HAND-BOOK K 
FOR THE 
SHIP’S MEDICINE CHEST. 
WASHINGTON: 
GOYEENMENT PRINTING OFFICE. 
1881. PREFA C E. 
Treasury Department, 
Document Xo. 150. 
Marine Hospital Service. 
Treasury Department, 
Office Supervising Surgeon-General, 
United States Marine Hospital Service, 
Washington, July 1, 1881. 
This book is issued only to vessels subject to the payment of 
hospital dues, and is intended to be one to which the master or 
other officer in charge of a vessel at sea may refer for information 
upon the occasion of an injury to any of the crew or the appear- 
ance of sickness among them, to aid in obtaining a knowledge of 
the art of preventing disease, to give the necessary information 
as to the means of obtaining hospital or dispensary relief, and to 
serve as a guide to the proper use of the medicine chest required 
bylaw to be kept on board. (Sec. 4569 E. S.) Technical phrase- 
ology has been avoided as much as possible, as an article couched 
in professional language would be useless or worse than useless, 
for it might be misunderstood and lead to the commission of 
positive blunders. 
It must also be remembered that the size of the book precludes 
the discussion of subjects about which more or less doubt might 
reasonably be expressed, but after all, such discussion would only 
serve as a stumbling block in the way of those who may be ex- 
pected at best, only to gain a glimmering of a science in which 
to be fully informed, requires the earnest devotion of a life-time. 
The suspicion of dogmatism, which might otherwise attach to 
the work, the writer trusts may be averted when the necessity 
for condensation is so apparent. 
JOHN B. HAMILTON, 
Supervising Surgeon-General. 
3 HAND BOOK FOR THE MEDICINE CHEST. 
PREVENTION OF DISEASE. 
When the vessel is to proceed on a foreign voyage the master 
should see that dried fruit is added to the ration required by law, 
which is elsewhere quoted. The men should have the fruit stewed 
and issued each day at supper while on the voyage. This will be 
useful in preventing the obstinate constipation which is so often 
the forerunner of sickness among sailors. The practice of climb- 
ing over the bows of a vessel to relieve the bowels is one that can- 
not with safety be practiced by landsmen, nor, in rough weather, 
by seamen, and the bowels are frequently left unrelieved for several 
days, simply from the difficulty in reaching the place which cus- 
tom has selected. This pernicious evil cannot too strongly be 
condemned nor too soon abandoned. A simple porcelain-lined 
spout set to discharge through the scuppers will answer for 
a water closet if none is provided elsewhere; it can be easily 
cleansed and is very essential to the comfort of the men. 
During the voyage the decks should be kept as dry as practi- 
cable. The ueternal swashing of the decks” by daily scrubbing- 
is one of the surest means of making a rotten and disease-breed- 
ing ship. It is often the case that a deck plank, bright on the 
surface, is completely rotten underneath. This is caused by the 
soaking which the plank receives during scrubbing. Dry scrub- 
bing with sand daily, when practicable; only occasionally scrubbing 
with water, and then drying icith a good rubber squillgee, followed 
by a dry swab, will keep the decks clean and postpone rotting. 
The Crew.—No vessel should proceed to sea unless the men compos- 
ing the crew have been examined by a competent surgeon and pro- 
nounced physically able seamen.—Provision has been made by the 
Secretary of the Treasury, by which the examinations will be made 
by medical officers of the Marine Hospital Service, at all principal 
ports of the United States. At New York, the examinations will 
be made either at the marine hospital office at the custom house, 
or at the shipping commissioner’s office. At the smaller ports the 
5 6 
HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
examinations will be made only at the marine hospital office, which 
is usually at the custom house. 
No argument is needed to show the great advantage to the 
oWners and the master of having a sound crew on board their 
vessel, nor to speak to experienced shipmasters of the disadvan- 
tages of pursuing the opposite course, for everyone who has been in 
command of a vessel must frequently have called the men aft at the 
commencement of a voyage only to find a large proportion of them 
utterly unseawortliy, and that the voyage must be made “ short- 
handed.” Be sure then that your men are sound and healthful. 
THE MEDICINE CHEST. 
The medicine cliest should be inspected by the medical officer 
of the Service who examines the crew, and should contain the fol- 
lowing articles: 
LIST OF MEDICINES AND INSTBUMENTS IN THE MEDICINE CHEST. 
Acid nitrate of mercury. 
Adhesive plaster. 
Anodyne, No. 4. 
Bandages, suspensory. 
Bandages, roller. 
Binders’ board. 
Beef juice. 
Black wash. 
Camphor, spirits. 
Castor oil. 
Calomel. 
Cholera mixture No. 10. 
Compound cathartic pills. 
Cough mixture. fi 
Chlorate potash. 
Carbolic acid. 
Carbolic solution No. 3. 
Catheter. 
Chloroform liniment, No 6. 
Cotton batting (wadding). 
Carbolized oil, No. 7, 2 a (frost bite). 
Carbolized oil and laudanum, No. 8. 
Dovers powders, 10 grs. each. 
Epsom salts. 
Flaxseed meal. 
Fid. Ext. ginger. 
Hollow needle. 
Iodoform. 
Iodide of potassium mixture No. 11. 
Laudanum. 
Lime water. 
Lint. 
Mustard. 
Mixture No. 9, for malarial fevers, pre- 
vention of. 
Mustard plasters. 
Olive oil. 
Opium. 
Opium and camphor pills. 
Powdered charcoal. 
Paregoric. 
Pills, No. 5. 
Plaster of Paris. 
Pair forceps. 
Quinine pills. 
Sweet spirits nitre. 
Saltpetre. 
Simple cerate. 
Sulphate of zinc. 
Salicylic acid pills No. 12. 
Soda bicarb. 
Syringes. 
Styptic solution No. 1. 
Styptic powder No. 2. 
Senna extract. 
Sponge. 
Saddlers’ silk. 
Surgeons’ needles. 
Sulphur ointment. 
Tincture of iron. 
Tincture of iodine. 
Tincture iron and quinine No. 14. 
Tweezers, or forceps. 
Tooth forceps. 
Vaseline, cosmoliue, or petrolina. HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
7 
No. l. 
Monsel’s solution. 
No. 2. 
Persulphate of iron. 
No. 3. 
R Carbolic acid, 10 gm. 
Glycerine, 50 f. gm. 
Aquae, q. s. ad., 500 f. gm. 
No. 4. 
Dover’s powder (in .00 gm. doses). 
No. 5. 
R Acidi galliei, 7.5 gm. 
Pulv. opii, 1 gm. 
Ft. pill No. 50. 
No. 6. 
R Chloroform, 30 f. gm. 
Tinct. opii, 30 f. gm. 
Tinct. aconiti rad., 10 f. gm. 
01. olivie, 30 f. gm. 
No. 7. 
R Ol. olivse, 10 parts. 
Carbolic acid, 10% solution, 2 parts. 
No. 8. 
R Ol. olivse, 10 parts. 
Carbolic acid, 10%solution, 2 parts. 
Tinct. opii, 4 parts. 
No. 9. 
R Quiniae sulph., 2.5 gm. 
Cinclioniae sulph., 3.5 gm. 
Acidi sulpli. dil., q. s. 
Tinct. opii, 3.5 f. gm. 
Aquae menth. pip., ad 100 f. gm. 
Dose. A teaspoonful in water. 
No. 10. 
R Tinct. capsici, 10 f. gmi 
Tinct. opii, 25 f. gm. 
Tinct. camph., 25 f. gm. 
Spts. ammoniae aroin., 25 f. gm. 
Ethcris sulpli., 10 f. gm. 
Dose. A teaspoonful in water. 
No. 11. 
R Potassii iodidi, 10 gm. 
Syr. sarsap. co. 
Aquae aurantii, aa 50 f. gm. 
Dose. A teaspoonful in water. 
No. 12. 
Salicylic acid pills, .3 gm. 
No. 13. 
R Ammonii chlor., 1.5 gm. 
Ext. scillae lid., 3 f. gm. 
Ext. senegae Ad., 3 f. gm. 
Tr. opii camph., 20 f. gm. 
Syr. tolut., 20 f. gm. 
Aquae, q. s., ad 100 f. gm. 
Dose. A teaspoonfnl. 
It is supposed that before starting to sea the master will have 
carefully inspected his medicine chest, and have ascertained that 
it is furnished with all the articles enumerated above. 
ACCIDENTS. 
Treatment.—The first thing to be done in case of an injury, is to 
ascertain its nature by a careful examination of the patient. If 
the patient has fallen from aloft and is unconscious, this will be a 
matter of more or less difficulty. If there be no injury apparent, 
the clothes of the patient should be removed and the body care- 
fully examined for bruises or wounds. Should any wound bleed, 
the blood vessels should be secured in the wound if the bleeding 
is by jets. This is best done by taking a delicate pair of forceps 
or tweezers and seizing the bleeding artery while an assistant 
ties the vessel between the wounded end of the artery and the 8 
body. When this is done the other end of the artery should be 
secured in the same manner if possible. In case a wound is not 
large enough to enable the master to see the point from which the 
spurting takes place, it is a very proper procedure to enlarge 
the wound with a knife. Whenever the blood is oozing or does 
not come by jets or jumps, the bleeding can usually be stopped 
by the use of lint. When the lint is applied and a bandage firmly 
secured over the wound, pressing it tightly, and if from certain 
of the system the bleeding still continues, it will be 
proper to make use of the styptic solution (No. 1), with which the 
lint should be soaked before it is applied. 
HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
BURNS AND SCALDS. 
Treatment.—In case the burn or scald is slight, sprinkle with 
bicarb, soda or apply cloths wet with solution of soda or borax. 
If neither of these are at hand, flour may be dusted over the 
burnt surface, thus forming a crust, which is not to be removed 
until it falls off. 
In severe cases apply carbolized-oil mixture (No. 8), and cover 
with cotton wool, keeping the parts well saturated with the mix- 
ture, and changing the dressings only often enough to insure 
cleanliness. Pain may be relieved by giving a dose of anodyne 
(No. 4), and the strength of the patient supported with generous 
food, and, if necessary, stimulants. 
INJURIES OF THE HEAD. 
When a man has received an injury about the scalp or face it 
should be carefully examined to see the nature of the bleeding, 
whether by spurts or oozing; and, secondly, to see whether there 
be any fracture or breaking of bones. For the purpose of this 
examination the wound should be well cleaned with a sponge 
and the little finger introduced into it, and if any fracture has 
taken place it can usually be easily discovered. 
