3*r£ NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL o 3 3NOia3w jo Aavaan ivnouvn snidicsw jo Aavaan ivnouvn 3nidici3w NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL 3NiDia3w jo Aavaan ivnouvn aiMOiaaw jo Aavaan ivnouvn jnoicuw NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL 4 3NOia3w jo Aavaan ivnouvn 3Nom3w jo Aava8n ivnouvn snioiqsvn 3NWW3H jo Aavaan ttnouvn h QTShETSD U~IN WSZ/.Q 00T, VM NLM051345604 o Aavaan ivnouvn 3NiDiaj-/ jo Aavaan ivnouvn 3noio3w jo Aavaan ivnc BRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDI o Aavaan ivnouvn 3noiq3w jo xavagn ivnouvn 3NOI03W jo Aavaan 1VNI 2 V MhL o Mr* / 2 Q. 5PARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MED -6 2 5 jo Aavaan ivnouvn 3nidio3w jo Aavaan ivnouvn snidiqjw jo Aavaan ivn BRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MED tvaan ivnouvn jnoiqbw jo Aivaan ivnouvn 3nidiq3w jo Aavaan ivn 7) General Plan of the Circulation A MANUAL OF INSTRUCTION IX THE PRINCIPLES OF PROMPT AID TO THE INJURED j INCLUDING A CHAPTER ON HYGIENE AND THE ^RILL REGULATIONS FOR THE HOSPITAL CORPS, U. S. A. » v DESIGNED FOR MILITARY AND CIVIL USE BY ALVAH h. doty, m.d. HEALTH OFFICER OF THE PORT OF NEW YORK LATE MAJOR AND SURGEON, NINTH REGIMENT, N. G. S. N. Y. LATE ATTENDING SURGEON TO BELLEVUE HOSPITAL DISPENSARY, NEW YORK SECOND EDITION, REVISED ANI^SLilfcEL*- * \ t K \ ^ Jut- m<) NEW YORK / (j> U' /- V(/ * j D. APPLETON AND-^O-iW-ArNY LONDON : 33 BEDFORD STREET 1898 loo J) 7 25m Copyright, 1889, 1894, By D. APPLETON AND COMPANY. 1 TO JOSEPH D. BRYANT, M. D., IN ACKNOWLEDGMENT OF HIS HIGH POSITION AS A TEACHER OF ANATOMY AND SURGERY, AND AS A LUCID WRITER AND EXPONENT OF THEIR PRACTICAL APPLICATION, THIS MANUAL IS DEDICATED BY THE AUTHOR. 7 PREFACE TO SECOND EDITION. In" preparing the second edition of " Prompt Aid to the Injured " I have endeavored to make such changes as will cause the subject-matter to conform to the pres- ent knowledge of the different topics included in this work. A chapter on Hygiene has been introduced, with the hope that it will give to the reader a general idea of the methods by which the body may be kept in a healthy state. A chapter on Nursing was contemplated, but the space available for this purpose was insufficient to properly present the subject; it was therefore omitted. Through the courtesy of the Surgeon-General of the U. S. Army I am permitted to add the recently adopt- ed drill regulations for the Ambulance Corps of this service. Alvah H. Doty, M. D. 59 West Thirty-fifth Street, New York, March 11, 1894. PREFACE. The object of this Manual is to instruct those who arc desirous of knowing what course to pursue in emer- gencies, in order that sick or injured may be tempora- rily relieved. Special effort has been made to so ar- range the matter and introduce such points as will be of use to the ambulance corps connected with the dif- ferent military organizations. It will be appreciated that it is a difficult task to give to non-medical persons information which will properly instruct them to cope with emergencies without encouraging them to usurp the functions of the physician or surgeon. In order that the subject may be well understood, it is essential to know something of the construction of the human body and the functions of the different organs; for this reason, considerable space has been devoted to anatomy and physiology. The author has endeavored to explain each topic in a plain and sim- ple manner, and when medical terms are used their lay synonyms are also given. Numerous illustrations have been inserted to aid in making the work the more intelligible—many of which have been taken from the works of Esmarch, Flint, Tracy, and others, due credit, however, being given in each instance. viii PREFACE. The author is particularly indebted to Dr. Glover C. Arnold, of this city, for proof-reading, and also many valuable suggestions. To Major Charles Smart, Surgeon, U. S. A., the author wishes to express his thanks for the permission given to introduce in this work the Manual of Transportation now used by the U. S. Army. Alvah H. Doty, M. D. 59 West Thirty-sixth Street, New York, March 4, 1889. CONTENTS. CHAPTER I. PAGE Bone........... 1 Bone: its composition and function—Periosteum and endosteum —Classification of bone—The skeleton—Spine—Bony landmarks —Skull—Hyoid bone—Thorax—Sternum and ribs—Scapula— Clavicle—Bones of upper extremity—Pelvis—Bones of lower extremity. CHAPTER II. Joints—Cartilage—Ligaments—Synovial Membrane—Muscles . 23 Joints : their classification and movement—Cartilage—Liga- ments—Synovial Membrane—Muscles—Tendons and aponeu- roses—Definition of organs—Glands—Mucous and serous mem- brane—Excretion and secretion. CHAPTER III. The Blood and Circulatory Organs......30 Blood : its composition and function—Heart—Pericardium— Circulation of the blood—Endocardium—Blood-vessels. CHAPTER IV. Respiration............39 Definition of respiration—Larynx—Trachea—Bronchial tubes- Lungs. CHAPTER V. Alimentation and Digestion........45 Alimentary tract—Mastication—Teeth—Salivary glands.-Phar- ynx—(Esophagus—Stomach—Small and large intestine—Liver —Pancreas. X CONTENTS. CHAPTER VI. page Kidneys—Bladder—Skin—Spleen.......55 CHAPTER VII. Nervous System...........59 Cerebro-spinal system — Brain—Cerebrum—Cerebellum—Pons Varolii—Medulla oblongata—Spinal cord—Cranial and spinal nerves—Sympathetic system. CHAPTER VIII. Bandages and Dressings.........68 Bandages: their classification — Material for construction — Method of application—Roller, Esmarch, or handkerchief band- ages—Slings—Knots—Compresses—Tampons—Poultices—Moist and dry heat. CHAPTER IX. Antiseptics—Disinfectants—Deodorants.....91 Manner of using—Rules of Health Department, New York city— Sterilization of milk for infants. CHAPTER X. Contusions and Wounds.........109 Classification and treatment. CHAPTER XI. Hemorrhage......„ 120 Hsemorrhage—Arterial—Venous—Capillary—Means of arresting haemorrhage, and how applied. CHAPTER XII. Fractures, Dislocations, Sprains.......136 Fractures: their classification—Signs of fracture—Method of repair by Nature—Treatment of special fracture—Dislocations- Sprains. CHAPTER XIII. Burns, Scalds, and Frost-bite........156 Burns: their classification—Treatment of each degree—Scalds and frost-bite, and their treatment. CHAPTER XIV. Unconsciousness, Shock or Collapse, and Syncope or Fainting 161 Definition of, and treatment, CONTEXTS. XI CHAPTER XV. PAGE Concussion and Compression of the Brain—Apoplexy, or Stroke of Paralysis — Intoxication — Epilepsy, Hysteria, and Heatstroke or Sunstroke.......lua Definition of, and treatment. CHAPTER XVI. Asphyxia and Drowning.........1<8 Asphyxia, or suffocation—Treatment—Prevention—Drowning— Artificial respiration—Different methods—Sylvester's, Howard's, and Hall's. CHAPTER XVII. Poisons and Poisoning......_• . . 186 Varieties of poisons—Narcotics, irritants, and corrosives—Anti- dotes and treatment. CHAPTER XVIII. Convulsion of Children—Tetanus—Foreign Bodies in Eye, Ear, Nose, Larynx, and Pharynx—Bed-sores—Foot-soreness and Chafing.......... Convulsions of children and treatment-Tetanus, or locked-jaw, and treatment—Foreign bodies in eye, ear, nose, larynx, aud pharynx—Method of removal—Bed-sores, prevention and treat- ment—Foot-soreness and treatment—Chafing and treatment. CHAPTER XIX. Hygiene........... Baths—Clothing—Food—Water—Air—Exercise. CHAPTER XX. Transportation of the Wounded.......222 Litters or stretchers—Essential of litters— Varieties— Halstead's —Marsh's—Extemporized litters—Drill Regulations for the Hos- pital Corps, U. S. Army. 199 207 ILLUSTRATIONS. figure page 28. Abdominal contents, position of....................... Flint. 50 24. Air-cells and terminal bronchial tubes................. Flint. 43 66. Arteries, diagram showing position of important. Pye, modified. Face 125 70. Artery, brachial, digital compression of............. Esmarch. 131 69. Artery, brachial, line showing course of............... Tracy. 130 67. Artery, common carotid, digital compression of. Esmarch, modified. 128 73. Artery, femoral, compression by tourniquet......... Esmarch. 134 72. Artery, femoral, digital compression of............. Esmarch. 133 71. Artery, femoral, line showing course of............... Tracy. 132 68. Artery, subclavian, digital compression of. Esmarch, modified. 129 84. Artificial respiration : Hall's method; first position.. Original. 185 85. Artificial respiration: Hall's method; second position. Original. 185 82. Artificial respiration: Howard's method; first part.. Original. 183 83. Artificial respiration: Howard's method: second part. Original. 184 80. Artificial respiration: Sylvester's method; first move- ment........................................ Original. 182 81. Artificial respiration: Sylvester's method; second movement.................................... Original. 182 58. Bandages, cravat, for hand............... Esmarch, modified. 84 59. Bandages, cravat, for knee......................... Esmarch. 84 47. Bandages, diagram of triangular---................ Original. 77 44, Bandages, four-tailed, for head..................... Esmarch. 75 43. Bandages, four-tailed, for jaw...................... Original. 75 39. Bandages, method of rolling. Reference Hand-book of Medical Sciences. 69 42. Bandages, knotted................................ Esmarch. 74 45, 46. Bandages, large square handkerchief.......... Esmarch. 76, 77 41. Bandages, spica of shoulder. Reference Hand-book of Medical Sciences. 73 xiv ILLUSTRATIONS. figure page 40. Bandages, spiral reverse. Reference Hand-book of Medical Sciences. 71 51. Bandages, triangular, for chest, etc........ Esmarch, modified. 80 57. Bandages, triangular, for foot............. Esmarch, modified. 83 48, 49. Bandages, triangular, for head......... Esmarch, modified. 78 56. Bandages, triangular, for hip............. Esmarch, modified. 83 50. Bandages, triangular, for shoulder, hand, etc. Esmarch, modified. 79 52. Bandages, triangular, for shoulder, head, etc. Esmarch, modified. 80 1. Bone, cancellous and compact tissue, arrangement of... Tracy. 2 33. Brain inclosed in membranes....................... Didama. 59 35. Brain, under surface of........................,...... Tracy. 61 36. Brain, upper surface of.......,..................... Didama. 62 37. Brain and spinal cord................................ Tracy. 65 9. Clavicle (collar-bone)............................. Original. 14 75. Clavicle, dressing for fracture of............... Pye, modified. 145 18. Corpuscles of human blood, red and white............. Flint. 31 87. Extemporized stretcher............................ Original. 225 76. Femur, fracture of; gun used for temporary splint. Esmarch, modified. 149 13. Femur (thigh-bone)............................... Original. 19 15. Foot, bones of.................................... Original. 21 11. Forearm (radius and ulna), bones of................ Original. 16 21. Frog's foot, web of, magnified........................ Flint. 37 12. Hand, bones of.................,................. Original. 17 19. Heart............................................. Didama. 32 20. Heart and ribs, relation of............................ Flint. 33 10. Humerus (arm-bone).............................. Original. 15 25. Jaws and teeth.................................... Didama. 46 31. Kidney, vertical section of............................ Flint. 55 77. Knot, Gerdy's extension..................................... 150 63. Knot,granny....................................... Bryant. 85 62. Knot, granny, handkerchief........................ Esmarch. 85 60. Knot, reef.......................................... Bryant. 85 61. Knot, reef handkerchief........................... Esmarch. 85 64. Knot, surgeon's..................................... Bryant. 86 14. Leg, bones of..................................... Original. 20 79. Leg, fracture of; pillow for temporary splint....... Original. 152 78. Leg, fracture of; umbrella for temporary splint..... Original. 151 29- Liver.........,..................................... Tracy. 51 86. Marsh stretcher................................... Original. 224 17. Muscular system..................................... Tracy. 26 34. Nerves, cerebro-spinal system........................ Tracy. 60 38. Nerves, sympathetic system.......................... Tracy. 66 ILLUSTRATIONS, XV figure page 30. Pancreas (sweet-breads).............................. Tracy. 53 16. Patella (knee-cap)................................ Original. 22 7. Rib, a........................................... Original. 12 26. Salivary glands...................................... Tracy. 47 8. Scapula (shoulder-blade).......................... Original. 13 2. Skeleton............................................. Tracy. 5 32. Skin, vertical section of............................ Didama. 56 4. Skull............................................ Original. 9 74. Sling, sleeve of coat used as a............. Esmarch, modified. 140 54. Slings, triangular, for arm................ Esmarch, modified. 81 55. Slings, triangular, for arm................ Esmarch, modified. 82 53. Slings, triangular, for arm................ Esmarch, modified. 81 3. Spine, vertical section of............................ Tracy. 6 27. Stomach.......................................... Didama. 48 65. Suspender, Esmarch's............................. Original. 124 5. Thorax (chest), anterior view........................ Sappey. 10 6. Thorax (chest), posterior view....................... Sappey. 11 23. Thorax (chest), cavity of, showing position of heart and lungs..................................... Didama. 41 22. Trachea and bronchial tubes......................... Sappey. 40 Drill Regulations for the Hospital Corps, U. S. Army. Par. 18. Right oblique.......................................... 230 21. Detachment right...................................... 231 24. Fours right.............................................233 29. Right forward, fours right.............................. 235 34. On right into line...................................... 237 35. Right front into line .................................. 238 38. Right by twos......................................... 239 42. Form fours, left oblique................................ 240 54. The strapped litter..................................... 24-2 57. The vertical position................................... 243 58. Order litter............................................ 243 59. Shoulder litter......................................... 244 62. Carry litter............................................ 245 66 and 71. At litter posts with open litter................... 247 67. Sling secured.......................................... 247 69. Strap litter............................................ 248 88. Litters right........................................... 252 103. Posts at patient.......................... ............. 255 108. The patient lifted..................................... 257 121. Passing an obstacle................................... 260 125. By four, carry litter.................................... 261 xvi ILLUSTRATIONS. page Par."128. Carrying a loaded litter upstairs....................... 263 129. Carrying a loaded litter downstairs..................... 264 131. Carrying by three bearers............................. 265 144. Lifting the patient erect............................... 269 147. Patient across back................................... 270 148. Patient across shoulder................................ 271 150. Two-handed seat..................................... 272 153. The rifle seat......................................... 274 157. The travois........................................... 276 167. Loading ambulance................................... 281 197. Scheme for packing medical oificer's orderly pouch...... 294 198. Scheme for packing hospital corps pouch............... 295 199. Hospital corps bugle call.............................. 295 PROMPT AID TO THE INJURED. CHAPTER I. BONE. Bone is composed of animal and earthy matter ; the former consists of gelatin, fat, and blood-vessels, and the latter, known as " bone-earth," is principally composed of phosphate of lime. Bone derives its tenacity and elasticity from the animal portion, and the " bone-earth " gives to it the necessary hardness.