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Miscellaneous Publication No. 9

THE
SHIP'S MEDICINE CHEST

AND

FIRST AID AT SEA

Compiled and Edited by

Medical Officers of the United States Public Health Service

By Direction of the Surgeon General

UNITED STATES

GOVERNMENT PRINTING OFFICE

WASHINGTON

1929

\

DEDICATED

TO

THE AMERICAN MERCHANT SEAMAN

AT WHOSE BEHEST THE MARINE HOSPITALS

WERE FIRST ESTABLISHED IN THE YEAR

1798 AND WHOSE HISTORY AS A

PATIENT OF THE PUBLIC HEALTH

SERVICE IS A RECORD OF

THE PROGRESS OF MEDICINE

AND SANITATION IN

THE UNITED STATES

n

FOREWORD

The duty of furnishing medical and surgical relief to sick and
disabled American merchant seamen was begun in 1798, but it was not
until 1881 that a medical handbook. The Ship's Medicine Chest, was
prepared for use aboard ship. That volume, representing a consider-
able knowledge acquired by officers of the United States Public
Health Service of the needs of seamen and the conditions under
which they work, has been revised and rewritten from time to time
as medical science advanced. The present handbook, like its pre-
decessors, is for use on ships having no physician. It can not, in the
nature of things, cover all emergencies arising on shipboard ; but in
the hands of intelligent seamen and ship's officers, who have always
displayed great ingenuity and resourcefulness in the emergency treat-
ment of their sick and injured, it may be useful.

I would urge upon ship's officers a study of this book, especially of
the chapter on hygiene and sanitation on shipboard. A sick man on
board ship not only weakens the crew but may be a danger to the
health of others. Care in the selection of the ship's company and
the preservation of its health are measures of insurance against dis-
ease, death, and quarantine delays. Nothing which affects the well-
being of the sailor is trivial ; and medical officers of the United States
Public Health Service are always ready to advise ship's officers how
to protect the health of crews. In the interests of both ship and crew
and to the end that suffering may be prevented and human life at sea
made more safe, this book has been written.

H. S. Gumming,
Surgeon General
m

PREFACE

Since the object of this book is to teach officers and crews of
American merchant vessels how to preserve their health and to meet
intelligently the accidents of disease and injury, the structure and
uses of the various parts of the human body are taken as the point of
departure. This is logical, since, in order that a machine may be
operated successfully and repaired when it is out of order, the person
in charge of it must know of what each part consists, what it is sup-
posed to do, and how it does it. It is, therefore, urged that this
portion of the book be carefully studied in order that when emer-
gencies arise, their nature will be promptly recognized and the
exigency met.

If the entire book is read and its basic points are remembered, it
will be possible to apply appropriate treatment without delay, and
this may lessen pain and perhaps save life. Emergencies are best
met by knowing how and why to do the necessary thing at the
moment. Such knowledge is not to be acquired in an instant, par-
ticularly in times of urgent stress, and preparation before the event
is the surest way of avoiding errors and preventing loss of time.
This is especially true in the first-aid care of the sick and injured,
when every moment may be of the utmost importance. Throughout
the book, wherever a technical word is used, its meaning is placed
in parentheses. In logging an accident or in making a wireless re-
quest for medical or surgical advice, these words will be found
concise and accurate. For convenience in reference, important words
and phrases have been printed in italics.

For ready reference, there is appended a set of concise directions,
at the beginning of which a tab should be placed so that they may be
consulted without the necessity of searching through the index. This
is intended for emergency use only, it being urged that the remainder
of the book be studied in time of leisure as a preparation for the time
of acute need. As a further aid in consulting the book, its subject
matter is arranged alphabetically.

It should be the aim of every seafarer to keep himself and his ship
in the best possible condition. To do so makes for efficiency and
usefulness. Careful attention to the rules of health is the surest way
of preventing sickness, disability, expense, and, perhaps, premature
death. The safety factor of ships is now so high that there is no
reason why the mariner should not live to a happy, ripe old age, if

v

VI

PREFACE

he will but avoid those things which bring disease and suffering in
their train. These things are set forth in considerable detail in the
second chapter, which should be carefully read and followed.

It is desired to acknowledge valuable assistance received from
numerous officers of the United States Public Health Service who
have reviewed the manuscript of this book in whole or in part and
have contributed photographs and drawings thereto. Numerous
standard American works on medicine, surgery, hygiene, and sanita-
tion have been consulted freely and used in the compilation of this
book. It is not practicable to mention them individually, but, repre-
senting as they do the best thought of the medical profession of the
United States, their help is highly appreciated.

The Ship's Medicine Chest and First Aid at Sea has been adopted
by the United States Coast Guard, the United States Coast and
Geodetic Survey, and the United States Lighthouse Service as the
official standard for use on ships and at stations where no medical
officer is available.

NOTICE

Special Attention Is Called to

THE EMERGENCY REFERENCE SECTION

on page 182
and

FIRST AID BY RADIO

on page 188

CONTENTS

CHAPTER I

Pago
The Structure and Functions of the Human Body 1

CHAPTER II

Hygiene and Sanitation on Shipboard 23

CHAPTER III
The Ship's Medicine Chest and Equipment 47

CHAPTER IV
Medical First Aid and Symptomatic Treatment 63

CHAPTER V
Specific Diseases and Their Treatment 85

CHAPTER VI
Surgical Conditions and Their Treatment 129

CHAPTER VII

Emergency Reference Section 182

CHAPTER VIII

Radio Messages Requesting Medical Advice 188

APPENDIX

Regulations of the United States Public Health Service Concerning

Beneficiaries 192

List of Marine Hospitals and Relief Stations 194

Care and Disposal of Bodies of the Dead 195

Glossary of Medical and Surgical Terms 198

Index 200

Maritime Laws Concerning Crew Accommodations and Water Supply, 203

VII

THE SHIP'S MEDICINE CHEST AND
FIRST AID AT SEA

CHAPTEE I

THE STRUCTURE AND FUNCTIONS OF THE HUMAN BODY

ANATOMY— PHYSIOLOGY— HYGIENE— SANITATION— THE BONES— THE JOINTS— THE
MUSCLES— THE BLOOD VESSELS— THE BLOOD— THE RESPIRATORY SYSTEM— THE
ABDOMINAL CAVITY— THE SKIN— THE NERVOUS SYSTEM

No man can intelligently operate, maintain, and repair a machine
unless he knows how it is built and how it works. With this knowl-
edge, he can get the most out of it with the smallest repair bills ; and
should it get out of order, he will immediately know that it is not
working properly, what is necessary to fix it, and how this is to be
done.

Anatomy is the science of the structure of the bodies of living
things.

Human anatomy is the science of the structure of the body of
man.

Physiology is the science of the functions of living things, both as
a whole and as to their various organs.

Human physiology is the application of this knowledge to human
bodies and organs.

Anatomy is the science of how the machine is made; physiology
is the science of how it works.

Hygiene is the science of keeping living things in good working
condition. It includes the prevention of the accidents of disease and
other injuries, but, more important still, it has for its object the
maintenance of man in the state of abounding good health.

Sanitation really means the same thing as hygiene, it being merely
a Latin word for the Greek word " hygiene," but it has come to mean
those measures which are applied to the place in which living things
live and work, in order that disease may be prevented. As now gen-
erally used, hygiene applies to the body and sanitation to the place.

l

2 THE SHIP'S MEDICINE CHEST

ANATOMY

THE BONES

The human body is built up over a framework of bones bound
together by more or less elastic pads of cartilage (gristle) and tough,
fibrous bands .known as ligaments. Bones are dense — like ivory — on

SCAPULA

-t/OMEJWS

Radius...

Fig. 1. — The human skeleton (semidiagrammatic)

the outside and have a fine lattice work on the inside. This arrange-
ment makes them light yet very strong and permits the passage of
the blood vesels to the innermost parts of the bone. They are
covered by a tough, fibrous membrane and contain marrow, a sub-
stance which produces blood' cells.

The framework is known as the skeleton (see fig. 1) and consists,
in the human being, of 206 bones l as shown in the following list:

1 Ships' officers should know the names of the bones for convenience and accuracy in
sending radiograms about injuries.

STRUCTURE AND FUNCTIONS OF THE BODY 3
THE BONES OF THE BODY

Vertebra* (back boae) '- 20

( Jervical (nock) 7

Thoracic (chest) 12

Lumbar < back) 5

Sacral (lower back) "5

Coccygeal (lower end) 24

Skull (head) 22

Cranium :

Occipital (back of liead) 1

Parietal (side of bead) 2

Frontal (front of bead) 1

Temporal (sides of bead, forward) 2

Sphenoidal (base of bead) 1

Ethmoidal (base of bead) 1

Face:

Nasal (nose) 2

Maxillae (jaws) 2

Miscellaneous 10

Hyoid (neck) 1

Ribs 24

Sternum (breast bone) 1

Upper extremities (shoulders, arms, wrists, hands, and fingers) G4

Shoulders :

Clavicle (collar bone) 2

Scapula (shoulder blades) 2

Arms :

Humerus (upper arm) 2

Ulna (elbow) 2

Radius (forearm) 2

Wrists (carpals) 16

Hands :

Metacarpals (hands proper) 10

Phalanges (fingers) 28

Lower extremities (hips, thigh, legs, ankles, feet, and toes) 62

Innominates (haunches) 1 2

Femur (thighs) 2

Legs :

Patella (knee pan) 2

Tibia (shin) 2

Fibula (calf bone) 2

Ankles (tarsal) 14

Feet:

Metatarsal (foot proper) : 10

Phalanges (toes) 2S

Auditory ossicles (ear bones) 6

Total 206

These bones are classed, for purposes of description, according to
their size and shape, as long, short, flat and irregular, large or
small. A detailed description of each is not necessary here. If the

-Fused into 1.

THE SHIP'S MEDICINE CHEST

reader be especially interested in the subject, he is referred to any-
standard textbook on anatomy. All that is needed here is to state
the outstanding features of those bones about which the mariner
should have some definite knowledge in order to give intelligent
emergency treatment in cases of fractures and dislocations. It is
important that he first know something about the normal condi-
tion and relations of these in order that he may diagnose (find out
what is the matter) in case of injury. This helps a great deal in
applying treatment, since, unless one has a fairly definite idea of
what is the matter, he is very liable to make a mistake in the selec-
tion of a method to
relieve the condition.
The hack hone
{spinal c olu ??v n) . —
This is placed up and
down in the middle line
of the back and is the
central frame to which
all the rest of the body
is directly or indirectly
attached. From this
point of view it may
be compared to the keel
of a ship. It consists
of bones which are
bound firmly together
by bands of very tough,
strong, fibrous mate-
rial, while between
each of the vertebras there is placed a pad of yellowish cartilage
(gristle), which is tough and elastic at its rim, and soft, pulpy, and
highly elastic at its center. These pads act as shock absorbers and
assist in permitting movement' of the neck and trunk. Further bind-
ing down and protecting the spinal column (backbone) are thick
layers of muscles behind, and, in the neck, in front of it. Each of the
vertebras, except the first, the atlas, consists of a more or less cylinder-
shaped bone in front, and behind of an arch of bone inclosing a
hole through which runs the spinal cord or large cable of nerves
running to and from the brain.

Fractures (breaks) and dislocation® (out of joint) of the spine are
very rare, those of the neck and lower back being most frequent.
When they do occur, there is usually both a fracture and a disloca-
tion, and they are seldom the result of direct violence, such as a blow.

Fig.

-First cervical vertebra (upper) and phalanx
(lower)

sti,t<"h'i;k and itxctioxs of tiik nonv 5

They may be produced by a fall upon tho shoulders, a heavy weight
falling upon t ho shoulders or from a fall upon the buttocks, but more
commonly they result from very forced forward or backward bend-
ing. In hanging, death may occur from dislocation of the second
from the first vertebrae of the neck. In this and in all other injuries
of the spinal column harm results from compression and tearing of
the spinal cord.

The skull. — Placed on top of the spinal column is the skull. It con-
tains the brain, which sends out and receives nerves to and from the
various parts of the body. The skull consists of the cranium and the
face. The bones of the cranium are very firmly mortised, into one
another and, hence, are rarely dislocated. They may be fractured,
however, by direct violence, but not as frequently as might be thought.
They are typical flat bones. At its base, the cranium has a number
of openings, a large one (the foramen magnum) for the passage of
the spinal cord and a considerable number of smaller ones through
which pass nerves, arteries, and veins. In fractures of the base of
the skull, the spinal cord or the nerves may be injured. Attached
to the cranium are some of the muscles of the face, neck, and trunk.

To assist in sending accurate radiograms describing a head injury,
roughly, the occipital bone is at the base of the cranium above the
neck; the position of temporal bones corresponds to the area about
the ears ; above and in front of the occipital bone and above the tem-
poral bones are the parietals, which meet in* the mid line at the top
of the head ; in front of these and forming the forehead is the frontal
bone. In sending a radiogram about injuries in these locations, one
may say " Occipital region, right or left temporal region, right or
left parietal region, frontal region."

The face proper begins above at the eyebrows and ends with the
lower jaw. Above on either side of the middle line are the orbits,
deep, pyramid-shaped cavities surrounded by a strong projecting
rim of bone. These contain the eyes, protected by the lids, and their
muscles, nerves, blood supply, and the tear-producing apparatus.
Above each eye is more or less of a bulge which represents the loca-
tion of the frontal sinuses. These are cavities which connect with
the nose. They may become infected and produce headache and
fever. Occasionally, they are fractured by direct violence. If the
nose is blown soon afterward, air is forced upward from the nose
under the tissues covering the bone, thus producing a considerable
swelling. If this is touched by the examining finger, a crackling
sensation is received. This may cause worry, because it feels as
though the bones of the forehead were badly shattered, an accident
which is very rare.

6 THE SHIP'S MEDICINE CHEST

Below the orbits are the two cheeks, separated by the nose. Be-
neath the cheeks are the upper jaws which meet in the mid line and
give attachment to some of the muscles of mastication (chewing) and
of expression. Beneath the cheeks and in the interior of the superior
maxillae (upper jaw) are two cavities which are connected with the
nose and act as sounding boards for the voice. These are sometimes
infected, giving rise to fever and neuralgia-like pains on the affected
side of the face. In the lower border of this bone are the upper
teeth, 16 in number. Fractures of the upper jaw are usually caused
by direct violence of great force and are accompanied by great
swelling, pain, and inability to chew.

The nasal bones form the bridge of the nose. They are two rather
thin plates of bone which meet in the mid line somewhat like a
roof-tree. They are often broken by a direct blow.

The lower jaw is shaped like a horseshoe, from the ends of which
rise vertical plates. These are joined to the skull through a movable
hinge joint just in front of the ears. In the upper border of the
horseshoe-shaped portion are lodged the lower teeth, 16 in number.
To the lower jaw are attached, the muscles used in chewing. This
bone is quite often fractured. These fractures are usually the result
of a direct blow and are most often located just below the eyetooth.

Dislocation (getting out of joint) of the lower jaw is not an un-
common accident. It is accompanied by pain in front of the ears and
inability to shut the mouth. This latter symptom by itself does not
necessarily mean a -dislocated jaw.

Man is provided by nature with two sets of teeth. The first set
are called the milk teeth, and are 20 in number. The second teeth
are called the permanent teeth, of which there are 32. The cutting
of the first set ordinarily begins between the sixth and ninth month
of life, and at the age of about 2y2 years the child should have cut all
its milk teeth. The permanent teeth begin to come in about the sixth
year, when the milk teeth begin to be shed. This process continues
until the 17th to the 25th year, when all the permanent teeth are
usually in place. The teeth are designed for the cutting, tearing,
and grinding of food. Their function is to prepare food for diges-
tion, in fact, mastication (chewing) is the first step in digestion.
Upon the condition of the teeth the health of man depends to a
great extent ; therefore, the time devoted to the care and attention of
the teeth necessary to keep them in good condition is time well spent.

Attached to the backbone on either side through movable joints are
the ribs, 24 in number, 12 on either side. These are shaped more or
less like an incomplete loop and, with exception of the lower two
(floating ribs), are united to the sternum (breastbone) in front by
cartilages. These elastic arches of bone are arranged more or less

STi;rc"rn;K and itxctioxs ok tin'. BOD"!

like a cage inclosing the chest cavity, which contains the heart, its
large blood vessels, and the Lungs. The ribs are sel at varying angles

with the spine, and, hence, when they are raised, the front-to-back
diameter of the chest is increased. This plays a part in respiration
(breathing). There is a groove on the lower border of each rib, in
which run nerves and blood vessels. Sometimes these nerves become
inflamed, producing great pain. To the ribs are attached numerous
muscles. The ribs are not infrequently fractured by direct violence.
Such a condition is accompanied by pain on breathing or on pressure
at the site of the injury.

The .sternum (breastbone) is a broad, flat bone and is situated in
the mid line of the chest, extending from the root of the neck to the
upper part of the abdo-
men (belly). This bone is
not often broken. When
it is broken it is usually
done by a direct, crushing
force.

At the upper part of the
chest is attached the shoul-
der girdle, which is the
framework whereby the
arms are united to the
body. This consists of the
clavicle (collar bone) in
front and the scapida
(shoulder blade) behind.

The clavicle is a long
bone, somewhat the shape
of an old-fashioned letter/.
It is fastened to the top of
the sternum at one end
and to the scapula and
humerus (arm bone) at
the other. To it are attached numerous muscles which have to do
with the movements of the arms and shoulders. This bone is often
fractured by indirect violence, such as falls on the point of the
shoulder.3 Fractures of this bone are accompanied by pain, particu-
larly on motion of the upper arm on the side of the injury.

The scapula is an irregularly shaped bone placed at the back of the
shoulder. It is more or less triangular, wTith the point downward.

3 When a bone is broken by direct violence, the force which breaks it acts directly; when
it is broken by indirect violence, the force travels through another bone to the one which
is broken.

Fig. 3. — Scapula (shoulder blade)

8 THE SHIP'S MEDICINE CHEST

Running across its upper portion is a strong plate of bone. Many
muscles are attached to it. Fractures of this bone are not common.
A joint exists between it and the upper end of the humerus. Dislo-
cation at this point is common.

Running from the shoulder to the elbow is the humerus, a long bone
having a more or less cylindrical shaft, a globe-shaped knob at the
upper end and a somewhat flattened portion at the other. Above it
articulates (has a joint) with the scapula, while below it articulates
with the ulna (elbow bone). It has numerous muscles attached to it,
including those which move the arm, forearm, wrists, hands, and
fingers. Fractures of this bone are not at all uncommon and may
occur at either end or in the shaft. They will be discussed under the
heading " Fractures."

Forming the prominent point of the elbow and extending to the
wrist is the ulna. It is attached to the humerus by a heavy hook-
shaped piece of bone from which it runs as a prism-shaped shaft to
end in a rather sharp point. Muscles attached to it move the fore-
arm, wrist, hand, and fingers. Fractures of the upper end of this
bone may be due to direct violence, such as a fall on the elbow, or to
muscular action ; those of the shaft are always due to direct violence.

On the thumb side of the forearm is the radius. This bone is
cylindrical at its upper end and broadened out and flattened at its
lower. These extremities are connected by a shaft which is somewhat
triangular on cross section. It may be fractured almost anywhere,
either alone or in common with the ulna.

In each wrist there are the eight irregularly shaped carpal hones.
They are rarely injured. In the hand are five metacarpal bones.
These make the framework of the hand proper. They are occasion-
ally broken by direct violence.

The fingers consist of 14 bones (2 for the thumb and 3 for each
finger), called phalanges. These are very frequently fractured or
dislocated.

The backbone ends in a large wedge-shaped piece of bone, the
sacrum, which represents several vertebra? fused together. On the
end of this is a small wedge, the coccyx. Extending out on either
side of the sacrum are two large, heavy, irregular bones, the innomi-
nates ("nameless," so called by the ancients because they resembled
nothing and hence were hard to name). These meet in front in the
mid line at the pubis, thus forming a sort of a cylinder which flares
at the top and is smaller at the bottom. This extensive framework,
the pelvis, serves for the attachment of numerous muscles which
move the trunk, the thighs, and the legs. It supports the contents of
the abdominal cavity; through it pass numerous important blood
vessels and nerves to the lower extremities; and it contains the

STRUCTURE AND FUNCTIONS OF Till'. I'.ODV

9

Madder, the rectum, and the female generative organs. Occasionally,
these bones are fractured, but always by a great, usually a crushing,
force.

On the outer surface of each innomimate bone is a cup-shaped
cavity into which fits the globe-shaped head of the femur (thigh
bone), the longest bone in the body. Its shaft is somewhat cylindrical,
with a roughened heavy upper end to which
are attached numerous strong muscles. Run-
ning inward at an angle of about 125° from
the upper end is a strong shaft of bone
which ends in a spherical head which articu-
lates with the innomimate bone, its shape
being such as to permit great freedom and
latitude of motion. The lower end is ex-
panded into a broad, smooth, rounded sur-
face which is divided by a notch for articu-
lation with the tibia at the knee joint. Frac-
ture of the femur is a very common injury ;
either end or the shaft may be broken. Dis-
location of the hip joint is also not uncommon.

Below the knee and running to the ankle is
the tibia (shin) . This bone has a more or less
prism-shaped shaft which ends above in a
broad expanded portion for articulation with
the femur at the knee joint ; while below, it
again expands to enter into the formation of
the ankle joint and forms a rounded projection
on the inner side of the ankle. This bone
may be fractured at either end or in the shaft
by direct or indirect force or by twisting.

On the outer side of the leg from just be-
low the knee to the outer side of the ankle,
there is a long slender bone, the fibula, or
calf bone. This bone is more commonly
fractured alone than is the tibia. Fracture
of both bones is a very common injury.

In front of the knee and situated in the tendon (leader) of the
muscle with which man kicks is the patella, or knee cap, a more or less
rounded triangular bone. It strengthens the tendon and protects the
knee joint. While this bone is subjected to many injuries, these are
not frequently serious. The bone may be fractured, however, and,
infrequently, it may be dislocated.
112055°— 29 2

10 THE SHIP'S MEDICINE CHEST

The tibia and the fibula meet at their lower ends and inclose between
them the talus, or ankle bone, below and behind which lies the calca-
neus, or heel bone. The remaining tarsal bones lie in front of it.
These are firmly bound together by very tough, fibrous bands. In
front of them are the metatarsal bones, or foot bones proper. Still
further forward are the phalanges, or bones of the toes. The foot is
an elaborate and very strongly built mechanism consisting of a series
of elastic arches which serve to spread the force of blows and falls.
The heel and the ankle bone are the most often fractured, generally
by direct crushing force.

The functions of bones are to support the body, to give attachment
and leverage to the muscles, and to protect some of the more delicate
organs, such as the brain, heart, and lungs.

The bones which form the skeleton are joined to one another by
articulations, or joints. Some of these, as in the skull, may be im-
movable; others are only slightly movable, as those between the
vertebra?, while some are freely movable, such as the shoulder and
the hip joints. In the freely movable joints the bones are further
separated than in the less movable and, hence, are more liable to dis-
location. The intervening space is taken up by cartilage, which acts
as a shock absorber. The cartilage is covered with a glistening white
membrane which produces a slippery fluid, and this fluid acts as a
lubricant. Thrown about the whole joint is a capsule, or inclosing
membrane, of very tough material, the fibers of which run in different
directions so as to increase its strength. This capsule, with the aid
of the muscle, assists in keeping the ends of the bones together, and,
in case of dislocation, it is not infrequently torn. The lining mem-
brane of joints does not have .a high degree of resistance to the
microbes which cause disease; hence it may easily become infected,
with the result that the joint is greatly damaged. The individual
joints will be further described in connection with dislocations.

THE MUSCLES

Muscles are contractile, elastic tissue, made up of bundles of fibers
bound together by elastic membranes. They compose about half
the body weight and are of three kinds. Muscles which are under
the control of the will, like the muscles of the arms, consist of long
spindle-shaped fibers which are striped crosswise; in the intestine,
the muscles are n'ot under voluntary control, and these have no stripes;
in the heart the muscle stripes are rather imperfect, and this muscle
is also involuntary. Muscles are connected with bones, cartilage
(gristle), ligaments (leaders), and the skin. Their function is to
perform work, and they are able to do this by contracting and
relaxing, using the bones as a lever, or by a squeezing action as in

STRUCTURE AND FUNCTIONS OF TITE BODY

11

the heart or the intestine. Muscles respond to nervous force, which
may be likened to an electric current. This "current" is brought
to them by a nerve, which may be likened to an electric wire. It
is believed by some that nervous force actually is an electric current.
"When it reaches a muscle it causes it to shorten and broaden and to
jmll upon its two ends.

OF

Fingers

Dairo/D

Fig. 5. — External muscles of the body

Muscles generally arise from some fixed point or attachment to a
bone. This point is called the origin. The point where the muscle
applies its force is called the insertion. Frequently muscles end in
a small, strong, inelastic band, a tendon, or leader. Tendons some-
times run through a bearing, or sleeve, of dense, strong tissue which
is lined with the same material that lines the joints and here also
produces a lubricator. Muscles are always more or less taut ; hence,

12

THE SHIPS MEDICINE CHEST

in case of fractures of the long bones, they may pull the fragments
out of alignment.

Muscles are liable to a great variety of injuries. They may be
subjected to strains by pulling on their long axis so that some of their
small fibers are torn. The muscle then becomes swollen, tender, stiff,
weak, and sore, and its use produces sharp pain. Muscles may be
bruised, crushed, or wounded with or without breaking the skin.
They may rupture from the force of their own action. The mem-
branes lining the sheaths
in which the tendons run
may become inflamed and
more or less stiffness and
limitation of motion result.

Carotid .

, Aorta

Brachial,,

Radial

Femoral

.Heart

THE BLOOD VESSELS

The circulatory system
consists of the heart, or
pump, the arteries, which
carry blood from it, and
the veins, which bring
blood to it. Its function
is to send to the tissues
foodstuffs which have been
prepared for their nour-
ishment by digestion and
to remove waste products
which are to be thrown
off by the lungs, the skin,
the bowels, and the kid-
neys.

The heart is a hollow,
muscular, cone-shaped or-
gan, situated in the chest
between the two lungs,
beneath and mostly to the
left of the breast bone. It
is divided into a right and left half, each half consisting of two cham-
bers. The heart, therefore, has four chambers, the two upper being
called the auricles (ears), and the two lower the ventricles (bellies).
Its openings are guarded by valves, so that when the heart muscle
relaxes (slacks off) after contraction (squeezing down), the blood can
not reverse its direction. The right half contains the blood which is
coming to the heart through the veins — venous, or impure, blood; the
left half contains blood which has been returned from the lungs,

Arterial system

sTi;rcni;K and fi'xctioxs nr tiik imnv

13

where it has undergone purification, and is going out to the various
parts of the body — arterial, or purified, Hood. The heart undergoes

a series of rhythmic contractions and relaxations, producing the
heartbeat. When it contracts, blood is sent out to the lungs and the
body; "when it relaxes, blood Hows into it from the Lungs and the body.

If the ear is applied to the chest over the heart, the heart sounds
may be heard. The normal heart sounds resemble the sound " lub-
dup," pause, " lub-dup." These may be greatly changed by disturb-
ance or injury to the heart's mechanism or change in the character
of the blood itself. These changed sounds are usually called mu-r-
iiiui'x, which may be blowing, harsh, loud, or soft.

The arteries consist of hollow, elas-
tic, muscular tubes beginning at the
heart as the aorta, or large trunk,
which gives off branches which divide
and subdivide until they can not be
seen with the naked eye and reach
every portion of the body. "When the
heart contracts it forces the purified
blood into the arteries, causing them
to expand. Their muscular fibers
then contract, assisting the heart in
forcing the blood forward. This alter-
nate expansion and contraction of the
arteries produces the pulse which may
readily be felt if the finger is placed
over a point where the artery is near
the surface. Usually, the pulse is
taken at the wrist. This is for con-
venience only; the pulse might just as
well be taken in the neck or in any other place where an artery my
be easily felt.

There are several reasons for taking the pulse. It enables one to
determine the rate at which the heart is beating. In the sitting
adult this is about 70 per minute. It beats faster when a person is
standing, and its rate is also increased by muscle work, fever, eating,
a warm bath, or a hot drink. A given person's pulse may be de-
scribed a,s slow or fast, quick (if the pulse wave strikes the finger
quickly and then promptly recedes), and soft or hard. The degree
of the latter gives some indication of the olood pressure. A pulse
may also be described as large or small, strong, weak, or thready.
The pulse may be bounding or very sluggish. It also indicates the
state of the heart's rhythm ; thus the pulse may be regular or irreg-
ular and it may intermit — that is, drop a beat from time to time.

14

THE SHIP'S MEDICINE CHEST

The veins have thinner walls than the arteries and are provided
with valves. They carry venous (impure) blood from the tissues
to the heart. They usually accompany the arteries, but have no pulse.
Associated with them is the lymphatic system, which consists of a
network of tubes guarded by a series of filters called glands. The
lymphatics from the small intestine contain a milky fluid formed
from digested food. They are called lacteals. In the rest of the
body they contain lymph, a liquid which is practically the same as the

fluid portion of the blood.
The lymph bathes the
cells of which the various
organs and tissues are
made, brings them food,
and removes their waste
products.

m_.JvGULAR

Cephalic.

BASILIC .

-.A.. Heart

\..veNfl Cava

THE BLOOD

. Z..FEMOAAL

Flowing through the
veins and the arteries is a
red fluid, the blood. This
is from 52 to 60 per cent
water containing various
dissolved salts and 48 to
40 per cent solids. The
latter consists of red cor-
puscles (little bodies or
cells), white corpuscles,
and platelets (little
plates). These cells can
be seen only with the aid
of a microscope. The red
cells are disk shaped and
contain a chemical (hemo-
globin) by means of which
oxygen is carried from
the lungs to the cells of the body and there exchanged for carbon
dioxide which eventually will be thrown off by the lungs. The white
corpuscles have an irregular shape and are the policemen of the
body. Whenever the germs of disease enter it, the white corpuscles
attack them fiercely and try to destroy them, many of these cells
being killed in the battle. Pus (matter) consists of their dead bodies.
Blood coagulates, or clots, on exposure to air in order to prevent
the further loss of blood through a tear or cut into a blood vessel.
This is a complicated process into which the blood platelets enter
and consists in the formation of a sticky, jelly-like substance which

The venous system

STRUCTURE AND FUNCTIONS OP THE BODY 15

soon becomes dry and hard and plugs the opening into the blood
vessel. Clotting is hastened by contact with a rough surface. This
is why sterile gauze or bandage material is applied to wounds to
stop hemorrhage (bleeding).

"When hemorrhage takes place from an artery (arterial blood),
the blood escapes in spurts and is of a bright red color. When it is
from a vein (venous blood), it flows steadily or oozes and is darker
in color. To control hemorrhage, it is easy to understand that, since
arterial blood comes directly from the heart, the artery should be
compressed (squeezed) between the site of bleeding and the heart,
and that to stop bleeding from a vein, just the opposite should be
done, because the blood is going to the heart.

THE RESPIRATORY SYSTEM

In order that blood shall give up its harmful gases and receive
healthful oxygen in return, it must be exposed to air. For this
purpose, the heart pumps venous blood to the lungs. These are
two in number and are located in the chest on either side of the
heart. They are of a very light, porous, spongy, elastic structure,
being practically nothing but a series of very fine, branching air tubes
surrounding equally fine blood vessels. In this way the blood is
spread out in a very thin sheet and is separated from the air by an
exceedingly thin membrane through which the gases, oxygen, and
carbon dioxide, can pass. Air usually enters the body through the
nose, but in moments of great exertion it may enter through the
mouth. It is warmed in the nose and passes to the trachea, a tube
of cartilage and membrane in the neck. This branches into the right
and the left bronchus (plural, bronchi), one for each lung. These
divide and subdivide until they are very minute and covered only by
the thinnest membrane. The hemoglobin (red coloring matter) of
the blood brings to the lungs carbon dioxide, which is the product
of combustion in the tissues. This corresponds to the funnel gases
of an engine. Just as an engine requires air to keep its fires going,
so does the body to keep itself going. When the hemoglobin brings
the carbon dioxide back to the lungs, it exchanges it for the oxygen
of the air which it carries back to the tissues.

The lungs are not frequently injured, but they are susceptible to
several diseases, especially to tuberculosis (consumption), pneumonia
(inflammation of the lungs, lung fever) and bronchitis 4 (inflamma-
tion of the bronchi). They are inclosed in a sack of smooth, glisten-
ing membrane, the pleura, which serves to protect these delicate
organs and to help their movement inside the bony cage of the chest.

1 itis on the ends of a word means " inflammation of."

16 THE SHIP'S MEDICINE CHEST

This membrane is sometimes inflamed, producing pleurisy, in which
condition there are fever and pain in the side, particularly on
breathing.

Respiration (breathing) is performed by increasing the capacity
of the chest. This is done in two ways: Stretched across the chest
near the bottom of the ribs is a dome-shaped muscle, the diaphragm.
When this contracts, it pulls down and hence increases the up-and-
down diameter of the chest. It has already been shown how the ribs
may be pulled up, thus increasing the front-to-back diameter of
the chest. In this way a vacuum is created and the air rushes in.
This is inspiration. When the diaphragm and the muscles which
raise the ribs relax, the diaphragm rises and the ribs fall. This is
expiration. This process continues rythmically at the rate of about
16 per minute in a sitting person. The rate is less when reclining
or sleeping and greater when standing or exercising. If the oxygen-
carrying power of the blood is decreased, it is more rapid. The ratio
of respiration to heartbeat is about 1 to 4 or 5. Hence the respiratory
rate bears a definite relation to the pulse rate. Difficult breathing
is called dyspnea?

THE ABDOMINAL CAVITY

The abdomen (belly) is situated below the diaphragm and above
the pelvis. In front it is protected by strong muscles which consist
of several layers with fibers running in different directions to add
strength. Its weakest point is in the groin, and it is at this point
that hernia (rupture) most frequently occurs. Sometimes there is
a hernia at the umbilicus (navel, belly button) ; in fact, a hernia
may occur at any point where the abdominal wall is weakened.
Since there is at times considerable pressure within the abdomen,
any weak point in its wall is likely to become enlarged and part of
the abdominal contents forced through the opening so made. Some-
times this is a loop of intestine (gut), and should this get caught
(strangulated), great harm or even death may follow. Any hernia
is likely to give trouble; and since it is a health hazard it should be
repaired by a competent surgeon.

The abdomen is lined by an extensive closed sack of membrane,
the peritoneum. This enfolds all of the abdominal contents and
secretes a slippery fluid which acts as a lubricant. This membrane
may become inflamed, in which case peritonitis, a very serious con-
dition, occurs.

Hanging in front of the abdominal contents is an apron of fibrous
tissue containing a layer of fat, which varies with the fatness or

B Dys on the front of a word means " bad " or " difficult."

STRUCTURE AND FUNCTIONS OF TTTE BODY 17

leanness of the individual. This is called the omentum (suet) and
acts as a reservoir for fats and as a protecting pad against injury.

In this genera] region is located the stomach and intestines, the
liver, the spleen, the pancreas, the kidneys, with their ureters (tubes)
leading to the urinary bladder, and, in the female, the generative,
organs.

The stomach is located in the upper left quadrant of this area,
partly protected by the ribs and close to the diaphragm. This
organ is a somewhat funnel-shaped dilated part of the digestive
tube, lying between the esophagus (gullet) above and the small
intestine (gut) below. The esophagus, which is a tube for carrying
food and drink which has been swallowed, pierces the diaphragm
and enters the stomach at its upper end. Below, the stomach empties
into the first part of the small intestine (bowel), the duodenum.
The stomach is provided with an extensive set of muscle fibers, which
run in various directions and assist in the movements of the organ
during the process of digestion. Its interior is thrown into rough-
ened folds to assist in thoroughly mixing food with the digestive
juices which it produces.

The small intestine is a membranous tube well provided with
muscles which serve to move its contents through it. It is about
23 feet in length and gradually diminishes in size from its com-
mencement to the point where it empties into the large intestine.
In its first part the food which has been discharged into it from
the stomach is mixed with the secretions of the liver (bile) and the
pancreas. Its interior is greatly roughened to assist in the process
of digestion and the absorption of food products which have been
prepared by the action of the digestive juices.

The large intestine begins in the right flank, runs upward, crosses
the abdomen in its upper part, descends along the left flank, empties
into the rectum, which ends at the anus. The arch so formed sur-
rounds the small intestine. It is about 5 feet long. Where it begins,
it is pouch shaped and has the appendix, which may become in-
flamed— appendicitis. The large intestine has muscular coats, one
of which is in the form of a band which may be seen running along
the long diameter of the gut from the appendix.

The entire digestive tube is held in place by folds of peritoneum
which are thrown about it. Throughout, it is richly supplied with
arteries, which bring nourishment to its cells, and with veins and
lacteals which carry away digested products. Some of these are
carried to the liver, there to be further changed and stored, but
others are carried by the lacteals into the blood stream and dis-
tributed to the tissues. Nerves reach the muscles of this tube and
stimulate them to action,

18 THE SHIP'S MEDICINE CHEST

The functions of the stomach and intestines are digestion and ab-
sorption of foodstuffs and the elimination of waste products. It is
remarkably tolerant of the abuses to which man subjects it, but once
in a while it retaliates with an attack of constipation, diarrhea, and
indigestion. With reasonably intelligent care, it will function
throughout life without trouble; but overeating, overdrinking, the
selection of a diet which is not well balanced, and the neglect of the
bowel functions are bound to disarrange it and cause many of the
ailments from which man suffers.

The liver, the largest gland of the body, weighing about 4: pounds,
is located in the right upper quadrant of the abdomen under the
ribs and the diaphragm. It is richly supplied with blood vessels
and serves as a storehouse for the digested sugars and starches, the
digestion of which it completes. It also secretes bile, which it
discharges into the upper part of the small intestine as need arises.

Below the stomach and extending on either side of the middle
line, is the pancreas, a fish-shaped organ that produces a fluid which
assists in digestion. This it empties into the small intestine through
an opening through which also passes the bile.

Digestion begins at the mouth with the mastication (chewing) of
food. This has a twofold purpose. The first is to reduce the food
to small particles so that it may be easily swallowed, may be ren-
dered more soluble, and may more easily come into contact with the
digestive juices. Second, the parotid gland situated on the outer
side of the lower jaw just in front of the ear produces saliva (spit),
which contains a digestive substance, ptyalin, which assists in digest-
ing starches. In mastication this is mixed with the food. If, how-
ever, food is bolted without proper chewing a harder task is placed
upon the remainder of the digestive tract.

One of the great causes of ill health is the inadequate chewing of
food. Good health depends upon the teeth to a considerable extent.
The person who neglects his teeth is laying up trouble, pain, and
perhaps premature death for himself. He is handicapping his use-
fulness and interfering with his happiness.

The food which has been ground up by the teeth and made slippery
by the saliva is next rolled into a ball by the tongue, pushed back-
ward and swallowed. It enters the esophagus, descends it, and is
discharged into the stomach. The stomach secretes (makes) hydro-
chloric (muriatic) acid and pepsin. This latter is called a ferment,
because it produces changes in other substances without itself under-
going change. The stomach, by its muscular movements, churns
up the food to a certain extent and mixes it with the hydrochloric
acid, pepsin, and remdn, another ferment, which curdles milk so

STRUCTURE AND FUNCTION'S OP Till'. BODY 19

that it may be digested by the pepsin. In the stomach, proteids —

tlif animal foods — meat, milk, eggs, etc.. are digested.
At the lower end of the stomach there is a valve, the pylorus.

From time to time this valve opens and allows some of the contents
of the stomach to pass into the small intestine. Here the partially
digested food is mixed with bile and the" secretion from the pancreas.
Bile has a variety of functions, the greatest of which is the aid
which it gives in the digestion and absorption of fats. Fats are
digested by turning them into soaps, with the formation of glycerine
as a by-product. This can be done only in the presence of an alkali.
The food which has come from the stomach is acid. Bile assists in
rendering it alkaline. If the tube which discharges the bile into the
small intestine becomes closed, the bile, which contains several pig-
ments, is picked up by the blood stream and deposited in the skin,
making it turn yellow, jaundice. At the same time the stools, because
of the lack of oile -pigment in them, will become clay-colored.

The secretion of the pancreas contains ferments which act on a
great variety of foods and is considered the most important of the
digestive fluids. Its trypsin acts on the proteids, its steapsin on fhe
fats, much as does bile, its amylopsin on the starches, and its maltase
on the sugars.

The intestines also secrete ferments. These serve to complete the
digestive processes. From the intestines, digested food is absorbed.
The indigestible portion is more or less dried by the absorption of
the water from it, and what remains is discharged from the body as
feces (dung). A certain amount of indigestible material is a neces-
sary part of the diet. This is called roughage and acts as a mechani-
cal stimulant to intestinal action.

Below the stomach and to the left is the spleen. This has a rich
blood supply and has to do with the destruction of red-blood cor-
puscles which have outlived their usefulness.

The kidneys are located in the back part of the abdomen on either
side of the backbone, lying in a pad of fat and supporting tissues.
They are complicated glands and are designed to remove from the
blood stream waste products which are dissolved in it. They are
somewhat bean-shaped with a notch on one side. At this notch is a
funnel-shaped sack of membrane out of which runs a small tube, the
ureter. This tube carries the urine to the bladder, from which it is
discharged by another tube the urethra. When a person has some-
thing wrong with his kidneys, he is sick because of the failure of his
body to get rid of the waste products which should be carried off in
the urine. These poison him. Infections of the urethra, such as
gonorrhea (clap), are likely to travel up into the bladder and by

20 THE ship's medicine chest

the ureters to the kidney, which may thus be badly damaged. In
such a process, the prostate, a gland which surrounds the neck of
the bladder, is usually also infected. This may produce much trouble,
particularly in middle-aged men.

THE SKIN

The entire body is covered with skin, and its openings with a
modified skin, called mucous membrane. It acts as a protector
against injury of the more delicate structures beneath it and, to
assist in this, lodges the special cells of touch, temperature sense
and pain. It assists the body in the regulation of its temperature
and secretes sweat and an oily material which helps to keep the skin
in good condition. Sweating assists in the discharge of waste prod-
ucts brought to the skin by the blood and, by evaporation, lowers the
temperature of the body. This aids greatly in maintaining the sense
of well-being and explains why frequent baths are so necessary to
health and efficiency. This is especially true aboard ship where a
dirty man is so objectionable to his fellows. People who are dirty
are more susceptible to disease and, hence, may menace the health of
others. The hair and nails are a part of the skin. The former
should always be kept very clean because it may harbor parasites,
such as lice.

THE NERVOUS SYSTEM

The nervous system is the apparatus which controls and operates
ihe entire body. It is like the electrical equipment of a gas engine;
if it is out of order, the machine works badly or not at all. It con-
sists of the brain, the spinal cord, and the nerves. The latter are
of two varieties — the motor, which go from the brain, and the sensory,
which go to the brain. The spinal cord is a cable made up of fibers
carrying messages to and from the brain. It also has the ability
to intercept a message from a sensory nerve and to relay it to a
motor nerve. This is called a reflex action. If, for example, the
end of a lighted cigar is accidentally touched with the finger tip
the hand is jerked away before the sensation of heat has reached
the brain. This is a very valuable protective quality and is capable
of high development. To be really efficient in any kind of work or
sport, the reflexes must be in good order. Much of the discipline of
the sea has in view the upbuilding of a proper set of reflexes.

Through the senses the brain is kept informed as to what is going
on about the body. These consist of sight, hearing, touch, taste,
smell, pain, heat, and equilibration (balance). The safeguarding
of these is one of the most important duties in life, since these senses
are really prolongations of the brain into special organs designed to

STRUCTURE AND I'INiTHiXS OF THK BOI>Y 21

keep it in touch with the outside world. Hearing and equilibration,

(lie sense by which we maintain our balance, are associated in the
same organ, the ear, a complicated mechanism designed to receive
sound waves and transmit the sensations produced by them to the
brain. In the ear. there is a balancing apparatus which is connected
with the brain in such a manner that if the body gets off center,
nervous impulses are automatically sent out to the muscles so that
the body will right itself. Touch is associated with the temperature
sense and the pain sense. Sight is performed through a complicated
cameralike organ which receives waves of light and focuses them
upon the retina, a highly sensitive membrane in the interior of the
eye. Taste is accomplished by means of sense organs located in the
tongue. It is intimately associated with the sense of smell, the
organs of which are located in the nose. Nature has a wonderful
way of making up for the loss of some of the senses. Thus, the blind
hear and feel more keenly and the deaf learn to see more acutely.
The brain, may be likened to a telephone exchange which receives
and sends out messages. It is also an automatic regulator for the
heart, for respiration, heat control, vomiting, and several other
things. For the most part the central stations for these are located
in a small area in the upper expanded portion of the spinal cord.
Grouped thus, coordination between them is easy and constant; and
when some external cause interferes with the operation of one, the
remainder respond in an attempt to overcome the untoward condi-
tion. To illustrate : Heat is made in the tissues by the union of the
oxygen of the air with them, much as happens when coal or some
other substance is burned. In this way heat is constantly being
made; and unless there was some way of getting rid of it, the body
would become greatly overheated. Part of it is carried off in the
air exhaled from the lungs, and by the urine, the feces, and in warm-
ing the air surrounding the body. The chief way in which heat is
lost, however, is by the evaporation of sweat. If, now, something
occurs which stops the sweating, the heat regulator in the brain must
provide for heat losses in other ways. Until this has been done, the
temperature of the body is above normal — there is fever. To get rid
of heat in other ways, breathing must be made more rapid, and this
requires that the heart speed up, increasing the pulse rate, and the
reaction may be so great that vomiting occurs. This is just what
happens in sunstroke. These functions are all more or less mechan-
ical. The brain's highest work is to think, to create ideas, and to
reason. It is this last faculty, the ability to think from the known
to the unknown, which distinguishes man from the beast. Just as he
strives to upbuild and control his reflexes, so does he try to improve
his mental processes, to reason more and more, and consequently to

22 the ship's medicine chest

advance. Thought is what moves the world and man with it. It
can readily be imagined how delicate is the adjustment of the entire
nervous apparatus; yet, if it is well treated, it is remarkably sturdy.
Its greatest enemies are syphilis and alcohol, which seem to have a
special affinity for it. If syphilis could be wiped off the face of the
earth, most of the insane asylums could be closed. Some people
think that they are immune to the effects of alcohol, but no one is.
If its immoderate use is continued, it may not directly do the body
great harm, but it will surely wreck the nervous system and through
it the body also. The hygiene of the nervous system and the mind
will be considered in the chapter which follows.

CHAPTER II

HYGIENE AND SANITATION ON SHIPBOARD

As has been stated in the foregoing chapter, sanitation has to do
with the place, and hygiene with the body. Public hygiene partakes
of the nature of sanitation in that it has to do with the health pro-
tection of groups or collections of people. These things are done
for the group by persons selected for this purpose. Personal hygiene
concerns itself with those things which the individual must do for
himself to preserve his health. Public health aims at sanitation,
public hygiene, and the teaching of the truths of the whole science
of hygiene so that the individual will acquire health habits as a mat-
ter of conviction. There is nothing mysterious about this science,
and its application is largely common sense plus knowledge. It must
be admitted that there are still many unexplored corners in this vast
realm, but great strides have been made in the conquest of disease
and in the promotion of health, while all over the world scientists
are studiously trying to discover new facts which may lead to fresh
victories. All the other sciences are being drawn upon for assistance ;
even the diseases of the lower animals are being studied in order that
the knowledge so gained may be applied to the preservation of
human life.

"When " colds " and similar common ailments are taken into con-
sideration, it is probably not too much to say that at least half the
people in the United States are never at any one time wholly well.
They may be able to continue their occupations, but always with a
handicap. This is bound to lower national production and, hence,
national wealth. This means an enormous loss in which every person
living in the nation must share. If this is only 5 cents per daj^ per
person, this means $18.25 annual loss for each inhabitant, or more
than $2,000,000,000 per year. As a matter of fact, sickness costs
alone far exceed this amount, without taking into count the losses
which are caused by being " half-sick." Therefore, sickness and
being below the mark of good health cause a tremendous expense.
And what is worse, it is, to a large extent, an unnecessary expense
and one which brings no good returns. It is almost wholly a pre-
ventable waste, if the people will learn how to prevent disease.
Health is an asset, disease is a liability; health saves money, disease
wastes money; health makes men useful, disease lowers their use-
fulness; health brings happiness, disease brings sadness.

Ship sanitation is one of the oldest branches of public health, a
book on the subject having been written by Elda the Wise early in

23

24 the ship's medicine chest

the eleventh century. It was recognized even before that early date
that ship cleanliness is essential to health, Homer mentioning: it.
Fortunately, this idea still prevails; and the first thing an ordinary
seaman learns is that he must keep himself and his ship clean :

Dirty ships and dirty men
Bring disaster now and then.

After all, a ship is nothing more than a floating house, and the
same sanitary rules apply to both.

This means mechanical cleanliness, adequate provision for the dis-
posal of the waste products of the ship and her company, and ade-
quate apparatus and opportunity for frequent baths. It demands
that water for drinking and cooking be from a supply of known
purity. This is both a moral and a legal duty, and is required by
the Federal act approved June 4, 1914. It is not enough that it
shall be clear and sparkling. Definite knowledge must be had that
the water is wholly safe before it is put into the vessel's tanks. To
secure this the health officer of the port should be consulted. In
American ports, water should not be purchased from any water boat
which does not hold an unrepealed certificate from the United States
Public Health Service. Fire hose should not be used to fill tanks.
For this purpose it is best to have a special hose which is used for no
other purpose.

Sanitation also means sound, wholesome food which shall not be
spoiled and which shall be sufficiently cooked to kill parasites and
disease germs which may be in it.

It also means adequate ventilation of forecastles,1 cabins, galleys,
and fire rooms, and complete protection of the passengers and crew
against vermin.

One of the great menaces to health aboard ship is vermin. Of
these, the most prevalent is the cockroach, a filthy insect which can
be gotten rid of by frequent fumigations and scrupulous cleanliness.
There are on the market various roach sprays, pastes, and powders,
but, as a rule, these afford only temporary relief, since they usually
kill only the adults and leave the eggs, which are hidden in cracks
and other places difficult to get at, to hatch crop after crop. They
like to hang around the " heads," and if these are not kept abso-
lutely clean they may eat the discharges of sick men, get into food,
and thus carry disease to other persons.

While it has not been proved that ants spread disease, they may be
a disgusting nuisance aboard ship. The best way to rid a ship of
them is thorough fumigation. To keep the vessel clean of them there
are several good ant poisons on the market. The efficacy of these
depends upon the carriage of the poison to the ant nest, where the
entire colony is destroyed. The basis of these poisons is arsenic and

1 See Appendix, p. 196.

HYGIENE ON SHIPBOA i;l> 25

honey. It is pu< oul in anal] baking-powder tins, the top of which

is slightly bent in at one place and the lid applied. The can is tacked
in a convenient place and should be recharged (about one-fifth full)
at regular intervals.

Lice are of three varieties — the bead louse, the body louse, and the
pubic louse (crabs) — and when they are on board ship they mean
only one thing — dirty men. The infested individual, his clothes, and
his surroundings should be deloused, because lice may carry disease
from one person to another. The head louse is destroyed by washing
the hair with a mixture of equal parts of kerosene and vinegar, care
being taken that it does not run down over the face or neck.

Bedhiu/s mean dirty sleeping quarters. They spread disease. To
get rid of them, boiling water or kerosene in cracks, especially around
bunks, thorough cleansing, and repainting help a good deal. The
bedding should be steam sterilized or boiled, and at the first oppor-
tunity the living quarters should be thoroughly fumigated.

In port, flies may be a nuisance and a danger, since they have a
fondness for manure. They must therefore be kept away from food,
and the ship should get rid of them as soon as possible.

Mosquitoes are another menace to comfort and health. In the old
sailing ships it was not uncommon for a vessel to breed her own mos-
quitoes in her tanks. This seldom happens on modern ships; the
great danger now is from shore mosquitoes. Mosquitoes are the
spreaders of malaria, yellow fever, and dengue (break-bone fever).
They do this when they bite, by squirting the tiny animals (parasites)
which cause these fevers beneath the skin of the person being bitten.
Every endeavor should be made to keep the ship free from them ; and
when they are on the ship, it is wise to sleep in a screened compart-
ment or under a bed net.

Fleas are a grave danger on board ship because they usually come
from rats which suffer from bubonic plague (the black death). Fleas
carry the germ of this disease from rats to men.

