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First Aid in Illness and Injury 
 
FIRST AID 
 
 ILLNESS AND INJURY 
 
 COMPRISED IN A SERIES OF CHAPTERS ON 
 
 THE HUMAN MACHINE 
 
 ITS STRUCTURE, ITS IMPLEMENTS OF REPAIR, AND 
 
 THE ACCIDENTS AND EMERGENCIES 
 
 TO WHICH IT IS LIABLE 
 
 JAMES E. PILCHER, M.D., Ph.D. 
 
 MAJOR AND BRIGADE SURGEON OF UNITED STATES VOLUNTEERS; CAPTAIN 
 IN THE MEDICAL DEPARTMENT OF THE UNITED STATES ARMY 
 
 SIXTH EDITION, REVISED 
 WITH 175 ILLUSTRATIONS 
 
 NEW YORK 
 
 CHARLES SCRIBNER'S SONS 
 
 1899 
 
v 
 
 6 i* 
 
 36315 
 
 COPYRIGHT, 1892, 1899, BY 
 CHARLES SCRIBNER'S SONS. 
 
 TWOeOPIES RECEIVED. 
 
 FEB 271899 
 
 
-v 
 
 I 
 
 PREFACE TO THE SIXTH EDITION 
 
 The Spanish War has afforded an opportunity for testing 
 the value of instruction in first aid, which had been introduced 
 into the United States army during the interval of peace 
 which had preceded the difficulties with the Spanish govern- 
 ment. The result was an entire confirmation of the predic- 
 tions of the most enthusiastic advocates of the plan. The 
 unstinted praise of officers who, previous to the war, were not 
 friendly to first aid, is most gratifying to its friends. To 
 many who had not had the advantage of previous instruction, 
 the first aid packet, with its pictured procedures, was a most 
 happy help ; while those who had previously been taught first 
 aid methods were able to apply them with the greatest suc- 
 cess. Siboney, El Caney, and Santiago mark a new era in 
 military first aid. 
 
 The contrast displayed between the work of the hospital 
 corps men, who had been trained prior to the war, and those 
 who came newly into the work, albeit with the best of inten- 
 tions and the most earnest desire to succeed, still further 
 emphasized the value of first aid study ; and it is hoped that 
 in view of these facts the more general extension of first aid 
 in civil as well as military circles may still further increase the 
 number of trained men in the event of other hostilities. 
 
 In the hope that this book may contribute to further so 
 desirable an end, a number of changes have been made in the 
 
IV PREFACE TO THE SIXTH EDITION 
 
 present edition, with the purpose of embodying in it the les- 
 sons of recent events, and bringing it fully up to date. In 
 this connection, careful consideration has been given to all 
 recent contributions to the subject, and the results of later 
 progress have been fully incorporated in the text. 
 
 January, 1899. 
 
PREFACE TO THE FOURTH EDITION 
 
 The exhaustion of three editions of this work is a most 
 gratifying indication of the rapid extension of First Aid study. 
 Signs of progress are becoming apparent in many directions. 
 The number of first aid classes formed in civil life is con- 
 tinually enlarging ; much interest in the subject has latterly 
 been displayed in railway circles ; the army has recently 
 recognized the increased necessity for early aid to the 
 wounded, imposed by the enormous development of destruc- 
 tive power in modern ordnance, by the inauguration of a 
 system of first aid instruction, which will enable every soldier 
 in the service to apply temporary emergency treatment either 
 to himself or to his comrade ; and the energetic and intel- 
 ligent labors of many medical officers in the state forces have 
 given birth in those organizations to an era of promptness 
 and efficiency in caring for the disabled such as has never 
 been known before. 
 
 It is gratifying also to learn that a sentiment is gaining 
 ground in favor of first aid instruction in schools and col- 
 leges. The substitution of practical work upon a foundation 
 of anatomy and physiology, instead of the naked facts per- 
 taining to those branches of knowledge ordinarily taught, 
 
VI PREFACE TO THE FOURTH EDITION 
 
 meets with much favor upon the part of students, while the 
 increased practical value of the information acquired renders 
 the study appreciably more useful. * * * * 
 
 February, 1897. 
 
PREFACE TO THE FIRST EDITION 
 
 The importance of a general knowledge of the steps to be 
 taken immediately in order to prevent serious consequences 
 from accident or injury is now everywhere recognized. In 
 the preparation of this contribution to the literature of the 
 subject, three objects have been kept in view: I. To strip 
 the subject as far as possible of technicality. 2. To avoid 
 dwelling upon procedures requiring medical experience for 
 their application. 3. To make a distinction between essential 
 points and details, which, while valuable, might be omitted 
 without damage — accomplishing this by stating the impor- 
 tant facts in large and the accessory points in small type. 
 
 While it has been the author's aim to produce a text-book 
 for civilian and military first-aid classes, he has also sought 
 to provide a manual for quick reference in the emergencies, 
 which arise not only before the soldier on detached service, 
 the explorer or hunter in sparsely peopled districts, and the 
 dweller at a distance from medical service, but in the quiet 
 household, the crowded factory, the overflowing streets, and 
 everywhere that work is done and lives are lived ; for wherever 
 humanity exists, the means of learning how to stay the 
 arrival of impending death and how to afford relief to the 
 suffering cannot fail to be of advantage. 
 
Vlll PREFACE TO FIRST EDITION 
 
 In the effort to cover the ground as completely as possible, 
 all available works bearing upon the subject have been exam- 
 ined with great care. While it is impracticable to acknowl- 
 edge in detail the assistance derived from so many sources — 
 save, perhaps, Holders Osteology, Esniarc/i's Surgeon's Hand- 
 book, and the U. S. Arjny Manual of Drill for the Hospital 
 Corps, which is reprinted entire, with original illustrations, in 
 connection with carrying the disabled — the author gladly 
 takes this opportunity of acknowledging in general his indebt- 
 edness to his many co-workers in teaching early aid in illness 
 and injury, whose writings have been both suggestive and 
 inspiring to him. 
 
CONTENTS 
 
 Part I. —THE CONSTRUCTION OF THE HUMAN 
 MACHINE 
 
 Chapter I. The Covering — the Skin 
 
 PAGE 
 
 Its functions; its composition ; its appendages 3 
 
 Chapter II. The Padding — the Fat 
 
 Its functions ; its varieties ; its appearance in the body 5 
 
 Chapter III. The Framework — the Bones 
 
 Their function ; their composition ; their structure ; the skeleton ; 
 their varieties ; the skull ; the teeth ; the spinal column ; the 
 thorax; the shoulder; the arm ; the hand ; the pelvis; the leg; 
 the foot 6 
 
 Chapter IV. The Hinges — the Joints 
 
 Their function ; their varieties ; their composition ; ligaments ; 
 synovial membrane ; cartilage 25 
 
 Chapter V. The Moving Apparatus — the 
 Muscles 
 
 Their function ; their composition ; their action ; the motions pro- 
 duced ; voluntary muscles ; involuntary muscles ; their forms ; 
 
 their attachments ; tendons ; the individual muscles 29 
 
 ix 
 
CONTENTS 
 
 Chapter VI. The Central Power — the Brain 
 and Nerves 
 
 PAGE 
 
 Its functions ; its divisions ; cranial nerves ; spinal nerves ; motor 
 nerves ; sensory nerves ; nerve and brain substance ; the parts 
 of the brain; its delicacy; the spinal cord; the sympathetic 
 nerves 36 
 
 Chapter VII. The Repair Apparatus — the 
 Blood and its Circulation 
 
 The function of the blood ; its composition ; the heart ; its compo- 
 sition ; the blood-vessels ; the arteries ; the capillaries ; the 
 veins ; the circulation ; the pulse ; the location Of the indi- 
 vidual arteries ; the situation of the individual veins ; blood 
 glands 46 
 
 Chapter VIII. The Speaking and Breathing 
 Apparatus — the Larynx and the Lungs 
 
 Its composition; the pharynx; the epiglottis ; Adam's apple; the 
 vocal cords ; the windpipe ; the bronchial tubes ; the lungs ; 
 breathing ; the effect of breathing on life 64 
 
 Chapter IX. The Digestive Apparatus — the 
 Stomach and Bowels 
 
 Its function; the forms in which food is absorbed; chewing; 
 saliva; the gullet; the stomach; the gastric juice ; the bowels ; 
 the liver ; the pancreas or sweetbread ; the process of digestion 70 
 
 Chapter X. The Waste Removers— the Ex- 
 cretory Apparatus 
 
 Their function ; the skin ; the lungs ; the rectum or lower bowel ; 
 
 the kidneys; the bladder 76 
 
CONTENTS XI 
 
 Chapter XI. The Perceptive Apparatus — the 
 Senses 
 
 PAGE 
 
 Touch; taste; the tongue; smell; the nose; hearing; the ear; 
 
 sight; the eye 79 
 
 Part II.— THE IMPLEMENTS OF REPAIR 
 
 Chapter XII. Germs, their Action and its 
 Control 
 
 Micro-organisms ; their agency in producing disease and contami- 
 nating wounds ; germicides ; antiseptics ; cleanliness ; individ- 
 ual antiseptic agents 87 
 
 Chapter XIII. Knots and Bandages 
 
 The granny ; the reef knot , the surgeon's knot ; the clove hitch ; 
 bandages ; the triangular bandage ; the narrow arm-sling ; the 
 broad arm-sling; the large arm-sling; the triangular bandage 
 as applied to various parts ; the square bandage ; the four- 
 tailed bandage ; the roller bandage — sizes and rules for its 
 application; individual uses of the roller; the double-headed 
 roller 90 
 
 Chapter XIV. Dressings and Applications 
 
 The compress; antiseptic gauze; other materials; protective 
 applications ; the first dressing-packet ; fixative applications ; 
 plasters ; emollient applications ; poultices ; moist fomenta- 
 tions ; dry fomentations ; counter-irritants; mustard-plaster; 
 spice-plaster 107 
 
 Part III. — ACCIDENTS AND EMERGENCIES 
 
 Chapter XV. How to Act at First 
 
 Keep cool ; be prompt and quiet ; summon a doctor; keep crowds 
 back, and give patient air; observe situation and surround- 
 ings; place patient in comfortable position; remove tight 
 clothing; be careful about stimulants; method of examina- 
 tion; indications of diseases; feigning ng 
 
Xii CONTENTS 
 
 Chapter XVI. Bruises, Burns, and Freezing 
 
 PAGE 
 
 Bruises; definition; causes; symptoms; treatment; burns; defi- 
 nition ; causes ; varieties ; symptoms ; treatment ; sunburn ; 
 burning clothing ; freezing ; definition ; causes ; varieties ; 
 symptoms ; treatment ; chilblains . . . . : 125 
 
 Chapter XVII. Wounds 
 
 Definition ; varieties ; causes ; symptoms ; treatment ; possibilities 
 of surgery; cleanliness; drawing edges together; dressing; 
 torn wounds ; punctured wounds ; splinters ; fish-hooks and 
 arrows ; gunshot wounds ; wounds of the chest ; wounds of the 
 abdomen ; dangers of improper treatment ; process of healing ; 
 poisoned wounds 133 
 
 Chapter XVIII. Bleeding 
 
 Definition ; varieties ; causes ; symptoms ; treatment ; clotting; 
 blood-pressure ; bleeding from arteries ; twisting ; tying ; po- 
 sition ; pressure; ligature of limbs; tourniquets; treatment of 
 bleeding from individual arteries in detail ; bleeding from veins ; 
 direct pressure in the wound; pressure below wound; eleva- 
 tion ; bleeding from capillaries ; hot water ; pressure ; styptics ; 
 spitting of blood; from the nose; from the mouth; from the 
 throat ; from the lungs ; nose-bleed ; internal bleeding in gen- 
 eral ; secondary bleeding ; special susceptibility to bleeding . 145 
 
 Chapter XIX. Sprains and Dislocations 
 
 Sprains ; definition ; causes ; symptoms ; treatment ; bones out of 
 joint; definition; causes; symptoms; treatment; the fingers; 
 the lower jaw ; the shoulder 168 
 
 Chapter XX. Broken Bones 
 
 Definition ; varieties ; causes ; symptoms ; treatment ; splints ; 
 slings ; fractures of the skull ; fractures of the upper extremity ; 
 fractures of the chest and spine ; fractures of the lower extremity 172 
 
 Chapter XXI. Foreign Bodies 
 In the eye; in the ear; in the nose; in the throat — choking . . 192 
 
CONTENTS Xlii 
 
 Chapter XXII. Fainting 
 
 PAGE 
 
 Unconsciousness in general ; fainting ; shock ; stunning ; compres- 
 sion of the brain ; apoplexy ; drunkenness ; sunstroke ; insen- 
 sibility from poisoning ; insensibility from freezing 196 
 
 Chapter XXIII. Fits 
 
 Epileptic fits ; hysterics ; convulsions from kidney disease ; chil- 
 dren's fitS o . . . . 211 
 
 Chapter XXIV. Smothering 
 
 Definition ; causes ; restoring the breathing — artificial respiration ; 
 Sylvester's method ; Marshall Hall's method ; Howard's meth- 
 od ; drowning ; definition ; causes ; symptoms ; treatment ; 
 Satterthwaite's method ; rescuing the drowning ; breaking 
 through the ice; smothering by gases; smothering by press- 
 ure on the chest ; smothering by strangling or hanging . . . 214 
 
 Chapter XXV. Poisons 
 
 Definition ; varieties ; symptoms; treatment; emetics; poison ivy, 
 oak, sumach ; poisoned wounds ; dog bites ; snake bites ; in- 
 sect stings 226 
 
 Chapter XXVI. Death 
 
 Definition ; causes ; proofs 234 
 
 Chapter XXVII. The Emergencies of the 
 Battle-field 
 
 Provisions for treatment ; medical officers ; company bearers ; hos- 
 pital corps ; hospital stewards ; acting hospital stewards ; uni- 
 forms ; equipment ; organization for national guard ; articles 
 of Geneva Convention ; work on the line of battle ; at the first 
 dressing stations ; at the ambulance station ; the field hospital ; 
 permanent hospitals 236 
 
XIV CONTENTS 
 
 Chapter XXVIII. Carrying the Disabled 
 
 PAGE 
 
 The U. S. Army litter ; necessity for definite system ; U. S. Army 
 system : forming the detachment ; alignments ; marchings with- 
 out the litter; rests; the litter and sling; manual of the litter; 
 marchings with the litter; the loaded litter; position of 
 patient on litter ; carrying litter past obstacles and over stairs ; 
 loading with reduced numbers ; improvisation of litters ; car- 
 rying by one bearer ; carrying by two bearers ; the injured on 
 horseback ; the travois ; two-horse litter ; carrying by ambu- 
 lance ; carrying by ordinary wagons ; inspection and muster of 
 hospital corps; positions on the march; hospital corps bugle 
 call 244 
 
 Part IV. — THE CARE OF THE HUMAN MACHINE 
 Chapter XXIX. Sanitary Suggestions 
 
 Dwellings; ventilation; disinfection; heat; corrosive sublimate; 
 chloride of lime ; sulphur ; deodorization ; cleanliness ; cloth- 
 ing ; chafing ; foot-soreness ; food 305 
 
 INDEX 315 
 
Part I 
 
 THE CONSTRUCTION OF THE HUMAN 
 MACHINE 
 
Part I 
 
 THE CONSTRUCTION OF THE HUMAN 
 MACHINE 
 
 The body of man is a machine of most complicated 
 structure, containing thousands of distinct pieces and 
 many different varieties of materials. For practical pur- 
 poses it may be considered in eleven groups, it being 
 understood that it is designed not to give a complete 
 account of them, but merely to convey such a general 
 idea of the various parts as may be requisite for under- 
 standing the means of staying danger from the emergen- 
 cies of illness and injury. The eleven groups are : 
 
 i. The Covering — the skin. 
 
 2. The Padding — the fat. 
 
 3. The Framework — the bones. 
 
 4. The Hinges — the joints. 
 
 5. The Moving Apparatus — the muscles. 
 
 6. The Central Power — the brain and nerves. 
 
 7. The Repair Apparatus — the blood-vessels. 
 
 8. The Speaking and Breathing Apparatus — the 
 
 larynx and lungs. 
 
 9. The Digestive Apparatus — the stomach and bow- 
 
 els, 
 to. The Waste Removers — the excretory apparatus 
 11. The Perceptive Apparatus — the senses. 
 
CHAPTER I 
 
 THE COVERING -THE SKIN 
 
 The first structure forms a covering for all the others. It 
 may be compared with the sacking of which a bag is com- 
 posed, which covers and protects the articles stored within it. 
 As a rip or tear in the sacking exposes the contents of the 
 bag to damage, so a cut or laceration of the skin subjects 
 the structures underlying it to injury. In it terminate many 
 of the nerves of sensation, and it is therefore a very important 
 organ of touch. It is, moreover, a very efficient organ of 
 excretion of fluid and gaseous waste products, throwing off 
 under ordinary circumstances as much as two and a half 
 pounds of fluid during a day. Those of its functions then 
 which come under our observation are (i) enclosure of con- 
 tained parts, (2) protection of subjacent organs, (3) the loca- 
 tion of the sense of touch, and (4) excretion of certain waste 
 products. 
 
 The skin, simple though it seems to be, is a very complicated struc- 
 ture, and not only contains many forms of the elements composing it 
 but presents in its substance a number of organs of great importance to 
 the maintenance of life and health. It is ordinarily considered in three 
 layers, (1) the epidermis or cuticle, (2) the dermis or cutis, and (3) the 
 subcutaneous cellular tissue. 
 
 The epidermis or " scarf-skin " consists of successive layers of scaly 
 particles, which are flattened and dried cells. These cells are techni- 
 cally known as epithelium. They cover all surfaces of the body, both 
 external and internal, lining alike the skin, mucous membrane, and se- 
 rous membrane, and are of varying shapes. At some points, but a 
 single layer of epithelial cells is found, while others present many. The 
 number of cells may also be abnormally increased as in the callous 
 spots on the hands of men engaged in heavy manual labor, or in warts 
 which are local overgrowths of the epithelium forming the epidermis. 
 The epidermis is well shown in a blister where it is elevated by a watery 
 effusion. 
 
 3 
 
CONSTRUCTION OF THE HUMAN MACHINE 
 
 The dermis or " true skin " is a tissue composed of closely interwoven 
 strong fibres with an admixture of elastic fibres, containing in its meshes 
 many vessels, nerves, and minute glands. Blood-vessels are very abun- 
 dant here, and hemorrhage results from the slightest incision. Here 
 also lie the ends of the nerves from which is derived the sense of touch. 
 The subcutaneous cellular tissue, from its close relation to the 
 skin, may properly be considered as a part of it; its composition is 
 
 practically the same, the apparent 
 difference being caused by the 
 loose manner in which the fibrous 
 material is interwoven into a more 
 open fabric. Enclosed in its meshes 
 and spaces are found the origins 
 of many of the appendages of 
 the skin, together with numerous 
 masses of fat. 
 
 The appendages of the skin 
 are of two kinds, — modifications 
 of the epidermis, and excretory 
 glands. The hair and nails are, 
 like warts and callosities, a local 
 overgrowth of the epidermic epi- 
 thelium, differing from them, how- 
 ever, in not being abnormal and 
 performing certain functions. 
 
 The sweat and sebaceous glands 
 are organs of excretion located in 
 the subcutaneous cellular tissue, 
 and opening externally by mi- 
 croscopic twisted ducts passing 
 through both the dermis and the 
 epidermis. The former are the source of perspiration, while the latter 
 produce a yellow unctuous matter somewhat resembling suet, the func- 
 tion of which is the lubrication of the surface of the body. 
 
 When this sebaceous matter collects and hardens in the unclosed 
 ducts, forming a sort of plug, the external end of which is black, we 
 have the "black heads," "worms," or "grubs," very commonly seen in 
 the skin of the face. These plugs of sebaceous matter, which assume, 
 when squeezed out, a worm-like form, with a head formed by the outer 
 end blackened probably by dust — are not infrequently supposed by 
 the ignorant to be actual worms. 
 
 If, however, the external orifice of the duct be closed by any acci- 
 dent, the sebaceous matter continues to collect behind the obstruction, 
 distending the duct in all directions until a tumor known as a wen, 
 sometimes of considerable size, is formed. They are quite frequently 
 
 Fig. I. — Section of skin, showing its 
 layers and the origin of its appen- 
 dages. 
 
THE PADDING THE FAT 5 
 
 found in the scalp, where they produce a peculiar knobby appear- 
 ance. 
 
 The excretion of waste products, particularly by the sweat glands, is 
 essential to life, and its diminution produces poisoning of the system, as 
 is seen in the dry skin of fevers, while its entire cessation would produce 
 early death. 
 
 CHAPTER II 
 THE PADDING — THE FAT 
 
 In packing into the same receptacle articles of various 
 shapes and sizes, some tender like ripe fruit, and others hard 
 and stiff like blocks of wood, some sort of padding or filling 
 is necessary to prevent mutual injury. This function is per- 
 formed in the bodies of man and animals by the fat which 
 fills in the interstices between the various parts. 
 
 In addition to this, the fat serves as a reserve of nourish- 
 ment upon which the system may draw in case of lack of 
 ordinary means of nutrition. This function is familiar in 
 cases of illness ; when the appetite is poor and but little food 
 is absorbed into the system, the sick one grows thin because 
 the small quantity of food taken is not sufficient to sustain 
 him, and he is compelled to draw upon the reserve of fat 
 stored up in the interstices of his system. 
 
 Perhaps the most important function of the fat, however, 
 is the maintenance and retention of the animal heat. Every 
 one has observed that a stout person requires less clothing 
 than a thin one, and this is due to the greater amount of fat 
 underlying his skin. 
 
 While this constituent has its advantages, it may also be 
 the source of no little inconvenience in certain cases : it may 
 choke up certain organs so as to interfere with their action, 
 and, by mingling with the tissues of other organs, render 
 them weak and inefficient ; it may also obscure adjacent tis- 
 sues, as is seen in the case of a wounded artery in a stout 
 person, where the fat renders it difficult to find the bleeding 
 
CONSTRUCTION OF THE HUMAN MACHINE 
 
 vessel above the wound and interferes with proper compres- 
 sion when it is found. 
 
 There are three principal fats in the body, — stearin, palmitin, and 
 olein. These all consist of glycerine, which is an alcohol, in combina- 
 tion with a fatty acid, stearic, palmitic, or oleic, as the case may be. 
 In the manufacture of soap, these acids set free the glycerine and 
 combine instead with an alkali. 
 
 Fat is ordinarily seen in the form of adi- 
 pose tissue, which is formed by masses of 
 minute vesicles consisting of an exceedingly 
 delicate membrane filled with fatty matter and 
 having an average diameter of zfo of an inch. 
 These vesicles are grouped together and 
 retained in place mainly by microscopic 
 blood-vessels. The amount of adipose tissue 
 in the body is subject to great variations ac- 
 cording to its location, being entirely absent, 
 for instance, in the brain and in the eyelids, 
 while it is present in great abundance about 
 the kidneys and other parts of the ab- 
 domen. 
 
 Fig. 2. — Adipose tissue 
 magnified. 
 
 CHAPTER III 
 
 THE FRAMEWORK — THE BONES 
 
 The bones form the framework about which are grouped 
 the soft parts of which the body is otherwise composed. 
 They also are designed for the protection of vital centres, as 
 the brain is protected by the skull, and the heart and lungs 
 are guarded from injury by the thorax. They consist of a 
 hard, brittle substance, liable to become broken by sudden 
 severe violence, but of sufficient strength to sustain any 
 strain that may ordinarily be applied to them. 
 
 Bones are composed of one-third animal matter, principally gelatin 
 and blood-vessels, and two-thirds mineral matter, carbonate, phosphate, 
 and fluoride of lime, soda, common salt, and phosphate of magnesia. 
 
 The mineral constituents of bone may be dissolved by chemica. 
 action, leaving behind only the gelatinous animal matter while still re- 
 
THE FRAMEWORK THE BONES 
 
 taining the original shape and dimensions of the bone. It may then 
 be bent freely in all directions, and it is a common class-room ex- 
 periment to tie into a knot a long bone so 
 prepared. Similarly, the animal matter may 
 be extracted by calcining or burning the 
 bone. The proportion of animal to mineral 
 matter is constant in the bones of the dead 
 as well as the living, and it was this charac- 
 teristic which enabled Gimbernat to make 
 soup from a mastodon's tooth, and Buckland 
 to obtain the body of a broth from fossil 
 hyaena bones. 
 
 The presence of animal matter contrib- 
 utes to the toughness and elasticity of bone. 
 In children this is particularly apparent — 
 the latter quality rendering fractures far less Fig 3. -Bone from which 
 n J ° all mineral matter has been 
 
 frequent in proportion to the frequency of removed, tied in a knot, 
 accidents, while the former accounts for the 
 
 frequency of a mere bend in a child's bone where that of an adult 
 would be broken. This characteristic is very notable in some of the 
 lower animals. Arab children are said to make excellent bows of the 
 ribs of camels, while the elasticity of the clavicle or " wish-bone " 01 
 fowls is familiar to every one. 
 
 Microscopically, bone consists of concentric layers called lamellae, 
 arranged about the course of a vascular or Haversian canal. Through- 
 out these lamellae are minute 
 cavities called lacunae, each 
 containing a bone cell or osteo- 
 blast, which influences the nutri- 
 tive processes going on in the 
 neighboring bone ; and diverg- 
 ing from these cavities in every 
 direction are minute canals or 
 canaliculi, by which the lacunae 
 are connected with one another 
 and with the Haversian canals, 
 providing free intercommunica- 
 tion throughout the bone sub- 
 stance for blood and lymphatic 
 vessels. 
 These elements unite to form two kinds of bone substance, — the 
 ivory-like compact substance seen for instance in the shaft of a long 
 bone, and the spongy cancellous substance seen in its extremities. 
 
 Both the structure and composition of bone are so arranged as to 
 endue it with great strength, particularly remarkable as compared with 
 
 The structure of bone 
 magnified. 
 
8 CONSTRUCTION OF THE HUMAN MACHINE 
 
 other substances. It has nearly four times the resisting power of lead 
 and three times that of ash wood. A cubic inch of bone will support 
 5000 pounds' weight. Moreover, the structure of bone is such as to 
 give it this strength with but little expenditure of materials. 
 
 Bones are covered externally by the periosteum, a fibrous membrane 
 in which run many blood-vessels, branching in all directions and sup- 
 plying nutriment to the bone. Cavities in bone are similarly lined with 
 a delicate membrane, the endosteum, and filled with marrow. Both 
 the periosteum and the endosteum contain many bone-forming cells, 
 and fulfil a very important function in the formation, repair, and repro- 
 duction of bone. 
 
 The bones in the human body are two hundred in number, 
 not counting the teeth and the small bones in the ears and 
 in certain of the tendons. Taken together they constitute the 
 skeleton, which weighs from twelve to fourteen pounds, the 
 right side usually being a little heavier than the left. The 
 points where the bones are joined to one another are called 
 joints, and at these points a certain amount of motion is in- 
 variably present, varying in extent from the extreme degree 
 permitted at the shoulder to the almost imperceptible amount 
 present in the pelvis. To this provision of the economy is 
 due the ability to perform most of the functions of life. The 
 condition of an individual with immovable joints, making the 
 skeleton practically a single bone, would be deplorable in 
 the extreme. He might live by the use of liquid food, but 
 he could neither chew nor talk. He could not stand, because 
 a certain amount of joint motion is necessary for the main- 
 tenance of an erect posture. Continued disuse would cause 
 his muscles to waste away, and he would be compelled to drag 
 out a miserable existence, looking forward to death as a 
 bearer of freedom to his imprisoned life. 
 
 Bones are classed as long, short, flat, and irregular. A 
 glance at the skeleton will emphasize the correctness of this 
 classification. The bones of the arms and legs will readily 
 be recognized as long bones. In the wrist and about the heel 
 ivill be seen short bones. The shoulder-blade and the bones 
 of the cranium are flat bones-, while those composing the 
 spinal column are distinctly irregular bones. 
 
 The long bones serve as supports and levers for locomotion and lift- 
 ing. They consist of a shaft, or body, and two extremities, articulating, 
 
THE SPINAL COLUMN AND THE SKULL Q 
 
 or forming joints, with neighboring bones, and for this reason called 
 articular extremities. In addition, they present various projections, 
 called processes, which, it should be remarked, are found in most other 
 bones ; they are mostly designed to afford additional surface for the 
 attachment of muscles. 
 
 The short bones are situated at points where strength and limited 
 motion is desired. 
 
 The fiat bones are designed to protect important viscera, such as the 
 brain, or to afford extensive surfaces for the attachment of muscles. 
 
 In addition to the bones which are invariably present in the skeleton, 
 are certain adventitious bones called Wormian bones and sesamoid 
 bones. The former are irregular bits of bone, developed at points of 
 the skull covered in infancy by membrane, the fontamelles, or " soft 
 spots." Sesamoid bones are developed in the course of tendons, and 
 contribute additional leverage to the muscles which terminate in these 
 tendons. They are found in the tendons of the hand and foot. The 
 patella, or " knee cap," is, in fact, a sesamoid bone, although, on 
 account of its size, it is usually considered as a part of the skeleton 
 proper. 
 
 In the development of the body from the ovum, the first 
 trace of the future skeleton, and almost the first evidence of 
 the future individual, is a minute cellular cord called the noto- 
 chord or corda dorsalis. The notochord occupies the place 
 in which from this time the spine or vertebral column begins 
 to be formed. Here appear ultimately the skull and the 
 twenty-six bones forming the spinal column. 
 
 The skull is the upper expansion of the spinal column. Its 
 analogy to other parts of the spinal column may be very 
 clearly traced. It is designed primarily to contain and pro- 
 tect the brain, and its structure is marvellously adapted to 
 these purposes. The skull is properly considered in two 
 parts, the cranium, or brain-case, formed by eight bones, and 
 the face, formed by fourteen bones, making a total of twenty- 
 two bones, or a little more than one-tenth the number in the 
 whole body. 
 
 The cranium is a dome-like structure, the arching roof of 
 which is so arranged as to decompose and disperse forces 
 striking upon it, thus preventing their action upon the delicate 
 brain substance contained in it. Were it not for this fortunate 
 provision, injuries to the brain would occur much more fre- 
 quently than they do. 
 
10 CONSTRUCTION OF THE HUMAN MACHINE 
 
 Fig. 5. — The Skeleton, and its Relation to the Contour of the Body. 
 
THE BONES OF THE SKULL 
 
 The bones of the cranium are : one frontal, forming the forehead 
 and the arches over the eyes ; two parietal, covering the top and sides 
 of the head, and separated from one another at the apex of the cranial 
 vault; two temporal, occupying the temples on either side, and con- 
 taining the organs of 
 hearing; one occipital, 
 occupying the lower back 
 part of the cranium, 
 which is called the occi- 
 put, articulating with the 
 spinal column, and con- 
 taining the large aper- 
 ture, or foramen mag- 
 num, through which the 
 spinal cord passes to 
 join the brain ; one eth- 
 moid, occupying the low- 
 er anterior part of the 
 cranium, and forming a 
 part of the posterior 
 chambers of the nose ; 
 and one sphenoid, lying 
 at the bottom of the Flg ' 6 * 
 
 cranium, wedged in between the other cranial bones; it derives its 
 name from the Greek word meaning wedge, and forms the keystone 
 to the cranial dome. 
 
 The joints between the cranial bones are unlike those of the limbs, 
 and almost entirely preclude movements of the bones in the child, and 
 render them impossible in the adult. They consist of rows of tooth-like 
 processes, which fit into corresponding depressions in the margins of 
 the articulating bones, and are called sutures. There are eighteen of 
 these, that between the two parietals being called the sagittal or arrow 
 suture ; that between the frontal and parietals being called the coronal 
 or crown suture, that between the occipital and parietals being called 
 lambdoid, from its resemblance to the Greek letter lambda, A ; while 
 the others derive their names from the bones which they join. 
 
 In infants, at the corners of the parietal bones, there are points not 
 yet filled by bone, but covered by membrane. These are the "soft 
 spots," and are called fontanelles. There are six of them. The lar- 
 gest, the anterior fontanelle, lies just above the forehead, at the junction 
 of the sagittal with the parietal suture, and remains open until not later 
 than the second year; the posterior fontanelle lies at the back of the 
 head, at the junction of the sagittal and lambdoid sutures, and remains 
 not filled by bone for several months after birth. The other four lie 
 one before and one behind each ear. 
 
 •The skull. 
 
12 CONSTRUCTION OF THE HUMAN MACHINE 
 
 The bones of the cranium present an external and internal table or 
 layer of compact substance, with a layer of cancellous substance between 
 them, called the diploe. Channelled in various directions throughout 
 the diploe are many large and capacious veins, called the veins of the 
 diploe. The internal table of the skull is remarkable for its brittleness, 
 and for this reason is called the glass-like or vitreous table. Violence, 
 insufficient to affect the tougher outer table, may break the inner table, 
 so that a fracture of the inner face of a cranial bone may not be visible 
 externally, even at the point where the violence was received. 
 
 Hollowed out in each temporal bone is the cavity containing the 
 organs of hearing, — an exceedingly complicated structure, with three 
 chambers, three intrinsic bones, and many other important parts, to 
 which reference will be made in the chapter on The Senses. 
 
 The face owes its shape in a considerable degree to the 
 bones, which aid in giving it beauty or ugliness. They de- 
 termine the contour of the chin, the shape of the cheek, the 
 height of the forehead, the size of the eyes, and the character 
 of the nose. 
 
 They also contribute to the formation of a number of cavi- 
 ties, containing organs 01 the most vital importance to organ- 
 ized life. The orbits contain, on either side, the organs of 
 sight ; the nasal cavities are the site of the sense of smell ; 
 the mouth or buccal cavity is the location of the sense of 
 taste, and the first of the cavities in which the process of 
 digesting food occurs. 
 
 The bones of the face are : two superior maxillary, the upper jaw 
 bones ; two malar, the cheek bones ; two nasal, forming the foundation 
 of the nose; two lachrymal, thin plates filling an opening in the orbit; 
 two palate bones, attached to the rear of the superior maxillary, and 
 continuing the bony roof of the mouth ; two inferior turbinated bones, 
 forming the roof to the lower chamber of the nose; one vomer, shaped 
 like a ploughshare, and separating the lateral halves of the nose ; and 
 one inferior maxillary bone, the lower jaw bone. 
 
 The upper and lower jaws contain the teeth, the function 
 of which is the reduction of food to fragments in order to 
 permit the penetration of the digestive fluids. Every tooth 
 presents a crown, or body projecting above the gum ; a neck, 
 the constricted portion between the crown and the root ; and 
 the root, or fang set into the jaw bone. Each tooth also 
 contains a pulp cavity filled with tooth pulp. 
 
THE TEETH 
 
 13 
 
 The teeth are composed of four distinct structures. (1) The enamel 
 
 forms the outer covering of the crown, and consists of six-sided parallel 
 
 rods, about ^V of an inch in diameter. It 
 
 is the densest of all animal tissues and con- 
 tains 96.5 per cent of mineral matter, which 
 
 renders possible the use of the teeth in divid- 
 ing even very hard foods. (2) The dentine, 
 
 composing the greater part of the tooth, con- 
 sists of wavy branching tubes called dental 
 
 tubuli, about jJ^ of an inch in diameter and 
 
 embedded in a hard substance called the 
 
 inter-tubular tissue. (3) In the pulp cavity 
 
 lies the pulp, a soft cellular substance, very 
 
 freely supplied with blood-vessels and nerves, 
 
 which enter at the tip of the root. (4) The 
 
 cement, or crusta petrosa, consists of true 
 
 bone and forms the covering of the root of 
 
 the tooth. 
 
 The teeth appear in two crops : (1) the 
 
 deciduous or milk teeth, ten in each jaw, and 
 
 (2) the permanent teeth, sixteen in each jaw. 
 
 The four front teeth are provided with a 
 
 wedge-shaped crown and are adapted for 
 
 cutting food, whence they are called incisors: 
 
 they have but a single root. On either side of the incisors are the 
 
 canines, so called from their resemblance to those of the dog. They 
 
 are spear-shaped, and adapted for rending food, — an evidence of the 
 
 carnivorous phase of man : they also 
 have but one root. Those in the 
 upper jaw are vulgarly known as 
 " eye teeth " ; those in the lower 
 jaw, as " stomach teeth." On either 
 sides of these are two bicuspids or 
 premolars, generally with a single 
 root, and on either side of them 
 are two molars or "grinders," with 
 two or three roots. These teeth 
 have a more or less cubical crown, 
 the masticating surface of which is 
 ridged to admit of the trituration 
 or grinding of the food. The last 
 
 molars are known as the "wisdom teeth." The molars represent the 
 
 herbivorous phase of man. 
 
 At birth, the teeth have not yet appeared, and it is not until from the 
 
 fourth to the seventh month that the lower central incisors push their 
 
 Fig. 7. — Structure of 
 a tooth. 
 
 Fig. 8. — The teeth. 
 
14 CONSTRUCTION OF THE HUMAN MACHINE 
 
 way through the gums, and are followed during the first two and a half 
 years of life, in the order given, by the other incisors,, the first molars, 
 the canines, and the second molars. The eruption of the teeth through 
 the gums — "teething" — is commonly attended by more or less dis- 
 turbance of the system, varying from a slight indigestion to violent con- 
 vulsions. Where the trouble is sufficient to demand interference, a 
 slight cut in the gum over the coming tooth will relieve it. 
 
 During the years following their appearance, in sacs at the roots of 
 the deciduous teeth, a second set of teeth has been forming, which, as 
 they grow, press upon the deciduous roots until they cause their entire 
 absorption, leaving only the crowns, which are finally cast off, leaving 
 room for the new permanent teeth. The first permanent teeth to appear 
 are the first molars at the end of the sixth year, followed during the 
 next six or seven years, in the order given, by the incisors, the bicuspids, 
 the canines, and the second molars, while the appearance of the third 
 molars or wisdom teeth is delayed until the age of seventeen to twenty- 
 one years. 
 
 The spinal column or "backbone" con- 
 sists not of a single bone, but of a chain of 
 small bones called vertebrae so locked to- 
 gether that the degree of motion between 
 any two is limited, although that of the 
 entire column is considerable. This gives 
 it flexibility and permits the bending of the 
 body. The cartilages between the verte- 
 brae give it elasticity and prevent frequent 
 stunning. At the same time it possesses 
 great strength and firmness. It encloses 
 and protects the spinal cord, forms a basis 
 for the attachment of the muscles of the 
 trunk and for those which maintain the 
 body in the erect posture. Its bones 
 are not arranged in a straight line, but in 
 four gentle curves, which not only add 
 greatly to the beauty of the contour, but 
 very greatly increase its strength ; they also 
 i na i add to the elasticity of the spine and assist 
 in the formation of the cavities for the lodge- 
 ment of internal organs. 
 There are seven cervical vertebrae, which enter into the 
 
THE SPINAL COLUMN 1 5 
 
 neck ; twelve dorsal vertebrae,. which enter into the chest, and 
 from which spring the twelve ribs ; five lumbar vertebrae, 
 forming the framework of the loins; five sacral vertebrae, 
 which are fused into a single bone, the sacrum or "rump 
 bone," which forms the keystone of the pelvis ; and four coc- 
 cygeal vertebrae, also consolidated into a single bone, the 
 coccyx, which forms the human rudimentary tail, and receives 
 its name from its fancied resemblance to the beak of the 
 cuckoo : the spinal column then, formed by thirty-three ver- 
 tebrae, consists in reality of but twenty-six distinct bones. 
 The cervical, dorsal, and lumbar vertebrae are called true ver- 
 tebrae, and the sacral and coccygeal are called false vertebrae. 
 
 Each vertebra consists of a main portion like a segment of a solid 
 cylinder and called the body. From the back of this body spring two 
 plates which meet and form an arch, the vertebral arch, circumscribing 
 an aperture which is a segment of the spinal canal. It presents a num- 
 ber of projections called processes, the chief of which springs from the 
 posterior surface of the vertebral arch and is called the spinous process. 
 The lowest cervical vertebra — the seventh — has a noticeably long 
 spinous process, and for that reason is called the vertebra prominens. It 
 can easily be felt at the base of the neck. Indeed, with the exception of 
 those of the few upper vertebrae of the neck, the spinous processes of 
 all the vertebrae can readily be felt, particularly if the body be bent 
 forward and the arms drawn across the chest. Having identified the 
 vertebra prominens by feeling, the others can readily be recognized by 
 counting from it. It may be well to remark also that the seventh dorsal 
 vertebra lies on a level with the lower angle of the shoulder blades, 
 while the fourth lumbar vertebra is on a level with the highest point of 
 the hip bones. 
 
 Having become acquainted with the relations of the vertebrae to the 
 principal organs of the chest and belly, the knowledge of how to identify 
 the vertebrae renders it easy to discover what organs may probably have 
 been injured in case of a wound of the body. In connection with the 
 viscera (p. 143) will be found a table in which these relations are very 
 clearly stated. 
 
 The hunchback owes his hump to the fact that the bodies of certain 
 of his vertebrae have been worn away, rendering the curve of the back 
 more pronounced, so as to make a prominence of greater or less size. 
 
 Between the vertebrae are certain elastic discs called the intervertebral 
 cartilages, which act not only as buffers between the bones, but also as 
 jigaments to hold them together. These discs yield to weight and flat- 
 ten out to a slight extent ; even the weight of the head and body will 
 
l6 CONSTRUCTION OF THE HUMAN MACHINE 
 
 have some effect upon them, so that every person is shorter when he 
 retires at night than when he arises in the morning. They also yield 
 in any direction to adapt themselves to any desired attitude; this 
 yielding may become permanent and result in deformity, if a vicious 
 attitude be habitually maintained, as in the one-sided attitude some- 
 times assumed by the clerk who leans all day over his desk, or the 
 stoop seen in the farmer who constantly bows over hoe or plough in 
 his work. 
 
 The first two cervical vertebrae, called respectively the atlas and the 
 axis, are peculiar in that the atlas has no body, but is simply a ring of 
 bone moving about an upward extension of the body of the axis. It is 
 supposed that at first these vertebrae were like the others, but that in the 
 evolution of the skeleton, in order to permit greater mobility of the 
 head, the body of the first became fused with that of the second, form- 
 ing the upward projection known as the odontoid process of the axis, 
 and the first became the bony ring now known as the atlas, from its 
 supporting the head as the mythical Atlas was wont to balance the 
 earth on his shoulders. 
 
 The atlas is joined directly to the skull, and the spinal canal at this 
 point becomes continuous with the foramen magnum of the occipital 
 bone. 
 
 In front of the vertebrae is a small horseshoe-shaped bone not 
 attached to any other, called the hyoid 
 bone. It lies just above the larynx, 
 which may readily be felt in the neck, 
 the front of it being known as the " Ad- 
 am's apple." This bone is a very im- 
 portant part of the foundation of the 
 tongue, and also gives attachment to 
 the muscles which give the contour to 
 Fig. 10. — The hyoid bone. the chin. 
 
 The thorax is a bony cage designed to contain and protect 
 the heart and lungs. The foundation of the thorax is the 
 dorsal portion of the spinal column. Passing out from each 
 one of the dorsal vertebrae are the ribs, twelve on each side, 
 ten of which turn again to become united with the sternum 
 or " breast bone " in front by means of the costal cartilages, 
 thus taking the shape of a sickle. The twenty-four ribs 
 are known by their numbers on either side from top to bot- 
 tom, the upper rib on either side being the first rib, right 
 or left, etc. The eleventh and twelfth ribs, which are not 
 attached to the sternum, are called " floating ribs." 
 
BONES OF THE CHEST AND SHOULDER 
 
 17 
 
 Fig. II. — The thorax. 
 
 The sternum or " breast bone " is a flat bone from six to seven inches 
 long, which was compared by the ancients to a sword, and considered 
 
 in three pieces ; the upper they 
 called the manubrium or handle, 
 the middle and longest part is 
 called the mucro or blade, while 
 the third and smallest portion is 
 called the ensiform appendix or 
 sword-like appendage. 
 
 The costal cartilages, to which 
 reference will again be made under 
 the head of Cartilage, are tough, 
 elastic continuations of the ribs, con- 
 necting them with the sternum and 
 by their elasticity permitting move- 
 ments of the chest in breathing, 
 which would be impossible were 
 the ribs and sternum joined directly 
 together. This peculiarity will be fully considered in connection with 
 the subject of breathing. 
 
 The upper extremity consists of the shoulder, the arm, 
 the forearm, and the hand, 
 and is formed by the scapula, 
 the clavicle, the humerus, the 
 radius and ulna, the carpus, 
 and the bones of the hand. 
 The length of the upper ex- 
 tremities should be exactly 
 proportional to the height of 
 the person. When the arms 
 are outstretched in the same 
 horizontal line, the distance 
 between the tips of the mid- 
 dle fingers should be equal to 
 the height. 
 
 The shoulder is formed by 
 the scapula, the clavicle, and 
 the upper end of the hu- 
 merus. Fig. 12. — The shoulder blade. 
 
 The scapula or "shoulder blade" is a broad, triangular, flat bone, 
 which lies upon the upper back part of the thorax, covering the first 
 
l8 CONSTRUCTION OF THE HUMAN MACHINE 
 
 seven ribs. Its anterior surface is smooth and slightly concave, while 
 from its posterior surface springs a sloping ridge known as the spine, 
 the outer apex of which — the acromion — projects over the shouldej 
 joint to protect it and prevent the arm bone from slipping up. A1 
 the outer angle is found a shallow cup facing outward, — the glenoid 
 cavity, — which receives the rounded head of the arm bone. The scap- 
 ula also contributes largely to the strength of the thorax and affords an 
 
 extensive surface for the at- 
 tachment of many of the 
 powerful muscles of the up- 
 per extremity. 
 
 _. ,„ _, ,, , The clavicle, or "collar 
 
 Fig. 13. — The collar bone. , ,, ,. ,, 
 
 bone, so called from its re- 
 semblance to an ancient key, " clavis," is a long bone about six inches 
 in length, shaped like an italic letter s, and readily felt under the skin. 
 Extending in a horizontal line from the sternum to the 
 scapula, it acts as a prop to the shoulder, bracing it 
 upward, outward, and backward. This function is 
 very clearly seen in broken collar bone, when the 
 shoulder falls downward, inward, and forward. An- 
 other important function is the protection of the great 
 vessels of the upper extremity as they pass out of the 
 thorax into the arm, under the arch formed by the 
 outer curve of the clavicle. Pressure between the first 
 rib and the collar bone will discover the beating of 
 the artery, and, in case of an injury to the arm, bleed- 
 ing may be checked by pressing this vessel against 
 the first rib behind the clavicle. 
 
 The humerus or " arm bone " is a long bone with 
 a head, a shaft, and a broadly flattened lower ex- 
 tremity, extending from the shoulder to the elbow. 
 The rounded head fits into the socket formed by the 
 glenoid cavity of the shoulder blade. The shaft is 
 cylindrical and light; its junction with the head is 
 called the surgical neck, on account of the frequency 
 with which the bone is broken at this point. The 
 lower end of the bone spreads out flatly to form a 
 part of the hinge of the elbow. A projection on either 
 side of the bone can readily be felt in every elbow ; 
 these projections are the condyles, about which the 
 strong muscles of the forearm are attached. On the 
 anterior and posterior face, between the condyles, are 
 depressions for receiving the projections of the ulna, 
 the bone at the bottom of these cavities being ex- Fig. 14. — The hu- 
 tremely thin. It should be observed that the shoulder merus or arm bone. 
 
BONES OF THE ARM AND FOREARM 
 
 19 
 
 joint is a ball and socket joint and almost universal in its movements, 
 permitting the upper extremity to act in every direction. 
 
 The portion of the upper extremity between the elbow and the wrist 
 is called the forearm, and is formed by two parallel long bones, the 
 ulna and the radius. The ulna is the larger bone of the forearm, and 
 lies on the same side as the little finger. It receives its name from the 
 Greek word meaning elbow, because of its participation in that joint. It 
 does not enter into the wrist joint at all. The most peculiar feature of 
 the ulna is the hook-like olecranon process at its head, in front of 
 which the bone is hollowed out into the greater sigmoid cavity to receive 
 the cylindrical lower end of the humerus into a 
 hinge joint. This process is of the greatest impor- 
 tance ; it gives leverage to the great muscle which 
 enables the pugilist to " strike out " ; it prevents the 
 elbow from bending backward, and it protects the 
 joint in leaning or striking on the elbow. From 
 the front of the upper end of the ulna projects 
 another but less important process, the coronoid 
 process. The ulna terminates below in a blunt 
 projection, the styloid process, the prominence of 
 which can readily be felt and frequently seen in the 
 living wrist. 
 
 The radius receives its name from its resemblance 
 to the spoke of a wheel. It is a long bone, on the 
 same side of the wrist as the thumb, lighter than the 
 ulna, and, uniike that bone, is broader at the lower 
 end than at the upper. It enters but very slightly 
 into the elbow joint, and alone of the forearm bones 
 enters into the wrist. Both its ends rotate upon the 
 ulna, — a provision which enables the hand to be 
 turned palm upward or downward at will. The roll- 
 ing of the radius upon the ulna, to turn the palm 
 downward, is called pronation ; the reverse motion, 
 turning the palm upward, is called supination. The 
 lower end of the radius is broadened and hollowed 
 out to receive the wrist bones ; and on its inner face 
 is a projection, called the styloid process of the 
 radius, which can readily be felt in the living. The 
 lower end of the radius is very frequently broken by 
 persons falling upon the palms of the hands, or very violent pushing 
 with the palms. 
 
 It should be observed that the bones of the forearm do not lie in the 
 same line as the arm bone, but that they form an obtuse angle with it. 
 This provision makes it possible for the hand to be carried at some 
 distance from the side, when the arm is held tightly against the ribs, 
 
 Fig. 15. — The ulna 
 and radius or 
 forearm bones. 
 
20 CONSTRUCTION OF THE HUMAN MACHINE 
 
 and gives to the upper extremity the " carrying function," enabling a 
 person to carry a weight in his hand with the elbow braced against the 
 side. 
 
 The wrist is formed by the carpus, consisting of eight small bones, 
 arranged in two horizontal rows, called respectively, counting from 
 the thumb inward, scaphoid, semilunar, cuneiform, and pisiform, in the 
 upper row, and trapezium, trapezoid, os magnum, and unciform in the 
 lower row. The contiguous surfaces are encrusted 
 with cartilage, and form regular joints. The division 
 of the wrist into so many bones gives it strength and 
 elasticity, together with a certain degree of motion, 
 and it renders the liability of the wrist to be dislo- 
 cated or broken vastly less than if it consisted of a 
 single bone. 
 
 The hand is composed of nineteen long bones, 
 
 arranged end to end in five lines, corresponding to 
 
 the five digits, the thumb presenting three bones, 
 
 and each of the fingers four. The bones adjacent 
 
 to the wrist are called metacarpal bones, and the 
 
 Fig. 16. — The bones g rou P °f nve metacarpal bones is called the meta- 
 
 of the hand and carpus. The remaining bones are called phalanges, 
 
 wrist. and numbered in each digit from the metacarpus to 
 
 the tip, — first, second, and last or ungual phalanges. 
 
 The spaces between the four metacarpal bones belonging to the fingers 
 
 is filled, in the living person, with muscles and other organs, and the 
 
 entire mass covered with skin, the front of it being the palm of the hand. 
 
 The thumb is entirely independent from the beginning, and is peculiar 
 
 not only in possessing but two phalanges, but also in having its action 
 
 opposed to that of the fingers, which greatly facilitates the grasping of 
 
 an object. For this reason the loss of the thumb disables the hand 
 
 more than that of any of the fingers ; indeed, the loss of all of the three 
 
 outer fingers would not affect the usefulness of the hand as much as 
 
 that of the thumb alone. 
 
 The hand is a piece of mechanism most wonderfully adapted to the 
 thousands of purposes for which it is designed. Even the unevenness 
 in the length of the fingers adds to its utility as well as its beauty. As 
 an implement of labor, its uses are almost innumerable ; but it is also a 
 most important feature of expression. In the words of Quintilian, it 
 may express desire or willingness, it may bid one come or go, it may 
 threaten or supplicate, it may display defiance or fear ; joy or sadness, 
 doubt or penitence, want or plenty, number or time, may all be shown 
 by it. 
 
 The pelvis is a great bony arch supporting the body and 
 transmitting its weight to the lower limbs ; it is a basin con- 
 
PELVIS AND HIP BONES 
 
 21 
 
 Fig. 17. — The pelvis or hip bones. 
 
 taining and protecting a number of important viscera, whence 
 the French call it"Ie dassm." It is composed of four bones, 
 the innominate or 
 " hip bones, 11 on either 
 side, and the sacrum 
 or "rump bone, 11 in 
 the centre at the top, 
 forming, as has al- 
 ready been observed 
 in connection with the 
 spine, the keystone of 
 the pelvic arch. At- 
 tached to the lower 
 end of the sacrum is 
 the coccyx, which does 
 not enter into the arch, but assists in the formation of the 
 pelvic cavity. 
 
 About the circumference of the pelvic cavity runs a line where the 
 bone is thickened, and forms a projecting ridge ; this ridge is the brim 
 of the pelvis. All that portion above the brim is called the false pelvis, 
 and the portion below is called the true pelvis. The pelvis differs 
 slightly in the two sexes. In order to facilitate childbirth in the female, 
 the sacrum is wider and less curved, the cavity shallower and broader, 
 and the pubic arch has a broader span. 
 
 The pelvic arch is enormously powerful ; a wagon contain- 
 ing over five tons has been known to pass over it without 
 breaking the bones. The sacrum, shaped like the keystone 
 of an arch and performing that function here, directly sup- 
 ports the spine while the hip bones act as the pillars of the 
 arch in continuation with the bones of the lower limbs. The 
 bones of the pelvis afford extensive surfaces for the attach- 
 ment of the immensely powerful muscles of the trunk and 
 lower limbs. 
 
 The upper margin of the innominate or hip bones may readily be 
 felt in the living person. In the direct line of the weight of the body on 
 the outer convex surface of each hip bone, is a projecting cup with a 
 hemispherical cavity called the acetabulum or vinegar cup. This is 
 the socket into which the ball-like head of the thigh bone is set to form 
 
22 CONSTRUCTION OF THE HUMAN MACHINE 
 
 the hip joint. The hip bones are formed by the fusion of three bones 
 which are more or less distinct up to adult age, and which meet at the 
 bottom of the acetabulum. The upper flaring portion, which may be 
 felt at the hip, is the ilium ; this portion enters more extensively into the 
 pelvic arch when standing. The thick heavy portion on the under and 
 back part is called the ischium, and enters into the arch more particularly 
 in the sitting posture, these bones forming the supports of the body in 
 that attitude. The lighter portion, combining with the ischium to encir- 
 cle a large opening, the obturator foramen, and uniting with its fellow 
 of the opposite side in front of the body, is called the pubes; these 
 portions of the innominate not only form the front of the pelvic cavity, 
 but act as a tie-beam for the pelvic arch. 
 
 The lower extremity includes the hip, 
 already referred to ; the thigh, extending 
 from the hip joint to the knee ; the leg, 
 extending from the knee to the ankle ; 
 and the foot, from the ankle to the tips 
 of the toes. 
 
 18. — The femur or 
 thigh bone. 
 
 The femur or thigh bone is the longest and 
 strongest in the body. Its length is a peculiarity 
 of the human skeleton. The finger tips in man 
 reach about to the middle of the thigh ; in the 
 most man-like of the monkeys they reach to 
 the knee, and in others to the ankle, because of 
 the shortness of the thigh bones. These bones 
 do not stand perpendicularly. 
 
 Like other long bones, the thigh bone presents 
 two extremities and a shaft. The head is practi- 
 cally a ball mounted upon a somewhat smaller 
 neck ; this head is very firmly fixed in its socket, 
 the acetabulum of the hip bone, and the motion 
 of the joint is very free, so that the lower limbs 
 swing like pendulums in walking, and the muscles 
 need have but little to do either with keeping the 
 bone in place or in moving the limb in walking. 
 The head is mounted upon a portion of the shaft 
 which is set somewhat at an angle with the rest, 
 and is called the neck ; in infancy, this angle is 
 quite obtuse, but it diminishes with age until in 
 the old it may be even less than a right angle. 
 This, in addition to the fact that its compact 
 tissue becomes less and its cancellous tissue 
 
BONES OF THE THIGH AND LEG 23 
 
 greater in amount, renders the neck of the femur much more liable to 
 break in old persons than in the young. 
 
 At the other end of the neck are two projections called the greater 
 and lesser trochanters, to which the great hip muscles are attached. 
 The great trochanter can readily be felt a few inches below the promi- 
 nence of the hip. The shaft is very strong, and ridged and roughened 
 in places for muscular attachments. The femur, like the humerus, 
 widens as it approaches its lower extremity and presents a prominence 
 on either side called the internal and external condyles. The two con- 
 dyles are separated by an intercondyloid notch, dividing the end of the 
 bone into two hemispherical portions which participate in the knee 
 joint. 
 
 In the tendon of the great muscular mass which straightens the knee, 
 and directly in front of the knee joint, is found a 
 triangular bone, the patella or " knee cap." It 
 not only protects the joint, but increases the lev- 
 erage of the muscles so as to add greatly to their 
 power. It fits down into the intercondyloid notch 
 when the knee is bent, but it lies quite free when 
 the leg is straightened. When this bone is bro- 
 ken, the power of straightening the leg is lost. 
 
 The leg has two parallel long bones. The 
 tibia or " shin " bone is vastly the larger, and 
 
 1 .- 1 . -ii 1 ■ , , 1 , Fig. 19. — The patella 
 
 alone articulates with the thigh bone, and almost or |< nee caRi 
 
 alone with the foot. Next to the femur it is the 
 
 largest and strongest bone in the skeleton, and the two tibiae sustain 
 the entire weight of the body. Both its upper and lower ends are 
 widened, the upper more than the lower, while the shaft has the form 
 of a prism. The top consists of two shallow cups separated by a slight 
 elevation called the spine ; in these cups lie and move the condyles of 
 the thigh bone. Just below this, in front, is a projection to which is 
 attached the great muscle which straightens the leg. Its lower end is 
 somewhat hollowed out to receive the upper extremity of the foot. Ex- 
 tending downward and inward is a process which prevents the foot from 
 being dislocated inward ; this makes a projection under the skin which 
 is called the internal malleolus. The shin bone lies directly under the 
 skin, in front, where its angle can readily be felt. 
 
 Running parallel with the shin bone is the fibula, so called from a 
 Latin word meaning clasp. In proportion to its length, it is the most 
 slender of all the long bones. It does not sustain any of the weight of 
 the body, nor does it enter into the knee joint. It is attached to the 
 tibia just below and external to the knee, and passes down the leg to 
 project as a process just below and external to the ankle. Firmly at- 
 tached to the tibia at this point, it prevents the foot from being dislo- 
 cated outward and forms the external malleolus, readily seen and felt 
 
24 CONSTRUCTION OF THE HUMAN MACHINE 
 
 •"?n 
 
 under the skin. This bone is frequently broken about 
 two and a half inches above the ankle by a sudden 
 twist of the foot, the shin bone remaining unaffected. 
 This injury is called " Pott's fracture." 
 
 There are twenty-six bones in the foot, divided 
 among the tarsus, the metatarsus, and the phalanges. 
 The multiplication of bones produces an increased 
 freedom of motion and greater elasticity, like the 
 similar condition in the wrist. 
 
 The tarsus, producing what the shoemakers call 
 the "instep," is analogous to the carpus in the wrist 
 It is composed of seven tarsal bones, — the astraga- 
 lus, which enters into the ankle joint, the calcaneum, 
 the scaphoid, three cuneiform, and the cuboid 
 bones. 
 
 There "are five metatarsal bones, numbered first, 
 second, etc., from within outward ; unlike the meta- 
 carpus, all five of the metatarsal bones are included 
 within the same covering of skin, the interspaces 
 being filled with muscles and 
 other soft parts. Beyond the 
 metatarsus are found the pha- 
 langes of the foot, three in each 
 toe, except in the great toe, 
 which, like its analogue the 
 thumb, has but two, and, like 
 those of the fingers, they are 
 called first, secondhand ungual 
 Fig. 20.— The tibia phalanges. The ungual pha- 
 and fibula or leg lanx of the little toe is very 
 bones. often fused with the second. 
 
 In antique art the second toe 
 is represented as longer than the first, but in the 
 present age the great toe is found to be the longer 
 in a great majority of cases. 
 
 The foot forms two very important bony 
 arches, one longitudinal, with the calcaneum be- 
 hind and the heads of the metatarsus in front as 
 its pillars, and the astragalus as its keystone ; the 
 other arch is transverse, with its greatest con- 
 vexity at the instep and its inner side thicker 
 than the outer, while the cuboid and the cunei- 
 form bones are so shaped as to unite in keying 
 
 the arch. The absence of these arches consti- ... .. _, , . 
 
 , Fig. 21. — The bones of 
 
 tutes flat foot. the foot 
 
THE HINGES THE JOINTS 25 
 
 In the bony framework of the body the arch, as a means of 
 economizing material, is freely used. The skull is a dome 
 of which the sphenoid bone is the keystone. The upper 
 extremities and the chest form an arch, of less importance 
 than some others, and yet not to be neglected. The ribs, 
 the sternum, and the spine form a series of arches. The pel- 
 vic arch has been described in detail, the lower extremities 
 forming its columns. And those of the foot have just been 
 noted. 
 
 CHAPTER IV 
 
 THE HINGES — THE JOINTS 
 
 A joint is the juncture of two adjacent bones. Anatomists 
 enumerate nineteen different kinds of joints in the human 
 body. They may be (i) immovable, like the sutures be- 
 tween the bones of the skull-cap ; (2) permitting but limited 
 motion, like those between the vertebrae ; and (3) freely 
 movable, as in the shoulder and other commonly recognized 
 joints. 
 
 Of the movable joints, three are worthy of note : (1) The ball-and- 
 socket joint, enabling the limb to be freely moved in all directions : this 
 is the case with the shoulder joint, where the ball-like upper end of the 
 arm bone fits into the glenoid cavity of the shoulder-blade ; the spher- 
 ical head of the thigh bone is set in a similar way into the acetabulum 
 of the hip bone. (2) The hinge joint, where the movement is limited 
 practically to two directions, like a hinge : the knee and elbow joints 
 are the most conspicuous examples of this. (3) The rotatory joint, 
 where the end of one bone turns in a ring formed partly by the other 
 bone and partly by a fibrous loop : this is seen in the joint between the 
 upper ends of the two arm bones, the upper end of the radius revolving 
 in a ring formed by a fibrous loop and a depression in the upper end of 
 the ulna. 
 
 The bones in a movable joint are retained in juxtaposition 
 only to a small extent by the bony structure, and to a much 
 greater degree by ligaments and muscles. The character of 
 
26 CONSTRUCTION OF THE HUMAN MACHINE 
 
 the ligaments, together with the shape of the adjoining por- 
 tions of bone, determines the character of the joints. The 
 parts of the bones participating in the joint are coated with a 
 bluish white elastic substance known scientifically as carti- 
 lage and popularly as "gristle"; sometimes, also, cartilage, 
 strengthened by fibrous matter, is found at the edge of joint 
 cavities, contributing to deepen them ; in some cases liga- 
 ments lie within the joint cavity, and, covering all, is a 
 capsule of fibrous tissue : the capsule also has a serous lining 
 called the synovial membrane. 
 
 Ligaments are masses of white fibrous tissue designed to 
 unite separate bones. They may consist of bundles or cords 
 extending from one bone to another, or they may take the 
 form of capsules surrounding and covering the entire joint. 
 
 The number of ligaments may 
 vary from one, as seen in the 
 joint between the upper ends of 
 the bones of the forearm, to 
 fifteen, as seen in the knee. 
 While pliable and flexible so 
 as to permit great freedom of 
 motion, ligaments are strong, 
 tough, and, with few exceptions, 
 inelastic. They are attached to 
 the bones by a mutual interlace- 
 ment with the fibres of the 
 periosteum. 
 
 They are sometimes so powerful 
 that the bone will be torn off before 
 they are broken. A rupture of the 
 ligament in front of the wrist joint is 
 almost unknown, while the tearing 
 off of the end of one of the bones of 
 the forearm, the radius, by force ex- 
 erted on the ligament, is one of the 
 most common forms of broken bones. 
 A similar condition is observable at the knee joint, where the " knee cap " 
 is broken very much more frequently than the portions of the ligament 
 attached to either end of it. In other joints the ligaments are com- 
 
 Fig. 22. —The shoulder joint, a ball- 
 and-socket joint. Showing also 
 ligaments connecting the collar 
 bone with the shoulder blade. 
 
THE LIGAMENTS AND LINING OF THE JOINTS 2? 
 
 paratively weak, in consequence of which some bones are much more 
 frequently put out of joint than others. At the shoulder joint, where 
 there is practically but one not very strong ligament, dislocations are 
 very frequent, while at the knee, with its fifteen 
 ligaments, that accident is almost unknown. 
 
 A few ligaments consist of yellow elastic 
 tissue. Such are the ligamenta subfiava run- 
 ning down the side of the spine. Such also 
 is the ligamentum nuchae, extending from 
 the vertebrae of the neck to the back of 
 the head. The elasticity of this ligament is 
 very important in the lower animals, whose 
 neck habitually assumes a horizontal atti- 
 tude; for when the head is lowered, as in 
 grazing, it may be elevated to its natural 
 position by simply relaxing the muscles, and 
 it is maintained in 
 that position without 
 weariness simply by 
 the elasticity of this 
 ligament. 
 
 About the wrists 
 and ankles the white 
 fibrous tissue called 
 the fascia, which lies 
 underneath the skin 
 throughout the body, 
 is thickened to such 
 
 an extent as to form a strong ligament-like 
 ring. These rings are called the annular liga- 
 ments of the wrists or ankles, and their func- 
 tion is to hold the tendons of the muscles 
 moving the hands and feet close to the 
 bone, thus giving additional power to their 
 action. 
 
 Fig. 23. — The knee joint, a 
 hinge joint, cut down 
 the middle to show the 
 relations of the bones 
 and the ligaments. 
 
 Tig. 24. —The joint be- 
 tween the upper end 
 of the forearm bones, a 
 rotatory joint. The ra- 
 dius has been removed 
 to show the fibrous 
 loop. 
 
 The synovial membrane is a delicate 
 membrane lining the capsules of joints 
 and covering all ligaments that may be 
 contained within joints, but not covering 
 the cartilage. It secretes the synovia, 
 or "joint oil," a yellowish or slightly 
 reddish fluid, something like the white of an egg in feeling, 
 which has for its function the lubrication of the joint. 
 
28 CONSTRUCTION OF THE HUMAN MACHINE 
 
 In some joints the synovial membrane is thrown into folds which 
 cross the joint and are known as synovial ligaments. Synovial mem- 
 brane is also found lining certain bursae or pockets interposed between 
 certain muscles and the bony surfaces over which they play, and certain 
 sheaths, synovial sheaths, through which play the tendons of still 
 other muscles ; in both these cases the secretion fulfils its function of 
 lubrication. The synovial membrane is subject to inflammation in all 
 these localities, producing an affection called " synovitis." 
 
 Cartilage is a tough bluish or yellowish white elastic sub- 
 stance, which, when found in meat on the table, is called 
 " gristle." It is the precursor of bone ; even up to adult age 
 some bones remain partly cartilaginous, while in the embryo 
 the skeleton is almost altogether cartilage, the bones of the 
 skull cap being the only exception. A child, then, has far 
 more cartilage in his system than a man. In the adults it 
 forms caps for the ends of the bones, and, by its elasticity, 
 contributes to the diminution of shock and friction between 
 them. It forms a large part of the walls of the windpipe and 
 bronchial tubes, where it serves to maintain rigidity and pre- 
 vent collapse ; it performs a similar function in the nose and 
 ear, combining firmness and yielding. It supplies an elastic 
 material in the costal cartilages, which form a part of the 
 cage containing the breathing apparatus. 
 
 There are no blood-vessels in cartilage, which reduces its liability to 
 inflammation, to which its situation and its subjection to pressure would 
 incline it otherwise. It imbibes its nourishment from adjacent tissues. 
 
 The compressibility of cartilage, with which the ends of all bones are 
 encrusted, makes possible another curious circumstance. Every per- 
 son is taller upon arising in the morning than when retiring at night ! 
 This is due to the weight of the body in an erect posture acting upon 
 the intervertebral and other cartilages so as to flatten them, their elas- 
 ticity causing them to regain their original thickness at night, when, in 
 the recumbent posture, all weight is removed. 
 
 The value of this elastic substance between the bones, where it acts 
 as a buffer, cannot be overestimated. Walking or jumping would be 
 almost impossible were it not for this means of diminishing the jar 
 which would be felt if the bones were directly in contact. 
 
 Combined in the way described, the bones of the skeleton 
 are joined together, every joint having a distinctive name. 
 
THE MOVING APPARATUS THE MUSCLES 29 
 
 The shoulder, elbow, and wrist, the hip, knee, and ankle 
 joints are familiar to every one. The knuckles, or metacarpo- 
 phalangeal and the first, and second interphalangeal joints in 
 the fingers, are better known than the corresponding metatarso- 
 phalangeal and interphalangeal joints of the foot and toes. 
 The intercarpal and carpo-metacarpal joints of the wrist, and 
 the intertarsal and tarso-metatarsal joints in the foot, are still 
 less known. Joints between vertebrae and ribs, between the 
 spine and the head, and between the head and the lower jaw, 
 are all present and are considered by the anatomist. 
 
 CHAPTER V 
 THE MOVING APPARATUS — THE MUSCLES 
 
 Having become acquainted with the bones and the joints 
 which permit them to move in relation to one another, 
 the question of the means of producing the movements 
 naturally arises . The motive power of the body^ lies in the 
 muscles. 
 
 Muscles are " lean meat." Upon examination of the steak 
 or roast, fibrous lines will be seen intersecting the meat in 
 various directions, and, extending the examination to the beef 
 before it is cut, these intersections will be seen to form sacks 
 of considerable extent surrounding masses of meat of varying 
 form and size, but alike in being attached at two extremities 
 to bones. These masses are the individual muscles, and the 
 fibrous intersections are sections of the weblike fibrous tissue, 
 called fascia, which encloses not only each muscle, but certain 
 masses of muscle and the entire body. 
 
 The action of muscles is produced by the contraction and 
 relaxation of their fibres shortening and lengthening the 
 muscles, and thus bringing nearer together the two bones to 
 which its ends are attached. This is well seen in the biceps 
 muscle of the arm, one end of which is attached to the 
 
30 CONSTRUCTION OF THE HUMAN MACHINE 
 
 shoulder and the other to one of the forearm bones. When 
 the biceps is contracted, it draws the forearm and hand toward 
 the shoulder, and when it relaxes, it allows the arm to be 
 thrown out straight. When a muscle contracts, it also grows 
 thicker, as each person may see for himself by strongly draw- 
 ing his forearm up toward the shoulder and feeling the thick- 
 ness of the biceps muscle in front of his arm. The contrac- 
 tile character of muscle is also shown by the wide separation 
 of the lips of a cut into a muscle, the fibres on either side con- 
 tracting and drawing them apart. 
 
 The muscles act upon the bones, producing motion in various direc- 
 tions ; these motions have received distinct names. When a limb is 
 simply bent, as in bending the elbow or 
 knee, the motion is called flexion, — the limb 
 A is flexed; straightening the limb is called 
 
 extension, — the limb is extended : the move- 
 ments, pronation, turning the palm down- 
 ward, and supination, turning it upward, have 
 been described. Turning a limb about its 
 long axis is called rotation. Abduction is 
 throwing a limb outward, as when a leg is 
 thrown to one side. Adduction, drawing 
 ___ ._ a limb inward, is the reverse of abduction. 
 
 wjj £■§• Muscles produce all voluntary and 
 
 ■B *$ j£\ some involuntary motion. If a man in 
 
 2 £/ ■■ *<$ walking catches his foot against an ob- 
 
 mi ^ # 4 H • struction and falls, the fall is involun- 
 
 ■■ *# Sm ' tar Y motion ; but when he throws his 
 
 =<? ■* other foot forward to regain his equi- 
 
 wm "* librium, that is involuntary motion. 
 
 _. oc .. , , There are in the body both voluntary 
 
 Fig. 25. — Voluntary mus- . J ■> 
 
 cuiar fibres, aa. Large and involuntary muscles. The volun- 
 coiiections of fibrils, bb. tary muscles are those which are under 
 ?r a ," er c + !! ecti0 ,? s f the control of the will, like those of the 
 
 fibrils, c. Still smallercol- . , . 
 
 lections, d. The small- jaws, the arms, and tu t legs. The mvol- 
 
 est that could be sepa- untary muscles are those over which 
 
 rated * the will has no control, such as the 
 
 heart and the muscles of the bowels. The word ?nusde, 
 
 unmodified, is used in this book to signify voluntary muscle. 
 
VOLUNTARY AND INVOLUNTARY MUSCLES 3 1 
 
 Voluntary muscles are also called striated, and the involuntary nu- 
 cleated, from their appearance under the microscope. The fibres of 
 voluntary muscle consist of fasciculi about 500 of an inch in diameter 
 across which are seen regularly arranged transverse lines or striae, 
 each fasciculus being enclosed in its own fibrous sheath or perimysium. 
 The fasciculi are united into a single bundle by means of a network 
 of fine white connective tissue. The fasciculi are composed of a 
 number of smaller fibrils about tsuutt of an inch in diameter, also en- 
 closed in a transparent elastic sheath, the sarcolemma : each of these 
 fibrils is composed of a series of discs or " sarcous elements " arranged 
 end to end like a roll of coins. The contraction and extension of these 
 discs produces the contraction and extension of the whole muscle. 
 
 Involuntary muscles are composed of spindle-shaped cells, each with 
 a clearly marked nucleus, but not striated. They are about 5^ of an 
 inch long by joVit of an inch broad, and are 
 found in the muscular coats of the stomach, 
 bowels, bladder, arteries, veins, and the heart 
 and lungs. Involuntary muscles are not, then, 
 attached to bones, and their contractions are 
 irregular, one part contracting while a con- 
 tiguous portion is relaxing, — a movement 
 which may readily be seen in the intestines, 
 where it is called the peristaltic motion. 
 
 The advantage of the provision of 
 involuntary muscles is evident ; for if it 
 required an effort of will to cause their 
 action, one might forget to breathe or to 
 keep his heart beating, and die. But 
 the involuntary muscle continues to 
 act irrespective of the individual — the 
 heart beats on, sleeping or waking, the 
 stomach and bowels proceed with the 
 act of digestion, and the lungs contract 
 and expand in breathing regardless of the will of their owner 
 or any surrounding circumstances. 
 
 Fig. 26. — Involuntary mus- 
 cularfibre, magnified 350 
 times, a. Nucleus of the 
 fibre. 
 
 If the muscle which moves a limb be severed, the power of motion in 
 the limb is lost. The voluntary are generally so arranged that the 
 action of one group of muscles is counterbalanced by that of another. 
 In the case, for instance, of a wound across the back of the hand divid- 
 ing the muscles opening it, those closing it would have no opposition, 
 and the hand would remain permanently closed; the reverse would be 
 the case if the palm should receive such a wound. 
 
2,2 CONSTRUCTION OF THE HUMAN MACHINE 
 
 It frequently occurs that these muscles of equilibrium are not at- 
 tached to directly opposite portions of a bone; so that the bone 
 may be broken between them and the broken 
 ends of the bone drawn in opposite directions. 
 This is shown in Fig. 27, where the thigh 
 bone is broken between the psoas iliacus and 
 the short head of the biceps cruris muscles, 
 resulting in great displacement of the frag- 
 ments. This action of muscles is of great im- 
 portance in connection with broken bones, 
 and will be referred to again in connection with 
 that subject. 
 
 A similar effect is produced when a bone 
 has been thrown out of joint : the end which 
 has escaped from its socket being held out of 
 place by the tension of muscles, which must 
 be relaxed before it can be returned. 
 
 Muscles constitute the greater por- 
 tion of the body, and to them it chiefly 
 owes its contour. The calf of the leg, 
 for instance, is composed entirely of 
 muscles. The most beautiful figure, 
 then, is the one in which the muscles 
 are most uniformly and symmetrically 
 developed, irregularities between them 
 being filled in with fat. This function 
 alone would require the existence of a 
 large amount of muscular tissue, and, 
 as a matter of fact, there are about 
 four hundred and forty muscles in the 
 human body, arranged in symmetrical pairs, one on each side 
 of the body and forming about two-fifths of its weight. 
 
 Muscles vary greatly in shape, some being cylindrical or 
 spindle-shaped, others broad and thin, while still others are 
 long and ribbon-shaped. Those of the arm and thigh are 
 required to be the thickest in the body because of the heavy 
 work required of them. The muscles of the abdomen and 
 cheek on the contrary are broad and thin because they are 
 designed to form walls to cavities. Muscles increase in size 
 in proportion to their use. This fact is shown by comparison 
 
 Fig. 27. — A fracture of the 
 thigh bone, showing the 
 action of the psoas ilia- 
 cus muscle in pullingthe 
 upper fragment out of 
 place. A portion of the 
 biceps is seen pulling the 
 lower fragment in the 
 opposite direction — the 
 two muscles counter- 
 balancing one another 
 when the bone is whole. 
 
