FOR COMMANDERS 
OF NAVAL VESSELS 
1944 
NAVM3IB 12*1 MEDICAL COMPEND 
For 
Commanding Officers of Naval Vessels to 
Which no Member of the Medical Department 
of the United States Navy Is Attached 
To Accompany Medicine Box 
PUBLISHED RY THE 
BUREAU OF MEDICINE AND SURGERY 
UNDER THE AUTHORITY OF THE 
SECRETARY OF THE NAVY 
NAVMED 124 
REVISED, JULY 1944 
UNITED STATES 
GOVERNMENT PRINTING OFFICE 
WASHINGTON : 1944 
For sale by the Superintendent of Documents, Washington, D. C. Bureau of Medicine and Surgery, 
Navy Department, 
Washington, D. C., July i, 1941. 
This Medical Com pend for commanding officers 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. 
Ross T McIntire, 
Surgeon General. United States Navy. Chapter I 
MEDICAL SUPPLIES 
This Medical Com pend, which accompanies the medical units, is pub- 
lished primarily for the use of commanding officers of naval vessels to 
which no representative of the medical department is attached. In its 
preparation, an endeavor has been made to cover, in nontechnical lan- 
guage, the recognition and emergency treatment of those injuries and 
diseases commonly met with on board ship, as well as to provide directions 
for the management of quarantinable diseases and those cases beyond the 
ability of the ship's force to handle. 
It is not intended that use of these instructions shall replace the services 
of a medical officer or civilian doctor whenever one can be contacted, nor 
take the place of hospitalization whenever or wherever such facilities are 
available. On the contrary, it is desired that commanding officers of 
naval vessels 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. The medical and dental officer of a yard or station 
will be found at the dispensary, where, with the approval of the com- 
mandant, assistance and advice in the treatment and care of the sick may 
be received. 
So far as possible the treatment outlined in this compend has been 
restricted to the employment of those agencies supplied in the medical 
units or which may be obtained in the customary ship’s stores. Sugges- 
tions as to any special agencies which are mandatory, and which should 
be obtained ashore at the earliest opportunity, are so indicated. 
In addition to first-aid measures and the treatment of special diseases, 
there have been included chapters on hospitalization, preventive medicine, 
personal hygiene, quarantine and bills of health, and the disinfection and 
fumigation of ships, as well as the action to be taken in cases of death 
which may occur on board. At the end of the volume is a glossary con- 
taining some of the terms used in the text which will aid in interpreting 
the instructions given. 
The outfits of medicines and medical supplies likely to be furnished 
consist, as listed, of either (a) the Medicine Box, (b) the Medical Boat 
Introduction 
1 MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
2 
Box, (c) the First-Aid Case (armed guard), and (d) the First-Aid 
Kit (gas casualties), Navy standard. 
Medical stores should be obtained in advance of actual need. Certain 
types of small vessels rarely require medical stores other than those 
listed. It is intended that such vessels will be furnished necessary medi- 
cal treatment and stores by the shore station, base, tender, or larger vessel 
with which contact is had. During periods in transit or on detached 
service, such vessels may obtain medical stores from any naval Medical 
Department activity, in the following order of preference: (1) Shore 
stations or bases regularly supplying similar vessels; (2) any shore sta- 
tion or base; (3) any naval medical supply depot or storehouse; (4) 
other ships. Activities receiving such requests are directed to issue such 
essential medical stores as may be so requested. Shore activities located at 
ports where such vessels frequently call shall be prepared to render this 
service. Financial reports will not be submitted by vessel not having an 
allotment. Medicine Box, United States Navy. Illustration shows stowage of contents. Shelves 
are detachable. 
Medicine Box, United States Navy. Container and contents shown. Medical Boat Box, United States Navy. Illustration shows stowage of contents. 
Medical Boat Box, United States Navy. Container and contents shown. First-Aid Case (Armed Guard), United States Navy. Illustration shows stowage 
of contents. 
First-Aid Case (Armed Guard), United State Navy. Container and contents shown. First-Aid Kit (Gas casualties), United States Navy. Container and contents shown. 
First-Aid Kit (Gas casualties), United States Navy. Illustration shows stowage of 
contents. Contents of Medical Units 
The Medicine Box 
Case, Tablets, U. S. N., consisting of: 
Alkaline and aromatic (Seiler) vial.... 1 
Aspirin, 5-gr (Acetylsalicylic Acid) vial.... 1 
Azochloramid, saline mixture tablets vial.... I 
Bismuth Subnitrate (powdered) vial.... 1 
Borax (powdered) vial.... I 
Brown Mixture, 1-dr (Opium and Glycyrrhiza) vial.... 1 
Calomel, vial.... 1 
Cascara Sagrada, 4-gr vial.... 1 
Dover’s Powder, 5-gr vial.... 1 
Phenacetin, 5-gr vial.... 1 
Phenobarbital, vial.... 1 
Quinine Sulfate, 3-gr vial.... 1 
Soda Bicarbonate, 10-gr - vial.... 1 
Sodium Salicylate, 5-gr vial 1 
Case, Tablets, U. S. N., empty one.... 1 
(Medicines, Dressings, Etc.) 
Adhesive Plaster, 2-in. by 5-yd spool.... 1 
A PC Tablets 100 bot.... 1 
Applicator, wood 500 in bundle..,.. 1/10 
Azochloramid, saline mixture, 0.5508-gm 100 bot.... 1 
Bag, combination, hot water or ice one.... 1 
Bandage, gauze, 1-in doz 1 
Bandage, gauze, 2-in doz 2 
Bandaze, gauze, 3-5n doz.... I 
Bandage, suspensory one.... 2 
Basin, dressing one.... 1 
Castor Oil 1-qt tin 1 
Catheter, soft rubber, No. 12 F one 1 
Cotton, absorbent... 1-lb roll 1 
Dental Analgesic, local (Toothache drops) 1-oz bot.... 1 
Magnesium Sulfate (Epsom Salts) pkg 1 
Rye Bath one.... 2 
First Aid Packet (with sulfanilamide) one.... 6 
Forceps, dressing one.... 1 
Forceps, hemostatic, straight, 5k2-in. (Kelly) one.... 2 
Gauze, plain 25-yd roll.... 1 
Tincture of Iodine, Mild, 10-cc applicator vial ....3 in pkg.... 2 
Irrigator one 1 
Medicine Glass one.... 1 
Morphine Tartrate, 0.032-gm, tube with sterile needle syrette 10 
Muslin yard 5 
Ointment, Boric Acid 4-oz tube.... 5 
Ointment, Sulfur.... v 1-lb jar.... 1 
Ointment, Yellow Oxide of Mercury 1-dr tube.... 3 
Ointment, Zinc Oxide 1-lb jar.... 1 
Pins, assorted paper,... 1 
Pins, safety, large doz.... 1 
3 MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
4 
The Medicine Box—Continued 
(Medicines, Dressings, Etc.)—Continued 
Pins, safety, medium doz 1 
Prophylactic Tubes tube 100 
Shears, 6-in one.... 1 
Shut-Off, spring type one 1 
Silver Protein, Mild, 0.299-gm (tablet) 100 bot 1 
Silver Protein, Strong, 0.150-gm (tablet) 100 bot I 
Soap Liniment 1-pt bot 1 
Soda Bicarbonate (powder) 1-lb ctn 1 
Spirit of Ammonia, aromatic Y\-\b bot.... 1 
Sulfanilamide, powdered, 5-gm. packet 25 in pkg 4 
Sulfathiazole, 0.5-gm (tablet) 100 bot 1 
Suture, surgical gut, untreated, No. 2, threaded in needle tube.... 6 
Suture, surgical gut, mild treatment No. 2 threaded in needle... .tube.... 6 
Syringe, p., pipette one 2 
Thermometer, clinical one.... 2 
Tongue Depressor, wood , ..500 in pkg.... 1/10 
Tourniquet, Web one.... 2 
Tube, glass, window (for irrigator rubber tubing) one 2 
Tube, rectal one 1 
Tubing, rubber, %-'m 12-ft length.... 
Petrolatum, White, Vaseline 1-lb can.... 1 
Wire Mesh (for splints) 3-ft piece 3 
Case, empty, 30- by 19- by 17-in one.... 1 
Medical Compend book 1 
The Medical Boat Box 
Morphine Tartrate, 0.032-gm, tube with sterile needle... .syrette.... 10 
Petrolatum, liquid 1-qt tin 2 
Spirit of Ammonia, aromatic, tube and paper cup.. 4 in pkg 1 
Acetylsalicylic Acid, 0.324-gm. (Aspirin) (tablet) 100 in bot.... 1 
Extract of Cascara Sagrada, 0.259-gm. (tablet) 100 in bot 1 
Tincture of Iodine, Mild, 10-cc applicator vial 3 in pkg.... 1 
Bandage Compress, 2-in, camouflaged 4 in pkg.... 2 
Bandage Compress, 4-in, camouflaged 1 in pkg.... 1 
Bandage, gauze, compressed, 1-in., camouflaged one.... 6 
Bandage, gauze, compressed 2-in., camouflaged one.... 6 
Bandage, gauze, compressed, 3-in., camouflaged one.... 6 
Bandage, triangular, compressed, camouflaged one.... 2 
Cotton absorbent, compressed 1-oz pkg.... 4 
Gauze, plain, compressed 1-oz pkg 6 
Pins, safety, large doz.... 1 
Splint, wire mesh for, 5- by 36-in piece 1 
Tourniquet, Web, camouflaged pkg 1 
Ointment, Boric Acid 4-oz tube.... 3 
Sulfadiazine, 24 1-gm tablets in package pkg.... 2 
Sulfanilamide, powdered, 5-gm packet 25 in pkg.... 1 
Sodium Bicarbonate, 0.648-gm (tablet) 100 bot.... 1 
Box, boat, empty one 1 MEDICAL SUPPLIES 
5 
The First Aid Case (Armed Guard) 
(Medicines, Dressings, Etc.)—Continued 
Magnesium Sulfate (Epsom Salt) pkg 1 
Morphine Tartrate, 0.032-gm, tube with sterile needle syrette.... 20 
Ointment, Mercurous Chloride, Mild, compound tube.... 50 
Ointment, Yellow Mercuric Oxide, 1% 1-dr tube.... 5 
Petrolatum, White (Vaseline) 1-lb. can.... 1 
Sodium Bicarbonate (powder) 1-lb. ctn.... 1 
Spirt of Ammonia, aromatic G~lb. bot.... 1 
Acid, Acetylsalicylic, 0.324-gm (tablet) 100 bot.... 2 
Alkaline and Aromatic (Seiler) (tablet) 100 bot.... 1 
Extract of Cascara Sagrada, 0.259-gm (tablet) 100 bot.... 1 
Opium and Glycyrrhiza Compound, 3.7-cc (tablet) 1,000 bot.... 1 
Tincture of Iodine, Mild, 10-cc applicator vial 3 in pkg. ... 3 
Applicator, wood 500 in bundle. 25/500 
Bandage, gauze, 1-in doz.... 1 
Bandage, gauze, 2-5n doz.... 2 
Bandaze, gauze, 3-in doz.... 1 
Bandage, triangular, compressed one.... 2 
Bath, eye one.... 1 
Case, Pins, Scissors and Dressing Forceps one.... 1 
Cotton, absorbent, compressed 1-oz pkg.... 6 
Dressing, battle, large one.... 6 
Dressing, battle, small one.... 18 
Dressing, head, adjustable, compressed one.... 4 
Gauze, plain, compressed 1-oz pkg.... 18 
Medicine Glass one.... 1 
Plaster, adhesive, 2-in. by 5-yd spool.... 2 
Shade, eye, single one.... 2 
Spectacles, smoked glass one.... 3 
Splint, basswood for, 18- by 3%-in 12 in set.... 1 
Syringe, p., pipette, with rubber bulb, %-oz capacity one.... 2 
Thermometer, clinical one.... 2 
Tourniquet, braided line (Spanish windlass type) one.... 4 
Tongue Depressors, wood .500 in bundle. 25/500 
Pencil, indelible one.... 1 
Dental Analgesic, local (Toothache drops, NF) 1-oz bot.... 1 
Suture, surgical gut, boilable No. 2, threaded in needle tube.... 6 
Tag, Medical Emergency 25 in pkg.... 1 
Suitcase, hard fiber, 30- by 12- by 11-in one.... 1 
Alcohol 200-cc. bot.... 1 
Benzedrine Inhaler one.... 4 
Boric Acid Solution, 4% 200-cc. bot.... I 
Detergent Emulsion 1-pt. bot.... 1 
Ointment, Boric Acid 4-oz. tube.... 6 
Sulfanilamide, powdered (for topical application) 5-gm packet.25 in pkg.... 2 
A PC Tablets 100 bot.... 1 
Atabrine, 0.1-gm (tablet) 100 bot.... 1 
Silver Protein, Mild, 0.299-gm (tablet) 100 in bot.... 1 
Silver Protein, Strong, 0.150-gm (tablet) 100 bot.... 1 
Sodium Bicarbonate, 0.648-gm (tablet) 100 bot 2 
Sulfathiazole, 0,5-gm (tablet) 100 bot.... 2 MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
First Aid Kit (Gas Casualties) 
(Medicines, Dressings, Etc.)—Continued 
Forceps, hemostatic, straight, 5-in. (Jones) one 1 
Pencil, dermatographic, double end blue and red. (skin marking) ... .one.... 1 
Litter, canvas, complete with splints and straps one.... 1 
Insecticide, powder (for body lice) 2-oz pkg.... 2 
Medical Compend (book) one.... 1 
Prevent Venereal Disease (leaflet) one.... 15 
Venereal Prophylaxis Instructions (leaflet) one.... 1 
First Aid Kit (Gas Casualties) 
Amyl Nitrate, 5 minim pearl 12 in box.... 1 
Copper Sulfate Solution, 10%, 2(4-oz with Blunt Dressing Forceps, .pkg.... 1 
Ointment, Anesthetic 1-oz tube.... 1 
Ointment, BAL tube 1 
Ointment, Butyn Ophthalmic, 2% 1-dr tube.... 2 
Ointment, Protective, S-330 3-oz tube.... 2 
Ointment, Protective, S-461 3-oz tube 2 
Cotton Pads, 1- by 2-in 50 in pkg.... 1 Directions for Use of Important Medical Supplies 
Medicines 
Alkaline and Aromatic (Seiler) (tablet). A mild, soothing antiseptic; for sore 
throat and rhinitis. 
Dose.—Dissolve two tablets in half a glass of warm water, and use as gargle 
or nasal douche every 3 to 4 hours. 
Argyrol (Silver protein, mild). A mild antiseptic; for use in inflammations of the 
eyes and as a preventive and treatment of gonorrhea (clap). Prepare a 10-percent 
solution by sprinkling one part of the crystals on the surface of 10 parts of boiled, 
distilled water, or ten tablets to one ounce of water; later, agitate until com- 
pletely dissolved. 
Warning.—Solutions should be prepared only in small amounts as needed and 
should not be used after standing more than 1 or 2 days, as the drug tends to 
deteriorate rapidly in solution. Stains may be removed with bichloride solution. 
Aspirin (Acetylsalicylic acid) (S-grain tablet). An anodyne and analgesic; for 
headache, neuralgia, rheumatism, colds and fever. May also be used as a gargle 
in painful sore throat. 
Dose.—For headache: One tablet, preferably followed by a half teaspoonful of 
sodium bicarbonate (baking soda), repeated in 1 hour if necessary. For sore 
throat: One tablet dissolved in one-fourth glass of warm water. 
Atabrine. Used in the prevention and treatment of malaria. Antabrine is a yellow 
bitter powder supplied in the form of 0.1-gram tablets. When operating in known 
malarious areas it is essential that all men take Atabrine regularly to prevent the 
development of the symptoms of malaria. This is known as suppressive or pre- 
ventive therapy. 
Dose (suppressive schedule).—One tablet each day for 6 days. 
Dose (treatment schedule).—Use schedule on page 79. 
Warning.—The skin of many patients taking Atabrine turns slightly yellow. 
This is not serious and should not be mistaken for jaundice. If taken before meals 
Atabrine may produce nausea and vomiting. 
Azochloramid Saline Mixture Tablets. A mild antiseptic for the treatment of 
infected wounds and burns. To prepare, place one tablet in 2 ounces of water, 
crush and stir. Infected wounds may be soaked in Azochloramid solution or cov- 
ered with gauze dressings moistened with the solution. Do not use this solution 
in the eyes, mouth, or nose. 
Bismuth Subnitrate (powder). An astringent; for diarrhea. Should be mixed 
with equal parts of sodium bicarbonate (baking soda). 
Dose.—One-half teaspoonful of mixture in water every 2 hours until relieved. 
Usually 10 doses or less are sufficient. 
Borax (powder). A mild antiseptic and astringent; to be used in making eye lotion. 
Dose.— (See under Eye, diseases of). 
Brown Mixture (Opium and Glycyrrhiza tablets) (1-dram tablet). An expec- 
torant; for coughs and bronchitis. 
Dose.—One tablet dissolved in the mouth every hour. 
Warning.—Limit, 20 tablets in 24 hours. 
Caffeine (coffee and tea). Stimulantes the brain, breathing and the circulation 
(heart and blood vessels) ; useful in the treatment of collapse or shock resulting 
from injuries. Coffee and tea contain the drug and are of value not only because MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
of the Caffeine, but also because of the increased body warmth resulting from the 
administration of hot liquids. 
Dose.—Six to eight ounces in cup. 
Warning.—Coffee or tea should not be hot enough to burn when given. 
Calomel tablet). A cholagogue and cathartic; used for constipation and 
biliousness; also in some fevers. 
Dose.—One tablet every hour until five are taken. Should be followed in a few 
hours or the next morning by a dose of Epsom salt (magnesium sulfate), one 
tablespoonful dissolved in a small quantity of hot water. 
Warning.—Do not give a cathartic or laxative to a patient with abdominal or 
stomach pain. If the pain is caused by appendicitis the drug might cause the ap- 
pendix to burst. 
Cascara Sagrada (4-grain tablet). A mild laxative; preferable for chronic consti- 
pation. 
Dose.—One or two tablets at bedtime. 
Castor Oil (cathartic). Useful for emptying the bowel in beginning diarrhea. 
Dose.—One to two tablespoonfuls. First wet the mouth with a hot liquid (milk, 
coffee, or tea), then take the oil and follow with some more of the liquid. 
Dentalone (solution). Analgesic for toothache. Apply in cavity on small pellets 
of cotton after first touched to another piece of cotton to remove excess fluid, and 
after cavity has been cleaned out and dried. 
Epsom Salt (magnesium sulfate, crystals). A quick acting cathartic; for consti- 
pation. 
Dose.—One to two tablespoonfuls, preferably dissolved in a small quantity of 
hot water. Should be taken on an empty stomach. Excellent also as a wet dress- 
ing and hot soak in the treatment of infected wounds. (25 percent solution is 
used for inflamed areas and wounds). 
Formaldehyde Solution (Poison). Disinfectant; for use as disinfectant only. 
Should be kept well stoppered and in a cool place. Two tablespoonfuls of this 
solution to 1 quart of water serves as an excellent disinfectant for knives, forks, 
cups, etc. (See Disinfectants). 
Warning.—The escaping vapor is very irritating to the eyes, nostrils, and lungs. 
Iodine, Tincture (Poison), (mild tincture, in applicator vials). Antiseptic for 
minor wounds. Unscrew cap of vial and apply according to instructions or swab 
out wound with moistened cotton applicator. Use lightly and only once. 
Warning.—Applied to skin may cause blisters especially when covered by a 
dressing. Never use iodine on wet skin or in connection with bichloride of 
mercury. 
Mineral Oil (Petroleum, liquid). A lubricant; used externally in the treatment 
of burns of the body and eyes, and treatment of immersion foot. It is also used 
to remove fuel oil from the skin. Given internally, mineral oil relieves consti- 
pation. 
Dose.—One tablespoonful on empty stomach before retiring. 
Morphine Syrette (Morphine Tartrate, /2-grain). A narcotic which acts upon 
the brain and nervous system and thus relieves severe pain; of great value in 
treating shock resulting from severe injuries. Prepared in handy form for emer- 
gency use. 
Dose.—One syrette. 
Directions for use of morphine syrette: 
1. Use only to relieve pain. MEDICAL SUPPLIES 
9 
2. Usually the outer surface of the upper arm is the site selected for the 
injection as it is convenient and the skin is less sensitive. However, the 
needle may be injected into the thighs if the arms are burned or injured. 
3. Give patient one injection of morphine. If pain recurs, 
a second syrette may be given 4 hours or more after 
the first. 
4. Do not give morphine if breathing is slow, 12 per min- 
ute or less. 
5. Keep a record of. each dose, noting the time given. If 
patient is to be moved, note dose and time on tag tied 
to patient’s wrist. 
Technique of administration: 
1. Remove transparent hood from the needle. 
2. Grasp wire loop and push wire in to pierce inner seal. 
3. Pull out and discard wire. 
4. Thrust needle through the skin at least half its length. 
5. Inject the morphine solution by slowly squeezing the 
syrette from the sealed end. 
Warning.—Morphine is a habit forming drug. Do not give re- 
peated regular injections of this drug to the same patient. In 
general one or two injections are all that should be given. Care 
should be taken to prevent loss or theft of the morphine syrettes. 
Ointment, Boric Acid (tube). For dressing minor wounds, 
chafing, and for protecting the skin. Apply and then bandage. 
Ointment, Sulphur (jar). For itch and ringworm. Rub on affected part thor- 
oughly. (See Itch, treatment of). 
Ointment Yellow Oxide of Mercury (tube). For styes and other inflamma- 
tions of the eyes and lids. Pull down the lower lid and place the uncovered open- 
ing of the tube just above the everted lid. Press out a small portion of the oint- 
ment and close the lid. Movement of the eye will spread the ointment over *the 
inflamed eye and lids. Do not use this ointment with Argyrol. 
Ointment, Zinc Oxide (jar). For eczema, sunburn, cold sores, etc. Apply locally 
and bandage. 
Phenacetin (5-grain tablet). An analgesic and antipyretic; for headache, neural- 
gia, and fever. 
Dose.—One tablet with a glass of water, repeated in 1 hour if necessary. 
Phenobarbital tablet). A sedative and hypnotic; for producing sleep 
and quieting restlessness. 
Dose.—One tablet with a warm drink a half hour before bedtime, may be re- 
peated with caution. 
Warning.—Limit, five tablets in 24 hours. An occasional individual is allergic 
to this drug. In such cases, patients may develop skin rash, high fever and mental 
confusion. 
Prophylactic Tubes. For venereal prophylaxis. To be used in accordance with 
accompanying instructions. 
Protargol (Silver protein, strong) (0.150-gram tablet). An antiseptic; in 1 per- 
cent solution used as injection into the urethra as a preventive and treatment of 
gonorrhea (clap). For use, dissolve 3 tablets in pint of distilled water. The 
solution should be freshly prepared, made in small quantities as needed, and kept 
in amber-colored bottles. 
Warning.—More irritating than Argyrol. Do not use in eyes. 10 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Quinine Sulfate (3-grain tablet), Antimalarial; for suppression and treatment 
of malarial fevers. 
Dose (suppressive—if Atabrine not available).—3 tablets (9 grains) daily. 
Dose (treatment schedule).—5 tablets (15 grains) three times daily for 2 days 
followed by 3 tablets (9 grains) three times daily for the following 5 days. Repeat 
if fever returns. 
Warning.—Limit, 12 tablets in 24 hours. An occasional individual is allergic to 
this drug. In such cases, patients may develop itching and skin rash, ringing in 
the ears, nausea, and vomiting. Administration of the drug should be discontinued 
on the first appearance of any of these symptoms. 
Salt (Sodium Chloride—common table salt). A chemical required by the body 
to maintain healthy function. Externally a mild antiseptic. Used in the preven- 
tion and treatment of heat cramps and heat exhaustion. With baking soda or 
alone, dissolved in water makes a soothing alkaline gargle. 
Dose (for heat cramps).-Five-grain tablet (or l/% teaspoonful) in 6 ounces of 
water; (for gargle or wet dressing).—to teaspoonful in 8 ounces of water. 
Soap Liniment. Use with massage for lumbago, painful muscles, sprains, etc. 
Warning.—External use only. 
Sodium Bicarbonate (baking soda). Antacid; for indigestion and heartburn. Also 
for use with Bismuth Subnitrate (see above), and for preparing eye wash (see 
Eye, diseases of). 
Dose.—Two tablets or 1 teaspoonful dissolved in one-half glass of water for 
mild cases of indigestion. A paste or solution of baking soda relieves the itching 
caused by poison ivy, hives and insect bites. 
Sodium Salicylate (5-grain tablet). Analgesic and antirheumatic; for rheuma- 
tism and rheumatic pains. 
Dose.—Two tablets every 4 hours. 
Warning.—Limit, 12 tablets in 24 hours. Watch for symptoms of drug intoxica- 
tion, such as ringing in the ears, nausea, vomiting, and deafness. Administration 
of the drug should be discontinued on the first appearance of symptoms. 
Spirit of Ammonia, Aromatic (bottle). Antacid and diffusible stimulant; for 
faintness, shock and relief of nausea. 
Dose.—By mouth; one-half teaspoonful well diluted with water; by inhalation: 
from saturated gauze or handkerchief. 
Sulfadiazine (i-gram tablet). A chemical substance which, when SWAL- 
LOWED, destroys or prevents the growth of certain bacteria in the body. These 
tablets are given ONLY to persons having open wounds of the flesh, bones, brain, 
etc. 
Dose.—Four tablets by mouth—at once. Water can be given to help swallowing. 
After the initial dose of 4 tablets, if delay is experienced in getting patient to a 
doctor, give 1 tablet (AND ONLY i) every 6 hours. 
Warning.—Do not give these tablets any longer than 2 days. 
Sulfanilamide (Sterile powder in S-gram package). A special antiseptic for 
severe wounds of muscle, bone, brain, chest, and abdominal organs. 
Dose.—Dust the powder evenly into the deep recesses of and over entire wound 
(or wounds). 
Warning.—Do not apply powder too thickly. Do not give by mouth. Do not use 
in connection with iodine or any other chemical substance. 
Vaseline (Petrolatum white) (tin). Protective ointment and lubricant. Apply 
locally for burns, sunburn, chapped hands, etc., and as a substitute for mineral oil 
in treating immersion foot. May be used as a lubricant for catheters, rectal tubes, 
etc. MEDICAL SUPPLIES 
11 
Dressings, Etc. 
Adhesive Plaster (2 inches by 5 yards, spool) (deteriorative). For securing 
dressings to skin, and for minor abrasions. 
Bag, Hot Water (rubber) (deteriorative). Fill to one-half its capacity with hot 
water, expelling the air before screwing down the stopper; then hold the bag up- 
side down to be sure there is no leakage. Wrap bag in a bath towel and place 
over the desired area. 
Warning.—Watch carefully to see that bag is not too hot, especially with an un- 
conscious or delirious patient. 
Bag, Ice (rubber) (deteriorative). Break ice into small pieces by pounding it in 
a piece of canvas. Fill the bag to three-quarters of its capacity, expel the air, 
replace cover, and wrap bag in a towel. 
Warning.—Never put the rubber directly on the skin. 
Bandage, gauze (1, 2, and 3 inch). For retaining dressings. 
Warning.—Do not bandage too tightly. 
Bandage, suspensory. For supporting painful testicles, and retaining dressings in 
cases of orchitis. 
Basin, dressing. For bathing patients and preparing solutions. 
Catheter (soft rubber, sizes 10 to 20 French) (deteriorative). To be used for 
drawing off the urine in an unconscious patient or one with an obstructing stric- 
ture of the urethra. Boil for 10 minutes before use, and handle only with sterile 
hands. Lubricate with sterile oil or vaseline before passing and use the utmost 
gentleness. Try the larger sizes first. 
Cotton, aborbent (roll). For dressings, wipes, and for padding under bandages. 
Warning.—Do not place in contact with wounds (use sterile gauze). 
Eye Bath (glass). To be used in bathing the eyes. Should be sterilized before 
using. (See Eye Wash under Eye, diseases of). 
First-Aid Packet. Sterile dressings sealed in tin. For emergency treatment of 
wounds. 
Forceps, hemostatic. For catching the ends of bleeding vessels until they are tied 
(ligated), and for use as a needle holder. Boil, with scissors and dressing forceps, 
for 15 to 20 minutes before using, and handle only with sterile hands. Dry well 
after use. 
Gauze, plain, absorbent (roll). For dressings, etc. Should not be placed in con- 
tact with wounds until sterilized. Cut in pieces as desired. 
Irrigator. For giving enemas, washing ears, etc. Fluids flow by gravity and bag 
should not be elevated more than 2 or 3 feet above the nozzle. 
Medicine Glass. Graduated in teaspoons and tablespoons, for measuring doses of 
medicine. Keep clean. 
Muslin (5-yard piece). Cut as desired for supportive dressings, slings, and for 
special bandages. 
Pencil, hair. For applying collodion to dressings. Clean brush well after use to 
prevent hardening. 
Pins, Scissors, and Dressing Forceps (set in case). For applying surgical dress- 
ings ; the forceps for holding edges of wounds while suturing, and scissors for 
cutting sutures and dressings. 
Spatula (3 inch). For mixing and spreading ointments on dressings. 
Suture, surgical gut, untreated (boilable, No. 2, threaded in needle) (tube). For 
ligating blood vessels which must be buried. Place tube in formaldehyde solution, 
or boil with instruments. Break at file mark in sterile gauze, and handle only with 
sterile hands. Use hemostatic forceps as needle holder. 12 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Suture, surgical gut, mild treatment (boilable, No. 2, threaded in needle) (tube). 
For suturing wounds. Handle as above. 
Syringe, p. pipette. For injection of argyrol solution into urethra as preventive and 
treatment of gonorrhea (clap). Do not inject more than ll/2 teaspoonfuls at a time. 
Thermometer, clinical (in case). For taking patient’s temperature. (See note 
under Fevers). 
Tourniquet. For control of hemorrhage from arteries. To be wrapped around 
limb above bleeding point enough to stop the bleeding until other means can be 
taken. Use with caution. (See under Hemorrhage). 
Wire Mesh, for splints (roll). For immobilizing fractured limbs and dislocations. 
Cut to desired size with heavy shears and mold to affected part after thorough 
padding. Secure with bandage. Chapter II 
FIRST AID 
General Instructions 
To maintain the high degree of physical fitness and mental alertness 
essential to the men of every ship, it is important that first aid be prac- 
ticed until all hands are prepared to quickly and properly treat casualties. 
It is to be expected that accidents will occur during storms or freezing 
weather, or that there will be excitement and danger resulting from col- 
lision, fire, or battle. Often during such times of stress the necessary 
first aid materials are difficult to obtain or an unexpected number of 
casualties may require immediate treatment. Only men trained in first aid 
are able to improvise and adapt themselves to every situation. 
If an accident occurs, and a medical officer is not available, tbe person 
giving first aid must take charge and administer emergency care to the 
victim. 
Follow these general rules : 
1. Be quiet and cool, don’t get excited, and do the best possible with 
the facilities at hand. 
2. Keep the injured man lying down. Do not move him more than 
necessary. 
3. Locate all injuries. Remove only the clothing necessary to examine 
the injury. Clothing must be removed in such a way as to disturb the 
patient as little as possible. If necessary, the outer clothing should be 
ripped up the seam; the under clothing torn or cut. In removing shoes 
it is often necessary to cut them off when they cannot be removed other- 
wise without causing great pain or increasing the injury. 
4. If a bone is broken, apply a splint before moving the patient. 
5. Treat the most serious injuries first— 
(o) Stop severe bleeding. 
(b) If breathing has stopped give artificial respiration. 
6. Treat for shock. Often when serious injuries occur, emergency 
treatment should consist of doing nothing other than keeping the patient 
comfortably warm and quiet. 
7. Loosen tight clothing which may be present around the neck, chest, 
abdomen, legs, and ankles. 
8. If there is vomiting, turn the head to one side so the vomited mat- 
ter may escape easily from the mouth. This eliminates the risk of vomited 
matter going into the windpipe and choking the patient. 14 
MEDICAL COM PEND FOR COMMANDERS OF NAVAL VESSELS 
9. If the patient is unconscious, do not try to force him to drink, for 
he cannot swallow and may choke. If conscious and able to swallow, a 
few sips of water will be refreshing. 
10. If stimulants are needed, whisky and brandy are not always indi- 
cated. In fact, there are conditions in which they do harm. Hot tea or 
coffee are excellent stimulants, as is also aromatic spirits of ammonia—a 
teaspoonful well diluted in water. 
Injuries 
shock 
Most injuries are followed immediately, or several hours after they 
occur, by a depression of the body’s nervous system and other vital activi- 
ties. This condition is usually known as “shock,” although it is sometimes 
called collapse, exhaustion, or prostration. Shock following minor injuries 
is usually mild; however, shock brought on by more severe injuries is 
very serious, and is frequently the cause of death. 
Remember: Shock, if it is not treated, may cause death even though the 
body injury is not of a type which ordinarily would prove fatal. 
All injured men, unless they are bleeding or have stopped breathing, 
should be treated for shock before the actual body injury is treated. The 
more serious the injury, the more important it is to treat shock prompt!y. 
Loss of blood, cold, fatigue, fear, and pain tend to make shock more 
severe, therefore relieve these conditions as soon as possible. 
Symptoms 
1. Blunted sensibility—Varies from faintness or dizziness in mild shock 
to drowsiness or complete loss of consciousness in severe shock. 
2. Skin—Pale, cold, and sweaty. 
3. Pulse—Weak and rapid. 
4. Breathing—Irregular, sighing, gasping. 
5. Nausea and vomiting—May be present. 
Even though the symptoms of shock may not be present when the in- 
jured man is first examined, regular shock treatment should be given 
promptly, as the procedures which are used to treat shock also help pre- 
vent shock. 
Treatment 
1. Keep head low—Place patient on his back with the head slightly 
lower than the feet. If the face is flushed, the head may be slightly 
raised. 
2. Keep patient warm—In shock the body loses heat rapidly. Place a 
coat or blanket under and over the patient, and, if available, hot 15 
FIRST AID 
water bottles may be placed alongside the body. (Be careful not 
to burn the patient.) 
3. Stimulants—Aromatic spirits of ammonia is available for emergency 
use in handy collapsible tubes containing y2 teaspoonful of the 
liquid. The aromatic spirits of ammonia may be either inhaled by 
holding the open tube under the nose of the injured man, or the 
contents of the tube may be emptied into a cup of water and given 
to the injured man to drink. 
Hot coffee or tea may be given if the patient is conscious. The hot 
liquid helps warm the body, and coffee and tea contain caffeine, a 
good heart and breathing stimulant. 
4. Morphine—Morphine is given to quickly relieve pain. For emer- 
gency use it is supplied in a handy collapsible tube and needle unit, 
commonly known as a “morphine syrette.” The syrette contains 
enough morphine grain) for one injection. 
Directions for use: See page 8. 
Serious Bleeding 
The heart may be considered as a muscular pump which, by its beats, 
forces the blood to all parts of the body through a series of tubes known 
as blood vessels. The arteries carry the blood from the heart; the veins 
return the blood to the heart. The capillaries are a network of smaller 
vessels situated between and connecting the arteries and veins. 
Arterial bleeding is recognized by the fact that the blood is bright red 
in color and spurts out with each heart beat. In venous bleeding the 
blood is dark red and flows steadily. Capillary bleeding occurs as a gen- 
eral oozing and is of a brick red color. 
Bleeding from most wounds is easily controlled; however, if a large 
artery or vein is cut, bleeding will be severe and may cause death if it is 
not stopped promptly. 
Three methods of stopping bleeding are: 
1. Direct pressure over the wound. 
2. Digital pressure over the main artery. 
3. Tourniquet. 
Direct Pressure 
Most bleeding can be controlled by placing a sterile gauze pad directly 
over the wound and bandaging it securely in position. If necessary, apply 
pressure with the hand directly over the gauze pad until bleeding stops. 
Elevation and rest of the wounded part decreases the flow of blood and 
assists clotting. 
If the bleeding cannot be controlled by the use of a sterile gauze pad, MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
16 
pressure with the fingers at the proper one of the six pressure points 
should be applied, as described below. 
Digital Pressure 
No first aid materials are required; therefore, digital pressure can be 
used immediately to stop severe arterial bleeding. 
With the fingers, pressure is applied firmly to the main artery supplying 
blood to the injured part. 
Pressure is applied at a 
point between the heart 
and the wound where the 
artery is near the skin 
surface and lies over a 
bone. 
The six major digital 
pressure points for con- 
trolling severe arterial 
bleeding are as follows: 
For bleeding from the 
region of the temple and 
scalp apply pressure to a 
point just in front of the 
ear on the same side of 
the head where the wound 
is. This presses the main 
artery to the temple 
against the skull bone. 
For bleeding from the 
cheek, below the level of 
the eye, apply pressure to 
a point on the lower edge 
of the jaw bone. Starting 
at the angle of the jaw, 
run the finger forward 
along the lower edge of 
the jaw bone until a 
small notch is found. The 
pressure point is at this 
notch. 
For bleeding from the 
neck apply pressure be- 
low the wound just in FIRST AID 
17 
front of the prominent neck muscle. Press inward and slightly backward, 
thereby compressing the main artery of that side of the neck against the 
bones of the spinal column. 
For bleeding from the shoulder or upper part of the arm apply pres- 
sure with the fingers in hack of the inner third of the collar bone, thereby 
compressing against the first rib the main artery to the shoulder. 
For bleeding from the upper arm, forearm, and hand apply pressure 
with the fingers on the inner side of the upper arm, about one-half way 
between the shoulder and elbow, thereby compressing the artery against 
the bone of the upper arm. 