If there are no rats on a ship, she is relatively safe from plague.
Rat-proof ships can be built; but if the ship is not so constructed,
she should be freed from rats by frequent, complete, routine fumiga-
tions. Between these fumigations, rats should be kept off the vessel
by breasting off in port, putting rat guards on all mooring lines, and
raising the gangplank at night. Should they come aboard, they
should be destroyed by poisoning or trapping. A good ship's cat is
a great aid in this. Before sailing, the entire ship should be care-
fully inspected to make sure that she is in a sanitary condition, par-
ticular attention being given to cleanliness of quarters, galleys, mess
halls, and heads, the presence of vermin being noted and corrected.
112055°— 29 3

26 the ship's medicine chest

Drinking-Water Distributing System

The drinking-water system on a vessel should be independent of
all other water systems aboard. Check valves, blind flanges, and all
other types of fittings for separating the drinking-water system from
other systems aboard should not be tolerated. A physical break in
all such connections should be effected by removing a short section
of pipe and closing the two ends of the break. There should, more-
over, be no by-passes around water treatment apparatus ; if any exist,
they should be removed or " broken." Preferably the drinking-water
system — seacocks, pumps, storage tanks, and piping — should be
separate and independent.

These precautions are usually insufficient to insure safe drinking
water, and should be supplemented by measures which will kill any
disease-producing germs which the water may contain.

Tanks one or more walls of which are formed by the hull should
not be used, on account of the danger of leakage into them by the
opening of a seam. Water tanks should be thoroughly cleansed and
flushed at the beginning of the season and at least every two weeks
that the vessel is in service. After mechanical cleansing they should
be filled and 1 pound of hypochlorite of lime added for each 5,000
gallons of water. After standing 24 hours, this water should be dis-
charged and the tank filled with water of known safety and then
securely locked and sealed.

When fitting out, and monthly afterwards, the piping system for
distributing drinking water on a vessel should be sterilized by a solu-
tion of hypochlorite of lime. This can be done when the storage
tanks are sterilized. Allow the hypochlorite-of-lime solution to fill
the pipes for an hour, then open all faucets and other vents and
draw off the solution. Flush the pipes with clean, safe water until
the chlorine taste has disappeared. Sterilization of tanks and dis-
tributing systems by live steam is usually not so satisfactory as the
hypochlorite-of-lime method.

In the galley of a vessel only drinking and culinary water should
be available. If large quantities of water for scrubbing floors and
washing are needed, and the supply of drinking and culinary water
is limited, it may be advisable to have a tap from the sanitary system
conveniently available; but this tap should not be over 18 inches
from the floor, should be painted red, and should be posted with a
sign warning against the use of this water for drinking or cooking.

Ice used to cool drinking water should not come in contact with the
water. Coolers should have separate ice and water compartments.
A satisfactory way to chill drinking water is to pass it through a coil
in the ice chest. Lead pipe should not be used for such coils, because
the lead might dissolve in the water and cause poisoning. Common
drinking cups should not be supplied on vessels.

HYGIENE ON SHIPIiOAKI) 27

Disinfection and Sterilization of Drinking Water

(a) Chlori 'nation. — Hypochlorite of lime, commonly known as
chloride of lime, or bleaching powder, is a very effective agent for
sterilizing drinking water. In excessive amounts it may impart a
chemical taste to the water, but the quantity necessary for disinfec-
tion should not have such an effect. This chemical deteriorates
quickly when exposed to the atmosphere and should therefore be
purchased in air-tight cans of pound or half-pound size. To be
effective for use, the powder should be dry; if it is damp, it has
probably lost most of its sterilizing power. Chloride of lime may
also be purchased in tablets or in glass ampules, under various
trade names. Ordinarily, one-fourth teaspoonful (approximately 1
gram) of the powder to 50 gallons of water will make the water
safe to drink without affecting its taste. In small quantities it may
be put into the water directly and dissolved by vigorous stirring.
In about half an hour the water should be safe to drink.

If used in considerable quantities, the chemical should be made
into a paste by covering it with water and mixing. The paste
should then be poured into a pail of water, which should be stirred
vigorously. Allow the mixture to settle, draw off the solution, and
pour this into the water to be sterilized. A white ash will be left
in the bottom of the pail. Add more water to this, stir vigorously
as before, and draw off the solution into the water. Repeat a second
time, and then throw away the ash. Chloride of lime is difficult to
keep and not pleasant to make into solution. There have recently
been put on the market under various trade names, saturated solu-
tions of sodium hypochlorite which keep very well and are easy
to use for disinfecting drinking water. The use of these solutions
does away with the troublesome mixing of chloride-of-lime solutions.
In purchasing these solutions, it should be made sure that competent
authorities indorse them for the purpose for which they are to be used.

If for any reason chloride of lime is not available, drinking water
may be disinfected by adding 1 tablespoonful of tincture of iodine to
1 barrel of water (about 55 or 60 gallons) stirring and allowing to
stand for half an hour before using. The chloride-of-lime method
is better.

(b) Distillation.. — Distilled water, which is water in the purest
form obtainable, is, of course, safe for drinking purposes. It may
have a flat taste unless well mixed with air. Distilled water is ex-
pensive to produce in quantities. Distillers should not be forced
beyond their rated capacity. Coils should be cleansed frequently.
It is well to test the distilled water occasionally to see that the
apparatus is working properly. To do this, collect about a half glass
of water directly from the distiller (before filtering, if charcoal filter
is used), and, if sea water is being distilled, drop a small crystal of

28 the ship's medicine chest

silver nitrate into the water collected. A white, cloudy color or
turbidity will develop if the distiller is out of order. In this case,
overhaul the distiller and examine it to see if there is a leak between
the evaporating and condensing compartments. Wash glass thor-
oughly after making this test, because silver nitrate is a poison.

(c) Filtration. — Water filters of various types are offered for sale.
These are usually efficient for removing suspended matter from
water, but can not be relied upon to rid the water of germs. Ozone
or chlorine treatment and filtration is valuable as a preliminary
treatment before disinfection by ultra-violet rays. To assist in this
process, a chemical coagulant such as alum should be used.
Ordinarily, filters should be washed at least once a day.

(d) Ultra-violet ray process. — The ultra-violet ray process for
disinfecting drinking water is used on most of the large passenger
vessels of the Great Lakes fleet. This process is efficient and gives
good results if the apparatus is properly designed and carefully
operated. The water to be treated must be quite free from suspended
matter ; for this reason, difficulties in operating the process are likely
to arise if the vessel is navigated on highly turbid waters. The
maintaining of proper voltage across the mercury vapor lamp and
regular cleaning of the quartz tube and lamp are essential for satis-
factory results. The equipment used is largely electrical, and should,
therefore, be set up in a suitable place by an expert and carefully
maintained and operated.

(e) Ozone. — Ozone is a powerful sterilizing agent which is used
to a limited extent to disinfect drinking water on vessels. As in the
ultra-violet ray process, the water to be treated by ozone should
be free from suspended matter. A thorough mixing of the ozonized
air and water and a sufficiently long period of contact are necessary
for good results.

In the navigation of the Great Lakes and rivers, water is fre-
quently taken from outboard. This is dangerous. It is far better to
take water for drinking and cooking from a city water supply of
known safety, unless the vessel is equipped with adequate purifica-
tion apparatus. There may be times when it is necessary to use
outboard supplies; and since they are usually heavily polluted by
sewage, special precautions must be taken in order to prevent an
outbreak of diarrhea, dysentery, or typhoid fever on board. Great
care must be taken that sea cocks are located forward of sewage out-
lets and are kept tightly closed so that they can not allow leakage
into tanks. It is well to have two valves with a leakage drainpipe
between. Water should be taken only while the vessel is under way,
and in so doing the whole intake system should be flushed for several
minutes before allowing any water to enter the tanks. Tanks should
never be filled except under the personal supervision of an officer.

in (Ml XE ON" SHIPBOAIMi 29

Not only must the ship herself be kept in good condition if she
is going to make good voyages, but it is even more important that

her erew be maintained in the best of health. A poor ship with a
sound crew is far better than a sound ship with a -irk crew. The
operator is responsible for the condition of the ship, but it is the
duty of the master to take every precaution that his crew is kept in
the best physical condition. Effort expended in this direction pays
dividends in quicker voyages, freedom from hospital expenses in
foreign ports, quarantine delays, and shorthandedness.

One of the best ways of accomplishing this is careful physical
examinations prior to signing on or beginning a voyage. If the ship
has a medical officer he should make the inspection. American
ships may obtain these examinations free at any United States Public
Health Service relief station or marine hospital. If no physician is
available, some officer of the ship should inspect the men. Men hav-
ing severe cough, fever, diarrhea, chills, venereal disease, very defec-
tive teeth, hernia, chronic inflammation of the eyes, or who are in a
run-down condition or have any disabling condition should be sent
to a marine hospital (if they are eligible) and replaced by sound men.
Those with venereal diseases and hernia are especially poor risks.
It is therefore wise to do a thorough " short-arm " inspection before
beginning the voyage. A sick man on board ship is worse than no
man at all, because he may require another man to look after him.
Furthermore, he may give his disease to some other member of the
crew. A shorthanded ship is badly handicapped. It is therefore
wise to ship only sound men. Carelessness in the selection of a
physically sound crew sometimes affords opportunity for a dishonest
person to bring suit for alleged injuries.

A sound crew having been secured, it must be kept so. Since ships
sail the globe over and enter many ports whose public health is not
good, special knowledge is necessary to do this well. There are,
of course, many rule-of -thumb methods to this end, but in the long
run better results will be accomplished by following accurate
scientific knowledge.

The Maintenance of the Human Body

In the foregoing chapter, the structure of the human body and
the functions of its various parts have been considered, because
knowledge of how the human machine is constructed and what each
part is supposed to do is necessary to its intelligent upkeep and oper-
ation. "When the human mind and body run smoothly and efficiently,
it is in the condition of health. This word carries with it the idea
of whole or completeness; also, the thought of holy as representing
the sacredness of man's body. The opposite of health is disease —
dis + ease. i. e.. the state of not being at ease. or. in other words, of being
uncomfortable. Disease means, then, the absence of a state of health.

30 the ship's medicine chest

As ordinarily used, it means the existence of a named condition or
set of symptoms, as heart disease, pneumonia, appendicitis. Specific
diseases are those whose cause is definitely known or which have- a
definite train of symptoms, as tuberculosis, typhoid fever, malaria.
It should be borne in mind that between health and disease there is
a borderland in which a person is neither in health nor in disease; in
this condition people are not really sick and yet are not really well.
Such people are sometimes genuinely sick, but, by pride or necessity,
carry on; sometimes they imagine themselves ill or enjoy dosing
themselves with patent medicines or other nostrums, of which they
know little. These are usually people who are not mentally well. It
should not be forgotten that the mind may produce conditions which
closely resemble sickness of the body and that these conditions may
actually do quite as much harm and produce as much suffering as
disease itself.

The science of disease is known as pathology and has to do with
the defects and injuries of the body. Therapeutics is the science
of the treatment of disease. Hygiene has to do with the operation
of the human machine as a whole.

While some people can run the human engine for a short time
without a knowledge of anatomy (how the machine is built), physi-
ology (how it works), pathology (what may go wrong with it),
and therapeutics (how to repair it) , the most successful engineer of
his own body is he who has learned these things. Also, he has
learned not to tinker with his engine.

Hygiene may be positive or negative. In other words, there are
some things which one must do if he is to avoid disease and, also,
there are things which he must not do if he is to keep well. It is
sometimes said that every person knows instinctively what is harm-
ful and what is healthful, that the life of the savage is the only
healthy one, in other words, "Let your instinct be your guide."
Beautiful as all this " return-to-nature " dream is, unfortunately it
is not true. Primitive man was a relatively short-lived animal ; but
by learning what can not be done with safety and what must be done
for safety, the span of life for the average individual has been in-
creased over 50 per cent in modern times, while his efficiency through-
out life has been greatly multiplied.

Disease comes from outside the body, unless the wearing out process
of old age be considered as disease. It is universally distributed ; in
fact the struggle against it is the battle of life itself. Scientists
are constantly learning more about how to combat it, and many of
the plagues which once scourged mankind may now be prevented.
It is for the nonscientific person to adopt and use these discoveries
if he is to remain well.

HYGIENE i>\ SHIPBOARD 31

1 )iseases may ho classified as follows :

.1. Those which may be transmitted from sick persons t<> well
persons — the comommicable diseases.
/>. Those resulting from improper, insufficient, or too great a

diet — the diseases of nutrition.

C. Those which result from taking poisonous materials into the
body — the poisons.

/>. Those which result from an abnormal mental attitude — the
functional diseases.

/'.'. Those produced by the growth of abnormal new tissues in the
body — tumors and the cancers.

In a broad, general way, injuries are diseases, since all diseases pro-
duce injury. Usually they are considered in a class by themselves and
include the harm done to the body by mechanical, chemical, and thermic
(heat) agents. Sometimes they may be clue to a combination of these.

The causes of disease vary with the different classes of disease.
The communicable diseases are those caused by parasites. Parasites
are living things which live at the expense of other living things
without doing anything for their welfare. They may be vegetable
or animal in their nature and do harm by producing poisons in the
body or by robbing it of its food supply or mechanically by plugging
up important parts of the human system. Other causes of disease
have been indicated in the preceding paragraph.

Vegetable parasites are extremely minute plants which grow
upon or in the body. The}^ include the bacteria*, which are of various
shapes and grow rapidly, producing poisons which interfere with the
operation of the human machine and may destroy it, in whole or in
part. They are also called germs or microbes; those which are rod
shaped are called bacilli. Some of these produce definite diseases,
such as typhoid fever, diphtheria, and gonorrhea ; or they may cause
general conditions, such as septicemia (blood poisoning), or they
may produce local infections, such as boils or infected wounds.

They may be transmitted directly from the sick to the well by
contact. This is why persons sick with communicable diseases should
always be isolated. They may be spread by food or drink into which
they have gotten from a sick person. This is why food and drink
supplies should be protected against the discharges of the sick. They
may be spread by inanimate objects, such as cups, handkerchiefs,
pipes, harmonicas, etc. As has been stated, insects such as flies and
vermin, bedbugs, and rats, also act as disease-distributing agents.
The greatest spreader of human disease, however, is man himself.

Bacteria leave the body of the sick through the skin, as from an
infected wound which discharges pus (matter) ; or by blood-sucking
insects, such as mosquitoes, fleas, bedbugs, or lice. Others leave in
the discharges from the nose and mouth, from the bowels, or in urine

32 the ship's medicine chest

or the discharges from the vagina. They enter the body through the
skin or at any of the body openings, the eye, nose, mouth, anus, urethra,
or vagina. As a rule, they do not live very long after they leave the
body unless they get into another body quickly; therefore, fairly close
contact is the great disease spreader. In this connection, sneezing,
coughing, kissing, and the sexual act are particularly dangerous.

Some of the diseases produce immunity by creating, in the body,
substances which will prevent the growth of certain germs. Im-
munity may be acquired by having had a disease or it may be arti-
ficially produced by injecting into the body small doses of the sub-
stance or product of a germ so that the tissues will be stimulated to
produce substances antagonistic to that germ. Immunity against
typhoid fever may be produced by having the disease or by the
injection into the body of a small quantity of the dead bacteria, the
typhoid bacilli. Smallpox produces immunity, and vaccination with
cowpox, a very mild disease, like smallpox, will protect against it.
Every person in the ship's company should be vaccinated against
typhoid fever and smallpox.

Sometimes persons who have had a disease continue to pass the
bacteria of the disease in their discharges, even though they may be
in good health. These are known as carriers and may serve to infect
many nonimmune persons with whom they come in contact. There
are carriers of diphtheria and typhoid fever. Such persons should
never be employed in the preparation or serving of food. To detect
carriers requires a careful examination by a trained bacteriologist.

The general measures to be employed against the communicable
diseases are (a) the isolation (keeping away from the well) of the
sick; (b) the disinfection (destruction of germs) by heat or chemi-
cals of their discharges and everything with which they have been
in contact; (c) the development of the body defenses against disease
by keeping it in good health; and (d) protection of the individual
by vaccination.

In the linal analysis, the way to keep from having a disease is to
keep away from the microbe which causes it and to keep the body in
such a condition of health that it will resist the infection if exposed
to it. The specific measures to be employed in the prevention of
disease vary for the different diseases. This depends upon the nature
of the infectious agent (cause of the disease), the source of infection
(place the germ comes from), and the mode of transmission (route
by which it leaves the body of the sick and enters that of the well).
The length of the incubation period — that is, the length of time
which elapses between the receipt of the infection and the appearance
of the symptoms — and the period of commwnicabil it y also influence
the methods of control.

An outline of these is set forth in the accompanying table :

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34 the ship's medicine chest

Chicken pox in itself is usually a relatively mild disease. It is of
importance because smallpox may be mistaken for it. It is wise, in
the absence of a diagnosis by a doctor, to consider all such cases as
smallpox. This rule should be applied to all pus eruptions of the
skin about which there is any doubt.

Cholera cases should be isolated in a screened room and all dis-
charges and articles soiled by the patient disinfected by heat or
chemicals. Food left by the patient should be burned or thrown
overboard. Those attending the sick must be scrupulously clean and
scrub their hands carefully every time after touching the sick man or
anything that he has touched. They should not eat or drink in
the sick room and they must not be allowed to enter the galley or
handle food for others while on this duty. When the sick room is
vacated, it should be thoroughly scrubbed down and repainted. Dead
bodies should be cremated or buried at sea. If it is desired to bring
the body home, it should be wrapped in a sheet saturated with a strong
solution of bichloride of mercury and sealed in a water-tight coffin,
and the quarantine officer should be notified on arrival. When
cholera has appeared on board and while the ship is in a port where
the disease exists, shore liberty should not be granted; all water for
drinking, cooking, or washing dishes should be boiled; food and
drink must be protected against flies and human handling; only hot
food and drink should be taken.

Dengue (breakbone fever) cases should be kept in a screened com-
partment until the fifth day of the disease. The ship should be ren-
dered free, from mosquitoes by fumigation and the drainage, empty-
ing, or chemical treatment of all water containers in which mosquitoes
may be breeding. (See Yellow fever.)

Against diphtheria there is the specific measure of immunization
with a mixture of its toxin (poison) and antitoxin. This is a great
preventive. It is called the toxin-antitoxin mixture.

The cause of typhoid fever is the typhoid bacillus, which is spread
chiefly in water and milk, by dirty fingers and flies. Butter, ice,
shellfish, and certain vegetables which are eaten raw are known to
have carried the germ. The bacillus enters the body through the
mouth and for the most part leaves it in the bowel discharges. Any
measure which will kill it before it gets in contact with fingers, flies,
and food will prevent its spread. The disposal of human manure so
that it can not get into water and food supplies — that is, the safe-
guarding of those things which go into the human body — is the way to
prevent typhoid fever. To this should be added sterilization of the
discharges and everything which has been in contact with the
typhoid-fever patient, careful washing of foods which are eaten raw
and recognition and treatment of carriers. Water of doubtful purity

HYGIENE ON SHIPBOARD 35

should never bo drunk. When there is a doubt about the purity of
water, it should be boiled.

"When in doubt never eat food that does not come hot off the fire.
Individual protection against typhoid fever is most easily acquired
by antityphoid wzceinatikm.

What has been said about the prevention of typhoid fever applies,
in the main, to dysentery and the diarrheas. The germs of these
diseases enter and leave the body in the same way as they do in
typhoid fever; therefore, the same precautions regarding the dis-
charges of the sick, the protection of food and drink against them,
and the same rules regarding eating only food which has been
sterilized by heat should be followed.

There is a large group of diseases the bacteria of which enter and
leave the body through the respiratory passages (nose and throat).
These are the most difficult of prevention because most people are
careless about coughing, sneezing, and spitting. In these diseases the
germs which cause them are thrown off in the sputum. If these germs
can be prevented from getting into the bodies of wTell persons, these
diseases will be prevented. In this group are influenza (grippe) , tuber-
culosis, pneumonia (lung fever), scarlet fever, diphtheria; measles,
cerebrospinal meningitis (brain fever), whooping cough, mumps, and,
possibly, smallpox. The general measures to be employed in prevent-
ing their spread include rigid isolation! as soon as there is a hint of
their presence, sterilization of the discharges, clothing, and bedding
of the sick by heat or chemicals, and thorough cleansing of the com-
partment occupied by the sick before it is again used. Persons suffer-
ing from these diseases should be sent to a hospital at the first oppor-
tunity. Every precaution should be taken to recognize these diseases
early in the course of the sickness, because it is at this time that they
are most readily communicable. For this purpose, the crew should
be inspected daily and temperatures taken of all hands, if there is
thought to be any chance that the disease may be on board.

The prevention of influenza is a thing about which there remains
a great deal to learn. At the present time practically all that can be
said about it with any certainty is that Avhen the disease is prevalent,
one should try to keep himself in the best physical condition and
avoid crowds. Whisky as a preventive is a failure.

Tuberculosis is a very prevalent disease; in fact, it is so widespread
that nearly everybody at some age during life, particularly during
childhood, picks up its germ. Happily, the general public has
learned a great deal about this disease, and its toll of human life has
been materially lessened in recent years. Nevertheless it probably is
still the most prevalent disease in the world. While the bacillus
which causes it may attack any tissue of the body, the lung form of

36 the ship's medicine chest

the disease (consumption) is the most common. Infants and children
are peculiarly susceptible to its infection, the passage of the infection
from adult to adult being infrequent. Usually the germ enters the
body during childhood and, taking advantage of lowered body resist-
ance produced by disease, dissipation, and overwork, develops and
causes the lung, bone, or joint forms of tuberculosis in later life-

To prevent tuberculosis, adults having it should be kept away
from, children. This is the first and great rule. The other rules are
simply those having to do with bodily vigor and health, fresh air,
adequate food, exercise, cleanliness in body and mind, the avoidance
of the strains of overwork and overplay — in other words, the leading
of a wholesome, healthy life. Ships nowadays give their crews ade-
quate food and opportunities for cleanliness. The deck force, at
least, gets plenty of fresh air. It isn't always overwork that makes
seamen break down; dissipation lowers their resistance. Neverthe-
less, tuberculosis among the beneficiaries of the United States Public
Health Service is becoming less frequent. Perhaps this is because
the seafarer has learned to take the disease in time and to apply
for treatment while there is yet hope for cure. Early recognition,
sterilization of the patient's sputum and whatever he has soiled
by it, by heat or chemicals, and frequent thorough scrubbing down
and repainting of forecastles and living compartments are good
preventive methods, as are also good ventilation, adequate food, and
attention to those things which keep the body in general health.
The sailor who goes on a heavy round of dissipation is undermining
nature's greatest defenses against tuberculosis.

It takes time and great patience to arrest or cure tuberculosis. In
a large way, the cure of the disease depends upon what there is
" above the patient's ears." If he will control himself and make up
his mind from the beginning of treatment that he will scrupulously
obey the rules of life laid down for him by his physician, his chances
of recovery will be greatly increased. Above all, he should not
travel around from place to place in the belief that the climate which
he is not in is sure to cure him. This is chasing will-o'-the-wisps,
and many men have killed themselves in this way. A good many
men cease treatment as soon as they begin to show signs of improve-
ment. This is about as sensible as starting a broken-down engine
before it has been properly repaired. Tuberculosis should be treated
in a sanatorium.

Colds are also spread by sputum ; but " colds " is a large, loose term
which probably includes a number of different diseases. Most people
carry around in their mouths or noses the germs which cause this
condition. So long as the body is in good condition to resist them
they may do no harm, but if the nose itself is out of order, or if any-
thing happens to lower the body tone, they get in their work. Lack

HYGIENE ON SHIPBOARD 37

of ventilation, dust, suddi ru, prolonged chitting, hot, dry rooms, over-
clothing, underbathing, overeating, loss of sleep, and lack of physical
exercise are the chief causes. Colds are communicable and may be
spread from person to person.

Smallpox is a disease of which the method of spread from the sick
to the well is not fully understood. Before the discovery of vaccina-
tion the disease was so common that it used to be said, " There are
three things no man may escape — love, smallpox, and death." Com-
pared with those days, the disease is not so common, but it is still dis-
tributed throughout the world, especially in those countries in which
vaccination is not rigidly enforced. Vaccination against smallpox
has been a routine thing among seamen for many years, with the re-
sult that they seldom have the disease, or if they do, in mild form only.
It scarcely seems necessary to describe the simple process of vaccina-
tion, which consists of giving a person cowpox, a mild disease, to
protect him against smallpox, a dangerous disease. If properly
done, a sore arm should not result. Whenever possible, vaccination
should not be done except by a physician; but if a physician is not
available, the master should vaccinate the entire crew if they have
been exposed to smallpox. Full description of the method of doing
this will be found in Chapter V.

One of the diseases from which seamen commonly suffer is
gonorrhea, a very serious ailment. It is not unusual for persons to
treat this disease with levity and to regard it as " no worse than a
cold." As a matter of fact, it is a serious disease. It is hard to
cure ; it may spread up the urethra to the bladder and thence to the
kidneys; it may get into the blood stream and attack the heart or
the joints; it may attack the eyes and produce blindness; and it
may produce sterility. In the female, its effects are even more
disastrous, and it may produce chronic invalidism and perhaps death.
Children born of such mothers may contract the disease in their eyes
at birth and become blind. It is not a manly disease to have and
its presence means stupidity, ignorance, or willful carelessness. It
is contracted by close, intimate contact, usually by the sexual act.
It is not caught from " water-closet seats, etc." It is best prevented
by continence (letting the women alone). If a man has exposed him-
self to this disease, he should urinate (make water) as soon as possible
after the act and wash his private parts and hands with plenty of
soap and water- At the first symptom of trouble, he should go to a
good doctor, not to those who advertise. (See also p. 121.)

Acute rheumatic fever is a disease which has ruined many a fine
sailorman. Its cause has not been accurately determined, but is prob-
ably one of the vegetable parasites (germs). In about 80 per cent
of cases tonsillitis plays a very important part, The removal of

38 the ship's medicine chest

diseased tonsils, the proper treatment of inflammation of the gums
and teeth and any infections which may be present in the nose or else-
where seem to be the best preventive measures.

Of the animal parasites the one which is most widely distributed
is the spiral-shaped germ which causes syphilis. Syphilis attacks
any part of the body ; it is hard to cure ; it is responsible for at least
one-sixth of all cases of insanity; it destroys health, homes, and hap-
piness; it wrecks the nervous system; it may ruin the circulatory
system ; it is transmissible by heredity and hence curses innocent
children with feeble-mindedness, idiocy, bone diseases, blindness, and
deafness. In the sum total of its effects it is the worst scourge of the
human race.

It is contracted by close, intimate contact, most frequently by the
sexual act, but it may be caught by kissing or by using things which
have been smeared with the secretions of a person who has the dis-
ease. The parasite which causes it enters the blood through a break
in the skin or mucous membrane, and about 10 days or 3 weeks later
produces at that point a sore — a hard chancre. This sore is generally
on the private parts, but it may appear on the lip, the finger, or any
other place where there is a break in the skin. This sore is called the
first stage of the disease. In the second stage there is a ham-colored
inflammation of the throat and soft patches (shallow ulcers) of the
mucous membranes of the mouth, a skin eruption, and frequently
loss of hair. The third stage may begin in from 2 to 20 years from
the first stage — this is a most treacherous disease — with disturbances
of any tissue of the body — bones, joints, liver, heart, blood vessels,
and, aboAe all, the nervous system. In almost every hospital one
may see patients, once fine, upstanding men, riding around in wheel
chairs, paralyzed, insane, with ruined hearts, merely shells of their
former selves because of syphilis. These men are paying the price
for their ignorance, stupidity, or wanton willfulness; but not alone,
since for many years they will be a care and a burden to family and
friends as well as to themselves.

Venereal prophylaxis (prevention of venereal disease) has re-
ceived attention elsewhere. (See Gonorrhea, p. 121.) If every case
of syphilis received appropriate treatment immediately, much would
be accomplished, because the earlier that treatment is begun the
greater the chance of cure. Syphilis is a hard, slow disease to treat ;
only the very best doctor should be consulted for it and the patient
should make up his mind at the start to stick to the treatment rigidly
until it is complete. Quacks are interested only in the money which
they can bleed from the unfortunate. A really good physician does
not have to advertise. It is equally unwise for the sick man to try
to doctor himself; if he does he will have a fool for a patient.

nvciKXK ox siiii'i;o.\!;i) 39

"Blood" medicines, etc., are a waste of money and, what is more
valuable in the cure of the disease, of time. Every precaution
should he taken by him not to infect other people; lie should he
particularly careful that no one else use his shaving gear, towels,
brushes, or combs; he should not pass pipes, cigars, cigarettes, mouth
organs, or anything else from his mouth to that of anyone else; he
should use and wash his own mess gear; above all, he must not have
sexual intercourse until told by his physician that he may do so with-
out spreading the infection.

Another disease caused by an animal parasite is iii<ih/r/</, a wide-
spread sickness which has done much to lower the vitality and pro-
ductiveness of many peoples. It is said that it caused the downfall
of Greece and Rome; certainly in our own time it has hampered the
development of many countries. It is widely distrihuted in the
tropics and subtropics between latitudes of 40° south and 60° north.
Its distribution corresponds to that of the mosquito which carries
and spreads the infection, depending upon a sufficient temperature
and the presence of pools of fresh water in which it can breed.
There is only one kind of mosquito which spreads malaria — the
Anopheles. When a female mosquito of this species bites a person
who has malaria, she sucks some of his blood into her body and with
it some of the malaria parasites. These must undergo a certain regu-
lar development in her body before she can infect a person. This
requires about 10 or 12 days, at the end of which time she is ready
to begin spreading the disease. This is done by biting, usually be-
tween sunset and sunrise. This is why it used to be thought that
malaria (bad-air) was caused by the night air from swamps.

After a person is so bitten, the malaria parasite undergoes another
chain of development before the appearance of any symptoms. This
is the period of incubation. The length of this period, depending
upon the kind of malaria parasite, varies from eight days to three
weeks. The disease is first manifested by a cold stage, a hot stage,
and a sweating stage (see p. 99). This is called a malaria paroxysm,
or chill, and occurs every 48 or 72 hours, depending upon the t}^pe of
parasite. It is caused by the bursting of those red blood cells in
which the parasite has been developing, thus throwing more para-
sites and the poison which they produce into the blood. When
another crop of parasites develops and bursts the red cells, there
is another paroxysm. These continue until the infected person
recovers. In case there is infection with two sets of parasites or
with the most severe form (there are three varieties), there may be a
daily paroxysm or the fever may be continuous or very irregular.
A microscopic examination is necessary to make sure that such cases
are malaria. Malaria, if not fully and intelligently treated, may

40 the ship's medicine chest

become a chronic disease. All cases of malaria should be sent to a
skilled physician for thorough treatment as early as practicable.

The prevention of malaria depends upon (a) the protection of
infected persons from mosquitoes and (b) the protection of mos-
quitoes from infected persons. If man is not bitten by mosquitoes,
he will not have malaria. If mosquitoes do not bite persons who
have malaria, they can not get the parasites into their bodies and,
hence, can not spread them to well persons. The taking of quinine
daily to prevent the infection has been recommended for persons in
a place where the disease is widespread. A far better method is to
live in mosquito-proof (well-screened) surroundings and to sleep
under a bed net which will prevent mosquitoes from biting the
sleeper.

Yellow fever is a disease which, happily for the seafarer, is ap-
parently almost extinct, thanks to the way in which sanitarians have
made sanitary the great distribution centers of the disease, such as
Panama and Guayaquil, and also in no small measure to the sub-
stitution of steam for sail. This disease is spread by a mosquito
(the Aedes aegypti) which breeds in clean, fresh water and, for
the most part, in water in artificial containers, such as tanks, barrels,
and the like. This is a black-and-white mosquito, with bands of
white on the legs and white markings on the back. The period of
incubation in the mosquito is from 12 to 14 days. The yellow-fever
patient is able to infect mosquitoes only during the first three days
of his sickness. The prevention of yellow fever depends upon pro-
tecting people who have not had the disease from the Aedes mos-
quitoes and the screening of persons sick of the disease so that mos-
quitoes can not bite them.

Personal Hygiene

As was indicated in the beginning of this chapter, there are cer-
tain things which a person must do for himself in order that he
may remain well. Keeping in health is primarily a matter of intel-
ligence, aided and directed by knowledge. The man of real brains
takes care of his body, but the fool abuses his. The wise man keeps
his body clean, is careful about his eating, and does not dissipate;
barring accidents he is likely to live in health a long time. The sub-
intelligent does not. keep clean, he is not restrained in eating, drink-
ing, or dissipating; his is a short and not a very merry life. The
science of these things is personal hygiene and concerns itself with
what every person should do for himself in order to maintain his
health. One of the most important branches of it has to do with
food.

HYGIENE ON SHIPBOAED 41

The Hygiene of Nutrition

Food is taken into the body for the purposes of growth and repair
and as a fuel to provide heat. It really represents a portion of the
sun's energy which has been taken up by vegetables. Man cats
these vegetables and thus is able to make this energy a part of his
body. Animals which are used as foods do the same thing, their
stored-up energy being absorbed by man when he eats them. Diges-
tion is the breaking up of these foods in such a way that their
energy can best be utilized by the body as food and building
material.

Foods contain certain chemical compounds which yield energy
(heat units) and build up tissues. These are derived from animals
(proteins and fats) and vegetables (carhohyd rates). Proteins are
tissue builders, and while chiefly found in animal tissues — meat, milk,
eggs. etc. — they also are found in smaller proportions in wheat, rye.
barley, corn, peas, and beans. Fats are found in meat, milk, cream,
butter, nuts, olive, and other vegetable oils. These are heat pro-
ducers. Sugars and starches are carbohydrates. They are fat
savers, and when eaten in excessive amounts they permit the body
to store up fats for future use. This is why people who habitually
eat large quantities of potatoes, candy, cereals, and bread get fat.
As has been stated in Chapter I, a certain amount of indigestible
material is essential to the proper regulation of the body processes.
This includes such things as the vegetable fiber of plants and fruits
and certain foods, such as cabbage, sauerkraut, and spinach, wdiich
are eaten because they contain this material which is called roughage.
Food likewise contains small amounts of mineral salts and consid-
erable water, since food can not be absorbed unless it is in solution.

It has long been recognized that the absence of certain vital princi-
ples from the diet may cause certain disease conditions, for example,
scurvy. Within recent years considerable knowledge has been
gained by scientists as to the nature and behavior of these things,
to which the name vitamins has been applied. It has been found
that the presence or absence of them from the diet profoundly in-
fluences nutrition and growth. Long before any definite knowledge
of the vitamins existed, sailors knew that lime juice would prevent
scurvy. This it is able to do because it supplies these vitamins which
otherwise might be lacking in the diet.

The hygiene of nutrition bears a most important relation to the
health of man. Except under very unusual circumstances, this is
entirely under the control of the individual. It may be summed up
as choosing food wisely, eating correctly, and attending to the bowel
functions regularly.
112055°— 29 4

42 the ship's medicine chest

The choice of food depends to a certain extent on its condition
when fresh. Most American ships " feed " well and purchase only
food of good quality. Refrigeration has done away with the old
steady diet of " salt horse " and permits the daily service of fresh
meats and vegetables. As a rule, more food is served than is neces-
sary to sustain men at heavy labor, and as a result most people eat
too much. The diet should contain meat, vegetables, bread, and
sweets, and these should be properly cooked. The amount of food
which should be taken depends upon the amount of physical work
to be done and the age of the person. A ship's officer does not need
as much food as a foremast hand or a fireman who performs heavy
physical labor all his waking hours ; a child does not need as much
nourishment as a man, nor a man of 60 as much as one of 30.

A great deal depends upon the way that food is cooked. Fried
foods are coated in fat, and hence the digestive juices have hard work
getting into contact with them. Food may be boiled or baked until
it is tough and unpalatable. Vegetables may not be cooked enough
to break open the starch granules. If food is cooked into messes
with much fat in them they are less digestible and more unpalatable.
It should be borne in mind that it is not enough to provide proper
amounts of food; it must be well prepared and served in a clean
place. Monotony in the diet discourages people from eating it until
they may not eat enough properly to sustain their strength. In the
maintenance of a healthy, happy crew, nothing is so important as
clean, well-cooked food.

Not every person who eats at the same table has the same diet.
There is a tendency for each person to choose those things which
appeal to his appetite. As a result, one man will subsist almost
wholly on meat, while another may live largely on bread, potatoes,
and sweets. The result is a lopsided diet containing too much of
one thing and too little of another. The ideal is to eat some of each
food, not too much of each or too much as a whole, to eat slowly,
chew thoroughly, not to wash down, the food with fuids, and not to
begin the meal with a big drinh of ice water. Incidentally, one
should never drink a lot of ice water when one is hot.

Indigestion sometimes comes from improperly cooked food ; but
rapid eating, overeating, and unwise choice of foods are the great
causes. If one is very tired, he should eat very lightty. Food fads
and dieting (unless under the orders of a physician) are dangerous.
Many fat people spend considerable time and money trying to get
thin. Some of them are naturally built that way, and can be no
other and remain well. This is not true of the majority, however.
As a rule, it is a question of intake and outgo — overeating and under-
exercising. The " thickening of middle age " results largely from
lessened physical activity without a corresponding decrease in eat-

HYGIENE ON SHIPBOARD 43

Lag. Many a skipper still eats as heartily as when ho was before the
mast, and wonders why his waistline is greater than his chest meas-
urement. He notes thai the scales show him as weighing perhaps
20 pounds more than ever before, and when he consults a table of
weights, heights, and ages he finds that he should be much Lighter.
Overweight is a handicap; it causes foot and joint troubles; and when
a fat man has an acute infection his chances of getting well are not
so good. If he tries to reduce according to his own 'ulcus, he may do
himself great harm; at any rate, he makes himself very uncomfort-
able, and his disposition slitters. The principle on which reducing
diets are based is abstinence from butter, fat meat, oils, and fried
foods, cutting down on bread, rice, sugars, and starches, and, above
all, gradually increasing physical exercise. It is not a rapid or a
comfortable process, and it never should be undertaken, except on a
physician's orders and according to his directions. Patent medicines
for reducing are usually inefficient, and frequently they are actually
harmful.

Xext in importance to eating wisely is the disposal of the body
wastes. Constipation is a great menace to health, and it may dis-
arrange the entire machinery of the body. Its prevention lies in
eating plain, wholesome food with plenty of roughage in it and the
cultivation of the habit of having a bowel movement every day.
If possible, it should always be at the same hour each day; and when
a person goes to the toilet, he should not read but should apply his
mind strictly to the business in hand. In this connection it should
be noted that dirty, foul-smelling toilets tend to increase constipa-
tion. Medicines and other preparations for the cure of constipation
should not be habitually taken except on a physician's orders, as they
are likely to lower the tone of the bowels to such an extent that they
will no longer move without them. Keeping the body in good physi-
cal trim, the taking of bending exercises morning and evening, regu-
lar habits in going to the toilet, and the eating of foods containing
roughage in addition to a limited, well-balanced diet will go far
toward preventing and relieving this uncomfortable condition.

Cleanliness

On board ship the man who is not personally clean is an annoyance
and danger to himself and others. With water all about and salt-
water soap in abundance, uncleanliness is inexcusable. The entire
body should be bathed at least once daily for the purpose of removing
dried sweat and the dead skin. If this is done, the well-being of
the entire body will be increased, and many ,skin diseases and para-
sites will be prevented. The hands and face should always be
thoroughly washed in soap and water before eating. After going to

44 the ship's medicine chest

the toilet it is specially important to wash the hands. The hair and
nails should be kept trimmed and clean. After bathing, clean clothes
should be put on, if possible. This is especially true of those engaged
in the preparation and serving of food. The common towel has no
proper place anywhere, especially on board ship. It is a menace to
health because it may carry the germs of disease. Each member of
the crew should have his own towels and be responsible for their
cleanliness.

Clothing is necessary to the human animal in most climates, be-
cause he is not provided with a natural covering of fur or feathers
which will serve as a protection against the weather. If anything,
most people wear too many clothes. The ideal in clothing is to
afford protection from wind, rain, snow, or sun, and at the same time
to permit of body ventilation.

Next in importance to cleanliness of the outside of the body is the
cleanliness of the mouth. One of the best ways of preventing dis-
eases of the gums is by keeping the mouth clean. One should there-
fore bmsh the teeth the first thing after sleeping. Tooth powders
and pastes are a help in this, but plain water or sea water will do
quite as well. The point is to brush the teeth thoroughly with a
clean brush, care being taken to brush up and down so as to clean
out all the spaces between the teeth and to clean the biting surfaces
of the teeth. This should be a matter of regular habit and should
be done at least once daily. At regular intervals a good dentist
should be consulted and any dental defects repaired by him. Keep-
ing the mouth and teeth in good, clean, sound condition is one of
the best known ways of maintaining health and efficiency.

Another important factor in the preservation of health is sleep.
This is nature's way of giving the tissues a chance to build up again
and store energy for future use. A good many people believe that
they can get along without much sleep, but they are those who are
always tired and never quite up to the mark in mind and body.
Fatigue plays a great part in undermining the vital forces of the
body, and to keep well one must get sufficient rest. Sailors learn to
sleep almost anywhere and at almost any time. This is one of the
most valuable habits that they can cultivate. It is preferable that
one sleep on a clean bed which does not sag. " Sun and air the
bedding " should be the order for every fair day.

A good many backaches in middle-aged men come from sleeping
on a bed which is not flat. The sleeping compartment should always
be well ventilated, and it is preferable that it be cool and darkened
during the hours of sleep. When a person has insomnia (inability
to sleep), it is a danger signal which should not be disregarded.

HYGIENE ON SHIPBOAED 45

Sometimes it comes from improper diet and the drinking of too much
strong coffee in the evening. Drinking alcohol after the evening
meal sometimes produces this. In this case the person will sleep
heavily for an hour or so and then remain awake until early
morning, when he may doze off.

Mental Hygiene

It has been recognized for ages that a relationship exists between
bodily states and the mind; for example, the word "melancholy"
means black bile, because the ancients thought a melancholy mental
state resulted from the liver secreting black bile. Not only does the
body affect the mind, but the mind also affects the body. The man
who has real courage, fortitude, and a cheerful attitude toward life is
constantly aiding his physical health. On the contrary, he who is
beset by fears, who whines in adversity, and who is always looking
on the dismal side of life is bound to lower his physical strength
and resistance. Part of this is the result of bad mental training in
childhood and much of it is due to the fact that in adult life many
people fail to develop the ability to adjust themselves to the diffi-
culties of life. Unless this is met and conquered, it wTill increase
until the person has little power to live happily with others. A
homesick boy at sea is a sad spectacle, worthy of every sympathy,
for he may be really ill. This is just his mental reaction until he has
adjusted himself to ship life. If he conquers this feeling of lone-
someness, he will grow in character and adaptability; if he can not,
he has weakened himself. At base, it is a question of developing
mental habits; and while so doing, it is not much harder, and far
better, to develop good ones.

One of the bad mental habits most frequently met with is that of
worrying. Worry really is fear, fear of what usually never happens.
It is the great enemy of individual efficiency and good teamwork.
Worriers fret over what they have done, what they are going to do,
and what other people are going to think. The skipper wTho is
forever worrying about his position, the chief engineer who frets
about fuel consumption, the purser who is apprehensive for his
famil}T — these do themselves much injury and. at the same time, hurt
the ship's spirit. This is self-torture of the highest cruelty. Many
things that people worry over are none of their business. If the thing
is a person's business and requires attention at the immediate time,
he should then think it over, choose the plan of action which seems
most logical, and then do his best to carry it out. Nine times out of
ten he will succeed, and if, on the tenth, he makes a mistake, he
should forget it because he has done his best.

46 the ship's medicine chest

The worrier is likely to take life too seriously and to believe that
he and his work are the most important things in life. How foolish !
The world went on before us and it will after we are gone ; the indi-
vidual is really not so very important in the great scheme of things.
These are the people who never play, who are afraid to leave the
ship because something might happen while they are ashore. Play,
diversion, and recreation are necessary to normal mental health. At
any rate, the man who takes life too seriously is headed for a nervous
breakdown. "Worrying is largely the lack of faith and courage. If
a man has faith in himself and faith in the job, why should he worry?
If he hasn't faith in himself, no one else will have ; if he has no
faith in the job, he should quit it. " Life is never as good or as bad
as we think it is."

A rather common bad mental habit is that of putting off decisions,
of trying to slip around hard situations. This is fear — mental
cowardice. Situations met are triumphs won. Another mental
habit which is harmful is that of always being critical of others.
If other people were as bad as some people think they are, this
would be a terrible world. To look for good in others is to add to
well-being. People who are so certain that others have faults are
very likely to be lenient with their own. This is bad enough, but
when it extends to self-pity it harms the entire outlook on life. Self-
pitiers are winners, and by this whining one lowers his mental
health. It is morbid. Some people love to wallow in the morbid,
to recount their symptoms, to enjoy the details of unwholesome
gossip, or the trial of a perverted murderer. This is another way
of undermining mental health, because it turns the imagination to
unclean things. Clean thoughts make clean minds ; clean minds make
for health. It is better and far healthier to indulge in the mental
suggestion of healthy, wholesome things. Leaving out of question
those diseases, such as syphilis, and those poisons, such as alcohol or
opium, which produce mental derangements, the great cause of mental
troubles is the mind itself. A mind is as it thinks. Lack of self-
confidence, lack of optimism, narrow-mindedness, and selfishness
are the handicaps which minds impose upon themselves, to their
great undoing.

rilAI'TKK III

THE SHIP'S MEDICINE CHEST AND EQUIPMENT

The navigation laws require certain ships of the I ni t »■< I States to
carry medicine chests and to provide hospital facilities.
The act of December 21, 1898, states that—

every vessel belonging to a citizen of the United States, hound from a porl
In the United Slates to any foreign port, or being of the burden of 75 tons
or upward, and bound from a port on the Atlantic to a port on the Pacific, or
vice versa, shall be provided with a chest of medicine * * *.

The act of March 4, 1915, states that—

in addition to the space allotment for lodgings hereinbefore provided, on all
merchant vessels of the United Stales which in the ordinary course of their
trade make voyages of more than three days' duration between ports, and
which carry a crew of 12 or more seamen, there shall be constructed a com-
partment suitably separated from other spaces, for hospital purposes, and
such compartment shall have at least 1 bunk for every 12 seamen constituting
tier crew, provided that not more than 6 bunks shall be required in any
case. * * *.

In case of ships carrying passengers, there are other requirements,
which are given in section 5 of the act of August 2, 1882, as follows :

On every such steamship or other vessel there shall be properly built and
secured, or divided off from other spaces, two compartments or spaces to be
used exclusively as hospitals for such passengers, one for men and the other
for women. * * * The hospital spaces shall in no case be less than in the
proportions of 18 clear superficial feet for every 50 such passengers who are
carried or brought on the vessel, and such hospitals shall be supplied with
proper beds, bedding, and utensils, and be kept so supplied throughout the
voyage. * * *.

The ship's hospital is usually called the " sick bay," and includes
hospital bunks, dispensary, dressing rooms, isolation quarters, and
toilet facilities- It should be located in a part of the ship where
there is good ventilation — preferably in the after part and in a deck
house. The bunks should be so placed that they can be easily reached
by an attendant when caring for the sick. The compartment should
contain lockers near the bunks so that the patient's clothing and
other belongings may be kept near him. There should be ample
toilet facilities, a water-closet, a bath with hot and cold water, and a
wash bowl. In addition, there should be a dressing table and suffi-
cient locker space for supplies. If there is enough room, there should
be a folding cot for the use of the attendant, and it should be sepa-
rated from the hospital bunks proper by a bulkhead.

47

48

THE SHIPS MEDICINE CHEST

The medicine chest should be equipped with drugs and supplies,
as listed, and should be kept in the sick bay, but under the care of
one of the officers of the ship. Below is given a list of the supplies
that should be carried, and following it there is a section explaining

Fig. 9. — The ship's medicine chest (for large ocean-going vessels). (See list A)

the use of the drugs and giving directions for their employment in
the treatment of the sick.

The American Marine Standards Committee has cooperated with
the United States Public Health Service in standardizing ships'
medicine chests and lists of supplies for vessels of different sizes.

EQUIPMENT OF SHIP S MEDICINE OHEST

49

Cuts and specifications for constructing medicine chests to accom-
modate the lists of supplies No. 1, No. 2, and No. 3, respectively, will
be forwarded upon request addressed to the Surgeon General, United
States Public Health Service, Washington, D. C.

Fig. 10. — Ship's medicine chest for use on board coastwise vessels and lake freighters.

(See list B)

(A) CONTENTS OF SHIP'S MEDICINE CHEST FOR USE ON BOARD LARGE OCEAN-
GOING VESSELS

The amounts given are deemed, adequate for crews of 25 to 50 persons
(passengers and crew). For larger numbers of persons and for very long
voyages the amounts should be proportionately increased. Replenishment of
supplies should be made as required.

VACCINES AND ANTITOXINS

Vaccines and antitoxins should be kept in a refrigerator and replaced before
the period of potency expires ; this is indicated by the date marked on each
package.

50 the ship's medicine chest

Smallpox vaccine, tubes 25

Diphtheria antitoxin :

10,000-unit therapeutic syringe package 4

1,000-unit prophylactic syringe package___ 12

Tetanus antitoxin, 1,500-unit prophylactic syringe package 2

DRUGS AND CHEMICALS

Those supplies marked " one year " or " six months " should be renewed after
that interval. Mark containers of all such articles with date of receipt.