Treatment.—But little, however, can be done by the master of the 
vessel in case of fracture except to place the man in his berth, 
well lashed, raise his head considerably above his body, and 
administer a full dose of salts in solution, if he is able to swallow. 
Opium or morphine should not be given, as its use, unless under 
the direction of a physician, might hasten a fatal result. Gruel, 
milk, or beef tea may be given the patient as diet; solid food 
should not be allowed. 
While it is a general principle among surgeons that all wounds HAND BOOK FOR THE SHI1>7S MEDICINE CHEST. 
9 
of the head are serious, yet a wound may be a simple scalp wound 
and not extend to the bone. In that event, after making an 
examination in the manner above stated, the hair should be clipped 
from about the wound with the scissors, or, if the motion of the 
vessel will permit it, shaved with a razor, and tbe edges of the 
wound stitched together by a needle threaded with silver wire. 
A piece of lint should then be wetted with the carbolic solution 
(No. 3), and laid loosely over the wound without a bandage. The 
patient should then be kept quiet three or four days. The stitches 
may be removed at the end of the third or fourth day. The stitches 
must not be drawn tightly, on account of the swelling which will 
afterwards take place. Simply bringing together the edges of 
the wound is all that is necessary. In injury of the head, if the 
patient is unconscious, and bleeding has occurred from the ears, 
it is probable that a blood-vessel has been broken within the skull, 
and the consequences of the injury are likely to be fatal. 
WOUNDS OF THE FACE. 
Treatment.—Wounds of the face can usually be treated, after 
careful cleansing, by stitching them in the same manner as wounds 
of the scalp, and using lint wetted with the solution (No. 3) in 
the same way. In order to prevent straining on the stitches, it 
will be very proper to apply strips of adhesive plaster between 
each stitch, not to exceed fths of a/n inch wride. The stitches 
should be removed earlier from the face than from any other part 
of the body, as they are liable to cause deep scars if allowed to 
remain too long. 
INJURIES OF THE CHEST. 
Injuries of the chest which are likely to come under the notice 
of a master of a vessel (except such as destroy life), will usually 
be found to be fracture of one or more of the ribs. This injury 
will be best detected by the pain that the patient feels in breath- 
ing, which will be of a sharp character, by a cough, and in some 
cases by spitting or vomiting of blood. It can also be dis- 
covered by grasping the chest of the patient with both hands, 
and moving them about over the chest during the action of 
breathing, when, if the rib be broken, a grating will be felt near 
the point where the pain is the most acute. 
Treatment.—The treatment of this injury is best accomplished 
by using broad bands of adhesive plaster one inch and a half, or 
two inches wide, reaching entirely around the chest and applied 10 
HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
horizontally from the arm-pits downward covering the whole 
chest. This plaster should be covered with a bandage from below 
upwards, also extending 
around the chest, and it 
can be fastened by taking 
a turn over one or the 
other shoulder and fasten- 
ing with a pin at the back. 
The form of this bandage 
is shown in Figure 1. 
INJURIES OF THE 
BACK. 
In a severe injury of 
the back the danger to 
be feared is from paraly- 
sis, or loss of motion and 
sensation in the legs as 
well as a loss of control of 
the bladder and bowels. 
Treatment.—For an in- 
jury of this kind a band- 
age should be applied around the hips, extending well up toward 
the chest, then the patient should be placed in his bunk and se- 
curely lashed. A Dover’s powder should be given at once, and 
repeated every two hours if there is severe pain. The next morn- 
ing, or at least within twenty-four hours, the hand should be 
placed over the belly of the patient just above the yard, and if the 
bladder is found to be full, and the patient has not passed his 
water, it should be drawn by passing a catheter into the bladder. 
The passing of the catheter will be described in speaking of strict- 
ures. If the urine is bloody, one of the pills (No. 5) should be 
given instead of the anodyne, to be repeated every three hours 
when the patient is awake, for several days. Care should be 
taken not to arouse the patient from sleep to give any of these 
pills, as they contain opium. 
Nothing can be done for the legs should they prove to be par- 
alyzed after this injury. Paralysis is a very common result of 
injuries low down on the back. 
Instances sometimes occur where a man falls from aloft and 
strikes astride a beam or bar or other object and injures his yard 
back of the purse. When this happens sometimes a stoppage of 
Fig. i. HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
11 
water will follow. If tlie catheter cannot be passed, and the vessel 
is more than three days from port, the captain will be justified in 
tapping the bladder with a hollow needle. This should be done 
by passing the needle directly into the bladder in the center ot 
the belly just above the bone. Pass it freely and directly back- 
ward into the bladder, holding the handle a little upwards toward 
the chin as the patient lies on his back. After the needle has 
passed into the bladder the urine will flow by raising the patient 
to a sitting position. This procedure should in no case be at- 
tempted if the patient is able to sustain the pain and the vessel 
is within reasonable distance of a port where the services of a sur- 
geon can be obtained. 
BROKEN BONES. 
It is not always easy to determine on examination of a patient 
whether a bone be broken or not, but in the case of any of the 
longer bones being broken the fact can usually be ascertained by 
the deformity or shortening of the limb and a grating being felt 
at the point of the injury. When practicable, the sound limb 
should be bared and placed alongside for comparison. 
FRACTURES OF THE JAW, 
Fractures of the lower jaw can usually be detected without 
difficulty, as a grat- 
ing will be felt op- 
posite the broken 
point ou move- 
ment. 
Treatment.—The 
treatment is very 
simple, and conists in molding a 
piece of binder’s board to the 
| shape of the jaw by softening in 
warm water, and, after drying, 
it should be well padded and 
fastened with a bandage. See 
Figures 2 and 3. 
Fig. 3. 
Fig. 2. 
FRACTURE OF THE FINGERS 
Treatment.—If a finger is broken it will best be treated by tak- 
ing a thin piece of board or cigar box, covering it with clothr 12 
HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
placing it on the palm side of the finger, and passing a bandage 
around the whole hand. The board should be wider than the 
hand when lying flat upon it, should reach beyond the ends of the 
fingers, and extend at least two inches along the wrist. One 
edge of the board (next to the thumb) may be hollowed out to fit 
the ball of the thumb, which need not be covered with the band- 
age. This splint should be left on the hand for two or three 
weeks. When, from time to time, the bandage becomes loose, 
it may be removed and replaced. 
FRACTURES OF THF THUMB. 
Treatment.—The bones of the thumb, if broken, may be treated 
by applying a roller bandage about the thumb and placing it on 
a splint prepared in the same manner as that for the fingers. 
FRACTURES OF THE FOREARM. 
The forearm is that part of the upper extremity which extends 
from the wrist to the elbow. There are two bones in the forearm. 
Treatment.—If the forearm 
be broken, the roller should 
not be applied to it until after 
the splints are applied, for 
the reason that if the bones 
are squeezed together by a 
bandage they may become 
united in the process of heal- 
ing, and the rolling motion 
of the arm prevented. In or- 
der therefore to keep the bones 
as far apart as possible during 
the healing process, it should 
be dressed on a splint pre- 
pared in the manner indicated 
above, well padded before be- 
ing applied. The splint should 
extend from the elbow beyond 
the ends of the fingers, and be 
wider than the hand and forearm; a shorter, broader splint should 
be applied on the back of the forearm. The roller bandage can 
Fig. 4. HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
13 
then be placed around them, binding both together, after which 
the arm should be placed across the body in a sling, with the 
thumb pointing di- rectly upward, and the hand lying flat on the 
side of the chest. The sling should also support the elbow. 
The manner of dressing this fracture is shown in Figure 4. 
FRACTURES OF THE ARM. 
The arm extends from the elbow to the shoulder. It has one 
bone. 
Treatment.—Dressing a broken arm is very simple. It consists 
in applying short splints*around the arm over the fracture, one 
on each side (four or five inches long will be sufficient), covered 
and padded as the other sifiints, and the whole surrounded with 
a bandage, in order to more certainly keep them in place. The 
fore-arm will be placed in a sling in the manner heretofore de- 
scribed. 
FRACTURES OF THE THIGH. 
The thigh extends from the hip to the knee. It has one bone. 
Fractures of the thigh are difficult to discover when they are 
high up near the hip joint, and in many cases they cannot be de- 
tected by an unprofessional person. If, however, a sailor has 
received an injury about the hip, the foot of the side injured falls 
easily on one side or the other, and the power to voluntarily roll 
the foot in any way is lost by the patient, it can be safely con- 
cluded that a fracture has taken place in or about the hip joint. 
The only treatment to be pursued in a case of this kind is to 
apply a bandage about the hip in such manner as to prevent mo- 
tion as far as possible. It is difficult to prevent motion of the 
limb even in the best hospitals and with the best appliances, 
and it becomes almost impossible on board a ship, except in the 
hands of a skillful surgeon. Let it be remembered that in all 
severe injuries of the hip, when the nature of the injury is un- 
known, it is always safe to treat the accident as though it were a 
fracture. 
When the fracture is lower down, between the hip and knee, 
it can more easily be detected by the difference in the shape 
and the great amount of shortening that takes place, as com- 
pared with the other thigh. There will be pain, the thigh itself 
will be crooked, and there will usually be a grating felt on apply- 
ing one hand over the injury and attempting to roll the foot with 
the other hand. 14 
HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
Treatment.—Place the limb on a double inclined splint, which 
must be well padded (Figs. 5 and 6). The splint is made with hinges 
at (A) and (B) so as to place the leg at any angle desired, and 
Fig. 5. 
notches are cut in the lougi>ieces (C), in which the piece on which the 
leg rests (D) catches. After the limb has been placed on the splint, 
a bandage should be passed over the limb securing it from the 
Fig. 6. 
heel to the hip. Much pain often occurs in the heel after placing 
the leg on the splint, which can be relieved by moving the pad- 
ding around the ankle or placing a pad just above the heel so as 
to raise it form the splint. 
FRACTURES OF THE LEO. 
The leg extends from the ankle to the knee, and has two bones. 
When one of these are broken there will be little if any shorten- 
ing, as they are usually but slightly thrown out of place. 
Treatment.—The easiest, and perhaps the most convenient, way HAND-BOOIv FOR THE SHIP’S MEDICINE CHEST. 