* When soup is made by boiling a bone, there is simply a liberation of the gelatin or animal matter, which prin- ciple may be extracted, by the same process, even from bone two or three thousand years old. In early life the animal part forms about one third and the earthy matter two thirds of bone ; later in life, however, the proportion of phosphate of lime is somewhat increased, and the bone also becomes denser. This will explain why the bones of children are so elastic that, when considerable force is ap- plied, they are apt to bend, like a green stick, rather than break, as in the adult bone under similar circumstances. Rickets is a disease of childhood representing a dimin- ished amount of earthy matter, when the bones become bent and distorted. The deformities are particularly marked in the bones of the lower extremity, and in pelvis and chest. * With the exception of the teeth, bone is the hardest structure in the body. 2 PROMPT AID TO THE INJURED. A section of bone (Fig. 1) shows it to be composed of two kinds of tissue—compact, which is exceedingly dense and hard like ivory; and cancellated or "spongy" bone, which is a network of thin plates and columns of bone. The com- pact tissue constitutes the outer por- tion of bone, and is very much in- creased where great strength is re- quired, as in the shaft of the femur or "thigh-bone/' The cancellated tissue is internal, and especially abundant where bone expands to form large surfaces for support, as in the extremities of the bones of the thigh, legs, etc. Cancellated tissue is not only very light, but very strong; a portion, correspond- ing in size and shape to a piece of loaf or cut sugar, will support a weight of three or four hundred pounds, while a square inch of com- pact tissue, about one half inch in thickness, will support a weight of five thousand pounds. Bone is twice the strength of oak. In the skull, where great strength is necessary to support and protect the brain, we find two layers of com-' pact tissue : the external portion, known as the " outer" table, and the internal as the "inner" table, with a small amount of cancellated tissue, known as the diploe, existing between them. The long bones are hollow. This condition admits of the proper length, diameter, and strength, while it greatly diminishes the weight. The " medullary " or " hollow canal" in the shaft, and Fig. 1.—The right femur, or thigh-bone, sawn in two lengthwise. Showing ar- rangement of compact and cancellous tissues. BOXE. 3 the cancellated tissue of the extremities of long bones, also the cancellated tissue of other bones throughout the body, contains a substance called marroic or " oil of bone." In the medullary canal it is called yellow marrow, and is composed of about ninety-six per cent of fat, while the "red marrow," which is found in cancellated tissue, is three fourths water and contains but a trace of fat. The medullary canals in the bones of birds communicate with the lungs and contain air instead of marrow, thereby ren- dering them very light and properly adapted for flight. Bone is supplied with nutrition from two sources; the periosteum, and the nutrient arteries. The periosteum is a firm and resisting fibrous membrane, pinkish in color, which is adherent to the bone, and covers it at all points except where cartilage exists. This membrane is a struct- ure in which blood-vessels divide, subdivide, and pass into minute openings in the compact tissue, supplying it with nutrition. The cancellated tissue and medulla receive their nutrition from larger vessels (nutrient arteries), which are branches of the main arteries in the vicinity of the bone, and pass through the compact tissue to their des- tination. When the periosteum is removed from the bone, the compact tissue is deprived of its principal means of nutrition, and death or "necrosis " (corresponding to gan- grene in soft tissues) is apt to ensue. This may happen in disease, or as the result of an injury, particularly to super- ficial bones such as the tibia, bones of the head, etc. A familiar example is a " felon," which demands immediate and special treatment at the hands of the surgeon. When bone is in the normal condition and properly covered with periosteum, it feels smooth and moist, and when struck with a probe it gives a dull sound ; but when the periosteum is removed, it feels rough and hard, and striking it with a probe produces a metallic sound. It is important to the surgeon to recognize these different condi- tions, and be thus easily enabled to decide whether the periosteum is present or absent. 4 PROMPT AID TO THE INJURED. The endosteum is a thin, fragile membrane which cor- responds in nutritive function to the periosteum, and lines the medullary canal in the long bones. Bones are supplied with nerves aud lymphatics or ab- sorbents. The lymphatics have been known to remove by ab- sorption ivory pegs used to hold in place the broken ends of a bone which would not unite by the natural process. The shape of a bone depends upon the function it per- forms. Bones are divided into long, short, flat, and ir- regular. The long bones, of which the femur or " thigh- bone " is a type, are composed of a shaft and two extremi- ties, and, with their muscular attachments, act as levers, and also for support. The short bones are found where a number of joints are required for limited motion com- bined with strength. An example of this class is the carpus or wrist. The flat bones are used in the construction of cavities and to protect their contents, and are also for muscular attachment, as the bones of the skull, the shoulder-blades (scapulae), etc. Examples of the irregular bones are the upper and lower jaw (superior and inferior maxillary), and the vertebrae. The skeleton (Fig. 2), which represents the bones in their proper relations, is the framework to which the soft structures of the body are attached. It consists of a cen- tral column (the spine); four extremities : two upper (the arms), and two lower (the legs); and three bony cavities: (1) the cranium or skull, containing the brain ; (2) the thorax or chest, containing the heart and lungs ; and (3) the pelvis or basin, containing the pelvic and some of the abdominal organs. The skeleton is composed of two hundred bones. There are several small bones found in the tendons of muscles, at the union of the skull-bones, and also in the ear, which are not included in this enumeration. This number is divided in the following manner : Fig. 'J.—The skeleton. 6 PROMPT AID TO THE INJURED. The spine or vertebral column........ 26 Cranium........................... & Face............................ 14 Os hyoides, sternum, and ribs........ 26 Upper extremities................... 64 Lower extremities.................. 62 200 V> The spine (Fig. 3), which is about one third the length of the body, is a jointed column consisting of a series of bones (vertebrae) articulated or joined together, forming three slight curves. It supports the skull and its contents, and protects the spinal cord, which is contained in a canal formed by the union of the bony parts. At its base the column rests upon the upper portion of the pelvis—between the "haunch-bones." A vertebra consists of two impor- tant parts—a body, in front, and a posterior portion or vertebral arch. The bodies are piled one upon the other for support and strength, the arch behind forming, by its junction with the body, a canal for the passage of the spinal cord. Between the bod- ies of the vertebrae are found layers or pads of a very elastic and flexible substance, known as " intervertebral cartilage," which forms a soft cush- ion for each vertebra to rest upon. Its elasticity prevents or diminishes shock, and also tends to restore the column to its erect position. Continued pressure on this substance during the day diminishes its thickness, consequently a person will lose about half an Vl) Fig. 3.—The spine, sawn in two lengthwise. BONE. 7 inch in height during this period ; the rest and recum- bent position of the night restore it to its previous condi- tion. It is important to remember that leaning too much on one side, as at a desk, will cause a permanent change in the cartilage, so that the vertebral column may be bent to one side without the bone being primarily involved. The curves in the vertebral column are necessary to assist in forming cavities for the reception of important organs. It is said that the curves increase the strength of the column tenfold ; they also aid in destroying shock. The twenty-six bones comprising the vertebral column are divided in the following manner, viz.: Cervical or neck.............................. 7 Dorsal or back.................................. 12 Lumbar or loins... .......................... 5 The sacrum, which represents five vertebras (in foetal life) fused into a single bone.................... 1 The coccyx or " crupper," which is formed from four bones........................................ 1 26 The freest movement in the vertebral column is found in the neck or cervical region, and the least movement in the back, between the shoulders, the spine here being con- nected with the ribs. The weakest part of the spine is at the last dorsal vertebra, and this portion of the vertebral column is very movable. It is very essential to know that different elevations on the surface of the body (bony prominences, etc.) indicate the situation of certain important internal organs ; thus the vertebral column furnishes valuable information. Rubbing the fingers briskly up and down the spine will produce sufficient friction to redden the skin over the bony prominences known as "spinous processes." These pro- cesses are formed by the union posteriorly of the sides of 8 PROMPT AID TO THE INJURED. the vertebral arches already spoken of. With the body bent forward and the arms folded across the chest, the spinous processes can be made even more apparent. The spinous process of the seventh or lowest cervical vertebra is particularly prominent, and has received the name of " vertebra prominens," and should be carefully sought for, as it will aid in locating others. The lower or inferior angle of the scapula or " shoulder- blade " is on a line with the seventh dorsal vertebra. Having located the spinous processes of the different vertebrae, the following points are to be remembered, viz.: Interval betiveen Sixth and Seventh Cervical Spines. —CEsophagus and trachea begin. Seventh Cervical—Apex or upper part of lung; con- sequently a knife, or bullet wound, above this line, unless carried downward, would not injure the lung. Third Dorsal— Upper border of arch of aorta. • Fourth Dorsal—Arch of aorta ends; upper level of heart; division of trachea into two portions; right and left bronchus. Eighth Dorsal—Left side, lower level of heart. Ninth Dorsal—Left side, lower end of oesophagus, passing through diaphragm ; upper or cardiac opening of stomach and upper edge of spleen. Tenth Dorsal—Left side, lower level of lung. First Lumbar.—About the middle of kidneys; lower edge of spleen. The skull (Fig. 4) is the case for the lodgment and pro- tection of the brain and its membranes, and important blood-vessels and nerves. It is composed of twenty-two bones, enumerated in the following manner : Cranium (8 bones).—Occipital, 1; parietal, 2; frontal, 1; temporal, 2; sphenoid, 1; ethmoid, 1. Face (14 bones).—Nasal, 2 ; superior maxillary, 2 ; lachrymal, 2 ; malar, 2 ; palate, 2 ; inferior turbinated, 2 ; vomer, 1; inferior maxillary, 1. The cranial bones protect the brain, and are uniformly BONE. 9 Fig. 4.—The sknll. strong and compact; while the bones of the face contain principally the organs of special sense, and give the proper symmetry to this portion of the skull, some of them are extremely thin, and are readily broken. The different bones of the skull are connected by sutures or " seams," and the overriding of these bones lessens the size of the head during birth, and permits variations, in size, for some little time afterward. The fontanelles, or "soft spots" on an infant's head, cor- respond to the subsequent points of union of two or more bones of the cranium, which have not become fully hard- ened or ossified, but still retain the character of the mem- 10 • PROMPT AID TO THE INJURED. brane or soft structure from which the cranial bones are originally developed. These spots disappear when the bone becomes fully developed or ossified, which generally occurs within one and a half or two years after birth. A large opening exists at the base of the skull in the occipital bone, called the " foramen magnum," for the trans- mission of the spinal cord from the brain to the canal in the spinal column. Other and smaller openings are found in the skull which transmit blood-vessels and nerves. The skull is supported by the vertebral column. The first cervical vertebra is firmly attached to the base of the skull at the " foramen magnum," while the second cervical acts as a piv- ot, having a vertical or upright portion, called the " odontoid " process, which fits into the first cervical vertebra, and around which the head ro- tates. The hyoid bone is an arch, something like a horseshoe, which is placed above the prominence on the front of the neck called the pomum Ad- ami, or " Adam's ap- ple," and aids in sup- porting the tongue, and gives attachment to certain muscles. The thorax or chest (Figs. 5 and 6) is the bony frame-work which contains the heart, lungs, and important blood-vessels and nerves. It is formed Fig. 5.—Thorax, anterior view (Sappey). 1, 2, 3, sternum ; 4. circumference of the upper portion of the thorax ; 5, circumference of the base of the thorax ; 6. first rib ; 7, sec- ond rib ; 8, last two, or floating ribs ; 9, costal cartilages. BONE. 11 Fig. 6.—Thorax, posterior view (Sappey). 1, 1, spinous processes of the dorsal vertebrae ; 2, 2. laminae of the vertebrae ; 3, 3, trans- verse processes ; 4. 4. dorsal portions of the ribs ; 5, 5, angles of the ribs. by the sternum in front, and the ribs and vertebrae at the side and back, and is sepa- rated from the abdom- inal cavity by a mus- cular partition known as the diaphragm or "midriff." The sternum or " breast - bone " is a flat and narrow bone about seven inches long, situated in the front of the chest, and supporting the clavi- cles or " collar-bones " and the ribs, with the exception of the last two ribs. The ribs (Fig. 7) are twenty - four in are numbered from posteriorly with the number, twTelve on each side, and above downward. They articulate dorsal vertebrae, and the upper ten connect in front with the sternum by means of cartilages (costal cartilages), which are interposed between the ends of the ribs and the sternum, and allow of greater motion and elastic- ity. The two lower ribs, the eleventh and twelfth, are simply connected with the vertebrae, and are known as "floating" ribs, as thoy have no attachment in front. The peculiar arrangement and attachment of the ribs ren- der them a very important element in respiration ; during this act the ribs are elevated and depressed by the action of the respiratory muscles. When the ribs are elevated during inspiration, the thorax or chest is enlarged and air passes into the lungs ; in expiration the ribs are de- 12 PROMPT AID TO THE INJURED pressed, the cavity diminished in size, and the air in the lungs is ex- pelled. The elasticity of these bones is illustrated by the fact that chil- dren in Arabia use the ribs of cam- els for bows. Upper extremities.—Each upper extremity is composed of thirty-two bones, and includes the following : scapula, clavicle, humerus, radius, ulna, eight carpal bones, five meta- carpal bones, and fourteen phalanges. The scapulce,ov "shoulder-blades" (Fig. 8), are thin, flat, and triangular bones, which have on their posterior and upper part an elevation or ridge known as the " spine " ; the external extremity of the spine is the acro- mion process, which connects with the outer end of the clavicle. The outer and upper portion of the scap- ula forms the glenoid cavity or "socket" which receives the ball- shaped head of the humerus or " arm- bone." The scapula, in this manner, assists in the formation of the shoul- der-joint. It also furnishes broad sur- faces for the attachment of muscles, and aids in protecting the contents of the thorax. The clavicles or "collar-bones" (Fig. 9), shaped something like the italic letter /, are on the anterior and upper part of the chest, and extend from the upper portion of the ster- num or "breast-bone" to the acro- mion processes of the shoulder- BONE. 13 blades referred to above ; they hold the shoulders upward, backward, and outward. When a clavicle is broken the Fig. 8.—Left scapula, or shoulder-blade. arm drops downward, forward, and inward, its support be- ing gone. Manual labor increases the size, strength, and curvature of the clavicle. The collar-bone is less curved in women than in men. 14 PROMPT AID TO THE INJURED. The humerus or " arm-bone " (Fig. 10) is the longest and strongest bone of the upper extremity. It has a shaft and two extremities; the upper extremity is the largest part of Fig. 9.—Anterior surface of left clavicle, or collar-bone. the bone, and consists of a head joined to the shaft by a very short and constricted portion called the "anatomi- cal "neck. The head is globular in form, covered with cartilage, and articulates with the glenoid cavity of the scapula, already spoken of, forming with it a ball-and- socket joint. The cartilage covering the head protects it and prevents undue friction in the joint. At the point where the anatomical neck joins the shaft are found two rough eminences called tuberosities, which are for muscu- lar attachment. Just below the tuberosities is another constriction—the " surgical" neck—so called from the fact that it is the common seat of fracture. The shaft is partly cylindrical, prismatic, and flattened, and roughened for the attachment of muscles. The lower extremity is a broad and flattened (from before backward) portion of the bone which articulates with the ulna principally, and to a cer- tain degree, with the radius of the forearm, these three bones forming the elbow-joint. The humerus has a greater range of motion than any other bone in the body, and is oftener dislocated; it is also frequently broken or fract- ured, particularly just below the head, at the surgical neck already described. The radius and ulna (Fig. 11) are the bones that con- stitute the forearm. The radius, so called from its fancied resemblance to BONE. 15 the spoke of a wheel, is the external bone lying parallel with the ulna when the palm of the hand is turned up- ward. It resembles other long bones in having a shaft and two extremities. The up- per or lesser extremity forms only a small portion of the el- bow-joint, while the lower ex- tremity, which is broad, forms the wrist-joint by articulat- ing with two of the carpal or wrist bones. The lower end also articulates with the cor- ' responding portion of the ul- na. The shaft of the radius is more or less irregular and rough for the origin and in- sertion of muscles. The ease with which the forearm and hand may be turned with the palm down (" pronation "), and with the palm up ("su- pination "), is due to the pe- culiar articulation of the up- per end of the radius with the ulna. The upper end of the radius (or head) is somewhat knob-shaped, with a depression or excavation on its upper surface; the excavation artic- ulates with a small portion of the lower extremity of the humerus, and represents the limited part it takes in the formation of the elbow-joint. Trochlea. Radial Head. Fig. 10.