  • 1 Close stool bucket, with pan
  • 1 Iron Kettle of 6 Gallons

Articles to be purchased by the surgeon:

  • 1 Long scrubbing brush, with heavy block leaded
  • 1 Hair broom
  • 1 Rag mop
  • 8 Earthen chamber pots

Appendix No V. Instructions for Vaccine Inoculation

Let the vaccine fluid be taken, for the purpose of inoculation from a pustule that is making its progress regularly, and which possesses the true vaccine character, on any day from the fifth to the eighth, or even a day or two later, provided the efflorescence be not then formed around it. When the efflorescence is formed, it is always most prudent to desist from taking any more of the virus from that pustule.

To obtain the virus, let the edges of the pustule be gently punctured with a lancet in several points. It will gradually ooze out, and should be inserted upon the arm about midway between the shoulder and the elbow, either by means of a very slight scratch, not exceeding the eighth part of an inch, or a very small oblique puncture.

A little red spot will appear on the punctured part on the third day, if the operation succeed, which on the fourth or fifth becomes perceptibly vesicated. It goes on increasing till the tenth day, when it is generally surrounded by a rose coloured efflorescence, which remains nearly stationary for a day or two. The efflorescence then fades away, and the pustule is gradually converted into a hard glossy scab, of a dark mahogany colour. These progressive stages of the pustule are commonly completed in sixteen or seventeen days.

A single pustule is sufficient to secure the constitution from the small-pox; but as we are not always certain the puncture may take effect, it will be prudent to inoculate in both arms, or to make two punctures in the same arm, about an inch and a half asunder, except in very early infancy, when there is a great susceptibility of local irritation.

If the efflorescence surrounding the pustule should be extensive, and occasion much local heat upon the arm, it may be cooled by the repeated application of pieces of folded linen dipped in cold water; or still more expeditiously by a strong solution of the aqua lythargyri acetati in water; an ounce, for example, of the former in five or six of the latter.

If the scab should at any time be prematurely rubbed off, and not succeeded by another within twenty-four hours, the part may be occasionally touched with the undiluted acqua lythargyri acetati.

Vaccine virus taken from a pustule and inserted immediately in its fluid state, is preferable to that which has been previously dried; but as it is not always practicable to obtain it in this state, we are compelled to seek for some mode of preserving it. Various means have been suggested, but from the test of long experience, it may be asserted, that preserving it between two plates of glass is the most eligible. Let a piece of common window glass be cut into squares of about an inch each, so that they shall lie smooth when placed upon each other. Let the collected vaccine fluid be confined to a small spot (about the size of a split pea) upon the centre of one of these glasses; which should be suffered to dry in the common heat of the atmosphere, without exposure to the heat of fire or the sun. When dry, it should be immediately secured by placing over it the other piece of glass. Nothing more is necessary for its preservation than wrapping it in clean writing paper.

The virus, thus preserved, when wanted for the purpose of inoculation may easily be restored to its fluid state by dissolving it in a small portion of cold water, taken up on the point of a lancet. It may then be used in the same manner as when just taken from a pustule.

The vaccine fluid is liable, from causes apparently trifling, to undergo a decomposition. In this state it sometimes produces what has been denominated the spurious pustule; that is, a pustule, or an appearance on the arm not possessing the characteristic marks of the genuine pustule. Anomalies, assuming different forms, may be excited, according to the qualities of the virus applied, or the state of the person inoculated; but by far the most frequent variety, or deviation from the perfect pustule, is that which arrives at maturity, and finishes its progress much within the time limited by the true. Its commencement is marked by a troublesome itching: and it throws out a premature efflorescence, sometimes, extensive, but seldom circumscribed, or of so vivid a tint as that which surrounds the pustule completely organised; and (which is more characteristic of its degeneracy than the other symptoms) it appears more like a common festering produced by a thorn, or any other small extraneous body sticking in the skin, than a pustule excited by the vaccine virus.

It is generally of a straw colour; and when punctured, instead of that colourless, transparent fluid of the perfect pustule, its contents are found to be opaque. That deviation from the common character of the pustule, arising from vaccine virus which has been previously exposed to a degree of heat capable of decomposing it, is very different. In this instance, it begins with a creeping scab, of a pale brown or amber colour; making a long and slow progress, and sometimes going through its course without any perceptible efflorescence. Its edges are commonly elevated, and afford, on being punctured, a limpid fluid.

A little practice in vaccine inoculation, attentively conducted, impresses on the mind the perfect character of the vaccine pustule; therefore when a deviation arises, of whatever kind it may be, common prudence points out the necessity of re-inoculation, first, with vaccine virus of the most active kind, and secondly, should this be ineffectual, with variolous virus. But if the constitution shows an insusceptibility of one, it commonly does of the other.

When any constitutional symptoms occur in inoculated cow-pox, they are commonly first perceptible (especially in children) on the fourth or fifth day. They appear again, and sometimes in adults, not unlike a mild attack from inoculated small-pox, on the eighth, ninth, or tenth day. The former arise from the general effects of the virus on the habit, the latter from the irritation of the pustule.

If the effluvia of the small-pox have been received into the habit previously to the inoculation of the vaccine virus, the vaccine inoculation will not always be found to stop its progress although the pustule may make its advances without interruption.

The lancet used for inoculation should always be perfectly clean. After each puncture, it is proper to dip it into water, and wipe it dry. The practitioner should be particularly cautious in observing that its point be free from rust, either contracted by common means, or from the action of the vaccine virus; which, even when dry and in contact with it, has a tendency, in a little time, to produce it; therefore the preservation of vaccine virus upon a lancet, beyond the period of a few days, should never be attempted.
Edward Jenner.