15 
to treat this injury is to place the leg in a box (Fig. 7) which must 
be well padded. This will allow free access to the leg at all times, 
as it can readily be seen by pulling 
down the hinged sides of the box. 
A weight attached to the foot may 
be applied if the fractured ends 
appear to over ride each other. 
The ship carpenter can make this 
box out of ordinary lumber, and if 
no small hinges are obtainable, bits 
of leather will answer the purpose. Holes should be bored in the 
upper edge of the sides in order that they may be tied together 
in front. The leg should be washed every second morning with 
warm water, openig the closed box at the time for this purpose. 
Fig. 7. 
FRACTURES OF THE RONES OF THE FOOT. 
Fractures of the bones of the foot are very difficult to discover, 
unless the soft parts are wounded so that the bone can be seen. 
Treatment.—Unless the fracture is an open one, or much 
swollen, it is best treated by placing a roller bandage about the 
ankle and foot, and then smearing it all over with a mixture of 
plaster of paris and water. 
When plaster of paris is applied it should not be removed un- 
til twenty-one days after the injury, unless much pain supervenes. 
It is better not to apply the plaster until the third day after in- 
jury, in order to allow for the swelling of the soft parts, the foot 
and ankle, in the mean time, being bathed frequently with warm 
water, and if much pain is present, chloroform liniment (No. 6) 
should be used. 
Fractures of the toes should be treated in the same way as frac- 
tures of the foot. 
OPEN FRACTURES. 
It must be understood that in giving the treatment for fract- 
ures, nothing has been said about those fractures which are 
open; that is, where the soft parts have been so wounded that the 
bone is exposed. 
Treatment.—Open fractures should never be entirely covered by 
a bandage; a space should always be left at the wound to allow 
drainage. A bit of linen cloth, or piece of clean muslin, say half 
an inch wide and two or three inches long, should be pushed 
gently down to the bottom of the wound, by means of the blunt 16 
HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
end of a catheter or a probe; the cloth be freshly inserted each 
day until the wound heals up from the bottom. A piece of lint 
should be wet with the carbolic solution (Xo. 3) and laid loosely 
over the wound. This will not materially interfere with the appli- 
cation of the bandages and splints above described, but a hole 
should be cut in them opposite the wound. 
DISLOCATIONS. 
A dislocation is the displacement of a bone from its natural 
position at a joint. 
As in fractures a comparison of the injured side with the sound 
side is of the greatest advantage in determining the character of 
the injury. But contrary to the conditions which prevail in fract- 
ures there is a loss of motion in dislocations. For instance in a 
dislocation of the shoulder, the patient will be unable to move his 
arm in certain directions, whereas in a fracture of the arm near 
the shoulder joint the motion will be greater after the injury than 
before. 
Dislocations are usually produced by a sudden wrench or twist- 
ing of the arms, legs, or body. They have been produced by 
hauling on hawsers and ropes, swinging from ladders, or falls 
from aloft. 
Treatment.—Dislocations, after they have been properly re- 
placed, should be treated in the same way as fractures, by keeping 
the part at rest and firmly bandaged or supported until a suffi- 
cient time has been given for the healing process to be completed. 
DISLOCATIONS OF THE FINGERS. 
Dislocations of the finger may be either backward or forward, 
but they are usually backward. 
Treatment.—The treatment in either case is the same; to grasp 
the finger firmly with one hand, and with the other seize the pa- 
tient’s hand at or near the wrist, and pull directly in the line of 
the finger with the hand. The bone will usually be pulled back 
with a distinct snap. Sometimes it may be necessary to take a 
clove hitch around the fiuger with a small bit of muslin, stout 
linen cloth, or handkerchief, in order to get a firmer hold. The 
pulling need not be very great, but steady. 
DISLOCATIONS OF THE THUMB. 
Treatment.—In dislocations of tlie thumb, where the bone over- 
rides the joint at its juncture with the hand, the reduction will be HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
17 
found more difficult. It is better in that case, while pulling the 
thumb away from the hand, to give it an inclination backward 
•at the same time the pulling is done. In this case a “ clove hitch” 
is nearly always necessary. 
DISLOCATIONS OF THE WRIST. 
Dislocation of the wrist is almost invariably produced by falls, 
where the patient throws out the hand to sustain himself, strik- 
ing sharply on the palm of the hand. The two bones of the fore- 
arm are pushed forward, and the wrist thus presents a peculiar 
appearance which is not likely to be mistaken for any other injury. 
It is a very serious accident and will usually result in the forma- 
tion of a stiff joint when recovery finally takes place, but recov- 
ery from this accident is always slow. 
Treatment.—Dislocations of the wrist should be reduced by 
grasping the hand of the patient in the same manner as if shak- 
ing hands, using the right hand if it is of the right wrist and the 
left hand if of the left wrist, with the other hand seizing the fore- 
arm above it, while an assistant seizes the forearm just below 
the elbow and pulls steadily. When the wrist has been pulled 
back to its proper place it can almost always be retained by ban- 
daging, unless a fracture has taken place, in which event the 
crooked appearance will usually return. 
In the treatment of this injury a splint should always be ap- 
plied in the same manner as is described in the chapter on frac- 
tures. If there is much pain the wrist may be bathed with the 
chloroform liniment (Ko. 6) and kept constantly wet with cold or 
tepid water. In very cold weather warm water should be used 
in preference. 
DISLOCATIONS OF THE ELBOW. 
Dislocations of the elbow are also very serious accidents, and can 
scarcely be treated to advantage by an unprofessional person, 
from the fact that there is no joint in the body where the same 
difficulty will be experienced in detecting the nature of the injury. 
In this dislocation the arm may be thrown directly forward, either 
bone may be displaced from side to side, or both bones may be 
thrown forward by reason of a fracture of the sharp bone which 
forms the prominence at the back of the elbow, or, finally, it may 
be a fracture of the point of the smaller bone on the outside of 
the joint. 18 
HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
Treatment.—Xo force should be used in reducing this disloca- 
tion, except what can be applied by the hands, as more injury 
may result from injudicious meddling than would naturally re- 
sult from the injury itself. 
The swelling that takes 
place about injuries of the 
elbow joint, after twenty- 
four hours, will make it 
impossible to tell the na- 
ture of the accident, and 
therefore whatever is done 
for relief should be done 
at once. Care must be 
taken to observe the sound 
arm, noticing particularly 
the shape and direction of 
the joint, so that in applying force the injured arm will be made, 
as nearly as possible, to resemble the uninjured one. 
It will be well, after the bone is replaced, to apply on the in- 
side an angular splint, made of a bit of pasteboard soaked in 
warm water, or sole-leather also soaked in water, either of which, 
if used, must be padded and placed on the inside of the arm 
with a roller bandage securing it in place, and with the arm 
firmly resting in a sling, as in fractures. The shape of this splint 
is shown in the accompanying figure (iNo. 8). 
Fig. 8. 
DISLOCATIONS OF THE SHOULDER. 
Dislocations of the shoulder are easily produced, and are also 
easily restored to their natural position. But it is a principle 
that the shoulder joint once dislocated is thereafter liable to slip 
out of its socket if the arm is raised above the head in the mus- 
cular effort of climbing, swinging by a rope, or hauling down- 
ward. When a sailor is known to have received a dislocation of 
the shoulder, he should not again be allowed to ship unless he 
has been examined by a medical officer and pronounced sea- 
worthy. 
The shoulder may be dislocated inward toward the arm pit, 
ui> ward under the collar bone, or backward upon the shoulder blade. 
Treatment.—Dislocation inward is more common. This is easily 
reduced by causing the patient to lie on his back while the oper- 
ator, after removing his boot, places his heel in the arm-pit of the 
patient and with both hands seizes the patient’s wrist, and^by HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
19 
steady pulling while using the arm as a lever, it is thrown back 
into the socket. 
Should the arm be thrown backward upon the shoulder blade, 
the patient may sit in a chair while the assistant standing back 
of the patient clasps both hands under the arm-pits and supports 
the body; the operator then seizes the arm, carries it well for- 
ward across the chest, at the same time pulling with one hand, 
brings the arm across the face by a rolling or rotary motion, and 
then allows it to fall at the side. In this dislocation the arm will 
be thrown slightly in front of the body, the patient will be unable 
to move it, and a hard lump will be felt over the back of the 
shoulder, while the point of the shoulder which on the sound side 
would be rounded, will, on the injured one, present a sharp angle. 
When the head of the bone is found raised just under the collar- 
bone, it will be discovered as a hard lump at that point, and the 
point of the shoulder will be very much flattened in comparison 
with the other shoulder, while it will be impossible for the man to 
allow his elbow to fall by his side. These characteristics are also 
common to dislocations directly in the arm-pit. This dislocation 
may be reduced in much the same way as in the case where the 
head of the bone is upon the shoulder blade. 
After the reduction of these various dislocations of the shoulder, 
the elbow should be supported in a sling and a broad bandage 
placed over the shoulder and around the body on the opposite 
side. All dressing may be removed after the sixth or seventh 
day, but the patient will not be able to “haul” for two or three 
weeks. 
DISLOCATIONS OF THE COLLAR BONE 
In dislocations of the collar bone but little can be done by’an 
unprofessional person, except to fasten the hand on the front of 
the opposite shoulder by means of a bandage extending from the 
arm and shoulder around the body to the opposite side. This 
should remain for eight or ten days. In this injury, even with the 
best surgeons, the treatment is frequently unsatisfactory. 
DISLOCATIONS OF THE TOES. 
Dislocations of the toes are rare injuries, hut when they do 
occur they may be treated in the same manner as dislocations of 
the fingers. In these cases, as in that of fractures, it will be found 
more convenient to treat them with a plaster of paris bandage. 20 
HAND-BOOK FOK THE SHIP’S MEDICINE CHEST. 
DISLOCATIONS OF THE ANKLE. 
Dislocations of the ankle are difficult to recognize after swelling 
has taken place, which usually occurs within a few hours after the 
injury. 
The dislocation forwards of both bones of the leg on to the foot 
is perhaps the most common, in which event the heel will be seen 
projecting quite out of its natural shape, and is the most promi- 
nent mark of this injury. 
Treatment.—It may be reduced by the operator seizing the foot 
with one hand and with the other grasping the heel while the 
assistant pulls strongly in the opposite direction by grasping the 
ankle above the joint with both hands. After the bones have been 
replaced, it will best be managed by placing the patient where 
the leg and foot can be kept in a horizontal position, by the patient 
remaining in bed with the leg extended, or sitting in one chair 
with the leg in another. 
