MEDICAL COMPEND 
FOR 
COMMANDERS OF NAVAL VESSELS 
TO ACCOMPANY MEDICINE BOX 
1923 MEDICAL COMPEND 
For 
Commanders of Naval Vessels to Which 
no Member of the Medical Department 
of the United States Navy is Attached 
and Others 
To accompany Medicine Box 
PUBLISHED BY THE 
BUREAU OF MEDICINE AND SURGERY 
UNDER THE AUTHORITY OF THE 
SECRETARY OF THE NAVY 
(M. & S. File Number 127219) 
WASHINGTON 
GOVERNMENT PRINTING OFFICE 
1923 Bureau of Medicine and Surgery, 
Navy Department, 
' Washington, D. G., July 1,1923. 
This Medical Compend for Commanders of Naval Vessels to which 
no member of the Medical Department of the United States Navy is 
attached is published for their aid in the knowledge and use of the 
contents of the medicine box, United States Navy, as well as to be a 
general guide in the preservation of the health of the personnel under 
their command. 
E. R. Stitt, 
Surgeon General, United States Navy. 
Approved: 
Edwin Denby, 
Secretary of the Navy. CONTENTS. 
Page. 
Chapter 1. The medicine box and boat box 1 
Chapter 2. First aid : 6 
Chapter 3. Special diseases 29 
Chapter 4. Hospital facilities 52 
Chapter 5. Deaths 54 
Chapter 6. Quarantine and disinfection 58 
Disinfecting plants 88 
Glossary 88 
Index 91 MEDICAL COMMEND FOR COMMANDERS OF NAVAL 
VESSELS TO WHICH NO MEMBER OF THE MEDICAL 
DEPARTMENT OF THE UNITED STATES NAVY IS 
ATTACHED, AND OTHERS. 
TO ACCOMPANY MEDICINE BOX. 
CHAPTER I. 
THE MEDICINE BOX. 
The outfit of medicines and medical supplies furnished vessels of 
the Navy having no medical officer or member of the Hospital Corps 
consists of (a) one medicine box, Navy standard, and (b) a box of 
additional medical supplies in an ordinary packing case, or of (c) 
a boat box. The contents of these boxes, with simple directions for 
their use, are given below. 
MEDICINE BOX (CONTENTS). 
[Medicine case. Tablets. 1-ounce bottles.] 
Alkaline and antiseptic (Seiler’s) 1 
Aspirin, 5 grains 1 
Brown mixture, 1 dram 1 
Calomel, \ grain 1 
Cathartic, vegetable 1 
Chlorodyne 1 
Coryza 1 
Dover’s powder, 5 grains 1 
Iron, quinine, arsenic, and strych- 
nine 1 
Lead and opium 1 
Potassium chlorate, 2$ grains; so- 
dium borate, 2i grains 1 
Quinine sulphate, 3 grains 1 
Salol, 5 grains 1 
Soda mint 1 
Sodium salicylate, 5 grains 1 
Trional, 5 grains 1 
MEDICINES, DRESSINGS, ETC. 
Adhesive plaster, 2 inches wide, 
spool 1 
Bag, hot-water number— 1 
Bag, ice do 1 
Bandage, gauze, assorted—do 36 
Bandage, suspensory do 2 
Basin, dressing, agate do 1 
Belladonna plaster box— 1 
Bichloride of mercury (antiseptic 
tablets) bottle— 1 
Castor oil do 1 
Catheter, soft rubber set— 1 
Collodion flexible bottle— 1 
Colloidal silver do 1 
Cotton, absorbent roll 1 
Epsom salts tin— X 
First-aid packet number__ 6 
Formaldehyde solution—bottle— 1 
Fountain syringe number— 1 
Gauze, plain, absorbent roll— 1 
Iodine tincture, 50 c.c., in bot- 
tle bottle— 1 
1 2 
THE MEDICINE BOX. 
medicines, dressings, etc.—continued. 
Ligature, silk, No. 4, threaded in 
needle tubes— 6 
Ligature, silk, No. 8, threaded in 
needle tubes 6 
Lint, absorbent roll 1 
Liquid extract of beef bottle— 1 
Medicine glass number 1 
Muslin yards 5 
Mustard plaster box 1 
Ointment, aristol jar 1 
Ointment, sulphur do 1 
Oinment, zinc oxide do 1 
Pencil, hair number— 6 
Picric acid solution bottle 1 
Pins, scissors, and dressing forceps 
(set in case) (contents in detail, 
page 68) . set— 1 
Soai> liniment , bottle 1 
Soda bicarbonate can 1 
Spatula, 3-inch number 1 
Spirit of ammonia, aromatic 
bottle— 1 
Syringe, penis, rubber number 2 
Thermometer, clinical do 1 
Tourniquet, instant do 2 
Vaseline tin 1 
Wire mesli for splints feet 3 
“ Medical Compend ” number 1 
DIRECTIONS, ETC. 
Alkaline and antiseptic tablets (Seiler’s). For sore throat. Dis- 
solve one tablet in four tablespoonfuls of water and use as gargle or 
nasal douche. 
Aspirin, 5 grains. For headache, neuralgia, and fever. Dose: 
One tablet, repeated in one hour if necessary. 
Brown mixture tablets (1 dram). For coughs. Dose: One tablet 
every hour dissolved on the tongue. Limit, 20 tablets in 24 hours. 
Calomel tablets, one-half grain. Cathartic in fevers. Dose: One 
every hour until five are taken. Should be followed in a few hours 
or the next morning by a dose of salts (magnesium sulphate). 
Garthartic vegetable tablets. Purgative. Dose: One to three 
tablets. 
Poison.—Chlorod}-ne tablets (contain morphine). Should be used 
with great care. For colic. Dose: One tablet; repeat in an hour if 
necessary. Stop when three tablets have been taken. For diarrhea: 
One tablet every three hours until four tablets have been taken. 
Coryza tablets. For commencing colds in head. Dose: One tablet 
every 15 minutes until four tablets have been taken, then one tablet 
every 30 minutes for four doses, and then one every hour for four 
doses. Limit, 12 tablets taken as directed. 
Poison.—Dover’s powder, 5 grains (contains opium). To produce 
sweating. Should be used with care. Dose: Two tablets. 
Iron, quinine, arsenic, and strychnine. Tonic tablets. Dose: One 
tablet three or four times a day. 
Lead and opium. For diarrhea. Dose: One tablet. 
Potassium chlorate and borax. For sore throat: Dissolve on tongue 
or dissolve tablet in a little water and use as a gargle. Limit, 8 to 
10 tablets a day. 
Quinin sulphate, 3 grains. For malarial fevers. Dose: One to 
three tablets every four hours. Limit, 12 tablets in 24 hours. As DIRECTIONS. 
3 
many as seven tablets may be given at a dose in severe malarial 
fevers. 
Salol. For intestinal fermentation. Dose: One to two tablets in 
milk or water three times a day. 
Soda-mint tablets. For sour stomach and heartburn. Dose: One 
every two hours dissolved on the tongue. 
Sodium salicylate, 5 grains. For rheumatism. Dose: Three tab- 
lets every four hours. Limit, 12 tablets in 24 hours. 
Trional, 5 grains. For producing sleep. Dose: Two to three tab- 
lets in a little water half an hour before bedtime. 
Belladonna plaster. Apply locally for rheumatic pains. Also see 
directions on box. 
Poison.—Bichloride of mercury tablets (antiseptic). For external 
use only. Dissolve one tablet in a pint of distilled or boiled water 
and use externally as an antiseptic wash for cleaning ulcers or in- 
fected wounds. Great care should be exercised with these tablets. 
The utensils should be carefully washed after their use with the 
solution. The solution should never be used in metallic vessels nor 
on metallic instruments. 
Castor oil. Cathartic. Dose: Two tablespoonfuls. Wet the mouth 
with hot liquid (milk, coffee, or tea) and give the oil floating in 
some of the liquid. 
Collodion, flexible. For holding on small cotton dressings. May 
be applied directly to very small wounds with a hair pencil. Keep 
bottle securely closed to prevent evaporation. 
Colloidal silver. Prepare a solution of 1 part of colloidal silver 
to 10 parts of water. Use as injection in gonorrhea (clap). Solu- 
tions should be prepared fresh as required and should not be used 
after standing for any long period of time, as the drug deteriorates 
rapidly in solution. 
Epsom salts (magnesium sulphate). For constipation. Dose: 
One to two tablespoonfuls dissolved in half glass of water taken on 
empty stomach. 
Formaldehyde solution. Poison. For use as disinfectant only. 
Should be kept well stoppered and in a cool place. The escaping 
vapor is very irritating to the eyes, nostrils, and lungs. Three parts 
of this solution to 2,000 parts of water serves as an excellent dis- 
infectant for knives, forks, cups, etc. 
Poison.—Iodine tincture, 4 per cent. External use only. For dis- 
infecting wounds. Apply with hair pencil or cotton on match. 
Liquid extract of beef. Dissolve two tablespoonfuls in half a pint 
of hot water. 
Mustard plaster. Apply locally for not over 20 minutes. See direc- 
tions on box. 
Ointment of aristol. For painful sores and wounds. Apply spread 
on gauze. 4 
THE MEDICINE BOX. 
Ointment, sulphur. For itch and ringworm. Rub on affected part 
thoroughly. 
Ointment of zinc oxid. For eczema, sunburn, etc. Apply locally. 
Poison.—Picric-acid solution, about 1 per cent. For scalds and 
bums. Wet strips of gauze with this solution, apply directly to 
burned surface, and lightly secure with bandage. Dressing should be 
kept moist with the solution. 
Soap liniment. For external use only. For sprains, lumbago, and 
rheumatic pains. Apply locally with rubbing. 
Sodium carbonate (baking soda). For burns. Turn top of can to 
open holes and sprinkle well over surface, cover with gauze, and 
bandage. 
Spirits of ammonia, aromatic. For faintness. Dose: One-half to 
one teaspoonful well diluted with water. 
Vaseline (petrolatum). For sunburn, chapped hands, etc. Apply 
locally. 
Bag, hot-water Fill to one-half its capacity with hot water Lay 
the bag on its side and squeeze the bag above the water to expel the 
air and, after screwing in the stopper, hold the bag upside down to 
be sure there is no leakage. Wrap bag in a bath towel: place over 
desired area. Watch carefully to see if bag is too hot. 
Bag, ice Break the ice into small pieces Fill the bag to three- 
quarters of its capacity and wrap it in a towel; never put the rubber 
directly upon the skin. 
Bandages, gauze. 
Basin, dressing, agate. 
Camel’s-hair pencils. For application of tincture of iodin. 
Cotton, hospital. For dressings. 
Dressing forceps, pins, scissors, and scalpel. 
Gauze for dressings. 
Ligature, silk, with needle in tube. For sewing up wounds. 
Medicine glass for measuring. 
Muslin, bleached. For preparation of bandages. 
Packages, first-aid. Directions on package. 
Penis syringes, glass. For injection of colloidal silver. 
Plasters, belladonna. For rheumatic pains. Also see directions 
on box. 
Plasters, mustard. See directions on box. 
Plaster, rubber, adhesive. Two-inch spool. For holding dress- 
ings in place. 
Spatula, small. For spreading ointments. 
Thermometers, clinical, in case. 
Tourniquets, instant, rubber. For stopping flow of blood from 
wounds or constricting circulation. 
The additional supplies in packing case are largely supplementary, 
and are as follows: DIRECTIONS, 
5 
MEDICINES, ETC. 
tablets—continued. 
Castor oil bottles 6 
Collodium flexible do 4 
Colloidal silver do 5 
Epsom salts tins 3 
Formaldehyde solution bottles 2 
Iodine tincture, 50 c. c. in bottle 
bottles 2 
Mustard plaster boxes— 4 
Picric-acid solution bottles 2 
Soap liniment do 2 
Sodium bicarbonate do 2 
Vaseline tins— 4 
Quinine sulphate, 3 grains 
: bottles 3 
Sodium salicylate, 5 grains 
bottle 1 
HOSPITAL STORES. 
Liquid extract of beef bottles 12 
MISCELLANEOUS. 
Adhesive plaster spools 2 
Bandage, gauze, assorted 
number 36 
Bandage, suspensory do 6 
Cotton, absorbent rolls 2 
Gauze, plain, absorbent do 2 
Lint, absorbent do 2 
Jledicine glass number 2 
Syringe, penis, rubber do 12 
Thermometer, clinical do 2 
Tourniquet, instant do 2 
TABLETS. 
Alkaline anti antiseptic (Seiler’s) 
bottle 1 
Aspirin, 5 grains ' do 1, 
Brown mixture, 1 dram bottles 2 
Cathartic vegetable do 2 
Lead and opium bottle 1 
Supplies listed above may be procured as required by requisition 
Form 4 of the Bureau of Medicine and Surgery. Requisitions, 
when approved, will be filled by the naval medical supply depot 
most convenient to the ship; that is, if in Atlantic waters, by the 
depot in Brooklyn, 1ST. Y.; if in Pacific waters, by the depot at Mare 
Island, Calif.; if in the Philippines or on the Asiatic station, by the 
depot at Canacao, P. I. 
Advantage should be taken of opportunities when in the vicinity 
of a supply depot or when at navy yards or in dry dock to replenish 
the stock of medicines, etc. 
A supply of requisition Form 4 may be secured from any supply 
depot, but if this form is not available request may be made by letter 
addressed to the Bureau of Medicine and Surgery. Requisitions 
should be limited to the articles listed above and should be arranged 
by classes and correspond in amount with packages as indicated. 
THE BOAT BOX. 
Adhesive plaster, 2-inch wide 
spool 1 
Bandages, gauze, assorted 
number 8 
Brown mixture, tablets bottle 1 
Calomel tablets, i-grain bottle 1 
Carbolated vaseline jar 1 
Cathartic pills bottle— 1 
First-aid packets number 6 
Gauze, compressed packages— 6 
Lead and opium tablets bottle 1 
Liquid extract of beef bottles— 2 
Muslin yards 2 
Mustard plasters box 1 
Pins, scissors, and dressing for- 
ceps (set in case) set 1 
Quinine tablets, 3-grain bottle 1 
Soda bicarbonate can— 1 
Tourniquets, instant, rubber 
number 4 CHAPTER II. 
FIRST AID. 
Do not attempt to rival the doctor, but aid him through emer- 
gency measures, and thus put the patient into his hands with a better 
chance of recovery than would have been the case if prompt and 
efficient emergency treatment had not been rendered. 
In the presence of an accident the “ first aider ” must take charge,, 
if the services of a doctor can not be obtained, and he should observe 
the following general rules: 
1. Be quiet and cool, don’t get excited, and do the best you can 
with the facilities at hand. 
2. Give the patient plenty of air; keep the crowd from gathering 
around, many of whom will be there only for curiosity’s sake. Keep 
only those around you whose assistance you may need. 
3. Lay the patient on his back, with head lower than the body, 
except in cases with marked flushing of the face, when the head may 
be raised a little on folded clothing or other suitable material. 
4. If there is vomiting, turn the head to one side so the vomited 
matter may easily escape from the mouth, thus eliminating the risk 
of its going into the windpipe and choking him. 
5. If the patient is unconscious, do not try to force him to drink, 
for he can not swallow, and you may choke him. 
6. Do not move patient from place of injury unless his condition 
justifies it. Often the injury will have to be attended to before it is 
safe to move him. 
7. Loosen tight clothing which may be present around the neck, 
chest, abdomen, legs, and ankles, such as collar, belt, garters, and 
shoe lacings. 
8. If stimulants are needed, whisky and brandy are not always 
indicated. In fact, there are conditions in which they do harm. 
Aromatic spirits of ammonia, if on hand, is safer for general use. 
9. In order to treat the injury the part has to be exposed and the 
clothing in some cases has to be removed. This should be done in 
such a manner as to disturb the patient as little as possible. The 
outer clothing should be ripped up the seam: the underclothing torn 
or cut. The sound side should be undressed first. In removing the 
shoes it is often necessary to cut them off when they can not be re- 
moved otherwise without causing great pain or increasing the injury. 
6 7 
RESUSCITATION FROM DROWNING. 
10. An injured person often wants a drink of water. If conscious 
and able to swallow, a few sips of cold water will be very re- 
freshing. 
11. If several injuries are present, care for the most severe one 
first. 
12. Don’t put your -fingers into the wound; they carry germs, and 
you will infect the wound. 
THE RESUSCITATION OF THE APPARENTLY DROWNED. 
The indications in treating one apparently drowned are to remove 
the water from the upper air passages, to make the patient breathe, 
and to stimulate the weak heart. 
Various methods for the production of artificial respiration have 
been described, but the one that is considered the best, namely, 
Schafer’s, will be outlined here. 8 
FIRST AID. 
• Schafer’s description of his method is in substance as follows: 
The subject, whether a drowned person or not, is allowed to lie 
prone, i. e., face downward, no preliminary manipulation of the 
tongue being required. The operator kneels or squats either across 
or on one side of the subject, facing the head, and places his hands 
close together upon the back of the subject over the loins, the fingers 
extending over the lowest ribs. By now leaning forward upon the 
hands, keeping the elbows extended, the weight of the operator’s 
body is brought to bear upon the subject, and this not only com- 
presses the lower part of the chest but also the belly upon the ground, 
the pressure being fairly equally distributed. The result of this 
is that not only is the chest diminished in extent from before back 
but owing to the pressure which is communicated to the belly the 
belly contents are compressed and tend to force the muscle partition 
between the chest and belly up, so that the chest is diminished in 
capacity from above down. The pressure is applied not violently 
but gradually during about three seconds, and is then released by 
the operator swinging his body back, but without removing his 
hands. The elasticity of the chest and belly causes these to resume 
their original dimensions, and air passes in through the windpipe; 
after two seconds the process is again commenced, and is continued 
in the same way, the operator swinging his body forward and back- 
ward once every fi,ve seconds, or about 12 times a minute, without 
any violent effort and with the least possible exertion. 
This last condition, viz, the absence of muscular exertion other 
than that involved in swinging forward and backward, renders it 
possible to continue the process without fatigue for an indefinite 
time. Its advantages in drowning cases over a method which in- 
volves the position on the back are sufficiently obvious, for with it 
there is no risk of obstruction by water or slime or the contents of 
the stomach. These can not accumulate in the throat, but must come 
away by the mouth, and the tongue, instead of falling backward, as 
in the position on the back, falls forward and is unable to produce 
obstruction. 
When respiration has been established and the patient is able to 
swallow, stimulants may be administered, consisting of a little warm 
coffee or whisky. The patient should be removed to a warm place, 
his wet clothes removed, body should be dried and rubbed, then 
wrapped in blankets surrounded by hot-water bags. The patient 
should be kept quiet and carefully treated, and if signs of collapse 
appear renewed effort should be made. Systematic rubbing of the 
skin and muscles greatly assist in promoting the circulation of the 
blood. 
Before commencing any artificial respiration see that all clothing 
or other constrictions about the neck, chest, and abdomen are 
loosened. RESUSCITATION FROM ELECTRIC SHOCKS. 
9 
Do not get discouraged at the slow results that sometimes happen 
when resuscitating the apparently drowned. You often have to 
continue a long time before signs of life are apparent. Do not dis- 
continue your efforts until you are certain that all chance is lost. 
Sometimes even after several hours’ work recovery takes place. 
In order to prevent drowning every person should learn the art 
of swimming and how to keep afloat for a sufficient length of time 
to allow assistance to effect rescue. In rescuing a drowning person 
the rescuer himself should be a fairly strong swimmer and have 
a knowledge of the different conditions that he will have to en- 
counter. If possible, he should remove most of his clothes, especially 
the shoes. He should reassure the drowning man that help is at hand. 
The drowning man should be approached from the rear, seized by 
the hair, if possible, and turned upon his back, the rescuer assuming 
the same position, and with the drowning person’s back to his stom- 
ach lie swims for the shore or floats until a boat or other assistance 
comes to him. If the drowning person struggles, it may be necessary 
to render him unconscious by a blow in the face before he can be 
handled. 
RESUSCITATION FROM GAS POISONING. 
In treating this condition the patient needs plenty of fresh air. 
Artificial respiration as described under drowning should be started 
at once. Stimulants and rubbing are also helpful. 
RESUSCITATION FROM ELECTRIC SHOCK. 
A person accidentally shocked by electricity is not necessarily 
killed. He may be only stunned or the breathing be stopped momen- 
tarily. The following instructions should be followed: 
(1) Break the circuit immediately. 
(2) Separate the victim from the live conductor by quick motion, 
using some nonconductor, as dry rope, dry coat, or dry board. The 
victim’s clothes if dry may be used to pull him from the live wire. 
Use nothing metallic: 
(3) Beware of touching the heels or soles of his shoes. 
(4) Do riot touch his body with your hands unless they are cov- 
ered with rubber gloves, mackintosh, dry clothing, or other noncon- 
ducting material. 
(5) If you have to cut a live wire, use an ax or hatchet with a 
dry wooden handle, or insulated pliers. 
After you have removed patient from wire, institute artificial 
respiration by the Schafer method. Attend to the burns as de- 
scribed under treatment for burns (see p. 13). Apply warmth to 
body, rubbing skin and muscles and giving stimulants if patient can 
swallow. 10 
FIRST AID. 
BITES FROM DOGS OR CATS. 
If bitten by a dog or cat let the wound bleed as freely as possibly; 
encourage this by milking the part. Some advise sucking the wound, 
but this is not altogether safe, for if you have a cut or abrasion in 
your mouth you may infect yourself. Cauterize the wmund with a 
hot poker, or carbolic acid, and dress with an antiseptic dressing 
(alcohol, bichlorid of mercury, or tincture of iodin). 
It is a common error to assume that a dog with fits is rabid. As a 
matter of fact, fits are common from worms, from acute indigestion, 
and from exposure to excessive heat. On the other hand, the so- 
called “ dumb rabies ” occurs without fits and is common. No one 
but a skilled veterinary is competent to judge if an animal has rabies. 
Where a person is bitten by an animal suspected of being mad, it is 
not only important to treat the patient but to take steps to ascer- 
tain positively whether the bite was dangerous or not as a long time 
may elapse before any symptoms develop, and this period might be 
fraught with needless and terrible anxiety for the patient. 
Keep the cat or dog under observation to see whether or not it 
shows signs of madness. If it does, kill it, pack the body in ice, and 
tend it to some laboratory for examination. 
In the meantime the person bitten should, as soon as possible, be 
landed at the nearest place for the Pasteur treatment for the preven- 
tion of rabies. 
A tourniquet above the wound is advised to limit the amount of 
poison entering the system. If this is done, the part should be care- 
fully watched and if it becomes blue the constriction should grad- 
ually be released; after circulation has been reestablished the tour- 
niquet may be reapplied. Strong ammonia may be used to cauterize 
the wound. 
UNCONSCIOUSNESS AND INSENSIBILITY. 
If the person is unconscious and the cause is unknown, let him 
rest flat on his back. If he is pale and surface of body is cold, apply 
heat to body and hold smelling salts or a little ammonia under his 
nose. If the surface of the body is very hot, cold water may be ap- 
plied to the head. 
Unconsciousness is usually due to disease of the brain or heart, 
general diseases, injuries to the head, or to some poison. 
FAINTING. 
This results from diminution of blood in the brain, due to many 
causes. The person gets paler and paler; there is a sinking feeling, 
and he falls unconscious. This often can be prevented by placing POISONS. 
11 
the patient in a chair with his head forward between his legs lower 
than his hips. But after its occurrence patient should be laid flat on 
his back with head low; loosen clothes and give plenty of fresh air; 
a little ammonia held under nose will often revive him. After re- 
covery give whisky or aromatic spirits of ammonia. 
EPILEPTIC FITS. 
The patient usually utters a cry, falls suddenly unconscious, has 
convulsions, foams at the mouth, and bites his tongue. After con- 
vulsions cease he passes into a deep sleep and remains in that state 
for several hours. 
During the convulsions the only thing to do is to try to prevent 
him from hurting himself. Something suitable (a piece of wood or 
cork covered with a handkerchief) should be put between his back 
teeth to keep his mouth open so he can not bite his tongue. Do not 
let this gag fall down his throat. When consciousness has completely 
returned a cathartic may be given, because in those subject to epilepsy 
clogging up of the bowels often brings on an attack. If some time 
must elapse before medical aid can be obtained or the epileptic dis- 
charged, give three or four potassium bromide 5-grain tablets three 
times a day. The tablets should be dissolved in half a tumbler of 
water. A man known to have fits should not be retained aboard ship. 
He is unfit for the service and may injure himself seriously by fall- 
ing down a hatch or in the way of machinery, etc. 
POISONS 
Prevention.-—Keep all poisonous drugs and solutions locked up. 
Label all bottles with tlieir contents and a Poison label. See that 
all bottles are properly labeled and no drug is put in them that does 
not belong there. 
In treating patients for poisoning the indications are: 
1. To neutralize the poison (give antidote). 
2. To get rid of the poison from the stomach (produce vomiting). 
3. To prevent further absorption into the system of the poison 
that may have remained in the stomach (oils, etc., except in case of 
phosphorus poisoning). 
4. To cause elimination from the system of the poison that may 
already have been absorbed (large drafts of water, purgatives, etc.). 
5. In case of collapse, to sustain and support the body strength 
(by stimulants, external application of heat, etc.). 
Unknown poison.—Produce vomiting. This can be done by giving 
2 teaspoonfuls of mustard in a cup of warm water; can also be in- 
duced by 2 teaspoonfuls of common salt in a cup of warm water; 12 
FIRST AID. 
soapsuds; putting fingers down throat; and tickling back part of 
throat with a feather. Sirup of ipecac, 1 tablespoonful in cup of 
tepid water, is also a good emetic. After vomiting give whites of 
raw eggs, or milk, or flour in water. If signs of collapse are present, 
give hot tea, coffee, and other stimulants. Keep body warm and rub 
extremities. 
Bichloride of mercury.—Give whites of 2 raw eggs. If these are 
not on hand give milk, or raw meat chopped finely in water or milk, 
or give soap and water. Then cause vomiting, and later give strong 
tea, flour in water, flaxseed tea, or barley water. Keep patient warm, 
and if stimulants are necessary, give strong coffee. 