For bleeding from the thigh, leg, and foot apply pressure in the middle 
of the groin with the heel of the hand, thereby compressing the main 
artery of the lower limb against the pelvic bone. 
When trying to control bleeding, fingers or dirty cloths should not 
touch the wound because of the danger of infection. However, in an 
emergency if no sterile gauze is available and if everything else fails, apply 
pressure directly to the wound. 
Tourniquet 
A tourniquet should not be applied to a limb unless all other measures 
available for stopping arterial bleeding have failed. These measures in- 
clude the application of a pressure dressing to the wound, elevation of the 
part, tying off the visible end of the severed artery, and, as described on 
page 15, pressure with fingers over the artery above the bleeding point. 
To be effective a tourniquet must be applied tightly enough to stop the 
arterial blood flow to the limb. Pressure from a tourniquet less than the 
arterial pressure will allow arterial bleeding to continue and may constrict 
the veins so as to increase bleeding from them. 
A tourniquet properly applied interrupts the entire blood supply of that 
part of the limb which is below' the point of its application. It must be 
loosened every 15 minutes. If left on continuously for more than 3 or 
4 hours, severe damage to the tissues will result, and upon release of the 
tourniquet, swelling of the limb will take place and the patient may develop 
shock. If left on uninterruptedly for a longer period, gangrene of the 
limb will result; hence, the advice to loosen a tourniquet frequently and 
never to cover it with a dressing in such a way that its presence may be 
overlooked. 
Tourniquets furnished in the Navy first aid kits are of two types—a 
rubber tourniquet and a cotton webbing tourniquet which is tightened by 
means of a buckle attached to one end. 
When a tourniquet is the only available means of stopping hemorrhage, 
the following directions should be carried out: 18 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
To stop severe bleeding from the arm apply a tourniquet about a hand’s 
breadth below the shoulder. 
To stop severe bleeding from the leg apply a tourniquet about a hand’s 
breadth below the groin. 
The rubber tubing tourniquet is quickly applied by stretching it and 
then wrapping it tightly twice about the injured limb and looping one end 
under the other to hold it securely in place. 
The cotton webbing tourniquet is applied by wrapping it once about the 
limb, and then running the free end of the strap through the slit in the 
felt pad and thence through the buckle. The strap is then drawn suffi- 
ciently tight to stop the flow of blood. The skin is protected from the 
buckle by the piece of felt. 
In an emergency tourniquets may be improvised from such articles as 
a belt, neckerchief, or any piece of cloth folded to make a flat band at 
least one inch wide and forty to fifty inches long. An improvised tourni- 
quet made of a neckerchief is applied by wrapping the cloth band twice 
about the limb and tying a half knot. A short stick or similar object is 
then placed on the half knot and a square knot tied over it. The stick is 
then twisted rapidly to tighten the tourniquet and stop the flow of blood. 
Rubber tourniquet. 
Web tourniquet. 
Spanish windlass. 
A tourniquet must he loosened every 75 minutes. If bleeding does not 
start again let the tourniquet remain loosely in place. If severe bleeding 
begins, retighten the tourniquet for another 15 minutes. 19 
FIRST AID 
WOUNDS 
Wounds are divided into several classes; the treatment of those more 
commonly encountered is given in the following pages. 
Treatment of Fresh Wounds 
In the first aid treatment of all types of fresh wounds the three main 
points are—first, stop severe bleeding, second, treat shock, and third, pre- 
vent infection. 
General directions for treating fresh wounds 
1. Stop severe bleeding—Direct pressure, digital pressure, tourniquet. 
2. Treat shock—Keep patient lying down and comfortably warm. Give 
morphine if necessary. 
3. Prevent infection: 
(a) Sulfadiazine—Each pill contains 0.5 gram of the drug and is pep- 
permint flavored. These pills are taken by mouth to prevent infec- 
tion. Four (4) pills are placed in the mouth and are to be chewed 
and swallowed. Small sips of water will aid in swallowing. If there 
is any delay in getting the patient to a doctor give one tablet (AND 
ONE ONLY) every 4 hours during the day. Do not give these 
tablets any longer than 2 days. Do not attempt to give tablets to a 
person who is unconscious or has serious injury of the mouth, throat, 
or stomach that would interfere with swallowing. 
(b) Remove dirt from wound—Using sterile forceps or tweezers re- 
move from the wound all visible dirt, bits of clothing, shrapnel, etc. 
Note: Metal instruments are sterilized by placing them in boiling 
water for at least 15 minutes. Do not attempt to probe or hunt for 
a bullet or other deeply buried objects. Do not touch wound with 
fingers. Do not wash a fresh wound with alcohol or other anti- 
septic solution. 
(c) Apply sulfanilamide—Sterile sulfanilamide powder is carried in 
paper envelopes or packets, each of which contains about one table- 
spoonful of the powder. When needed, one end of the paper envelope 
should be torn off, and the sterile powder sprinkled lightly over the 
wound. Do not use more than two (2) packets in wounds of one 
person. 
(d) Apply sterile gauze pad—Small and large size battle dressings, 
made of several thicknesses of sterile gauze, are carried in the first aid 
kit ready for emergency use. When opened, the small battle dressing 
measures 4" x 6", and the large battle dressing measures 12" square. 
If battle dressings are not available, several thicknesses of regular 
sterile gauze may be used to cover the wound. 
Note: It is advisable not to use sulfanilamide powder in wounds when 
sulfadiazine tablets have been administered by mouth. MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
20 
(e) Bandage—Battle dressings are held securely in position by means 
of four gauze or muslin bandages attached firmly to the back of the 
sterile gauze pad. (Resembles a large four-tailed bandage). These 
bandages or “tails” should be wrapped snugly about the pad and the 
injured part. Roller gauze or triangular bandages are used to hold 
regular gauze pads in position. 
The use of iodine or other antiseptics on fresh wounds is not recom- 
mended, as antiseptics may, in addition to killing germs, injure or kill the 
tissues surrounding the wound, thereby preventing healing. Recent ex- 
perience with war wounds indicates that sulfonamides properly adminis- 
tered stops the growth of most germs causing wound infection. 
If a wound is smeared with grease or oil, cover the wound with sterile 
gauze and cleanse around the wound with soap and water or alcohol. To 
avoid washing germs into the wound begin near the edge of the wound 
and wipe away from it—never toward it. If it becomes necessary to wash 
a wound to get the dirt out, use sterile warm water, mild soap, and a pad 
of sterile gauze as a sponge. A boiled common-salt solution (1 teaspoonful 
to a pint of water) is a very good one with which to wash and dress 
wounds. Be sure the water is sterile before applying it to the wound. 
(Should be boiled at least 15 minutes). 
Gas gangrene is unlikely to develop in a wound as long as it is left open. 
Therefore it is usually best not to attempt to suture or close open wounds. 
Merely cover the open wound with sterile gauze. 
Keep the patient at rest. Body defenses are best increased by complete 
rest of the body and by elevation of the injured part. 
Under battle conditions it may be possible to give only very limited 
emergency treatment to wounds. Minimum treatment under such condi- 
tions would consist of: 
1. Stop bleeding. 
2. Cover wound with a sterile gauze pad (battle dressing). 
At the earliest opportunity further treatment should be given as di- 
rected above. 
Wounds Requiring Special Treatment 
The symptoms and treatment of the following special wounds are de- 
scribed : 
Infected wounds. 
Puncture wounds. 
Chest wounds. 
Abdominal wounds. 
Blast injuries. 
Eye wounds. 
Wounds caused by splinters. 
Insect bites. 
Dog bites. 
Snake bites. 
Bruises. 
Strains. 
Sprains. 
Blisters. FIRST AID 
21 
Infected Wounds 
War wounds and accidental wounds always contain many germs. For- 
tunately the body tissues, if given a chance, are capable of taking care of 
any infection that may be present. If, however, the germs are present in 
large numbers, they may overcome the body’s resistance and spread into 
the surrounding tissues, producing what is known as an infected wound. 
This is especially apt to occur if the wound contains much dirt, bits of 
clothing, metal, etc., and if the tissues surrounding the wound are bruised 
and torn. 
Symptoms 
1. Pain—Throbbing in character. 
2. Swelling—Tissues about the wound are swollen. 
3. Inflammation—Skin about the wound is red. 
4. Pleat—Skin about the wound is warm. 
5. Pus—Usually seen in the wound. 
6. Red streaks—May radiate from the wound. 
7. “Kernels”—Swollen lymph nodes or “kernels” may be found— 
(a) In the groin, if the infection is in the leg. 
(b) In the armpit, if the infection is in the arm. 
(c) In the neck, if the infection is in the head. 
Treatment 
1. Rest—Rest of the infected part helps the body overcome infection. 
2. Elevation—Elevation of the infected part helps reduce the swelling— 
thus improving circulation to the infected part. 
3. Warm wet dressings—Apply warm wet dressings to the infected 
wound. 
(a) Wet dressings are large, bulky pads made of gauze, absorbent lint, clean 
cloths, or towels. It is important that the pad be large enough to extend at 
least 5 or 6 inches beyond the infected wound in every direction, and it 
should be at least 1 inch thick. The dressing is wrung out in a warm 
solution of any one of the following—ordinary table salt, epsom salt, or boric 
acid. A solution of table salt should be approximately normal, that is, a 
teaspoonful of salt to a pint of water. A solution of Epsom Salt or Boric 
Acid should be saturated. 
(Note: A saturated solution is made by putting as much of the salt or boric 
acid in the water as will dissolve.) 
Warm Azochloramid solution may also be used as a wet dressing or soak 
for the infected wounds. Azochloramid tablets are carried in the medicine 
box and the solution is easily made by dissolving 8 tablets in 1 pint of 
water. 
(b) Bandage the wet dressings in place. 
(c) The dressings must be kept wet and warm. Change them as necessary. 
(d) For the first six hours the wet dressings should be applied continuously. After 
that the wet dressings are applied only for an hour at a time, followed by 
a drying period of an hour. This alternate wet-dry treatment should be 
continued until the symptoms of infection disappear. MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
4. Warm soaks—Infections of the hands and feet are often treated 
more conveniently by “soaking” rather than with wet dressings. The 
infected part is merely immersed in a warm saturated salt, boric acid, 
or Azochloramid solution for several hours with drying intervals of 
Yz to 1 hour between soaks. The solution should be kept comfortably 
warm. 
5. Do not cut or attempt to open an infected wound. Cutting with a 
knife through infected skin and other body tissues may only cause the 
infection to spread. 
PUNCTURE WOUNDS 
These wounds, also known as stab or bullet wounds, are caused by 
small piercing objects such as a nail, sharp stick, knife, or bullet. 
Although the opening of a puncture wound may be small, the wound is 
often deep, and there may be serious internal bleeding. 
Do not hunt for, or attempt to remove, deeply buried objects. In the 
case of bullet wounds look for wounds of entrance and exit. 
Formerly many men with puncture wounds developed tetanus or “lock- 
jaw” infection; however, this danger has been overcome by giving tetanus 
toxoid to all men in the United States Navy. 
Treatment 
1. Treat the wound as directed under “Treatment of Fresh Wounds." 
2. The presence of internal bleeding is indicated by the development 
of symptoms of shock. Treat as directed under “Treatment of 
Shock.” 
CHEST WOUNDS 
If the lung is punctured, patient will cough up frothy, bright red blood. 
Treatment 
1. Treat the wound as directed under “Treatment of Fresh Wounds.” 
2. Treat for shock as directed under “Treatment of Shock.” 
3. Bandage the chest firmly. Adhesive strapping of the injured side 
of the chest often makes the patient more comfortable. 
4. It may be necessary to prop the patient up on pillows to make 
breathing easier, despite the fact that this position is not recom- 
mended for a patient in shock. 
ABDOMINAL WOUNDS 
There may be serious injury of the stomach, intestines (gut), large 
blood vessels, or other internal organs. 
Do not give water by mouth if there is injury of the stomach or intes 
tines. FIRST AID 
23 
T reatment 
1. Treat for shock as directed under “Treatment of Shock.” 
2. If the intestine or gut is exposed, cover it with a sterile moist 
gauze dressing. Water which has been boiled for at least 15 min- 
utes then allowed to cool to about body temperature should be 
used. If no sterile water is available, merely cover the wound with 
a dry sterile gauze dressing. 
3. Sterile sulfanilamide powder sprinkled into the abdominal wound 
is of great value in preventing infection. (See “Treatment of 
Fresh Wounds.”) 
Blast Injuries of the Abdomen and Chest 
Injury to the internal organs may be caused by pressure or suction 
waves set up by the detonation of high explosives in the air or in the 
water. 
Usually there is no external evidence of a bruise or wound, but there 
will be signs of shock. 
Treatment 
1. Treat for shock as directed under “Treatment of Shock.” 
Eye Wounds (Foreign Bodies) 
Small particles such as dirt, coal, or bits of metal may become lodged 
in the eye. 
Treatment 
1. Do not rub the eye. 
2. Gently hold the lids apart and examine the surface of the eye and 
the inner surfaces of the upper and lower lids. 
3. Gently wash out the particle with plain water or the 2 percent 
boric acid solution which is carried in the medicine box. Either 
the medicine dropper or the eye cup is useful for this purpose. 
They should be sterilized before use by placing them in boiling 
water for 15 minutes. 
4. If washing is unsuccessful, brush the particle gently with a little 
cotton wound around the end of a match stick or a wooden applica- 
tor. The cotton should be moistened with clean water or boric acid 
solution. 
5. If the particle is buried in the eye, do not attempt to dig it out. 
Instead, put two drops of 10 percent Argyrol in the eye, followed 
by several drops of clean mineral oil, castor oil, or olive oil. MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
6. Close the eyelid. Apply several thicknesses of gauze (1 inch 
thick) and secure with adhesive or gauze bandage. This prevents 
movement of the eyelid and keeps out light, thereby alleviating 
pain. Dress in this manner daily. 
Splinters of wood, metal, glass, and other materials frequently pierce 
the skin and remain buried in the tissues. If the splinter is deeply buried, 
make no effort to remove it, but treat the wound as a puncture wound. 
Wounds Caused By Splinters 
Treatment 
1. Sterilize the skin over the splinter with iodine. 
2. If the splinter is clearly visible, open or pierce the skin with a 
needle or sharp knife point which has been sterilized by passing it 
through a flame several times. 
3. Remove the splinter. For this purpose, forceps (tweezers) or a 
hemostat (small pincers) are useful instruments. They are car- 
ried in the first aid kit. Boil the instruments for 15 minutes before 
using. 
4. Encourage bleeding from the wound (if it is superficial), thus 
washing it from inside out. 
5. Apply a sterile gauze dressing. 
BRUISES 
A bruise is caused by a blow to some part of the body, and though the 
skin is usually not broken, there may be extensive damage to underlying 
muscles, tendons, blood vessels, and nerves. Blood oozes from the broken 
vessels into the soft tissues under the skin causing swelling and discolora- 
tion which is commonly known as a “black and blue” mark. A bruise is 
usually not serious; however, severe blows to the head, chest, and abdo- 
men may result in serious internal injuries even though the only visible 
evidence of the injury is a “bruise.” 
Symptoms 
1. Pain—Pain is felt at the site of the blow. 
2. Swelling—Swelling is caused by blood oozing into the soft tissues 
under the skin. 
3. Discoloration—A fresh bruise is red. Gradually the skin becomes 
“black and blue,” then after 3 or 4 days becomes green or yellow. 
Treatment 
1. Rest—The injured part should be protected and kept at rest. FIRST AID 
25 
2. Elevation—A bruised hand or arm may be supported in a sling while 
a bruised leg should be elevated on pillows or folded blankets, 
3. Cold (First 24 hours)—Apply an ice bag or cold cloths wrung out 
in ice water to the bruise during the first 24 hours. 
4. Heat (After 24 hours)—After 24 to 36 hours the application of 
heat and gentle massage helps diminish the swelling and discolora- 
tion. 
5. Bandage—The patient is often made more comfortable if a gauze or 
elastic bandage is applied snugly about the bruise. 
6. Treat shock—If the bruise is complicated by serious internal in- 
juries, it will be necessary to treat the patient for shock. (See 
“Treatment of Shock.”) 
STRAINS 
A strain is a muscular injury caused by sudden, forcible, overstretch- 
ing of the muscle fibers due to vigorous muscular effort such as lifting, 
running, or jumping. The muscles of the back are often involved, the 
thigh and leg muscles less frequently. 
Symptoms 
1. Pain—Develops in the muscle at the time of physical effort. 
2. Lameness—The injured muscle is unable to function properly. 
3. Swelling—Moderate swelling may develop at the site of the muscular 
injury. 
4. Stiffness—The injured muscle becomes stiff and “knotted” as in the 
so-called “Charley horse.” 
5. Aching—The pain subsides and is replaced by an aching and ten- 
derness. 
Treatment 
1. Rest—The injured muscle should be put at rest. 
2. Elevation—If the strained muscle is in the arm support it with a 
sling. If it is in the leg elevate the leg on pillows or folded blankets. 
3. Heat—Hot wet gauze dressings, hot water bottles, or a heat lamp 
may be used to apply heat to the injured area. 
4. Bandage—Apply an elastic bandage or adhesive strapping so as to 
keep the injured muscle relaxed. An elastic bandage is excellent 
to make pressure, control swelling, and provide additional support. 
Sprains 
A sprain is an injury of the joint ligaments caused by an abrupt stretch- 
ing or twisting of a joint beyond its limit of motion. The ankle, knee, 
finger, and wrist joints suffer most frequently. MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Symptoms 
1. Pain—Sharp pain is felt in the joint at the moment of injury. 
2. Swelling—Develops rapidly about the joint. 
3. Lameness—Movement of the joint increases the pain. 
Treatment 
1. Rest—The injured ligaments should be put at rest by preventing 
use or movement of the joint. 
2. Elevation—If the injured joint is in the arm or leg, the injured 
part should be elevated to help reduce pain and swelling. 
3. Cold (first 24 hours)—An ice bag or cloths wrung out in ice 
water should be applied to the injured joint for the first 24 hours. 
4. Heat (after 24 hours)—After 24 to 36 hours the pain will have 
subsided and heat and gentle massage should be applied to obtain 
early return of joint function. 
5. Bandage—A snugly fitting adhesive or elastic bandage about the 
joint helps support the injured ligaments. Care should be taken 
to loosen the bandage if it interferes with circulation of the blood. 
Sometimes it is difficult to tell the difference between a sprain and a 
fracture. If in doubt, treat as a fracture. 
A fracture is a broken bone. 
Fractures are of two types: 
1. Simple—Bone is broken, but there is no connection with the sur- 
face of the skin. 
2. Compound—An open wound extends from the skin surface to 
the broken bone. The broken bone may or may not protrude from 
the wound. 
FRACTURES 
Normal bones. 
Symptoms of a Simple Fracture 
1. Pain and tenderness—At site of fracture. 
2. Swelling—At site of fracture. 
3. Unnatural position Compare injured limb with uninjured limb. 
4. Loss of motion or power—May or may not be present. FIRST AID 
27 
5. Grating movement—Broken ends of the bone may be felt grating 
together. 
6. Following a blow or injury the patient may say he heard the bone 
crack and give way. 
7. Shock may be present. 
Compound fracture 
Simple fracture. 
Symptoms of a Compound Fracture 
1. All of the symptoms described under simple fractures may be pres- 
ent. In addition: 
2. Open wound—An open wound extends down to the broken bone. 
The hone may or may not protrude from the wound. 
3. Bleeding—Bleeding from the wound may be quite serious due to 
the torn blood vessels. 
4. Shock—Shock is usually severe. 
General Procedures in the Treatment of Simple Fractures 
1. Avoid moving patient. Treat him where he lies. 
2. Remove clothing over the injured part. Handle part carefully. If 
necessary, clothing may be cut or torn along the seams. 
3. Apply splint—A splint is any material used to prevent movement 
of the broken bones. 
Do not attempt to “set” a broken bone. A broken long bone of the 
arm or leg should be straightened carefully before applying the splint; 
however, an injured joint, such as the elbow, should not he straightened, 
but should he immobilized with a splint in whatever position it is found. 
Remember: The blood vessels, nerves, muscles, and other soft tissues 
surrounding a broken bone are easily injured by movement of the sharp 
ends of the bone. Rough handling may convert a simple fracture into 
a compound fracture. 
General Procedures in the Treatment of Compound Fractures 
1. Stop bleeding—Direct pressure. Digital pressure. Tourniquet. 
2. Treat wound—See “Treatment of Fresh Wounds,” 28 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
3. Straighten limb—If the end of the broken bone is protruding 
slightly from the wound, it will often disappear when the injured 
limb is carefully and gently straightened; however, do not force the 
end of the bone back into the wound. 
4. Apply a splint. 
Emergency treatment is described for fractures of the following bones: 
Arm. Rib. Skull. 
Leg. Collar bone. Spine. 
Jaw. Nose. 
Fractures of the Arm and Leg 
Emergency splints used on the arm and leg are of two types; 
1. Fixed-traction splints. 
2. Improvised rigid splints. 
fixed-traction splints 
Fixed-traction splints for the arm and leg are usually available 
aboard ship. 
Fixed-traction splint for the arm. 
Fixed-traction splint for the leg. FIRST AID 
29 
Apply a fixed-traction splint for 
all fractures located between the 
hip and the foot. 
Apply a simple rigid splint and 
sling for all fractures located 
between the shoulder and the 
middle forearm. See page 33. 
Diagram of sites for application of splints. 
APPLICATION OF FIXED-TRACTION SPLINT TO THE LEG 
The method of applying a fixed-traction splint to the leg is similar to 
the method described above for the arm. The end of the splint must be 
kept elevated to prevent the heel of the foot resting on the deck or ground. 
Fixed-traction splint applied to leg. 30 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Preparation of traction-bandage for looping and applying to foot. 
Fracture of Lower Jaw 
Symptoms 
1. Deformity—Line of lower teeth is irregular. 
2. Bleeding—From mouth (gums). 
3. Pain—Opening and closing mouth extremely painful. 
“Four-tailed” bandage. 
“Four-tailed” bandage applied to jaw. FIRST AID 
31 
T reatment 
1. “Four-tailed” bandgage. Muslin or gauze. 
2. Feed patient through a tube. 
3. Cleanse mouth frequently. 
Fracture of Rib 
Symptoms 
1. Pain—Over point of fracture—increased by deep breathing and 
coughing. 
2. Cough—If lung is punctured, will cough up frothy and bright red 
blood. 
T reatment 
1. Splint fractured rib—Wide strips of adhesive tape, applied so as 
to almost encircle the chest, decrease movement of the broken rib. 
First, shave hair from 
chest. Then after the pa- 
tient has completely ex- 
haled, apply several strips 
of inch wide adhesive 
tape, each succeeding 
strip overlapping the one 
below by 1 inch. The 
strips should encircle the 
chest, except for a space 
of about 8 or 10 inches on 
the uninjured side. 
Chest strapped with adhesive plaster. 
Fracture of Collar Bone 
Symptoms 
1. Deformity—Collar bone is near skin surface and broken ends of 
bone are easily seen. 
2. Shoulder is low—Injured shoulder drops downward, inward and 
forward. 
.3. Pain—Movement of arm is painful. Patient usually supports elbow 
of injured side with opposite hand. 
T reatment 
1. Arm sling—Temporary or emergency dressing. The sling is 
made of triangular bandage, neckerchief, etc., and is used to sup- 
port the arm on the injured side. The arm is drawn close to 
the body by means of a cloth or gauze band which is tied around 
the injured arm and chest. As soon as possible apply the “figure- 
of-eight” bandage. 32 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Stages of applying arm sling and encircling band for emergency treatment of 
broken collar bone. 
2. “Figure-of-eight” bandage—Made of long strips of muslin or 
gauze. Before applying this bandage, large cloth or felt pads must 
be placed under the arms. This bandage requires daily adjustment. 
An arm sling should also be worn to help support the arm on the 
injured side. 
“Figure-of-eight” bandage for treatment of broken collar bone. An arm sling should 
also be worn. 
Back 
Front FIRST AID 
33 
Improvised Splints 
In an emergency, if fixed-traction splints are not available, splints may 
be improvised from materials found near the scene of the accident. Suit- 
able materials for splints are boards, oars, paddles, boat hooks, light 
spars, guns, bayonet scabbards, or heavy wire mesh. Soft, flexible mate- 
rials such as pillows, blankets, coats, cardboard, or folded newspapers 
Diagram showing where splints should be placed for fractures of the arm' or leg. 
make excellent splints for fractures of the lower arm or lower leg if 
properly applied. 
An improvised splint must be: 
1. Rigid enough to keep the broken bone from moving or bending. 
2. Long enough to extend well beyond the joints above and below the 
broken bone. 
3. Reasonably light in weight. 
4. Padded with soft materials such as cotton, gauze, cloth, or oakum 
(old rope untwisted and pulled into loose hemp). 
Improvised rigid splint made from a 
well padded board applied to a fracture 
of the upper arm. After application 
complete sling. 
Wire mesh splint for the arm. A roll 
of mesh wire 5 inches wide and 36 
inches long is standard equipment in 
Navy first-aid kits. With it excellent 
splints may be made for the upper 
arm, elbow, or lower arm. It should be 
well padded. After application complete 
sling. 34 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
(a) Fracture of the upper arm. 
(b) Fracture of the elbow. Do not try to change the position of an 
injured elbow. Apply a splint to the elbow in whatever position it 
is found. 
(c) Fracture of the forearm (lower arm). 
(d) Fracture of the thigh (upper leg). 
(e) Fracture of the lower leg. 
Pillow splint applied to the lower leg. Boards have also been used to give greater 
rigidity; however, they are not always necessary. Folded blankets or coats could 
also be used. Folded newspapers or cardboard may be used for fractures of the 
forearm (lower arm). 
If materials for leg splints are not readily found, the thighs and legs 
may be bound together using the uninjured leg as a splint. Soft padding 
should be placed between the legs. 
Fracture of Nose 
Injuries to the nose result from blows or falls and fracture of the nasal 
bones should always be suspected. 
Symptoms 
1. Deformity—The nose may be flattened or out of position. 
2. Nosebleed. 
3. Swelling and tenderness. 
T reatment 
1. Control nosebleed—The patient should sit upright and breathe 
through the mouth. If the patient remains quiet for a few minutes, 
the bleeding will usually stop; however, if it continues, pressure 
may be applied gently by means of the thumb and forefinger. 
If this fails, narrow gauze strips {y2 inch wide) may be inserted 
into the nostril. 
2. Splint nose—Place two small rolls of gauze on either side of 
the nose. Secure the rolls of gauze with strips of adhesive tape. FIRST AID 
35 
Skull Fracture 
Skull fractures are serious chiefly because of the possibility of injury 
to the brain. 
Symptoms 
1. Bruise or wound of the scalp. 
2. Loss of consciousness. 
3. Pupils unequal. 
4. Bleeding from the ears or nose. 
5. Vomiting. 
The above symptoms are not always seen; however, any man “knocked 
out” by a head blow, even though for only a moment or two, should be 
kept quiet and in a reclining position. 
T reatment 
1. Keep patient lying down. 
2. Treat shock—See “Treatment of Shock.” 
3. Cold cloths or ice bag to head. 
4. Treat scalp wound if present. 
5. If the patient is very restless, sedatives such as bromides or one 
of the barbiturates (Sodium Amytal, Nembutal) may be given. 
Morphine should not be given. 
6. Observe the patient’s condition carefully. Record the pulse, 
respiration, and temperature every half hour. A rising pulse and 
respiration rate with a temperature above 101.5° or 102° indicates 
serious brain injury. 
Fracture of the Spine (Broken Neck or Back) 
Fractures of this type are often caused by a fall from a height, diving 
into shallow water, or a heavy weight falling across the shoulders when 
the body is bent forward. 
The spinal column not only supports the head and body, but it also 
contains the spinal cord which carries nerve impulses to and from the 
brain. Severe fractures of the spine may, therefore, cause the spinal 
cord to be crushed or cut in two, so that it can no longer carry nerve 
impulses. If this occurs, the lower part of the victim’s body will be found 
partially or completely paralyzed. Fortunately, however, in many cases 
the spinal cord is not seriously injured even though the neck or back has 
been broken, and if the patient receives proper emergency treatment, he 
will recover completely. 36 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Symptoms 
1. Pain—If in the neck, the neck may be broken. If in the back, the 
back may be broken. 
2. Paralysis—If present, it means the spinal cord has been injured. If 
the injured man cannot move his legs, his back is broken, and if 
he cannot move his fingers, his neck may be broken. 
It must be remembered that if the neck or back is broken, twisting or 
bending of the neck or body may injure the spinal cord and result in 
paralysis or death of the victim. Do not attempt to move an injured per- 
son, or raise his head until he has told you whether he can move his 
fingers and legs. 
First Aid Treatment and Transportation 
1. Treat patient for shock (see page 14). 
2. If the neck is broken, the injured man should be transported lying 
on the back, face upward. Taking great care not to bend or 
twist the body or neck, the patient should be slid or drawn by 
his clothing on to a rigid stretcher or improvised support such as 
long, well padded boards or planking. Lifting should only be 
attempted if at least four, and preferably six, men are present to 
assist. Blankets should be placed under and over the injured 
man. Do not put a pillow under the head or neck; however, pil- 
lows or sandbags should be placed alongside the head to prevent 
turning, 
3. If paralysis is present, all hard uneven objects, such as buttons or 
buckles, should be removed from the clothing beneath the para- 
lyzed parts to prevent the development of pressure sores. 
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.—Shock, pain, swelling, loss of function, limited motion, and 
the head of the bone may be seen 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 immobilization. It is better for a layman not to attempt reduction 
except, perhaps, in dislocations of the fingers and the lower jaw. By un- 
skilled 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 FIRST AID 
37 
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 pa- 
tient see a doctor as soon as possible. 
RUPTURE (hernia) 
As encountered by the layman this is usually a swelling in the groin. 
Rupture makes its appearance suddenly after exertion and is evidenced 
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. 
BLISTERS 
Water blisters develop on the skin as a result of local irritation such as 
chaffing or pinching. They most commonly occur on the hands and feet. 
It is important to remove the cause of the friction (such as ill-fitting shoes) 
as soon as possible. If an unusual amount of unavoidable pressure or rub- 
bing of the skin is anticipated, blisters can often be prevented by placing 
a strip of adhesive plaster firmly over the area. 
Treatment (Not for blisters caused by burns.) 
1. Wash—The blistered area should be washed gently with clean 
water and soap. 
2. Apply iodine—After drying the skin carefully, apply iodine to one 
edge of the blister. 
3. Sterilize needle—Sterilize a needle in an open flame. 
4. Puncture blister—Puncture the blister at its edge where the skin 
was sterilized with iodine. Gently press out the water. 
5. Apply dressing—Apply a dry sterile gauze pad over the blister. 
If the blister ruptures, a raw painful area will be exposed. This should 
be protected with a small amount of vaseline, and then covered with a 
sterile gauze dressing. 
If the blister becomes infected, it should be treated as an infected wound. 
(See “Treatment of Infected Wounds.”) 38 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
BURNS 
Burns, in general, are caused by such agents as hot air, hot liquids, steam, 
hot solids, sunlight, acids, alkalis, electricity, and irritant gases. The 
majority of burns occurring aboard naval vessels during war are of the 
“flash” type, due to the hot blast of shell and bomb explosions and burning 
ammunition. 
The severity of burns is variable, the amount of tissue destroyed depend- 
ing upon the degree of heat and the length of time that the skin is exposed 
to the burning gases. Fortunately, flash from explosions is but momentary, 
although a high degree of heat is generated. Burns are classified according 
to the depth to which the body tissues are damaged, as follows: 
First degree—Skin reddened. 
Second degree—Skin reddened and blistered. 
Third degree—Destruction of the entire skin. Often there is injury to 
the tissues underneath. 
The size or extent of a burn may be more important than its depth. A 
first or second degree burn which covers a very large area of the body 
ordinarily causes much greater shock to the victim than a small third- 
degree burn. 
Shock brought on by extensive burns is the most serious factor in caus- 
ing death. Therefore, when treating seriously burned casualties, first 
treat them for shock and then treat the burn. 
1. Shock: 
(a) Conserve body heat—Do not remove all of patient’s clothes immediately, 
but keep him comfortably warm with blankets or whatever is at hand. 
(b) Relieve pain—Administer a syrette of morphine (Y grain). 
2. The Burn: 
(a) Expose burned area—Carefully remove the clothing that covers the burned 
area, but do not remove more clothing than necessary. In the case of a large burn, 
prevent chilling by exposing only a part of the body at one time. If the clothing 
sticks to the burn, cut the cloth around it but do not attempt to remove any ad- 
herent clothing. Leave it in place. 
(b) Protect the burned area—Apply petrolatum (vaseline) over the burned 
area. If vaseline is not available, use liquid petrolatum or clear lubricating oil. 
Apply sterile gauze smoothly over the ointment or oil-covered burn in sufficient 
number of layers to make a fairly thick dressing. Secure the dressing with roller 
gauze bandage. Such pressure as is consistent with comfort is to be used in the 
bandaging. If a medical officer is not available, the dressing is not to be changed 
for about 14 days, or until healing is well begun. 
(c) Give Sulfadiazine:—Give the patient 4 tablets (4 grams) of Sulfadiazine 
in a single dose. 
(d) Supply ample fluid intake—Men who have been severely burned require an 
increased amount of liquid. Regularly, once each hour, water or some other liquid, 
such as fruit juice, should be given to the patient. 
T reatment FIRST AID 
39 
(e) Acid and alkali burns—In case of an acid or alkali burn, get any clothing 
soaked with the chemical off the victim as quickly as possible. Pour water freely 
over the burned area in order to remove the chemical. In the case of extensive 
burns place the patient under a shower if immediately available. In the case of an 
acid burn finally apply a solution of bicarbonate of soda or common baking soda. 
If of the alkali type finally apply ordinary vinegar. After once more washing with 
water, treat the condition as in the case of any other burn of the skin. 
3. Burns of the Eye—Burns of the eye may result from hot gases, steam, acids, lye, 
or other strong alkalis, and flash from explosion. 
(a) Wash with water—All burns of the eye, from whatever cause, should im- 
mediately be flushed with large quantities of water. 
(b) Oil Treatment—After thoroughly washing with water, mineral oil or cas- 
tor oil should be gently dropped into the eye. 
Prevention of Flash Burns 
Experience has shown that almost any cloth fabric will protect against 
flash burns, but for complete protection, the entire body must be covered. 
Antiflash equipment has been adopted by the Navy to accomplish this 
covering and consists of a face mask of such a weave as to permit easy 
respiration, an eye-shield of flash-resistant plastic, hood, and gloves. 
To protect himself from flash, the man first pulls his socks up over the 
outside of his trouser legs, and then adjusts the face mask, hood, eye- 
shield and gloves in that order. The lower portion of the hood should 
be kept in place by tucking it securely under the dungaree collar. 
Antiflash garments may be improvised in any manner, the important 
thing being complete coverage of the skin. Recently a flash-resistant 
cream has been developed and will probably come into more general use. 
The cream is merely applied to the head, neck and hands as in the case 
of a skin lotion, and permitted to dry. The kapok life-jacket (with filler 
treated to render it flame-resistant) offers protection against flash burns. 
BLAST OR CONCUSSION 
Blast or “concussion injury” may occur at the site of naval actions 
or sinkings where men are swimming or floating in the water in the im- 
mediate neighborhood of exploding depth charges. 
These injuries are caused by the “shock wave” set up by the blast, 
which travels rapidly through the water (4,800 feet per second) and 
when at high pressure (about 300 pounds per square inch) close to the 
charge, produces severe injury to the swimmer as it strikes his body and 
is transmitted through it. 
Blast injuries consist of hemorrhage into the lungs and perforations of 
the intestine. Thus, it is the air- or gas-containing organs that are af- 
fected and the injuries may be either mild or so severe (in the case of 
the lungs) as to cause almost instant death. 40 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Blast injury may be suspected in personnel who have been in the 
water where any explosion has taken place. The symptoms of pulmonary 
injury are the raising of bloody or brown sputum, coughing, gasping 
respiration, a bluish color of the skin, and rales in the chest. Those 
who have suffered intestinal damage from blast describe feeling the con- 
cussion as a powerful blow in the stomach, followed by cramps, and 
often by loose bowel movements while still in the water. The stools 
are frequently tinged with blood and there is persistent abdominal pain. 
T reatment 
Blast injuries are serious and require the care of a physician for proper 
handling, but one can prevent aggravating the condition by employing 
certain common-sense procedures. Victims should be handled carefully 
and moved about as little as possible to avoid increasing bleeding in the 
lungs. Morphine may be given (lA grain) to control pain and if oxygen 
is available it may be administered through a regular, or improvised mask 
with beneficial effect. Sulfadiazine should be given to combat the devel- 
opment of infection. Perforation of the intestine requires a surgeon for 
adequate handling and where this event is suspected—persisting high 
fever with tender, hard abdomen—every effort must be made to obtain 
medical aid. These people should not be given food or water by mouth 
when evidence of intestinal injury persists. They should be kept at rest, 
in bed. 
Prevention 
From a practical standpoint, we are particularly concerned with means 
by which blast injury may be prevented, rather than with its pathology 
and treatment, since proper treatment is not always possible. Crews 
should be instructed in the following ways of avoiding injury from under- 
water explosions. 
(a) Wear a kapok life jacket (when possible), properly tied and ad- 
justed. It is a “life preserver” that will protect from underwater con- 
cussion as well as from drowning. 
(b) Swim away from an expected underwater explosion as rapidly as 
possible since a person will be safe from injury by a 300-pound depth 
charge at about 300 feet. 