—Left humerus, or arm-bone. PROMPT AID TO THE INJURED. Artie, with Semi-li and Scaphoid of Carpus. Fig. 11.—Left radius and ulna, or bones of the fore-arm. Below the portion of the radius just described is a constricted portion, called the neck ; a ligament in the form of a loop, named the orbicular ligament, is thrown around this part, and attached to the outer side of the ulna ; this ligament, while it holds the radius in position, al- lows the neck of the ra- dius, which it encircles, to freely rotate. The ulna, which is composed of a shaft and two extremities, is the companion of the radius, and situated internal to it; the lower extremity is very small, and, although connected with the radi- us, has no articulation with the carpal or wrist bones, consequently it does not enter into the formation of the wrist- joint ; but the upper end is large, and contains a depression or cavity which receives the lower extremity of the humer- us. The prominent point of the elbow is the ex- treme end of the ulna, and is known as the "olecranon process" of BONE. 17 Articulate with Radius forming Wrist-Joint. Carpus Metacarpus Fig. 12.—Bones of the left hand. Palmar surface 18 PROMPT AID TO THE INJURED. the ulna or " funny-bone," so called from the peculiar sen- sation experienced when the ulnar nerve, which is closely associated with the inner border of this process, is struck. The upper extremity of the ulna and the lower extremity of the humerus make up the elbow-joint—that is, the prin- cipal part of it ; while, as already described, the upper end of the radius articulates with a small and less important part of the lower extremity of the humerus. The carpus or wrist (Fig. 12) consists of the following small and irregular bones, arranged in two rows: the up- per, composed of the scaphoid, semi-lunar, cuneiform, and pisiform, and the lower row, of the trapezium, trapezoid, os magnum, and unciform. The large number of bones constituting the carpus, and having so many small joints, increases its strength, motion, and elasticity. They also diminish shock and the tendency to fracture, which would be frequent if the wrist were composed of one bone. The carpus supports the hand and preserves its symmetry. The metacarpus (Fig. 12) consists of five long bones (metacarpal), connecting the carpus with the bones of the fingers and thumb; they form the bony framework of the palm and back of the hand. The phalanges (Fig. 12) are miniature long bones, hav- ing a shaft and two extremities, and are fourteen in num- ber, three for each of the fingers and two for each thumb; their position can be easily demonstrated by bending the fingers. The bases of the first row of phalanges articulate with the heads of the metacarpal bones ; the remaining phalanges articulate with each other. When the hand is open, the fingers do not correspond in length; but when closed, in grasping an object, there is no apparent differ- ence. If the fingers wThen closed were uneven, the grasp- ing power would be diminished. The three rows of pha- langes grow progressively smaller toward the end of the fingers. The pelvis or " basin " supports the trunk and protects the pelvic, and a portion of the abdominal organs. It is BONE composed of the two innom- inate or " haunch " bones, the sacrum, and the coccyx ; the last two have been described with the spinal column. The innominate bones (Fig. 2) are situated one on each side and in front, and form the greater portion of the pelvis, while the sacrum and coccyx form the posterior portion. On the outer side of an innominate bone is found a depression or socket, known as the cotyloid cavity or ace- tabulum, corresponding in function to the glenoid cav- ity of the scapula, which re- ceives the head of the femur or "thigh-bone." The femur (Fig. 13) is the longest and strongest bone in the body ; its length is characteristic of the human skeleton. In the erect posi- tion, the tips of the fingers reach to about the middle of the thigh, while in the orang- outang, the fingers reach to the ankle. This depends also on the comparative short- ness of the arm in the human skeleton. The femur is divided into a shaft and two extremities, the upper extremity being composed of a globular head, Outer Condyle. Inner Condyle. Fig. 13.—Right femur, or thigh-bone. 20 PROMPT AID TO THE INJURED. which is connected ob- liquely with the shaft by quite a long neck; at the point where the neck joins the shaft there are two prominences, the higher being the larger, and on the outer side of the bone, and called the great trochanter, the i smaller one being on the inner side, and somewhat below, known as the lesser trochanter. The eminences are for the in- sertion of muscles. The head of the femur is con- tained in the cotyloid cav- ity or acetabulum of the innominate or haunch bone. The long neck of the femur keeps the shaft at the proper distance from the pelvis, prevents any interference with its action, and allows greater motion. The shaft of the femur is almost cylindri- cal, and furnishes sur- faces which are some- what roughened for the origin and insertion of muscles. The lower ex- tremity is very large and broad, articulates with the upper extremity of the tibia or leg-bone and BONE. 21 the patella or knee- cap, and forms the knee-joint. The femur ar- ticulates with the pelvis, tibia, and pa- tella. The tibia or "shin- bone " and fibula or "splint-bone" (Fig. 14) are the bones of the leg, and have the characteristics of long bones. The tibia, which is very superficial in front (having only the skin as a cover- ing), is the larger of the two bones, and is constructed mainly for strength, and sup- ports the femur; it also furnishes attach- ment for a few mus- cles. The direction of the tibia is verti- cal. The fibula is the companion - bone of the tibia and is ex- ternal to it. It is about the length of the tibia, and is very slim, and helps to support the tibia and form the ankle-joint, Fig. 15.—Bones of right foot. Dorsal surface. 22 PROMPT AID TO THE INJURED. and also furnishes the origin of a number of important muscles. The patella or " knee-cap " (Fig. 16) is situated in front of the knee-joint; it is in the tendon of a muscle, and as- sists in protecting the joint, and also aids in properly extending the leg. When the leg is ex- tended and the muscles are re- laxed, it will be found that the patella is freely movable. The tarsus or "instep" (Fig. 15) corresponds to the carpus in the upper extremity, and consists of seven bones (tarsal), viz.: cal- caneum or os calcis, astragalus, cuboid, scaphoid, internal cunei- form, middle cuneiform, and external cuneiform. The metatarsal (Fig. 15) bones correspond to the meta- carpal bones in number, and in a general way to their description. The phalanges (Fig. 15) are fourteen in number, and arranged in the same manner as the phalanges of the hand. Fig. 16.—The patella, or knee cap. I CHAPTER II. JOINTS— CARTILA GE—LIGAMENTS-STNO VIAL MEM- BRANE—MUSCLES. JOINTS. Bones are joined at different points, constituting articu^ lations or " joints " ; some are immovable, as joints of the skull ; others slightly movable, as joints of the spine ; while the remainder are freely movable, as the knee and shoulder joints, joints of the fingers, etc. The movable joints are divided into three kinds : 1. Joints having a gliding movement; as the tarsus and carpus. 2. Ball-and-socket joints, as where a globular head is received into a cup-like cavity, and admitting of motion in all directions, as shoulder and hip. 3. Hinge-joints, where the motion is limited to two directions ; forward and backward, as the elbow. 4. Pivot joints, where rotation only is permitted, as the joint between the atlas and axis and the joint between the radius and ulna. Other varieties of joints sometimes described are sim- ply modifications of the above. Joints admit of the following movements : flexion, ex- tension, rotation, adduction, abduction, circumduction, pro- nation, and supination. Flexion takes place when the forearm is bent upon the arm, the leg upon the thigh, etc.; and extension, when these parts are extended or straightened; rotation occurs when a part is turned in and out; adduction is illustrated by the movement which carries the arm or leg toward the one of the opposite side or toward the median line of the body; abduction, the movement in the opposite direction; circumduction is exemplified when the arm is swung in a circle, as at the shoulder-joint; pronation is when 24 PROMPT AID TO THE INJURED. the palm of the hand is turned downward; and supina- tion is when the palm is turned upward. The following structures enter into the formation of a joint, viz.: bone, cartilage, ligaments, tendons, synovial membrane, blood-vessels, and nerves. CARTILAGE. Cartilage or "gristle" is a very firm and dense sub- stance, found principally in joints, and covers the ends of bones entering into their formation ; it protects the adja- cent bony surfaces against friction, and also prevents shock which would occur if the bones were directly ap- plied to each other. The continued pressure brought to bear on cartilage in a joint would render it subject to inflammation and disease if it were supplied with blood- vessels ; consequently, cartilage has no blood-supply, and is known as the non-vascular tissue ; it absorbs its nutri- tion from the surrounding tissues by a process known as "imbibition." Cartilage connected with ribs has already been described (see Ribs). Cartilage is also found in tubes such as the air-passages, ear, nose, etc., where it is neces- sary that the tubes should be kept permanently open. LIGAMENTS. Ligaments are of two kinds, viz., the white fibrous and the yellow elastic. The white fibrous ligaments are composed of bundles of white fibrous tissue which are closely interlaced ; they are found at the movable joints, and serve to connect the extremities of the bones forming an articulation ; they are inextensible but very flexible and strong, and, while they admit of the free movement necessary at the joint, they do not allow the articular ends of the bones to be abnormally displaced. When a dislocation occurs, the ligaments are either ruptured or torn from their attachments. The liga- ments composed of yellow elastic tissue are extremely ex- tensible, and are fewer in number than those composed of JOINTS, LIGAMENTS, MUSCLES, ETC. 25 white fibrous tissue. Examples of this variety are the ligamenta subflava and the ligamentum nuchae. The latter extends from the spinous process of the seventh cervical vertebra to a protuberance on the occipital bone at the base of the skull. It is rudimentary in man, but well developed in animals, where it aids in supporting the head, and acts as a substitute for muscular power. The " ligamenta subflava" are small ligaments of the same tissue (yellow elastic) connected with the different verte- brae composing the spinal column; their action is similar to that of the ligamentum nuchae, and assist in bringing the vertebral column to an erect position. SYNOVIAL MEMBRANE. The synovial membrane is a delicate structure con- nected with movable joints and covering the inner side of the ligaments. It is not found between the articular sur- faces of the bones composing the joints. The synovial membrane secretes a thickish, glairy fluid, resembling in appearance the white of an egg, and it is known as sy- novia or "joint oil," which, passing into the joints, lubri- cates the cartilages and prevents friction. The synovial membrane may become inflamed as the result of injury or disease, producing stiffness of the joint, or anchylosis. MUSCLES. Muscles are bundles of reddish-brown Abel's having the power of contraction, and are divided into two kinds, viz., voluntary or striped, and involuntary or unstriped; the terms striped and unstriped refer to the microscopical ap- pearance of the fibers composing the muscle. The voluntary muscles are under the control of the will, and comprise the bulk of the muscular system ; they are attached to the different parts of the skeleton, and act on the bones as levers ; they are the agents of locomotion and of the movements of all portions of the body, they also protect the different structures beneath them, and give 26 PROMPT AID TO THE INJURED. Fig. 17.—The muscular system. JOINTS, LIGAMENTS, MUSCLES, ETC. 27 grace and symmetry to the form (Fig. 17). When mus- cles become diminished in size or illy developed, the per- son is angular or bony. The lean meat used for food is muscular tissue. Muscles are of different lengths and shapes—long, short, broad, etc. They are arranged in pairs—that is, there are corresponding muscles on each side of the body, although some exist singly. There are over four hundred muscles in the human frame. In many situations the outlines of muscles are apparent to the eye, and are utilized as guides to the location of important blood-vessels and nerves. Muscles are surrounded by a thin, web-like tissue known as fascia, which serves as a support for them and allows of their movements without undue friction. Muscles are composed of a belly and two extremities. The more fixed extremity is called the origin, and the movable one the insertion ; however, in some muscles the origin and insertion are equally movable. During con- traction their origins and insertions approximate, and mus- cles shorten and thicken; this can be illustrated by raising a heavy weight with the hand, when the biceps muscle in the arm will be seen to thicken and bulge forward. Mus- cles gradually diminish in size toward their extremities, the muscular tissue being replaced by an extremely firm and resisting substance called white fibrous tissue, consti- tuting a tendon. The tendons are directly and intimately connected with the periosteum covering the bone, and sometimes directly with the bone. They differ from muscular tissue in ap- pearance—being white and glistening. An aponeurosis is simply an expanded tendon, and is found where the muscle has a broad attachment. Muscles are abundantly supplied with blood-vessels, nerves, and lymphatics, but tendons have few blood-vessels and only those of the largest size have nerves. The nerves connected with the muscles transmit to them a stimulus from the brain and spinal cord, which 28 PROMPT AID TO THE INJURED. calls their function into action. In the disease known as tetanus, or " locked-jaw," the stimulus is sometimes so great, and the contraction so intense, that the muscular fibers are ruptured. The stiffness that ensues after death (rigor mortis) is due to a solidification of some of the fluid portions of the muscle, which is succeeded after a short time, however, by relaxation of the body. It is said that this rigidity is not present, or only very transient, in one killed by lightning. If a muscle is not sufficiently used it becomes dimin- ished in size (atrophy), and from continued non-use may undergo degeneration, from which there is no recovery ; consequently a muscle should not be confined or unused too long. Hypertrophy represents the opposite condition to atrophy, the muscles being increased in size, and may be the result of constant exercise ; it is often noticeable in athletes. The contraction of a voluntary muscle is very rapid and abrupt. The involuntary or unstriped muscles are not con- nected with bones, but form the muscular portion of the stomach, intestines, and other internal organs, and also the muscular coat of the blood-vessels. The contraction of this form of muscular fiber is slow, unequal, and does not affect all portions of the muscle simultaneously. The involuntary muscles are nqt, as a rule, under the control of the will; they have no tendons; the muscular fibers simply interlace with each other. Although the muscular fibers of the heart are striped, like voluntary muscular fibers, this organ is an involuntary muscle, and not under the control of the will, this being the only exception to the rule. Reference will frequently be made in the following chapters to organs, glands, mucous and serous membranes, and also tp secretion and excretion, so then for the sake of convenience these terms will now be explained. An organ is a part of the animal organism having a JOINTS, LIGAMENTS, MUSCLES, ETC. 29 special