Strong metallic acid (as nitric, sulphuric, hydrochloric, etc.).— 
Give no emetic. Neutralize the poison by giving alkalis, such as 
large quantities of water or milk with chalk, borax, baking soda, 
soapsuds, or plaster; raw whites of eggs in water; later, flaxseed tea, 
gruel, or starch. 
Carbolic acid.—Give equal parts of grain alcohol and water. If 
alcohol is not on hand, give brandy or whisky and a teaspoonful 
of glycerin. If none of these are at hand, give vinegar, raw whites 
of eggs in water, or soapsuds; then produce vomiting; then give 
solution of Epsom salts. Do not give oils. Milk, gruel, or flax- 
seed tea may be given later. If there is evidence of collapse, apply 
heat to body, give hot coffee and stimulants, and if breathing stops 
apply artificial respiration. 
Alkalis (lye, etc.).—Give mild acids, such as vinegar, lemon or 
orange juice, hard cider. Whites of eggs may be given later. Assist 
vomiting by large amounts of tepid water; then give something 
soothing, such as oil, gruel, barley water, milk, butter or lard, etc. 
Opium, laudanum, paregoric, heroin, morphin.—Give potassium 
permanganate solution (one-third teaspoonful in pint of water) or 
hydrogen peroxid (2 teaspoonfuls in pint of water) ; then give 
emetic. The best emetic in this case is mustard and hot water. Some- 
thing irritating is needed to start vomiting, as the nerves of the 
stomach are dulled by the opium. Give strong tea or coffee; if 
patient is unable to swallow, inject into bowel. Keep patient awake 
by applying cold water to head and face, slapping him with wet 
towel, and walking him about, but do not exhaust patient by over- 
doing this. Give no wines or liquors. When respiration is slow and 
irregular, apply artificial respiration. 
Arsenic, Paris green, rough on rats.—The best antidote, if it can 
be obtained, is two teaspoonfuls of magnesia, one tablespoonful of 
tincture of iron in a cup of water; take as one dose. Give an emetic; 
the whites of raw eggs and a large amount of greasy or salty water 
may be given. Lime water, or plaster in water may be given. Later BURNS AND SCALDS. 
13 
gruel, sweet oil, starch and water, and castor oil (1 ounce) may be 
given. 
Strychnine (nux vomica).—Give strong tea, then an emetic. If 
available give, next, bromide of sodium or potassium, six tablets (30 
grains) in water and repeat in a little while. Give whisky. Give 
Epsom salts. Apply artificial respiration if necessary. Remove, 
patient to a dark room, keep quiet, avoid sudden noises, etc. 
Ptomaine poisoningResults from eating bad meat, fish, or other 
articles of tainted or decayed food. 
Treatment: Give emetic, then give a purge, castor 'oil or Epsom 
salts. If there is much pain in stomach, apply hot-water bag or hot 
cloths and a mustard plaster. Give stimulants if necessary. Give 
no food until symptoms have disappeared. Should be careful with 
diet for several days after recovery. 
SHOCK. 
As almost all injuries cause a certain amount of shock, it is well to 
know what it is and how to treat it. It is a profound depression of 
the nervous system and is sometimes called collapse, exhaustion, or 
prostration. In this condition the face is pale, expression is anxious, 
eyes dull, and pupils enlarged, skin cold and clammy; patient is 
listless and takes no interest in surroundings; pulse is rapid and 
■weak: breathing may be gasping, spasmodic, or feeble. 
Treatment: Place on back with head low, administer stimulants, 
hot coffee, tea, aromatic spirits of ammonia, whisky, or brandy. 
Keep up body heat, wrap in warm blankets, apply hot-water bags, 
and rub extremities toward body to stimulate circulation. 
BURNS AND SCALDS. 
Burns result from exposure of body to dry heat, while scalds fol- 
low exposure to moist heat, as hot water, steam, etc. These are very 
serious accidents, attended, at times, with marked shock, and their 
danger to life depends more upon the extent of the body involved 
than the degree. 
For convenience burns are divided into three degrees, as follows: 
1. Reddening of the skin. 
2. Reddening of the skin with formation of blisters. 
3. Charring and destruction of the deeper tissues. 
There is usually considerable pain with burns and, if burn is 
extensive, marked shock. 
Treatment: Exclude air from the part. This may be done by 
making a paste with water and baking soda, starch, or flour. Smear 
the paste on a pad of sterile gauze, apply to burn, and hold in place 14 
FIRST AID. 
by a light bandage. An excellent dressing is a solution of ordinary 
washing soda (2 tablespoonfuls in a pint of warm water). A salt- 
solution dressing is also good (a teaspoonful of common salt to pint 
of warm water). Do not use strong antiseptic on burns. Soaking 
the part in warm water is itself good and is very often useful to soak 
off clothing sticking to a burned surface. If blisters have formed 
and are painful, they may be opened by passing a sterile needle 
through them and allowing the fluid to escape. Do not destroy the 
skin raised by a blister. The needle used may be sterilized by burn- 
ing in a flame. Do not put cotton next to a burn; it sticks and causes 
trouble. In dressing burns take pad of sterile gauze, soak in the solu- 
tion, apply to part, and hold in place by bandage. In removing the 
dressings it is often necessary to soak them off, and warm water or 
one of the solutions mentioned above may be used for this purpose. 
An excellent dressing for burns, if at hand, is a saturated solution of 
picric acid. Be careful not to get it on clothing, because the stain 
is hard to remove. Antiseptic ointments, such as boric acid or aristol 
and opium, are soothing and good at times, but oils, greases, etc., as 
a rule are not advised, because they are liable to favor infection. 
The burned part should be put at rest; and if there is much pain, 
20 drops of laudanum in a little water may be given, or 1 to 2 chlo- 
rodyne tablets, repeated in two hours if necessary. There is liable 
to be considerable shock, so don’t forget to treat it. A person badly 
burned should be seen by a doctor as soon as possible. If a person 
is extensively burned, it may be impossible to cover him with band- 
ages. A sheet soaked in any of the above-mentioned solutions and 
wrapped about the person is a convenient and sometimes only way 
to handle the case. The early treatment of burns caused by acids is 
to apply a dressing soaked in an alkaline solution, such as baking 
soda, washing soda, limewater, soapsuds, etc. 
Burns caused by alkalis are treated by acid solutions, such as 
vinegar, lemon juice, etc. Burns caused by carbolic acid should be 
treated freely with pure grain alcohol and dressed. 
EFFECTS OF COLD. 
Freezing.—If expecting to be exposed to the cold for a long time, 
endeavor to prevent any ill effects therefrom, but if freezing does 
occur there is marked depression and cautious treatment is necessary. 
Treatment: The object is to restore gradually the body warmth. 
The patient should at first be in a moderately cold room, and with 
woolen cloths soaked in cold water or snow the limbs should be 
gently and systematically rubbed toward the body. When the cir- 
culation becomes active, the cloths should be soaked in warmer and 
Warmer water. When patient can swallow, give stimulants, such as SPRAINS. 
15 
hot coffee or tea, whisky, brandy, or aromatic spirits of ammonia. 
The patient should not be brought into a warm room, placed before 
an open fire, etc., until the circulation of the blood has been reestab- 
lished and is active, as evidenced by increased force of the pulse, 
increased warmth, and color to the skin. 
Frostbite.—Parts most involved are those where circulation is 
sluggish, as ears, tips of nose, fingers and toes, etc. 
Treatment: Gradually restore normal temperature. Soak part in 
cold or ice water. Rub gradually with woolen cloth soaked in cold 
water, ice water, or snow. Gradually increase warmth of water as 
circulation becomes reestablished and active in part, as evidenced by 
more warmth to skin and better color. If the frostbite is an old one 
and the skin has turned black or commenced to scale off, it is dan- 
gerous to attempt to restore the vitality by friction; just apply a 
little cotton and hold in place by a bandage ; apply heat externally. 
RUPTURE (HERNIA). 
As encountered by the layman this is a swelling in the groin. 
Rupture makes its appearance suddenly after exertion and is evi- 
denced by pain and swelling. 
Treatment: Let patient take a hot bath and go to bed, lying on his 
back with thighs bent. By so doing, the rupture will often reduce 
itself. Keep patient in bed for several days and do not let him move 
until he has seen a doctor. 
If the rupture does not reduce itself it may be damaged by rough 
or unskilled handling. The'patient should see a doctor as soon as 
possible, as the condition, if unrelieved, may cause gangrene of the 
bowel and death. 
STRAINS. 
Condition caused by overstretching the muscles. The muscles of 
the back and shoulders are the ones most often involved. 
Symptoms: Pain, stiffness, lameness, and sometimes swelling. 
Treatment: Rest, hot applications, gentle massage with liniment. 
SPRAINS. 
Condition caused by a tearing or stretching of the ligaments and 
capsule about a joint. It is at times hard to distinguish from a 
fracture and should be cautiously handled. It often takes a long 
time for complete recovery. 
The joints most often involved are the ankle, knee, wrist, elbow, 
and shoulder. 
Symptoms: Pain, redness, swelling, loss of function, and often 
shock. 16 
FIRST AID. 
Treatment: Soak the joint in water either as hot as patient can 
stand or cold as you can get it, not tepid water. If it is a joint of 
the lower extremity, put patient to bed; elevate the limb on a pillow 
or other support. 
If joint is bandaged, do this loosely, because there is liable to be 
considerable swelling, which may cause damage. When pain and 
swelling have subsided, gently massage the joint. Let patient get 
about gradually on crutches. If sprain is in upper extremity, the 
treatment is the same, except the patient need not stay in bed. The 
joint is put at rest and supported either by a sling or splint. 
If shock is present, it should be treated. 
HEMORRHAGE. 
The heart may be considered as a pump, which by its beats forces 
the blood to all parts of the body through a series of tubes. The 
arteries carry the blood from the heart; the veins return the blood 
to the heart. The capillaries are a network of smaller vessels sit- 
uated between the arteries and veins. 
Remember that in the character of wounds that you will encounter 
death from bleeding is very rare. Bleeding is dangerous when a 
large artery is injured. In the majority of cases of bleeding all that 
will be necessary to do is to put a gauze compress over the wound 
and hold it in place by a firm, snug bandage; put the injured part, 
at rest; if arm or leg, elevate; keep the patient quiet and give plenty 
of fresh air. Very hot water applied will at times do good. 
If, however, bleeding is profuse and life seems endangered, it may 
be necessary to apply some kind of tourniquet. Arterial bleeding is 
most dangerous and is recognized by the fact that the blood is bright 
red in color and is expelled in jets. 
In venous bleeding the blood is dark blue and flows in a constant 
stream. 
Capillary, bleeding occurs as a general oozing and is of a brick 
color. 
Tourniquets may be improvised, as a clean handkerchief bandage, 
soft-rubber tubing, or other similar material, encircling the limb, 
and tied sufficiently tightly to stop the flow of blood. 
Tourniquets in the hands of laymen are extremely dangerous and 
should not he used unless absolutely necessary, which is rare. When 
used, the part should be carefully watched, and if signs of extreme 
swelling or bluish color appear the tourniquet should be loosened. 
A tourniquet should not be left on at one time more than one-half 
hour. It should then be loosened and, if necessary, retiglitened. The 
arms and legs are the only parts to which tourniquets should be 
applied. BANDAGING. 
17 
Arterial hemorrhage.—Apply the tourniquet between the heart and 
the wound; generally speaking, above the wound. Place a com- 
press over the wound and hold by snug bandage. Put part and 
patient at rest. 
Venous hemorrhage.—Apply tourniquet on far side of wound from 
heart; generally speaking, below the wound. Then treat as above. 
Capillary oozing.—Pressure by compress and bandage applied over 
the wound is all that is usually necessary. 
Bleeding can often be stopped by pressure from the thumb, or 
anything else suitable, over the injured artery or vein, as the case 
may be. 
It is often difficult to determine whether the blood is from an 
artery or vein. In such a case, if a tourniquet is necessary, apply it 
above the wound; and if injury is in arm or leg, apply your com- 
press over the wound, hold it with a snug bandage, and put part at 
rest, elevated. Remember that tourniquets, as a rule, are condemned 
and should not be used by the layman unless necessary, which will 
larely be the case. 
The main arteries in the body which play a part in external hem- 
orrhage are four, namely, the carotid, which supplies the head; the 
subclavian, supplying the middle of the shoulder; the brachial, run- 
ning along the inner side of the arm and supplying the arm, fore- 
arm, and hand; and the femoral, running along the inner side of the 
thigh and supplying the thigh, leg, and foot. The pulsations in 
these arteries should be studied, as pressure at the correct spot on 
them will often check external hemorrhage in the extremities, neck, 
or head. 
Internal hemorrhage.—Caused by wounds usually of abdomen or 
chest. No external evidence of bleeding. Symptoms are those of 
shock. Treatment: Rest in bed; ice bag or cloth to chest or abdo- 
men. Do not give stimulants unless patient becomes very weak. 
Nose bleeding.—Place patient in chair with head thrown back. 
Apply cold cloths to back of neck. Place a small wad of paper well 
up between the upper lip and gum. Finely crushed ice on gauze or 
thin cloth applied to bridge of nose is often effective. May snuff 
salt -water up nose. If it still persists, small strips of gauze with 
ends hanging out may be pushed up the nostrils. Keep patient quiet 
and caution him not to pick off or bloic out the clots as they form 
in the nostril. These clots are nature's stoppers. Have him breathe 
through the mouth and leave his nose alone. 
BANDAGING. 
Those bandages most frequently used are the— 
1. Roller bandage. 
2. Triangular bandage. 
3. Many-tailed bandage. 18 
FIRST AID. 
Bandages are used (1) to hold dressings in place, (2) to hold 
splints in place, (3) to check hemorrhage, (4) as slings. 
Materials most commonly used for bandages are (1) gauze, (2) 
muslin, (3) flannel, (4) plaster. The gauze and muslin bandages 
are the two that the layman will be called upon to use, generally 
gauze. Good bandaging comes by practice, and all that will be 
expected of the layman is the application of the bandage so it will 
accomplish its object, be comfortable to the patient, and do no dam- 
age. Bandage uniformly, firmly, but not tightly. In bandaging 
arm or leg commence from below and bandage up. Leave the tips 
of fingers and toes unbandaged, so the effect of the bandage on the 
circulation can be watched. In bandaging a part that is liable to 
swell, bandage loosely, so if the part should swell the bandage will 
not be too tight and constrict. Do not apply a bandage when wet, 
because when it dries it will shrink. In bandaging apply the band- 
age to the part in the position in which the latter is to be carried 
during treatment. A bandage should not be put on under a splint, 
but always over it. The triangular bandage is probably the easiest 
for general application by the first aider. However, the roller band- 
age is supplied to auxiliary ships and is the one that probably will 
be most used by first aiders of these vessels. The triangular bandage 
is usually made from unbleached cotton cloth, though any strong 
cloth will do, as bed sheets, pillow covers, napkins, handkerchiefs, etc. 
A triangular bandage is extremely useful because of its simplicity. 
It can be used as a tourniquet, as a sling for arm or forearm, and to 
retain a dressing. The black-silk neckerchief furnishes a good tri- 
angular bandage or one can be made by cutting in two, diagonally, 
a square of muslin or sheeting 34 inches on each side. 
To use the triangular bandage as a sling or tourniquet, bring the 
apex or point of the triangle over to the base and then fold the whole 
again on itself. If the ends are now’ knotted at the back of the neck, 
the hand or forearm can be passed through and supported by the loop 
thus made. Or fold the triangular bandage with its base up and 
down (vertically) along the front of the body from collar bone to 
thigh, with the apex or point of the triangle pointing to the injured 
side. Bring the forearm to be supported across the bandage. Next 
bring up the lower end of the base in front of the injured forearm 
and knot the two ends of the base behind the neck. The apex is now 
folded inward across the arm above the elbow and pinned to the 
front and back portions of the sling. 
To hold a dressing in place on hand or foot, or to protect them, 
proceed as follows: Fold the base over on itself a couple of inches. 
Lay this folded base of the triangle under the wrist or under the 
sole of the foot a few7 inches back of the heel. Bring the point or 
apex up over the fingers to the wrist or over the toes to the instep WOUNDS. 
19 
and ankle. Now, wrap the long ends of the base round and round 
wrist or ankle and tie. The point or apex caught by the circular 
turns is folded back over the knot and pinned. The same principle 
can be used on almost any part of the body. For example, to cover 
over the scalp, lay the apex or point on the center of the forehead, 
extending down on the nose, while the base lies on the back of the 
head and neck. Bring the ends of the base forward and upward 
just above the ears and tie them low down over the center of the 
forehead. The apex or tip is now folded back over the knot and 
secured with a safety pin. 
Roller l>andages.—These are furnished already prepared, but in an 
emergency where none are at hand they can be improvised from 
sheets, pillow covers, muslin, flannel, etc. Those that are furnished 
come in different widths and lengths. The size to be used depends 
upon the part to be bandaged. 
For the fingers and toes the one about three-fourths inch wide 
should be used. 
For the arm and head use one about 2| inches wide. 
For leg and thigh use one about 3 inches wide. 
For the chest and abdomen use one about 4 inches wide. 
For general use the most serviceable bandage is about inches 
wide and about 4 yards long. 
The roller bandage is applied by holding the roller in the right 
hand and the free loose end in the left, and the outer side of the 
bandage is applied on the place where it is desired to start the 
bandage. In securing the bandage the free end is turned back and 
pinned, preferably with a safety pin, or the end may be ripped up 
the middle a sufficient distance, then a knot tied to prevent further 
ripping, and the ends carried around the limb in opposite directions 
and tied. 
BRUISES AND CONTUSIONS. 
These are conditions where the soft tissues below the skin are in- 
jured and torn, the skin itself remaining intact. There is hemor- 
rhage under the skin, but the blood does not escape. 
Symptoms: Pain, loss of function, swelling, and discoloration (red, 
purple, black, green, and yellow’). 
Treatment: Put the part at rest. Apply cold applications, except 
in the feeble or aged, where hot applications are better. 
WOUNDS. 
These are usually divided into the following classes: 
1. Incised. 
2. Lacerated. 20 
FIRST AID. 
3. Punctured. 
4. Poisoned. 
5. Gunshot. 
Incised wounds are those caused by sharp instruments, such as 
razor, sharp knives, glass, etc. 
Lacerated wounds are those caused by a blunt instrument, by 
machinery, falling block, etc. 
Punctured wounds are those caused by deep, pointed instruments, 
such as a nail, dagger, bayonet, etc. 
Poisoned wounds are those caused by bites of animals, stings of 
insects, etc. 
The term “ gunshot wounds ” is self-explanatory. 
Symptoms of wounds: Local—(1) pain; (2) hemorrhage; (3) loss 
of function; (4) gaping of edges. General—shock. 
The dangers from wounds are hemorrhage and infection. As we 
have seen, grave hemorrhage is usually rare, and a compress and 
bandage is usually all that is necessary to check it. Infection is the 
main danger. By this is meant the introduction into the wound of 
germs, which will cause pus and later trouble. Our main effort in 
treating wounds is to prevent infection. 
Treatment of wounds.—Prevent infection. Do not touch the 
wound with your dirty fingers and do not let the patient do so with 
his. If wound is not extensive and there is very little bleeding or 
dirt or foreign particles in it, apply into and for about II inches 
distance around the wound tincture of iodin, either in full strength 
or diluted one-half with water or alcohol. Then apply to the wound 
a sterile gauze compress and hold in place by a snug bandage. 
If the part injured is a hairy part of the body, it should be shaved 
before treatment. If iodin is to be used, it would be better to shave 
the part dry, as iodin is less active on a moist surface. 
Before dressing a wound the dresser should see that his hands are 
surgically clean. To render them so, scrub for five minutes with a 
nail brush, hot water, and soap. Rinse off soap with hot water, then 
soak hands in hot bichloride of mercury solution (1-1000), carbolic 
acid solution (1-100), alcohol, or other antiseptic solution. If nothing 
else is at hand, use whisky or brandy, or, better still, paint the hands 
thoroughly, front and back, with tincture of iodin. If none of the 
above antiseptics are at hand, thoroughly scrub your hands with hot 
water and soap for oi least 10 minutes, and do not put your fingers 
into the wound unless absolutely necessary. These are the two 
essential features of aseptic work. 
If foreign particles are in the wound they may be picked out with 
a pair of sterile forceps. If it becomes necessary to wash a wound 
to get the dirt out, use sterile hot water, soap, and a pad of sterile 
gauze as a sponge. A boiled common-salt solution (1 teaspoonful to WOUNDS. 
21 
a pint of water) is a very good one to wash and dress wounds with. 
Be sure your water is sterile before applying it to the wound. 
(Should boil at least 20 minutes.) 
The dressing contained in the first-aid packet, although intended 
for a gunshot wound of small caliber, makes an excellent dressing 
for any wound it will cover and may be applied after the wound has 
first been treated with tincture of iodin, if on hand. 
In case of a jagged and bruised wound, with its edges far sepa- 
rated, strips of gauze should be laid in the wound before being 
finally dressed. 
It is better for the layman not to sew a wound, but at some time 
or other it may be necessary. Sometimes in wounds of the scalp 
the best way to check the hemorrhage is to bring the edges of the 
wounds together by suture. Usually, however, a bandage or tourni- 
quet carried around the forehead just above the eyebrows, then just 
above the ears, and continued low down on the back of the head to 
the starting point and drawn tight will stop bleeding of the scalp. 
A stitch may prevent marked scarring. However, this should not 
be given much consideration by the aider, except for cosmetic pur- 
poses on exposed parts of the body. If you do suture a wound, 
remember that your hands, needles, all instruments, etc., that come 
in contact with the wound should be sterile. 
The stitches should pierce the skin about one-eighth inch from 
the edge of the wound, and they should be placed about one-half 
inch apart, tied, and cut off. They should not be tied too tightly, 
only sufficient barely to bring the edges together. It is better not 
to close the wound entirely, but to leave a little opening at its lower 
end, where a little wick of sterile gauze may be inserted for drainage. 
If after stitching a wound it becomes red, swollen, and painful, or 
there is other evidence of pus forming, the stitches should be removed 
and the wound left open. Carry the needle through the entire thick- 
ness of the skin. Remember that occasions will be few where a 
layman will have to stitch a wound. 
In all wounds put the part at rest and treat shock if present. 
To treat gunshot wounds, see instructions in first-aid packet. 
Sterilizing dressings.—An easy and convenient way is by boiling 
in plain water for about 20 minutes. If a dry dressing is desired, it 
can be sterilized by placing in a hot oven for about 20 minutes and 
removed just before scorching. Sterile dressings can be bought. 
The contents of a first-aid packet are sterile. 
Sterilizing instruments.—The scissors, forceps, knives, needles, etc., 
used in dressing wounds should be sterilized by placing them m 
water that has been brought to boiling point and boiling them for 
15 to 20 minutes. If, on hand, a little soda added to the water will 
greatly assist the sterilization and protect the instruments. It is 22 
FIRST AID. 
better to protect the blade of the knife by wrapping a little cotton 
around it before boiling. 
Remember that in dressing wounds you apply your pad of sterile 
gauze, then your bandage. In large wounds, or those from which 
there is liable to be considerable oozing, it is probably better after 
the pad of sterile gauze has been applied to apply several layers of 
absorbent cotton, then bandage. Do not put the cotton next to the 
wound. 
DISLOCATIONS. 
These are injuries to joints; the head of a bone has slipped out of 
its socket. 
Causes: (1) From a blow or fall; (2) muscular action. 
Symptoms: Pain, swelling, loss of function, limited motion, and 
the head of the bone is noted as out of its usual place. The limb may 
seem lengthened or shortened, according to the way in which the dis- 
location has taken place. 
Treatment: The proper treatment is reduction and retention by 
some means of immobilizaton. 
It is better for a layman not to attempt reduction except, perhaps, 
in dislocations of the fingers and lower jaw. By unskilled attempts 
at reduction a layman may cause considerable damage to the nerves, 
vessels, and soft parts. 
Put the part in the position most comfortable to the patient. The 
joint should be surrounded with cotton and a bandage applied, not 
too tight, and then supported. The patient should be kept as quiet 
as possible. If the joint involved is the shoulder, elbow, hip, knee, 
or ankle, the patient should be kept in bed. If the joint is painful 
and greatly swollen, hot or cold applications may be applied. A 
sling makes a good support to the shoulder, elbow, and wrist joints. 
If shock is present, treat it. Have patient see a doctor as soon as 
possible. 
SPLINTS. 
Before considering fractures it becomes necessary to know some- 
thing about splints, the correct application of which is so essential 
in the treatment of fractures. 
We understand by a splint a more or less stiff support that will 
immobilize a fractured bone or a joint. It can be made from pieces 
of wood, broom handles, cardboard, wire netting, rolls made of 
blankets, pillows, rifles, swords, bayonets, etc. The material should 
be rigid enough to keep the parts in position. The splints should 
be long enough to prevent movements in the nearest joints and as 
wide or wider than the limb to which applied, so that the bandages 
which hold them in place will not press on the limb. They should be FRACTURE (BROKEN BONE). 
23 
well padded with cotton or other soft material, as wool, oakum, flan- 
nel, etc., before being applied. The padding should extend well over 
the side of the splint. After splint has been well padded and applied 
to the limb it is held in place by a snug bandage. The bandage 
should not be applied too tightly, and if pain and swelling occur it 
should be loosened. 
FRACTURE (BROKEN BONE). 
Causes: (1) Direct violence, (2) indirect violence, (3) muscular 
action. 
Symptoms: (1) History of injury, (2) pain, (3) swelling, (4) loss 
of function of parts, (5) usually shortening, (6) excessive mobility 
(movement) where there should be none, (7) crepitus or grating of 
the ends of bone. 
Varieties: 
Simple fracture, where the skin is intact and there is no external 
wound. 
Compound fracture, where the skin is broken and the external 
wound communicates with the fractured bone. 
Complete fracture, where the break extends through the entire 
bone- 
incomplete fracture, where the break is not entirely through the 
bone. 