(c) Make use of any floating objects to draw yourself as far out of 
the water as possible, for only those parts of the body below the surface 
can be injured by underwater blast. 
(d) Keep your head out of water, and when floating, lie on your back, 
as high in the water as possible. 
(e) Do not lie on a partly submerged raft or float when underwater 
explosions are expected. Stand or sit. 41 
FIRST AID 
FIRST AID TREATMENT OF SHIPWRECK SURVIVORS 
Survivors may be afflicted with injuries received during combat previ- 
ous to abandoning ship; these include burns, flesh wounds, and broken 
bones, possibly with consequent shock. These conditions should be kept 
in mind and, if present, should be treated as directed elsewhere in this 
compendium. The treatment of such symptoms of underwater blast 
injury as the coughing of blood and abdominal pain and rigidity is also 
discussed in another section, as is that of immersion foot and frost bite. 
The occurrence of high fever may indicate pneumonia caused by exposure. 
Men who are weakened from lack of food and water should be helped 
aboard ship and carried to a bunk, particularly if their feet have been 
injured by cold. In general, the rescued survivor can be given all the 
water he can comfortably take as often as he likes. If he is very weak, 
during the first and second day, the food should be in a liquid or soft 
form, such as sweetened fruit juices and condensed milk to which sugar 
has been added, toast, and cooked cereal. If vitamin pills are available, 
they should be given to survivors who have been shipwrecked for about 
10 days or more. 
Sunburn should be treated like any other burn. Eyes whose lids are 
crusted should be treated frequently with eye drops of a weak solution 
of baking soda or boric acid in water. 
The removal of dirty fuel oil from the skin can be facilitated by using a 
light oil such as mineral oil as a wash, followed by soap and water. 
Boils and ulcers are sometimes found on the skin of survivors. Clean 
the skin, remove any crusts from the sores, if it can be easily done, and 
dust on some powdered “sulfa” drug, if it is available. Do not touch 
the sores on the legs of those suffering from immersion foot. 
Mental disturbances are common in survivors; they may be excited, or 
very depressed. Someone should stay with survivors who are mentally 
abnormal, to make sure they do not hurt themselves. 
METHODS OF PROLONGING SURVIVAL ON LIFEBOATS AND RAFTS 
Methods of protecting against such effects of cold as frostbite and im- 
mersion foot have been described on pages 45-46 
The following paragraphs deal with other methods of prolonging sur- 
vival at sea, particularly as regards the rationing of food and water. The 
information is presented in the form of instructions issued to the survivor. 
All of it is applicable to survivors on lifeboats or rubber rafts. Many of 
the instructions, however, cannot be followed by those on floats. 
Seasickness 
Even in survivors accustomed to ships, on a raft or lifeboat seasickness 42 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
may be so severe as to cause loss of water from the body through vomit- 
ing and to interfere with efficient operation of signalling devices. Some 
life raft kits contain a medicine preventing seasickness. If the water is 
rough, as soon as you have hoarded your craft, take the seasickness pre- 
ventive as directed on the lalbel. 
Protection Against the Weather 
Against cold—The most serious adversary in cool waters is the effect 
of cold wind and water upon the body. Under such conditions, leave on 
all clothing, dry or wet, save when a favorable moment for drying some 
of your clothing is encountered. Then he sure to dry your clothing as 
much as possible. Great pains should he taken to dry out wet stockings 
and footgear whenever possible in order to reduce chances of the injury 
due to cold and wet known as “immersion foot.”’ The lacings of footgear 
should be loosened when you board your craft, and if later the feet become 
swollen and the footgear feel tight, the boots or shoes should be removed. 
(Do not throw them away—you’ll need them when you get ashore). 
Exercise your toes from time to time to increase circulation of blood. 
Even in the tropics you may become cold at night if vou cannot dry out 
your clothing before nightfall. 
Against sunburn—Because its effects come several hours after ex- 
posure, sunburn always tends to “slip up on you,” particularly in cloudy 
weather. Rig an awning if you can, but be sure it does not shut you off 
from the cooling effects of the breeze in warm weather. Do not cover 
your body with a tarpaulin or poncho for protection against sunburn in 
warm weather, as if they rest directly on you they will prevent cooling 
and increase your water requirement. If no satisfactory awning can be 
rigged, the head, including the neck, can be protected by use of cloths 
that may be available or by sunburn-preventive ointment. The boric 
ointment contained in some raft first aid kits can be applied to the lips 
in the absence of antisunburn ointment to prevent cracking. Protect your 
eyes from glare and nose from sunburn by tying a strip of cloth over 
your nose just under your eyes. Leave your shirt, trousers, and socks 
on. Hands can be protected by the sunburn-preventive ointment or by 
tucking them under your shirt. The unprotected space over the lower 
legs can be covered by using a safety pin to attach trouser bottoms to 
sock tops. 
Method of Conserving the Water in Your Body 
The amount of water which you need to keep you normal depends on 
how much water you waste from your body unnecessarily. You cannot 
help losing slightly less than a pint of water in your urine each day; 
also you will always lose some vapor in your breath. But in warm 
weather you will lose more water than is necessary by evaporation from FIRST AID 
43 
your skin unless you take steps to prevent the loss. When the sun strikes 
you, it heats your body. Your temperature will rise unless you are 
cooled by the breeze and unless water evaporates from your body to 
cool you. This water leaves your skin long before you can see any 
drops of sweat. Unless you take precautions, you may sweat away un- 
necessarily a quart or more of your precious water each day. Unless you 
are already cold, the only way to prevent this “unseen sweating” is to 
take the following steps to keep your body cool, adding a new procedure, 
while continuing the former ones until you feel definitely chilly. Then 
omit the procedure which made you cold for awhile; try it again after an 
hour or two. By keeping yourself just short of being chilly, you will keep 
your unseen sweat loss at a minimum. 
The procedures for saving water are as follows: 
1. Perform no unnecessary exercise. 
2. Remove (but do not throw away) all clothes save the head cover- 
ing, shirt, pants, and socks necessary to protect you from sunburn. Un- 
button the front of your shirt. 
3. Expose your body thus clothed to the breeze as much as possible. 
It will cool you. Fewer of the sun’s rays will strike and overheat you if 
you sit up as much as you can, rather than lying flat. 
4. Rig an awning if you can, protecting you from the sun, but not 
interfering with the breeze. Do not use for this purpose an article which 
will rest directly on your body and interfere with circulation of the air. 
5. Keep your clothes constantly wet with sea water during the day. The 
sea water will evaporate and cool your body, and you won’t have to sweat 
and evaporate the water stored in your tissues in order to keep your tem- 
perature form rising. This procedure is the only way you can prevent 
unnecessary water loss on a bright or only moderately overcast day in 
warm waters when there is no wind. Probably you will find it most 
satisfactory to shower yourself or each other thoroughly with the bailing 
cup. Wetting your clothing by going overboard for a swim will use up 
your strength if you do it often. Carefully rinse the accumulated salt 
out of your clothes with sea water from time to time so that the salt will 
not hurt your skin. Let your clothes dry in the late afternoon if they 
will, otherwise you may be chilly at night even in the tropics. 
Of course, if you are in cool waters and your problem is to keep 
warm, you don’t have to worry about these five procedures for reducing 
the unseen sweating. And if you or others on the raft are injured, you 
will have to use your head as to how vigorously you carry out these 
procedures. 
How to Ration Your Water 
The amounts of water recommended below will satisfy you only in 
cool weather, or in warm weather when you are taking the recommended 44 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
steps to prevent unseen sweating. If you allow unseen sweating to occur, 
you may waste a quart (32 ounces) or more of your water daily. 
1. Unless you become thirsty, drink no water for the first 24 hours 
on the raft. Take a drink of water before abandoning ship. 
2. Thereafter, drink 16 ounces of water a day if your supply is limited; 
drink 24 ounces a day if you have plenty of rain water, or more if you 
continue to be really thirsty and your supply permits it. 
3. When you have a total of only about 10 ounces of water left per man, 
use it merely to moisten your mouth and throat occasionally until rain 
is encountered. , 
If it rains when you have been drinking 16 to 24 ounces of water a 
day or less, drink your fill slowly over the course of about 1 hour. Next 
day return to your usual 16 to 24 ounce allotment. 
If your craft is equipped with a kit for treating sea water to make it 
drinkable, ration out the treated water in the same amounts recommended 
above. 
If you have no special device for measuring water available, remember 
that a coffee cup holds about 8 ounces, or half a pint. A quart is 32 ounces. 
If you see a rain squall approaching, wash off any accumulations of 
dry salt on your rain-collecting sheet with sea water so you will con- 
taminate the rain with salt as little as possible when it starts falling. One 
useful method of transferring rain water from the sheet to a container is 
to use a sponge or rag. If your rain water has been contaminated with 
sea water and has a salty taste, go ahead and drink it. II it doesn’t make 
you vomit or give you diarrhea when you drink it in small amounts, it’s 
all right. 
Don’t drink your urine. 
Don’t dilute your freslj water with sea water. You won’t gain any- 
thing. Don’t drink straight sea water or put sea water into your rectum. 
You may smoke if you can and care to. You may find it increases 
your thirst, however. 
Solid Food 
In warm waters, one can survive several weeks without food pro- 
vided one has water. In cooler waters when shivering uses up the body’s 
supply of energy rapidly, the eating of food is probably important to sur- 
vival, and the daily ration should be larger than that for warm waters. 
Various types of ration are now found on emergency craft; many of 
them are of the candy type. Candy, which contains chiefly sugar and 
fat, has been found a very satisfactory ration for survivors. 
The daily allotment of solid ration per man will have to be decided upon 
by the leader of a group of survivors, taking into consideration the type of 
ration, the temperature of air and water, and the number of men on the 
craft. FIRST AID 
45 
FISH AND BIRD FLESH 
The flesh and liver of fish, turtles, and birds are valuable foods; but 
do not eat them in large quantities unless you have an abundance of 
water. Too much of this food, because of the protein it contains, may 
cause you to waste water from your body as urine. 
If your ration of water is less than 24 ounces a day, eat only small 
quantities of flesh—say 10 one-inch cubes, equal to 5 ounces, daily or if 
the fish is a shark, skate, ray, or dogfish, only 4 such cubes daily. Be 
sure not to let the flesh dry out before eating it if you are short of water, 
and reduce the amount eaten if it makes you persistently thirsty. 
Eat no dried flesh or entrails unless you are drinking a quart (32 
ounces) of water a day. Reduce the amount eaten if it makes you per- 
sistently thirsty. 
You will probably not be able to wring or chew “water” out of fish 
flesh. Regard fish as a solid food, not as a source of water. 
Coconuts, which you may find floating in the water, are a useful source 
of food. Eat them in small amounts at first; if they cause no diarrhea, 
you can eat all you want, even if your supply of water is limited. The 
same holds for the milk they contain. 
EXPOSURE TO COLD AND HEAT 
Though one may be working in severe cold or excessive heat, the body 
is usually able to maintain a normal temperature of about 98.6 degrees. 
Prolonged exposure to extremes of temperature will, however, cause a 
marked rise or fall in the body’s temperature as well as other changes 
in the body’s vital functions which may prove fatal unless promptly 
treated. 
Exposure to Cold 
Prolonged exposure to freezing temperature, 32 degrees or below, will 
result in freezing of the body tissues. Exposure to a temperature some- 
what above freezing may cause body injury if the effect of the cold is 
intensified by dampness and high wind. The injury to the tissues may 
be localized as in immersion foot and frostbite, or generalized as in pro- 
longed exposure of the whole body. 
IMMERSION FOOT 
This condition, which is similar to frostbite, is most often seen in men 
who have abandoned ship and are exposed for long hours to cold and 
wind, frequently with their feet and legs immersed in icy water or cov- 
ered by wet socks and shoes. The feet become first white, then blue, 
swollen, and painful. Blisters often appear upon the skin and infection 
may set in. During the war of 1914-T8 a similar condition, known as 46 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
trench foot, was seen frequently after men had stood in cold, muddy 
trenches for long hours with their feet encased in water soaked boots 
and puttees. 
Prevention 
1. Apply mineral oil—Men who are forced to abandon ship should ap- 
ply mineral oil or vaseline to their feet and legs at frequent inter- 
vals during the period of exposure. This helps protect the skin from 
the cold water. 
2. Avoid tight shoes—Tight fitting shoes interfere with the normal 
circulation of blood in the feet, and it is helpful to wrap the feet 
loosely in odd bits of clothing. Elevation of the legs and exercising 
the toes is also of value. 
3. Apply warmth—If the foot becomes numb, the shoe and sock must 
be removed and the foot warmed by placing it inside another man’s 
clothing. Do not massage or rub the foot. 
T reatment 
When survivors are rescued with chilled, numb, swollen, and blistered 
feet, they should be carried aboard and their skin protected against 
rupture of the blisters. 
1. Elevate legs—Place patient in a bunk and elevate the legs. The 
legs should be placed comfortably on dry, soft, woolen cloths or a 
dry bath towel. 
2. Keep legs cool—The injured feet and legs must be kept cool. This 
is best done by exposing the legs below the knees to a cool room 
temperature and directing a blast of air from an electric fan or 
blower over them. Cooling the tissues helps relieve pain and 
reduce swelling. 
3. Keep patient warm—The patient should be kept comfortably 
warm by placing a warm blanket over his body and thighs. Do not 
cover the legs and feet. Give nourishing hot liquids such as soups 
and chocolate milk drinks. 
4. Treat blisters—If blisters form, treat with sterile vaseline dressings 
as directed under the “Treatment of Burns.” 
FROSTBITE 
This condition results from the freezing of a small part or area of the 
body—usually the ears, nose, cheeks, fingers or toes. 
1. Warm clothing—Wear a sufficient amount of warm, dry clothing. 
2. Apply warmth—If the ears, nose, or cheeks begin to tingle or appear 
Prevention 47 
FIRST AID 
red, they may be warmed by holding the warm ungloved hand over 
them for a short time. The fingers may be warmed by placing them 
inside the clothing next to the body, and similarly the toes may be 
warmed by placing the foot inside the clothing of a shipmate. 
Symptoms 
1. Tingling of the part—First warning. 
2. Redness of the skin—First warning. 
3. Numbness—Tissues frozen. 
4. Grayish-white color of the skin—Tissues frozen. 
5. Bluish color of the skin—Late signs. 
6. Swelling of the tissues—Late signs. 
7. Blisters of the skin—Late signs. 
8. Black color of the skin—Tissues dead. 
T reatment 
1. Keep frozen part cool—Thaw or warm the frozen part very slow- 
ly. This is best done by immersing the frozen part in ice cold 
water which is gradually warmed to body temperature. 
2. Keep patient warm—Apply heat to the rest of the body by means 
of warm blankets. Give patient hot liquids such as hot coffee, 
soups or hot chocolate milk. 
3. Protect skin—The skin covering the frozen part should be gently 
cleansed with soap and water, and after the part has thawed out 
it should be placed on dry, soft, woolen cloths or a dry bath towel. 
4. Treat blisters—If blisters form, treat with sterile vaseline dress- 
ings as directed under the “Treatment of Burns.” 
Caution—In treating immersion foot or frostbite do not massage the 
frozen part, and do not apply heat to the frozen part. 
EXPOSURE OF THE WHOLE BODY TO COLD 
Prolonged exposure of the whole body to severe cold results in a gen- 
eral depression of the vital body functions. 
Symptoms 
1. Numbness—Arms, legs, and body feel numb. 
2. Movement slow—Arms and legs feel heavy. 
3. Drowsiness—Unconsciousness may develop. 
4. Breathing is slow Breathing becomes gradually slower and may 
stop. 
5. Pulse is slow and weak. 
T reatment 
1. Apply artificial respiration, if breathing has stopped. 48 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
2. Wrap patient in warm blankets. 
3. Treat frozen parts of the body as directed under “Frostbite.” 
4. Give hot coffee or tea as soon as patient is conscious. 
Exposure to Heat 
Under ordinary conditions, when the body is overheated, the excess 
heat is lost by the evaporation of sweat from the skin surface. Prolonged 
exposure to high temperatures may result, however, in one of the follow- 
ing conditions: 
1. Heat cramps—This condition is usually seen in men working in the 
engine room. It is due to the loss of large amounts of salt from 
the body by sweating. 
2. Heat exhaustion—This condition results from the over-heating of 
the body. Sweating cools the body only if the sweat is evaporated. 
In heat exhaustion the skin is sweating profusely, but evaporation 
and cooling are prevented by such external obstacles as heavy, tight- 
fitting clothing, poor ventilation, or a high moisture content of the 
surrounding air (high humidity). 
3. Heat stroke (Sunstroke)—This condition results from the failure 
or “breakdown” of the body’s cooling system. Though the body is 
overheated, the skin jails to sweat, and since the excess body heat 
cannot be lost by evaporation, the temperature rises to dangerous 
and frequently fatal heights. 
Heat cramps, heat exhaustion, and heat stroke occur after exposure to 
heat, either indoors or outdoors, and are largely due to the loss of body 
salts in perspiration. 
Prevention 
When working in overheated surroundings one should — 
1. Take an increased amount of salt. 1 salt tablet should be taken with 
each glass of water, or 1 teaspoonful of salt should be added to each 
quart of drinking water. 
2. Take an increased amount of water. 3 or 4 quarts of water may be 
needed in one day. 
3. Wear light, porous, loose-fitting clothes. 
4. Use blowers or electric fans to ventilate all compartments in which 
men are working. 
5. Do not work too long in overheated surroundings. Regular short 
rest periods should be permitted. 
6. Eat a moderate amount of light. easiR digestible food such as 
vegetables and fruit. Avoid fats and heavy greasy foods. 
7. Avoid the over use of alcohol. FIRST AID 
49 
Symptoms 
Heat Exhaustion 
Heat Stroke 
Heat Stroke 
1. May collapse and faint, but usually 
remains conscious. 
2. Skin—pale. 
3. Skin—sweaty. 
4. Pulse—weak and rapid. 
5. Breathing—shallow. 
6. Mouth temperature—normal or be- 
below normal. 
7. Seldom causes death. 
1. Suddenly collapses and loses con- 
sciousness. 
2. Skin—red, flushed. 
3. Skin—hot and dry. 
4. Pulse—strong and rapid. 
5. Breathing—deep, snoring. 
6. Mouth temperature—very high, from 
105° to 110°. 
7. Frequently causes death. 
Treatment 
Heat Exhaustion 
1. Remove patient to a cool comfort- 
able place where he can rest. 
2. Loosen clothing. 
3. Keep the head low. 
4. Give the patient plenty of water to 
drink. 
5. Give salt. May be given in the form 
of salt tablets or 1 teaspoonful may 
be added to each quart of drinking 
water. 
6. If the patient is in SHOCK, wrap 
blankets about him and give warm 
liquids such as coffee or tea. 
Heat Stroke 
1. Remove patient to a cool place. 
2. Place patient in a tub of ice water. 
3. Rub skin vigorously. This brings the 
blood to the surface where it is 
cooled. 
4. Remove patient from the tub when 
the body temperature drops to 102°. 
An excellent method of treatment which 
does not require a tub or ice is as fol- 
lows : 
1. Remove patient to a cool place. 
2. Spray a fine stream of water over 
the body. For this purpose tepid 
water is as good as ice water. 
3. Fan the body by means of hand or 
electric fans. Cooling results 
from the rapid evaporation of 
water from the body surface. 
HEAT CRAMPS 
Symptoms 
1. Severe, painful, muscular cramps, involving particularly the muscles 
of the abdomen, legs, and arms. 
2. There may be symptoms similar to those of heat exhaustion. 
Treatment 
1. Apply hot water bottles or hot cloths to the abdomen and other 
areas of muscle cramping. ■ 
2. Keep patient at rest. 
3. Give plenty of water. 50 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
4. Give salt in the form of salt tablets or added to the drinking water. 
(1 teaspoonful to a quart of water.) 
Breathing may stop as a result of such accidents as: 
1. Drowning. 
2. Electrical shock. 
3. Carbon monoxide poisoning. 
4. Suffocation due to smoke, gas, fumes. 
5. Prolonged exposure to cold. 
Even though the victim of one of the above accidents has stopped 
breathing, his heart usually continues to beat for some time, and because 
of this fact the victim’s life may be saved if breathing can be resumed 
before the heart stops. 
Natural breathing may be restored after it has stopped by promptly 
applying the Schaefer Prone Pressure Method of artificial respiration. 
The purpose of artificial respiration is to force breathing. Pressure on 
the victim’s chest forces air out of the lungs. Release of pressure lets 
the lungs expand and draw air in. Thus air is kept moving in and out 
of the lungs so that the body can get the necessary oxygen to keep alive. 
If artificial respiration is started soon enough and kept up long enough, 
the heart will continue to beat and the victim will start normal breathing 
again. 
If breathing stops, begin artificial respiration at once. Every second 
counts so waste no time. Do not take time to examine the patient, loosen 
clothing, etc., but let an assistant do that. 
ARTIFICIAL RESPIRATION 
Standard Technique 
position 
1. Lay the patient on his belly, one arm extended directly overhead, 
the other arm bent at elbow and with the face turned outward and rest- 
ing on hand or forearm, so that the nose and mouth are free for breath- 
ing. (See inset Fig. 1.) 
2. Kneel straddling the patient’s thighs with your knees placed at 
such a distance from the hip bones as will allow you to resume the posi- 
tion shown in Figure 1. 
Place the palms of the lands on the small of the back with fingers 
resting on the ribs, the little finger just touching the lowest rib, with the 
thumb and fingers in a natural position, and the tips of the fingers just 
out of sight. FIRST AID 
51 
Figure 1.—First movement. 
3. With the arms held straight, swing forward slowly, so that the 
weight of your body is gradually brought to bear upon the patient. The 
shoulder should be directly over the heel of the hand at the end of the 
forward swing. (See Fig. 2.) Do not bend your elbows. This operation 
should take about 2 seconds. 
Figure 2.—Second movement. 
4. Now immediately swing backward, so as to remove the pressure 
completely. (See Fig. 3.) 
5. After 2 seconds, swing forward again. Thus repeat deliberately 
12 to 15 times a minute the double movement of compression and release, 
a complete respiration in 4 or 5 seconds. 
As soon as artificial respiration has been started and while it is being 
continued, an assistant should— 
1. Examine the victim’s mouth and wipe away the sticky mucous or 
saliva which frequently blocks the exchange of air through the 52 
MEDICAL COM PEND FOR COMMANDERS OF NAVAL VESSELS 
mouth. Also remove from the mouth any object, such as false 
teeth or particles of vomited food. 
2. Loosen clothing about the victim’s neck, chest, and waist. 
3. Keep the patient warm. Without interrupting artificial respiration 
cover the victim with blankets or coats, and if hot water bottles are 
available, place them alongside the body. 
Resuscitation should be carried on at the nearest possible point to 
where the patient received his injuries. He should not be removed from 
this point until he is breathing normally of his own volition, and then 
Figure 3.—Third movement. 
moved only in a lying position. Should it he necessary, due to extreme 
weather conditions, to move the patient before he is breathing normally, 
resuscitation should be carried on during the time he is being moved. 
Continue artificial respiration without interruption until normal breath- 
ing is restored, if necessary, 4 hours or longer. Even though the victim 
appears dead, do not give up. Remember that the usual tests for death, 
such as absence of heart heat and pulse, are not acceptable for these cases. 
Beginning recovery is indicated by a slight catch of the breath or sigh. 
Breathing gradually becomes deeper and more regular and the operator 
should attempt to time his compression of the chest with the breathing 
efforts of the patient. Discontinue artificial respiration after the patient 
is breathing regularly; however, watch carefully and be ready to resume 
artificial respiration if the breathing stops. 
In carrying out resuscitation it may be necessary to change the opera- 
tor. This change must be made without losing the rhythm of respiration. 
The relief operator should kneel beside the one giving the artificial 
respiration with the operator astride one leg of the patient and the relief 
astride the other leg. The relief, then, goes through the motions until he FIRST AID 
53 
has established exact rhythm with the operator, when he takes over from 
the first operator. By this procedure no confusion results at the time of 
the change of operators, and a regular rhythm of pressure and release 
of pressure on the patient’s thorax is kept up. 
After the patient revives, treat for shock. 
(a) Keep patient warm with blankets, and give warm liquids such 
as coffee or tea. 
(b) Keep patient lying down. 
(c) Keep patient quiet. 
DON’TS in drowning cases. 
Do not roll the victim over a barrel or similar object. 
Do not “jack-knife” the body, or hold the victim upside down in an 
effort to get water from the lungs. It is much more important to get 
started at once giving artificial respiration. Usually there is little or no 
water in the lungs anyway. 
Remember: The most important thing in giving artificial respiration is 
to GET STARTED AT ONCE. 
INSECT BITES 
Insect bites, such as those produced by mosquitos, fleas, ants, and bees, 
require but little treatment. The local application of a solution of baking 
soda or dilute ammonia water affords considerable relief. 
Bites of the more poisonous spiders and scorpions are often severe and 
require prompt treatment. Poisonous spiders do not sting but actually 
bite. The poison is contained in sacs at the base of the fangs through 
which it is transmitted by small tubes. Scorpions occur practically all 
over the world and are especially common in the tropics. The stinger and 
venom sacs are located in the tail of the scorpion. 
Symptoms of Poisonous Spider and Scorpion Bites 
1. Pain—Spider bites are usually felt as a sharp prick and the pain is 
not severe. However, the sting of a scorpion causes intense pain. 
2. Slight swelling—The swelling at the site of the bite is usually not 
pronounced. 
3. Shock,—Symptoms of shock develop within 5-4 hour to 2 hours. Pa- 
tient becomes anxious and restless. He is very thirsty and nausea 
and vomiting may develop. 
4. Muscular cramps (Spiders)—About hour after the spider bite 
painful muscle cramps begin near the bite then spread to involve the 
other muscles of the body. 
Numbness (Scorpions)—Numbness and partial paralysis develop at 
the site of the scorpion sting, and if the sting is on the arm or leg, the 
part becomes useless for a time. 54 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
5. Death—Adults rarely die from spider or scorpion bites although 
they are often made very ill. The severity of symptoms depends 
largely upon the size of the individual. 
Treatment 
1. Tourniquet—(a) If the bite occurs on the patient’s arm or leg, 
apply a tourniquet above the bite just tight enough to stop the return 
flow of blood through the veins. This does not require much pres- 
sure—just enough to make the veins swell. When applied to an arm 
or leg the hand or foot will turn a dusky bluish color. 
(b) Release the tourniquet every 15 minutes for 1 minute. 
2. Treat shock—(a) Keep the patient lying down and at rest. 
(b) Body heat may be conserved by placing a blanket under and 
over the patient. 
(c) The severe muscle pains which follow poisonous spider bites are 
sometimes relieved by hot baths. Morphine may be given if necessary 
to relieve the pain. (See method of administering the morphine 
syrette under “Treatment of Shock.”) 
ANIMAL BITES 
Animal bites are usually badly torn and dirty wounds which are likely 
to become infected unless careful immediate treatment is given. In addi- 
tion to this usual danger of infection there is the even more serious danger 
of rabies. The disease rabies most commonly occurs in dogs, but wolves, 
cats, goats, sheep, horses, and pigs are also occasionally infected. Animals 
having rabies transmit the germs through the saliva to man at the time 
of biting. 
If rabies once develops in man it cannot be cured; therefore, prevention 
of the disease is of utmost importance. A preventive treatment known as 
the Pasteur vaccine treatment is available and is almost 100% effective. 
When a person is bitten by an animal suspected of being rabid, it is im- 
portant not only to treat the patient’s wound but also to keep the animal 
confined and under observation. After the patient has received first aid 
treatment of the bite wound, he should be transferred to the nearest Naval 
or civilian hospital along with a complete report of the circumstances in- 
volved in the animal bite. 
Treatment of Bite Wound (Suspected rabid animal) 
1. Wash—Using soap and plenty of water carefully wash the wound 
and surrounding skin area. After all saliva and dirt have been re- 
moved, dry the area with sterile gauze. 
2. Cauterize—The wound should be cauterized as soon as possible with FIRST AID 
55 
foaming nitric acid. If the cauterization is done within 12 hours the 
patient may be protected. A red hot needle may be used to cauterize 
the wound if nitric acid is not available. 
3. Gauze dressing—Cover the wound with a dry sterile gauze dressing. 
Care of the suspected animal 
Do not shoot the animal but shut it up in a safe place and observe it for 
at least 3 weeks. If the animal has rabies it will die of the disease within 
7 to 10 days. The time required for rabies to develop in man after being 
bitten is 3 to 8 weeks. Thus, while the animal is under observation, it is 
safe to wait a few days before starting the Pasteur preventive treatment. 
If the animal dies its head should be removed, packed in ice, and sent 
at once to a laboratory where a definite diagnosis of rabies may be made 
by examining the animal’s brain. 
The Pasteur vaccine treatment should be given— 
(a) If the animal is known to be rabid. 
(h) If the animal cannot be found after the biting. 
(c) If the animal is killed too early for a definite laboratory diag- 
nosis of rabies. 
(d) If the animal develops symptoms of rabies during the 3 weeks’ 
observation period. 
Poisonous snakes, such as the rattlesnake, copperhead, water moccasin, 
coral snake, pit viper, and cobra, have teeth arranged in two rows with 
a pair of fangs near the fore part of the jaw. These fangs have either a 
groove or a canal through which the poison is injected at the time of the 
bite. Nonpoisonous snakes have four rows of teeth without fangs, and 
therefore the imprint of the bite will sometimes enable one to determine 
whether a person has been bitten by a poisonous or nonpoisonous snake. 
The majority of snake bites occur on the leg or thigh and therefore pre- 
vention is possible to a great extent by wearing high leather shoes or 
leggings. 
SNAKE BITES 
Symptoms 
1. Pain—Severe pain develops rapidly at the site of the bite. 
2. Swelling—The skin around the bite becomes swollen, tender, and red. 
3. Shock—Within 15 minutes to 2 hours the patient develops nausea, 
vomiting, and loose watery bowel movements. Faintness sets in, 
followed by drowsiness. The skin becomes pale and sweaty, and the 
arms and legs are cold. The pulse is rapid and weak and breathing 
is labored. Muscular weakness and difficulty in swallowing and 
speaking gradually develop. The poisonous venom is usually ab- 
sorbed slowly and therefore the symptoms of collapse and prostra- 
tion often develop gradually over a period of hours or days. MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
4. Death—Death occurs in many untreated cases. The patient may go 
into a state of unconsciousness, his breathing gradually weaken, be- 
come slower and finally stop. 
T reatment 
1. Prevent absorption of the venom: 
(a) Apply a tourniquet above the snake bite just tight enough to 
stop the blood flowing back through the veins. The veins should 
“stand out” prominently on the skin. 
(b) Release the tourniquet every 15 minutes for 1 minute. As the 
swelling spreads, it will be necessary to reapply the tourniquet 
higher above the snake bite. 
2. Remove the venom: 
(a) Sterilize a sharp knife blade with a match flame. 
(b) Make several “crisscross” cuts at each fang mark and in the 
swollen area surrounding the bite. The cuts should be about J/2 
inch in length and deep enough (about % inch) to permit free 
oozing of the clear lymph from the swollen tissues. Avoid cutting 
through large veins. 
(c) Apply suction at the snake bite and at the site of each “cross” 
cut in the swollen area. Suction is applied for 20 minutes out of 
every hour either by mouth or with a glass suction syringe. Any 
venom accidentally swallowed during mouth suction will be de- 
stroyed in the stomach and produce no symptoms; however, it is 
not advisable for mouth suction to be applied by anyone with 
cracked lips or open sores in the mouth. 
(d) Between suction periods keep the cuts covered with gauze pads 
soaked in Epsom salt solution. 
3. Treat for shock. 
(a) Give the patient plenty of water to drink. 
(b) Keep the patient lying down and at rest. 
(c) Conserve body heat by covering the patient with a blanket or 
coat. 
Note: The patient should not receive stimulants such as alcohol. 
4. Antivenom: 
(a) Antivenom has been prepared to neutralize the venoms of most 
poisonous snakes. The proper antivenom, if it is available, should 
be injected into the muscles of the arm or leg. FIRST AID 
57 
POISONS 
Keep all poisonous drugs and solutions locked up. Label 
all bottles with their 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 and 
preserve material for chemical examination). 
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 w'ater, 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 induced 
by 2 teaspoonfuls of common salt in a cup of warm water; soapsuds; en- 
courage patient to put fingers down throat. Syrup of ipecac, 1 table- 
spoonful in cup to tepid water, is also a good emetic. After vomiting, 
give whites of raw' eggs, or milk, or flour in w'ater. If signs of collapse are 
present, give hot tea, coffee, and other stimulants. Keep the body warm 
and rub the extremities. 
Itichloridc of mercury. Give whites of two 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 the patient warm, and, 
if stimulants are necessary, give strong coffee. Cases must be treated 
with as much haste as a severed artery. 
Strong metallic acid (as nitric, sulfuric, hydrochloric, etc,).— 
Give no emetic. Neutralize the poison by giving alkalies, such as large 
quantities of water, milk of magnesia, or mflk with borax, chalk, or lime- 
water (plaster). Baking soda and soapsuds may be given to neutralize 
hydrochloric acid only. Follow with olive oil or other demulcent drinks 
as for carbolic acid. Place patient in recumbent position and keep body 
warm. Give aromatic spirit of ammonia and other stimulants. 
Carbolic acid (Cresol, phenol).—The treatment indicated is to im- 
mediately give a strong solution of Epsom salt in warm water and induce 
vomiting by giving mustard and water, salt and water, or putting fingers 
down throat. Then give demulcent drinks such as milk, flour in water, 
egg whites, flaxseed tea, or barley water, followed by hot tea, strong 58 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
coffee, or other stimulants. Keep body warm. Alcohol may be used 
for local burns. If breathing stops, apply artificial respiration. 
Alkalies (lye, etc.).—The treatment indicated is to give mild acids 
such as vinegar, lemon or orange juice, hard cider. Whites of eggs may 
be given later, then give something soothing, such as oil, gruel, barley 
water, milk, butter, or lard. Place patient on back; apply heat externally; 
fresh air; strong coffee or other stimulants. 
Opium, laudanum, paregoric, heroin, morphine.—Give an emet- 
ic. The best emetic in this case is mustard and hot water. Something irri- 
tating 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 overdoing 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 tahlespoonful 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 gruel, sweet oil, 
starch and water, and castor oil (1 ounce) may be given. 
Strychnine (nux vomica).—Give strong tea, then administer an 
emetic until free vomiting is induced. Give Epsom salt. Apply artificial 
respiration if necessary. Remove patient to a dark room, keep quiet, avoid 
sudden noises. Give phenobarbital to control spasms to the limit indi- 
cated under that drug. 
Trinitrotoluene (TINT) poisoning.—Because of the extensive use of 
this substance on board ships and in naval magazines ashore, poisoning 
caused by it is not uncommon. 
The poison may be removed from the skin with a solution of sodium 
hyposulfite. Remove the patient from the vicinity of tire substance, pro- 
vide absolute rest, fresh air, and simple diet. Large amounts of water 
with large doses of sodium citrate and sodium bicarbonate should be 
given. Restrict the meat intake, give small doses of iron daily, and 
regulate the bowels. 
Gasoline, benzine, wood alcohol and naphtha poisoning.— 
This usually results from inhalation of fumes or accidental swallowing in 
siphoning, etc. Symptoms from the ingestion of gasoline resemble those 
caused by acute alcoholism, the patient is very apt to develop mania and 
later become unconscious. FIRST AID 
59 
Remove the patient to the open air, remove all gasoline, benzine, or 
naphtha-soaked clothing, apply external heat if necessary. Administer 
stimulants and treat as for carbon-monoxide poisoning. 
Carbon monoxide.—Most frequently results from exposure to exhaust 
fumes of gasoline motors particularly in confined spaces and after enter- 
ing airtight compartments closed for some time. (See section on 
ventilation.) 
The treatment indicated is: (1) Remove the patient from atmosphere 
containing monoxide; (2) administer oxygen as quickly as possible and 
in as pure a form as is obtainable, preferably from a cylinder of oxygen 
through an inhaler mask; (3) if breathing is feeble, start artificial 
respiration at once by prone-pressure method; (4) keep the patient flat, 
quiet, and warm; (5) afterward give plenty of rest. 
Chloral hydrate (“knock out” drops) —Overdose renders person 
suddenly helpless. Symptoms start with burning sensation in throat, 
nausea, vomiting and pain in stomach. Later, patient becomes cold, re- 
laxed, comatose and blue. May die from paralysis of the respiratory 
center. 
The stomach should be emptied by an emetic, patient kept warm and 
artificial respiration administered if necessary. Strong black coffee is 
valuable as a stimulant, if patient is conscious and stomach has been 
evacuated. 
Barbital (veronal), luminal, nembutal, sulphonal, etc.—The 
symptoms of poisoning are headache, mental confusion, staggering gait, 
difficult breathing, stupor and coma. There may be skin eruptions and 
paralysis of various types. 
Vomiting should be induced. Stimulation and artificial respiration 
should be used according to need. 
Iodine.— Poisoning may be caused when the Tincture of Iodine is 
applied too heavily or when swallowed. The vapor is irritating to the 
eyes and respiratory system. When swallowed, the mouth and lips are 
corroded and stained and there is pain, thirst, vomiting, suppression of 
urine, diarrhea, and collapse. 
Administer starch in water, freely; induce vomiting, apply external 
heat and establish absolute rest. 
Chemical Warfare Agents 
Emergency Treatment of Cases Exposed to Common War Gases. 