THE MOVING APPARATUS THE MUSCLES 33 
 
 of the powerfully muscular athlete, who devotes himself to the 
 exercise of his muscular system, with the thin, flabby man of 
 sedentary occupation who neglects exercise. If a muscle be 
 unused for a long time, it suffers not only diminution in size, 
 "atrophy," but degeneration of its tissue, which is perma- 
 nently fatal to its usefulness. 
 
 Muscles begin at their attachment to one bone with reddish 
 muscular tissue and end in inelastic glistening white fibrous 
 tissue, forming the cord-like or strap-like tendons which are 
 attached to the other bone and are commonly known as 
 "sinews, 11 "leaders, 11 or "cords. 11 Where a muscle has a 
 broad attachment, the tendon may be expanded into a strong 
 fibrous sheet which is called an aponeurosis. Muscles may 
 begin in several masses terminating in a single tendon as in the 
 triceps, "three-headed, 11 or biceps, "two-headed, 11 muscles 
 of the arms. Or they may begin as a single muscular mass 
 and divide into a number of distinct tendons as in the fore- 
 arm muscles which open and close the hand. Tendons are 
 attached to bone by a mutual interlacement of their fibres 
 with those of the periosteum. 
 
 Within from seven to twenty-four hours after death, by 
 reason of certain chemical changes, all muscles become rigid, 
 producing what is known as rigor mortis, the stiffness of 
 death, and the muscular tissue loses its contractility. The 
 contractile power is a quality requiring the stimulus of vitality 
 for its exercise, and although beginning decomposition relaxes 
 the muscles again, it does not return. In persons suffering 
 from great muscular exhaustion immediately prior to death, as 
 in soldiers killed in a battle, rigor mortis sets in very quickly. 
 In this way the attitudes and expressions of life are sometimes 
 continued after death upon the battle-field. 
 
 An important group of muscles is the muscles of expression in the face. 
 As a rule, but one end of these muscles is attached to bone, the other 
 being inserted into the skin. Joy and grief, pleasure and disappoint- 
 ment, anger and satisfaction, are made evident in the countenance by 
 the contraction and relaxation of these muscles. The occipito-frontalis 
 is the muscle of the scalp, and produces the horizontal wrinkles in the 
 forehead. The orbicularis palpebrarum and the orbicularis oris each 
 aid in closing the eyes and mouth respectively, while the square masseter, 
 
34 CONSTRUCTION OF THE HUMAN MACHINE 
 
 Fig. 28. —The Chief Superficial Muscles of the Human Body. 
 
THE MOVING APPARATUS THE MUSCLES 35 
 
 aided by the temporal, contributes largely to the powerful closure of 
 the jaws. 
 
 Beginning just back of each ear and passing down the neck to the 
 front of the breast bone are two muscles, one on each side, the sterno- 
 cleido-mastoid muscles. They can readily be felt under the skin of the 
 neck, and are for this reason of importance in marking the course of the 
 great arteries of the neck, which run just in front of them. When 
 one of them, through disease, becomes permanently contracted, the 
 common affection " wry neck " is produced by the consequent drawing 
 of the head to one side. 
 
 On the chest lies the great fan-like chest muscle, thepectoralis major, 
 extending from the chest to the arm bone and tending to draw the arm 
 inward and forward. Just above this is the deltoid, a great triangular 
 muscle attached to the shoulder and the arm bone and raising the arm 
 to a right angle with the body. On the back the serratus magnus and 
 a number of scapular muscles extend from the shoulder blade to the 
 arm bone and draw the arm backward and inward. Another great 
 muscle extends from the spine over to the arm bone and draws the arm 
 downward and inward, or, if one hangs by the hands, it lifts the body 
 upwards — this is the latissimus dorsi. 
 
 In the arm, the biceps muscle extends down the front and bends the 
 elbow, while the triceps extends down the back and straightens the arm. 
 The biceps can be felt under the skin, and its inner border is a land- 
 mark for the great artery of the arm. In the forearm are the muscles 
 which move the wrist, hand, and fingers. On the back and external 
 side of the forearm are the extensor muscles which straighten the wrist, 
 hand, and fingers. These tendons, beginning above the wrist, extend 
 down the back of the hand, like cords, which can readily be felt under 
 the skin. On the front and inner side of the forearm are the muscles 
 which bend the hand, wrist, and fingers, the flexor muscles, the ten- 
 dons extending from the forearm to the hand. In the forearm are 
 also pronator muscles which turn the palm downward, and supinators 
 which turn it up. 
 
 In the lower extremity are the glutei muscles, extending from the 
 hip to thigh bone and drawing the thigh outward. Passing from the 
 pubic bone to the thigh is a mass of adductor muscles which counter- 
 balance the action of the glutei. In front is the great four-headed 
 muscle, composed of the rectus femoris, the vastus externus and in- 
 ternus, and the crureus, uniting into a single tendon in which the knee- 
 cap is set, and acting together to straighten the knee. On the back are 
 the biceps femoris and other hamstring muscles, which bend the knee, 
 and whose tendons can readily be felt standing out under the skin, just 
 above the back of the knee. The thigh muscles are the largest and 
 most powerful in the body. 
 
 In the leg are the muscles which move the foot, the tendons passing 
 
$6 CONSTRUCTION OF THE HUMAN MACHINE 
 
 over the ankle to their attachment in the foot or on the toes. The 
 gastrocnemius and other great calf muscles unite into a single great 
 tendon which is attached to the heel, and is called the tendo Achillis, 
 or tendon of Achilles, since that hero is reputed to have been invul- 
 nerable except at that point. The calf muscles enable one to rise on 
 the toes ; hence the exercise of rising on the toes produces growth in the 
 size of the calf. The extensor muscles, on the front of the leg, turn the 
 foot and toes upward, while the peioneus muscles, on the outside, turn 
 the foot upward and outward. 
 
 The interstices between the ribs are filled with muscles, while the 
 entire abdomen is enclosed by the rectus abdominalis, the obliquus 
 externus, and other abdominal and lumbar muscles, which form a 
 muscular pocket for containing the stomach, bowels, and other ab- 
 dominal viscera. Separating the chest from the abdomen is a muscular 
 partition, the diaphragm or midriff, which assumes a dome-like form, 
 projecting into the chest and thus increasing the capacity of the abdo- 
 men. The fibres of this muscle are attached to the circumference of 
 the chest and converge to a tendinous centre. When these fibres con- 
 tract, then they tighten the diaphragm and reduce the amount of pro- 
 jection into the chest. This muscle performs an important function in 
 connection with the act of breathing. 
 
 It has already been remarked that those muscular organs which are 
 not under the control of the will are composed of involuntary muscular 
 tissue, and that these include the heart, bowels, bladder, stomach, lungs, 
 arteries, and veins. 
 
 CHAPTER VI 
 THE CENTRAL POWER — THE BRAIN AND NERVES 
 
 It has been stated in the preceding chapter that the muscles 
 moving the body are subject to the control of the will. The 
 question then logically follows, Where is the will located, and 
 how are its wishes conveyed to the muscles ? The will is 
 located in the brain, and its volitions are carried to the 
 muscles by the nerves. 
 
 The nervous system, consisting of the brain and nerves, is 
 much like a great railway system. The train despatcher sits 
 in his office surrounded by ticking telegraph instruments, by 
 which he is kept constantly informed of the movements of a 
 large number of trains at varying distances, on a network of 
 
THE BRAIN AND NERVES 
 
 37 
 
 steel rails, at frequent points upon which are telegraph sta- 
 tions, at which his messages, sent over the wires following 
 the tracks everywhere, are delivered to the train officials. If 
 it is necessary to detain a train, he quickly transmits a mes- 
 sage to it and governs all its movements. When, on the 
 contrary, the officials of a train are uncertain as to the course 
 to take, they telegraph back over the same wires for orders. 
 The office of the train despatcher is the brain of the rail- 
 way, and he himself is the mind which controls and directs 
 the workings of the trains, the muscles, through its nerves, 
 the telegraph lines. Reversing the simile, the brain is the 
 office of the train despatcher, that official is the mind which 
 telegraphs its wishes over the nerves to the muscles, which 
 move the body. 
 
 Fig. 29. — Section of the brain down the middle line. 
 
 The nervous system comprises the brain, the spinal cord, 
 and the nerves. The brain is a large collection of gray cells 
 and white fibres, situated in the dome-like cavity of the skull. 
 It naturally divides itself into two parts, the cerebrum or 
 brain, and the cerebellum or little brain. The former, which 
 
38 CONSTRUCTION OF THE HUMAN MACHINE 
 
 appears like a gray mass of macaroni, lies in the upper and 
 anterior part of the cranial cavity, and is by far the larger ; 
 the latter is located in the posterior and lower part of the 
 cranium, and its surface presents a succession of parallel 
 horizontal ridges. The cerebrum is the site of the mind, the 
 centre of all perceptions, and the seat of the intellect and the 
 emotions. The cerebellum contributes the harmony of move- 
 ments and the property of equilibrium. 
 
 These organs are connected with the various portions of 
 the body by means of innumerable white threads, called 
 
 nerves — the telegraph 
 lines with which the seat 
 of the will is connected 
 with the organs upon 
 which it acts. From the 
 under portion of the 
 brain a great collection 
 of nerves, crowded to- 
 gether into a single great 
 cord, passes down 
 through the great aper- 
 ture in the bottom of the 
 skull into the canal in the 
 spinal column — this is 
 the spinal cord, or " spi- 
 nal marrow." It extends 
 from the brain to the 
 loins, a distance of about 
 eighteen inches. 
 
 At a point just before 
 it passes out of the skull 
 into the spine, the spinal cord swells out, forming an enlarge- 
 ment called the medulla oblongata. The nerves of the fact 
 and head, and also those which influence the movements or 
 the heart and lungs, come from the medulla oblongata. For 
 this reason, wounds at this point are extremely grave, and 
 death inevitably follows in a very short time. Breathing and 
 the beating of the heart are stopped by the destruction of the 
 
 Fig. 30. — The upper surface of the brain, show- 
 ing the hemispheres, the great fissure, and 
 the convolutions. 
 
THE CRANIAL AND SPINAL NERVES 
 
 39 
 
 nerve centres at which they originate. Small animals are 
 often instantaneously killed for food by thrusting a needle into 
 the medulla or by a quick blow just behind the ears, which 
 wounds the delicate medullary substance. This is the prin- 
 ciple upon which capital punishment by hanging is founded : 
 the sudden drop should throw the spine out of joint with the 
 skull and wound the medulla, producing instant death. 
 
 A number of smaller collections of nerve fibres pass directly 
 from the brain to the organs which they supply. These are 
 the cranial nerves. It is worthy of note that the higher the 
 function of an organ, the nearer the brain does it derive its 
 nerve supply. This 
 is evident from the 
 important functions 
 accorded to the 
 cranial nerves, from 
 which we derive 
 smell, sight, hear- 
 ing, and taste. 
 There are twelve 
 cranial nerves on 
 each side, subdivid- 
 ing into an immense 
 number of branches. 
 
 Out through the 
 apertures between 
 the vertebrae and 
 on the sides of the 
 spine, pass to the 
 body the subdivi- 
 sions of the spinal 
 cord, the spinal 
 nerves. There are 
 thirty-one spinal 
 nerves coming from each side of the spine, — sixty-two in all. 
 These branch so as to reach all parts of the system and pro- 
 vide every portion of the economy with a nerve centre, a 
 telegraph station to the brain. 
 
 '. 31. — The lower surface of the brain, showing the 
 cerebrum, cerebellum, pons Varolii, and medulla 
 oblongata, with the great fissures, the origins of all 
 the cranial nerves and other organs. 
 
40 CONSTRUCTION OF THE HUMAN MACHINE 
 
 There are two kinds of nerves, the motor nerves or nerves 
 of motion, and the sensory nerves or nerves of feeling. The 
 motor nerve conveys the impulse from the brain to the 
 muscles which are to act. If a man wishes to grasp the hand 
 of a friend, the desire is telegraphed instantaneously through 
 the spinal cord and motor nerves to the muscles of the upper 
 extremity, and the arm is extended and the hand clasped as 
 desired. If he wishes to greet his friend, a similar impulse is 
 telegraphed over the motor nerves of the face and throat, and 
 the words of greeting are formed. Any other movement — 
 winking, eating, walking, running, sitting, or standing — is 
 influenced or produced in the same way. 
 
 The sensory nerve, acting in a direction opposite to the 
 motor nerve, conveys impressions or sensations from an 
 organ to the brain. The man who has clasped the hand of a 
 friend knows that his friend has returned the greeting, because 
 the sensory nerves in his hand perceive the pressure and flash 
 the information to the brain through the spinal cord. The 
 slightest touch is appreciated, and the brain informed of it 
 with wonderful rapidity. The forms of the letters on this 
 page make, upon the sensory nerves of sight, an impression 
 which is conveyed to the brain, where the thought presented 
 is appreciated. The alderman enjoys his terrapin, the florist 
 is delighted by the odor of his flowers, the musician is 
 charmed by sweet sounds, and the soldier feels the pain of 
 his wounds, through sensory nerves passing from the tongue, 
 the nostrils, the ears, and the injured part to the brain. 
 
 Certain nerves contain both motor and sensory fibres, and an impulse 
 and a perception going in opposite directions may pass through the 
 same nerve at the same time. These are compound nerves. 
 
 We know that this system of nerve telegraphy between the organs of 
 the body exists, because when the line is cut by section of the nerve, 
 the action or perception of the organ reached by it is lost. When the 
 motor nerve fibres supplying a part are cut, the power of motion is lost 
 in the part, — it is paralyzed, — and this is called motor paralysis. When 
 the sensory fibres are divided, we have loss of sensation or sensory pa- 
 ralysis. We more frequently see the two varieties of paralysis combined. 
 
 The gray matter forming the outer coating and a few lumps in the 
 centre of the brain, and the centre of the spinal cord, is composed of 
 
 
THE BRAIN AND THE NERVE CELLS 4 1 
 
 very minute cells of varying shape, most of them with one or more pro- 
 cesses, some of which are directly continuous with nerve fibres. The 
 white substance consists (Fig. 33) of a mass of fibres composed of a 
 central fibre, the axis cylinder, about which is a coat of fatty matter 
 called the white substance of Schwann, and, covering the whole, a deli- 
 cate membrane, the neurilemma. 
 
 The surface of the cerebrum (Figs. 30 and 31) is irregularly divided 
 ofi into rounded prominences called convolutions, the deeper depres- 
 
 Fig. 32. — Nerve cells, from the gray matter of the brain, showing the varying 
 number of processes and the nuclei. 
 
 sions between which are called fissures, while the more shallow are 
 known as sulci. The cerebrum is divided by a deep fissure into two 
 egg-shaped bodies called the right and left " hemisphere." The hemi- 
 spheres are united at the bottom of the fissure by the corpus callosum, 
 a mass of white fibres passing from one side to the other. The hemi- 
 spheres are further subdivided, by other fissures, into " lobes." In each 
 hemisphere is an irregular cavity called the right and left "ventricle" 
 respectively, and into them project several masses of gray matter found 
 
42 CONSTRUCTION OF THE HUMAN MACHINE 
 
 Fig. 33. — Diagram of struc- 
 ture of nerve fibre. I. Neu- 
 rilemma. 2. Medullary 
 sheath, or white substance 
 of Schwann. 3. Axis 
 cylinder. 
 
 in the interior of the brain, from some of which originate sight and 
 smell. There are five ventricles in the brain. Upon the base of the 
 brain (Fig. 31) are a number of projections and depressions which have 
 received names, as well as the origins of the twelve cranial nerves. The 
 pituitary body is a small reddish gray gan- 
 glion, which is of interest because it was 
 thought by the ancients to be the source of 
 the nasal mucus, which was supposed to 
 find its way thence in some way through the 
 sphenoid bone to the nose. 
 
 The gray matter of the brain seems to be the 
 source of the intelligence, and the white sub- 
 stance to be merely the carrier of impulses to 
 or from it. The intelligence increases in pro- 
 portion to the amount of gray matter, which 
 is increased in proportion to the growth in 
 the number of convolutions, by allowing it to 
 dip down into the sulci, which afford a more 
 extensive surface for its accommodation. 
 The comparatively few convolutions in children, and the still smaller num- 
 ber in the lower animals, then, reduces their capacity for mental action. 
 The pons Varolii (Fig. 31), bridge of Varolius, is a mass of nerve 
 fibres passing from the spinal cord to the 
 various parts of the brain and connecting 
 them. 
 
 In the medulla oblongata, many of the 
 fibres of the spinal cord cross from one side 
 to the other. It is due to this crossing or 
 " decussation " that an injury to the right 
 side of the brain causes paralysis of organs 
 on the left side of the body, since a nerve 
 starting from the right side of the brain 
 passes down to the medulla oblongata, there 
 crosses to the left side, and, passing down 
 the left side of the spinal cord, emerges to 
 the left side of the body. A nerve arising 
 on the left side takes the opposite course. 
 
 The brain of man weighs more than that 
 of any of the lower animals except the ele- 
 phant and the whale, that of the elephant turning the scales at eight or 
 ten pounds, while the brain of a whale seventy-five feet long weighed 
 only a little more than five pounds. The brain of a man weighs about 
 three pounds, and that of a woman a few ounces less. The brain 
 increases in weight with varying rapidity from infancy to between the 
 thirtieth and fortieth year, after which it declines at the rate of about an 
 
 
 Fig. 34. — Diagram of human 
 brain, showing the course 
 of the fibres and the situ- 
 ation of the gray matter 
 — the latter in black. 2, 
 2, 2. Hemisphere. I, 3, 4, 
 5, 7, 8. Central gray gan- 
 glia. 6. Cerebellum.. 
 
CRANIAL NERVES AND MEMBRANES 43 
 
 ounce for each ten years. Contrary to the generally conceived opinion, 
 the size of the brain does not appear to have any influence upon the 
 power of the mind. 
 
 The brain is enclosed in three membranes : (1) Immediately next 
 to the brain is the pia mater, consisting of a minute network of blood- 
 vessels held together by fine connective tissue ; it dips down into all the 
 sulci and fissures. (2) The arachnoid or spider-web-like, a delicate 
 membrane which does not dip into the grooves. (3) Outside of this is 
 the dura mater, a dense fibrous membrane, which forms a strong and 
 inextensible sac for the brain. Between the arachnoid and the pia 
 mater is found a fluid, the cerebro-spinal fluid, affording a water 
 cushion to lessen the effects of jar upon the brain. 
 
 The substance of the brain is exceedingly tender, and easily crushed. 
 For this reason it is protected not only by a strong, dense membrane, 
 but also by a case of bone — the skull-cap — which prevents contact 
 with injurious violence. Pressure of any kind, even the most gentle, 
 interferes with the action of the brain. When the skull is broken and 
 the fragments press in upon the brain, paralysis in some part of the 
 body, or loss of consciousness, or both, invariably appears. Even so 
 gentle a pressure as that exerted by blood leaking from a small vessel 
 is sufficient to cause insensibility, paralysis, and often death; for it is 
 apoplexy. 
 
 Continuous with the brain are the twelve pairs of cranial nerves and 
 the spinal cord. (1) The olfactory nerve contributes the sense of 
 smell. (2) The optic nerve conveys the sense of sight. (3) The 
 motor oculi influences the movements of the eye. (4) The patheticus 
 controls the act of rolling the eye upward. (5) The trifacial gives 
 feeling to the eye, face, and mouth, influences chewing, and helps to fur- 
 nish the sense of taste. (6) The abducens makes it possible to turn 
 the eye to the side. (7) The facial supplies the expression of the 
 features. (8) The auditory imparts the power of hearing. (9) The 
 glossopharyngeal contributes feeling to the throat and helps the sense 
 of taste. (10) The pneumogastric gives feeling to the throat and con- 
 trols the muscles of talking, breathing, and the beating of the heart. 
 (11) The spinal accessory supplies motion to certain muscles of the 
 neck. (12) The hypoglossal imparts the power of motion to the 
 tongue. 
 
 The spinal cord is a long, rod-like mass of white nerve fibres sur- 
 rounding a central mass of gray matter. The fibres communicate 
 with the gray matter of the brain. The front of the spinal cord gives 
 origin to motor nerve fibres, and the back of the cord gives origin to 
 sensory fibres. When a man is struck, he feels it with the back of the 
 spinal cord, but the front of the cord causes him to move forward, to 
 seek safety. The front of the cord then may be diseased so that impulses 
 can no longer be conveyed through it, while the back may be unaffected, 
 
44 CONSTRUCTION OF THE HUMAN MACHINE 
 
 pjg. 35. — Diagram of the nervous system, showing the superficial nerves on th« 
 right, and the deep nerves on the left side of the body. I. The cerebrum, 
 2. The cerebellum. 3, 3. The spinal cord. 4. The sciatic nerve. 
 
THE SPINAL CORD AND THE NERVES 45 
 
 in which case the sick person would be unable to move his limb, while 
 at the same time he could feel every touch upon it. In the same way- 
 feeling may be paralyzed, while motion is not affected. 
 
 The gray cells themselves of the spinal cord have the power of orig- 
 inating certain unimportant acts. If the hand be accidentally brought 
 in contact with a hot stove, it is often drawn back by a rapid convulsive 
 motion before the pain is felt or the reason of the act is realized. In 
 the same manner, if one loses his balance, he throws his hands out to 
 regain it automatically, not realizing the act until it is all over. The 
 rapid movements of the fingers of the piano-player become unconscious 
 and automatic. These acts are unintentional and even unconscious — 
 and dependent upon no volition of the brain. They originate in the 
 gray cells of the spinal cord, and this is called the refiex action of the 
 spinal cord. 
 
 From the sides of the spinal cord pass the nerves to the various parts 
 of the body. Through the interstices between the cervical vertebras 
 passes, among others, the phrenic nerve, which passes down to the dia- 
 phragm or midriff, and is an important factor in breathing, and the 
 brachial plexus which supplies the upper limb. This plexus gives off 
 nerves to the skin and muscles of the arm, the median and ulnar to the 
 front of the forearm, and the musculo-spiral and radial to the back of 
 the forearm. Between the dorsal vertebras emerge nerves to the chest 
 and back. Between the lumbar vertebrae pass out the nerves forming 
 the lumbar plexus, branches of which go to the front of the lower limb. 
 And between the sacral vertebras pass out the nerves which, together 
 with the lower lumbar, form the great sciatic nerve, which runs down 
 the back of the thigh and supplies the back of the lower extremity. 
 
 A knowledge of the points from which the nerves arise is a help to the 
 diagnosis of the points at which the cord is injured in case of spinal 
 injury. If the back of the lower limb, for example, is paralyzed and the 
 front is not affected, we know that the lesion lies between the lumbar 
 and sacral vertebras. The origin of the various nerves being known 
 minutely, the location of an injury may be very definitely located in this 
 way in any part of the cord. 
 
 The Sympathetic System. — In connection with the involuntary 
 muscles, we have referred to the necessity for a system which should be 
 free from the control of the will. The involuntary muscles receive their 
 nerve supply, not from the great cerebro-spinal system, which has been 
 described, but from a special system, called the sympathetic system, 
 and consisting of a double set of small collections of gray matter called 
 ganglia, lying along the sides of the spinal column. These ganglia are 
 mutually interconnected, and send off nerves which form plexuses, and 
 go directly to special organs. It controls the heart and blood-vessels — 
 a fortunate circumstance ; for were they under the control of the volun- 
 tary nerves, the heart would stop when one goes to sleep. It supplies 
 
46 CONSTRUCTION OF THE HUMAN MACHINE 
 
 and controls the involuntary muscles and organs of secretion and excre- 
 tion. Were it not for this system, digestion would cease and breathing 
 would be suspended. Perhaps the action of the sympathetic system 
 may be seen most clearly in the pupil of the eye, which, without any 
 aid from the will, invariably adapts itself to the circumstances under 
 which it is placed : if it be dark, it dilates in order to let as much light 
 as possible into the eye ; if, on the contrary, the light be brilliant, it 
 contracts to a mere pin point, to avoid flooding the eye with light. 
 
 While, as in the beating of the heart and the breathing, in most 
 instances the sympathetic system acts continuously, in some others it 
 requires some irritation to produce its action. The iris, with its changes 
 subject to the variations of the light, is an excellent example. The con- 
 tact of food with the interior of the stomach, which causes that organ to 
 begin the churning motion needed for digestion, is another. 
 
 Mental emotions may also have a reflex action upon the sympathetic. 
 Terror dilates the pupil, and bashfulness acts upon the nerves of the 
 small blood-vessels of the face so as to produce blushing. 
 
 Irritation of the sympathetic nerves may in its turn have a reflex 
 action upon the cerebro-spinal system. The convulsions of children 
 are often due to the presence in the bowels of undigested food. The 
 same cause has been known to make a child cross-eyed and even 
 partially paralyzed 
 
 CHAPTER VII 
 
 THE REPAIR APPARATUS — THE BLOOD AND ITS 
 CIRCULATION 
 
 The human machine, like artificial machines, is affected 
 by constant use with wearing and breakage. When the 
 machinery of a clock becomes worn or broken, it is neces- 
 sary to take it to a clock-maker and have it repaired by replac- 
 ing the disabled part with a new one, or joining together the 
 fragments. The human machinery, however, contains in 
 itself the means of overcoming the effects of wear and tear — 
 it is self-repairing. By this provision waste is remedied, 
 growth is produced, and good working order is maintained. 
 
 This combined function, common to all animal bodies, 
 is called nourishment. The nourishment of the body is pro- 
 vided by the blood. In addition, the blood acts as a scaven- 
 ger in carrying off the waste products, a contribution to the 
 
Fig. 36. — Human blood-corpus- 
 
 THE BLOOD 4/ 
 
 process of excretion which will be studied in a separate 
 chapter. 
 
 The blood forms from one-twelfth to one-eighth of the 
 weight of the body and is estimated at about a gallon and 
 a half in bulk. Its presence is necessary to the continu- 
 ance of life, death rapidly ensuing 
 after great losses. The blood is 
 a bright red color in one set of 
 blood-vessels — the arteries — and 
 dark red or purple in another — 
 the veins. This color is due to the 
 presence of microscopic red blood- 
 corpuscles, which, when viewed 
 singly, under a high magnifying 
 power, are light yellow in color, 
 but when aggregated together in ~ c | es . a. Red corpuscles seen 
 
 Vast numbers produce the familiar flatwise ; 6. Seen edgewise ; 
 
 Crimson hue. C " White corpuscle. 
 
 The blood is composed of red and white corpuscles floating 
 in a liquid called the liquor sanguinis. The red corpuscle 
 is a circular disc about -g-^oo of an inch in diameter, and fifty 
 million of them may be collected into a cubic line. Their 
 number, however, is so enormous that it has been estimated 
 that if all the red blood-corpuscles in the blood of a single 
 individual were placed end to end in a single row, they would 
 form a continuous line long enough to encircle the globe four 
 times. They are hollowed out on both faces into a bicon- 
 cave shape. They are soft and elastic in structure, readily 
 resuming their form after the removal of pressure which has 
 distorted them. 
 
 Next to water, which forms a little more than half of these bodies, 
 their principal constituent is haemoglobin, a compound containing iron, 
 to which is due the red color of the corpuscles. Haemoglobin unites 
 readily with oxygen, and contributes the oxygen-carrying function to 
 these corpuscles. 
 
 White blood-corpuscles or leukocytes are also present in 
 the blood, in the proportion, in health, of but one to five 
 hundred of the red. They are shaped much like a sphere, 
 
48 CONSTRUCTION OF THE HUMAN MACHINE 
 
 are granular in appearance, and about zifav of an inch in 
 diameter. 
 
 They are peculiar in the ability to exhibit spontaneous changes of 
 shape like the amoeba, an infusorial animalcule of the lowest grade of 
 life. These movements are thence called amoeboid, and consist in the 
 protrusion of processes of the jelly-like mass composing the corpuscle, 
 which may be drawn back and other processes protruded. By the 
 exercise of this function, the white corpuscles under certain circum- 
 stances are enabled to penetrate through the walls of blood-vessels into 
 the neighboring tissues. The corpuscle first throws out a slender proc- 
 ess which it insinuates through the vessel wall and then draws the rest 
 of its body through the opening thus made. In any severe inflam- 
 mation the white corpuscles crowd to 
 the inflamed part and, unless the 
 inflammation is subdued very early, 
 they congregate in the tissues and 
 form the yellow "matter" — pus — 
 found in abscesses or boils. 
 
 
 Fig. 37. — Large frog's capillary, show- 
 ing white corpuscles pushing 
 through the walls by means of 
 amoeboid motion. a, a, a, a, 
 Cells in the act of passing through. 
 The red corpuscles of the frog are 
 oval, as seen in the figure. 
 
 The liquor sanguinis is a 
 clear, slightly thickened yellow- 
 ish fluid in which the corpuscles 
 float. It consists of serum and 
 the elements of fibrin. Fibrin 
 is an albuminous "substance 
 which remains in solution when 
 the blood is in motion in the 
 body, but when the flow of blood 
 is stopped for any reason in the 
 vessels, or when it has been lost 
 from the body, it appears as a network of fine fibrils which 
 entangles the corpuscles in its meshes and forms a jelly-like 
 mass called a blood-clot. 
 
 This process is coagulation, or clotting of the blood, and 
 a clot may be formed in a few minutes. It first includes 
 the serum in its substance, but this gradually separates, the 
 clot contracting in size, until the two are entirely separate. 
 The function of fibrin as a producer of clotting is of very great 
 importance : if clotting did not occur, a very small cut might 
 cause bleeding sufficient to empty the body and cause death ; 
 but in moderate cuts the clot forms quickly and. closing the 
 
THE FUNCTIONS OF THE BLOOD 49 
 
 bleeding vessels, stops the bleeding. Moreover, the material 
 which is produced for the permanent healing of the injured 
 part contains a principle identical with fibrin, which thus 
 exercises important healing functions. 
 
 The serum is liquor sanguinis from which the fibrin has been removed. 
 It contains albumen, a substance similar to the white of an egg, fatty 
 matters, carbonic acid, oxygen and nitrogen gases, and salts. The salts 
 of the blood must not be confused with the salt used for seasoning food 
 or with the " salts " used in medicine as a cathartic : they are substances 
 formed by the union of a base, such as iron or lime, with an acid. 
 Some of these salts enter into the formation of tissues, especially of 
 bone, others are decomposed and recombined in the body, and still 
 others are on their way to be thrown off as waste products. Certain of 
 them also increase the absorptive power of the serum for gases. While 
 the fatty matters are partly the means by which the supply of fat in the 
 body is maintained, they also are the main source of the secretions of 
 milk and bile, and, by their union with oxygen, assist in maintaining the 
 warmth of the body. Of the gases, the oxygen is a nutritive on its way 
 to be absorbed, and the carbonic acid is a waste product on its way to 
 be cast off. The albumen goes to the nourishment of the tissues, which 
 consist largely of modifications of it. 
 
 When, as the result of certain diseases, the serum passes out of the 
 blood-vessels, the condition is called dropsy. When it is distributed 
 through the tissues, giving them a puffed, swollen appearance, and the 
 depression made by pressing the finger into the swelling is not promptly 
 effaced, the condition is called cedema. When the serum collects 
 in cavities, it receives still other names. Dropsy of the chest occurs in 
 pleurisy, and ascites, or dropsy of the abdomen, is comparatively 
 common. 
 
 An important function of the blood is to maintain and 
 equalize the heat of the body, as well as to provide it with 
 the requisite moisture for the performance of the various 
 functions of life. 
 
 Its function as the source of the materials needed for the 
 nourishment of the system has been noted. It is a vehicle 
 for the reception and storage of nutriment — food, drink, and 
 oxygen — and for its conveyance to the tissues. 
 
 It absorbs refuse matters from the tissues and conveys them 
 to the organs provided for separating them and removing 
 them from the body. This process is more fully discussed in 
 connection with the apparatus for the disposal of waste. 
 
50 CONSTRUCTION OF THE HUMAN MACHINE 
 
 The vehicle' for the conveyance of food to and the carriage 
 of waste from the tissues, being the blood, we naturally look 
 for the force which moves the vehicle and the roads over 
 which it travels. The blood is kept in perpetual movement 
 through the body by a great stationary engine, the heart, 
 over innumerable roads called blood-vessels. 
 
 The heart is a hollow conical involuntary muscle, rather 
 larger than a man's closed fist — about five inches long and 
 between three and four inches wide, weighing about nine 
 ounces in woman, and eleven in man. It lies in the chest, 
 behind the breast bone, rather more upon the left side, with 
 
 
 Fig. 38. — Human heart, front view. 
 a. Right ventricle, b. Left ventricle. 
 c. Right auricle. d. Left auricle. 
 e. Pulmonary artery, f. Aorta. 
 
 Fig. 39. — Human heart, back view. 
 a. Right ventricle. b. Left ven- 
 tricle, c. Right auricle, d. Left 
 auricle. 
 
 its larger end, or base, above, and its point, or apex, point- 
 ing downward and to the left. It rests upon the midriff below, 
 and its apex during life beats against the chest wall in the 
 space between the fifth and sixth intercostal cartilages, 
 about two inches below the left nipple, and an inch and a half 
 to the left of the middle line of the body. At this point the 
 beating of the heart can readily be felt, heard, and often seen 
 moving the chest Wall as it strikes against it. 
 
 The heart, practically consisting of two conical muscles 
 laid side by side, is usually considered as divided by a par- 
 tition into two divisions which have no communication with 
 one another. Each of these divisions contains two cavities, 
 separated from one another by a horizontal muscular wall 
 containing a communicating aperture. The upper cavities 
 are called auricles, right and left, and the lower are known as 
 
THE HEART 
 
 Si 
 
 ventricles, right and left, and the openings between them are 
 the auriculo-ventricular openings, right and left. 
 
 The walls of the auricles are thin and rather membranous, while 
 those of the ventricles are thicker and muscular. The walls of the left 
 ventricle are the thicker, and the muscle the more powerful because of 
 the greater amount of work it has to do. Each of these chambers con- 
 tains other openings, where the great vessels communicate with them. 
 These apertures are all provided with valves which permit the blood 
 passing through them to go in but one direction. The valve on the 
 right side, which permits 
 blood to pass from the right 
 auricle to the right ventricle, 
 but prevents its return, 
 is called the " tricuspid " 
 valve, because it consists 
 of three little membranous 
 flaps which fall over the 
 opening and close it, being 
 kept from falling through to 
 the other side by a number of 
 fine cords attached to them. 
 The valve on the left side 
 is called the " mitral " valve, 
 from its supposed likeness 
 to a bishop's mitre, and con- 
 sists of two flaps which close 
 together in the same manner 
 as those of the tricuspid 
 valve. 
 
 The other apertures in the 
 heart are the openings of the 
 great blood -vessels.the veins, 
 into the auricles, and the 
 arteries into the ventricles. 
 Valves are situated at these openings also, those in the auricles prevent- 
 ing the return of the blood into the veins, and those in the ventricles 
 preventing the return from the arteries. The vessels all enter the heart 
 at its base, — the upper extremity, — and the heart is suspended from the 
 chest walls by them. 
 
 The heart is enclosed in a bell-like membranous sac, the pericardium, 
 the lower end of which, in order to give room for the play of the apex of 
 the heart, spreads out on the midriff, while the upper end is lost 
 upon the great blood-vessels. This sac is lined with a serous membrane, 
 which is also continued over the surface of the heart itself: serous sur- 
 
 Fig. 40. — The heart, in relation to the chest 
 walls and the lungs, the flap of the latter 
 which partly covers it in front, having been 
 removed, vi. Innominate vein. ao. Aorta. 
 v. c. Superior vena cava. r. au. Right 
 auricle. 1. au. Left auricle, r. v. Right 
 ventricle. /. v. Left ventricle. 
 
52 CONSTRUCTION OF THE HUMAN MACHINE 
 
 faces are characterized by extreme smoothness, which is increased by 
 the secretion of a lubricating fluid. This, then, makes it possible for 
 the surfaces of the heart and pericardium to glide upon one another 
 with the least possible amount of friction. 
 
 The blood-vessels are closed pipes or tubes through which 
 the fluid blood is propelled throughout the body. They are 
 of three kinds, — the arteries, the capillaries, and the veins. 
 
 The arteries are fibro-muscular tubes through which the 
 blood is carried from the heart to the various portions of the 
 body. They permanently retain the shape of a hollow cylin- 
 der, even when empty. They are open from end to end, 
 presenting no valves to limit the flow of blood in them. 
 Consequently, if one of them be cut, the blood will continue 
 to flow from the wound until there is none left in the body, 
 and death will follow unless it be closed. 
 
 They contain a large amount of elastic tissue in their walls, which pre- 
 vents shock from the sudden influx of blood following a heart-beat, 
 maintains an equal pressure during the interval between the heart-beats, 
 enables the vessels to adapt themselves to any increase or diminution 
 in the amount of blood, and also to different movements of the body. 
 The muscular elements of the arteries regulate the amount of blood to 
 be received by each part or organ at any given time in accordance with 
 their needs ; and when an artery is cut, the muscular elements diminish 
 the size of the opening, in some cases even closing it, and help to check 
 the bleeding. 
 
 Two great arteries start from the ventricles, the pulmonary 
 artery from the right, and the aorta from the left. These 
 break up by continual dividing into a great number of 
 branches, constantly diminishing in size. The smallest 
 arteries are sometimes called arterioles. 
 
 The smaller arteries freely communicate with one another by branches 
 extending from one to another, thus constituting an arterial network. 
 This communication is called anastomosis. It is a wise provision to 
 obviate the cutting off of the blood supply and producing the death and 
 decay of a part by the closure of the artery supplying it. The intercom- 
 munications of the arteries are especially extensive about the joints, the 
 upper extremity, and the head. In consequence of this anastomosis, 
 when an artery is cut, the blood flows not only from the end toward the 
 heart, but when that is closed by any means, the blood passes around 
 through an anastomosis and spurts out through the farther end of the 
 
THE BLOOD-VESSELS 
 
 53 
 
 vessel. This route for the blood around an accidental closure is called 
 the collateral circulation, and where it exists freely it makes it neces- 
 sary to close both ends of a divided artery. 
 
 The capillaries are the smallest of the blood-vessels, and 
 may be considered either as the terminations of the arteries 
 or the beginnings of the veins, for it is impossible to ascertain 
 the exact point at which the venules begin or the arterioles 
 end. They form an immense network, furnishing the blood 
 supply of the entire system, and are characterized by main- 
 taining the same diameter from end to end, unlike other 
 vessels, which diminish in size in one direction. They are 
 about 3 0V0 of an inch in diameter, and 
 are composed of two very delicate 
 membranes, which do not interfere 
 with the passage of the constituents of 
 the blood through them into the tissues, 
 or from the tissues into the blood. It 
 is in these vessels that the final aim of 
 the circulation is accomplished. Here 
 is extracted from the blood the nutrition 
 brought into the circulation by the 
 arteries, and here the blood acquires 
 the waste products which are to be 
 carried away by the veins. 
 
 The veins are formed by the union 
 of two or more capillaries, and contin- 
 ually joining together, ultimately form 
 
 large trunks, just as the little brooks and streamlets join to 
 form larger streams, and, by continually uniting, at last 
 form the mighty river flowing down to the sea. Finally the 
 veins unite into two great venous trunks, — the inferior vena 
 cava, bringing the blood from the body and lower extremities, 
 and the superior vena cava, bringing the blood from the head 
 and the upper extremities into the right auricle. The pulmo- 
 nary veins, four in number, bring the blood from the lungs to 
 the left auricle. 
 
 Unlike the arteries, the veins collapse when empty, and 
 enlarge when filled. This can readily be seen in the veins 
 
 AttcTU 
 
 Fig. 41. — Capillary network 
 from the bowel, showing 
 how the capillaries con- 
 nect the veins and arteries. 
 
54 CONSTRUCTION OF THE HUMAN MACHINE 
 
 in the hand and forearm, which are ordinarily small and 
 inconspicuous, but after any exercise which tends to increase 
 the flow of venous blood, or when the arm is tightly bound 
 so as to delay the flow of blood toward the shoulder, the 
 vessels become large and prominent. 
 
 Unlike the arteries, the flow of blood in which is caused by the pump- 
 ing of the heart, the veins have no organ which directly forces their 
 contents to their destination. The movement of blood through the 
 veins is due to four causes, (i) The 
 pressure behind of the blood pushed into 
 the capillaries from the arteries by the 
 heart; this is the main cause. (2) The 
 presence of valves at frequent intervals, 
 which prevent the backward flow of blood. 
 This provision in veins is of great surgical 
 importance, for the blood can only flow 
 from the smaller end of the vein, which 
 greatly diminishes the danger of bleeding 
 in such injuries. (3) The pressure of 
 muscles upon the veins presses out the 
 blood from the veins underneath them, 
 
 Fig. 42. Diagram showing a and; as the valves prevent its retreat, it 
 
 vein with the valves ciosed. must go forward. (4) The suction on the 
 The blood is passing off in large veins, when, in breathing, the air is 
 this case by a lateral channel, drawn into the lungs, also assists slightly 
 as indicated by the arrow. in the movement f the blood. 
 
 The blood has two distinct courses, called the pulmonic or 
 lung circulation, and the systemic circulation. In the lungs 
 the blood is purified, and in the system it is polluted. 
 
 Such are the various portions of the machinery by which 
 the blood is forced through the body. The blood-vessels are 
 simply pipes through which the blood is forced by a pump. 
 The pump is the heart, and its mechanism is very simple. 
 The blood having passed through the auricle into the ventricle, 
 the muscular fibres contract and the walls of the cavity are 
 brought together ; the backward pressure closes the valve at 
 the auriculo-ventricular opening, leaving in each side of the 
 heart but one means of exit — the opening into the aorta in 
 the left ventricle, and that into the pulmonary artery in the 
 right ; the blood is consequently forced into these vessels. 
 
THE CIRCULATION OF THE BLOOD 
 
 55 
 
 As the ventricle contracts, the 
 corresponding auricle relaxes 
 and is filled with blood. The 
 contents of the ventricle having 
 been expelled, it relaxes while 
 the auricle contracts, filling it 
 again. This contraction and 
 relaxation of the heart muscle 
 produces the heart-beat ; it oc- 
 curs in the adult about seventy- 
 five times a minute. 
 
 The circulation of the blood 
 is well shown in the accom- 
 panying diagram. Starting in 
 the (i) lungs, where after its 
 excess of carbonic acid has been 
 cast off and its supply of oxy- 
 gen has been taken on, giving 
 the blood a bright red color, 
 (2) it passes through the pul- 
 monary veins into (3) the left 
 auricle ; thence through the left 
 auriculo-ventricular opening 
 into (4) the left ventricle, 
 where, by the contraction of 
 the ventricular walls, it is sent 
 through the aortic opening into 
 (5) the arteries. From the 
 arteries it floods the entire body 
 
 Fig. 43. — Diagram of the circulation. 
 I. The lungs. 2. The pulmonary veins. 
 3. The left auricle. 4. The left ven- 
 tricle. 5. The arteries. 6. The capil- 
 laries. 7. The veins. 8. The right 
 auricle. 9. The right ventricle. 10. The 
 pulmonary artery. II. The capillaries of 
 the liver. 12. The capillaries of the 
 spleen. 13. The capillaries of the ali- 
 mentary canal. 14. The kidneys. 
 
56 CONSTRUCTION OF THE HUMAN MACHINE 
 
 by means of the great network of (6) capillaries. In the capil- 
 laries, the blood discharges its load of oxygen and other nu- 
 tritious substances into the body, and takes on a load of waste 
 carbonic acid which changes its hue to a purplish tinge. The 
 blood, now darkened by impurities, passes on from the capil- 
 laries into (7) the veins, and thence, by a separate vein for 
 the upper and lower extremities, into (8) the right auricle of 
 the heart, and on into (9) the right ventricle, whence it is 
 thrown through (10) the pulmonary artery back into (1) the 
 lungs. 
 
 In the diagram are indicated also (11) the capillaries of the liver, (12) 
 those of the spleen, and (13) those of the alimentary canal, which unite 
 together to form the " portal circulation " so called, because all the blood 
 is delivered into the vena cava through the portal vein in the abdomen. 
 A portion of the blood also passes through (14) the kidneys, where is 
 performed a most important excretory function which will be considered 
 in connection with the apparatus for the disposal of waste. 
 
 It takes about half a minute for the blood to pass through 
 this entire course. During this period all the blood in the 
 body makes the circuit of the system. 
 
 The pulse is caused by the wave produced by throwing a mass of 
 blood into the arteries already containing that fluid. It is the same 
 effect as is produced by suddenly throwing a bucket of -water into a 
 quiet pool. Waves are made to travel in all directions. The blood 
 wave, as it travels through the vessels, striking upon the elastic wall of 
 the arteries, causes a temporary dilatation which is followed by imme- 
 diate contraction — this is the pulse. The pulse can be felt in any 
 artery, but for the sake of convenience, it is usually felt in the radial 
 artery on the outer side of the palmar face of the wrist. The pulse 
 wave could not be caused by the progress of the new blood thrown 
 out from the heart, for the wave travels much faster than the blood 
 itself; in any case, however, the difference is not more than a fraction 
 of a second. 
 
 The pulse beat agrees in frequency with that of the heart which causes 
 it. In adult life, the average number of pulsations in a minute is 75. 
 In infancy it runs between 120 and 100, and in old age between 70 and 
 60, although in extreme old age, " second childhood," it again becomes 
 more rapid, running between 75 and 80. The pulse of woman is usu- 
 ally more frequent than that of man, and it is more rapid when standing 
 than when lying down, quicker when exercising than when quiet, and 
 
THE ARTERIES AND VEINS 57 
 
 slower in rest or in the interval between meals than when exercising 
 mentally or physically or during digestion. 
 
 The pulse is an invaluable adjunct to the diagnosis of disease. 
 Fever is invariably characterized by increased frequency of the pulse, 
 the amount of quickening varying according to the variety of fever. 
 Inflammation causes rapidity of the pulse with a hard, tense feeling 
 added. In extreme weakness, as just before death, the pulse is very 
 rapid and very small, so that it is called "thready." A pulse of 160 in 
 an adult is an almost positive sign of impending death. The pulse may 
 be normally slow in certain individuals, and an abnormally slow pulse 
 is present in pressure on the brain and in opium poisoning. The pulse 
 may be irregular in its beat or even intermittent. Still finer distinctions 
 with regard to the character of the pulse are made, each one of which 
 have their value in the diagnosis of disease. 
 
 Differences between Arteries and Veins. — Before pro- 
 ceeding to a consideration of the individual arteries and 
 veins, we may with advantage briefly recite the differences 
 between the two varieties of vessels : (i) Arteries are stiff 
 tubes, having strong elastic walls and remaining open when 
 empty ; veins, on the contrary, are thin and flaccid, and their 
 walls collapse after their contents have flowed out. (2) Ar- 
 teries present no obstruction throughout their entire length ; 
 veins present frequent valves to prevent the backward flow of 
 blood. (3) Arteries present a rapid flow of blood with a 
 remittent pulsation dependent upon the heart beat; veins 
 present a slow and steady current. (4) Many veins lie close 
 to the surface, and where veins and arteries run together the 
 vein is almost invariably the more superficial ; the arteries lie 
 more deeply. (5) Arteries carry blood from the heart ; veins 
 bear it toward the heart. (6) Arteries are filled with bright 
 red blood, purified by oxygen for the nutrition of the system ; 
 veins bear a current of dark purplish blood, polluted with 
 carbonic acid and other waste matters. This condition is 
 reversed in the case of the pulmonary artery and vein. 
 
 The Arteries. — The aorta is the greatest artery in the body. Start- 
 ing from the left ventricle of the heart, by an orifice closed with semi- 
 lunar valves to prevent the blood flowing back into the ventricle, it 
 passes upward on the right side of the spine ; it then arches over across 
 the spine to the left side, where it descends through the chest, perforates 
 the midriff into the abdomen, and terminates opposite the fourth lumbar 
 vertebra. 
 
58 CONSTRUCTION OF THE HUMAN MACHINE 
 
 The innominate artery arises from the aorta, passes upward for from 
 one and a half to two inches and divides into the right common carotid 
 and right subclavian arteries. 
 
 The common carotid arteries arise, the right from the innominate, 
 the left from the left side of the arch of the aorta ; they pass up into the 
 neck, one on each side of the windpipe, running along a line followed 
 by the inner border of the sterno-cleido-mastoid muscles ; at a point 
 about an inch below the angle of the lower jaw they divide into an 
 internal and external branch. 
 
 The internal carotid arteries pass from the termination of each com- 
 mon carotid up to the base of the skull through canals in the temporal 
 bones and contribute to the supply of the brain and eyes. 
 
 The external carotid artery, not so deep as the internal, passes up 
 the neck to the temples, giving off branches to the larynx, pharynx, 
 tongue, scalp, ear, mouth, and nose. The facial branch can be felt as it 
 passes across the lower jaw bone, about an inch in front of the angle. 
 The temporal artery with its two branches, anterior and posterior, in 
 front of each ear, can always be felt and often seen beating under the 
 skin. 
 
 The subclavian artery, arising from the innominate on the right 
 side and from the aorta on the left, passes up on each side and curves 
 over the first rib, but under the collar bone, and again passes down to 
 the lower edge of the first rib, where it changes its name to axillary. 
 Lying on the first rib, it can be compressed on that bone to stop bleed- 
 ing in case of a wound of one of the arteries of the upper extremity. 
 
 The axillary artery is then a continuation of the subclavian from the 
 lower border of the first rib, whence it extends across the armpit into 
 the arm, where it changes its name to brachial. 
 
 The brachial artery is a prolongation of the axillary, and runs down 
 the arm along the inner edge of the biceps muscle into the forearm, 
 about an inch below the bend of the elbow, where it divides into the 
 radial and ulnar. Its course is approximately shown by a line extend- 
 ing from the middle of the armpit to the middle of the elbow. It lies 
 on the arm bone, along the inner margin of the biceps muscle and com- 
 paratively near the surface, so that it can readily be compressed. 
 
 The radial artery, one of the terminal branches of the brachial, ex- 
 tends down the outer side of the forearm to the wrist, on a line extending 
 from the middle of the elbow to just within the outer margin of the 
 lower end of the radius, where it turns and, winding around the back of 
 the thumb and between the thumb and forefinger, finds its way deeply 
 into the palm, which it crosses, forming the deep palmar arch by meet- 
 ing with a branch of the ulnar. Measuring off the palm in thirds and 
 indicating them by horizontal lines drawn across it, the upper line 
 would indicate the deep palmar arch and the lower one, near the fingers, 
 the superficial palmar arch, to be considered presently. 
 
THE ARTERIES 
 
 59 
 
 The radial artery is quite superficial in the lower part of the forearm, 
 and lies upon the radius, where its pulsation can be felt with great facil- 
 ity, for which reason the Pulse is usually felt at this point. The artery 
 can also be easily compressed against the bone. 
 
 The ulnar artery, the larger terminal branch of the brachial, extends 
 down the inner side of the forearm to the wrist and into the palm, where 
 it turns and, crossing the palm and meeting a branch of the radial 
 which passes in front of the ball of the thumb, forms the superficial 
 palmar arch, which crosses the palm at the junction of its lower with 
 its middle third. 
 
 From the palmar arches digital arteries pass down to all the fingers 
 and the thumb. 
 
 As the aorta passes down the chest, it gives off a number of small 
 branches, among which the intercostal arteries, ten on each side, are 
 the most important from the standpoint of emergencies. Giving off 
 branches running along the inner surface of the upper and lower mar- 
 gins of the ribs, they are likely to be implicated in injuries of the chest. 
 
 Passing then into the abdomen, great arterial branches are given off 
 to the viscera, among which may be mentioned the gastric to the 
 stomach, the splenic to the spleen, the hepatic to the liver, the renal to 
 the kidneys, and the mesenteric to the bowels. 
 
 The common iliac arteries, the branches in which the aorta termi- 
 nates at the level of the fourth lumbar vertebra, pass downward and 
 outward to the brim of the pelvis, where they in turn divide into two 
 branches, internal and external. 
 
 The internal iliac arteries pass into the pelvis and give off branches 
 to the various pelvic viscera. 
 
 The external iliac arteries pass along the back of the pelvis in a 
 direction indicated by a line drawn from the navel to the middle of the 
 fold of the groin, on each side, where they pass out of the abdomen into 
 the thigh and become the femoral arteries. 
 
 The femoral artery, the continuation of the external iliac in the thigh, 
 passes down in a direction indicated by a line drawn from the middle 
 of the fold of the groin to the inner side of the knee. The upper portion 
 of the artery lies quite near the anterior surface of the thigh, and its 
 pulsation can readily be felt at this point ; this portion can also be com- 
 pressed in case of injury below it. Its lower portion plunges into the 
 thigh through a channel called Hunter's canal, passes through the 
 muscles and emerges at the back of the thigh, where it receives a new 
 name. 
 
 The popliteal artery — so called from the Latin word meaning ham — 
 is a continuation of the femoral through the middle of the back of the 
 thigh from its emergence on that face of the lower extremity to its 
 division into two branches a little below the knee. 
 
 The anterior tibial artery, one of the terminal branches of the pop- 
 
60 CONSTRUCTION OF THE HUMAN MACHINE 
 
 FiK . 44. -The Principal Arteries in their Relation to Other Structure 
 
THE VEINS. 
 
 6l 
 
 Fig. 45.— The Veins of the Body. 
 
62 CONSTRUCTION OF THE HUMAN MACHINE 
 
 liteal, plunges through the leg between the two bones and passes down 
 to the ankle, whence it passes on to the back of the foot, where it 
 becomes the dorsalis pedis artery, which is distributed to the back of 
 the foot. 
 
 The posterior tibial artery, the other terminal branch of the popliteal, 
 makes its way down through the calf of the leg to the inner side of the 
 ankle, where it curves forward about the internal maleolus into the sole 
 of the foot and ends in the plantar arteries, which supply the sole of the 
 foot. This artery lies very superficially at the ankle and can be readily 
 felt or compressed there. 
 
 The peroneal artery is given off by the posterior tibial soon after its 
 origin, and extends down the outer side of the leg to the ankle. 
 
 The Veins. — All veins carrying impure blood from the body back to 
 the right side of the heart are called systemic, in contradistinction to 
 the pulmonary veins, which carry pure blood from the lungs to the left 
 side of the heart. There are four pulmonary veins, two to each lung. 
 
 It being the duty of the systemic veins to carry back to the heart 
 the blood which has been brought into the system by the arteries, it is 
 natural that the veins should return back to the heart along the same 
 lines as the arteries took in passing out. It is found then to be the 
 case that one or more veins run parallel to every artery. Veins are, 
 however, especially near the surface found unaccompanied by arteries. 
 
 The systemic veins appear in two classes, the veins accompanying 
 arteries and penetrating deeply into the tissues, and the superficial 
 veins which run in or directly beneath the skin, where they can fre- 
 quently and readily be seen. 
 
 Accompanying each of the arteries of the foot, ankle, and leg are 
 veins known by the same name as their accompanying artery, or as the 
 vena coma of the artery. The anterior and posterior tibial veins unite 
 in the bend of the knee to form the popliteal vein which, passing through 
 the muscles to the front of the thigh, becomes the femoral vein, which 
 in turn, passing up on the inner side of the femoral artery into the ab- 
 domen, becomes the external iliac: The external iliac unites with the 
 internal iliac to form the common iliac on each side, and these unite in 
 turn to form the inferior vena cava, which delivers the blood into the 
 right auricle. 
 
 Into the vena cava in the abdomen also empty the hepatic vein from 
 the liver, and the renal veins from the kidneys, the latter having removed 
 from the blood passing through it the waste matter properly excreted 
 there. The hepatic vein carries the blood from the liver, into which 
 enters the portal vein formed by the union of the mesenteric, splenic, 
 and gastric veins, collecting the blood from the organs concerned in 
 digestion. This vessel subdivides in the liver substance to capillaries 
 in which the blood, containing matter from the digestive organs, under- 
 
THE VEINS 63 
 
 goes certain changes before passing out into the general circulation 
 through the hepatic vein. It will be observed that the liver contains 
 two systems of veins, one the nutritive veins of the gland itself, and the 
 other the digestive vessels. 
 
 Of the superficial veins of the lower extremity, two are particularly 
 prominent. The internal saphenous vein collects the blood from the 
 superficial parts on the inner side of the back of the foot, and passes up 
 the inner side of the lower limb, receiving, on its way, contributions 
 from numerous tributary veins. Arrived at a point just below the fold 
 of the groin, it dips down through a special opening in the fascia of the 
 thigh, to enter the femoral vein. 
 
 The external saphenous vein, from a similar origin on the outer side 
 of the foot, passes up the middle of the back of the leg and empties into 
 the popliteal vein just below the bend of the knee. 
 
 The small veins of the hand unite into the deep radial and ulnar, 
 which in turn unite just below the elbow to form the brachials, and 
 these become successively the axillary and the subclavian, each of 
 them following the course of the arteries of the same name. 
 
 The superficial veins of the palmar face of the forearm are very con- 
 spicuous and curious in their arrangement. The median vein passes 
 up the middle of the forearm, and just below the bend of the elbow it 
 divides into two branches, the median basilic and the median cephalic, 
 which form a V in front of the elbow. These veins are joined just above 
 the bend of the elbow by the radial and ulnar veins on either side, which 
 changes the V in front of the elbow to an M. The ulnar and the median 
 basilic unite to form the basilic, which a short distance above the elbow 
 enters into the brachial. The radial and the median cephalic unite to 
 form the cephalic, which passes up the outer side of the arm to the 
 shoulder, where it dips down between the shoulder and the pectoral 
 muscles to enter the axillary. 
 
 In the days of bloodletting, these veins were the favorite sites for that 
 operation. The median basilic is the larger, but on account of its 
 crossing the brachial artery, which is liable to be wounded, the median 
 cephalic was often chosen. These veins can readily be shown by tightly 
 bandaging the arm above the elbow, when, the progress of the blood to 
 the heart being checked, the veins below the bandage will swell and 
 become prominent under the skin. 
 
 The external jugular vein collects the blood from each side of the 
 face and the superficial portions of the head and neck, and passes down 
 the side of the neck to empty into the subclavian vein. These large 
 veins can often be seen prominently projecting in the neck. They are 
 the vessels usually cut by suicides in " cutting the throat." 
 
 The internal jugular veins collect the blood from either side of the 
 brain, and passing down by the side of the carotid artery, receiving by 
 the way veins from the neck and head, join with the subclavian to form 
 the common trunk, the innominate. 
 
64 CONSTRUCTION OF THE HUMAN MACHINE 
 
 At the junction of the left subclavian and internal jugular veins, the 
 thoracic duct, containing the food digested in the alimentary canal, 
 empties its contents into the blood. At the same point on the right 
 side the right lymphatic duct enters the veins. 
 
 The innominate veins, on either side, formed by the junction of the 
 subclavian and internal jugular veins, unite on the left side of the spine 
 just below the first costal cartilage to form the superior vena cava, which 
 carrier the blood into the right auricle. 
 
 Vascular Glands. — The spleen is an oval glandular organ, five 
 inches long by three wide and two thick, situated on the left side of 
 the abdomen, presenting no duct, having no secretion, and connected 
 with other organs only by the arteries which enter and the veins which 
 pass out of it. Just what its functions may be is unknown. Its removal 
 does not seem to affect the system in any evident way. It is thought by 
 some to be the organ in which red blood-corpuscles are manufactured 
 from the white, and that it also presides over the disintegration of the 
 red corpuscles when they are worn out. By others it is considered to 
 be a safety valve for the blood supplying the digestive organs. During 
 the act of digestion these organs demand a much greater blood supply 
 than when at rest, and it is thought that the surplus blood in the latter 
 case is stored up in the spleen. In chronic malarial affections the 
 spleen often becomes greatly enlarged, and is then vulgarly known as 
 " ague cake." 
 
 In the neck, just below the chin and in front and on either side of 
 the upper part of the windpipe, is another gland possessing no duct, 
 producing no secretion, and connected with other parts only by its blood- 
 vessels, — this is the thyroid gland or " throat sweetbread." This, too, 
 is thought to have something to do with the formation and destruction 
 of the blood corpuscles, but its function is not known positively. It is 
 this gland, become greatly enlarged, which forms the tumor in front of 
 the neck in " goitre." 
 
 CHAPTER VIII 
 
 THE SPEAKING AND BREATHING APPARATUS —THE 
 LARYNX AND THE LUNGS 
 
 From the posterior portion of the cavities of the mouth 
 and nose is suspended a combination of two organs which 
 greatly resembles an inverted hollow tree. The trunk of the 
 tree is formed by the larynx or organ of speech and the 
 trachea or windpipe ; the trachea divides into two branches 
 
THE SPEAKING AND BREATHING APPARATUS. 65 
 
 called bronchi or bronchial tubes, and these in turn divide — 
 the process of division keeping on until it finally terminates 
 in very minute tubes or pouches, called the pulmonary vesi- 
 cles, and these vesicles taken together form the lungs or, as 
 the butchers call them, the " lights." 
 
 Looking into the mouth, an arch will be seen at its back part, and 
 this arch marks the end of the mouth proper. A similar condition 
 exists at the posterior part of the nose. And the cavity into which both 
 the nose and the mouth open is called the pharynx. In its lower 
 portion- are two apertures, that of the larynx in front and that of the 
 oesophagus or "gullet" behind. 
 
 The larynx, the enlarged upper part of the trachea or windpipe, is a 
 short, irregularly shaped tube, in which is located the organ of speech. 
 At its upper limit is a cover composed of cartilage, which closes the 
 air passage when food is swallowed. At the moment of swallowing, the 
 larynx is drawn up against this cover, the epiglottis, and the cavity is 
 completely closed, so that, although the food passes directly over it, 
 none can enter. The accidental lifting of the epiglottis during the act 
 of swallowing, as sometimes occurs 
 during laughter, allows food to enter 
 the larynx, and the effort to expel it 
 produces the choking and coughing 
 always seen at that time. 
 
 The larynx can be felt from the 
 outside in front of the neck, where it 
 appears as a hard lump just under 
 the chin, known as "Adam's apple," 
 from an old story that it was a por- 
 tion of the forbidden fruit swallowed 
 by the common ancestor of humanity, 
 but which " stuck in his throat." It 
 is composed of a number of cartilages 
 bound together by ligaments, and 
 moved upon one another by mus- 
 cles. It is about an inch and a half 
 long and an inch in diameter. 
 
 Inside of the larynx are two nar- 
 row fibrous bands extending across it 
 from front to back : these are called 
 the vocal cords, and they are relaxed 
 
 or tightened by the laryngeal muscles moving the cartilages. The 
 vibration of the vocal cords, caused by the air passing over them from 
 the lungs, produces the voice. 
 
 Fig. 46. — Diagram of human larynx, 
 trachea, bronchi, and lungs, show- 
 ingthe ramification of the bronchi, 
 and the division of the lungs into 
 lobules. 
 
66 CONSTRUCTION OF THE HUMAN MACHINE 
 
 The larynx is constructed on the principle of a reed organ. It con- 
 tains but one pipe, but that one is susceptible of such adjustment that 
 no others are necessary. The vocal cords are the reeds. 
 
 The larynx is continuous below with the trachea or windpipe, a tube 
 composed of rings of cartilage, incomplete behind, and of elastic fibrous 
 membrane. These rings keep the tube constantly open, and prevent 
 interference with the passage of air by the collapse of the windpipe. 
 The trachea is from three-quarters of an inch to an inch in diameter, 
 and extends down the middle of the neck for four or four and a half 
 inches into the chest, where, opposite the third dorsal vertebra, it divides 
 into the right and left bronchi, one for each lung. 
 
 The bronchi, constructed in exactly the same manner as the trachea, 
 continue branching by dividing and subdividing to the terminal lobules 
 of the lung. The rings, as the bronchi decrease in size, become scarcer 
 and more irregular until they are but mere flakes of cartilage, and when 
 the tubes are reduced to a diameter of one-fortieth of an inch, they 
 disappear entirely. The tubes, however, still continue branching until 
 the walls consist of but a thin elastic membrane, which expands into a 
 little sac or lobule (Fig. 48), the walls of which are pouched out irregu- 
 larly into little pockets called air vesicles or cells. The air passages 
 are lined with mucous membrane, presenting upon its surface epithelial 
 cells covered with cilia or hair-like processes, which by a continual 
 waving motion carry off mucous and other secretions. 
 
 The lungs or "lights" thus formed are two in number, one in each 
 side of the chest. The fact of their substance consisting of air cells, 
 with elastic walls, gives them a light, spongy appearance and feeling. 
 They are covered externally by a smooth serous membrane, the pleura, 
 which also lines the inner walls of the chest, providing smooth surfaces 
 to avoid friction in the movements of the lungs in breathing. Although 
 these two pleural surfaces are ordinarily in so close contact as to leave 
 no vacancy between them, the cavity which may be formed is called the 
 pleural cavity. When these membranes become inflamed, we have 
 pleurisy, and the dropsical secretion which is then thrown out makes 
 the cavity between the two pleural surfaces apparent. 
 
 Between the lungs lie the heart in the pericardium, the oesophagus 
 or "gullet," the large bronchi, and the great vessels. Below the lungs 
 lies the dome-like diaphragm or midriff, a most important factor in 
 breathing. 
 
 The pulmonary veins and arteries penetrate to the substance of 
 the lungs with the bronchi, dividing and subdividing with them until, 
 in the walls of the ultimate divisions, the air cells are found in the 
 capillaries of the lungs. Between the blood in the capillaries and 
 the air in the air vesicles, nothing intervenes except the thin walls of 
 the vessels and the vesicles, so that it is possible for the blood readily 
 to cast off its carbonic acid and other impurities into the air of the 
 
BREATHING OR RESPIRATION. 
 
 6 7 
 
 Fig. 47. — Lobule of lung. 
 aa. Exterior of lobules. 
 bb. Vesicles of lung. 
 cc. Smallest bronchi. 
 
 lungs, and absorb from it the supply of oxygen needed for the nutrition 
 
 of the system. The enormous extent of the walls of the air cells is 
 
 evident when it is considered that the capilla -ies contained in them 
 
 must be able to contain a quantity of blood 
 
 equal to that contained in the capillaries of all 
 
 the rest of the body taken together. It has 
 
 been estimated that the surface afforded by 
 
 them is equal to more than ten thousand 
 
 square inches. How vast the number of these 
 
 cells is, may be inferred from this fact. 
 
 Breathing or respiration consists of 
 the alternate enlargement and contrac- 
 tion of the chest, by means of which 
 air is drawn into or forced out of the 
 lungs. Breathing air into the lungs is 
 called /aspiration, and expelling it fro?n 
 the lungs is called ^jrpiration. 
 
 The chief agent in breathing is the diaphragm or midriff, 
 the great dome-like muscular floor of the chest, which, when 
 its fibres contract, flattens down the 
 dome, increasing the amount of space 
 in the chest, and at the same time 
 causing the abdomen beneath it to 
 swell out. In addition to this, the 
 capacity of the chest is further in- 
 creased by the muscles which draw 
 the ribs upward and outward. These 
 acts create a vacancy in the chest, 
 which is filled by the air rushing 
 through the windpipe into the air cells 
 of the lungs. This is inspiration. 
 Expiration, or breathing out, is a 
 much more simple act, and consists simply in the relaxation 
 of the muscles causing inspiration, — the diaphragm resumes 
 its dome-like projection into the chest, the ribs drop to their 
 original position, and the elastic lungs contract to adapt 
 themselves to the reduced capacity of the chest. 
 
 These movements occur from fifteen to eighteen times a 
 minute in health. 
 
 Fig. 48. — Section of a single 
 lobule of human lung. 
 
 a. Ultimate bronchial tube. 
 
 b. Cavity of lobule, c, c, c. 
 Pulmonary cells or vesicles. 
 
68 CONSTRUCTION OF THE HUMAN MACHINE 
 
 In case of an obstruction in the windpipe, or any other interference 
 with the free entrance and exit of air, the breathing is much more diffi- 
 cult, and in this case most of the muscles of the chest, neck, and 
 
 shoulders, and some on the 
 back, join with the muscles 
 named in the effort to expand 
 the chest — the act then being 
 called forced respiration. 
 
 There are a number of 
 common acts closely allied 
 to breathing which it may be 
 interesting to consider here. 
 Sighing consists of a pro- 
 longed and almost noiseless 
 inspiration, followed by a sud- 
 den noisy expiration, due to 
 the elastic recoil of the lungs 
 and chest walls. 
 
 In hiccup the inspiration 
 is sudden, from the spasmod- 
 ic action of the diaphragm, 
 causing the air to rush sud- 
 denly through the larynx and 
 produce the peculiar sound. 
 
 Coughing consists first of 
 an inspiration and then, when 
 the lungs have been filled, 
 the air is not immediately let 
 out through the larynx, which 
 is momentarily closed so 
 that the abdominal muscles 
 strongly act in pushing the 
 viscera up against the dia- 
 phragm, and increase the pressure on the air in the lungs, until the 
 tension is sufficient to overcome the spasmodic closure which opposes 
 its passage. This makes it possible to drive a stream of air with con- 
 siderable force upon any mass of mucus or other obstructing matter 
 and expel it. 
 
 Sneezing is similar to coughing, except that the force of the expi- 
 ratory act is spent on the nostrils. 
 
 Speaking has already been referred to ; it should be observed that 
 the vocal cords produce the sounds only, and that the words are formed 
 by the tongue, teeth, lips, and palate. 
 
 Singing is a modification of speaking, the key being altered by vari- 
 ations in the tension of the vocal cords. 
 
 Fig. 49. — The changes in the chest during 
 breathing. In A, the ribs are seen to be lifted 
 up and the diaphragm pressed down to in- 
 crease the capacity of the chest in inspiration. 
 In B, the ribs are seen to be drawn down, 
 and the diaphragm is lifted up, diminishing 
 the capacity of the chest in expiration. 
 
BREATHING AND THE BREATH 69 
 
 Sobbing, laughing, and yawning are still other modifications of the 
 act of breathing. 
 
 In each respiratory act, during ordinary breathing, from twenty-five to 
 thirty cubic inches of air are drawn in and expelled from the lungs. This 
 quantity of air, constantly flowing in and out, is known as the tidal air. 
 But much more than this quantity can be drawn into the chest. After 
 an ordinary inspiration, about a hundred cubic inches of air can be 
 drawn into the lungs in addition to that already there ; this is the com- 
 plemental air. On the contrary, after an ordinary expiration, about a 
 hundred cubic inches of air can be expelled from the lungs by a forcible 
 expiration, and this is the reserve air. But after every effort has been 
 made to empty the air cells, there still remains a quantity of air equal to 
 about a hundred cubic inches ; this is the residual air. The amount 
 of air which can be forcibly expired after taking the deepest possible 
 inspiration, is the vital capacity, and, including the tidal, comple- 
 mental, and reserve air, amounts to about 225 cubic inches. 
 
 The complemental and reserve air are drawn upon in running, row- 
 ing, or other violent exercise, at which time the full vital capacity of the 
 lungs is often employed. 
 
 The air which we inspire contains seventy-nine parts of 
 nitrogen and twenty-one parts of oxygen, with a mere trace 
 of carbonic acid and other matters of animal or vegetable 
 origin. When, however, it is returned to the atmosphere by 
 ^.rpiration, its composition has been changed. None of the 
 nitrogen has been lost — indeed, it rather gains in amount ; 
 but five parts of the oxygen have been lost, while the car- 
 bonic acid has increased by four and a half parts. Light as 
 are these two gases, a man ordinarily throws out in the breath 
 more than two pounds of carbonic acid a day, and consumes 
 in the lungs a trifle less of oxygen. A large quantity of water 
 and some animal matter are also thrown out from the lungs. 
 
 The blood coming into the lungs from the body is laden 
 with carbonic acid to be expelled there. This gas, when 
 breathed in large quantities, is fatal to life. 
 
 Oxygen in the air that is breathed is an absolute necessity, 
 and its absence for but a short period will cause rapid death. 
 In a tightly closed room the oxygen of the air may be used 
 up by repeatedly breathing it until, unless there is some 
 means of renewing the supply, smothering will close life just 
 as surely as if a pillow were pressed tightly over the face. 
 The chinks about the doors and windows often allow the 
 
70 CONSTRUCTION OF THE HUMAN MACHINE 
 
 passage of sufficient fresh air into a room to prevent death, 
 while at the same time not admitting enough to fully supply 
 the demands of the system for oxygen ; headache, languor, 
 and unaccountable weakness result from this partial smother- 
 ing. It must be admitted, however, that the disagreeable 
 sensations are probably due also to some extent to breathing 
 again the decaying animal matters thrown out in small quan- 
 tities in each breath. The continual breathing of impure air 
 with an insufficient supply of oxygen has a deleterious effect 
 upon the health, and many deaths have been hastened if not 
 directly produced by it. 
 
 This is the reason why ventilation or the supply of ample 
 quantities of fresh air has been so strongly dwelt upon by 
 physicians and sanitarians ; and why the medical man insists 
 so earnestly upon the desirability of providing sleeping and 
 living rooms with suitable ventilators, and with ample means 
 for keeping them open. 
 
 CHAPTER IX 
 
 THE DIGESTIVE APPARATUS — THE ALIMENTARY CANAL 
 AND ITS APPENDAGES 
 
 The digestive apparatus is that portion of the human ma- 
 chine in which material destined to repair the wear and tear 
 is worked up into a condition suitable for its purpose. The 
 process by which the oxygen of the air has been conveyed 
 into the system through the lungs has been described, and it 
 remains to refer briefly to the manner in which other materi- 
 als are adapted to the nutritive process. 
 
 The forms in which foods are absorbed are four in number : 
 (i) Nitrogenous matter, of which the egg is a perfect exam- 
 ple. (2) Fats. (3) Sugar; and (4) metals. All these are 
 present at the same time in some articles of food, such as 
 milk, while others may contain but one or two. The object 
 of digestion, then, is to convert these four varieties of food 
 
THE DIGESTIVE APPARATUS 7 1 
 
 into a form suitable for introduction into the blood, and 
 carriage to the system by it. 
 
 The first step in the process of digestion occurs in the mouth. Here 
 the food is chewed by the teeth into a mass of fine particles, each of 
 which can readily be reached by the digestive juices. The teeth have 
 been fully described in connection with the anatomy of the jaws. They 
 are assisted in their work by the tongue, a large, free, muscular organ, 
 which keeps the food between the teeth during the act of chewing, and 
 forms it into a mass of a shap a suitable for swallowing. 
 
 Opening into the mouth are three pairs of glands like minute bunches 
 of grapes, which also contribute to digestion. They secrete the saliva 
 or " spittle." The parotid glands lie just below the temples on either 
 side ; their location will be remembered by every one when it is re- 
 called that it is the inflammation and swelling of these glands which 
 causes the " mumps." Under the lower jaw and at the root of the 
 tongue are other salivary glands, the submaxillary and sublingual 
 glands. Chewing the food mixes it with saliva, which not only lubri- 
 cates the mass and makes it easy to swallow, but changes a portion of 
 the starches it contains into sugar. Bread, beans, corn, or wheat can- 
 not be absorbed without change ; the starch, of which they chiefly con- 
 sist, must first be transformed into sugar. 
 
 Up to this point the food has been under the control of the will, but 
 now it is pushed by the tongue back into the pharynx, over the epi- 
 glottis, where it is seized by the pharyngeal muscles and passed into the 
 oesophagus or " gullet," and the will can control it no longer. A knowl- 
 edge of this fact is sometimes useful in administering pills to children 
 or animals; if the mouth be opened and the pill be pushed back to the 
 root of the tongue, it passes beyond the child's control and into the 
 stomach. A mouthful of water swallowed immediately after will help 
 to carry it into the stomach. 
 
 The alimentary canal is a musculo-membranous tube from twenty 
 to thirty feet in length, with a diameter varying at different points, re- 
 ceiving ducts connecting it with certain accessory organs, and bearing 
 different names in its different parts. 
 
 The oesophagus or gullet, the first division of the alimentary canal, 
 runs behind the windpipe and the heart, in front of the spine and be- 
 tween the lungs, through the neck and chest, perforates the diaphragm 
 or midriff, and ends in an expansion of the canal, called the stomach. 
 It is about ten or eleven inches long from the pharynx opposite the fifth 
 cervical vertebra to the stomach opposite the ninth dorsal vertebra. 
 Its muscular coat is composed of involuntary fibres so arranged as to 
 carry the food downwards. When not dilated by food, it is collapsed. 
 
 The stomach (Fig. 50) is the most dilated portion of the alimentary 
 canal, and it is the principal organ of digestion. It appears in the form 
 
72 CONSTRUCTION OF THE HUMAN MACHINE 
 
 of an irregularly conical bag with tubes opening into either end, and 
 lies chiefly on the left side of the abdomen, under the diaphragm, and 
 protected by the lower ribs. Its size is subject to greater variations 
 than any other organ in the body, according as it is full or empty, and 
 according to individuals ; but it averages twelve inches long and tour 
 in diameter, with an average capacity of about four pints. The oesoph- 
 agus enters at the larger extremity, and its opening is called the cardiac 
 orifice, from its proximity to the heart ; its other opening, connecting it 
 with the small intestine, is called the pyloric orifice, and is guarded by 
 a sort of valve, the pylorus or " gate keeper." 
 
 Fig. 5G. — A section of the stomach and upper bowel, showing the internal arrange- 
 ment, the location of the hepatic and pancreatic ducts from the liver and pan- 
 creas respectively, and the valvules conniventes. 
 