Treatment: Along general lines. The thing to do is to set the bone 
and hold it in place by means of splints. A broken limb should be 
handled as gently as possible. It is usually best not to move patient, 
especially if break is in lower extremity, until splint has been ap- 
plied. In handling a fracture the limb should be grasped above and 
below the seat of fracture. 
To treat fracture, say, of the arm or leg, grasp the limb above and 
below the seat of break, make gentle extension and counterextension 
(pulling in one direction on one fragment and pulling in the opposite 
direction on the other) in line of body, and while held in that posi- 
tion by an assistant splints should be applied. Observe the pre- 
cautions mentioned under the heading of splints. After application 
of splints the limb should be supported and elevated over pillows, 
clothes, sheets, etc. After application do not remove splint unless 
it becomes loose or shows evidence of being too tight, etc. Let pa- 
tient see a doctor as soon as possible. 
Compound fracture.—Dress the wound, then apply splint. Splint 
should be so arranged that wound can be dressed if necessary. In 
all fractures you may have to treat shock. Remember the one great 
thing in treating fractures is to keep the bone at rest, so do not move 
the limb or let the patient move it without reason. 24 
FIRST AID. 
SPECIAL FRACTURES. 
Fracture of skull.—These are very serious injuries. Apply sterile 
dressing to wound. Place patient in lying position with head 
slightly elevated. May have to treat shock, but do not give stimu- 
lants unless patient is very weak. 
Whenever a man is unconscious from overindulgence in alcohol, 
it is well to bear in mind the possibility of fractured skull and brain 
injury also. This is especially true where there is any mark of a 
blow or cut, however slight, on the head. With such a complication 
the gentlest treatment is necessary. 
Fracture of nose.—Treatment: Put bones in natural position. Put 
small compress of gauze on each side of nose, then a piece of adhesive 
plaster across nose from cheek to cheek. If adhesive plaster is not 
at hand, put bandage across nose and around head. Do not tie too 
tightly. 
Fractured back.—Keep patient still and quiet on his back. Treat 
shock. 
Fractured lower jaw.—Treatment: Raise the broken bone and bring 
lower teeth against upper and hold there by a bandage carried under 
the chin, tied over the head and maintained in position by pinning to 
another bandage running horizontally around brow and back of 
head. The mouth should be kept clean by a little warm water, plain, 
or to which a little soda or salt is added if on hand. The patient will 
have to subsist for a while on liquid food through a tube. 
Fractured collar bone.—Apply a pad of gauze in the armpit of the 
injured side. Support the arm in a sling with the forearm at right 
angles to the arm and across the chest. 
Fracture of rib.—Keep patient quiet in bed. With arms over head 
and chest emptied of air, apply snugly a wide roller bandage or 
adhesive straps around chest, the straps as indicated for pleurisy. 
Fracture of the upper arm.—Straighten so as to put in natural 
position. Secure two splints (flat wood shingle, cardboard, etc.), one 
to extend from shoulder to elbow, the other from armpit to elbow. 
Pad well with cotton, apply one to inner and one to outer side of 
arm, secure by bandage, and support in sling. 
Fracture of forearm.—Straighten as above; secure twTo splints as 
above to extend from a little below elbow to middle of hand. With 
forearm across chest and thumb up apply padded splints, one to 
outer and the other to inner side of forearm; then support in sling. 
Fractured wrist.—Treat like fractured forearm. 
Factured fingers.—Draw gently into natural position. Apply 
harrow padded splint to palm surface of finger, hold in place by 
narrow bandage, and support forearm and hand in a sling. VENEREAL DISEASES. 
25 
Fractured, hand.—Apply padded palm splint as wide as the hand 
and to extend from above the wrist to beyond tips of fingers; hold 
in place by a bandage and support forearm and hand in sling. 
Fracture of thigh.—By gentle extension and counterextension pull 
parts into natural position (p. 29). While limb is held by an assist- 
ant, apply a well-padded outer splint to extend from armpit to below 
foot. Then apply a well-padded inner splint to extend from crotch 
to below foot. Hold splints in place by a snug bandage. 
If nothing else is at hand, the injured leg may be splinted by 
bandaging it to the other leg. 
Fracture of lower leg.—An excellent splint can be made by placing 
the leg on an ordinary pillow and tying the pillow around it; fasten- 
ings above and below should be well away from point of fracture. 
Wooden splints may be applied on the outside of the pillow, extend- 
ing from above the knee to below the ankle. The wooden splints, 
well padded, may be applied without the pillow. 
Fractured kneecap.—Straighten leg. Pad well a wooden splint as 
wide as the thigh and long enough to extend from middle of thigh 
to middle of lower leg. Apply splint to back of thigh and leg, 
with center opposite bend of the knee. Secure by strips of bandage. 
Do not bandage directly over break, but one strip above and one 
below knee. 
Fmctured foot.—Apply a well-padded splint as wide as foot from 
heel to toes. Elevate and support. 
VENEREAL DISEASES. 
Gonorrhea (clap).—Inflammation of tlie urethra due to micro- 
organisms called gonococci. Usually occurs in from three days to 
two weeks after exposure, oftenest during the first week. First there 
is noticed an itching sensation, with a slight pufliness and redness 
about the lips of the opening. This is soon followed by a creamy 
discharge. There may be marked burning and difficulty in urinat- 
ing. May have such complications as chordee, phimosis, paraphi- 
mosis, orchitis, or bubo. 
The disease usually subsides in from one to three months. It is 
often difficult to tell absolutely when it is cured. The gonococci may 
invade the blood stream and attack numerous organs of the body. 
Treatment: Rest is essential, and if any of the complications are 
present rest in bed is absolutely necessary. Should drink plenty of 
water, avoid stimulants (alcohol, tea, coffee), and be regular in eat- 
ing and sleeping. Avoid eating greasy food. Keep bowels well open 
and bathe frequently in hot water, if practicable. 
A 10 per cent colloidal silver solution is an excellent injection. In- 
jections should be twice a day, or, if discharge is profuse, three times 26 
FIRST AID. 
a day. Injection of warm sterile plain water or salt solution may 
be used. 
Before injection urinate, then run the solution into the canal from 
a penis syringe and hold solution in canal from 5 to 10 minutes before 
allowing to escape. 
The penis should be kept clean, thoroughly bathed in hot water 
or hot salt solution (1 teaspoonful of common salt to pint of water). 
Do not put cotton over the head of penis, but take a small piece of 
gauze, slit it in the center, and slip back over the head of penis and 
pull foreskin down over it; this Avill catch the discharge. The ends 
of the gauze should be sufficiently long to extend out over the head of 
the penis. 
If urination causes pain or burning immerse penis in a basin of 
hot water and allow urine to flow. Increase the amount of water 
drunk and add to each tumbler a pinch of soda. 
Remember this is a contagious disease and you are liable to con- 
vey it to others. You should use your own towels and have your 
clothes washed separately. Your hands should be washed thoroughly 
after handling your penis. Be careful not to carry any of the pus 
into your eyes. By so doing you are liable to set up trouble there, 
which often causes complete blindness. Keep your fingers away 
from your eyes. Avoid all violent exercise. It may be well to wear 
some support for your testicles. This may prevent a swollen and 
painful testicle. 
Chordee {'painful erection, especially at night).—If this occurs, 
apply cold applications. Avoid too warm bed clothing. Keep 
bowels open. Keep mind clear of sexual thoughts. Empty bladder 
before turning in. Sleep on side. 
Phimosis.—The foreskin is elongated and contracted down over the 
head of penis. 
Treatment: Soak in hot water or salt solution, and inject same 
under the foreskin. 
Paraphimosis.—A condition where the foreskin is swollen, rolled 
back, and tight. 
Treatment: About the same as for phimosis. Patient should be 
put to bed in treating the above complications. Get a doctor. 
Bubo (“ hlueballs ”).—Swollen glands in the groin. 
Treatment: The most important thing is rest in bed. Cold appli- 
cations are effectual at the outset, but later hot ones are better. If 
suppuration occurs (pus forms), an incision may be necessary. This 
should not be done by a layman. In time the abscess will break of 
itself. Wash out with sterile, warm, plain water or salt solution, ap- 
ply wicks of gauze in the opening for drainage, and dress. Should 
be redressed as often as dressing becomes soiled. Burn all soiled 
dressings and wash your hands after dressing a bubo. VENEREAL DISEASES. 
27 
Orchitis (swollen testicle.)—Not an infrequent complication. 
Treatment: Rest in bed most important. Support and elevate 
the testicle. Apply cold or hot application; hot is probably more 
agreeable. Keep bowels open. 
Stricture of urethra.—Usually a later complication and probably 
you will not have to treat. Sometimes, however, it does not occur in 
early stages and patient is in great pain and unable to pass his urine. 
You may induce him to void his urine by applying hot applications 
over the bladder or placing him in a hot bath. If tincture of bella- 
donna is at hand 20 drops may be administered. 
If the condition is urgent, and a doctor can not be gotten, as the 
last resort you may attempt to pass a catheter, if one is at hand. It 
should be sterile (boiled) and well greased with oil, albolene, 
glycerin, etc. It should be manipulated gently and with as little 
force as possible. 
Chrancroid.—A soft chancre, veneral ulcer upon the penis. 
Usually occurs from 2 to 10 days after exposure. Is sometimes 
hard to differentiate from hard chancre—primary stage of syphilis. 
Sore may be mixed—-both chancre and chancroid. Keep sores clean 
with soap and warm water, then wash with warm salt solution (1 
teaspoonful of common salt to pint of water). This should be done 
several times daily. The same general rules about attention to the 
cleaning of hands of both patient and aider after handling penis 
apply here as in gonorrhea. Also attention to towels, etc., of patient, 
to prevent its spread to others. 
The most frequent complications of chancroid are bubo, phimosis, 
and paraphimosis; and the treatment of these is as given under 
gonorrhea. 
Syphilis.—This is a very virulent and severe communicable consti- 
tutional disease, and is usually acquired during sexual contact. It 
may, however, be contracted otherwise. The primary lesion of 
syphilis is a sore called a chancre, and starts at the point of inocula- 
tion of the virus. If due to sexual contact, it is found upon the 
penis. It may start upon the lips, tongue, or tonsils. It usually 
appears from three to six weeks after exposure. However, the sore 
may not develop for 90 days after exposure. The average is about 
one month. It may appear as early as 10 days. It usually starts as 
a papule or pimple, which breaks in the center and forms an ulcer 
with hardened edges. This is soon followed by enlargement of the 
glands in groins and neck. In about one or two months the skin 
eruption appears. There may be sores on the lips, tongue, or cheeks, 
and a general sore throat. Hair may fall out. May complain of 
headache, general muscular and bone pains, fever, and the whole 
system may become involved. 28 
FIRST AID. 
Treatment: A man in the active stage of syphilis should not be 
allowed to start on a cruise. He is a menace to himself and others. 
If it breaks out on a voyage, he should be more or less isolated. 
Should use his own mess gear, drinking cups, towels, toilet articles, 
etc. The contagion is most liable to be carried from man to man 
by the saliva, and so the syphilitic should be forbidden to lend his 
pipe, roll a cigarette for another person, etc. He should not be 
detailed for work as a messenger, cook, mess attendant, or for any 
work about the galley. The primary sore should be kept clean with 
warm water and soap and then washed with warm salt solution. 
The mouth and teeth; should be kept clean. The mouth may be 
washed out with sodium bicarbonate solution, or if sores appear in 
mouth, by a mild antiseptic solution (potassium chlorate) if on 
hand. 
The clothes of a man suffering from syphilis should be washed 
separately from the rest of the crew. 
The patient should see a doctor for treatment and advice as soon 
as possible. The same precautions as given under gonorrhea and 
chancroid should be observed in regard to chancre and syphilitic 
sores to prevent spread of the disease to others. 
Under no circumstances should anything that has been used in the 
mouth of a person with active syphilis be used by others. 
The person should use his own mess gear, etc., as stated above, 
and this should be thoroughly scalded out after each using with 
boiling water. CHAPTER III. 
SPECIAL DISEASES. 
FEVERS. 
By fever we mean a rise in the temperature of the body, accom- 
panied by a general disturbance of health. Some fevers are infec- 
tious ; that is, they may be conveyed from one person to another; but 
it is proboble that all fevers are due to germs.1 
TYPES OF FEVERS. 
1. Continued fever.—Where there is a variation of less than 2a 
between the morning and evening temperatures; these do not come 
down to normal. 
2. Remittent fever.—Where there is a variation of more than 2° 
and the temperature does not come down to normal. 
3. Intermittent fever.—Where there is a variation of more than 
2° and the temperature does come down to normal at least in 
every 24 hours. 
Termination of fever. 
1. By crisis.—When the temperature comes down suddenly, 
2. By lysis.—When the temperature comes down gradually. 
1 In taking the bodily temperature the small clinical thermometer with a. scale ranging 
from 92° to 110° F. is employed in this country. 
To read the height of the mercury column some practice is necessary. The front aspect 
of the glass tube is conical, in order, by refraction of light, so to broaden the image of the 
mercury column as to make the latter more readable. Hold the apex or sharper edge of 
this cone toward you, and gently turn from side to side until the flash of the broad 
metallic column strikes the eye, then hold in that position and read the degree at the top 
of the column. 
Familiarize yourself with the normal height, 98.6°, denoted by a special marking. 
Always see that the mercury is below this before taking a temperature. 
To force the mercury down hold firmly in hand by upper end, and following repeated 
smart, snappy swings of the forearm. as if working a pump handle, the column will be 
found to have been carried down. 
Temperature by mouth is taken as the normal standard ; by rectum it is roughly one 
degree higher, in armpit one degree lower than by mouth. Leave the thermometer in 
position for three minutes before reading. 
After using, clean in cold water, and immerse for 20 minutes in bichlorid, 1-1000, or 
carbolic acid, 1—20. 
29 30 
SPECIAL DISEASES. 
INFECTIOUS FEVEKS. 
1. Those common in the United States: 
(a) Those accompanied by rash— 
Chicken pox. 
Scarlet fever. 
Smallpox. 
Measles. 
German measles. 
Typhus fever. 
Typhoid fever. 
(b) Those not accompanied by rash— 
Mumps. 
Whooping cough. 
Diphtheria. 
Influenza. 
2. Those met with abroad: 
Malta (or Mediterranean) fever. 
Malaria. 
Cholera. 
Dysentery. 
Plague. 
Yellow fever. 
Dengue. 
In dealing with infectious disease the following terms are em- 
ployed : 
Incubation period.—This is the time which elapses between the 
date of infection and the appearance of the first symptoms. During 
this period the germs of the disease are growing and multiplying in 
the body. 
Quarantine period.—This is the time during which apparently 
healthy people are isolated after being in contact with a case of an 
infectious disease to see if the infection has occurred. This period 
is always two or three days longer than the incubation period. 
Isolation period.—This is the time during which the patient suffer- 
ing from an infectious disease is kept by himself because he is infec- 
tious to others. 
In describing the rash which accompanies infectious fevers the 
following terms are used: 
A papule (or pimple) is a small, red, solid elevation of the skin. 
A macule is a small spot of congested skin; it is larger and flatter 
than a papule. 
A vesicle is a small collection of serum under the skin; i. e., a 
water blister. 
A bulla or bleb is a large vesicle. PREVENTION. 
31 
A pustule is a small collection of pus under the skin or infected 
papule. 
A scab is an irregular mass of dried serum or pus. 
A scale is a particle of dried skin that peels off. 
In infectious fevers the rash appears after a certain definite inter- 
val from the commencement of the illness, and to remember the 
day on which the rash appears the following is sometimes used: 
Learn this sentence, “Very sick people must take no exerciseand 
apply it thus: 
Disease. 
Day on which rash usually appears. 
1. Very 
2. Sick 
Varicella (chicken pox) 
Scarlet fever 
First day of illness. 
Second day of illness. 
Third day of illness. 
Fourth day of illness. 
Fifth day of illness. 
Seventh day of illness. 
3. People 
Smallpox 
4. Must 
Measles 
5. Take 
Typhus fever 
6. No 
No disease 
7. Exercise 
Enteric (typhoid fever) 
Infection is spread in various ways—by actual contact, by the air, 
food or drink, clothing, books, utensils, etc. 
The most infectious part of a patient may be his breath, saliva, 
urine, or feces, or discharges from the throat, nose, or ears. 
PREVENTION OF THE SPREAD OF INFECTION. 
1. Isolation.—As soon as a case is suspected of being- infectious the 
patient should be kept away from other persons. On board ship 
any suitable place may be employed, such as a spare cabin, chain 
locker, a boat roofed over with tarpaulin, any compartment which 
can be afterwards thoroughly disinfected and where the individual 
will not come in contact with the rest of the crew. The patient 
should be sent to a hospital as soon as the proper authority has 
been obtained from the quarantine officer of the port or other author- 
ized person to land him. The person detailed to attend an infectious 
case must not mingle with other people. The patient must have his 
oAvn separate utensils, cup, plate, knife, fork, and spoon, etc., and use 
a commode and urinal instead of the general head. Isolation must 
be complete, so that there is no possible way by which infection can 
be carried to others. 
2. Disinfection.—By disinfection is meant the killing of the germs 
of the disease. This is carried out by heat, by chemicals, or by fresh 
air and sunlight. 
Disinfection by heat: Boiling in water is the best and surest method 
of disinfection, but it can not, of course, be used for every infected 
article. For bedding and clothing a steam disinfector is used. This 32 
SPECIAL DISEASES. 
consists of two large metal cylinders, one inside the other, leaving a 
space between inclosed at the ends by hinged doors. The articles 
to be disinfected are put into the inner chamber through the door, 
which is then closed, and steam turned into both the inner and outer 
chambers, so that the steam in the inner chamber, being under pres- 
sure, attains a temperature of about 240° F. After about 30 minutes 
the articles are removed through the door and hung in fresh air 
and sunlight to dry. (See also chapter on Quarantine.) 
GENERAL TREATMENT OF INFECTIOUS DISEASES. 
The fundamental principles of the treatment of infectious diseases 
are: 
1. Rest. 
2. Diet. 
3. Fresh air. 
4. Hydrotherapy (the use of water, hot or cold, as baths or for 
sponging). 
5. Drugs. 
Rest.—Should be actual rest, in a comfortable bed, placed in a 
quiet, well-ventilated compartment, and every means exercised to 
relieve the patient from anxiety and concern and to promote sleep. 
Diet.—Should be liquid or semisolid, such as milk, raw or soft- 
boiled eggs, tapioca, cornstarch; chicken, beef, or mutton broths 
seasoned and thickened with rice. Food should not be urged in the 
■early hours or days of a disease against the patient's disinclination 
to take food. However, when the patient has lost his aversion for 
food it should be appreciated, and the appetite catered to as far as 
may be consistently done, keeping in mind the general diet of liquids 
or semisolids, as given above Water, or such drinks as lemonade, 
limeade, orangeade, or carbonated water should be given frequently 
and offered to the patient, not waiting for his request, because fre- 
quently there is a mild delirium, and the patient’s state of mind will 
not cause him to ask for water though he needs it in abundance to 
keep kidneys and skin active. 
Fresh air.—Means of supplying abundant fresh air, preferably 
cold air, should be provided. If praticable all cases of fever should 
be treated in the open air on deck, but if the weather is particularly 
cold the patient should be kept warm, covering the bed clothing with 
a rubber blanket and all tucked well in under the mattress to pre- 
vent the cold air getting under the bed clothing; a hot-water bottle 
placed at the feet gives great comfort in treating the patient in the 
•open. 
Hydrothempy.—The effects of cold water are the same as the 
effects of cold air. Water is a conveyor of heat, and cold stimulates INSTRUCTIONS. 
33 
vital centers reflexly through nerves from the skin. The essentials 
to success in using water as a means of treatment are, the water 
must be cold and friction must be applied, rubbing the skin vigor- 
ously until the patient reacts. Cold baths should never be carried 
to the extent where patient collapses. 
Drugs.—At the beginning of a fever a drug to open the bowels 
freely should be given. Usually castor oil in two-tablespoon doses, 
or Epsom salts, two-tablespoon doses in water, or divided doses of 
calomel, giving one-tenth of a grain every 20 minutes for 10 doses, 
followed in 12 hours by an ounce of Epsom salts. This movement 
of the bowels relieves stagnation and absorption of products of putre- 
faction. Seiler’s solution, 4 tablets dissolved in a pint of water, 
should be used frequently to clean the nose and mouth during fever; 
stimulants when the heart begins to fail; phenacetin or aspirin in 
5-grain doses for the relief of headache and muscular pains. 
Careful nursing is an essential in the treatment of all disease; and 
while it is not to be expected that the nursing available on board 
auxiliary ships will be as efficient as that which may be had from 
persons trained in the art of nursing, much may be done to aid the 
sick if attention is given to providing- for their wants and promot- 
ing their comfort. A sick man should have a man detailed to wait 
on him and watch him. This makes rest possible for the patient. 
Fever patients often get delirious; and if not watched, may injure 
themeslves, jump overboard, etc. 
Keeping the patient’s face, hands, and body clean and the nose 
and mouth clear and moistened (a little glycerine and water, to 
which may be added a small pinch of soda, is useful to wet lips, 
tongue, and inside of cheeks with), reflexly makes him feel fresher 
and better able to combat the germs and toxins of disease. 
INSTRUCTIONS TO BE GIVEN TO THE PERSON DETAILED TO CARE FOR AN 
INFECTIOUS DISEASE. 
1. Wash your hands as soon as possible after touching the patient, 
his clothing, or bedding, also after handling the bedpan, urinal, 
thermometer, etc. 
2. Wash your hands carefully before eating your meals. 
3. Never use cups, plates, spoons, knives, forks, etc., which have 
been used by the patient. Keep your own utensils in a separate place 
so that you will know that you are always using the same articles. 
4. See that your patient does not mix with the other people of 
the ship. 
5. On no account are you yourself allowed to mingle with others 
of the crew, etc. 34 
SPECIAL DISEASES. 
6. Never eat your meals with the patient. 
7. Wear white clothes (because these can be washed and boiled 
more easily). 
CHICKEN POX. 
Incubation period, 10 to 16 days. 
Quarantine period, 18 days. 
Isolation period, until all scabs have fallen off, usually 21 days. 
Symptoms: Rash appears on the first day of the illness and con- 
sists of blisters, which dry and form scabs. The blisters come out 
in crops mostly on the trunk, face, and scalp, and only a few on the 
limbs. There is usually very slight fever, and the patient does not 
feel very ill. The blisters which form on the scalp may be painful 
and prevent sleep. 
Treatment: Put to bed if there is fever, otherwise not necessary. 
Diet, no change unless there is fever, then exclude solids. Give 
water freely. For itching, wash parts gently with a solution of 
sodium bicarbonate, 1 tablespoonful to a pint of water. Keep mouth 
clean with Seiler’s solution. Keep bowels open with salts (Epsom), 
1 tablespoonful in water. 
SCARLET FEVER. 
Incubation period, 1 to 8 days, usually 3 to 5. 
Quarantine period, 10 days. 
Isolation period, until scaling and sore throat disappear; never 
less than six weeks. 
Symptoms: These come on suddenly, the most marked being fever 
and sore throat. 
The rash appears on the second day and consists of bright-red 
papules set very close together, which give the skin its scarlet hue. 
It is seen first on the neck and then spreads to the chest, arms, 
abdomen, and legs. It is usually most marked on the neck, the 
flanks, the buttocks, the bend of the elbows, and on the inner side 
of the thighs and knees, but never appears on the face. It usually 
lasts about five days. 
The throat remains sore for some days, the tonsils are red and 
swollen and often covered with yellow patches. The tongue is at 
first covered with white fur through which the red papillae show, 
giving it the appearance of a strawberry. Later when the fur dis- 
appears the tongue becomes very red. The fever is usually high and 
lasts about a week. It may cause some flushing of the face, which 
must not be mistaken for the rash. 
Desquamation, or peeling of the skin, commences as the rash dis- 
appears, and is first noticed on those parts of the body where the 
rash was most marked. It commences as a small white spot, in the SMALLPOX, 
35 
center of which a hole appears. From this center a circular scale 
separates. This pinhole peeling is characteristic of scarlet fever. 
The scales may be small or may come away in large flakes. The last 
parts to peel are the palms of the hands and the soles of the feet. 
Treatment: The patient should be kept in bed even in the mildest 
cases, on account of possible inflammation of the kidneys, which is 
the most serious complication of this disease. The body should be 
sponged daily during the fever with warm water in a warm room, 
under a blanket, exposing one part of the body after another. 
The diet should be restricted to milk, giving two quarts a day 
during the fever. If milk is not available, gruels made from cereals, 
arrowroot, cornstarch, barley flour, or tapioca may be substituted. 
Feed at two-liour intervals, but do not interrupt sleep at night. 
Water, lemonade, orangeade, limeade, etc., sweetened, should be given 
freely. No meat broths should be given, or solid food. 
Particular care should be given to the nose and mouth, and they 
should be frequently cleansed with salt solution; one teaspoonful of 
common salt dissolved in a pint of tepid water. 
The patient should be under treatment for six or seven weeks, or 
until peeling is completed. 
The case should, of course, come to the attention of a medical officer 
as soon as possible. 
To relieve the pain of the sore throat apply the ice bag or cloths 
wrung out in cold water to the neck and have the patient gargle with 
Seiler’s solution, dissolving four of the tablets in a pint of warm 
w’ater or dissolve a half teaspoonful of soda bicarbonate in a tumbler 
of hot water and use as gargle. When the skin commences to peel, 
the patient- may be rubbed with olive oil or a simple ointment to 
prevent the scales floating about, or a daily hot bath may be given. 
The infection is most potent in the secretions of the nose and throat 
during the first five days of the disease. 
SMALLPOX. 
Incubation period, about 12 days. 
Quarantine period, 14 days. 
Isolation period, until every scab has disappeared—about 10 weeks. 
Symptoms: The beginning is sudden, with a chill, headache, and 
pain in the back. The headache and backache are very severe and 
quite characteristic. The temperature rises rapidly to 103° or 104° 
F., and the patient may be delirious. 