function to perform, as the brain, heart, stomach, kidneys, etc. A gland is an organ, but it also has the additional function of abstracting from the blood, material which it discharges from the body unchanged (excretion), as urine, or, it manufactures from certain parts of the blood, a fluid (secretion) which has a particular function, as the gastric juice. Mucous and serous membranes line the interior of cavi- ties, sacs, tubes, etc. Serous membranes, except the peri- tonaeum in the female, line cavities and tubes which are closed and have no communication with the outer world (examples: pericardium pleura, and peritonaeum) ; while mucous membranes line structures which open exter- nally (examples: respiratory and alimentary tracts). Both membranes secrete a small amount of fluid, which keeps their surface moist and pliable, and prevents fric- tion ; in addition to this, some mucous membranes have small glands in their structure which produce a secretion having a distinctive function, as the mucous membrane lining the stomach, which secretes the gastric juice. A secretion is a fluid formed in and by a gland or organ for a special purpose. It is peculiar to the organ that produces it and is found in no other part, and conse- quently never exists in the blood ; examples : gastric juice, bile, etc. An excretion represents certain material which is always present in the blood, composed principally of waste matter ; it is not formed in the excretory organ, but is simply removed from the blood and discharged from the body. The urine is an example of an excretion, the kidneys being excretory organs. Some organs have both excreting and secreting func- tions ; the liver is an example of this type. CHAPTER III. THE BLOOD AND CIRCULATORY ORGANS. Blood is the great nutritive fluid of the body. It dis- tributes to the different tissues material necessary for their proper maintenance and activity. It supplies heat and also oxygen, receiving the latter from the air. It is absolutely necessary that the tissues should be constantly furnished with oxygen, otherwise death would ensue from suffoca- tion, as in drowning. The blood has also the important function of removing from the body through certain or- gans, principally the kidneys, lungs and skin, worn-out and waste matter, which, if retained in the body, would produce serious disease or death. Blood is composed of a liquid and a solid portion, about equally divided. The liquid portion or " plasma " is almost colorless when separated from the solid matter or "cor- puscles," and contains the principal elements of nutrition, which it distributes to the different tissues in its course throughout the system, receiving in return waste material which is to be discharged from the body. The corpuscles or solid portion float in the plasma, and constitute about one half of the bulk of the blood. They are divided into three kinds, viz., red corpuscles, leuco- cytes or white corpuscles, and those known as blood plaques. The red corpuscles are by far the most impor- tant and numerous ; they resemble in appearance a thick coin which has been made thin in the center on both sides, or biconcave. These little bodies are exceedingly small; thirty-five hundred of them laid side by side on their flat surface would be required to cover the space of one inch. They are, of course, not visible to the naked eye. When examined by the microscope they appear straw-colored; but when vast numbers are crowded to- gether, as in the normal condition of the blood, they give THE BLOOD AND CIRCULATORY ORGANS. 31 to it the characteristic red color. Physiologists have cal- culated that there are over fifty billions of them in the human body. The red corpuscles are the agents that re- ceive oxygen from the air in the lungs and distribute it to the tissues throughout the body. The white corpuscles are larger than the red (about 3^7 of an inch in diameter), and are globular in form. The blood plaques are exceed- ingly small, only about TT^57 to To£ >^ of each four halts: the other files oblique to ^^™^^* the left, and place themselves successively ?AR' frl!rm four.8' on the left of the leading file, the distance left oblique. •■,-,-,•■, between the fours being one hundred inches. Column of twos is formed from column of files on the same principles. 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 fall 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 preserve silence, but not immobility. 45. To resume the attention: 1. Detachment, 2. Attention. The men take the position of the soldier and fix their atten- tion. 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 center 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. TRANSPORTATION OF THE WOUNDED. 241 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 return sword and fall out, the senior non-commissioned officer salutes, steps in front of the detachment, aud commands: Dismissed. LITTER DRILL. THE LITTER AND SLING. 4S. 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 loop-shaped, 4 inches high and If inch wide. On the left front and right rear handles a half round iron ring is fixed, 4-£ inches from the end; between this and the canvas plays the movable ring of the sling. Two cross straps, each with a ring at one end and a snap at the other, play through staples fastened to the bottom of each pole beneath the canvas and near its free edges. When the litter is open the straps lie transversely under the can- vas ; when the litter is closed they are passed around it through the free loop of the slings and fastened to the snaps, thus securely closing the litter. 49. One pair of regulation slings is permanently attached to each litter. They are made of gray woolen webbing, 21 inches wide, with a leather-lined loop at one end and a leather strap (with buckle) at the other, the strap passing through a steel swivel, itself attached to the movable ring on the handle. 50. Officers and non-commissioned officers at this drill will wear side arms, and the latter leggings. The instructor will re- quire that the clothing of the men be clean and neatly adjusted; that the privates of the Hospital Corps fall in equipped with pouch, belt, knife, and leggings, and that the company bearers wear belts and brassards.* 51. For purposes of litter drill each set of four is a litter squad. The litter squad is marched by the commands applicable to a set of four, substituting "litter" for "four." * When practicable it is advisable to have the men who are to repre- sent the wounded dressed in fatigue suits; they remain in the line of file closers until needed. 17 242 PROMPT AID TO THE INJURED. 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 personnel of the sets of four as he deems ad- visable. The selection of No. 1 should be deter- mined by the intelligence and experience of the men ; No. 4 should be as near in size as possible 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, the slings placed parallel to each other thereon, and all se- cured by the cross straps. It is said to be closed when unstrapped, the two loops of the front sling upon the left handle, and of the rear sling upon the right, the bight of each sling embracing the opposite handle. 55. The foot 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-commissioned 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, and promptly return in the same order, each man resuming his place by passing through his interval one pace to the rear, facing about and stepping into line. Par. 54.—The strapped litter. TRANSPORTATION OF THE WOUNDED. 243 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, if practicable, 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 forearm hori- zontal. This position should likewise be taken in any formation or movement in which there may be danger of the lower or upper handles of the lit- ter 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 the right foot, canvas to the left, the right arm natu- rally extended and the hand grasping the front pole; the left hand is dropped to the side. Par. 57.—The vertical position. Par. 58.—Order litter. 244 PROMPT AID TO THE INJURED. 59. Being at the order: 1. Shoulder, 2. Litter. At shoulder, the litter is raised to the vertical position; at litter, it is laid, can- vas down, upon the shoulder (as in Par. 50), where it is supported by the right arm, the right hand grasping the left pole; the left hand is dropped to the side. 60. A stack consists of three litters, to which more may be added. Being in line at the shoulder, the in- structor designates the center squad and commands: 1. Stack, 2. Litter. At stack, each No. 3 brings his litter to the vertical position and steps one pace to the front; No. 3 of the designated squad stands fast; the other Nos. 3 facing toward the center close in upon him and face to the front. At litter, Nos. 3 of the squads on right and left of the designated squad advance two paces, and facing each other lock the upper handles of their litters together; No. 3 of the designated squad locks the upper handles of his litter between those of the other two squads, when all lower stack to the ground, spreading the foot sufficiently to make it stand securely. As soon as the stack is formed the other litters are laid on, and all take their posts. 61. Being at the stack : 1. Take, 2. Litter. At take, the Nos. 3 close in on the center as in previous para- graph. At litter, they advance to the stack, grasp their respective litters, break the stack, and resume their places in line. 62. Being in line, litters at the shoulder, or order : 1. Carry, 2. Litter. Par. 59. —Shoulder litter. TRANSPORTATION OF THE WOUNDED. 245 At carry, each No. 3 brings his litter to the vertical position ; at litter, he drops the upper handles forward and downward until the litter is in a horizontal position, canvas to the left; meanwhile Par. 62.—Carry litter. the other numbers step directly to the front. No. 2 until he is op- posite the front handles, which he seizes with his left hand, and Nos. 1 and 4 until they are opposite the center 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. 63. Being at the carry :* 1. Ground, 2. Litter. * A line of litters at the carry, or lift, may be aligned as follows: At tin' command right (or left) dress, all cast their eyes to the right; No. 1 extends his left arm and hand laterally, his fingers touching the fingers of No. 4, who in like manner extends his right arm and hand, and at the 246 PROMPT AID TO THE INJURED. At ground, the Nos. 2 and 3 face inward ; at litter, they Stoop and lower litter to the ground, lengthwise between the files, canvas up, then standing erect they face to the front. 64. Being at the ground : 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. 65. Being at the carry : 1. Shoulder, 2. Litter. At shoulder, No. 3 reaches forward with his left hand and grasps the litter near its center; at litter, he brings it to the verti- cal position and then to the shoulder; meanwhile, the other num- bers step backward and align themselves upon him in regular order. 66. Being at the carry, litter strapped : 1. Open, 2. Litter. At open, all face litter; at litter, No. 4 supports litter at center, canvas up, by grasping a pole in each hand, Nos. 2 and 3 unfasten the straps and slip the free loop of each sling upon the ring handle, the bight embracing the opposite handle; they then grasp the right handles with their right hands, and Nos. 1 and 4 resume their posts. This leaves the litter suspended longitudinally, can- vas to the left. They then extend the braces, and supporting the litter horizontally by the handles, canvas up, lower it to the ground, and resume the attention standing between the handles, facing the litter. With only two bearers, the strapped litter is first grounded. A strapped litter may be unstrapped by arresting the execution of open Utter, as above described, by the commands Carry Litter given when the slings have been looped around the handles. If the litter be merely closed at open, Nos. 2 and 3 face the litter and grasp the upper handles with the right hands. At litter, they drop the left pole, extend the braces, lower the litter, and take position as before. same time places his left hand above his hip. All then dress as directed, Nos. 2 and 3 bringing the center of the litter under the hands of Nos. 1 and 4. At front, all cast their eyes to the front, and drop the hands. TRANSPORTATION OF THE WOUNDED. 247 Pars. CO and 71.—At litter posts with open litter. 67. To secure slings, the litter being lowered: 1. Secure, 2. Slings. Nos. 2 and 3 each slips off the bight of his sling, drops the doubled end over the free handle and brings it up around it be- tween the inner edges of the sides of the sling, and slips the bight over the end of the handle, thus making the sling taut. The slings will be secured when it is desired to prevent them from dragging on the ground, or from being in the way when passing obstacles, loading am- bulance, etc. <>s. Being at the open: j 5" 1. Close, 2. Litter. i At close, Nos. 2 and 3 step re- Par. 67.—Sling secured. spectively outside the right front and left rear handles and face inward ; at Utter, they stoop and with their right hands raise the litter by the right handles; they 248 PROMPT AID TO THE INJURED. then fold the braces, and bringing the lower pole against the upper, canvas to the left, support the litter at the carry. 69. The litter being closed: 1. Strap, 2. Litter. At strap, all face the litter; at litter, No. 4 supports the litter at the center, bringing the canvas up; Nos. 2 and 3, assisted by No. 1, fold canvas by doubling it smoothly on top of the poles, re- lease free loops of slings, and place slings lengthwise of the litter on the canvas, buckles out, and neatly secure all by the cross-strap at each end, passed around poles and through loops of slings, when all take their posts at the carry. With only two bearers the closed litter is first grounded. 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, be- ing at the open, at the command strap litter, when the motions begin with those described under close litter. [Par. 68.J TRANSPORTATION OF THE WOUNDED. 249 70. To bring the squad into line, the litter being at the ground or the open : 1. Form, 2. Rank. At form, No. 2, if facing litter, faces about; at rank, he ad- vances 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. 71. 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 the litter, and Nos. 1 and 4 as with litter at the ground. This is the invariable position taken by each number at the above commands, whatever may have been his previous position or duty. 72. 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. 73. Being in line: 1. Change posts. 2. March. No. 2 stands fast; Nos. 1 and 3 back step and oblique to the left of No. 4, who closes against No. 2 ; the order now being 2, 4, 1. 3. Posts are resumed by the same commands, the movements being reversed. 74. 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, 250 PROMPT AID TO THE INJURED. respectively, and grasp the handles relinquished by Nos. 3 and 2, who step to left and right center, respectively. 75. The squad leader continues to exercise command from whatever position he may occupy. 76. To resume the original positions the movement is reversed by the commands: 1. At Utter, 2. Posts. 7 7. Being at the open : 1. Prepare to lift, 2. Lift. At the first command Nos. 2 and 3 stoop and seize each the free loop and bight of sling, No. 2 with right and left hands, No. 3 with left and right hands, respectively, slip them off the handles, retaining hold, and (No. 2 facing right about) each places the sling over the shoulders, slips the loop upon the free handle and grasps both handles. At the second command they rise slowly erect, when No. 4 advances to side of No. 2, and No. 1 steps obliquely backward to side of No. 3. adjust slings, lengthening or shortening if necessary, to level litter, and observe that everything is right, when they resume their posts. 78. At the commands : * 1. 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. 79. Being at the lift: 1. Lower, 2. Litter. At litter, Nos. 2 and 3 slowly lower the litter to the ground. They then seize, each, the free loop and bight of sling, No. 2 with the right and left hands, No. 3 with left and right hands, respec- tively, slip off loops and remove slings from shoulders, when (No. 2 facing left about) each drops the bight over the free handle and * The so-called single step, which is by far the easiest for the patient, but which is acquired with difficulty, may also be practiced ; No. 2 steps oft'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 immediately followed by No. 3's left. TRANSPORTATION OF THE WOUNDED. 251 places the loop upon the ring handle, avoiding any twist of the sling. SO. 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. SI. The open litter should be lifted and lowered slowly and without jerk, both ends simultaneously, the rear bearer moving 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 as the men are familiar with its manual, the drill should, whenever practicable, be with loaded litter. 82. 