 The walls of the stomach are formed (a) by an external smooth serous 
 coat, derived from the peritoneum, the general lining of the abdomen ; 
 (b) two muscular coats extending horizontally and perpendicularly, 
 and by their contractions producing the peculiar movements of the 
 organ ; (c) an internal lining of mucous membrane continuous with 
 that of the intestine below and, through the oesophagus, with that of the 
 mouth above. In the mucous membrane are found a multitude of 
 glands which, when food comes into the stomach, pour forth the gastric 
 juice, a sour liquid which acts upon the food in the stomach and con- 
 tinues the process of digestion. So long as any food remains in the 
 stomach, the muscles keep up a churning movement which thoroughly 
 mixes the contents with the gastric juice, and greatly aids the digestion. 
 
THE STOMACH AND BOWELS 73 
 
 A small part of the food is completely digested here and absorbed into 
 the blood in the capillaries of the stomach ; the remainder is converted 
 into a thick, whitish fluid called chyme, which passes on into the small 
 intestine, where it is acted upon by other agents. 
 
 Fig. 51. — The contents of the abdomen. The liver is shown at the top, drawn up so 
 as to show the gall bladder underneath. The stomach is seen on the right with 
 the duodenum passing out from it. Crossing the abdomen just below the stomach 
 is the large intestine, which may be traced up the right side of the body, across, 
 and down the left side. In the centre is seen the small intestine gathered into a 
 twisted mass. 
 
 At the pyloric end of the stomach, and under the left end of the liver, 
 the alimentary canal contracts again into a slender tube called the small 
 
74 CONSTRUCTION OF THE HUMAN MACHINE 
 
 intestine, bowel, or gut. About one inch in diameter and twenty feet 
 long, it is attached to the lumbar portion of the spine by a membrane 
 called the mesentery, which is disposed in numerous folds to adapt 
 itself to the turns of the intestine, which is rolled into a mass suitable to 
 lie in the cavity of the abdomen. The small intestine is divided by 
 anatomists into three parts : the first eight or ten inches is known as 
 the duodenum ; the two fifths following is called the jejunum, from the 
 Latin word meaning empty, because it is usually found empty after 
 death ; the remaining three fifths is known as the ileum, from the Greek 
 word meaning to twist, because of the numerous folds into which it is 
 thrown. The small intestine presents a serous, a muscular, and a mu- 
 cous coat. The mucous coat presents numerous folds called valvulae 
 conniventes (Fig. 50), which greatly increase the amount of surface 
 coming into contact with the food. It also presents an immense num- 
 ber of little projections called villi, which give it a velvety appearance : 
 through the villi the digested food passes into the blood. A number 
 of glands are also found producing a fluid, the " succus entericus," 
 which promotes digestion. Into the small intestine open ducts from 
 the liver and pancreas (Fig. 50), giving passage to fluids fulfilling a 
 most important function in digestion. 
 
 There are two important glands which pour into the small intestine 
 fluids essential to digestion : these are the liver and pancreas. The 
 liver is the largest gland, and indeed the largest single organ, in the 
 
 body, weighing three or 
 four pounds, and meas- 
 uring ten or twelve inches 
 in breadth, six or seven 
 in thickness, and two or 
 three in depth. It lies 
 on the right side of the 
 abdomen, and is slung 
 by its ligaments high up 
 against the diaphragm 
 and under the lower ribs. 
 It is a large, reddish 
 brown organ, marked by 
 a number of fissures di- 
 viding it into lobes, in 
 one of which lies a membranous bag, the gall bladder, in which is 
 held in reserve a quantity of the secretion of the liver. It is connected 
 with the small intestine by the portal vein, which collects the blood from 
 the bowels, and by the gall duct, which carries its secretion into them. 
 The liver has two chief functions : (1) It produces the bile, a yellowish 
 brown fluid of an intensely bitter taste, which (a) assists in converting 
 the contents of the small intestine into a form suitable for absorption 
 
 Fig. 52. — The liver seen from below. 
 
THE PANCREAS AND LARGE INTESTINE 75 
 
 into the blood, and (b) acts as a stimulant to the muscles of the bowel, 
 thus producing some cathartic action. (2) It completes the digestion 
 of certain portions of the food already absorbed into the blood, and 
 produces sugar, the burning of which aids in maintaining the heat of 
 the body. 
 
 The pancreas, which derives its name from the Greek words meaning 
 "all-flesh," is known to butchers as the "belly sweetbread," in distinc- 
 tion from the thyroid gland or " throat sweetbread," and the thymus 
 gland or " breast sweetbread." It is a tongue-like mass lying across the 
 back of the abdomen with its smaller extremity or " tail" on the left, 
 is six or eight inches long, and from a half an inch to an inch thick. 
 From its larger end passes out the pancreatic duct, which joins with the 
 bile duct from the liver 
 and enters the small 
 intestine. The pancre- 
 atic juice completes the 
 digestion of the digesti- 
 ble portions left un- 
 touched by the other 
 fluids, but its chief func- 
 tion is the division of Fig. 53. — The pancreas, 
 fats and oils into parti- 
 cles sufficiently minute to permit of absorption into the blood. The 
 digested food is now a milky fluid called chyle. 
 
 The process of digestion, then, begun by finely dividing the food 
 and converting a part of the starch into sugar in the mouth, is con- 
 tinued by the churning movement and the mixture with the gastric 
 juice in the stomach, converting the food into chyme. The chyme, in 
 the small intestine, mixes with the bile and the pancreatic and intestinal 
 juices, which convert it into chyle. Certain portions of the digested food 
 are absorbed into the circulation by the veins of the stomach, and 
 others pass through the veins of the mesentery and the portal vein into 
 the liver, while still others are absorbed by a set of vessels called lacteal 
 from their milky white appearance when full of chyle, and which pass 
 from the villi of the intestine into the mesentery and through small 
 glands also in the substance of the mesentery, into the thoracic duct, 
 which empties them into the left innominate vein, whence they pass into 
 the general circulation. 
 
 The small intestine, just above the right groin, runs into the large 
 intestine (Fig. 51), which, about five feet in length and thrice the size 
 of the lesser bowel, passes up to about the level of the " navel," arches 
 across the abdomen, and descends on the other side, where, passing to 
 the middle line, it descends and opens on the external surface of the 
 body. A valve — the ileo-csecal valve — at the junction of the small 
 with the large intestine prevents the return of matter which has passed 
 
j6 CONSTRUCTION OF THE HUMAN MACHINE 
 
 into the latter. A dilated pocket at the beginning of the large intestine 
 is called the caecum, and from it passes a worm-like process called 
 the appendix vermiformis, the function of which is unknown, but which 
 is of great surgical interest from its liability to become inflamed and 
 produce an abscess which is exceedingly dangerous to life. The re- 
 mainder of the large intestine, except the last six or eight inches, is 
 called the colon. The last portion is called the rectum, and terminates 
 externally in the anus or fundament. But little if any digestive action 
 goes on in the large intestine, the principal work of which is absorption. 
 As its contents approach its lower extremity, they become more and 
 more solid and free from nourishment, until finally only the waste 
 matter is left, in the form of excrement, which is thrown off. 
 
 CHAPTER X 
 
 THE APPARATUS FOR THE DISPOSAL OF WASTE — THE 
 EXCRETORY APPARATUS 
 
 A considerable amount of matter is introduced into the 
 alimentary canal which cannot be utilized for the nourish- 
 ment of the system, and the various operations of the human 
 machine cause parts to be worn away which, in the process 
 of repair, are replaced by new ones and thrown off. This 
 process of casting off useless, worn, or waste matters from 
 the body is called excretion. 
 
 Excretion is accomplished through the skin, the lungs, the 
 rectum, and the kidneys with the bladder. 
 
 In the skin, which has been described in the chapter devoted to it, 
 are millions of glands through which water is extracted from the blood 
 and thrown off — the sweat glands, producing the perspiration. The 
 evaporation of the perspiration is an important provision for keeping 
 the surface of the body cool, and is the original utilization of the prin- 
 ciple which the soldier adopts when he wets the canvas cover of his 
 canteen in hot weather to cool its contents. Perspiring is constantly 
 going on, although it is imperceptible except during unusual physical 
 exercise or great heat, when the sweat is poured out faster than it can 
 be removed by evaporation, and it stands out in drops upon the skin. 
 When perspiration is unusually abundant, the amount of water excreted 
 by the kidneys is diminished. In addition to the water, the perspiration 
 
THE EXCRETORY APPARATUS 
 
 77 
 
 carries out of the system salt, — which can readily be appreciated by the 
 taste, — carbonic acid, a poisonous exhalation called urea, and other 
 noxious substances. In case of extensive injuries, such as burns, where 
 a considerable extent of the skin is injured so that its excretory functions 
 cannot be exercised, and the blood relieved of the impurities collecting 
 there, serious and often fatal results may follow. 
 
 The lungs, which have been considered in the chapter on the breath- 
 ing and speaking apparatus, throw off more than two pounds of carbonic 
 acid a day, a little less than a pint of water, and about three grains of 
 decaying animal matter and ammonia. 
 
 Reference to the rectum has been made in the preceding chapter in 
 connection with the large intestine. As the food taken through the lips 
 passes down the alimentary canal, it comes in contact with various juices 
 which prepare the nourishing parts of 
 it for absorption, and these portions 
 are gradually passed into the blood 
 at points throughout the stomach and 
 bowels until, when it arrives in the 
 lower bowel, only the refuse matter 
 which cannot be utilized is left. This 
 takes the form of excrement and is 
 cast off. 
 
 The kidneys are two glandular or- 
 gans situated in the loins on the pos- 
 terior wall of the abdomen on either 
 side of the spinal column. They are 
 shaped like large beans, and are about 
 four inches long, two and a half broad, 
 and an inch and a half thick ; they 
 weigh about a quarter of a pound 
 each. They are composed chiefly of 
 arteries, veins, and urinary tubes, and 
 these are combined in such a way as 
 to produce a cortex or bark-like sub- 
 stance and a medullary or central sub- 
 stance. The arteries are larger than 
 the veins, so that a greater bulk of 
 blood is brought into the kidneys than 
 is carried away from them ; the bulk 
 
 is reduced by the passage of a portion of the water with certain waste 
 products, notably urea, into the urinary tubules. The extremity of each 
 urinary tubule is expanded into a sac (Fig. 55), into which a small 
 arterial twig runs and is subdivided and turned and twisted upon itself, 
 until it passes into a minute venous tube of a somewhat smaller size ; the 
 blood then being pushed through into the vein, the water is forced out 
 
 Fig. 54. — A kidney divided length- 
 wise. I. The cortex. 2. Pyra- 
 mids of urinary tubes. 3, 3. Apex 
 of pyramids. 4. Pelvis of the 
 kidney. 5. Ureter. 6. Renal ar- 
 tery. 7. Renal vein. 8. Small 
 vessels in the kidney. 
 
78 CONSTRUCTION OF THE HUMAN MACHINE 
 
 through the walls of the small vessels into the enclosing sac and carried 
 off by the urinary tubule. The sacs with the intertwined vessels are 
 called malpighian tufts. These tufts form the principal portion of the 
 cortical substance of the kidney. Besides the water removed from the 
 
 blood in the kidneys, a considerable 
 number of chemical salts are excreted 
 with it, and some waste animal com- 
 pounds, particularly urea, a noxious 
 substance referred to in connection 
 with the perspiration. The fluid thus 
 formed of water, salts, and animal 
 compounds is a yellowish liquid 
 known as urine. 
 
 The urinary tubes pass down to a 
 cavity at what corresponds to the hilus 
 of the bean, and is called the pelvis of 
 the kidney, from which passes out a 
 tube about the size of a goose quill, 
 and runs down along the back to the 
 bladder: this is the ureter, and its 
 function is to carry the urine from the 
 kidneys to the bladder. A little more 
 than three pints of urine is formed 
 during a day. 
 
 The urinary bladder is a bag formed 
 of involuntary muscle and membranes, 
 lying in the cavity of the pelvis. Its 
 function is to store the fluid continu- 
 ally secreted by the kidneys until such 
 time as is convenient to discharge it. 
 When moderately distended, it con- 
 tains about a pint, and is oval in form, 
 measuring about five inches in height and three in breadth. In the 
 bladder chemical salts may settle and form a hard deposit, which in- 
 creases in size until it resembles a veritable stone : this is " stone in the 
 bladder." The act of discharging the contents of the bladder is under 
 the control of the will, and occurs several times a day. 
 
 Fig. 55. — Greatly enlarged diagram, 
 showing the arrangement of the 
 parts of the kidney. I. Uri- 
 nary tubules. 2. Malpighian tuft. 
 3. Artery. 4. Artery entering the 
 tuft. 5, 6. Malpighian tuft, with the 
 sac removed. 7, 7, Veins emerging 
 from the tufts. 8, 8. Veins. 
 
THE SENSES TOUCH AND TASTE 79 
 
 CHAPTER XI 
 THE PERCEPTIVE APPARATUS — THE SENSES 
 
 The senses are the portals of the intelligence ; for through 
 them all perceptions find their way to the seat of the intelli- 
 gence in the brain. They comprise touch, taste, smell, hear- 
 ing, and sight. 
 
 The sense of touch and its relation with the brain through 
 the sensory nerve filaments distributed throughout the body 
 has been described in connection with the nerves. In the 
 sense of touch is also included the appreciation of heat and 
 cold. In connection with the bones reference has been made 
 to the wonderful mechanism of the hand. A great portion 
 of the usefulness of that member is due to the sense of touch, 
 which is most highly developed on the palmar face, and in 
 particular at the tips of the fingers. 
 
 The sense of taste, situated in the cavity of the mouth, 
 consists in the perception of the flavor of articles, particularly 
 in their relation to food. A sweet, a sour, a bitter, or a saltish 
 taste is understood by every one. Dependent upon taste is 
 the appetite. The study of the gratification of the taste has 
 been the life work of not a few, and the art of cookery — 
 the preparation of food in such a manner as to gratify the 
 taste — is a vocation well worthy the attention of a higher 
 grade of mind than is wont to be devoted to it. 
 
 The adaptation of food to the taste has a hygienic value ; for experi- 
 ence has shown that, as a general rule, the most savory food is the most 
 easily digested. There seems to be a correlation between the sense of 
 taste and that of sight as referred to the perception of colors, although 
 the former has not been developed to the same extent as the latter. 
 There should be considered, in cooking, a harmony of savors, in order 
 to attain full palatability, just as in painting a harmonious combination 
 of colors is needed to please the eye. 
 
 The sense of taste is most highly developed in the tongue, and the 
 full advantage of the sense is obtained only after the food has been 
 passed back over the tongue to the pharynx. The object to be tasted 
 
80 CONSTRUCTION OF THE HUMAN MACHINE 
 
 must be moistened in order to make its impression upon the nerves of 
 this sense. The perception of taste is carried to the brain by a branch 
 of the trifacial and by the glosso-pharyngeal, both cranial nerves, the 
 latter supplying the back of the tongue, and the former the tip. 
 
 Upon the top of the tongue toward the back are seen eight or ten 
 minute prominences arranged in the form of a V: these are the circum- 
 vallate papillae, and contain the terminations of the filaments of the 
 glosso-pharyngeal nerves. Along the sides and tip are a number of 
 smaller prominences called the fungiform papillae, containing the ter- 
 minations of the lingual branch of the trifacial nerve. A third set, 
 called the filiform papillae, are distributed over the tongue, but are 
 probably not involved at all in the sense of taste. The back portion of 
 the tongue perceives taste the best, although the tip more quickly appre- 
 ciates sweet and pungent savors, the bitter and savory flavors being best 
 perceived at the back. 
 
 The sense of smell consists in the perception of odors. 
 This sense is located in the upper chamber of the nose, and 
 is due to the filaments of the olfactory, the first cranial nerve, 
 
 which form a network on the 
 mucous membrane of that cav- 
 ity (Fig. 56). 
 
 Odors are minute particles given 
 off by the substances from which 
 they emanate. And it is necessary 
 for the action of the sense of smell 
 that air, bearing the odor, should be 
 breathed through the nose, when the 
 particles come in contact with the 
 mucous membrane where the sense 
 is located. 
 
 Fig. 56. — The nose divided down the 
 middle line to show the distribution 
 of the olfactory nerve. The roof of 
 the mouth is seen below. 
 
 The sense of hearing consists 
 in the appreciation of sonorous 
 or sound-producing vibrations. 
 That these vibrations are better transmitted by solid bodies 
 even the savage knows, when he puts his ear to the ground 
 to hear the approaching footsteps of his enemy. In the same 
 way sound can be transmitted to the auditory nerve through 
 the bones of the head as well as through the orifice of the 
 ear, as can be shown by taking a watch between the teeth 
 and stopping the ears with the fingers. 
 
SENSES OF HEARING AND SEEING 
 
 8 
 
 It is rarely possible, however, for the ear to be connected 
 with the source of sound vibrations by solids, and they are 
 usually transmitted by the air and through the ear. 
 
 The ear, or organ of hearing, is composed of the pinna, the auditory 
 meatus, the tympanic membrane, the middle ear, and the internal ear. 
 The pinna is the external portion, the object of which is to collect the 
 vibrations into the orifice of the 
 auditory meatus. This portion is 
 not of much importance in man, 
 but in the rabbit or the donkey its 
 importance is very great. The vi- 
 brations collected by the pinna then 
 pass into the auditory meatus, 
 which is a short tube closed at its 
 inner end by a thin, strong mem- 
 brane stretched tightly across it, 
 the tympanic membrane. On the 
 other side of the tympanic mem- 
 brane is another cavity, the middle 
 ear, closed at its inner end by bone, 
 in which, however, are apertures also 
 closed with membrane ; through the 
 middle ear and connecting the tym- 
 panic with the other membrane is a 
 chain of very small bones called the 
 ossicles of the ear. Beyond the 
 middle ear is the internal ear, a 
 cavity filled with fluid, in which 
 
 reside the terminations of the auditory nerve, the cranial nerve which 
 carries perception of sound to the brain. In order to reach the intelli- 
 gence, then, the vibrations have to pass through the air, the tympanic 
 membrane, the ossicles, the membrane of the internal ear, the fluid of 
 the internal ear, and the auditory nerve. 
 
 The sense of sight is the perception of form, size, color, 
 light, or shade. It is the most important of the senses, and 
 gives origin to the greatest number of perceptions. If a room 
 be darkened, and light be admitted only through a small 
 aperture, an image of the external objects opposite to the 
 aperture may be seen on the wall where the rays of light 
 strike. Were the rays of light further concentrated by a 
 lens, the image would be still more distinct. The photog- 
 rapher's camera is but a reproduction of this room on a small 
 
 Fig. 57. — The ear, the temporal bone 
 being divided to show the internal 
 structures. I, I, I. The pinna. 2. 
 The auditory meatus. 2'. The mem- 
 brana tympana. 3. The middle ear. 
 6. The internal ear, showing the 
 cochlea and semicircular canals. 
 
82 CONSTRUCTION OF THE HUMAN MACHINE 
 
 scale, and the eye is the original embodiment of both. It is 
 a dark cavity, upon the posterior wall of which the filaments 
 of the optic nerve are spread, so that when the light passes 
 into the cavity through the pupil, an image of the objects 
 opposite to it is formed on the posterior wall and transmitted 
 by the optic nerve to the intelligence in the brain. 
 
 The eye is a ball surrounded by three coats, the internal of which — 
 the retina — is an expansion of the optic nerve, and destined to receive 
 the impressions of sight ; the external in front is called the cornea, and 
 is a transparent membrane; behind, it is a strong, whitish opaque 
 membrane, called the sclerotic. The middle coat is incomplete in 
 front, where it is called the iris, and the opening in the centre is called 
 the pupil ; the iris may be blue, gray, brown, or black, and from it the 
 
 Fig. 58. — A section of the eye. I. The sclerotic coat. 2. The cornea, connecting 
 with the sclerotic coat by a bevelled edge. 3. The choroid coat 6, 6. The iris. 
 7. The pupil. 8. The retina. 10, II, II. Chambers or cavities of the eye, con- 
 taining the aqueous humor. 12. The crystalline lens. 13. The vitreous humor. 
 15. The optic nerve. 14, 16. Arteries of the eye. 
 
 eye derives its color; the middle coat behind is a dark-brown mem- 
 brane, profusely supplied with blood-vessels, and called the choroid 
 coat. Set in front of the eye, just back of the iris, is a lens, the crys- 
 talline lens, and before and behind the lens the cavities are filled 
 with transparent matter called respectively the aqueous and vitreous 
 humors. The eyeball is set into the orbit of the skull, and protected by 
 the overarching brows and by the curtain-like eyelids, and the visible 
 portion of the eyeball, except the cornea, is covered by the conjunctiva, 
 
THE EYE 83 
 
 a membrane very abundantly supplied with blood-vessels and very sub- 
 ject to inflammation. The inflammation of the conjunctiva is the ordi- 
 nary "sore eyes," and is technically known as conjunctivitis. 
 
 In using a burning-glass, it will be noticed that the glass has to be at 
 a certain distance from the object to be burned in order to affect it. 
 This is the distance at which the rays of light are concentrated by the 
 lens, and is called its focus.- Glasses of varying degrees of convexity 
 have different foci. The crystalline lens of the eye has certain muscles 
 which cause it to adapt itself to varying foci ; this is the " power of 
 accommodation." In some persons the lens is so altered that it cannot 
 adapt itself to all circumstances. If the person can see better at dis- 
 tances, the lens is not convex enough, and the focus for near objects 
 passes behind the retina ; such a person is hypermetropic or " far- 
 sighted," and needs convex glasses. If the person can see only at short 
 distances, the lens is too convex, and the focus strikes in front of the 
 retina, and the person is myopic or " near-sighted." Old people are 
 often afflicted with far-sightedness, because, as age advances, the crys- 
 talline lens becomes harder and the muscles of accommodation cannot 
 make it convex as before : this is called presbyopia or " old eyes." 
 Sometimes the lens is not symmetrical, and the focus is not clearly 
 thrown upon the retina: this is astigmatism, and a person affected with 
 it would want a glass formed of a segment of a cylinder. 
 
 It not infrequently happens that the eye cannot distinguish colors. 
 This is called " color-blindness." In some cases the power of discrimi- 
 nating between colors is entirely lost ; in others the recognition of certain 
 colors only is absent. A man may be green blind or red blind, for 
 example. This defect is of vital importance, particularly in railway or 
 steamship management, where signals are made by different colored 
 flags or lights, as well as in many other avocations where the percep- 
 tion of colors is necessary. 
 
Part II 
 
 THE IMPLEMENTS OF REPAIR 
 
CHAPTER XII 
 GERMS, THEIR ACTION AND ITS CONTROL 
 
 When a ray of sunlight shines into a room, the sunbeam 
 will be seen to be full of minute particles or motes floating in 
 the air. These are not observed by the naked eye except 
 under an extremely bright light, and from this we recognize 
 the fact that the atmosphere is filled with floating particles. 
 Some of these are large enough to be seen under a bright 
 light, as we have remarked, but by far the larger number are 
 invisible except with the aid of a microscope. The character 
 and composition of these vary greatly. They may be merely 
 floating bits of metal or of vegetable origin ; they may be 
 particles emanating from an animal ; they may be decaying 
 emanations from the breath ; or they may be independent 
 living organisms. 
 
 The discovery of the latter class, called micro-organisms, or 
 microbes, has within a few years thrown a flood of light upon 
 the practice of medicine and revolutionized the art of surgery. 
 Many diseases are now acknowledged to be due to these 
 micro-organisms. In consumption, for example, the tubercle 
 bacillus — the micro-organism of consumption — finds its way 
 into the system through the food or the breath, and wanders 
 about until it finds a weak spot where circumstances are 
 favorable for its growth. In the more common class of cases, 
 this is found in the lungs, and here it establishes its home 
 and increases and multiplies until the subject is carried off by 
 the disease which it has planted in his system. The micro- 
 organism of cholera and of some other diseases have been 
 recognized. 
 
 There is another class of micro-organisms which require a 
 break in the skin in order to exercise their power. These are 
 the microbes which in former days rendered surgical opera- 
 
 87 
 
88 THE IMPLEMENTS OF REPAIR 
 
 tions so dangerous. An instance of the terrible power of 
 some of them was of almost daily occurrence. How often 
 has death resulted from the prick of a pen-knife or even the 
 scratch of a pin ! And in how many other cases has death 
 been averted only by the amputation of a limb which has 
 received some apparently insignificant wound. 
 
 Micro-organisms may be introduced into a wound either by 
 the instrument making the wound, they may be floated to it 
 in the air, or they may be derived from other substances 
 coming in contact with it. Finding in a wound a suitable 
 soil for its growth, the micro-organism multiplies with incred- 
 ible rapidity, and by its presence produces processes of 
 decay which result in the formation of poisonous substances 
 called "toxins." The products of the decay set up in a 
 wound by micro-organisms are not only irritating to the 
 wound itself, producing inflammation and pus, but when 
 absorbed into the body cause disease of the entire system. 
 
 The agency of micro-organisms, then, in the production of 
 disease, and the contamination of wounds being known, it 
 becomes evident that the development of such troubles can 
 be avoided (i) by preventing the entrance of micro-organ- 
 isms, and (2) by their destruction in case they should be 
 present. Upon these premises is founded the modern treat- 
 ment of consumption, cholera, and other affections. The 
 physician of the present day aims at the destruction of the 
 infecting microbe in these cases by flooding the saliva in the 
 first case and the excrement in the latter with a solution 
 which shall have the power to annihilate the microbes. 
 Such a solution is called a germicidal solution, and the agent 
 giving it its power is a germicide or u germ-killer." 
 
 Materials from which germs are absent are said to be " ster- 
 ile " ; anything which has been rendered sterile is said to 
 have been "sterilized.'" Heat is the most efficient sterilizing 
 agent, and may be applied by means of boiling in a solution, 
 or by the application of steam brought to a high temperature. 
 Where an operation is performed upon a part not previously 
 infected, infection by micro-organisms is avoided by prevent- 
 ing contact with the wound of any dressings or instruments 
 
GERMS, THEIR ACTION AND ITS CONTROL 89 
 
 which have not been carefully sterilized. The surgeon fur- 
 ther contributes to the sterilization of the operation by the 
 most careful cleansing of his own hands and of the parts to 
 be operated upon previous to his work, and by scrupulously 
 preserving cleanliness during the operation. In case of a 
 wound which might have become infected, such as would be 
 the case with any one received out of the limits of a properly 
 equipped surgical operating-room, or with any instrument not 
 previously purified, all possible infection should be avoided 
 by bathing it with a germicidal solution which would either 
 kill the microbes, or an antiseptic solution which would 
 paralyze and render them harmless. To prevent infection 
 from the atmosphere, some surgeons keep a germicidal 
 solution constantly flowing over the parts during an entire 
 operation. 
 
 When the time comes for a wound to be dressed, the future 
 contact of micro-organisms is prevented by the application of 
 a dressing that has itself been made antiseptic. Such dress- 
 ings are prepared by filling a clean dressing with a germicide 
 in a certain proportion. Cheese-cloth or tarlatan are the 
 fabrics most frequently used for this purpose, and when so 
 treated are called " antiseptic gauze." Where a bit of anti- 
 septic gauze is available in case of a wound, it is a good plan 
 to apply it at once in the absence of a medical man and 
 retain it in place until removed by a surgeon. 
 
 In military life, such a dressing is made constantly avail- 
 able by the provision of the first aid dressing-packet issued 
 to soldiers. The essential portion of this packet, which is 
 fully described in the chapter on dressings and applications, 
 is an antiseptic compress which is designed to be applied 
 immediately after the wound has been received. 
 
 It must not be inferred that the use of antiseptic agents as 
 a protection against micro-organisms insures a good result in 
 every case of injury, for such is not the case. Antiseptics 
 merely greatly increase the probability of a happy issue, and 
 their effect upon microbes may be counteracted by other 
 causes. 
 
 As has been remarked, where absolute cleanliness in dress- 
 
90 THE IMPLEMENTS OF REPAIR 
 
 ings and handling of the wound can be had in a fresh wound 
 in a healthy person, antiseptics are not necessary. But this 
 means surgical cleanliness, which does not mean the same as 
 ordinary cleanliness, for the daintily white fabric from my 
 lady's linen closet may be a nest of unseen carriers of putre- 
 faction. Surgical cleanliness signifies the absence of germ 
 life. 
 
 Surgical cleanliness by means of sterilized applications, 
 however, is not always obtainable, in which case ordinarily 
 clean dressings and clean water may be used, since they are 
 apt to be surgically clean also. It is sometimes of advantage, 
 when in localities which do not appear to be clean, to add 
 also some one of the germicidal agents. The most available 
 for this purpose are the following : 
 
 Carbolic acid, a dangerous corrosive poison when taken 
 internally, was the first antiseptic agent to be used in sur- 
 gery. It should be in small transparent crystals, and used in 
 the proportion of two teaspoonfuls to the pint of water. 
 
 Corrosive sublimate, when obtainable, is the most efficient 
 germicide we have. It is, however, a most powerful poison, 
 and must be greatly diluted when used. In the proportion of 
 four grains to the pint of water, however, wounds may be 
 bathed by it with perfect security. Corrosive sublimate does 
 not dissolve rapidly in cold water, but a solution is quickly 
 made by heating the water. 
 
 The destruction of germs by the disinfection of clothing, 
 furniture, and houses, and its application to the prevention 
 of the spread of disease, is again considered in the chapter 
 on hygiene. 
 
 CHAPTER XIII 
 
 KNOTS AND BANDAGES 
 
 In the application, particularly of extemporized dressings, 
 the knowledge of the proper method of tying a knot is of the 
 greatest importance. If a bandage be fastened with an inse- 
 
KNOTS AND BANDAGES 
 
 91 
 
 cure knot, it may slip and cause irreparable damage. Conse- 
 quently the consideration of the subjects of knots should not 
 be overlooked. 
 
 The False Knot or "Granny." — This knot is described 
 only for the purpose of showing what should not be used. It 
 is formed — the ends of the cord or handkerchief being held 
 in the two hands — by winding the end held in the right 
 
 Fig. 59. — The false knot in cord. 
 
 Fig. 60. — The false knot in hand- 
 kerchief. 
 
 hand over that held in the left, and then, changing hands, 
 winding that now held in the right hand over that held in 
 the left. In other words, the " granny " knot is tied by simply 
 repeating the same movements in making the second turn 
 that were made in the first, and for that reason it is the knot 
 most commonly tied by those who have not been instructed. 
 The Square or Reef Knot. — This knot is very secure when 
 tied, so that it may be trusted to hold any kind of appliance 
 in place. It is also very easy to untie, a matter of no little 
 consequence in removing dressings. This knot should always 
 be employed. It is formed — the ends of the cord or hand- 
 kerchief being held in the two 
 hands — by winding the end held 
 
 Fig. 61. — The reef knot in cord. Fig. 62. — The reef knot in handkerchief. 
 
 in the right hand over that held in the left, — in this respect 
 being exactly the same as the " granny " ; then winding the 
 end now held in the left hand over that held in the right. In 
 
9 2 
 
 THE IMPLEMENTS OF REPAIR 
 
 other words, the same end of the handkerchief is wound ovef 
 the other in both instances, it having changed hands after 
 the first turn. 
 
 Other knots which it is useful to know are the surgeon's knot and 
 the clove hitch. The surgeon's knot is used by surgeons particularly 
 in drawing tissue together, to prevent slipping of the first turn of the 
 knot. It is tied simply by turning the right- 
 hand end of the cord twice about the left in 
 the first turn, and then completing the knot 
 as in the ordinary reef knot. It should not 
 be used in tying bandages. 
 
 The clove hitch is used when it is de- 
 sired to get a firm hold of a limb in order 
 to pull hard upon it, as in setting a dislo- 
 cated joint. Its advantage over the ordinary loop is that it will not 
 slip and bind the limb so as to stop the current of blood. Its con- 
 struction can readily be understood from Fig. 64. The loops thus 
 formed being slipped on to a limb, are drawn snugly 
 but not so tightly as to constrict it, and then any amount 
 of pulling on the two ends will not tighten it. 
 
 Fig. 63. — The surgeon's knot. 
 
 Fig. 64. —The 
 clove hitch. 
 
 The triangular bandage presently to be de- 
 scribed is always fastened either by the reef 
 knot or by pins ; and, in the latter case, the 
 safety pin (Fig. 65), used by Esmarch him- 
 self, is much the more suitable. 
 
 Bandages are used to support various parts of the body 
 when injured ; to bind on and keep in place dressings for 
 wounds and splints for broken bones ; to overcome excessive 
 
 muscular action ; to prevent 
 disturbance of parts by the 
 patient himself; as tempo- 
 rary appliances to check 
 bleeding ; and for the pro- 
 tection of wounds from ex- 
 posure to the elements, from insects, and from dirt. 
 
 Unbleached muslin, of a moderately heavy quality, is the 
 material usually employed for bandages, although the bleached 
 variety, linen, cheese-cloth, cambric, and other similar fabrics 
 may be used with full as much satisfaction. Flannel is often 
 used where warmth with elasticity is desired. 
 
 Fig 65. — The safety pin. 
 
THE TRIANGULAR BANDAGE 
 
 93 
 
 While bandages should be fitted snugly, care should be 
 taken not to draw them so tightly as to constrict the limb. 
 A tightly drawn bandage may readily cut off the blood supply 
 of the parts beyond it, and cause gangrene or death of the 
 part. 
 
 Bandages are chiefly of two shapes, the triangular and the 
 ribbon-like, or roller bandage. 
 
 The triangular bandage, recommended by Mayor of Lau- 
 sanne early in the present century, was introduced to popular 
 use by Surgeon-General Esmarch of the Prussian service, 
 who, in 1869, caused them to be furnished to the army 
 under his supervision, with pictures printed upon them 
 (Fig. 66) showing the principal methods of application. 
 
 LOWER BORDER 
 
 Fig. 66. — Esmarch's triangular bandage. 
 
 Triangular bandages are made by dividing a piece of muslin 
 a yard square into halves by a diagonal cut joining two 
 opposite corners. This bandage is pre-eminently adapted 
 for use on the battle-field and for any emergency. 
 
 These bandages, as issued under the direction of Esmarch, 
 are like that shown in the cut, which is a photographic 
 
94 THE IMPLEMENTS OF REPAIR 
 
 reproduction of one issued by the medical department of the 
 United States Army. 1 
 
 The St. John Ambulance Association 2 of England, and the St. 
 Andrew's Ambulance Association 3 of Scotland, each issue a pictorial 
 triangular bandage. The Scotch bandage is really a remarkable affair, 
 with no less than fifty illustrations, covering almost the entire field of first 
 aid to the injured in a most clear and minute manner, and accompanied 
 by a little book of instructions on its use. 
 
 In the illustration may be seen the creases made by folding 
 the bandage. To fold it, the two ends are folded down to 
 the point, and the square thus formed is folded in five. 
 
 The shape and size of the triangular bandage may be 
 modified in various ways to adapt it to different purposes. 
 If smaller triangles are desired, one, half the size of the large 
 
 Fig. 67. — Diagram, showing the points at which the triangular bandage is folded 
 for use. AB, CD. Folds for broad cravat. AB, ivx, yz. Folds for narrow 
 cravat. 
 
 one, can be formed by folding the two ends together, and 
 two may be made by cutting it along the line of the fold. 
 Or it may be made into a cravat of varying width by folding 
 
 1 Illustrated triangular bandages can be obtained in this country from any- 
 dealer in surgical instruments, either direct or through a druggist. 
 
 2 These bandages can be had post free for sixpence each on application to the 
 Honorable Director of Stores, St. John's Gate, Clerkenwell, London, E.G., 
 England. 
 
 3 The illustrated triangular bandage of the St. Andrew's Ambulance Associa- 
 tion can be obtained post free for eight and one-half pence each, from the Secre- 
 tary at the Head Office, 93 West Regent Street, Glasgow, Scotland. 
 
THE TRIANGULAR BANDAGE AS A SLING 95 
 
 it in lines parallel to the lower border. A broad cravat is 
 made by folding the point down to the middle of the lower 
 border, and then folding this again in the same way ; the 
 first fold would then be along the line AB (Fig. 67), and 
 the second along the line CD. To form a narrow cravat, 
 the first fold would be the same, AB, but there would be two 
 secondary folds, wx and yz, instead of one. A twisted cord, 
 formed by twisting the narrow cravat, may be used as an 
 improvised tourniquet for checking bleeding. 
 
 The triangular bandage is of especial value because of the 
 facility with which its uses can be learned and the rapidity 
 with which it can be applied, while at the same time it makes 
 as good a temporary dressing as may be desired. For this 
 reason its use is first to be learned, and unless a high degree 
 of proficiency is desired, a familiarity with its applications is 
 a sufficient knowledge of bandaging. 
 
 The Triangular Bandage as a Sling. — There are three 
 forms in which the triangular bandage may be utilized as a 
 sling to support an injured arm. 
 
 1 . The Narrow Arm Sling (Fig. 74) is made from either 
 the broad or narrow cravat, as desired, and is applied by 
 (1) placing one end over the shoulder of the injured side 
 and (2) allowing the other end to hang down in front, while 
 (3) the injured arm is bent up to the desired height in front 
 of it ; (4) the end hanging down is then drawn up in front 
 of the arm and over the shoulder of the uninjured side ; 
 (5) the ends are drawn up over the shoulders so as to hold 
 the arm in the most comfortable position and (6) tied with a 
 reef knot behind the neck or over one shoulder. 
 
 2. The Broad Arm Sling is formed by folding the triangle 
 but once — along the line AB (Fig. 67) — and applied in 
 the same manner as the narrow arm sling. 
 
 3. The Large Arm Sling may be applied in three different 
 ways, according to the extent and character of the injury. 
 
 a. (1) Placing one end (Fig. 68) of an unfolded tri- 
 angular bandage over the uninjured shoulder, (2) let it hang 
 down in front of the body with the point toward the injured 
 side ; (3) draw the point over well beyond the elbow of that 
 
g6 THE IMPLEMENTS OF REPAIR 
 
 side, (4) raise the forearm to the desired level, and (5) lift 
 the loose end of the bandage so as to support the arm in that 
 position, and (6) pass it over the shoulder of the injured 
 side, where (7) it is tied behind the neck or over the shoulder 
 with a reef knot ; (8) then the point is brought over in front 
 and secured with a safety pin so as to form a rest for the 
 elbow. 
 
 b. A second form (Fig. 69) of the large sling is formed 
 by passing the loose end of the triangular bandage around 
 
 under the arm of the injured side to the 
 back, and tying the two ends there, the 
 sling thus passing over the sound shoul- 
 der only. This variety is used where 
 the shoulder of the 
 injured side is so 
 tender as not to be 
 able to bear any 
 weight. 
 
 i m\\ x^ 1 
 
 Fig. 68. — Large arm sling, 
 where the shoulder of the 
 injured side is unhurt. 
 
 c. A third form 
 
 (Fig. 70) of the Fig- 69 - — Lar g e arm slin g> 
 
 large arm sling is where the shoulder of 
 
 ° the injured side is hurt 
 
 the same as the a lso. 
 second form, except 
 
 that the sling passes over the shoulder Fig. 70. — Large arm sling, 
 of the injured side only, so that the 
 sound arm can remain free for any pur- 
 pose that may be required. 
 
 The Triangular Bandage for Wounds. — The mode of 
 application varies according to the location and character of 
 the injury, and each variety will be considered individually. 
 
 The Top of the Head. — If possible, the patient should be 
 seated in a chair. Standing behind him, (1) fold the lower 
 border of the bandage under, as if making a hem about two 
 inches broad; (2) place the bandage (Fig. 71) with the 
 
 where it is desired not to 
 place it over the shoul- 
 der of the sound side. 
 
THE TRIANGULAR BANDAGE FOR WOUNDS 
 
 /' 
 
 middle of the hem just over the nose, and the point of the 
 
 bandage hanging over the back of the head to the neck ; 
 
 (3) bring the two ends back around the head above the 
 
 ears ; (4) cross them ; (5) bring them around to the front 
 
 again, and (6) tie them in a reef knot ; 
 
 then (7) pull the point downward to 
 
 make it fit closely over the head, and 
 
 (8) turn it up on to the top of the head 
 
 (Fig. J$) and pin it there. 
 
 The Chin, Ears, or Side of the Face. 
 
 — Using the narrow cravat, (1) place 
 
 the middle under the chin, (2) draw 
 
 the ends upward, and (3) tie them in 
 
 a reef knot on top of the head. 
 
 The Eyes, or Front of the Face. — 
 
 The narrow cravat is folded about the 
 
 head, with the middle at the middle line of the face, and the 
 
 ends tied behind in a reef knot. 
 
 The Neck. — The narrow or broad cravat may be used here, 
 as circumstances may indicate, en- 
 circling the neck, and having the 
 ends tied on the side opposite to 
 the injury. 
 
 Fig. 71. — Triangular band- 
 age applied to the head, 
 from in front. 
 
 Fig. 72. — Triangular bandage for 
 the chest, front view. 
 
 The Chest and Back.— (1) 
 Apply the triangle (Figs. 72 
 and y^) with its centre at 
 the middle of the chest and 
 the point over the shoulder 
 of the affected side ; (2) carry 
 the two ends about the body, 
 and (3) tie them in a reef knot 
 
 Fig. 73. — Triangular bandage for chest, 
 — back view, — shoulder, hand, and 
 amputation-stump of arm. 
 
9 8 
 
 THE IMPLEMENTS OF REPAIR 
 
 at the back, (4) leaving one end considerably longer than 
 the other; (5) then draw the point over the shoulder, and 
 (6) tie it to the longer end left from the preceding knot. In 
 case of injury to the back, reverse the procedure. 
 
 The Ribs. — In case of injury to the ribs, use two broad 
 cravats. (1) Place the middle of the upper one over the site 
 of injury, if it affect the upper ribs, and well up under the 
 armpits ; (2) pass it about the body, and (3) tie in a reef 
 knot on the opposite side. (4) Place the other one similarly 
 directly below the upper one, and apply it in the same 
 manner. 
 
 The Shoulder. — (1) Lay the triangle (Figs. J3 and 74) on 
 the shoulder so that the lower border will come down to the 
 middle of the upper arm and the point will extend well up on the 
 neck ; (2) carry the two ends about 
 the arm, (3) cross them on its inner 
 face, and tie them in a reef knot on 
 the outside ; (4) make a narrow or 
 broad arm sling, and (5) draw the 
 point under the sling where it passes 
 over the affected shoulder. In case 
 the shoulder is injured so as not to 
 be able to sustain the sling, a small 
 cravat bandage passed about the neck 
 may be used in its place. 
 
 The Upper Arm. — Using the 
 broad cravat, (1) place the middle 
 of the bandage in front of the limb ; 
 (2) pass the ends about it, (3) cross- 
 ing them behind, and (4) tie them in 
 a reef knot in front (Fig. 74) . Support the arm in a sling. 
 
 The Elbow. — Two plans may be adopted : a. (1) Place the 
 middle of a narrow cravat on the back of the upper arm, near 
 the elbow ; (2) draw the ends to the front ; (3) cross them ; 
 
 (4) pass them back, crossing them at the tip of the elbow ; 
 
 (5) cross them in front of the upper portion of the forearm, 
 and (6) pass them around it, (7) tying the ends in a reef knot 
 at the back. 
 
 Fig. 74. — Triangular bandage 
 for shoulder, hand, and fore- 
 arm, and as a narrow arm 
 sling. 
 
THE TRIANGULAR BANDAGE FOR WOUNDS 99 
 
 Fig. 75. — Triangular bandage, 
 as a figure of eight, for the 
 hand. 
 
 b. Or pass a broad cravat about the elbow in the same 
 
 manner as in the upper arm (Fig. 74) . 
 
 The Forearm and Wrist. — Apply a broad cravat as in the 
 
 upper arm (Fig. 74), and use a large arm sling. 
 
 The Hand. — There are two ways : a. Where it is desired 
 
 to cover the whole hand (Fig. 74), (1) spread a triangle out, 
 
 (2) lay the hand upon it with the wrist on the lower border 
 
 and the fingers toward the point; (3) fold the point back 
 
 over the fingers, carrying it above the wrist ; (4) pass the 
 
 ends about the wrist, binding down the point ; (5) cross 
 
 them ; (6) bring them back, and 
 
 (7) tie them in a reef knot over 
 
 the point. This method may be 
 
 used with advantage in dressing 
 
 stumps after amputation, as has 
 
 been done on the right arm of 
 
 Fig- 73- 
 
 b. In case of an injury (Fig. 75) 
 
 to the back of the hand, (1) place 
 
 the middle of a narrow cravat across the back of the hand, 
 
 just below the thumb ; (2) bring the ends around the hand, 
 
 crossing them on the palm; (3) bring the ends over the 
 back, (4) crossing them over the 
 back; (5) pass them back about 
 the wrist, (6) cross them and (7) 
 bring them back, (8) tying them in 
 a reef knot on the back of the wrist. 
 If the palm is wounded, the pro- 
 cedure is simply reversed. This is 
 called a figure of eight handker- 
 chief bandage for the hand, and 
 the part should be supported in the 
 large arm sling. 
 
 The Hip. — (1) Pass a narrow 
 cravat about the body like a belt, 
 (2) tying it in a reef knot on the 
 side opposite to the injury. (3) Lay 
 
 a triangle upon the hip with its lower border well down on 
 
 Fig. 76. — Triangular bandage 
 for the hip. 
 
IOO 
 
 THE IMPLEMENTS OF REPAIR 
 
 Fig. 77. — Triangular 
 bandage for the 
 knee. 
 
 the thigh, and the point upward. (4) Pass the ends about 
 the thigh, (5) crossing them and (6) tying them in a reef 
 knot, or pinning them on the outside ; (7) slip the point 
 
 under the belt, bring it over, and secure it 
 
 with a pin (Fig. 76). 
 
 The Thigh, Knee, and Leg. — The cravat 
 
 is used (Fig. 77) in the same manner as in 
 
 the upper arm. 
 
 The Foot. — (1) Spread a triangle out, 
 
 and (2) place the foot in its centre, with the 
 
 toes directed toward the point ; (3) draw 
 
 the point back over the toes and instep; 
 
 (4) take the ends and pass 
 
 them about the ankle over 
 
 the tip, (5) crossing them 
 
 on the instep ; (6) again 
 
 in the sole of the foot, and 
 (7) bringing them back, (8) tie them in a 
 reef knot over the instep (Fig. 78): 
 
 The Square Bandage. — A handkerchief a yard Fig 78 —Triangular 
 square makes a covering for the entire head and bandage for the 
 
 neck, excepting the face, and makes a very efficient foot, 
 
 protection. The handkerchief is so folded that the 
 
 under layer projects about four inches 
 beyond the upper. The long rectangle 
 thus produced is laid upon the head so 
 that its middle rests upon the middle line 
 of the cranium, while the margin of the 
 longer flap falls down to the tip of the 
 nose, and that of 
 the upper to the 
 eyebrows, th e 
 short borders 
 hanging upon the 
 shoulders. Ofthe 
 four corners hang- 
 ing down upon 
 the chest in front, 
 the two outer ones 
 are first tied firmly under the chin. The border 
 of the under fold is then turned upward against 
 
 Fig. 79. — Large square hand 
 kerchief for the head. Pre 
 I i mi nary stage. 
 
 Fig. 80. — Large square 
 handkerchief applied. 
 
THE ROLLER BANDAGE 
 
 IOI 
 
 Fig. 81. —The four-tailed 
 cap for the top of the 
 head. 
 
 Fig. 82. —The four-tailed 
 cap for the back of the 
 head. 
 
 the forehead, and the two inner corners belonging to it are pulled for- 
 ward from under the upper borders and carried to the back of the head, 
 where they are tied in a reef knot. 
 
 The Four-tailed Cap. — A handkerchief three-quarters of a yard long 
 and a quarter of a yard wide, and slit up for a considerable distance at 
 the narrow ends, forms 
 a most excellent cover- 
 ing for the head, and 
 support for surgical 
 dressings there. If it 
 is desired to apply it to 
 the top of the head, it 
 is placed thereon, and 
 the two front tails tied 
 at the back of the head, 
 and the back tails un- 
 der the chin. If the 
 
 back of the head is to be covered, the front corners are tied under the 
 chin, and the two back ones over the forehead. 
 
 The Four-tailed Bandage. — A bandage three inches wide and thirty 
 to seventy inches long, is slit from both its ends, leaving a space three 
 inches long in the centre, producing four tails of equal length. A little 
 slit is also made in the middle of the centre piece. If the bandage is 
 short, the centre piece is applied to the chin, and the upper tails are 
 carried behind the neck and tied in a reef knot, while the lower tails 
 are similarly carried up and tied on the top of the head. 
 
 The Roller Bandage. — The roller bandage is a ribbon-like 
 strip of varying material, prepared for binding about disabled 
 parts of the body, and when not in use is rolled up into a 
 cylinder. 
 
 The proper application of the roller bandage requires con- 
 siderable practice and experience in order not only to apply 
 it so as to appear smooth and even, but also to avoid unequal 
 pressure, by some folds being drawn tighter than others, the 
 entire bandage being drawn tight enough to prevent slipping, 
 and loose enough not to strangle the part, from which great 
 harm — extending even to the death and decay of the limb — 
 may result. For this reason these bandages are better adapted 
 to the trained hand of the physician and nurse. The triangu- 
 lar bandage is better adapted to the non-professional hand, 
 and for that reason greater prominence has been given it in 
 this work. 
 
102 THE IMPLEMENTS OF REPAIR 
 
 Roller bandages may be elastic, semi-elastic, or inelastic, according 
 to the material composing them. India rubber is the chief constituent 
 of the elastic bandages, which are used to check the flow of blood — 
 when drawn tightly enough to cut off the circulation in a part, and, when 
 so applied as to exert gentle pressure, are of value in the treatment of 
 en'arged veins and the ulcers resulting from them. Semi-elastic band- 
 ages are made of flannel, silk net, or other materials possessing a 
 certain amount of elasticity. They are easier to apply than the inelastic, 
 for they can be simply rolled on without reversing. 
 
 Inelastic roller bandages, like triangular bandages, are usually made 
 from a medium-weight unbleached muslin, although cheese cloth, 
 bleached muslin, linen, cambric, and other similar fabrics may be used 
 when necessary. Tarlatan and mosquito netting are used where the 
 bandage is to be impregnated with a stiffening material. 
 
 The inelastic bandage is the most generally useful, and is far less 
 expensive than the other varieties. 
 
 Bandages should not be cut, but torn, where the texture is of sufficient 
 firmness to permit. And in any case the selvage should be torn from 
 the edge, since it renders the margin less yielding than the remainder 
 of the bandage, and is liable to produce unequal pressure. 
 
 The sizes most convenient for use vary both in width and length, 
 according to the locality in which they are to be employed. The follow- 
 ing table will indicate that of the more commonly used : — 
 
 Bandage for the Head, 2 to 2| inches wide and 5 to 7 yards long. 
 
 " " Finger, | " 
 
 " " Hand, 1 inch 
 
 " " Arm, i| to 2| " 
 
 " " Shoulder, 23 " 
 
 " " Chest, 3 to 4 " 
 
 " Leg, a| 
 
 " Foot, 2} 
 
 The roller bandage can only be conveniently applied after the strip 
 has been rolled into a close, compact cylinder. The simplest and 
 quickest way to form a strip into the cylinder is (1) to turn in one end 
 of the bandage sufficiently to start a roll ; (2) to place the bandage upon 
 the thigh, with the partial roll near the groin, and the strip extending 
 down on the thigh to the knee ; (3) beginning with the tips of the 
 fingers, roll the cylinder, already begun, between the hand and the thigh 
 until the roll reaches the wrist; (4) draw the bandage up the thigh with 
 the partly completed roll just below the groin, and repeat the manoeuvre 
 until the entire bandage is rolled. 
 
 A bandage may be rolled by turning the roll between the thumb at 
 one end and the fingers at the other end, but the method is so slow as 
 to be much less desirable than that given above. 
 
 " 1 to 
 
 2 
 
 " 4 to 
 
 5 
 
 " 8 to 
 
 12 
 
 " 8 to 
 
 12 
 
 " 6 to 
 
 8 
 
 " 10 to 
 
 12 
 
 " 4 
 
 
THE ROLLER BANDAGE 
 
 103 
 
 Points to be observed in applying Roller Bandages in general : — 
 
 1. Begin at the lower end of a limb. 
 
 2. Avoid binding the limb too tightly or leaving the bandage too 
 loose. 
 
 3. Leave the tips of the fingers or 
 toes uncovered, so that they can be 
 easily examined to see whether the 
 bandage is too tight or not. If they 
 are cold and blue, it should be loos- 
 ened at once. 
 
 4. Apply the bandage smoothly, 
 leaving no wrinkles. 
 
 5. Avoid unequal pressure, taking 
 care that the turns of the bandage are 
 applied with equal force, and that one 
 edge is not tighter than the other. 
 
 6. Avoid reversing a bandage over 
 a sharp bone ; make reverses on the 
 fleshy side of a limb. 
 
 7. Bandage a limb in the position 
 in which it is to be retained ; bandag- 
 ing a limb straight, and then bending 
 it, will bind it too tightly; and if a 
 limb be bandaged, bent, and then 
 
 Fig. 83. — Rolling a roller bandage. 
 
 Fig. 84. — Roller bandage arm sling. 
 
 straightened, the bandage will 
 be too loose. 
 
 8. A bandage should not be 
 applied wet, for it will shrink 
 upon drying, and bind the limb 
 too tightly. 
 
 The Roller Bandage Arm 
 Sling. — (1) Raise the forearm 
 to the height desired; (2) pass 
 a three or four inch bandage 
 about the forearm, just below 
 the elbow; (3) then pass both 
 ends around the neck ; (4) bring 
 the long end down under the 
 wrist or hand, and (5) pass it 
 up to the neck and tie it to the 
 
104 
 
 THE IMPLEMENTS OF REPAIR 
 
 Fig. 85. — The circular and rapid spiral turns. 
 
 short end. The arm is now swung in a double sling, being supported 
 
 at the forearm and at the hand or wrist. 
 
 The Circular Turn. — In this turn the bandage passes directly about 
 
 a limb, all the turns 
 being upon the same 
 level. A soldier's belt 
 is a circular bandage 
 of the abdomen. 
 
 The Spiral Turn. 
 — In these turns the 
 bandage is placed at 
 an angle so that they 
 
 encircle a limb in a spiral direction. There are two varieties of the 
 
 spiral turn. 
 
 (a) The rapidly ascending spiral (Fig. 85) 
 passes up the limb without its edges overlapping, 
 and is used for holding dressings in place. 
 
 (b) The slowly ascending spiral (Fig. 86) 
 passes up a limb, with the lower edge of each 
 turn overlapping the upper edge of the preced- 
 ing. This turn is applicable only where a limb 
 is of uniform thickness, as often occurs in the 
 upper arm. 
 
 The Reversing Spiral Turn. — This is a modi- 
 fication adapted to limbs which increase or di- 
 minish in size, and is designed to avoid the 
 gaping of the turns which would occur with a 
 simple spiral. Its application, clearly shown in 
 Fig. 87, consists in simply turning the bandage 
 over forward so that its upper margin will be 
 below when the point of separation of two turns 
 is reached, — repeating the manoeuvre whenever 
 necessary to prevent gaping. 
 
 The Figure of Eight Turn (Figs. 75 and 88). 
 — This turn owes its name to the fact that it brings the bandage into 
 the form of the numeral 8. In the hand it is formed (1) by placing 
 
 Fig. 86. — The slow 
 spiral turn. 
 
 Fig. 87. —The three steps taken in applying the reversing spiral turn. 
 
THE ROLLER BANDAGE 
 
 I05 
 
 1. — Figure-of-eight turn applied to the 
 hand. 
 
 The Spica Turn (Fig. 
 
 the end of the bandage at the palmar face of the wrist ; (2) bringing it 
 across the back of the hand and below the thumb, and (3) across the 
 palm at the root of the 
 fingers ; then (4) up and 
 across the back to the 
 wrist; (5) across the pal- 
 mar face of the wrist; 
 then (6) up and across 
 the back, over the first 
 turn ; (7) repeating these 
 manoeuvres as many 
 times as it may be de- 
 sired to fold the band- 
 age about the hand, and (8) finally securing it with a circular turn about 
 the wrist. 
 
 The figure-of-eight turn is employed especially where the bandage 
 needs to pass over a joint. 
 
 9) . — This is a figure of eight with one loop 
 very much larger than the other, and is 
 employed at the junction of a limb with 
 the body, as at the 
 shoulder and the hip. 
 Its mode of applica- 
 tion is exactly similar 
 to the figure of eight. 
 To bandage the 
 Whole Upper Ex- 
 tremity (Fig. 89). — 
 To secure technical 
 correctness, every 
 digit and the entire 
 hand should be 
 bandaged with a 
 narrow roller, as 
 shown in Fig. 89. 
 As a matter of fact 
 this is rarely done, 
 on account of the length of time required for it. 
 The more common method is, (1) placing layers 
 of cotton between the fingers and a larger mass Rg 90 _ Ro;|er bandage 
 in the palm ; (2) to begin with the arm bandage of the who|e iower ex _ 
 at the tips of the fingers, and carry it up to the tremity. 
 wrist by figure-of-eight turns, leaving the thumb 
 
 out; (3) the forearm is then bandaged by a reversing spiral, (4) the 
 elbow by a figure of eight, (5) the arm by an ascending spiral, and 
 C6) the shoulder by a spica. 
 
 Fig. 89. — Roller bandage of 
 the whole upper extremity. 
 
io6 
 
 THE IMPLEMENTS OF REPAIR 
 
 Fig. 91.— The knotted 
 turn. 
 
 To bandage the Whole Lower Extremity (Fig. 90). — (1) Catch the 
 bandage by a turn or two about the toes, then (2) cover the foot by a 
 narrow figure-of-eight turn; (3) bandage the leg with a reversing spiral, 
 (4) the knee by a figure of eight, (5) the hip by a spica, (6) which is 
 completed by a few circular turns about the belly. 
 
 The Double-headed Roller. — This is the roller bandage rolled from 
 both ends to the middle. It is used for amputation stumps, and for 
 drawing together the edges of wounds, but is 
 especially employed for the head. 
 
 The Knotted Turn (Fig. 91), used especially to 
 control bleeding from the temples, is formed by 
 a double head, where turns — one perpendicular 
 under the chin, and the other horizontal about 
 the brow — are crossed at right angles upon the 
 wound, and tightly drawn, as in tying up a parcel. 
 A compress is thus held upon the wound under 
 the knot. 
 
 The Capelline Turn (Fig. 92) is formed by a 
 double-headed roller, one end of which passes 
 around the head horizontally just above the ears, and fixes the turns 
 of the other, which is carried alternately over the right and left side of 
 the scalp, each turn overlapping the preceding one, so as to form a 
 skull cap when complete. 
 
 There are a number of other special turns of the roller bandage used 
 to protect and support various parts of the body, 
 and of the head in particular, but it is believed 
 that those enumerated here will suffice to meet 
 any emergency. 
 
 To secure the Ends of Bandages. — Roller 
 bandages are best secured with needle and 
 thread : in default of that, with a safety pin ; 
 and in the absence of both, with an ordinary 
 pin. Where neither pins nor needles are avail- 
 able, the end of the bandage should be split by 
 a tear long enough to encircle the limb ; tie the 
 two ends at the end of the slit with the first 
 
 motion of a knot, then pass them about the limb in opposite directions, 
 drawing the bandage firmly, and tie them in a reef knot. 
 
 Bandages filled with Hardening Material are often applied where 
 it is desired to render a limb immovable. These bandages are made of 
 light, open-meshed material, such as gauze, tarlatan, crinoline, and 
 mosquito netting. Plaster of Paris is the most common material used 
 for filling these bandages ; but starch and water-glass are also used for 
 the purpose. 
 
 
 Fig. 92. — The capelline 
 turn. 
 
DRESSINGS AND APPLICATIONS IOJ 
 
 CHAPTER XIV 
 DRESSINGS AND APPLICATIONS 
 
 A dressing is a material applied to a wound both to pro- 
 tect it and to assist the healing process. It absorbs dis- 
 charges and stands guard against dirt and micro-organisms 
 seeking admission. 
 
 There are certain features of the dressings of wounds which 
 are common to all varieties and which should consequently 
 be considered before entering upon the discussion of indi- 
 vidual injuries. Special dressings suited for particular injuries 
 will be considered in connection with wounds, bleeding, and 
 broken bones. 
 
 A wound having been prepared for dressing, it is customary 
 to place upon it a mass of soft substance called a compress. 
 Compresses may be made of various substances, the condi- 
 tions demanded being that they are soft and unirritating, and 
 are both generally and surgically clean — free from both 
 dirt and germs. The materials most commonly used for this 
 purpose by surgeons are cheese-cloth and tarlatan, and from 
 these is prepared the modern surgical dressing, antiseptic 
 gauze, made by impregnating these materials with a germi- 
 cide. In this case, the fabric is folded into many layers, so 
 that a sheet of the gauze has considerable thickness. Rolls 
 of antiseptic gauze already prepared and put up in tin boxes, 
 so as to avoid contact with the deteriorating action of the 
 atmosphere, may be purchased in the apothecary shops, and 
 should be present in every first-aid dressing-case. In using 
 this material, the compress should be cut from the sheet, using 
 the entire thickness. 
 
 Other materials useful for compresses are absorbent cotton, 
 prepared from ordinary cotton by removing its oily constitu- 
 ents ; absorbent cotton may be made antiseptic like gauze, 
 and is often thus used in antiseptic surgery. Lint, prepared 
 by scraping clean old linen, and charpie, prepared by ravelling 
 
108 THE IMPLEMENTS OF REPAIR 
 
 old linen and cutting up the resulting mass, have been very- 
 popular as wound dressings, although they are now practically 
 disused. Oakum, formed by separating the strands of tarred 
 rope, has been prominently in vogue, on account of the slight 
 antiseptic quality imparted to it by the tar. It is rather harsh 
 for a direct application to a wound, but the finer quality of 
 oakum, called marine lint, is comparatively free from this 
 objection. Linen worn soft and thin is an excellent wound 
 dressing, provided that it is clean, both practically and sur- 
 gically. Clean tissue paper makes an excellent application, 
 and is often available in the form of toilet paper ; it is much 
 preferable as a dressing to handkerchiefs that have been used, 
 and to bits of clothing that have been worn, for it is likely to 
 be entirely free from germs. Clean printed paper crumpled 
 into a mass and softened by clean water is not at all objec- 
 tionable, and is vastly superior to soiled clothing. The iron 
 in the ink rather adds to than detracts from its usefulness. 
 
 The shape and size of a compress varies according to the 
 size, shape, and location of the wound it is to cover. It 
 should never fail to be from a quarter of an inch to an inch 
 in thickness — better too thick than too thin. It should 
 overlap the wound in every direction by at least an inch, and, 
 as before, it had better be too much than not enough. Sur- 
 gical dressings are either wet or dry. Dry dressings are 
 used where the direct application to the wound is a powder, 
 but the wet dressings are much the more common and had 
 better be used while awaiting a medical man. Where sugar, 
 salt, vinegar, or, better, corrosive sublimate is present, anti- 
 septic solutions, as described on page 90, can always be manu- 
 factured for wetting dressings, and should always be used. 
 In the rare cases where none of these can^-be obtained, or 
 where antiseptic gauze is available, clean water may be used. 
 
 Protective applications are used to cover and protect injured 
 parts on one hand, and to protect the clothing from being 
 soiled on the other. Sir Joseph Lister, the father of anti- 
 septic surgery, was accustomed to apply a bit of gutta-percha 
 tissue directly over his wounds to protect them from the 
 irritating effects of his dressings. Where wet dressings are 
 
 
DRESSING FOR WOUNDS 
 
 IO9 
 
 used, it is well to cover them with oiled silk or oiled muslin, 
 which not only avoids soiling the clothing, but also prevents 
 the evaporation of moisture. 
 
 The First-Dressing Packet. — There are many occupa- 
 tions in which men are daily exposed to injuries. In times 
 of peace, accidents are of frequent occurrence in large manu- 
 factories, sailors of the navy and more particularly in the 
 merchant marine, workers in mines, railroad operatives, 
 and many others are continually incurring considerable 
 risk of injuries ; in war times, perhaps, soldiers are in even 
 greater danger; and, such is the perversity of inanimate 
 things, accidents are most likely to occur when it is particu- 
 larly difficult to obtain suitable dressing materials. This is 
 
 
 ijs& 
 
 Fig. 93.— The first-dressing pad 
 
 especially true in the military service, where, if an engage- 
 ment be not fought in an inaccessible locality, the number of 
 injuries is so great as to make it exceedingly difficult to 
 provide proper dressings for all. 
 
 For this reason, an attempt has been made by the military 
 authorities to guard against such emergencies by having 
 
110 THE IMPLEMENTS OF REPAIR 
 
 every soldier carry with him the dressing materials for his 
 own possible injuries. This is the first-dressing packet, the 
 one issued to the Hospital Corps of the U. S. Army, being a 
 flat, flexible package (Fig. 93), about four inches square, and 
 from three quarters to seven eighths of an inch thick, con- 
 taining all the necessary materials for an emergency dressing, 
 wrapped in a piece of gutta-percha cloth nine inches square. 
 Upon the cover is printed a list of its contents and some 
 brief directions for its use, viz. : — 
 
 Esmarch's First Help for Wounds 
 
 Contents of Package 
 
 2 antiseptic compresses of sublimated gauze in oiled paper. 
 1 antiseptic bandage of sublimated cambric, with safety pin. 
 1 EsmarcICs triangular bandage, with safety pin ; mode of appli- 
 cation illustrated on same. 
 
 
 Directions 
 
 Place one of the compresses on the wound, removing the oiled paper. 
 In cases of large wounds open the compress and cover the whole 
 wound. Apply the antiseptic bandage over the compress. Then use 
 the triangular bandage as shown by illustrations on the same. 
 
 The antiseptic compresses are cheese-cloth roller bandages, 
 a yard long and three and a half inches wide, folded to two 
 inches wide and three and a half long ; the antiseptic band- 
 age is a roller two yards long and four inches wide, and both 
 are impregnated with corrosive sublimate, the most efficient 
 germicide known to science. The oiled papers in which the 
 compresses are wrapped serve to protect them from any 
 external influences which may penetrate through the outer 
 covering, and keep them from all possible contamination, and 
 as well as the gutta-percha cloth cover itself can be used as a 
 protective. 
 
 In case of a wound by a rifle ball passing through any part 
 of the body, the two compresses should be applied, one at 
 the entrance and one at the exit of the ball. In case of a 
 
THE FIRST-DRESSING PACKET III 
 
 single large wound, the two may be combined, and by unfold- 
 ing and refolding into another form they may be made to 
 cover a wound ten or twelve inches long and three inches 
 wide, or eight inches long and six inches wide. This would 
 protect a shell wound of considerable size, while almost any 
 sword cut that might be received could be dressed by it. 
 The oiled papers should be bound over the compresses with 
 the antiseptic bandage and secured with the safety pin. The 
 whole wounded part may then be covered with the triangular 
 bandage after the manner described in the chapter on knots 
 and bandages, or that portion of the dressing may be used 
 as a bandage to bind on a splint in case a bone has been 
 injured, as a tourniquet to check bleeding in case of a 
 wounded artery, or as a sling in case of an injury of an arm. 
 
 The first dressing packet of the British army consists of two com- 
 presses of tow impregnated with carbolized wood tar, a carbolized gauze 
 roller bandage with a safety pin, and a triangular bandage, without illus- 
 trations, folded and fastened together with four common pins, all 
 wrapped in tin foil with a cover of parchment paper, upon which are 
 printed directions for use. 
 
 In the German and British armies, every soldier carries one of these 
 packets in some specified portion of his clothing. The German carries 
 it stitched, in some branches of the service, in his trousers, and in 
 others, in his coat skirts ; in the Soudan expedition the British carried 
 them in their breast pockets. The place where the packet is carried 
 is not of so much consequence as that it should always be the same, so 
 that when required for use it can be found at once. The German plan 
 of stitching it into the clothing so that it cannot be removed is an 
 excellent one and prevents its loss. 
 
 The value of these packets has been conclusively demonstrated in 
 actual warfare. At Tel-el-Kebir, after the Egyptians had been driven 
 from their position, and the wounded of the British forces were still 
 lying near their works, the dressings from the packets were applied in 
 numerous instances with great benefit, either by the wounded men 
 themselves, by their comrades, or by sanitary soldiers. During the oper- 
 ations around Santiago, in 1898, the American troops found the packet, 
 there used for the first time by the United States army, of incalculable 
 value, and numerous wounded men owed their lives to the opportunity 
 which it afforded for promptly treating their injuries. At Santiago, as 
 at Tel-el-Kebir, the dressings were in many instances applied so satis- 
 factorily by the soldiers themselves that the surgeons found no further 
 dressing necessary until the men were removed to the hospital. 
 
112 THE IMPLEMENTS OF REPAIR 
 
 The use of the packet as an immediate dressing insures for 
 wounds a temporary treatment which will prevent the inroads 
 of micro-organisms, and, as well, protect the parts from heat 
 and cold, insects and dirt, until they can receive proper 
 treatment. In this way are avoided erysipelas, gangrene, and 
 other diseases resulting from neglect of the prompt treatment 
 of wounds, while in many instances loss of limb, and even of 
 life, is prevented. 
 
 Fixative applications are used both to hold the lips of 
 wounds together and to retain dressings in place. The 
 suture of silk or catgut with which a surgeon stitches a wound 
 together is a fixative, and so is the bandage with which the 
 dressings are bound upon the wound. Adhesive plaster is 
 used for the latter purpose, but on account of the difficulty of 
 keeping clean wounds that have been treated with it, it should 
 never be applied to fresh wounds. They should rather be 
 dressed with a compress and so retained until a surgeon can 
 close them with sutures. The use of adhesive plaster in 
 connection with wounds, then, is mainly confined to fixing 
 dressings in place. Court plaster may be used for closing 
 slight cuts of the skin resulting from ordinary household 
 accidents. It is best, however, not to dampen the court 
 plaster with the tongue, but with a little pure water, because 
 the saliva is filled with micro-organisms, some of which may 
 produce serious trouble in the wound. 
 
 Emollient applications are bland substances, either fatty 
 or not, which, when applied to sore and inflamed surfaces, 
 exert a soothing influence upon them. Such are the petro- 
 leum oils sold under the name of vaseline, cosmoline, petro- 
 latum, and the like. Sweet, unsalted lard and butter, and oils 
 of various kinds, are included under this head. They are 
 also of use as applications to the surfaces about wounds, tc 
 prevent the dressings sticking. These ointments are often 
 impregnated with antiseptics, so that they make an antiseptic 
 application in themselves and, when covered with a suitable 
 compress, make a very useful dressing. Carbolic acid is the 
 antiseptic substance most commonly used for this purpose, 
 and carbolized vaseline, cosmoline, and the like can be bought 
 in the shops. 
 
POULTICES 113 
 
 Poultices are emollients of sufficient importance to be 
 considered by themselves. They are applied for the purpose 
 of giving and maintaining in a part heat and moisture ; they 
 are soothing and allay pain ; they assist the formation of 
 matter in boils and abscesses ; they draw the blood to the 
 surface, relieving congestion of deep parts, and they absorb 
 foul secretions and loosen sloughing matter from septic 
 wounds. They are easily infected with micro-organisms, and 
 should on that account, when used in connection with open 
 sores or old wounds, be made antiseptic by the addition of 
 some suitable germicide. Corrosive sublimate is not admissi- 
 ble here, but carbolic acid may be added in the proportion of 
 a couple of teaspoonfuls to the pint of water, and powdered 
 boracic acid and charcoal may be dusted over the face of the 
 sore and over the surface of the poultice. 
 
 Any material which satisfies the requisite of retaining 
 warmth and moisture may be used for a poultice. A com- 
 press of Iceland moss soaked for an instant in boiling water 
 makes an excellent poultice. These compresses are sold in 
 the shops as the "Poultice Instantaneous." Linseed meal 
 is the material generally used by medical men, but other 
 materials, such as bread crumbs, oatmeal, starch, corn meal, 
 and bran may be used. 
 
 In order to prevent the escape of heat and moisture, a poul- 
 tice should be covered in with oiled silk or muslin, or a layer 
 of cotton wadding. They are very apt to stick unpleasantly 
 to the parts after being worn for some time, and this may be 
 prevented by covering the under surface with some thin 
 material such as mosquito netting, or by smearing the part 
 with oil or vaseline before applying the poultice. A poultice 
 should be as hot as can be borne by the patient, remember- 
 ing that children's skin is more sensitive than adults 1 , and 
 some adults' more than others 1 ; testing it by laying it upon 
 the back of the hand, or by holding it close to the cheek, is 
 usually sufficient. Poultices cool after an hour or two and 
 should be renewed at least as often as once in two hours 
 to secure the best result. The poulticed part should never be 
 left uncovered, but a new poultice should always be on hand 
 to replace one when it is taken away. 
 
114 THE IMPLEMENTS OF REPAIR 
 
 Linseed-meal Poidtices require for their manufacture (i) a 
 small dish, (2) heat sufficient to boil water, (3) a table-knife, 
 (4) a piece of muslin or flannel two or three inches larger 
 each way than the desired poultice, (5) a piece of oiled silk 
 or muslin of the same size, (6) a piece of thin cheese-cloth, 
 tarlatan, or, better than either, mosquito netting, (7) sufficient 
 linseed meal, and (8) boiling water. The poultice is then 
 made by first scalding out the dish, then pouring in the boil- 
 ing water — which should be kept boiling — and adding lin- 
 seed meal little by little, stirring the mixture all the time, 
 until it has the consistence of a thick paste. When the 
 ingredients are thoroughly mixed, take a table-knife, and, pre- 
 viously dipping it into boiling water so that the poultice will 
 not stick to it, spread the poultice about half an inch thick 
 upon the muslin, which has been evenly laid upon the oiled 
 silk ; then lay the thin fabric over its face and neatly turn in 
 the margins of the muslin and oiled silk to prevent the 
 poultice spreading, and — first testing it to make sure that 
 while as hot as it can be borne, it is not hot enough to be 
 painful — apply it as needed. 
 
 Oatmeal and Corn-meal Poultices are made in the same manner as 
 those of linseed meal. 
 
 Bread Poultices are made by boiling down some stale bread with 
 water for five minutes, then draining off the water and spreading the 
 bread on the muslin ; then treating it the same as a linseed-meal poul- 
 tice, except that its inner face should always be smeared with oil or 
 vaseline before applying it. An objection to a bread poultice is its 
 liability to become sour. 
 
 Starch Poultices are prepared by first making a stiff paste with cold 
 water, then adding boiling water to give it the required degree of 
 warmth. All the foregoing are spread and applied in the same manner 
 as the linseed-meal poultice. 
 
 Bran Poultices are prepared by first making a flannel bag of the 
 desired size, and then, after scalding the bran in a basin, putting it into the 
 bag, the open end of which should be quickly sewed or pinned together ; 
 the bag with its contents should then be quickly wrung out in a towel 
 and applied like a linseed-meal poultice. 
 
 Hot Moist Fomentations form another means of applying 
 warmth and moisture to painful parts ; they are more quickly 
 
HOT FOMENTATIONS 1 1 5 
 
 made than poultices and may be applied where quick action 
 is desired. They form a useful application in sprains, and 
 headache may often be relieved by laying them upon the 
 brow, while the rapidity with which they may be made ready 
 renders them peculiarly useful as an application to the belly 
 in colic. The fomentations usually consist of flannel cloths 
 wrung out in hot water. The best way to prepare them is to 
 crumple the flannel into a wad and roll it up into the middle 
 of a towel, then dip the middle of the towel with the flannel 
 into hot water and wring it out well by twisting the ends of 
 the towel in opposite directions, touching only the dry ends 
 of the towel. The fomentation should be taken to the 
 patient before it is removed from the towel, and, with pre- 
 cautions not to have it too hot, duly applied, the loss of heat 
 and moisture being prevented by a covering of oiled silk or 
 cotton wadding. They should be renewed as often as cooling 
 shows it to be necessary. The action of the fomentations 
 is said to be assisted by the addition of two or three table- 
 spoonfuls of turpentine to the water. 
 
 Hot Dry Fomentations are applied whenever there is a 
 lack of heat in the system, or in any part of it. The most 
 common method of application is by means of hot-water bags 
 of india rubber. However, in their absence, flannel bags 
 filled with salt, bran, or sand, and thoroughly heated, may be 
 used with great advantage. Where the heat is needed very 
 quickly, ordinary bottles filled with hot water and tightly 
 corked are an excellent substitute. Heated bricks, frag- 
 ments of rock, flatirons, and many similar articles, when 
 carefully wrapped in flannel or a bit of blanket, have been 
 used for this purpose. The chill following great loss of 
 blood, the coldness following an escape from drowning, the 
 lack of warmth accompanying extreme prostration from 
 many conditions, are all to be treated by dry fomentations. 
 In these cases, the heated articles should be wrapped in 
 cloths and laid in contact with the feet and along the side 
 of the body, care being taken not to have them too hot, for in 
 partially unconscious conditions the patient might be burned 
 without having the power to move away. 
 
Il6 THE IMPLEMENTS OF REPAIR 
 
 Counter-irritants are commonly used as a relief to pain. 
 They are useful in colic, muscular rheumatism, and other 
 painful affections, and should be used as a rule under the 
 direction of a physician. 
 
