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TREASURY DEPARTMENT
REVENUE-CUTTER SERVICE
MEDICAL HANDBOOK
FOR THE USE OF THE
REVENUE-CUTTER SERVICE
Revised by
W. J. PETTUS, M. D.
Assistant Surgeon General, United States Public Health Service
WASHINGTON
GOVERNMENT PRINTING OFFICE
1912
J! •-'
» •» v
CONTENTS.
Page.
Medicines and articles to be supplied for medicine lockers (class A) 6
Sanitation 7
Poisons and antidotes 9
Use of clinical thermometer 9
Malarial fever 10
Measles 12
Mumps 14
Smallpox 15
Dysentery 18
Sunstroke 19
Diarrhea 20
Cholera morbus 21
Colic 22
Scurvy 23
Sore throat 24
Coughs and colds 25
Erysipelas 26
Poison ivy 27
Rheumatism 27
Fainting 30
Delirium tremens 30
Appendicitis 31
Syphilis 31
Soft chancre (chancroids) : 32
Gonorrhea 34
Stricture 35
Boils 37
Piles 37
Injuries — Hemorrhage (bleeding) 37
Wounds 38
Burns or scalds 40
Effects of cold — Frostbite 41
Scalp wounds 42
Injuries to the chest 42
Injuries to the back 43
Fractures 43
Dislocations 56
Sprains 63
Nosebleed 64
Drowning 65
Medicine and articles to be supplied for medicine lockers (class B)
3
254909
MEDICAL HANDBOOK FOR USE OF VESSELS AND STATIONS OF
THE REVENUE -CUTTER SERVICE.
TREASURY DEPARTMENT,
Division of Revenue- Cutter Service, 1912.
This Handbook has been prepared primarily for the use of officers
and enlisted men of the Revenue-Cutter Service serving on vessels
to which no surgeon is regularly attached. In all cases of serious
sickness or injury, however, medical assistance should be obtained
as soon as practicable. Written directions must imperfectly supply
the place of the physician and surgeon. With a medicine locker and
handbook it is not possible to provide for and explain the treatment
by persons who have not had a medical education of more than a
few of the commoner diseases.
Medicine lockers on vessels of the first and second class having
no medical officers attached will be supplied with the (A) outfit,
page 6, and those having medical officers attached with the (B) outfit,
page 71.
In the records of public property, proposals, requisitions, and
vouchers the units used will be those given in these lists, and the
items will be arranged in the order in which they appear thereon.
In requesting any of these articles on requisition they will be
noted as " allowance." If for any special reason articles other than
those on these lists are required, they shall appear on the requisi-
tion following the items of regular allowance, and the necessity for
each should be fully explained.
The dates when obtained must appear on all medicines and pack-
ages, and they must be renewed when no longer serviceable, accord-
ing to the length of time stated in the list of medicines and articles.
This Handbook is a revision for the use of the Re venue- Cutter
Service of the Handbook for the Ship's Medicine Chest, prepared by
George W. Stoner, surgeon, United States Public Health Service, by
direction of the Surgeon General of that Service.
5
6 MEDICAL HANDBOOK.
CLASS A.
Medicines and articles to be supplied for medicine lockers of vessels having no
medical officers attached.
MEDICINES.
Amounts.
100
4 ounces
100
500
200
500
16 ounces
100
600
500
100
100
200
2 ounces
500 capsules
100
1 ounce
48 papers
32 ounces
16 ounces
100
4 ounces
8 ounces
32 ounces
8 ounces
16 ounces
100
8 ounces
32 ounces
16 ounces
100
16 ounces
8 ounces
8 ounces
500
100
10 gross
Items.
Ammonii chlorid, tabs, compr., 5 gr.
Ammon., arom. spir. (1 year).
Antipyrine, tabs, compr., 5 gr.
Antiseptic tabs. (Bernay's large blue).
Aspirin, tabs, compr., 5 gr.
Bismuth subnitrate, tabs, compr., 5 gr.
Boric acid.
Bromide, potass., tabs, compr., 5 gr.
Brown Mixture, tabs, trit., 1 fl. dr.
Calomel and sod. b. c., tab. trit., A gr.
Cathart. co., veget. pills.
Chlorate, potass., tabs, compr., 5 gr.
Cholera Mixture, Sun, tabs, compr., 15 min.
Collodion flexile.
Copaiba, 5 min.
Coryza, tabs, compr. (P. D. & Co., No. 2).
Creosote.
Effervesc. co. (Seidlitz powders).
Epsom salts.
Glycerinum.
Iodide, potass., tabs, compr., 5 gr.
lodi, tra.
Laudanum (1 year).
Mustard.
Myrrh, tra.
Olive oil.
Opii and camph. pills (J gr. opii).
Paregoric (1 year).
Petrolatum.
Phenol.
Quinine sulph., tabs, compr., 3 gr.
Ricini, ol. (castor oil).
Saponis, liniment.
Soda, bicarbonate.
Sod. salicyl., tabs, compr., 5 gr.
Strychn. sulph., tabs, trit., A gr.
Venereal prophylactic tubes.
MEDICAL AND SURGICAL APPLIANCES.
25
25
2
1
1
1 pound . . .
1 envelope.
5 yards
3 spools . . .
5 yards —
1 box (10).
4!!!!!!!!!!
1 spool
I...
Bandages, gauze, 2-inch.
Bandages, muslin, 2-inch.
Bandages, suspensory.
Bottle, hot-water, 2-qt.
Catheter, soft rubber, No 10 Engl. (1 year).
Cotton, absorbent.
Court plaster.
Gauze, plain, sterilized.
Plaster, adhesive, O. Z. (2 1-inch, 1 2-inch).
Plaster, belladonna (1 year).
Plaster, mustard.
Pocket case of instruments (Hamilton, with metal case).
Surgical needles, in glass-stoppered bottles.
Silk ligature, medium size.
Syringe, bulb.
Syringes, glass.
Thermometer, clinical.
Tongue depressor.
Tourniquet (Esmarch's).
These medicines will remain serviceable until used if kept in glass-
stoppered bottles, with the exception of those marked " 1 year,"
which should be renewed after that interval.
For bulky articles not over a pint of each need be kept in the
medicine chest.
All poisonous medicines must be plainly so marked on the bottles
or packages.
SANITATION. 7
SANITATION.
On vessels.— The commanding officer of a vessel should observe
the following measures on board his vessel, and the same rules should
be applied at shore stations, so far as useful.
The water-closets, forecastle, bilges, and similar portions of the
vessel liable to harbor infection should be frequently cleansed.
Free ventilation and rigorous cleanliness should be maintained in
all portions of the ship during the voyage and measures taken to
destroy rats, mice, fleas, flies, roaches, mosquitoes, and other vermin.
A patient sick of a communicable disease should be isolated and
one member of the crew detailed for his care and comfort, who, if
practicable, should be immune to the disease.
Communication between the patient or his nurse and other persons
on board should be reduced to a minimum.
Used clothing, body linen, and bedding of the patient and nurse
should at once be immersed in boiling water or in a disinfecting solu-
tion of 1 to 1,000 bichloride of mercury, and should be kept so im-
mersed for 20 minutes.
The compartment from which the patient was removed should be
disinfected and thoroughly cleansed.
Any person suffering from malarial fever should be kept under
mosquito bars and the apartment in which he is confined closely
screened with mosquito netting. All mosquitoes on board should be
destroyed by burning Pyrethrum powder (Persian insect powder)
or by fumigation with sulphur, burning 4 pounds sulphur to 1,000
cubic feet air space, the room or compartment to be closed for 4 hours.
Mosquito larvas (wigglers or wiggle tails) should be destroyed in
water barrels, casks, and other collections of water about the vessel
by the use of petroleum (kerosene). Where this is not practicable,
use mosquito netting to prevent the exit of mosquitoes from such
breeding places.
Formulas for disinfecting solutions recommended for use.
Bichloride of mercury (1 : 1,000) :
Bichloride of mercury 1
Sea water 1, 000
Carbolic acid (2.5 per cent) :
Carbolic acid, pure • 25
Fresh water 1, 000
Flies as carriers of disease. — It is a well-known fact that flies carry
the germs of such well-known diseases as tuberculosis, typhoid fever,
and probably smallpox; hence the importance of preventing their
breeding near a dwelling or securing access to a house. They breed
in such things as stable manure, garbage, etc., in from eight to ten
days after the eggs are deposited. The fly deposits its eggs, which
8 MEDICAL HANDBOOK.
in a few days hatch into a white worm, popularly called the mag-
got, then turning into the fly. If there is a stable near the light-
house, the manure in it should be protected from the access of flies
by a screening or some similar method. All garbage not buried
or burned should be in cans, protected by tops, so that the flies can
not get in. All openings to the house should be protected by wire
netting, preferably bronze wire, 16 mesh to the inch.
Mosquitoes. — Mosquitoes are known to convey such diseases as
malarial and yellow fever by biting a person sick with this disease
and afterwards inoculating other persons by biting them. The
screens mentioned above, properly applied to all the openings of the
house, will prevent their entrance into it. They breed usually in
stagnant water. The eggs are deposited on the surface of the water
and are hatched out first in the form of what is known as wiggle
tails or wigglers. At the end of about ten days these wigglers go
through certain changes and become full-fledged mosquitoes. It is
important that no water be allowed to stand in containers about the
dwelling for a period as long as eight days. If there are such con-
tainers, they should be emptied every five or six days or protected by
a netting, so that the mosquitoes can not obtain access to lay their
eggs. Ponds are the principal breeding ground of mosquitoes, and if
possible they should be drained or oiled when near a dwelling. The
malarial mosquito only bites about sundown or during the night.
Diet. — In all acute diseases, especially those attended with fever,
the question of diet is a very important one, and the main reliance
may be placed on such food as eggs and milk. Thin soups may be
used, but they contain very little nutrition and can not be depended
upon to maintain the strength of the sick.
The proper mastication or chewing of the food is necessary to
good digestion and the maintenance of a healthful condition. On
this account the drinking of large quantities of fluid at mealtime is
objectionable, as it has a tendency to wash down the solids before
they are properly chewed. It is desirable to have the meals at regu-
lar hours.
Cleanliness of the person. — A cold bath every morning is probably
the best plan for a person in vigorous health, but to take one with
benefit there should be a pleasant glow of exhilaration afterwards,
and it is necessary in cold weather for the average person to have a
warm room in which to take this cold bath. A great many people
do better with a bath in tepid water; but it is impossible to fix any
hard and fast rule in these matters.
The presence of bedbugs in dwellings is indicative of want of
care and cleanliness as to bed, bedclothes, etc., and means should be
taken to exterminate them when they appear. A liberal application
POISONS. 9
of kerosene oil to the places infested is probably the best means of
killing them.
Care of the mouth and teeth. — The teeth should be cleansed after
each meal with a soft brush, using some mild dentifrice. Castile
soap makes an excellent cleanser in the absence of a dentifrice.
For toothache caused by a decaying tooth often the only cure is
pulling out the tooth. Relief, however, can sometimes be obtained
by cleaning out the cavity and putting in two or three drops of
creosote on a small piece of cotton. For toothache without the
presence of a decayed tooth to cause it, the application of heat to
the seat of the pain will often give relief.
COMMON POISONS AND THEIR ANTIDOTES.
Bichloride of mercury or corrosive sublimate. — Give the whites
of several eggs mixed with milk or water, or flour and water, if eggs
can not be obtained. Then administer an emetic of a tablespoonful
of mustard in warm water. The importance of giving these remedies
as soon as possible .after taking of the poison should be understood.
Opium including morphine, laudanum, and paregoric. — An emetic —
a tablespoonful of mustard in warm water — should be immedi-
ately administered, and if the patient becomes very drowsy cold
water may be dashed in his face and he may be beaten with a wet
towel and forced to walk up and down. When the respiration be-
comes slow and irregular, artificial respiration should be made, the
same as is used to restore the partially drowned.
Carbolic acid. — Give grain alcohol (not wood alcohol) liberally,
as much as a half glass, followed immediately by an emetic. If the
alcohol is not obtainable, a half ounce of Epsom salts in warm water
may be administered; then give the emetic consisting of a table-
spoonful of mustard in warm water. Common table salt, two table-
spoonfuls in a glass of warm water, is an excellent emetic if nothing
else can be secured.
Arsenic, including Paris green. — Administer immediately a table-
spoonful of mustard in a glass of warm water, and repeat if vomiting
is not very free, as it is all important to empty the stomach at once.
Afterwards give milk and eggs freely, or olive oil, one-fourth pint.
A tablespoonful of common washing soda in a half glass of water
will often relieve the symptoms.
USE OF CLINICAL THERMOMETER.
Place bulb of mercury in mouth under tongue for five minutes. If
it registers over 101 degrees, send for physician. Stay in bed until
he arrives. See that it registers less than 97 before using.
10 MEDICAL. HANDBOOK.
MALARIAL FEVER.
Malarial fever is an endemic infectious disease, caused by a para-
site of the blood. The disease is transmitted to man (inoculated) by
the bite of certain kinds of mosquitoes, of the genus Anopheles.
It is a disease of warm and temperate regions; very prevalent
and of severe type in hot countries, especially along the seacoast
and basins of rivers, but gradually declining in extent and virulence
in proportion to the distance on either side from the Equator. In
the Tropics the disease is constantly prevalent. In the cooler, or
temperate regions, as, for example, along the coast of the Central
Atlantic States, it is active only during summer and autumn. It is
seldom developed at a lower temperature than 60° F. (15.5° C.),
and even in the hot climates malaria is probably never contracted
far away from land. The disease is said to be most frequently con-
tracted during the night, just after sunset and just before sunrise
being the most dangerous periods. It is, therefore, very important
in infected localities not to permit the men to go ashore nor to allow
them to sleep on deck if the vessel is lying near the land ; or, if they
must sleep on deck or other exposed places, to provide suitable pro-
tection by means of blankets and properly constructed mosquito bars.
There are different varieties and types of malarial intermittent
fever: (1) Quotidian, when the paroxysm occurs every day; (2)
tertian, when it occurs every other day; and (3) quartan, when it
occurs every fourth day. The disease is popularly known as " fever
and ague," " chills and fever," " the shakes," etc. It is characterized
by recurring paroxysms, consisting as a rule of three distinct
stages: The cold, the hot, and the sweating stage. The attack may
be sudden or it may be preceded by a feeling of uneasiness, a desire
to stretch the limbs and yawn, headache, loss of appetite, and some-
times by vomiting. The chill may be of any degree of severity.
Patients sometimes complain only of chilliness or of a creeping sen-
sation of coldness over the back. More frequently the chill is well
marked; the feeling of cold spreads all over the body, the teeth
chatter, the patient shivers, and his whole body shakes. This cold
stage may last from a few minutes to an hour, or longer.
The hot stage gradually comes on as the cold stage subsides, and
soon there is a feeling of intense heat. The face becomes flushed,
the pulse full or bounding, the headache continues, and the patient
is in high fever. This stage may last from half an hour to four or
five hours, when perspiration appears, first on the forehead and
gradually over the entire body, and the sweating stage is fully estab-
lished. With the appearance of perspiration the fever declines, the
distressing symptoms gradually cease, the patient experiences a feel-
ing of great relief, and soon falls into a refreshing sleep. The dura-
DISEASES. 11
tion of the sweating stage varies from one to three hours. It may
be very profuse or very slight. At the end of the sweating stage
the patient may be greatly prostrated or may feel quite well, and
able to be up and about until the beginning of the cold stage of the
next fit, twenty-four, forty-eight, or seventy-two hours from the
beginning of the first.
There are three varieties of malarial fever — intermittent, remit-
tent, and a very severe type known as pernicious malarial fever.
In the intermittent the paroxysms may recur at irregular intervals,
the cold stage may be absent, the fever may come on gradually and
decline to normal in the same manner.
When the attacks are prolonged, and when instead of declining to
normal there may be only a slight fall in the temperature and slight
sweating, the fever is called remittent fever.
Pernicious malarial fever, as the name indicates, is a very fatal
disease. It occurs chiefly in hot climates, but is occasionally met with
in temperate regions. It may be preceded by an apparently mild at-
tack of intermittent fever or the patient may be taken suddenly with
intense headache, high fever, wild or perhaps muttering delirium,
rapidly passing into unconsciousness, and death may occur within
a few hours from the beginning of the attack.
In another form of the disease the attack begins with extreme cold-
ness of the surface of the body, with vomiting, or with severe diar-
rhea or dysentery, and the patient may die from collapse.
There is also a hemorrhagic form in which bleeding may occur
from the nose, mouth,*or gums. The urine may be bloody or quite
dark in color, in some cases almost black. In tropical Africa and
other hot countries where the disease prevails it is known as " black-
water fever."
Hemorrhages, however, may occur in any severe or prolonged form
of malarial infection, and bloody urine (malarial hematuria) is not
infrequently met with.
Treatment. — Quinine is the remedy, and quinine also acts as a pre-
ventive. In going to a malarial region, treatment should be com-
menced several days before arriving at port. To each man on board
should be given at least 10 grains (0.6 gm.) of quinine daily for a
period of one week. The allowance may then be reduced to 5 grains
(0.3 gm.) or even to 3 grains (0.2 gm.) a day. The bowels should
be kept freely open.
If a chill occur, the patient should at once be wrapped in blankets
and given hot drinks. During the hot stage, cold drinks, lemonade,
etc., may be given. As soon as the sweating stage begins, 10 or 15
grains (0.6 gm. to 1 gm.) of quinine should be given, and thereafter 5
grains (0.3 gm.) every six hours, for two or three days, and then con-
12 MEDICAL, HANDBOOK.
tinued in smaller doses, say 3 grains (0.2 gm.) three times daily, for
the next two weeks.
If the chill is severe, or if the surface of the body is very cold, hot-
water bottles or heated bricks or stones wrapped in cloth or in a
separate piece of blanket should be placed to the feet. Mustard
plasters may also be applied to the extremities and over the region
of the heart, and hot stimulating drinks should be given.
If vomiting occur, a mustard plaster may also be placed over the
region of the stomach, above the navel, and cracked ice may be given
by the mouth. Headache may be relieved by cold applications.
If the hot stage is severe, a tepid bath may be given in a tub or by
means of a sponge. If the temperature is very high, 105° or 106° F.
(40.5° or 41.1° C.), a cold bath should be given.
In remittent and other severe types of malarial fever the treatment
should be more active. No time should be lost in giving the quinine ;
10 or 15 or 20 grains (0.6 gm. to 1.3 gm.) should be given imme-
diately, and along with this, if the bowels are not freely open, a calo-
mel tablet, one-tenth grain each, should be given every half hour until
10 have been taken. After the bowels move, the quinine should be
continued in 5-grain (0.3 gm.) doses every four or five hours.
The symptoms and signs of typical malarial intermittent fever are
so striking that they can hardly be mistaken for anything else. It
must not be forgotten, however, that there are typical and irregular
forms of malarial fever, and that they may be mistaken for other
diseases, such as tubercle (consumption) of the lungs, abscess of the
lungs or of the liver or any part of the bocfy, or the result of the
passing of a catheter, all of which produce chills or chilliness and
fever.