The eruption appears on the third day, on the forehead, scalp, 
forearms, trunk, and legs. At first the eruption consists of papules,, 
which are small and red and feel like shot under the skin. On the 
sixth day the papules become vesicles; on the eighth, pustules; and 36 
SPECIAL DISEASES. 
on the tenth scabs form, which in time fall off, leaving, finally, deep, 
white pitted scars. When the papules appear the temperature falls, 
but rises again when the pustules are forming. The patient’s skin 
has usually a very foul odor. 
There are four varieties of smallpox: 
1. Modified smallpox, where the symptoms are less severe and 
the amount of rash smaller, owing to the patient having been vac- 
cinated. 
2. Discrete smallpox, where the pustules are scattered and do not 
run together. 
3. Confluent smallpox, where the pustules run together and the 
symptoms are very severe. 
4. Malignant smallpox, where, in addition to the ordinary symp- 
toms, hemorrhages occur under the skin, or from the bowels, lungs, 
kidneys, or bladder. This variety is fatal in a day or two. 
Treatment: The body must be sponged over twice daily, or warm 
baths given when the patient is strong enough. The mouth must be 
kept clean and the eyes washed with boric-acid solution. The erup- 
tion is usually covered with some oily dressing, such as vaseline or 
carbolized oil, or with cold-water compresses covered with oiled silk 
or muslin. A mask is made to cover the face and the eyes pro- 
tected from the light. An arrangement to relieve the patient of the 
weight of bedclothes will become necessary. Feeding may become 
difficult, owing to the condition of the mouth. Delirium is common, 
and the patient must be carefully watched. Treat the patient along 
the general lines under that heading. Report the suspected case by 
wireless if possible. 
MEASLES. 
Incubation period, T to 14 days or longer. 
Quarantine period, 16 days. 
Isolation period, 21 days from appearance of the rash. 
Symptoms: The disease commences like a common cold, with 
sneezing, running at the eyes and nose, headache, cough, and slight 
fever. On the fourth day the rash appears on the face, and thence 
spreads downward to the neck, chest, abdomen, and limbs. It con- 
sists of dull, red macules, which run together, forming various pat- 
terns, and lasts about three days. The lining of the mouth and 
throat appears of the same bright red color, dotted by minute white 
spots, which condition is diagnostic of measles. The temperature 
falls at the end of the fifth day and the symptoms disappear, but the 
cough may remain for some time. 
Treatment: On general lines. Guard against chilling, as the com- 
plications, bronchitis and pneumonia, may prove fatal. TYPHOID FEVER. 
37 
■GERMAN MEASLES. 
Incubation period, T to 18 days. 
Quarantine period, 20 days. 
Isolation period, 10 days from the appearance of the rash. 
Symptoms: These are usually very mild, consisting of sore throat, 
headache, very mild fever, lasting only a day or two, and enlarge- 
ment of the glands of the neck. The rash appears on the third or 
fourth day on the face and chest, spreading to the trunk and limbs. 
It consists of red papules larger and duller than in scarlet fever, 
smaller and brighter than in measles, and last about two days. 
Beyond keeping the patient isolated for a few days and avoiding 
a chill, no treatment is usually necessary. 
TYPHUS FEVER. 
Incubation period, 5 to 12 days. 
Quarantine period, 12 days. 
Isolation period, 4 weeks. 
This disease is transmitted from a person infected with the 
disease to the well by the body louse; therefore the presence of lice 
on board a ship is a great menace to the health of the crew; no lice, 
no typhus. 
Symptoms: These come on suddenly with headache, shivering, 
vomiting, and a rapid rise of temperature to 104° or 105° F. 
The rash appears on the fifth day on the trunk and limbs, but not 
on the face. It consists of dull-red mottling of the skin with small 
hemorrhages like fleabites, and has been called the “ mulberry ” 
rash. 
It lasts about two weeks. 
Great prostration is a marked symptom, and delirium is common. 
The fever ends by crisis usually on the thirteenth day. 
Treatment: On general lines. An abundance of fresh air is essen- 
tial. Thoroughly examine the rest of the crew to ascertain the 
presence of lice. If found, immediately burn all clothing infested. 
Hair of the head and body should be shaved, the hair thus collected 
burned immediately. The body should be thoroughly washed, and 
the water thus used immediately thrown overboard. In short, use 
every means to get rid of lice. 
TYPHOID FEVER. 
Incubation period, 1 to 3 weeks. 
Quarantine period is not observed. 
This important disease is now very rare in the naval service be- 
cause of antityphoid inoculation used throughout the Navy. 38 
SPECIAL DISEASES. 
The germ of the disease enters the body through the mouth in 
infected foods or drinks, of which ■ water and milk are the com- 
monest, and, after that, food contaminated by flies, thus showing 
the importance of protecting all foods, both cooked and uncooked, 
from flies. 
Symptoms: These come on very gradually with loss of appetite, 
general indisposition, and headache; there may be also some cough, 
diarrhea, and bleeding from the nose. 
It is a disease in which the fever lasts about four weeks. During 
the first week the temperature gradually rises until the beginning of 
the second week, when it reaches its height, and then continues until 
about the end of the third week, when it gradually begins to fall, 
ending by lysis at the end of the fourth week. 
The rash appears on the seventh day on the abdomen, back, and 
lower part of the chest. It consists of fairly large, raised rose-spots, 
which fade on pressure. They are usually fewT in number and come 
out in crops. Each spot lasts about four days and the rash lasts 
about 14 days. As the fever progresses the patient becomes very 
weak; he loses flesh; his cheeks are slightly flushed; he is drowsy; 
and he is not capable of any exertion. He suffers from thirst; unless 
carefully attended, his lips and teeth become covered with scabs and 
crusts. Delirium is common. 
Treatment along general lines: The patient needs careful nursing 
and should be removed to a hospital at the very first opportunity. 
When the fever is high, sponge baths should be given both night 
and morning, or oftener if necessary. Careful feeding is quite neces- 
sary in the treatment of typhoid fever, and the diet should consist 
principally of milk, although soft-boiled eggs, well-baked potato 
with a little butter and salt, broths and puddings, and a few crackers 
may be added. Food should be given a little at a time and at 
frequent intervals—two or three hours. 
Drugs are of little use. The patient must be carefully watched and 
all his wants given attention. Diarrhea is rather common at first. 
Later on if there is constipation move bowels by enemas, not by 
cathartics. 
MUMPS. 
This is an infectious disease characterized by swelling of one or 
more of the salivary glands, usually the parotid—the one at the side 
of the jaw. 
Incubation, 10 to 22 days. 
Quarantine period, 24 days. 
Isolation period, three weeks, but one week must have elapsed since 
all swelling has subsided. DIPHTHERIA. 
39 
Symptoms: The patient complains of pain and stiffness on moving 
the lower jawT, and there will be swelling of one or more of the sali- 
vary glands. His temperature is raised often to 104° F. The fever 
lasts about a week and the swelling about 10 days. 
Treatment: On general lines. Isolate; keep the bowels well open, 
and for the pain hot-water bags may be used, applied to the swelling. 
Complications: Orchitis, or inflammation of the testicles, is very 
liable to occur at the end of the first week. The temperature rises 
rapidly, and the testicle is found to be painful, tender, and swollen. 
This condition does not usually last more than a week. The testicles 
should be supported by a suspensory bandage or a broad strip of 
adhesive plaster, with gauze or cotton between testicles and support, 
applied across the upper part of the thighs in such a manner that 
the testicles will be thoroughly supported. The ice bag should be 
applied to relieve the pain and the bowels freely opened with Epsom 
salts—two tablespoonfuls dissolved in water. 
DIPHTHERIA. 
This is an infectious disease characterized by the formation of a 
membrane in the throat and on the tonsils and soft palate. It is 
caused by the diphtheria bacillus; all secretions from the nose and 
mouth are infectious. 
Incubation period, 2 to 10 days. Quarantine period, 12 days. 
Isolation period, until seen by medical officer and discharged. 
Symptoms: These come on gradually, with general indisposition, 
sore throat, headache, enlarged glands in neck, and moderate fever. 
There is a creamy-white deposit formed on the tonsils, which spreads 
to the uvula and soft palate. This membrane may form on other 
adjacent parts and block the breathing tubes, in which case there is 
great danger of asphyxia. In addition to the symptoms caused by 
blocking of the air passages by the formation of the membrane, the 
patient suffers greatly from an overwhelming intoxication due to 
the formation of the poison by the diphtheria bacillus located in the 
membrane. 
Treatment: Along general lines until the case can be seen by a 
medical officer. Keep the patient closely isolated and the throat 
clean by frequent gargling with warm Seiler’s solution—four tablets 
dissolved in 1 pint of water, or with the soda bicarbonate solution 
described under scarlet fever. All secretions from the nose and 
mouth are very infectious, and these should be particularly taken 
care of. The attendant may become infected by the patient coughing 
in his face. To prevent this kind of infection, the attendant should 
at once wash his mouth out with Seiler’s solution and bathe his eyes 
with boric-acid solution. 40 
SPECIAL DISEASES. 
INFLUENZA (GRIP). 
This disease is due to a definite germ and is highly contagious. 
Incubation period, 1 to 6 days. 
The onset is fairly sudden with fever and signs of a bad cold, but 
the patient feels much more ill than with ordinary colds, and has 
severe pains in the back, limbs, and head. In some forms the lungs 
are mostly affected and pneumonia or bronchitis may complicate the 
disease. In others the heart may suffer, causing palpitation and 
difficult breathing; while in others, again, diarrhea and vomiting 
may be the chief symptoms. The acute illness lasts about a wTeek, 
but convalescence may be very prolonged and complicated. 
Treatment: On general lines. In the beginning of the disease open 
the bowels well with a dose of castor oil—two tablespoonfuls. After 
this has acted give 10 grains of Dover’s powder at night. If the 
headache and pains in the limbs and back continue and are severe 
give aspirin, 5 grains every three hours. Do not continue this treat- 
ment more than two days, as aspirin depresses the heart. 
MALARIAL FEVER ( CHILLS AND FEVER). 
This is a recurrent fever caused by the malarial parasite which is 
carried by a mosquito, and which enters the body when the insect 
bites. The disease is not infectious except through the bite of a 
mosquito which has bitten fever cases at some time during its life. 
Symptoms: The disease consists in attacks of fever which recur 
at regular intervals. Each attack may be divided into three stages: 
1. The cold stage: The patient shivers and feels cold when his 
temperature is rapidly rising. He goes to bed and covers himself 
with extra blankets. This stage lasts about half an hour. 
2. The hot stage: He begins to feel warm and removes most of the 
bedclothes. The skin feels hot and dry, and he suffers from severe 
headache. The temperature will now be 105° F. or higher. This 
stage lasts three or four hours. 
3. The sweating stage: During this stage the patient perspires 
freely, the headache and flush disappear, and the temperature re- 
turns to normal. This stage lasts about two hours. 
These attacks occur every day, every other day, or every third 
day, according to the form of malarial parasite, and each lasts about 
six hours. There are other types of malaria in which the fever is 
continuous, and somewhat resembles the fever of typhoid. Fre- 
quently this type of malaria can be diagnosed only by the aid of a 
microscope, and therefore requires the attention of a medical officer. 
Treatment: During the attack, treat along general lines. The only 
drug which has any effect is quinine, which can be given by mouth. YELLOW FEVER. 
41 
in capsules of 5 grains every two hours, or as 3-grain tablets, taking 
two, three times a day. 
Prevention: The malarial mosquito bites preferably at dusk or at 
night, therefore when in malarial countries everyone should sleep 
under mosquito nets. A dose of quinine, 5 grains every third day, 
tends to prevent the disease and should be given when in ports where 
malaria is prevalent. 
YELLOW FEVER. 
An important epidemic disease of tlie West Coast of Africa, of 
South America, Central America, and the West Indies. The virus 
is contained in the blood of infected patients only during the first 
three days of the disease, and the disease is transmitted by the bite 
of a mosquito, Stegomyia calopus. As it is important to be able 
to recognize the mosquito, a brief description of it follows: The 
insect is almost black and has white bands on its back resembling a 
lyre or jew’s-harp, and the legs also have white bands. If deprived 
of water, the adult insect only lives about five days. It is essentially 
a house mosquito and rarely travels more than 75 feet from the house 
where it has been feeding, and it is probable that it is brought aboard 
ships in connection with coaling or provisioning rather than blown 
aboard by prevailing winds. 
When a susceptible individual is bitten by an infected mosquito 
there develops, after a period of incubation of from two to five days, 
a rapid rise of fever, with marked congestion of the face and severe 
pains of the back and head. Vomiting first of mucus and bile conies 
on very early. The temperature remains fairly high for three or 
four days, but notwithstanding the high temperature the pulse rate 
becomes less, and by the third or fourth day will have decreased by 
20 to 40 beats from its initial rate. This is a very important symp- 
tom. On the fourth day the temperature falls and the face loses its 
congested appearance, and it is now that the most characteristic fea- 
ture of yellow fever appears—namely, jaundice. Vomiting of mate- 
rial resembling coffee grounds is common. 
Prevention: By screening a patient during the first three days of 
the disease to prevent infection. Any receptacle, tank, double bot- 
tom, or other place where fresh water may be collected should be 
thoroughly screened and frequently inspected in order to prevent the 
breeding of mosquitoes. 
Treatment: During the first three days of the disease no nourish- 
ment whatever should be given. The patient should be allowed an 
abundance of fluid, of which the best is vichy or soda water, un- 
flavored, giving a couple of ounces every 10 minutes, iced or just 
cool, as the patient prefers. If vichy is not available, water, to wdiich 42 
SPECIAL DISEASES. 
has been added a teaspoonful of sodium bicarbonate (baking soda) 
to the quart, is a good substitute. It is of vital importance to put the 
patient to bed and keep him quiet. When vomiting is severe cracked 
ice may be of value. 
A mustard foot bath should be given, the feet and legs of the 
recumbent patient being immersed in a foot tub half full of warm 
water in which a pound of ground mustard has been stirred. Every 
few minutes a quart of very hot water should be added, keeping the 
bath very hot, just short of burning the feet. The blankets are kept 
over the patient and foot tub, so that a vapor bath is also given, 
which produces sweating. This treatment relieves the head and 
backache and can be repeated two or three times in 24 hours. During 
the treatment, to make the patient sweat, apply cold to the head—wer 
cloths, ice bag, etc. After the bath the sweating patient should be 
thoroughly dried. Stimulants every three hours should be given if 
the patient shows signs of collapse. 
DISEASES OF THE STOMACH AND INTESTINES. 
Colic.—This is a term applied to abdominal pain occurring in 
paroxysms of varying degrees of severity. The pain is usually 
located in the region of the navel—that is, in the middle of the belly. 
Colic is often preceded by constipation and accompanied by vomiting. 
The causes are various and the pain often may be a symptom of 
serious trouble. For example, abdominal pain is almost always the 
first and most pronounced symptom of appendicitis, gallstone, stone 
in the kidney, and the well-known cramps of lead poisoning (paint- 
ers’ colic). 
Besides being a symptom of these conditions, colic is most fre- 
quently due to overeating, and when such is the case emptying the 
overloaded stomach generally gives prompt relief. 
The very best treatment which can be used to relieve abdominal 
pain, no matter what may be the cause, is gastric lavage or washing 
out the stomach. This is usually accomplished by means of a soft- 
rubber stomach tube, but as this method requires considerable skill to 
be effective it is not advised except when done by a medical officer 
or a well-trained member of the Hospital Corps. However, the 
stomach may be safely, thoroughly, and effectively washed by the 
following simple means: 
Make the patient drink as rapidly as possible five or six glasses of 
lukewarm water and then cause him to vomit by tickling the back of 
his troat with the finger or a feather. After this has been done the 
patient should be placed in bed and a hot-water bag applied to the 
abdomen, a cloth to be interposed between the bag and skin to protect 
the latter from being burned or blistered. No food or drink should 
be allowed until the colic has subsided, and if it returns the stomach DISEASES OF THE STOMACH AND INTESTINES. 
43 
should again be washed out, following the procedure described above. 
An individual suffering with colic is vastly better off with nothing 
in the stomach, and such a person can easily go without food for five 
or six days, but must have water, which should be given in small 
amounts' after the first 24 hours. If the patient’s bowels have not 
moved during the past 24 hours, an enema (injection into the rec- 
tum), consisting of a pint of warm water and soapsuds, should be 
given, and repeated in half an hour if there has been no result from 
the other. 
A mustard plaster, or cloths wrung out in hot water, may be 
applied to the belly. The patient is apt to be most comfortable 
lying on his side with the knees drawn up. In using hot applications 
the utmost care must be used not to burn the patient. In using 
mustard plasters it is to be remembered that some persons have very 
sensitive skin. Wet the mustard leaf in cold water and lay a piece 
of gauze or layer of a pocket handkerchief between mustard and 
skin; otherwise the application should be very brief, a few moments 
at the most. 
After all pain has subsided the patient may be given liquid or semi- 
solid foods, such as clear soups, custards, milk, milk toast, or soft- 
boiled eggs, and this diet may be cautiously and gradually increased 
to the use of solid foods as the pain and vomiting subside and do 
not return. 
As the patient gradually gets over the acute symptoms and the 
pain, which at first was general, becomes localized, particularly as a 
tender spot in the right side of the abdomen, an ice bag should re- 
place the hot-water bag and the patient be placed in an inclined 
position in bed, the incline being toward the feet. 
It should be particularly noted and remembered that abdominal 
colic is only a symptom, and may indicate some very serious condi- 
tion—appendicitis, for example—which can be relieved only by a 
surgical operation or other means which could only be applied by a 
skilled physician. However, if the treatment as given above is used, 
the unskilled person will be doing as much as any trained physician 
could do until the sufferer can be admitted to a hospital and come 
under the care of a surgeon. Do not give cathartics. 
Diarrhea.—Diarrhea is understood as an abnormal frequency of 
the stools with a change in their character and consistency. Com- 
monly it is an acute condition caused by some inflammation or irri- 
tation of the intestines. It is one of the main symptoms of typhoid 
fever, cholera, and dysentery. 
It is simple diarrhea when it occurs independently of any appre- 
ciable disease. It may be caused by exposure to cold or by eating 
unripe and indigestible vegetables and fruits, or decomposed or im- 44 
SPECIAL DISEASES. 
properly cooked meat, fish, and shellfish. Drinking large quantities 
of cold water when the body is overheated is a frequent cause. 
The symptoms are frequent watery and straining stools accom- 
panied by loss of appetite, nausea, and sometimes vomiting and 
abdominal cramps. 
Treatment: In simple diarrhea first clear the intestines with a 
quick-acting purgative in order to get rid of its irritating contents; 
give castor oil—two tablespoonfuls—or two or three compound 
cathartic pills. After one or two actions of the bowels from the 
cathartic, favorable cases are usually checked; but if not, put the 
patient on a liquid or semi sol id diet, keep him at rest, apply the 
hot-water bag to the abdomen, and give lead and opium pill (or 
Dover’s powder, 5 grains) every four hours for three or four doses. 
While the diarrhea is acute, the less food taken the better. 
Dysentery.—Dysentery, or bloody flux, as it is sometimes called, is 
an inflammation and ulceration of the large bowel caused by an 
infection. 
It occurs in different degrees of severity and may be either acute 
or chronic. Its severest form is met with in tropical countries, where 
it frequently occurs in widespread endemics and may attack a whole 
ship’s company. 
It is caused by specific microorganisms which enter the system with 
contaminated food or drink. 
Symptoms: The disease may begin suddenly or gradually. The 
first stools may be like those of ordinary diarrhea, and after a day 
or two, or maybe a few hours, the stools contain slime and blood. 
Later they may become shreddy and brownish or greenish in color. 
The patient complains of cramps and “ colicky ” pains in the belly, 
with a burning sensation in the rectum, accompanied by a feeling as 
if something must be expelled, and a constant desire to go to stool. 
The number of bowel movements may be from 10 to 50 a day, or 
even 100, depending upon the severity of the case, but the quantity 
expelled with each movement may not exceed a teaspoonful. 
Treatment: The patient should rest in bed, and if possible use the 
bedpan, so as to insure the greatest amount of rest, which is of great- 
est importance. Keep the patient warm, apply hot-water bag or 
cloths wrung out in very hot water to abdomen, and stop all solid 
food. In the tropical form of the disease ipecac, or its active prin- 
ciple emetin, acts as a specific, but it is required that it should be 
administered by skilled hands and is only mentioned here to impress 
the fact that a person suffering from dysentery should come under 
the care of a medical officer as soon as possible. 
In countries where dysentery is prevalent no fruit or uncooked 
vegetables should be allowed, and all foods, both cooked and un- DISEASES OF THE RESPIRATORY SYSTEM. 
45 
cooked, should be protected from flies, which carry the contagion. 
Nothing but distilled or boiled water should be used for drinking 
or cooking purposes. 
DISEASES OF THE RESPIRATORY SYSTEM. 
Tonsillitis {sore throat).—All cases of tonsillitis and sore throat 
should he promptly isolated because of the possibility of their being 
dipththeria, and the consequent probability of an epidemic of that 
disease should such be the case. Sore throat often accompanies a 
bad cold and is common where ventilation is imperfect. Patient 
complains of rawness and difficulty in swallowing and the tonsils 
are swollen and red. There are headaches, general muscular and 
joint pains, and the fever is often high. Small beads of yellow pus 
are seen on the red, swollen tonsils, and in some cases abscesses may 
form. 
If there is a grayish-white tenacious membrane formed in the 
throat, which bleeds readily when touched, the case should be re- 
garded as diphtheria and the individual promptly and completely 
isolated, and a medical officer consulted as soon as possible. 
Treatment: Isolate all cases of sore throat. Rest in bed, open 
bowels freely with castor oil (two tablespoonfuls) or cathartic pills, 
make patient gargle every half hour with Seiler’s solution (made by 
dissolving four of Seiler’s tablets in a pint of warm water) or by 
gargling with one-half teaspoonful soda bicarbonate dissolved in 
tumbler of hot water. Apply ice bag to the neck, or cold cloths if an 
ice bag is not available. Give liquid and soft diet; avoid hot and 
highly seasoned food which will burn and irritate an already in- 
flamed throat. 
As rheumatism of the joints is a frequent sequel of tonsillitis it is 
well to give antirheumatic medication during and for about a week 
after the attack. Sodium salicylate (gr. 10), three times a day after 
food, should be administered, or if this is not available a pinch of 
soda bicarbonate in one-half teacupful of water four times a day. 
Coughs and colds.—When a person' has a cough that lasts more 
than two weeks, even though the symptoms are mild, the case is 
serious enough to require an examination by medical officer, which 
should be done at the first opportunity. A cold often marks the 
beginning of an acute infectious disease, such as measles, scarlet 
fever, etc. 
A case of bronchitis or bad cold usually begins with a cough, 
sometimes starting with an irritation in the throat, which gradually 
travels down into the lungs. The cough is at first usually dry, but 
later there is a free discharge from the nose and the cough becomes 
loose and considerable mucus is raised from the lungs. This sputum 46 
SPECIAL DISEASES. 
may at first be white and later yellowish. With this there will be 
soreness over the upper and front part of the chest, and if the cough 
is violent there will be considerable soreness of the muscles between 
the ribs. 
Treatment: Colds may often be headed off, certainly benefited, if at 
the beginning the patient’s bowels are freely opened with castor oil, 
Epsom salts, or cathartic pills, and after either of these has acted 
he is given a hot bath, put to bed, receives a drink of hot lemonade, 
and is covered with blankets until a good perspiration is induced. 
While in this condition care should be taken not to get the body 
chilled and make the cold worse. Dover’s powder, 10 grains should 
be taken on going to bed. 
Delirium tremens occurs as an incident in the life of persons ad- 
dicted to the excessive use of intoxicating liquors. 
Loss of appetite, sleeplessness, or a marked mental depression are 
the chief symptoms of the first stage of the affliction known among 
drunkards as “ the horrors.” 
As the disease advances the patient talks incoherently, has a wild 
expression, his mind wanders from one thing to another. He answers 
questions in a rambling manner and fancies he is being pursued by 
wild animals, or that he sees rats, snakes, and other animals crawling 
on the walls around his bed. The delirium is always worse at night, 
but the patient requires watching at all times, for he may try to jump 
overboard or commit suicide in some other way. 
Delirium tremens may be confounded with delirium of acute fevers. 
Pneumonia is a frequent complication of delirium tremens and in 
fatal cases may be the direct cause of death. It may, in drunkards, 
follow a fracture or other injury. 
Treatment: The patient requires constant attendance. In all cases 
the symptoms are aggravated by the lack of food, which the patient 
has been either unable or unwilling to take. Careful feeding is of 
the utmost importance. Thick, nourishing soup constitutes the best 
food in this condition and should be given every two hours, and the 
patient encouraged in every way to take food. Until a medical officer 
can assume charge of the case whisky should not be withheld, but 
should be given in gradually diminishing quantities—1 or 2 ounces 
every two hours, especially if the pulse is weak. Give beef extract 
hot. This and the soups are rendered more effective and palatable 
by addition of pepper as seasoning. 
The serious symptoms are largely due to sleeplessness, and if sev- 
eral hours of sound sleep can be produced improvement is almost 
sure to follow. To this end trional in 15-grain doses should be given 
DELIRIUM TREMENS. SUNSTROKE. 
47 
in water every three hours. Sometimes by wrapping the patient 
in a sheet and blankets wrung out in very hot water and at the 
same time applying cold to the head a sedative or quieting effect is 
produced and the patient gets rest even if no sleep. 
SUNSTROKE. 
Sunstroke is an attack of illness caused by exposure to the rays of 
the sun; but the same condition may be produced in hot weather by 
exposure to high temperatures not in the direct rays of the sun, 
particularly if the person is engaged at hard work in close quarters. 
Coal passers and firemen are sometimes affected by the heat of the 
furnace. Men debilitated from or addicted to the excessive use of 
stimulants are more apt to suffer than those of temperate habits. 
Sunstroke occurs in tAvo forms—heat stroke (heat fever), in which 
the temperature of the body is very high, and heat prostration or 
heat exhaustion, in Avhich the surface of the body is cool. The dif- 
ference is A-ery important because of the different treatment required. 