 The Mustard Plaster is perhaps the most common form in 
 which counter-irritation is applied. The dry mustard should 
 be mitigated by mixing with an amount of flour varying 
 according to the effect desired, and stirred up with water, or 
 preferably the white of an egg. This mixture is then spread 
 upon a bit of flannel or muslin and laid upon the skin ; if the 
 skin be very sensitive, however, it may be desirable to lay a 
 layer of some thin material over its face. The plaster should 
 not be kept on too long, or it will form a blister instead of 
 merely reddening the skin, as is desired. Fifteen minutes is 
 usually long enough. 
 
 The Spice Plaster forms an agreeable and gentle counter-irritant, 
 and is made by using a mixture of ordinary cooking spices with the 
 white of an egg, in the same manner as a mustard plaster. This is 
 particularly useful in children and persons with a very delicate skin. 
 
 The Mustard Poultice combines the good qualities of a poultice and 
 a counter-irritant, and is a particularly excellent way to apply counter- 
 irritation where deep-seated parts are to be affected. It is prepared by 
 mixing mustard thoroughly with warm — not hot — water, making from 
 a tablespoonful to half the bulk of the proposed poultice, according to 
 the strength desired. Then, having made a linseed-meal poultice as 
 already described, mix the mustard into it before spreading, and pro- 
 ceed as in a simple poultice. 
 
Part III 
 
 EMERGENCIES AND ACCIDENTS 
 
CHAPTER XV 
 HOW TO ACT AT FIRST 
 
 In the presence of an accident or other emergency, the 
 first requisite is presence of mind. The slang expression, 
 keep cool, is the first precept to be impressed upon the mind. 
 Nothing is more fraught with danger to a person suffering 
 from the depressing shock of a severe accident than the noise 
 and excitement of an officious bystander ; nothing, on the 
 contrary, is more soothing and satisfying to such an one 
 than a quiet, collected demeanor upon the part of those 
 assisting him. A knowledge of the proper course to pursue 
 in such cases will contribute largely toward investing one 
 with the proper manner, but it is necessary, particularly for 
 those of a more or less excitable temperament, to practise 
 curbing the nerves, and to restrain themselves by the knowl- 
 edge that a hasty act may precipitate most unhappy results. 
 
 But while excitement and haste are to be condemned, 
 promptness coupled with quiet cannot be too earnestly sought. 
 In many instances, the ready appreciation of the emergency, 
 followed immediately by the application of the proper treat- 
 ment, has been the means of saving a life to which a moment's 
 delay would have been fatal. But rapidity must be distin- 
 guished from haste, and quick movements from excitement. 
 The patient should never be able to read the danger of his 
 condition from the countenance of his helper. 
 
 And while applying quietly and quickly whatever means of 
 assistance he may be able to contribute, the helper must 
 remember that his services are but temporary and only to 
 tide over the time until educated assistance can be brought. 
 Then, if it has not already been done, on coming into the 
 presence or a medical or surgical emergency, send for a 
 doctor iimnediately ! The great danger of instruction in 
 
 "9 
 
120 EMERGENCIES AND ACCIDENTS 
 
 methods of meeting emergencies is the tendency developed 
 in some students to feel that they have mastered the healing 
 art, and worse, to act in accordance with their feeling. The 
 work of the layman instructed in first aid should be restricted 
 strictly to the interval between his arrival and that of a 
 qualified medical man. A step beyond this is a piece of 
 presumption that might readily result in permanent damage, 
 if not a fatal result to the patient. 
 
 The reason for the morbid curiosity which induces people 
 to crowd about an injured person is difficult to discover. It 
 may be a characteristic not eliminated in the evolution of 
 man from the monkey. Even cattle and horses crowd about 
 an injured one of their kind. It is not uncommon to see a 
 person disabled on the street surrounded by a dense over- 
 arching wall of humanity, cutting off his supply of fresh air 
 and polluting with the breath the small amount that he can 
 obtain. The impropriety of this is evident ; then always 
 keep crowds back and give the patient an abundance of 
 fresh air. On no account should a patient be annoyed by 
 miscellaneous questioning, and certainly not by unnecessary 
 handling or moving, which might, by reopening a wound or 
 displacing a broken bone, cause serious injuries and even the 
 death of the patient. 
 
 In many cases the course of action to be pursued in an 
 emergency will be suggested by circumstances, especially to 
 one who has made a study of the subject. Where no imme- 
 diate action seems to be necessary, the patient should be 
 placed in as comfortable a position as possible until the med- 
 ical attendant summoned can arrive. 
 
 On finding a person who has been injured, particularly if 
 he be unconscious, the individual himself and his surround- 
 ings should be observed with great care, since the case may 
 come into the courts, where such evidence has been of vital 
 importance. The location of the person with regard to sur- 
 rounding objects should be observed, his relation to neighbor- 
 ing dwellings and the possibility of his having fallen from an 
 elevated point, such as a window or roof. Any articles lying 
 near by should be noted with a view to the possibility of their 
 
HOW TO ACT AT FIRST 121 
 
 having been used as missiles or weapons. A whiskey flask 
 near by would suggest intoxication ; a bottle labelled lauda- 
 num would create a suspicion of opium poisoning ; a recently 
 discharged pistol would cause a shot wound to be suspected, 
 and a bloody knife would be suggestive of stabbing ; while a 
 riderless horse or a fallen ladder would make one think of 
 injuries consecutive to a fall. The appearance of the ground 
 surrounding should be examined to see whether it bears 
 traces of having been trampled upon as in a scuffle or not. 
 
 The patient himself should be observed with great care — ■ 
 even his attitude may tell an important story. His clothing, 
 if torn or cut, or soiled with blood, may be a valuable link in 
 future evidence ; and the location of his injuries, if there be 
 any, should be noticed, as well as their relation to surround- 
 ing objects. All this should be taken in by a rapid survey 
 immediately upon arriving upon the scene, and should not 
 interfere with rendering the victim immediate assistance. 
 
 A sick or injured person should always be made to lie 
 down on his back if the character of his injuries does not 
 forbid, with his lower extremities extended and his arms by 
 his side. If he seems faint, his head should be rather lower 
 than his feet ; if faintness is not present, the head may be 
 raised a little and turned rather to one side. Nausea and 
 vomiting are very apt to accompany emergency attacks, and 
 the probability of this occurring should always be considered. 
 If the patient be insensible, he should be watched carefully, 
 and in case of nausea, turned to one side, so that the vomited 
 matter can be thrown out of his mouth ; if he is left upon his 
 back, it will be likely to fall back into the windpipe and cause 
 fatal choking. If he be conscious, he will the more easily be 
 cared for. 
 
 All tight articles of clothing should be loosened to prevent 
 interference with breathing or the circulation. Belts and 
 collars in particular need attention. 
 
 The popular idea of relief to the injured seems to begin 
 with the administration of stimulants. This is an incorrect 
 and dangerous notion ; for while there are but few cases in 
 which stimulants are of benefit, there are many in which 
 
122 EMERGENCIES AND ACCIDENTS 
 
 they are injurious. Where there has been any bleeding, 
 stimulants are liable to cause recurrence with all the dangers 
 attendant upon it. In case of thirst, water is the best bever- 
 age — cold in summer and warm in winter. Warm water 
 being distasteful to most persons, it may be administered in 
 the form of tea or coffee or broth — they are vastly superior 
 to alcoholic drinks. While there are a few conditions in 
 which brandy or whiskey or wine may be given with advan- 
 tage, they are comparatively so few, and subject to so many 
 modifications, that such beverages should never be admin- 
 istered except under the direction of a physician. 
 
 In case of a person who is unconscious, or so weak as not 
 to be able to give an account of himself, after meeting such 
 indications as are conspicuous, he should be systematically 
 examined. Beginning with the head, the fingers should be 
 passed gently over it in the search for wounds, depressions, 
 or bruises. If the eyes are closed, the upper eyelid should 
 be raised to permit of examination, and the open eye should 
 be examined as to whether the pupils are dilated or con- 
 tracted, of the same size or unequal, and whether the eyeball 
 is sensitive to the touch. Passing down the neck in the 
 same manner, the two sides of the body should be carefully 
 compared and any variation noted ; the ribs and collar bones 
 should be felt to see if they are sound. The breathing should 
 be watched to see if it is easy or difficult, snoring or imper- 
 ceptible, and the odor of the breath should be tested for 
 indications of drugs or liquors taken. The arms and legs 
 should then be looked over ; the attitude, the increase or 
 diminution of length of one as compared with the other, the 
 possibility of bending at an abnormal point and crackling 
 felt at the point, — all have their value and should be sought 
 for. 
 
 If a wound be discovered in some part covered by the 
 clothing, it should be examined to see whether it needs treat- 
 ment or not, and if dressings are demanded, the part should 
 be uncovered to a sufficient extent to permit their ready appli- 
 cation. The examination should be made with the greatest 
 gentleness on account of the extreme sensitiveness of injured 
 
INDICATIONS OF DISEASES 1 23 
 
 parts ; and as little as possible of the person should be uncov- 
 ered, for the natural tendency of an accident is to produce a 
 greater or less amount of shock, which is manifested in a 
 diminution of the heart's action with a cold feeling all over 
 the body, often manifested by shaking chills and cold sweat. 
 The chill, certainly, should not be increased by exposure of 
 the body. The injured part should be exposed by ripping 
 the nearest seam in the clothing and cutting the under- 
 clothing under it, taking care to uncover no more of the part 
 than is absolutely necessary for the dressings. 
 
 When an injured person has been brought to his bed and 
 has received proper attention, it will be desirable to remove 
 his clothing. This should be done with the utmost gentle- 
 ness, the sound side should be undressed first, and then the 
 clothing removed from the injured side with as little disturb- 
 ance as possible, assisting the process by ripping and cutting 
 whenever the slightest difficulty appears. If it is necessary 
 to replace the clothing upon an injured person, the injured 
 side should be clothed first and then the sound side ; but 
 ordinarily no attempt should be made to put clothing on 
 again — it is sufficient to lay it loosely about a patient. 
 
 Indications of Diseases. — Certain conditions or appear- 
 ances point toward the existence of certain affections ; these 
 are signs or symptoms. A flushed face is a symptom of 
 fever, of apoplexy, of epilepsy, and of intoxication, while a 
 pale face indicates poor circulation or faintness. The eyes 
 afford important symptoms : if the pupils are enlarged and 
 the patient unconscious, paralysis, apoplexy, or belladonna 
 poisoning are indicated ; if they are very much contracted, 
 on the contrary, opium poisoning and congestion, and inflam- 
 mation of the brain are indicated ; while if they are unequal, 
 there is probably some brain trouble affecting but one side. 
 Inability to move a limb or to feel sensations in a part indi- 
 cate paralysis there; the same affection is indicated by a 
 drawing of the face to one side and a dragging gait. 
 
 Bleeding from the mouth or nose occurs in a large number 
 of disorders and cannot be said to be in itself a distinctive 
 symptom ; but when frothy blood is coughed in considerable 
 
124 EMERGENCIES AND ACCIDENTS 
 
 quantity from the mouth, bleeding from the lungs is to be 
 suspected, and when the bleeding comes from the ears, nose, 
 and mouth after a fall upon the head, fracture of the floor of 
 the cranium has probably occurred. 
 
 Fits, spasms, or convulsions also occur in a variety of 
 affections and may be very violent in epilepsy, drunkenness, 
 and in insanity, kidney troubles, and apoplexy ; comparatively 
 slight causes, such as teething and even indigestion, will pro- 
 duce them in children, and on the other hand they may indi- 
 cate extensive brain disease. The drunken man staggers in 
 his gait, but disease of the brain or spine may also cause 
 irregularity in walking. 
 
 A weak pulse is a sign of fainting, bleeding, shock, or 
 collapse ; an irregular pulse indicates heart disease ; a slow 
 pulse is a symptom of pressure on the brain and opium 
 poisoning; and a rapid pulse leads to a suspicion of fever, 
 although it may be due to nervous excitement, or may be the 
 normal condition of the patient. 
 
 Difficult breathing may be due to a stoppage of the air 
 passages, to broken ribs, to water in the chest, to disease of 
 the heart or lungs, and to disease or injury of the breathing 
 centre in the brain, or the nerves supplying the breathing 
 apparatus. Snoring breathing, also called "stertorous," is a 
 sign of pressure on the brain, as in apoplexy. Hiccup is 
 a spasmodic breathing, and may be caused by indigestion, 
 nervous trouble, and exhaustion. Coughing occurs in foreign 
 body in the larynx, irritation in the windpipe or bronchial 
 tubes, and in lung and heart disease. 
 
 Dizziness may be due to digestive disorders, kidney troubles, 
 and brain affections, while shivering chills, aside from cold- 
 ness, may point to the beginning of fevers, or to weakness 
 and danger in the course of an illness. 
 
 It will be observed that it is rare that a single symptom 
 points exclusively to a single disorder, and the physician 
 relies upon a combination of signs for the identification. 
 Typical cases of disease are rare, and two cases of the same 
 affection may differ so greatly that the uneducated mind 
 would never class them together. 
 
BRUISES 125 
 
 Cases of feigning accidents or disease in order to profit by 
 the sympathies of bystanders are not unknown. Indeed, men 
 have been known to make an excellent living by simulating 
 epileptic fits ; in cases of fits, then, where the fall is very 
 gentle and always at a point where a generous contribution 
 is to be expected, and where the convulsions are never directed 
 toward a body, contact with which might hurt the subject, 
 such cases should be looked upon with suspicion. All the 
 symptoms are probably assumed and the froth at the mouth 
 produced by a bit of soap. Blindness and deafness are fre- 
 quently feigned, and it has been a common practice among 
 mendicants to irritate ulcers and other sores in order to 
 obtain an excuse for soliciting charity. 
 
 CHAPTER XVI 
 BRUISES, BURNS, AND FREEZING 
 
 Bruises. — Definition : Wounds under the skin. 
 
 Causes: Blows, falls, squeezes, pinches. 
 
 Symptoms : Pain, at first numb, later sharper. Swelling. 
 Change of color : at first a purplish red, fading out to 
 a greenish brown, and lastly to a dirty yellow. In 
 severe cases the symptoms of shock are present. 
 
 Treatment : If it be slight, cold applications, in the form 
 of wet cloths and sponges ; if more severe, cloths 
 wrung out in hot water, and bran poultices ; laudanum 
 directly to the part relieves pain. Very severe and 
 extensive bruises may involve deep tissues to a great 
 extent, and treatment appropriate to each case must be 
 administered by a physician. Shock, however, should 
 be treated with hot, dry fomentations pending his 
 arrival. 
 
 Bruises are technically known as contusions, and vulgarly as " black- 
 and-blue spots," " black eyes," and by other names, varying according 
 to the location. 
 
126 EMERGENCIES AND ACCIDENTS 
 
 The discoloration is caused by blood issuing usually from capillary 
 blood-vessels, broken under the skin by the violence which has torn 
 the surrounding tissues to a greater or less extent. Where the tissues 
 under the skin are loose and spongy, a considerable amount of dis- 
 coloration may occur. This is seen in the " black eye," where the 
 amount of blood issuing into the tissues may be quite considerable. 
 The discoloration does not appear at once, since it takes some little 
 time for the blood to spread into the tissues sufficiently to be seen 
 under the skin, but it is usually apparent in from a few minutes to sev- 
 eral hours. However, if the parts especially bruised lie very deep, as 
 when a bone is broken, it may take several days for the color to reach 
 the skin. The blood soon begins to decompose to a suitable condition 
 for absorption, and as the color fades out it is carried off and discharged 
 from the system. The time required for the return to the normal color 
 occupies a period varying — according to the extent of the injury — from 
 a few days to several weeks, and even longer, in very severe cases. 
 
 While it would seem that without a break in the skin, an injury could 
 not be very severe, as a matter of fact, the greatest amount of damage 
 may be accomplished. The entire substance of a limb may be crushed 
 to a pulp ; large veins and arteries may be torn ; the liver, kidneys, or 
 spleen may be broken, and the stomach or bowels may be bursted, 
 while the brain is peculiarly subject to such injuries, — without any ex- 
 ternal wound. In these severe cases the symptoms are correspondingly 
 accentuated. Where the chest or abdomen has been bruised, injury to 
 their contents is shown by spitting or vomiting blood, or passing it from 
 the bladder or bowels. This is usually accompanied by great pros- 
 tration, with feeble pulse, cold, clammy skin, anxious expression, and 
 bewildered mind. The most important point of treatment in this case 
 is to counteract the tendency to weakness by the application of warmth, 
 inside and out. Hot, dry fomentations, consisting of bottles of hot 
 water, hot flatirons, hot stove-lids — in fact, anything hot that can be 
 obtained quickly, taking care to cover it, so as not to burn the patient's 
 skin — should be applied at once. Hot drinks should be given him, 
 coffee preferably, but in default of that any similar material. On 
 account of their effect upon bleeding, alcoholic drinks should not be 
 given. And, above all, a surgeon should be instantly summoned / 
 
 Where the accident affects larger vessels than the capillaries, the 
 amount of blood lost into the tissues may be very large, and form a 
 haematoma or " blood-tumor," and these require the care of a physician. 
 If an artery is torn, the swelling forms very rapidly, and beats with the 
 heart like the pulse of an artery. 
 
 In large bruises the parts may be so injured as to make it necessary 
 to remove the bruised limb ; and even in comparatively slight bruises 
 the blood may break down into an abscess which has to be opened to 
 let the matter out. Paralysis of a limb, necrosis or death of a part, and 
 long-continued tenderness may result from an extensive bruise. 
 
BURNS 127 
 
 The treatment looks toward three points: (1) to stop the issue of 
 blood ; (2) to hasten the removal of blood already in the tissues ; and 
 (3) to diminish any resulting inflammation. 
 
 The first indication is fulfilled by the application of cold water or 
 chopped ice to the bruise. 
 
 Both the first and second are fulfilled by stimulating washes ; a 
 mixture of three drachms of table salt and one drachm of muriate of 
 ammonia in six ounces of baywater is perhaps the best of these; dilute 
 alcohol and a mixture of dilute alcohol and water are also excellent 
 applications for this purpose. 
 
 The second indication is also well fulfilled by kneading or rubbing 
 the bruise with oil or a simple liniment, and by pressing a compress 
 firmly upon it. The application of a mass of raw lean beef, so popular 
 in the treatment of " black eyes," also belongs to this class. 
 
 The third indication is fulfilled by the cooling applications already 
 mentioned. If an abscess should form, it should be treated by a 
 surgeon. 
 
 Pain may be treated, in addition to the applications detailed, by the 
 administration of anodynes, locally and internally, and always under 
 the direction of a medical man. 
 
 Burns. — Definition : Injuries due to the action of too great 
 heat on a part. 
 
 Causes : Contact with fire, very hot bodies or chemicals. 
 
 Varieties: Burns are divided into three classes, accord- 
 ing to the degree of severity of the injury: (1) Mere 
 painful redness. (2) The formation of blisters. 
 (3) Charring. 
 
 They are also classified, in accordance with the mate- 
 rial inflicting the injury, into (a) burns, produced by 
 contact with fire, hot solids, or chemicals, and (b) scalds, 
 caused by hot liquids. 
 
 Symptoms : Pain. Simple reddening of the skin in the 
 first class, redness with the formation of blisters in the 
 second class, and actual destruction of the skin and 
 more or less of the underlying tissues in the third. 
 In burns of the first two degrees, the skin only is 
 involved, while in charring there is no limit. In severe 
 burns there is apt to be a great amount of prostration 
 with the symptoms which together form shock, de- 
 scribed in the chapter on Fainting. 
 
128 EMERGENCIES AND ACCIDENTS 
 
 Treatment: Remove the clothing by cutting it away 
 with a knife or scissors ; if it sticks, do not pull it off, 
 simply cut around it and flood it with oil. 
 
 Let the water out of blisters by pricking them with 
 a new and absolutely clean needle or pin, and gently 
 pressing them, taking great care not to break them 
 and expose the tender surface underneath. 
 
 Promptly exclude the air by : — 
 
 a. In case of a slight burn of the first degree, and 
 in particular of a scald, applying a compress wet with 
 water in which is dissolved as much baking-soda as 
 the water will take up. 
 
 b. In any case, applying any clean oil such as salad 
 oil, olive oil, sweet oil, fresh lard, unsalted butter, 
 vaseline, cosmoline, petrolatum. The white of an egg 
 is even better than these, and all of them are improved 
 by being carbolized by the addition of fifteen grains of 
 carbolic acid to the ounce. 
 
 c. Better, however, by applying " carron oil," a mix- 
 ture of equal parts of linseed oil and lime water. 
 
 d. In the absence of oils, by dusting flour or whiting 
 over the burn. If nothing else can be gotten, moist 
 earth, preferably clay, makes a useful application. 
 
 Cover the part with cotton or the nearest available 
 substitute for it. 
 
 Burns caused by acids, such as oil of vitriol or sul- 
 phuric acid, carbolic acid, and the like, should first be 
 thoroughly drenched with water and then washed with 
 a solution of washing or baking soda and water ; then 
 treated like an ordinary burn. 
 
 Burns caused by alkalies, such as caustic potash, 
 caustic soda, strong ammonia, and the like, should first 
 be thoroughly drenched with water and then washed 
 with vinegar or some other dilute acid; then treated 
 like an ordinary burn. 
 
 Treat shock by hot, dry fomentations and warm 
 drinks as prescribed in the chapter on Fainting. 
 
 In severe cases send for a physician. 
 
BURNS 129 
 
 Burns are by surgeons divided into six classes instead of three, as 
 follows : (1) Simple redness of the skin. (2) Redness, with slight 
 blistering, which leaves no mark after recovery except, perhaps, a slight 
 stain. In these two classes the burn does not go below the epidermis 
 or scarf skin. (3) Partial destruction of the true skin also, which leaves 
 a scar, but no deformity. (4) Entire destruction of both scarf skin and 
 true skin, which invariably leaves a scar, and always produces deformity, 
 sometimes frightful in extent. (5) Destruction of muscles and other 
 soft parts, followed by great deformity and possible loss of limb, if 
 recovery takes place. (6) Charring of the entire thickness of a limb, 
 which always imposes loss of the limb if the patient survives. 
 
 Burns are more frequently the result of carelessness than not. But 
 they cannot always be avoided, as in accidents of various kinds, such as 
 explosions of gas and gunpowder, explosions of lamps, falls upon stoves 
 or into fireplaces, burning clothes, and the like. Scalds are caused by 
 contact with steam, hot water, and other fluids. 
 
 The pain attending a burn is very intense, and the removal of cloth- 
 ing by cutting, instead of pulling it off in the usual way, is designed to 
 avoid increasing it as well as to avoid tearing of the blistered skin and 
 exposing the exquisitely tender surface below. 
 
 The chief indication in severe burns is to cover them as quickly as 
 possible with something that will exclude the air. The application 
 should be ready to apply the moment the clothing is removed. A very 
 brief delay is likely to be fatal to the patient, from exposure of the 
 burned surface to the air, especially in case of the chest and abdomen. 
 For this reason it is well, where a burn is extensive, to expose and dress 
 but a small portion of the burn at a time. 
 
 Baking-soda water — the bicarbonate, not washing soda or baking 
 powder — and the oils are best applied by dipping into them, and the 
 ointments like vaseline, by spreading them thickly upon, cloths, which 
 are then immediately laid upon the burned or scalded surface. Both 
 baking soda and carbolic acid have a soothing effect upon the pain. 
 It is well to complete the dressing of a burn by covering the cloths with 
 layers of cotton batting, cotton wadding, flannel, oakum, and other simi-* 
 lar materials which should be bound lightly upon the part. 
 
 The inside of the mouth and throat may be scalded by drinking hot 
 fluids or swallowing chemicals. In addition to the dangers attendant 
 upon burns in other parts of the body, choking and smothering from 
 swelling in the throat is to be feared in this case. Cloths cannot be 
 applied here, and the oil or the white of an egg must be applied by 
 drinking them. If the injury is due to chemicals, the mouth and throat 
 should be rinsed by the proper antidote — vinegar or exceedingly dilute 
 acid in case of caustic soda, potash, ammonia, or lye, and a solution of 
 baking soda or washing soda in case of an acid. 
 
 It does no good to hold a burn to the heat, and the exposure may 
 
I3O EMERGENCIES AND ACCIDENTS 
 
 often cause great injury to the system. Warm moist cloths are, how- 
 ever, very grateful in slight burns. 
 
 Where charring has occurred, more or less of the tissues have been 
 
 killed, and the dead or " necrosed " portions will be cast off with the 
 
 formation of matter. In these cases, the physician will take great care 
 
 to use antiseptics to prevent infection of the wounds by micro-organisms. 
 
 The process of casting off the dead matter 
 
 may be hastened by the use of poultices, 
 
 which must be antiseptic. 
 
 Where the entire skin has been involved 
 in a burn, the healing will form a trouble- 
 some scar which will ultimately contract 
 and produce a deformity varying in degree 
 pig. 94, — Deformity of the according to the extent of the burn. The 
 hand, due to a contract- accompanying illustration shows a deformity 
 ing scar after a burn. of the hand due to a contracting scar after 
 
 a burn. It is one of the milder cases ; the 
 deformities are often frightful in the extreme. To avoid this as much 
 as possible, the parts should be placed in a natural position while heal- 
 ing and kept so. 
 
 Sunburn is caused by exposure to the rays of the sun, and is a burn 
 of the first degree — simple redness of the skin ; mustard causes a simi- 
 lar condition. The application of baking-soda water and of oils, un- 
 salted lard and butter, white of egg and vaseline — plain, but preferably 
 carbolized — is indicated here as in other burns of the same class. 
 
 Sunstroke and heatstroke, although they are accidents due to the action 
 of heat, are considered to be best treated in the chapter on Fainting. 
 
 Burning Clothing, particularly that of females, has been 
 the unnecessary cause of many horrible deaths, either from 
 ignorance of the proper means of extinguishing the flames, 
 or from lack of presence of mind to apply them. A person 
 whose clothing is blazing should (1) immediately be made 
 to lie down — be thrown down, if necessary. The tendency 
 of flames is upward, and when the patient is lying down, they 
 not only have less to feed upon, but the danger of their 
 reaching the face, with the possibility of choking and of ulti- 
 mate deformity, is greatly diminished. (2) The person 
 should then quickly be wrapped up in a coat, shawl, rug, 
 blanket or any similar article, preferably woollen, and never 
 cotton, and the fire completely smothered by pressing and 
 patting upon the burning points from the outside of the 
 envelope. 
 
FREEZING 131 
 
 The flames having been controlled in this way, when the 
 wrap is removed, great care should be taken to have the 
 slightest sign of a blaze immediately and completely stifled. 
 This is best done by pinching it, but water may be used. 
 Any burns and any prostration or shock should be treated in 
 the manner prescribed for them. 
 
 It is always dangerous for a woman to attempt to smother the burn, 
 ing clothing of another, on account of the danger to her own clothing. 
 If she attempts it, she should always carefully hold between them the 
 rug in which she is about to wrap the sufferer. 
 
 Freezing. — Definition : An injury due to the action of too 
 great cold on a part. 
 
 Causes : Exposure to excessive cold. 
 
 Varieties: (1) The frost bite, where portions only of the 
 system have been affected. (2) General freezing, 
 where the entire system is affected. 
 
 Symptoms : (1) Of the frost bite: Affecting projecting 
 points on the person, such as the ears, nose, fingers, 
 and feet, the affected part first tingles with pain and is 
 red, and then blue or purple in color ; as the freezing 
 goes on, the part becomes white and free from pain. 
 
 (2) Of general freezing : The entire person, under 
 exposure to severe cold, becomes chilled, stiffened, and 
 pale ; the mind becomes sluggish and drowsy ; the 
 extremities are benumbed and shrunken ; unconscious- 
 ness supervenes, and unless proper restorative means 
 are applied, death ensues without awakening. 
 
 Treatment: (1) Of frost bite: Too rapid warming is apt 
 to cause mortification, hence the frozen part should be 
 restored by rubbing with snow or with cold water 
 until the white color is replaced by the natural hue 
 and an aching pain is felt in the part — then treat like 
 a burn. 
 
 (2) Of general freezing : In a dry, cool room which 
 can be gradually heated, but not near a fire, the clothing 
 should be removed and the body rubbed briskly and 
 carefully, at first with snow or cold cloths, and then 
 
132 EMERGENCIES AND ACCIDENTS 
 
 with dry flannel ; as soon as the ability to swallow is 
 restored, stimulants and hot drinks should be given ; 
 upon restoration the patient should be snugly wrapped 
 in warm clothing and put to bed ; individual frost bites 
 being treated as above. 
 
 Under ordinary circumstances, an hour's exposure to intense cold 
 may determine a fatal result. This outcome, however, may be modified 
 by circumstances : a covering of snow retains the heat of the body to 
 such an extent as to considerably delay death ; well authenticated cases 
 are on record in which persons, buried even for days in the snow, have 
 nevertheless survived and ultimately recovered with little permanent 
 damage. 
 
 In a still day a very low temperature can be endured with compara- 
 tive comfort, while a wind will make a much warmer day productive of 
 great suffering. The rapid movement of the surrounding air carries 
 away from the surface of the body the warmth which remains undis- 
 turbed on a quiet day. 
 
 When a part is frozen, it becomes bloodless, as is shown by the white 
 color, and the object of treatment is to bring the blood back into the 
 emptied tissues. There is danger, however, if the return of the circula- 
 tion be produced too rapidly, that the resulting excess of blood in the 
 part will produce mortification and decay, — gangrene and sloughing, — 
 and for this reason, cold applications are combined with the rubbing, 
 by which the circulation is restored. 
 
 The effect of cold is very similar to that of heat, and frost bites are 
 much like burns, so much, indeed, that the after-treatment is the same. 
 Like heat, cold produces blisters, which are treated by careful pricking 
 with a new and absolutely clean needle or pin, pressing the fluid out, 
 and dressing the frozen surface with oils or ointments. 
 
 Like charred burns, the dead matter resulting from the mortification 
 of a frozen part should be treated antiseptically, and the process of 
 throwing it off hastened by an antiseptic poultice. 
 
 Chilblains are the result of too rapid warming of cold feet. The 
 blood having been to a considerable extent crowded out of the feet by 
 the cold, when they are rapidly warmed, it finds its way back in so large 
 a quantity that it cannot all be disposed of, and the excess can be seen 
 collected in small patches, scattered over the sole of the foot — the chil- 
 blains. This form of congestion sometimes becomes chronic in persons 
 of poor circulation. An individual subject to chilblains should never 
 come in out of the cold and toast his feet at a warm fire. He should 
 warm them by stamping or briskly rubbing them, and by warming 
 other parts of the body. Astringent applications to his feet, such as 
 alcohol or alum water, will usually control them when they have been 
 developed. 
 
WOUNDS I33 
 
 CHAPTER XVII 
 
 WOUNDS 
 
 Wounds. —Definition : Injuries, in which an opening is 
 made through the skin and more or less of the parts 
 underneath. 
 
 Varieties : ( 1 ) Cut or incised wounds ; (2) Torn or lac- 
 erated wounds ; (3) Bruised or contused wounds ; (4) 
 Pierced or punctured wounds, including gunshot 
 wounds ; (5) Poisoned wounds. 
 
 Causes : (1) Of cut wounds, blows with sharp-edged in- 
 struments, such as knives, razors, and swords ; (2) Of 
 torn wounds, blows with blunt instruments, such as 
 clubs or stones ; irregular bodies, like fragments of 
 shell and forcible tearing of a part from the body ; 
 (3) Of bruised wounds, blows with blunt instruments — 
 torn wounds are usually bruised also ; (4) Of pierced 
 wounds, thrusts with narrow, sharp-pointed instru- 
 ments, such as bayonets, arrows, and daggers — a gun 
 or pistol shot also produces a punctured wound ; (5) 
 Of poisoned wounds, usually bites of venomous reptiles 
 or insects. 
 
 Sy7nfttoms : Pain at the point of injury. An opening 
 through the skin. Bleeding, varying in amount ac- 
 cording to the injury. Where bones are broken, the 
 signs of that injury. 
 
 Treatment : 1 . If the wound be a large or disabling one, 
 lay the patient in as comfortable a position as possible. 
 
 2. Stop the bleeding as far as practicable by the 
 employment of the means described in the chapter on 
 Bleeding, taking care not to destroy the clot, if one 
 has formed. 
 
 3. Cleanse the wound from bits of glass, stone, 
 splinters of wood, dirt, or any other matters of the 
 kind, by washing with absolutely clean water, rendered 
 
134 EMERGENCIES AND ACCIDENTS 
 
 antiseptic if possible by a tablespoonful of common 
 salt to the pint, or vinegar in the proportion of one 
 fourth ; or, better, carbolic acid or corrosive sublimate 
 solutions, prepared as directed in the chapter on Germs. 
 If clean water cannot be obtained, do not wash the 
 wound ; simply pick out the larger particles. 
 
 4. Place the edges of the wound as nearly as possi- 
 ble in their natural position. 
 
 5. Set any broken bones by the methods related in 
 the chapter on Broken Bones. 
 
 6. Use a first-dressing packet in accordance with 
 directions, if available ; if not, apply compresses, pre- 
 pared according to the methods detailed in the chapter 
 on dressings, wetting them with the same antiseptic 
 solution used for cleansing. Bandage this dressing 
 neatly in place. 
 
 7. Apply splints, if necessary, not binding them di- 
 rectly upon the wound. 
 
 8. Apply a triangular bandage over the wound now 
 dressed, and if it affect an upper extremity, support it 
 in a suitable sling, as detailed in the chapter on Band- 
 aging, and keep it quiet. 
 
 9. Treat shock by hot drinks, and hot, dry fomen- 
 tations, as directed in the chapter on Fainting. 
 
 Through the appreciation of the germ theory, both the treatment of 
 wounds and its results have, within a few years, undergone striking 
 changes. The recognition of the fact that bad results and slow healing 
 of wounds are due to the presence of poisons, developed by noxious 
 germs, which have found their way into wounded tissues, has led to the 
 observance, by surgeons, of the strictest precautions to prevent the 
 entrance of germs, and to destroy or paralyze them if they should gain 
 access to them. And by doing this, the surgeon of the present day is 
 able to perform operations that would in former times have been con- 
 sidered as actual murder. With improved means of proceeding, hardly 
 any part of the body is sacred from the surgeon's knife. We saw open- 
 ings into the skull, and operate upon the brain ; we open the belly and 
 cut out kidneys, spleens, and parts of the stomach and bowels, the liver 
 and pancreas, the bladder, and whatever other organs are contained in 
 the abdomen ; we open up joints and nail bones together, or cut out 
 pieces of them ; we cut off bits of the lungs, and even the heart itself is 
 
WOUNDS 135 
 
 likely to become subject to operation at no distant day, for it has already 
 been pierced, and had blood pumped out of its cavity. 
 
 Several circumstances modify the danger of a wound, such as its 
 depth, its extent, and its location. The character of the deeper parts 
 affected also has a powerful influence upon the result : wounds of the 
 blood-vessels are likely to result fatally, unless the bleeding is checked ; 
 wounds of the brain, lungs, and intestines are likely to be followed by 
 death, unless treated with the utmost skill and care ; heart wounds rarely 
 fail to be mortal, while those affecting the bones and joints are liable 
 to complications which may induce death. 
 
 The kind of wound inflicted also affects the result. Punctured 
 wounds, such as stabs and shot-wounds, are the most dangerous in 
 proportion to the amount of external injury inflicted, both because they 
 may penetrate deep enough to sever a blood-vessel or injure other vital 
 organs, and because foreign bodies, such as bits of clothing and splinters 
 of bone, may have been carried into the wound in addition to the bullet, 
 which is generally harmless to the surrounding tissues. 
 
 In a chapter devoted to the subject, methods of checking bleeding 
 will be discussed in detail. It will be seen that bright red blood spout- 
 ing in a jet from a wound indicates that an artery has been opened, and 
 that such bleeding may be stopped by pressure upon a limb above the 
 wound, or by thrusting a finger or thumb into the wound itself and 
 holding it there until other means of arresting bleeding have been 
 applied. If the bleeding consist of dark, blackish red blood pouring 
 steadily from the wound, it will have originated in an injured vein, and 
 this should be treated by pressing a thumb or finger into the wound 
 until other more serviceable means of treatment can be applied. In 
 either one of these cases a surgeon should be summoned immediately, 
 especially if the amount of bleeding be great, and, meanwhile, no 
 other dressings can well be applied except where bleeding has been 
 checked by pressure above the wound, or by a plug in it : in this case 
 a wet compress may be laid upon the wound pending the arrival of a 
 surgeon. The wound, however, should still be watched with increas- 
 ing vigilance, so that any recurrence of bleeding may be observed at 
 once. 
 
 Slight bleeding, especially, that from the capillaries, may be readily 
 controlled by the application of a little hot or cold water, and by the 
 pressure of dressings which may be applied at once. 
 
 Cleanliness is of Vital Importance to Wounds. All foreign matters 
 should be removed. Dirt, bits of glass, gravel, or cloth, splinters oi 
 wood, fishhooks, pins or thorns, should be picked out and the wound 
 washed with clean, or, preferably, clean water with germicides — corro- 
 sive sublimate, carbolic acid, salt, sugar, vinegar, etc. — in solution. 
 Micro-organisms contained in water are killed by boiling, and fresh- 
 boiled water may always be used with advantage where antiseptic solu- 
 
136 
 
 EMERGENCIES AND ACCIDENTS 
 
 Fig. 95. 
 
 tions cannot be obtained. In washing wounds, use absolutely clean 
 materials, sponges, or masses of absorbent cotton or gauze if available, 
 and failing these, use clean handkerchiefs or other linen, or paper. 
 Do not use materials torn from the clothing of the patient or by- 
 standers. 
 
 The wound should not be mopped with the sponge, and except in 
 assisting in the removal of something especially difficult to extract, 
 should not be allowed to be touched by it. The sponge should be 
 
 dipped into the water 
 and then held in the 
 closed hand a few 
 inches above the 
 wound, with one cor- 
 ner protruding, and 
 gently squeezed so as 
 to cause- a single stream 
 to trickle gently down 
 upon the injured sur- 
 face. The force of the 
 flow of the fluid used 
 for washing should be 
 varied according to the 
 difficulty of washing 
 away the dirt; the size 
 of the stream can be increased by squeezing the sponge harder, and its 
 force by holding it at a greater distance from the wound. 
 
 Unclean water should never be used — a wound had better be left 
 dry. Stagnant water is particularly liable to be full of vegetable and 
 animal microscopic life. 
 
 Any hair in the vicinity of a wound should, if possible, be carefully 
 clipped short, and preferably shaven, to obviate any irritant action by 
 its contact with the wound. 
 
 Having cleansed the wound, the injured parts should be carefully 
 drawn as nearly as possible into their original position. This is of 
 importance in diminishing the size of the scar. In a simple cut, if the 
 edges are promptly drawn closely together, healing will occur without 
 leaving any scar. The rapidity and completeness of the healing in such 
 cases is often astonishing. Where a greater or less part of a finger or 
 toe has been cut off with a sharp instrument like a knife or an axe, it 
 has often been made to unite to the stump by binding it closely to the 
 point whence it has been removed. In these cases, the amputated 
 finger or toe has often readily grown again to its old place. A finger 
 or toe, then, which has 'been cut off should be immediately fitted into its 
 place and neatly bound there in order to give it a chance to grow to the 
 body again. 
 
 How to squeeze a sponge in washing a 
 wound. 
 
CLOSING WOUNDS 1 37 
 
 The preferable method of retaining the edges of wounds together 
 is by means of stitches of antiseptic materials ; the surgeon uses silk, 
 catgut, silkworm gut, and a number of similar materials. Horse hair 
 properly treated may be used with advantage. Stitching, however, 
 should not be attempted except by a medical man, or one who has had 
 practical experience in the manoeuvre under the eye of a surgeon. 
 Stitching a wound leaves a much smaller scar than any other means of 
 closing, and where a surgeon can be obtained, a wound should always 
 be so treated. 
 
 Sticking-plaster will retain the edges of a i — -\ / — | 
 
 wound together superficially, but it is impossi- / * — x | 
 
 ble to keep an injury clean with plaster sticking 
 
 to it, and where practicable to avoid it, the Fig. 96. — Mode of cutting 
 plaster should not be used. If, however, one strips of plaster to afford 
 is driven by necessity to use it, the wound a larger st.ck.ng surface; 
 
 should never be entirely covered by the plaster, 
 
 since it would then confine any matter which might be secreted. The 
 edges of the wound should be drawn closely together and held in place 
 by narrow strips of plaster, leaving intervals between them for the escape 
 of secretions and the contact of dressings. Where there is a marked 
 tendency for the edges to gape, a larger sticking surface may be obtained 
 by making the plaster a little larger at either end. 
 
 However, where adhesive plaster spread on muslin, such as surgeons 
 use, is available, all contact of the plaster with the wound may be avoided 
 by taking two strips of plaster one or two inches wide and a trifle longer 
 than the wound. Lay these on either side of the wound with their inner 
 
 Fig. 97. — Wound closed by sticking plaster and laced threads. 
 
 edges a half an inch from it on either side, parallel to it and leaving 
 about a quarter of an inch of the upper margin loose and having the 
 remainder tightly stuck. Then with a needle and thread, preferably 
 silk, draw the edges of the wound together by lacing the free edges of 
 the plaster as shown in Fig. 97, fastening the thread at either end with 
 
I38 EMERGENCIES AND ACCIDENTS 
 
 knots and pressing the plaster firmly down as soon as the thread has 
 been drawn tight. 
 
 Any hair should be cut, by shaving, if possible, from localities where 
 the plaster is to be applied. If the hair is left in place, the removal 
 of the plaster sticking to it will be painful. Strips of sticking-plaster 
 should not be drawn completely about a limb, on account of the 
 danger of interference with the circula- 
 tion of the blood in the extremity. In 
 removing strips of plaster from a wound 
 where it has been applied, the two ends 
 should each be raised as in Fig. 98, and 
 that part lying over the wound removed 
 last. 
 
 Where stitching and closure with stick- 
 ing-plaster are both impracticable, the 
 Fig. 98. — Mode of removal of parts should be drawn together as well 
 sticking-plaster strips. as possible, and a compress applied and 
 
 bandaged in place. 
 In dressing a wound, two objects are to be considered: (1) to retain 
 the parts in a position suitable for healing, and (2) to prevent future 
 dangerous complications. To fulfil the first, we apply stitches, adhesive 
 plaster, compresses, splints, and bandages. The fulfilment of the 
 second demands care against (a) catching cold, (b) getting into painful 
 positions, or being jarred, and (c) the access of micro-organisms. 
 
 The parts having been cleansed and brought into proper position, 
 the application of a compress is the next procedure in order. In the 
 chapter on Dressings and Applications, the method of preparing corn- 
 presses has been fully described. After a pad of antiseptic gauze, cloth, 
 lint, oakum, cotton, paper, or other proper substance has been duly 
 prepared, soaked with clean water, preferably boiled, or an antiseptic 
 solution, it is gently placed upon the wound and made to lie closely 
 upon it. As has already been noted, where absolutely clean water or 
 antiseptic solutions cannot be obtained the dressings may be applied 
 dry. 
 
 The compress is then bound securely in place by a triangular band- 
 age, a folded handkerchief, or possibly a roller bandage, and the part 
 placed in a comfortable attitude. The bandages may be left in place 
 until the wound heals, or until the production of matter of a disagreeable 
 odor shows that the dressings need renewing. 
 
 The injured part should lastly be placed in such a position as to give 
 the patient the least discomfort, whether he remains on the spot or is 
 carried away. If the head be so injured that the patient is unable to 
 hold it up, he should be laid down with the head resting upon a pillow, 
 extemporized, if necessary, from folded clothing, hay, straw, grass, or 
 any other material which would answer the purpose, taking care that 
 
TORN AND PIERCED WOUNDS 1 39 
 
 the injury be kept from contact with the surrounding articles which 
 might prove painful. If the arm be injured, it should be supported in 
 a sling if the patient is able to walk ; or supported in a comfortable 
 attitude either across the body or by his side, if it be necessary to carry 
 him. If a lower limb be affected, it may be supported by pillows, 
 extemporized if necessary, in such a position as may be comfortable, 
 while at the same time not tending to disturb the parts. If the chest be' 
 injured, the head and shoulders should be raised by pillows until the 
 patient is able to breathe comfortably, the body being turned slightly 
 to the injured side. If the belly be wounded, the patient should be 
 made to lie down with his knees well drawn up and turned upon the 
 injured side, or upon the back if the wound is in front. 
 
 Torn or lacerated wounds are almost always bruised as well, but are 
 characterized by ragged edges. They may be caused by stones or 
 bricks, clubs or broken glass, machinery, and many other agents. They 
 may be dangerous in the extreme, especially in connection with accidents 
 due to the railway, or machinery. An entire limb may be torn away, or 
 it may be so crushed as to require to be amputated. In these accidents 
 it often happens that the blood-vessels are so twisted as to close them, 
 and render the bleeding comparatively trifling. Such injuries are to be 
 treated temporarily like ordinary wounds — foreign matters are to be 
 removed, the parts cleansed and covered with suitably prepared com- 
 presses, bandaged, and placed in as comfortable a position as possible. 
 The pain in extensive injuries of this kind is often not very great, but 
 the depression or shock is likely to be extreme ; it should be treated 
 with hot, dry fomentations, hot drinks, and the like, as detailed in the 
 chapter on Fainting. Where the head, chest, or belly has been crushed, 
 the accident is almost always immediately fatal ; but in other localities, 
 recovery occasionally occurs in apparently desperate cases. Small 
 wounds of the head and face, because of the abundant blood supply, 
 usually unite promptly, and with but a trifling scar, if the parts are 
 neatly drawn together. Torn wounds generally, however, heal slowly, 
 and by granulation, producing a greater or less amount of offensive 
 matter, requiring frequent renewals of the dressings. 
 
 Pierced or punctured wounds are caused in war, by bayonets, swords, 
 arrows, daggers, and similar implements; and in peace, by needles, 
 thorns, splinters, fish-hooks, bits of glass, and other articles of like 
 character. The immediate treatment of pierced wounds in general, 
 after the piercing body has been removed, consists simply in the appli- 
 cation of suitable wet compresses. If the wound be large, the injury of 
 important organs of bleeding may modify the treatment. Upon re- 
 moving a needle, examine it, to see if any of it has been broken off in 
 the flesh. If any portion has been left behind, or if the whole needle 
 has been pushed in, do not try to remove it, but keep the part absolutely 
 still, and summon a surgeon. Any movement of the part will cause 
 
140 
 
 EMERGENCIES AND ACCIDENTS 
 
 muscular contractions, which may so move the needle in the flesh that 
 it cannot be found when the surgeon comes to look for it. Thorns 
 should be pulled out, and, if poisonous, the wound should be treated 
 like a poisoned wound. 
 
 Splinters should be pulled out by slipping the point of a pen-knife 
 under the protruding end of the splinter, catching it against the blade 
 with the thumb nail, and drawing it out. If the end does not protrude, 
 the scarf skin over it can be pricked away with the point of the knife, 
 
 Fig. 99. — How to pull out a splinter. 
 
 until the end of the splinter is uncovered, when it can be removed 
 as before. If a splinter be located wider a nail, and the end be 
 broken off so that it cannot be reached, the nail over the splinter 
 should be scraped thin to the tip on the outside; a little tongue can 
 then be gently cut out over the end of the splinter, which may then 
 be raised on the point of the knife, and drawn out as in other parts. 
 When the splinter cannot all be removed in this way, the cutting away 
 df the nail will make it easier for the remainder to work its way to 
 the surface after the formation of matter. A splinter in the eye may 
 be drawn out, as in other parts, if it can be reached. If it cannot 
 be reached, the eye should be covered with a cold, wet compress, 
 and so kept until the arrival of a medical man. On no account 
 should a non-medical person attempt to interfere with splinters buried 
 in the eye. 
 
 In the case of needles or large splinters, where a portion may possibly 
 remain in the flesh, the part which has been pulled out should be kept 
 to show to the medical adviser when he shall have arrived, in order to 
 assist him to determine the character of the portion left behind. 
 
PENETRATING WOUNDS I4I 
 
 Fish-hooks and arrows in the tissues demand much the same treat- 
 ment, the difficulty in removing both being due to the barbed point. 
 As fish-hooks never penetrate deeply, they can readily be pushed through 
 the tissues — they should never be drawn back unless the barbed point 
 has been cut off. The best method of treating fish-hooks in the flesh is 
 to draw them through : this procedure is assisted by cutting off the loop 
 by which they are connected to the lines. So with arrows — where the 
 tip lies near the surface, and important organs are not in the way, — 
 they may be pushed through. Where this is impossible, a string should 
 be firmly tied about the shaft, so that it cannot slip, within a half an inch 
 of the wound, and the shaft should then be cut off a half an inch above 
 that point. The wound should then be treated with antiseptic com- 
 presses, until a surgeon can remove the arrow. The string will prevent 
 the arrow's being lost, should an accidental movement push it into the 
 tissues. 
 
 Gunshot wounds, including pistol-shot wounds, are pierced and often 
 torn wounds. Like other wounds, they should be treated by checking 
 bleeding, removing superficial dirt, applying antiseptic compresses, and, 
 lastly, splints to prevent unnecessary movements. Often the bleeding 
 from these wounds is very slight, and is checked by the simple pressure 
 of the dressings. There is apt to be much depression and other symp- 
 toms of shock, which should be treated by hot drinks, and hot dry 
 fomentations, as directed in the chapter on Fainting. The bullet is apt 
 to be the source of much anxiety to the uninitiated. Ordinarily, there 
 is no danger whatever in the presence of a bullet in the tissues. It is 
 the wound made by the bullet that bothers us. There are thousands of 
 men walking about the country to-day with bullets in their bodies, which 
 are not of the least trouble to them. A shot wound, then, should be 
 treated like an ordinary wound, and without regard to the presence of 
 the bullet. 
 
 Wounds of the chest may penetrate into its cavity or not. If they do 
 not, their treatment is the same as that of simple wounds in other parts. 
 If they do penetrate, they are liable to involve the organs contained 
 within it. If the heart is wounded, death usually quickly follows; 
 although that this is not always so is shown by a considerable num- 
 ber of cases recorded in surgical literature. If the lung be wounded, 
 difficulty of breathing, coughing, and spitting of blood will occur, and 
 the lung may protrude through the wound. Such an injury should be 
 treated by making the patient lie down upon the wounded side, so as 
 to let the blood drain to that side, and keep absolutely quiet : an attempt 
 should be made to check excessive bleeding, and the wound should be 
 dressed with a compress, and the entire chest closely surrounded with 
 bandages. Penetrating wounds, in rare instances, do not involve the 
 organs in the chest. 
 
 Wounds of the abdomen, like those of the chest, may penetrate into 
 
EMERGENCIES AND ACCIDENTS 
 
 Fig. 100. — Relations of the organs of the chest 
 and abdomen to the clothing. 
 
 the cavity or not. If they do 
 not, their treatment is the same 
 as that of simple wounds in 
 other parts. If they do pene- 
 trate, they may involve the 
 organs of the belly or not. 
 The bowels or other parts may 
 protrude from the wounds, and 
 may or may not be injured. 
 If the bowels or other parts 
 protrude, they should be care- 
 fully examined, — the hands 
 having previously been washed 
 either with an antiseptic solu- 
 tion or with clean water, — and 
 if they are uninjured, gently 
 pushed back into the belly. 
 If they have been injured, they 
 should not be returned, but 
 should be covered with wet 
 fomentations as hot as can be 
 comfortably endured with the 
 hand. These in turn should 
 be thoroughly covered to pre- 
 vent cooling. And a surgeon 
 should have been summoned. 
 
 All wounds of the body are 
 likely to produce great shock, 
 and every effort should be 
 made to sustain the victim by 
 hot drinks and other treatment 
 appropriate to this condition. 
 
 Penetrating wounds affect 
 different organs according to 
 their location. In Fig. ioo an 
 effort has been made to show 
 the relations of these organs 
 to the uniform of the soldier, 
 and from it a similar notion 
 of the relations of the clothing 
 of others may be derived. 
 
 In the chapter on Bones, 
 the method of identifying the 
 different vertebras of the spine 
 has been related. The verte- 
 
DANGERS OF WOUNDS 
 
 H3 
 
 brae bear constant relations to the organs of the chest and belly, and 
 by an examination of them an idea of the parts probably injured in a 
 wound of the body may be obtained. It is easy to discover the spinal 
 processes of the vertebrae by briskly rubbing the hand up and down 
 along the back of the spine, when each one will be marked by a red 
 spot. The following table, from Holden's Landmarks, indicates the 
 relations : — 
 
 Cervical f 5th. 
 
 Vertebrae. ( 7th. 
 3d. 
 
 4th. 
 
 Dorsal 
 Vertebrae. 
 
 Lumbar 
 
 Vertebrae. 
 
 8th. 
 
 10th. 
 
 nth. 
 12th. 
 
 1st. 
 2d. 
 
 3d. 
 
 4th. 
 
 Beginning of the oesophagus or " gullet." 
 Upper extremity of the lungs. 
 (a) Apex of the arch of the aorta, the great funda- 
 mental blood-vessel of the body, (b) Division of 
 the trachea or " windpipe " into two primary bron- 
 chial tubes. 
 
 (a) Upper margin of the heart, (b) The begin- 
 ning of the arch of the aorta on the right side, and 
 (c) its end on the left side. 
 Apex or lowest point of the heart on the left. 
 (a) Passage of the oesophagus or " gullet," through 
 the diaphragm or " midriff" into the abdomen or 
 " belly." (b) Upper edge of the spleen on the 
 left. 
 
 (a) Lower edges of lungs, (b) Upper orifice of 
 stomach on the left. 
 Lower edge of spleen on the left, 
 (a) Lowest part of the cavity of the chest (b) Pas- 
 sage of the aorta through the diaphragm. 
 (a) Arteries of the kidneys, and (b) the centres of 
 the kidneys themselves on both sides. 
 (a) End of spinal cord, (b) Pancreas or " belly 
 sweetbread." 
 Umbilicus or " navel." 
 
 (a) Division of the aorta, (b) Highest part of the 
 hip bones on both sides. 
 
 The dangers of wounds, when not properly treated, are many. Blood 
 poisoning, gangrene, or death of a part, excessive production of matter, 
 together with great depression due to it, long-continued inflammation, 
 and high fever are liable to follow any wound, and are due to the fact that 
 micro-organisms have gained access to the wound. Even the smallest 
 wounds may be productive of the most unfortunate consequences, when 
 neglected. Small scratches and pricks, when not properly cared for, may 
 result in inflammations and formations of gatherings or abscesses, which 
 may disable a person for a considerable time, or cause loss of a limb, or 
 even of life itself. This fact still further emphasizes the necessity for the 
 utmost care in removing all impurities from a wound at once by washing 
 
144 EMERGENCIES AND ACCIDENTS 
 
 with clean water at least, and covering the wound with a bandage oi 
 some kind to protect it from contact with possibly injurious matter. 
 
 The process of healing of wounds varies according to the nature of 
 the injury and the character of the treatment. The processes may be 
 grouped into two general classes, (i) Primary union or " first intention," 
 and (2) Secondary union or " second intention." 
 
 1. Primary union occurs rapidly and without the formation of matter, 
 and leaves only a slight scar. It can be obtained in wounds with clean- 
 cut edges, where the margins can be perfectly fitted together without 
 anything intervening ; they must be kept perfectly quiet and protected 
 from outward injury and from contact with external impurities. In this 
 case, a material called lymph, which is practically the liquor sanguinis, 
 is thrown out from the capillaries in the wound and acts like glue in 
 sticking the sides of the wound together. The capillary vessels are 
 then extended across the wound, and the circulation through it be- 
 comes as complete as before the injury. The surgeon always seeks to 
 approach as near primary union as possible, a wound uniting by this 
 process completely in two or three days. Under old methods such a 
 result was comparatively uncommon, but with the recognition of the 
 functions of micro-organisms and the means of preventing their action, 
 the surgeon is able to obtain primary union in the great majority of 
 cases. 
 
 2. Secondary union, second intention, or granulation, occurs slowly 
 with the formation of matter and leaves a considerable scar. In this 
 case (a) more or less of the tissues may have been lost, as in deep burns, 
 ulcers, or wounds where more or less of the tissues have been torn out ; 
 (b) the tissues adjoining the wound may be so injured as to be incapa- 
 ble of new life, as in cases where the parts have been bruised or torn to 
 a greater or less extent ; (c) foreign matters, such as bits of cloth, or 
 even clots of blood, maybe interposed between the edges of the wound ; 
 (d) the wound may not have been kept quiet ; (e) micro-organisms and 
 dirt may have been allowed to enter the wound, causing decay of the 
 tissues and the formation of matter. 
 
 In these cases there is a vacancy which has to be filled up by new 
 tissue. This is accompanied by the development in the wound of small 
 red bodies like pin heads, called gramdatlons, which are often covered 
 to a greater or less extent with a thick, creamy fluid consisting of lymph 
 with white blood corpuscles which have escaped from the capillary 
 vessels. These granulations increase in number until the cavity of the 
 wound is entirely filled. When this occurs, the skin at the edges of the 
 wound begins to grow inward toward the centre, gradually diminishing 
 the size of the opening until it is entirely covered by a fine red skin 
 called scar tissue ; as time passes, the unnecessary blood-vessels which 
 at first are very numerous disappear and the scar loses its red tinge, often 
 becoming whiter than the surrounding skin ; at the same time the scat 
 
BLEEDING I45 
 
 becomes harder and contracts, so that if it be a large one the parts may 
 be greatly drawn, as seen in the hand illustrated on page 130. While 
 this is going on at the surface, the capillary blood-vessels find their way 
 among the granulations, and the mass is organized into new tissue. 
 Healing by second intention requires from a week to several months 
 for its completion, according to the size of the wound and the favorable 
 character of its surroundings. 
 
 The excessive formation of granulations causing them to project 
 above the surrounding skin is commonly known as " proud flesh." 
 And where a wound refuses to heal, but breaks down with the forma- 
 tion of granulations and the production of yellow or greenish yellow 
 matter or pus, it is commonly said that the wound has " festered." 
 
 The healing of wounds is modified by many conditions. A wound is 
 apt to heal more rapidly in a healthy than in a delicate person. Youth 
 is a great advantage, and habitual drinking a great disadvantage. A 
 wound of the head heals, as a rule, more rapidly than one in any other 
 part of the body, while one of the upper extremities closes more quickly 
 than one of the lower. 
 
 Poisoned wounds naturally heal badly, but these are reserved until 
 they can be considered in the light of an acquaintance with the action 
 and effects of poisons in the chapter devoted to that subject. 
 
 CHAPTER XVIII 
 BLEEDING 
 
 Bleeding. — Definition : The escape of blood from its 
 
 vessels. 
 Varieties: (1) Arterial bleeding — the most dangerous. 
 
 (2) Venous bleeding. (3) Capillary bleeding or 
 
 oozing — the least dangerous. 
 Causes : (1) Of arterial bleeding: a wound of an artery. 
 
 (2) Of venous bleeding : a wound of a vein. (3) Of 
 
 capillary bleeding or oozing : a wound involving only 
 
 capillary vessels. 
 Symptoms. A. Common to all: The appearance of 
 
 blood, except in internal bleeding. Where severe 
 
 and not promptly checked, the face is first pale and 
 
146 
 
 EMERGENCIES AND ACCIDENTS 
 
 then blue, the pulse sinks, the body becomes cold, the 
 patient is dizzy and inclined to vomit, the eyes are 
 dazzled, he hears noises, and finally becomes uncon- 
 scious. 
 
 B. Peculiar to each variety, (i) Of arterial 
 bleeding : color bright red, and spurts in jets. (2) Of 
 venous bleeding : color dark red or purplish, and wells 
 out in a continuous stream. (3) Of capillary bleed- 
 ing : slow oozing of blood, neither dark nor bright red. 
 Treatment : 1 . Of arterial bleeding. Summon a surgeon 
 immediately ! (a) Expose the wound. (&) Make 
 the patient lie down, and lift up the wounded part. 
 (c) Press with the thumb or finger on or into the 
 wound to temporarily stop the bleeding, (d) If the 
 location of the large artery of the part is known (as 
 per appended table), press upon it above the wound 
 with the fingers, and later with a tourniquet ; if the 
 location of the large artery is not known, surround 
 the limb above the wound with a bandage drawn so 
 tightly as to check the flow of blood, (e) Dress the 
 wound with a compress and bandage. 
 
 Point Wounded. 
 
 Artery to 
 Compress. 
 
 Location. 
 
 Part pressed 
 
 AGAINST. 
 
 f 
 
 1 
 
 1 
 
 Arm (see also J 
 Forearm) j 
 
 Subclavian. 
 
 Runs over ist rib, back 
 of middle of collar 
 bone. 
 
 First rib. 
 
 Axillary. 
 
 Runs along the arm 
 side of the armpit, 
 near the front of the 
 arm. 
 
 Arm bone 
 (Humerus). 
 
 Brachial. 
 
 Runs along inner bor- 
 der of the biceps 
 muscle. 
 
 Arm bone 
 (Humerus). 
 
 Armpit. 
 
 Subclavian. 
 
 Runs over ist rib, back 
 of middle of collar 
 bone. 
 
 First rib. 
 
 Cheek. 
 
 Facial. 
 
 Runs over lower jaw 
 bone one inch in 
 front of its angle. 
 
 Lower jaw 
 bone. 
 
BLEEDING 
 
 147 
 
 Point Wounded. 
 
 Artery to 
 Compress. 
 
 Location. 
 
 Part pressed 
 
 AGAINST. 
 
 Chest. 
 
 Intercostal. 
 
 Runs along inner mar- 
 gin of upper or lower 
 border of rib. 
 
 Inner face of 
 adjacent rib. 
 
 | 
 
 Face-^ 
 
 1 
 
 Lower part 
 
 Facial. 
 
 Runs over lower jaw 
 bone one inch in 
 front of its angle. 
 
 Lower jaw 
 bone. 
 
 Upper part 
 
 Temporal. 
 
 Runs along temporal 
 bone just in front of 
 the ear. 
 
 Temporal 
 bone. 
 
 f 
 
 Finger . . . -i 
 
 Digital. 
 
 Front of finger on 
 either side. 
 
 Phalanges. 
 
 Palmar arches. 
 
 Palm of hand. 
 
 Metacarpus. 
 
 Foot <j 
 
 Sole. . 
 
 Posterior 
 tibial. 
 
 Runs about and below 
 the internal malleolus. 
 
 Tarsus. 
 
 Top. . 
 
 Anterior 
 tibial. 
 
 Runs down middle of 
 front of ankle. 
 
 Instep 
 (Tarsus). 
 
 Forearm. 
 
 Brachial. 
 
 Middle of elbow and 
 inner side of biceps. 
 
 Arm bone 
 (Humerus). 
 
 Hand. 
 
 Brachial. 
 
 Middle of elbow and 
 inner side of biceps. 
 
 Arm bone 
 (Humerus). 
 
 Knee. 
 
 Femoral. 
 
 Middle of upper part 
 of thigh. 
 
 Hip bone. 
 
 Leg (see also 
 knee and thigh). 
 
 Popliteal. 
 
 Middle of back of 
 knee. 
 
 Thigh bone 
 (Femur). 
 
 Neck. 
 
 Carotid. 
 
 Front margin of ster- 
 no-mastoid muscle 
 from back of ear to 
 sternum. 
 
 Spine. 
 
 Thigh. 
 
 Femoral. 
 
 Middle of groin. 
 
 Hip bone. 
 
 2. Of venous bleeding. Summon a surgeon imme- 
 diately ! (a) Expose the wound, (b) Make the 
 patient lie down, and lift up the wounded part. 
 (c) Loosen any tight clothing between the wound 
 
I48 EMERGENCIES AND ACCIDENTS 
 
 and the heart, (d) Press with thumb or finger on 
 or into the wound to temporarily check the bleeding. 
 (e) Prepare a thick compress and, removing the 
 thumb or finger, bandage it firmly upon the wound. 
 
 3. Of capillary bleeding. Apply water as hot as 
 can be endured, or apply ice-cold water to the wound ; 
 or simply bind a compress firmly upon the part. 
 
 In no class of injuries is the prompt application of ample means of 
 relief of so great value as in bleeding or hemorrhage. At least one-fifth 
 of the deaths upon the battle-field in former days were due to bleeding, 
 which might have been controlled by the prompt application of means 
 with which every person might readily have been familiar. And in no 
 class of cases is the aid applied more clearly a makeshift until the 
 proper relief can be given by a surgeon. This is especially true of 
 arterial bleeding, for the means already stated will permanently relieve 
 capillary bleeding, and in the majority of cases venous bleeding will 
 require no further treatment. 
 
 The chief agent in permanently controlling hemorrhage is the clotting 
 of the blood. It has been shown that when the movement of blood 
 through the blood-vessels ceases, the fibrin appears in a network which 
 entangles the corpuscles in its meshes and produces a red elastic 
 mass, a blood-clot. When there is an obstruction within a vessel, the 
 current of the blood is interfered with, and a clot forms behind the 
 obstruction. 
 
 Where the force of the blood in a vessel is not very great, a clot 
 formed may be a sufficient stay to the flow of blood. This force is 
 called the blood pressure. In veins, it is only a quarter of a pound to 
 the square inch. Consequently, when a flaccid vein is compressed' 
 together, and a clot firmly forms at the point of pressure, there is not 
 force enough to drive this plug of clotted blood out of the vein and 
 start the bleeding again. For this reason, simple pressure for a short 
 time upon a bleeding vein is often sufficient of itself to check such 
 bleeding. In the capillaries, the blood pressure is lighter still, so that 
 clots form with great rapidity and promptly close these vessels when 
 wounded. 
 
 The blood pressure in the arteries, however, is from ten to sixteen 
 times that in the veins, or four pounds to the square inch. Conse- 
 quently, except in very small arteries, where the force has become 
 greatly diminished, a clot formed during pressure will be promptly 
 forced out of the vessels. 
 
 There are other factors beside pressure which co-operate to assist in 
 the formation of the clot in hemorrhage. The elasticity of the vessel 
 diminishes the opening through which the blood escapes, and when a 
 
TREATMENT OF BLEEDING FROM ARTERIES I49 
 
 large amount has been lost, all the blood-vessels contract to meet the 
 lessened demand upon them, while the weakened action of the heart 
 itself causes less distention of the vessels. 
 
 Moreover, when an artery is cut across, the inner coats contract and 
 curl over inward sufficiently to entirely close small vessels and to not 
 only diminish the size of the opening in large ones, but to afford a pro- 
 jection inward upon which the fibrin may catch and form a clot. The 
 projection of the inner coat also strengthens the clot. Obviously the 
 inner coats cannot turn in unless the vessel is completely severed, so 
 that a partially cut artery is more dangerous than one completely 
 divided. Severe bleeding is thus sometimes checked like magic by 
 the simple dash of a knife, completing the division, the inner coats, 
 loosened, promptly turning back and closing the vessel. Vessels of 
 considerable size may be closed in this way by being pulled and 
 twisted, as sometimes occurs in the large torn wounds occurring in 
 railroad and machinery accidents. The clot formed in a vessel, if not 
 disturbed, becomes " organized." Blood-vessels push their way through 
 it and send out white corpuscles which are transformed into tissue cells, 
 and in time the entire clot is transformed into scar tissue. 
 
 Treatment of Bleeding from Arteries. — In the treatment of arterial 
 bleeding four classes of procedure are used : (a) twisting the vessel 
 or "torsion," (b) tying or "ligaturing" the vessel, (c) position, and 
 (d) pressure upon it in various ways. 
 
 Twisting or " torsion " occurs naturally, as has been remarked in 
 certain extensive lacerations, and it is often resorted to by surgeons 
 particularly for the relief of bleeding from small arteries. With a small 
 pair of forceps the cut end of the artery is grasped, pulled out, and 
 twisted by a few turns of the forceps. The vessel is closed by the 
 turning in of the inner coats. 
 
 Tying or " ligaturing" the vessel consists in passing a suitable thread 
 about it and tying up the bleeding end. This is the proper way to 
 permanently close any artery, except very small ones. The materials 
 used for this purpose are a fine quality of silk, prepared catgut, silver 
 wire, and a large variety of similar materials. The material used in 
 each case is called a ligature. 
 
 To practise the methods of twisting and tying requires a knowledge 
 of anatomy and surgery such as only a professional man can possess, 
 and consequently these methods are to be used only by a surgeon. 
 
 Position, however, is very simple in its application, and can be 
 learned without difficulty. Where the body is sound, there is a perfect 
 balance of the circulation, with no greater tendency for the blood to 
 settle at the lower points than at the higher. If this balance is broken 
 by a wound of an artery from which the blood flows out instead of 
 returning to the system, the blood follows ordinary physical laws — it 
 goes down more readily than it goes up. Consequently the elevation 
 
i5o 
 
 EMERGENCIES AND ACCIDENTS 
 
 of a bleeding part as high as possible above the heart, renders it more 
 difficult for the blood to reach the wound and lessens the bleeding. In 
 a wound of an artery of the foot, the patient should be laid on his 
 back and the affected limb raised ; in a wound of the hand or upper 
 
 extremity the patient 
 should preferably be 
 seated and the limb 
 raised; similarly, a sit- 
 ting or standing pos- 
 ture would be advisa- 
 ble in an injury of the 
 head. 
 
 Pressure is the most 
 commonly applicable 
 of the methods of 
 temporarily checking 
 bleeding, and can be 
 used with the greatest 
 readiness by laymen. 
 Pressure may be exert- 
 ed (a) directly upon a 
 wound, (&) in a wound, 
 plugging, (c) upon an 
 entire limb above the 
 wound, or (d) upon 
 the vessel itself above 
 the wound. 
 
 (a) Where a wound 
 is small, pressure may 
 be made directly upon 
 it either with a finger 
 or by any other imple- 
 ment used for exerting such pressure without entering the wound itself. 
 I have seen a considerable number of cases where death has been 
 averted in wounds of arteries by simply pressing firmly upon the 
 wound with a thumb or finger. 
 
 {b) Perhaps the most natural thing to do in case of a leak in any- 
 thing is to put in a plug. A bleeding wound is a leak in the circulation, 
 and the most natural thing to do in such a case is to put in a plug, 
 and the most natural plug is the finger. The plug acts by producing 
 pressure on the surrounding parts, thus closing the vessels. It is held 
 by many surgeons that this method alone is the best to be taught to 
 troops in general for the emergencies of the battle-field. In 1859, a 
 young Austrian soldier in whom the great artery of the thigh had been 
 wounded, controlled the bleeding for four hours by firmly plugging the 
 
 #f*'i • +k 
 
 
 1 11 
 
 '.'JSj 
 
 ' .^mi 
 
 
 Fig. 101. — Applying position in the treatment of bleed- 
 ing from a wound of the arm. Pressure with the 
 fingers is also being used. 
 
TREATMENT OF BLEEDING FROM ARTERIES 1 5 I 
 
 wound with his thumb ; if he had not done this, but a few moments 
 would have sufficed to launch his soul into eternity. The hand, how- 
 ever, is liable to tire, and this treatment may be made more permanent 
 by substituting some clean, hard body covered with clean gauze, cloth, 
 or paper and bound firmly into the wound by a bandage. It is well to 
 have the plug so shaped as to not only fill the wound, but project 
 beyond it, so that the encircling bandage will not constrict the person. 
 
 In the upper and lower extremities a more efficient method of arrest- 
 ing bleeding may be applied. This is closure of the bleeding artery by 
 pressure upon it between the heart and the wound. 
 
 (c) The most primitive method of pressing upon an artery above a 
 wound is by tying something, such as a bandage torn from clothing, 
 a triangular bandage, a handkerchief, or even a rope, tightly about the 
 limb. But it is practically impossible to 
 get enough pressure in this way, so, pick- 
 ing up anything that may be at hand — a 
 knife, a bayonet, a sword, a ramrod, or 
 a revolver — and thrusting it under the 
 bandage, by using it as a lever and twist- 
 ing it about, it is possible to bind the limb 
 so tightly as to entirely stop the circulation 
 below it. Appliances for arresting the cir- 
 culation in a limb by tightly compressing it 
 in this way are called tourniquets. They 
 may be improvised in this and other ways, 
 and surgeons have them made expressly 
 for the purpose. This particular extempo- 
 rized tourniquet is often called the Spanish Fig. 102. — The Spanish wind- 
 windlass. ' ass extemporized tourniquet. 
 
 There are other methods of attaining 
 this result more neatly by the application of elastic bands. If a bit of 
 soft rubber tubing be at hand, nothing could be better; it may be 
 applied by tying it strongly about the limb. The same result may 
 be accomplished by the use of an elastic suspender, if any bystander 
 happens to have one to spare. Surgeon-General Esmarch of the 
 Prussian Army has availed himself of this principle in devising a pair 
 of suspenders expressly for this purpose. It is composed of a long 
 strip of elastic webbing so arranged that the tags by which it is attached 
 to the trousers can be readily removed, leaving a simple elastic bandage 
 — an elastic tourniquet of the most improved pattern. 
 
 If the bleeding is not too severe it may be possible to constrict the 
 limb sufficiently by binding it firmly with a muslin roller bandage 
 which may be made to shrink by saturating it with cold water. In the 
 absence, however, of a rubber tube or an Esmarch's suspender, the 
 twisted band or handkerchief would be better. 
 
152 EMERGENCIES AND ACCIDENTS 
 
 The great disadvantage of this class of methods is the complete 
 stoppage of the circulation in the entire portion of the limb below the 
 tourniquet. Where continued for a considerable time, serious troubles, 
 extending even to gangrene or death of the limb, may ensue. If the 
 circulation then can be arrested in the wounded artery alone without 
 affecting the circulation in the rest of the limb, the same result can be 
 obtained with far less danger to the patient. 
 
 (d) A readily available method of applying continuous pressure to a 
 particular vessel is by applying a hard lump of some kind — a pebble or 
 a cartridge, for instance — upon the vessel, and binding it on by a band- 
 age tightened in the ways mentioned in the preceding class. This 
 takes off the pressure on either side of the lump and allows a sufficient 
 amount of blood to pass the obstruction to prevent strangulation of the 
 limb. In Fig. 102 this method has been adopted in an extemporized 
 tourniquet. 
 
 The surgeon's tourniquet utilizes this principle. It consists of a 
 webbing strap with a buckle at one end, and attached to the strap 
 a padded lump. The lump is applied over the artery 
 and the strap is tightly buckled about the limb. The 
 lump thus pressed upon the artery checks the circu- 
 lation in the vessel. 
 
 The tourniquet, however, is subject to the same ob- 
 jection as the band drawn about a limb without twisting 
 it — it is not tight enough. To obviate this difficulty, 
 the screw tourniquet (Fig. 103) has been invented. It 
 
 " is applied in exactly the same way as the other, but 
 
 screw tourni- , . , . , . , / , 
 
 t when applied, it can be tightened to any degree by 
 
 simply turning the screw. 
 
 A tourniquet which can be quickly extemporized, but which can be 
 applied only to the arm, is Volker's stick tourniquet (Fig. no). Two 
 sticks from six to eight inches long, and from a half to three-quarters 
 of an inch thick, are notched at either end ; one is then laid directly 
 across the artery of the arm and the other is applied to the other side 
 of the arm parallel to the former. The ends are then tied firmly to- 
 gether. In this way the circulation in the great artery is arrested, while 
 the collateral circulation of the small arteries running in the same direc- 
 tion on either side is not disturbed. 
 
 Another method of applying limited pressure consists in placing 
 some hard body, such as a rod, a bottle, or even a stone, in the joint 
 next above the bleeding point, and strongly bending the limb upon it 
 (Figs. 112, 115). The limb may then be fastened in this position and 
 so retained for a long time without damage. Where an extemporized 
 method is necessitated, and this method can be used, as in the leg and 
 in the upper extremity, it is probably the most useful ; next to this, the 
 twisted bandage with a lump. 
 
BLEEDING FROM ARTERIES OF THE HEAD 1 53 
 
 In case of bleeding of any kind, presence of mind is of the greatest 
 importance. It is rare that prepared appliances for arresting it are at 
 hand. The mind must be capable of at once divining the proper action 
 and of instantly executing it. The lump may be composed not only 
 of a stone, but of a cartridge, a cork, a ball of any kind, a marble, a 
 hard knot in a bandage or handkerchief, a small spool, or a firmly 
 rolled mass of cloth, or even a strongly crumpled mass of paper. The 
 band may be formed not only of a triangular bandage cravat, twisted or 
 flat, but of a handkerchief, a roller bandage, strips of clothing, ropes, 
 cords, belt, or any soft tough strip which can be firmly tied about a 
 limb. On the battle-field arms, or fragments of arms, will be available 
 for twisting the band, and in civil life sticks of various kinds, parasols 
 and umbrellas, rulers and bottles, pocket knives and scissors, keys and 
 canes, and innumerable substitutes which will be found at various 
 places. The mind should be familiar with this fact, and should be pre- 
 pared to adapt neighboring articles to the present emergency. 
 