Some forms of remittent or continued remittent malarial fever
may be difficult to distinguish from typhoid fever. The remittent
type may be mistaken for yellow fever.
Quinine is the remedy for any form of malarial fever. If the
fever does not yield to full doses of quinine, it is probably not mala-
rial. At any rate this is the most practical method for determining
the question as to whether the fever is malarial or not. In the hos-
pital or laboratory the diagnosis is made by microscopical examina-
tion of the blood.
The diet in any form of acute fever should be light, liquid, and
nourishing; and if there is much prostration, stimulants will be re-
quired. Solid food should not be allowed.
MEASLES.
Measles is an acute infectious disease, which most commonly at-
tacks children but may occur in adults. It usually spreads from per-
son to person by exposure to a patient with the disease, as going into
DISEASES. 13
the room where he is sick, riding in the same street car, or being in
the same schoolroom. It generally makes its appearance from twelve
to fourteen days after exposure. One attack is usually a protection
against a second one.
It usually begins with the symptoms of an ordinary cold. There
may be an initial chill; the patient's face looks flushed and some-
times slightly swollen about the nose and eyes, and the eyes are red-
dened. There may be a tendency to sneeze, and an examination of
the throat will disclose a reddening of the mucous membrane. The
rash often appears first in the throat. Some cough may be present
at the onset, with more or less headache. Fever is generally present
with the onset of these symptoms. The eruption on the skin devel-
ops on the third or fourth day of the fever. It may be most marked
on the forehead or about the ears, looking like fleabites, and gradu-
ally spreads over the entire body. The patient has considerable
cough with expectoration. In children there is some liability to a
form of pneumonia called broncho-pneumonia, which renders the
disease much more dangerous. It may also have the complication of
diarrhea and vomiting, due to implication of the bowels and stomach.
As soon as a case is discovered it should be put in bed and isolated
in a room, from which children should be excluded and only those
adults admitted who are directly concerned in the care of the case.
It is necessary to protect the patient from becoming chilled, and
he should not be exposed to drafts, but fresh air should be admitted
to the room. If the weather is cold, he should be provided with
plenty of covering.
The treatment of an ordinary case of measles is practically nil, as
little or no medication is required. If there is much irritation of the
eyes, it is well to have the room darkened and to wash out the eyes
with a saturated solution of boric acid in warm water. Take a glass
of warm water and put into it all the boric acid it will dissolve and
use it as a wash for the eyes, keeping it covered to prevent dust or
other impurities getting into the solution. Everything applied to
the eyes should be scrupulously clean.
If the skin is dusky and the eruption is not well marked, the pa-
tient may be enveloped in sheets or blankets wrung from hot water,
but care must be exercised that he does not become too rapidly chilled
afterwards. Only sufficient covering should be used to render the
patient comfortable.
If the cough is very troublesome, a tablet of brown mixture may be
given three or four times a day.
After the eruption has disappeared and the peeling of the skin has
begun, the patient should bathe daily in order that the skin may be
freed from the scales. Children should not be allowed to approach
the patient until after this scaling has entirely ceased.
14 MEDICAL, HANDBOOK.
During the period of the disease the patient may be fed on broths,
milk, soft-boiled eggs, etc.
After recovery of a case of measles, the bedding should be disin-
fected by boiling twenty minutes or by soaking in a bichloride of
mercury solution, 1 to 1,000, for two or three hours.
The hangings in the room and the rug or carpet, if any, should
be disinfected, if possible ; but if disinfection is not practicable, they
should be hung out in the sunshine and well beaten before being used
again. The room should be thoroughly cleaned and p.ired for several
days.
MUMPS.
Mumps is an acute infectious disease usually affecting children,
but may occur in adults. It affects the parotid gland, which is
situated just below the ear on each side. It is usually conveyed by
contact from one patient to another. Hence, the patient should be
isolated in a room, and children should not be exposed to the dis-
ease. Only the adults directly in charge of the case should be ad-
mitted to the room unless they have been protected by a previous
attack. An attack usually comes on about fifteen days after the
exposure to the disease.
The chief symptoms are pain and swelling in the parotid region
under the ear. Movements of the jaw, such as chewing and talking,
will be painful. Swelling may occur on one or both sides, but nearly
always both are involved. It is usually worst about the third day,
and may gradually disappear after that. It is usually a very mild
disease, but swelling of the testicle is a frequent complication in the
male.
Treatment. — Light diet, such as broths, eggs, milk, rice puddingSy
etc., should be given. Sour food and acid drinks will be found to
give considerable pain if taken in the mouth ; hence, they should be
avoided. Hot applications may be placed over the swollen glands if
there is very much pain. No internal medicines are indicated. If
the bowels are constipated, a tablespoonful of Epsom salts may be
administered with benefit.
After recovery of a case of mumps, the bedding should be dis-
infected by boiling twenty minutes or by soaking in a bichloride of
mercury solution, 1 to 1,000, for two or three hours.
The hangings in the room and the rug or carpet, if any, should be
disinfected, if possible; but if disinfection is not practicable, they
should be hung out in the sunshine and well beaten before being used
again. The room should be thoroughly cleaned and aired for several
days.
DISEASES. 15
SMALLPOX.
Smallpox is an acute, contagious disease, characterized by an initial
fever and successive stages of eruption. It spreads rapidly among
persons unprotected by vaccination. It may be communicated by the
breath, by exhalations from the skin, by clothing, or by anything that
has been in contact with a person suffering from the disease. It is
very contagious during the latter stage of eruption, and especially
during the period of convalescence when the dried pus scales become
detached from the skin and in the form of dry powder or dust settle
on everything about the room or compartment, and may be conveyed
not only to all parts of the ship or light station, but to any part of
the world to which the ship is bound.
After a period of incubation of from eight to fourteen days, occa-
sionally longer, the disease begins suddenly, usually with a chill,
always with severe pain in the back and loins, intense headache, and
high fever. Vomiting occurs in many cases. The bowels may or
may not be constipated.
About the end of the third day or on the fourth day a papular
eruption appears on the forehead, and frequently on the lips and the
wrists, occasionally in the mouth and throat, and gradually extends
to other parts of the body. The eruption begins as a bright red dot
or spot slightly elevated above the surrounding skin, enlarging until
the second day, when it forms a papule. The papule is hard to the
touch, feels like shot under the skin. As soon as the eruption appears
the temperature begins to fall, and the distressing symptoms subside.
On the fifth or sixth day a small vesicle, with a depression of the
center, appears on the top of each papule. The vesicles gradually
become distended, the depressed centers rounded out, and about the
eighth or ninth day the change is completed and the vesicles become
pustules. They have a yellowish gray appearance and each pustule
is surrounded by a red border. The skin between them is swollen,
the eyes may be closed. During this change the temperature rises
again, secondary fever sets in, the chief symptoms return, and a day
or two later another change begins. The pustules break, matter oozes
out, crusts form, first on the face and then over other parts of the
body, following the order of the appearance of the eruption. The
secondary fever may be quite high in the beginning, but gradually
declines as the pustules change into crusts, and in favorable cases
seldom lasts more than two or three days. The crusts then rapidly
dry and fall off, leaving red spots on the skin and here and there the
characteristic pockmarks or pits. The healing of the pustules is
usually attended by troublesome itching.
In some cases a diffuse redness of the skin or red spots appear on
the abdomen, or on the side of the chest, or on the inner surface of
16 MEDICAL, HANDBOOK.
the thighs as early as the second day, but the distinctive papular
eruption makes its appearance, as stated, at the end of the third or
on the fourth day and nearly always begins on the forehead.
In the confluent form of smallpox the eruption may appear a day
earlier and all the symptoms are more severe. The pustules run
together and form large brownish scabs, chiefly on the face and head,
but also on the hands and feet. The face and neck are greatly swol-
len, the eyes are closed, the features are distorted. The patient com-
plains of tension and burning of the skin ; there is much thirst. The
eruption may also appear in the mouth and throat. The secondary
fever is high. Delirium may be quite marked. In fatal cases the
pulse becomes rapid and feeble; and death occurs about the tenth or
eleventh day or later.
In favorable cases, about the eleventh or twelfth day the pustules
begin to break. The matter dries and forms crusts which slowly fall
off, leaving the skin quite red and in many cases dreadfully scarred
and pitted.
The crusts begin to drop off about the fourteenth day, but the proc-
ess of desquamation may not be completed until the end of the third
or fourth week, and the fever may persist during that period. There
is a milder form of smallpox called varioloid, in which the symptoms
are usually milder and of shorter duration. Varioloid occurs in per-
sons who have been vaccinated. Sometimes the eruption begins on the
feet. In some cases it is confined to the feet and hands. Occasionally
the eruption is extensive and the symptoms are severe.
The most severe type of smallpox is the hemorrhagic (bloody). It
occurs in two forms. In one the case goes on in the usual way until
about the ninth or tenth day, when blood makes its appearance in the
pock. This form is sometimes called black smallpox. In the other
form the eruption may be blood-colored from the second day, and
bleeding may take place from the nose or mouth or from the rectum.
The face is greatly swollen and the eyes are deeply bloodshot. Death
occurs during the first week, sometimes as early as the second day.
Before the characteristic eruption appears it is frequently very
difficult to determine the existence of smallpox. It is easily con-
founded with other eruptive diseases. The important points to
remember are the intense pain in the back, the high fever, and
bounding pulse, all of which precede the eruption, and that when
the eruption appears the fever and all the severe symptoms subside.
The temperature before the eruption may be up to 105° or 106° F.
(40.5° or 41.1° C.). When the eruption appears it begins to decline
and within twenty-four or thirty-six hours is down to about 100° F.
(37.7° C.). When the secondary fever sets in the temperature rises
again.
DISEASES. 17
Treatment. — The patient should be placed in a cool, well-ventilated
room, and strictly isolated; and every person at the light station or
on board the ship should be immediately vaccinated. No one should
be allowed to come in contact with him except the nurse or attendant,
and the nurse or attendant should not be allowed to come in contact
with other persons. While in immediate attendance on the sick he
should wear overalls and jumper, and a head covering, to be removed
when he leaves the room, and immediately put on again when he
returns. Separate dishes and necessary utensils should be provided.
The food should be placed at a convenient place near the door of the
sick room where the nurse can come and get it. Nothing should be
allowed in the room except the articles absolutely necessary. The
soiled clothing should be wrapped in a clean sheet (or in a sheet that
has been dipped in a 1 to 1,000 solution of bichloride of mercury),
and the bundle placed in a kettle of water and thoroughly boiled.
If there is a sufficient supply of bedclothing the soiled articles should
be destroyed by fire (burned). The patient must be kept thoroughly
clean. Good nursing is very important.
In the early stage, when the fever is high, place the patient in a
cold bath, or give him a cold sponge bath, note the temperature of the
body, and repeat the bath every three hours if the thermometer regis-
ters above 103° F. (39.4° C.). If the bowels are constipated, give
small doses of Epsom salts, 2 teaspoonfuls, every two or three hours.
The food should be soft and nourishing and given at regular inter-
vals. Cold drinks, lemonade, barley water, etc., may be freely given.
The pain and tension in the skin may be relieved by cold applica-
tions. A piece of lint, wet with a cold 2 per cent solution of carbolic
acid, may be applied to the face and frequently renewed. Holes
should be cut into the lint corresponding to the eyes, nose, and mouth.
When the pustules begin to form it is a good plan to touch each one
with tincture of iodine (a camel's-hair brush may be used for the
purpose) , and a day later to puncture them with the point of a needle.
The needle should first be boiled, and the point should then be dipped
in tincture of iodine before making the puncture. When crusts begin
to form, olive oil or glycerin should be applied. If the hair is long
it should be cut short early in the disease before the pustular stage
begins. The eyes must be carefully cleansed several times a day, else
blindness may follow. A solution of boric acid, 5 grains to a fluid
ounce of water, is a good eyewash. The mouth, throat, and nose also
require attention. A saturated solution of boric acid may be used
as a mouth wash and gargle.
When the crusts and scabs drop off they should be carefully gath-
ered up and burned. The patient should then have a daily bath with
soap and water. When the case is ended the room and all exposed
62431°— 12 2
18 MEDICAL, HANDBOOK.
articles must be disinfected by burning sulphur (4 pounds to every
1.000 cubic feet of air space).
On shipboard if near port when the disease breaks out the ship
should be taken direct to the quarantine station, where the patient
may be taken care of and the ship disinfected.
DYSENTERY.
Dysentery, or bloody flux, as it is sometimes called, is an affection —
an inflammation and ulceration — of the mucous membrane of the
large bowel. It occurs in different degrees of severity. It may be
acute or chronic. There are different varieties. Its severest form is
met with in tropical countries, where it frequently occurs in wide-
spread epidemics. Epidemics also occur in temperate regions. Spo-
radic cases may be found almost everywhere. The disease prevails
in summer and autumn. It may attack an entire ship's crew.
Bad food, unripe fruit, impure drinking water, exposure to cold
and dampness, while probably not in themselves the direct cause of
dysentery, doubtless favor the operation of other causes.
Symptoms. — The onset may be sudden or gradual. There may
or may not be chills or chilliness. There is usually some feverish -
ness. The tongue is furred and moist, but soon becomes red and dry
or brownish and glazed.
The first stools may be like those of an ordinary diarrhea. After
a day or two, or maybe within a few hours, these are replaced by
small mucous stools frequently mixed with blood and small particles
of fecal matter. Soon the evacuations consist of mucus alone, or of
blood and mucus, or of a jelly-like matter and small white clumps
of mucus. Later they may be shreddy, and brownish or greenish in
color. Patient complains of cramps and "colicky" pains in his
belly; a burning sensation in the rectum, with a feeling as if some-
thing must be expelled, and of a constant desire to go to stool. The
evacuations may number from ten to twenty, or forty to fifty, or
even a hundred or more a day, according to the severity of the case.
The quantity of each may not exceed a teaspoonful.
In mild cases there is a gradual change to normal, and patient may
recover after a period of a week or ten days. Severer cases continue
for several weeks or longer and then recover, or become chronic and
incurable, or death may occur from general weakness.
Tropical dysentery, the variety which occurs most frequently and
in epidemic form in tropical or subtropical regions, but also occa-
sionally in temperate climates, is said to be produced by a micro-
organism which enters the system in drinking water.
The symptoms in this form of dysentery are similar to those
already described. The burning sensation and bearing-down pain,
however, are less marked. The stools are less frequent, but they
DISEASES. 19
are larger and more watery ; at times more like diarrhea than typical
dysentery. The disease in favorable cases runs a course of from
six to twelve weeks. Recovery is always slow. Death may occur
from exhaustion, or from abscess of the liver, which is a common
complication. In the most fatal epidemics the course of the disease
is very rapid. Death sometimes occurs within a few hours.
Treatment. — Rest in bed. If possible, the patient should use the
bedpan instead of the commode or closet, so as to insure the greatest
amount of rest, which is very important. Stop all solid food. Give
2 tablespoonfuls (30 c. c.) of castor oil and 15 drops of laudanum
in one dose, and, if necessary, repeat the dose in six hours, or give
smaller doses at intervals of four hours. After the bowels have
been thoroughly cleared out, a pill of camphor and opium should
be given every three hours. Hot applications should be placed on
the abdomen. The bearing-down pain and the burning sensation
may be relieved by washing out the rectum with a pint of warm
water and by injecting 2 ounces of thin starch containing 25 or 30
drops of laudanum.
In place of the castor oil, Epsom salts may be given in tablespoon-
ful doses, repeated every two hours until a free and large action of
the bowels results, and then the pill of camphor and opium given
every three hours. Or, instead of the camphor and opium pills,
bismuth subnitrate may be given in 30 or 40 grain (2 gm. or 2.6
gm.) doses.
After two or three days, if the disease continues, the castor oil or
the Epsom salts may be repeated, and after its effect is produced,
the same line of treatment continued.
The diet should be limited to the lightest articles, such as thin
porridge, milk, and broths. And even in the lightest cases the pa-
tient should be kept warm in bed.
The best means of protection or prevention is to keep the body in
sound condition. If the disease occurs among a ship's crew, the
healthy men should be very careful not to catch cold, and to avoid
errors in eating and drinking. Sudden changes of temperature
should be guarded against by a proper supply of clothing. The
drinking water should be boiled.
SUNSTROKE.
The term sunstroke denotes a sudden attack of illness from expo-
sure or prolonged exposure to the rays of the sun; but the same
condition may be produced in hot weather by exposure to high
temperature not in the direct rays of the sun, particularly if the
person is engaged at hard work in close quarters. Stokers on steam-
ships are sometimes affected by the heat of the furnace. Men debili-
20 MEDICAL, HANDBOOK.
tated from or addicted to the excessive use of stimulants are more
apt to suffer than those of temperate habits.
Sunstroke occurs in two forms: Heat stroke (heat fever), in which
the temperature of the body is very high, and heat prostration or
heat exhaustion, in which the surface of the body is cool, sometimes
considerably below normal. The difference is very important because
of the different treatment required.
In severe cases of heat stroke, the patient may be stricken down
in a state of unconsciousness and die instantly or within an hour or
two. In other cases there may be intense headache, dizziness, marked
restlessness, nausea and vomiting, and hot " burning " skin. The
thermometer may register 105° F. Pulse is full and may be slow or
fast. Breathing is labored, may be sighing or rattling. Patient soon
becomes unconscious, the stupor deepens, and death may occur within
24 hours; or the temperature may drop, consciousness may return,
and the patient get well.
In heat prostration, as already stated, the surface of the body is
cool, the pulse rapid and feeble, and there is a feeling of general
weakness. There may be only slight faintness and nausea, and under
prompt treatment patient may rapidly recover, or, on the other hand,
there may be complete loss of consciousness and a rapid and fatal
termination from exhaustion.
Treatment. — In heat stroke (heat fever) the temperature of the
body should be reduced as rapidly as possible. Remove the patient
to the coolest and best- ventilated part of the ship or station. Place
him in a cold-water bath, add ice, rub the body with the blocks of ice,
apply iced water with ice cap to his head ; and keep up the treatment
until the temperature, as shown by the thermometer in the rectum,
is reduced to 100° F. If the temperature rise again, repeat the
treatment. If symptoms of exhaustion follow the reduction of the
temperature, stimulants should be given — strychnia sulphate, one-
fortieth grain.
In heat prostration, with cool skin, weak and rapid pulse, stimu-
lants and friction are required. Give strychnia sulphate, one-fortieth
grain, rub the surface of the body and the extremities, place hot-
water bottles to the feet, and cover the body with blankets. If the
head is hot, apply cold water to the forehead. If vomiting occur,
inject the stimulants into the rectum. Apply mustard over the region
of the stomach. Mustard may also be applied to the feet.
DIARRHEA.
Acute diarrhea is caused by acute inflammation or by irritation
of the intestines. It may occur as a complication in many different
diseases. It is usually one of the symptoms of typhoid fever. It is
not infrequently met with in severe cases of malaria. It is called
DISEASES. 21
functional or simple diarrhea when it occurs independently of any
other appreciable disease. It may be caused by exposure to cold or
by errors in diet.