As soon as the swelling ceases, the plaster bandage should be 
applied to prevent motion of the joint. 
DISLOCATIONS OF THE KNEE. 
Dislocations of the knee are very uncommon accidents, and 
when met with require considerable force in their reduction. 
Treatment.—The best means of reduction will consist in fasten- 
ing the patient’s hips astride an immovable board or post while a 
large bandage is attached below the knee with a clove hitch, upon 
which an assistant makes extension by steady pulling, while the 
bones are properly supported at the joint by the hands of the 
operator being placed about the knee, pushing them into position. 
The knee should then be inclosed with a roller bandage, and the 
patient should keep the leg straight for several days. The patient 
should not be allowed to walk for at least two weeks after the 
injury. 
DISLOCATIONS OF THE THIGH. 
Dislocations at tlie hip-joint are always serious, particularly 
when they occur at a distance from port, as with the best skill 
they are often difficult to manage, and in any event the master 
may expect to be deprived of the services of the man for the 
remainder of the voyage. The position of the foot is perhaps as 
good an indication as any of the character of the injury, when 
taken together with the loss of motion at the joint. The head of HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
21 
the bone may be thrown forward, downward, or backward. The 
position of the bone in each of these situations is shown in the 
accompanying cuts. [Figs. 9, 10, 11.] 
Treatment.—The reduction need not necessarily require a great 
amount of force. A skillful surgeon usually effects a reduction 
by taking the ankle in one hand while the other hand is applied 
to the hip; the leg is then doubled on the back of the thigh, and 
the thigh in turn is doubled on the body, while both the leg and 
thigh are brought across to the opposite limb; the knee is then 
pushed toward the navel, and with a rolling, rocking motion the 
leg is suddenly extended and brought down into a straight posi- 
tion. Should the reduction not be ac- 
complished by this means it must be 
repeated over and over again until the 
bone is properly replaced within its 
socket. As soon as the vessel arrives 
in port the case should be immediately 
reported to the marine-hospital sur- 
geon, and his attendance requested. 
Fig .9. 
Fig. 10. 
Fig. 11. 
SPRAINS. 
Sprains usually occur at tlie wrist 
and ankle joint. 
Treatment.—Perfect rest, elevation 
of the limb, and frequent applications of hot-water dressings, 
give almost immediate relief. The limb should not be used until 
Fig. 12. 22 
HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
all pain and swelling has disappeared, and the application of a 
snugly-fitting bandage will give support to the weakened joint 
when it is used. The manner of applying a bandage for frac- 
tures, sprains, and other injuries is shown in the cut. [Fig. 12.] 
In any of the above accidents, if the vessel is near port, the 
case should be immediately reported to the medical officer of the 
Marine Hospital Service for his attention and advice. 
APPLICATION OF PLASTER BANDAGE. 
In applying the plaster of paris bandage before mentioned, it 
is best to surround the part with a roller bandage. A second 
bandage is then placed in a basin of water, in order that it may be 
thoroughly soaked. As soon as this is well wetted, the plaster 
may be mixed in another basin with a little water until it is the 
consistency of thickened milk. The wet bandage is then started 
and with each turn of the bandage the assistant smears it over 
with the plaster, and so on in successive layers of bandage and 
plaster, until several thicknesses have been made. The parts 
should be kept perfectly quiet for ten or fifteen minutes, until the 
plaster is thoroughly set and hardened. 
FROST-BITE. 
When the frost-bite is recent, that is, within a few hours, the 
circulation will be suspended to a greater or less extent in pro- 
portion to the depth of the freezing. If the freezing is simply on 
the surface, but little care need be taken ; but, on the contrary, 
if the freezing be very deep, it will require great care to prevent 
the parts affected from mortification and sloughing off. 
Treatment.—The treatment should be rubbing with great gen- 
tleness with snow if accessible until the parts are restored to 
their natural temperature. This will usually be the work of a 
few minutes, sometimes half an hour or more. If, however, the 
freezing lias gone on to the extent of rupturing the deeper blood- 
vessels, the vitality of the part cannot be restored. 
As soon as the natural temperature shall have been estab- 
lished, apply cotton batting, previously saturated with carbolized 
oil (Ho. 7). The cotton should be laid on very loosely and then 
covered with a light flannel cloth. 
If snow be inaccessible, ice should be put into water until 
it stands at a temperature of 32° F., and the parts sponged or rub- 
bed gently with this water until the temperature shall have been 
restored, as in the preceding instance. HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
23 
In cases where the frost-bite is older, and the parts have 
already turned black, or begun to mortify, it is useless to attempt 
to restore the vitality, and the carbolized oil in which has been 
placed the laudanum (No. 8) should be applied. This mixture 
serves the triple purpose of relieving pain, of protecting the part 
from the influence of external air, and of disinfecting the parts 
where decomposition has commenced. 
The method of friction needs no special comment; as before 
stated, it must be made with the greatest gentleness and perse- 
verance. The frost-bitten parts should never be brought near the 
fire, placed in warm water, or exposed to any external heat, until 
after the temperature shall have been fully restored. Of course, 
in cases where the prostration is from other causes, as in the 
resuscitation of persons apparently drowned, the frost-bite being 
the lesser evil of the two, it will not do to allow the patient to 
perish from the cold to prevent the loss of a comparatively unim- 
portant member of the body. 
NOSE-BLEED. 
Bleeding at the nose very frequently occurs, not only as the 
result of an injury, but as the result of a debilitated condition of 
the system following malarial and other fevers. 
Treatment.—When the bleeding is severe it will perhaps be 
found more practicable to treat it by blowing into the nostrils 
with a quill some of the “styptic powder” (No. 2). In case this 
fails after three or four attempts, the nose should be plugged 
with lint, and the patient should be directed to keep his head 
perfectly still and quiet, and allow the clot to remain in the nose 
for several days, or at. least as long,as practicable. 
MALARIAL FEVERS IN GENERAL. 
When a vessel is sailing off the western coast of Africa, off the 
eastern coast of Brazil, in the Caribbean Sea, off the West Indies, 
off the shores of the Gulf of Mexico, or about the capes and shores 
of the Chesapeake (in the northern hemisphere during the months 
of April to November, and in the southern hemisphere from 
November to April), malarial fevers are very liable to attack the 
crew. 
It is not known how far malaria extends out at sea, but very 
much depends on the force and velocity of the land breezes. 
Much may be done to prevent the occurrence of these malarial 
fevers by insuring proper cleanliness among the men, seeing that 24 
HAND BOOK FOR THE SHIP’S MEDICINE CHEST. 
they are warm enough at night, that they do not sleep in the open 
air, and that the decks of the ship are, as far as possible, dry and 
clean. Frequent wet-scrubbing of the deck should always be 
avoided in hot climates. During the months named and in the 
places mentioned the captain will find it to his advantage to issue 
an extra quantity of lime juice each day, and give a small dose, 
say a teaspoonful, of mixture No. 9 to the entire crew each morn- 
ing, without regard to whether they are sick or well. It never 
does an injury under such circumstances, and may frequently be 
of the greatest service in preventing sickness. Should these 
precautions fail to ward off disease, and a man turn out in the 
morning complaining of headache, pain in the back, and dizziness, 
and have a white-coated tongue, hot skin, and a rapid, full pulse, 
with loss of appetite, the captain may know that a malarial fever 
of some kind is threatening. If it has begun with a chill it may 
be simple ague, or it may be bilious fever, or yellow fever. 
Treatment.—In such circumstances the captain should begin 
at once energetically treating his patient. If the bowels are 
constipated, a physic should be given—preferably a dose of infu- 
sion of senna.* If, however, there is diarrhoea, the fever will usu- 
ally be found not to be of a malarial type, but is more likely to 
be typhus or typhoid. 
If the edges of the tongue be very red and the tongue is thin 
instead of thick, there will be more reason to fear the latter, as 
malarial fevers are usually accompanied by thick or broad tongues. 
After having given senna tea and waiting three or four hours for 
an operation, if the bowels do not move, the tea may be repeated. 
If the patient is sick at his stomach and vomits, a mustard plas- 
ter may be placed directly over the centre of the belly, above the 
navel. It will be better to make a large plaster, say five by six 
inches. After the physic has operated, if the skin is very hot, it 
will be found advantageous to give a Dover’s powder every two 
or three hours until three or four are taken, or the patient sleeps. 
The patient should not be wakened from sleep to give these powders, 
because they contain opium; but they should be given often enough 
to quiet the pain, produce sweating, and thus reduce the fever. If 
the patient is thirsty, it will be useful to give a teaspoonful of the 
nitre mixture every two hours during the fever. The nitre mix- 
ture is prepared as follows: take 20 grains, or about half a tea- 
spoonful of powdered saltpetre, mix it in half a tumbler of water,. 
* The infusion may he made by placing a tablespoonful of the extract in a 
half pint of hot water; when cool enough it may be drank at a single dose. HAND-BOOK FOR* THE SHIP’S MEDICINE CHEST. 
25 
and put into this a tablespoonful of sweet spirits of nitre j stir 
well together and give it in teaspoonful doses as directed. This 
medicine has the effect of increasing the amount of urine and 
perspiration. 
After the fever has abated, sweating established, and the skin 
becomes cool, it will be proper to administer a dose of quinine* 
say 15 or 20 grains. This should not be repeated more than twice 
in twenty-four hours, and not more than 40 or 50 grains should 
be given in forty-eight hours. 
During the presence of the chill, the patient can be made more 
comfortable by being placed between blankets with bottles of hot 
water to his feet, or bricks or stones heated and wrapped in cloth 
will answer the same purpose. If the patient’s lips are white and 
he is unconscious, it will be of advantage to put mustard plasters 
on his legs and administer quinine in whisky at once. This may 
be given by taking half a tablespoonful of whisky and stirring' 
into it 10 or 15 grains (half a teaspoonful) of quinine and admin- 
istering at a single dose. This may be repeated in three hours. 
In the so-called u congestive chills ” this active treatment is espe- 
cially necessary. 