 Bleeding fro?n Arteries of the Head. — Owing to the fact 
 that the entire scalp is underlaid by a plate of bone, there is 
 no difficulty in deciding where to exert pressure in order to 
 check bleeding there. Press directly down upon the scalp 
 near the edge of the wound on the side from which the 
 bleeding proceeds. The artery will not always be found at 
 once, owing to its small size, but two or three trials will lo- 
 cate it without difficulty. Permanent compression may be 
 exerted by laying a hard pad, extemporized from any available 
 material, upon the point of pressure, and 
 holding it in place with a bandage formed 
 also of the most convenient substance. 
 The shape of the head makes it some- 
 times a little difficult to tie on the band- 
 age so that it will hold the pad firmly in 
 place, but perseverance and a little inge- 
 nuity, particularly when reinforced by 
 previous practice on the head of a friend, 
 will always be rewarded with success. ' g j he thumb^controNing 
 
 In case of a wound of either temple, bleeding in the temple. 
 the temporal artery below the wound 
 should be compressed upon the bone (Fig. 104) . It will be 
 remembered that this artery runs up in front of the ear, and 
 divides into two branches. Permanent compression may be 
 
154 
 
 EMERGENCIES AND ACCIDENTS 
 
 Fig. 105. — Pressure with 
 the thumb, controlling 
 bleeding from the face. 
 
 applied by means of the knotted turn of the roller bandage 
 (page 106), a suitable pad being held in place under the knot. 
 The arteries of the face are mostly branches of the facial, 
 which crosses the lower jaw about an inch in front of the 
 angle of the jaw, where its pulse can be readily felt, 
 (i) Bleeding can then be controlled by pressing the artery 
 down firmly upon the jaw bone with the 
 thumb, or, if it be desirable to make it 
 permanent, a suitable pad may be ap- 
 plied instead of the thumb, and bound 
 firmly in place by a bandage passing 
 under the lower jaw and over the top 
 of the head. (2) Temporary control of 
 the bleeding may also be obtained in 
 wounds of the cheeks or lips by passing 
 the thumb into the mouth, and, grasping 
 the cheek just below the wound, between the thumb and 
 fingers, pressing the artery between them. 
 
 Bleeding from Arteries of the Neck. — When the large 
 vessels of the neck are severed, as in " cut throat 11 or other 
 wounds in that region, the utmost quickness in checking the 
 bleeding is necessary to save life. A moment's delay may be 
 fatal, for the blood rushes from 
 these vessels in tumultuous tor- 
 rents. All of the carotid arte- 
 ries and most of their branches 
 are large and important vessels. 
 It should be remembered that 
 the line of the carotid arteries 
 extends from the mastoid pro- 
 cess behind the ear down to the 
 edge of the top of the breast 
 bone. Without an instant's de- 
 
 Fig. I06. — Pressure with the thumb, 
 controlling bleeding in the neck. 
 
 lay, in a wound of this kind, 
 the vessel should be promptly 
 pressed back upon the spine 
 
 with the thumb, and held there until the assistance of a 
 surgeon is brought. No attempt should be made to substi- 
 tute a pad for the finger, for nothing else can be trusted. 
 
BLEEDING FROM ARTERIES OF THE ARM 1 55 
 
 Fig. 107. — Pressure tack of the collar 
 bone, controlling bleeding from the 
 upper extremity. 
 
 As the hemorrhage in the neck may proceed from the 
 
 veins, and as this is almost equal in danger to that from 
 
 arteries, it may perhaps be best in all cases to apply the 
 
 pressure directly in the wound. It should be remembered, 
 
 however, that there must be no 
 
 hesitation or delay in applying 
 
 the treatment, whatever it is. 
 Bleeding from Arteries of the 
 
 Upper Extremity. — The course 
 
 of the great artery of the upper 
 
 extremity may be remembered 
 
 (Fig. 113) as arising out of the 
 
 chest ; it runs over the first rib 
 
 just under the middle of the 
 
 collar bone {subclavian artery), 
 
 passes thence to the inner side 
 
 of the arm {axillary artery), 
 
 running down along the inner 
 
 edge of the biceps muscle 
 
 {brachial artery) to the middle of the elbow, just below 
 
 which it divides into two main branches {radial and ulnar 
 
 arteries), which course down either anterior edge of the 
 
 forearm, and form two arches in the palm of the hand 
 {palmar arches) . 
 
 If the injury be in the armpit, the 
 artery must be compressed either under 
 the collar bone or in the wound itself. 
 (1) To compress the artery under the 
 collar bone, the thumb should be thrust 
 strongly down behind the middle of the 
 bone until the pulsation of the subclavian 
 
 Fig 108. — The handle of artery is felt, when the pressure should 
 a door key padded for be cont i n ued until the blood ceases to 
 
 pressure under the col- n _. . , 
 
 !ar bone now. The subclavian is not easy to 
 
 compress, and this manoeuvre should be 
 
 thoroughly practised upon one's friends. If a surgeon can 
 
 be got within a reasonable time, the pressure of the thumb 
 
 should be maintained until his arrival. If, however, some 
 
1 56 
 
 EMERGENCIES AND ACCIDENTS 
 
 considerable time must elapse, the thumb, even of the strong- 
 est man, will become tired and powerless, and a substitute for 
 it will be desirable. In this case the handle of a key or any 
 similar article, suitably padded, may be slipped down under 
 the thumb and applied upon the artery. (2) Pressure in the 
 wound is performed by pushing the thumb forcibly into it, 
 and pressing the parts strongly against the arm bone. 
 
 If the injury be in the ar?n y the bleeding may be checked 
 by compression of the subclavian, as described above, 
 and by pressure upon the brachial 
 artery in the wound itself or in the 
 arm. Aside from pressure in the 
 wound itself, (1) pressure of the ar- 
 tery with the fingers against the arm 
 bone is the most readily applied. 
 The arm should always be raised 
 in cases of this kind, as shown in 
 Fig. 1 01. 
 
 (2) Volker's stick tourniquet (Fig. 
 1 10) — composed of two sticks six to 
 eight inches long, a half to three 
 quarters of an inch thick, and notched 
 at the ends, which are bound together 
 by any available material — is an excellent means of exerting 
 permanent pressure upon the artery of the arm. 
 
 (3) A tourniquet extemporized 
 from a handkerchief, a bandage, 
 or any similar article, as described 
 on page 151, — particularly when 
 supplied with a pad to press 
 directly upon the artery (Fig. 
 102), — is of the utmost value, 
 and perhaps the most valuable 
 extemporized means of checking 
 bleeding from the arm. 
 
 (4) Where a screw tourniquet can be had, it should be 
 used in preference to the other appliances, provided the 
 artery can be located readily. 
 
 Fig. 109. — Pressure upon the 
 artery above the wound, 
 controlling bleeding from 
 the arm. 
 
 Fig. 110. — Volker s stick tourniquet 
 for pressure upon the artery of the 
 arm. 
 
BLEEDING FROM ARTERIES OF THE ARM 1 57 
 
 The foregoing demand some knowledge of the course of 
 the vessels, and, while they are the best for the patient, yet 
 it often occurs that those who are obliged to render first aid 
 are not at all familiar with anatomy. In this case, methods 
 not demanding such knowledge may be used, but it should 
 not be forgotten that where a limb is tightly surrounded by, 
 any band, it is likely to become strangled 
 and permanently injured. Still, where 
 a life is at stake a certain amount of 
 risk must be taken. 
 
 (5) Rubber tubing, elastic bandages, 
 and the like are available here as well 
 as in other extremities, and can be 
 used when obtainable with the greatest 
 advantage. 
 
 (6) A rod of wood, a base or billiard 
 ball, and other articles of the kind, 
 when pushed strongly into the armpit, 
 form an excellent means of checking 
 bleeding from the arm, if the limb be 
 strongly bound down to the side, so as to compress the artery 
 closely against the bone (Fig. 112). 
 
 In case of a wound at the elbow, all the procedures pre- 
 scribed for the arm are to be applied. 
 
 If an artery in the forearm be wounded, in addition to 
 pressure in the wound itself, (1) the methods 
 employed for the arm and elbow may be 
 used; for if the arm be so bound that the 
 blood cannot pass below the arm or elbow, 
 it certainly cannot issue from the forearm. 
 (2) A readily applied method consists in 
 Fig. 112. — Pressure placing a hard body, such as a cane, a small 
 
 upon the artery of bottle< a rod f rom a tree Qr any smi il ar art i c l e 
 the arm by a ruler . ' J 
 
 in the armpit. m the elbow, and strongly bending it upon 
 it: this may be made permanent by band- 
 aging the forearm strongly to the arm (Fig. 115). 
 
 If the injury be low down, particularly in the wrist, in ad- 
 dition to methods in the arm and elbow, bleeding may be 
 
 Fig. III. — The screw tourni- 
 quet applied for control- 
 ling bleeding of the arm. 
 
I58 EMERGENCIES AND ACCIDENTS 
 
 checked by pressing the wounded artery strongly upon the 
 forearm bones. However, in this case, it is better to apply 
 the pressure in the arm or elbow ; for, on account of the large 
 palmar arches, the blood will spurt out of both ends of the 
 divided artery. Pressing the artery on both sides of the 
 wound, however, will arrest the bleeding and, as well, pressure 
 in the wound itself. 
 
 In the palm of the hand, the same condition exists, and 
 pressure must be exerted either in the arm or elbow, or both 
 forearm arteries must be compressed. Bleeding here can, 
 however, often be controlled by grasping some hard object, 
 like a billiard ball, or a smooth stone, or, in emergency, even 
 an apple or a potato, in the palm : the pressure may be made 
 permanent by bandaging the hand strongly in this position. 
 
 Bleeding from the fingers can always be controlled by 
 pressure in the wound or above it, with the finger, or any 
 other means of applying it. 
 
 Bleeding from the Arteries of the Body. — In bleeding 
 wounds of the chest and abdomen, pressure should always be 
 exerted in the wound itself, with a single exception. The 
 exception is the case of a wound of one of the intercostal 
 arteries, running along the edges of the ribs, and rather inside 
 of the chest, so that the pressure upon the bone must be 
 exerted from within outwards. To effect this, make up a 
 little roll, preferably of antiseptic gauze, or of any other clean 
 cloth, and tie it firmly with a string ; work the roll through 
 the wound into the chest, and then pull upon the string 
 forcibly enough to press the roll against the bleeding vessel 
 upon the rib. 
 
 In other wounds of the trunk, the bleeding should be con- 
 trolled by pressure in the wound, with the fingers temporarily, 
 or with a hard lump or pad and bandage permanently. 
 
 Bleeding from Arteries of the Lower Extremity. — The 
 arrangement of the arteries of the lower extremity is very 
 similar to that of the upper extremity. A single large vessel 
 {femoral artery} passes into the thigh, over the front of 
 the hip bone, at the middle of the groin ; it runs down the 
 middle of the thigh, and in the lower portion passes through 
 
BLEEDING FROM THE ARTERIES 1 59 
 
 Fig. 113. — The arteries of the body, showing their relations to the bones at trie 
 points where pressure is to be made to control bleeding. 
 
i6o 
 
 EMERGENCIES AND ACCIDENTS 
 
 to the back of the thigh, where it runs behind the knee 
 {Popliteal artery), and, just below the joint, separates into two 
 arteries, one of which runs down, skirting the lower edge of 
 the internal malleolus, at the inner face of the ankle, to supply 
 the sole of the foot {posterior tibial artery), and the other 
 down the front of the ankle, to the top of the foot (anterior 
 tibial artery) . The artery is found near the surface in the 
 groin and the upper part of the thigh, the back of the knee, 
 
 These points are naturally the proper localities for the appli- 
 cation of pressure to check bleeding. 
 
 In case of bleeding from the arteries of the thigh, (i) the 
 great femoral artery must be compressed in the middle of the 
 groin, against the hip bone. Wounds of this artery are 
 rapidly mortal unless immediate treatment is applied. Delay 
 is fatal I Like the subclavian, it is very difficult to compress, 
 and both thumbs should be applied 
 upon it with all the force possible. 
 If the arrival of a surgeon — who 
 should be summoned immediately — 
 is delayed, a substitute should be pro- 
 vided in a tourniquet, extemporized or 
 prepared. (2) The Spanish windlass 
 (Fig. 102) — a lump, suitably padded, 
 being applied directly upon the artery 
 — may be used. (3) An elastic band 
 or a rubber tube is useful here as in 
 other places. A screw tourniquet, with 
 the pad upon the artery, is of service. 
 (4) A pole, extending from the ceiling 
 to the bed, may be so arranged — one 
 end pressing upon the ceiling and the 
 other upon the artery — as to hold the 
 flow of blood in check. (5) Compression by the finger in 
 the wound is here of value as well as elsewhere, and the only 
 objection to it is the liability to soil the wound with matters 
 clinging to the thumb. 
 
 Bleeding from the back of the knee or ha?n proceeds from 
 
 Fig. 114. — Pressure upon the 
 artery of the thigh by the 
 thumbs, to control bleed- 
 ing below it. 
 
BLEEDING FROM ARTERIES OF THE LEG l6l 
 
 the popliteal artery, a continuation of the femoral, and it 
 must be controlled by precisely the same manoeuvres as 
 bleeding from the thigh, — compression of the femoral artery 
 in the middle of the groin, or pressure in the wound. 
 
 If the injury involve an arterial wound of the leg, (i) the 
 bleeding may be controlled in the same way as that of the 
 thigh and ham. (2) It may be checked for a short time by 
 bending the leg strongly back on the thigh, but this position 
 cannot be maintained long on account of the resulting weari- 
 ness to the patient. (3) But the appli- 
 cation in the ham of a pad, such as an 
 ordinary base ball, or an apple, potato, 
 or even a stone of a similar size and 
 shape, with the leg strongly bent upon 
 it, will control the bleeding without the 
 insufferable weariness. A rod, such as 
 a cane or umbrella, a branch from a 
 tree, or anything of the kind should be Fig. 115. — Pressure by a pad 
 passed under it, and supported strongly in the hollow of the knee 
 
 r . , , , • , with a rod, to hold it in 
 
 upon it by a bandage passing about p , ace controlling b | eed . 
 the bent limb. (4) The finger in the ing in the leg and below, 
 wound may be used here also, subject 
 to the objection of being a possible conveyer of infection. 
 
 The foot is supplied by three arteries, ' all of which, like 
 those of the hand, communicate so freely with one another, 
 that, as in the hand, it is usually best to apply the pressure 
 directly upon the wound. This may be done first by the 
 thumb, and later by a suitably prepared pad and bandage. 
 The foot is peculiarly adapted to treatment by elevation, the 
 patient lying on his back ; and it is well to apply all treat- 
 ment with the foot lifted up. Bleeding from a wound of the 
 sole of the foot may usually be controlled by pressure upon 
 the posterior tibial artery, just below the internal malleolus, 
 applied in the usual way. If the bleeding is not checked, 
 pressure added upon the anterior tibial in front of the ankle 
 will generally stop the bleeding ; and if this is not successful, 
 the peroneal, a small artery on the outer ankle, may also be 
 subjected to pressure. This will control the bleeding in the 
 
l62 
 
 EMERGENCIES AND ACCIDENTS 
 
 most extreme cases. If the back of the foot be the seat of 
 injury, the anterior tibial in front of the ankle should be 
 compressed first, and then the others as needed (Fig. 116). 
 
 Bleeding from Wounds of Veins. — Venous bleeding hi 
 general is comparatively free from danger, although a wound 
 of one of the great veins of the neck {jugulars) in " cut 
 throat " is a condition to be feared nearly as much as an 
 arterial wound. Other large veins, especially in the extremi- 
 ties, accompany the arteries, and although they are often 
 injured at the same time, the veins may be divided alone. 
 Not uncommonly, superficial veins, particularly in the leg, 
 become greatly enlarged, and form twisted, knotted ridges 
 
 Fig. 116. — Pressure at the inner side of the ankle, controlling bleeding in the foot, 
 
 under the skin : these are varicose veins. Injuries to them 
 are equal in danger to those of veins normally greater in 
 
 It will be remembered that veins are provided with frequent 
 valves, which prevent the return of blood from the heart. 
 In large veins, however, it often happens that the valves are 
 absent, or incompetent, so that in case of a venous wound, 
 
BLEEDING FROM VEINS AND CAPILLARIES 1 63 
 
 the blood will flow from both ends of the divided vessel. In 
 varicose veins the valves are, by disease, rendered useless, so 
 that in case of a wound or rupture the blood will escape freely 
 from both directions. 
 
 It will also be recalled that veins are very flaccid and easily 
 compressed, so that but little pressure is needed to control 
 bleeding from these vessels. 
 
 To control bleeding from any vein, then, a method which 
 would compress both ends at the same time is desirable ; and 
 this is found in the method of direct pressure in the wound 
 itself. It is accomplished by pressing firmly with the thumb 
 at first, in order to hold the bleeding in check temporarily. 
 Then, a suitable pad having been provided, it should be 
 bound upon the wound firmly enough to restrain the bleed- 
 ing permanently. 
 
 Any tight article of clothing which binds the body between 
 the injury and the heart — since it may interfere with the 
 return of the blood — should be loosened. Garters should 
 be removed, belts should be unfastened, and collars should 
 be taken off, so as to allow the blood free flow toward the 
 heart. 
 
 And the application of elevation to all venous wounds 
 should not be forgotten. 
 
 Bleeding from wounds of veins may be controlled, where the valves 
 are intact, by simple pressure upon the vein below the wound — be- 
 tween the capillaries and the wound. This method of treatment is 
 advised by many authorities, and may be used with advantage where it 
 is absolutely impossible to find clean materials for a pad — which will be 
 rarely. Indeed, pads above and below the wound may be used to con- 
 trol vein injuries where the blood comes from both ends of the vessel. 
 
 Bleeding from Wounds of the Capillaries. — This is the 
 variety of bleeding most frequently seen when blood, not so 
 bright as that in the arteries nor so dark as that in the veins, 
 oozes from a small wound. Capillaries are so generally pres- 
 ent in the tissues that capillary bleeding is present in all 
 wounds, even though injury of larger vessels may mask it. 
 It may vary in severity, sometimes oozing very slowly, as 
 when a bit of scarf skin is scraped off, and again, flowing in 
 
164 EMERGENCIES AND ACCIDENTS 
 
 a considerable stream, as when a finger has been cut with a 
 pocket knife. It will be found in scratches, pricks, and slight 
 cuts of all kinds, whether from the careless use of the razor, 
 a slip of a knife, accidental contact with broken glass, or 
 similar accidents. 
 
 The treatment is simple. Mere exposure to the air for a 
 few moments, with no other treatment, will often see capillary 
 bleeding completely checked. The exposure causes contrac- 
 tion of the open vessels and clotting of the blood, which, 
 together with the small amount of blood pressure, renders it 
 possible for plugs of blood clot to quickly fill them. 
 
 Hot water, as hot as it can be borne by the patient, is one 
 of the most valuable and efficient means, of controlling cap- 
 illary bleeding, and is often used by surgeons to diminish 
 the flow of blood during operations. It may be applied by 
 squeezing out a sponge or a mass of cloth, as shown in con- 
 nection with the cleansing of wounds (page 136). 
 
 Extremely cold water has a similar effect to hot, although it 
 is not quite as satisfactory in its action. Ice or ice water may 
 be used with advantage for the relief of capillary bleeding. 
 
 The pressure of a pad directly upon the bleeding part is 
 also of advantage in controlling capillary bleeding. In this 
 case the pad may well be wet with hot or cold water before 
 binding it tightly in place. 
 
 The use of styptics, such as perchloride of iron, Monsel's solution, 
 tannic acid, styptic cotton, and the like, should be absolutely discouraged 
 in any kind of bleeding, on account of their interference with the process 
 of healing. The application of cobwebs or tobacco to bleeding surfaces 
 is still more objectionable, — the first, on account of its liability to intro- 
 duce not only dirt but disease-producing germs ; and the second, on 
 account of the danger of absorption of its poisonous constituent, nico- 
 tine. If a styptic is really needed, a little alum dissolved in clean water 
 may be used, particularly in bleeding from the mouth and nose. 
 
 Spitting of Blood. — The discharge of blood from the 
 mouth is commonly known by this name, although it may be 
 due to a number of different causes, and proceed from a num- 
 ber of sources. 
 
 (a) Blood may come from the mucous membrane of the 
 
SPITTING OF BLOOD 165 
 
 nose, and run down through the posterior opening of the nose 
 into the mouth. In this case, the blood can be felt passing 
 down into the mouth ; and the treatment is the same as that 
 for nosebleed. 
 
 (b) Blood may come from the mucous membrane of the 
 mouth, and particularly from the gums. Slight bleeding of 
 this kind is of no moment, and will quickly recover without 
 treatment. At other times it continues so long and is so 
 abundant as to be annoying in the extreme. In this case, 
 filling the mouth with fluid as hot as can be borne, thus 
 bringing it in contact with every bleeding point, is of advan- 
 tage. Hot coffee or tea are as good as hot water, and are 
 more agreeable to some. Pieces of ice in the mouth are also 
 useful. Here alum can be used with advantage in a strong 
 solution washed about the mouth. In the absence of alum, 
 a strong solution of salt in water is of value, used in the same 
 way. In case of bleeding from the cavity left after the ex- 
 traction of a tooth, a plug of cotton saturated with either of 
 the two latter agents may be of advantage. 
 
 Severe bleeding from the tongue or the inner surface of 
 the cheek may require to be controlled by pressure, which is 
 best applied by pressing a pad directly upon the bleeding 
 point with one finger, and supporting the opposite side with 
 a thumb or another finger. 
 
 (V) Blood may come from the throat, and in this case either 
 the windpipe or the gullet may be injured. It is not prac- 
 ticable to apply pressure directly here, and the treatment 
 should be confined to placing the patient in a lying-down 
 position, and keeping him as quiet as possible. If the bleed- 
 ing is considerable, and ice is obtainable, he should be made 
 to swallow a considerable quantity pounded into pieces the 
 size of a pea. 
 
 (d) Bleeding from the lungs, " pulmonary hemorrhage," is 
 caused by the breaking of a vessel in the lungs, and is accom- 
 panied by coughing, with rattling in the chest, while the blood 
 itself is frothy and bright red. The break in the vessel is 
 usually produced by the advance of consumption, although it 
 may be due to a splinter from a broken bone sticking into 
 the lung, or a wound due to any other cause. 
 
l66 EMERGENCIES AND ACCIDENTS 
 
 A physician should be called at once. While awaiting his 
 arrival, the patient should immediately be made to lie down, 
 with pillows or their equivalent so placed as to slightly elevate 
 the head and shoulders. Finely chopped ice should be eaten 
 in this case also. If a teaspoonful or so of salt can be eaten 
 with it occasionally, so much the better, or the salt may be 
 dissolved in a little cold water, which may then be drank. 
 The patient should be kept absolutely quiet, and while he 
 should not be placed in danger of taking cold, the room 
 should be kept very cool. If available, a quarter of a tea- 
 spoonful of spirits of turpentine may be given in a little cold 
 milk every two or three hours. The patient should be kept 
 in a darkened room, and no persons not essential for his care 
 should be admitted, while every effort should be made to 
 have as little noise as possible. 
 
 (e) Bleeding in the stomach is due to the breaking of 
 a vessel in the stomach, and may be caused by an ulcer 
 eating into the vessel, or other causes which might produce 
 rupture of a vessel in any part of the body. Blood from 
 the stomach is vomited up, is usually clotted and never 
 frothy, is of a color extending from dark red to black, and 
 may be mingled with masses of food. It should be remem- 
 bered that vomiting of blood is not invariably caused by 
 bleeding into the stomach. Blood from the mouth, or even 
 the nose, may be swallowed and thrown up again. 
 
 The proper treatment in this case, after sending for a phy- 
 sician, is to make the patient lie down, with the head and 
 shoulders slightly raised ; keep him absolutely quiet, and 
 feed him with chopped ice, and give him turpentine in 
 quarter-teaspoonful doses in a little cold milk every two or 
 three hours. 
 
 Nosebleed, " nasal hemorrhage," proceeds from the vessels 
 of the mucous membrane of the nose, and, while it is usually 
 of no moment, and stops spontaneously, it may be so severe 
 and prolonged as to be very alarming. Usually, however, it 
 need not be the source of the least anxiety, for a sufficient 
 clot will readily form to hold it in check. If it be obstinate, 
 cold water, or solutions of salt or alum, or even vinegar, may 
 
NOSEBLEED AND INTERNAL BLEEDING 1 67 
 
 be snuffed or syringed into the bleeding nostril. The arms 
 may be lifted above the head — a procedure which is said to 
 have been eminently successful. These having failed, the 
 nostril must be plugged. The plug is best made of a long 
 strip of cheese-cloth or old linen or muslin, a half an inch 
 wide. With a pencil or a penholder, one end should be 
 pushed into the nose as far as it will go ; the rest of the strip 
 should then be pushed in firmly and packed tightly, the end 
 being allowed to hang out of the nose. To remove the plug, 
 the strip may readily be drawn out by this protruding end. 
 If the blood, dammed up in front, begins to find its way into 
 the mouth through the posterior opening of the nostril, the 
 plug has not been packed tightly enough behind, and it 
 should be drawn out and packed in again. This plug should 
 be kept in place for several hours, and when drawn out, the 
 greatest care should be employed to prevent a renewal of the 
 bleeding by too much force. If the dried blood has caused 
 it to stick, it should not be pulled forcibly away, but should 
 be loosened by warm water or oil. 
 
 Internal Bleeding in General. — In internal bleeding, the 
 blood may escape into a closed cavity, such as the abdomen 
 or cranium, and present no external evidences, or it may 
 escape through an opening in the cavity, artificial or natural, 
 as through a wound in the chest or abdomen, or through the 
 gullet or windpipe, from the lungs or stomach. Bleeding 
 into the cranium is most often caused by rupture of one of 
 the minute arteries of the brain, and constitutes the accident 
 known as apoplexy, which will be treated further in the 
 chapter on Fainting. Bleeding into the chest, where the 
 lung is not wounded, may fill up the cavity with blood, and 
 press upon the lung so much as to seriously interfere with 
 breathing. In any case, the paleness, small pulse, chill of 
 the body, dizziness, and inclination to vomit, and other symp- 
 toms of bleeding are present, and demand the treatment 
 due to shock in all cases, — a lying-down position, warmth in 
 hot-water bottles to counteract the chill, and hot coffee or 
 tea internally, except in case of bleeding from the lung or 
 stomach. 
 
168 EMERGENCIES AND ACCIDENTS 
 
 Secondary Bleeding, or " recurrent hemorrhage," not as common 
 now as before the advent of the antiseptic era in surgery, may be due 
 to the renewal of strength in the circulation after severe bleeding, or to 
 the ulceration of a blood-vessel. In the former case, the bleeding 
 comes on within a few hours, but the latter may occur after several 
 weeks. Where the bleeding is slight, it may be controlled by the ad- 
 dition of a little pressure upon the wound. If this is not sufficient, the 
 dressing must be renewed, and the treatment proper to a fresh wound 
 applied with great promptness. In severe secondary bleeding a surgeon 
 should be summoned without delay. 
 
 Special Susceptibility to Bleeding is sometimes found in persons 
 who are surgically known as "bleeders." In these persons, the least 
 scratch produces alarming bleeding, and the extraction of a tooth has 
 been known to result in death, by bleeding from the cavity. In such 
 persons, the greatest care should be taken to avoid the occurrence of 
 bleeding of any kind, and where the accident does occur, no delay 
 should be made in applying temporary treatment and summoning a 
 surgeon. 
 
 CHAPTER XIX 
 
 SPRAINS AND DISLOCATIONS 
 
 Sprains. — Definition : A violent twist or strain of the soft 
 parts about a joint. 
 
 Causes : Any accident which may cause a twist or strain 
 of a joint. 
 
 Symptoms : Great pain at the joint, following an unusual 
 strain, such as a wrench or twist. Swelling about the 
 joint rapidly follows. Discoloration similar to that 
 produced by a bruise is apt to appear in the swelling. 
 The bones are in their proper place, as seen by com- 
 parison with the same joint on the opposite side. The 
 absence of signs of broken bones shows that that acci- 
 dent has not occurred. 
 
 Treatment : Place the joint in a position where it will 
 have complete rest. Apply water as hot as can be 
 borne freely about the joint, gradually increasing the 
 heat, as long as it can be endured. Continue this for 
 
SPRAINS AND DISLOCATIONS 169 
 
 half an hour, and then substitute ordinary hot, moist 
 fomentations for another half-hour, and finally put the 
 joint up in a wet bandage, keeping it well elevated. 
 Consult a surgeon. 
 
 This affection invariably follows an accident. A man walking rap- 
 idly, steps into a hole, and is thrown down, with a turn of his body. 
 His foot being caught, the twist comes upon his ankle, and he has a 
 sprain of the ankle, where this accident is by far the more frequently 
 situated. Next in frequency comes the wrist, which is sprained by a 
 fall, the hands being thrown out to catch the body, or in other ways. 
 Other joints — the hip, shoulder, elbow, knee, etc. — are less frequently 
 affected. 
 
 The injury in a sprain depends to a great extent upon the inability 
 of the ligaments to stretch when they are subjected to a strain. When 
 a joint is wrenched or strongly pulled upon, the strain comes upon the 
 ligaments, and they become bruised, and even torn. A small bit of 
 the adjacent bone may even be torn off in a sprain. The same violence 
 which has acted upon the ligaments is likely to act also upon the neigh- 
 boring soft parts, the muscles, and even the skin. While in extreme 
 cases, the bone and periosteum themselves are bruised. 
 
 It is evident that a sprain is apt to be a much more serious accident 
 than would appear at first. While there are slight sprains which will 
 require no attention, it should not be forgotten that severe sprains are 
 injuries of great importance, and that permanent lameness has often 
 followed a failure to give such an injury proper immediate care. 
 
 In sprains of the ankle, the entire foot and ankle should be plunged 
 into water as hot as could be borne, and the heat should be gradually 
 raised as high as possible without passing the endurance of the patient. 
 In sprains of the wrist or fingers, the same course may be adopted. 
 After continuing this from a half an hour to an hour, the part should be 
 supported in an elevated position, — the foot placed on a chair, and the 
 wrist in a sling, — and hot, wet cloths kept wrapped about it. After 
 the first acute pain has subsided, in a day or so begin gently moving 
 the joint, and rubbing it with soap liniment, oil, or vaseline ; and 
 kneading it gently at intervals. 
 
 Bones out of Joint. — Definition : The displacement of 
 the end of a bone from its proper contact with another 
 — a dislocation. 
 Causes : Those of sprain in a more violent form ; a sud- 
 den wrench or twist sufficient to tear the ligaments, and 
 allow the bone to slip out of place. 
 
7o 
 
 EMERGENCIES AND ACCIDENTS 
 
 Symptoms : (i) The shape of the joint is changed. To 
 ascertain this, the joint should be compared with that 
 of the opposite side. (2) The limb is longer or shorter 
 than that of the opposite side. (3) The relation of 
 the limb to adjacent parts is changed. (4) Pain at 
 the joint. (5) The patient cannot move the limb : 
 this is an important factor in distinguishing a dislo- 
 cated from a broken bone. 
 
 Treatment : Send for a surgeon instantly. While await- 
 ing his arrival, place the patient in as comfortable a 
 position as possible, supporting the injured side by 
 pillows and pads in its new attitude, and surround the 
 
 joint with hot moist 
 In most varieties of 
 although delay in 
 
 Fig. 117. — Method of replacing a 
 dislocated lower jaw. The upper 
 diagram shows the relation of 
 
 the bones in the dislocation. 
 
 $&*Cjl 
 
 fomentations, 
 dislocation, 
 ] treatment is 
 harmful, un- 
 educ ate d 
 handling is 
 still more so ; 
 consequently 
 they had bet- 
 ter be left untouched. 
 
 Where, however, the services 
 of a surgeon cannot be obtained 
 for several hours, an attempt may 
 be made to correct dislocations 
 of the fingers or toes, the lower 
 jaw, and the shoulder. 
 
 Dislocations of fingers can be re- 
 duced by strongly pulling on the finger, 
 at the same time pushing the tip of the 
 finger backward, if the end of the bone 
 has slipped on to the back of its neigh- 
 bor, or forward, if it has slipped on to 
 the palmar face ; and also pushing the 
 dislocated end into its place. When 
 returned to its proper place, the finger 
 may be wound with a strip of sticking- 
 plaster as wide as the finger is long. 
 
BONES OUT OF JOINT 171 
 
 Some dislocations of the finger are very difficult to reduce, and if suc- 
 cess is not promptly attained by the method suggested here, the injury 
 should not be irritated by further efforts. Dislocations of the thumb 
 are very difficult to manage, and should be let alone. 
 
 Dislocation of the lower jaw occurs as a consequence of extreme 
 yawning or laughing, and is a most embarrassing accident to the victim, 
 who remains with his mouth fixed widely open, with the saliva dripping 
 from its corners, and deprived of the power of distinct speech. In this 
 case, wind a handkerchief thickly about both your thumbs, padding 
 them sufficiently to prevent injury by the sudden closing of the mouth 
 when reduced. Place one thumb on to the lower jaw on each side as 
 far back as possible, and grasp the jaw between it and the fingers with- 
 out. Then press firmly downward and backward, when the jaw will be 
 felt to move quickly into place. The thumbs should be drawn out from 
 between the teeth with the greatest quickness, or they will be in danger 
 of being crushed between the jaws when the muscles, tired by their 
 enforced extension, rapidly and involuntarily contract. Once replaced, 
 the jaw should be kept in position for a while by a handkerchief, bound 
 about the point of the chin and the top of the head, or a four-tailed 
 bandage would answer better still. 
 
 Fig. 118. — Method of replacing a dislocated shoulder, by the foot in the armpit. 
 
 Dislocation of the Shoulder. — In this injury, in addition to the signs 
 of dislocation mentioned in the beginning of this chapter, the elbow 
 usually projects from the side, and the upper arm appears to be slightly 
 lengthened. The arm cannot be moved, and there is great pain in the 
 joint. 
 
 Make the patient lie down on a bed or couch, or on the ground — 
 failing a better place. Roll a pad out of several handkerchiefs, or 
 something else that will make a pad of about that size, and place it 
 
172 EMERGENCIES AND ACCIDENTS 
 
 in the armpit, to avoid injury, by your foot. Then seat yourself by 
 his side, with your foot in a direction opposite to his ; remove the 
 shoe from your foot nearest to him; put your foot in his armpit; grasp 
 his dislocated arm in both your hands, and, pushing your foot in his 
 armpit, pull strongly on the arm, at the same time swinging it toward 
 his body. A snap will usually be felt, and the bone will be found to 
 have returned to its place. If one or two attempts at reduction by this 
 method fail, further efforts should be left to the surgeon, who should 
 have been summoned in any case. After the dislocation is reduced, 
 the arm should be bandaged firmly to the side for a day or two, in order 
 to give the torn and bruised parts an opportunity to recover. 
 
 CHAPTER XX 
 BROKEN BONES 
 
 Fracture. — Definition : A break in a bone. 
 
 Varieties : 1 . Simple, when the bone is broken in a 
 single place, and there is no opening to the surface of 
 the body. 
 
 2. Comminuted, when the bone is broken into 
 several pieces. A comminuted fracture may also be 
 compound. 
 
 3. Compound, when, in addition to the break in the 
 bone, there is an opening through the soft parts to the 
 surface of the body. A compound fracture may also 
 be comminuted. 
 
 Causes : 1 . Direct violence, where some powerful force 
 strikes upon the body at a certain point, breaking the 
 bone there. 
 
 2. Indirect violence, where powerful forces strike 
 upon the ends of a bone, causing it to break between 
 them. 
 
 Symptoms : 1 . A violent accident of some kind, involv- 
 ing either a fall of the patient or of some heavy body 
 upon him. 
 
 2. Pain at a fixed point — the place of the fracture. 
 
BROKEN BONES 1 73 
 
 3. A crack may have been felt or heard by the 
 patient when the accident occurred. 
 
 4. The limb can be bent at that point, when it was 
 immovable before. 
 
 5. The broken ends may be displaced by the action 
 of the muscles, the ends having slipped past one an- 
 other, in which case a limb would be shortened. 
 
 6. Upon gently feeling of the part, some irregularity 
 of the bone will be felt at the painful point. 
 
 7. A crackling, called "crepitus 1 ' by surgeons, may 
 be felt when the bone is firmly grasped above and 
 below the painful point, and gently moved so as to 
 cause the ends to rub upon one another. 
 
 Treatment : 1. Simple Fracture, (a) If a surgeon 
 can be gotten in a short time, place the patient in as 
 comfortable a position as possible, supporting the in- 
 jured part upon a pillow, or a similar pad made of 
 clothing or other suitable material. 
 
 (b) Where a physician cannot be obtained, and 
 where it may be necessary to move the patient any 
 distance, further treatment may be attempted. Apply 
 splints or some stiff material, properly cushioned, in 
 such a way as to prevent the fragments of bone moving 
 upon one another. 
 
 (c) If there is a prospect of several days elapsing 
 before a physician's help can arrive, replace the frac- 
 ture and dress it as specified hereafter in connection 
 with individual fractures. 
 
 2. Compound Fracture. This is a most danger- 
 ous injury, and needs the most thoughtful care. It is 
 to be treated like a simple fracture, and, in addition, 
 the wound is to receive the treatment proper for such 
 an injury. 
 
 By far the most common variety of broken bone is the simple frac- 
 ture, in which there is no opening through the skin and other soft parts 
 down to the break. It readily heals when properly treated, and is net 
 in the least a dangerous accident. 
 
 If, however, it is carelessly handled, and one of the broken ends is 
 
174 EMERGENCIES AND ACCIDENTS 
 
 pushed through the tissues to the external air, or an opening down to 
 the break is made in any other way, it is transformed into a cojnpouud 
 fracture, which, except under the most advanced surgical treatment, is 
 an exceedingly dangerous injury, entailing prolonged illness, if not re- 
 sulting in death. 
 
 On the other hand, careless handling may not push the bone through 
 the skin, but may cause it to cut across a large blood-vessel or an im- 
 portant nerve, or in some way injure other tissues of importance, and 
 in this way entail serious danger. Such an injury is called a complicated 
 fracture. Since the bone may both push through the skin and produce 
 these injuries, it is evident that a fracture may be both compound and 
 complicated. It is hardly necessary to remark that the force causing 
 the accident, and many other agents beside the bone, may render a 
 fracture complicated. 
 
 When a powerful force falls upon any portion of the body sufficiently 
 strongly to crush a bone into several fragments, producing a commi- 
 nuted fracture, the same force is very liable to injure the soft parts about 
 it to such an extent as to render the fracture compound, and then we 
 have a compound comminuted fracture. 
 
 In some cases one end of the fractured bone is driven into the other, 
 so that the fragments are wedged tightly together — this is an impacted 
 fracture. The lack of an abnormal joint and of crackling in these cases 
 makes their detection exceedingly difficult for the experienced surgeon, 
 and entirely impossible for the amateur. 
 
 A bone may be completely or partly broken. The former is a com- 
 plete and the latter an incomplete fracture. The incomplete fracture is 
 often called a green stick fracture, owing to its resemblance to a break 
 in a green stick, where the tough, green fibres break with difficulty. 
 This fracture is never found in the brittle bones of old people, but often 
 occurs in young children, where, owing to the larger proportion of carti- 
 lage or gristle, the bones are softer and tougher. 
 
 If you strike your wrist violently with a hammer, you will break the 
 bone at the point where you strike — this is fracture by direct violence. 
 But if you fall from a distance upon the palms, you will break one of 
 the bones between the hand and the shoulder; this is a fracture by 
 indirect violence, the violence being applied at the shoulder and the 
 hand, and the break being at a distance from both points. 
 
 Cases sometimes occur where bones are broken by violent contrac- 
 tions of the muscles. The knee cap is very subject to breaking by mus- 
 cular action : its fracture, in the great majority of instances, being due to 
 the violent contraction of the great extensor muscular mass of the thigh. 
 I saw a soldier a short time ago who, while playing football, missed the 
 ball with his foot in an attempt to kick it with great force : by this act 
 his leg was thrown forward so violently as to break his thigh bone at its 
 middle ; in other words, he kicked his leg in two by indirect violence. 
 
BROKEN BONES 1 75 
 
 The more important signs of fracture are the fact of an accident 
 having occurred, pain at a certain fixed point, the ability to bend the 
 limb or move the bone in an improper location, and the crackling felt 
 or heard at the point of the injury. 
 
 All these symptoms may not be present in every case, for abnormal 
 motion is absent in an impacted fracture, and it .may be impossible to 
 get crackling or crepitus, since other tissues may have gotten between 
 the broken ends so as to prevent their rubbing together. And it is 
 evident that there can be no crepitus in a green stick fracture, since the 
 broken ends are not free to be rubbed together. 
 
 When a bone is broken, the blood-vessels of the bone itself and some 
 of the surrounding soft tissues are broken, and a certain amount of 
 bleeding occurs, followed by the formation of a blood clot between and 
 around the broken ends. It takes about a week after the accident for 
 this clot to be absorbed and carried off. During the second week a 
 repair material called callus is thrown out about the broken points. It 
 forms, in the case of long bones, a perfect sheath containing the two 
 broken ends, and holding them in place ; where the broken bone is 
 hollow, callus forms in the medullary canal, and forms an internal 
 support, further uniting the bone. A certain amount of callus also 
 lies between the broken ends of bone, and acts as a sort of cement in 
 causing them to hold together. The callus develops into cartilage, and 
 after four to eight weeks into bone. The cartilage ensheathing and 
 lining the bone, after about a year, disappears, being absorbed into the 
 system ; but that between the ends of the bone remains a permanent 
 part of the bone, from which it is called permanent callus. 
 
 The indication for treatment of broken bones is to bring the frag- 
 ments into proper position and keep them there. Any inflammation or 
 other condition due to the injury is to be treated according to the needs 
 of the particular case. The great majority of fractures occur in the 
 limbs, and the general remarks upon the treatment of broken bones are 
 applied to them. Fractures of the bones of the head and trunk are con- 
 sidered only where treated individually. 
 
 The injured point, if located in a part of the body covered by the 
 clothing, should be uncovered and examined, due attention being given 
 to the avoidance of pain to the patient by unnecessary movements in re- 
 moving the clothing, and to the preservation of the clothing itself by 
 unnecessary mutilation. Any limb may be neatly and satisfactorily 
 exposed by carefully ripping up one of the seams in the garment cover- 
 ing it. Moreover, when the splint is to be applied, the flaps of clothing 
 folded assist in the formation of padding for it. 
 
 The bringing the fragments of a broken bone into place, or " setting 
 the bone," is called by surgeons " reducing the fracture." Where a 
 fracture is complete, the ends of the bone are often drawn by the 
 action of the muscles so that the ends overlap. To reduce a fracture, 
 
iy6 EMERGENCIES AND ACCIDENTS 
 
 then, it is necessary to pull the fragments in opposite directions until 
 the ends can be placed end to end ; this is accomplished in case of a 
 fracture of the arm bone, for example, by having one person, with his 
 hands in the armpit, pulling in one direction, while another, holding 
 the forearm and wrist, pulls in the opposite direction. When the 
 fragments are drawn out far enough, the ends should be worked into 
 their position end to end. 
 
 It should not be forgotten that where the services of a physician can 
 be secured within a few hours, and it is not necessary to move the 
 patient, no attempts should be made to set the bone ; but that mean- 
 while the fractured part should be pillowed in as comfortable a position 
 as possible, and the patient kept perfectly quiet. 
 
 Splints. — The fragments having been brought into the 
 proper relation, the next object to secure is their retention in 
 that position until nature can complete the healing process. 
 This is accomplished by fixing the broken limb to some stiff 
 material which will not permit movements of the broken 
 pieces. Such applications are called splints. 
 
 Four qualities are desirable in a splint : (i) It is absolutely 
 necessary that the splint be composed of material sufficiently 
 stiff to maintain the parts in position in spite of considerable 
 tendency to displacement. (2) In order to properly support a 
 broken limb, the splint must extend for some distance above 
 and below the injury. And as the action of the muscles is 
 liable to displace the fragments (Fig. 27), it is well to have 
 the splints extend beyond the joints on either side of the 
 injury, so that by making it impossible to bend the joints, 
 movements of the muscles may be obviated. (3) It is de- 
 sirable that the width of the splint should be as great and 
 perhaps a trifle greater than the thickness of the injured 
 limb. In temporary dressings, however, this is often im- 
 possible, and narrow articles, such as scabbards, ramrods, and 
 broom-handles may be utilized in emergencies. (4) The 
 surface of the splint which is to come next to the patient 
 should always be cushioned with some soft and more or 
 less elastic material to obviate irritation from an unyielding 
 surface. 
 
 It is generally best to have two splints, one on either side 
 of the limb, both held in place by the same bandage passed 
 about them when in place. 
 
SPLINTS 177 
 
 In a hospital or in a surgeon's office may be found prepared 
 splints, shaped to the limbs to which they are to be applied, 
 and materials especially intended for the ready manufacture 
 into splints. Among the latter are binder's board, felt, thin 
 strips of wood glued to cloth, coarse wire cloth, and telegraph 
 wire. Plaster-of-paris and similar bandages are used in the 
 formation of permanent splints. 
 
 But in ordinary emergencies the resources of the hospital 
 and the surgeon's office are not available, and such materials 
 as are at hand must be adapted to the purpose. It is difficult 
 to conceive of a place where something from which to extem- 
 porize a splint cannot be found. 
 
 It has been remarked that splints must be cushioned with 
 some soft material on the side coming in contact with the 
 injured limb, for an unyielding surface might induce inflam- 
 mation sufficient to greatly increase the trouble. Materials 
 suitable for this padding may be found wherever splints are 
 required. 
 
 1. In a Dwelling or its Vicinity. — Small splints may be cut out from 
 cigar boxes, and from ordinary pasteboard boxes, although the latter 
 are usually so thin that several thicknesses are required; the binder's 
 board, with which the covers of books are made, is excellent. Laths, 
 shingles, and bits of wooden boxes of thin materials are good ; while 
 flour or sugar barrel staves are unsurpassed. Broom or mop handles, 
 fire tongs, pokers and shovels ; rulers from the desk ; and many other 
 articles may be found for this purpose. 
 
 The padding may be made from cotton, clean rags from the rag-bag, 
 crumpled soft paper, crumpled soft muslin, linen, cheese cloth, or other 
 fabrics. 
 
 2. In a Shop or Factory. — Tools and their handles, strips of leather 
 belting, etc. 
 
 Padding may be made from cotton waste, fine shavings, tow, oakum, 
 and many other materials. 
 
 3. On a Public Street. — Splints may be extemporized from umbrellas 
 and canes, parasols, folded fans, and policemen's batons. 
 
 Padding may be made from bits of clothing, crumpled grass, cotton, 
 and articles of that kind. 
 
 4. In the Country. — Splints may be found in branches, or sheets of 
 bark from trees, bundles of rushes, straw or stiff grass, cornstalks, sugar- 
 cane, and the like. 
 
 Padding here may be gotten from the leaves, hay, grass, soft bits of 
 clothing crumpled, and other soft and elastic substances. 
 
178 EMERGENCIES AND ACCIDENTS 
 
 5. On the Battle-field. — Splints here are easily extemporized from 
 weapons of various kinds, such as bayonets, knives, swords, and sabres 
 and their scabbards, ramrods, rifles, picket pins, leather from saddles, 
 and the like, while Munson has shown that the carbine boot is most 
 excellently adapted to this purpose. 
 
 Padding materials are found here in grass, hay, crumpled clothing, 
 saddle cloths, blankets, tow from the limber-chest, etc. 
 
 Splints may be held in place by triangular bandages in the 
 broad or narrow cravat form, by roller bandages, which may 
 be torn from sheets or shirts, and other articles of clothing. 
 Pocket-handkerchiefs, napkins, towels, and scarfs make excel- 
 lent substitutes ; while even garters, suspenders, tape, cord, 
 and straps of various kinds may be utilized. In fixing a 
 splint in place, care should be taken to avoid bending the 
 limb so tightly as to interfere with the free circulation of the 
 blood in the part, and the tips of the fingers or toes should 
 always be left uncovered, so that they can easily be felt, to 
 see if coldness or a purplish color indicates interference with 
 the circulation. 
 
 Great care is demanded in handling persons with broken 
 bones, not only to inflict as little pain as possible upon the 
 unfortunate victim, but to prevent further injury. The trans- 
 formation of a simple into a complicated or compound frac- 
 ture is an easy matter, but one fraught with evil consequences 
 of the most dangerous description. Permanent disability — 
 not to speak of death itself — has not infrequently resulted 
 from the ignorant or officious treatment of broken bones. 
 The lung has been injured by a sharp fragment of a broken 
 rib, an artery has been sawn off by the rough end of a frac- 
 tured bone, and other important organs have been and are 
 liable to be affected in the same way. 
 
 In raising a fractured limb, it should be supported by a hand gently 
 slipped under it, both above and below the injury, in such a way that 
 there will be no tension on the break itself, and so that there is no 
 bending at that point. If this be done with care, the limb may be moved 
 with practically no pain. And the patient may be transferred to a litter 
 or to a temporary resting-place, or splints may be applied without fur- 
 ther displacement of the fragments. In applying splints, where possible 
 the help of a second person should be utilized to support the limb 
 while the dressings are being put in place. 
 
SLINGS FOR BROKEN BONES 
 
 179 
 
 Slings. — The slings made from the triangular and roller 
 
 bandages should always be used when available. But some- 
 times they are not 
 
 at hand, and other 
 
 devices must be 
 
 employed. The 
 
 sleeve may be util- 
 ized as a sling ; 
 
 when it can be 
 
 drawn on over the 
 
 arm, it may simply 
 
 be pinned to the 
 
 breast of the coat ; 
 
 where it has been 
 
 necessary to slit 
 
 the sleeve, it may 
 
 be drawn around 
 
 under the arm and 
 
 pinned to the 
 
 breast of the coat 
 
 also as a sling 
 
 (Fig. 119). The 
 
 front flap of the 
 
 skirt of a coat may be used as a sling by turning it up arid 
 
 pinning it to the coat, or by cutting a small slit in one corner 
 and buttoning it on to one of the but- 
 tons of the garment in front (Fig. 120). 
 Two small handkerchiefs may be used 
 for a sling. The first should be tied 
 around the neck as loosely as possible, 
 the knot being as near the opposite 
 corners of the handkerchief as possi- 
 ble ; the second should then be tied 
 about the first in the same manner, and 
 the forearm slipped through it. 
 
 Fig. 119. — A sfit sleeve utilized as a sling. 
 
 Patients should not be alone. — A man who 
 Fig. 120. — Coat flap turned has received even so slight an injury as a 
 up and utilized as a sling. 
 
 fracture of the collar bone should not be left 
 
l80 EMERGENCIES AND ACCIDENTS 
 
 alone, and certainly should not be permitted to go either to the surgeon 
 or home unassisted. If able to walk, he should be helped; and if in 
 great suffering or unable to walk, he should be carried on a litter or in 
 other ways, as described in the chapter on carrying the disabled. The 
 reaction from an accident is liable to be accompanied by dizziness and 
 faintness, even to unconsciousness, so that if alone, a fall may aggravate 
 the injuries already received. 
 
 The treatment required by fractures in various parts of the body 
 differs in many respects, according to their location. The individual 
 fractures, then, should be considered independently. 
 
 Fracture of the Skull. — Causes : Either the skull cap or 
 the floor of the skull may be affected. The former are due 
 to falls, where the head strikes the ground, and to blows upon 
 the head. The latter — fractures of the base of the skull — 
 are caused by falls, striking upon the feet or upon the lower 
 end of the spine in a sitting posture, or they are sometimes 
 due to blows upon the vault of the skull itself. In some in- 
 stances comparatively slight violence will cause very severe 
 injuries. I have seen cases where the skulls of boys have 
 been frightfully caved in by a blow from a base-ball club, 
 carelessly thrown behind him by the batter. 
 
 Symptoms : In a fracture of the skull cap there will be a 
 large bruise, or more frequently an open wound, at the point 
 struck. The bone will be movable or, if impacted, it will be 
 depressed below the level of the skull. Fractures of the 
 skull cap are almost always compound fractures. 
 
 In a fracture of the floor of the skull there would usually 
 be bleeding from the mouth, nose, and ears. The discharge 
 of a clear, serous fluid — the cerebro-spinal fluid — from the 
 ear is positive evidence of a fracture of the floor. The blood 
 may settle in red patches under the eye. 
 
 And in both cases there may be insensibility, with symp- 
 toms of stunning and of compression of the brain. 
 
 Treatment : Summon a surgeon immediately. Then carry 
 the patient gently into a shady place, — a darkened room if 
 possible. Lay him on his back, with his head and shoulders 
 slightly raised, and keep him absolutely quiet. If there be 
 an open wound in the head, it should be temporarily dressed 
 with a wet antiseptic compress, as prescribed for the treatment 
 
BROKEN NOSE AND BROKEN JAW l8l 
 
 of wounds. Any tendency to heat or fever should be com- 
 bated by cloths wet with cold water or bags of chopped ice 
 to the head. 
 
 Fracture of the Nose. — Causes : A blow, a fall, or some 
 crushing force, such as a wagon wheel running over the nose. 
 The bones of the nose are prodigiously strong, and the vio- 
 lence must be very great to cause the accident. 
 
 Syjnptoms : The bridge of the nose is flattened down, or 
 perhaps pushed to one side. The bones may be movable. 
 Crackling or crepitus may be felt. The parts about the 
 break soon display the signs of a bruise. The nose bleeds 
 freely. The cartilage of the nose is fixed very firmly, so that 
 it is rarely broken loose, although such accidents may occur. 
 
 Treatment : Treat bleeding by injecting hot water and 
 plugging the nostril, as described in connection with nose- 
 bleed. Treat the bruise by moist fomentations, or a wound 
 as directed for such injuries. 
 
 Fracture of the Lower Jaw. — Causes : The lower jaw may 
 be broken by a kick from a horse or a man, by a blow with 
 the fist, a club, or a bottle ; by a heavy fall, striking on the 
 chin, or by any similar accident producing direct violence. 
 
 Symptoms : The patient often feels the bone give way at 
 the time of the accident ; finds that he has not the power of 
 moving it, and tries to support it with his hand. The gums 
 are torn and bleeding, and the line of the teeth irregular. 
 The broken fragments can be felt both in 
 the mouth and from without, and crackling 
 or crepitus can be felt on moving them. 
 This fracture is often compound, opening 
 into the mouth. 
 
 Treatment : ist method. With the 
 hand, gently push the bones into place, Fig. 121.— Treatment of 
 and apply a broad cravat under the chin fracture of the lower 
 
 , , , , . , jaw with two tnangu- 
 
 and over the head ; then apply a narrow lar handkerchiefs. 
 cravat in front of the chin, tying the ends 
 behind the neck, and passing them under the first cravat on 
 either side. The cravats may be made from triangular band- 
 ages or from ordinary pocket-handkerchiefs. 
 
1 82 EMERGENCIES AND ACCIDENTS 
 
 2d method. Make a four-tailed bandage (page 101) from 
 a piece of muslin, of sufficient length to pass under the chin 
 and over the head, or by cutting a pocket-handkerchief diago- 
 nally, leaving uncut a space about two inches long in the 
 middle, and apply this like a four-tailed bandage. 
 
 Fracture of the Collar Bone. — Causes : A fall upon the 
 outstretched arm or upon the elbow. A fall upon the shoul- 
 der. A blow or a fall upon the bone itself. The most com- 
 mon of fractures. 
 
 Sy7nptoms : The shoulder drops downward and inward. 
 There is loss of power in the arm, and the patient generally 
 leans his head toward the injured side, and supports the elbow 
 with the hand of his sound side. On running the finger along 
 the collar bone, an irregularity can be felt, due to the projec- 
 tion of the outer fragment, the inner being pressed inward. 
 Keeping one hand upon this point, and with the other raising 
 the affected arm, abnormal motion is felt, and the irregularity 
 is to a considerable extent removed ; crackling or crepitus 
 may also be felt. 
 
 Treatment : Remembering that the function of the collar 
 bone is to hold the shoulder upward, backward, and outward, 
 it is evident that the treatment needed 
 to correct the deformity is to apply such 
 apparatus as will accomplish the same 
 end. (i) Make a good-sized pad, two 
 or, better, three inches in thickness, 
 and (2) thrust it high up into the arm- 
 pit, (3) at the same time pushing the 
 elbow as high up as possible, while 
 
 r. 122.— Treatment of frac- . . . & 1 1 -j 
 
 tureofthe collar bone. keeping the arm as close to the side 
 as the pad will permit. (4) Where 
 triangular bandages are available, put on a large arm sling, so 
 as to hold the arm high up in this attitude. (5) With a broad 
 cravat, a scarf, a couple of handkerchiefs folded diagonally 
 and tied end to end, or a roller bandage torn from some con- 
 venient material, bind the arm to the side. The pad for the 
 armpit can with advantage be made wedge-shaped, three 
 inches thick at its upper end and tapering to nothing below. 
 
BROKEN SHOULDER BLADE AND BROKEN ARM 1 83 
 
 Fracture of the Shoulder Blade. — Causes : The fall of 
 some heavy body directly upon the bone, by some crushing 
 accident, by the kick of a horse, by a fall upon the back, and 
 similar instances of direct violence. This bone is very rarely 
 broken. 
 
 Symptoms : Inability to move the arm freely without pain. 
 Great pain at the injured bone. Unusual irregularities in the 
 bone. Movability of the fragments. Crackling or crepitus 
 on moving them together. Swelling and other symptoms of 
 a bruise at the point of injury. 
 
 Treatment : Apply a large arm sling, if a triangular bandage 
 is available, or otherwise a substitute for it. Then bandage 
 the arm to the side with a broad cravat or other bandage, as 
 in fracture of the collar bone — the treatment being practi- 
 cally the same, with the omission of the pad in the armpit. 
 The bruises on the back should be treated with cloths wet 
 with cold water, and other applications, like bruises else- 
 where, until the arrival of the medical man. 
 
 Fracture of the Arm. — Causes : A fall upon the arm or 
 elbow. Direct violence, such as a laden wagon rolling across 
 the limb. It may in rare cases be caused by violent contrac- 
 tion of the muscles. 
 
 Symptoms : The arm is helpless, and 
 there is more or less change in its shape, 
 shortening — if the fragments override 
 one another — and an unnatural bending 
 at the broken point, even where there is 
 little shortening. The arm can be bent 
 at an unnatural point, and at the same 
 point — the site of the break — crackling 
 or crepitus can be obtained. Fracture 
 lying near the upper end of the bone is 
 often very difficult to recognize. 
 
 Treatment : An attempt may be made 
 to set the bone, one person steadying the 
 shoulder by grasping with both hands in 
 the armpit, while another pulls strongly upon the arm from 
 below, and a third gently pushes the bones together with his 
 
 Fig. 123. — Treatment of 
 fracture of the arm. 
 
184 EMERGENCIES AND ACCIDENTS 
 
 hands over the break. If the first attempt is unsuccessful, a 
 second should not be made, but all future efforts should be 
 left to a surgeon. Then (a) place a pad composed of a 
 folded towel or handkerchief in the armpit. (b) Make two 
 or more splints out of such materials as may be available — 
 laths, book covers, picket pins, etc. ; (c) carefully pad them, 
 and (d) apply them about the arm, taking care not to draw 
 the bandages or handkerchiefs too tightly, and yet tightly 
 enough to hold the parts in place. The splints which are to 
 be applied to the outer face of the arm may well extend to the 
 top of the shoulder above and to the tip of the elbow below ; 
 while those that are on the inner side of the arm should be 
 shorter. The object of the pad in the armpit is to avoid com- 
 pression of the axillary nerves and blood-vessels by the inner 
 splint. The forearm should then be well supported by a 
 sling ; but in this fracture, unlike that of the collar bone, 
 care must be taken not to push the elbow up, as it would 
 tend to displace the bone. The small arm sling about the 
 wrist should be used alone. 
 
 Fracture at the Elbow. — Causes : A fall, striking upon 
 the elbow. A blow upon the elbow. 
 
 Symptoms : The patient cannot bend his elbow. Pain is 
 felt at the joint, accompanied, after a while, by swelling and 
 
 heat. Crackling or crepitus may be felt on 
 
 bending the joint. 
 
 Treatment : Take two straight splints, 
 
 > extemporized from any available source, 
 
 ■f" 1 ' and bind them together in the form of a 
 
 right angle. Thoroughly pad the splint 
 
 FiS ' l24 's~int n angU ' ar thus formed < and > a PP¥ n g it t0 the inner 
 face of the arm and forearm with the thumb 
 up, bind it securely in place. Support it in a broad sling, if 
 available ; in others, if not. 
 
 Fracture of the Forearm. — Causes : A fall or a blow. 
 
 Sy?nptoms : One or both bones may be broken. (1) If 
 both bones be broken, the usual symptoms — pain, an un- 
 natural joint, and crackling or crepitus — will show the 
 character of the injury very clearly. 
 
BROKEN FOREARM AND BROKEN WRIST 1 85 
 
 (2) If only one bone be broken, the indications are not so 
 evident. The finger should then be run along each bone to 
 see if there is any unnatural motion or unusual projection ; 
 if an inequality is discovered, it is easy to determine whether 
 the bone is broken at the point or not, by turning the hand 
 around, when crackling or crepitus will be felt if there is a 
 fracture there. 
 
 Treat?nent : Get or make two splints as long, if possible, as 
 from the elbow to the tips of the fingers, and pad them well. 
 Bending the elbow to a little more than a right angle, place 
 the forearm with the thumb up. Then apply the two splints, 
 one to the back and one to the face of the forearm, and secure 
 them firmly with whatever means may be at hand. Support 
 the forearm in the large arm sling, with the hand raised a 
 little higher than the elbow. 
 
 Fracture at the Wrist. — It should be noted that this is 
 not a fracture of the wrist proper, but of the lower end of one 
 of the bones of the forearm — the radius. It has been called 
 Colles' fracture, Barton's fracture, 
 Pilcher's fracture, etc., from sur- 
 geons who have particularly in- 
 vestigated it. This is, next to 
 fracture of the collar bone, the 
 most frequent in the body. 
 
 Causes : The cause is invariably Fig. 125 - The deformity in 
 
 J fracture at the wrist. 
 
 forcibly pressing the open hand 
 
 backward, as in a fall, when the hands are outstretched to 
 
 break the fall, or in attempting to push some heavy mass. 
 
 Symptoms : Pain at the point of the break. A deformity 
 at the back of the wrist (Fig. 125), called the silver-fork 
 deformity, from its resemblance to the back of a silver fork. 
 On turning the hand about, crackling or crepitus may be 
 felt, and the fragment may be seen to be movable, although 
 they are more often firmly fixed, and the deformity is the 
 chief symptom. 
 
 Treatment : If a surgeon can be gotten within a day, simply 
 apply a small well-padded splint until his arrival. If some 
 time must elapse, set the bones by forcibly bending the hand 
 
1 86 EMERGENCIES AND ACCIDENTS 
 
 backward and at the same time pushing the lower fragment 
 forward. A surgeon would bind a broad strip of adhesive 
 plaster about the wrist, which would be sufficient in the vast 
 majority of cases to retain the fragments in place. But in an 
 emergency, a small well-padded splint should be applied, ex- 
 tending from the fingers well up the forearm on the palmar 
 face. Apply whatever sling may be convenient. 
 
 Fracture in the Hand. — Causes : Direct violence, in the 
 form of a blow or a fall. The hand may be broken in games 
 of various kinds and in fighting. 
 
 Symptoms : When one of the bones of the metacarpus 
 forming the hand is broken, pain will be felt at the point, 
 the fragments of the bone will be found to be movable, crack- 
 ling or crepitus will be felt, and the knuckle with which the 
 bone terminates will usually be sunken. 
 
 Treatment : Cut out a small splint from a cigar box, a bit 
 of pasteboard, or something of the kind, having it long enough 
 to extend from the tip of the fingers a little way up the fore- 
 arm. Pad the splint well and apply it to the palm, taking 
 care to have a thick wad of padding in the palm itself. Bind 
 this splint in place, and put the arm in a sling with the hand 
 rather higher than the elbow. 
 
 Fracture of the Fingers. — Causes: A blow or a fall — 
 direct violence. An injury to which ball-players are very 
 subject. 
 
 Symptoms : Pain, an irregularity at the broken point, pos- 
 sible motion there, crackling or crepitus, and swelling. 
 
 Treatment : The fracture in this case can easily be set. 
 After this apply a small well-padded splint of cardboard, 
 cigar box, or even a twig from a tree, extending from the tip 
 of the finger up to the wrist ; bind it firmly in place, and sap- 
 port it in a small sling. 
 
 Fracture of the Spine. — Causes : They may be indirect, 
 from a fall upon the head, feet, or buttocks ; or direct, either 
 from the body falling across some projection or from some 
 heavy article falling upon the body. These injuries are more 
 frequent in railroad accidents and in mines and factories. 
 
 Sympto?ns : Paralysis of all that portion of the body below 
 
BROKEN SPINE AND BROKEN RIBS 1 87 
 
 the injury, due to compression of the spinal cord by the 
 broken bone. Deformity may be felt upon gently running 
 the tips of the fingers along the spine. But no attempt 
 should be made to obtain motion, or crackling or crepitus, 
 on account of the danger of still further injuring the delicate 
 structures within the spinal canal. 
 
 Treatment : On account of the danger of increasing the 
 injury, the treatment should be confined to placing the patient 
 in as comfortable a position as possible, using the utmost pre- 
 caution in moving him, to prevent injury. Apply hot dry 
 fomentations to the body if cold, and send for a surgeon. 
 
 Fracture of the Ribs. — Causes : A blow or a fall upon 
 the chest. Squeezing in a crowd has been known to break 
 ribs, while in still other cases violent muscular action in 
 coughing has produced a fracture. The fifth to the tenth 
 ribs are the more frequently broken, while the eleventh or 
 twelfth, the " floating ribs,' 1 are rarely injured. 
 
 Symptoms : The patient complains of a stitch at some 
 point in the side, and his breathing is catching and in short 
 breaths. Passing the finger over the painful spot, crackling 
 or crepitus can usually be obtained, either by making the 
 patient cough or by pressing with the thumbs alternately on 
 either side of the break. In case the lung is torn by the 
 sharp points of broken bone, which is frequently the case, 
 there will be spitting of bright frothy blood. In many cases 
 the symptoms are very obscure, and it cannot be decided 
 whether there is a fracture or simply a bad bruise. In this 
 case, the injury should be treated like a fracture. 
 
 Treatment : In ordinary fractures, it is considered that the 
 bones must be kept absolutely quiet in order to heal properly. 
 But in case of the ribs, this cannot be done without stopping 
 the breathing, which will be impossible. However, the indi- 
 cation is to limit the breathing as much as possible, and this 
 may be done by the application about the chest of two broad 
 cravats of the triangular bandage. A broad flannel roller 
 bandage carried firmly about the chest several times so as to 
 cover it, is better still ; while strips of adhesive plaster long 
 enough to extend half-way around the body, and passed from 
 
1 88 EMERGENCIES AND ACCIDENTS 
 
 the spine to the breast bone, one overlapping the other, are 
 better yet. The patient should be moved as little and as 
 gently as possible, his chest and head being well elevated to 
 prevent interference with his breathing. 
 
 Fracture of the Pelvis. — Causes : Great and direct vio- 
 lence, such as is incurred by the wheels of a heavily laden 
 wagon passing over the hips, being squeezed between two 
 railway cars, or being crushed by the fall of an enormously 
 heavy weight. 
 
 Symptoms : There is a sense of falling apart, the patient 
 cannot stand, and an attempt to rise produces great pain. 
 Crackling or crepitus is sometimes felt. And a most im- 
 portant symptom is the fact of a tremendous crushing force 
 having been exerted on the pelvis. Serious injuries to the 
 bowels and bladder are apt to complicate this injury. 
 
 Treatment : Summon a surgeon instantly. Place the pa- 
 tient in a lying-down position, and pass a bandage about his 
 pelvis. Handle him with the greatest care, and place him 
 where he can have as nearly absolute quiet as possible. 
 
 Fracture of the Thigh. — Causes : Direct violence either 
 through a fall of the patient or through a fall of a heavy weight 
 upon his thigh. Indirect violence, through a jump from a 
 height or a fall of heavy matter upon his body. 
 
 Symptoms : Differing somewhat, according to the location, 
 the toes and foot are turned outward. There is pain at a 
 fixed point. There is loss of power in the limb, which at the 
 same time is shortened by the immense muscles of the thigh 
 strongly drawing the lower fragment up with the leg. This 
 is well shown in Fig. 27, page 32. The limb bends at an 
 unnatural point, and crackling or crepitus may be obtained. 
 
 Treatment : This injury is one in which much depends 
 upon the treatment. With proper care, it will progress to a 
 perfect recovery ; and on the other hand, with improper man- 
 agement, permanent lameness and even death itself may 
 result. Much depends upon the gentleness and skill with 
 which the limb is touched. In so large an injury it is easy, 
 by injudicious or hasty movements, to convert a simple frac- 
 ture into a complicated one, by allowing the sharp points of 
 
BROKEN THIGH I 89 
 
 the broken bone to thrust themselves through the tissues, 
 or to pierce a blood-vessel, — accidents which may make it 
 necessary to remove the limb. In all manipulations, then, 
 employ the utmost gentleness. 
 
 First, summon a surgeon without delay. Then, place the 
 patient in as comfortable a position as possible, preferably 
 on his back, slightly inclined to the injured side, and with his 
 head and shoulders some- 
 what raised. Then look 
 about for material from 
 which to extemporize a 
 splint. On the battle-field, 
 a rifle may be used. A Fjg _ |2g _ Broom . handle used as . splint 
 board from a board fence for broken thigh, 
 
 will do well. Two billiard 
 
 cues or a broom-handle will answer the indications excel- 
 lently. These should be padded with clothing, blankets, 
 leaves, grass, hay, or whatever may be available, and laid 
 along the outer side of the injured limb. The limb should 
 now be drawn out straight to its full length, and the splint 
 bandaged to it by a bandage just above and below the break, 
 with another about the waist and about the knee and the 
 ankle. This done, additional support should be given the 
 limb by bandaging it to the other limb. 
 
 If a surgeon cannot be gotten within a day, more perma- 
 nent treatment may be applied. Place the patient on a bed, 
 with the foot raised five or six inches higher than the head. 
 Then put a stocking and shoe on the foot of the affected 
 limb, first having slit the shoe in the instep a quarter of 
 an inch above the sole on either side, and passed a strap 
 of leather or cloth through it. Fill a pail or bag with ten 
 or twelve bags, six by three inches in size, filled with sand or 
 earth ; having fastened the strap through the shoe to one 
 end of a cord and the pail to the other, pass it over the foot 
 of the bed in such a way that the pail will not touch the floor, 
 but hang suspended and constantly drawing upon the foot. 
 In this way the muscles drawing the leg up will soon be tired, 
 and the ends of the bone will gradually be drawn into place 
 
190 
 
 EMERGENCIES AND ACCIDENTS 
 
 and retained there. In a less primitive fashion this is the 
 treatment now given a fracture of the thigh by modern 
 surgeons. 
 
 Fracture of the Knee-Cap. — Causes : A blow or fall upon 
 the knee ; great and sudden muscular exertion, such as is 
 caused by efforts to regain one's equi- 
 librium on standing or slipping. 
 
 Symptoms : Inability to move the 
 limb or bend the knee. The limb is 
 not shortened, and, upon feeling of 
 the knee, one part of the bone will be 
 felt pulled up by the thigh muscles, 
 while another is left in place attached 
 to the ligament, and there is a marked 
 depression between them. 
 
 Treatment : Keep the leg straight, guarding against bend- 
 ing it, which would have a tendency to further separate the 
 fragments. Place a splint of some kind — long enough if 
 possible to run the entire length of the limb — on the lower 
 extremity, bind it firmly at the ankle and the thigh, and 
 
 Fig. 127. — Separation of the 
 fragments of a broken 
 knee-cap. 
 
 Fig. 128. — Splint and figure-of-eight bandage for broken knee-cap. 
 
 include it and the knee in a figure-of-eight bandage, which 
 would tend to draw the fragments together. 
 
 Fracture of the Leg. — Causes : Direct violence : heavy 
 bodies falling on the leg, kicks from horses, and the like. 
 Indirect violence : heavy falls, jumps, and turns of the leg. 
 
BROKEN LEG AND BROKEN FOOT 
 
 I 9 I 
 
 Fig. 
 
 29. — Bundles of straw or rushes 
 as splints for broken leg. 
 
 Symptofns : Pain at a fixed point, swelling and an alteration 
 in the contour of the leg. On running the finger along the 
 bone, a point of unnatural motion will be found, and at this 
 point crackling or crepitus may be obtained. Where both 
 bones are broken, the injury is 
 easily detected, but where but 
 one is affected, there is more 
 difficulty, since the other bone 
 forms a splint maintaining the 
 limb in position. 
 
 Treatment : Lay the patient 
 comfortably upon his back, and 
 
 having provided two splints from whatever material is avail- 
 able, pad them well, and apply them to either side of the leg. 
 
 The splints would 
 preferably be a little 
 longer than from 
 the knee to the sole 
 of the foot. On 
 the battle-field, they 
 could be extempo- 
 rized from bayonets 
 and other weapons ; 
 on the street, from canes and* umbrellas ; and in a house, 
 from a host of materials. The padding may be made from 
 clothing, bedding, hay, straw, 
 and other materials used for 
 the purpose. In civil life, 
 a pillow can always be ob- 
 tained, and if the leg is laid 
 in it and splints applied on 
 
 either side, We have a most Fig. I3I. — Pillow for fracture of the leg. 
 
 satisfactory temporary dress- 
 ing. Additional security will be contributed by tying the 
 two limbs together. 
 
 Fracture of the Foot. — Causes : Direct violence, such as 
 is inflicted by a horse stepping on the foot, or by a wagon 
 running over it. 
 
 Fig. 130. — Splint extemporized from bayonets. 
 
I92 EMERGENCIES AND ACCIDENTS 
 
 Symptoms : Pain, swelling, and other symptoms of a 
 bruise, an alteration in the shape of the foot, motion at an 
 unnatural point, crackling or crepitus. These fractures are 
 often compound. 
 
 Treatment : Uncover the foot and place it in a good po- 
 sition. Dress a wound, if it be present. Apply wet cloths 
 to the bruised spot. Support the foot by an angular splint 
 (Fig. 124), which may be improvised by a short and a long 
 splint tied together, and applied with an abundance of pad- 
 ding to the side of the foot and leg. A surgeon should be 
 consulted. 
 
 CHAPTER XXI 
 
 FOREIGN BODIES 
 
 Foreign Body in the Eye. — Character : Cinders from a 
 railway locomotive ; grains of sand and similar bodies 
 blown about by the wind ; bits of metal and grains of 
 gunpowder. 
 Symptoms : Feeling the body in the eye. A copious 
 flow of tears. Sometimes the body can be seen em- 
 bedded in the cornea or conjunctiva. 
 Treatment : Close the eye for a few moments and allow 
 the tears to accumulate ; upon opening it, the body 
 may be washed out by them. Never rub the eye. 
 
 If the body lies under the lower lid, make the patient 
 look up, and at the same time press down upon the 
 lid ; the inner surface of the lid will be exposed, and 
 the foreign body may be brushed off with the corner 
 of a handkerchief. 
 
 If the body lies under the upper lid, (1) grasp the 
 lashes of the upper lid and pull it down over the 
 lower, which should at the same time, with the other 
 hand, be pushed up under the upper. Upon repeating 
 this two or three times, the foreign body will often be 
 brushed out on the lower lid. (2) If this fail, the 
 
FOREIGN BODY IN THE EYE AND EAR 1 93 
 
 upper lid should be turned up : make the patient shut 
 his eye and look down ; then with a pencil or some 
 similar article press gently upon the lid at about its 
 middle, and, grasping the lashes with the other hand, 
 turn the lid up over on the pencil, when its inner sur- 
 face will be seen, and the foreign body may readily be 
 brushed off. 
 
 If the body is firmly embedded in the surface of the 
 eye, a careful attempt may be made to lift it out with 
 the point of a needle. If not at once successful, this 
 should not be persisted in, as the sight may be injured 
 by injudicious efforts. 
 
 After the removal of a foreign body from the eye, a sensation as if of 
 its presence often remains. People not infrequently complain of a 
 foreign body when it has already been removed by natural means. 
 Sometimes the body has excited a little irritation, which feels like a 
 foreign body. If this sensation remains over night, the eye needs 
 attention, and a surgeon should be consulted ; for it should have passed 
 away if no irritating body is present. 
 
 After the removal of an irritating foreign body from the eye, some 
 bland fluid should be poured into it. Milk, thin mucilage of gum 
 arabic, sweet oil, or salad oil are excellent for this purpose. 
 
 Foreign Body in the Ear. — Character : Usually insects 
 in adults, although other articles may find their way 
 thither. Children may insert various small articles, 
 including grains of corn, beans, buttons, and the like. 
 
 Symptoms : The foreign body, particularly if a living 
 insect, may be felt by the patient. In most cases, 
 however, it is not felt. It may be seen in the ear on 
 examination. It may have been seen to be inserted. 
 
 Treat7)ient : In case of a living insect, {a) hold a bright 
 light to the ear. The fascination which a light has 
 for insects will often cause them to leave the ear to 
 go to the light. If this fails, (b) syringe the ear with 
 warm salt and water, or (c) pour in warm oil from a 
 teaspoon, and the intruder will generally be driven out. 
 If the body be vegetable, or any substance liable to 
 swell, do not syringe . the ear, for the fluid will cause it 
 
194 EMERGENCIES AND ACCIDENTS 
 
 to swell, and soften and render it much more difficult 
 to extract. In a case of this kind, where a bean, a 
 grain of corn, etc., has gotten into the ear, the body 
 may be jerked out by bending the head to the affected 
 side and jumping repeatedly. 
 
