Books and Documents > Medical Department of the U.S. Army in the World War, Volume III, Finance & Supply
CHAPTER XIX
SURGICAL DRESSINGS
FIRST-AID PACKET
At the request of the Surgeon General of the Army, December 18, 1905, a joint board of medical officers of the Army and Navy was appointed for the improvement and standardization of first-aid dressing. This board utilized the observations of the medical observers on both sides in the Russo-Japanese war1 and concluded that a satisfactory first-aid packet must meet the following requirements.2
FIG. 13 - First -aid packet in metal case, and pouch.
1. It should be simple in construction and should have few separate parts.
2. It should be easy of application, even by the unskilled.
3. It should be so made and so arranged as to require no handling of that part of the dressing which comes in contact with the wound.
4. The compresses and bandages should be of sufficient thickness and area to afford effective protection to the wound.
5. The compresses and bandages should be made entirely of absorbent material rendered antiseptic by mercuric chloride.
6. The completed packet should be as small and as light as possible consistent with effectiveness.
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7. It should be provided with a waterproof hermetically sealed durable covering.
* * * A case made of brass or copper is the best and, on the whole, much more economical than rubber or cloth covers, and insures to a much greater degree the presence of the packet on the person of the soldier when needed.
8. The container should be easily opened and should have an arrangement for secure attachment to the belt of the soldier.
FIG. 14.- Contents of first-aid packet.
The board also decided that a larger dressing would be required for the extensive wounds made by fragments of shell, splinters, etc., resulting from the high-explosive shells used by the seacoast artillery. A suitable packet was developed for this purpose and given the name shell wound dressing. The name of this packet was later changed to first-aid packet, shell wound. Specifications for both these packets were prepared by the board and have undergone but few changes. The findings of the board were published to the Army in May, 1906.2 The specifications for these packets used in making purchases during 1917-18 appear below. The quantities purchased during those years are given in the consolidated table of surgical dressings for field use which appears on pp. 329.
SPECIFICATIONSFOR FIRST-AID PACKETS, MEDICAL DEPARTMENT, U. S. A.
First-aid packets to be made up as described below:
Materials. - All gauze to be in accordance with United States Government Standard Specifications for Absorbent Gauze in weight, mesh, and chemical analysis. Gauze for bandages to have 44 threads to the inch in the warp and 40 threads to the inch in the filling. Gauze for compresses to have 32 threads to the inch in the warp and 28 threads to the inch in the filling.
1. Two bandages of absorbent, sublimated (1: 1,000) gauze, 4 by 84 inches.
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2. Two compresses of absorbent, sublimated (1: 1,000) gauze, each composed of one-half square yard of gauze so folded as to make a compress 3 ½ by 7 inches. One compress to be placed lengthwise in the center of each bandage and retained in position by sewing along one end and across the center. The loose end of the compress is then folded on the sewed part and held by one or two stitches, thus making a compress 3 ½ by 3 ½ inches. Each bandage thus prepared to be rolled loosely from each end, with the roll toward the back of the bandage, until the compress is reached. The latter is now covered with a strip of standard quality, heavyweight, blue tissue paper 3 by 3 inches, and folded through the center, the flattened rolls of the bandage laid on either side of the folded compress, the strip of paper being between back of compress and the flattened bandages. Each bandage then to be wrapped separately in parchment or wax paper.
3. Two No. 3 safety pins, wrapped in wax paper.
The two compresses and the two safety pins are then wrapped together in tough waxed paper. One copy of the “Directions for application,” the specifications for which are attached here to, to be in closed in each packet.
4. The packet thus prepared to be placed in a hermetically sealed metal case of No. 30 Brown & Sharpe gauge brass, same provided with the standard stripping device for opening the container. Containers to be sealed by soldering, best grade solder (soft) being used; soldering to be neatly and carefully done. Metal cases to be covered on the outside with olive-drab paint. Dimensions of case, 4 by 2 ¼ by 1 inch over all. Contents of the case to be sterile. The words “FIRST-AIDPACKET, U. S. ARMY,” to be stamped on the metal ease, also directions for opening, the manufacturer’s name, and the date of the contract.
Packing and delivery. - All packages must be packed in well-made, new boxes, constructed of 7/8 inch material. Boxes must be of uniform size, and each box must contain the same number of packages and must be plainly stenciled showing the contents and quantity in box, name of the contractor, and the date of the contract. Boxes must not exceed 5 cubic feet in capacity and must have no dimension greater than 30 inches. Packages must be packed inboxes in multiples of 10. For shipment boxes will be tagged and not stenciled.