In simple diarrhea there may or may not be griping and colicky
pains. In the more severe forms the tongue is coated and there is
some fever. Thirst is marked in proportion to the size and frequency
of the thin or watery discharges. If the rectum is affected, there is a
constant desire to go to stool, and a burning sensation and bearing-
down pain, as in dysentery.
Diarrhea may last from a few hours to as many days, or longer.
It may become chronic.
Treatment. — In all cases, rest and light diet. In the milder forms
nothing further may be required. In the more severe forms it is
a good plan to begin with a dose of 1 or 2 tablespoonfuls of castor oil,
to which 10 or 12 drops of laudanum may be added, or in place of the
oil and laudanum Epsom salts may be given. The diet should be
limited to light articles, such as cornstarch, gruel, weak broths, soft-
boiled eggs, milk, and thoroughly toasted bread. As a rule, in very
acute cases, the less food and drink taken the better. The patient
should rest in bed and keep his body warm.
After the bowels have been freely moved by the oil or salts, if the
diarrhea or pain continue, give 1 camphor and opium pill, and, if
necessary, repeat the dose after an interval of three or four hours.
If nausea and vomiting occur, apply mustard to the region of the
stomach, and give tablespoonful doses of equal parts of milk and
limewater.
In chronic diarrhea careful attention to diet is of the greatest im-
portance. The treatment is about the same as for chronic dysentery.
CHOLERA MORBUS (SPORADIC CHOLERA).
Cholera morbus is an affection of the stomach and intestines,
attended by vomiting, purging, and cramps. It comes on suddenly,
and may begin by vomiting or purging. It is usually met with dur-
ing the hot months of summer. It is frequently caused by eating
unripe and indigestible fruits and vegetables, decomposed or im-
properly cooked fish, shellfish, or salad mixtures. Drinking large
quantities of iced water and sudden checking of the perspiration, or
irritants of any kind, may set up the trouble. The disease usually
begins suddenly, often at night, with vomiting, after a feeling of
uneasiness, nausea, or a severe cramp. The contents of the stomach
are first thrown up, then a bilious matter. The stools are at first
solid or semisolid, but they soon become more watery, lose their color,
and sometimes appear not unlike the rice-water stools of genuine
Asiatic cholera. The patient soon has a wasted look. His thirst
is unquenchable. His skin may become cold and clammy and the
22 MEDICAL, HANDBOOK.
pulse very weak. Cramps may occur in the feet and in the calves
of the legs. The disease runs a rapid course. The acute symptoms
may subside in a few hours. The attack seldom lasts more than
twelve hours. Recovery is the rule, but treatment should be promptly
applied.
Treatment. — Apply a large mustard plaster to the abdomen. Give
15 drops of laudanum. If the dose is rejected (immediately vomited) ,
try it again. If it is still not retained, then try 2 tablets of " Sun
Cholera Mixture." If vomiting quickly occur, then inject into the
rectum by means of a glass or rubber syringe about 20 drops of
laudanum mixed with a little thin starch or a little water. The
rectal injection should be given immediately after an evacuation, and
the patient should be instructed to hold it as long as possible. In
whatever way the remedy is given the dose should be repeated in
about one hour if the vomiting and purging continue.
It must not be forgotten, however, that all these remedies contain
opium, and that if the patient is inclined to sleep or shows other con-
stitutional effect of the drug the dose must not be repeated.
The nausea and thirst may be controlled by cracked ice placed in
the mouth. Small quantities of carbonated water may be allowed,
If the thirst is very urgent, a tablespoonful of iced water may be
given at short intervals.
COLIC.
Intestinal or spasmodic colic. — These terms are applied to abdom-
inal pain occurring in paroxysms of different degrees of severity.
The pain is usually referred to the region of the navel or middle
of the belly. It may be due to indigestible food, cold or acid drinks,
poisons, gases, or any irritating substance. It is often preceded by
obstinate constipation. Vomiting frequently occurs.
Another variety of colic, called lead colic or painter's colic, is
caused by lead poisoning. It is not uncommon in painters or work-
ers in lead. It may be caused by drinking water taken from leaden
pipes. An attack may be mild or exceedingly severe. It is usually
attended by obstinate constipation and by contraction of the abdo-
men.
The severe, paroxysmal pain attending the passage of a gallstone
from the gall bladder to the intestine is called biliary colic. In
biliary colic the pain is usually most marked in the region above the
navel or about the stomach (epigastric region). The paroxysms
begin and end suddenly. Severe nausea and vomiting occur. The
skin and eyes may become yellow or of a yellowish hue (jaundiced),
the same as in bilious colic. Gallstones may occasionally be found
in the stools if carefully looked for. Some cases, however, are
difficult to distinguish from ordinary intestinal colic.
DISEASES. 23
The severe, excruciating pain caused by the passage of a small
rough stone or calculus or particles of sandy substance from the
kidney through the ureter to the urinary bladder is called nephritic
colic, kidney colic, or an attack of " the gravel." The pain usually
begins with a one-sided, boring backache. Suddenly it increases in
intensity and shoots down the loin to the hip and thigh, and the
patient wTrithes in agony until the "stone" or particle, sometimes
not larger than the head of a medium-sized pin, reaches the bladder,
when the pain suddenly ceases. The paroxysm may last from half
an hour to a number of hours, or one or two days. It may not recur
for months or years; on the other hand, there may be two or more
paroxysms at comparatively short intervals.
Colicky pains are present in many different diseases. Appendicitis
frequently begins with pain not unlike that of intestinal colic.
Treatment. — If the colic is due to indigestible food, or too much
food of any kind, an emetic should be given, such as mustard and
water.
After the stomach is emptied give a teaspoonful of aromatic spirits
of ammonia in water. Apply a large mustard plaster or a hot poul-
tice or cloths wrung out of hot water, or heat of any kind to the
abdomen. (Local applications of hot water usually afford some relief
in any variety of colic or wherever pain exists.) If the colicky pains
persist, 10 or 12 drops of laudanum should be given by the mouth,
and repeated, if necessary, in two hours ; or 30 or 40 drops of lauda-
num in a little wrater or starch may be injected into the rectum.
If the bowels were constipated when the attack began, an injection
of soap and warm water should be given by the rectum, or small doses
of Epsom salts or castor oil may be given by the mouth. The diet
for a day or two should be light articles in small quantities at a time.
The treatment for lead colic is about the same, except that the consti-
pation should be relieved at once by full doses of Epsom salts or castor
oil. Apply heat to the abdomen or place the patient in a warm bath.
Pressure applied to the abdomen affords some relief. Remove the
cause or remove the patient from the cause of the disease.
In biliary colic, the bowels should be freely moved, patient should
be placed in a hot bath, and laudanum, 30 drops, given to relieve pain.
In nephritic or kidney colic, hot baths and laudanum, 30 drops,
are the remedies.
SCURVY.
Scurvy is a disease produced by improper or unsuitable food.
Many years ago it was of frequent occurrence among seafaring men
on long voyages. Now it is a comparatively rare disease, thanks to
better provisions and better methods in issuing food supplies.
Symptoms. — Swelling, sponginess, and bleeding of the gums. The
teeth become loose and frequently drop out. The breath is foul, the
24 MEDICAL, HANDBOOK.
tongue swollen. The skin becomes dry and scaly. Hemorrhages
(small dark red spots) occur under the skin, first on the legs and then
on the arms and other parts of the body. Bleeding from the nose
frequently occurs. Swelling about the ankles is common. The skin
of the legs is frequently discolored in large blotches, and there is often
a peculiar hardness or induration of the muscles of the calf of the
leg. The complexion is frequently of greenish or dirty-yellow hue.
The pulse is rapid and weak. There may or may not be slight fever.
The bowels may be constipated or there may be a troublesome
diarrhea.
In severe cases debility and emaciation are quite marked. The
mind wanders, and occasionally there is wild delirium.
Treatment. — This consists almost wholly in a change of diet. Give
fresh vegetables, fresh milk, fresh beef, oranges, lemons, limes, or
lime juice. Begin with small quantities at short intervals, and
increase the allowance as rapidly as the stomach can take care of it.
Pickles, onions, sauerkraut, raw potatoes, and raw cabbage are valu-
able articles in the make-up of a varied diet.
Potassium chlorate dissolved in water should be used as a mouth
v,-ash, and the gums should be frequently painted with tincture of
myrrh. The skin should be kept in good condition by frequent bath-
ing. The sleeping quarters should be clean and well ventilated.
SORE THROAT (TONSILLITIS, QUINSY).
Sore throat is a common disease. It is usually the result of expo-
sure to wet and cold. Talking, laughing, or shouting in a damp,
cold atmosphere is sometimes the cause of it. It frequently occurs
in persons predisposed to rheumatism. It may accompany or be
nn extension from an ordinary " cold in the head." Sometimes
the inflammation is limited to the mucous membrane of the pharynx
and soft palate; it is then known as pharyngitis or acute catarrhal
sore throat. More frequently the tonsils are affected, and the inflam-
mation is then called tonsillitis. When the inflammation is more
deeply seated in the tonsil and tends to suppurate or form an
abscess the term quinsy is applied. An attack of sore throat may
last from two to ten days, or longer.
Symptoms of acute sore throat are chilliness and feverishness,
pain or soreness on swallowing, dryness, or a tickling or scratching
sensation in the throat.
There is apt to be a stiffness and some tenderness along the side of
the neck. If one or both tonsils are involved, as they usually are
to a greater or less extent, the symptoms are more severe. In marked
cases examination shows redness and swelling of the parts affected-
swollen tonsils (tonsillitis) and white or cream-colored spots may be
seen on the surface of one or both tonsils. (This form of the disease
DISEASES. 25
is frequently mistaken for diphtheria.) There may be high fever
and great prostration.
In the severest form of tonsillitis (quinsy) the tonsil is hard and
swollen to twice or three times its natural size, and the patient
is unable to swallow or to open his mouth beyond a fraction of an
inch. The saliva dribbles away; if suppuration occur the tonsil
gradually softens until the abscess breaks. With the discharge of
the pus the severe pain is relieved and the patient rapidly recovers.
If the abscess is large, and if the pus is discharged in a backward
direction, there is danger from suffocation, particularly if the abscess
breaks during sleep. Fortunately the abscess usually points toward
the mouth, and the pus runs out.
Treatment. — Persons who are subject to attacks of sore throat
should keep their feet dry and be very careful not to catch cold.
If a case develop, give a gargle of salt water or potassium chlorate
and water (saturated solution), or boric acid and water may be
applied to the tonsil. Dry bicarbonate of soda (baking soda) is
highly recommended as a local application, a small quantity to be
applied every hour. Apply cold water or a light ice bag to the
neck, or a thick piece of flannel saturated with ice water may be
placed around the neck and covered with muslin. Small pieces of
ice placed in the mouth are usually agreeable. The bowels should
be kept open by means of Epsom salts.
If the cold applications to the neck do not give relief, or if they
are not agreeable to the patient, apply hot water or poultices and
give hot gargles, or let the patient gargle with hot tea. If the swell-
ing is very great, he can not gargle. If practicable, send for a
plwsician.
COUGHS AND COLDS.
When a person has a cough that lasts more than two or three
weeks, even though the symptoms are very mild, the case is serious
enough to require an examination by a physician, and one should be
consulted on the first opportunity.
A case of bronchitis or bad cold usually begins with a cough,
sometimes starting with an irritation in the throat, which gradually
travels down into the lungs. Though the cough at first is dry, there
will be some expectoration later on, especially marked in the morn-
ing on first arising. It may be at first white and tenacious, later
on becoming yellowish. With this there will be some soreness over
the upper and front part of the chest, and if the cough is violent
there will be considerable soreness of the muscles between the ribs.
Treatment. — For the soreness over the chest, a good rubbing with
soap liniment may help to relieve the symptom. A tablet of brown
mixture given three or four times a day is serviceable, but not more
26 MEDICAL. HANDBOOK.
than 4 should be given during the 24 hours. The bowels should be
kept open by a tablespoonful of Epsom salts, when necessary.
Patients with coughs and colds should not be kept in a hot, dry
room without ventilation. Plenty of fresh air should be allowed to
come into the room, with the precaution, however, that the patient
be not exposed to a draft and that he be properly clothed so as not
to become chilled when the weather is cold.
ERYSIPELAS (ST. ANTHONY'S FIRE).
Erysipelas is an inflammation of the skin. It usually begins with
a chill, followed by a high fever. It is a frequent complication of
wounds, but is more frequently developed without any apparent
injury. A large majority of cases begin on the face, usually on the
nose, first as a small red spot, which is soon elevated above the sur-
rounding skin, and gradually or rapidly spreads over the face and
ears, and not infrequently over the entire hairy scalp; sometimes over
the neck and chest, and occasionally down the back and to other
parts of the body. The skin is painful, red, hot, and swollen, and
blisters frequently form. The swelling may be most marked about
the eyes and ears, the eyes closed, and the patient's features changed
and distorted to sucih a degree that the appearance once seen will
not soon be forgotten. The disease limited to the face and scalp
usually runs its course in a few days or a week, but sometimes before
the face is healed red spots appear on other parts of the body, and
the case may be prolonged. Abscesses beneath the skin are not
uncommon.
Besides the symptoms already mentioned there are headache, loss
of appetite, coated tongue, frequently vomiting, and in some cases
delirium and marked depression.
The outcome is usually favorable, but in drunkards or in persons
debilitated from previous diseases death is sometimes the result.
Treatment. — Erysipelas is only slightly contagious under ordinary
circumstances; but persons suffering from wounds or scratches of
the skin are very apt to be attacked. The patient should therefore be
isolated — placed in a room by himself — and his attendant should be a
healthy man and free from any skin injury.
Erysipelas being a self-limited disease, it is a common saying
among physicians that the majority of ordinary or moderately severe
cases would get well without any treatment. But this is probably
true of many other diseases, and while it may be difficult, perhaps
impossible, to limit the spread of the eruption or shorten the course
of the disease in a given case of erysipelas, something may be done to
relieve distressing symptoms and, particularly in feeble persons, to
fortify the system against the attack. " Treat the patient rather
than the disease " is good advice in more troubles than one.
DISEASES. 27
The oldest and one of the best local applications for erysipelas is
cold water, and if the fever is very high cold sponging of the entire
body or a cold bath may afford considerable relief. Bismuth sub-
nitrate may be dusted over, or petrolatum may be applied to the skin.
In feeble persons stimulants may be required.
POISON IVY.
Contact of the skin with the poison ivy causes in many people a
very annoying inflammation of the skin. The vine is of the climbing
variety, with three pointed leaves on each stem. A few hours or about
a day after the skin is exposed to the poison of this plant a red rash
appears, with more or less swelling and itching; small blisters appear,
filled with serum, even becoming quite large. When they burst, there
is considerable weeping from the surface. Later it may go on to a
formation of pus. The hands and face, being the most exposed parts
of the body, and the feet and ankles of those who go barefooted, are
usually first affected. If the inflammation is very severe, there may
be some incidental disturbance, such as fever, headache, and general
feeling of malaise.
Treatment. — One of the best treatments for this disease is bathing
with salt water, sea water being the best. Weak alkaline solutions,
such as boric acid, about 2 grains to the ounce, are good applications.
The large blisters should be punctured and the contents allowed to
run out. Every one or two days the affected parts should be bathed
with warm water, carefully dried without rubbing, and the alkaline
treatment resumed.
RHEUMATISM.
There are different forms of rheumatism and some of the forms
have several different names. Acute rheumatism, acute articular
rheumatism, inflammatory rheumatism, and rheumatic fever are
terms applied to one and the same disease. A milder form of the
affection is called subacute rheumatism. In this form the symptoms
are less severe, but the disease is more prolonged. It may continue
for a long time and become chronic. Chronic rheumatism, however,
or the different affections and deformities of joints to which this
term is frequently applied, may develop independently of any acute
or subacute attack.
The term muscular rheumatism indicates an affection of the mus-
cles as distinguished from joint affections. Lumbago and stiff neck
are varieties of muscular rheumatism. The muscles, however, to
a greater or less extent may be involved in any form of rheumatism.
Other conditions simulating rheumatism, occuring in connection
with or directly due to gonorrhea or to syphilis, are called gonor-
rheal rheumatism or syphilitic rheumatism, as the case may be.
28 MEDICAL, HANDBOOK.
Acute rheumatism (rheumatic fever) is a comparatively common
disease in all climates within the Temperate Zone. It occurs chiefly
during the winter and spring. Exposure to a cold, damp atmosphere
is the most frequent exciting cause in persons predisposed to the
disease.
It may or may not begin with a chill or with a sore throat. The
larger joints are usually affected. Swelling, heat, redness, tender-
ness, and pain are the chief symptoms. The inflammation is apt to
shift from one joint to another. The pain and fever are usually
increased in proportion to the number of joints involved. The ma-
jority of cases are attended with profuse perspirations, scanty, highly
acid urine, coated tongue, and constipation. The heart is frequently
involved.
Treatment. — Wrap the joint in cotton or flannel; keep it very
quiet — the slightest movement aggravates the pain. Flannel wrung
out of hot water and applied to the joint sometimes affords relief.
Soap liniment may be applied if the pain is severe, or cold applica-
tions may be applied if agreeable to the patient.
Place the patient in a good bed, and let him wear flannel next to
his skin. Change the flannel frequently, and bathe the body with
tepid water.
For internal medication give salicylate of soda in doses of 10 to
15 grains (0.6 gm. to 1 gm.) every two hours until about eight doses
are taken or the pain is relieved, then give it in smaller doses of
from 3 to 5 grains (0.2 gm. to 0.3 gm.) every six hours.
The food should be soft and nourishing and given every three
hours. Epsom salts should be given to keep the bowels open. The
patient should be kept in bed for a few days after the symptoms
have subsided. The duration of the disease is very uncertain. The
acute symptoms may subside in a few days and the patient may be
up and about in a week or ten days, but relapses are common and the
acute may pass into the subacute or chronic form.
In chronic rheumatism there is stiffness and pain. A cracking or
grating sound is frequently produced when the joints are suddenly
moved. In severe cases the joints become enlarged and distorted.
The deformity is sometimes very great.
The treatment consists chiefly in local application of liniments,
etc., which afford relief because of the rubbing (massage) by which
they are applied. Severe pain in the joint may be relieved by cold
applications (flannel wrung out of iced water, applied to the joint
and covered with muslin). Hot applications to the joints are some-
times of value. Belladonna plaster may be applied.
Five to eight grains (0.3 gm. to 0.5 gm.) of potassium iodide in a
glass of water may be given three times a day between meals.
DISEASES. 29
The general health should be looked after. The skin should be
kept in good condition by frequent baths of tepid water. The
bowels should be moved at least once a day. Patient should be
allowed good food. Fresh air is also important.