 If the body is not liable to swell, syringing with 
 tepid water will often wash it out. 
 
 If these methods fail, consult a medical man. The 
 presence of a foreign body in the ear will do no imme- 
 diate harm, and it is quite possible to wait several days, 
 if a surgeon cannot be gotten before. 
 
 It will be remembered that at the bottom of the external auditory 
 meatus, about an inch from the opening, lies the tympanic membrane, 
 a very delicate structure, which is essential to hearing. Very slight 
 pressure is sufficient to break this delicate organ ; consequently the 
 insertion of button-hooks, hairpins, etc., into the ear in order to extract 
 foreign bodies should never be attempted. I have known the tympanic 
 membrane to be perforated and one of the small bones of the ear to be 
 pulled out in an ignorant attempt to extract a foreign body, which a 
 surgeon could have removed without the slightest difficulty. The tech- 
 nical knowledge of the surgeon is required here, and he will use instru- 
 ments constructed for the express purpose of clearing the ear. 
 
 Foreign Body in the Nose. — Character : Usually small 
 articles introduced by children, either into their own 
 nostrils or that of their playmates. 
 
 Symptoms : The irritation of the presence of the body in 
 the nostril. The obstruction to breathing. The sight 
 of the body. The knowledge of its introduction. 
 
 Treatment : Close the clear side of the nose by pressure 
 with a finger, and make the patient blow the nose 
 hard. This will usually dislodge the object. 
 
 If this fails, induce sneezing either by tickling the 
 nose with a feather or something of the kind, or by 
 administering snuff. 
 
 The nasal douche, where a syringe or a long rubber 
 tube suitable for a siphon is available, may be used in 
 case the body is not liable to swell, injecting luke- 
 warm water into the clear nostril with the expectation 
 that it will push the. body out of the other. 
 
FOREIGN BODY IN THE NOSE AND THROAT I95 
 
 If these fail, and the body can be seen clearly, an 
 effort may be made to fish it out by passing a piece of 
 wire, bent into a little hook, back into the nostril close 
 to the wall, and catching the body with it. A hairpin 
 may be bent straight and the hook formed at one end. 
 Do not continue these manoeuvres very long nor let 
 them be rough in the slightest degree. 
 
 All simple efforts having failed, send for a physician. 
 There is no danger in leaving the foreign body in 
 place for some days if it is impossible to consult a 
 physician in less time. 
 
 Foreign Body in the Throat. Choking. — Character : 
 Masses of food, bones, false teeth, etc., in adults. 
 Coins, buttons, marbles, etc., in children. 
 Symptoms : Sudden difficulty in breathing, a distressing 
 cough, retching, the face assuming a purplish hue, the 
 eyes starting from their sockets, clutching at the throat, 
 unconsciousness . 
 
 It is often difficult to tell where the foreign body 
 lies. When it is possible for the patient to swallow, 
 it is safe to presume that the body lies in the larynx 
 or windpipe. 
 
 When the foreign body lies in the. gullet, there is 
 little or no cough, although swallowing is impossible. 
 
 When the foreign body lies in the pharynx, there is 
 both coughing and inability to swallow. 
 Treatment : The common practice of slapping the back 
 often helps the act of coughing to dislodge choking 
 bodies in the pharynx or windpipe. 
 
 When this does not succeed, the patient's mouth 
 may be opened and two fingers passed back into the 
 throat to grasp the object. If the effort to grasp the 
 foreign body is not successful, the act will produce 
 vomiting, which may expel it. 
 
 A wire, such as a hairpin, may be bent into a loop 
 and passed into the pharynx to catch the foreign body 
 and draw it out. The utmost precautions must be 
 taken neither to harm the throat nor to lose the loop. 
 
I96 EMERGENCIES AND ACCIDENTS 
 
 In children, and even in adults, the expulsion of the 
 body may be facilitated by lifting a patient up by the 
 heels and slapping his back in this position. 
 
 Summon a physician promptly, taking care to send 
 hint information as to the character of the accident, so 
 that he may bring with him the instruments needed 
 for removing the obstruction. 
 
 Where there is no serious interference with the breathing, any action 
 should be relegated to the surgeon. For, as a matter of fact, there may 
 really be nothing in the throat, the impression of some body already 
 swallowed remaining there. This often occurs in swallowing pills, a 
 sensation as if the pill were in the throat not unfrequently continuing for 
 a considerable time after it has passed into the stomach. 
 
 It may be impossible by any means to remove foreign bodies from 
 the gullet or windpipe. A surgeon will, however, remove them from 
 the latter, opening into it in the neck by a comparatively slight opera- 
 tion. If they are caught in the gullet, particularly if it be well down in 
 the chest, a most serious operation may be demanded, requiring cutting 
 into the stomach and reaching it from below. 
 
 When a foreign body, particularly one with sharp or rough edges, 
 has been swallowed, do not give an emetic, for it will only increase any 
 possible trouble. Make the patient eat freely of soft bread, potatoes, 
 and similar starchy articles of diet, that they may surround the body 
 with a mass of waste matter, cover its sharp edges and carry it safely 
 through the bowels. Coins, nails, fragments of bone and the like may 
 be carried through the bowels in this way with perfect safety. 
 
 CHAPTER XXII 
 
 FAINTING 
 
 Unconsciousness in General. — Sudden loss of conscious- 
 ness is an accident frequently productive of the greatest alarm 
 among bystanders, and deservedly so, for it is often the pre- 
 liminary to a fatal illness. A very large majority of such 
 cases are not dangerous, however, and they generally possess 
 sufficiently marked characteristics to make it possible to dis- 
 tinguish them readily. 
 
UNCONSCIOUSNESS IN GENERAL I97 
 
 The cause of the insensibility often throws light upon the 
 character of the trouble. If the patient has suffered a fall, 
 striking upon his head, a depressed fracture would be proof 
 positive of compression of the brain, while a similar fall, with- 
 out any fracture and striking either upon the head or feet 
 would indicate stunning. Fright, fatigue, loss of blood, and 
 similar weakening occurrences would tend to produce faint- 
 ing. Drinking freely of intoxicating liquors would cause 
 drunkenness, while an irresistible tendency to sleep, after 
 partaking of any suspicious medicine, would look like opium 
 or chloral poisoning. Convulsions would suggest epileptic 
 fits, hysteria, or kidney disease. A sudden insensibility in a 
 person of advanced age after unusual physical or mental 
 exertion would indicate apoplexy. Great weakness and de- 
 pression, with or without unconsciousness, and following an 
 accident or a sudden mental emotion, would suggest shock, 
 while sudden loss of sensibility following exposure to long- 
 continued heat would cause one to suspect sunstroke. 
 
 If, however, the cause of the injury be unknown and the 
 patient be found in a state of unconsciousness, the diagnosis 
 must rest upon other points. And in this case a systematic 
 examination should be made, beginning with the head. Com- 
 pression would be indicated by a depressed wound, while a 
 simple bruise would look more like stunning. The eyes 
 should be examined to see if they are sensitive to the touch, 
 and if so, brain injuries could be eliminated ; contraction of 
 the pupils is a sign of opium poisoning, while unequal con- 
 traction of the two pupils is a characteristic of affections of 
 the brain. 
 
 A glance at the face might discover that it is drawn to one 
 side, in which case one-sided paralysis would be indicated, 
 and pressure upon the brain either through a depressed injury, 
 or apoplexy would be suspected. A bloated and flushed face 
 is a sign of a hard drinker. 
 
 The odor of liquor or opium on the breath would be a sign 
 of drunkenness or poisoning, while froth at the mouth and a 
 bite of the tongue or lip would be present in cases of epileptic 
 and other fits. The breathing is slowed in great weakness, 
 
I98 EMERGENCIES AND ACCIDENTS 
 
 as in shock, and snoring in brain trouble, although it may be 
 present in intoxication and poisoning by anodynes. 
 
 A very slow pulse is found in brain troubles ; a very rapid 
 pulse in sunstroke and other affections characterized by high 
 fever, while a quick, thready pulse exists in great weakness, 
 such as is present in shock. 
 
 Abnormal coldness of the skin is to be expected in 
 freezing, while it is always found in intoxication and in col- 
 lapse from cholera, etc. Great heat of the skin, on the 
 contrary, is found in sunstroke and diseases accompanied 
 by high fever. 
 
 Convulsions are present in epileptic fits, certain kidney 
 troubles, hysterics, and in the indigestion and teething of 
 children. 
 
 Other points of distinction may be learned by a careful 
 study of the symptoms attending the individual affections. 
 
 Fainting. — Definition : A loss of consciousness due to a 
 diminution in the circulation of the blood in the brain 
 from a temporary weakening or stopping of the heart's 
 action. Swooning. Syncope. 
 
 Symptoms : Sudden paleness of face and whiteness of 
 lips. Cold sweat on the brow. Pulse greatly weak- 
 ened. Breathing quickened. Muscular power weak- 
 ened, causing patient to stagger and fall. 
 
 Treatment : Do not attempt to support the patient either 
 in a standing or sitting posture. Lay him flat on his 
 back with his head lower, if anything, than his feet. 
 Let him have plenty of fresh air. Loosen tight clothing, 
 such as collars and belts. Sprinkle the face with cold 
 water. Apply smelling-salts to 'the nose if available. 
 A glass of wine, or a cup of coffee, when consciousness 
 has begun to return, will assist to give the patient 
 strength . 
 
 Fainting is the variety of insensibility most frequently seen, and 
 occurs in a number of conditions, in all of which, however, weakness 
 of the heart's action is present. Hunger and indigestion, pain and 
 fright, heat and fatigue, tight lacing, and bleeding may all cause it. 
 The close warm atmosphere of crowds is especially apt to induce it in 
 
FAINTING AND SHOCK I99 
 
 the weak, and the fainting of one or more persons is an almost constant 
 feature of large assemblages. Mental emotions acting upon the heart 
 often produce fainting; bad news, and even good news suddenly re- 
 ceived, often throws delicate people into a swoon. 
 
 Among soldiers, aside from bleeding, fatigue is the most frequent 
 cause of fainting. It is a common occurrence on a long or forced 
 march for men, especially recruits, to fall out of ranks and into a faint 
 by the road. Where the man has suffered greatly from heat, the con- 
 dition is apt to be much more serious, heat-exhaustion being added to 
 fatigue-faintness and demanding special treatment. 
 
 The loss of consciousness is usually of very brief duration, although 
 it may in exaggerated cases extend over several hours. The growing 
 strength of the pulse, flushing of the cheeks and lips, and warmth of 
 the fingers, indicate approaching recovery, followed by opening of the 
 eyes and speech. 
 
 The main indication for treatment is to restore the blood to the 
 brain. This will be assisted mechanically by laying the patient down 
 with his feet higher than his head. If he be seated in a chair, or if he 
 fall into one, nothing can be better than to tip him directly back in the 
 chair; his feet will then be kept higher than his head without difficulty. 
 
 If bleeding be the cause of the accident, it is hardly necessary to re- 
 mark that checking the flow of blood is the first thing to be done. 
 Warmth should then be applied to the extremities and warm drinks 
 administered. 
 
 When a person faints in an* assembly where the seats are placed 
 closely together, it maybe convenient in some cases to cause the patient 
 to lean forward with his head between his knees for a few moments, 
 when he may have regained consciousness sufficiently to walk out of 
 the room. 
 
 When the patient does not become conscious in a few minutes, a 
 physician should be summoned without delay. Meanwhile, heat should 
 be applied to the pit of the stomach, and diluted whiskey or brandy 
 may be injected into the lower bowel — a tablespoonful of either, di- 
 luted with five or six times its bulk of warm water or milk. And if the 
 heart is very weak and the breathing seems likely to cease, artificial 
 breathing, as described in connection with Smothering, should be 
 tried. 
 
 Shock. — Definition : A state of great nervous depression 
 induced by severe injuries. Collapse. 
 Symptoms : Following an accident, a surgical operation, 
 or a mental emotion such as grief or fright, the face 
 becomes pale and pinched and assumes an anxious, 
 frightened expression. 
 
200 EMERGENCIES AND ACCIDENTS 
 
 The patient is weak and faint, depressed and chilly. 
 
 The skin is cold and suffused with cold sweat, espe- 
 cially abundant on the forehead. 
 
 The pulse may be absent, and if present is weak, 
 rapid, and irregular, while the breathing is sighing and 
 irregular. 
 
 The eyes are dull and sunken, the pupils dilated and 
 generally turned upward, while the finger-nails are of a 
 bluish hue. 
 
 The condition is greatly like dying, and differs from 
 fainting in the fact that the patient is not necessarily 
 unconscious. 
 
 These symptoms are lessened in light cases and 
 exaggerated in severe ones. 
 Treatment : Lay the patient at full length on his back, 
 with his head low. 
 
 Loosen all tight clothing, — collars, belts, etc. 
 
 If there is bleeding or other causative conditions, 
 control them. Dress wounds and bind up broken 
 bones. 
 
 Rub the limbs and body, where uninjured, with 
 flannel or similar substances, to restore the circu- 
 lation. 
 
 Treat the coldness by hot, dry fomentations applied 
 along his body and his extremities. A hot plate 
 wrapped in a towel may be applied over his stomach, 
 and bottles of hot water, hot flatirons, stones or bricks, 
 may be applied to other parts. 
 
 Hot and stimulating drinks should be given him, 
 under proper limitations. Hot coffee is always good. 
 If there is no bleeding, whiskey or brandy in hot water 
 or milk may be given, a couple of teaspoonfuls at a 
 time. If the patient is so depressed that he cannot 
 swallow, whiskey or brandy may be injected into the 
 lower bowel, a tablespoonful in five or six times its 
 bulk of warm water or milk. These doses may be 
 repeated three or four times an hour until the patient 
 is better. 
 
SHOCK AND STUNNING 201 
 
 In shock, as in fainting, the brain is deprived of its proper supply of 
 blood — indeed, it is held that shock is simply another form of fainting, 
 differing simply in being the result of mechanical injury. 
 
 The severity of shock varies greatly according to the person. A 
 woman usually suffers less from shock than a man, although the weak, 
 nervous, and timid suffer more than the strong, calm, and bold. The 
 temperament of the injured person is almost as important a factor in 
 determining the amount of shock as the severity of the accident itself. 
 A plucky, determined man will endure a comparatively severe accident 
 with less nervous depression than a flabby nervous individual. 
 
 The mind has considerable control over shock. Not a few instances 
 are on record where men have endured severe surgical operations, and 
 through their mental equipoise banished shock entirely. The instinct 
 of self-preservation may also prevent or delay shock. Sir Charles Bell 
 tells of a sergeant of the King's German Legion at Waterloo, who, after 
 his arm had been torn off by a cannon-ball, close to his shoulder, with- 
 out any dressing whatever, galloped fifteen miles to Brussels ; but 
 immediately upon arriving at the hospital he succumbed to shock and 
 remained unconscious for a long time. 
 
 The shock may be so slight as to need no treatment, a natural and 
 slight reaction setting in immediately. In the more severe cases the 
 reaction is longer in coming and greater in amount. It appears with a 
 quickening of the pulse and flushing of the cheeks, with brightening of 
 the eyes and dryness and heat of the skin, — the characteristics of fever, 
 — and should be treated during the time which it lasts in the same way 
 as fever of any kind. In other cases, and these the more fortunate, the 
 heart simply regains its normal strength, the body returns to its ordinary 
 warmth, and the mind resumes its wonted vigor — the system simply 
 returns to the natural condition. 
 
 A patient may suffer so severely from shock that reaction will not 
 follow at all, in which case the symptoms will become more pronounced 
 and gradually terminate in death. On the other hand, the reaction 
 may be so violent as to produce congestive troubles, particularly of the 
 brain, such as to render survival doubtful. 
 
 Stunning. — Definition : A condition of the mind, extend- 
 ing from bewilderment to insensibility, due to shaking 
 of the brain by sudden violence . Concussion of the 
 brain. 
 Causes : Blows or falls upon the head. Falls upon the 
 feet, or the lower end of the spine as in jumping — in 
 all cases the violence being transmitted to the brain 
 either through the skull or spine. 
 
202 EMERGENCIES AND ACCIDENTS 
 
 Symptoms: (i) Slight stunning: — After a blow or a 
 fall the patient is confused, bewildered, and giddy for 
 a few moments, with the pulse possibly a little weak, 
 the breathing slow, and the face pale. 
 
 (2) Moderate stunning : — After a blow or a fall, 
 the patient lies insensible and immovable. His skin 
 feels cold, his pulse weak and irregular, his eyes closed, 
 and on examination his pupils are found to be con- 
 tracted. May be aroused, but is peevish and falls 
 back again into unconsciousness. After a time he 
 becomes uneasy and tosses about, which is prelimi- 
 nary to recovery : if vomiting occurs, it is a sign of 
 recovery. 
 
 (3) Severe stunning: — In this case the brain 
 substance is usually torn and the symptoms are in- 
 tensified. The patient cannot be aroused at all, 
 the pulse is very weak and irregular, the skin is cold 
 and clammy, and the patient is in a condition of 
 marked shock, with a liability to excessive reaction. 
 Death often occurs, and recovery is very slow, and 
 liable to be complicated with acute congestion of the 
 brain. 
 
 Treatment: (1) Slight stunning: — Rest, lying down 
 with perhaps a cloth, wet with cold water, to the brow 
 is all that is needed for slight cases. 
 
 (2) Moderate stunning : — Rest, lying down, the 
 head somewhat raised, and perfect quiet maintained in 
 order to enable the patient to sleep. Warmth should 
 be applied to his extremities and body in hot water 
 bottles, etc., as in shock. The head, on the contrary, 
 should be kept cool by cloths wet with cold water, 
 bags of chopped ice, etc. Stimulating drinks should 
 not be given. 
 
 (3) Severe stunning : — In this case the treat- 
 ment should be the same as that for moderate stun- 
 ning, particular attention being given to keeping the 
 head cool, on account of the liability to excessive 
 reaction followed by inflammation of the brain. 
 
STUNNING AND BRAIN COMPRESSION 2C»3 
 
 Stunning is liable to be complicated with other affections of the 
 brain. The most common are compression and inflammation of the 
 brain. The former may be due to the bursting of a blood-vessel by a 
 tear in the brain substance, which is likely to occur in severe stunning. 
 The rupture is also liable to induce subsequent inflammation. 
 
 The extreme liability of the brain to excessive reaction after stunning 
 absolutely prohibits the administration of alcoholic liquors which, them- 
 selves producing congestion of the brain, would greatly increase the 
 danger of subsequent inflammation. 
 
 Compression of the Brain. — Definition: Pressure upon 
 the brain substance, producing loss of brain power. 
 Causes: The skull may be broken and a fragment of 
 bone pushed in upon the brain, a tumor may grow in 
 the brain itself, a blood-vessel may have been cut, and 
 the blood, running between the skull and the brain, 
 press upon it ; when this occurs, with or without an 
 external wound, it produces apoplexy, which is con- 
 sidered on the next page. 
 Symptoms: Profound unconsciousness, even the eyes 
 being insensible to the touch, while one or both pupils 
 are dilated, but not uniformly. 
 
 The breathing is deep and snoring, with a puffing 
 of the lips and cheeks with each breath. 
 
 The pulse is full, slow, and labored. 
 
 There is paralysis, more or less complete. The face 
 may be drawn to one side. 
 
 The signs of a broken skull may be found in cases 
 due to that accident. 
 Treatment : But little can be done for these cases except 
 by a surgeon, who should be summoned at once. 
 
 The patient should be laid down with his head 
 somewhat raised, and any clothing compressing the 
 person should be loosened, such as the collar, sus- 
 penders, and belt. 
 
 Dress the wound with cold, moist dressings and 
 apply cold to the head in the form of cloths wet with 
 cold water, or ice bags. 
 
 Keep the patient quiet and in the dark, if possible- 
 
 Give no stimulants of any kind I 
 
204 EMERGENCIES AND ACCIDENTS 
 
 Compression of the brain is apt to be mistaken for stunning, but 
 a comparison of the symptoms given for the two accidents will make it 
 possible to distinguish clearly marked cases. Stunning, however, is 
 present in almost every case of compression, so that it is not often that 
 we have a distinct case of the latter to observe. A doubtful case should 
 be treated like one of compression, the more dangerous accident. 
 Compression of blood from a bursted blood-vessel is called apoplexy, 
 and is of sufficient importance to entitle it to distinct consideration. 
 
 Apoplexy. — Definition ; Compression of the brain due to 
 escape of blood between the skull and brain from a 
 bursted blood-vessel. Paralytic stroke. 
 Causes : Sudden mental or physical excitement inducing 
 distention and bursting of one of the vessels of the 
 brain weakened usually by advancing age. The blood 
 thus escaped forms a clot between the skull and the 
 brain and presses upon the brain substance. 
 Symptoms : The subject is usually a person advanced in 
 years. 
 
 The patient usually falls suddenly to the ground as 
 if struck down. 
 
 In many cases he becomes unconscious at once, and 
 when this does not occur, insensibility follows in a few 
 minutes, and he cannot be aroused. 
 
 The face is flushed. 
 
 The eyes are insensible to the touch and irregularly 
 dilated. 
 
 The breathing is slow, labored, snoring, and puffing, 
 the cheeks being puffed out during expiration and 
 sucked in during inspiration. 
 
 Convulsive movements may occur. 
 
 There is paralysis of one side of the body, shown 
 by lifting up the hands, when one will be found to be 
 cold and lifeless, while the other is normal. 
 Treatment : Send for a medical man instantly. 
 
 Make the patient lie down with his head slightly 
 raised, and keep him very quiet and undisturbed. 
 
 Loosen suspenders, collars, belts, and any tight 
 articles of clothing. 
 
PARALYTIC STROKE OR APOPLEXY 205 
 
 Apply chopped ice or cloths wet with cold water 
 to the head. 
 
 Apply warmth to the body and extremities by means 
 of hot-water bottles, etc. 
 
 Give no stimulating drinks of any kind 1 . 
 
 The cause of the bursting of the blood-vessel producing apoplexy is 
 usually the softening and degeneration of the vessel due to advancing 
 age. It most frequently affects persons over fifty years old. Anything 
 which causes a strain on the vessels by overfilling them — such as joy 
 or grief, bodily exertion or mental effort, a stooping posture, or a glass 
 of wine — may burst the bleeding vessel. Younger persons, and even 
 children, are occasionally attacked. Both physical indolence and 
 mental activity render a man liable to it. 
 
 A form of apoplexy is caused by excessive congestion of the brain 
 without bursting of a vessel. This variety is more likely to affect a 
 younger class of patients. 
 
 Apoplexy is always alarming and dangerous. Many subjects, par- 
 ticularly the elderly, never arise from the first stroke. Younger and 
 more robust persons may survive a number of recurrences. The third 
 stroke is apt to prove fatal, although this is by no means invariable, for 
 double that number have been endured in some cases. The immediate 
 danger of the attack does not pass away in less than ten days, and a 
 patient should be carefully watched for that length of time. 
 
 The paralysis due to apoplexy affects only one side of the body, and 
 that the side opposite to the side of the brain injured. This is due to 
 the fact that the nerves arising from the brain on one side cross to the 
 other side to be distributed, as has already been described in the chaptei 
 on the Brain and Nerves. 
 
 The object sought in the treatment of apoplexy is the diminution and 
 checking of the bleeding. Direct treatment of the bleeding point being 
 impossible, general measures for quieting the heart's action and assist- 
 ing the formation of a clot must be adopted. Anything which would 
 be likely to increase bleeding should be strictly avoided, such as admin- 
 istering wines or liquors, lifting the patient into an erect posture, moving 
 the limbs, or rubbing the skin. 
 
 Apoplexy has often been confounded with less serious troubles. 
 " Drunk 01 Dying," has been a frequent newspaper head-line to articles 
 reflecting upon the police who have imprisoned a man suffering from 
 a paralytic stroke, under the impression that he was " dead drunk." 
 
 Apoplexy may be distinguished from Drunkenness (1) by the; fact that 
 the heat of the body is raised in the former and lowered in the laticr; 
 (2) vomiting is common in drunkenness, and (3) the subject can be 
 aroused to a greater or less extent by pinching, etc., while in apoplexy 
 
206 EMERGENCIES AND ACCIDENTS 
 
 there is no odor of liquor on the breath — this circumstance cannot be 
 positively relied upon, however, since the subject himself may have 
 taken a drink just before the attack, or the odor may arise from liquor 
 which an officious bystander may have spilled in the effort to make him 
 drink. 
 
 Apoplexy may be distinguished from Opium Poisoning (i) by the fact 
 that the pupils of the eyes in the latter are contracted uniformly to fine 
 points; (2) there is no paralysis, and (3) the patient may be aroused 
 by shouting at him, while (4) there is a characteristic odor of opium 
 upon his breath. 
 
 Apoplexy may be distinguished from Fits or Epilepsy (1) by the 
 absence, in the latter, of one-sided paralysis, (2) by the foaming at the 
 mouth, (3) by the spasmodic movement, and (4) by the short duration 
 of the attack. 
 
 One form of sunstroke is actually congestive apoplexy, and should be 
 treated like apoplexy. Other varieties of unconsciousness may be 
 differentiated from apoplexy by a careful comparison of their symptoms 
 with those of that affection. 
 
 Cases are liable to occur of most all of these affections which are so 
 much like apoplexy as to deceive experts. In such a case the treat- 
 ment should be that suitable to the most serious affection — an apo- 
 plectic stroke. 
 
 Drunkenness. — Definition : A state of more or less com- 
 plete unconsciousness, resulting from drinking alco- 
 holic liquor. Intoxication. Inebriation. 
 Symptoms : These vary from a simple state of exhilaration 
 to a condition of profound stupor, when the patient is 
 " dead drunk." The symptoms given refer to the latter 
 stage. 
 
 Complete unconsciousness, from which the patient 
 can be partially aroused. 
 
 Face flushed and bloated. 
 
 Eyes reddened and bloodshot ; the pupils equally 
 dilated and fixed : if the eyeball be touched, the patient 
 will attempt to close the eye. 
 
 The lips are livid, and the breathing is slow and 
 redolent with the odor of liquor. 
 
 The temperature of the body is lowered two or three 
 degrees. 
 Treatment : Cold water dashed in the face often proves 
 a most satisfactory awakener. 
 
DRUNKENNESS AND SUNSTROKE 207 
 
 Cause vomiting by tickling the pharynx with a feather 
 or something of the kind ; by administering a table- 
 spoonful of salt or mustard in a cup of warm water. 
 Aromatic spirits of ammonia is very efficient in sobering 
 a drunken man — a teaspoonful in half a cup of water. 
 
 A cup of hot coffee after vomiting will aid to settle 
 the stomach and clear the mind. 
 
 Lay the subject in a comfortable position, applying 
 hot, dry fomentations, if there is marked coldness. 
 
 While intoxication is particularly noteworthy, because of its liability 
 to be confounded with apoplexy, — from which it is distinguished by the 
 signs noted in connection with that affection, — it is a condition fraught 
 with danger in itself. 
 
 Every one knows the effect of long-continued and often-repeated 
 inebriation. The weak stomach, the enfeebled hand, the muscular 
 trembling, and the shambling gait of the habitual drunkard are all 
 familiar. But it is not so well known that alcoholic liquors taken in 
 large quantities will cause fatal shock, — death occurring sometimes at 
 once and sometimes within a few hours. These cases should be treated 
 on the principles laid down for the treatment of shock. 
 
 The system of an inebriated person is particularly subject to the influ- 
 ence of cold. Nothing is more dangerous than to permit a man in such 
 a condition to be subject to the influences of inclement weather, by 
 lying exposed to rain, snow, or severe cold. The practice of confining 
 a profoundly intoxicated man in a chilly and damp cell is very objec- 
 tionable, for the same reason, — a fatal pneumonia or congestion of the 
 brain is very likely to follow. 
 
 It is sometimes very difficult to distinguish between drunkenness and 
 apoplexy, and where the shadow of a doubt exists apply the treatme?it 
 for apoplexy. In such a case never cause the patient to vomit. The 
 treatment for apoplexy is not ill-adapted to drunkenness, and certainly 
 will not be harmful ; while that for the drunkard might prove fatal to 
 the apoplectic. 
 
 Sunstroke. — Definition : Unconsciousness, due to exposure 
 to the heat, usually of the sun. Heatstroke. Heat- 
 exhanstion. Insolation. 
 Causes : Exposure to long-continued heat — usually of 
 the sun, but often to artificial heat in factories, etc., — 
 is the chief cause ; but bad air, excessive clothing, 
 fatigue, and in particular intemperate habits are im- 
 portant accessories. 
 
208 EMERGENCIES AND ACCIDENTS 
 
 Symptoms: (i) Preliminary. In many cases the attack 
 is preceded by giddiness, weakness, and nausea; 
 the eyes becoming bloodshot, and the skin hot and 
 dry. 
 
 (2) Preceded by these symptoms or not, the subject 
 falls unconscious, the skin becomes exceedingly dry 
 and hot, the breathing is quick and noisy, the pupils 
 are contracted, and the heart is rapid and tumultuous. 
 Treatme?it : Place the patient on his back, with his head 
 raised, in the coolest immediately available spot. 
 
 The chief object of all treatment is to reduce the 
 excessive heat of the patient. 
 
 After removing his clothing, pour a stream of cold 
 water over his body, holding the vessel four or five 
 feet above him. First pour on the head, then on his 
 chest and abdomen, and last on his extremities. 
 Repeat until the patient becomes conscious. 
 
 Cold may be applied in other ways. Bags of cracked 
 ice to the head and armpits should be used when 
 available. The patient may be wrapped in cold 
 sheets, or laid in a bath-tub which is then to be filled 
 with cold water. 
 
 Continue the cold applications until the patient be- 
 comes conscious, or the heat is greatly diminished. 
 
 Renew it again at once if the symptoms arise 
 again. 
 
 Heat-stroke seems to be an accident most common in the heated 
 season in comparatively cool latitudes, or to persons who have not 
 become acclimated in warm countries. Dampness seems also to have 
 an important influence on the production of heat-stroke, the percentage 
 of such accidents being greatly increased by an increase in the amount 
 of moisture in the atmosphere. Fatigue is another important factor in 
 the causation of heat-stroke. Soldiers upon a long march on a hot day 
 are extremely subject to it. Heavy clothing should be avoided in hot 
 weather, although, on account of their favoring the evaporation of 
 sweat from the body, woollen garments are preferable. Any cause 
 which weakens the system permanently or temporarily will favor the 
 production of heat-stroke, and confinement in illy ventilated rooms and 
 the use of intoxicating liquors are conspicuous among these. 
 
INSENSIBILITY FROM POISONING 209 
 
 The heat may cause merely a form of exhaustion, without insensi- 
 bility, the patient complaining of great weakness and headache, while 
 others are incoherent and stupid. These cases are to be treated with 
 cold applications, and rest on the general lines laid down for severer 
 cases, but less energetically. 
 
 Another variety, however, is more serious and demands entirely 
 different treatment. In these cases the attack seems to direct itself upon 
 the heart. The skin is comparatively cool, the face is very pale, and 
 the breathing is sighing or gasping, while the pulse is rapid and hardly 
 perceptible. The attack comes on with great rapidity, and the subject 
 falls to the ground, gasps, and sometimes expires almost instantly. In 
 these cases the shock of cold applications should be strictly avoided ; 
 warmth should be applied externally and stimulating drinks internally. 
 The treatment which would save life in one case would be fatal in the 
 other. 
 
 The treatment of the ordinary cases, however, is very simple, and 
 consists in efforts to reduce the temperature of the over-heated blood. 
 If the patient is in a close room, he should be laid near an open window ; 
 if he is in the open air, he should be placed in the shade where a breeze 
 can reach him. All tight clothing should be loosened and as much as 
 possible removed. If in a dwelling-house, it will be very convenient to 
 place him in a bath-tub ; out of doors, he can be laid on the grass, or 
 the best available substitute for it. 
 
 In drenching him, the water may be gathered in a hat or bucket, or 
 anything else that will hold water. A watering-pot is an excellent instru- 
 ment for applying the water. After the heat has been reduced, the 
 patient should be watched with the utmost care, and any rise in tem- 
 perature should be promptly met by a renewal of the treatment. 
 
 An attack may be fatal at once, or it may last from a few minutes to 
 forty-eight hours. Recovery is apt to be followed by permanent effects 
 upon the system ; the mind may be permanently weakened, or the 
 patient may become a confirmed epileptic. A liability to frequent head- 
 aches and muscular spasms is a not infrequent result. 
 
 Insensibility from Poisoning. — Definition : Loss of con- 
 sciousness from taking sleep-producing drugs. 
 Causes : Taking opium — including laudanum, morphine, 
 paregoric, and its other preparations — chloral and 
 anodyne mixtures. 
 Symptoms: Unconsciousness progressively increasing. 
 The pupils of the eyes are contracted to the size of a 
 pin's point in opium poisoning. 
 
 The breathing grows progressively slower. 
 
210 EMERGENCIES AND ACCIDENTS 
 
 The smell of opium or chloral on the breath. 
 
 Traces of the poison, or the bottle from which it has 
 been taken may often be found. 
 Treatment : Arouse the patient by slapping, pinching, 
 and similar irritating proceedings 
 
 When aroused sufficiently to swallow, give the 
 patient an emetic of mustard or alum, a tablespoonful 
 to a glass of warm water. Continue the vomiting by 
 repeated doses given again and again. 
 
 Make the patient drink freely of strong coffee. 
 
 Keep the patient awake by slapping him with wet 
 towels, pinching him, talking to him, and even making 
 him walk up and down until he no longer feels the 
 intense desire for sleep. 
 
 The subject of opium and chloral poisoning is again referred to in 
 the chapter on Poisons. 
 
 Insensibility from Freezing. — Definition : Loss of con- 
 sciousness due to exposure to extreme cold. 
 Symptoins : Paleness and coldness of the frozen parts. 
 Sluggishness of the pulse, slowness of the breathing, 
 etc. 
 Treatment ; Rubbing with cold applications in a cool 
 but gradually warmed room. Stimulants and hot 
 drinks as soon as the patient is able to swallow. Rest 
 in warm clothing. 
 
 The subject of freezing in all its details has been fully discussed in 
 the chapter on Bruises, Burns, and Freezing. 
 
FITS 211 
 
 CHAPTER XXIII 
 FITS 
 
 Epileptic Fits. — Definition : Periodical convulsions, due 
 to disease of the brain. Epileptic convulsio7is . Falling 
 sickness. 
 Symptoms : Patient often utters a peculiar cry just before 
 falling. Immediately becomes absolutely unconscious. 
 Fails in violent convulsions, jerking the arms, legs, and 
 body. 
 
 Foaming at the mouth, grinding of the teeth, and 
 biting of the tongue or lips are common. 
 
 Face becomes livid, the eyeballs roll, and the pupils 
 are unaffected by light. 
 
 Fit lasts from five to ten minutes. 
 
 Fit generally followed by drowsiness or deep sleep, 
 sometimes by headache and debility. 
 Treatment: Nothing can be done to stop a fit. 
 
 Place the patient so that he cannot strike his head 
 or limbs against anything likely to injure them. 
 
 Loosen the clothing about the neck and body to 
 make the breathing and circulation as free as possible. 
 
 Tie a handkerchief between the teeth and about the 
 back of the head to prevent the teeth closing upon the 
 tongue. 
 
 Give the patient an abundance of fresh air. 
 
 Favor his tendency to rest after the fit has ceased. 
 
 Epilepsy is a disease of the brain which manifests itself in fits or con- 
 vulsions, recurring at more or less frequent intervals, sometimes as often 
 as two or three times daily. The victims generally experience premoni- 
 tory symptoms, such as headache, dizziness, terror, or a peculiar creep- 
 ing sensation like that of a current of air or a stream of water, beginning 
 in a hand or foot and extending toward the trunk. Warned by these 
 sensations, the subjects often attempt to place themselves in a situation 
 favorable to the attack. 
 
212 EMERGENCIES AND ACCIDENTS 
 
 On account of the suddenness of the onset, however, it is often im- 
 possible for the epileptic to remove himself from dangerous locations. 
 He may tall across a railway track, or down a flight of stairs, into a fire, 
 or under water. In such cases, injuries of various kinds are likely to 
 complicate the fit, and demand the treatment suited to them. If in a 
 situation where his movements are likely to bring him into danger, it 
 goes without saying that he should be removed. 
 
 Epilepsy is rarely cured. As life advances, the mind is likely to be 
 affected to a greater or less degree. Nevertheless, a number of the 
 great men of history have been subject to epilepsy. Caesar and Napo- 
 leon, Petrarch and Byron, Mahomet and Paul, were victims of the dis- 
 ease, and achieved greatness in spite of it. 
 
 Hysterics. — Definition : Paroxysms, varying in extent from 
 an uncontrollable fit of laughing or sobbing to convul- 
 sions similar to epileptic fits. 
 Symptoms : The subject is usually a weak girl or young 
 woman. 
 
 May simply be affected with uncontrollable laughing 
 or crying. 
 
 May fall suddenly to the ground, with clenched 
 hands, grinding of teeth, and jerking of limbs, in imi- 
 tation of epilepsy. 
 
 Partial unconsciousness is assumed, not real, as is 
 shown by muscular resistance on attempting to open 
 the eyelids. 
 
 The convulsions are never so directed as to hurt the 
 patient, nor does she fall uncomfortably, nor bite her 
 tongue, as in epilepsy. 
 
 There is no one-sided paralysis, no snoring breathing, 
 nor flapping of the cheeks, as in apoplexy. 
 Treatment : No treatment is necessary. A patient will 
 promptly recover, if left alone. 
 
 It is essential that no sympathy be shown. 
 
 A dash of cold water in the face, repeated if neces- 
 sary, will complete recovery in most cases. 
 
 Hysterics must not be confounded with hysteria, which is an actual 
 disease of the nervous system, demanding medical skill of the highest 
 order for its treatment, and manifesting itself in a multitude of various 
 symptoms. 
 
HYSTERICS AND CHILDREN S FITS 213 
 
 Convulsions from Kidney Disease. — Definition : Parox- 
 ysms, due to blood poisoning, from the failure of the 
 kidneys to cast off waste products. 
 Symptoms : Dropsy, particularly of the feet and lower 
 limbs, existing some time previously. 
 
 Patient presents convulsions, varying from twitch- 
 ings of the face and fingers to general severe jerk- 
 ings of all the muscles of the body, with complete 
 unconsciousness. 
 
 The breath and skin have a clammy odor. 
 
 The paroxysms may be preceded and followed by 
 delirium. 
 Treatment : Summon a physician instantly, notifying him 
 of the exact character of the trouble. 
 
 Place the patient in a comfortable position. 
 
 Apply cold, moist fomentations to the head — wet 
 cloths or ice bags. 
 
 Apply a mustard plaster across the small of the back. 
 
 A previous history of kidney disease will exist in almost all cases of 
 this kind and will help to distinguish it. It is not uncommon in women 
 during the months preceding childbirth, and in this case it is fraught 
 with great danger. 
 
 These convulsions are usually directly due to an alteration of the 
 kidney by disease in which the excreting power of the urinary tubules 
 is diminished, and the poisonous waste products, not able to be thrown 
 off, are retained in the blood. 
 
 Children's Fits. — Definition : Paroxysms, due to irritation 
 of the nervous system in children. Convulsions of 
 children . 
 Causes: Constipation, indigestion, worms, eruption of 
 teeth, fright, and similar irritating things. Convul- 
 sions are not as serious in children as in adults. 
 Symptoms : Before a fit, fretfulness, restlessness, and 
 gritting of the teeth in sleep. 
 
 In a fit, the child is absolutely unconscious. 
 The muscles of the face twitch, the body stiffens at 
 first and then passes into a series of jerking motions — 
 the head and neck are drawn backward, and the limbs 
 violently bent and straightened. 
 
214 EMERGENCIES AND ACCIDENTS 
 
 The pulse is very rapid and weak, the breathing 
 hurried and labored, and the skin is wet with perspira- 
 tion, often cold and clammy. 
 
 After a few minutes the child usually recovers in a 
 quiet sleep, but the fits may be repeated with short 
 intervals between them. 
 
 The first fit may be fatal, or later ones ; or recovery 
 may be prompt and permanent. 
 Treatment : A bath of water as hot as it can be borne 
 should be prepared, a teaspoonful of mustard dissolved 
 in it, if available, and the child should be set into it for 
 several minutes, repeating the operation if the fit recurs. 
 
 Follow this with an injection of a little oil or a great 
 deal of soapsuds to clear out the bowels, in case the 
 cause of the trouble may lie there. 
 
 Then tickle the roof of the mouth with a feather, or 
 use other means to produce vomiting, since the cause 
 may lie in the stomach. 
 
 Summon a physician without delay. 
 
 CHAPTER XXIV 
 
 SMOTHERING 
 
 Smothering, suffocation, or asphyxia is a state of uncon- 
 sciousness due to cutting off the supply of oxygen to the 
 lungs. Smothering may be due to a number of causes. The 
 most common is drowning, where the water prevents the access 
 of air to the lungs. Hanging and strangling, where the pas- 
 sage of air through the windpipe is prevented by compres- 
 sion of that tube, are well known. Anything which will close 
 the air-passage will produce smothering ; such are bits of food 
 and other articles diverted from their proper channels in the 
 attempt to swallow ; a variety of croup, in which the windpipe 
 is stuffed up by secretions, comes into this class. Pressure 
 upon the chest sufficiently to prevent its movement in 
 
RESTORING THE BREATHING IN SMOTHERING 215 
 
 breathing is another cause. The methods of Othello and 
 Richard III., causing smothering by pressing a pillow tightly 
 down upon the face, are classical. Smothering is the cause 
 of death in persons who have been buried under avalanches 
 of snow or sand, grain falls, and the like. 
 
 Another variety of smothering is that produced when the 
 atmosphere is so filled with other gases that the proper 
 amount of oxygen cannot find its way into the blood. 
 Smothering by breathing air filled with illuminating gas is a 
 common accident in cities where the victims from carelessness 
 or ignorance have failed to turn off the gas in extinguishing a 
 light. The gases formed by burning coal and decaying sew- 
 age, and the smoke of burning buildings, produce insensibility 
 from the same cause. 
 
 The restoration of the function of breathing is the chief 
 aim in treating cases of smothering — by this means carrying 
 off the waste, poisonous products from the blood and giving 
 new life to the system by an abundant supply of oxygen. 
 
 Restoring the Breathing. — The act of breathing is restored 
 by causing the chest walls to expand and contract in the same 
 manner as in the normal acts of inspiration and expiration. 
 
 Fig. 132. — Restoring the breathing by Sylvester's method — Inspiration. 
 
 This is called artificial respiration and is performed in sev- 
 eral ways. One of the most convenient and useful is Sylves- 
 ter's method, which is as follows : — 
 
 Lay the smothered person on his back, with a pillow of 
 folded clothing or other articles under his shoulders. 
 
2l6 EMERGENCIES AND ACCIDENTS 
 
 Take a position at the head of the patient, grasp his arms 
 just below the elbow, and draw them slowly and steadily up 
 over the head, holding them there long enough to deliberately 
 count four. 
 
 Then push the arms down upon the chest, bending the 
 elbows as they come down, and press them strongly, but 
 gently, against the chest long enough to again count four. 
 
 Repeat these movements until the patient begins to breathe 
 naturally, or until it is evident that life is beyond recall. 
 
 Fig. 133. — Restoring the breathing by Sylvester's method — Expiration. 
 
 The first sign of returning breathing is a change in the 
 color of his face; if white, it becomes red; and if red, it 
 changes to white. With this a faint fluttering breath may be 
 seen passing the lips. 
 
 Drawing the arms up over the head pulls upon certain 
 muscles which expand the chest, creating a vacuum which 
 the air rushes in to fill. Pushing the arms down upon the 
 chest again compresses it and forces the air out of the lungs. 
 Air is thus drawn into and forced out of the lungs in the 
 same manner as breathing. The blood is gradually purified 
 by the oxygen brought into contact with it, and the system is 
 again inspired with life. 
 
 Marshall Hall's method was long the most popular method of restor- 
 ing the breathing, and is still described at length and illustrated, in many 
 works, in connection with the resuscitation of the drowning. It consists 
 in laying the body on one side and rolling it on to the chest so as 
 
DROWNING 217 
 
 to compress its walls and produce expiration, and on to the back, to 
 permit the chest walls to spring out to their normal position, producing 
 inspiration. The method is clumsy in requiring several assistants, and 
 incomplete in that the amount of contraction and expansion of the 
 chest is slight. Either Sylvester's or Satterthwaite's methods are vastly 
 preferable to it. 
 
 Howard's method is better than Hall's. The patient is laid flat on 
 his back with a roll of clothing under his shoulders thick enough to 
 allow the head to be thrown well back, and his hands are tied together 
 above his head. Then kneeling beside or astride of the patient, the 
 operator places his hands upon the lower ribs, grasping the waist, and 
 presses them in by throwing his weight upon his hands, at the same 
 time pressing upward. Then he lets go with a push that brings him 
 back to the kneeling position, the pressure producing expiration, and its 
 removal, inspiration. 
 
 Drowning. — Definitio?i : Suffocation through the stoppage 
 of the air-passages by fluid . 
 Causes : The stoppage of the air-passages by fluid. Any 
 amount of fluid will cause the accident, provided that 
 it is sufficient to prevent the passage of air to the 
 lungs. Men have been drowned in a basin of water 
 and a tankard of beer, as well as in water fathoms 
 deep — the immersion of the face being enough. 
 Symptoms : The chief symptom is the fact of the patient 
 having been immersed in water. 
 
 Upon being taking out, the face is swollen and 
 purple. 
 
 The lips are livid and the eyes bloodshot. 
 
 The mouth, windpipe, and lungs contain a frothy 
 fluid, and there is considerable water in the stomach. 
 
 The tongue may be swollen and bluish, and grasped 
 by the teeth. 
 
 The feet and hands also are often swollen and 
 discolored. 
 
 The body is cold. 
 Treatment : 1 . Summon a physician as soon as possible 
 without leaving the patient in danger. 
 
 2. The treatment should be applied in the open air 
 unless prevented by inclement weather. 
 
218 
 
 EMERGENCIES AND ACCIDENTS 
 
 3. The clothing should be rapidly removed, cutting 
 with knife or scissors for the sake of haste, and the 
 body quickly wiped dry. 
 
 4. {a) Wedge open the mouth and keep it open by 
 tying a handkerchief or bandage through it like a gag. 
 This will also help to keep the tongue in place. 
 (J?) Get rid of the water that is in the body, by rolling 
 the person over on to his face, with his head a little 
 lower than the body, if possible, and (c) then, getting 
 astride of the patient, gently raise his middle by the 
 hands clasped under the abdomen ; in a few seconds 
 the water will have run out sufficiently to permit the 
 next step. 
 
 Fig. 134. — Emptying the water from the lungs. 
 
 5. Restoring the Breathing, (a) Turn him on to 
 his back, placing him on level ground, and keeping the 
 mouth wedged open as before. (6) Place the left 
 forefinger on the tongue to keep it in place, and 
 (c) with ■ the right hand press upon the abdomen. 
 
DROWNING 
 
 2I 9 
 
 making the pressure toward the back and head of the 
 patient. Press gently at first., but increase the pressure 
 until as much air as possible has been forced out of 
 the chest, (d) Then withdraw the hand so that the 
 lungs may fill with air. (e) Repeat these movements, 
 at first making them three or four times a minute, 
 increasing to ten or fifteen, and persisting at that rate 
 until breathing has been re-established, or it is evident 
 that the patient is dead. This is Sattei'thwaite*s 
 method of restoring the breathing. 
 
 Fig. 135. — Restoring the breathing by Satterthwaite's method. 
 
 Where several persons are present to assist, Sylves- 
 ter's method may be used in addition to this. The 
 arms should be pressed upon the chest at the same 
 time that the abdomen is pressed upon. When the 
 hand is withdrawn from the abdomen, the arms should 
 be brought up by the side of the head. 
 
 6. Wrap him in warm, dry clothing, blankets and 
 overcoats, or other articles of clothing which can he 
 borrowed. Then rub the limbs and body briskly under 
 the clothing to assist in restoring the circulation. 
 
220 EMERGENCIES AND ACCIDENTS 
 
 7. A good healthy reaction of the system having 
 been obtained, the patient may be carried to a com- 
 fortable room and placed in a warm bed. Hot dry 
 fomentations, such as hot-water bottles, hot bricks, and 
 the like should be applied to the body. 
 
 8. When the patient is able to swallow, warm fluids 
 may be fed to him with a spoon. Stimulants to a 
 moderate extent may also be given, and he should 
 be encouraged to pass into a restful sleep. 
 
 The symptoms of drowning described are developed by suffocation, 
 which the patient has fought as long as life held out, and more or less 
 water has found its way into the lungs. In a few cases, the patient 
 faints at once — the heart-beat and breathing stopping immediately, and 
 the windpipe being closed by the epiglottis so that the water cannot pass 
 through. Here the face of the patient is pale and flabby, and there 
 is no frothy matter in the mouth and no water in the lungs. The treat- 
 ment of both varieties is the same, but the prospect of recovery in this 
 case is much better than the other. 
 
 The importance of emptying the water out of the lungs and stomach 
 has always been recognized. It is accomplished with perfect ease by 
 the method given here. The plans of rolling upon a barrel or hanging 
 up by the heels occasionally practised are barbarous and liable to cause 
 harm rather than do good. They should NEVER be employed/ 
 
 The diaphragm or midriff is the chief factor in the methods of restor- 
 ing the breathing. Satterthwaite's method is directed especially toward 
 utilizing its function in breathing. In pressing toward the patient's 
 back and head, he presses the diaphragm directly upward and pushes 
 the air out through the windpipe. When he withdraws his pressure, 
 the diaphragm returns to its ordinary position, and the air is sucked 
 into the lungs to fill the increased space. When Sylvester's method is 
 added to it, we have the breathing act still further imitated by the addi- 
 tion of the chest movements to those of the diaphragm. Artificial 
 respiration, as performed by the combination of these methods, is the 
 most perfect substitute for the natural breathing possible. 
 
 When the person has not been long in the water, it is often possible 
 to restore breathing by irritating the nostrils with snuff, smelling salts, 
 or ammonia, or tickling the throat with a feather, and rubbing the body 
 briskly. But these methods are not to be relied upon, and too much 
 delay in resorting to artificial respiration will endanger the life of the 
 patient. Where there are several persons present to assist, one of these 
 may apply these procedures in addition. 
 
 It is difficult to decide just how long a person can be under water 
 
RESCUING THE DROWNING 221 
 
 • 
 
 without dying. In some cases, it has been impossible to resuscitate 
 persons after but a few minutes' submersion, while in others life 5. as not 
 been extinct after hours have been passed in the water. Hope, then 
 should not be abandoned even if an hour or two has elapsed since the 
 patient sunk. 
 
 The time required for artificial respiration to restore the breathing is 
 also very variable, some cases responding in a few moments, while with 
 others it is a matter of hours. Efforts then should be employed with 
 great persistence, and discontinued only after hours of faithful laboi 
 have demonstrated their uselessness. 
 
 Rescuing the Drowning. — Swimming is an art that is 
 easily acquired with a little self-confidence, and when once 
 learned is never forgotten. The main point for one to re- 
 member — who does not know how to swim, and who has 
 accidentally fallen into the water, or who is learning to swim 
 — is, that the human body will float if properly managed. 
 
 Even a very small article, such as an oar or a small board, 
 will make it easy to keep the head above water, if the chin 
 be rested upon it. And this can be done without an} 
 assistance. 
 
 It is possible, however, to float without any assistance. The secret 
 of success is a willingness to sink on the back so that the face alone 
 will be out of water. Throwing the arms out of the water or attempting 
 to get the head and shoulders above the surface will cause the entire 
 body to sink. But if a person lies back, with his hands above his head, 
 and allows the water to arise nearly to his mouth and lips, he may float 
 for an indefinite period. 
 
 The conduct of a bystander, in case of a drowning person, should 
 vary according to his acquaintance with the art of swimming. 
 
 If none of the bystanders can swim, and the person has sunk within 
 reaching distance, they should hold an oar, a fish-pole, or something 
 of the kind to him, that he may grasp it as he arises, as almost invaria- 
 bly occurs at least once and often several times. If there is nothing 
 else at hand, a coat should be taken off, and, holding it by one sleeve, 
 the other or the skirts should be thrown to the unfortunate. Esmarch 
 was told by an old sea-captain that he had saved many lives in that way. 
 
 When life-preservers are available, their use will occur to any one in 
 the presence of a drowning person. But it should be remembered that 
 anything that will float may be substituted for it, such as boards, boxes, 
 logs, sticks of wood, etc. If one is not a good swimmer, he may throw 
 a float of this kind to the drowning person, and then obtaining one 
 himself, paddle by its aid to the one whom he is trying to save. 
 
222. 
 
 EMERGENCIES AND ACCIDENTS 
 
 Fig. 136. 
 
 Grasping the drowning persor 
 
 When one is a good swimmer, and the drowning person is 
 at some distance, he should throw off as much clothing as 
 possible and swim out to him, taking great care to avoid his 
 
 clutch, for the death of a 
 would-be rescuer has often 
 resulted from being grasped 
 at an inconvenient point, 
 hampering him so that he 
 could neither save himself 
 or the one whom he hoped 
 to rescue. 
 
 i . Swim behind him and 
 grasp him, preferably, by 
 the hair — or if that be too 
 short, by the collar — with 
 the left hand, and with the 
 right hand grasp his right shoulder ; he can thus be kept 
 harmless, with his face above water. Hold him at arm's 
 length, and " tread 
 water." 
 
 2. Watching 
 the right arm of 
 the drowning per- 
 son until a favor- 
 able opportunity 
 appears, seize it 
 at the wrist, and 
 
 draw it behind the head. Then prepare to swim to shore. 
 
 3. Having the right arm held behind his head, take a few 
 
 strokes so as to 
 float on the back 
 and draw the 
 drowning man 
 on to the chest, 
 gaining his con- 
 fidence if possi- 
 ble, and swim 
 
 Fig. 138. — Drawing the drowning person on to the chest. toward the 
 
 Fig. 137. — Controlling the right arm. 
 
SMOTHERING BY GASES 223 
 
 shore, not attempting to keep the head of either high above 
 the water. 
 
 4. If the drowning person be unconscious, the work is 
 made much easier, for he can then be drawn upon the chest 
 without an effort either to avoid his clutch or to render him 
 harmless. 
 
 Fig. 139. — Swimming to shore. 
 
 Breaking through the Ice. — A person who has become 
 apparently drowned by breaking through the ice should be 
 treated according to the methods prescribed for drowning in 
 general. 
 
 To rescue such a person, it is not wise to attempt to walk out to him, 
 for the ice may give way, and involve the would-be rescuer also. But 
 if a person's weight is spread out upon the ice by creeping on all-fours, 
 or, better still, by working his way fiat on his abdomen, he may go 
 where the ice would not bear the weight of a person erect. Or he may 
 push a long board, a plank, or a pole out to the unfortunate, who may 
 pull himself out upon it. Whoever attempts the rescue of a person 
 who has broken through the ice, should attach to himself a long rope 
 of some kind, with the other end made fast to the shore, for his own 
 protection in case the ice gives way. 
 
 Smothering by Gases. — The gas which is particularly 
 liable to affect life is carbonic acid. It is present in nearly 
 every form of noxious vapor, whether in the so-called sewer- 
 gas, the coal gas used for lighting houses, the choke-damp of 
 the mines, the bad atmosphere of crowded rooms, vaults in 
 which the fermentation of wine or beer is in process, or in 
 the smoke of burning buildings. 
 
 Symptoms : The symptoms of smothering by gases are 
 those of smothering in general — a swollen and purple 
 face, livid lips, and bloodshot and staring eyes. 
 
224 EMERGENCIES AND ACCIDENTS 
 
 Treatment : In case a man is overcome by noxious gases, 
 the main thing is to get him out into the open air. 
 Rapidly loosen and, if possible, remove his clothing. 
 Hold him in a half-sitting posture, with his head higher 
 than his feet — just the opposite of the attitude advised 
 for fainting. Rub the whole body briskly with flannel, 
 or other fabric and restore the breathing by performing 
 artificial respiration. From time to time dash mod- 
 erate quantities of cold water over the body. 
 
 Caves and underground passages are liable to contain a greater or 
 less quantity of carbonic acid gas. It is of frequent occurrence in mines, 
 where it is known as " choke-damp," and in cellars containing ferment- 
 ing beer or wine ; it is found in sewers and drains intermingled with 
 the sulphuretted hydrogen — which gives the offensive odor to rotten 
 eggs — and still more noxious vapors. For this reason all unused 
 underground places should be entered with caution. If a lighted 
 candle burns all the way to the bottom, when let down into a pit, no 
 dangerous amount of carbonic acid is present ; still there may be other 
 dangerous gases by which visitors may be overcome. 
 
 The first person to enter a pit or drain should carry tied to his person 
 the end of a rope by which he can occasionally signal his safety to those 
 remaining outside. Upon his failure to reply to any signals he should 
 promptly be drawn out into the fresh air by the rope. Upon the dis- 
 covery of noxious air in an excavation, it should be purified by violently 
 agitating the air, by firing guns into it, by lowering and raising open 
 umbrellas, by pouring water or quick-lime into it. When lowering a 
 lighted candle, or firing a gun into a pit, precautions should be taken 
 against injury by the possible explosion of inflammable gases. 
 
 If it be necessary to enter a poisoned shaft to rescue persons already 
 insensible, the rescuer should have his nose and mouth covered with a 
 cloth wet with vinegar, and, as previously stated, should be connected 
 with the outer world by a signal rope. 
 
 If a room be filled with poisonous gas from any source, it is easily 
 and rapidly cleared by opening the doors and windows from the outside. 
 The victim should then be promptly carried out of the room and treated 
 for smothering. 
 
 The gaseous products of fire are a frequent cause of death in burning 
 buildings, and it is worth while to remember that in a room full of 
 smoke from such a cause, the purer air is to be found near the floor. 
 Hence it is often best to creep into a room in a burning house on 
 the hands and knees. Moreover, the flames are an indication of 
 oxygen, and air can be found to breathe wherever flames are seen. 
 
SMOTHERING BY STRANGLING OR HANGING 225 
 
 They may burn one, but they indicate air to breathe. If these facts be 
 known and remembered, many lives may be saved both of the occu- 
 pants of burning buildings and of those who would save them. 
 
 Smothering by Pressure on the Chest. — This accident 
 occurs when men are caught under falling earth or heavy 
 debris, the face remaining uncovered. Other injuries which 
 are liable to complicate the trouble add materially to the 
 danger. 
 
 In this case, the victims should be dug out with as little 
 delay as possible, and the suffocation should be treated by 
 loosening the clothing, rubbing the body and dashing cold 
 water upon it, and restoring the breathing by artificial res- 
 piration. 
 
 Smothering by Strangling or Hanging. — This injury is 
 most frequently self-inflicted with suicidal intentions, although 
 cases occasionally occur where men are caught by the straps 
 of a harness or bridle and dragged about by. the neck by 
 a fractious horse, or are strangled in other accidental ways. 
 
 The most important point in the treatment of hanging is to 
 cut the person dow7i, and that with the least possible delay. 
 When a person is seen hanging, it is homicidal to run to tell 
 others of it before cutting him down, for in the minutes so 
 occupied the victim may have passed completely to his death. 
 So far as possible, support him with one arm, while cutting 
 the rope with the other, so that he may not injure himself by 
 falling too heavily to the ground. Then loosen the noose 
 and treat him as for smothering from other causes. Quickly 
 loosen, and if possible remove the clothing, keeping him in a 
 half lying-down position, with the head higher than the feet. 
 Rub the body briskly with flannel, towels, etc. Restore the 
 breathing by practising artificial respiration, and dash cold 
 water upon the body occasionally. 
 
 In all these cases a surgeon should be summoned imme- 
 diately, the measures prescribed being resorted to while 
 awaiting his arrival. 
 
226 EMERGENCIES AND ACCIDENTS 
 
 CHAPTER XXV 
 POISONS 
 
 Poisons. — Definition : A poison is any substance which 
 taken into the system in small quantities will produce 
 death or serious disorder. 
 Varieties : Poisons may be general, affecting the entire 
 system, or local, affecting some particular part pri- 
 marily, and the whole system only secondarily. 
 Symptoms : The symptoms of the various poisons differ 
 according to the individual drug. But certain of them 
 possess enough characteristics in common to enable 
 them to be grouped and to render it easy to distinguish 
 them. They are : — 
 
 i . Locally irritating poisons in which the symptoms 
 are due entirely to the location of the poison. 
 
 2. General poisons, causing local irritation in which 
 the poison affects the system at large in addition to 
 producing local irritation. 
 
 3. Sleep-producing or narcotic poisons. 
 
 4. General poisons in which there is no local irri- 
 tation. 
 
 Treatment: In the first class never cause vomiting. 
 Give dilute acids to neutralize alkalies, and dilute alka- 
 lies to neutralize acids. Follow with soothing drinks 
 of oil, raw eggs, and flour and water. Give opiates to 
 quiet pain, and whiskey or brandy to relieve the 
 weakness. 
 
 In the second class, except in case of arsenic, no 
 emetic should be given, but the effect of the poison 
 should be counteracted by bland doses of oil, flour 
 and water, white of egg, and the like, while stimulating 
 drinks should be given to counteract depression. The 
 treatment of arsenic is peculiar to itself and should be 
 studied individually in the tables. 
 
POISONS 
 
 227 
 
 In the third class, sleep-producing poisons, give an 
 emetic ; after producing repeated vomiting make the 
 patient drink strong coffee and other stimulating drinks, - 
 and use every available means to keep him awake. 
 
 In the fourth class, general poisons, always give an 
 emetic, follow with stimulating drinks to relieve weak- 
 ness ; give opiates to relieve pain, and put the patient 
 to rest. 
 The individual poisons may best be considered in the form 
 of a table, where they can moreover more quickly be found in 
 an emergency. 
 
 1. Locally Irritating Poisons. 
 
 Poison. 
 
 Symptoms. 
 
 Treatment. 
 
 Acids : — 
 
 Muriatic. 
 
 Nitric (aqua fortis). 
 
 Oxalic. 
 
 Sulphuric (vitriol). 
 
 Excessively severe burn- 
 ing pain in the mouth, 
 throat, and stomach. 
 Difficult swallowing. 
 Great depression. Ex- 
 tremities cold and 
 clammy. Convulsions. 
 (Death.) 
 
 No emetic. Alkali (bak- 
 ing soda, saleratus, 
 magnesia, chalk, lime, 
 plaster) — 3 or 4 tea- 
 spoonfuls in a glass of 
 water. Drink soothing 
 fluids, like oil. Stimu- 
 lating drinks, if neces- 
 sary. Opiates to re- 
 lieve pain. 
 
 Acid, Carbolic: — 
 Creosote. 
 
 Vomiting of frothy mucus. 
 Lining membrane of 
 mouth white, hardened, 
 and benumbed. Severe 
 pain in belly. Cold, 
 clammy skin; insensi- 
 bility. Snoring breath- 
 ing. Odor of carbolic 
 acid. 
 
 No emetic. White of 
 eggs. Milk, or flour 
 and water. Rest. Opi- 
 ates. 
 
 Alkalies : — 
 
 Ammonia (hartshorn). 
 
 Lye. 
 
 Pearlash. 
 
 Potash, Caustic. 
 
 Soda, Caustic. 
 
 Painful burning in mouth, 
 throat, and stomach. 
 Difficult swallowing. 
 Bloody vomiting and 
 purging. Great depres- 
 sion, etc., like acids. 
 
 No e77tetic. Dilute acids 
 (vinegar or lemon 
 juice). Soothing fluids, 
 like oil, melted fat, thick 
 cream, etc. Stimulat- 
 ing drinks. Opiates to 
 relieve pain. 
 
 Silver: — 
 
 Nitrate (Lunar caustic) . 
 
 Same as above. 
 
 No emetic. Copious 
 draughts of salt and 
 water. Soothing drinks. 
 Opiates. 
 
228 EMERGENCIES AND ACCIDENTS 
 
 2. Ceneral Poisons, causing Local Irritation. 
 
 Poison. 
 
 Symptoms. 
 
 Treatment. 
 
 Mercury:— 
 
 Corrosive sublimate. 
 
 Calomel. 
 
 Vermilion. 
 
 Burning pain in throat, 
 stomach, and bowels. 
 Metallic taste. Vomit- 
 ing and purging — fre- 
 quently bloody. In- 
 crease of saliva. Sleep- 
 iness. Convulsions. 
 Stupor. 
 
 No emetic. Raw eggs, 
 milk, or flour and water. 
 Castor oil. Stimulating 
 drinks. 
 
 Arsenic:— 
 
 Fowler's solution. 
 Green coloring matter. 
 Paris green. 
 Rough on Rats. 
 Scheele's green. 
 
 Burning pain in stomach 
 and bowels. Tender- 
 ness of belly on pres- 
 sure. Retching. Vom- 
 iting. Dryness of 
 throat. Clammy sweat. 
 Convulsions. 
 
 Cause repeated vomit- 
 ing: Give hydrated 
 oxide of iron made by 
 adding 8 parts of am- 
 monia water to io parts 
 ofsolutionoftersulphate 
 of iron. Then castor 
 oil. Rest, and stimu- 
 lating drinks if needed. 
 
 Copper:— 
 
 Verdegris. 
 Blue vitriol. 
 Food cooked in copper 
 vessels. 
 
 Similar to those of arsenic. 
 Coppery taste in mouth. 
 Tongue dry. Colic. 
 Bloody stools. 
 
 No emetic. White of 
 eggs, if obtainable, — if 
 not, flour and water. 
 Ice. Opiates to relieve 
 pain and excitement. 
 
 Iron: — 
 
 Copperas. _ 
 Green vitriol. 
 
 Burning pain in throat, 
 stomach, and bowels. 
 Colic. Vomiting. Purg- 
 ing. Cold skin. Weak 
 pulse. 
 
 No e7iietic. Baking-soda 
 in water. Then raw 
 eggs and milk. Opiates 
 for pain. Stimulating 
 drinks for depression. 
 
 Sleep-producing or Narcotic Poisons. 
 
 Poison. 
 
 Symptoms. 
 
 Treatment. 
 
 Chloral: — 
 
 A white, crystalline sub- 
 stance, with an acrid 
 taste. 
 
 Profound sleep. Breath- 
 ing slow and shallow. 
 Pulse weak, rapid, and 
 irregular. Remains of 
 poison near by. 
 
 Cause vomiting. Stimu- 
 lating drinks. Heat. 
 Motion. 
 
 Opium : — 
 
 Laudanum. 
 Morphine. 
 Paregoric. 
 
 Sleeping mixtures in 
 general. 
 
 Giddiness. Heaviness of 
 the head. Sleepiness. 
 Stupor. Pupils of eyes 
 contracted to fine point. 
 Signs of the poison near 
 by. 
 
 Cause vomiting. Stimu- 
 lating drinks — strong 
 coffee. Keep up breath- 
 ing. Warmth. Keep 
 patient awake by whip- 
 ping, if necessary. Mo- 
 tion. 
 
POISONS 
 
 229 
 
 4. General Poisons. 
 
 Poison. 
 
 Symptoms. 
 
 Treatment. 
 
 Aconite:— 
 
 Wolfsbane. 
 Monkshood. 
 
 Great depression. Ex- 
 treme weakness. Cold 
 sweat. Numbness of 
 extremities. Weak and 
 slow pulse. 
 
 Cause vomiting. Stimu- 
 lating drinks. 
 
 Belladonna:— 
 
 Atropia. 
 
 Deadly nightshade. 
 
 Eyes very bright, and pu- 
 pils enlarged. Dryness 
 of throat. Paralysis of 
 excretory organs. De- 
 lirium. Convulsions. 
 
 Cause vomiti?ig. Opi- 
 ates to relieve nervous 
 excitement. Rest. 
 
 Lead:— 
 
 Red lead. 
 
 Sugar of lead. 
 White lead. 
 
 Metallic taste in mouth. 
 Cramps. Paralysis. 
 Vomiting. Increase of 
 saliva. Giddiness. 
 Convulsions. Stupor. 
 
 Cause vomiting. Large 
 doses of Epsom or Glau- 
 ber's salts. Stimulating 
 drinks. 
 
 Phosphorus:— 
 Matches. 
 
 Pain in stomach and bow- 
 els. Vomiting. Purg- 
 ing. Signs of poison 
 near by. 
 
 Cause vomiting. Mag- 
 nesia in water. Soap 
 suds. Rest. Warmth. 
 
 Prussic acid:— 
 
 Cyanide of potash. 
 Oil of bitter almonds. 
 Laurel water. 
 
 Death may occur instant- 
 ly in ordinary doses. 
 In very small doses, 
 giddiness, blindness, 
 convulsions, fainting. 
 Death may occur from 
 smelling the odor only. 
 
 No emetic. Stimulating 
 drinks (strong) without 
 delay. 
 
 Strychnine: — 
 
 Nux vomica. 
 
 Slight shuddering. Feel- 
 ing of constriction of 
 throat. Starting s. 
 Paleness. Intermittent 
 jerkings. Convulsions. 
 Ghastly grin. 
 
 Cause vomiting once or 
 twice. Rest. Opiates. 
 Chloral. Tannin. 
 
 Vegetable poisons:— 
 
 Berries (Bitter-sweet, 
 Deadly nightshade, 
 Mountain ash, Poke, 
 Potato). Hellebore, 
 Hemlock, Horse chest- 
 nut, Indian tobacco, 
 Jamestown weed, Wild 
 lettuce, Wild parsley, 
 Rhubarb leaves, Toad- 
 stools, Tobacco plant. 
 
 Nausea. Depression. In- 
 toxication, Stupor, etc., 
 varying somewhat with 
 the poison. 
 
 Cause vomiting. Stimu- 
 lating drinks. Rest. 
 
23O EMERGENCIES AND ACCIDENTS 
 
 Emetics. — In the majority of cases of general poisoning, 
 the first step to be taken is to cause the patient to disgorge 
 as much of the poison as possible by vomiting. Articles 
 producing these acts are called "emetics." 
 
 1. Vomiting can be induced frequently by thrusting the 
 finger back in the mouth to the pharynx ; where another 
 person's mouth is in question a feather, or some other soft 
 object, may be used. 
 
 2. Drinking large quantities of warm water will often cause 
 the desired effect. A little salt added to the water will in- 
 crease the effect. 
 
 3. Chewing and swallowing tobacco in considerable quan- 
 tities will cause the stomach to rebel. The tobacco itself in 
 this case is poisonous, but by inducing vomiting it acts as its 
 own antidote. 
 
 4. Drinking mustard or salt and water, made by adding a 
 tablespoonful of common salt, or powdered mustard, to a 
 tumblerful of lukewarm water, makes an excellent emetic. 
 
 Medical men will administer ipecac, apomorphine, sulphate 
 of zinc, tartar emetic, and other drugs. But the readily 
 available means of inducing vomiting here given should be 
 employed while awaiting their arrival. 
 
 Weakness and shock following poisoning and its treatment 
 should be treated by stimulation and warmth as already pre- 
 scribed for those conditions. 
 
 Poison Ivy, Oak, Sumac. — Certain plants produce a 
 painful rash when they merely touch the skin. In some 
 cases the eruption has followed a near approach only to the 
 plant, without direct contact, the poisonous effect being prob- 
 ably due to a noxious emanation from it. The more common 
 of these plants belong to the rhus family, and are commonly 
 known as the " poison ivy," or " poison vine," the " poison 
 oak," and the " poison sumac." 
 
 The poison ivy or poison vine {Rhus radicans) is a climb- 
 ing plant growing luxuriantly upon trees and rocks, and 
 somewhat resembles the woodbine or Virginia creeper. But 
 the poison ivy is three-leaved (Fig. 140), while the harm- 
 less variety is five-leaved. The poison ivy has a hairy 
 
POISON PLANTS AND POISONED WOUNDS 23 1 
 
 trunk and often has little white berries from the axils of the 
 leaves. 
 
 The " poison oak" {Rhus toxicodendron} is an erect plant 
 twelve to eighteen inches in height, with a leaf like that of 
 the poison vine, consisting 
 of three smaller leaflets (Fig. 
 140). 
 
 The "poison sumac " {Rhus 
 venenata) is very similar to 
 the ordinary sumac, except 
 that, like the poison ivy, it 
 has small, slender clusters of 
 white berries growing from 
 the axils of the leaves. In 
 all other sumacs the berries Fig ' l40 ' ~ Leaf of the poison ivy or 
 
 poison vine. 
 
 are red and in close bunches 
 
 at the ends of the branches, and these are not only harm- 
 less, but have an agreeable and wholesome acid taste. 
 
 Symptoms : A painful rash, sometimes uniformly red, and 
 at other times consisting of collections of small eleva- 
 tions, surrounded by a greatly reddened surface. It is 
 rather more frequent on.the hands, face, and neck, but 
 is often seen on and about the thighs. It may last 
 from two or three days in mild cases to one or two 
 weeks in the more severe. 
 Treatment : A very strong solution of bicarbonate of 
 soda {baking-soda) will frequently check the trouble 
 in the beginning. Any soothing ointment such, as 
 vaseline or petrolatum is also useful, and in the ab- 
 sence of these lathering the part with a soft shaving- 
 brush will diminish the itching and burning. 
 Poisoned Wounds. — Certain poisons may be introduced 
 directly into the circulation through wounds. Wounds may 
 become poisoned in three ways : (1) By the development and 
 multiplication of germs which induce death and decay of the 
 tissues in an otherwise healthy wound. This variety of 
 poisoned wounds has been fully discussed in connection with 
 the germ theory, and rules have been given for its prevention 
 
232 EMERGENCIES AND ACCIDENTS 
 
 and treatment. (2) Wounds may become poisoned by the 
 introduction of a poison after they have been inflicted. 
 And (3) wounds may become poisoned by being inflicted 
 with some poisoned instrument. 
 
 1. Poisons in common with most medicinal substances are 
 readily absorbed through wounds with which they may come 
 in contact. This is occasionally seen when, through the 
 injudicious use of poisonous antiseptic agents in the treat- 
 ment of wounds, or for other reasons, enough carbolic acid, 
 corrosive sublimate, or iodoform has been absorbed to pro- 
 duce serious and even fatal poisoning. Wounds into which 
 the poison has been introduced after the infliction of the 
 injury should be treated, prior to the arrival of a surgeon, by 
 removing the source of the poisoning and then employing the 
 measures ordinarily applied to healthy wounds. Great care 
 should be taken to avoid the introduction of poisons by the 
 prompt application to wounds of clean dressings. 
 
 2. Wounds may be poisoned by being inflicted by some 
 poisoned instrument, such as a poisoned arrow or dagger, or 
 the teeth of an animal, the fangs of a reptile, or the sting of 
 an insect. Poisoned weapons are rarely used at the present 
 time even by savages. 
 
 If shallow, these wounds should be treated like bites of 
 rabid animals ; but if deep, such treatment would be of little 
 avail, and ordinary wound treatment must suffice until the 
 advice of a surgeon can be obtained. 
 
 Dog Bites, and wounds inflicted by the teeth of other 
 animals, are usually simple wounds, unless the animal be mad. 
 In this case the saliva of the animal contains a poison which 
 is carried into the wound by the teeth, to pass into the circu- 
 lation and produce a similar disease in man. 
 
 Treatment : Absolute safety to a person who has been 
 bitten by a mad animal can only be secured by imme- 
 diately and entirely cutting or burning the wound out 
 of the body. While preparations are being made for 
 doing this a bandage or handkerchief should be bound 
 tightly about the limb — the Spanish windlass (page 151) 
 is excellent for this purpose — above the wound, to 
 
BITES OF ANIMALS AND INSECTS 233 
 
 prevent the poison being carried into the circulation. 
 The wound should be sucked to extract as much as 
 possible of the poison, it being remembered that there 
 is no danger from the poison being taken into the 
 mouth, although it should be expectorated, not swal- 
 lowed. Then with a sharp knife cut the bite out 
 completely, or burn it out with a red-hot iron, or by 
 filling it with powder and firing it. The patient should 
 then be quietly laid to rest and given alcoholic drinks 
 in large quantities to counteract the effects of shock. 
 Snake Bites. — This injury is most commonly due m this 
 country to the rattlesnake, the copperhead, and the moccasin. 
 Symptoms : Following a bite, swelling and discoloration 
 of the wound; headache, chills, and great weakness. 
 If fatal, death may occur in from a few hours to several 
 days. 
 Treatment : The bites of poisonous snakes may be treated 
 in the same way as those of mad dogs. Suck the 
 wound, — after having put a tourniquet about the limb 
 above the bite, — taking care to expectorate the poi- 
 son. Then cut or burn the bite and administer 
 whiskey or other alcoholic drinks to the patient in 
 large quantities. 
 Insect Stings. — Under this head are included the bite of 
 the so-called tarantula, as well as the stings of the centipede 
 and scorpion, the wasp, hornet, and bees. 
 
 The bite of the tarantula is sometimes fatal, and in Eastern 
 countries the same result is said to follow the sting of the 
 scorpion. But in this country the scorpion, as well as the 
 centipede, does not produce fatal results, although the latter 
 may inflict a painful and annoying injury. The bite of the 
 tarantula and the stings of the centipede and scorpion should 
 be treated in the same way as snake bites. 
 