Appendix No VI. General Orders. Horse Guards 31 August 1802.

The regulation for improving regimental hospitals, bearing date in the month of September 1799, having directed that the sum of 4s per week should be retained out of the pay of the soldier, for his maintenance while in the regimental hospital, and for the incidental expenses of the said hospital; and it being thought proper to establish a new rate of stoppage applicable to the above purposes, and to the other purpose hereafter mentioned. It is His Majesty's pleasure, that, from the 25th September next inclusive, the sum of 10d a day shall be retained by the Pay-Master, or Acting Pay-Master, out of the pay and beer-money of each non-commissioned officer, trumpeter, drummer, and private man of His Majesty's Regiments of every description, during the time of them being in the regimental hospital; and that the same be paid over to the regimental surgeon, as a fund, to be applied by him, under the superintendence of the commanding officer, to the maintenance of the men, and the general expenses of the hospital.

It is His Majesty's further order, that regular accounts of the expenditure for the above services, to be kept by the regimental surgeons of the regiments of cavalry and Infantry of the line, to be furnished by them (being previously certified by the commanding officer) to the Inspector-General of Army-Hospitals, at such times and in such forms as shall be prescribed through the said Inspector-General, in order that, in the case of a deficiency of the said fund, the same may be made good; and that, in the case of a surplus, the same may be applied to the general medical expenses of the corps.

By order of  His Royal Highness
The Commander in Chief
Harry Calvert
Adjutant-General.

Appendix No VII. Diet Table.

Diet Table
Meals Full Half Low Spoon or fever diet Remarks
Breakfast 1 pint of milk, porridge or rice, gruel 1 pint of milk, porridge or rice, gruel 1 pint of milk, porridge or rice, gruel tea All extra diet to be given at discretion of the surgeon, but it must be stated and charged in the proper table of the weekly return, against the respective patient's name whose situation demands it. Wine used in panado, sago, or in any kind of food must be similarly specified in the wine return.
Dinner 3/4 pound of meat
1 pound of bread
1 pound of potatoes
1/2 pound of meat
1 pound of bread
1/2 pound of potatoes
1/4 pound of meat or weak broth
1/2 pound of bread
1/2 pound of potatoes
1/4 pound of bread made into panado with as much milk, or sago The allowance of 1 penny for beer money will be admitted to any patients, where the surgeon may think it proper to grant beer. The milk porridge is supposed to consist of three parts gruel with one part milk.
Supper 1 pint of broth made from meat 1 pint of broth made from meat 1 pint of milk, porridge or rice, Gruel tea The spoon diet is adapted to fevers, and such cases as will not allow of any excitement from animal food, in the shape of broth or otherwise.
Diet Table

Appendix No VIII - Invoice of a Regimental Chest of Medicines

  • Acid: vitriolic
  • Aerug: Aeris pulv
  • Alumin
  • Ammon: ppt
  • Antimon: tartarisat
  • Aq: lytharg: acetat
  • Argent: nitrat
  • balsam: copaiv
  • calomel: ppt
  • camphor
  • cerat: lap: calaminar
  • cerat: sapon
  • ceruss: acetat
  • confect: opiat
  • conserv: rosle
  • cort: peruv: opt: pulv
  • cremor: tartar: pulv
  • cretae ppt
  • empl: cantharid
  • empl: lythargyr refin
  • extr: colocynth: camp
  • ferr: vitriolat
  • flor: chamom: pulv
  • flor sulphuris loti
  • fol: sennae
  • Gum: Ammoniac
  • Gum: Arabic
  • Gum: pulv
  • Gum: Guaiac: pulv
  • hydrarg, muriat
  • hydrarg nitrat: rub
  • Kali acetat
  • Kali ppt
  • Kali pur
  • liniment: sapon: comp
  • liquor: vol: cc
  • magnes: alb
  • natri vitriolat
  • nitri purificat
  • ol menth: piper
  • ol olivffi opt
  • ol ricini
  • ol terebinthin
  • opii purificat
  • pilul: hydrarg
  • pulv: antimonial
  • pulv: aromatic
  • pulv: digital
  • pulv: Ipecac: comp
  • pulv: rad: Ipecac
  • pulv: Jalap
  • pulv: rhabarb
  • pulv: squill
  • pulv: Zingiber
  • Quass: abras
  • spir: vini rectificat
  • succ: Inspissat: cicutae
  • tinct: opii
  • Ung: cerae
  • Ung: hydrarg: fort
  • Ung: nitrat
  • Ung:psoric
  • Zinc: vitriolat
  • dr. James's powder

Appendix No IX - Materials

  • fine lint
  • surgeon's tow
  • linen
  • skins of leather
  • linen rollers
  • flannel rollers
  • eighteen-tailed bandages
  • bag trusses
  • bougies in a case
  • tape
  • thread for ligatures
  • pins
  • Grain scales and weights
  • ounce scales and weights
  • vials in sorts
  • Gallipots in sorts
  • A Graduated Glass measure
  • writing paper
  • wrapping paper
  • pens
  • Ink powder
  • wafers
  • A bolus tile
  • A mortar and pestle
  • pill boxes
  • Urethra syringe
  • A Glyster syringe and pipes
  • A pewter bleeding porringer
  • bolus Knives
  • A spreading spatula
  • A pot spatula
  • A tin panakin
  • A tin funnel
  • packthread
  • surgeon's sponges
  • vial corks
  • horn cups
  • common splints