In severe cases of heat stroke the person may be stricken doAvn and 
die in a feA\’ hours. In other cases there may be intense headache, 
dizziness, marked restlessness, nausea and vomiting, and hot, burning 
skin. The clinical thermometer may register 105° F. Pulse is strong 
and may be sIoav or fast and breathing difficult. The patient soon be- 
comes unconscious, and if left untreated the unconsciousness deepens 
and death may folloAV within 24 hours. 
In heat prostration the surface of the body is cool, the pulse Aveak 
and rapid, and the patient feels exhausted. There may be only slight 
nausea and Aomiting, and under treatment the patient may rapidly 
recover; or, on the other hand, there may be complete loss of con- 
sciousness and a rapid and fatal termination from exhaustion. This 
prostration is often accompanied by muscular cramps, particularly in 
persons who have been doing hard work Avhile exposed to high tem- 
peratures. These cramps are extremely painful, and the attacks may 
last from 12 to 24 hours. The muscles may remain sore and the 
patient Aveak and listless for several days after the seizure, although 
the attacks vary from a slight cramp in the abdomen or limbs to 
general cramps in all the muscles. 
Treatment: In heat stroke (heat fever) the temperature of the 
body should be reduced as rapidly as possible. Place the patient 
in a tub of cold Avater, add ice, and rub the body briskly with the 
hands, keep an ice bag to the head, and continue the treatment until 
the temperature is reduced to 100° F., as shoAvn by the thermometer 
inserted in the rectum. 
In heat prostration, Avith cool skin, stimulate the patient and rub 
his body and limbs. Hot rich soup given with the patient at rest 48 
SPECIAL DISEASES. 
in bed has proven very useful in this condition. It is necessary that 
the soup should be hot; and even when there has been vomiting 
administering hot soup has both stimulated the patient and stopped 
the vomiting. This should be repeated as soon as the patient feels 
at all hungry, and in the meantime hot tea should be given. In the 
more severe cases hot food and drink will not suffice, and then the 
patient should be given stimulants (aromatic spirits of ammonia), 
kept warm by blankets and hot-water bags, and a mustard plaster 
placed on the abdomen; and if the cramps are severe the muscles 
should be vigorously rubbed. 
HEADACHE. 
Headache is a symptom of disease of some part of the body. It 
generally accompanies the acute fevers, is associated with constipa- 
tion, disorders of the stomach, liver, kidneys, and genital organs. 
Eye strain is a frequent cause. 
Treatment: Remove the cause if possible. Open the bowels with 
a dose of castor oil or salts, and give 10 grains of aspirin and repeat 
in three hours if necessary. A little hot tea and toast should be 
given with this medicine to prevent nausea. A medical officer should 
be consulted if this does not benefit the patient. 
Stye.—A stye is a pustule which forms on the margin of the eyelid 
around an eyelash. The lid is inflamed, painful, and has the general 
appearance of a small boil. 
Treatment: Pain may be relieved by applying squares of gauze 
wrung out of hot boric-acid solution. When the stye ruptures, keep 
the lid clean with frequent washings with boric-acid solution in order 
to prevent recurrence of more styes. 
Inflammation of the eye.—In all inflammations of the eye ascertain 
at once if the individual has the clap. If he has, the chances are that 
you are dealing with a very severe condition, which should be brought 
to the attention of a medical officer immediately. 
' Simple inflammation of the eye.—This is caused by irritation, sucl 
as exposure to the wind or dust, by foreign bodies in the eye, anc 
frequently by the fumes of turpentine contained in paint used in 
confined places, as when painting double bottoms, etc. 
Symptoms: The eye is bloodshot and watery, the patient complains 
of pain, the sensation of sand in the eye, and heat. A thin watery 
discharge appears, which tends to stick the lids together. 
Treatment: Turn back the upper lid. pull down lower lid. remove 
all’small particles of dust and dirt by gently wiping the lid witl 
cotton loosely wound about a match stem. To turn back the uppei 
DISEASES OF THE EYE. THE ITCH (SCABIES). 
49 
lid lay a match stem lengthwise along the middle of the lid, press 
down gently and at the same time pull up on the lashes, Have the 
patient look in all directions, for by this means* particles of irri- 
tating matter which do not at first appear may be brought to view. 
After having removed all the irritating particles, wash the eye with 
warm solution of boric acid, using a small piece of cotton saturated 
with this solution held very closely to the inner angle of the eye. 
Do not drop solution on the eye. 
Gonorrheal inflanvrrwtion of the eye.—This is usually found in 
patients who have the clap and is caused by the individual rubbing 
or touching his eye after handling the penis and not having washed 
his hands. The inflammation is very rapid and very severe. The 
lids are swollen as are the inner parts of the eye, and thick pus 
soon begins to discharge. 
Treatment: The sound eye should at once be protected by a shield 
consisting of a watch-glass crystal fixed over the eye with adhesive 
plaster. The infected eye should then be washed frequently with 
boric-acid solution, and a little vaseline applied to the edges of the 
lids so they will not stick together and retain the pus. Cold appli- 
cations should then be applied to the infected eye, and this may be 
done by placing small pieces of cloth on a cake of ice and transfer- 
ring them to the eye, making the changes frequently. 
In all cases of inflammation in the eye the patient should be kept 
in a dark place, or the eye protected from the light by a shield. 
Earache is due to so many different causes that a medical officer 
should be consulted as soon as possible. To relieve pain apply liot- 
water bag, move bowels freely with two tablespoonfuls of castor oil, 
and, if pain continues and is very severe, give Dover’s powder (5 
grains) two or three times at intervals of four hours. 
EARACHE. 
TOOTHACHE. 
Usually due to a decayed and hollow tooth. Remove particles of 
food from the cavity and plug with a small piece of cotton saturated 
with oil of cloves, and over this place a small piece of dry cotton so 
as to protect the tongue and mouth from the irritant effect of the oil 
of cloves. Apply the hot-water bag, and if necessary give Dover’s 
powder (5 grains) two or three times at intervals of four hours. 
THE ITCH (SCABIES). 
This is an itching disease (known as the seven-years’ itch, etc.) 
found among people living in uncleanly surroundings and habits. 50 
SPECIAL DISEASES. 
The cause of scabies is the itch mite. It is therefore a contagious 
disease and may be passed from one to the other by close contact. 
The itch mite travels from one patient to another through the 
medium of the clothing, the towels, the bed clothing, personal arti- 
cles, etc. The most common way of passing the disease from one to 
another is in having two or more persons using the same bed and 
same clothing. 
Treatment: The treatment should be carried out in the following 
way until the disease is eradicated: Upon going to bed at night the 
patient takes a hot bath with plenty of soap. The surface of the 
skin is thoroughly scrubbed, particularly in the vicinity of the erup- 
tion. Following this bath an ointment, consisting of sulphur and 
lard, commonly known as the official sulphur ointment, in the pro- 
portions of about 1 teaspoonful of sulphur to one ounce of lard, 
is now rubbed thoroughly into the skin from the collar bone en- 
tirely over the body to the soles of the feet, particularly in the 
vicinity of the eruption between the fingers, between the toes, and 
in the folds. There is no occasion to apply the ointment above the 
collar bone, as the disease seldom attacks that portion of the body. 
The patient should now put on clean night clothing, and the bed 
linen on his bunk should also be changed to clean linen and blankets. 
The next morning the patient takes another soap and water bath and 
puts on fresh, clean underclothing which has not been worn since 
laundered. The next night the patient goes through the same per- 
formance. lie takes a hot bath with soap and water, applies the 
ointment, and wears the same clothing and sleeps in the same bed 
as on the previous night. The next morning he takes another hot 
water and soap bath and puts on either clean clothing or the cloth- 
ing he has worn the day before. This application of hot water and 
soap baths and sulphur ointment is carried out for three or four 
nights, and then freshly laundered clothing is put on, following a 
most thorough soap and water bath. The bed clothing is again 
changed, so that upon retiring at night he sleeps in a fresh bed. 
The patient should continue to take a hot soap and water bath 
daily for several days in order to remove the ointment and sulphur 
from the skin, and also the effects of the disease. After a few days 
have elapsed, if there is no return of the eruption and the itching is 
subsiding, the patient has probably been cured of the condition. 
Should, however, the eruption continue and the itching remain un- 
abated, a second series of treatments as described above should be 
gone through with. Too long an application, however, of these 
treatments is not advisable, as the sulphur tends to cause an irrita- 
tion of the skin which may cover up the scabies. If the skin gets 
very rough and generally red from irritation, limit treatment to 
anointing the body with vaseline or zinc ointment. SPECIAL DISEASES. 
51 
LICE (VERMIN). 
There are three forms of lice, which vary in size and somewhat in 
appearance. 
The condition is contagious, as these parasites can be conveyed 
from one person to another through the medium of comb and brush, 
using the same bed and sleeping clothes, the use of the same outer 
garments, the presence of the vermin within the quarters inhabited 
by all the crew, and in other ways. 
The general appearance of the skin is caused largely by scratch 
marks induced by the parasites. The main symptom is that of 
itching. 
The scalp.—Little lumps are seen along the shafts and at the ends 
of the hairs. These are the nits or eggs of the parasite. The most 
effective way of curing the condition is to shave the scalp closely. 
If this is not practicable, the hair should be cut short. Then tie up 
the head in a towel after rubbing equal parts of vinegar and crude 
petroleum (coal oil) into the scalp and wetting the hair 
therewith. Be sure to caution the patient about the danger of fire 
when the hair is saturated with petroleum. The petroleum should 
remain on for about half an hour. Then scrub the scalp with soap 
and water, and comb with a fine-tooth comb wet with vinegar. 
The genitals.—The louse which lives in the hair around the 
genitals is a small, round parasite commonly known as the crab 
louse. It deposits nits upon the hair, as does the louse of the scalp. 
The entire area, including the inner side of the thighs, should be 
shaved in order to remove all nits. This treatment may be combined 
with the use of mercurial ointment commonly known as “ blue 
butter.” The use of this ointment does little good unless the nits are 
removed. 
The body.—The body louse is the largest of the three varieties. It 
inhabits the clothing of the patient and usually seeks the seams of 
garments. The treatment consists of changing the entire outer and 
under clothing after taking a bath and scrubbing the person thor- 
oughly with a liquid soap. Infected clothing should be boiled or, if 
this is not practicable, immersed in bichloride solution for several 
hours. The patient’s mattress cover and blankets should likewise 
be disinfected. CHAPTER IV. 
HOSPITAL FACILITIES. 
Officers and men of the naval service are entitled to treatment in 
naval hospitals and on naval hospital ships. (R. 1142.) By ar- 
rangements between the Navy and Treasury Departments they will 
also receive treatment in hospitals of the United States Public 
Health Service, and will be allowed treatment in civil hospitals 
when naval and public health hospitals are not accessible. 
Naval hospitals to which patients from the naval service may be 
admitted are located as follows: Portsmouth, N. H.; Chelsea, Mass.; 
Narragansett Bay, R. I. (Newport) ; New York, N. Y. (Brooklyn) ; 
Philadelphia, Pa. (navy yard); Washington, D. C.; Annapolis, 
Md.; Norfolk (Portsmouth, Va.) ; Charleston, S. C.; Parris Island, 
S. C.; Pensacola, Fla.; Key West, Fla.; Great Lakes, 111.; San 
Diego, Calif.; Mare Island, Calif.; Puget Sound, Wash.; Pearl 
Harbor, Hawaii; Canacao, P. I.; Guam; St. Thomas, Virgin Islands. 
Members of the naval service in need of hospital treatment should 
always be transferred to a naval hospital if convenient to the ship. 
If there is no naval hospital convenient transfer should be made to 
a Public Health Service hospital or one of its contract stations. 
The public health officer of the port, if present, should be consulted 
regarding hospital facilities, and admission of the patient should 
be made with his approval and under his directions. A list of the 
Public Health Service hospitals as well as its contract stations will 
be found in the annual circular, Contracts for the Care of Seamen, 
etc., issued by the Public Health Service. The following is an ex- 
tract from the Regulations of the Public Health Service bearing 
on its care and treatment as patients of officers and crews of naval 
vessels: 
Officers and enlisted men of tfie United States Army and Navy may be 
admitted for care and treatment as patients of the service only upon the 
written request of their respective commanding officers. Every such admis- 
sion shall be immediately reported to the Surgeon General by the officer in 
charge of the station, on a daily report (Form 1957) or relief certificate 
(Form 1916), accompanied by a copy of the request upon which such officer 
or man was admitted. They will be furnished treatment at stations of the 
first, second, and third class only. The rate of charge to be made for the 
care and treatment of the said officers and men will be fixed by the depart- 
ment at the beginning of each fiscal year, and will be announced to officers 
52 HOSPITAL FACILITIES. 
53 
iind others in the annual circular entitled “ Contracts for Care of Seamen.” 
Patients of the above-named classes are not subject to the provision requiring 
transportation to marine hospitals. 
United States Public Health Service hospitals to which naval pa- 
tients may be admitted are located as follows: Baltimore, Md.; Bos- 
ton, Mass.; Buffalo, N. Y.; Cape Fear Quarantine Station; Chicago, 
111.; Cleveland, Ohio; Delaware Breakwater, Del.; Detroit, Mich.; 
Evansville, Ind.; Fort Stanton, N. Mex.; Gulfport, Miss.; Key West, 
Fla.; Louisville, Ky.; Memphis, Tenn.; Mobile, Ala.; New Orleans, 
La.; New York, N. Y.; Portland, Me.; Port Townsend, Wash.; St. 
Louis, Mo.; San Francisco, Calif.; Savannah, Ga.; Vineyard Haven, 
Mass. In addition to the foregoing there are a large number of con- 
tract hospitals under the Public Health Service referred to in para- 
graph 3 the location of which may be ascertained from the annual 
circular, Contracts for the Care of Seamen, and which are not 
listed herein because of changes made in the contracts from year to 
year. 
Expenses occurring in connection with the treatment of men as 
patients of the Public Health Service are adjusted by transfer of 
appropriations between the Bureau of Medicine and Surgery and the 
Public Health Service, and no payment by the commanding officer of 
the ship is therefore required. In emergency, and when none of the 
hospitals mentioned above are available, a patient may be transferred 
to a civil hospital ashore as provided for in Navy Regulations. 
(R. 1143, 1187, 1203.) 
Due to tie uncertainty of the movements of vessels of the auxiliary 
service, whenever an officer or man of the service is transferred to a 
hospital for treatment, his personal effects shall be sent with him. 
It is intended and desired that commanding officers of naval ves- 
sels to which no member of the Medical Department of the Navy is 
attached consult freely with medical and dental officers of the Navy, 
whenever opportunity offers, both ashore and afloat, regarding the 
care and treatment of the sick, as well as the general health of the 
crew and the sanitation of the ship. If urgent the medicine box of 
the ship may be replenished from medical stores of a yard, station, 
or ship. The medical and dental officer of a yard or station will be 
found at the dispensary, where, with the approval of the comman- 
dant, assistance and advice in the treatment and care of the sick may 
be received. CHAPTER Y. 
DEATHS. 
The commanding officer shall cause to be entered in the log book 
the name and rank or rating of any person who may die on board, 
with a statement as to the exact time and cause of death. 
When death occurs while the ship is at a port within the con- 
tinental limits of the United States, he shall report the same to the 
Secretary of the Navy by dispatch, giving the full name, rank or 
rating, and service number, date, and cause of death, stating whether 
or not the next of kin has been notified and what disposition has 
been made of the body. In such cases he shall also inform (by dis- 
patch) the nearest relative or legal representative of the deceased 
(unless living outside of the continental limits of the United States) 
and request him to communicate by telegram with the Bureau of 
Medicine and Surgery, Navy Department, Washington, D. C., re- 
garding the desired disposition of the remains. If practicable, the 
body shall be transferred immediately to the nearest naval hospital 
or to the medical department of the nearest navy yard or station for 
embalming, preparation, and retention for such further disposition 
as may be directed by the Bureau of Medicine and Surgdry. Other- 
wise the body shall be placed in the care of a civilian undertaker, to 
be embalmed and retained until directions for disposition are re- 
ceived. 
When death occurs at sea or in a port outside the continental 
limits of the United States he shall not notify the next of kin, but 
shall make report by dispatch to the Secretary of the Navy, giving 
the full name, rank or rating, and service number, date, and cause of 
death, name and address of next of kin, and state whether or not it 
is possible to retain the body for preparation and shipment. If more 
than 24 hours must elapse from time of death until the vessel can 
reach port, burial at sea probably will be necessary. Whenever prac- 
ticable, however, the remains will be retained for embalming and 
awaiting receipt of instructions from the Bureau of Medicine and 
Surgery as to disposition. Burials at sea or in a foreign port shall be 
made only when preservation or retention of the body is impossible, 
which fact will be reported by dispatch as noted above. 
When burial is necessarily made in a foreign country, the health 
regulations as to disinterment shall be ascertained and reported by 
54 55 
DiiAT liS. 
lc ttei- to the Bureau of Medicine and Surgery, together with infor- 
mation as to date, place, and other circumstances of burial. 
Whenever the services of a civilian undertaker are required, ar- 
rangements will be made to limit the expenses to the lowest amount 
consistent with decent preparation and encasement in accordance 
with Navy Regulations, or to meet the requirements of laws govern- 
ing transportation. In such cases, the expenses of preparation and 
encasement will be paid by public bill approved by the command- 
ing officer. When practicable, such bills will be further submitted 
to the Bureau of Medicine and Surgery for approval prior to pay- 
ment. 
Expenses incident to burial are a charge against the appropriation 
u Contingent, Bureau of Medicine and Surgery ”; those incident to 
transportation against “ Bringing home remains of officers, etc., 
Xavy Department.” 
The funeral expenses of an officer who dies and is buried in a 
foreign country are limited by Navy Regulations to an amount not 
in excess of one month’s pay. In the United States the expenses may 
not exceed $150. 
In the case of enlisted men of the Navy and Marine Corps who die 
and are buried elsewhere than within the United States, the amounts 
paid for funeral expenses, including preparation, encasement, and in- 
terment of remains, shall not exceed $50 each, unless due regard for 
decent burial renders greater expense necessary, which fact must be 
certified on all copies of the public bill by the officer ordering the 
payment of the bill. In the United States no specific limit has been 
set, but expenses will be held to actual necessities. 
The remains of naval dead shall be prepared for interment or for 
shipment to their homes under the supervision of an officer wdio shall 
determine by final inspection in each instance that the wmrk of em- 
balming, cleansing, shaving, and dressing have been competently per- 
formed, and that the encasement, clothing, etc., meet all the require- 
ments of the occasion. 
Each body shall be dressed in a clean, presentable, and complete 
(except for cap and shoes) uniform of the proper rank or rating. A 
cap may be placed inside of the casket. When a body is sent to a 
hospital or hospital ship for embalming and further disposition, suit- 
able uniform for burial shall be sent with it. 
Where available clothing belonging to a deceased enlisted man is 
not sufficient in quantity or of proper kind or quality, or is too much 
worn, new clothing (outer and under) shall be obtained as may be 
necessary from the supply department and charged to the appropria- 
tion “ Contingent, Medicine and Surgery.” 
Transportation, when authorized by the Bureau of Medicine and 
Surgery, shall be effected either on two first-class tickets or by 56 
DEATHS. 
express on Government bill of lading. One copy of the bill of lading, 
on which transportation of remains of the dead is elfected, shall be 
securely pasted on top of the shipping casket with a dextrin paste, 
similar to that used by the express company, and then covered with 
shellac or varnish. If Government bills of lading are not available, 
the civilian undertaker should include transportation charges in his 
bill, submitting receipts from the transportation company. Under 
no circumstances should a bhdy be sent “ collect.5' 
The next of kin, family, legal representative of the deceased, or 
the consignee, should the bod}- be sent to other than the preceding, 
shall be informed by telegram of the time of forwarding and of any 
special attending circumstances, such as communicable disease and 
the advisability or inadvisability of opening the casket for the pur- 
pose of viewing the remains. One copy of the bill of lading should 
be promptly forwarded to the consignee under special-delivery stamp 
and accompanied by an explanatory memorandum. 
When relatives of the deceased are present and desire to accom- 
pany the remains to destination, transportation may be effected on 
two first-class tickets (Government transportation request) and one 
delivered to the relative to cover his transportation. Pullman or 
sleeping-car accommodations for such escort will not be furnished. 
When an officer or enlisted man of the Navy or Marine Corps dies 
where the services of a medical officer of the Navy were not available, 
a report of the death shall be requested from the physician who at- 
tended such person. This report shall be forwarded to the Bureau 
of Medicine and Surgery and, upon its receipt, a report of death 
(Form N) will be prepared and signed by the Surgeon General of 
the Navy. 
The commanding officer shall, upon the death of any person on 
board the ship under his command, cause all of the effects of the de- 
ceased to be collected and inventoried. If the deceased was an officer, 
this shall be done by two officers of the ship; if a member of the 
crew or other person, by the officer of his division or one detailed for 
the purpose. The inventories shall be made out in duplicate, duly 
attested and signed by the officers making them. Upon the comple- 
tion of the inventory the effects, if not of a perishable nature, shall 
be put up in packages of convenient size and sealed with the seal of 
the ship. The commanding officer shall retain one copy of the in- 
ventory himself, and shall deliver the other to the supply officer, 
who shall also take charge of the effects for safekeeping. 
If any of the effects of a deceased person are perishable and de- 
teriorating they shall be immediately sold at auction, the proceeds 
of which shall be disposed of in the same manner as other money 
found in his effects. DEATHS. 
57 
All moneys, articles of value, papers, keepsakes, and other similar 
effects shall be forwarded to the legal representative or, in default 
of such, the heirs at law of the deceased. Should it be impossible to 
ascertain the existence of the legal representative or of heirs at law, 
the moneys and articles mentioned and other similar effects shall be 
sent to the Chief of the Bureau of Navigation or to the Major Gen- 
eral Commandant of the Marine Corps, as the case may be, for safe- 
keeping. Should the above-described property be unclaimed for a 
period of two years after the death of the owner thereof, all articles 
and effects so deposited shall be sold at auction to the highest bidder, 
and the proceeds of such sale, together with the moneys above men- 
tioned, shall be deposited in the Treasury to the credit of the Navy 
pension fund. 
If at any time during the two years such above-described property 
is in the custody of naval authorities the executor or legal representa- 
tive of the deceased person shall apply for his effects, all shall be 
delivered to him. 
The commanding officer shall exercise his discretion in causing the 
effects of deceased enlisted men to be sold at auction at the mast, or 
retaining them for transmission to the heirs, relatives, or friends. 
In exercising this discreton he shall be governed by the wishes of the 
heirs, relatives, or friends, if possible to learn them before closing 
the accounts of the deceased. 
He shall cause the accounts of all deceased persons to be closed 
as soon as possible and forwarded to the Military Division, General 
Accounting Office, Washington, D. C., together with the will, if any 
can be found. These accounts must be examined and approved by 
the commanding officer. 
Immediately upon official notification of the death, from wounds 
or disease not the result of his own misconduct, of any officer or en- 
listed man on the active list of the Navy and Marine Corps, the 
Paymaster General of the Navy shall cause to be paid to the widow, 
and, if no widow, to the children, and if there be no children to 
any other dependent relative of such officer or enlisted man previ- 
ously designated by him, an amount equal to six months’ pay at the 
rate received by such officer or enlisted man at the date of his death. CHAPTER VI. 
QUARANTINE AND DISINFECTION. 
QUARANTINE. 
The term “ quarantine ” lias its origin from the Italian “ quar- 
anta,” meaning 40, this figure representing the number of days for 
■which vessels, beginning early in the fifteenth century, were held 
under observation on account of the frequent invasions of plague. 
The term now means any limitation placed upon the freedom or 
movement of persons or animals with the object of preventing or 
controlling the spread of communicable disease. The expression 
“quarantine methods” is often used to cover all restrictive measures 
instituted by health officials for the purpose of limiting the spread 
of disease on land as well as at sea. We have community* quarantine 
when one city or town imposes restrictions upon travelers from 
some other place in the same country, and border quarantine when 
the aim is to prevent the introduction of disease over land br across 
a river from a foreign country. Interstate quarantine is enforced 
by the Federal Government through the agency of the United States 
Public Health Service, and consists of routine and special activities 
planned tq limit the spread of disease incident to interstate travel 
and traffic. 
Maritime quarantine includes all measures undertaken by the 
Government to prevent the introduction of disease through sea- 
ports. 
The first quarantine station established—that at Venice in 1403, 
on a small island adjoining the city—differed in its basic idea from 
those stations now protecting the ports of New York, Hamburg, or 
London, in the blind application of the theory of isolation, as com- 
pared with the scientific and accurate periods of detention now in 
use to prevent the ingress of certain threatened diseases. From the 
earliest days until the determination of the exact modes of trans- 
mission and periods of incubation of the quarantinable diseases, quar- 
antine consisted in more or less rigorous periods of detention, even 
up to 100 days, with the expectation that in this time the disease, if 
present, would “ wear itself out,” or that the “ effluvium ” would be 
removed by the influence of sun, rain, frosts, or snows. This 
haphazard quarantine was extremely expensive, proceeding at times 
even to burning the entire ship and cargo. 
58 QUARANTINE. 
59 
Modern methods of quarantine both on land and sea are based, 
as stated above, upon known modes.of transmission and periods of 
incubation of certain diseases which are classed as quarantinable. 
The studies of the last 30 years have established that many diseases, 
including all of those known as quarantinable, are due to certain 
microorganisms with definite habits of life and capable of growth 
and multiplication. These so-called pathogenic organisms may be 
carried from individual to individual by direct contact with a per- 
son sick of the disease or by a carrier, a “ carrier ” being a person 
who harbors a pathogenic organism without showing evidence of the 
disease; they also may exist a relatively short time in or on other 
than living material as in water, milk, or other food, or they may be 
transmitted from one human being to another by an intermediary 
living agent or “ vector,” as the body louse in typhus, the mosquito 
in yellow fever, and the flea in transmitting plague to the human 
being from an infected rat. 