Workmanship, finish, etc. - Packets to be made of best materials throughout; workmanship to be first class; finished packets to be equal to and like standard in every respect. Sample packet will be selected at random from deliveries made at this depot and tested as to sealing and sterility, materials, etc., and if found defective the entire lot from which sample was taken will be rejected. Excessive compression of the packet contents will not be permitted.
DIRECTIONS FOR APPLYING FIRST-AID PACKETS, MEDICAL DEPARTMENT, UNITED STATES ARMY
The following is to be printed on a sheet of paper, Measuring 3 ¼ by 4 ¼ inches, paper to be of standard quality:
DIRECTIONS FOR APPLYING (In caps.)
Carefully Remove the Wrapper and Proceed as Follows: (In dark face smaller letters.)
1. If there is only one wound, carefully remove the paper from one of the two packages without unfolding the compress or bandage and hold by grasping the outside roll of bandage between the thumb and fingers. When ready to dress wound, open compress by pulling on the two rolls, being careful not to touch the inside of the compress with fingers or anything else. The back of the compress is marked by a strip of blue paper. In grasping the rolls, if the thumbs are slipped in the spaces marked by the blue strip the face of the compress will not be touched. Still holding one roll of the bandage in each hand, apply the compress to the wound, then wrap the bandage around the limb or part and tie the ends together or fasten with safety pins. The second compress and bandage may be applied over the first, or it may be used for a sling if the arm is wounded or to bind both legs together if one is injured.
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2. If there are two wounds opposite each other, apply to one wound a compress without unrolling the bandage, and hold it in place by the bandage of the compress used to cover the other wound.
3. If there are two wounds not opposite each other, tie compress over each.
4. If the wound is too large to be covered by the compress, find and break the stitch, holding the compress together, unfold it, and apply as directed above.
NOTE - In printing the above a space should be left at the middle of the sheet so that when the directions are folded to place in the packet the folding line will fall in this space.
United States Government Standard Specifications for Absorbent Gauze GAUZE, PLAIN, 32 INCHES WIDE
1. A variation in count of one thread in the warp to the inch and one thread in the filling to the inch or two threads to the square inch shall be allowed.
2. Free from loading material and visible particles other than cotton and be colorless,
3. The extract obtained by a hot distilled water extraction of the gauze shall weigh. when dried to constant weight, not more than 0.25 per cent of the weight of the gauze extracted; the weight of inorganic matter is not to exceed 30per cent of the water extract. The aqueous extract shall be of neutral reaction and free from starell, dextrin, glue, or loading material.
4. One yard extracted with 95 per cent ethyl alcohol in a Soxhlet extractor for five hours shall yield a solid extract, when dried at 100oC., of not more than 0.55 per cent by weight.
5. One yard extracted with ethyl ether in a Soxhlet extractor for five hours shall yield a solid extract, when dried at100o C., of not more than 0.55 per cent by weight.
6. One yard incinerated in a platinum crucible shall yield not more than 0.06 to 0.08 per cent by weight of ash, containing potassium, sodium, magnesium, calcium, iron, and aluminum which were originally in combination with hydrochloric, sulphuric, and phosphoric acids.
7. One yard folded into a square, the surface of which measures 16 square inches, with the loose end loosely joined by No. 50 white cotton thread when held nearly in contact with the surface of distilled water and dropped thereon, at 25° C. temperature, shall be completely submerged in five seconds.
SPECIFICATIONS FOR FIRST-AID PACKETS, FOR SHELL WOUNDS, MEDICAL DEPARTMENT, UNITED STATES ARMY
First-aid packets to be made up as described below.
Gauze. - All gauze to be in accordance with United States Government Standard Specifications for Absorbent Gauze, in weight, mesh, and chemical analysis. Gauze for bandages to have 44 threads to the inch in the warp and 40threads to the inch in the filling Gauze for compresses to have 32threads to the inch in the warp and 28 threads to the inch in the filling.
Rubber Sheeting - To be made of fine quality bleached sheeting, weighing not less than 4 ounces to the linear yard, 36 inches wide, counting not less than 84 threads to the inch in the warp and not less than 76 threads to the inch in the filling; to be thoroughly and uniformly coated with a high-grade white rubber compound, equal to standard sample.
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The rubber compound to be calendered on, and not spread upon the sheeting. Sheeting to be vulcanized by steam, and in finish to be equal to and like standard sample. Finished sheeting to have an average tensile strength of not less than 40 pounds in the warp and 30 pounds in the filling, per inch of width.