General Rules.—The sooner self-aid first-aid treatment is administered, 
the greater are the chances of early recovery. There must he no delay— 
quick action is paramount. 60 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
CHEMICAL WARFARE 
Tactical 
Class 
Physio- 
logical 
Class 
Symbol 
Name 
Odor 
Color and State 
H 
Mustard 
Garlic 
Horse-radish 
Dark-oily Liquid 
Colorless Gas 1 
HN 
Nitrogen Mustards 
Faint; Fishy 
do 
lister Gases 
L 
Lewisite 
Geraniums 
do 
c0 
W 
CO 
< 
o 
fH 
h 
J 
ED 
Ethyldichlorarsine 
Biting and 
Stinging 
Colorless or 
Brown Liquid i 
Colorless Gas | 
rO: 
PD 
Phenyldichlorarsine 
Shoe Polish 
Clear Viscid 
Liquid 
Mixed 
H and L 
HN and L, etc. 
Combination of 
H and L 
Combination of ' 
H and L 
CO 
M 
CG 
Phosgene 
Musty Hay 
Green Corn 
Colorless Gas 
u 
.5 ai 
tn 
DP 
Diphosgene 
do 
do 
o 
6° 
PS 
Chlorpicrin 
Flypaper 
Licorice 
Yellow Oily 
Liquid 
Colorless Gas | 
Blood and 
Nerve 
Poisons 
CL 
Chlorine 
Chloride of 
Lime 
Greenish 
Yellow Gas 
AC 
Hydrocyanic Acid 
Bitter Almonds 
Colorless Liquid j 
or Gas 
CC 
Cyanogen Chloride 
Biting 
do 
CO 
CN 
Chloracetophenone 
Apple Blossoms 
Cloud of Particles' 
Droplets 
w 
m 
< 
C/3 
a 
O 
CNS 
Chloracetophenone 
Solution 
Fly Paper 
do 
O 
o 
0) 
H 
CNB 
Chloracetophenone 
Training Solution 
Sweetish Benzine 
do 
g 
So 
CO 
-< 
BBC 
Brombenzyl Cyanide 
Sour Fruit 
Colorless Liquid j 
or Gas 
bfi 
DM 
Adamsite 
Coal Smoke 
Yellow Cloud 
DS 
<5 
B 
omiti 
Case 
DA 
Diphenylchloarsine 
Shoe Polish 
White or Gray 
Cloud 
> 
DC 
Diphenylcyanarsine 
Garlic 
Bitter Almonds 
White Cloud 
SCREENING 
SMOKES 
1 
HC 
Hexachlorethane 
Mixture 
Sharp; Stinging 
White to Gray 1 
Smoke 
FS 
Sulfur Trioxide 
do 
Dense White 
Smoke 
FM 
Titanium 
Tetrachloride 
do 
White Smoke 
WP 
White Phosphorus 
None or 
Burning Matches 
Burns to White 1 
Smoke in Air 
INCENDI- 
ARIES 
TH 
Thermite 
Magnesium Bomb 
None 
White Hot Metal; 
Burns with White 
Light 
IM 
NP 
Thickened 
Gasoline 
Burning Oil 
Yellow Jelly 
Black Smoky 
Flame FIRST AID 
61 
REFERENCE CHART 
rsistence 
Effect on Body 
Protection 
Self-Aid 
Must be Immediate 
>ay to 
Winter 
fours 
Days 
No immediate symptoms. 
3 to 36 hours later irri- 
tates Eyes, Skin, Nose, 
Lungs. Worse in Tropics. 
Gas Masks 
Eye Shields 
EVES. Wash out with water. 
SKIN. Blot off liquid. Rub in 
ointment S-461 or S-330. Do not 
use in Eyes or on reddened Skin. 
CLOTHES. SeeL. 
>ay to 
l7eek 
o 12 
urs 
urs to 
ys 
Immediate stinging pain 
of Eyes and Skin. Irri- 
tates Nose, Throat, and 
Lungs. Worse in Tropics. 
Protective 
Clothing 
Protective 
C overs 
EYES. Squeeze ointment BAL 
into eyes. 
SKIN. Blot off liquid. Rub in 
ointment BAL. Do not use on 
reddened Skin. 
CLOTHES. Remove clothing 
contaminated and discard. Avoid 
fumes. Treat underlying Skin. 
Combination of 
H and L. 
Protective 
Ointments 
S-461, S-330 
EYES. Ointment BAL. SKIN. 
Ointment S-461 or S-330. Re- 
move. Use BAL. CLOTHES. 
As L. 
3 10 
nutes 
Minutes 
four to 
t'eek 
Coughing. Choking. 
Difficulty in breathing. 
Fluid in Lungs. 
Gas Masks 
If breathing becomes difficult 
keep quiet and comfortably warm 
until given medical attention. 
Irritates Eyes. 
Same as CG. 
Gas Masks 
Rest and comfortably warm. 
Wash Eyes, Nose and Throat 
for irritation. 
Minutes 
I Hour 
Same as PS. 
Gas Masks 
Same as PS. 
3 10 
nutes 
Dizziness, headache, 
coma. 
Gas Masks 
Whiffs of amyl nitrite. 
First aid if not breathing 
is artificial respiration. 
Irritates Eyes, Nose, 
Throat. Also as AC. 
Gas Masks 
Minutes 
Weeks 
lour to 
v7eek 
t 
ermined 
ys to 
eks 
Irritates Eyes. Heavy 
concentration irritates 
Nose, Throat, and Lungs 
Also burns and blisters 
the skin in warm climates. 
Gas Masks 
Wash out Eyes with water and 
wash Skin with soap and water. 
Face upwind. Additional self- 
aid usually not necessary. 
Minutes 
3 10 
nutes 
Irritates Eyes, Nose, and 
Throat. 
Vomiting, headache. 
Gas Masks 
Sniff chloroform. Keep masked. 
Lift mask only when actually 
vomiting. Additional self-aid 
usually not necessary. 
life 
rning 
3 10 
nutes 
Minutes 
Heavy concentration ir- 
ritates Eyes, Nose, and 
Throat. 
FS and FM liquid burns 
Skin. 
Gas Masks for 
heavy concen- 
trations. 
Wash out Eyes if irritating. 
Wash Skin burns with water. 
Additional self-aid usually not 
necessary. 
Minutes 
— 
Burns Skin. 
Avoid burning 
particles. 
Keep wet with water or cover 
with copper sulfate. Remove 
particles. Do not use grease, 
salve. 
Heat, burns. 
do 
do 
Cool burning material and re- 
move. 
Treat as any burn. 62 
MEDICAL COM PEND FOR COMMANDERS OF NAVAL VESSELS 
War gas may be defined as a substance which, by its chemical action, 
has a harmful efifect on man, food, water and material. Its purpose is to 
keep the combatant from his object or to make him use such elaborate 
protection as will reduce his fighting effectiveness. At times it may he 
recognized as a solid, a liquid, a cloud of vapor or by its odor. However, 
there are some gases that can neither he seen nor smelled. It is wise, 
therefore, to regard any suspicious odor, gas, liquid or solid, or any feeling 
of choking irritation of eyes, nose, throat as indicating the presence of gas 
until proved otherwise. This also includes enemy smoke since it may 
mask a poisonous gas. Other chemical warfare agents include smoke for 
screening objects and incendiaries for starting fires. 
CLASSIFICATION 
1. For convenience war gases are classified according to their physio- 
logical action, persistency, and tactical use. 
2. Physiological classification depends upon the main efifect of the gas 
on the body. The gas may be a blistering, choking, vomiting, tearing 
agent, or a systemic poison. 
3. Tactical classification depends upon the most important use of the 
gas in war. Casualty gases produce injury serious enough to put person- 
nel out of action. Harassing agents retard operations because they force 
the wearing of masks and other protective clothing. Screening smokes 
obscure objects and prevent observation. Incendiaries ignite material and 
produce burns on personnel. 
4. Persistency classification depends on the length of time the war gas 
remains effective under field conditions. As a general rule, it may be 
said that the persistency of war gases decreases under tropical weather 
conditions and increases in colder climates. Persistent gases remain 
effective longer than 10 minutes and may last for days or weeks. They 
are used to neutralize or force evacuation of certain areas. Non-persistent 
gases remain effective less than 10 minutes. They do not render areas un- 
tenable after the cloud has passed. 
1. The chart summarizes present day concepts of war gases. The 
symbols are letters which have been designated to be used instead of the 
names of the various agents. 
REFERENCE CHART 
BLISTER GAS 
These gases form the most important group of all war gases, not only 
because they seriously injure the unprotected body, but also because they FIRST AID 
63 
are most likely to be used should chemical warfare begin. It is wise, there- 
fore, to study them in some detail, and to define clearly the decontamina- 
tion measures which must be taken when exposed to them. 
Recent reports prove that a specific routine of self-decontamination 
must he accomplished within 5 minutes if serious eye, skin and lung dam- 
age is to be prevented after contamination by a liquid vesicant gas. This 
must be begun by the individual himself. Speed is essential. There is no 
time to wait for help from others. However, if battle conditions at the 
time of exposure compel continuous manning of guns and stations, then 
self-decontamination must be accomplished at the earliest possible moment. 
The fact must be recognized that the use of prescribed protective equip- 
ment is the most effective means of preventing serious injury from liquid 
vesicant gases. 
Procedure of Self-Decontamination for Liquid Mustard 
Instantly on contamination each man will carry out all of the self- 
decontamination procedures exactly and consecutively in the following 
order: (see The First Aid Kit—Gas Casualties, Medical Supplies, 
page 6.) 
a. Liquid mustard vaporizes from the skin, clothing, equipment, and any other 
objects. Therefore, turn the face away and breathe as little as possible until the eyes 
and face are decontaminated and the mask is in place as directed. 
b. When eye shields are not worn, wash eyes at once. Hold the lids open with 
fingers and pour water slowly from canteen or other uncontaminated source into 
one eye and then into the other. This must be done immediately after exposure; a 
delay of 2 minutes may result in blindness. Irrigate for at least 30 seconds and 
no longer than 2 minutes. If uncontaminated water is not available, use urine. 
c. When eye shields are worn, irrigation of eyes is not necessary. 
d. Blot, not rub, all visible liquid on the skin with the paper absorbent provided 
with the ointment, or any other suitable material. 
e. Decontaminate hands by covering and rubbing for 20 to 30 seconds with oint- 
ment protective S-461 or S-330. 
f. Decontaminate face, neck, and ears by covering and rubbing for 20 to 30 
seconds with ointment S-461 or S-330. Avoid getting the ointment into the eyes, as 
irritation will result. 
g. Discard the eye shield worn. 
h. Put on the gas mask after the face, neck, and ears have been decontaminated. 
The mask must be on the face within 3 to 4 minutes at the latest after exposure. 
i. Continue decontamination by covering all untreated exposed skin with the 
ointment, whether or not actual contamination can be seen. 
j. If tactical conditions permit, remove contaminated clothing. Dispose of 
clothing in such a way that it cannot serve as a source of poisonous fumes. These 
cause serious eye, skin and lung damage. 
k. If clothing has been removed, spread ointment on areas which may be con- 
taminated. 
l. If not possible to remove clothing, cover contaminated areas of clothing with 
protective ointment. 64 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
m. As soon as tactical conditions permit, remove all ointment, protective, S-461 
or S-330, and bathe with soap and water. 
Self-decontamination is the same as that described above for liquid 
mustard, except: 
a. Ointment BAL is used as the specific decontaminant and substitutes ointment, 
protective S-461 or S-330 referred to. 
b. When eye shields are not worn, pull open the lids with the fingers and squeeze 
ointment BAL directly into the injured eye or eyes, and gently massage the lids. 
If the eye cannot be opened because of pain, the ointment BAL should be applied 
to the closed lids and as well as possible rubbed into the slits between them. As 
soon as the pain lessens and the lid can be pulled apart, squeeze additional ointment 
BAL into the eyes. 
c. Ointment BAL must remain on the skin for at least 5 minutes, after which 
it may be removed, when conditions permit. 
Procedure of Self-Decontamination for Liquid Lewisite 
Procedure of Self-Decontamination for Liquid Nitrogen Mustard 
Self-decontamination is the same as described for liquid mustard. 
Wash off the ointment at the earliest possible moment, since ointment 
protective S-461 or S-330 dissolves but does not effectively neutralize the 
nitrogen mustards. 
Procedure of Self-Decontamination for Mixed Blister Gases 
Self-decontamination is a combination of that described for mustard 
and lewisite gases. 
Eyes. 
a. If there is not immediate pain on contamination, it is to be assumed 
that mustard only is present and irrigation of the eyes as described for 
liquid mustard should be carried out immediately after blotting the lids. 
b. If there is immediate severe eye pain, it is to be assumed that an 
arsenical is present and ointment BAL should be used at once, as directed 
for liquid lewisite. Visible droplets on the lids should be dabbed off if 
possible before BAL is applied. 
Face and Respiratory Tract. 
a. Decontaminate face as described. 
b. Put on gas mask. 
Skin. 
a. Quickly blot all gross liquid from the skin. 
b. Immediately apply ointment protective S-461 or S-330 to the con- 
taminated areas as described for liquid mustard. Ointment should be 
kept out of the eyes. 
c. Remove as much ointment, protective, as can be done quickly and 
apply ointment BAL to the same areas. FIRST AID 
65 
d. Remove this BAL and reapply fresh ointment which should be left 
on the skin. 
e. Remove contaminated clothing and treat underlying skin possibly 
contaminated as above. 
Other Gases 
The chart will suffice for specific information relative to choking gases, 
tear gases, vomiting gases, systemic poisons, screening smokes, and in- 
cendiaries. 
Personal Anti-Gas Equipment 
Gas mask. Protective covers. 
Anti-Dim. Ointments. 
Eye shield. Absorbent material. 
Protective clothing. Chapter III 
SPECIAL DISEASES 
In this chapter will be discussed the symptoms, treatment, and methods 
for control of a number of diseases that may occur on board ship. 
Communicable diseases are caused by animal and plant microorganisms 
which are communicated by man to man or by animals or insects to man. 
A person suffering with a communicable disease is said to be infected 
with that disease and for that reason the communicable diseases are often 
termed infectious diseases, and sometimes as infectious fevers. 
Communicable Diseases 
In general, the communicable diseases are usually sudden in onset and 
may be classified as general infections which affect the body as a whole 
or as localized infections which primarily affect some particular system 
of the body, such as the skin, the lungs and respiratory passages, or j:he 
digestive organs. 
Those diseases which affect the body as a whole are characterized by 
generalized symptoms, such as headache, fever, weakness, loss of appetite, 
chills, or a chilly sensation, and muscle aches and pains. Frequently these 
may be accompanied or followed by symptoms of a local nature such as 
sore throat, cough, or a skin rash. 
Diseases which chiefly affect some particular system of the body 
usually also cause some generalized symptoms, such as those mentioned 
above, in addition to the localized symptoms of the infection. The differ- 
entiation between these two types of diseases depends upon whether the 
symptoms are predominantly general or local. In the course of an illness 
its type may change. For instance, an attack of influenza may localize 
as a pneumonia or an infected wound may develop into a general sep- 
ticemia, commonly called blood poisoning. 
Only by careful search for symptoms and observations of these symp- 
toms during the progress of the illness can the correct diagnosis be made 
and the proper treatment be given. 
The season of the year, the geographical location, and the environmental 
conditions are also factors to be considered in the diagnosis of an illness. 
For instance, dengue, malaria, and yellow fever are diseases transmitted 
by certain species of mosquitos. Consequently, these diseases may be 
found where mosquitos harboring these diseases are prevalent. Cholera, 
dysentery, and typhoid fever are often associated with defective sewage 
disposal and contaminated food and water supply. Typhus fever, plague 
and relapsing fever are, however, transmitted by insects and other 68 
MEDICAL COM PEND FOR COMMANDERS OF NAVAL VESSELS 
arthropods and are therefore more apt to be prevalent under conditions 
which make bathing of the body and washing of the clothes difficult or 
bring about exposure to the bite of rat fleas, mite larvae, or ticks. 
When the body is invaded by the microorganisms of a disease there 
is a general disturbance of the health which is usually accompanied by 
a rise in the heat, or temperature, of the body that is known as fever. 
Fever may be continuously elevated for a period of several days, or it 
may vary upward and downward from time to time. 
The termination of fevers occurs in one of two ways: By crisis, when it 
drops suddenly to normal or below, never again rising to any consider- 
able extent unless there is a relapse or a complication sets in, or by lysis, 
when it gradually comes down to normal. Pneumonia, influenza, measles, 
and typhus fever are examples of diseases in which the fever terminates 
by crisis, most other fevers terminating by lysis. 
Body temperature is measured by means of the clinical thermometer, 
a small glass cylinder, the center of which is a slender hollow tube dilated 
at its lower end into an oblong or round bulb and containing mercury. 
When heat is applied to the bulb the mercury expands and is forced as a 
silvery, thread-like line to a height in the tube depending on the amount 
of heat applied to the base. The front aspect of the glass tube is conical 
which, by the refraction of light, magnifies or broadens the image of the 
mercury column so that it is easily seen. On the tube is a scale which, 
in this country, is usually marked in degrees and tenths of degrees Fahren- 
heit, and ranges from 92° to 110°. To read the temperature the conical 
edge of the tube is held toward the reader, the thermometer is rotated 
slightly in the fingers until the flash of the magnified metallic column is 
seen, and then held in that position while the degree on the scale at the 
top oF the column is read. 
A special marking on the scale indicates the normal temperature of 
the human being, 98.6° F., and one should be familiar with its location. 
Before taking the temperature the mercury in the thermometer should 
always be below that mark, usually at about 95° F. To get the mercury 
below the normal mark hold the upper end of the thermometer firmly, but 
not stiffly, between the thumb and the first and second fingers of the 
hand, and, with the wrist relaxed, shake the mercury down by quick 
swings repeated as long as necessary. 
Temperature taken by mouth is considered as the standard, but it 
may also be taken by rectum or in the armpit. When taken by rectum 
it is roughly 1° higher and in the armpit 1° lower than when taken by 
mouth. The thermometer should be left in the mouth about 3 minutes, 
in the rectum for 3 to 5 minutes, and in the armpit for 5 to 7 minutes 
before reading. 
In taking temperature by mouth the thermometer is placed in a slant- SPECIAL DISEASES 
69 
ing position in the mouth with the bulb under the tongue and the tube 
against the corner of the mouth, and the lips kept closed. 
After use clean the thermometer in cold water (hot water wall break 
it, immerse it for 20 minutes in 1-20 solution of carbolic acid, rinse in 
cold water and dry. Equally safe and much simpler is to provide a 
watertight case, keep it filled with 70% grain alcohol and return the 
thermometer after washing (with soap and cold water) to this disin- 
fecting solution. 
Before considering the communicable diseases separately it is necessary 
that certain matters pertaining to and terms employed in dealing with 
them be briefly discussed. 
A rash is a temporary eruption that appears on the surface of the skin. 
It occurs most commonly in the following communicable diseases: 
Measles, German measles, chicken pox, scarlet fever, smallpox, cerebro- 
spinal fever, typhoid fever, and typhus fever. In each of these diseases, 
the character of the rash and the time of its appearance are very important 
factors in making the diagnosis. In describing a rash the following terms 
are used: 
A macule is a small spot of congested skin; it is larger and flatter than 
a papule. It is not elevated above the skin. 
A papule (or pimple) is a small, red, solid elevation of the skin. 
A vesicle is a small collection of serum under the skin; e.g., a water 
blister. 
A bulla or bleb is a large blister. 
A pustule is a small collection of pus under the skin, or an infected 
papule. 
A scab is an irregular mass of dried serum or pus, usually brown in 
color. 
A scale is a particle of dried skin that peels off. 
CONTROL OF COMMUNICABLE DISEASES 
In dealing with communicable or infectious diseases certain terms are 
frequently used and a few of them will be next explained. 
Cleaning.—This term signifies the removal by scrubbing and washing, 
as with hot water, soap, and washing soda, of organic matter on which and 
in which germs may find favorable conditions for living; also the removal, 
by the same means, of germs adherent to surfaces. 
Contact.—A “contact” is any person or animal known to have been 
sufficiently near to an infected person or animal to have been presumably 
exposed to the transfer of infectious material directly or by articles 
freshly soiled with such material. 
Incubation period.—This is the period of time which elapses between 70 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
the date of infection with a communicable disease and the appearance of 
the first symptoms of the disease. During this period the germs of the 
disease are growing and multiplying in the body. 
Isolation.—This is the period of time during which a patient suffering 
with a communicable disease is kept by himself and separated from 
others in order to prevent the conveyance of infectious material to them. 
Quarantine.—This is the time during which the freedom of movement 
of apparently healthy persons who have been exposed to communicable 
diseases is restricted and they are kept under observation to see if they 
develop the disease to which they have been exposed. The period of 
quarantine is generally 2 or 3 days longer than the incubation period. This 
term is also applied to animals and plants. 
Spread of Infection 
The infection of communicable diseases is spread or transmitted in 
various ways—by actual contact, by the air (droplets of saliva or germ- 
carrying dust), food, or drink, clothing, books, utensils, insects, etc. The 
most infectious part of a patient may be discharges from the mouth, 
throat, nose, or ears, the urine, or the feces. 
Prevention of 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 suit- 
able 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 con- 
tact 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 person authorized to land him. The person detailed 
to attend an infectious case must not mingle with other people. The 
patient must have his own separate utensils—cup, plate, knife, fork, 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 cannot, of course, be used for every infected article. 
For bedding and clothing a steam disinfector is used. Habitual disin- 
fection of the mess gear of all the crew by boiling water should be 
meticulously observed after each meal and particularly upon the appear- SPECIAL DISEASES 
71 
ance of a communicable disease. (See also chapter on Quarantine and 
Disinfection; and instructions under specific diseases.) 
3. Disinfesting.—By disinfesting is meant any process, such as the 
use of dry or moist heat, gaseous agents, poisoned food, trapping, etc., 
by which insects and animals known to be capable of conveying or trans- 
mitting infection may be destroyed. 
4. Fumigation.—By fumigation is meant a process by which the 
destruction of insects, as mosquitos and body lice, and of animals, as 
rats, is accomplished by the employment of gaseous agents. 
TREATMENT OF COMMUNICABLE DISEASES 
The fundamental principles of the treatment of communicable diseases 
Rest.—Should be actual rest, in a comfortable bed, placed in a quiet, 
warm, well-ventilated compartment, and every means exercised to relieve 
the patient from anxiety and concern, and to promote sleep. 
Fluids.—As a general rule, clear liquids, such as water, tea, coffee, 
carbonated beverages, lemonade, fruit juices and the like should be given 
to a patient with fever. It should be insisted that he drink from 2 to 5 
quarts (depending on the height of the fever) for each 24 hour period, 
unless he is vomiting or there is some other good reason for his refusal to 
take the desired amounts. It is not necessary to wait for his request 
because frequently 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 the bowels and kidneys and skin active. 
Diet.—Should be as desired or tolerated by the patient. Ordinarily 
this will be liquid or semisolid, such as milk, raw or soft boiled eggs, 
tapioca, cornstarch; chicken, beef, or mutton broths seasoned and thick- 
ened 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 before. 
FRESH AIR.—Means of supplying abundant fresh air, preferably 
cold air, should be provided. Care should be used in making sure that 
the patient is kept warm and is not exposed to direct drafts of cold air 
by the abundant supply of air provided. 
HYDROTHERAPY.—Ordinary personal cleanliness requires that a 
patient receive a bath every day, if possible. This is particularly true 
in the case of patients who have sweats and fever. Sponge baths of tepid 
water (98°-100° F.) may be given occasionally to bring down a high 
temperature (over 104° F. orally), and to add to the comfort of the 72 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
patient. Care should be exercised not to expose the patient to cold air 
during this procedure. 
DRUGS.—Treatment should be carried out primarily to ease the 
patient’s complaints of pain, headache, itching, etc. In the outline of 
treatment of each disease directions will be given for any specific treat- 
ments which may be indicated. 
SULFANILAMIDE, SULFADIAZINE, and related drugs.—These 
medicines are provided in 7.7 grain (0.5 gram) and 15 grain (1.0 gram) 
tablets as well as in powder form. They are of great value in the treat- 
ment of certain diseases, such as pneumonia, meningitis, gonorrhea, blood 
poisoning and the like. The powder is used in the local treatment of 
wounds and compound fractures. 
Indiscriminate use of these drugs is dangerous. Under ordinary cir- 
cumstances when their use is indicated, 1 or 2 tablets (0.5-1.0 gram), 
depending on the size of the tablets available and on the dose recom- 
mended, is given with teaspoonful of soda bicarbonate every 4 hours, 
a day and night until the patient is well. Unless it is impossible to obtain 
medical care, do not continue the use of these drugs for more than 5 days 
without medical consultation. 
Certain precautions must be taken when a patient is taking one of the 
Sulfanilamide group: 
1. Fluids must be drunk daily to the total of 3-3*/2 quarts (12-15 
full glasses) and the urine output must be maintained at 1-2 pints or 
more in each 24 hours. 
2. Patients should not be permitted to carry on any duties which re- 
quire use of judgment. 
3. Nausea, vomiting, and cyanosis (blue lips and finger nails) are 
annoying, but are not important. 
4. If the patient develops a rash or sore eyes, becomes delirious, 
jaundiced (yellow skin), if he feels weak and has a very pale tongue, if 
his fever becomes worse, or if he has pains in his sides like kidney colic 
and his urine is red and smoky, stop the medicine and force fluids. 
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 ships, to 
which no member of the medical department is attached, will be as ef- 
ficient 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 promoting 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 are delirious, and, if not watched, 
may injure themselves, 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 73 
SPECIAL DISEASES 
added a little lemon juice or a small pinch of soda, is useful to wet the lips, 
tongue, and inside of cheeks) makes him feel fresher and renders him 
better able to combat the germs and toxins of disease. 
Instructions for the Person Nursing a Communicable-Disease Patient 
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 come in contact with the other people 
of the ship. 
5. On no account are you yourself allowed to mingle with others of 
the crew, etc. 
6. Never eat your meals with the patient. 
7. Wear white clothes, as these can be washed and boiled more easily. 
8. When it is suspected that the patient carries infection in his nose 
and throat avoid as far as possible direct exposure to his cough spray 
and talk spray and wear a gauze mask over the mouth and nose when 
obliged to be in close proximity to the patient’s face. 
GENERAL INFECTIONS 
INFLUENZA (GRIP) 
Symptoms.—Incubation period—short, usually 24 to 72 hours. The 
onset is fairly sudden with fever and signs of bad cold, but the patient 
feels much more ill than with an ordinary cold, and lias severe prostra- 
tion and pains in the back, limbs, and head. In some forms, the lungs 
are chiefly 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 cramps and vomiting may be 
the chief symptoms. The acute illness usually lasts about a week but con- 
valescence may be very prolonged and complicated. 
Treatment.—Keep the patient in bed and force fluids by mouth. Give 
1-2 tablets (5-10 grains) of aspirin every 4 hours when patient is awake. 
One teaspoonful of salt to a pint of warm water makes a good gargle for 
use when there is a sore throat. A teaspoonful of Brown Mixture every 
3 hours will help the cough. 74 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Methods of control.—Isolation.—During acute stage of the disease, 
especially in severe cases and those complicated by pneumonia. 
Quarantine.—None, but visiting the patient should be discouraged. 
General measures.—Disinfect discharges from the nose and throat of 
the patient. Avoid the crowding of beds. Discourage the congregating 
of crowds. 
CHICKENPOX 
Symptoms.—Incubation period—2 to 3 weeks. The rash appears on 
the first day of the illness and consists of vesicles, which dry and form 
scabs. The vesicles 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 vesicles may be so few as to 
escape observation. 
Treatment.—Put to bed if there is fever, otherwise not necessary. 
No change in diet unless patient is unable to swallow solids. Give water 
freely. For itching, wash parts gently with a solution of sodium bicarbon- 
ate, 1 tablespoonful to a pint of water. Keep mouth clean with alkaline 
and aromatic solution. 
Methods of control.—Isolation.—Avoidance of contact with non- 
immune persons should be made effective until all pustules are gone. 
Quarantine.—None. Contacts who have not already had the disease 
should be observed daily for a period of 21 days following last day of 
contact. 
General measures.—Disinfection of articles soiled by discharges from 
lesions. Investigate source of infection (may be mistaken for smallpox). 
Thorough cleaning of compartment after recovery or removal of patient. 
SMALLPOX 
Symptoms.—Incubation period—8 to 16 days, commonly 12 days. The 
beginning is usually sudden with a chill, headache, and pain in the back. 
The headache and backache are very severe and quite characteristic. The 
temperature may rise rapidly to 103° or 104° F. The eruption commonly 
appears 1 to 5 days after the onset of fever on the forehead, scalp, fore- 
arms, legs, and trunk. At first the eruption consists of papules which 
are small and red and feel like shot under the skin. About the sixth day, 
the papules become vesicles; about the eighth day, pustules, and about the 
tenth day scabs form, which in time fall off, leaving, finally, deep white 
pitted scars. When the papules appear, the temperature tends to fall 
but rises again when the pustules are forming. The patient’s skin has 
usually a very foul odor. The severity of the disease may vary from a 
mild form, with a few discrete pustules, to a severe form with hemorrhages 
into the skin, which is often fatal in 1 to 2 days. 75 
SPECIAL DISEASES 
Treatment.—Treatment is to be directed primarily toward making 
the patient as comfortable as possible, and yet preventing any of the 
complications. Food should be liquid or soft and easily digestible. Feed- 
ing may become difficult, owing to the condition of the mouth; therefore, 
special attention should he given to mouth washes and care of the lips 
with vaseline or mineral oil from the onset of the disease. Fluids should 
he given frequently, to the extent of 3-5 quarts daily, in order to prevent 
the patient from becoming “dried out,” and in order to maintain satis- 
factory urine output (at least 1 quart in every 24 hour period). In order 
to relieve the itching and to prevent increased scarring, scratching should 
be prevented and the eruption should be covered with some oily dress- 
ing, such as vaseline, or with cold-water compresses covered with oiled 
silk or muslin. An arrangement to relieve the patient of the weight of 
bedclothes is often necessary. Aspirin, 2 tablets (gr. 10), and pheno- 
barbital 1 tablet (gr. may be given 2-4 times a day to make patient 
more comfortable. The eyes may be washed with borax eye solution (See 
Diseases of the Eye). Delirium is common and the patient must be 
carefully watched. Report the suspected case by radio if possible. 
Methods of control.—Isolation.—Strict isolation in screened quar- 
ters until period of infectivity (disappearance of all scabs and crusts), is 
passed. 
Quarantine.—All members of the crew should be kept aboard and no 
visitors should be permitted aboard until (a) all members of the crew 
have been revaccinated and the height of the vaccination reaction has 
passed or (b) 16 days have elapsed since the first case and no new 
cases have developed. See chapter IX, page 143 for measures to be 
taken upon arrival at port with a case of smallpox aboard. 
General measures.—Disinfection of all articles before leaving sur- 
roundings of patient. Thorough cleaning and disinfection of compart- 
ment after recovery or removal of patient. In all cases of smallpox, 
every effort should be made to obtain medical assistance and the earliest 
vaccination of all members of the crew, regardless of exposure, is neces- 
sary. Investigate the source of infection as many cases of chicken pox are 
mistaken for smallpox. 
MEASLES 
Symptoms.—Incubation period—8 to 14 days. The disease commonly 
commences like a common cold, with sneezing, running of 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 consists of dull, red macules which run together, 
forming various patterns and lasts about 3 days. The lining of the 76 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
mouth and throat appears of the same red color, dotted by minute white 
spots which appear before the skin eruption and are diagnostic of measles. 
The temperature falls as a rule at the end of the fifth day and the symptoms 
disappear, hut the cough may remain for some time. 
Treatment.—The patient is usually quite uncomfortable because of 
his annoying cough, his sore eyes, his fever and his itching. Brown 
mixture (1 teaspoonful), a darkened and quiet room, aspirin, 1-2 tablets 
(gr. 5-10) 2-3 times a day, and soda bicarbonate solution for the 
skin (see Chicken Pox) will often he of help. Otherwise care is quite 
general. Guard against chilling and exposure, as pneumonia is a seri- 
ous and often fatal complication. If pneumonia develops, sulfadiazine, 
2 tablets (15 grains) every 4 hours day and night is to be given until 
patient is well or medical help has been obtained. (See discussion of 
Sulfa-drugs, page 72.) Reading should he prohibited -while patient's 
eyes are inflamed. 
Methods of control.—Isolation.—During period of serious catarrhal 
symptoms, a minimum period of 5 days from the bginning of the rash. 
Quarantine.—None.—Contacts who have not already had the disease 
should be observed daily for 14 days. 
General measures.—Disinfection of all articles which have been in con- 
tact with patient and all articles soiled by his discharges. Thorough clean- 
ing of compartment after recovery or removal of patient. Investigation 
of source of infection. 
GERMAN MEASLES 
Symptoms.—Incubation period—14 to 21 days, usually about 16 days. 
These symptoms are usually very mild, consisting of sore throat, head- 
ache, very mild fever, lasting only a day or two, and enlargement 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; consists of red papules 
larger and duller than in scarlet fever, smaller and brighter than in 
measles, and lasts about two days. 
Treatment.—Along general lines. Beyond keeping the patient iso- 
lated for a few days and avoiding a chill, no treatment is usually necessary. 
Methods of control.—Isolation.-—Until catarrhal symptoms and rash 
disappear. 
Quarantine.—None. Non-immune contacts of first cases should be 
observed daily for 21 days. Observation of contacts when the disease is 
epidemic is probably futile. 
General Measures.—Disinfection of discharges from nose and throat 
of patient and articles soiled by discharges. Airing and cleaning of com- 
partment after recovery or removal of patient. Investigate source of in- 
fection (may be mistaken for scarlet fever in early stages). 77 
SPECIAL DISEASES 
SCARLET FEVER 
Symptoms.—Incubation period—2 to 7 days, usually 3 to 4 days. 
Symptoms come on suddenly, the most marked being fever and sore 
throat with nausea and vomiting. The rash appears on the second or 
third day and consists of bright red papules set very close together, 
which gives 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 may not appear on the face 
in mild cases. It usually lasts about 5 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 coverd with white fur through 
which the red papillae show, giving it the appearance of a strawberry. 
Later when the fur disappears, the tongue becomes very red. The fever 
is usually high and lasts about a week and 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 disappears and is first noticed 
on those parts of the body where the rash was most marked. It com- 
mences as small white spots in the center of which holes appear. From 
this center, circular scales separate. 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. 
The complications of scarlet fever are to be feared. The commonest 
of these are discharging ears, swollen and discharging glands in the 
neck, and kidney involvement (passage of blood in the urine). 
Treatment.—Patient should receive treatment designed to make 
him more comfortable, and to prevent complications as far as possible. 
He should be kept in bed from 2 to 3 weeks, and when first allowed 
up, his exercise should be limited to a few minutes at a time. Diet will 
depend on patient’s appetite, but fluids must be taken to a total of no less 
than 3 quarts a day. Gargles and mouth washes should be given at least 
every 3 hours when the patient is awake. (A good gargle can be made 
by dissolving 1 teaspoonful of ordinary table salt in a pint of hike-warm 
water, or by using alkaline and aromatic solution). Aspirin, 2 tablets, 
(gr. 10) and phenobarbital. 1 tablet (gr. \J/2) may be given several times 
a day for discomfort and restlessness. Wet, cold cloths are sometimes 
useful applications to the neck and throat for relieving pain. It is ad- 
visable to give sulfadiazine, 1 tablet (gr. 7.7), and sodium bicarbonate, 
teaspoonful, 4 times a day until patient is seen by a medical officer. If 
complications are observed, treatment of symptoms should continue. To 
allay itching and when the skin commences to peel, the patient may be 
rubbed with olive oil or a simple ointment or a daily hot bath may be 78 
MEDICAL COM PEND FOR COMMANDERS OF NAVAL VESSELS 
given. The infection is most potent in the secretions of the nose and 
throat during the first 5 days of the disease. 
Methods of control.—Isolation.—If medical inspection is not avail- 
able, isolation for 21 days from onset for uncomplicated cases, longer if 
abnormal discharges continue. 
Quarantine.—None. Non-immune contacts should be given 1 gram (15 
grains) of sulfadiazine daily and observed daily for one week. Such con- 
tacts should be excluded from food handling for 1 week. 
General measures.—Disinfection of all articles which have been in 
contact with patient and all articles soiled by his discharges. Thorough 
cleaning of compartment after recovery or removal of patient. Investiga- 
tion of source of infection (carrier). 
MUMPS 
Symptoms.—Incubation period—12 to 26 days, most commonly 18 
days. The patient complains of pain and stiffness on moving the lower 
jaw, and there will be swelling of one or more of the salivary glands. His 
temperature is raised, often to 104° F. The fever lasts about a week 
and the swelling about 10 days. Orchitis, or inflammation of the testicles, 
is very liable to occur in about 25 percent of cases 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 but is very painful and usually results in atrophy of the af- 
fected testicle, and possible sterility, if both testicles are affected, sterility 
may result. 
Treatment.—Along general lines. Isolate the patient, keep the bowels 
well open, and for the pain, hot water bags may be used applied to the 
swelling. Strict bed treatment and avoidance of exercise and chilling is 
absolutely necessary to avoid complications. If orchitis occurs the testicles 
should be supported by a suspensory bandage or a broad strip of adhesive 
plaster, with gauge 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 salt—2 tablespoonfuls dissolved 
in water. 
Methods of Control.—Isolation.—Until all swelling has subsided. 
Patient should be kept in bed one week after swelling about jaws has sub- 
sided in order to avert occurrence of orchitis. 