In muscular rheumatism the muscles most frequently affected
are those of the back (lumbago), side of neck (stiff neck or wry
neck), and side of chest (pleurodynia). Exposure to cold, sudden
cooling of the body — especially after active exercise, and sitting in
a draft of air — are the chief causes, or exciting causes.
As a rule there are no symptoms other than the stiffness and pain
on motion. The muscles may be slightly swollen, and very sensi-
tive. Sometimes the attacks come on suddenly and apparently with-
out cause, or following a slight twist or strain, as a " kink in the
back," or patient may wake up in the morning with a stiff neck.
Treatment. — In acute cases salicylate of soda may be given in 5 or
10 grain doses (0.3 gm. to 0.6 gm.) every three hours until four or
six doses are taken. Apply hot applications, dry heat, hot-water
bag, or a hot poultice locally, or the heat may be applied by a flat-
iron, over folds of flannel or a piece of blanket, and the rheumatism
" ironed out." Later apply liniment with friction (massage). Keep
the affected muscles at rest. If the muscles of the chest are affected,
apply strips of adhesive plaster, the same as for fractured rib. Acute
attacks are of short duration, but relapses are not uncommon, and
chronic forms are frequently met with. Good food, fresh air, and
attention to the general health are especially important in the treat-
ment of chronic muscular rheumatism.
Gonorrheal rheumatism (gonorrheal inflammation of joints) may
occur during an acute attack of gonorrhea, but it is more frequently
associated with chronic gonorrhea or gleet. One or several joints
may be affected. There may or may not be considerable fever. If
only one joint is affected it is apt to be the knee or the ankle. In
chronic cases the pain is sometimes centered in the heel. The attack
may begin in the wrist, elbow, or shoulder. The disease is not always
limited to the joints. Sometimes the inflammation is in the tissues
outside the joint proper, in the sheaths of the tendons of muscles,
or in the fascia of the soles of the feet. The swelling is frequently
quite marked. In chronic cases there may be effusion (" water on
the joint ") . In very severe cases suppuration occurs (abscess forms) .
The eye and the heart may also be seriously involved.
Treatment is not very satisfactory. Give from 5 to 10 grains (0.3
gm. to 0.6 gm.) potassium iodide in a little water between meals.
Keep the joint at rest. Apply a flannel bandage. Change it fre-
quently and wash the joint with hot water and soap. In chronic
cases liniments and passive motion should be applied. Tincture of
iodine may be painted over the joint.
30 MEDICAL, HANDBOOK.
Syphilitic rheumatism, so called, is associated with secondary or
tertiary syphilis. The joints and the shafts of long bones may be
affected — thickened and painful. The pain is always worse at night.
The treatment is by potassium iodide, beginning with 10 grains
(O.G6 gm.) of potassium iodide three times a day between meals.
Good food and attention to the bowels are important.
FAINTING.
Treatment. — When a person feels faint, or actually faints, he
should be laid flat upon the bed or the floor, with the head at least
as low as the body, and the clothing around the neck and chest
loosened. A teaspoonful of aromatic spirits of ammonia should be
given in a third of a glass of water. He should remain in this reclin-
ing position until the attack has passed off.
DELIRIUM TREMENS.
Delirium tremens occurs as an incident in the life of persons
addicted to the excessive use of intoxicating liquors.
Loss of appetite, sleeplessness, or a marked mental depression are
the chief symptoms of the first stage of the affection which is known
among drunkards as " the horrors."
As the disease advances the patient talks incoherently ; has a wild
expression; his mind wanders from one thing to another. He an-
swers questions in a rambling manner. He fancies he is being pur-
sued by wild animals or that he sees rats, snakes, and the other
animals crawling on the walls or around his bed, or he may imagine
himself to be engaged in his regular duties or as master of the ship,
giving directions to the men.
The delirium is always worse at night, but the patient requires
careful watching all the time. He may try to jump overboard or
commit suicide.
Delirium tremens may be confounded with acute inflammation of
the brain or with acute mania (insanity) or with certain forms of
pneumonia, and any one of these diseases may also be present. Pneu-
monia is a frequent complication of delirium tremens, and in fatal
cases may be the direct cause of death.
In favorable cases the symptoms begin to improve in three or four
days from the onset. The patient sleeps and gradually recovers.
Treatment. — The patient requires constant attendance. Physical
restraint should be avoided if possible. To support the patient and
to procure sleep are the great objects of treatment. Careful feeding
is very important. Milk or concentrated broths should be given at
regular intervals of two hours. A cold bath is of value in some
cases, especially if agreeable to the patient. In other cases a warm
bath or a hot foot bath may have a better effect.
DISEASES. 31
The serious symptoms are largely, if not entirely, due to the sleep-
lessness, and if several hours of sound sleep can be procured improve-
ment is almost sure to follow. To this end potassium bromide in
30-grain doses may be given in water every three hours. Morphia
or opium are not to be recommended in this disease except under
the immediate direction of a physician.
APPENDICITIS.
Appendicitis is an inflammation involving the appendix vermi-
formis. This is a small attachment of the large intestine situated in
the right groin. It may begin suddenly with violent pains in the
right groin, some fever, collicky pains, nausea, and vomiting. The
seat of the pain is usually on a line drawn between the bony promi-
nence (the large bone of the pelvis) just above and on the outer side
of the right groin and the umbilicus. As the attack progresses, that
region of the abdomen may become hard like a board and exceed-
ingly sensitive to the touch. Often you will find that the patient
flexes the right leg on the abdomen, and the effort to straighten it out
causes him great pain. Sometimes the attack is much milder with
only an uneasy sensation in the right groin, very slight fever, if any,
and a sense of tenderness over the part affected. This pain may be
in the pit of the stomach or about the umbilicus.
After this pain has been present for a few days a swelling in the
right groin may appear, due to the formation of pus or to a large
protective exudation of lymph.
Treatment. — The right course to pursue in a case of appendicitis
is to call in a surgeon. If the services of a surgeon or physician can
not be secured, the plan of treatment should be as follows : Absolute
rest in bed with an ice bag over the appendix, to be continued during
the stage of severe pain. Do not give purgatives. Reduce the allow-
ance of food and drink of all kinds to the lowest possible limit. If
the pain is very severe, 20 drops of laudanum in a little water may be
given to control it. If the bowels move, a bed pan should be used,
and under no circumstances should the patient be allowed to get up.
SYPHILIS.
Syphilis is a constitutional disease. It is contagious, or commu-
nicable, and is usually acquired during sexual contact. It may, how-
ever, be contracted in many different ways, direct and indirect. It
begins by a primary lesion or sore called a chancre at the seat of inoc-
ulation (where the virus enters), and is followed by eruptions of the
skin of different forms and different degrees of severity and variable
duration. Sores also appear at the angle of the mouth, and mucous
patches develop on the lips, tongue, inner sides of the cheeks, and
sore throat is very common.
32 MEDICAL, HANDBOOK.
Mucous patches or syphilitic warts are also frequently seen about
the anus or in any region where the skin is moist. The hair fre-
quently falls out, the eyes are sometimes seriously involved, and sooner
or later every organ in the body may become affected. A man suffer-
ing from syphilis in active form should not be allowed to go on
board a ship, and if the disease breaks out while on the voyage he
should be isloated, or at least be compelled to use separate drinking
cups, knives, spoons, forks, towels, etc. He should under no circum-
stances smoke the pipe belonging to another man nor allow another
man to smoke his. All his belongings should be kept strictly to
himself, for unless the greatest care is taken other men of the crew
will suffer. Chancre of the lip may be acquired by smoking the pipe
of a syphilitic.
The primary or initial lesion of syphilis (the hard chancre) usually
appears about three weeks after exposure, but may be as early as ten
or twelve days or as late as five or six weeks. It begins as a red spot
or papule, which usually breaks and forms a small ulcer with hard
edges; sometimes the sore appears as a simple excoriation or super-
ficial ulcer without hard edges. The neighboring lymph glands
become, in the course of a week or two, enlarged and hard. They
seldom suppurate. About two months later the skin eruption and
ether secondary symptoms begin. The lymph glands above the
elbow, along the side and back of neck, and all over the body are
usually enlarged. Patient frequently complains of headache and
pain in the limbs, always worse at night, and may have slight, occa-
sionally considerable, fever.
Treatment. — For the primary sore bathe the part with soap and
water and dust boric acid over it twice a day.
If secondary symptoms, eruptions of skin, etc., appear, give a pill
of calomel, one-fifth grain, three times a day. The mouth and
teeth should be kept clean by means of a soft toothbrush and castile
soap and water, or water to which a small quantity of bicarbonate
of soda (baking soda) or tincture of myrrh has been added. If
mucous patches appear in the mouth, smoking must not be allowed.
If on board ship, as soon as the ship arrives in port send or take the
man to the marine-hospital office and receive the advice of a surgeon
as to further treatment.
SOFT CHANCRE (CHANCROID).
Soft chancre or chancroid is a virulent ulcer. It usually begins
within thirty-six hours after exposure, first as a red spot, but rapidly
developing into an ulcer covered with thick yellowish pus. The
period of development is about three or four days. Sometimes a
week elapses from the time of exposure to the development of the
sore, and occasionally a period of incubation is as long as ten days.
DISEASES. 33
A sore appearing within a few days or a week or even as late as ten
days after the exposure is usually regarded as a chancroid; but in
practice this is not a safe rule, for the reason that many venereal
sores are of a mixed character. The inoculations of both poisons may
take place at the one and same spot — the result is a mixed chancre ; or
if two sores appear, the orgin of one may be syphilitic, the other
chancroidal. It is therefore difficult, if not impossible, in many
cases to determine the character of the disease from the period of
incubation or from the appearance or local characteristics of the
sore. A mixed chancre is a syphilitic chancre (a hard chancre),
while its appearance may be precisely like that of the soft chancre or
chancroid. The only safe plan is to regard all venereal sores as sus-
picious. But while this is true, treatment for syphilis should not be
commenced before the appearance of secondary symptoms, for unless
such symptoms appear it is impossible to determine that syphilis
really exists in any case. The mixed chancre, as already stated, is
essentially a syphilitic chancre, and the beginning of constitutional
disease. Its local effects, however, may be precisely the same as those
of soft chancre or chancroid. The ulcer (or ulcers — sometimes there
are two or more) may remain as small as a pea or grow as large as
a quarter, and if it becomes phagedenic (eating) may spread over a
large surface of the body. It is also proper to state that a secondary
syphilitic sore may appear under the foreskin, as well as at any
other place on the body, and that cancer (epithelioma) of the organ
may begin as a small ulcer. The latter, however, is a rare disease
as compared with the different varieties of chancre.
The most frequent complication of soft chancre or chancroid is
inflammation of the lymph glands of the groin (bubo), known to
the sailor as "blue balls." Another troublesome and serious com-
plication is the elongation and contraction of the orifice of the fore-
skin (phimosis), on the inner surface of which the sores may be
located, and the swelling and tension may be so great as to pro-
duce gangrene (mortification). If the foreskin is very tight and
pulled back and can not be brought forward again, the condition
is known as paraphimosis, which produces great swelling, the same
as if a string were tied around the organ, frequently resulting in
severe ulceration and destruction of tissue. This condition may also
be the result if the inflammation and swelling are marked and the
foreskin very tight.
The sore should be dried and covered with a small piece of aseptic
gauze or absorbent cotton, and later a dusting powder of boric acid
may be applied.
If phimosis exist, the cavity of the foreskin should be syringed
out with hot water, and if there are sores under the foreskin which
can hot be reached by the acid the cavity should be syringed with
G24310— 12 3
34 MEDICAL, HANDBOOK.
a solution of one part of carbolic acid to forty parts of water (1 to
40). Soft chancres or chancroids appearing at the anus or rectum
should be treated by frequent washings of warm water and the appli-
cation of calomel.
In all cases, wherever the sore is located, cleanliness must be insisted
upon, and, as already stated, in nearly all inflammations of whatso-
ever character, hot water alone is a valuable remedy ; and rest in bed
is of equal importance. If a lump (bubo) appear in the groin, rest in
bed is of the greatest importance. The diet should be light but nour-
ishing. Tincture of iodine, pure or diluted one-half with alcohol,
may be painted over the lump, but it is not of much value. Rest is
the important thing. If the bubo go on to suppuration, it should be
carefully opened with the point of a knife, and kept open by a strand
of aseptic gauze, which must be frequently changed, and enough
aseptic gauze should be placed on top of the wound to absorb the
discharges. The soiled gauze should be burned, and the person
handling it must be careful to wash his hands in soap and water and
in one of the antiseptic solutions already referred to. The patient's
bowels should be moved once a day.
GONORRHEA (CLAP).
Gonorrhea is a specific inflammation of the urethra due to a micro-
organism, called gonococcus. It usually begins during the first week
after exposure, sometimes as early as three or four days, and occasion-
ally as late as ten days or two weeks. The first symptoms are a
tickling or itching sensation and a slight swelling about the lips of
the orifice of the urethra. A purulent creamy colored discharge soon
appears, and a burning or stinging pain attends the passage of urine.
The inflammation gradually extends to the deeper parts of the
urethra, and, unless checked by medication, reaches its height about
the end of the second or during the third week. The patient may
experience great difficulty in passing water. If the inflammation
run very high, abscesses may form in the tissues around the urethra,
and swelled testicle and bubo are frequent complications; also pain-
ful erections and bending of the organ (chordee). Phimosis or para-
phimosis occurs if the foreskin is tight or becomes involved in the
inflammation.
If phimosis occur, and if the cavity of the foreskin is not thor-
oughly and frequently washed out. " venereal warts " are apt to form.
True gonorrhea, if carefully treated, gradually subsides and recov-
ery may take place in from four weeks to two months. A urethral
discharge that recovers in a few days or a week is probably a simple
urethritis.
Gonorrhea is urethritis (inflammation of the urethra), but ure-
thritis is not necessarily gonorrhea.
DISEASES. 35
Treatment. — Rest in bed, light diet, plenty of water to drink,
regularity in eating and sleeping. Keep the bowels open by taking
a moderate dose of Epsom salts in the morning. Avoid strong coffee
and tea, all stimulants, and greasy articles of food. Keep the body
and mind at rest. Bathe frequently in hot water. Be very careful
not to carry any of the pus from the urethra to the eyes. (Gonor-
rheal inflammation of the eyes is a very serious disease, which not
infrequently results in total blindness and loss of the eyes.)
Give a copaiba capsule three times a day. If much pain in the
back or over the region of the kidneys follow the use of the copaiba,
it must be discontinued for a time or the dose lessened.
If the chordee is troublesome, apply cloths wrung out of cold
water.
A snug suspensory bandage worn from the beginning may prevent
the complication of swelled testicles. If the patient is lying in bed,
the dragging of the testicles should be prevented by placing them on
a support. The best local remedy for swelled testicles is heat, which
may be applied by pieces of cloth or flannel wrung out of hot water.
STRICTURE OF THE URETHRA.
True or organic stricture of the urethra is a narrowing of the
tube. It is commonly the result of long-continued or neglected
gonorrhea. Stricture of the urethra may be produced by direct
injuries, as kicks or falls on the perineum, or by the use of too
strong injections, or by the careless passage of instruments.
Occasionally stricture results from simple urethritis, not gonor-
rheal, and symptoms not unlike those of stricture are sometimes
caused by a stone in the bladder obstructing the passage, and by an
enlarged prostate gland.
Gonorrheal stricture of the urethra is usually of slow development.
It may be several months or years after the attack of gonorrhea
before the patient becomes conscious of any change in the size or
shape of the stream. First there may be only a twisting or flattening
of the stream. In severe cases it gradually becomes smaller and
smaller, until it is no larger than a knitting needle and passed with
great difficulty, or it comes away drop by drop, and finally results
in complete retention. One of the earliest symptoms of stricture is
a gleety discharge from the urethra.
Occasionally retention of urine is the first symptom of the disease.
Sudden retention may be due to spasm of the urethra (spasmodic
stricture) .
Spasmodic stricture may occur independently of any specific dis-
ease of the urethra, but it is more frequently a complication of
organic stricture. Exposure to cold and wet (catching cold), or a
debauch, are the usual exciting causes.
36 MEDICAL. HANDBOOK.
When retention occurs the bladder gradually becomes distended
and a fullness or distinct tumor may be felt in the lower part of the
abdomen, which in severe cases may extend as high as the navel.
Sometimes there is an involuntary flow, or an overflow of urine from
a distended bladder — patient says he can not hold his water, and in
such case it may be difficult to convince him that he is suffering from
retention, until a catheter is passed and a quantity of urine is with-
drawn.
Treatment. — A neglected stricture of the urethra is a serious dis-
ease, the treatment of which is very difficult in many cases, even in
the hands of the most experienced surgeon.
If a case is allowed to run on until there is an actual stoppage or
retention of urine, unless this condition is relieved the consequences
are extremely serious and death may be the result.
Place the patient on his back with his knees slightly drawn up,
and try to pass a catheter. The instrument should first be thoroughly
cleansed by placing it in boiling water. It should then be oiled with
FIG. 1. — How to use catheter ; shows the curve of the channel through which the catheter
must pass.
olive oil, and carefully passed into the urethra and effort made with
the greatest gentleness to pass into the bladder. (Fig. 1)
Try the largest size catheter (about a No. 10 English) first; if this
fail, try the smaller ones. If a catheter can not be passed at the first
trial, place the patient in a hot bath, give him 20 drops of laudanum,
and an hour or two later try the catheter again. If it is not prac-
ticable to place the patient in a full bath of hot water, then cover his
belly and other parts of his body with flannels wrung out of hot
water and change them every fifteen minutes. The object of the hot
bath and the laudanum is to produce relaxation. Sometimes a pa-
tient will pass his water in the bath. If, however, the symptoms are
very urgent, if the patient can not pass any water, and after the
most careful and gentle manipulation the catheter can not be passed
into the bladder, the services of a surgeon should be secured.
DISEASES. 37
BOILS.
A boil is a circumscribed inflammation of the skin and connective
tissue. It is often caused by infection following a slight wound or
scratch of the skin, but may occur apparently without any cause. It
begins as a small red pimple and gradually increases in size and
forms a dusky red swelling, the size of a silver dollar or less. The
central portion of the swelling sloughs or forms a "core," and as
soon as the core is separated or cast off the inflammation subsides, the
pain lessens, and the ulcer begins to heal.
Treatment. — Hot applications, frequently renewed, until the cen-
tral portion of the boil is softened. Then the separation of the core
may be aided by an incision. The incision should be made by a thin
blade, thoroughly boiled before it is used. After the core is dis-
charged the ulcer should be dressed with aseptic gauze, held in
place by a bandage.
PILES.
Piles are varicose dilatations of the veins of the rectum. The
symptoms may be slight or severe. Inflamed piles are very painful.
There is a constant burning sensation at the anus, which is greatly
increased during and immediately after each movement of the bowels.
When the veins rupture you have " bleeding piles." Occasionally
the inflammation of a nodule results in an abscess.
Treatment. — Piles are frequently due to habitual constipation, and
when that condition is improved the piles often disappear, or at least
cease to be troublesome. The bowels should be kept in good condi-
tion. One easy movement should take place regularly every day.