After the germs have invaded or attacked a healthy individual 
they either die or survive. If the latter, a certain number of days 
must elapse before they have multiplied to sufficient numbers to 
produce symptoms of disease. This interval of time is known as the 
period of incubation. This period of incubation varies in length for 
the different diseases, as well as for the same disease within certain 
well-defined limits. The period of detention or observation in quar- 
antine is based upon the maximum number of days within which 
experience has shown the suspected disease will manifest itself if 
present. 
The absence of sickness in the personnel of a vessel does not 
necessarily mean an absence of infection aboard the vessel. This 
on be readily understood when it is remembered that a healthy 
person may carry or harbor the germs of a disease in his body, as, 
for instance, a cholera carrier, or that the intermediary host may be 
present without actually coming in contact with the crew, as, for 
instance, plague-infected rats in cargo under battened hatches. In 
either event possible contact with an individual on ship or ashore 
might mean the beginning of an epidemic. It is therefore clear why 
a vessel may be detained in quarantine, even though there be no 
sickness among crew or passengers. 
The United States Government has declared the following diseases 
to be quarantinable and subject to quarantine under the provisions 
of the United States quarantine laws and regulations of the Treas- 
ury Department, enforced by the United States Public Health 
Service: Asiatic cholera, yellow fever, plague, anthrax, smallpox, 
typhus fever, leprosy. 60 
QUARANTINE AND DISINFECTION. 
Inspection is required of— 
(a) All vessels from ports at which cholera, yellow fever, or plague 
in men or rodents prevail, or at which smallpox or typhus fever 
prevails in epidemic form, and at which a medical officer is detailed. 
(b) All vessels carrying steerage passengers; but need only include 
the inspection of such passengers and their living apartments if sail- 
ing from a healthful port. 
Inspection of the vessel is such an examination of the vessel, cargo, 
passengers, crew, personal effects of same, including examination of 
manifests and other papers, food and water supply, the ascertain- 
ment of its relations with the shore, the manner of loading, and 
possibilities of invasion by rats and insects as will enable the inspect- 
ing officer to determine if these regulations have been complied with. 
When an inspection is required, it should be made by daylight, as 
late as practicable before sailing. The vessel should be inspected 
before the passengers go aboard, the passengers just before embark- 
ation, and the crew on deck, and no communication should be had 
with the vessel after such inspection except by permission of the 
officer issxiing the bill of health. 
Vessels, prior to stowing cargo or receiving passengers, should be 
mechanically clean in all parts, especially in the hold, forecastle, 
and steerage, and loose dunnage in unladened compartment shall be 
so arranged as to prevent harborage of rodents. 
Any portions of the vessel liable to have been infected by any 
communicable disease should be disinfected before the issuance of 
the bill of health. 
The air space, ventilation, food and water supply, hospital ac- 
commodations, and all other matters mentioned therein promotive 
of the health and comfort of the passengers must be in accordance 
with the provisions of the act of Congress approved August 2, 1882, 
entitled “An act to regulate the carriage of passengers by sea.'’ 
Bedding, upholstered furniture, soiled wearing apparel, personal 
effects, and secondhand articles of a similar nature coming from a 
district known to be infected with smallpox or as to the origin of 
which no positive evidence can be obtained, and which the consular 
or medical officer has reason to believe is infected, should be disin- 
fected prior to shipment. Articles similar to the above mentioned, 
if from a district infected by plague or typhus, should be inspected, 
and, if necessary, treated to destroy vermin. 
Articles from an uninfected district shipped through an infected 
port may be accepted without restriction if not exposed to infection 
in transit. 
Nothing in these regulations shall be construed to modify or nul- 
lify in any way existing restrictions promulgated by the Secretary GENERAL REQUIREMENTS AT SEA. 
61 
of the Treasury at the instance of the Secretary of Agriculture for 
the prevention of the introduction of diseases of animals. 
Any article shipped from or through an infected port or place 
which the consul or medical officer has reason to believe infected, 
should be disinfected. 
Any article presumably infected which can not be disinfected 
should not be shipped. 
Passengers, for the purpose of these regulations, are divided into 
two classes, cabin and steerage. 
So far as possible passengers should avoid embarking at a port 
where quarantinable disease prevails, and communication between 
the vessel and the shore should be reduced to a minimum. In such 
a port the personnel of the vessel should remain on board during 
tlieir stay. 
No person suffering from a quarantinable disease, or scarlet fever, 
measles, diphtheria, poliomyelitis (infantile paralysis), influenza, 
chicken pox, or cerebrospinal meningitis should be allowed to ship. 
Passengers and crews, merchandise, and baggage, prior to ship- 
ment at a noninfected port but coming from an infected locality 
should be subject to the same restrictions as are imposed at an in- 
fected port. 
GENERAL REQUIREMENTS AT SEA. 
The master of a vessel should observe the following measures on 
board his vessel: 
(a) The water-closets, forecastle, bilges, and similar portions of 
the vessel liable to harbor infection should be frequently cleansed 
and disinfected. 
(b) Free ventilation and rigorous cleanliness should be main- 
tained in all portions of the ship during the voyage and measures 
taken to destroy rats, mice, fleas, flies, mosquitoes, and all vermin. 
(c) A patient sick of a communicable disease should be isolated 
and one member of the crew detailed for his care and comfort, who, 
if practicable, should be immune to the disease. 
(d) Communication between the patient or his nurse and other 
persons on board should be reduced to a minimum. 
(e) Used clothing, body linen, and bedding of the patient and 
nurse should be immersed at once in boiling water or in a disinfect- 
ing solution. 
(/) The compartment from which the patient was removed should 
be disinfected and thoroughly cleansed. Articles liable to convey 
infection should remain in the compartments during the disinfection, 
when gaseous disinfection is used. 62 
QUARANTINE AND DISINFECTION. 
(g) Any person suffering from malaria or yellow fever should be 
kept under mosquito bars and the apartment in which he is confined 
closely screened with mosquito netting. All mosquitoes on board 
should be destroyed by fumigation. Mosquito larvae (wigglers or 
wiggle tails) should be destroyed in water barrels, casks, and other 
collections of water about the vessel by the use of petroleum (kero- 
sene) ; where this is not practicable, the receptacle should be covered 
by mosquito netting to prevent the exit of mosquitoes from such 
breeding places. 
(h) In the case of bubonic plague, special measures must be 
taken to destroy rats, mice, fleas, and other vermin on board, and in 
case of pneumonic plague, the patient should be isolated, the body 
discharges disinfected, especially sputum, and the attendant should 
wear a mask. 
(i) In the case of typhus, special measures should be taken to 
destroy vermin. 
(j) In the case of cholera, typhoid fever, or dysentery, the drink- 
ing water should be boiled and the food thoroughly cooked. The dis- 
charges from the patient should be immediately disinfected and 
thrown overboard. 
An inspection of the vessel, including the steerage, should be made 
by the ship’s physician once each day. 
Should cholera, yellow fever, smallpox, typhus fever, plague, or 
any other communicable disease appear on board a ship while at sea, 
those who show symptoms of these diseases should be immediately 
isolated in a proper place; the ship’s physician should then imme- 
diately notify the captain, who should note same in his log, and all 
of the effects liable to convey infection which have been exposed to 
infection should be destroyed or disinfected. In the case of small- 
pox, the entire personnel should be vaccinated. 
The hospital should be cleansed as soon as it becomes vacant. 
The dead, except those dead of yellow fever, should be enveloped 
in a sheet saturated with one of the strong disinfecting solutions, 
without previous washing of the body, and at once buried at sea or 
placed in a coffin hermetically sealed. 
A complete clinical record shall be kept by the ship’s surgeon of 
all cases of sickness on board and the record delivered to the quar- 
antine officer at the port of arrival. 
The following disinfecting solutions are recommended for use 
at sea: 
Formula for Strong Disinfecting Solutions. 
Bichloride of Mercury (1: 500). 
Parts. 
Bichloride of mercury 1 
Sea water 500 
Mix. INSPECTION. 
63 
Carbolic Acid (5 Per Cent). 
car none acici (& Per Cent). Partg 
Alcohol 50 
Carbolic acid, pure 50 
Mix. 
Then add fresh water 900 
Formulae for Weak Solutions. 
Bichloride of Mercury (1:1,000.) 
Bichloride of mercury 1 
Sea water 1, 000 
Carbolic Acid (2| Per Cent). 
Carbolic acid, pure 25 
Fresh water . 1, 000 
Formalin (5 Per Cent). 
Formalin (or formal) 50 
Water 950 
It is suggested that a vessel should carry for every 100 passengers: 
Bichloride of mercury, 5 pounds; carbolic acid, 10 pounds; alcohol, 
10 pounds; formalin, 10 pounds; 100 pounds of sulphur and 12 
Dutch ovens, about 12 inches diameter, and an adequate supply of 
fresh vaccine virus. 
INSPECTION. 
Every vessel subject to quarantine inspection, entering a port of 
the United States, its possessions or dependencies, shall be con- 
sidered in quarantine until given free pratique. Such vessel shall 
fly a yellow flag at the foremast head and shall observe all the other 
requirements of vessels actually quarantined. 
Vessels arriving at ports of the United States under the following 
conditions shall be inspected by a quarantine officer prior to entry: 
(a) Vessels from a foreign port shall be inspected only at first 
port of call in the United States, except vessels from ports sus- 
pected of yellow fever arriving during the active quarantine season 
at southern, via northern, ports. 
(b) Any vessel with sickness on board. 
(c) Vessels from domestic ports where cholera, plague, or yellow 
fever prevails, or where smallpox or typhus fever prevails in epi- 
demic form. 
The inspection of vessels required by these regulations shall be 
made between sunrise and sunset, except in case of vessels in distress. 
Exception may also be made in the case of vessels carrying perish- 
able cargoes, and regular line vessels under regulations approved by 
the Secretary of the Treasury. 
In making the inspection of a vessel the bill of health and clinical 
record of all cases treated during the voyage, crew and passengers* 64 
QUARANTINE AND DISINFECTION. 
lists and manifests, and, when necessary, the ship’s log shall be 
examined. The crew and passengers shall be mustered and examined 
and compared with the lists and manifests and any discrepancies 
investigated. The clinical thermometer should be used in the 
examination /of the personnel of vessels under suspicion. When a 
freight manifest shows that articles requiring disinfection under 
these regulations are carried by the vessel, a certificate of disinfec- 
tion, signed by a United States consul or a medical officer of the 
United States, shall be exhibited and compared with same. If no 
certificate of disinfection is produced the collector of customs at 
the port of entry shall be notified of same by the quarantine officer. 
The collector of customs shall then hold such consignment in a 
designated place, separate from other freight, pending the arrival 
of the certificate of disinfection; and in the event of its nonarrival 
the articles shall be disinfected as hereinbefore prescribed, or shall 
be returned by the common carrier conveying same. 
Medical officers of the United States duly clothed with authority 
to act as quarantine officers at any port or place within the United 
States, when performing the said duties, are hereby authorized to 
take declarations and administer oaths in matters pertaining to the 
administration of the quarantine laws and regulations of the United 
States. (Act of Mar. 2, 1901, sec. 12.) 
No person, except the quarantine officer, his employees, or pilots, 
shall be permitted to board any vessel subject to quarantine inspec- 
tion until after the vessel has been inspected by the quarantine 
officer and granted pratique, and all such persons so boarding such 
vessel shall, in the discretion of the quarantine officer, be subject 
to the same restrictions as the personel of the vessel, or otherwise 
action may be taken as provided for in section 10, act of March 
2, 1901, provided, however, that the United States customs officials 
may be permitted to board a vessel that has been inspected and held 
in quarantine for detention or treatment, they being subject to the 
same restrictions as the personnel of the vessel. 
When a vessel arriving at quarantine has on board any of the 
communicable but nonquarantinable diseases the quarantine officer 
shall promptly inform the local health authorities of the existence of 
such disease aboard and shall make every effort to furnish such 
notification in ample time, if possible, to permit of the case being 
seen by the local authorities before discharged from the vessel. 
QUARANTINE DETENTION. 
Vessels arriving under the following conditions shall be placed 
in detention: 
(a) With quarantinable disease on board or having had such dis- 
ease on board during the voyage. 65 
SPECIAL REGULATIONS. 
(b) Any vessel which the quarantine officer considers infected with 
quarantinable disease. 
(c) A vessel arriving at a port south of the southern boundary 
of Virginia in the season of active quarantine, April 1 to November 
1, from a port infected or suspected of infection with yellow fever. 
(d) Vessels arriving at ports north of this line and south of the 
southern boundary of Maryland between May 15 and October 1. if 
from a port infected or suspected of infection witlj yellow fever. 
(e) In the case of vessels arriving at a northern port without 
sickness on board from ports where yellow fever prevails the per- 
sonnel shall be detailed under observation at quarantine to complete 
six days from the port of departure. 
(/) Towboats and other vessels having had communication with 
vessels subjected to quarantine shall themselves be quarantined if 
they have been exposed to infection. 
The duration of detention of vessels or personnel herein contem- 
plated will depend upon the quarantinable disease involved and will 
hereinafter be specifically provided for. 
SPECIAL REGULATIONS RELATING TO NAVAL VESSELS. 
Vessels of the United States Navy entering ports of the United 
States, its possessions or dependencies, are exempt from inspection 
if there be a medical officer aboard, provided such vessel has not 
sailed from a foreign port known to be or suspected of being infected 
with typhus, cholera, yellow fever, plague, or smallpox. 
Vessels of the United States Navy are subject to quarantine inspec- 
tion upon arrival at ports of the United States, its possessions or 
dependencies, when from a foreign port known or suspected to be 
infected with yellow fever, bubonic plague, typhus, cholera, and 
such subsequent detention for disinfection as may be required by 
reason of disease aboard or exposure to such disease in foreign ports. 
The certificate of the medical officer of the United States Navy 
as to the sanitary history of the vessel and its personnel may be 
accepted for naval vessels by the quarantine officer boarding the 
vessel in lieu of actual inspection. 
Vessels of the United States Navy having entered the harbors of 
infected ports but having held no communication which is liable to 
convey infection may be exempted from the disinfection and deten- 
tion imposed on merchant vessels from such ports. 
Vessels of the United States Navy not carrying a medical officer 
shall, upon arrival at ports of the United States from foreign ports, 
be subject to the same provisions of these regulations as apply to 
merchant vessels. 
No vessel from a foreign port is permitted to enter any port of 
the United States until pratique has been granted by a United States 66 
QUARANTINE AND DISINFECTION. 
quarantine official. Until pratique has been granted the vessel is in 
quarantine and can hold no unauthorized communication with the 
shore. A merchant vessel can not enter at the customhouse without 
presenting the certificate of pratique which shows that the vessel has 
been released from quarantine. 
Masters of vessels clearing from or leaving any foreign port or 
any port in the possessions or other dependencies of the United 
States for a port in the United States or its possessions or other 
dependencies must obtain a bill of health, in duplicate, signed by 
the proper officer or officers of the United States as provided for by 
law. 
By act of Congress certain vessels are exempt from this require- 
ment. Vessels so exempt are those plying between Canadian ports 
on the St. Croix River, the St. Lawrence River, the Niagara River, 
the Detroit River, the St. Clair River, and the St. Marys River, and 
adjacent ports of the United States on the same waters; also vessels 
plying between Canadian ports on the following-named lakes, viz, 
Ontario, Erie, St. Clair, Huron, Superior, Rainy Lake, Lake of the 
Woods, Lake Champlain, and ports of the United States; also ves- 
sels plying between ports in British Columbia and ports on the 
Pacific coast of the United States as far south as (inclusive) San 
Francisco; also vessels plying between Canadian ports on the Atlan- 
tic coast and ports of the United States on the Atlantic coast as far 
south (inclusive) as Boston; also vessels plying between Mexican 
ports on the Rio Grande River and ports of the United States on the 
same river. Vessels sailing originally from other foreign ports and 
merely calling at Canadian ports en route to the United States are 
not exempt from the provisions of section 2 of the act approved 
February 15, 1893. During the prevalence of any of the quarantin- 
able diseases at the foreign port of departure, vessels above referred 
to are required to obtain from the consular officer of the United 
States, or from the medical officer of the United States, when such 
officer has been detailed by the President, a bill of health, in dupli- 
cate, in the form prescribed by the Secretary of the Treasury. 
Naval vessels clearing from one United States port for another 
United States port do not ordinarily procure a bill of health for 
presentation at the port of arrival. Local or State authority at the 
port of arrival may, however, require the exhibition of a bill of 
health under special circumstances, such as when some epidemic dis- 
ease exists at the port of departure, and under such circumstances 
it is advisable to procure a bill of health. 
A naval vessel from a United States port to a port in the Canal 
Zone or the possessions or other dependencies of the United States 
BILLS OF HEALTH. BILLS OF HEALTH. 
67 
should secure a bill of health from the customhouse or the port au- 
thorities. 
Jurisdiction in matters of sanitation and quarantine in the waters 
of Colon and Panama is exercised by the United States authorities 
of the Canal Zone. In all ports in the Canal Zone original bills of 
health in duplicate are required to be obtained by masters of vessels 
clearing from any foreign port or any port in the possessions or 
other dependencies of the United States. (Executive Order No. 1761 
of April 15, 1913.) 
Naval vessels entering ports of the Dominican Republic will be 
required to have bills of health in order to pass quarantine exami- 
nation at their original ports of entry in that country and otherwise 
comply with the existing quarantine lawTs and regulations. 
Naval vessels sailing from a United States port to a foreign port 
should always procure a bill of health from the proper authorities 
and have it viseed by the consular or other representative of the 
country or countries of ports of call, if such ports can be determined 
upon prior to sailing. It is sometimes advisable to secure bills of 
health for several ports to which the vessel might go, when definite 
information of the exact destination is not procurable. A naval ves- 
sel sailing from a foreign port to another foreign port should like- 
wise procure and have viseed a bill of health. 
When preparing to leave a port in the United States the necessary 
bill of health may be obtained at the customhouse. In case the 
office of the United States Public Health Service is not in the same 
building the necessary directions can be obtained at the customhouse. 
The person applying for the bill of health should take with him 
bills of health from the last port of departure and be prepared to 
furnish all data required for filling in the form indicated below. 
If epidemic or communicable diseases are present in the port at 
the time of making the request, the consul of the nationality of the 
next port of call should be visited for his vise. 
In foreign ports request for a bill of health should be made at the 
office of the captain of the port (Bureau de Capitaine de Port, 
Uffizio dell Capitano dell Porto, Capitania del Puerto). 
A United States consular bill of health should also be obtained at 
a port where the issue of such is customary, or a bill of health issued 
by the United States public health officer, if one is stationed there. 
Vessels clearing from a foreign port or from any port in the pos- 
sessions or other dependencies of the United States for any port in 
the United States, its possessions, or other dependencies, and enter- 
ing or calling at intermediate ports, must procure at all such ports a 
bill of health in duplicate signed by the proper officer or officers of 
the United States. 68 
QU ARAN TINE AND DISINFECTION. 
Bills of health for naval vessels or indorsements by consular offi- 
cers are usually extended gratis. Any expense involved in procur- 
ing bills of health or in quarantine is a charge against appropriations 
not under the Bureau of Medicine and Surgery. Quarantine ex- 
penses (bills of health and pratique) are a charge against “ Pay, 
miscellaneous.” 
Bills of health for naval vessels in the fleet may be procured for 
the fleet as a whole by the fleet surgeon, if no diversion of individual 
ships is contemplated. Bills of health for individual ships should 
always be procured, however, in the absence of orders to the con- 
trary, in view of the fact that a ship may at any time be detached 
from the fleet and ordered to operate singly. 
On entering port, in addition to the bill of health, the medical 
officer of the ship shall be prepared to furnish the quarantine officer, 
if required, Avith a statement relative to health conditions prevailing 
on board ship. Certain diseases of a communicable or infectious 
character, not included among quarantinable diseases under the 
quarantine laAvs and regulations of the Treasury Department, such 
as the exanthemata, diphtheria, cerebrospinal meningitis, etc., will 
ordinarily be viewed by local or State authorities as constituting 
quarantinable diseases and their presence on board should be con- 
sidered as rendering the A7essel subject to local quarantine restric- 
tions. All such diseases should be fully reported to the inspecting 
health officer. 
The folloAving form is prescribed for the United States bill of 
health: 
Form 1937. 
United States of America. 
BILL OF HEALTH. 
I (the person authorized to issue the hill at 
the port of ), do hereby state that the vessel hereinafter 
named clears (or leaves) from the port of 1 under the fol- 
lowing circumstances: 
Name of vessel . 
Nationality 
Master 
Tonnage, net 
Name of medical officer — 
Number of officers 
Of crew, including petty officers 
Officers’ families 
Passengers destined for the United States 
First cabin 
Second cabin ' 
Steerage 
Ports visited within preceding four months GENERAL REQUIREMENTS. 
69 
Location of vessel while in port: 
Wharf 
Open bay 
Distance from shore 1 1 
If any passenger or member of crew disembarked on account of sickness, 
state disease 1 
Time vessel was in port 
Character of communication with shore 
Sanitary condition of vessel 
Sanitary measures, if any, adopted while in port 
Sanitary condition of port and vicinity 
Prevailing diseases at port and vicinity 
Number of cases and deaths from the following-named diseases during the 
past two weeks ending 
Diseases. 
Number 
of cases. 
Number 
of deaths.1 
Remarks. 
(Any condition affecting the 
public health existing in the 
port of departure or vicinity 
to be here stated.) 
Yellow fever 
Asiatic cholera 
Cholera nostras or cholerine 
Smallpox 
Tvphus fever 
Plague 
Leprosy 
1 When there are no cases or deaths, entry to that effect must he made. 
Date of last ease (within preceding year) : 
Cholera 
Yellow fever 
Human plague 
Typhus 
Rodent plague 
I certify that the vessel has complied with the Quarantine Rules and Regu- 
lations made under the act of February 15, 1893, and that the vessel leaves 
this port bound for , United States of America, 
via 
Given under my hand and seal this day of , 
19__. 
(Signature of consular officer.) n 
[seal.] 
Countersigned by— — 
Medical Officer, United States Public Health Service. 
GENERAL REQUIREMENTS OF THE UNITED STATES PUBLIC HEALTH SERVICE 
AT FOREIGN AND INSULAR PORTS. 
The officer issuing the bill of health to vessels leaving foreign ports 
and ports in the possessions or other dependencies of the United 
States for ports in the United States or its possessions or other 70 
QUARANTINE AND DISINFECTION. 
dependencies shall satisfy himself, by inspection if necessary, that 
the conditions certified to therein are true. He is authorized, in 
accordance with law, to withhold the bill of health until he is satis- 
fied that the vessel, the passengers, the crew, and the cargo have 
complied with all the quarantine laws and regulations of the United 
States. 
SPECIAL QUARANTINE MEASURES. 
CHOLERA. 
This disease is caused by the cholera vibrio when introduced into 
the gastrointestinal tract. Food or water indirectly contaminated is 
the chief means by which the disease is conveyed, but on board ship 
direct contact or the immediate pollution of alimentary substances 
by “ carriers ” or acute cases are to be considered the more common 
means by which the cholera infection is transmitted. The possibility 
of water ballast being infected or constituting a probable source of 
spreading the disease is so remote as to be negligible, and the same 
applies in a general way to cargo and ship supplies. Accurate knowl- 
edge that none of the personnel is harboring cholera organisms in his 
gastrointestinal tract is the most important feature in the treatment 
of cholera-infected vessels. 
In cholera the control of the human host and the safe disposal of 
the excreta therefrom, the destruction of contaminated food or water, 
or their sterilization—cooking, boiling, etc.—are the essential features 
in preventive measures. Fumigation or place disinfection is not 
called for in cholera preventive measures. Where a case of cholera 
has resulted in soiling the bedding, as an added precaution such 
effects should be sterilized and the floors and walls of the compart- 
ment washed down with bichloride solution. The cholera vibrio has 
practically no resistance to drying, however, and under natural con- 
ditions it is improbable that soiled linen or an infected place will 
result in the spread of the disease. While bathing and personal 
cleanliness is to be encouraged at the quarantine station, it is not to 
be assumed that disinfection of wearing apparel and personal effects 
of the contacts or the disinfection of the body has any material 
effect in preventing the spread of the infection. The control of the 
personnel and the assured safe disposal of body discharges and pro- 
tection of food and water supply are the important features to be 
observed in the prevention of cholera. 
SPECIAL MEASURES AGAINST CHOLERA AT FOREIGN AND INSULAR PORTS. 
At ports where cholera prevails special care should be taken to 
prevent the water and the food supply from being infected. The 
drinking water, unless of known purity, should be boiled and the SPECIAL QUARANTINE MEASURES. 
71 
food thoroughly cooked and protected against contamination by 
flies, etc. 
The latrines of vessels must be so arranged that they, including 
their discharge pipes, can be made and kept mechanically clean. 
Certain food products that are ordinarily consumed in an uncooked 
state coming from cholera-infected localities or through such locali- 
ties, if exposed to infection therein, should not be shipped. Vege- 
tables ordinarily eaten in an uncooked state when grown in districts 
where cholera prevails shall not be shipped. Fruits grown on trees 
or on shrubs may be shipped. 
The baggage of steerage passengers shall be inspected, and no food 
shall be taken aboard in such baggage. 
Steerage passengers and crew coming from cholera-infected dis- 
tricts should be subjected to bacteriological examination or otherwise 
detained five days in an environment known to be free from any 
source of infection. 
Steerage passengers and crew from districts not infected with 
cholera, shipping at a port infected with cholera, unless passed 
through without danger of infection, should be treated as those in 
the last paragraph. 
Cabin passengers coming from cholera-infected districts should 
produce satisfactory evidence as to their exact place of abode during 
the five days immediately preceding embarkation. If it appears 
that they have been exposed to infection, they shall be detained under 
medical supervision a sufficient time to cover the period of incuba- 
tion since last exposure, or otherwise be subjected to bacteriological 
examination. 
Should cholera appear in the barracks or houses in which passen- 
gers are undergoing detention, no passengers from said houses or 
barracks who have been previously exposed to this new infection 
should embark until they have been determined free of the infection 
by bacteriological examination or otherwise isolated for a period of 
five days. 
SPECIAL MEASURES AGAINST CHOLERA AT DOMESTIC PORTS. 