Alcohol, grain pint— 1

Alkaline antiseptic tablets 500

Aromatic spirit of ammonia pint__ 1

Aspirin tablets, 5-grain 500

Bicarbonate of soda tablets, 5-grain 500

Bichloride of mercury tablets, 7%-grain (poison) 500

Bismuth subnitrate tablets, 5-grain 500

Boric acid (boracic acid) pound 1

Boric acid ointment do 1

Bromide of soda tablets, 5-grain 500

Brown mixture tablets, 20-grain 1, 000

Calomel, powdered ounces__ 2

Calomel and soda tablets, %-grain 500

Calomel ointment, collapsible tubes, U. S. Navy formula, V. D. prophylactic pack-
age 1 dozen— 2

Castor oil quart 1

Chlorate of potash tablets, 5-grain 250

Chloride of lime, 14-pound cans 8

Chloroform, %-ounce vials 6

Compound cathartic pills, vegetable 1,000

Cresol solution, 1-pound tin (poison) 1

Dover's powder tablets, 5-grain 500

Eardrops (Formula: Carbolic acid, 1 fluid dram; glycerin, 7 fluid drams, well

mixed) ,. ounce— 1

Epsom salt pound. _ 1

Epsom salt, reserve supply, 4-pound tin 1

Extract of beef, 4-ounce containers 8

Eye solution, 4 per cent solution cocaine hydrochloride (6 months) (poison) (see

p. 59 before using) ounce %

Mercurial ointment (blue ointment) pound 1

Mercurial ointment (blue ointment) reserve supply pound 1

Morphine sulphate tablets, 14 -grain (poison) 50

Mustard (1 year) pound— %

Oil of cloves ounce 1

Paregoric (poison) pint 1

Permanganate of potash tablets, 1-grain 200

Quinine sulphate capsules, 5-grain 500

Rhinitis tablets, full strength 500

Sirup of ipecac pint %

Soap liniment quart 1

Strychnine sulphate tablets (poison), „Vgrain 100

Sulphur ointment pound— 1

Sulphur ointment, reserve supply do 1

Sun cholera tablets, 5-grain 500

Sweet spirit of niter (1 year) pint 1

Tincture of iodine (poison) (1 year) do %

Turpentine do 1

Vaseline, 1-pound tins 2

Zinc oxide ointment pound 1

SURGICAL AND GENERAL SUPPLIES

Absorbent cotton :

1-ounce packages, compressed 16

1-pound packages 2

Adhesive plaster :

1 inch by 10 yards (1 year) spools 2

2 inches by 10 yards (1 year) do 2

Applicators, wooden, 6-inch, with cotton dozen— 4

Bandages :

Compressed, 3 inches by 6 yards 100

Gauze, 2 inches by 10 yards dozen 1

Muslin, 2 inches by 5 yards do 1

Muslin, 4 inches by 5 yards do 1

Triangular, Esmarch's do %

Bed pan, regular shape, white enameled steel, with cover 1

Belladonna plaster, 5-yard length, 7 inches wide, in tin (1 year) 1

Bistoury, sharp pointed 1

Catgut No. 1, needle attached, in glass tubes (1 year) '. tubes 12

Catgut No. 2, needle attached, in glass tubes (1 year) do 12

Catheters, soft rubber (20 F., 2 ; 6 F'., 1) (1 year) 3

Corkscrew, steel, nickeled, self-puller, hard maple handle 1

Eyecups, blue glass 2

Feeding cups, crystal glass, tilted top 2

Forceps :

Artery, straight, 5% inches 3

Dressing 1

EQUIPMENT OP ship's MEDICINE CHEST 51

Gauze, plain, sterile, 1-yard package 20

Gauze, picric acid, I yard each, In glass jar 10

Hut water bottle ami Fountain syringe (combination), 2 quarts, good quality

rubber (l year) :;

ice bags, medium size, good quality rubber (l year) ._ l:

Ligature, silk, medium size .-i i i

Medicine droppers, curved 6

Medicine glasses, thin uiass (graduated up to t table and 8 tea spoons) 2

Needles, surgical, threaded with silk, medium size, in glass tube, sterile 0

Safety pins. .No. .'{ dozen -

Scissors, bandage, 7 inches 1

Splints, yucca, sheets. 18 inches Ions', 3'y inches wide, <,. inch thick 12

Sputum cups :

Paper folding, hospital size 12

Taper folding, hand size I 2

Thermometers, clinical 2

Tongue depressors, wood, C inches dozen— 8

Tourniquet ti yean 1

Urinal, male, white enameled steel 1

Book : The Ship's Medicine Chest and First Aid at Sea, United States I'uhlic Health

Service 1

(B) CONTENTS OF SHIP'S MEDICINE CHEST FOR USE ON BOARD COASTWISE AND

LAKE FREIGHTERS

DRUGS

Alkaline antiseptic tablets 50

Aromatic spirit of ammonia ounces— 2

Aspirin tablets, 5-grain 100

Bicarbonate of soda tablets, 5-grain 500

Boric acid ounces 8

Boric-acid ointment (preferably in collapsible tube) do 8

Brown mixture tablets, 20-grain 500

Calomel and soda tablets, %-grain 50

Calomel ointment, collapsible tubes, U. S. Navy formula, V. D. prophylactic pack-
age dozen __ 1

Castor oil ounces — 8

Compound cathartic pills, vegetable 50

Ear drops (Formula: Carbolic acid. 30 drops; glycerin, sufficient to make %

ounce, well mixed ounce — y2

Epsom salt pound — %

Oil of cloves ounce — %

Paregoric (poison) ounces-- 4

Quinine sulphate, capsules. 5-grain 50

Rhinitis tablets, full strength 50

Soap liniment ounces. _ 8

Sun cholera tablets, 5-grain 50

Tincture of iodine (poison) (1 year) ounces — 4

Vaseline pound— %

SURGICAL AND GENERAL

First-aid kits, United States Public Health Service1 2

Absorbent cotton :

1-pound packages 2

1-ounce packages, compressed 6

Adhesive plaster. 1 inch by 10 yards (1 yean spool-- 1

Applicators, wooden, 6 inches dozen__ 4

Bandages :

Compressed, 3 inches by 6 yards 12

Muslin. 2 inches by 5 yards 3

Triangular. Esmarch's 3

Catgut No. 1, needle attached, in glass tubes (1 year) tubes__ 12

Catgut No. 2, needle attached', in glass tubes (1 year) do 12

Eye cup, blue glass each — 1

Forceps :

Dressing 1

Artery, straight, 5%-inch 1

Gauze, picric acid, 1 yard each, in glass jar 1

Gauze, plain, sterile. 1-yard packages 6

Hot-water bottle and fountain syringe, combination. 2 quarts, good-quality rubber

(1 year) _ 1

Medicine droppers, curved 4

1 Contents of first-aid kit :

Applicators, wooden each — 12

Aromatic spirit of ammonia ounce — 1

Bandages, gauze, compressed, sterilized, assorted sizes each__ 4

Compress, sterile do — 2

Cotton, absorbent, sterilized, 1 ounce package — 1

Muslin, for sling. 1 yard piece,.- 1

Tincture of iodine (poison) (1 yean ounce — 1

Tourniquet (1 year) each — 1

Vaseline, carbolated (for burns.), 1 ounce tube — 1

52 the ship's medicine chest

Medicine glass, tbin glass (graduated up to 4 table and 8 teaspoons) 1

Safety pins, No. 2V& dozen__ 1

Scissors, bandage, 7 inches 1

Splints, yucca, sheets 18 inches long, 3^ inches1 wide, % inch thick set__ 1

Thermometers, clinical 2

Tourniquet (1 year) , 1

Book : The Ship's Medicine Chest and First Aid at Sea, United States Public Health

Service , 1

(C) CONTENTS OF SHIP'S MEDICINE CHEST FOR USE ON SMALL VESSELS WITH
CREWS NOT EXCEEDING 18 MEN

Bicarbonate of soda . ounces__ 8

Calomel ointment, collapsible tubes, U. S. Navy formula, V. D. prophylactic pack-
age dozen 1

Epsom salt pound- _ 1

Solution boric acid, 4 per cent (saturated solution) (1 year) ounces, 8

Tablets :

Alkaline antiseptic , 25

Aspirin, 5-grain 100

Brown mixture, 20-grain 500

Sun cholera, 5-grain 100

Tincture of iodine (poison) (1 year) ounces-- 4

Vaseline do 4

First-aid kits, United States Public Health Service1 2

Applicators, wooden dozen 4

Bandages, roller or compressed, 2 inches wide 2

Cotton, absorbent, sterilized, 4 ounces to package packages-- 4

Gauze, sterile, l yard do 2

Tourniquet (1 year) 1

Book : The Ship's Medicine Chest and First Aid at Sea, United States Public

Health Service 1

Medical Supplies fob Ships and Stations of United States Lighthouse

Service

Alkaline antiseptic tablets each 50

Aromatic spirit of ammonia ounces__ 4

Aspirin tablets, 5-grain each 100

Boric acid ointment, preferably in collapsible tube ounces__ 8

Boric acid, powdered do 8

Brown mixture tablets, 20-grain each 100

Bicarbonate of soda ounces 4

Calomel and soda tablets, %-grain each__ 100

Camphorated oil ounces 4

Castor oil do 8

Compound alum ointment (for burns, scalds, etc.) preferably in collapsible

tube pound- _ %

Compound' cathartic pills, vegetable each— 100

Eardrops (Formula: Carbolic acid, 1 fluid dram; glycerin, 7 fluid drams; well

mixed) ounce- _ 1

Epsom salt pound 1

Essence of Jamaica ginger ounces 4

Essence of peppermint do 2

Mustard, powdered (for emetic — to cause vomiting — see p. 60) (1 year) do 4

Oil of cloves do %

Paregoric ( poison ) do 4

Quinine sulphate. 5-grain capsules or tablets each__ 100

Rhinitis tablets, full strength —do 100

Soap liniment ounces 8

Sirup of ipecac (for use as emetic — to cause vomiting — see p. 61) do 4

Sun cholera tablets, 5-grain each__ 100

Sweet spirit of niter, dark-colored bottle (1 year) . ounces— 4

Tincture of iodine (poison) (1 year) do 4

Vaseline pound. _ %

Absorbent cotton, 1-pound packages each — 2

Absorbent cotton, 1-ounce packages do 6

Adhesive plaster, 1 inch by 10 yards (1 year) spool — 1

Applicators, wooden, 6 inches each — 12

Atomizer, de Vilbiss No. 15 do 1

Bandages :

Compressed, 3 inches do 12

Muslin, 2 inches by 5 yards . do 3

Triangular, Esmarch's do 3

Catgut No. 1, needle attached, in glass tubes (1 year) tubes— 12

Catgut No. 2, needle attached, in glass tubes (1 year) do 12

1 Contents of first-aid kit :

Applicators, wooden 12

Aromatic spirit of ammonia ounce — 1

Bandages, gauze, compressed, sterilized, assorted sizes 4

Compress, sterile 2

Cotton, absorbent, sterilized, 1 ounce package — 1

Muslin, for sling, 1 yard piece-- 1

Tincture of iodine (poison) (1 year) ounce 1

Tourniquet (1 year) , 1

Vaseline, carbolated (for burns), 1 ounce tube — 1

EQUIPMENT OF SHIP'S MEDICINE CHEST 53

Catheter, rubber, No. 20 F. (1 yean each__ 1

Eyecup, blue glass do 1

Forceps, artery, straight. (Tbla can be used to grasp a bleeding vessel until

it can be tied, or until the doctor arrives. A catch holds the grip "f the forceps.

Sterilize by boiling) each-- 1

Forceps, dressing, or dissecting. (Will be found convenienl in cleaning up a
wound and applying dressings; also in removing splinters, etc. Sterilize by

boiling) each__ 1

Fountain syringe, 2-quart (1 year) do l

Gauze, picric add', 1 yard each, in glass jar do 1

Gauze, plain, sterile, l yard packages do 6

Hot-water bottle and fountain syringe (combination), 2-quart, good quality rubber

i 1 year) each 1

Medicine droppers do •'>

Medicine glass, thin glass (graduated up to 4 table and S teaspoons) do 1

Safety pins. No. 2% or No. S dozen.- 1

Scissors, bandage, 7 inches, for cutting gauze and bandages. (Sterilize by

boiling) each-_ 1

Splints. Yucca, sheets is inches long, 3% inches wide, % inch thick set__ 1

Thermometer, clinical each— l

Tourniquet (1 year) do 1

Tooth forceps, incisor do__ 1

Tooth forceps, molar do 1

Wire gauze, made of heavy mesh malleable wire. (When well padded can he

wrapped around a fracture for temporary dressing) each__ 1

Book : The Ship's Medicine Chest and First Aid at Sea. United States Public

Health Service each — 1

Those supplies above listed marked "one year" or "six months" should be
renewed after that interval. Mark containers of all such articles with date
of receipt.

This standard list should be consulted by the master or keeper when pre-
paring requisition for medical supplies. The requisition should be forwarded
to the Commissioner of Lighthouses (through the local superintendent) for
approval and transmission to the Surgeon General, United States Public Health
Service.

Unless otherwise stated, the doses mentioned in this book are
intended for adults. To determine the dose for children, add 12
to the age of the child, and divide the age of the child by this sum.
The fraction obtained will represent the size of the dose compared
with that of an adult. For example, a child of 6 years old will

require fi 9 = 6/18, or one-third of the adult dose.

CAUTION: Preparations containing opium, such as laudanum,
paragoric, camphor, and opium pills, sun cholera mixture tablets,
etc., should not be repeatedly used unless it is absolutely necessary to
do so, because their frequent use is liable to produce the drug habit.

Alcohol, grain.

As a heart stimulant, alcohol should be given in 2 to 4 teaspoonful
doses, well diluted with water. It acts quickly, but its effects are not
of long duration, and the dose should be repeated as necessity indi-
cates. Alcohol is used also as a disinfectant when cleaning sores.
Alcohol rubs given over the whole body, but especially the back, are
much appreciated by sick people.

Alkaline antiseptic tablets.

Useful for making gargles and mouth washes. One tablet dis-
solved in a glassful of water gives a good proportion. The tablets
are not poisonous.

54 the ship's medicine chest

Aromatic spirit of ammonia.

Useful in weakness, faintness, headache, and shock. Dose : One-
lialf teaspoonful in water every half-hour until relieved, or until
three doses have been taken.
Aspirin (5-grain tablets).

Aspirin is useful to reduce fever, and to relieve headache, rheuma-
tism, or pain in the joints and muscles. It is given in doses of 1 to 3
tablets (5 to 15 grains), repeated every 4 hours, if necessary. It
should not be given in more than 60-grain amounts in 24 hours, and
this amount should not be given more than 2 or 3 days consecutively.
As soon as the pain is lessened, reduce the amount of the drug.
Aspirin sometimes upsets the stomach; if given with small amounts
of milk or other food, it will not do so.

Belladonna plasters.

Useful in rheumatism and for pains in the back. Should be worn
only long enough to have the desired effect. Many persons have
special susceptibility to belladonna, and poisoning may follow the use
of a small plaster. Patients should be closely watched; and if the
throat becomes noticeably dry or the pupils are dilated, belladonna
poisoning is indicated and the plaster should be removed.

Bicarbonate of soda.

Bicarbonate of soda, or baking soda, is very useful for the relief of
heartburn or for an uncomfortable feeling of fullness in the stomach
after eating. It is best given in dose of three to four tablets of 5
grains each ; or a half teaspoonful of the powder may be dissolved in
a half glass of cool water and administered. In the acute stages of
gonorrhea, or "clap," three or four tablets taken dissolved in a
glassful of water will often help to relieve the pain which occurs with
urination.

Bichloride of mercury (poison. For external use only).

Caution: Read directions carefully before using bichloride of
mercury, because it is a violent poison, and great care should be
exercised in its use. It is supplied in tablet form, each tablet con-
taining 7y2 grains of the drug. The tablet contains a blue dye so
that the solution will be colored. It is useful as an antiseptic wash
for cleansing wounds, and also, in strong solutions, for disinfection
of clothing, etc., and for washing floors and walls. For wounds and
wet dressings it is useful in dilutions of 1 to 5,000 (one tablet to each
2y2 quarts of water) . For scrubbing floors and walls, it is used in
strengths of 1 to 1,000 ; for this purpose the bichloride is generally
carried in the crude powdered form. Bichloride of mercury must not
be used internally.

EQUIPMENT OF SHIP'S MEDICI X K CHEST 55

Bismuth subnitrate (5-graii) tablets).
Useful in heartburn, dysentery, and diarrhea. In diarrhea or

loose bowels it should be given in doses of from 20 to 40 grains (4 to
S tablets, or, best, in a powdered form) every 3 or 4 hours. For
heartburn. 2 to 3 tablets are usually sufficient.

Boric acid (powdered).

Boric arid makes a very good dusting powder for wounds; it is
nonirritating to the flesh and may prevent the growth of germs. In
solution it is a very good wet dressing, and is especially good as an
eye wash. Four level tablespoonfuls of the powder dissolved in 1
pint of boiling water makes a satisfactory eye wash or a good solu-
tion for wet dressings for wounds or burns. To dissolve the powder,
moisten it first with a few drops of water and break up the lumps,
making the power into a paste, and then add the rest of the water
while stirring.

Boric-acid ointment.

This is a mildly antiseptic ointment and is nonirritating. so that it
can be used for many purposes, such as dressing chafed skin, chronic
sores, etc. It is especially useful as a dressing for burns, because it
excludes the air and thus aids in reducing the pain to a considerable
degree.

Bromide of soda.

This drug is useful in nervous conditions when there is much rest-
lessness and sleeplessness. It is also of benefit in convulsions and in
delirium tremens. It may be given in doses of 20 to 60 grains. The
tablets should be dissolved in a half glass of cool water before they
are taken.

Brown mixture.

This is a cough mixture put up in tablet form, each tablet equal to
20 grains. It is useful in controlling coughs. A tablet is allowed
to dissolve on the tongue and the solution is swallowed. This may
be repeated as necessary.

Calomel powder.

This powder may be used as a dressing for ulcers, sores, and
wounds — especially those about the private organs. It is useful as
a dusting powder for small skin wounds of any nature.

Calomel and soda (y2-gra'm tablets).

Calomel is a very valuable cathartic given at the beginning of an
illness, where it is desired to clean out the bowels completely. It is
especially valuable in so-called " bilious attacks." It is usually given
in doses of y± grain or y2 grain. 20 or 30 minutes apart, until two

56 the ship's medicine chest

or three grains have been taken. It may be given in one dose of
S1/^ or 3 grains. However given, it should be followed in five or
six hours by a dose of castor oil or Epsom salt.

Castor oil.

This oil is very generally used as a cathartic and is a very good
one. It should not be given frequently, because it causes more or
Jess constipation. A dose is 2 to 4 tablespoonfuls. The taste may
be somewhat disguised by giving it in orange or lemon juice.

Chlorate of potash (5-grain tablets).

These tablets, dissolved in water, make a very good mouth wash
and gargle in cases of sore mouth and throat. Dissolve five or six
tablets in a wineglass of water. The solution should not be
swallowed.

Calcium hypochlorite, or bleaching powder (Chloride of lime).

This drug is used for disinfecting impure drinking water. A
fourth of a teaspoonful of bleaching powder, taken from a freshly
opened can, should be added to each barrel of water to be treated, and
the water should be stirred thoroughly and allowed to stand a half-
hour before using it. A 5 per cent solution (about 6 or 7 ounces to
a gallon of water) is very effectual for disinfecting bedding, clothes,
toilets, urinals, etc., that have come in contact with sick persons.

Chloroform.

Chloroform is one of the most valuable drugs used for rendering
persons unconscious when it is necessary to perform surgical opera-
tions, or when it is necessary to put a patient to sleep in order to
relax his muscles so as to reduce a dislocation or fracture of the
bones.

Chloroform should be used with extreme care and should be given
only when absolutely necessary.

When putting a patient to sleep, see that he has no food, tobacco,
false teeth, nor anything else in his mouth, because such things
might find their way into the windpipe and strangle him to death.
See that the neckband of his clothing is loosened and turned back.
Chloroform often blisters the skin, and so the skin of the face should
be lightly covered with vaseline or zinc-oxide salve. Place a chloro-
form mask (use two or three thicknesses of cloth or gauze, if a regular
mask is not available) over the patient's nose and mouth. Drop (do
not pour) the chloroform upon the cloth at the rate of about 10 drops
a minute. The exact amount of chloroform to drop in a minute
necessarily depends upon the patient, some requiring more than
others. Do not be in too much of a hurry to put the patient to sleep.

EQUIPMENT OF SHIP'S MEDICINE CHEST

57

Watch him closely. The person who is giving chloroform should
know how to take the pulse. There is a small artery Located on the
temple just in front of and a little below the upper margin of (lie ear.
By placing the tip of the finger over this artery, the pulse may be felt.
The finger should be kept on this pulse all the time; the instant it
becomes irregular or stops, take the mask away and begin to revive
(he patient by giving fresh air, slapping his chest, or giving artificial
respiration.

Another danger signal that must be constantly watched for is the
cessation of breathing. Often before a patient falls sound asleep he

Fig. 11. — Method of administering chloroform

will unconsciously hold his breath. Take the mask away, and as soon
as he takes a deep breath put it back again. The next fewr breaths
will be quicker and deeper, and he will very likely get enough chloro-
form to put him to sleep. When he is asleep, it takes but a drop of
chloroform now and then to keep him under its influence. Should he
stop breathing and not begin again within a reasonable period, take
the mask away and proceed immediately to give artificial respiration
(see p. 178).

"Watch the patient's pupils. If they enlarge suddenly, take the
mask away, since enlargement of the pupils is a sign that too much
chloroform is being given.
112055°— 29 5

58 the ship's medicine chest

The person giving the chloroform should constantly watch the
patient's face and should not pay any attention to what the first-aid
man is doing for the patient.

When the patient is falling asleep, his jaw often drops; hold the
jaw up with the little finger and ring finger of one hand. Have a
pair of forceps at hand, and if the tongue falls back in the throat and
begins to choke the patient, pull it forward with the forceps.

If the patient begins to vomit, turn his head to one side; keep his
head low and his mouth open. With a piece of cloth keep mouth
and nose free from vomit.

Most people who are being put to sleep will struggle and fight
against the operation. It is therefore advisable to have others at
hand to hold the patient.

If a patient's color changes, taking on a purplish tinge, something
is wrong. Remove the mask and allow him to take one or more
breaths of fresh air; as soon as his natural color returns, continue
with the chloroform.

After the operation someone should sit by the patient until he
has come out from under the influence of the chloroform, because
he will need attention in case he should vomit or attempt to get out
of the bed.

Chloroform is also used in liniment, and in this form is valuable
in cases of rheumatism. Chloroform liniment is made by adding 1
tablespoonful of chloroform to 2 tablespoonfuls of soap liniment.
Allow the chloroform liniment to evaporate completely before apply-
ing a bandage or covering the skin If the liniment is confined
against the skin, it will make a bad blister.

Internally, chloroform is of use in prolonged attacks of hiccough,
and for cramps, or pains in the stomach. The dose for internal use
is 8 or 10 drops in half a glass of water.

Compound cathartic pills.

These pills are very effective. A dose is one to three pills; one
usually produces a movement of the bowels, while three cause rather
violent purgation.

Cresol solution (poison).

Caution : Read directions carefully before using. Cresol solution
is used only as a disinfectant. It is excellent for scrubbing floors,
etc., and for disinfecting soiled clothing and discharges of those sick
with infectious diseases. Its strength may be 1 to 5 per cent. Two
teaspoonfuls of the drug added to 1 quart of water will make a 1
per cent solution.

EQUIPMENT OF snip's MEDICINE CHEST 59

Dover's powder tablets.

Contains powdered opium.

Useful in colds and bronchitis and to stop cough and bronchial
irritation. If takes with hot drinks, they often produce sweating.
Dose: One tablet every three or Tour hours.

Ear drops.

Formula: Carbolic acid, 1 fluid dram: glycerin, 7 fluid drams.
Mix well by shaking;.

The solution should be warmed before it is used, but not made too
hot. Two or three drops put in the aching ear are usually sufficient,
but may be repeated two or three times during the day if necessary.
Shake well before using.

Epsom salt.

This is a very good cathartic and produces a watery stool. It is
generally given after a dose of calomel. A dose is 2 to 4 tablespoon-
fuls dissolved in water. It is less difficult to take if dissolved in a
small rather than a large amount of water; but a full glass of water
should be drunk immediately after swallowing the dose.

Extract of "beef.

Useful when patient can not take solid food. Has some food value,
but can not be depended upon to supply all the nourishment required
by the patient. It often serves to stimulate the appetite and may
be of value in this way. Directions on jar should be followed in pre-
paring the extract for use.

Eye solution (-4 per cent cocaine solution) (poison).

This cocaine solution is to be used to relieve severe pain in
the eye, particularly that caused by the presence of a foreign body.
It sometimes happens that a particle of steel or some other for-
eign body becomes lodged in the eye, and that because of the pain
and tenderness the patient can not bear to have the particle removed.
The cocaine solution may be used to deaden the pain so that the
foreign body may be extracted. A few drops (2 to 3) of the solu-
tion are placed in the affected eye, and a few minutes are allowed to
elapse before attempting the removal of the foreign body. Some-
times it may be necessary to add another drop or so of the solution
and to wait a few minutes more until the eye has no further feeling
of pain, when the foreign body can probably be removed. But
great care must be used in this operation not to injure the eye. When
irrigating the eye, use either an eyecup or a medicine dropper.
Some persons have marked susceptibility to cocaine, and it should be
used with great caution. The patient should be closely watched.

60 the ship's medicine chest

Mercurial ointment.

This is commonly known as blue ointment. It is useful in destroy-
ing crab lice and is sometimes used as a dressing for chronic ulcers.
For crab lice, it should be smeared over the hairy parts and allowed
to remain for a day or two. The parts should then be thoroughly
washed with soap and water. Repeat the application, if necessary.

Morphine sulphate (poison).

Morphine is one of the most valuable drugs and also one of the most
dangerous. It is habit -forming, and therefore should be used only
when, absolutely necessary. It is the most effective drug we have for
the relief of pain, but should never be used until other remedies have
been tried. For use by the mouth it is supplied in ^-grain tablets
and should be given in this form, one tablet (14-grain) at a dose.
If the pain is not relieved within three-quarters of an hour, another
dose of 14 grain may be given. Not more than three doses (a total
of three-fourths of a grain) should be given within a period of four
hours.

Mustard.

Applied externally, this is useful as a counterirritant to the skin.
It should be put on as a plaster, or poultice, made as follows : One
part of mustard is thoroughly mixed with two to four parts of flour
and the mixture is made into a paste with a small amount of tepid
water. The paste should be spread on a cloth and applied. Care
should be taken that the mustard does not blister the skin. As soon
as the skin becomes red, which will be only a few minutes after the
application, remove the plaster.

Mustard is sometimes given internally to produce vomiting. The
dose for this purpose is one tablespoonful of mustard stirred to a
cream with a small amount of tepid water and a cupful of tepid
water added.

Oil of cloves (for external use only).

Useful in toothache; one or two drops on a piece of absorbent
cotton are introduced into the cavity of the tooth, care being taken
that the oil does not get on the gums or tongue. Bo not give oil of
cloves internally.

Paregoric (poison; contains opium).

Useful to quiet cough, to relieve pain in the stomach and bowels,
and to check diarrhea. Dose : 1 to 2 teaspoonf uls in water. It may
be repeated in three or four hours; but since paregoric contains
opium, it should not be given oftener than is absolutely necessary.

KQUIPMKXT OK SHIP'* MKDICIXE CHEST 61

Permanganate of potash.

This is used in solution as an injection in the treatment of gonor-
rhea (clap), and as a wash for sores and ulcers of any kind, but
especially for those that have a bad odor. In treating gonorrhea
it should be used in proportions of 1 to 4,000 or 1 to 5,000, three or
four 1-grain tablets being dissolved in 1 quart of water. For ulcers
and wounds it may be as strong as 1 to 1,000, the solution being
made by dissolving fifteen 1-grain tablets in 1 quart of water.
Quinine sulphate (capsules or tablets. 5-grain).

This is the one drug that will cure malaria, and which, moreover,
if taken in time and properly, will usually prevent the development
of the disease. For the treatment of the disease it should be given
as follows: 10 grains 3 times a day for the first 3 or 4 days, then 10
grains every night for 8 weeks. When a ship is going to a port
where malaria prevails, each member of the crew should take from 5
to 10 grains of quinine each day for at least a week before entering
the port and continue taking it until well away from the infected area.
Such a precaution will usually prevent the contraction of the disease.
In any case the personnel of the ship should be protected against
mosquitoes.
Rhinitis tablets (full strength).

These tablets are useful in the early treatment of colds. Dose :
One or two tablets every two hours; but not more than four doses
a day should be taken. If the throat becomes dry, stop taking the
t ablets.
Sirup of ipecac.

Useful in bronchitis, cough, and hiccough. Given in doses of 10
drops every three hours. To produce vomiting, it is given in doses
of 1 to 2 tablespoonfuls.

Soap liniment (for external use).

This is a good all-round liniment for muscular soreness, bruises,
.sprains, etc., though perhaps as much benefit is derived from the
rubbing used in applying it as from the liniment itself.

Strychnine sulphate (poison). (Tablets, i/Q-grain.)

Strychnine is a stimulant and is sometimes used when the heart
action is weak, or in cases of general body weakness. The chief use
of strychnine is as a general tonic, for which purpose it .should be
given in doses of one ^0-grain tablet three times a day.

Sulphur ointment.

The chief use of sulphur ointment is for the treatment of scabies
or itch ; it is also effective in the treatment of other skin diseases.
In treating itch, the ointment should be thoroughly rubbed into the
skin for three successive nights, and no baths should be taken until

62 the ship's medicine chest

the fourth day, when the patient should take a warm, cleansing
hath and put on fresh clothes. It may be necessary to repeat this
treatment, but not for several days. Too frequent use of sulphur
ointment may cause an eczema which may be mistaken for itch.

Sun cholera mixture.

The combination of drugs is useful in relieving distress from cramps
and diarrhea and in reducing the number of bowel movements. The
dose is from 5 to 10 grains (1 or 2 tablets) every 2 or 3 hours.

Sweet spirit of niter.

Useful in fevers, wind colic, and colds, and to increase the secretion
of urine and sweat. Dose: From one-half teaspoonful to 1 teaspoon-
ful in water every 3 or 4 hours.

Tincture of iodine (for external use only).

This substance is very generally used as an antiseptic, and is of
value because it is not only effective but very simple to apply. It
should be painted on the skin around the wound, which should also
be swabbed out with it. When it is to be used copiously within
wounds it should be diluted with an equal quantity of alcohol. Be-
fore opening a boil or an abscess, the skin over the affected area
should be painted with iodine. Before a cut is sewed up, the wound
should be painted with iodine. In very strong solutions, especially
when the area is covered after painting, iodine may blister the skin ;
therefore do not put a heavy dressing over an area that has been
painted. Any excess of iodine may be removed by washing the spot
with alcohol. Do not paint any portion of skin with iodine several
times in succession, or blistering will follow.

Turpentine (to be used externally).

A counterirritant in pleurisy, colds, bronchitis, and lumbago. Its
most important use, however, is for getting rid of the gas which
sometimes accumulates in the bowels during the course of pneumonia
and typhoid fever, and sometimes from other causes, such as indi-
gestion. In such cases turpentine stupes are often of great assistance.
These are prepared by wringing out a cloth, of a double layer of
thin flannel, or small towel, soaked in a pint of hot water to which
a teaspoonful of turpentine has been added. The flannel, while hot,
is applied to the abdomen, covered with a thick towel, and allowed
to remain for 10 or 15 minutes. It is then removed, allowing the
thick towel to remain, and again soaked, wrung out, and applied as
before. This process may be repeated several times if necessary.

Zinc oxide ointment.

Useful in case of inflamed, itching, or irritated skin and for erup-
tions or breaking out of the skin. It is also of value in cases of
sunburn.

CHAPTER IV

MEDICAL FIRST AID AND SYMPTOMATIC TREATMENT
The General Principles of the Treatment of Disease

The object of all treatment is to assist nature to a cure. Violent
methods should never be employed ; gentleness and great care should
be the rule. The restraint of the sick man should be just enough to
prevent his doing injury to himself and others. It is not enough
that his physical wants shall receive attention; his mind should be
kept in as cheerful a condition as possible. No two people react
exactly alike to disease or treatment.

Rest may be local or general. Its object is to allow nature a
chance to work. Thus, in a broken finger the entire hand should be
tied up in such a way as to prevent it being used, since, by motion,
the broken ends of bone may be displaced and the new bone tissue
injured, with the result that pain, interference with healing, and
deformity may follow. A certain amount of shock follows every
injury. Rest is the best method of allowing the body to readjust
itself.

In the absence of a medical officer, the treatment of the sick is the
responsibility of the master; while he may detail others to perform
this duty, he can not evade the responsibility for their acts ; he must
see to it that those so detailed perform their duties with judgment
and great patience. Knowledge and experience are equally essential.

Before going into a discussion of the treatment of each disease, it
will be necessary to take up general principles that should be followed
in the handling of sick patients aboard ship. Very often the general
care of the patient does more to hasten his recovery than all of the
remedies in the Ship's Medicine Chest.

The bed for the sick man should be clean and comfortable. Pref-
erably, the mattress should be made of hair and should have a fairly
even and firm surface. A rubber sheet should be spread over the
mattress to prevent it from becoming soiled. The rubber sheet
should be covered by a blanket and sheet to prevent chafing. The
remainder of the bed clothing should be sufficient to retain heat, but
not so heavy as to cause restlessness and discomfort. Very weak
patients and those with burns or fractures may require protection
by a framework so arranged that the bed clothing does not rest upon
the patient. Before being put to bed, the patient should be bathed

63

64 the ship's medicine chest

and put into clean night clothes, pajamas or night shirt, if prac-
ticable ; at least he should be put into clean underwear. Night clothes
should be changed often enough to keep the patient clean.

The sick room should be well ventilated, with plenty of natural
light. (See Chapter III: Sick bay.) Simple furnishings that can
be scrubbed at the end of the illness are highly desirable and
advantageous.

Cleanliness of the patient's body is essential. Baths should be
given to cleanse the skin ; and in patients with high fever, cold baths
have a definite action in lowering the temperature. For cleansing
baths, soap, warm water, and a cloth are all that are necessary. If
the patient is not too ill, he should be bathed in a tub ; if that much
exertion is not advisable, he should be bathed in bed. (See p. 70.)
It is well to begin with the face, arms, and hands, drying these parts
before uncovering the chest and abdomen. In very sick patients and
in those who are likely to be bedridden for some time, brisk alcohol
rubs over the back and outbacks are very essential procedures for the
prevention of bed sores and breaks in the skin.

As has been previously stated, accurate records of all cases of illness
should be kept regardless of their nature. These should state the
patient's name, age, and previous illnesses, and all the important
details of the present complaint. The patient should be examined
and the data obtained by the examination should be added to the
record. The treatment given the case, the daily temperatures, pulse,
and respirations should be recorded, and the daily progress of the
case should be noted. Precautions taken to prevent the spread of the
disease, if it is communicable, should also be noted on the record.

The information afforded by such records will be of tremendous
value to quarantine officers and other physicians who may be con-
sulted when the ship arrives at a port.

EXAMINATION OF THE SICK

The first step in treating a sick person is to make a diagnosis.
To repair a machine, one must first know what is wrong with it ;
therefore, the sick man should be questioned in detail as to his
complaint and the duration of his symptoms. He should then be
sent to his quarters, if no hospital is maintained aboard ship, where,
after1 he has undressed, the officer will examine him carefully. A
good plan is to make a written record first, describing the complaints
of the patient and giving all the history it is possible to obtain in
respect to those complaints, and then to make the physical exami-
nation as follows: Observe the patient's general appearance, the
color of his skin, any sores or enlargements and anything else about
him that appears to be abnormal, from the top of his head to the

SYMPTOMATIC TI.'K \TMKNT

Go

soles of his feet. Examine liis mouth, throat, tonsils, etc. Go over
his body carefully with the fingers to Locate tender or painful pari-.
This should be 'lone with gentleness and care.

Such a thorough examination often brings out valuable additional
information which will enable the officer to make a correct diagno-
The temperature and pulse and respiratory rates

SIS.

+> 0)
•H »«cf •

■O-'MH

(DO -HO

CO 0)

1^

*»-=

*-=

1 El

-^ -1

should be counted in all instances, and, if abnormal,
should lie retaken at least three times a day while the
illness lasts.

In every ship's medicine chest there should be a clin-
ical thermometer for measuring the patient's tempera-
ture. In taking the temperature, the mercury should
be shaken down. To do this, grasp the end opposite
the bulb firmly in the hand; the hand and arm then
describe a short arc and end abruptly with a sharp
snap of the wrist; repeat until the column of mercury
is well below the arrow on the scale. The thermometer
should then be cleaned with alcohol.

The bulb of the thermometer should then be placed
under the patient's tongue and his mouth closed; it
should remain for at least two minutes in this position.
The Centigrade thermometer graduated from 34° to 44°
(37° being normal) is the one most commonly used on
board ship. (See illustration.1) It is very essential
that all cases of sickness with temperature above 37° C.
should immediately be reported to the quarantine officer
upon arrival in port.

In cases of very severe illness, the temperature may be
taken in the armpit (axillaiy temperature) or in the
rectum (rectal temperature). The axillary temperature
is about half a degree Centigrade below mouth tempera-
ture and the rectal temperature is about half a degree
above the mouth temperature.

Rest. — A sick person needs rest; and so the patient
should undress, go to bed, and stay there. Since rest
is one of Nature's best remedies and plays a most im-
portant part in all cases of recovery from illness, it
should be enforced. Physical rest is best obtained by
lying in a comfortable bed. Mental rest, which is of
almost equal importance, is promoted by placing the
patient amid pleasant surroundings and, as far as
possible, relieving him of worry — particularly in respect to the out-
come of his illness.

'To change from Centigrade to Fahrenheit reading: Centigrade reading times 9 divided
by 5, plus 32. To change Fahrenheit to Centigrade : Fahrenheit reading minus .'iL' times
5 divided by 9.

« —

*• —

Fig. 12. — A
clinical
thermometer

66 the ship's medicine chest

NURSING THE SICK

One of the most essential qualifications for an attendant is experi-
ence in handling the sick, which includes giving sponge baths, taking
temperatures, pulse, and respiratory rates; preparing the food to be
given; administering medicine at regular intervals; giving enemas;
and otherwise carrying out the directions of the ship's master or other
officer in charge of the case. Another and very important requisite
for an attendant is kindliness; a sick person should be handled with
tact and sympathy, which can do much to help him to secure mental
rest.

In cases of suspected communicable disease, the person designated
to care for the sick should not be allowed to perform any of the
other duties, especially the preparation of food for the remainder of
the crew. If possible, he should wear clothes that may be sterilized
by boiling. He should help to prevent the spreading of the disease
by strictly avoiding contact with the well. In all cases of communi-
cable disease the patient and attendant should be isolated, and contact
with other persons on board forbidden.

FOOD FOR THE SICK

A sick person should not be allowed an ordinary or heavy diet. If
he has fever, his food should consist of liquids or semiliquids, milk,
cocoa, egg drinks, buttermilk, fruit juice from canned fruits, such
as pineapples, pears, etc. Strained soups may be given. A semisolid
diet may consist of oatmeal, custard, soft-poached or soft-boiled eggs,
milk toast, jelly, ice cream, cream, butter, etc. When giving a liquid
diet, the patient must be fed frequently and at regular intervals —
about every two or three hours. The diet should be varied from time
to time or from meal to meal, in order to stimulate the appetite.
When practicable, the diet tray should be temptingly arranged, be-
cause it is often difficult to induce a sick person to take sufficient
nourishment.

CARE OF THE BOWELS

When a person reports sick, prompt attention should be invariably
given to the question of the excretions. The intestines should be
thoroughly emptied by the method best suited to the condition of the
patient. If he is suffering from colic or gas and pain in the abdo-
men, he should be given a rectal injection of soapsuds. If an
evacuation is not so urgent, a cathartic may be given by mouth.
There are various remedies that will act effectively by this method,
such as Epsom salts, compound cathartic pills, calomel, and castor
oil. // appendicitis is suspected, cathartics should never be given.

In most other conditions the bowels should move at least once a
day; in case they do not, one of the above-named remedies should

SYMPTOMATIC TREATMENT 67

be given. Remember thai one of the iirst steps in the treatment of
the sick is to clean out the bowels so as to remove the poisonous sub-
stances they may contain, and that throughout the period of sickness
the bowels must be constantly kept open. The severity and the dura-
tion of a disease are usually much lessened by keeping up good
elimination through the bowels.

ENEMAS

Enemas are used when it is necessary to wash out the lower part
of the bowel. Many different preparations or solutions are used
for this purpose, according, of course, to the condition of the patient.
For example, to simply wash out the bowels, the best solution to use
is soapsuds. To make this solution, shave a few pieces of castile
soap into a container, add warm water, and mix until enough soap
is dissolved to make good suds. Olive oil is sometimes used as an
enema. A normal salt enema is made by dissolving 2 level tea-
spoonfuls of table salt in a quart of warm water. Salt enemas
are often given in shock; they should be injected very slowly, so
slowly, in fact, that the solution may enter the bowel at the rate of
about 30 or 40 drops a minute. Given at this rate, the salt solu-
tion can be absorbed by the body so as to stimulate it. Often a
turpentine enema — a teaspoonful of turpentine to a quart of water —
is given when the intestines become distended with gas. A nutrient
enema is used when it is necessan^ to give food to a patient who
can not take it by mouth. By means of nutrient enemas, perhaps
in different combinations, such liquid foods as meat broth, milk,
and eggs are injected into the intestines.

When giving an enema, have the patient lie on either his back or
his left side with the knees drawn up. The rectal tube should be
smeared with vaseline. The solution should not be allowed to flow
in too rapidly. A quart of solution is usually all that can be taken
at one time. The patient should be told to hold the solution as long
as he can — at least 10 or 20 minutes, if possible. Sometimes mas-
saging the abdomen increases the effectiveness of the enema. For
washing out the bowel, the enema may be repeated until there is
reason to believe that the intestines are thoroughly emptied. In case
the first injection does not return after waiting a half-hour or an
hour, another quart of liquid should be injected.

When a saline (salt) enema is given for stimulation in case of
weakness, or when a nutrient enema is given, the solution should
enter the bowel very slowly by the drop method, so that absorption
may take place.

Should a patient, for any reason, become unable to pass his urine,
such as in spasm from a urethral stricture, it will be necessary to
catheterize him. Before resorting to the catheterization every means

68 THE SHIP'S MEDICINE CHEST

available to make the patient void his urine should be tried. Turning
on the faucet and allowing the water to run for a few minutes will
often cause relaxation of the bladder sphincters and allow urination
to follow. Sometimes after many attempts to use a urinal while
lying down in bed, a bed patient can pass urine on standing.
Allowing the patient to sit in a tub of warm water will often cause
relaxation and allow him to void his urine. If all of these fail, it
is necessary to catheterize the patient.

Two kinds of catheters may be used — the rubber catheter, which
is soft and pliable, and the metal catheter, firm and bent in a curve
to fit the natural curve of the prostatic urethra. It is always best to
first try the rubber catheter. It should be boiled each time before
using and oiled with sterile vaseline. The mouth of the urethra
should be cleansed with soap and water and the catheter gently
passed into the opening. If resistance is met, it is probably due to
spasm of the neck of the bladder. Continuous gentle pressure will
often overcome this, and the catheter will slip into the bladder.

If the rubber catheter can not be passed, the metal one should be
tried, but not until every patient and careful attempt has been made
with the rubber catheter. Too much pressure with the metal cathe-
ter is dangerous, and if resistance is met after prolonged gentle
pressure, attempt at catheterization .should be abandoned for the
time.

Patients with high fever and those obviously ill should not be
allowed to get out of bed to move the bowels or pass the urine, but
should be made to use the bedpan. This should be washed and disin-
fected carefully, especially in cases with infectious diseases.

DISINFECTION OF EXCRETIONS

The attendant should be familiar with the use of disinfectants.
If the patient has typhoid fever, dysentery, cholera, or a similar
communicable disease, certain precautions must be taken to prevent
the spreading of the disease to others. Any or all of the excretions —
saliva, stools, urine, and sweat, especially the first three — may con-
tain the disease germs. The patient should expectorate in a sputum
cup, which should later be burned. The stools and urine should be
disinfected in the receptacle in which they are collected. In disin-
fecting the excretions the germicide (germ killer) best suited for
the material to be treated should be used. Formaldehyde, carbolic
acid, and cresol are best for disinfecting excretions from the bowels
and kidneys. From 2 to 5 per cent is the correct proportion for
carbolic acid or cresol ; in other words, to a quart of excretion (stool
and urine) add not less than 2 teaspoonfuis of either carbolic acid or

SI MPTOMATIO TREATMENT 69

cresol, stir the mixture thoroughly, and allow to stand for three or
four hours before final disposition is made.2

In using formaldehyde*, add enough to the excretions to make a LO
per cent solution; that is, to a quart of excretions add not less than
4 teaspoonfuls of formaldehyde, stir the mixture thoroughly, and
allow it to stand for several hours before disposing of it.

Other disinfectants of value for treating the excretions are lime,
chloride of lime, or bleaching powder, and bichloride of mercury.
Lime is cheap and effective. It destroys organic matter and, in 20
per cent strength, kills practically all germs. To a quart of feces or
excretions, add not less than 8 heaping teaspoonfuls of fresh lime,
thoroughly mix, and allow7 mixture to stand from 1 to '1 hours before
disposing of it.

Chloride of lime, or bleaching powder, is a good disinfectant, but
the presence of organic matter decreases its power ; therefore, as wTith
lime, considerable quantities of it have to be used for the disinfection
of feces and similar material. With a quart of feces, mix not less
than 8 teaspoonfuls of chloride of lime, stir thoroughly, and allow to
stand for a few hours before final disposition.

Bichloride of mercury, or corrosive sublimate, is furnished in the
medicine chest in 7y2 -grain tablets, a convenient form for making
solutions of a definite strength. Bichloride of mercury is a very
effective germ killer, but the presence of organic matter decreases its
power; therefore, in disinfecting feces and urine, it must be used in
strong solutions. To a quart of excretion (bowel content and urine)
add two to four bichloride tablets, first dissolving these in a small
quantity of warm, fresh water or sea water. Mix the bichloride
thoroughly wTith the excretion and allow the mixture to stand from
three to four hours before final disposition.

DISINFECTION OF BEDDING, DISHES, ETC.

The attendant caring for a patient with a communicable disease
should look after the disinfection of all bed sheets, other bed clothing,
and dishes — everything, in fact, that has been handled by the patient
or his attendant should be thoroughly disinfected before being
handled by others.

When the bedding and clothing, sheets, blankets, pillowcases, night-
shirts, etc., are changed, the soiled pieces should be soaked in a solu-
tion of bichloride of mercury or carbolic acid. If bichloride of
mercury (corrosive sublimate) is used, add two 714-grain tablets to
a quart of water. If carbolic acid is used, add 2 or 3 teaspoonfuls to
a quart of water. Allow the articles to soak for several hours, and

2 When at sea, disinfection of stools and urine is not necessary, but in port and on the
lakes and rivers it is necessary. The bedpan or bucket should always be sterilized.

70 THE SHIP'S MEDICINE CHEST

then boil them. Several rinsings of clear water should be given to
remove the odor of carbolic acid, which is disagreeable to some people.
Dishes and other articles that can be boiled may be sterilized by
boiling them in water for at least a half-hour. Any food left on his
tray by the patient is best disposed of by burning.

PRECAUTIONS FOR ATTENDANTS

The attendant should know how to protect himself. In handling
infections or communicable cases, certain precautions should be taken.
After each occasion of handling the patient, the attendant should
wash his hands with soap and water, rinse them, and wash again in a
solution of bichloride of mercury (two 7^-grain tablets to a quart of
water). It is a good plan to keep a bucket or basin of disinfectant
solution by patient's bedside. The attendant should be careful always
to keep his hands away from his face, this being the most frequent
way of transferring germs to the mouth. The hands should be
washed before eating and after going to the toilet.

TERMINAL DISINFECTION OF SICK ROOM

The quarters occupied by the sick should be kept as clean as
possible. No one except patients should be allowed to occupy the
sick room. The floors, walls, and furniture of sick rooms may be-
come contaminated with disease-producing germs and these disease
organisms must be destroyed. Dryness and sunlight will kill the
germs in time, but are slow and not absolutely reliable. For prompt
and sure results, therefore, it is necessary to employ other means of
disinfection.

The floors, walls, and furniture may be washed with a strong
solution of bichloride of mercury, one or two 7i/>-grain tablets to
a quart of water.

Bleaching powder, or chloride of lime, makes an excellent dis-
infectant for unvarnished walls, floors, etc. It should be used in a
strong solution, not less than 6 ounces to a gallon of water. Car-
bolic acid, cresol, lysol, and formaldehyde may be used, but chloride
or bichloride of lime is quite reliable and is easily handled.

Before permitting a patient who has recovered from a con-
tagious disease to associate with other members of the crew, he
should be cleansed as thoroughly as possible. He should then be
given a warm bath and should put on clean clothing. His head
and beard should be well shampooed.

BATHS

Whether or not a patient is confined to bed, he should be given
a bath at regular periods — daily, if possible. A warm shower is

s^ M PTOMATIC TREATMENT 71

besi for a patient who is not confined to bed. A patient who is con-
fined to bed must be bathed by the attendant. A rubber sheet should
be placed beneath the patient and a sponge bath should then be
given, washing one part at a lime and keeping the resl covered
until the whole body has been gone over. Drying with a towel
should be accompanied by brisk rubbing, in order to stimulate the
circulation.

To reduce fever, baths are a most important method. It" the fever
is over 39° C., a sponge bath should be given every four or five hours.
The temperature of the water should vary according to the illness
of the patient and his physical condition. If extremely ill, a warm
bath is used; but if the patient is robust and strong, there is no
objection to the use of cold water.

To give the bath in bed, strip the patient and cover him with a
sheet or blanket. Using a cloth dipped in the water, rapidly go
over the upper portion of the body several times until thoroughly
cooled: quickly dry the area sponged and cover with the sheet
while the lower area is being sponged. Follow the whole procedure
with a quick alcohol rub. Change the sheet or blanket for a dry one
and leave the patient covered only lightly for 15 or 20 minutes.

The tongue of a sick person often becomes coated, and there is a
collection of foul-looking mucus on the teeth. It is therefore neces-
sary to look after the patient's mouth regularly. If the patient is
able to do so, he should brush his teeth and rinse his mouth daily
with a solution made by dissolving an alkaline antiseptic tablet in
a glass of warm water. The teeth should be cleaned and the mouth
rinsed at least twice a day. If the patient is unable to care for his
mouth, the nurse should do it for him, swTabbing out the mouth and
cleaning the teeth with a piece of clean gauze wrapped around the
linger and wet with the alkaline antiseptic solution.

Medicines prescribed should be given at regular intervals. The
nurse should not guess at the dose, but should measure it, if it is
a liquid, with a teaspoon or a medicine dropper.

Relief of pain, is often obtained by the application of either heat
or cold. If the patient feels cold he should be covered with blankets
and hot-water bottles should be placed near him. A warning may
be given here in respect to the use of hot-water bottles: A patient
who is unconscious or asleep may easily receive a bad burn from ai
hot-water bottle placed too close or not well wrapped up. Fruit jars
or other bottles or jugs rilled with hot water may be used.

Hot applications, or wet heat, are applied by wringing a flannel
cloth or gauze out of a hot solution and laying it on the spot to be
treated. In case of wounds, the hot solution is best made of boracic
acid. If there is no wound, the cloth may be wrung out of hot

72 the ship's medicine chest

water in which Epsom salts have been dissolved : this solution is
recommended for painful joints, as in rheumatism, or for bruises.
Turpentine stupes also afford much relief for painful and swollen
joints, as well as for pains in the abdomen. These are prepared by
wringing out a towel or cloth which has been soaked in hot water
containing a teaspoonful of turpentine to the quart.

Cold application* often help to relieve headaches. An ice bag
partly filled with chipped ice or ice-cold water should be applied to
the head and left on for 15 to 20 minutes. It should then be
removed and kept off for the same length of time. The application
should be repeated as often as necessary.

Sometimes there may be a suspicion that a person who sa}'s he
is sick is only pretending. In such a case caution must be exercised
since it sometimes happens that a very sick man does not have the
appearance of being sick. It would be much better to have a malin-
gerer succeed in his deception than to be unjust to a really sick man.
If malingering is suspected the deception can nearly always be
detected by careful watching.

When a patient is recovering from a disease he should not be
allowed to resume his work until the ship's master is satisfied that he
is able to do so without injuring his health. During the period of
recovery, when the patient is able to sit up, he should, whenever the
weather permits, be carried on deck and placed where he can get
the sun.

In all cases of contagious disease definite steps should be taken to
prevent the disease from affecting other members of the crew. The
steps that should be taken in this regard will depend upon the way
in which the disease is spread from one person to another. If water
is the medium by which the disease is spread, the water containers
must be cleaned and disinfected and then filled with fresh, clean
water which is free from the disease-producing germs. If the disease
is spread by mosquitoes, these insects must be destroyed as far as
possible, and the patient and crew must be protected by screening.
For each disease there are certain precautions to be followed out.
These are discussed in Chapter V under the names of the various
diseases.

Asthma.

Asthma comes on abruptly, beginning, as a rule, during the after-
noon or early evening. Sometimes the attack is preceded by a feel-
ing of constriction in the chest ; later there is an intense desire for
air and the breathing is labored and accompanied with loud wheezing ;
the face is flushed — at times even blue. The eyes are staring, the eye-
balls protrude, the muscles of the neck stand out. The breathing
becomes so difficult that each inspiration is but a gasp; the patient

SYMPTOMATIC TREATMENT 73

Eeels as if death were impending. After some minutes, or perhaps
hours, the attack subsides.

Treatment. — The treatment of asthma on board ship should be
limited to relieving the acute attack. This can often be done in
milder cases by giving 10 to 15 grains of aspirin early in the attack.
More severe attacks are nearly always relieved by hypodermic injec-
tion 8 of from 5 to 10 drops of adrenalin. Either of these medicines
can be repeated once or twice after an interval of one hour after the
previous dose. Morphine should be used only in the very extreme
cases where the above remedies are not effective. It should be given
in i^-grain dose, repeated once or twice, if necessary, after a half
hour. Not more than four doses should be given. The earlier the
attack is treated, the easier it Is to break it up.

Backache.

Backache may be due to a number of causes. It may result from
a strain, the onset of an infectious fever, or from influenza and
rheumatism. Severe backache is one of the first symptoms of small-
pox and yellow fever. Many backaches result from sleeping on a
sagging bed.

If the backache is not severe, it is usually best for the patient to be
given a liniment (soap liniment is good) and to have an attendant
rub it thoroughly into the back.

A mustard plaster applied to the back often gives relief. The
plaster is made by mixing one teaspoonful of mustard with four tea-
spoonfuls of flour and making this into a thick paste with a small
amount of water. Spread the paste on a piece of cloth and apply
to the back. In a few minutes, or when the skin becomes quite red,
remove the plaster, or it may blister.