This desirable habit should be brought about by careful attention to
diet and by drinking water in the morning before breakfast rather
than by the use of cathartics.
In acute attacks, if the bowels are constipated give a full dose of
epsom salts ; put the patient on light, soft diet. Apply ice to the anus
or inject cold water into the rectum. A hot application is some-
times very grateful. If the piles protrude, especially if they become
strangulated, they should be pushed back with the finger; olive oil
or petrolatum may be applied. If the piles are large and persistently
painful, see a surgeon and have them removed by operation, which
is the only sure cure.
INJURIES— HEMORRHAGE (BLEEDING).
In all cases of injury careful examination should be made of the
part, after carefully washing the hands.
Hemorrhage is of three kinds — arterial, venous, capillary.
Arterial (bright-red blood from arteries in jets or spurts).
38 MEDICAL, HANDBOOK.
Venous (dark-red or purple blood welling out or flowing from
veins in steady stream).
Capillary (blood oozing from the capillaries over the general sur-
face of a wound).
If the bleeding is by jets or spurts, pressure should immediately
be made above the wound by the thumb or finger, or better by tying
rubber tubing around the limb, or, in the absence of such a tube, a
bandage, handkerchief, suspender, strap, or soft rope may be used to
stop or lessen the flow of blood ; the blood vessel should then be seized
and drawn gently forward with a pair of artery forceps and the
ends tied with silk ligature in a reef knot, when the tubing or strap
should be loosened or removed.
If the blood vessel is torn but not completely divided, tie a silk
ligature around the vessel on each side of the wound.
Straps or bandages applied to control or lessen the danger of
hemorrhage must always be placed above the wound — that is to say,
between the bleeding point and the heart. In wounds of the foot,
for example, if the arteries spurt, pressure should be made in the
hollow back of the knee. If the blood is flowing slowly or oozing
and does not come by jets or spurts, aseptic gauze or lint wrung out
of hot water should be applied and firmly bandaged over the wound,
or hot water may be poured over the wound before applying the
aseptic gauze or lint. In any case it is well to cleanse the wound
with hot water. The oozing may also be stopped by exposing the
wound to fresh air and by allowing a stream of cold water to fall
upon it, and then applying pressure.
Before beginning the treatment of any wound or any bleeding
point, the operator must carefully cleanse his hands and arms, also
the wound and surrounding parts, and the instruments and silk liga-
ture should be boiled, as will be described under the head of wounds.
In the after treatment of severe bleeding the patient should be kept
perfectly quiet in mind and body, his head should be lowered by
raising the foot end of his bed or bunk. Give him plenty of fresh
air, but keep his body warm and give him hot drinks. After reaction
the temperature of the body may rise a degree or two above normal,
but if this should continue longer than two or, at most, three days,
the dressing should be removed and the wound thoroughly irrigated,
first with hot water, then with a solution of bichloride of mercury
(1 to 5,000), and dressed with aseptic gauze.
WOUNDS.
Incised wounds inflicted by sharp cutting instruments may, after
the bleeding has been stopped, be drawn together with the fingers
or with a needle and silk ligature, a thin layer of absorbent cotton
applied over the wound and held with adhesive plaster. Strips of
INJURIES. 39
adhesive plaster may be used over the dressing. The parts should be
thoroughly cleansed, first by scrubbing with hot water and soap — the
skin to be shaved if hairy — then washed with grain alcohol (not wood
alcohol) and then again with hot water before the edges are drawn
together. The needle and silk ligature and all instruments should
be boiled before they are used. The operator must roll up his sleeves,
scrub his hands and arms with hot water and soap, clean and trim
his finger nails, scrub again with soap and water, then with grain
alcohol (not wood alcohol), and finally soak his hands in a solution
of bichloride of mercury (1 to 1,000) before beginning the operation.
The wound, if deep, should not be completely closed ; one end should
be left open for drainage unless the patient is under the direct care
and treatment of a surgeon.
Contused and lacerated wounds with torn and ragged edges, espe-
cially if the surrounding parts are bruised or crushed, should not be
drawn tightly together. The bleeding from lacerated wounds at the
time of the accident is not so profuse as in incised wounds, but the
shock is greater, and very troublesome and serious hemorrhage may
come on within a few hours or later. To guard against this the
wound should be carefully examined (the operator's hands and all
instruments to be first prepared as above described), and if any blood
vessels have been torn they should be tied with silk ligatures, though
they may not be bleeding at the time. The wound should be scrubbed
off with soap and warm water, and then with grain alcohol (not
wood alcohol), and finally with a solution of bichloride of mercury
(1 to 5,000). Thick layers of clean (aseptic) gauze dressing should
then be applied and held in place by means of a bandage. If the
wound is large, the edges of a portion of it may be carefully drawn
together. A strand of aseptic gauze should then be placed in the
bottom of the wound and allowed to project through the opening,
so that it may drain into the layers of gauze placed on top.
When dressings become soaked with the discharges they do more
harm than good; they must, therefore, be changed as soon as the
soaking is apparent, and the change must be made with all the
aseptic precautions exercised in the operation. Clean hands, clean
instruments, clean dressings, clean everything, are the watchwords.
Water that has been boiled is perfectly safe, and boiling is the best
disinfectant for instruments.
The stitches may be removed from a wound about the fifth or
sixth day, or earlier if they begin to cut or irritate. If the wound
is large, they need not all be taken out at the same time.
Gunshot wounds are frequently more or less contused and lacer-
ated, and unless one of the main blood vessels is divided, or the lung
or other internal organ penetrated, the bleeding is slight. The
general treatment for such wounds is about the same as for other
40 MEDICAL, HANDBOOK.
lacerated wounds already described, but if the materials for thor-
oughly cleansing the wound are not readily at hand, and if there
is not much bleeding, the wound had better be let alone, simply cov-
ering it with aseptic gauze until the patient can be placed under the
care of a surgeon. No effort should be made by anyone other than a
physician to find or feel the bullet or other missile by a probe or other
instrument, especially if the wound is in the chest or abdomen, as
there is more danger in searching for it than in leaving it where it
may be lodged. The wound made by a Mauser bullet not infre-
quently looks as if made by a large needle — a punctured wound.
Punctured wounds are made by a narrow sharp-pointed instru-
ment, e. g., pin, needle, dagger, or point of a knife or stiletto. They
may penetrate to any depth, and if the instruments are clean and
no large blood vessels or nerves have been wounded, withdrawal
of the instrument may be followed by rapid recovery. But if such
wounds are produced by irregularly shaped blunt instruments, or
by nails or splinters of wood, and especially if contaminated by any
poisonous material, the walls of the wound track are at once dan-
gerously contused, lacerated, and infected, and if large blood vessels,
nerves, or other organs have been injured the danger is very great,
and the patient should be placed under the care of a surgeon as
soon as possible, for unless the master or keeper is sufficiently famil-
iar with the nature of such wounds and the anatomy of the part
to lay it open to the bottom by additional incisions, he can do little
more than apply aseptic dressings to the surface and keep the patient
quiet.
BURNS OR SCALDS.
Burns or scalds are serious and dangerous to life in proportion
to the extent and depth of the injury. A burn covering a large
area and producing mere reddening and swelling of the skin is as
serious as a burn one-half the size in which the skin is destroyed.
The danger is from shock, from fever following reaction, from hem-
orrhage following sloughing, and from congestion and inflammation
of internal organs. Burns of slight extent or moderate degree are
not so dangerous, and most of the cases commonly met with will
recover. But all cases require careful treatment.
Treatment. — For shock give strychnia sulphate, one-fortieth grain.
In slight or moderate burns apply clean cloths wet with warm satu-
rated solution of bicarbonate of soda (baking soda). In severe
burns cut away the clothing, avoid exposure to cold, wash the
part with warm saturated solution of bicarbonate of soda, or with
solution of boric acid. The parts burned or the entire body, except
the head, may be kept immersed in tepid or warm water for days.
INJUEIES. 41
Prick the blister with a clean (aseptic) needle, but do not remove
the cuticle. Sprinkle with dry bicarbonate of soda or with powdered
boric acid and dress the part with thick layers of clean (aseptic)
cotton. (Cotton may be rendered aseptic by heating it in an oven
to a point just short of burning.) The dressing should be changed
only when absolutely necessary. Keep the patient quiet and his
bowels active. Pain or restlessness may be relieved by laudanum,
20 drops, repeated in two hours if necessary. Carron oil (equal
parts of olive oil and limewater) is an old remedy that affords con-
siderable relief if applied to the surface. Petrolatum is also some-
times used. The scars resulting from burns and scalds always con-
tract, and in severe cases terrible deformities are produced. These
may be prevented to some extent by active and passive motion and
by splints.
EFFECTS OF COLD— FROSTBITE.
Severe cold depresses the action of the heart — suspends the circu-
lation. These effects are first noticed in the ears, nose, fingers, and
toes. Numbness and tingling are the first symptoms, then loss ol
sensation. If not too long exposed, the circulation may be restored
by proper treatment. But if the exposure is long continued, or if
the cold is very intense, the parts are hopelessly frozen and gangrene
will be the result. The parts may look all right for a few days after
reaction, and then become discolored, bluish, and finally black.
Another effect of extreme cold is an overpowering sense of drowsi-
ness, but to lie down under such circumstances and go to sleep is
almost certain death.
Treatment of frostbites. — 1. Do not bring the patient to the fire
nor bathe the parts in warm water.
2. If snow be on the ground, or accessible, take a woolen cloth in
the hand, place a handful of snow upon it, and gently rub the frozen
part until the natural color is restored. In case snow is not at hand,
bathe the part gently with a woolen cloth in the coldest fresh water
obtainable — ice water if practicable.
3. In case the frostbite is old and the skin has turned black or
begun to scale off, do not attempt to restore its vitality by friction,
but apply a little cotton, after which wrap the part loosely in flannel.
4. In the case of a person apparently dead from exposure to cold,
friction should be applied to the body and the lower extremities, and
artificial respiration practiced as in cases of the apparently drowned.
As soon as the circulation appears to be restored, administer strychnia
sulphate one- fortieth grain. Even if no signs of life appear, friction
should be kept up for a long period, as instances are on record of
recovery after several hours of suspended animation.
42 MEDICAL, HANDBOOK.
SCALP WOUNDS.
Treatment. — Examine the parts carefully ; clip and shave the hair
from a wide area about the wound; wash with warm water; draw
the edges of wound together with the fingers and apply absorbent
cotton with adhesive plaster. Stitches of silk ligature may be used.
All the precautions given on page 39 as to cleanliness of hands and
instruments must be followed. The stitches must not be drawn too
tightly, the edges simply brought together. Bleeding is often severe,
but usually stops under pressure or after the stitches have been put
in and the dressing applied; but if an artery spurts it must first
be tied. A few strands of silk ligature may be put in at the most
dependent part of the wound for drainage, but this is not usually
necessary. No part of the scalp should be removed, no matter how
slender its attachment. If replaced it will probably retain its vital-
ity. Dress the wound with a pad of clean (aseptic) gauze and apply
a bandage, not tightly.
The stitches should be removed the sixth day. Unconsciousness
and bleeding from the ears are grave symptoms, indicating fracture
of base of skull or rupture of blood vessels within.
INJURIES TO THE CHEST.
Contusions of the chest and fracture of the ribs are of frequent
occurrence, and it is not always easy to determine in a given case
of injury to the chest walls whether fracture actually exists, but if
in doubt, give the patient the benefit, and treat the case as one of
fracture.
Fracture involving several ribs, or one or more ribs at two points
each, is not difficult to make out, for in addition to the sharp pain
in breathing, and the bloody expectoration which is present in cases
where the lung is wounded, there is considerable deformity.
In single fracture of the ribs there is little or no deformity, but
the pain in breathing and coughing is apt to be severe. Pressure
on the broken bone is also quite painful, and if a hand is placed
over the seat of injury, or a finger on either side of the fracture, and
the patient requested to cough, a grating may be felt, unless the rib
is covered with heavy muscle or fat, when, as before stated, it may
be difficult if not impossible to say whether or not fracture exists.
Treatment. — Strips of adhesive plaster, 3 or 4 inches wide and
long enough to extend from the spine to the middle or a little beyond
the middle of the breastbone, should be applied horizontally from
the armpits downward over the whole side of the chest. Each piece
to be forcibly applied at the end of expiration (when the lungs
are empty) and to overlap the preceding piece to one-half its width.
INJURIES. 43
Any slight outward deformity at the seat of fracture may be reduced
by pressure before the plaster is applied at that point. A broad
bandage should then be applied around the chest from below upward.
INJURIES TO THE BACK.
Sprains of the back are of all degrees of severity. In slight
sprains the muscles alone are involved, and beyond a temporary
stiffness, and pain over a limited area, there may be no trouble.
In severe sprains it is difficult to determine the degree of injury.
Marked pain and stiffness are always present, and not infrequently
paralysis of the legs, bowels, and bladder. Death may be produced
by shock, or occur later from secondary effects of the injury.
Treatment. — Rest in bed. Epsom salts to move the bowels; rub
the back with soap liniment. Apply a binder or bandage around the
body from the hips up over the chest. See that the bladder does not
become distended. If necessary, introduce a catheter and draw off the
urine. Boil catheter for five minutes before using.
BROKEN BONES (FRACTURES).
There are many varieties of fracture. A fracture is said to be
simple where there is no open wound directly over the bone injury ;
compound when there is an opening in the skin and soft parts extend-
ing down to the broken bone ; comminuted when the bone is broken
in several places; complicated when associated with other injuries, as
dislocation of the joint or rupture of the main artery of the limb;
impacted when one fragment is driven into another.
The reliable signs or symptoms of simple fracture are deformity,
crepitus (grating) when the ends of the broken bone are rubbed
together, unnatural or false point of motion, and, if in the shaft of a
long bone, shortening, due to the fact that in most cases the break is
obliquely across the bone and the fragments override. But in trans-
verse fracture, where the break is straight across the bone at a right
angle with the long axis of the bone, or in a fracture near a joint,
there may be no shortening and no deformity. In fractures of cer-
tain boneSj as the skull or the spine, or in an impacted fracture, there
may be no motion. In fracture of the kneepan or the elbow the frag-
ments are pulled apart by the muscles, so there is lengthening instead
of shortening.
Examination should always be made as soon as possible after the
accident. Under the most favorable circumstances it is difficult in
some cases to determine whether a bone is broken or not, and the
difficulty is greatly increased if the examination is delayed until
inflammatory swelling has set in. In fractures of the extremities the
sound limb should always be placed alongside the injured one for
44 MEDICAL, HANDBOOK.
comparison. The shortening in fracture of the thigh may be from
1 to 3 inches, but it must not be forgotten that in some persons there
is a natural difference of as much as half an inch in length of the
o
pair of legs ; and a limb may be otherwise naturally deformed which
should not be mistaken for accidental deformity. In the leg below
the knee there are two parallel bones (tibia and fibula). In simple
fracture affecting only one of these bones the deformity and crepitus
are less marked ; and the same may be said of the forearm, if frac-
ture exists in only one of the bones (radius or ulna). If both bones
of the leg (tibia and fibula) or of the arm (radius and ulna) are
affected, there may be considerable deformity, and it is a curious fact
that fracture of these bones seldom occurs on the same level. The
distance between the fractures may be from 1 to 3 inches, usually
greater in the leg than in the forearm.
Crepitus (the sound heard, or feeling imparted to the hand when
the broken ends of the bone are rubbed together) is a valuable symp-
tom of fracture, but it can not always be detected, and when other
marked signs or symptoms are present, need not and should not be
looked for. In fractures of the leg below the knee or of the forearm,
involving only one of the bones^ it is hard to make out because of the
difficulty of rubbing the broken ends together, and when much swell-
ing exists the difficulty is increased, or a false crepitus may be pro-
duced. In impacted fractures, which occur chiefly in the neck of the
thigh bone, no effort should be made to obtain crepitus. The impor-
tant thing in such cases is not to disturb the impacted fragments, for
if pulled apart recovery is rendered more difficult.
FRACTURE OF THE LOWER JAW.
Fracture of the lower jaw may be simple, compound, or com-
minuted. The mucous membrane of the mouth is nearly always
lacerated, the bleeding is usually not severe (oozing only), but there
may be hemorrhage from an artery (the inferior dental), saliva drib-
bles from the half-open mouth, the teeth may be out of line, pain is
apt to be severe, there may be considerable deformity and a false
point of motion.
Treatment. — Restore the parts to the natural position and keep
them at perfect rest, first washing out the mouth with hot water to
cleanse it and check bleeding. If the bleeding is very severe, pressure
should be made by the thumb or finger for a time on the bleeding
point if possible, or on the large artery (carotid) on the side of the
neck, which may be easily located by the pulsation. Loose teeth or
pieces of bone should not as a rule be removed. Mold them into
place, bring the teeth and jaw into natural line, and keep them so by
a pasteboard or binder's board splint (figs. 2 and 3), held in place
by a four-tailed bandage.
INJUKIES. 45
Take a piece of pasteboard about 8 or 9 inches long by 4 inches
wide and cut it up in the middle from each end to within about an
inch or inch and a half from the center, according to the size of the
chin. Dip it in hot water and mold it to the chin and jaw. (Fig. 3.)
Kemove it carefully, line it with absorbent cotton, reapply it, and
retain it in place by the four-tailed bandage. (Fig. 4.) The four-
tailed bandage may be made in the following manner: Take a
bandage or piece of heavy muslin about 3 inches wide and a yard or
FIG. 2.
PIG. 3.
PIG. 4.
FIG. 5.
Fig. 2 shows the pasteboard or leather as cut out ; Fig. 3 shows the same molded to fit
the chin and jaw ; Fig. 4 is a four-tailed bandage ; and Fig. 5 shows how they are
applied.
a yard and a half long. In the middle of this or a little to one side of
the middle cut a slit large enough for the point of the chin ; place the
narrower portion upward, then tear the bandage down the middle
from each end to within 2 inches of the slit, so as to make four ends or
tails ; then carry the two upper ends backward and tie at the nape of
the neck ; carry the two lower tails to the top of the head and tie in a
knot. (Fig. 5.)° The ends of the knots at nape of neck and top of
head may then be tied together to hold them in place and prevent
0 The application of the bandage as directed causes a lapping of the tails, which is not
shown in the plate. The object of the lapping is to prevent the tearing of the bandage at
the angle and make it much stronger.
46 MEDICAL, HANDBOOK.
slipping. If necessary, a bandage may also be carried around the
head and secured with pins.
If the parts can not be kept in place by the methods described, the
teeth may be fastened together with silver wyire passed between the
teeth on each side of the break and twisting the ends together. Feed
the patient on liquid food through a rubber tube introduced behind
the last tooth or through any space left by the loss of a tooth, the
object being to prevent movement of the jaw. Wash out the mouth
frequently with hot water, and, if necessary, change the dressing
every two or three days until the end of about the sixth or eighth
week, when, if all goes well, union will be complete, and the splint and
bandage may discontinued.
FRACTURE OF THE THUMB AND FINGERS.