When, however, the patient’s tongue is red and dry, with a 
smooth glazed appearance,'and there is more or less tendency to 
sleep and stupor, which is the first stage of the so-called u typhoid” 
condition, quinine will be of little advantage. In this condition 
frequent bathing of the legs wfith mustard water, and administer- 
ing the nitre mixture, together with a Dover’s powder, once in 
six hours, w ith plenty of beef tea or condensed milk, will be about 
all that can be done. 
Where there is tenderness over the stomach it is found very 
advantageous to give with each Dover’s powder a single grain, or 
perhaps twTo grains of camphor. As this fever is likely to be ot 
long duration, the strength of the patient must be supported by 
all possible means, and stimulants should be reserved for a later 
period in the disease, when they may be used to good advantage. 
After the patient has been sick eight or ten days, milk-punch 
may be given regularly three or four times a day, alternating with 
beef tea. 
DYSENTERY. 
The characteristic sign of dysentery is great pain in the bowels, 
with frequent movements, and generally accompanied with bloody 
discharges. 
These discharges at first have a greenish, slimy character, after- HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
26 
wards becoming yellowish, and streaked with blood; later, shreds 
like bits of torn, thin linen are passed, and finally there is but a 
teaspoonful or tablespoonful passed at a movement, which is 
accompanied with severe bearing-down pain. 
Probably the best treatment to be adopted for cases of dysen- 
tery at the beginning is to give a large dose of castor-oil, say 
two tablespoonfuls, into which 15 or 20 drops of laudanum are 
placed. Castor-oil in tablespoonful doses witli laudanum may 
be continued once in four hours for several days. If the pain 
becomes more severe and the griping more frequent, an opium 
and camphor pill may be given every two hours until the pain 
ceases or the patient sleeps. Laudanum should not be given in 
the castor-oil when the pills are taken. Sometimes the patient 
will experience great relief from an injection of lime-water, or 
simply tepid water, just previous to an operation. Starch injec- 
tions, to which 20 or 25 drops of laudanum have been added, are 
frequently given. 
Perfect rest and quiet should be insisted upon, and the diet of 
the patient should be of the lightest character. Salt meat or fish 
should not be allowed. The principal diet should be arrowroot, 
cornmeal gruel, or condensed milk, or beef tea may be given. 
This can be easily made by mixing a little meat juice with cold 
water. The patient should be kept in bed, and his abdomen 
covered with flannel. 
It should be remembered that dampness or sudden changes of 
climate, from warm to cold, are very apt to produce dysentery, 
and for this reason, where the climate is changeable, the crew 
should wear extra underclothing. 
YELLOW FEVER. 
When the vessel is near the West Indies, off the Mexican shore, 
in the Gulf, or off the Brazilian coast, precautionary measures 
should always be adopted against yellow fever. This is to be done 
by observing the strictest cleanliness. The cabin, the steerage, 
the cook’s galley, the forecastle, the hold, and all parts of the 
ship, everything in and about it, should be made as dry as possi- 
ble and kept clean. It should be remembered that fumigation 
never takes the place of cleansing, and, more than that, the cleans- 
ing should be dry cleansing as far as possible. 
Treatment.—When cleansing has been fully carried out it will 
be well to give the men each morning a dose of No. 9, not only HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
27 
for the prevention of yellow fever, but also for the prevention of 
malarial fevers in general. The men should bathe frequently, 
and should observe the precautions detailed in speaking of mala- 
rial fevers. If, however, yellow fever breaks out on board the 
vessel, the infected person should not be allowed to lie sick in his 
quarters. A hammock should be swung where the air may have 
free access to it. By this means infection of the ship may be 
measurably prevented. 
In order to prevent injury to the patient from exposure to the 
wind, it will be well to cover the hammock with an awning. At 
the onset of the disease the patient will usually be constipated 
and the skin dry, without moisture, and great pain in the back 
and legs; later on in the disease vomiting, pains in the stomach, 
and instense yellowness in the skin and eyes may supervene. 
Treatment.—It will be proper in such cases to commence with 
a brisk physic of senna tea, and if the skin be very dry rub the 
legs with mustard water; if vomiting be present, the nitre mix- 
ture should be given as directed for malarial fevers. If the fever 
is not high fifteen grains of quinine may be given twice in the 
forenoon. From the beginning to the end of the disease three 
cardinal points must be observed: First, to insure rest to the pa- 
tient by giving a Dover’s powder, and inducing him to remain in 
bed; secondly, to insure free action of the skin by warm baths and 
sweating medicines; and, thirdly, to support the strength of the 
patient by means of weak whisky and water, beef tea, quinine, and 
other stimulants. ]Sh> solid food should be given the patient until 
after convalescence. 
SUNSTROKE. 
Treatment.—Remove patient to coolest part of ship; apply cold 
water to head and hot bottles or bricks to the feet; give him a 
dose of Epsom salts, and keep him quiet. He should be fed on 
solution of condensed milk (if obtainable) and beef tea, and, if 
very weak, a little whisky and water three times daily. 
SCURVY. 
Although this disease is seldom met with among American 
sailors, it occasionally appears. 
Treatment.—In addition to doubling the allowance of lime-juice, 
give any kind of vegetables that can be obtained, with a liberal 
allowance of pickles or vinegar. 28 
HAND-BOOK FOR THE SHIFTS MEDICINE CHEST. 
COLIC. 
This may occur from eating indigestible articles, drinking 
too much water while overheated, or without obvious cause; or it 
may be the result of lead poisoning after using white or red lead 
in painting ship. 
Treatment.—If from over-eating, an emetic followed by a little 
spirits containing 10 drops fluid extract ginger or 10 drops of 
laudanum, and a mustard plaster over the stomach, will give 
relief. If several of the crew are affected at the same time, par- 
ticularly if they have been working among paints, you may sus- 
pect lead poisoning, in wTliick case give two tablespoonfuls of cas- 
tor oil with 10 drops of laudanum, remove them from proximity 
to the fresh paint, see that their clothing is clean and free from 
it, and after their bowels are well open from the oil (which may 
be repeated if found necessary), give an occasional dose of ginger 
and whisky. It may be necessary to apply hot cloths to abdo- 
men and give a Dover’s powder every three or four hours if the 
pain continues severe. 
SORE THROAT—u QUINSY.” 
Treatment.—Gargle frequently with chlorate of potash in warm 
water; keep the bowels well open, and if the pain is severe give 
a Dover’s powder at bedtime. 
ERYSIPELAS. 
This disease is characterized by itching and redness of the 
parts affected, with or without swelling, and a shining skin. This 
redness is more or less diffused, disappears under the finger, and 
reappears immediately upon the finger being removed. The dis- 
ease has a tendency to spread over the surface of the body. 
Treatment.—The proper remedies are tincture of iron and qui- 
nine (No. 14) in teaspoonful doses every two or three hours; paint- 
ing the parts with tincture of iodine or tincture of iron once or 
twice in twenty-four hours, making a broad line with the iodine 
on the sound skin and covering the diseased skin. Tonics and 
beef tea should be given freely. 
Erysipelas following a wound should be treated with the same 
internal remedies and the same local applications to the skin, 
but carbolized water dressings should be applied to the wound. HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
29 
RHEUMATISM. 
Bheumatism usually commences with pain; it may be in the 
joints, or it may be complained of in the muscles between the 
joints. 
Treatment.—If a patient has had syphilis previously, the pain will 
nearly always be increased at night. If, however, no history of 
syphilis can be found, and the pain is located in a joint, which is con- 
siderably swollen, the case will doubtless prove to be one of acute 
rheumatism. In this event it will be best treated by wrapping 
the joint in flannel wrung out of hot water through the day, and 
occasionally bathing it with chloroform liniment through the 
night; afterwards by covering with dry, warm flannels and ad- 
ministering internally pills (Xo. 12), which should be given every 
two hours until sweating is produced freely and the pain has 
ceased. But if it is found that the pain is more severe at night, 
and the patient acknowledges to having had syphilis previously, 
it will be better to administer the iodide of potassium mixture 
(Xo. 11) in teaspoonful doses three times a day in the same man- 
ner as for constitutional syphilis. p 
Acute rheumatism may last for an indefinite period, but, if 
treated in the mantier indicated, will usually run its course in 
about two weeks. Syphilitic rheumatism, on the contrary, will 
be of longer duration. 
CHOLERA MORBUS 
Is usually the result of eating unripe or decaying fruit, and is 
characterized by great pain in the stomach and bowels, cramps, 
watery diarrhoea, and vomiting. 
Treatment.—Mustard to the abdomen, one opium and camphor 
pill every two hours until relieved or the patient sleeps; and 
when free from cramps, a dose of castor-oil with ten drops of 
laudanum should be given. 
DIARRHOEA. 
By simple diarrhoea is meant a looseness of the bowels where 
the discharges are thin in consistency and large in amount. They 
may be either whitish, watery, or greenish in color. 
Treatment.—In order to properly treat a case of diarrhoea, the 
cause must be carefully investigated. If it has been produced 
by imprudence in eating, by bad water or tainted meat, or bad 
food of any kind, a few days of rest in bed, a little dry toast, a 30 
HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
little brandy or whisky and water twice a day, will be all that is 
necessary. But if it can be traced to none of these things, the 
treatment must be directed to the digestive organs. If in a hot 
country, or especially in the Indian Ocean, where cholera is likely 
to prevail, diarrhoea may be checked more rapidly without danger. 
But in a northern latitude greater care should be taken in check- 
ing the disease by astringents. It should rather be done by the 
patient’s abstaining from meat, from water as much as practica- 
ble, from potatoes and all kinds of fruit, with the exception of 
lemons and oranges. One opium and camphor p)ill (No. 15) may 
be given after each operation of the bowels, provided the opera- 
tions are not more frequent than once in two hours. 
CHOLERA. 
Should the vessel be lying off the Indian coast near the mouth 
of the Ganges, or in the vicinity of any other country where 
cholera is likely to prevail, all cases of diarrhoea should be looked 
upon with suspicion aud treated for incipient cholera. 
Treatment.—In such cases it will be better to confine the patient 
to bed, and if the discharges are large and watery, opium and 
camphor pills may be given, one every two ljours; or, if there is 
much pain, a dose of the cholera mixture (No. 10) may be given 
every half hour until the pain ceases. If the patient has col- 
lapsed; that is, if the face, fingers, nose, ears, and feet are cold, 
stimulants must be given, the legs wrapped in cloths and rubbed 
with dry mustard, bottles of hot water or bricks applied to the 
feet, and great care taken to insure circulation of the blood in the 
extremities, and to keep up the strength of the patient. Neither 
the opium pills nor the cholera mixture should be given when the 
patient is asleep, and when asleep he should be allowed to remain 
so. His diet should be confined to milk, gruel, buttered toast, 
and sparingly of beef tea. 