Quarantine.—None. All contacts, however, should be inspected daily 
for a period of 3 weeks from date of last exposure. 
General measures.—Disinfect all articles soiled by discharges of nose 
and throat of patient. Investigate source of infection (e. g., recent cases 
of swollen jaw or orchitis). SPECIAL DISEASES 
79 
MALARIA 
Symptoms.—Incubation period—usually 14 days in the tertian variety. 
This is a recurrent fever caused by malarial parasites which are carried by 
certain anopheline mosquitoes and injected into the body when the insects 
bite. The disease is not infectious except through the bite of a mosquito 
which has bitten malaria patients or carriers at some time during its life. 
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 bed clothes. The skin feels hot and dry, and he suffers from 
severe headache. The temperature will now be elevated and in some cases 
may reach 105° F. or higher. This stage lasts 3 or 4 hours. (3) The 
sweating stage: During this stage the patient perspires freely, the headache 
and flush disappear, and the temperature returns to normal. This stage 
lasts about 2 hours. These attacks occur every day, every other day, or 
every third day, according to the species of malarial parasite with which 
infected, and each lasts about 6 hours. There are other types of malaria in 
which the fever is continuous, and somewhat resembles the fever of 
typhoid. 
Treatment.—Quinine, 5 tablets, (15 grains) should be given three 
times a day for 2 days and then, 3 tablets, (9 grains) three times a day for 
the next 5 days. If chills and fever begin again, the same dosage should 
be repeated. (If Atabrine is available, the dosage is 2 tablets (gr. 3) every 
6 hours for 5 doses followed by 1 tablet (gr. l*d>) three times a day for 
6 days. This should not be repeated for at least 1 week). Diet will be as 
tolerated. Fluids should be forced at least 3 quarts a day. Patients are 
often restless and sometimes disoriented, so they should be watched. Dur- 
ing a chill, patients should be given extra blankets, even though the 
weather is quite warm, and care should be taken not to permit too rapid 
exposure at the time of the sweating. If hot water bottles are used, care 
must be exercised not to burn patient. (105°-110° F. is sufficiently warm 
and does not feel hot). Frequent sponges and baths will be required by the 
sweating. Mouth cleanliness should be watched. Aspirin, 2 tablets, (gr. 
10) may be used every 3 or 4 hours for headache and discomfort. 
Methods of control.—Isolation.—The individual with malarial para- 
sites in his blood should be protected from the bites of mosquitoes. With 
the exception of this simple precaution, isolation and quarantine are of 
no avail. 
Quarantine.—None. (See Isolation.) 
General measures.—The malarial mosquito bites preferably at dusk or 
at night, therefore when in malarial countries everyone should sleep un- 80 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
der mosquito nets. Suppressive (preventive) treatment should not be 
started without consultation with a naval medical officer or one of the naval 
malaria-control units which have been set up in many malarious areas. 
Advice as to the use of repellent and as to the destruction of all possible 
breeding places for mosquitoes aboard should be obtained from the same 
sources 
DENGUE 
Symptoms.—Incubation period—3 to 15 days, most often 7 or 9 days. 
Sudden onset, intense headache, joint and muscle pains (breakbone fever), 
and irregular eruption. 
Treatment.—Treat the symptoms. Aspirin, 2-3 tablet (gr. 10-15), 
every 3-4 hours will make patient somewhat more comfortable. The pa- 
tient will seem to get well for a day or 2 after 3 to 5 days of illness, but will 
become sick again for 1 or 2 days. Treatment during this second stage is 
the same. Diet will be as tolerated. Force fluids. 
Methods of control.—Isolation.—The patient must be kept in a 
screened room. 
Quarantine.—N one. 
General measures.—Protection against mosquitoes by means of screen- 
ing and repellents and elimination of mosquitoes. 
UNDULANT FEVER 
Symptoms.—Incubation period—6 to 30 days or more. Onset grad- 
ual with irregular fever of prolonged duration; profuse sweating, chilliness, 
pain in joints and muscles. This disease, also called Malta or Mediter- 
ranean fever, is transmitted from infected cattle and goats chiefly through 
unpasteurized milk or by direct contact with infected animals (including 
swine) or animal products. 
Treatment.—On general lines. Patient will probably need prolonged 
care and should be hospitalized. Fluids and diet will be given as tolerated. 
Aspirin, 2 tablets, (gr. 10) 4 times a day will diminish fever and relieve 
pain. 
Methods of control.—Isolation.—None. 
Quarantine.—None. 
General measures.—Pasteurization of milk, whether from cows or goats. 
Investigation of source of infection. 
plague 
See description under “Quarantine”, chapter IX. This disease probably 
will not be encountered aboard naval vessels. It should be remembered 
that this disease is usually transmitted by rat fleas or by direct contact SPECIAL DISEASES 
81 
with other cases. The best means of control, therefore, are by rat surveys 
and eradication. 
If plague is encountered, give sulfadiazine (sulfathiazole is less effective 
but may be used when sulfadiazine is not available). Four (4) tablets (4.0 
gms.) at once and then \ l/2 or 2 tablets (1.5-2.0 gms.) every 4 hours, day 
and night until temperature is normal. Continue with y2 tablet (0.5 gms.) 
every 4 hours at least 10-15 days after temperature is normal. One-half 
teaspoonful of soda bicarbonate should be given with each dose of tablets. 
Fluids should be given to the extent of at least quarts a day. Watch 
for any signs of Sulfadiazine poisoning. 
YELLOW FEVER 
Symptoms.—Incubation period—3 to 6 days, rarely longer. When a 
susceptible individual is bitten by an infected mosquito, there develops, 
after the period of incubation, a rapid rise of fever, with marked conges- 
tion of the face and severe pains of the back and head. Vomiting, first 
of mucus and bile, comes on very early. The temperature remains fairly 
high for 3 or 4 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 sign. On 
the fourth day the temperature falls and the face loses its congested ap- 
pearance, and it is now that the most characteristic feature of yellow 
fever appears; namely, jaundice, a yellow discoloration of the skin, mucus 
membranes, eyeballs, and secretions. Vomiting of material resembling 
coffee grounds is common. This is an important epidemic disease of the 
West Coast of Africa. There has been no case of the urban type in North 
or Central America or the West Indies for many years. Outbreaks of 
the so-called jungle type have occurred in recent years in South America, 
in Colombia, Brazil, and Bolivia. The virus is contained in the blood of 
infected patients only during the first 3 days of the disease, and the 
disease is transmitted by the bite of a mosquito, Aedes aegypti formerly 
known as Stegomyia fasciata or c do pus, which has fed on the blood of 
an infected person about 12 days previously. 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 5 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. 
Treatment.—Fluids should be forced. Soda water (made by adding 1 
teaspoonful of sodium bicarbonate (baking soda) to a quart of water and 
citrus fruit juices should be given to the total of at least 3 quarts daily. 82 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Bed rest is essential and hospitalization should be brought about as soon 
as possible. Vomiting may be difficult to control, and if so, a retention 
enema (rectal installation) of the above mentioned soda water should be 
given not oftener than every 5-6 hours. As soon as possible, patient should 
be started on a light diet which is high in carbohydrate (fruit, starches, 
grains, cereals, etc.), but low in fat. Convalescence will be long. 
Methods of control.—Isolation.—Necessary, during first 4 days of 
fever, in a mosquito-free room. 
Quarantine.—None. 
General measures.—Any receptacle, tank, double bottom, or other place 
where fresh water may be collected should be thoroughly screened and 
frequently inspected in order to prevent the breeding of mosquitos. Pro- 
tection against mosquitoes by screening and repellents is essential. See 
Special Quarantine Measures, chapter IX. 
SYSTEMIC DISEASES 
Diseases of the Respiratory Tract 
COUGHS AND COLDS 
When a person has a cough that lasts more than 2 weeks, even though 
the symptoms are mild, the case is serious enough to require an examina- 
tion by a 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. 
Symptoms.—A bad cold usually begins with a stuffed nose or an irrita- 
tion in the throat, which gradually travels down the larger tubes. The 
cough is at first usually dry, but later it becomes loose and considerable 
mucus is raised. This sputum 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.—Several nights of good sleep and drinking 3-4 quarts of 
fluids each day are about as satisfactory remedies for a cold as may be 
found. Aspirin, 2 tablets, (gr. 10) 4 times a day will relieve discomfort. 
Brown Mixture, 1 teaspoonful, at the same time is useful in relieving the 
cough. If sweating occurs, exposure should be avoided. SPECIAL DISEASES 
83 
TONSILITIS (SORE THROAT) 
All cases of tonsilitis and sore throat with fever should be promptly 
isolated because of the possibility of their being diphtheria, scarlet fever, 
etc., and the consequent possibility of an epidemic of that disease should 
such be the case. 
Symptoms.—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 regarded as diphtheria and 
the individual promptly and completely isolated, and a medical officer con- 
sulted as soon as possible. 
Treatment.—Bed rest is useful. Fluids (3-4 quarts a day) should be 
pushed. Warm salt water or alkaline and aromatic gargles (see Scarlet 
Fever) every 2 hours will relieve the sore throat. Liquid or soft diet is 
usually more acceptable than a heavy diet. Aspirin, 2 tablets, (gr. 10) will 
help relieve the discomfort. 
PNEUMONIA 
Pneumonia is an acute infectious disease which results in an inflamma- 
tion of the lungs. It usually begins suddenly with a chill, followed by high 
fever (102°-104° F. or higher). Often there is a sharp pain in the chest 
(pleurisy), which is made worse by deep breathing and by the cough 
which regularly accompanies this disease. Rusty or prune juice colored 
sputum is coughed up. Breathing is rapid and shallow. Headache and 
prostration are common. 
Treatment.—Bed rest in a ventilated but not drafty room is impera- 
tive. Sulfadiazine is almost specific for this disease. Give 8 tablets (4.0 
grams) as the first dose and then 2 tablets (1.0 gram) with y2 teaspoon- 
ful of soda bicarbonate every 4 hours day and night, thereafter until pa- 
tient’s temperature has been below 99° F. for 72 hours. Force fluids to 3l/2 
quarts a day. Watch for signs of sulfadiazine poisoning. Brown Mixture 
(2 teaspoonfuls) every 4 hours used for cough. Be careful not to expose 
patient when bathing him. Diet will be liquid or light. 
Methods of control.—Isolation.—Until temperature returns to nor- 
mal. 
Q uarantine.—N one. 
General measures.—Avoidance of overcrowding, chilling, and fatigue. 
Disinfect all articles soiled by nose and throat discharges of patient. 84 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
DIPHTHERIA 
This is an acute 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 and all secretions from the nose and mouth are 
infectious. 
Symptoms.—Incubation period—usually 2 to 5 days, occasionally long- 
er. Symptoms 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 ad- 
dition to the symptoms caused by blocking of the air passages by the forma- 
tion of the membrane, the patient suffers greatly from an overwhelming in- 
toxication due to the formation of a poison by the diphtheria bacilli 
located in the membrane. 
Treatment.—Isolation of patient from rest of crew, and complete bed 
rest are essential. The disease may spread rapidly to other people, and 
sometimes causes rapidly fatal heart trouble in the patient. Serum (anti- 
toxin) is available for this disease, and it will make the disease less severe, 
as well as remove the chance of the heart disease. Therefore, have the 
patient seen by a medical officer at the earliest possible moment. Warm 
saline gargles will ease the sore throat. Avoid having the patient cough 
into the face of the attendant, and require the attendant to wash his hands 
thoroughly each time after being near patient. Attendant should wear 
a gauze face mask while helping patient. 
Methods of control.—Isolation.—Until released on advice of medical 
officer. 
Quarantine.—All members of the crew should be kept aboard and no 
visitors should be permitted aboard until ship is released by medical officer. 
General measures.—Disinfection of all articles which have been in con- 
tact with patient or soiled by his discharges. Thorough disinfection and 
airing of compartment after recovery or removal of patient. Immunization 
of susceptible contacts. Investigate source of infection (milk, carriers, and 
pasteurization of milk supply). 
acute abdominal conditions 
The most common, serious, acute abdominal conditions are acute appen- 
dicitis, perforating ulcers of the stomach or duodenum, intestinal obstruc- 
tion, gallstone colic, kidney stone colic, and poisoning by infected food or 
by other poisons. Pain and tenderness in the abdomen, general or localized 
or both, nausea and vomiting, and more or less shock are symptoms com- 
mon to these conditions. All cases presenting symptoms of abdominal SPECIAL DISEASES 
85 
pain or nausea and vomiting, particularly when associated with more or 
less shock, should be brought under the care of a medical officer as soon 
as possible. If patient will be seen by a medical officer within a few hours, 
morphine should not be given. If no medical aid is available and the pain is 
excruciating, one-half of one morphine syrette may be given, but should 
not be operated on in less than 6 hours. 
One always should suspect more than ordinary indigestion or constipa- 
tion if there is much prostration, shock, or elevated temperature, or if the 
symptoms persist for any length of time. Many a person suffering from 
acute appendicitis or obstruction of the bowel will ascribe the condition to 
something that has been eaten, but do not be deceived by such a statement. 
Get all the information possible as to how the attack started, history of pre- 
vious attacks, and symptoms prior to the present attack, whether the pa- 
tient has vomited blood or not, and when the bowels last moved; take the 
temperature and pulse rate; lay the patient flat with the abdomen bared 
and determine by gentle and careful palpation where the pain and tender- 
ness are most marked. 
ACUTE APPENDICITIS 
Symptoms.—Appendicitis is an inflammation of the appendix. A patient 
frequently complains for several days before the attack of indigestion, loss 
of appetite, constipation or diarrhea, and uneasiness in the abdomen, or the 
attack may come on suddenly. The pain may start in the pit of the stomach, 
then become generalized over the abdomen, and finally, after several hours, 
become localized in the right lower quadrant of the abdomen with marked 
tenderness on pressure and rigidity of muscles over that point. Vomiting 
generally comes on 3 or 4 hours after the beginning of the attack. The 
temperature may be subnormal from mild shock or be elevated to 100° or 
101° F. In acute appendicitis the appendix becomes full of pus and the 
danger lies in its rupture with resulting peritonitis. 
Treatment.—Place the patient under the care of a surgeon as soon as 
possible. Put patient to bed with head and shoulders somewhat elevated. 
Give nothing by mouth unless a medical officer will not be available for 
some time (12-24 hours), in which event small amounts of water may be 
given by mouth. An ice bag or a hot water bottle (whichever is more com- 
fortable) may be placed over the appendix. Give sulfadiazine, 2 tablets, 
(gr. 15) every 4 hours. Never give a cathartic to a person suspected of 
having acute appendicitis. 
ACUTE INTESTINAL OBSTRUCTION 
Symptoms.—In this condition, a loop of bowel becomes constricted, re- 
sulting in the inability of the intestinal contents to move beyond the point 86 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
of constriction and cutting off the blood supply to the loop of the bowel 
with resulting gangrene or death to that section of the bowel. This condi- 
tion is followed by absorption of poisons from the intestine, peritonitis, and 
death if the condition is not relieved. Two very common ways for the bowel 
to become constricted are by means of adhesions within the abdomen and 
by a loop of bowel becoming strangulated in a hernia, or rupture, as it is 
commonly called. The symptoms are inability to pass gas or feces by the 
rectum, pain in the abdomen, vomiting becoming more and more frequent, 
and intense shock. The bowel will be distended above the point of con- 
striction and be flat below that point. The bowel must be relieved of its 
constriction or death will ensue. 
Treatment.—Place the patient under the care of a surgeon at the 
earliest possible moment. In the meantime, take the following measures; 
(1) If the obstruction is due to a strangulated hernia, and the case has 
not gone too far, put the patient in a hot tub with the thighs flexed in order 
to relax the inguinal ring, and exert gentle pressure over the tumor; (2) 
put the patient to bed, give a soap and water enema, and nothing by 
mouth. Never give a person suspected of suffering from obstruction of the 
bowels a purgative. 
PERFORATED GASTRIC OR DUODENAL ULCER 
Symptoms.—Generally, though not always, a person suffering from 
perforated ulcer of the stomach or duodenum gives a long history of 
stomach trouble. Acute pain “in the pit of the stomach,” associated with 
more or less shock, is suddenly felt. The pain is sudden and intensely 
violent, which is greatly increased by swallowing fluids, by vomiting, by 
turning the body, by coughing, by respiration, and by pressure. This pain 
may radiate throughout the abdomen, but the chief tenderness is in the 
region of the stomach. Vomiting occurs in about one-half the cases at the 
time of perforation. Shock may be severe following the perforation, but, 
as a rule, does not last long. A board-like rigidity of the muscles of the 
abdomen is present, and the temperature is usually normal or subnormal. 
The danger from perforated ulcer of the stomach or duodenum is peri- 
tonitis, due to the escape of stomach or duodenal contents into the peri- 
toneal cavity. 
Treatment.—Bring the patient under the care of the surgeon as soon 
as possible before peritonitis sets in; in the meantime, put the patient to 
bed, give absolutely nothing by mouth, and put an ice bag over the stomach; 
and treat shock if present. 
GALLSTONE COLIC 
Symptoms.—Gallstone colic is due to the passage, or the attempt at 
passage, of a gallstone from the gallbladder to the intestines. Depending SPECIAL DISEASES 
87 
on the location of the stones, a person with gallstones may or may not be 
jaundiced. The patient frequently gives a history of stomach trouble with 
or without jaundice and may give a history of previous gallstone colic. 
The colic consists of spasmodic, excruciating pain over the stomach and 
liver, radiating upward over the right half of the thorax, frequently up 
under the right shoulder blade. The patient is very nauseated, and usually 
vomits, and often the vomiting is violent. The abdomen is distended and a 
condition of collapse soon comes on. The respirations are shallow, the 
patient groans, cries out, or flings himself about the bed, often assuming 
strange contorted positions, trying to obtain relief, frequently holding one 
hand over the liver region. The duration of an attack is from 4 to 20 hours, 
although it may last much longer. The temperature is usually normal O’ 
subnormal. 
Treatment.—Bring the patient under the care of a medical officer as 
soon as possible. In the meantime, place a hot-water bag over the liver 
at the lower border of the ribs. 
KIDNEY STONE COLIC 
Symptoms.—This condition is due to a small stone from the kidney 
entering into the ureter, which it blocks, tears, or distends. The pain is 
gradual or sudden in onset, is fearful in intensity and runs from the lumbar 
region down the corresponding thigh and testicle and into the abdomen and 
back. There are nausea, vomiting, collapse, and sometimes unconsciousness 
or convulsions. Frequent attempts at urination result in pain but little 
urine. The urine is often smoky or red from injury to the ureter. After 
a time the pain vanishes, due to the stone falling back into the pelvis of 
the kidney or to its passing on into the bladder. 
Treatment.—Bring the patient under the care of a medical officer as 
soon as possible. In the meantime, put patient to bed, give plenty of 
water by mouth to increase the flow of urine, place a hot-water bag on 
the affected side of the abdomen, and administer 1 syrette of morphine to 
relieve pain. 
Diseases of the Intestinal Tract 
COLIC 
Symptoms.—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 ex- 
ample, abdominal pain is almost always the first and most pronounced 
symptom of appendicitis, intestinal obstruction, perforating ulcers, gall- 88 
MEDICAL COMl’END FOR COMMANDERS OF NAVAL VESSELS 
stones, kidney stones, lead poisoning (painter’s colic), and food poisoning. 
Besides being a symptom of these conditions, colic is most frequently due 
to overindulgence in food and drink. 
Treatment.—Place the patient in bed and apply a hot-water hag to 
the abdomen, interposing a cloth between the hag and the skin or wrapping 
it in a towel to protect the skin from being burned or blistered. No food or 
drink should be allowed until the colic has subsided. 
Never give a purgative or a cathartic to a person suspected of having 
appendicitis or intestinal obstruction and give absolutely nothing by mouth 
to a person suspected of having a perforated ulcer of the stomach or intes- 
tine, but bring him under the care of a medical officer at once. 
An individual suffering with colic is vastly better off with nothing in 
the stomach and such a person can easily go without food for 2 or 3 days, 
but must have water, which should be given in small amounts. If the 
patient’s bowels have not moved, an enema (injection into the rectum) 
consisting of a pint of warm water and soapsuds, should be given and re- 
peated in half an hour if there has been no result. 
After all pain has subsided, the patient may be given liquid or semisolid 
foods, such as clear soups, custards, milk, milk-toast, or soft-boiled eggs. 
This diet may be cautiously and gradually increased to solid foods as the 
pain and vomiting subside and do not return. 
DIARRHEA 
Symptoms.—Frequent, watery and painful stools are often accompanied 
by loss of appetite, nausea, and sometimes vomiting and abdominal cramps. 
Commonly it is an acute condition caused by some inflammation or irrita- 
tion of the intestine. It is one of the main symptoms of typhoid fever, 
cholera, and dysentery. It is termed simple diarrhea when it occurs in- 
dependently of any definitely diagnosable disease. It may be caused by 
exposure to cold or by eating unripe and indigestible vegetables and 
fruits, or decomposed or improperly cooked meat, fish, and shell fish. 
Drinking large quantities of cold water when the body is overheated is a 
frequent cause. 
Treatment.—The patient should be encouraged to take fluids by mouth 
to the extent of his ability. A hot-water bag should be applied to the ab- 
domen and the patient kept at rest in bed. 
While the diarrhea is acute, the less food taken the better. During con- 
valescence he should be given salty soups to relieve muscle cramps incident 
to the loss of salt in the evacuation and he should be kept on a smooth, 
bland diet until all symptoms have disappeared. No medicine ordinarily 
should be given. Small quantities of soda bicarbonate, 10 grains or 15 
grains, in a little hot water may be given three or four times a day. SPECIAL DISEASES 
89 
FOOD POISONING 
Symptoms.—Sudden onset (usually 2 to 6 hours after the food has been 
eaten though may be as long as 72 hours) with violent diarrhea, vomiting, 
abdominal cramps, prostration, and dizziness, occurring usually in epidemic 
form. The severity of symptoms will vary with different individuals. In 
most cases the acute symptoms will be over in 12 to 24 hours, leaving for 
several days a marked weakness, loss of appetite, and abdominal discom- 
fort. Recovery is usually complete in 48 hours. 
Outbreaks are caused by bacterial contamination of foodstuffs that have 
been prepared and allowed to remain at room temperature for varying pe- 
riods of time prior to being served. The most common foodstuffs are: 
Ham, other meats and meat mixtures ; salads; milk and cream preparations 
such as cream puffs, custards, and pies. 
Treatment.—Give water freely. The patient should be placed in bed 
and a hot water bottle applied to the abdomen. Food should he withheld 
until 24 hours after cessation of the acute symptoms. There should be a 
slow return to a full diet. 
Methods of control.—Isolation.—Not Required. 
Quarantine.—None. 
General measures.—Sources of infection can be eliminated only by in- 
suring freedom from disease and a high standard of personal hygiene in 
all food handlers (particularly in regard to the matter of washing their 
hands after visiting the toilet), by serving foodstuff promptly after its 
preparation, and by maintaining a high standard of sanitation in the galley 
and butcher shop. It is particularly important that persons with boils, 
or infected cuts or sores on their hands not be permitted to handle foods. 
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 fre- 
quently occurs in widespread endemics and may attack a whole ship’s com- 
pany. 
It is caused by specific microorganisms winch enter the system with con- 
taminated 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 90 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
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.—Rest in bed is important. Keep the patient warm. Large 
amounts of fluids by mouth are required in order to replace those lost 
in the frequent bowel movements. Water with 1 teaspoonful of table salt 
to the pint is often very acceptable to these patients. Sulfadiazine, 2 tab- 
lets, (gr. 15) with y2 teaspoonful soda bicarbonate every 4 hours day and 
night will relieve the number of stools in many cases. Care should be 
taken not to permit any of the diarrheal or bloody bowel movement mate- 
rial to get onto the hands or into the mouth. Diet should be light. 
In countries where dysentery is prevalent no fruit or uncooked 
vegetables should be allowed, and all foods, both cooked and uncooked, 
should be protected from flies, which carry the contagion. Nothing but 
distilled or boiled water should be used for drinking or cooking purposes. 
TYPHOID FEVER 
This important disease is now very rare in the naval service because 
of antityphoid inoculation used throughout the Navy. 
Symptoms.—These come on very gradually with loss of appetite, gen- 
eral 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 4 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 about the seventh day on the abdomen, back, and 
lower part of the chest. It consists of fairly large, raised rosespots, 
which fade on pressure. They are usually few in number and come out 
in crops. Each spot lasts about 4 days and the rash lasts about 14 days. 
As the fever progresses the patient becomes very weak; he loses weight; 
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 necessary in the treatment of 
typhoid fever. The chief articles of diet in typhoid fever are; milk, cream, 
well-cooked cereals, such as rice, grits, cream of wheat, strained oatmeal, 
etc.; soft boiled, soft poached, hard boiled or soft scrambled eggs; toast or SPECIAL DISEASES 
91 
crackers; fruit juices; stewed apples, peaches, or apricots, apple float, 
butter, soups thickened with rice or barley flour, creamed soups, mashed 
or baked potatoes, scraped meats or finely minced meat. Simple desserts 
such as boiled custard, ice cream, bread or tapioca pudding, junket, cup 
custard, blanc mange, eggnog, and jellies are allowed. Food should be 
given a little at a time and at frequent intervals—2 or 3 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. 
Method of control.—Isolation.-—In fly-proof compartment. Re- 
lease from isolation should be determined by a medical officer. 
Q uarantine.—N one. 
General measures.—Disinfection of all bowel and urinary discharges and 
articles soiled by them. Dishes and soiled linen should be boiled. Thorough 
cleaning of compartment after recovery or removal of patient. Immunize 
all members of crew, who are not protected. Investigate source of infec- 
tion (water, milk, shellfish, and other food supplies), and carriers of the 
disease. Serve no raw milk or food until sure of its safety. Eliminate flies. 
The germ of the disease enters the body through the mouth in infected 
foods or drinks, of which water and milk are the commonest, and, after 
that, food contaminated by flies, thus showing the importance of protect- 
ing all foods, both cooked and uncooked, from flies. 
CHOLERA (ASIATIC) 
An acute diarrheal disease transmitted by food, flies, water, and con- 
tact with infected persons. 
Symptoms.—Sudden onset with headache, prostration, diarrhea, and 
colic; later vomiting, purging, high fever, cold, clammy, shrunken and 
livid skin, rapid wasting of body, thirst, muscular cramps, watery (rice 
water) stools, with collapse. 
Treatment.—Isolation, absolute quiet, application of external heat. 
Force fluids if possible. See a doctor immediately. (See dysentery.) 
Methods of control.—Isolation.—In hospital or screened room dur- 
ing period of communicability, usually 7 to 14 days. 
Quarantine.—Until stools are negative; contacts for 5 days from last 
exposure, or longer if the stools are found to contain the cholera vibrio. 
General measures.—Thorough disinfection of all discharges from the 
bowels and vomited matter. Investigate source of infection. Use only 
boiled water and cooked foods and protect against flies and human han- 
dling. Immunization of contacts by vaccine, and of all personnel in 
presence of an epidemic. (See Special Quarantine Measures, Chapter IX.) 92 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Diseases of the Skin 
THE ITCH (SCABIES) 
This is an itching disease (known as the “7 years’ itch,” etc.) found 
among people living in unclean surroundings and habits. 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 articles, 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.—All clothing and bedding belonging to or used by the 
patient which has been in contact with the skin, whether freshly laundered 
or soiled, such as underwear, pajamas, and socks, should be collected and 
sterilized by heat (steam or boiling water). Woolen clothing may be 
sterilized by thorough steaming with a hot iron and wet cloth as in 
pressing, or may be dry-cleaned. Before retiring, the patient should take 
a hot bath with plenty of soap. The surface of the skin, particularly in 
the vicinity of the eruption should be thoroughly scrubbed. Following 
this bath, an ointment consisting of sulfur and lard, commonly known as 
the official sulfur ointment (in Medicine Box) in the proportions of 
about 1 teaspoonful of sulfur to 1 ounce of lard, is now rubbed thor- 
oughly into the skin from the collarbone entirely 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 oint- 
ments above the collarbone, as the disease seldom attacks that portion of 
the body. Whenever an application of sulfur ointment is applied at 
night, a hot bath with much soap must be taken the next morning. The 
sulfur-ointment application should be repeated once a day preferably 
just before retiring until the eruption and itching have subsided, when it 
may be assumed that the patient has been cured. All clothing used by 
the patient during the preceding 24 hours should be collected each day 
and sterilized. The patient may use two sets of clothing, underwear, 
socks, pajamas, sheets, etc., changing each day and sterilizing that worn 
or used the day before. Laundering each day is desirable but not neces- 
sary. Should the eruption continue and the itching remain unabated, a 
second series of treatments as described should be given. Too long an 
application of these treatments, however, is not advisable as the sulfur 
tends to cause an irritation of the skin which may cover up the scabies. 
If the skin gets very rough and generally red from irritation, limit treat- 
ment to anointing the body with vaseline or zinc ointment. 
Any locker or other place used by the patient in storing clothes, should 
be disinfected with the Navy standard insecticide. This may not be used SPECIAL DISEASES 
93 
in treatment, however, as actual contact is required and the insects like 
termites, being within the layers of the patient’s skin, cannot be reached. 
RINGWORM 
This is a highly infectious disease of widespread prevalence, particu- 
larly in the Tropics and subtropics and during a hot, humid summer in 
the temperate zone. In adults it affects all parts of the body, though rarely 
the scalp: On the face it is commonly called “barber’s itch,” in the crotch 
“dhobie itch,” or “jock-strap itch,” and on the feet “athlete’s foot.” The 
cause is an infection with a fungus or mould. When well developed, 
it tends to form circles (ringworm) or parts of circles. Itching is a 
prominent symptom. In some cases, concentric circles develop or rings 
form upon one another, making various patterns. The spreading border 
is red or reddish and more scaly than the central portion which may 
appear normal to the unaided eye. It may begin as a few or numerous 
small red patches with scaling vesicles and crusts. It may be trans- 
ferred from one part of the body to another by scratching the bare skin. 
Treatment.—The fungus is very partial to dark, damp places, such 
as swimming pools, wash and bath rooms, and the inner recesses of 
deck swabs. As the infection frequently starts on the feet, members of 
the crew as well as the patient should be advised not to go barefooted 
but to wear some sort of a sandal, particularly in going to and from 
the shower, and to dry the toes thoroughly after bathing. Maceration of 
the skin in hot, moist weather favors spread. After bathing and while 
wearing shoes, the use of a good antiseptic powder on the feet and 
between the toes is advised. Such a powder, which may be obtained at 
any naval medical activity, consists of: Salicylic acid, 5 gm., menthol, 
2 gm., camphor, 8 gm., boric acid, 50 gm., and starch, 35 gm. It may 
also be used in the treatment of the disease. The floors of shower 
baths, washrooms, etc., should be swabbed daily and mops should be 
dried in the sunshine. The patient should see a medical officer. The 
more intractible cases may require extended medical treatment. 
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 eggs are attached to the hairs by a covering which 
is soluble in acids such as vinegar (acetic acid). 94 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
The irritated appearance of the skin is caused largely by scratch marks. 
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 hair should be 
cut short. Thoroughly anoint scalp with vaseline or mild mercurial oint- 
ment which should be left on for about 1 hour. Then scrub head with 
soap and water and comb with a fine-tooth comb wet with vinegar. The 
egg cases or “nits” are soluble in acids and the vinegar tends to dissolve 
or destroy them. This treatment should be repeated in 3 or 4 days in 
order to “mop up” any remaining “nits” or adults that may have escaped 
the first treatment. 
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. In treating the crab 
louse it is first necessary to trim the hairs short around the genitals 
and to cut the hairs in the arm pits where there is a possibility of the 
infection spreading. The area is thoroughly scrubbed with soap and water 
and a thin coating of vaseline or mild mercurial ointment thoroughly 
rubbed in and allowed to remain for 24 hours. These areas are then 
scrubbed again with more soap and water and ordinary table vinegar 
is applied several times during the day. This treatment must be re- 
peated a day or two later. 
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 gar- 
ments. The treatment consists of changing the entire outer and under 
clothing after taking a bath and scrubbing the person thoroughly with 
a liquid soap. Infected clothing should be boiled. The patient’s mattress 
cover and blankets should likewise be disinfected, preferably by heat. 
Diseases of the Nervous System 
HEADACHE 
Headache is a symptom of disease of some part of the body. It gen- 
erally accompanies the acute fevers, is associated with constipation, dis- 
orders 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 Epsom salt and give 10 grains of aspirin or 5 grains 
of phenacetin, and repeat in 3 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. SPECIAL DISEASES 
95 
CEREBROSPINAL FEVER (MENINGITIS) 
Symptoms.—Incubation priod—2 to 10 days, commonly 7. Onset is 
sudden with symptoms of an acute cold, fever, headache which may 
be almost unbearable, nausea, rigidity of neck and insomnia followed by 
delirium or coma. In some cases marked drowsiness and headache and 
presence of an acute cold are the only symptoms. Frequently appears 
during epidemic of acute colds. A rash of dusky red spots, not vanishing 
upon pressure first appears upon the chest, abdomen, and back. It may 
be slight in mild cases but prominent in severe cases. 
Treatment.—Patient should be kept in bed in a cool, darkened room. 
Give Sulfadiazine, 8 tablets (4.0 grams) at once and 2 tablets (1.0 grams) 
with y2 teaspoonful of soda bicarbonate every 4 hours day and night 
until temperature has stayed below 99° F. for 48 hours. Give at least 
3p2 quarts of liquids a day. Watch for poisoning from Sulfadiazine 
(q.v.). Diet will be tolerated. Patient may become delirious so should 
be watched. 
Methods of control.—Isolation.—Isolation of infected persons 
until 14 days after onset of the disease. 
Quarantine.—None, but all close contacts should receive 15 grains of 
sulfadiazine 3 times a day for 3 days. 
General measures.—Disinfection of articles soiled by discharges from 
the nose and throat. Prevent overcrowding, chilling, fatigue, and undue 
strain. Thorough cleansing of compartment after recovery or removal 
of patient. 
DELIRIUM TREMENS 
Delirium tremens occurs as an incident in the life of persons addicted 
to the excessive use of intoxicating liquors. 
Symptoms.—Loss of appetite, sleeplessness, or a marked mental de- 
pression 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. De- 
lirium tremens may be confused with the delirium of acute fevers. Pneu- 
monia 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 96 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
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 2 hours and the patient encouraged 
in every way to take food. Arrangements should be made for a medi- 
cal officer to assume charge of the case as soon as possible. Give hot 
beef extract. This, and the soups are rendered more effective and palat- 
able by addition of pepper as seasoning. The serious symptoms are 
largely due to sleeplessness, and if several hours of sound sleep can be 
produced, improvement is almost sure to follow. To this end, pheno- 
,barbital in 1 -grain doses should be given with water every 3 hours 
for 4 doses. 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. 
UNCONSCIOUSNESS 
The common causes for unconsciousness are asphyxiation, bleeding, 
shock, electric shock, heat exhaustion, freezing, sunstroke, epilepsy or 
fits, apoplexy and injury to the brain, alcoholism and certain other poisons, 
hysteria and uremia (deficient secretion of urine). In all cases of un- 
consciousness strenuous efforts should be made to bring the patient under 
the care of a medical officer as soon as possible. 
If the person is unconscious and the cause is unknown, let him rest 
flat on his back. If he is pale and the surface of his body is cold, apply 
heat to the body and hold smelling salts or a little ammonia under his 
nose. If the surface of the body is very hot, cold water and ice bag should 
be applied to the head. 
Patients who have been rendered unconscious because of injuries 
should, in general, be treated for shock and kept as quiet as possible until 
medical aid can be obtained. 
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 the patient in a chair 
with his head forward between his legs, lower than his hips. But after 
its occurrence, the patient should be laid flat on his back with head low; 
loosen clothes and give plenty of fresh air; a little ammonia held under 
the nose will often revive him. After recovery, give whisky or aromatic 
spirit of ammonia. 
EPILEPTIC FITS 
The patient usually utters a cry, falls suddenly unconscious, has con- 
vulsions, foams at the mouth, and bites his tongue. After convulsions SPECIAL DISEASES 
97 
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 cov- 
ered with a handkerchief) should be put between his back teeth to keep his 
mouth open so he cannot bite his tongue, taking care that it does not 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 discharged, give one tablet of pheno- 
barbital (D/2 grains) three times a day. The tablet should be crushed or 
chewed and taken with a half 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 falling down a hatchway or into the machinery, 
etc. 
Diseases of the Eye 
INFLAMMATION 
In all inflammations of the eye, ascertain at once if the individual has 
gonorrhea. 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. Treatment of this condition (gonorrheal ophthalmia) 
is discussed in the next chapter. Simple inflammation is caused by irri- 
tation, such as exposure to the wind or dust, by foreign bodies in the 
eye, and 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 dis- 
charge 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 with cotton 
loosely wound about a match stem. To turn back the upper lid, have 
the patient look downward then 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 irritating matter which do not at first appear may be brought 
to view. After having removed all the irritating particles, wash the eye 
with warm borax solution 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 eyeball. 
Eye wash (or borax lotion).—A simple, soothing and antisepetic eye 
wash may be made as follows: To 2 quarts of boiled, distilled water in 98 
MEDICAL COM PEND FOR COMMANDERS OF NAVAL VESSELS 
a large bottle, add 1 level teaspoonful each of borax, sodium chloride 
(table salt), and sodium bicarbonate (baking soda). Dissolve by shak- 
ing, and let stand until clear. Pour off the clear fluid and bottle. Use in 
the eye bath freely, either cold or warm. This solution is alkaline, non- 
irritating, and is much superior to boric acid solution. 