Special measures shall be employed against vessels and persons 
from a cholera-infected place, as likewise when cholera has appeared 
on board during the voyage. 
All steerage passengers arriving at ports in the United States, its 
possessions or dependencies, from ports or places where cholera pre- 
vails, shall be subjected to bacteriological examination and shall not 
be admitted to entry until it has been determined by said examina- 
tion that they are free from cholera vibrios. 
All persons on vessels upon which cholera has appeared during 
the voyage shall upon arrival at quarantine be detained until it has 72 
QUARANTINE AND DISINFECTION. 
been determined by bacteriological examination that they are free 
from cholera vibrios. 
Persons in detention who are proven by bacteriological examina- 
tion (performed not less than 24 hours after removal from exposure 
to infection in cholera case or carrier) to be free from cholera 
organisms may be discharged from quarantine without further 
detention. 
In lieu of bacteriological examination (and then only when it is 
impracticable) persons exposed to infection in cholera case or car- 
rier shall be detained in quarantine five days after being isolated 
from such case or carrier. 
If a case clinically diagnosed as cholera has occurred on voyage, or 
if bacteriological examination should reveal the presence of infec- 
tion in any person on board, such infected person or persons should 
be removed and isolated. All contacts should be segregated in small 
groups, and no material capable of conveying infection shall be re- 
moved from the ship. 
Fruits and vegetables from an infected ship, that are ordinarily 
consumed in an uncooked state, shall be destroyed or rendered harm- 
less by cooking. 
The food served to persons in quarantine, unless from a source 
known to be free from cholera infection, shall be cooked. 
The water supply of a vessel detained in quarantine on account of 
cholera infection, unless determined by bacteriological examination 
to be free from cholera organisms or B. coli, shall be sterilized. 
Otherwise it shall be discharged after disinfection. 
The dejecta of all persons in quarantine on account of cholera shall 
be disinfected Before final disposition, and special precautions shall 
be exercised in order to prevent the contamination of food or water 
supply or the spread of the infection through the agency of flies or 
other insects. 
Personal effects contaminated by dejecta from a cholera case or 
carrier shall be disinfected. 
Any part of the ship that has been contaminated by dejecta from 
a cholera case or carrier shall be washed down with a solution of 
bichloride or carbolic acid. 
Carriers or recovered cases shall not be released from quarantine 
detention until three bacteriological tests performed on consecutive 
days shall have been proven to be negative. 
YELLOW FEVER. 
The organism causing this disease is the Leptospira icteroides, 
transmitted to man only by a species of mosquito, i. e., Aedes calopiis 
(Stegomyia), and this only after an intrinsic cycle of development SPECIAL QUARANTINE MEASURES. 
73 
in the body of such mosquito, which requires about 12 days. The 
mosquito can acquire the organism by sucking blood from a patient 
ill with yellow fever only during the first three days of the disease. 
The only procedure that is called for in preventing the spread of 
yellow fever (aside from the control of the human host) is that for 
the destruction of mosquitoes, and this is best accomplished by 
fumigation with sulphur dioxide or hydrocyanic acid gas. Bac- 
tericidal measures have no place in the prevention or destruction of 
yellow-fever infection. 
SPECIAL MEASURES AGAINST YELLOW FEVER AT FOREIGN AND INSULAR PORTS. 
For the purpose of these regulations six days shall be considered 
as the period of incubation of yellow fever. 
It is advisable that at ports where yellow fever prevails precau- 
tions should be taken to prevent the introduction of mosquitoes, 
Aecles calopus (Stegomyia), on board the vessel. Water tanks, water 
buckets, and other collections of water about the vessel should be 
guarded in such a manner that they shall not become breeding places 
for mosquitoes. Where the vessel has lain in such proximity to the 
shore at such places as to render it liable, in the opinion of the 
inspecting officer, to the access of Aedes calopus (Stegomyia) meas- 
ures should be taken to destroy mosquitoes that may have come on 
board. 
Passengers and crew who, in the opinion of the inspecting officer, 
have been definitely exposed to the infection of yellow fever (i. e., as 
from a house or locality known to be infected) should not be allowed 
to embark for six days after said exposure. Those immune to yellow 
fever are exempt from this provision. 
SPECIAL MEASURES AGAINST YELLOW FEVER AT DOMESTIC AND INSULAR PORTS 
OF ARRIVAL. 
A vessel aboard which a case of yellow fever has occurred* at any- 
time during the voyage shall be treated as follows: 
(a) Careful visual and thermometric inspection of all persons. 
(b) The sick are to be immediately disembarked, protected by 
netting against the access of Stegomyia mosquitoes, and transferred 
to a place of isolation. 
( c) Other persons'should be disembarked, if possible, and detained 
under observation for six days, dating from the day of last possible 
exposure. 
(d) Persons under observation presenting an elevation of tem- 
perature above 37.6° C. shall be isolated in a screened apartment. 
(e) The ship shall be moored, if possible, at least 200 meters froim 
the inhabited shore. 74 
QUARANTINE AND DISINFECTION. 
(/) The ship shall be fumigated for the destruction of mosquitoes 
before the discharge of cargo, if possible. If a fumigation be not 
possible before the discharge of the cargo, the discharge of cargo 
shall be under the supervision of the quarantine officer and may be 
permitted as follows: By (1) the employment of immune persons 
for discharging the cargo; or (2) if nonimmunes be employed, they 
shall be kept under observation during the discharging of cargo and 
for six days, to date from the last day of exposure on board. 
A vessel which has lain in such proximity to the shore of a port 
known to be infected as to render it liable to the access of Stegomyia 
mosquitoes shall be fumigated and the personnel held in detention 
under observation for six days. 
A vessel arriving at a southern port (either direct or by way of a 
northern port of the United States) which, although coming from 
an infected port or suspected port, has had neither death nor case 
of yellow fever on board, either before departure, during the voyage, 
or at the time of arrival, and which the quarantine officer is satisfied 
has not lain in such proximity to the shore as to render it liable to the 
access of Stegomyia mosquitoes, or which has been fumigated under 
the supervision of an accredited medical officer of the United States 
immediately before sailing, may, upon arrival at a port of destina- 
tion in the United States with good sanitary history and in good 
condition (including the absence of any exposed collection of water 
in which A. calopus might breed) be subjected to the following 
treatment: 
(a) If arriving in six days or less, she may be admitted to pratique 
with or without fumigation, in the discretion of the quarantine 
officer, and without further detention than is necessary to complete 
the six days. 
(b) If arriving after six days, she shall be immediately fumigated 
(unless previously fumigated at a northern port) and may be ad- 
mitted .without detention. 
Vessels from ports infected or suspected of infection with yellow 
fever, calling at southern ports for bunker coal or supplies during 
the active quarantine season, may be allowed to take on such cargo 
after fumigation, provided the vessel be anchored in a place in- 
accessible to Stegomyia and the crew or passengers be detained on 
board. 
Traffic without detention may be allowed during the active quar- 
antine season from ports infected or suspected of infection with 
yellow fever to ports in the United States south of the southern 
boundary of Maryland under the following conditions: 
(a) The vessel must lie at approved moorings in the open harbor; 
the crew must not be allowed ashore at the port of departure. SPECIAL QUARANTINE MEASURES. 
75 
Every possible precaution must be taken to prevent the ingress of 
Stegomyia mosquitoes and their access to the crew. 
(b) The officer who must go ashore to enter his vessel must be 
immune to yellow fever. Passengers unless immune to yellow fever 
must have been free from possible exposure to yellow fever for six 
days immediately prior to embarking. 
(c) All the above conditions to be certified to specifically by an 
accredited medical officer of the United States. 
All persons who can prove their immunity to yellow fever or who 
have not been exposed to possible infection of yellow fever may be 
permitted to land at once. 
For the destruction of mosquitoes there shall be a complete and 
simultaneous fumigation of all parts of the vessel by sulphur dioxide 
gas, 2 per cent volume gas, two hours’ exposure, or by cyanide gas in 
strength of one-half ounce of cyanide per 1,000 cubic feet of space, 
one-half hour exposure. 
PLAGUE. 
This disease is caused by the Bacillus pestis. 
Bubonic plague.—This is the most common form of the disease 
and is transmitted to man through the agency of rats and mice and 
their ectoparasites, i. e., fleas. It is primarily and essentially a 
disease of rodents. It is only accidentally transmitted to the human 
by means of the fleas which have fed on an infected rodent host 
and which, having become dislodged and finding no other preferred 
host available, perforce turn to the human as the only source of 
blood supply. It is alleged that the bedbug may transmit the dis- 
ease. As it is not a parasite of the rat, it probably would never at- 
tack the rat under natural conditions. The only means of its trans- 
mitting the disease would be through the ingestion of blood from the 
human host during the infectious stage. This would be possible 
only in cases of septicemic plague. Under such conditions it is not 
improbable that the bedbug may be infectious for any subsequent 
human host which it might attack. Such a combination of circum- 
stances is a rare occurrence. In any event, the bedbug would cause 
only individual cases of the disease and would not be productive of 
an epidemic or operate to the widespread dissemination of the dis- 
ease. 
From the foregoing, therefore, it is evident that the treatment 
of plague-infected vessels calls for the definite destruction of all ro- 
dents and their parasites and bedbugs where there have been sep- 
ticemic types of the disease. While fleas normally have their habitat 
on their preferred host, it must be borne in mind that these parasites 
may occasionally be dislodged and temporarily be found in the en- 76 
QUARANTINE AND DISINFECTION. 
vironment. When rodent infection has actually been demonstrated 
on board a vessel, consideration should be given to the destruction of 
rats, mice, and fleas in all parts of the vessel by some disinfecting 
agent which will penetrate to all parts of the vessel and will be toxic 
both to animal and insect life. Sulphur dioxide and hydrocyanic 
acid gas are best adapted for this purpose. When human cases are 
found on vessels that have acquired their infection en route, indicat- 
ing the dispersal of infected fleas, it may be advisable that the 
clothing and personal effects of the passengers and crew be treated 
for the destruction of any fleas that may have become lodged thereon. 
Disinfection for the purpose of destroying bacteria for the pre- 
vention of bubonic plague is irrational and unnecessary. 
Pneumonic form of 'plague.—From an epidemiological standpoint 
and as to the application of preventive measures, pneumonic plague 
and bubonic plague are to be considered as wholly separate diseases. 
Pneumonic plague is transmitted solely through personal contact in 
the same fashion as pneumonia or other respiratory diseases. Neither 
the flea nor other insects are concerned in the direct transmission of 
pneumonic plague. 
SPECIAL MEASURES AGAINST PLAGUE AT FOREIGN AND INSULAR PORTS. 
At ports or places suspected of plague infection in rodents every 
precaution shall be taken to prevent rats (mice) and fleas from 
getting aboard. 
Vessels sailing from such ports shall be simultaneously fumi- 
gated in all parts, preferably when empty, for the destruction of rats. 
Lighters should be free of rats, and this is best accomplished by 
periodic fumigation. 
If the vessel lies at a dock all connecting lines should be guarded 
by inverted cones or disks not less than 3 feet in diameter and so 
fixed as to be always at a right angle to the line to which it is 
attached. % 
Articles which harbor or are liable to harbor rats or rat fleas 
should not be shipped until freed of such vermin, either by the use 
of chemicals, fumigation, or by preventing the access of rats. The 
nature of the merchandise and the place and method of stowing 
prior to shipment must be considered in determining its liability to 
be a rat or vermin carrier, thus: Crated cargo, bags of grain, etc., 
so stowed as to be used as nesting places for rats would be flea, and 
might be rat, carriers, and cargo should preferably have been pre- 
viously stored in rat-proof warehouses. Articles of cargo in open 
crates should be carefully inspected to determine freedom from 
rats and, at the discretion of the inspector, may be rejected for ship- 
ment if considered as rodent infected. When the cargo of a vessel SPECIAL QUARANTINE MEASURES. 
77 
consists of grain or other rat food, extra precautions should be 
taken to prevent rats from going aboard. 
SPECIAL MEASURES AGAINST PLAGUE AT PORT OF ARRIVAL. 
Ships on which plague has occurred in men or rodents shall be de- 
tained in quarantine, the sick, if any, shall be removed and isolated, 
and the destruction of rats shall be effected as soon as practicable. 
A plague-infected ship shall be fumigated simultaneously in all 
parts for the destruction of rats, including those that may be within 
articles of cargo, and other precautions shall in the meantime be 
observed to prevent the escape of rats from the ship. 
All rodents destroyed on vessels at quarantine shall, when practi- 
cable, be bacteriologically examined. 
All persons sick of plague shall be detained in quarantine until 
well, but no detention of healthy contacts is contemplated (except in 
the pneumonic type of the disease), other than is incidental to the 
treatment of vessels or cargo. 
If pneumonia plague has occurred on board ship during the voy- 
age, the sick shall be removed and isolated and all crew and passen- 
gers that have been exposed to the infection shall be detained in 
quarantine for a period of seven days, or, at the discretion of the 
quarantine officer, until their secretions shall be proven to be free 
from B. pestis. 
The quarantine officer, before granting pratique to a vessel that has 
been detained in quarantine on account of plague infection, shall 
assure himself that the vessel is free from rats and vermin. 
The personal effects in use and the belongings of crew and passen- 
gers which in the opinion of the quarantine officer are considered 
as infected shall be disinfected and rendered free from vermin. 
Vessels from foreign ports or ports in the possessions or depend- 
encies of the United States or domestic ports that are known or 
suspected of being infected with plague may, when loaded with 
cargo the nature of which or manner of storage precludes effective 
fumigation, be permitted to enter subject to the terms of a provi- 
sional pratique. When lying alongside wharf or dock at United 
States ports such vessels shall take proper precautions to prevent the 
passage of rodents. The vessel shall be fended off from wharf or 
dock not less than 4 feet, and on all connecting lines shall be fixed 
rat guards of sheet metal of an approved design not less than 3 feet 
in diameter. All cargo nets and similar devices extending between 
the vessel and shore structures shall be removed at night unless in 
actual use, as likewise gangways and ladders, unless guarded. Any 
vessel so entering and neglecting to effectively apply such measures 
may, at the discretion of the Surgeon General, be remanded to the 78 
QUARANTINE' AND DISINFECTION. 
quarantine station for discharge of cargo or required to discharge 
cargo at anchor well removed from the wharf. 
Vessels from ports known to be infected with plague in man or 
rodents which have docked or which have not taken precautions 
necessary to prevent the ingress of rats and on which effective meas- 
ures have not been taken to destroy the same under the supervision 
of an accredited medical officer of the United States Government 
shall, upon arrival at a port in the United States, be fumigated for 
the destruction of rats. 
All vessels engaged in trade with foreign ports shall be fumigated 
not less than once every six months for the purpose of destroying 
rats. This is best done when the vessel is empty. 
A fumigation certificate signed by an accredited medical officer 
of the United States Government will be the evidence accepted by 
the quarantine officer in considering the enforcement of paragraph 
103. 
In applying plague-preventive measures vessels without cargo shall 
be fumigated simultaneously in all parts with sulphur dioxide gas, 
not less than 3 pounds per 1,000 cubic feet, for six hours’ exposure, 
or by hydrocyanic-acid gas in the proportion of 5 ounces of sodium 
cyanide per 1,000 cubic feet of space (or equivalent amount of potas- 
sium cyanide) for two hours. If the vessel be loaded, the time of 
exposure shall be doubled. 
When necessary in the treatment of infected vessels, the quarantine 
officer may require the master to partially discharge cargo for the 
purpose of effective performance of fumigation. 
SMALLPOX. 
The causative agent of this disease has not been identified, but for 
all practical purposes it may be considered that more or less inti- 
macy of contact is essential for the spread of the disease. It should 
also be borne in mind that immune contacts or convalescents may 
transmit the virus in either their clothing, their personal effects, or 
possibly in the body secretions. 
SPECIAL MEASURES AGAINST SMALLPOX AT FOREIGN AND INSULAR PORTS. 
For the purpose of these regulations 14 days shall be considered as 
the incubation period of smallpox. 
Passengers and crew coming from districts where smallpox pre- 
vails in epidemic form, or who have been exposed to smallpox, should 
be vaccinated before embarkation, unless they show satisfactory evi- 
dence of having acquired immunity to smallpox by previous attack, 
or successful vaccination within one year, and their baggage in- 
spected and, if necessary, disinfected. SPECIAL QUARANTINE MEASURES. 
79 
SPECIAL MEASURES AGAINST SMALLPOX. AT PORT OF ARRIVAL. 
Vessels arriving with smallpox on board, or having had smallpox 
on board during the voyage, shall be treated as follows: 
(a) The sick shall be removed and detained until recovered. 
(b) All persons who in the opinion of the quarantine officer have 
been exposed to the infection shall be vaccinated, unless protected 
by a previous attack of smallpox, and detained in quarantine until 
the vaccination is protective against said exposure or, if they refuse 
vaccination, detained in quarantine for 14 days after last exposure 
to the infection. 
(c) Those persons that have not been exposed to the infection may 
be released. 
(d) All personal effects of passengers and crew that have been 
exposed to infection shall be disinfected. All compartments that 
have been exposed to the liability of infection shall be disinfected. 
TYPHUS FEVER. 
The causative organism of this disease has not as yet been defi- 
nitely isolated and accepted as such. The transmitting agent of 
typhus, however, is the louse, both the body louse and the head louse, 
but chiefly the former. No natural means of transmission of typhus 
infection other than the louse has been accepted. 
The important feature in typhus-preventive measures is the as- 
sured destruction of all vermin on the person, clothing, and personal 
effects of those actually sick with typhus and those who have been 
in contact with typhus-infected persons. In this latter group are to 
be included those persons from a known typbus-infected area. The 
destruction of lice on clothing is best effected by heat, steam under 
pressure by preference, but flowing steam without pressure will 
suffice, provided the articles to be disinfected are not closely packed. 
Dry heat is likewise effective. Body lice and head lice can very 
well be destroyed by mechanical cleaning—soap and hot water—but 
the application of a solution of equal parts of vinegar and kerosene 
to hairy parts will greatly assist in the removal of nits and lice. 
This solution should be allowed to remain 15 minutes or half an 
hour before bathing. The treatment of personal effects and baggage 
of verminous persons is necessary, but in the case of those individuals 
who are passed free of vermin and not requiring disinfection their 
baggage likewise should be passed without treatment. Bactericidal 
measures are not called for in typhus prevention. The question is 
solely that of the destruction of lice and the detention in quarantine 
for a period of 12 days of those persons who have been intimately 
exposed to typhus infection and who presumably may develop the 
disease, as well as those actually sick. 80 
QUARANTINE AND DISINFECTION. 
SPECIAL MEASURES AGAINST TYPHUS FEVER AT FOREIGN AND INSULAR PORTS. 
For the purpose of these regulations 12 days shall be considered 
as the period of incubation for typhus fever. 
Passengers and crew from ports infected with typhus shall not 
be allowed to embark unless demonstrably free from vermin, or 
otherwise treated for the destruction of verfnin. The personal 
effects, wearing apparel, and baggage of those infested with vermin 
shall be disinfected. 
Passengers from localities where typhus prevails embarking at a 
port not infected with typhus shall be treated as in the preceding 
paragraph. 
Passengers and crew who, in the opinion of the inspecting officer, 
have been definitely exposed to infection (from a house, barracks, 
or other building in which has occurred a case of typhus) shall not 
be allowed to embark until 12 days after removal from the infected 
environment. 
SPECIAL MEASURES AGAINST TYPHUS FEVER AT PORT OF ARRIVAL. 
Vessels on which typhus infection has occurred shall be detained 
in quarantine and the sick, if any, removed and isolated. The 
clothing, personal effects, and baggage of those infected and of 
those not demonstrably vermin free shall be treated for the destruc- 
tion of vermin. 
All persons found to be vermin (louse) infested shall be treated 
for destruction of lice. 
All passengers and crew that have been exposed to the infection 
shall be detained under observation for a period of 12 days from 
last exposure to infection. 
Those of the personnel that are demonstrably free from vermin 
and have not been exposed to the infection may be released without 
detention or disinfection of baggage. 
Vessels on which typhus has appeared shall be detained and fumi- 
gated for destruction of vermin. 
Cargo compartments of typhus-infected vessels need not be fumi- 
gated unless there be exceptional conditions that may render them 
vermin infested. 
Sulphur dioxide and hydrocyanic acid gas are effective agents 
for the destruction of lice when used in proper strength and 
exposure. 
LEPROSY. 
The causative agent of this disease is believed to be B. leprae, 
which is an “ acid-fast ” bacillus found in the tissues of persons 
having the disease. Nothing definite has been worked out as to the SPECIAL QUARANTINE MEASURES. 
81 
manner in which the infection is transmitted and preventive meas- 
ures are practically confined solely to the isolation and segregation 
of the leprous persons. 
For the prevention of the spread of leprosy, the chief and prac- 
tically the only measure called for is the isolation of the patient, 
either in a national or State leprosarium. When in temporary con- 
finement at the quarantine stations, when traveling, or under other 
conditions that would entail contact with the public, especial pre- 
cautions would include the sterilization of eating utensils used by 
the leper and the disinfection of bedclothes. As a measure of added 
precaution, the compartment in which the leper has lived or been 
confined should, after his removal, be sterilized by mechanical clean- 
ing and fumigation with formaldehyde gas. 
Alien lepers should not be permitted to embark at a foreign port 
for a port of the United States, its possessions or dependencies, 
either as a passenger or as a member of the crew. 
Vessels arriving in quarantine with leprosy on board shall not be 
granted pratique until the leper and his baggage have been removed 
from the vessel to the quarantine station. 
No alien leper shall be permitted to land, and to this end the case 
shall be certified as a leper and reported to the nearest commissioner 
of immigration. 
If the leper be a citizen of the United States, the case shall 
promptly be reported to the Surgeon General for further action. 
ANTHRAX. 
Shaving brushes or lather brushes destined for shipnient into the 
United States shall be made only from hair or bristles known to be 
free from anthrax spores. 
Unless known to be free from anthrax spores such hair or bristles, 
before being made into shaving or lather brushes, shall be disin- 
fected by one of the following methods: (a) By boiling for not less 
than three hours; (b) by exposure to steam under not less than 15 
pounds gauge for not less than 30 minutes with a preliminary vacuum 
of at least 10 inches; (c) by exposure to streaming steam for not 
less than six hours. 
Consignments of shaving brushes of foreign manufacture shall be 
accompanied by a consular certificate containing a statement as to 
the prevalence or nonprevalence of anthrax in the territory from 
which the brushes emanate and also to the effect that the materials 
entering into the manufacture of the brushes have or have not com- 
plied with the requirements of these regulations. 82 
QUARANTINE AND DISINFECTION. 
DISINFECTION. 
PHYSICAL DISINFECTANTS. 
Cleansing with soap and water.—The liberal and energetic use of 
soap and hot water will mechanically remove a high percentage of 
bacteria from the hands as well as from contaminated articles such 
as furniture, door knobs, bed frames, and all washable materials. 
Consequently, this measure is always to be carried out thoroughly 
preliminary to or in connection with other methods of disinfection. 
Exposure to direct sunlight in fresh outdoor air.—Such exposure 
for several hours is always desirable, particularly for clothing and 
bedding and other articles which may not, or in the particular in- 
stance need not, be treated more energetically. Bright sunlight 
which has not penetrated a glass window, and hence had the ultra 
violet rays filtered out, will kill the common disease producing 
bacterial organisms in a few hours. Also these organisms can not 
withstand the complete drying that takes place in the fresh air. The 
tubercle bacillus, the virus of chickenpox, the virus of smallpox, and, 
in general, all spore-bearing bacteria are more resistant to sunlight 
and drying. Thirty hours of sunning is usually required to kill an 
anthrax spore. 
Burning.—Of unquestioned efficacy, but seldom required. 
Boiling.—Very efficient and of wide range of applicability. The 
articles must be wholly immersed for not less than 10 minutes in 
water actually boiling (100° C.). The addition of 1 per cent of 
carbonate of soda renders the process applicable to polished steel, 
cutting instruments, or tools. 
Steam.— {a) Flowing steam (not under pressure) : Flowing steam 
when applied under suitable conditions is an efficient disinfecting 
agent. The exposure must be continued 30 minutes after the tem- 
perature has reached 100° C. 
(b) Steam under pressure without vacuum: Steam under pres- 
sure will sterilize, provided that the process is continued 20 minutes 
after the pressure reaches 15 pounds per square inch. The air must 
be expelled from the apparatus at the beginning of the process. If 
impracticable to obtain the designated pressure, a longer exposure 
will accomplish the same result. 
(<?) Steam under pressure with vacuum: Steam in a special ap- 
paratus with vacuum attachment is the best method of applying* 
steam under pressure, the object of the vacuum apparatus being to 
expel the aid and to promote the penetration of the steam. The pro- 
cess is to be continued for 20 minutes after the pressure reaches 10* 
pounds to the square inch. special QUARANTINE MEASURES. 
83 
CHEMICAL DISINFECTANT SOLUTIONS. 
Bichloride, of mercury.—Bichloride of mercury is a disinfectant 
of undoubted potency and wide range of applicability. It can not 
he depended upon to penetrate substances in the presence of al- 
buminous matter, such as foodstuffs, blood, thick pus, feces, etc. It 
should be used in solutions of 1 to 1,000. The solubility of bichloride ' 
of mercury may be increased by using sea water for the solution, or 
by adding 2 parts per 1,000 of sodium or ammonium chloride to the 
water employed. 
Carbolic acid.—Carbolic acid in the strength of 5 per cent may 
be substituted for the bichloride of mercury, and should be em- 
ployed in the disinfection of the cabins and living apartments of 
ships to obviate injurious action on polished metals, bright work, 
etc. Carbolic acid is not as efficient as one of the soluble prepara- 
tions of cresol in the same strength. 
Formalin.—Formalin containing 40 per cent of formaldehyde 
may be used in a 5 per cent solution as a substitute for bichloride 
of mercury or carbolic acid and is useful for the disinfection of 
surfaces, dejecta, fabrics, and a great variety of objects, owing to 
its noninjurious character. Formalin solutions act harshly upon the 
hands. 