In this connection it may be very properly said that no pas- 
sengers should be allowed to come on board the vessel in an 
infected district until their baggage has been examined by the 
physician to the United States consul and a permit for the ship- 
ment of the baggage countersigned by that officer. 
ITCH. 
Treatment.—Make the man wash thoroughly with soap and 
water, and after drying, apply sulphur ointment liberally to the HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
31 
parts affected, or to the whole body if necessary. This should 
be repeated often enough to keep the parts thoroughly anointed 
and continued morning and night until the itching has disap- 
peared. 
BOILS 
What are known among sailors as saltwater boils are quite 
common and very painful. 
Treatment.—They may sometimes be destroyed by caustic or a 
blister, if applied early. Later, poultice until soft and then open 
with a lancet. 
PILES. 
Treatment.—Keep the bowels open with pills or salts, make 
cooling application to the parts, and if the piles protrude, push 
them back gently and keep them in by means of a cloth and 
bandage applied to the vent. 
SYPHILIS. 
It is presumed that before going to sea the crew will have been 
examined by a medical officer of the Marine Hospital Service, in 
which event this disease will rarely be seen on the outward 
voyage. 
Syphilis is usually noticed in the shape of a little pimple which will 
appear on the foreskin, head of the “ yard,” or in some'instances 
underneath the foreskin. This will gradually become an open 
sore and discharge a considerable amount of pus, and is usually 
somewhat painful. Should the pimple be what is known as the 
“hard” variety, there will be little pus and but little if any pain. 
Careful questioning of the man will show, in the case of a soft sore 
which discharges freely, that he has but recently been exposed to 
the infection, whereas in a hard sore he may have been exposed to 
the infection several days previously, or in some instances even 
weeks before it makes its appearance. 
Treatment.—The treatment of the two varieties in the first 
stages is essentially different. In the soft variety of sore, it will 
be necessary to burn it thoroughly with caustic, using for the 
purpose the acid nitrate of mercury, while in the variety 
no burning will be necessary. The soft sore, after having been 
once thoroughly burned, will scarcely require its repetition, 
though the application of iodoform is found to be beneficial. The 
dry sore may then be bathed with a black wash or sprinkled with 
calomel. 32 
HAND-BOOK FOR TIIE SHIP’S MEDICINE CHEST. 
The hard sore will require nothing except the application of a 
little simple cerate or cosmoline, which is spread on a cloth and 
applied directly to the sore. 
In either variety of these sores it will be necessary to keep the 
sore and the “yard” thoroughly clean, using for this purpose a 
little castile soap and water. It will be a safe plan, to prevent 
constitutional infection of the patient, to give the iodide of potas- 
sium mixture, No. 11, in teaspoonful doses three times a day until 
the arrival of the vessel in port, when he should be taken to the 
marine hospital office, a full history of the case given to the sur- 
geon, and advice as to further treatment obtained. 
When the crew has been examined previous to the sailing of 
the vessel, this disease is not likely to be found on the outward 
voyage (though it may appear when several days out), but it is 
quite likely to be contracted in foreign ports where prostitutes 
are unregistered. 
Treatment.—If treated in the beginning it may be easily man- 
aged by very mild injections of warm water with three grains of 
sulphate of zinc to an ounce of water. These injections should be 
made morning, noon, and night, and at least half an ounce should 
be injected at each operation. In the event of the sulphate of 
zinc by any means being absent, ordinary sea-water will make a 
very good injection if mixed with about one-lialf fresh water. 
As the disease progresses and degenerates into gleet, injections 
must be made stronger, using a solution of 10 grains of the sul- 
phate of zinc to the ounce of water. If there is any curving 
downwards of the yard (chordee), an infusion of opium may be 
injected, and the yard should be wrapped loosely with a cloth 
wet with cold water. The infusion may be made by placing a 
couple of tea-spoonfuls of powdered opium in an earthern vessel, 
and pouring on one-half gill of tepid water, allow it to simmer 
over a tire or spirit-lamp for a half an hour, then add another 
half gill of cold water, and the infusion is ready. 
Swelled testicles are best treated by keeping the patient quiet 
in bed. If very painful, a warm poultice generally gives relief, 
or the testicle may be strapped with adhesive plaster, cut in nar- 
row strips and made to overlap each other until the entire testi- 
cle is covered. Beside the local treatment, a dose of epsom salts 
should be given each morning, unless the bowels are already too 
loose. A suspensory bandage will always be useful in such cases 
as soon as the patient commences to walk about. 
CLAP. HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
33 
STRICTURE OF THE URETHRA. 
Very many cases of clap are followed by a stricture, and indeed 
most all cases of stricture may be traced to clap which has oc- 
curred at some period previously. 
The stricture may be discovered by stoppage or difficulty in 
passing water, and the water coming out in a very fine stream, 
the stream being forked, or by the length of time required to pass 
it, and great labor of the patient in its performance. No more 
distressing sight can be seen than that of a patient in the vain 
endeavor to force water from a full bladder through a close and 
tight stricture. Care should be taken by the captain in cases of 
stricture to see that the patient’s bladder is emptied, without al- 
lowing it to become entirely filled up. 
Fig. 13. 
Treatment.—A patient with stricture 
should make water frequently and not at- 
temptto wait as long as a person in health. 
Should, however, a stoppage occur, a catheter should be passed and 
the urine removed twice a day. In passing the catheter the patient 
should be placed on his back with the knees drawn up while the 
operator seizes the yard with his left hand, while with the otlierr 
holding the catheter like a pen, it is gently introduced. The 
operator should exercise in this operation the utmost patience, 
and never be in a hurry to force the catheter into the bladder, 
nor should it be done by an unprofessional persou when it is prac- 
ticable to avoid it. The method of its introduction is shown in the 34 
HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
cuts. [Figs. 13 and 14.] It is better to begin with a large instru- 
ment and push it down until it meets with obstruction, where it 
should be allowed to remain 
for a few moments; then if it 
will not pass further without 
pain, introduce a smaller one 
and pass it as far as it will 
go, allowing it to remain for a 
few moments gently pressed 
against the stricture, where 
it may be retained for a few 
moments and then passed 
into the bladder. If it is 
found that the catheter cannot be made to pass by gentle efforts, 
warm flannel cloths may be wrung out of hot water and placed 
over the lower part of the belly and the space back of the purse 
of the patient and changed as often as every 20 or 30 minutes. 
In a short time the parts are likely to be so relaxed that the cathe- 
ter can be pushed into the bladder without difficulty. 
Fig. 11. 
DELIRIU31 TREMENS. 
Treatment.—Beef-tea every two hours or milk every three hours, 
given iu generous quantity, and until the patient falls asleep, 
when he should not be disturbed. Upon awaking, additional beef- 
tea or milk should be given three or four times a day. The prac- 
tice formerly recommended of giving strong stimulants and opiates 
is believed to be unnecessary and harmful. 
SMALL-POX. 
This disease is recognized by its eruption, which at first feels 
like small shot beneath the surface of the skin, and appears after 
the patient has had fever for six or seven days $ with the fever 
there is severe pain in the small of the back. 
Treatment.—But little medical treatment is required. In the 
'commencement, it should be treated as any other fever. The 
should be kept open, the patient removed to a cool place, 
and isolated. 
All persons aboard ship should be vaccinated, and all clothing, 
bedding, &c., used by the patient destroyed. 
The intolerable itching may be relieved by anointing the body 
with vaseline, cosmoline, or petrolina, in which powdered char- HAND-BOOK FOR THE SHIP'S MEDICINE CHEST. 
35 
coal has been stirred. It is said that the charcoal dressing ap- 
plied freely over the sores, by preventing the access of light, 
diminishes the “pits” or scars left by the disease. Moreover, the 
charcoal has a tendency to destroy the peculiar odor which is 
always present in the later stages of the disease. 
RESUSCITATION. 
When a man has fallen overboard and is apparently drowned, all 
means possible should be taken to restore him to life. The fol- 
lowing are the directions of the United States Life Saving Serv- 
ice, which have been found to be useful in such cases : 
Rule I. Arouse the patient.—Unless in danger of freezing, do not move tlie 
patient, hut instantly expose the face to a current of fresh air, wipe dry the 
mouth and nostrils, rip the clothing, so as to expose the chest and waist, and 
give two or three quick smarting slaps on the stomach and chest with the 
open hand. If the patient does not revive, then proceed thus : 
Rule II. To draiv off icater, ffc., from the stomach and chest.—If the jaws are 
clinched, separate them, and keep the mouth open by placing between the 
teeth a cork or small bit of wood ; turn the patient on the face, a large bundle 
of tightly-rolled clothing being placed beneath the stomach, and press heavily 
over it for half a minute, or so long as fluids flow freely from the mouth. 
Rule III. To produce breathing.—Clear the mouth and throat of mucus,'by 
introducing into the throat the corner of a handkerchief wrapped closely 
around the forefinger; turn the patient on the back, the roll of clothing being 
so placed beneath it as to raise the pit of the stomach above the level of any 
other part of the body. If there be another person present, let him, with a 
piece of dry cloth, hold the tip of the tongue out of one corner of the mouth 
(this prevents the tongue from falling back and choking the entrance to the 
windpipe), and with the other hand grasp both wrists and keep the arms 
forcibly stretched back above the head, thereby increasing the prominence of 
the ribs, which tends to enlarge the chest. The two last-named positions are 
not, however, essential to success. Kneel beside or astride the patient’s hips, 
and with the balls of the thumbs resting on either side of the pit of the stom- 
ach, let the fingers fall into the grooves between the short ribs, so as to afford 
the best grasp of the waist. Now, using your knees as a pivot, throw all your 
weight forward on your hands, and at the same time squeeze the waist be- 
tween them, as if you wished to force everything in the chest upward of not 
the mouth; deepen the pressure while you can count slowly one, two, three; 
then suddenly let go with a final push, which springs you back to your first 
kneeling position. Remain erect on your knees while you can count one, two, 
three; then repeat the same motions as before at a rate gradually increased 
from four or five to fifteen times in a minute, and continue thus this bellows 
movement with the same regularity that is observable in the natural motions 
of breathing which you are imitating. If natural breathing be not restored, 
after a trial of the bellows movement for the space of three or four minutes, 
then, without interrupting the artificial respiration, turn the patient a second 
time on the stomach, as directed in Rule II, rolling the body in the opposite 
direction from that in which it was first turned, for the purpose of freeing the 
air-passages from any remaining water. Continue the artificial respiration 36 
HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
from one to four hours, or until the patient breathes ; and for a while, after the 
appearance of returning life, carefully aid the first short gasps until deepened 
into full breaths. Continuing the drying and rubbing, which should have 
been unceasingly practised from the beginning, taking care not to interfere 
with the means employed to produce breathing. Thus the limbs of the patient 
should be rubbed, always in an upward direction toward the body, with firm- 
grasping pressure and energy, using the bare hands, dry flannels, or handker- 
chiefs, and continuing the friction under the blankets or over the dry clothing. 