1. One compress composed of 1 square yard of absorbent sublimated (1:1,000) gauze, so folded as to make a pad 6 inches by 9 inches. Across the back of each end of this compress to be placed a piece of gauze bandage 3 inches wide by 48 inches long, the bands to project beyond the compress 21 inches on each side. These bandages to be held in position by securely stitching along the edges of the compress, stitching to pass through all layers of the compress. The tails of the bandages are loosely rolled toward their back and placed on the hack of the compress. The compress is then to be folded once across its length face inside, and then from side to side. Thus folded, the compress to be securely wrapped in parchment or waxed paper.
2. One bandage, compressed, 3 inches wide by 6 yards long, wrapped in parchment or waxed paper.
3. Two No. 3safety pins, wrapped in waxed paper.
The whole dressing, prepared as above, to be wrapped and sealed in a tough waxed paper, compressed to form a package about 2 ½ inches wide, 4 ¼ inches long, by 1¼ inches thick, and then tightly in closed in a piece of rubber sheeting 6 by 8 inches, the edges and ends of the sheeting to be cemented so as to make the packet waterproof. On the outside of the packet will be printed a list of the contents, directions for using same, together with the name of the contractor and the date of the contract.
On the other side of the container will be securely pasted a standard label on which is printed: “The directions for applying first-aid packet,” the specifications for which are attached here to.
SPECIFICATIONS FOR FIRST-AID PACKETS, FOR SHELL WOUNDS, MEDICAL DEPARTMENT, UNITED STATES ARMY
Packing and delivery. - All packages must be packed in well-made, new boxes, constructed of 7/8-inchmaterial.Boxes must be of uniform size and each box must contain the same number of packages and must be plainly stenciled showing the contents and quantity in box, name of the contractor and the date of the contract. Boxes must not exceed 5 cubic feet in capacity and must have no dimension greater than 30 inches. Packages must be packed inboxes of multiples of 10. For shipment, boxes will be tagged and not stenciled.
Workmanship and finish. - Packets to be made of best materials throughout; workmanship to be first class; finished packets to be equal to and like standard in every respect.
The following printing to be on the outer surface of rubber sheeting cover of first-aid packets for shell wounds:
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INDIVIDUAL DRESSING PACKET
The experience and observation during the years following its adoption in 1906 amply demonstrated the efficiency of the metal covering of the first-aid packet. This packet was able to withstand, for considerable periods, the rough usage to which, from conditions incident to the service, it must be subjected as a part of the individual equipment of combatant troops. This rough usage was materially less in the equipment of the Medical Department personnel. Many of the first-aid packets used in battle by medical personnel would betaken almost directly from the boxes of surgical dressings carried on the ambulances and as a part oft he regimental medical combat equipment. Here a great degree of protection against damage by rough usage was not required. The covering of the metal first-aid packet added appreciably to its weight. It also added materially to its cost and limited the sources from which it could be obtained. Its manufacture required extensive and expensive machinery and practically only one firm had such equipment. It was decided, therefore, in 1916, to add another first-aid packet to the list which should be identical in contents with the metal-covered packet but be in closed in an impervious cover of rubber sheeting, a reversion to the type of covering in use prior to 1906. To this packet was given the name individual dressing packet.3 It was issued with the web belt of the enlisted personnel of the Medical Department, and in the two types of surgical dressingsboxes.4 The specifications under which these packets were purchased during 1917-18 are given below.5 The quantities purchased during those years are given in the consolidated table of surgical dressings for field use which appears elsewhere in this chapter.6
SPECIFICATIONS FOR INDIVIDUAL DRESSING PACKETS MEDICAL DEPARTMENT, UNITED STATES ARMY
To be made up as described below.
Materials.- All gauze to be in accordance with United States Government Standard Specifications for Absorbent Gauze, in weight, mesh, and chemical analysis. Gauze for bandage to have 44 threads to the inch in the warp and 40 threads to the inch in the filling. Gauze for compresses to have 32 threads to the inch in the warp and 28 threads to the inch in the filling.
1. Two bandages of absorbent, sublimated (1: 1,000) gauze, 4 by 84 inches.
2. Two compresses of absorbent, sublimated (1:1,000) gauze, each composed of one-half square yard of gauze, so folded as to make a compress 3 ½ by 7 inches. One compress to be placed lengthwise in the center of each bandage, and retained in position by sewing along one end and across the center. The loose end of the compress is then folded on the sewed part and held by one or two stitches; thus making a compress 3 ½ by 3 ½ inches. Each bandage thus prepared to be rolled loosely from each end, with the roll toward the back of the bandage, until the compress is reached. The latter is now covered with a strip of standard quality, heavy weight, blue tissue paper 3 by 3 inches, and folded through the center, the flattened rolls of the bandages laid on either side of the folded compress, the strip of paper being between back of compress and the flattened bandages. Each bandage then to be wrapped separately in parchment or wax paper.