Persistent backache may sometimes be relieved by strapping with
adhesive plaster, which extends from the front of the hip on one
side to a similar point on the opposite side, being very tightly ap-
plied. Strips 3 or 4 inches wide should be used and should overlap
each other at least an inch. The whole dressing should be about 8
inches wide. The plaster may irritate the skin after being applied
several days, causing eczema-like eruption and sometimes little blis-
ters. This condition readily heals after an application of talcum
powder.

Chills. (See also Malaria and Pneumonia.)

Chills are usually an indication of the onset of some general dis-
ease. They frequently occur either combined with or shortly followed
by fever. The chill may be either mild or severe. It may be merely
a chilly feeling or the patient may become blue and shake with cold.

8 Every ship's officer should learn the simple operation of hypodermic injection.
112055°— 29 6

74 the ship's medicine chest

Treatment. — During the chill put the patient to bed, give "warm
drinks, such as hot whisky and water, or hot tea. Cover well with
blankets and use hot-water bottles under the blankets, being careful
not to burn the patient. When the chill is over, take the temperature,
which will usually be elevated. In such case treat as for the fever,
trying to find the cause of the chill if possible and then treating the
specific disease.
Colic, Abdominal.

An ordinary attack of colic is manifested by sharp pains in the
abdomen, which last from a few seconds to several minutes and then
subside, only to recur again and again. The pain and distress are
at times very severe; the patient is pale and is covered with a cold
sweat ; vomiting may or may not occur. The application of pressure
to the abdomen during an attack may somewhat relieve the pain.

The usual cause of colic is indigestion which has resulted from eat-
ing unripe fruit or tainted food. There may be constipation or
diarrhea. If the attacks of colic persist and the prostration is great,
ptomaine poisoning or lead poisoning should be suspected. Do not
mistake a case of appendicitis for colic.

Treatment. — If sure that the case is one of colic, begin by giving the
patient an ounce or two of castor oil. A hot-water bottle placed on
the abdomen or a hot turpentine application by adding a tablespoon-
f ul of turpentine to 2 quarts of hot water ; wring out cloths in the
hot solution and apply to the abdomen, covering them so that they
will retain the heat as long as possible. If there is diarrhea, clear
the bowels well with castor oil. Then one or two sun cholera tablets
or paregoric in 1 or 2 teaspoonful doses may be given every two or
three hours.

In all cases of colic the diet should be liquid. Refrain from giving
food of any kind, or the tablets, or paregoric, until after the bowels
have been thoroughly emptied by a cathartic. If there is profuse
diarrhea, give plenty of water by mouth. For several days after an
attack of colic, the diet should be light and of easily digestible
material.

Colic, Gallstone.

Gallstone colic is caused by the effort of a gallstone to pass from
the gall bladder into the bowel. The pain comes on suddenly as an
extremely severe, cutting cramp, beginning on the right side of the
abdomen just beneath the ribs and travels toward the navel. The
paroxysm of pain may last from a few minutes to several hours or
may persist for one or more days. Frequently within 24 hours, the
whites of the eyes and the skin become yellow — jaundice. Some-
times after such attacks the gallstones may be found in the stools.

SYMPTOMATIC TKKATMKNT 75

There may be a history of previous attacks: and it' so, the patient
should be advised t<> consult a surgeon before attempting another
voyage.

Treatment. — To relieve the pain, a lint -water Untile or a hot fomen-
tation, as described for colic, may be applied. The pain is often so
severe that it is necessary to resort to morphine. In such an instance,
give a 14-grain morphine and atropine tablet, and if pain is not
relieved in 45 minutes, give another. (Note : Not more than three
doses of morphine should be given in one day.)

Colic, Kidney.

Kidney colic is very painful and caused by the passage of a kidney
stone along the narrow tube (the ureter) from the kidney to the
bladder. The pain is most intense in the loin, whence it is usually
transmitted down to the groin and to the head of the penis. The
testicle on the side affected often becomes sore. The urine may con-
tain blood. Kidney colic begins suddenly and stops suddenly wThen
the stone reaches the bladder. Sometimes the stone becomes lodged
in the ureter, and unless the patient receives prompt surgical treat-
ment from a competent surgeon he will die.

Treatment. — The medical treatment of kidney colic aims chiefly at
relief of the pain. Put the sufferer into a hot bath and keep him
there for a while. If this does not relieve the pain, a hot water bottle
or hot turpentine fomentations may be applied. The patient's
shoulders should be placed low and his hips high. If the application
of heat does not afford relief, a 14-grain tablet of morphine should be
given and the dose should be repeated at the end of 45 minutes, if
absolutely necessary to do so.

Cold on the Chest.

This very common affection, which is bronchitis, frequently follows
exposure to bad weather. Illness may begin with soreness of the
throat, the soreness extending down the wind pipe. There is usually
a husky cough, and perhaps there is slight fever with headache.

Treatment. — The best treatment is to put the patient to bed, cover
him well, and induce sweating with hot water bottles and a hot
drink, such as lemonade, or tea. Ten grains of aspirin or 10 grains
of Dover's powder may be given. During the sweating process the
patient should be kept well covered. The bowels should be evacuated
by means of Epsom salts, compound cathartic pills, or castor oil.
The diet should be light for two or three days. The patient should
avoid exposure when he gets up.

Cold in the Head.

Acute cold in the head is also known as acute rhinitis, or acute
coryza. The disease affects the lining membrane of the nose. There

76 • THE SHIP'S MEDICINE CHEST

is feverishness, a feeling of fullness and discomfort in the head, a
discharge from the nose, headache, a tired feeling, and sneezing.

Five grains of aspirin should be given three or four times a day.
A Dover's powder tablet, repeated in two hours, will often serve to
stop an attack. It is helpful to take a hot bath and a hot drink upon
going to bed. A half teaspoonful of bicarbonate of soda in half a
glass of water every two hours for three doses may abort an attack.
The bowels should be opened by a dose of Epsom salts, castor oil, or
compound cathartic pills. Exposure to bad weather should be
avoided.

Constipation.

Constipation is a condition in which the. bowels lack sufficient
power to empty themselves.

Acute constipation should be treated by the use of cathartics,
such as Epsom salts, castor oil, or compound cathartic pills. For
quick results, a rectal injection of a quart of soapsuds may be given ;
but even after the injection, a cathartic should also be given by
mouth, because an injection cleans out only the lower portion of the
bowels.

Chronic constipation may be best overcome by rearranging the
diet to include plenty of fresh fruits and vegetables, particularly
cabbage, spinach, and salads. The food should be eaten slowly and
chewed thoroughly. Massage of the abdomen helps to tone up the
intestines. The habit of routinely taking cathartics should be
avoided ; but if it has already been acquired, mineral oil is probably
the best. The establishment of regular time and habit, as discussed
in Chapter II, should be developed.

Convulsions (Fits). (See also Epilepsy and Delirium Tremens.)

The most common cause of fits in adults is epilepsy, though

occasionally similar attacks occur in poisoning and kidney disease.
Treatment. — Prevent the patient from injuring himself against

hard objects. A handkerchief should be put in his mouth to prevent

him from biting his tongue. When inserting the handkerchief or

rag, use a blunt piece of wood to avoid having the fingers bitten.

After the attack give bromides until the end of the trip, when he

should be sent to a physician.

Cough.

Cough is a symptom of diseases of the throat or lungs. It is also
induced by irritating dust, fumes, or gases.

Treatment. — Remove the cause of the irritation. Dissolving a
brown mixture tablet on the tongue every three or four hours will
sometimes gives relief. If the cough lasts more than two weeks a
physician should be consulted, because it may come from tuberculosis.

SYMPTOMATIC TREATMENT 77

The earlier that this disease is discovered and treated, the better are
the chances of recovery.

Diarrhea.

Looseness of the bowels may he due to many different, causes, such
as badly cooked, fermented, or contaminated food, and unripe or
overripe fruit; impure water; sudden changes of temperature; radi-
cal changes in diet; dysentery; or cholera.

Diarrhea is usually a trivial and transient ailment, and all that
is necessary to treat it is to clear the intestinal tract of the irritating
substance by means of a dose of castor oil, Epsom salts, or compound
cathartic pills and to keep the patient on a light diet for a few days.

Sometimes, however, diarrhea is a symptom of a very serious
disease, such as typhoid fever, dysentery, or cholera. A continued
diarrhea of light-colored stools, accompanied by fever, headache,
and prostration, should excite a suspicion of one of these diseases.

Treatment. — If the diarrhea does not respond to the measures sug-
gested for simple cases of diarrhea, the treatment should be directed
toward lessening the number of stools. For this purpose the patient
should be given one or two Sun cholera tablets every three hours.
Relief may often be obtained by giving from four to eight bismuth
subnitrate tablets every four hours. If there are signs of collapse,
give a teaspoonful of aromatic ammonia in a little water ; cover patient
with blankets and keep him warm by the use of hot-water bottles.
Give the patient plenty of water to drink to make up for what he has
lost by the bowels.

Dropsy. (See also Heart and Kidney Disease.)

Dropsy is a condition in which the hands, feet, legs, and perhaps
other parts of the body become very much swollen. Dropsical swell-
ings have the peculiarity that when the flesh is pressed down by the
finger, the depression made remains for some time after the finger has
been removed. Dropsy is caused chiefly by heart disease and kidney
disease.

Treatment. — Put the patient to bed. Restrict the diet and keep it
light. Give two teaspoonfuls of Epsom salts in a glass of water
every morning. If his condition is such that he can not be taken to
his home port, place the patient in the first convenient hospital.
The amount of fluids and table salt taken by the patient should be
reduced.

Earache.

Earache often follows or accompanies sore throat but is some times
independent of throat conditions. Pain in the ear is often relieved
by the ear drops which are provided in the medicine chest. The bottle
containing the drops should first be well shaken and should then be

78 THE SHIP'S MEDICINE CHEST

placed in a basin of warm water and warmed before any of the
drops are put into the ear, or a few drops may be heated in a spoon.
A hot-water bottle placed over the affected ear serves to give some
relief from the pain.

Earache is sometimes the sign of a serious inflammation which
may extend to the inner ear and perhaps to the brain. It therefore
should never be disregarded and at the first opportunity a physician
should be consulted.

Fainting. (See also Apoplexy, Heat Exhaustion, Epilepsy, Sunstroke.)

Fainting, like many other symptoms, is not a disease but rather
an indication that something has gone wrong with the patient.
Often it may not be serious, resulting perhaps from hunger, weak-
ness, or a feeling of nausea upon seeing blood; but, on the other
hand, it may be very serious, as in the case of heat exhaustion or
sunstroke.

Usually preceding a fainting attack the patient will feel weak and
nauseated, often he will yawn. Following this his pupils begin to
dilate and he lapses into unconsciousness, which rarely lasts long.

Treatment. — Place the patient flat on his back with his head lower
than his feet. Loosen any tight clothing, especially about the neck,
and apply cold water to the head and back of the neck. Smelling
salts or breathing weak ammonia fumes may help revive him.

Fever.

If a patient has fever he should be isolated from the other members
of the crew until it is certain that he is not suffering from a conta-
gious disease.

He should be undressed and put to bed. His bowels should be
emptied either by the use of a rectal injection of soapsuds or by
giving one calomel tablet (1/,-grain) every hour until four tablets
have been taken and then giving a tablespoonful of Epsom salts dis-
solved in a full glass of water. Castor oil or compound cathartic
pills may be given instead of the calomel and Epsom salts. The
patient should then be given a sponge bath. If his temperature is
high, 39° C. or above, the bath should be cold. A cold bath is best
given a sick person by covering the patient with a sheet wrung out
in cold water or else by sponging a small portion of the body at a
time, under the covers, until the whole body has been sponged. The
temperature of the cold bath should be regulated according to the
feeling expressed by the patient. Friction by rubbing should be
kept up constantly while the wet sheet is applied. Sometimes it is
advisable to continue the cold application for an hour or more. In
such case cold water may be sprinkled upon the sheet from time to
time.

SYMPTOMATIC TREATMENT 79

If the patient objects to the cold bath, an alcohol and water rub
will be very refreshing to him. The application of cold t<» reduce
fever may be accomplished by the use of ice bags or ice packs.

Cold applications or cold baths should not be continued long
enough to produce shock. If shock or weakness develops, it will be
necessary to apply heat and to give the patient a teaspoonful or two
of alcohol well diluted with water, or a teaspoonful of aromatic
spirits of ammonia well diluted with water.

Patients with a moderate degree of fever secure most comfort from
a mild sponge bath or an alcohol rub, which should be given two or
three times a day. The occasional application of an ice bag to the
head aids in producing- comfort.

The diet for a patient with fever should be liquid or semisolid until
the temperature becomes normal.

If the fever is due to indigestion, a cathartic will probably be all
that is necessary.

If the fever persists for more than 21 hours, the patient should be
kept in bed until the temperature becomes normal. If a diagnosis of
an infectious fever is made, the patient should be kept isolated from
the crew until recovery.

An aspirin tablet every three or four hours will de much to reduce
fever, especially if it is due to a cold. In giving aspirin, it must
be borne in mind that some people react unfavorably to this drug;
and if the patient does not seem to bear it well, its use should be
discontinued. Quinine should be used only in cases of malaria.

Foul Breath (Halitosis).

Halitosis, or foul breath, may be due to many different causes,
chief among which are neglect of the teeth and gums, indigestion,
and chronic constipation.

Treatment. — Find out the cause and remove it. Use a mouth wash
several times daily. Keep the teeth clean. An alkaline antiseptic
tablet dissolved in a half glass of warm water makes an excellent
mouth wash. At the first opportunity, the teeth should be given
proper attention by a competent dentist. The stomach and intestinal
tract should be kept active by the use of cathartics. The diet should
be regulated so as to avoid indigestion.

Headache.

Headache is the most common of all complaints. It usually indi-
cates the retention of poisonous material in the system and often
occurs with constipation and with- attacks of indigestion, or from
eating food that has fermented, etc. Headache is present at times
in almost all cases of sickness. It is frequently a warning signal
of the onset of an infectious disease.

80 THE SHIP'S MEDICINE CHEST

Treatment. — Give the patient a cathartic to clean out the bowels.
Then give him a 5-grain tablet of aspirin. Repeat the aspirin in an
hour, if necessary. An ice bag or a hot-water bottle, as the patient
prefers, applied to the head, will afford some relief. The patient
should lie down and keep quiet until the pain has subsided. His diet
for the next day or two should be light and of easily digested
material.

Chronic headache is a frequent symptom of eye strain, infected
teeth, and a great variety of faulty physical conditions, and should
never be neglected. At the first opportunity the sufferer should
place himself under the care of a competent physician for the pur-
pose of receiving adequate treatment. Since the object to be attained
is the removal of the cause, an accurate diagnosis is necessary before
treatment can be intelligently instituted.

Heat Exhaustion.

Heat exhaustion is caused by continued exposure to very high
temperature. Firemen, coal passers, and others employed in work
in considerable heat are prone to have attacks of heat exhaustion.

An attack develops rapidly, beginning with a feeling of weakness
and prostration. The body surface is cool, the face pale, the voice
weak, and the pulse rapid and feeble. The breathing is quick. The
vision grows dim and imaginary noises are heard. This condition
rapidly changes into unconsciousness. Sometimes the prostration is
rapid and without warning symptoms, the person falling unconscious,
perhaps with tremors or convulsions.

Treatment. — Place the patient in a comfortable position; loosen
his clothing; put cold applications on his head; and apply heat to
the rest of the body. A dose of whisky in a cup of strong black coffee
Avill be valuable in combating the shock. Aromatic spirits of am-
monia, 1 teaspoonful well diluted in water, is also a valuable stimu-
lant. If the patient recovers from the attack, he should be kept quiet
for several days. His diet should be light and nutritious, and his
bowels should be kept open by the use of cathartics when necessary.
Indigestion.

Indigestion may be due to various causes, such as excessive smok-
ing, drinking, overeating, eating food that is improperly cooked, a
poorly balanced diet, and bolting food without proper chewing.

Ordinary indigestion is characterized by pain in the abdomen after
eating. There may also be pain in the back, heartburn, and headache.
The bowels may be constipated or too loose. The tongue is coated
with a dirty white or a brown fur. The breath is usually very foul,
and frequently there is much belching of gas or hiccoughs.

Treatment. — The cause should be determined, if possible, and efforts
should then be directed toward eliminating it. It is frequently help-

SYMPTOMATIC TREATMENT 81

ful to produce vomiting. This may be done by giving warm water
to drink and then sticking the finger gently down the throat. The

intestines should be thoroughly cleaned out with a cathartic, such as
Epsom salts, castor oil, or compound cathartic pills. For three or
four days, or longer, if necessary, the patient .should be kept <»n a
light but nutritious diet. The use of tobacco or alcoholic liquor should
be prohibited.

If there is much gas in the stomach or intestines, considerable
relief may be derived from taking a level teaspoonful of baking soda
(bicarbonate of soda) in a half glass of water, repeating, if necessary.
after a while.

Persistent indigestion may indicate some serious condition in
the digestive s}^stem and should receive prompt and appropriate
treatment.
Itching.

Itching is a very disagreeable symptom which may be associated
with various diseases, but is most frequently due to scabies (the
itch) or lice. Persons with severe jaundice often complain of itching.
Irritation and itching near the opening of the urethra may be
associated with diabetes. Sometimes certain foods in certain people
cause local swellings in the skin, called " hives," which itch intensely.

In treating itching, bathing the part of the skin involved with a
weak solution (1 per cent) of carbolic acid, will usually give tem-
porary relief. Carbolized vaseline will also be helpful. The cause,
if it can be determined, should be treated and corrected.

Jaundice.

Jaundice is manifested by a yellow tinge of the whites of the eyes
and of the skin of the whole body. The yellow tinge is caused by the
presence of bile in the blood. Because of some disorder of the liver,
where it is secreted, bile escapes thence into the blood and imparts
a yellow color to the skin. Jaundice is seen in yellow fever, in liver
diseases, in inflammations of the gall bladder, in indigestion, and in
attacks of gallstones.

Treatment. — A course of calomel is the best treatment. Give one
i/^-grain tablet every hour until four tablets have been taken,
and follow by a tablespoonful of salts. Repeat the course on the
second or third day, if necessary. If jaundice persists, a physician
should be consulted.
Pain.

Pain in chest (see Pleurisy and Pneumonia).

Pain in extremities (see Neuralgia).

Pain in joints (see Rheumatism).

Pain is a warning signal that something is wrong and that nature
wants the painful region put at complete rest. If movement is at-

82 the ship's medicine chest

tempted, the notice is enforced by more severe twinges of pain. The
underlying cause of the pain is always to be sought out and treat-
ment directed at it. It is usually some sort of inflammation or in-
jury. Pain can usually be lessened or relieved in part by hot or cold
applications locally, and by taking drugs. Aspirin is very valuable
in relieving some forms of pains, but many of the more severe types
of pain yield only to opiates.

Throat Diseases.

Sore throat is a very common affection. Few people escape oc-
casional attacks of it, but some people are more liable to it than
others. There is a certain severe type of sore throat that may be
spread by the use of infected milk or water. Sore throat may mean
scarlet fever or diphtheria. Exposure to sudden change in tempera-
ture, such as occurs so often during the winter months, is a frequent
cause of attacks of sore throat. Engine-room workers are quite likely
to expose themselves carelessly to sudden changes when leaving the
hot workroom to cool off.

Sore throat often begins with a slight shivering, some fever, and
depression of spirits; and the throat feels sore, particularly in
swallowing. Within a few hours the throat and tonsils become
swollen and very red; the pain has increased in intensity and the
patient feels very ill, and sometimes the fever runs high. The tongue
is coated with a heavy white fur. There is often a general soreness
and aching of the muscles. If the tonsils are much swollen, there is
likely to be some interference with breathing and with the taking of
nourishment. Patients with sore throat should use an individual
drinking glass.

Treatment. — The patient should go to bed. A good gargle may be
made by dissolving one or two alkaline antiseptic tablets in a glass
of hot water. The patient should gargle with the solution as hot as
can be borne.

In addition to having him use the gargle, the patient should be
given one calomel tablet (y2 grain) every hour until four tablets
have been taken; he should then have a tablespoonful of Epsom
salts. If, on examining the throat, white patches are seen on either
throat or tonsils, these should be carefully swabbed twice a day with
tincture of iodine diluted one half with water. Care should be taken
not to have the swab too wet with the solution or it may drip or the
excess may run down the throat. If it gets into the windpipe it will
cause violent spasm and severe cough and possibly serious inflamma-
tion. Hot or cold applications to the outside of the neck may afford
some relief, and sucking pieces of ice is also helpful. The patient
should be given as much liquid and semisolid diet as he can be in-

BYW PTOW \i'i< i 'RE \TM ENT S.'->

duced id take and he should be encouraged to drink quantities of

water.

Toothache and Gumboils.

Toothache usually occurs when there is a cavity or a decayed area
in a tooth or when pus around the root produces pressure. In treat-
ing toothache, the cavity or decayed area should first be cleaned out
as well as possible. Then a very small piece of cotton should be
saturated with oil of cloves and placed in the cavity. Carbolic acid
may be used in place of oil of cloves. The piece of cotton that is
saturated with carbolic acid should be just large enough to fill the
cavity and care should be taken not to allow any of the carbolic acid
to come in contact with the gums.

A gumboil is a small, painful abscess, usually connected with the
root of a decayed tooth. Ordinarily a gumboil discharges within a
few days and soon heals. Sometimes the abscess tends to spread
and may cause much discomfort and even high fever. In such a
case, the patient should be put to bed and should be restricted to a
light diet. A hot-water bottle should be applied to the face. An
excellent hot application is made by dissolving five or six of the
alkaline antiseptic tablets in a pint of hot water. A soft flannel or
woolen cloth is wrung out in the hot solution and applied to the face.
A piece of heavy brown paper or of oil cloth may be applied over
the cloth to keep it from cooling off quickly or a hot-wTater bottle may
be used for the same purpose. The mouth should be washed out
several times daily with a wash made by dissolving one alkaline anti-
septic tablet in a glass of hot water. If the hot application fails to
reduce the swelling and relieve the pain, it may be necessary to pull
the tooth. At the first opportunity a competent dentist should be
consulted.

Vomiting.

Vomiting may be due to various causes. Sometimes it is an early
symptom of a contagious disease. It is common in cholera, yellow
fever, dysentery, and blood poisoning. It is often caused by indi-
gestion, disorder of the liver, eating unripe fruit or tainted meat or
fish, or by the presence of some poison in the stomach.

In disorders of the liver and of digestion, the matter vomited may
be of a greenish or yellowish color and may contain quantities of
partly digested food. The best treatment is to clear out the stomach
and intestines by the use of Epsom salts, castor oil, or compound
cathartic pills.

There is a serious form of vomiting in which the patient casts up a
thick fluid appearing and smelling somewhat like the stools and
which is probably due to an obstruction of the intestines. In such a
case the patient should be carefully examined for hernia or rupture.

84 the ship's medicine chest

The most frequent location of a rupture is in the groin or the scrotum
and the next is at the navel, or umbilicus. Ruptures have a tendency
to strangulate and hence are a grave menace to life. Therefore they
should be treated by a competent surgeon at the first opportunity.

If there is frequent vomiting of small quantities of blood and the
patient has much pain and shows marked loss of weight, ulcers of
the stomach should be suspected. The presence of stomach ulcers is
indicated also by the stools which resemble tar in color and
consistency.

Treatment. — The first requisite is to learn the cause of vomiting.
If the diet is at fault, a good cleaning out with a cathartic and re-
striction to a light diet for a few days is all the treatment that is
necessary.

If caused by the presence of a poison, the vomiting is an effort of
nature to remove the offending substance. In such a case it is helpful
to give a tablespoonful of mustard in a pint of hot water, repeated
until the stomach is thoroughly washed out, and to administer a
cathartic later to clean out the intestines.

If the vomiting is due to bleeding ulcers, the patient should not be
made to vomit. He should fast for 24 or 48 hours, except for taking
possibly small quantities of beef tea or coffee. Nutrient enemas may
be given by rectal injection. An ice bag placed over the stomach
often gives some relief. If the vomiting is profuse, it may be advis-
able to give the patient a y± -grain table of morphine. In cases of
ulcers and of hernia the patient should be put ashore as soon as
possible. // a strangulated hernia is suspected, cathartics should not
be given.

CHAPTER V

SPECIFIC DISEASES AND THEIR TREATMENT

In the pages which follow, the subject matter has been arranged
alphabetically to assist in ready reference. Many diseases have
been omitted and many of the descriptions and directions have been
reduced to the minimum because it is not necessary or desirable
that ship's officers be instructed in all the intricacies of medical
knowledge. It is again emphasized that this book should be read
as a whole in time of leisure so that emergencies may be promptly
and efficiently met as they arise.

Anthrax.

Anthrax is sometimes known as malignant pustule, or wool-sorter's
disease. It is due to a germ which may find its way into the body
through a wound in the skin, or which may be inhaled, in which
case the disease develops in the lungs. Person3 engaged in handling
hides are most likely to contract this disease. When the disease
develops on the skin it is manifest by very angry-looking boils;
there is fever, the breathing is rapid, and the patient suffers from
thirst. Death may occur within a few days from the blood poison-
ing induced by the germs. The lung type of the disease resembles
a severe attack of pneumonia and usually results in death within
three or four days.

Treatment. — For prevention, gloves should be worn in handling
hides, and every wound, regardless of its nature, should be cleaned
and painted with tincture of iodine. The boils should be opened and
cleaned out and painted with tincture of iodine.

Apoplexy, or Cerebral Hemorrhage.

A " stroke " is the result of the sudden rupture of a blood vessel
in the brain (cerebral hemorrhage), and is followed by the escape
of blood into the brain tissue. There are sudden unconsciousness,
irregular, noisy respirations, and complete relaxation of the body.

This disease seldom occurs until after middle age. Its principal
cause is disease of the blood vessels; and its contributing causes are
syphilis, Bright's disease, chronic alcoholism, and hardening of the
arteries.

A stroke may be preceded by headache, dizziness, irritability, and
transient deafness or blindness. The attack is, as a rule, sudden in

85

86 the ship's medicine chest

onset. Occasionally it begins with vomiting, followed immediately
by unconsciousness. There may be convulsive movements; the breath-
ing is noisy, slow, and labored; the cheeks are drawn in during
inspiration and blown out during expiration; the pulse is slow and
full, and the face is flushed : the eyes are inflamed or congested.
The temperature is subnormal during the first 24 hours; later it
rises perhaps 1 or 2 degrees.

The extent of the paralysis following a stroke depends upon the
amount of blood which escapes from the ruptured vessel, upon the
location of the ruptured vessel in the brain, and upon the extent to
which the brain tissue is damaged.

A stroke always indicates a serious condition; and though the first
attack may be very light, sooner or later another is bound to occur.
A seaman who has had one attack should not go to sea again.

Treatment. — The patient should be undressed and put to bed. An
ice bag should be placed on his head, and a hot mustard foot bath
should be given. When the patient becomes conscious, the bowels
should be emptied by a dose of Epsom salts. The diet should be
liquid for a few days, after which there should be a gradual change
to a semisolid diet. After recovery, overeating, overexertion, and
excitement should be carefully avoided.

Beriberi.

Beriberi is a disease sometimes called multiple neuritis. It occurs
most frequently in China and Japan, where people live chiefly on rice,
but is not infrequent in fishermen on the Banks of New Foundland.
It has been proved that the disease is due to eating almost exclusively
polished rice, or rice from which the shell has been removed. The
shell of rice contains elements called vitamins, which are essential
for the welfare of the body.

The disease is characterized by pain in the inflamed nerves and
paralysis of the musc'es. The heart action is weak, and often the
feet and hands swell greatly.

Treatment. — Treatment is limited chiefly to correcting the diet by
giving milk, fresh vegetables and uncooked fruits. Careful attention
to sanitary and hygienic conditions, together with the proper kind of
diet, will prevent the occurrence of this disease. The patient should
be put to bed and kept there on account of the liability of damage to
the heart.

Bladder, Inflammation of.

Inflammation of the bladder, also known as c}Tstitis, is an inflamma-
tion of the lining membrane of the bladder. The symptoms are a
ehill, moderate fever, 'and pain over the region of the bladder. The
urine may contain pus: the quantity of urine is often reduced,
although there is a frequent desire to void urine.

SPECIFIC DISEASES AND TIII.II; TREATMENT 87

Treatment. — The patient should be placed upon liquid diet, with
no high seasoning, for a few days. He should drink Large quantities
of water every day, but should take qo alcoholic liquors, tea, or
coffee. One teaspoonful of bicarbonate of soda (baking soda) given
every three hours in water will do much to relieve the condition.

Bronchitis.

Bronchitis begins like a cold on the chest. It occurs most fre-
quently among firemen and stokers, because they arc most often
exposed to sudden changes of temperature. The symptom-- are fever,
pain over the front of the chest, and more or less cough. The matter
coughed up is at first thin, but later it becomes thick and puslike.
Breathing is rather short and rapid and is painful. It may be accom-
panied with wheezing.

Treatment. — Put the patient to bed. Clean out the bowels with
Epsom salts or castor oil and give 5 grains of aspirin every 4 hours.
If the pain in the chest is severe, apply heat by means of either hot-
water bottles or a turpentine stupe. Rub the chest with camphorated
oil or olive oil containing a teaspoonful of turpentine to the pint.
The diet should be light and nutritious. Urge the patient to drink
plenty of water.

Bronchitis, Acute.

This disease, which is also known as bronchial catarrh, acute
bronchial catarrh, or cold on the chest, is an acute catarrhal inflamma-
tion of the lining membrane of the lungs, characterized by fever,
pain in the chest, labored breathing, and more or less profuse
expectoration.

The disease is most frequently the result of exposure to inclement
weather, or to irritating dusts, smoke, or fumes. It may follow any
of the acute diseases or precede measles or typhoid fever.

The onset is often accompanied with a cold in the head or throat.
There is generally a feeling of chilliness, at first followed by flushes
of heat. The muscles of the limbs, joints, and trunk may ache. There
is loss of strength, the tongue is furred, and as a rule, the bowels are
constipated. The pain in the chest increases as the disease progresses,
and is often described by the patient as a burning or tearing pain
located beneath the breastbone, and made worse by deep breathing.
At first the cough is hard, hoarse, and accompanied with little expec-
toration, but later it is loose, with free expectoration. The disease
lasts about two weeks.

Treatment. — The patient should be confined to a warm but well-
ventilated room and should be kept on a soft diet. Free movement
of the bowels should be produced by administering calomel, a half-
grain tablet every hour until four tablets have been taken, followed

SS THE SHIP S MEDICINE CHEST

by a dose of Epsom salts. A Dover's powder tablet may be given
three or four times a day, and quinine, 5 grains, three times a day.
A daily sponge bath will be very refreshing to the patient. The
mouth should be cleaned every day with a solution made with an
alkaline antiseptic tablet.

Broncho-pneumonia.

Broncho-pneumonia differs from lobar pneumonia, or lung fever.
In broncho-pneumonia the small bronchial tubes of both lungs are, '
as a rule, affected, while in lobar pneumonia, usually one or more
lobes of one side are affected, although both sides may be involved.

Broncho-pneumonia may result from downward extension of a
sore throat. The disease may follow or accompany any of the in-
fectious diseases, or it may be due to the inhalation of irritating
substances, such as dust, smoke, ammonia, paints, or gases.

The disease begins with a slow rise of temperature. The breath-
ing is rapid, laborious, and shallow. The pulse is more rapid than
in normal condition. The cough is usually loose, but may be dry and
hacking. The appetite is poor; the bowels are somewhat free. The
duration of the disease varies ; it usually lasts one or two weeks, but
may become chronic and continue for several weeks.

Treatment. — Confinement to bed is important. The diet should be
nutritious. A mustard plaster to the chest may relieve pain. A
5-grain aspirin tablet should be given two or three times a day and
a cathartic when necessary. The patient should not resume work
too soon after recovery.

Cerebrospinal Fever.

Epidemic cerebrospinal fever is a severe infectious, communicable
disease that may be recognized by the following symptoms: Rapid
onset, headache, vomiting, painful contractions of the muscles of the
back of the neck, retraction of the head, delirium, stupor, and coma.
Sometimes there is a skin eruption of dark red spots. The disease
is due to a number of different kinds of germs and spreads from the

sick to the well.

p

Treatment. — The patient should be carefully isolated and all pre-
cautions taken against the spread of the disease. Treatment requires,
in addition to careful nursing in a quiet, dark room, the evacuation
of the bowels with either Epsom salts or castor oil and the application
of either heat or cold to the head and spine to help to reduce the pain.
Cold sponge baths will assist in reducing the fever. This is a very
difficult disease to treat under the very best conditions, and about all
that the mariner can do is to make the unfortunate patient comfort-
able and to prevent his disease from spreading to others.

Chancroid. (See p. 126.)

SPECIFIC DISEASES A.ND TIIKIl; TREATMENT 89

Ch;cken pox.

Chicken pox is a mild, contagious affection. An eruption of small
blisters usually appears after a few hours of moderate fever, thirst,
loss of appetite, and constipation. The eruption firsl appears as
red spots, which soon turn to small blisters, or elevations containing
a clear or cloudy fluid; sometimes pus forms in these vesicles. There
is intense itching. The eruption dries up after a few days and the
scabs fall off. Sometimes there is pitting which somewhat resembles
that of smallpox.

Treatment. — The disease is self -limited. Treatment consists of rest
in bed, isolation, cathartics, and a light diet. An ointment consist-
inn- of two drops of carbolic acid rubbed into a tablespoonful of
vaseline will do much to allay the itching.

Cholera.

Cholera is an acute specific and infectious disease caused by the
cholera germ. Stools from persons suffering with the disease are
the principal, if not the only, medium of infection, the germs being
conveyed from the infected stools to water used for drinking pur-
poses, or perhaps to food and milk, which may also become vehicles
for the spread of the disease. Flies and other insects may mechani-
cally carry the germs on their feet and bodies.

The disease sets in suddenly with severe and persistent diarrhea,
accompanied by pain, nausea, vomiting, and depression of spirits.
Stools are frequent and watery and contain a wheylike substance.
As the disease progresses, the number of stools rapidly increases.
There is great thirst. The temperature is below normal ; the skin is
cold and covered with perspiration. There is rapid loss of body
weight. Prostration is marked, and death may occur at any time
during this stage. In a case that is likely to recover, the number of
stools begins to lessen, the temperature gradually returns to normal,
and the general condition of the patient rapidly improves.

Treatment. — The patient should be put to bed and isolated. All
excretions — stools, urine, sputum — should be thoroughly disinfected.
All bedding, clothes, dishes, etc., used in the sick room "Should be
thoroughly disinfected. The attendant must exercise great care as
to the cleanliness of his hands, washing them in an antiseptic solu-
tion each time after contact with patient.

In event of death, the body should be wrapped in sheets soaked
in bichloride of mercury solution (two T^-gram tablets to a quart
of water). All water on board ship should be thoroughly boiled
before it is used and all food should be thoroughly cooked before
it is eaten. All persons who have anj^thing to do with preparing
food should be examined and, if they appear sick, they should not
be allowed to handle food or cooking utensils.
112055°— 29 7

90 the ship's medicine chest

Medical treatment should begin with clearing out the bowels with
Epsom salts or castor oil. To reduce the number of stools, one or
two Sun cholera tablets should be given every two or four hours.
Bismuth should be given three times a day in half-teaspoonful doses.
The patient should be kept warm and given large quantities of water
to make up for that lost by the running off of the bowels. Vomiting
may be relieved by sucking small pieces of ice. Some writers recom-
mend the internal administration of sodium bicarbonate (baking
soda). Black coffee may be given during the cold stage of the dis-
ease. Morphine will control the colic. Hot applications to the
abdomen, using either hot-water bottles or turpentine stupes, will
help to relieve abdominal pain. It is essential for the patient to be
kept warm by means of hot-water bottles; jugs filled with hot water
may also be used as extra means for supplying heat. No food .should
be given during the acute attack; and during convalescence the diet
of a cholera patient should be light and nutritious, arrow root, diluted
milk and rice water. Meat extract should be avoided.

Delirium Tremens.

Delirium tremens is sometimes called " the horrors." As a rule,
this disease attacks only seasoned or chronic drinkers. It may fol-
low a bout of heavy drinking or the sudden and complete withdrawal
of liquor. The latter condition may occur when a drinker becomes
ill either from a disease or as the result of an accident.

An attack of delirium tremens usually begins with muscular
trembling; the patient is excitable, talkative, and at times very noisy.
His hands and tongue are kept in more or less meaningless motion.
As the attack develops, there are extreme restlessness and wild excite-
ment. The patient imagines that he sees horrible objects; he can not
sleep and has no desire for food ; he often begs for a drink of liquor.
He may die from severe exhaustion. A patient suffering from this
disease must be carefully guarded as he is temporarily insane and,
hence, not responsible for his actions and may harm himself or
others.

Five or six sodium bromide tablets and sodium bicarbonate, half
a teaspoonful, dissolved in a glass of water, should be given every
three or four hours. Some physicians are in favor of giving alcoholic
liquor in the treatment of persons in this condition, as also to persons
known to be chronic drinkers, in case of accident or illness, with the
idea that the liquor may prevent an attack of the tremens. Every
effort should be made to induce the patient to take nourishment.
Red pepper given in hot milk stimulates the appetite. Ginger ale
and lemonade are usually acceptable to the patient. In case of
extreme exhaustion, a half teaspoonful of aromatic spirits of am-

SPECIFIC DISEASES AND THEIB TREATMENT 91

inoniii in a glass of water will stimulate the heart; the dose may be
repeated, if necessary. The patient should be kept warm with hot
water bottles and plenty of covers.

Diabetes Mellitus (Sugar in the Urine).

Diabetes mellitus is chronic in its course and is characterized by
the presence of sugar in the urine, an excessive thirst, an increase in
the quantity of urine voided, and a progressive loss of both flesh and
of strength.

Treatment. — It is not likely that a ship's officer will be called upon
to treat diabetes, but there are certain complications of this disease
which he may have to take care of. These complications include
skin changes, involving boils, carbuncles, eczema, and even gangrene,
lung troubles, as tuberculosis, pneumonia, and gangrene of the lungs
and affections of the eye, such as cataract, palsies, and occasionally
blindness.

Diabetic coma or acidosis is a complication characterized by un-
consciousness, dyspnea, pain in the head, delirium, rapid and feeble
pulse. The breath has a sweetish odor.

Simple remedies for the relief of pain and the free use of sodium
bicarbonate are about all an officer can prescribe in these cases. The
diet should be altered so as to reduce to the minimum foods which
contain sugar and starches. The intestines should be kept open by
cathartics. Boils should be opened and painted with tincture of
iodine. At the first opportunity the diabetic should enter a hospital
for treatment at the hands of a competent physician.

Dysentery (Bloody Flux).

Dysentery is an acute disease of the intestines caused by either a
germ or a very small organism called an ameba. The germs or the
amebas find their way into drinking water, and through it as a
medium, gain entrance into the intestines of human beings. The
disease is manifested by fever, griping pains, and a persistent in-
clination to have bowel movements; the stools are frequent, small,
contain much mucous and, in many cases, blood and pus. The symp-
toms last about a week. The patient loses much weight. In the t3^pe
of dysentery that is caused by a germ, there is often persistent vomit-
ing; the prostration is great, and death may occur on the third or
fourth day. Recovery is slow and may not be completed for three
or four weeks. The amebic type of the disease often becomes
chronic.

Treatment. — When a case of dysentery appears, attention must at
once be directed toward prevention of the spread of the disease
among the other members of the crew ; this can be done best by boil-
ing all the water used for drinking and cooking, and thoroughly

92 the ship's medicine chest

cooking all food before it is eaten. The discharges from the patient
must be carefully disinfected before they are disposed of. The sick
should be isolated. Flies and roaches and all vermin should be de-
stroyed because they may play a part in transmitting the germs of
the disease.

The patient should be kept in bed. His treatment should begin
with a course of calomel — i/4-grain tablet every hour until four
tablets have been taken, when a tablespoonful of Epsom salts
should follow. Useful remedies for lessening the number of bowel
movements are Dover's powder, a 5-grain tablet every two or three
hours, or a Sun cholera tablet every two or three hours. The diet
should be liquid or semisolid and should not contain eggs. In case
of collapse, keep the patient warm with hot- water bottles and plenty
of covers; give either aromatic spirits of ammonia or a tablespoonful
of alcohol, well diluted in water. Strychnine (amount in tablet, one
tablet three times a day) is an excellent stimulant. Chronic dysen-
tery requires thorough treatment at the hands of a competent
physician.

Diphtheria.

Diphtheria is an acute specific infectious disease. It is localized in
the throat, sometimes in the nose, but produces a general blood poison-
ing. The onset of the disease may be mild, resembling an ordinary
sore throat, or it may be indicated by a chill. Headache and some
fever are almost always present. The most prominent symptom is
the sore throat. The appetite is poor; the tongue is slightly coated.
Examination of the throat discloses patches of false membrane which
appear as a white or dirty white coating. At first these patches are
confined to small areas of the tonsils or throat, but the membrane
spreads rapidly and soon covers a considerable part of these. The
patient becomes weak from general poisoning of the blood which is
caused by absorption of toxins from the throat lesion.

Treatment. — All sore throats should receive immediate attention.
Dissolve one to three alkaline antiseptic tablets in a glass of hot water
and have the patient gargle every hour or two. Give 5 grains of
quinine three or four times a day. The sore throat may be swabbed
with tincture of iodine, diluted one-half with water. Care should be
taken not to have the swab too wet with the solution. If it gets into
the windpipe it will cause severe cough and possibly serious inflam-
mation. A person with a sore throat that shows patches, as de-
scribed above, should be isolated, because if the case proves to be
diphtheria, the disease is likely to spread.

Diphtheria antitoxin is a specific remedy for this disease and,
if practicable to do so, the patient should be landed at the nearest
port so that the antitoxin may be given as soon as possible.

SI'l'.CIl'U' DISKASKS AND THBIB TREATMENT 93

Epilepsy.

Epilepsy is sometimes failed "fits." It is a chronic disease. The
specific cause of ii can not always be determined. Injuries to the
head are sometimes followed by epileptic fits.

The attack sets in suddenly, the patient falling with a peculiar1
cry. There is loss of consciousness, the face is pale. The body is
rigid, but in a few moments is shaken by more or less pronounced
convulsions. Often the patient bites his tongue and makes it bleed.
The pupils of the eyes are dilated.

Treatment. — Means should be taken to prevent the patient from
injuring his tongue by biting it deeply. To this end a portion of a
towel, a handkerchief, a long piece of wood, or the handle of a tooth-
brush should be inserted between his teeth. Whatever is placed in
his mouth for this purpose should be fastened with a string or held
so that the patient can not swallow it. The attack is self-limiting
and lasts but a short time. A person subject to epilepsy would be
much better engaged at work on shore.

Attacks of epilepsy are likely to recur at any time, so that it is ad-
visable, because of the danger to himself and others, not to include
in a crew anyone subject to such attacks.

Between attacks, an epileptic should live on a moderate diet and his
bowels should be kept free by the use of cathartics.

Erysipelas.

Erysipelas, a common and acute infectious disease, is caused by a
specific germ. Its onset is marked by a chill, nausea, vomiting, tired
feeling, headache, pains in the limbs, and rise of temperature. The
pulse rate is increased; the tongue is coated. There may be either
constipation or diarrhea. Delirium may occur, especially if the
patient is an alcoholic. The disease manifests itself externally as a
tense, shining, crimson, or violet-hued area of the skin, most fre-
quently of the face. This area is swollen and firm, feels hot, and is
tender to the touch. The borders of it are sharply outlined. The
patient complains of the swelling which, at times, may be severe;
heat, pain, and itching are constant. The affection of the skin
usually subsides in from five to seven days and later the skin over
the affected area scales.

Treatment. — Isolate the patient. The disease is self-limited. Keep
the bowels in good condition. Put on a wet dressing of alcohol,
water, and glycerine, each one cup, and two bichloride of mercury
tablets dissolved therein. Keep the dressing constantly saturated
with this mixture. The diet should be light and nutritious.

The Eyes.

The most common affection of the eye is irritation, due to the
presence of some foreign substance such as a chip of paint, or a

94 the ship's medicine chest

piece of dirt, sand, coal, etc. "When anj-thing gets into the eye, it
should be removed immediately before the patient has had time to
rub the eye, for rubbing only produces more injury. If the foreign
body is allowed to remain, it may bury itself in the eye and cause an
ulcer.

The proper way to remove a foreign particle from the eye is as
follows : First, have ready a wooden applicator with a small amount
of cotton tightly wound around one end. (A toothpick or a match
may be used as an applicator.) The cotton should be slightly
dampened so that the foreign object will adhere to it more easily.
The next step is to examine the eye. Pull down the lower lid and
look carefully; if the foreign substance is on the lower lid, it can
be removed easily. Usually it will be found on the under surface
of the upper lid, and the lid should be folded back by placing a
match against the lid, then picking up the lid by the lashes and
folding the lid back over the match. The folding is facilitated by
slightly pressing downward with the match. With a little practice
this operation becomes quite easy. The under surface of the upper
eyelid is thus brought into plain view. If the object is on the upper
lid, it may easily be removed with the dampened applicator. If
the object is on the eyeball and not firmly attached, it may be
removed by a light, swift, flicking motion. If the object is embedded
in the eyeball, it is necessary to deaden the sensibility of the eye
before removing the object. A few drops of a solution of cocaine
(eye solution) dropped in the eye and allowed to remain for five
minutes will so deaden sensation that the object may be taken out
without pain. The eyeball is very delicate, and too much care can
not be used in working with it. After the foreign object has been
removed, the eye should be thoroughly washed with boracic-acid
solution, warm, but not too hot. The eyecup should be filled with
the boracic-acid solution and placed over the eye; then the head
should be thrown back and the eye should be opened and closed at
least a dozen times. The eye should be washed in this way at least
two or three times a day. The issuance of goggles to men detailed
to chip and scrape paint will prevent many eye injuries.

Other Conditions Affecting the Eyes.

Sudden blindness, if not due to an accident, is due to internal
causes and can not be treated by a ship's master.

A cold in the eye or any condition in which the eye is inflamed
or discharges pus requires irrigation with warm boracic-acid solution
as described above. Whenever there is a discharge from the eyes
they should be washed as indicated above several times daily. If, as
occasionally happens, substances are spattered into the eyes, prompt
action must be taken to keep the eyes from being damaged. In the

SPECIFIC DISEASES AND Til Ell; TREATMENT 95

use of lye, for instance, some of it may accidentally gel into the eye,
and this condition should be treated immediately. Castor oil will
quickly stop the burning, and enough of the oil should be poured into
the eyes from time to time to keep them constantly bathed with it.

After an hour or two, the oil may be washed a way with boracic-acid
solution used in the eyecup, and a small amount of boracic-acid salve
may then be applied to the inner surfaces of the eyelids.

Other irritating substances splashed into the eye should be washed
out with either clear water or boracic-acid solution.

Gonorrhea. (Seep. 121.)
Gout.

Gout often resembles rheumatism, and in many instances it is
difficult to tell the difference between the two affections. Gout affects
chiefly the small joints; a frequent site for it is the great-toe joint.
Even more pain, redness, and swelling may occur in gout than in
rheumatism. There is moderate fever. Sweating is not profuse.
Small nodules in the lobes of the ears are frequently seen in this
disease. The attacks recur frequently and at fairly regular intervals.

Treatment. — The treatment of acute gout is similar to that recom-
mended for rheumatism — rest, light nutritious diet, and cathartics,
when necessary. Consult a physician at the first opportunity to
secure an accurate diagnosis and careful treatment.

Heart Disease.

There are various t}-pes of heart disease, but a seaman will not be
able to recognize the different types. Suffice it to say that if a man
has distress in the region of his heart with spitting of a thick fluid
sometimes stained with blood; marked shortness of breath upon the
least exertion or exercise ; a dusky or livid color of the face ; swelling
or dropsy in any part of the bocly; pain in the region of the heart
and extending down the little-finger side of the left arm, it is probable
that he is suffering from an acute attack of heart disease.

Treatment. — Place the patient in bed and keep him quiet. It may
be necessary to prop him up with pillows. His diet should be liquid
or semisolid for a few days and should be gradually increased as he
improves. The pain and the rapid heart action may often be con-
trolled by placing an ice bag over the heart. If there is severe
collapse, give a tablespoonful of alcohol or whisky well diluted wTith
water, or a teaspoonful of aromatic spirits of ammonia well diluted
wTith water.

In case there is dropsy it is a good plan to give a teaspoonful of
sweet spirits of niter two or three times a day to stimulate the kidneys.
A cup of black coffee will usually accomplish the same result. Two
teaspoonfuls of Epsom salts in a glass of water every morning before
breakfast will help to reduce the dropsy.

96 the ship's medicine chest

A person suffering from an acute attack should not be allowed to
continue at work, but should be put ashore if it is practicable for him
to reach his home by a land route. A seaman whose heart is liable
to cause trouble is not able to endure the rigors of his occupation and
should not be employed at arduous tasks.
Heart Neuralgia (Angina Pectoris).

Neuralgia of the heart is manifested by an intense, agonizing pain,
mainly in the region of the heart, but extending to the neck and down
the left arm. The breathing is short and there is a sense of compres-
sion over the heart. The chest is rigid and the action of the heart is
weak and feeble. The face has an ashen gray color and the facial
expression is anxious, the patient being apprehensive of death. The
pain usually lasts a few minutes and then quickly disappears.

Treatment. — During the acute attack allow the patient to inhale a
little chloroform, or give a tablet of morphine (14-grain). In a mild
attack, a mustard plaster, applied over the region of the heart, will
sometimes afford sufficient relief. A person subject to angina pectoris
should not engage in an occupation that requires heavy work, either
mental or physical, nor should he follow the sea, unless on a ship
which carries a physician.

Intestinal Worms.

Tape worms and round worms sometimes infest the intestinal tract
of man. Tape worms are of three kinds — pork, beef, and fish tape
worms. These worms are very long and are made up of many small,
flat, white, ribbonlike segments, which are constantly being passed off
with the stools. Tape worms are usually conveyed into the stomach
of man in infected meat. Thorough cooking of meat will destroy any
tape worm eggs contained in it.

The round worms that infest man are of various kinds and sizes.
Those of the largest type look very much like common earthworms.
There is a very small round worm which infests the flesh of hogs,
and persons who eat meat so infested when it is not thoroughly
cooked are likely to become infested also. The hookworm is also very
small. This parasite is common in tropical and subtropical countries.
The tiny worms and their eggs are passed with the bowel discharges
of infested persons and infest the soil. The worms in the soil work
their way through the skin of the feet of persons who go barefooted,
causing a condition of the feet called "ground itch"; or they may
be taken into the body in the drinking water. Infestation with
intestinal worms is very prevalent in the Orient. The people who
live there should never eat uncooked vegetables.

Treatment. — Infestation with such worms as are mentioned in this
section can not very well be treated on board ship. Mention is made
of them in order to stress the importance of wearing shoes and of

SPECIFIC DISEASES AND THEIR TREATMENT 97

thoroughly cooking all food before it is eaten. If a cook or messboy
is the sufferer, he should be relieved from duty, if practicable. A
hup' dose of Epsom salts will often give temporary relief in cases of
worm trouble; but any members of a ship's crew who are infested
with worms should consult a physician at the first opportunity.

Itch (Scabies).

This skin disease is caused by a very small animal parasite which
burrows beneath the skin and which is transferred from one person
to another by direct contact, by common use of towels, rags, and
clothing.

The rash produced by these minute creatures appears as small
blisters and red pimples which are very itchy and cause the patient
to scratch. They break out most frequently on the sides of the
fingers and between them and on the wrists, the elbows, and the
lower part of the belly. The face and head are seldom affected.

Treatment. — The patient should take a warm bath at night, and
after drying the skin, he should rub sulphur ointment thoroughly
over the parts affected. The next night he should take a bath and
rub in more salve. This treatment should be repeated every night
for three or four nights. The morning following the last treatment,
take warm bath and put on clean clothing. The clothing and
bedding should be thoroughly disinfected. This treatment should
not be repeated for several days, as too frequent use of sulphur
ointment may cause an eczema that may be mistaken for itch.

Itch, Dhobie.

This type of itch is caused by a minute vegetable parasite and is
common in the hot countries. It is really a ringworm.

Treatment. — Sulphur as prescribed for itch, except that it may have
to be repeated oftener.

Itch, Barber's.