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 appear- 
ance of a small boil. 
Treatment.—Pain may be relieved by applying squares of gauz? 
wrung out of hot salt solution. When the stye ruptures, keep the lid 
clean with frequent washings with salt solution or borax solution in order 
to prevent recurrence of styes. Yellow oxide of mercury ointment 
painted on the margins of both lids of both eyes upon retiring will assist 
in the cure and act as a preventative. Recurring styes may be a symptom 
of defective vision. In such cases, the patient’s eyes should be refracted 
by a medical officer when the schedule of the ship will permit. 
Diseases of the Ear 
earache 
Treatment.—Earache is due to so many different causes that a medi- 
cal officer should be consulted as soon as possible. To relieve pain, if 
severe, aspirin, 2 tablets, (gr. 10) may be given every 4 hours. 
Diseases of the Teeth 
TOOTHACHE 
This condition is usually due to an inflamed pulp which has become 
infected or irritated through a cavity in the tooth, the congestion com- 
pressing the pulp against unyielding sides of pulp cavity causing pain. 
To give relief, remove particles of food from cavity and insert a small 
piece of cotton moistened with dentalone or eugenol after first being 
touched to another piece of cotton to remove excess fluid. Excess fluid 
may burn the gums. This treatment should be renewed every day or 
two until dental attention is available. Should swelling of soft tissue 
occur, apply heat and administer sedatives. Chapter IV 
VENEREAL DISEASE 
The venereal diseases yon will deal with are gonorrhea, syphilis, chan- 
croid, lymphogranuloma venereum, and granuloma inguinale. The first 
three are the major and most important, being much more common than 
the last two named. 
When no medical officer is available, venereal disease cases should be 
transferred to adequate medical facilities as soon as possible. During 
war time, however, when long periods at sea are necessary, transfers are 
often not possible and thus it is essential that you know the basic facts 
about these very common diseases. It has often been said the venereal 
disease rate of any command reflects the efficiency of that command. 
As all venereal diseases can be prevented, prophylaxis, or how to pre- 
vent, is listed first. 
PROPHYLAXIS 
Continence.—Avoiding exposure is the only sure way of avoiding 
any disease. This method of avoiding venereal disease is called con- 
tinence. No exposure—no disease—and no worries. Remember too that 
close intimate contact with an infected girl as kissing, preliminary sex 
play, etc., even without actual exposure may result in venereal disease, 
especially syphilis. 
Chemical and Mechanical Prophylaxis.—If exposure does oc- 
cur, venereal disease can usually be prevented by these methods: 
Mechanical.—The most common and best form is the condom (sheath, 
rubber). It should be applied early before any “playing around” occurs, 
leaving adequate space at end, and removed very carefully when no 
longer needed. Only the best condoms should be purchased. Those sold 
at cheap prices in cheap places and often those in foreign ports are in- 
ferior makes and/or “rejects.” Immediately after removal of the condom, 
all parts should be washed including the hands, and then the chemical 
prophylaxis applied to protect those areas not covered by the condom. 
Remember too, condoms sometimes leak or break, so the chemical pro- 
phylaxis should be applied to ALL parts immediately. 
Chemical.—If used properly within the first hour this chemical pro- 
phylaxis affords a high degree of prevention. Its efficiency decreases 
rapidly with time, however. Use it as soon as possible after exposure. 
Some protection is gained even 8 to 10 hours after exposure. 100 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Types of Chemical Prophylaxes 
The best is the Navy Tube prophylaxis as it can be applied immedi- 
ately. One half of the contents of the tube should be injected into the 
urethra (canal in penis) and the other half spread over the pubic region, 
the thighs, penis, and scrotum. Massage in thoroughly for 10 minutes 
and avoid urinating for at least 6 hours. 
Ship Prophylaxis.—A good and almost sure preventive can be ob- 
tained by the following method if administered within 2 hours of 
exposure. 
a. Urinate. 
b. Wash the penis, scrotum and pubic area with warm water and soap 
and dry. 
c. Inject gently x/z syringe of 1 percent solution protargol (strong pro- 
tein silver) or 10 percent argyrol (silvol or mild protein silver) into the 
canal. Hold end of penis for 4 minutes then allow the solution to drain 
out. 
d. Apply either the contents of the Navy prophylactic tube or a 33 per- 
cent calomel ointment to all parts as outlined above. Special attention 
should be given to the various skin folds and crevices. Clothing can be 
protected by paper or gauze dressings. 
GONORRHEA 
Gonorrhea is the most common of all venereal diseases. 
Cause.—A microscopic organism always occurring in pairs. The 
disease is contracted almost always through sexual intercourse. 
Symptoms and Signs.—A creamy yellow discharge from the penis 
which may be accompanied by burning and difficult urination. This most 
often occurs 3 to 5 days after exposure but can come on any time in the 
first two weeks. 
Treatment.—Sulfathiazole will cure a high percentage of the cases 
in five days. The tablets are one half gram (7.5 grains). Two tablets 
should be given at 0800, 1200, 1600, and 2000 each day for 5 days—a 
total dosage of 20 grams (40 tablets). Extra water should be taken 
while on this drug. Some men may be sensitive to this drug and will 
show it with nausea, vomiting, dizziness, headaches, or red rash on skin. 
The drug should be stopped if this occurs. 
The older form of treatment of injections of Y* syringe of 5 percent 
to 10 percent argyrol (mild silver protein), freshly prepared, into the 
canal and held 5 to 10 minutes may be used for patients sensitive to 
sulfathiazole. This should be injected daily morning and night. This 
solution can be diluted with water if too much burning results. 
Dressings should be used to protect the clothing and to catch the VENEREAL DISEASE 
101 
draining pus. Under no circumstances should the canal be obstructed. 
Regular diet, plenty of water and normal duty are indicated. Excessive 
watches and heavy duty should be avoided. 
Complications.—These are rare with the modern methods of treat- 
ment but may occur. 
Epididymitis (swollen testicle).—Bed rest—support testicle—apply 
heat with hot water hottle. Sulfathiazole medication should be completed 
if already started—at least one course is necessary. 
Phimosis and paraphimosis—The foreskin is swollen either down over 
the head of the penis and can’t be drawn back or back of the head of the 
penis and can’t be drawn forward. 
Soak penis every 2 to 3 hours in hot salt water or hot epsom salts 
solution. Cold soaks sometimes help where heat has failed. 
Put patient to bed. 
Bubo (Bln eh alls).—Swollen glands in groin. Bed rest. Apply cold 
(ice bag) early. If swelling persists and gets worse substitute heat for 
cold. Do not worry over size of glands. They may rupture of their 
own accord and drain. In that case, apply dressings and continue heat. 
Keep all parts clean with frequent soap and water baths. 
Stricture Urethra.—This usually is a late completion of gonorrhea and 
is quite rare. The patient is unable to urinate. Put to bed, reassure 
patient, apply heat over bladder (lower abdomen), place in hot bath if 
necessary. As a last resort attempt to pass rubber catheter after it has 
been boiled and greased (be gentle). 
Gonococcus injection eye.—Usually occurs in patients with gonorrhea 
of the urethra. Marked by angry red inflamed eye with creamy dis- 
charge of pus. 
Immediately protect other eye with dressings or a shield (watch crystal, 
celluloid, plastic) secured in place with adhesive tape. 
Wash infected eye every 3 hours with boric acid solution. 
Cold compresses usually are more comfortable. The sulfathiazole 
medication should be completed. Transfer to a medical officer as soon 
as possible. 
Note.—Every case of gonorrhea should be warned of this danger and 
should be careful not to contaminate towels, clothing and hands with the 
discharge from his penis. Washing of hands is a necessity. 
SYPHILIS 
Syphilis is the most serious of the more common venereal diseases. 
Usually contracted through sexual intercourse with an infected person— 
occasionally through kissing—always through close intimate contact. 102 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Cause.—A microscopic, corkscrew-like organism. 
Symptoms and signs.—The first lesion is a sore—a small painless, hard 
ulcer somewhat like the common cold sore, usually occurring on the penis. 
It develops 3 to 6 weeks after exposure. If not treated it will heal in 
3 to 6 weeks and almost always is followed by the secondary stage of skin 
rash (coppery colored), sore throat, headaches, and general aches and 
pains. This occurs usually 6 to 15 weeks after the original sore. 
Treatment.—Don’t treat the sore with antiseptics. Simply keep it 
dressed and moist with salt solution (J/2 teaspoonful salt to pint of 
water). Any other care will make diagnosis difficult or impossible. Trans- 
fer as soon as possible to adequate medical facilities. 
If desired and it is thought that the sore on the penis is chancroid (see 
below) sulfathiazole may be given as for gonorrhea and chancroid. This 
medication by mouth does not affect syphilis nor delay its diagnosis and 
yet gives good results in both gonorrhea and chancroid. 
CHANCROID 
A disease of southern United States and the tropical countries. 
Cause.—A microscopic long, rod-like organism. 
Signs and Symptoms.—A dirty, soft irregular and often painful ulcer of 
the penis or scrotum. Often there is more than one ulcer. May be con- 
fused with syphilis (above). Often complicated by bubo (blueballs). Oc- 
casionally a patient may have syphilis and chancroid at the same time. 
Treatment.—Cleanliness—wash frequently with soap and water and 
dry with disposable gauze. Sulfathiazole by mouth exactly as directed 
under gonorrhea and with the same precautions. 
Complications as under gonorrhea may occur and should be treated 
similarly. 
LYMPHOGRANULOMA VENEREUM 
Lymphogranuloma venereum is a disease of the lymph channels and 
lymphnodes and is more common in the tropical climates. 
Cause.—A filtrable virus. 
Signs and Symptoms.—A small hardly noticeable lesion of the penis or 
near parts occurring 5 to 21 days after intercourse, followed most often 
by bubo in inguinal area. Fever, loss of both appetite and weight may 
be present. 
Treatment.—Same as for chancroid. Transfer to medical care as 
soon as possible. 
GRANULOMA INGUINALE 
This fifth venereal disease is not too common and occurs most often 
in the tropics. It is characterized by slowly progressing irregular type VENEREAL DISEASE 
103 
of lesions. It is very chronic and should be remembered simply that it 
exists, requires prolonged treatment and any such case should be trans- 
ferred to adequate medical care as soon as possible. No treatment is in- 
dicated outside of ordinary cleanliness while the patient is aboard your 
ship. Chapter V 
HOSPITALIZATION 
Sick, wounded, or disabled officers and enlisted men of the Navy, or 
Marine Corps are entitled to the benefits of medical and dental attend- 
ance by naval medical and dental officers either within or without a naval 
hospital, and to hospitalization within naval hospitals so long as they re- 
main sick, wounded, or disabled (N. R. 1187, 1191). 
In the absence of naval hospital facilities, the hospitals of the United 
States Army, the Public Health Service (including hospitals under con- 
tract), or the Veterans’ Administration shall be utilized for hospitaliza- 
tion of naval personnel. 
Patients may be hospitalized in civil hospitals subject to the following 
conditions: 
1. Facilities of naval or other Government hospitals are not available. 
2. Patient must be in a duty status or under control and supervision 
of competent naval authority. 
3. Immediate hospitalization is required for the proper care and 
treatment of the patient. 
4. Hospitalization must be authorized by the commanding officer, or 
by the senior officer present when practicable; and, when not an emer- 
gency, by the Bureau of Medicine and Surgery. 
Attention is also invited to instructions in articles 1143 and 1203, 
N. R., concerning patients transferred to other than a naval hospital, 
particularly in a foreign port. 
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 an- 
nual circular, Contracts for the Care of Seamen, etc., issued by the Public 
Health Service. 
Claims for dental expenses will be allowed only when such expenses 
have been incurred in emergencies by personnel of the Navy and Marine 
Corps to whom the services of a naval dental officer were not available, 
and when the approval of a naval medical officer, if available, has been 
secured. 
The term “in emergencies” is intended to be applied to treatment ren- 
dered to alleviate suffering or to prevent suffering which will obviouslv 
occur before the approval of the Bureau of Medicine and Surgery can 
be obtained. Emergency treatment will not include the furnishing of 
prosthetic appliances or the use of precious metals. 106 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
Attention is invited to article 1189, Navy Regulations, in which are 
stated the conditions under which medical expenses may be allowed, and 
especially to the requirement that payment of such expenses is con- 
tingent upon the prompt reporting of illness or injury to the Bureau of 
Medicine and Surgery. 
Upon completion of treatment, unless authorized in advance by an 
approved requisition, itemized certified bills shall be submitted to the 
Bureau of Medicine and Surgery in duplicate, and shall show the cost 
of each item of expense and the dates on or between which the services 
were rendered; for dental treatment they shall also show in detail which 
teeth were treated, the nature of the treatment rendered and the materials 
used. Bills of other Government hospitals will be submitted through 
their respective headquarters. 
Receipt of the services by the party receiving treatment or by tbe 
officer authorizing same shall be acknowledged either on the face of the 
bills or by separate certificate. 
When requisitions for civilian medical, dental, nursing, or hospital 
treatment of service personnel are approved by the senior officer present 
in advance of the Bureau’s approval, Form U report shall be accompanied 
by a copy of the requisition and a copy of each public voucher covering 
payment. 
Ordinarily, naval personnel on leave are not in a duty status and are 
not, therefore, entitled to medical or hospital treatment at Government ex- 
pense. When leave is cancelled or extended, the status remains the same 
and commanding officers are without authority to authorize treatment 
for them at Government expense. Personnel who have been granted 
liberty for a period of 24 hours or less are considered as in a duty status 
provided that during the period of liberty it would be fairly practicable to 
secure their return for the performance of duty should their presence be 
required. 
Commanding officers are responsible for bringing this information to 
the attention of all officers and enlisted men about to go on leave of 
absence and to the personnel under their charge when on detached duty. 
Personnel on leave of absence may be hospitalized in other Government 
hospitals in the absence of naval hospital facilities. 
A report on navmed u shall be immediately forwarded in dupli- 
cate to the Bureau in each case of any sickness or injury of personnel of 
the Navy or Marine Corps where treatment is received from other than 
the Medical Department of the Navy. This report is required in all 
cases where medical, dental, or hospital treatment is furnished by civilian 
physicians, civilian dentists, civil hospitals, or Government hospitals other 
than naval to personnel of the Navy and Marine Corps, whether on duty 
or on liberty or leave, under circumstances that eventually may be used HOSPITALIZATION 
107 
as the basis of a claim against the Navy Department. This report 
should be prepared by a naval medical officer when practicable, and in 
the absence of such officer, by the senior officer present, or by the in- 
dividul concerned as soon as able. 
If printed forms are not available, a typewritten report may be made 
in duplicate giving the following information: Name and rank or rat- 
ing ; date and place of birth; station or vessel to which attached; diagnosis ; 
prognosis; status (duty or not). If on liberty or leave, state exact 
period for which granted and the hours and dates from and to; cir- 
cumstances ; disposition; give dates on or between which services were 
rendered; by whom were the services rendered. Were the services neces- 
sary and authorized, and by whose authority? Where authority is 
given in writing, a certified copy of same should be attached to this form. 
Where authority is given verbally, a certificate of the officer granting same 
should be attached and should show when and how the services were 
authorized. Were the services of a naval medical (or dental) officer 
or a naval hospital available? In the case of an officer, the date of his 
orders and the name of the Supply Corps officer carrying his accounts 
shall be stated. When an officer is admitted to a hospital for treatment, 
statement shall also be made as to whether or not hospital ration notice 
has been issued. 
Due to the uncertainty of the movements of naval vessels, the per- 
sonal effects of an officer or man of the service are sent with him when- 
ever he is transferred to a hospital for treatment (N. R. 1143). Chapter VI 
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 (N. R. 908 (1)). 
When death occurs while the ship is at a port within the continental 
United States, the commanding officer shall report the same to the Secre- 
tary of the Navy by dispatch, giving the following information: (a) full 
name; (b) rank or rating and service number; (c) branch of service; 
(d) in the case of a reservist, whether or not on active duty; (e) date, 
place, and cause of death; (f) line of duty and misconduct status; (g) 
full name and relationship of next of kin; (h) address of next of kin; 
(i) whether or not next of kin has been notified; (j) what disposition 
has been or will be made of remains, or where the remains are being 
held; (k) pay per month; (1) full name and address of beneficiary: (m) 
whether or not the deceased carried United States Government life in- 
surance and date to which premiums have been paid. In case full in- 
formation under any of the foregoing headings must await later investi- 
gation or determination, the dispatch shall be sent with whatever data 
are available, and supplemented with complete information at the earliest 
possible date. In such cases he shall also inform (by dispatch) the 
nearest relative or legal representative of the deceased (unless living out- 
side of continental United States) and request him to communicate by 
telegram with the Bureau of Medicine and Surgery, Navy Department, 
or the Commandant, Marine Corps, Washington, D. C., regarding disposi- 
tion of the remains. If practicable, the body shall be transferred immedi- 
ately 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 Surgery. Otherwise the body shall be embalmed and retained on board 
until directions for disposition are received (N. R. 908 (2)). 
When death occurs at sea or in a port outside the continental United 
States, the commanding officer shall not notify the next of kin by dispatch 
but shall make report by dispatch to the Secretary of the Navy, giving 
the information specified in the preceding paragraph, and request instruc- 
tions for disposing of the body. Whenever practicable, the remains shall 
be embalmed and retained on board awaiting instructions from the Bu- 
reau of Medicine and Surgery, and burial shall not be made in a foreign 
port or at sea in advance of receipt of such instructions, except when 
preservation or retention of the body is impossible (N. R. 908 (3)). MEDICAL COM PEND FOR COMMANDERS OF NAVAL VESSELS 
Note : Pursuant to a directive of the Secretary of the Navy, on June 25, 
1942, the Bureau of Medicine and Surgery issued the following in- 
structions : 
For the duration of the war, the remains of naval personnel, inclusive of the 
Marine Corps and the Coast Guard, shall be interred locally whenever death occurs 
in areas beyond the continental limits of the United States and where transportation 
by sea is involved. 
In making overseas burials, naval forces shall take all necessary measures to 
preserve identity, to definitely locate and record burial places by proper geographical 
data, names, landmarks, charts, etc., and will transmit this data to the Bureau of 
Medicine and Surgery with copy for the Bureau of Naval Personnel, Marine Corps 
Headquarters, or Coast Guard Headquarters, as may be appropriate. 
During this time when remains of the dead may not be returned home, in any 
case where burial ashore can not be accomplished or is inadvisable, burial at sea is 
to be preferred to cremation. Cremation should not be done, except as a sanitary 
measure, without the prior approval of the Bureau. 
Whenever loss of life occurs from accident or under peculiar or doubt- 
ful circumstances, a court of inquiry or a board of investigation should 
be ordered to investigate fully and report on the circumstances and facts, 
and also to give an opinion and to make such recommendation as may be 
appropriate. The court of inquiry or board of investigation is held in 
accordance with the provisions of chapter X, Naval Courts and Boards. 
In all cases of death occurring in the Navy under unnatural or sus- 
picious circumstances, or where the cause of death is obscure or not ap- 
parent and a decision as to origin affecting pension or gratuity is 
involved, the commanding officer should have such post mortem exam- 
ination or autopsy as may be required in determining the exact cause of 
death performed by a medical officer, or, if none is available, by a com- 
petent civilian physician. In all cases the autopsy must be performed 
in a manner requiring no more disfigurement of the body than is neces- 
sary to obtain the evidence necessary. The results of all autopsies shall 
be fully recorded in the reports of death and health records. 
When burial is necessarily made in a foreign country, the health regu- 
lations as to disinterment shall be ascertained and reported by letter to 
the Bureau of Medicine and Surgery, together with information as to 
date, place, and other circumstances of burial. 
Payment of expenses in connection with burial in a foreign country 
may be arranged through the nearest United States consul in the same 
manner as payment of bills for hospital treatment, reimbursement to be 
made by the Navy Department to the State Department upon presenta- 
tion of receipted vouchers. Such expenses, so far as practicable, should 
be limited to the lowest amount consistent with decent preparation and 
encasement in accordance with Navy Regulations, or to meet the re- 
quirements of laws governing transportation. DEATHS 
111 
Whenever the services of a civilian undertaker are required within the 
United States or any of its possessions, the same ‘limitations will be 
observed and itemized bills properly certified will be forwarded to the 
Bureau of Medicine and Surgery for settlement. 
Cremation of remains will be permitted at Government expense only 
when authorized in advance by the Bureau of Medicine and Surgery. 
The necessary and proper funeral expenses of officers and enlisted 
personnel of the Navy and Marine Corps at naval stations within the 
United States will be provided for by annual contracts, and elsewhere 
within the United States will be allowed when approved by the Bureau 
of Medicine and Surgery, or by such officers as may be designated by 
the Commandant, Marine Corps, respectively. 
The amounts paid for funeral expenses, including preparation, encase- 
ment, and interment of remains, shall not exceed $200 each, unless due 
regard for decent burial renders greater expense necessary, which fact 
must be certified on all copies of the public voucher by the officer ordering 
the payment of the bill. 
The remains of naval dead shall be prepared for interment or for 
shipment to their homes under the supervision of an officer who shall 
determine by final inspection in each instance that the work of embalming, 
cleansing, shaving, and dressing have been competently performed, and 
that the encasement, clothing, etc., meet all the requirements of the oc- 
casion and comply with the terms of the contract. 
Each body shall be dressed in a clean, presentable, and complete uni- 
form (except for cap and shoes) 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, suitable uniform for 
burial shall be sent with it. Where available clothing belonging to a de- 
ceased officer or 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 appropriation “Medical Department.” 
Especial care shall be exercised that the evidences of autopsies shall 
not cause unnecessary distress to parents, and that the wounds so made 
shall be neatly closed, and that packings and dressings employed shall 
be of clean and suitable material. 
Navy (or Army) standard caskets, when available, shall be used for 
transportation of remains of officers and enlisted men. 
When transportation of remains of naval or Marine Corps personnel 
is to be effected, the shipment if by rail will be either on tickets pro- 
cured by transportation request or by express on Government bill of 
lading; and, if by commercial steamship, on minimum first-class fare. One 
copy (fifth) of the bill of lading, on which transportation of remains 112 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
of the dead is effected, 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. A special label, prohibiting col- 
lection of express charges from consignee, should be obtained from the 
local express agent and attached to the outside case, in addition to the 
copy of the bill of lading. If Government bills of lading are not avail- 
able, the civilian undertaker should include transportation charges in his 
bill, submitting receipts from the transportation company. Under no 
circumstances should a body be sent “collect.” 
Personal effects of active-duty personnel not to exceed 150 pounds may 
be forwarded with the body when shipped either by express or on trans- 
portation request without additional charges. When personal effects ex- 
ceed 150 pounds, any excess should be delivered to the supply officer 
for shipment, such excess being chargeable to the appropriation “Trans- 
portation of Things,” Bu. S. & A. for Navy personnel and “General ex- 
penses, Marine Corps,” for Marine Corps personnel. 
The next of kin, family, legal representative of the deceased, or, the 
consignee, should the body be sent to other than the preceding, shall be 
informed by telegram of the time and method of forwarding and, if 
practicable, the routing and scheduled time of arrival at destination; also 
of any special attending circumstances, such as communicable disease and 
the advisability or inadvisability of opening the casket for the purpose of 
viewing the remains. Original and one copy of the bill of lading will be 
promptly forwarded to the consignee, under special-delivery stamp, and 
accompanied by an explanatory memorandum. Investigation has de- 
termined that in most instances where the express company attempts to 
collect express charges from consignee, the difficulty has been due to 
failure of the bill of lading to arrive in advance of the body, or to a 
misunderstanding on the part of consignee as to its purpose. 
The senior officer present is authorized to issue a national flag (United 
States national ensign No. 7) to accompany all bodies of naval or Marine 
Corps personnel forwarded or delivered to the next of kin or relatives for 
private interment, in order that the flag may be available for use at 
the time of burial. Request for such issue shall be construed as included 
in application for the body. The flag shall be inclosed in a suitable canvas 
bag or sack and securely attached to the casket, or placed inside the 
shipping box, in which case the box shall be labeled “FLAG INSIDE” 
or the consignee otherwise notified. The act of May 26, 1928, authoriz- 
ing the Secretary of the Navy to furnish an escort to place of burial for 
the naval dead who have lost their lives in the naval service, permits the 
selection of a relative or other person not a member of the Navy or 
Marine Corps to be sent as such escort at Government expense. The 
expenses so authorized include subsistence en route and sleeping-car ac- DEATHS 
113 
commodations to place of burial and return therefrom when necessary. Up- 
on request of the next of kin or family of the deceased, a service or civilian 
escort of one person may be assigned to accompany the remains to place 
of burial. The escort, if of the service, shall be of the equivalent rank or 
rate of the deceased so nearly as may be practicable, and, when possible, 
a friend or associate. United States Navy Travel Instructions contain 
full instructions relative to travel allowances and outline the details to be 
followed in sending an escort to accompany to place of burial the remains 
of officers and enlisted men who have lost their lives in the naval service. 
The travel of the escort may be from point of shipment to place of burial 
and return, or from the place of prospective burial to the point of ship- 
ment and return, the amount of travel involved in either case being the 
same. When the remains are returned to the Unitd States from points 
outside the continental limits, a relative may travel as escort to point 
of reshipment within the United States. One first-class passage at mini- 
mum rate will be furnished such civilian escort. From this point the 
commandant of the yard or station shall arrange for escort to final 
destination of remains as in other cases. 
All transportation and travel expenses of the escort to the prospective 
place of burial and return therefrom will be a charge to “ ‘Pay,’ ‘Subsis- 
tence,’ and ‘Transportation’ or ‘General Expenses,’ Marine Corps,” as the 
case may be. The only charge to be lodged against the appropriation 
‘‘Medical Department,” when remains of naval dead are shipped on trans- 
portation requests, is for the cost of the corpse ticket. In the case of 
Marine Corps dead, the cost of both escort and corpse ticket is a charge 
to ‘‘General expenses, Marine Corps.” 
The commanding officer shall, upon the death of any person on board 
the ship under his command, cause all of the effects of the deceased 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 per- 
son, 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 completion of the inventory the 
effects, if not of a perishable nature, shall be put up in packages of a con- 
venient size and sealed with the seal of the ship. The commanding officer 
shall retain one copy of the inventory himself, and shall deliver the other 
to the supply officer, who shall also take charge of the effects for safe- 
keeping (N. R. 908 (4)). 
If any of the effects of a deceased person are perishable and de- 
teriorating, they shall be immediately sold at auction, and the proceeds of 
sale shall be dipsosed of in the same manner as other money found in his 
effects (N. R. 908 (5)). 
All moneys, articles of value, papers, keepsakes, and other similar ef- 114 
MEDICAL COM PEND FOR COMMANDERS OF NAVAL VESSELS 
fects 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 articles men- 
tioned and other similar effects shall be sent to the Chief of the Bureau 
of Naval Personnel or to the Commandant of the Marine Corps, as the 
case may be, for safekeeping. Should the above-described property be un- 
claimed for a period of 2 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 shall be deposited in the Treasury 
as miscellaneous receipts (N. R. 908 (6)). 
If at any time during the 2 years such above-described property is in 
the custody of naval authorities the legal representative of the deceased 
person shall apply for his effects, all shall be delivered to him (N. R. 
908 (7)). 
The commanding officer shall exercise his discretion in causing the 
effects of deceased enlisted personnel to be sold at auction at the mast, 
or retaining them for transmission to the heirs, relatives, or friends. In 
exercising this discretion, he shall be governed by the wishes of the heirs, 
relatives, or friends, if possible to learn them. If sold at auction, the 
proceeds of sale shall be disposed of in the same manner as moneys found 
in their effects (N. R. 908 (8) ). 
He shall cause the accounts of all deceased persons to be closed as soon 
as possible and forwarded to the General Accounting Office, together 
with the will, if any can be found. These accounts must be examined and 
approved by the commanding officer (N. R. 908 (9). 
He shall advise the heirs or next of kin of a deceased officer, nurse, or 
enlisted man to communicate with the Bureau of Supplies and Accounts 
relative to the submission of claim for arrears and pay due. Payment of 
death gratuity will be made by the Bureau of Supplies and Accounts 
(N. R. 908 (10)). For additional information pertaining to deaths and 
resultant duties, the reader is referred to articles 908 and 1841, United 
States Navy Regulations, and chapter 19, Manual of the Medical De- 
partment, 1939. 
Note : Distribution Centers in the United States have been established 
by the Secretary of the Navy by letter of 17 June, 1943, to All Ships 
and Stations, as follows: 
In order to relieve commanding officers outside the continental limits of the 
United States of the necessity of sorting and shipping personal effects of deceased 
or missing personnel, the following distribution centers are hereby established, each 
under an officer in charge: 
Personal Effects Distribution Center 
U. S. Naval Supply Depot 
Clearfield, Utah DEATHS 
115 
as an activity of the Twelfth Naval District. 
Personal Effects Distribution Center 
U. S. Naval Supply Depot 
Scotia, New York 
as an activity of the Third Naval District. 
In order to reduce delay and the possibility of loss by subsequent enemy action 
commanding officers may immediately inventory and ship personal effects to these 
centers without waiting for notification of next of kin. Chapter VII 
PERSONAL HYGIENE 
By personal hygiene is meant any measure taken by the individual by 
which he can avoid disease and promote his health and strength. Such 
measures include the eating of the proper amount and kind of food, 
drinking the proper kind and amount of water, the wearing of proper 
clothing to suit the temperature, the breathing of wholesome air, all of 
which tend to heighten resistance; the avoidance of habits and practices 
which are liable to contract or transmit infectious diseases such as those 
borne by the mouth, nose, intestinal, venereal discharges, etc.; the 
proper use of the eyes, etc. Cleanliness of the person and the clothing is 
one of the first requisites for good health. The entire body, if practicable, 
but at last the feet, armpits, and genitals should be bathed daily, and the 
exposed parts of the body, face, and neck as often as necessary. The 
hair should be kept cut short, and the finger and toe nails kept trimmed 
and clean. Dirty bodies and dirty, infected clothing are very often the 
cause of skin and other diseases. A moderate amount of exercise in the 
open air should be taken regularly. With proper exercise the elimina- 
tion of waste products from the body is increased through deeper breath- 
ing, and more perspiration; the muscles and heart become better nour- 
ished and a better circulation improves all the other functions of the body; 
the digestion is improved; and resistance to certain diseases is in- 
creased. The bowel should move daily, otherwise poisonous substances 
are absorbed into the system. If proper food is eaten and proper exer- 
cise taken, the bowel generally will look after itself. The mental state may 
affect the health and a cheerful state of mind promotes and benefits all 
the functions of the body and vice versa. 
Not only is the practice of personal hygiene one of the greatest factors 
in the prevention of disease, but also it is one of the chief aids to the sani- 
tarian in destroying or preventing the transmission of the agents which 
cause the communicable diseases. Infective discharges from the respira- 
tory tract can be readily transferred to others by promiscuous coughing, 
sneezing, and expectorating, or by the use in common of towels, drinking 
cups, and eating utensils. Good personal hygiene will prevent many of 
the air-borne and hand-to-mouth infections. 
Following is a summary of the principles of personal hygiene which 
are adaptable to naval life; 
1. Keep the body clean. Bathe the entire body, or as much of it as 
possible daily. ]18 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
2. Keep the hands clean. Always wash them before eating and after 
leaving the toilet. Keep the fingers away from the nose and mouth, and 
the fingernails clean and cut short. 
3. Keep the feet clean and the toenails cut short and straight across. 
4. Change the underwear and socks frequently. Wear socks that are 
1 y2 or 2 sizes larger than the shoe size and shoes that have been fitted 
carefully. 
5. Brush the teeth every morning and evening or after each meal if 
possible. Have the teeth examined by a dentist at least every 6 months. 
6. Eat slowly a moderate amount of nutritious food regularly and 
drink plenty of pure water. 
7. Be regular in going to the toilet for bowel actions, 
8. Take a moderate amount of exercise in the open air regularly. 
Breathe deeply at all times. 
9. Sleep in a well-ventilated place with plenty of fresh air. 
10. Avoid excesses of any kind, but especialy alcoholic drinks and 
promiscuous sexual intercourse. If exposed to venereal infection immedi- 
ately use prophylaxis. 
11. Avoid persons with colds or coughs and keep away from others 
when suffering with one. Cough and sneeze in a handkerchief. 
12. Avoid unnecessary exposure to extremes of weather. Change into 
dry clothes as soon as possible after getting wet, and dry the wet clothing 
before stowing it away. Clothing wet with perspiration should be dried 
and, if possible, washed before being stowed away. 
13. Avoid using the toilet or other personal articles of others and do 
not allow others to use one’s own. 
14. Be cheerful. 
The precautions regarding the care of the hands and fingers are of 
particular importance for the majority of infections are taken into the 
body through the mouth, and the hands are responsible for a large num- 
ber. Likewise the principle pertaining to “colds” should be closely ob- 
served. Finally, if there is one basic law, it is to avoid excesses of any 
kind (Handbook, Hospital Corps, 1939). Chapter VIII 
PREVENTIVE MEDICINE 
In general, preventive medicine has for its objective the control or pre- 
vention of disease and the conservation and maintenance of health. 
In the Navy it is similar in its scope to public health activities of civilian 
communties, except insofar as it is modified, of necessity, by conditions 
peculiar to the Navy. These modifying conditions are mainly those re- 
sulting from factors of environment accompanying naval activities under 
restrictions imposed by the nature of the service. 
The following references in the Navy Regulations pertain to the duties 
of the commanding officer of a naval vessel in relation to preventive 
medicine: 
1. Provisions (art. 20 (7), N. R.). 
2. Health of crew (art. 20 (8), N. R.). 
3. Care of crew (art. 843, N. R.). 
4. Service on unhealthy stations (art. 901, N. R., see art. 741, N. R.). 
5. Effects destroyed to prevent spread of disease (art. 916, X. R.). 
6. Cleanliness (art. 1319 (1), N. R.). 
7. Precautions as to health of the crew (art. 1319 (2), N. R.). 
8. Clothing (art. 1319 (3), N. R.). 
9. Bedding (art. 1319 (4), N. R.). 
10. Allowance of water (art. 1319 (5), N. R.). 
11. Inspection and use of fresh food, etc. (art. 1320 (2), N. R.). 
12. Food and water (art. 1320 (5), N. R.). 
13. Athletic exercises (art. 1323 (1), N. R.). 
14. Bumboats and traffic (art. 1323 (3), N. R.). 
15. Harbor water (art. 1324, N. R.). 
16. Disposal of refuse (art. 1337, N. R.). 
17. Leave to enlisted men (art. 1731 (1), N. R.). 
18. Unserviceable and unsanitary articles (art. 1919 (1), N. R.). 
19. Clothing and personal effects of officers and men (art. 1925, N. R.). 
HEALTH RECORDS 
These records, if aboard, should be checked at intervals, once each 
quarter, to see that there is one for each member of the crew, that they 
have received the required protective inoculations against smallpox and 
typhoid fever, and that any belonging to men who have been transferred 
are forwarded to the proper activity. 120 
MEDICAL COM PEND FOR COMMANDERS OF NAVAL VESSELS 
FOOD 
Regular inspections should be made of the issue room, galley, etc., to 
observe and correct any unsatisfactory condition regarding the storage, 
handling, preparation, and serving of food, special attention being given 
to foods liable to become culture media for bacteria—meats and meat 
products, fish and shellfish, milk and milk products, salad ingredients, 
and cream fillers. 
FOOD HANDLERS 
Cooks, butchers, bakers, helpers, and messmen must be required to 
keep their hands, as well as utensils and implements used in the prepara- 
tion and serving of foods, scrupulously clean. Sufficiently close super- 
vision should be maintained over the health of food handlers to insure 
prompt detection of infectious disease, including venereal infection. 
UTENSILS AND MESS GEAR 
Cooking utensils should be washed thoroughly with hot water and soap 
or other cleansing agent after use and after application of mechanical or 
chemical polishing agents. Mess gear should, after each meal, be washed 
sufficiently to remove adherent particles of food and mouth secretions, 
sterilized, and allowed to dry without wiping. The minimum safe sterili- 
zation requirement is submersion in, or equivalent exposure to, water at 
a temperature above 180° F. for not less than 1 minute. 
WATER 
The evaporation of water, either at atmospheric or reduced pressures 
and temperatures, is a physical separation of water from its dissolved and 
suspended constituents, including bacteria. Low pressure and tempera- 
ture evaporation can produce even from contaminated water as reliable 
and sterile an effluent as high temperature distillation if raw water does 
not prime or leak into it. The salinity of the distilled water may be 
watched as an index of operation and the standard of 0.25 grain per 
gallon should be maintained if possible. If the salinity exceeds 0.5 grain 
per gallon the water should be discarded and not pumped into the 
ship’s tanks. When reliable information regarding the sanitary quality 
of water taken aboard at a dock or from a water boat is not available the 
water should be passed through the ship’s distiller. Water from Gatun 
Lake or other fresh-water lake in the Canal Zone should always be so 
treated. 
The average minimum actual consumption of fresh water per person 
on board ship required in the interests of personal hygiene is about 20 PREVENTIVE MEDICINE 
121 
gallons per day. Arbitrary limitation of hours during which washrooms 
are open for use, or restriction of members of the crew to definite small 
quantities of water for bathing and washing clothes tend to result in seri- 
ous breaches of hygiene. If unusual circumstances require drastic restric- 
tions in the use of fresh water the allowance should be not less than two 
full buckets per man per day for the general crew and not less than four 
buckets for men of the engine room, fireroom, and shop forces. 