3. Two No. 3 safety pins, wrapped in wax paper. The two compresses and the two safety pins are then wrapped together in waxed tough paper. One copy of the “Directions for application,” the specifications for which are attached hereto, to be in closed in each packet. The packet thus prepared to be placed in an outer wrapping of rubber sheeting of sufficient size to completely cover same. The edges and ends of the sheeting to be cemented so as to make the packet waterproof. Finished packet to measure 4 by 2 ¼ by 1inch, over all (these dimensions not to be exceeded).
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Rubber sheeting. - Rubber sheeting for outer wrapper of packet to be made of fine quality bleached sheeting, weighing not less than 4 ounces to the linear yard, 36 inches wide, counting not less than 84 threads to tile inch in the warp and not less than 76 threads to the inch in the filling; to be thoroughly and uniformly coated with a high-grade white rubber compound, equal to the standard sample. The rubber compound to be calendered on, and not spread upon the sheeting. Sheeting to be vulcanized by steam, and in finish equal to and like standard sample. Finished sheeting to have an average tensile strength of not less than40 pounds in the warp and 30 pounds in the filling, per inch of width. Contents of package to be sterile.
The words “INDIVIDUAL DRESSING PACKET, U.S. ARMY,” to be printed on top of packet; also the date of the contract and the name of the contractor.
FIRST-AID PACKETS FOR INSTRUCTION
To insure the maximum benefit from the first-aid packet it was essential that the individuals who were to be provided therewith should know how to use it. For a number of years after the first-aid packet was adopted, the issue was limited to members of the Hospital Corps and to companybearers.7 At that time four men in every company were selected by the company commander to look after the sick and wounded of the company, to administer temporary first aid if the need required it during an engagement, and to carry the wounded to the dressing stations in the rear.7 These men were usually selected with the advice of the medical officer with the command.7 They were trained with the detachment of the Hospital Corps in the duties of stretcher bearers and in rendering first aid under the immediate supervision of the surgeon. The standard first-aid packet was utilized in this instruction in1 first aid and the same packages were used repeatedly until worn out. A few years later it was decided that all officers and enlisted men of the Army should be instructed in tile use of the first-aid packet.8 The number of packets required for this purpose and the expense of the metal first-aid packet led to the development of another packet designed for instruction only.9 It was called first-aid packet for instruction. It contained the same materials as the standard first-aid aid packet, but they were put up in pasteboard cartons. These containers were of sufficient size to permit the dressings to be easily replaced in them after use. The instruction packets made their appearance in the supply table of 1911 as one of three forms of first-aid packets authorized.9 The Manual for the Medical Department authorized the issue of 20 first-aid packets to each company for instruction purposes.10 The supply table of 1916 allowed 40 instruction packets per 100 men of the command.11 The specifications under which first-aid packets for instruction were purchased in 1917-18 are given below.5 These quantities purchased during those years are given in the consolidated table of surgical dressings for field use which appears at the end of this chapter.6
SPECIFICATIONS FOR FIRST-AID PACKETS FOR INSTRUCTION, MEDICAL DEPARTMENT, UNITED STATES ARMY
Packets to be made up as described below.
Materials. - All gauze to be in accordance with United States Government Standard Specifications for Absorbent Gauze in weight, mesh, and chemical analysis. Gauze to have 32 threads to the inch in the warp and 28 threads to the inch in the filling. Muslin to have 56 threads to the inch in the warp and 56 threads to the inch in the filling.
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Contents and construction of packets - l. Two bandages of muslin 4 inches by 84 inches.
2. Two compresses of absorbent gauze, each composed of one-half square yard of gauze, so folded as to make a compress 3 ½ inches by 7 inches.
One compress to be placed lengthwise in the center of each bandage, and retained in position by sewing along one end and across the center. The loose end of the compress is then folded on the sewed part and held by one or two stitches, thus making a compress 3 ½ by 3 ½ inches.
Each bandage thus prepared to be rolled loosely from each end, with the roll toward the back of the bandage, until the compress is reached. The latter is now covered with a strip of standard quality, heavy weight, blue tissue paper, 3inches by 3 inches, and folded through the center, the flattened rolls of the bandage laid on either side of the folded compress, the strip of paper being between back of the compress and the flattened bandages. Each bandage then to be wrapped separately in parchment or waxed paper.