Barber's itch is a disease of the skin or the face caused by a fungus.
The disease is easily transmitted from one person to another by the
common use of towels and shaving and toilet articles.

The fungus first invades the roots of the hair. Reddish, scaly
patches first appear and the hairs soon become dry, brittle, and
loosened. The skin becomes distinctly nodular and lumpy; postules
develop and discharge a purulent matter, which accumulates and
forms crusts. Itching, burning, and pain of varying severity are
always present. The disease is chronic and very persistent and
requires continuous treatment to affect a cure.

Treatment. — Dissolve the crusts and scales by the use of warm olive
oil or sweet oil, then apply sulphur ointment. The treatment must
be continued faithfully if a cure is to be effected. The patient should

98 the ship's medicine chest

not use towels, rags, toilet articles, etc., in common with other per-
sons. The towels and other articles used by the patient should be
sterilized, preferably by boiling, in order to prevent reinfection.

Lice.

Head lice. — If these parasites are present on any member of the
crew, they may soon infest the other members. The eggs, or nits, as
they are called, can often be found attached to the hair, especially
behind the ears. They are also found on any part of the body where
there is hair, as the eyebrows, the armpits, the chest, etc.

Body lice. — Body lice feed upon the body, but when not feeding
they secrete themsehTes in the folds and seams of the clothing.

Pubic lice. — Pubic, or crab lice, are found chiefly among the pubic
hairs, but sometimes under the arms, in the eyebrows, and even on
the scalp.

To prevent lousiness, strict cleanliness is necessary. This means
clean men, clean forecastles, and clean " heads."

To get rid of lice, first clip off all the hair and then apply kero-
sene and vinegar as directed elsewhere in this book (p. 25). Mer-
cury ointment will kill crab lice. The ointment should be applied
after the subject has taken a good bath, and should be washed off
on the following day. The treatment should be repeated within a
few days.

To destroy body lice, fumigate the clothes with either sulphur or
steam. A hot flatiron pressed over the clothes may be used if
sulphur or steam is not available. Cleanliness is the best means
for keeping free from lice. Every effort should be put forth to
exterminate these parasites, not only because they cause discomfort
and are loathsome and filthy, but because they sometimes convey the
deadly disease called typhus fever.

Malaria.

Malaria is variously called ague, fever and ague, chills and fever,
marsh fever, and swamp fever. The disease is caused by protozoa,
a low form of animal life a little higher in the scale than germs or
bacteria. These protozoa are taken up with the blood of malaria
patients by mosquitoes which bite them. In the body of the mos-
quito the protozoa undergo a certain part of their development;
and when the mosquito afterwards bites another person some of the
protozoa are injected into the new victim and he falls ill with
malaria. The disease is thus transmitted from one person to another
by mosquitoes.

There are three types of malaria, but only one type of mosquito
which carries the protozoa — the Anopheles mosquito.

SPECIFIC DISEASES and THEEB TREATMENT 99

An attack may occur daily, every other day, or two days in suc-
cession; then there is ;i day or perhaps a greater interval of intermis-
sion before the next attack comes on

The symptoms usually appear in three stages — the stages of chill,
fever, and sweating. The chill begins with yawning, a tired feeling,
headache, and perhaps nausea, or a desire to vomit. The patient is
very chilly, his teeth chatter, and he can not get warm. He is also
very thirsty. This stage of the attack lasts about a half hour or an
hour, when it gradually merges into the second stage, the stage of fever.
The patient now becomes hot, feels as if he is burning up. The tem-
perature may rise as high as 106° F. There are intense headache,
backache, nausea, and a great desire to drink cold water. This stage
lasts from 1 to 10 hours, when the patient passes into the third stage,
that of sweating, during which the whole body is bathed in a profuse
sweat. With the sweating stage, which usually lasts from one to
four hours, the symptoms subside and the patient feels more com-
fortable and finally falls asleep.

Treatment. — The prevention of malaria is far easier than its treat-
ment. A person must be bitten by an infected mosquito before the
disease can be transmitted to him. For prevention, 5 to 10 grains
of quinine should be taken daily by all aboard for about 10 or 1-4
days before entering a malarial section and until well out of the
malarial district. Sleeping quarters should be thoroughly screened.
Mosquitoes do not fly any great distance from shore; therefore,
when in a malarial country, the ship should, if possible, anchor at
some distance from shore. Buckets and all water containers on
board ship should be tightly covered so as to prevent mosquitoes
from breeding in them. Mosquitoes on board may be killed with sul-
phur fumes and by swatting them. Seamen should remain on
board at night, for if they go ashore, they run the risk of being
bitten by mosquitoes.

When the disease has been contracted, the only specific remedy is
quinine. Five to ten grains of quinine should be given from three
to five hours before an attack is due and the patient should con-
tinue to take quinine until he is proved free from malaria parasites
by an examination of his blood by a physician. The bowels should
be kept open by giving a cathartic.

Malta Fever (Undulant Fever).

The onset of this disease frequently follows the drinking of infected
cow's or goat's milk, a medium through which the germ is conveyed
to man. The symptoms, which develop slowly, are headache, tired
feeling, restlessness, prostration, and gradual rise of temperature.
There may be bleeding of the nose. The tongug is coated. There are

100 the ship's medicine chest

profuse night sweats. The temperature gradually returns to normal
in two or three weeks, but relapses are common.

Treatment. — The disease must run its course, and so treatment must
consist chiefly of good nursing. The bowels should be kept free by
the use of cathartics. Five grains of quinine may be given three or
four times a day. The diet should be light and nutritious. The
crew should be cautioned against drinking raw milk unless it is
certain that the milk came from a healthy animal.

Measles.

Measles is a disease of children or young adults, probably because
most children have an opportunity to contract the disease from
others. Adults may, however, contract it at any time during life.
One attack usually confers immunity.

The disease ordinarily begins with a cold, chill, or chilliness,
and a fever ranging from 101° to 102° F. The muscles of the body
are sore and tender. There are headache, intense nasal and throat
catarrh, sneezing and coughing, and the eyes are red and watery.
On the second day the fever declines but rises again on the fourth
day, when a small dark-red eruption appears on the face and rapidly
spreads over the entire body. Even before the skin eruption appears,
small irregular bright red spots with white or bluish centers are
often seen on the lining membrane of the lips and cheeks. These
spots are called Koplik's spots, and their presence aids in making an
early diagnosis of measles.

Treatment. — Measles is a self-limited disease. The patient should
be isolated in a dark, well-ventilated room. The bowels should be
kept regular by the use of castor oil, Epsom salts, or compound
cathartic pills. The patient must be prevented from catching cold.
The diet should be light. The chief danger from measles is that
the patient may develop bronchial pneumonia.
German Measles.

This disease is also called Liberty measles, French measles, roseola,
or rubella.

It is an acute, self-limited, contagious disease. Onset occurs with
a mild fever, suffused eyes, little or no cold or sore throat. The
glands of the neck are somewhat enlarged. An eruption appears at
some time between the first and fourth day of the illness. Symptoms
last about a week and then gradually disappear.

Treatment. — There is no special treatment. Iveep the patient in
bed and isolated. Give a cathartic. The diet should be light and
nutritious.

Mental Diseases, Insanity.

Insanity is a mental disease which affects people so that their
actions seem unnatural as compared with those of other people. On

SPECIFIC DISEASES A\H TITl'.n; TREATMENT 101

account of his mental disorder, an insane person forms unusual ideas

and opinions, and these impel him to do things which he would
not do under normal conditions.

There are many people who. while not actually mentally unbal-
anced, are different from the average individual by reason of some
defect in their personality. Some of these are mentally defective
by reason of a bad heredity; others have disorders of memory, at-
tention, ideas, or judgment; they may have alternate periods of
melancholy or exaltation; they may have morbid imaginations or
they may commit unusual and disgusting sexual acts, or they may
be chronic, wanton liars. Such persons do not make good sailors;
they are trouble makers and upset the discipline of the ship; they
may be positively dangerous because of their lack of judgment and
irresponsibility. The chronic criminal and those who commit crimes
of violence fall in this class. In choosing a crew, " queer " people
should never be shipped.

Insanity may be acute or chronic and may develop suddenly or
slowly. There are many types of insanity, so that special knowledge
and training are necessary in order to be able to name the class to
which any certain case belongs.

Treatment. — A person who shows signs of insanity while on board
ship should be closely watched in order that he may harm neither
himself nor anyone else. Not much can be done in the way of treat-
ment. Bromide, three or four tablets three times a day, may be of
some benefit in quieting the patient. The diet should be light. The
bowels should be kept free by the use of cathartics. At the first
opportunity, such persons should be sent to a hospital.

Mumps.

This is an acute, specific, infectious disease, affecting one or both
parotid glands and other salivary glands, which are located in front
of the ears and beneath the jaws. There is a tendency for the
testicles to become involved also. There should be no difficulty in
recognizing mumps by the swelling of the face in front of the ear
and on and beneath the jaw. If only one side is affected, the other
side usually begins to swell as the first begins to subside.

Treatment. — Isolation, light diet, and cathartics. If the testicles
become involved, they should be supported by a suspensory or by
a. handkerchief or towel and the patient kept in bed. Since the
disease is spread by the sputum, great care should be taken lest the
patient's sputum gets on the hands of other people or articles which
are in common use.

Neuralgia.

Neuralgia is a disease affecting the nerves. It is characterized by
sudden sharp and darting pains which extend along the course of

102 the ship's medicine chest

the nerve affected. The usual cause of this affection is exposure to
cold, damp weather.

Neuralgia may affect an}' nerve of the body. It may be centralized
in the face, the arm, the leg, or an}^ other part of the body.

Treatment. — Hot applications are effective for relieving the pain.
The bowels should be emptied by cathartics, preferably castor oil.
The diet should be light and nutritious. Sometimes relief from the
pain may be obtained by applying a mustard plaster to the affected
part or by painting it with tincture of iodine; if persistent, a physi-
cian should be consulted.

The Nose.

An offensive discharge from the nose such as often accompanies
a cold is best treated by gently washing out the nose with a solution
prepared by dissolving one alkaline antiseptic tablet in a glass of
warm water. This solution should be used three times a day or
oftener, if necessary.

Bleeding from the nose is sometimes difficult to stop. The appli-
cation to the nose of a cloth wrung out in cold water will suffice to
stop a mild bleeding. If the bleeding persists, a pledget of cotton
should be packed into the nose and left there for two hours or more.
When removing the cotton be sure that all of it is out. The patient
should be warned not to blow the nose when it bleeds, but to allow
the blood to collect and clot.

Paralysis, Facial.

Facial paralysis is an acute paralysis of one of the cranial nerves
called the facial nerve, which controls the muscles of the face. The
condition is caused by exposure to cold, but sometimes follows dis-
eases of the ear.

Its onset is sudden, beginning with a tingling of the lips and
tongue. The paralyzed side of the face takes on a blank expression;
the corner of the mouth is depressed ; the eyelids are open ; the face
is drawn toward the side that is not affected. The patient is unable
to spit or to whistle.

Treatment. — The bowels should be opened by the use of a cathartic.
After the acute symptoms subside, the affected parts should be mas-
saged. The prognosis of this disease depends upon its cause. Many
cases of it clear up within a short time.

Plague.

Plague (black death, oriental plague, bubonic or pneumonic
plague) is a specific infectious disease caused by the plague germ.

The disease begins with extreme prostration; there is a rapid rise
of temperature and the pulse beats much faster than usual. There
may be hemorrhages (bleeding) into the skin. The lymphatic glands

SPECIFIC DISEASES AND Til 1. 1 1; TREATMENT 103

of the groin, armpit, or meek enlarge, and on the second <>r third day
buboes (swellings) appear on the groin, neck, or armpit : the tempera-
ture drops when the buboes appear and profuse sweating occurs. In
the beginning the buboes may be very small, but are very painful and

tender. When touched with the hand they feel as if matted together.

The pneumonic type of this disease resembles an acute pneumonia
and is almost always fatal.

Treatment. — The best preventive measure is to kill all the rats on
board and to keep other.- from taking their places. This requires the
complete periodic fumigation of ships. The disease is transmitted
to man by the bite of rat fleas. Therefore it is of vital importance to
exterminate rats and their fleas. Measures for their destruction have
been suggested elsewhere in this book.

The patient should be isolated, given a cathartic, and kept on a
light nutritious diet. The buboes should be painted with tincture of
iodine and covered with sterile gauze.

The body discharges — sputum, stools, urine, and discharges from
buboes — should be thoroughly disinfected. Burning is the best and
safest means of disposing of them. The members of the crew should
be frequently and thoroughly examined. Clothing and quarters
should be thoroughly disinfected in order to destroy fleas. When
plague appears on board, the ship should proceed to the nearest port
for quarantine treatment.

Pleurisy.

Pleurisy is an inflammation of the pleura, the sac which surrounds
the lungs. The disease is manifested by severe pains in the chest
on both sides or on one side only. There is also rise of temperature.

Treatment. — Treatment must be directed mainly toward the relief
of pain. Keep the patient in bed. Give a tablespoonful of Epsom
salts. Apply strips of adhesive plaster from the backbone to the
middle of the chest. Attach an adhesive strip first over the backbone,
bring it forward and during a deep exhalation, or breathing out of
air from the lungs, fasten the strip over the center of the breastbone ;
let the next strip just overlap the preceding one and so on until the
side is covered with adhesive strips from above the nipple to the
lower border of the ribs. The strapping prevents the full expansion
of the chest on the side afflicted and thus helps to relieve the. pain.
A hot-water bottle also gives some relief. Sometimes the applica-
tion of cold, as in an ice bag, will lessen the pain. The patient should
be given aspirin three or four times daily. The diet should be light
and nutritious. Sweating is a favorite treatment for pleurisy, but
care should be taken to avoid exposure afterwards. The sweating
should not be continued until the patient is exhausted.

104 the ship's medicine chest

Pneumonia (lung" fever).

The onset of pneumonia, or lung fever, is rather sudden. It begins
with a chill, which lasts from a few minutes to an hour or more.
Sometimes the disease follows an acute cold. The fever remains
high, the breathing becomes rapid, and there are usually pains in
the chest and headache. The cough may not be distressing at first,
but grows very troublesome. Soon the sputum becomes thicker and
brown or rusty in color, and sometimes frothy and bloodstained.
Quite often the cheeks are flushed. The patient lies upon the
affected side of the chest. A chill, followed by high temperature,
rapid and painful breathing, rapid pulse and rusty sputum, furnishes
a sufficient basis for a fairly accurate diagnosis of pneumonia.

Treatment. — Put the patient to bed. Give one calomel tablet
(^4-grain) every hour for four doses; follow this course by a dose
of either Epsom salts or castor oil. Cover the patient well with
blankets and, regardless of cold weather, have all doors, windows,
and other apertures opened to their maximum capacity. The patient
can be kept comfortably warm with covers. In emphasizing the need
of fresh air for the patient, it is not intended that he should be
exposed to drafts, but one of his great needs is an abundance of
fresh air. The diet should be liquid or semisolid and the patient
should be fed every two hours. Give him all the water he will
drink. Lemonade, ginger ale, and other such drinks are good for
getting fluid into the body in order to wash out the poisons caused
by the pneumonia germs. On the fifth, seventh, ninth, or eleventh
day the disease usually subsides suddenly and passes through what
is called the crisis. As just mentioned, the crisis generally occurs
during the night hours of an odd day, but may occur on an even day.
The occurrence of the crisis means that the disease has spent its
force and that the patient will probably recover. The period of
crisis is critical, since at this time the vital forces are at their lowest
and the patient hovers between life and death and may pass one way
or the other. At this stage it is often necessary to stimulate the
patient. Hot-water bottles should be placed around him, because he
becomes cold and his heart action is very weak. For the weak heart
give two %0-grain tablets of strychnine. Sometimes stimulation may
be effected by giving the patient a tablespoonful of whisky well
diluted in water. Aromatic spirits of ammonia, a half teaspoonful
to a teaspoonful in a glass of water, is also a heart stimulant. A
patient who is recovering from pneumonia must have his diet care-
fully and gradually increased in order to hasten the return of his
strength. If at any time during the disease the cough becomes dis-
tressing, it may be allayed somewhat by a Brown mixture tablet,
dissolved on the tongue; one of these tablets may be given quite often
unless it is found that they irritate the stomach.

SPECIFIC DISEASES \xn THEIR TREATMENT 105

A person who is recuperating from pneumonia must be warned
not to expose himself to inclement weather, for there is always
danger that the disease may recur.

Poisoning.

While poisoning may be self-inflicted in the effort to commit sui-
cide, accidental poisoning is much more frequent. Poison should
be suspected if (1) severe and alarming symptoms suddenly attack
a person who has been in good health; (2) if severe symptoms de-
velop shortly after taking food or drink, or after taking medicine;
(:$) or if several persons become ill in the same way at the same
time.

Some poisons are corrosive when swallowed and may be readily
detected because they burn or corrode the lining membrane of the
month and throat. Examples of sitch poisons are carbolic acid.
corrosive sublimate, lye, and cresol.

Some poisons do not burn nor destroy the lining membrane of
the mouth and throat, but have, nevertheless, a very severe effect
upon the stomach and intestines. In this class of poisons are in-
cluded the ptomaines, present in tainted fish and meat and other
animal foods. Another class of poisons includes opium, morphine,
and alcohol when taken in overdoses.

Treatment of poisoning. — In the treatment of poisoning, the general
plan is (1) to help the patient rid himself of the poison by vomit-
ing; (2) to counteract the poison by its proper antidote; (3) to
stimulate the patient, if there are signs of collapse; (4) to relieve
suffering as far as possible.

Vomiting, or Emetics.

One of the best and quickest means of helping the patient to rid
himself of the poison is to induce vomiting. This may be done by
(1) placing the finger far back in the throat or (2) by giving a
tablespoonf ul of either mustard or common table salt in a tumblerful
of warm water. Warm sea water makes an excellent emetic.

The various types of poisoning which are liable to occur on board
ship are those named below :

Alcohol Poisoning.

Any strong alcoholic liquor taken in excess is likely to produce
acute poisoning. The diagnosis of alcoholic poisoning is made by
noting the odor of the breath and the symptoms, which are giddiness,
reeling, stupor, insensibility, and the other symptoms of drunken-
ness. The face is flushed and the eyes are bloodshot.

Treatment. — Loosen the clothing about the neck and waist. Give
an emetic, such as mustard (a tablespoonf ul in a glass of warm
112035°— 29 8

106 the ship's medicine chest

water) or warm sea water until vomiting occurs. Three drops of a
solution of carbolic acid in a glass of warm water is a good antidote.
After the stomach has been emptied, place the patient in bed and
give him a teaspoonful of aromatic spirits of ammonia in a half
glass of water. Keep him warm by placing hot-water bottles around
him. On recovery from the acute attack give him a carthartic. Keep
him on a light diet. For the first 24 to 48 hours hot milk, made hotter
still with pepper, should be given; this is usually very acceptable to
the patient.

Wood-Alcohol Poisoning.

Wood-alcohol poisoning has become a frequent occurrence since
the advent of prohibition. Seamen should be warned of the danger
of drinking so-called bootleg liquor. Even a small quantity of wood
alcohol may cause blindness, mental disease, or death.

The symptoms of this poisoning are somewhat similar to those
which follow the use of grain alcohol, but with certain differences.
In case of poisoning by wood alcohol the symptoms, which may not
appear for some hours after drinking the alcohol, are marked blue-
ness of skin, labored breathing, and subnormal temperature. There
if often permanent, complete, or partial loss of vision, which may
occur within a few hours or may be delayed for .some days.

Treatment. — There is no specific treatment for wood-alcohol poison-
ing. Blindness produced by it can neither be prevented nor cured.
Death frequently results from the poison. The patient should be
stimulated with aromatic spirits of ammonia and should be kept
warm, and the bowels should be kept open by cathartics. Very di-
lute carbolic-acid solution may be used as an antidote. Get the
patient into a hospital.

Ammonia Poisoning.

Ammonia poisoning produces burning pain in the mouth and
throat. The lips and tongue are inflamed and swollen. There is
often difficulty in breathing. The eyes are bloodshot. There is
usually vomiting and the matter vomited may contain a small amount
of blood. The odor of ammonia can be readily detected.

Poisoning from ammonia fumes such as may occur around re-
frigerating apparatus using ammonia is manifested by violent affec-
tion of the lungs and eyes. Death from it may be sudden. Pneu-
monia is quite likely to set in as a result of the irritation of the lungs.

Treatment. — When ammonia has been swallowed, give lime juice or
lemon juice or white of egg in small and repeated doses. The irri-
tation of the lungs may be relieved by inhaling steam from boiling
water.

SPECIFIC DISEASES AND THEIR TREATMENT 107

Arsenic Poisoning.
Arsenic poisoning may occur from the accidental ingestion of

rat poisoning or poisoned fly paper. Symptoms usually appear in
about a half-hour; they are nausea, and vomit inn- of a brown or
bloodstained matter; faintness and much thirst, with dryness of the
throat and perhaps diarrhea and cramps in the abdomen and legs.

If a Large quantity of the poison has been ingested, stupor- and slight
convulsions follow.

Treatment.— If patient is not unconscious, give whites of eggs,
induce vomiting by giving either mustard or salt water, and. after
vomiting, large drafts of fresh water. Give a large dose of castor
oil in order to empty the intestines quickly. Keep the patient Avarm
with covers and hot-water bottles. Stimulate, if necessary, by giv-
ing dilute whisky or aromatic spirits of ammonia, in teaspoonful
doses, well diluted with water.
Carbolic-Acid Poisoning.

Carbolic acid is a very active and dangerous poison. If it is
spilled on the skin, immediate destruction of the tissue takes place.
Taken internally in sufficient quantity, it quickly causes death.

Carbolic acid produces, when swallowed, a white and swollen ap-
pearance of the lining membrane of the mouth and throat. There is
intense pain along the under surface of the breastbone and in the
stomach. Delirium and collapse soon follow.

Treatment. — If spilled upon the skin, carbolic acid should be
washed off with water, and a wet alcohol compress should be applied
and left on at least an hour; this should be followed by an applica-
tion of boracic-acid salve. If carbolic acid has been swallowed, give
a large tablespoonful of Epsom salts in a glass of warm wTater and
also give whisky diluted with water. Olive oil, castor oil, the
white of an egg, or a thin flour paste may be given to counteract
the corrosive action of the acid. After a few7 minutes the stomach
should be emptied by means of an emetic (a tablespoonful of mustard
in a glass of warm water). Keep the patient warm with covers and
hot-water bottles. He should be kept on liquid diet for a few days.

Iodine Poisoning.

Iodine, when swallowed, produces intense scalding pain in throat
and stomach. It often induces vomiting. If it is taken in large quan-
tity, unconsciousness and early collapse follow.

Treatment. — Make a thin paste of starch (corn starch) or flour and
give the patient as much as his stomach will hold. After a few min-
utes or a half-hour, empty the stomach by inducing vomiting by
giving a tablespoonful of mustard to a glass of hot water. Warm
sea water also makes a good emetic.

108 the ship's medicine chest

Morphine Poisoning.

Shortly after taking an overdose of morphine or opium, a etage
of mental excitement sets in. This is followed by drowsiness: and
later by complete insensibility. The face is flushed or livid. The
lower jaw falls, the pupil of the eye is extremely small, being reduced
often to the size of a pin point. The pulse gradually falls and
breathing is noisy and slow.

Treatment. — Give a mustard emetic (1 tablespoonful of mustard to
a glass of hot water) or sea water in order to empty the stomach.
Irritating the throat with the finger will also induce vomiting. Give
plenty of black coffee at repeated intervals. Pour sea water over
the face and chest. It is important to keep the patient awake by
walking him about the deck, slapping him with a cold, wet towel, etc.
Should the patient become cold and show signs of collapse, give a
teaspoonful of aromatic spirits of ammonia in half a glass of water.

Strychnine Poisoning.

Strychnine is an ingredient of many of the preparations used to
kill rats and other vermin. If a person accidentally ingests a suffi-
cient quantity of any of these preparations, poisoning results.

The symptoms of strychnine poisoning are painful and rigid
spasms of the trunk, limbs, and body. The body is often curved
backwards until it rests on the back of the head and the heels. The
spasms recur every few minutes. The breathing is labored. The
face is drawn into a fixed grin by spasms of the facial muscles. Quite
often the patient is unable even to open his mouth or to swallow.

Treatment. — Give an emetic to cause vomiting (mustard, 1 table-
spoonful to a glass of hot water). Keep the patient as quiet as pos-
sible. A morphine tablet may be given to reduce the convulsions and
may be repeated in an hour, if necessary. (Do not give more than
three morphine tablets during any one day and give as many as three
only when absolutely necessary.)

Tobacco Poisoning.

Beginners in either smoking or chewing are often made sick by the
effect of tobacco. As a rule, the illness is not serious. There is
violent vomiting and the patient is pale and feels very sick.

Treatment. — Have the patient lie down and apply a hot-water bot-
tle to the stomach. Within a short time the symptoms will begin to
subside. A cathartic should be given and the patient should be put
on light diet for a few days.

Bichloride of Mercury (or Corrosive Sublimate) Poisoning.

Bichloride of mercury, or corrosive sublimate, produces a violent
disturbance of the stomach and intestines. There is a sense of con-
striction in the throat and there is a burning pain beneath the breast-

SPECIFIC DISK ASKS AX It THEIB TREATMENT 100

bono and in the stomach with colicky pain- also and diarrhea; vomit-
ing: is frequent and the matter vomited contain- much mucus, which

is often bloodstained. The breath is foul. The pulse IS weak, rapid.
and irregular. The face is pinched and has an anxious expression.
The hands and feet are cold. Convulsions and unconsciousness may
occur.

Treatment. — Fill the patient's stomach with whites of eggs. In
half an hour give an emetic of 1 tablespoonful of mustard in a glass
of hot water. Apply heat to the body by means of hot-water bottles
and extra covers.

Formaldehyde Poisoning.

Formaldehyde poisoning is marked by pain and vomiting, the
vomited matter containing mucus and blood. The heart is very much
depressed.

Treatment. — Give mustard in hot water as an emetic. Allow the
patient to inhale ammonia. Give a hot bath. If prostration is great,
give a teaspoonful of aromatic ammonia in half a glass of water.
Cover patient well and place hot-water bottles around him.

Lye Poisoning.

If lye comes in contact with the flesh it corrodes and destroys the
tissues. If lye is swallowed, intense burning pain is felt immedi-
ately in the mouth and throat, beneath the breastbone and in the
stomach. There is early collapse if the close is of sufficient quantity.

Treatment. — The object is to neutralize the lye with an acid. This
can be done by giving the victim dilute vinegar, lemon juice, or lime
juice. If there are signs of collapse, give a teaspoonful of aromatic
ammonia in hot water. Cover the patient with blankets and sur-
round him with hot- water bottles.

Food Poisoning.

Unless properly cared for, certain foods, such as meat, cheese, and
particularly fish, will spoil and are likely to poison those who eat
them. Decayed fruits will also cause poisoning, as is indicated by
marked, digestive disturbances after eating them. Meat should be
obtained from reliable sources, because, if it has been taken from
a diseased animal, disease is liable to be transmitted to those who
eat it. Shellfish, such as mussels and crabs, sometimes produce
serious symptoms when eaten; this is believed to be due to a
diseased condition of the flesh rather than to putrefaction. It is
Avell known that sea food undergoes putrefaction very readily;
therefore, when a ship is cruising in a tropical climate, all fish
and sea food should be cooked as soon as possible after being taken
from the water and should be kept on ice until they are cooked.

110 THE SHIP'S MEDICINE CHEST

It sometimes happens that the flesh of animals and birds becomes
poisoned, as when game birds eat poisoned grain or when sheep
feed upon poison weeds or plants.

Canned vegetables should be thoroughly cooked, since it is possible
otherwise for them to cause serious poisoning, botulism, by the
poison of the Bacillus botulinus.

Poisonous mushrooms eaten by mistake for edible mushrooms,
cause dangerous poisoning. Certain tropical sea fish are very
poisonous.

The symptoms produced by food poisoning resemble those of
an irritant poison, which are violent vomiting, colic, and severe
prostration.

Treatment. — To make the patient vomit, give an emetic, such as a
tablespoonful of mustard in a glass of hot water; repeat, if neces-
sary. After the stomach has been thoroughly emptied, give an
ounce of castor oil. Keep the patient warm with blankets and hot-
water bottles. Combat the shock by giving a teaspoonful of aro-
matic ammonia in half a glass of water.

Prickly Heat.

This skin rash often occurs among seamen when they pass from
a cold to a warm climate. It results in most cases from the exces-
sive sweating induced by the sudden change in temperature and the
fact that the men are dressed for cold weather. Failure to take
daily shower baths and the wearing of dirty underclothes are con-
tributing causes of this distressing rash.

Prickly heat rash may be recognized by crops of minute hard
pimples which are most numerous between the shoulders, on the
forehead, on the back of the wrists and forearms, and over the front
of the chest. The chief complaint made of this rash is that it itches
intensely.

Treatment. — Have the patient take a bath and change his clothing
to suit the climate. A sponge bath with water containing 10 or 15
drops of carbolic acid to a quart often helps to relieve the itching,
as also an application of zinc oxide salve in which carbolic acid,
10 drops to 1 ounce, has been thoroughly mixed. Be careful not to
get the carbolic acid in the eyes. Sodium bicarbonate, 1 teaspoonful
in a glass of water thrice daily, is very helpful.

Relapsing Fever.

This is an acute infectious and contagious disease which is self-
limited in its course and is characterized by a period of fever lasting
about six days to be succeeded by an intermission of about six days,
when there is a relapse, or return, of the symptoms. The disease
is due to an organism called the tipirocheta obermeieri. Bedbugs,

SPECIFIC DISEASES A X I > THEIR TREATMENT 111

body lice, and ticks, arc believed to be the carriers which transmit
this disease from one person to another.

Treatment. — This disease may be prevented by destroying bedbugs,
lice, and ticks by the methods already described in another section
of this book (see p. 25).

A-pirin may be given when the fever is high. The diet should be
light and nutritious. The bowels should be kept open by cathartics.
Rheumatism, Acute Articular.

Acute articular rheumatism is also known as inflammatory rheu-
matism or simply as acute rheumatism.

It is an acute infectious disease characterized by fever, inflamma-
tion and swelling of the joints, acid sweats, and a tendency to com-
plications involving the heart.

The disease usually follows exposure to severe weather. It may
follow other sickness. Diseased teeth and tonsils contribute largely
in the production of the disease.

The onset is abrupt, occurring generally at night with a chill and
pain and stiffness of the joints. There is loss of appetite and some-
times the stomach is upset by nausea and vomiting. The tempera-
ture is raised, ranging perhaps from 102° to 104° F. Profuse sweat-
ing, great thirst, and constipation are additional sjonptoms, and
there is much loss of sleep, due to the pain and the profuse sweating.

The disease is extremely irregular as to the number of joints af-
fected. The affected joints are usually those that are analogous, the
knee and elbow, wrist and ankle, hip and shoulder being attacked
together, either on one side of the body only, or on both sides. The
pain may leave one joint or joints and affect others. The joints that
swell most are those of the knee, wrist, elbow, and ankle, or those
joints that are not thickly covered with muscle tissue. Serious
damage is often done to the heart by repeated attacks of rheumatism.

An attack of this disease usually lasts from four to six weeks.
Relapses are frequent.

Treatment. — In all cases the patient should be placed at absolute
rest in bed. He should wear woolen garments, and blankets should
be used instead of sheets. A frame made of slate or barrel staves
may be used to keep the bedclothes from coming in contact with
the painful joints. The diet should consist of easily digested food.
The patient should drink plenty of water and lemonade; alkaline
mineral waters should be given, if possible to obtain them. Give a
teaspoonful of bicarbonate of soda (baking soda) in a half glass or
a full glass of water two or three times a day, and aspirin, in 5-grain
doses (5-grain tablets), four times a day. The bowels should be
thoroughly evacuated by cathartics. Chloroform liniment may be
applied to the affected joints, and they may be protected from sudden

112 THE SHIP'S MEDICINE CHEST

changes in temperature by wrapping them in cotton. At the first
opportunity the patient should be put in a hospital.

Rheumatism, Muscular.

Muscular rheumatism is an inflammatory affection of the muscles
characterized by pain, tenderness, and stiffness in them. The dis-
ease may be either acute or chronic. One attack of rheumatism
predisposes to another. Exposure to cold, damp weather or to
sudden changes in temperature will induce an attack. Infected
teeth or tonsils and gonorrhea are also causes. The onset of the
disease is usually sudden; the symptoms are pain, slight tenderness
and stiffness of the muscles. As a rule there is no fever. An attack
lasts about a week or 10 days. When affecting the muscles of the
neck, rheumatism is called wry neck or stiff neck. When affecting
the muscles of the back or lumbar regions it is called lumbago.

Treatment. — The patient should rest in bed. Hot applications are
soothing to the affected muscles. The applications should be changed
frequently so as to maintain constant heat about the affected parts.
Aspirin, given in 5-grain doses, three or four times a day, will help
to relieve the pain. The bowels should be kept open by giving
Epsom salts.

Rheumatism, Arthritic (Joint).

This type of rheumatism is a destructive disease of the joints,
resulting in more or less deformity. The cause of this disease is not
definitely known. Heredity, disregard of hygiene, exposure, grief,
mental anxiety, tuberculosis, and any other debilitating diseases may
play a part in causing the condition.

The disease may be acute or chronic. Several joints are usually
attacked at the same time. There may or may not be fever. The
affected joints are swollen and painful. As a rule, the attacks last
only a short time, but recur at varying intervals. The repeated
attacks increase the destructive process in the joint and gradually
result in deformity. Sometimes there are hard nodules or outgrowths
of bone on the sides and ends of the fingers and toes.

Treatment. — The general health should be improved by the mainte-
nance of personal hygiene. Decayed teeth, abscessed gums, chroni-
cally inflamed tonsils, and disorders of digestion play a part in this
disease and should be corrected if cure is to follow. The food should
be nutritious and properly balanced. The bowels should be regu-
lated by the use of cathartics whenever necessary. Hot applications
during acute attacks will relieve the pain, and chloroform liniment is
also helpful.

Scarlet Fever.

Scarlet fever usually occurs in children and young adults. The
disease is self-limited and very contagious. It is marked by a high

SPECIFIC DISK ASKS AND THEIR TREATM] 113

fever, m rapid pulse, and a diffuse scarlet eruption. The eruption is
followed by ;i peeling of the skin, which occurs about two or three
weeks after the rash has disappeared. The throat is usually sore,
and the tongue has a peculiar redness which has given rise to the
expression "strawberry tongue." heard only in connection with
scarlet fever.

The disease is not common among adults, and tests show that most
people have it in relatively mild form in childhood. It is now
possible to immunize children and adults against it. In many
cases there is no skin rash, the symptoms being merely a rather severe
sore, throat. For this reason, all severe sore throats occurring in
persons who have not had scarlet fever should be looked upon with
suspicion.

Treatment. — The disease is self-limited and treatment is therefore
confined to good nursing. The patient should be isolated and all
evacuations should be disinfected. The bowels should be kept free by
cathartics. The diet should be light.

Sciatica.

This disease, sometimes called sciatic rheumatism, affects the sciatic
nerve, which is located in the back part of the hip and leg. The
disease is a true neuralgia and, therefore, the treatment for neuralgia
is applicable for it.

Scurvy.

Scurvy is caused by a diet lacking in fresh vegetables and citrus
fruits. The disease is manifested by loss of weight and strength and
hemorrhages (bleeding) into the skin. The gums become swollen and
spongy and bleed from the slightest irritation. The onset of the
disease is slow, with a general weakness and loss of strength. The
gums may become so badly involved that the teeth loosen and fall out.
Because of the great improvement in the seaman's diet, the disease,
once the scourge of the sea, is now relatively rare.

Treatment. — Scurvy may be prevented by including vegetables in
the diet. Fresh vegetables and fresh and cooked fruits and fresh
meats should be eaten. When it is impossible to obtain such food,
then men should be given lime juice and vinegar.

Seasickness.

The symptoms of seasickness are so well known by every mariner
that it seems scarcely necessary to describe them. They vary from
slight chilliness and dizziness to the most profound physical depres-
sion. In such cases the performance of labor is not possible and life
may even be endangered. Fortunately, this is very rarely the case
and the sufferer soon gains his " sea legs " and is able to carry on.

114 THE SHTP's MEDICINE CHEST

It is believed that the condition results from interference with the
balancing and stabilizing apparatus of the body. Dietary and other
indiscretions and, in some cases, imagination, also play a part.

Treatment.— The treatment for seasickness is directed mainly to-
ward prevention, because when an attack begins there is not much
that can be done to shorten the illness; apparently it must run its
course. Before setting out on a voyage, it is a good plan to live on a
light but nutritious diet, taking care not to overload the stomach for
a few days before sailing. This precaution will do much to prevent
seasickness, or at least to lessen the severity of an attack. If an
attack comes on, the patient should be kept quiet, either in bed or
in a deck chair on deck. He should be warmly clad. Three to
four bromide of soda tablets dissolved in a glass of water will help
to relieve him. If vomiting is persistent, he may suck chips of ice,
or sip ginger ale or lemonade. Hot milk with enough red pepper in
it to give it a hot taste will provide a nourishment that will often be
retained in the stomach even in severe cases of seasickness. Liquids
often keep up the vomiting. An excellent treatment is to give only
dry food; dry toast or crackers, a bit of lean ham, grilled or cold
boiled, etc. To swallow such food it is necessary to chew it a long
time and the act of chewing has a quieting effect upon the stomach.
Such food provides nourishment without great bulk and will be kept
down in cases when bulky liquids will be vomited. Sometimes it is
necessary to apply hot fomentations or a hot-water bottle to the
abdomen in order to relieve the pain. Sun cholera tablets some-
times give relief. A 5 or 10 grain tablet of aspirin may relieve
the headache.
Shingles.

This is a disease of the skin caused by an inflammation of the
nerve supplying the part involved. It appears as bright red patches
covered by clusters of small watery blisters which, in a few days,
become yellow and then break down and discharge. They finally
dry up and form scabs.

The disease is painful and pain may continue even after the scabs
have fallen off. As a rule, only one side of the body is affected ; the
eruptions are most frequently seen on the chest, but sometimes extend
from the backbone around to the center of the breast. They may
occur upon one arm or leg or even over the eyebrow, but are rarely
found in these locations.

Treatment. — Protect the sores by dusting them with bismuth sub-
nitrate or anoint them with boracic-acid salve. A piece of gauze
should be laid over the sores and fastened in place by means of
adhesive plaster. The general health of the patient should be built
up. It is best that patient go to bed.

SPECIFIC DISEASES AND THEIR TREATMENT 11;")

Smallpox.

Smallpox is sometimes called variola. It is an acute communi-
cable epidemic disease. Its onset is sudden, with a violent chill,
vomiting, intense headache, and agonizing pains in the back which
seem to dart thence down the limbs. In small children a convulsion
may occur instead of a chill. The temperature may be 103° to 104° F.
The pulse is full, strong, and rapid. The face is red and the eyes
are injected. There may be delirium or convulsions. On the third
day the characteristic eruptions, which may be described as coarse
red spots, appear, breaking out first on the forehead and wrists..
Within 24 hours the eruptions have acquired a shot-like hardness.
With the appearance of the eruption the severe headache and high
temperature decrease. By the sixth day the eruption has changed
into little blisters with flat or depressed tops containing a cloudy
fluid, and on the ninth day these have become converted into blisters
containing pus. At this time the temperature and other symptoms
reappear. The patients have an offensive and characteristic odor.
Sometimes, especially in the severe forms of the disease, the erup-
tions fuse and may show hemorrhage or bleeding into the pocks.
This type is ofen called black smallpox. Mild cases of smallpox are
dangerous factors in the spread and continuance of the disease.
These are not at all uncommon; and while an epidemic may be char-
acterized by great mildness, there is no telling when it may turn
into the very severe fatal form.

The answer to smallpox is vaccination, a very simple and harmless
procedure when properly executed. There is no excuse for having
an unvaccinated man in a ship's crew. Attention to this detail will
prevent quarantine delays and the expense incident thereto.

Treatment. — A smallpox patient should be isolated for six weeks.
Persons who have been in close contact with the patient just before
he fell ill should be kept apart from others for about two weeks.
Everybody on board should be vaccinated.

The patient should be kept in a darkened room. The eruption
should be covered with a salve such as zinc oxide ointment. Some-
t imes hot dressings are used in place of the ointment. Painting w ith
dilute tincture of iodine has been recommended.

The bowels should be kept free by the use of cathartics. The diet
should be light and nutritious. If the patient becomes weak, it will
be necessary to stimulate with internal doses of whisky or the ad-
ministraton of one strychnine tablet (-^-grain) three or four times
daily.

Sunstroke.

Exposure to the extreme heat of the sun may produce an attack
of illness called sunstroke, The condition develops suddenly, usually

116 THE SHIP'S MEDICINE CHEST

without any warning signs or indications. There may be and usually
is insensibility with perhaps delirium, convulsions, or paralysis.
The body is flushed and hot. The eyes are injected and red. The
breathing is rapid, shallow, and labored. The pulse is either bound-
ing or weak. The temperature is very high — sometimes reaching
110° F.

Treatment. — Treatment is directed mainly toward reducing the high
temperature. Remove all clothing. Give a cold bath, cold rectal
injections, or an ice rub to reduce the temperature. The cold appli-
cations should be discontinued as soon as the skin becomes cool, or
if there are any indications of convulsions. If the patient becomes
too cool or the pulse becomes too weak, it is well to stimulate him by
whisky well diluted with water ; it should be given by mouth, but only
if patient is conscious. Good results may also be obtained by giving
a teaspoonful of aromatic spirits of ammonia well diluted with
water. Never give any medicine by mouth when a patient is
unconscious.

When consciousness has returned, the patient should have a large
close of Epsom salts. He should be kept quiet for at least a week
after the attack and should be warned to be careful when resuming
work, because he will be more sensitive than before to the effects of
the sun.

Syphilis. (See p. 123.)
Tetanus, or Lockjaw.

Lockjaw may occur on board ships that carry domestic animals.
The disease is caused by a germ which enters the body through a
wound in the skin. The wound involved may be very slight, but
usually it is a puncture or fairly deep wound, such as would be pro-
duced by a nail, a tack, or a splinter of wood.

The disease attacks suddenly; there is first a stiffness of the jaw,
neck, and tongue, with a difficulty in swallowing, which increases
in extent, the stiffness passing down the spinal (back) muscles to the
legs. Gradually spasms develop, which involve especially the muscles
of the jaw and face. The fever is usually moderate, the pulse rapid?
and the breathing rate slightly increased.

Treatment. — Treatment consists chiefly of prevention. For this
purpose every wound, no matter how slight, should be treated by
cleaning and applying tincture of iodine.

During the convulsions have the patient inhale a little chloroform
or ether. Place a few drops of chloroform on a handkerchief or piece
of cloth and hold it within a few inches of the nose ; add chloroform,
a drop at a time, until the spasm begins to lessen. When giving
chloroform, be careful not to give enough to put the patient to sleep,

SPECIFIC DISEASES AND THEIR TREATMENT 117

as there is danger of doing. The bowels should be kepi open by the

use of soapsuds injections. The food should be liquid. It may be
necessary to inject it slowly into the bowels.

Tonsillitis, Acute.

Tonsillitis, sometimes known as quinsy, is an acute inflammatory
infection of the tonsils which often ends in pus formation. Acute
tonsillitis is easily contracted; exposure to inclement weather and
weakness from other conditions favor its contraction. The disease
is sometimes epidemic.

The onset of tonsillitis is more or less sudden. There may be
chilliness or an actual chill followed by a rise of temperature. The
pulse is increased. There are headache, thirst, pain, and swelling
of the tonsils, general muscular aching, pain on swallowing, and
perhaps some difficulty in breathing. The saliva may be increase 1
in quantity. Sometimes there is earache. These symptoms being
present, if a look at the throat shows that the tonsils are enlarged
and inflamed, a diagnosis may be promptly made.

Treatment. — The patient must rest in bed. Give a calomel tablet-
s-grain) every hour until eight doses have been taken; then give
a tablespoon ful of Epsom salts dissolved in a glass of water. An
aspirin tablet three or four times a day wTill give considerable relief.
Either hot or cold applications may be placed over the throat. A
gargle made by dissolving one or two alkaline antiseptic tablets in
a glass of hot water should be used every hour or two. Have patient
use the gargle as hot as he can stand it.

Persons having repeated attacks of tonsillitis should consult a
physician with the view of having the tonsils removed. Diseased
tonsils are the cause of many bodily ills.

The Tongue.

Swelling of the tongue may result from taking food into the
mouth too hot or from an insect bite or perhaps from an injury.
A swollen tongue is best treated by using the mouth wTash freely and
by sucking pellets of ice or sipping cold water. If the swelling
becomes so alarming as to interfere with breathing, several small cuts
should be made on top of the tongue to make it bleed freely.

The tongue may become sore from excessive smoking, from the
irritation caused by a ragged tooth, or as a result of syphilis.

Before treating the tongue condition the cause of it should first be
ascertained. If it is due to tobacco, the use of tobacco should be
stopped ; if it is due to syphilis or cancer, the patient should be placed
in a hospital at the first port visited unless conditions are such that
he can be sent to his home. A simple ulceration or inflammation of

118 THE SHIP'S MEDICINE CHEST

the tongue should be treated by the use of a mouth wash. It is often
advisable to clean out the intestines with Epsom salts or compound
cathartic pills.

Tuberculosis.

Tuberculosis may affect any part of the body, but most frequently
affects the lungs. Persistent cough, gradual loss of weight, weakness,
and an afternoon or evening fever of about 1° together with
heavy night sweats, are symptoms that .should arouse a suspicion of
tuberculosis. Officers or members of the crew with a chronic or
persistent cough should be sent to a medical officer of the United
States Public Health Service for physical examination.

Tuberculosis may be chronic or acute. Sometimes an acute lung
tuberculosis resembles pneumonia. The so-called galloping, or quick,
tuberculosis (consumption) is an acute form of the disease which
affects practically the entire body. Chronic tuberculosis may last for
years. By the modern methods of treatment many cases are arrested.

A sudden bleeding from the mouth of bright red, frothy blood
indicates hemorrhage from the lungs, and in most instances such a
hemorrhage is due to tuberculosis.

Treatment. — The main factors in the treatment of tuberculosis are
rest, fresh air, abundance of nourishing food, and measures to pre-
vent the spread of the disease. A seaman showing signs of tubercu-
losis should be placed at complete rest in bed until his temperature is
normal. His bowels should be kept open by the use of cathartics,
such as Epsom salts, castor oil, or compound cathartic pills. His
food should be nutritious ; every effort should be made to induce the
patient to eat heartily. The quarters occupied by the patient should
be well ventilated. Excretions — sputum, stools, and urine — should
be thoroughly disinfected before being disposed of. Dishes, cloth-
ing, and all articles handled by a tuberculous patient should also be
thoroughly sterilized. A tuberculous patient should be instructed as
to the danger to which he exposes others when he spits or sneezes
carelessly. All sputum should be collected, best in a paper cup, and
burned. In sneezing or coughing the patient should place a hand-
kerchief or cloth before his nose and mouth.

Permanent arrest and cure of tuberculosis is largely a matter of
self-control. If the patient will place himself under the care of a
competent physician and obey his instructions fully, the chances of
recovery are greatly improved. On the contrary, the patient who is
impatient, who will not follow the directions given for him, who
wanders from place to place, greatly handicaps his opportunity for
recovery.

SPECIFIC DISEASES AND THEIR TREATMENT 119

Typhoid Fever.

Typhoid fever is an acute infectious disease caused by a special
germ. The typhoid-fever germs get into the drinking water and
food and are thence transferred to man. No one can contract typhoid
fever unless some of these germs enter his body. Persons sick with
the disease, and occasionally persons who are not sick but who have
the germs in their body, are constantly passing them from the bowel,
and with the urine. From these excretions some of the germs, if
precautions are not taken, find their way to the water or food supply,
often through the agency of flies and perhaps other insects which
carry them mechanically.

The disease begins slowly. The patient complains of a constant
and severe headache and perhaps he has bleeding from the nose;
he feels tired, listless, and exhausted upon exertion. During the first
few days he has some fever, higher at night than in the morning.
After a few more days his temperature becomes quite high and re-
mains so. The patient's face indicates mental dullness. The tongue
is heavity coated. The abdomen becomes painful and tender, dis-
tended, and full of gas. There is usually a rash which appears as
small red spots on the abdomen. During the third week there may
be bleeding from the bowels. Ulceration of the intestines may occur.
One of the most serious complications is presented when an in-
testinal ulcer eats through the intestines and causes death from
bleeding, or peritonitis.

In mild cases the patient begins to improve at the end of the second
or the beginning of the third week, but sometimes the disease persists
for six, eight, or more weeks before convalescence sets in.

Treatment. — The patient should be placed in a hospital at the
earliest possible moment. Good nursing is the chief treatment of
typhoid. The disease must run its course, and medicines do not
shorten it. The patient should be kept in bed on a liquid or semi-
solid diet. He should drink plenty of water. The mouth and teeth
should be cleansed daily. The patient should not be allowed to exert
himself or to get up. He should use a bedpan and urinal. An ice
bag applied to the head will relieve the headache somewhat. Tur-
pentine stupes on the abdomen will help to relieve the pain. A large
catheter inserted in the rectum will often enable gas to escape and
thus relieve abdominal distress. A few drops of turpentine on a
lump of sugar taken by mouth will sometimes reduce or prevent gas.
Cold baths should be given when the temperature is above 102°. Ex-
cretion from bowels and bladder should be thoroughly disinfected
before they are disposed of. Bedding, clothes, dishes, and every-
thing handled by either patient or nurse should be disinfected.

120 the ship's medicine chest

When the patient is well again, the quarters should be thoroughly

cleaned and disinfected.

Antityphoid Prophylaxis (Prevention of Typhoid Fever).

Typhoid fever is a preventable disease. Sanitary precautions and
vaccination have greatly reduced its prevalence. Every possible
sanitary precaution should be taken against it, and every seaman
should be vaccinated against it before sailing.

Typhus Fever.

Common names for typhus fever are ship fever, jail fever, and
spotted fever.

The disease is an acute infectious and epidemic fever characterized
by sudden onset, profound depression of the vital powers, a sickening
odor, and a peculiar mottled eruption. The disease terminates
suddenly about the fourteenth day.

The disease is caused by a germ which is carried by body lice and
bedbugs. A person becoming ill with typhus is taken with a sudden
chill and has pains in the head, back, and limbs. There is high
fever, ranging from 105° to 106°. About the third or fourth day a
skin eruption appears. The eyes are red and injected; there is
muscular soreness and tenderness, particularly over the shin bone.
There is often severe headache and there may or may not be
delirium. Constipation is the rule.

Treatment. — Isolate the patient. Keep him in bed. Evacuate the
bowels with Epsom salts or castor oil. Disinfect all feces and urine.
Boil all dishes and all bedclothes used by the patient. Disinfect his
clothes to kill any lice that may be in them. Examine all members
of the crew for lice and disinfect their clothing. A thorough clean-
ing should be given the sleeping quarters in an effort to destroy all
bedbugs and fleas. The diet should be light and nutritious. Spong-
ing the body with cold water helps to reduce the fever. Good nurs-
ing is the most essential part of the treatment, medicine having
little or no effect upon the course of the disease. Should the patient
become weak, he should be stimulated by giving him a teaspoonful
of aromatic spirits of ammonia in half a glass of water. A good
stimulant is a strychnine tablet ( gVgrain) three times daily.

The Venereal Diseases.

This group of diseases, of which the most important are gonor-
rhea, syphilis, and chancroid, are called venereal because they are
spread chiefly by sex contact. They are caught by healthy persons
from persons who are diseased. Most prostitutes (90 per cent), are
infected, and any " loose " woman is likely to have the disease.

Each of the venereal diseases is caused by a different germ and
has different symptoms, but they have one feature in common — they
are passed from men to women and from women to men through

SI'KC'IFIC HISKASKS A X I > TIIKIK TKKAT.MKXT 121

contact of the sex organs. Occasionally they may be acquired by

other forms of close contact, such as by kissing or by using common
drinking cups or other article- freshly soiled with (he infection.
This applies chiefly to syphilis, which also may be inherited.