Scuttle-butt terminals should be kept in good condition and at a slight 
angle so that water does not fall back on the outlet. Valve handles, like 
door knobs, may be an important indirect means of transmitting the causa- 
tive agents of communicable disease. This can be obviated by the use of 
a foot-controlled valve. Under epidemic conditions they should be fre- 
quently disinfected and disinfectant solution provided for hands. In places 
where sanitary scuttle-butts are not available suitable arrangements must 
be made to prevent the use in common of drinking cups or glasses. 
VENTILATION 
Living compartments, offices, and work spaces are to be kept in the 
comfort zone, insofar as weather conditions permit. Ventilation ordinarily 
is effected by supply and exhaust blowers, electric fans, and by natural 
means. 
In cool and cold weather adequate ventilation requires a sufficient quan- 
tity of air flowing through a given space to keep the air reasonably free 
from harmful substances and disagreeable odors. In hot weather the vol- 
ume of air required for the removal of excess heat is so great that other 
ventilation factors usually become inconsequential. Exhaust-system blow- 
ers are required for rapid removal of overheated or malodorous air from 
compartments in which good ventilation cannot otherwise be maintained. 
Both supply and exhaust systems are considerably reduced in efficiency by 
accumulation of dirt in ducts and upon screens. 
Compartments which have been closed for some time, or those which 
have been sealed, should not be entered until after they have been well ven- 
tilated and the air tested by a lighted candle. If the flame is extinguished 
the air is unsafe. Men should not descend into such compartments without 
having a life line attached to them and carefully guarded. 
GARBAGE 
Garbage is unsightly and usually malodorous. By attracting flies or rats 
it may indirectly menace health. When prompt disposal is not possible 
cans with well-fitting covers should be used. With an unusual number of 
cans in use it is difficult to keep them in satisfactory sanitary condition. 
To avoid nuisance base-force arrangements should be made in advance for 
daily disposal. 122 
MEDICAL COMFEND FOR COMMANDERS OF NAVAL VESSELS 
Accumulations of refuse below decks increase fire hazards and have a 
certain hearing on health by inviting expectoration (article 1337 N. R.). 
Dock garbage and refuse platforms must be properly used and kept clean 
by ship’s forces. Good sanitary condition at all hours is necessary to limit 
numbers of flies, roaches, and rodents. 
SEWAGE DISPOSAL 
Disposal of ship sewage overboard by salt water carriage offers no sani- 
tary problem except the pollution load added to harbor water about the 
ship. When conditions are otherwise favorable and swimming is per- 
mitted, discharge of sewage from the side on which men are in the water 
should he discontinued at least one-half hour before swimming call is 
sounded. 
LIGHTING 
Hygienic lighting connotes adequate illumination, general and focal, 
with freedom from glare, troublesome shadows, and annoying high lights, 
to permit reading, writing, required work, or other activity to be per- 
formed without avoidable eyestrain. The most important single funda- 
mental factor in lighting is brightness contrast. Adequate general illumina- 
tion permits sufficiently deep vision into shadows in all parts of the room 
or compartment so that in glancing up from work the iris will not dilate 
widely and contract suddenly upon turning back to the work in hand. 
Moving shadows and flickering light should be prevented. Glare is direct 
when a source of light comes within the field of vision with the eyes fo- 
cused upon work, and indirect when light from source is reflected to the 
eyes by the work or some adjacent object. In general, glare is troublesome 
if the work itself is not brighter than other objects in the field of vision. 
Focal lights while undesirable are often necessary. Such lights should 
ordinarily be placed directly over the work if the plane of work is hori- 
zontal; otherwise the location should be such as to afford the best view 
of the details of the work, while avoiding as much as possible under il- 
lumination, glare, and troublesome shadows. Too great concentration at 
one point in the work field will result in tremendous eyestrain from glare, 
shadows, and high lights. Places where falls may occur should be ade- 
quately illuminated. Focal illumination should be provided for band saws, 
lathes, grinders, and cutting, mixing, and chopping machines. A sufficient 
number of lights of adequate candlepower should be maintained in crew’s 
compartments for reading and writing. Individual lights used in focal 
illumination should be so placed that light rays will not enter directly into 
the eyes of the worker. PREVENTIVE MEDICINE 
123 
ACCIDENT PREVENTION 
The majority of accidents are avoidable. Accidents usually occur be- 
cause someone fails to observe simple precautionary rules or fails to em- 
ploy well-known safety measures. Dangerous machinery and electric ap- 
pliances should have adequate safeguards. All passageways should have 
adequate illumination. Ladders should have handrails or lines and open 
hatches should have substantial guards. The Bureau of Ships’ Construc- 
tion and Repair Manual contains much valuable information on safety 
measures and appliances. 
SWIMMING 
Caution should be taken, especially when the temperature of the water is 
below 70° F., to recall men who, not reacting well in the water, develop 
cyanosis and severe shivering. In the Tropics care should be taken to 
prevent swimmers from developing severe sunburn. Swimming should 
not be permitted in water contaminated with sewage. Chapter IX 
QUARANTINE, DISINFECTION, AND BILLS OF 
HEALTH 
Quarantine 
The term “quarantine” has its origin from the Italian quaranta, mean- 
ing 40, this figure representing the number of days for which vessels, be- 
ginning early in the fifteenth century, were held under observation on ac- 
count of the frequent invasions of plague. 
The term now means any limitation placed upon the freedom or move- 
ment of exposed or contact persons or animals with the object of prevent- 
ing or controlling the spread of communicable disease. The expression 
“quarantine methods” is often used to cover all restrictive measures in- 
stituted by health officials for the purpose of limiting the spread of disease 
on land as well as at sea. There is 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 introduc- 
tion of disease over land or across a river from a foreign country. Inter- 
state 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 to limit the spread of disease incident to 
interstate travel and traffic. 
Maritime quarantine includes all measures undertaken by the Govern- 
ment to prevent the introduction of disease through seaports. 
The first quarantine station was established at Venice in 1403, on a 
small island adjoining the city, and had as its basic idea the blind applica- 
tion of the theory of isolation to prevent the spread of plague. Today quar- 
antine stations are to be found in the principal ports of the world at which 
scientific and accurate periods of detention are in use to prevent the ingress 
of certain threatened diseases. From the earliest days until the determina- 
tion of the exact modes of transmission and periods of incubation of the 
quarantinable diseases, quarantine consisted in more or less rigorous pe- 
riods 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 hap- 
hazard quarantine was extremely expensive, proceeding at times even to 
burning the entire ship and cargo. 
Modern methods of quarantine both on land and sea are based 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 126 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
established that many diseases, including all of those known as quarantin- 
able, are due to certain microorganisms or viruses with definite habits of 
life and capable of growth and multiplication. These so-called pathogenic 
(disease producing) organisms or viruses may be carried from individual 
to individual by direct contact with a person 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 having invaded or attacked a healthy individual, the germs 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 quarantine 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 neces- 
sarily mean an absence of infection aboard the vessel. This can 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 car- 
rier, or that the intermediary host may be present without actually com- 
ing 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 there- 
fore 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 Federal Security 
Agency, enforced by the United States Public Health Service: 
1. Cholera, period of incubation 1 to 5, usually 3 days. 
2. Yellow Fever, period of incubation, 3 to 6 days. 
3. Smallpox, period of incubation 8 to 16 days. 
4. Typhus Fever, period of incubation 5 to 20 days. 
5. Leprosy. If the patient is an alien, not permitted to land; if a citizen, 
the case is dealt with according the State Laws of the port of entry. 
6. Plague, period of incubation 3 to 7 days. 
7. Anthrax, period of incubation 7 days. QUARANTINE 
127 
REQUIREMENTS AT FOREIGN AND INSULAR PORTS 
Vessels leaving foreign ports and ports in the possessions or other de- 
pendencies of the United States for ports in the United States or its posses- 
sions or other dependencies are subject to inspection by the officer issuing 
bills of health whenever, in his opinion, such inspection is necessary to the 
issuance of a bill of health. United States Quarantine Laws and Regula- 
tions require that an inspection be made 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 if sailing from a 
healthful port, the inspection need include only such passengers and their 
living apartments. (See paragraph under General Requirements of the 
United States Public Health Service at foreign and insular ports.) 
Inspection of the vessel is such an examination of the vessel, cargo, 
passengers, crew, personal effects of same, including examination of mani- 
fests and other papers, food and water supply, the ascertainment of its 
relations with the shore, the manner of loading, and possibilities of invasion 
by rats and insects as will enable the inspecting 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 embarkation, and the 
crew on deck, and no communication should be had with the vessel after 
such inspection except by permission of the officer issuing 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 steer- 
age, and loose dunnage in unladened compartments shall be so arranged 
as to prevent harborage of rodents. 
Any portions of the vessel liable to have been infected by any com- 
municable disease should be disinfected before the issuance of the bill of 
health. 
The air space, ventilation, food and water supply, hospital accommoda- 
tions, 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 second-hand 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 disinfected prior to shipment. Ar- 128 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
tides 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 nullify in 
any way existing restrictions promulgated by the Administrator of the 
Federal Security Agency 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 disin- 
fected. 
Any article presumably infected which cannot 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 per- 
sonnel of the vessel should remain on board during their 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 shipment at 
a noninfected port but coming from an infected locality should be subject 
to the same restrictions as are imposed at an infected port. 
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 disin- 
fected. 
(b) Free ventilation and rigorous cleanliness should be maintained in 
all portions of the ship during the voyage and measures taken to destroy 
rats, mice, fleas, flies, 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 prac- 
ticable, 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 disinfecting solution. 
(f) The compartment from which the patient was removed should be QUARANTINE 
129 
disinfected and thoroughly cleansed. Articles liable to convey infection 
should remain in the compartments during the disinfection when gaseous 
disinfection is used. 
(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 de- 
stroyed by fumigation or by the proper use of an accepted insecticide. 
Mosquito larvse (wigglers or wiggle tails) should be destroyed in water 
barrels, casks, and other collections of water about the vessel by the use 
of petroleum (kerosene) ; where this is not practicable, 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 pneu- 
monic plague, the patient should be isolated, the body discharges disin- 
fected, especially sputum, and the attendant should wear a mask. 
(i) In the case of typhus, special measures should be taken to destroy 
vermin. 
(;) In the case of cholera, typhoid fever, or dysentery, the drinking 
water should be boiled and the food thoroughly cooked. The discharges 
from the patient should be immediately disinfected and thrown overboard. 
An inspection of the vessel, including the steerage, should be made 
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 captain should note the 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 smallpox, the entire per- 
sonnel should be vaccinated. 
The compartment used for isolation should be cleansed as soon as it be- 
comes vacant. 
The dead, except those dead of yellow fever, should be enveloped in a 
sheet saturated with one of the strong disinfecting solutions, without pre- 
vious washing of the body, and at once buried at sea or placed in a coffin 
hermetically sealed. (See ch. VI.) 
A complete clinical record shall be kept of all cases of sickness on board 
and the record delivered to the quarantine officer at the port of arrival. 
The following disinfecting solution is recommended for use at sea: 
Formula for disinfecting 
Formalin or Formaldehyde (5 Percent) 
Formaldehyde solution 50 
Water 950 130 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
REQUIREMENTS AT UNITED STATES PORT 
Every vessel subject to quarantine inspection, entering a port of the 
United States, its possssions or dependencies, shall be considered in quar- 
antine 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. (See arts. 1451, 1452, 1453, N. R.) 
Vessels arriving at ports of the United States under the following con- 
ditions 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 suspected of yellow 
fever arriving during the active quarantine season at southern, via north- 
ern, 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 epidemic form. 
The inspection of vessels required by these regulations shall be made 
between sunrise and sunset, except in case of vessels in distress. Excep- 
tion may also be made in the case of vessels carrying perishable cargoes, 
and regular line vessels under regulations approved by the Federal Se- 
curity Agency. 
In making the inspection of a vessel the bill of health and clinical record 
of all cases treated during the voyage, crew and passengers’ 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 disinfection, signed by a United States consul or a medical officer of the 
United States, shall be exhibited and compared with same. If no certi- 
ficate of disinfection is produced the collector of customs at the port of 
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 here- 
inbefore prescribed, or shall be returned by the common carrier convey- 
ing 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 March 2, 
1901, sec. 12). QUARANTINE 
131 
No person, except the quarantine officer, his employees, or pilots, shall 
be permitted to board any vessels subject to quarantine inspection until 
after the vessel has been inspected by the quarantine officer and granted 
pratique, and all of such persons so boarding such vessel shall, in the 
discretion of the quarantine officer, be subject to the same restrictions as 
the personnel 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 must 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 communi- 
cable 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. 
Vessels arriving under the following conditions shall be placed in deten- 
tion : 
(o) With quarantinable disease on board or having had such disease 
on board during the voyage. 
(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 Vir- 
ginia 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 south- 
ern boundary of Maryland between May 15 and October 1, if from a port 
infected or suspected of infection with yellow fever. 
(e) In the case of vessels arriving at a northern port without sickness 
on board from ports where yellow fever prevails the personnel shall be 
detained under observation at quarantine to complete six days from the 
port of departure. 
(/) Towboats and other vessels having had communication with ves- 
sels subjected to quarantine shall themselves be quarantined if they have 
been exposed to infection. 
The duration of detention of vessels or personnel herein contemplated 
will depend upon the quarantinable disease involved and will hereinafter 
be specifically provided for. 
QUARANTINE DETENTION 
REQUIREMENTS RELATING TO NAVAL VESSELS 
Vessels of the United States Navy which carry a medical officer, upon 132 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
entering United States ports from foreign ports, are exempt from quaran- 
tine inspection provided that such vessels have not sailed from a port in- 
fected with cholera, yellow fever, or plague, or in which typhus or small- 
pox is epidemic, and further provided that no cases of these quarantinable 
diseases have occurred on board en route. 
Vessels of the United States Navy may be subjected to quarantine in- 
spection upon arrival at ports of the United States, its possessions, or 
dependencies when coming from a port known or suspected to be infected 
with cholera, plague, or yellow fever, or where smallpox, or typhus fever is 
present in epidemic form, and may be detained in quarantine for such 
disinfection or disinfestation as may be required by reason of disease 
aboard or exposure to quarantinable disease at the port of departure or 
call. By arrangement with the Federal Security Agency, ships of the Navy 
to which medical officers are attached are ordinarily exempt from quar- 
antine inspection. A certificate furnished by the ship’s medical officer as 
to the sanitary condition of the vessel and record of communicable diseases 
is accepted by the quarantine officer in lieu of actual inspection. In case 
pratique is granted by radio communication the medical officer upon ar- 
rival in port must forward the bill of health in duplicate to the quarantine 
officer, together with a statement as to sanitary condition, including num- 
ber of cases of any communicable disease on board. 
Vessels of the United States Navy having entered the harbors of in- 
fe'cted ports but having held no communication which is liable to convey 
infection may be exempted from the disinfection and detention 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 sub- 
ject to the same provisions of these regulations as apply to merchant ves- 
sels. 
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 quar- 
antine official. Until pratique has been granted the vessel is in quarantine 
and can hold no unauthorized communication with the shore. A merchant 
vessel cannot enter at the customhouse without presenting the certificate 
of pratique which shows that the vessel has been released from quarantine. 
“G.O. #199 dated 2 Aug. 1943, directs that the importation of par- 
rots on Navy vessels be discontinued. For the purpose of the quarantine 
regulations, the term ‘birds of the parrot family’ are held to include all 
birds commonly known as parrots, Amazons, Mexican double heads, 
African grays, cockatoos, macaws, parrakeets, love birds, lories, lorikeets, 
and all similar birds. Birds of the parrot family may harbor a virus dan- 
gerous to Naval personnel and in these instances would not be eligible for 
entry into the United States. In view of the fact that very few of the QUARANTINE 
133 
naval personnel can comply with quarantine regulations noted in Foreign 
Quarantine Division Circular Letter No. 67, U. S. Public Health Service, 
and, as a precaution against introducing psittacosis into the Fleet, it is 
directed that no person be permitted to take aboard naval vessels any 
bird of the parrot family.” 
BILL OF HEALTH 
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, unless there is no such officer 
at the port of departure, excepting vessels operating during the absence of 
quarantinable disease in the foreign ports of call, exclusively between 
ports in the United States and Alaska and ports in Canada, and ex- 
clusively between ports in the United States, and ports in the Bahama 
Islands and ports in Cuba, and exclusively between ports in the State of 
California and ports on the west coast of lower California. The provisions 
of this section shall not apply to vessels plying between foreign ports on 
or near the frontiers of the United States and ports of the United States 
adjacent thereto; but the Federal Security Agency is hereby authorized, 
when, in his discretion it is expedient for the preservation of the public 
health to establish regulations governing such vessels. Vessels sailing 
originally from other foreign ports and merely calling at Canadian ports 
enroute 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 quarantinable 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 duplicate, in the form 
prescribed by the Administrator of the Federal Security Agency. Guan- 
tanamo Bay, Cuba, is considered under the law as a foreign port. A bill 
of health is required and may be obtained from the medical officer prior 
to departure. (See art. 1172 N. R. and G. O. 25.) Naval vessels clear- 
ing 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 disease exists at the port of departure, and under such 
circumstances it is advisable to procure a bill of health. 
A naval vessel departing from a port in the continental United States 
for a port in the Canal Zone or United States possessions is not required 
to procure a bill of health or port sanitary statement at such port of de- 134 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
parture, except when plague, cholera, or yellow fever exists, or typhus 
fever or smallpox prevails in epidemic form, in the port of departure. 
A naval vessel departing from a port in the possessions or dependencies 
of the United States for a port in the Canal Zone or other United States 
possessions is required to procure a bill of health in duplicate at each port 
of departure. 
Bills of health or port sanitary statements are issued in United States 
ports by medical officers of the Public Health Service where available; 
otherwise by the collector of customs. 
Naval vessels sailing from a United States port to a foreign port shall 
always procure a bill of health from the proper authorities and have it 
visaed 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 vessel sailing from a foreign port to another 
foreign port shall likewise procure and have visaed a bill of health. 
A vessel leaving a foreign port for a home port shall obtain a bill of 
health from a port official and also a United States consular bill of health, 
at a port where the issue of consular bills of health is customary, or from 
the United States Public Health Officer, if one be stationed there. 
The form, United States of America bill of health, sets forth under hand 
and seal of the officer authorized to sign, certification that the vessel has 
complied with quarantine rules and regulations and leaves the port of is- 
sue bound for stated port of the United States via the designated port of 
call, if any, under circumstances described, including the name of the 
vessel; nationality; master’s name ; gross tonnage; net tonnage; medical 
officer’s name; number of officers; number of crew, including petty offi- 
cers ; number of officers’ families; number of passengers destined for the 
United States; number of first cabin, second cabin, and steerage passen- 
gers ; names of ports visited during the preceding 4 months; statement as 
to the location of the vessel while in port—wharf, open bay, distance from 
shore; character of communication with shore; time the vessel was in 
port; sanitary condition of the vessel; sanitary measures, if any, adopted 
while in port; sanitary condition of the port and vicinity; and the names of 
diseases prevailing at the port and in the vicinity. The form also calls 
for entering the number of cases and number of deaths from each of the 
quarantinable diseases during the most recent fortnight for which statistics 
are available, as well as the date of the last case within the preceding year. 
Vessels clearing from a foreign port or from any port in the possessions 
or other dependencies of the United States for any port in the United 
States, its possessions, or other dependencies, and entering or calling at QUARANTINE 
135 
intermediate ports, must procure at all such ports a bill of health in dupli- 
cate signed by the proper officer or officers of the United States. 
Bills of health for naval vessels and indorsement by consular officers 
are usually extended gratis. Any expense involved in procuring bills of 
health or in quarantine is a charge against appropriations not under the 
Bureau of Medicine and Surgery Quarantine expenses (bills of health and 
pratique are a charge against “Instruments and supplies, Bureau of Navi- 
gation." (For decision as to the liability of a naval vessel for the payment 
of quarantine charges growing out of a State law, see Official Opinions of 
the Attorney General, 1906, vol. 25, p. 234.) 
In the United States a bill of health is procured by applying in person to 
the medical officer of the Public Health Service where available, otherwise 
to the collector of customs. 
In foreign ports request for a bill of health should be made at the 
office of the captain of the port (Bureau du Capitaine du Port, Offizio dell 
Capitano dell Porto, Capitania del Puerto). 
The person applying for the bill of health should take with him bills of 
health from last port of departure and be prepared to furnish the necessary 
data therefor. 
If epidemic or contagious diseases are present in the port at the time of 
making the request, a visit should also be made to the consul of the na- 
tionality of the next port of call, particularly in the Mediterranean, for 
his visas. 
On entering port, in addition to the bill of health, the ship shall be 
prepared to furnish the quarantine officer, if required, with a statement 
relative to the health conditions prevailing on board ship. Certain diseases 
of a communicable or infectious character, not included among the quar- 
antinable diseases under the quarantine laws and regulations of the Federal 
Security Agency, such as the exanthemata, diphtheria, cerebrospinal fever 
etc., will ordinarily be viewed by local or State authorities as constituting 
quarantinable diseases and their presence on board should be considered 
as rendering the vessel subject to quarantine restrictions. All such diseases 
should be fully reported to the inspecting health officer. 
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 dependencies is re- 
quired to 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 satisfied that the vessel, the passen- 
gers, the crew and the cargo have complied with all the quarantine laws 
and regulations of the United States. 136 
MEDICAL COM PEND FOR COMMANDERS OF NAVAL VESSELS 
Special Quarantine Measures 
cholera 
This disease is caused by a germ, the vibrio comma, 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 knowledge that none of the per- 
sonnel 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 preven- 
tive 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 compartment washed down with formaldehyde 
solution. The cholera vibrio has practically no resistance to drying, how- 
ever, and under natural conditions 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 protection of food and 
water supply are the important features to be observed in the prevention 
of cholera. 
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 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 localities, 
if exposed to infection therein, should not be shipped. Vegetables ordinari- 
ly eaten in an uncooked state when grown in districts where cholera pre- QUARANTINE 
137 
vails 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 districts 
should be subjected to bacteriological examination or otherwise detained 
5 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 pro- 
duce satisfactory evidence as to their exact place of abode during the 5 
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 incubation since last exposure, or 
otherwise be subjected to bacteriological examination. 
Should cholera appear in the barracks or houses in which passengers 
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 exam- 
ination or otherwise isolated for a period of 5 days. 
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 pos- 
sessions or dependencies, from ports or places where cholera prevails, 
shall be subjected to bacteriological examination and shall not be ad- 
mitted to entry until it has been determined by said examination that they 
are free from cholera vibrios. 
All persons on vessels upon which cholera has appeared during the voy- 
age shall upon arrival at quarantine be detained until it has been deter- 
mined by bacteriological examination that they are free from cholera 
vibrios. 
Persons in detention who are proven by bacteriological examination 
(performed not less than 24 hours after removal from exposure to in- 
fection 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 imprac- 
ticable) persons exposed to infection in a cholera case or carrier shall 
be detained in quarantine five days after being isolated from such case or 
carrier. 138 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
If a case clinically diagnosed as cholera has occurred on voyage, or if 
bacteriological examination should reveal the presence of infection 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 mate- 
rial capable of conveying infection shall be removed from the ship. 
Fruits and vegetables from an infected ship, that are ordinarily con- 
sumed in an uncooked state, shall be destroyed or rendered harmless 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 the organism E. 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 exer- 
cised 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 formalde- 
hyde solution. 
Carriers or recovered cases shall not be released from quarantine de- 
tention until three bacteriological tests performed on consecutive days 
shall have been proven to be negative. 
Inoculation with cholera vaccine of persons liable to be exposed should 
be considered because active artificial immunity for about 1 year is 
probable. 
YELLOW FEVER 
The causative agent of this disease is a filtrable virus, ordinarily trans- 
mitted to man by a species of mosquito; i. e., Aedes aegypti and this only 
after an intrinsic cycle of development in the body of such mosquito, which 
requires about 12 days. It has been found that a number of mosquitoes 
other than A. aegypti are capable of transmitting yellow fever by bite 
under certain environmental conditions found in and near tropical forests 
in the complete absence of A. aegypti, and it is then called jungle yellow 
fever. The mosquito can acquire the virus by sucking blood from a patient 
ill with yellow fever only during the first 3 days of the disease. 
Immunes are those who have had yellow fever or have been vaccinated 
against yellow fever within the past two years. One attack confers lasting 
active immunity for life. Children often have a mild unrecognized at- QUARANTINE 
139 
tack and are immune thereafter. Passive immunity of brief duration may 
be conferred by convalescent serum, and artificial active immunity of 
prolonged duration is now being practiced by the subcutaneous injection 
of a living virus modified by prolonged passage through chick embryos. 
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 destruc- 
tion of mosquitoes, and this is best accomplished by fumigation with sul- 
fur dioxide or hydrocyanic acid gas. Bactericidal measures have no place 
in the prevention or destruction of yellow fever infection. 
MEASURES AGAINST YELLOW FEVER AT FOREIGN AND INSULAR PORTS 
For the purpose of these regulations 6 days shall be considered as the 
period of incubation of yellow fever. 
It is advisable that at ports where yellow fever prevails precautions 
should be taken to prevent the introduction of mosquitoes, A. aegypti, 
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 A. aegypti measures 
should be taken to destroy mosquitoes that may have come on board. 
Passengers and crew who, in £he 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 6 days after said exposure. Those immune to yellow fever are exempt 
from this provision. 
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 Aedes mosquitoes, and transferred to a place of 
isolation. 
(c) Other persons should be disembarked, if possible, and detained 
under observation for 6 days, dating from the day of last possible ex- 
posure. 
(d) Persons under observation presenting an elevation of temperature 
above 37.6° C. (99.7° F.) shall be isolated in a screened apartment. 
(e) The ship shall be moored, if possible, at least 200 meters from the 
inhabited shore. 140 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
(/) The ship shall be fumigated for the destruction of mosquitoes be- 
fore 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 6 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 Aedes mosquitoes shall 
be fumigated and the personnel held in detention under observation for 
6 days. 
A vessel arriving at a southern port (either direct or by way of a north- 
ern 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 prox- 
imity to the shore as to render it liable to the access of Aedes mosquitoes, 
or which has been fumigated under the supervision of an accredited medi- 
cal officer of the United States immediately before sailing, may, upon 
arrival at a port of destination in the United States with good sanitary 
history and in good condition (including the absence of any exposed col- 
lection of water in which A. aegypti might breed) be subjected to the 
following treatment: 
(a) If arriving in 6 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 6 days. 
(b) If arriving after 6 days, she shall be immediately fumigated (un- 
less previously fumigated at a northern port) and may be admitted with- 
out detention. 
Vessels from ports infected or suspected of infection with yellow fever, 
calling at ports south of the southern boundary of Virginia, April 1 to 
November 1, or at a port north of that line and south of the southern 
boundary of Maryland, between May 15 and October 1, 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 inaccessible to Aedes and the crew or passengers be detained on 
board. 
Traffic without detention may be allowed during the active quarantine 
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 He at approved moorings in the open harbor; QUARANTINE 
141 
the crew must not be allowed ashore at the port of departure. Every 
possible precaution must be taken to prevent the ingress of Aedes mos- 
quitoes and their access to the crew. 
(b) The officer who must go ashore to contact authorities in an in- 
fected port must be immune to yellow fever. Passengers unless immune 
to yellow fever must have been free from possible exposure to yellow fever 
for 6 days immediately prior to embarking. 
(c) All the above conditions to be certified to specifically by an ac- 
credited 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. 
PLAGUE 
This disease is caused by the Pasteurella pestis. The bubonic type 
(called bubonic plague) is the most common form of the disease and is 
transmitted to man through the agency of rats and mice and their ecto- 
parasites ; 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 dis- 
lodged 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 disease. In any event, the bedbug would cause only in- 
dividual cases of the disease and would not be productive of an epidemic 
or operate to the widespread dissemination of the disease. The bubonic 
type is not communicable from person to person. 
From the foregoing, therefore, it is evident that the treatment of 
plague-infected vessels calls for the definite destruction of all rodents and 
their parasites and bedbugs where there have been septicemic 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 environment. 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. Sulfur di- 
oxide and hydrocyanic acid gas are best adapted for this purpose. When 
human cases are found on vessels that have acquired their infection en 
route, indicating 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 prevention 
of bubonic plague is irrational and unnecessary. General preventive 142 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
measures also include: Methodical destruction of rats and other rodents 
living in the wild state in area of endemic rodent infection; examination 
of carcasses for the detection of plague; rat-proofing of buildings and 
elimination of breeding places; guarding of grains and other food ma- 
terials against access to rats; investigation of all deaths during an epi- 
demic, with autopsy and laboratory examination when indicated. Pas- 
sive immunity of 3 to 4 weeks’ duration is conferred by antiplague serum. 
Plague vaccine usually confers active immunity of about 6 months’ dura- 
tion. 
The pneumonic type (called pneumonic plague) is intensely com- 
municable during the course of the disease; susceptibility is general; it 
is transmitted solely through personal contact in the same fashion as 
pneumonia or other respiratory diseases. Neither the flea nor other in- 
sects are concerned in the direct transmission of pneumonic plague. From 
an epidemiological standpoint and as to the application of preventive 
measures, pneumonic plague and bubonic plague are to be considered 
wholly separate diseases. 
MEASURES AGAINST PLAGUE AT FOREIGN AND INSULAR PORTS 
At ports or places suspected of plague infection in rodents every pre- 
caution shall be taken to prevent rats, mice, and fleas from getting aboard. 
Vessels sailing from such ports shall be simultaneously fumigated 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 mer- 
chandise 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 prefer- 
ably have been previously stored in ratproof 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 
shipment if considered as rodent infested. When the cargo of a vessel con- 
sists of grain or other rat food, extra precautions should be taken to pre- 
vent rats from going aboard. 
MEASURES AGAINST PLAGUE AT PORT OF ARRIVAL 
Ships on which plague has occurred in men or rodents shall be de- QUARANTINE 
143 
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 practicable, 
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 pneu- 
monic type of the disease), other than is incidental to the treatment of 
vessels or cargo. 
If pneumonic plague has occurred on board ship during the voyage, 
the sick shall be removed and isolated and all crew and passengers that 
have been exposed to the infection shall be detained in quarantine for a 
period of 7 days, or, at the discretion of the quarantine officer, until 
their secretions shall be proved to be free from P. 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 passengers 
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 dependencies 
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 provisional pratique. When lying along- 
side 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 be- 
tween 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 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 measures have not been 
taken to destroy the same under the supervision of an accredited medical 144 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
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 6 months for the purpose of destroying rats. This is 
best done when the vessel is empty. The periods may be extended for ves- 
sels plying regularly between ports not infected with plague and for ves- 
sels whose construction does not favor harborage of rats. 
A certificate signed or visaed by an accredited medical or consular 
officer of the United States may be accepted by the quarantine officer as 
competent evidence as to the last fumigation, provided such certificate 
contains the same, or substantially as complete information as contained 
in Certificate of Fumigation, United States Public Health Service, Form 
1939 or Form 1945. 
In applying plague-preventive measures vessels without cargo shall be 
fumigated simultaneously in all parts with sulfur-dioxide gas, not less 
than 3 pounds per 1,000 cubic feet, for 6 hours’ exposure, or by hydro- 
cyanic-acid gas in the proportion of 5 ounces of sodium cyanide per 1,000 
cubic feet of space (or equivalent amount of potasium cyanide) for 2 
hours. If the vessel be loaded, the time of exposure shall be doubled. 
When necessary in the treatment of infected vessels, the quarantine of- 
ficer may require the master to partially discharge cargo for the pur- 
pose of effective performance of fumigation. 
SMALLPOX 
The causative agent of this disease is a specific filtrable virus and for 
all practical purposes it may be considered that more or less intimacy 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. 
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 prevails 
in epidemic form, or who have been exposed to smallpox, should be vac- 
cinated before embarkation, unless they show satisfactory evidence of 
having acquired immunity to smallpox by previous attack, or successful 
vaccination within 1 year, and their bagg.age inspected and, if necessary, 
disinfected. QUARANTINE 
145 
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 be removed and detained until recovered. 
(b) All persons who in the opinion of the quarantine officer have been 
been exposed to the infection shall be vaccinated, unless protected by a 
previous attack of smallpox, and detained in quarantine until the vac- 
cination 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 ex- 
posed 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 is believed to be a microor- 
ganism known as the Rickettsia prowaseki. The transmitting agent of 
typhus, however, is the louse, both the body louse and the head louse, 
chiefly the former, and in some outbreaks, fleas. 
Rats, as well as infected persons, may be a transmission factor and 
their destruction is therefore an indicated general measure of prevention, 
along with the operation of facilities for the delousing of persons, cloth- 
ing, and premises. No other natural means of transmission of typhus 
infection has been accepted. 
The important feature in typhus-preventive measures is the assured 
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 per- 
sons from a knowrn typhus-infected area. The destruction of lice on cloth- 
ing is best effected by heat, steam under pressure by preference, but 
flowing steam without pressure wall 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. Then follow the treatment given in the paragraph 
on the treatment of vermin. The treatment of personal effects and bag- 
gage of verminous persons is necessary, but in the case of those indi- 
viduals 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 rat fleas and the detention in quarantine 
for a period of 12 days of those persons who have been intimately ex- 146 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
posed to typhus infection and who presumably may develop the disease, 
as well as those actually sick. 
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 vermin. The personal effects, wearing ap- 
parel, 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. 
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, per- 
sonal effects, and baggage of those infected and of those not demonstrably 
vermin free shall be treated for the destruction 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 fumigated 
for destruction of vermin. 
Cargo compartments of typhus-infected vessels need not be fumigated 
unless there be exceptional conditions that may render them vermin in- 
fested. 
Sulphur dioxide and hydrocyanic acid gas are effective agents for the 
destruction of lice when used in proper strength and exposure, but must 
only be used under the supervision of the U. S. Public Health Service 
or a naval doctor. 
LEPROSY 
The causative agent of this disease is believed to be Mycobacterium QUARANTINE 
147 
leprae, which is an “acid fast” bacillus found in the tissues of persons 
having the disease. 
The incubation period is long and may extend to several years. The 
conditions and circumstances under which transmission occurs are not 
completely understood and preventive measures are confined almost en- 
tirely to the isolation and segregation of the leprous persons. 
For the prevention of the spread of leprosy, the chief and practically 
the only measure called for is the isolation of the patient, either in a na- 
tional or State leprosarium. When in temporary confinement at the quar- 
antine stations, when traveling, or under other conditions that would en- 
tail contact with the public, especial precautions would include the ster- 
ilization of eating utensils used by the leper and the disinfection of bed- 
clothes. Terminal disinfection consists of thorough cleansing of the 
patient’s living premises. No immunization method is recognized and 
quarantine of contacts is not contemplated. 
Alien lepers are not 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, or if discovered on board, the case shall be 
certified as a leper and reported to the nearest commissioner of im- 
migration. If the leper be a citizen of the United States, the case shall 
promptly be reported to the Navy Department, if transportation in a 
naval vessel is involved. 
ANTHRAX 
Quarantine regulations contemplate that anthrax is primarily a disease 
of animals, not transmitted from man to man, and that responsibility for 
exclusion of the disease rests upon the United States Bureau of Animal 
Industry. It was designated a quarantinable disease to afford additional 
protection from infection from imported animal products, especially hair 
and bristles for shaving brushes. It is required that shaving brushes 
destined for shipment to the United States be made only from hair or 
bristles known to be free from anthrax spores, or that such hair or 
bristles before being made into brushes shall be disinfected by one of 
three methods: (1) Boiling for 3 hours; (2) autoclaving for 30 minutes 
at 15 pounds pressure with preliminary vacuum of at least 10 inches; and 
(3) exposure to streaming steam for 6 hours. 
DISINFECTION AND FUMIGATION 
The distinction between disinfection and fumigation must be kept 
clearly in mind. Disinfection properly applied is of great value in the 
prevention of communicable diseases. With the destruction of infective 
discharges and the exercise of great care and cleanliness throughout the 
course of a communicable disease there is less need for terminal disinfec- 
tion. The boiling of sheets, pajamas, towels, and similar articles and a 148 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
thorough scrubbing of the surfaces with hot water and soap, and dis- 
infecting of bedding with steam is a more effective method of disinfection 
than by the use of one of the gaseous agents. Gaseous fumigation for the 
destruction of bacteria and viruses had been discontinued. Gases, such as 
formaldehyde, are uncertain in practice and have the merest surface ac- 
tion and cannot be depended on against tuberculosis or diphtheria. Fumi- 
gation has its place in preventive medicine and is used principally for the 
destruction of rodents in the control of plague, the extermination of in- 
sects, especially bedbugs, and, in exceptional instances, for the extermina- 
tion of mosquitoes as a disease-prevention measure. 
The agents used in disinfection are of two types, physical and chemical. 
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 con- 
nection with other methods of disinfection. 
PHYSICAL DISINFECTANTS 
Exposure to direct sunlight in fresh outdoor air.—Such exposure for 
several hours is always desirable, paritcularly for clothing and bedding 
and other articles which may not, or in the particular instance 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 cannot 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 ar- 
ticles must be wholly immersed for not less than 10 minutes in water 
actually boiling (100° C.). The addition of 1 percent 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 temperature has 
reached 100° C. 
(h) Steam under pressure without vacuum: Steam under pressure will 
sterilize, provided that the process is continued 20 minutes after the pres- 
sure reaches 15 pounds per square inch. The air must be expelled from QUARANTINE 
149 
the apparatus at the beginning of the process. If impracticable to obtain 
the designated pressure, a longer exposure will accomplish the same 
result. 
(c) Steam under pressure with vacuum; Steam in a special apparatus 
with vacuum attachment is the best method of applying steam under pres- 
sure, the object of the vacuum apparatus being to expel the air and to 
promote the penetration of the steam. The process is to be continued for 
20 minutes after the pressure reaches 10 pounds to the square inch. 