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 verti- cal 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 same 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 as described in Par. 56. When practicable this movement should be supervised by a non-com- missioned officer. It can be executed in double time. MARCHINGS WITH LITTER. S3. The intervals between litters are ordinarily sufficient for the execution of all movements, in line or column, but if it be- comes necessary to extend them, the litters, if in line, are first wheeled into column [Par. 88], when the commands are given: 1. lo 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 dis- tance ; if in march the first squad maintains the quick time, while the other squads take the short step as above. S4. The column is closed by the commands: 1. Litters, 2. Close, 3. March ; 252 PROMPT AID TO THE INJURED. 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. 85. The line, or column of litters, is marched by the com- mands already given [Par. 24 and following], substituting "lit- ters" for '• fours." The following movements require special notice or description : BEING IN LINE, TO TURN AND HALT. 86. 1. Detachment, 2. Right (or 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 themselves successively upon the alignment established by the right litter [Par. 21].' 87. BEING IN LINE, TO TURN AND ADVANCE. 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. BEING IN LINE OF LITTERS, TO MARCH BY THE FLANK IN COLUMN OF LITTERS. 88. 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 revolve horizontally on its center until both face to the right, when they take the full step in the new direction; Nos. 1 and 4 maintain their rel- ative positions opposite the center 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 •••.. 71 Par. 88.—Litters right. TRANSPORTATION OF THE WOUNDED. 253 BEING IN LINE, TO MARCH IN COLUMN OF LITTERS TO THE FRONT. 89. 1. Right (or left) forward, 2. Litters right (or left), 3. March. At the command march, the right litter moves straight to the front: the other litters wheel to the right and then to the left in column. [Par. 2!!.] To form line from column—see Par. 33 and following. BEING IN LINE OR COLUMN, TO MARCH TO THE REAR. 90. 1. Litters about, 2. March. Nos. 2 and 3 step off as in Par. 88, but continue the movement until both face to the rear, the other numbers maintaining their relative positions opposite the center of the litter. The about with the litter is always to the right. TO MARCH TO THE REAR WITHOUT WHEELING. 91. This movement, which may be occasionally necessary, can only be executed with strapped or closed litters. The commands are: 1. To the rear, 2. March ; when the squad faces about, No. 2 left, the others right, the two bearers meanwhile transferring the handles from one hand to the other. On halting, the squad faces about without command. MOVEMENTS BY SECTIONS. 92. A section consists of two litter squads in line. 93. To form column of sections from line : 1. Sections right (or left), 2. March, 3. Front; when each section turns, as in Par. 80; or, 94. 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. 87. 95. The advantage of this formation is that it permits the shortening of the column, at the carry, without increasing its front, by the commands : 1. Sections, 2. Close, 3. March ; when the sections close up to one pace, and the litters oblique to- ward each other until close against the inner free bearers (1 and 254 PROMPT AID TO THE INJURED. 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. 96. The normal formation is resumed by the command: 1. Sections, 2. Extend, 3. March. Line is reformed by the same commands used to form column. 97. To form single column from column of sections: 1. 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. 98. To form column 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. 99. The column of strapped litters at the carry [Par. 62] is the habitual column of route. The rate is three to three and a half miles per hour. Marching in quick time: 1. Route step, 2. March. The men are not required to preserve silence or keep the step. The litter squads preserve their distance. If from a halt: 1. 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. 63.] 100. To march at ease: 1. At ease, 2. March. The detachment marches as in the route step, except that silence is preserved. Marching at route step or at ease, at a halt, and at the rest, officers carry the sword in the scabbard. TRANSPORTATION OF THE WOUNDED. 255 THE LOADED LITTER. 101. 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. 102. The litter being at the carry, at the commands: 1. Take post to load, 2. March; the squad advances toward its assigned patient, and as it ap- proaches him the free bearers start ahead in double time and take posts by his side, No. 1 on the right and No. 4 on the left. The Right. Left. Left. Right. Par. 103.— Posts at patient. 256 PROMPT AID TO THE INJURED. litter is halted and opened (by No. 3's command) as nearly as pos- sible one pace from the patient's head and in a line with his body; after sufficient practice in this position, the litter is lowered at the feet, or in any other convenient position. The squad leader then commands: 103. 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. 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 fac- ing 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 positions of Nos. 2 and 3 are always at the ankle and shoulder, respectively, on the right or left of the patient, as the command may be; if right, they are on each side of No. 1; if left, they are on each side of No. 4. These positions are taken by the bearers, whatever may have been their previous positions or duties. 104. In the field. Nos. 1 and 4 having reached the patient and taken position on their respective sides, remove his arms and accou- terments 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. 105. 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 positions at variable distances, in or out of sight, such as they would occupy on the battlefield. At the commands: 106. 1. Search for wounded, 2. March ; each leader assumes charge of his squad and proceeds independ- ently. Nos. 1 and 4 at once start ahead to search, but without losing sight of the litter, which follows in quick time, taking the TRANSPORTATION OF THE WOUNDED. 257 double time as soon as a patient is discovered. The litter having been opened and the injury dressed, No. 1 commands: 107. 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. 108. 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 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; Par. 108.—The patient lifted. 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 short- est 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. 109. 1. Lower. 2. Patient. The free bearer, No. 1 or 4, stoops and assists the other num- 18 258 PROMPT AID TO THE INJURED. bers in gently and carefully lowering the patient upon the litter. The bearers then rise and at once resume their positions at litter posts. [Par. 71.] 110. In the field, when the ground on which the patient lies is such that the litter can not be placed directly under him, it should be placed as near him as possible, and preferably 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 pa- tient. In such case, the bearers having brought the patient upon their knees, as described in Par. 108, at the command rise, take firm hold of him and rise, and at march, carry him head or feet first, as directed. From this position he is first lowered to the knees of the bearers, and thence placed upon the litter or ground. 111. At the command: 1. Cease, 2. Drilling, the squads re- form in line and lower litters, when the patients, if still upon the litters, are then directed to rise and resume their posts, after which the litters are strapped. position of patient on the litter. 112. 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. Difficulty of breathing in wounds of the chest is relieved by a sufficient padding under- neath. In wounds of the abdomen the best position is on the injured side, or on the back if the front of the abdomen is wound- ed, 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 transpor- tation, the best position is on the back, with the injured arm laid over the body or suitably placed by its 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 inclin- ing toward the wounded side : in cases of fracture of either lower extremity, if a splint can not be applied, it is always well to bind both limbs together. TRANSPORTATION OF THE WOUNDED. 25(J general directions. 113. 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. 114. The loaded litter should never be lifted or lowered without orders. 115. The rear bearer should watch the movements of the front bearer and time his own by them, so as to insure ease and steadi- ness of action. 116. The number of steps per minute will depend on the weight carried and other conditions affecting each individual case. 117. 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. 118. The bearers should keep the litter level notwithstanding any unevenness of the ground. 119. In making ascents or descents, the rear or front handles should be raised to bring the litter to the proper level, Nos. 1 and 4 supporting the poles on their respective sides. With only three bearers, the free bearer takes hold of the handle on his side. 120. 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 fore- most, and down hill head foremost, to prevent the weight of the body from pressing down on the injured part. TO PASS OBSTACLES. 121. 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 should it be necessary to surmount the obstacle the commands aieglV( 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 sling from shoulders (dropping it upon the canvas) and climbing over, re- 260 PROMPT AID TO THE INJURED. ceives 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 off his sling, now also Par. 121.—Passing an obstacle. climbs over and takes his place between the handles ; the slings having been adjusted without halting, Nos. 1 and 4 resume their posts. 122. 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 re- sumed his hold, when the litter is carried over; No. 3 then crosses and all resume their places. 123. If the cut or ditch be wide the litter is halted and low- ered with the front handles (or feet) near the edge, when, the slings being secured, if necessary, the movement proceeds as in Par. 127. 124. In crossing a running stream, or broken or otherwise dif- ficult ground, or going up or down a hill, Nos. 1 and 4 give sup- TRANSPORTATION OF THE WOUNDED. 261 port on their respective sides of the litter at the command ob- stacle. [Par. 121.] 125. When it is necessary or advisable that the four bearers should carry the litter while marching, the commands are: 1. By four, 2. Carry, 3. Litter. At litter, No. 1 steps backward to right rear, No. 4 forward to left front, and each grasps the handle nearest him relinquished Par. 125.—By four, carry litter. by Nos. 2 and 3 respectively, who, without changing their places, grasp the other handles. 126. The squad being in position by four, carry, litter, to sur- mount an obstacle over five feet high, the commands are given : 1. Raise, 2. Litter ; 262 PROMPT AID TO THE INJURED. when the litter is carefully raised to the level of the obstacle and passed half way over, 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 until only the rear handles rest upon the obstacle, when Nos. 1 and 3 get over and resume hold of their handles; the litter is then lowered. In this movement the slings when freed should be thrown over the patient's head and feet respectively. 127. If desirable, the litter may be lowered before passing a high or low obstacle when at the commands : 1. By four, 2. Prepare to lift, 3. Lift. Nos. 2 and 3 may take posts outside (instead of inside) the right front and left rear handles respectively, Nos. 4 and 1 being outside the opposite handles : the litter is then lifted and raised, or lowered. TO CARRY A LOADED LITTER UPSTAIRS. 128. A loaded litter is usually carried upstairs head front, and downstairs feet front, as follows: The litter is marched to the foot of the stairs in the usual manner, wheeled about and halted, when the commands are given : 1. Prepare for stairs, 2. March. At the first command Nos. 1 and 4 face inward, advance to center of litter and support it by each grasping a pole with both hands; Nos. 2 and 3 slip free loops of sling off handles, face about, readjust slings, and grasp handles ; No. 4 now 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. At the second command the litter is carried up by Nos. 3, 2, 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 shoul- ders. They must carefully watch the patient, to prevent acci- dent. In this movement No. 1 falls out and accompanies litter, to render any assistance required. With three bearers only, the litter must be lowered before the first command is given. 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. TRANSPORTATION OF THE WOUNDED. 263 Par. 128.—Carrying a loaded litter upstairs. TO CARRY A LOADED LITTER DOWNSTAIRS. 129. 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, for any reason, it is necessary to carry a patient feet first upstairs or head first downstairs, the. bearers are simply re- versed, in the former case No. 2 becoming front bearer, and in the latter No. 3. 264 PROMPT AID TO THE INJURED. Wx\ !i 1" III IfiiF I1//,'. 11 uiir- life;' 1.7//, II', i, /7>, Par. 129.—Carrying a loaded litter downstairs. TO LOAD WITH REDUCED NUMBERS. 130. 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 supported TRANSPORTATION OF THE WOUNDED. 265 on the knees of the two on one side, while the third (No. 1 or 4) places the litter in position under him. 131. Another method for three bearers, when it is necessary to carry the patient to the litter, is as follows: Two bearers take Par. 131.—Carrying by three bearers. their positions on the same side opposite the knee and hip, while the third stands by the opposite hip. At 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 inter- 266 PROMPT AID TO THE INJURED. lock 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 extremi- ties with both arms passed under them, one above, the other be- low the knee. 132. 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 di- rected [Par. 150], the legs remaining unsupported, and carry him feet foremost over the near end of the litter. In case of fractured lower extremity, 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 extremities, while No. 3 supports the body, the patient clasping his arms around his neck, when they rise. TO UNLOAD THE LITTER. 133. To unload with four or three bearers, posts are taken at patient as in loading. At the commands: 1. Prepare to lift, 2. Lift [Par. 108], they raise him upon the knees, the free bearer removes the litter, and at lower patient, they lower him carefully to the ground. 134. With two bearers, they form a two-handed seat [Par. 150], and lift the patient off the litter. In the case of fracture, they stand on the same side, and kneeling [Par. 132], 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. TO TRANSFER PATIENT FROM LITTER TO BED OR ANOTHER LITTER. 135. 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. 136. From fitter to litter : The patient is lifted upon the knees TRANSPORTATION OF THE WOUNDED. 267 of the bearers, the litter removed and replaced by the other 'litter. IMPROVISATION OF LITTERS. 137. Many things can be used for this purpose: Camp cots, window shutters, doors, benches, boards, ladders, etc., properly padded. Litters may be made with sacks or bags of any description, if large and strong enough, by ripping the bottoms and passing two poles through them and tying cross pieces 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 framework 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. 138. But the usual military improvisation is by means of rifles and blankets. Each squad should be supplied with two rifles and bayonets, carried by Nos. 3 and 4 (at the carry), who assure themselves that the rifles are unloaded, and a regulation blanket rolled up, and carried by No. 2, over right shoulder, the ends being secured by strap and hanging at left side. The detachment being in line, the commands are given : 1. Squads, 2. Right by twos, 3. March, 4. Halt. The command halt is given when the left two of each squad has obtained its position in rear of the right two. 1. Squads to 3 paces interval, 2. Right {or left) step, 3. March, 4. Halt. The left (or right) squad standing fast, the command halt is given as the squads gain the prescribed interval. 1. Prepare. 2. Blanket Litter. 268 PROMPT AID TO THE INJURED. Nos. 1 and 2 face about; No. 2 unbuckles strap, slips it under his belt, seizes blanket roll with right hand at right shoulder, brings it to the front and passes one end to No. 1, when Nos. 3 and 4 seize free edge of blanket (with free hands) as near the corners as possible; Nos.'l and 2 step backward till the blanket is unrolled, when all stoop and place blanket smoothly on the ground. Nos. 3 and 4 (after pulling out ramrods 12 inches, in the absence of bayonets) lay rifles under edges of blanket, muzzles toward 1 and 2, somewhat converging, hammers in, when all bearers roll blanket tightly about rifles, an equal number of turns on each piece, until the space between thein measures 20 inches, hammers down, and stand erect. 