Treatment. — Put the fragments in place by extension and pressure ;
then cut a piece of pasteboard, leather, cigar box, or thin board long
enough to extend from above the wrist joint to a little below the ends
of the fingers and a little wider than the hand. Cover the board with
lint or any soft cloth, place the palm of the hand flat upon it, and
apply a bandage around the whole hand and wrist.
If pasteboard or leather be used, it may first be dipped into hot
water and then molded to the shape of the thumb or finger and palm
of the hand, then lined or covered with cloth, and bandaged as above,
care being taken not to make the bandage too tight.
FRACTURE OF THE FOREARM.
The forearm extends from the<wrist to the elbow. When both
bones are broken there is apt to be marked displacement and crepi-
tus (grating felt by rubbing the broken ends of the bone together).
When only one bone is broken the signs and symptoms are not so
clear, but by careful examination the nature of the injury may be
determined. When fracture of one of the bones (the radius) occurs
near the wrist joint (Colics' fracture) there is generally marked
deformity resembling a silver fork in shape.
Treatment. — Prepare two splints of thin board or heavy binder's
board, one for the palmar side of the forearm long enough to extend
from the elbow to the palm of the hand. The other for the back of the
forearm may be a little shorter, but should extend from the elbow to
below the wrist back of the hand. Both splints must be a little wider
than the arm so as to prevent the bones from being drawn together
by the bandage. Line the splints with several layers of lint or with
absorbent cotton or soft cloth. If deformity exists, reduce it by ex-
tension and counter extension. Pull on the hand while an assistant
holds or pulls at the elbow, and gently press the projecting fragment
to its normal position. Place the arm between the splints in such a
INJURIES. 47
•>
way that when bent at an angle the thumb will point directly upward
and the palm of the hand lie flat against the chest. Apply a roller
bandage outside and around the splints from fingers to elbow, being
careful not to make it too tight, and hang the forearm in a broad
sling.
Another way to hold the splints in place is to apply strips of adhe-
sive plaster around them, one at the upper and the other at the lower
end. If swelling occurs, the bandage must be loosened. The splints
should be worn six weeks or two months, and passive motion — that is,
gently bending and straightening of the fingers with the other hand —
must be made every few days to prevent stiffening.
FRACTURE OF THE ARM (BETWEEN THE ELBOW AND
SHOULDER).
Treatment. — Splints of binder's board dipped in water and molded
to the part or any thin board will answer the purpose if properly
lined or padded. Place one splint on the outside of the arm extend-
ing from the elbow to the shoulder (fig. 6), an internal angular splint
extending from the armpit to the fingers on the inner side (fig. 7),
and if need be a narrower splint in front and one behind, and the
whole surrounded with a well-fitted bandage. Support the forearm
by a sling, but leave the elbow free. (Fig. 8.)
If much swelling occurs, all bandages must be loosened.
The splint should be worn about eight weeks. Under the most
favorable circumstances, after fracture, this bone (the humerus)
sometimes fails to unite. At least once a week the joints should be
moved to prevent stiffness.
Fractures of the arm (of the humerus) at or near the elbow joint
or shoulder joint are frequently very difficult to make out, even by
the most skillful surgeon, especially if some time has elapsed since
the injury was received; and the treatment of necessity is equally
difficult.
If near or at the elbow joint, and if there is much pain, heat, and
swelling, as is apt to be the case, cold applications should be applied,
and the arm laid upon a pillow until the swelling has gone down. A
rectangular splint of binder's board or leather should then be dipped
in hot water and applied to the inner side of the arm 'and forearm.
The splint should be wide enough to extend nearly halfway around
the arm. It must be well padded and held in place by a roller band-
age, and the forearm supported by a sling.
Fracture of the humerus near the shoulder joint may be treated by
means of a shoulder cap of thick pasteboard molded to fit the shoul-
der and extending nearly to the elbow, or a splint on the outer side
of the arm, and a pad of folded lint or of absorbent cotton under the
arm (in the armpit). The shoulder cap or splint should be padded
48
MEDICAL, HANDBOOK.
the same as in any other fracture and the whole surrounded by a
roller bandage which encircles the chest, binding the arm to the chest.
If the deformity is marked, a second and shorter splint may be placed
on the inner side of the arm, taking care that the upper end does
Fig. 6.
Fig. 7.
FIG. 8.
Fig. 6 Is the outside splint to extend from shoulder to elbow ; Fig. 7 is the internal
angular splint to be placed between the arm and the body ; and Fig. 8 shows the two
splints applied with a bandage around them and the arm from the fingers to the
shoulder, with a sling properly arranged to support the forearm but not to raise the
elbow.
not press too hard into the armpit. The arm should then be bound
to the chest by a board bandage.
After the application of any apparatus for fracture of the arm or
forearm, the circulation should be carefully watched by feeling the
pulse at the wrist. If it can not be felt, or if the fingers swell, the
bandages should be removed and reapplied less tightly.
INJURIES. 49
FRACTURE OF THE THIGH.
The thigh bone (femur) extends from the hip to the knee. Frac-
ture of this bone may occur in any portion of the shaft, but the most
common seat of fracture is about the middle or the middle third.
Fractures high up near the hip joint are frequently very difficult to
make out, and the results of treatment in such cases, even under the
care of skillful surgeons, are not always satisfactory.
In fracture of the middle or middle third of the bone, the deform-
ity is usually produced by the lower fragment (the broken end of
the lower portion of the bone) being drawn up behind and to the
inner side of the upper fragment ; the weight of the limb then causes
rotation and the foot and toes are turned outward.
If the fracture is a little higher up, displacement is shown by the
upper fragment, which, by the action of the muscles, is thrown
strongly forward and outward. In either case there are complete
loss of power, shortening to the extent of 1 to 2 or 3 inches, pain on
the slightest movement, crepitus (grating) if the broken ends of the
bone are rubbed together, and abnormal motion.
In impacted fractures, which are met chiefly at or near the hip
joint, the shortening may be, and usually is, less marked. Loss of
power is usually complete, but not always. Patients have been known
to stand and even walk a few steps. Injuries of this kind require
the greatest care; the limbs should be handled very carefully. If
on slight traction or manipulation crepitus is not felt, no further
attempt should be made to obtain this symptom, for in doing so the
impacted bones may be pulled apart, which is to be avoided unless
especially directed by a skillful surgeon.
Treatment. — In the absence of a physician, about all that may
reasonably be expected to be done in impacted fracture is to apply
a broad bandage around the hips and place the patient in a good bed
on a firm mattress and make lateral support by means of sand bags,
one on the outside long enough to reach from the upper end of the
hip bone to the foot, the other along the inner side of the leg from
the crotch to the foot. Fill the bags three-quarters full of dry sand.
Keep the leg straight, toes upward.
Treatment of nonimpacted fracture of the thigh bone at or near
the hip joint. — Place both legs on the double-inclined plane, or make
extension and fix the limb in the straight position by means of a long
splint (a splint extending from the armpit to the foot), or by the
weight and pulley, or by the long splint and the weight and pulley
combined, in the manner now about to be explained in connection
with the
Treatment of fractures of the shaft of the thigh bone. — In frac-
ture of the shaft of this bone the signs and symptoms, as already
62431°— 12 4
50
MEDICAL, HANDBOOK.
stated, are usually well marked. If the fracture is at the upper end
or in the upper third of the bone, especially if the upper fragment is
tilted forward, the double-inclined plane (fig. 9) well padded or
covered with pillows, with weight and pulley attached by means of
adhesive plaster stuck to each side of the thigh as far as the knee,
PIG. 9. — Shows a double-inclined plane with the weight and pulley — 1 is the double-in-
clined plane, 2 and 3 are circular pieces of adhesive plaster to prevent 4, the longi-
tudinal strip on each side of the thigh, from slipping ; 5 and 6 are the pulley and
weight.
affords the easiest and probably the best means of treatment. But
in the majority of cases when the fracture is farther down, about the
middle or in the middle third of the bone, the weight and pulley with
the leg and thigh in a straight line (fig. 10), or the weight and pul-
ley and long splint combined (fig. 11) are better adapted if properly
applied. Sand bags may also be used in connection with any of the
FIG. 10. — Shows the weight and pulley applied with the leg and thigh in the straight posi-
tion— the adhesive strips being attached to the leg as well as the thigh.
straight splints placed alongside. In all cases the fracture should be
reduced by gradually pulling and carefully pressing the broken bones
into their natural position. In addition to the splints already men-
tioned, short splints of narrow strips of thin board or binder's board
should be applied directly over the seat of fracture.
INJURIES.
51
If a double-inclined plane is not at hand, two broad pieces of
board may be nailed together at a suitable angle and used instead,
always property padded or covered with pillows.
The weight and pulley (figs. 10 and 12). — The weight and pulley
are applied as follows: Measure the distance from 1 inch below the
crotch to a point 4 inches below the foot. Cut a strip of adhesive
plaster exactly twice as long as the distance just measured and 3
FIG. 11. — Shows the long lateral splint extending from the armpit to a point a little below
the foot. It is bandaged to the body and the lower extremity, and may be used with
the weight and pulley.
inches wide, and stretch it on a table or on the floor, with the
sticky side up. Get a block of wood 4 inches long, about 3 inches
wide, and about | inch thick, with a hole bored through the center
large enough to admit a large cord. Place the block exactly in
the center of the long strip of adhesive plaster. Cut another strip
of plaster the width of the first and 18 inches long, and place it
on the first strip, sticky surfaces together, so as to include the block
Pio. 12.
A shows the long strip of adhesive plaster ; B shows the short strip. C is the block of
wood 4 x 3 x J inches with a hole in the center. D shows the block placed between the
two strips of plaster, all ready for application to the leg or thigh.
between the center of each. Thus a stirrup is made and the plaster
kept from sticking to the ankle bones, because it would make them
sore. The long strip of plaster on each side of the stirrup is then
applied to the leg and thigh after shaving on each side the surface
to which it is to be applied, extending from a point just above the
ankle bone to a point about 1 inch below the crotch on the inner
side and to the same level on the outer side, being careful to keep the
52 MEDICAL, HANDBOOK.
block square when the two ends of the plaster are stuck to the limb.
A roller bandage is then applied over the plaster from the ankle
up. A strong cord is then passed through the hole in the block
and knotted so that it can not slip through, the other end being
passed over a pulley attached to the foot of the bed or elsewhere, as
may be convenient, on a line with the extended limb, and a weight
of from 5 to 30 pounds, as may be necessary or comfortable to the
patient, gradually increased, attached. The same kind of apparatus
may be used with the double -inclined plane, except that the plaster
is applied only to the thigh, the stirrup coming just below the bent
knee.
Counter extension may be obtained by raising the foot end of the
bed on blocks 4 to 6 inches high. The short splints should be well
padded and extend well above and below the fracture, and be held
in place by strips of plaster or bandage.
The long splint gives additional support and prevents outward
rotation of the leg. It should be well padded, and have a cross-
FIG. 13. — Shows a splint and bandage applied for fracture of the kneecap. A is a notch
in the board to prevent slipping of the bandage. B is the end of a bandage which is
to be carried above the knee over the bandage shown at A.
piece at the lower end to keep it in position. Treatment will be
required for a period of eight to ten weeks, but the extension may
be lessened about the end of the sixth week and passive motion made
at the knee joint.
FRACTURE OF THE KNEECAP.
Fracture of the kneecap may be transverse, vertical, or oblique.
The bone may be broken into two or more irregularly shaped pieces.
Symptoms and signs. — Loss of power, inability to extend the
joint or raise the limb from the bed. In the transverse variety the
fragments are widely separated. If seen soon after the accident,
the line of fracture — the gap between the fragments — may be seen
and felt. Swelling rapidly appears and the signs are obscured.
INJURIES. 53
Treatment. — Various forms of apparatus are employed, and in hos-
pital practice the injury is frequently treated by surgical operation,
with good result. The simplest form of treatment is to place the
limb on a long posterior splint (fig. 13) with the foot raised so as
to relax the thigh muscles, or if the patient is propped up in bed by
pillows or a back rest, the limb may be allowed to lie on a level.
Apply iced water or the ice bag for a few days, until the swelling
and heat have subsided; then remove the splint and apply a roller
bandage. The turns of the bandage below and above the knee should
be made in an oblique direction, figure-of-eight fashion, so as to press
and hold the fragments of bone together, the indications being, as
in other fractures, to restore the broken ends of the bone to their
natural position and keep them there. A pad of cotton should be
placed in the hollow back of the knee and another smaller pad on
the front of the thigh above the upper fragment before the bandage
is applied. The splint should then be relined with layers of dry
cotton or folds of lint and the limb placed upon it as before, secured
by another roller bandage. If swelling or numbness of the foot is
complained of, the bandage is too tight and must be removed.
If the bandages become loose, as they are apt to do every few days,
they should be reapplied.
The long splint should be worn about six weeks or two months,
when it may be replaced by a shorter molded splint of leather, felt,
or pasteboard to prevent motion at the joint when the patient may
be allowed to walk with canes or crutches. The short splint should
be worn for at least a month, and then a suitably constructed knee-
cap should be worn for one year to support the joint. More or less
stiffness of the joint is to be expected.
FRACTURE OF THE LEG (BETWEEN THE KNEE AND ANKLE).
The leg extends from the knee to the ankle and has two bones,
tibia and fibula.
Fracture of the leg may be simple or compound. Both bones may
be broken or only one ; the line of fracture may be oblique or trans-
verse. When both bones are broken at the middle or lower third
the deformity is usually quite marked. The break is apt to be in an
oblique direction and at a lower level in the tibia (the shin) than in
the fibula. In simple fracture of the upper part of the leg the de-
formity may be less marked, but if the knee is involved there may be
great swelling because of acute and serious inflammation of the
joint.
When the shaft of only one bone (the tibia or fibula) is broken
there is not much displacement, because in such case the sound bone
acts as a side splint. Fracture at the lower end of the tibia at the
54 MEDICAL, HANDBOOK.
projection on inner side of ankle is sometimes mistaken for sprained
ankle, and if the small fragment of bone is not accurately adjusted
and kept in proper position the result may be a weak and stiff joint.
The fibula may be fractured at any point, but the important frac-
ture of this bone is known as "Pott's fracture." (Fig. 14.) This
fracture occurs about 3 inches above the ankle, on outer side of the
leg, and is accompanied or complicated by outward dislocation of the
foot, and not infrequently by the breaking or tearing off of the tip
of the lower end of the tibia.
FIG. 14.— Shows the appearance of the right foot after a " Pott's fracture."
Treatment. — If the line of fracture is oblique, the limb must be
handled very carefully so as to prevent injury to the soft parts by the
sharp ends of the bone and thus avoid the conversion of a simple
fracture into a compound one.
A Pott's fracture should be treated as follows : Take a board splint
long enough to extend from the knee to a few inches beyond the sole
of the foot. Pad the splint well, having the lower end of the pad-
ding at least 2 inches thick, and do not let it extend quite to the ankle
joint below. Apply the splint to the inner side of the leg so that the
foot and ankle project below the padding. The foot and leg are
B A
FIG. 15. — Shows the splint applied for a " Pott's fracture." A shows the thick padding
(3 inches) ending just above the ankle. The bandage B keeps the foot turned in and
prevents the tendency to outward displacement.
then bandaged to the splint in such a way as to turn the foot inward
and thus correct the outward displacement. (Fig. 15.)
In all ordinary cases of simple fracture of the leg, unless a phy-
sician is present, probably nothing better can be done than to place
the leg in a fracture box (fig. 16) containing a soft pillow, and if
necessary an extra pad of cotton for the heel. The side pieces of
the fracture box are fastened each by two hinges to the backboard
so as to be easily opened or closed. A pillow is placed on the back-
board and after the fracture is reduced, by extension and counter
INJURIES. 55
extension, the leg is carefully placed upon the pillow and the sides
of the box are closed or drawn together closely enough to make easy
and equable support to the broken bones. Two or three holes should
be bored in the upper edge of the sideboards so that they may be tied
together, or strips of bandage may be tied around the box. Two mor-
tise holes should be made in the footboard for the reception of strips
of adhesive plaster, so that in addition to the fractare box the weight
and pulley may be applied to overcome any shortening or deformity.
Another good plan is to line the backboard (the bottom of the box)
with a layer of cotton or folds of lint and then fill in and surround
the leg with bran.
In the absence of any of the apparatus mentioned, three well-
padded splints may be applied — one on each side and one on the back
of the leg. But if there is any displacement or overriding the frac-
ture must be reduced and held in proper position while the splints
are being applied.
Whatever form of appliance is adopted, care must be taken that the
foot is at a right angle with the leg, the toes pointing directly upward.
The inner side of the kneecap, the projection on the inner side of the
ankle, and the inner side of the big toe should be on the same line.
In the hospital or where the patient is under the care of a surgeon
a fixed dressing of plaster of Paris or silicate of soda may be used to
the greatest advantage after the first week, or, in some cases, from the
very beginning of treatment.
COMPOUND FRACTURES.
Compound fractures are serious accidents and require prompt
attention. The general principles of treatment so far as the bone
is concerned (place it in normal position and keep it there) are the
same as for simple fracture. But to do this and at the same time
give proper attention to the wound in the soft parts (the open wound
extending down to the bone) frequently demands the highest surgical
skill.
Shock from loss of blood is the immediate danger. Inflammation,
erysipelas, blood poisoning, or lockjaw may set in later, and still
later the patient may become exhausted from long-continued suppu-
ration.
56 MEDICAL HANDBOOK.
Treatment. — If the wound is very small, it should be well cleaned
with hot water (water that has been raised to the boiling point and
allowed to cool down to about 120° F.) or by antiseptic solution
(solution bichloride of mercury 1 to 5,000), then covered with aseptic
gauze, and the case treated as a simple fracture. (Clean hands as
indicated on page 39.)
In nearly all cases, however, the safest and best plan is to leave
the wound uncovered by splint or bandage, so that light dressings
may be easily applied and frequently changed. The wound should
be thoroughly cleansed with hot water and antiseptic solution, and,
after reducing the fracture, the splints or extending apparatus should
be so arranged that the wound is freely accessible and easily drained.
Strips of aseptic gauze should be placed in the wound and gently
carried down to the bottom by means of a probe, and a larger piece
of aseptic gauze in loose folds should be laid over the wound.
The aseptic-gauze dressing should be renewed every day or every
second day or as often as necessary to keep the wound well drained
until it heals from the bottom.
In severe cases amputation may be necessary to save life, and in
all cases the patient should be placed under the care of a surgeon as
soon as possible.
DISLOCATIONS.
A bone is dislocated or "out of joint" when it is displaced or
forcibly separated from another bone entering into the composition
of a joint.
Dislocations may be complete or incomplete. A dislocation is
complete when the articular surfaces are entirely separated and the
ligaments torn, as in dislocation of the hip joint; incomplete when
the articular surfaces are not entirely displaced. Dislocations may
be simple, compound, or complicated.