 Insects in stinging usually leave their stings in the wound. 
 It should first be extracted and the wound then treated with 
 a solution of baking-soda. Clay made up into a paste with 
 saliva is a favorite application which may be used in the 
 absence of soda. The sting can usually be forced out by 
 
234 EMERGENCIES AND ACCIDENTS 
 
 pressing upon the skin by its side, or if a watch-key, or some- 
 thing with an open centre be pressed down upon it, the sting 
 will be pressed out. 
 
 CHAPTER XXVI 
 DEATH 
 
 Death is the permanent cessation of all the functions which 
 taken together constitute life. 
 
 i. The lungs cease drawing in and throwing out air — pass- 
 ing oxygen into the blood and extracting carbonic acid. 
 
 2. The heart ceases throwing the blood into the system 
 and into the lungs. 
 
 3. The blood stops carrying its freight of oxygen into the 
 tissues and its load of carbonic acid out of it. 
 
 4. The muscles cease acting and moving the body. 
 
 5. The nerves stop carrying telegraphic messages from the 
 mind in the brain and spinal ganglia. 
 
 6. The viscera cease their digestive and excretory action. 
 
 7. Heat and motion depart. 
 
 8. The eyes become glazed and half open. 
 
 9. There is no feeling in the body. 
 
 10. The teeth are clenched, and froth often forms about the 
 mouth. 
 
 1 1 . The inciting power of all these actions, the soul, de- 
 parts, and — 
 
 12. The process of decay sets in. 
 
 When all these conditions have been fulfilled, death has 
 occurred without a doubt, but in some cases the functions are 
 carried on so imperceptibly as not to be readily perceived. 
 Cases have occurred where, owing to a temporary diminution 
 of these vital phenomena, death has been simulated so suc- 
 cessfully that persons have been buried alive. This is, how- 
 
DEATH 235 
 
 ever, by no means as frequent as is often supposed, as is 
 shown by the experience of certain foreign cities where pro- 
 visions have been made for keeping bodies unburied until 
 advancing decomposition places death beyond a doubt, sur- 
 rounding them meanwhile with every appliance available for 
 assisting resuscitation. Not a case is on record, however, of 
 revival from trance or any other supposed counterfeit of death 
 during all these years. 
 
 There are a number of more or less positive proofs of 
 death : — 
 
 1 . The breathing has stopped : there is no movement of 
 the chest ; the sound of the air passing in and out is absent, 
 and there is no watery vapor proceeding from the mouth. 
 
 2. The heart has stopped: there is no pulse; the move- 
 ments and sounds of the heart have ceased, and the veins do 
 not become swollen upon making pressure between them and 
 the heart. 
 
 3. The blood in the veins becomes clotted. 
 
 4. The red color in semi-transparent parts disappears. 
 
 5. The warmth of the body is replaced by coldness. 
 
 6. The muscles of the body relax at first and then become 
 stiff usually in from five to six hours, remaining so for from 
 sixteen to twenty-four hours. 
 
 7. There are no signs of rusting on a bright steel needle 
 after plunging it deeply into the tissues. 
 
 8. Electricity has no effect upon the contraction of the 
 muscles. 
 
 9. Decomposition of the tissues sets in, as is shown by the 
 odor and the greenish blue discoloration, usually appearing 
 first on the abdomen. 
 
 The fact of the breathing having stopped may be deter- 
 mined in two ways : (a) If the movements of the chest have 
 absolutely ceased, there will be no movement in a glass of 
 water, or better, a cup of quicksilver .set upon the chest. 
 (&) The absence of watery vapor proceeding from the mouth 
 may be shown by holding a looking-glass or a bit of brightly 
 polished metal, such as a razor-blade, over the mouth ; if any 
 breath proceeds from the lungs, it will be shown by the 
 
236 EMERGENCIES AND ACCIDENTS 
 
 collection of some drops of moisture upon the reflecting 
 surface. 
 
 The cessation of the heart's action may be shown by tying 
 a string rather tightly around a finger ; if the person is living, 
 the end of the finger will become reddened by the collection 
 of blood beyond the string, and the removal of the string will 
 leave a white line about the finger at that point. 
 
 When the body has become cold and, beyond all question, 
 when decomposition has set in, death has occurred. 
 
 CHAPTER XXVII 
 THE EMERGENCIES OF THE BATTLE-FIELD 
 
 In no place is the demand for prompt attention to emergen- 
 cies greater than on the battle-field. And with the progress 
 of civilization, efforts to meet this demand have grown more 
 systematic, until at the present time aid to the injured on the 
 battle-field is rendered by thoroughly organized corps con- 
 sisting of four classes: (1) Medical officers, (2) the hospital 
 corps, (3) civilian assistants, including female nurses, the vari- 
 ous volunteer organizations for first aid, etc., and (4) the 
 soldiers themselves, each one of whom is taught the applica- 
 tion of the elements of first aid to himself and his comrades. 
 
 The medical officers comprise all those connected with an 
 army, and include (1) the surgeons and assistant-surgeons 
 attached to regiments, and (2) the medical officers of the 
 general staff, who administer the field- and permanent hos- 
 pitals, etc. 
 
 In the organization of the army, the work of the hospital 
 corps was formerly assisted by " company bearers," or privates 
 detailed — four to each company — from the line. This feat- 
 ure of first aid work has now been abandoned, the training of 
 the entire command in extemporaneous wound treatment be- 
 
SANITARY SOLDIERS 237 
 
 ing substituted. Each company is allowed two litters, and a 
 certain amount of litter drill also forms a part of the training 
 of every soldier. 
 
 The hospital corps is a distinct organization, consisting of 
 men whose duties are limited entirely to sanitary work, and 
 is consequently of much greater importance in the care of the 
 sick and wounded. Its members are selected because of their 
 conspicuous adaptability to the peculiar duties of the corps. 
 They must be brave and active, strong and gentle, and pos- 
 sessed of presence of mind and inventive faculty sufficient to 
 meet the varying emergencies of succor to the injured. 
 
 The uniform of the hospital corps is similar to that of other enlisted 
 men, the trimmings being of emerald-green, and privates as well as 
 non-commissioned officers wearing the stripe upon the trousers. They 
 wear a white brassard, bearing a red cross, on the left arm above the 
 elbow, and the cap ornament is a white metal Geneva cross. They 
 have no full dress uniform, as they are not expected to take part in 
 parades or ceremonies, but are allowed white duck uniform for hospital 
 ward service. 
 
 The articles of the Geneva Convention prohibit the bearing of arms 
 by those who come under its provisions ; consequently the hospital 
 corps is unarmed except when engaged with an enemy who does not 
 recognize the Geneva Convention, in which case the men carry revolvers. 
 
 The non-commissioned officers are known as hospital sergeants and 
 hospital corporals, and wear chevrons suitable for those grades, with a 
 red cross in the angle. 
 
 In case of active hostilities, the hospital corps is present 
 with the troops in the proportion of five per cent of the 
 aggregate strength of the command — a proportion which 
 experience has shown to best supply the needs of the removal 
 and care of the injured. To every ten privates of the hospital 
 corps there should be a hospital corporal, and to every thirty 
 privates there should be a hospital sergeant. 
 
 The privates of the hospital corps are divided in the field 
 into ambulance companies and hospital companies with the 
 full company organization of an infantry company. The am- 
 bulance companies have to do principally with the transpor- 
 tation of the disabled by litter and by wheeled vehicles ; 
 while the hospital companies are attached to the brigade or 
 division hospitals, and are concerned principally with the 
 nursing of the sick, police of the grounds, and other work 
 demanded in hospital. The ambulance companies habitually 
 
238 EMERGENCIES AND ACCIDENTS 
 
 encamp near the field hospital, with the ambulance and wagon 
 train in the immediate vicinity. The hospital companies 
 form a part of the hospital itself. The companies are com- 
 manded by officers of the medical department, assigned to 
 that duty. In addition to those who are formed into com- 
 panies, each regiment is allowed a detachment of four non- 
 commissioned officers and twelve privates. 1 
 
 To the hospital corps is committed the care of the sick and 
 wounded after they are brought to the first dressing-stations, 
 and except by special assignment of competent military 
 authority no others are permitted to take or accompany sick 
 men to the rear, either on the march or upon the field of 
 battle. They perform all the duties connected with their 
 corps at various points, under the direction of their officers, 
 and after an action or upon the completion of any special 
 duty, they rendezvous at the camp near the division hospital. 
 
 The non-commissioned officers are mounted in the field, and all the 
 men are mounted when serving with mounted commands. A mounted 
 private of the hospital corps, carrying, slung over his left shoulder, an 
 orderly pouch consisting of a canvas bag containing the articles inven- 
 toried on page 301, together with a canteen of water, and such other 
 dressings and appliances as may be considered necessary, accompanies 
 every medical officer in the field. The medical officer carries, slung 
 across his shoulder, a field case of instruments sufficient with ingenuity 
 and intelligence to perform almost any operation that may be required. 
 
 The equipment of the privates of the hospital corps in the field, aside 
 from the orderlies, consists of a hospital corps pouch, the contents of 
 
 1 In connection with the National Guard and State Forces it is often imprac- 
 ticable to organize a distinct hospital corps, and in this case the company bearers 
 may be utilized in the formation of a corps, which may not only form the nucleus 
 of a hospital corps in case of active hostilities, but also provide for the safety of 
 the community a body of men well instructed in meeting ordinary medical, emer- 
 gencies. This should be formed by the detail of four men from each company, 
 of whom a proper proportion should be non-commissioned officers. 
 
 For a regiment of ten companies the sanitary corps should be formed (1) from 
 the regimental staff by the Surgeon, the Assistant-Surgeon, and the Hospital 
 Steward, who will act in the capacity of first sergeant; (2) from the companies, 
 by one sergeant, four corporals, and thirty-five privates. 
 
 For a regiment of twelve companies, the sanitary corps should be formed 
 (1) from the regimental staff by the Surgeon, the Assistant-Surgeons, and the 
 Hospital Steward, who will act in the capacity of first sergeant; (2) from the 
 companies, by two sergeants, four corporals, and forty-two privates. 
 
 Such an organization, when properly instructed in anatomy and physiology, 
 in aid in medical and surgical emergencies, and in the carriage of the disabled, 
 will form a very satisfactory peace substitute for a hospital corps t 
 
SANITARY ORGANIZATION IN BATTLE 239 
 
 which are detailed upon page 300, a webbing litter sling, and a canteen 
 of water, to which is added the blanket and shelter tent, suitably rolled, 
 when in heavy inarching order. 
 
 The work of the hospital corps in the field is attended with 
 some immunity by the provisions of the Articles of the 
 Geneva Convention, which have been adopted by nearly all 
 civilized nations. The articles provide for the neutrality of 
 field and permanent hospitals, of all their attendants, and of 
 members of the hospital corps, — not of company bearers, — 
 and permit the staff of hospitals to continue their labors after 
 the occupation of the country by an enemy, or to pass unmo- 
 lested to their own commands. The sick are protected, those 
 caring for them are rewarded by protection, and wounded 
 prisoners, when cured, are returned to their own country on 
 parole. A flag having a red cross on a white field insures the 
 safety of hospitals, while a white brassard on the left arm, also 
 bearing a red cross, protects the members of the sanitary corps. 
 
 During an engagement, the regimental hospital corps de- 
 tachments, together with such privates of the line as may be 
 designated to assist them, render first aid to the injured on the 
 line of battle, under the supervision of the medical officer on 
 duty at that point. Here the regimental detachments, with the 
 details from the ambulance and hospital corps companies, when 
 they shall have arrived, take measures to prevent immediate 
 danger from wounds, not, however, attempting any operations. 
 
 To each case is affixed a diagnosis tag, consisting of a white centre, 
 with a red stripe on one edge and a blue stripe on the other, the stripes 
 being attached to the centre by perforations so that they can be easily 
 torn off. The centre contains space for writing the diagnosis upon 
 one side, and the treatment given upon the other. The removal of 
 both stripes indicates that the patient is able to walk ; if the blue stripe 
 only is left, the patient requires to be carried away, and if only the red 
 stripe remains, the patient must not be moved. In order to save time, 
 certain characters are prescribed to abbreviate the notes upon the tags, 
 which, in time of battle, is naturally very essential. If the case requires 
 immediate action, a tag with " urgent " in blue letters is also attached. 
 
 Immediate danger having been temporarily forestalled by 
 the attention given on the line of battle, the bearers — of the 
 hospital corps, or of the company, if the former have not 
 arrived, or both, if the demand is too great to be satisfied by 
 the hospital corps alone — place the wounded upon litters, if 
 
240 
 
 EMERGENCIES AND ACCIDENTS 
 
 they are unable to walk, and carry them back to the next 
 point. If the injured are able to walk alone or with the assist- 
 ance of a single helper, they are not carried. 
 
 Fig. 14!.— The Work of the First Line. 
 From a photograph taken on board the United States Hospital Ship Missouri. 
 
 The next point of relief, as well as all the remaining points, 
 is to be located by the medical director of the army corps, or 
 the senior medical officer present. It is the first dressing- 
 station, and is situated as near the line of battle as possible, 
 consistent with safety. When the troops are fighting behind 
 fortified works, it may be on the line of battle itself. In any 
 case no attempt is made to place it beyond the range of 
 artillery fire, but it should be so placed as not to be affected 
 by ordinary rifle fire, and in as sheltered a spot as possible. 
 To this point are brought or sent all wounded men. Here 
 are performed all urgent operations, and here the wounded 
 are prepared for conveyance to the field hospitals. 
 
 The importance of this station is recognized by the sur- 
 geons of the present day, among whom the character of the 
 first dressing is considered to be of paramount importance. 
 Whence the necessity of surgical assistance at this point, 
 ample both in amount and in skill, will be evident. 
 
 The first dressing-station is established early during the 
 
FIRST AID ON THE BATTLE-FIELD 24I 
 
 engagement by men of the hospital corps under the direction, 
 of the medical officers, care being taken not to locate it at a 
 point where it will be in the way of the manoeuvres of the 
 combatants. This having been done, the men provide water 
 and straw, prepare the dressings, and when required assist in 
 the removal of the wounded. This is the point beyond which 
 the company bearers cannot pass. After depositing their 
 charges they are required to return to the front. When the 
 line of battle is of considerable length and large bodies of 
 troops are engaged, there are a number of these stations, 
 varying according to the necessities of the case, certainly not 
 less than one to each brigade. 
 
 The wounded having received proper immediate treatment, 
 they are now to be transported to the field hospitals. At a 
 point as near the first dressing-station as possible the ambu- 
 lances rendezvous for this purpose. This point is the ambu- 
 lance station, and the injured are borne to this point upon 
 hand-litters. Where the character of the country is such as 
 to permit it, the ambulances may be driven directly to the 
 first dressing-station, thus obviating the necessity of having a 
 separate station. In removing a man, care is taken to send 
 with him his arms and accoutrements, always seeing that his 
 piece is discharged before placing it in the ambulance. At 
 the ambulance station tents are pitched and arrangements 
 made for the temporary accommodation of the wounded as 
 they are brought in from the first dressing-stations. Attend- 
 ants are at hand with hot drinks and other means of relieving 
 suffering. Medical officers are present to inspect the patients 
 and make it sure that they are in a suitable condition to be 
 forwarded ; dressings are altered if necessary, and other at- 
 tentions, the need of which may have been overlooked at the 
 first dressing-station, are given. 
 
 The three points now enumerated all lie near the line of 
 battle, and are all included in the phrase the first line of 
 medical assistance. The combination is also known as the 
 service of the front. 
 
 An important part of the duty of the hospital corps stationed 
 at the front is the careful examination of the field after an 
 
CARE OF WOUNDED IN BATTLE 243 
 
 engagement, to see if any wounded men remain uncared for, or 
 to ascertain if any men supposed to be dead still show signs 
 of life. If there is simply a cessation of hostilities due to the 
 nightfall, the search is greatly facilitated by the use of the 
 electric search-light (Fig. 142), and where one is not present, 
 lanterns must be used. 
 
 The fourth point is the field hospital or division hospital, 
 still further to the rear. The field hospitals form the second 
 line of medical assistance. They are located by the medical 
 director at points decided upon in consultation with the com- 
 manding general. A field hospital should be two or three 
 miles to the rear of the dressing-stations, and should be more 
 permanently organized. The duties of the hospital corps 
 here are multifarious, and consist in arranging the beds for 
 the wounded, assisting the surgeons in operating and in 
 applying dressings, administering stimulants to this man, and 
 sedatives to that one, caring for the belongings of the patients, 
 and maintaining order in the hospital — meeting all the innu- 
 merable emergencies which necessarily arise at such a time. 
 The hospital sergeant in charge of the stores will have estab- 
 lished his kitchen at a suitable point, and his cooks will be 
 engaged in preparing not only the necessaries for the sick, 
 but the food for the attendants. The hospital sergeant in 
 charge of the medicine wagon will have abundant occupation 
 in putting up such medicines as may be demanded, while those 
 to whom is assigned the care of instruments and dressings 
 will have no time to spare. A guard is mounted and the 
 hospital property patrolled to prevent injury to its occupants 
 or loss of property. 
 
 The field hospitals are necessarily temporary in character, 
 and the sick and wounded require more permanent quarters 
 for their ultimate treatment. These are found in the third 
 line of jnedical assistance, which consists of the stationary 
 hospitals in the extreme rear, and includes the general hospi- 
 tals located in the vicinity of the base of operations, and still 
 farther to the rear, and includes hospital boats and hospital 
 railway trains. The nursing and attendance at these points, 
 as at others, falls upon the hospital corps with the assistance 
 of volunteer male and female nurses. 
 
244 EMERGENCIES AND ACCIDENTS 
 
 In this way is provided a complete system of treatment for 
 the sick and wounded, covering the entire period from their 
 fall upon the battle-field to their recovery and discharge from 
 the general hospital. 
 
 CHAPTER XXVIII 
 CARRYING THE DISABLED 
 
 In carrying the disabled for short distances, a manufactured 
 litter is to be used where practicable, consisting essentially of 
 a bed long enough and wide enough to hold a man lying upon 
 his back, and having along either side a pole projecting at each 
 end for handles. The authorized litter of the United States 
 Army, the result of the most careful experiment and prolonged 
 experience, is shown in Figs. 151 to 164. The bed is of 
 canvas, six feet long and twenty-two inches wide, with side 
 poles seven and a half feet long, and four stirrup-shaped fixed 
 strap-iron legs four inches high. This litter is described in 
 detail on page 258. 
 
 To the injured man the slightest movement may be preg- 
 nant with excruciating agony. The least jar is productive of 
 actual torture. A mere touch may cause him to shriek with 
 pain. The chief aim, then, in carrying him is to move with 
 such gentleness and care as to render the motion as nearly 
 imperceptible as possible and certainly free from any jar. In 
 order to accomplish this, there must be a perfect understand- 
 ing among the several bearers, as to the course to be taken 
 and the method to be adopted, and all must unite in perform- 
 ing the movements in perfect unison. A well-defined uniform 
 system of manipulating the injured, which may be perfectly 
 understood by all participating in the movements, is then a 
 prime requisite for success. The system of the United States 
 Army x is the result of a long series of experiments and care- 
 ful comparison of the work of others during several years of 
 
 1 Hospital Corps Drill Regulations. Published by authority of the Secre- 
 tary of War. Washington, Government Printing Office, 1896. 
 
THE DETACHMENT FOR BEARER DRILL 245 
 
 study by the entire medical and hospital corps, and is the 
 best yet devised. We have been kindly permitted to reprint 
 this system, only designating by the smaller type those por- 
 tions not particularly interesting to the civilian bearer. 
 
 HOSPITAL CORPS DRILL REGULATIONS. 
 
 1 . The senior medical officer of the detachment is respon- 
 sible for the theoretical and practical instruction of the officers, 
 non-commissioned officers, and privates. He requires them 
 to study and recite these regulations so that they can 
 explain thoroughly every movement before it is put into 
 execution. 
 
 THE DETACHMENT. 
 
 2. The detachment, when formed, is in single rank, pri- 
 vates of the Hospital Corps on the right, company bearers on 
 the left, each class graduated in size, the tallest men on the 
 right. 
 
 POSTS OF OFFICERS AND NON-COMMISSIONED OFFICERS. 1 
 
 3. The medical officer commanding is three paces in front 
 of the centre of the detachment, the junior medical officers 
 according to rank from right to left are in the line of file- 
 closers two paces in rear. Medical officers above the rank of 
 lieutenant are four paces in rear of the file-closers. 
 
 Medical officers take posts in their respective lines at equal 
 intervals; if only one, he is opposite the centre; if two, one 
 is opposite the centre of each half of the detachment ; if 
 three, one is opposite the centre, the others as with two. 
 
 The senior non-commissioned officer is two paces in rear 
 of the second file from the right, on the right of the line of 
 file-closers. 
 
 The second non-commissioned officer is on the right of the 
 
 1 For the purposes of these drill regulations, the term non-commissioned 
 officer includes hospital stewards and acting hospital stewards. 
 
246 EMERGENCIES AND ACCIDENTS 
 
 The third non-commissioned officer is on the left of the 
 rank, and is the left guide. 
 
 The remaining non-commissioned officers are distributed 
 along the line of file-closers from right to left, according to 
 rank. 
 
 If necessary, a suitable private may be designated to act as 
 right or left guide. 
 
 TO FORM THE DETACHMENT. 
 
 4. At the signal for the assembly?- the senior non-commis- 
 sioned officer takes his position in front of where the centre 
 of the detachment is to be, and facing it, commands : 
 
 Fall in. 
 
 The second non-commissioned officer, or a designated pri- 
 vate, places himself facing to the front, where the right of the 
 detachment is to rest, and at such a point that its centre will 
 be six paces from and opposite the senior non-commissioned 
 officer ; he closes his left hand and places the knuckles against 
 the waist above the hip, wrist straight, back of hand to the 
 front. The men, with left arm in the same position, assemble 
 rapidly at attention, so that the right arm of each man rests 
 lightly against the left elbow of the man next on his right, 
 each dropping the left hand as soon as the man next on his 
 left has his interval. 
 
 The other non-commissioned officers then take their posts. 
 
 The senior non-commissioned officer calls the roll, each 
 man answering, " Here, 1 ' as his name is called. 
 
 TO SIZE THE DETACHMENT. 
 
 5. The men being in line as described, the senior non- 
 commissioned officer faces them to the right and arranges 
 them according to height, tallest man in front ; he then faces 
 them to the left into line. The detachment being sized, 
 habitually forms in the same order. 
 
 1 The assembly may be sounded by bugle or whistle. 
 
ALIGNMENTS 247 
 
 6. The senior non-commissioned officer commands : 
 
 1. Count, 2. Fours. 
 
 Beginning on the right the men count One, Two, Three, 
 Four, and so on to the left. The guides do not count. 
 
 If the four on the left consists of less than three men, they 
 are ordinarily assigned to other fours and placed in the line 
 of file-closers, each in rear of the four to which assigned. 
 He then commands : 
 
 1. Count, 2. Squads; 
 
 when each No. 1 calls out the number of his squad in 
 numerical order from right to left. 
 
 The officer commanding having approached the front and 
 centre of the detachment, the senior non-commissioned officer 
 faces about, salutes 1 him, reports the result of the roll call, 
 and then, without command, takes his post, passing around 
 the right flank. 
 
 The junior medical officers take their posts as soon as the 
 non-commissioned officer has reported. 
 
 ALIGNMENTS. 
 
 7. The officer commanding, having received the detach- 
 ment, commands : 
 
 1. Right (or left), 2. Dress, 3. Front. 
 
 At the command dress, the men place the left hand above 
 the hip, turn the head and eyes in the direction of the guide, 
 
 1 The salute for all enlisted men without arms is as follows : The right hand 
 is raised smartly till the forefinger touches the lower part of the headdress above 
 the right eye, thumb and fingers extended and joined, palm to the left, forearm 
 inclined at about forty-five degrees, hand and wrist straight; and the arm is then 
 dropped quietly by the side. 
 
 If uncovered, the forefinger touches the forehead above the eye. 
 
 The salute for officers is the same as the above; the left hand is used only 
 when the right is engaged. Officers and men, when saluting, look toward the 
 person saluted. Enlisted men salute with the hand farthest from the officer, giv- 
 ing the salute six paces before passing the officer and holding the hand at the 
 visor until the salute is acknowledged or the officer passed. 
 
248 EMERGENCIES AND ACCIDENTS 
 
 and dress up to the line ; the officer commanding verifies the 
 alignment. At the command front, the men turn the head 
 and eyes to the front and drop the left hand. 
 
 In all alignments, excepting of the file-closers, the left 
 hand is placed above the hip, and at front dropped to the 
 side. The detachment is aligned whenever necessary. 
 
 MARCHINGS. 
 
 8. When the execution of a movement is improperly 
 begun and the instructor wishes to begin it anew for the 
 purpose of correcting it, he commands : As you were ; at 
 which the movement ceases and the former position is re- 
 sumed. 
 
 9. The length of the full step in quick time is 30 inches 
 measured from heel to heel, and the cadence is at the rate 
 of 120 steps per minute. 
 
 TO MARCH IN LINE. 
 
 10. Being in line at a halt : 
 
 1. Forward, 2. Guide right (or left), 3. MARCH. 
 
 The men step off, the guide marching straight to the front. 
 
 The instructor sees that the men preserve the interval and align- 
 ment. 
 
 To change the guide : Guide left (or right). 
 
 n. If the men lose step, the instructor commands : Step. 
 
 The men glance toward the side of the guide, retake the step, and 
 cast their eyes to the front. 
 
 TO MARCH BACKWARD. 
 
 12. Being at a halt : 
 
 1. Backward, 2. Guide right {ox left), 3. MARCH. 
 
 At the command march, step back with the left foot 15 inches straight 
 to the rear, measuring from heel to heel, then with the right, and so on, 
 the feet alternating. 
 
MARCHINGS 249 
 
 TO MARCH TO THE REAR. 
 
 13. Being in march : 
 
 1. To the rear, 2. MARCH, 3. Guide right (or left) . 
 
 At the command march, given as the right foot strikes the ground, 
 advance and plant the left foot ; then turn on the balls of both feet, face 
 to the right about, and immediately step off with the left foot. 
 
 If marching in double time, turn to the right about, taking four short 
 steps in place, keeping the cadence, and then step off with the left foot. 
 
 TO SIDE STEP. 
 
 14. Being at a halt : 
 
 1. Right (or left) step, 2. MARCH. 
 
 At the command march, carry the right foot 12 inches to the right, 
 keeping knees straight and shoulders square to the front ; as soon as 
 the right foot is planted, bring the left foot to the side of it, and continue 
 the movement. 
 
 TO MARCH BY THE FLANK, IN COLUMN OF FILES. 
 
 15. Being in line at a halt : 
 
 1. Right (or left), 2. FACE, 3. Forward, 4. MARCH. 
 Being in march : 
 
 1. By the right (or left) flank, 2. MARCH. 
 At the command march, given as the right foot strikes the ground, 
 advance and plant the left foot, then face to the right in marching and 
 step off in the new direction with the right foot. 
 
 To halt the column of files : 1. Detachment, 2. HALT ; and to face it 
 to the front : 3. Left (or right) , 4. FACE. 
 
 MARCHING IN COLUMN OF FILES, TO MARCH IN LINE. 
 
 16. 1. By the left (or right) flank, 2. MARCH, 3. Guide right (or 
 left). 
 
 TO CHANGE DIRECTION IN COLUMN OF FILES. 
 
 17. Being in march : 
 
 1. Column right (or left) ; or, 1. Column half right (or half 'left) , 
 
 2. March. 
 The leading file wheels to the right. The other files follow the first 
 and wheel on the same ground. 
 
25O EMERGENCIES AND ACCIDENTS 
 
 Being at a halt : 
 
 1. Forward, 2. Column right (or left) , 3. MARCH; or, 
 
 2. Column half right {ox half left), 3. MARCH. 
 
 THE OBLIQUE MARCH. 
 
 18. Being in line at a halt, or in march : 
 
 1. Right (or left) oblique, 2. MARCH. 
 
 At the command march, each man half faces to the right, at the 
 
 same time stepping off in the new direc- 
 
 i^^WWy.^P^F^P ti° n - He preserves his relative position, 
 
 /////// / keeping his shoulders parallel to those of 
 
 f ////.// / the man next on his right, and so regu- 
 
 n a m ■ M a «' lates his step as to make the head of this 
 
 Fig. 143 (Par. 18). Right man c ° ncea l tne heads of the other men 
 
 oblique. in the rank; the rank remains parallel 
 
 to its original front. 
 At the command halt, the men halt, faced to the front. 
 To resume the original direction : 
 
 1. Forward, 2. MARCH. 
 
 The men half face to the left in marching and then move straight to 
 the front. 
 
 TO MARCH IN DOUBLE TIME. 
 
 19. The length of the full step in double time is 36 inches; the 
 cadence is at the rate of 180 steps per minute. 
 
 Being in line at a halt : 
 
 1. Forward, 2. Guide right (or left) , 3. Double time, 4. MARCH. 
 
 At the third command the hands are raised until the forearms are 
 horizontal, fingers closed and toward the body, the elbows to the rear. 
 
 TO PASS FROM QUICK TO DOUBLE TIME, AND THE REVERSE. 
 
 20. 1. Double time, 2. MARCH. 
 
 At the command march, given as the left foot strikes the ground, 
 advance the right foot in quick time, and step off with the left foot in 
 double time. 
 
 To resume quick time : 
 
 1. Quick time, 2. MARCH. 
 
 At the command march, given as either foot is coming to the ground, 
 the detachment resumes quick time. 
 
TURNINGS IN MARCHING 25 1 
 
 TURNINGS. 
 
 TO TURN AND HALT. 
 
 21. Marching in line : 
 
 1. Detachment right (or left) , 2. MARCH, 3. FRONT. 
 
 At the command march, the right guide halts and faces to the right ; 
 the other files half face to the right in march- 
 ing, and without changing the length or ca- 
 dence of the step place themselves succes- 
 sively upon the alignment established by the 
 right guide; all dress to the right without 
 command. The instructor verifies the align- 
 ment from the pivot flank and commands : 
 Front. 
 
 If at a halt, the movement is executed in 
 
 ♦fco coi^o ™o™ ,. Fi S- '44 ( Par - 21). — Detach- 
 
 tne same manner. & v . J 
 
 Detachment half right (or half left) is 
 
 executed in the same manner, except that the guide makes a half face to 
 
 the right. 
 
 TO TURN AND ADVANCE. 
 
 22. Marching in line : 
 
 I. Right (or left) turn, 2. MARCH, 3. Forward, 4. MARCH, 5. Guide 
 right {ox left). 
 
 At the second command, the guide marches by the right flank, 
 taking the short step without changing the cadence ; the other men half 
 face to the right in marching, and moving by the shortest line succes- 
 sively place themselves on the new line, when they -take the short step 
 (15 inches). 
 
 When the last man has arrived on the new line, the fourth command 
 is given, when all resume the full step. 
 
 During the turn the guide is, without command, on the pivot flank. 
 The guide is announced on resuming the full step. 
 
 If at a halt, the movement is similarly executed, and in quick time, 
 unless the command double time is given. 
 
 Right (or left) half turn is executed in the same manner, except 
 that the guide makes a half face to the right. 
 
 Should the command halt be given during the execution of the 
 movement, those men who are on the new line halt ; the others halt on 
 arriving on the line ; all dress to the right without command. 
 
 The instructor verifies the alignment from the pivot flank and com- 
 mands : Front. 
 
252 EMERGENCIES AND ACCIDENTS 
 
 MARCHING IN LINE, TO EFFECT A SLIGHT CHANGE OF 
 DIRECTION. 
 
 23. Incline to the right (or left) . 
 
 Each man advances the left shoulder and marches in the new 
 direction. 
 
 BEING IN LINE, TO MARCH BY THE FLANK IN COLUMN 
 OF FOURS. 
 
 24. I. Fours right (or left), 2. MARCH. 
 
 Each four wheels ninety degrees to the right on a fixed pivot, the 
 pivot man turning strictly in his place ; the man on the marching flank 
 maintains the full step, moving on the 
 * arc of a circle with the pivot man as 
 ^•""1 y*"™ /■ me centre ! me men dress on the march- 
 
 /' /-""I / y''"^ '/ * n S A an k, shorten their steps according 
 
 / / y'fl ~~ I / x-| I to their distance from it, and keep their 
 
 /^^Jj^^y^j^, intervals from the pivot. Upon the com- 
 
 pletion of the wheel each four takes the 
 full step, marching in a direction paral- 
 J c! tM lei to its former front ; the second four 
 
 Fig. 145 (Par. 24). Fours right, is one hundred inches from the first 
 
 four, and so on to the rear of the 
 column ; the right and left guides place themselves forty-four inches 
 in front and rear respectively of the left file of the leading and rear 
 fours ; the file-closers face to the right and maintain their relative 
 positions. 
 
 The officer commanding in columns of fours, twos, and files is by the 
 side of the leading guide on the flank opposite the file-closers ; he takes 
 this position at the command march. 
 
 The leading and rear guides in columns of fours, twos, and files are 
 in front and rear respectively of the leading or rear file on the side 
 opposite the file-closers. 
 
 The file-closers march two paces from the flank of the column and 
 see that the fours maintain their distances. 
 
 In all changes by fours from line into column and column into line, 
 or from column of fours into twos, files or the reverse, and in all 
 wheels about by fours, either in line or column, the officer commanding 
 and guides take their proper places in the most convenient way as 
 soon as practicable. 
 
 All wheels by fours, except in changing direction, are executed on a 
 fixed pivot. 
 
 These rules are general. 
 
TURNINGS IN MARCHING 253 
 
 BEING IN LINE, TO FORM COLUMN OF FOURS AND HALT. 
 
 25. I. Fours right (or left) , 2. MARCH, 3. Detachment, 4. HALT. 
 The command halt is given as the wheel is completed; all dress 
 
 toward the marching flank. 
 
 In column of fours, the ranks dress toward the side of the guide. 
 
 In all wheelings by fours, the forward march is taken upon the com- 
 pletion of the movement, unless the command halt be given. 
 
 At the command halt, given as either foot is coming to the ground, 
 the foot in rear is brought up and planted without shock by the side 
 of the other. 
 
 MARCHING IN COLUMN OF FOURS, TO CHANGE DIRECTION. 
 
 26. 1. Column right (or left), 2. MARCH. 
 
 The leading four wheels on a movable pivot ; the pivot man takes 
 steps of ten inches in quick time, and twelve inches in double time, 
 gaining ground forward so as to clear the wheeling point ; the wheel com- 
 pleted, the full step is taken ; the man on the side of the guide follows 
 forty-four inches in rear of the guide; the other fours move forward 
 and wheel on the same ground. If the change of direction be toward 
 the side of the guide, he shortens his step and wheels as if on the pivot 
 flank of a rank of four ; if the change be to the side opposite the guide, 
 he wheels as if on the marching flank of a rank of four. 
 
 Column half right (or half left) is similarly executed, each four 
 wheeling forty-five degrees. 
 
 TO PUT THE COLUMN OF FOURS IN MARCH AND CHANGE 
 DIRECTION AT THE SAME TIME. 
 
 27. I. Forward, 2. Column right (or left) ; or, 2. Column half right 
 (or half 'left) , 3. March. 
 
 BEING IN LINE, TO FORM COLUMN OF FOURS AND CHANGE 
 DIRECTION. 
 
 28. 1. Fours right (or left), 2. Column right (or left) ; or, 2. Column 
 half right {ox half left), 3. MARCH. 
 
 BEING IN LINE, TO MARCH IN COLUMN OF FOURS TO THE 
 FRONT. 
 
 29. i. Right (or left) forward, 2. Fours right (or left), 3. 
 March. 
 
■~A 
 
 254 EMERGENCIES AND ACCIDENTS 
 
 bm At the command march, the right guide 
 
 places himself in front of the left file of the 
 ■ right four; the right four moves straight to 
 the front, shortening the first three or four 
 steps; the other fours wheel to the right, 
 each on a fixed pivot ; the second four, when 
 its wheel is two-thirds completed, wheels to 
 the left on a movable pivot and follows the 
 first ; the other fours, having wheeled to the 
 right, move forward, and each wheels to 
 
 p. 145 /p ar oqn Rieht tne * e ^ on a mova bl e pivot, so as to follow 
 
 Forward, Fours' Right. the second. 
 
 BEING IN COLUMN OF FOURS, TO CHANGE THE FILE-CLOSERS 
 FROM ONE FLANK OF THE COLUMN TO THE OTHER. 
 
 30. I. File-closers on left (or right) flank, 2. MARCH. 
 
 At the first command the file-closers close in to the flank of the 
 column, and at the command march, dart through the column. 
 
 TO OBLIQUE IN COLUMN OF FOURS, AND TO RESUME THE 
 DIRECT MARCH. 
 
 31. I. Right (or left) oblique, 2. MARCH. 
 
 Each four obliques as prescribed (Par. 18). 
 To resume the direct march : 
 
 1. Forward, 2. MARCH. 
 
 TO MARCH IN COLUMN OF FOURS TO THE REAR. 
 
 32. 1. Fours right (or left) about, 2. MARCH. 
 
 Each four wheels 180 degrees to the right. 
 
 The file-closers do not pass through the column, but gain the space 
 to the right or left necessary to preserve their interval from the flank. 
 
 TO FORM LINE FROM COLUMN OF FOURS. 
 
 33. To the right or left : 
 
 I. Fours right (or left), 2. MARCH, 3. Guide right (or left) ; or, 
 3. Detachment, 4. HALT. 
 
:/•' 
 
 TURNINGS IN MARCHING 255 
 
 At the command march, the fours wheel to the right. 
 
 The guide is announced, or the command halt is given, the instant 
 the fours unite in line. 
 
 If the line be formed toward the side of the file-closers, they close 
 in to the flank of the column at the first command, and at the com- 
 mand march dart through the column. 
 
 34. On right or left : 
 
 I. On right (or left) into line, 2. MARCH, 3. Detachment, 4. HALT, 
 5. Front. 
 
 At the command march, the leading four wheels to the right on a 
 movable pivot and moves forward, dressing to the right; the guide 
 places himself on its right; each of 
 the other fours marches a distance f 
 
 equal to its front beyond the wheel- 
 ing point of the four next preceding, 
 wheels to the right and advances as 
 explained for the first four ; the rear 
 guide places himself on the left of 
 the rear four after it halts. 
 
 At the command halt, given when 
 the leading four has advanced a 
 suitable distance in the new direc- 
 tion, it halts and dresses to the right ; 
 the other fours successively halt and 
 dress upon arriving in line. 
 
 The command front is given 
 when the left four completes its 
 
 dressing. Fig. 147 (Par. 34). — On Right into 
 
 If the movement be executed & Line 
 
 toward the side opposite the file- 
 closers, each follows the four nearest him, passing in front of the 
 following four. 
 
 35. To the front : 
 
 1. Right (ox left) front into line, 2. MARCH, 3. Detachment, 4. HALT, 
 5. Front. 
 
 At the command march, the leading four moves straight to the front, 
 dressing to the left ; the guide in front places himself on its left ; the 
 other fours oblique to the right till opposite their places in line, when 
 each marches to the front. * 
 
 At the command halt, given when the leading four has advanced 
 a suitable distance, it halts and dresses to the left; the other fours 
 
 1 
 
 ■ ■■■ 
 
 LJ 
 
256 EMERGENCIES AND ACCIDENTS 
 
 halt and dress to the left upon arriving in line; the guide in rear 
 
 o places himself on the right of the rank upon the 
 
 •*. arrival of the last four in line; the command 
 
 | 1 front is given when the last four completes its 
 
 * : dressing. 
 
 \ j If the movement be made toward the side of 
 
 I s the file-closers, they dart through the column as 
 
 j I the oblique commences. 
 
 ■/ ./ If marching in double time, or in quick time, 
 
 / / and the command be double tim.e, the command 
 
 MM 1- " / guide left is given immediately after the com- 
 
 ji mand march; the leading four moves to the 
 
 •■■»-' front in quick time ; the other fours oblique in 
 
 Fig. 148 (Par. 35).— double time, each taking the quick time and 
 
 Right Front into Line. dressing to the left upon arriving in line. 
 
 BEING IN LINE, TO FACE TO THE REAR AND TO MARCH TO 
 THE REAR. 
 
 36. i. Fours right (or left) about, 2. MARCH, 3. Detachment, 4. 
 HALT; or, 3, Guide right (or left) . 
 
 The fours wheel about; the file-closers dart through the nearest 
 intervals. 
 
 37. The detachment at a halt, may be marched a few paces to the 
 rear by the commands : 
 
 1. Detachment, 2. About, 3. Face, 4. Forward, 5. Guide right (or 
 left), 6. March; 
 
 or, if in march, by the commands: 
 
 1. To the rear, 2. MARCH, 3. Guide right (or left) . 
 
 The file-closers on facing about maintain their relative positions. 
 
 BEING IN COLUMN OF FOURS, TO FORM COLUMN OF TWOS. 
 
 38. This movement is always executed toward the — m 
 file-closers; it is used only for the purpose of reducing 
 
 the front of the column to enable it to pass a defile 
 
 or other narrow place, immediately after which the $^^? 
 
 column of fours should be re-formed. <v//C 
 
 mmmm 
 
 1. Fight (or left) by twos, 2. MARCH. p. (49 ,p ar 
 
 At the command march, the two files on the right of , j s 
 each four move forward ; the two files on the left take 
 the short step till disengaged, when they oblique to the right and follow 
 the right files. 
 
TURNINGS IN MARCHING 257 
 
 The distance between ranks in column of twos is forty-four inches ; 
 the guides take the same distance in front and rear of the column. 
 
 BEING IN COLUMN OF FOURS AT A HALT, TO FORM COLUMN 
 OF FILES. 
 
 39. I. Right (or left) by file, 2. MARCH. 
 
 At the command march, the right file of each four moves forward, 
 followed in succession by the files on his left, who oblique to the right, 
 the men keeping closed as nearly as possible to facing distance; the 
 guides take the same distance. 
 
 If marching, the leading file continues the march ; the others take the 
 short step, oblique to the right and follow the leading file. 
 
 Column of files from column of twos is similarly executed. 
 
 40. A column of twos or files changes direction, is halted and put in 
 march by the same commands as a column of fours. 
 
 The march in column of fours, twos, or files is always in quick time 
 unless otherwise ordered. 
 
 41. A column of fours, twos, or files may be faced to the rear, or to a 
 flank, and marched a short distance, but no other movements should 
 be executed until the column is again faced to the original front. The 
 officers and non-commissioned officers face with the column and retain 
 their positions. 
 
 BEING IN COLUMN OF TWOS OR FILES, TO FORM COLUMN 
 OF FOURS. 
 
 42. These movements are always executed away from the file-closers. 
 Marching in column of twos : 
 
 1. Form fours, 2. Left {ox right) oblique, 3. MARCH. 
 
 At the command march, the leading two of each four take the short 
 step ; the rear two oblique to the left until they uncover 
 the leading two, when they move to the front, and the 1 
 fours having united, all resume the full step. 
 
 Being in column of files : l ^ c ^ — m 
 
 \> 
 
 43. Form fours, 2. Left {or right) oblique, 3. MARCH. <A<£ 
 
 At the command march, the leading file of each four Fig. 150 (Par. 
 halts ; the other files oblique to the left and place them- 42). — Form 
 selves successively on the left of the leading file, the ' 
 
 distance between the fours being one hundred inches. 
 
 Column of twos is formed from column of files on the same principles. 
 
258 EMERGENCIES AND ACCIDENTS 
 
 THE RESTS. 
 
 44. Being at a halt, to rest the men : 
 
 Fall Out; or Rest; or At Ease. 
 
 At the command fall out, the men may leave the ranks, but will 
 remain in the immediate vicinity. 
 
 At the command /a// in, they resume their former places. 
 
 At the command rest, the men keep one heel in place, but are not 
 required to preserve silence or immobility. 
 
 At the command at ease, the men keep one heel in place and pre- 
 serve silence, but not immobility. 
 
 45. To resume the attention : 
 
 1. Detachment, 2. ATTENTION. 
 The men take the position of the soldier and fix their attention. 
 
 46. 1. Parade, 2. REST. 
 
 Carry the right foot six inches straight to the rear, left knee slightly 
 bent; clasp the hands in front of the centre of the body, left hand 
 uppermost, left thumb clasped by thumb and forefinger of right hand ; 
 preserve silence and steadiness of position. 
 
 To resume the position of the soldier : 
 
 1. Detachment, 2. ATTENTION. 
 TO DISMISS THE DETACHMENT. 
 
 47. Being in line at a halt, the officer commanding directs 
 the senior non-commissioned officer : Dismiss the detachment. 
 The officers fall out, the senior non-commissioned officer 
 salutes, steps in front of the detachment, and commands : 
 Dismissed. 
 
 LITTER DRILL. 
 
 THE LITTER AND SLING. 
 
 48. The regulation hand litter consists of a canvas bed, 
 6 feet long and 22 inches wide, made fast to two poles 7^ feet 
 long, and stretched by two jointed braces. The ends of the 
 poles form the handles, 9 inches long, by which the litter is 
 carried. The fixed iron legs are stirrup-shaped, 4 inches 
 
LITTER DRILL 259 
 
 high and \% inches wide. A strap is permanently fastened 
 to the bottom of each pole near the legs. When the litter is 
 open each strap lies under the pole to which it is attached, its 
 free end buttoned to a stud ; when the litter is strapped it is 
 passed over the canvas and the free end buttoned to a stud 
 under the opposite pole. 
 
 49. One regulation sling is issued to each private as part 
 of his equipment. It is made of blue webbing, 2>£ inches wide, 
 with a leather-lined loop at each end, and a slide to regulate 
 its length. 
 
 Before falling in, each man verifies the length of his sling 
 so that it is always exactly adjusted to his size, places it 
 smoothly over his shoulders, the slide on the right side, pass- 
 ing the loops under the belt, and, during drill with the litter, 
 never removes it from the body. The loops, when oil the 
 handles, are invariably secured under the belt. 
 
 50. When the detachment is formed for drill or instruc- 
 tion, officers do not wear swords. The instructor will require 
 that the clothing of the men be clean and neatly adjusted ; 
 that the privates of the Hospital Corps fall in equipped with 
 pouch, belt, and sling, and that the company bearers wear 
 belts and brassards. 1 Hospital stewards and acting hospital 
 stewards wear the belt, but no equipment of any kind, unless 
 specially ordered. 
 
 51. For purposes of litter drill each set of four is a litter 
 squad. The litter squad is marched by the commands ap- 
 plicable to a set of four, substituting "litter 1 ' for "four." 
 
 52. No. 1 is the squad leader; he commands his squad 
 and is responsible for it ; in his absence, No. 4, and both 
 Nos. 1 and 4 being absent, No. 3 commands. 
 
 With reduced numbers, No. 1 ordinarily assumes the duties 
 of No. 3, and No. 4 of No. 2. No. 1 being absent, No. 4 
 assumes his duties and vice versa. 
 
 53. The instructor will make such changes in the person- 
 nel of the sets of four as he deems advisable. The selection 
 
 1 When practicable it is advisable to have the men who are to represent the 
 wounded dressed in fatigue suits; they remain in the line of file closers until 
 needed. 
 
260 EMERGENCIES AND ACCIDENTS 
 
 of No. i should be determined by the intelligence and expe- 
 rience of the men; No. 4 should be as near in size as possi- 
 ble to No. 1, and No. 2 to No. 3. The fours are then counted 
 again if necessary. 
 
 54. A litter is said to be strapped when folded, the canvas 
 doubled smoothly on top and secured by the straps. It is 
 said to be closed when folded and unstrapped, the free ends 
 of the straps buttoned to the studs on their respective poles. 
 
 55. The foot, or front, of a grounded or open (unloaded) 
 litter is the end farthest from the approaching squad, unless 
 otherwise designated. The foot of a loaded litter is always 
 the end corresponding to the feet of the patient. 
 
 MANUAL OF THE LITTER. 
 
 Having assigned the medical officers and the non-commis- 
 sioned officers to appropriate duties, the instructor commands : 
 
 56. 1. Procure litter, 2. Right (or left) face, 3. March. 
 At the first command the Nos. 3 step one pace to the front, 
 
 at the second command they face as required, and at the third 
 proceed in column of files, by the nearest route, to the (strapped 
 or closed) litters. They each take one, placing it on the right 
 shoulder at a slope of at least 45 degrees, canvas down [Par. 
 59], and promptly return in the reverse order, each man re- 
 suming his place by passing through his interval one pace to 
 the rear, facing about and stepping into line. 
 
 If the litters are in front of the detachment, the Nos. 3 may 
 be marched directly forward, converging toward them, and 
 then back, diverging to their intervals. 
 
 This march should be supervised by a non-commissioned 
 officer. It can be executed in double time. 
 
 With but one squad the commands are simply procure (or 
 return) litter, March ; when the bearer proceeds and returns 
 by the shortest practicable route. 
 
 57. In all motions from the shoulder, or to the shoulder, 
 the litter should invariably be brought to the vertical position 
 against the shoulder, one pole in front of the other, canvas to 
 the left, both hands grasping the front pole, the left above the 
 right, and the left fore-arm horizontal. 
 
LITTER DRILL 
 
 26l 
 
 This position should be taken by the bearer when passing 
 through his interval to resume his place in the line [Par. 56], 
 and in any formation or movement in which there may be 
 danger of the lower or upper handles of the litter striking 
 neighboring men, after which the shoulder is resumed with- 
 out command. 
 
 58. Being at the shoulder : 
 
 1. Order, 2. Litter. 
 At order, the litter is brought to the vertical position ; at 
 litter, the lower handles are brought to the ground, outside 
 
 Fig. 151 (Par. 57).— 
 The Vertical Po- 
 sition. 
 
 Fig. 152 (Par. 58).— 
 Order Litter. 
 
 Fig. 153 (Par. 59).— 
 Shoulder Litter. 
 
 the right foot, canvas to the left, the right arm naturally ex- 
 tended and the hand grasping the front pole ; the left hand is 
 dropped to the side. 
 
 59. Being at the order: 
 
 1. Shoulder, 2. Litter. 
 
262 
 
 EMERGENCIES AND ACCIDENTS 
 
 At shoulder, the litter is raised to the vertical position ; at 
 litter, it is raised vertically until the left wrist is level with the 
 chin, when it is laid, canvas down, upon the shoulder [Par. 56] ? 
 where it is supported by the right arm, the right hand grasp- 
 ing the left pole ; the left hand is dropped to the side. 
 
 60. Being in line, litters at the shoulder, or order: 
 
 1. Carry, 2. Litter. 
 
 At carry, each No. 3 brings his litter to the vertical posi- 
 tion ; at Utter, he drops the upper handles forward and down- 
 ward until the litter is in a horizontal position, canvas to the 
 
 left ; meanwhile the 
 other numbers step 
 directly to the front, 
 No. 2 until he is op- 
 posite the front han- 
 dles, which he seizes 
 with his left hand, 
 and Nos. 1 and 4 
 until they are oppo- 
 site the centre of the 
 litter. Nos. 2 and 3 
 take hold by passing 
 the left and right 
 hands respectively 
 outside the handles 
 and grasping the 
 lower one, the litter 
 resting against the 
 hip. The guides step forward and place themselves in line 
 with the front bearers. 
 
 61. Being at the carry : 
 
 1 . Ground, 2. Litter. 
 
 At ground, Nos. 2 and 3 face inward, grasping the handles 
 with both hands ; at litter, they stoop and lower litter to the 
 ground, lengthwise between the files, canvas up, then, stand- 
 ing erect, they face to the front. 
 
 Fig. 154 (Par. 60).— Carry Litter. 
 
LITTER DRILL 
 
 263 
 
 62. Being at the groimd: 
 
 1. Carry, 2. Litter. 
 At carry, Nos. 2 and 3 face inward; at litter, they stoop, 
 grasp handles with both hands and raise the litter from the 
 ground to the carry. 
 
 63. Being at the carry : 
 
 1. Shoulder, 2. Litter. 
 
 At shoulder, No. 3 reaches forward with his left hand and 
 grasps the litter near its centre ; at litter, he brings it to the 
 vertical position and then to the shoulder; meanwhile the 
 other numbers step backward and align themselves upon 
 him in regular order. 
 
 64. Being at the carry, litter strapped: 
 
 1. Open, 2. Litter. 
 
 At opeti, Nos. 2 and 3 face litter ; at litter, they unbutton 
 the straps and button them to the studs on their respective 
 poles, when they 
 grasp the right 
 (upper) handles, 
 leaving the litter 
 suspended longi- 
 tudinally, canvas 
 to the left. They 
 then extend the 
 braces, and sup- 
 porting the litter 
 horizontally by 
 the handles, can- 
 vas up, lower it 
 to the ground, 
 and resume the 
 attention, stand- 
 ing between the 
 
 Fig. 155 (Pars. 64 and 68). — At Litter Posts with 
 Open Litter. 
 
 handles, facing 
 
 to the front. If the litter be merely closed, they at once grasp 
 
 the upper handles and proceed as above. 
 
264 
 
 EMERGENCIES AND ACCIDENTS 
 
 65. Being at the open : 
 
 1. Close, 2. Litter. 
 At close, Nos. 2 and 3 step respectively outside the right 
 front and left rear handles and face inward ; at litter, they 
 stoop and raise the litter by the right handles ; they then 
 fold the braces, and bringing the lower pole against the upper, 
 canvas to the left, support the litter at the carry. 
 
 66. The litter being closed: 
 
 1. Strap, 2. Litter. 
 
 At strap, Nos. 2 and 3 face litter ; at litter, they fold can- 
 vas by doubling it smoothly on top of poles, then pass straps 
 
 Fig. 156 (Pa 
 
 Strap Litter 
 
 around litter, over canvas, and button them to studs, when 
 they take their posts at the carry. 
 
 In opening or strapping litter Nos. 1 and 4 may assist when 
 so directed. 
 
 In the field, the litter should habitually be carried strapped 
 or closed, and only opened on reaching the patient. 
 
 The litter may in like manner be closed and then strapped, 
 being at the open, at the command strap litter, when the mo- 
 tions begin with those described under close litter. [Par. 65.] 
 
LITTER DRILL , 265 
 
 67. To bring the squad into line, the litter being at the 
 ground or open : 
 
 1. Form, 2. Rank. 
 
 At rank, No. 2 advances one pace, and all align themselves 
 upon him in regular order. 
 
 This movement permits the marching of the squad, without 
 litter, to any desired point. 
 
 68. Posts at the litter may at any time be recovered by the 
 commands : 
 
 1. At litter, 2. Posts. 
 
 If at the ground, the numbers take posts, No. 2 on the 
 right of the front handles, No. 3 on the left of the rear handles 
 and close to them, and Nos. 1 and 4, respectively, on the right 
 and left of the litter at its mid-length and one pace from it ; 
 all facing to the front. 
 
 If at the open, Nos. 2 and 3 take posts between the front 
 and rear handles, respectively, facing to the front, and Nos. 1 
 and 4 as with litter at the ground, but one short step (15 
 inches) from it. 
 
 This is the invariable position taken by each number at the 
 above commands, whatever may have been his previous posi- 
 tion or duty. 
 
 69. Being at litter posts, to change posts : 
 
 1. Change posts, 2. March. 
 
 No. 1 takes No. 3's post, and No. 4 No. 2's, while Nos. 3 
 and 2 step to the left and right of the litter, respectively, into 
 the vacated positions, all thus describing part of a circle in the 
 same direction around the litter. 
 
 70. Being at the carry in marching : 
 
 1. Change bearers, 2. March. 
 
 Nos. 1 and 4 step to the right rear and left front of the 
 litter, respectively, and grasp the handles relinquished by 
 Nos. 3 and 2, who step to left and right centre, respectively. 
 
 71. The squad leader continues to exercise command from 
 whatever position he may occupy. 
 
266 EMERGENCIES AND ACCIDENTS 
 
 72. To resume the original positions the movement is 
 reversed by the commands : 
 
 1. At litter, 2. Posts. 
 
 73. Being at the open : 
 
 1. Prepare to lift, 2. Lift. 
 
 At the first command Nos. 2 and 3 draw loops from the 
 belts, take one in each hand, stoop, slip them upon the 
 handles, and grasp handles. At the second command they 
 slowly rise ; No. 4 advances to side of No. 2, and No. 1 steps 
 backward to side of No. 3, adjust slings and observe that 
 everything is right, when they resume their posts. 
 
 74. At the commands : 
 
 1 i. Forward, 2. March, 
 
 the bearers step off, No. 2 with the left, No. 3 with the right 
 foot, taking short sliding steps of about 20 inches, to avoid 
 jolting and to secure a uniform motion to the litter. Nos. 1 
 and 4 step off with the left foot. 
 
 75. Being at the lift : 
 
 1. Lower, 2. Litter. 
 
 At litter, Nos. 2 and 3 slowly lower the litter to the ground, 
 slip loops from the handles, stand erect and pass the loops 
 under their belts. 
 
 76. When the litter is to be moved but a few paces, it may 
 be lifted and marched without slings by prefixing without 
 slings to the commands : Prepare to lift, lift. 
 
 77. To carry the litter by four bearers, being at the open, 
 the commands are : 
 
 1. By four, 2. Prepare to lift, 3. Lift. 
 
 At the second command Nos. 2 and 3 take posts outside 
 the right front and left rear handles, respectively, and Nos. 4 
 
 1 The so-called single step, which is by far the easiest for the patient, but 
 which is acquired with difficulty, may also be practised; No. 2 steps off with 
 the left foot, and No. 3 follows with his right an instant later, and before No. 2 
 has planted his right; No. 2's right foot next touches the ground, and is im- 
 mediately followed by No. 3's left. 
 
LITTER DRILL 
 
 267 
 
 and 1 outside the opposite handles ; they all stoop and grasp 
 handles with both hands. At lift, they slowly rise. 
 
 78. The open litter should be lifted and lowered slowly and 
 without jerk, both ends simultaneously, the rear bearer mov- 
 ing in accord with the front bearer, so as to maintain the 
 canvas horizontal ; in fact, the open litter should be handled 
 for purposes of drill as if it were a loaded litter, and as soon 
 
 Fig. 157 (Par. 77). — Litter lifted by Four. 
 
 as the men are familiar with its manual, the drill should, when- 
 ever practicable, be with loaded litter. 
 
 79. Being in line at the shoulder : 
 1. Return litter, 2. Right (or left) face, 3. March. 
 
 At the first command, the Nos. 3 bring the litter to the 
 vertical position and step one pace to the front ; at the second 
 they face as required and bring the litter to the shoulder, and 
 at the third proceed in column of files, by the nearest route, 
 to the place designated for the litters, where they leave them, 
 and, returning in the reverse order, resume their positions by 
 passing through their intervals one pace to the rear and facing 
 about into line. If the place designated is in front of the 
 detachment (or if there be but one squad), the Nos. 3 proceed 
 
268 EMERGENCIES AND ACCIDENTS 
 
 as. described in Par. 56. This movement should be super- 
 vised by a non-commissioned officer. It can be executed in 
 double time. 
 
 MARCHINGS WITH LITTER. 
 
 80. The interval between litters, that is, between No. 1 of a squad 
 and No. 4 of the next squad on the right, is 6 inches. It is ordinarily 
 sufficient for the execution of all movements, and should be carefully 
 maintained. 
 
 To align a line of litters, at a halt, the litters being at the carry or lift, 
 the commands are : 
 
 I. Right (or left), 2. DRESS, 3. FRONT. 
 
 At dress, all dress to the right, the Nos. 2 aligning themselves on the 
 right guide, or No. 2 of the right squad, all promptly recovering their 
 intervals, if lost. At front, all face to the front. 
 
 81. Being in column, to extend distances, the commands are given : 
 
 1. To two (or more) paces, extend, 2. MARCH. 
 
 The first squad advances forward in quick time and the other squads 
 take the short step and successively gain the increased distance ; if in 
 march the first squad maintains the quick time, while the other squads 
 take the short step as above. 
 
 82. The column is closed by the commands : 
 
 1. Litters, 2. Close, 3. MARCH ; 
 when the first squad stands fast (if at a halt), or takes the short step (if 
 in a march), and the other squads successively close up. 
 
 83. The line, or column of litters, is marched by the commands 
 already given (Par. 24 and following), substituting " litters " for "fours." 
 
 The following movements require special notice or description: 
 
 BEING IN LINE, TO TURN AND HALT. 
 
 84. I. Detachment, 2. Right {ox left), 3. MARCH, 4. FRONT. 
 The first litter halts, and taking the short step, wheels to the right on 
 
 its own ground ; the other litters half wheel to the right and place them- 
 selves successively upon the alignment established by the right litter. 
 [Par. 21.] 
 
 BEING IN LINE, TO TURN AND ADVANCE. 
 
 85. 1. Detachment, 2. Right (or left) turn, 3. MARCH. 
 
 The first litter takes the short step and wheels to the right on a 
 movable pivot, followed by the others as in Par. 22. 
 
MARCHINGS WITH LITTER 
 
 269 
 
 BEING IN LINE OF LITTERS, TO MARCH BY THE FLANK IN 
 COLUMN OF LITTERS. 
 
 86. 1. Litters, 2. Right (or left) , 3. MARCH. 
 
 At the command march, No. 2 steps off to the right and No. 3 to the 
 left, both describing a quarter of a circle, so as to make the litter re- 
 volve horizontally on its centre 
 until both face to the right, 
 when they take the full step 
 in the new direction ; Nos. 1 
 and 4 maintain their relative 
 positions opposite the centre 
 of the litter. The right guide 
 places himself one pace in 
 front of the first litter, and the 
 left guide one pace in rear of 
 the last litter. 
 
 
 2 
 
 * , 
 
 3* 
 
 ** 
 
 
 K 
 
 3 
 
 
 Fig. 158 (Par. 86). — Litters Right. 
 
 BEING IN LINE, TO MARCH 
 IN COLUMN OF LITTERS 
 TO THE FRONT. 
 
 87. 1. Right (or left) for- 
 ward, 2. Litters right (or left) , 
 3. March. 
 
 At the command tnarch, the right litter moves straight to the front ; 
 the other litters wheel to the right and then to the left in column. [Par. 
 29.] 
 
 To form line from column — see Par. 33 and following. 
 
 BEING IN LINE OR COLUMN, TO MARCH TO THE REAR. 
 
 88. 1. Litters about, 2. March. 
 
 Nos. 2 and 3 step off as in Par.*86, but continue the movement until 
 both face to the rear, the other numbers maintaining their relative posi- 
 tions opposite the centre of the litter. 
 
 The about with the litter is always to the right. 
 
 MOVEMENTS BY SECTIONS. 
 
 89. A section consists of two litter squads in line. 
 
 90. To form column of sections from line : 
 
 1. Sections right (or left), 2. MARCH, 3. FRONT; 
 when each section turns, as in Par. 84 ; or, 
 
 91. 1. Sections, 2. Right (or left) turn, 3. MARCH, 4. Forward, 
 5. MARCH, 6. Guide right (or left) ; 
 
 when each section turns, as in Par. 85. 
 
27O EMERGENCIES AND ACCIDENTS 
 
 92. The advantage of this formation is that it permits the shortening 
 of the column, at the carry, without increasing its front, by the com- 
 mands : 
 
 I. Sections, 2. Close, 3. MARCH; 
 
 when the sections close up to one pace, and the litters oblique toward 
 each other until close against the inner free bearers (1 and 4) , the outer 
 free bearers meanwhile closing in on their respective sides. In this 
 manner the front is reduced to that of a column of litters. 
 
 93. The normal formation is resumed by the commands : 
 
 1. Sections, 2. Extend, 3. MARCH. 
 
 Line is re-formed by the same commands used to form column. 
 
 94. To form single column from column of sections : 
 
 I. Right (or left) by litter, 2. MARCH; 
 
 when the second litter of each section takes the short step and obliques 
 ^to the right behind the first. 
 
 95. To form colu?nn of sections from single column : 
 
 1. Form sections, 2. Left (or right) oblique, 3. MARCH; 
 
 when the first squad of each section takes the short step, until the 
 second squad, obliquing to the left, is in line with it. 
 
 ROUTE STEP. 
 
 96. The column of strapped litters at the carry [Par. 60] is the 
 habitual column of route. The rate is 3 to 3% miles per hour. 
 
 Marching in quick time : 
 
 1. Route step, 2. MARCH. 
 
 The men are not required to preserve silence nor keep the step. 
 The litter squads preserve their distance. 
 If from a halt : 
 
 I. Forward, 2. Route step, 3. MARCH. 
 
 To resume the cadence step : 
 
 1. Detachment, 2. ATTENTION. 
 
 At the command attention, the cadence step in quick time is resumed. 
 Upon halting while marching in route step, the men come to the rest 
 at the ground. [Par. 61.] 
 
 97. To march at ease : 
 
 1. At ease, 2. MARCH. 
 
 The detachment marches as in the route step, except that silence is 
 preserved. 
 
THE LOADED LITTER 
 
 271 
 
 THE LOADED LITTER. 
 
 TO LOAD AND UNLOAD THE LITTER. 
 
 98. For drill in loading litter, the "patients" are directed 
 to lie down, at suitable intervals, near the line of litters, first 
 with head and later with feet toward it, and lastly in any 
 position. Each squad may be separately exercised under its 
 leader or an instructor, or several squads simultaneously. 
 
 Fig: 159 (Par. 99). — Posts at Patients. 
 
 99. The litters being at the open, the instructor commands : 
 1. At patient, 2. Right (or left), 3. Posts. 
 
 If the command is right, Nos. 2, 1, and 3 take positions, 
 No. 2 at the right ankle, No. 1 at the right hip, and No. 3 at 
 the right shoulder, while No. 4 takes position by the left hip 
 opposite No. 1, all facing the patient. 
 
272 
 
 EMERGENCIES AND ACCIDENTS 
 
 If the command is left, Nos. 2, 4, and 3 take position, No. 
 2 at the left ankle, No. 4 at the left hip, and No. 3 at the left 
 shoulder, while No. 1 takes position at the right hip opposite 
 No. 4, all facing the patient. 
 
 It will be seen from the above that, whether the command 
 is right or left, the positions of Nos. 1 and 4 are invariable, 
 No. 1 at the right hip, No. 4 at the left hip, and that the posi- 
 tions of Nos. 2 and 3 are always at the ankle and shoulder, 
 respectively, on the right or left of the patient, as the com- 
 mand may be ; if right, they are on each side of No. 1 ; if 
 left, they are on each side of No. 4. 
 
 These movements assume that the patient is lying on his 
 back ; but as in the field he will often lie on his face or side, 
 the bearers should be practised in promptly taking their proper 
 positions under all circumstances. 
 
 These positions are taken by the bearers, whatever may 
 have been their previous positions or duties. 
 
 100. 1. Prepare to lift, 2. Lift. 
 
 At the first command all the bearers kneel on the knee 
 nearest the patient's feet (right knee if on the right of the 
 
 Fig. 160 tPar. 100).— The Patient lifted. 
 
THE LOADED LITTER 2/3 
 
 patient, and on the left knee if on his left) ; No. 2 passes 
 both forearms under the patient's legs, carefully supporting 
 the fracture, if there be one ; Nos. 1 and 4 pass their arms 
 under the small of his back and thighs, not locking hands ; 
 No. 3 passes one hand under his neck to the further armpit, 
 with the other supporting the nearer shoulder. 
 
 At the second command all lift together slowly and carefully 
 and place the patient upon the knees of the three bearers. 
 As soon as he is firmly supported there, the bearer on the 
 free side (No. 1 or 4) relinquishes his hold, passes quickly and 
 by the shortest line to the litter, which he takes up by the 
 middle, one pole in each hand, and returning rapidly places 
 it under the patient and against the bearers' ankles. 
 
 1 01. 1. Lower, 2. Patient. 
 
 The free bearer, No. 1 or 4, stoops and assists the other 
 numbers in gently and carefully lowering the patient upon 
 the litter. The bearers then rise and at once resume their 
 positions at litter posts. [Par. 68.] 
 
 102. To unload, posts are taken at patient as in loading. 
 At the commands : 
 
 1. Prepare to lift, 2. Lift [Par. 100], 
 
 they raise him upon the knees, the free bearer removes the 
 litter, and at lower patient, they lower him carefully to the 
 ground. 
 
 103. In the field, Nos. 1 and 4 going ahead, having reached the 
 patient and taken position on their respective sides, remove his arms 
 and accoutrements and examine him to determine the site and nature 
 of the injury ; they administer restoratives, if required, and apply such 
 dressings or splints as are needful or available. As soon as Nos. 2 and 
 3 reach the patient, they help, as far as may be necessary, in rendering 
 this first aid. 
 
 104. The drill should be made as nearly as possible like service in 
 actual warfare. For this purpose a diagnosis tag having been attached 
 to the clothing of the "wounded," indicating the site and character of 
 the injury to be dressed before loading, they are directed to take posi- 
 tions at variable distances, in or out of sight, such as they would occupy 
 on the battlefield. 
 
274 
 
 EMERGENCIES AND ACCIDENTS 
 
 105. The litter being at the carry, at the commands : 
 
 I. Search for wounded, 2. MARCH ; 
 
 each leader assumes charge of his squad and proceeds independently. 
 Nos. 1 and 4 at once start ahead to search, but without losing sight of 
 the litter, which follows in quick time, taking the double time as soon as 
 a patient is discovered. The litter is halted and opened (by No. 3's 
 commands) in the most convenient position near the patient. 
 
 The injury having been dressed, No. 1 commands : 
 
 106. 1. At patient, 2. Right (or left), 3. Posts. 
 
 As a rule, the command should be right or left, according 
 as the right or left side of the patient is injured, so that by 
 having the three bearers on that side a better support may be 
 given to the wounded parts. 
 
 107. In the field, when the ground on which the patient 
 lies is such that the litter cannot be placed directly under 
 him, it should be placed as near him as possible, and prefer- 
 ably in a direction parallel to, or in line with him, when it will 
 be necessary to carry the patient to the litter, instead of the 
 litter to the patient. In such case, the bearers having brought 
 the patient upon their knees, as described in Par. 100, at the 
 command rise, take firm hold of him and rise, and at march, 
 carry him forward, or by the flank as directed. From this 
 position he is first lowered to the knees of the bearers, and 
 thence placed upon the litter or ground. 
 
 108. At the commands, 
 
 1. Cease, 2. DRILLING, 
 
 the squads re-form in line and lower litters, when the patients, if still 
 upon the litters (the dressings, if any, having been removed), are 
 directed to rise and resume their posts, after which the litters are 
 strapped. 
 
 POSITION OF PATIENT ON THE LITTER. 
 
 109. The position of a patient on the litter depends on the 
 character of his injury. An overcoat, blanket, knapsack, or 
 other suitable and convenient article, should be used as a 
 pillow to give support and a slightly raised position to the 
 head. If the patient is faint, the head should be kept low. 
 
POSITION OF PATIENT ON THE LITTER 275 
 
 Difficulty of breathing in wounds of the chest is relieved by a 
 sufficient padding underneath. In wounds of the abdomen 
 the best position is on the injured side, or on the back if the 
 front of the abdomen is wounded, the legs in either case being 
 drawn up, and a pillow or other available object placed under 
 the knees to keep them bent. 
 
 In an injury of the upper extremity, calling for litter trans- 
 portation, the best position is on the back, with the injured 
 arm laid over the body or suitably placed by his side, or on 
 the uninjured side, with the wounded arm laid over the body. 
 In injuries of the lower extremity the patient should be on his 
 back, or inclining toward the wounded side ; in cases of 
 fracture of either lower extremity, if a splint cannot be 
 applied, it is always well to bind both limbs together. 
 
 GENERAL DIRECTIONS. 
 
 I io. In moving the patient either with or without litter, 
 every movement should be made deliberately and as gently as 
 possible, having special care not to jar the injured part. The 
 command steady will be used to prevent undue haste or other 
 irregular movements. 
 
 111. The loaded Utter should never be lifted or lowered 
 without orders. 
 
 112. The rear bearer should watch the movements of the 
 front bearer and time his own by them, so as to ensure ease 
 and steadiness of action. 
 
 113. The number of steps per minute will depend on the 
 weight carried and other conditions affecting each individual 
 case. 
 
 114. The handles of the litter should be held in the hands 
 at arm's length and supported by the slings. Only under the 
 most exceptional conditions should the handles be supported 
 on the shoulders. 
 
 115. The bearers should keep the litter level notwithstand- 
 ing any unevenness of the ground. 
 
 116. In making ascents or descents, the rear or front han- 
 dles should be raised to bring the litter to the proper level, 
 Nos. 1 and 4 supporting the poles on their respective sides. 
 
276 
 
 EMERGENCIES AND ACCIDENTS 
 
 With only three bearers, the free bearer takes hold of the 
 handle on his side. 
 
 117. As a rule the patient should be carried on the litter 
 feet foremost, but in going up hill his head should be in front ; 
 in case of fracture of the lower extremities, he is carried up 
 hill feet foremost, and down hill head foremost, to prevent 
 the weight of the body from pressing down on the injured 
 part. 
 
 TO PASS OBSTACLES. 
 
 118. A breach should be made in a fence or wall for the 
 passage of the litter, if there be no gate or other opening, but 
 
 Fig. 161 (Par. 118). — Passing an Obstacle. 
 
 should it be necessary to surmount the obstacle, the commands 
 are given : 
 
 1. Obstacle, 2. March. 
 
 At obstacle, Nos. 1 and 4 close in to side of litter, grasp 
 poles with both hands and support it ; at march, No. 2 slips 
 loops from handles and climbing over, receives litter as it 
 advances (facing to the front) ; Nos. 1 and 4 then pass the 
 obstacle and resume their places at the poles when the litter 
 is carried over; No. 3, slipping loops from handles, now also 
 climbs over and takes his place between the handles ; the 
 
PASSING OBSTACLES WITH THE LITTER 277 
 
 slings having been adjusted without halting, Nos. 1 and 4 
 resume their posts. 
 
 119. The passage of a narrow cut or ditch is effected in a 
 similar manner; Nos. 1 and 4 bestride or descend into the 
 cut, support and advance the litter until No. 2 has crossed 
 and resumed his hold, when the litter is carried over ; No. 3 
 then crosses and all resume their places. 
 
 120. In crossing a running stream, or broken or otherwise 
 difficult ground, or going up or down a hill, Nos. 1 and 4 give 
 support on their respective sides of the litter at the command 
 
 Fig. 162 (Par. 121). — Surmounting an Obstacle. 
 
 obstacle [Par. 118] ; or. the litter may be carried by four 
 [Par. 77] . 
 
 121. To surmount an obstacle over 5 feet high, the litter 
 being lifted by four [Par. 77], the commands are given: 
 
 1. Raise, 2. Litter; 
 
 when the litter is carefully raised to the level of the obstacle 
 and passed over until the front legs have cleared it, where 
 it is rested ; Nos. 2 and 4 cross the obstacle and resume hold 
 of their handles on the other side ; the litter is then advanced 
 
278 
 
 EMERGENCIES AND ACCIDENTS 
 
 until only the rear handles rest upon the obstacle, when Nos. 
 I and 3 get over and resume hold of their handles ; the litter 
 is then lowered. 
 
 122. To pass a wide cut or ditch, the litter being lowered 
 with the front legs near the edge, Nos. 2 and 4 descend into 
 the cut, take hold of the front handles and the movement 
 proceeds as in Par. 121. 
 
 TO CARRY A LOADED LITTER UPSTAIRS. 
 
 123. A loaded litter is usually carried upstairs head front, 
 and downstairs feet front, as follows : The litter is marched 
 
 Fig. 163 (Par. 123). — Carrying a Loaded Litter Upstairs. 
 
 to the foot of the stairs in the usual manner, wheeled about, 
 halted, and lowered, when the commands are given : 
 
CARRYING THE LITTER OVER STAIRS 279 
 
 I. Prepare for stairs, 2. Lift, 3. March. 
 
 At the first command, No. 4 steps to the handle nearest 
 him at the foot of the litter, which he grasps firmly with both 
 hands, while No. 2 grasps the opposite handle; No. 3 faces 
 about, stoops, replaces loops and grasps handles. At lift, the 
 litter is lifted, and at march, carried up by Nos. 3, 2, and 4, 
 the rear bearers (Nos. 2 and 4) keeping it as level as possible 
 by raising their end, and, if necessary, resting the handles on 
 shoulders. They must carefully watch the patient to prevent 
 accident. In this movement No. 1 falls out and accompanies 
 litter, to render any assistance required. 
 
 If the litter is to be carried any considerable distance, it 
 must be lowered as soon as possible after the stairs are 
 mounted, and the usual positions resumed. 
 
 ■ TO CARRY A LOADED LITTER DOWNSTAIRS. 
 
 124. As the litter approaches the stairs, the command Pre- 
 pare for stairs is given, when No. 4 advances to left front 
 handle, which he grasps firmly with both hands, while No. 2 
 grasps the opposite handle. The front bearers, as the descent 
 proceeds, bring handles to shoulders, if necessary, to keep the 
 litter as level as possible ; the rear bearer carefully observes 
 patient to see that no accident happens to him. When the 
 level is reached the usual positions are resumed. When 
 necessary the litter may be lowered at the head of the stairs. 
 
 When, for any reason, it is necessary to carry a patient feet 
 first upstairs or head first downstairs, the bearers are simply 
 reversed, in the former case No. 2 becoming front bearer, and 
 in the latter No. 3, who is assisted by No. 1. 
 