139. The commands are then given: 1. By four, 2. Prepare to lift, 3. Lift. At the first command the bearers take positions on the outside of each rifle, facing each other, Nos. 1 and 3 opposite the butts, Nos. 2 and 4 opposite the muzzles. At the second command they all stoop and grasp the rifles firmly with both hands; at lift, they rise slowly with the litter. The litter may now be carried in any direction, and all move- ments of loading, unloading, etc., are executed as laid down for the hand litter. When no longer required, the commands are given: 140. 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. 3 and 4 take up the rifles, and having returned ramrods (if used), stand at the order; Nos. 2 and 1 fold the blanket lengthwise, then roll it tightly, when No. 2 brings the ends of the roll together and secures them with the strap ; he then passes the roll over his head. slips left arm through it, and brings the strap to the left side; all stand facing to the front in columns of two. 1. Form fours, 2. Left oblique, 3. March, when line is reformed. 141. Should it be desirable, by reason of the patient's con- dition, or because of reduced numbers of the squad, the following method may be used : One half of the blanket is rolled lengthwise into a cylinder. TRANSPORTATION OF THE WOUNDED. 269 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 hammers downward. 142. A litter may also be prepared with two rifles and two or three blouses, by turning the blouses lining out, and buttoning 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 improvisations, but it is better, whenever possible, that four men should do so, two on each side. METHODS OF RE- MOVING WOUNDED WITHOUT LITTERS. FOR ONE BEARER. 143. While it is not desirable that one bearer should, ordinarily, be re- quired or permitted to lift a patient unassisted, emer- gencies may arise when a knowledge of proper meth- ods of lifting and carrying by one bearer is of the ut- most value. A single bearer may carry a patient in his arms, on his back, or across his shoulder. Par. 144.—Lifting the patient erect. 270 PROMPT AID TO THE INJURED. To bring the patient into any of these positions, the first steps are as follows: 144. 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 drawing 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. 145. 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. To place patient astride of back. 14(5. The bearer shifts himself to the front of pa- tient, 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 im- practicable with an uncon- scious man. To place patient across back. 147. The bearer with his left hand seizes the right wrist of the patient and draws the arm over his head and down upon his left shoulder, then shifting himself in front, stoops and clasps the right thigh with his right arm passed between the legs, Par. 147.—Patient across back. TRANSPORTATION OF THE WOUNDED. 271 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. 148. The bearer clasps his hands about the pa- tient'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 be- tween the thighs—securing the right thigh—and with his left grasps patient's right hand, bringing 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. 149. In lowering pa- tient from these positions the motions are reversed. Should a patient be wound- ed 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 motions proceed as directed, substituting right for left, and vice versa. Par. 148.—Patient across shoulder. FOR TWO BEARERS. By the two-handed seat. 150. The patient lying on the ground, the commands are given: 1. Form two-handed seat, 2. Prepare, to lift, 3. Lift. 272 PROMPT AID TO THE INJURED. 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 pos- ture, pass each one hand and arm around his back, while the Par. 150.—Two-handed seat. 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. TRANSPORTATION OF THE WOUNDED. 273 By the extremities. 151. This method requires no effort on the part of the pa- tient ; but it is not applicable to severe injuries of the lower ex- tremities. 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, having raised the patient to the sitting posture, clasps him from behind around the body under the arms, while the front bearer passes his hands from the outside under the flexed knees. At lift, both bearers rise together. By the rifle seat. 152. A good seat may be made by running the barrels of two rifles through the sleeves of an overcoat, buttoned as in Par. 142, so that the coat lies back up, collar to the rear. The front bearer rolls the tail tightly around the barrels and takes his grasp over them ; the rear bearer holds by the butts, hammers down. 153. A stronger seat is secured when the gun-slings are used, a seat twenty inches wide and two feet long being formed on which the patient sits with his back against the rear bearer, his legs hanging over outside, and the hollow of his knees resting upon the barrels. A bearer takes in each hand a rifle, with slings fully extended and trigger guard to the front; he passes the butt and sling of the piece held in the right hand through the sling of the piece held in the left hand; he then raises the rifle held in the left hand and passes its butt through the sling of the other piece, taking care that the turn of the sling comes above the ham- mers. In carrying this seat the bearers take position between the pieces, No. 2 in front and No. 3 in rear. To take apart the rifle seat reverse the movements, beginning with the piece held in the left hand. TO PLACE A SICK PATIENT ON HORSEBACK. 154. 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 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 bearers. The horse is, if necessary, blind- folded. To load from the near side, the bearers take posts at patient left, lift the patient, and at the command prepare to mount carry 19 274 PROMPT AID TO THE INJURED. him to horse, his body parallel to that of the horse, his head to- ward the horse's tail. 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 principle is observed. 155. To dismount, at the commands, 1. At patient, 2. Right (or left), 3. Posts, 4. Prepare to dismount, 5. Dismount, the movements are reversed. TRANSPORTATION OF THE WOUNDED. 275 156. The patient once mounted should be made as safe and comfortable as possible. A comrade may be mounted behind him to hold him and guide the horse; 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. 157. The travois is a vehicle intended for transporting the sick or wounded when the use of wheeled vehicles or other means of transportation 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. To assemble the Travois.—Nos. 2 and 1 on the right and 4 and 3 on the left, pass the shaft through the collar on the travois pole from rear to front, pulling them until they are snugly home. Then Nos. 2 and 4 pass the front crossbar over the ironed ends on the front of the travois poles, driving it home until its collars strike the front collar of each pole, while Nos. 1 and 3 pass the rear crossbar (keeping uppermost the surface on which are the flat bolts) over the rear ends of the poles, pushing it forward until it reaches the squared points intended for its place, and passes the bolt slots of the poles when they throw the barrel bolts into place. To harness the Travois.—The animal is placed between the shafts. If he has an ordinary wagon harness, the rings on the front end of the shafts are put over the iron hook on the names and the toggle of each trace chain is fastened to the ring of the corresponding travois pole. If he is saddled, the ring on the front of each shaft is fastened to that on the pommel of the saddle by means of the straps that belong there, and the shafts are se- cured by a surcingle passed over all. To place a Litter on the Travois.—If the litter is loaded, it is wheeled so that the head of the patient is toward the rear of the travois and two paces from it; it is then halted and lowered. No. 276 PROMPT AID TO THE INJURED. 1 throws back the flat bolts on the rear travois bar, while Nos. 2 and 3 secure slings. The litter is then carried by four lengthwise over the travois, and Nos 4 and 2 set the litter legs into the mor- tises and secure them by the bolts, while Nos. 1 and 3 pass the leather loops on the front end of the travois poles over their han- dles of the litter. 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 2£ feet TRANSPORTATION OF THE WOUNDED. 277 apart; the large ends about 3 feet apart, 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 cross pieces the litter bed, 6 feet long, is filled in with canvas, blanket, etc., securely fastened to the poles and crossbars, or with rope, lariat, raw- hide 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. THE TWO-HORSE LITTER. 15S. 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 pa- tient lies in the horizontal position, and, in case of fractured limbs, they can easily be secured against disturbance. The great disadvantage of this litter is that it requires two animals and at least three men for each patient—one or more to attend to the dis- abled man and the others to watch over and guide the movements of the animals. This litter may be improvised in the same man- ner as the travois, only the poles should be 16£ 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. 159. A patient is lowered upon or lifted from a horse litter or travois in the same general manner as upon or from a bed or other litter. The service of the travois requires three men—one to lead the animal, the others to watch the litter, and be ready to lift its rear poles when passing over obstacles, crossing streams, or going uphill. 278 PROMPT AID TO THE INJURED. THE AMBULANCE* 160. 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 recum- bent. It is fitted with four removable seats, which, when not used as such, are hung, two against each side, thus answering the pur- pose of cushions. The floor is 7£ feet long and 4 feet wide. Be- neath 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. 161. 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. 162. Being in line: 1. At ambulance, 2. Posts. The designated squad marches in column of files to the ambu- lance ; when No. 1 takes post on the left, No. 2 in the center, and I ., 1 1 » 12 3 4 No. 3 on the right of the rear of the ambulance and close to it, No. 4 on the right of No. 3. * 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, begin- ning 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 pa- TRANSPORTATION OF THE WOUNDED. 279 In the case of a litter lowered in rear of ambulance prepara- tory to loading, head of patient toward it, at the command posts, each No. faces about (except No. 2), 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, be- ing grounded or lowered), and when disarranged, from whatever cause, the squad may be reassembled by these commands for serv- ice at the ambulance. 163. 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 ambu- lance posts. 164. 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 front and No. 3 the rear seat of their respective sides. Each man, hav- ing 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. tient is unloaded and transferred to the regulation litter, No. 1 com- mands: 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. 280 PROMPT AID TO THE INJURED. 165. Seats can be prepared or packed on one side only (leav- ing room on the packed side for one recumbent patient) by the commands: Prepare (or pack) seats, right (or left). 166. 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 accouterments 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 ambulance and two paces from it, when the litter is halted and lowered. If it be necessary to prepare the ambu- lance 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. 167. At the first command, the slings are secured; No. 2 stands fast; 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 otherwise renders any needful assistance. At load, the bearers slowly raise the litter to the level of the floor of the ambulance 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 the others. When this is accomplished, Nos. 1, 2, and 3 are in position at ambulance posts. No. 4 places the arms and accouterments of the patient (if any) under the lit- ter, and then takes his position on the right; Nos. 1 and 3 close the tail-gate and, if necessary, lower the curtain. The squad may then be faced in any desired direction and marched away. 168. The squad being at ambulance posts : 1. Prepare to unload, 2. Unload. At the first command, Nos. 1 and 3 raise the curtain, if neces- sary, open the tail-gate, and No. 2 takes hold of the projecting handles of the litter; at unload, No. 2 draws out the litter, assist- TRANSPORTATION OF THE WOUNDED. 281 Par. 167.—Loading ambulance. ed by Nos. 1 and 3, who, facing inward, support 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. 169. 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 with- draw 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. 282 PROMPT AID TO THE INJURED. 170. The right side of the ambulance is always loaded or un- loaded first, unless otherwise ordered. 171. When necessary to load the feet first, at the commands: By the feet, take post to load ambulance, march, the litter is low- ered with foot toward the ambulance, when the loading pro- ceeds as above described, excepting that No. 3 remains between his handles, No. 2 takes post opposite the right ankle, and No. 4 opposite him. 172. At the conclusion of the drill with ambulances the detachment is reformed in line. TO PREPARE AND LOAD ORDINARY WAGONS TO TRANSPORT WOUNDED. 173. In active service, the use of the ordinary army or other wagons for transporting the sick and wounded is of every-day occurrence, and it is important that bearers should be practiced 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 unload, will, if thoroughly understood, meet 'the requirements of any emergency of this character. It must, however, always be 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 appli- ances are at hand. INSPECTION AND MUSTER. INSPECTION OF DETACHMENT. 174. 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, except with the knapsack, when it hangs in front to the right. The detachment should be frequently inspected in the uniform and equipment for field service, which consist of the blouse, trousers, campaign hat, shoes, and leggings, the waist-belt and knife, the knapsack packed, the haversack and canteen suspended from the right shoulder to the rear over the left hip, and the tin cup hung from the loop at the bottom of the knapsack. TRANSPORTATION OF THE WOUNDED. 283 If required, a revolver is carried at the belt on the right side and a cartridge pouch on the left. 1 75. The detachment being formed, the senior non-commis- sioned 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 center of the detachment, then draws sword and commands: 1. 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 inspection; 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 facing 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 clos- ers; the officers and file closers cast their eyes to the front as soon as their alignment is verified. At the command front, the men cast their eyes to the front and drop the left hand. 176. 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. Arms ; and facing to the front salutes him. At the command inspection, each man armed with a knife grasps and slightly raises the scabbard with the left hand and seizes the grip with the right, thumb to the rear and against the guard ; at arms, he draws the knife quickly and raises the arm to 284 PROMPT AID TO THE INJURED. its full extent, at an angle of about 45 degrees, the knife in a straight line with the arm, then drops the arm naturally extended by the side, back of the blade to the front, point down; simulta- neously the non-commissioned officers draw saber and bring it to the carry. 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 mi- nutely inspect the saber or knife, accouterments and dress of each soldier in succession. Each man, as the inspector approaches him, brings his saber or knife vertically to the front, raises the hand as high as the neck and six inches in front of it, guard at the height of the chin, edge to the left, thumb on the back of the grip ; after a slight pause he turns the wrist outward to show the other side of the blade, and, as the inspector passes on, resumes the original position; after the inspector has passed he returns saber or knife without command. 177. To return knife, each man grasps the scabbard with the left hand, quickly raises up the right hand as high as the neck and six inches in front of it (as for inspection), then drops the point of the knife and sheaths the blade. 178. This inspection being completed, the junior officers come to attention, carry sword and face to the front; the officer com- manding again takes his post on the right, draws his sword, and facing to the left commands: 1. Open, 2. Pouches ; then facing to the front returns sword, and accompanies the in- spector as before. At the last 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. Simul- taneously the non-commissioned officers take their dressing packets between the thumb and forefinger of the right hand, held to the front, forearm horizontal, palm up. After the inspector has passed each man closes and replaces the pouch, or returns the packet. TRANSPORTATION OF THE WOUNDED. 