A dislocation is simple when there is no wound of the skin and soft
parts — when the articular surfaces are not exposed to the outer air;
compound when there is an open wound and the outer air is brought
into contact with the articular surfaces of the joint; complicated
when besides the dislocation there is a fracture and serious damage
to the soft parts, or to blood vessels or nerves.
Dislocations are said to be most common in adult or middle life,
when the bones are strong and the muscles powerful. In the young
and old the bones are more apt to break. There are, however, strik-
ing exceptions to this rule when applied to the elbow joint and the
shoulder joint. The elbow joint in young subjects is frequently dis-
located; and dislocation of the shoulder joint in old men is not
uncommon.
INJURIES. 57
Symptoms and signs of dislocations. — Deformity is always present
and may be determined by comparing the injured side with the
sound one. The head or end of the bone is in an abnormal position ;
the attitude of the limb is changed; the patient can not move the
limb; and when effort is made to move the joint it is found to very
stiff. There may be shortening or lengthening. For example, in
dislocation of the hip the head of the thigh bone may be thrown
outward and upward, when there will be shortening of the leg ; or it
may be forced downward and inward, when the length of the limb
will be increased.
Treatment. — The indications are to replace the bones in their
natural position and to keep the parts at. rest until the ligaments and
damaged tissues about the joint are healed. A dislocation should be
reduced immediately after the accident whilst the patient is faint
and the muscles are in a relaxed condition.
Having thus briefly described a dislocation and the treatment indi-
cated, the question now arises, How shall the treatment be applied,
how shall the dislocation be reduced ? And when it is taken into con-
sideration that the reduction of dislocations not infrequently taxes
the skill of the most experienced surgeon (even with the aid of gen-
eral anesthetics), it is hardly to be expected that a nonprofessional
man will be able to accomplish the desired results in many cases. It
must also be borne in mind that there are certain dangers attending
efforts at reduction, especially at the larger joints, if improperly or
too forcibly applied — such as fraction of bone or rupture of blood
vessel.
DISLOCATION OF THE FINGERS.
Dislocation of the bones of the fingers may be backward or forward.
Treatment. — Extension and counter extension and manipulation.
Pull the finger directly in line with the hand, and when fully ex-
tended make pressure on the head of the bone. Reduction is usually
effected without much difficulty. Place the finger on a well-padded
splint for one week, then make passive motion, and, if necessary, the
splint may be worn for another week.
DISLOCATION OF THE THUMB.
Dislocation of the thumb may be backward or forward.
Treatment. — The treatment is not the same as for dislocation of
the fingers, and reduction, especially of the backward dislocation, is
usually very difficult. Try by pushing the end of the thumb upward
and backward until it stands perpendicularly on the bone from which
it is dislocated, then make strong pressure against the base of the
dislocated bone from behind forward, sliding it on the bone beneath
till it gets to the end, then flex or bend the thumb into place.
58 MEDICAL, HANDBOOK.
DISLOCATION OF THE WRIST.
Dislocation of the wrist joint may be backward or forward. It is
a rare injury. Fracture about the wrist is more common, and is
sometimes mistaken for dislocation. A stiff joint is apt to be the
result.
Treatment. — Extension, counter extension, and direct pressure.
Grasp the hand of the patient, pull in a straight line, and have an
assistant pull on the forearm in the opposite direction, and when the
parts are fully extended jnake direct pressure upon the wrist 'bones.
Apply a bandage, and place the hand and forearm on a well-padded
splint for a week ; then remove the splint and make passive motion at
the joint; reapply the splint and remove it after an interval of an-
other week. If there is much pain or swelling after reduction of the
dislocation, apply cold water.
DISLOCATION OF THE ELBOW.
Dislocations of the elbow are serious accidents. They present a
variety of forms, backward, forward, outward, and inward, and these
are divided into a number of subvarieties. One or both bones may be
involved, and the dislocation may be associated with fracture. Re-
duction in some cases is comparatively easy, in others it is very diffi-
cult, even in the hands of experienced surgeons.
Without a thorough knowledge of the anatomy of the normal joint
it is very difficult to understand the different forms of dislocation, and
of necessity equally difficult to apply the proper treatment.
Immediately after the accident and before swelling sets in the
injured elbow should be carefully compared with the sound one.
When the normal arm is extended (straight) the tip of the elbow and
the bony points on either side should be in a transverse line across the
joint. If these prominences are found out of line, dislocation or frac-
ture is probably present.
Treatment. — Fixation of the arm above the elbow, extension or
flexion of the forearm, and direct pressure by means of the thumbs or
fingers on the head of the dislocated bone, so as to push it back into
the socket. After reduction an angular splint should be applied to
inner side of arm (fig. 7), lightly bandaged, and the forearm carried
in a sling. Cold water may be applied to reduce inflammatory action.
Passive motion should be employed at the end of a week.
DISLOCATION OF THE SHOULDER.
[After Helfrich.]
Dislocation of the shoulder joint is a very common accident. It
occurs as frequently as all other dislocations put together. The fre-
quency is explained by the great latitude of motion of the joint, the
INJURIES.
59
shallowness of the socket, and the size and rounded shape of the head
of the bone, the laxity of the capsular ligament, and the leverage
exerted on the joint by the long bone.
There are three chief forms of dislocation of the shoulder — (1) for-
ward and downward below the collar bone, (2) directly downward
into the armpit, and (3) backward on the shoulder blade.
The symptoms and signs are pain, swelling, rigidity (stiffness),
loss of power, flattening and angular appearance of the shoulder as
compared with the other shoulder, abnormal situation of the head of
the bones, and change in the axis of the long bone. (Fig. 17.) In
FIG. 17. — Dislocation of the right shoulder.
the first variety, the most common of all, the head of the bone may
be felt in front of the armpit and below the collar bone, and the elbow
points outward and backward. In the second the head of the bone
may be felt in the armpit, and the elbow points outward. In the
third the head of the bone may be felt on the back of the shoulder
blade, the elbow points forward, and the forearm is thrown across
the chest. Another valuable sign is that when the elbow is placed on
the chest the patient can not place the hand of the injured side upon
the opposite shoulder, or if the hand is placed on the shoulder the
elbow can not be brought into contact with the chest.
60 MEDICAL, HANDBOOK.
Treatment. — The treatment for the first variety (forward and
downward) is as follows : Lay the patient down or let him sit on a
chair; bend the forearm on the arm; press the elbow against the
side of the chest and hold it there ; rotate the arm outward by carry-
ing the forearm outward ; pull steadily on the arm and rotate inward
by carrying the elbow upward and forward with forearm across the
chest. While this is going on have an assistant place his hand in
the armpit and press the head of the bone into place.
For the second variety (directly downward into the armpit) place
the patient on his back; remove your boot; place your heel in the
armpit ; grasp the wrist and pull steadily on the arm. If the dislo-
cation is in the right shoulder, seat yourself on the right side of the
patient and use your right foot; and if the injury is in the left
shoulder seat yourself on the left side and use your left foot. The
same principles may be carried out by seating the patient on a low
chair and placing your knee in the armpit.
Another method is to have an assistant stand upon a table and
make counter extension with a towel, or a strong piece of soft cloth
of any kind, passed under the armpit of the patient, while the oper-
ator pulls the arm downward. The same method may be employed
by causing the patient to lie on his back, and an additional advantage
may be obtained by placing a rolled bandage or a pad of any kind in
the folds of a towel in the armpit.
In dislocation backward on the shoulder blade, pull the arm for-
ward and make direct pressure forward on the head of the bone, or
stand behind the patient, draw the elbow backward, and with the
thumb press upon the head of the bone and guide it into place.
After reduction a soft pad should be placed in the armpit, the
upper arm bandaged to the body, and the forearm placed in a sling
across the chest. Passive motion at the joint should begin at the
end of a week and be repeated daily, but the arm should be carried
in the sling about three weeks.
DISLOCATION OF THE COLLAR BONE.
The collar bone extends from the upper border of the breast bone
to the highest point of the shoulder blade. Dislocation may occur
at either end. Reduction is comparatively easy, but it is difficult
to retain the bone in position.
Treatment. — Make extension by drawing back the shoulders, the
knee, if necessary, being placed between the shoulder blades; push
the end of the bone in place and try to keep it there by a firm pad
fastened by adhesive plaster and bandage. The best result may be
obtained by placing the patient at rest on his back for three weeks.
INJURIES. 61
DISLOCATION OF THE TOES.
Dislocations of the toes are very rare accidents. The treatment is
the same as for dislocation of the fingers. Dislocation of the big
toe may be treated the same as dislocation of the thumb.
DISLOCATION OF THE ANKLE.
The foot may be dislocated forward, backward, outward, inward,,
or upward. The dislocation may be complete or incomplete.
The lower ends of the bones of the leg enter into the formation
of the ankle joint, the end of the tibia on the inner side and the end
of the fibula on the outer side of the joint. Dislocations of the ankle
are usually complicated by fracture of the tip of one or both of these
bones. When, in addition, the fibula is broken above the ankle, the
injury is known as Pott's fracture, already referred to.
Treatment. — Extension, counter extension, and pressure. Flex
the leg on the thigh and the thigh at right angle to body; pull
steadily on the foot, while an assistant makes counter extension at
the thigh, and press the bones in place. Apply cold water and place
the foot and leg in a fracture box or apply well-padded molded
splints. Binder's board dipped in warm water and molded to the
part and lined with thick layers of cotton will answer the purpose.
If a Pott's fracture, use the splint shown in figure 15. Make passive
motion at the joint at the end of two weeks.
DISLOCATION OF THE KNEE.
Dislocation of the knee may be complete, incomplete, compound,
or complicated. The direction of the dislocation may be forward,
backward, outward, or inward. The deformity is quite marked.
Reduction is not very difficult, but the injury is a serious one and
care must be taken in making reduction not to produce additional
damage by too forcible extension. Fortunately the injury is exceed-
ingly rare.
Treatment. — Extension, counterextension, and pressure. Have
one assistant pull steadily, not too hard, on the leg or ankle, while
another fixes or pulls on the thigh and presses the bone into place.
After reduction apply cold water, and place the leg in a posterior
straight splint, well padded, especially below the hollow of the knee,
and make passive motion at the end of two weeks. When the patient
begins to walk, a kneecap or flannel bandage should be applied.
DISLOCATION OF THE HIP.
Dislocation of the hip joint is a serious injury. It occurs much less
frequently than dislocation of the shoulder joint. The socket of the
hip joint is very deep, and the ligaments and muscles surrounding the
62
MEDICAL HANDBOOK.
joint are very strong and powerful. Dislocation occurs only when
the limb is in a certain position, when its axis is changed from that
of the body, and when in consequence of any sudden or great force
received on the lower end of the leg or knee the head of the bone is
forced through the ligament (the capsule) which surrounds the joints.
The head of the bone may then be thrown ( 1 ) backward and upward,
(2) backward, (3) forward and downward, (4) forward. The dif-
ferent directions indicate the different forms of dislocation. The
first is the most common.
In the first form examination from below up shows the big toe
turned toward or resting on the instep of the opposite foot ; the knee
flexed and resting against thigh at upper margin of opposite knee-
FIG. 18. FIG. 19.
Fig. 18 shows a backward dislocation of the hip with the knee and toe turned in and
the heel raised and the limb shortened. Fig. 19 shows a forward and downward dis-
location of the right hip with the knee and toe turned out and the limb lengthened.
cap ; the thigh rotated inward and drawn toward its fellow ; bulging
of the hip ; and about 2 inches shortening of the entire limb.
In the second form the signs are the same as in the first, but less
marked. (Fig. 18.) Fracture of the neck of the thigh bone Is
sometimes mistaken for this injury. But in fracture there is abnor-
mal motion, and the foot is turned outward.
, In the third form (fig. 19) the signs are almost exactly the reverse
of the first form. The foot and knee are turned outward, the hip is
flattened, and the entire limb is lengthened.
The signs of the fourth form are nearly the same as those of the
third, except that the entire limb is shortened.
Treatment. — The treatment is by manipulation, or by extension
and counterextension.
INJURIES. 63
For the first and second forms of dislocation, above-described treat-
ment may be applied as follows : Place the patient on his back on a
mattress on the floor. Seize the foot or ankle with one hand and
place the other hand under the knee. Flex the leg upon the back of
the thigh, and the thigh upon the body to about a right angle ; then
carry the knee inward and rotate it inward on its own axis, then sud-
denly raise it (lift it toward the ceiling) so that the head of the bone
may be thrown over the rim of the socket, and immediately extend
the limb with outward rotation to its normal position so that the head
of the bone may return to the socket through the hole in the capsule
by which it escaped.
The treatment of the third and fourth forms of injury corresponds
to that for the first and second, except that the limb should be carried
outward first, then inward, across the median line, and rotated
inward on its own axis, and then suddenly lifted and brought down
to its normal position by the side of its fellow.
No great force should be used in making these movements. If any
considerable resistance is met with in rotating or lifting the bone the
movement should be modified in such a way that the head of the bone
may follow the path of least resistance.
If extension and counterextension be applied they should follow
the line of the axis of the dislocated thigh. It must not be forgotten
in the consideration of these methods that the application of too
much force or of force improperly applied may produce fracture of
the bone.
SPRAINS.
A sprain is a stretching or wrenching of a joint. The joints most
frequently affected are the ankle, wrist, knee, and shoulder.
The symptoms and signs are pain, swelling, impairment or loss of
motion, and discoloration from effusion of blood. When there is
much swelling it may be difficult to determine whether sprain or
fracture, or both, are present.
Treatment. — If seen at once, before there is much swelling, a
bandage should be applied from the toes to 2 or 3 inches above the
ankle, and the joint should be kept at perfect rest in an elevated
position. If much swelling has already taken place, apply cold ap-
plications continuously for several hours. If the symptoms do not
rapidly subside, apply hot applications — cloths or towels wrung out
of hot water and frequently changed. After the swelling has gone
down a bandage properly applied will afford considerable benefit.
(Fig. 20.)
The joint must not be kept too long at rest. Passive motion should
be performed as soon as the inflammatory symptoms have subsided.
64 MEDICAL, HANDBOOK.
NOSEBLEED.
If bleeding of the nose occur in a full-blooded person, especially
if such person is subject to dizziness, we should not be in too much of
a hurry to stop it. But if the bleeding is the result of injury or if it
occur in a person suffering from disease of the heart or lungs or from
the effects of malarial fever, scurvy, or any disease of the general
system, effort should be made to stop it.
Treatment. — Remove all pressure of clothing from neck and chest.
Caution patient not to blow his nose. If too weak to stand, place
him on his back with his arms raised and his head on a high pillow.
Bathe the nose in cold water, apply cold water to back of neck or an
ice bag to the forehead. Pack the nostrils with pellets of absorbent
cotton. The bleeding is sometimes brought under control by the
application of hot water to the nostrils.
FIG. 20. — Shows the application of adhesive plaster to an ulcer of the leg at A and of an
ordinary bandage from the foot up the leg, B.
In very severe cases the posterior as well as the anterior nares
should be plugged. In the absence of a physician the application of
this method may be attended with some difficulties. But if the
master or keeper decides to try it he may proceed as follows : Pass a
fine string twine, about 20 inches long, through the eye of a hard
rubber catheter, and thus armed pass the catheter along the floor of
the nose to the back of the mouth below the soft palate ; introduce a
forceps into the mouth back to the end of the catheter^ seize the
twine, and bring it out of the mouth. Then tie a wad of absorbent
cotton or lint to the twine about 12 inches from the end of it; then
pull on the catheter and the other end of the twine and draw the wad
into the mouth, guided by the finger, behind the soft palate into the
posterior nares. He will then have the posterior nares plugged, and
one end of the twine hanging out at the mouth and the other end at
the nose.
RESTORATION OF APPARENTLY DROWNED.
65
Secure the ends of the twine by tying them together, and allow
the plug to remain about two days.
The wad of cotton or lint should be about an inch long and half an
inch wide.
DIRECTIONS FOR RESTORING THE APPARENTLY DROWNED.
[As practiced in the United States Life-Saving Service.]
Rule I. — Arouse the patient. — Do not move the patient unless in
danger of freezing; instantly expose the face to the air, toward the
wind if there be any ; wipe dry the mouth and nostrils ; rip the cloth-
ing so as to expose the chest and waist; give two or three quick,
smarting slaps on the chest with the open hand.
FIG. 21.
If the patient does not revive, proceed immediately as follows:
Rule II. — To expel water from the stomach and chest (see fig.
21). — Separate the jaws and keep them apart by placing between the
teeth a cork or small bit of wood ; turn the patient on his face, a large
bundle of tightly rolled clothing being placed beneath the stomach ;
press heavily on the back over it for half a minute, or as long as fluids
flow freely from the mouth.
Rule III. — To produce breathing (see figs. 22 and 23). — Clear the
mouth and throat of mucus by introducing into the throat the corner
of a handkerchief wrapped closely around the forefinger; turn the
patient on the back, the roll of clothing being so placed as to raise the
pit of the stomach above the level of the rest of the body. Let an
assistant with a handkerchief or piece of dry cloth draw the tip of the
tongue out of one corner of the mouth (which prevents the tongue
62431°— 12 5
66
MEDICAL, HANDBOOK.
from falling back and choking the entrance to the windpipe), and
keep it projecting a little beyond the lips. Let another assistant
grasp the arms just below the elbows and draw them steadily upward
by the sides of the patient's head to the ground, the hands nearly
meeting (which enlarges the capacity of the chest and induces inspi-
ration). (Fig. 22.) While this is being done let a third assistant
take position astride the patient's hips with his elbows resting upon
his own knees, his hands extended ready for action. Next, let the
assistant standing at the head turn down the patient's arms to the
sides of the body, the assistant holding the tongue changing hands if
necessary 1 to let the arms pass. Just before the patient's hands
FIQ. 22.
reach the ground the man astride the body will grasp the body with
his hands, the balls of the thumb resting on either side of the pit of
the stomach, the fingers falling into the grooves between the short
ribs. Now, using his knees as a pivot, he will at the moment the
patient's hands touch the ground throw (not too suddenly) all his
weight forward on his hands, and at the same time squeeze the waist
between them, as if he wished to force anything in the chest upward
out of the mouth ; he will deepen the pressure while he slowly counts,
one, two, three, four (about five seconds), then suddenly let go with a
final push, which will spring him back to his first position.2 This
completes expiration. (Fig. 23.)
At the instant of his letting go, the man at the patient's head will
again draw the arms steadily upward to the sides of the patient's
1 Changing hands will be found unnecessary after some practice; the tongue, however,
•ast not be released.
*A child or very delicate patient must, of course, be more gently handled.
RESTORATION OF APPARENTLY DROWNED.
67
head as before (the assistant holding the tongue again changing hands
to let the arms pass if necessary) , holding them there while he slowly
counts one, two, three, four (about five seconds).
Repeat these movements deliberately and perseveringly twelve to
fifteen times in every minute — thus imitating the natural motions of
breathing.
If natural breathing be not restored after a trial of the bellows
movement for the space of about four minutes, then turn the patient
a second time on the stomach, as directed in Rule II, rolling the body
in the opposite direction from that in which it was first turned, for
the purpose of freeing the air passage from any remaining water.