Gonorrhea (Clap). — The germ that causes gonorrhea grows 'm the;
sex organs of men and women. The first sign of the disease in the
male is usually a burning pain in the penis on urination (passing
water). This happens about 3 to 10 days after the man has gone
with a diseased woman. A day or two later a yellowish white dis-
charge comes from the penis. This discharge is loaded with germs,
and unless every precaution is taken they may be transferred to the
eyes and cause an inflammation which may result in blindness. If
gonorrhea is not treated early, the germs may spread to other organs,
such as the bladder and testicles. The germs also may get into the
blood stream and cause swollen joints or fatal heart disease. Fre-
quently gonorrhea causes the inside of the tube of the penis to " pull
together," causing a stricture.

After the acute stage of gonorrhea has passed, a man may be free
from symptoms except for a slight burning on urination and an
occasional drop of pus. In this stage the disease still is infectious
and can cause as much damage as a fresh case.

The effect of gonorrhea in a woman is even more serious than in
men. It often causes disease of her internal sex organs which may/
prevent her from bearing children. Many serious abdominal opera-
tions on women are necessitated by this disease. Also the germs may
enter the eyes of the child of an infected mother during birth and
cause an inflammation likely to result in blindness.

Early treatment is important. — Although gonorrhea is a serious
disease, it can be cured if treatment is started at once. If it is treated
promptly, it is less likely to end in complications or produce after-
effects which cripple the joints, cause stricture, or attack the heart
or other organs. If treatment is neglected or stopped too soon, the
disease may go one for a long time, often showing itself for years
as a slight discharge called the " morning drop " or " gleet." When
the discharge stops, it does not always mean that the disease is
entirely cured. Gonorrhea may be present even when there is no
discharge and the person seems to be well; during this time it is
possible to give the disease to others. Therefore the infected person
must not have sexual intercourse nor stop treatment until a doctor
finds out whether or not the disease is cured.

Instructions for patients with gonorrhea. — If you think you have
gonorrhea and are a beneficiary of the Public Health Service, go
immediately to a marine hospital out-patient office for examination
and treatment by a Government doctor.
112065°— 29 9

122

THE SHIP S MEDICINE CHEST

FIRST AID FOR PATIENTS WITH ACUTE GONORRHEA

1. Rest in bed the first week of the disease, if possible.
Avoid all heavy work or active exercise. By doing this
you will be cured sooner and avoid complications.

2. Apply a clean gauze dressing to the penis. Change
the dressing frequently. Keep the parts clean by spong-
ing with an antiseptic solution, such as bichloride of
mercury, 1-4000.

3. Always wash your hands thoroughly after touching
the diseased parts or after handling gauze, bandage, or
underwear that has been soiled by the discharge. If you
fail to wash your soiled hands, you are likely to carry
the disease germs to your eyes and infect them.

4. Always burn pieces of gauze or other dressings that
have been soiled with the discharge of pus or matter or
dispose of them so they will never be touched or handled
by others.

5. Have separate towels, wash cloths, soap, and all
other toilet articles, and never allow anyone to use those
used by you, because such articles may have been soiled
by germs from your diseased parts and may give the
disease to others.

6. Your bowels should move every day; if they do not,
take a laxative medicine.

7. Drink plenty of water during the day (six or eight
glasses).

8. Don't take spicy food or drinks, such as smoked
meats or delicatessen, pickles, mustard, pepper, horse-
radish, salt, ginger ale, or other carbonated soft drinks
until your doctor tells you that you may. They irritate
the inflamed parts.

9. Don't drink alcohol in any form. It aggravates the
disease and makes the cure slower and more difficult.

10. In order to avoid chordee while the disease is acute,
drink no water after supper, urinate before going to bed,
and sleep on your side. Never " break " a chordee. To
get rid of it, wrap the penis in cold wet cloths or pour
cold water on it.

SPECIFIC DISEASES AND THEIR TREATMENT 123

If the disease develops while you are at sea and do doctor is on
board ship, observe the accompanying first-aid measures listed here.

As soon as possible place yourself under a doctor's care and follow
the advice he gives you. Stay under the care of a reputable doctor.

Keep under treatment until the doctor tells you that you are cured.
Remember that some cases have to be treated for a long time. Do
not become discouraged no matter how long it takes.

Remember that reputable doctors don't advertise; therefore keep
away from the advertising "specialist." Don't go to a druggist for
treatment. Don't use patent medicines or other self -treatment.

Stay away from women. Don't have sexual relations. Intercourse
will bring your disease back to its acute stage, and you are almost
certain to infect the woman. Sexual intercourse, while you have
gonorrhea, is a criminal act.

Do not marry until your doctor, by careful tests and examinations,
finds out. whether it is safe for you to do so. If you marry before
you are cured, you are almost sure to infect your wife and make her
dangerously sick.

Syphilis. — Syphilis is one of the most serious diseases which affect
the human race. It attacks any part of the body, is difficult to cure,
and many cases, especially if not treated early and thoroughly, result
in insanity or in damaged heart and blood vessels. The chief danger
lies in the fact that the obvious symptoms of the disease may dis-
appear, although it may be steadily undermining health and causing
permanent damage to important organs and structures.

The germ that causes syphilis enters the blood through the skin or
mucous membrane. Usually there is no visible break in the skin at
the point of entrance. After from 10 days to 3 weeks a sore develops
which is called a chancre. The chancre may be so small or so slightly
inflamed that no attention is paid to it. It usually appears on the
penis, but may appear on the lips, tongue, or other part of the body
which has been in contact with the infection. Later, the disease
may show itself by a skin rash, sore mouth and throat, swollen
glands, headache, bone pains, fever. All of these signs may appear
at one time or only one or two of them at a time. In some cases the
symptoms may be so slight that they are not noticed and the disease
may not be discovered until years later when it has damaged the body
beyond repair.

Prompt treatment necessary. — If the right treatment is started
as soon as the disease is recognized, and if it is kept up long enough,
such serious results may be avoided. Therefore be on the lookout
for any sign of a syphilitic sore which may appear on the sex organs
or any other part of the body. If you have been with a " loose "

124 the ship's medicine chest

woman, do not wait for the signs to appear, but go to a marine
hospital for early treatment and advice.

Syphilis is curable. — The disease is generally curable, especially
if treatment is begun early. Therefore it is important that treat-
ment be started promptly and be continued for a long enough period.

The modern and most successful treatment of syphilis includes
the use of arsphenamine (" 606 ") given into a vein, mercury
given by injection or by rubbing into the skin, and bismuth injec-
tions. To be successful a, full course of treatment must be repeated
several times. Not less than one year of treatment and another year
of observation i,s necessary before any assurance of cure can be given.
More often three years of treatment and observation are necessary.

Keep up treatment until you are cured. — Soon after treatment is
begun, and often when no treatment has been given, all external
signs of the disease may disappear and the patient may think himself
well again. Herein lies the great danger of syphilis. The disease
often is still present in the body without showing any signs, and it
may appear again in some dangerous form even after some years
of what seems to be good health. For this reason the patient must
remain under the care of a doctor for a long time and must not stop
ti"eatment until the doctor says it is safe.

The doctor can tell when treatment should stop by making thorough
physical examinations and by careful special laboratory tests of
the blood or spinal fluid. Such physical examinations and lab-
oratory tests are used to find out how successful the treatment
has been and to know when the disease is cured. One or more
tests of blood or spinal fluid which fail to show evidence of the
disease — so-called " negative " tests — do not prove that the disease
is cured unless repeated laboratory tests and examinations of the
entire body show no sign of the disease.

Instructions for patients with syphilis. — If you think you have
syphilis and are a beneficiary of the Public Health Service, go im-
mediately to a marine hospital out-patient office for examination and
treatment by a Government doctor. Every day's delay in treatment
will make your cure more difficult.

If the disease develops while you are at sea and no doctor is on
board ship, observe the first-aid measures listed here.

There is very little to be done for a patient who develops a chancre
except to get him under a doctor's care as soon as possible and prevent
him from spreading the disease to others.

Stay under the care of a reputable doctor. Keep under treatment
until the doctor tells you that you are cured. Kemember that some
cases have to be treated a long time. Do not become discouraged
no matter how longr it takes.

SPECIFIC DISEASES AND TIIEll! TKKATMKXT 125

FIRST AID FOR PATIENTS WITH PRIMARY SYPHILIS

1. Apply no local treatment to the sore. It is only by
use of a microscope to examine the discharge that the
difference between the chancre of syphilis and soft
chancre (or other infection) can be detected; therefore
to apply strong antiseptics will make the diagnosis diffi-
cult. Dress the penis with dry gauze or a piece of gauze
moistened with a solution of boric acid.

2. Always sleep alone in order to avoid giving the
disease to others; especially if you are in the infectious
stage with " open " signs, such as rash on the skin, sores
on the body, or sore mouth.

3. Always wash your hands thoroughly after touching
the diseased parts or after handling gauze, bandage, or
underwear that has come in contact with the open sores.

4. Always burn pieces of gauze or other dressings that
have been soiled with the discharge of pus or matter, or
dispose of them so they will never be touched or handled
by others.

5. Have separate towels, wash cloths, soap, and all
other toilet articles, and never allow anyone to use those
used by you, because they may have been soiled by germs
from your diseased parts and may give the disease to
others.

6. Don't kiss anyone; don't handle food that other
people have to eat; don't get drinks at soda fountains or
other public drinking or eating places until your doc-
tor tells you that it is not longer dangerous to others for
you to do so.

7. Don't take any alcoholic drinks, such as beer, gin,
whisky, brandy, etc. Avoid the use of tobacco.

126 the ship's medicine chest

Remember that reputable doctors don't advertise; therefore keep
away from the advertising " specialist." Don't go to druggists for
treatment. Don't use patent medicines. Don't follow your own
judgment or the advice of a friend about treatment.

Stay away from women. Do not have sexual relations until your
doctor tells you that you are no longer in the infectious stage of the
disease.

Go to a dentist to have your teeth put in good condition, but be
sure to tell him that you have syphilis before he examines you.
The dentist will then sterilize his instruments with special care in
order to protect others. The teeth should be brushed at least once a
day. Use a soft toothbrush.

If you go to a doctor for any ailment, be sure to tell him you
have had syphilis. This may help him to find out what your
disease is.

Do not marry until your doctor, by careful tests and examinations,
finds out whether it is safe for you to do so. If you marry before
you are cured, you are almost sure to infect your wife and make
her dangerously sick. A child born of syphilitic parents usually is
infected. This is called " congenital syphilis."

Chancroid. — Chancroid is also called " soft chancre." It is a conta-
gious germ disease. The germs do not get into the blood, but the
disease may eat away the flesh and cause ulcers and buboes (" blue
balls"). The soft chancre is a sore on or near the penis. It may
occur along with syphilis and hide a syphilitic chancre. Even doc-
tors can not always tell the difference between a chancre and a chan-
croid or soft chancre except by repeated examinations. Go to a
marine hospital out-patient office for examination and treatment.

If a sore develops on your penis while your are at sea and no
doctor is available, follow the first-aid direction given for syphilis,
since it is impossible for you to know from which disease you are
suffering.

Prevention of the Venereal Diseases. — The most certain method of
preventing a venereal disease is to keep away from prostitutes and
other " loose " women. These diseases are kept alive and spread
by promiscuous intercourse. Every sex contact outside of marriage
is likely to be the beginning of a venereal infection; therefore, pre-
ventive or first-aid treatment should be applied immediately after
each sex act.

When no doctor is available, this preventive treatment should be
applied by the exposed person as follows:

1. Urinate immediately.

2. Wash the sex organs thoroughly with soap and water. Soap
is a disinfectant against the germs of syphilis and chancroid. The

SPECIFIC DISEASES AND THEIU TREATMENT 127

use of this treatment will prevent many cases, but to be effective it
must be applied within an hour after exposure — the sooner the
better. It may do some good up to six hours after exposure.

3. The soap should be thoroughly rubbed into the folds of the
skin of the penis and scrotum and adjacent parts of the abdomen
and thighs. Ordinary laundry or hand soap is suitable.

4. Dry the parts thoroughly so that no moisture remains.

5. An additional means of prevention of syphilis both before and
after intercourse is to rub calomel ointment thoroughly into the penis
and on the scrotum and adjacent parts of the abdomen and thighs.
The calomel ointment can be procured in a collapsible tube.

6. For the prevention of gonorrhea an injection of argyrol (10
per cent solution) or protargol (2 per cent solution) should be used
if available. If the protargol solution is not at hand, insert the tip
of the tube of calomel ointment into the penis and inject part of the
contents.

This first-aid treatment is of no value in treating cases which have
already developed. It may then do more harm than good.

Yellow Fever.

Yellow fever is transmitted from a sick to a well person by the
bite of a mosquito as is malaria. A certain kind of mosquito, known
as the Aedes mosquito, bites a person suffering from yellow fever and
takes into its body the yellow-fever germ along with the blood it
sucks; it later bites another person and so infects him with this
disease.

Yellow fever is ushered in by a tired feeling, pain in the head,
back, limbs, and joints, loss of appetite, and a chill which is quickly
followed by a high fever. The attack usually begins at night or in
the early morning. The pulse is rapid, the face is flushed, the eyes
are bright, and there may be some disturbance of the stomach, such as
nausea or vomiting. As the fever continues to rise, the pulse rate
becomes slower, the patient becomes restless, and a peculiar odor
becomes noticeable about him that some regard as characteristic of
the disease. In from two to four days the skin of the body becomes
yellowish in color. In severe cases there may be delirium. After a
few days the symptoms subside, but may return from one to four days
later, usually in severer form. The jaundiced or yellow color of
the skin becomes more intense and the patient vomits black or
" coffee-ground " matter. There is great prostration, the skin is cold
and clammy, and the pulse is feeble. The patient may die during
this stage or may gradually recover. If the vomiting of " coffee-
ground " matter occurs, the case is always serious.

Treatment. — As with malaria, yellow fever may be prevented by
destroying all mosquitoes. Shore liberty should not be granted at

128 THE SHIP'S MEDICINE CHEST

yellow-fever-infected ports. A yellow-fever patient must be strictly
protected from mosquitoes in order that these may not obtain from
his blood any germs with which to inoculate other persons. During
the stage of pain, great relief may be obtained by giving a foot bath
according to the following method : Cover the patient with a sheet
and one or more blankets; place a small tub half full of hot water
under the covers at the foot of the bed and put the patient's feet in it;
add two tablespoonfuls of mustard tied up in a piece of thin cloth and
keep adding hot water — just as hot as the patient can bear. Con-
tinue this until the patient breaks into a profuse sweat. This gener-
ally relieves the pain. Keep the patient absolutely quiet in bed and
give nothing by mouth except water. Use cold sponge baths or ice
packs for reducing the fever. The bowels should be evacuated with
Epsom salts, castor oil, or compound cathartic pills. It may be neces-
sary to catheterize the patient. The vomiting may be relieved by
sucking pellets of ice or by placing a mustard plaster over the stom-
ach. If prostration is great, stimulate with alcohol or with strych-
nine, one tablet (^ grain) every three or four hours.

Let it be repeated that the patient must be kept absolutely quiet in
bed and must be given plenty of water to drink and absolutely no
food of any description until one week after the disappearance of the
fever. After recovery, the patient will feel like returning to work
at once ; this should not be permitted for some time.

CHAPTER VI

SURGICAL CONDITIONS AND THEIR TREATMENT

Most of the accidents that occur at sea are of a minor character
and require only simple first-aid treatment; but sometimes serious
accidents occur on board ship, and in such cases the ship's master,
or some other licensed officer, is called upon to care for those who
are injured.

A glance at an injured man will often show how badly he is hurt.
His position will often suggest whether there has been a fracture or
dislocation of a limb; bleeding, pallor, the character of the breath-
ing, all are helpful in forming a decision. An injury sufficient to
produce unconsciousness should always be regarded as serious.

In case of a minor accident, no matter what its nature, any wound
or scratch, or any injury that has been received should be given
prompt and careful treatment, because even a slight break in the
skin may become infected and give trouble, and blood poisoning and
perhaps death may result.

If an accident is of a serious nature, examination should be imme-
diately made for bleeding, for broken bones, for dislocation of bones
and for symptoms of shock.

The ship's medicine chest and sick bay should always be in
readiness.

Accident Prevention.

Ships should be inspected at regular periods in order to detect
and to correct conditions which might lead to the occurrence of
accidents. Such a safety inspection might very well be made in
conjunction with the sanitary inspection.

In making the safety inspection the examiner should be keen to
detect not only such conditions as are immediately dangerous but also
those that may be remotely so. Sometimes a seaman falls through
an unguarded hatch or gangway because the hatch covers are short
or badly in need of repair ; the gangways may be in a deteriorated
condition or tackle may be defective ; staging may be unstable. Since
accident prevention is of the utmost importance in the successful
operation of ships and the protection of their personnel, all apparatus
should be carefully inspected before it is used, and hatches and sim-
ilar openings safeguarded. A little care and effort expended in this

129

130 THE SHIP'S MEDICINE CHEST

way will result in the saving of human lives, the prevention of
suffering;, and the avoidance of tedious and expensive lawsuits.

Fire at sea is one of the most terrible marine hazards; sometimes
the character of the cargo makes the risk of fire unusually great. As
required by law, the crew should be given boat and fire drills periodi-
cally at irregular intervals. All fire apparatus should be kept in
good condition and ready for use at a moment's notice. The appa-
ratus should be inspected regularly, because valves may become cor-
roded, hose may rot, or some of the equipment may not be in its
proper place when it is needed. Lifeboats, rafts, and life preservers
should be carefully inspected at regular intervals. It is of impor-
tance for all members of the crew to be familiar with the location
and proper use of all life-saving apparatus. There should be gas
masks on board all tank ships, and special precautions in respect to
fires and smoking should be observed on those ships which cany
inflammable or explosive cargoes.

Disinfection of Wounds.

In examining or treating a wound of any sort the operator should
wash his hands thoroughly, clean and trim his finger nails, and then
carefully wash his hands again. He should not touch the wound with
his fingers if he can possibly avoid so doing ; instruments which have
been sterilized by boiling or sterile gauze should be used for the
purpose.

It is best not to wash a wound unless it is necessary to do so in order
to remove dirt or foreign particles from it. If the wound is reason-
ably clean, tincture of iodine should be applied to it, and it should be
covered with a piece of sterile gauze, held in place by either a bandage
or strips of adhesive plaster. The tincture of iodine may destroy
some of the harmful germs. If the skin surrounding the wound is
dirty, a piece of sterile gauze should be placed over the wound, and
another piece of gauze should be used to wash the surrounding skin
with an antiseptic solution, such as a teaspoonful of cresol to a quart
of water. In wiping off the skin, do not use a motion toward the
wound but away from it ; and take care to avoid touching the wound
or getting any of the washing fluid into it. Since tincture of iodine is
a strong antiseptic, it would be best to dilute it one-half with boiled
water before using it in redressing wounds. A swab for applying
iodine is made by twisting a small amount of cotton around one end
of a wooden applicator, a clean match, or a toothpick.

Wounds Which Are Soiled with Dirt or Foreign Bodies.

In the foregoing paragraph it is remarked that wounds should
preferably not be washed or irrigated; however, when they contain
dirt or foreign particles, these may be best removed by irrigation.

SURGICAL, CONDITIONS AND THEIR TREATMENT 131

Large particles may be picked out with forceps; under n<> circum-
stances should the lingers be put into a wound or even touch a wound,
unless they are covered with gloves which have been thoroughly
sterilized.

For washing out dirt and foreign particles, the best solution is
one of boracic acid, made by dissolving a tablespoon ful of boracic
acid in a pint of boiling water. To dissolve the powder, moisten it
first with a few drops of water and break up the lumps, making the
powder into a paste; then add the rest of the water while stirring.
Turpentine is also excellent for cleaning greasy wounds. Other anti-
septic solutions that may be used are a 1 to 2,000 strength solution of
bichloride of mercury and a 1 per cent solution of cresol. In irrigat-
ing a wound, care should be used not to cause any further injury to
the tissues. The irrigator should be boiled immediately before use.
It is well to allow the wound to dry naturally after it is cleaned, or
to dry it by dabbing it with a piece of sterile gauze or cotton ; do not
wipe or rub. It should then be swabbed with tincture of iodine,
using this first in the wound, then around the edges of it for a
distance of 2 to 3 inches. After the swabbing, apply a sterile gauze
dressing. Be careful about disturbing blood clots in a wound; dis-
turbing them may induce bleeding. If, however, a blood clot contains
foreign particles, it must be removed.

Surgical Cleanliness.

Surgical cleanliness does not mean ordinary cleanliness, but
" germ-free " cleanliness. A wound may not contain any dirt or
foreign particles so far as may be seen with the eye, yet it may
contain the most virulent germs, such as are capable of producing
blood poisoning.

In treating wounds, it should constantly be kept in mind that
everything, including the hands, that is used in the process of
treatment should be sterile. Surgical instruments are sterilized by
boiling them for 15 or 20 minutes. A very small quantity of bicar-
bonate of soda added to the water will prevent them from rusting.
After boiling the instruments, pour off the water, and turn the in-
struments out upon a piece of sterile gauze. In handling them, pick
the instruments up and hold them by the handles; never touch
that part of the instrument that is to come in contact with a wound ;
furthermore, be careful that the instrument does not, just before it is
used, come in contact with anything except the wound. Unless care
is observed, the instrument may accidentally touch the skin sur-
rounding a wound, or may come in contact with the clothing, or
some other object.

The gauze supplied in the medicine chest is sterile and need not
be further sterilized. When using the gauze, cut off a piece of

132 the ship's medicine chest

the desired size with sterilized scissors; when unfolding the gauze,
take hold of the edges; and always apply the inner surface of
the gauze to the wound ; never allow the edges of the gauze which
are held in the fingers to come in contact with the wound.

Cleaning the Hands.

To clean the hands, wash with soap and water, scraping up some of
the soap beneath the nails, and trim and clean the finger nails ; scrub
the hands carefully with a hand brush and soap; change the water
at least four or five times while scrubbing with the hand brush*;
then immerse the hands in a solution of bichloride of mercury for at
least a minute. After the hands have been cleansed, while working
with a patient do not touch anything except sterile objects. In
hospital work rubber gloves sterilized by heat are put on after
the hands have been cleaned as directed. Even the most carefully
washed hand is not sterile.
A Wound or Injury Without Serious Bleeding.

If a wound is bleeding very little, the bleeding may be stopped by
pressure; for instance, if a piece of sterile gauze or cotton is placed
over the bleeding vessel and held there for a few minutes, the bleeding
will stop.

The next step in the treatment of a wound of this type is to swab
it gently with tincture of iodine and then to cover it with sterile
gauze and a bandage. The dressing should be changed every day.
Under ordinary conditions, the wound will heal in a few days. If
it becomes painful, red, and swollen, an infection should be suspected.
For the treatment of infections, see Infected Wounds, p. 144.

Wounds with Hemorrhage (Bleeding).

If a wound is bleeding, the first requisite is to check the flow of
blood. The bleeding may be from either an artery or a vein. If it
is from an artery, the blood is of a light red color and flows in spurts.
If it is from a vein, the blood is of a dark color and flows evenly,
not in spurts, as from an artery; however, in case of rupture of large
veins the flow is very rapid, and the loss of blood may cause death
within a few minutes.
To Stop Arterial Bleeding.

To stop bleeding from an artery, first use direct pressure; that is,
with a piece of sterile gauze press upon the bleeding artery, and hold
it for a few minutes ; the end of the artery may fill with a blood clot,
which will stop the bleeding. This method is only for small arteries ;
it may suffice for rather large arteries, also, but it can not be depended
upon for these; even if it does stop the bleeding from large arteries,
the bleeding may begin again after a short while.

SURGICAL CONDITIONS AND THEIR TREATMENT 133

Fig. 13. — Illustration showing point of com-
pression for carotid artery

Fig. 14. — Point of compression for bra-
chial artery

Fig. 15. — Point of compression for femoral
artery

Fig. 16. — Showing application of wind-
lass tourniquet

134

THE SHIP S MEDICINE CHEST

If a large artery is torn or cut so that it bleeds, the bleeding must
be stopped immediately or the patient will bleed to death in a very
short time. The first thing to do is to press the artery with the
fingers above the wound until a tourniquet can be applied. One who
undertakes to give assistance in such cases should be familiar with the
location of the large arteries in the neck, head, arms, and legs.

Tourniquet for Stopping Severe Bleeding.

A tourniquet is a contrivance used to compress a blood vessel when
it is necessary to stop hemorrhage. There are many kinds of tourni-
quets, but the principle of them all is the same. A piece of heavy

Fig. 17. — Showing application of rubber
tourniquet

Fig. IS.

-Showing application of rubber
belt tourniquet

string, rope, rubber tubing, a belt, a bandage, a cloth, or similar
material, or a handkerchief may be used as a tourniquet. To apply
a tourniquet, wrap it around the limb above the bleeding, draw it
fairly tight, then insert a stick under the wrapping and twist it until
the bleeding stops. Good judgment must be used in applying the
tourniquet so as not to injure the skin. If the tourniquet is narrow,
as when a heavy string is used, extra precautions must be taken not
to cut the flesh. Under no circumstances should a tourniquet be
left on for a greater period than 20 minutes. Should it be necessary
to keep it on for a longer time, the tourniquet should be loosened,
so as to allow the blood to circulate in the limb for a few minutes;
it may then be tightened again, if necessary.

SURGICAL CONDITIONS AND Till. II; Tl; I. ATM I .XT

135

After a tourniquet has been applied, the necessary preparations
for tying the artery may be made and should be made as quickly

as possible.

How to Tie an Artery.

Loosen the tourniquet a little at a time, until the bleeding end of
the artery can be located in the wound; pick up the end of the artery
with artery forceps; then, with either a piece of catgut or silk Liga-
ture, tie the artery. Material for sewing with a threaded needle is
provided in a sterile glass tube and will be found in the medicine
chest, ready for use.

How to Stop Venous Bleeding.

The flow of blood from a vein proceeds with a great deal less
force than that from an artery. Bleeding from a vein may be
controlled in most instances by
pressure. With a piece of sterile
gauze, press upon the bleeding
vein, and hold it for a few min-
utes. If the vein is large, it may
be necessary to apply a tourni-
quet or to tie the vessel. In ap-
plying a tourniquet to stop
bleeding from a vein, it should
be remembered that the tourni-
quet should be applied oelow the
wound — that is. away from the
heart. A vein is tied in the same
way as an artery, except that
both ends of a vein must be tied,
while only in the case of very
large arteries is it necessary to
have both ends tied.
Lacerated Wounds.

A lacerated wound is one in which the flesh is badly torn; the
edges are generally ragged, and there is likely to be a considerable
amount of bleeding. A lacerated wound is alwa}Ts serious, because
there is more or less destruction of tissue, and because the danger
of blood poison is increased on account of damage to the blood and
nerve supply, whereby the natural resistance is weakened.

In treating a lacerated wound, ragged pieces of flesh in which it
is certain that the blood and nerve supply is destroyed should be
clipped away with sterile scissors. If these ragged shreds are not
removed, they will have to slough off and will greatly interfere
with rapid healing.

Fig. 19. — Proper method of tying artery

136 the ship's medicine chest

Lacerated wounds may be either shallow or deep. Usually the
edges of such wounds do not make good contact with each other.

Crushed Wounds.

A crushed wound is one in which the flesh is crushed to such an
extent that its nerve and blood supply is destroyed. As a rule, such
a wound does not bleed profusely, since the blood vessels having
been crushed, the inner lining membrane of the vessels curls up and,
together with the blood clotting, forms an effective plug.

Crushed wounds are serious injuries, because the flesh in which
the blood and nerve supply has been destroyed must slough away.
This type of wound is likely to become infected, since the act of
crushing may grind germs into the wound, and infection, together
with the poor blood and nerve supply, renders healing very difficult.

In treating a crushed wound, all shreds of flesh in which the blood
and nerve supply is destroyed should be removed.

Punctured Wounds.

A punctured wound is one that has been caused by some small
instrument, such as a pin, a nail, a sliver or splinter of wood, a knife,
a bullet, etc.

Punctured wounds are especially dangerous, because germs and
other foreign substances have been carried to the bottom of the
wound by the entrance of the instrument of injury and can not be
removed without opening and perhaps probing the wound. Lock-
jaw and other infections often follow punctured wounds. It is not
the rusty nail that causes blood poisoning; the blood poisoning comes
from germs that adhere to the rough surface of the rusty nail and are
carried by it deep into the wound; the skin, as it heals, soon covers
the wound over, and in doing so provides an ideal place for the growth
of the blood poisoning germs.

Treatment. — In the treatment of a punctured wound the primary
object is to induce healing to proceed from the bottom of the wound.
With a sterile knife, freely open the wound. Remove any foreign
substance that may be present, wash out the wound with 1 : 5,000
bichloride of mercury solution, and put on a sterile dressing.

Healing of Wounds.

There are two different processes by which healing is accom-
plished— healing by first intention and healing by second intention.

Healing by first intention is healing that takes place in the most
natural way and with the least obstruction; that is, when the cut
edges of the wound are smooth ; when the edges fall together in a
correct position; and when there are no complications whatever.
Wounds that heal by first intention are usually small wounds, in
which there is but little interference with the blood and nerve supply
of the flesh.

SURGICAL CONDITIONS AND 'III K III TKKATMKNT 137

Healing by second intention is a more complicated process, which
takes place when more or less destruction of flesh and usually -dine
injury to the nerve and blood supply are involved. The edges of
the wound are ragged, or else gape so that they can not be brought
together in the natural way. Foreign particles, such as dirt, bullets,
pieces of clothing, splinters, etc., may be present in the wound and
may interfere with healing, as may also infection by pus-producing
germs, which may occur in even a very slight wound.

In the process of healing, scrum and blood, which soon clot, are
poured out upon the surfaces of the wound. From the edges of the
flesh new tissue forms, growing into the clot and absorbing it, and,
as it increases in quantity, fills the wound. The skin around the
edges grows and spreads over the surface and provides a new cover-
ing, which is a modified form of skin, composed of white fibrous
tissue, known as scar tissue. Scar tissue is at first red in color,
because of the presence in it of blood vessels; but as it grows older
the new cells composing the tissue contract and destroy the blood
vessels, leaving a white scar, the appearance of which is familiar.
If a wound heals without the formation of a scar, it is because of
the fact that but little tissue was destroyed, or else because the wound
did not extend through the whole depth of the skin. Sometimes
there is an enormous growth of scar tissue; but this is a complication
that a ship's master will probably not be called upon to treat.
Preparation of Wounds for Stitching.

Small wounds should not be stitched, because it is better to allow
them to drain, especially if an infection should occur to complicate
the healing. They should be swabbed out with tincture of iodine
and should be protected by a sterile dressing.

Wounds that gape widely or that are very extensive should be
stitched. The first requisite in the treatment of such wounds is to
stop the severe bleeding, either by tying the bleeding vessel or by
applying pressure ; the next step is to clean the wound, by which we
mean to remove any foreign substances, such as are mentioned in
the foregoing pages, which may be present. Swab out the wound
with tincture of iodine, and apply iodine around the edges of it
and on the skin for a distance of at least 2 or 3 inches all around
the wound. The wound now being ready to be stitched, bring the
edges together with the suture material. Put the first stitch about
midway of the wound, just bringing the edges of the wound together ;
there is sure to be some swelling, and if the edges are tied too closely
together the swelling may cause the sewing material to cut through
the flesh, or may shut off the blood supply and cause the death of the
flesh and so increase the danger already done. For sewing a wound,
catgut, silk thread, or even horsehair may be used. These suture
112055°— 29 10

138

THE SHIP'S MEDICINE CHEST

Fig. 20. — The insertion of gauze wick drain into a wound

Fig. 21. — Showing method of sewing a wound

SURGICAL CONDITIONS AND Tlll.il; TREATMENT 139

materials are especially prepared and sterilized, and are usually put
up in glass tubes ready for use. After putting ID stitches, it is a
good plan to paint the knots and the skin with tincture of iodine.
Then apply a sterile gauze dressing, and secure it in place by a
bandage.

Drainage of Wounds.

It is sometimes necessary to drain a wound, as is the case when in-
fection has set in, or when there is an accumulation of pus. If the
wound has been sewed up, the stitches should be removed; if it has
not been sewed, open it carefully with a sterile knife point, enough
to allow the pus to drain out freely; then swab it with tincture of
iodine. If pus continues to accumulate and the opening closes up,
the wound should be kept opened with a wick of sterile gauze. The
size of this gauze wick depends upon the size of the wound. The
wick should be renewed every day. The wick of gauze or other ma-
terial used for a drain should be fastened to the dressing with a
safety pin ; otherwise it might be lost within the wound.

Removal of Stitches.

As a rule, stitches are not removed from a wTound under 7 or 10
days. To remove stitches, paint one stitch at a time with tincture
of iodine; then with sterile scissors cut the painted stitch on one
side of the knot, and remove the stitch with a pair of sterile forceps.
Boracic acid, or tincture of iodine, or some other dusting powder
should then be applied, and the wound should be covered with
sterile gauze and a bandage.

Splinters of wood often cause wounds, and usually remain in
the wounds and have to be removed. A splinter may be removed
with a needle, or better still wTith a knife, sterilized immediately
before use. After the splinter has been removed, the wound should
be painted wTith tincture of iodine, and a sterile gauze dressing
should be applied.

Wounds from Fishhooks.

AVhen a fishhook enters the skin, do not attempt to pull it out,
because the barbed end will tear the flesh. Pour iodine on the
wTound and paint the hook thoroughly with iodine ; then shove the
barbed end of the hook forward through the skin, and cut off the
barb with a pair of pliers. The fishhook can then be pulled back
out of the wound; but before pulling it back, repaint the hook writh
tincture of iodine. Dress the wound with sterile gauze.

Gunshot Wounds.

The treatment of gunshot wounds should be governed to a great
extent by conditions. The injury in case of a wound caused by a
shotgun is, as a rule, extensive. Such a wound often contains many

140

THE SHIP S MEDICINE CHEST

Fig. 22. — The beginning of the application of a figure-of-eight bandage

to the elbow

Fig. 23. — Completed figure-of-eight bandage of the elbow

SURGICAL CONDITIONS AND THKIi: TIM ATMENT 141

pieces of shot, the felt wadding, fragments of clothing, and perhaps
dirt. In treating a wound caused by a shotgun, a badly lacerated
wound has to be dealt with; therefore, all foreign part ides. Mich as
shot, wadding, particles of clothing, and dirt should be removed
at once, and all ragged shreds of flesh should be clipped away.
Bleeding should be stopped, either by pressure or by tying the
vessels, and the wound should finally be sterilized with tincture of
iodine. Wounds of this kind sometimes need a few stitches.

A wound caused by a rifle ball or a pistol bullet presents a different
condition. The entrance of the bullet makes a small hole, while the
exit is quite likely to be larger. The bullet may sever a nerve or a
blood vessel, or it may pass through the flesh without doing much
damage; it maj' strike and shatter a bone; it may carry a part of
the clothing or some other foreign substance into the wound. Often
a bullet that is entering the body is deflected, as is proved by instances
in which a bullet has been located at a considerable distance either
above or below the point where it entered the body.

In case the bullet does not injure important vessels or nerves, the
gravest danger lies in the possibility of infection. To probe about
may injure an important blood vessel or nerve and may increase the
danger of blood poisoning. Do not probe for bullets.

The wound should be treated with tincture of iodine, and a gauze
wick should be inserted in the opening so that the wound may drain.
Shock.

Shock is the reaction produced by a severe injury, or by fright.
This reaction may follow the accident immediately, or its occurrence
may be delayed for some hours. It is a condition of extreme depres-
sion or collapse. The patient is pale and his skin is cold and covered
with a clammy perspiration. He complains of chilliness or may
actually be cold. His pulse is rapid and weak. He is usually con-
scious, but he may be unconscious. His breathing is rapid, shallow,
and irregular. Nausea and vomiting may occur.

Treatment. — A person suffering from shock should be undressed and
placed in bed, with hot- water bottles about him. Glass bottles filled
with hot water or heated bricks may be used when it is necessary to
provide more heat than can be supplied by hot-water bottles. Hot-
water bottles, glass bottles, and hot bricks should be covered with
towels or other cloths, so that they may not burn the patient, as may
easily happen when a patient is unconscious. Burns from such
sources are nearly alwaj^s troublesome and heal with difficulty.

In shock the action of the heart is weak and needs stimulating.
A good heart stimulant is aromatic spirits of ammonia, a half
teaspoonful to a teaspoonful well diluted with water. Alcohol, a
tablespoonful, well diluted with water, is also an excellent and
effective heart stimulant to use in cases of shock.

142

THE SHIP S MEDICINE CHEST

Fig. 24. — The beginning of the application of a spiral reverse bandage

Fiu. 25. — Showing the reversal of bandage in the spiral reverse bandage

SUKGICAL CONDITIONS AND THEIII TIM.ATMENT I lo

Fig. 2G. — Completed spiral reverse bandage to the forearm

Fig. 27. — Bandage of the band

144

THE SHIP'S MEDICINE CHEST

To stimulate a person who is unconscious from shock, let him
inhale the fumes from ammonia ; sprinkle a few drops on a handker-
chief and hold this near his nose, or give a rectal injection of salt
solution, two teaspoonfuls of salt to a quart of warm water. Allow
the salt solution to flow into the rectum at the rate of about 20 to 30
drops a minute. Do not be in a hurry about doing these things; a
period of unconsciousness does no harm and this may be excellent
time to set broken bones, replace dislocations, or treat wounds.

When recovering from shock, a patient is likely to vomit. Should
he begin to vomit before he becomes conscious, his head should be
held to one side, in order that the vomit may find free exit and not
be drawn into the lumrs.

Fig. 28. — Application of a recurrent Fig. 29. — Recurrent bandage of the bead
bandage of the bead completed

Infected Wounds.

The infection of wounds arises from the presence and growth in
them of pus-producing germs, of which there are a great many
different kinds. The presence of pus germs in a wound alwaj^s
constitutes a serious condition. A small wound is just as likely to
become infected as a large wound; in fact, a small punctured wound
may be more dangerous than a large one, because a small wound
is likely to be neglected, while a severe one receives proper attention.

As any wound may become infected, every wound should be care-
fully treated immediately after the accident which caused it; and
this rule holds good regardless of the size or extent of the wound.
A pin scratch has been known to cause death.

SURGICAL CONDITIONS AND THKIl; TIM ATMENT 145

When a wound becomes infected, the patient recognizes the fad
from the increased swelling, redness, and pain that accompany the
infection; these symptoms are ushered in by chilliness or perhaps
a severe chill. Following the chill, there is a fever which runs an
i rregi liar course. The pulse is increased in rate; in severe cases it
becomes weak and the patient may appear quite ill. The wound
discharges pus, which may have a foul odor.

Treatment of infection. — The first step in the treatment of an in-
fected wound is to open it, so that there will be free drainage of the
pus. If the wound has been sewed, the stitches should be removed.
If necessary to do so for free drainage, the opening of the wound
should be enlarged by cutting it. After opening the wound, allow
the pus to drain out; then: paint the wound with tincture of iodine
and apply a hot dressing. The infected part of the body should be
elevated as high as possible; for example, if the infected wound is
on the hand, arm, or legs the limb should be placed upon one or more
pillows; keeping the limb high aids the circulation and reduces the
swelling.

The patient should be given a purgative, and the bowels should be
kept in a free condition by repeating the dose whenever necessary.
The diet should be light and nutritious; the patient should drink
large quantities of water.

Hot applications. — To make hot applications, dissolve a table-
spoonful of boracic acid in a pint of boiling water; wring out sterile
gauze in the boracic-acid solution, having the solution as hot as the
hands can bear it, and apply to the wound. As soon as they become
cold the compresses should be replaced by others that are hot. A
compress may be kept hot over a longer period if it is covered with
a towel and then with heavy paper or oilcloth ; or a hot-water bottle
may be used to keep the compress hot.

Gurry Wounds.

It sometimes happens that in carelessly handling a fish which has
just been caught, or in stepping on a fish in shallow water, serious
wounds may be inflicted by the fins, the tail, or the gill covers of
the fish. Such wounds, if inflicted by certain tropical fish, such as
stingarees, catfish, devilfish, and sea devils, are actually poisoned, and
are followed by much general disturbance, as well as pain and. inflam-
mation in the injured part.

The wound should be well washed with a strong solution of bicar-
bonate of soda or of Epsom salts; a hot-water bottle should be
applied to it. The patient should be kept quiet for a time and
stimulated by doses of aromatic spirits of ammonia or alcohol.

146 the ship's medicine chest

Bee and Wasp Stings.

The stings of bees, wasps, and yellow jackets are very painful,
but are not, as a rule, dangerous to life, unless the number of stings
is excessive. If the stinging apparatus of the bee is left in the
wound, it should be removed and ammonia or a thick paste of sodium
bicarbonate should be applied. An alcohol compress is also useful
for reducing the pain and swelling.

Snake Bites.

A snake bite is very dangerous if the snake that inflicts it is of a
venomous variety and the dose of poison injected is large. The bite
of such a snake is followed by much pain and rapid swelling in and
about the wound, and often by early and extreme collapse, which
may lead to death.

Treatment. — About the limb, above the wound, tie a belt or a piece
of rope or other material so as to shut off the circulation ; then open
the wound with a knife and allow it to bleed freely ; afterwards rub
into the wound some potassium permanganate. Crush a tablet of
the permanganate and rub it into the wound. Stimulate the patient
with alcohol. Loosen the constriction about the limb gradually.
Whisky or alcohol is not a specific treatment for snake bite and
should not be used.

Stings of Centipedes, Tarantulas, Scorpions, and Spiders.

The stings of these insects are no more painful than those of bees
or wasps; but they are, as a rule, more poisonous and sometimes
cause alarming symptoms, such as headache, weakness, sweating, and
vomiting, though they are seldom, if ever, fatal.

Treatment. — It should be remembered that stings of insects are just
as likely to become infected as any other wounds of the skin. If
death follows an insect sting, it is usually because the wound became
infected and blood poisoning set in.

Stings or wounds inflicted by the insects mentioned above should
be encouraged to bleed ; after they have bled they may be cauterized
with red-hot metal or tincture of iodine may be applied. A .sterile
gauze dressing should always be applied to such a wound as in the
treatment of any other wound. For the general symptoms of head-
ache and weakness, 30 drops of aromatic spirits of ammonia may be
given in half a glass of water, repeating the dose within half an
hour, if necessary. The patient should have a cathartic, .such as
Epsom salts or castor oil.

Stings of Other Insects.

The pain and swelling that follow an insect sting are believed to
result from the formic acid which is injected into the skin by the
insect. Some people react more strongly to insect bites than others;

SURGICAL CONDITION'S AND TIM'.li; TREATMENT 147

in case of such people the bites of bedbugs, mosquitoes, ti<-ks, fleas
and other insects sometimes cause considerable swelling. The best
treatment to follow in all cases is to apply an alkali, such as am-
monia, or a thick paste of sodium bicarbonate, to the wound; alcohol
and spirits of camphor are also beneficial. When the pain and
Swelling have subsided, paint the part with tincture of iodine and
apply a sterile dressing in order to prevent infection.

Burns and Scalds.

Burns may be caused by dry or moist heat, by chemicals, or by
electricity. They are extremely painful and are often attended by
more or less severe shock. As the pain subsides, there is, if the burn
is extensive, a varying degree of fever. If the burn becomes infectei I
all the .symptoms of blood poisoning are developed.

When a person is taken out of a burning compartment dead,
asphyxiation by gases has probably been the cause of death. In case
of extensive burns on the body, ulcers of the intestines may develop
after a few days and may cause death. Shock or blood poisoning
are, however, the most frequent causes of death from burns.

Treatment. — A simple burn is best treated by applying a thick
salve of boracic acid and covering it with sterile gauze, over which a
thick application of cotton is placed and then heavy paper, oilcloth,
or anjidiing that will help keep air from coming in contact with the
burn. Sterile heavy engine grease is useful to exclude air from
burns. This treatment is for the relief of the severe pain. The use of
morphine sulphate, i/^-grain tablet as a dose, may be necessary for
the relief of pain in severe or extensive burns.

After a few hours, when the pain has subsided, it will be found
that the burned area is blistered. The method of treatment of the
blister is a matter of opinion. Some physicians clip away the blister
and treat the burn as an open wound ; others believe that the raised
skin is a protection and do not remove it but paint the area with
dilute tincture of iodine and apply the sterile dressing over a frame-
work, so that the gauze will not touch the wound and interfere with
the tender and newly formed cells which nature provides to repair
the injury.

Frostbite.

A frostbite is produced by cold that is so severe as to stop the
circulation, so that the tissues freeze. If the frozen flesh is not
properly treated, there is bound to be ulceration and sloughing.

Treatment. — The frozen part should be thawed out gradually, not
by the application of heat, but of cold water and friction, or by
rubbing with the hands. Snow may be used in place of cold water,
if it is preferred to do so. After the frozen part has been thawed

148 the ship's medicine chest

and the circulation has been reestablished, the patient may go into a
warm room. If the flesh has been frozen for a long time (several
hours) or has been frozen to such a degree that death of the tissue
has ensued, the affected area must be treated as a severe wound,
because the dead frozen tissue will slough away, and there is danger
of blood poisoning and gangrene. In such a case, the wound should
be treated with tincture of iodine and covered with sterile gauze
The limb should be kept elevated, in order to help limit the swelling.

Bruises.

A bruise is usually made by some blunt instrument which, though
it injures the flesh beneath the skin, does not break the skin. Some- .
times a small blood vessel beneath the skin is ruptured, and the
blood pours out into the flesh and produces the familiar discoloration
of a bruise.

Treatment. — A bruise requires protective treatment. The skin
should be dressed with sterile gauze. If the bleeding under the
skin is extensive, it may sometimes be advisable to open the skin and
let out the clot. When this is done, the wound must be treated as an
ordinary open wound. Small bruises ordinarily require no treat-
ment.

Gangrene.

Gangrene is the death of the tissues. If it involves the soft tissues,
it is called sloughing; if it involves the bone, it is called necrosis.

Gangrene is classified as either moist or dry.

The signs of gangrene are (1) loss of pulsation in the blood ves-
sels; (2) loss of normal body heat in the parts affected; (3) loss of
sensation or feeling; (4) loss of function — that is, the part can not
be used in the normal manner; (5) change of color, the part present-
ing a purpls or mottled appearance if the affected part contains
blood, and a waxy or colorless appearance if there is little or no blood
in the part.

Dry gangrene. — Dry gangrene occurs when the body fluids have
been drained from the affected part, as happens when a blood vessel
becomes clogged, or when the vessel is pressed upon long enough to
cause death of the tissues by depriving them of blood. If the part
affected is kept free from germs, it will dry and shrivel into a black
or dark-brown mass. If infection occurs, the affected area becomes
very offensive.

Moist gangrene. — Moist gangrene occurs when the dead part is full
of fluids, which may or may not be infected with germs. If germs
are present, the tissues putrefy, and foul-smelling pus is formed.

The progress of the case depends upon the part that is affected and
upon the size of the gangrenous area, and the fact of its spreading

SURGICAL CONDITIONS AM' TIIl'.Ii: TEBATMBNT 149

or not spreading. The junction of the gangrenous area with the
healthy (issue is marked by a sharply outlined area of inflammation
(nature's effort to repair), called the "line of demarcation."

Treatment.— Treatment is local and general. Local treatment con-
sists in keeping the skin sterile by antiseptic dressings, such as hot
wet dressings of boric acid solution. General treatment consists in
keeping the patient at rest, with the affected part elevated, putting
the patient on a light but nutritious diet, and keeping the bowels in
good condition by administering cathartics whenever necessary.

Blood Poisoning (Septicaemia).

Blood poisoning is an acute infection, or a disease produced by cer-
tain germs which have found their way into the body and so into
the blood.

Blood poisoning is a serious condition. Its onset is often indicated
by a chill, followed by a rise of temperature. The pulse rate is
increased and weak; there is loss of appetite; the tongue is brown.
Early in the course of the disease the bowels are constipated; but
diarrhea may develop later. The victim is very ill and his chances
for recovery are always questionable. Blood poisoning usually fol-
lows the introduction of outside disease-producing germs into a
wound; but sometimes the germs may have been already in the body
and blood and may settle in a wound or bruise and so produce
infection.

Treatment. — If the blood poisoning is due to infection of a wound
or bruise, pus may be formed at the site of infection; the abscess,
as such a collection of pus is called, should be freely opened with a
knife, so that all the pus may readily drain out. Unless the blood
is badly affected by the poison, the patient will get well rapidly after
the pus has been drained from the abscess ; but if the poison has been
widely circulated through the blood, his condition is very serious.
He should be stimulated with alcohol. His bowels should be kept
free by the use of Epsom salts or castor oil. He should be put on a
liquid diet, and should drink plenty of water.

Boils, or Furuncles.

A boil is a localized inflammation that begins in a hair follicle
(root) and finally results in a core of dead tissue.

The boil appears first as a small red pimple around the hair,
but rapidly increases in size and is painful and tender. After a
few days a whitish spot appears at the center of the boil; this breaks
open a few days later and discharges pus. As soon as the boil opens,
the intense pain is relieved.

Treatment. — With a sterile knife, open the boil so as to permit free
drainage. Do not " squeeze out " boils or pimples. Using an appli-

150 the ship's medicine chest

cator, swab the boil thoroughly with tincture of iodine or with equal
parts of iodine and carbolic acid, and then apply an antiseptic
dressing.

Carbuncle.

A carbuncle is somewhat like a boil, but is different in that it goes
deeper into the tissues, is more extensive, and has, as a rule, more
than one opening. A carbuncle is more serious than a boil, because
of the fact that it is more extensive and is more likely to result in
general blood poisoning.

Treatment. — A carbuncle should be opened with a sterile knife, the
pus should be cleaned out, and the wound should be swabbed with
tincture of iodine, swabbing the outside toward the center, great
care being observed lest the pus get on to the surrounding skin. A
sterile dressing should then be applied. Give the patient a cathartic
whenever necessary, to aid in removing absorbed poisons from the
body, and have him drink plenty of water for the same purpose. At
the first opportunity a physician should examine a specimen of the
patient's urine.

Ingrowing toenails.

An ingrowing toenail causes considerable pain and discomfort,
which result from ulceration of the soft tissues surrounding the nail.
The swelling causes them to curl over the edge of the nail. The
great toe is most frequently affected. The condition is due in most
cases to the pressure of poorly fitting shoes. If infection occurs, the
condition becomes still more serious.

Treatment. — The foot should be soaked twice a day for at least a
half hour in a hot solution of boracic acid, and pieces of cotton should
be tucked underneath the soft overgrowing flesh. Relief may some-
times be obtained by scraping away the center of the nail until it is
ATery thin, or by cutting out a wedge-shaped piece from the edge
of the nail, in order to allow the nail to buckle. The toe should be
painted with tincture of iodine and protected with a sterile dress-
ing. A pad placed between the second and the big toe will assist
materially in relieving pressure on the affected toe. A shoe should
not be worn on the affected foot unless the toe of the shoe has been
cut away. If pus develops, it should be gotten out, and it may be
necessary to remove the nail completely. The operation causes pain
for a few minutes, but healing takes place rapidly after it. The
nail grows again.

Abscess.

An abscess is a walled-off area containing pus. The formation of
an abscess is caused by the invasion of a wound or a bruise by
pus-producing germs. Sometimes an abscess forms in the internal

SURGICAL CONDITIONS AND THKIK TltKATM KNT 151

organs of the body, as the lungs or the Liver; in such cases, the
germs have been carried to the affected organ by the Mood.

The wall that forms around an abcess is the protective device of
nature, and is the means of saving many lives. Sooner or hit .f
an abcess bursts and empties its contents either at the surface of the
body or into one of the body cavities. Sometimes several abscesses
develop in different parts of the body at the same time. An abscess
may develop in any part of the body and in either flesh or bone.
The glands, such as those located in the neck, under the arms, or in
the groin, are frequent sites for surface abscesses.

Treatment. — After having made absolutely certain that an abscess
exists, the best treatment is to open it with a sterile knife, clean
out the pus thoroughly, swab the sore with tincture of iodine, insert
a gauze wick, and apply a sterile gauze dressing. Sterile gauze
dressings should be changed daily. An abcess that drains freely will
soon heal.
Sprains.

A sprain is an injury which results from stretching or tearing
the ligaments and tissues that surround or enter into the formation
of a joint. Such an injury is usually caused by direct violence, as
a twist. Sprains of the ankle, the knee, or the back are of common
occurrence.