285 179. If the detachment is equipped with knapsacks,* the officer commanding from his post as before commands: 1. Unsling, 2. Knapsack, 3. Open, 4. Knapsack. At the first command each man unhooks the right-hand strap; at the second command he removes the knapsack and places it on the ground at his feet, flap inward ; at the fourth command he opens it, and then stands at attention. The knapsacks having been inspected, the officer commanding commands: 1. Close, 2. Knapsack, 3. Sling, 4. Knapsack. At the second command each man repacks and closes his knapsack, and then stands erect, leaving his knapsack on the ground. At the command sling, each man takes his knapsack and standing erect holds it by the straps, the flap next to the knees ; at the command knapsack, he places it on the back. 180. The inspection being completed, the officer commanding commands: 1. Close ranks, 2. March. At the command march, the junior officers face about and re- sume 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. 1S1. If the detachment, or part of it, should be mounted, or armed with revolvers, it will be inspected in this respect in accord- ance with cavalry drill regulations. INSPECTION OF LITTERS. 182. The detachment being in line with strapped litters at the carry, the commands are given : 1. Litters left, 2. March, 3. Halt. 1. Inspection, 2. Litters. At litters No. 1 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. * The word knapsack will be used in the commands for all patterns of packs. 286 PROMPT AID TO THE INJURED. INSPECTION OF AMBULANCES. 183. The ambulances being in line at intervals of ten paces, with seats packed, each with a squad at ambulance posts, the commands are given : 1. 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 practi- cable, preceded by a minute and careful inspection. The detachment being in line with ranks open, the officer commanding, upon intimation of the mustering officer, com- mands : 1. Draw, 2. Knife, 3. Attention, to muster. [Draw knife is executed as in Par. 176.] He then returns sword, and hands a roll of the Hospital Corps detachment, 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 returns saber or knife; men without saber or knife, after answering, step forward one pace. The muster completed, the ranks are closed and the detachment dis- missed. After mustering, the presence of the men reported in the hos- pital or on duty is verified by the mustering officer, who is accom- panied by the officer commanding. APPENDIX. 185. The canvas of a field hospital consists of hospital tents, conical wall tents, and common tents. The hospital tents are intended for use as wards, the conical wall tents as dispensary, squad, and mess tents, and the common tents as latrine covers. Tentage for medical officers is not included in that for the field hospital. Each medical officer is allowed one wall tent com- plete. TRANSPORTATION OF THE WOUNDED. 287 HOSPITAL TENT. 186. A hospital tent is 14 feet long, 15 feet wide, and 11 feet to ridge, the wall being 4$ feet high; it furnishes comfortable accommodations for six patients, and requires to pitch it a ridge pole and two upright poles, seven long tent pins on each side for the guy ropes and two on each side for the long guys, eighteen in all. Twenty-four small pins are needed for the front, rear, and walls. 187. The hospital tents should always be pitched first in the field hospital. Two squads (8 men) under direction of a non-commissioned officer: 1. Take posts to pitch tent, 2. March. 1st squad: Posts, No. 1 right rear, No. 2 right front, No. 3 left rear, No. 4 left front (in position by four, carry). Nos. 1 and 2 bring ridge and upright poles, unfasten them and place the ridge poles as directed by the non-commissioned officer; they then place the upright poles in position on the ground, usually on the side opposite that from which the wind is blowing. Nos. 3 and 4 bring tent, unroll it, and all now open canvas and place it in position for pitching. Nos. 1 and 3 work- ing in rear, Nos. 2 and 4 in front, fix the ridge pole and slip the pins of the upright poles through the ridge pole and tent, Nos. 2 and 3 going to the bottoms of the uprights and tapping them with a maul, if necessary, to drive them home. The fly (if used) is now placed in position over tent and the loops of the long guys over front and rear pole pins. Nos. 1 and 4, at their respective ends, now raise the ridge pole to a convenient height, when Nos. 2 and 3 enter tent through openings and support upright at their respective ends until Nos. 1 and 4 enter, when the second squad having pinned down the corners, all lifting together raise tent by first carrying it toward the side opposite that on which the upright poles (usually placed on the leeward side) are and then bringing the upright poles ver- tical. 2d squad : Same posts as 1st squad and working simultaneously with it. Nos. 1 and 3 each take a maul, five large and six small tent pins. Nos. 2 and 4 each take a maul, four large and six small tent pins and place them at their respective corners of the hos- 288 PROMPT AID TO THE INJURED. pital tent. No. 4 places a small pin, notch to front, in front of hospital tent ridge pole, to mark front opening; No. 1 places a small pin at rear end of hospital tent ridge pole to mark rear opening. Nos. 1 and 2 work to right side of tent, Nos. 3 and 4 to left side. Nos. 1 and 4 place the front and rear door loops over the center pins already driven; No. 1 then quickly goes to right rear corner, No. 3 to left, No. 2 to right front corner, and No. 4 to left. All draw bottom of tent taut and square, front and rear being at right angles to ridge, and secure the corner loops with pins. Each now steps two full paces directly out from side of tent at their respective corners and one pace to the right or left (front bearers to front, rear bearers to rear), at which points they each set a large pin, and slip their corner guy rope, fully ex- tended, over it. They now set the guy pins in line with the cor- ner guy pins at intervals of two feet (seven pins on each side), Nos. 1 and 2 working toward each other, as do Nos. 3 and 4. As soon as tent is raised, which is never done until the cor- ners are pinned down, they secure the guy ropes over their pins and then set the wall pins in line with the corner wall pins, be- ginning at the front and rear openings and working toward each other on their respective sides, No. 1 to No. 2 on the right, No. 3 to No. 4 on the left. All then fasten the long roof guy ropes on their respective sides and take their posts. With two hospital tents the front one is pitched first, the 2d squad, if necessary, not setting the wall pins of the front tent until the rear tent is raised. 188. With one squad (4 men). They take posts as in Par. 186, work proceeding as therein described until the canvas is spread, Nos. 3 and 4 in the mean- time each getting two mauls, nine large and twelve small tent pins, which they drop at their respective ends of the tent; they then set the small pins to mark the rear and front openings. When canvas is spread, No. 1 secures center (door) loops over cen- ter pin in rear, and No. 4 in front, and each goes to his corner, No. 1 right rear, No. 2 right front, No. 3 left rear, No. 4 left front. All draw bottom of tent taut and square, the front and rear at right angles to the ridge, and fasten it with pins through the corner loops ;-then stepping outward two paces from the corner pins and one pace to the front (Nos. 2 and 4) or rear (Nos. 1 and 3), each securely sets a long pin, over which is passed the extended corner V TRANSPORTATION OF THE WOUNDED. guy rope. Nos. 1 and 3 now go to rear, Nos. 2 and 4 to front pole and raise the tent to a convenient height from the ground, when Nos. 2 and 3 enter and seize their respective poles, and all together raise the tent by first carrying it as far as possible to the side opposite that on which the upright poles are, and then rais- ing the upright poles vertical. While Nos. 2 and 3 support the poles, Nos. 1 and 4 tighten the corner guys, beginning on the windward side. The tent being thus temporarily secured, all set the guy pins and fasten the guy ropes, Nos. 1 and 2 right, Nos. 3 and 4 left, and then the wall pins, when all take their posts. The tents having been pitched, they should be thoroughly ditched as soon as convenient. 189. A wall tent or common tent is pitched in the same man- ner as a hospital tent, by four bearers. Care must be taken that the tent is properly squared and pinned to the ground at the door and four corners before being raised. conical wall tent. 190. The conical wall tent is 16t% feet in diameter and 11 feet to the peak. It is provided with a hood, and will comfortably ac- commodate ten men, and may be made to hold twice that number. 191. To pitch it requires a tripod, pole, and forty-eight tent pins. One squad [posts as at litter] : 1. Take posts to pitch tent, 2. March. No. 1 procures tent; No. 4 tripod and pole, which he opens; Nos. 2 and 3 each twenty-four tent pins and a maul, which they place near front and rear of tent respectively. Nos. 2, 3, and 4 unroll the tent and spread it out upon the ground near where it is to be pitched, top of tent at its center. No. 1 having taken a maul and two pins, steps off eight paces directly outward (right or left) from the front corner of the hospital tent, on a line with its front, and drives a pin to mark the door of the conical wall tent; he then measures with the tent pole from this pin directly backward, the far end of the pole determining the center of the tent, which he also marks with a pin; No. 4 places the tripod opened out flat, with ring over the center pin, and lays the pole on the ground, pin-end at center pin. All now being at their posts, bring the canvas over the tripod till its center comes to the center pin and door at the front pin, when No. 2 slips the wall 20 290 PROMPT AID TO THE INJURED. loop at one side of door over front pin, and fastens the rope of the flap to the same pin. This is an important duty and upon its proper performance depends the proper pitching of the tent. The door is double. Nos. 1 and 4 commencing at rear and front of tent respec- tively, and working to the right and left, scatter the pins and pull out the guy ropes. Nos. 2 and 3 take each a maul, and commenc- ing front and rear respectively, work right and left of the tent, driving the guy pins, placing them about one yard from the edge of the tent, each on a line with a seam. As the pins are driven, Nos. 1 and 4 place the ends of the guy ropes over them, working on their respective sides. When the pins are set, No. 2 crawls under the canvas, slightly raises the tent and places the pin of the pole through the plate attached to the chains at the top of the tent, and raising the pole, sets it in the ring of the tripod; No. 3 having, from the outside, placed the hood over the pole pin, enters the tent by crawling under, and assists No.* 2 in raising the tripod, which being done, Nos. 1 and 4 tighten the guys; they then scatter the wall pins. The tent having been secured, Nos. 2 and 3 now take their posts outside and drive the wall pins, working as before, No. 2 toward the right rear, and No. 3 toward the left front; Nos. 1 and 4 straighten the tent and fasten the hood guys. Upon the completion of the pitching the squad takes its posts. In pitching, as soon as any man has completed his assigned work, he assists the others until all have finished. 192. To strike a tent: At the commands take posts to strike tent, march, the men take their posts; they first remove the wall pins, and then all the guy pins on their respective sides, except the four corner pins of the square tents, or the quadrant pins of the conical wall tents. Standing at their respective posts they re- move the corner, or quadrant, guys from the pins and hold the tent until the command strike is given, when the tent is lowered to the indicated side. The canvas is then rolled up and tied by Nos. 1 and 4, while Nos. 2 and 3 fasten the poles, or tripod and pole, together, and collect the pins. With two hospital tents the first squad strikes the front and the second squad the rear tent. All canvas of the field hospital, except the hospital tents, is usually struck before the " general" is sounded. TRANSPORTATION OF THE WOUNDED. TO pack knapsack. 193. Contents: One (1) woolen blanket; One (1) blue flannel shirt; One (1) undershirt; One (1) towel; Two (2) pairs socks; One (1) pair shoes; One (1) pair drawers; Toilet articles; Tin cup (suspended underneath). First. Fold woolen blanket from end to end, and then from side to side, and again from side to side; double the long end so that its edge comes even with the lower edge of the stripe, and slip the doubled end into the knapsack so that the long end of the blanket is against the back of the knapsack; push the blan- ket well down to the bottom of the knapsack and smooth it out. This leaves a space between the sides of the doubled end of the blanket into which the clothing is slipped. The exposed end of the blanket is left to be tucked in over the clothing, and secured by the tapes on the knapsack. Second. Fold the undershirt flat in the usual manner; place upon it, side by side and lengthwise with the shirt, two (2) pairs of socks, folded flat; over these, place a pair of drawers, folded once lengthwise, and then in three crosswise; upon them a blue flannel shirt folded in the usual manner, and lastly, at each lower angle . (collar end of shirts) place a shoe, the " upper " of which is opened out and slipped over the package of clothing, the two shoes thus covering in the entire lower end and half of the sides of the pack- age. Secure the package of clothing with tapes or twine, push it well down into the center space of the blanket, shoe end first, and, tucking in the exposed end of the blanket over the clothing, secure it with the tapes on the knapsack. Place the toilet articles [tooth- brush, comb, soap, towel, etc.] in the compartment provided there- for. Then close the flap and secure it. The tin cup is to be suspended from the tape at the bottom of the knapsack, and the overcoat, rolled in a half shelter tent, is to be secured by the coat straps on top of the knapsack. To roll Overcoat.—Turn one sleeve wrong side out, fold the over- coat right side out along middle back seam, sleeve laid straight, sleeve wrong side out underneath. Fold cape twice from side to side, lay it on coat, collar to collar. Turn edges of coat in so as to make sides parallel, so as to measure 12 inches wide at shoulder, 292 PROMPT AID TO THE INJURED. and 16 inches at bottom. Roll from collar down to within 20 inches of bottom, turn up bottom and pull one thickness of skirt over the roll, making all snug. To roll Shelter Tent Half—Turn in the flap, bring front and rear edges together, then fold resulting front and rear edges until they meet in the middle, making the canvas 15 inches wide. Roll the overcoat in the shelter tent. PACKING. 194. The pack equipment complete consists of— 1 combination halter and bridle, with leading line; 1 breast strap and chains; 1 breeching strap and chains; 1 pack saddle, with parts as follows, viz.: One (1) iron yoke frame; Two (2) wooden side pieces; Two (2) side pads of leather, lined with blanket and stuffed with hair; Four (4) small straps to fasten saddle and pads together; Two (2) pairs of quarter straps (each connected by a cross strap) with rings and two cincha (latigo) straps for each side; Two (2) webbing cinchas; One (1) surcingle (cargo cincha); Two (2) pairs of sling ropes; Two (2) saddle blankets. The purpose of this equipment is to permit of the packing of the medical (No. 1) and surgical (No. 2) chests, in the event of wheeled transportation being impracticable. It will be observed that the chests are so arranged upon the saddle as to permit of immediate access to their contents, to facili- tate which the animal carrying the pack must habitually be led. One litter squad will be designated as packers, who will see that the equipment is accurately fitted to the animal, and will be responsible for its care and condition. No. 1 brings the saddle and puts it on from the near side; No. 2 bridles and blindfolds the animal, and holds him, taking care that he is never moved without first removing the blinder. He will also assist No. 1 in saddling, working on the off side. TRANSPORTATION OF THE WOUNDED. 293 TO SADDLE. 