3. Two No. 3 safety pins wrapped in waxed paper.
The above articles, as prepared, to be placed in a strong dark-brown cardboard box, with slip cover, of standard quality, size, and construction, measuring 2 ¼ inches by 3 ¾ inches by 4 ½ inches deep, inside measurements. On the face of the container will be securely pasted a standard label on which is printed the following:
U. S. ARMY FIRST AID INSTRUCTION PACKET
This packet to be used only forgiving instruction in first aid.
It may be used repeatedly and should be washed and ironed when soiled.
(Name of contractor and date of contract.)
All the contents of the packet must be sterile.
Packing an delivery. - All packages must be packed in well-made new boxes, constructed of 7/8 inch material. Boxes must be of uniform Size and each box must contain the same number of packages and must be plainly stenciled showing the contents and quantity in box, name of the contractor, and the date of the contract. Boxes must not exceed 5 cubic feet in capacity, and must have no dimension greater than 30 inches. Packages must be packed inboxes in multiples of 10. For shipment boxes will be tagged and not stenciled.
Workmanship, finish, etc. - Packets to be made of best material throughout; workmanship to be first class, finished packets to be equal to and like standard in every respect.
Sample packets will be selected at random from deliveries made at this depot and tested as to sterility, materials, etc., and if found defective the entire lot from which the sample was taken will be rejected. Excessive compression of the packet contents will not be permitted.
GAUZE PACKETS
In providing dressing for field use, particularly in field and evacuation hospitals, it was anticipated that conditions would arise wherein the standard first-aid packet and the shell-wound packet would prove inadequate. In redressing or reinforcing the dressing of wounds it was likely that additional quantities of sterile gauze would be required. To meet these conditions gauze packets in impervious containers were included in the list of field dressings. Two types of packets were provided, plain sterile gauze and sublimated gauze. The plain gauze was intended primarily for evacuation hospitals.12 The sublimated gauze packets were intended for regimental medical detachments and field hospitals as well as evacuation hospitals.13 Two packets of sublimated gauze were carried in packet No. 3 of the Hospital Corps web belt.14 They were also included in both types of boxes of surgical dressings.15 Specifications for these gauze packets appear below. The quantities purchased during 1917-18 are given in the consolidated table of surgical dressings for field use which appears elsewhere in this chapter.6
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SPECIFICATIONS FOR GAUZE, PLAIN, 1-YARD PACKAGE, MEDICAL DEPARTMENT, UNITED STATES ARMY
(28 by 24)
Materials. - All gauze to be in accordance with the United States Government Standard Specifications for Absorbent Gauze, in weight, mesh, and chemical analysis. Gauze to have 28 threads to the inch in the warp and 24 threads to the inch in the filling. Gauze to be sterile and packed by an approved process.
Packages. - Each package to consist of 2 one-half square yards (2 pieces) of gauze; each ½-yard piece to be properly folded and securely wrapped in a satisfactory paper wrapper, the two pieces thus wrapped to be placed in an outer cardboard container and thoroughly sealed by means of paraffin process; completed package to measure 1 by 2 3/8 by 3 ¾ inches (not exceed measurements). Excessive compression will not be allowed. Each package will bear a label showing its contents, name of the contractor, and the date of the contract.
Packing and delivery. - All packages must be packed in well-made, new boxes constructed of 7/8 inch material. Boxes must be of uniform size, and each box must contain the same number of packages and must be plainly stenciled showing the contents and quantity in box, name of the contractor, and the date of the contract. Boxes must not exceed 5 cubic feet in capacity and must have no dimension greater than 30 inches. Packages must be packed in boxes in multiples of 10. For shipment boxes will be tagged and not stenciled.
Inspection. - Specimens of gauze delivered at the depot will be subjected to standard tests, cultural and otherwise. If a sample is found to he defective the entire lot from which it was taken will be rejected.
Quality, etc. - Quality of gauze and method of packing to be equal to the standard in every respect.
SPECIFICATIONS FOR GAUZE SUBLIMATED, 1-YARD PACKAGES, MEDICAL DEPARTMENT, UNITED STATES ARMY
(28 by 24)
Materials. - All gauze to be in accordance with United States Government Standard Specifications for Absorbent Gauze, in weight, mesh, and chemical analysis. Gauze to have 28 threads to the inch in the warp and 24 threads to the inch in the filling. Gauze to be sublimated, 1 to 1,000, sterilized and packed by an approved process.