Chlorinated lime.—Chlorinated lime in a 5 or 6 per cent solution 
freshly made from the powder which has been kept free from 
deterioration in a small sealed can or tightly stopped colored bottle 
is efficient and useful in the disinfection of sewage, stools, glass 
and earthen wTare, and materials or articles which will not be dam- 
aged by its bleaching and corrosive action. When the package con- 
taining the chlorinated lime is opened there should be a strong odor 
of chlorine. It can be used for washing painted surfaces and scrub- 
bing floors, and in water-closet bowls or urinals. It serves as a de- 
odorant as well as a disinfectant. It may be used by attendants 
upon the sick to disinfect their hands. In disinfecting dejecta, 
stools should be completely covered with the solution, thoroughly 
mixed and allowed to stand for at least 30 minutes. The powder 
may be sprinkled over the stool, taking care to add sufficient in excess 
so that a 5 per cent solution will result when thoroughly mixed. 
In making a solution for use, one-half pound of commercial 
chlorinated lime or “ bleach ” is to be dissolved in a gallon of 
water. The insoluble residue sinks to the bottom; the solution above 
contains about 6 per cent of chlorinated lime which is equivalent to 
2 per cent of chlorine, the active disinfecting agent. Chlorinated 
lime can not be depended upon to kill the tubercle bacillus. 
Disinfection of drinking water by chlorination.—Dissolve the 
soluble portions of 1 gram of chlorinated lime of tested chlorine 84 
QUARANTINE AND DISINFECTION. 
strength in a small volume of water and add this to 40 gallons of the 
water to be disinfected; mix thoroughly and allow to stand for at 
least 1 hour before using for drinking purposes. 
GASEOUS DISINFECTANT AGENTS. 
Gaseous agents are of value chiefly to kill insects and vermin. 
If it is considered necessary to fumigate in the case of a disease 
in the spread of which insects, vermin, or other forms of animal 
life play no part, formaldehyde is the best agent to use. Sulphur 
dioxide is not an efficient germicide but it is effective when used in 
proper concentrations to kill insects, rats, and vermin. 
F ormaldehyde gas.—Formaldehyde in the form of a fumigant 
has no value except as a surface disinfectant, and it is not efficient 
then unless the temperature of the air is above 50° F. and unless 
the relative humidity is at least 60 per cent. 
One of the best methods of producing formaldehyde gas, and the 
one for which the necessary materials are issued for use on board 
naval vessels, is by the action of formalin on potassium permanga- 
nate or on barium dioxide. 
To prepare a room for disinfection, measure the gross cubic space 
and calculate the amounts of ingredients required. Allow 500 cubic 
centimeters of formalin (solution of foraldehyde), which has not 
lost its strength, and 250 grams of potassium permanganate or 250 
grams of barium dioxide for each 1,000 cubic feet of space. Paste 
up all cracks and openings with strips of paper. Open up all 
drawers in furniture and hang up all articles to be disinfected with 
separation between them so that all surfaces possible will be exposed 
to the gas. Then place a large pan partly filled with water near 
the center of the room on the floor. In this place a second re- 
ceptacle of glass or metal containing the permanganate or barium 
dioxide. This should be large enough to contain 10 times the volume 
of formaldehyde to be used, as there is a tendency of the mixture to 
foam over. Pour the formalin from a bucket or pitcher on the per- 
manganate crystals or barium dioxide powder. The gas is generated 
in great amount in a few seconds. The room or compartment should 
be kept tightly closed for 6 to 12 hours and then flooded with fresh 
air and sunshine if possible. 
Another practical method is that of spraying formalin on sheets 
suspended in the room in such manner that the solution remains on 
the sheets in small drops. A sheet will hold about 5 ounces without 
dripping. Not less than 10 ounces of formalin should be sprayed 
for each 1,000 cubic feet of space. The method is limited to rooms 
or compartments not exceeding 2,000 cubic feet of space. The room 
must be tightly sealed and kept closed for not less than 12 hours. SPECIAL QUARANTINE MEASURES. 
85 
Formaldehyde does not injure fabrics or most colors. In fumigat- 
ing with formaldehyde the danger of fire should be guarded against. 
In the rapid evolution which occurs when formalin is poured on 
potassium permanganate or barium dioxide the gas may be in a com- 
paratively dry state and as such is inflammable in the presence of a 
light, such as lighted matches, oil lamps, etc. 
GASEOUS AGENTS FOR THE DESTRUCTION OF INSECTS AND VERMIN. 
Sulphur dioxide.—Sulphur dioxide is the safest and most gener- 
ally applicable and useful fumigant for the destruction of rats, 
fleas, lice, bed bugs, mosquitoes, etc. 
Sulphur dioxide is only efficient in the presence of moisture, and 
it is only a surface disinfectant, as it lacks penetrating properties. 
An atmosphere containing 4.5 per cent can be obtained by burning 5 
pounds of sulphur per 1,000 cubic feet of space. This amount would 
require the evaporation or volatilization of about 1 pint of water. 
The following standards for sulphur dioxide as to strength and 
exposure appear in the Quarantine Laws and Regulations of the 
United States, published by the Treasury Department, United States 
Public Health Service: 
V 
(ia) For mosquito destruction: 2 pounds of sulphur per 1,000 
cubic feet of space, exposure for one hour. 
(b) For destruction of lice: 4 pounds of sulphur per 1,000 cubic 
feet of space, exposure for six hours. 
(c) For destruction of rats and fleas: 3 pounds of sulphur per 
1,000 cubic feet of space, exposure for six hours. 
These standards are for superstructures, partially filled store- 
rooms, and empty holds. For cargo-laden holds and well-filled 
storerooms, or in compartments that are packed with materials, the 
time of exposure should be doubled. 
The sulphur may be burned in shallow iron pots (Dutch ovens), 
and each pot should stand in a vessel of water as a protection against 
fire. Shallow receptacles which afford ample burning surface are 
desirable. Dutch ovens with iron legs are convenient, but any iron 
pot of the proper size or even an iron bucket resting on bricks in 
a tub will do. Not more than 30 pounds of sulphur should be 
burned in one pot, and it is preferable to use a sufficient number of 
pots so that not more than 10 pounds need be burned in each one. 
With too great a quantity the sulphur does not always burn out com- 
pletely within the exposure period, and better diffusion is secured 
with a number of pots well distributed. 
The sulphur pots should be elevated from the bottom of the 
compartment to be fumigated in order to secure the maximum pos- 
sible percentage of combustion of sulphur. Sulphur dioxide gas is 86 
QUARANTINE AND DISINFECTION. 
heavy and if the container is too low the gas in settling may smother 
the flame. 
The sulphur should always be ground or mashed into a state of 
fine division. The sulphur is most conveniently ignited by placing 
upon it a pledget of waste saturated with alcohol or by pouring a 
little alcohol on the surface of the sulphur, making a little crater on 
top. Kerosene may be used in the same way or a red-hot coal may 
be used. Care should always be used to prevent damage to the 
cargo or vessel by fire. The pot farthest away from the point where 
the fumigator is to make his exit should be ignited first, and the 
others in succession as promptly as possible, care being taken to see 
that each pot is welf lighted. 
Liquefied sulphur dioxide may be used for disinfection in place 
of sulphur dioxide generated as above, it being borne in mind that 
this process will require 2 pounds of the liquefied gas for each pound 
of sulphur, as indicated in the above paragraphs. 
Sulphur dioxide is especially applicable to the holds of vessels or 
to freight cars and apartments that may be tightly closed and 
which do not contain objects which will be injured by the gas. 
Sulphur dioxide bleaches fabrics or materials dyed with vegetable 
or aniline dyes. It destroys linen or cotton goods by rotting the 
fiber through the agency of the acids formed. In injures most 
metals. 
Hydrocyanic acid gas.—This is the most penetrating and the most 
deadly of all fumigants. It or the newer gas, cyanogen chloride, is 
to be used in preference to sulphur dioxide by quarantine officials, 
but hydrocyanic acid gas always involves such danger to human 
life that it is never to be used except under the careful direction 
of a medical officer specially trained in quarantine work. 
GENERAL DETAILS IN THE FUMIGATION OF VESSELS. 
All spaces to be fumigated must be made as nearly air-tight as 
possible. In fumigating the holds of vessels the hatches should be 
covered over with their regular waterproof tarpaulins and tightly 
battened down, leaving a corner that can be opened as a vent for 
the escape of the sulphur fumes. All air slits, scuttles, and chain 
ports should be closed. Doors should be sealed by means of strips 
of paper pasted over the cracks left between the frame and the 
door. All machinery and bright metal should be wiped over with 
vaseline in advance. 
For computing the air space of a vessel a registered ton should be 
estimated as containing 100 cubic feet. A vessel of 1,000 net tonnage 
would, therefore, contain 100,000 cubic feet of air space in the holds 
alone, since net tonnage indicates the cargo-carrying capacity in con- SPECIAL QUARANTINE MEASURES. 
87 
tradistinction to the gross tonnage which indicates the ship’s total 
cubic capacity. 
The cubic capacity of crews’ quarters, cabins, engine room, poop 
deck, or other above-deck compartments have to be computed for 
each individual compartment. 
The various details in connection with the fumigation of vessels 
are of almost equal importance as the nature of the fumigant used, 
and the observation of these details to a large extent determines the 
effectiveness or the inefficiency of the fumigation. All possible care 
should be observed by the quarantine officer to see that dead space in 
the vessel is opened up and all practical measures should be taken to 
aid in the diffusion of the fumigating gas, and this is especially im- 
portant when sulphur dioxide is used. All dunnage and loose ma- 
terial from the holds of a vessel that is not cargo laden should be 
arranged in compact order and placed on elevated platforms to avoid 
rat harborage. If sulphur dioxide is generated in a furnace and lead 
into the vessel, it should be introduced at the lowest point and the 
hatches left open for a short while so as to permit of the escape of air 
and hasten diffusion of the sulphur fumes. Pipe casings should be 
opened up and from one end of the vessel to the other there should be 
a certain number of limber boards removed so as to permit of pene- 
tration of the gas into the bilges. Any planked-over space between 
the outer and the inner sheathing of a vessel should also be freely 
opened, and wherever there is dead space it should be opened up so 
that there will be free circulation of the gas. Careful attention 
should be given to lifeboats, which are often infested by rats which 
resort to these places for water. Preferably, lifeboats should be 
cleaned and flooded by water prior to fumigation. Very close atten- 
tion should be given to the poop deck, which is a space frequently 
containing a heterogeneous collection of litter and is generally badly 
rat infested. In general, the engine room and fireroom do not harbor 
rats, but in the treatment of a vessel infested with plague-infected 
rats they should be fumigated. DISINFECTING PLANTS. 
The following-named quarantine stations of the United States 
Public Health Service are prepared to perform disinfection and 
fumigation when called upon. At some of the smaller stations a 
reasonable length of notice should be given in order that the fumigat- 
ing materials may be procured. The fact that some of the stations 
are not provided with wharfage facilities is not an index to the 
capacity of the stations for performing disinfection: 
Station. 
Depth of 
water at 
dock, 
feet. 
Detention 
facilities 
(bar- 
racks), 
persons. 
Hospital 
beds. 
Boston, Mass 
15 
1,400 
1, 400 
65 
Cape Charles, Ya. (Craney Island) 
10 
90 
Cape Fear, N. C 
15 
46 
12 
Charleston, S. C 
22 
80 
5 
Columbia River, Oreg 
24 
0 
20 
Galveston, Tex 
25 
69 
15 
Honolulu Hawaii 
1, 000 
31 
Mobile, Ala 
65 
0 
New Orleans, La 
25 
200 
30 
New York, N. Y 
1, 800 
150 
Pensacola, Fla 
22 
6 
7 
Portland, Me 
7 
500 
20 
Port Townsend, Wash. (Puget Sound, Wash.) 
30 
661 
26 
Providence, R. I ; 
100 
56 
Reedy Island, Del 
30 
400 
20 
San Diego, Calif 
22 
80 
18 
San Francisco, Calif 
19 
623 
8 
75 
8 
Savannah, Ga 
20 
600 
7 
Subports: 
Marcus Hook, Pa 
700 
90 
800 
40 
Tampa Bay, Fla 
19 
36 
8 
GLOSSARY. 
Abdomen.—That part of the body which lies below the chest as far as the pelvis 
and contains stomach, liver, intestines, etc.; the belly. 
Albuminous.—Containing albumin or proteid, i. e.,' meat, egg, milk, etc., and 
certain material in bodies of plants and animals. 
Antidote.—A medicine given to counteract some action in another or to neu- 
tralize the effect of a poison. 
88 GLOSSARY. 
89 
Antiseptic.—A substance which prevents or retards the growth of organisms, 
especially of the septic variety, thus hindering putrefaction. 
Asphyxia.—Suspension of respiration and animation; suffocation, as in drown- 
ing or from breathing poisonous gases. 
Autoclave.—An apparatus for sterilization by steam under pressure. 
Bubonic.—Relating in any way to a bubo. B. plague, the most common form of 
the plague, characterized by the occurrence of buboes in the groin or armpit. 
Capillaries.—The smallest blood vessels of the body; those which connect veins 
and arteries. 
Cathartic.—An agent causing active movements of the bowels. 
Catheter.—A slender tubular instrument, generally of soft rubber or of silver, 
used chiefly for passing through urethra into bladder to draw off the urine. 
Cauterize.—To burn or sear with caustics or a hot iron. 
Clinical.—Relating to the course of the disease. C. thermometer, a self-regis- 
tering thermometer for taking the bodily temperature. 
Contagion.—The communication of disease from person to person b,y contact, 
direct or indirect. 
Coryza.—Acute rhinitis; cold in the head. 
Dejecta.—The matter passed from the bowel; feces. 
Delirium.—A temporary mental derangement, occurring in fevers, etc., charac- 
terized by incoherent and wandering talk, illusions, etc. 
Disinfectant.—A substance used to destroy the germs of infectious and con- 
tagious diseases. 
Disinfection.—The act or process of disinfecting; purification from infecting 
matter. 
Dislocation.—Where the bones forming a joint do not occupy their usual re- 
lation to each other. 
Emetic.—An agent which causes vomiting. 
Endemic.—A disease constantly present in a community, as distinguished from 
an epidemic. 
Enema.—A fluid injected into the rectum for the purpose of clearing out the 
bowel or of administering drugs or food. 
Epidemic.—The extensive prevalence in a community of a disease brought from 
without or a temporary increase in number of cases of an endemic disease. 
Eruption.—A breaking out, especially the appearance of changes in the skin; 
a rash. 
Feces.—The matter discharged from the bowels during defecation. 
Fountain syringe.—One which has no pistons, but is hung up and acts by 
gravity. 
Fracture.—A break, usually in bone. 
Fumigation.—The destruction of germs by means of some disinfecting vapor, 
as that of sulphur or formaldehyde. 
Fungus.—A Cellular vegetable organism feeding on organic matter; such are 
mushrooms, yeasts, molds, and bacteria. 
Germ.—A microbe or pathogenic cell. 
Germicide.—An agent which is destructive to germs or microbes. 
Immobilization.—The act of rendering a part immovable or of preventing all 
possibility of movement in a part; especially applied to fractured bones. 
Infection.—Communication of disease, as by entrance of pathogenic germs into 
an organism in any manner. 
Insecticide.—An agent which kills insects. 
Laxative.—A remedy which assists the movement of the bowels which move 
but sluggishly. A laxative is useless where the bowels have been clogged 
for several days. (Use cathartic.) 90 
GLOSSARY. 
Maceration.—Softening by the action of a liquid. 
Microbe.—A microscopic organism, especially a bacterium. 
Microorganism—Bacillus, bacterium, microbe, germ. 
Palpitation.—Rapid and perceptible beating of the heart, which may be regular 
or irregular. 
Pathogenic.—Productive of disease. 
Pleura.—A thin membrane which covers the inside of the chest wall on both 
sides, and also covers either lung. 
Pneumonic.—Relating to pneumonia. P. plague, a particularly fatal form, 
with marked lung involvement. 
Pratique.—A license or permission granted by the authorities of a port to the 
master of a vessel, especially after sanitary inspection or quarantine, to hold 
communication with the shore. 
Prophylaxis.—The prevention of disease. 
Purgative, purge.—A remedy that moves the bowels actively. 
Purulent.—Consisting of pus or matter. 
Pus.—The matter from a sore. 
Pustule.—A small circumscribed elevation on the skin, containing pus. 
Rabies.—A disease affecting certain animals, especially dogs, from which hy- 
drophobia is communicated to man. 
Rash.—An eruption on the skin. 
Rectum.—The lowest part of the large intestine opening at the anus. 
Sanitation.—The employment of measures designed to promote health and 
prevent disease. 
Sedative.—A medicine which allays irritation and quiets the nerves. 
Shock.—A condition of collapse or profound prostration sometimes following 
hemorrhage, injury, anesthetic, and operation. 
Spatula.—A broad instrument like a knife with blunt edges for spreading 
ointments. 
Sterile.—Free from pathogenic bacteria or other microorganisms; aseptic. 
Stimulant.—A medicine having power to excite organic action or to increase 
the vital activity of an organ, as heart stimulant, respiratory stimulant. 
Stricture.—A narrowing of a passage or canal in the body due to disease or 
injury. 
Suture.—A stitch used to draw together the lips of a wound. 
Tourniquet.—An instrument for stopping the flow of blood through an artery 
by means of strong compression. 
Toxin.—A poisonous substance of undetermined chemical nature, elaborated 
during the growth of pathogenic microorganisms. 
Urethra.—The canal by which the urine is conducted from the bladder and 
discharged. 
Urination.—The act of discharging the contents of the bladder. 
Uvula.—The small, fleshy body which hangs from the soU palate over the root 
of the tongue. 
Varicose.—Having an unnatural enlargement or dilation, knotty and irregular 
in shape, as often seen in the veins of the lower extremities. 
Venereal—Pertaining to sexual intercourse or caused by it. 
Virus.—Contagious poisonous matter, as of smallpox or hydrophobia. INDEX. 
Acid : Page. 
carbolic, disinfection by . 83 
poisoning by 12 
strong, poisoning by 12 
Air, fresh 32 
Alkalis, poisoning by ' 12 
Anthrax 81 
Arm, fracture of 1 24 
Arsenic, poisoning by 12 
Arterial hemorrhage 17 
Arteries, main, location of 17 
Back, fracture of 24 
Bandaging 17 
Bichloride of mercury: 
disinfection by 62, 63, 83 
poisoning by 12 
Bills of health 66 
Bites from dogs or cats 10 
Bleb 30 
Boiling, disinfection by 82 
Box, medicine, contents of 1 
boat 5 
Bruises ,19 
Bubo 26 
Bulla 30 
Burial, at sea * 54 
Burns 13 
Capillary oozing 17 
Carbolic acid: 
dis'nfection by 63 
poisoning by 12 
Cats, bites from 10 
Chancroid 27 
Chemical: 
disinfectants 83 
gases, disinfection by 85 
Chicken-pox 34 
Chills and fever 40 
Chlorinated lime 83 
Cholera 70 
Chordee 26 
Clap 25 
Clinical thermometer 29 
Cold, effects of 14 
Colds and coughs 45 
91 92 
INDEX. 
Page. 
Colic 42 
Collar bone, fracture of 24 
Compound fracture i 23 
Continued fever 29 
Contusions 19 
Cough, whooping 30 
Coughs and colds 45 
Crisis as termination of fever 29 
Deaths 54 
Delirium tremens 46 
Dengue , ■*. 30 
Dental treatment : 53 
Diarrhea 43 
Diet 32 
Diphtheria • 39 
Diseases: 
infectious, general treatment of 32 
of the— 
eye 48 
respiratory system 45 
stomach and intestines 42 
special 29 
venereal 25 
Disinfectants 82 
chemical 83 
gaseous, agents 84 
physical 82 
Disinfecting plants 88 
Disinfection 31, 58 
by- 
bichloride of mercury 62, 63, 83 
boiling 82 
carbolic acid 63, 83 
chemical gases 83 
chlorinated lime 84 
formaldehyde gas 84 
formalin 63, 83 
steam .— 82 
sulphur 85 
Dislocations 22 
Dogs, bites from 10 
Dressings, sterilization of 21 
Drowned, resuscitation of the apparently 7 
Drowning, method of handling, in water 7 
Drugs 33 
Dysentery 44 
Earache 49 
Electric shock, resuscitation from 9 
Embalming 54, 55 
Emergency measures 6 
Epileptic fits 11 INDEX. 
93 
Expenses: Page. 
funeral 55 
while in hospital 52, 53 
Eye: 
diseases of : 48 
inflammation of 48 
Fainting 10 
Fever: 
continued 29 
infectious , 30 
intermittent 29 
malarial 40 
Malta 30 
Mediterranean 30 
remittent - 29 
scarlet 34 
typhoid 37 
typhus ‘ 37. 79 
yellow 41, 72 
Fevers 29 
terminations of 29 
types of 29 
Finger, fracture of r 24 
First-aid 6 
Fits, epileptic 11 
Foot, fracture of 25 
Forearm, fracture of 24 
Formaldehyde gas, disinfection by 84 
Formalin 63, 83 
disinfection by 63 
Fractures 23 
special 24 
Freezing • 14 
Fresh air 32 
Frostbite 15 
Funeral expenses 55 
Gas poisoning, resuscitation from 9 
German measles 37 
Glossary 88 
Gonorrhea 25 
Gonorrheal inflammation of eye 49 
Grip 40 
Hand, fracture of , 25 
Headache 48 
Health, bills of . 66 
Heat: 
exhaustion 47 
stroke —- 47 
Hemorrhage 16 
Hernia 15 
Heroin, poisoning by 12 
Hospital: 
expenses while in 52. 53 
facilities 52 94 
INDEX. 
Hospitals: Page. 
naval 52 
Public Health Service ‘Sa.-JL— 52,53 
Hydrochloric acid, poisoning by 12 
Hydrophobia, prevention of 10 
Hydrotherapy 32 
Incubation period 30 
Infection, prevention of spread of 31 
Infectious: 
diseases, general treatment of_«. 32 
fever 30 
Inflammation of eye 48 
Influenza 40 
Insensibility 10 
Instruments, sterilization of 21 
Intermittent fever L —— 29 
Internal hemorrhage 17 
Intestines and stomach, diseases of 42 
Isolation 31 
period 30 
Itch 49 
Jaw, fracture of 24 
Kneecap, fracture of 1 25 
Laudanum, poisoning by 12 
Leg, fracture of 25 
Leprosy 80 
Lice 51 
Lye, poisoning by 12 
Lysis as termination of fever — 29 
Macules T 30 
Malaria 40 
Malta fever 30 
Measles j. 36 
German 37 
Medicine box, contents of 1 
Medicines, directions for . 2 
Mediterranean fever 30 
Mercury, bichloride of: 
disinfection by • 62, 63 
poisoning by 12 
Morphine, poisoning by 12 
Mumps 38 
Naval: 
hospitals 52 
medical supply depots 5 
Nitric acid, poisoning by 12 
Nose: 
bleeding 17 
fracture of 24 
Nursing 32, 33 
Nux vomica, poisoning by 13 
Opium, poisoning by — 12 95 
INDEX. 
Page. 
Orchitis 27 
Papule 30 
Paraphimosis 26 
Paregoric, poisoning by 12 
Paris green, poisoning by 12 
Pay while in hospital ; :— 52 
Phimosis 26 
Physical disinfectants 82 
Plague 
Poisoning: 
by- 
alkalis 12 
arsenic 12 
bichloride of mercury 12 
carbolic acid 12 
heroin 12 
hydrochloric acid 12 
laudanum 12 
lye 12 
morphine 12 
nitric acid 12 
nux vomica ,-v 13 
opium 12 
paregoric 12 
Paris green 12 
ptomaines 13 
rough-on-rats 12 
strong acids 12 
strychnine 13 
sulphuric acid 12 
unknown poison 11 
gas, resuscitation from 9 
prevention of 11 
Poisons 11 
Precautions, sanitary v 61 
Prevention of infection : 31 
Procedure, quarantine 58 
Ptomaines, poisoning by 13 
Public Health Service hospitals 53 
Pustule 31 
Quarantine -— 58 
detention 64 
period 30 
procedure 69 
stations, list of 88 
use of disinfectants in 62 
Hat: 
extermination 76 
guards 77 
Hemittent fever 29 96 
INDEX. 
Requisitions: Page. 
for medical stores 5 
forms 5 
Rescuing the drowning 7 
Respiratory system, diseases of 45 
Rest 32 
Resuscitation from: 
drowning 7 
electric shock 9 
gas poisoning 9 
Rib, fracture of 24 
Roller bandage 19 
Rough-on-rats, poisoning by 12 
Rules for first-aid 6 
Rupture 15 
Sanitary precautions 61 
Scab 31 
Scabies 49 
Scalds 13 
Scale 31 
Scarlet fever : 34 
Schafer method of artificial respiration 8 
Shock 13 
electric, resuscitation from 9 
Skull, fracture of 24 
Smallpox 35, 78 
Sore throat 45 
Special diseases 29 
Splints 22 
Sprains 15 
Steam, disinfection by 82 
Sterilization of dressings and instruments ; 21 
Stomach and intestines, diseases of 42 
Strains 15 
Stricture of urethra 27 
Stroke: 
heat T 47 
sun 47 
Strychnine, poisoning by 13 
Stye 48 
Sulphur: 
dioxide 85 
disinfection by 85 
Sulphuric acid, poisoning by 12 
Sunstroke 47 
Supplies: 
medical and surgical 1 
requisitions for 5 
Supply depots, naval medical 5 
Syphilis 27 
Temperature, taking of 29* INDEX. 
97 
Page. 
Testicle, swollen 27 
Thermometer, clinical 29 
Thigh, fracture of * 25 
Throat, sore 45 
Tonsillitis 45 
Toothache ; 49 
Treatment of infectious diseases : 32 
Triangular bandage 17 
Typhoid fever 37 
Typhus fever 37, 79 
Unconsciousness 10 
Urethra, stricture of 27 
Venereal diseases 25 
Venous hemorrhage 17 
Vermin 51 
Vesicle ' 30 
Whooping cough 30 
Wounds 19 
Wrist, fracture of 24 
Yellow fever 41, 72