195. Place the folded saddle blankets one above the other, so that their front edges will come 2-J- inches in front of where the pommel end of the saddle is to rest; take the saddle by both yokes and place it squarely in position, a little in rear of its proper place ; place the crupper under the dock and gently move the saddle for- ward into position, taking care not to disarrange or move the blankets; pass the latigo strap through the free end of the front cincha and tighten and secure it; then secure the rear cincha in the same manner, taking care that the rings of the cinchas, when cinched, are above the lower edge of the pads. Place the breast strap in position, and fasten the chains of the breast and breech- ing straps to the saddle. Pass the strap end of the cargo cincha, to its mid-length, under the yoke bars of the saddle, and throw both ends to the rear, off of the saddle, taking care that the bight of the cincha remains between the hooks of the saddle yoke. TO LOAD. 196. Nos. 3 and 4 bring the chests, and, beginning with the medical (No. 1) on the near side, hang them upon the saddle, sus- pended from the yoke hooks by two rings permanently fastened to the back of each chest. No. 1 having steadied the saddle by supporting the medical (No. 1) chest until the surgical (No. 2) chest is in place, then se- cures the load as follows: No. 4 from the off side takes the strap end of the cargo cincha, brings it over No. 2 chest, and passes it under the animal's belly to No. 1, who, in the meantime, has brought the buckle end of the cincha over No. 1 chest; No. 1 then passes the strap through the buckle, and, with the assistance of No. 4, draws the cincha snug and buckles it. Anything other than medical and surgical chests are packed by means of the sling ropes. No. 1 passes the sling ropes over the saddle to the off side, un- til the cross-strap, placed mid-length of the ropes and joining them, comes parallel to the animal's spine ; Nos. 3 and 4 place the off-side pack well up on the saddle, where No. 3 supports it with the left shoulder, and throws the ends of the sling ropes over his PROMPT AID TO THE INJURED. right shoulder in readiness to pass them over the pack; No. 4 then passes to the near side and assists No. 1 to place near-side pack well up on saddle, its edge, if possible, overlapping the up- per edge of the off-side pack, where he supports it; No. 1 takes the end of the front rope and slipping it through loop passed to him by No. 3, secures it, then passes to the off side, secures the rear rope, the loop of which is passed to him by No. 4. The packs having been slung, are balanced, when No. 1 secures them with the cargo cincha, passed over the pack and under the animal's belly. 197. Scheme for packing medical officer's orderly pouch. Rear portion {in loops). (Top.) Esmarch's tourniquet. 2 sponges in bag. 1 measuring glass. 1 bottle aro- matic spirits of ammonia. Scissors and hypo- dermic syringe. 1 bottle chloro- form. Front portion. 1 package boric wool. 2 roller bandages, 1 pus basin, 1 box vaseline, carbolated; 1 first aid packet; pins, assorted and safety. Catheter, elastic. 1 diagnosis tag book (in rear). 1 medicine case (in front). (Bottom.) (Top.) 1 package lint, sublimated. (Bottom.) TRANSPORTATION OF THE WOUNDED. 295 198. Scheme for packing hospital corps pouch. (Top.) Rear portion. In case, dressing forceps, scissors. jack knife, pins, as-sorted ; pins, safety; needles and thread. (Bottom.) Candle and matches in tin case. 2 band-ages, anti-septic. 1 bandage. 1 tourniquet, field. Aromatic spirits of ammonia. 2 sponges in bag. c _~ c .5 c c Thread. 1 tourni-quet, field. o 53 Front portion. (Top.) 1 package of sublimated lint. 1 first aid package (in rear), 1 bandage (on top of box), 1 box of adhesive plaster (in front). 1 package of boric wool. (Bottom.) 2 wire splints with six tapes. 199. Hospital Corps Bugle Call |S position of the medical officers, hospital corps detachment, and ambulances on the march. 200. The position of the medical department of a marching command is immediately in rear of the rear company of the or- ganization to which it pertains, and in front of the rear guard. 296 PROMPT AID TO THE INJURED. The medical officers and their orderlies are immediately in front of the ambulances. The Hospital Corps detachment imme- diately in rear, followed by the senior non-commissioned officer. With each ambulance is a driver and an ambulance orderly. In camp the ambulance and medical department wagons are parked near the field hospital, and not with the wagon train. INDEX. Acetic acid, poisoning by, 197. Acids, poisoning by, 197. Aconite, poisoning by, 189. " Adam's apple," 39. Air cells, or vesicles, 41. Air, quantity of, respired, 43. Alcohol, poisoning by, 190. Alimentation, 45. Alkalies, poisoning by, 198. Ammonia, poisoning by, 198. Antiseptics, 91. Aponeurosis, 27. Apoplexy, 170. treatment of, 172. heat, 175. Arm-bone or humerus, 14. Arm slings, 81. Arsenic, poisoning by, 193. Arteries, anatomy of, 36. nutrient, 3. Artificial respiration, 181. Hall's method, 185. Howard's method, 183. Sylvester's method, 181. Asphyxia, 178. precautions in rescuing, 178. treatment of, 178. Atropine, poisoning by, 190. Axillary artery, compression of, 129. Bandages, 68. application of, 69, 71. Bandages, circular, 70. cravat, 83. double-headed knotted, 73. Esmarch or triangular, 76. Esmarch, a triangular, for chest, 79. for foot, 83. for hand, 78. for head, 78. for hip, 82. for shoulder, 78. figure-of-8, 71. four-tailed, 74. head, 73. hip spica, 72. large, square handkerchief for head, 76. materials for, 68. method of rolling, G9. roller, 68. shoulder spica, 73. six-tailed, 75. sling, 81. spiral reverse, 70. triangular, 76. Basin, the, or pelvis, 18. Bed-sores, 118. Belladonna, poisoning by, 190. Bladder, urinary, 55. Blood, 30. amount of, in human body, 31. arterial, 35. circulation of, 34. 298 PROMPT AID TO THE INJURED. Blood, coagulation of, 31. composition, 30. corpuscles, 30. venous, 34. vessels, anatomy of, 36. Bone, cancellous tissue, 2. compact tissue, 2. composition of, 1. hyoid, 10. innominate, 19. marrow of, 3. necrosis of, 3. oH of, 3. spongy tissue, 2. Bones, classification of, 4. Bony landmarks, artificial, 7. Brachial artery, compression of, 130. Brain, 59. compression of, 170. concussion of, 169. weight of, 63. Brandy, 93. Bread poultices, 89. Breast-bone, or sternum, 11. Bromine, solution of, 105. Bronchial tubes, 41. Bruises, 107. Burns, 156. constitutional treatment of, 159. of first degree, 156. treatment of, 157. of second degree, 157. treatment of, 158. of third degree, 158. treatment of, 158. Camphor, poisoning by, 190. Cantharides, poisoning by, 194. Capillaries, anatomy of, 37. Carbolic acid, or phenol, 93. ^ poisoning by, 197. Carpus, or wrist, 18. Cartilage, or gristle, 24. Catching fire, 159. Caustic potash, poisoning by, 198. Caustic soda, poisoning by, 198. Cerebellum, 62. Cerebro-spinal system, 59. Cerebrum, 61. Chafing, 205. Chest, or thorax, 10. bandages, 79. Chloral, poisoning by, 191. Chloroform, poisoning by, 191. Clavicle, or collar-bone, 12. Colic, kidney, 55. Collapse, 162. Collar-bone, or clavicle, 12. Common carotid artery, compres- sion of, 127. Compresses, 86. Compression of axillary artery, 129. of brachial artery, 130. of brain, 170. treatment of, 170. of common carotid artery, 127. of femoral artery, 132. of popliteal artery, 132. of radial and ulnar arteries, 131. of subclavian artery, 128. Concussion of the brain, 169. treatment of, 169. Contusions, 107. Convulsions of children, 199. Copper, poisoning by, 194. Corn-meal poultices, 89. Corrosive sublimate, or bichloride of mercury, 92. poisoning by, 197. Cranial bones, fracture of, 142. Cravat bandages, 83. Creasote, poisoning by, 197. Croton-oil, poisoning by, 194. Cuticle, 56. Deodorants, 105. Derma, or true skin, 57. INDEX. 299 Diaphragm, 42. Digestion, 45. Digitalis, poisoning by, 191. Diploe, 2. Disinfectants, 93. bichloride solution, 96. carbolic-acid solution, 96. dry chloride of lime, 97. heat, 96. milk of lime, 96. soap-suds solution, 95. strong soda solution, 98. Disinfection, metliods of effecting, 100. of closets and sinks, 99. of clothing, towels, etc., 97. of dead body, 100. of discharges, 98. of dishes, knives, etc., 99. of food and drink, 98. of hands and person, 97. of rags, cloths, etc., 100. of rooms and contents, 100. of sputum from consumptives, 99. Dislocations, 153. of humerus, 153. of lower jaw, 154. of phalanges, 154. Dog-bite, treatment of, 115. Drill regulations for the hospital corps, U. S. Army, 226. Alignments, 228. Ambulance, the, 278. Detachment, the, 226. Inspection, 282. Litter drill, 241. marchings with, 251. the loaded, 255. improvisation of, 267. Marchings. 228. with litter, 251. Muster, 282. Rests, the, 240. Drill regulations for the hospital corps, U. S. Army. Wounded, methods of remov- ing, without litters, 269. Appendix, 286. Knapsack, to pack, 291. Load, to, 293. Packing, 292. Saddle, to, 293. Tent, conical wall, 289. hospital, 287. Drowning, 179. treatment of, 180. Hall's method, 184. Howard's method, 183. Sylvester's method, 181. Ear, foreign bodies in, 201. Emetics, 187. Endocardium, 36. Endosteum, 4. Epidermis, 56. Epiglottis, 39. Epilepsy, 173. treatment of, 173. Epistaxis, or nose-bleed, 126. Eucalyptus, oil of, 93. Excretion, 29. Eye, foreign bodies in, 200. Fainting, 166. treatment of, 167. Falling-sickness, 173. Femoral artery, compression of, 132. Femur, the, or thigh-bone, 19. fractures of, 149. Fever, sun, 175. Fibula, the, or splint-bone, 22. fractures of, 151. Fingers, dislocation of, 154. fractures of, 148. Fits, epileptic, 173. Flaxseed poultices, 88. Fontanelles, the, 9. 300 PROMPT AID TO THE INJURED. Food, ration of, 216. Foot bandages, 83. Foot soreness, 205. Forearm, fractures of, 146. Foreign bodies in ear, 201. in eye, 200. in larynx, 203. in no3e, 202. in pharynx, 203. Fractures, 136. classification of, 136. diagnosis of, 137. treatment of, 138. of clavicle, 145. treatment of, 145. of cranial bones, 142. of femur, 148. treatment of, 149. of forearm, 146. treatment of, 147. of forearm, middle of, 147. treatment of, 147. of humerus, 146. treatment of, 146. of inferior maxillary bone, 142. of leg, 151. treatment of, 152. of metacarpal bones, 147. treatment of, 148. of metatarsal bones, 153. of patella, 152. treatment of, 153. of phalanges of fingers, 148. of toes, 153. of ribs, 143. treatment of, 144. of scapula, 146. treatment of, 146. of spinal column, 143. treatment of, 143. of tibia and fibula, 151. of vertebral column, 143. splints for, 140. Frost-bite, 159. Fiost-bite, treatment of, 160. u Funny-bone," 18. Gangrene, 117. treatment of, 118. Gastric juice, function of, 49. Gland, definition of, 29. Glands, salivary, 47. sweat, 57. Gravel, 54. Gristle, or cartilage, 24. Gullet, or oesophagus, 47. Haematemesis, or haemorrhage from stomach, 135. Haemoptysis, or " spitting of blood," 134. Haemorrhage, arrest of, 120. classification of, 120. treatment of, after extraction of teeth, 126. arterial, 121. capillary, 125. nasal, 126. venous, 124. from axillary artery, 129. from brachial artery, 130. from common carotid artery, 127. from femoral artery, 132. from lips, 126. from mouth, 126. from popliteal artery, 132. from radial artery, 131. from scalp, 126. from subclavian artery, 128. from ulnar artery, 131. secondary, 132. symptoms of, 133. treatment of, 134. Hair-follicles, 57. Halstead's litter, 222. Hand bandages, 78. '' Haunch," or innominate bone, 19. INDEX. 301 Head bandages, 78. Heart, 32. anatomy of, 33. power of, 36. Heat, dry, application of, 90. moist, application of, 90. Heat-Btroke, 175. Hip bandages, 82. Hominy poultices, 89. Humerus, or arm-bone, 14. Hydrocyanic acid, poisoning by, 192. Hygiene, 207. air, 218. effects of bad, 219. baths, 207. addition to, of alcohol, etc., 208. Russian or Turkish, 208. sea, 208. warm, 208. clothing, cotton and linen, 210. woolen, 209. dandruff, 209. exercise, 221. food, 211. constituents of, 212-215. scurvy, 215. skin, activity of, 207. soap, the use of, 209. water, 216. amount required daily, 216. lake, 217. rain, 216. spring, 216. well, 217. Hyoid bone, 10. Hysteria, 174. treatment of, 174. Hysterics, 174. Inferior maxillary bone, dislocation of, 154. fracture of, 142. Innominate, or " haunch " bone, 10. Insolation, 175. Instep, or tarsus, 22. Integument, or skin, 56. appendages of, 57. care of, 57. functions of, 57. Intestine, large, 50. Intestine, small, 49. Intoxication, 172. ■ treatment of; 172. Iodine, poisoning by, 195. Iodoform, 93. Irritant poisons, 193. Joints, classification of, 23. ( composition of, 24. movements of, 23. Kidney colic, 55. Kidneys, 54. Knee-cap, or patella, 22. Knots, 85. Landmarks, superficial bony, 7. Larynx, 39. foreign bodies in, 203. Laudanum, poisoning by, 192. Ligaments, 24. Lips, haemorrhage of, 126. Litter, Halstead's, 222. extemporized, 225. manufactured, 222. Liver, 51. functions of, 52. Lower jaw, dislocation of, 154. fracture of, 142. Lungs, 42. capacity of, 44. Lye, poisoning by, 198. Lymphatics, 4. Marrow of bone, 3. Marsh's stretcher, 225. 302 PROMPT AID T Mastication, 45. Matches, poisoning by, 196. Membranes, mucous, 29. serous, 29. synovial, 25. Mercury, bichloride of, 92. Metacarpal bones, 18. fracture of, 147. Metacarpus, the, 18. Metatarsal bones, 22. fracture of, 153. Milk, sterilization of, for infants, 102. Morphine, poisoning by, 192, Mouth, haemorrhage of, 126. Mucous membranes, 29. Muriatic acid, poisoning by, 197. Muscles, 25. atrophy of, 28. involuntary, 28. rigidity of, at death, 28. voluntary, 25. Mushrooms, poisoning by, 192. Mussels, poisoning by, 192. Mustard poultices, 89. Narcotic poisons, 189. Necrosis of bone, 3. Nerves, 63. cranial, 64. motor, 64. sensory, 64. spinal, 66. sympathetic, 66. Nervous system, 59. Nitric acid, poisoning by, 197. Nose-bleed, or epistaxis, 126. Nose, foreign bodies in, 202. Nux vomica, poisoning by, 195. Oesophagus, or gullet, 47. Opium, poisoning by, 192. Organ, definition of, 28. Oxalic acid, poisoning by, 197. THE INJURED. Padding for splints, 141. Pancreas, 52. function of, 53. Paralysis, stroke of, 170. Paris green, poisoning by, 193. Patella, the, or knee-cap, 22. Pearlash, poisoning by, 198. Pelvis, the, or basin, 18. Pericardium, 34. Periosteum, 3. Phalanges, 18, 22. dislocation of, 154. fractures of, 148. Pharynx, or throat, 47. foreign bodies in, 203. Phenol, 93. Phosphorus, poisoning by, 196. Pleura, 42. Plugs or tampons, 87. Poisoning, 186. treatment of constitutional, 189. local, by emetics, 189. by stomach-pump, 188. Poisoning by "acetic acid, 197. by aconite, 189. by alcohol, 190. by ammonia, 198. by arsenic, 193. by atropine, 190. by belladonna, 190. by camphor, 190. by cantharides, 194. by carbolic acid, 197. by caustic potash, 198. by caustic soda, 198. by chloral, 191. by chloroform, 191. by copper, 194. by corrosive sublimate, 197. by creasote, 197. by croton-oil, 194. by digitalis, 191. by hydrocyanic acid, 192. by iodine, 195. INDEX 303 Poisoning by laudanum, 192. by lye, 198. by matches, 196. by morphine, 192. by muriatic acid, 197. by mushrooms, 192. by mussels, 192. by nitric acid, 197. by nux-vomica, 195. by opium, 192. by oxalic acid, 197. by Paris green, 193. by pearlash, 198. by phosphorus, 196. by poison oak or ivy, 198. by prussic acid, 192. by salts of lemon and sorrel, 197. by Spanish fly, 194. by strychnine, 195. by sulphuric acid, 197. by tartar emetic, 196. by zinc, 196. treatment of, 186. Poison oak or ivy, poisoning by, 198. Poisons, classification of, 186. irritant, 186, 193. narcotic, 186,189. Potash, caustic, poisoning by, 198. Poultices, 87. bread, 89. corn-meal, 89. flaxseed, 88. hominy, 89. mustard, 89. Prussic acid, poisoning by, 192. Radial artery, compression of, 131. Radius, 14. Respiration, 39. Ribs, 11. fracture of, 143. Salivary glands, 47. Salts of lemon, poisoning by, 197. Scalds, 159. Scalp, haemorrhage of, 126. Scapula, or shoulder-blades, 12. Secondary haemorrhage, 132. constitutional symptoms of, 133. treatment of, 134. Secretion, 29. Serous membranes, 29. Shin-bone, or tibia, 21. Shock, 162. treatment of, 163. Shoulder bandages, 78. Shoulder-blade, or scapula, 12. Skeleton, the, 4. Skin, or integument, 56. appendages of, 57. care of, 57. false, 56. functions of, 57. true, 56. Skull, division of bones of, 8. Sling bandages, 81. Snake-bite, treatment of, 115. Sorrel, poisoning by, 197. Spanish fly, poisoning by, 194. Spinal cord, 62. Spine, the, 6. changes in, 6. " Spitting of blood," or haemop- tysis, 134. Spleen, 58. Splint-bone, the, or fibula, 22. Splints, 140. padding for, 141. Sprains, 155. treatment of, 155. Sterilization of milk for infants, 102. Sternum, the, 11. Stomach, 48. anatomy of, 48. capacity of, 48. 304 PROMPT AID TO THE INJURED. Stretcher, essentials of, 222. Halstead's, 222. Marsh's, 225. Stroke of paralysis, 170. Strychnine, poisoning by, 195. Stunning, 169. Suffocation, 178. Sulphuric acid, poisoning by, 197. Sunstroke, 175. treatment of, 176. Sweat-glands, 57. Sweet-breads, 52. Sympathetic system, 66. Syncope, 166. treatment of, 167. Synovial membrane, 25. Tampons, or plugs, 87. Tarsus, or instep, 22. Tartar emetic, poisoning by, 196. Teeth, 45. haemorrhage following extraction of, 126. Tendons, 27. Tetanus, or lockjaw, 199. Thigh-bone, or femur, 19. Thorax, or chest, 10. Throat, or pharynx, 47. foreign bodies in, 203. Thymol, 93. Tibia, or shin-bone, 21. Toes (phalanges), fracture of, 153. Trachea, or windpipe, 39. Transportation of wounded, 222. (See also Drill regulations for the hospital corps, U. S. Army.) Ulna, 16. Ulnar artery, compression of, 131. Unconsciousness, 161. Ureters, 54. Urine, 54. quantity secreted, 57. Veins, anatomy of, 38. Vertebrae, the, 6. Vertebral column, curves of, 7. division of, 7. fracture of, 143. Vesicles, or air-cells, 41. Vitriol, oil of, poisoning by, 194. Whisky, 93. Windpipe, or trachea, 39. Wounded, transportation of, 222. (See also Drill regulations for the hospital corps, U. S. Army.) Wounds caused by insects, 116. classification of, 109. contused, 111. gangrenous, 117. gunshot, 109. healing of, 111. incised, 109. lacerated, 109. poisoned, 110. punctured, 109. of abdominal walls, 116. of thorax, 117. treatment of, 112. Wrist, or carpus, 18. Zinc, poisoning by, 196. THE END. 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