Packages. - Each package to consist of 2 one-half square yards (2 pieces) of gauze; each ½-yard piece to be properly folded and securely wrapped in a satisfactory paper wrapper, the two pieces thus wrapped to be placed in an outer cardboard container and thoroughly sealed by means of paraffin process; completed package to measure 1 by 2 3/8 by 3 ¾ inches (not exceed measurements). Excessive compression will not be allowed. Each package will bear a label showing its contents, name of the contractor, and the date of the contract.
Packing and delivery. - All packages must be packed in well-made, new boxes, constructed of 7/8 inch, material. Boxes must be of uniform size, and each box must contain the same number of packages and must be plainly stenciled showing the contents and quantity in box, name of the contractor, and the date of the contract. Boxes must not exceed 5 cubic feet in capacity and must have no dimension greater than 30 inches. Packages must be packed in boxes in multiples of 10. For shipment boxes will be tagged and not stenciled.
Inspection. - Specimens of gauze at the depot will be subjected to standard tests, cultural and otherwise. If a sample is found to be defective, the entire lot from which it was taken will be rejected.
Quality, etc. - Quality of gauze and method of packing to be equal to the standard in every respect.
COMPRESSED GAUZE BANDAGES
Two other forms of surgical dressings intended for field use appear on the supply table, viz, compressed gauze bandages and 1-ounce packets of absorbent cotton. These 1-ounce packets of absorbent cotton corresponded in quality, sterility, and general manner of preparation to the 1-pound package, but were
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compressed and in closed in a waterproofed pasteboard carton for protection and for convenience in carrying.
The compressed gauze bandage was made of the same grade of gauze as the standard roller bandage, 44 threads per inch in the warp and 40 threads per inch in the filling, but differed from it in length, manner of rolling, and the carton in which packed. The bandages were of the standard widths, 2½-inch, 3-inch, and 3 ½-inch,but were only 6 yards long, while the roller bandage was 10 yards long. To permit shaping the compressed bandage into a fiat form, for convenience in packing and carrying, it was necessary to roll it loosely and without a central core. The standard roller bandage was rolled as tightly as possible from the center outward. Compressed bandages were individually wrapped and sealed and packed one gross to a pasteboard carton. While this carton differed in shape from that of the roller bandage, it was but little more than half the size. The standard basic specifications for absorbent gauze, already quoted, applied to these bandages. For economy in manufacture, the width of the 3 ½-inchbandage was reduced one-eighth inch. The salvage could not be used for bandages, and cutting the yard-wide gauze resulted in the waste of the equivalent of one bandage per width. By rearranging the bandage a little it was possible to remove the salvage and still cut nine bandages per width. The quantities purchased during the years 1917-18, both of compressed bandages and of 1-ounce packets of absorbent cotton, are given in the consolidated table of surgical dressings for field use at the end of this chapter.6
SPECIAL SURGICAL DRESSINGS DEVELOPED DURING THE WORLD WAR
The surgical dressings for field use, described in the preceding pages, had been developed after years of experience and trial under field and simulated combat conditions. The first-aid packet had proved satisfactory for small arms wounds in open warfare. The compressed bandage and the sublimated gauze packet had served well as supplementary dressings in those cases where the first-aid packet proved inadequate to properly protect the wound. The adequacy of the first-aid packet, shell wound, had never been demonstrated because no occasion for its use had been presented during the years following its adoption. It was still an untried article, but theoretically it should have furnished satisfactory protection to large wounds.
The progress of the World War had marked the advent of new engines of destruction vastly more violent than those witnessed in any previous war. The destruction of tissue caused by the fragments from these missiles was correspondingly greater. Massive wounds became more frequent. The casualties in the various engagements increased. The pollution of the soil greatly enhanced the infection of wounds and increased the problems of first aid. New types and greater quantities of surgical dressings became necessary.
To meet the requirements by the United States Army the commander in chief of the American Expeditionary Forces in France, appointed a board of medical officers in August, 1917, “for the purpose of investigating and reporting upon the advisability of standardizing certain appliances to be used by the Medical Department.” The board, in its deliberations, was guided by instruc-
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tions from the chief surgeon, A. E. F.15 While the principal mission of this board was the investigation of splints and surgical appliances for hospital use, it was extended to cover field dressings. The board, in its deliberations on field dressings, was governed by the general principle that 16 -
Surgical dressings should protect the wounded man from-
1.Trauma to his wounds;
2.Loss of blood;
3.Secondaryinfection,
and should be so applied as to add to his comfort during treatment and transportation.