"When a sprain occurs, there is usually a feeling that something
has given way, and this feeling is accompanied with a severe
pain. The joint and the tissues immediately around the sprain
swell rapidly; within a short time, the skin about the joint may
show a bluish discoloration. The joint becomes stiff, and severe
pain is felt on attempting to move it.

Treatment. — Place the. part in the position most comfortable for it.
This position will be found to differ in the different joints ; but in all
cases the joint should be elevated as much as the patient can bear to
have it. Keeping the limb high relieves the throbbing pain and
reduces the swelling. A snug- fitting (but not too tight) bandage
sometimes helps to make a sprained joint comfortable ; cold applica-
tions sometimes relieve the pain. After 12 to 24 hours, hot appli-
cations may be put on.

In the case of a sprained joint — for example, a sprained ankle —
some physicians use a strapping or adhesive plaster, applying the
adhesiv.e in strips, each a half-inch wide and 10 to 12 inches long.
Apply the center of the first strip over the back of the sole of the heel
and carry the ends up along the back of the leg. The next strip has
its center over the back of the heel, low down, and the ends pass along
the sides of the foot, low down. Leave the point of the heel
uncovered; pressure of the plaster directly on the heel may cause

152

THE SHIP S MEDICINE CHEST

Fig. 30. — Showing the proper method of beginning the strapping of an ankle with

adhesive tape

Fig. 31. — The proper method of strapping an ankle with adhesive tape

SURGICAL CONDITIONS AND THEIR TREATMENT 153

great discomfort. The third strip is put on so as to overlap the first,
and the fourth to overlap the second. Alternate these strips until
foot and ankle are covered and the dressing is complete. A sprained
knee may also be strapped with alternate layers of adhesive.

Unless the joint is well strapped and ordinary movements are pain-
less, do not allow the patient to use a sprained joint until the condi-
tion has cleared up. In all cases of sprains, examination should be
made most carefully in order to determine whether there is a fracture
of any of the bones. At the first opportunity, an X ray of the point
should be made.

Fractures.

A fracture is the sudden breaking of a bone by some form of
violence. There are numerous conditions which tend to make bones
more liable to fracture; for instance, age; new growths, such as
cancer; syphilis; scurvy; rickets; and any inflammatory condition,,
whatever its cause.

The immediate causes of fractures are (1) direct violence, in
which the break in the bone occurs at the point struck; (2) indirect
violence, in which the bone is broken at some distance from the
application of the violence; (3) the sudden action of muscles, which
sometimes fractures bones such as the tip of the elbow or the knee
cap.

Fractures are divided into two great classes, simple and,
compound '.

A simple fracture is one in which the bone is broken but in which
the broken ends have no communication with the external air, and
which is uncomplicated by extensive injury to the flesh in the imme-
diate vicinity of the break.

A compound fracture is one in which the ends of the broken bone
protrude through the skin and in which there is also injury to the
surrounding tissue.

A fracture may be complete or incomplete. An incomplete frac-
ture is one in which the broken ends are not entirely separated.
This type is often called a " green-stick " fracture, because it re-
sembles the breaking of a green stick. A complete fracture is one
in which the bone is entirely broken through; and such a fracture
may be transverse or straight across, depressed, oblique, or at an
angle, or spiral, as in a twisted fracture.

The term comminuted fracture designates a fracture in which
the bone is broken into a number of small pieces.

An impacted fracture is one in which one end of the broken bone
is driven into the other end.

Signs of fracture. — When a bone is broken, the victim of the acci-
dent, if he is conscious, may hear or feel the bone snap and feels
112055°— 29 11

154 the ship's medicine chest

intense pain on attempting to move. The hurt part swells rapidly,
and there is often a pouring out of blood from the wound into the
flesh about it.

An abnormal mobility, or looseness of motion, is perceptible in
examining the bone. This is not true in cases of impacted fractures.
There is loss of function of the limb, and some deformity is usually
present. This deformity may be angular, or sidewise, and is caused
by the overlapping, turning, or separation of the end of the broken
bone. In most cases the position of the broken limb is determined
by the direction of the force which caused the fracture.

A person who has sustained a fracture also suffers from shock,
and sometimes from bleeding, which may be severe, especially if a
large blood vessel is torn. Within a day or two after the occurrence
of the fracture there is likely to be a rise of temperature. With this
increase of temperature, persons who have been addicted to alco-
holic liquors may develop delirium tremens.

Repair of fractures. — When a bone is fractured, its broken ends are
rough and irregular; the membrane covering it is more or less
torn, but some portions or shreds of the membrane usually remain
to connect the broken fragments. The soft tissues surrounding the
broken ends are more or less lacerated, and there is an outpouring
of blood and serum between these.

New tissue cells begin at once to form; and these increase until
the blood clot is replaced by new tissue called " granulation tissue,"
which soon becomes changed into new bone.

The new bone tissue appears as an overgrowth and is called
the " callus." The callus gradually becomes more solid bone, at the
same time growing less and less in size until it is about level with
the surrounding bone surface.

As a rule, in the course of three or four weeks a broken bone will
be sufficiently repaired to resist bending. Usually, after six weeks a
healthy person may dispense with splints. For small bones, like
those in the arm, three weeks may be long enough in splints.

Treatment of fractures. — In examining the victim of an accident,
the possibility that bones have been broken should always be borne
in mind, and a careful search for fractures should be made. The
position of a limb often indicates the occurrence of a fracture. If,
upon examination, a broken bone is found, the patient should be
handled very cautiously, because if the broken ends of the bone are
allowed to move they will injure the surrounding flesh and perhaps
destroy important blood vessels and nerves. Sometimes the ends of
the broken bones are forced through the skin, producing a compound
fracture, which is much more serious than a simple fracture because
of greater liability to infection and blood poisoning.

SUEGIOAL CONDITIONS AND THEIB TREATMENT 155

When the patient has been conveyed to the sick bay, the next step
in the treatment is to cut away the clothing and wash the affected
limb, great care being exercised not (<> disturb its position. The next
step is to reduce the fracture or deformity; that is,t to place the
broken ends in correct position in relation to each other and, by
means of splints, so to retain them that good union may take place.

Proper treatment of a fracture is of great importance to the
patient ; therefore, if the ship is near a port, the best plan is to make
the patient as comfortable as possible by putting him in bed and
placing the broken limb in as near a normal position as possible, and
keeping it there by splints. In this way the patient may be kept
fairly comfortable for three or four days, or until the ship makes
port.

The treatment of fractures of the most frequent type is described
in the following pages.

Complications that are liable to arise during treatment of frn<--
twres. — With persons of advanced years there is always danger that
pneumonia (lung fever) may develop, especially if the patient is
kept on his back. The occurrence of bed sores often causes con-
siderable trouble ; in order to prevent them,, alcohol rubs should be.
given. If a splint is too tight or is improperly applied, the pressure
produced by it may cause paralysis or contraction of the muscles,
which may impair the usefulness of the limb. Sometimes, after
putting on splints, there is a great deal of swelling, which may result
in injury of the soft tissues, and even in gangrene. Gangrene may
arise, too, from injury to important blood vessels, or from persistent
swelling of the flesh, or as an extension from the infection of a
compound fracture.

In compound fractures, those in which the skin is broken by the
fractured bone, there is great danger of infection by germs. A most
essential feature in treating compound fractures is to render the
wound clean and well drained. Any loose fragments of bone should
be removed. Bleeding should be stopped either by pressure or by
tying the bleeding vessel. The ends of the bone should be brought
into proper relation to each other and held in this position and the
splints applied. Splints should be so arranged that the wound
is accessible for redressing and observation.

The use of a fracture box and padding the limb with sand bags
of various sizes will also produce good results. The wound should
not be sewed up, but a sterile gauze dressing should be applied to it,
and it should be freshly dressed every day.

Ununited fractures. — Sometimes broken bones unite and heal with
difficulty; sometimes they will not unite at all. There are many
reasons for this, the chief of which are lack of apposition, or failure

156

THE SHIP S MEDICINE CHEST

to place and keep the broken ends in proper relation, and imperfect
immobilization, or failure to keep the limb perfectly still. The
broken ends of a bone may not heal unless they are kept absolutely
still. The presence of flesh, or of loose fragments of bone between
the broken ends of the bone, imperfect blood supply to the ends of
the broken bone or the surrounding flesh, and infection or blood
poisoning prevent or interfere with healing, as do also constitutional
causes, such as infectious diseases, scurvy, alcholism, and syphilis.
A fracture can not be said to be ununited by true bone until 12
months have elapsed. In case of slow healing, the part should
be massaged two or three times a day, so as to keep up and improve
the blood supply of the limb. The massage should be administered

Fig. 32. — Showing how to pad a splint with cotton

with due regard to the fact that the limb must not move. The
general health should be built up. The diet should be nutritious,
and the intestines should be kept free by giving cathartics when-
ever necessary.

A " vicious union " is a union which has occurred when the ends
of the broken bone have not been placed in proper relation and
healing has taken place in such bad position that deformity or loss
of function is the result. A vicious union is treated by rebreaking
the bones and setting the ends in proper relation. This should not
be done except by a surgeon.

Splints. — There are various kinds of splints, but the purpose of
them all is to retain broken bones in a normal position so that they
will heal correctly. If there is any movement of the broken ends of

sriUiU'AL CONDITIONS AND TIIKIK TUKAT.M K N T

157

bones, healing does not take place. Splints also serve to reduce
the pain caused by a fracture. Splints are quite often used in the
treatment of sprains, to keep the part from moving, and in such
cases they not only help to relieve pain, but hasten healing. Splints

MJ HBBBJHhbmw

Pig. 33. — Showing application of gauze bandage to hold the cotton in place

are made of various substances. They should be strong enough not
to bend, and their shape should conform as nearly as possible to
that of the part of the body to which they are to be applied. They

Fig. 34. — Protective padding for fracture of the hand

must be carefully padded before they are used. Cover each splint
with a heavy layer of cotton or other soft substance and wrap a
bandage over this to hold it in place. A set of splints is provided
in the medicine chest.

158

THE SHIP'S MEDICINE CHEST

In applying a splint, it must not be bandaged to the limb so
tightly as to press upon any important blood vessels and thus stop
the circulation. Pressure should not be made upon any open sore,
nor upon the wound of a compound fracture. If a splint feels un-
comfortable, there is probably too much pressure, or the bone is
not properly set, and it may be necessary to take the splint off and
to reapply it. In practically all cases of fracture, the flesh swells
considerably; and even after the bandage and splints are applied,
the swelling must be watched, so that these appliances may be
loosened if necessary. If the swelling becomes extensive and is not
relieved by loosening the bandage and splints, gangrene may set in

and cause delay in healing, or
ma}' become so extensive as to
cause loss of limb, or general
blood poisoning and death.

In padding and applying a
splint, any bony prominences
should have extra padding, or
else a hole or depression of
sufficient size should be made in
the splint.
Special Fractures.

Fracture of nose bones. — The
bones of the nose are often
broken (mashed) by direct vio-
lence. The signs of fracture are
pain, swelling, and displacement.
Nosebleed usually occurs.

Treatment. — Pad the blades of
a small pair of artery forceps
with short pieces of rubber
tubing, and place them in the
nostrils. By expanding the blades and by manipulating the nose on
the outside with the fingers, the broken bones may be brought together
into proper position. A splint of moistened cardboard or similar
material, with openings for breathing, should be made to fit over the
external surface of the nose. The nose should be washed out two
or three times a day with a solution made by dissolving an alkaline
antiseptic tablet in a half glass of warm water.

Fracture of the lower jaw. — The lower jaw may be broken by direct
or indirect violence; but fracture of this bone is usually caused by
a direct blow. The most usual location of a fracture is the weakest
point in the jaw, which is in the neighborhood of the canine tooth
(stomach tooth). Little trouble should be experienced in detecting
a fracture of the lower jaw because in case of a fracture the gums

Fig. 35.

-Four-tailed bandage for fracture
of the jaw

SUBGICAL CONDITIONS AND TIIKH; TBEATMENT

159

are usually lacerated and the line of the teeth is likely to be irregu-
lar, and abnormality of motion may be not.iced.

Fracture of the Lower jaw is frequently of the compound type,
and some pus is always sure to form before it heals. If the fracture
is at an angle or is in the upright portion of the jaw, there is usually
hut little displacement and deformity.

Treatment. — If there is little displacement, the jaw can be effec-
tively fixed in place by a four-tailed bandage, which supports the
lower jaw. Two of the tails are tied over the top of the head, some-
what hack toward the crown, and the two upper ends are then tied
to the lower ends, to prevent slipping.

Fig. 36. — Beginning of strapping of chest
with adhesive

Fig. 37. — Completed strapping of chest

The patient should be fed with fluids for four or five weeks, and
his mouth should be frequently washed out. A molded cast, like
that described for use in fracture of the nose, may be made for the
lower jaw. At the first opportunity the patient should be taken to
a competent surgeon-dentist to have the jaw wired in place.

Fracture of the ribs. — Fracture of the ribs is not an uncommon
injury, the ribs breaking at their most convex (curved) part. In-
jury to the lungs from fracture of the ribs is uncommon, but may
occur, especially if the broken ends of the bone are driven inward.
The fifth to eighth ribs are most commonly broken, the patient usu-
ally feeling them snap, and immediately begins to suffer from pain,
which is worse when he takes a breath.

160 the ship's medicine chest

Treatment. — As a rule there is but little displacement of the broken
ends, and so the treatment is quite simple, consisting in the applica-
tion, in row after row, of strips of adhesive plaster, that reach
from the spine to the center of the breastbone. Each strip of ad-
hesive should begin at the spine and be brought forward, and, dur-
ing a deep expiration, or blowing out of air from the lungs, fastened
to the center of the breastbone. Each strip should overlap the last
one about half its width. A bandage should be put on over the
plaster.

If the fracture is due to direct violence and it is suspected that
the broken ends are driven inwards, the adhesive should not be
applied, but the patient should be placed in bed, and his chest should
be held still by sand bags packed around his body. Broken ribs
nearly always heal rapidly and without complications.

Fracture of the clavicle (collar bone). — Fracture of the collar bone
is of common occurrence, and usually results from a fall on the hand
or shoulder.

There may or may not be much displacement of the broken ends.
The amount of deformity depends upon the location of the break.
The patient usually supports the elbow of the injured side with the
hand of the other side, and keeps his head bent toward the fracture,
in order to relax the muscles of the neck. The displacement of the
broken bone is due chiefly to the fact that the weight of the arm
pulls down the outer end of the broken bone.

Treatment. — In an ordinary fracture of the collar bone, the dis-
placement of the bones is corrected by drawing the shoulder up-
ward, backward, and outward, and maintaining it in that position.
There are three methods by which the ends of the broken bone may
be kept in proper position.

Sayre's method is to place a pad of cotton in the armpit on the
injured side; a broad strip of adhesive plaster is then looped loosely
around the middle of the arm, so that the arm may be pulled back-
ward by it. This strip is carried around the back, beneath the
opposite axilla (or under the opposite arm), and across the front of
the chest, beneath the armpit on the injured side, being stuck to the
skin throughout. A broad piece of plaster, with a hole cut in it for
the tip of the elbow, is fastened back and front over the opposite
shoulder. The apparatus should be worn for three weeks and after
it has been discarded a siing should be used for at least two weeks
longer.

The " three-handkerchiefs " method for maintaining proper posi-
tion in fracture of the collar bone is equally as effective as that
described above, if it is properly applied. A handkerchief is folded
and tied over each shoulder so as to form two loops and the two loops

SURGICAL CONDITIONS AND THEIR TREATMENT

161

are pulled upon from behind until the ends of tin- fractured bone are
brought into place; the two loops are then fastened together with
the third handkerchief. The same effect may be obtained by tying
the patient to a padded cross made of two pieces of half -inch pine
board, 3 by 18 inches and 3 by 16 inches.

The third method for treating a fractured collar bone is to place
the patient on his back, with his head low, a pad between his
shoulders, and his arm bound to the affected side. Examination
should show the ends of the broken bone to be in proper place, and
this position should be kept until the bone has healed.

Fracture of arm bone (humerus). — The humerus, or the long bone
that extends from the shoulder to the elbow, is frequently broken;
and great care must be used in set-
ting it in order that the arm may not
become useless.

When a physician sets a fracture
of the arm bone, he proceeds to de-
termine the exact location at which
the bone is broken and plans his
treatment accordingly; but for a
nonmedical man the best plan of
treatment is probably as follows :
Straighten the limb by taking hold
of it on either side of the fracture
and placing the limb in its natural
position. To hold the broken ends
in place, use two well-padded splints
about 4 inches wide and of unequal
length; place the shorter splint on
the inner side of the arm, so that it
will extend from the armpit to about
1 inch below the point of the elbow ;
then place the longer splint on the
outer side of the arm, to extend from the point of the shoulder to
about 1 inch below the point of the elbow. The two splints should
then be fastened with strips of adhesive. First wind a strip of ad-
hesive around the middle of the two splints, and then a strip near
each end. If necessary, other strips may be used. The splints should
be held in rigid position while the adhesive is being applied. Rein-
force the adhesive strip with a gauze bandage. Make a sling to hang
about the neck, and place the hand in the sling. Do not forget to
watch for swelling; if the arm becomes much swollen and painful,
it will be necessary to loosen the splints, which may be done without
disturbing the position of the arm. The injured man should be sent
to a competent surgeon at the first opportunity.

Fig. 38. — Splint for fracture of arm
(humerus)

162

THE SHIPS MEDICINE CHEST

Fracture of forearm bones. — The forearm contains two bones, the
radius and the ulna. The radius extends from the elbow to the
wrist, on a line with the thumb ; while the ulna extends from the
elbow to the wrist, on a line with the little finger.

The terms pronation and supination are used in describing the
positions in which a broken arm may be placed in treating a fracture
of the forearm. The first of these terms, pronation, designates a
position in which the palm is turned down ; supination is the reverse
of pronation.

Fracture of the radius. — When the head of the radius — that is, the
extreme upper end, near the elbow — is broken, a grating of the
bones may be detected, and the upper fragment does not rotate when

Fig. 39.

-First position for applying
triangle arm sling

Fig. 40. — Completed triangle arm sling

the forearm is rotated. Treatment consists in fixing the arm in
splints in such a position that the thumb points upward.

If the neck of the radius, which is the portion just below the
head of the radius, is broken, the lower fragment is drawn upward
and forward, and projects upon the front of the elbow ; and the head
of the bone can not be rotated when the forearm is rotated. The
treatment of this type of fracture consists in fixing the arm in
sjDlints in a fixed position.

Fracture of the shaft of the radius is characterized by pain,
deformity, and abnormal mobility and grating of the bones.

If the fracture occurs in the upper portion of the shaft, the arm
should be put in splints with the palm of the hand up. If the

SURGICAL CONDITIONS AND THEIR TREATMENT

1G3

fracture is located in the lower part of the shaft, the arm should bo
put up in a position that is between pronation and supination.

Fracture of lower end of radius (Colles's fracture). — Fracture of the
lower end of the radius is of common occurrence and is caused by
falling upon the outstretched hand. The line of fracture is about
1 inch above the wrist. In such a case, a characteristic deformity
appears, which has often been referred to as the "silver fork
deformity."

Fig. 41. — Internal angular splint for fracture of the elbow

Treatment. — Reduction of this fracture is brought about by grasp-
ing the hand of the injured arm with a " shaking-hands grip " and
drawing the hand toward the body of the operator; with the free
hand the fragments are molded or worked into correct position.
The arm is then put up in splints.

It is important in this type of fracture to begin early, about the
end of the first week, with massage and passive movement of the
wrist to prevent stiffness. Healing should be accomplished within
about three weeks.

164

THE SHIP S MEDICINE CHEST

Fig. 42. — Splint for fracture of both bones of the forearm

Fracture of both bones of the forearm. — In treating this type of
fracture, which results from direct violence, it is important to pre-
vent lateral or side compression of the broken fragments ; otherwise,
the four ends may unite in one mass. If the break is located at the
upper end of the bone, near the elbow, the arm should be put up in
an extended position, with the palm supinated, or facing up. If the
break is located lower down on the bone, the arm should be put up
midway between pronation and supination.

Fig. 43. — Completed splint for fracture of the hand

SURGICAL CONDITIONS AND THEIR TREATMENT

165

Fracture of the femur (thigh bone). — Fracture of tlio hip or thigh
bone may be caused by either direct or indirect violence and is liable
to occur from tripping and falling. The bone may be broken at any
point along its length. If the break occurs near the head or neck

Fig. 44. — Splint for fracture of the thigh

of the bone — that is, near the hip joint — there may be some difficulty
in its healing. A break at either extremity of the bone is more serious
and difficult to treat than a break at some point along the shaft of
the bone.

Fig. 45. — Splint for fracture of the leg (tibia or tibula)

The signs of fracture are pain, swelling, deformity, and often
marked shortening of the limb. A person who has had a fracture
of this bone is usually unable to move the injured limb, and in most
cases, as he lies on his back, the foot on injured side turns outward.

16G the ship's medicine chest

The deformity depends to some extent upon the direction from which
the force was directed; and the weight of the limb itself influences
its displacement. In addition to the symptoms just described, the
injured person often shows signs of severe shock.

Treatment. — Use two splints, one to reach from the armpit to a
point just below the heel, the other to reach from the crotch to a
point just below the heel.

The splints should be well padded with cotton, so that they will
conform to the shape of the limb. The cotton is held in place by
pieces of gauze bandage. Extra padding of cotton should be put
in above and below the bony prominences, otherwise pressure may
cause troublesome sores over them.

The limb should be placed in normal position — that is, when the
patient is on his back, the great toe should point directly upward,
never outward, and should be held in such position by an assistant.
The splints should then be placed in position and should be tied in
place with gauze strips. It may be well to reinforce these strips
with strips of adhesive tape. Care should be observed in fastening
the splints to see that they fit properly throughout their entire
length; and the splints should be well looked over after they have
been fastened, to make sure that they will stay in place and that there
is no undue pressure at any point. Frequent examination of the
splints and bandages is necessary, because some of them may require
readjustment.

The patient should be put ashore at the first port where proper
hospital attention can be given.

Fracture of the leg. — The leg bones, which extend from the knee to
the ankle, are called the tibia and the fibula. The tibia, which is the
larger of the two, is situated in front of the fibula. The sharp edge
of the tibia is known as the " shin." The fibula lies to one side of
the shin bone and behind it.

In a fracture of the leg one of the bones or both bones may be
broken ; as a rule, both are broken and at different levels. The near-
ness of these bones to the skin accounts for the fact that the broken
ends often protrude through it, creating a compound fracture.

Treatment. — The fracture should be reduced by bending the knee
to relax the calf muscles, and then, by manipulation, bringing the
broken ends into proper position. If the ends of the bones have
pushed through the skin, the wound made by them should be cleaned
and painted with tincture of iodine. The wound should be examined
daily and, if necessary, redressed with sterile gauze. Should infec-
tion occur, it may be necessary to enlarge the opening in the flesh
and to swab the wound out with iodine. The dressing should be
changed daily. Two splints should be applied, one on the outside

BXTBGICAL CONDITIONS AND TIIKIli II; I. ATM K XT 107

of the leg and extending from the hip to the ankle, the one on the
inner side reaching from the crotch to the ankle Care must be
taken that the splints arc properly padded and not too tight. An-
other method is to construct a trough of %-inch boards, 8 inches
wide. (') inches deep, and long enough to extend from the crotch to
below the heel. This should be padded and the leg held in position in
the trough by sand bags.

Fracture of the ankle joint. — Fracture of the ankle joint, or Pott's
fracture, as it is sometimes called, is of common occurrence, and is
usually caused by direct violence, such as accidentally turning or
twisting the ankle toward the outside of the foot. The strain tears
the ligaments, and the fibula may overbend to such an extent as to
break off about 3 inches above the ankle. At the same time the foot
is displaced outward, or outward and backward. In many cases,
however, the displacement is slight. Sometimes the tibia may also
be broken.

Treatment. — Relax the calf muscles by bending the knee. Steady
pulling and manipulation should then be applied to the foot, and
the limb should be fixed on a right-angle splint applied to the back
of the leg and sole, with side splints in addition. The foot should be
kept at right angles to the leg.

The proper treatment of fracture of the ankle joint is of great
importance, because permanent deformity may result from careless
treatment. The patient should therefore be placed ashore in hospital
at the earliest opportunity.

Fracture of the spine. — Fracture of the spine may occur as the
result of direct violence, such as a fall over a railing, or a heavy blow
on the back. Indirect violence, as in forcible bending of the spine,
is, however, the more usual cause of such a fracture.

Treatment. — The patient should be handled with greatest gentleness
and placed in bed in a comfortable position. Sandbags should be
placed along the neck and sides to prevent motion of the spine. If
the spinal cord is injured, the symptoms displayed will depend upon
the location and extent of the injury of the cord. The patient
should be kept on a semisolid diet. His bowels should be regulated
by either cathartics or rectal injections. If there is paralysis of the
bladder, the patient should be relieved by drawing off the urine with
a catheter. The patient should be placed in hospital at the first
opportunity.
Bedsores.

Special care should be taken to prevent bedsores. The bed should
be as comfortable as possible. The back and buttocks, which are
the most usual sites for bedsores, should be kept clean by frequent
washing with soap and water. The skin should be dried with a

168 the ship's medicine chest

soft towel and then rubbed with a mixture of equal parts of alcohol
and water and dusted with starch. If the skin becomes red, indicating
the beginning of a bedsore, zinc ointment should be applied, and the
part should be surrounded by a thick ring of cotton shaped like a
bird's nest.
Dislocations.

A dislocation is a displacement of the ends of the bones which
enter into the formation of a joint.

The contributing causes of accidental dislocations are the nature
of the joint and the age of the patient ; young people are more likely
to have a separation of the bone, while older people are more liable
to fractures as the result of accidents. The condition of the muscles
and the flesh around a joint also has an influence in dislocation; for
example, if the flesh is wasted, there is less hindrance to dislocation
than when the muscles are strong and hard. The exciting cause of
dislocation is always violence, which may be direct, indirect, or mus-
cular. A dislocation may be complicated by a fracture or by more
or less injury to important blood vessels and nerves.

The signs of dislocation are pain, discoloration, swelling, de-
formity, and limitation of movement.

The difficulties in reducing dislocations arise from the shape of
the joint, from the fact that the surrounding fibrous capsule and
tendons get in the way, and from the contraction or tightening up
of the surrounding muscles.

If a dislocation is allowed to remain untreated, the displaced head
of the bone becomes in time surrounded by a false joint; the true
articular cavity (or the hollow which formerly held the head of the
bone) becomes filled with fibrous tissue, and adhesions are likely to
occur between the injured fibrous tissues and the adjacent blood
vessels and nerves, so that an attempt at a late reduction may injure
those vessels and nerves.

Lower jaw, dislocation of. — Dislocation of the jaw may occur as a
result of yawning, of other muscular action, or of a blow received on
the chin while the mouth is open. When the lower jaw is dislocated,
the mouth is widely opened and remains so, and the jaw projects
forward. Motion is interfered with and saliva dribbles from the
mouth.

Treatment. — The person who reduces this dislocation should first
cover his thumbs with a fold of towel or similar material, in order
to prevent them from being bitten ; because the dislocation is usually
reduced with a snap that brings the teeth together with sufficient force
to produce a bite that might do injury.

The padded thumbs are placed in the mouth over the lower molar
(large back) teeth, are pressed firmly downward until the head of

SURGICAL CONDITIONS AND Til Kill Tl; I . ATM KNT 1G9

the bono is free, and then, with the fingers under the chin, the jaw-
is brought forward and upward, and the heads of the bone slip back
into place. A four-tailed bandage should be worn for a lew days.

Shoulder dislocation. — The most frequent dislocation in adults is
that of the shoulder. Such a dislocation is usually caused by a fall
on the hand or the elbow while the arm is extended, throwing the
head of the humerus (long bone of the upper arm) upon the weakest
point of the joint capsule, which gives way and allows the head of
the bone to pass out of its socket.

In case of dislocation the shoulder is flattened; a prominent bony
process may be felt at the point of it; the head of the humerus may
be felt to be in an abnormal rjosition ; the elbow is displaced from the
side and can not be made to touch it while the hand of the affected
side is placed on the opposite shoulder; a comparison of the injured
shoulder with the opposite one will show a conspicuous difference in
shape and contour. When the head of the bone is displaced back-
ward, close to the shoulder blade, the elbow is displaced forward and
may be made to touch the chest wall.

Treatment. — In treating a dislocation of this type, give an anes-
thetic, such as chloroform or ether, until the muscles are relaxed ; as
a rule, the slightest motion will then suffice to produce reduction.

Kocher's method of reduction is to grasp the elbow of the affected
arm with the corresponding hand, i. e., if the left shoulder is dis-
located, grasp the elbow7 with the left hand. Grasp the wrist with
the opposite hand. Bend the forearm and press the elbow to the
side. The arm is then turned fully outward at a right angle with
the body. The elbow is then brought to the mid line of the body and
the hand of the affected side is placed on the opposite shoulder.
These movements relax the tense part of the capsule, and bring the
head of the bone down to the tear in the capsule and then through
it back into the joint.

The elbow joint. — Dislocation of the elbow joint occurs mostly in
young people. If such dislocation is observed before much swelling
has occurred, the deformity or the location of the ends of the bones
may be easily felt.

There are several types of dislocation of the elbow. Both bones
may be dislocated backward, or, rarely, both may be dislocated for-
ward— the latter type usually being complicated by a fracture of
the tip of the elbow ; lateral or side dislocation is sometimes seen ;
the ulna or the radius alone may be dislocated ; and there is a con*
dition often called " pulled arm."

Treatment. — Reduction of a backward dislocation should be made
early ; otherwise, rapid swelling will greatly interfere with reduction,
112055°— 29 12

170

THE SHIP'S MEDICINE CHEST

Fig. 46. — First position of Kocher's
method for reduction of a dislocated
shoulder

Fig. 47. — Second position for reduction
of dislocated shoulder

Fig. 48. — Dislocated shoulder reduced by Fig. 49. — Method of reducing dislocation
Kocher's method of a finger

SURGICAL CONDITIONS AND THEIR TREATMENT 171

if it does not prevent it. To reduce the dislocation the patient
should be placed in a sitting position and the first-aid man should
place his knee against the dislocated elbow, grasp the patient's wrist
with one hand and the lower part of his arm with the other hand,
pull forward on the wrist, and at the same time bend the arm around
his knee.

If the bones of the arm are dislocated forward, the treatment con-
sists in forced bending of the forearm, and then fully extending the
arm, at the same time making pressure upon the dislocated ends
of the bones, in order to force them into place. After reducing a
dislocation, apply splints, which should be kept on for two weeks.
After that the joint should be bent gently back and forth daily by
the ship's officer until well.

" Pulled arm " may occur in adults when, in falling, some object
is grasped in an effort to prevent the fall. Severe pain is immedi-
ately complained of in an injury of this nature. The patient can
not turn his hand over either when the palm faces up or when it is
down. Treatment consists in pronating or supinating, flexing fully,
and then extending the arm.

Dislocation of the thumb. — A backward dislocation of the thumb is
sometimes difficult to reduce, because the tendons hook around the
head of the bone.

Treatment. — Take a piece of bandage and throw two half hitches
around the dislocated thumb. The thumb should be pulled outward
until it is at right angles with the hand ; then, while it is still being
pulled, the thumb should be quickly bent until it lies along the index
finger.

Dislocation of a finger. — Treat as above directed.

Hip dislocation. — The hip joint, composed of the thigh bone and its
socket in the pelvic bone, is of the ball-and-socket variety, the ball
being the end of the thigh bone.

In case of dislocation at the hip, the injured limb will be shorter
than the other one; the foot may be twined inward or outward;
the hip will be less moveable; there will be pain on attempted mo-
tion. If there is any suspicion of fracture at the hip, make the in-
jured man as comfortable as possible and do not meddle with
the hip.

Treatment. — The patient is placed upon a mattress on the floor, and
is given chloroform. The leg is bent upon the thigh, and the thigh
is bent upon the abdomen. The head of the femur, or leg bone, is
thus rolled down to the lower part of the socket. The knee is then
turned outward and brought down straight into its normal position ;
this motion carries the head through the tear in the tough ligament

172 the ship's medicine chest

surrounding and connecting head and socket and allows it to enter
the socket where it belongs.

Transportation of the Injured.

Stretchers are appliances for moving the sick or injured. They
are borne by two or more persons. The essential parts of a stretcher
are two stout poles, about 8 feet long, with a strip of some strong
material fastened between them, for the person carried to lie on.
The ends of the poles serve as handles. Regular stretchers are the
most convenient, but in an emergency equivalent appliances may
easily be improvised. A very serviceable litter may be devised out
of two gunny sacks and two suitable poles. Two holes are made in
the bottom of the sacks at opposite corners. The poles are placed
inside the bags and thrust through the holes, and the sacks are
drawn into place. Cross strips of wood may be lashed or nailed
between the poles to hold them apart.

Another method is to lay a blanket on the deck and roll the outside
edges around the poles and to continue the rolling until the poles are
about 20 inches apart. The blankets are then fastened by nailing
them to the poles or tying them securely with strips of strong twine.
Canvas may be used in place of a blanket.

A coat stretcher is constructed out of two coats and two side poles.
The coat sleeves are first turned inside out. The poles are thrust
through the sleeves from the shoulder and the coats are buttoned
around the poles with the buttons down, so as to make a webbing
across the poles.

If tools and lumber are available an excellent stretcher may be
constructed out of boards. Make the bed about 6 feet long and 18
or 20 inches wide. Suitable handles may be fastened to the ends or
sides. Injured persons may also be carried on doors, shutters,
benches, short lengths of ladders, etc.; but all rigid appliances of
this sort must be padded with blankets, clothing, mats of straw, or
some other cushioning material.

Every improvised stretcher should be tested by placing a well man
on it before it is used for an injured person.

A great many instructions have been written about the methods
to be used in lifting a patient onto a stretcher. Such instructions are
very useful for military forces and other trained bodies, but they are
somewhat elaborate and are likely to be forgotten by the ordinary
person in an emergency. It is best, therefore, to depend mainly
upon common sense, while taking special care that no additional
harm is inflicted on the injured part. Place the stretcher alongside
the patient, and, if plenty of help is available, have one person raise
the head and shoulders, another the hips, and a third the knees of
the patient. These helpers stand or kneel on one side of the patient,

SURGICAL CONDITIONS AND THE I!; TREATMENT 173

with the stretcher on the other side. A fourth assistant stands on
the opposite side and his whole duty is to reach over the stretcher
and handle and support the injured arm or leg.

If but two persons are present, the head and shoulders of the
patient may be placed upon the stretcher first. The helpers then
change their position to the lower part of the bod}- and lift the hips
and legs so as to place them upon the stretcher, guarding the injured
part as rare fully as possible.

When the patient is on the stretcher, he should be well covered
with blankets or clothing. Ordinarily the bearers can well dispense
with their coats for this purpose. It makes no material difference
whether the patient is carried feet or head forward, except in going
uphill or upstairs, when the head should always go first. The bear-
ers should break step and proceed slowly. The stretcher handles
should be supported with the arms hanging down, and should not be
borne upon the shoulders. If obstacles are encountered, it is best to
try to go around them.

It is sometimes difficult to handle a stretcher in narrow halls,
ship's holds, and similar places; and so in such places the patient
may be carried in a chair. Two poles may be lashed between the
legs of the chair and used as handles. The poles should be attached
so that the chair will tip well backward when the handles are level.
The poles should be sufficiently long to afford space for the bearers
to walk without coming in contact with the patient; or the Stokes or
wire-basket stretcher may be used.

A sling may be constructed by taking two blankets and rolling each
of them up diagonally from one corner, to form a large cylinder.
The two rolls are united by tying them together at the ends. The
loops thus formed are slipped over the heads of the two bearers and
allowed to rest on their shoulders, the middle parts of the blankets
forming two slings. The patient sits on the slings and steadies
himself by placing his arms around the necks of the bearers.

Other devices for carrying men up ladders or hoisting them
perpendicularly on stretchers are sometimes used on vessels.

Occasions may arise when it is impossible to take sufficient time
to obtain a stretcher or other such appliance for carrying an injured
person. Under such circumstances helpers must carry the patient
without the assistance of any apparatus. If there are two bearers,
a man may be carried for a short distance on what is known as a
" lady's chair." This is formed by each bearer grasping his left
wrist with his right hand. The free left hand then grasps the right
wrist of the other assistant. The injured person sits on the support
thus formed and places his arms around the necks of the bearers.

174 the ship's medicine chest

Another plan is for the bearers to stand side by side and each to grasp
the other's nearest shoulder. The outside hands are clasped together,
and the patient sits upon these. The other arms act as a backrest.
To carry an unconscious man for a short distance, the forward bearer
may walk between the patient's legs, grasping his knees, while the
rear bearer supports the patient's shoulders by putting his hands in
his armpits.

It is extremely difficult for one person to carry a patient for a con-
siderable distance. If the patient is conscious, he may be carried on
the back of the bearer with his arms around the neck of the latter
and his thighs supported by the bearer's forearms, after the fashion
called " picka-back." The greatest difficulty, however, is encoun-
tered when a single bearer attempts to pick up an unconscious person.
It is, of course, quite practicable to lift a child or a small adult in
the arms, but it is difficult for a man of ordinary strength to lift a
heavy individual in this way.

Methods by which One Operator May Carry an Unconscious Person.

Various methods are described for getting an unconscious person
up on the bearer's back. An unconscious person is limp; and al-
though he may be lifted to his knees without great difficulty, he is
likely to fall forward on his face as soon as the bearer's grip is shifted
below the hips.

If the patient is only partially unconscious and is capable of
stiffening himself a little, he may be got upon the bearer's back
by the following maneuvers :

First, turn the patient on his face. Stand astride of his body at
the hips. Place the hands under the patient's flanks and raise him
to his knees ; then lift him to his feet. Holding him in this position
with the right arm, grasp his left wrist with your left hand, lower
your head, and pull his left arm around your neck. Now work
your right foot forward until it is in front of his legs, and bend
forward until his body is supported on your back. Now put your
right hand forward and pass it between the unconscious person's
legs, grasping his right thigh above the knee from behind. With a
sudden motion, throw the patient upon your back. Shift him far-
ther upward, release his left wrist, and grasp his right wrist with
your left hand. The unconscious person will then be on your back
and can be carried without great difficulty.

Appendicitis.

Appendicitis, which is caused by an infection of the appendix,
may be induced by digestive disturbances, indiscretions in diet, by
injury, the presence of a foreign substance in the appendix, and by
the presence of germs. An attack begins with a feeling of distress
in the abdomen, increasing rapidly in intensity until it is a real

SURGICAL CONDITIONS A X I > TIIKIi: I'll I . A 'I'M KN'T 175

pain, which at first may be general, extending through the entire
abdomen but which finally localizes in the Lower right Hank, about
3 or 4 inches below the ribs. The patient may be nauseated and
may vomit. Sometimes the pain in the abdomen is very intense
ami the abdominal muscles of the right side arc hard and rigid.
The greatest danger attending an attack of appendicitis is that the
appendix may burst and cause general peritonitis, which is liable to
result in death.

Treatment.— DO NOT GIVE CATHARTICS. The patient should
be placed in bed and kept absolutely quiet. The patient should
abstain from all food until all symptoms have subsided. Pain
should be controlled by giving morphine. A rise of temperature and
a sudden relief from the pain and the distention and rigidity of the
abdomen are signs of a ruptured appendix and the case is a serious
one. Should the pus wall off, the outlook is much better than when
it fails to do so. A marked swelling of the abdomen is usually a
sign of general inflammation of the abdomen and of an unwalled-off
abscess.

In a great many instances the attack of appendicitis will subside
without rupture of the appendix. Yet, since there is no way of
knowing when an appendix will rupture, even the severe symptoms
can not be depended upon to indicate the outcome of an attack;
therefore such patients should receive very careful attention and
be kept absolutely at rest until it is certain that the attack has
passed. At the first opportunity the patient should be put ashore, to
receive proper treatment in a hospital.

Rupture (Hernia).

A rupture (hernia) is the protrusion of a portion of intestine or
other viscus through an opening in the wall of the abdomen. Any
bulging in the abdominal wall should be suspected as a rupture and
should be examined. Rupture may be present in any part of the
abdominal wall, but is most frequently located in the groins and in
the navel.

The protruding portion of the intestines may carry with it any
one of the abdominal organs, but it usually includes only intestine
and omentum. Hernias occur more often in the small intestines
than in the large intestines.

A rupture in the groin is known as an inguinal hernia.

Treatment. — Hernia may be relieved either by the use of trusses or
by operation. The first step in the treatment is to reduce the rup-
ture— that is, to put the contents of the bulging sac back into the
abdomen. The patient should be placed upon his back with the hips
higher than the shoulders, with knees drawn up, so as to relax the
abdominal muscles; then, by gentle manipulation with the ringers,

176 the ship's medicine chest

the protruding mass may be gradually worked back into the abdo-
men. Great gentleness and patience must be used in reducing a
rupture, in order not to injure the intestine. If a rupture has been
protruding for a long time, adhesions may have formed, and there-
fore it can not be reduced. When the rupture has been reduced, a
truss should be put on. A temporary truss may have to be made,
as follows: Make a smooth pad which will fit over the hernal open-
ing. The pad may be made from a block of wood, a flat piece of
steel, a flat piece of coal, or any such, object. Cover the pad with
cotton and then with gauze. Strap it to the body with adhesive
plaster and reinforce it with a gauze bandage extending around the
waist, with a strip drawn through the crotch, to hold the pad in
place.

In cases in which the rupture can not be reduced, there is danger
that the intestine may become compressed by adhesions or swelling
to such a degree that its blood supply is shut off. If this occurs,
gangrene rapidly sets in and causes general peritonitis and death
within a few days. A case of strangulated rupture, as this type is
termed, calls for an operation, but on board ship conditions are not,
as a rule, suitable for major surgery ; therefore, use hot applications,
wash out the bowels with soapsuds, and give a liquid diet until the
patient can be either placed ashore or transferred to a passing ship,
provided the latter carries a physician and has facilities, or else
can make port promptly.

Piles (Hemorrhoids).

"Piles " is the name given to a vericose or swollen condition of
the veins surrounding the anus and the lower inch or two of the
rectum.

One reason for the formation or production of piles is the fact
that the veins in this location receive very little support from the
tissues. The principal exciting cause of piles is constipation, in
connection with which prolonged straining in the effort, to evacuate
the bowels causes the veins to become distended and gradually to
break away from their normal location and to form tumors. Other
causes of piles may be tumors in the pelvis or abdomen.

Piles may be either external or internal, or both. External piles
are those which protrude below the external sphincter and are
covered with skin. Internal piles lie within the bowel and cause
only slight symptoms, unless they become inflamed.

Treatment. — Piles which protrude from the rectum should be re-
placed. Hot applications give a great deal of relief; a solution to
use for the hot applications may be made by dissolving several
alkaline antiseptic tablets in a pint of hot water. An excellent pile
salve may be made by mixing well a heaping tablespoonful of zinc

BURGICAI; CONDITION'S AND THEIK TREATMENT 177

oxide ointment with a half teaspoonful of turpentine. Turpentine

blended thus with zinc oxide salve does not burn, but, on the con-
trary, has a cooling and pain-relieving effect.
Affections of the Penis.

"Phimosis" is the inability to retract or draw hack the prepuce
(foreskin). This condition is frequently caused by venereal disease.

Treatment. — The proper treatment is circumcision; hut relief may
be obtained by splitting the foreskin, under aseptic conditions, with
a knife or scissors. A hot, wet dressing should he applied and
should he replaced by a fresh one as soon as it grows cold. A moder-
ate amount of bleeding does no harm; but should the bleeding con-
tinue it should be controlled by pressure with a piece of sterile gauze
held between the fingers.

Paraphimosis is a. condition in which the foreskin is back of the
head of the penis, and because of swelling and inflammation can not
be brought, forward. This condition, like phimosis, is a frequent
complication of venereal disease. If either of these conditions is
neglected, extensive ulceration may occur.

Treatment. — Apply wet dressings for three or four hours: then
attempt to bring the foreskin forward by grasping the penis between
the fore and middle fingers of each hand ; and, as a rule, by pressing
with the thumbs on the head the swelling is gradually lessened and
the skin may be drawn forward over it. If the swelling can not be
reduced by the above method, make a number of punctures through
the skin of the swollen part with a sterile knife point; through the
openings so made the fluid and blood will be able to escape from
the part, and the swelling will be reduced so that the skin may be
brought into proper place. Circumcision should be performed by
a competent surgeon at the earliest opportunity.

Stricture. — Stricture is a narrowing of the urethra which obstructs
the flow of urine from the penis. The most common cause of stric-
ture is venereal disease. When a venereal sore heals it contracts
and thus lessens the size of the canal in the penis and so interferes
with the passing of urine. In such cases, the size of the stream is
smaller than it should be ; and in severe cases the urine is passed only
in dribbles or is shut off entirely.

Treatment. — The patient must be relieved; therefore, take the
smallest catheter from the medicine chest, boil it in water, cover it
with a thick film of vaseline, and pass it into the penis and to the
bladder. Do not be rough, but be patiently persistent, until the
catheter enters the bladder and thus empties it of urine.

Effects of Electricity.

Electricity exerts both a general and a local action. Its general
action is evidenced by a shock, as in the passage of a strong electric

178 the ship's medicine chest

current through the body, which may lead to momentary uncon-
sciousness, to prolonged unconsciousness, or perhaps to death. When
a person comes into contact with a strongly charged wire, he is unable
to break the contact, because of spasm of the muscles. The electric
current should be immediately shut off. If rubber gloves or some
nonconducting material are at hand, these should be used in pulling
the victim away from the electric wire. If nothing else is available,
a dry board may be used to break the contact. Whatever the rescuer
uses for the purpose, he must be sure it is of nonconducting material,
or else he will be in as bad a plight as the victim.

Electrical burns should receive the same treatment as any other
kind of burns.

If a person who has been shocked by electricity is unconscious,
artificial respiration should be given and should be kept up for at
least an hour or two. Early and effective artificial respiration may
save life in such a case, and it should be continued until it is certain
that life is beyond recall.

Artificial Respiration.1

When a person has been rendered unconscious by fumigation gas,
by an electric shock, drowning, or any other cause, and breathing
ceases or becomes very shallow, artificial respiration should be begun
at once. Proceed as follows:

1. Lay the patient on his belly, one arm extended directly over-
head, the other arm bent at elbow and with the face turned outward
and resting on hand or forearm, so that the nose and mouth are
free for breathing. (See fig. 50.)

2. Kneel straddling the patient's thighs with your knees placed
at such a distance from the hip bones as will allow you to assume
the position shown in Figure 50.

Place the palms of the hands on the small of the back with fingers
resting on the ribs, the little finger just touching the lowest rib,
with the thumb and fingers in a natural position, and the tips of the
fingers just out of sight. (See fig. 50.)

3. With arms held straight, swing forward slowly, so that the
weight of your body is gradually brought to bear upon the patient.
The shoulder should be directly over the heel of the hand at the end
of the forward swing. (See fig. 51.) Do not bend your elbows.
This operation should take about two seconds.

4. Now immediately swing backward, so as to remove the pressure
completely. (See fig. 52.)

1 This method (the prone pressure method) has been approved by the foUowing organiza-
tions : American Telephone & Telegraph Co. ; American Red Cross ; American Gas Associa-
tion ; Bethlehem' Steel Co. ; National Electric Light Association ; National Safety Council ;
Bureau of Medicine and Surgery. Navy Department ; Office of the Surgeon General, War
Department ; U. S. Bureau of Mines ; U. S. Bureau of Standards ; and U. S. Public Health
Service.

SURGICAL CONDITIONS AND TMKIi; TREATMENT 17(.)

Fig. 51

Fig. 52

180 the ship's medicine chest

5. After two seconds, swing forward again. Thus repeat deliber-
ately twelve to fifteen times a minute the double movement of com-
pression and release, a complete respiration in four or five seconds.

6. Continue artificial respiration without interruption until natural
breathing is restored, four hours or longer if necessary, or until a
physician declares the patient is dead.

7. As soon as this artificial respiration has been started and while
it is being continued, an assistant should loosen any tight clothing
about the patient's neck, chest, or waist. Keep the patient warm.
Do not give any liquids whatever by mouth until the patient is fully
conscious.

8. To avoid strain on the heart when the patient revives, he
should be kept lying down and not allowed to stand or sit up. If
the doctor has not arrived by the time the patient has revived, the
patient should be given some stimulant, such as one teaspoonful of
aromatic spirits of ammonia in a small glass of water or a hot drink
of coffee or tea, etc. The patient should be kept warm.

9. Resuscitation should be carried on at the nearest possible point
to the place where the patient received his injuries. He should not be
moved from this point until he is breathing normally of his own
volition and then moved only in a lying position. Should it be
necessary, due to extreme weather conditions, etc., to move the patient
before he ,is breathing normally, resuscitation should be carried on
during the time that he is being moved.

10. A brief return of natural respiration is not a certain indication
for stopping the resuscitation. Not infrequently the patient, after
a temporary recovery of respiration, stops breathing again. The
patient must be watched; and if natural breathing stops, artificial
respiration should be resumed at once.

11. In carrying out resuscitation it may be necessary to change
the operator. This change must be made without losing the rhythm
of respiration. By this procedure no confusion results at the time
of change of operator, and a regular rhythm is kept up.

Instructions for Saving Drowning Persons by Swimming to Their Relief.

1. Before jumping into the water to save a drowning person,
undress as quickly as possible. If there is any object lying about
that may be thrown to the person in the water, such as a life buoy,
or other buoyant object that may help to keep a person afloat, throw
it to him before jumping overboard.

2. On swimming up to a person in the water, assure him with a
loud and firm voice that he is safe. If he is struggling, do not seize
him at once, but keep off for a few seconds until he becomes quiet;
it is sheer madness to take hold of a man when he is struggling in
the water; if you do so, you run a great risk. Always endeavor to

SURGICAL CONDITIONS AND TIIKII! Tl: I ".AT M I'.N'T 181

make your approach from behind. It is important to retain your
presence <>i' mind and a clear, cool head, and to keep at a safe distance

until the person is nearly exhausted.

3. "When he has ceased to struggle, get close to him, and. grasping
him firmly by the hair of his head, turn him as quickly as possible
upon his back, give him a sudden pull, which will cause him to float,
then throw yourself on your back also and swim for the shore —
one or both your hands having hold of his hair, you on your back
and he on his, and, of course, his back to your stomach. In this
way you will get more quickly and safely to shore than by any other
plan. One great advantage of this method is that it enables the
swimmer to keep his head up and also to hold up the head of the
person whom he is trying to save.

4. There is probably no such thing as a " death grasp." As soon
as a drowning man begins to grow weak and to lose consciousness,
he gradually slackens his hold until he quits it altogether. No
apprehension need therefore be felt in regard to a " death grasp "
when attempting to rescue a drowning person.

5. After a person has sunk to the bottom, if the water is smooth,
the exact place where the body lies may be known by the air bubbles
which will occasionally rise to the surface, allowance being made, of
course, for the motion of the water, which, in a tideway or stream,
will have carried the bubbles out of a perpendicular course as they
rise to the surface. Often a body may be regained from the bottom,
before it is too late for recovery, by diving for it in the direction
indicated by these bubbles.

6. In rescuing a person by diving to the bottom after him, the
hair of his head should be seized with one hand only, and the other
should be used with the feet in raising yourself and the drowning
person to the surface.

7. If the accident occurs some distance out at sea, it is sometimes
a great mistake to try to get to land. If there is a strong outsetting
tide, and you are swimming either alone or while holding a person
who can not swim, get on your back, and float till help comes.
Many a man exhausts himself by trying to stem the billows for the
shore on a back-going tide, and sinks in the effort, whereas, if he had
floated, a boat or other aid might have reached him.

8. These instructions apply alike in all circumstances, whether they
involve roug;h sea or smooth water.

CHAPTER VII

EMERGENCY REFERENCE SECTION

This section is designed for speedy reference in time of emergency
only. It is urged that the other chapters be carefully studied at
other times so that proper treatment may be instituted promptly and
intelligently. After emergency treatment has been given, read over
the chapter dealing with the disease or injury and begin regular
treatment.

Alcoholism (drunkenness).

Induce vomiting with several spoonfuls of mustard dissolved in a
pint of warm water and then put patient to bed.

Amputations (accidental). (See Ch. VI, hemorrhage and shock.)

The first thing is to stop the bleeding and then get the patient into
bed; treat for shock and dress the wound.

Asphyxia (suffocation).