 TO LOAD AND UNLOAD WITH REDUCED NUMBERS. 
 
 125. In loading with reduced numbers, No. 2 or 3 (absent) 
 is ordinarily replaced by No. 4 or 1, respectively, while Nos. 
 1 and 4 replace each other. [Par. 52.] 
 
 With three bearers the litter is placed as usual, and at the 
 prescribed commands the bearers take their proper positions. 
 The patient, having been lifted by the three bearers, is sup- 
 
28o 
 
 EMERGENCIES AND ACCIDENTS 
 
 ported on the knees of the two on one side, while the third 
 (No. i or 4) places the litter in position under him. 
 
 126. Another method for three bearers, when it is neces- 
 sary to carry the patient to the litter, is as follows : Two 
 bearers take their positions on the same side opposite the 
 knee and hip, while the third stands by the opposite hip. At 
 
 Fig. 164 (Par. 124). —Carrying a Loaded Litter Downstairs. 
 
 the usual commands the two bearers at the hips stoop, and 
 raising the patient to a sitting position, place each one hand 
 and arm around the back and interlock the fingers of the 
 other hand, palms up, under the upper part of the thighs. 
 The patient, if able, clasps his arms around their necks. The 
 third bearer (No. 2 or 4) supports the lower extremities with 
 
LOADING LITTER WITH REDUCED NUMBERS 28 1 
 
 both arms passed under them, one above, the other below the 
 knee. 
 
 127. If only two bearers are available (e.g. Nos. 2 and 3), 
 the patient is necessarily always carried to the litter. No. 2 
 proceeds by the right and No. 3 
 by the left, and take position on 
 opposite sides of the patient near 
 his hips. They lift the patient 
 as directed [Par. 145], the legs 
 remaining unsupported, and 
 carry him feet foremost over the 
 near end of the litter. 
 
 In case of fractured lower ex- 
 tremity, the two bearers kneel 
 on the injured side, raise the 
 patient upon their knees, and 
 take firm hold of him, No. 2 
 supporting both lower extremi- 
 ties, while No. 3 supports the 
 body, the patient clasping his 
 arms around his neck, when they 
 rise. 
 
 128. To unload with three bearers, posts are taken at 
 patient as in loading. At the commands : 
 
 1. Prepare to lift, 2. Lift [Par. 100], 
 
 they raise him upon the knees, No. 1 (or 4) removes the 
 litter, and at lower patient, they lower him carefully to the 
 ground. 
 
 129. With two bearers, they form a two-handed seat [Par. 
 145], and lift the patient off the litter. In the case of fracture, 
 they stand on the same side, and kneeling [Par. 127], lift him 
 upon their knees, then rise and take two steps backward to 
 clear the litter, when they lower him to their knees and then 
 to the ground. 
 
 Fig. 165 (Par. 126). — Carrying by 
 Three Bearers. 
 
282 EMERGENCIES AND ACCIDENTS 
 
 TO TRANSFER PATIENT FROM LITTER TO BED OR ANOTHER 
 LITTER. 
 
 130. From litter to bed: With four or three bearers the 
 litter is placed at the foot of the bed, as nearly as possible in 
 line with it ; the bearers taking their positions (all on one 
 side if only three), lift the patient upon their knees, then, at 
 the command Rise, taking firm hold of him, they rise, and, 
 moving cautiously by side steps to the bedside, lower him 
 upon the bed. 
 
 With two bearers, the patient is likewise first lifted upon 
 their knees, then carried by side steps to the bed. 
 
 131. From litter to litter: The patient is lifted upon the 
 knees of the bearers, the litter removed and replaced by the 
 other litter. 
 
 IMPROVISATION OF LITTERS. 
 
 132. Many things can be used for this purpose : 
 
 Camp cots, window shutters, doors, benches, boards, lad- 
 ders, etc., properly padded. 
 
 Litters may be made with sacks or bags of any description, 
 if large and strong enough, by ripping the bottoms and pass- 
 ing two poles through them and tying crosspieces to the poles 
 to keep them apart ; two, or even three, sacks placed end to 
 end on the same poles may be necessary to make a safe and 
 comfortable litter. 
 
 Bedticks are used in the same way by slipping the poles 
 through holes made by snipping off the four corners. 
 
 Pieces of matting, rug, or carpet, trimmed into shape, may 
 be fastened to poles by tacks or twine. 
 
 Straw mats, leafy twigs, weeds, hay, straw, etc., covered or 
 not with a blanket, will make a good bottom over a frame- 
 work of poles and cross sticks. 
 
 Better still is a litter with bottom of ropes or rawhide strips 
 whose turns cross each other at close intervals. 
 
 133. But the usual military improvisation is by means of 
 rifles and blankets. Each squad should be supplied with two 
 
IMPROVISED BLANKET AND RIFLE LITTER 283 
 
 rifles (bayonets fixed), carried by Nos. 1 and 3, who assure 
 themselves that they are unloaded, and a regulation blanket 
 rolled up, and carried by No. 4 over right shoulder. The 
 detachment being in line, is formed in column of fours [Par. 
 25], when the commands are given : 
 
 1. For blanket litter, 2. March. 
 
 At march, Nos. 2 and 4 step two paces forward, and Nos. 1 
 and 3 place themselves behind them. 
 
 1. Prepare, 2. Blanket litter. 
 
 Nos. 2 and 4 face about; No. 4 takes blanket roll and 
 passes one end to No. 2, when Nos. 1 and 3 seize free edge 
 
 Fig. 166 (Par. 133). — Preparing Blanket Litter. 
 
 of blanket (with free hands) as near the corners as possible ; 
 Nos. 2 and 4 step backward till the blanket is unrolled, when 
 all stoop and place it smoothly on the ground. Nos. 1 and 3 
 lay rifles under edges of blanket, trigger guard in, muzzles 
 toward 2 and 4, somewhat converging, when all roll blanket 
 tightly about rifles, an equal number of turns on each piece, 
 until the space between them measures 20 inches, and stand 
 erect. 
 
 134. The blanket litter is lifted by four as in Par. 77. It 
 may be carried in any direction, and all movements of load- 
 
284 
 
 EMERGENCIES AND ACCIDENTS 
 
 ing, unloading, etc., are executed as laid down for the hand 
 litter. 
 
 135. When no longer required, the commands are given : 
 
 1. Take apart, 2. Blanket litter. 
 
 The bearers having resumed their original positions, face 
 the litter, stoop and unroll blanket on their respective sides ; 
 Nos. 1 and 3 take up the rifles and stand at the order ; Nos. 
 2 and 4 fold the blanket lengthwise, then roll it tightly, when 
 No. 4 places the roll upon his shoulder and all stand facing 
 to the front. 
 
 At form, rank, each squad is re-formed as in Par. 67. The 
 column of fours may now be re-formed into line. [Par. 33.] 
 
 136. Should it be desirable, by reason of the patient's con- 
 dition, or because of reduced numbers of the squad, the fol- 
 lowing method may be used : 
 
 One-half of the blanket is rolled lengthwise into a cylinder, 
 which is placed along the back of the patient, who has been 
 turned carefully on his side. The patient is then turned over 
 upon the blanket and the cylinder unrolled on the other side. 
 The rifles are then laid down and rolled tightly in the blanket, 
 each a like number of turns, until the side of the body of the 
 patient is reached, when they are turned trigger guards up. 
 
 137. A litter may also be prepared with two rifles and two 
 or three blouses, by turning the blouses lining out, and but- 
 toning them up, sleeves in, when the rifles are passed through 
 the sleeves, the backs of the blouses forming the bed. 
 
 Two bearers may carry the wounded man in these improvi- 
 sations, but it is better, whenever possible, that four men 
 should do so, two on each side. 
 
 METHODS OF REMOVING WOUNDED WITHOUT 
 LITTERS. 
 
 FOR ONE BEARER. 
 
 138. While it is not desirable that one bearer should, ordi- 
 narily, be required or permitted to lift a patient unassisted, 
 
REMOVING A PATIENT BY ONE BEARER 285 
 
 emergencies may arise when a knowledge of proper methods 
 of lifting and carrying by one bearer is of the utmost 
 value. 
 
 A single bearer may carry a patient in his arms, on his 
 back, or across his shoulder. 
 
 To bring the patient into any of these positions, the first 
 steps are as follows : 
 
 139. To lift the patient erect. 
 
 The bearer, turning patient on his face, steps astride body, 
 facing toward the head, and with hands in his armpits lifts 
 him to his knees, then clasping hands 
 over the abdomen, lifts him to his 
 feet ; he then with the left hand seizes 
 the patient by the left wrist and draw- 
 ing the left arm about his (the bearer's) 
 neck, holds it against his left chest, the 
 patient's left side resting against his 
 body, and supports him with his right 
 arm about the waist. 
 
 140. From this position the bearer 
 proceeds as follows : 
 
 To lift the patient in arms. 
 The bearer, with his right arm behind 
 patient's back, passes his left under 
 thighs and lifts him into position. 
 
 Fig. 167 (Par. 139). — Lifting 
 Patient Erect. 
 
 To place patient astride of back 
 
 141. The bearer shifts himself to 
 
 the front of patient, back to him, stoops, and grasping 
 his thighs, brings him well up on his back. 
 
 As the patient must help himself by placing his arms around 
 the bearer's neck, this method is impracticable with an uncon- 
 scious man. 
 
 To place the patient across back. 
 
 142. The bearer with his left hand seizes the right wrist 
 of the patient and draws the arm over his head and down 
 
286 
 
 EMERGENCIES AND ACCIDENTS 
 
 upon his left shoulder, then shifting himself in front, stoops 
 and clasps the right thigh with his right arm passed between 
 the legs, his right hand seizing 
 the patient's right wrist ; lastly, 
 he, with his left hand grasps the 
 patient's left and steadies it against 
 his side, when he rises. 
 
 To place patient across 
 shoulder. 
 
 143. The bearer clasps his 
 hands about the patient's waist, 
 shifts himself to the front, facing 
 him, and stooping places his right 
 shoulder against the abdomen ; he 
 passes his right hand and arm 
 between the thighs — securing 
 the right thigh — and with his left 
 grasps patient's right hand, bring- 
 ing it from behind under his 
 (bearer's) left armpit, when, 
 the wrist being firmly grasped 
 by his right hand, he rises. 
 This position leaves the left 
 hand free. 
 
 144. In lowering patient 
 from these positions the mo- 
 tions are reversed. Should a 
 patient be wounded in such 
 manner as to require these 
 motions to be conducted from 
 his right side instead of left, 
 as laid down, the change is 
 simply one of hands — the mo- 
 tions proceed as directed, sub- 
 stituting right for left, and vice Fig< m (Rar l43) ._ Patient across 
 
 Versa. Shoulder. 
 
 Fig. 168 (Par. 142). — Patient 
 across Back. 
 
REMOVING A PATIENT BY TWO BEARERS 287 
 
 FOR TWO BEARERS. 
 
 By the two-handed seat. 
 
 145. The patient lying on the ground, the commands are 
 given : 
 
 1. Form two-handed seat, 2. Prepare to lift, 3. Lift. 
 
 At the first command the two bearers take position facing 
 each other on the right and left of the patient near his hips. 
 
 At the second command they raise the patient to a sitting 
 posture, pass each one hand and arm 
 around his back, while the other hands 
 are passed under the thighs, palms up, 
 and the fingers interlocked. 
 
 At lift, both rise together. 
 
 In marching, the bearers should 
 break step, the right bearer starting 
 with the right foot, the left bearer with 
 the left foot. 
 
 By the extremities. 
 
 146. This method requires no effort 
 on the part of the patient ; but it is 
 not applicable to severe injuries of the 
 lower extremities. One bearer stands 
 by the patient's head, the other between 
 his legs, both facing toward the feet. 
 At prepare to lift, the rear bearer hav- 
 ing raised the patient to the sitting posture, clasps him from 
 behind around the body under the arms, while the front 
 bearer, standing between the legs, passes his hands from 
 the outside under the flexed knees. At lift, both bearers 
 rise together. 
 
 By the rifle seat. 
 
 147. A good seat may be made by running the barrels of 
 two rifles through the sleeves of an overcoat, buttoned as in 
 Par. 137, so that the coat lies back up, collar to the rear. The 
 front bearer rolls the tail tightly around the barrels and takes 
 
 Fig. 170 (Par. 145).— Two- 
 handed Seat. 
 
288 
 
 EMERGENCIES AND ACCIDENTS 
 
 his grasp over them ; the rear bearer holds by the butts, trig- 
 ger guards up. 
 
 148. A stronger seat is secured in the following manner : 
 A blanket being folded once from side to side, a rifle is laid 
 
 upon it transversely across its centre so that the butt and 
 muzzle project beyond edges ; one end of the blanket is folded 
 upon the other end and a second rifle laid upon the new cen- 
 tre in the same manner as before. The free end of the blanket 
 is folded upon the end containing the first rifle so as to pro- 
 ject a couple of inches beyond the first rifle. The litter is 
 raised from the ground with trigger guards up. 
 
 TO PLACE A PATIENT ON HORSEBACK. 
 
 149. The help required to mount a disabled man will depend on the 
 site and nature of his injuries ; in many cases he is able to help himself 
 
 Fig. 171 (Par. 149). — Placing Patient on Horseback. 
 
 materially. If he be entirely helpless, five men — if available — should 
 be used to mount him, one to hold the horse, the others to act as bear- 
 ers. The horse is, if necessary, blindfolded. 
 
 To load from the near side, the bearers take posts at patient left, lift 
 the patient and, at the command prepare to mount, carry him to horse, 
 his body parallel to that of the horse, his head toward the horse's tail. 
 
REMOVING A PATIENT ON HORSEBACK 289 
 
 No. 1 stands on the off side of the horse ready to grasp the right leg of 
 the patient when it is brought within his reach. When close to the 
 horse's side, at the command mount, the patient is carefully raised and 
 carried over the horse until his seat reaches the saddle, when he is raised 
 into position. 
 
 When necessary to load from the off side the bearers take posts at 
 patient right. 
 
 To mount with the assistance of three or two bearers, the same prin- 
 ciple is observed. 
 
 150. To dismount, at the commands, 
 
 1. At patient, 2. Right (or left) , 3. POSTS, 4. Prepare to dismount, 
 5. Dismount, 
 
 the movements are reversed. 
 
 151. The patient once mounted should be made as safe and comfort- 
 able as possible. A comrade may be mounted behind him to hold him 
 and guide the hprse ; otherwise, a lean-back must be provided, made 
 of a blanket roll, a pillow, or a bag filled with leaves or grass. If the 
 patient be very weak, the lean-back can be made of a sapling bent into 
 an arch over the cantle of the saddle, its ends securely fastened, or of 
 some other framework to which the patient is bound. 
 
 THE TRAVOIS. 
 
 152. The travois is a vehicle intended for transporting the sick or 
 wounded when the use of wheeled vehicles, or other means of transpor- 
 tation is impracticable It consists of a frame, having shafts, two side 
 poles and two crossbars, upon which a litter may be rested and partly 
 suspended. When in use, a horse or mule is attached to the shafts and 
 pulls the vehicle, the poles of which drag on the ground. One pole is 
 slightly shorter than the other in order that, in passing an obstacle, the 
 shock may be received successively by each and the motion be equally 
 distributed. 
 
 153. No. 4 procures the animal, sees that it is properly harnessed, 
 and keeps charge of it. The travois having been procured by Nos. 2 
 and 3, the commands are given : 
 
 154. 1. Prepare, 2. TRAVOIS. 
 
 Nos. 1 and 3 take posts (left and right respectively) at the ring (or 
 front) ends of the shafts, and No. 2 at the shoe (or rear) ends of the 
 side poles. They pull the shafts forward through the collars until fully 
 extended ; then Nos. 1 and 3 place the front crossbar over the front 
 ends of the side poles, driving it home until its collars strike the front 
 collars of the side poles, and No. 2 passes the collars of the rear cross- 
 bar (keeping uppermost the surface on which are the flat bolts) over 
 
290 
 
 EMERGENCIES AND ACCIDENTS 
 
 the rear ends of the poles, pushing them forward until they reach the 
 squared places, beyond the bolt slots, when the barrel bolts are thrown 
 
 into place. 
 
 155. 1. Hitch, 2. Travois. 
 
 Nos. 1 and 3 hitch the travois. 
 If the animal has an ordinary 
 wagon harness, the rings on the 
 front ends of the shafts are put 
 over the iron hooks on the hames, 
 and the toggle of each trace chain 
 is fastened to the ring of the cor- 
 responding side pole. If it is sad- 
 dled, the rings on the front ends 
 of the shafts are fastened to the 
 pommel of the saddle by means 
 of the straps that belong there, 
 and the shafts secured by a sur- 
 cingle passed over all. 
 
 The saddle should have a 
 breast strap if practicable. 
 
 156. Nos. 1, 2, and 3 having 
 taken their posts at litter, the tra- 
 vois is loaded as in ambulance 
 drill [Pars. 169 and 170], by the 
 commands : 
 
 1. Take post to load travois, 
 2. March. 
 
 1. Prepare to load, 2. LOAD. 
 
 At load, the three bearers slowly 
 raise the litter, and carry it length- 
 wise over the travois. Nos. 1 and 
 3 slip the handles of the litter 
 through the leather loops on the 
 front ends of the side poles, and 
 set the front legs into the mortises, 
 securing them by the bolts, when 
 they take posts at travois, facing 
 
 the animal, No. 1 at the patient's right shoulder, No. 3 at his left, and 
 
 No. 2 at his feet. 
 
 157. The squad being at travois posts, at the commands : , 
 
 1. Prepare to unload, 2. UNLOAD, 
 
 the movements are reversed and the litter lowered clear of the travois. 
 
REMOVING PATIENTS BY TRAVOIS 29 1 
 
 158. The travois may be loaded or unloaded by two bearers who 
 take posts opposite each other at mid-length of litter, which they lift on 
 or off the travois, grasping each pole with both hands. 
 
 159. The travois being unloaded, at the commands : 
 
 1. Unhitch, 2. TRAVOIS. 
 
 The travois is unhitched by Nos. 1 and 3, and the animal led out by 
 No. 4. 
 
 1. Pack, 2. Travois. 
 
 Nos. 1, 2, and 3 at their respective posts, remove the rear and front 
 crossbars, then slip the shafts backward under the side poles, and secure 
 all by the cross straps. 
 
 160. A travois may be improvised by cutting poles about 15 feet long 
 and 2 inches in diameter at the small end. These poles are laid parallel 
 to each other, small ends to the front, and 25 feet apart ; the large ends 
 about 3 feet apart, and one of them projecting 8 or 10 inches beyond 
 the other. The poles are connected by a crossbar about 6 feet from the 
 front ends, and another about 6 feet back of the first, each notched at 
 its ends and securely lashed at the notches to the poles. Between the 
 crosspieces the litter bed, 6 feet long, is filled in with canvas, blanket, 
 etc., securely fastened to the poles and crossbars, or with rope, lariat, 
 rawhide strips, etc., stretching obliquely from pole to pole in many 
 turns, crossing each other to form the basis for a light mattress or 
 improvised bed; or a litter may be made fast between the poles to 
 answer the same purpose. The front ends of the poles are then 
 securely fastened to the saddle of the animal. A breast strap and 
 traces should, if possible, be improvised and fitted to the horse. On 
 the march, the bearers should be ready to lift the rear end of the 
 travois, when passing over obstacles, crossing streams, or going up hill. 
 
 THE TWO-HORSE LITTER. 
 
 161. The two-horse litter consists of a litter with long handles used 
 as shafts for carrying by two horses, or mules, one in front, the other in 
 rear of the litter. It accommodates one recumbent patient. On a good 
 trail, it is preferable to the travois, as the patient lies in the horizontal 
 position, and, in case of fractured limbs, they can easily be secured 
 against disturbance. This litter maybe improvised in the same manner 
 as the travois, only the poles should be 165 feet long, and the crossbars 
 forming the ends of the litter bed should be fastened 5 feet from the 
 front and rear ends of the poles. The ends are made fast to the saddles 
 by notches, into which the fastening ropes are securely tied. 
 
 162. A patient is placed upon a horse litter after it is hitched, and 
 removed from it before it is unhitched, in the same general manner as 
 when lowered upon or lifted from a bed or other litter. 
 
292 EMERGENCIES AND ACCIDENTS 
 
 THE AMBULANCE. 
 
 163. The regulation ambulance is a four-wheeled vehicle 
 drawn by two horses. It provides transportation for eight 
 men sitting or two recumbent on litters, or four sitting and 
 one recumbent. It is fitted with four removable seats which, 
 when not used as such, are hung, two against each side, thus 
 answering the purpose of cushions. The floor is 7^ feet long 
 and 4 feet wide. Beneath the driver's seat is a box for the 
 medical and surgical chests, and under the body are two 
 water tanks ; outside, on each side, are two brackets upon 
 which litters are carried. 
 
 AMBULANCE DRILL. 1 
 
 164. The litters are said to be packed when they are 
 strapped and placed upon the brackets. The seats are said 
 to be prepared when they are horizontal, supported by the 
 legs ; and packed when they are hooked against the sides of 
 the wagon. 
 
 To take posts at ambulance. 
 
 165. Being in line : 
 
 1. At ambulance, 2. Posts. 
 
 The designated squad marches in column of files to the 
 ambulance, when No. 1 takes post on the left, No. 2 in the 
 
 1 With the old pattern ambulance, which has a litter rest and special litters 
 (the latter carried suspended each by two straps from the hand rails), and which 
 will not accommodate the regulation litter, the bearers proceed as follows: After 
 the seats are packed, No. 2 passes the two rear rollers to No. 3, and adjusts the 
 two front rollers; they then, beginning on the right, unbuckle the straps, place 
 the litter upon the rollers, and resume their posts. No. 1 then commands: 
 Procure litter, about face, when the litter is brought to the carry and opened ; 
 after which the patient is transferred to the ambulance litter and loaded. After 
 the patient is unloaded and transferred to the regulation litter, No. 1 commands: 
 At ambulance litter posts, when the litter is closed, shouldered, and returned 
 to ambulance; he then marches his squad back to the regulation litter. To 
 prepare seats, the litters are suspended, beginning on the right, the rollers are 
 returned to their compartment, and the seats prepared. 
 
PREPARING THE AMBULANCE 293 
 
 centre, and No. 3 on the right of the rear of the ambulance 
 and close to it, No. 4 on the right of No. 3. 
 
 In the case of a litter lowered in rear of ambulance prepara- 
 tory to loading, head of patient toward it, at the command 
 
 1 2 3 4 
 
 Fig 173 (Par 165).— At Ambulance Posts. 
 
 posts, each number faces about and proceeds directly to his 
 post. 
 
 This is the invariable position of the squad at ambulance 
 Posts ; it may be taken from any position (the litter, if any, 
 being grounded or lowered}, and when disarranged, from 
 whatever cause, the squad may be reassembled by these com- 
 mands for service at the ambulance. 
 
 166. The ambulance having seats packed, and the squad 
 being at ambulance posts : 
 
 1. Prepare, 2. Seats. 
 Nos. 1 and 3 raise the curtain, if necessary, and open the 
 tail gate; Nos. 2 and 3 enter the ambulance, No. 2 facing 
 the front and No. 3 the rear seat of their respective sides. 
 Each man seizes the lower edge of the seat, about 6 inches 
 from the ends, with both hands, and lifts it carefully to free 
 the hooks from the upper, slots, and then slips them into the 
 lower slots ; he raises the legs and adjusts them to the seat, 
 fastening the keepers, and tries the seat for firmness before 
 leaving it. He then prepares in like manner the opposite 
 seat. Nos. 3 and 2 now resume their places at ambulance 
 posts. 
 
 167. The ambulance having seats prepared, and the squad 
 being at ambulance posts : 
 
 1. Pack, 2. Seats. 
 Nos. 1 and 3 raise the curtain, if necessary, and open the 
 tail gate, Nos. 2 and 3 enter the ambulance, No. 2 facing the 
 
294 
 
 EMERGENCIES AND ACCIDENTS 
 
 front and No. 3 the rear seat of their respective sides. Each 
 man, having pushed aside the keepers covering the slots, 
 releases the legs, then, seizing the front of the seat with both 
 hands, raises the seat to clear the hooks from the lower slots, 
 and slips them into the upper slots. He then packs in like 
 manner the opposite seat. Nos. 3 and 2 now resume their 
 posts at ambulance. 
 
 168. Seats can be prepared or packed on one side only 
 (leaving room on the packed side for one recumbent patient) 
 by the commands : Prepare (or pack) seats, right (or left) . 
 
 169. The litter being lifted, at the commands : 
 
 1 . Take post to load ambulance, 2. March ; 
 
 the squad proceeds to the ambulance. No. 4, starting ahead 
 in double time, lays the arms and accoutrements of the patient 
 (which he carries) on the ground by the right rear wheel ; 
 he then raises the curtain, if necessary, opens the tail gate, 
 observes the condition of the ambulance, and (resuming his 
 post at the litter) reports it to the squad leader. Upon 
 approaching the ambulance the litter is wheeled about so 
 that the head of the patient is toward the rear of the ambu- 
 lance, and two paces from it, when the litter is halted and 
 lowered. If it be necessary to prepare the ambulance before 
 loading, the squad takes posts at ambulance, No. 4 remaining 
 in charge of the patient ; if ready for the reception of the 
 litter, the commands are given : 
 
 1. Prepare to load, 2. Load. 
 
 170. At the first command, No. 2 faces about ; No. 3 steps 
 around his left handle and takes post at the patient's left 
 shoulder; No. 1 takes post opposite No. 3; all facing the 
 litter stoop, No. 2 grasping his handles, and Nos. 1 and 3 
 their respective poles ; No. 4 watches the patient, and other- 
 wise renders any needful assistance. At load, the bearers 
 slowly raise the litter to the level of the floor of the ambu- 
 lance and advance to it, being careful to keep the litter in 
 a horizontal position; the legs are placed on the floor by 
 Nos. 1 and 3, and the litter pushed in by No. 2, assisted by 
 
LOADING THE AMBULANCE 
 
 295 
 
 the others. When this is accomplished, Nos. 1, 2, and 3 are 
 in position at ambulance posts. No. 4 places the arms and 
 accoutrements of the patient (if any) under the litter, and 
 then takes his position on the right ; Nos. 1 and 3 close the tail 
 
 Fig. 174 ( 
 
 Loading Ambulance. 
 
 gate and, if necessary, lower the curtain. The squad may 
 then be faced in any desired direction, and marched away. 
 171. The squad being at ambulance posts : 
 
 1. Prepare to unload, 2. Unload. 
 
 At the first command, Nos. 1 and 3 raise the curtain, if 
 necessary, open the tail gate, and No. 2 takes hold of the 
 projecting handles of the litter; at imload, No. 2 draws out 
 the litter, assisted by Nos. 1 and 3, who, facing inward, sup- 
 
296 EMERGENCIES AND ACCIDENTS 
 
 port the poles until the inner handles are reached. The litter, 
 carefully supported in a horizontal position, is then lowered 
 with the head of the patient two paces in rear of wagon ; 
 No. 4 closes the tail gate, and all take posts at litter. 
 
 172. To load with two bearers, the litter being lowered in 
 position for loading, at prepare to load, the bearers take posts 
 on their respective sides, mid-length of the litter and facing 
 it ; they stoop and grasp each a pole firmly with both hands. 
 At load, they lift the litter and push it into the ambulance. 
 
 At unload, each bearer grasping his handle, they partly 
 withdraw the litter, then shifting their hands to their respective 
 poles and facing each other they continue to withdraw it until 
 the head reaches the rear of the ambulance, when they lift the 
 litter out and lower it to the ground. 
 
 173. The right side of the ambulance is always loaded or 
 unloaded first, unless otherwise ordered. 
 
 174. When necessary to load the feet first, at the com- 
 mands : By the feet, take post to load ambulance, march, the 
 litter is lowered with foot toward the ambulance, when the 
 loading proceeds as above described, excepting that No. 3 
 remains between his handles, No. 2 takes post opposite the 
 right ankle, and No. 4 opposite him. 
 
 175. At the conclusion of the drill with ambulances the 
 detachment is re-formed in line. 
 
 TO PREPARE AND LOAD ORDINARY WAGONS TO 
 TRANSPORT WOUNDED. 
 
 176. In active service, the use of the ordinary army or 
 other wagons for transporting the sick and wounded is of 
 everyday occurrence, and it is important that bearers should 
 be practised in preparing, loading, and unloading such 
 vehicles. Patients may be laid on straw or other like material 
 spread thickly over the bottom of the wagon, or on hand 
 litters placed on the bottom, or suspended by ropes or straps. 
 The movements heretofore fully described, to load and imload, 
 will, if thoroughly understood, meet the requirements of any 
 emergency of this character. It must, however, always be 
 
INSPECTION OF HOSPITAL CORPS 297 
 
 remembered that such work demands a far greater amount of 
 care, on the part of the bearers, for the safety and comfort of 
 their patients than when the proper appliances are at hand. 
 
 INSPECTION AND MUSTER. 
 
 INSPECTION OF DETACHMENT. 
 
 177. Inspection is in such uniform as may be prescribed. The 
 Hospital Corps pouch is worn with all uniforms, suspended from the 
 left shoulder to the rear over the right hip. 
 
 The detachment should be frequently inspected in the uniform and 
 equipment for field service, which consist of the blouse, trousers, cam- 
 paign hat, shoes, and leggings, the waist belt, pouch and sling, the 
 haversack and canteen suspended from the right shoulder to the rear 
 over the left hip, and the tin cup hung from the flap strap of the haver- 
 sack. 
 
 If required, a revolver is carried at the belt on the right side and a 
 cartridge pouch on the left. 
 
 178. The detachment being formed, the senior non-commissioned 
 officer salutes, reports, and takes his place on the right of the line of file 
 closers. [Par. 3.] 
 
 The officer commanding, standing in front of the centre of the detach- 
 ment, then draws sword and commands : 
 
 I. Open ranks, 2. MARCH, 3. FRONT. 
 
 At the first command the senior non-commissioned officer steps one 
 pace to the rear to mark the new alignment of the file closers ; the 
 medical officers above the rank of lieutenant stand fast during the in- 
 spection ; the junior officers place themselves on the right and left of the 
 rank ; the officer commanding goes to the right flank and verifies the 
 position of the senior non-commissioned officer, then places himself fac- 
 ing to the left, three paces in front of the right of the detachment, and 
 commands : MARCH. At this command the junior officers take post 
 three paces in front of the detachment, distributing themselves equally 
 along the line, in order of rank, from right to left ; the rank (the left 
 hand above the hip) dresses to the right; the file closers step backward 
 to the line established by the senior non-commissioned officer, and 
 dress to the right. 
 
 The officer commanding aligns the officers and the rank ; the senior 
 non-commissioned officer, the file closers. 
 
 The officer commanding verifies the alignment of the file closers ; the 
 officers and file closers cast their eyes to the front as soon as their 
 alignment is verified. 
 
298 EMERGENCIES AND ACCIDENTS 
 
 At the command front, the men cast their eyes to the front and drop 
 the left hand. 
 
 179. The officer commanding takes post facing to the front, three 
 paces in front of the right guide, and as the inspector approaches, he 
 faces to the left, commands : 
 
 1. Inspection, 2. POUCHES, 
 
 and facing to the front salutes him. 
 
 At the second command the pouches are shifted under the right arm 
 to the front, the flap opened and held by the left hand, fingers extended, 
 palm against the body, so that the flap strap covers the line of buttons, 
 right hand at side. 
 
 As soon as inspected, the officer commanding returns sword and 
 accompanies the inspector. When the latter begins to inspect the rank, 
 the junior officers face about and stand at ease, sword at the order. 
 
 Commencing on the right, the inspector now proceeds to minutely 
 inspect the pouch, accoutrements, and dress of each soldier in succes- 
 sion. 
 
 After the inspector has passed each man closes and replaces the 
 pouch. 
 
 180. The inspection being completed, the junior officers come to 
 attention, carry sword and face to the front ; the officer commanding 
 again takes his post on the right, draws his sword, and facing to the 
 left commands : 
 
 1. Close ranks, 2. MARCH. 
 
 At the command march, the junior officers face about and resume 
 their posts in line of file closers ; the file closers close to two paces from 
 the rank. The officer commanding may direct the junior officers to 
 stand fast in front of the detachment. 
 
 181. If the detachment, or part of it, should be mounted, or armed 
 with revolvers, it will be inspected in this respect in accordance with 
 cavalry drill regulations. 
 
 The clothing roll will be inspected, unrolled, on the soldier's bunk at 
 inspection of quarters. 
 
 INSPECTION OF LITTERS. 
 
 182. The detachment being in line with strapped litters at the carry, 
 the commands are given : 
 
 I. Litters left, 2. MARCH, 3. HALT. 
 1. Inspection, 2. LITTERS. 
 At litters No. I of each squad steps back in line with No. 3, the litters 
 are opened, held suspended until inspected, and then lowered, when the 
 squads take posts at litters. 
 
INSPECTION AND MUSTER 299 
 
 INSPECTION OF AMBULANCES. 
 
 183. The ambulances being in line at intervals often paces, with seats 
 packed, each with a squad at ambulance posts, the commands are given : 
 
 I. Inspection, 2. AMBULANCES; 
 when each squad steps back three paces in rear of its ambulance. The 
 inspector first examines the animals and harness, then the ambulance 
 and contents, after which he directs the seats to be prepared, or such 
 other work to be done as he desires executed. 
 
 MUSTER. 
 
 184. All stated musters of the detachment are, when practicable, pre- 
 ceded by a minute and careful inspection. 
 
 The detachment being in line with ranks open, the officer command- 
 ing, upon intimation of the mustering officer, commands : 
 
 Attention to muster. 
 
 He then returns sword, and hands a roll of the Hospital Corps de- 
 tachment, with a list of absentees, to the mustering officer. The latter 
 calls over the names on the roll; each man, as his name is called, 
 answers, " Here," and steps forward one pace. The muster completed, 
 the ranks are closed and the detachment dismissed. 
 
 After mustering, the presence of the men reported in the hospital or 
 on duty is verified by the mustering officer, who is accompanied by the 
 officer commanding. 
 
 CLOTHING ROLL. 
 
 The articles heretofore carried in the knapsack or blanket bag will, 
 together with the overcoat, be rolled in the piece of shelter tent supplied 
 each soldier, and carried in the transportation wagon, or in the ambu- 
 lance when no other transportation is provided. When the soldier is 
 mounted and no wheel transportation is available, they will be carried on 
 the saddle, as directed in the drill regulations for the cavalry. 
 Contents : 
 
 1 woollen blanket ; 1 towel ; 
 
 1 blue flannel shirt ; 5 shelter tent pegs ; 
 
 1 undershirt ; 2 shelter tent poles ; 
 
 1 pair drawers ; 1 overcoat. 
 
 2 pair socks ; 
 
 The roll, which should, when completed, be 26 inches in length, is 
 packed as follows : 
 
 First, spread out the blanket upon the ground, and turn in its sides, 
 making them overlap in such manner that the blanket, when so folded, 
 shall equal in width the length of the longer shelter tent pole. Double 
 
300 
 
 EMERGENCIES AND ACCIDENTS 
 
 the blanket lengthwise, bringing the upper end 18 inches short of the 
 lower end. Upon the doubled end of the blanket place, in the following 
 order, the flannel shirt, undershirt, socks, drawers, and towel, so folded 
 as to equal width of blanket. 
 
 SCHEME FOR PACKING HOSPITAL CORPS POUCH. 
 
 Rear (in loops). 
 
 Case with 
 scissors, pins, etc. 
 
 Roll of 
 wire gauze. 
 
 Flask with 
 
 ammonise spiritus 
 
 aromaticus. 
 
 Rubber 
 
 tourniquet. 
 
 Knife. 
 
 Front. 
 
 
 
 
 
 
 
 
 
 Packet. 
 
 
 Packet. 
 
 
 racket. 
 
 
 
 
 
 
 
 
 
 
 Packet. 
 
 
 Packet. 
 
 
 Packet, 
 
 
 
 
 
 
 
 
 
 Bottom. 
 
 Six roller bandages. 
 
 Spool plaster 
 
 Next, arrange pegs of shelter tent at upper end of clothing, three on 
 one side and two on the other, points inward, bases flush with outer 
 edge of clothing. On these place the shoes, one on each side, soles up, 
 toes inward. Now roll tightly (beginning at bundle of clothing) as far 
 
POUCHES AND BLANKET ROLL 
 
 30I 
 
 as the blanket is doubled. Turn up the remaining 18 inches of the 
 blanket, and pull the upper thickness of this end over the bundle, thus 
 securing it. The poles are now laid upon the bundle, and the overcoat, 
 folded with its inside outward in such manner as to equal the width of the 
 
 SCHEME FOR PACKING ORDERLY POUCH. 
 
 Rear (chiefly in loops). 
 
 Chloro- 
 form in 
 case. 
 
 Roll wire 
 gauze. 
 
 Spools adhesive plaster. 
 
 Bottle 
 
 catgut 
 
 ligatures. 
 
 Ammonise 
 spiritus 
 
 aroruaticus. 
 in flask. 
 
 Hypodermic 
 syringe. 
 
 Mist. 
 
 chloroformi 
 
 et opii, 
 
 in case. 
 
 Front. 
 
 Packet. 
 
 Packet. 
 
 Catheter, 
 in case. 
 
 Pins. 
 
 Packet. 
 
 Diagnosis 
 tags. 
 
 Pocket 
 case. 
 
 Packet. 
 
 In tray at bottom. 
 
 Four packages gauze. 
 Six roller bandages. 
 
 Rubber tourniaueL 
 Antiseptic tablets. 
 
 previous bundle, is rolled round the latter. Finally, the roll is completed 
 by spreading out the shelter-tent half, folding in the rear flap, placing 
 the bundle upon the flap, turning in the sides of the tent and rolling 
 tightly. The whole is now secured by the straps furnished for the 
 purpose. 
 
302 
 
 EMERGENCIES AND ACCIDENTS 
 
 POSITION OF THE MEDICAL OFFICERS, HOSPITAL CORPS 
 DETACHMENT, AND AMBULANCES ON THE MARCH. 
 
 The position of the medical department of a marching 
 command is immediately in rear of the rear company of the 
 organization to which it pertains, and in front of the rear 
 guard, if necessary. 
 
 With each ambulance is a driver and an ambulance orderly. 
 
 In camp the ambulances and medical department wagons 
 are parked near the field hospital, and not with the wagon 
 train. 
 
 ^m 
 
 /f\ 
 
 Fig. 175. — Hospital Corps Bugle Call. 
 
Part IV 
 
 THE CARE OF THE HUMAN MACHINE 
 
CHAPTER XXIX 
 SANITARY SUGGESTIONS 
 
 The human body resembles other machines in requiring 
 proper care to maintain it in good order. It must be suitably 
 housed and protected, the effects of wear and tear must be 
 removed and harmful extraneous matters must not be per- 
 mitted to reach it, it must be kept clean and sufficient power- 
 producing matter or fuel must be provided for it. 
 
 Dwellings. — For privacy and protection, man is accus- 
 tomed to build for himself shelters varying in extent from 
 the wickyup of the savage to the palace of the prince. By so 
 doing he introduces a fruitful source of disease. The con- 
 finement of the air within the walls of a dwelling compels it 
 to be breathed repeatedly until, by the extraction of all of its 
 nourishing elements and the pollution derived from the em- 
 anations of living bodies, it is not only no longer capable of 
 supporting life, but is a direct cause of death. The process 
 of supplying fresh air to dwellings is called ventilation. 
 
 Ventilation. — The reasons for the necessity of an abun- 
 dant supply of fresh air have already been considered (pages 
 69 and 70). Ventilation is usually accomplished by the flow 
 of air in and out of doors and windows. More than one per 
 1000 of carbonic acid in the air is injurious, and rooms 
 should be of a sufficient size to permit the constant introduc- 
 tion of enough fresh air and the prompt removal of enough 
 contaminated air to keep the percentage continually below 
 this point without the production of a draught. This can be 
 accomplished by limiting the number of well persons in a 
 room to such a degree that each one shall have about 800 
 cubic feet of air-space, or a portion measuring nine feet in 
 each direction ; in this case the entire bulk of air would need 
 to be renewed but once in twenty minutes, which can readily 
 
 305 
 
306 THE CARE OF THE HUMAN MACHINE 
 
 be accomplished by the ordinary means of doors and win- 
 dows. In case of the sick, the requisite air space is double 
 the amount named. 
 
 The presence of foul air in dwellings — whether due to the 
 breath of persons crowding a room or to other causes — is a 
 fertile source of certain diseases, such as consumption, mala- 
 rial affections, typhoid and typhus fevers, and the like. For 
 this reason homes should not only be provided with proper 
 ventilation, but swampy surroundings, foul cellars, cesspools 
 or pools formed by accumulations of slops, uncared-for water- 
 closets, and sewer openings should be avoided as far as 
 practicable and, when existing, should be rendered as harm- 
 less as possible by disinfection. 
 
 Disinfection. — Certain agents, when applied to disease- 
 inducing matters, destroy their power. These agents are 
 disinfectants, and the process of applying them is disinfection. 
 
 The term disinfectant has popularly been applied to agents 
 which counteract offensive odors — deodorizers — or arrest 
 decay — antiseptics. This is an error, for many of these 
 agents are entirely without effect upon disease germs. A 
 large number of the proprietory " disinfectants " advertised 
 in the public press are of this character. 
 
 The more valuable agents for disinfection are four in number : 
 
 i . Heat. — A temperature elevated to the boiling-point or 
 higher is the most efficient of disinfectants ; it is also a deo- 
 dorizer and an antiseptic. Boiling for half an hour destroys 
 germs of the greatest vitality. Infected materials, which will 
 not be harmed by it, may be treated either in this way or by 
 the application of superheated steam. 
 
 2. Corrosive Sublimate. — Known also as bichloride of 
 mercury, this is the most powerful chemical germicide, and 
 consequently, for purposes where heat is not practicable, the 
 most efficient germicide known. 
 
 For Disinfection of Clothing. — Fifteen grains should be 
 dissolved in a gallon of water, with one-half grain of 
 permanganate of potassium. The clothing must be 
 thoroughly soaked in this solution for at least two hours, 
 after which it may be laundered in the ordinary way. 
 
DISINFECTION AND DISINFECTANTS 307 
 
 For Disiiifectio?i of Other Infections Matter. — Two 
 drachms each of corrosive sublimate and permanganate 
 of potassium should be dissolved in a gallon of water. 
 
 3. Chloride of Lwie. — Popularly known as "bleaching 
 powder, 1 *' this agent is especially useful in disinfecting the 
 discharges from the body or foul soil of any kind. It is also 
 a deodorant. 
 
 For Ordinary Disinfection. — One part of chloride of 
 lime with nine parts of dry earth is an excellent dis- 
 infectant sprinkled copiously into privy vaults, cess- 
 pools, etc. 
 
 For Disinfection of Infections Matter. — Four ounces of 
 chloride of lime dissolved in a gallon of water form 
 a solution into which should be passed the discharges 
 from cholera, typhoid fever, and other affections hav- 
 ing discharges of an infectious character. 
 
 4. Sulphur. — Sulphur may be used in the form of roll 
 sulphur or brimstone or cast into sulphur candles. The 
 disinfecting element is sulphurous acid gas, which is liberated 
 by burning. To get the effect of this agent, every aperture 
 in a room must be tightly closed to prevent its escape, and 
 three pounds of sulphur used for every thousand cubic feet of 
 air-space. The sulphur should be broken into small pieces 
 and moistened with alcohol before lighting. To obviate the 
 danger of fire, it should be placed in a shallow iron pan set 
 upon a couple of bricks in a tub partly full of water. After 
 twenty-four hours the doors and windows should be thrown 
 wide open to permit the sulphurous acid gas to be blown out. 
 
 The stools in cholera and typhoid fever, and probably in epidemic 
 dysentery, consumption, diphtheria, and yellow, scarlet, and typhus fevers 
 are infectious. The vomited matter in cholera, diphtheria, and yellow 
 and scarlet fevers is liable to convey infection ; and the expectoration 
 of consumption, diphtheria, scarlet fever, and infectious pneumonia is 
 similarly dangerous. They should all then be discharged into vessels 
 containing enough corrosive sublimate or chloride of lime solution to 
 cover them. 
 
 Clothing contaminated by small-pox, scarlet fever, and other con- 
 tagious diseases may be disinfected by immediately boiling it or by 
 soaking it in a corrosive sublimate solution. But clothing and beddifTg 
 
308 THE CARE OF THE HUMAN MACHINE 
 
 too bulky, or otherwise unsuited to such treatment, should be burned 
 without delay. 
 
 During the occupation of a room by a subject of infectious disease 
 it cannot be disinfected except by free ventilation, — removing the con- 
 taminated and introducing fresh air. To render this easier, the carpets, 
 pictures, hangings, and all unnecessary furniture should be removed 
 when the room is given to the patient. 
 
 After the removal from a room, by death or recovery, of a subject of 
 infectious disease, the walls, ceiling, and floor should be washed with a 
 solution formed by the addition of a pint of the stronger corrosive 
 sublimate solution to four gallons of water. All woodwork should be 
 scrubbed with soap and water. After this the room may also be fumi- 
 gated with sulphur. 
 
 Centres of putrefaction, such as cesspools, drains, and privy vaults 
 may be treated with the weaker sublimate solution, or with chloride of 
 lime in solution or in powder, as may be convenient. 
 
 Food and drink are readily and infallibly disinfected by cooking. 
 Boiling or roasting for half an hour destroys the most active germs. 
 In case of an epidemic of cholera or typhoid fever, nothing should be 
 taken into the stomach that has not been so treated. 
 
 Deodorization. — As already remarked, certain agents are 
 of value in overcoming offensive odors, although not useful 
 as disinfectants. 
 
 Dry earth, wood ashes, and powdered charcoal belong to 
 this class, and are to be applied by free sprinkling. 
 
 Chloride of zinc, an ounce dissolved in a quart of water, is 
 an effective deodorant. 
 
 Chloride of lime, in solution and in powder, belongs to 
 both classes. 
 
 Cleanliness. — Nothing is a more efficient preventive of 
 sickness than cleanliness of person, habitation, and surround- 
 ings. Filth of every kind is a most favorable soil for the 
 culture of disease. The surroundings of a dwelling, then? 
 should be carefully cleaned, no piles of decaying matter — 
 either vegetable or animal — being permitted. That the 
 house itself should be kept clean goes without saying. 
 
 The skin throws off every day two or three pounds cf ex- 
 crementitious matters, both solid and liquid, and to insure its 
 proper action, they must be removed. If they are permitted 
 to' remain, decomposition soon sets in, and the skin is then 
 
CLEANLINESS AND CLOTHING 3O9 
 
 covered with a layer of decaying matter which closes the 
 pores and paves the way for much ill-health. When practi- 
 cable, then, the entire person should be bathed daily with 
 fresh water, or, better, with a solution of an ounce of car- 
 bonate of soda to the gallon of water. 
 
 Clothing. — The prime object of clothing being the pro- 
 tection of the body from the harmful action of atmospheric 
 heat, cold, and moisture, it follows that the clothing should 
 be modified from time to time to suit the weather. The mate- 
 rials should vary in weight, texture, and character, according 
 to the season and the latitude, since both extremes of bodily 
 temperature are equally dangerous to health. The fit of the 
 clothing is of importance, for ill-fitting clothing is apt to be 
 chafing to the body as well as to the spirit. 
 
 Chafing occurs chiefly in the bends of the joints, such as 
 the armpits, elbows, and knees, and between the thighs, but 
 it may appear at any point where the clothing rubs the skin. 
 The chafed parts should be carefully washed with soap and 
 water and thoroughly dried ; they may then be dusted with a 
 suitable bland powder, such as magnesia, fuller's earth, and 
 even starch, meal, or flour, although the latter are objection- 
 able on account of their liability to form with the perspira- 
 tion a sour and irritating paste. 
 
 Foot-soreness is chiefly due to ill-fitting shoes, although it 
 may arise from other causes.. It is a common complaint in 
 marching. Soaking in hot salt water, or alum and water, the 
 night before is said to reduce the liability to foot-soreness. 
 Rubbing the feet with grease of any kind before starting is 
 an advantage. In the German army there is sifted into the 
 shoes and stockings, to prevent trouble with the feet, a pow- 
 der composed of three parts by weight of salicylic acid, ten 
 of starch, and eighty-seven of powdered soapstone. Blisters 
 should be opened at the end of the march by pricking at 
 either end and gently pressing the fluid out of the openings, 
 taking care not to break the skin. Where the difficulty is 
 due to inflamed corns, bunions, or ingrowing toenail, the 
 surgeon should apply the treatment. 
 
3io 
 
 THE CARE OF THE HUMAN MACHINE 
 
 Food. — The food forms an important part of the fuel of 
 the human machine. The more easy the digestion, — the 
 process of extracting the portions of the fuel utilizable in 
 the machine, — the more easily the machine runs. The fol- 
 lowing table, showing comparatively the time required for 
 the digestion of some of the more common articles of diet, 
 may serve as a guide to the selection of food for the body — 
 fuel for the machine : — 
 
 Rice, Boiled 
 Tripe, Boiled 
 
 Eggs, Uncooked 
 Tapioca 
 Barley or Sago 
 Milk, Boiled 
 Codfish 
 
 Turkey, Roast 
 Lamb, Roast 
 Beans 
 Potatoes 
 
 i hour. 
 
 > 2 hours. 
 
 [- 25 hours. 
 
 Beef, Roast 
 Mutton, Roast 
 Oysters 
 Eggs, Soft 
 
 Bread 
 Butter 
 Cheese 
 Eggs, Hard 
 Eggs, B'ried 
 
 Duck 
 Chicken 
 
 Veal, Roast 
 Pork, Roast 
 
 } 3 hours. 
 
 - 35 hours. 
 
 hours. 
 
 [ 4! hours. 
 
 The amount of food required to maintain a healthful exist- 
 ence varies according to the individual and his occupation. 
 Physiologists have carefully worked out the proportion of the 
 various elements required for this purpose. The ration of 
 the United States soldier, while not absolutely complete as 
 a dietary, perhaps approaches as nearly the amount needed 
 daily by a healthy man as may be required. It contains — 
 
 Fresh beef or other fresh meat 
 
 or Salt beef 
 
 or Salt pork or bacon, or canned beef 
 
 Potatoes 
 
 or Potatoes } 
 and Onions j 
 
 or Potatoes 
 and Tomatoes (or other vegetables in cans) 
 
 Sugar 
 
 Salt 
 
 20 oz. 
 
 22 
 
 12 
 
 16 
 
 12.8 
 
 3-2 
 
 II. 2 
 
 4.8 
 
 2.4 
 
 .64 
 
FOOD 
 
 311 
 
 Pepper . 
 
 Flour 
 or Soft bread 
 or Hard bread 
 or Corn meal 
 
 Beans or peas 
 
 Rice or hominy 
 
 Coffee, green 
 or Coffee, roasted 
 or Tea 
 
 Vinegar . 
 
 Soap 
 
 Where illuminating oil is not furnished, .24 oz 
 field, when necessary, .48 oz. yeast powder. 
 
 .04 oz. 
 18 
 18 
 16 
 20 
 2.4 
 1.6 
 1.6 
 1.28 
 •32 
 
 .04 qt. 
 .48 oz. 
 
 candles ; and in the 
 
 Of equal if not greater importance than the amount of 
 food is its proper preparation. As has been remarked in 
 connection with the sense of taste, the rendering food savory 
 and digestible, and serving it in a tempting manner, is a study 
 worthy the attention of a higher grade of talent than is ordi- 
 narily devoted to it. Recent experiments by Edward Atkin- 
 son have shown that the art of cookery is still in its infancy. 
 It is impossible, however, within the limits of this Manual to 
 do more than to call attention to the deficiency and to urge 
 a more general attention to the subject. 
 
INDEX 
 
INDEX 
 
 Accidents, how to act in, 119. 
 Acid, prussic, poisoning by, 229. 
 Acids, poisoning by, 227. 
 Aconite poisoning, 229. 
 Adam's apple, 16. 
 Adipose tissue, 6. 
 Air supply, 305. 
 Alimentary canal, 70. 
 Alkalies, poisoning by, 227. 
 Almonds, bitter, poisoning by oil 
 
 of, 229. 
 Ambulance corps, 238. 
 Ambulance drill, 292. 
 Ambulance station, 241. 
 Ammonia poisoning, 227. 
 Anatomy of man, see Human ma- 
 chine, 1. 
 Antisepsis, 89, 90. 
 Antiseptic surgery, 107. 
 Apoplexy, 204. 
 
 Aqua fortis, poisoning by, 227. 
 Arm, bleeding from arteries of, 155 ; 
 broken, 183 ; slings for, 95, 103 ; 
 triangular bandages for, 98. 
 Army, first-aid organization, 236. 
 Arteries, 52. 
 
 and veins, difference between, 57. 
 
 bleeding from, 146. 
 
 of body, bleeding from, 158. 
 
 of elbow, bleeding from, 157. 
 
 of foot, bleeding from, 161. 
 
 of forearm, bleeding from, 157. 
 
 of hand, bleeding from, 158. 
 
 of head, bleeding from, 153. 
 
 of knee, bleeding from, 160. 
 
 of leg, bleeding from, 161. 
 
 of lower extremity, bleeding from, 
 158. 
 
 of neck, bleeding from, 154. 
 
 of thigh, bleeding from, 160. 
 
 of upper extremity, bleeding 
 from, 155. 
 
 Arteries, principal, 57. 
 
 pulmonary, 66. 
 Arrows and fish-hooks, wounds by, 
 
 141. 
 Arsenic poisoning, 228. 
 Ash berries, poisoning by moun- 
 tain, 229. 
 Asphyxia, 214. 
 Atropia poisoning, 229. 
 
 Bacilli, 87. 
 
 Back, triangular bandage for, 97. 
 
 Bacteria, 87. 
 
 Bandage, arm sling, roller, 103. 
 
 double-headed roller, 106. 
 
 four-tailed, 101. 
 
 hardened, 106. 
 
 method of rolling a, 103. 
 
 roller, 101. 
 
 square, 100. 
 
 triangular, 93. 
 
 turns and reverses, 104. 
 Battle-field, emergencies of, 236. 
 Bearer drill, 245. 
 Bearers, company, 236. 
 Belladonna poisoning, 229. 
 Berries, poisoning by, 229. 
 Bites, dog, 232. 
 
 insect, 233. 
 
 snake, 233. 
 
 tarantula, 233. 
 Bittersweet berries, poisoning by, 
 
 229. 
 Black-heads, 4. 
 Bladder, 78. 
 Bleeding, 145. 
 
 from arteries, treatment of, 149. 
 
 of body, 158. 
 
 of elbow, 157. 
 
 of foot, 161. 
 
 of forearm, 157. 
 
 of hand, 158. 
 
3i6 
 
 INDEX 
 
 Bleeding of head, 153. 
 
 of knee, 160. 
 
 of leg, 161. 
 
 of lower extremity, 158. 
 
 of neck, 154. 
 
 of thigh, 160. 
 
 of upper extremity, 155. 
 
 from the nose, 166. 
 
 from wounds of capillaries, 163. 
 
 from wounds of veins, 162. 
 
 internal, 167. 
 
 secondary, 167. 
 
 special susceptibility to, 168. 
 Blood, 46. 
 
 circulation of, 54. 
 
 clotting, 48. 
 
 corpuscles, 47. 
 
 functions of, 49. 
 
 spitting of, 164. 
 Blood-vessels, 52, 57. 
 Body, bleeding from arteries of, 158. 
 Bones, 6, 10. 
 
 ankle, 23. 
 
 arm, 18. 
 
 arm, broken, 183. 
 
 back, 14. 
 
 breast, 17. 
 
 broken, 172. 
 
 carpus, 20. 
 
 cheek, 12. 
 
 chest, 16. 
 
 clavicle, 18. 
 
 coccyx, 15. 
 
 collar, 18. 
 
 collar, broken, 182. 
 
 femur, 22. 
 
 fibula, 23. 
 
 fingers, 20. 
 
 fingers, broken, 186. 
 
 foot, 24. 
 
 foot, broken, 191. 
 
 forearm, 19. 
 
 forearm, broken, 184. 
 
 hand, 20. 
 
 hand, broken, 186. 
 
 hip, 21. 
 
 humerus, 18. 
 
 hyoid, 16. 
 
 innominate, 21. 
 
 instep, 24. 
 
 jaw, 12, 13. 
 
 jaw, broken, 181. 
 
 knee-cap, 23. 
 
 Bones, knee-cap, broken, 190. 
 
 lachrymal, 12. 
 
 leg, 23. 
 
 leg, broken, 190. 
 
 malar, 12. 
 
 malleolus, 23. 
 
 maxillary, 12. 
 
 nasal, 12. 
 
 nose, broken, 181. 
 
 occipital, 11. 
 
 palate, 12. 
 
 patella, 23. 
 
 pelvic, 21. 
 
 pelvic, broken, 188. 
 
 radius, 19. 
 
 ribs, 16. 
 
 ribs, broken, 187. 
 
 rump, 15. 
 
 sacrum, 15. 
 
 scapula, 17. 
 
 sesamoid, 9. 
 
 shoulder blade, 17. 
 
 shoulder blade, broken, 183. 
 
 skull, broken, 180. 
 
 sphenoid, 11. 
 
 spinal, 14. 
 
 spinal, broken, 186. 
 
 sternum, 17. 
 
 teeth, 12. 
 
 temporal, 11. 
 
 thigh, 22. 
 
 thigh, broken, 188, 
 
 thorax, 16. 
 
 tibia, 23. 
 
 ulna, 19. 
 
 wormian, 9. 
 
 wrist, 20. 
 
 wrist, broken, 185. 
 Bowels, 73, jj. 
 Brain, 36. 
 
 compression of, 203. 
 
 concussion of, 201. 
 
 membranes, 43. 
 
 structure, 41. 
 Breath, 67. 
 
 nourishment from, 69. 
 
 poison in, 69. 
 Breathing, 67. 
 
 and speaking apparatus, 64. 
 
 indications of different kinds of, 
 124. 
 
 restoring the, 215, 218. 
 Broken bones, 172. 
 
INDEX 
 
 317 
 
 Bronchial tubes, 66. 
 Bruises, 125. 
 Burning clothing, 130. 
 Burns, 127. 
 
 Callosities, 4. 
 Calomel poisoning, 228. 
 Capelline bandage, 106. 
 Capillaries, 53. 
 
 bleeding from, 148. 
 
 bleeding from wounds of, 163. 
 Carbonic acid in breath, 69. 
 Cartilages, 16, 17, 28. 
 Caustic poisoning, 227. 
 Centipede sting, 233. 
 Cerebellum, 37. 
 Cerebrum, 37. 
 Chafing, 309. 
 Chest, 16, 66. 
 
 triangular bandage for, 97. 
 
 wounds of, 141. 
 Chilblains, 132. 
 Chloral poisoning, 228. 
 Chloride of lime as a disinfectant, 
 
 3°7- 
 Choking, 195. 
 Circulation of blood, 54. 
 Clavicle, fracture of, 182. 
 Cleanliness, 308. 
 Clothing, 309. 
 Clove hitch, 92. 
 Collar bone, broken, 182. 
 Company bearers, 236. 
 Compression of brain, 203. 
 Concussion of the brain, 201. 
 Contagious disease, disinfection in, 
 
 3°7- 
 
 Contusions, 125. 
 
 Convulsions, 211. 
 
 Copper poisoning, 228. 
 
 Copperas poisoning, 228. 
 
 Corda dorsalis, 9. 
 
 Corrosive sublimate as a disinfect- 
 ant, 306. 
 poisoning, 228. 
 
 Coughing, 68. 
 
 Cranium, 9. 
 
 Cuts, see Wounds. 
 
 Cynanide of potash, poisoning by, 
 229. 
 
 Death, 234. 
 proofs of, 235. 
 
 Deodorization, 308. 
 Dermis or true skin, 4. 
 Digestion of food, 310. 
 
 process of, 75. 
 Digestive apparatus, 70. 
 Disabled, carrying {see also Hospi- 
 tal corps drill), 244. 
 Diseases, indications of, 123. 
 Disinfection, 306. 
 Dislocations, 169. 
 Dizziness, 124. 
 Dog bites, 232. 
 Dressings, 107. 
 Dressing packet, first, 109. 
 Dressing station, first, 240. 
 Drill, ambulance, 292. 
 
 bearer, 245, 284. 
 
 hospital corps, 244. 
 
 litter, 258. 
 Drowning, resuscitation from, 217. 
 
 rescuing the, 221, 223. 
 Drunkenness, 206. 
 Dwellings, hygiene of. 305. 
 
 Ears, 80. 
 
 foreign body in, 193. 
 Elbow, bleeding from arteries of, 
 
 157. 
 
 broken, 184. 
 
 roller bandage for, 105. 
 
 triangular bandage for, 98. 
 Emergencies, how to act in, 119. 
 Emetics, 230. 
 Endosteum, 8. 
 Epidermis, or scarf-skin, 3. 
 Epilepsy, 211. 
 Esmarch's bandage, 93. 
 Excretion, apparatus for, 76. 
 Examination of an injured person, 
 
 122. 
 Eye, 82. 
 
 foreign body in, 192. 
 
 Face, see Black-heads. 
 
 bones of, 9. 
 
 triangular bandage for, 97. 
 Fainting, 196, 198. 
 Palling sickness, 211. 
 Fat, 5. 
 
 Femur, broken, 188. 
 Fevers and infection, 306. 
 Fibula, broken, 190. 
 Fingers, broken, 186. 
 
INDEX 
 
 Fingers, dislocations of, 170. 
 
 roller bandage for, 105. 
 First-dressing packet, 109. 
 Fish-hooks and arrows, wounds 
 
 by, 141. 
 Fits, 211. 
 
 children's, 213. 
 
 epileptic, 211. 
 Fomentations, 114, 115. 
 Fontanelles, 9, 11. 
 Foods, digestion of, 70. 
 
 hygiene of, 310. 
 
 ration of the soldier, 310. 
 Foot, bleeding from arteries of, 161. 
 
 broken, 191. 
 
 roller bandage for, 105, 106. 
 
 triangular bandage for, 100. 
 Foot-soreness, 309. 
 Forearm, bleeding from arteries of, 
 
 157. 
 
 broken, 184. 
 
 roller bandage for, 105. 
 
 triangular bandage for, 99. 
 Foreign body in the ear, 193. 
 
 in the eye, 192. 
 
 in the nose, 194. 
 
 in the throat, 195. 
 Fowler's solution, poisoning by, 
 
 228. 
 Fracture, 172. 
 
 at elbow, 184. 
 
 at wrist, 185. 
 Fracture, compound, 173. 
 
 in the hand, 186. 
 
 of arm, 183. 
 
 of collar bone, 182. 
 
 of fingers, 186. 
 
 of foot, 191. 
 
 of forearm, 184. 
 
 of jaw, 181. 
 
 of knee-cap, 190. 
 
 of leg, 190. 
 
 of nose, 181. 
 
 of pelvis, 188. 
 
 of ribs, 187. 
 
 of skull, 180. 
 
 of spine, 186. 
 
 of thigh, 188. 
 
 simple, 173. 
 Freezing, 131. 
 
 insensibility from, 210. 
 Frostbite, 131. 
 
 Gases, smothering by, 223. 
 
 Gauze for dressings, 107. 
 
 Geneva Convention, provisions of, 
 
 239- 
 Germicides, 89, 90. 
 Germs, 87. 
 Glands, salivary, 71. 
 
 sebaceous, 4. 
 
 sweat, 4. 
 
 vascular, 64. 
 Granulations, 144. 
 Green coloring-matter, poisoning 
 by, 228. 
 
 Paris, poisoning by, 228. 
 
 vitriol, poisoning, 228. 
 Gunshot wounds, 141. 
 Gullet, 71. 
 Guts, 73. 
 
 Hair, nails, and warts, 4. 
 Hand, bleeding from arteries of, 
 158. 
 
 broken, 186. 
 
 roller bandage for, 105. 
 
 triangular bandage for, 99. 
 Hanging, smothering by, 225. 
 Head, bleeding from arteries of, 
 
 153- 
 
 bones of, 9. 
 
 four-tailed bandage cap for, 101. 
 
 roller bandage for, 106. 
 
 square bandage for, 100. 
 
 triangular bandage for, 96, 97. 
 Healing in wounds, 144. 
 Hearing, 80. 
 Heart, 50. 
 
 Heat as a disinfectant, 306. 
 Heatstroke, 207. 
 Hellebore poisoning, 229. 
 Hemlock poisoning, 229. 
 Hemorrhage, 145. 
 
 from the lungs, 165. 
 
 secondary, 168. 
 Hiccup, 68. 
 Hip, roller bandage for, 105. 
 
 triangular bandage for, 99= 
 Hip-bones, 21. 
 
 broken, 188. 
 Hitch, clove, 92. 
 Horse-chestnut poisoning, 229. 
 Horseback, loading patient on, 288. 
 Horse-litters, 291. 
 Hospital corps, 245. 
 
INDEX 
 
 319 
 
 Hospital corps drill, 245. 
 alignments, 247. 
 ambulance drill, 292. 
 bugle call, 302. 
 formation for drill, 245. 
 horseback, placing on, 288. 
 inspection, 297. 
 litter, carrying without, 284. 
 drill, 258. 
 
 drill with closed, 260. 
 drill with improvised, 282. 
 drill with loaded, 271. 
 drill with open, 263. 
 two-horse, 291. 
 marchings, 248. 
 
 with litter, 268. 
 muster, 301. 
 
 obstacles, carrying litter past, 276. 
 travois drill with, 289. 
 turnings, 251. 
 
 wagons for carrying wounded, 
 296. 
 Hospital, field, 243. 
 stewards, 237. 
 acting, 237. 
 Human machine, 1. 
 Humerus, fracture of, 183. 
 Hunchback, cause of, 15. 
 Hygiene, 305. 
 Hysterics, 212. 
 
 Knee, triangular bandage for, 100, 
 Knee-cap, broken, 190. 
 Knot, clove-hitch, 92. 
 
 false, 91. 
 
 granny, 91. 
 
 reef, 91. 
 
 square, 91. 
 
 surgeon's, 92. 
 
 Larynx, 65. 
 
 Laudanum poisoning, 228. 
 
 Laurel water poisoning, 229. 
 
 Lead poisoning, 229. 
 
 Leg, bleeding from arteries of, 161. 
 
 broken, 190. 
 
 roller bandages for, 106. 
 
 triangular bandage for, 100. 
 Lettuce, wild, poisoning by, 229. 
 Ligaments, 26. 
 
 Lime chloride as a disinfectant, 307. 
 Litter, U. S. army, 258. 
 Litter-drill, 258. 
 Litter, posture of disabled on, 138, 
 
 275- 
 Liver, 74. 
 
 Lunar caustic, poisoning by, 227. 
 Lungs, 66. 
 
 action in excretion, 77. 
 
 hemorrhage from the, 165. 
 Lye poisoning, 227. 
 
 Ice, breaking through, 223. 
 
 Indian tobacco, poisoning by, 229. 
 
 Inebriation, 206. 
 
 Injured, carrying the, 244. 
 
 Insolation, 207. 
 
 Inspection of hospital corps, 297. 
 
 Instep, 24. 
 
 Intestines, 73. 
 
 Intoxication, 206. 
 
 Iron, poisoning by, 228. 
 
 Ivy poisoning, 230. 
 
 Jamestown weed, poisoning by, 
 
 229. 
 Jaw, broken, 181. 
 
 dislocation of lower, 171. 
 Joints, see Sprains, 8, 25. 
 
 dislocations of, 169. 
 
 Kidneys, jj. 
 
 Knee, bleeding from arteries of, 160. 
 roller bandage for, 106. 
 
 Matches, poisoning by, 229. 
 Medical officers, 236. 
 Medulla oblongata, 42. 
 Mercuric bichloride as a disinfect- 
 ant, 306. 
 Microbes, 87. 
 Micro-organisms, 87. 
 Morphine poisoning, 228. 
 Mouth, 65. 
 
 action on food in, 71. 
 Mumps, 71. 
 Muscles, 29. 
 
 description of, 35. 
 
 involuntary, 31. 
 
 movements of, 30. 
 
 voluntary, 30, 31. 
 Mushrooms, poisoning by, 229. 
 Mustard plaster, 116. 
 Muster of hospital corps, 301. 
 
 Nails, warts, and callosities, 4. 
 Neck, bleeding irom arteries of, 154. 
 
320 
 
 INDEX 
 
 Neck, triangular bandage for, 97. 
 Nerves, 36. 
 
 cells, 41. 
 
 cranial, 39, 43. 
 
 location of principal, 44, 45. 
 
 motor, 40. 
 
 sensory, 40. 
 
 sympathetic, 45. 
 Nightshade, deadly, poisoning by, 
 
 229. 
 Nose, 80. 
 
 broken, 181. 
 
 foreign body in, 194. 
 Nosebleed, 166. 
 Nux vomica, poisoning by, 229. 
 
 Odors, to overcome offensive, 308. 
 CEsophagus, 71. 
 Ointments, 112. 
 Opium poisoning, 228. 
 Oxygen in breath, 69. 
 
 Packet, first-dressing, 109. 
 Pancreas, 75. 
 Paralytic stroke, 204. 
 Paregoric poisoning, 228. 
 Parsley, poisoning by wild, 229. 
 Patella, broken, 190. 
 Pelvis, 21. 
 
 broken, 188. 
 Perceptive apparatus, 79. 
 Periosteum, 8. 
 Pharynx, 65. 
 Physiology of man, see Human 
 
 machine. 
 Phosphorus poisoning, 229. 
 Plaster, court, 112. 
 
 mustard, 116. 
 
 sticking, 112. 
 Poke berries, poisoning by, 229. 
 Poisoned wounds, 231. 
 Poisoning, treatment of, 226. 
 
 acids, 227. 
 
 aconite, 229. 
 
 alkalies, 227. 
 
 ammonia, 227. 
 
 aqua fortis, 227. 
 
 arsenic, 228. 
 
 atropia, 229. 
 
 belladonna, 229. 
 
 berries, 229. 
 
 bittersweet berries, 229. 
 
 blue vitriol, 228. 
 
 Poisoning, calomel, 228. 
 
 caustic, 227. 
 
 chloral, 228. 
 
 copper, 228. 
 
 copperas, 228. 
 
 corrosive sublimate, 228. 
 
 cyanide of potash, 229. 
 
 Fowler's solution, 228. 
 
 green coloring-matter, 228. 
 
 green, Paris, 228. 
 
 green vitriol, 228. 
 
 hellebore, 229. 
 
 hemlock, 229. 
 
 horse-chestnut, 229. 
 
 Indian tobacco, 229. 
 
 insensibility from, 209. 
 
 iron, 228. 
 
 ivy, 230. 
 
 Jamestown weed, 229. 
 
 laudanum, 228. 
 
 laurel water, 229. 
 
 lead, 229. 
 
 lettuce, wild, 229. 
 
 lye, 227. 
 
 matches, 229. 
 
 mercury, 228. 
 
 morphine, 228. 
 
 mountain ash berries, 229. 
 
 mushrooms, 229. 
 
 nux vomica, 229. 
 
 oil of bitter almonds, 229. 
 
 opium, 228. 
 
 paregoric, 228. 
 
 parsley, wild, 229. 
 
 poke berries, 229. 
 
 phosphorus, 229. 
 
 potash, 227. 
 
 prussic acid, 229. 
 
 rhubarb leaves, 229. 
 
 rhus, 230. 
 
 rough on rats, 228. 
 
 Scheele's green, 228. 
 
 sleeping mixture, 228. 
 
 soda, 227. 
 
 strychnia, 229. 
 
 sumac, 230. 
 
 toadstools, 229. 
 
 tobacco, 229. 
 
 verdigris, 228. 
 
 vermilion, 228. 
 
 vitriol, 227. 
 Position of injured, best, 138, 275. 
 Potash poisoning, 227. 
 
INDEX 
 
 321 
 
 Poultices, 113. 
 
 Pressure on chest, smothering by, 
 
 225. 
 Pronation, 19. 
 
 Prussic acid poisoning, 229. 
 Pulse, 56. 
 indications of the, 124. 
 
 Radius, fracture of, 184. 
 Ration of the soldier, 310. 
 Rectum, 76, 77. 
 Respiration, 67. 
 
 artificial, 215, 218. 
 Rhubarb poisoning, 229. 
 Rhus poisoning, 230. 
 Ribs, 16. 
 
 broken, 187. 
 
 triangular bandage for, 98. 
 Roller bandage, 101. 
 
 double-headed, 106. 
 Rough on rats, poisoning by, 228. 
 
 Saliva, 71. 
 
 Salves, ii2< 
 
 Sanitary soldiers, 237. 
 
 suggestions, 305. 
 Scapula, fracture of, 183. 
 Scheele's green, poisoning by, 228. 
 Scorpion sting, 233. 
 Senses, 79. 
 Shock, 199. 
 Shoulder, dislocation of, 171. 
 
 roller bandage for, 105. 
 
 triangular bandage for, 98. 
 Shoulder blade, broken, 183. 
 Sighing, 68. 
 Sight, 81. 
 
 defective, 83. 
 Singing, 68. 
 Skeleton, see Bones. 
 Skin, 3. 
 
 action in excretion, 76. 
 
 appendages of, 4. 
 
 scarf, 3. 
 
 true, 4. ' 
 Skull, 9. 
 
 broken, 180. 
 Sleeping-mixture poisoning, 228. 
 Slings for broken bones, 179. 
 
 roller bandage arm, 103. 
 
 triangular bandage for, 95. 
 Smell, 80. 
 Smells, to overcome offensive, 308. 
 
 Smothering, 214. 
 
 by gases, 223. 
 
 by hanging, 225. 
 
 by pressure on chest, 225. 
 
 by strangling, 225. 
 Snake bites, 233. 
 Sneezing, 68. 
 Soldiers, sanitary, 237. 
 Spanish windlass tourniquet, 151. 
 Speaking, 68. 
 
 and breathing apparatus, 64. 
 Spica turn of bandage, 105. 
 Spinal column, 14. 
 
 cord, 43. 
 Spine, broken, 186. 
 Spiral turns of bandage, 104. 
 Spitting of blood, 164. 
 Splinters, 140. 
 Splints, 176. 
 Sprains, 168. 
 Stewards, hospital, 237. 
 Stings, insect, 233. 
 Stomach, 71. 
 
 Strangling, smothering by, 225. 
 Stroke, paralytic, 204. 
 
 sun, 207. 
 Strychnine poisoning, 229. 
 Stunning, 201. 
 Suffocation, 214. 
 Sulphur as a disinfectant, 307. 
 Sumac poisoning, 230. 
 Sunburn, 130. 
 Sunstroke, 207. 
 Supination, 19. 
 Surgeons, military, 236. 
 Sweetbreads, 75. 
 Swooning, 198. 
 Symptoms, 123. 
 Syncope, 198. 
 Synovial membrane, 27. 
 
 Tarantula bite, 233. 
 Taste, 79. 
 Teeth, 12. 
 Tendons, 33. 
 
 Thigh, bleeding from arteries of, 
 160. 
 
 broken, 188. 
 
 roller bandage for, 106. 
 
 triangular bandage for, 100. 
 Thorax, 16. 
 
 Throat, foreign body in, 195. 
 Tibia, broken, 190. 
 
,22 
 
 INDEX 
 
 Toadstools, poisoning by, 229. 
 Tobacco poisoning, 229. 
 Travois, 289. 
 Tongue, 80. 
 Touch, 79. 
 Tourniquets, 151. 
 Transportation of disabled, 244. 
 
 Ulna, fracture of, 184. 
 Unconsciousness, 196. 
 
 Veins, 53. 
 
 and arteries, difference between, 
 
 57- 
 
 bleeding from, 147. 
 
 bleeding from wounds of, 162. 
 
 principal, 62. 
 
 pulmonary, 66. 
 Ventilation, 305. 
 
 necessity for, 70. 
 Verdigris poisoning, 228. 
 Vermilion poisoning, 228. 
 Vitriol, blue, poisoning by, 228. 
 
 green, poisoning, 228. 
 
 poisoning, 227. 
 Vocal cords, 65. 
 Voice, production of, 65. 
 Vomiting, methods of producing, 
 230. 
 
 Warts, nails, hair, 4. 
 
 Waste, apparatus for disposal of, 
 
 76. 
 Wens, 4. 
 Windpipe, 66. 
 Wounded, carrying the, 244. 
 
 posture of, 138, 275. 
 Wounds, 133. 
 
 cleansing, 135. 
 
 closing, 135. 
 
 danger of, 143. 
 
 dressing, 138. 
 
 dressings for, 107. 
 
 gunshot, 141. 
 
 healing of, 144. 
 
 of arteries, bleeding from, 149. 
 
 of capillaries, bleeding from, 163. 
 
 of chest, 141. 
 
 of veins, bleeding from, 162. 
 
 pierced or punctured, 139. 
 
 poisoned, 231. 
 
 torn or lacerated, 139. 
 
 triangular bandage for, 96. 
 Wrist, broken, 185. 
 
 roller bandage for, 105. 
 
 triangular bandage for, 99. 
 
 jSTorteooti $r?ss: 
 
 J. S. Cushing- & Co. — Berwick &. Smith. 
 
 Boston, Mass., U.S.A. 
 
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