In the manufacture of these dressings it is not essential that absolute accuracy in measurements be observed.
The special dressings recommended by the board are described below. Of these dressings the front-line packets numbered 1, 2, and 3 were used principally by the divisional medical units in the zone of combat. The larger dressings were intended for use in all hospital organizations from front to rear, field hospitals, surgical hospitals, evacuation hospitals, and base hospitals. They were put up in convenient packages and greatly facilitated the work at the hospitals and saved the time of the nurses and attendants. All front-line packets were protected by an impervious covering against moisture and vesicant gases.
SPECIAL SURGICAL DRESSINGS REQUIRED BY THE MEDICAL DEPARTMENT OF THE UNITED STATES ARMY
PACKET NO. 1 (RED LABEL), FOR SMALL WOUNDS
This packet contains the following supplies, wrapped up in a paper covering that has been dipped in paraffin to protect its contents from moisture. It is marked with two red bands.
On opening the outer covering there will be found:
1. Two unbleached muslin bandages, 4 inches by 5 yards, cut on the bias; 2 safety pins, 1½- inches long, are attached to each bandage.
2. A muslin bag, which opens at one end. This bag contains dressings which are sterile.
The sterile dressings comprise:
1. One toothpick swab wrapped in oiled paper to be used for applying alcohol or iodine.
2. Two cotton tampons.
3. Four gauze wipes, 4 by 4 inches.
4. One absorbent pad, 4 by 6 inches, attached to a muslin bandage 2 inches by 7 feet long.
* * * * * *
PACKET NO. 2 (WHITE LABEL), FOR MEDIUM-SIZED WOUNDS
This packet contains the following supplies, wrapped up in a paper covering that has been dipped in paraffin to protect its contents from moisture. It is marked with two white bands.
On opening the outer covering there will be found:
1. Two unbleached bandages, 5 inches by 5 yards, cut on the bias; two safety pins, 1 ½ inches long, are attached to each bandage.
2. A muslin bag, which opens at one end. This bag contains dressings which are sterile.
The sterile dressings comprise:
1. One toothpick applicator wrapped in oiled paper to be used for applying alcohol or iodine.
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2. Four cotton tampons.
3. Four gauze wipes, 4 by 4 inches.
4. One gauze wick, ½- inch by 8 inches.
5. One absorbent pad, 5 by 7inches, attached to a muslin bandage 2 inches by 7 feetlong.
* * * * * *
PACKET NO. 3 (BLUE LABEL), FOR LARGE WOUNDS
This packet contains the following supplies, wrapped in a paper covering that has been dipped in paraffin to protect its contents from moisture. It is marked with two blue bands.
On opening the outer covering there will be found:
1. Two unbleached muslin bandages, 6 inches by 5 yards, cut on the bias; two safety pins, 1 ½ inches long, are attached to each bandage.
2. A muslin bag which opens at one end. This bag contains dressings which are sterile.
The sterile dressings comprise:
1. One toothpick applicator wrapped in oiled paper to be used for applying alcohol or iodine.
2. Six cotton tampons.
3. Six gauze wipes, 3 by 7inches.
4. Two gauze wicks, 1 by 15 inches.
5. One absorbent pad, 11 by 12 inches, attached to a muslin bandage, 4inches by 7 feet long.
Gauze roll (5yards) . - This dressing is made of one piece of gauze 30 inches wide, 5 yards long, folded to a width of 4 ½ inches and rolled into bandage form 5 yards long; 2 in a pack.
Gauze roll(3 yards). - This dressing is made of one piece of gauze 30 inches wide, 3 yards long, folded to a width of4 ½ inches and rolled into bandage form 3 yards long; 2 in a pack.
Sponges. - Small size cut gauze 9 inches by 16 inches and fold to 2 inches by 2 ¼inches; 25 in a package. Large size cut gauze 12 inches by 18 inches and fold to 4 inches by 4 ½inches; 25 in a package.
Sterile dressing pads. - One size, cut 16 inches and folded 8 by 4 inches; 25in a package.
Unsterile dressing pads. - Two types; two sizes.
Type 1, size1, 8by 12 inches; one-half absorbent cotton; one-half nonabsorbent cotton; covered with one-half yard of gauze.
Size 2, 14 by 20inches; one-half absorbent cotton; one half-nonabsorbent cotton; covered with 1 yard of gauze.
Type 2, size 1, 11½ by 18 inches; one-half absorbent cotton, newspaper back; one-half non absorbent cotton, newspaper back; covered with 1 yard of gauze.