The warmth of the body can also be promoted by the application of hot flan- 
nels to the stomach and arm-pits, bottles or bladders of hot water, heated 
bricks, &c., to the limbs and soles of the feet. 
Rule IV. After-Treatment.—Externally: As soon as breathing is estab- 
lished, let the patient be stripped of all wet clothing, wrapped in blankets 
only, put to bed comfortably warm, but with a free circulation of fresh air, 
and left to perfect rest. Internally : Give a little brandy and hot water, or 
other stimulant at hand, every ten or fifteen minutes for the first hour, and as 
often thereafter as may seem expedient. Later manifestations : After reaction 
is fully established, there is great danger of congestion of the lungs, and if 
perfect rest is not maintained for at least forty-eight hours, it sometimes occurs 
that the patient is seized with great difficulty of breathing, and death is lia- 
ble to follow unless immediate relief is afforded. In such cases apply a large 
mustard-plaster over the breast. If the patient gasps for breath before the 
mustard takes effect, assist the breathing by carefully repeating the artificial 
respiration. 
Note.—An eminent authority, Dr. Labordette, the supervising surgeon of 
the Hospital of Lisieux, in France, appears to have established that the clench- 
ing of the jaws and the semi-contraction of the fingers, which have hitherto 
been considered signs of death, are, in fact, evidences of remaining vitality. 
After numerous experiments with apparently-drowned persons, and also with 
animals, he concludes that these are only signs accompanying the first stage 
of suffocation by drowning, the jaws and hands becoming relaxed when death 
ensues.* This being so, the mere clenching of the jaws and semi-contraction 
of the hands must not be considered as reasons for the discontinuance of 
efforts to save life, but should serve as a stimulant to vigorous and prolonged 
efforts to quicken vitality. Persons engaged in the task of resuscitation are, 
therefore, earnestly desired to take hope and encouragement for the life of the 
sufferer from the signs above referred to, and to continue their endeavors ac- 
cordingly. In a number of cases Dr. Labordette restored to life persons whose 
jaws were so firmly clenched that, to aid respiration, their teeth had to be 
forced apart with iron instruments. 
Additional Note.—The “ heat methodwhich has recently been strongly 
advocated, does not materially differ from the concluding sentence of Rule 
III, and lays especial stress upon heat, by whatever means employed, as the 
real factor in resuscitation of the apparently drowned ; but the proper method 
would appear to be: I. Raise the feet above the head, for two or three seconds, 
to allow any water in the air passages to escape by its own gravity. II. Apply 
heat and artificial respiration, according to the above directions, simultaneously. 
* The muscular rigidity of death (rigor mortis) occurs later, after the tempo- 
rary relaxatiou here referred to. HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
37 
GENERAL INSTRUCTIONS. 
On arriving at any port in the United States, if the master of 
the vessel has on board a man who is sick and is unable to walk, 
and this seaman has paid hospital dues, the hospital signal should 
be displayed on entering the harbor. 
The hospital signal will be the seal of the Service in white 
(shown on the cover of this book) on a blue ground with a scar- 
let border around it. 
The boarding officer of the customs service should also be in- 
formed of the character of the patient’s illness. Marine-hospital 
surgeons will be found at the following seaports: Portland, Me.; 
Boston, Mass.; New York, N. Y.; Philadelphia, Pa.; Baltimore, Md.; 
Norfolk, Ya.; Washington, D. C.; Wilmington, N. C.; Charleston, 
S. C.; Savannah, Ga.; Key West, Fla.; Mobile, Ala.; New Or- 
leans, La.; Galveston, Tex.; San Francisco, Cal.; Portland, Oreg.; 
and Port Townsend, Washington Territory. 
Physicians are employed to treat marine-hospital patients at 
Eastport, Calais, Bockland, Macliias, Bangor, Ellsworth, Castine, 
and Bath, Me.; Portsmouth, N. H. From Salem and Lynn, Mass., 
patients are sent to Chelsea. At Vineyard Haven, Mass., there 
is a marine hospital. At Hyannis, a local physician; also at New 
Haven, Conn.; New Bedford, Mass.; Tuckerton, N. J.; New 
Berne, N. C.; Georgetown, S. C.; Brunswick, Ga.; Jacksonville 
and Fernandina, Fla. 
On the Lakes there are marine hospitals at Cleveland, Ohio; 
Detroit, Mich.; and Chicago, 111. There are medical officers of 
the service at Chicago, Detroit, and Buffalo. 
There are local physicians employed to attend seamen at 
Oswego, N. Y., Cleveland and Toledo, Ohio, Grand Haven and 
Marquette, Mich., and Milwaukee, Wis. On the Ohio Biver, 
medical officers of the Service at Pittsburgh, Pa., Cincinnati, Ohio, 
LouisAille, Ky., Evansville, Ind., and Cairo, 111. On the Missis- 
sippi Biver, medical officers of the Service at Saint Louis, Mo., 
Cairo, 111., Memphis, Tenn., and New Orleans, La. Local physi- 
cians under contract at Saint Paul, Minn., La Crosse, Wis., Du- 
buque, Iowa, and Vicksburg, Miss. On Bed Biver, local physi- 
cian at Shreveport, La. On the Tennessee Biver, at Chattanooga 
and at Nashville. On the Missouri Biver, local physician, Bis- 
marck. At all ports of entry where there is no medical officer 
on duty, or physician regularly employed, necessary arrange- 
ments are made by the collectors of customs. APPENDIX. 
THE UNITED STATES MAKINE-HOSPITAL SERVICE. 
ITS CHARACTER AND OBJECTS. 
I. —The Marine-Hospital Service is the medical department for the mercan- 
tile marine of the United States. It was established in 1798, and is charged 
with the duty of preserving the health interests of the officers and seamen em- 
ployed on American vessels engaged in the foreign, coastwise, and inland 
commerce. 
II. —The Marine-Hospital Service is bylaw placed under the immediate direc- 
tion of a supervising Surgeon-General, who is appointed by the President by 
and Vitli the advice and consent of the Senate of the United States. Said 
Surgeon-General is responsible for his official acts to the Secretary of the 
Treasury, and is required by law, under the direction of the Secretary, to 
“ supervise all matters connected with the Marine-Hospital Service.” 
III. —The expenses of the Marine-Hospital Service are defrayed out of the 
marine-hospital fund, which consists of hospital dues assessed and collected 
in accordance with law out of the wages of the seamen, at the rate of forty 
cents per month while actually employed. The hospitals belonging to the 
Service have, however, been erected at the expense of the United States, and 
the repairs and preservation of buildings, are provided for in common with 
those of other public buildings under the charge of the Secretary of the 
Treasury. 
LAWS RELATING TO THE UNITED STATES MARINE-HOSPITAL SERVICE. 
[Extracts from Revised Statutes of the United States.] 
Sec. 3689. There are appropriated, out of any moneys in the Treasury not 
-otherwise appropriated, for the purposes hereinafter specified, such sums as 
may be necessary for the same respectively; and such appropriations shall be 
deemed permanent annual appropriations; * * * of the moneys collected 
from masters or owners of vessels of the United States, at the rate of forty 
cents per month for every seaman employed, to constitute a general fund, to 
be used for the benefit and convenience of sick and disabled American seamen. 
* * * Of the proceeds of leases and sales of marine-hospital buildings, and 
lands appertaining thereto, for the marine-hospital establishment. 
Sec. 3692. All moneys received from the leasing or sale of marine hospitals 
* * * shall * * * revert to that appropriation out of which they were 
orignally expended, and shall be applied to the purposes for which they are 
appropriated by law. 
39 40 
HAND BOOK FOR THE SHIP’S MEDICINE CHEST. 
Sec. 4545. When no claim to the wages or effects of a deceased seaman or 
apprentice, received hy a circuit court, is substantiated within six years after 
the receipt thereof by the court, it shall be in the absolute discretion of the 
court, if any subsequent claim is made, either to allow or refuse the same. 
Such courts shall, from time to time, pay any moneys arising from the un- 
claimed wages and effects of deceased seamen, which, in their opinion, it is 
not necessary to retain for the purpose of satisfying claims, into the Treasury 
of the United States, and such moneys shall form a fund for, and be appro- 
priated to, the relief of sick and disabled and destitute seamen belonging to 
the United States merchant-marine service. 
Sec. 4569. Every vessel belonging to a citizen of the United States, bound 
from a port in the United States to any foreign port, or being of the burden of 
seventy-five tons or upward, and bound from a port on the Atlantic to a port 
on the Pacific, or vice versa, shall be provided with a chest of medicines; and 
every sailing-vessel bound on a voyage across the Atlantic or Pacific ocean, 
or around Cape Horn or the Cape of Good Hope, or engaged in the whale or 
other fisheries, or in sealing, shall also be provided with, and cause to be kept, 
a sufficient quantity of lime or lemon-juice, and also sugar and vinegar, or 
other anti-scorbutics, to be served out to every seaman, as follows: The master 
of every such vessel shall serve the lime or lemon-juice, and sugar and vine- 
gar, to the crew within ten days after salt provisions mainly have been served 
out to the crew, and so long afterward as such consumption of salt provisions 
continues; the lime or lemon-juice and sugar daily, at the rate of half an 
ounce each per day, and the vinegar weekly, at the rate of half a pint per 
week for each member of the crew. 