Due to inhaling poisonous gases or from drowning. Get the
patient into the open air as quickly as possible and give artificial
respiration at once.

Bleeding. (See Hemorrhage.)

Types: Spurting, flowing, oozing.

Spurting bleeding is from a cut artery ; the blood is bright red ; and
if the bleeding is not soon checked, the patient may quickly bleed to
death. The best method of stopping it is to clamp with a forceps and
tie both of the cut ends of the artery with sterile catgut. Usually a
tourniquet, as described on page 134, should be applied first to control
the bleeding.

Bleeding from a vein does not spurt, but wells up and flows from
the wound. If the ends of the cut vein can be found, they can be
clamped and tied as above, but a tight bandage beyond the wound
toward the extremity will control the bleeding so that it will clot
when a snug bandage is applied.

Oozing bleeding comes from the small capillaries; the amount of
blood lost is seldom large. A snug bandage over a clean dressing
will control the bleeding and allow a clot to form.

Bites (insect).

In treating insect bites, apply 1 per cent carbolic acid solution to
stop itching, then poultice with a paste of wet soda or soap.

182

EMERGEN ( V 1S3

Rat bites should be thoroughly washed, first with soap and water.
then with alcohol, and the wound opened with a knife and washed
out with •") per cent carbolic acid.

Broken bones (fractures).

The first thing is to out away the clothing from the broken part.
Splint the patient where he Ues to avoid further damage in moving
him. If the broken end is sticking through the skin (compound
fracture), pull gently and steadily on the part until it goes in through
the skin wound; then tie well padded boards to the part and put a
clean sterile dressing over the wound before attempting to move the
patient. If the skin is not broken (simple fracture), merely pull
the parts into approximately normal position and apply splint. The
patient can now be moved to a hard bed and after detailed study of
the kind and location of the fracture (see Ch. VI), proper reduction
and splinting may be attempted.

Bruises (contusions).

Apply to the skin ,ice or cloths wrung out in cold water. No
treatment is necessary for the " black and blue " discoloration ; it
will fade away slowly.

Burns.

Cut away the clothes from the burned skin. If the skin is only
reddened, apply a clean ointment or linseed oil to the surface. If
there are large blisters, they should be drained, best through a
hollow needle, going under the good skin a short distance from the
blister and then coming up into it. Do not break or remove the skin
over a blister but bandage it with a clean snug dressing. Deep burns
with black charred edges should have the dead charred flesh cut
away and then dressed as wounds.

Cramps.

Look up " Colic " in Chapter V and decide on the type and follow
the treatment advised. In the meantime put the patient to bed with
several hot-water bottles to the flanks and abdomen (belly).

Crushing-.

Examine for fractures, stop bleeding, and dress as instructed under
"Wounds (this chapter). If the part is so badly crushed that it is
certain that it will not recover, cutting it off (amputation), as dis-
cussed in Chapter VI, is to be considered. Never perform an ampu-
tation at sea if it is possible to reach port within several days.

Dislocations.

First, move the patient to a warm, comfortable bed and give him
a hot drink (whisky or tea). Then determine the type of disloca-

184 the ship's medicine chest

tion and read it up in Chapter VI before attempting to get it back
in place.

Drowning-.

Hold the patient with the head hanging downward and shake him
several times to allow as much water as possible to run out of his
lungs. Then start artificial respiration (see p. 178). After breath-
ing is well established, put the patient in a warm bed with some
one to watch him and start artificial respiration again if his breathing
should stop.

Electric Shock.

If the patient is still in contact with the live wire, do not touch
him but shut off the current first, or else push him away from the
wire with a dry board. Start artificial respiration at once and later
when he is breathing normally, dress the burns.

Fainting.

Get the patient into the open air, loosen his clothing, lay him
flat, so that his head is as low as possible, and dash cold water in his
face. Try to determine the cause of the faint, if possible ; especially
look up heat exhaustion and apoplexy in Chapter V.

Fits (Spasms). (See Epilepsy, Chapter V.)

During the fit, the patient should be prevented from injuring
himself by striking against surrounding objects. He can be held by
several men, or a blanket tied around him. A handkerchief may be
stuffed into his mouth to prevent him from biting his tongue. Use a
stick to push it into his mouth, so that the fingers will not be bitten.

Gassing. (See Asphyxia,, above.)
Gunshot Wounds.

Look especially for fractures and for evidences of bleeding in-
ternally. If bits of clothing can be seen in the wound, they should
be fished out. Do not probe around and try to get out the bullet if it
is deep. Apply dressing as described under wounds.

Intoxication. (See Alcoholism.)
Knife Wounds.

Usually the wound is clean. Stop the bleeding as outlined above
and sew (see Suturing, Chapter VI) the cut edges together. Dress
as any clean wound.

Mortification (gangrene).

Death of the flesh of a part is due to something cutting off its blood
supply and is usually preceded by swelling and a reddish-blue dis-

EMERGENCY 185

coloration. These advance signs indicate that something is wrong
and tourniquets, splints, or bandages above the pari should be

loosened at once. After the tissues are dead, nothing can be done to
restore them.

Pain.

Pain is an indication that something is wrong and is Nature's way
of insisting on rest, since any movement of the part causes additional
pain. In the treatment of pain, the underlying cause must be sought
and treated in order to secure permanent relief. In the meantime,
the pain can usually be lessened by rest, hot applications locally to the
seat of the pain, and quieting drugs like aspirin or morphine, if
necessary.

Paralysis. (See Apoplexy, Chap. V.)

Paralysis is usually the result of some injury to the nervous
system. If a nerve is cut, the muscles supplied by it are paralyzed
until the nerve grows back. If a part of the brain is destroyed, as
by a bursting blood vessel in apoplexy, the muscles supplied are
paralyzed. Little or nothing can be done for paralysis as an emer-
gency measure. Massage and splinting of the part involved pre-
vents muscular wasting and contractures while new nerve fibers are
growing.

Poisoning.

In treating poisoning correctly, it is very desirable to know wdiat
poison was used. If this is known, look up the specific treatment
in Chapter IV and give the proper antidote.

If the poison has been taken by mouth, although its nature is un-
known, it is always safe to give large amounts of white of egg and
then try to induce vomiting by tickling the throat. A stomach tube
can usually be passed safely and the stomach washed out, if neces-
sary. Later a large dose of Epsom salts is helpful in removing the
poison which has passed into the intestines.

Respiration, Artificial. (See Artificial Eespiration, p. 178.)

Place the individual on his belly with one arm above his head and
the other arm bent to support his cheek, the head being turned
somewhat to one side. Kneel astride the patient facing his head.
The palms of the hands are placed on the lowTer part of the patient's
chest and by leaning the weight forward, pressure is made against
the lower part of the chest, decreasing its size, and thus forcing out
the air or water contained in the lungs. (See illustrations, p. 179.)
When the pressure is removed, air will be sucked into the lungs by
the springing out of the chest wall. This motion is continued slowly,
112055°— 29 13

186 the ship's medicine chest

not any faster than twelve or fifteen times to the minute. If an
assistant is at hand, continuous rubbing of the limbs toward the
body helps to restore the circulation. Do not stop artificial respira-
tion under two hours, as there is still a chance to restore life within
this time. As soon as breathing is established at a regular rate,
undress the patient, wrap him in warm blankets, give him a drink
of whisky, and put him to bed for several days. During the first
day he should be continually watched, as breathing may suddenly
stop and more artificial respiration be necessary to start it again.

Retention of Urine.

Retention of urine is usually due to a stricture and comes on
slowly. It may be due to rupture of the urethra or disease or injury
of the nerves of the bladder. Look up strictures (Ch. V and methods
of passing catheters in other sections of this book.

Rupture (Hernia).

The only emergency treatment of rupture is to get the protruding
mass back and keep it back with large pads and snug bandages. To
reduce a rupture, the patient should be lying on his back with the
knees bent; and while he relaxes as much as possible, by breathing
with the mouth wide open, gentle, steady pressure is made with the
palms against the mass. It will usually slip back with little trouble,
but the difficulty is to keep it back. A person with a hernia can be
finally cured only by an operation, closing the unnatural opening,
and a sailor should enter a hospital for operation and repair of the
hernia as soon as possible.

Scalds.

Scalds are treated like any burn, except that the clothing must
always be cut away very carefully so as not to tear open the large
blisters. These are then drained and the burns dressed in the usual
manner. It is advisable to give morphine at once to patients with
severe scalds to relieve the pain.

Sprains.

Sprains are due to stretching or tearing of the ligaments around
a joint. These ligaments are very important structures, as they hold
the bones together ; and, since they heal slowly, a bad sprain requires
splints and careful treatment as described in Chapter VI.

Spasms. (See Fits and Epilepsy.)
Strangling.

Strangling is due to something shutting off the windpipe. It may
be around the neck, as in hanging, or may be something caught in
the throat. If a patient is strangling, always look and feel down
his throat. The throat may be straightened out by putting a pillow

EMERGENCY 187"

under the shoulders, letting the head fall back, and pulling up on
the tongue. By doing this, and using a Hash light, it is often possible
to see directly down into the larnyx ("voice box"') and lift oui a
foreign body, such as a piece of meat, with a pair of forceps or even
with the fingers. Then loosen the clothing around his neck and,
if he does not start to breathe, give artificial respiration.

Suffocation.

Get the suffocated person out into the fresh air and give artificial
respiration.

"Unconsciousness.

Unconsciousness may be temporary and of little importance, as in
fainting, but, if it lasts for several hours it usually indicates a serious
condition. Drunken stupor should be recognized as differing from
true unconsciousness. Serious injuries, especially head injuries, may
give long continued unconsciousness. Apoplexy, diabetic coma,
uremia, poisoning, especially by morphine, are to be considered.
The points in recognizing these conditions are discussed in Chapter V.

Vomiting.

Vomiting is a symptom usually due to an overloaded or poisoned
stomach. It should be encouraged rather than suppressed, as it is
nature's method of getting rid of what is harmful. Vomiting of
greenish material is not in itself serious, but merely indicates that
nature is emptying the first part of the small intestine also. Hoav-
ever, if the vomiting is long continued or contains foul-smelling
black material, it is a sign of serious trouble, usually some obstruc-
tion in the intestinal tract, and the patient should have medical
attention as soon as possible. Vomiting without sensation of sick-
ness in the stomach occasionally occurs with head injuries or brain
disease.

After the action of vomiting is over, a drink of cold lemonade or
some whisky in hot water may help " quiet the stomach."

Wheezing.

Wheezing is a noisy rasping sort of breathing heard in asthma
or may be caused by a foreign body in the windpipe, when it is
really a partial strangulation.

Wounds.

Stop the bleeding. (See Bleeding, this section.) Foreign bodies,
such as bits of cloth, should be lifted out and the wound cleansed by
washing with some antiseptic like peroxide or boric acid if it con-
tains much dirt. If it looks clean, leave it alone, bring the edges
together with adhesive or sutures, apply a clean dressing, and change
the dressings daily.

CHAPTER VIII

RADIO MESSAGES REQUESTING MEDICAL ADVICE

It sometimes happens that a ship's master is in urgent need of
advice in regard to the treatment of a sick member of his crew. In
such an emergency, the radio provides a means of communication
with the shore and with the medical officers of the United States
Public Health Service, so that the master or his officers may receive
from them instructions as to how to relieve, if possible, the sufferings
of the sick on board until it is possible to reach port, where further
and more adequate treatment can be given.

It can not be too strongly impressed upon the officer charged
with radioing for advice that he should impart to the physician con-
sulted sufficient information concerning the case to enable him to
make a diagnosis and to outline the best possible treatment. If the
radio message contains all the necessary data, the physician will
probably not have to ask for additional and more specific data.
To embody in the first message all pertinent information may save
time and suffering, and perhaps life.

The medical officers of the United States Public Health Service
are familiar with the contents of a standard medicine chest and this
book, so that treatment advised by them will be in accordance with
the medicines at hand and this book of instructions. For instance,
if a physician advises the application of a mustard plaster, it will
not be necessary for him to go into details and explain how to make
the mustard plaster, because the method of making and applying one
is described in this book. This applies also to the preparation and
application of other remedies contained in the medicine chest. It
is evident that much time can be saved and that the chances for
misunderstanding can be lessened in handling cases of sickness on
board ship, if advice is requested by radio.

Information That Should Be Obtained and Sent By Radio to a Hospital or
Relief Station of the United States Public Health Service

Before attempting to send a radio message for medical advice.
the sender should first carefully examine the patient and should
obtain all the information possible in other ways and he should then
embody in one message all the data found.

188

MEDICAL ADVICE r.Y RADIO 189

The following outline is presented in order to guide in obtaining
data concerning the patient:

1. How long has the patient been sick? Wms be taken sick suddenly or
did the sickness come on slowly?
'2. Has the patient a lever, and If so, how much?
3. What is the patient's pulse rate per minute?
•1. How man; breaths decs the patient take per minute?

5. What is the general appearance of the patient ? Is the llesh in any part
of body swollen?

6. Is the sickness thought to be due to a poison or to poisoned food?

7. Is the sickness believed to be due to a communicable disease, such as
cholera, smallpox, etc-.? To what diseases have the crew been exposed? Name
and how long out of port of departure?

8. Are other members of the crew suffering from the same sickness, or have
other members been sick and recovered or died?

9. Mention all the symptoms or complaints of the patient.

Following is a list of common symptoms which may be used to aid
in bringing out all the information :

1. Headache.

2. Chill.

3. Fever.

4. Pain, location and character.

5. Nausea.

6. Vomiting.

7. Diarrhea.

8. Constipation.

9. Appearance of tongue, coated or swollen.

10. Colic.

11. Urine, increased, decreased, or absent.

12. Consciousness.

13. Unconsciousness.

14. Labored breathing.

15. Convulsions.

16. Bleeding from any part of body, as mouth, bowel, or skin.

17. Rash, jaundice, or any discoloration of the skin.

18. Swelling of any part of the body.

19. Areas of tenderness.

20. Paralysis in any part.

21. Injury to any part of body.

22. The treatment that has been given.

Examples of good radio messages :

Man. aged 30, deck hand, sick for past 24 hours with severe pains and
cramps in lower right side of abdomen, which is hard and tender to touch.
There is nausea and some vomiting. Temperature is 99^ ; pidse, 120 per
minute; breathing, 25 per minute. Have given no medicine.

Information such as that above will inform the physician that
the patient is probably suffering from an acute attack of appendi-
citis, and he will therefore advise treatment accordingly.

190 THE SHIP'S MEDICINE CHEST

Man, aged 20, fireman, became sick three days ago with chill and head-
ache, followed in few hours by high fever, which does not go down. Fever is
304; pulse, 140; breathing, 50 per minute.' Has severe pains in chest when he
breathes. Face Hushed. Lies on left side. Coughs ; sputum rusty or blood-
colored. Has hot- water bottle to side.

Such information immediately conveys to the physician the idea
that this patient is perhaps suffering from pneumonia and he will
outline the treatment accordingly.

Man, aged 45, cook, fell and broke both bones right leg, apparently near
middle. Bones protrude through skin.

The physician receiving such a message will have, no difficulty
in understanding the nature of this fracture, and will advise proper
treatment.

It can be seen from the above messages that it is important to
give all the facts noted about the sick person. Contrast the above
messages with the following, which are vague and unsatisfactory:

Man ill, temperature 102. Complains backache, headache and fever, pain
in chest, thinks he has pneumonia.

Man taken ill suddenly. Cramps in abdomen for two days. Has fever,
gave castor oil, no better. Request advice.

From the facts given in these messages no definite diagnosis could
be made and only symptomatic treatment advised.

Through the courtesy of private radio corporations and the co-
operation of Government ships or stations having radio equipment,
messages may be sent to marine hospitals of the Public Health Serv-
ice and other points on shore and medical advice furnished in reply
to ships at sea. Under ordinary circumstances there is no great
urgency for the exchange of these messages, but in serious emer-
gencies it is permissible for a ship to use the emergency signal, which
in priority of claim is second only to the distress signal. The fol-
lowing is quoted from the code of regulations adopted by the Inter-
national Radio Telegraph Conference which met in Washington,
D. C, in November, 1927 :

The emergency signal consists of several repetitions of the group 1 * * *,
sent by clearly separating the letters of each group from the successive groups.
It is sent before a call. This signal indicates that the calling station has a very
urgent message to transmit concerning the safety of the ship * * * or the
security of a person aboard a vessel or within sight thereof.

Such signal shall have priority over all other communications, except those
of distress, and all the mobile stations or land stations which hear it shall
take care not to cause interference with the transmission of the emergency
traffic.

As a general rule, the emergency signal may be employed only if the mobile
station which sends it addresses a determined station.

1 In great emergency the call is preceded by three X's. This, however, must be author-
ized by the captain. The purpose is to clear the air.

MEDICAL ADVICE BY RADIO 191

Mobile stations which honr the emergency signal must romnin on watch
during three minutes al least When this period of delay Is past, If qo emer-
gency message has been heard, they may resume their normal service.

Nevertheless, the land stations and ship stations, which are in communica-
tion on the authorized waves other than that used for the transmission of

the emergency signal which follows it. may continue, without stopping, their
normal work.

The emergency Signal shall be transmitted only with the authorization of
the master or of the person responsible for the ship, * * *.

Marino Hospitals and other relief stations of the Public Health
Service at the following ports have been especially designated to
furnish medical advice by radio:

New York. X. Y. Chicago, 111.

Key West. Fla. Cleveland, Ohio.

New Orleans, La. Sault Ste. Marie, Mich.

Galveston, Tex. Honolulu, T. H.

Ban Francisco, Calif. Manila, P. I.

APPENDIX

Excerpts from the Regulations of the United States Public Health Service

Concerning Beneficiaries

Par. 590. The following persons are entitled to the benefits and facilities of
the hospitals and other relief stations of the service as hereinafter prescribed :

(1) Persons (hereafter designated as American seamen) employed on board
in the care, preservation, or navigation of any registered, enrolled, or licensed
vessel of the United States, or in the service on board of those engaged in
such care, preservation, or navigation.

(2) Officers and enlisted men of the Coast Guard.

(3) Officers and seamen on vessels of the Coast and Geodetic Survey.

(4) Officers and crews of vessels, certain keepers and assistant keepers of
the Lighthouse Service.

(5) Officers and crews of vessels of the Bureau of Fisheries.

(6) Immigrants detained at Ellis Island.

(7) Seamen from vessels of the Army Engineer Corps and Army transports,
or other vessels belonging to United States Army.

(8) Seamen employed on the vessels of the Mississippi River Commission.

(9) Beneficiaries of the Employees' Compensation Commission.

(10) Patients of the Veterans' Bureau.

(11) Lepers.

(12) Pay patients designated as such under departmental authority, as
officers and enlisted men of the United States Army and Navy.

(13) Officers of the Public Health Service and employees of the Public
Health Service on field duty.

Par. 591. No person employed in or connected with the navigation, manage-
ment, or use of vessels under 5 tons, or canal boats engaged in the coasting
trade, shall, by reason thereof, be entitled to any benefit or relief from the
service.

Par. 593. Sick or disabled seamen taken from wrecked vessels of the United
States returned to the United States from foreign ports by the United States
consular officers, if sick or disabled at the time of their arrival in a port of the
United States, shall be entitled to the benefits of the service without reference
to length of service.

Par. 594. A sick or disabled seaman, in order to obtain ihe benefits of the
service, must apply in person, or by proxy if too sick or disabled so to do, at
the office of the Public Health Service, to an officer of that service, or to the
proper customs officer acting as the agent of the said service at stations where
no medical officer is on duty, and must furnish satisfactory evidence that he
is entitled to relief under the regulations.

Par. 595. Masters' certificates and discharges from United States shipping
commissioners, made out and signed in proper form, showing that the appli-
cant for relief has been employed for 60 days of continuous service " in a
registered, enrolled, or licensed vessel of the United States," a part of which
192

APPENDIX 193

time musl have been during the 60 days Immediately preceding his applica
tion Cor relief, shall entitle bim to treatment The phrase "60 days of con-
tinuous service" shall nol be held to exclude seamen whose papers show brief
Intermissions between shun services thai aggregate the required 60 days, pre

vided thai any such Intermission does net exceed 60 days.

I'm;. 596. The certificate of the Owner or accredited com rcial agent of

a vessel a- to the facts <<\' the employmenl of any seaman on said vessel may
he accepted as evidence in lieu of the master's certificate in cases where the
latter is nol procurable.

Par. ,r>!)7. Masters or owners of documented vessels of the United States
shall, on demand, furnish any seaman who has been employed On Such vessel
a certificate of the Length of time said seaman has been so employed, giving the
dates of such employment.

Pab. 599. Any master of a vessel or other person who shall furnish a false
certificate of service with intent t<> procure treatment of a seaman shall be
immediately reported to the nearest 1'nited States district attorney for prose-
cution. A person who ships for the purpose of thereby qualifying for treatment
of a preexisting disability is ineligible.

Par. 603. Whenever a beneficiary applies for relief without a master's cer-
tificate, the oath or affirmation of the applicant as to the facts of his last
employment, stating names of vessels and dates of service, may be accepted
as evidence in support of his claim for relief. This oath or affirmation shall
be taken before a notary or other person authorized by law to administer oaths.

Par. GOT. When a seaman applies for relief after an absence of 60 days or
more from his last vessel and it satisfactorily appears that it was impracticable
for him to apply to the proper officer for treatment, or that he obtained treat-
ment at his own expense, a statement of the facts, together wnth a copy of the
application and other papers in support of same, shall be filed and the seaman
admitted to hospital.

Par. 60S. Any seaman who is able to write will be expected to sign his name
upon the face of the master's certificate issued to him before said certificate is
signed by the master of the vessel, and the officer receiving such certificate shall
require the applicant to verify the signature in his presence.

Par. 610. When a seaman who has received continuous treatment at the
out-patient office for a period of two months applies for further treatment, he
must, to entitle him to treatment, furnish a new certificate of service showing
that he is still following his vocation as seaman, or has been prevented
from resuming this occupation by reasons not under his control, giving the
latest dates of services, and, in case of lack of recent service, its explanation,
to appear on his record card. The medical officer in charge may waive this
requirement in instances where the nature of the disability has been such as
to prevent a resumption of a seaman's vocation or when the port is closed.

Par. 611. The expenses of caring for sick and disabled seamen incurred
during a voyage, or when not prearranged by an authorized agent of the
Government, will not be paid by the service.

Par. 613. In no case shall money be paid to a seaman or to his family or
friends by the service as reimbursement for expenses incurred during his sick-
ness or disability.

Par. 614. Seamen who may be injured in street brawls or while committing
a breach of the peace, and are, therefore, confined in jail or taken to civil
hospitals by the local authorities for such acts, shall not receive treatment at
the expense of the service. Such seamen should, however, be furnished treat-
ment if brought to service or contract hospital.

194

THE SHIP S MEDICINE CHEST

Par. 615. Seamen taken sick or injured on board or ashore while actually
employed on a documented vessel shall be entitled to treatment at relief stations
without reference to the length of their service.

Par. 616. A certificate of discharge may, at the discretion of the officer in
charge, be given to a hospital patient, but such certificate, when presented at
another relief station, shall not be taken as sufficient evidence of the applicant's
title to hospital relief, but may be considered as collateral to other satisfactory
data submitted by the seaman.

Par. 617. Temporary relief only is contemplated, and admission to hospital
is not intended to permit as indefinite residence therein for cause other than
actual disease or injury. Seamen who have changed their occupation or who
have retired from their calling because of age or for any other reason not
requiring relief from actual disease or injury within a period of 60 days after
leaving the vessel shall not be entitled to service relief.

TREASURY DEPARTMENT

U. S. Public Health Service

Form 1915

Revised August, 1926

MASTER'S CERTIFICATE OF SERVICE OF SICK OR INJURED SEAMEN

(Place)

19.

Medical Officer in Chargb,

United States Public Health Service.

I certify, on honor, that , whose signature and

description appear below, has been employed on board in the care, preser-
vation, or navigation, or in the service on board of those so employed, of the

of

(Name and class of vessel) (Home port, where permanent document issues)

Official Registry No. , a vessel whoso personnel is entitled to medical treat-
ment by the United States Public Health Service. His period of service on the

above-named vessel was from the day of 19 , to

the day of , 19 1 further certify that the person

named herein has, in my presence, signed his name in the blank space provided
below for that purpose.

(Master of the above-named vessel)

Signature of the person named above

Nativity , age years, height feet inches,

color of eyes , color of hair , distinguishing marks

Previous service

Total service on United States vessels years months.

Notice : This certificate must be signed by the master or authorized agent
of the vessel. Any person defrauding the United States by forging signatures
or gaining admission to a hospital when not a seaman will be prosecuted and
punished according to sections 5418, 5421, or 5438, Revised Statutes.

This certificate is merely for information of Public Health Service officers
at marine hospitals and other relief stations of the Public Health Service.
It does not authorize relief by any private agency.

United States Marine Hospitals

Baltimore, Md., Remington Avenue and Wyman Park Drive. Out-patient office,

Customhouse.
Boston (Chelsea), Mass., High Street. Out-patient office. Customhouse.
Buffalo, N. Y., 2183 Main Street. Out-patient office, 228 Federal Building.
Chicago, 111., 4141 Clarendon Avenue. Out-patient offices: 536 Lake Shore

Drive, Old Post Office, Van Buren Street Station, East Ninety-first Street.
Cleveland, Ohio, 1041 Lakeside Avenue. Out-patient office, Parcel-post Building.

APPENDIX 195

Detroit, Mich., East Jefferson and Mount Elliott. Out-patient office, Post-office
Building.

Evansville, Iin!.. 17(H) West Illinois Street.

Fort Stanton, N. Mex.. Public Health Service Tuberculosis Sanatorium.

Key West, Fla., Front and Emma Streets.

Louisville, Ky., Portland Avenue and Twenty-second Street. Out-patient ollice.

Customhouse.
Memphis, Tenn., Delaware and California Streets.
.Mobile, Ala., St. Anthony and I'.ayou.
New Orleans, La.. TchoupitOUlas and Henry Clay Avenue. Out-patient office,

Customhouse.
Pittsburgh, Pa., Fortieth Street and Penn Avenue.

Portland. Me.. Woodford's Station. Out-patient office. Customhouse.
Port Townsend, Wash.. Franklin and Quincy.

St. Louis, Mo., 3(540 Marine Avenue. Out-patient office, old Customhouse.
San Francisco, Calif., Fourteenth Avenue and Lake. Out-patient office,

Appraiser's Building.
Savannah, Ga., York and Abercorn Streets.
Stapleton. N. Y., Bay Street.
Vineyard Haven, Mass.
Ellis Island.

Carville, La., Leprosarium
Hudson Street, New York, N. Y., 67 Hudson Street. Out-patient offices : Barge

office ; Post-office Building, Thirty-fourth Street and Seventh Avenue ; Seamen's

Church Institute, 25 South Street.
Norfolk, Va., Hampton Boulevard, Larchmont. Out-patient office, Customhouse.

In addition to the hospitals listed above, the United States Public Health
Service maintains relief stations at 126 other ports. The out-patient offices
are usually located in Federal buildings. The address may usually be obtained
by referring to the local telephone directory. A complete list of relief stations
of the United States Public Health Service will be sent to ship masters and
vessel owners upon request addressed to the Surgeon General, United States
Public Health Service, Washington, D. C.

Excerpts from Maritime Laws

PROVISIONS AND WATER

Should any master or owner of any merchant vessel of the United States
neglect to provide a sufficient quantity of stores to last for a voyage of ordinary
duration to the port of destination, and in consequence of such neglect the
crew are compelled to accept a reduced scale, such master or owner shall be
liable to a penalty as provided in section 4568 of the Revised Statutes. (R. S.
4564; December 21, 1898, sec. 12.)

Any three or more of the crew of any merchant vessel of the United States
bound from a port in the United States to any foreign port, or being of the
burden of 75 tons or upward, and bound from a port on the Atlantic to a port
on the Pacific, or vice versa, may complain to any officer in command of any
of the vessels of the United States Navy, or consular officer of the United
States, or shipping commissioner or chief officer of the customs, that the pro-
visions or water for the use of the crew are, at any time, of bad quality, unfit
for use, or deficient in quantity. Such officer shall thereupon examine the
provisions or water, or cause them to be examined; and if, on examination,
such provisions or water are found to be of bad quality and unfit for use, or

196 the ship's medicine chest

to be deficient in quantity, the person making such examination shall certify
the same in writing to the master of the ship. If such master does not there-
upon provide other proper provisions or water, where the same can be had, in
lieu of any so certified to be of a bad quality and unfit for use, or does not
procure the requisite quantity of any so certified to be insufficient in quantity,
or uses any provisions or water which have been so certified as aforesaid to
be of bad quality and unfit for use, he shall, in every such case, be liable to a
penalty of not more than one hundred dollars ; and upon every such examination
the officers making or directing the same shall enter a statement of the result of
the examination in the log book, and shall send a report thereof to the district
judge for the judicial district embracing the port to which such vessel is
bound; and such report shall be received in evidence in any legal proceedings.
(R. S. 4565.)

If the officer to whom any such complaint in regard to the provisions or
the water is made certifies in such statement that there was no reasonable
ground for such complaint, each of the parties so complaining shall forfeit to
the master or owner his share of the expense, if any, of the survey. (This
section shall not apply to fishing or whaling vessels or yachts; Dec. 21, 1S98,
sec. 26.) (R. S. 4566; Dec. 21, 1898, sec. 13.)

If any seamen, while on board any vessel, shall state to the master that they
desire to make complaint, in accordance with the twro preceding sections, in
regard to the provisions of the water, to a competent officer against the master,
the master shall, if the vessel is then at a place where there is any such officer,
so soon as the service of the vessel will permit, and if the vessel is not then
at such a place, so soon after her first arrival at such place as the service of
the vessel will permit, allow such seamen, or any of them, to go ashore, or
shall send them ashore in proper custody, so that they may be enabled to make
such complaint ; and shall in default be liable to a penalty of not more than
$100. (R. S. 4567.)

CREW ACCOMMODATIONS

Crew space required on vessels constructed between June 30, 1895, and
March ^, 1915. — (a) The tonnage of the spaces or compartments occupied by
or appropriated to the use of the crew of the vessel. Every place appropriated
to the crew of the vessel shall have a space of not less than 72 cubic feet and
not less than 12 superficial feet, measured on the deck or floor of that place,
for each seaman or apprentice lodged therein. The provisions of this act re-
quiring a crew space of 72 cubic feet per man shall apply only to vessels the
construction of which shall be begun after June 30, 1895. Such place shall be
securely constructed, properly lighted, drained, and ventilated, properly pro-
tected from weather and sea, and, as far as practicable, properly shut off and
protected from the effluvium of cargo or bilge water ; and failure to comply
with this provision shall subject the owner to a penalty of $500. Every place
so occupied shall be kept free from goods or stores of any kind not being the
personal property of the crew in use during the voyage ; and if any such place
is not so kept free the master shall forfeit and pay to each seaman or appren-
tice lodged in that place the sum of 50 cents a day for each day during which
any goods or stores as aforesaid are kept or stored in the place after complaint
has been made to him by any two or more of the seamen so lodged. No de-
duction from tonnage as aforesaid shall be made unless there is permanently
cut in a beam and over the doorway of every such place the number of men
it is allowed to accommodate with these words, " certified to accommodate
seamen." (August 5, 1882: March 2, 1895.)

APPENDIX 197

Crcir space required on vessels constructed after March '/. 1915. — On all
merchant vessels of the United States the construction of which shall be begun
after the passage of this act, except yachts, pilot boats, or vessels of less than
100 tons register, every place appropriated t<> the crew of the vessel shall
have a space of not less than 120 cubic feet and not less than 1G square feet,
measured on the floor or deck of that place, for each seaman or apprentice
Lodged therein, and each seaman shall have a separate berth and not more

than one berth shall be placed one above another; such place or Lodging shall

be securely constructed, properly Lighted, drained, heated, and ventilated, prop-
erly protected from weather and sea, and. as far as practicable, properly shut
off and protected from the effluvium of cargo or bilge water. And every such
crew space shall be kept free from goods or stores not being the personal prop-
erty of the crew occupying said place in use during the voyage.

Hospital space. — That in addition to the space allotment for lodgings herein-
before provided, on all merchant- vessels of the United States which in the ordi-
nary course of their trade make voyages of more than three days' duration
between ports, and which carry a crew of 12 or more seamen, there shall be
constructed a compartment, suitably separated from other spaces, for hospital
purposes, and such compartment shall have at least one bunk for every 12
seamen constituting her crew : Provided, That not more than six bunks shall
be required in any case.

Steamboats on the Mississippi, etc. — Every steamboat of the United States
plying upon the Mississippi River or its tributaries shall furnish an appropri-
ate place for the crew, which shall conform to the requirements of this section,
so far as they are applicable thereto, by providing sleeping room in the engine
room of such steamboat, properly protected from the cold, wind, and rain by
means of suitable awnings or screens on either side of the guards or sides
and forward, reaching from the boiler deck to the lower or main deck, under
the direction and approval of the Supervising Inspector General of Steam
Vessels, and shall be properly heated.

Washing accommodations on new vessels. — All merchant vessels of the
United States, the construction of which shall be begun after the passage of
this act, having more than 10 men on deck, must have at least one light, clean,
and properly ventilated washing place. There shall be provided at least one
washing outfit for every two men of the watch. The washing place shall be
properly heated. A separate washing place shall be provided for the fireroom
and engineroom men, if their number exceed 10, which shall be large enough
to accommodate at least one-sixth of them at the same time, and have hot and
cold water supply and a sufficient number of wash basins, sinks, and shower
baths.

Fumigation. — Any failure to comply with this section shall subject the owner
or owners of such vessel to a penalty of not less than $50 nor more than $500 :
Provided, That forecastles shall be fumigated at such intervals as may be
provided by regulations to be issued by the Surgeon General of the Public
Health Service, with the approval of the Department of Commerce, and shall
have at least two exits, one of which may be used in emergencies. (March 3,
1897, sec. 2; March 4. 1915, sec. 6.)

MEDICINES AND ANTISCORBUTICS

Every vessel belonging to a citizen of the United States, bound from a port,
in the United States to any foreign port, or being of the burden of 75 tons or
upward, and bound from a port on the Atlantic to a port on the Pacific, or
vice versa, shall be provided with a chest of medicines; and every sailing

198 THE ship's medicine chest

vessel bound on a voyage across the Atlantic or Pacific Ocean, or around Cape
Horn, or the Cape of Good Hope, or engaged in the whale or other fisheries,
or in sealing, shall also be provided with, and cause to be kept, a sufficient
quantity of lime or lemon juice, and also sugar and vinegar, or other anti-
scorbutics, to be served out to every seaman as follows : The master of every
such vessel shall serve the lime or lemon juice and sugar and vinegar to the
crew within 10 days after salt provisions mainly have been served out to the
crew, and so long afterwards as such consumption of salt provisions continues ;
the lime or lemon juice and sugar daily at the rate of half an ounce each
per day ; and the vinegar weekly at the rate of half a pint per week for each
member of the crew. (R. S. 4569.)

If on any such vessels such medicines, medical stores, lime or lemon juice,
or other articles, sugar, and vinegar, as are required by the preceding section,
are not provided and kept on board, as required, the master or owner shall
be liable to a penalty of not more than $500; and if the master of any such
vessel neglects to serve out the lime or lemon juice and sugar and vinegar in
the case and manner directed, he shall for each such offense be liable to a
penalty of not more than $100 ; and if any master is convicted in either of the
offenses mentioned in this section, and it appears that the offense is owing to
the act or default of the owner, such master may recover the amount of such
penalty and the costs incurred by him from the owner. (R. S. 4570.)

Care of Bodies After Death

It is not expected that a ship's master will be called upon to embalm a
body ; and, therefore, the following suggestions refer only to the general
care of bodies after death.

Within a very short time after death the muscles become hardened, and
the position of the limbs, eyes, jaw, etc., becomes more or less fixed ; it is
therefore essential that immediately after death the body should be placed in
the position desired. For example, the eyelids should be closed ; the lower
jaw, which often sags, leaving the mouth opened, should be raised to its
proper place, and if it will not stay there, a roll of cloth should be placed
under the chin, or a bandage may be placed under the jaw and tied over the
crown of the head to hold it in place. After a few hours this bandage may
be removed. The arms should be folded across the chest, and the legs should
be straightened out.

If the patient died of a contagious disease, the body should be carefully
and completely wrapped in a sheet which has previously been soaked in a
strong solution of bichloride of mercury (one tablet to a quart of water).

If the body is to be buried at sea, it should be prepared for burial by
carefully wrapping it in a sheet and then sewing it up tightly in canvas ;
and a heavy weight should be attached to the feet.

If the body is to be kept on board ship for a day or two, it should be
washed, and vaseline should be applied to the face and hands. The anus,
mouth, and nostrils should be plugged with cotton saturated with dilute
formaldehyde solution (1 part formaldehdye to 7 parts of water). Some
embalmers recommend washing the whole body with this formaldehdye solution.

If it is possible to put the body in a refrigerator, it will keep in good con-
dition for some days. Some large ships have special arrangements for such
refrigeration. In the absence of such equipment, it is best either to send the
body ashore or to bury it at sea.

APPENDIX 199

If the body is to ho delivered at the nearest port, it should ho turned over
to the proper authorities. All available Information concerning the deceased,

his family, or his friends, together with a history of his illness and any other

information regarding the case, should he given to the authorities. The per-
sonal property of the deceased should be turned over to the proper authorities,
and a receipt should he taken for it. The relatives or friends of the deceased

would probably he grateful to the ship's master if lie notified them of the death

and sent them all the Information possible regarding the case and its final dis-
posal. If the body is buried at sea, the personal projierty of the deceased should
he listed and should be eheeked by a witness and then sent to Ins relatives or
friends. A complete record of the case and its final disposal should be recorded
in the ship's log.

GLOSSARY

Abdomen. — Belly.

Abscess. — A local collection of pus.

Acid. — Sour, opposite of alkali.

Acute. — Sharp, sudden, usually severe.

Adhesive. — Sticking plaster of large size used to hold dressings in place and

also wound edges together until healing occurs.
Alkali. — Opposite of acid, neutralizes acid. Vinegar is an acid ; lye is an alkali.
Anaesthesia. — Loss of feeling.

General anaesthesia. — Sleep under ether or chloroform.
Local anaesthesia. — Production of loss of feeling in a part.
Antidote. — A remedy for counteracting a poison and stopping its action.
Antiscorbutic. — A substance, usually a food, used to prevent scurvy.
Antiseptic. — A substance which will prevent the growth of germs.
Artificial respiration. — Breathing caused by artificial methods.
Bacteria. — Germs ; very small forms of vegetable life which can be seen only

with the microscope.
Bladder. — The organ which holds urine, located in the lower abdomen.
Blood clot. — Blood which exposed to air has become solid.
Bowel.— Intestine ; gut.
Bubo. — Swollen gland.

Capillary. — A very fine blood vessel, too small to see with the naked eye.
Capsule. — A small case made of gelatin for giving bad-tasting drugs.
Cathartic. — A substance which, when taken by mouth, causes a movement of

the bowels.
Caustic. — A drug which burns or destroys tissues.

Centigrade thermometer. — One in which freezing temperature reads 0 and boil-
ing water 100°.
Charring. — To turn black.

Clinical record. — A record of occurrences during illness.
Clinical thermometer. — A thermometer used to take the body temperature of a

person.
Colic. — Cramp-like pains, especially in the abdomen.

Collapse. — Extreme prostration and depression, with failure of the circulation.
Comminute. — Splintered, broken into small pieces.
Compress. — A wad of cotton or gauze, applied over wounds or over a painful

area.
Constitutional. — Throughout the whole body or system.
Contamination. — To become dirty by touching.
Contused. — Bruised.

Counter irritant. — Some substance applied to the skin to produce redness.
Cramps. — Sharp pains due to spasms of muscles, usually come and go.
Crepitus. — A grating sensation which can be felt when broken ends of bones are

rubbed together.
Delirium. — Condition in which patient is said to be " out of his head."
200

GLOSSARY 201

Diagnosis. — The ad of distinguishing one disease from another.

Digestion.- The process of preparing food taken into the body for use by the

body.
Dilute. — Not strong.

Disinfection. — The destruction of germs.
Disinfestation. — Destruction of vermin.
Distended. — Filled, enlarged.

Epidemic. — Condition in which there are many cases of a disease.
Eruption. — A "breaking out," as on the skin.

Excretion. — A process by which the body disposes of waste, as in urine or sweat
Extension. — To straighten out: to pull.
Fahrenheit thermometer. — One in which freezing temperature is 32° and boiling

is 212°.
Fever. — Higher body temperature than normal.

Forceps. — An instrument with two blades for clamping, grasping, or crushing.
Fumigation. — The exposure to poisonous gases or fumes (usually with the idea

of killing vermin or germs).
Gangrene. — Local death of a part.
Gauze. — A very thin cloth used for dressing wounds.
Hemorrhage. — Bleeding.
Hypodermic. — Under the skin.
Incise. — To cut.
Incubation period. — The time required for a disease to develop after exposure

to it.
Infection. — The growth of germs, frequently with the formation of pus.
Inoculation. — The intentional introduction of a virus to produce a mild form of

a disease which will protect against the severe form of that disease.
Inunction. — Rubbing medicines or salves into the skin.
Isolate. — To separate: to place alone.
Jaundice. — Yellowness of the eyes and skin.
Laceration. — A torn wound.
Ligate. — To tie off, as a blood vessel.
Ligature. — A thread for tying a vessel.
Malinger. — To pretend ; to fake.

Manipulate. — To work with the hands ; to move and place.
Mucous membrane. — The reddish lining of all body cavities which communicate

with the air, as the mouth.
Nausea. — " Sick at the stomach " ; desire to vomit.
Organism. — An individual form of life constituted to carry on the activities of

life. An animal or plant.
Papular. — Composed of papules which are small, round elevations on the skin.
Pox. — A term used to designate smallpox or syphilis (great pox).
Pratique. — Permission given to a ship that has satisfied the health regulations

to enter a port.
Prevalence. — To be present and extend widely.
Prophylaxis. — The prevention of disease.

Purgative. — A medicine which causes the bowels to move freely.
Pus. — The creamy discharge from an infected wound.
Eelax. — To make loose ; to slacken.
Retching. — Attempts at vomiting without results.
Rupture. — To break through.
Saliva. — Spit.

112055°— 29- 14

202 the ship's medicine chest

Septicemia. — Blood poison.

Serum. — The fluid part of the blood in which the corpuscles float.

Sloughing. — The separation and fluffing out of dead tissue from a wound.

Sterile. — Free of all germ life.

Sterilization. — The process of killing all germs.

Stimulate. — To produce activity or quicken and strengthen action, as of the

heart.
Stool. — Material passed from the bowels.

Strangulated. — A condition in which a part is pinched or constricted.
Suture. — A substance used for sewing.

Symptoms. — The complaints and discomforts of a patient indicating disease.
Tincture. — A medicine dissolved in dilute alcohol.
Ulcer. — A local open sore.

Ventilation. — The process of continually supplying fresh air.
Vesicle. — A blister on the skin or mucous membrane and filled with clear fluid.
Vitality.— Life.

INDEX

Page

Abdomen 1G

Abscess 150

Accidents, prevention of 129

Alcohol, effects and use of 53

Alcoholism 182

Amputations 182

Anatomy 2

Anthrax 85

Antidotes for poisons 105, 185

See also under Poisoning.

Apoplexy 85

Appendicitis 17

treatment of 174

Applications of heat'and cold__ 71, 72

Arteries 12, 13

Artificial respiration 178

Asphyxia (suffocation) 182

Aspirin, directions for use of 54

Asthma 72

Backache, cause and treatment. 73

Bandaging 140,

142, 143, 144, 152, 158, 159
Baths, cleansing 24, 70

during illness 70, 71

sponge 71

to reduce fever 71

Bedsores 167

Beneficiaries of Public Health

Service , 192

Beriberi 86

Bicarbonate of soda, directions

for use of 54

Bichloride of mercury, direc-
tions for use of 54

Bismuth powder, directions for

use of 55

Bites, insect 146, 182

snake 146

Bladder, inflammation of 86

Bleeding, arterial 132, 182

method of stopping 132,

133, 134, 135

use of tourniquet in stop-
ping 133,134,135

venous 135,182

Page

Blood 14

arterial 13

composition of 14

venous 12

Blood poisoning 149

Blood pressure 13

Blood vessels 12

Bodies, care of after death 198

Body, structure and functions

of. 1

maintenance of 29

Boils 149

Bones 2

functions of 10

See also Fractures.

Boric acid, directions for use of. . 55

Bowels, care of 66

Bronchitis 87

Bronchopneumonia 88

Bruises 148, 183

Burial of the dead 198

Burns . 147, 183

electrical 177

Calomel and soda, directions for

use of 55

powder, as dressing, direc-
tions for use of 55

Carbuncle 150

Castor oil, directions for use of _ 56

Catheterization 67, 68

Catheters, kind of 68

Cerebral hemorrhage 85

Cerebrospinal fever 88

Certificate, master's, of service

of sick or injured seamen 194

Chicken pox 34

treatment of 89

Chills, in malaria 99

in pneumonia 104

treatment of 73

Chloroform, directions for use

of 56

Cholera 34

treatment of S9

Circulatory system 12

203

204 INDEX

Page

Cleanliness 43

Clinical thermometer 65

Cloves, oil of, directions for use. 60

Colds 23, 36

on the chest 75

in the head 75

Colic, abdominal 74

gallstone 74

kidney 75

Communicable diseases 31

cause of 33

incubation period 33

mode of transmission of 33

period of communicability_ 33

source of infection of 33

Compound cathartic pills, dose _ . 5S

Constipation 76

Consumption IIS

Convulsions, cause and treat-
ment of 76

Cough 76

Cramps 183

See also Colic.

Cresol solution, use of 58

Dead bodies, care of after death, 198

Delirium tremens 90

Dengue 34

Diabetes 91

Diarrhea 77

Digestion 18

Diphtheria 1 34

treatment of 92

Diseases 31

causes of 31,33

classification of 31

communicable 31,33

specific, treatment of 85

Disinfection after infectious dis-
eases 70

of bedding, dishes, etc 69

of excretions 68

of hands and arms 70

Dislocations 168, 183

elbow 167

finger 171

hip 171

jaw 168

shoulder 169

thumb 171

Dover's powder, directions for

use of 59

Drainage of wounds 139

Page
130

77

Dressing of wounds

Dropsy

Drowning, artificial respiration

in 17S

saving persons from 180, 184

Dysentery 33, 35

treatment of 91

Earache 77

Electric burns 177

Electric shock 177, 184

artificial respiration in 178

Emergencies 182

Emetics 105

Enemas 67

Epilepsy 93

Epsom salt, dose 59

Erysipelas 93

Examination of sick 64

Exhaustion from heat 80

Eyes, affections of 93

foreign body in 93

inflammation of 94

solution for 59

Fainting, cause and treatment

of 78, 184

First aid 63

Fever 78

Fits 93, 184

Fractures 153

ankle 167

collar bone 160

comminuted 153

complications in 155

compound 153

femur (thigh bone) 165

forearm 162

humerus (arm bone) 161

impacted 153

jaw 15S

lower leg 166

nose bones 158

ribs 159

simple 153

spine 167

treatment of 154

Frostbite 147

Fumigation 24, 25

Gangrene 148

Glossary (medical terms) 200

Gonorrhea 37

cause and treatment of 121

Gout 95

INDEX

•_><>:

Page

Gumboils 83

Headache, cause and treatment

of ; 79

Bear! 12

Heart disease 95

Heat exhaustion 80

Hemorrhoids 176

Hernia 10

treatment of 175, 186

Hip, dislocation of 171

Hygiene 1

mental 45

of nutrition 41

on shipboard 23

personal 10, 43

Immunity 32

Indigestion 80

Infection, treatment of 145

Influenza 35

Injured, method of transporta-
tion of 172

Insanity 100

Instruments, sterilization of 131

Iodine (tincture), directions for

use of 62

Ipecac, sirup of, directions for

use of 61

Itch, types of, treatment 81, 97

Jaundice 81

Jaw 3,6

dislocation of 168

fracture of 158

Kidney 19

colic 75

Lice, destruction of 98

Lockjaw 116

Malaria 39

cause and treatment of 98

Malta fever 99

Marine hospitals, list of 194

Maritime laws 195

Master's certificate of service of

sick or in j ured seamen 194

Measles 100

Medicine chest 47

contents for large vessels-- 49
for coast and lake ves-
sels 51

for small vessels 5?

Mental diseases 100

Mercury bichloride 54

l'uge
Mercurial ointment, directions

for use of 6

Morphine, directions for use of... .>>

Mosquitoes 25

See also Malaria and Yellow
fever.

Mumps 101

M uscles 10

Mustard, use of 60

Neuralgia 101

Nose, bleeding from 102

Nursing the sick 66

Nu1 rition 41

Nervous system 20

Orbit..--. 5

Ozone 28

Pain, types of 81

treatment 185

Paralysis 85, 185

facial 102

Paregoric, use of 60

Penis, affections of 177

stricture 177

Peritonitis 16

Physical examinations 29

Piles 176

Plague 102

Pleurisy 103

Pneumonia, symptoms and

treatment 104

Poisoning, types of, treatment

for 105, 185

alcohol 105

ammonia 106

arsenic 107

bichloride of mercury (cor-
rosive sublimate) 108

carbolic acid 107

food 109

formaldehyde 109

iodine 107

lye 109

morphine 108

strychnine 108

tobacco 108

woodalcohol 106

Prickly heat 110

Pulse 13

methods of taking 13

reasons for taking 13

Quinine, use of. 61

206

INDEX

Pag«

Quinsy 117

Radio messages, directions for

preparation of 188

samples of 189

stations furnishing medical

advice by 191

Rats 25

Records, sick 64

Regulations concerning bene-
ficiaries of the Public Health

Service 192

Relapsing fever 110

Respiration 16

Respiratory system 15

Rest, value of 65

Rheumatic fever 37

Rheumatism, cause and treat-
ment of 111

Rupture 175, 186

Sanitation 1

on shipboard 24

Scalds 186

See also Burns.

Sciatica 113

Scurvy 113

Seasickness 113

Shingles 114

Ship's medicine chest 47

contents, for large vessels. _ 49
for coast and lake ves-
sels 51

for small vessels 52

Shock 141

Sickbay . 47

Sick records ^_ 64

Sinuses 5

Sick, care of the 66

Sling, arm 161, 162

Sleep, importance of 44

Smallpox 37

symptoms and treatment. 115

Snakebites 146

Spasms 93, 184

Splints 156,

157, 161, 163, 164, 165, 166

Sprains 151, 186

Sterilization of instruments 131

of water 26

Stings, bee and wasp 146

centipede, tarantula, scor-
pion, and spider 146

other insects 146

Page

Strangling 186

Stretcher, improvised 172

Strychnine, directions for use of _ 61

Suffocation 187

artificial respiration in 178

Sun cholera mixture, directions

for use of 62

Sunstroke 115

Syphilis 38

early symptoms and treat-
ment 123

Teeth 6

care of 44

Temperature 65

Tendons 11

Tetanus 116

Thermometer 65

Throat diseases 82

Tongue, swelling, treatment 117

Toothache 83

Tonsillitis 117

Tourniquet 134

Tuberculosis 35

symptoms and treatment. _ 118

Turpentine, external use of 62

Typhoid fever 34

causes, symptoms, and

treatment 119

prevention of.. 120

Typhus fever 120

Unconsciousness 187

Undulant fever 99

United States Public Health
Service, certificate of service

of sick or injured seamen 194

marine hospitals _ _ 194

maritime laws 195

regulations concerning bene-
ficiaries 192

stations furnishing medical

aid by radio 191

Urine, retention of 186

Veins 12, 14

Venereal diseases 120

prevention of 126

See also name of disease.

Vermin 24, 25

Vomiting 83, 105, 187

Water, drinking 25

chlorination of 26

coolers 26

disinfection of 26, 28

i.\m:\

207

Pago

Water, distillation of 27

filtration of 28

sterilization of 26

system 26

Wheezing ._"_ L87

Worms, intestinal 96

Wounds, disinfection of 130

crushed 136

drainage of 139

dressing of 130

fishhook 139

gunshot 139

gurry 145

Page

Wounds, healing of L36

infected I 1 1

lacerated 135

| )ll I let 11 red 136

ivmoval of stitches of 139

stitching of 137

with hemorrhage L32

without hemorrhage 132

Yellow fever 40

s v n i ptoms 127

transmission of 127

treatment of 127

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