Clothing, fabrics, textiles, curtains, hangings, etc., may be treated by 
any of the above methods as circumstances may demand. 
Articles injured by steam, such as leather, furs, skins, rubber, trunks, 
valises, hats and caps, bound books, silks, and fine woolens should not be 
disinfected by steam. Such articles should be disinfected by formaldehyde 
gas or any of the chemical disinfecting agents mentioned next which may 
be applicable thereto. Those which will be injured by wetting should be 
disinfected by a gaseous agent. 
Textiles which are soiled with discharges of the sick or which are pre- 
sumably deeply infected must be disinfected by one of the following 
methods: (1) Boiling, (2) steam, (3) immersion in one of the germi- 
cidal solutions. 
Cooking and eating utensils should always be disinfected by immer- 
sion in boiling water or by steam. Chloride of lime may be used in an 
emergency. 
CHEMICAL DISINFECTANT SOLUTIONS 
Chemical disinfectants not supplied in the medicine box may be ob- 
tained from the supply officer for general use aboard naval vessels. 
Cresol.—Cresol, a mixture of cresols derived from coal tar, in the 
strength of 5 percent may be substituted for bichloride of mercury, and 
should be employed in the disinfection of contaminated clothing or fab- 
rics, on swabs for sides and decks of cabins and living spaces of ships to 
obviate injurious action on metal surfaces, bright work, etc., and for 
feces, urine, sputum and spitkits. Exposure should be 1 hour. Fingers 
should not be immersed in this solution for any length of time as numb- 
ness will result and if immersion is continued gangrene may follow. Its 
action is similar to carbolic acid. 
Formaldehyde solution (formalin).—Formaldehyde, a watery solution, 
containing about 40 percent of formaldehyde gas, 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. It is an excellent 
deodorant. Formaldehyde solutions act harshly upon the hands. 
Chlorinated lime.—Chlorinated lime in a 5- or 6-percent solution fresh- 
ly made from the powder which has been kept free from deterioration in 150 
MEDICAL COM PEND FOR COMMANDERS OF NAVAL VESSELS 
a small sealed can or tightly stopped colored bottle is efficient and useful 
in the disinfection of sewage, stools, glass and earthen ware, and mate- 
rials or articles which will not be damaged by its bleaching and corrosive 
action. When the package containing the chlorinated lime is opened there 
should be a strong odor of chlorine. It can be used for washing painted 
surfaces and scrubbing floors, in water-closet bowls or urinals, and in 
shower baths to prevent the spread of ringworm. It serves as a deodorant 
as well as a disinfectant. It may be used by attendants upon the sick 
to disinfect their hands. In disinfecting dejecta, stools should be com- 
pletely 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-percent 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 resi- 
due sinks to the bottom; the solution above contains about 6 percent of 
chlorinated lime which is equivalent to 2 percent of chlorine, the active 
disinfecting agent. Chlorinated lime cannot be depended upon to kill the 
tubercle bacillus. 
Disinfection of drinking zvater by chlorination.—Dissolve the soluble 
portions of 1 gram of chlorinated lime of tested chlorine strength in a 
small volume of water and add this to 40 gallons of the water to be disin- 
fected ; mix thoroughly and allow to stand for at least 1 hour before using 
for drinking purposes. 
If it should be considered necessary to fumigate, facilities of the United 
States Public Health quarantine station should be sought, or similar 
public health facilities, if in a foreign port. In their absence, contact 
should be made with a naval vessel having a regular medical department. 
FUMIGANTS 
FUMIGATION OF VESSELS 
All spaces to be fumigated must be made as nearly airtight 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 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. All possible care should be observed 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 impor- 
tant when sulfur dioxide is used. Pipe casings should be opened up and 
from one end of the vessel to the other there should be a certain number QUARANTINE 
151 
of limber boards removed so as to permit of penetration 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 
with rats which resort to these places for water. Preferably, lifeboats 
should be cleaned and flooded by water prior to fumigation. Very close 
attention 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. Be sure all personnel have been removed from the 
area to be fumigated or likely to be exposed to the fumes. 152 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
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 fumigating materials may be procured. 
The fact that some of the stations are not provided with wharfage facili- 
ties is not an index to the capacity of the stations for performing disin- 
fection : 
Station 
Depth of 
water at 
dock, feet 
Detention 
facilities 
(barracks), 
persons 
Hospital 
beds 
Astoria, Oreg 
Baltimore, Md.1 
8 
100 
12 
Boston, Mass.1 
15 
1,400 
65 
Brownsville, Tex.1 
Wilmington, N. C.2 
Charleston, S. C.1 
22 
80 
5 
El Paso, Tex.1 
Fort Monroe, Va, (Craney Island)1 
10 
1,000 
69 
25 
Galveston, Tex.1 
25 
15 
Gulf, Miss.2 
7 
20 
10 
Honolulu, T. H.1 
18 
1,000 
31 
Laredo, Tex.1 
Los Angeles, Calif 
35 
6 
Miami, Fla 
18 
Mobile, Ala 
35 
65 
15 
New Orleans, La.1 
25 
200 
30 
New York, N. Y 
Port Townsend, Wash.1 
12 
200 
25 
Reedy Island, Del.1 
6 
200 
15 
30 
40 
San Diego, Calif.1,2 
22 
80 
18 
19 
600 
10 
San ]uan, P. R.1 
12 
75 
8 
Substations:2 
Beverly, Mass. 
Lynn, Mass. 
Perth Amboy, N. J. 
Salem, Mass. 
San Ysidro, Calif. 
• 
12 
30 
10 
1 Stations having disinfecting plants. 
2 Stations having fumigating service obtainable from other principal stations, GLOSSARY 
ABDOMEN.—That part of the body which lies below the chest as far as the pelvis 
and contains stomach, liver, intestine, etc.; the belly. 
ALBUMINOUS.—Containing albumin or protein: e. g., meat, egg, milk, etc., and 
certain materials in bodies of plants and animals. 
ANALGESIC.—A medicine that relieves pain. 
ANESTHETIC.—A medicine used to produce local or general insensibility. 
ANODYNE.—A medicine that soothes irritated nerves. 
ANTACID.—A medicine correcting or neutralizing acidity. 
ANTIDOTE.—A medicine given to counteract some action in another, or to neutralize 
the effect of a poison. 
ANTIMALARIAL.-—Curing or preventing malaria. 
ANTIPYRETIC.—A remedy for fever. 
ANTIRHEUMATIC.—Relieving or preventing rheumatism. 
ANTISEPTIC.—A substance which prevents or retards the growth of organisms, 
especially of the septic variety, thus hindering putrefaction. 
ANTISPASMODIG.—An agent that relieves nervous irritability and minor spasms. 
ASPHYXIA.—Suspension of respiration and animation; suffocation, as in drowning 
or from breathing poisonous gases. 
ASTRINGENT.—An agent that arrests bodily discharges by shrinking mucus 
membranes. 
AUTOCLAVE.—An apparatus for sterilization by steam under pressure. 
BACILLUS.—A rod-shaped microorganism. 
BACTERIA.—Microscopic vegetable organisms of many varieties, some of which 
produce disease. 
BILL OF HEALTH.—A document which must be obtained by the master of a 
vessel from a consul before his vessel may sail; a health clearance. 
BLEB.—A blister. 
BUBONIC.—Relating in any way to a bubo. Bubonic 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 which connect the veins 
and arteries. 
CARRIER.—A person who harbors in his body disease-producing germs without 
actually suffering from or showing symptoms of the disease, 
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 sc ,r with caustics or a hot iron. 
CHEMICAL AGENT.—A war gas. 
CHOLAGOGUE.—Causing increased evacuation of bile. 
CLEANING.—Removal by scrubbing and washing of material contaminated by 
disease-producing germs. 
CLINICAL.—Relating to the course of a disease. Clinical thermometer, a self- 
registering thermometer for taking the bodily temperature. 
COMMUNICABLE.—As of disease, capable of being passed from one individual 
to another. Commonly referred to as “contagious,” if readily communicable, 
as by the air; “infectious,” if not readily communicable, as by contact, water, 
food, etc. 
BLEB.—A blister. 154 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
CONTACT.—Any person or animal who has been sufficiently close to an infected 
individual to contract the disease. 
CONTAGION.—The communication of disease from person to person by contact, 
direct or indirect. 
CORYZA.—Acute rhinitis; cold in the head. 
DECONTAMINATION.—Removing and neutralizing a war gas from body, clothing, 
equipment, food, water or compartment. 
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. 
DELOUSING.—The killing of lice or their eggs on the person or clothing of an 
individual. 
DEODORANT.—A substance which destroys or hides foul odors. 
DIAPHORETIC.—A medicine that increases perspiration. 
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 rela- 
tion to each other. 
EMETIC.—An agent which causes vomiting. 
ENDEMIC.—A disease constantly present in a community, as distinguished from 
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. 
EPIDIDYMITIS.—Inflammation of the seminal ducts of the testicle. 
ERUPTION.—A breaking out, especially the appearance of changes in the skin; 
rash. 
EXPECTORANT.—A medicine that promotes expectoration. 
FEBRIFUGE.—Medicine which lessens fever. 
FECES.—The matter discharged from the bowels during defecation. 
FRACTURE.—A break, usually of a bone. 
FUMIGATION.—The destruction of germs, insects, and rodents by means of chemical 
gases and fumes, as that of formaldehyde and sulfur. 
FUNGUS.—A cellular vegetable organism of low order, feeding on organic matter; 
such as mushrooms, toadstools, yeasts, and molds. 
GERM.—A microbe or pathogenic bacillus. 
GERMICIDE.—An agent which is destructive to germs and microbes. 
HEMOSTATIC.—An agent which stops the flow of blood, especially internal. 
HERNIA.—Rupture. The protrusion of tissue through an abnormal opening. Most 
common is “inguinal,” the protrusion of a loop of gut through an opening in the 
belly wall at the groin. 
HYPNOTIC.—A drug that induces sleep. 
IMMOBILIZATION.—The act of rendering a part immovable or of preventing 
all possibility of movement in a part; especially applied to fractured bones. 
IMMUNITY.—Security against any particular disease; “active,” when resulting 
from an attack of the disease, or from “vaccination”; “passive,” when produced 
by injection of serum of an immunized animal. The former is prolonged, the 
latter temporary. 155 
GLOSSARY 
INCUBATION PERIOD.—The period between exposure of an individual to and 
the onset of symptoms of a communicable disease. 
INFECTION.—Communication of disease, as by entrance of pathogenic germs 
into an organism in any manner. 
INSECTICIDE.—An agent which kills insects. 
ISOLATION.—Limitation of the movement of known sick or "carrier” individuals 
or animals. 
LAXATIVE.—A remedy which assists the movement of the bowels which move 
sluggishly. A laxative is useless where the bowels have been clogged for several 
days, in which case a cathartic is necessary. 
LIGATURE.—A thread for tying a blood vessel. 
MACERATION.—Softening by the action of a liquid. 
MACULE.—A discolored spot on the skin not elevated above the surface. 
METABOLISM.—Tissue change; consists of “anabolism” (building up), and "cata- 
bolism” (breaking down of tissues). It is the process of nourishing the tissue 
cells, and their production of heat and energy. 
MICROBE.—A microscopic organism, especially a bacterium. 
MICROORGANISM,—A microscopic living organism of the animal or vegetable 
kingdom, bacillus, bacterium, microbe, germ. 
ORCHITIS.—Inflammation of the testicle; a common complication of mumps. 
ORGANIC.—Having an organized structure, or a substance derived from living 
organisms. 
PALPITATION.—Rapid and perceptible beating of the heart, which may be regular 
or irregular. 
PARASITICIDE.—A chemical agent which destroys the various animal and vegetable 
parasites. 
PATHOGENIC.—Productive of disease. 
PLEURA.—A thin membrane which lines the inside of the chest wall and covers 
the lungs. 
PNEUMONIC.—Relating to pneumonia. Pneumonic plague, a particularly fatal 
form of plague, 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 com 
munication with the shore. 
PROPHYLAXIS.—The prevention of disease. 
PROTOZOA.—The lowest division of the animal kingdom, including the unicellular 
organisms, such as the malarial parasite. 
PURGATIVE, PURGE.—A medicine that moves the bowels actively. 
PURULENT.—Consisting of pus, or matter. 
PUS.—The matter from a sore or abscess. 
PUSTULE.—A small circumscribed inflamed elevation on the skin, containing 
pus. 
QUARANTINE.—Limitation of movements of persons exposed to communicable 
disease, or of those who have been in contact with persons ill with such disease* 
RABIES.—A disease affecting certain animals, especially dogs, from which hydro- 
phobia is communicated to man. 
RASH.—An eruption on the skin. 
RECTUM.—The lowest part of the large intestine, opening at the anus. 
RENOVATION.—Rendering a space or room sanitary, in addition to cleaning, 
as by painting. 
RHINITIS.—Inflammation of the mucus membrane of the nose. 156 
MEDICAL COMPEND FOR COMMANDERS OF NAVAL VESSELS 
SANITATION.—Employment of measures designed to promote health and prevent 
disease through proper care of surroundings and things. 
SEDATIVE.—A medicine which allays irritation and quiets the nerves. 
SEPTIC.—Produced by or due to putrefaction. 
SHOCK.—A condition of collapse or profound prostration sometimes following 
hemorrhage, injury, anesthetic, and operation. 
SOPORIFIC.—A hypnotic. 
SPATULA.—A broad-bladed instrument like a knife with blunt edges for spreading 
ointments. 
SPECIFIC.—A medicine which has a direct curative influence on a particular disease; 
as quinine in malaria. 
STAPHYLOCOCCUS.—A bead-shaped microorganism occurring in clumps. 
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. 
STREPTOCOCCUS.—A bead-shaped microorganism occurring in chains. 
STRICTURE.—A narrowing of a passage or canal in the body due to disease or 
injury. 
STYPTIC.—Medicine or application to control external hemorrhage. 
SUSCEPTIBLE.—A person or animal who is not immune to a specific disease. 
SUTURE.—A stitch used to draw together the edges of a wound. 
TONIC.—An agent which tends to restore normal tone to the body. 
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 dis- 
charged. 
URINATION.—The act of discharging the contents of the bladder. 
UVULA.—The small, fleshy body which hangs from the soft palate over the root 
of the tongue. 
VARICOSE.—Having an unnatural enlargement or dilation, knotty and irregu- 
ular in shape, as often seen in the veins of the lower extremities. 
VENEREAL.—Pertaining to sexual intercourse or caused by it. 
VERMICIDE.—A medicine which causes the death and expulsion of intestinal 
worms. 
VIRUS, FILTRABLE.—The causative agent of some diseases, differentiated from 
other agents such as bacteria, protozoa, or molds; is ultramicroscopic, and passes 
through the finest filters. The cause of smallpox, yellow fever, and many other 
diseases. INDEX 
Abdominal conditions, acute 84, 85 
Accident prevention 123 
Acid: 
Acetylsalicylic, dose 3, 7 
Carbolic, disinfection by 149 
Poisoning by 56 
Hydrochloric, poisoning by 56 
Nitric, poisoning by 56 
Treatment of rabies, in 54 
Sulphuric, poisoning by 56 
Acute abdominal conditions 84, 85 
Acute appendicitis, symptoms and treatment of 85 
Alcoholism (delirium tremens) 95,96 
Alkalies 57 
Alkaline and aromatic tablet 7 
Ammonia, spirits of aromatic 5, 10 
Amyl Nitrite ointment 6, 61 
Animal bites 53 
Anti-flash garments 38 
Anti-gas equipment, personal 64 
Appendicitis, acute, symptoms and treatment of 85 
Argyrol 7 
Arm, fracture of 28 
Aromatic spirits of ammonia 5, 10 
Arsenic, poisoning by 57 
Arterial hemorrhage 15 
Arteries, main, location of 16 
Artificial respiration 49,50,51,52 
Aspirin 3, 7 
Atabrine 7, 79 
Dose, suppressive schedule 7 
Dose, treatment schedule 79 
Autopsy 110 
Azochloramid saline mixture tablets 3, 7, 21 
Back, fracture of 35 
Baking soda 3, 4, 56 
Bandage: 
“Figure-of-eight” . 32 
Traction splint, foot 30 
Barbitol, poisoning by 58 
Bichloride of mercury, poisoning by 56 
Bills of health.... 125 
Bismuth subnitrate 7 
Bites: 
Animal 53 
Animal, rabid, nitric acid treatment in 54 
Insect ..............,., 52 
Poisonous spider and scorpion 52, 53 
Snake , 54 
Page 158 
INDEX 
Page 
Blast, under water 38, 39 
Blast injury 38,39 
Prevention 39 
Treatment 39 
Bleeding: • 
Control of 15 
Digital pressure 16 
Direct pressure 15 
Pressure points 16 
Tourniquet 17 
Blister Gas 60, 62 
Effect of 60, 62 
Blisters 36 
Blood and nerve poisoning gases 60 
Boat box, medical 1,4 
Body temperature 66 
Measurement of 66 
Normal 66 
Taking of 68, 69 
Borax 3, 7 
Lotion 96 
Boric acid ointment 9 
Broken back 35 
Broken neck 35 
Brown mixture 7 
Bruises 24 
Bubo (blue balls) 99 
Bubo tropical 102 
Burial 110 
In foreign countries 110 
Burns 37 
First degree 37 
Flash, prevention of 38 
Anti-flash garments 38 
Clothing in 38 
Flash-resistant cream, in 38 
Second degree 37 
Third degree 37 
Treatment of 37, 38 
Butyn ophthalmic ointment, 2% 6 
Caffeine 7 
Calomel 8 
Carbolic acid, poisoning by 56 
Carbon monoxide, poisoning by 58 
Care of sick, medical and dental officer * 1 
Carrier of diseases 126 
Cascara segrada 8 
Case, first-aid (armed guard) 2, 5 
Castor oil 8 
Casualty gases 60 
Catheter 11 
Cerebrospinal fever (meningitis), symptoms and treatment of 95 159 
INDEX 
Page 
Chancroid, cause, signs, symptoms and treatment of 102 
Chemical disinfectants 149, 150 
Chemical gases, disinfection by 150 
Chemical warfare agents (war gases): 
Classification ; 59 
Color and state of 60 
Effect on body 61 
Emergency treatment 58 
Names of 60 
Odor of 60 
Presistence of 61 
Physiological class 60 
Protection against 61 
Reference chart 59,60,61 
Self-aid in 61 
Symbols 60 
Treatment of cases exposed to 58 
Chickenpox, symptoms and treatment of 74 
Chills and fever 79 
Chloral hydrate, poisoning by 58 
Chlorinated lime 149, 150 
Chlorination of water : 150 
Choking gases 60 
Cholera (asiatic) symtoms and treatment of 91 
Clap 100,101 
Of eye 101 
Cleanliness, personal 117,118 
Cleansing of wounds 20 
Clinical thermometer 68, 69 
Cold and heat, exposure to 44,46,47 
Cold, effects of 44,46 
Cold, exposure to 44,46 
Colds and coughs 82 
Colic, gallstone, symptoms and treatment of 86, 87 
Colic, kidney stone, symptoms and treatment of 87 
Colic, symptoms and treatment of 87, 88 
Communicable diseases 67 
Cleaning 69 
Contact 69 
Control of 69 
Description of 67 
Geographical location 67 
Incubation period 69 
Isolation in 70 
Keeping patient clean in 72 
Quarantine 70 
Transmittal by insects 67 
Treatment of. . . 71 
Communicable disease patient, instructions for person nursing 73 
Compound fractures 27 
Concussion 58, 39 
Prevention of 39 160 
INDEX 
Treatment of 39 
Control of bleeding 15 
Convulsions 94 
Copper sulfate solution ointment 6, 61 
Coughs and colds, symptoms and treatment of 82 
Crabs 93, 94 
Cream, flash-resistant 38 
Cremation of remains 110, 111 
Cresol, poisoning by 56 
Disinfection by 149 
Crisis, as termination of fever 68 
Page 
Deaths: 
At sea 109 
Beyond continental limits for duration of war 110 
Board of investigation in 110 
Burial in foreign countries 110 
Burial of remains, use of national flag in 112 
Cremation of remains 110,111 
Funeral expenses 110, 111 
In port 109 
Inventory and disposition of personal effects in 113, 114 
Navy Regulations applying 109,110,113,114 
Notification of next of kin 112 
Preparation for interment Ill 
Shipment of remains, escort 112,113 
Transportation of remains Ill, 112 
Unnatural or suspicious circumstances 110 
Decontamination, self, war gases 62, 63 
Delirium tremens, symptoms and treatment of 95,96 
“The horrors” 95,96 
Dengue (fever) symptoms and treatment of 99 
Dentalone 8 
Dental treatment 98 
Diarrhea, symptoms and treatment of 88 
Digital pressure 16 
Diphtheria, symptoms and treatment of 84 
Direct pressure 15 
Diseases: 
Infectious, general treatment of 71 
Carrier of ; 126 
Ear 97 
Eye 96 
Intestinal tract 87 
Nervous system 94 
Respiratory system 82 
Skin 92 
Stomach 86 
Special ; 67 
Subject to quarantine 126,127,128, 129,130 
Teeth 97 
Vector of 126 
Venereal 99 INDEX 
161 
Disinfectants: 
Chemical 149,150 
Physical 148, 149 
Disinfecting, formula for 129 
Disinfecting plants 152 
Disinfection 125, 147 
By: 
Boiling 148 
Burning 148 
Chemical gases 150 
Chlorinated lime 149 
Chlorination of water 150 
Cresol 149 
Formaldehyde solution 149 
Formalin 149 
Steam 148 
Dislocations 36 
Disposal of sewage 123 
Dogs, bites of 53 
Dressings, medicines, etc 3 
Drowned, resuscitation of the apparently 49 
Drugs, use of 72 
Duodenal ulcer, perforated, symptoms and treatment of 86 
Dysentery, symptoms and treatment of 89, 90 
Ear, diseases of 97 
Earache, treatment of 97 
Elbow, fracture of 34 
Electric shock, resuscitation from 50 
Epididymitis (swollen testicle) 101 
Epileptic fits 96 
Epsom salts 8 
Exposure 41,44 
Expenses: 
Funeral 110 
While in hospital 105, 106 
Eye, diseases of 96 
Gonococcus, infection of 101 
Inflammation, symptoms and treatment of 106 
Stye 97 
Wash 96 
Fever: 
Cerebrospinal 95 
Dengue 80 
Infectious 73 
Malarial 79 
Plague 80,141 
Scarlet 77 
Termination of by crisis 68 
Termination of by lysis 68 
Typhoid 90,91 
Typhus 145 
Undulant 80 162 
INDEX 
Yellow 81,138 
Figure-of-eight bandage 32 
First-aid 13 
General rules 13 
First-aid case (armed guard) 2, 5 
First-aid kit (gas casualties) 2,6 
Fits, epileptic 96 
Fixed traction splints 28, 29, 30 
Flash burns, prevention of 38 
Flash cream 38 
Food 120 
Food handlers 120 
Food poisoning, symptoms and treatment of 89 
Foot, immersion 45 
Forceps, hemostatic 11 
Foreskin, swollen 101 
Formalin, disinfection by 149 
Form U 106 
Formaldehyde solution 8,149 
Formalin 149 
Formula for disinfecting 129 
Four-tailed bandage 30 
Page 
Fractures: 
Arm 28 
Collarbone 31,32 
Compound 27 
Treatment of 27 
Elbow v 34 
Forearm 34 
Leg 28 
Lower jaw 30 
Bandage, four-tail 30 
Lower leg 28 
Nose 34 
Rib 31 
Simple 26 
Skull 35 
Spine 35 
First-aid treatment and transportation of 36 
Upper arm 34 
Freezing 46 
Fresh air 71 
Frostbite 46 
Fumigants 150 
Fumigation 147 
Fumigation of vessels 150,151 
Funeral expenses 110, 111 
Gallstone colic, symptoms and treatment of 86, 87 
Gangrene, gas 20 
Garbage 121 
Gases, war 58 
Gas gangrene 20 INDEX 
163 
Gas poisoning, resuscitation from 49 
Gastric ulcer, perforated, symptoms and treatment of 86 
General infections 73 
German measles, symptoms, and treatment of 7 6 
Glands, groin, swollen 101 
Glossary 153,154,155,156 
Gonorrhea (clap), cause, symptoms and signs, and treatment of 100, 101 
Gonorrhea: 
Complications in 101 
Inflammation of eye 96 
Granuloma, inguinale 102, 103 
Grip 73 
Harassing gases 60 
Headache 94 
As a symptom 94 
Treatment of 94 
Page 
Health: 
Bills of 125 
Conservation and maintenance of 119 
Navy Regulations applying 119 
Records 119 
Heat: 
Cramps 47,48 
Use of salt in 10 
Exhau stion 47,48 
Exposure to 47,48 
Stroke 47,48 
Hemorrhage 15 
Hernia..; 3 7 
Heroin, poisoning by 57 
Hospitalization: ; 105 
Authorized by commanding officer 105 
Dental expenses 105 
Form U report on 106 
In absence of naval hospital facilities 105 
In civil hospitals 105 
Navy Regulations in 105, 106 
Payment for 106 
Personal effects to accompany 107 
Personnel not in a duty status 106 
Personnel on leave 106 
Sick and wounded officers and men 105 
Hospitals: 
Civilian 106 
Expenses, while in 105,106 
Facilities 105,106 
Naval 105,106 
Public Health 105,106 
Hydrochloric acid, poisoning by 56 
Hydrotherapy 71 
Hygiene, personal 117, 118 
Immersion, foot 45 164 
INDEX 
Page 
Prevention of 45 
Treatment of 45 
Improvised splints, rigid 28, 29, 30, 33 
Incendiaries 60 
Infections, general 73 
Prevention of spread of 70 
Inflammation of eye 96 
Influenza, symptoms and treatment of 73 
Injuries 14 
Blast, abdomen and chest 23, 38,39 
Caused by fall 35 
Insect bites 52 
Inspection of food 120 
Insensibility 96 
Intestinal obstructions, acute, symptoms and treatment of 85, 86 
Intestinal tract, diseases of 87 
Colic, symptoms and treatment of 87, 88 
Inventory and disposition of personal effects 113,114 
Iodine, tincture of 8, 58 
Irrigator 11 
Itch (scabies), treatment of 92 
“Seven years’itch” 92 
Jaw, fracture of 30 
Kidney stone colic, symptoms and treatment of 87 
Kit, first-aid; 
Armed guard 5 
Gas casualties 2,6 
Knock-out drops, poisoning by 58 
Laudanum, poisoning by 57 
Leg, fracture of 28, 34 
Leprosy 146 
Lewisite gas, liquid, self-decontamination 63 
Lice 93, 94 
Life boats and rafts, survival on 40 
Lighting 122 
Liniment, soap 10 
Liquid petrolatum 8 
Luminal, poisoning by 58 
Lye, poisoning by 57 
Lymphogranuloma venereum (tropical bubo), cause, signs, symptoms and 
treatment of 102 
Lysis as termination of temperature 68 
Malaria, symptoms and treatment of 79 
Carried by Anopheline mosquitoes 79 
Maritime quarantine 125 
Measles, symptoms and treatment of 75, 76 
German 76 
Medical and dental officer, care of sick 1 
Medical boat box 1,4 
Medical supplies 1, 2 
Medical units 1 
Medicine box 1,3 INDEX 
165 
Medicines, directions tor use 7 
Medicines, dressing, etc 3 
Meningitis, symptoms and treatment of 95 
Mercury, bichloride of, poisoning by 56 
Mess gear and utensils 130 
Mineral oil 8 
Mixed blister gases, self-decontamination of 63 
Morphine, poisoning by 57 
Page 
Morphine: 
Administration of 9 
Dose 8, 9 
Syrette 8, 9 
Tartrate 3 
Tartrate, syrette, dose 8, 9 
Mosquitoes, Anapheline 79 
Mumps, symptoms and treatment of 78 
Mustard gas, liquid 62 
Self-decontamination of 62 
Naval: 
Hospitals 105, 106 
Medical supply depots 2 
Vessels, requirements relating to quarantine 131, 132 
Nembutal, poisoning by 58 
Nervous system, diseases of 92 
Nest of kin, notification of 11 
Nitric acid, poisoning by 56 
Nitrogen mustard gas, liquid, self-decontamination of 63 
Notification of next of kin 112 
Nursing 73 
Nux vomica, poisoning by 57 
Obstructions, intestinal, acute 85, 86 
Oil, mineral v 8 
Ointment; 
Amyl Nitrite 6, 61 
Boric acid 9 
Butyn, ophthalmic, 2% 6 
Copper sulfate solution 6, 61 
Protective, S-461 6, 61,62, 63 
Protective, S-330 6,61,62,63 
Protective, BAL 6, 61, 62, 63 
Sulphur 9 
Yellow oxide of mercury 9 
Zinc oxide 9 
Opium, poisoning by 57 
Paraphimosis 101 
Paregoric, poisoning by 57 
Paris green, poisoning by 57 
Personal anti-gas equipment 64 
Personal cleanliness 117,118 
Personal hygiene 117,118 
Pet olatum, liquid 8 
Petrolatum, white 10 166 
INDEX 
Phenacetin 9 
Phenobarbital, poisoning by 9 
Phenol, poisoning by 56 
Phimosis 101 
Physical disinfectants 148,149 
Pillow splint 34 
Plague ; 80 
Pneumonia, symptoms and treatment of 83 
Page 
Poisoning by: 
Alkalis 57 
Arsenic 57 
Barbital (veronal) 58 
Benzine 57 
Bichloride of mercury 56 
Carbon monoxide 58 
Chloral hydrate 58 
Food 89 
Gasoline 57 
Heroin 57 
Iodine 58 
Hydrochloric acid 56 
Laudanum 57 
Luminal 58 
Lye 57 
Morphine 57 
Naphtha 57 
Nembutal 58 
Nitric acid 56 
Nux vomica 57 
Opium 57 
Paregoric 57 
Paris green 57 
Ptomaines 89 
Rough-on-rats 57 
Strong acids 56 
Strychnine 57 
Sulphonal 58 
Sulphuric acid 56 
Trinitrotoluene * 57 
Unknown poison 56 
Wood alcohol 57 
Gas, fumes, resuscitation from 49 
Prevention of 56 
Poisons 56 
Ports, foreign and insular, quarantine requirements 127 
Postmortem 110 
Pratique 135 
Pressure points 16 
Preventive medicine 119 
Health records 119 
Prevention of infection 119 
Prophylactic tubes.......... 9 INDEX 
167 
Prophylaxis, venereal 97 
Protargol 9 
Protective ointment: 
BAD 6,61,62,63 
S-330 6,61,62,63 
S-461 6,61,62,63 
Ptomaines, poisoning by 89 
Public Health Service Hospitals 105, 106 
Page 
Quarantine: 
Anthrax 147 
Bill of health 133, 134, 135 
Cholera 136, 137, 138 
Detention, naval vessels, requirements relating to 131, 132 
Leprosy 146,147 
Maritime 125 
Measures, special 136 
Navy Regulations applying 130 
Plague 80, 141, 142, 143, 144 
Requirements at foreign and insular ports 127 
Requirements at sea 128 
Requirements at U. S. Port 130 
Smallpox 144, 145 
Typhus Fever 145, 146 
Vessels, leaving foreign ports 127, 128 
Yellow fever 81, 138, 139,140 
Quinine: 
Dose, suppressive schedule 10 
Dose, treatment schedule 10 
Sulphate 10 
Rabid animal, bite 54 
Suspected animal 54 
Rash, skin 69 
Description of 69 
Rat: 
Extermination 142, 143 
Guards 143 
Respiratory tract, diseases of 82 
Resuscitation: 
From: 
Drowning 49 
Electric shock 49 
Gas fume poisoning... 49 
Method 49 
Requisitions: 
For medical stores 2 
Rib, fracture of 31 
Rikettsia prowazeki 145 
Ringworm: 
“Athlete’s foot” 93 
“Barber’s itch” 93 
“Dhobie itch” 93 
“Jock strap itch” 93 168 
INDEX 
Symptoms and treatment of 
Rough-on-rats . 
Rupture 
Sait ZZ"Z". ■;■■■■ * 10 
In heat cramps jq 
Sanitary precautions j2Q 128 
Scabies 92 
Scalds 27 
Scarlet fever, symptoms and treatment of 77 
Schafer method of artificial respiration 49 
Scorpion bites 22 S3 
Screening smokes ’ 
Seasickness 
Self-aid 2g 
Self-decontamination: 
Lewisite gas, liquid g3 
Mixed blister gases £3 
Mustard gas, liquid 62 
Nitrogen mustard gas, liquid 63 
Seven years’itch 92 
Sewage, disposal of J22 
Shipment of remains U2 113 
Shipwreck survivor, first-aid treatment of ’ 40 
Shock 
Symptoms j a 
Treatment <4 
Silver protein, mild 7 jqq 
Silver protein, strong 9’ jqq 
Skin diseases 92 
Skull, fracture of 33 
Sling, arm, application 39 
Smallpox, symptoms and treatment of 74 75 
Smokes, screening 60 
Snake bites 34 
Soap liniment....*. jq 
Sodium bicarbonate jq 
Anti-acid jq 
Eyewash jq 
Heartburn jq 
Sodium salicylate jq 
Analgesia 10 I 
Anti-rheumatic jq 
Sore throat, symptoms and treatment of 83 
Spanish windlass jg 
Spatchela jj 
Special diseases 67 
Spider bites 39 33 
Spine, fracture of 33 
Splint: 
Fixed traction 28 29 30 
Improvised 33 
Improvised rigid 28, 29, 30, 33 INDEX 
169 
Pillow, in fracture of leg 34 
Sites for application of 29 
Traction, bandage looping of, and applying to foot 30 
Wire mesh, in fracture of arm 33 
Sprains 25 
Spread of infection 70 
Disinfection 70 
Disinfesting 71 
Fumigation 71 
Prevention of 70 
Steam, disinfection by 148 
Sterilization of dressings and equipment 148 
Stomach and intestines, diseases of 86 
Stomach ulcer 86 
Stone: 
In gall bladder 86, 87 
In kidney 87 
Strichnine, poisoning by 57 
Stricture of urethra 101 
Stroke: 
Heat 47,48 
Sun 47,48 
Stye 97 
Sulfadiazine 10, 19 
Sulfadiazine and related drugs 72 
Sulfanilamide 10, 19 
Sulfanilamide and related drugs 72 
Sulfathiazole 4, 100 
Sulphonal, poisoning by 58 
Sulphur ointment 9 
Sulphuric acid, poisoning by 56 
Sunburn 40,41 
Sun stroke 47, 48 
Supplies, medical and surgical 1, 2 
Requisitions for 2 
Supply depots, naval medical 2 
Suppressive schedule, Quinine, in Malaria 10 
Survival, on life boats and rafts, prolonging of 40 
Fish and bird flesh 44 
Solid food 43 
Survivors, shipwreck, first-aid treatment of 40 
Suture, surgical gut 11,12 
Swimming 123 
Swollen foreskin 101 
Swollen glands in groin 101 
Syphilis 101, 102 
Cause, symptoms, signs and treatment of 102 
Syrette, morphine 8, 9 
Syringe, p. pipette 12 
Systemic -diseases 82 
Tear gases 60 
Page 170 
INDEX 
Teeth, diseases of 97 
Toothache, description and treatment of 97 
Temperature, taking of 68 
Testicle, swollen 101 
The “horrors” 95,96 
Thermometer, clinical 4, 5, 68, 69 
Cleansing after use 69 
Thigh, fracture of 34 
TNT, poisoning by 57 
Tonsillitis (sore throat) symptoms and treatment of 83 
Toothache 97 
Tourniquet: 
Rubber 18 
Spanish windlass 18 
Web 18 
Transmission of disease 125,126 
Transportation of remains 111,112 
Treatment, burns 37, 38 
Gas, self-aid 58 
Infectious diseases 73 
Treatment schedule, Quinine in Malaria 10 
Trinitrotoleune, poisoning by 57 
Throat, sore 83 
Typhoid fever, symptoms and treatment of 90, 91 
Typhus fever 145 
Ulcer, duodenal, symptoms and treatment of 89, 90 
Ulcer, duodenal, perforated 86 
Ulcer, gastric, symptoms and treatment of 86 
Unconsciousness 96 
Under-water blast 38,39 
Undulant fever, symptoms and treatment of 80 
Units, medical 1 
Unknown poisons 56 
Urethra, stricture of 101 
Utensils and mess gear 120 
Vaseline 10 
Vector of disease 126 
Venereal diseases 99 
Chemical 99, 100 
Mechanical 99 
Prophylaxis 99 
Ventilation 121 
Vermin 93,94 
Veronal, poisoning by 58 
Vessels: 
Bill of health for 133,134,135 
Quarantine, leaving foreign ports 127,128 
Quarantine requirements at sea 128 
Quarantine requirements in U. S. ports 130 
Vomiting gases 62 
War gas, definition of 59 
Page INDEX 
171 
Water: 120 
Disinfection of 150 
How to ration 43 
In the body, conservation of 42 
Weather, protection against 41 
Wire mesh, for splints 12 
Wire mesh splint in fracture of arm 33 
Wounds: 19 
Abdominal 22,23 
By splinters 24 
Chest 22 
Cleansing of 20 
Eye (foreign bodies) 23 
Infected 21 
Symptoms 21 
Treatment 21 
Punctured 22 
Treatment of fresh wounds 19 
Yellow fever, symptoms and treatment of 81,82 
Transmitted by Aedes aegypta 81,82 
Yellow oxide of Mercury ointment 9 
Zinc oxide ointment 9 
Page 
fa 584577—1944.