Continue the artificial respiration from one to four hours, or until the
patient breathes, according to Rule III; and for a while, after the
PIG. 23.
appearance of returning life, carefully aid the first short gasps until
deepened into full breaths. Continue the drying and rubbing, which
should have been unceasingly practiced from the beginning by assist-
ants, taking care not to interfere with the means employed to produce
breathing. Thus the limbs of the patient should be rubbed, always
in an upward direction toward the body, with firm-grasping pressure
and energy, using the bare hands, dry flannels, or handkerchiefs, and
continuing the friction under the blankets or over the dry clothing.
The warmth of the body can also be promoted by the application of
hot flannels to the stomach and armpits, bottles or bladders of hot
water, heated bricks, etc., to the limbs and soles of the feet.
Rule IV. — After treatment. — Externally: As soon as breathing is
established let the patient be stripped of all wet clothing, wrapped
68
MEDICAL HANDBOOK.
in blankets only, put to bed comfortably warm, but with a free
circulation of fresh air, and left to perfect rest. Internally: Give
aromatic spirits of ammonia in water in doses of a teaspoonful, or
other stimulant at hand. Later manifestations: After reaction is
fully established there is great danger of congestion of the lungs,
and if perfect rest is not maintained for at least forty-eight hours, it
sometimes occurs that the patient is seized with great difficulty of
breathing, and death is liable to follow unless immediate relief is
afforded. In such cases apply a large mustard plaster over the breast.
If the patient gasps for breath before the mustard takes effect, assist
the breathing by carefully repeating the artificial respiration.
Modification of Rule III (to be used after Rules I and II in case
no assistance is at hand). — To produce respiration. — If no assist -
FlG. 24.
ance is at hand and one person must work alone, place the patient
on his back with the shoulders slightly raised on a folded article of
clothing; draw forward the tongue and keep it projecting just beyond
the lips. If the lower jaw be lifted, the teeth may be made to hold
the tongue in place; it may be necessary to retain the tongue by
passing a handkerchief under the chin and tying it over the head.
Grasp the arms just below the elbows and draw them steadily
upward by the sides of the patient's head to the ground, the hands
nearly meeting. (Fig. 24.)
Next lower the arms to the sides and press firmly downward and
inward on the sides and front of the chest over the lower ribs,
drawing toward the patient's head. (See fig. 25.)
Kepeat these movements twelve to fifteen times every minute, etc.
SAVING PERSONS FROM DROWNING.
69
INSTRUCTIONS FOR SAVING DROWNING PERSONS BY SWIM-
MING TO THEIR RELIEF.
1. When you approach a person drowning in the water, assure
him, with a loud and firm voice, that he is safe.
2. Before jumping in to save him, divest yourself as far and as
quickly as possible of all clothes ; tear them off, if necessary ; but if
there is not time, loose at all events the foot of your drawers, if they
are tied, as, if you do not do so, they fill with water and drag you.
3. On swimming to a person in the sea, if he be struggling do not
seize him then, but keep off for a few seconds till he gets quiet, for it
is sheer madness to take hold of a man when he is struggling in the
water ; and if you do, you run a great risk.
4. Then get close to him and take fast hold of the hair of his head,
turn him as quickly as possible onto his back, give him a sudden
PIG. 25.
pull, and this will cause him to float, then throw yourself on your
back also and swim for the shore, having hold of his hair, you on
your back and he also on his, and, of course, his back to your
stomach. In this way you will get sooner and*safer ashore than by
any other means, and you can easily thus swim with two or three
persons; the writer has even, as an experiment, done it with four,
and gone with them 40 or 50 yards in the sea. One great advantage
of this method is that it enables you to keep your head up and also
to hold the person's head up you are trying to save. It is of primary
importance that you take fast hold of the hair and throw both the
person and yourself on your backs. After many experiments, it is
usually found preferable to all other methods. You can in this man-
70 MEDICAL, HANDBOOK.
ner float nearly as long as you please, or until a boat or other help can
be obtained.
5. It is believed there is no such thing as a death grasp ; at least
it is very unusual to witness it. As soon as a drowning man begins
to get feeble and to lose his recollection, he gradually slackens his
hold until he quits it altogether. No apprehension need, therefore,
be felt on that head when attempting to rescue a drowning person.
6. After a person has sunk to the bottom, if the water be smooth,
the exact position where the body lies may be known by the air bub-
bles, which will occasionally rise to the surface, allowance being, of
course, made for the motion of the water, if in a tide way or stream
which will have carried the bubbles out of a perpendicular course in
rising to the surface. Oftentimes a body may be regained from the
bottom before too late for recovery by diving for it in the direction
indicated by these bubbles.
7. On rescuing a person by diving to the bottom the hair of the
head should be seized by one hand only and the other used in con-
junction with the feet in raising yourself and the drowning person
to the surface. '
8. If in the sea, it may sometimes be a great error to try to get to
land. If there be a strong " outsetting " tide, and you are swimming
either by yourself or having hold of a person who can not swim, then
get on your back and float till help comes. Many a man exhausts
himself by stemming the billows for the shore on a back-going tide
and sinks in the effort, when if he had floated a boat or other aid
might have been obtained.
9. These instructions apply alike to all circumstances, whether as
regards the roughest sea or smooth water.
CLASS B.
MEDICINES.
Amounts.
Items.
Bounces Acetic acid.
500 Acetphenitidini , tabs, compr. , 5 gr. ( Phenacetine) .
32 ounces ^Ether for anaesthesia (in 125 gm. cans), " Squibbs. "
4 tubes ^Ethylis chlorid.
64 ounces Alcohol.
1,000 Ammon. chlor., tabs, compr., 5 gr.
32 ounces Ammonise, aqua.
4 ounces Ammon. , arom. spir.
4 ounces Amyl nitris (50 pearls, 2 c. c. ea.).
300 Anaesthesia, local, tabs, compr. (No. 2 normal).
5,000 Antiseptic tabs. (Bernay's large blue).
25 Apomorph. hydrochl., tabs, hypod., A gr.
1 ounce Argent nitras, fus.
4 ounces Argyrol.
4 ounces Arsen . , liquor potass.
1,000 Aspirin, tabs, compr., 5 gr.
25 Atropin sulph., tabs, hypod., Tfo gr.
1 ounce Balsam Canad. in xylol (30 c. c.).
12 cans Beef, extract of, Liebig's.
500 Bismuth subnitr., tabs, compr., 5 gr.
2 ounces Benzoin, adeps.
16 ounces Boric acid.
1,000 Bromid., potass., tabs, compr., 5 gr.
5,000 Brown Mixture, tabs. trit. , 1 fl. dr.
300 Caffeine citrate, tabs, compr. , 2 gr.
1,000 Calomel and sod. b. c., tabs, trit., •& gr.
16 ounces Camph. , opii. tra.
1 ounce Caryophyli ol.
500 Cascara sagrada, tabs, compr., 5 gr.
1,000 Cathart. co., veget. pills.
J ounce Cedri ligni, ol., Zeiss (15 c. c.).
8 ounces Cera alba.
4 ounces Chloralum hydratum.
16 ounces Chloroformum for anaesthesia (in 100-gm. glass-stoppered bottles).
$ ounce Cocainae hydrochlor.
100 Cocainae hydrochlor. , tabs, hypod. , 4 gr.
300 Codeine, tabs, trit., J gr.
4 ounces Collodion flexile.
2,000 capsules Copaiba, 5 min.
500 Coryza, tabs, compr. (P. D. & Co. No. 2).
50 Digitalini, tabs, hypod., t>5 gr.
500 Dobell's solution, tabs, compr.
300 Dovers powder, tabs, compr. , 5 gr.
240 papers Effervesc. co. , pulv. (Seidlitz powders).
64 ounces Formaldehydi, liquor.
8 ounces Gaultheriae, ol.
16 ounces Gentian co., tra.
25 Glonoini, tabs, hypod., TJ-s gr.
16 ounces Glycerinum.
500 Heroin dyhrochlo., tabs, trit., •& gr.
500 Hexamethylenamine, tabs, compr., 5 gr. (urotropin).
16 ounces Hydrarg. cnlor. mite.
2,000 Hydrarg. iod. flav. pills, J gr.
48 ounces Hydrarg. , unguent.
8 ounces Hydrochloric acid.
80 ounces Hydrogen dioxid., aqua.
8 ounces Hydroxid, potass, liquor.
32 ounces Ichthyolum. . .
16 ounces lodi, tra.
1,000 Iodide, potass., tabs, compr., 5 gr.
16 ounces Lanse hydros, adeps.
500 Laxative co., pills.
80 ounces Magnesii sulph .
1 ounce Menth. pip. , ol.
100 Morphine sulph., tabs, hypod., $ gr.
8 ounces Nitric acid.
flounces Opii, tra.
500 Opii and camphor pills ( J gr . opii) .
500 Opii and plumbi acet . pills.
32 ounces Permanganass , potassii .
71
72
MEDICAL HANDBOOK.
MEDICINES-Continued.
Amounts.
Items.
64 ounces
16 ounces
500
32 ounces
25
8 ounces
4 ounces
1,000
1,000
4 ounces
16 ounces
500
80 ounces
80 ounces
2,000
500
1,000
50
300
800 ounces
500
20
15 gross
5 gallons
16 ounces
8 ounces . . .
Petrolatum.
Petrolatum, album.
Phenacetine and salol, tabs, compr. (2J gr. ea.).
Phenol.
Pilocarpini hydrochlor., tabs, hypod., J gr.
Plumbi acetas.
Protargel.
Quinine, iron, and strychn. phos., tabs, compr.
Quinine sulph., tabs, compr., 3 gr.
Resorcinol.
Ricini.ol.
Salt, normal, tabs, compr.
Sapo mollis.
Saponis, liniment.
Soda mint and pepsin, tabs, compr.
Sod. salicyl., tabs, compr., 5 gr.
Strychn. sulph., tabs, compr., j1, gr.
Strychn. sulph., tabs, hypod., ^ gr.
SuTphonal, tabs, compr., 5 gr.
Sulphur, roll.
Terpin hydrate, tabs, compr., 5 gr.
Vaccine points.
Venereal prophylactic tubes.
Whisky, rye.
Zinci oxid!
Zinci sulph.
MEDICAL AND SURGICAL APPLIANCES.
2
1
1
100
50
12
12
1
1 sheet
2
1
1
1
2
4
50
50
25
1
200
5
2
1
100
1
5 pounds
2 pieces
10 sheets
1 box
1 pair
l'.'.'.'. '..'.'.
100
6
4
1
5
1
2
10
1
40 yards
20 yards
50 yards
2 pairs
5 yards
l'.'.'.'...'.'.
I
25 sheets
1...
r>ags. HDD,
Bandage, Esmarch's (tourniquet), complete with chain, etc.
Bandage roller.
Bandages, gauze, 2-inch and 3-inch.
Bandages, muslin, 2-inch.
Bandages, plaster paris, 3-inch.
Bandages, suspensory.
Basin, dressing, 9-inch, white enamel.
Binder's boards.
Bistouries, 1 str. shp. ptd., 1 curved.
Bone chisel, McEwen's.
Bone curette, sharp, Volkman's med.
Bone gouge, McEwen's med.
Bottles, hot water, 2 art.
Bougies, filiform, whalebone.
Boxes, ointment.
Boxes, pill.
Boxes, powder.
Button, anastomosis (Murphy's) med.
Capsules, empty gelatin.
Catheters, soft rubber (1 ea. 5, 6, 8 Engl., 2 10 Engl.)
Chamois skins.
Commode, bucket.
Corks, asstd.
Corkscrew.
Cotton, absorbent.
Cotton tape.
Cotton wadding.
Court plaster.
Crutches.
Cup, feeding.
Director, grooved.
Envelopes, dispensing.
Eye shades, single.
Finger cots.
Forceps, bone-gouging.
Forceps, dental, assorted.
Forceps, dissecting, mouse tooth, 5-inch.
Forceps, dressing, 5-inch.
Forceps, haemostatic.
Funnel, glass, 1 pt.
Gauze, bichloride.
Gauze, iodoform.
Gauze, plain, sterilized.
Gloves, rubber. No. 8.
Gutta-percha tissue.
Inhaling apparatus, Esmarch's, frame.
Irrigator, 2 qrt., white enamel.
Knife, amputating, med.
Labels.
Lamp, spirit.
MEDICAL AND SURGICAL APPLIANCE^. '
MEDICAL AND SURGICAL
73
Amounts.
Items.
6 tubes Ligatures, catgut, sterilized (Nos. 1, 2, and 3).
2 reels Ligatures, silk, iron dyed, med.
100 Ligatures, silkworm gut, med.
3 Measures, grad'd., glass, asstd.
10 Medicine droppers, str.
5 Medicine glasses.
3 Mirrors, laryngeal, 1. 3, and 5.
1 Mortar and pestle, glass, 8 oz.
1 Mouth gag, Ferguson's.
4 Nailbrushes.
1 Needle holder, Richter's, 7-inch.
2 Needles, hypodermic, universal thread.
12 Needles, surgical, asstd.
6 Ointment jars, 8-oz.
1 Pad, operating, med., Kelly's.
1 package (100) Papers, filter, 6-inch.
2 bottles Paper, litmus, red and blue.
10 Pencils, camel's-hair, asstd.
1 Periostotome, Sayre's double-ended.
72 Pins, safety, asstd.
8 spools Plaster, adhesive, O. Z., 1-inch and 2-inch.
2 yards Plaster, belladonna.
3 boxes Plaster, mustard (10 in a box).
1 Pocket case, Hamilton's, in metal case.
1 Probe, silver, 6-inch.
1 Razor strop.
1 Reflector, laryngeal, 3-inch, with headband and handle.
1 pair Retractors, plain, med.
1 Saw, metacarpal.
1 Saw, wire, Gigli's, 12-inch.
1 Scales, prescription, torsion balance.
2 Scalpels, IJ-inch and 2-inch blades.
2 Scissors, dressing, 6-inch and 4-inch.
10 gm Silver wire.
1 set Sounds, urethral, n. p. steel, 10-32, French.
4 Spatulas, steel, asstd.
1 set Specula, ear, Wilde's, silver.
1 Specula, eye, plain wire.
1 Specula, nasal, bivalve, Ingal's.
1 Spray apparatus, De Villbiss's.
1 Sterilizer, instrument, small, white enamel, with extra deep sieve tray, 16 by 6 by 4
inches.
1 Stethoscope, Bowles's.
1 Stove, alcohol.
1 Stretcher, hand, U. S. hospital and army litter.
1 Syringe, ear, Hartmann's with 3 tips, h. r. mounted.
2 Syringes, fountain, 2 and 4 qt.
1 Sy/inge, hypodermic, glass bbl., metal mountings, with finger rest and 4 tablet vials
in metal case.
1 Syringe, nasal, plain, h. r. with post nasal tip.
20 Syringes, p. p., glass.
1 Syringe, self-injecting.
1 Syringe, urethral, deep, Keyes-Ultzmann's, plated, in case.
1 Tape measure, 2 miter, all metal.
4 Thermometers, clinical.
5 Test tubes, 8-inch.
1 card Test types, ophthalmic, " Snellen's letters."
1 Tongue depressor, Bosworth's.
1 Tray, instrument, medium, white enamel.
1 Trocar and canula, small.
1 Tube, stomach, soft rubber, 60 inches long.
1 Tank for sterilized water, 1 gall., white enamel.
12 Towels, huck.
1 Rubber apron, check cambric coated with best maroon rubber, 49 inches long.
3 yards Rubber sheeting, black.
5 yards Rubber tubing, asstd.
1 Urinal, glass, male.
1 Urinometer, Squibbs.
125 Vials, twenty-five 50 c. c., twenty-five 75 c. c., seventy-five 125 C. C.
1 Wash basin, med., white enamel.
1 set Worsteds, for color-blind tests, Holmgren's.
1 ounce Cover glasses.
2 Erlenmeyer flasks.
1 Hsemaglobinometer scale (Tallquist's).
100 sheets Lens paper.
1 Pinch cock, Mohr's.
1 Section lifter.
144 Microscopic slides.
1 Urine test glass.
1 Microscope ( Bausch & Lomb), BBS, and accessories. (Submit list of accessories.)
• • •
INDEX
Page.
Page.
Ankle:
Dislocation
61
Kneecap, fracture
52
Sprain
63
Leg:
Antidotes for poisons
Appendicitis
9
31
Fracture
Ulcer, bandage for treatment (fig. 20). ..
49,53
64
Arm, fracture
46,47
Laudanum, antidote for
9
Arsenic, antidote for
9
Malarial fever
10
Articles for medicine chest
6
Measles
12
Back, injuries
43
Medicines, list
6
Bichloride of mercury, antidote for
9
Morphine, antidote for
9
Bleeding
37
Mosquitoes
8
Boils
37
Mouth, care of
9
Bones, broken
43
Mumps
14
Bronchitis
25
Nosebleed
64
Burns
40
Opium, antidote for
9
Carron oil, formula
41
Paregoric, antidote for
9
Carbolic acid, antidote for
9
Paris green, antidote for
9
Chancre (chancroid)
32
Personal cleanliness
8
Chest, injuries
42
Poison ivy
27
Cholera morbus
21
Poisons
9
Clap (gonorrhea)
34
Pott's fracture
54
Cleanliness of person
8
Piles
37
Cold, effects of
41
Quinsy
24
Colds..
25
Rheumatism
27
Colic
22
Rib, fracture
42
Collar bone, dislocation
60
St. Anthony's fire (erysipelas)
26
Corrosive sublimate, antidote for
9
Sanitation
7
Coughs
25
Scalds
40
Delirum tremens
30
Scalp, wounds
42
Diarrhea
20
Scurvy
23
Diet
8
Shoulder:
Disinfecting solutions
7
Dislocation
58
Dislocations
56
Sprain
63
Drowning presons:
Smallpox
15
Resuscitation of
65
Sore throat
24
Swimming to relief of
69
Spine, sprain of
43
Drugs, list
6
Sprains:
Dysentery
18
General
63
Elbow, dislocation '.
58
Of the back
43
Erysipelas
26
Stricture of urethra
35
Fainting
30
Sunstroke
19
Fever:
Syphilis
31
Malarial
10
Syphilitic rheumatism
30
Rheumatic
27
Teeth:
Fingers:
Care of
9
Dislocation
57
Toothache
9
Fracture
46
Thermometer
9
Flies
7
Thigh, fracture
49
Forearm, fracture
46
Toothache
9
Fractures
43
Thumb:
Frostbite
41
Dislocation
57
Gonorrhea
34
Fracture
46
Gonorrheal rheumatism
29
Toes, dislocation
61
Hemorrhage
37
Tonsillitis
24
Hip, dislocation
61
Ulcer, bandage for treatment of (fig. 20)
64
Injuries
37
Urethra, stricture of
35
Jaw, fracture
44
Wounds i
38
Knee:
Wrist:
Dislocation
61
Dislocation
58
Sprain
63
Sprain
63
75
o
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