Sec. 4585. There shall be assessed and collected by the collectors of customs 
at the ports of the United States, from the master or owner of everjr vessel of 
the United States arriving from a foreign port, or of every registered vessel 
employed in the coasting trade, and before such vessel shall be admitted to 
entry, the sum of forty cents per month for each and every seaman who 
shall have been employed on such vessel since she was last entered at any port 
of the United States; such sum such master or owner may collect and retain 
from the wages of such seamen. 
Sec. 4586. Whenever a sale or transfer of any vessel of the United States is 
made in a foreign port or water, the consular officer of the United States, 
within whose consulate or district the same is made, or in whose hands the 
papers of such vessels are, is required to collect of the master or agent of such 
vessel all moneys that shall have become due to the United States by virtue of 
the preceding section, and shall remain unpaid at the time of such sale or 
transfer; and such consular officer shall retain possession of the papers of such 
vessel until such money shall have been paid as herein provided; and, in 
default of such payment, the sale or transfer shall be void, excepting as 
against the vender. 
Sec. 4587. No collector shall grant to any vessel, except canal-boats em- 
ployed in navigating the canals within the United States whose enrolment or 
license for carrying on the coasting trade has expired, a new enrolment or 
license, unless the master of such vessel shall have tirst rendered a true account 
to the collector of the number of seamen and the time they have been em- 
ployed on such vessel during the continuance of the license which has so ex- 
pired, and shall have paid to such collector forty cents per month for every 
such seaman who shall have been employed; which sum the master is hereby HAND-BOOK FOR THE SHIPPS MEDICINE CHEST. 
41 
authorized to retain out of the wages of such seamen. Whenever the master 
of any registered, enrolled, or licensed vessel of the United States renders a 
false account of the number of seamen so employed, or of the length of time 
they have severally been employed, as is herein required, he shall he liable 
to a penalty of fifty dollars, which shall he applied to, and shall make a 
part of, the general fund created for the relief of sick and disabled seamen; 
and all needful regulations for the mode of collecting the sums hereinbefore 
mentioned shall be prepared, under the direction of the Secretary of the Treas- 
ury, by such person as by him may be designated. 
Sec. 4792. The quarantines and other restraints established by the health- 
laws of any State respecting any vessels arriving in or bound to any port or 
district thereof, shall be duly observed by the officers of the customs revenue 
of the United States; * * * and all such officers of the United States shall 
faithfully aid in the execution of such quarantines and health-laws, according 
to their respective powers and within their respective precincts, and as they 
shall be directed from time to time by the Secretary of the Treasury. 
Sec. 4801. The President is authorized to receive donations of real or per- 
sonal property, in the name of the United States, for the erection or support 
of hospitals for sick and disabled seamen. 
Sec. 4803. The several collectors of the customs shall respectively deposit, 
withoqt abatement or reduction, the sums collected by them, under the pro- 
visions of law imposing a tax upon seamen for hospital purposes, with the 
nearest depositary of public moneys, and shall make returns of the same, 
with proper vouchers, monthly, to the Secretary of the Treasury, upon forms 
to be furnished by him. All such moneys shall be placed to the credit of “the 
fund for the relief of sick and disabled seamen ”; of which fund separate accounts 
shall be kept in the Treasury. Such fund is appropriated for the expenses of 
the Marine-Hospital Service, and shall be employed, under the direction of 
the Secretary of the Treasury, for the care and relief of sick and disabled sea 
men employed in registered, enrolled, and licensed vessels of the United 
States. 
Sec. 4804. No person employed in or connected with the navigation, man- 
agement, or use of canal-boats engaged in the coasting trade shall by reason 
thereof be entitled to any benefit or relief from the marine-hospital fund. 
Sec. 4805. Sick foreign seamen may be admitted to the marine hospitals 
within the United States, if it can with convenience be done, on the applica- 
tion of the master of any foreign vessel to which any such seamen may belong. 
Each seaman so admitted shall be subject to a charge of seventy-five cents per 
day for each day he may remain in the hospital, which shall be paid by the 
master of such foreign vessel to the collector of the collection-district in which 
such hospital is situated. And the collector shall not grant a clearance to any 
foreign vessel until the money so due from her master shall be paid. The offi- 
cer in charge of each hospital is hereby directed, under penalty of fifty dollars, 
to make out the accounts against each foreign seaman that may be placed in 
the hospital under his direction, and render the same to the collector. 
Sec. 2. That from and after May first, eighteen hundred and seventy-five, 
every vessel subject to hospital-tax, except vessels required by law to carry 
crew-lists, shall have and keep on board, subject to inspection and verifica- 
tion at all times by any officer of the customs, a seaman’s time-book, which 
shall be furnished by the Treasury Department; aud iu which time-book shall 
be entered the name, date of shipment, and date of discharge of every seaman 42 
HAND-BOOK FOR THE SHIP’S MEDICINE CHEST. 
employed on board such vessel; and the master or owner of any vessel sub- 
ject to hospital-tax, vessels carrying crew-lists as above excepted, shall for- 
feit and pay the sum of fifty dollars for each and every seaman found employed 
on board his vessel without a corresponding entry in said time-book; and the 
sums so forfeited shall be collected by the collector of customs upon the sworn 
statement of the customs-officers who make the inspections, and shall be paid 
into the Treasury to the credit oi the marine-hospital fund, for the general 
purposes of which fund said sums are hereby appropriated. 
Sec. 3. That term “ seaman,” wherever employed in legislation relating to 
the Marine-Hospital Service, shall be held to include any person employed on 
board in the care, preservation, or navigation of any vessel, or in the service, 
on board, of those engaged in such care, preservation, or navigation. 
Sec. 5. That insane patients of said Service shall be admitted into the 
government hospital for the insane upon the order of the Secretary of the 
Treasury, and shall be cared for therein until cured or until removed by the 
same authority ; and the charge for each such patient shall not exceed four 
dollars and fifty cents a week, which charge shall be paid out of the marine- 
hospital fund. 
Sec. fi. That sick and disabled seamen of foreign vessels and of vessels not 
subject to hospital-dues may be cared for by the Marine-Hospital Service at 
such rates and under such regulations as the Secretary of the Treasury may 
prescribe. 
[Part of section 4612 Revised Statutes.] 
RATIONS. 
Scale of provisions to be allowed and served out to the crew during the voyage. 
Bread. 
Beef. 
Pork. 
U 
S3 
JO 
s 
Pease. 
Bice. 
Barley. 
Tea. 
Coffee. 
C3 
bfi 
S3 
TJ1 
"W ater. 
Lbs. 
1 
1 
1 
1 
1 
1 
1 
Lbs. 
14 
Lbs. 
Lbs. 
4 
rts. 
rts. 
Pts. 
Ozs. 
4 
4 
4 
4 
4 
4 
4 
Ozs. 
4 
4 
4 
4 
4 
4 
4 
Ozs. 
2 
2 
2 
2 
2 
2 
2 
Qts. 
3 
3 
3 
3 
3 
3 
3 
14 
4 
14 
14 
14 
4 
14 
4 
4 
14 
4 
One ounce of coffee, or cocoa, or cliocolate may be substituted for one- 
quarter ounce of tea; molasses for sugar, the quantity to he one-lialf more; 
one pound of potatoes or yams, one-half pound flour or rice; one-third pint 
of [lease or one-quarter pint of barley may be substituted for each other. 
When fresh meat is issued, the proportion to be two pounds per man per day 
in lieu of salt meat. Flour, rice and pease, beef and pork may be substituted 
for each other, and, for potatoes, onions may be substituted. 
SUBSTITUTES. INDEX. 
Page. 
Accidents, treatment of 7 
Ankle, dislocation of 20 
Arm, fractures of - 13 
Ague 24 
Back, injuries of 10 
Bandage, how to apply 22 
Bilious fever 24 
Bleeding, how to stop 7,8 
Boils 31 
Broken bones 11 
Burns 8 
Catheter, how to pass the 34 
Chest, injuries of the 9 
Chills 25 
Cholera 30 
Cholera-morbus 29 
Clap 32 
Colic 28 
Collar bone, dislocation of 19 
Constipation, how to prevent 5 
Crew, should be examined 5 
Deck should be kept dry 5 
Delirium tremens 34 
Dianhcea 29 
Dislocations 1(5 
Ankle 20 
Collar bone 19 
Elbow 17 
Fingers 16 
Knee 20 
Shoulder 18 
Thigh 20 
Thumb 16 
Toes 19 
Wrist 17 
Drowning, treatment of 35 
Dysentery 25 44 
INDEX. 
Page. 
Elbow, dislocation of 17 
Erysipelas 28 
Face, wounds of 9 
Fever, malarial 23 
Fingers, dislocation of 16 
Fingers, fracture of 11 
Foot, fracture of 15 
Forearm, fracture of 12 
Formulae, list of 7 
Fractures— 
Arm 13 
Fingers 11 
Foot 15 
Forearm 12 
Jaw 11 
Leg 14 
Open 15 
Ribs 9 
Skull 8 
Thigh 13 
Thumb 12 
Frost-bite 22 
General instructions 37 
Head, injuries of 8 
Hospital relief, how obtained 37 
Injuries of head 8 
Instructions, general 37 
Itch 30 
Jaw, fractures of 11 
Knee dislocations 20 
Laws relating to the Marine Hospital Service 39, 40, 41, 42 
Leg, fractures of 14 
Malarial fevers 23 
Marine Hospital Service, laws regarding 39, 40, 41, 42 
Marine hospitals, list of 37 
Medicine chest— 
Contents of 6 
Laws regarding 40 
Nose-bleed 23 
Open fractures 15 
Paralysis, after injury to back 10 
Piles 31 INDEX. 
45 
Page. 
Plaster-bandage, liow applied 22 
Prevention of disease 5 
Provisions, allowance to crew 42 
Quinsy. 28 
Resuscitation 35 
Rheumatism 29 
Ribs, fracture of 9 
Scalds 8 
Scalp, wound of 8 
Scurvy 27 
Senna tea 24 
Shoulder, dislocation of 18 
Skull, fracture of 8 
Small-pox 34 
Sore throat 28 
Sprains 21 
Stoppage of water 33 
Stricture urethra 33 
Sunstroke 27 
Syphilis 31 
Thigh, dislocation of 20 
Thigh, fractures of 13 
Thumb, dislocation of 16 
Thumb, fractures of 12 
Toes, dislocation of 19 
Wrist, dislocation of 17 
Yellow fever 26