Size 2, 18 by 23 inches; one-half absorbent cotton, newspaper back; one-half non-absorbent cotton, newspaper back; covered with 1 ½ yards of gauze.
The numbers given below indicate the relative quantities required by the forces overseas.
For example, for every ten 3-yardgauze rolls sent there should be 600 red-label packets.
Number Number
Packet No. 1 (red label). For small wounds................................ 600
Sterile dressing pads............................................... 300
Packet No. 2 (white label.). For wounds of moderate size....... 500
Unsterile dressing pads:
Packet No. 3 (blue label). For large wounds.............................. 400
Type 1-
Gauze roll:
Size1................................................................. 200
5 yards....................................................................................... 8
Size2................................................................. 150
3 yards....................................................................................... 10
Type 2 -
Sponges:
Size1................................................................. 75
Small...........................................................................................400
Size2.................................................................50
Large...........................................................................................350 3,043
* * * * * *
329
The front-line packets were somewhat modified in October, 1918, by another board of medical officers whose findings were duly approved. Before the recommendations of this board could be put into effect in production of dressings the armistice had been signed and the need for them had ceased. The modifications recommended by the board were the omission of one roller bandage from front-line packets 1 and 2 and the omission of the toothpick applicator and cotton tampon from all three packets. The sizes of the absorbent gauze pads was changed and the pad was no longer sewed to the bandage. This made for simplicity of manufacture and for convenience of application.7
The dressings recommended by the board in 1917corresponded very closely to those being furnished to the armies of the Allies by the American Red Cross. An agreement was entered into, in March, 1918, between the Medical Department and the American Red Cross for the manufacture of these dressings. Under this agreement the Medical Department furnished all the materials and arranged for their delivery to the Red Cross; arranged for the sterilization of all dressings which required it; provided for the paraffin treatment of the outer covering of front-line packets and the preparation of such packets for shipment overseas; provided bills of lading on which shipments were made from the central shipping points of the Red Cross to the ports of embarkation and thence to the medical supply depots in France. The American Red Cross distributed the materials to its various chapters where those materials were fabricated into finished dressings. The output of the various chapters was collected at central points where the dressings were turned over to the Medical Department. The front-line packets were sterilized at New York City under contract, paraffined, and packed in suitable boxes, cases, or bales for ocean shipment under the supervision of the medical supply officer in that. city.
STANDARD SURGICAL DRESSINGS PURCHASED
The following table shows the quantities of standard surgical dressings for field use purchased during the years 1917-18 by the Medical Department of the United States Army: 6
Standard surgical dressings for field use purchased during 1917-18
330
Standard surgical dressings for field use purchased during 1917-18--Continued
331
Standard surgical dressings for field use purchased during 1917-18--Continued
REFERENCES
(1) Letter from the Surgeon General to the Secretary of War, December 18, 1905, relative to improvements in first-aid packets. On file, Record Room, S. G. O.,113655 (Old Files).
(2) G.O., No. 84, W. D., May5, 1906, 2.
(3) Manual for the Medical Department, 1916, par. 969.
(4) Ibid., par. 954. 955.
(5) Taken from retained copies of contracts made at the Field Medical Supply Depot and now on file at the Medical Section, New York General Intermediate Depot, Brooklyn, N. Y.
(6) Data compiled from copies of contracts and schedules of delivery on file in the Office of Chief of Finance, Miscellaneous Section.
(7) G. O., No. 56, Headquarters of the Army, Washington, D. C. August 11, 1887, pars. 17-18. Also: Circular No. 9, Headquarters of the Army, August 8, 1891, Sec. VI.
(8) Letter from Maj. J. P. Sanger, Inspector General, South Atlantic District, to the Inspector General, January 21, 1896, relative to instruction in first aid, and the recommendations
of the Surgeon General thereon. On file, Record Room, S. G. O., 14852-E (Old Files).
332
(9) Manual for the Medical Department, 1911, par. 898 (b); ibid., 1916, par. 945
(10) Ibid., 1911, par. 394.
(11) Ibid., 1916, par. 845.
(12) Ibid., p. 298.
(13) Ibid., par. 866, 879, 891, 932.
(14) Ibid., par. 907.
(15) S. O., No 73, H. Q., A. E. F., France, August 20, 1917, par. 17.
(16) Manual of Splints and Appliances for the Use of the Medical Department of the U. S. Army, American Red Cross, Second Edition, 1918, p. 17.
(17) S. O., No. 824, G. H. Q., H. A.E. F., France, October 11, 1918, par. 169.
